Category: Nevin Manimala

PLoS One. 2023 Mar 3;18(3):e0282751. doi: 10.1371/journal.pone.0282751. eCollection 2023.

ABSTRACT

BACKGROUND: Sex differences in vascular cognitive impairment (VCI) at risk for future dementia are still debatable. Transcranial magnetic stimulation (TMS) is used to evaluate cortical excitability and the underlying transmission pathways, although a direct comparison between males and females with mild VCI is lacking.

METHODS: Sixty patients (33 females) underwent clinical, psychopathological, functional, and TMS assessment. Measures of interest consisted of: resting motor threshold, latency of motor evoked potentials (MEPs), contralateral silent period, amplitude ratio, central motor conduction time (CMCT), including the F wave technique (CMCT-F), short-interval intracortical inhibition (SICI), intracortical facilitation, and short-latency afferent inhibition, at different interstimulus intervals (ISIs).

RESULTS: Males and females were comparable for age, education, vascular burden, and neuropsychiatric symptoms. Males scored worse at global cognitive tests, executive functioning, and independence scales. MEP latency was significantly longer in males, from both sides, as well CMCT and CMCT-F from the left hemisphere; a lower SICI at ISI of 3 ms from the right hemisphere was also found. After correction for demographic and anthropometric features, the effect of sex remained statistically significant for MEP latency, bilaterally, and for CMCT-F and SICI. The presence of diabetes, MEP latency bilaterally, and both CMCT and CMCT-F from the right hemisphere inversely correlated with executive functioning, whereas TMS did not correlate with vascular burden.

CONCLUSIONS: We confirm the worse cognitive profile and functional status of males with mild VCI compared to females and first highlight sex-specific changes in intracortical and cortico-spinal excitability to multimodal TMS in this population. This points to some TMS measures as potential markers of cognitive impairment, as well as targets for new drugs and neuromodulation therapies.

PMID:36867595 | DOI:10.1371/journal.pone.0282751

Prehosp Emerg Care. 2023 Mar 3:1-10. doi: 10.1080/10903127.2023.2187103. Online ahead of print.

ABSTRACT

Position StatementEmergency medical services (EMS), similar to all aspects of health care systems, can play a vital role in examining and reducing health disparities through educational, operational, and quality improvement interventions. Public health statistics and existing research highlight that patients of certain socioeconomic status, gender identity, sexual orientation, and race/ethnicity are disproportionately affected with respect to morbidity and mortality for acute medical conditions and multiple disease processes, leading to health disparities and inequities. With regard to care delivery by EMS, research demonstrates that the current attributes of EMS systems may further contribute to these inequities, such as documented health disparities existing in EMS patient care management, and access along with EMS workforce composition not being representative of the communities served influencing implicit bias. EMS clinicians need to understand the definitions, historical context, and circumstances surrounding health disparities, health care inequities, and social determinants of health in order to reduce health care disparities and promote care equity. This position statement focuses on systemic racism and health disparities in EMS patient care and systems by providing multifaceted next steps and priorities to address these disparities and workforce development. NAEMSP believes that EMS systems should:Adopt a multifactorial approach to workforce diversity implemented at all levels within EMS agencies.Hire more diverse workforce by intentionally recruiting from marginalized communitiesIncrease EMS career pathway and mentorship programs within underrepresented minorities (URM) communities and URM-predominant schools starting at a young age to promote EMS as an achievable profession.Examine policies that promote systemic racism and revise policies, procedures, and rules to promote a diverse, inclusive, and equitable environment.Involve EMS clinicians in community engagement and outreach activities to promote health literacy, trustworthiness, and education.Require EMS advisory boards whose composition reflects the communities they serve and regularly audit membership to ensure inclusion.Increase knowledge and self-awareness of implicit/unconscious bias and acts of microaggression through established educational and training programs (i.e., anti- racism, upstander, and allyship) such that individuals recognize and mitigate their own biases and can act as allies.Redesign structure, content, and classroom materials within EMS clinician training programs to enhance cultural sensitivity, humility, and competency and to meet career development, career planning, and mentoring needs, particularly of URM EMS clinicians and trainees.Discuss cultural views that affect health care and medical treatment and the effects of social determinants of health on care access and outcomes during all aspects of training.Design research and quality improvement initiatives related to health disparities in EMS that are focused on racial/ethnic and gender inequities and include URM community leaders as essential stakeholders involved in all stages of research development and implementation.

PMID:36867425 | DOI:10.1080/10903127.2023.2187103

Drugs. 2023 Mar 3. doi: 10.1007/s40265-023-01842-3. Online ahead of print.

ABSTRACT

BACKGROUND: Many clinical trials have reported that low-dose aspirin decreases the risk of pre-eclampsia in women with prior pre-eclampsia. However, its impact in a real-world population has not been fully assessed.

OBJECTIVES: To assess the rates of low-dose aspirin initiation during pregnancy in women with a history of pre-eclampsia, and to evaluate the impact of low-dose aspirin in prevention of pre-eclampsia recurrence in a real-world population.

STUDY DESIGN: CONCEPTION is a French nationwide cohort study which uses data from the country’s National Health Data System database. We included all women in France who gave birth at least twice between 2010-2018, and who had pre-eclampsia during their first pregnancy. Every dispensing of low-dose aspirin (75-300 mg) between the beginning of their second pregnancy and 36 weeks of gestation (WG) was identified. We used Poisson regression models to estimate the adjusted incidence rate ratios (aIRRs) of receiving aspirin at least once during their second pregnancy. In women who had early and/or severe pre-eclampsia during their first pregnancy, we estimated the IRRs of pre-eclampsia recurrence during their second pregnancy according to the aspirin therapy.

RESULTS: In 28,467 women who were included in the study, the aspirin initiation rate during the second pregnancy ranged from 27.8% for women in whose first pregnancy the pre-eclampsia was mild and late, to 79.9% for those women whose pre-eclampsia was severe and early. Just over half (54.3%) of those treated with aspirin-initiated treatment before 16 WG and adhered to treatment. Compared with women with mild and late pre-eclampsia, the aIRRs (95% CI) for receiving aspirin at least once during the second pregnancy were 1.94 (1.86-2.03) for women with severe and late pre-eclampsia, 2.34 (2.17-2.52) for those with early and mild pre-eclampsia, and 2.87 [2.74-3.01] for those with early and severe pre-eclampsia E. Social deprivation was associated with a lower initiation of aspirin (IRR = 0.74 [0.70-0.78]). Aspirin was not associated with a lower risk of mild and late pre-eclampsia, severe and late pre-eclampsia, or mild and early pre-eclampsia during the second pregnancy. The aIRRs for severe and early pre-eclampsia during the second pregnancy were 0.77 (0.62-0.95) for women who received prescribed aspirin at least once, 0.71 (0.5-0.89) for those who initiated aspirin therapy before 16 WG, and 0.60 (0.47-0.77) for those who adhered to aspirin treatment throughout their second pregnancy. The risk of severe and early pre-eclampsia was lower only when the prescribed mean daily dose was ≥ 100 mg/day.

CONCLUSION: In women with a history of pre-eclampsia, aspirin initiation during a second pregnancy and adherence to the prescribed dosage were largely insufficient, especially for women experiencing social deprivation. Aspirin initiated before 16 WG at a dose ≥ 100 mg/day was associated with a lower risk of severe and early pre-eclampsia.

PMID:36867398 | DOI:10.1007/s40265-023-01842-3

Am J Cardiovasc Drugs. 2023 Mar 3. doi: 10.1007/s40256-023-00574-9. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of antithrombotic regimens and their combinations in preventing thrombotic incidents in patients with stable atherosclerotic cardiovascular disease (S-ASCVD).

METHODS: A systematic literature search was conducted in the PubMed, Embase, Cochrane Library, Scopus, and Google Scholar databases. The primary comprehensive endpoint was a major adverse cardiovascular event (MACE) composite of cardiovascular death, stroke, or myocardial infarction, while the secondary endpoints were cardiovascular death, all-cause stroke, ischemic stroke, myocardial infarction, and all-cause death. The safety endpoint was major bleeding. Bayesian network meta-regression analysis in R software was used to calculate the final effect size and to correct for the effect of follow-up time on the outcome effect size.

RESULTS: Twelve studies reporting 122,190 patients with eight antithrombotic regimens were included in this systematic review. For the primary composite endpoint, low-dose aspirin plus clopidogrel 75 mg (hazard ratio [HR] 0.53, 95% confidence interval [CI] 0.33-0.87) and low-dose aspirin plus rivaroxaban 2.5 mg twice daily (HR 0.53, 95% CI 0.34-0.82) showed significantly better efficacy than clopidogrel monotherapy, and the efficacy was comparable among the first two regimens. Unfortunately, none of the active regimens significantly decreased all-cause death, cardiovascular death branch, and all-cause stroke as part of the secondary endpoints. Low-dose aspirin plus ticagrelor 90 mg twice daily (HR 0.81, 95% CI 0.69-0.94) and low-dose aspirin plus ticagrelor 60 mg twice daily (HR 0.84, 95% CI 0.74-0.95) had a significant advantage in myocardial infarction compared with low-dose aspirin monotherapy, while low-dose aspirin plus 2.5 mg rivaroxaban twice daily (HR 0.62, 95% CI 0.41-0.94) was better than low-dose aspirin in the treatment of ischemic stroke. In the major bleeding branch, low-dose aspirin plus ticagrelor 90 mg twice daily (HR 2.2, 95% CI 1.70-2.90), low-dose aspirin plus ticagrelor 60 mg twice daily (HR 2.1, 95% CI 1.70-2.60), low-dose aspirin plus rivaroxaban 2.5 mg twice daily (HR 1.7, 95% CI 1.30-2.00), and rivaroxaban 5 mg twice daily (HR 1.5, 95% CI 1.20-1.90) showed higher major bleeding risk compared with low-dose aspirin.

CONCLUSIONS: Considering MACEs, myocardial infarction, all kinds of stroke, ischemic stroke, and major bleeding, low-dose aspirin plus rivaroxaban 2.5 mg twice daily should be considered the preferred regimen for S-ASCVD patients with low bleeding risk.

PMID:36867384 | DOI:10.1007/s40256-023-00574-9

Environ Sci Pollut Res Int. 2023 Mar 3. doi: 10.1007/s11356-023-25742-x. Online ahead of print.

ABSTRACT

The construction of supplier transaction is one of the strategic choices of many firms. However, the impact of business strategies on the persistence of earnings remains to be further investigated. The innovation of this paper lies in interpreting the impact of supplier transaction on earnings persistence from the perspective of characteristics of the top management team (TMT). We consider Chinese listed manufacturing firms from 2012 to 2019 to examine the relationship between the supplier transaction and the persistence of earnings. Statistical results show that supplier transaction characteristics of the TMT have a significant moderating effect on the relationship between the supplier transaction and the persistence of earnings. This implies that the behavior of TMT can be vital to the firm in maintaining sustainable performance. The higher age level or longer average tenure of TMT can significantly improve the positive effect of the supplier transaction tenure heterogeneity of TMT that will significantly improve the negative effect. This paper expands the literature on supplier relationship, and corporate earnings from a new perspective that improves the empirical evidence of the upper echelons theory, and also provides evidence support for the construction of supplier relationship and TMT.

PMID:36867336 | DOI:10.1007/s11356-023-25742-x

Adv Ther. 2023 Mar 3. doi: 10.1007/s12325-023-02437-w. Online ahead of print.

ABSTRACT

INTRODUCTION: For patients with generalized myasthenia gravis (gMG), the association between symptom severity, often measured with the Myasthenia Gravis Activities of Daily Living (MG-ADL) instrument, and utility values is unknown.

METHODS: Data was analyzed from the phase 3 ADAPT trial, which included adult patients with gMG randomly assigned to treatment with efgartigimod + conventional therapy (EFG + CT) or placebo + CT (PBO + CT). MG-ADL total symptom scores and the EQ-5D-5L, a measure of health-related quality of life (HRQoL), were collected biweekly up to 26 weeks. Utility values were derived from the EQ-5D-5L data with the United Kingdom value set. Descriptive statistics were reported for MG-ADL and EQ-5D-5L at baseline and follow-up. A normal identity-link regression model estimated the association between utility and the eight MG-ADL items. A generalized estimating equations (GEE) model was estimated to predict utility based on the patient’s MG-ADL score and treatment received.

RESULTS: A total of 167 patients (84 EFG + CT, 83 PBO + CT) contributed 167 baseline and 2867 follow-up measurements of MG-ADL and EQ-5D-5L. EFG + CT-treated patients experienced more improvements than PBO + CT-treated patients in most MG-ADL items and EQ-5D-5L dimensions, with the largest improvements observed in chewing, brushing teeth/combing hair, eyelid droop (MG-ADL); self-care, usual activities, mobility (EQ-5D-5L). The regression model indicated that individual MG-ADL items contributed differently to utility values, with the largest impact from brushing teeth/combing hair, rising from a chair, chewing, and breathing. The GEE model showed that each unit improvement in MG-ADL led to a statistically significant utility increase of 0.0233 (p < 0.001). In addition, a statistically significant improvement of 0.0598 (p = 0.0079) in utility was found for patients in the EFG + CT group compared to the PBO + CT group.

CONCLUSION: Among patients with gMG, improvements in MG-ADL were significantly associated with higher utility values. MG-ADL scores alone were not sufficient to capture the utility gained from efgartigimod therapy.

PMID:36867327 | DOI:10.1007/s12325-023-02437-w

J Robot Surg. 2023 Mar 3. doi: 10.1007/s11701-023-01548-4. Online ahead of print.

ABSTRACT

Penile shortening is a recognized but neglected side effect of prostate cancer treatment. In this study we explore the effect of maximal urethral length preservation (MULP) technique on penile length preservation after robot assisted laparoscopic prostatectomy (RALP). In an IRB approved study, we prospectively evaluated the stretched flaccid penile length (SFPL) pre and post RALP in subjects with a diagnosis of prostate cancer. The multiparametric MRI (MP-MRI) was utilized for surgical planning if available preoperatively. Repeated measures t-test, linear regression and 2-way ANOVA analyses were performed. A total of 35 subjects underwent RALP. Mean age was 65.8 yr (SD: 5.9), preoperative SFPL was 15.57 cm (SD: 1.66) and postoperative SFPL was 15.41 cm (SD: 1.61) p = 0.68. No change in the postoperative SFPL was recorded among 27 subjects (77.1%) while 5 subjects (14.3%) had 0.5 cm shortening, and 3 subjects (8.6%) had 1 cm shortening. Pathologic stage, preoperative MP-MRI and body mass index (BMI) were significant predictors of postoperative SFPL on linear regression analysis, p = 0.001. Among 26 subjects with pathologic stage 2 disease, no statistical difference was seen in repeated measures t-test between pre and postoperative SFPL, 15.36 vs 15.3 cm, p = 0.08. All subjects were continent by 6 months postoperatively, with no complications. We demonstrate that incorporating MULP technique and preoperative MP-MRI preserves SFPL in subjects undergoing a RALP.

PMID:36867324 | DOI:10.1007/s11701-023-01548-4

Oral Radiol. 2023 Mar 3. doi: 10.1007/s11282-023-00675-w. Online ahead of print.

ABSTRACT

OBJECTIVES: Assess knowledge, attitudes and practices of paediatric dentists towards dentomaxillofacial imaging and correlate findings with practitioner and practice-specific characteristics.

METHODS: An online questionnaire was sent to all paediatric dentists who attended a scientific seminar organized by the European Academy of Paediatric Dentistry (EAPD) regarding dental radiology. Data regarding available equipment, number, type and reason for performing radiographs, frequency and reasoning for retakes were collected. Data analysis was performed according to practitioner- and practice-specific characteristics and factors directly associated with the type and frequency of radiographs taken, and reason and frequency of repeats were determined. Significant differences were tested using Chi-square and Fisher’s exact test. Statistical significance was set at p < 0.05.

RESULTS: More than half of the participants (58%) reported having digital radiographic equipment and almost 1/4 (23%) conventional. A panoramic equipment was available in 39% working places and a CBCT scanner in 41%. Two thirds of the participants reported taking up to 10 intra-oral radiographs per week, mainly for trauma (75%) and caries diagnosis (47%). Extra-oral radiographs were prescribed to monitor development (75%) and for orthodontic evaluation, (63%) with a frequency of less than 5 weekly (45%). Participants reported that they repeat radiographs in a frequency of < 5 per week (70%) mainly due to patient’s movement (55%).

CONCLUSIONS: The majority of paediatric dentists within Europe use digital imaging equipment for both intra- and extra-oral radiographs. Nevertheless, great variation in practices exists and, therefore, continuous education in oral imaging is crucial to maintain high quality standards for the radiographic examination of patients.

PMID:36867317 | DOI:10.1007/s11282-023-00675-w

Sleep Breath. 2023 Mar 3. doi: 10.1007/s11325-023-02799-z. Online ahead of print.

ABSTRACT

STUDY OBJECTIVES: This study aimed to investigate the effects of continuous positive airway pressure (CPAP) and mandibular advancement appliance (MAA) therapy on rhythmic masticatory muscle activity (RMMA), a biomarker of sleep bruxism (SB), and to compare the effects of CPAP with MAA in adults with obstructive sleep apnea (OSA).

METHODS: This cohort study included individuals with OSA who received treatment with CPAP or MAA. Polysomnographic recordings with and without therapy were performed in each individual. Statistical analyses were performed with repeated measures ANOVA.

RESULTS: A total of 38 individuals with OSA were enrolled, 13 on CPAP and 25 with MAA, mean age 52.6 ± 10.6 years, 32 men, mean baseline apnea-hypopnea index (AHI) 26.5 ± 15.2 events/hour, mean RMMA index 3.5 ±events/hour. In the total group, the RMMA index decreased significantly with CPAP and MAA therapies (P < 0.05). The changes in the RMMA index with therapy did not differ significantly between CPAP and MAA (P > 0.05). The RMMA index decreased in 60% of the individuals with OSA, and the changes ranged widely, with a median of 52% and an interquartile range of 107%.

CONCLUSIONS: Both CPAP and MAA therapies significantly reduce SB in individuals with OSA. However, the interindividual differences in the effects of these therapies on SB are large.

CLINICAL TRIAL REGISTRATION: https://trialsearch.who.int (NL8516); April 08, 2020.

PMID:36867294 | DOI:10.1007/s11325-023-02799-z

Biomech Model Mechanobiol. 2023 Mar 3. doi: 10.1007/s10237-023-01698-2. Online ahead of print.

ABSTRACT

Within this work, we investigate how physiologically observed microstructural changes induced by myocardial infarction impact the elastic parameters of the heart. We use the LMRP model for poroelastic composites (Miller and Penta in Contin Mech Thermodyn 32:1533-1557, 2020) to describe the microstructure of the myocardium and investigate microstructural changes such as loss of myocyte volume and increased matrix fibrosis as well as increased myocyte volume fraction in the areas surrounding the infarct. We also consider a 3D framework to model the myocardium microstructure with the addition of the intercalated disks, which provide the connections between adjacent myocytes. The results of our simulations agree with the physiological observations that can be made post-infarction. That is, the infarcted heart is much stiffer than the healthy heart but with reperfusion of the tissue it begins to soften. We also observe that with the increase in myocyte volume of the non-damaged myocytes the myocardium also begins to soften. With a measurable stiffness parameter the results of our model simulations could predict the range of porosity (reperfusion) that could help return the heart to the healthy stiffness. It would also be possible to predict the volume of the myocytes in the area surrounding the infarct from the overall stiffness measurements.

PMID:36867283 | DOI:10.1007/s10237-023-01698-2