Category: Nevin Manimala

Indian J Community Med. 2023 May-Jun;48(3):413-417. doi: 10.4103/ijcm.ijcm_839_22. Epub 2023 May 30.

ABSTRACT

BACKGROUND: “Donation gap” refers to the shortage of organ donors worldwide. The medical/nursing students and various healthcare workers have poor awareness and attitude toward organ donation.

OBJECTIVE: We conducted this study to assess the current level of knowledge and perception regarding cadaver organ donation and transplantation among nursing students and to evaluate the impact of structured training interventions on their baseline knowledge and perception level.

METHODS: It was a single-group pre-post interventional study done by nursing students of one government and one private nursing college.A pre-tested questionnaire was used as a study tool.

STATISTICAL ANALYSIS: Various statistical tests like one-way repeated measure ANOVA, Mauchly’s test of sphericity, and Greenhouse-Geisser correction were used. Pairwise comparisons used Bonferroni corrections.

RESULTS: The pre-test group had the lowest mean knowledge (50.2346, SD = 15.35188), and immediately after training group had the highest (57.3900, SD = 14.34626). After one month, knowledge decreased but was still higher than pretraining (mean = 52.3607, SD = 13.28141).

CONCLUSIONS: The positive attitude of nursing students may augment cadaver organ donation and transplantation in the future. The study has also highlighted the further training needs of the participants.

PMID:37469919 | PMC:PMC10353686 | DOI:10.4103/ijcm.ijcm_839_22

Alcohol (Hanover). 2023 Jul 19. doi: 10.1111/acer.15155. Online ahead of print.

ABSTRACT

BACKGROUND: Effective pharmacologic treatments for comorbid alcohol use disorder (AUD) and post-traumatic stress disorder (PTSD) are lacking. Kappa (κ) opioid receptor antagonists may address this unmet need. Buprenorphine is a κ-opioid antagonist and a partial agonist of mu (μ) opioid receptors, and naltrexone blocks all μ-mediated effects, thus, yielding a pharmacological net effect of a κ-opioid receptor antagonist. This combination was tested in this proof-of-concept study since no specific κ-opioid receptor antagonist was available.

METHODS: Consenting participants were enrolled in a Phase II, multisite, double-blinded, randomized, placebo-controlled trial to evaluate the effectiveness of sublingual buprenorphine combined with extended-release (XR) injectable naltrexone for the treatment of comorbid AUD and PTSD. Eligible participants (n=75) were randomized (1:1:1) to receive either buprenorphine 2mg/d plus naltrexone-XR (n=35), buprenorphine 8mg/d plus naltrexone-XR (n=6) or sublingual plus injectable placebo (n=34) for 12 weeks. The buprenorphine 8mg/d plus naltrexone-XR arm was dropped early due to the negative impact of COVID-19 on enrollment. A binary primary outcome of response at week 8 was defined as a decrease from baseline of ≥10 points on the past week Clinician-Administered PTSD Scale (CAPS-5) and a reduction of ≥1 of past month alcohol risk level, as defined by World Health Organization (WHO) and measured by the Timeline Follow-Back.

RESULTS: Based on the results of a futility analysis, enrollment was stopped prior to reaching initial goal of 90 participants. At the week 8 primary timepoint, there were no statistically significant differences between buprenorphine plus naltrexone-XR and placebo group for the primary composite outcome (OR = 0.63; p-value = 0.52), or the subcomponents of the PTSD outcome (OR = 0.76; p-value = 0.69) and AUD outcome (OR = 0.17; p-value = 0.08). The placebo arm had a significantly higher proportion of participants with ≥1 WHO risk reduction compared to the buprenorphine plus naltrexone-XR arm (OR=0.18, p value = 0.02).

CONCLUSIONS: This is the first study to evaluate the potential of κ-opioid receptor antagonism for the treatment of comorbid AUD and PTSD. The combination of buprenorphine and naltrexone-XR showed no significant improvement over placebo for the composite, PTSD or alcohol measures.

PMID:37468230 | DOI:10.1111/acer.15155

Emerg Med J. 2023 Jul 19:emermed-2022-213057. doi: 10.1136/emermed-2022-213057. Online ahead of print.

ABSTRACT

Clinical risk prediction models can support decision making in emergency medicine, but directing intervention towards high-risk patients may involve a flawed assumption. This concepts paper examines prognostic clinical risk prediction and specifically describes the potential impact of treatment effects in model development studies. Treatment effects may lead to models failing to achieve the aim of identifying the patients most likely to benefit from intervention, and may instead identify patients who are unlikely to benefit from intervention. The paper provides practical advice to help clinicians who wish to use clinical prediction scores to assist clinical judgement rather than dictate clinical decision making.

PMID:37468227 | DOI:10.1136/emermed-2022-213057

Pigment Cell Melanoma Res. 2023 Jul 19. doi: 10.1111/pcmr.13113. Online ahead of print.

ABSTRACT

Sentinel lymph node biopsy (SLNB) provides important prognostic information for early-stage melanomas. However, statistics regarding the survival comparison between SLNB and nodal observation in Asia, where acral lentiginous melanoma (ALM) predominates, are limited. This study aimed to identify if SLNB offered survival benefits over nodal observation in early-stage melanomas in Taiwan. The retrospective study included 227 patients who met the SLNB criteria according to the National Comprehensive Cancer Network guidelines and were treated at National Taiwan University Hospital from June 1997 to June 2021. Survival analysis was performed using Kaplan-Meier curves and Cox proportional hazards regression models. Of the study population, ALM accounted for 73.1%; 161 patients (70.9%) underwent SLNB and 66 patients (29.1%) were under nodal observation. Multivariate analysis showed significantly improved melanoma-specific survival (hazard ratio [HR], 0.6; p = .02) in the SLNB group. Among those who underwent completion lymph node dissection (CLND), the non-sentinel node positivity rate was 44.4%. Immediate CLND resulted in significantly longer melanoma-specific survival and distant-metastasis-free survival (DMFS) compared to nodal observation. (HR, 0.2; p = .01 for melanoma-specific survival. HR, 0.3; p = .046 for DMFS). In conclusion, SLNB may provide survival benefits of cutaneous melanoma over nodal observation in the Taiwanese population.

PMID:37468225 | DOI:10.1111/pcmr.13113

J Am Coll Cardiol. 2023 Jul 25;82(4):336-349. doi: 10.1016/j.jacc.2023.05.024.

ABSTRACT

BACKGROUND: The relationship between omega-3 fatty acids and atrial fibrillation (AF) remains controversial.

OBJECTIVES: This study aimed to determine the prospective associations of blood or adipose tissue levels of eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), and docosahexaenoic acid (DHA) with incident AF.

METHODS: We used participant-level data from a global consortium of 17 prospective cohort studies, each with baseline data on blood or adipose tissue omega-3 fatty acid levels and AF outcomes. Each participating study conducted a de novo analyses using a prespecified analytical plan with harmonized definitions for exposures, outcome, covariates, and subgroups. Associations were pooled using inverse-variance weighted meta-analysis.

RESULTS: Among 54,799 participants from 17 cohorts, 7,720 incident cases of AF were ascertained after a median 13.3 years of follow-up. In multivariable analysis, EPA levels were not associated with incident AF, HR per interquintile range (ie, the difference between the 90th and 10th percentiles) was 1.00 (95% CI: 0.95-1.05). HRs for higher levels of DPA, DHA, and EPA+DHA, were 0.89 (95% CI: 0.83-0.95), 0.90 (95% CI: 0.85-0.96), and 0.93 (95% CI: 0.87-0.99), respectively.

CONCLUSIONS: In vivo levels of omega-3 fatty acids including EPA, DPA, DHA, and EPA+DHA were not associated with increased risk of incident AF. Our data suggest the safety of habitual dietary intakes of omega-3 fatty acids with respect to AF risk. Coupled with the known benefits of these fatty acids in the prevention of adverse coronary events, our study suggests that current dietary guidelines recommending fish/omega-3 fatty acid consumption can be maintained.

PMID:37468189 | DOI:10.1016/j.jacc.2023.05.024

J Mol Biol. 2023 Aug 1;435(15):168181. doi: 10.1016/j.jmb.2023.168181. Epub 2023 Jun 9.

ABSTRACT

Identifying the common structural elements of functionally related RNA sequences (family) is usually based on an alignment of the sequences, which is often subject to human bias and may not be accurate. The resulting covariance model (CM) provides probabilities for each base to covary with another, which allows to support evolutionarily the formation of double helical regions and possibly pseudoknots. The coexistence of alternative folds in RNA, resulting from its dynamic nature, may lead to the potential omission of motifs by CM. To overcome this limitation, we present D-ORB, a system of algorithms that identifies overrepresented motifs in the secondary conformational landscapes of a family when compared to those of unrelated sequences. The algorithms are bundled into an easy-to-use website allowing users to submit a family, and optionally provide unrelated sequences. D-ORB produces a non-pseudoknotted secondary structure based on the overrepresented motifs, a deep neural network classifier and two decision trees. When used to model an Rfam family, D-ORB fits overrepresented motifs in the corresponding Rfam structure; more than a hundred Rfam families have been modeled. The statistical approach behind D-ORB derives the structural composition of an RNA family, making it a valuable tool for analyzing and modeling it. Its easy-to-use interface and advanced algorithms make it an essential resource for researchers studying RNA structure. D-ORB is available at https://d-orb.major.iric.ca/.

PMID:37468182 | DOI:10.1016/j.jmb.2023.168181

BMJ. 2023 Jul 19;382:e071757. doi: 10.1136/bmj-2022-071757.

NO ABSTRACT

PMID:37468141 | DOI:10.1136/bmj-2022-071757

Can J Cardiol. 2023 Jul 17:S0828-282X(23)01521-0. doi: 10.1016/j.cjca.2023.07.014. Online ahead of print.

ABSTRACT

The Cox proportional hazards model is one of the most popular statistical tools to model time to event outcomes without the need for specifying the hazards or survival time distributions. The Cox model requires that the ratio of the hazards of the occurrence of the outcome for any two individuals remain constant during the entire follow-up. Studies comparing coronary revascularization strategies, however, might be prone to violations of proportionality by the crossing of the hazard functions over time. Early increases in the risk of cardiovascular outcomes are commonly observed when comparing coronary artery bypass grafting versus percutaneous coronary intervention, while decreased risk might be observed later during the follow-up. The same is valid for comparisons between invasive versus conservative coronary revascularization strategies. In these situations, the statistical power of the Cox model is reduced, and hazard ratios might not be an informative summary measure of treatment effect. In this manuscript, we discuss methods to identify and account for nonproportionality. We illustrate the use of these methods in a case study, based on reconstructed data from a coronary revascularization clinical trial. Finally, we review the cardiovascular literature to estimate how the proportionality assumption has been reported in coronary revascularization studies recently.

PMID:37468120 | DOI:10.1016/j.cjca.2023.07.014

Am J Ophthalmol. 2023 Jul 17:S0002-9394(23)00288-X. doi: 10.1016/j.ajo.2023.07.010. Online ahead of print.

ABSTRACT

PURPOSE: Ultra-widefield (UWF) imaging is commonly used in ophthalmology in tandem with scleral depressed examinations (SDE) to evaluate peripheral retinal disease. Due to increased reliance of this technology in tele-ophthalmology, it is critical to evaluate its efficacy for detecting the peripheral retina when performed in isolation. Therefore, we sought to evaluate UWF imaging sensitivity in detecting retinal horseshoe tears (HST).

DESIGN: A retrospective clinical validity and reliability study METHODS: A single-institutional retrospective analysis was performed on patients at the Shiley Eye Institute, UC, San Diego. Those with HSTs seen on SDE and underwent treatment with laser were included in the study. 140 patients with HSTs in the right and/or left eyes met the inclusion criteria. Those with concomitant ruptured globes, retinal detachments and vitreous hemorrhages were excluded. A total of 123 patients with 135 HSTs were included in the final analysis. The primary outcome was the number of HSTs detected by UWF imaging. A secondary outcome was HST location. Sensitivity was measured with respect to HST location and statistical significance was calculated by Fisher exact testing.

RESULTS: 69 (51.1%) HSTs were visualized on UWF images and 66 (48.9%) were not visualized. The sensitivity of UWF imaging in capturing HSTs was 7/41 (17.1%), 8/25 (32.0%), 7/14 (50.0%) and 47/55 (85.5%) for the superior, inferior, nasal and temporal quadrants, respectively. Sensitivities among HST visibility and location were statistically significant (p < 0.001) CONCLUSIONS: Nearly half of HSTs were missed by UWF imaging. This study demonstrates that UWF imagin.

PMID:37468086 | DOI:10.1016/j.ajo.2023.07.010

Prev Med. 2023 Jul 17:107624. doi: 10.1016/j.ypmed.2023.107624. Online ahead of print.

ABSTRACT

This paper tried to observe the relationship between the personality of patients with different personalities and the survival rate of replantation of traumatic amputated finger, and analyzed the influencing factors. EPQ psychological quality scores of patients with different gender, average monthly family income and age were significantly different (P < 0.05). In terms of the internal and external tendency score of EPQ, there were statistical requirements for differences in the mean monthly income of patients from different families (P < 0.05). For the concealment degree of EPQ, there were statistical requirements for differences in gender, family income, education level and patient scores (P < 0.05). In terms of mental state, the scores were higher than the standard, whether from the perspective of obsessive-compulsive symptoms, or from the perspective of interpersonal sensitivity, hostility, paranoia and other dimensions, the difference was statistically significant (P < 0.05). Patients with different personality types have different psychological problems after accidental amputation and replantation, which is directly related to the survival rate of postoperative finger amputation. Therefore, in order to effectively improve the survival rate of patients with finger amputation, the psychological condition of patients can be assessed, early detection and intervention of patients’ psychological problems, and appropriate intervention measures can be taken according to the personality characteristics of patients.

PMID:37468075 | DOI:10.1016/j.ypmed.2023.107624