Author: Nevin Manimala

Drug Metab Pers Ther. 2021 Mar 26. doi: 10.1515/dmpt-2020-0187. Online ahead of print.

ABSTRACT

OBJECTIVES: Osteoporosis often occurs in individuals of different age groups, frequently during menopause and after ovariectomy. It increases the risk of pathological fractures almost twice. The aim of our research was to assess bone metabolism, nanocomposite structure of the tibia under conditions of ovariectomy and zoledronic acid treatment.

METHODS: X-ray diffraction has been performed for nanostructure analysis of mineral crystallites and crystal lattice of hydroxyapatite in the tibia samples of ovariectomized rats with additional application of bisphosphonate zoledronic acid (0.025 mg/kg). Markers of remodeling – osteocalcin, alkaline phosphatase, tartrate resistant acid phosphatase 5b – were determined. Quantitative amount of calcium in the bones was detected by atomic absorption method.

RESULTS: Zoledronic acid prevented loss of mineral mass after ovariectomy. Rats after ovariectomy, treated with zoledronic acid, showed statistically higher (р<0.05) values of crystalline phase and calcium content compared with the SHAM-surgery and ovariectomy groups (р<0.05). Zoledronic acid inhibited bone remodeling, which is proved by tartrate resistant acid phosphatase 5b reduction and inhibition of osteoclasts during the experiment.

CONCLUSIONS: These results enable to suggest that zoledronic acid can improve mineral mass of the bone during menopause in individuals of different age groups.

PMID:33770826 | DOI:10.1515/dmpt-2020-0187

Female Pelvic Med Reconstr Surg. 2021 Apr 1;27(4):230-237. doi: 10.1097/SPV.0000000000000912.

ABSTRACT

OBJECTIVE: To evaluate national trends in major adverse cardiovascular and cerebrovascular events (MACCE) in female pelvic reconstructive surgery (FPRS).

METHODS: Data from the National Inpatient Sample was used to identify women undergoing FPRS between 2012 and 2016. Demographic, procedural, and comorbidity data were collected. Patients were stratified into those with and without MACCE (defined as all-cause mortality, cardiac arrest, myocardial infarction (MI) and acute ischemic stroke). Descriptive statistics are expressed as medians and interquartile ranges. Pairwise analysis was performed using Wilcoxon rank-sum or Fisher exact test as appropriate. Multivariable logistic regression was used to identify independent risk factors for MACCE.

RESULTS: During the study period, 53,540 patients underwent FPRS. The rate of MACCE was 4.8 per 1000 surgeries; MI, 3.7; acute ischemic stroke, 0.6; cardiac arrest, 0.4; and all-cause mortality, 0.3. Patients experiencing MACCE were more likely to have major preexisting cardiovascular comorbidities, coagulopathy, neurologic disease (ND), and diabetes and were more likely to undergo robotic colpopexy (20.7% vs 9.6%, P < 0.001), vaginal colpopexy (32.0% vs 28.5%, P = 0.04), and to receive a blood transfusion (8.2% vs 2.5%, P < 0.001).On logistic regression, preexisting coagulopathy was the strongest predictor of MACCE (adjusted odds ratio [aOR], 5.53; 95% confidence interval [CI], 2.39-12.78), followed by blood transfusion (aOR, 4.84; 95% CI, 1.89-12.45), congestive heart failure (aOR, 3.61; 95% CI, 1.56-8.37), ND (aOR, 3.14; 95% CI, 1.23-8.06), and electrolyte abnormalities (aOR, 1.99; 95% CI, 1.05-3.99).

CONCLUSION: Major adverse cardiovascular and cerebrovascular events after FPRS is a rare event, with MI being the most common manifestation. Preexisting ND, congestive heart failure, coagulopathy, electrolyte disturbances, and perioperative transfusions are strongly associated with MACCE.

PMID:33770806 | DOI:10.1097/SPV.0000000000000912

Female Pelvic Med Reconstr Surg. 2021 Apr 1;27(4):225-229. doi: 10.1097/SPV.0000000000001001.

ABSTRACT

OBJECTIVE: This study aimed to determine if routine assessment of patients after onabotulinumtoxinA injections for overactive bladder is necessary to detect clinically significant voiding dysfunction.

METHODS: This retrospective cross-sectional cohort study analyzed patients who underwent intravesical injection of onabotulinumtoxinA for overactive bladder during a 4-year period. Patients were included for analysis if they returned for an office follow-up visit within 1 month of administration. Baseline demographic data; procedural details; postvoid residual volumes; abnormal postprocedure voiding symptoms, including urinary frequency, pain, or inability to void; urinary tract infections; and initiation of intermittent self-catheterization were recorded. Descriptive statistics, point-biserial and Pearson correlation analyses were performed.

RESULTS: Two hundred thirty-seven injections were included in our analysis. Fifteen encounters, from 13 patients, required the initiation of intermittent self-catheterization (6.3%). The median postvoid residual in those treated with intermittent self-catheterization was 300 mL (min, max: 200, 750 mL); all had received 100 units of onabotulinumtoxinA. The most common symptom among those requiring intermittent self-catheterization was urgency (n = 13; 87%), whereas 93% (n = 14) had at least 1 bothersome symptom. Correlation analyses showed a weak positive correlation with elevated postvoid residual volume and a history of prolapse repair (r = 0.269, P = 0.004), and prior pelvic surgery (r = 0.205, P = 0.029).

CONCLUSIONS: Clinically relevant urinary retention that required intermittent self-catheterization after onabotulinumtoxinA injection for overactive bladder occurred in 6.3% of participants in this sample. The vast majority of patients who required intermittent self-catheterization described symptoms that they were able to self-identify.

PMID:33770805 | DOI:10.1097/SPV.0000000000001001

J Neurosurg. 2021 Mar 26:1-10. doi: 10.3171/2020.9.JNS201828. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of this study was to investigate whether neurosurgical intervention for traumatic brain injury (TBI) is associated with reduced risks of death and clinical deterioration in a low-income country with a relatively high neurosurgical capacity. The authors further aimed to assess whether the association between surgical intervention and acute poor outcomes differs according to TBI severity and various patient factors.

METHODS: Using TBI registry data collected from a national referral hospital in Uganda between July 2016 and April 2020, the authors performed Cox regression analyses of poor outcomes in admitted patients who did and did not undergo surgery for TBI, with surgery as a time-varying treatment variable. Patients were further stratified by TBI severity using the admission Glasgow Coma Scale (GCS) score: mild TBI (mTBI; GCS scores 13-15), moderate TBI (moTBI; GCS scores 9-12), and severe TBI (sTBI; GCS scores 3-8). Poor outcomes constituted Glasgow Outcome Scale scores 2-3, deterioration in TBI severity between admission and discharge (e.g., mTBI to sTBI), and death. Several clinical and demographic variables were included as covariates. Patients were observed for outcomes from admission through hospital day 10.

RESULTS: Of 1544 patients included in the cohort, 369 (24%) had undergone surgery. Rates of poor outcomes were 4% (n = 13) for surgical patients and 12% (n = 144) among nonsurgical patients (n = 1175). Surgery was associated with a 59% reduction in the hazard for a poor outcome (HR 0.41, 95% CI 0.23-0.72). Age, pupillary nonreactivity, fall injury, and TBI severity at admission were significant covariates. In models stratifying by TBI severity at admission, patients with mTBI had an 80% reduction in the hazard for a poor outcome with surgery (HR 0.20, 95% CI 0.04-0.90), whereas those with sTBI had a 65% reduction (HR 0.35, 95% CI 0.14-0.89). Patients with moTBI had a statistically nonsignificant 56% reduction in hazard (HR 0.44, 95% CI 0.17-1.17).

CONCLUSIONS: In this setting, the association between surgery and rates of poor outcomes varied with TBI severity and was influenced by several factors. Patients presenting with mTBI had the greatest reduction in the hazard for a poor outcome, followed by those presenting with sTBI. However, patients with moTBI had a nonsignificant reduction in the hazard, indicating greater variability in outcomes and underscoring the need for closer monitoring of this population. These results highlight the importance of accurate, timely clinical evaluation throughout a patient’s admission and can inform decisions about whether and when to perform surgery for TBI when resources are limited.

PMID:33770754 | DOI:10.3171/2020.9.JNS201828

Psychiatriki. 2021 Mar 26. doi: 10.22365/jpsych.2021.014. Online ahead of print.

ABSTRACT

Problem gambling emerges as a serious and ever growing problem of modern societies, largely affecting adolescents as well. The etiology of gambling disorder is complex and multifaceted as it is governed by multiple and interrelated factors. In this context and in light of the pervasive financial crisis in Greece, we conducted a study in order to explore adolescents’ gambling involvement in Athens region and also to identify the socio-economic characteristics of adolescents who have engaged into gambling activities. Students were recruited from a sample of schools in Athens area. For the assessment of gambling involvement in adolescents, the Diagnostic and Statistical Manual of Mental Disorders-IV Multiple Response Adapted for Juveniles Questionnaire (DSM-IV-MR-J) was administered. Additional self-constructed questions enquired about students’ socio-demographic and economic characteristics. Our results indicate that adolescents that had problem with gambling or had at least one pathological item on DSM were more likely to be boys and to have been born in a country other than Greece. Additionally, the proportion of those having at least one pathological item on DSM was greater in those with low school grades. Τhe lack of food in the household due to inability of providing food during the last month was significantly associated with both having problem with gambling and having at least one pathological item on DSM. Furthermore, having been worried that there would not be enough food during the last month and having been fed with a restrained variety of food due to lack of recourses were associated with at least one pathological item on DSM. These findings are congruent with the literature suggesting that youth living under poverty often resort to gambling. In conclusion, our results point out the adverse effects of the financial crisis on the development of problem gambling in adolescents within the Greek society. Problem gambling may have developed in response to the ubiquitous insecurity characterizing the Greek society during this rough time period. Interventions should prioritize endowing adolescents with the necessary coping skills for dealing with daily obstacles or life adversities productively and without losing their self-control.

PMID:33770751 | DOI:10.22365/jpsych.2021.014

Psychiatriki. 2021 Mar 26. doi: 10.22365/jpsych.2021.013. Online ahead of print.

ABSTRACT

Atrial fibrillation (AF) is a common sustained cardiac arrhythmia, which is expected to expand enormously due to population ageing. The aim of the present study was to explore the significance of AF patients’ needs and the associated factors as well as the impact of anxiety and depression on these needs. The sample of the study included 215 AF hospitalized patients. Data were collected by the completion of a questionnaire which, in addition to patients’ characteristics, it also included the Hospital Anxiety and Depression Scale (HADS) and the questionnaire “Needs of hospitalized patients with coronary artery disease”, that is evaluating the significance of the following 6 categories of needs: a) for support and guidance, b) for information from medical and nursing staff, c) for communication with other patients and family, d) for individualization of care and participation, e) to trust the medical and nursing staff and f) to meet emotional and physical needs. The statistical significance level was p< 0.05. Of the 215 participants, 68.4% were men and 67.5% were > 60 years old. Moreover, 47.5% of the participants experienced anxiety and 29.5% depression. The need for support, to be informed and to trust the medical and nursing staff considered to be of high significance by the patients (median 29,20 and 6, respectively). Anxiety and depression were significantly associated with all patients’ needs (p<0.05) apart from the need to meet the emotional and physical needs and the need to trust the medical and nursing staff, which were not associated with anxiety levels. In terms of patients’ needs, those who reported to be little or not at all informed about their disease considered of a higher significance the need for support and guidance (p=0.030), the need to be informed and to trus the medical and nursing staff (p=0.001 and p=0.012, respectively) and the need for communication with other patients and family (p=0.007). The need for individualization of care and participation in it, was considered more significant by patients aged >70 years and those having no children (p=0.039 and p=0.029, respectively) while the need for communication with other patients and family was considered more significant by women (p=0.028). The present findings emphasize the importance of providing care tailored to meet the needs of AF patients who experience anxiety and depression.

PMID:33770750 | DOI:10.22365/jpsych.2021.013

Cognition. 2021 Mar 23;212:104469. doi: 10.1016/j.cognition.2020.104469. Online ahead of print.

ABSTRACT

Researchers across cognitive science, economics, and evolutionary biology have studied the ubiquitous phenomenon of social learning-the use of information about other people’s decisions to make your own. Decision-making with the benefit of the accumulated knowledge of a community can result in superior decisions compared to what people can achieve alone. However, groups of people face two coupled challenges in accumulating knowledge to make good decisions: (1) aggregating information and (2) addressing an informational public goods problem known as the exploration-exploitation dilemma. Here, we show how a Bayesian social sampling model can in principle simultaneously optimally aggregate information and nearly optimally solve the exploration-exploitation dilemma. The key idea we explore is that Bayesian rationality at the level of a population can be implemented through a more simplistic heuristic social learning mechanism at the individual level. This simple individual-level behavioral rule in the context of a group of decision-makers functions as a distributed algorithm that tracks a Bayesian posterior in population-level statistics. We test this model using a large-scale dataset from an online financial trading platform.

PMID:33770743 | DOI:10.1016/j.cognition.2020.104469

Phys Ther Sport. 2021 Mar 8;49:204-213. doi: 10.1016/j.ptsp.2021.03.001. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this review was to synthesize the current understanding relating to the risks of lower body functional asymmetry with injury in athletic populations.

METHODS: An iterative data mining and sampling approach was used to construct a search phrase from key words, which were used to identify studies within SPORTdiscus, Medline and Academic Search Complete databases. Additional references were sourced from the reference lists of these articles.

RESULTS: After screening, 31 papers were reviewed, from an initial search identifying 302 possible studies. A total of 6228 participants were involved in the studies, of which soccer players were the most observed sporting demographic (n = 2171). Of the 31 studies reviewed eight found no statistical association between lower limb asymmetry and injury risk, 10 studies provided partial statistically significant evidence and a further 10 provided statistically significant statistical links.

CONCLUSION: Overall moderate to lower quality evidence for functional asymmetry as a risk factor for injury in sport was observed. While the possibility of a relationship between lower limb functional asymmetry and injury risk cannot be ruled out, further higher quality investigations, adopting standardised methodologies, is required.

PMID:33770741 | DOI:10.1016/j.ptsp.2021.03.001

J Neurol Sci. 2021 Mar 20;424:117410. doi: 10.1016/j.jns.2021.117410. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to investigate the prevalence and factors associated with oral anticoagulant undertreatment of atrial fibrillation (AF) among a cohort of rural patients with stroke outcomes and examine how undertreatment may influence a patient’s one-year survival after stroke.

METHODS: This retrospective cohort study examined ischemic stroke patients with pre-stroke AF diagnosis from September 2003 to May 2019 and divided them into proper treatment and undertreatment group. Analysis included chi-square test, variance analysis, Kruskal-Wallis test, logistic regression, Kaplan-Meier estimator, and Cox proportional-hazards model.

RESULTS: Out of 1062 ischemic stroke patients with a pre-stroke AF diagnosis, 1015 patients had a CHA₂DS₂-VASc score ≥2, and 532 (52.4%) of those were undertreated. Median time from AF diagnosis to index stroke was significantly lower among undertreated patients (1.9 years vs. 3.6 years, p < 0.001). Other thromboembolism, excluding stroke, TIA, and myocardial infarction (OR 0.41, p < 0.001), the number of encounters per year (OR 0.90, p < 0.001), and the median time between AF diagnosis and stroke event (OR 0.86, p < 0.001) were negatively associated with undertreatment. Kaplan-Meier estimator showed no statistical difference in the one-year survival probability between groups (log-rank test, p = 0.29), while the Cox-Hazard model showed that age (HR 1.05, p < 0.001) and history of congestive heart failure (HR 1.88, p < 0.001) increased the risk of mortality.

CONCLUSIONS: More than half of our rural stroke patients with a pre-index AF diagnosis were not on guideline-recommended treatment. The study highlights a large care gap and an opportunity to improve AF management.

PMID:33770707 | DOI:10.1016/j.jns.2021.117410

J Environ Radioact. 2021 Mar 23;233:106571. doi: 10.1016/j.jenvrad.2021.106571. Online ahead of print.

ABSTRACT

The geographic variation of terrestrial radiation can be exploited in epidemiological studies of the health effects of protracted low-dose exposure. Various methods have been applied to derive maps of this variation. We aimed to construct a map of terrestrial radiation for Switzerland. We used airborne γ-spectrometry measurements to model the ambient dose rates from terrestrial radiation through a Bayesian mixed-effects model and conducted inference using Integrated Nested Laplace Approximation (INLA). We predicted higher levels of ambient dose rates in the alpine regions and Ticino compared with the western and northern parts of Switzerland. We provide a map that can be used for exposure assessment in epidemiological studies and as a baseline map for assessing potential contamination.

PMID:33770702 | DOI:10.1016/j.jenvrad.2021.106571