Category: Nevin Manimala

Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2024 Dec 4. doi: 10.1007/s00103-024-03986-3. Online ahead of print.

ABSTRACT

National mortality registers provide important data for monitoring population health. Analyses of cardiovascular mortality in particular-and especially mortality from coronary heart disease-are frequently the basis for conclusions about the quality of healthcare and prevention. To be able to interpret disease-specific mortality differences between countries and changes in mortality over time, it is necessary to know the basics of monocausal cause-of-death statistics and the associated limitations in comparative statements.Conclusions from disease-specific mortality data can be problematic due to the highly subjective selection of diseases that are entered on a death certificate after a post-mortem examination. In death certification, unawareness of the different “roles” of specific diseases-known at the time of death-within the causal chain leading to death can result in incomplete death certificates as a data basis for mortality statistics. Comparisons of disease-specific mortality rates are difficult due to different proportions of non-informative-including unknown-causes of death and due to country-specific preferences for which diseases are recorded on a death certificate-especially in the prevalence of multimorbidity. A population’s morbidity is therefore only reflected to a limited extent by mortality rates. Conceptual ambiguities with regard to the concepts of lethality and mortality when describing mortality rates can also lead to erroneous conclusions.Training of medical staff on how to complete a death certificate and the introduction of an electronic death certificate can improve the quality of mortality data. Irrespective of this, knowing potential pitfalls when analyzing mortality data will improve the quality of health reporting.

PMID:39630243 | DOI:10.1007/s00103-024-03986-3

Pediatr Radiol. 2024 Dec 4. doi: 10.1007/s00247-024-06105-1. Online ahead of print.

ABSTRACT

OBJECTIVE: Accurate and early prediction of neurodevelopmental impairment is a crucial endeavor in caring for very preterm infants (<31 weeks’ gestation). Sequential cranial ultrasound is the standard of care for the evaluation of preterm brain injury. However, there is no consensus on the timing and frequency of ultrasound screening. At Izaak Walton Killam (IWK) Health Centre, Halifax, Canada, four-time points for routine ultrasound of very preterm infants are performed at weeks 1, 2, 6, and term age. The hypothesis behind this work is that a three-time-point model will be appropriate for neurodevelopmental impairment prognostication.

MATERIALS AND METHODS: In this retrospective cohort, all very preterm infants (22⁰-30⁶ weeks) born between January 2004 and December 2018 with a neurodevelopmental assessment at 36 months corrected age were included. Three prediction models of neurodevelopmental impairment were compared: 1. A reference model including the gestational age, infant sex, and 2-week and 6-week ultrasound 2. A model including the gestational age, infant sex, and 6-week ultrasound 3. A model including the gestational age, infant sex, and 2-week ultrasound RESULTS: Of 786 eligible preterm infants born during the study period, 656/786 survivors were included in the analysis (mean gestational age 27⁵ weeks, mean birth weight 1,133 g, and 55% male infants). At 36 months of corrected age, 30% developed neurodevelopmental impairment. All three models provided comparable discrimination areas under the curve (AUC) of neurodevelopmental impairment at 36 months of corrected age. Both the 6-week and the reference model had similar AUC of 0.68 (95% CI 0.63-0.72) and were not noticeably different from the 2-week model (AUC 0.66 (95% CI 0.61-0.70)). The 6-week model provided the best prediction with the lowest Akaike information criterion (AIC) of 766 for the 6-week-only model, AIC 769 for combined weeks 2 and 6 (reference model), and AIC 784 for the 2-week-only model.

CONCLUSION: In this cohort of very preterm infants, a model including 6-week ultrasound only was comparable to a reference model combining 2-week and 6-week ultrasound and showed nearly identical predictive performance of neurodevelopmental impairment at 36 months corrected age across a broad set of metrics; thus, it is redundant to do both the 2-week and 6-week ultrasound.

CLINICAL RELEVANCE STATEMENT: Late ultrasound at 6 weeks of age provided comparable diagnostic and prognostic information to a reference model combining 2-week and 6-week ultrasound and, if anything, was slightly superior to the 2-week ultrasound model, across a broad set of metrics. The 2-week ultrasound can be eliminated with no impact on the prediction of neurodevelopmental impairment at 36 months, promoting prudent resource allocation and stewardship in healthcare.

PMID:39630240 | DOI:10.1007/s00247-024-06105-1

World J Urol. 2024 Dec 4;43(1):12. doi: 10.1007/s00345-024-05365-8.

ABSTRACT

PURPOSE: Ureteroscopy (URS) is considered one of the first-line surgical treatments for urinary stones < 2 cm. Preoperative stenting (PS) employment in URS for urolithiasis remains debated, with evidence differing in terms of outcomes and recommendations. We sought to evaluate the influence of PS on surgical outcomes compared to non-PS (NPS) in patients with renal and ureteral stones undergoing ureteroscopic lithotripsy.

METHODS: Databases were searched until December 2023 for randomized and non-randomized studies reporting perioperative outcomes for PS and NPS. Pooled data were analyzed through a Random-Effects model when Higgins I2% heterogeneity values were > 50%; otherwise, a Fixed-Effects model was employed. Results were reported as risk ratios (RR), or mean differences (MD) with 95% confidence intervals (CI). Statistical significance was set at p < 0.05.

RESULTS: The analysis included 23,668 patients from 25 included studies (5 non-randomized prospective and 20 retrospective studies). Higher stone-free rates (SFR) were observed in kidney and ureteral stones (RR 1.05; 95%CI 1.03-1.08; p ≤ 0.0001), especially if managed with flexible URS (RR 1.05; 95%CI 1.01-1.09) in the PS cohort. Additionally, lower rates of intraoperative (RR 0.70; 95%CI 0.49-0.99; p = 0.04) and postoperative complications (RR 0.82; 95%CI 0.70-0.95; p = 0.008) were seen with PS. Both groups had a comparable operative time, length of stay (LOS), ureteral access sheath (UAS) placement success, and SFR in semi-rigid URS.

CONCLUSION: Higher SFR with PS were seen in kidney and ureteral stones, especially if f-URS was employed. Moreover, perioperative complications did not increase with PS. Future randomized studies, evaluating cost-effectiveness and quality of life are needed.

PMID:39630233 | DOI:10.1007/s00345-024-05365-8

Med Mol Morphol. 2024 Dec 4. doi: 10.1007/s00795-024-00412-0. Online ahead of print.

ABSTRACT

This study aimed to evaluate corneal findings of pterygium cases using in vivo confocal microscopy (IVCM) which is a non-invasive and repeatable method. In this case-control study, 54 patients diagnosed with pterygium and 50 healthy controls were investigated, between 2020 and 2021. After a comprehensive ophthalmological examination, the central corneas of all participants were evaluated by corneal IVCM. Surface epithelial cell, wing cells, basal epithelial cells, nerve fiber density, nerve branch density, anterior and posterior stroma keratocyte densities were measured. Corneas from cases with and without pterygium were similar in terms of age (p = 0.306) and gender (p = 0.564). No statistically significant differences were found in the epithelium cell counts including surface, wing, and basal cells between the two groups (p = 0.950, p = 0.334, and p = 0.624, respectively). No statistically significant differences were observed in subepithelial nerve fiber density (p = 0.849), nerve branch density (p = 0.752), and posterior stromal keratocyte density (p = 0.683) between corneas from cases with and without pterygium. However, corneas from cases with pterygium had significantly higher scores in anterior stromal keratocyte density than those from cases without pterygium (p = 0.045). Corneas from grades 1, 2, and 3 pterygium were similar in cell counts, anterior and posterior stromal keratocyte densities (p > 0.05). However, patients with grade 1 had significantly increased nerve fiber density (p = 0.015) and nerve branch density (p = 0.001) than those with grade 2 and grade 3 pterygium. Corneal IVCM may be useful to better understand the corneal microstructure in cases with pterygium. Comprehensive research on the subject is needed.

PMID:39630225 | DOI:10.1007/s00795-024-00412-0

Eur Arch Paediatr Dent. 2024 Dec 4. doi: 10.1007/s40368-024-00973-9. Online ahead of print.

ABSTRACT

BACKGROUND: Bruxism is defined as the recurring muscular activity of the jaw, which is distinguished by the unconscious grinding or clenching of teeth or pushing and forcing of the lower jaw. The present study was conducted to assess sleep bruxism and its association with sleep quality, stress levels, and dental health in the paediatric population.

METHODOLOGY: 384 children aged 6-12 years were recruited for the study. Ethical approval from the institutional ethical committee and informed consent from parents and guardians were obtained. Children with systemic diseases, mental or developmental disorders, CNS-affecting medications, or those whose parents did not provide consent were not included. Bruxism was identified using the American Academy of Sleep Medicine (AASM) criteria through parental reports. Sleep quality and stress levels were assessed using AASM guidelines and the Perceived Stress Scale for Children (PSS-C). A chi-square test was applied to assess association, with a p value < 0.05 considered to be significant.

RESULTS: The number of siblings and the mother’s education level were also significantly associated. It was found that sleep bruxism is significantly associated with all parameters of sleep quality except the usage of pillows. When stress levels among children were assessed, it was found that 60 (15.6%) children had very low stress, 131 (34.1%) children had low stress, 95 (24.7%) children had average stress, 92 (24%) children had high stress, and 6 (1.6%) children had a very high level of stress. A statistically highly significant (p = 0.001) association was found between bruxism and stress levels among children.

CONCLUSION: The results of the present study concluded that sleep bruxism was significantly linked with sleep quality and stress levels among children, which ultimately affect dental health.

PMID:39630217 | DOI:10.1007/s40368-024-00973-9

Bratisl Lek Listy. 2024;125(12):844-850. doi: 10.4149/BLL_2024_129.

ABSTRACT

BACKGROUND: Fractures of thoracolumbar spine in the field of ankylosing diseases such as ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH) can by surgically treated with miniinvasive posterior transpedicular fixation. The exact length of implant is the subject of several studies. In our study, we retrospectively evaluated the treatment of B3 fractures of the ankylosed thoracolumbar spine with use a shorter versus longer implant, always with 8 screws.

METHODS: A total of 46 patients were included in the study (36 men and 10 women). Sixteen patients had AS and 30 patients had DISH. Patients treated between 2018 and 2022 with minimally invasive dorsal transpedicular fixation using 8 transpedicular screws were included in this study. We compared two groups where the first consisted of patients operated on with fixation of a maximum of 4 segments and the second group of patients consisted of patients in whom longer stabilization was used, at least 5 to 8 segments, with skipping of some vertebra between screws. We compared the effect of fixation length on reduction and retention before surgery, after surgery, and after 6 and 12 months. We evaluated the effect of reduction and retention on the basis of differences in the measurement of the Cobb angle and the angle, which we called “vege”, which was formed by dislocation of the fracture. Furthermore, we monitored demographic data, the length of surgery, the number of complications, the number of concomitant injuries, the presence of a neurological deficit, and the result was assessed by the AO Spine PROST questionnaire.

RESULTS: In the entire group of 46 patients, the difference in the “vege” angle was significant (p<0.001). When comparing the reduction between the groups with short and longer fixation, the difference was not significant (p=0.829). The difference of the Cobb angle before and after the surgery in the comparison between the two groups did not show a statistically significant difference (p=0.434). Measurements of the Cobb angle bisegmentally after 6 and 12 months showed a progressive change in terms of kyphotization, which was smaller in the group with longer fixation, this difference was not statistically significant (p=0.709). Complete reduction was achieved in the group with short fixation vs 75% vs 63.3% with longer fixation (p-0.739). At the check-up after 6 months, all incomplete intraoperative reductions were spontaneously reduced.

CONCLUSIONS: Based on this study, we could conclude that both used constructions are comparable in terms of treatment results. It can be observed that longer fixation is more resistant to kyphotization at 6 and 12 months, but we would need a larger group of patients to confirm this hypothesis. In all incomplete reduced fractures through the surgery, complete reduction after verticalization occurred within 6 months in both groups. The angle of reduction was greater in the group with longer fixation, but the difference was not significant (Tab. 6, Fig. 8, Ref. 31).

PMID:39629657 | DOI:10.4149/BLL_2024_129

J Endovasc Ther. 2024 Dec 4:15266028241292468. doi: 10.1177/15266028241292468. Online ahead of print.

ABSTRACT

PURPOSE: To date, no direct comparison has been made between the patency rates of drug-eluting stents (DESs) and interwoven stents (IWSs) in addressing hemodialysis access dysfunction. This study aims to directly compare the primary patency rates of DES and IWS in clinically significant vein-graft anastomotic stenosis of arteriovenous grafts (AVGs).

MATERIAL AND METHODS: Between January 2015 and October 2022, we enrolled all hemodialysis patients with clinically significant vein-graft anastomotic stenosis of AVGs who presented at our institution. Patient demographics, AVG details, lesion characteristics, and primary patency data for each stent group were systemically recorded. Following this, a Kaplan-Meier analysis of the primary stent patency was performed, with statistical significance set at p<0.05.

RESULTS: A total of 51 patients (19 men and 32 women; mean age=64 years; range=49-79 years) were enrolled. Among them, 16 were treated with DES and 35 were treated with IWS. Notably, the most common stent placement location in each group was the vein-graft anastomosis of the brachioaxillary grafts, and the primary patency rate was monitored over a follow-up period of 24 months. At 6, 12, and 24 months, the primary patency rates for DES vs IWS were 100% vs 62.7%, 91.7% vs 38.8%, and 62.9% vs 21.4%, respectively (p<0.001).

CONCLUSION: Our findings suggest that DES may be a more effective treatment choice for clinically significant vein-graft anastomotic stenosis in AVGs for hemodialysis access than nondrug-coated IWS.

CLINICAL IMPACT: Drug-eluting stents (DES) have been widely recognized for their efficacy in reducing reintervention rates in coronary and femoropopliteal pathologies. However, their application in managing failing hemodialysis access remains inadequately explored. This study highlights the promising potential of DES in addressing clinically significant vein-graft anastomotic stenosis in hemodialysis arteriovenous grafts (AVG). DES may represent a viable alternative for mitigating substantial immediate recoil stenosis following balloon angioplasty and for preventing early restenosis at the vein-graft anastomosis of AVG, offering a novel therapeutic avenue for future clinical practice.

PMID:39629634 | DOI:10.1177/15266028241292468

BJPsych Open. 2024 Dec 4;10(6):e217. doi: 10.1192/bjo.2024.817.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has disproportionately affected women’s mental health. However, most evidence has focused on mental illbeing outcomes, and there is little evidence on the mechanisms underlying this unequal impact.

AIMS: To investigate gender differences in the long-term trajectories of life satisfaction, how these were affected during the pandemic and the role of time-use differences in explaining gender inequalities.

METHOD: We used data from 6766 (56.2% women) members of the 1970 British Cohort Study (BCS70). Life satisfaction was prospectively assessed between the ages of 26 (1996) and 51 (2021) years, using a single question with responses ranging from 0 (lowest) to 10 (highest). We analysed life satisfaction trajectories with piecewise latent growth curve models, and investigated whether gender differences in the change in the life satisfaction trajectories with the pandemic were explained by self-reported time spent doing different paid and unpaid activities.

RESULTS: Women had consistently higher life satisfaction than men before the pandemic (Δ_{intercept,unadjusted} = 0.213, 95% CI 0.087-0.340; P = 0.001) and experienced a more accelerated decline with the pandemic onset (Δ_{quad2,unadjusted} = -0.018, 95% CI -0.026 to -0.011; P < 0.001). Time-use differences did not account for the more accelerated decrease in women’s life satisfaction levels with the pandemic (Δ_{quad2,adjusted} = -0.016, 95% CI -0.031 to -0.001; P = 0.035).

CONCLUSIONS: Our study shows pronounced gender inequalities in the impact of the pandemic on the long-term life satisfaction trajectories of adults in their 50s, with women losing their pre-pandemic advantage over men. Self-reported time-use differences did not account for these inequalities. More research is needed to tackle gender inequalities in population mental health.

PMID:39629603 | DOI:10.1192/bjo.2024.817

Circ Cardiovasc Imaging. 2024 Dec 4:e017425. doi: 10.1161/CIRCIMAGING.124.017425. Online ahead of print.

ABSTRACT

BACKGROUND: In aortic stenosis, the myocardium responds with left ventricular hypertrophy, which is characterized by increased left ventricular mass due to cellular hypertrophy and extracellular matrix expansion. Following aortic valve replacement (AVR), left ventricular hypertrophy regression occurs, but early cellular and extracellular dynamics are unknown.

METHODS: Patients with severe symptomatic aortic stenosis undergoing surgical or transcatheter AVR were prospectively recruited. Pre- and early post-AVR cardiac magnetic resonance imaging assessed left ventricular remodeling, global longitudinal strain, and T1 mapping to determine extracellular volume fraction and volume of cellular and extracellular compartments.

RESULTS: In all, 39 patients (aged 71.4±9.8 years, male 79%, aortic valve peak velocity 4.4±0.5 m/s) underwent cardiac magnetic resonance before and at median 7.7 weeks post-AVR. Left ventricular mass index reduced significantly by 15.4% (P<0.001*), primarily driven by cellular compartment regression (18.7%, P<0.001*), with a smaller reduction in the extracellular compartment (7.2%, P<0.001*). This unbalanced regression led to an apparent increase in extracellular volume fraction (27.4±3.1% to 30.2±2.8%; P<0.001*). Although there was no significant change in global longitudinal strain post-AVR, an increase in extracellular volume fraction was associated with worsening of global longitudinal strain (Pearson r=0.41, P=0.01). Mode of intervention (transcatheter versus surgical) did not influence the above myocardial parameters post-AVR (all P>0.05). The asterisk in P values indicates a statistical significance of <0.05.

CONCLUSIONS: Within 8 weeks of AVR for aortic stenosis, substantial left ventricular hypertrophy regression occurs involving both cellular and extracellular compartments, demonstrating the early myocardial adaptability to afterload relief. Cellular compartment regression is greater than extracellular regression, leading to an apparent increase in extracellular volume fraction. Mode of intervention did not affect degree of reverse remodeling, indicating that both are effective at resulting beneficial changes post-AVR.

REGISTRATION: URL: https://www.isrctn.com; Unique identifier: NCT04627987.

PMID:39629586 | DOI:10.1161/CIRCIMAGING.124.017425

Curr Rheumatol Rev. 2024 Dec 3. doi: 10.2174/0115733971314061241126044624. Online ahead of print.

ABSTRACT

INTRODUCTION: Investigating CD68+ positive cells in the synovial tissue is crucial for understanding the pathogenesis of psoriatic arthritis (PsA) and developing targeted treatment strategies. The role of CD68+ positive cells in the synovial tissue of patients with PsA for joint destruction has not been fully studied.

OBJECTIVE: The objective of the study was to examine the presence of CD68+ cells in the synovial tissue of patients with PsA, particularly those with high inflammatory activity.

METHODS: Synovial tissue samples were collected during knee joint replacement surgeries from patients with PsA (16 patients) and gonarthrosis (25 patients). Immunohistochemical methods were employed to detect CD68+ cell expression in the tissue samples. The results were analyzed by histologists, and the staining intensity and percentage of positively stained cells were evaluated. The data were then divided into three groups for statistical analysis: negative, weakly positive, and strongly positive histological samples. Routine indices for disease activity, VAS, DAPSA, PASDAI, and mCPDAI were used to assess PsA activity in all patients and to assess correlations with CD68+ positive cells in the synovial tissue. Statistical analysis was performed using SPSS version 26.0 (SPSS Inc., Chicago, IL, USA).

RESULTS: The expression of CD68+ positive cells was significantly higher in patients with PsA compared to those with activated gonarthrosis (p < 0.001). The indices for disease activity, VAS, DAPSA, PASDAI, mCPDAI, and mCPDAI showed a significant positive relationship with the expression of CD68 + cells on synovial tissue in patients with PsA (p < 0.01) Conclusion: The findings of the study confirm the increased numbers of CD68+ cells in PsA vs. gonathrosis synovium. This suggests the need to explore therapeutic approaches aimed at suppressing or blocking CD68+ cells to potentially mitigate joint damage.

PMID:39629578 | DOI:10.2174/0115733971314061241126044624