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Frontiers in Medicine 2024We aimed to assess the impact of myasthenia gravis (MG) on the long-term prognosis in patients with thymoma after surgery and identify related prognostic factors or...
INTRODUCTION
We aimed to assess the impact of myasthenia gravis (MG) on the long-term prognosis in patients with thymoma after surgery and identify related prognostic factors or predictors.
METHODS
This retrospective observational study included 509 patients with thymoma (thymoma combined with MG [MG group] and thymoma alone [non-MG group]). Propensity score matching was performed to obtain comparable subsets of 96 patients in each group. A comparative analysis was conducted on various parameters.
RESULTS
Before matching, the 10-year survival and recurrence-free survival rates in both groups were 93.8 and 98.4%, and 85.9 and 93.4%, respectively, with no statistically significant difference observed in the survival curves between the groups ( > 0.05). After propensity score matching, 96 matched pairs of patients from both groups were created. The 10-year survival and recurrence-free survival rates in these matched pairs were 96.9 and 97.7%, and 86.9 and 91.1%, respectively, with no statistical significance in the survival curves between the groups ( > 0.05). Univariate analysis of patients with thymoma postoperatively revealed that the World Health Organization histopathological classification, Masaoka-Koga stage, Tumor Node Metastasis stage, resection status, and postoperative adjuvant therapy were potentially associated with tumor recurrence after thymoma surgery. Multivariate analysis demonstrated that the Masaoka-Koga stage and postoperative adjuvant therapy independently predicted the risk of recurrence in patients with thymoma after surgery.
CONCLUSION
There was no difference in prognosis in patients with thymoma with or without MG. The Masaoka-Koga stage has emerged as an independent prognostic factor affecting recurrence-free survival in patients with thymoma, while postoperative adjuvant therapy represents a poor prognostic factor.
PubMed: 38947244
DOI: 10.3389/fmed.2024.1407830 -
Aerosol and Air Quality Research Apr 2024Air pollution is the leading environmental cause of death globally, and most mortality occurs in resource-limited settings such as sub-Saharan Africa. The African...
Air pollution is the leading environmental cause of death globally, and most mortality occurs in resource-limited settings such as sub-Saharan Africa. The African continent experiences some of the worst ambient air pollution in the world, yet there are relatively little African data characterizing ambient pollutant levels and source admixtures. In Uganda, ambient PM levels exceed international health standards. However, most studies focus only on urban environments and do not characterize pollutant sources. We measured daily ambient PM concentrations and sources in Mbarara, Uganda from May 2018 through February 2019 using Harvard impactors fitted with size-selective inlets. We compared our estimates to publicly available levels in Kampala, and to World Health Organization (WHO) air quality guidelines. We characterized the leading PM sources in Mbarara using x-ray fluorescence and positive matrix factorization. Daily PM concentrations were 26.7 μg m and 59.4 μg m in Mbarara and Kampala, respectively (p<0.001). PM concentrations exceeded WHO guidelines on 58% of days in Mbarara and 99% of days in Kampala. In Mbarara, PM was higher in the dry as compared to the rainy season (30.8 vs 21.3, p<0.001), while seasonal variation was not observed in Kampala. PM concentrations did not vary on weekdays versus weekends in either city. In Mbarara, the six main ambient PM sources identified included (in order of abundance): traffic-related, biomass and secondary aerosols, industry and metallurgy, heavy oil and fuel combustion, fine soil, and salt aerosol. Our findings confirm that air quality in southwestern Uganda is unsafe and that mitigation efforts are urgently needed. Ongoing work focused on improving air quality in the region may have the greatest impact if focused on traffic and biomass-related sources.
PubMed: 38947180
DOI: 10.4209/aaqr.230203 -
MedRxiv : the Preprint Server For... Jun 2024Tongue swabs represent a potential alternative to sputum as a sample type for detecting pulmonary tuberculosis (TB) using molecular diagnostic tests. The methods used to...
UNLABELLED
Tongue swabs represent a potential alternative to sputum as a sample type for detecting pulmonary tuberculosis (TB) using molecular diagnostic tests. The methods used to process tongue swabs for testing in the WHO-recommended Xpert MTB/RIF Ultra (Xpert Ultra) assay vary greatly. We aimed to identify the optimal method for processing diagnostic tongue swabs for subsequent testing by Xpert Ultra. We compared four methods for treating dry tongue swabs with Xpert Ultra sample reagent (SR) mixed with various concentrations of Tris-EDTA-Tween (TET), to treatment with SR alone or to a commonly used SR-free heat-inactivation protocol. In each condition, swabs obtained from volunteers without TB were placed into test buffer spiked with known amounts of ( ) strain H37Rv-mc 6230. Swabs processed with 1:1 diluted SR buffer had the lowest limit of detection (LOD) at 22.7 CFU/700 µl (95% CI 14.2-31.2), followed by 2:1 diluted SR buffer at 30.3 CFU/700 µl (95% CI 19.9-40.7), neat SR at 30.9 CFU/700 µl (95% CI 21.5-40.3) and SR prefilled in the Xpert Ultra at 57.1 CFU/700 µl (95% CI 42.4-71.7). Swabs processed using the heat-based protocol had the highest LOD (77.6 CFU/700 µl; 95% CI 51.2-104.0). Similar findings were observed for LOD of RIF-susceptibility. Assay sensitivity using the 2:1 diluted SR buffer did not vary considerably in the presence of sputum matrix or phosphate buffer saline. Further studies are needed to assess the performance of this processing protocol in a clinical setting.
IMPORTANCE
Xpert MTB/RIF Ultra (Xpert Ultra) is approved by the World Health Organization for the diagnosis of tuberculosis (TB). This test is typically performed using sputum specimens obtained from people with presumptive TB. In order to inactivate and aid liquefaction, sputum must be mixed with Xpert SR prior to transfer into the Xpert Ultra. However, some people under evaluation for TB are unable to produce sputum. Alternative sample types for TB diagnosis would therefore be of value. Oral-swabs, including tongue-swabs have shown promise, but there are technical challenges associated with sample processing. In this study, several new tongue swab processing conditions were evaluated, utilizing SR, either neat or diluted in buffer. The ability of Xpert Ultra to detect TB was improved under these conditions compared with the previously published heat-processing method (1-3), processing steps were simplified, and technical challenges were overcome.
PubMed: 38947094
DOI: 10.1101/2024.06.20.24309244 -
Innovative COVID-19 Point-of-Care Diagnostics Suitable for Tuberculosis Diagnosis: A Scoping Review.MedRxiv : the Preprint Server For... Jun 2024Rapid and accurate point-of-care (POC) tuberculosis (TB) diagnostics are a key priority to close the TB diagnostic gap of 3.1 million people without a diagnosis....
INTRODUCTION
Rapid and accurate point-of-care (POC) tuberculosis (TB) diagnostics are a key priority to close the TB diagnostic gap of 3.1 million people without a diagnosis. Leveraging the recent surge in COVID-19 diagnostic innovation, we explored the potential adaptation of commercially available SARS-CoV-2 tests for TB diagnosis, aligning with World Health Organization (WHO) target product profiles (TPPs).
METHODS
A scoping review was conducted following PRISMA-ScR guidelines to systematically map commercially available POC molecular and antigen SARS-CoV-2 diagnostic tests potentially meeting the TPPs for TB diagnostic tests for peripheral settings. Data were gathered from PubMed/MEDLINE, bioRxiv, and medRxiv, along with publicly accessible in vitro diagnostic test databases, and developer websites, up to November 23, 2022. Data on developer and test attributes, operational characteristics, pricing, and clinical performance were charted using standardized data extraction forms. Each identified test was evaluated using a standardized scorecard. A narrative synthesis of the charted data is presented.
RESULTS
Our database search yielded 2,003 studies, from which 408 were considered eligible. Among these, we identified 58 commercialized diagnostic devices, including 17 near-POC antigen tests, one POC molecular test, 29 near-POC molecular tests, and 11 low-complexity molecular tests. We summarized the detailed characteristics, regulatory status, and clinical performance data of these tests. The LumiraDx (Roche, Switzerland) emerged as the highest- scoring near-POC antigen platform, while Visby (Visby, USA) was the highest-performing near-POC molecular platform. The Lucira Check-It (Pfizer, USA) was noted as the sole POC molecular test. The Idylla (Biocartis, Switzerland) was identified as the leading low- complexity molecular test.
DISCUSSION
We highlight a diverse landscape of commercially available diagnostic tests suitable for potential adaptation to TB POC testing. This work aims to bolster global TB initiatives by fostering stakeholder collaboration, leveraging COVID-19 diagnostic technologies for TB diagnosis, and uncovering new commercial avenues to tackle longstanding challenges in TB diagnosis.
PubMed: 38947060
DOI: 10.1101/2024.06.13.24308880 -
MedRxiv : the Preprint Server For... Jun 2024Computer-aided detection (CAD) algorithms for automated chest X-ray (CXR) reading have been endorsed by the World Health Organization for tuberculosis (TB) triage, but...
BACKGROUND
Computer-aided detection (CAD) algorithms for automated chest X-ray (CXR) reading have been endorsed by the World Health Organization for tuberculosis (TB) triage, but independent, multi-country assessment and comparison of current products are needed to guide implementation.
METHODS
We conducted a head-to-head evaluation of five CAD algorithms for TB triage across seven countries. We included CXRs from adults who presented to outpatient facilities with at least two weeks of cough in India, Madagascar, the Philippines, South Africa, Tanzania, Uganda, and Vietnam. The participants completed a standard evaluation for pulmonary TB, including sputum collection for Xpert MTB/RIF Ultra and culture. Against a microbiological reference standard, we calculated and compared the accuracy overall, by country and key groups for five CAD algorithms: CAD4TB (Delft Imaging), INSIGHT CXR (Lunit), DrAid (Vinbrain), Genki (Deeptek), and qXR (qure.AI). We determined the area under the ROC curve (AUC) and if any CAD product could achieve the minimum target accuracy for a TB triage test (≥90% sensitivity and ≥70% specificity). We then applied country- and population-specific thresholds and recalculated accuracy to assess any improvement in performance.
RESULTS
Of 3,927 individuals included, the median age was 41 years (IQR 29-54), 12.9% were people living with HIV (PLWH), 8.2% living with diabetes, and 21.2% had a prior history of TB. The overall AUC ranged from 0.774-0.819, and specificity ranged from 64.8-73.8% at 90% sensitivity. CAD4TB had the highest overall accuracy (73.8% specific, 95% CI 72.2-75.4, at 90% sensitivity), although qXR and INSIGHT CXR also achieved the target 70% specificity. There was heterogeneity in accuracy by country, and females and PLWH had lower sensitivity while males and people with a history of TB had lower specificity. The performance remained stable regardless of diabetes status. When country- and population-specific thresholds were applied, at least one CAD product could achieve or approach the target accuracy for each country and sub-group, except for PLWH and those with a history of TB.
CONCLUSIONS
Multiple CAD algorithms can achieve or exceed the minimum target accuracy for a TB triage test, with improvement when using setting- or population-specific thresholds. Further efforts are needed to integrate CAD into routine TB case detection programs in high-burden communities.
PubMed: 38946949
DOI: 10.1101/2024.06.19.24309061 -
MedRxiv : the Preprint Server For... Jun 2024Limited data are available on the diagnostic accuracy of blood RNA biomarker signatures for extrapulmonary TB (EPTB). We addressed this question among people...
BACKGROUND
Limited data are available on the diagnostic accuracy of blood RNA biomarker signatures for extrapulmonary TB (EPTB). We addressed this question among people investigated for TB lymphadenitis and TB pericarditis, in Cape Town, South Africa.
METHODS
We enrolled 440 consecutive adults referred to a hospital for invasive sampling for presumptive TB lymphadenitis (n=300) or presumptive TB pericarditis (n=140). Samples from the site of disease underwent culture and/or molecular testing for complex (Mtb). Discrimination of patients with and without TB defined by microbiology or cytology reference standards was evaluated using seven previously reported blood RNA signatures by area under the receiver-operating characteristic curve (AUROC) and sensitivity/specificity at predefined thresholds, benchmarked against blood C-reactive protein (CRP) and the World Health Organization (WHO) target product profile (TPP) for a TB triage test. Decision curve analysis (DCA) was used to evaluate the clinical utility of the best performing blood RNA signature and CRP.
RESULTS
Data from 374 patients for whom results were available from at least one microbiological test from the site of disease, and blood CRP and RNA measurements, were included. Using microbiological results as the reference standard in the primary analysis (N=204 with TB), performance was similar across lymphadenitis and pericarditis patients. In the pooled analysis of both cohorts, all RNA signatures had comparable discrimination with AUROC point estimates ranging 0.77-0.82, superior to that of CRP (0.61, 95% confidence interval 0.56-0.67). The best performing signature (Roe3) achieved an AUROC of 0.82 (0.77-0.86). At a predefined threshold of 2 standard deviations (Z2) above the mean of a healthy reference control group, this signature achieved 78% (72-83%) sensitivity and 69% (62-75%) specificity. In this setting, DCA revealed that Roe3 offered greater net benefit than other approaches for services aiming to reduce the number needed to investigate with confirmatory testing to <4 to identify each case of TB.
INTERPRETATION
RNA biomarkers show better accuracy and clinical utility than CRP to trigger confirmatory TB testing in patients with TB lymphadenitis and TB pericarditis, but still fall short of the WHO TPP for TB triage tests.
FUNDING
South African MRC, EDCTP2, NIH/NIAID, Wellcome Trust, NIHR, Royal College of Physicians London.
EVIDENCE BEFORE THIS STUDY
Blood RNA biomarker signatures and CRP measurements have emerged as potential triage tests for TB, but evidence is mostly limited to their performance in pulmonary TB. Microbiological diagnosis of extrapulmonary TB (EPTB) is made challenging by the need for invasive sampling to obtain tissue from the site of disease. This is compounded by lower sensitivity of confirmatory molecular tests for EPTB compared to their performance in pulmonary disease. We performed a systematic review of diagnostic accuracy studies of blood RNA biomarkers or CRP measurements for EPTB, which could mitigate the need for site-of-disease sampling for the diagnosis of TB. We searched PubMed up to 1 August 2023, using the following criteria: "extrapulmonary [title/abstract] AND tuberculosis [title/abstract] AND biomarker [title/abstract]". Although extrapulmonary TB was included in several studies, none focused specifically on EPTB or included an adequate number of EPTB cases to provide precise estimates of test accuracy.
ADDED VALUE OF THIS STUDY
To the best of our knowledge, we report the first diagnostic accuracy study of blood RNA biomarkers and CRP for TB among people with EPTB syndromes. We examined the performance of seven previously identified blood RNA biomarkers as triage tests for TB lymphadenitis and TB pericarditis compared to a microbiology reference standard among people referred to hospital for invasive sampling in a high TB and HIV prevalence setting. Multiple blood RNA biomarkers showed comparable diagnostic accuracy to that previously reported for pulmonary TB in both EPTB disease cohorts, irrespective of HIV status. All seven blood RNA biomarkers showed superior diagnostic accuracy to CRP for both lymphadenitis and pericarditis, but failed to meet the combined >90% sensitivity and >70% specificity recommended for a blood-based diagnostic triage test by WHO. Nonetheless, in decision curve analysis, an approach of using the best performing blood RNA biomarker to trigger confirmatory microbiological testing showed superior clinical utility in clinical services seeking to reduce the number needed to test (using invasive confirmatory testing) to less than 4 for each EPTB case detected. If acceptable to undertake invasive testing in more than 4 people for each true case detected, then a test-all approach will provide greater net benefit in this TB/HIV hyperendemic setting.
IMPLICATIONS OF ALL THE AVAILABLE EVIDENCE
Blood RNA biomarkers show some potential as diagnostic triage tests for TB lymphadenitis and TB pericarditis, but do not provide the level of accuracy for blood-based triage tests recommended by WHO for community-based tests. CRP has inferior diagnostic accuracy to blood RNA biomarkers and cannot be recommended for diagnostic triage among people with EPTB syndromes referred for invasive sampling.
PubMed: 38946942
DOI: 10.1101/2024.06.21.24309099 -
European Review For Medical and... Jun 2024The World Health Organization (WHO) declared that the human papillomavirus (HPV) is the most widespread infection that affects women's reproductive system. HPV is a...
OBJECTIVE
The World Health Organization (WHO) declared that the human papillomavirus (HPV) is the most widespread infection that affects women's reproductive system. HPV is a serious concern to women's health, as it has a negative impact on women's quality of life. Approximately 70% of all occurrences of cervical cancer globally are caused by HPV strains 16 and 18. A few studies have found that HPV vaccinations play a significant role in protecting women against HPV infections. This study aims to identify the effectiveness of the HPV vaccine and to examine the influence of this vaccine on women's health.
MATERIALS AND METHODS
EBSCO, PubMed, Cochrane, Google Scholar, Science Direct, and ProQuest were selected as electronic databases for systematic research. The inclusion criteria encompassed studies published in English from January 2019 to August 2023, evaluating the effectiveness of the HPV vaccine in women aged 18-76 years globally. This review included different types of studies, including cross-sectional, retrospective cohort, original randomized controlled trials, and prospective studies. Moreover, the included studies were evaluated using the Jonna Briggs Institute (JBI) methodological quality checklist tool. Two reviewers assessed the methodological quality of all studies using JBI guidelines.
RESULTS
The search identified 11,095 articles, 19 of which were included in this review. Significant findings were found regarding the relationship between HPV vaccines and women's health.
CONCLUSIONS
This review highlights the importance of the HPV vaccine and its administration among women to promote their health and prevent future infections.
Topics: Humans; Female; Papillomavirus Vaccines; Papillomavirus Infections; Women's Health; Uterine Cervical Neoplasms; Adolescent; Adult; Middle Aged; Quality of Life; Young Adult; Aged
PubMed: 38946386
DOI: 10.26355/eurrev_202406_36464 -
Langmuir : the ACS Journal of Surfaces... Jul 2024Atmospheric water harvesting (AWH) technology is a new strategy for alleviating freshwater scarcity. Adsorbent materials with high hygroscopicity and high photothermal...
Green Synthesis of Polyurethane Sponge-Grafted Calcium Alginate with Carbon Ink Aerogel with High Water Vapor Harvesting Capacity for Solar-Driven All-Weather Atmospheric Water Harvesting.
Atmospheric water harvesting (AWH) technology is a new strategy for alleviating freshwater scarcity. Adsorbent materials with high hygroscopicity and high photothermal conversion efficiency are the key to AWH technology. Hence, in this study, a simple and large-scale preparation for a hygroscopic compound of polyurethane (PU) sponge-grafted calcium alginate (CA) with carbon ink (SCAC) was developed. The PU sponge in the SCAC aerogel acts as a substrate, CA as a moisture adsorber, and carbon ink as a light adsorber. The SCAC aerogel exhibits excellent water absorption of 0.555-1.40 g·g within a wide range of relative humidity (40-80%) at 25 °C. The SCAC aerogel could release adsorbed water driven by solar energy, and more than 92.17% of the adsorbed water could be rapidly released over a wide solar intensity range of 1.0-2.0 sun. In an outdoor experiment, 57.517 g of SCAC was able to collect 32.8 g of clean water in 6 h, and the water quality meets the drinking water standards set by the World Health Organization. This study suggests a new approach to design promising AWH materials and infers the potential practical application of SCAC aerogel-based adsorbents.
PubMed: 38946296
DOI: 10.1021/acs.langmuir.4c01119 -
Journal of Advanced Nursing Jun 2024To review the current nursing and midwifery contribution to leading digital health (DH) policy and practice and what facilitates and/or challenges this. (Review)
Review
AIM
To review the current nursing and midwifery contribution to leading digital health (DH) policy and practice and what facilitates and/or challenges this.
DESIGN
Integrative literature review.
METHODS
Pre-defined inclusion criteria were used. Study selection and quality assessment using the appropriate critical appraisal tools were undertaken by two authors, followed by narrative synthesis.
DATA SOURCES
Six databases and hand searching for papers published from 2012 to February 2024.
FINDINGS
Four themes were identified from 24 included papers. These are discussed according to the World Health Organization's Global Strategic Directions for Nursing and Midwifery and indicate nurses/midwives are leading DH policy and practice, but this is not widespread or systematically enabled.
CONCLUSION
Nurses and midwives are ideally placed to help improve health outcomes through digital healthcare transformation, but their policy leadership potential is underused.
IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE
Nurses/midwives' DH leadership must be optimized to realize maximum benefit from digital transformation. A robust infrastructure enabling nursing/midwifery DH policy leadership is urgently needed.
IMPACT
This study addresses the lack of nursing/midwifery voice in international DH policy leadership. It offers nurses/midwives and health policymakers internationally opportunity to: drive better understanding of nursing/midwifery leadership in a DH policy context; enhance population outcomes by optimizing their contribution; Develop a robust infrastructure to enable this.
REPORTING METHOD
Reporting adheres to the EQUATOR network, Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines.
PATIENT OR PUBLIC CONTRIBUTION
No patient or public contribution.
PubMed: 38946119
DOI: 10.1111/jan.16265 -
Cancer Cytopathology Jun 2024The World Health Organization (WHO) classification system revised the Papanicolaou Society of Cytopathology (PSC) system for reporting pancreaticobiliary cytopathology....
BACKGROUND
The World Health Organization (WHO) classification system revised the Papanicolaou Society of Cytopathology (PSC) system for reporting pancreaticobiliary cytopathology. To better stratify intraductal and/or cystic neoplasms by cytologic grade, the neoplastic, other category was replaced by two new categories: pancreaticobiliary neoplasm, low-risk/grade (PaN-Low) and pancreaticobiliary neoplasm, high-risk/grade (PaN-High). Low-grade malignancies were placed in the malignant category, and benign neoplasms were placed in the benign/negative for malignancy category.
METHODS
An institutional pathology database search identified patients who underwent endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for pancreatic lesions from January 2015 to April 2022. The absolute risk of malignancy (ROM) was determined by histologic and/or clinical follow-up of at least 6 months, and overall survival rates were calculated across diagnostic categories, comparing the WHO and PSC systems.
RESULTS
In total, 1012 cases were reviewed and recategorized. The ROM for the WHO system was 8.3% for insufficient/inadequate/nondiagnostic, 3.2% for benign/negative for malignancy, 24.6% for atypical, 9.1% for PaN-Low, 46.7% for PaN-High, 75% for suspicious for malignancy, and 100% for malignant. Comparatively, the ROM for the PSC system was 7.4% for nondiagnostic, 3.0% for negative for malignancy, 23.1% for atypical, 0% for neoplastic, benign, 7.3% for neoplastic, other, 75% for suspicious for malignancy, and 100% for malignant. The WHO system demonstrated superior stratification for overall survival.
CONCLUSIONS
The WHO system significantly improves the stratification of ROM and overall survival across diagnostic categories by introducing the PaN-Low and PaN-High categories and reassigning low-grade malignancies to the malignant category. Analyzing EUS-FNA samples with the WHO system provides critical insights for guiding clinical management.
PubMed: 38944695
DOI: 10.1002/cncy.22880