Category: Nevin Manimala

Diabetes Metab Res Rev. 2023 Jan 19:e3616. doi: 10.1002/dmrr.3616. Online ahead of print.

ABSTRACT

AIMS: To develop and validate a risk prediction model for Chinese patients with type 2 diabetes with the recurrence of diabetes foot ulcers (DFU) based on systematic review and meta-analysis.

METHODS: A prospective analysis was performed with 1333 participants and followed up for 60 months. Three models were analyzed using derived cohort. The risk factors were screened by meta-analysis and logistic regression, and the missing variables were interpolated by multiple imputation. The internal validation was performed by the bootstrap procedure, validation cohort was applied to the external validation. The performance of model was evaluated the area under the discrimination receiver Operating Characteristic Curve (ROC). The calibration and discrimination methods were used for the validation cohort. The variables were selected according to their clinical and statistical importance to construct the nomograms.

RESULTS: Three models were developed and validated. Model 1 included seven social and clinical indicators like Sex, DM duration, Previous DFU, Location of ulcer, Smoker, History of amputation and Foot deformity. Model 2 included four more indicators besides those in Model 1, which were Statin agents used, Antiplatelet agents used, SBP and BMI. Model 3 added further laboratory indicators to Model 2 such as LDL-C, HbA1C, FIB and BUN. In the derivation cohort, 20.1% (206/1027) participants with DFU were recurred as compared to the validation cohort, which was 38.2% (117/306). The AUC in the derivation cohort for Models1-3 were 0.781 (0.744-0.817), 0.843 (0.813-0.873) and 0.899 (0.876-0.922) respectively. The Youden index for Model 1-3 were 0.430, 0.559 and 0.653 respectively. Model 3 showed the highest sensitivity and specificity. All models performed well for both discrimination and calibration.

CONCLUSION: Model 1-2 were non-invasive, which indicated their role in general screening for patients at the high-risk of recurrence DFU. However, Model 3 offered a more specific screening due to its best performance in predicting the risk of DFU recurrence amongst three models. This article is protected by copyright. All rights reserved.

PMID:36657181 | DOI:10.1002/dmrr.3616

Physiol Meas. 2023 Jan 19. doi: 10.1088/1361-6579/acb4dd. Online ahead of print.

ABSTRACT

OBJECTIVE: Pulse wave velocity (PWV) is a key diagnostic parameter of the cardiovascular system state. However, the approaches aimed at the PWV characterization often suffer from inevitable drawbacks. The statistical results demonstrating how closely the PWV in the radial artery (RA) and the respiration phase correlate, as well as the RA PWV evolution during breath-holding (BH), have not been presented in the literature yet. The aims of this study are: a) to propose a simple robust technique for measuring RA PWV, b) to reveal the phase relation between the RA PWV and spontaneous breathing, c) to disclose the BH influence on the RA PWV.

APPROACH: The high-resolution remote breathing monitoring method, Sorption-Enhanced Infrared Thermography (SEIRT), and the described new technique aimed at measuring RA PWV, were used synchronously, and their measurement data were processed simultaneously.

MAIN RESULTS: Spontaneous breathing leaves a synchronous “trace” on the RA PWV. The close linear correlation of the respiration phase and the phase of concomitant RA PWV changes is statistically confirmed in 5 tested persons (Pearson’s r is of the order of 0.5-0.8, P<0.05). The BH appreciably affects the RA PWV. A phenomenon showing that the RA PWV is not indifferent to hypoxia is observed for the first time.

SIGNIFICANCE: The proposed technique for the RA PWV characterization has high prospects in biomedical diagnostics. The presented pilot study deserves attention in the context of mutual respiratory and cardiovascular systems interplay. It may also be useful in cases where the peripheral pulse wave propagation helps assess the respiratory function.

PMID:36657177 | DOI:10.1088/1361-6579/acb4dd

Nutr Neurosci. 2023 Jan 19:1-12. doi: 10.1080/1028415X.2023.2166803. Online ahead of print.

ABSTRACT

BACKGROUND: Functional connectivity (FC) measures statistical dependence between cortical brain regions. Studies of FC facilitate understanding of the brain’s function and architecture that underpin normal cognition, behavior, and changes associated with various factors (e.g. nutritional supplements) at a large scale.

OBJECTIVE: We aimed to identify modifications in FC patterns and targeted brain anatomies in piglets following perinatal intake of different nutritional diets using a graph theory based approach.

METHODS: Forty-four piglets from four groups of pregnant sows, who were treated with nutritional supplements, including control diet, docosahexaenoic acid (DHA), egg yolk (EGG), and DHA + EGG, went through resting-state functional magnetic resonance imaging (rs-fMRI). We introduced the use of differential degree test (DDT) to identify differentially connected edges (DCEs). Simulation studies were first conducted to compare the DDT with permutation test, using three network structures at different noise levels. DDT was then applied to rs-fMRI data acquired from piglets.

RESULTS: In simulations, the DDT showed a greater accuracy in detecting DCEs when compared with the permutation test. For empirical data, we found that the strength of internodal connectivity is significantly increased for more than 6% of edges in the EGG group and more than 8% of edges in the DHA and DHA + EGG groups, all compared to the control group. Moreover, differential wiring diagrams between group comparisons provided means to pinpoint brain hubs affected by nutritional supplements.

CONCLUSION: DDT showed a greater accuracy of detection of DCEs and demonstrated EGG, DHA, and DHA + EGG supplemented diets lead to an improved internodal connectivity in the developing piglet brain.

PMID:36657164 | DOI:10.1080/1028415X.2023.2166803

Gac Med Mex. 2022;158(6):376-385. doi: 10.24875/GMM.M22000716.

ABSTRACT

INTRODUCTION: To the best of our knowledge, the research herein presented is the first multicenter study in Mexico to analyze the development of clinical aptitude in medical units that train cardiologists.

OBJECTIVE: To determine the degree of development of clinical aptitude in cardiology residents at three High Specialty Medical Units.

METHODS: Multicenter, cross-sectional design. All students of the 2019-2020 academic year were included in the study. An instrument was constructed that evaluated clinical aptitude based on eight indicators and 170 items; conceptual/content validity and reliability were assessed by five cardiologists with teaching and educational research experience.

RESULTS: By indicator and year of residence, significant statistical differences were observed in the CMN20Nov academic site. At HCSXXI and INCICh, statistically significant differences were observed in one of eight indicators. Differences between R1 residents (n = 41) of all three academic sites were estimated by indicator, with statistical significance being recorded in three of eight indicators. Between R2 (n = 35) and between R3 residents (n = 43), the result was similar.

CONCLUSIONS: The degree of clinical aptitude development can be considered intermediate in all three academic sites, probably because the instrument explored problematized clinical situations that required for the residents to critically reflect on their clinical experience.

PMID:36657137 | DOI:10.24875/GMM.M22000716

Gac Med Mex. 2022;158(6):423-429. doi: 10.24875/GMM.M22000722.

ABSTRACT

INTRODUCTION: A national survey in the general population showed that gastroesophageal reflux disease (GERD) is highly prevalent in Mexico.

OBJECTIVE: To compare the efficacy and safety of two isomers, dexrabeprazole (10 mg) vs. esomeprazole (20 mg), in the treatment of GERD for four weeks.

METHODS: Randomized, multicenter, prospective, double-blind phase III clinical trial in two groups that included 230 patients.

RESULTS: A statistically significant decrease in the severity of GERD symptoms (heartburn, regurgitation, epigastric pain and dysphagia), evaluated using a visual analogue scale, was observed with both treatments. Mean score for dexrabeprazole on Carlsson-Dent questionnaire at 28 days was 2.12, and for esomeprazole, 3.02. Both treatments were effective, with no statistically significant difference being recorded (p < 0.05). On SF-36 health questionnaire, both were observed to improve the quality-of-life score, with no significant difference being identified. Both drugs were well tolerated, and the adverse event incidence profile was low.

CONCLUSIONS: In the treatment of non-erosive GERD, the use of dexrabeprazole at 10 mg/day is as effective as esomeprazole 20 mg/day, with the advantage that the dose is lower with an appropriate safety profile.

PMID:36657136 | DOI:10.24875/GMM.M22000722

Gac Med Mex. 2022;158(6):349-354. doi: 10.24875/GMM.M22000712.

ABSTRACT

INTRODUCTION: SARS-CoV-2 infection spatial and temporal distribution overlaps with endemic areas of vector-borne diseases (VBD), whose surveillance in Mexico has substantially changed since the first COVID-19 confirmed case.

OBJECTIVES: To estimate and compare the incidence rates of VBDs before and after the introduction of SARS-CoV-2 in Mexico.

METHODS: Retrospective study of VBD cases from 2014 to 2021. The incidence rates of each VBD in the period before (2014-2019) and after (2020-2021) the introduction of SARS-CoV-2 in Mexico were calculated and compared.

RESULTS: Before the introduction of SARS-CoV-2, the incidence rates of VBDs were high and after the introduction of coronavirus there was a decrease in epidemiological indices; however, there was only statistically significant difference in the incidence rate of malaria (p ≤ 0.05) and other rickettsiae (p ≤ 0.05).

CONCLUSIONS: Some measures to reduce COVID-19 cases, such as social distancing, home confinement, reductions in public transport and working at home (home office), probably temporarily decreased the number of VBD cases; however, there may be a resurgence of VBDs in the near future.

PMID:36657121 | DOI:10.24875/GMM.M22000712

Australas Psychiatry. 2023 Jan 19:10398562231153006. doi: 10.1177/10398562231153006. Online ahead of print.

ABSTRACT

OBJECTIVE: The primary objective of this study was to use clinical indicators to track changes in efficiency of a Consultation-Liaison service as part of a clinical audit cycle.

METHODS: This was a clinical audit cycle. The auditing phase involved measuring the efficiency of the service. The ‘intervention’ was simply the team’s awareness and involvement in tracking these statistics. Subsequently, these indicators were re-audited.

RESULTS: In the initial audit cycle, 315 referrals to the C-L service were audited over a 3 month period, showing a 24 hour time-to-seen rate of 80% and a 36 hour time-to-seen rate of 89.2%. Upon re-auditing of 112 referrals following our intervention, 24 hr timeliness had risen to 92% and 36 hr timeliness had risen to 96.4%.

CONCLUSION: The measuring of clinical indicators of efficiency in C-L may give service improvement personnel a reflection of the functionality of a C-L service. By involving team members in the measuring and tracking of these indicators, we may be able to boost overall clinical efficiency and outcomes.

PMID:36657114 | DOI:10.1177/10398562231153006

Gac Med Mex. 2022;158(6):343-348. doi: 10.24875/GMM.M22000711.

ABSTRACT

INTRODUCTION: In older adults, the association of frailty and sarcopenia with vitamin D deficiency is well known, but the association of the components of frailty syndrome has been poorly studied.

OBJECTIVE: To determine the association of the components of frailty and sarcopenia with vitamin D insufficiency in older adults.

METHODS: Adults were studied, in whom age, education, marital status, history of fractures, hospitalizations, anthropometric indicators, sarcopenia, Charlson index, polypharmacy, Fried’s frailty phenotype, and plasma vitamin D were recorded; figures < 30 ng/mL were considered indicative of vitamin D insufficiency. Descriptive and inferential statistics were used for statistical analysis. The association was determined by binary logistic regression.

RESULTS: One-hundred and seventy-five adults with a mean age of 71.7 ± 6.7 years (95% CI = 60-90 years) were studied. Binary logistic regression showed that the variables associated with vitamin D deficiency were exhaustion (OR = 2.6, 95% CI = 1.0-6.5, p = 0.03), frailty (OR = 9.2, 95% CI = 2.5-34.1, p = 0.001) and pre-frailty (OR = 4.6, 95% CI = 2.1-10.0, p < 0.001).

CONCLUSION: The frail and pre-frail phenotypes, as well as exhaustion, are associated with vitamin D insufficiency.

PMID:36657111 | DOI:10.24875/GMM.M22000711

Health Care Women Int. 2023 Jan 19:1-19. doi: 10.1080/07399332.2022.2164582. Online ahead of print.

ABSTRACT

In this study, we aimed to determine the effects of the PRECEDE-PROCEED model-based educational program on women’s genital hygiene behaviors. A randomized controlled trial was conducted with 120 women diagnosed with genital infections and assigned to the experimental (n = 60) and control (n = 60) groups. Educational intervention was designed based on the PRECEDE-PROCEED model and implemented in the experimental group. Data were collected three times before (pretest), right after (posttest) and 1 month after the intervention using the personal information form, Data Form for Knowledge, Attitudes, and Beliefs about Genital Hygiene and Genital Hygiene Behaviors Inventory (GHBI). After the educational intervention, the participants’ hygiene-related knowledge, attitudes and behaviors improved in the experimental group at the posttest and follow-up test from the baseline. A statistically significant difference was found between the groups. We concluded that PRECEDE-PROCEED model-based educational program positively affected the women’s genital hygiene-related knowledge, attitudes, and behaviors.

PMID:36657105 | DOI:10.1080/07399332.2022.2164582

JCO Oncol Pract. 2023 Jan 19:OP2200551. doi: 10.1200/OP.22.00551. Online ahead of print.

ABSTRACT

PURPOSE: The Accelerated Diagnostic Assessment Program (ADAP) manages patients with imaging abnormalities, with or without concomitant symptoms, where cancer is suspected. The ADAP is offered to primary care practitioners and emergency departments with cases triaged by a medical oncologist.

METHODS: We performed a retrospective patient chart review of electronic medical records from January 2019 until June 2021 to validate the program. We collected information on the referral pathways, patient demographics, wait-times, and diagnostic results. The control group consisted of outpatients who were referred for biopsy over a 1-year period outside the ADAP stream. Statistical analyses were performed using IBM SPSS software.

RESULTS: Of the 97 patients included, 54% were female, with ages ranging from 18 to 96 years. Twenty-nine percent (n = 20) of the malignant cases were incidental findings. Most patients referred to the ADAP were diagnosed with a malignancy (71%; n = 69), comprising hematologic (45%; n = 31), GI (26%; n = 18), or other cancers (29%; n = 20). The ADAP had decreased wait-times from referral to biopsy collection (17.6 days ± 10.7 [standard deviation (SD)]; n = 43) when compared with the control group (41.2 days ± 40.0 [SD]; n = 67; P < .001). ADAP patients with malignancies saw a treating specialist 7.6 ± 7.6 days [SD] after their follow-up appointment at the ADAP.

CONCLUSION: The ADAP accelerated time to biopsy in a statistically significant manner when compared with age-, referring physician-, and biopsy site-matched controls. It also outperformed national and provincial standards, suggesting that its model addresses a gap in care by providing an underserved population timely access to diagnosis and treatment.

PMID:36657095 | DOI:10.1200/OP.22.00551