Clinical Characteristics and Outcomes in Patients with COVID-19 and Cancer: a Systematic Review and Meta-analysis.

Much of routine cancer care has been disrupted due to the perceived susceptibility to SARS-CoV-2 infection in cancer patients. Here, we systematically review the current evidence base pertaining to the prevalence, presentation and outcome of COVID-19 in cancer patients, in order to inform policy and practice going forwards. A keyword-structured systematic search was conducted on Pubmed, Cochrane, Embase and MedRxiv databases for studies reporting primary data on COVID-19 in cancer patients. Studies were critically appraised using the NIH National Heart, Lung and Blood Institute's quality assessment tool set. The pooled prevalence of cancer as a co-morbidity in patients with COVID-19 and pooled in-hospital mortality risk of COVID-19 in cancer patients were derived by random-effects meta-analyses. In total, 110 studies from 10 countries were included. The pooled prevalence of cancer as a co-morbidity in hospitalised patients with COVID-19 was 2.6% (95% confidence interval 1.8%, 3.5%, I2: 92.0%). Specifically, 1.7% (95% confidence interval 1.3%, 2.3%, I2: 57.6.%) in China and 5.6% (95% confidence interval 4.5%, 6.7%, I2: 82.3%) in Western countries. Patients most commonly presented with non-specific symptoms of fever, dyspnoea and chest tightness in addition to decreased arterial oxygen saturation, ground glass opacities on computer tomography and non-specific changes in inflammatory markers. The pooled in-hospital mortality risk among patients with COVID-19 and cancer was 14.1% (95% confidence interval 9.1%, 19.8%, I2: 52.3%). We identified impeding questions that need to be answered to provide the foundation for an iterative review of the developing evidence base, and inform policy and practice going forwards. Analyses of the available data corroborate an unfavourable outcome of hospitalised patients with COVID-19 and cancer. Our findings encourage future studies to report detailed social, demographic and clinical characteristics of cancer patients, including performance status, primary cancer type and stage, as well as a history of anti-cancer therapeutic interventions.

Development, behaviour and sensory processing in Marshall-Smith syndrome and Malan syndrome: phenotype comparison in two related syndromes.

BACKGROUND: Ultrarare Marshall-Smith and Malan syndromes, caused by changes of the gene nuclear factor I X (NFIX), are characterised by intellectual disability (ID) and behavioural problems, although questions remain. Here, development and behaviour are studied and compared in a cross-sectional study, and results are presented with genetic findings. METHODS: Behavioural phenotypes are compared of eight individuals with Marshall-Smith syndrome (three male individuals) and seven with Malan syndrome (four male individuals). Long-term follow-up assessment of cognition and adaptive behaviour was possible in three individuals with Marshall-Smith syndrome. RESULTS: Marshall-Smith syndrome individuals have more severe ID, less adaptive behaviour, more impaired speech and less reciprocal interaction compared with individuals with Malan syndrome. Sensory processing difficulties occur in both syndromes. Follow-up measurement of cognition and adaptive behaviour in Marshall-Smith syndrome shows different individual learning curves over time. CONCLUSIONS: Results show significant between and within syndrome variability. Different NFIX variants underlie distinct clinical phenotypes leading to separate entities. Cognitive, adaptive and sensory impairments are common in both syndromes and increase the risk of challenging behaviour. This study highlights the value of considering behaviour within developmental and environmental context. To improve quality of life, adaptations to environment and treatment are suggested to create a better person-environment fit.

Ants Do Not Traverse the Silk of Adult Female Nephila clavipes (Linnaeus) Webs.

Many organisms use chemicals to deter enemies. Some spiders can modify the composition of their silk to deter predators from climbing onto their webs. The Malaysian golden orb-weaver Nephila antipodiana (Walckenaer) produces silk containing an alkaloid (2-pyrrolidinone) that functions as a defense against ant invasion-ants avoid silk containing this chemical. In the present study, we test the generality of ants' silk avoidance behavior in the field. We introduced three ant species to the orb webs of Nephila clavipes (Linnaeus) in the tropical rainforest of La Selva, Costa Rica. We found that predatory army ants (Eciton burchellii Westwood) as well as non-predatory leaf-cutting ants (Atta cephalotes Linnaeus and Acromyrmex volcanus Wheeler) avoided adult N. clavipes silk, suggesting that an additional species within genus Nephila may possess ant-deterring silk. Our field assay also suggests that silk avoidance behavior is found in multiple ant species.

Effectiveness of a comprehensive educational programme for Accredited Social Health Activists (ASHAs) to identify individuals in the Udupi district with bleeding disorders: A community-based survey.

INTRODUCTION: The awareness and knowledge on bleeding disorders is generally poor among the rural population. Accredited Social Health Activists (ASHAs) serve as the facilitators between the rural community and the health care system. Training of ASHAs in screening of rural population for early identification of bleeding disorders can enable prompt referral, timely detection and management of bleeding disorders. AIM: The aim of the study was to evaluate the effectiveness of an ASHA training programme for identification of suspected bleeding disorder cases. METHODS: A population-based, cross-sectional survey was implemented by 586 Accredited Social Health Activists (ASHAs) in rural Udupi district, who underwent a structured training programme on identification of bleeding disorders. A survey record book with a screening tool on assessment of bleeding symptoms was given to each ASHA. The screening tool consisted of symptoms related to bleeding disorders and family history of bleeding disorders. Using the screening tool, ASHAs carried out a door-to-door survey. After screening, those who reported with bleeding symptoms were referred by the ASHAs to the investigator, who conducted further assessment. A detailed bleeding history was documented and bleeding symptom assessment was carried out using bleeding assessment tool (BAT) at the haemophilia treatment centre. Further coagulation assessments were carried out as per the treatment centre protocol. This paper highlights the evaluation of an ASHA training programme on identification of individuals with bleeding symptoms in the rural population. RESULTS: A total of 586 trained ASHAs surveyed a population of 318 214 in rural Udupi district. Out of the 124 cases reported by ASHAs, 29 bleeding disorder cases were identified; haemophilia (A and B) was the most commonly found bleeding disorder 22 (75.8%), followed by von Willebrand disease (vWD) 3 (10.3%) and 4 (13.8%) immune-mediated thrombocytopenic purpura (ITP), with an overall prevalence of 2.2/10 000 population. CONCLUSION: Training ASHA health care workers, who are the most important link between the community and health services, resulted in increased awareness among the public for the early detection of bleeding disorders.

Functional and cosmetic outcome of single-digit ray amputation in hand.

PURPOSE: To assess patient satisfaction, functional and cosmetic outcomes of single-digit ray amputation in hand and identify factors that might affect the outcome. METHODS: Forty-five patients who underwent ray amputation were evaluated, 37 males and eight females whose mean age was 36.6 years ranging between 15 and 67 years. Twenty-eight patients had dominant hand involvement. Twenty-one patients underwent primary ray amputation, and 24 patients had secondary ray amputation. Eight out of the 23 patients with central digit injuries underwent transposition. Grip strength, pinch strength, tactile sensibility and functional evaluation using Result Assessment Scale (RAS) and DASH score were analysed. Cosmetic assessment was performed using visual analogue scale (VAS) for cosmesis. RESULTS: Median time of assessment after surgery was 20 months. Average loss of grip strength and pinch strength was found to be 43.3 and 33.6%, respectively. Average RAS score was 3.75. Median DASH score was 23.4. Eighty-three percentage of patients had excellent or good cosmesis on the VAS. Transposition causes significant increase in DASH scores for central digit ray amputations but was cosmetically superior. Middle finger ray amputation had the maximum loss of grip strength, and index finger ray amputation had greater loss of pinch strength. Affection of neighbouring digits caused greater grip and pinch loss, and a higher DASH score. Primary ray resection decreased the total disability and eliminated the costs of a second procedure. CONCLUSION: Following ray amputation, one can predict an approximate 43.3% loss of grip strength and 33.6% loss of pinch strength. The patients can be counselled regarding the expected time off from work, amount of disability and complications after a single-digit ray amputation. Majority of the patients can return to the same occupation after a period of dedicated hand therapy. LEVEL OF EVIDENCE: Therapeutic, Level III.

Association of angiogenic cytokines (VEGF-A and VEGF-C) and clinical characteristic in women with unexplained recurrent miscarriage.

INTRODUCTION: Recurrent miscarriage (RM) defined as 2 or more spontaneous miscarriage before 20 weeks of gestation, affects at least 1 % of couples trying to conceive. In over 50 % of cases, the cause of the loss of pregnancy remains unexplained. Reduced expression of Angiogenic factors such as: vascular endothelial growth factor (VEGF-A) and VEGF-C has been linked with spontaneous miscarriage, likely due to defective foetal and placental angiogenesis. AIMS AND OBJECTIVES: To investigate the relationships between serum level of VEGF-A and VEGF-C with clinical characteristic in women with URM and compare to pregnant and healthy women. MATERIALS AND METHODS: A case-control study, which was conducted between 90 non-pregnant women with history of RM, age-matched with 70 non-pregnant women without history of recurrent abortion with at least one child (controls) and 70 pregnant women without history of recurrent abortion with at least one child (controls). Those with unexplained RM were eligible. Demographic and Anthropometric data were retrieved by pre-test questionnaire and serum level of VEGF-A and VEGF-C measured by ELISA kit. RESULTS: This study showeds that maternal levels of VEGF-A and VEGF-C were distinctly lower in RSA (189.87±88.1 vs 238.8±99.6) compared to healthy (239.1±99.7 vs 275.5±133.08) and pregnant (301.5±76.4 vs 402.5±128.6) women as control groups. Univariate analysis demonstrated that clinical characteristic factors were significantly associated with concentration of VEGF-A and VEGF-C in cases and controls. CONCLUSIONS: Our findings suggest that these molecules could be used as potential predictive markers of miscarriage in these women presenting with URM (Tab. 4, Fig. 5, Ref. 40).

Shear bond strength of composite resin bonded to preformed metal crowns for primary molars using a universal adhesive and two different surface treatments: an in vitro study.

AIM: This was to determine the shear bond strength of composite resin bonded to preformed metal crowns with a new adhesive. Buccal surfaces of the crowns were roughened by two different methods to increase retention. METHOD: Typodont mandibular second primary molars (38) were divided into two groups (19 per group). Preformed metal crowns were cemented to the teeth with glass-ionomer cement. To enhance retention, buccal surfaces of the crowns in group I were roughened with cross-cut carbide burs (SS White #56); crowns in group II were sandblasted (aluminium oxide, 50 µm). Scotchbond Universal Adhesive (3 M-ESPE) was used to bond composite resin to the crowns. A universal testing machine tested the maximum shearing force withstood by the veneered composite surfaces. RESULTS: Sandblasted crowns demonstrated significantly higher resistance (p = 0.001) to shearing force (324.4 N) than did the crowns that were roughened with a bur (234.2 N). CONCLUSION: Chairside veneering of composite resin to pretreated crowns could be a feasible, aesthetically pleasing, and an economical option in paediatric dentistry.

Simultaneous versus staged bilateral direct anterior Total Hip Arthroplasty: Are early patient-centered outcomes equivalent?

While accumulating data on the direct anterior approach to total hip arthroplasty (THA) have demonstrated clinical benefit and durable results, there is little data that exists on patient-centered outcomes and satisfaction when comparing simultaneous bilateral procedures with staged arthroplasty. The aim of this study was to determine whether simultaneous bilateral THA and staged arthroplasty result in equivalent early (1) patient-centered outcomes and patient satisfaction; while maintaining acceptable rates of (2) objective clinical outcome scores, (2) complication rates; and (3) radiographic results. In retrospective review, 41 patients who underwent bilateral one-stage THA were compared to 44 patients who underwent staged bilateral THA during the same time period. The minimum clinical follow up was two years. Generic (EQ-VAS and EuroQoL-5D index) and condition-specific (Oxford Hip Score) instruments were used to assess patient-reported outcomes. Other variables included length of hospital stay (LOS), operative and anesthetic times, blood loss, intra- and post-operative (local and systemic) complications, and radiographic analysis. No significant differences between the two groups were found for patient-reported outcomes, complications, or radiographic assessment. The simultaneous THA group had shorter LOS and operative and anesthetic times, as well as less blood loss.

Effect of Perioperative ß-Blockers on Pulmonary Complications among Patients with Chronic Obstructive Pulmonary Disease Undergoing Lung Resection Surgery.

The aim of this study is to determine if COPD patients undergoing lung resection with perioperative ß-blocker use are more likely to suffer postoperative COPD exacerbations than those that did not receive perioperative ß-blockers. Methods. A historical cohort study of COPD patients, undergoing lung resection surgery at Memorial Sloan-Kettering Cancer Center between 2002 and 2006. Primary outcomes were the rate of postoperative COPD exacerbations, defined as any initiation or increase of glucocorticoids for documented bronchospasm. Results. 520 patients with COPD were identified who underwent lung resection. Of these, 205 (39%) received perioperative ß-blockers and 315 (61%) did not. COPD was mild among 361 patients (69% of all patients), moderate in 117 patients (23%), and severe in 42 patients (8%). COPD exacerbations occurred among 11 (5.4%) patients who received perioperative ß-blockers and among 20 (6.3%) patients who did not. Secondary outcomes, which included respiratory failure, 30-day mortality, and the presence or absence of any cardiovascular complication, ICU transfer, cardiovascular complication, or readmission within 30 days, did not differ in prevalence between the two groups. Conclusions. This study implies that perioperative ß-blockers use among COPD patients undergoing lung resection surgery does not impact the rate of exacerbations.

Short-term outcomes of a program developed to inculcate research essentials in undergraduate medical students.

BACKGROUND: Participation in research during undergraduate studies may increase students' interest in research and inculcate research essentials in them. AIMS: The purpose of this study was to evaluate the effectiveness of the mentored student project (MSP) program. SETTINGS AND DESIGN: In the MSP program, students in groups (n = 3 to 5) undertook a research project, wrote a scholarly report, and presented the work as a poster presentation with the help of a faculty mentor. To begin with, the logic model of the program was developed to identify short-term outcomes of the program on students, mentors, and the institution. A quasi-experimental design was used to measure the outcomes. MATERIALS AND METHODS: A mixed method evaluation was done using a newly-developed questionnaire to assess the impact of the MSP on students' attitude, a multiple-choice question (MCQs) test to find out the impact on students' knowledge and grading of students' project reports and posters along with a survey to check the impact on skills. Students' satisfaction regarding the program and mentors' perceptions were collected using questionnaires. Evidence for validity was collected for all the instruments used for the evaluation. STATISTICAL ANALYSIS: Non-parametric tests were used to analyze data. Based on the scores, project reports and posters were graded into A (>70% marks), B (60-69% marks), and C (<59% marks) categories. The number of MSPs that resulted in publications, conference presentation and departmental collaborations were taken as impact on the institution. RESULTS: Students' response rate was 91.5%. The students' attitudes regarding research changed positively (P = 0.036) and score in the MCQ test improved (P < 0.001) after undertaking MSP. Majority of project reports and posters were of grade A category. The majority of the items related to skills gained and satisfaction had a median score of 4. The MSPs resulted in inter-departmental and inter-institutional collaborations, 14 publications and 15 conference presentations. An area for improvement noted was to have the MSP implemented in the curriculum without increasing students' overall workload and stress. CONCLUSION: The study identified strengths and weaknesses of the MSP program. Our model of undergraduate research project may be incorporated in undergraduate medical programs to foster positive attitude and knowledge base about scientific research and to instil research skills among students.

Establishing a clinic-based pancreatic cancer and periampullary tumour research registry in Quebec.

BACKGROUND: Enrolling patients in studies of pancreatic ductal adenocarcinoma (pdac) is challenging because of the high fatality of the disease. We hypothesized that a prospective clinic-based study with rapid ascertainment would result in high participation rates. Using that strategy, we established the Quebec Pancreas Cancer Study (qpcs) to investigate the genetics and causes of pdac and other periampullary tumours (pats) that are also rare and underrepresented in research studies. METHODS: Patients diagnosed with pdac or pat were introduced to the study at their initial clinical encounter, with a strategy to enrol participants within 2 weeks of diagnosis. Patient self-referrals and referrals of unaffected individuals with an increased risk of pdac were also accepted. Family histories, epidemiologic and clinical data, and biospecimens were collected. Additional relatives were enrolled in families at increased genetic risk. RESULTS: The first 346 completed referrals led to 306 probands being enrolled, including 190 probands affected with pdac, who represent the population focus of the qpcs. Participation rates were 88.4% for all referrals and 89.2% for pdac referrals. Family history, epidemiologic and clinical data, and biospecimens were ascertained from 91.9%, 54.6%, and 97.5% respectively of patients with pdac. Although demographics and trends in risk factors in our patients were consistent with published statistics for patients with pdac, the qpcs is enriched for families with French-Canadian ancestry (37.4%), a population with recurrent germ-line mutations in hereditary diseases. CONCLUSIONS: Using rapid ascertainment, a pdac and pat research registry with high participation rates can be established. The qpcs is a valuable research resource and its enrichment with patients of French-Canadian ancestry provides a unique opportunity for studies of heredity in these diseases.

Femoroacetabular impingement inducing non-union of a femoral neck fracture: a case report.

INTRODUCTION: We describe a case in which femoroacetabular impingement (FAI) was identified as the cause of non-union of a femoral neck fracture and the subsequent treatment strategy. MATERIALS AND METHODS: Retrospective review of a 35-year-old patient, without any risk factors for non-union, who sustained a femoral neck fracture. Pre-existing FAI was identified as the cause for the non-union of the femoral neck fracture, with successful treatment of the non-union according to established arthroscopic treatment of the hip. RESULTS: After treatment of the FAI, the non-union healed uneventfully within 3 months. CONCLUSIONS: FAI may be a less common but potential cause of delayed union or non-union in the setting of femoral neck fracture in the young.

Effect of Red Bull energy drink on muscle performance: an electromyographic overview.

AIM: The present study was aimed at investigating the effect of Red Bull Energy drink (RB) on muscle endurance and fatigue. METHODS: Twenty students of second year MBBS (males N.=10, females N.=10) were involved in a cross over design separated by 7 days, where they received either RB (caffeine at 2 mg/kg body weight) or isoenergetic, isovolumetric, noncaffeinated control drink (CD). After one hour of intake of the drink, maximum isometric force (MVC) and electromyogram (EMG) (flexor carpi radialis) were recorded from the dominant hand using Biopac Systems. After MVC, all subjects performed a sustained isometric contraction at 75% of MVC to fatigue. The Root mean square amplitude (RMS) and mean frequency (MNF) were calculated from the EMG data. Statistical analysis was done using r within and across groups. RESULTS: Following consumption of RB, the fatigue task showed a decreased tendency to fatigue based on the MNF value for both the drinks. However the EMG index with reference to RMS was inconclusive to interpret any delaying effect on fatigue. There was no significant difference between the two drinks in the parameters assessed during MVC and endurance time. CONCLUSION: The Red Bull energy drink (caffeine at 2 mg/kg body weight) was no better than CD at significant delaying effect on fatigue during isometric contraction.

Cost analysis of fresh-frozen femoral head allografts: is it worthwhile to run a bone bank?

To assess the sustainability of our institutional bone bank, we calculated the final product cost of fresh-frozen femoral head allografts and compared these costs with the use of commercial alternatives. Between 2007 and 2010 all quantifiable costs associated with allograft donor screening, harvesting, storage, and administration of femoral head allografts retrieved from patients undergoing elective hip replacement were analysed. From 290 femoral head allografts harvested and stored as full (complete) head specimens or as two halves, 101 had to be withdrawn. In total, 104 full and 75 half heads were implanted in 152 recipients. The calculated final product costs were €1367 per full head. Compared with the use of commercially available processed allografts, a saving of at least €43 119 was realised over four-years (€10 780 per year) resulting in a cost-effective intervention at our institution. Assuming a price of between €1672 and €2149 per commercially purchased allograft, breakeven analysis revealed that implanting between 34 and 63 allografts per year equated to the total cost of bone banking.

Single-stage revision for fungal peri-prosthetic joint infection: a single-centre experience.

Fungal peri-prosthetic infections of the knee and hip are rare but likely to result in devastating complications. In this study we evaluated the results of their management using a single-stage exchange technique. Between 2001 and 2011, 14 patients (ten hips, four knees) were treated for a peri-prosthetic fungal infection. One patient was excluded because revision surgery was not possible owing to a large acetabular defect. One patient developed a further infection two months post-operatively and was excluded from the analysis. Two patients died of unrelated causes. After a mean of seven years (3 to 11) a total of ten patients were available for follow-up. One patient, undergoing revision replacement of the hip, had a post-operative dislocation. Another patient, undergoing revision replacement of the knee, developed a wound infection and required revision 29 months post-operatively following a peri-prosthetic femoral fracture. The mean Harris hip score increased to 74 points (63 to 84; p < 0.02) in those undergoing revision replacement of the hip, and the mean Hospital for Special Surgery knee score increased to 75 points (70 to 80; p < 0.01) in those undergoing revision replacement of the knee. A single-stage revision following fungal peri-prosthetic infection is feasible, with an acceptable rate of a satisfactory outcome.