Category: Nevin Manimala

Clin J Pain. 2023 Nov 30. doi: 10.1097/AJP.0000000000001182. Online ahead of print.

ABSTRACT

OBJECTIVES: The understanding of the role that cognitive and emotional factors play in how an individual recovers from a whiplash injury, is important. Hence, we sought to evaluate if pain-related cognitions (self-efficacy beliefs, expectation of recovery, pain catastrophizing, optimism, and pessimism) and emotions (kinesiophobia) are longitudinally associated with the transition to chronic whiplash associated disorders (WAD) in terms of perceived disability, and perceived recovery at 6 and 12-months.

METHODS: One-hundred and sixty-one participants with acute or subacute WAD were included. The predictors were: self-efficacy beliefs, expectation of recovery, pain catastrophizing, optimism, and pessimism, pain intensity, and kinesiophobia. The two outcomes were the dichotomized scores of perceived disability and recovery expectations at six and twelve months. Stepwise regression with bootstrap resampling was performed to identify the predictors most strongly associated with the outcomes, and the stability of such selection.

RESULTS: Baseline perceived disability, pain catastrophizing, and expectation of recovery were the most likely to be statistically significant, with an overage frequency of 87.2%, 84.0%, and 84.0%, respectively.

DISCUSSION: Individuals with higher expectation of recovery and lower levels of pain catastrophizing and perceived disability at baseline, have higher perceived recovery and perceived disability at 6 and 12-months. These results have important clinical implications as both factors are modifiable via health education approaches.

PMID:38031848 | DOI:10.1097/AJP.0000000000001182

J Atten Disord. 2023 Nov 30:10870547231211024. doi: 10.1177/10870547231211024. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the improvement of ADHD related symptoms in school-aged children ages 5 to 12 in treatment with a monobloc appliance (MOA) for Sleep Disordered Breathing (SDB).

METHODS: A retrospective review of questionnaire scores of ADHD symptoms from school-aged children being treated with a MOA for SDB. Data was obtained from parent survey questionnaires of 40 school-aged children in three dental offices in treatment with an MOA for SDB showing symptoms of ADHD yet to be confirmed with a formal diagnosis between 2019 and 2021. ADHD symptom scores were ascertained by a parent survey questionnaire completed at the initial visit before MOA treatment, and 2 to 6 months, and 7+ months during MOA treatment.

RESULTS: At the 7+ month endpoint, 17 of the 28 (61%) children ages 5 to 12 saw at least a 1-point drop in the sum of their questionnaire scores indicating an improvement in ADHD symptoms after initiating treatment with an MOA. Although there was a reduction of the overall average symptom score from the initial visit to 2 to 6 months (M = 4.06, SD ± 1.55), a statistically significant improvement in ADHD symptoms occurred at the 7+ month endpoint (M = 15.29, SD ± 4.50) during MOA treatment.

CONCLUSIONS: Treatment with an MOA may be highly effective in addressing the dual pathologies of SDB and ADHD in school-age children ages 5 to 12.

PMID:38031843 | DOI:10.1177/10870547231211024

Pediatr Endocrinol Diabetes Metab. 2023;29(3):143-155. doi: 10.5114/pedm.2023.131162.

ABSTRACT

INTRODUCTION: Atherosclerosis, a precursor to cardiovascular disease (CVD), is deeply intertwined with lipid metabolism. The metabolic process in the Down syndrome (DS) population remain less explored. Aim of the study: This study examines the lipid profiles of DS in comparison to their siblings (CG), aiming to uncover potential atherosclerotic and CVD risks.

MATERIAL AND METHODS: The study included 42 people with DS (mean age 14.17 years) and the CG – 20 individuals (mean age 15.92 years). Anthropometric measurements: BMI, BMI SDS, and TMI were calculated. Lipid profile (LP) and metabolomics were determined.

RESULTS: LP: DS display significantly reduced HDL (DS vs. CG: 47±10 vs. 59 ±12 mg/dl; p = 0.0001) and elevated LDL (104 ±25 vs. 90 ±22 mg/dl; p = 0.0331). Triglycerides, APO A1, and APO B/APO A1 ratio corroborate with the elevated risk of CVD in DS. Despite no marked differences in: TCH and APO B, the DS group demonstrated a concerning BMI trend. Of 31 identified metabolites, 12 showed statistical significance (acetate, choline, creatinine, formate, glutamine, histidine, lysine, proline, pyroglutamate, threonine, tyrosine, and xanthine). However, only 8 metabolites passed the FDR validation (acetate, creatinine, formate, glutamine, lysine, proline, pyroglutamate, xanthine).

CONCLUSIONS: Down syndrome individuals show distinct cardiovascular risks, with decreased HDL and increased LDL levels. Combined with metabolomic disparities and higher BMI and TMI, this suggests an increased atherosclerosis risk compared to controls.

PMID:38031830 | DOI:10.5114/pedm.2023.131162

Pediatr Endocrinol Diabetes Metab. 2023;29(3):134-142. doi: 10.5114/pedm.2023.131513.

ABSTRACT

INTRODUCTION: Down syndrome (DS), a common genetic disorder, leads to various physical, cognitive, and developmental challenges. The supplementary copy of chromosome 21 introduces an abundance of genes, which potentially can influence metabolic irregularities. The aim of the study is to conduct a comprehensive comparative assessment of oxidative stress indicators (TAS, TOS, OSI), BMI, fasting glucose, and insulin levels, HOMA-IR among children and adolescents with DS in contrast to their non-DS siblings.

MATERIAL AND METHODS: and the control group (CG) comprised 20 individuals, siblings of SG (mean age 15.92 years). Anthropometric measurements were conducted. TAS, TOS, fasting glucose, and insulin were assessed. BMI, BMI SDS, OSI and HOMA-IR were calculated.

RESULTS: SG vs. CG: BMI – overweight (29,19% vs. 15%), obese (19,05% vs. 5%); TAS (1.92 mmol/l vs. 1.79 mmol/l (p = 0.0015)); TOS (51.52 mmol/l vs. 33.05 mmol/l (p = 0.014)); OSI (2475.02 vs. 1949,75 (p = 0.038)); no significant differences in fasting glucose, insulin and HOMA-IR. Statistically significant correlations in SG: TOS and BMI, BMI SDS, HOMA-IR; OSI and BMI, BMI SDS, HOMA-IR; HOMA-IR and BMI SDS; fasting insulin and BMI PC; in CG: TAS and BMI; fasting glucose and fasting insulin.

CONCLUSIONS: The research results indicate differences in metabolic processes between the group of individuals with DS compared to the CG, despite shared environmental conditions. The presence of an additional copy of chromosome 21 may contribute to the occurrence of metabolic disorders. These findings emphasize the need for further research that will lead to a better understanding of these relationships and contribute to the development of effective therapeutic strategies.

PMID:38031829 | DOI:10.5114/pedm.2023.131513

Pediatr Endocrinol Diabetes Metab. 2023;29(3):128-133. doi: 10.5114/pedm.2023.132025.

ABSTRACT

INTRODUCTION: Proper control of blood glucose in children with type 1 diabetes has a direct effect on their metabolism and quality of life by reducing the risk of complications. The use of probiotics may have a beneficial effect on glucose levels.

PURPOSE: The aim of this study was to evaluate the effect of oral consumption of probiotics on glycosylated haemoglobin in children with type 1 diabetes.

MATERIAL AND METHODS: In this single-blind randomized controlled clinical trial, 52 children with type 1 diabetes were studied. We created 2 groups of 26 individuals each. The probiotic group received a daily probiotic capsule for 90 days, in addition to routine insulin therapy. The control group received only insulin therapy. Blood samples were taken to measure HbA1c, fasting plasma glucose, and lipid profiles at the beginning and end of the trial.

RESULTS: The study showed that HbA1c was high in both groups, but this increase was lower in the probiotic group than in the control group. This difference was not statistically significant. The mean level of fasting plasma glucose in the probiotic group was significantly reduced compared to the control group (p = 0.016).

CONCLUSIONS: According to the results of our study, consumption of oral probiotics has no significant effect on HbA1c levels in children with type 1 diabetes mellitus.

PMID:38031828 | DOI:10.5114/pedm.2023.132025

Diabetes Obes Metab. 2023 Nov 30. doi: 10.1111/dom.15380. Online ahead of print.

ABSTRACT

AIM: To assess the potential heterogeneity in cardiovascular (CV), renal and safety outcomes of canagliflozin between Whites and Asians, as well as these outcomes in each subgroup.

MATERIALS AND METHODS: The CANVAS Program enrolled 10 142 patients with type 2 diabetes, comprising 78.34% Whites and 12.66% Asians. CV, renal and safety outcomes were comprehensively analysed using Cox regression models, while intermediate markers were assessed using time-varying mixed-effects models. Racial heterogeneity was evaluated by adding a treatment-race interacion term.

RESULTS: Canagliflozin showed no significant racial disparities in the majority of the CV, renal and safety outcomes. The heterogeneity (p = .04) was observed on all-cause mortality, with reduced risk in Whites (hazard ratio 0.84; 95% confidence interval 0.71-0.99) and a statistically non-significant increased risk in Asians (hazard ratio 1.64; 95% confidence interval 0.94-2.90). There was a significant racial difference in acute kidney injury (p = .04) and a marginally significant racial heterogeneity for the composite of hospitalization for heart failure and CV death (p = .06) and serious renal-related adverse events (p = .07).

CONCLUSION: Canagliflozin reduced CV and renal risks similarly in Whites and Asians; however, there was a significant racial discrepancy in all-cause mortality. This distinction may be attributed to the fact that Asian patients exhibited diminished CV protection effects and more renal adverse events with canagliflozin, potentially resulting from the smaller reductions in weight and uric acid. These findings highlight the importance of investigating the impact of race on treatment response to sodium-glucose cotransporter-2 inhibitors and provide more precise treatment strategies.

PMID:38031821 | DOI:10.1111/dom.15380

Arch Pathol Lab Med. 2023 Nov 28. doi: 10.5858/arpa.2023-0002-OA. Online ahead of print.

ABSTRACT

CONTEXT.—: Pleural effusion cytology has been widely used in the investigation of pathologic fluid accumulation in pleural spaces. However, up to one-tenth of the cases were not given a definitive diagnosis. These cases have largely been neglected in the bulk of the literature.

OBJECTIVE.—: To provide real-world data on indefinite diagnoses including “atypia of uncertain significance” (AUS) and “suspicious for malignancy” (SFM) in pleural effusion cytology and to investigate pathologists’ practice patterns on using these diagnostic categories.

DESIGN.—: We reported the diagnoses of 51 675 cases. Descriptive statistics and correlation coefficients were used to analyze the relationships between different diagnostic categories and pathologists’ practice patterns and possible explanatory variables.

RESULTS.—: The diagnoses AUS and SFM were reported in 4060 cases (7.86%) and 1554 cases (3.01%) in the cohort, respectively. The mean rates for these indefinite diagnoses varied up to 3-fold between pathologists. Correlations were found between AUS and SFM, as well as between indefinite diagnoses and negative for malignancy (NFM). No correlations were found between pathologists’ years of experience or case volume and the rates of indefinite diagnosis or diagnostic certainty.

CONCLUSIONS.—: A real-world baseline for the rates of indefinite diagnoses in pleural effusion cytology is provided in this large retrospective study. Pathologists show significant variation in their use of indefinite diagnostic categories, and the tendency to use these ambiguous terms was not correlated with individuals’ experience or case volume. How to untangle the intertwined relationship between the uncertainty of indefinite diagnoses and that of NFM requires future prospective studies.

PMID:38031811 | DOI:10.5858/arpa.2023-0002-OA

Curr Drug Saf. 2023 Nov 28. doi: 10.2174/0115748863276904231108095255. Online ahead of print.

ABSTRACT

BACKGROUND: COVID-19 vaccines have played a crucial role in reducing the burden of the global pandemic. However, recent case reports have indicated the association of the COVID- 19 vaccines with cardiovascular events but the exact association is unclear so far.

OBJECTIVE: Therefore, the objective of the current study is to find out the association of cardiovascular events with COVID-19 vaccines.

METHODS: The COVID-19 Vaccine Knowledge Base (Cov19VaxKB) tool was used to query the Vaccine Adverse Event Reporting System (VAERS) database. The proportional reporting ratio [PRR (≥2)] with associated chi-squared value (>4), and the number of cases > 0.2% of total reports, was used to assess the association of COVID-19 vaccines with cardiovascular events.

RESULTS: A total of 33,754 cases of cardiovascular events associated with COVID-19 vaccines were found in the Cov19VaxKB tool. The cases were observed in different age groups (18-64, and 65 years and above) and gender. The disproportionality measures indicate a statistically significant association between cardiovascular events and COVID-19 vaccines.

CONCLUSION: The current study identified a signal of various cardiovascular events with the COVID-19 vaccines. However, further causality assessment is required to confirm the association.

PMID:38031796 | DOI:10.2174/0115748863276904231108095255

Curr Med Imaging. 2023 Nov 29. doi: 10.2174/0115734056250970231117111810. Online ahead of print.

ABSTRACT

INTRODUCTION: Artificial intelligence (AI) in medical imaging rapidly expands regarding image processing and interpretation. Therefore, the aim was to explore radiographers’ and radiologists’ perceptions and attitudes towards AI use in medical imaging technologies in Saudi Arabia.

METHODS: The survey was distributed online, and responses were collected from 173 participants nationwide. Data analysis was performed using SPSS Statistics (version 27).

RESULTS: The participants scored an average of 1.7, 1.6, and 1.8 on a scale of 1-3 for attitudinal perspectives on clinical application and the positive and negative impact of integrating AI technology in diagnostic radiology. Lack of knowledge (43.9%) and perceived cyber threats (37.7%) were the most cited factors hindering AI implementation in Saudi Arabia.

CONCLUSION: The radiographradiology radiologists in this study had a favorable attitude toward AI integration in diagnostic radiology; nonetheless, concerns were raised about data protection, cyber security, AI-related errors, and decision-making challenges.

PMID:38031793 | DOI:10.2174/0115734056250970231117111810

Curr Diabetes Rev. 2023 Nov 28. doi: 10.2174/0115733998268034231101091236. Online ahead of print.

ABSTRACT

BACKGROUND: Diabetic retinopathy is the most common complication of diabetes mellitus and is one of the leading causes of vision impairment globally, which is also relevant for the Russian Federation.

OBJECTIVE: To evaluate the diagnostic efficiency of a convolutional neural network trained for the detection of diabetic retinopathy and estimation of its severity in fundus images of the Russian population.

METHODS: In this cross-sectional multicenter study, the training data set was obtained from an open source and relabeled by a group of independent retina specialists; the sample size was 60,000 eyes. The test sample was recruited prospectively, 1186 fundus photographs of 593 patients were collected. The reference standard was the result of independent grading of the diabetic retinopathy stage by ophthalmologists.

RESULTS: Sensitivity and specificity were 95.0% (95% CI; 90.8-96.4) and 96.8% (95% CI; 95.5- 99.0), respectively; positive predictive value – 98.8% (95% CI; 97.6-99.2); negative predictive value – 87.1% (95% CI, 83.4-96.5); accuracy – 95.9% (95% CI; 93.3-97.1); Kappa score – 0.887 (95% CI; 0.839-0.946); F1score – 0.909 (95% CI; 0.870-0.957); area under the ROC-curve – 95.9% (95% CI; 93.3-97.1). There was no statistically significant difference in diagnostic accuracy between the group with isolated diabetic retinopathy and those with hypertensive retinopathy as a concomitant diagnosis.

CONCLUSION: The method for diagnosing DR presented in this article has shown its high accuracy, which is consistent with the existing world analogues, however, this method should prove its clinical efficiency in large multicenter multinational controlled randomized studies, in which the reference diagnostic method would be unified and less subjective than an ophthalmologist.

PMID:38031785 | DOI:10.2174/0115733998268034231101091236