Category: Nevin Manimala

J Clin Endocrinol Metab. 2023 Aug 11:dgad448. doi: 10.1210/clinem/dgad448. Online ahead of print.

ABSTRACT

BACKGROUND: Atrial fibrillation (AF) has been linked to increased hyperthyroidism risk, but contributing factors are unclear.

METHODS: This retrospective cohort study was conducted in a tertiary medical institution and included patients aged 18 years or older with AF but without hyperthyroidism at diagnosis. The endpoint was defined as newly diagnosed hyperthyroidism during follow-up.

RESULTS: The study cohort included 8,552 participants. Patients who developed new hyperthyroidism were younger and had a higher proportion of females. They had fewer comorbidities, including diabetes (26% vs 29%, p = 0.121), hypertension (51% vs 58%, p < 0.001), coronary artery disease (17% vs 25%, p < 0.001), stroke (16% vs 22%, p < 0.001), and end-stage renal disease (ESRD) (6% vs 10%, p = 0.001). The CHADS2 score was lower in patients with hyperthyroidism (1.74 vs 2.05, p = 0.031), but there was no statistically significant difference in the CHA2DS2-VAsc and HAS-BLED score. Cox regression analysis identified younger age, female gender, history of congestive heart failure, hypertension, diabetes, non-ESRD status, and lower CHADS2 score but not CHA2DS2-VASc as independent predictors of incident hyperthyroidism during follow-up. We also propose a novel, simple risk stratification score (SAD HEC2 score) with excellent predictive power for incident hyperthyroidism during follow-up.

CONCLUSIONS: Our results provide insight into clinical risk factors for the development of hyperthyroidism in AF patients, as identified by the novel SAD HEC2 score. AF appears to be a common precursor of hyperthyroidism.

PMID:37565329 | DOI:10.1210/clinem/dgad448

Int J Cosmet Sci. 2023 Aug 11. doi: 10.1111/ics.12893. Online ahead of print.

ABSTRACT

OBJECTIVE: Barrier creams (BCs) are marketed as locally-applied medical devices or cosmetic products to protect the skin from exposure to chemicals and irritants. Generally, the mechanism of action of such products is mainly due to the formation of a superficial thin film between the skin and the irritant or sensitizer, thus reducing or totally blocking the cutaneous penetration of such agents. Specifically, studies focusing on the effectiveness of commercial protective creams to prevent nickel cutaneous penetration are extremely scarce. The aim of the current work, therefore, is to evaluate the protective role of a commercially available barrier cream for nickel and compare the results with a simple moisturizing, following exposure to Ni powder.

METHODS: Marketed BCs were evaluated and tested. Human skin absorption of Ni was studied in vitro using static Franz diffusion cells.

RESULTS: Our results demonstrate that the application of both formulations caused a reduction of Ni inside the skin (8.00 ± 3.35 μg·cm^-2 for the barrier cream and 22.6 ± 12.6 μg·cm^-2 for the general moisturizing product), with the specialized barrier cream being statistically (p = 0.015) more efficient on forming a protective barrier, thus evidencing the importance of some ingredients of such formulations on the nickel dermal accumulation.

CONCLUSIONS: The composition of the formulations based on film forming or chelating agents may play an imperative role to reduce the cutaneous penetration of Ni.

PMID:37565324 | DOI:10.1111/ics.12893

Int J Cosmet Sci. 2023 Aug 11. doi: 10.1111/ics.12890. Online ahead of print.

ABSTRACT

OBJETIVE: Sisal is a common stiff fiber produced around the world, corresponding to approximately 70% of commercial production of all fibers of this type. The fibers are extracted from the leaves of Agave sisalana, from which approximately 4% of its weight is obtained, with the remaining 96% considered to be residues from the process of the sisal industry. The objective of this work was to obtain a polyphenols-enriched extract from the A. sisalana residue by ultrasonically assisted extraction (UAE), characterize it chemically, evaluate in vitro antioxidant activity, and develop safe and stable photoprotective formulations for future application in cosmetic preparations.

METHODS: Ultrasonic extraction of solid plant material was performed using 50% ethanol/water (v/v). The extract was chemically characterized by high-performance liquid chromatography (HPLC) equipment associated with classical molecular networking (MN) and evaluated for in vitro antioxidant activity by different methodologies. Ten formulations were prepared varying the component concentrations and the shear time. The 1.0% sisal extract was incorporated into the most stable formulations and preliminary and accelerated stability was evaluated. The emulsions were investigated for safety by assessment of primary accumulated dermal irritability and sensitization and dermatological clinical study of phototoxicity and photosensitization. The photoprotective formulations containing or not the extract that were stable after 90 days, had their in vivo Sun Protection Factor, UVA Protection Factor, critical wavelength, and protection against visible and blue light determined.

RESULTS: Ultrasound extraction using 50% ethanol/water (EH 50) as an extractor vehicle showed the best yield. The extract exhibited a concentration of phenolic compounds (77.93 mg of EAG/g) and showed in vitro antioxidant activity. Emulsions without and with 1.0% sisal extract remained stable and safe. The addition of the extract to the photoprotective formulation statistically increased the SPF when compared to the formulation without the extract and offered protection against UVA radiation, critical wavelength, and absorption of visible and blue light.

CONCLUSION: Based on the findings, the solid residue of A. sisalana may be indicated as a component of photoprotective and antioxidant cosmetic formulations.

PMID:37565318 | DOI:10.1111/ics.12890

Clin Psychol Psychother. 2023 Aug 11. doi: 10.1002/cpp.2897. Online ahead of print.

ABSTRACT

INTRODUCTION: This work aims to demonstrate, through the International Affective Picture System (IAPS) responses, an altered emotional pattern in borderline personality disorder (BPD) patients and to find a specific emotional response pattern by understanding their relationship with traumatic experiences and attachment bonds towards their primary caregivers.

METHOD: A total of 50 BPD patients and 39 control patients were evaluated using the IAPS, and its assessment was carried out through the Self-Assessment Manikin (SAM). Paternal and maternal attachment bonds as well as traumatic experiences in BPD patients were evaluated. Statistical associations were analysed in the different variables.

RESULTS: Significant differences between BPD and control patients were found in all emotional response components for pleasant, unpleasant and neutral images (p < .01), with one exception, the arousal in pleasant images. Patients’ experience of traumatic experiences was positively related to scores on the happiness component of pleasant imagery (p = .057) and on the arousal component of unpleasant imagery (p = .058). Poorer maternal bonding in BPD patients was significantly related to lower scores on happiness (p < .01) and dominance (p < .05) components of pleasant imagery and all emotional response components for unpleasant imagery (p < .01).

CONCLUSIONS: The results of the study confirm an impaired emotional response pattern in patients with borderline personality disorder (BPD), showing an emotional response to pleasant images similar to that of depression, while the pattern found to unpleasant images could be related to the complex trauma observed in these patients, which includes PTSD experiences such as sexual abuse and attachment trauma experiences.

PMID:37565308 | DOI:10.1002/cpp.2897

Orthod Craniofac Res. 2023 Aug 11. doi: 10.1111/ocr.12693. Online ahead of print.

ABSTRACT

OBJECTIVE: Mandibular condylar cartilage (MCC) of the rat was examined with the Fourier-transform infrared (FITR) spectroscopic imaging to study the effects of ageing, oestrogen level and altered dietary loading on the structure of MCC.

MATERIALS AND METHODS: The Sprague-Dawley rats (n = 96) aged 5 and 14 months were divided into 12 subgroups according to age, oestrogen status (ovariectomized [OVX], non-ovariectomized [non-OVX)]) and diet (hard, normal, soft). Specimens of the MCC were examined with FTIR spectroscopic imaging to quantify the distribution of collagens and proteoglycans. MCC was divided sagittally into three segments: anterior, most superior and posterior. From each segment, the collagen and proteoglycan contents at different depths of cartilage were statistically compared between the groups using an N-way analysis of variance (ANOVA).

RESULTS: The amount of collagen content was significantly associated with old age in the deep layer of the anterior segment and in the middle layer of the posterior segment of MCC. In the deep layer of the most superior segment, the collagen content also increased with ageing. The amount of proteoglycan content increased significantly when dietary loading increased, and the oestrogen level decreased in the deep layer of the most superior segment of MCC.

CONCLUSION: Ageing, oestrogen level and altered dietary loading have a significant effect on the location and content of collagens and proteoglycans of rat MCC. Ageing significantly increased the amount of collagen content in the superior and posterior segments, being highest in the older soft-diet rats. Decreased oestrogen levels and increased dietary loading increased the amount of proteoglycan content.

PMID:37565299 | DOI:10.1111/ocr.12693

AIDS Res Hum Retroviruses. 2023 Aug 11. doi: 10.1089/AID.2023.0025. Online ahead of print.

ABSTRACT

INTRODUCTION: Adult T-cell leukemia/lymphoma is a malignancy with a poor prognosis caused by HTLV-1 infection. TAX and HBZ are two major viral proteins that may be involved in oncogenesis by disrupting apoptosis. Because Bcl-xL plays an integral role in the anti-apoptotic pathway, this study examines the interaction between host apoptosis and oncoproteins.

METHOD AND MATERIAL: We investigated 37 HTLV-1-infected individuals, including 18 asymptomatic and 19 ATLL subjects. mRNA was extracted and converted to cDNA from peripheral blood mononuclear cells (PBMCs), and then gene expression was determined using TaqMan qPCR. Moreover, the HTLV-I proviral load was also measured using a commercial absolute quantification kit (Novin Gene, Iran).

RESULTS: Data analysis revealed that the mean of TAX, HBZ, and PVL was significantly higher among the study groups (ATLL and carriers groups P= (0.003), P= (0.000), and P= (0.002) respectively). There was no statistical difference in Bcl-xL gene expression between studies groups (P=0.323).

CONCLUSION: It is proposed that this anti-apoptotic pathway may not be directly involved in the development of ATLL lymphoma. TAX, HBZ gene expression, and PVL can be utilized as prognostic markers.

PMID:37565279 | DOI:10.1089/AID.2023.0025

Pediatrics. 2023 Aug 11:e2022058758. doi: 10.1542/peds.2022-058758. Online ahead of print.

ABSTRACT

BACKGROUND: High-flow nasal cannula oxygen therapy (HFNC) is increasingly used to treat bronchiolitis. However, HFNC has not reduced time on supplemental oxygen, length of stay (LOS), or ICU admission. Our objective was to reduce HFNC use in children admitted for bronchiolitis from 41% to 20% over 2 years.

METHODS: Using quality improvement methods, our multidisciplinary team formulated key drivers, including standardization of HFNC use, effective communication, knowledgeable staff, engaged providers and families, data transparency, and high-value care focus. Interventions included: (1) standardized HFNC initiation criteria, (2) staff education, (3) real-time feedback to providers, (4) a script for providers to use with families about expectations during admission, (5) team huddle for patients admitted on HFNC to discuss necessity, and (6) distribution of a bronchiolitis toolkit. We used statistical process control charts to track the percentage of children with bronchiolitis who received HFNC. Data were compared with a comparison institution not actively involved in quality improvement work around HFNC use to ensure improvements were not secondary to the COVID-19 pandemic alone.

RESULTS: Over 10 months of interventions, we saw a decrease in HFNC use for patients admitted with bronchiolitis from 41% to 22%, which was sustained for >12 months. There was no change in HFNC use at the comparison institution. The overall mean LOS for children with bronchiolitis decreased from 60 to 45 hours.

CONCLUSIONS: We successfully reduced HFNC use in children with bronchiolitis, improving delivery of high-value and evidence-based care. This reduction was associated with a 25% decrease in LOS.

PMID:37565278 | DOI:10.1542/peds.2022-058758

Hosp Pediatr. 2023 Aug 11:e2022006730. doi: 10.1542/hpeds.2022-006730. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Penicillin allergy is the most common medication allergy, and the penicillin allergy label is commonly over-applied without adequate reaction history inquiry or documentation. Because penicillin allergy labels are often applied in childhood and carried into adulthood, we sought to increase the completeness of reaction history documentation from 20% to 70% for pediatric hospital medicine patients and from 20% to 50% for all other pediatric inpatients within 12 months. As a secondary outcome, we also aimed to increase the proportion of delabeling unnecessary penicillin labels to 20% for all pediatric inpatients.

METHODS: To address our aims, our quality improvement initiative included education for pediatric faculty and staff, development and implementation of a clinical pathway for allergy risk stratification, and electronic health record optimizations. Statistical process control charts were used to track the impact of the interventions facilitated by an automated dashboard.

RESULTS: Within 12 months of interventions, the completeness of allergy labels improved from 20% to 64% among patients admitted to the pediatric hospital medicine service and improved from 20% to 45% for all other pediatric inpatients. The frequency of penicillin allergy delabeling remained unchanged; however, 98 patients were risk stratified and 34 received outpatient allergy referrals for further testing. The number of adverse drug reactions to penicillin, a balancing measure, did not change during the study period.

CONCLUSIONS: We increased the completeness of penicillin allergy documentation using a standardized workflow facilitated by a multidisciplinary clinical pathway. With ongoing efforts, more penicillin delabeling in low-risk patients is anticipated.

PMID:37565275 | DOI:10.1542/hpeds.2022-006730

Front Pediatr. 2023 Jul 26;11:1135876. doi: 10.3389/fped.2023.1135876. eCollection 2023.

ABSTRACT

BACKGROUND: Untreated maternal postpartum depression (PPD) has consequences for children’s physical growth, but no published study has evaluated changes in this effect over time. Here we therefore aimed to evaluate the dynamic effects of PPD on the physical growth of children in a prospective birth cohort.

METHODS: Between 2015 and 2019, 960 mother-child pairs in Changsha, China were followed up when the child was aged 1-48 months. Data were obtained through household surveys. The mothers’ depressive symptoms were measured using the Edinburgh Postpartum Depression Scale (EPDS) at 1 month postpartum. Linear mixed models were used to examine the changes in the association of PPD and EPDS scores with physical growth in six different age groups of children between 1 and 48 months.

RESULTS: A total of 604 mother-child pairs completed the follow-up, and 3.3% of mothers reported PPD. No associations were found between PPD and weight or height growth at any age. While EPDS scores were associated with weight gain (β = -0.014, 95% CI (-0.025, -0.002), P = 0.024) and height growth (β = -0.044, 95% CI (-0.084, -0.004), P = 0.030) rates at 1-3 months, no associations were found in older children.

LIMITATIONS: The number of mothers who reported PPD was relatively small, and the measurement of PPD was not continuously taken.

CONCLUSIONS: After adjustments for confounders, no dynamic association was found between PPD and children’s weight and height growth. EPDS scores, in contrast, did negatively affect children’s weight and height growth at age 1-3 months, but this effect was not long-lasting.

PMID:37565240 | PMC:PMC10410140 | DOI:10.3389/fped.2023.1135876

Front Pediatr. 2023 Jul 26;11:1212711. doi: 10.3389/fped.2023.1212711. eCollection 2023.

ABSTRACT

BACKGROUND: The 5-year survival rate of childhood cancer exceeds 80%, however, many survivors develop late effects including infertility. The aim of this study was to evaluate the current status of oncofertility care at Vilnius University Hospital Santaros Klinikos (VULSK) within the framework of the EU-Horizon 2020 TREL project.

METHODS: All parents or patients aged 12-17.9 years treated from July 1, 2021 until July 1, 2022 were invited to complete an oncofertility-care-evaluation questionnaire. After completing the questionnaire, patients were triaged to low-risk (LR) or high-risk (HR) of gonadal damage using a risk stratification tool (triage). Data was assessed using descriptive statistics.

RESULTS: Questionnaires were completed by 48 parents and 13 children triaged as 36 (59%) LR and 25 (41%) HR patients. Most HR respondents (21/25, 84%) were not counseled by a fertility specialist. Six boys (4 HR, 2 LR) were counseled, none of the girls was counseled. Three HR boys underwent sperm cryopreservation. Only 17 (27.9%, 9 HR, 8 LR) respondents correctly estimated their risk. All counseled boys (n = 6) agreed the risk for fertility impairment had been mentioned as compared to 49.1% (n = 27) of uncounseled. All counseled respondents agreed they knew enough about fertility (vs. 42%).

CONCLUSIONS: Respondents counseled by a fertility specialist were provided more information on fertility than uncounseled. HR patients were not sufficiently counseled by a fertility specialist. Based on the current experience oncofertility care at VULSK will be improved.

PMID:37565239 | PMC:PMC10411952 | DOI:10.3389/fped.2023.1212711