Category: Nevin Manimala

Circ Heart Fail. 2024 Aug 22:e011749. doi: 10.1161/CIRCHEARTFAILURE.123.011749. Online ahead of print.

ABSTRACT

BACKGROUND: Chloride plays a crucial role in renal salt sensing. This study investigates whether serum chloride is associated with clinical outcomes and decongestive response to acetazolamide in patients with acute decompensated heart failure.

METHODS: This post hoc analysis includes all 519 patients from the ADVOR trial (Acetazolamide in Decompensated Heart Failure With Volume Overload), randomized to intravenous acetazolamide or matching placebo on top of intravenous loop diuretics. The impact of baseline serum chloride on the main trial end points and the treatment effect of acetazolamide was assessed, as was the evolution of serum chloride under decongestive treatment.

RESULTS: Hypochloremia (<96 mmol/L) and hyperchloremia (>106 mmol/L) were present in 80 (15%) and 53 (10%), respectively, at baseline. Hypochloremia was associated with significantly slower decongestion, a longer length of hospital stay, and increased risk of all-cause mortality and heart failure readmissions. Acetazolamide increased the odds of successful decongestion and reduced length of stay irrespectively of baseline serum chloride levels. No statistically significant interaction between serum chloride levels and the effect of acetazolamide on death or heart failure readmissions was observed. The placebo group exhibited a progressive decline in serum chloride, which was effectively prevented by acetazolamide (P<0.001).

CONCLUSIONS: Hypochloremia is associated with diuretic resistance and worse clinical outcomes. Add-on acetazolamide therapy improves decongestion across the entire range of serum chloride and prevents the drop in chloride levels caused by loop diuretic monotherapy.

REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03505788.

PMID:39171394 | DOI:10.1161/CIRCHEARTFAILURE.123.011749

Age Ageing. 2024 Aug 6;53(8):afae187. doi: 10.1093/ageing/afae187.

ABSTRACT

INTRODUCTION: Recurrent falls are observed frequently among older people, and they are responsible for significant morbidity and mortality. The aim of the present study was to verify sensitivity, specificity and accuracy of World Guidelines for Falls Prevention and Management (WGFPM) falls risk stratification algorithm using data from the Osteoarthritis Initiative (OAI).

METHODS: Participants aged between 40 and 80 years were stratified as ‘low risk’, ‘intermediate risk’ or ‘high risk’ as per WGFPM stratification. Data from the OAI cohort study were used, a multi-centre, longitudinal, observational study focusing primarily on knee osteoarthritis. The assessment of the outcome was carried out at baseline and during the follow-up visit at 24 months. Data about sensitivity, specificity and accuracy were reported.

RESULTS: Totally, 4796 participants were initially included. Participants were aged a mean of 61.4 years (SD = 9.1) and were predominantly women (58.0%). The population was divided into three groups: low risk (n = 3266; 82%), intermediate risk (n = 25; 0.6%) and high risk (n = 690; 17.3%). WGFPM algorithm applied to OAI, excluding the intermediate-risk group, produced a sensitivity score of 33.7% and specificity of 89.9% for predicting one or more falls, with an accuracy of 72.4%.

CONCLUSION: In our study, WGFPM risk assessment algorithm successfully distinguished older people at greater risk of falling using the opportunistic case finding method with a good specificity, but limited sensitivity, of WGFPM falls risk stratification algorithm.

PMID:39171386 | DOI:10.1093/ageing/afae187

J Pediatr Orthop. 2024 Aug 22. doi: 10.1097/BPO.0000000000002792. Online ahead of print.

ABSTRACT

OBJECTIVE: While the implementation of enhanced recovery after surgery protocols and improvements in pain control have decreased the length of stay (LOS) after scoliosis surgery, adolescents are typically hospitalized for several days after posterior spinal instrumented fusion (PSF). The purpose of this study was to determine whether next-day discharge after PSF for adolescent idiopathic scoliosis (AIS) had an equivalent safety profile compared with longer LOS. The secondary purpose was to examine perioperative factors associated with next-day discharge.

METHODS: We performed a retrospective study of all patients who underwent PSF for AIS at a single institution from 2017 to 2022. We compared patients based on postoperative LOS with an early discharge group consisting of those who were discharged on the first postoperative day 1 (POD1; n = 40) and a standard discharge group consisting of those who were discharged after POD1 (n = 71). We documented preoperative variables, including patient demographics and curve characteristics, intraoperative variables, including levels fused, implant density, operative time, and blood loss, and postoperative variables, including emergency department (ED) visits within 30 days and hospital readmissions within 90 days.

RESULTS: One hundred eleven patients were included with a mean curve magnitude of 67 degrees. Forty patients (36%) were discharged on POD1. There were one (3%) ED visit and 2 (5%) readmissions in the early discharge group and 3 (4%) ED visits and 2 (3%) readmissions in the standard discharge group (P = 0.64 and 0.55, respectively). Patients in whom intravenous methadone was used intraoperatively were more likely to discharge POD1 (P = 0.02). There were no other significant differences in perioperative variables between the two groups including: BMI, distance from home to hospital, magnitude of main curve, curve flexibility, number of levels fused, estimated blood loss, implant density, operative time, or postoperative pain scores.

CONCLUSIONS: Next-day discharge after PSF for AIS has an equivalent safety profile compared with longer LOS. Over one-third of patients were discharged on POD1, and there was no statistically significant difference in ED visits or hospital readmissions between the groups. Patients in whom intravenous methadone was used intraoperatively were more likely to discharge POD1.

CLINICAL RELEVANCE: In a retrospective study of posterior spinal fusions for AIS, we found no increase in ED visits or hospital readmissions for those discharged the next day.

LEVEL OF EVIDENCE: Level III.

PMID:39171367 | DOI:10.1097/BPO.0000000000002792

Orthop Surg. 2024 Aug 22. doi: 10.1111/os.14178. Online ahead of print.

ABSTRACT

OBJECTIVE: Previous cementless total knee arthroplasty (TKA) designs faced challenges with insufficient initial fixation on tibial side, resulting in inferior functional outcomes and survival rates. The Zoned Trabecular Bone Cementless Knee is a novel implant designed for cementless TKA which aims to achieve excellent initial fixation, promoting effective osseointegration. The aim of this research was to compare the early clinical and radiographic results of this cementless TKA with cemented TKA.

METHODS: Between September 2021 and April 2022, 64 patients (64 knees) were recruited in this prospective randomized controlled trial to receive either cementless 3D-printed trabecular metal TKA or a cemented posterior stabilized TKA. Preoperative and postoperative clinical evaluations, including the range of motion (ROM), Knee Society Score (KSS), and the Reduced Western Ontario and MacMaster Universities Score (WOMAC), were conducted and analyzed for comparison. Radiographs and computed tomography scans were utilized to assess the initial fixation. The complications between the two groups were also recorded and compared. Continuous data were analyzed for significance using independent-samples t-test or the Mann-Whitney U test and categorical data were analyzed using chi-squared or Fisher’s exact test.

RESULTS: Both groups demonstrated significant enhancement at 12 months follow-up in the ROM compared with baseline (ROM: 94.7 ± 23.4 vs. 113.1 ± 12.3 in cementless group and 96.5 ± 14.7 vs. 111.0 ± 12.8 in cemented group, p < 0.05). However, no statistical differences were observed between the two groups in postoperative ROM, KSS, or WOMAC score. The radiographs and computed tomography scans showed similar results, including radiolucent lines and osteolysis in either femoral or tibial. Additionally, there was no statistical difference in the overall complication rate between the two groups. Notably, one patient in the cementless TKA group required revision for periprosthetic infection as the end point.

CONCLUSIONS: This novel 3D-printed trabecular metal cementless TKA achieved comparable clinical outcomes and initial fixation to cemented TKA in early stage. Longer-term examination is necessary to validate these results.

PMID:39171362 | DOI:10.1111/os.14178

Stomatologiia (Mosk). 2024;103(4):67-69. doi: 10.17116/stomat202410304167.

ABSTRACT

OBJECTIVE: To reveal need for prosthodontics in permanent teeth in children aged 8-18 years.

MATERIALS AND METHODS: The study was performed in Khimki Dental Municipal Clinic. Dental examination and radiological studies were conducted in 97 primary patients aged 8-18 years. Indications for prosthodontics in permanent teeth were occlusal deterioration index more than 40% and crown decay of more than 50% in incisors and canines. Additional features were registered including DMFT index, the presence of extracted teeth and teeth after root canal treatment, as well and teeth with extensive restorations with resins and marginal seal quality.

RESULTS: From 97 primary patients (27.8%) children needed prosthodontics in permanent teeth (in average 2.3±2.1 teeth): 1 tooth in 10 children, 2 teeth in 11 children, 3 teeth in 1 child, 4 teeth in 3 children and 4 teeth in 2 children. Mean DMFT was 8.1±4.5 teeth. Six children already had extracted permanent teeth (9 teeth in total). Half of the teeth (49.2%) which needed orthodontic treatment had history of root canal treatment while 46% needed primary or secondary endodontic treatment. Occlusal deterioration index was more than 40% in 41.3% of cases, more than 60% in 49.2% of teeth and more than 80% in 9.52% of teeth. From all the teeth restored with composite resins 41.7% had good marginal seal but 58.3% showed macroscopic signs of marginal leakage.

CONCLUSION: Our study shows high percentage of adolescents having need for prosthodontics in permanent teeth and unjustified widening of indications for direct resin restorations in this group of patients.

PMID:39171346 | DOI:10.17116/stomat202410304167

Front Public Health. 2024 Aug 6;12:1390636. doi: 10.3389/fpubh.2024.1390636. eCollection 2024.

ABSTRACT

BACKGROUND: Compared to civilians and non-medical personnel, military medical doctors are at increased risk for sleep disturbances and impaired psychological well-being. Despite their responsibility and workload, no research has examined sleep disturbances and psychological well-being among the medical doctors (MDs) of the Swiss Armed Forces (SAF). Thus, the aims of the proposed study are (1) to conduct a cross-sectional study (labeled ‘Survey-Study 1’) of sleep disturbances and psychological well-being among MDs of the SAF; (2) to identify MDs who report sleep disturbances (insomnia severity index >8), along with low psychological well-being such as symptoms of depression, anxiety and stress, but also emotion regulation, concentration, social life, strengths and difficulties, and mental toughness both in the private/professional and military context and (3) to offer those MDs with sleep disturbances an evidence-based and standardized online interventional group program of cognitive behavioral therapy for insomnia (eCBTi) over a time lapse of 6 weeks (labeled ‘Intervention-Study 2’).

METHOD: All MDs serving in the SAF (N = 480) will be contacted via the SAF-secured communication system to participate in a cross-sectional survey of sleep disturbances and psychological well-being (‘Survey-Study 1’). Those who consent will be provided a link to a secure online survey that assesses sleep disturbances and psychological well-being (depression, anxiety, stress, coping), including current working conditions, job-related quality of life, mental toughness, social context, family/couple functioning, substance use, and physical activity patterns. Baseline data will be screened to identify those MDs who report sleep disturbances (insomnia severity index >8); they will be re-contacted, consented, and randomly assigned either to the eCBTi or the active control condition (ACC) (‘Intervention-Study 2’). Individuals in the intervention condition will participate in an online standardized and evidence-based group intervention program of cognitive behavioral therapy for insomnia (eCBTi; once the week for six consecutive weeks; 60-70 min duration/session). Participants in the ACC will participate in an online group counseling (once the week for six consecutive weeks; 60-70 min duration/session), though, the ACC is not intended as a bona fide psychotherapeutic intervention. At the beginning of the intervention (baseline), at week 3, and at week 6 (post-intervention) participants complete a series of self-rating questionnaires as for the Survey-Study 1, though with additional questionnaires covering sleep-related cognitions, experiential avoidance, and dimensions of self-awareness.

EXPECTED OUTCOMES: Survey-Study 1: We expect to describe the prevalence rates of, and the associations between sleep disturbances (insomnia (sleep quality); sleep onset latency (SOL); awakenings after sleep onset (WASO)) and psychological well-being among MDs of the SAF; we further expect to identify specific dimensions of psychological well-being, which might be rather associated or non-associated with sleep disturbances.Intervention-Study 2: We expect several significant condition-by-time-interactions. Such that participants in the eCBTi will report significantly greater improvement in sleep disturbances, symptoms of depression, anxiety, stress reduction both at work and at home (family related stress), and an improvement in the overall quality of life as compared to the ACC over the period of the study.

CONCLUSION: The study offers the opportunity to understand the prevalence of sleep disturbances, including factors of psychological well-being among MDs of the SAF. Further, based on the results of the Intervention-Study 2, and if supported, eCBTi may be a promising method to address sleep disturbances and psychological well-being among the specific context of MDs in the SAF.

PMID:39171319 | PMC:PMC11337202 | DOI:10.3389/fpubh.2024.1390636

Front Public Health. 2024 Aug 7;12:1392813. doi: 10.3389/fpubh.2024.1392813. eCollection 2024.

ABSTRACT

BACKGROUND: Polycyclic aromatic hydrocarbons (PAHs), as organic pollutants widely present in daily environments, have been shown by existing epidemiological studies to be significantly associated with deficits in learning and memory functions in children and adults. However, the association between exposure to PAHs and cognitive function in older adults remains unclear. Additionally, existing related studies have only assessed the association between individual PAH exposures and cognitive assessments, overlooking the risks posed by mixed exposures. This study aims to use three statistical models to investigate the individual and overall effects of mixed PAH exposures on the cognition of older adults in the United States.

METHODS: The study cohort was obtained from the NHANES database, which included individuals aged 60 and older from 2011 to 2014. Weighted generalized linear models (GLM), weighted quantile sum (WQS) models, and Bayesian kernel machine regression (BKMR) models were utilized to evaluate the connections between urinary PAH metabolites and the standardized Z-scores of four cognitive tests: Immediate Recall Test (IRT), Delayed Recall Test (DRT), Animal Fluency Test (AFT), and Digit Symbol Substitution Test (DSST).

RESULTS: Our analysis involved 899 individuals aged 60 and above. In the fully adjusted GLM, 2-hydroxynaphthalene (2-OHNa), 3-hydroxyfluorene (3-OHFlu), and 2-hydroxyfluorene (2-OHFlu) demonstrated negative associations with DSST Z-scores. In the WQS model, six urinary PAH metabolites were negatively linked to AFT Z-scores (β (95% confidence intervals [CI]): -0.120 (-0.208, -0.033), p = 0.007) and DSST Z-scores (β (95% CI): -0.182 (-0.262, -0.103), p < 0.001). In both assessments, 2-OHNa exerted the greatest influence among the urinary PAH metabolites. In the BKMR model, there was an overall negative correlation between urinary PAH metabolites and AFT and DSST Z-scores when the concentration was within the 25th to 75th percentile, where 2-OHNa dominated the main effect of the mixture. The WQS and BKMR models were adjusted for all covariates.

CONCLUSION: Increased concentrations of urinary PAH metabolites are associated with cognitive decline in older adults, mainly on language ability, executive function, sustained attention, working memory, and information processing speed, with 2-OHNa playing a major effect.

PMID:39171318 | PMC:PMC11335504 | DOI:10.3389/fpubh.2024.1392813

Front Public Health. 2024 Aug 7;12:1436415. doi: 10.3389/fpubh.2024.1436415. eCollection 2024.

ABSTRACT

INTRODUCTION: Monoterpenes, a subset of the terpene family composed of two isoprene units, have garnered significant attention in research circles owing to their potential medicinal benefits. Recent experimental studies indicate that they might exert positive effects on bone health. Nevertheless, the impact of monoterpenes exposure on bone health remains unexplored in humans.

METHODS: We examined 748 adults (age ≥ 40 years) from the National Health and Nutrition Examination Survey (NHANES) 2013-2014 to explore the correlation between three monoterpenes (α-pinene, β-pinene, and limonene), bone mineral density (BMD) in the total lumbar spine and proximal femur, FRAX^® scores, and prior bone fracture history.

RESULTS AND DISCUSSION: Our analysis unveiled a significant inverse association between a one-unit increase in the natural logarithm (ln) of α-pinene and limonene and total proximal femur BMD (ß = -0.027, S.E. = 0.008, P = 0.004 and ß = -0.019, S.E. = 0.007, P = 0.016, respectively). As serum α-pinene levels ascended across quintiles, there was a notable decrease in total proximal femur BMD (P for trend = 0.025). The inverse relationship between ln α-pinene levels and total proximal femur BMD was more pronounced in women, especially pre-menopausal women. Compared to subjects with α-pinene and limonene levels at or below the 50^th percentiles, those exceeding this threshold exhibited the lowest mean value of total proximal femur BMD (0.8628 g/cm2, S.E. = 0.026, P = 0.009). However, the trend was not statistically significant (P = 0.070). Additionally, all three monoterpenes were linked to a higher prevalence of previous spine fractures, whereas β-pinene showed a reduced incidence of other types of fractures. In this comprehensive survey of American adults aged 40 and above, higher serum levels of α-pinene and limonene correlated with decreased total proximal femur BMD. Furthermore, our findings suggest a potential combined effect of α-pinene and limonene on total proximal femur BMD. Further investigation is essential to elucidate the clinical relevance and causative nature of our findings.

PMID:39171315 | PMC:PMC11335497 | DOI:10.3389/fpubh.2024.1436415

Front Public Health. 2024 Aug 6;12:1450935. doi: 10.3389/fpubh.2024.1450935. eCollection 2024.

ABSTRACT

BACKGROUND: Recent years have seen an increase in school refusal behavior among adolescents, potentially due to factors like excessive short-form video viewing, bullying, and school anxiety. Limited research has investigated how these factors contribute to school refusal behavior. This study used random forest regression, path analysis, and network analysis to identify key variables and pathways leading to school refusal behavior.

METHODS: In this cross-sectional questionnaire-based study, 2,056 (996 male, 1,060 female, mean age: 14.79 ± 1.24 years) middle and senior high school students were asked to complete the School Refusal Behavior Assessment questionnaire to assess school refusal behavior features, the Excessive Short-Form Video Viewing Scale as well as self-reported viewing times during leisure days to assess excessive short-form video viewing, the SNAP-IV Rating Scale to assess the severity of inattention symptoms, and the self-administered questionnaires to assess experiences of being bullied and school anxiety.

RESULTS: The prevalence of school refusal behavior in the surveyed adolescents was found to be 31.9% [95% confidence interval (CI): 29.8-33.9%]. In terms of significance, the severity of inattention symptoms exhibited the greatest predictive power, while excessive short-form video viewing accounted for the most variance. Path analysis revealed that excessive short-form video viewing not only directly affects school refusal behavior features but also does so indirectly through severity of inattention symptoms and school anxiety. Key bridge factors in this pathway include intense fear and anxiety associated with school attendance, manifesting as somatic symptoms and avoidance behaviors.

CONCLUSION: The findings indicate that not only does excessive short-form video viewing directly influence school refusal behavior features in adolescents, but it also indirectly impacts these features through mechanisms involving severity of inattention symptoms and school anxiety. The bridge factors highlight potential targets for interventions among the SRB features and predictors.

PMID:39171313 | PMC:PMC11337196 | DOI:10.3389/fpubh.2024.1450935

Front Public Health. 2024 Aug 7;12:1443844. doi: 10.3389/fpubh.2024.1443844. eCollection 2024.

ABSTRACT

BACKGROUND: Landscaping studies related to public health education in India do not exclusively focus on the most common Masters of Public Health (MPH) program. The field of public health faces challenges due to the absence of a professional council, resulting in fragmented documentation of these programs. This study was undertaken to map all MPH programs offered across various institutes in India in terms of their geographic distribution, accreditation status, and administration patterns.

METHODOLOGY: An exhaustive internet search using various keywords was conducted to identify all MPH programs offered in India. Websites were explored for their details. A data extraction tool was developed for recording demographic and other data. Information was extracted from these websites as per the tool and collated in a matrix. Geographic coordinates obtained from Google Maps, and QGIS software facilitated map generation.

RESULTS: The search identified 116 general and 13 MPH programs with specializations offered by different universities and institutes across India. India is divided into six zones, and the distribution of MPH programs in these zones is as follows, central zone has 20 programs; the east zone has 11; the north zone has 35; the north-east zone has 07; the south zone has 26; and the west zone has 17 MPH programs. While 107 are university grants commission (UGC) approved universities and institutes, only 46 MPH programs are conducted by both UGC approved and National Assessment and Accreditation Council (NAAC) accredited universities and institutes. Five universities are categorized as central universities; 22 are deemed universities; 51 are private universities; and 29 are state universities. Nine are considered institutions of national importance by the UGC, and four institutions are recognized as institutions of eminence. All general MPH programs span 2 years and are administered under various faculties, with only 27 programs being conducted within dedicated schools or centers of public health.

CONCLUSION: The MPH programs in India show considerable diversity in their geographic distribution, accreditation status, and administration pattern.

PMID:39171312 | PMC:PMC11335718 | DOI:10.3389/fpubh.2024.1443844