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Keogh RH, Van Geloven N. Prediction Under Interventions: Evaluation of Counterfactual Performance Using Longitudinal Observational Data. Epidemiology 2024; 35:329-339. [PMID: 38630508 DOI: 10.1097/ede.0000000000001713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Predictions under interventions are estimates of what a person's risk of an outcome would be if they were to follow a particular treatment strategy, given their individual characteristics. Such predictions can give important input to medical decision-making. However, evaluating the predictive performance of interventional predictions is challenging. Standard ways of evaluating predictive performance do not apply when using observational data, because prediction under interventions involves obtaining predictions of the outcome under conditions that are different from those that are observed for a subset of individuals in the validation dataset. This work describes methods for evaluating counterfactual performance of predictions under interventions for time-to-event outcomes. This means we aim to assess how well predictions would match the validation data if all individuals had followed the treatment strategy under which predictions are made. We focus on counterfactual performance evaluation using longitudinal observational data, and under treatment strategies that involve sustaining a particular treatment regime over time. We introduce an estimation approach using artificial censoring and inverse probability weighting that involves creating a validation dataset mimicking the treatment strategy under which predictions are made. We extend measures of calibration, discrimination (c-index and cumulative/dynamic AUCt) and overall prediction error (Brier score) to allow assessment of counterfactual performance. The methods are evaluated using a simulation study, including scenarios in which the methods should detect poor performance. Applying our methods in the context of liver transplantation shows that our procedure allows quantification of the performance of predictions supporting crucial decisions on organ allocation.
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Affiliation(s)
- Ruth H Keogh
- From the Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nan Van Geloven
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
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Martins JO, Borges MM, Malta CE, Guerra JM, Crispim AA, Coelho BC, Silva LF, Silva PG. Risk factors for oral mucositis in patients with solid tumors under treatment with cetuximab: a retrospective cross-sectional study. Med Oral Patol Oral Cir Bucal 2024; 29:e248-e254. [PMID: 37992137 PMCID: PMC10945870 DOI: 10.4317/medoral.26237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/23/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND This study retrospectively analyzed the risk factors for oral mucositis (OM) during cetuximab treatment. MATERIAL AND METHODS We screened patients using cetuximab and retrospectively evaluated the presence of OM based on medical records. We collected information from 2 years of evaluations. Patient medical records were reviewed to obtain data on chemotherapy cycle and dose, sex, age, primary tumor, TNM stage, and head and neck radiotherapy (HNR) history. The X2 test and multinomial logistic regression were used for statistical analysis (SPSS 20.0, p < 0.05). RESULTS Among 1831 patients, OM was showed in 750 in any grade (41%), during cetuximab treatment. Most patients were female (n=944, 51.6%), <70years-old (n=1149, 62.8%), had larynx cancer (n=789, 43.1%) in T4 (n=579, 47.7%), N0 (n=509, 52.6%) stages. Primary tumor surgery was performed in 1476 (80.6%) patients, radiotherapy in 606 (33.1%) patients and cetuximab protocols most used involved up to four cycles (n=1072, 58.5%) of <400mg (n=996, 54.4%) cetuximab doses. Female (OR [odds ratio] = 2.17, CI95% = 1.26-3.75), >70 years-old patients (OR = 16.02, CI95% = 11.99-21.41), with HHNR (OR = 1.84, 1.41-2.40), treated with >4 cycles (OR = 1.52, CI95% = 1.16-2.01) and high doses of cetuximab (OR = 3.80, CI95% = 2.52-5.71) are the greatest risk factors for OM. CONCLUSIONS Since the clinical benefit of cetuximab in the treatment of older patients is limited and there is a high OM, especially in women with head and neck treated with radiotherapy, high doses and a high number of cetuximab cycles must be administered with caution.
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Affiliation(s)
- J-O Martins
- Department of Dental Clinic, Faculty of Pharmacy Dentistry and Nursing Federal University of Ceará Rua Monsenhor Furtado, S/N, Rodolfo Teófilo CE, 60430-355, Fortaleza, CE, Brazil
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Zheng J, Huang Y, He J, Zhou H, Liu T, Huang J, Shi M, Zhao Y, Fang W, Yang Y, Zhang L. Trends in pain undertreatment among lung cancer patients at the EOL: Analysis of urban city medical insurance data in China. Thorac Cancer 2024; 15:693-701. [PMID: 38316629 PMCID: PMC10961226 DOI: 10.1111/1759-7714.15240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 01/20/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Cancer-related pain is one of the common priority symptoms in advanced lung cancer patients at the end-of-life (EOL). Alleviating pain is undoubtedly a critical component of palliative care in lung cancer. Our study was initiated to examined trends in opioid prescription-level outcomes as potential indicators of undertreated pain in China. METHODS This study used data on 1330 patients diagnosed with lung cancer of urban city medical insurance in China who died between 2014 and 2017. Opioid prescription-level outcomes were determined by annual trends of the proportion of patients filling an opioid prescription, the total dose of opioids filled by decedents, and morphine milligram equivalents per day (MMED) at the EOL (defined as the 60 days before death). We further analyzed monthly changes in the number of opioid prescriptions filled, MMED, and mean daily dose of opioids per prescription (MDDP) of the last 60 days of life by year at death and age, respectively. RESULTS A total of 959 patients with exact dates of death were included, with 432 cases (45.06%; 95% CI: 44.36%-45.77%) receiving at least one opioid prescription at the EOL. The declining trends were shown in the proportion of patients filling any opioid prescription, the total dose of opioids filled by decedents and MMED, with an annual decrease of 0.341% (p = 0.01), 104.23 mg (p = 0.011) and 2.84 mg (p = 0.014), respectively. Within the 31-60 days to the 0-30 days of life, the MMED declined 6.08 mg (95% CI: -7.14 to -5.03; p = 0.000351), while the number of opioid prescriptions rose 0.66 (95% CI: 0.160-1.16; p = 0.025). Like the MMED, the MDDP fell 4.11 mg (95% CI: -5.86 to -2.37; p = 0.005) within the last month before death compared to the previous month. CONCLUSION Terminal lung cancer populations in urban China have experienced reduced access to opioids at the EOL. The clinicians did not prescribe a satisfactory dose of opioids per prescription, while the patients suffered increasing pain in the last 30 days of life. Sufficient opioid analgesic administration should be advocated for lung cancer patients during the EOL period.
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Affiliation(s)
- Jiani Zheng
- Department of Medical OncologySun Yat‐sen University Cancer CenterGuangzhouPeople's Republic of China
- State Key Laboratory of Oncology in South ChinaGuangdong Provincial Clinical Research Center for CancerGuangzhouPeople's Republic of China
| | - Yihua Huang
- Department of Medical OncologySun Yat‐sen University Cancer CenterGuangzhouPeople's Republic of China
- State Key Laboratory of Oncology in South ChinaGuangdong Provincial Clinical Research Center for CancerGuangzhouPeople's Republic of China
| | - Junyi He
- Department of Medical OncologySun Yat‐sen University Cancer CenterGuangzhouPeople's Republic of China
- State Key Laboratory of Oncology in South ChinaGuangdong Provincial Clinical Research Center for CancerGuangzhouPeople's Republic of China
| | - Huaqiang Zhou
- Department of Medical OncologySun Yat‐sen University Cancer CenterGuangzhouPeople's Republic of China
- State Key Laboratory of Oncology in South ChinaGuangdong Provincial Clinical Research Center for CancerGuangzhouPeople's Republic of China
| | - Tingting Liu
- Department of Medical OncologySun Yat‐sen University Cancer CenterGuangzhouPeople's Republic of China
- State Key Laboratory of Oncology in South ChinaGuangdong Provincial Clinical Research Center for CancerGuangzhouPeople's Republic of China
| | - Jie Huang
- Department of Medical OncologySun Yat‐sen University Cancer CenterGuangzhouPeople's Republic of China
- State Key Laboratory of Oncology in South ChinaGuangdong Provincial Clinical Research Center for CancerGuangzhouPeople's Republic of China
| | - Mengting Shi
- Department of Medical OncologySun Yat‐sen University Cancer CenterGuangzhouPeople's Republic of China
- State Key Laboratory of Oncology in South ChinaGuangdong Provincial Clinical Research Center for CancerGuangzhouPeople's Republic of China
| | - Yuanyuan Zhao
- Department of Medical OncologySun Yat‐sen University Cancer CenterGuangzhouPeople's Republic of China
- State Key Laboratory of Oncology in South ChinaGuangdong Provincial Clinical Research Center for CancerGuangzhouPeople's Republic of China
| | - Wenfeng Fang
- Department of Medical OncologySun Yat‐sen University Cancer CenterGuangzhouPeople's Republic of China
- State Key Laboratory of Oncology in South ChinaGuangdong Provincial Clinical Research Center for CancerGuangzhouPeople's Republic of China
| | - Yunpeng Yang
- Department of Medical OncologySun Yat‐sen University Cancer CenterGuangzhouPeople's Republic of China
- State Key Laboratory of Oncology in South ChinaGuangdong Provincial Clinical Research Center for CancerGuangzhouPeople's Republic of China
| | - Li Zhang
- Department of Medical OncologySun Yat‐sen University Cancer CenterGuangzhouPeople's Republic of China
- State Key Laboratory of Oncology in South ChinaGuangdong Provincial Clinical Research Center for CancerGuangzhouPeople's Republic of China
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Sevdem GA, Ozlem KS, Nazan Y, Nahide O. Does the risk of basal cell carcinoma increase in patients with psoriasis under treatment? Photodermatol Photoimmunol Photomed 2024; 40:e12956. [PMID: 38404169 DOI: 10.1111/phpp.12956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/23/2024] [Accepted: 02/06/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Psoriasis is a common, chronic, inflammatory disease. Although it mainly affects the skin, it has been associated with a large number of comorbidities. In addition to comorbidities such as depression and psoriatic arthritis, it is known that there is an increased prevalence of cancer in psoriasis patients. Skin cancers, particularly squamous cell carcinoma, have been associated with psoriasis. However, basal cell carcinoma data are limited. METHODS 346 psoriasis patients and 306 individuals were selected as the control group. There were no differences between the patient and control groups in terms of age and gender. The mean age of the psoriasis patients was 49.9 ± 15.8 years and the control group was 49.4 ± 13.4 years. Sociodemographic data of the patients were recorded. Pharmacological agents used in the treatment of psoriasis were included in the analysis. Disease severity was assessed by the psoriasis area severity index (PASI). In the physical examination of the patients, biopsies were taken from lesions suspicious for BCC. BCC diagnosis was made by histopathologically. RESULTS The frequency of BCC was higher in psoriasis patients than in the control group (6.6% vs. 2.9%, p < .001). Advanced age (p < .001), smoking (p = .003), and arthritis (p < .001) were associated with BCC in psoriasis patients. However, there was no relationship between PASI and BCC (p = .142). Among the psoriasis treatments, only UV therapy was associated with BCC (p = .038). The frequency of PUVA (p < .001) and number of PUVA session (p = .010) was higher in psoriasis patients with BCC rather than NB-UVB. CONCLUSION The frequency of BCC is increased in psoriasis patients. Psoriasis is associated with an increased risk of BCC, especially when treated with PUVA therapy for a long time.
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Affiliation(s)
| | | | - Yilmaz Nazan
- Bezmialem Vakif University, Fatih/İstanbul, Turkey
| | - Onsun Nahide
- Bezmialem Vakif University, Fatih/İstanbul, Turkey
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Khalil MT, Rathore FA, Ahmed O. Comment on Atiq U, Rafique R, Sami Atiq S, et al. (J Pak Med Assoc. 2023; 73: 1753) Osteoporosis's undertreatment in Pakistan. J PAK MED ASSOC 2024; 74:606-607. [PMID: 38591315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Affiliation(s)
| | - Farooq Azam Rathore
- Armed Forces Institute of Rehabilitation Medicine (AFIRM), Convoy Road, Rawalpindi
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O'Neil H, Todd A, Pearce M, Husband A. What are the consequences of over and undertreatment of type 2 diabetes mellitus in a frail population? A systematic review. Endocrinol Diabetes Metab 2024; 7:e00470. [PMID: 38411378 PMCID: PMC10897870 DOI: 10.1002/edm2.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 02/28/2024] Open
Abstract
AIMS This review aims to identify the evidence base for the consequences of over and undertreatment of type 2 diabetes mellitus in a frail population. METHOD In this systematic review, we searched MEDLINE, Embase, PubMed, CINAHL and the Cochrane Library for studies from January 2001 to 15th August 2022. We included a variety of study types that assessed and reported frailty including patients ≥18 years old. Studies included those that reported the prevalence of over or undertreatment of diabetes mellitus in a frail population and those examining outcomes related to glucose control in frail older people living with diabetes. Data were extracted using a bespoke extraction table using a narrative synthesis approach. RESULTS A total of 4114 articles were identified with 112 meeting inclusion criteria. These included 15,130 participants across the 11 studies with sample sizes ranging from 101 to 11,140. Several areas were identified in the included studies where under or overtreatment of diabetes impacted outcomes for patients. These included hospital admissions, readmissions, length of stay, falls, mortality, cognitive impairment and cardiovascular disease outcomes. CONCLUSION The results showed that there was a high heterogeneity of outcomes between the studies and that many examined small numbers of participants. In this review, both over and undertreatment were shown to increase adverse outcomes in frail older people. Further research around optimal glycaemic control for frail older people living with diabetes is required with the aim to identify ideal target ranges and produce practical clinical guidelines to promote attainment of these.
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Affiliation(s)
- Helen O'Neil
- School of PharmacyNewcastle UniversityNewcastleUK
- South Tyneside and Sunderland NHS Foundation TrustSinderlandUK
- NIHR North East and North Cumbria Applied Research Collaboration (NIHR NENC ARC)NewcastleUK
| | - Adam Todd
- School of PharmacyNewcastle UniversityNewcastleUK
| | - Mark Pearce
- Population Health Sciences Institute, Newcastle UniversityNewcastle upon TyneUK
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Fischer MM, Blüthgen N. On minimising tumoural growth under treatment resistance. J Theor Biol 2024; 579:111716. [PMID: 38135033 DOI: 10.1016/j.jtbi.2023.111716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 12/10/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023]
Abstract
Drug resistance is a major challenge for curative cancer treatment, representing the main reason of death in patients. Evolutionary biology suggests pauses between treatment rounds as a way to delay or even avoid resistance emergence. Indeed, this approach has already shown promising preclinical and early clinical results, and stimulated the development of mathematical models for finding optimal treatment protocols. Due to their complexity, however, these models do not lend themself to a rigorous mathematical analysis, hence so far clinical recommendations generally relied on numerical simulations and ad-hoc heuristics. Here, we derive two mathematical models describing tumour growth under genetic and epigenetic treatment resistance, respectively, which are simple enough for a complete analytical investigation. First, we find key differences in response to treatment protocols between the two modes of resistance. Second, we identify the optimal treatment protocol which leads to the largest possible tumour shrinkage rate. Third, we fit the "epigenetic model" to previously published xenograft experiment data, finding excellent agreement, underscoring the biological validity of our approach. Finally, we use the fitted model to calculate the optimal treatment protocol for this specific experiment, which we demonstrate to cause curative treatment, making it superior to previous approaches which generally aimed at stabilising tumour burden. Overall, our approach underscores the usefulness of simple mathematical models and their analytical examination, and we anticipate our findings to guide future preclinical and, ultimately, clinical research in optimising treatment regimes.
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Affiliation(s)
- Matthias M Fischer
- Institute for Theoretical Biology, Charité and Humboldt Universität zu Berlin, 10115 Berlin, Germany
| | - Nils Blüthgen
- Institute for Theoretical Biology, Charité and Humboldt Universität zu Berlin, 10115 Berlin, Germany.
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Carnero Contentti E, López PA, Pappolla A, Alonso R, Silva B, Deri N, Balbuena ME, Burgos M, Luetic G, Alvez Pinheiro A, Cabrera M, Hryb J, Nofal P, Pestchanker C, Vrech C, Tavolini D, Tkachuk V, Zanga G, Marrodan M, Ysrraelit MC, Correale J, Carrá A, Federico B, Garcea O, Fernandez Liguori N, Patrucco L, Cristiano E, Giunta D, Alonso Serena M, Rojas JI. Incidence of SARS-CoV-2 infection in patients with multiple sclerosis who received SARS-CoV-2 vaccines and are under treatment with high-efficacy therapies in Argentina. Neurol Sci 2024; 45:379-389. [PMID: 38159147 DOI: 10.1007/s10072-023-07282-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
We aimed to evaluate the incidence of SARS-CoV-2 breakthrough infection of SARS-CoV-2 vaccines in people with MS (PwMS) on high-efficacy disease-modifying therapies (HET) included in the national MS registry in Argentina (RelevarEM). METHODS Non-interventional, retrospective cohort study that collected information directly from RelevarEM. Adult PwMS who had been treated for at least 6 months with a HET (ocrelizumab, natalizumab, alemtuzumab, cladribine) who had received at least two doses of SARS-CoV-2 vaccines available in Argentina were included. Full course of vaccination was considered after the second dose of the corresponding vaccines. Cumulative incidence of SARS-CoV-2 infection was reported for the whole cohort by Kaplan-Meier survival curves (which is expressed in percentage) as well as incidence density (which is expressed per 10.000 patients/day with 95% CI). RESULTS Two hundred twenty-eight PwMS were included. Most frequent first and second dose received was AstraZeneca vaccine, followed by Sputnik vaccine. Most frequent HETs used in included patients were cladribine in 79 (34.8%). We found an incidence density of breakthrough COVID-19 infection of 3.5 × 10.000 patients/day (95% CI 2.3-6.7) after vaccination in Argentina. We described the incidence rate after vaccination for every HET used, it being significantly higher for ocrelizumab compared with other HETs (p = 0.005). Only five patients presented a relapse during the follow-up period with no differences regarding the pre-vaccination period. CONCLUSIONS We found an incidence density of breakthrough COVID-19 infection of 3.5 × 10.000 patients/day (95% CI 2.3-6.7) after vaccination in Argentina.
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Affiliation(s)
- Edgar Carnero Contentti
- Department of Neurosciences, Neuroimmunology Unit, Hospital Aleman, Buenos Aires, Argentina.
| | - Pablo A López
- Department of Neurosciences, Neuroimmunology Unit, Hospital Aleman, Buenos Aires, Argentina
| | - Agustín Pappolla
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ricardo Alonso
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, Buenos Aires, Argentina
- Sanatorio Güemes, Buenos Aires, Argentina
| | - Berenice Silva
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, Buenos Aires, Argentina
| | - Norma Deri
- Centro de Investigaciones Diabaid, Buenos Aires, Argentina
- Hospital Fernandez, Buenos Aires, Argentina
| | - María E Balbuena
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Marcos Burgos
- Servicio de Neurología, Hospital San Bernardo, Salta, Argentina
| | - Geraldine Luetic
- Instituto de Neurociencias de Rosario, San Lorenzo, Rosario, Santa Fé, Argentina
| | | | | | - Javier Hryb
- Servicio de Neurología, Hospital Carlos G Durand, Buenos Aires, Argentina
| | - Pedro Nofal
- Hospital de Clínicas Nuestra Señora del Carmen, Tucumán, Argentina
| | - Claudia Pestchanker
- Neurology Department, Hospital Central Dr. Ramon Carrillo, San Luis, Argentina
| | - Carlos Vrech
- Departamento de Enfermedades Desmielinizantes, Sanatorio Allende, Córdoba, Argentina
| | | | - Verónica Tkachuk
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Gisela Zanga
- Departamento de Neurología, Hospital Cesar Milstein, Buenos Aires, Argentina
| | | | | | - Jorge Correale
- Departamento de Neurología, FLENI, Buenos Aires, Argentina
| | - Adriana Carrá
- Sección de Enfermedades Desmielinizantes, Hospital Británico, Buenos Aires, Argentina
- Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
| | | | - Orlando Garcea
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, Buenos Aires, Argentina
| | | | - Liliana Patrucco
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Edgardo Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Diego Giunta
- Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Marina Alonso Serena
- Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Juan I Rojas
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
- Servicio de Neurología, Unidad de EM y Enfermedades Desmielinizantes, Hospital Universitario de CEMIC, Buenos Aires, Argentina
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Borborema MEA, da Silva Santos AF, de Lucena TMC, Crovella S, da Silva Rabello MC, de Azevêdo Silva J. Pathogen recognition pathway gene variants and inflammasome sensors gene expression in tuberculosis patients under treatment. Mol Biol Rep 2024; 51:161. [PMID: 38252221 DOI: 10.1007/s11033-023-09155-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 12/12/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Several epidemiological studies have suggested that genetic variations in encoding pattern recognition receptors (PRRs) genes such as Toll Like Receptors (TLRs) and their signaling products, may influence the susceptibility, severity and outcome of tuberculosis (TB). After sensing a pathogen, the cell responds producing an inflammatory response, to restrain the pathogen's successful course of infection. Herein we assessed single nucleotide polymorphisms (SNP) and gene expression from pathogen recognition and inflammasome pathways in Brazilian TB patients. METHODS AND RESULTS For genetic association analysis we included MYD88 and TLR4, PRRs sensing proteins. Allele distribution for MYD88 rs6853 (A > G) and TLR4 rs7873784 (C > G) presented conserved among the tested samples with statistically differential distribution in TB patients versus controls. However, when testing according to sample ethnicity (African or Caucasian-derived individuals) we identified that the rs6853 G/G genotype was associated with a lower susceptibility to TB in Caucasian population. Meanwhile, the rs7873784 G/G genotype was associated with a higher TB susceptibility in Afro-descendant ethnicity individuals. We also aimed to verify MYD88 and the inflammasome genes NLRP1 and NLRC4 expression in order to connect to active TB and/or clinical aspects. CONCLUSIONS We identified that inflammasome gene expression in TB patients under treatment display a similar pattern as in healthy controls, indicating that TB treatment impairs NLRP1 inflammasome activation.
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Affiliation(s)
- Maria Eduarda Albuquerque Borborema
- Laboratory of Human Genetics and Molecular Biology, Department of Genetics, Center for Biosciences, Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235, Recife, PE, 50670-901 - CEP, Brazil
- Keizo Asami Institute, Federal University of Pernambuco, Recife, PE, 50740-465 - CEP, Brazil
| | - Ariane Fernandes da Silva Santos
- Laboratory of Human Genetics and Molecular Biology, Department of Genetics, Center for Biosciences, Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235, Recife, PE, 50670-901 - CEP, Brazil
- Keizo Asami Institute, Federal University of Pernambuco, Recife, PE, 50740-465 - CEP, Brazil
| | - Thays Maria Costa de Lucena
- Laboratory of Human Genetics and Molecular Biology, Department of Genetics, Center for Biosciences, Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235, Recife, PE, 50670-901 - CEP, Brazil
- Keizo Asami Institute, Federal University of Pernambuco, Recife, PE, 50740-465 - CEP, Brazil
| | - Sergio Crovella
- Keizo Asami Institute, Federal University of Pernambuco, Recife, PE, 50740-465 - CEP, Brazil
| | | | - Jaqueline de Azevêdo Silva
- Laboratory of Human Genetics and Molecular Biology, Department of Genetics, Center for Biosciences, Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235, Recife, PE, 50670-901 - CEP, Brazil.
- Keizo Asami Institute, Federal University of Pernambuco, Recife, PE, 50740-465 - CEP, Brazil.
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Lilja J, Själander A, Själander S. Prevalence of atrial fibrillation and reasons for undertreatment with oral anticoagulants. J Thromb Thrombolysis 2024; 57:101-106. [PMID: 37704908 PMCID: PMC10830806 DOI: 10.1007/s11239-023-02890-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVES To investigate the prevalence of atrial fibrillation (AF), the proportion of AF patients not receiving oral anticoagulation (OAC) and reasons for abstaining from OAC treatment. METHODS A retrospective cross-sectional study of patients aged 18 years or older with an AF diagnosis on June 1st 2020 in Västernorrland County, Sweden. AF diagnosis was retrieved using the ICD10 code I.48, and medical records were reviewed for comorbidities and documented reasons to abstain OAC treatment. RESULTS Of 197 274 residents in Västernorrland County, 4.7% (9 304/197 274) had a documented AF diagnosis. Of these, 19% (1 768/9 304) had no OAC treatment, including 4.2% (393/9 304) with no indication, 2.5% (233/9 304) with a questionable and 2.5% (231/9 304) with a documented clear contraindication for OAC. In total 9.8% (911/9 304) were not treated with OAC despite indication and no reasonable documented contraindication, thus 90.8% (8 447/9 304) of all AF-patients were eligible for OAC treatment. Common reasons for abstaining treatment without reasonable contraindication were present sinus rhythm in 13.7% (125/911), perceived not an OAC candidate in 10.6% (97/911) and anemia in the past in 4.3% (39/911). CONCLUSIONS In the population of Västernorrland County, a very high AF prevalence of 4.7% was found, of which just over 90% would theoretically benefit from OAC treatment. This is higher than previously reported and stresses the importance of stroke prevention in this large patient group.
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Affiliation(s)
- Johan Lilja
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Anders Själander
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Sara Själander
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
- Department of Cardiology, Sundsvall Hospital, 856 43, Sundsvall, Sweden.
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Perriot J, Underner M, Peiffer G. [Smoking cessation in smokers under treatment for lung cancer. Current data]. Rev Med Liege 2024; 79:29-33. [PMID: 38223967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
In 2020, lung cancer was the cause of 18 % of all cancer deaths; smoking accounting for around 90 % of all lung cancers. Despite advances in lung cancer treatment, tobacco control measures are the most effective in curbing the lung cancer epidemic. Nevertheless, smoking cessation at all stages of the cancer process is associated with benefits in terms of cure, improved life expectancy and quality of life for patients, reduced medical or surgical complications, and reduced risk of recurrence or occurrence of a second primary cancer. Consequently, smoking cessation is an essential component of lung cancer treatment. All healthcare professionals, particularly those involved in the care of lung cancer patients, must help smokers to quit.
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Affiliation(s)
- Jean Perriot
- Dispensaire Emile Roux, Centre de Lutte antituberculeuse et Centre de Tabacologie, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Michel Underner
- Centre Henri Laborit, Unité de Recherche clinique, Université de Poitiers, France
| | - Gérard Peiffer
- Service des Maladies respiratoires, CHR Metz-Thionville, France
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12
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Erfanian N, Nasseri S, Miraki Feriz A, Safarpour H, Namaie MH. Characterization of Wnt signaling pathway under treatment of Lactobacillus acidophilus postbiotic in colorectal cancer using an integrated in silico and in vitro analysis. Sci Rep 2023; 13:22988. [PMID: 38151510 PMCID: PMC10752892 DOI: 10.1038/s41598-023-50047-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 12/14/2023] [Indexed: 12/29/2023] Open
Abstract
Colorectal cancer (CRC) is a prevalent and life-threatening cancer closely associated with the gut microbiota. Probiotics, as a vital microbiota group, interact with the host's colonic epithelia and immune cells by releasing a diverse range of metabolites named postbiotics. The present study examined the effects of postbiotics on CRC's prominent differentially expressed genes (DEGs) using in silico and in vitro analysis. Through single-cell RNA sequencing (scRNA-seq), we identified four DEGs in CRC, including secreted frizzled-related protein 1 (SFRP1), secreted frizzled-related protein 2 (SFRP2), secreted frizzled-related protein 4 (SFRP4), and matrix metallopeptidase 7 (MMP7). Enrichment analysis and ExpiMap, a novel deep learning-based method, determined that these DEGs are involved in the Wnt signaling pathway as a primary cascade in CRC. Also, spatial transcriptome analysis showed specific expression patterns of the SFRP2 gene in fibroblast cell type. The expression of selected DEGs was confirmed on CRC and normal adjacent tissues using Real-Time quantitative PCR (RT-qPCR). Moreover, we examined the effects of postbiotics extracted from Lactobacillus acidophilus (L. acidophilus) on the proliferation, migration, and cell cycle distribution of HT-29 cells using MTT, scratch, and flow cytometry assays. Our results showed that L. acidophilus postbiotics induce cell cycle arrest at G1 phase and also had anti-proliferative and anti-migration effects on HT-29 cells, while it did not exert anti-proliferative activity on control fibroblasts. Finally, we revealed that treating HT-29 cells with postbiotics can affect the expression of selected DEGs. We suggested that L. acidophilus postbiotics have therapeutic potential in CRC by modulating key genes in the Wnt pathway.
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Affiliation(s)
- Nafiseh Erfanian
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
| | - Saeed Nasseri
- Cellular and Molecular Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Adib Miraki Feriz
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
| | - Hossein Safarpour
- Cellular and Molecular Research Center, Birjand University of Medical Sciences, Birjand, Iran.
| | - Mohammad Hassan Namaie
- Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran.
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Arias Horcajadas F, Marín M, Prieto R, López-Trabada JR, Parra A, Sanz P, Guerrero Y, Delgado P, González L, Sáiz N, Suárez de Figueroa S, Villalba A, Rubio G. Effects of the lockdown due to the COVID-19 pandemic on alcohol consumption in patients under treatment in an alcohol relapse prevention programme. Adicciones 2023; 35:455-468. [PMID: 36200223 DOI: 10.20882/adicciones.1593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
During the COVID-19 pandemic, several exceptional measures were put in place in order to avoid virus propagation, such as lockdown and the discontinuation of usual health care assistance services. It was considered that these changes might be associated with an increase in alcohol consumption and a higher risk of relapse for patients under treatment. The aim of this study was to assess changes in alcohol consumption during the lockdown period (between March and May, 2020) in patients following treatment under the Alcohol Use Disorders Programme at the "Hospital 12 de Octubre" in Madrid. A total of 311 patients were assessed through interviews carried out by telephone in accordance with usual clinical practice during that period. 76% of the total number of patients did not experience changes in their alcohol consumption, 9.2% stopped drinking and some experienced severe withdrawal syndrome, while 7.5% relapsed. The risk factors found for worsening the prognosis of the patients were: being female, drinking alcohol alone or at home, binge drinking, concomitant substance misuse and failure to attend therapy groups or self-help groups online during the lockdown. 31.6% of the sample described psychopathological symptoms due to the lockdown, especially those who already had psychiatric comorbidities. For this reason, we can conclude that during the lockdown as a result of the pandemic, most of our alcohol dependent patients did not modify their drinking patterns, but specific factors enabled us to identify a more vulnerable subgroup.
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