Limited role of multi-attribute utility scale and SF-36 in predicting management outcome of heavy menstrual bleeding

Objective

To compare the value of SF36v2 versus multi-attribute utility score (MAS) for predicting treatment outcome in heavy menstrual bleeding (HMB).

Study design

Longitudinal observational study, in an outpatient service of a large UK teaching hospital. 193 women took part. Women were asked to complete SF36v2 and a multi-attribute utility score (MAS) for menorrhagia before the first consultation. Patient management was determined through an evidence based guideline and blind to their response to the questionnaire. Treatment outcome at 8 months was examined in relation to the physical (PCS) and mental (MCS) health summary scales of SF36v2 and to MAS.

Results

At study entry equal numbers of patients, 179 (93%), returned usable responses for SF36v2 and the multi-attribute scale; 178 (92%) returned both. Baseline SF36v2 scores for role physical, bodily pain, social functioning and mental health were significantly lower (p < 0.05) for the group of women who finally required surgery, but the difference in PCS or MCS was not statistically significant. The mean MAS score for those who did not need surgery was 50.7, and for those who needed surgery following failed medical treatment was 35.06. The difference was statistically significant (p < 0.001, 95% CI 7.47–23.82). Using logistic regression analysis there was a statistically significant association between baseline MAS but not MCS or PCS and the need for surgery. However, there was considerable overlap between treatment groups.

Conclusions

MAS may be a better predictor of management outcome compared to SF36v2 for HMB; but its utility for the individual patient is limited.     

Therapeutic Outcome of Anti-inflammatory and Antioxidative Medicines on the Dermonecrotic Activity of Cerastes cerastes Venom

Inflammation - Envenomation by Cerastes cerastes often results in local dermonecrotic lesions. While immunotherapy is effective in reversing systemic symptoms, this strategy remains deficient in...     

Endometrial responses to hormone replacement therapy: the bleeding pattern

Little information is available concerning the response of theendometrium to exogenous sex steroid therapy, particularly inthe post-menopausal state. In this study we examined the variabilityof the bleeding pattern in 103 post-menopausal women receivingcyclical sequential combined hormone replacement therapy (HRT)over 6 months. All patients kept menstrual diary cards to recordthe onset, duration and subjective assessment of the severityof bleeding. We defined a cycle as starting from the commencementof treatment till the day of onset of bleeding. Two groups wereidentified amongst 99 women who experienced bleeding: thosewith a mean cycle length of 29 or more days (late bleeders,n = 50) and those with shorter mean cycle length (early bleeders,n = 49). The former were characterized by less variability incycle length and bleeding that was of shorter duration. Fourwomen experienced no bleeding. There were no significant differencesbetween the two groups in age, year since the menopause, weight,height, body mass index (BMI), parity, or in the previous useof HRT. The only significant difference was in their smokinghabits. This suggests a possible link of a hypo-oestrogenicstate to poor cycle control.     

The Effects of Bariatric Surgery on Vitamin B Status and Mental Health

Diet is a modifiable factor that ensures optimal growth, biochemical performance, improved mood and mental functioning. Lack of nutrients, notably vitamin B, has an impact on human health and wellbeing. The United Arab Emirates is facing a serious problem of micronutrient deficiencies because of the growing trend for bariatric surgery, including Roux-en-Y gastric bypass and sleeve gastrectomy. People undergoing bariatric surgery are at high risk of developing neurological, cognitive, and mental disabilities and cardiovascular disease due to deficiency in vitamin B. Vitamin B is involved in neurotransmitter synthesis, including γ-aminobutyric acid, serotonin, dopamine, and noradrenaline. Deficiency of vitamin B increases the risk of depression, anxiety, dementia and Alzheimer’s disease. In addition, vitamin B deficiency can disrupt the methylation of homocysteine, leading to hyperhomocysteinemia. Elevated homocysteine levels are detrimental to human health. Vitamin B deficiency also suppresses immune function, increases the production of pro-inflammatory cytokines and upregulates NF-κB. Considering the important functions of vitamin B and the severe consequences associated with its deficiency following bariatric surgery, proper dietary intervention and administration of adequate supplements should be considered to prevent negative clinical outcomes.     

Porous sorbents for the capture of radioactive iodine compounds: a review

The number of studies on the capture of radioactive iodine compounds by porous sorbents has regained major importance in the last few years. In fact, nuclear energy is facing major issues related to operational safety and the treatment and safe disposal of generated radioactive waste. In particular during nuclear accidents, such as that in 2011 at Fukushima, gaseous radionuclides have been released in the off-gas stream. Among these, radionuclides that are highly volatile and harmful to health such as long-lived ¹²⁹I, short-lived ¹³¹I and organic compounds such as methyl iodide (CH₃I) have been released. Immediate and effective means of capturing and storing these radionuclides are needed. In the present review, we focus on porous sorbents for the capture and storage of radioactive iodine compounds. Concerns with, and limitations of, the existing sorbents with respect to operating conditions and their capacities for iodine capture are discussed and compared.

In the capture of radioactive iodine compounds by porous sorbents, concerns with, and limitations of, the existing sorbents with respect to operating conditions and their capacities for iodine capture are discussed and compared.     

Postural blood pressure electrocardiographic changes are associated with falls in older people

Objectives

To determine the magnitude of postural blood pressure change, differences in ECG between fallers and non-fallers were measured. Postural blood pressure change is associated with symptoms of dizziness, presyncope, and syncope.

Methods

In this cross-sectional study were included participants from The Malaysian Falls Assessment and Intervention Trial: fallers, aged 65 years or older with two or more falls or one injurious fall in 12 months, from a teaching hospital; and non-fallers, aged 65 years and older found through word-of-mouth and advertising. Noninvasive beat-to-beat blood pressure was measured at 10 min supine rest and 3 min standing. The maximal drop in systolic and diastolic pressure was calculated from a 12-lead ECG interpreted by a cardiologist. Basic demographics, medical history, and symptoms of dizziness, presyncope, and syncope were recorded for all patients.

Results

We recruited 155 fallers and 112 non-fallers. Fallers had a significantly longer PR interval (179 ± 32 vs. 168 ± 27 ms, p = 0.013) and a longer corrected QT interval (449 ± 41 vs. 443 ± 39 msec, p = 0.008), and larger change in SBP (28 ± 14 vs. 19 ± 9 mmHg, p < 0.001) with posture change. SBP drop of ≥30mmHg associated with recurrent and injurious falls [odds ratio [95 % confidence interval] = 7.61 (3.18–18.21)]. The changes remained significant after adjustment for symptoms of dizziness, presyncope and syncope.

Interpretation

Older individuals with recurrent and injurious falls have significantly longer PR and QT intervals and larger SBP reduction with posture change as compared to non-fallers, and these are not explained by the presence of dizziness, presyncope, or syncope. SBP cut-off of ≥30mmHg considered for postural measurements using continuous BP monitors, the significance of this value needs to be evaluated.

     

A Comparative Study of Trabecular Bone Mass Distribution in Cursorial and Non‐Cursorial Limb Joints

Skeletal design among cursorial animals is a compromise between a stable body that can withstand locomotor stress and a light design that is energetically inexpensive to grow, maintain, and move. Cursors have been hypothesized to reduce distal musculoskeletal mass to maintain a balance between safety and energetic cost due to an exponential increase in energetic demand observed during the oscillation of the distal limb. Additionally, experimental research shows that the cortical bone in distal limbs experiences higher strains and remodeling rates, apparently maintaining lower mass at the expense of a smaller safety factor. This study tests the hypothesis that the trabecular bone mass in the distal limb epiphyses of cursors is relatively lower than that in the proximal limb epiphyses to minimize the energetic cost of moving the limb. This study utilized peripheral quantitative computed tomography scanning to measure the trabecular mass in the lower and upper limb epiphyses of hominids, cercopithecines, and felids that are considered cursorial and non‐cursorial. One‐way ANOVA with Tukey post hoc corrections was used to test for significant differences in trabecular mass across limb epiphyses. The results indicate that overall, both cursors and non‐cursors exhibit varied trabecular mass in limb epiphyses and, in certain instances, conform to a proximal–distal decrease in mass irrespective of cursoriality. Specifically, hominid and cercopithecine hind limb epiphyses exhibit a proximal–distal decrease in mass irrespective of cursorial adaptations. These results suggest that cursorial mammals employ other energy saving mechanisms to minimize energy costs during running. Anat Rec, 298:797–809, 2015. © 2014 Wiley Periodicals, Inc.     

Patient age and positive margins are predictive factors of residual tumor on mastectomy specimen after conservative treatment for breast cancer

AimsTo determine factors predictive of the presence of residual tumor on the specimen from mastectomy performed after conservative treatment for breast cancer in order to limit potentially unnecessary mastectomies (free of residual lesions).Materials and methods294 patients treated in 2 expert centers for breast cancer with breast-conserving therapy (BCT) followed by mastectomy, according to French recommendations, were investigated between January 1, 1998 and January 1, 2005. Patients with residual tumor on the mastectomy specimen were compared with patients whose mastectomy specimens did not reveal any residual tumor. All the clinical risk factors (age, previous history of breast cancer, tumor focality) and histological risk factors (tumor size, histological type, positive margins, estrogen and progesterone receptor expression, histological grade) for residual tumor after BCT were compared between the 2 patient groups.ResultsOf the 294 patients studied, 202 (68.71%) mastectomies had residual tumor and 92 (31.29%) were tumor-free. Four predictive factors for residual tumor were found in the univariate analysis: age under 45 years (p = 0.01), absence of estrogen receptor expression (p = 0.05), positive margins (p = 0.01), and presence of lymph node metastases (p = 0.05). The multivariate analysis revealed only 2 independent risk factors that were significantly associated with increased risk of residual tumor on the mastectomy specimen: age under 45 years (p = 0.05) and presence of positive margins on the lumpectomy specimen (p = 0.05).ConclusionYoung age of patients (under 45-years-old) and presence of positive margins on the operative specimen are independent risk factors of residual tumor after conservative treatment of breast cancer.