Category: Nevin Manimala

Dermatol Ther (Heidelb). 2024 Oct 25. doi: 10.1007/s13555-024-01293-y. Online ahead of print.

ABSTRACT

INTRODUCTION: Despite advancements in the treatment of psoriasis (PsO), there are few head-to-head studies assessing comparative effectiveness of the newest therapies approved to treat PsO. Our objective was to assess the comparative clinical effectiveness of risankizumab and deucravacitinib in patients with moderate-to-severe PsO.

METHODS: This placebo-anchored matching-adjusted indirect comparison (MAIC) analysis utilized data from UltIMMa-1/2 risankizumab and POETYK PSO-1/2 deucravacitinib trials. Individual patient data from UltiMMA-1/2 were weighted via propensity score to match POETYK PSO-1/2 published summary data. Rate differences between risankizumab and deucravacitinib were assessed for Psoriasis Area and Severity Index (PASI) 75/90/100, the Static Physician Global Assessment (sPGA = 0 or 0/1), and the Dermatology Life Quality Index (DLQI) 0/1.

RESULTS: At 16 weeks, risankizumab-treated patients demonstrated statistically significantly higher rates of skin clearance and greater improvement in quality of life (QoL) compared to those treated with deucravacitinib. Across all outcomes, risankizumab demonstrated a lower number needed to treat compared to deucravacitinib. Limitations are potential bias due to unobserved/unmeasurable differences and limited generalizability of the results.

CONCLUSIONS: This indirect comparison demonstrates that risankizumab has higher rates of skin clearance and greater improvements in QoL than deucravacitinib. This study will help inform healthcare providers in their treatment and management strategy of PsO.

PMID:39453596 | DOI:10.1007/s13555-024-01293-y

Environ Monit Assess. 2024 Oct 25;196(11):1104. doi: 10.1007/s10661-024-13261-2.

ABSTRACT

Due to the continued increase in land use changes and changing climatic patterns in the Lake Victoria basin, understanding the impacts of these changes on the water quality of Lake Victoria is imperative for safeguarding the integrity of the freshwater ecosystem. Thus, we analyzed spatial and temporal patterns of land cover, precipitation, and water quality changes in the Lake Victoria basin between 2000 and 2022 using global satellite products. Focusing on chlorophyll-a (Chl-a) and turbidity (TUR) in Lake Victoria, we used statistical metrics (correlation coefficient, trend analysis, change budget, and intensity analysis) to understand the relationship between land use and precipitation changes in the basin with changes in Chl-a and TUR at two major pollution hotspots on the lake, i.e., Winam Gulf and Inner Murchison Bay (IMB). Results show that the Chl-a and TUR concentrations in the Winam gulf increase with increases in precipitation. Through increases in precipitation, the erosion risks are increased and transport of nutrients from land to the lake system, promoting algal growth and turbidity. In the IMB, Chl-a and TUR concentrations decrease with an increase in precipitation, possibly due to dilution, but peak during moderate rainfall. Interestingly, changes in land use and land cover (LULC) at 5-year intervals showed no substantial correlation with water quality changes at selected hotspots even though a broader LULC change analysis over the past two decades indicated a notable 300% increase in built-up areas across the Lake Victoria basin. These findings underscore the dominant influence of precipitation changes over LULC changes on the water quality of Lake Victoria for the selected hotspot areas.

PMID:39453572 | DOI:10.1007/s10661-024-13261-2

Eur Geriatr Med. 2024 Oct 25. doi: 10.1007/s41999-024-01082-y. Online ahead of print.

ABSTRACT

OBJECTIVE: This study explores the effectiveness of 3D pose estimation technology in Yi Jin Jing (a traditional Chinese exercise) interventions for sarcopenic older individuals.

DESIGN: A randomized controlled trial involving 93 participants (mean age: 71.64 ± 7.09 years; 41 males and 52 females) divided into three groups: a face-to-face offline traditional training group (OFFG), a general remote online training group (ONG), and an AI-based online remote training group (AIONG).

METHODS: Participants in each group underwent their respective training programs. The effectiveness of the interventions was measured using Appendicular Skeletal Muscle Mass Index, Grip Strength, 6-meter Walking Speed, Timed-Up-and-Go Test, and Quality of Life assessments.

RESULTS: Significant improvements were observed across all groups in ASMI, Grip Strength, 6-meter Walking Speed, TUGT, and QoL. However, there were no statistically significant differences between the groups in terms of the magnitude of these improvements. AIONG showed outcomes comparable to OFFG and ONG methods.

CONCLUSIONS: AI-based telerehabilitation with 3D pose estimation is a viable and effective alternative for remote exercise interventions. It offers precise guidance and enhances the quality of rehabilitation training, demonstrating outcomes comparable to traditional and general online methods.

PMID:39453567 | DOI:10.1007/s41999-024-01082-y

Acta Neurol Belg. 2024 Oct 25. doi: 10.1007/s13760-024-02584-z. Online ahead of print.

ABSTRACT

BACKGROUND: Findings from functional neuroimaging techniques, such as single-photon emission computed tomography (SPECT), may add useful evidence improving Frontotemporal Dementia (FTD) diagnosis. The aim of the present study was to investigate patterns of hypoperfusion in a group of patients diagnosed with the behavioral variant of FTD (bvFTD) and to explore the relationship between brain perfusion and clinical characteristics.

MATERIALS AND METHODS: Brain perfusion of 23 bvFTD patients was measured with SPECT scintigraphy in lobes and Brodmann areas (BAs) and the NeurogamTM software was used for image analysis. To assess behavioral disturbances and dementia severity, patients’ informants completed the Frontotempotal Behavioral Inventory and the Frontotemporal Dementia Rating Scale. Descriptive statistics were used for the detection of pathological hypoperfusion in lobes and selected BAs. Associations among patients’ clinical characteristics and perfusion in lobes were explored via non-parametric correlations.

RESULTS: Participants presented pathological hypoperfusion in frontal, limbic and temporal lobes. The most prominent deficit was observed in limbic lobes, where all participants showed pathological hypoperfusion. Decreased perfusion was also observed in limbic, frontal and temporal BAs. Perfusion in the left and right frontal lobe was associated with behavioral disturbances and disease severity, which was also correlated with perfusion in right limbic, left and right temporal areas.

CONCLUSION: Patterns of limbic, frontal and temporal hypopefusion were reported in the present study, along with associations between brain perfusion, behavioral disturbance and severity of dementia. Perfusion patterns can help to understand further associated brain biomarkers, contributing to early diagnosis and intervention in bvFTD.

PMID:39453559 | DOI:10.1007/s13760-024-02584-z

Int J Colorectal Dis. 2024 Oct 25;39(1):171. doi: 10.1007/s00384-024-04745-1.

ABSTRACT

BACKGROUND: Metastatic colorectal cancer (mCRC) poses a clinical challenge and requires a combination of systemic therapy and conversion surgery. Although first-line chemotherapy and targeted therapy are considered the standard treatments for mCRC, the role of primary tumor resection (PTR) in asymptomatic synchronous mCRC with unresectable metastatic lesion after initial therapy remains relatively underexplored.

MATERIALS: A retrospective review was conducted from January 2015 to January 2021, involving 74 patients with synchronous mCRC who received bevacizumab plus FOFIRI as first-line systemic therapy. All 74 patients had unresectable metastatic lesions confirmed through multidisciplinary team discussion. Patient characteristics, PTR data, and radiotherapy (RT) and overall survival (OS) outcomes were analyzed. The patients were categorized into a “PTR” group and a “No PTR” group and then further stratified into “4A,” “4B,” and “4C” subgroups based on the initial mCRC stage. Additionally, four subgroups-namely “PTR( +)/RT( +),” “PTR( +)/RT( -),” “PTR( -)/RT( +),” and “PTR( -)/RT( -)”-were formed to assess the combined effects of PTR and RT.

RESULTS: The median OS for all the patients was 23.8 months (20.5-27.1 months). The “PTR” group exhibited a significantly higher median OS of 25.9 months (21.3-30.5 months) compared with 21.4 months (15.8-27.1 months) in the “No PTR” group (p = 0.048). Subgroup analyses revealed a trend of improved survival with PTR in patients with stage IVA and IVB; however, the results were not statistically significant (p = 0.116 and 0.493, respectively). A subgroup analysis of PTR and RT combinations revealed no significant difference in median OS rates.

CONCLUSION: For asymptomatic mCRC with synchronous unresectable distant metastasis, PTR following first-line therapy with bevacizumab plus FOLFIRI may provide a potential survival benefit, particularly in stage IVA/IVB patients compared with stage IVC patients. Additionally, RT for primary tumor did not provide an additional OS benefit in mCRC with unresectable metastasis. A prospective randomized trial with a larger sample size is essential to further elucidate the role of PTR in this context.

PMID:39453531 | DOI:10.1007/s00384-024-04745-1

Discov Ment Health. 2024 Oct 25;4(1):46. doi: 10.1007/s44192-024-00104-2.

ABSTRACT

BACKGROUND: Postpartum Depression (PPD) is a severe mental health condition that adversely affects mothers and their infants. The influence of PPD on maternal-infant bonding and breastfeeding practices has been scarcely reported in Nigeria. Therefore, we examined the prevalence of PPD, the associated factors, and the relationship with maternal-infant bonding and breastfeeding practices in Abeokuta, Nigeria.

METHOD: A descriptive cross-sectional survey was conducted among 600 mothers within the extended postpartum period (≤ 1 year) from three government-owned immunisation clinics at primary, secondary, and tertiary health facilities in Abeokuta, Ogun State. PPD was assessed using the Edinburgh postnatal depression Scale (EPDS ≥ 13), and maternal-infant bonding was evaluated using the Postpartum Bonding Questionnaire (PBQ ≥ 50). We also examined breastfeeding practices (i.e. the time to initiation by 30 min, exclusive breastfeeding for 6 months and early commencement of complementary feeding by 2 months). Data was analysed using chi-square and logistics regression models at a 5% significance level.

RESULTS: The prevalence of PPD was 21.8%, 95% CI (18.7-25.3). Factors associated with PPD were maternal age: 25-34 years [AOR = 0.52; 95% CI (0.29-0.90)]; ≥ 35 years [AOR = 0.44; 95% CI (0.20-0.96)], being married [AOR = 0.43; 95% CI (0.21-0.85)], perceived stress increased the odds of PPD: moderate stress level [AOR = 8.38; 95% CI (3.50-19.9)]; high-stress level [AOR = 47.8; 95% CI (8.65-263.7)] and self-reported history of emotional problems [AOR = 3.25; 95% CI (1.43-7.38)]. There was a significant direct association between PPD and poor maternal-infant bonding [AOR = 3.91; 95% CI (1.04-4.60)]. PPD reduces the odds of early breastfeeding initiation [AOR = 0.43; 95% CI (0.28-0.68)], but no association was found between PPD and exclusive breastfeeding [AOR = 1.07; 95% CI (0.07-1.67)].

CONCLUSION: The prevalence of PPD was high in our study population and associated with poor maternal-infant bonding and late breastfeeding initiation but not with exclusive breastfeeding. Promoting maternal mental health to foster stronger mother-infant relationships and better breastfeeding practices has become crucial.

PMID:39453530 | DOI:10.1007/s44192-024-00104-2

BJPsych Open. 2024 Oct 25;10(6):e184. doi: 10.1192/bjo.2024.738.

ABSTRACT

BACKGROUND: The COVID-19 pandemic initiated a mass switch to psychological therapy being delivered remotely, including at Anxiety UK, a national mental health charity. Understanding the impact of this forced switch could raise implications for the provision of psychological therapies going forwards.

AIMS: To understand whether the forced switch to remote therapy had any impact on outcomes, and if certain groups should continue to be routinely offered certain delivery modalities in future.

METHOD: Data were available for 2323 individuals who accessed Anxiety UK services between January 2019 and October 2021. Demographic data, baseline and discharge anxiety and depression symptoms, and mode of therapy delivery were available.Regression models were built to model (a) the mode of therapy delivery received pre-pandemic using logistic regression, and (b) outcomes pre- and post-pandemic onset within demographic groups.

RESULTS: No statistically significant changes in baseline anxiety symptoms, demographics or outcomes were observed before and after the onset of the COVID-19 pandemic.Pre-pandemic, males were more likely to receive online video therapy than telephone therapy (Relative Risk Ratio (RRR) 1.42, [1.01, 1.99]), while older clients were less likely to receive online video therapy (RRR 0.98, [0.97, 0.99]). However, no differences in outcomes were observed post-pandemic onset within these groups, with only the number of sessions of therapy being a significant predictor of outcomes.

CONCLUSIONS: Anxiety UK services remained effective throughout the pandemic. We observed no evidence that any demographic group had worse outcomes following the forced switch to remote therapy.

PMID:39450561 | DOI:10.1192/bjo.2024.738

BJPsych Open. 2024 Oct 25;10(6):e189. doi: 10.1192/bjo.2024.775.

ABSTRACT

BACKGROUND: Depression is common in people with dementia, and negatively affects quality of life.

AIMS: This paper aims to evaluate the cost-effectiveness of an intervention for depression in mild and moderate dementia caused by Alzheimer’s disease over 12 months (PATHFINDER trial), from both the health and social care and societal perspectives.

METHOD: A total of 336 participants were randomised to receive the adapted PATH intervention in addition to treatment as usual (TAU) (n = 168) or TAU alone (n = 168). Health and social care resource use were collected with the Client Service Receipt Inventory and health-related quality-of-life data with the EQ-5D-5L instrument at baseline and 3-, 6- and 12-month follow-up points. Principal analysis comprised quality-adjusted life-years (QALYs) calculated from the participant responses to the EQ-5D-5L instrument.

RESULTS: The mean cost of the adapted PATH intervention was estimated at £1141 per PATHFINDER participant. From a health and social care perspective, the mean difference in costs between the adapted PATH and control arm at 12 months was -£74 (95% CI -£1942 to £1793), and from the societal perspective was -£671 (95% CI -£9144 to £7801). The mean difference in QALYs was 0.027 (95% CI -0.004 to 0.059). At £20 000 per QALY gained threshold, there were 74 and 68% probabilities of adapted PATH being cost-effective from the health and social care and societal perspective, respectively.

CONCLUSIONS: The addition of the adapted PATH intervention to TAU for people with dementia and depression generated cost savings alongside a higher quality of life compared with TAU alone; however, the improvements in costs and QALYs were not statistically significant.

PMID:39450544 | DOI:10.1192/bjo.2024.775

Trans R Soc Trop Med Hyg. 2024 Oct 25:trae081. doi: 10.1093/trstmh/trae081. Online ahead of print.

ABSTRACT

Scrub typhus and leptospirosis are re-emerging zoonotic infections with significant morbidity and mortality rates in India. Overlapping aetiological and epidemiological patterns indicate a high possibility of their co-infection in India, which can be a diagnostic challenge due to non-specific clinical features. A systematic search of the PubMed/MEDLINE, Scopus and Embase databases was conducted to identify relevant studies published through 31 August 2023. Studies reporting co-infection of scrub typhus and leptospirosis among the Indian population were included. Data extraction, quality assessment and statistical analysis were performed in accordance with established guidelines. Six studies met the inclusion criteria, comprising a total of 58 co-infection cases. Pooled prevalence of scrub typhus-leptospirosis co-infection among acute undifferentiated febrile illness patients was 3.7% (95% confidence interval [CI] 0.00 to 0.126). Among scrub typhus patients, the prevalence of co-infection with leptospirosis was 13.7% (95% CI 0.027 to 0.304). Significant heterogeneity was observed among the included studies, highlighting the need for cautious interpretation of prevalence estimates. This meta-analysis underscores the clinical importance of scrub typhus-leptospirosis co-infection in India and emphasizes the need for enhanced clinical awareness, improved diagnostic strategies and targeted research efforts to address this emerging infectious disease threat.

PMID:39450535 | DOI:10.1093/trstmh/trae081

BJPsych Open. 2024 Oct 25;10(6):e188. doi: 10.1192/bjo.2024.755.

ABSTRACT

BACKGROUND: Although immigrants are considered to be vulnerable to mental illness, there is limited knowledge regarding their suicide mortality.

AIMS: To investigate standardised mortality ratios (SMR) for suicide among the largest immigrant populations in Germany before and after the refugee movement of 2015.

METHOD: Data on immigrants and the general population in Germany between 2000 and 2020 were provided by the scientific section of the Federal Statistical Office. SMR with 95% confidence intervals were calculated by indirect standardisation for gender, age and calendar year for the pre-2015 and post-2015 time interval, first for all the immigrant populations studied and second for the Syrian, Afghan and Iraqi populations separately.

RESULTS: Immigrants from the countries studied showed a lower suicide risk compared with the German reference population (SMR = 0.38, 95% CI = 0.35-0.41). No differences in SMR were found between pre- and post-2015 time intervals, in either the aggregate data for all populations or the data for Syrian, Afghan and Iraqi populations. Post-2015, Afghan immigrants (SMR = 0.68, 95% CI = 0.54-0.83) showed a higher SMR than Syrians (SMR = 0.30, 95% CI = 0.25-0.36) or Iraqis (SMR = 0.37, 95% CI = 0.26-0.48).

CONCLUSIONS: Despite the many and varied stresses associated with flight, comparison of the pre- and post-2015 time intervals showed that the suicide risk of the populations studied did not change and was considerably lower than that of the German reference population. We attribute this to lower suicide rates in the countries of origin but also to flight-related selection processes that favour more resilient individuals.

PMID:39450528 | DOI:10.1192/bjo.2024.755