Category: Nevin Manimala

Egypt Heart J. 2023 Jul 19;75(1):63. doi: 10.1186/s43044-023-00383-0.

ABSTRACT

BACKGROUND: Many patients would require repeated ablation procedures owing to recurrent atrial fibrillation with its associated symptoms. Identifying those who are at risk of recurrent AF could assist us to develop preventive strategies and to properly select those who will benefit more from catheter ablation. Our aim is to study the role of preprocedural serum level of certain biomarkers in the prediction of AF recurrence after catheter ablation.

RESULTS: The present study included 117 patients: 26 patients with persistent and 91 patients with paroxysmal AF. Blood samples for estimation of serum levels of studied cytokines were obtained prior to the procedure. Pulmonary vein isolation was performed in all patients through point-by point radiofrequency ablation guided by 3D electroanatomical mapping system. Patients were followed for 12 months for AF recurrence. Forty-one (35%) patients developed AF recurrence. Those patients were significantly older, had significantly higher BMI, lower ejection fraction, and wider maximal left atrial diameter (LAD). Serum hs-CRP, IL-6, TNF-α, visfatin, and adiponectin levels were significantly higher compared to those who did not develop AF recurrence. Correlation analysis showed positive correlations between the incidence of RAF and patients’ age, BMI, and maximum LAD and elevated cytokine levels and maximal LAD showed significant correlations with the type of AF and elevated serum TNF-α, visfatin, and adiponectin. Statistical analyses defined elevated serum levels of TNF-α, visfatin, and adiponectin as positive predictors for RAF, and automatic linear modeling analysis showed that elevated serum visfatin, TNF-α, and adiponectin can predict RAF by accuracy rates of 50%, 34%, and 16%, respectively.

CONCLUSIONS: RAF is most probably an outcome of the interplay between patients’ clinical data, obesity, and inflammation. Pre-procedural estimation of serum levels of visfatin and TNF-α might determine patients with probability for RAF.

PMID:37466800 | DOI:10.1186/s43044-023-00383-0

Arch Osteoporos. 2023 Jul 19;18(1):101. doi: 10.1007/s11657-023-01311-0.

ABSTRACT

Participation in Orthogeriatrics TeleECHO was associated with improvement in physicians’ knowledge and self-confidence in managing elderly patients with fractures.

PURPOSE: To develop and conduct an interactive case-based virtual TeleECHO program to expand the knowledge of healthcare professionals in the field of orthogeriatrics.

METHODS: The project included twelve 90-min sessions for physicians and healthcare managers. Each session was based on real clinical cases discussed by the multidisciplinary group of faculty. The efficacy of the project was assessed using questionnaires.

RESULTS: The attendance of individual sessions ranged from 129 to 224 with the total number of participants 829; 25% of participants were from remote rural regions. A survey conducted at the beginning of the project showed insufficient knowledge and ability to apply the concepts of orthogeriatrics. A final questionnaire showed that 74% of respondents participated in most sessions, with 94% wishing to continue participating in further sessions. There was a statistically significant overall improvement in confidence of caring for fragility fracture patients with an effect size of 0.75 (p<0.001). The proportion of responders who were able to apply their new knowledge in clinical practice shortly after TeleECHO showed a substantial increase (p<0.0001).

CONCLUSION: The Orthogeriatrics TeleECHO program was effective in changing perceptions and self-confidence of the participants, and applying knowledge acquired to patient care. This model of learning could be applied in other countries in other languages to improve post-fracture care worldwide.

PMID:37466787 | DOI:10.1007/s11657-023-01311-0

Neuro Endocrinol Lett. 2023 Jul 5;44(4):256-264. Online ahead of print.

ABSTRACT

OBJECTIVE: Thyroid function may be useful prognostic predictor of acute ischemic stroke. However, the relationship between thyroid function and stroke prognosis remains controversial. We aimed to explore the correlation between thyroid function at admission and 90-day functional outcome in patients with acute ischemic stroke.

METHODS: Our data were collected from patients with AIS (acute ischemic stroke) registered in the Stroke Center of Jiangsu Provincial Hospital of Chinese Medicine from January 2021 to July 2021.The outcome was divided into good outcome as mRS (Modified Rankin Scale) score <3, poor outcome as mRS≥3 (including hemorrhage, recurrence, and death within 90 days after stroke).Univariate, multivariate logistic regression analysis, tertile analysis and subgroup analysis were used to evaluate the relationship between TSH (Thyroid-stimulating hormone), FT3 (Free Triiodothyronine), FT4 (Free thyroxine) and 90-day outcome.

RESULTS: 699 patients with AIS were included in this study. In univariate analysis, FT3 was negatively correlated with poor outcome of AIS patients at 90-day, TSH was not statistically correlated with 90-day outcome. Multivariate analysis showed that FT3 was negatively correlated poor outcome of AIS patients at 90-day. After adjusting for potential confounders, TSH was negatively correlated with poor outcome. Participants were categorized based on the tertile cut-off points of FT3 and TSH. With the increase of TSH value, the incidence of poor outcomes in Q3 was 0.57 times higher than that of Q1. Similarly, with the increase of FT3 value, the incidence of poor outcomes in Q3 is 0.3 times than that of Q1.

CONCLUSIONS: FT3 and TSH were negatively correlated with poor 90-day outcome in patients with AIS. Measurement of thyroid function on admission may provide independent prognostic information for 90-day outcome of AIS.

PMID:37466064

Acta Med Port. 2023 Jul 18. doi: 10.20344/amp.19382. Online ahead of print.

ABSTRACT

INTRODUCTION: New evidence and extrapolated data from other coronaviruses suggest that symptoms and consequences of COVID-19 may persist beyond the cure. The aims of this study were to evaluate persistent symptoms after SARS-CoV-2 infection and its impact on physical condition, activities of daily living, and quality-of-life; establish whether symptom persistence is associated with higher disability; and document the evolution of the multiple domains after a home exercise program.

METHODS: Prospective study with patients referred to a Physical and Rehabilitation Medicine clinic, after SARS-CoV-2 infection. Patient evaluations, including a symptom questionnaire, the 1-Min Sit-to-stand test (1-MSTS), the EQ-5D questionnaire and the London Chest Activity Daily Living (LCA-DL) questionnaire, were performed before and after a home exercise program.

RESULTS: Seventy-four patients were included. The majority (n = 71) had been hospitalized (mean stay 19.66 ± 13.35 days), 51% required intensive care. At first evaluation, 54 days after symptom onset, a mean of 18.6 repetitions in the 1-MSTS were performed. The percentage of LCA-DL was above 28% in 23% of the patients. Impairments on EQ-5D were present in 44% for mobility and 44% for anxiety/depression. Mean EQ-5D VAS was 66.5 out of 100. Fifty-one (70%) had at least one persistent symptom (Symptomatic Group), while 22 (30%) were asymptomatic (Asymptomatic Group). The Symptomatic Group had statistically significantly worse mean results on 1-MSTS (16.8 vs 22.9; p < 0.001), % LCA-DL score, EQ-D5 (7.8 vs 5.7; p < 0.001) and EQ-D5-VAS. No patient characteristic, clinical background, comorbidity, or hospitalization characteristics was significantly different between groups. Every patient was given a home exercise program; 47 patients joined an additional rehabilitation program or were clinically discharged and were therefore excluded from the second evaluation. Twenty-seven patients participated in a second evaluation. In the matched analysis, mean 1-MSTS improved by 3.4 repetitions. Mean LCA-DL, mean EQ-5D score (7.1 to 6.6) and EQ-VAS score changed favourably and significantly.

CONCLUSION: Two months after infection by SARS-CoV-2, persistent symptoms were frequent in patients referred to a Physical Medicine and Rehabilitation clinic. Additionally, the SARS-CoV-2 infection, as well as the persistence of symptoms, had a negative impact in the physical condition and functionality in ADL and quality-of-life. With a home exercise program in place, a statistically significant improvement was observed. Referral of patients with persistent symptoms to Physical and Rehabilitation Medicine may be warranted.

PMID:37466050 | DOI:10.20344/amp.19382

Ann Vasc Surg. 2023 Feb;89:1-10. doi: 10.1016/j.avsg.2022.08.014. Epub 2022 Sep 19.

ABSTRACT

BACKGROUND: Options for endovascular treatment of carotid artery disease have been developed to compliment with carotid endarterectomy, transfemoral carotid artery stenting (TFCAS) and a hybrid approach with transcarotid artery revascularization (TCAR). We sought to capture endpoints outside of stroke, myocardial infarction (MI), and death involved with each procedure at our institution as well as evaluate cost.

METHODS: Carotid stent procedures performed from 2014 to 2020 at our institution underwent comparative analysis based upon access site and type of stent procedure performed, TFCAS versus TCAR. Procedural details and outcomes were captured prospectively and included in the National Cardiovascular Data Peripheral Vascular Intervention Registry (NCDR-PVI). Further retrospective review was performed to evaluate endpoints beyond stroke, MI, and death. Total in-hospital cost, including administrative, capital and utilities (fixed cost), and labor and supplies (variable cost) were also evaluated.

RESULTS: One hundred thirty-seven patients were reviewed. Seventy-seven were treated with TFCAS and 60 with TCAR. The mean age was 74 years, predominantly male (68%) and Caucasian (90%). Patients undergoing TFCAS were more likely to be symptomatic compared to those receiving TCAR (81.8% vs. 50.0%, P = <0.001). There were no statistically significant differences in event rates, including mortality, recurrent cerebrovascular accident / transient ischemic attack, or bleeding. Complications not captured in the NCDR-PVI database were more frequent in the TCAR group (21.7% vs. 5.2%, P = 0.004) and included pneumothorax (n = 2), neck hematoma (n = 8), and common carotid artery stenosis or injury (n = 3). Rates of complications in the TFCAS group (n = 4) were lower and limited to groin hematoma (n = 2), central retinal artery occlusion causing vision loss and a case of postoperative dysphagia. Geographic miss of initial stent placement was identified in 15.0% of TCAR patients and 2.6% (P = 0.008) of TFCAS patients. Restenosis rates on duplex ultrasound were similar between the two groups (14.6% of patients) and were not associated with symptoms. The mean follow-up interval was similar for both groups of 31.8 months for TCAR and 30.7 months for TFCAS (P = 0.797). There was a statistically significant difference in total cost with TCAR being more expensive ($22,315 vs. $11,001) driven by direct costs that included devices, imaging, and extended length of stay in the TCAR group (P < 0.001). There was no significant difference between stroke free survival (91.1% vs. 88.6%, P = 0.69) and mortality (78.1% vs. 85.2%, P = 0.677) at 3 years follow-up between TCAR and TFCAS, respectively.

CONCLUSIONS: Both TFCAS and TCAR provide similar 3-year stroke and mortality risk/benefit and are distinctly different procedures. Both should be evaluated independently with analysis of variables beyond stroke, death, and MI. TFCAS is more cost-effective than TCAR in this single institution study.

PMID:37466045 | DOI:10.1016/j.avsg.2022.08.014

Addiction. 2023 Jul 19. doi: 10.1111/add.16299. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Injuries often involve alcohol, but determining the proportion caused by alcohol is difficult. Several approaches have been used to determine the causal role of alcohol, but these methods have not been compared directly with one another. Such a comparison would be useful for understanding the strengths and comparability of different approaches. This study compared estimates of average annual alcohol-attributable deaths in the United States from injuries during 2015-19 using a blood alcohol concentration (BAC) method compared with a population attributable fraction (PAF) approach.

METHODS: For the BAC method, we used a direct method involving the proportion of decedents with a high blood alcohol concentration (BAC; e.g. ≥ 0.10%). For the PAF approach, we compared the use of unadjusted survey data with average consumption data adjusted using alcohol sales data to account for underreporting and also accounting for the underreporting of binge drinking. Survey data were from the Behavioral Risk Factor Surveillance System and mortality data were from the National Vital Statistics System.

RESULTS: The number of alcohol-attributable injury deaths using the direct method (48 516 deaths annually) was similar to that using PAF methods (47 879 deaths annually), but only when alcohol use measures were adjusted using alcohol sales data. Furthermore, estimates were similar for cause-specific categories of deaths, including non-motor vehicle unintentional injuries and motor vehicle crashes. Among PAF methods, excessive drinking accounted for 38.3% of injury deaths using unadjusted survey data, but 64.8% of injury deaths using adjusted data.

CONCLUSIONS: Estimates of alcohol-attributable injury deaths from a direct method and from a population attributable fraction method that adjusts for alcohol use based on alcohol sales data appear to be comparable.

PMID:37466014 | DOI:10.1111/add.16299

Stroke. 2023 Jul 19. doi: 10.1161/STROKEAHA.123.042644. Online ahead of print.

ABSTRACT

BACKGROUND: It is unknown if ambulance paramedics adequately assess neurological deficits used for prehospital stroke scales to detect anterior large-vessel occlusions. We aimed to compare prehospital assessment of these stroke-related deficits by paramedics with in-hospital assessment by physicians.

METHODS: We used data from 2 prospective cohort studies: the LPSS (Leiden Prehospital Stroke Study) and PRESTO study (Prehospital Triage of Patients With Suspected Stroke). In both studies, paramedics scored 9 neurological deficits in stroke code patients in the field. Trained physicians scored the National Institutes of Health Stroke Scale (NIHSS) at hospital presentation. Patients with transient ischemic attack were excluded because of the transient nature of symptoms. Spearman rank correlation coefficient (r_s) was used to assess correlation between the total prehospital assessment score, defined as the sum of all prehospital items, and the total NIHSS score. Correlation, sensitivity and specificity were calculated for each prehospital item with the corresponding NIHSS item as reference.

RESULTS: We included 2850 stroke code patients. Of these, 1528 had ischemic stroke, 243 intracranial hemorrhage, and 1079 stroke mimics. Correlation between the total prehospital assessment score and NIHSS score was strong (r_s=0.70 [95% CI, 0.68-0.72]). Concerning individual items, prehospital assessment of arm (r_s=0.68) and leg (r_s=0.64) motor function correlated strongest with corresponding NIHSS items, and had highest sensitivity (arm 95%, leg 93%) and moderate specificity (arm 71%, leg 70%). Neglect (r_s=0.31), abnormal speech (r_s=0.50), and gaze deviation (r_s=0.51) had weakest correlations. Neglect and gaze deviation had lowest sensitivity (52% and 66%) but high specificity (84% and 89%), while abnormal speech had high sensitivity (85%) but lowest specificity (65%).

CONCLUSIONS: The overall prehospital assessment of stroke code patients correlates strongly with in-hospital assessment. Prehospital assessment of neglect, abnormal speech, and gaze deviation differed most from in-hospital assessment. Focused training on these deficits may improve prehospital triage.

PMID:37465998 | DOI:10.1161/STROKEAHA.123.042644

Stroke. 2023 Jul 19. doi: 10.1161/STROKEAHA.123.042980. Online ahead of print.

ABSTRACT

BACKGROUND: Previous observational studies reported that a lower serum 25-hydroxyvitamin D [25(OH)D] concentration is associated with a higher burden of cerebral small vessel disease (cSVD). The causality of this association is uncertain, but it would be clinically important, given that 25(OH)D can be a target for intervention. We tried to examine the causal effect of 25(OH)D concentration on cSVD-related phenotypes using a Mendelian randomization approach.

METHODS: Genetic instruments for each serum 25(OH)D concentration and cSVD-related phenotypes (lacunar stroke, white matter hyperintensity, cerebral microbleeds, and perivascular spaces) were derived from large-scale genome-wide association studies. We performed 2-sample Mendelian randomization analyses with multiple post hoc sensitivity analyses. A bidirectional Mendelian randomization approach was also used to explore the possibility of reverse causation.

RESULTS: We failed to find any significant causal effect of 25(OH)D concentration on cSVD-related phenotypes (odds ratio [95% CI], 1.00 [0.87-1.16], 1.01 [0.96-1.07], 1.06 [0.85-1.33], 1.00 [0.97-1.03], 1.02 [0.99-1.04], 1.01 [0.99-1.04] for lacunar stroke, white matter hyperintensity, cerebral microbleeds, and white matter, basal ganglia, hippocampal perivascular spaces, respectively). These results were reproduced in the sensitivity analyses accounting for genetic pleiotropy. Conversely, when we examined the effects of cSVD phenotypes on 25(OH)D concentration, cerebral microbleeds were negatively associated with 25(OH)D concentration (0.94 [0.92-0.96]).

CONCLUSIONS: Given the adequate statistical power (>0.8) of the analyses, our findings suggest that the previously reported association between 25(OH)D concentration and cSVD phenotypes might not be causal and partly attributed to reverse causation.

PMID:37465996 | DOI:10.1161/STROKEAHA.123.042980

Int Wound J. 2023 Jul 19. doi: 10.1111/iwj.14319. Online ahead of print.

ABSTRACT

Among the assortment of available dressings aimed at promoting wound healing, moist dressings have gained significant popularity because of their ability to create an optimal environment for wound recovery. This meta-analysis seeks to compare the effects of moist dressing versus gauze dressing on wound healing time. A comprehensive literature search was conducted, encompassing publications up until April 1, 2023, across multiple databases including PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), and Cochrane Library. Stringent criteria were used to determine study inclusion and evaluate methodological quality. Statistical analyses were performed utilizing Stata 17.0. A total of 13 articles, encompassing 866 participants, were included in the analysis. The findings indicate that moist dressing surpasses gauze dressing in terms of wound healing time (standard mean difference [SMD] -2.50, 95% confidence interval [CI] -3.35 to -1.66, p < 0.01; I² = 97.24%), wound site infection rate (odds ratio [OR] 0.30, 95% CI 0.17 to 0.54, p < 0.01; I² = 39.91%), dressing change times (SMD -3.65, 95% CI -5.34 to -1.97, p < 0.01; I² = 96.48%), and cost (SMD -2.66, 95% CI -4.24 to -1.09, p < 0.01; I² = 94.90%). Subgroup analyses revealed possible variations in wound healing time based on wound types and regions. This study underscores the significant advantages associated with the use of moist dressings, including expedited wound healing, reduced infection rates, decreased frequency of dressing changes, and lower overall treatment costs.

PMID:37465989 | DOI:10.1111/iwj.14319

Dev Sci. 2023 Jul 19:e13435. doi: 10.1111/desc.13435. Online ahead of print.

ABSTRACT

Learning to read depends on the ability to extract precise details of letter combinations, which convey critical information that distinguishes tens of thousands of visual word forms. To support fluent reading skill, one crucial neural developmental process is one’s brain sensitivity to statistical constraints inherent in combining letters into visual word forms. To test this idea in early readers, we tracked the impact of two years of schooling on within-subject longitudinal changes in cortical responses to three different properties of words: coarse tuning for print, and fine tuning to either familiar letter combinations within visual word forms or whole word representations. We then examined how each related to growth in reading skill. Three stimulus contrasts-words versus pseudofonts, words versus pseudowords, pseudowords versus nonwords-were presented while high-density EEG Steady-State Visual Evoked Potentials (SSVEPs, n = 31) were recorded. Internalization of abstract visual word form structures over two years of reading experience resulted in a near doubling of SSVEP amplitude, with increasing left lateralization. Longitudinal changes (decreases) in brain responses to such word form structural information were linked to the growth in reading skills, especially in rapid automatic naming of letters. No such changes were observed for whole word representation processing and coarse tuning for print. Collectively, these findings indicate that sensitivity to visual word form structure develops rapidly through exposure to print and is linked to growth in reading skill. RESEARCH HIGHLIGHTS: Longitudinal changes in cognitive responses to coarse print tuning, visual word from structure, and whole word representation were examined in early readers. Visual word form structure processing demonstrated striking patterns of growth with nearly doubled in EEG amplitude and increased left lateralization. Longitudinal changes (decreases) in brain responses to visual word form structural information were linked to the growth in rapid automatic naming for letters. No longitudinal changes were observed for whole word representation processing and coarse tuning for print.

PMID:37465984 | DOI:10.1111/desc.13435