Category: Nevin Manimala

AIDS. 2023 Dec 7. doi: 10.1097/QAD.0000000000003811. Online ahead of print.

ABSTRACT

OBJECTIVE: Bone loss in people with HIV (PWH) is poorly understood. Switching tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF) has yielded bone mineral density (BMD) increases. PETRAM (NCT#:03405012) investigated whether BMD and bone turnover changes correlate.

DESIGN: Open-label, randomized controlled trial.

SETTING: Single-site, outpatient, secondary care.

PARTICIPANTS: Nonosteoporotic, virologically suppressed, cis-male PWH taking TDF/emtricitabine (FTC)/rilpivirine (RPV) for more than 24 weeks.

INTERVENTION: Continuing TDF/FTC/RPV versus switching to TAF/FTC/RPV (1 : 1 randomization).

MAIN OUTCOME MEASURES: :[18F]NaF-PET/CT for bone turnover (standardized uptake values, SUVmean) and dual-energy x-ray absorptiometry for lumbar spine and total hip BMD.

RESULTS: Thirty-two men, median age 51 years, 76% white, median duration TDF/FTC/RPV 49 months, were randomized between 31 August 2018 and 09 March 2020. Sixteen TAF:11 TDF were analyzed. Baseline-final scan range was 23-103 (median 55) weeks. LS-SUVmean decreased for both groups (TAF -7.9% [95% confidence interval -14.4, -1.5], TDF -5.3% [-12.1,1.5], P = 0.57). TH-SUVmean showed minimal changes (TAF +0.3% [-12.2,12.8], TDF +2.9% [-11.1,16.9], P = 0.77). LS-BMD changes were slightly more favorable with TAF but failed to reach significance (TAF +1.7% [0.3,3.1], TDF -0.3 [-1.8,1.2], P = 0.06). Bone turnover markers decreased more with TAF ([CTX -35.3% [-45.7, -24.9], P1NP -17.6% [-26.2, -8.5]) than TDF (-11.6% [-28.8, +5.6] and -6.9% [-19.2, +5.4] respectively); statistical significance was only observed for CTX (P = 0.02, P1NP, P = 0.17).

CONCLUSION: Contrary to our hypothesis, lumbar spine and total hip regional bone formation (SUVmean) and BMD did not differ postswitch to TAF. However, improved LS-BMD and CTX echo other TAF-switch studies. The lack of difference in SUVmean may be due to inadequate power.

PMID:38061030 | DOI:10.1097/QAD.0000000000003811

Annu Rev Public Health. 2023 Dec 7. doi: 10.1146/annurev-publhealth-101322-031206. Online ahead of print.

ABSTRACT

The industrial revolution and urbanization fundamentally restructured populations’ living circumstances, often with poor impacts on health. As an example, unhealthy food establishments may concentrate in some neighborhoods and, mediated by social and commercial drivers, increase local health risks. To understand the connections between neighborhood food environments and public health, researchers often use geographic information systems (GIS) and spatial statistics to analyze place-based evidence, but such tools require careful application and interpretation. In this article, we summarize the factors shaping neighborhood health in relation to local food environments and outline the use of GIS methodologies to assess associations between the two. We provide an overview of available data sources, analytical approaches, and their strengths and weaknesses. We postulate next steps in GIS integration with forecasting, prediction, and simulation measures to frame implications for local health policies. Expected final online publication date for the Annual Review of Public Health, Volume 45 is April 2024. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

PMID:38061019 | DOI:10.1146/annurev-publhealth-101322-031206

Br J Dermatol. 2023 Dec 7:ljad488. doi: 10.1093/bjd/ljad488. Online ahead of print.

ABSTRACT

BACKGROUND: Occupational exposure to metals such as nickel, chromium and cobalt can be associated with contact dermatitis which can adversely affect the individual’s health, finances and employment. Despite this, little is known about the incidence of metal-related occupational contact dermatitis over prolonged periods of time.

OBJECTIVES: This study aimed to investigate the medically reported trends in the incidence of work-related contact dermatitis attributed to nickel, chromium and cobalt in the UK.

METHODS: Incidence and trends in incidence of cases of occupational contact dermatitis caused by nickel, chromium, or cobalt between 1996 and 2019 (inclusive), reported to the EPIDERM surveillance scheme, was investigated and compared to trends in incidence of occupational contact dermatitis attributed to agents other than the aforesaid metals. A sensitivity analysis restricting the study cohort to cases attributed to only one type of metal was also conducted.

RESULTS: Of all cases reported to EPIDERM during the study period, 2374 cases (12%) were attributed to nickel, chromium, or cobalt. Cases were predominantly females (59%), with a mean (±SD) age (males plus females) of 38 ± 13 years. Cases were most frequently reported in manufacturing, construction and human health and social activities. The most frequently reported occupations were hairdressers, sales and retail assistants/cashiers/check-out operators. The highest annual incidence rate of contact dermatitis was observed in females (2.60 per 100,000 person employed per year), with the first and second peak seen in those aged 16-24 and ≥65 years old, respectively. A statistically significant decrease in the incidence of occupational contact dermatitis attributed to metals over the study period was observed for all occupations (annual average change -6.9% [95% CI -7.8, -5.9]), with much of the decrease occurring between 1996 and 2007. Similar findings were observed in the sensitivity analyses.

CONCLUSIONS: Over a period of 24 years, a statistically significant decline in the incidence of metal-related occupational contact dermatitis was observed in the UK. This could be attributed to improvements in working conditions which resulted in reduced metal exposure but could also be due to closure of industries in the UK that might have generated cases of contact dermatitis due to metal exposure.

PMID:38061005 | DOI:10.1093/bjd/ljad488

J Clin Endocrinol Metab. 2023 Dec 7:dgad700. doi: 10.1210/clinem/dgad700. Online ahead of print.

ABSTRACT

BACKGROUND: Barraquer-Simons syndrome (BSS) is a rare acquired form of lipodystrophy characterized by progressive loss of upper body subcutaneous fat, which affects face, upper limbs, and trunk. The pathogenesis of the disease is not entirely known and may involve autoimmune mechanisms.

AIM: This study aimed to provide a comprehensive picture of the clinical, immunological, and metabolic features of a large cohort of BSS patients. Our primary objectives included the validation of existing diagnostic tools, the evaluation of novel diagnostic approaches, and the exploration of potential disease triggers or genetic predispositions.

SUBJECTS AND METHODS: Twenty-six patients were diagnosed with BSS based on accepted criteria defined by international guidelines. Anthropometric parameters, biochemical tests, organ- and non-organ-specific autoantibodies, HLA status, and screening of the LMNB2 gene were performed.

RESULTS: Patients were predominantly females (73%); fat loss occurred mostly during childhood (77%) at a median age of 8 years. Among various anthropometric measures, the ratio between the proportion of fat mass in upper limbs/lower limbs showed the best predictive value for diagnosis. 11.5% of patients had diabetes, 34.6% dyslipidemia, and 26.9% hepatic steatosis. 75% of children and 50% of adults had C3 hypocomplementemia; 76% of patients were positive for one or more autoantibodies. HLA-DRB1 11:03 had higher allelic frequencies compared to the general population. A single variant in the LMNB2 gene was found in one patient.

CONCLUSIONS: BSS has a childhood onset and is often associated with autoimmune diseases. Skinfold thickness measurements and fat assessment by DEXA are useful tools to identify the disease. C3 hypocomplementemia and the presence of autoantibodies may be used as additional diagnostic supportive criteria but prevalence of C3 hypocomplementemia may be lower than previously reported.

PMID:38061004 | DOI:10.1210/clinem/dgad700

Br J Dermatol. 2023 Dec 7:ljad486. doi: 10.1093/bjd/ljad486. Online ahead of print.

ABSTRACT

BACKGROUND: Atopic dermatitis (AD) may affect cognitive function, but studies are limited and inconsistent. The effect of AD severity on cognition remains underexplored and few previous studies have examined clinically validated or repeated measures of cognition throughout childhood.

OBJECTIVE: To evaluate the relationship of AD activity and severity with validated measures of general cognition in a longitudinal birth cohort.

METHODS: We conducted cross-sectional analyses using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a U.K. cohort of 14,975 individuals followed prospectively since their birth in 1991-1992. AD was assessed 11 times between 6 and 166 months old. Mothers were asked if their child had an “itchy, dry skin rash in the joints and creases,” and AD status was accordingly time-updated as never, maybe, inactive, active/mild, or active/moderate-severe. General cognition (i.e., IQ) was measured at 18, 49, 103, and 186 months old using the Griffiths Mental Development Scales (GMDS), Wechsler Preschool and Primary Scale of Intelligence (WPPSI), Wechsler Intelligence Scale for Children (WISC), and Wechsler Abbreviated Scale of Intelligence (WASI), respectively. Multivariable linear regression was used to compare IQ with respect to nearest time-updated AD status. Secondary analyses were stratified by the presence or absence of psychiatric or learning disorders. An exploratory longitudinal analysis of IQ across all four outcome assessments was conducted using generalized estimating equations.

RESULTS: No significant associations between AD status and full-scale IQ scores on the GMDS, WPPSI, WISC, and WASI were observed after adjustment for sociodemographic factors, atopic comorbidities, and sleep characteristics. However, at 8 years old, WISC Performance IQ was slightly though statistically significantly lower among children with active/moderate-severe AD (β-coefficient -2.16 [95% CI -4.12, -0.19]) and Verbal IQ was slightly but statistically significantly higher among those with inactive AD (β 1.31 [0.28, 2.34]) compared to those without AD. Analyses stratified by psychiatric or learning disorders, and exploratory longitudinal analyses of cognition revealed similar findings.

CONCLUSIONS: We did not find any clinically meaningful associations between AD activity and severity and general cognitive function during early childhood and adolescence. Future studies should incorporate objective measures of AD severity and investigate outcomes beyond IQ.

PMID:38060978 | DOI:10.1093/bjd/ljad486

JCO Glob Oncol. 2023 Sep;9:e2300182. doi: 10.1200/GO.23.00182.

ABSTRACT

PURPOSE: Multiple myeloma (MM) is a highly heterogeneous, incurable disease most frequently diagnosed in the elderly. Therefore, data on clinical characteristics and outcomes in the very young population are scarce.

PATIENTS AND METHODS: We analyzed clinical characteristics, response to treatment, and survival in 103 patients with newly diagnosed MM age 40 years or younger compared with 256 patients age 41-50 years and 957 patients age 51 years or older.

RESULTS: There were no statistical differences in sex, isotype, International Scoring System, renal involvement, hypercalcemia, anemia, dialysis, bony lesions, extramedullary disease, and lactate dehydrogenase (LDH). The most used regimen in young patients was cyclophosphamide, bortezomib, dexamethasone, followed by cyclophosphamide, thalidomide, dexamethasone and bortezomib, thalidomide, dexamethasone. Of the patients age 40 years or younger, only 53% received autologous stem-cell transplant (ASCT) and 71.1% received maintenance. There were no differences in overall survival (OS) in the three patient cohorts. In the multivariate analysis, only high LDH, high cytogenetic risk, and ASCT were statistically associated with survival.

CONCLUSION: In conclusion, younger patients with MM in Latin America have similar clinical characteristics, responses, and OS compared with the elderly.

PMID:38060975 | DOI:10.1200/GO.23.00182

J Clin Oncol. 2023 Dec 7:JCO2301814. doi: 10.1200/JCO.23.01814. Online ahead of print.

ABSTRACT

PURPOSE: The optimal management of fever without severe neutropenia (absolute neutrophil count [ANC] ≥500/µL) in pediatric patients with cancer is undefined. The previously proposed Esbenshade Vanderbilt (EsVan) models accurately predict bacterial bloodstream infections (BSIs) in this population and provide risk stratification to aid management, but have lacked prospective external validation.

MATERIALS AND METHODS: Episodes of fever with a central venous catheter and ANC ≥500/µL occurring in pediatric patients with cancer were prospectively collected from 18 academic medical centers. Variables included in the EsVan models and 7-day clinical outcomes were collected. Five versions of the EsVan models were applied to the data with calculation of C-statistics for both overall BSI rate and high-risk organism BSI (gram-negative and Staphylococcus aureus BSI), as well as model calibration.

RESULTS: In 2,565 evaluable episodes, the BSI rate was 4.7% (N = 120). Complications for the whole cohort were rare, with 1.1% (N = 27) needing intensive care unit (ICU) care by 7 days, and the all-cause mortality rate was 0.2% (N = 5), with only one potential infection-related death. C-statistics ranged from 0.775 to 0.789 for predicting overall BSI, with improved accuracy in predicting high-risk organism BSI (C-statistic 0.800-0.819). Initial empiric antibiotics were withheld in 14.9% of episodes, with no deaths or ICU admissions attributable to not receiving empiric antibiotics.

CONCLUSION: The EsVan models, especially EsVan2b, perform very well prospectively across multiple academic medical centers and accurately stratify risk of BSI in episodes of non-neutropenic fever in pediatric patients with cancer. Implementation of routine screening with risk-stratified management for non-neutropenic fever in pediatric patients with cancer could safely reduce unnecessary antibiotic use.

PMID:38060973 | DOI:10.1200/JCO.23.01814

Salud Publica Mex. 2023 Sep 15;65(5, sept-oct):475-484. doi: 10.21149/14733.

ABSTRACT

OBJECTIVE: To analyze, from the perspective of intersectionality, the association of social inequality dimensions (occupation, poverty, and educational level) and socio-demographic and health characteristics with the proportion of depressive symptoms among males and females aged 50 years and older who participated in the 2001 and 2012 waves of the Mexican Health and Aging Study (MHAS).

MATERIALS AND METHODS: Descriptive analysis and logistic regression models stratified by sex were performed, including interaction terms between poverty, educational level, and employment conditions on the presence of depressive symptoms.

RESULTS: The proportion of females with depressive symptoms was significantly higher than that of males in both waves. A high proportion of older females in poverty, with five years or less of education and manual occupational activities, reported depressive symptoms in the MHAS-2001. The interactions evaluated between occupation, poverty, and educational level were not statistically significant under adjusted models; however, disability and comorbidities were associated with depressive symptoms in both sexes.

CONCLUSION: A higher proportion of females have depressive symptoms under conditions of inequality; however, the effect of the intersection between employment and socio-demographic characteristics on depressive symptoms was not observed under adjusted models.

PMID:38060918 | DOI:10.21149/14733

Salud Publica Mex. 2023 Mar 10;65(2 mar-abr):151-159. doi: 10.21149/14232.

ABSTRACT

OBJECTIVE: To evaluate indoor use of commercial aerosols for dengue vector mosquito control, and estimate the number of treatable houses per can.

MATERIALS AND METHODS: Four aerosol products containing combinations of pyrethroids (two containing propoxur and one containing synergists too), were evaluated with mosquitoes in a room of a Tapachulastyle house. Eight cages containing 20 insecticide susceptible or resistant females were hung from tripods, another set was placed in sheltered areas of the room. From the entrance of the room, one of 4-9 concentrations was sprayed for each aerosol, leaving the mosquitoes for 30 min after sprayed. Mortality was recorded after 24 h and lethal concentrations were calculated.

RESULTS: Aerosol A had the highest LC50, with 0.308 g for mosquitoes hanging from tripods and 0.453 g for sheltered mosquitoes; followed by aerosols C, D and B, with statistical differences between types of exposure.

CONCLUSIONS: Aerosols B-D could spray 20-25 3-room houses (56 m3-room), killing all resistant mosquitoes. Aerosols may become a good tool for indoor mosquito control, if the optimal concentration and correct spray method are used.

PMID:38060852 | DOI:10.21149/14232

Acta Biochim Pol. 2023 Dec 7. doi: 10.18388/abp.2020_6817. Online ahead of print.

ABSTRACT

BACKGROUND: We aimed to analyze the value of serum (sdLDLc*HCYc)/HDLc ratio in the stability of intracranial arterial plaques among patients with acute cerebral infarction.

METHODS: A retrospective analysis was conducted on 140 patients with acute cerebral infarction admitted to the neurology department and 101 healthy individuals for regular examinations in our hospital from 2013 to 2019, who were respectively allocated into the study group and the control group. Participants in both groups were measured for serum sdLDLc, HDLc, and HCYc using peroxidase method, enzyme-linked immunosorbent assay, and enzyme method, respectively. The laboratory indexes of the two groups were compared. The multivariate logistic regression analysis was done to analyze the influencing factors of the stability of intracranial artery plaque in patients with acute cerebral infarction. The value of high-density lipoprotein cholesterol (HDL-C), homocysteine, sdLDLc, (sdLDLc*HCYc)/HDLc in diagnosing the stability of intracranial artery plaque was also evaluated in patients with acute cerebral infarction.

RESULTS: There was no distinct difference in height, hypertension, diabetes, coronary heart disease, smoking history and drinking history between the two groups (P>0.05). The study group showed statistically significant differences in age, gender, weight, and BMI (P<0.05). The current study demonstrated no statistical difference in the levels of TG, low-density lipoprotein cholesterol (LDL-C), α-lipoprotein, and HCYc between the two groups (P>0.05). However, the levels of TC, HDL-C, sdLDLc, (sdLDLc*HCYc)/HDLc in the study group were significantly different when comparing with the control group (P<0.05). No statistically significant difference was found in the levels of TG, triglycerides, LDL-C, α-lipoprotein, and HCYc among patients with different degrees of stenosis in the study group (P>0.05). The level of HDL-C was significantly lower in cases of severe stenosis compared to no stenosis, mild stenosis and moderate stenosis, with severe stenosis showing the lowest levels; mild stenosis had lower levels than no stenosis, while moderate stenosis had lower levels than both no stenosis and mild stenosis (P<0.05). The levels of sdLDLc, (sdLDLc*HCYc)/HDLc exhibited a significant increase in cases of severe stenosis as compared tono stenosis, mild stenosis, and moderate stenosis. Furthermore, the levels of sdLDLc, (sdLDLc*HCYc)/HDLc were found to be higher in moderate stenosis as compared to no stenosis and mild stenosis. Similarly, the levels of sdLDLc, (sdLDLc*HCYc)/HDLc were observed to be higher in mild stenosis than no stenosis (P<0.05).The independent variables were set as the indicators with difference in single factor comparison, including age, gender, BMI, TC, LDL-C, HDL-C, HCYc, sdLDLc, (sdLDLc*HCYc)/HDLc. The dependent variable was the stability of intracranial artery plaque in patients with acute cerebral infarction. After variable selection, the results showed that the factors influencing the stability of intracranial artery plaque in patients with acute cerebral infarction were age, BMI, (sdLDLc*HCYc)/HDLc. The degree of plaque enhancement was used as a criterion to reflect the stability of plaque. ROC curve analysis showed that (sdLDLc*HCYc)/HDLc had a higher evaluation value for the stability of intracranial artery plaque than HDL-C, homocysteine, and sdLDLc in patients with acute cerebral infarction.

CONCLUSION: The serum (sdLDLc*HCYc)/HDLc ratio was found to have potential in evaluating the stability of intracranial arterial plaques in patients with acute cerebral infarction.

PMID:38060820 | DOI:10.18388/abp.2020_6817