Category: Nevin Manimala

Int Health. 2023 Apr 21:ihad012. doi: 10.1093/inthealth/ihad012. Online ahead of print.

ABSTRACT

BACKGROUND: The public health impact of neglected tropical diseases (NTDs) is quite substantial. The objective of this study was to assess the knowledge and response capability of health professionals regarding NTDs in Kaduna State, Nigeria.

METHODS: A pre-tested questionnaire with a Cronbach’s α coefficient of 0.716 was administered to 350 health professionals. The questionnaire assessed the knowledge, resource availability and capacity to handle NTD cases.

RESULTS: Only 38 (12.6%) respondents were familiar with the World Health Organization’s definition of NTDs. Although self-reported knowledge was highest for physicians (37 [82.2%]), there was no statistically significant knowledge disparity between cadres of health professionals. Only 12 (46.2%) practitioners in private health facilities reported adequate knowledge. The tier of practice was significantly associated with management of NTDs (χ2 = 10.545; df 2; p = 0.005). Only 24 (47.1%) medical laboratory scientists and 18 (40.0%) physicians had adequate clinical resources for management of NTDs. Nearly three-quarters (211 (70.1%)] of respondents had never been trained in the management of NTDs. More than half (177 [58.8%]) of facilities lacked pharmaceuticals or standard operating procedures for management of NTDs.

CONCLUSIONS: Self-reported knowledge of NTDs was suboptimal. Physical and clinical resources for the diagnosis and treatment of NTDs were inadequate. Targeted training, increased funding and provision of adequate resources are needed in order to ameliorate the situation.

PMID:37083280 | DOI:10.1093/inthealth/ihad012

Europace. 2023 Apr 21:euad103. doi: 10.1093/europace/euad103. Online ahead of print.

ABSTRACT

AIMS: Atrial fibrillation (AF) is one of the major causes of ischaemic stroke. In addition to clinical risk evaluated by the CHA2DS2-VASC score, the impact of genetic factors on the risk of AF-related thromboembolic stroke has been largely unknown. We found several copy number variations (CNVs) in novel genes that were associated with thromboembolic stroke risk in our AF patients by genome-wide approach. Among them, the gasdermin D (GSDMD) gene was related to inflammation. We aimed to test whether GSDMD deletion was associated with AF-related stroke.

METHODS AND RESULTS: A total of 400 patients with documented non-familial AF were selected, of which 100 patients were diagnosed with ischaemic stroke. The baseline characteristics of age, sex, valvular heart disease, coronary artery disease, heart failure, and CHA2DS2-VASc scores were not statistically different between cases and controls. We found that individuals who carried GSDMD homozygous deletion genotype had a higher risk for ischaemic stroke (odds ratio 2.195; 95% confidence interval, 1.24-3.90; P = 0.007), even adjusted by CHA2DS2-VASc scores. We also validated the association of GSDMD with AF stroke in a large Caucasian population (UK Biobank).

CONCLUSION: We found a link between the homozygous deletion of the GSDMD gene and an increased risk of stroke in patients with AF. This may implicate the use of therapy targeting GSDMD in the prevention of ischaemic stroke for AF patients.

PMID:37083255 | DOI:10.1093/europace/euad103

Environ Toxicol Chem. 2023 Apr 21. doi: 10.1002/etc.5636. Online ahead of print.

ABSTRACT

In 2019, the Idaho Department of Environmental Quality (IDEQ) implemented a paired surface water and fish tissue data collection program to derive a state-specific bioaccumulation factor (BAF) for inorganic arsenic (iAs) as part of the development of new human health water quality criteria (HHWQC). No statistically significant relationship was found between total arsenic (tAs) or iAs in surface water and fish tissue. Fish body weight was the only parameter with a statistically significant effect on iAs concentration in fish tissue. The ratio of iAs to tAs in fish tissue declined significantly with both increasing trophic level and increasing body weight. The decrease in iAs concentration in fish tissue with increasing size and trophic level, as well as the decrease in the proportion of tAs that is iAs with increasing trophic level, are likely the result of metabolic transformation of iAs to organic As by organisms in each level of the aquatic foodweb. Although the linear regression-based BAF using the Idaho paired fish and water data best predicted observed iAs fish tissue concentrations compared to several alternative BAFs, it was not statistically significant (p < 0.05) and was a poor predictor (R² = 0.01) of iAs concentrations in fish tissue. These results illustrate that iAs, and possibly other metals, in the natural environment do not conform with commonly used bioaccumulation models and the paradigm used by USEPA for determining HHWQC. These results indicate modifications to the paradigm are necessary, such as a fish tissue criterion as Idaho has proposed, to assure public health is protected.

PMID:37083247 | DOI:10.1002/etc.5636

J Forensic Sci. 2023 Apr 21. doi: 10.1111/1556-4029.15258. Online ahead of print.

NO ABSTRACT

PMID:37083238 | DOI:10.1111/1556-4029.15258

Pediatr Pulmonol. 2023 Apr 21. doi: 10.1002/ppul.26425. Online ahead of print.

ABSTRACT

INTRODUCTION: Although impaired lung function after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been described in adults, it is unclear whether lung function might be altered in children, especially among asymptomatic or mildly symptomatic patients. In this study, we report the results of lung function testing performed after SARS-CoV-2 infection in a large pediatric population.

METHODS: The study included 589 patients with previous confirmed SARS-CoV-2 infection aged 0-18 years. Both symptomatic and asymptomatic patients during acute infection were enrolled in the study. A spirometry was performed in all cooperating patients.

RESULTS: The mean age of enrolled patients was 9.6 years and the mean time from infection to enrollment was 171 days. Spirometry was performed and deemed evaluable in 433 patients. No patient had reduced forced vital capacity (FVC) and only 14 patients (3.2%) had a forced expiratory volume in the First second (FEV1) < 80%. The mean spirometry values recorded were in the normal range. There were no statistically significant differences in spirometry values between patients with respiratory symptoms during infection and those without. Similarly, there were no differences in spirometry parameters according to the time elapsed between infection and enrollment.

CONCLUSION: Lung function, according to spirometry values, does not appear to be impaired long after infection in the pediatric population. The presence of respiratory symptoms during SARS-CoV-2 infection would not represent a risk factor for impaired lung function in this cohort of patients.

PMID:37083203 | DOI:10.1002/ppul.26425

Rev Esp Salud Publica. 2023 Apr 21;97:e202304031.

ABSTRACT

OBJECTIVE: Prescribing errors and drug-drug interactions constitute a relevant topic for health professionals in these hospital settings and for the strengthening of strategies to mitigate these errors. The aim of this article was to determine the prescribing errors and drug-drug interactions present in adult patients hospitalized in an intensive care unit in the city of Barranquilla (Colombia).

METHODS: A quantitative study was conducted in which 158 medical records of adult patients who were hospitalized in an Intensive Care Unit (ICU) in the city of Barranquilla during 2019 were analyzed. Medication errors and drug-drug interactions were determined by means of the Medscape application. Statistical analysis was performed using the RStudio program, descriptive and inferential statistics were applied to the data.

RESULTS: Sociodemographically, male sex prevailed, the most frequent pathological history was arterial hypertension, most patients were receiving between one±five drugs, the most common errors were related to omission of dosage, route and time of administration. Drug-drug interactions were reported in 64.5% (102) of the histories and, in terms of the level of severity of the interactions, moderate interactions predominated in 32.9% (52).

CONCLUSIONS: It is evident that there is a high number of medication prescription errors in hospitalized adults, among which pharmacological interactions associated mainly with the number of medications received by individuals in the ICUs stand out.

PMID:37083193

Future Oncol. 2023 Apr 21. doi: 10.2217/fon-2022-0932. Online ahead of print.

ABSTRACT

Aim: The correlation between response and survival has not been well-studied in relapsed or refractory multiple myeloma (RRMM). Materials & methods: A systematic literature review of Medline, Embase and Cochrane databases (2010-06/2020) and relevant congresses (2018-2020) was performed to identify randomized clinical trials in RRMM reporting median overall survival (mOS), progression-free survival and response endpoints. The relationship between mOS and response endpoints was analyzed using Pearson’s product-moment correlation. Results: A total of 81 records for 65 original studies, representing 12,827 patients were included. The correlation was moderate for mOS with overall response rate (Pearson r = 0.79), very good partial response (r = 0.73) and duration of response (r = 0.78); all were statistically significant. In linear regression models, estimated mOS gain was 0.48, 0.47 and 1.94 months per percentage point of overall response rate, very good partial response and complete response, respectively (all p < 0.001). Significance was maintained after adjustment for age, relapsed versus refractory multiple myeloma and study year. The analysis was limited by small sample sizes and inconsistent reporting of study-level covariates. Conclusion: These findings support short-term response-based endpoints as surrogates to survival in RRMM.

PMID:37083162 | DOI:10.2217/fon-2022-0932

J Cutan Med Surg. 2023 Apr 21:12034754231168851. doi: 10.1177/12034754231168851. Online ahead of print.

ABSTRACT

BACKGROUND: There is limited real-life evidence with brodalumab in patients with plaque psoriasis in Canada.

OBJECTIVES: To examine real-world effectiveness of brodalumab in Canadian routine care with a focus on clinician and patient-reported outcomes, as well as measuring continuation rates and persistency.

METHODS: Retrospective analysis was conducted on data collected through the brodalumab patient support program (PSP) in Canada for patients initiating brodalumab between June 2018 (PSP launch)- June 2020 with a minimum of 16 weeks follow-up from first dose. Effectiveness was assessed by improvements in PASI, BSA and DLQI; continuation rates and persistency on therapy were reported.

RESULTS: Overall, 864 patients (male, 59%; median age, 52 years) were included in the analysis. In a subset of patients with both baseline and follow-up scores, statistically significant improvements were observed: PASI improved from 13.9 to 1.8, BSA improved from 16.6% to 2.5% and DLQI improved from 16.2 to 2.9. Brodalumab demonstrated high continuation rates (89.9%), with similar rates in biologic-naïve and biologic-experienced patients (92.1% and 88.6%, respectively) and in patients who received secukinumab or ixekizumab as their most recent biologic therapy (89.0% and 86.2%, respectively). Persistence at 6, 12, and 18 months was 82.0%, 69.9%, and 63.4%, respectively.

CONCLUSIONS: The effectiveness of brodalumab was demonstrated in this Canadian routine care study, with significant improvements in disease severity and patient-reported outcomes. High continuation rates were achieved; including in patients previously treated with IL-17A inhibitors. Future studies will provide further evidence of brodalumab’s benefits for the management of plaque psoriasis in the real-world setting.

PMID:37083148 | DOI:10.1177/12034754231168851

Clin Anat. 2023 Apr 21. doi: 10.1002/ca.24046. Online ahead of print.

ABSTRACT

The traditional approach to anatomy teaching is still the most common. Recently, there has been a demand for methods that make students more active and open to communication and cooperation, and are well integrated with technology. Our aim in this study was to determine the social media usage characteristics and anatomy learning experiences of medical and dentistry students, and their expectations about learning via social media. A questionnaire was prepared and distributed to faculties of Medicine and Dentistry in 10 different universities in Türkiye via Google forms. The questionnaire was voluntarily answered by 762 students. Frequency, exploratory factor and confirmatory factor analyses were applied to the data acquired, and a structural equation modeling (SEM) approach was used. The results showed that 54.3% of the students spent more than 90 min/day on social media; 96.5% of the participants preferred to follow anatomical content pages on social media (acpSM) administered by an academic. They stated that the instant responses from acpSM’s admin had a positive effect on motivation to learning (4.08 ± 0.89, mean ± SD, on 5-point Likert-type scale). The SEM revealed a statistically significant correlation between the students’ learning motivation and the sufficiency and suitability of acpSM content (p < 0.010). Thus, medical and dental students are eager to learn anatomy via social media. However, they found acpSM to be insufficient in quality and quantity and wanted future content to be administered by academics. An acpSM optimized for content sufficiency and suitability increased students’ learning motivation.

PMID:37083146 | DOI:10.1002/ca.24046

J Magn Reson Imaging. 2023 Apr 21. doi: 10.1002/jmri.28724. Online ahead of print.

ABSTRACT

BACKGROUND: The suitability of hepatectomy among patients with multinodular hepatocellular carcinoma (MHCC) beyond the Milan criteria remains controversial. There is a need for a reliable risk stratification tool among these patients for the selection of ideal candidates of curative resection.

PURPOSE: To determine the clinicoradiological prognostic factors for patients with MHCC beyond the Milan criteria to further develop a stratification system.

STUDY TYPE: Retrospective.

SUBJECTS: 176 patients with pathologically confirmed MHCC beyond the Milan criteria.

FIELD STRENGTH/SEQUENCE: The 1.5 T scanner, including T1-, T2-, diffusion-weighted imaging, in/out-phase imaging, and dynamic contrast-enhanced imaging.

ASSESSMENT: Conventional MRI features and preoperative laboratory data including aspartate aminotransferase (AST) and α-fetoprotein (AFP) were collected and analyzed. Two nomograms incorporating clinicoradiological variables were independently constructed to predict recurrence-free survival (RFS) and overall survival (OS) with Cox regression analyses and verified with 5-fold cross validation. Based on the nomograms, two prognostic stratification systems for RFS and OS were further developed.

STATISTICAL TESTS: The Cohen’s kappa/intraclass correlation coefficient, C-index, calibration curve, Kaplan-Meier curve, log-rank test. A P value <0.05 was considered statistically significant.

RESULTS: AST > 40 U/L, increased tumor burden score, radiological liver cirrhosis and nonsmooth tumor margin were independent predictors for poor RFS, while AST > 40 U/L, AFP > 400 ng/mL and radiological liver cirrhosis were independent predictors for poor OS. The two nomograms demonstrated good discrimination performance with C-index of 0.653 (95% confidence interval [CI], 0.602-0.794) and 0.685 (95% CI, 0.623-0.747) for RFS and OS, respectively. The 5-fold cross validation further validated the discrimination capability of the nomograms. Based on the nomogram models, MHCC patients beyond the Milan criteria were stratified into low-/medium-/high-risk groups with significantly different RFS and OS.

DATA CONCLUSION: The proposed MRI-based prognostic stratification system facilitates the refinement and further subclassification of patients with MHCC beyond the Milan criteria.

EVIDENCE LEVEL: 4.

TECHNICAL EFFICACY: 2.

PMID:37083126 | DOI:10.1002/jmri.28724