Category: Nevin Manimala

Vopr Pitan. 2023;92(3):45-53. doi: 10.33029/0042-8833-2023-92-3-45-53. Epub 2023 May 29.

ABSTRACT

The study of the influence of nutrition and its associations with other parameters, which are closely related to the metabolic profile, in order to better understand the mechanisms of realization of the obesity phenotype in the child population is of particular interest. The aim of the study was to investigate the eating habits of elementary school children and their dependence on the parameters of physical development and body composition of the child population of Tomsk. Material and methods. 506 children aged 7 to 12 years were examined. The main group consisted of 216 children (53.1% boys, 46.9% girls) with overweight and obesity, the control group – 290 healthy children (49.0% boys, 51.0% girls). All children underwent measurement of anthropometric parameters with the calculation of SDS body mass index (WHO Anthro Plus), estimation of body composition by bioimpedancemetry. The actual nutrition of schoolchildren was assessed by the frequency method using a questionnaire. Results. Overweight and obese children had levels of body fat, percent body fat, visceral fat area and whole-body phase angle which were statistically significantly (p<0.001) higher in comparison with the control group. Regular meals were more typical for schoolchildren of the control group compared to the main group (p=0.002). A survey of parents showed that 55.0% of them don’t have problems with the nutrition of their children, 32.0% do not have conditions for monitoring their nutrition, 37.5% of children consume high-calorie foods, 29.0% do not comply with the diet, 64.5% – eat while watching TV. Only 21.1% of children consume fresh vegetables daily, cereals – 21.8%, dairy products – 30.3%, milk – 56.5%, meat – 58.5%, cottage cheese – 10.3%. Fish is not consumed by 25.6% of children, consumed less than once a week – by 47.2%. Several times a week, sausages and sausages are consumed by 41.7% of schoolchildren, confectionery – by 32.5%, chocolate and sweets – by 51.5%. Conclusion. The food habits of primary school students in Tomsk are characterized by an insufficient amount of vegetables and fruits, dairy products, fish dishes, a high level of consumption of ultra-processed red meat and various confectionery products (sweets, chocolate, cakes). The absence of statistically significant differences in the results of the survey between the control group and the main group may be due to the multifactorial nature of obesity associated with a variety of behavioral, biological and social factors, the real contribution of which remains to be determined.

PMID:37432706 | DOI:10.33029/0042-8833-2023-92-3-45-53

Clin Cardiol. 2023 Jul 11. doi: 10.1002/clc.24082. Online ahead of print.

ABSTRACT

This study aimed to evaluate the efficacy of single-pill combination (SPC) antihypertensive drugs in patients with uncontrolled essential hypertension. Through Searching Pubmed, EMBASE, the Cochrane Library, and Web of Science collected only randomized controlled trials on the efficacy of single-pill combination antihypertensive drugs in people with uncontrolled essential hypertension. The search period is from the establishment of the database to July 2022. The methodological quality of the included studies was assessed using the Cochrane Risk of Bias Assessment, and statistical analyses were performed using Review Manage 5.3 and Stata 15.1 software. This review ultimately included 32 references involving 16 273 patients with uncontrolled essential hypertension. The results of the network meta-analysis showed that a total of 11 single-pill combination antihypertensive drugs were included, namely: Amlodipine/valsartan, Telmisartan/amlodipine, Losartan/HCTZ, Candesartan/HCTZ, Amlodipine/benazepril, Telmisartan/HCTZ, Valsartan/HCTZ, Irbesartan/amlodipine, Amlodipine/losartan, Irbesartan/HCTZ, and Perindopril/amlodipine. According to SUCRA, Irbesartan/amlodipine may rank first in reducing systolic blood pressure (SUCRA: 92.2%); Amlodipine/losartan may rank first in reducing diastolic blood pressure (SUCRA: 95.1%); Telmisartan/amlodipine may rank first in blood pressure control rates (SUCRA: 83.5%); Amlodipine/losartan probably ranks first in diastolic response rate (SUCRA: 84.5%). Based on Ranking Plot of the Network, we can conclude that single-pill combination antihypertensive drugs are superior to monotherapy, and ARB/CCB combination has better advantages than other SPC in terms of systolic blood pressure, diastolic blood pressure, blood pressure control rate, and diastolic response rate. However, due to the small number of some drug studies, the lack of relevant studies has led to not being included in this study, which may impact the results, and readers should interpret the results with caution.

PMID:37432701 | DOI:10.1002/clc.24082

JAMA Netw Open. 2023 Jul 3;6(7):e2321730. doi: 10.1001/jamanetworkopen.2023.21730.

ABSTRACT

IMPORTANCE: The Colonoscopy Versus Fecal Immunochemical Test in Reducing Mortality From Colorectal Cancer (CONFIRM) randomized clinical trial sought to recruit 50 000 adults into a study comparing colorectal cancer (CRC) mortality outcomes after randomization to either an annual fecal immunochemical test (FIT) or colonoscopy.

OBJECTIVE: To (1) describe study participant characteristics and (2) examine who declined participation because of a preference for colonoscopy or stool testing (ie, fecal occult blood test [FOBT]/FIT) and assess that preference’s association with geographic and temporal factors.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study within CONFIRM, which completed enrollment through 46 Department of Veterans Affairs medical centers between May 22, 2012, and December 1, 2017, with follow-up planned through 2028, comprised veterans aged 50 to 75 years with an average CRC risk and due for screening. Data were analyzed between March 7 and December 5, 2022.

EXPOSURE: Case report forms were used to capture enrolled participant data and reasons for declining participation among otherwise eligible individuals.

MAIN OUTCOMES AND MEASURES: Descriptive statistics were used to characterize the cohort overall and by intervention. Among individuals declining participation, logistic regression was used to compare preference for FOBT/FIT or colonoscopy by recruitment region and year.

RESULTS: A total of 50 126 participants were recruited (mean [SD] age, 59.1 [6.9] years; 46 618 [93.0%] male and 3508 [7.0%] female). The cohort was racially and ethnically diverse, with 748 (1.5%) identifying as Asian, 12 021 (24.0%) as Black, 415 (0.8%) as Native American or Alaska Native, 34 629 (69.1%) as White, and 1877 (3.7%) as other race, including multiracial; and 5734 (11.4%) as having Hispanic ethnicity. Of the 11 109 eligible individuals who declined participation (18.0%), 4824 (43.4%) declined due to a stated preference for a specific screening test, with FOBT/FIT being the most preferred method (2820 [58.5%]) vs colonoscopy (1958 [40.6%]; P < .001) or other screening tests (46 [1.0%] P < .001). Preference for FOBT/FIT was strongest in the West (963 of 1472 [65.4%]) and modest elsewhere, ranging from 199 of 371 (53.6%) in the Northeast to 884 of 1543 (57.3%) in the Midwest (P = .001). Adjusting for region, the preference for FOBT/FIT increased by 19% per recruitment year (odds ratio, 1.19; 95% CI, 1.14-1.25).

CONCLUSIONS AND RELEVANCE: In this cross-sectional analysis of veterans choosing nonenrollment in the CONFIRM study, those who declined participation more often preferred FOBT or FIT over colonoscopy. This preference increased over time and was strongest in the western US and may provide insight into trends in CRC screening preferences.

PMID:37432690 | DOI:10.1001/jamanetworkopen.2023.21730

JAMA Netw Open. 2023 Jul 3;6(7):e2322650. doi: 10.1001/jamanetworkopen.2023.22650.

ABSTRACT

IMPORTANCE: The prescribing of stimulant medications for attention-deficit/hyperactivity disorder (ADHD) has increased in the US. Prescription stimulants are one of the most commonly misused controlled substances during adolescence. Despite a 10-fold increase in stimulant-related overdose deaths in the past decade, the transitions from prescription stimulants to illicit stimulants (eg, cocaine, methamphetamine) remain relatively unknown in longitudinal population-based studies.

OBJECTIVE: To determine the longitudinal transitions from adolescents’ prescription stimulant exposure (ie, stimulant therapy for ADHD and prescription stimulant misuse [PSM]) to later cocaine and methamphetamine use during young adulthood.

DESIGN, SETTING, AND PARTICIPANTS: National longitudinal multicohort panels of US 12th grade public and private school students in the coterminous US were assessed annually (baseline cohort years 2005-2017 [between March and June]) and followed up across 3 waves over a 6-year period to 23 to 24 years of age (follow-up years 2011-2021 [between April and October]).

EXPOSURE: History of self-reported stimulant therapy for ADHD at baseline.

MAIN OUTCOMES AND MEASURES: Incidence and prevalence of past-year use of cocaine and methamphetamine during young adulthood (19-24 years of age).

RESULTS: Among 5034 students enrolled at baseline (2589 [52.0%] female), 470 (10.2% [95% CI, 9.4%-11.2%]) reported use of stimulant therapy for ADHD, 671 (14.6% [95% CI, 13.5%-15.6%]) reported PSM only, and 3459 (75.2% [95% CI, 73.9%-76.4%]) reported neither (and served as population controls). In controlled analyses, there were no statistically significant differences between adolescents who reported stimulant therapy for ADHD at baseline compared with population controls in the adjusted odds of transitioning to later cocaine or methamphetamine initiation or use during young adulthood (19-24 years of age). In contrast, PSM during adolescence in those not treated with stimulants for ADHD had significantly higher odds of transitioning to later cocaine or methamphetamine initiation and use during young adulthood compared with population controls (adjusted odds ratio, 2.64 [95% CI, 1.54-4.55]).

CONCLUSIONS AND RELEVANCE: In this multicohort study, adolescents’ stimulant therapy for ADHD was not associated with increased risk of later cocaine and methamphetamine use during young adulthood. Adolescents’ prescription stimulant misuse offered a signal for subsequent cocaine or methamphetamine use and warrants monitoring and screening.

PMID:37432689 | DOI:10.1001/jamanetworkopen.2023.22650

JAMA Netw Open. 2023 Jul 3;6(7):e2322720. doi: 10.1001/jamanetworkopen.2023.22720.

ABSTRACT

IMPORTANCE: Numerous studies have shown that the prevalence of mental health (MH) conditions worsened during the COVID-19 pandemic. Further research is needed on this phenomenon over a longer time horizon that considers the increasing trend in MH conditions before the pandemic, after the pandemic onset, and after vaccine availability in 2021.

OBJECTIVE: To track how patients sought help in emergency departments (EDs) for non-MH and MH conditions during the pandemic.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used administrative data on weekly ED visits and a subset of visits for MH from the National Syndromic Surveillance Program from January 1, 2019, to December 31, 2021. Data were reported from the 10 US Department of Health and Human Services (HHS) regions (Boston, New York, Philadelphia, Atlanta, Chicago, Dallas, Kansas City, Denver, San Francisco, and Seattle) for five 11-week periods. Data analysis was performed in April 2023.

MAIN OUTCOMES AND MEASURES: Weekly trends in total ED visits, mean MH-related ED visits, and proportion of ED visits for MH conditions were investigated to determine changes in each measure after the pandemic onset. Prepandemic baseline levels were established from 2019 data, and time trends of these patterns were examined in the corresponding weeks of 2020 and 2021. A fixed-effects estimation approach with weekly ED region data by year was used.

RESULTS: There were 1570 total observations in this study (52 weeks in 2019, 53 weeks in 2020, and 52 weeks in 2021). Statistically significant changes in non-MH and MH-related ED visits were observed across the 10 HHS regions. The mean total number of ED visits decreased by 45 117 (95% CI, -67 499 to -22 735) visits per region per week (39% decrease; P = .003) in the weeks after the pandemic onset compared with corresponding weeks in 2019. The mean number of ED visits for MH conditions (-1938 [95% CI, -2889 to -987]; P = .003) decreased significantly less (23% decrease) than the mean number of total visits after the onset of the pandemic, increasing the mean (SD) proportion of MH-related ED visits from 8% (1%) in 2019 to 9% (2%) in 2020. In 2021, the mean (SD) proportion decreased to 7% (2%), and the mean number of total ED visits rebounded more than that of mean MH-related ED visits.

CONCLUSIONS AND RELEVANCE: In this study, MH-related ED visits demonstrated less elasticity than non-MH visits during the pandemic. These findings highlight the importance of addressing the provision of adequate MH services, both in acute and outpatient settings.

PMID:37432688 | DOI:10.1001/jamanetworkopen.2023.22720

One Health Risk Manag. 2023 Mar 11;4(2):25-32. doi: 10.38045/ohrm.2023.2.04.

ABSTRACT

INTRODUCTION: Road traffic injuries are a significant issue for society in the twenty-first century, but public health experts frequently ignore them despite the fact that massive and coor-dinated efforts are required for their effective and long-term prevention. Human factors and poor driving performance are the most significant contributors to car accidents globally, as shown by a series of studies exploring the causes of traffic road accidents. Since road safety is a key concern in developing countries, our research focuses on the car driver behavioral risk factors in the Republic of Moldova.

MATERIAL AND METHODS: A cross-sectional quantitative descriptive using a questionnaire was applied online via a Google form document among car drivers, between January-March 2022. Microsoft Excel was used for the statistical analyses.

RESULTS: The questionnaire was completed by 257 respondents above 18 years, of which 61.9% were female and 38.1% were male, mostly with a category B license (73.5%) and majority from urban area (87.5%). More than half (55.6%) mention that drove a car daily and 30% of them have a drive experience of more than ten years. Respondents express great concern (71.2%) about the issue of traffic accidents, and 76.3% think that unsafe roads are a key contributing factor. At least once being involved as a driver in road accidents where medical care was needed was mentioned by 2.7% of respondents.

CONCLUSIONS: Educational programs and awareness campaigns about road safety among drivers and other vulnerable road users should be systematically organized.

PMID:37432678 | PMC:PMC10331824 | DOI:10.38045/ohrm.2023.2.04

Mol Cell Biochem. 2023 Jul 11. doi: 10.1007/s11010-023-04788-y. Online ahead of print.

ABSTRACT

In our study, we aimed to create an inflammation model in endothelial and macrophage cell lines and to examine the changes in the expression of hyperpolarization activated cyclic nucleotide gated (HCN) channels at the molecular level. HUVEC and RAW cell lines were used in our study. 1 µg/mL LPS was applied to the cells. Cell media were taken 6 h later. TNF-α, IL-1, IL-2, IL-4, IL-10 concentrations were measured by ELISA method. Cell media were cross-applied to cells for 24 h after LPS. HCN1/HCN2 protein levels were determined by Western-Blot method. HCN-1/HCN-2 gene expressions were determined by qRT-PCR method. In the inflammation model, a significant increase in TNF-α, IL-1, and IL-2 levels was observed in RAW cell media compared to the control. While no significant difference was observed in IL-4 level, a significant decrease was observed in IL-10 level. While a significant increase in TNF-α level was observed in HUVEC cell medium, no difference was observed in other cytokines. In our inflammation model, an 8.44-fold increase in HCN1 gene expression was observed in HUVEC cells compared to the control group. No significant change was observed in HCN2 gene expression. 6.71-fold increase in HCN1 gene expression was observed in RAW cells compared to the control. The change in HCN2 expression was not statistically significant. In the Western-Blot analysis, a statistically significant increase in HCN1 level was observed in the LPS group in HUVEC cells compared to the control; no significant increase in HCN2 level was observed. While a statistically significant increase in HCN1 level was observed in the LPS group in RAW cells compared to the control; no significant increase in HCN2 level was observed. In immunofluorescence examination, it was observed that the level of HCN1 and HCN2 proteins in the cell membrane of HUVEC and RAW cells increased in the LPS group compared to the control group. While HCN1 gene/protein levels were increased in RAW and HUVEC cells in the inflammation model, no significant change was observed in HCN2 gene/protein levels. Our data suggest that the HCN1 subtype is dominant in endothelium and macrophages and may play a critical role in inflammation.

PMID:37432633 | DOI:10.1007/s11010-023-04788-y

Spine Deform. 2023 Jul 11. doi: 10.1007/s43390-023-00723-9. Online ahead of print.

ABSTRACT

PURPOSE: Vertebral body tethering (VBT) is a recent procedure to correct and reduce spinal curves in skeletally immature patients with adolescent idiopathic scoliosis (AIS). The purpose of this systematic review and meta-analysis is to determine the expected curve reduction and potential complications for adolescent patients after VBT.

METHODS: PubMed, Embase, Google Scholar and Cochrane databases were searched until February 2022. Records were screened against pre-defined inclusion and exclusion criteria. Data sources were prospective and retrospective studies. Demographics, mean differences in Cobb angle, surgical details and complication rates were recorded. Meta-analysis was conducted using a random-effects model.

RESULTS: This systematic review includes 19 studies, and the meta-analysis includes 16 of these. VBT displayed a statistically significant reduction in Cobb angle from pre-operative to final (minimum 2 years) measurements. The initial mean Cobb angle was 47.8° (CI 95% 42.9-52.7°) and decreased to 22.2° (CI 95% 19.9-24.5°). The mean difference is – 25.8° (CI 95% – 28.9-22.7) (p < 0.01). The overall complication rate was 23% (CI 95% 14.4-31.6%), the most common complication was tether breakage 21.9% (CI 95% 10.6-33.1%). The spinal fusion rate was 7.2% (CI 95% 2.3-12.1%).

CONCLUSION: VBT results in a significant reduction of AIS at 2 years of follow-up. Overall complication rate was relatively high although the consequences of the complications are unknown. Further research is required to explore the reasons behind the complication rate and determine the optimal timing for the procedure. VBT remains a promising new procedure that is effective at reducing scoliotic curves and preventing spinal fusion in the majority of patients.

LEVEL OF EVIDENCE: Systematic review of Therapeutic Studies with evidence level II-IV.

PMID:37432604 | DOI:10.1007/s43390-023-00723-9

J Robot Surg. 2023 Jul 11. doi: 10.1007/s11701-023-01617-8. Online ahead of print.

ABSTRACT

Single-port (SP) robot-assisted laparoscopic partial nephrectomy (RAPN) is a promising new technique. The aim of this study was to compare surgical and oncological outcomes of SP-RAPN to the multi-port (MP) surgical platform. This is a retrospective, cohort-based study involving patients undergoing SP-RAPN between 2019 and 2020 at a single institution. Demographic, preoperative, surgical, and postoperative outcomes data were gathered and compared to a 1-to-1 matched MP cohort. A total of 50 SP and 50 matched MP cases were included. Length of surgery and ischemia time were not statistically significant between the two cohorts; however, estimated blood loss (EBL) was significantly lower in the SP group than in the MP (IQR 25-50 vs. IQR 50-100 mL, p = 0.002). No differences were seen in regard to the 30-day readmission rate, surgical margin status, pain scores, and complications between the two approaches. We found no statistically significant differences in positive margins, pain score, length of stay, or readmission rate between matched SP and MP patients. These data support the viability of the SP technique as an alternative to MP-RAPN when in the hands of experienced surgeons.

PMID:37432590 | DOI:10.1007/s11701-023-01617-8

Diabetes Ther. 2023 Jul 11. doi: 10.1007/s13300-023-01441-1. Online ahead of print.

ABSTRACT

INTRODUCTION: We have developed the Building, Relating, Assessing, and Validating Outcomes (BRAVO) diabetes model, an individual-level, discrete-time microsimulation model specifically designed for type 2 diabetes (T2D) management. This study aims to validate the model’s performance when populated exclusively with a fully de-identified dataset to ensure its applicability in secure settings.

METHODS: Patient-level data from the Exenatide Study of Cardiovascular Event Lowering (EXSCEL) trial were fully de-identified by removing all identifiable information and masking numerical values (e.g., age, body mass index) within ranges to minimize the risk of re-identification. To populate the simulation, we imputed the masked numerical values using data from the National Health and Nutrition Examination Survey (NHANES). We applied the BRAVO model to the baseline data to predict 7-year study outcomes for the EXSCEL trial and assessed its discrimination power and calibration using C-statistics and Brier scores.

RESULTS: The model demonstrated acceptable discrimination and calibration in predicting the first occurrence of non-fatal myocardial infarction, non-fatal stroke, heart failure, revascularization, and all-cause mortality. Even with the fully deidentified data from the EXSCEL trial primarily presented in ranges rather than specific values, the BRAVO model exhibited robust prediction performance for diabetes complications and mortality.

CONCLUSIONS: This study demonstrates the feasibility of using the BRAVO model in settings where only fully de-identified patient-level data are available.

PMID:37432547 | DOI:10.1007/s13300-023-01441-1