Category: Nevin Manimala

J Bras Pneumol. 2024 Jun 17;50(3):e20230292. doi: 10.36416/1806-3756/e20230292. eCollection 2024.

ABSTRACT

OBJECTIVE: Cystic fibrosis (CF) affects multiple organs, the most severe consequences being observed in the lungs. Despite significant progress in developing CF transmembrane conductance regulator-specific treatments for CF lung disease, exploring alternative CF-targeted medications seems reasonable. We sought to evaluate the potential beneficial effects of oral benzbromarone as an adjuvant therapy in CF patients with reduced lung function.

METHODS: This was a prospective open-label pilot study of oral benzbromarone (100 mg/day) administered once daily for 90 days. Patients were followed at a tertiary referral center in southern Brazil. Safety was assessed by the number of reported adverse events. Secondary objectives included percent predicted FEV1 (FEV1%) and pulmonary exacerbations.

RESULTS: Ten patients were enrolled. Benzbromarone was found to be safe, with no serious drug-related adverse events. Eight patients completed the study; the median relative change in FEV1% tended to increase during the treatment, showing an 8% increase from baseline at the final visit. However, a nonparametric test showed that the change was not significant (p = 0.06). Of a total of ten patients, only one experienced at least one pulmonary exacerbation during the study.

CONCLUSIONS: Oral benzbromarone appears to be safe, and improved FEV1% has been observed in patients with CF. Further assessment in larger trials is warranted to elucidate whether oral benzbromarone can be a potential adjuvant therapy for CF.

PMID:38896732 | DOI:10.36416/1806-3756/e20230292

Crit Care Sci. 2024 Jun 17;36:e20240258en. doi: 10.62675/2965-2774.20240258-en. eCollection 2024.

ABSTRACT

RATIONALE: Evidence about long-term sequelae after hospitalization for acute respiratory distress syndrome due to COVID-19 is still scarce.

PURPOSE: To evaluate changes in pulmonary, cardiac, and renal function and in quality of life after hospitalization for acute respiratory distress syndrome secondary to COVID-19.

METHODS: This will be a multicenter case-control study of 220 participants. Eligible are patients who are hospitalized for acute respiratory distress syndrome due to COVID-19. In the control group, individuals with no history of hospitalization in the last 12 months or long-term symptoms of COVID-19 will be selected. All individuals will be subjected to pulmonary spirometry with a carbon monoxide diffusion test, chest tomography, cardiac and renal magnetic resonance imaging with gadolinium, ergospirometry, serum and urinary creatinine, total protein, and urinary microalbuminuria, in addition to quality-of-life questionnaires. Patients will be evaluated 12 months after hospital discharge, and controls will be evaluated within 90 days of inclusion in the study. For all the statistical analyses, p < 0.05 is the threshold for significance.

RESULTS: The primary outcome of the study will be the pulmonary diffusing capacity for carbon monoxide measured after 12 months. The other parameters of pulmonary, cardiac, and renal function and quality of life are secondary outcomes.

CONCLUSION: This study aims to determine the long-term sequelae of pulmonary, cardiac, and renal function and the quality of life of patients hospitalized for acute respiratory distress syndrome due to COVID-19 in the Brazilian population.

PMID:38896723 | DOI:10.62675/2965-2774.20240258-en

Rev Bras Enferm. 2024 Jun 14;77(2):e20230384. doi: 10.1590/0034-7167-2023-0384. eCollection 2024.

ABSTRACT

OBJECTIVE: To learn the strategies used regarding underreporting of pesticide use in rural areas.

METHODS: A qualitative study was carried out in eight primary healthcare units in rural areas and two emergency care units in a municipality in southern Brazil. Data collection took place in 2023 through interviews. Twenty professional nurses participated. The data was submitted to content analysis.

RESULTS: The strategies identified were lifelong and continuing education for the professionals who carry out the notification, active search and training of workers who deal directly with this type of substance, computerizing the notification by filling in the forms online, and carrying out research on the subject.

FINAL CONSIDERATIONS: Nurses play an important role in reporting occupational accidents caused by the use of pesticides, improving occupational safety in rural areas.

PMID:38896714 | DOI:10.1590/0034-7167-2023-0384

Elife. 2024 Jun 18;12:RP89712. doi: 10.7554/eLife.89712.

ABSTRACT

Durable serological memory following vaccination is critically dependent on the production and survival of long-lived plasma cells (LLPCs). Yet, the factors that control LLPC specification and survival remain poorly resolved. Using intravital two-photon imaging, we find that in contrast to most plasma cells (PCs) in the bone marrow (BM), LLPCs are uniquely sessile and organized into clusters that are dependent on APRIL, an important survival factor. Using deep, bulk RNA sequencing, and surface protein flow-based phenotyping, we find that LLPCs express a unique transcriptome and phenotype compared to bulk PCs, fine-tuning expression of key cell surface molecules, CD93, CD81, CXCR4, CD326, CD44, and CD48, important for adhesion and homing. Conditional deletion of Cxcr4 in PCs following immunization leads to rapid mobilization from the BM, reduced survival of antigen-specific PCs, and ultimately accelerated decay of antibody titer. In naïve mice, the endogenous LLPCs BCR repertoire exhibits reduced diversity, reduced somatic mutations, and increased public clones and IgM isotypes, particularly in young mice, suggesting LLPC specification is non-random. As mice age, the BM PC compartment becomes enriched in LLPCs, which may outcompete and limit entry of new PCs into the LLPC niche and pool.

PMID:38896451 | DOI:10.7554/eLife.89712

JMIR Public Health Surveill. 2024 Jun 19;10:e57807. doi: 10.2196/57807.

ABSTRACT

BACKGROUND: The World Health Organization declared mpox an international public health emergency. Since January 1, 2022, China has been ranked among the top 10 countries most affected by the mpox outbreak globally. However, there is a lack of spatial epidemiological studies on mpox, which are crucial for accurately mapping the spatial distribution and clustering of the disease.

OBJECTIVE: This study aims to provide geographically accurate visual evidence to determine priority areas for mpox prevention and control.

METHODS: Locally confirmed mpox cases were collected between June and November 2023 from 31 provinces of mainland China excluding Taiwan, Macao, and Hong Kong. Spatiotemporal epidemiological analyses, including spatial autocorrelation and regression analyses, were conducted to identify the spatiotemporal characteristics and clustering patterns of mpox attack rate and its spatial relationship with sociodemographic and socioeconomic factors.

RESULTS: From June to November 2023, a total of 1610 locally confirmed mpox cases were reported in 30 provinces in mainland China, resulting in an attack rate of 11.40 per 10 million people. Global spatial autocorrelation analysis showed that in July (Moran I=0.0938; P=.08), August (Moran I=0.1276; P=.08), and September (Moran I=0.0934; P=.07), the attack rates of mpox exhibited a clustered pattern and positive spatial autocorrelation. The Getis-Ord Gi^* statistics identified hot spots of mpox attack rates in Beijing, Tianjin, Shanghai, Jiangsu, and Hainan. Beijing and Tianjin were consistent hot spots from June to October. No cold spots with low mpox attack rates were detected by the Getis-Ord Gi^* statistics. Local Moran I statistics identified a high-high (HH) clustering of mpox attack rates in Guangdong, Beijing, and Tianjin. Guangdong province consistently exhibited HH clustering from June to November, while Beijing and Tianjin were identified as HH clusters from July to September. Low-low clusters were mainly located in Inner Mongolia, Xinjiang, Xizang, Qinghai, and Gansu. Ordinary least squares regression models showed that the cumulative mpox attack rates were significantly and positively associated with the proportion of the urban population (t_0.05/2,1=2.4041 P=.02), per capita gross domestic product (t_0.05/2,1=2.6955; P=.01), per capita disposable income (t_0.05/2,1=2.8303; P=.008), per capita consumption expenditure (PCCE; t_0.05/2,1=2.7452; P=.01), and PCCE for health care (t_0.05/2,1=2.5924; P=.01). The geographically weighted regression models indicated a positive association and spatial heterogeneity between cumulative mpox attack rates and the proportion of the urban population, per capita gross domestic product, per capita disposable income, and PCCE, with high R² values in north and northeast China.

CONCLUSIONS: Hot spots and HH clustering of mpox attack rates identified by local spatial autocorrelation analysis should be considered key areas for precision prevention and control of mpox. Specifically, Guangdong, Beijing, and Tianjin provinces should be prioritized for mpox prevention and control. These findings provide geographically precise and visualized evidence to assist in identifying key areas for targeted prevention and control.

PMID:38896444 | DOI:10.2196/57807

J Clin Gastroenterol. 2024 Jun 13. doi: 10.1097/MCG.0000000000002031. Online ahead of print.

ABSTRACT

OBJECTIVE: The diagnosis of RGERD in patients typically involves 24-hour esophageal pH monitoring, but due to its invasiveness and low patient compliance, new screening methods are needed. In this study, a lactulose breath test (LBT) was conducted to detect the growth of small intestine bacteria (SIBO) and explore the potential relationship between LBT and RGERD to identify a new treatment method for RGERD.

METHODS: A total of 178 patients with gastroesophageal reflux were enrolled from June 2020 to December 2022 in the Gastroenterology Department, Building 3, the First Affiliated Hospital of Kunming Medical University; these patients included 96 patients with nonrefractory GERD (NRGERD) and 82 patients with RGERD. The Gerd Q score, reflux symptom index (RSI) score, gastroscopy results, clinical symptoms, and other related indicators were collected. Statistical methods were used to analyze the gathered data.

RESULTS: The incidence of acid reflux and heartburn in patients with RGERD was significantly greater than that in patients with NRGERD (67.10% vs. 42.70%, P<0.01 and 65.00% vs. 34.40%, P<0.01). The CH4 values of patients with RGERD were significantly greater than those of patients with NRGERD at each time point, and there was a correlation between the CH4 values at 60 min and RGERD (P<0.05). For patients with RGERD, the incidence of abdominal pain, acid regurgitation, and heartburn was greater in the CH4-positive group than in the CH4-negative group (61.90% vs. 57.50%, 69.05% vs. 65.00%, 69.05% vs. 57.50%, P>0.05). The incidence of nausea was also greater in the CH4-positive group than in the CH4-negative group (61.90% vs. 35.00%, P<0.05).

CONCLUSION: Increased CH4 levels are correlated with RGERD. In addition, patients with RGERD may develop SIBO after long-term use of PPIs, and interventions involving SIBO could provide new ideas for the treatment of RGERD.

PMID:38896424 | DOI:10.1097/MCG.0000000000002031

Health Rep. 2024 Jun 19;35(6):16-28. doi: 10.25318/82-003-x202400600002-eng.

ABSTRACT

BACKGROUND: This study explores the link between dental insurance, income, and oral health care access among seniors (aged 65 and over) in Canada. It contributes to the understanding of oral health care among seniors before the implementation of the Canadian Dental Care Plan.

DATA AND METHODS: This study uses data from the 2019/2020 Canadian Health Survey on Seniors (n=41,635) to report descriptive statistics and logistic regression model results and examine factors associated with seniors living in the community and access to oral health care services.

RESULTS: At the time of the survey (2019/2020), 72.5% of seniors in Canada reported having had a dental visit in the past 12 months, with 83.0% of insured and 65.3% of uninsured seniors reporting visits. Seniors reporting excellent or very good oral health had a higher prevalence of visits (79.2%) compared with those with good, fair, or poor oral health (62.3%). Among seniors who had not visited a dental professional in three years, 56.3% deemed it unnecessary, and 30.8% identified cost as the major barrier. After sociodemographic characteristics were controlled for, insured seniors were more likely to have had a dental visit in the past 12 months (adjusted odds ratio [OR]: 2.27; 95% confidence interval [CI]: 2.03 to 2.54) and were less likely to avoid dental visits because of cost (OR: 0.18; 95% CI: 0.12 to 0.28) compared with their uninsured counterparts.

INTERPRETATION: This study underscores the role of dental insurance in seniors’ oral health care access. While insurance is associated with seniors’ access to oral health care services, the study also emphasizes the need to consider social determinants of oral health such as income, gender, age, level of education, and place of residence when assessing oral health care access for seniors.

PMID:38896417 | DOI:10.25318/82-003-x202400600002-eng

Health Rep. 2024 Jun 19;35(6):3-15. doi: 10.25318/82-003-x202400600001-eng.

ABSTRACT

BACKGROUND: Extreme heat has significant impacts on mortality. In Canada, past research has analyzed the degree to which non-accidental mortality increases during single extreme heat events; however, few studies have considered multiple causes of death and the impacts of extreme heat events on mortality over longer time periods.

DATA AND METHODS: Daily death counts attributable to non-accidental, cardiovascular, and respiratory causes were retrieved for the 12 most populous cities in Canada from 2000 to 2020. Generalized additive models were applied to quantify daily mortality risks for people aged younger than 65 years and for those aged 65 years and older in each city and for each cause of death. Model results were used to calculate the change in mortality risks and the number of excess deaths attributable to extreme heat during extreme heat events.

RESULTS: Elevated mortality risks were observed during extreme heat events in most cities for non-accidental and respiratory causes. The impacts of extreme heat on non-accidental mortality were typically greater for people aged 65 and older than for those aged younger than 65. Significantly higher non-accidental mortality risks were observed during extreme heat events for people aged 65 and older in Montréal, the city of Québec, Surrey, and Toronto. For cardiovascular and respiratory causes, people aged 65 and older had significantly higher mortality risks during extreme heat events in Montréal, and both Montréal and Toronto, respectively. In the 12 cities, approximately 670 excess non-accidental deaths, 115 excess cardiovascular deaths, and 115 excess respiratory deaths were attributable to extreme heat events during the study period. Mortality risks during extreme heat events were generally higher in cities with larger proportions of renter households and fewer extreme heat events.

INTERPRETATION: This study estimates the longer-term impacts of extreme heat events on three mortality outcomes in a set of large Canadian cities. As climate change causes more frequent and intense extreme heat events, and as policy makers aim to reduce the health impacts of heat, it is important to understand how and where extreme heat affects health.

PMID:38896416 | DOI:10.25318/82-003-x202400600001-eng

Int J Comput Assist Radiol Surg. 2024 Jun 19. doi: 10.1007/s11548-024-03200-4. Online ahead of print.

ABSTRACT

PURPOSE: The conventional method to reconstruct the bone level for orbital defects, which is based on mirroring and manual adaptation, is time-consuming and the accuracy highly depends on the expertise of the clinical engineer. The aim of this study is to propose and evaluate an automated reconstruction method utilizing a Gaussian process morphable model (GPMM).

METHODS: Sixty-five Computed Tomography (CT) scans of healthy midfaces were used to create a GPMM that can model shape variations of the orbital region. Parameter optimization was performed by evaluating several quantitative metrics inspired on the shape modeling literature, e.g. generalization and specificity. The reconstruction error was estimated by reconstructing artificial defects created in orbits from fifteen CT scans that were not included in the GPMM. The developed algorithms utilize the existing framework of Gaussian process morphable models, as implemented in the Scalismo software.

RESULTS: By evaluating the proposed quality metrics, adequate parameters are chosen for non-rigid registration and reconstruction. The resulting median reconstruction error using the GPMM was lower (0.35 ± 0.16 mm) compared to the mirroring method (0.52 ± 0.18 mm). In addition, the GPMM-based reconstruction is automated and can be applied to large bilateral defects with a median reconstruction error of 0.39 ± 0.11 mm.

CONCLUSION: The GPMM-based reconstruction proves to be less time-consuming and more accurate than reconstruction by mirroring. Further validation through clinical studies on patients with orbital defects is warranted. Nevertheless, the results underscore the potential of GPMM-based reconstruction as a promising alternative for designing patient-specific implants.

PMID:38896405 | DOI:10.1007/s11548-024-03200-4

Bull Math Biol. 2024 Jun 19;86(8):93. doi: 10.1007/s11538-024-01322-z.

ABSTRACT

Virotherapy treatment is a new and promising target therapy that selectively attacks cancer cells without harming normal cells. Mathematical models of oncolytic viruses have shown predator-prey like oscillatory patterns as result of an underlying Hopf bifurcation. In a spatial context, these oscillations can lead to different spatio-temporal phenomena such as hollow-ring patterns, target patterns, and dispersed patterns. In this paper we continue the systematic analysis of these spatial oscillations and discuss their relevance in the clinical context. We consider a bifurcation analysis of a spatially explicit reaction-diffusion model to find the above mentioned spatio-temporal virus infection patterns. The desired pattern for tumor eradication is the hollow ring pattern and we find exact conditions for its occurrence. Moreover, we derive the minimal speed of travelling invasion waves for the cancer and for the oncolytic virus. Our numerical simulations in 2-D reveal complex spatial interactions of the virus infection and a new phenomenon of a periodic peak splitting. An effect that we cannot explain with our current methods.

PMID:38896363 | DOI:10.1007/s11538-024-01322-z