Background - Strict isolation measures and interrupted healthcare services during the COVID 19 pandemic are contemplated to instigate stress universally, particularly in those with chronic illnesses such as Type 1 Diabetes (T1D).Objective- To evaluate perceived stress towards COVID-19 among T1D individuals.Study Design - A cross-sectional, observational study. Participants - Adolescents and young adults (aged 10 - 25), living with T1D; and age, gender matched controls.Interventions - An online, semi-structured survey including Perceived Stress Scale. Outcomes - Determinants of stress and its impact on glycemic control.Results - A total of 97 cases (49 males; mean age 18.8 ± 4.5 years), diagnosed with T1D (mean diabetes duration 8.0 ± 5.0 years; mean HBA1C 8.1 ± 1.5%) completed the survey. Among cases, 53.6% reported moderate stress; 41.2% low stress and 5.2% severe stress. No significant difference was observed in the mean PSS score between the cases and controls. Cases with higher PSS scores tracked pandemic-related updates with significantly lesser frequency than those with lower scores (mean rank 78.75; p = 0.01). High PSS score was significantly associated with HbA1C over last 6 months (r 0.276; p = 0.015) and worsened glycemic control (mean rank 63.97 p = 0.012). Conclusion- An increased apprehension was seen regarding the acquisition of optimal diabetes management and care during the current infectious outbreak. Tele-medicine could emerge as an effective tool and a promising initiative to manage T1D patients during the pandemic.
Background: Minimally invasive spinal surgery (MISS) and endoscopic spine surgery (ESS) are both well-established surgical techniques for lumbar spinal stenosis; however, there is limited literature comparing the efficacy of the two techniques with respect to radiological decompression data. Methods: In this review, PubMed, Google Scholar, and Scopus databases were systematically searched from inception until July 2022 for studies that reported the radiological outcomes of endoscopic and minimally invasive approaches for decompressive spinal surgery, namely, the spinal canal area, neural foraminal area, and neural foraminal heights. Results: Out of the 378 papers initially retrieved using MeSH and keyword search, nine studies reporting preoperative and postoperative spinal areas and foraminal areas and height were finally included in our review. A total of 581 patients: 391 (67.30%) underwent MISS and 190 (32.70%) underwent ESS. The weighted mean difference between the canal diameter in pre-operative and post-operative conditions was 56.64 ± 7.11 mm2 and 79.52 ± 21.31 mm2 in the MISS and ESS groups, respectively. ESS was also associated with higher mean difference in the foraminal area postoperatively (72 ± 1 mm2 vs. 35.81 ± 11.3 mm2 in MISS and ESS groups, respectively) but was comparable to MISS in terms of the foraminal height (0.32 ± 0.037 vs. 0.29 ± 0.03 cm in the MISS and endoscopic groups, respectively). Conclusions: Compared to MISS, ESS was associated with improved radiological parameters, including spinal canal area and neural foraminal area in the lumbar spinal segments. Both techniques led to the same endpoint of neural decompression when starting with more severe compression. However, the present data does not allow the correlation of the radiographic results with the related clinical outcomes.
Background: The COVID-19 pandemic seems to have influenced lifestyle behaviors and diabetes self-management practices. The aim of the present study is to determine the impact of psychological stress on various lifestyle behaviors, diabetes self-management practices, and glycemic control among Indian adults with type 2 diabetes (T2D), amidst the COVID-19 pandemic. Materials and Methods: This was a cross-sectional observational study. The data pertaining to psychological stress, lifestyle behaviors, diabetes self-management practices, and glycemic control were collected at two time-points (before and after lockdown). Results: A total of 252 T2D patients (145 males, 57.5%) with mean age 51.2 ± 9.8 years and mean diabetes duration of 8.5 ± 6.3 years participated in the study. A statistically significant decrease in body mass index (27.68 vs. 27.22 kg/m2; P < 0.0001) and an increase in HbA1c was noted in the post-lockdown period (8.31% vs. 8.70%; P < 0.0001). The mean Impact of Event Scale-Revised (IES-R) score was 19.3 ± 11.6. No significant correlation of mean IES-R score was observed with the age of the participants (r =−0.077, P = 0.224) and diabetes duration (r = 0.002, P = 0.970). Female gender (mean rank 140.4; P = 0.007) and co-existing hypertension (mean rank 132.18; P = 0.016) were associated with significantly higher IES-R score. No impact of total IES-R score was seen on the various lifestyle behaviors, diabetes self-management practices, and glycemic control. Conclusion: Psychological stress was higher among female gender and those with co-existing hypertension. Further, glycemic control worsened despite preserved diabetes self-management practices.
Purpose: To investigate the ability of radiotherapy (RT) to prolong progression-free survival (PFS) and to report treatment-related toxicities among oligoprogressive metastatic Merkel cell carcinoma (mMCC) patients on avelumab. Methods: We retrospectively collected clinical data on mMCC patients who underwent radiotherapy for limited progression on avelumab. Patients were categorized as primary or secondary immune refractory depending on the time of onset of resistance to immunotherapy (at the first or subsequent follow-up visits after avelumab initiation). Pre- and post-RT PFS were calculated. Overall survival (OS) from the first progression treated with RT was also reported. Radiological responses and toxicities were evaluated according to the irRECIST criteria and RTOG scoring system, respectively. Results: Eight patients, including five females, with a median age of 75 years, met our inclusion criteria. The median gross tumor and clinical target volumes at first progression on avelumab were 29.85 cc and 236.7 cc, respectively. The treatment sites included lymph node, skin, brain, and spine metastases. Four patients received more than one course of RT. Most patients were treated with palliative radiation doses (mainly 30 Gy in 3 Gy/day fractions). Two patients were treated with stereotactic RT. Five/eight patients were primary immune refractory. The objective response rate at the first post-RT assessment was 75%, whereas no local failure was reported. The median pre-RT PFS was 3 months. The pre-RT PFS was 37.5% at 6 months and 12.5% at 1 year. The median post-RT PFS was not reached. The post-RT PFS was 60% at 6 months and 1 year. The post-RT OS was 85.7% at 1 year and 64.3% at 2 years. No relevant treatment-related toxicity was observed. After a median follow-up of 18.5 months, 6/8 patients are still alive and continuing on avelumab therapy. Conclusions: Adding radiotherapy to mMCC patients with limited progression on avelumab seems to be safe and effective in prolonging the successful use of immunotherapy, regardless of the type of immune refractoriness.
Background: Strict isolation measures imposed during the coronavirus disease (COVID-19) pandemic have confined families in their homes, interrupted functioning of schools and colleges, and disrupted play and exploration time. Aim: The aim was to analyze psychological stress and its determinants among Indian adolescents and young adults during the COVID-19 pandemic. Methodology: A cross-sectional, observational study design was adopted. A semi-structured survey including demographic details, COVID-19 awareness, Perceived Stress Scale (PSS-10), and coping methods was distributed among 12–24 year olds, and analyzed to study the determinants of stress. Results: Out of a total of 235 (112 males; 19.4 ± 4.0 years) participants, nearly half of the participants (53%) reported moderate stress; low stress was perceived by 42.3% and severe stress was observed in 4.7%. The mean PSS score was 13.4 ± 8.9. Higher PSS score was associated with age (r = 0.194, P = 0.003), female gender (mean rank = 132.0, P = 0.001), higher education (mean rank = 154.5, P = 0.006), salaried occupation (mean rank = 143.79, P = 0.047), dissatisfaction with the available information (mean rank = 155.64, P = 0.009), and accessing information multiple times a day (mean rank = 133.51, P = 0.041). On multivariate linear regression analysis, age, gender, dissatisfaction with the available information, and higher frequency of accessing information were identified as significant correlates of mean PSS-10 score. Conclusion: Stress was highly prevalent among the Indian adolescents and young adults during the pandemic. Older age, female gender, higher education, salaried job, dissatisfaction toward the available information, and a tendency to view updates frequently were associated with higher stress levels.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.