Category: Nevin Manimala

Gynecol Endocrinol. 2023 Aug 8;39(1):2245479. doi: 10.1080/09513590.2023.2245479.

ABSTRACT

OBJECTIVE: To develop a model to identify women likely to be severely impacted by vulvovaginal atrophy (VVA), based on their experience of symptoms and non-clinical factors.

METHODS: Multivariate statistics and machine-learning algorithms were used to develop models using data from a cross-sectional, observational, multinational European survey. A set of independent variables were chosen to assess subjective VVA severity and its impact on daily activities.

RESULTS: A final composite model was selected that included three categories of variables: clinical severity, patient demographics/clinical characteristics and Day-to-Day Impact of Vaginal Aging (DIVA) variables related to emotion/mood, impact on lifestyle and frequency of sex. The model accurately classified 71% of women. Three DIVA variables (feeling bad about yourself, desire/interest in sex, physical comfort related to sitting) explained much of the variation in the dependent variable of the model. Over 90% of the impact of VVA relates to certain psychosocial and behavioral aspects that can be identified without the need to consider physical signs/symptoms.

CONCLUSION: Non-clinical factors can contribute significantly to the overall VVA burden.Questions used in developing the composite model could form the basis of an instrument to help screen women prior to clinical consultation and improve VVA management.

PMID:37582396 | DOI:10.1080/09513590.2023.2245479

Anasthesiol Intensivmed Notfallmed Schmerzther. 2023 Jul;58(7-08):436-447. doi: 10.1055/a-1977-7297. Epub 2023 Aug 15.

ABSTRACT

According to data from the German Federal Statistical Office, 424635 patients died in hospitals across Germany in 2020. That is 43% of all deaths. Deaths occur everywhere in hospitals – not just in palliative care units – and caring for the dying is considered a basic task of medical practice 1. The German Medical Association has published principles for end-of-life care and the S3 guideline on palliative medicine also provides instructions on what end-of-life care should look like. However, there is often uncertainty as to what the care of the dying should look like in concrete terms. The following explanations are intended to convey how ideal end-of-life care should be designed and provide concrete assistance and suggestions as to how this can also succeed outside a palliative care unit.

PMID:37582354 | DOI:10.1055/a-1977-7297

J Breath Res. 2023 Aug 15. doi: 10.1088/1752-7163/acf066. Online ahead of print.

ABSTRACT

In order to prevent long-term immunity-related complications after lung transplantation, close monitoring of immunosuppressant levels using therapeutic drug monitoring (TDM) is paramount. Novel electronic nose (eNose) technology may be a non-invasive alternative to the current invasive procedures for TDM. We investigated the diagnostic and categorization capacity of eNose breathprints for Tacrolimus trough blood plasma levels (TACtrough) in lung transplant recipients (LTR).&#xD;Method: We performed eNose measurements in stable LTR attending the outpatient clinic. We evaluated 1) the correlation between eNose measurements and TACtrough, 2) the diagnostic capacity of eNose technology for TACtrough, and 3) the accuracy of eNose technology for categorization of TACtrough into three clinically relevant categories (low: <7 µg/mL, medium: 7 – 10 µg/mL, and high: >10 µg/mL).&#xD;Results: A total of 186 measurements from 86 LTR were included. There was a weak but statistically significant correlation (r = 0.21, p = 0.004) between the eNose measurements and TACtrough. The root mean squared error of prediction (RMSEP) for the diagnostic capacity was 3.186 in the training and 3.131 in the validation set. The accuracy of categorization ranged between 45-63% for the training set and 52-69% in the validation set. &#xD;Conclusion: There is a weak correlation between eNose breathprints and TACtrough in LTR. However, the diagnostic as well as categorization capacity for TACtrough using eNose breathprints is too inaccurate to be applicable in TDM. &#xD.

PMID:37582348 | DOI:10.1088/1752-7163/acf066

Endocr Connect. 2023 Aug 1:EC-23-0314. doi: 10.1530/EC-23-0314. Online ahead of print.

ABSTRACT

CONTEXT: In individuals with hypothyroidism and overweight, levothyroxine substitution therapy is often expected to cause weight loss due to its effect on resting energy expenditure. However, despite levothyroxine-induced enhancement of resting energy expenditure, fat mass loss is rarely seen after levothyroxine substitution therapy. The mechanism behind this conundrum is unknown.

OBJECTIVE: To assess the effect of levothyroxine therapy on hunger sensations and ad libitum food intake in individuals with hypothyroidism.

DESIGN AND SETTING: Prospective cohort study of 18 newly diagnosed hypothyroid women (thyroid-stimulating hormone (TSH) >10 mU/L). Participants were investigated at diagnosis, after normalization of TSH (<4.0 mU/L), and after six months of successful treatment. Eighteen age and body mass index-matched healthy controls were also included.

INTERVENTION: Hypothyroid individuals were treated with levothyroxine according to European Thyroid Association guidelines.

MAIN OUTCOMES: Changes in hunger sensation were assessed using visual analog scales (cm) before and during a standardized mixed meal test, and food intake was measured during a subsequent ad libitum meal (g).

RESULTS: After six months of levothyroxine therapy, mean resting energy expenditure was increased by 144 kcal/day (10%) (P < 0.001). Weight loss was comprised of 0.8 kg fat-free mass while fat mass remained unchanged. Fasting hunger sensation increased from a mean of 4.5 (SD 2.2) cm to 5.5 (SD 2.2) cm (P = 0.047). The numerical increase in ad libitum meal intake did not reach statistical significance.

CONCLUSION: Our data suggest that levothyroxine-induced hunger may be a culprit in the lack of fat mass loss from levothyroxine therapy.

PMID:37582332 | DOI:10.1530/EC-23-0314

Zhonghua Wei Chang Wai Ke Za Zhi. 2023 Jul 25;26(7):689-696. doi: 10.3760/cma.j.cn441530-20221125-00493.

ABSTRACT

Objective: To assess the effectiveness of transanal drainage tube (TDT) in reducing the incidence of anastomotic leak following anterior resection in patients with rectal cancer. Methods: We conducted a systematic search for relevant studies published from inception to October 2022 across multiple databases, including PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang, and VIP. Meta-analysis was performed using Review Manager 5.4 software. The primary outcomes included total incidence of anastomotic leak, grade B and C anastomotic leak rates, reoperation rate, anastomotic bleeding rate, and overall complication rate. Results: Three randomized controlled trials involving 1115 patients (559 patients in the TDT group and 556 in the non-TDT group) were included. Meta-analysis showed that the total incidences of anastomotic leak and of grade B anastomotic leak were 5.5% (31/559) and 4.5% (25/559), respectively, in the TDT group and 7.9% (44/556) and 3.8% (21/556), respectively, in the non-TDT group. These differences are not statistically significant (P=0.120, P=0.560, respectively). Compared with the non-TDT group, the TDT group had a lower incidence of grade C anastomotic leak (1.6% [7/559] vs. 4.5% [25/556]) and reoperation rate (0.9% [5/559] vs. 4.3% [24/556]), but a higher incidence of anastomotic bleeding (8.2% [23/279] vs. 3.6% [10/276]). These differences were statistically significant (P=0.003, P=0.001, P=0.030, respectively). The overall complication rate was 26.5%(74/279) in the TDT group and 27.2% (75/276) in the non-TDT group. These differences are not statistically significant (P=0.860). Conclusions: TDT did not significantly reduce the total incidence of anastomotic leak but may have potential clinical benefits in preventing grade C anastomotic leak. Notably, placement of TDT may increase the anastomotic bleeding rate.

PMID:37583027 | DOI:10.3760/cma.j.cn441530-20221125-00493

Zhonghua Wei Chang Wai Ke Za Zhi. 2023 Jun 25;26(6):595-602. doi: 10.3760/cma.j.cn441530-20230315-00083.

ABSTRACT

Objective: To compare the long-term outcomes of intersphincteric (trans-internal and external) sphincter resection (ISR) and abdominoperineal proctocolectomy (APR) for low-grade rectal cancer. Methods: We used a meta-analytic approach to compare these procedures . Published reports comparing ISR and APR for low rectal cancer in Pubmed, Medline, EMBASE and Cochrane, China Knowledge Network (CNKI), China Biomedical Literature Database, and Vipers databases between January 2005 and January 2023 were searched and those meeting the eligibility criteria were selected for extraction of data for analysis. Inclusion criteria were as follows: (1) all reports comparing ISR and APR for low rectal cancer before January 2023; and (2) prospective randomized controlled studies or well-designed cohort studies. Exclusion criteria were as follows: (1) full text not available; (2) duplicate publications, missing primary outcome indicators, and unknown data; and (3) invalid statistical analysis. Results: Sixteen studies with 2498 patients were included in this study. Compared with the APR group, patients in the ISR group were relatively younger (weighted mean difference [WMD]=-1.82, 95%CI=-2.94 to -0.70, P=0.01), had tumors farther from the anal verge (WMD=0.43, 95%CI=0.18 to 0.67, P<0.01), and lower pathological T-stage (T3-4 stage: OR=0.54, 95%CI=0.36 to 0.81, P<0.01). In contrast, there were no statistically significant differences between the two groups in gender (P=0.78), body mass index (P=0.77), or pathological N stage (P=0.09). Compared with the APR group, patients in the ISR group had a lower rate of postoperative complications (OR=0.77, 95%CI=0.60 to 0.99, P=0.04), shorter hospital stay (WMD=-4.30, 95%CI=-7.07 to -1.53, P<0.01), higher 5-year overall survival (HR=0.54, 95%CI=0.33 to 0.88, P=0.01), and higher 5-year disease-free survival (HR=0.65, 95%CI=0.47 to 0.90, P<0.01). Five-year locoregional failure (HR=0.66, 95%CI=0.40 to 1.10, P=0.11) and time to surgery (WMD=-9.71, 95%CI=-41.89 to 22.47, P=0.55) did not differ significantly between the two groups. Conclusion: ISR is a safe and effective alternative to APR for early-stage low-grade rectal cancer.

PMID:37583014 | DOI:10.3760/cma.j.cn441530-20230315-00083

J Urban Health. 2023 Aug 15. doi: 10.1007/s11524-023-00752-9. Online ahead of print.

ABSTRACT

We examined the impact of the first year of the COVID-19 pandemic on unmet healthcare need among New Yorkers and potential differences by race/ethnicity and health insurance. Data from the Community Health Survey, collected in 2018, 2019, and 2020, were merged to compare unmet healthcare need within the past 12 months during the pandemic versus the 2 years prior to 2020. Univariate and multivariable logistic regression models evaluated change in unmet healthcare need overall, and we assessed whether race/ethnicity or health insurance status modified the association. Overall, 12% of New Yorkers (N = 27,660) experienced unmet healthcare during the 3-year period. In univariate and multivariable models, the first year of the pandemic (2020) was not associated with change in unmet healthcare need compared with 2018-2019 (OR = 1.04, p = 0.548; OR = 1.03, p = 0.699, respectively). There was no statistically significant interaction between calendar year and race/ethnicity, but there was significant interaction with health insurance status (interaction p = 0.009). Stratifying on health insurance status, those uninsured had borderline significant lower odds of experiencing unmet healthcare need during 2020 compared to the 2 years prior (OR = 0.72, p = 0.051) while those with insurance had a slight increase that was not significant (OR = 1.12, p = 0.143). Unmet healthcare need among New Yorkers during the first year of the pandemic did not differ significantly from 2018-2019. Federal pandemic relief funding, which offered no-cost COVID-19 testing and care to all, irrespective of health insurance or legal status, may have helped equalized access to healthcare.

PMID:37583004 | DOI:10.1007/s11524-023-00752-9

Int J Legal Med. 2023 Aug 16. doi: 10.1007/s00414-023-03068-0. Online ahead of print.

ABSTRACT

Time since death estimation is a vital part of forensic pathology. Despite the known tissue degradation after death, the efficacy of using biomechanical tissue properties to estimate time since death remains unexplored. Here, eight brain tissue localizations were sampled from the frontal lobe, parietal lobe, anterior and posterior deep brain, superior colliculi, pons, medulla, and cerebellum of 30 sheep; were then stored at 20 °C; and subsequently subjected to rheometry tests on days zero to four after death. Overall, the measured tissue storage modulus, loss modulus, and complex shear modulus decreased after death for all of the tested regions in a site-specific manner. Day zero to day one changes were the only 24-h interval, for which statistically significant differences in tissue mechanical moduli were observed for some of the tested brain regions. Based on receiver operator characteristic analyses between day zero and the pooled data of days one to four, a post mortem interval of at least 1 day can be determined with a sensitivity of 90%, a specificity of 92%, and a positive likelihood ratio of 10.8 using a complex shear modulus cut-off value of 1461 Pa for cerebellar samples. In summary, biomechanical properties of brain tissue can discriminate between fresh and at least 1-day-old samples stored at 20 °C with high diagnostic accuracy. This supports the possible value of biomechanical analyses for forensic time since death estimations. A striking advantage over established methods to estimate the time since death is its usability in cases of disintegrated bodies, e.g. when just the head is found.

PMID:37582986 | DOI:10.1007/s00414-023-03068-0

Clin Res Cardiol. 2023 Aug 15. doi: 10.1007/s00392-023-02282-5. Online ahead of print.

ABSTRACT

INTRODUCTION: The aim of the present study was to evaluate the prevalence and prognosis of structural heart disease (SHD) among competitive athletes with negative T waves without pathological findings at transthoracic echocardiogram.

METHODS: From a prospective register of 450 athletes consecutively evaluated during a second-level cardiological examination, we retrospectively identified all subjects with the following inclusion criteria: (1) not previously known cardiovascular disease; (2) negative T waves in leads other than V1-V2; (3) normal transthoracic echocardiogram. Patients underwent cardiac MRI and CT. The primary endpoint was the diagnosis of definite SHD after multimodality imaging evaluation. A follow-up was collected for a combined end-point of sudden death, resuscitated sudden cardiac death and hospitalization for any cardiovascular causes.

RESULTS: A total of 55 competitive athletes were finally enrolled (50 males, 90%) with a mean age of 27.5 ± 14.1 years. Among the population enrolled 16 (29.1%) athletes had a final diagnosis of SHD. At multivariate analysis, only deep negative T waves remained statistically significant [OR (95% CI) 7.81 (1.24-49.08), p = 0.0285]. Contemporary identification of deep negative T waves and complex arrhythmias in the same patients appeared to have an incremental diagnostic value. No events were collected at 49.3 ± 12.3 months of follow-up.

CONCLUSIONS: In a cohort of athletes with negative T waves at ECG, cardiac MRI (and selected use of cardiac CT) enabled the identification of 16 (29.1%) subjects with SHD despite normal transthoracic echocardiography. Deep negative T waves and complex ventricular arrhythmias were the only clinical characteristic associated with SHD diagnosis.

PMID:37582977 | DOI:10.1007/s00392-023-02282-5

Evid Based Dent. 2023 Aug 15. doi: 10.1038/s41432-023-00922-3. Online ahead of print.

ABSTRACT

DATA SOURCES: Electronic scientific databases Embase, CINAHL, MEDLINE, PsycINFO and Web of Science were systematically searched and restricted to articles published from 1996 onwards and limited to articles published in English. This was carried out following an initial scoping search using keywords conducted in PubMed.

STUDY SELECTION: Original studies investigating the use of mobile phone applications as a delivery method of healthcare interventions to parents and caregivers with children ≤6 years of age were included. As this was a mixed-methods systematic review, studies that have quantitative clinical outcomes and also qualitative outcomes of experiences, attitudes and beliefs of parents and caregivers were included. EndNote X8.2 and Rayyan.ai software was employed for title and abstract screening.

DATA EXTRACTION AND SYNTHESIS: Three independent authors developed a combined data extraction tool to examine titles, abstracts and full texts of relevant articles against the inclusion criteria. The development of this tool was guided by the JBI reviewer’s manual. Data extraction was completed by one reviewer, and verified by two further reviewers. Disagreements were resolved by discussion. Retrieved studies were assessed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data extracted included study reference information, study design, setting, sample sizes and intervention characteristics. A risk of bias assessment was undertaken using the Quality Appraisal for Diverse Studies tool, and a further risk assessment of quantitative and mixed methods studies.

RESULTS: From 5953 studies initially identified, 5 studies were included in the review. One study identified using a gamification design within a mobile health app to promote oral health had statistically significant improvements in plaque and gingival indices compared to a control group at both a 6 and 12-week recall. Two studies reported a significant improvement in maternal knowledge of children’s oral health as a result of using an oral health app.

CONCLUSIONS: The delivery of oral health promotion through mobile health apps may be effective in reducing early childhood caries through improving health literacy in parents and caregivers, however key challenges in the app development process exist surrounding privacy issues and data protection.

PMID:37582973 | DOI:10.1038/s41432-023-00922-3