Category: Nevin Manimala

Neurosurgery. 2023 Apr 1;69(Supplement_1):22. doi: 10.1227/neu.0000000000002375_101.

ABSTRACT

INTRODUCTION: Symptomatic intracranial atherosclerotic disease (sICAD) is estimated to cause over 10% of strokes annually in the US alone. Previous investigations employing stenting, most notably SAMMPRIS trial, have produced unfavorable results in regards to both periprocedural complications and risk of recurrent stroke. However, newer generation balloon-mounted drug-eluting stents (BM-DES) have been hypothesized to harbor several technical advantages that may confer improvements in these critical metrics.

METHODS: Prospectively maintained databases from eight comprehensive stroke centers were reviewed to identify adult patients undergoing RO-ZES for the treatment of sICAD between January,2019 and December,2021. Only patients that presented with either recurrent stroke or TIA, intracranial stenosis 70-99%, with at least one stroke on best medical management were included. The primary outcome was 30-days composite of stroke, ICH, and/or mortality. A propensity-score matched analyses was performed comparing the results of RO-ZES to the intervention arm of SAMMPRIS.

RESULTS: A total of 132 patients met the inclusion criteria for analysis (mean age:64.2 years). Mean severity of stenosis (±SD) was 81.4% (±11.4%). Four (3.03%) stroke and/or deaths were reported within 30 days in RO-ZES group. A propensity-score matched analysis based on age, HLD, HTN, DMII, and smoking demonstrated a statistically significant decreased risk of 30-day stroke and/or death rate in RO-ZES in comparison to SAMMPRIS (2.6% vs. 15.6%, respectively; OR 6.88, 95% CI 1.92-37.54, p < 0.001).

CONCLUSIONS: Patients treated with RO-ZES had a decreased rate of 30-day major complications in comparison to SAMMPRIS. Further large-scale prospective studies are warranted to evaluate the safety and efficacy of RO-ZES for the treatment of sICAD.

PMID:36924488 | DOI:10.1227/neu.0000000000002375_101

Alcohol Clin Exp Res. 2023 Mar 16. doi: 10.1111/acer.15054. Online ahead of print.

ABSTRACT

BACKGROUND: Endorsement of specific DSM-IV alcohol use disorder (AUD) criteria items changed significantly over time in men in their thirties with persistent or recurrent AUD. Few studies have documented whether endorsement of AUD items change over time in younger individuals or in women. The prospective analyses presented here evaluate changes in endorsement of AUD criteria in 377 men and women with persistent or recurrent AUD during their twenties.

METHODS: AUD item endorsement over time between average ages of 20 and 25 in 223 men and 154 women with persistent or recurrent AUD in at least three interviews were available from participants in the Collaborative Study on the Genetics of Alcoholism. Statistical significance of endorsement changes over time were evaluated using related-samples Cochran’s Q for the full sample and for men and women separately. Additional analyses evaluated potential sex differences in the patterns of change.

RESULTS: In the full sample, the predominant pattern was for significant increased rates of endorsements for six of the seven alcohol dependence criteria, but not in the four abuse items. A similar pattern was seen within men, but women demonstrated significant changes in only three of the seven dependence criteria.

CONCLUSIONS: Endorsement of the seven alcohol dependence criteria during the twenties generally increased in individuals with persistent or recurrent AUD, but few changes were observed regarding rates of endorsement of the four abuse items. The paper discusses how the results might reflect on the nature of AUD and on the DSM criteria.

PMID:36924463 | DOI:10.1111/acer.15054

Gerodontology. 2023 Mar 16. doi: 10.1111/ger.12685. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to assess dentists’ attitudes toward providing dental care for older adults with disabilities in Singapore and the factors influencing their willingness to provide care.

BACKGROUND: Dentists face a rapidly ageing patient demographic. Practitioner unwillingness to circumvent the attending challenges of care provision prevents older adults from accessing the dental care necessary for better oral and systemic health. Previous studies have reported on dentists’ attitudes toward caring for older adults with disabilities; however, these are mostly limited to dependent older adults and exclude frail, community-dwelling older persons.

METHODS: A cross-sectional study was conducted in 2020 using a self-administered questionnaire. Quantitative data analysis was presented in the form of descriptive statistics, followed by bivariate analyses.

RESULTS: There were 193 respondents, a response rate of under 9%. Dentists were less willing, confident and involved in the care of older adults with disabilities as the individual’s severity of impairments increased. Less than half of respondents were willing to treat individuals with severe disabilities in cooperation (23.3%), swallowing (30.6%), mobility (33.7%) and communication (45.1%). Dentists with training in geriatric dentistry were more willing to provide care. However, younger dentists, general dental practitioners, private practitioners and public sector dentists had specific restraining and driving forces, which further modulated their willingness to provide care.

CONCLUSIONS: The current areas of training needs among Singapore dentists are in severe impairments of swallowing, communication, cooperation and mobility. Further geriatric dentistry training may effectively increase dentists’ willingness to provide care; however, additional specific targeted interventions are also needed.

PMID:36924433 | DOI:10.1111/ger.12685

J Appl Clin Med Phys. 2023 Mar;24(3):e13853. doi: 10.1002/acm2.13853. Epub 2022 Nov 21.

ABSTRACT

PURPOSE: The single isocenter for multiple-target (SIMT) technique has become a popular treatment technique for multiple brain metastases. We have implemented a method to obtain a nonuniform margin for SIMT technique. In this study, we further propose a method to determine the isocenter position so that the total expanded margin volume is minimal.

MATERIALS AND METHOD: Based on a statistical model, the relationship between nonuniform margin and the distance d (from isocenter to target point), setup uncertainties, and significance level was established. Due to the existence of rotational error, there is a nonlinear relationship between the margin volume and the isocenter position. Using numerical simulation, we study the relationship between optimal isocenter position and translational error, rotational error, and target size. In order to find the optimal isocenter position quickly, adaptive simulated annealing (ASA) algorithm was used. This method was implemented in the Pinnacle³ treatment planning system and compared with isocenter at center-of-geometric (COG), center-of-volume (COV), and center-of-surface (COS). Ten patients with multiple brain metastasis targets treated with the SIMT technique was selected for evaluation.

RESULTS: When the size of tumors is equal, the optimal isocenter obtained by ASA and numerical simulation coincides with COG, COV, and COS. When the size of tumors is different, the optimal isocenter is close to the large tumor. The position of COS point is closer to the optimal point than the COV point for nearly all cases. Moreover, in some cases the COS point can be approximately selected as the optimal point. The ASA algorithm can reduce the calculating time from several hours to tens of seconds for three or more tumors. Using multiple brain metastases targets, a series of volume difference and calculating time were obtained for various tumor number, tumor size, and separation distances. Compared with the margin volume with isocenter at COG, the margin volume for optimal point can be reduced by up to 27.7%.

CONCLUSION: Optimal treatment isocenter selection of multiple targets with large differences could reduce the total margin volume. ASA algorithm can significantly improve the speed of finding the optimal isocenter. This method can be used for clinical isocenter selection and is useful for the protection of normal tissue nearby.

PMID:36924428 | DOI:10.1002/acm2.13853

J AOAC Int. 2023 Mar 16:qsad037. doi: 10.1093/jaoacint/qsad037. Online ahead of print.

ABSTRACT

BACKGROUND: Nebivolol and valsartan in combination with each other successfully control blood pressure and improve hypertension patient outcomes.

OBJECTIVE: to develop and validate innovative, simple, and sustainable spectrophotometric methods for the simultaneous analysis of Nebivolol and Valsartan.

METHODS: The new modified difference amplitude modulation method uses only unified regression equation and doesn’t require any resolution techniques. Other different approaches were also applied for the determination of the same mixture including univariate and multivariate spectrophotometric methods. The multivariate methods were (PLS and PCR), while the univariate methods were derivative ratio(DD1), ratio difference(RD), Constant center(CC), Constant center spectrum subtraction(CC-SS), constant value coupled with amplitude difference (CV-AD), and Advanced concentration value(ACV), amplitude difference(AD). The proposed methods utilize a green solvent; thus, the environmental impact of the presented procedures was evaluated qualitatively and quantitatively using six well-known evaluation tools.

RESULTS: All methods were applied successfully for the analysis of the studied drugs in their bulk powder, pharmaceutical dosage form Byvalson, and in vitro release at intestinal pH (7.4) using a USP dissolution tester. Results obtained were compared statistically with the reported method and with each other using One-way ANOVA statistical test and no significant differences were found.

CONCLUSION: All green and white analytical chemistry evaluation tools results confirm the safety, sustainability, and cost-effectiveness of the approaches, indicating that the methods are regarded green and sustainable. results were agreeable, encouraging their applicability in quality control laboratories for dosage form and making these methods an eco-friendly substitute for the analysis of this combined dosage form and for evaluating dissolution profile.

HIGHLIGHTS: For the first time, a severely overlapped spectrum was determined using unified regression equation without the need of extended part or zero contribution regions by the novel method MD-AM. The proposed methods are the first study of in vitro dissolution profiling of Nebivolol hydrochloride and Valsartan and the first sustainable and green methods applied without compromising the analytical criteria.

PMID:36924427 | DOI:10.1093/jaoacint/qsad037

J Low Genit Tract Dis. 2023 Mar 16. doi: 10.1097/LGT.0000000000000731. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to examine potential discriminatory characteristics of dermatoscopy and dynamic optical coherence tomography (D-OCT) on vulvar high-grade squamous intraepithelial lesions (vHSIL) and lichen sclerosus (LS) compared with healthy vulvar skin.

METHODS: A prospective observational clinical trial was performed in 10 healthy volunteers, 5 vHSIL and 10 LS patients. Noninvasive imaging measurements using dermatoscopy and D-OCT were obtained at several time points, including lesional and nonlesional vulvar skin. Morphologic features of vHSIL and LS were compared with healthy controls. Epidermal thickness and blood flow were determined using D-OCT. Patients reported tolerability of each study procedure, including reference vulvar biopsies. The main outcome measures were feasibility and tolerability of imaging modalities, dermatoscopy and OCT characteristics, OCT epidermal thickness and D-OCT dermal blood flow.

RESULTS: The application of dermatoscopy and D-OCT is feasible and tolerable. In vHSIL, dermatoscopic warty structures were present. In LS, sclerotic areas and arborizing vessels were observed. Structural OCT in the vulvar area aligned with histology for hyperkeratosis and dermal-epidermal junction visualization. Currently, the OCT algorithm is unable to calculate the epidermal thickness of the uneven vulvar area. Dynamic optical coherence tomography showed statistically significant increased blood flow in LS patients (mean ± SD, 0.053 ± 0.029) to healthy controls (0.040 ± 0.012; p = .0024).

CONCLUSIONS: The application of dermatoscopy and D-OCT is feasible and tolerable in vHSIL and LS patients. Using dermatoscopy and D-OCT, we describe potential characteristics to aid differentiation of diseased from healthy vulvar skin, which could complement clinical assessments.

PMID:36924426 | DOI:10.1097/LGT.0000000000000731

Transfusion. 2023 Mar 16. doi: 10.1111/trf.17311. Online ahead of print.

ABSTRACT

BACKGROUND: The success of allogeneic hematopoietic stem cell transplantation is dependent on a world-wide network of collection centers providing donations that predominantly have been infused as fresh cells. The logistics chain that supports the just-in-time delivery model for stem cell and immunotherapy products was severely stressed by the COVID pandemic, and in early 2020 a number of national and international bodies recommended that cells should be cryopreserved at the collection or transplant center to avoid interruptions in their acquisition or delivery to patients who had started conditioning.

STUDY DESIGN: To assess the potential consequences of such pandemic-related deviations to normal practice, we surveyed nine international laboratories to determine if the characteristics or transplant outcomes of allogeneic stem cell donations differed in the immediate periods before and after the switch to routine cryopreservation.

RESULTS: Nine centers on two continents provided data for 72 HSC donations just before, and 71 just after, switching to cryopreservation for allogeneic HSC products. No statistically significant differences between the period before and after cryopreservation were noted for time from product collection to receipt, product temperature at receipt, or CD34⁺ cell viability at receipt. There was an indication of slower absolute neutrophil count recovery after cryopreservation was required (mean time of 15 vs. 17.6 days).

DISCUSSION: While there were no apparent changes to most parameters studied, there was an indication of slower neutrophil engraftment that will need to be examined in larger, longer term studies.

PMID:36924403 | DOI:10.1111/trf.17311

Nucleosides Nucleotides Nucleic Acids. 2023 Mar 16:1-13. doi: 10.1080/15257770.2023.2188911. Online ahead of print.

ABSTRACT

OBJECTIVE OF THE STUDY: To explore the association of leukemia inhibitory factor receptor (LIFR) gene variant rs3099124, ovarian steroids, and leukemia inhibitory factor with unexplained infertility in Pakistani females.

METHODOLOGY: A case-control investigation in which eighty-one (81) females with unexplained infertility and one hundred and sixty-two (162) fertile counterparts (age and body mass index compared) were recruited between October 2016 and 2018. Ten milliliters of venous blood was collected from all participants. “Genomic DNA” was taken out from lymphocytes in peripheral blood samples. “Tetra Amplification Refractory Mutation System Polymerase Chain Reaction (T-ARMS-PCR)” was constructed through software “Primer-I”. Amplification was carried out by “T-ARMS-PCR” followed by subsequent sequencing for confirmation and extensive consonance. Estradiol, Progesterone and Leukemia Inhibitory Factor (LIF) were measured in serum by ELISA.

RESULTS: Statistically significant difference was noticed in genotype frequency in “LIFR-gene variant; rs3099124” (χ² = 28.222, P value < 0.01) between research participants. Although, rs “3099124” “AA” (OR = 0.000; 95%CI = 0-0) and “GA” genotypes (OR = 0.525; 95%CI = 0.226-1.22) showed non-significant safety/protection against unexplained infertility yet minor/risk allele “A” frequency was greater in women with unexplained infertility suggesting a possible explanation of implantation failure. LIF concentration varied between fertile and infertile groups (χ² = 9.857, P < 0.05) revealing significant threat of unexplained infertility in women with decreased LIF concentration (OR = 2.316, 95%CI = 1.214-4.416). Progesterone was significantly related to unexplained infertility in both study groups (χ² = 20.347, P < 0.05). High progesterone reduced the possibility of unexplained infertility (OR = 0.306; 95% CI = 0.166-0.567).

CONCLUSION: LIFR gene variation (rs3099124) and reduced LIF secretion may cause implantation failure in women with unexplained infertility.

PMID:36924393 | DOI:10.1080/15257770.2023.2188911

Arch Ital Urol Androl. 2023 Feb 22. doi: 10.4081/aiua.2023.10849. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the efficacy of Tamsulosin, Silodosin and Tadalafil as a medical expulsive therapy for treatment of distal ureteral calculi.

PATIENTS AND METHODS: Over a period of 6 months (January 2022 to June 2022) this prospective randomized study was conducted on 170 patients with distal ureteric stone ≤ 10 mm. Patients were randomly divided into three groups. Patients in group A received Tamsulosin 0.4mg, in group B received Silodosin, and in group C receive Tadalafil 5 mg. Therapy was given for a maximum of 4 weeks. The rate and time of stone expulsion, the analgesic use, attacks of colic and hospital visits for pain, and adverse effects of drugs were recorded.

RESULTS: Among 170 patients who were enrolled in study, 20 were lost to follow-up (7, 8, 5 in group A, B, And C respective-ly). There was a significant higher stone passage rate in group C than group A and B (90% vs. 70% and 76% respectively; p-value = 0.043) and shorter expulsion time in group C (8.7 ± 3.3 days) vs. group A (12.5 ± 5.2 days) and group B (11.3 ± 4.2 days) with (p-value = 0.001)(highly statistically significant with p-value < 0.001) and increased amount of analgesics required in group A (225 ± 115.7 mg) and group B (163 ± 77.5 mg) when compared with group C (120 ± 55.3 mg).

CONCLUSION: Tadalafil is more effective than Tamsulosin and Silodosin in treatment of patients with distal ureteric stones ≤ 10 mm as regard stone expulsion rate, expulsion time with decreased number of colicky episodes and side effects.

PMID:36924384 | DOI:10.4081/aiua.2023.10849

Arch Ital Urol Androl. 2023 Feb 22. doi: 10.4081/aiua.2023.11101. Online ahead of print.

ABSTRACT

OBJECTIVE: The major strengths of surgical treatment of benign prostatic hyperplasia with laser are reduced morbidity compared to endoscopic resec-tion. No studies analysed the different risk of intra/peri-opera-tive events between patients undergoing Thulium and GreenLight procedures.

MATERIALS AND METHODS: We retrospectively reviewed 100 con-secutive cases undergoing GreenLight vaporization and Thulium procedures performed during the learning curve of two expert endoscopic surgeons. Pre-operative data, intra and post-opera-tive events at 90 days were analysed.

RESULTS: Patients on antiplatelet/anticoagulant therapy were pre-dominant in the Green group (p < 0.0001). Rates of blood trans-fusion (p < 0.0038), use of resectoscope (p < 0.0086), and tran-sient stress urinary incontinence were statistically higher in the Thulium group. On the contrary conversions to TURP (p < 0.023) were more frequent in GreenLight patients. Readmissions were more frequently necessary in GreenLight group (24%) vs. Thulium group (26.6%). The overall complica-tion rate in GreenLight and Thulium groups were 31% and 53%respectively; Clavien 3b complications were 13% in Thulium patients versus 1% in GreenLight patients.

CONCLUSIONS: GreenLight and Thulium treatments show similar safety profiles. Randomized controlled trial are needed to better clarify the rate of major complications in Thulium group, and the incidence of post-operative storage symptoms in these patients’ populations.

PMID:36924373 | DOI:10.4081/aiua.2023.11101