Category: Nevin Manimala

J Neurosci. 2024 Jun 3:e1344232023. doi: 10.1523/JNEUROSCI.1344-23.2023. Online ahead of print.

ABSTRACT

It was proposed that a reorganization of the relationships between cognitive functions occurs in dementia, a vision that surpasses the idea of a mere decline of specific domains. The complexity of cognitive structure, as assessed by neuropsychological tests, can be captured by Exploratory Graph Analysis (EGA).EGA was applied to the neuropsychological assessment of people (humans) with Subjective Cognitive Decline (SCD), Mild Cognitive Impairment (MCI), and Alzheimer’s Disease (AD) (Total N=638). Both sexes were included.In AD, memory scores detach from the other cognitive functions and memory subdomains reduce their reciprocal relation. SCD showed a pattern of segregated neuropsychological domains, and MCI showed a noisy and less stable pattern.Results suggest that AD drives a reorganization of cognitive functions toward a less fractionated architecture compared to preclinical conditions. Cognitive functions show a reorganization that goes beyond the performance decline. Results also have clinical implications in test interpretations and usage.Significance Statement The manuscript proposes an innovative vision for the study of the complex reorganization of cognition in people with dementia.We applied a sophisticated, reliable, cutting-edge statistical method (i.e., Exploratory Graph Analysis – EGA) to the neuropsychological evaluations of 638 patients classified into Subjective Cognitive Decline (N=155), Mild Cognitive Impairment (N=242) and Alzheimer’s Disease (N=241).Patients with Alzheimer’s Disease showed a simplified architecture as compared to subjects with Subjective Cognitive Decline. The MCI group resulted in sharing specific aspects with the SCD and others with the AD.Recognizing the complexity of the cognitive organization is fundamental for properly understanding cognitive impairment and stimulate the discussion about the interpretation of neuropsychological profiles from a more systemic point of view.

PMID:38830757 | DOI:10.1523/JNEUROSCI.1344-23.2023

BMJ Open. 2024 Jun 3;14(6):e085743. doi: 10.1136/bmjopen-2024-085743.

ABSTRACT

OBJECTIVE: To assess antibiotic prescribing practice and its determinants among outpatient prescriptions dispensed to the elderly population.

DESIGN: A prescription-based, cross-sectional study.

SETTING: Six community chain pharmacies in Asmara, Eritrea.

PARTICIPANTS: All outpatient prescriptions dispensed to the elderly population (aged 65 and above) in the six community chain pharmacies in Asmara, Eritrea.

DATA COLLECTION AND ANALYSIS: Data were collected retrospectively, between 16 June 2023 and 16 July 2023. Antibiotic prescribing practice was assessed using the 2023 World Health Organization (WHO) Access, Watch and Reserve (AWaRe) classification system. Descriptive statistics and logistic regression were performed using IBM SPSS (V.26.0). P values less than 0.05 were considered as significant.

RESULTS: Of the 2680 outpatient prescriptions dispensed to elderly population, 35.8% (95% CI: 34.0, 37.6) contained at least one antibiotic. Moreover, a total of 1061 antibiotics were prescribed to the elderly population. The most commonly prescribed antibiotics were ciprofloxacin (n=322, 30.3%) and amoxicillin/clavulanic acid (n=145, 13.7%). The Access category accounted for the majority of antibiotics (53.7%) with 32.1% from the Watch category. Prescriber qualification (Adjusted Odds Ratio (AOR)= 0.60, 95% CI: 0.44, 0.81) and polypharmacy (AOR= 2.32, 95% CI: 1.26, 4.27) were significant determinants of antibiotic prescribing in the elderly population. Besides, sex (AOR=0.74, 95% CI: 0.56, 0.98), prescriber qualification (AOR=0.49, 95% CI: 0.30 to0.81) and level of health facility (AOR 0.52, 95% CI 0.34 to 0.81) were significant determinants of a Watch antibiotic prescription.

CONCLUSION: Antibiotics were prescribed to a considerable number of the elderly population, with more than half of them falling into the Access category. Further efforts by policy-makers are needed to promote the use of Access antibiotics while reducing the use of Watch antibiotics to mitigate risks associated with antimicrobial resistance.

PMID:38830743 | DOI:10.1136/bmjopen-2024-085743

BMJ Open. 2024 Jun 3;14(6):e079719. doi: 10.1136/bmjopen-2023-079719.

ABSTRACT

OBJECTIVE: The aim of this study was to investigate the prevalence of indigenous herbal medicine use and its associated factors among pregnant women attending antenatal care (ANC) at public health facilities in Dire Dawa, Ethiopia.

DESIGN: A facility-based cross-sectional study design.

SETTING: The study was conducted in seven public health facilities (one referral hospital, three urban and three rural health centres) in Dire Dawa, Ethiopia, from October to November 2022.

PARTICIPANTS: 628 pregnant women of any gestational age who had been on ANC follow-up at selected public health facilities were included.

MAIN OUTCOME MEASURES: Prevalence of indigenous herbal medicine (users vs non-users) and associated factors.

RESULTS: The study revealed that 47.8% (95% CI 43.8% to 51.6%) of pregnant women used herbal medicines. Lack of formal education (adjusted OR, AOR 5.47, 95% CI 2.40 to 12.46), primary level (AOR 4.74, 95% CI 2.15 to 10.44), housewives (AOR 4.15, 95% CI 1.83 to 9.37), number of ANC visits (AOR 2.58, 95% CI 1.27 to 5.25), insufficient knowledge (AOR 4.58, 95% CI 3.02 to 6.77) and favourable perception (AOR 2.54, 95% CI 1.71 to 3.77) were factors significantly associated with herbal medicine use. The most commonly used herbs were garden cress (Lepidium sativum) (32%), bitter leaf (Vernonia amygdalina) (25.2%), moringa (Moringa oleifera) (24.5%). Common indications were related to gastrointestinal problems, blood pressure and sugar.

CONCLUSION: The prevalence of herbal medicine use is high (one in two pregnant women) and significantly associated with education level, occupation, ANC visits, knowledge and perceptions. The study’s findings are helpful in advancing comprehension of herbal medicines using status, types and enforcing factors. It is essential that health facilities provide herbal counselling during ANC visits, and health regulatory bodies ought to raise awareness and implement interventions to lower the risks from over-the-counter herbal medicine use by pregnant women.

PMID:38830740 | DOI:10.1136/bmjopen-2023-079719

BMJ Open. 2024 Jun 3;14(6):e082025. doi: 10.1136/bmjopen-2023-082025.

ABSTRACT

OBJECTIVE: The aim of this study is to estimate the indirect economic burden of 22 cancer types in Jordan using both the human capital approach (HCA) and the value of a statistical life year (VSLY) approach. Additionally, this study aims to forecast the burden of these cancers for the next 5 years while employing time series analysis.

DESIGN: Retrospective observational study with a time series analysis.

PARTICIPANTS: Disability adjusted life years records from the IHME Global Burden Disease estimates 2019 data.

PRIMARY OUTCOME MEASURE: Indirect economic burden of cancer in Jordan.

RESULTS: The mean total economic burden for all cancers is estimated to be $1.82 billion using HCA and $3.13 billion using VSLY approach. The cancers contributing most to the total burden are ‘tracheal, bronchus and lung cancer’ ($359.5 million HCA, $618.3 million VSLY), followed by ‘colon and rectum cancer’ ($300.6 million HCA, $517.1 million VSLY) and ‘breast cancer’ ($292.4 million HCA, $502.9 million VSLY). The indirect economic burden ranged from 1.4% to 2.1% of the gross domestic product (GDP) using the HCA, and from 2.3% to 3.6% of the GDP using the VSLY approach. The indirect economic burden is expected to reach 2.3 and 3.5 billion Intl$ by the year 2025 using the HCA and VSLY approach, respectively.

CONCLUSION: The indirect economic burden of cancer in Jordan amounted to 1.4%-3.6% of total GDP, with tracheal, bronchus and lung cancer; colon and rectum cancer; and breast cancer contributing to over 50% of the total burden. This will help set national cancer spending priorities following Jordan’s economic modernisation vision with regard to maximising health economic outcomes.

PMID:38830736 | DOI:10.1136/bmjopen-2023-082025

BMJ Open. 2024 Jun 3;14(6):e078198. doi: 10.1136/bmjopen-2023-078198.

ABSTRACT

OBJECTIVE: This study investigated the correlation between uncertainty stress (US) and depression among healthcare professionals (HCPs) in China.

DESIGN, SETTINGS AND PARTICIPANTS: A cross-sectional online survey was conducted by recruiting HCPs from three provinces in China (central, eastern and western) through purposive sampling between 29 September 2022 and 18 January 2023. US was measured using the Life Stress Questionnaire and depression was measured using the Patient Health Questionnaire-9. In total, 2976 questionnaires were deemed valid.

PRIMARY AND SECONDARY OUTCOME: This study examined the prevalence of US and depression among HCPs in China; the correlating sociodemographic traits; and the correlation between US and depression.

RESULTS: The prevalence of US and depression among HCPs in China was 26.54% (790 out of 2976) and 71.63% (2132 out of 2976). Binary logistic analysis revealed that individuals with graduate degrees (OR: 1.83; 95% CI 1.07 to 3.11; p<0.05), central China (OR: 1.75; 95% CI 1.36 to 2.24; p<0.01), primary medical institutes (OR: 1.33; 95% CI 1.03 to 1.72; p<0.05), secondary medical institutes (OR: 1.30; 95% CI 1.01 to 1.68; p<0.05), an annual income of less than ¥50 000 (OR: 1.85; 95% CI 1.26 to 2.73; p<0.01) and an income range of ¥50 000-¥99 999 (OR: 1.49; 95% CI 1.10 to 2.03; p<0.05) were associated with a higher likelihood of US. The adjusted logistic regression model demonstrated that HCPs with higher US had a greater likelihood of depression (adjusted OR: 5.02; 95% CI 3.88 to 6.50; p<0.01). The increase in the US score was paralleled by an increased depression score (beta (B): 1.32; 95% CI 1.25 to 1.39; p<0.01).

CONCLUSION: These findings reveal a significant correlation between US and depression among HCPs and suggest that improving the management of US may help reduce the prevalence of depression among HCPs.

PMID:38830732 | DOI:10.1136/bmjopen-2023-078198

BMJ Open Qual. 2024 Jun 3;13(2):e002654. doi: 10.1136/bmjoq-2023-002654.

ABSTRACT

BACKGROUND: Manual chart review using validated assessment tools is a standardised methodology for detecting diagnostic errors. However, this requires considerable human resources and time. ChatGPT, a recently developed artificial intelligence chatbot based on a large language model, can effectively classify text based on suitable prompts. Therefore, ChatGPT can assist manual chart reviews in detecting diagnostic errors.

OBJECTIVE: This study aimed to clarify whether ChatGPT could correctly detect diagnostic errors and possible factors contributing to them based on case presentations.

METHODS: We analysed 545 published case reports that included diagnostic errors. We imputed the texts of case presentations and the final diagnoses with some original prompts into ChatGPT (GPT-4) to generate responses, including the judgement of diagnostic errors and contributing factors of diagnostic errors. Factors contributing to diagnostic errors were coded according to the following three taxonomies: Diagnosis Error Evaluation and Research (DEER), Reliable Diagnosis Challenges (RDC) and Generic Diagnostic Pitfalls (GDP). The responses on the contributing factors from ChatGPT were compared with those from physicians.

RESULTS: ChatGPT correctly detected diagnostic errors in 519/545 cases (95%) and coded statistically larger numbers of factors contributing to diagnostic errors per case than physicians: DEER (median 5 vs 1, p<0.001), RDC (median 4 vs 2, p<0.001) and GDP (median 4 vs 1, p<0.001). The most important contributing factors of diagnostic errors coded by ChatGPT were ‘failure/delay in considering the diagnosis’ (315, 57.8%) in DEER, ‘atypical presentation’ (365, 67.0%) in RDC, and ‘atypical presentation’ (264, 48.4%) in GDP.

CONCLUSION: ChatGPT accurately detects diagnostic errors from case presentations. ChatGPT may be more sensitive than manual reviewing in detecting factors contributing to diagnostic errors, especially for ‘atypical presentation’.

PMID:38830730 | DOI:10.1136/bmjoq-2023-002654

BMJ Open Qual. 2024 Jun 3;13(2):e002618. doi: 10.1136/bmjoq-2023-002618.

ABSTRACT

BACKGROUND: The demand for healthcare services during the COVID-19 pandemic was excessive for less-resourced settings, with intensive care units (ICUs) taking the heaviest toll.

OBJECTIVE: The aim was to achieve adequate personal protective equipment (PPE) use in 90% of patient encounters, to reach 90% compliance with objectives of patient flow (OPF) and to provide emotional support tools to 90% of healthcare workers (HCWs).

METHODS: We conducted a quasi-experimental study with an interrupted time-series design in 14 ICUs in Argentina. We randomly selected adult critically ill patients admitted from July 2020 to July 2021 and active HCWs in the same period. We implemented a quality improvement collaborative (QIC) with a baseline phase (BP) and an intervention phase (IP). The QIC included learning sessions, periods of action and improvement cycles (plan-do-study-act) virtually coached by experts via platform web-based activities. The main study outcomes encompassed the following elements: proper utilisation of PPE, compliance with nine specific OPF using daily goal sheets through direct observations and utilisation of a web-based tool for tracking emotional well-being among HCWs.

RESULTS: We collected 7341 observations of PPE use (977 in BP and 6364 in IP) with an improvement in adequate use from 58.4% to 71.9% (RR 1.2, 95% CI 1.17 to 1.29, p<0.001). We observed 7428 patient encounters to evaluate compliance with 9 OPF (879 in BP and 6549 in IP) with an improvement in compliance from 53.9% to 67% (RR 1.24, 95% CI 1.17 to 1.32, p<0.001). The results showed that HCWs did not use the support tool for self-mental health evaluation as much as expected.

CONCLUSION: A QIC was effective in improving healthcare processes and adequate PPE use, even in the context of a pandemic, indicating the possibility of expanding QIC networks nationwide to improve overall healthcare delivery. The limited reception of emotional support tools requires further analyses.

PMID:38830729 | DOI:10.1136/bmjoq-2023-002618

BMJ Paediatr Open. 2024 Jun 3;8(1):e002651. doi: 10.1136/bmjpo-2024-002651.

ABSTRACT

BACKGROUND: Partial or complete thymectomy is routinely performed in paediatric open-heart surgeries when treating congenital heart defects. Whether or not thymectomised children require systematic immunological monitoring later in life is unknown. The objective of this study was to investigate the effects of preoperatively and postoperatively used antibiotics, hospitalisation and surgical complications on self-reported immunological vulnerability in paediatric patients with early thymectomy to better recognise the patients who could benefit from immunological follow-up in the future.

METHODS: We conducted a retrospective cohort study, including 98 children and adolescents aged 1-15 years, who had undergone an open-heart surgery and thymectomy in infancy and who had previously answered a survey regarding different immune-mediated symptoms and diagnoses. We performed a comprehensive chart review of preoperative and postoperative factors from 1 year preceding and 1 year following the open-heart surgery and compared the participants who had self-reported symptoms of immunological vulnerability to those who had not.

RESULTS: The median age at primary open-heart surgery and thymectomy was 19.5 days in the overall study population (60% men, n=56) and thymectomies mainly partial (80%, n=78). Broad-spectrum antibiotics were more frequently used preoperatively in participants with self-reported immunological vulnerability (OR=3.05; 95% CI 1.01 to 9.23). This group also had greater overall use of antibiotics postoperatively (OR=3.21; 95% CI 1.33 to 7.76). These findings were more pronounced in the subgroup of neonatally operated children. There was no statistically significant difference in the duration of intensive care unit stay, hospitalisation time, prevalence of severe infections, surgical complications or glucocorticoid use between the main study groups.

CONCLUSION: Antimicrobial agents were more frequently used both preoperatively and postoperatively in thymectomised children with self-reported immunological vulnerability after thymectomy. Substantial use of antimicrobial agents early in life should be considered a potential risk factor for increased immunological vulnerability when evaluating the significance of immune-mediated symptom occurrence in thymectomised paediatric patients.

PMID:38830724 | DOI:10.1136/bmjpo-2024-002651

J Fish Biol. 2024 Jun 3. doi: 10.1111/jfb.15823. Online ahead of print.

ABSTRACT

Some cichlid fishes release urine-containing chemical cues that lower aggression in their opponents. Bioassays to identify the aggression-modulating pheromone include assessing the effect of urine fractions on the behavior towards a mirror image or in interactions with another male. However, many of these methods can be time-consuming and require many fish. The objective of the present study was to assess the behavior of male Mozambique tilapia (Oreochromis mossambicus) towards male urine using two methods with the intent of simplifying the bioassays: aggression towards a mirror image (mirror assay) and real opponents in which the urogenital papilla was tied using surgical silk to prevent urination. The results confirm the aggression-reducing effect of dominant male urine in both experimental approaches. Ten minutes of biting or 15 min of tail-beating behaviors in the mirror assay, or 5 min of opercular expansion or 15 min of lateral display in interactions with real opponents were necessary to detect a statistically significant reduction in aggressive behavior towards dominant male urine. We also found that males with subordinate status had lower latency to initiate aggressive behaviors towards the mirror than dominants in the same condition, even though fish had been isolated for 1 week. However, no such differences in latency were found in the real opponent assay. We conclude that 5 min of opercular expansion behavior in real opponent fights or 10 min of biting behavior in the mirror assay are the shortest times necessary to test aggressive behavior in urine fractions in bioassay-guided identification of pheromones.

PMID:38830691 | DOI:10.1111/jfb.15823