(A Clinicopathological Aspects of Resectable Pancreatic Neoplasm)

2021 ◽  
Vol 6 (15) ◽  
pp. 39-44
Author(s):  
Şeref Dokcu ◽  
Mehmet Ali Çaparlar ◽  
Salim Demirci
Keyword(s):  
Pancreatic Cancer ◽  
Survival Analysis ◽  
Survival Rates ◽  
Pancreatic Neoplasm ◽  
Population Based ◽  
Clinicopathological Features ◽  
Categorical Variables ◽  
Malignant Neoplasms ◽  
Continuous Variables ◽  
Common Diagnosis

Aim Pancreatic cancer is one of the deadliest malignant neoplasms. As with many malignant neoplasms, survival rates depend on the histopathological type of cancer, its stage, tumor size, and treatment. In this study, we aimed to classify pancreatic cancer according to clinicopathological features and histological subtypes. Material and method The data of all adult patients diagnosed and treated for pancreatic neoplasm in our clinic were collected retrospectively from the hospital's computerized database and medical files. Patients were categorized according to their clinicopathological features. Chi-square test and Fisher's exact test were used for between-group comparisons, and t-test was used for independent samples for quantitative data. Data were expressed as mean ± SD for continuous variables and numbers and percentages for categorical variables. A value of p<0.05 was considered significant. Results The mean age of the patients was 60.5 years, 70.8% were male. There were five types of tumors defined histopathologically, and the most common diagnosis was adenocarcinoma (76.9%). The most common localization of the tumor was head and neck (44.4%). Whipple surgery was performed predominantly in 69.2% of patients, and distal pancreatectomy in 29.0%. Postoperative complications were observed in more than one third (34%) of the patients. The main complications were pancreatic cyst (16.3%). In the survival analysis performed with the Kaplan-Meier test, median survival of 30.5 months, and overall survival (OS) at 1.2 and 5 years were 67.8%, 40.5%, and 16.6%, respectively. Discussion However, survival analysis results were optimistic compared to population-based studies as all patients had resectable tumors.

scholarly journals Long term prognostic implication of newly detected abnormal glucose tolerance among patients with stable cardiovascular disease: a population-based cohort study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Maryam Kabootari ◽  
Samaneh Asgari ◽  
Seyedeh Maryam Ghavam ◽  
Hengameh Abdi ◽  
Fereidoun Azizi ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Glucose Tolerance ◽  
Plasma Glucose ◽  
Population Based ◽  
World Health ◽  
Incident Diabetes ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Diabetes Status ◽  
Adjusted Model

Abstract Background Fasting plasma glucose (FPG) and 2-h post challenge plasma glucose (2 h-PCPG), whether as continuous or categorical variables, are associated with incident cardiovascular disease (CVD) and diabetes; however, their role among patients with existing CVD is a matter of debate. We aimed to evaluate associations of different glucose intolerance states with recurrent CVD and incident diabetes among subjects with previous CVD. Methods From a prospective population-based cohort, 408 Iranians aged  ≥  30 years, with history of CVD and without known diabetes were included. Associations of impaired fasting glucose (IFG) according to the American Diabetes Association (ADA) and World Health Organization (WHO) criteria, impaired glucose tolerance (IGT), newly diagnosed diabetes (NDM) with outcomes of interest were determined by multivariable Cox proportional hazard models after adjustment for traditional risk factors. Furthermore, FPG and 2 h-PCPG were entered as continuous variables. Results Over a decade of follow-up, 220 CVD events including 89 hard events (death, myocardial infarction and stroke) occurred. Regarding prediabetes, only IFG-ADA was associated with increased risk of hard CVD [hazard ratio(HR), 95%CI: 1.62,1.03–2.57] in the age-sex adjusted model. In patients with NDM, those with FPG ≥ 7 mmol/L were at higher risk of incident CVD/coronary heart disease(CHD) and their related hard outcomes (HR ranged from 1.89 to 2.84, all P < 0.05). Moreover, those with 2 h-PCPG ≥ 11.1 mmol/L had significant higher risk of CVD (1.46,1.02–2.11), CHD (1.46,1.00–2.15) and hard CHD (1.95:0.99–3.85, P = 0.05). In the fully adjusted model, each 1 SD increase in FPG was associated with 20, 27, 15 and 25% higher risk of CVD, hard CVD, CHD and hard CHD, respectively; moreover each 1 SD higher 2 h-PCPG was associated with 21% and 16% higher risk of CVD, and CHD, respectively. Among individuals free of diabetes at baseline (n = 361), IFG-ADA, IFG-WHO and IGT were significantly associated with incident diabetes (all P < 0.05); significant associations were also found for FPG and 2 h-PCPG as continuous variables (all HRs for 1-SD increase > 2, P < 0.05). Conclusions Among subjects with stable CVD, NDM whether as high FPG or 2 h-PCPG, but not pre-diabetes status was significantly associated with CVD/CHD and related hard outcomes.

scholarly journals COVID-19 associated hospitalization in 571 patients with fibromyalgia—A population-based study

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261772
Author(s):  
Mor Amital ◽  
Niv Ben-Shabat ◽  
Howard Amital ◽  
Dan Buskila ◽  
Arnon D. Cohen ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Model ◽  
Logistic Regression Model ◽  
Multivariable Analysis ◽  
Population Based ◽  
Female Dominance ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Multivariable Logistic Regression Model ◽  
Population Based Study

Objective To identify predicators of patients with fibromyalgia (FM) that are associated with a severe COVID-19 disease course. Methods We utilized the data base of the Clalit Health Services (CHS); the largest public organization in Israel, and extracted data concerning patients with FM. We matched two subjects without FM to each subject with FM by sex and age and geographic location. Baseline characteristics were evaluated by t-test for continuous variables and chi-square for categorical variables. Predictors of COVID-19 associated hospitalization were identified using univariable logistic regression model, significant variables were selected and analyzed by a multivariable logistic regression model. Results The initial cohort comprised 18,598 patients with FM and 36,985 matched controls. The mean age was 57.5± 14.5(SD), with a female dominance of 91%. Out of this cohort we extracted the study population, which included all patients contracted with COVID-19, and consisted of 571 patients with FM and 1008 controls. By multivariable analysis, the following variables were found to predict COVID-19 associated hospitalization in patients with FM: older age (OR, 1.25; CI, 1.13–1.39; p<0.001), male sex (OR, 2.63; CI, 1.18–5.88; p<0.05) and hypertension (OR, 1.75; CI, 1.04–2.95; p<0.05). Conclusion The current population-based study revealed that FM per se was not directly associated with COVID-19 hospitalization or related mortality. Yet classical risk factors endangering the general population were also relevant among patients with FM.

scholarly journals Profile of self-triage with a cellphone app for pediatric emergency patients: A population-based study in Japan (Preprint)

2021 ◽  
Author(s):  
Yusuke Katayama ◽  
Kosuke Kiyohara ◽  
Tomoya Hirose ◽  
Tasuku Matsuyama ◽  
Kenichiro Ishida ◽  
...  
Keyword(s):  
High School Students ◽  
Junior High School ◽  
Population Based ◽  
Pediatric Emergency ◽  
Mobile App ◽  
Categorical Variables ◽  
Continuous Variables ◽  
School Students ◽  
Emergency Patients ◽  
Medical Apps

BACKGROUND When children suffer sudden illness or injury, many parents wonder whether they should go to the hospital immediately or call an ambulance. In 2015, we developed a mobile app that allows parents or guardians to determine the urgency of their child’s condition or call an ambulance, and which indicates available hospitals and clinics when their child is suddenly sick or injured by simply selecting the child’s chief complaints and symptoms. However, the effectiveness of medical apps used by the general public has not been well evaluated. OBJECTIVE The purpose of this study was to reveal a profile of the use of this mobile app based on data usage in the app. METHODS This study was a descriptive epidemiological study with a 4-year study period running from January 2016 to December 2019. We included cases in which the app was used either by the children themselves or by their parents and other guardians. The cases in which the app was downloaded but never actually used were excluded from this study. Continuous variables are presented as medians and interquartile range (IQR), and categorical variables are presented as actual number and percentages. RESULTS The app was used during the study period for 59,375 children whose median age was 1 year (IQR: 0-3 years). The app was used for 33,874 (57.1%) infants, 16,228 (27.3%) toddlers, 8,102 (13.6%) elementary school students, 1117 (1.9%) junior high school students, and 54 (0.1%) were unknown. Among them, 31,519 (53.1%) were male, 27,329 (46.0%) were female, and sex was unknown for 527 (0.9%). “Sickness” was chosen for 49,101 (78.5%) patients, and “Injury, poisoning, foreign substances and others” was chosen for 13,441 (21.5%). For “Sickness”, “fever” was most commonly selected (22,773, 36.4%), followed by “cough” (4054, 6.5%) and “nausea/vomiting” (3528, 5.6%), whereas for “Injury, poisoning, foreign substances and others”, “head and neck injury” was most commonly selected (3887, 6.2%), followed “face and extremities injury” (1493, 2.4%) and “injury and foreign substances in eyes” (1255, 2.0%). CONCLUSIONS This study revealed the profile of use of a self-triage app for pediatric emergency patients in Japan.

scholarly journals Placement on COVID-19 Units Does Not Increase Seroconversion Rate of Pediatric Graduate Medical Residents

2021 ◽  
Vol 9 ◽  
Author(s):  
Timothy Crisci ◽  
Samuel Arregui ◽  
Jorge Canas ◽  
Jenaya Hooks ◽  
Melvin Chan ◽  
...  
Keyword(s):  
Seroconversion Rate ◽  
Population Based ◽  
Immunoglobulin M ◽  
Medical Residents ◽  
Categorical Variables ◽  
Fisher Exact Test ◽  
Continuous Variables ◽  
Cross Sectional ◽  
Graduate Medical ◽  
The Impact

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its associated disease COVID-19 (coronavirus disease 2019) has presented graduate medical education (GME) training programs with a unique set of challenges. One of the most pressing is how should hospital systems that rely on graduate medical residents provide appropriate care for patients while protecting trainees. This question is of particular concern as healthcare workers are at high risk of SARS-CoV-2 exposure.Objective: This cross-sectional study sought to assess the impact of hospital COVID-19 patient placement on pediatric graduate medical residents by comparing rates of SARS-CoV-2 seroconversion rates of residents who worked on designated COVID-19 teams and those who did not.Methods: Forty-four pediatric and medicine–pediatric residents at Riley Children's Hospital (Indianapolis, IN) were tested for SARS-CoV-2 immunoglobulin M (IgM) and IgG seroconversion in May 2020 using enzyme-linked immunosorbent assays (Abnova catalog no. KA5826), 2 months after the first known COVID-19 case in Indiana. These residents were divided into two groups: those residents who worked on designated COVID-19 teams, and those who did not. Groups were compared using χ2 or Fisher exact test for categorical variables, and continuous variables were compared using Student t testing.Results: Forty-four of 104 eligible residents participated in this study. Despite high rates of seroconversion, there was no difference in the risk of SARS-CoV-2 seroconversion between residents who worked on designated COVID-19 teams (26% or 8/31) and those who did not (31% or 4/13). Eleven of 44 residents (25%) tested positive for SARS-CoV-2 IgG, whereas only 5/44 (11.4%) tested positive for SARS-CoV-2 IgM, without a detectable difference between exposure groups.Conclusion: We did not observe a difference in SARS-CoV-2 seroconversion between different exposure groups. These data are consistent with growing evidence supporting the efficacy of personal protective equipment. Further population-based research on the role of children in transmitting the SARS-CoV-2 virus is needed to allow for a more evidence-based approach toward managing the COVID-19 pandemic.

scholarly journals Sudden cardiac death in cancer patients: results from the Paris-Sudden Death Expertise Centre

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Mirabel ◽  
J.S Hulot ◽  
A Lillo-Lelouet ◽  
X Jouven ◽  
E Marijon
Keyword(s):  
Sudden Cardiac Death ◽  
Cancer Patients ◽  
Cardiac Death ◽  
Univariate Analysis ◽  
Population Based ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Multiple Sources ◽  
Exact Test ◽  
Respiratory Causes

Abstract Background Sudden cardiac death (SCD) in cancer patients regardless of their therapies has not been addressed. Methods Population-based registry (2011) via multiple sources to collect every case of SCD in Paris and its suburbs, covering a population of 6.6 million. Data of SCD patients (2011–2017) were analysed by identifying patients with known cancer or past medical history of cancer. Categorical variables were compared using chi-square test or Fisher's exact test; continuous variables using Student t-test or Wilcoxon rank sum test, as appropriate. Results Of 22,570 out of hospital cardiac arrests, 3,311 SCD patients (124 cancer patients and 3,187 non cancer patients) were admitted alive to the hospital and were included in the analysis. Characteristics of patients and cardiac arrest circumstances differed on univariate analysis (Table). The final aetiology of SCD varied: more respiratory causes to SCD (pulmonary embolism and hypoxia) among cancer patients and less acute coronary artery syndromes. Conclusions SCD in cancer patients differs significantly when compared to non-cancer patients. Coronary events are less prominent whereas respiratory causes are common aetiologies in cancer. Funding Acknowledgement Type of funding source: None

scholarly journals Immunonutrition in Patients with Pancreatic Cancer Undergoing Surgical Intervention: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Nutrients ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2798
Author(s):  
Fu-An Yang ◽  
Yang-Ching Chen ◽  
Cheng Tiong
Keyword(s):  
Systematic Review ◽  
Pancreatic Cancer ◽  
Immune System ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Postoperative Outcome ◽  
Categorical Variables ◽  
Controlled Trials ◽  
Continuous Variables ◽  
Randomized Controlled

Immunonutrition is administered to improve the outcome of patients with pancreatic cancer undergoing surgery. However, its effect and mechanism of action remain unclear. Therefore, we conducted this systematic review and meta-analysis to assess its effects on postoperative outcome and the immune system. Randomized controlled trials (RCTs) were identified and data extracted by two reviewers independently from electronic databases from their inception to 31 October 2019. The result was expressed as the risk ratio (RR) for categorical variables and mean difference (MD) for continuous variables with 95% confidence intervals (CIs). Six RCTs published from 1999 and 2016, with a total of 368 patients, were included. The results revealed that immunonutrition significantly decreased the rate of infectious complications (RR = 0.47, 95% CI (0.23, 0.94), p = 0.03) and the length of hospital stay (MD = −1.90, 95% CI (−3.78, −0.02), p = 0.05) by modulating the immune system, especially in preoperative group in subgroup analysis. We therefore recommend that patients with pancreatic cancer undergoing surgery could take the advantage of immunonutrition, especially in the preoperative period.

scholarly journals Trends in survival based on treatment modality in patients with pancreatic cancer: a population-based study

2020 ◽  
Vol 27 (1) ◽  
Author(s):  
S. Shakeel ◽  
C. Finley ◽  
G. Akhtar-Danesh ◽  
H. Y. Seow ◽  
N. Akhtar-Danesh
Keyword(s):  
Pancreatic Cancer ◽  
Treatment Modality ◽  
Survival Rates ◽  
Population Based ◽  
Parametric Models ◽  
Stage I ◽  
Analysis Survival ◽  
Long Term Prognosis ◽  
Over Time

Background Pancreatic cancer (PC) is one of the most lethal types of cancer and surgery remains the most optimal treatment modality for patients with resectable tumors. The objective of this study is to examine and compare the trends in survival rate among PC patients based on treatment modality.Methods This population-based retrospective analysis included all patients with known stage for PC in Ontario, Canada between 2007 and 2015. Flexible parametric models were used to conduct survival analysis. Survival rates were calculated based on treatment modality, while adjusting for patient and tumor specific covariates.Results In total, 6437 patients were included in this study. More than half of the patients aged 80 and over received no curative treatment. The proportion of patients receiving chemoradiation decreased over time. The 1-, 2- and 5-year survival rates increased 30-40% for stage I disease and less than 15% for stage II over the study period. Noticeable increases in 1-, 2, and 5-year survival rates were observed for patients underwent for distal pancreatectomy and Whipple procedures. There were no changes in survival for stage III and IV disease from 2007 to 2015.Conclusions A majority of cases for PC continue to be diagnosed in late stage, with poor short-term and long-term prognosis. The survival for stage I tumors and surgical modalities increased over time without any evidence of changes in stage distribution. We speculate that improvements in chemotherapy modalities and adoption of quality standards for surgical resection could be attributed for the positive trends in survival.

scholarly journals Stunting and Wasting Among Children 0-59 Months of Age in Zambézia and Nampula Provinces of Mozambique: An Assessment of Population-Based Survey Results Against Global Targets

2021 ◽  
Author(s):  
Ann F. Green ◽  
Carole J. Wilson ◽  
Lazaro Gonzalez-Calvo ◽  
Leslie Pierce ◽  
Diana Quelhas ◽  
...  
Keyword(s):  
Action Plan ◽  
Population Based ◽  
Child Growth ◽  
Anthropometric Measurements ◽  
Anthropometric Measurement ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Cross Sectional ◽  
Survey Tool ◽  
Survey Results

Abstract Background: The number of undernourished children worldwide has increased by 45 million since 1990. In Mozambique, Zambézia and Nampula Provinces carry a heavy burden of infectious diseases, as well as high rates of stunting and wasting. Mozambique developed a Multisectoral Action Plan for the Reduction of Stunting (2011–2014) that aimed to reduce the national prevalence of stunting to 20% by 2020, but little is documented of its impact on childhood stunting since the 2011 DHS survey.Methods: Cross-sectional data from a population-based household-level survey was collected between February and July 2019, among heads of households ≥ 15 years of age in Zambézia and Nampula Provinces. The survey tool was a 500-item questionnaire covering domains related to household health and economics, with a special emphasis on maternal and child health, nutrition and WASH and the collection of anthropometric measurements in children 0-59 months. Children were assessed for Stunting and Wasting according to the WHO Child Growth Standards. SurveyToGo software was used for developing the data collection form, gathering data on mobile devices and sending securely to a server. Descriptive statistics were calculated for continuous variables as median with interquartile range and for categorical variables as percentages. The significance level for all testing was two-sided, set at 0.05.Results: A total of 3,937 households were included in our analysis, including anthropometric measurements of 5,423 children under five. Nearly half (45%, n=2,460) of all children assessed met the criteria for stunting, with a higher prevalence in Nampula Province (51%, n=1,180) than Zambézia Province (41%, n=1,280). Four percent of children met the criteria for wasting in both provinces with children aged 6-11-months having the highest wasting prevalence overall (7%).Conclusions: Based on survey results using highly standardized anthropometric measurement methods, these two provinces are on track to meet international 2025 targets for reduction in wasting in children under 5 years. However, stunting prevalence over time in both provinces has maintained at 40-50% with no clear evidence of decline since 2003. It is doubtful the related Sustainable Development Goal targets will be reached unless a focused multi-sectoral approach is employed and closely monitored.

scholarly journals Endoscopic ultrasonography in pancreatic carcinoma

2005 ◽  
Vol 52 (1) ◽  
pp. 65-72 ◽  
Author(s):  
D. Tomic ◽  
A.R. Pavlovic ◽  
M. Krstic ◽  
R. Jesic ◽  
G. Jankovic ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Diagnostic Method ◽  
Preoperative Evaluation ◽  
Survival Rates ◽  
Tnm Staging ◽  
Medical Centers ◽  
Common Diagnosis ◽  
The World ◽  
Before And After ◽  
Penetration Ability

Even though pancreatic cancer is not such a common diagnosis, its treatment is very expensive and it has a great economic impact to the health system. 5-year survival rates after excessive surgical treatment is only 5%, which imposes more careful selection of patients that have to be surgically treated. According to experience from some medical centers all over the world, EUS is considered as a high sensitive diagnostic method for establishing a diagnosis of pancreatic cancer and evaluation of TNM staging. The main purpose of this survey is to present our experience in using of EUS as a diagnostic method in establishing a diagnosis of pancreatic cancer, as well as to evaluate how reliable this method is in preoperative evaluation if tumor could be successfully resected. We examined the group of 63 patients with pancreatic cancer, which were surgically explored after EUS examination. We wanted to compare TNM status before and after the penetration ability of the probe working with the frequency of 7,5 MHz, EUS is not a suitable method for evaluation of M stage (figure 8,9). Patients were divided in different groups, specified by TNM status. For 10 patients resection was estimated as a probably successful solution, but only 8 of them was surgically treated. According to this, our estimation was 79,7% accurate, which is in accordance to results obtained from other medical centers all over the world.

Carcinoids and High-Grade Neuroendocrine Carcinomas of the Ampulla of Vater: A Comparative Analysis of 139 Cases From the Surveillance, Epidemiology, and End Results Program—A Population Based Study

2010 ◽  
Vol 134 (11) ◽  
pp. 1692-1696 ◽  
Author(s):  
Jorge Albores-Saavedra ◽  
Alexandra Hart ◽  
Fredy Chablé-Montero ◽  
Donald E. Henson
Keyword(s):  
Survival Rates ◽  
Relative Survival ◽  
Large Cell ◽  
Ampulla Of Vater ◽  
Population Based ◽  
Carcinoid Tumors ◽  
Malignant Neoplasms ◽  
High Grade ◽  
Neuroendocrine Carcinomas ◽  
End Results

Abstract Context.—Neuroendocrine tumors of the ampulla of Vater constitute a heterogeneous group of neoplasms clinically and morphologically. Because they are rare, little is known about their demographics and biologic behavior. Objective.—To analyze the demographics and the 5- and 10-year relative survival rates of 139 patients with carcinoid tumors and high-grade neuroendocrine carcinomas of the ampulla. Design.—Using data from National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program from 1973 to 2006, we analyzed the demographics, morphology, and survival of patients with carcinoids and neuroendocrine carcinomas of the ampulla. Results.—SEER recorded 6081 cases of malignant neoplasms of the ampulla, of which 82 were carcinoid tumors and 57 were high-grade neuroendocrine carcinomas. Of these 57, 42 were neuroendocrine carcinomas, not otherwise specified; 9 were small cell carcinomas; and 6 were large cell neuroendocrine carcinomas. The incidence was higher in men than in women. Patients with carcinoid tumors were younger (mean age, 61.6 years) than those with high-grade neuroendocrine carcinomas (mean age, 67.5 years). Carcinoid tumors were smaller than high-grade neuroendocrine carcinomas. The frequency of lymph node metastasis was 28.5% for carcinoid tumors and 62% for high-grade neuroendocrine carcinomas. The 5- and 10-year relative survival rates of patients with carcinoid tumors were 82% and 71%, respectively. The 5- and 10-year relative survival rate of patients with high-grade neuroendocrine carcinomas was 15.7%. Conclusions.—Carcinoids of the ampulla of Vater are relatively rare. Carcinoids and high-grade neuroendocrine carcinomas of the ampulla are biologically and clinically similar to these tumors arising in other sites. Carcinoids were smaller and metastasized less frequently than high-grade neuroendocrine carcinomas.

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