Synthesis of metal anthranilate complexes: catalytic and antipathogenic studies.

BACKGROUND: Anthranilic acid is an active compound with diverse biological activities such as anti-inflammatory, antineoplastic, anti-malarial and α-glucosidase inhibitory properties. It can also chelate transition metals to form complexes with applications as antipathogens, photoluminescent materials, corrosion inhibitors, and catalysts. RESULTS: Anthranilic acid complexes (1-10) of Zn(II), Bi(III), Ag(I), Fe(II), Co(II), Cu(II), Mn(II), Al, Ni(II), and Cr(III) were synthesized and characterized using thermogravimetric (TGA), elemental analysis, FT-IR, UV-vis spectrometry, mass spectrometry and magnetic susceptibility. The morphology and size of metal complex (1-10) particles were determined by scanning electron microscope (SEM) and the surface area was determined by BET analysis. TGA and CHN analysis data indicated that the stoichiometries of complexes were 1:2 metal/ligand except for Ag(I), Al and Bi. Furthermore, DFT study was performed to optimize the structure of selected complexes. The complexes (1-10) were evaluated for their catalytic activity in the reduction of 4-nitrophenol (4-NP), antibacterial activity against S. aureus, P. aeroginosa and E. coli as well as their antifungal activity against F. solani and A. niger. The complexes were also tested against the second-stage juveniles (J2) root-knot nematodes. CONCLUSION: Co(II) complex 5 and Cu(II) complex 6 showed high catalytic activity for the reduction of 4-NP to 4-aminophenol (4-AP). Ag(I) complex 3 showed the best activity against the pathogens that were tested namely clinically important bacteria S. aureus, P. aeroginosa and E. coli, commercially important fungi F. solani and A. niger and J2 root-knot nematodes M. javanica.

Trends in Breast Cancer Survival by Race-Ethnicity in Florida, 1990-2015.

BACKGROUND: This study was conducted to evaluate trends in survival, by race-ethnicity, for women diagnosed with breast cancer in Florida over a 26-year period. METHODS: This was a retrospective cohort study of women diagnosed with invasive breast cancer in Florida between 1990 and 2015. Data were obtained from the Florida Cancer Data System. Women in the study were categorized according to race (white/black) and Hispanic ethnicity (yes/no). Cumulative incidence estimates of 5- and 10-year breast cancer-related death with 95% confidence intervals (CI) were obtained by race-ethnicity, according to diagnosis year. Subdistribution hazard models were used to obtain subdistribution HRs (sHR) for the relative rate of breast cancer death accounting for competing causes. RESULTS: Breast cancer mortality decreased for all racial-ethnic groups, and racial-ethnic minorities had greater absolute and relative improvement for nearly all metrics compared with non-Hispanic white (NHW) women. However, for the most recent time period (2010-2015), black women still experienced significant survival disparities with non-Hispanic black (NHB) women, having twice the rate of 5-year [sHR = 2.04; 95% confidence interval (CI), 1.91-2.19] and 10-year (sHR = 2.02; 95% CI, 1.89-2.16) breast cancer-related death. Adjustment for covariates substantially reduced the excess rate of breast cancer-related death for black women. CONCLUSIONS: Despite efforts to improve disparities in breast cancer outcomes for underserved women in Florida, black women continue to experience significant survival disparities. IMPACT: These results highlight the need for targeted approaches to eliminate disparities in breast cancer survival for black women.

Characteristics Associated With Nonreceipt of Surveillance Testing and the Relationship With Survival in Stage II and III Colon Cancer.

We investigated characteristics of patients with colon cancer that predicted nonreceipt of posttreatment surveillance testing and the subsequent associations between surveillance status and survival outcomes. This was a retrospective cohort study of the Surveillance, Epidemiology, and End Results database combined with Medicare claims. Patients diagnosed between 2002 and 2009 with disease stages II and III and who were between 66 and 84 years of age were eligible. A minimum of 3 years' follow-up was required, and patients were categorized as having received any surveillance testing (any testing) versus none (no testing). Poisson regression was used to obtain risk ratios with 95% confidence intervals for the relative likelihood of No Testing. Cox models were used to obtain subdistribution hazard ratios with 95% confidence intervals for 5- and 10-year cancer-specific and noncancer deaths. There were 16,009 colon cancer cases analyzed. Patient characteristics that predicted No Testing included older age, Black race, stage III disease, and chemotherapy. Patients in the No Testing group had an increased rate of 10-year cancer death that was greater for patients with stage III disease (subdistribution hazard ratio = 1.79, 95% confidence interval: 1.48, 2.17) than those with stage II disease (subdistribution hazard ratio = 1.41, 95% confidence interval: 1.19, 1.66). Greater efforts are needed to ensure all patients receive the highest quality medical care after diagnosis of colon cancer.

Internal Medicine Residents and the Practice of Defensive Medicine: A Pilot Study Across Three Internal Medicine Residency Programs.

Background Defensive medicine is becoming increasingly prevalent in the United States and is estimated to cost billions of dollars in excess healthcare spending. There is evidence that the practice of defensive medicine starts early in the medical career. Defensive medicine has been investigated among residents in high medico-legal risk specialties, but there is a paucity of information on its prevalence among internal medicine residents. Objective  To examine the prevalence and patterns of defensive medical practices among internal medicine residents. Methods We conducted an online survey among the residents of three internal medicine residency programs in the 2018-2019 academic cycle. We invited all internal medicine residents within the selected programs to participate through email and asked them to complete an electronic survey assessing defensive medical practices. Results A total of 49 out of 143 residents participated in the study (response rate: 34.3%); 55% (n = 27) of the residents who participated considered the risk of being sued during residency to be low, compared to 40.8% (n = 20) who considered it to be moderate and 4.1% (n = 2) who considered it to be high. Defensive medical practices were found to be widely prevalent (40.0-91.3%) among internal medicine residents across all three clinical training stages. Assurance defensive practices were more common than avoidance practices. Conclusion Defensive medical practices, especially of the assurance type, were widely prevalent among our sample of internal medicine residents.

Analyzing the Efficacy and Cost-effectiveness of Anti-platelet Therapy in Unstable Angina/Non-ST Elevation Myocardial Infarction: A Decision Analysis.

Current pretreatment guidelines for coronary angiography in unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI) involve the use of dual antiplatelet therapy (DAPT: aspirin + adenosine diphosphate (ADP) P2Y12 inhibitor), whereas the use of triple antiplatelet therapy (TAPT: aspirin + ADP P2Y12 inhibitor + GpIIb/IIIa inhibitor) has limited data due to the increased bleeding risk. However, a study directly comparing the efficacy and cost-effectiveness of DAPT vs. TAPT has not been done. A decision analysis was constructed to determine the ideal pretreatment antiplatelet regimen for UA/NSTEMI patients. The parameters were calculated based on published randomized clinical trials. They consisted of probabilities based on a pretreatment strategy (DAPT, TAPT), interventions (percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), medical management), and 30-day outcomes (no event, bleeding, vascular event, death). A 10,000 run Monte Carlo simulation provided two outputs: estimated life-years extended and costs for each treatment modality. Quality-adjusted life-years (QALYs) were taken into consideration using calculated coefficients from the literature. The cost/QALY ratio was $1,923/QALY for DAPT vs. $4,734/QALY for TAPT. The use of DAPT for pretreatment was favored (2.46 more cost-effective than TAPT). These results will aid clinicians in providing the most clinically sound and fiscally responsible care for UA/NSTEMI patients.

Musculoskeletal symptoms (MSS) and their associations with ergonomic physical risk factors of the women engaging in regular rural household activities: A picture from a rural village in Bangladesh.

BACKGROUND: Musculoskeletal complaints among housewives are very common around the world. In Bangladesh, although the majority of women are involved in various household activities, no studies were found related to musculoskeletal health and ergonomic risk factors for this work. OBJECTIVE: This study explored the prevalence of commonly affected body parts where the women experienced Musculoskeletal Symptoms (MSS), the disruption of normal activities due to the MSS, and the association of MSS with ergonomic physical risk factors among women engaging in regular household activities in a rural village of Bangladesh. PARTICIPANTS: Participants were women aged 20-45 in a small village in Bangladesh who were involved in regular household activities for at least 5 hours a day for the past year. METHOD: A total of 73 women were found eligible though door-to-door home visits to determine the prevalence of MSS. Women who had already been diagnosed with any arthritic conditions like rheumatoid and osteoarthritis were excluded for the study. The Standardized Nordic Questionnaire (SNQ) was used to determine the prevalence of MSS. Forty-six women out of 73 who reported MSS in the past 12 months were voluntarily assessed using the Musculoskeletal Disorder (MSD) risk assessment to determine the association between physical risk factors and MSS. RESULTS: 68.49% (n=50) women reported having MSS during the last 12 months and 50.68% (n=37) of the respondents were prevented from normal daily activities due to MSS. Most commonly affected regions were upper and lower back, wrist, knees and elbows. Awkward posture, such as bending, lifting and working in squatting position, movements of repetition were associated with MSS in different body parts. CONCLUSION: The prevalence of MSS and the resultant disruption of regular activities among rural women indicate that ergonomic attention is needed to improve their well-being.

The outcome of laparoscopic cholecystectomy in diabetic patients: a prospective study.

BACKGROUND: Diabetes mellitus is considered a risk factor associated with morbidity in patients who undergo laparoscopic cholecystectomy (LC), in comparison with nondiabetics. The aim of this study was to evaluate this risk factor in Saudi patients and evaluate the outcome LC in diabetic patients with nondiabetics. PATIENTS AND METHODS: We analyzed data from 968 patients with symptomatic gallbladder stones who underwent an LC between January 2005 and June 2008. Age, sex, operative records, morbidity, and length of hospital stay for each patient were analyzed. RESULTS: There were 175 (18%) diabetic and 793 nondiabetic patients. There was no significant difference between the two groups regarding complication, conversion to open, or operative time. Length of hospital stay was significantly different in the two groups. CONCLUSIONS: LC in diabetic patients had the same outcome in nondiabetic patients. Careful preoperative preparations, meticulous intraoperative surgical technique, and cautious postoperative care are mandatory to achieve this outcome.

Breast cancer knowledge, risk factors and screening among adult Saudi women in a primary health care setting.

OBJECTIVE: To assess level and determinants of knowledge about risk factors and utilization of screening methods used for breast cancer early detection among adult Saudi women in Al Hassa, KSA. STUDY DESIGN: cross-sectional descriptive. PARTICIPANTS AND METHODS: A total of 1,315 Saudi adult females were included, selected through a multistage stratified sampling method from ten primary health care centers. No previous history of breast cancer, attendance for routine services or accompanying patients were prerequisites for eligibility. Participants were invited to personal interview with pre-tested validated questionnaire including inquiries regarding knowledge, screening practices including clinical breast examination (CBE), mammography, individual breast cancer risk factors and perceived barriers towards (CBE). Both descriptive and inferential statistics were applied; logistic regression was conducted to determine the possible correlates of knowledge. RESULTS: Overall level of knowledge regarding risk factors and appropriate screening was low and dependent upon educational and occupational status. Early screening is underutilized among participants due to several perceived barriers. Clinical breast examinations were employed by less than 5% and mammography by only 3% of cases. A positive family history was found in 18% of cases among first and second degree relatives, and 2 % had a prior history of benign breast lesions. CONCLUSION: Included women, irrespective of their educational status, had knowledge deficits regarding breast cancer risk factors and underutilization of the recommended breast cancer screening. Several barriers are contributing to such knowledge deficits and screening behavior.

Histopathological patterns of female breast lesions at secondary level care in Saudi Arabia.

OBJECTIVE: The objective of this study was to characterize the histopathological patterns of female breast lesions encountered at a secondary level care centre in Al Hassa, Saudi Arabia, with special emphasis on multiplicity of benign lesions, their proliferative nature and level of risk for progression. METHODS: In this retrospective, hospital record-based descriptive study, all histopathology records of patients attending King Fahd Hospital in Hofuf, Al Hassa between January 2001 and December 2007, were reviewed using a structured compilation form. Nine and hundred-sixty nine histopathology reports were legible and included. Data regarding type of specimens, age, laterality of the lesions and the prominent cellular morphology were analyzed. RESULTS: Out of 969 records reviewed, benign lesions accounted for 60.1%, followed by malignancy (21.4%) and inflammatory lesions (18.5%). Multiple benign lesions were found in 51.1% and more than two lesions in 21.1% of cases. Non-proliferative breast lesions with low risk were reported in 81.4%, intermediate risk lesion without hyperplastic atypia in 14.6%, while high risk lesions with atypia were only 4.0%. Infiltrating ductal carcinoma was the dominant lesion among the latter and 62.1% of cases were diagnosed before the age of 50 years. CONCLUSION: Benign breast lesion multiplicity is frequent among Saudi female patients; with or without atypia these lesions represent a sizable risk of potential progression to breast cancer. Meticulous follow up with frequent screening may be useful for prevention of cancer development and early intervention in affected patients.

Access to Mammography Facilities and Detection of Breast Cancer by Screening Mammography: A GIS Approach.

OBJECTIVES: The objective of the study was to examine the association between access to mammography facilities and utilization of screening mammography in an urban population. METHODS: Data on female breast cancer cases were obtained from an extensive mammography surveillance project. Distance to mammography facilities was measured by using GIS, which was followed by measuring geographical access to mammography facilities using Floating Catchment Area (FCA) method (considering all available facilities within an arbitrary radius from the woman's residence by using Arc GIS 9.0 software). RESULTS: Of 2,024 women, 91.4% were Caucasian; age ranged from 25 to 98 years; most (95%) were non-Hispanic in origin. Logistic regression found age, family history, hormone replacement therapy, physician recommendation, and breast cancer stage at diagnosis to be significant predictors of having had a previous mammogram. Women having higher access to mammography facilities were less likely to have had a previous mammogram compared to women who had low access, considering all the facilities within 10 miles (OR=0.41, CI=0.22-0.76), 30 miles (OR=0.52, CI=0.29-0.91) and 40 miles (OR=0.51, CI=0.28-0.92) radiuses. CONCLUSIONS: Physical distance to mammography facilities does not necessarily predict utilization of mammogram and greater access does not assure greater utilizations, due to constraints imposed by socio economic and cultural barriers. Future studies should focus on measuring access to mammography facilities capturing a broader dimension of access considering qualitative aspect of facilities, as well as other travel impedances.

Breast Cancer Perceptions, Knowledge and Behavioral Practices among Women Living in a Rural Community.

We performed this study to assess women's perceptions, knowledge and behavioral practices for breast cancer prevention in a rural setting. A 61-item questionnaire was developed based on Health Belief Model constructs and completed by 185 women age 35 and older. Results showed significant differences in several areas including perceived susceptibility and severity. Overall knowledge was poor. In logistic regression perceived barriers and yearly clinical breast examination appeared to be significant predictors for regular screening behavior (OR=0.02, CI=0.03-0.09 and OR=0.23, CI=0.05-0.99, respectively). Behavioral interventions targeting barriers for rural women need to be designed to include consideration of specific barriers and clear information on the need for regular screening.

Social and Environmental Risk Factors for Hypertension in African Americans.

This study tests the hypothesis that disparities of hypertension risk in African Americans is related to lead exposure, perceptions of racism, and stress, among urban (Roxbury, MA) and rural (Gadsden, FL) communities. Analysis of preliminary data from Phase I reveal 60% in Gadsden and 39% in Roxbury respondents self-reported having hypertension. In Gadsden 80% people did not know if their residence contained lead paint, compared to 45% in Roxbury. In Gadsden County, 58% of respondents reported experiencing racial discrimination in different settings compared with 72% in Roxbury. In regression analyses high cholesterol emerged as a significant predictors of hypertension in Gadsden County (OR=8.29, CI=1.4-49.3), whereas monthly household income (OR=0.15, CI=0.04-0.7) and diabetes (OR=6.06, CI=1.4-26.17) were significant predictors of hypertension in Roxbury after adjusting for other covariates. These preliminary findings set the stage for initiating Phase II (Phase I continues recruitment), that entail biological marker measurements to rigorously test main hypothesis.

Factors associated with adherence to recommendations for screening mammography among American Indian women in Colorado.

OBJECTIVE: To compare adherence to screening mammography recommendations of American Indian and non-Hispanic White women in the Denver, Colorado, area. DESIGN/SETTING/PARTICIPANTS: This study retrospectively examined adherence patterns in 229 American Indian and 60,197 non-Hispanic White women > or = 40 years and older, with at least one screening mammogram in the Colorado Mammography Project (CMAP), from January 1, 1999, to December 31, 2003. The CMAP was a prospective study of women receiving mammograms at participating clinics around Denver. MAIN OUTCOME MEASURES: Using logistic mixed models, we defined two dependent variables as annual and biennial adherence from the intervals between screening mammograms for each woman. RESULTS: Biennial adherence was substantially higher than annual adherence for both American Indian and non-Hispanic White women in our analyses. American Indian women were less likely than non-Hispanic White women to adhere to biennial recommendations in multivariate models controlling for age, family history of breast cancer, and economic status (zip code): odds ratio (OR) .4 and 95% confidence interval (CI) .2-.6. The association between American Indian race/ethnicity and annual adherence was similar, although not as strong (OR .5, 95% CI .3-.8). CONCLUSIONS: American Indian women in the CMAP cohort were less likely than non-Hispanic White women to adhere to recommendations for screening mammography, both annually and biennially. Additional research is needed to explore the effect of biennial screening and other barriers among American Indian women.

A Theory-Based Model for Predicting Adherence to Guidelines for Screening Mammography among Women Age 40 and Older.

OBJECTIVE: To examine theory-based selected factors associated with adherence to mammography screening guidelines in a surveillance database. METHODS: Data from Colorado Mammography Project (CMAP) from 1994-1998 was extracted and analyzed by using SAS statistical software. Based on the Health Belief Model and Behavioral Model of Health Services Utilization a prediction model was developed to examine the mammography utilization patterns and factors influencing the adherence to screening guidelines. RESULTS: Out of 27,778 women, 41.4% were adherent with mammography screening guidelines. According to the model tested in this study, race/ethnicity (Black vs White, OR=0.76, 95% CI=0.64-0.91); educational attainment (high school vs < high school, OR= 1.10, 95% CI= 1.04-1.18), college graduate vs < high school (OR=1.33, 95% CI=1.25-1.42); insurance status, (any coverage vs no coverage (OR=1.62, 95% CI=1.25-2.12); and community economic status as defined by median income by zip code of residence ($15,000-$24,999 vs <$15,000, OR=0.84, 95% CI=0.76-0.94; >$55,000 vs <$15,000, OR 1.14, 95% CI=1.03-1.26) were statistically significant predictors of adherence to guidelines. Interaction between age and family history of breast cancer was statically significant. Younger females with a family history of breast cancer were less likely to be adherent than their counterparts without a family history (OR=0.93, 95% CI=0.90-0.96). Inclusion or exclusion of women aged 70 years and older did not change the outcome of the analysis. CONCLUSION: The prediction model variables such as race/ethnicity, age and family history of breast cancer, educational level and community economic status, are associated with adherence status. Family history of breast cancer needs to be examined very carefully in future studies as it may play negative role in adherence to screening mammography.

Factors influencing adherence to guidelines for screening mammography among women aged 40 years and older.

OBJECTIVE: To explore patterns of adherence to guidelines for screening mammography among participants in the Colorado Mammography Project (CMAP) surveillance database. METHODS: An algorithm was developed to assess factors associated with adherence to mammography screening guidelines. RESULTS: Of the 27,778 women ranging from 40-90 years of age included in the analysis, 41.4% were adherent with mammography screening guidelines. According to the model tested in this study, race/ethnicity (Black vs White, OR=0.76, 95% CI=0.64-0.91); educational attainment (high school vs 55,000 dollars vs <15,000 dollars, OR 1.14, 95% CI=1.03-1.26) were statistically significant predictors of adherence to guidelines. A significant interaction between age and family history of breast cancer (BC) was also found. Younger females with a family history of BC were less likely to be adherent than their counterparts without a family history (OR=0.93, 95% CI=0.90-0.96). In general, elderly women were more likely to be adherent compared with the youngest group in this cohort (OR=1.21, 95% CI=1.11-1.33). Inclusion or exclusion of women aged 70 years and older did not change the outcome of the analysis. CONCLUSION: Adherence with screening mammography guidelines was found to be associated with women's personal characteristics including race/ethnicity, age, and family history of BC. In addition, socioeconomic status, as measured by educational level and community economic status, are important predictors of adherence. Efforts to increase adherence may need to be specific to race/ethnic group and age, but the effect of age is mediated by family history of BC and vice versa.