Do axillary sentinel lymph node micrometastases predict involvement of the non-sentinel lymph nodes in breast cancer?

Palazuelo, PabloLlibre obert fet amb planxes d'acer inoxidable. Fet en motiu del 150è aniversari del naixement de mossèn Jacint Verdaguer. Ubicada davant la finca Vil·la Joana, on el mossèn va morir. N'hi ha un altre al poble de Folgueroles

Evaluation of BACTEC™ FX and BacT/Alert™ Automated Blood Culture Systems for Detection of Clinically Relevant Bacterial and Yeast Species

Background: Bloodstream infections (BSI) are a significant health concern, necessitating effective diagnostic tools. This study evaluates the performance of the BD Bactec FX system in comparison to the established BacT/Alert system, examining mean time till detection (TTD) across various blood culture bottles.Methods: The study involves 148 blood culture bottles, inoculated with representative bacterial ATCC strains (n= 15) and 04 yeast isolates. Parallel testing is conducted by seeding 10–30 colony-forming units (CFU) in duplicate in both BD Bactec FX and BacT/Alert systems. TTD is assessed across aerobic, anaerobic, and pediatric bottles for diverse microbial species.Results: All 148 bottles tested in parallel show positive signals in both systems. BD Bactec FX demonstrates significantly shorter TTD for adult-seeded cultures in aerobic and anaerobic bottles compared to BacT/Alert Similarly, pediatric bottles with BD Bactec FX exhibit a shorter TTD compared to BacT/Alert. The statistical significance of TTD, 95% confidence intervals (CI), and p-values is evident for Bactec FX aerobic, anaerobic, and pediatric bottles across tested organisms. Notable examples of faster TTD include; Bacteroides ovatus (16.6h by Bactec FX vs. 70.5h by Bact/Alert 3D), Stenotrophomonas maltophilia (33.7h vs. 72.5h), and Streptococcus pyogenes (8.1h vs. 11.9h).Conclusions: In conclusion, the study’s findings demonstrate that BD Bactec FX surpasses BacT/Alert in prompt microbial detection, showcasing potential for early identification of bacteremia and fungemia. Faster TTD implies the potential to initiate timely antimicrobial treatment, thereby reducing patient morbidity and mortality. However, exceptions in certain microbial species highlight the need for comprehensive clinical validation to establish the broad applicability of these findings.Keywords: Blood Culture System; Recovery Rate; Time to detection; Blood stream infection; BTA3D; Bactec FX 

Self-directed learning: health care professional’s perspective - A study

Background: Self-directed learning is a teaching learning method emphasized as a part of newly developed competency based medical education (CBME) which was implemented in 2019 and since then it is an active part of the curriculum. Aims and Objectives: To evaluate the shift in learning process from teacher based education to a student based instruction by assessment of Self-Directed Learning Readiness (SDLR) scores among health professional’s medical students, nursing students, Physiotherapy and Pharmacy students. Material and Methods: A questionnaire based prospective observational study was done in Deccan College of Medical Sciences from Aug 2022 to October 2022. Statistical analysis was done using R language. Results: Maximum SDLR score obtained was 105 and minimum was 21. Scores 80 as high. SDLR scores of most students were low. The scores were comparable to other studies like a South Indian study done who reported a mean SDLRS score in the low readiness category and some studies scores were high readiness to learn. Conclusion: Most students are ready for self- directed learning but their scores need to improve

The evolving role of social media in enhancing quality of life: a global perspective across 10 countries

Background: Excessive or inappropriate use of social media has been linked to disruptions in regular work, well-being, mental health, and overall reduction of quality of life. However, a limited number of studies documenting the impact of social media on health-related quality of life (HRQoL) are available globally. Aim: This study aimed to explore the perceived social media needs and their impact on the quality of life among the adult population of various selected countries. Methodology: A cross-sectional, quantitative design and analytical study utilized an online survey disseminated from November to December 2021. Results: A total of 6689 respondents from ten countries participated in the study. The largest number of respondents was from Malaysia (23.9%), followed by Bangladesh (15.5%), Georgia (14.8%), and Turkey (12.2%). The prevalence of social media users was over 90% in Austria, Georgia, Myanmar, Nigeria, and the Philippines. The majority of social media users were from the 18–24 age group. Multiple regression analysis showed that higher education level was positively correlated with all four domains of WHOQoL. In addition, the psychological health domain of quality of life was positively associated in all countries. Predictors among Social Media Needs, Affective Needs (β = -0.07), and Social Integrative Needs (β = 0.09) were significantly associated with psychological health. Conclusion: The study illuminates the positive correlation between higher education levels and improved life quality among social media users, highlighting an opportunity for policymakers to craft education-focused initiatives that enhance well-being. The findings call for strategic interventions to safeguard the mental health of the global social media populace, particularly those at educational and health disadvantages

HER2-enriched subtype and novel molecular subgroups drive aromatase inhibitor resistance and an increased risk of relapse in early ER+/HER2+ breast cancer

BACKGROUND: Oestrogen receptor positive/ human epidermal growth factor receptor positive (ER+/HER2+) breast cancers (BCs) are less responsive to endocrine therapy than ER+/HER2- tumours. Mechanisms underpinning the differential behaviour of ER+HER2+ tumours are poorly characterised. Our aim was to identify biomarkers of response to 2 weeks’ presurgical AI treatment in ER+/HER2+ BCs. METHODS: All available ER+/HER2+ BC baseline tumours (n=342) in the POETIC trial were gene expression profiled using BC360™ (NanoString) covering intrinsic subtypes and 46 key biological signatures. Early response to AI was assessed by changes in Ki67 expression and residual Ki67 at 2 weeks (Ki672wk). Time-To-Recurrence (TTR) was estimated using Kaplan-Meier methods and Cox models adjusted for standard clinicopathological variables. New molecular subgroups (MS) were identified using consensus clustering. FINDINGS: HER2-enriched (HER2-E) subtype BCs (44.7% of the total) showed poorer Ki67 response and higher Ki672wk (p<0.0001) than non-HER2-E BCs. High expression of ERBB2 expression, homologous recombination deficiency (HRD) and TP53 mutational score were associated with poor response and immune-related signatures with High Ki672wk. Five new MS that were associated with differential response to AI were identified. HER2-E had significantly poorer TTR compared to Luminal BCs (HR 2.55, 95% CI 1.14–5.69; p=0.0222). The new MS were independent predictors of TTR, adding significant value beyond intrinsic subtypes. INTERPRETATION: Our results show HER2-E as a standardised biomarker associated with poor response to AI and worse outcome in ER+/HER2+. HRD, TP53 mutational score and immune-tumour tolerance are predictive biomarkers for poor response to AI. Lastly, novel MS identify additional non-HER2-E tumours not responding to AI with an increased risk of relapse

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown