Diagnostic and prognostic factors in patients with prostate cancer: a systematic review

OBJECTIVES

As part of the PIONEER Consortium objectives, we have explored which diagnostic and prognostic factors (DPFs) are available in relation to our previously defined clinician and patient-reported outcomes for prostate cancer (PCa).

DESIGN

We performed a systematic review to identify validated and non-validated studies.

DATA SOURCES

MEDLINE, Embase and the Cochrane Library were searched on 21 January 2020.

ELIGIBILITY CRITERIA

Only quantitative studies were included. Single studies with fewer than 50 participants, published before 2014 and looking at outcomes which are not prioritised in the PIONEER core outcome set were excluded.

DATA EXTRACTION AND SYNTHESIS

After initial screening, we extracted data following the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of prognostic factor studies (CHARMS-PF) criteria and discussed the identified factors with a multidisciplinary expert group. The quality of the included papers was scored for applicability and risk of bias using validated tools such as PROBAST, Quality in Prognostic Studies and Quality Assessment of Diagnostic Accuracy Studies 2.

RESULTS

The search identified 6604 studies, from which 489 DPFs were included. Sixty-four of those were internally or externally validated. However, only three studies on diagnostic and seven studies on prognostic factors had a low risk of bias and a low risk concerning applicability.

CONCLUSION

Most of the DPFs identified require additional evaluation and validation in properly designed studies before they can be recommended for use in clinical practice. The PIONEER online search tool for DPFs for PCa will enable researchers to understand the quality of the current research and help them design future studies.

ETHICS AND DISSEMINATION

There are no ethical implications.

A comprehensive review on the documented characteristics of four Reticulitermes termites (Rhinotermitidae, Blattodea) of China

Termites are known as social insects worldwide. Presently in China 473 species, 44 genera and 4 families of termites have been reported. Of them, 111 Reticulitermes species are widely spread in different zones of China. The dispersion flight season of these Chinese Reticulitermes species are usually started from February to June, but in some regions different species are distributed, sharing their boundaries and having overlapping flight seasons. These reasons become important sources of hybridization between two different heterospecific populations of termites. It was confirmed that the fertilized eggs and unfertilized eggs of some Reticulitermes termites have the capacity of cleavage. While the unfertilized eggs of R. aculabialis, R. chinensis and R. labralis cleaved normally and the only R. aculabialis unfertilized eggs develop in embryos. While, the R. flaviceps and R. chinensis were observed with their abnormal embryonic development, and not hatching of eggs parthenogenetically. They were reported more threatening to Chinese resources as they propagate with parthenogenesis, hybridization and sexual reproduction. Eggshell and macrophiles of eggs play important roles in species identification and control. Although, they are severe pests and cause a wide range of damages to wooden structures and products in homes, buildings, building materials, trees, crops, and forests in China's Mainland.

Can Patient Cooperation During Biometry Be A Predictor of The Type of Anesthesia For Phacoemulsification Cataract Surgery

Objective: To assess any association between the cooperation of patients during biometry and cataract surgery by phacoemulsification in order to predict the type of anesthesia for the subject surgery. Study Design: Cross-sectional study. Place and Duration of Study: Eye Department, Combined Military Hospital, Multan Pakistan, from Jan to Dec 2019. Methodology: A total of 332 patients requiring cataract surgery by phacoemulsification were recruited from the Eye department of Combined Military Hospital Multan. Patient cooperation level was measured during A-scan biometry. The cooperation level of same patient, assessed during biometry was used to plan the type of anesthesia to be administered during cataract surgery by phacoemulsification. Results: There were 209 male and 122 female patients with the mean age of 65.14 ± 0.57 years. A significant association was found between the cooperation of patient during biometry and cataract surgery by phacoemulsification appointments (p=0.02). A significant proportion of the patients 162 (81.4%) maintained their good cooperation during surgery. Out of the 133 patients, exhibiting poor cooperation during biometry procedure, 88 (66.3%) showed an improvement in their status by having good cooperation in surgery procedure. Conclusion: In the light of favorable clinical observation, the cooperation of the patients at the biometry procedure may be considered as a significant predictor of the type of anesthesia to be administered during cataract surgery by phacoemulsification.

Revisiting the energy-economy-environment relationships for attaining environmental sustainability: evidence from Belt and Road Initiative countries

The Belt and Road Initiative (BRI) is an ambitious development project initiated by the Chinese government to foster economic progress worldwide. In this regard, this study aims to investigate the dynamics of energy, economy, and environment among 42 BRI developing countries using an annual frequency panel dataset from 1995 to 2019. The major findings from the econometric analyses revealed that higher levels of energy consumption, economic growth, population growth rate, and FDI inflows exhibit adverse environmental consequences by boosting the CO₂ emission figures of the selected developing BRI member nations. However, it is interesting to observe that exploiting renewable energy sources, which are relatively cleaner compared to the traditionally-consumed fossil fuels, and fostering agricultural sector development can significantly improve environmental well-being by curbing the emission levels further. On the other hand, financial development is found to be ineffective in explaining the variations in the CO₂ emission figures of the selected countries. Besides, the causality analysis shows that higher energy consumption, FDI inflows, and agricultural development cause environmental pollution by boosting CO₂ emissions. However, economic growth, technology development, financial progress, and renewable energy consumption are evidenced to exhibit bidirectional causal associations with CO₂ emissions. In line with these findings, several relevant policies can be recommended for the BRI to be environmentally sustainable.

Ethnomedicinal and traditional uses of the Ferns of Khyber Pakhtunkhwa, Pakistan

Ferns are often used by indigenous people in Khyber Pakhtunkhwa, Pakistan. This study was designed to collect the ethnomedicinal and traditional knowledge of these locals about this group of vascular plants. Forty taxa belong to nineteen genera and ten families are used in the treatment of different diseases. The Pteridaceae was the most representative family with twelve taxa (30%), followed by Athyriaceae and Dryopteridaceae with six taxa each (30%), and Thelypteridaceae with five taxa (12.5%). Regarding the genera, Adiantum, Asplenium and Dryopteris ranked first with four taxa each (30%), followed by Aleuritopteris, Diplazium, Pteris and Equisetum with three taxa each (30%), followed by Athyrium, Oeosporangium, Polystichum and Pseudophegopteris with two taxa each (20%). These taxa were commonly used in the treatment of respiratory disorders i.e. asthma, bronchitis, emphysema, pneumonia; intestinal ulcer, stomach, urinary ailments and skin disorders by the methods of decoction and infusion. Traditional knowledge about ethnomedicinal plants is a valuable and essential source for the discovery of allopathic, herbal and homeopathic medicines.

Energy consumption, economic growth, and environmental sustainability challenges for Belt and Road countries: a fresh insight from "Chinese Going Global Strategy"

The present study investigated the impact of energy- and economy-related variables on CO2 emissions in 49 countries of the Belt and Road Initiative from 1995-2018. The robust type of cross-section dependence and heterogeneity methods was adopted to analyze data set of countries. Energy consumption, foreign direct investment, medium and high-tech industry, and GDP have been found highly unfavorable for the ecological health (CO2 emissions) in 49 nations on BRI panel. However, renewable energy consumption has been found in positive correlation with environmental quality (CO2). Financial development indicator has no significant impact on CO2 emissions in present study. The present outcomes clearly claim strong relationship of economic growth and energy with increased CO2 emissions in 49 nations. Therefore, it is important for policy makers, experts, and governments to incentivize and appreciate portfolio investors for sustainable green investments to transform the economic growth into a sustainable and energy efficient development.

THE ASSOCIATION OF CATARACT TYPE ON CENTRAL CORNEAL THICKNESS AFTER PHACOEMULSIFICATION CATARACT SURGERY

Objective: To assess any association between the type of cataract and the central corneal thickness at pre-operative and postoperative three-day and one-month appointments after phacoemulsification surgery. Study Design: Prospective, comparative study. Place and Duration of Study: Eye Department Combined Military Hospital Multan, from Jun 2020 to Apr 2021. Methodology: A total of 89 patients requiring cataract surgery by phacoemulsification were recruited. Age and gender were recorded for each patient. Patient’s type of cataract based on maturity was recorded before the surgery. Phacoemulsification cataract surgery using ‘divide and conquer’ technique was carried out. Patients’ central corneal thickness was measured at the pre-operative, three-day post-operative and one-month post-operative appointment using traditional non-contact tonopachymeter. Results: There were 49 (55.1%) male and 40 (44.9%) female patients with a mean age of 62.15 ± 12.40 years. No significant association was found between the type of cataract and central corneal thickness at the three-time intervals (p=0.14). Central corneal thickness significantly increased from 0.48 ± 0.04 mm pre-operatively to 0.51 ± 0.04 mm at the three-day post-operative appointment (p<0.001). It then reduced to 0.49 ± 0.04 mm at the one-month appointment (p=0.01). Conclusion: The type of cataract is not associated with the variation in central corneal thickness due to cataract surgery. Central corneal thickness significantly increases from the pre-operative to right after the cataract surgery. However, it returns to preoperative levels after a one-month period.

COVID-19 related multisystem inflammatory syndrome in children (MIS-C): a hospital-based prospective cohort study from Kerala, India

Objectives

To study (1) epidemiological factors, clinical profile and outcomes of COVID-19 related multisystem inflammatory syndrome in children (MIS-C), (2) clinical profile across age groups, (3) medium-term outcomes and (4) parameters associated with disease severity.

Design

Hospital-based prospective cohort study.

Setting

Two tertiary care centres in Kerala, India.

Participants

Diagnosed patients of MIS-C using the case definition of Centres for Disease Control and Prevention.

Statistical analysis

Pearson χ2 test or Fisher's exact test was used to compare the categorical variables and independent sample t-test or Mann-Whitney test was used to compare the continuous variables between the subgroups categorised by the requirement of mechanical ventilation. Bonferroni's correction was used for multiple comparisons.

Results

We report 41 patients with MIS-C, mean age was 6.2 (4.0) years, and 33 (80%) were previously healthy. Echocardiogram was abnormal in 23 (56%), and coronary abnormalities were noted in 15 (37%) patients. Immunomodulatory therapy was administered to 39 (95%), steroids and IVIg both were used in 35 (85%) and only steroids in 3 (7%) patients. Intensive care was required in 36 (88%), mechanical ventilation in 8 (20%), inotropic support in 21 (51%), and 2 (5%) patients died. Mechanical ventilation requirement in MIS-C was associated with hyperferritinaemia (p=0.001). Thirty-seven patients completed 3 months follow-up by April 2021, of whom 6 (16%) patients had some residual echocardiographic changes.

Conclusions

Patients with MIS-C in our cohort had varied clinical manifestations ranging from fever with mild gastrointestinal and mucocutaneous involvement to fatal multiorgan dysfunction. Immediate and medium-term outcomes remain largely excellent except for the echocardiographic sequelae in a few patients which are also showing a resolving trend. Hyperferritinaemia was associated with the requirement of mechanical ventilation.

1242 A Surfacing Staghorn: Spontaneous Expulsion of a Large Renal Calculus from A Nephrocutaneous Fistula

An 83-year-old lady presented to the urology department with right flank pain in the context of a previously known right renal staghorn calculus. On examination, she was found to have a visible discharging sinus in her right flank, and the renal calculus had become visible at the skin surface. Non-contrast CT imaging confirmed that her staghorn calculus had eroded through the skin via a nephrocutaneous fistula. The stone was manually extracted percutaneously on the ward, and she was treated with intravenous antibiotics. She subsequently passed a further stone through the tract and made a good recovery.

This is a highly unusual presentation of nephrolithiasis in a developed country in the 21st century. Review of the literature suggests that surgical management is almost always indicated in patients with staghorn calculi. However surgical management options are not without risk and conservative management of staghorn disease may be appropriate in select patient groups: those with multiple co-morbidities at high risk for GA, in cases of patient refusal of surgery, or in patients with aberrant anatomical factors

Our case highlights a potential complication of conservatively managed staghorn stone disease. To our knowledge our case is the first of spontaneous expulsion of renal stone of this size to be reported in the developed world.

Traditional knowledge about medicinal plant in the remote areas of Wari Tehsil, Dir Upper, Pakistan

Traditional medicine is cheaper and easily available to local people, to care for most frequent diseases in the Northern parts of Pakistan. Our study aimed at inventorying medicine from local plants, documenting their uses, and assessing their market value in 2015-2018 during spring, summer, and winter seasons. A total of 15 trips were made, 5 in each season. Semi-structured interviews with 165 inhabitant's age range between 20-80 years were conducted, analyzed the data is analyzed using Relative frequency of citation(RFC), Use Value(UV), Fidelity Level(FL), Informants consensus factor(ICF), and Jaccard index(JI) to find the most frequent and well-known used species in the area. A total of 86 species belonging to 39 vascular plant families, 33 genera were documented as medicinally important. Family Asteraceae was observed as the dominant family among all the families with 10 species, the leaf was the most used parts and decoction 36% was the most preferred preparation type. Herb was the predominant life form (67%). The maximum UV (0.92) was demonstrated by J. adhatoda L. species, while A. sativum L. shows maximum RFC (0.58), the highest ICF value represented by diarrhea and dermatitis 0.92, and high FL value is recorded 100%. According to our collections, wild species were 45%, invasive species were 38% and cultivated 17% recorded, dicots species were recorded more 81%. Seven 7 medicinal species is being economically important and export to the local and international market of the world, whereas P. integrima L. species were the most exported species according to the local dealers. The investigated area is rural and the local people depend on the area's plants for their health needs, and other uses like a vegetable, fuelwood, fodder, etc. The current result of RFC, UV, ICF, FL, and JI shows that medicinal flora needs to be pharmacologically and phytochemically investigated to prove their efficacy. The documentation of medicinal knowledge is important to preserve this precious old knowledge before it is lost forever, due to technological and environmental changes in the world.

Asymmetric impact of temperature on COVID-19 spread in India: Evidence from quantile-on-quantile regression approach

The emergence of new coronavirus (SARS-CoV-2) has become a significant public health issue worldwide. Some researchers have identified a positive link between temperature and COVID-19 cases. However, no detailed research has highlighted the impact of temperature on COVID-19 spread in India. This study aims to fill this research gap by investigating the impact of temperature on COVID-19 spread in the five most affected Indian states. Quantile-on-Quantile regression (QQR) approach is employed to examine in what manner the quantiles of temperature influence the quantiles of COVID-19 cases. Empirical results confirm an asymmetric and heterogenous impact of temperature on COVID-19 spread across lower and higher quantiles of both variables. The results indicate a significant positive impact of temperature on COVID-19 spread in the three Indian states (Maharashtra, Andhra Pradesh, and Karnataka), predominantly in both low and high quantiles. Whereas, the other two states (Tamil Nadu and Uttar Pradesh) exhibit a mixed trend, as the lower quantiles in both states have a negative effect. However, this negative effect becomes weak at middle and higher quantiles. These research findings offer valuable policy recommendations.

Frequency of subclinical hypothyroidism in chronic kidney disease patients

Objective: Objective of this study was to determine the frequency of sub clinical hypothyroidism among chronic kidney disease patients in our population. Study Design: Descriptive Cross sectional study. Settings: Department of Nephrology, Khyber Teaching Hospital Peshawar. Period: February 2018 to September 2018. Material & Methods: A total of 145 chronic kidney disease patients were included in this study. Thyroid function tests (TFT, s) were performed in all patients along with history and clinical examination. Sub clinical hypothyroidism was defined as high TSH (normal value 0.27-4.0 µIU/ml) and normal Free T47. (0.93 – 1.70 ng/dl). Results: Our study shows that Mean age was 55 years with standard deviation ± 2.83. Eighty seven (60%) patients were male and 58(40%) patients were female. Moreover, 25% patients had subclinical hypothyroidism. Conclusion: Our study concludes that the incidence of subclinical hypothyroidism in chronic kidney disease was found to be 25% in our population.

Is IS PSEUDOEXFOLIATION A SIGNIFICANT RISK FACTOR FOR GLAUCOMA? A CROSSSECTIONAL ANALYSIS OF A PAKISTANI POPULATION

Objective: To determine the association between pseudoexfoliation and glaucoma. Study Design: Cross-sectional analytical study. Place and Duration of Study: Eye Outpatient department of Combined Military Hospital, Multan from Jan to Dec 2019. Methodology: A total of 170 patients reporting to the eye outpatient department were examined for the presence of Pseudoexfoliation and glaucoma based on raised intraocular pressure >21mm Hg, increased cup disc ratio and visual field defects. Therefore, a total of 340 eyes were examined. Results: Out of a total of 252 eyes with pseudoexfoliation, 40 (15.9%) had glaucoma. This frequency of glaucoma was significantly higher in eyes with pseudoexfoliation 87 (98.9%), in comparison to eyes without pseudoexfoliation 1 (1.1%); p<0.01). Conclusion: Pseudoexfoliation was found to be strongly associated with glaucoma.

Upper tract imaging modality to investigate haematuria: cancer detection rates and changing guidelines

Background

To assess the imaging modalities used to investigate both visible haematuria and non-visible haematuria along with their detection rate of malignancy at two hospitals and the corresponding radiological workload produced.

Methods

A retrospective study was conducted across two hospitals. All CT urograms and ultrasound scans investigating haematuria in the outpatient setting over a 12-month period were evaluated.

Results

The detection rate for upper tract urothelial cancer with visible haematuria was 0.97% and for renal cell carcinoma was 0.64%. Of all the CT urograms performed for non-visible haematuria 4.9% had suspicious findings but none of these represents an underlying malignancy. Of all the ultrasound scans performed for either visible or non-visible haematuria, none were shown to have an underlying malignancy. The detection rate was thus zero for an upper tract urinary cancer or renal cell carcinoma in the non-visible haematuria group. A CT urogram was performed in 27% and 67% of cases in each respective hospital to further investigate non-visible haematuria. CT urography makes up 2.3% and 5.2% of each hospitals overall respective workload in the CT department. CT urography to investigate non-visible haematuria could be replaced by ultrasound in low-risk patients.

Conclusions

Radiological investigations are a limited resource and better rationalisation of upper tract imaging is needed in the setting of haematuria. Risk stratification of patients would be of benefit to help prevent a significant delay in timely diagnostics for higher risk individuals presenting with haematuria.

Comparative analysis of revascularization with percutaneous coronary intervention versus coronary artery bypass surgery for patients with end-stage renal disease: a nationwide inpatient sample database

BACKGROUND

The role of percutaneous coronary intervention (PCI) vs coronary artery bypass grafting (CABG) in patients with coronary artery disease (CAD) and concomitant end-stage renal disease (ESRD) remains unknown.

RESEARCH DESIGN & METHODS

The National Inpatient Sample (NIS) (2002-2017) was queried to identify all cases of CAD and ESRD. The relative merits of PCI vs CABG were determined using a propensity-matched multivariate logistic regression model. Adjusted odds ratios (aOR) for mortality and other in-hospital complications were calculated.

RESULTS

A total of 350,623 [CABG = 112,099 (32%) and PCI = 238,524 (68%)] hospitalizations were included in the analysis. The overall adjusted odds for major bleeding (aOR 1.28, 95% CI 1.25-1.31, P < 0.0001), post-procedure bleeding (aOR 5.19, 95% CI 4.93-5.47, P < 0.0001), sepsis (aOR 1.29, 95% CI 1.26-1.33, P < 0.0001), cardiogenic shock (aOR 1.23, 95% CI 1.20-1.26, P < 0.0001), and in-hospital mortality (aOR 1.65, 95% CI 1.61-1.69, P < 0.0001) were significantly higher for patients undergoing CABG compared with PCI. The need for intra-aortic balloon pump (IABP) placement (aOR 2.52, 95% CI 2.45-2.59, P < 0.001) was higher in the CABG group, while the adjusted odds of vascular complications were similar between the two groups (aOR 0.99, 95% CI 0.94-1.06, P = 0.82). As expected, patients undergoing CABG had a higher mean length of stay and mean cost of hospitalization.

CONCLUSION

CABG in ESRD may be associated with higher in-hospital complications, increased length of stay, and higher resource utilization.

A secure key dependent dynamic substitution method for symmetric cryptosystems

The biggest challenge for symmetric cryptosystems is to replace their static substitution with dynamic substitution, because static substitution S-boxes make the symmetric block ciphers more vulnerable to attacks. Previous well-known dynamic key-dependent S-boxes are lacking in dynamicity and do not provide optimal security for symmetric block ciphers. Therefore, this research aims to contribute an effective and secure method for designing key-dependent dynamic S-box with dynamic permutations to make the symmetric block ciphers optimally secure. The proposed S-box method has been experimentally evaluated through several measures such as bit independence criteria, non-linearity, hamming distance, balanced output, strict avalanche criteria including differential and linear approximation probabilities. Moreover, the randomness properties of proposed method have also been evaluated through several standard statistical tests as recommended by the National Institute of Standards and Technology (NIST). Thus, the results show that the proposed method, not only retains effective randomness properties but it also contains, good avalanche effect (up to 62.32%) which is significantly improved than others. Therefore, the proposed substitution method is highly sensitive to the secret key because, only a single bit change in key generates an entirely new S-box with all 256 values at different positions. Thus, the overall evaluation shows that the proposed substitution method is optimally secure and outperforming as compared to the existing S-box techniques. In future, the proposed method can be extended for different key sizes (192-256 bits) or even more.