Cross-sectional Observational Study Research Articles

Irish national real-world analysis of the clinical and economic impact of 21-gene oncotype DX® testing in early-stage, 1-3 lymph node-positive, oestrogen receptor-positive, HER2-negative, breast cancer.

The treatment landscape of Oestrogen receptor-positive (ER-positive) breast cancer is evolving, with declining chemotherapy use as a result of Oncotype DX Breast Recurrence Score® testing. Results from the SWOG S1007 RxPONDER trial suggest that adjuvant chemotherapy may benefit some premenopausal women with ER-positive, HER2-negative disease with 1-3 positive lymph nodes (N1), and a Recurrence Score® (RS) of ≤ 25. Postmenopausal women with similar characteristics did not benefit from adjuvant chemotherapy. We examine the clinical and economic impact of Oncotype DX® testing on treatment decisions in patients with N1 disease in Ireland using real world data. From March 2011 to October 2022, a retrospective, cross-sectional observational study was performed of patients with ER-positive, HER2-negative N1 breast cancer, who had Oncotype DX testing across 5 of Ireland's largest cancer centres. Patients were classified into low risk (RS 0-13), intermediate risk (RS 14-25) and high risk (RS > 25). Data were collected via electronic patient records. Information regarding costing was provided primarily by pre-published sources. A total of 828 N1 patients were included in this study. Post Oncotype DX testing, 480 patients (58%) were spared chemotherapy. Of the patients who had a change in chemotherapy recommendation based on Oncotype DX testing, 271 (56%), 205 (43%), 4 (1%) had a RS result of 0-13, 14-25 and > 25 respectively. Use of Oncotype DX testing was associated with a 58% reduction in chemotherapy administration overall. This resulted in estimated savings of over €6 million in treatment costs. Deducting the assay cost, estimated net savings of over €3.3 million were achieved. Changes in the ordering demographics of Oncotype DX tests were identified after RxPONDER data were presented, with increased testing in women ≥ 50years and a reduction in proportion of tests ordered for women < 50years. Between 2011 and 2022, assay use resulted in a 58% reduction in chemotherapy administration and net savings of over €3.3 million.

Psychiatrists’ beliefs, awareness, and attitudes toward gender variance: A French cross-sectional study

ObjectivesThe evolution of knowledge and recommendations concerning transgender health has led to various representations, especially for health professionals, that can influence the medical management of transgender individuals. The main objective of this study was to explore the representation of psychiatrists in France regarding gender variance. The secondary objective was to compare these data based on their characteristics. MethodsThis is a cross-sectional observational study based on the distribution in April 2022 of a questionnaire to psychiatrists and psychiatric residents in France. The questionnaire was developed after exploring the results of qualitative studies in the scientific literature. ResultsAmong 359 respondents, 181 were psychiatric residents and 178 were senior psychiatrists. Ninety percent had already met a transgender person in their professional practice. The representations observed among the respondents were heterogeneous. Most respondents did not consider “transgenderism” a symptom of a psychiatric disorder, and nearly all respondents used the gender and name their patients ask for. About 60% reported insufficient knowledge about “transgenderism”, with 86% considering that they had not been trained to adequately support transgender people. ConclusionsThe study reveals that representations, although weakened by a lack of knowledge recognized by psychiatrists, favor a non-pathologizing apprehension of gender variance and recognition of the importance of respecting gender diversity and self-determination. The heterogeneity of representations, as well as the high prevalence of professionals who describe a lack of knowledge, skills, and training, support the need for guidelines and the integration of evidence-based knowledge about gender variance into the psychiatric curriculum.

Epidemiological profile of patients with osteogenesis imperfecta assisted at a reference children's hospital in Brazil

Objective: To characterize the profile and care of patients with osteogenesis imperfecta (OI) treated at a reference hospital in southern Brazil. Method: This retrospective cross-sectional observational study analyzed secondary data from electronic medical records between 2010 and 2021. Data from patients aged 0–22 years with a confirmed OI diagnosis who underwent care at a reference hospital. Results: 97 medical records were included. The mean age of the children was 11 ± 4.99 years, with a prevalence of males (51.8%). Most obtained the postnatal diagnosis and were classified as type I (50.9%). The number of fractures, orthopedic surgeries, and cycles of pamidronate were higher in type III subjects. As for access to medication, 88.54% were hospitalized for the administration of pamidronate and 32.29% for zoledronate. Independent walking and type I modified independent walking (walker) and type IV, and the use of a wheelchair and type III had an association (X2 = 67.832; p=0.000) between them. Conclusions: The profiles of the individuals in this study reflect the characteristics of the classic division of types I to IV. The reference center offers multidisciplinary care, access to specific drugs, and essential orthopedic surgeries to improve the quality of life of patients with osteogenesis imperfecta.

Higher hair cortisol levels associated with previous cardiovascular events and cardiovascular risks in a large cross-sectional population study

BackgroundStress is today a common feature of patients seeking medical care and a growing public health issue in society. A method has been developed to measure biological chronic stress by Hair Cortisol Concentrations (HCC). This biomarker, for chronic stress, captures information about cumulative cortisol levels over the course of several months. Long-term stress might be one of the factors contributing to the onset of cardiovascular conditions and also affecting different risk factors. The aim of this study was to analyse the association between Hair Cortisol Concentrations and previous cardiovascular diseases and cardiovascular risk factors.MethodsThe method of measuring chronic stress by Hair Cortisol Concentration was applied in a large Swedish national observational cross-sectional study. A population-based random sample of N = 4,821 Swedish middle-aged men and women was analysed for hair cortisol levels in relation to diagnosed previous cardiovascular diseases and biologically measured cardiovascular risk factors.ResultsLong-term stress, measured by hair cortisol, was significantly associated with the classical cardiovascular risk factors hypertension and high cholesterol, but not smoking. Those with elevated HCC levels also had a significantly increased pre-history of myocardial infarction, type 2 diabetes, atrial fibrillation and by-pass surgery, but not regarding stroke, angina pectoris or sleep apnoea. Higher HCC was significantly associated (p < 0.001) with Body mass index and waist circumference, but only for females. HCC was also associated with the risk markers leukocytes, and high-sensitivity CRP, indicating a possible linkage between HCC and inflammation and hypothetically also the bodily immune defense. No association was found between perceived stress and HCC.ConclusionsAn overall conclusion of our results is that health care should put more emphasis on patients reporting that they have been exposed to long term stress. Altogether, these analyses of Hair cortisol levels in a large middle-aged population show that chronically elevated cortisol levels represent a relevant and significant factor associated with cardiovascular diseases and classical cardiovascular risk factors.

Awareness, attitude, and acceptance of post placental intra uterine contraceptive device (PPIUCD) among women in Jordan.

To assess the awareness, attitude, and acceptance of the Post Placental Intra Uterine Contraceptive Device (PPIUCD) as an immediate long-acting contraceptive method among Jordanian women. A cross-sectional observational study was conducted at King Abdulla University Hospital among women attending antenatal clinics after 20 weeks of gestation between January 2020 and May 2021. One thousand and 30 women had completed a structured questionnaire in Arabic. Only 41.4% of the sample was aware of the PPIUCD. The attitude toward PPIUCD after a brief introduction was 56.3%. Women who had used interval IUCD were 5.82 times more likely to express a positive attitude toward PPIUCD, while postgraduate women were 1.35 times more prone to show the same attitude. Only 34% accepted PPIUCD if offered, whereas the main barrier to acceptance was the false fear of extra complications in 34.5% of the sample. The rate of unintended current pregnancy was 35.8%, where 53.4% were using natural methods. The rate of awareness of PPIUCD is low among women in Jordan. Antenatal introduction encourages attitude toward PPIUCD.

Public perceptions related to healthcare preparedness to anti-amyloid therapies for Alzheimer’s Disease in Japan

BackgroundThe approval of lecanemab, an anti-amyloid therapy for Alzheimer’s disease (AD), necessitates addressing healthcare preparedness for disease-modifying treatment (DMT) to ensure appropriate, safe, and sustainable drug administration. Understanding public perceptions on this matter is crucial. We aimed to assess discrepancies and similarities in the perceptions of Japanese trial-ready cohort study (‘J-TRC webstudy’) participants and clinical specialists in the fields of dementia treatment and radiology, concerning affairs related to challenges in DMT preparedness.MethodsThis was a cross-sectional prospective observational study conducted in November–December 2023. The J-TRC webstudy participants were invited to participate in an online survey using Google Forms, and clinical specialists were invited to complete a mail-based survey. Main questionnaire items had been designed to be common in both surveys, and their responses were analyzed for participant attributes, interests, attitudes, expectations, and concerns about DMTs without specifying lecanemab.ResultsResponses were obtained from n = 2,050 J-TRC webstudy participants and n = 1,518 clinical specialists. Compared to specialists, more J-TRC respondents perceived the eligible proportion for DMT as smaller (59.1% versus 30.7%), perceived the eligible severity for DMT as more limited (58.0% versus 24.5%), and perceived the efficacy of DMT as slightly more encouraging (29.3% versus 34.8%). In terms of treatment prioritization, both J-TRC respondents and specialist respondents exhibited similar levels of acceptance for prioritizing patients to treat: e.g., approximately two-thirds endorsed patient prioritization under hypothetical resource constraints or other reasons. A medical rationale emerged as the most compelling reason for acceptance of patient prioritization across the surveys. In contrast, the need to address vulnerable populations was the reason that led to the least acceptance of prioritization, followed by economic considerations.ConclusionsOur findings offer valuable insights into the discrepancies in knowledge and perception between patients and healthcare providers. This could enhance the delivery of patient information in clinical settings and inform the discussion surrounding patient prioritization strategies.

A Comprehensive Assessment of the Environmental Impact of Different Infant Feeding Types: The Observational Study GREEN MOTHER.

To observe and compare the environmental impacts of different types of infant feeding, considering the use of formula, infant feeding accessories, potentially increased maternal dietary intake during breastfeeding (BF) and food consumption habits. An observational cross-sectional multicentre study conducted in the Barcelona Metropolitan Area of the Catalan Institute of Health. Data were collected from 419 postpartum women on infant feeding type (formula milk and accessories), maternal dietary intake (24-h register) and food consumption habits from November 2022 to April 2023. The environmental impacts (climate change (CC), water consumption and water scarcity) of the infant feeding types and maternal diet were calculated using the IPCC, ReCiPE and AWARE indicators, respectively. The differences in impacts were calculated by Kruskal-Wallis test. Significant differences for the three environmental impacts were observed. The CC impact of formula milk and feeding accessories was 0.01 kg CO2eq for exclusive BF, 1.55 kg CO2eq for mixed feeding and 4.98 kg CO2eq for formula feeding. While BF mothers consumed an extra 238 kcal, no significant differences were found related to maternal diet across feeding types. Exclusive BF was the most sustainable type of infant feeding, considering formula and infant feeding accessories. In our study, the difference between the impacts of BF and non-BF mothers' diet was insignificant. Offer informative and educational support for midwives and other healthcare professionals on BF and a healthy, sustainable diet to transfer this knowledge to the general public. Raise the general public's awareness about BF and a healthy, sustainable diet. To reduce environmental impacts through behavioural changes. STROBE. Patients of the Catalan Health Service reviewed the content of the data collection tools. (for the whole GREEN MOTHER project): NCT05729581 (https://clinicaltrials.gov).

Quality of life in women with early-stage and metastatic hormone receptor-positive, HER2-negative breast cancer receiving endocrine therapy.

Early discontinuation of endocrine therapy (ET) is higher among patients with early breast cancer (EBC) compared to patients with metastatic hormone receptor-positive (HR+) breast cancer (MBC). In our clinical experience the reasons for this may include a significant burden of ET side effects impacting quality of life (QOL) in patients with EBC. We hypothesized that QOL is lower in patients with HR + EBC compared to patients with HR + MBC on ET. We conducted a cross-sectional observational study to assess QOL utilizing FACT-ES & EORTC QLQ C30 tools among patients with EBC and MBC receiving ET across 5 Irish hospitals. A total of 417 patients were enrolled-EBC (79% n = 331) and MBC 21% (n = 86). Using the FACT-ES, we found no difference in overall QOL by stage (139.2 vs 141, P = .33). Patients with HR + MBC had a lower symptom burden from ET compared to HR + EBC (61.4 vs 54, P < .01). In adjusted multivariate linear regression models, there was no difference in QOL for patients with EBC and MBC receiving ET. There was no significant difference in overall QOL for patients with EBC and MBC. However, patients with EBC experienced more endocrine symptoms. In adjusted multivariate linear regression models, the stage did not predict QOL. Our results suggest that endocrine symptoms are significant contributors to impaired QOL for patients with EBC but the role of other determinants of QOL (eg, stage) is less clear. Future work could include the development of stage-specific QOL tools and utilization of electronic patient-reported outcomes (ePROs) to identify and manage emergent toxicities.

Association between lipid-lowering agents with intervertebral disc degeneration, sciatica and low back pain: a drug-targeted mendelian randomized study and cross-sectional observation

BackgroundAbnormal lipid metabolism is linked to intervertebral disc degeneration (IVDD), sciatica, and low back pain (LBP), but it remains unclear whether targeted interventions can prevent these issues. This study investigated the causal effects of lipid-lowering drug use on IVDD, sciatica, and LBP development.MethodsSingle-nucleotide polymorphisms (SNPs) linked to total cholesterol (TC), low-density-lipoprotein cholesterol (LDL-C), and non-high-density-lipoprotein cholesterol (non-HDL-C) were obtained from the Global Lipids Genetics Consortium’s genome-wide association study (GWAS). Genes near HMGCR, PCSK9, and NPC1L1 were selected to represent therapeutic inhibition targets. Using Mendelian randomization (MR) focusing on these drug targets, we identified causal effects of PCSK9, HMGCR, and NPC1L1 on the risk of developing IVDD, sciatica, and LBP, with coronary heart disease risk serving as a positive control. Using summary data from Mendelian randomization (SMR) analysis, we evaluated potential therapeutic targets for IVDD, sciatica, and LBP through protein quantitative trait loci (pQTL). The genetic associations with IVDD, sciatica, LBP, and coronary heart disease were derived from FinnGen (discovery) and UK Biobank (replication). Additionally, a cross-sectional observational study was performed using data from the National Health and Nutrition Examination Survey (NHANES) to further investigate the connection between LBP and statin use, with a sample size of 4343 participants. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were calculated to assess the outcomes.ResultsThe NHANES-based cross-sectional study indicated that non-statin use was associated with an increased risk of developing LBP (OR = 1.29, 95% CI [1.04, 1.59], P = 0.019). Moreover, Inverse-variance weighting (IVW) analysis revealed that NPC1L1-mediated reductions in TC, LDL-C, and non-HDL-C concentrations were associated with a decreased risk of developing IVDD (P = 9.956E-03; P = 3.516E-02; P = 1.253E-04). Similarly, PCSK9-mediated reductions in LDL-C and TC concentrations were linked to a lower risk of developing sciatica (P = 3.825E-02; P = 2.709E-02). Sensitivity analysis confirmed the stability and reliability of the MR results. MST1 (macrophage stimulating 1) levels was inversely associated with IVDD, sciatica, and LBP risks.ConclusionThe results of cross-sectional study suggested that non-use of statins was positively correlated with LBP. The results of Mendelian randomization study suggest that NPC1L1 could lower the risk of developing IVDD by reducing TC, LDL-C, and non-HDL-C levels. Additionally, PCSK9 may reduce the risk of developing sciatica by lowering LDL-C and TC levels. In contrast, HMGCR appears to have no significant effect on IVDD, sciatica, or LBP development. Nonetheless, further research is needed to verify these preliminary results. MST1 warrants further exploration as a potential therapeutic target. It is necessary to do further research to validate these findings.

Breath Analysis: Identification of Potential Volatile Biomarkers for Non-Invasive Diagnosis of Chronic Kidney Disease (CKD).

Recently, volatile organic compound (VOC) determination in exhaled breath has seen growing interest due to its promising potential in early diagnosis of several pathological conditions, including chronic kidney disease (CKD). Therefore, this study aimed to identify the breath VOC pattern providing an accurate, reproducible and fast CKD diagnosis at early stages of disease. A cross-sectional observational study was carried out, enrolling a total of 30 subjects matched for age and gender. More specifically, the breath samples were collected from (a) 10 patients with end-stage kidney disease (ESKD) before undergoing hemodialysis treatment (DIAL); (b) 10 patients with mild-moderate CKD (G) including 3 patients in stage G2 with mild albuminuria, and 7 patients in stage G3 and (c) 10 healthy controls (CTRL). For each volunteer, an end-tidal exhaled breath sample and an ambient air sample (AA) were collected at the same time on two sorbent tubes by an automated sampling system and analyzed by Thermal Desorption-Gas Chromatography-Mass Spectrometry. A total of 110 VOCs were detected in breath samples but only 42 showed significatively different levels with respect to AA. Nonparametric tests, such as Wilcoxon/Kruskal-Wallis tests, allowed us to identify the most weighting variables able to discriminate between AA, DIAL, G and CTRL breath samples. A promising multivariate data mining approach incorporating only selected variables (showing p-values lower than 0.05), such as nonanal, pentane, acetophenone, pentanone, undecane, butanedione, ethyl hexanol and benzene, was developed and cross-validated, providing a prediction accuracy equal to 87% and 100% in identifying patients with both mild-moderate CKD (G) and ESKD (DIAL), respectively.

Comparison of Elisar-Fast and Sita-Fast Strategy for Visual Field Assessment in Glaucoma.

To compare two fast threshold strategies of visual field assessment: SITA-Fast (SF; Humphrey field analyser) and Elisar-Fast (EF; Advanced vision analyser) in patients with glaucoma. In this cross-sectional observational study, of total 192 subjects, 138 subjects [150 eyes, 80 glaucoma subjects (91 eyes) and 58 healthy controls (59 eyes)] were analysed and included. Each subject underwent 24-2 EF and SF in randomized order with a minimum time interval of 1 hour between tests. Mean test-time, pointwise and sectoral sensitivity, significance of values of mean sensitivity (MS) and global indices [mean deviation (MD) & pattern standard deviation (PSD)] and their correlation. The mean test-time was 2.59±0.25 and 3.38±0.28 minutes (P = 0.001) with SF and EF respectively. Correlation coefficient for pointwise threshold values correlated strongly for both the devices (range from 0.70 to 0.92). The Intra class correlation (ICC) value of ≥ 0.8 was observed across all sectors indicating good reliability. Bland-Altman plot denoted 95% of data for MS values within limit of Agreement (LOA). The ICC values for overall MS, MD and PSD were 0.916, 0.913 and 0.872 respectively indicating good reliability. High degree of correlation was observed for MD (r = 0.912, P=0.00) and PSD values (r=0.732, P=0.00). Comparison of values indicated a difference of 1.09dB for MD and 0.06dB for PSD between both strategies. High degree of correlation existed between the global indices and pointwise threshold values. The study documents the ability of EF to successfully assess visual field in patients with glaucoma.

Time from Diagnostic Suspicion to In-Person Evaluation in Skin Cancer Using Teledermatology.

Introduction: Early diagnosis of skin cancer is crucial for improving prognosis. Teledermatology (TD) usage can optimize referrals and reduce waiting times. This study aims to evaluate waiting times at the critical referral nodes in teleinterconsultations that raised suspicion of skin malignancy in the Chilean TD platform of the public health care system. Materials and Methods: A cross-sectional observational study that analyzed asynchronous teleinterconsultations and raised suspicion for skin malignancy following the teledermatologist evaluation was uploaded on the Chilean Ministry of Health's TD platform from January 1 to June 30, 2022. Results: Out of 20,522 teleinterconsultations, 1,853 raised suspicion of skin cancer. Among them, 1,119 patients were assessed by in-person examination, while 669 were still on the waiting list. Response times averaged 3.98 days for TD diagnostic suggestions. Overall referral times averaged 75.98 days from initial teleinterconsultation to the final specialist in-person evaluation. Waiting times showed significant differences among health care services and geographic regions. Discussion: In resource-limited settings, TD serves as a valuable tool to optimize referrals and manage the demand for oncologic dermatological consultation. The long waiting times emphasize the need for targeted interventions, especially in regions with longer delays. Conclusion: While TD has shown to be an effective tool in optimizing referrals, waiting times still exceed international recommendations, even in urban centers. The considerable heterogeneity in referral times within health care services and geographic regions highlights the necessity of establishing standardized referral protocols and explicit deadlines to fulfill teleinterconsultations that raise suspicion of skin malignancy in the Chilean public system.

The Distribution of Coronal Plane Alignment of the Knee Classification in a Sample of Spanish Southeast Osteoarthritic Population: A Retrospective Cross-Sectional Observational Study

Background and Objectives: The Coronal Plane Alignment of the Knee (CPAK) classification is a pragmatic distribution of nine phenotypes for coronal knee alignment that can be used on healthy and arthritic knees. Our study aimed to describe the CPAK distributions in a Spanish southeast osteoarthritic population and compare them to other populations’ published alignment distributions. Method and Materials: Full-leg standing X-rays of the lower limb from 528 cases originating from the so-called Vega Alta del Segura (southeast of the Iberian Peninsula) were retrospectively analysed. We measured the mechanical hip–knee–ankle, lateral distal femoral, and medial proximal tibial angles. We calculated the arithmetic hip–knee–ankle angle and the joint line obliquity to classify each case according to the criteria of the CPAK classification. Results: Based on the aHKA result, 59.1% of the cases were varus (less than −2°), 32.7% were neutral (0° ± 2°), and 8.2% were valgus (greater than +2°). Based on the JLO result, 56.7% of the cases had a distal apex (less than 177°), 39.9% had a neutral apex (180° ± 3°), and 3.4% had a proximal apex (greater than 183°). The most common CPAK distribution in our Spanish southeast osteoarthritic population was type I (30.7%), followed by type IV (25.9%), type II (21%), type V (11.2%), type III (5%), type VI (2.8%), type VII (2.4%), type VIII (0.6%), and type IX (0.4%). Conclusions: We described the distribution according to the CPAK classification in a sample of the osteoarthritic population from southeastern Spain. In our sample, more than 75% of the patients were classified as type I, II, and IV.

Subtyping stage 3 epiretinal membrane: a comprehensive study of ectopic inner foveal layers architecture and its clinical implications

AimsTo evaluate the visual function and foveal architecture in patients with stage 3 idiopathic epiretinal membrane (iERM).MethodsA cross-sectional observational study included 56 eyes of 52 patients with stage 3 iERM....

Association between serum albumin and disease severity of non-cystic fibrosis bronchiectasis

Background Bronchiectasis is a chronic debilitating but neglected pulmonary disease. It is associated with substantial health related burden and health care costs. However, the biochemical parameters related to disease severity have not been sufficiently assessed. Objective: Aim of the present study to find out any association between serum albumin and disease severity of non-cystic fibrosis bronchiectasis. Methods This was a cross-sectional observational study of 33 subjects with non-cystic fibrosis bronchiectasis at department of Respiratory Medicine, National Institute of Diseases of the Chest and Hospital (NIDCH) from December 2019 to March 2021. After taking informed written consent BSI score be calculated and blood was taken for to measure serum albumin. Data was collected through questionnaire. After completion of the data collection, analysis was done with the help of Statistical Package for Social Science (SPSS) version 22. Results Mean age of the study subjects was 43.36 ± 15.65 years with a range of 21 -76 years and more likely to be men (60.6%). History of previous pulmonary tuberculosis found in 48.5% subjects as associated conditions and pseudomonas aeruginosa (21.2%) was the most common organisms in sputum culture. 87.9% of the study subjects had history of exacerbation within last 12 months and 60.6% were hospitalized within last 2 years. More than half (54.6%) of the study subjects had severe, 33.3% had moderate and 12.1% had mild bronchiectasis with the mean BSI score of 9.00 ± 3.05. Mean serum albumin was 3.22 ± 0.84 g/dl. Albumin had a significant negative correlation with BSI score (r = -0.457 and p = 0.008). Conclusion The serum albumin had moderate correlation with disease severity of non-cystic fibrosis bronchiectasis. Bangladesh Journal of Medical Science Vol. 23 No. 04 October’24 Page : 1104-1111

A Prospective Cross-Sectional Study on the Correlation of Adenosine Deaminase and HbA1c With Microvascular Complications in Type 2 Diabetes Mellitus at a Tertiary Care Hospital in Central India.

Background Type 2 diabetes mellitus (T2DM) is a prevalent chronic condition characterized by hyperglycemia, which can lead to various microvascular complications, including diabetic nephropathy, neuropathy, and retinopathy. Identifying reliable biomarkers for early detection and risk stratification of these complications is crucial for improving patient outcomes. Adenosine deaminase (ADA) and HbA1c have emerged as potential markers associated with immune function, inflammation, and long-term glycemic control. This study investigates the correlation between ADA and HbA1c levels and microvascular complications in patients with T2DM. Material and methods This prospective observational cross-sectional study involved 150 patients diagnosed with T2DM, focusing on those with diabetic nephropathy, neuropathy, and retinopathy. Clinical data were collected through patient interviews, clinical examinations, and laboratory tests, including measurements of fasting blood glucose, HbA1c, serum creatinine, ADA levels, and urine protein creatinine ratio (UPCR). Fundus examinations and nerve conduction velocity (NCV) tests were performed to assess diabetic retinopathy and neuropathy, respectively. Data were analyzed using SPSS version 25.0 (IBM Corp., Armonk, New York), with statistical tests to evaluate the correlation between ADA and HbA1c levels and microvascular complications. Results The study found a significant correlation between elevated ADA and HbA1c levels and microvascular complications in patients with T2DM. Higher ADA levels were particularly associated with diabetic nephropathy (p=0.003), while HbA1c levels showed a positive correlation with all three complications: nephropathy, neuropathy, and retinopathy. The findings suggest that ADA and HbA1c levels can serve as valuable biomarkers for identifying patients at higher risk of developing these complications. Conclusion This study highlights the potential of ADA and HbA1c as biomarkers for early detection and risk assessment of microvascular complications in T2DM patients. Routine monitoring of these markers could improve the management and prognosis of diabetic patients by enabling timely interventions to prevent or mitigate the progression of complications. Further research is needed to explore the underlying mechanisms linking ADA with diabetic complications and to validate its clinical utility.

Prevalence of Adhesive Capsulitis in Patients With Type 2 Diabetes Mellitus: A Single-Center Cross-Sectional Study From Pakistan.

Background An inflammatory condition leading to stiffness and pain in the shoulder joint, adhesive capsulitis is associated with conditions such as diabetes mellitus, cervical spondylosis, thyroid dysfunction, autoimmune rheumatic diseases, and shoulder injury due to trauma, fracture, rotator cuff tear, surgery, or immobilization. Adhesive capsulitis may affect a notable proportion of the diabetic population. There are numerous studies that show that patients with type 2 diabetes mellitus are not only at higher risk of developing adhesive capsulitis but also suffer poor outcomes despite treatment, especially in patients with long-standing diabetes mellitus. Furthermore, there is significant variation in data regarding the prevalence of adhesive capsulitis in Pakistani patients with type 2 diabetes mellitus. Objective To determine the prevalence of adhesive capsulitis among patients with type 2 diabetes mellitus presenting to a tertiary care hospital in Bahawalpur, Pakistan. Methods The present observational cross-sectional study was carried out at the Department of Medicine, Bahawal Victoria Hospital, Quaid-e-Azam Medical College, Bahawalpur, Pakistan, from February 2024 to August 2024. Type 2 diabetes mellitus was labeled by HbA1c of more than 7.0%, or two random blood glucose levels of 200 mg/dL or more, or an existing diagnosis of diabetes mellitus, and/or use of anti-hyperglycemic therapy. Adhesive capsulitis was diagnosed clinically on the basis of history (gradual onset shoulder pain with limitation of movements) and examination (reduction in active and passive range of motion (ROM) of the shoulder, especially abduction, internal rotation, and external rotation) in the absence of significant abnormalities on shoulder X-ray. After ethical approval and obtaining informed consent, 430 patients with type 2 diabetes mellitus were included in the study using a non-probability consecutive sampling technique. Demographic information, diabetes control, and HbA1c levels were noted, and the patients were assessed for adhesive capsulitis. All the data was recorded and entered into IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, NY, USA), for analysis. Results Having a female preponderance (266, or 61.9%), the mean age of the participants was 54.0 ± 13.1 years. With regard to occupational status, 126 (29.3%) had a sedentary occupation, 45 (10.5%) were unemployed, and 259 (60.2%) had a non-sedentary occupation. The mean diabetes duration was 6.4 ± 5.3 years, and the majority of patients had poor diabetes control (322, or 74.9%). Adhesive capsulitis was present in 61 (14.2%) patients with type 2 diabetes mellitus. On stratification, no significant statistical association of adhesive capsulitis was seen with gender (p-value: 0.075), age (p-value: 0.465), occupation (p-value: 0.056), diabetes duration (p-value: 0.118), or diabetes control (p-value: 0.090). Conclusion Adhesive capsulitis was not an uncommon finding in our study, reported in almost one-fifth of the 430 patients enrolled. We recommend that treating physicians screen diabetic patients for adhesive capsulitis so that proper pain relief, physiotherapy, and rehabilitation may be provided timely and efficiently, thereby reducing morbidity and improving the quality of life for such patients.

Knowledge and Performance on Intravenous Medication Administration to Patients: A Cross-Sectional Observational Study Among Nurses of Nepal.

To evaluate knowledge and performance levels regarding intravenous (IV) medication administration to patients among nurses working in paediatric centers of Nepal. A cross-sectional descriptive observational study. Enumerative sampling method was used for participant selection from the four hospitals having paediatric units. Data were collected using knowledge survey and observational checklist on four phases of IV medication administration. Of 115 nurses, 14 (12.2%) had adequate knowledge about IV medication administration whereas none had good level and only 20 nurses (17.4%) had fair level of performance. There was a weak negative correlation between knowledge and practice scores. Nurses working 8-h shifts had better performance than those working 6-h shifts; however, the recommended nurse-patient ratio was not maintained in 80% of observed shifts. The findings highlight the importance of upgrading nurses' knowledge and professional competencies on medication administration to improve the quality of patient care.

Osseous tumors of the foot, ankle, and lower leg: a cross-sectional observational study analysing 288 cases

BackgroundOsseous tumors of the foot and ankle are rarely encountered in general orthopaedic practice and represent only 3 % of osseous neoplasms. It can be difficult to distinguish between benign and malignant lesions, leading to misdiagnosis. Delays in diagnosis are the main cause of litigation in sarcoma of the extremities. Poor understanding of how sarcomas present in this region can lead to inappropriate initial procedures, limiting options for limb salvage and increasing rates of local recurrence. Our aim is to improve understanding of these rare tumors to reduce misdiagnosis and decrease the occurrence of inappropriate or unwarranted procedures. MethodsWe retrospectively analysed a prospectively maintained database of 288 new referrals to the West of Scotland regional musculoskeletal oncology service for osseous lesions of the foot, ankle and lower leg over a 10-year period. An analysis of patient demographics, presentation, anatomical location, diagnosis, classification, management and outcomes was performed. ResultsOf all new referrals, 52.4 % were diagnosed with primary benign osseous tumors, 8.7 % with primary malignant osseous tumors, 9.7 % with metastatic osseous lesions, and 29.2 % pseudotumors. The most common primary benign tumor in our population was osteoid osteoma (18.5 %), primary malignant tumor was osteosarcoma (32 %) and metastatic osseous lesions were from small cell lung cancer primary (14.3 %). In the foot and ankle, malignant bone tumors most commonly presented in the distal tibia and fibula (20 %). Rest pain was the most common symptom at presentation in all groups, followed by swelling. The average duration of symptoms was 5 months for malignant lesions before primary referral. ConclusionBone tumors in the foot and ankle remain a diagnostic challenge. We hope to have increased understanding of these rare lesions and have recommended a management protocol in order to reduce the number of inappropriate procedures performed, optimising clinical outcomes and reducing the cost of litigation to healthcare services. Level of EvidenceLevel III- Cross-sectional observational study

Computer Vision Syndrome and Ergonomic Practices among Students and Professionals

Purpose: To investigate the frequency of Computer vision syndrome (CVS) and its association with ergonomic practices among students and professionals. Study Design: Cross sectional observational study. Place and Duration of Study: Online survey. Methods: This study involved a pre-tested self-designed structured questionnaire distributed through Google Forms to gather responses from students and professionals regarding symptoms of CVS. The form was shared with approximately 2500 individuals, the response rate was 10.04%, resulting in 251 responses. After careful review, 237 responses were deemed suitable for inclusion in the study. The chi-square test was used and p-value less than 0.05 was considered statistically significant. Results: The relationship between symptoms of CVS (headache, body fatigue or tiredness, burning sensation, blurred vision, and dry eyes) and various ergonomic practices (screen time, longest uninterrupted time, breaks during screen use, screen size, type of screen, font size, refresh rate, and screen resolution) was seen in 237 subjects. The study revealed increased frequency of CVS symptoms when using screens. There was a statistically significant effect of prolonged screen time (p&lt;0.05), smaller screen sizes (p&lt;0.05), lower refresh rates (p&lt;0.05), small font size (p&lt;0.05) and lower screen resolutions (p&lt;0.05) on the severity of CVS symptoms. Conclusion: These findings enhance our understanding of the complex relationship between ergonomics and visual discomfort, and they will guide future interventions aimed at improving visual comfort and ergonomics in screen-based environments.