Category: Nevin Manimala

Malar J. 2023 Mar 4;22(1):75. doi: 10.1186/s12936-023-04515-4.

ABSTRACT

BACKGROUND: Over the last decades, enormous successes have been achieved in reducing malaria burden globally. In Latin America, South East Asia, and the Western Pacific, many countries now pursue the goal of malaria elimination by 2030. It is widely acknowledged that Plasmodium spp. infections cluster spatially so that interventions need to be spatially informed, e.g. spatially targeted reactive case detection strategies. Here, the spatial signature method is introduced as a tool to quantify the distance around an index infection within which other infections significantly cluster.

METHODS: Data were considered from cross-sectional surveys from Brazil, Thailand, Cambodia, and Solomon Islands, conducted between 2012 and 2018. Household locations were recorded by GPS and finger-prick blood samples from participants were tested for Plasmodium infection by PCR. Cohort studies from Brazil and Thailand with monthly sampling over a year from 2013 until 2014 were also included. The prevalence of PCR-confirmed infections was calculated at increasing distance around index infections (and growing time intervals in the cohort studies). Statistical significance was defined as prevalence outside of a 95%-quantile interval of a bootstrap null distribution after random re-allocation of locations of infections.

RESULTS: Prevalence of Plasmodium vivax and Plasmodium falciparum infections was elevated in close proximity around index infections and decreased with distance in most study sites, e.g. from 21.3% at 0 km to the global study prevalence of 6.4% for P. vivax in the Cambodian survey. In the cohort studies, the clustering decreased with longer time windows. The distance from index infections to a 50% reduction of prevalence ranged from 25 m to 3175 m, tending to shorter distances at lower global study prevalence.

CONCLUSIONS: The spatial signatures of P. vivax and P. falciparum infections demonstrate spatial clustering across a diverse set of study sites, quantifying the distance within which the clustering occurs. The method offers a novel tool in malaria epidemiology, potentially informing reactive intervention strategies regarding radius choices of operations around detected infections and thus strengthening malaria elimination endeavours.

PMID:36870976 | DOI:10.1186/s12936-023-04515-4

J Otolaryngol Head Neck Surg. 2023 Mar 4;52(1):21. doi: 10.1186/s40463-023-00634-9.

ABSTRACT

OBJECTIVES: There is a lack of robust evidence in regards to whether the intra and post-operative safety and efficacy of conventional curettage adenoidectomy is better than those of other available surgical techniques. Therefore, this study was conducted as a systematic review and network meta-analysis of published randomized controlled trials (RCTs) with the aim of comparing the safety and efficacy of conventional curettage adenoidectomy with all other available adenoidectomy techniques.

MATERIALS AND METHODS: A systematic search of published articles was performed in 2021 using databases such as PubMed/Medline, EMBASE, EBSCO, and the Cochrane Library. All RCTs that compared conventional curettage adenoidectomy with other surgical techniques and were published in English between 1965 and 2021 were included. The quality of the included RCTs have been assessed using Cochrane Collaboration Risk of Bias Tool.

RESULTS: After screening 1494 articles, 17 were identified for comparing several adenoidectomy techniques and were eligible for quantitative analysis. Of those, 9 RCTs were analyzed for intraoperative blood loss, and 6 articles were included for post-operative bleeding. Furthermore; 14, 10, and 7 studies were included for surgical time, residual adenoid tissue, and postoperative complications respectively. Endoscopic-assisted microdebrider adenoidectomy yielded a statistically significantly greater estimate of intraoperative blood loss compared with conventional curettage adenoidectomy (mean difference [MD], 92.7; 95% confidence interval [CI] 28.3-157.1), suction diathermy (MD, 117.1; 95% CI 37.2-197.1). Suction diathermy had the highest cumulative probability of being the preferred technique because it was estimated to result in the least intraoperative blood loss. Electronic molecular resonance adenoidectomy was estimated to be more likely to result in the shortest surgical time (mean rank, 2.2). Participants in the intervention group were 97% less likely to have residual adenoid tissue than children in the conventional curettage group (odds ratio 0.03; 95% CI 0.01-0.15); therefore, conventional curettage was not considered an appropriate technique for complete removal of adenoid tissue.

CONCLUSION: There is no single technique that can be considered best for all possible outcomes. Therefore, otolaryngologists should make an appropriate choice after critically reviewing the clinical characteristics of children requiring adenoidectomy. Findings of this systematic review and meta-analysis may guide otolaryngologists when making evidence-based decisions regarding the treatment of enlarged and symptomatic adenoids in children.

PMID:36870974 | DOI:10.1186/s40463-023-00634-9

BMC Cancer. 2023 Mar 4;23(1):210. doi: 10.1186/s12885-023-10673-0.

ABSTRACT

BACKGROUND: The clinical application of anthracycline chemotherapy is hindered due to the cumulative dose-dependent cardiotoxicity followed by the oxidative stress initiated during the mechanism of action of anthracyclines. Due to a lack of prevalence data regarding anthracycline-induced cardiotoxicity in Sri Lanka, this study was conducted to determine the prevalence of cardiotoxicity among breast cancer patients in Southern Sri Lanka in terms of electrocardiographic and cardiac biomarker investigations.

METHODS: A cross-sectional study with longitudinal follow-up was conducted among 196 cancer patients at the Teaching Hospital, Karapitiya, Sri Lanka to determine the incidence of acute and early-onset chronic cardiotoxicity. Data on electrocardiography and cardiac biomarkers were collected from each patient, one day before anthracycline (doxorubicin and epirubicin) chemotherapy, one day after the first dose, one day and six months after the last dose of anthracycline chemotherapy.

RESULTS: Prevalence of sub-clinical anthracycline-induced cardiotoxicity six months after the completion of anthracycline chemotherapy was significantly higher (p < 0.05) and there were strong, significant (p < 0.05) associations among echocardiography, electrocardiography measurements and cardiac biomarkers including troponin I and N-terminal pro-brain natriuretic peptides. The cumulative anthracycline dose, > 350 mg/m² was the most significant risk factor associated with the sub-clinical cardiotoxicity in breast cancer patients under study.

CONCLUSION: Since these results confirmed the unavoidable cardiotoxic changes following anthracycline chemotherapy, it is recommended to carry out long-term follow-ups in all patients who were treated with anthracycline therapy to increase their quality of life as cancer survivors.

PMID:36870959 | DOI:10.1186/s12885-023-10673-0

BMC Pregnancy Childbirth. 2023 Mar 4;23(1):145. doi: 10.1186/s12884-023-05457-0.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has led to unprecedented mental stress to women after childbirth. In this study, we assessed the association of disrespectful care after childbirth and COVID-19 exposure before/during labour with postpartum depression symptoms assessed at 7 and 45 days in Nepal.

METHODS: A longitudinal cohort study was conducted in 9 hospitals of Nepal among 898 women. The independent data collection system was established in each hospital to collection information on disrespectful care after birth via observation, exposure to COVID-19 infection before/during labour and other socio-demographic via interview. The information on depressive symptoms at 7 and 45 days was collected using the validated Edinburg Postnatal Depression Scale (EPDS) tool. Multi-level regression was performed to assess the association of disrespectful care after birth and COVID-19 exposure with postpartum depression.

RESULT: In the study, 16.5% were exposed to COVID-19 before/during labour and 41.8% of them received disrespectful care after childbirth. At 7 and 45 days postpartum, 21.3% and 22.4% of women reported depressive symptoms respectively. In the multi-level analysis, at the 7th postpartum day, women who had disrespectful care and no COVID-19 exposure still had 1.78 higher odds of having depressive symptom (aOR, 1.78; 95% CI; 1.16, 2.72). In the multi-level analysis, at 45^th postpartum day, women who had disrespectful care and no COVID-19 exposure had 1.37 higher odds of having depressive symptoms (aOR, 1.37; 95% CI; 0.82, 2.30), but not statistically significant.

CONCLUSION: Disrespectful care after childbirth was strongly associated with postpartum depression symptoms irrespective of COVID-19 exposure during pregnancy. Caregivers, even during the global pandemic, should continue to focus their attention for immediate breast feeding and skin-to-skin contact, as this might reduce the risk for depressive symptoms postpartum.

PMID:36870950 | DOI:10.1186/s12884-023-05457-0

BMC Neurol. 2023 Mar 4;23(1):97. doi: 10.1186/s12883-023-03143-4.

ABSTRACT

BACKGROUND: Previous studies have developed clinical prognostic models for Guillain-Barré syndrome including EGOS and mEGOS, they have good reliability and accuracy, but individual entries are poor. This study aims to establish a scoring system to predict the early prognosis, in order to provide additional treatment for patients with poor prognosis and shorten the length of hospital stay.

METHODS: We retrospectively analyzed risk factors affecting the short-term prognosis of Guillain-Barré syndrome, and developed a scoring system for early determination of disease prognosis. Sixty two patients were divided into two groups based on the Hughes GBS disability score at discharge. Groups were compared for differences in gender, age at onset, antecedent infection, cranial nerve involvement, pulmonary infection, mechanical ventilation support, hyponatremia, hypoproteinemia, impaired fasting glucose, and peripheral blood neutrophil-to-lymphocyte ratio. Statistically significant factors were included in a multivariate logistic regression analysis, and a scoring system to predict the short-term prognosis was established based on the regression coefficients. The receiver operating characteristic curve of this scoring system was plotted, and the area under the ROC curve was calculated to assess the accuracy of the prediction model.

RESULTS: Univariate analysis revealed that age at onset, antecedent infection, pneumonia, mechanical ventilation support, hypoalbuminemia, hyponatremia, impaired fasting glucose, and elevated peripheral blood neutrophil-to-lymphocyte ratio were risk factors for poor short-term prognosis. The above factors were included in the multivariate logistic regression analysis, and pneumonia, hypoalbuminemia, and hyponatremia could be used as independent predictors. The receiver operating characteristic curve was plotted with a calculated area under the ROC curve of 82.2% (95% CI 0.775-0.950, P < 0.0001). The best cut-off value for the model score was 2, with a sensitivity of 0.9091, a specificity of 0.7255, and a Youden index of 0.6346.

CONCLUSION: Pneumonia, hyponatremia, and hypoalbuminemia were independent risk factors for poorer short-term prognosis in patients with Guillain-Barré syndrome. The short-term prognosis scoring system of Guillain-Barré syndrome we constructed using these variables had some predictive value, and the short-term prognosis with quantitative scores of 2 or more was worse.

PMID:36870949 | DOI:10.1186/s12883-023-03143-4

Infect Dis Health. 2023 Mar 2:S2468-0451(23)00012-3. doi: 10.1016/j.idh.2023.02.003. Online ahead of print.

ABSTRACT

BACKGROUND: Hospital Housekeeping staff play a key role in maintaining safe and clean environments to prevent infection and its spread in hospital. Innovative training approaches are necessary for this category; especially since their educational level is below average. Simulation based training can be a valuable tool for them in health care sector. However, no studies have explored the impact of simulation-based training on housekeeping staff performance, which is the focus of this study.

OBJECTIVE: This research focuses on exploring the effectiveness of simulation-based training for Hospital Housekeeping Staff.

METHODS: The study used pre-post training data from 124 housekeeping staff in different work areas at KAUH to measure the effectiveness of the program on their performance. The training includes five segments: General Knowledge training, Personal Protective Equipment, Hand Hygiene, Cleaning Biological Materials, and Terminal Cleaning. The study incorporated a two-sample paired T-test, One-Way ANOVA to detect differences in mean performance pre-and post-training and between groups in terms of gender and work area.

RESULTS: Study results show a significant improvement in housekeeping staff performance after the training, where the performance measure of GK was improved by 33%, PPE 42%, HH 53%, Biological Spill Kit is 64%, and terminal cleaning 11% However, there is no significant difference in performance improvements in all stations in regards of gender and work area except for the Biological Spill Kit in terms of the work area.

CONCLUSION: Results show the effectiveness of training as there are statistically significant differences in housekeeping staff mean performance pre-and post-training. The simulation-based training changed the behavior of the cleaners, as they became more confident and understanding in performing their work. Expanding the use of simulation as a basis for training this important group and further study is recommended.

PMID:36870939 | DOI:10.1016/j.idh.2023.02.003

J Am Pharm Assoc (2003). 2023 Feb 12:S1544-3191(23)00028-6. doi: 10.1016/j.japh.2023.02.012. Online ahead of print.

ABSTRACT

BACKGROUND: Obesity is a common disease state within pediatrics, with 19.7% of children in the United States classified as obese. Medication dosing in this population is a challenge not commonly examined in clinical drug trials. Dosing based on total body weight may not always be appropriate; therefore, ideal body weight (IBW) and adjusted body weight (AdjBW) may provide more effective dosing.

OBJECTIVE: The goal was to implement a dosing protocol for pediatric patients with obesity to improve adherence. The primary endpoint was to evaluate adherence to evidence-based dosing recommendations and the secondary endpoints included cost saving analysis for immune globulin and accurate charting of IBW and AdjBW.

METHODS: This was a single center, quality improvement project composed of pre- and post-implementation groups. An IBW and AdjBW calculator were implemented in our electronic health record, as customized enhancements, along with specific weight ordering options. A literature search of pharmacokinetic and pharmacodynamic dosing recommendations based on IBW and AdjBW was conducted. For both groups, patients were included if they were 3-18 years old, had a body mass index greater than or equal to the 95th percentile, and if they received a specified medication.

RESULTS: A total of 618 patients were identified with 24 and 56 patients included for the pre- and post-implementation groups. There were no statistically significant differences in baseline characteristics of the comparator groups. The usage of correct body weight increased from 1.2% to 24.2% after implementation and education (P < 0.001). Cost savings was analyzed for immune globulin with the potential for a net savings of $9423 ± 3626.92.

CONCLUSION: Dosing medications for our pediatric patients with obesity improved with the implementation of calculated dosing weights in the electronic health record, provision of an evidence-based dosing chart, and education of providers.

PMID:36870938 | DOI:10.1016/j.japh.2023.02.012

Am J Orthod Dentofacial Orthop. 2023 Mar 3:S0889-5406(23)00033-1. doi: 10.1016/j.ajodo.2022.10.025. Online ahead of print.

ABSTRACT

INTRODUCTION: The simultaneous presence of maxillary and mandibular clear aligners alters the vertical dimension and the quantity and quality of occlusal contacts. Few data in the literature explain how this occurs and the effects on neuromuscular coordination. This study aimed to evaluate occlusal contacts and muscular balance during treatment with clear aligners over a short follow-up time.

METHODS: Twenty-six female adult patients were enrolled in this study. The center of occlusal force (COF) was evaluated using a T-Scan II device, whereas muscular symmetry and balance were determined through surface electromyography using a standardized protocol that reduces anthropometric and electrode variations. Both evaluations were performed in centric occlusion and with aligners worn before treatment, after 3 months, and after 6 months.

RESULTS: A statistically significant variation in COF position was reported in the sagittal plane but not in the transverse plane. The shift in the COF position was followed by a change in muscular balance evaluated through surface electromyography.

CONCLUSIONS: Treatment with clear aligners resulted in an anterior shift of the COF when biting in centric occlusion and a posterior shift when the aligners were worn in healthy female patients after 6 months of observation. This change in occlusal contact was followed by an improvement in muscular function symmetry in the short term when aligners were worn, compared with the centric occlusion during treatment.

PMID:36870918 | DOI:10.1016/j.ajodo.2022.10.025

Nutr Metab Cardiovasc Dis. 2022 Dec 26:S0939-4753(22)00492-6. doi: 10.1016/j.numecd.2022.12.005. Online ahead of print.

ABSTRACT

AIMS: To perform a systematic review to investigate the association between adolescents’ a posteriori dietary patterns with diabetes-related biomarkers (fasting blood glucose, fasting insulinemia, glycated hemoglobin and homeostatic model assessment insulin resistance index (HOMA-IR)).

DATA SYNTHESIS: Review registered with PROSPERO under number CRD42020185369. Studies with adolescents aged 10-19 years that identified dietary patterns by a posteriori methods were included. The databases used included: PubMed, SCOPUS, Web of Science, Food Science and Technology Abstracts, CINAHL, SPORTDiscus, Lilacs/BVS, The Cochrane Central Register of Controlled Trials, ProQuest Dissertations&Theses Global and Capes Theses Bank and Brazilian Digital Library of Theses and Dissertations. Risk of bias was assessed via the Agency for Healthcare Research and Quality tool. Eight cross-sectional studies that evaluated 6438 adolescents (55.5% females) were included. For fasting blood glucose, the results were inconsistent and some studies found no association for the dietary patterns called traditional (57%), Western (42%) and healthy (28%). For the fasting insulinemia and HOMA-IR outcomes, the Western dietary pattern showed a positive association or higher means in 60% and 50% of the studies, respectively. No studies that evaluated glycated hemoglobin were found.

CONCLUSION: Fasting insulinemia and HOMA-IR outcomes were positively associated with the Western dietary patterns. The studies reviewed did not present consistent evidence of an association with western, healthy and traditional dietary patterns with fasting blood glucose, as the results were conflicting or did not show statistical significance.

PMID:36870914 | DOI:10.1016/j.numecd.2022.12.005

J Adolesc Health. 2023 Mar 2:S1054-139X(23)00062-9. doi: 10.1016/j.jadohealth.2023.01.015. Online ahead of print.

ABSTRACT

PURPOSE: Youth with suicidality requiring psychiatric hospitalization may first experience boarding at acute care hospitals. Given infrequent provision of therapy during this period, we developed a modular digital intervention (I-CARE; Improving Care, Accelerating Recovery and Education) to facilitate delivery of evidence-based psychosocial skills by non-mental health clinicians. This pilot study describes changes in emotional distress, severity of illness, and readiness for engagement following I-CARE participation, and evaluates the feasibility, acceptability, and appropriateness of I-CARE.

METHODS: A mixed-methods approach was used to evaluate I-CARE, offered to youth 12-17 years from 11/21 to 06/22. Changes in emotional distress, severity of illness, and engagement readiness were evaluated using paired t-tests. Semistructured interviews with youth, caregivers, and clinicians were conducted concurrently with collection of validated implementation outcome measures. Quantitative measure results were linked to interview transcripts, which were analyzed thematically.

RESULTS: Twenty-four adolescents participated in I-CARE; median length of stay was 8 days (IQR:5-12 days). Emotional distress decreased significantly by 6.3 points (63-point scale) following participation (p = .02). The increase in engagement readiness and decrease in youth-reported illness severity were not statistically significant. Among 40 youth, caregivers, and clinicians who participated in the mixed-methods evaluation, 39 (97.5%) rated I-CARE as feasible, 36 (90.0%) as acceptable, and 31 (77.5%) as appropriate. Adolescents’ prior knowledge of psychosocial skills and clinicians’ competing demands were reported barriers.

DISCUSSION: I-CARE was feasible to implement and youth reported reduced levels of distress following participation. I-CARE has the potential to teach evidence-based psychosocial skills during boarding, which may provide a head-start on recovery before psychiatric hospitalization.

PMID:36870901 | DOI:10.1016/j.jadohealth.2023.01.015