Category: Nevin Manimala

J Cardiovasc Med (Hagerstown). 2022 May 1;23(5):338-343. doi: 10.2459/JCM.0000000000001292.

ABSTRACT

AIMS: Low-gradient aortic stenosis is a challenging entity that needs accurate preoperative evaluation. For this high-risk patient population, ad hoc predictive scores are not available and profile risk is currently revealed by the EuroSCOREs. Aims of this study are to verify the suitability of the ES II as predictor of mortality in low-gradient aortic stenosis and to analyse the role of surgery as a treatment.

METHODS: From June 2013 to August 2019, 414 patients underwent surgical aortic valve replacement for low-gradient aortic stenosis. Mean age was 75.78 ± 6.77 years and 190 were women. The prognostic value of Logistic EuroSCORE and EuroSCORE II were compared by receiver-operating characteristics (ROC) curve analysis.

RESULTS: In-hospital, 30-day and 1-year mortality rates were respectively 3.4, 2.9 and 4.8% (14, 12 and 20 patients over 414). In-hospital mortality risk calculated by the Additive EuroSCORE was 7.2 ± 2.7%, by the Logistic EuroSCORE was 9 ± 5.2% and by the ES II was 4.13 ± 2.56%. The prognostic values of the EuroSCORE II and of the EuroSCORE were analysed in a ROC curve analysis for the prediction of in-hospital mortality [area under the curve (AUC): 0.62 vs. 0.58], 30-day mortality (AUC: 0.63 vs. 0.64) and 1-year mortality (AUC: 0.79 vs. 0.65). Both scores did not show significant differences with the only exception of 1-year mortality, for which EuroSCORE II had a better predictive ability than the Logistic EuroSCORE (P < 0.05).

CONCLUSION: In low-gradient aortic stenosis undergoing surgery, the EuroSCORE II is a strong predictor of 1-year mortality.

PMID:35486684 | DOI:10.2459/JCM.0000000000001292

J Cardiovasc Med (Hagerstown). 2022 May 1;23(5):308-317. doi: 10.2459/JCM.0000000000001270. Epub 2021 Nov 8.

ABSTRACT

AIM: Lipid abnormalities often occur in patients with diabetes mellitus and the coexistence of diabetes mellitus and dyslipidaemia will increase the risk of cardiovascular diseases. However, the specific effects of sitagliptin on lipid control remain elusive in diabetic patients. The aim of this meta-analysis is to investigate the effects of sitagliptin alone or with other antidiabetic agents on serum lipid control.

METHODS: PubMed, Cochrane Library, Embase and the ClinicalTrials.gov website were systematically searched from 2006 (the first year that sitagliptin entered market) to 16 January 2021. Eligible studies were randomized clinical trials (RCTs) of sitagliptin including outcomes of serum total cholesterol (TC), triglycerides, high-density lipoprotein cholesterol (HDL-C) or low-density lipoprotein cholesterol (LDL-C).

RESULTS: A total of 14 RCTs with 2654 patients were identified. Treatment with sitagliptin alone or in combination with other antidiabetic agents significantly reduced serum TC [mean difference (MD) = -5.52 95% confidence interval (95% CI), -7.88 to -3.15; P < 0.00001] and LDL-C (MD = -0.07; 95% CI, -0.14 to 0.00; P < 0.00001) in patients with type 2 diabetes. No statistical significances were found in serum triglycerides (MD = 1.53; 95% CI, -8.22 to 11.28; P = 0.76) or HDL-C (MD = 0.65; 95% CI, -1.59 to 0.29; P = 0.18). Subgroup analyses suggest that sitagliptin can significantly decrease serum LDL-C, TC and triglyceride levels compared with placebo alone, and no statistical significance was found in comparison with the serum HDLC levels.

CONCLUSION: Sitagliptin alone or in combination with other antidiabetic agents significantly reduces serum TC and LDL-C in patients with type 2 diabetes mellitus, while no significant difference was observed in serum triglycerides or HDL-C.

PMID:35486682 | DOI:10.2459/JCM.0000000000001270

PLoS One. 2022 Apr 29;17(4):e0265367. doi: 10.1371/journal.pone.0265367. eCollection 2022.

ABSTRACT

This study was done to investigate the prevalence of depression and suicidal ideation among private medical students in Bangladesh. A total of 237 medical students participated in this cross-sectional web-based survey by e-questionnaire using the Google Form. The study was conducted from November 2020 to December 2020 at Enam Medical College and Hospital which is situated in Savar, Dhaka, Bangladesh. Out of 237 medical students, prevalence of depression was found 58.6%, and prevalence of suicidal ideation was found 27.4% which is higher than the global prevalence. Bivariate and multivariate analysis and logistic regression-based odds ratios (ORs) was done to see the association between grade of depression and suicidal thoughts with different variables. Association between grade of depression with family problems (x2 = 16.716, P = 0.001), drug addiction (x2 = 16.601, P = 0.001), committed relationship status (x2 = 40.292, P = <0.001) were statistically significant. Whereas, the association between suicidal thoughts with family problems (x2 = 29.881, P = <0.001), failed any subject during study (x2 = 12.024, P = 0.007), alcohol uses (x2 = 15.977, P = 0.001), drug addiction (x2 = 22.633, P = <0.001), committed relationship status (x2 = 35.219, P = <0.001) were statistically significant. However, medical students whom had to earn other than their family income were 2.3 times (OR: 2.285, 95% CL: 0.897, 5.820) greater prone to be depressed than those who do not had to earn by themselves. On the contrary, medical students who are single were 2.35 times (OR: 2.352, 95% CL: 0.926, 5.973) greater prone to have suicidal thoughts than the married students. This study showed that a large percentage of Bangladeshi medical students have been suffering from depression and suicidal ideation. Our recommendation for the authority of the medical colleges are, to build a system with counselling facilities inside every medical colleges in Bangladesh.

PMID:35486632 | DOI:10.1371/journal.pone.0265367

Dermatol Ther. 2022 Apr 29:e15543. doi: 10.1111/dth.15543. Online ahead of print.

ABSTRACT

INTRODUCTION: Continuous production of reactive oxygen species, induced by UV radiation, is one of the main mechanisms contributing to skin photoaging. Therefore, the use of novel superior antioxidants, which ferulic acid belongs to, is an innovative treatment option. The aim of this study was to evaluate the effect of 14% ferulic acid peel on skin hydration, topography, the level of melanin, and the severity of erythema, in people with skin photoaging symptoms.

METHODS: 20 women aged 45 to 60, received 8 treatments of chemical peeling in 1-week intervals. Efficacy was measured using The Multi Probe Adapter (MPA) Systems (Courage + Khazaka electronic GmbH, Köln, Germany). The measurements were taken before, 8, and 12 weeks after the first treatment. Additionally, the photo documentation was made with Fotomedicus (Elfo) and VISIA® Complexion Analysis System (Canfield Scientific, Inc.). Results The objective evaluation showed statistically significant improvement in all measured skin parameters (P<0,05). The best results of skin hydration and melanin level were observed right after the end of the series (P<0,001). The best improvement in erythema reduction was noted a month after the last treatment (P<0,0001). At the control, untreated point none of the probes showed statistically significant changes.

CONCLUSION: In conclusion, a series of treatments with 14% ferulic acid peel has a significant bleaching, erythema-reducing, and moisturizing activity. The results achieved by apparatus, are reflected by photo documentation. The effects achieved during a series persist over time.

PMID:35486440 | DOI:10.1111/dth.15543

J Med Internet Res. 2022 Apr 29;24(4):e30898. doi: 10.2196/30898.

ABSTRACT

BACKGROUND: The emerging health technologies and digital services provide effective ways of collecting health information and gathering patient-generated health data (PGHD), which provide a more holistic view of a patient’s health and quality of life over time, increase visibility into a patient’s adherence to a treatment plan or study protocol, and enable timely intervention before a costly care episode.

OBJECTIVE: Through a national cross-sectional survey in the United States, we aimed to describe and compare the characteristics of populations with and without mental health issues (depression or anxiety disorders), including physical health, sleep, and alcohol use. We also examined the patterns of social networking service use, PGHD, and attitudes toward health information sharing and activities among the participants, which provided nationally representative estimates.

METHODS: We drew data from the 2019 Health Information National Trends Survey of the National Cancer Institute. The participants were divided into 2 groups according to mental health status. Then, we described and compared the characteristics of the social determinants of health, health status, sleeping and drinking behaviors, and patterns of social networking service use and health information data sharing between the 2 groups. Multivariable logistic regression models were applied to assess the predictors of mental health. All the analyses were weighted to provide nationally representative estimates.

RESULTS: Participants with mental health issues were significantly more likely to be younger, White, female, and lower-income; have a history of chronic diseases; and be less capable of taking care of their own health. Regarding behavioral health, they slept <6 hours on average, had worse sleep quality, and consumed more alcohol. In addition, they were more likely to visit and share health information on social networking sites, write online diary blogs, participate in online forums or support groups, and watch health-related videos.

CONCLUSIONS: This study illustrates that individuals with mental health issues have inequitable social determinants of health, poor physical health, and poor behavioral health. However, they are more likely to use social networking platforms and services, share their health information, and actively engage with PGHD. Leveraging these digital technologies and services could be beneficial for developing tailored and effective strategies for self-monitoring and self-management.

PMID:35486428 | DOI:10.2196/30898

Nutr Cancer. 2022 Apr 29:1-9. doi: 10.1080/01635581.2022.2069273. Online ahead of print.

ABSTRACT

Purpose: To explore the prognostic role of the pretreatment geriatric nutritional risk index (GNRI) in patients with esophageal cancer. Methods: Several electronic databases were searched from inception to January 27, 2022, for relevant studies. Hazard ratios (HRs) and 95% confidence intervals (CIs) were combined to assess the association between pretreatment GNRI and the prognosis of patients with esophageal cancer. The primary and secondary outcomes were overall survival (OS) and progression-free survival (PFS), respectively. Statistical analyses were performed using STATA software (version 12.0). Results: Fourteen retrospective studies involving 3981 patients were enrolled. The pooled results demonstrated that lower pretreatment GNRI was an independent prognostic risk factor for poorer OS (HR = 1.47, 95% CI: 1.33-1.63, P < 0.001) and PFS (HR = 1.69, 95% CI: 1.24-2.31, P = 0.001). Subgroup analysis based on pathological type (squamous cell carcinoma vs. esophageal cancer) and treatment (non-surgery vs. surgery) showed similar results. Conclusion: Pretreatment GNRI was significantly associated with prognosis of patients with esophageal cancer, and lower pretreatment GNRI predicted worse survival. However, more prospective high-quality studies are needed to verify these findings.

PMID:35486420 | DOI:10.1080/01635581.2022.2069273

JMIR Form Res. 2022 Apr 29;6(4):e36043. doi: 10.2196/36043.

ABSTRACT

BACKGROUND: With increased reliance on digital health care, including telehealth, efficient and effective ways are needed to assess patients’ comfort and confidence with using these services.

OBJECTIVE: The goal of this study was to develop and validate a brief scale that assesses digital health care literacy.

METHODS: We first developed an item pool using existing literature and expert review. We then administered the items to participants as part of a larger study. Participants were caregivers of children receiving care at a pediatric clinic who completed a survey either on the web or over the telephone. We randomized participants into development and confirmatory samples, stratifying by language so that exploratory factor analysis and confirmatory factor analysis could be performed with separate samples of participants. We assessed the scale’s validity by examining its associations with participants’ demographics, digital access, and prior digital health care use.

RESULTS: Participants (N=508) were, on average, aged 34.7 (SD 7.7) years, and 89.4% (454/508) were women. Of the 508 participants, 280 (55.1%) preferred English as their primary language, 157 (30.9%) preferred Spanish, and 71 (14%) preferred Arabic; 228 (45%) had a high school degree or less; and 230 (45.3%) had an annual household income of <US $35,000. Using exploratory factor analysis, 3 items were retained in a reduced scale with excellent reliability (Cronbach α=.90) and a high variance explained (78%). The reduced scale had excellent fit, with factor loadings between 0.82 and 0.94. All fit statistics exceeded the criteria for good fit between the proposed factor structure and the data. We refer to this scale as the Digital Health Care Literacy Scale. The scale was positively associated with education (ρ=0.139; P=.005) and income (ρ=0.379; P<.001). Arabic speakers had lower scores than English (P<.001) and Spanish speakers (P=.02), and Spanish speakers had lower scores than English speakers (P<.001). Participants who did not own a smartphone (P=.13) or laptop computer (P<.001) had lower scores than those who owned these devices. Finally, participants who had not used digital tools, including health apps (P<.001) and video telehealth (P<.001), had lower scores than those who had used these tools.

CONCLUSIONS: Despite the potential for digital health care to improve quality of life and clinical outcomes, many individuals may not have the skills to engage with and benefit from it. Moreover, these individuals may be those who already experience worse outcomes. A screening tool such as the Digital Health Care Literacy Scale could be a useful resource to identify patients who require additional assistance to use digital health services and help ensure health equity.

PMID:35486413 | DOI:10.2196/36043

JAMA Netw Open. 2022 Apr 1;5(4):e229574. doi: 10.1001/jamanetworkopen.2022.9574.

ABSTRACT

IMPORTANCE: The role of healthy eating in the association between excess weight and psychosocial health among children is unknown.

OBJECTIVE: To investigate whether a diet based on healthy eating habits moderates the association between excess weight and psychosocial problems in a large sample of children in Spain.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cross-sectional study used data on a representative sample of 3772 children collected in 2017 through the Spanish National Health Survey. Statistical analysis was conducted from September 21 to October 27, 2021.

MAIN OUTCOMES AND MEASURES: Body mass index was calculated as weight in kilograms divided by height in meters squared; body mass index z scores were computed following the sex and age criteria of the International Obesity Task Force and were used to determine excess weight. Diet quality was assessed using the Spanish Healthy Eating Index (S-HEI; a higher score denotes greater adherence to the guidelines of the Spanish Society of Community Nutrition and, therefore, a higher quality of diet). Psychosocial problems were assessed with the Strengths and Difficulties Questionnaire completed by parents or guardians. All analyses were adjusted for major confounders.

RESULTS: Among the 3772 participants (1908 boys [50.6%]; mean [SD] age, 9.5 [3.1] years), the prevalence of excess weight (ie, overweight or obesity) was 38.4% (n = 1448). Diet quality moderated the association between excess weight and psychosocial problems (β = -0.06; 95% CI, -0.09 to -0.02). Moderation analysis revealed 2 different regions of significance according to the S-HEI score. First, the association between excess weight and psychosocial problems was greater for children with an S-HEI score lower than 67.5. Second, the association of excess weight with psychosocial problems was lower for children with an S-HEI score higher than 84.9. In addition, a neutral area was found, indicating that the association between excess weight and psychosocial problems neither increased nor decreased in those with an S-HEI score between 67.5 and 84.9.

CONCLUSIONS AND RELEVANCE: The results of this study suggest that the association between excess weight and psychosocial problems is moderated by diet quality among children in Spain. These findings are clinically relevant because psychosocial problems are a major concern among children with excess weight. Because obesity is a chronic disease, it requires ongoing counseling and treatment throughout life.

PMID:35486399 | DOI:10.1001/jamanetworkopen.2022.9574

JAMA Netw Open. 2022 Apr 1;5(4):e228573. doi: 10.1001/jamanetworkopen.2022.8573.

ABSTRACT

IMPORTANCE: In the United States, individuals with HIV infection have been recommended to receive a 2-dose series of the meningococcal A, C, W, Y (MenACWY) vaccine since 2016 owing to their increased risk of meningococcal disease.

OBJECTIVE: To examine uptake and time to receipt of the MenACWY vaccine among people with a new diagnosis of HIV.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used health insurance data from the US Optum Research Database from January 1, 2016, through March 31, 2018, to retrospectively identify 1208 individuals aged 2 years or older with 1 or more inpatient claim or 2 or more outpatient claims evidencing a new diagnosis of HIV infection and with continuous insurance enrollment for 12 or more months before and 6 or more months after diagnosis. Follow-up was 6 to 33 months. Statistical analysis was conducted from March 7, 2019, to January 5, 2022.

EXPOSURE: Receipt of the MenACWY vaccine.

MAIN OUTCOMES AND MEASURES: The coprimary outcomes were uptake and time to receipt of 1 or more doses of the MenACWY vaccine after a new HIV diagnosis. Secondary outcomes included uptake and time to receipt of 2 or more doses of the MenACWY vaccine. Vaccination uptake and receipt were estimated by Kaplan-Meier analysis; factors associated with receipt of 1 or more doses of the MenACWY vaccine were identified with multivariable Cox proportional hazards regression analysis.

RESULTS: Of 1208 individuals eligible for vaccination (1024 male patients [84.8%]; mean [SD] age, 38.8 [12.5] years; 35 [2.9%] Asian; 273 [22.6%] Black; 204 [16.9%] Hispanic; 442 [36.6%] White), 16.3% were estimated to have received a first dose of the MenACWY vaccine in the 2 years after a new HIV diagnosis. Among individuals who received a first dose, at 1 year or more of enrollment after the first dose, 66.2% were estimated to have received a second dose within 1 year of the first dose. Factors statistically significantly associated with uptake of the MenACWY vaccine included receipt of a pneumococcal vaccine (hazard ratio [HR], 23.03; 95% CI, 13.93-38.09), attendance at a well-care visit (HR, 3.67; 95% CI, 1.11-12.12), West or Midwest geographic region (West: HR, 2.24; 95% CI, 1.44-3.47; Midwest: HR, 1.78; 95% CI, 1.16-2.71), and male sex (HR, 2.72; 95% CI, 1.18-6.26), whereas age of 56 years or older was significantly associated with reduced uptake of the MenACWY vaccine (HR, 0.42; 95% CI, 0.18-0.97).

CONCLUSIONS AND RELEVANCE: This cohort study suggests that MenACWY vaccine uptake among people with a new diagnosis of HIV was low, highlighting the need to educate patients and clinicians about the recommendations for conditions such as HIV infection that increase the risk of meningococcal disease among high-risk populations.

PMID:35486405 | DOI:10.1001/jamanetworkopen.2022.8573

Angew Chem Int Ed Engl. 2022 Apr 29. doi: 10.1002/anie.202200983. Online ahead of print.

ABSTRACT

Understanding how mutations render a drug ineffective is a problem of immense relevance. Often the mechanism through which mutations cause drug resistance can be explained purely through thermodynamics. However, the more perplexing situation is when two proteins have the same drug binding affinities but different residence times. In this work, we demonstrate how all-atom molecular dynamics simulations using recent developments grounded in statistical mechanics can provide a detailed mechanistic rationale for such variances. We discover dissociation mechanisms for the anti-cancer drug Imatinib (Gleevec) against wild-type and the N368S mutant of Abl kinase. We show how this point mutation triggers far-reaching changes in protein’s flexibility and leads to a different, much faster, drug dissociation pathway. We believe that this work marks an efficient and scalable approach to obtain mechanistic insight into resistance mutations in biomolecular receptors that are hard to explain using a structural perspective.

PMID:35486370 | DOI:10.1002/anie.202200983