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Folic Acid Supplementation in Postmenopausal Women with Hot Flushes: Phase III Randomised Double-Blind Placebo-Controlled Trial

BJOG. 2021 May 13. doi: 10.1111/1471-0528.16739. Online ahead of print.


OBJECTIVE: To assess whether folic acid supplementation ameliorates hot flushes.

DESIGN: Double-blind, placebo-controlled randomised trial.

SETTING: Nine hospitals in England.

POPULATION: Postmenopausal women experiencing ≥50 hot flushes weekly.

METHODS: Women (n=164) were randomly assigned in a 1:1 ratio to receive folic acid 5mg tablet or placebo daily for 12 weeks. Participants recorded frequency and severity of hot flushes in Sloan Diary daily and completed Greene Climacteric and Utian Quality of Life (UQoL) Scales at 4-weekly intervals.

MAIN OUTCOME MEASURES: The change in daily Hot Flush Score at week-12 from randomisation based on Sloan Diary Composite Score B calculation.

RESULTS: Data of 143 (87%) women was available for the primary outcome. The mean change (SD) in Hot Flush Score at week-12 was -6.98 (10.30) and -4.57 (9.46) for folic acid and placebo group, respectively. The difference between groups in the mean change was -2.41 (95% CI: -5.68, 0.87), p=0.149 and in the adjusted mean change was -2.61 (95% CI: -5.72, 0.49), p=0.098. Analysis of secondary outcomes indicated an increased benefit in the folic acid group regarding changes in total and emotional UQoL scores at week-8 when compared with placebo. The difference in the mean change from baseline was 5.22 (95% CI: 1.16, 9.28) and 1.88 (95% CI: 0.23, 3.52) for total and emotional score, respectively.

CONCLUSIONS: The study was not able to demonstrate that folic acid had a statistically significant greater benefit in reducing Hot Flush Score over 12 weeks in postmenopausal women when compared with placebo.

PMID:33982872 | DOI:10.1111/1471-0528.16739

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Models of remote professional supervision for psychologists in rural and remote locations: A systematic review

Aust J Rural Health. 2021 Apr;29(2):211-225. doi: 10.1111/ajr.12740.


INTRODUCTION: Psychology workforce shortages in geographically rural or remote contexts have highlighted the need to understand the supervisory experiences of psychologists practising in these locations, and the models of supervision employed to support their practice and improve client safety.

OBJECTIVE: To review the models of remote professional supervision and the supervisory experiences of psychologists practising in rural and remote locations.

DESIGN: Using the Joanna Briggs Institute methodology for mixed-methods systematic review, 8 health and education databases were searched using keyword and subject heading searches.

FINDINGS: The initial search identified 413 studies. A full-text review identified 4 papers that met the inclusion criteria and were subjected to a methodological appraisal by 2 reviewers. Three studies included qualitative data, with 2 using transcribed interviews. Two studies reported quantitative data, with only one study including a statistical analysis of the outcomes.

DISCUSSION: The results for the efficacy of the current models of remote supervision being used within the allied health and psychology professions are limited, with methodological limitations cautioning generalisability of results. The experiences of psychologists engaged in remote supervision do not appear to have changed over the past decade despite technological advances.

CONCLUSIONS: Quality professional supervision is critical for the sustainability of the psychology workforce in rural and remote locations, reducing professional isolation, and for improved patient outcomes. This review identified a need for improved evidence for remote supervision models for psychologists working in geographically rural and remote locations. Lessons can be learned from other health professions’ models of remote supervision.

PMID:33982844 | DOI:10.1111/ajr.12740

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One-Pot Synthesis of Fluorescent Nitrogen and Sulfur-Carbon Quantum Dots as a Sensitive Nanosensor for Trimetazidine Determination

Luminescence. 2021 May 13. doi: 10.1002/bio.4083. Online ahead of print.


A water-soluble and highly stable N,S-doped CQDs (N,S-CQDs) have been synthesized by a low-cost strategy using citric acid (CA) and thiosemicarbazide (TSC) in one-step as a fluorescent nanosensor. The achieved N, S-CQDs have strong emission at 446 nm upon excitation at 370 nm and a high quantum yield of 58.5%. The quenching effect on the prepared N,S-CQDs has been utilized for determination of Trimetazidine (TMZ) spectrofluorimetrically in a wide linear range of 0.04-0.5μM (0.0106-0.133 μg mL-1 ) and low limit of detection of 0.01μM (0.002 μg mL-1 ). Furtherer, CDs was used to determine TMZ in its pharmaceutical formulations as well as in human plasma as a simple and rapid fluorescent probe. The method was tested in compliance with the ICH guidelines. The results obtained were statistically compared to those given by a reported method showing no significant variations regards accuracy and precision.

PMID:33982840 | DOI:10.1002/bio.4083

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Factors Associated with Neutropenia Post-Heart Transplantation

Transpl Infect Dis. 2021 May 13:e13634. doi: 10.1111/tid.13634. Online ahead of print.


BACKGROUND: Neutropenia is a serious complication following heart transplantation (OHT) however risk factors for its development and its association with outcomes is not well described. We sought to study the prevalence of neutropenia, risk factors associated with its development and its impact on infection, rejection and survival.

METHODS: A retrospective single center analysis of adult OHT recipients from July 2004 to December 2017 was performed. Demographic, laboratory, medication, infection, rejection and survival data were collected for 1 year post-OHT. Baseline lab measurements were collected within the 24 hours before OHT. Neutropenia was defined as absolute neutrophil count ≤1000 cells/mm3. Cox proportional hazards models explored associations with time to first neutropenia. Associations between neutropenia, analyzed as a time-dependent covariate, with secondary outcomes of time to infection, rejection or death were also examined.

RESULTS: Of 278 OHT recipients, 84 (30%) developed neutropenia at a median of 142 days (range 81-228) after transplant. Factors independently associated with increased risk of neutropenia included lower baseline WBC (HR 1.12; 95% CI 1.11 – 1.24), pre-OHT ventricular assist device (1.63; 1.00 – 2.66), high risk CMV serostatus [donor positive, recipient negative] (1.86; 1.19 – 2.88), and having a previous CMV infection (4.07; 3.92 – 13.7).

CONCLUSIONS: Neutropenia is a fairly common occurrence after adult OHT. CMV infection was associated with subsequent neutropenia, however no statistically significant differences in outcomes were found between neutropenic and non-neutropenic patients in this small study. It remains to be determined in future studies if medication changes in response to neutropenia would impact patient outcomes.

PMID:33982834 | DOI:10.1111/tid.13634

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Dietary nitrate prevents progression of carotid subclinical atherosclerosis through blood pressure-independent mechanisms in patients with or at risk of type 2 diabetes mellitus

Br J Clin Pharmacol. 2021 May 13. doi: 10.1111/bcp.14897. Online ahead of print.


AIM: To test if 6 months’ intervention with dietary nitrate and spironolactone could affect carotid subclinical atherosclerosis and stiffness, respectively, versus placebo/doxazosin, to control for blood pressure (BP).

METHODS: A subgroup of participants in our double-blind, randomized-controlled, factorial VaSera trial had carotid imaging. Patients with hypertension and with/at risk of type 2 diabetes were randomized to active nitrate-containing beetroot juice or placebo nitrate-depleted juice, and spironolactone or doxazosin. Vascular ultrasound for carotid diameter (CD, mm) and intima-media thickness (CIMT, mm) was performed at baseline, 3- and 6-months. Carotid local stiffness (CS, m/s) was estimated from aortic pulse pressure (Arteriograph®) and carotid lumen area. Data was analysed by modified intention to treat and using mixed-model effect, adjusted for confounders.

RESULTS: 93 subjects had a baseline evaluation and 86% had follow-up data. No statistical interactions occurred between the juice and drug arms and BP was similar between the juices and between the drugs. Nitrate-containing versus placebo juice significantly lowered CIMT [-0.06 (95% Confidence Interval -0.12, -0.01), p=0.034], an overall difference of ~8% relative to baseline; but had no effect on carotid diameter (CD) or carotid stiffness (CS). Doxazosin appeared to reduce CS from baseline [-0.34 (-0.62, -0.06)] however, no difference was detected versus spironolactone [-0.15 (-0.46, 0.16)]. No differences were detected between spironolactone or doxazosin on CIMT and CD.

CONCLUSION: Our results show that 6 months’ intervention with dietary nitrate influences vascular remodelling, but not carotid stiffness or diameter. Neither spironolactone nor doxazosin had a BP-independent effect on carotid structure and function.

PMID:33982797 | DOI:10.1111/bcp.14897

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Transvaginal Ultrasound-Guided Fine-Needle Aspiration Biopsy of Pelvic Lesions

J Ultrasound Med. 2021 May 13. doi: 10.1002/jum.15746. Online ahead of print.


OBJECTIVES: To assess adequacy of transvaginal ultrasound-guided fine-needle aspiration biopsy (TVUS-FNAB) for pathologic diagnosis of pelvic masses performed using onsite cytopathology consultation.

METHODS: In this Institutional Review Board approved, Health Insurance Portability and Accountability Act (HIPAA) compliant study, radiology records were retrospectively queried to identify patients who underwent TVUS-FNAB of a pelvic mass over a 11-year duration. TVUS-FNAB adequacy was determined by correlating cytopathology results with transvaginal ultrasound-guided core-needle biopsy (TVUS-CNB) or surgical pathology results when available, and with clinical diagnostic confidence when additional pathology confirmation was not available. Secondary analysis included patient age, history of hysterectomy, or pelvic malignancy. Target-specific features analyzed included mass size, depth, location, and final pathologic diagnosis.

RESULTS: Sixty patients underwent TVUS-FNAB of pelvic masses, 43 of which underwent FNAB only and 17 underwent both TVUS-FNAB and TVUS-CNB during the same procedure. TVUS-FNAB alone was adequate for diagnosis in 51 (85%) cases and addition of core-needle biopsy (CNB) achieved a diagnosis in additional 4 patients, increasing overall diagnostic accuracy to 92% (55/60). FNAB inadequacy had statistically significant association with increasing mass depth, occurrence of a minor intraprocedural complication, and decision to perform a CNB (P <.05). Number of FNAB passes, mass size, history of hysterectomy, and final diagnosis were not statistically significant predictors of FNAB adequacy.

CONCLUSION: TVUS-FNAB has a high specimen adequacy rate when performed with an onsite cytopathologist and can be considered first-line approach for image-guided sampling of pelvic lesions with option to add CNB if preliminary cytopathologic review does not confirm sample adequacy.

PMID:33982794 | DOI:10.1002/jum.15746

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Global scientific research progress in mycetoma: a bibliometric analysis

Trans R Soc Trop Med Hyg. 2021 May 13:trab072. doi: 10.1093/trstmh/trab072. Online ahead of print.


BACKGROUND: Mycetoma is a neglected tropical disease that attracts little attention in regard to research and publications and hence this study was undertaken to determine the trends and global scientific research output in mycetoma-related fields.

METHODS: Mycetoma data were retrieved from the Web of Science (WoS) and Scopus databases. The MeSH Browser was used to extract relevant keywords. Biblioshiny software (R-studio cloud), VOSviewer v. 1.6.6 and SPSS software were used for data management.

RESULTS: Research trends on mycetoma increased globally from 1999 to 2020. The results were 404 documents (4444 citations) in WoS and 513 documents (5709 citations) in Scopus, and the average number of citations per article was 11 in WoS and 11.13 in Scopus. There was a significant association between the total number of citations and the total citations per year in both WoS (r=0.833, p<0.0001) and Scopus (r=0.926, p<0.0001). Sudan, India, the Netherlands and Mexico were the top-ranking productive countries for mycetoma publications in WoS, while India, the USA and Mexico were the top-ranking countries in Scopus. Articles on mycetoma were mainly published in PLoS Neglected Tropical Diseases, the International Journal of Dermatology and the Journal of Clinical Microbiology. A. H. Fahal from the Mycetoma Research Centre, University of Khartoum, Sudan, had the highest number of citations in mycetoma research during 1999-2020, followed by W. W. J. van de Sande from the Erasmus Medical Centre, University of Rotterdam, the Netherlands, during 2003-2020.

CONCLUSION: The analysis provides insight into a global overview of Mycetoma research. In addition, the analysis holds a better understanding of the development trends that have emerged in Mycetoma over the past 21 years, which can also offer a scientific reference for future research.

PMID:33982760 | DOI:10.1093/trstmh/trab072

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Is there a Role for Antenatal Corticosteroids in Term Infants before Elective Cesarean Section?

Rev Bras Ginecol Obstet. 2021 Apr;43(4):283-290. doi: 10.1055/s-0041-1726055. Epub 2021 May 12.


OBJECTIVE: Cesarean section (CS) delivery, especially without previous labor, is associated with worse neonatal respiratory outcomes. Some studies comparing neonatal outcomes between term infants exposed and not exposed to antenatal corticosteroids (ACS) before elective CS revealed that ACS appears to decrease the risk of respiratory distress syndrome (RDS), transient tachypnea of the neonate (TTN), admission to the neonatal intensive care unit (NICU), and the length of stay in the NICU.

METHODS: The present retrospective cohort study aimed to compare neonatal outcomes in infants born trough term elective CS exposed and not exposed to ACS. Outcomes included neonatal morbidity at birth, neonatal respiratory morbidity, and general neonatal morbidity. Maternal demographic characteristics and obstetric data were analyzed as possible confounders.

RESULTS: A total of 334 newborns met the inclusion criteria. One third of the population study (n = 129; 38.6%) received ACS. The present study found that the likelihood for RDS (odds ratio [OR] = 1.250; 95% confidence interval [CI]: 0.454-3.442), transient TTN (OR = 1.,623; 95%CI: 0.556-4.739), and NIUC admission (OR = 2.155; 95%CI: 0.474-9.788) was higher in the ACS exposed group, although with no statistical significance. When adjusting for gestational age and arterial hypertension, the likelihood for RDS (OR = 0,732; 95%CI: 0.240-2.232), TTN (OR = 0.959; 95%CI: 0.297-3.091), and NIUC admission (OR = 0,852; 95%CI: 0.161-4.520) become lower in the ACS exposed group.

CONCLUSION: Our findings highlight the known association between CS-related respiratory morbidity and gestational age, supporting recent guidelines that advocate postponing elective CSs until 39 weeks of gestational age.

PMID:33979889 | DOI:10.1055/s-0041-1726055

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The Effect of Dialectic Behavioral Counseling on Depression, Anxiety, and Postpartum Hematocrit Level

Rev Bras Ginecol Obstet. 2021 Apr;43(4):275-282. doi: 10.1055/s-0041-1728780. Epub 2021 May 12.


OBJECTIVE: Childbirth is a biological, psychological, and sociological event that can be a positive or negative experience, and, without support, this period may be potentially damaging. Parturition may distort maternal emotions and lead to short- or long-term disorders such as postpartum depression and anxiety. The present research aims to study the effects of dialectic behavioral therapy-based counseling on depression, anxiety symptoms, and postpartum hematocrit level.

METHODS: The current research is a clinical trial study, and the sample was selected using parturients who were referred to the Health General Center with a diagnosis of postpartum depression and anxiety. The sample size consisted of 116 subjects who agreed to participate in the study. The patients in intervention group underwent group dialectic behavioral counseling (10 sessions/one session per week) and the control group did not receive any type of intervention. The patients were assessed in the first and last sessions as well as 2 months after the end of the sessions, using the Beck depression scale and Spielberg anxiety scale as well as the results of hematocrit tests. Data were analyzed using the IBM SPSS Statistics for Windows, Version 21.0 (IBM Corp., Armonk, NY, USA) RESULTS: The results implied the effectiveness of dialectic behavioral therapy on reduction of the depression score, anxiety symptoms (p-value ≤ 0.0001), and hematocrit level (p-value = 0.04). The participants’ depression, anxiety, and hematocrit levels decreased in the experiment group compared to the control group, and this decrease has remained until the 2-month follow-up.

CONCLUSION: It seems that dialectic behavioral counseling reduces the levels of postpartum depression, anxiety, and hematocrits.

PMID:33979888 | DOI:10.1055/s-0041-1728780

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5-HTTLPR-rs25531 and Antidepressant Treatment Outcomes in Korean Patients with Major Depression

Pharmacopsychiatry. 2021 May 12. doi: 10.1055/a-1478-4574. Online ahead of print.


INTRODUCTION: Despite the ethnic differences in 5-HTTLPR (S allele relates to better antidepressant response in Korean and Japanese people, while L allele with better response in Caucasians), it is unclear whether 5-HTTLPR and its high expression locus rs25531 are interactively associated with antidepressant treatment outcome. We investigated the individual and interaction effects of these polymorphisms on antidepressant treatment outcomes in the Korean population.

METHODS: A total of 464 Korean subjects with major depressive disorder completed 6 weeks of antidepressant monotherapy. Venous blood was extracted for genotyping 5-HTTLPR and rs25531 by polymerase chain reaction and DNA sequencing. We used logistic regression analyses to verify the main and interaction effects of 5-HTTLPR and rs25531 on response and remission after antidepressant treatment.

RESULTS: After adjusting for covariates, the SS genotype of 5-HTTLPR was significantly associated with better treatment outcomes (p<0.001, odds ratio [OR] [95% confidence interval (CI)]=2.435 [1.551, 3.823] in response; p<0.001, OR [95% CI]=2.912 [1.730, 4.903] in remission), while G-containing genotype (AG+GG) of rs25531 was only associated with remission (p=0.034, OR [95% CI]=2.104 [1.058, 4.181]). The interaction effect of 5-HTTLPR and rs25531 on response and remission was insignificant (all p>0.05).

DISCUSSION: Our findings suggest variations in allelic frequency and functionality of 5-HTTLPR and rs25531 among the different ethnicities. We found a minor advantage of rs25531 in achieving remission. However, there was no interaction effect with 5-HTTLPR.

PMID:33979867 | DOI:10.1055/a-1478-4574