Higher Chance Of Survival Research Articles

Patient delay impact on breast cancer survival at Khartoum Referral Hospital: a retrospective study

Background: Breast cancer can be invasive and advanced at diagnosis causing enormous suffering and premature death. Delay to stage diagnosis and treatment is related to survival evaluation and several factors determine delay. The aim of the study was to examine predictor covariates associated with breast cancer delay and its impact on patient prognosis and survival. Methods: This retrospective cross-sectional hospital-based study was carried out at Khartoum Oncology Hospital. Participants were 411 breast cancer patients diagnosed and treated during the period 2016. Patients’ pathological and socio-demographic data were extracted from their medical files and delay data from telephone questionnaire survey and survival times calculated from follow-up. Fisher exact test, Cox and Logistic regression models were used to examine relationships between demographic, clinical and delay variables and survival outcome. Results: The mean age of the study subjects was 50.07 years old and the majority were ≥45 years. Cancer delay analysis showed that there were different reasons for different types of delay but the majority of participants (86.2%) claimed fear of the disease and treatment and lack of information were real drivers of delay. The study confirmed the majority of participants expressed long delay estimated at 28.3 weeks and patient delay had a significant association with the advanced stage (P-value<0.05). The hazard ratio was four times for risk of dying from cancer for long delay compared to the short one. Conclusion: The results of the study suggest delays at diagnosis and treatment are more common steps leading to advanced stage at diagnosis and poor survival. Early detection of the disease provides tremendous opportunities for early diagnosis, effective treatment and high chances of survival.

Oxygen Sparing Effect of Bacteriotherapy in COVID-19.

Background: We previously reported that severe COVID-19 patients had higher chances of survival and a reduced risk of developing respiratory failure when administered with the probiotic formulation SLAB51. This study aimed to investigate further bacteriotherapy mechanisms and how early they are activated. Methods: We performed an analysis on the blood oxygenation parameters collected in sixty-nine severe COVID-19 patients requiring non-invasive oxygen therapy and presenting a CT lung involvement ≥50%. Twenty-nine patients received low-molecular-weight heparin, azithromycin and Remdesivir. In addition, forty subjects received SLAB51. Blood gas analyses were performed before the beginning of treatments and at 24 h. Results: The patients receiving only standard therapy needed significantly increased oxygen amounts during the 24 h observation period. Furthermore, they presented lower blood levels of pO2, O2Hb and SaO2 than the group also supplemented with oral bacteriotherapy. In vitro data suggest that SLAB51 can reduce nitric oxide synthesis in intestinal cells. Conclusions: SARS-CoV-2 infected patients may present lesions in the lungs compromising their gas exchange capability. The functionality of the organs essential for these patients’ survival depends mainly on the levels of pO2, O2Hb and SaO2. SLAB51 contains enzymes that could reduce oxygen consumption in the intestine, making it available for the other organs.

Hyperferritinemia as independent risk factor and biomarker in COVID-19 to predict severity and mortality.

Objectives: To determine the role of deranged serum ferritin levels as independent pathogenic risk factor to predict the progression towards a worse clinical outcome in COVID-19. Study Design: Descriptive Cross Section Study. Setting: Hayatabad Medical Complex Peshawar. Period: 1 March to 10 July 2020. Material & Methods: A total of 267 patients were enrolled from COVID-19 isolation units, Hayatabad Medical Complex Peshawar Descriptive statistics were used for numerical variables. Binary logistic regression analysis was used to predict the worst outcome in patients with deranged levels of ferritin. Correlation statistic were used to quantify the correlation of ferritin with mortality and severity of the disease. Kaplan Meir test was used for survival analysis to compare the mortality rate in gender groups in COVID-19 patients with deranged ferritin levels. Results: The mean age of the patients was 53+14years. The median value of the Serum ferritin levels of Covid-19 patients was 978 ug/L the ferritin distribution in gender groups was not normally distributed (Shapiro Wilk test, p-value 0.001). 215/267(80.5%) cases reported >400 ug/Lof serum ferritin. There was a statistically significant uphill positive correlation of serum ferritin levels with an increase in age (rs-0.213, p-0.001) and with disease outcome in terms of mortality (rs-0.29, p-0.05). The probability case fatality in patients with deranged serum ferritin levels was 1.8 times more as compared to patients without hyperferritinemia (p-0.05, OR 1.8). The surviving capability in female gender with deranged ferritin levels in extreme of age was 65% as compared to 20% in male gender. Conclusion: More than 80% of the COVID-19 patients had abnormally higher readings of serum ferritin. The deranged ferritin levels had a statistically significant correlation with an increase in age of patient and with worst outcome in terms of death. Female gender more protective with higher chances of survival with deranged serum ferritin levels in all age groups compared to male gender.

Risk factors for severe outcomes for COVID-19 patients hospitalised in Switzerland during the first pandemic wave, February to August 2020: prospective observational cohort study

As clinical signs of COVID-19 differ widely among individuals, from mild to severe, the definition of risk groups has important consequences for recommendations to the public, control measures and patient management, and needs to be reviewed regularly. The aim of this study was to explore risk factors for in-hospital mortality and intensive care unit (ICU) admission for hospitalised COVID-19 patients during the first epidemic wave in Switzerland, as an example of a country that coped well during the first wave of the pandemic. This study included all (n = 3590) adult polymerase chain reaction (PCR)-confirmed hospitalised patients in 17 hospitals from the hospital-based surveillance of COVID-19 (CH-Sur) by 1 September 2020. We calculated univariable and multivariable (adjusted) (1) proportional hazards (Fine and Gray) survival regression models and (2) logistic regression models for in-hospital mortality and admission to ICU, to evaluate the most common comorbidities as potential risk factors. We found that old age was the strongest factor for in-hospital mortality after having adjusted for gender and the considered comorbidities (hazard ratio [HR] 2.46, 95% confidence interval [CI] 2.33−2.59 and HR 5.6 95% CI 5.23−6 for ages 65 and 80 years, respectively). In addition, male gender remained an important risk factor in the multivariable models (HR 1.47, 95% CI 1.41−1.53). Of all comorbidities, renal disease, oncological pathologies, chronic respiratory disease, cardiovascular disease (but not hypertension) and dementia were also risk factors for in-hospital mortality. With respect to ICU admission risk, the pattern was different, as patients with higher chances of survival might have been admitted more often to ICU. Male gender (OR 1.91, 95% CI 1.58−2.31), hypertension (OR  1.3, 95% CI 1.07−1.59) and age 55–79 years (OR 1.15, 95% CI 1.06−1.26) are risk factors for ICU admission. Patients aged 80+ years, as well as patients with dementia or with liver disease were admitted less often to ICU. We conclude that increasing age is the most important risk factor for in-hospital mortality of hospitalised COVID-19 patients in Switzerland, along with male gender and followed by the presence of comorbidities such as renal diseases, chronic respiratory or cardiovascular disease, oncological malignancies and dementia. Male gender, hypertension and age between 55 and 79 years are, however, risk factors for ICU admission. Mortality and ICU admission need to be considered as separate outcomes when investigating risk factors for pandemic control measures and for hospital resources planning.

Predictive values of early head computed tomography for survival outcome after cardiac arrest in childhood: a pilot study

Predicting outcomes of children after cardiac arrest (CA) remains challenging. To identify useful prognostic markers for pediatric CA, we retrospectively analyzed the early findings of head computed tomography (CT) of patients. Subjects were non-traumatic, out-of-hospital CA patients < 16 years of age who underwent the first head CT within 24 h in our institute from 2006 to 2018 (n = 70, median age: 4 months, range 0–163). Of the 24 patients with return of spontaneous circulation, 14 survived up to 30 days after CA. The degree of brain damage was quantitatively measured with modified methods of the Alberta Stroke Program Early CT Score (mASPECTS) and simplified gray-matter-attenuation-to-white-matter-attenuation ratio (sGWR). The 14 survivors showed higher mASPECTS values than the 56 non-survivors (p = 0.035). All 3 patients with mASPECTS scores ≥ 20 survived, while an sGWR ≥ 1.14 indicated a higher chance of survival than an sGWR < 1.14 (54.5% vs. 13.6%). Follow-up magnetic resonance imaging for survivors validated the correlation of the mASPECTS < 15 with severe brain damage. Thus, low mASPECTS scores were associated with unfavorable neurological outcomes on the Pediatric Cerebral Performance Category scale. A quantitative analysis of early head CT findings might provide clues for predicting survival of pediatric CA.

Quantitative characterization of left ventricular function during pulseless electrical activity using echocardiography during out-of-hospital cardiac arrest

BackgroundSeveral prospective studies have demonstrated that the echocardiographic detection of any myocardial activity during PEA is strongly associated with higher rates of return of spontaneous circulation (ROSC). We hypothesized that PEA represents a spectrum of disease in which not only the presence of myocardial activity, but more specifically that the degree of left ventricular (LV) function would be a predictor of outcomes. The purpose of this study was to retrospectively assess the association between LV function and outcomes in patients with OHCA. Materials and methodsUsing prospectively obtained data from an observational cohort of patients receiving focused echocardiography during cardiopulmonary resuscitation (CPR) in the Emergency Department (ED) setting, we analyzed 312 consecutive subjects with available echocardiography images with initial rhythm of PEA. We used left ventricular systolic fractional shortening (LVFS), a unidimensional echocardiographic parameter to perform the quantification of LV function during PEA. Regression analyses were performed independently to evaluate for relationships between LVFS and a primary outcome of ROSC and secondary outcome of survival to hospital admission. We analyzed LVFS both as a continuous variable and as a categorial variable using the quartiles and the median to perform multiple different comparisons and to illustrate the relationship of LVFS and outcomes of interest. We performed survival analysis using Cox proportional hazards model to evaluate the hazard corresponding to length of resuscitation. ResultsWe found a positive association between LVFS and the primary outcome of ROSC (OR 1.04, 95%CI 1.01–1.08), but not with the secondary outcome of survival to hospital admission (OR 1.02, 95%CI 0.96–1.08). Given that the relationship was not linear and that we observed a threshold effect in the relationship between LVFS and outcomes, we performed an analysis using quartiles of LVFS. The predicted probability of ROSC was 75% for LVFS between 23.4–96% (fourth quartile) compared to 47% for LVFS between 0–4.7% (first quartile). The hazard of not achieving ROSC was significantly greater for subjects with LVFS below the median (13.1%) compared to the subgroup with LVFS greater than 13.1% (p < 0.05), with the separation of the survival curves occurring at approximately 40 min of resuscitation duration. ConclusionsLeft ventricular function measured by LVFS is positively correlated with higher probability of ROSC and may be associated with higher chances of survival in patients with PEA arrest.

Knowledge and awareness of the general population and healthcare providers about retinoblastoma: It is time to know the glow.

Retinoblastoma is the most frequent primary intraocular tumour in childhood. Early detection of retinoblastoma is the key to successful management with a higher chance of survival. This study aims to assess the knowledge of the general population and healthcare providers about retinoblastoma in term of presentation, risk factors, timing for diagnosis, and complications. A cross-sectional study using an online survey was conducted in three Arab countries (Jordan, Saudi Arabia, and Iraq) between 28 August and 16 September 2020. The questionnaire tool was constructed based on an extensive literature review to explore the study's aim and objectives. Logistic regression was used to identify predictors of better knowledge about retinoblastoma. A total of 3676 participants were involved in the study (Jordan=2654, Saudi Arabia=604, and Iraq=418). The average retinoblastoma knowledge score for the whole study population was 6.25 (SD=4.12) out of 21, representing 29.8% (out of the maximum possible total score). Participants aged above 50years old, married individuals, those with a secondary education level, those who work as professionals in industry, those who have more than four children, and those who reported that they were not in direct contact with a large number of children were less likely to be knowledgeable about retinoblastoma presentation, risk factors, the timing for diagnosis, and complications (P<.05). Early detection is the cornerstone for decreasing morbidity and mortality among children with retinoblastoma. However, the awareness and knowledge about retinoblastoma are very limited in our study population. Efforts should be directed at increasing awareness of both the general population and healthcare providers regarding retinoblastoma. Policymakers are responsible for improving knowledge and awareness about retinoblastoma to facilitate early detection of the disease by conducting awareness campaigns in addition to improve screening skills of healthcare providers and providing them with proper screening and diagnostic tools.

Current Condition of Pannonic Salt Steppes at Their Distribution Limit: What Do Indicator Species Reveal about Habitat Quality?

Little is known about the suite of ecological conditions under which characteristic species may continue to develop under the pressure of recent habitat deterioration. We aimed to determine the niche of three indicator species of the priority habitat Pannonic salt steppes and to find out how their vegetation composition, land use, and soil chemistry mirror the current condition of their typical habitat. A plot-based vegetation survey was conducted in degraded and in pristine (reference) inland salt steppes in East-Central Europe. We confirmed decreased habitat quality at their northern geographical limit. Most of the sites there showed a strong prevalence of generalists (e.g., Elytrigia repens) and lack of specialists, both resulting from lowered habitat extremity and inappropriate land use (abandonment). A small proportion of plots (19%) were in the same good condition as the reference vegetation in the central area. Soil analyses revealed that the studied halophytes are able to persist on desalinized soils if the land use is suitable. The occurrence of the annual Camphorosma annua (Amaranthaceae) was driven largely by abiotic stress; grazing alone is insufficient for its long-term persistence, while the perennial Artemisia santonicum (Asteraceae) and Tripolium pannonicum (Asteraceae) have higher survival chances as they are able to coexist with generalists. Overall habitat quality can be reliably determined from the analyzed ecological conditions of indicator species. The outcomes of the presented work are relevant for conservation practice and can serve as a quick tool for assessing the current stage of other grassland habitats.

The Golden Hour Trauma Care

AbstractGlobally the road accidents had become a great burden and claiming lot of precious lives today. However, the initial treatment within the first hour of the injury indeed had proven the high chance of survival after the trauma. This article updates and signifies the systematic emergency approach and current principles in saving lives after injury.

Intrinsic growth heterogeneity of mouse leukemia cells underlies differential susceptibility to a growth-inhibiting anticancer drug.

Cancer cell populations consist of phenotypically heterogeneous cells. Growing evidence suggests that pre-existing phenotypic differences among cancer cells correlate with differential susceptibility to anticancer drugs and eventually lead to a relapse. Such phenotypic differences can arise not only externally driven by the environmental heterogeneity around individual cells but also internally by the intrinsic fluctuation of cells. However, the quantitative characteristics of intrinsic phenotypic heterogeneity emerging even under constant environments and their relevance to drug susceptibility remain elusive. Here we employed a microfluidic device, mammalian mother machine, for studying the intrinsic heterogeneity of growth dynamics of mouse lymphocytic leukemia cells (L1210) across tens of generations. The generation time of this cancer cell line had a distribution with a long tail and a heritability across generations. We determined that a minority of cell lineages exist in a slow-cycling state for multiple generations. These slow-cycling cell lineages had a higher chance of survival than the fast-cycling lineages under continuous exposure to the anticancer drug Mitomycin C. This result suggests that heritable heterogeneity in cancer cells’ growth in a population influences their susceptibility to anticancer drugs.

Seasonal patterns in nest survival of a subtropical wading bird, the Hawaiian Stilt (Himantopus mexicanus knudseni).

Nest survival is influenced by where and when birds decide to breed. For ground-nesting species, nest-site characteristics, such as vegetation height and proximity to water, may impact the likelihood of nest flooding or depredation. Further, habitat characteristics, and thus nest survival, may fluctuate across the breeding season. The Hawaiian Stilt (‘Ae‘o; Himantopus mexicanus knudseni) is an endangered Hawaiian waterbird that nests in wetlands across the Hawaiian Islands. In this study, we used observational surveys and nest cameras to examine the impact of nest-site characteristics and day of nesting season on nest survival of the Hawaiian Stilt. Early nests had a higher chance of survival than late nests. For most of the nesting season, taller vegetation was correlated with increased nest survival, while shorter vegetation was correlated with increased nest survival late in the nesting season. Seasonal patterns in nest survival may be due to changes in parental behavior or predator activity. Nest depredation was responsible for 55% of confirmed nest failures and introduced mammals were the primary nest predators. Our study is the first to examine seasonality in nest survival of Hawaiian Stilts and suggests that, despite longer nesting seasons and year-round occupation of wetlands, late nesters in subtropical regions may have lower nest survival than early nesters, similar to trends observed in temperate regions.

Coronary stent implantation for acute basilar artery occlusion with underlying stenosis.

Our aim was to study the effectiveness of coronary stent implantation during the endovascular treatment (EVT) of acute basilar artery occlusion (BAO) with occlusion-underlying intracranial atherosclerotic stenosis (ICAS). We retrospectively analysed 91 consecutive BAO patients who underwent EVT between February 2014 and January 2019 in a single, high-volume neurointerventional centre. We studied the effect of immediate coronary stent implantation on the clinical outcome of BAO with occlusion-underlying stenosis. BAO patients with underlying ICAS (n=41) were characterised by longer symptom-onset-to-reperfusion times (231 min vs 173 min, p=0.0020), lower TICI 2b-3 reperfusion rates (65.85% vs 90.00%, p=0.0084), and higher overall mortality (HR 2.021, p=0.0417) compared to the BAO cases without ICAS (n=50). The patients undergoing stenting (n=18) had lower residual basilar artery (BA) stenosis (14.7% vs 81.0%, p<0.0001), higher chance for functional recovery (OR 7.6, p=0.0250) and higher chance of survival (HR 4.163, p=0.0026) compared to the BAO-ICAS cases treated without coronary stents (n=21). The immediate treatment of the occlusion-underlying stenosis with coronary stents and dual antiplatelet therapy (DAPT) in BAO was associated with improved overall survival and better functional outcomes.

Which factors should be included in triage? An online survey of the attitudes of the UK general public to pandemic triage dilemmas

ObjectiveAs cases of COVID-19 infections surge, concerns have renewed about intensive care units (ICUs) being overwhelmed and the need for specific triage protocols over winter. This study aimed to help...

Computational identification of biomarker genes for lung cancer considering treatment and non-treatment studies

BackgroundLung cancer is the number one cancer killer in the world with more than 142,670 deaths estimated in the United States alone in the year 2019. Consequently, there is an overreaching need to identify the key biomarkers for lung cancer. The aim of this study is to computationally identify biomarker genes for lung cancer that can aid in its diagnosis and treatment. The gene expression profiles of two different types of studies, namely non-treatment and treatment, are considered for discovering biomarker genes. In non-treatment studies healthy samples are control and cancer samples are cases. Whereas, in treatment studies, controls are cancer cell lines without treatment and cases are cancer cell lines with treatment.ResultsThe Differentially Expressed Genes (DEGs) for lung cancer were isolated from Gene Expression Omnibus (GEO) database using R software tool GEO2R. A total of 407 DEGs (254 upregulated and 153 downregulated) from non-treatment studies and 547 DEGs (133 upregulated and 414 downregulated) from treatment studies were isolated. Two Cytoscape apps, namely, CytoHubba and MCODE, were used for identifying biomarker genes from functional networks developed using DEG genes. This study discovered two distinct sets of biomarker genes – one from non-treatment studies and the other from treatment studies, each set containing 16 genes. Survival analysis results show that most non-treatment biomarker genes have prognostic capability by indicating low-expression groups have higher chance of survival compare to high-expression groups. Whereas, most treatment biomarkers have prognostic capability by indicating high-expression groups have higher chance of survival compare to low-expression groups.ConclusionA computational framework is developed to identify biomarker genes for lung cancer using gene expression profiles. Two different types of studies – non-treatment and treatment – are considered for experiment. Most of the biomarker genes from non-treatment studies are part of mitosis and play vital role in DNA repair and cell-cycle regulation. Whereas, most of the biomarker genes from treatment studies are associated to ubiquitination and cellular response to stress. This study discovered a list of biomarkers, which would help experimental scientists to design a lab experiment for further exploration of detail dynamics of lung cancer development.

Economic inequality affects perceived normative values

The degree of economic inequality may lead to different environments where people develop motives and behaviours that lend them higher chances of survival. However, the specific features attributed to an environment with a particular level of economic inequality have received little research attention. In this research, we explored how perceived economic inequality may influence the values inferred as normative in society. Results from three studies, one correlational and two experimental, showed that perceived normative values change according to the degree of perceived economic inequality in a given context: higher levels of perceived economic inequality are related to normative self-enhancement values, whereas lower levels of perceived economic inequality are related to normative self-transcendence values. These results are discussed in terms of how information on economic inequality is used to build a general perception of the normative climate in society and, accordingly, of the values that would best guide behaviours.

Entry of Not-for-Profit Food Cooperatives and Its Implications on For-Profit Retailers

To revitalize local communities and economies, more not-for-profit food cooperatives (coops) are establishing their presence in less-populated areas or poor communities in recent years. This trend has motivated us to examine the entry conditions for food coops with the following two related social missions: (A) maximize profit to support the local community needs; and (B) maximize sales to support the local economy. We analyze the competition between an incumbent for-profit retailer and an entrant not-for-profit coop in a market comprised of heterogeneous consumers with different annual consumption rates and social conscience levels. We examine the coop's pricing strategy and entry conditions, the impact of the coop's entry on an existing for-profit retailer's sales and profit, and the conditions under which the retailer should deter the coop's entry. We find that a coop can afford to enter the market only when its fixed annual operating cost is below a certain threshold. Upon entry, we find that it is optimal for the coop to set a membership fee and a member-only discount to attract at least consumers with high consumption rate. We further show that the entry of a coop with social mission (B) is more detrimental for the retailer than the entry of a coop with social mission (A). This insight becomes more prevalent when we examine the retailer's deterrence strategy. Specifically, we find that it is optimal for the retailer to tolerate the inevitable entry of a coop when the coop's annual fixed operating cost is below a threshold, where this threshold is lower for the coop with mission (B) than mission (A). Our results generate managerial insights about the pricing and entry strategies of not-for-profit food coops, help explain the coexistence of not-for-profit food coops and for-profit retailers in practice, and suggest that coops with mission (A) have a higher chance of survival.

Factors Influencing Survival Rates of Pronghorn Fawns in Idaho

ABSTRACTPronghorn (Antilocapra americana) occur throughout western North America. In Idaho, USA, following intensive hunting to reduce crop depredations in the late 1980s, pronghorn populations have not rebounded to desired levels. Because neonatal survival in ungulates is one factor limiting population growth, we evaluated cause‐specific mortality and the influence of intrinsic and extrinsic factors on survival rates of 217 radio‐collared pronghorn fawns across 3 study areas in Idaho during 2015–2016. For intrinsic variables, we determined the sex and body mass index (BMI) for each fawn. For extrinsic variables, we determined the abundance of predators and alternate prey, estimated the normalized difference vegetation index (NDVI) for 1 month pre‐ and post‐parturition, and measured fecal nitrogen and diaminopimelic acid (DAPA). We considered NDVI as a measure of plant productivity, and fecal nitrogen and DAPA as possible proxies of diet quality. We predicted NDVI, fecal nitrogen, and DAPA would be positively related to the nutritional status of females and positively related to fawn survival. We used Program MARK with known fate models to estimate semi‐monthly survival rates of pronghorn fawns for the first 4 months post‐parturition. During both years, the leading cause of fawn mortality was coyote (Canis latrans) predation (58%), followed by unknown causes of mortality (18%), unknown predation (12%), predation by bobcats (Lynx rufus; 6%), predation by golden eagles (Aquila chrysaetos; 3%), and other (3%). Mean fawn survival for the 4 months post‐parturition across years and study sites was 0.42 ± 0.04 (SE; range = 28–62%). The top survival model included BMI, lagomorph abundance, and DAPA and had a model weight of 83.3%. All 3 variables were positively related to pronghorn fawn survival. Because females with increased nutrition generally have heavier fawns, BMI was likely correlated to diet quality, which was supported by the positive relationship between DAPA and fawn survival. We hypothesize that high lagomorph abundance created an alternate prey base to buffer coyotes from preying on pronghorn neonates. We found no influence of measures of NDVI (pre‐ and post‐parturition), fecal nitrogen, or predator abundance on fawn survival. Management actions providing high‐quality forage for pronghorn are likely to contribute to production of heavier fawns having the highest chance of survival. © 2020 The Wildlife Society.

Inferior Vena Cava Filter in Cancer Patients: On Whom Should We Be Placing Them?

Standard treatment for venous thromboembolism is anticoagulation; vena cava filter placement is an alternative in special situations. We aimed to evaluate the outcomes in patients with cancer undergoing filter placement in a cancer center during a 10-year period and assess which preoperatory variables were associated with poorer survival. Retrospective unicenter analysis during a 10-year period was carried out in patients with cancer who had undergone placement of vena cava filter. Early deaths were those that occurred less than 30days after the filter placement or that occurred during the same hospital stay of the placement. About 250 patients were analyzed. About 51.6% were females; 77.2% had proximal lower limb deep vein thrombosis; 34.8% had contraindications to anticoagulation; 32.8% presented bleeding after the onset of anticoagulation; and 18.4% had the filter implanted because they were going to undergo surgery and could not be anticoagulated immediately after. About 51.2% of the filters were removable. However, only 2 had the filter removed. About 59.2% had metastatic disease at the time of filter placement. About 31.2% fulfilled criteria for early death. Of those, 34 patients were put in palliative care after filter insertion (median, 13.5days). Body mass index >18kg/m2, the absence of metastatic disease, and filter placement during the same anesthesia of another surgery (especially if elective and curative) were associated with a higher chance of survival. Multidisciplinary evaluation (and possibly consideration for palliation) should take place before the decision to insert a vena cava filter in severe oncologic cases depending on overall status. Patients with a greater chance of survival at a 3 or 5years interval seem to be those whose filters were placed in the perioperative context of other surgeries (specially elective and curative), who were not undernourished, and whose disease was not metastatic at that time. For patients who survived, an active investigation protocol for filter removal should be implemented.

Plasma cfDNA as a potential treatment monitoring and prognostic index in patients withnon-small cell lung cancer

The purpose of this study was to investigate the potential of cell-free DNA (cfDNA) as a prognostic factor for non-small cell lung cancer (NSCLC). Patients with NSCLC (n = 154) treated with gefitinib were recruited over a 5-year period for this study, and served as the observation group (79 males and 75 females, mean age = 53.74 ± 10.86 years). The control group (normal healthy individuals) consisted of 30 males and 22 females, aged 44 - 64 years (mean age = 54.12 ± 9.83 years). The follow-up lasted 5 years, or until the patient relapsed and died. The plasma level of cfDNA was determined in patients 1 day before treatment, 3 days after treatment, and on the 28th day of treatment.Based on the cfDNA expression level, NSCLC patients were subdivided into high-expression and low-expression groups, and differences in survival were compared. Univariate and multivariate analyses were performed on factors affecting patients survival using COX. Total effectiveness was significantly higher in observation group (49.35%) than in control group (13.95 %) (p&lt;0.05). The extent of disease control wasalso significantly higher in the observation group (93.51 %) than in control group (p&lt;0.05). Plasma cfDNA level of NSCLCpatients was significantly higher than that of control group before treatment, but was significantly and time-dependently reduced after gefitinib treatment (p&lt;0.05). Cell-free DNA (cfDNA) level increased with severity of disease (p&lt;0.05). Patients in cfDNA low-expression group had significantly higher chances of survival than those in the high-expression group (p&lt;0.05). The results of Cox multivariate analysis showed that pathological severity and cfDNA concentration were independent factors affecting prognosis of NSCLC (p&lt;0.05). Plasma cfDNA is a potential prognostic index in patients with NSCLC.

Evidence based practice a viable tool to manage the COVID-19 pandemic

Evidence based practice is the steps taken for precaution, treatment and intervention of a disease that is dictated by the previous studies. The data collected by the predecessors who observed the initiation, progression and the termination or cure of a disease would be the guidance to future treatment. Years of trials and tests are done to determine the timeline of a disease and its termination, along with the effects that it leaves behind in long term. These facts and figures are important evidence to the future treatments. The idea of evidence based practice was coined in the late 1970s. It dictates that the care of patients done based on the evidence provided by the previous studies results in better recovery of the patients and less load on the healthcare system. This system is supposed to be efficient and provide the basic guidelines for the healthcare workers with a concrete basis for their work. The patients treated under evidence based practice ideally have a higher chance of survival than those who are treated without it. COVID-19 being a new disease has lack of previously accumulated evidence to support any treatment regimen that can ease the symptoms. Most of the treatments are based on recent trials and tests which are helping but in a limited scope.