Diagnostic performance and clinical impact of 68Ga-PSMA-11 imaging in early relapsed prostate cancer after radical therapy: a prospective multicenter study (IAEA-PSMA study)

Biochemical recurrence (BCR) is a clinical challenge in prostate cancer (PCa) patients, as recurrence localization guides subsequent therapies. The use of PET with prostate-specific membrane antigen (PSMA) provides better accuracy than conventional imaging practice. This prospective, multicenter, international study was performed to evaluate the diagnostic performance and clinical impact of PSMA PET/CT for evaluating BCR in PCa patients in a worldwide scenario. Methods: Patients were recruited from 17 centers in 15 countries. Inclusion criteria were histopathologically proven prostate adenocarcinoma, previous primary treatment, clinically established BCR, and negative conventional imaging (CT plus bone scintigraphy) and MRI results for patients with PSA levels of 4–10 ng/mL. All patients underwent PET/CT scanning with ⁶⁸Ga-PSMA-11. Images and data were centrally reviewed. Multivariate logistic regression analysis was applied to identify the independent predictors of PSMA-positive results. Variables were selected for this regression model on the basis of significant associations in the univariate analysis and previous clinical knowledge: Gleason score, the PSA level at the time of the PET scan, PSA doubling time, and primary treatment strategy. All patients were monitored for a minimum of 6 mo. Results: From a total of 1,004 patients, 77.7% were treated initially with radical prostatectomy and 22.3% were treated with radiotherapy. Overall, 65.1% had positive PSMA PET/CT results. PSMA PET/CT positivity was correlated with the Gleason score, PSA level at the time of the PET scan, PSA doubling time, and radiotherapy as the primary treatment (P < 0.001). Treatment was modified on the basis of PSMA PET/CT results in 56.8% of patients. PSMA PET/CT positivity rates were consistent and not statistically different among countries with different incomes. Conclusion: This multicenter, international, prospective trial of PSMA PET/CT confirmed its capability for detecting local and metastatic recurrence in most PCa patients in the setting of BCR. PSMA PET/CT positivity was correlated with the Gleason score, PSA level at the time of the PET scan, PSA doubling time, and radiotherapy as the primary treatment. PSMA PET/CT results led to changes in therapeutic management in more than half of the cohort. The study demonstrated the reliability and worldwide feasibility of PSMA PET/CT in the workup of PCa patients with BCR.

Inhibition and kinetic studies of cellulose- and hemicellulose-degrading enzymes of Ganoderma boninense by naturally occurring phenolic compounds

AIM

Ganoderma sp, the causal pathogen of the basal stem rot (BSR) disease of oil palm, secretes extracellular hydrolytic enzymes. These play an important role in the pathogenesis of BSR by nourishing the pathogen through the digestion of cellulose and hemicellulose of the host tissue. Active suppression of hydrolytic enzymes secreted by Ganoderma boninense by various naturally occurring phenolic compounds and estimation of their efficacy on pathogen suppression is focused in this study.

METHODS AND RESULTS

Ten naturally occurring phenolic compounds were assessed for their inhibitory effect on the hydrolytic enzymes of G. boninense. The enzyme kinetics (V_max and K_m ) and the stability of the hydrolytic enzymes were also characterized. The selected compounds had shown inhibitory effect at various concentrations. Two types of inhibitions namely uncompetitive and noncompetitive were observed in the presence of phenolic compounds. Among all the phenolic compounds tested, benzoic acid was the most effective compound suppressive to the growth and production of hydrolytic enzymes secreted by G. boninense. The phenolic compounds as inhibitory agents can be a better replacement for the metal ions which are known as conventional inhibitors till date. The three hydrolytic enzymes were stable in a wide range of pH and temperature.

CONCLUSION

These findings highlight the efficacy of the applications of phenolic compounds to control Ganoderma.

SIGNIFICANCE AND IMPACT OF THE STUDY

The study has proved a replacement for chemical controls of G. boninense with naturally occurring phenolic compounds.

Use of psychoactive drugs among patients visiting outpatient clinics in Karachi, Pakistan

INTRODUCTION

This study was conducted to determine the proportion of usage of psychoactive drugs, and to identify factors associated with its use among patients visiting outpatient clinics of a tertiary care hospital in Karachi, Pakistan.

METHODS

A cross-sectional study was conducted involving 461 adult (age 18 years and above) patients, who were surveyed by using interviewer-administered questionnaires. All interviews were conducted by a medical students. Out of the total number of participants, 242 (52.5 percent) were males and 219 (47.5 percent) were females.

RESULTS

In all, 118 (25.6 percent) of the respondents were using some sort of psychoactive drugs, however, only 20 (4.3 percent) study subjects were diagnosed with any psychiatric illness. Factors found to be significantly associated with usage of psychoactive drugs included belonging to the female gender (p-value equals 0.019), older (more than 50 years) age (p-value is less than 0.001), being married (p-value equals 0.004), having formal schooling of up to 12 years (p-value equals 0.001) and physical inactivity (p-value equals 0.004). In addition, those whose family members were using psychoactive drug(s) or who suffered from non-communicable diseases were more likely to use psychoactive drugs in comparison to others (p-value is less than 0.001).

CONCLUSION

The use of psychoactive drugs is quite common in our patients regardless of having any psychiatric disease. Efforts are required to control and prevent the abuse of these drugs. Education and awareness programmes for doctors and patients may help to prevent the inappropriate use of psychoactive drugs. Regulatory intervention to control use of these drugs is also recommended.

Association of iron deficiency anaemia in children of 1-2 years of age with low birth weight, recurrent diarrhoea or recurrent respiratory tract infection--a myth or fact?

AIMS AND OBJECTIVE

To investigate for the presence or absence of any association between low birth weight, recurrent diarrhoea or recurrent acute respiratory infections with iron deficiency anaemia in Pakistani children aged 1-2 years.

METHODOLOGY

From July 1993 to July 1995 a case control study was conducted at the Community Health Centre (CHC). Fifty cases and 100 controls were included. Informed consent was taken from mothers for the blood tests of their children and a questionnaire was administered to them. Data obtained from the completed questionnaires was analyzed by chi-square and t-tests.

RESULTS

There was no statistically significant difference in low birth weight (p = 0.712), recurrent diarrhoea or respiratory infections between anaemic and non-anaemic children at 1-2 years age (OR of 1.71 and 1.48 respectively).

CONCLUSION

This study does not uphold the belief that low birth weight, recurrent diarrhoea or respiratory infections have a causal association with iron deficiency anaemia in 1-2 years children.

Is there a value of mantoux test and erythrocyte sedimentation rate in pre-employment screening of health care workers for tuberculosis in a high prevalence country?

SETTING

Pre-employment screening of health care workers (HCWs) is practiced widely. Research needs to be carried out to evaluate the screening procedure in developing countries.

OBJECTIVE

To evaluate the efficacy of Mantoux test and erythrocyte sedimentation rate (ESR) for the diagnosis of active tuberculosis (TB), in pre-employment screening of HCWs, in a high prevalence country.

DESIGN

Pre-employment screening of all new employees was reviewed from June to September 2000. The screening consisted of history, physical examination, blood and urine tests, Mantoux test and a chest radiograph. Patients with clinical, laboratory or radiological features suggestive of active TB were referred to a specialist.

RESULTS

Out of 207 employees, a Mantoux reaction of > or = 10 mm and ESR of > or = 25 mm/first hour was noted in 90 (43.5%) and 21 (10.1%), respectively. One person had symptoms suggestive of TB and was already on anti-tuberculosis therapy at the time of screening. All other employees were asymptomatic. Based on radiographic findings, four (2%) cases were referred and one was given anti-tuberculosis therapy. An additional 48 (23.1%) employees were referred on the basis of positive Mantoux or elevated ESR; none were found to have active TB.

CONCLUSION

In high prevalence countries use of Mantoux test and ESR in pre-employment screening of HCWs is not recommended for detection of active TB.

The relationship of socio-demographic factors with iron deficiency anaemia in children of 1-2 years of age

OBJECTIVE

To investigate associations between different socio-demographic factors with iron deficiency anaemia in Pakistani children of 1-2 years of age.

METHODOLOGY

A case control study, with 50 cases and 100 controls, was conducted at the Community Health Centre, an outpatient clinic of the Aga Khan University, Karachi, Pakistan, between July 1993-July 1995. Informed consent was taken from mothers for their children's blood tests and a questionnaire was administered to them. The data was analyzed using chi-square, t-tests and logistic regression.

RESULTS

The numbers of pregnancies, live births and living children were more among cases than controls but the differences were not statistically significant. Although father's education did not show a significant association (OR 1.35, 95% CI 0.22-8.33), maternal education was significantly associated with the children's anaemic status (OR 3.55, 95% CI 1.40-9.02). The difference in monthly incomes between families of cases and controls was the most significant variable among all those studied (p-value 0.006).

CONCLUSION

This study showed that while lack of maternal education and low monthly family incomes are both significantly associated with the development of childhood anaemia, low monthly income is most significant.

ACC/AHA guidelines as predictors of postoperative cardiac outcomes

PURPOSE

Recently, the American College of Cardiology - American Heart Association (ACC-AHA) published guidelines and an associated algorithm for preoperative cardiovascular evaluation of patients undergoing non-cardiac surgery. Our purpose was to (i) test guideline's ability to predict adverse cardiac events within seven days after surgery, (ii) determine whether medical clinical predictors or surgical risks was a better predictor of cardiac events.

METHODS

Retrospective review of 119 cardiology and anesthesia consultations over 15 mo, ending March 31, 1998. Patients were classified into their respective medical clinical predictor and surgical risk groups, as outlined in ACC-AHA guidelines. Associations between the medical predictor and surgical risk scores and adverse cardiac outcomes were quantified via multiple logistic regression analysis. Two outcomes were employed. Outcome I, included: myocardial infarction/ischemia; angina; congestive heart failure, arrhythmia or death. Outcome 2 expanded the definition to include "cancellation of surgery due to cardiac risk" as a negative cardiac outcome.

RESULTS

Diabetes, Canadian Cardiovascular Class (CCS) III or IV angina, and MI within six months before surgery were strongly associated with the two cardiac outcomes. For outcome 1 and 2, medical predictors and surgical risks, considered simultaneously, performed with a sensitivity of 93% and specificity of 46-51%. When considered separately, major clinical medical predictors had a sensitivity of 87-89%, while surgical risks showed a specificity of 89% in predicting the two outcomes.

CONCLUSION

Medical predictors in ACC-AHA classification scheme were highly sensitive whereas surgical risks were more specific in predicting adverse post-operative cardiac events. Prospective study is needed to confirm these observations.

Evaluation of Traditional Classroom Teaching Methods Versus Course Delivery Via the World Wide Web

Higher education is moving with deliberate speed to an electronic classroom. Much has been published on faculty experiences with World Wide Web (WWW) course delivery. However, little research exists on the evaluation of these methods. The purpose of this study was to evaluate students' perceptions of two approaches to teaching: classroom and WWW modules. Classroom methods were rated significantly higher in relation to content, interaction, participation, faculty preparation, and communication. Technical skills were rated higher for WWW modules. Critical thinking and time allotted for assignments were not significantly different between classroom and WWW instruction. Open-ended comments were rich and supported both positive and negative aspects of classroom and WWW-based modules. Implications call for creativity in course development, course redesign and orientation, active communication with students, support for technical problems, faculty development, and university-wide planning through partnerships.

Promotion of advance care planning in the nonhospitalized elderly

Factors that influence the execution or lack of execution of advance directives in 162 nonhospitalized older adults were examined. Significant results were found, and implications for geriatric nurses are presented.

Predictors of quality of life in women: hormone therapy self-efficacy and health-promoting behaviors

Osteoporosis and coronary heart diseases (CHD) are two major health problems that affect postmenopausal women. The literature emphasizes that prevention of osteoporosis and/or CHD through the practices of health-promoting behaviors and hormone therapy usage can improve quality of life (QOL) for women. The purpose of this study was to examine the impact of health-promoting behaviors and hormone therapy self-efficacy on QOL. The sample contained 210 women between the ages of 45 and 84 years of age, who completed three instruments developed specifically for this study. The majority of the participants perceived moderate satisfaction with their life as a whole, performed many health-promoting behaviors, and perceived slight confidence in their ability to continue hormone therapy. Among current users of hormones, hormone therapy self-efficacy beliefs explained 31% of the variance in QOL. Among non-users of hormones, health-promoting behaviors explained 7% of the variance in QOL. In the entire sample, health-promoting behaviors explained 10% of the variance in QOL. There were significant differences between current users of hormones and non-users of hormones in QOL and in health-promoting behaviors. The study has implications for intervention and for future research.

The hormone replacement therapy self-efficacy scale

This study describes the initial development and psychometric evaluations of an instrument to measure self-efficacy in hormone replacement therapy (HRT) use. The development of the scale was based upon Bandura's self-efficacy construct. The sample was 116 women who were 50 years old and above and who were current or past users of HRT. Factor analysis was used to develop construct validity and Cronbach's alpha was used to compute reliabilities. Factor analysis isolated two factors, efficacy beliefs in HRT (EBs-HRT) and outcome expectations in HRT (OEs-HRT). The developed tool contains 14 items, eight items compose the EBs-HRT subscale and six items make-up the OEs-HRT subscale. The two subscales and total instrument were found to have good internal reliabilities. Implications for HRT intervention using the developed tool are discussed.

Nocturnal enuresis in children

This common condition can be managed by the general practitioners. The key answer to nocturnal enuresis is nocturnal self-awakening and recently more emphasis is given on this which is an area of greatest promise. Behavioural modification in conjunction with an enuretic alarm also teaches this skill and has the highest cure rate and the lowest relapse rate. Enuretic alarms can be used any time from age 5 onwards. But drugs are only indicated when there is need for short term dryness e.g. when the child has to be away from home.

Providing culturally sensitive care to Egyptians with cancer

PURPOSE

This article describes key aspects of Egyptian culture and provides intervention strategies that oncology practitioners may use to provide quality care to Egyptian immigrants and Egyptian-American oncology patients.

OVERVIEW

The growing diversity of the United States population challenges oncology professionals to provide culturally appropriate care. Egyptian immigrants and Americans of Egyptian descent comprise a unique population whose cultural and religious beliefs impact on decision making and behaviors related to cancer diagnosis and treatment. This population is overwhelmingly Muslim, although a sizeable minority are members of Eastern Christian sects. Dietary restrictions, social conduct, and religious observance are among the areas that require understanding by health providers.

CLINICAL IMPLICATIONS

Learning about patients' perspectives on health and illness, in light of their cultural values and beliefs, will allow health professionals to enhance the quality of assessments and interventions and provide culturally appropriate care.

Cancer prevention and early detection among Egyptians

Although cancer is frequently not perceived as a significant health problem in developing countries, cancer death in developing countries is higher than in developed countries. Therefore, cancer prevention and early detection in developing countries is becoming a universal challenge to health care providers. The purpose of this exploratory study was to identify knowledge, attitudes, and behaviors related to cancer prevention and early detection among Egyptians. Data were collected from 99 people, and the design was descriptive and correlational, using a self-administered survey. Results showed that the Egyptians surveyed had some knowledge about warning signs of cancer as well as prevention and early detection strategies. In addition, results indicated a significant difference between males and females in warning signs of cancer as well as prevention and early detection methods. Participants were less likely to believe their lifestyle behaviors affect their chances of developing cancer. Current practices undertaken included dietary behaviors, abstinence from smoking, check-up for minor suspicious symptoms, and annual complete physical examinations. Barriers to undertaking practices included factors related to lack of preventive resources, lack of information about preventive strategies, family financial concerns, and specific attitudes toward cancer. The study findings indicate the need for providing people with information to help them make decisions regarding undertaking cancer prevention and early detection practices.

Health promotion and osteoporosis prevention among postmenopausal women

BACKGROUND

Although there is a plethora of literature about osteoporosis, little is known about the attitudinal variables that may predict osteoporosis-preventive behaviors (OPBs) among postmenopausal women. This study examined the relationship between variables from the Health Promotion Model (HPM) and OPBs of calcium intake, exercise participation, and taking of estrogen/hormone replacement therapy (ERT/HRT).

METHODS

One hundred women completed measures of benefits and barriers to calcium intake, exercise participation, ERT/HRT usage; self-efficacy; control of health; importance of health; and health status. Participants also reported their actual calcium intake, exercise participation, and use of ERT/HRT:

RESULTS

Participants consumed an average of 1,243 mg of calcium from milk, yogurt, calcium-rich foods, and supplements; 81% participated in weight-bearing and resistant training exercise but on an irregular basis; and 31% were users of ERT/HRT at the time of data collection. There were significant relationships between some of the HPM variables and calcium intake and exercise participation. There was a significant difference between past and current users of ERT regarding benefits and barriers to taking hormones. Hormone users reported higher calcium intake and greater exercise participation than nonusers.

CONCLUSION

There is early evidence that variables of the HPM are associated with OPBs. After continued testing, intervention programs for osteoporosis prevention may use variables of the HPM as a theoretical base for behavior changes.

A comparison of American and Egyptian cancer patients' attitudes and unmet needs

The purpose of this descriptive study was to compare and contrast similarities and differences in statements made by American and Egyptian cancer patients who expressed their attitudes toward cancer and reported their unmet needs. A total of 61 American and 66 Egyptian patients, who were receiving chemotherapy or radiotherapy, or a combination of the two treatments at the time of data collection, participated in the study. The American sample was drawn from patients at a large midwestern hospital, whereas the Egyptian sample was drawn from patients at the largest university hospital in Cairo, Egypt. Data were collected through a structured interview method in both patient populations. Analyses of responses showed five categories of attitudes for the American patients: (a) fighting spirit and adaptation, (b) fear/anxiety/disbelief, (c) hope, (d) passivity in plan of care, and (e) faith. For Egyptian patients, seven categories emerged: (a) stoicism and fatalism, (b) dependency, (c) compliance with the medical regimen, (d) anxiety/fear/insecurity, (e) powerlessness, (f) hope and optimism, and (g) family support. American cancer patients reported their unmet needs as (a) information, (b) needs related to treatment side effects, and (c) psychological support. Egyptian cancer patients reported their unmet needs as (a) relief from dependency, (b) relief from physical symptoms, and (c) information. These findings have implications for international oncology nursing, and imply the need for further research to determine if attitudes and unmet needs affect coping effectiveness and quality of life among cancer patients.

Preparing student nurses for patient education

Patient education is an integral part of the nurse's responsibility. Furthermore, public awareness of health issues has greatly increased public demand for information from health professionals. The author presents some teaching strategies that can be used by nurse educators to prepare students for their future role as teachers.

Postmenopausal women. Factors in osteoporosis preventive behaviors

Osteoporosis is a serious health hazard mainly affecting postmenopausal and elderly women. Osteoporotic fractures are one of the leading causes of morbidity and death in the elderly population. Prevention of further loss of bone mass in postmenopausal women can be achieved if women take estrogen replacement therapy, consume adequate levels of calcium, exercise regularly, and practice healthy lifestyle behaviors. Elderly women need to follow the same strategies as postmenopausal women with more emphasis on prevention of falls.

Identification of stressors, level of stress, coping strategies, and coping effectiveness among Egyptian mastectomy patients

The purpose of this study was to identify stressors, level of stress, coping strategies, and coping effectiveness in Egyptian female mastectomy patients. A total of 64 women who had had mastectomies participated in the study. Coping effectiveness was measured by McNett's Coping Effectiveness Questionnaire (MCEQ). Factor analysis and reliability measures were established on MCEQ using the study sample. Data were collected using a structured interview method. Participants were also asked about age, education, and time since mastectomy. These data were examined in an effort to predict coping effectiveness. The participants reported five stressors: hope for cure, treatment effectiveness, fear of the unknown, progression of the disease, and pain. The treatment effectiveness stressor had the highest mean level of stress. There was a significant difference in the level of stress among the five stressors. Coping strategies reported were categorized into four groups: faith, compliance with the medical regimen, seeking information and social support, and self-distraction. Coping effectiveness was significantly and positively correlated with age and time since mastectomy, which accounted for 35% of the variance in coping effectiveness. Findings suggest that continuing assessments of Egyptian mastectomy patients' needs, further research studies, and an intervention program to ameliorate cancer-related anxiety and to help cancer patients cope effectively may be helpful.

Teaching early breast cancer detection strategies

Breast cancer is the most common cancer occurring among women. Currently, breast cancer can be detected early and treated effectively if all asymptomatic women participate in the screening program. Screening strategies include a mammogram, medical examination of the breast, and breast self-examination. This article describes the nurse's role in promoting and decreasing barriers to these strategies for early detection of breast cancer.

Teaching osteoporosis prevention

The role of nutrition is critical in the prevention of osteoporosis. Teenagers and women, who consume adequate calcium throughout life and consider nutritional factors that may impair their bodies' use of calcium, can do much to prevent the onset of osteoporosis. The nurse's role in this prevention is described.

Effect of psychoeducational intervention on anxiety among Egyptian bladder cancer patients

This study examined the effect of psychoeducational preparation 1-2 days prior to surgery on postoperative state anxiety among Egyptian bladder cancer patients with urinary diversion. The theoretical rationale was based upon the Betty Neuman Health-Care Systems Model. State anxiety was measured by the A-state form of the State Trait Anxiety Inventory. A total of 30 patients were assigned randomly to experimental and control groups. Fifteen patients were included in each category. Preoperatively, the total sample was interviewed about their "worries" at that time, and data from this qualitative part were categorized into three subconcepts. Results revealed that their main anxieties are related to stress associated with being cancer patients followed by stress related to the impact of surgery on their bodies and on their social and marital life. Results from the quantitative part of the study showed that psychoeducational preparation lowered significantly state anxiety on the third day postoperatively and before discharge for those patients who had the intervention.