Category: Nevin Manimala

Musculoskeletal Care. 2022 Jan 4. doi: 10.1002/msc.1615. Online ahead of print.

ABSTRACT

INTRODUCTION/OBJECTIVES: Therapeutic alliance (TA) is an integral part of building a patient and clinician relationship. TA begins at the initial encounter; however, the specific TA behavioural practices that are most impactful and linked to pain reduction and improved function remain unclear. The primary objective of this study was to explore physical therapist behaviours and interactions during the initial physical therapy evaluation and how they related to the patient’s perception of TA. A secondary objective was to explore the relationship between TA, pain intensity, and function.

METHODS: A mixed methods study was conducted. Pain intensity, TA and self-reported function were assessed at three time points. Spearman’s Rho (ρ) was used to quantify if there was an association between increased TA and function and reduced pain intensity, while a checklist of TA themes and behavioural practices was used for the qualitative analysis.

RESULTS: There was a statistically significant negative correlation between patient-perceived TA and pain intensity immediately after the initial evaluation (ρ = -0.39 [p = 0.048]). Behavioural practices associated with higher TA included information gathering, pausing to listen, using humour and transitions, and use of clarifying questions. Behavioural practices associated with patient-perceived lower TA interactions were lack of touch, the absence of pain neuroscience education, and not restating what the patient said during the interview.

CONCLUSION: This study highlights a relationship between TA and reduction of pain intensity after the initial evaluation and identifies key behavioural practices that could positively and negatively impact TA during the clinical encounter.

PMID:34984781 | DOI:10.1002/msc.1615

Paediatr Anaesth. 2022 Jan 5. doi: 10.1111/pan.14392. Online ahead of print.

ABSTRACT

BACKGROUND: The goal of the present study was to investigate intraoperative factors associated with major neurological complications at 1 year following surgery for necrotizing enterocolitis.

MATERIAL AND METHODS: the study consisted of a retrospective review of medical charts of patients operated for over one calendar year in one institution. Data collected included demographic data, cardiac resuscitation at birth, Bell classification, antibiotics usage, time of day of surgery, surgical technique, surgical duration, type of ventilation, intraoperative vasoactive agents and albumin use, nadir cerebral saturation, the decrease in cerebral saturation from baseline, the time period when cerebral saturation was at least 20% below baseline, and the mean arterial pressure at nadir cerebral saturation. Reported follow up complications were assessed during formal neonatologist consultation and additional imaging exploration as needed. Analyses included descriptive statistics and, univariable and multivariable statistics.

RESULTS: The study included 32 patients with no prior clinical neurological complications, of which 25 had normal cerebral imaging. Severe neurological complications occurred in 9 patients at one year: Intraventricular hemorrhage (N=2) and Periventricular leukomalacia (N=7). However, preoperative cerebral imaging was lacking in 7 patients. Consequently, the observed neurological complications at one year might be present before the surgery. Multivariable analysis found the decrease in cerebral saturation ≥ 36% from baseline as the only factor associated with the occurrence of those complications.

CONCLUSION: Intraoperative decrease of cerebral oxygen saturation below ≥ 36% from baseline is associated with severe neurological complications in neonates undergoing surgery for necrotizing enterocolitis.

PMID:34984774 | DOI:10.1111/pan.14392

Paediatr Perinat Epidemiol. 2022 Jan 4. doi: 10.1111/ppe.12857. Online ahead of print.

ABSTRACT

BACKGROUND: Ischaemic placental disease (IPD) affects 16%-23% of pregnancies in the United States. In vitro fertilisation (IVF) is a risk factor for IPD, and the magnitude of increase in risk differs for individuals using donor oocytes (donor IVF) versus their own oocytes (autologous IVF). In addition, multifoetal gestations, which are more common in IVF than non-IVF pregnancies, also are a risk factor for IPD.

OBJECTIVE: To quantify the contribution of multifoetal gestations to the association between IVF and IPD.

METHODS: We conducted a retrospective cohort study at a tertiary hospital from 1 January, 2000 to 1 August 2018 using electronic medical records and state vital statistics data. IPD was defined as preeclampsia, placental abruption, small for gestational age (SGA) birth or an intrauterine foetal demise due to placental insufficiency. We used mediation analysis to decompose the total effect of IVF on IPD into a natural direct effect and an indirect effect through multifoetal gestations. We repeated the analyses separately for donor and autologous IVF. All models were adjusted for maternal age, race, parity, insurance, year of delivery and account for multiple pregnancies per person.

RESULTS: We identified 86,514 deliveries, of which 281 resulted from donor IVF and 4173 resulted from autologous IVF. IVF pregnancies had 1.99 (95% CI 1.88, 2.10) times the risk of IPD compared to non-IVF pregnancies, and 75.5% of this increased risk was mediated by multifoetal gestations. Autologous IVF pregnancies had 1.95 (95% CI 1.84, 2.07) times the risk of IPD compared to non-IVF pregnancies, and the per cent mediated was 78.8%. Donor IVF pregnancies had 2.50 (95% CI 2.09, 2.92) times the risk of IPD, but the per cent mediated was 37.5%.

CONCLUSION: The majority of the association between autologous IVF and IPD was mediated through multifoetal gestations; however, this was not the case for donor IVF pregnancies.

PMID:34984737 | DOI:10.1111/ppe.12857

Int J Health Plann Manage. 2022 Jan 4. doi: 10.1002/hpm.3413. Online ahead of print.

ABSTRACT

This work investigates the performance and inter-sectoral interaction mechanism of China’s largest vertically integrated care network, the national medical alliance (NMA). The data collected derive from the China Health Statistics Bulletin and the China Health Statistical Yearbook for the period 2009-2018. The data include 64 observation indicators for five medical sectors in the NMA, namely, tertiary hospitals (THS), secondary hospitals (SHS), community health centres (CHCS), township hospitals (TsHS) and professional public health institutions (PPHIS). This research combines complex systems theory with a multilevel structural dynamic factor model, and yields two main results. First, although the trend for the NMA’s global factor is increasing, the evolutionary paths for sectoral factors differ substantially. Among the sectoral factors, the sectoral factor of THS continued to decline, and neither the sectoral factor of CHCS nor the sectoral factor of TsHS has significantly improved. Then, the interaction mechanism between the various NMA sectors is investigated. While a close relationship has been formed between THS and CHCS and between SHS and CHCS, there remains no close two-way relationship between either THS and TsHS or THS and SHS. Thus, going forward, to reach the policy expectations, China’s NMA implementation must consider the interaction between different constituent sectors.

PMID:34984751 | DOI:10.1002/hpm.3413

J Anim Breed Genet. 2022 Jan 4. doi: 10.1111/jbg.12666. Online ahead of print.

ABSTRACT

Natural adaptation and artificial selection have shaped the genome of modern livestock breeds. Among SNP-based metrics that are used to detect signatures of selection at genome-wide level, runs of homozygosity (ROH) are getting increasing popularity. In this paper, ROH distribution and features of a sample of 823 Sarda breed ewes farmed at different levels of altitude are analysed to investigate the effect of the environment on the patterns of homozygosity. A total of 46,829 (33,087 unique) ROH were detected. OAR2 exhibited the largest average number of ROH per animal. The most frequent ROH (OAR27, 38.9-44.2 Mb) was shared by 327. ROH length was statistically affected (p < 0.001) by both the altitude and temperature of the place where the flock was located. The highest probability of a SNP falling in a ROH was observed for hill ewes, whereas the smallest one for mountain. A total of 457 SNP exceeded the 99th percentile of the ROH count per SNP distribution and were considered significant. These markers mapped in eight chromosomes and they clustered into 17 ROH islands, where 80 candidate genes were mapped. Results of this study highlighted differences in the ROH distribution and features among sheep farmed in flocks located at different levels of altitude, confirming the role of environmental adaptability in shaping the genome of this breed.

PMID:34984736 | DOI:10.1111/jbg.12666

Br J Clin Pharmacol. 2022 Jan 4. doi: 10.1111/bcp.15212. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine the safety and efficacy-potential of inhaled nebulised unfractionated heparin (UFH) in the treatment of hospitalised patients with COVID-19.

METHODS: Retrospective, uncontrolled multicentre single-arm case series of hospitalised patients with laboratory-confirmed COVID-19, treated with inhaled nebulised UFH (5000IU 8-hourly, 10000IU 4-hourly, or 25000IU 6-hourly) for 6±3 (mean±SD) days. Outcomes were APTT before treatment (baseline) and highest-level during treatment (peak), and adverse events including bleeding. Exploratory efficacy outcomes were oxygenation, assessed by SpO2 to FiO2 (S/F) ratio and FiO2, and the WHO modified ordinal clinical scale (MOCS).

RESULTS: 98 patients were included. In patients on stable prophylactic or therapeutic systemic anticoagulant therapy but not receiving therapeutic UFH infusion, APTT levels increased from baseline of 34±10 seconds to a peak of 38±11 seconds (p<0.0001). In 3 patients on therapeutic UFH infusion, APTT levels did not significantly increase from baseline of 72±20 to a peak of 84±28 seconds (p=0.17). Two patients had serious adverse events: bleeding gastric ulcer requiring transfusion; thigh haematoma; both were on therapeutic anticoagulation. Minor bleeding occurred in 16 patients, 13 of which were on therapeutic anticoagulation. The S/F ratio and the FiO2 worsened before and improved after commencement of inhaled UFH (change in slope, p<0.001).

CONCLUSION: Inhaled nebulised UFH in hospitalised patients with COVID-19 was safe. Although statistically significant, inhaled nebulised UFH did not produce a clinically relevant increase in APTT (peak values in the normal range). Urgent randomised evaluation of nebulised UFH in patients with COVID-19 is warranted and several studies are currently underway.

PMID:34984714 | DOI:10.1111/bcp.15212

Fundam Clin Pharmacol. 2022 Jan 4. doi: 10.1111/fcp.12750. Online ahead of print.

ABSTRACT

BACKGROUND: Due to high variability and rapid life cycle, influenza virus is able to develop drug resistance against direct acting antivirals. Development of novel virus-inhibiting drugs is therefore important goal. Previously, we identified camphor derivative, camphecene, as an effective anti-influenza compound. In the present study we optimize the regimen of its application to avoid high sub-toxic concentrations.

METHODS: The protective activity of camphecene was assessed on the model of lethal pneumonia of mice caused by influenza viruses. Camphecene was administered either once a day or four times a day, alone or in combination with Tamiflu. Mortality and viral titer in the lungs was studied. Pharmacokinetics of camphecene was studied in rabbits.

RESULTS: We have demonstrated that camphecene, being used every six hours at a dose of 7.5 mg/kg/day, results in anti-viral effect that was statistically equal to the effect of 100 mg/kg/day once a day, i.e. the same effect was achieved by thirteen-times lower daily dose of the drug. This effect was manifested in decrease of mortality and decrease of virus’ titer in the lungs. The studies of pharmacokinetics of camphecene have demonstrated that it does not accumulate in blood plasma and that its multiple applications with dosage interval of 65 min is safe. In addition, the results of the study demonstrate also that camphecene possesses additive effect with Tamiflu allowing to decrease the dose of the latter.

CONCLUSION: The results suggest that due to safety and efficacy, camphecene can be further developed as potential anti-influenza remedy.

PMID:34984730 | DOI:10.1111/fcp.12750

Stat Med. 2022 Jan 4. doi: 10.1002/sim.9296. Online ahead of print.

ABSTRACT

Longitudinal cohorts to determine the incidence of HIV infection are logistically challenging, so researchers have sought alternative strategies. Recency test methods use biomarker profiles of HIV-infected subjects in a cross-sectional sample to infer whether they are “recently” infected and to estimate incidence in the population. Two main estimators have been used in practice: one that assumes a recency test is perfectly specific, and another that allows for false-recent results. To date, these commonly used estimators have not been rigorously studied with respect to their assumptions and statistical properties. In this article, we present a theoretical framework with which to understand these estimators and interrogate their assumptions, and perform a simulation study and data analysis to assess the performance of these estimators under realistic HIV epidemiological dynamics. We find that the snapshot estimator and the adjusted estimator perform well when their corresponding assumptions hold. When assumptions on constant incidence and recency test characteristics fail to hold, the adjusted estimator is more robust than the snapshot estimator. We conclude with recommendations for the use of these estimators in practice and a discussion of future methodological developments to improve HIV incidence estimation via recency test.

PMID:34984710 | DOI:10.1002/sim.9296

J Neurochem. 2022 Jan 4. doi: 10.1111/jnc.15571. Online ahead of print.

ABSTRACT

Neurochemical biomarkers can support the diagnosis of Alzheimer’ disease and may facilitate clinical trials. In blood plasma, the ratio of the amyloid-β (Aβ) peptides Aβ-3-40/Aβ1-42 can predict cerebral amyloid-β pathology with high accuracy (Nakamura et al., 2018). Whether or not Aβ-3-40 (aka. amyloid precursor protein (APP) 669-711) is also present in cerebrospinal fluid (CSF) is not clear. Here, we investigated whether Aβ-3-40 can be detected in CSF and to what extent the CSF Aβ-3-40/Aβ42 ratio is able to differentiate between individuals with or without amyloid-β positron emission tomography (PET) evidence of brain amyloid. The occurrence of Aβ-3-40 in human CSF was assessed by immunoprecipitation followed by mass spectrometry. For quantifying the CSF concentrations of Aβ-3-40 in 23 amyloid PET-negative and 17 amyloid PET-positive subjects, we applied a sandwich-type immunoassay. Our findings provide clear evidence of the presence of Aβ-3-40 and Aβ-3-38 in human CSF. While there was no statistically significant difference in the CSF concentration of Aβ-3-40 between the two diagnostic groups, the CSF Aβ-3-40/Aβ42 ratio was increased in the amyloid PET-positive individuals. We conclude that Aβ-3-40 appears to be a regular constituent of CSF and may potentially serve to accentuate the selective decrease of CSF Aβ42 in Alzheimer’s disease.

PMID:34984682 | DOI:10.1111/jnc.15571

J Clin Ultrasound. 2022 Jan 5. doi: 10.1002/jcu.23134. Online ahead of print.

ABSTRACT

PURPOSE: We aimed to evaluate the clinical efficacy and safety of ultrasonographically (US)-guided percutaneous microwave ablation (MWA) in the treatment of primary hyperparathyroidism (PHPT).

METHODS: A total of 35 patients who received MWA treatment in our hospital between August, 2019 and January, 2021 were retrospectively analyzed. Serum parathyroid hormone (PTH), calcium, phosphorus levels, and improvement in clinical symptoms were recorded before and after MWA. All patients were followed up for 6 months. Paired-sample t-tests and paired sample Wilcoxon signed-rank tests were used to indicate PTH, calcium, and P levels before and after ablation. Postoperative complications were statistically analyzed to evaluate the therapeutic effect of MWA on PHPT patients.

RESULTS: A total of 38 parathyroid nodules in 35 PHPT patients were completely ablated at one time. These results indicated that MWA could effectively destroy parathyroid tissue and decrease the concentrations of PTH, calcium, and phosphorus compared with those before MWA, and the effect was sustained. Moreover, MWA improved clinical symptoms, and improved quality of life of patients. None of patients developed tracheal and esophageal injuries, peripheral hematoma, infection, or other serious complications.

CONCLUSION: US-guided MWA has shown to be an effective and safe approach to treat PHPT patients.

PMID:34984687 | DOI:10.1002/jcu.23134