Category: Nevin Manimala

Dysphagia. 2023 Apr 9. doi: 10.1007/s00455-023-10570-5. Online ahead of print.

ABSTRACT

There is a paucity of evidence from population-based studies identifying prevalence and incidence of dysphagia, as well as health and sociodemographic risk factors that may contribute to its development. As such, the current study aimed to determine prevalence, incidence, and associated predictors of dysphagia in adults. The Canadian Longitudinal Study on Aging is a nationally representative population study that follows 51,338 Canadians over 45 years of age. Biological, medical, psychological, social, lifestyle and economic data are collected. A secondary analysis of the data was conducted to determine prevalence, incidence, and the predictors of self-reported swallowing difficulty in adults between 45 and 85 years of age. Rates of swallowing difficulty by demographic risk factor, as well as lifestyle and health factors were analyzed using descriptive statistics. Associations between lifestyle and health variables with dysphagia were tested using Chi-square tests or t tests, as appropriate. Logistic regression was used to determine the predictors of self-reported swallowing difficulties. Overall prevalence of self-reported swallowing difficulties in adults over the age of 45 was 10.6% and increased to 13.7% after 3 years. Significant differences (p < 0.001) in self-reported swallowing difficulty at baseline were apparent across smoking status, requiring help to prepare meals, life satisfaction, social participation, all disease categories except dementia, number of medications, cognition, oral health status, and frailty. Incidence of dysphagia was 8.6%. Regression analyses suggested the following independent predictors of reports of swallowing difficulty: older age; non-white ethnicity; female sex; poor oral health; malnutrition; and frailty. These predictors should be carefully considered to ensure we are screening at-risk populations. Social determinants of health, such as ethnicity, must also be considered to ensure equitable care across the population.

PMID:37031453 | DOI:10.1007/s00455-023-10570-5

J Endocrinol Invest. 2023 Apr 9. doi: 10.1007/s40618-023-02082-8. Online ahead of print.

ABSTRACT

PURPOSE: Preventing fragility fractures by treating osteoporosis may reduce disability and mortality worldwide. Algorithms combining clinical risk factors with bone mineral density have been developed to better estimate fracture risk and possible treatment thresholds. This systematic review supported panel members of the Italian Fragility Fracture Guidelines in recommending the use of best-performant tool. The clinical performance of the three most used fracture risk assessment tools (DeFRA, FRAX, and FRA-HS) was assessed in at-risk patients.

METHODS: PubMed, Embase, and Cochrane Library were searched till December 2020 for studies investigating risk assessment tools for predicting major osteoporotic or hip fractures in patients with osteoporosis or fragility fractures. Sensitivity (Sn), specificity (Sp), and areas under the curve (AUCs) were evaluated for all tools at different thresholds. Quality assessment was performed using the Quality Assessment of Diagnostic Accuracy Studies-2; certainty of evidence (CoE) was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach.

RESULTS: Forty-three articles were considered (40, 1, and 2 for FRAX, FRA-HS, and DeFRA, respectively), with the CoE ranging from very low to high quality. A reduction of Sn and increase of Sp for major osteoporotic fractures were observed among women and the entire population with cut-off augmentation. No significant differences were found on comparing FRAX to DeFRA in women (AUC 59-88% vs. 74%) and diabetics (AUC 73% vs. 89%). FRAX demonstrated non-significantly better discriminatory power than FRA-HS among men.

CONCLUSION: The task force formulated appropriate recommendations on the use of any fracture risk assessment tools in patients with or at risk of fragility fractures, since no statistically significant differences emerged across different prediction tools.

PMID:37031450 | DOI:10.1007/s40618-023-02082-8

Orv Hetil. 2023 Apr 9;164(14):533-540. doi: 10.1556/650.2023.32713. Print 2023 Apr 9.

ABSTRACT

INTRODUCTION AND OBJECTIVE: The growing trend of childhood obesity is a major public health issue. Collaborations between medical and healthcare professionals, preventive and health preservative programs, dietary habit and nutrient intake studies are indispensable.

METHOD: A representative study has been performed among 4-10-year-old Hungarian children by gender, age, size of settlement and region. The study included 733 assessable questionnaires and 666 dietary records. Data on children’s eating habits were collected by using the internationally recommended three-day dietary record method. Body weight and height measurements were taken for each child to determine nutritional status. Data were analyzed with statistical methods.

RESULTS: The rate of overweight and obesity is 23%. Energy intake differs significantly between body mass index groups. The children’s fat intake is excessive (34.2 energy%), the saturated fatty acid intake exceeds the recommended 10 energy%, omega fatty acid ratio is disadvantageous and the children’s cholesterol intake is high. The average energy from carbohydrates is below the recommended 57 energy%, from added sugar it is 11%, which affects 52% of the children. Their low fibre intake (19.4 g/day) is due to low fruit, vegetable (263 g/day) and whole grain consumption. Of the micronutrients, sodium intake is 3-4 times higher than the recommended. In 35% of the children, the calcium intake is below the critical threshold, due to unfavourable milk and milk product consumption (290 g/day). Vitamin D intake was low in 98-100% of the children.

CONCLUSION: Compared to the results of other European and national studies performed among children, adolescent and adults, the nutritional status and nutrient intake of our sample is unfavourable. Comprehensive intervention, education of the children with the involvement of their parents is essential to reduce obesity. Orv Hetil. 2023; 164(14): 533-540.

PMID:37031445 | DOI:10.1556/650.2023.32713

J Psychoactive Drugs. 2023 Apr 9:1-11. doi: 10.1080/02791072.2023.2200780. Online ahead of print.

ABSTRACT

The purpose of this study was to examine the dynamic relationships between daily PTSD symptom severity (PTSS), cognitive and behavioral avoidance coping, and negative drinking consequences following recent injury. Participants consisted of 36 injury survivors (M_age = 34.0, SD = 10.8; 75.0% male; 69.4% White) who completed thrice daily assessments of PTSS, avoidance coping, and negative drinking consequences for 7 days at 6-weeks post-injury. Although hypothesized relationships were not statistically significant in full models with covariates that included alcohol consumption, the confidence intervals associated with focal predictors provided support for predictions. Follow-up analyses without covariates indicated that on occasions when an injury survivor engaged in more avoidance coping and experienced higher levels of PTSS, negative drinking consequences increased by 9% (b = 0.02, SE = 0.01, p = .006). This interaction was primarily driven by cognitive avoidance coping (b = 0.03, SE = 0.01, p = .008). Routine screening of avoidance coping, PTSS, and alcohol consumption in the aftermath of recent injury might assist with identifying survivors at risk for negative drinking consequences. Interventions that address cognitive avoidance coping and drinking among survivors experiencing elevated PTSS may help to prevent the development of this comorbidity.

PMID:37031432 | DOI:10.1080/02791072.2023.2200780

Qual Life Res. 2023 Apr 9. doi: 10.1007/s11136-023-03404-2. Online ahead of print.

ABSTRACT

PURPOSE: The European Organisation for Research and Treatment of Cancer (EORTC) quality of life core questionnaire (QLQ-C30) is a validated and widely-used Patient-Reported Outcome Measure for measuring the health-related quality of life (HRQoL) of cancer patients. To facilitate interpretation of results obtained in studies using the EORTC QLQ-C30, we generated normative data for the Dutch general population, stratified by age and sex.

METHODS: Dutch participants were selected from a larger cross-sectional online panel research study collecting EORTC QLQ-C30 general population normative data across 15 countries. EORTC QLQ-C30 raw scores based on a 4-point response scale were transformed to linear scores ranging from 0 to 100. Transformed scores were weighted based on the United Nations population distribution statistics and presented by age and sex/age. Differences in scale scores of ≥ 10 points in HRQoL were applied to indicate clinical relevance.

RESULTS: One thousand respondents completed the online survey. Stratified by age, clinically meaningful differences were observed, with worse physical functioning scores and better emotional functioning scores with increased age. Symptom scores remained stable across age groups, except for small age differences observed for fatigue, nausea/vomiting, diarrhoea, and financial difficulties. Stratified by sex/age, men generally scored better for both functioning and symptoms. However, these differences were not clinically meaningful.

CONCLUSIONS: These updated normative EORTC QLQ-C30 for the Dutch general population can be used to better interpret HRQoL data obtained from Dutch cancer patients. Being part of a larger international study, these data can further be used for inter-country comparisons in multi-national studies.

PMID:37031427 | DOI:10.1007/s11136-023-03404-2

Egypt J Immunol. 2023 Apr;30(2):37-46.

ABSTRACT

Breast cancer is the most common cancer among females with increasing incidence and death rates. Resistin is pro-inflammatory molecule which shares in diverse cellular signaling pathways. This study aimed to evaluate resistin and RETN rs3219175 gene polymorphism and their relevance to diagnostic susceptibility, prognostic value, and genetic risk among Egyptian female patients with breast cancer. Eighty female patients with breast cancer were recruited from the Oncology Department, Faculty of Medicine, Beni-Suef University. Breast cancer staging and grading were determined. Eighty age-matched normal females participated as controls. Quantitative determination of serum resistin was assayed by an enzyme-linked immunosorbent assay (ELISA). RETN rs3219175 gene polymorphism was determined by real time polymerase chain reaction (RT-PCR) TaqMan allelic discrimination assay. Serum resistin showed statistically significantly higher level among females with breast cancer when compared to controls (p < 0.001). Resistin showed sensitivity of 80% and specificity of 67.5% at cut off value of 1.27 ng/mL for diagnosis of breast cancer (p =0.001). RETN rs3219175 gene polymorphism showed significantly higher frequency of AG, AA genotypes, and A allele among cases when compared to controls (p < 0.001). No statistical difference was found in resistin level or RETN rs3219175 gene polymorphism regarding tumor characteristics including size, lymph nodes or distant metastasis. Resistin showed significantly higher level among carriers of AG followed by AA genotypes and among A allele (p < 0.001). In conclusion, resistin could be proposed as a possible potential diagnostic marker and A allele of RETN rs3219175 gene might be suggested as a genetic risk allele among female patients with breast cancer.

PMID:37031396

Egypt J Immunol. 2023 Apr;30(2):1-10.

ABSTRACT

Blastocystis is a polymorphic enteric parasite with a worldwide distribution. It is one of the most common human intestinal protozoans in developing countries. The primary objective of this study was to determine the diagnostic value of microscopy, stool culture, and a polymerase chain reaction (PCR) technique for assessment of Blastocystis prevalence and risk factors. Human stool samples were collected from 110 individuals from Dakahlia governorate, Egypt as a part of a routine check-up or having gastrointestinal tract (GIT) symptoms. These samples were subjected to direct fecal smear microscopy, culture, and PCR for the detection of Blastocystis sp. Positive results for Blastocystis screening among the study population were 36 (32.7%), 41 (37.3%), and 43 (39.1%) by microscopy, PCR, and culture, respectively. Statistical analyses demonstrated that the agreement between the culture and PCR was perfect (Κ=0.925). Compared to culture, the sensitivity of PCR was 95% and the specificity was 97% while the sensitivity of microscopy was 84% and the specificity was 90.5%. We concluded that the in vitro culture and molecular assay have significant diagnostic value for the accurate detection and identification of Blastocystis in stool samples. The pathogenic potential of Blastocystis cannot be ruled out because our results found a link between Blastocystis carriage and gastrointestinal symptoms.

PMID:37031393

Ann Saudi Med. 2023 Mar-Apr;43(2):76-81. doi: 10.5144/0256-4947.2023.76. Epub 2023 Apr 6.

ABSTRACT

BACKGROUND: Stomas are associated with multiple complications including dehydration which ultimately affects renal function. These complications begin with changes in the estimated glomerular filtration rate (GFR).

OBJECTIVES: Evaluate changes in GFR after stoma creation by stoma type and identify how different types of stoma affect GFR.

DESIGN: Retrospective, analytical cohort SETTING: Tertiary care center in Saudi Arabia PATIENTS AND METHODS: The colorectal surgery database was reviewed for all adult patients who underwent stoma creation (permanent and temporary ileostomies and colostomies) or reversal in 2000-2015. GFR was estimated at the first encounter, before the index surgery, at the time of stoma reversal, and upon the last follow-up. Patients with renal impairment, including low GFR before stoma creation, patients who had a temporary stoma converted to a permanent stoma, and patients who died with a stoma were excluded. We studied the association of several demographic and clinical factors on changes in GFR by univariate and multivariate analysis.

MAIN OUTCOME MEASURES: Estimated GFR at the last clinic visit for the permanent stoma group and at stoma closure for the temporary stoma group.

SAMPLE SIZE: 394 patients (149 ileostomates, 245 colostomates) RESULTS: Thirty-three (8.4%) of the 394 patients had a low GFR: 11 (7.4%) in the ileostomy group and 22 (9%) in the colostomy group (P= .579). The rate of readmissions with ileostomies was higher (11.4%) than with colostomies (3.3%) (P≤.001). The number of temporary ileostomies (n=9, 7.0%) differed from temporary colostomies (n=2, 1.9%) but the difference was not statistically significant (P=.06). In the multivariate analysis, stoma permanency, hypertension, chemotherapy and nephrotoxic drugs were risk factors associated with low GFR.

CONCLUSION: Ileostomies were not associated with a high rate of renal function deterioration in comparison to colostomies, but had a significantly higher rate of readmission due to dehydration and electrolytes imbalance possibly due to the hot climate in Saudi Arabia.

LIMITATIONS: Retrospective nature and limited sample size which may have resulted in a type 2 statistical error.

CONFLICTS OF INTEREST: None.

PMID:37031376 | DOI:10.5144/0256-4947.2023.76

Ann Saudi Med. 2023 Mar-Apr;43(2):63-69. doi: 10.5144/0256-4947.2023.63. Epub 2023 Apr 6.

ABSTRACT

BACKGROUND: Emergency medical services (EMS) play an essential role in treating and transporting patients to hospitals or between hospitals. EMS providers must be distributed wisely across all regions of the country to meet healthcare needs during normal times and disasters. No previous study has investigated the characteristics and distribution of the EMS workforce in Saudi Arabia.

OBJECTIVES: Examine the characteristics and distribution of the EMS workforce in Saudi Arabia to identify gaps and areas in need of improvement. Also, explore the sociodemographic and educational characteristics of licensed EMS providers in Saudi Arabia.

DESIGN: Cross-sectional SETTINGS: EMS in Saudi Arabia METHODS: We included all licensed EMS providers in Saudi Arabia as of 23 December 2020 who were registered in the Saudi Commission for Health Specialties (SCFHS) database. Sociodemographics, where they earned certification, and their job affiliations were collected and categorized.

MAIN OUTCOME MEASURES: EMS workforce distribution, gender, and EMS provider-to-population ratio.

SAMPLE SIZE: 18 336 EMS providers; 8812 (48.1%) with documented job affiliations.

RESULTS: The EMS provider-to-population ratio is very low. In Saudi Arabia, in general, the ratio is 1:3871 (based on n=8812 providers), which is low compared to the 1:1400 ratio for Australian EMS provider-to-population, for example. That makes it a challenge for EMS providers to meet the population’s needs, especially in times of disaster. The low ratio may have contributed to the delayed response time in Saudi Arabia (13 minutes for critical cases) which does not meet the international standard response time (8 minutes maximum). Also, only 3.5% of the total EMS providers registered were females, and the clear majority of all EMS providers were technicians.

CONCLUSIONS: The growth in the EMS workforce, including the recruitment of more females into the workforce and more EMS specialists compared to EMS technicians and health assistants, is critical to reaching a satisfactory EMS provider-to-population ratio.

LIMITATIONS: Most noteworthy of the limitations of this research are the insufficient statistics describing EMS distribution in Saudi Arabia, the lack of previous studies on the research topic in Saudi Arabia, and job affiliation not accurately recorded in the SCFHS database.

CONFLICT OF INTEREST: None.

PMID:37031375 | DOI:10.5144/0256-4947.2023.63

Int Ophthalmol. 2023 Apr 8. doi: 10.1007/s10792-023-02697-z. Online ahead of print.

ABSTRACT

PURPOSE: The aim this study is to determine anterior chamber parameters variations induced by PreserFlo MicroShunt implantation, in the early post-operative days.

METHODS: This is a prospective observational study on 48 eyes undergoing PreserFlo MicroShunt implantation alone (n = 30) or combined with phacoemulsification (n = 18). Anterior chamber depth (ACD) and volume (ACV), central corneal thickness (CCT) and total corneal astigmatism (TCA) were evaluated pre-operatively, post-operatively at day-1 and at 1 week with the Pentacam tomography.

RESULTS: Intraocular pressure decreased significantly from 20.9 ± 4.0 to 8.0 ± 2.8 mmHg (p < 0.0001) and to 10.8 ± 3.7 mmHg (p = 0.0001) at day-1 and week-1, respectively. TCA varied significantly from baseline (1.5 ± 1.2 D) to both day 1 follow up (2.7 ± 1.9 D, p = 0.0003) and week 1 follow up (2.2 ± 1.6 D, p = 0.02). Nevertheless, only K1 showed a transient flattening at day 1, while K2 value didn’t show any statistical variation in the early post-operative period. CCT value rose significantly at day 1 (547 ± 49 vs. 529 ± 32 µm at baseline, p = 0.04), but then returned toward pre-operative values at week 1 (537 ± 39 µm, p = 0.57). In contrast, ACD values changed insignificantly from 3.3 ± 0.9 to 3.7 ± 1.0 mm at day 1 (p = 0.21), and then stabilized at 3.4 ± 0.9 mm (p = 0.82) at week 1 follow up. ACV changed from 150.0 ± 36.2 to 159.5 ± 42.1 mm³ at day 1 (p = 0.58), and successively to 153.9 ± 37.9 mm³ at week 1 follow up (p = 0.96). The subgroup analysis in eyes undergoing standalone PreserFlo implantation didn’t show significant changes in both ACD and ACV.

CONCLUSION: PreserFlo implantation minimizes the anterior chamber modifications generated by traditional filtering surgery, inducing low and transient corneal and biometric changes only in the very early postoperative period and insignificant changes to ACD and ACV, label of its safety and minimal invasiveness.

PMID:37031312 | DOI:10.1007/s10792-023-02697-z