Category: Nevin Manimala

Eur Geriatr Med. 2024 Oct 19. doi: 10.1007/s41999-024-01063-1. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to describe the clinical presentation of COVID-19 in hospitalized patients aged 80 or above and to identify predictors for death and complications throughout the epidemic waves of the disease.

METHODS: This was an observational, multicenter, ambispective study conducted between March 2020 and August 2021 using data collected in five centers from southern metropolitan area of Barcelona (COVID-MetroSud cohort). Patients were grouped based on the pandemic waves of inclusion in the registry. We conducted a descriptive analysis, followed by bivariate and multivariate analyses (binary logistic regression) to identify predictors of risk for death or complications.

RESULTS: A total of 1192 patients (mean [SD] age 85.7 [4.22] years and 46.8% female) were included. The most frequently reported symptoms in all waves were fever (63.1%), cough (56.5%), dyspnea (48.2%), and asthenia (27.5%). Laboratory and radiological findings consistently showed abnormal bilateral chest X-ray results (72.5% of patients) and elevated inflammatory markers such as lactate dehydrogenase (mean [SD] 335 [188] U/L), C-reactive protein (CRP) (mean [SD] 110 [88.4] U/L), and ferritin (mean [SD] 842 [1561] U/L). Acute respiratory distress syndrome (43.7%), renal failure (19.2%), and delirium (17.5%) were the most frequent complications. The overall mortality rate was 41.4% and declined across the epidemic waves. Age, diabetes mellitus, heart failure, dyspnea, and higher baseline levels of creatinine were identified as risk factors for complications, while a higher Barthel index and presence of cough were found to be protective. Age, dyspnea, abnormal bilateral chest X-ray, CRP, and sodium were identified as risk factors for death.

CONCLUSIONS: This study demonstrates the clinical presentation of COVID-19 (fever, cough, dyspnea, and asthenia) and the different risk factors for mortality and complications in octogenarian hospitalized patients throughout the pandemic. These findings could be highly valuable for managing future virus pandemics.

PMID:39425809 | DOI:10.1007/s41999-024-01063-1

Graefes Arch Clin Exp Ophthalmol. 2024 Oct 19. doi: 10.1007/s00417-024-06666-9. Online ahead of print.

ABSTRACT

PURPOSE: To compare the visual and anatomical results of navigated subthreshold micropulse laser (nSML) and photodynamic therapy (PDT) in the treatment of chronic central serous chorioretinopathy (CSCR).

METHODS: Patients who underwent either half-dose PDT or nSML for the management of chronic CSCR were included in this study. Comprehensive ophthalmic examination, fundus autofluorescence, and spectral domain optical coherence tomography (SD-OCT) were performed at baseline and at 1-, 3-, and 6-month follow-up visits after nSML or PDT. Fluorescein angiography and indocyanine green angiography were performed only at baseline. Main outcome measures were best corrected visual acuity (BCVA), central macular thickness (CMT), subretinal fluid (SRF), subfoveal choroidal thickness (SFCT), and choroidal vascularization index (CVI) that were collected at baseline and at each follow-up visit for up to 6 months.

RESULTS: Forty-two eyes of 42 patients (PDT group-20 eyes, nSML group-22 eyes) affected by chronic CSCR were enrolled. At 6-month follow-up, no significant differences were observed between the nSML group compared to the PDT group in BCVA (0.10 [0.00; 0.20]) and 0.10 [0.10; 0.10], respectively, p=0.69, and between some OCT parameters, namely CMT and CVI. SFCT was significantly reduced in the PDT group more than in the nSML group (p=0.01). Twelve eyes (60%) in the PDT group had complete resolution of the SRF at 6 months compared to 8 eyes (36.4%) in the nSML group, but the difference was not statistically significant (p=0.14).

CONCLUSION: Results from patients treated with PDT and nSML showed that, at 6 months, no significant differences except for choroidal thickness. nSML is less invasive than PDT and can be used as an effective alternative to PDT.

KEY MESSAGES: WHAT IS KNOWN : Treating chronic CSCR is a therapeutic conundrum for clinicians because of a lack of definitive consensus over remediation options, two of which are photodynamic therapy (PDT) and navigated subthreshold micropulse laser (nSML) therapy.

THIS STUDY SHOWS: Results from patients treated with PDT and nSML showed no significant differences except for choroidal thickness. Even though patients treated with PDT recovered more quickly, retreatment was necessary due to fluid recollection. Although patients treated with nSML also needed retreatment, nSML is less invasive than PDT and can be used as an effective alternative to PDT.

PMID:39425791 | DOI:10.1007/s00417-024-06666-9

Langenbecks Arch Surg. 2024 Oct 19;409(1):313. doi: 10.1007/s00423-024-03499-2.

ABSTRACT

PURPOSE: To evaluate the safety and efficacy of transurethral holmium laser enucleation of the prostate (HoLEP) compared to bipolar transurethral resection of the prostate (bTUR-P) in the treatment of benign prostatic hyperplasia (BPH).

METHODS: A total of 220 BPH patients hospitalized from January 2022 to September 2023 were included in this study. These patients were randomly assigned to HoLEP and bTUR-P groups, with 110 participants in each group. We collected preoperative general information, perioperative data, complications, and postoperative follow-up indicators from both groups of patients.

RESULTS: The baseline characteristics of patients in both groups were similar, with no statistical significance (P > 0.05). Compared to the bTUR-P group, the HoLEP group exhibited significantly less intraoperative bleeding (P < 0.001), shorter bladder irrigation time (P = 0.002), shorter catheter retention time (P < 0.001), and reduced postoperative hospitalization (P = 0.002). Additionally, the pain score during urination after catheter removal was significantly lower in the HoLEP group (P < 0.001). Postoperative complications occurred in both groups; however, they were less frequent in the HoLEP group (4 cases), primarily consisting of urinary retention and postoperative bleeding. The bTUR-P group experienced more complications (9 cases). Significant reductions in postoperative residual urine volume (RUV) were observed in both groups (P < 0.001). Both groups also showed significant improvements in Quality of Life (QoL) scores and International Prostate Symptom Scores (IPSS), with the HoLEP group demonstrating a more significant decrease in IPSS (P < 0.001).

CONCLUSION: After comprehensive evaluation, HoLEP was superior to bTUR-P in terms of safety and efficacy. Therefore, HoLEP may be a preferable choice for the treatment of BPH.

PMID:39425787 | DOI:10.1007/s00423-024-03499-2

Environ Monit Assess. 2024 Oct 19;196(11):1079. doi: 10.1007/s10661-024-13231-8.

ABSTRACT

In response to the COVID-19 pandemic, the Iranian government swiftly implemented immediate and decisive measures to control the spread of the infection. This study aims to demonstrate the impact of restriction measure on air pollution, also to highlight the potential variability in results that can arias from different methodological approach. A comprehensive dual-approach assessment was conducted to evaluate the effect of the lockdown measures on criteria air pollutants. Firstly, a traditional approach compared air quality during the pandemic period with baseline conditions from 2013 to 2019. Secondly, observed air pollution values during different periods with varying restrictions in 2020 were compared with expected values. This comprehensive analysis allows for a robust comparison and quantification of the impact of different lockdown measures in Ahvaz. The study revealed significant changes in air pollutant concentrations in Ahvaz during 2020, with variations observed across different pollutants. Notable reductions were observed in O3 levels, particularly in November (-54.44% compared to the baseline) and December (-63.58% compared to expected values). Decreases in CO levels were observed in multiple months, while substantial reductions in PM10 and PM2.5 were observed during various periods. Inconsistencies in the magnitudes and directions of changes were found when comparing baseline and forecasted values. The overall stringency index showed an inverse association with changes in O3, NO2, and CO, with international travel controls and restrictions on internal movement having significant impacts. This study provides valuable insights into the impact of COVID-19 lockdown measures on air pollution in Ahvaz, Iran, using a comprehensive dual-approach assessment. The findings highlight the effectiveness of these measures in reducing specific criteria air pollutants and emphasize the importance of implementing appropriate strategies for air quality management during similar public health emergencies.

PMID:39425759 | DOI:10.1007/s10661-024-13231-8

Ann Work Expo Health. 2024 Oct 19:wxae077. doi: 10.1093/annweh/wxae077. Online ahead of print.

ABSTRACT

INTRODUCTION: Eldercare organizations face high sickness absence rates and staff turnover and rely heavily on temporary workers to fill staffing gaps. Temporary workers may experience differences in job demands and resources compared with permanent workers, but this has been largely understudied.

OBJECTIVE: To compare perceived job demands and resources between permanent and temporary Swedish eldercare workers.

METHODS: Permanent and temporary eldercare workers in a Swedish municipality were invited to answer a digital survey on work environment conditions. Differences between permanent and temporary workers in job demands and resources were analyzed using multivariate analysis of variance adjusted for age, sex, place of birth, and percent of full-time work and univariate analyses were conducted to consider differences in specific factors.

RESULTS: A total of 1076 permanent and 675 temporary workers received the survey, and the final study sample included 451 permanent and 151 temporary workers. Multivariate analyses revealed that temporary workers reported statistically significant lower job demands compared to permanent workers, but no statistically significant differences in resources were found between the groups. Univariate analyses showed that temporary workers reported lower quantitative demands, perceived exertion, and time spent bending forward, than permanent workers. These data suggest comparable support across groups, but a higher workload among permanent workers.

CONCLUSION: Our findings indicate that temporary workers experienced lower job demands than permanent workers, but that no notable difference was found in resources. Interventions aimed at distributing job demands more evenly among eldercare workers with different employment forms may be necessary.

PMID:39425749 | DOI:10.1093/annweh/wxae077

Cancer Control. 2024 Jan-Dec;31:10732748241290769. doi: 10.1177/10732748241290769.

ABSTRACT

BACKGROUND: Prescription opioids are essential in managing pain among adults with chronic pain conditions. However, persistent use over time can lead to negative health consequences. Identifying individuals with persistent use over time and their characteristics can inform clinical decision-making and aid in reducing the risk of abuse and overdose deaths.

OBJECTIVE: This study aims to examine trajectories of prescription opioid use over time and factors associated with these trajectories among older cancer survivors with any non-cancer pain conditions (NCPC).

METHODS: We conducted a retrospective cohort study design with longitudinal data of older (age at cancer diagnosis ≥67 years) cancer (incident breast, colorectal, and prostate cancers, or non-Hodgkin lymphoma) survivors with any NCPC. Data were derived from the 2007-2015 linked Surveillance, Epidemiology, and End Results (SEER)-Medicare dataset (N = 35,071). Group-Based Trajectory Modeling (GBTM) was used to identify homogeneous subgroups (distinct trajectories) of individuals based on every 90-day prescription opioid use during pre-cancer diagnosis (t₁-t₄), acute cancer treatment (t₅-t₈), and post-cancer treatment (t₉-t₁₂) periods. Biological factors, social determinants of health (SDoH), physical and mental health, medication use, health care use, and external factors associated with a trajectory membership were analyzed with multivariable multinomial logistic regressions.

RESULTS: Four distinct trajectories of opioid use were identified: (1) increase-decrease use (6.1%); (2) short-term use after cancer diagnosis (40.6%); (3) low-use (41.0%); and (4) persistent use (12.3%). In the fully-adjusted multinomial logistic regression, the SDoH such as Non-Hispanic Black [adjusted odds ratios (AOR) = 1.69; 95%CI = 1.48, 1.93)] and rural residence (AOR = 1.49; 95%CI = 1.15, 1.94)], comorbid anxiety (AOR = 1.33; 95%CI = 1.18, 1.51), and medication use (NSAIDs – AOR = 1.20; 95%CI = 1.10, 1.30) were associated with membership in the persistent use group. Persistent use was less likely among those with higher fragmented care index (AOR = 0.95, 95%CI = 0.93, 0.97) and those living in counties with higher Medicare advantage penetration (AOR = 0.96; 95%CI = 0.95, 0.97).

CONCLUSIONS: One in eight older adults had persistent opioid use over time. The profile characteristics of this group were different from the other trajectory groups. Policies and programs to reduce chronic opioid use need to consider the intra- and inter-individual variability to reduce opioid-related morbidity and mortality.

PMID:39425746 | DOI:10.1177/10732748241290769

J Adv Nurs. 2024 Oct 19. doi: 10.1111/jan.16532. Online ahead of print.

ABSTRACT

AIM: To evaluate the impact of nurse-led one-on-one psychoeducation sessions on gender diverse individuals seeking gender-affirming genital surgery.

DESIGN: A quasi-experimental, pre- and post-test research design was employed to examine the impact of a nurse-led initiative on improving patients self-perceived knowledge and confidence pertaining to gender affirming genital surgery. The study followed the SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence) guidelines and the COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines.

METHODS: The curriculum for the initiative was crafted through literature reviews, expert panel engagements, multidisciplinary team input and was delivered by two specialist gender nurses.

RESULTS: The results indicated a statistically significant increase in all participants’ self-perceived knowledge and confidence scores. Furthermore, the study increased confidence in the ability to ask questions and plan for the logistical and financial aspects of surgery.

CONCLUSION: Participants reported that the sessions were very useful, and for most, the information did not change their desire to seek surgery but did help them make more informed choices about the procedure, timing and preferred surgeon.

IMPLICATIONS FOR PATIENT CARE: The study underscores the imperative role of support networks and recommends interventions to facilitate open communication within families. The study emphasises the importance of customising healthcare approaches to align with the preferences of patients.

IMPACT: The study addressed the need for psychoeducation sessions for individuals considering gender-affirming genital surgery. The main findings revealed a significant increase in participants’ self-perceived knowledge and confidence, following a nurse-led intervention. The research’s impact extends to gender-diverse individuals seeking surgery globally.

PATIENT OR PUBLIC CONTRIBUTION: Four individuals who had undergone gender-affirming surgeries contributed their perspectives to the study design, ensuring that the educational content addressed specific information needs and concerns.

PMID:39425745 | DOI:10.1111/jan.16532

Cytotherapy. 2024 Oct 5:S1465-3249(24)00885-5. doi: 10.1016/j.jcyt.2024.09.004. Online ahead of print.

ABSTRACT

OBJECTIVE: This intermediate-size expanded access program aimed to evaluate safety and clinical efficacy of multiple intravenous infusions of autologous, Hope Biosciences adipose-derived mesenchymal stem cell (HB-adMSC) therapy in elderly patients with Parkinson’s disease (PD).

METHODS: Ten eligible participants (aged 76-95 years) received six intravenous infusions each with 200MM autologous HB-adMSCs over 18 weeks, with the end of study (EOS) at week 26. Safety was assessed through adverse events (AEs) and serious adverse events (SAEs). Efficacy was measured through improvements in both motor and non-motor symptoms, utilizing scales including Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) parts I-IV, Parkinson’s Disease Questionnaire-39 (PDQ-39), Parkinson’s disease Fatigue Scale (PFS-16), Patient Health Questionnaire-9 (PHQ-9), and Visual Analog Scale (VAS). Analysis employed paired t-tests and Minimal Clinically Important Difference (MCID) thresholds for the patient-reported outcomes.

RESULTS: Most AEs (37 out of 46) were mild in severity, with 5 SAEs reported, none attributed to the drug. No deaths occurred. Despite lack of statistical significance across the efficacy endpoints, modest yet clinically meaningful improvements with effect size > 0.3 were observed in several secondary efficacy endpoints (MDS-UPDRS part I & III, PDQ-39, and PHQ-9) at the EOS, nearing or surpassing the established MCID values.

CONCLUSIONS: The administration of autologous 200MM HB-adMSCs was found to be safe and well-tolerated in the elderly PD population. Although not achieving statistical significance, modest clinical improvements were noted across multiple secondary endpoints. These findings underscore the safety profile of the treatment in elderly patients and highlight the importance of evaluating clinical relevance alongside statistical measures for meaningful patient outcomes. Further investigation with a larger, randomized, placebo-controlled design is warranted to validate these observations.

PMID:39425736 | DOI:10.1016/j.jcyt.2024.09.004

Neuromodulation. 2024 Oct 18:S1094-7159(24)00673-1. doi: 10.1016/j.neurom.2024.08.008. Online ahead of print.

ABSTRACT

OBJECTIVES: The neuromodulatory effects of transcranial alternating current stimulation (tACS) on electroencephalogram (EEG) dynamics are quite heterogenous. The primary objective of the study is to comprehensively characterize the effects of two tACS protocols on resting-state EEG.

MATERIALS AND METHODS: A total of 36 healthy participants were recruited and were randomized into three groups. Two groups received either personalized theta (4-8 Hz) or gamma (40 Hz) stimulation bilaterally in the frontal regions for 20 minutes (4 minutes ON, 1 minute OFF, four cycles). The third group performed relaxed breath watching for 20 minutes. Artifact-free, 1-minute EEG segments from the baseline, during tACS, and after stimulation resting EEG were characterized to see the effects of tACS. Threshold-free cluster enhanced permutation tests (for spectral measures) and two-way mixed analysis of variance (for aperiodic slope) were used for statistical inferences.

RESULTS: Current modeling simulation using ROAST with preset parameters (800 μA, AF3 AF4 locations) showed that induced electric fields can activate frontal cortical regions. During the stimulation period, personalized theta tACS entrained theta band power in the centro-parietal areas. There was a compensatory power decrease in the beta and gamma bands after theta tACS. No entrainment effects were observed for gamma tACS during stimulation, but a significant entrainment was observed in the theta and beta bands in the parieto-occipital regions after stimulation. The delta band power decreased in the central regions. No spectral modulations were seen after breath watching. The spectral slope, which measures aperiodic activity, was not affected by either breath watching or tACS.

CONCLUSIONS: Characterizing the effects of multiple tACS protocols is critical to effectively target specific neural oscillatory patterns and to personalize the protocols. The study can be extended to target specific oscillatory patterns associated with cognitive deficits in neuro-psychiatric conditions.

PMID:39425734 | DOI:10.1016/j.neurom.2024.08.008

J Hand Surg Am. 2024 Oct 17:S0363-5023(24)00433-7. doi: 10.1016/j.jhsa.2024.09.009. Online ahead of print.

ABSTRACT

Single center studies are limited by bias, lack of generalizability and variability, and inability to study rare conditions. Multicenter observational research could address many of those concerns, especially in hand surgery where multicenter research is currently quite limited; however, there are numerous barriers including regulatory issues, lack of common terminology, and variable data set structures. The Observational Health Data Sciences and Informatics (OHDSI) program aims to surmount these limitations by enabling large-scale, collaborative research across multiple institutions. The OHDSI uses the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) to standardize health care data into a common language, enabling consistent and reliable analysis. The OMOP CDM has been transformative in converting multiple databases into a standardized code with a single vocabulary, allowing for coherent analysis across multiple data sets. Building upon the OMOP CDM, OHDSI provides an extensive suite of open-source tools for all research stages, from data extraction to statistical modeling. By keeping sensitive data local and only sharing summary statistics, OHDSI ensures compliance with privacy regulations while allowing for large-scale analyses. For hand surgery, OHDSI can enhance research depth, understanding of outcomes, risk factors, complications, and device performance, ultimately leading to better patient care.

PMID:39425718 | DOI:10.1016/j.jhsa.2024.09.009