Category: Nevin Manimala

Tob Induc Dis. 2024 Aug 6;22. doi: 10.18332/tid/190798. eCollection 2024.

ABSTRACT

INTRODUCTION: The effectiveness of nicotine replacement therapy (NRT) in critically ill patients remains uncertain, as conflicting research results have been reported. Despite potential side effects and inconsistent data on safety and efficacy, NRT is still prescribed in intensive care units (ICUs) to prevent withdrawal symptoms and manage agitation in patients who are smokers. This meta-analysis aimed to assess the effectiveness of nicotine replacement therapy in critically ill smoking patients.

METHODS: A systematic review and meta-analysis of randomized controlled trials investigated the outcomes of smokers admitted to ICUs and were randomized either to receive or not receive nicotine replacement therapy (NRT) during their ICU stay. The MEDLINE and Embase databases were searched from inception through 13 February 2023 using OVID. The primary outcome was ICU length of stay (LOS) for this systematic review and meta-analysis. Meta-analysis was conducted using both random-effects and fixed-effect models; the latter is recommended when meta-analysis is restricted to just a few studies. The study was registered in the Prospective International Register of Systematic Reviews (PROSPERO) under reference number CRD42023407804.

RESULTS: Of 28 studies initially identified, three, with 67 patients on NRT and 72 controls, were deemed eligible for pooled analysis. Patients who received NRT experienced a shorter LOS (mean difference, MD= -3.06; 95% CI: -5.88 – -0.25, p=0.0, I²=0%). The mechanical ventilation (MV) duration was also shorter in the NRT group, but this difference was not statistically significant (MD= -1.24; 95% CI: -3.21-0.72, p=0.22, I²=12.69%). Delirium duration was reported by two studies, from which pooled analysis revealed an MD of -0.50 (95% CI: -1.63-0.62, I²=0%). The vasopressor duration was assessed in two studies, and the overall MD for vasopressor duration was not statistically different between NRT patients and controls in the fixed-effects model (MD=0.11; 95% CI: -0.75-0.96, I²=0%).

CONCLUSIONS: Critically ill smoker patients who received NRT experienced a significantly shorter ICU LOS but no significant differences in the durations of MV, vasopressor use, or delirium.

PMID:39109253 | PMC:PMC11302334 | DOI:10.18332/tid/190798

Front Pain Res (Lausanne). 2024 Jul 23;5:1444401. doi: 10.3389/fpain.2024.1444401. eCollection 2024.

ABSTRACT

INTRODUCTION: Chronic back pain is one of the most prevalent conditions and has a large socio-economic impact. The lack of routine use of non-pharmacological options and issues associated with pharmacological treatments underscore high unmet needs in the treatment of back pain. Although blue light phototherapy has proven efficacy in dermatology, limited information is available about its use in back pain.

METHODS: In this proof-of-concept, randomized controlled trial, a pain relief patch (PRP) delivered blue light at the site of back pain for 30 min during five treatment sessions. The comparator device delivered green light for 5 s but was worn for 30 min. A follow-up visit took place after the last treatment. The primary objective was to demonstrate the superiority of treatment by PRP, compared to the control device, in reducing pain intensity at the end of the treatment period. The post-treatment visual analog scale (VAS) pain intensity score for each group was calculated across the five treatment sessions and compared to the baseline. Secondary objectives included the disability score (Roland-Morris Disability Questionnaire) and safety.

RESULTS: The full analysis set included 171 patients. A statistically significant reduction in pain intensity occurred after the use of PRP (p < 0.02), but the study did not meet its primary objective of a superiority trial aimed at demonstrating a 0.6 cm difference in favor of PRP on the VAS scale. There was no significant change in the disability scores. Subgroup analyses were performed to identify the treatment response by patient characteristics such as pain intensity at baseline and skin type. As expected, safety data showed erythema and skin discoloration in the PRP group but not in the control group.

DISCUSSION/CONCLUSION: This trial had multiple limitations that need to be addressed in future research. Although the primary objective was not achieved, this proof-of-concept study provides important efficacy and safety data in relation to the use of blue light in the treatment of chronic back pain and key insights that may support further research on similar devices.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, identifier NCT01528332.

PMID:39109241 | PMC:PMC11300367 | DOI:10.3389/fpain.2024.1444401

Food Waterborne Parasitol. 2024 Jul 11;36:e00235. doi: 10.1016/j.fawpar.2024.e00235. eCollection 2024 Sep.

ABSTRACT

This review analyzed reported data of Cryptosporidium prevalence in camels and the species/genotype distribution. Four databases (PubMed, Web of Science, Scopus, Google Scholar) were screened, and studies published by April 1, 2024, were included. Total estimates and 95% CIs were calculated using a random-effects model. The weighted prevalence of Cryptosporidium spp. in 7372 camels examined from 12 different countries was estimated at 13.8% with a 95% CI of 10.3-18.4%. The sensitivity analysis based on excluding the individual studies did not result in significant statistical changes in the final weighted prevalence. Subgroup prevalence of Cryptosporidium spp. in camels was analyzed by publication year, continent, WHO region, country, camel type, sample size, diagnostic method, age, and gender. A significant publication bias (P < 0.05) was reported in the present study. Limitations encountered in this study encompassed: insufficient study diversity, reliance on single study results, inadequate molecular and serological studies in comparison to microscopic studies, etc., all of which could impact the findings. The study identified eight Cryptosporidium spp. in camels: C. parvum, C. andersoni, C. bovis, C. muris, C. ratti, C. occultus, C. ubiquitum, and C. hominis. The first three species had pooled prevalence rates of 65.5%, 66%, and 19.2%, respectively. Each of the remaining five species was documented using a single dataset/study. Moreover, genotypes IIdA19G1, IIaA15G1R1, If-like-A15G2, IIdA15G1, IIaA15G2R1, IIaA17G2R1, and IIaA18G2R1 (C. parvum), genotype IV (C. ratti), genotype XIIa (C. ubiquitum), and genotype IkA19G1 (C. hominis) have been identified in camels globally. The findings suggest that camels can act as a source of infection for a variety of Cryptosporidium species/genotypes, and can therefore play a key role in disseminating this protozoan to humans and animals.

PMID:39109171 | PMC:PMC11298603 | DOI:10.1016/j.fawpar.2024.e00235

Inj Prev. 2024 Aug 6:ip-2023-045191. doi: 10.1136/ip-2023-045191. Online ahead of print.

ABSTRACT

INTRODUCTION: Household energy transitions have the potential to reduce the burden of several health outcomes but have narrowly focused on those mediated by reduced exposure to air pollution, despite concerns about the burden of injury outcomes. Here, we aimed to describe the country-level incidence of severe cooking-related burns in Ghana and identify household-level risk factors for adults and children.

METHODS: We conducted a national household energy use survey including 7389 households across 370 enumeration areas in Ghana in 2020. In each household, a pretested version of the Clean Cooking Alliance Burns Surveillance Module was administered to the primary cook. We computed incidence rates of severe cooking-related burns and conducted bivariate logistic regression to identify potential risk factors.

RESULTS: We documented 129 severe cooking-related burns that had occurred in the previous year. The incidence rate (95% CI) of cooking-related burns among working-age females was 17 (13 to 21) per 1000 person-years or 8.5 times higher than that of working-age males. Among adults, the odds of experiencing a cooking-related burn were 2.29 (95% CI 1.02 to 5.14) and 2.40 (95% CI 1.04 to 5.55) times higher among primary wood and charcoal users respectively compared with primary liquified petroleum gas users. No child burns were documented in households where liquified petroleum gas was primarily used.

CONCLUSION: Using a nationally representative sample, we found that solid fuel use doubled the odds of cooking-related burns compared with liquified petroleum gas. Ghana’s efforts to expand access to liquified petroleum gas should focus on safe use.

PMID:39107102 | DOI:10.1136/ip-2023-045191

J Am Assoc Lab Anim Sci. 2024 Aug 6. doi: 10.30802/AALAS-JAALAS-24-047. Online ahead of print.

ABSTRACT

Swine are widely used models in biomedical research due to their physiologic and anatomic similarities to humans. During transport from vendors to research facilities, pigs are subject to a number of stressors, including environmental, social, and stress as a result of deprivation from food and water. As stress can have a number of adverse psychologic and physiologic effects, an acclimation period, defined as the period of time that an animal has to adjust and stabilize in a new environment, is recommended. The literature indicates that swine should be conditioned to their new facility for 5 to 7 d prior to undergoing survival surgery; however, to date, there is no published scientific evidence to support this or any specific acclimation period for swine. To investigate whether a certain length acclimation period leads to decreased stress in swine, we measured 2 stress biomarkers, cortisol and chromogranin A (CgA), from the saliva of 12 naive Yorkshire swine (n = 6 males and 6 females) arriving at our facility for use in research protocols. Noninvasive saliva collection was performed on days 1, 3, 5, 7, 10, and 14 after arrival from the vendor (representing different acclimation periods). We hypothesized that longer acclimation periods would result in reduced levels of both cortisol and CgA, indicating reduced stress. Our data revealed that there was no statistical difference in cortisol levels over time (P = 0.8200), nor between the sexes (P = 0.9886) or individual animals (P = 0.6280). CgA, similarly to cortisol, showed no overall effect of time (P = 0.2017) or sex (P = 0.6598). For this analyte, individual animal was significant (P < 0.0001), which suggests high interanimal variation. Furthermore, there was a significant decrease (P = 0.0077) in salivary CgA from day 1 compared with day 14, suggesting that swine may benefit from an acclimation period of at least 14 d.

PMID:39107079 | DOI:10.30802/AALAS-JAALAS-24-047

BMJ Open Diabetes Res Care. 2024 Aug 6;12(4):e003841. doi: 10.1136/bmjdrc-2023-003841.

ABSTRACT

INTRODUCTION: The objective of this study was to determine the burden of influenza disease in patients with or without diabetes in a population of American adults to understand the benefits of seasonal vaccination.

RESEARCH DESIGN AND METHODS: We performed a retrospective cohort study using electronic medical records totaling 1,117,263 from two Louisiana healthcare providers spanning January 2012 through December 2017. Adults 18 years or older with two or more records within the study period were included. The primary outcome quantified was influenza-related diagnosis during inpatient (IP) or emergency room (ER) visits and risk reduction with the timing of immunization.

RESULTS: Influenza-related IP or ER visits totaled 0.0122-0.0169 events per person within the 2013-2016 influenza seasons. Subjects with diabetes had a 5.6-fold more frequent influenza diagnosis for IP or ER visits than in subjects without diabetes or 3.7-fold more frequent when adjusted for demographics. Early immunization reduced the risk of influenza healthcare utilization by 66% for subjects with diabetes or 67% for subjects without diabetes when compared with later vaccination for the 2013-2016 influenza seasons. Older age and female sex were associated with a higher incidence of influenza, but not a significant change in risk reduction from vaccination.

CONCLUSIONS: The risk for influenza-related healthcare utilization was 3.7-fold higher if patients had diabetes during 2013-2016 influenza seasons. Early immunization provides a significant benefit to adults irrespective of a diabetes diagnosis. All adults, but particularly patients with diabetes, should be encouraged to get the influenza vaccine at the start of the influenza season.

PMID:39107077 | DOI:10.1136/bmjdrc-2023-003841

Life Sci Alliance. 2024 Aug 6;7(10):e202402713. doi: 10.26508/lsa.202402713. Print 2024 Oct.

ABSTRACT

Probabilistic topic modelling has become essential in many types of single-cell data analysis. Based on probabilistic topic assignments in each cell, we identify the latent representation of cellular states. A dictionary matrix, consisting of topic-specific gene frequency vectors, provides interpretable bases to be compared with known cell type-specific marker genes and other pathway annotations. However, fitting a topic model on a large number of cells would require heavy computational resources-specialized computing units, computing time and memory. Here, we present a scalable approximation method customized for single-cell RNA-seq data analysis, termed ASAP, short for Annotating a Single-cell data matrix by Approximate Pseudobulk estimation. Our approach is more accurate than existing methods but requires orders of magnitude less computing time, leaving much lower memory consumption. We also show that our approach is widely applicable for atlas-scale data analysis; our method seamlessly integrates single-cell and bulk data in joint analysis, not requiring additional preprocessing or feature selection steps.

PMID:39107066 | DOI:10.26508/lsa.202402713

BMJ Open Qual. 2024 Aug 5;13(3):e002807. doi: 10.1136/bmjoq-2024-002807.

ABSTRACT

INTRODUCTION: Sequential compression devices (SCDs) are the mainstay of mechanical prophylaxis for venous thromboembolism in perioperative neurosurgical patients and are especially crucial when chemical prophylaxis is contraindicated.

OBJECTIVES: This study aimed to characterise and improve SCD compliance in neurosurgery stepdown patients.

METHODS: SCD compliance in a neurosurgical stepdown unit was tracked across 13 months (August 2022-August 2023). When not properly functioning, the missing element was documented. Compliance was calculated daily in all patients with SCD orders, and then averaged monthly. Most common barriers to compliance were identified. With nursing, we implemented a best practice alert to facilitate nursing education at month 3 and tracked compliance over 9 months, with two breaks in surveillance. At month 12, we implemented a patient-engagement measure through creating and distributing a patient-directed infographic and tracked compliance over 2 months.

RESULTS: Compliance averaged 19.7% (n=95) during August and 38.4% (n=131) in September. After implementing the best practice alert and supply chain upgrades, compliance improved to 48.8% (n=150) in October, 41.2% (n=104) in March and 45.9% (n=76) in April. The infographic improved compliance to 51.4% (n=70) in July and 55.1% (n=34) in August. Compliance was significantly increased from baseline in August to October (z=4.5838, p<0.00001), sustained through March (z=3.2774, p=0.00104) and further improved by August (z=3.9025, p=0.0001).

CONCLUSION: Beyond an initial Hawthorne effect, implementation of the best practice nursing alert facilitated sustained improvement in SCD compliance despite breaks in surveillance. SCD compliance nonetheless remained below 50% until implementation of patient-engagement measures which were dependent on physician involvement.

PMID:39107035 | DOI:10.1136/bmjoq-2024-002807

BMJ Open. 2024 Aug 6;14(8):e084485. doi: 10.1136/bmjopen-2024-084485.

ABSTRACT

OBJECTIVES: Inappropriate prescribing of antibiotics is a key driver of antimicrobial resistance. This study aimed to describe urine sampling rates and antibiotic prescribing for patients with lower urinary tract infections (UTIs) in English general practice.

DESIGN: A retrospective population-based study using administrative data.

SETTING: IQVIA Medical Research Database (IMRD) data from general practices in England, 2015-2022.

PARTICIPANTS: Patients who have consulted with an uncomplicated UTI in England general practices captured in the IMRD.

OUTCOME MEASURES: Trends in UTI episodes (episodes were defined as UTI diagnosis codes occurring within 14 days of each other), testing and antibiotic prescribing on the same day as initial UTI consultation were assessed from January 2015 to December 2022. Associations, using univariate and multivariate logistic regressions, were examined between consultation and demographic factors on the odds of a urine test.

RESULTS: There were 743 350 UTI episodes; 50.8% had a urine test. Testing rates fluctuated with an upward trend and large decline in 2020. Same-day UTI antibiotic prescribing occurred in 78.2% of episodes. In multivariate modelling, factors found to decrease odds of a urine test included age ≥85 years (0.83, 95% CI 0.82 to 0.84), consultation type (remote vs face to face, 0.45, 95% CI 0.45 to 0.46), episodes in London compared with the South (0.74, 95% CI 0.72 to 0.75) and increasing practice size (0.77, 95% CI 0.76 to 0.78). Odds of urine tests increased in males (OR 1.11, 95% CI 1.10 to 1.13), for those episodes without a same-day UTI antibiotic (1.10, 95% CI 1.04 to 1.16) for episodes for those with higher deprivation status (Indices of Multiple Deprivation 8 vs 1, 1.51, 95% CI 1.48 to 1.54). Compared with 2015, 2016-2019 saw increased odds of testing while 2020 and 2021 saw decreases, with 2022 showing increased odds.

CONCLUSION: Urine testing for UTI in general practice in England showed an upward trend, with same-day antibiotic prescribing remaining consistent, suggesting greater alignment to national guidelines. The COVID-19 pandemic impacted testing rates, though as of 2022, they began to recover.

PMID:39107033 | DOI:10.1136/bmjopen-2024-084485

BMJ Open. 2024 Aug 6;14(8):e085758. doi: 10.1136/bmjopen-2024-085758.

ABSTRACT

BACKGROUND: The 2018 Nigeria Demographic and Health Survey shows poor maternal health in northern Nigeria. Contraceptive use remains low and maternal mortality high. Studies show that cultural norms related to men’s decision-making role in the family significantly contribute to this phenomenon.

OBJECTIVES: The assessment was designed to identify barriers to service delivery and utilisation of maternal-health and family-planning services in three northern Nigerian states, focusing on aspects of service delivery affected by husband involvement.

DESIGN: Qualitative design included 16 focus group discussions and 12 in-depth interviews with facility clients, and 16 in-depth interviews with healthcare providers, in each of the three states.

SETTING: Primary healthcare facilities in three northern Nigeria states: Bauchi, Kebbi and Sokoto.

PARTICIPANTS: Women who came to the facility for family-planning services (n=233 in 24 focus groups); women who came for antenatal care (n=97 in 12 focus groups); men married to women who either received antenatal care or delivered in a facility (n=96 in 12 focus groups); mothers of newborns who delivered in a facility (n=36) and healthcare providers (n=48).

RESULTS: We found gender barriers to contraceptive use and to obtaining maternal healthcare, with some women requiring their husband’s permission to use services, even in emergencies. Several supply-side barriers exacerbate the situation. Many healthcare providers would not provide women with a family-planning method without their husbands’ presence or approval; some male providers would not admit a woman to deliver in a facility if her husband objected to her being treated by a man and there was no female provider present and some facilities do not have the infrastructure to accommodate men.

CONCLUSION: Despite years of programming, barriers to women’s family-planning and maternal-health service utilisation persist. State governments in northern Nigeria should invest in additional provider training, improving infrastructure and hiring more female healthcare providers.

PMID:39107032 | DOI:10.1136/bmjopen-2024-085758