Category: Nevin Manimala

J Clin Pathol. 2023 Jun 6:jcp-2023-208759. doi: 10.1136/jcp-2023-208759. Online ahead of print.

ABSTRACT

Aims To assess if ambient temperature-related effects on serum potassium levels impact clinical decision-making. Methods This study is an ecological time series consisiting of 1 218 453 adult patients with at least one ACE inhibitor (ACEI) prescription who participate in a large UK primary care dataset.Descriptive statistics and a quasi-Poisson regression model using time series data at regular time intervals (monthly) were undertaken to examine the association between potassium measurements and ACEI/potassium supplement prescriptions. RESULTS: It is noted that correlating with lower ambient temperature, serum potassium values follow a seasonal pattern; peaks in winter months and troughs in summer. During summer months, there are clear annual spikes in the number of potassium prescriptions suggesting a change in prescribing practice during periods of potentially spurious hyperkalaemia. The converse pattern is seen in the ACEI prescription proportion which spikes annually during the winter period with lower average ambient temperatures. Our time series modelling demonstrated that each one unit increase in potassium is associated with a 33% increased rate of ACEI prescriptions (risk ratio, RR 1.33; 95% CI 1.12 to 1.59) and 63% decreased rate of potassium supplements (RR 0.37; 95% CI 0.32 to 0.43). CONCLUSIONS: Our findings highlight the seasonal pattern in serum potassium and we observe a corresponding alteration in prescribing practice for potassium sensitive medications. These findings demonstrate the importance of educating clinicians on the presence of seasonal potassium variability in addition to standard measurement error, and its potential impact on their prescribing activity.

PMID:37280056 | DOI:10.1136/jcp-2023-208759

BMJ Open. 2023 Jun 6;13(6):e066744. doi: 10.1136/bmjopen-2022-066744.

ABSTRACT

OBJECTIVE: This study was aimed to determine the relationship between job stress and work-related quality of life (WRQoL) among emergency medical technicians (EMTs) in Lorestan province, Western Iran.

DESIGN: This was a cross-sectional study.

METHODS: Totally 430 EMTs who had been engaged in their respective units for more than 6 months from all emergency facilities in Lorestan province were selected using single stage cluster sampling method. Data were collected from April to July 2019 using two standard questionnaires: job stress (Health and Safety Executive (HSE)) and WRQoL. The OR with 95% CI was used to declare the statistical association (p≤0.05).

RESULTS: All participants were exclusively males, with a mean age of 32±6.87 years. The overall average score of job stress using the HSE scale was 2.69±0.43; while the overall quality of working life score was 2.48±1.01. The type of working shift was found to have a significant impact on the HSE-average score (F(3,417)=5.26, p=0.01); and on the WRQoL-average score (F(3,417)=6.89, p<0.01).

CONCLUSION: Two-thirds of EMTs working in governmental hospitals had job stress and a low quality of work-related life. Additionally, work shift was statistically significant associated with EMTs’ job stress and WRQoL.

PMID:37280030 | DOI:10.1136/bmjopen-2022-066744

BMJ Open. 2023 Jun 6;13(6):e069042. doi: 10.1136/bmjopen-2022-069042.

ABSTRACT

OBJECTIVE: Sedentary behaviour is associated with increased cancer risk. We aim to assess the associations of domain-specific and total sedentary behaviour with risk of endometrial cancer, with additional attention paid to potential differences in adjustment strategy for obesity and physical activity.

DESIGN: A systematic review and meta-analysis was conducted in accordance with the guidelines of Preferred Reporting Items for Systematic Reviews (PRISMA) and Meta-Analyses and the Meta-analysis of Observational Studies in Epidemiology (MOOSE).

DATA SOURCES: PubMed, Embase and MEDLINE databases were searched up to 28 February 2023, supplemented by grey literature searches.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Observational human studies evaluating the association between sedentary behaviour and endometrial cancer.

DATA EXTRACTION AND SYNTHESIS: Two reviewers extracted data and conducted the quality assessment based on Newcastle-Ottawa Scale (NOS) independently. We used a random-effects model with inverse variance approach to pool the estimates. The extent of heterogeneity was quantified with the I ² statistics.

RESULTS: Sixteen studies were included in the systematic review. Fourteen studies involving 882 686 participants were included in the meta-analysis. The pooled relative risks (RRs) for high versus low level of overall sedentary behaviour was 1.28 (95% CI: 1.14 to 1.43; I² =34.8%). The increased risk regarding specific domains was 1.22 (95% CI: 1.09 to 1.37; I²=13.4%, n=10) for occupational domain, 1.34 (95% CI: 0.98 to 1.83; I²=53.7%, n=6) for leisure-time domain and 1.55 (95% CI: 1.27 to 1.89; I²=0.0%, n=2) for total sedentary behaviour. Larger pooled RRs were observed among studies with adjustment for physical activity and studies without adjustment for body mass index.

CONCLUSIONS: Higher levels of sedentary behaviour, total and occupational sedentary behaviour in particular, increase the risk of endometrial cancer. Future studies are needed to verify domain-specific associations based on objective quantification of sedentary behaviour, as well as the interaction of physical activity, adiposity and sedentary time on endometrial cancer.

PMID:37280028 | DOI:10.1136/bmjopen-2022-069042

BMJ Open. 2023 Jun 6;13(6):e066897. doi: 10.1136/bmjopen-2022-066897.

ABSTRACT

OBJECTIVES: To (1) understand what behaviours, beliefs, demographics and structural factors predict US adults’ intention to get a COVID-19 vaccination, (2) identify segments of the population (‘personas’) who share similar factors predicting vaccination intention, (3) create a ‘typing tool’ to predict which persona people belong to and (4) track changes in the distribution of personas over time and across the USA.

DESIGN: Three surveys: two on a probability-based household panel (NORC’s AmeriSpeak) and one on Facebook.

SETTING: The first two surveys were conducted in January 2021 and March 2021 when the COVID-19 vaccine had just been made available in the USA. The Facebook survey ran from May 2021 to February 2022.

PARTICIPANTS: All participants were aged 18+ and living in the USA.

OUTCOME MEASURES: In our predictive model, the outcome variable was self-reported vaccination intention (0-10 scale). In our typing tool model, the outcome variable was the five personas identified by our clustering algorithm.

RESULTS: Only 1% of variation in vaccination intention was explained by demographics, with about 70% explained by psychobehavioural factors. We identified five personas with distinct psychobehavioural profiles: COVID Sceptics (believe at least two COVID-19 conspiracy theories), System Distrusters (believe people of their race/ethnicity do not receive fair healthcare treatment), Cost Anxious (concerns about time and finances), Watchful (prefer to wait and see) and Enthusiasts (want to get vaccinated as soon as possible). The distribution of personas varies at the state level. Over time, we saw an increase in the proportion of personas who are less willing to get vaccinated.

CONCLUSIONS: Psychobehavioural segmentation allows us to identify why people are unvaccinated, not just who is unvaccinated. It can help practitioners tailor the right intervention to the right person at the right time to optimally influence behaviour.

PMID:37280023 | DOI:10.1136/bmjopen-2022-066897

BMJ Open. 2023 Jun 6;13(6):e073777. doi: 10.1136/bmjopen-2023-073777.

ABSTRACT

OBJECTIVES: The purpose of this study was to assess the clinical and economic impact of adverse drug reactions (ADRs) among patients admitted to the University of Gondar Comprehensive Specialized Hospital (UoGCSH).

DESIGN AND SETTING: A prospective nested case-control study was conducted at the UoGCSH among admitted adult patients with (cases) and without ADRs (controls) between May and October 2022.

PARTICIPANTS: All eligible adult patients admitted in the medical ward of the UoGCSH during the study period were included in this study.

MAIN OUTCOME MEASURES: The outcome variables were the clinical and economic outcomes. Length of hospital stay, visits to intensive care units (ICU) and in-hospital mortality were used to measure and compare clinical outcomes in patients with and without ADRs. The economic outcome was also assessed using direct medical-related costs and compared for the two groups. Paired samples t-test and McNemar tests were used to compare measurable outcomes between the two groups. A p value <0.05 at the 95% CI was considered statistically significant.

RESULTS: Out of a total of 214 eligible enrolled patients, 206 (103 with and 103 without ADRs) with a 96.3% response rate were included in the cohort. The length of hospital stay was much longer in patients with ADRs than without ADRs (19.8 vs 15.2 days, p<0.001). Similarly, ICU visits (11.2% vs 6.8%, p<0.001) and in-hospital mortality (4.4% vs 1.9%, p=0.012) were significantly higher in patients with ADRs compared with those without ADRs. Patients with ADRs were significantly charged with higher direct medical costs compared with those without ADRs (6237.2 vs 5256.3 Ethiopian birr; p<0.001).

CONCLUSION: This study concluded that ADRs had a significant impact on patients’ clinical and medical costs. Healthcare providers should strictly follow the patients to minimise ADR-related clinical and economic adverse outcomes.

PMID:37280017 | DOI:10.1136/bmjopen-2023-073777

J Pharm Pract. 2023 Jun 6:8971900231176430. doi: 10.1177/08971900231176430. Online ahead of print.

ABSTRACT

BACKGROUND: Cytomegalovirus (CMV) infection after abdominal organ transplantation is associated with increased morbidity and mortality. The use of valganciclovir for CMV prophylaxis is limited by drug-induced myelosuppression and potential emergence of resistance. Letermovir is approved for primary CMV prophylaxis in CMV seropositive allogeneic hematopoietic cell transplant recipients. However, it is increasingly used off-label for prophylaxis in solid organ transplant (SOT) recipients.

METHODS: Based on pharmacy records, we examined retrospectively the use of letermovir for CMV prophylaxis in abdominal transplant recipients initiated on therapy at our center from January 1, 2018 through October 15, 2020. Data were summarized using descriptive statistics.

RESULTS: Twelve episodes of letermovir prophylaxis occurred in ten patients. Four patients received primary and 6 patients received secondary prophylaxis during the study period, with 1 patient receiving letermovir secondary prophylaxis on 3 separate occasions. All patients receiving letermovir for primary prophylaxis had successful outcomes. However, letermovir secondary prophylaxis was unsuccessful in 5 of the 8 episodes (62.5%) due to breakthrough CMV DNAemia and/or disease. Only 1 patient discontinued therapy due to adverse effects.

CONCLUSION: Although letermovir was generally well tolerated, the high rate of failure when used as secondary prophylaxis was noteworthy. Additional controlled clinical trials assessing the safety and efficacy of letermovir prophylaxis in SOT recipients are warranted.

PMID:37280011 | DOI:10.1177/08971900231176430

CMAJ Open. 2023 Jun 6;11(3):E475-E484. doi: 10.9778/cmajo.20220092. Print 2023 May-Jun.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has created major disruptions in cancer care, with reductions in diagnostic tests and treatments. We evaluated the impact of these health care-related changes on cancer staging by comparing cancers staged before and during the pandemic.

METHODS: We performed a retrospective cohort study at London Health Sciences Centre and St. Joseph’s Health Care London, London, Ontario, Canada. We evaluated all pathologically staged breast, colorectal, prostate, endometrial and lung cancers (the 5 most common cancers by site, excluding nonmelanoma skin cancer) over a 3-year period (Mar. 15, 2018-Mar. 14, 2021). The pre-COVID-19 group included procedures performed between Mar. 15, 2018, and Mar. 14, 2020, and the COVID-19 group included procedures performed between Mar. 15, 2020, and Mar. 14, 2021. The primary outcome was cancer stage group, based on the pathologic tumour, lymph node, metastasis system. We performed univariate analyses to compare demographic characteristics, pathologic features and cancer stage between the 2 groups. We performed multivariable ordinal regression analyses using the proportional odds model to evaluate the association between stage and timing of staging (before v. during the pandemic).

RESULTS: There were 4055 cases across the 5 cancer sites. The average number of breast cancer staging procedures per 30 days increased during the pandemic compared to the yearly average in the pre-COVID-19 period (41.3 v. 39.6), whereas decreases were observed for endometrial cancer (15.9 v. 16.4), colorectal cancer (21.8 v. 24.3), prostate cancer (13.6 v. 18.5) and lung cancer (11.5 v. 15.9). For all cancer sites, there were no statistically significant differences in demographic characteristics, pathologic features or cancer stage between the 2 groups (p > 0.05). In multivariable regression analysis, for all cancer sites, cases staged during the pandemic were not associated with higher stage (breast: odds ratio [OR] 1.071, 95% confidence interval [CI] 0.826-1.388; colorectal: OR 1.201, 95% CI 0.869-1.661; endometrium: OR 0.792, 95% CI 0.495-1.252; prostate: OR 1.171, 95% CI 0.765-1.794; and lung: OR 0.826, 95% CI 0.535-1.262).

INTERPRETATION: Cancer cases staged during the first year of the COVID-19 pandemic were not associated with higher stage; this likely reflects the prioritization of cancer procedures during times of reduced capacity. The impact of the pandemic period on staging procedures varied between cancer sites, which may reflect differences in clinical presentation, detection and treatment.

PMID:37279981 | DOI:10.9778/cmajo.20220092

J Sex Med. 2023 Jun 6:qdad066. doi: 10.1093/jsxmed/qdad066. Online ahead of print.

ABSTRACT

BACKGROUND: Limitation to the capacity to love is often a feature of a suffering personality.

AIM: We aimed to investigate the role of the capacity to love in hypersexual behavior, considering both distress and defense mechanisms as possible psychological mediators.

METHODS: Through an online platform, we recruited a convenience sample of 521 subjects (390 [74.9%] females and 131 [25.1%] males; mean [SD] age, 26.46 [5.89] years).

OUTCOMES: Recruited subjects completed a psychometric protocol that included completion of the following measurement tools: (1) the Capacity to Love Inventory (CTL-I), (2) the Hypersexual Behavior Inventory (HBI), (3) the 30-item self-report Defense Mechanisms Rating Scale, and (4) the Brief Symptom Inventory. We then performed correlation and regression analyses and used a mediation model for data analysis.

RESULTS: A significant negative relationship between the capacity to love and hypersexual behavior was found. Furthermore, indirect effects were also statistically significant, supporting the hypothesis that limitation to the capacity to love is related to hypersexuality through the paths of psychological distress and immature defense mechanisms. Finally, compared to the other subjects, those with pathological scores for the HBI showed significantly lower scores on the CTL-I, which suggested limitations to the capacity to love.

CLINICAL IMPLICATIONS: The relationship between limitation to the capacity to love and hypersexuality is fundamental to the diagnostic process in persons with problematic sexuality and psychopathological distress.

STRENGTHS AND LIMITATIONS: This study is the first, to our knowledge, to highlight the role of the capacity to love in sexual behavior, although future studies in specific clinical sample groups would be suitable for further investigation of the relationships among the considered variables.

CONCLUSION: The etiology of limitation in the capacity to love is related to dysfunctional aspects of psychological functioning, such as psychological distress and immature defense mechanisms, and these factors together generate problematic sexuality such as hypersexual behavior. Our results highlight the central role in mental and sexual health of the capacity to love. Based on these findings, clinicians should take these aspects into consideration for diagnosis and treatment of patients presenting with problematic sexuality.

PMID:37279963 | DOI:10.1093/jsxmed/qdad066

J Clin Endocrinol Metab. 2023 Jun 6:dgad339. doi: 10.1210/clinem/dgad339. Online ahead of print.

ABSTRACT

BACKGROUND: Few studies have examined the relationship between vitamin D and the risk of recurrent cardiovascular events in people with coronary heart disease (CHD).

AIM: This study aimed to investigate the associations of serum 25-hydroxyvitamin D [25(OH)D] concentration and the vitamin D receptor (VDR) polymorphisms with the risk of recurrent cardiovascular events in individuals with established CHD.

METHODS: A total of 22,571 participants with CHD were included from the UK Biobank. Recurrent cardiovascular events, including myocardial infarction (MI), heart failure (HF), stroke, and CVD mortality, were identified from electronic health records. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS: The median (interquartile range) of serum 25(OH)D concentration was 44.8 (30.3, 61.4) nmol/L, and 58.6% of participants had 25(OH)D below 50 nmol/L. During a median follow-up of 11.2 years, a total of 3,998 recurrent cardiovascular events were documented. After multivariable adjustment, there was a non-linear inverse relationship between serum 25(OH)D and recurrent cardiovascular events (P non-linearity <0.01), and the decreasing risk gradually leveled off at around 50 nmol/L. Compared with participants with serum 25(OH)D <25.0 nmol/L, the HRs (95% CIs) for participants with serum 25(OH)D of 50.0-74.9 nmol/L were 0.64 (0.58, 0.71) for recurrent cardiovascular events, 0.78 (0.65, 0.94) for MI, 0.66 (0.57, 0.76) for HF, and 0.66 (0.52, 0.84) for stroke. In addition, these associations were not modified by genetic variants in the VDR.

INTERPRETATION: In people with established CHD, higher serum 25(OH)D concentrations were non-linearly associated with a lower risk of recurrent cardiovascular events, with a potential threshold around 50 nmol/L. These findings highlight the importance of maintaining adequate vitamin D status in the prevention of recurrent cardiovascular events among individuals with CHD.

PMID:37279959 | DOI:10.1210/clinem/dgad339

Oncologist. 2023 Jun 6:oyad159. doi: 10.1093/oncolo/oyad159. Online ahead of print.

ABSTRACT

BACKGROUND: In recent years, breast cancer has become the most common cancer in the world, increasing women’s health risks. Approximately 60% of breast cancers are categorized as human epidermal growth factor receptor 2 (HER2)-low tumors. Recently, antibody-drug conjugates have been found to have positive anticancer efficacy in patients with HER2-low breast cancer, but more studies are required to comprehend their clinical and molecular characteristics.

METHODS: In this study, we retrospectively analyzed the data of 165 early breast cancer patients with pT1-2N1M0 who had undergone the RecurIndex testing. To better understand HER2-low tumors, we investigated the RecurIndex genomic profiles, clinicopathologic features, and survival outcomes of breast cancers according to HER2 status.

RESULTS: First, there were significantly more hormone receptor (HR)-positive tumors, luminal-type tumors, and low Ki67 levels in the HER2-low than in the HER2-zero. Second, RI-LR (P = .0294) and RI-DR (P = .001) scores for HER2-low and HER2-zero were statistically significant. Third, within HER2-negative disease, HR-positive/HER2-low tumors showed highest ESR1, NFATC2IP, PTI1, ERBB2, and OBSL1 expressions. Fourth, results of the survival analysis showed that lower expression of HER2 was associated with improved relapse-free survival for HR-positive tumors, but not for HR-negative tumors.

CONCLUSIONS: The present study highlights the unique features of HER2-low tumors in terms of their clinical characteristics as well as their gene expression profiles. HR status may influence the prognosis of patients with HER2-low expression, and patients with HR-positive/HER2-low expression may have a favorable outcome.

PMID:37279952 | DOI:10.1093/oncolo/oyad159