Category: Nevin Manimala

BJUI Compass. 2024 May 30;5(7):668-674. doi: 10.1002/bco2.372. eCollection 2024 Jul.

ABSTRACT

OBJECTIVES: The observational ‘Feeling Hot’ study aims to evaluate the feasibility of employing overnight penile temperature measurements for the detection of nocturnal erections, thereby contributing to the advancement and modernization of a non-invasive diagnostic system for erectile dysfunction.

SUBJECTS/PATIENTS AND METHODS: In this proof-of-concept study, 10 healthy men aged 20-25 were recruited, following the methodology outlined in the ‘Staying Hot’ study by Torenvlied et al. Participants underwent ambulatory overnight penile temperature measurements concurrent with RigiScan recordings. Key outcome measures included baseline and peak penile temperatures during RigiScan-annotated nocturnal erections. Reference measurements of the thigh temperature were also taken to assess nocturnal temperature variations.

RESULTS: Statistically significant penile temperature increases (p = 0.008, n = 9) were observed during nocturnal erections, with an average elevation of 1.47°C noted during the initial erections. This underscores the practical utility of penile temperature measurements in detecting erection onset. Challenges arose in accurately determining erection duration and subsequent erection onsets due to the persistence of elevated temperatures following initial erections, termed the ‘Staying Hot effect’. Reference thigh temperature measurements aided in addressing this challenge.

CONCLUSION: Examining overnight penile temperature alongside simultaneous RigiScan recordings has yielded valuable insights into the viability of using the temperature methodology for detecting nocturnal erections. The ‘Feeling Hot’ study findings demonstrate significant penile temperature elevation during nocturnal erections in healthy young men, highlighting the potential of integrating this measurement methodology into the design of a modernized tool for ambulatory erectile dysfunction diagnostics. Further development of an advanced sensor system to comprehensively assess erection duration and quality is essential for enhancing clinical applicability.

PMID:39022661 | PMC:PMC11249801 | DOI:10.1002/bco2.372

BJUI Compass. 2024 May 24;5(7):681-690. doi: 10.1002/bco2.391. eCollection 2024 Jul.

ABSTRACT

BACKGROUND: Urethrocutaneous fistula (UCF) is one of the major complications of circumcision. The risk factors associated with UCF are not clear-cut but its repair remains a challenge for urological surgeons. The aim of this study was to highlight the epidemiological, and clinical features and outcomes obtained from the management of UCF in the context of a country with limited medical resources where ritual circumcision is widely practiced.

PATIENTS AND METHODS: From February 2010 to December 2022, 35 patients underwent surgical repair for post-circumcision UCF in two tertiary hospitals in Yaounde, Cameroon. Simple closure, Thiersch-Duplay-Snodgrass and Mathieu techniques were performed.

RESULTS: The mean age of patients was 7.4 ± 4.1 years with a range of 2 to 21 years; the median age at circumcision was 24 months (12; 48). Most (95%) of circumcisions were performed by paramedical staff. The majority of patients (n = 26) consulted for a bifid stream, Three-quarters of fistulae were located at the corona. Small fistulae represented 74.28% (n = 26) of cases as opposed to large fistulae (25.71%). More than 70% of patients underwent a simple closure. The therapeutic results were satisfactory in 91.4% of cases (n = 32) after an average follow-up of 91.85 ± 51.92 months. There were no statistically significant differences between the patients with coronal fistula and patients with distal penile fistula concerning demographic, clinical and surgical characteristics.

CONCLUSION: Urethrocutaneous fistula is a major and frequent complication of circumcision mostly practiced by non-qualified personnel on children aged 24 months. The usual presentation is micturition with a bifid stream occurring on average 3 months after circumcision. Coronal fistulas are the commoner location. Simple closure, Thiersch-Duplay-Snodgrass and Mathieu technique appear to be safe with the advantages of low recurrence rate. An accurate diagnosis with a timeframe respecting the principles of fistula surgery combined with regular follow-up is mandatory for good long-term results with a low recurrence rate. Further prospective studies on the factors affecting the formation of urethrocutaneous fistula should be performed to prevent this complication of circumcision.

PMID:39022657 | PMC:PMC11250727 | DOI:10.1002/bco2.391

Neurooncol Adv. 2024 Jun 28;6(1):vdae112. doi: 10.1093/noajnl/vdae112. eCollection 2024 Jan-Dec.

ABSTRACT

BACKGROUND: The purpose of this study was to elucidate the relationship between distinct brain regions and molecular subtypes in glioblastoma (GB), focusing on integrating modern statistical tools and molecular profiling to better understand the heterogeneity of Isocitrate Dehydrogenase wild-type (IDH-wt) gliomas.

METHODS: This retrospective study comprised 441 patients diagnosed with new IDH-wt glioma between 2009 and 2020 at Heidelberg University Hospital. The diagnostic process included preoperative magnetic resonance imaging and molecular characterization, encompassing IDH-status determination and subclassification, through DNA-methylation profiling. To discern and map distinct brain regions associated with specific methylation subtypes, a support-vector regression-based lesion-symptom mapping (SVR-LSM) was employed. Lesion maps were adjusted to 2 mm³ resolution. Significance was assessed with beta maps, using a threshold of P < .005, with 10 000 permutations and a cluster size minimum of 100 voxels.

RESULTS: Of 441 initially screened glioma patients, 423 (95.9%) met the inclusion criteria. Following DNA-methylation profiling, patients were classified into RTK II (40.7%), MES (33.8%), RTK I (18%), and other methylation subclasses (7.6%). Between molecular subtypes, there was no difference in tumor volume. Using SVR-LSM, distinct brain regions correlated with each subclass were identified: MES subtypes were associated with left-hemispheric regions involving the superior temporal gyrus and insula cortex, RTK I with right frontal regions, and RTK II with 3 clusters in the left hemisphere.

CONCLUSIONS: This study linked molecular diversity and spatial features in glioblastomas using SVR-LSM. Future studies should validate these findings in larger, independent cohorts to confirm the observed patterns.

PMID:39022646 | PMC:PMC11253205 | DOI:10.1093/noajnl/vdae112

Front Sports Act Living. 2024 Jul 3;6:1372979. doi: 10.3389/fspor.2024.1372979. eCollection 2024.

ABSTRACT

Mobile gaming poses significant health risks, such as musculoskeletal (MSK) and eye problems, as players maintain the same posture for long periods. The objective of the current study is to describe the prevalence and assess the association of musculoskeletal and eye problems among professional gamers (PG) and casual gamers (CG) with their physical activity level and physical fitness. A total of 94 mobile-gaming athletes (43 PG, 51 CG) were prospectively recruited in this study. Descriptive analysis was performed for BMIs, fatigue scores, musculoskeletal problems profile, and eye problems profile. The associations between physical activity level, BMI, grip strength, flexibility, and MSK injury were tested with a Chi-square test. A total of 65.96% of the players experienced MSK complaints, with the shoulder (26.2%), neck (25.4%), and hand (21.3%) being the top three affected regions. This study also found ocular issues among the players, with eye fatigue (n = 50) as the most frequent complaint. Differential outcomes were observed between the PG and CG groups regarding physical activity (p = 0.001) and flexibility (p = 0.02). Conversely, no statistically significant variances were detected between the PG and CG concerning musculoskeletal (MSK) disorder indicators (p = 1.000), body mass index (BMI) (p = 0.132), body fat (BF) percentage (p = 0.317), grip strength (p = 0.006 for the right side, p = 0.116 for the left side), or waist circumference (p = 0.680). Furthermore, a significant association was observed between physical activity and BMI (p = 0.029). Study results showed that two-thirds of players experienced MSK injury, with the most common complaints being neck, shoulder, hand, and wrist pain. All participants reported at least one eye problem, with the majority reporting multiple complaints. There were significant differences observed in physical activity and flexibility between the PG and CG groups; however, no correlation was found between musculoskeletal injury incidence and the players’ physical fitness variables. This lack of correlation may be attributed to the relatively short career span of gamers.

PMID:39022640 | PMC:PMC11251960 | DOI:10.3389/fspor.2024.1372979

BMJ Open Gastroenterol. 2024 Jul 17;11(1):e001404. doi: 10.1136/bmjgast-2024-001404.

ABSTRACT

OBJECTIVE: We aimed to determine the association of statins with progression to a high risk for advanced fibrosis in primary care patients with metabolic dysfunction-associated steatotic liver disease (MASLD).

DESIGN: This retrospective cohort study of electronic health record data included patients with MASLD and an initial low or indeterminate risk for advanced fibrosis, determined by Fibrosis-4 Index (FIB-4) score (<2.67). Patients were followed from the index FIB-4 until the primary outcome of a high-risk FIB-4 (≥2.67) or the end of the study period. Prescription for a statin during follow-up was the primary exposure. We developed Cox regression models for the time to a high-risk FIB-4 score with statin therapy as the primary covariate and adjusting for baseline fibrosis risk, demographic and comorbidity variables.

RESULTS: The cohort of 1238 patients with MASLD was followed for a mean of 3.3 years, with 47% of patients receiving a prescription for a statin, and 18% of patients progressing to a high-risk FIB-4. In the adjusted Cox model with statin prescription as the primary exposure, statins were associated with a lower risk (HR 0.60; 95% CI 0.45 to 0.80) of progressing to a FIB-4≥2.67. In the adjusted Cox models with statin prescription intensity as the exposure, moderate (HR 0.60; 95% CI 0.42 to 0.84) and high intensity (HR 0.61; 95% CI 0.42 to 0.88) statins were associated with a lower risk of progressing to a high-risk FIB-4.

CONCLUSION: Statin prescriptions, and specifically moderate and high intensity statin prescriptions, demonstrate a protective association with fibrosis risk progression in primary care patients with MASLD.

PMID:39019623 | DOI:10.1136/bmjgast-2024-001404

BMJ Open Gastroenterol. 2024 Jul 17;11(1):e001376. doi: 10.1136/bmjgast-2024-001376.

ABSTRACT

OBJECTIVE: To identify the optimal incentive protocol for maximising participation while managing study costs during the Voyage trial.

DESIGN: Prospective cohort (Voyage trial) of colorectal cancer (CRC) incidence and mortality outcomes in individuals screened with multitarget stool DNA (mt-sDNA) served as the population. A subset was randomised to receive postage stamps as a pre-consent incentive, or as a post-consent incentive after completion of the consent and questionnaire. Descriptive statistics from year 1 are reported.

RESULTS: During year 1 of the Voyage trial, a total of 600 258 individuals with mt-sDNA orders received at Exact Sciences Laboratories were randomly selected and invited to participate. Of those, 26 429 (4.4%) opted in, 14 365 of whom (54.3%) consented. The opt-in and consent samples were similar to the target population with respect to sex but differed by geographic residence and age (p<0.001). For the embedded incentive experiment, 2333 were randomised to the pre-incentive arm, while 2342 were randomised to the post-incentive arm. Overall consent rate in the incentive trial was 56.4% (60.9% for the pre-consent incentive arm (1421/2333) vs 52.0% for the post-consent incentive arm (1217/2342), p<0.001). Cost reduction was observed for the pre-consent incentive group, and higher response rates were seen among older versus younger individuals.

CONCLUSIONS: Pre-consent incentive option was associated with a higher participation rate and lower costs and was used for the remainder of study recruitment. CRC incidence and mortality vary with age; thus, adjusting for differential participation by age and region will be important in analyses of Voyage data.

TRIAL REGISTRATION NUMBER: NCT04124406.

PMID:39019622 | DOI:10.1136/bmjgast-2024-001376

Environ Health Prev Med. 2024;29:34. doi: 10.1265/ehpm.24-00105.

ABSTRACT

BACKGROUND: Exposure to fine particulate matter (PM_2.5) has been associated with allergic diseases, including asthma. However, information about the effects of specific PM_2.5 components is limited. This study aimed to investigate the relationship of exposure to chemical components of PM_2.5 during pregnancy and early childhood with the development of asthma, allergies, and sensitization in school-age children.

METHODS: This study included 2,408 children in the second grade of elementary school. Questionnaire surveys of respiratory/allergic symptoms and measurements of serum total IgE and specific IgE levels to house dust mite (HDM) and animal proteins were conducted. Exposures to ambient PM_2.5 mass, sulfate (SO₄^2-), nitrate (NO₃^–), ammonium (NH₄⁺), elemental carbon (EC), and organic carbon (OC) of PM_2.5 in participants’ residences from conception to age six were estimated using predictive models. Multiple logistic regression analysis was used to analyze the association of respiratory/allergic symptoms and allergen sensitization with estimated exposure concentrations, after adjustment for survey year, sex, season of birth, feeding method during infancy, presence of siblings, history of lower respiratory tract infection, use of childcare facilities, passive smoking, presence of pets, mother’s age, history of allergic diseases, smoking during pregnancy, and annual household income.

RESULTS: No significant association was found between PM_2.5 and its component concentrations and asthma. However, wheezing significantly increased with mean NO₃^– concentrations during pregnancy (odds ratio of 1.64 [95% confidence interval: 1.10, 2.47] for an interquartile range increase). Significant associations were also found between EC in the second trimester of pregnancy and PM_2.5, NO₃^–, EC, and OC concentrations in early childhood. Higher PM_2.5, SO₄^–, and NH₄⁺ concentrations during the second trimester increased the risk of rhinitis. Sensitizations to HDM and animal proteins were significantly associated with exposure to components such as SO₄^2- and NH₄⁺ during pregnancy but not with postnatal exposure.

CONCLUSIONS: Exposures to NO₃^–, EC, and OC during pregnancy and early childhood were associated with wheezing. SO₄^2- and NH₄⁺ exposures during pregnancy were associated with sensitization to HDM and animal proteins. Asthma was not associated with exposure to PM_2.5 and its main components at any period.

PMID:39019615 | DOI:10.1265/ehpm.24-00105

J Matern Fetal Neonatal Med. 2024 Dec;37(1):2375021. doi: 10.1080/14767058.2024.2375021. Epub 2024 Jul 17.

ABSTRACT

OBJECTIVE: This study aimed to evaluate if placement of transverse cesarean skin incision above or below the overhanging pannus is associated with wound morbidity in morbidly obese patients.

STUDY DESIGN: We identified a cohort of patients with body mass index (BMI) ≥40 kg/m² undergoing cesarean delivery at a single center from 2017-2020 with complete postpartum records. Data was abstracted after institutional review board exemption, and patients were grouped by low transverse or high transverse skin incision. The primary outcome was a composite of wound infection, fascial dehiscence, incisional hernia, therapeutic wound vacuum, and reoperation. Secondary outcomes included the individual components of the composite, blood transfusion, operative time, and immediate neonatal outcome. T test and χ² were used for continuous and categorical comparisons. Logistic regression was used to compute adjusted odds ratios for categorical outcomes and linear regression to compare operative times adjusting for factors associated with wound complications and surgical duration respectively.

RESULTS: 328 patients met inclusion criteria: 65 with high transverse (infraumbilical and supraumbilical) and 263 with low transverse (Pfannenstiel) incision. 11% of patients had wound morbidity; high transverse incision was associated with 3.64-fold increased odds of composite wound morbidity (23.1% vs 8%, aOR 3.64, 95% CI 1.52-8.70) and 5.73-fold increased odds of wound infection (13.8% vs. 4.9%, aOR 5.73, 95% CI 1.83-17.96). Time from skin incision to delivery was 1.87 min longer (11.09 vs 14.98 min, β = 1.87, 95% CI 0.17-4.61). There was no significant difference in neonatal outcomes, non-low transverse hysterotomy, or total operative time.

CONCLUSION: High transverse skin incision for cesarean delivery was strongly associated with increased wound morbidity in morbidly obese patients.

PMID:39019608 | DOI:10.1080/14767058.2024.2375021

J Prosthodont Res. 2024 Jul 17. doi: 10.2186/jpr.JPR_D_23_00158. Online ahead of print.

ABSTRACT

PURPOSE: Acute stroke often leads to dysphagia. In the oral stage of dysphagia, there is a potential for immediate benefit from using a palatal augmentation prosthesis (PAP). We investigated whether our quickly fabricated, simple, and expedited version of PAP would result in an immediate improvement in swallowing function after an acute stroke.

METHODS: We analyzed the records of stroke patients that were hospitalized between October 2019 and March 2022 and met the following criteria: they had a rehabilitation prescription and had paralysis of facial or hypoglossal nerves and either repeated salivary swallowing test ≤2 times or modified water swallow test ≤3, they were fasting, were within 3 weeks of onset, and had a simple PAP made for them. Outcomes included with/without PAP, maximum tongue pressure, repeated salivary swallowing test, and modified water swallow test on the day after starting to wear PAP was started. In addition, within one week, a videofluoroscopic examination was performed to measure the oral transit time, pharyngeal transit time, and penetration aspiration scale. Statistical analyses were performed using Wilcoxon signed-rank tests. Statistical significance was set at P < 0.05.

RESULTS: Fifteen patients met the inclusion criteria and were included in this study. The mean age of the subjects was 76.9 ± 9.0 years. The use of PAP significantly increased maximum tongue pressure (P < 0.0001*) and shortened oral transit time (P < 0.0091*). There were no significant differences among the other items.

CONCLUSIONS: Simple PAP immediately increased the maximum tongue pressure and improved swallowing function during the oral stage.

PMID:39019592 | DOI:10.2186/jpr.JPR_D_23_00158

BMJ Open Qual. 2024 Jul 17;13(3):e002619. doi: 10.1136/bmjoq-2023-002619.

NO ABSTRACT

PMID:39019588 | DOI:10.1136/bmjoq-2023-002619