Study compares Postoperative morbidity in cancer patients with and without a history of Covid infection

Cancer patients who have had Covid-19 may experience unfavorable outcomes after cancer surgery due to specific risk factors such as immunosuppression, chemotherapy, radiotherapy, and increased susceptibility to infection and malnutrition. Recent research paper is a prospective, comparative study conducted to examine the impact of Covid-19 infection history on postoperative morbidity and mortality in cancer patients undergoing elective surgery. The study aimed to compare the outcomes in post-Covid-19 (PC) and non-Covid-19 (NC) groups and explore the implications for surgical risk. A total of 414 patients were included, with 109 experiencing postoperative complications, and the study found that the PC group had a higher incidence of complications, particularly pulmonary complications, compared to the NC group. The overall mortality rate was 0.72%. The study also investigated the impact of different intervals between Covid-19 diagnosis and surgery and revealed a higher incidence of respiratory complications within 2-4 weeks after Covid-19 diagnosis, decreasing over time. Additionally, the study examined various factors associated with postoperative complications, such as age, hypothyroidism, and prognostic nutritional index (PNI), providing insights into risk stratification for surgical outcomes

Morbidity Risk Profile and Waiting Period Recommendations

The study employed the Portsmouth-Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (P-POSSUM) score to estimate morbidity and mortality risk, and it was observed that PC and NC groups had a comparable morbidity risk profile. The findings indicated that cancer patients with a history of Covid infection are at a higher risk of postoperative pulmonary complications, suggesting the need for a minimum holding period before surgery for asymptomatic patients and a longer waiting period for symptomatic patients. This recommendation aligns with updated guidelines advising a 7-8 week waiting period for elective surgeries after Covid-19 infection. It was also noted that older age, hypothyroidism, and low PNI were associated with a higher incidence of complications, providing valuable insights for preoperative risk assessment and patient counseling.

Enhancing Surgical Outcomes for Covid-19-Recovered Cancer Patients

Overall, the study contributes to the understanding of the impact of Covid-19 infection on postoperative outcomes in cancer patients undergoing elective surgery. The findings underscore the importance of risk stratification, proper prehabilitation, and postoperative care to improve perioperative outcomes for Covid-19-recovered cancer patients. The study’s recommendations suggest a practical approach to optimize surgical outcomes in this patient population and provide valuable insights for future decision-making regarding the timing of elective surgeries for patients with a history of Covid-19 infection.

Key Points

1. The study was a prospective, comparative study that aimed to examine the impact of Covid-19 infection history on postoperative morbidity and mortality in cancer patients undergoing elective surgery.

2. The study included a total of 414 patients, with 109 experiencing postoperative complications. It revealed that the post-Covid-19 (PC) group had a higher incidence of complications, particularly pulmonary complications, compared to the non-Covid-19 (NC) group.

3. The overall mortality rate was found to be 0.72%. The study also looked at the impact of different intervals between Covid-19 diagnosis and surgery and found a higher incidence of respiratory complications within 2-4 weeks after Covid-19 diagnosis, decreasing over time.

4. The study used the Portsmouth-Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (P-POSSUM) score to estimate morbidity and mortality risk. It found that PC and NC groups had a comparable morbidity risk profile. Additionally, older age, hypothyroidism, and low prognostic nutritional index (PNI) were associated with a higher incidence of complications.

5. The study recommended a minimum holding period before surgery for asymptomatic patients and a longer waiting period for symptomatic patients with a history of Covid infection. It aligned with updated guidelines advising a 7-8 week waiting period for elective surgeries after Covid-19 infection.

6. Overall, the study emphasized the importance of risk stratification, proper prehabilitation, and postoperative care to improve perioperative outcomes for Covid-19-recovered cancer patients. It provided practical recommendations to optimize surgical outcomes in this patient population and offered valuable insights for future decision-making regarding the timing of elective surgeries for patients with a history of Covid-19 infection.

Reference –

Hemrajani M, Mongia P, Gupta P, Joad AK. Morbidity and mortality after elective cancer surgery—How does recent Covid‑19 infection impact outcome: A prospective, comparative study. J Anaesthesiol Clin Pharmacol 2024 DOI: 10.4103/joacp.joacp_232_23

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No Survival Benefit for Minimally Invasive Pneumonectomy Over Open Surgery in Lung Cancer Patients, Study Finds

USA: As thoracic surgery techniques evolve, minimally invasive pneumonectomy (MIP) is increasingly being compared to traditional open pneumonectomy (OP) for patient outcomes and surgical efficiency. Recent studies have highlighted the potential benefits of MIP, while also identifying key factors that contribute to the need for conversion to open procedures.

A recent study involving 3,784 patients with non-small cell lung cancer who underwent pneumonectomy found no significant survival benefit of minimally invasive techniques over traditional open surgery. The researchers showed comparable 30-day and 90-day mortality rates and median overall survival times for all surgical approaches; indicating that minimally invasive pneumonectomy does not provide a survival benefit over the open surgical method.

The findings were published online in The Annals of Thoracic Surgery on August 8, 2024. 

Minimally invasive pneumonectomy, performed through small incisions using video-assisted thoracoscopic surgery (VATS) or robotic assistance, offers several advantages over the conventional open approach. These include reduced postoperative pain, shorter recovery times, and fewer complications such as wound infections and prolonged air leaks. Savan K. Shah, Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, Illinois, USA, and colleagues aimed to determine if MIP for non-small cell lung cancer (NSCLC) provides a survival advantage over open pneumonectomy.

For this purpose, the researchers queried patients who underwent pneumonectomy for NSCLC between 2015 and 2020 from the National Cancer Database. The surgical approaches were classified into robot-assisted (RATS), video-assisted thoracoscopic (VATS), and open pneumonectomy.

Propensity score matching was employed to ensure balanced patient cohorts. Both univariate and multivariate regression analyses were conducted to explore the relationship between surgical approach and 30- and 90-day mortality, while a Cox proportional hazards model was utilized to evaluate overall survival.

The study led to the following findings:

  • 3784 patients were identified, including 73% open, 19% VATS, and 8% RATS.
  • The overall conversion rate from minimally invasive to open was 29.5%.
  • After propensity matching 212 patients per cohort, there were no differences between open, VATS, and RATS 30-day (9.4% versus 8.5% versus 7.5%, respectively) or 90-day mortality (14.2% versus 12.3% versus 10.4%, respectively).
  • Median overall survival was similar among open (48 months), VATS (51.0 months), and RATS approaches (50 months).
  • On multivariate analysis of the matched cohort, there was no association between approach and overall survival.
  • RATS (OR 0.67) and neoadjuvant chemotherapy (OR 0.52) were protective against conversion to open.

“The findings showed that minimally invasive pneumonectomy can achieve short-term and long-term survival rates comparable to those of open pneumonectomy,” the researchers concluded.

Reference:

Shah, S. K., Khan, A. A., Basu, S., & Seder, C. W. (2024). Minimally Invasive Pneumonectomy vs Open Pneumonectomy: Outcomes and Predictors of Conversion. The Annals of Thoracic Surgery. https://doi.org/10.1016/j.athoracsur.2024.07.027

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Surface Smoothness of stainless steel orthodontic archwires not affected by Use of salbutamol inhalers in asthma patients: Study

Smoothness of surface of stainless steel orthodontic archwires not affected by Use of salbutamol inhalers among asthma patients suggests a study published in the Clinical Dentistry.

This study aimed to compare the surface roughness and friction of different orthodontic archwires after exposure to salbutamol sulphate inhalation, an anti-asthmatic medication.

Orthodontic archwires (stainless-steel [StSt], nickel-titanium [NiTi], beta-titanium [β-Ti], and copper-NiTi [Cu-NiTi]) were equally divided into two groups. The exposed groups were subjected to 20 mg salbutamol sulphate for 21 days and kept in artificial saliva. The control groups were only kept in artificial saliva. Surface changes were visualized using scanning electron microscopy (SEM). The average surface roughness (Ra) was evaluated using atomic force microscopy (AFM), and friction resistance forces were assessed using a universal testing machine. Statistical analyses were performed using t-tests and ANOVA followed by post hoc tests. Results: Salbutamol sulphate did not change the surface roughness of StSt and NiTi archwires (p > .05). However, the change in the surfaces of β-Ti and Cu-NiTi archwires was significant (p < .001). The frictional forces of exposed StSt, NiTi, and Cu-NiTi archwires did not change (p > .05). However, the frictional forces of β-Ti archwires increased significantly after exposure to salbutamol sulphate (p = .021). Brushing with fluoride after exposure to salbutamol sulphate increased the frictional forces of β-Ti only (p = .002). Salbutamol sulphate inhalation significantly affected the surface texture of β-Ti and Cu-NiTi orthodontic archwires and increased the friction of β-Ti archwires. These deteriorating effects were not detected on the surface of StSt and NiTi archwires. Therefore, we suggest that β-Ti and copper titanium archwires should be used cautiously in individuals under salbutamol sulphate inhalation treatment.

Reference:

Alemran MA, Abbassy MA, Bakry AS, Alsaggaf DH, Abuhaimed TS, Zawawi KH. The effect of salbutamol sulphate inhalation (an anti-asthmatic medication) on the surfaces of orthodontic Archwires. Orthod Craniofac Res. 2024; 27: 447-454. doi:10.1111/ocr.12749

Keywords:

Smoothness, surface, stainless, steel, orthodontic, archwires, affected, Use, salbutamol, inhalers, asthma patients, study, Clinical Dentistry, Alemran MA, Abbassy MA, Bakry AS, Alsaggaf DH, Abuhaimed TS, Zawawi KH

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High insulin levels contribute to worse outcomes for Black women with aggressive form of breast cancer: Study

High insulin levels contribute to worse outcomes for Black women compared to white women who have an aggressive form of breast cancer called triple-negative breast cancer, according to a study presented Sunday at ENDO 2024, the Endocrine Society’s annual meeting in Boston, Mass.

Triple-negative breast cancer accounts for about 10-15% of all breast cancers. The term triple-negative breast cancer refers to the fact that the cancer cells do not have estrogen or progesterone receptors and do not make any or too much of the protein called HER2. The cells test ‘negative’ on all 3 tests. Triple-negative breast cancer differs from other types of invasive breast cancer in that it tends to grow and spread faster, has fewer treatment options and tends to have a worse prognosis.

“Obesity and type 2 diabetes, which are more common in Black women, are associated with poor breast cancer outcomes,” according to medical student researcher Alexis Engel, B.A., of the Icahn School of Medicine at Mount Sinai in New York, N.Y. “Black women have higher rates of triple-negative breast cancer and have a greater risk of death from breast cancer in comparison to white women.”

The researchers wanted to uncover the factors contributing to the discrepancy in survival rates. They investigated whether high levels of blood insulin in Black women contribute to breast cancer growth and spread, leading to worse outcomes.

They obtained tumor samples from 45 Black and 48 white women with triple-negative breast cancer and evaluated them for cellular signs of increased sensitivity to growth from insulin. They found signs of sensitivity to insulin were more prevalent in tumors from Black women compared to white women. Insulin signaling was also correlated with obesity and high blood insulin levels.

“These results suggest that high insulin levels in Black women may be contributing to cancer growth and worse breast cancer outcomes,” Engel said.

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Laparoscopic surgery for endometriosis linked to decreased urinary health not dependent on severity: Study

A recent study analyzed the long-term urinary function of women who were undergoing laparoscopic surgery for endometriosis. The findings published in the Journal of Minimally Invasive Gynecology highlights a concerning decline in urinary health post-operation, irrespective of the severity or location of the disease.

This study meticulously tracked the urinary function of women with histologically confirmed endometriosis from April 2012 to November 2019. This research assessed baseline urinary function before surgery and followed up with participants between February and October 2020.

The results involved a total of 289 participants out of 518 with confirmed endometriosis and unveiled a significant deterioration in urinary function over time. 12.1% of the participants sought treatment for bladder symptoms, while 28.0% reported at least one urinary tract infection since their initial surgery that occurred at an average of 50 months post-operatively.

Using validated questionnaires, the team led by Kimberly Nguyen evaluated various urinary domains including filling, voiding, incontinence and quality of life. The scores revealed a marked escalation in symptoms from pre-operative to post-operative stages which indicates a concerning decline in urinary health.

Also, this study found no substantial disparity in urinary questionnaire scores among participants with and without uterovesical endometriosis or across different stages of the disease. But, the participants who experienced post-operative urinary retention or infections expressed higher scores in certain domains when compared to their counterparts.

These findings underscore the importance of comprehensive post-operative care in monitoring and managing urinary complications for the women who were undergoing laparoscopic surgery for endometriosis. The implications of this study extend beyond clinical settings that emphasize the need for elevated awareness and support for individuals with long-term urinary challenges post-surgery.

Study:

Nguyen, K., McCormack, L., Deans, R., Nesbitt-Hawes, E., Knapman, B., Li, F., Lim, C., & Abbott, J. A. (2024). A Prospective Study of Bladder Function Following Endometriosis Surgery With Up to Eight years Follow-up. In Journal of Minimally Invasive Gynecology (Vol. 31, Issue 3, pp. 205-212.e4). Elsevier BV. https://doi.org/10.1016/j.jmig.2023.11.020

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NG Feeding Increase Risk of Diarrhea and Infection Within 48 Hours of Admission: BMC

A recent study published in BMC Gastroenterology unveiled the critical importance of selecting the appropriate method and timing for nutritional support in patients with acute pancreatitis (AP). While initiating nasogastric (NG) feeding within 48 hours of admission increases the risk of complications such as diarrhea and infection, it does not significantly impact mortality rates or the need for surgical intervention. Ming Wang and colleagues conducted this study to comprehensively compare NG and nasojejunal (NJ) feeding initiated within the first 48 hours of hospital admission. Their systematic analysis aims to equip clinicians with evidence-based insights to facilitate informed decisions regarding early nutritional management for AP patients.

Acute pancreatitis, a prevalent digestive disorder, involves inflammation and dysfunction of the pancreas, primarily caused in adults by gallstones and alcohol. These factors contribute significantly to the pathophysiological process leading to pancreatic inflammation and damage. Management strategies for AP have been extensively researched, focusing particularly on optimizing the timing and method of nutritional support. Early enteral nutrition (EN) is advocated to mitigate pancreatic stimulation, aid in the recovery of intestinal barrier function, and reduce complications associated with delayed feeding. However, the ongoing debate over whether nasogastric or nasojejunal feeding routes are superior during this crucial early phase remains unresolved.

Following PRISMA guidelines, this systematic review examined studies from PubMed, EMbase, Cochrane Central Register of Controlled Trials, and Web of Science. Search terms such as “Pancreatitis,” “NG feeding,” “Nasojejunal feeding,” and “mortality” were employed to select randomized controlled trials (RCTs) focusing on NG or NJ feeding in AP patients within 72 hours of admission. Exclusions encompassed non-English articles, case reports, and non-RCTs. Rigorous data extraction and quality assessment were conducted using Cochrane’s risk of bias tool, and statistical analyses included risk ratios (RR) and standardized mean differences (SMD) to assess heterogeneity via I² statistics. Subgroup analyses explored variables such as patient age and the impact of early intervention within 48 hours post-admission.

The meta-analysis findings revealed comparable mortality rates between NG and NJ feeding groups. Notable differences emerged, however, with the NG group expressed higher rates of diarrhea, pain, infection probabilities, and more frequent instances of multiple organ failure. Subgroup analysis focusing on early intervention underscored an elevated risk of diarrhea in the NG group. Conversely, no significant disparities were found regarding the need for surgical intervention, parenteral nutrition requirements, or the success rates of feeding procedures.

This study suggests that both NG and NJ feeding methods are similarly effective in the initial management of acute pancreatitis, without significant differences in mortality or primary clinical outcomes. The choice of feeding route should be tailored to individual patient characteristics and clinical contexts.

Reference:

Wang, M., Shi, H., Chen, Q., Su, B., Dong, X., Shi, H., & Xu, S. (2024). Comparative safety assessment of nasogastric versus nasojejunal feeding initiated within 48 hours post-admission versus unrestricted timing in moderate or severe acute pancreatitis: a systematic review and meta-analysis. In BMC Gastroenterology (Vol. 24, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12876-024-03290-z

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Alcohol use in older adults doubles risk of brain bleeds from falls, reveals study

Nationally, falls remain the leading cause of both fatal and non-fatal injuries in older adults and are the leading cause of traumatic brain injury. In 2021, falls led to the deaths of 36,500 older adults in the United States and 3,805 older Floridians. While some studies have hypothesized that alcohol use contributed to these outcomes, there are few studies which have examined this issue.

As such, little is known about the association between the frequency of alcohol use and the severity of injuries sustained after a fall in older adults. A study by Florida Atlantic University’s Schmidt College of Medicine and collaborators, is one of the first to examine the relationship between self-reported alcohol use and severe head trauma in this group.

For the study, researchers used data from the Geriatric Head Trauma Short Term Outcomes Project (GREAT STOP), which included a prospective cohort of consecutive patients presenting to the emergency departments (ED) of two level one, university-affiliated trauma centers in Palm Beach County, with annual volumes of 50,000 and 69,000.

Patients aged 65 and older who sustained blunt head trauma following a fall were included in the study. Trained research assistants screened all older ED patients to enroll those with head trauma. Data collected included age, race, sex, smoking, alcohol use, drug use, antiplatelet use, anticoagulant use, mechanism of injury, past medical history, and loss of consciousness.

All patients were asked about alcohol use and were asked to categorize their use as none, occasional, weekly, or daily. Intracranial hemorrhage (ICH), a head trauma that takes place in various areas of the brain, was determined from the patient’s head CT scan as read by the attending hospital radiologist.

The study, published in the Journal of the American College of Emergency Physicians Open, involved 3,128 participants who underwent an initial head CT after head trauma from a fall. Of these, 433 (13.5%) were diagnosed with ICH. Notably, 561 (18.2%) of older adults in the ED with head trauma reported drinking alcohol, with 6% indicating daily consumption.

“We observed that occasional alcohol use was associated with double the odds of intracranial hemorrhage when compared to patients with no alcohol use. Daily alcohol use was associated with 150% increased odds of intracranial hemorrhage,” said Richard Shih, M.D., corresponding author and a professor of emergency medicine, FAU Schmidt College of Medicine. “One of the unexpected findings in our study was the strong dose‒response relationship between reported alcohol use and intracranial hemorrhage.”

Weekly and daily alcohol users tended to be younger, with a mean age of 78 years, while non-alcohol users tended to be older, with a mean age of 83 years. ICH was more significantly common in alcohol users than in nonusers (22% vs. 12%). Strikingly, the prevalence of ICH increased with increasing frequency of alcohol use. While the risk of ICH was already high for non-alcohol users, the absolute risk of differences for ICH associated with alcohol use were substantial, rising from a risk increase of 8.5% in occasional alcohol users to an increase of 13.1% in daily alcohol users.

Many risk factors for falling have been identified in older adults such as polypharmacy, a sudden drop in blood pressure, and home environmental dangers. Findings from this study warrant the consideration that alcohol use should be regarded as another important, independent, modifiable risk factor for falling.

“Drinking alcohol can make you more likely to fall because it affects your balance, concentration and awareness,” said Shih. “It’s also worth noting that as individuals age, the effects of alcohol are increased. This is because older adults often have a higher percentage of body fat to body water ratio, thus increasing the concentration of alcohol in the bloodstream. Furthermore, alcohol metabolism decreases with age, exacerbating this effect, because older adults don’t process alcohol as efficiently as they used to.”

Current fall prevention guidelines, such as the Centers for Disease Control and Prevention’s Stopping Elderly Accidents, Deaths & Injuries (STEADI) initiative or the American Geriatrics Society Clinical Practice Guidelines for Prevention of Falls in Older Adults, do not address the relationship between alcohol use and falls.

“Our findings suggest that alcohol use assessment and mitigation strategies may be useful additions to fall prevention strategies,” said Shih. 

Reference:

Alexander Zirulnik ,Mike Wells,Scott M. Alter, Gabriella Engstrom, J. Solano, Lisa M. Clayton DO, Alcohol use is associated with intracranial hemorrhage in older emergency department head trauma patients, Journal of the American College of Emergency Physicians Open, https://doi.org/10.1002/emp2.13245.

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Arts and crafts may improve your mental health at least as much as being employed, scientists find

Could arts and crafts help protect the public’s mental health? A new study in Frontiers in Public Health provides evidence that indulging our creative side could provide everyone with a significant well-being boost. Because arts and crafts are relatively affordable and accessible, promoting the public’s access to artistic activities could provide a major boost to public mental health.

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Females’ and males’ muscles differ in sugar and fatty acid handling, study finds

Females’ and males’ muscles differ in glucose and fatty acid handling—but regular physical activity quickly triggers similar beneficial metabolic changes in the muscles of both sexes, new research to be presented at the Annual Meeting of the European Association for the Study of Diabetes (EASD) (Madrid, 9–13 September) has found.

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What the trained eye cannot see: Detecting movement defects in early stage Parkinson’s disease

A technique that uses videos and machine learning to quantify motor symptoms in early-stage Parkinson’s disease could help reveal signs of the disease and other movement disorders earlier, which could lead to better treatment outcomes.

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