TP53 Intronic Polymorphisms and Risk of Esophageal Cancer in Southern Thai Population

Objective: The study aimed to determine the frequency of intron 3 16 base pair (bp) duplication polymorphism and intron 6 G to C substitution (G>C) of the TP53 gene and to evaluate the association these two intronic variants with the risk of esophageal cancer (EC).Material and Methods: A case-control study was conducted to evaluate the frequency and association of cancer. Cases were patients with squamous cell carcinoma of esophagus and controls were age and sex-matched non-cancer patients. Blood samples were also obtained from healthy blood donors. Polymerase chain reaction (PCR) was used to detect intron 3 16 bp duplication and PCR-restriction fragment length polymorphism was applied to detect intron 6 G>C. Logistic regression was used for the analysis.Results: Heterozygous intron 3 16 bp duplication (Del/Ins) was found in 10.1% (31/308) of blood donors, 9.3% (28/302) of controls and 8.6% (26/301) of EC cases. Intron 6 G>C was found in 0.3% (1/308) of blood donors, in 2.6% (8/310) of controls and 3.9% (12/307) of EC cases. Both variants displayed no significant association with risk of esophageal cancer (odd ratio (OR) = 1.16 [95% confidence interval (CI) = 0.64–2.11] for intron 3 16 bp duplication and OR = 0.81 [95% CI = 0.47-4.61] for intron 6 G>C.Conclusion: Southern Thai population have low frequency of intron 3 16 bp duplication polymorphism and intron 6 G>C variant, both of which are not likely to be associated with esophageal cancer susceptibility.

PD-1/PD-L1 Immune Checkpoint Inhibitors after Platinum-based Chemotherapy in Metastatic or Locally Advanced Urothelial Bladder Carcinoma: A Systematic Review and Meta-analysis

Objective: This study aimed to assess the effect of anti-programmed cell death-1/programmed cell death-ligand-1 (PD-1/PD-L1) agents compared with second-line therapy in patients with metastatic or locally advanced urothelial bladder carcinoma following previous platinum-containing chemotherapy.Material and Methods: We systematically searched three electronic databases. The protocol of the study was registered in Prospero (CRD42019142494). Using the Grading of Recommendations Assessment, Development, and Evaluation approach, the certainty of evidence (CoE) was estimated.Results: The search results initially found 8168 publications. For qualitative synthesis, two publications were included. Pooled results indicated that patients treated with anti-PD-1/PD-L1 agents had significantly prolonged overall survival (hazard ratio (HR) 0.80; 95% confidence interval (CI) 0.7-0.9; I2 21.0%; moderate CoE). According to positive PD-L1 expression, PD-1/PD-L1 inhibitors had significantly more survival than chemotherapy (HR 0.75; 95% CI 0.5-0.9, I2 57.0%, low CoE). Furthermore, there was no significant difference in adverse events (AE) between the anti-PD-1/PDL1 agents and second-line chemotherapy (risk ratio 0.68; 95% CI 0.3-1.4; I2 97.0%, low CoE).Conclusion: The present meta-analysis and systematic review provide strong evidence that anti-PD-1/PD-L1 agents could improve overall survival and have similar results in AEs compared with second-line chemotherapy. Further studies will confirm the power of immunotherapy for the treatment of metastatic or locally advanced urothelial bladder carcinoma.

Laparoscopic Treatment of Annular Pancreas Causing Duodenal Obstruction in an Adult: A Case Report

Annular pancreas is a rare congenital anomaly characterized by the presence of a pancreatic tissue of variable amount which completely or partially obstructs the second part of duodenum. It usually affects infancy, but in adulthood it can mimic a wide range of clinical entity. Gastrojejunostomy or duodenojejunostomy are common operations in adults because the duodenum is less mobile. We report a case of annular pancreas in a 60-year-old male that presented with clinical condition of gastric outlet obstruction and was successfully treated with a laparoscopic Roux-en-Y gastrojejunostomy.

Effect of Installation of Alcohol Gel Dispensers and Behavioral Nudges on Behavioral Drivers for Hand Hygiene: A Quasi-Experimental Study at a Tertiary Hospital during the COVID-19 Pandemic

Objective: To compare the level of hand hygiene behavioral drivers before and after installation of alcohol gel dispensers and behavioral nudges among outpatients and visitors at a tertiary hospital in Thailand during the coronavirus disease 2019 (COVID-19) pandemic.Material and Methods: A quasi-experimental study was conducted among outpatients and visitors in June 2020. We installed 12 alcohol gel dispensers with signs serving as behavioral nudges at a tertiary hospital in the Internal Medicine Outpatient Department (OPD), Surgery OPD, and the Pharmacy. We trained enumerators to interview outpatients and visitors regarding their behavioral drivers (beliefs about COVID-19 and hand hygiene based on the health belief model, plus handwashing social norms). We analyzed data using descriptive statistics.Results: Enumerators recruited 206 participants in the pre-intervention phase (refusal rate = 37.6%) and 219 participants in the post-intervention phase (refusal rate = 32.2%). There were significant differences between the pre-intervention and post-intervention phases with regard to self-efficacy for hand hygiene (92.0% vs. 100%, respectively), perceived lack of barriers to hand hygiene with alcohol (93.2% vs. 98.2%, respectively), and the proportion of participants who reported that hand hygiene had become a habit (7.5 vs. 18.8%, respectively). Reports of other domains of health beliefs (perceived severity of COVID-19, perceived benefits of handwashing) were homogeneous in both periods.Conclusion: We found differences in perceived lack of barriers and reported habit of hand hygiene but while self-efficacy was homogeneous in both periods. Issues regarding selection bias, construct validity, and generalizability may limit the usefulness of the study data. Caveats should be considered in the interpretation of the study findings.

Caregiver and Palliative Care

Palliative care aims to improve the quality of life of both the palliative care patient and their caregiver. Palliative care caregivers care for palliative care patients who suffer from symptoms and unmet needs. Most reviews and research to date have focused on the palliative patient, also called the care recipient. However, we still have little knowledge about the palliative care caregivers, including the risk factors of these caregivers becoming overburdened leading to caregiver burnout. The objective of this review was to examine the responsibilities of palliative care caregivers and the associated risks of these caregivers developing caregiver burden. We review the caring work of the caregivers, the types of caregivers, the differences between palliative care and general caregivers, the different types and levels of problems they face in caring for their patients and the risk factors of developing palliative care caregiver burden. We hope this review will increase awareness of this problem and help to improve the palliative care system to look after the needs of not only the patients in the system but also the patients’ caregivers, who play such an important role.

Postpartum Pap Smear Results in Women with Abnormal Pap Smears Detected at First Antenatal Care: A Retrospective Study in a Songklanagarind Hospital

Objective: To assess the remission rate at postpartum periods of abnormal Pap smears during pregnancy, and to identify the demographic and clinical characteristics of pregnant women with abnormal Pap smears.Material and Methods: Pregnant women, who had antenatal care (ANC) in Songklanagarind Hospital in period of January 2011 to December 2019, were identified retrospectively. Exclusion criteria included inaccessible results of Pap smears during pregnancy and postpartum periods. Medical records of all pregnant women with abnormal Pap smears were reviewed. The association between Pap smear results during pregnancy and postpartum were analyzed by Cramer’s V statistic ranging from 0 to 1, with a 1 indicating perfect association.Results: Of these 8,238 pregnant women had available Pap smear results, 109 (1.3%) women were shown with abnormal results. The most common of abnormality from Pap smears were atypical squamous cells of undetermined significance. In postpartum period, 50 women who had abnormal Pap smear during pregnancy, underwent postpartum follow-up examination at six weeks postpartum, respectively. The majority of results (84.0%) were normal whilst rate of remission occurred in 45 women (90.0%). The association of Pap smears between during pregnancy and postpartum was shown to have a small association (Cramer’s V = 0.2).Conclusion: There was low prevalence of abnormal Pap smear during pregnancy and high remission rate at postpartum. However, health care providers should be aware of cervical cancer screening in all pregnant women, because many women had not undergone cervical cancer screening before pregnancy.

Measuring Pain Intensity in Elderly Patients

Pain intensity is considered as the fifth vital sign. However, it is the only vital sign which is subjective, with there being many pain measurement tools for adults to rate their level of pain. Additionally, there is an increasing number of aging populations throughout the world, and pain measurement in this group of people is challenging as geriatrics have both physical and cognitive impairment. The most frequently utilized pain measurement tools are; the Visual Analogue Scale (VAS), Verbal Rating Scale (VRS), Numerical Rating Scale (NRS); and faces scales [Faces Pain Scale (FPS) and Faces Pain Scale-Revised (FPS-R) are the faces scales studied most often] tend to be valid for measuring pain severity in cognitively intact elderly. When problems arise, the VAS is the pain measurement tool found to have more difficulties (including higher rates of failure) than the other tools. In elderly with cognitive deficits, fewer difficulties tend to occur as the tools become simpler, with the most valid and useful tools in the following order: the FPS/FPS-R, the VRS, the 0-10 NRS, and the VAS. Furthermore, simpler pain measurement tools tend to be favored over more complicated tools. Keywords: aging; elderly; geriatrics; older; pain measurement; pain measurement tools