Category: Nevin Manimala

Women Health. 2023 Mar 20:1-12. doi: 10.1080/03630242.2023.2188097. Online ahead of print.

ABSTRACT

How individuals perceive and cope with stressful situations may determine their level of anxiety or depression. The identification of coping strategies (CS) in pregnancy could help prevent depression and anxiety (D&A), and their consequent effects on the health of the mother and the baby. A cross-sectional descriptive correlational study was conducted to identify the CS most commonly used by pregnant women in a Spanish population and to evaluate the association of these CS with D&A. A consecutive sample of 282 pregnant women over 18 years of age were recruited when attended midwife consultations and through snowball sampling between December 2019 and January 2021 in the Basque public health system. CS were measured using the RevisedPrenatal Coping Inventory (NuPCI) questionnaire, assigning the score to an avoidant, preparatory or spiritual scale. Cutoff points were established to categorize anxiety and depressive symptomatology, using the STAI-S and EPDS scales. Multivariate logistic regression models were constructed to analyze the association between CS and D&A. The results show that the higher the score on the avoidance subscale, the higher the likelihood of having an anxiety disorder (OR: 8.88 (95 percent Confidence Interval [CI] 4.26-20.1), and depressive symptoms (OR: 8.29 (95 percent CI 4.24-17.4). Multiparous women are more likely to have anxiety (OR: 3.41 (95 percent CI 1.58-7.5) or depressive symptomatology (OR: 4.1 (95 percent CI 2.04-8.53) during pregnancy. These results highlight the need to consider the evaluation of CS used during pregnancy to tailor the care provided, but further studies on the implementation and effectiveness of interventions are needed.

PMID:36941108 | DOI:10.1080/03630242.2023.2188097

P R Health Sci J. 2023 Marzo;42(1):63-69.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the effect of support given to pregnant women during labor on their perception of childbirth and their breastfeeding self-efficacy.

METHODS: This descriptive and relational study was conducted with 331 primigravid women who had a vaginal delivery in a maternity unit from December 15, 2018, to March 15, 2020. Data were collected using a descriptive characteristics form prepared by the researcher and based on the relevant literature, the Scale of Women’s Perception for Supportive Care Given During Labor (SWPSCDL), the Perception of Birth Scale (POBS), and the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF).” The data were analyzed using descriptive statistics, a t test, a variance test, and Pearson’s correlation.

RESULTS: The mean total SWPSCDL, POBS, and BSES-SF scores of the participating women were 102.19 (±14.99), 54.75 (±9.39), and 76.24 (±11.37), respectively. A positive correlation was found between supportive care for women during delivery and both women’s perceptions of childbirth and breastfeeding efficacy. In addition, training given in antenatal classes positively increased the perception of support during delivery among the women.

CONCLUSION: Supportive care given during delivery had a positive effect on the perception of childbirth and on breastfeeding self-efficacy. Interventions to encourage more couples to participate in training given at antenatal classes and to improve the working conditions of midwives working in delivery rooms would contribute to the support that pregnant women require during delivery and would provide a more positive delivery experience for these women.

PMID:36941101

P R Health Sci J. 2023 Mar;42(1):50-56.

ABSTRACT

OBJECTIVE: This study aimed to explore how umbilical cord separation time and microbial colonization are affected by umbilical cord clamping distance.

METHODS: The randomized controlled study included 99 healthy newborns and was conducted at a hospital in Kahramanmaras, Turkey. The newborns were randomly divided into 3 groups: intervention group I (cord length: 2 cm); intervention group II (cord length: 3 cm; control group (not measured). On postpartum day 7, a sample of the umbilical cord was taken to assess microbial colonization. The mothers were contacted via mobile phone on the 20th day for an at-home follow-up. The data were analyzed by applying Pearson’s chi-square test, Fisher’s exact test, a 1-way analysis of variance test, and Tukey’s post hoc Honest Significant Difference test.

RESULTS: The mean umbilical cord separation time of the newborns was found to be 6.9 (±2.1) days in the intervention group I, 8.8 (±2.9) days in the intervention group II, and 9.5 (±3.4) days in the control group. The difference between the groups was statistically significant (P < .01). Microbial colonization was detected in 5 of the newborns, across the groups; no significant differences were found between the groups (P > .05).

CONCLUSION: In this study, it was determined that clamping the umbilical cord from a distance of 2 cm in vaginally delivered full-term newborns contributed to the shortening of the cord fall time and did not affect microbial colonization.

PMID:36941099

P R Health Sci J. 2023 Mar;42(1):35-42.

ABSTRACT

OBJECTIVE: Evidence supports the local application of non-steroidal antiinflammatory drugs such as dexketoprofen trometamol (DXT) for pain management, but little is known about the potential antinociceptive effect of chlorhexidine gluconate (CHX) and its possible synergistic effect when combined with DXT. The aim of this study was to evaluate the local effect of a DXT-CHX combination using isobolographic analysis in a formalin pain model in rats.

MATERIALS AND METHODS: Briefly, 60 female Wistar rats were used for the formalin test. Individual dose effect curves were obtained using linear regression. For each drug, the percentage of antinociception and median effective dose (ED50; 50% of antinociception) were calculated, and drug combinations were prepared using the ED50s for DXT (phase 2) and CHX (phase 1). The ED50 of the DXT-CHX combination was determined, and an isobolographic analysis was performed for both phases.

RESULTS: The ED50 of local DXT was 5.3867 mg/mL in phase 2 and for CHX was 3.9233 mg/mL in phase 1. When the combination was evaluated, phase 1 showed an interaction index (II) of less than 1, indicating synergism but without statistical significance. For phase 2, the II was 0.3112, with a reduction of 68.88% in the amounts of both drugs to obtain the ED50; this interaction was statistically significant (P < .05).

CONCLUSION: DXT and CHX had a local antinociceptive effect and exhibited synergistic behavior when combined in phase 2 of the formalin model.

PMID:36941097

P R Health Sci J. 2023 Mar;42(1):3-9.

ABSTRACT

OBJECTIVE: The mortality rate of schizophrenia patients is higher than that of the general population; cardiovascular disease (CVD) is their leading cause of death. This issue must be studied since people with schizophrenia are disproportionately burdened with CVD. Therefore, our goal was to identify the prevalence of CVD and other comorbidities, stratified by age and gender, in patients with schizophrenia living in Puerto Rico.

METHODS: A retrospective, case-control, descriptive study was conducted. Subjects in this study were admitted to Dr. Federico Trilla’s hospital from 2004 through 2014 for both psychiatric- and non psychiatric conditions. The sample populations were stratified by the confounding variables of tobacco use and alcohol abuse, and the resulting stratification was analyzed with the Cochran-Mantel-Haenszel method.

RESULTS: A higher frequency of CVDs was noted in the patients with schizophrenia compared to those in the control group. Although hypertension was the most frequent pathology encountered in both groups, ischemic heart disease was approximately four times more frequent in the patients with schizophrenia. CVD represented 58.4% and 52.7% in the schizophrenia and non-schizophrenia groups, respectively, although a statistically significant difference was not observed. The prevalence of malignancies in patients without schizophrenia was higher than in patients with schizophrenia. Moreover, the prevalence of asthma was 10.9% in the control group compared to 5.3% in the schizophrenia group.

CONCLUSION: These findings should motivate a systematic approach to prioritizing the aggressive management, early diagnosis, and prevention of comorbid risk factors in patients with schizophrenia.

PMID:36941092

Neuropsychopharmacol Rep. 2023 Mar 20. doi: 10.1002/npr2.12327. Online ahead of print.

ABSTRACT

INTRODUCTION: Selective serotonin reuptake inhibitors are considered the drugs, whose effectiveness in viral pandemics has been studied. The aim of this study was to evaluate of adding fluoxetine to the treatment regimen of patients with COVID-19 pneumonia.

METHODS: This study was a double-blind randomized placebo controlled clinical trial .36 patients in the fluoxetine and 36 patients in the placebo group were enrolled. Patients in the intervention group were first treated with fluoxetine 10 mg for 4 days and then the dose of 20 mg was continued for 4 weeks. Data analysis was conducted using SPSS V. 22.0.

RESULTS: There was no statistically significant difference between the two groups in terms of clinical symptoms at the beginning of the study and also the score of anxiety and depression, oxygen saturation at the time of hospitalization, mid-hospitalization and discharge periods. The need for mechanical ventilator support (p = 1.00), the need for admission in the intensive care unit (ICU) (p = 1.00), rate for mortality (p = 1.00), and discharge with relative recovery (p = 1.00) were not significantly different between the two groups. The distribution of CRP within the study groups showed a significant decrease during different time periods (p = 0.001), and although there was no statistically significant difference between the two groups on the first day (p = 1.00) and at discharge (p = 0.585), mid-hospital CRP showed a significant decrease in the fluoxetine group (p = 0.032).

CONCLUSION: Fluoxetine resulted in a faster reduction of patients’ inflammation without association with depression and anxiety.

PMID:36941089 | DOI:10.1002/npr2.12327

Neurology. 2023 Mar 20:10.1212/WNL.0000000000207200. doi: 10.1212/WNL.0000000000207200. Online ahead of print.

ABSTRACT

ObjectiveTo analyze the prevalence and associated clinical characteristics of apathy in sporadic cerebral amyloid angiopathy and investigate whether apathy was associated with disease burden and disconnections of key structures in the reward circuit through a structural and functional multi-modal neuroimaging approach.MethodsThirty-seven probable sporadic cerebral amyloid angiopathy participants without symptomatic intracranial hemorrhage or dementia (mean age, 73.3 ± 7.2, % male = 59.5%) underwent a detailed neuropsychological evaluation, including measures of apathy and depression, and a multimodal MR neuroimaging study. A multiple linear regression analysis was used to assess the association of apathy with conventional small vessel disease neuroimaging markers. A voxel-based morphometry with a small volume correction within regions previously associated with apathy and a whole-brain tract-based spatial statistics were done to identify differences in the gray matter and white matter between the apathetic and the non-apathetic groups. Gray matter regions significantly associated with apathy were further evaluated for their functional alterations as seeds in the seed-based resting-state functional connectivity analysis. Potential confounders, namely, age, gender, and measures of depression were entered as covariates in all analyses.ResultsA higher composite small vessel disease marker score (CAA-SVD) was associated with a higher degree of apathy (standardized coefficient = 1.35 (0.07 – 2.62), adjusted R² = 27.90, p = 0.04). Lower gray matter volume of the bilateral orbitofrontal cortices was observed in the apathetic group than the non-apathetic group (F = 13.20, family-wise error corrected p = 0.028). The apathetic group demonstrated a widespread decrease in white matter microstructural integrity compared to the non-apathetic group. These tracts connect key regions within and between related reward circuits. Finally, there was no significant functional alterations between the apathetic and the non-apathetic groups.ConclusionsOur findings revealed the orbitofrontal cortex as a key region in the reward circuit associated with apathy in sporadic cerebral amyloid angiopathy, independent from depression. Apathy was shown to be associated with a higher CAA-SVD score and an extensive disruption of white matter tracts, which suggested that a higher burden of CAA pathology and the disruption in large-scale white matter networks may underlie manifestations of apathy.

PMID:36941070 | DOI:10.1212/WNL.0000000000207200

Comp Med. 2023 Mar 20. doi: 10.30802/AALAS-CM-22-000018. Online ahead of print.

ABSTRACT

Methicillin-resistant Staphylococcus aureus (MRSA) remains a significant problem for human and animal health and can negatively affect the health status of macaques and other nonhuman primates (NHP) in research colonies. However, few publications provide guidance on the prevalence, genotype, or risk factors for macaques with MRSA and even fewer on how to effectively respond to MRSA once identified in a population. After having a clinical case of MRSA in a rhesus macaque, we sought to determine the MRSA carrier prevalence, risk factors, and genotypes of MRSA in a population of research NHPs. Over a 6-wk period in 2015, we collected nasal swabs from 298 NHPs. MRSA was isolated from 28% (n = 83). We then reviewed each macaque’s medical record for a variety of variables including animal housing room, sex, age, number of antibiotic courses, number of surgical interventions, and SIV status. Analysis of these data suggests that MRSA carriage is associated with the room location, age of the animal, SIV status, and the number of antibiotic courses. We used multilocus sequence typing and spa typing on a subset of MRSA and MSSA isolates to determine whether the MRSA present in NHPs was comparable with common human strains. Two MRSA sequence types were predominant: ST188 and a novel MRSA genotype, neither of which is a common human isolate in the United States. We subsequently implemented antimicrobial stewardship practices (significantly reducing antimicrobial use) and then resampled the colony in 2018 and found that MRSA carriage had fallen to 9% (26/285). These data suggest that, as in humans, macaques may have a high carrier status of MRSA despite low clinically apparent disease. Implementing strategic antimicrobial stewardship practices resulted in a marked reduction in MRSA carriage in the NHP colony, highlighting the importance of limiting antimicrobial use when possible.

PMID:36941053 | DOI:10.30802/AALAS-CM-22-000018

Ann Intern Med. 2023 Mar 21. doi: 10.7326/M22-3350. Online ahead of print.

ABSTRACT

BACKGROUND: Patients hospitalized with COVID-19 have an increased incidence of thromboembolism. The role of extended thromboprophylaxis after hospital discharge is unclear.

OBJECTIVE: To determine whether anticoagulation is superior to placebo in reducing death and thromboembolic complications among patients discharged after COVID-19 hospitalization.

DESIGN: Prospective, randomized, double-blind, placebo-controlled clinical trial. (ClinicalTrials.gov: NCT04650087).

SETTING: Done during 2021 to 2022 among 127 U.S. hospitals.

PARTICIPANTS: Adults aged 18 years or older hospitalized with COVID-19 for 48 hours or more and ready for discharge, excluding those with a requirement for, or contraindication to, anticoagulation.

INTERVENTION: 2.5 mg of apixaban versus placebo twice daily for 30 days.

MEASUREMENTS: The primary efficacy end point was a 30-day composite of death, arterial thromboembolism, and venous thromboembolism. The primary safety end points were 30-day major bleeding and clinically relevant nonmajor bleeding.

RESULTS: Enrollment was terminated early, after 1217 participants were randomly assigned, because of a lower than anticipated event rate and a declining rate of COVID-19 hospitalizations. Median age was 54 years, 50.4% were women, 26.5% were Black, and 16.7% were Hispanic; 30.7% had a World Health Organization severity score of 5 or greater, and 11.0% had an International Medical Prevention Registry on Venous Thromboembolism risk prediction score of greater than 4. Incidence of the primary end point was 2.13% (95% CI, 1.14 to 3.62) in the apixaban group and 2.31% (CI, 1.27 to 3.84) in the placebo group. Major bleeding occurred in 2 (0.4%) and 1 (0.2%) and clinically relevant nonmajor bleeding occurred in 3 (0.6%) and 6 (1.1%) apixaban-treated and placebo-treated participants, respectively. By day 30, thirty-six (3.0%) participants were lost to follow-up, and 8.5% of apixaban and 11.9% of placebo participants permanently discontinued the study drug treatment.

LIMITATIONS: The introduction of SARS-CoV-2 vaccines decreased the risk for hospitalization and death. Study enrollment spanned the peaks of the Delta and Omicron variants in the United States, which influenced illness severity.

CONCLUSION: The incidence of death or thromboembolism was low in this cohort of patients discharged after hospitalization with COVID-19. Because of early enrollment termination, the results were imprecise and the study was inconclusive.

PRIMARY FUNDING SOURCE: National Institutes of Health.

PMID:36940444 | DOI:10.7326/M22-3350

Am J Gastroenterol. 2023 Mar 20. doi: 10.14309/ajg.0000000000002252. Online ahead of print.

ABSTRACT

OBJECTIVES: There is a need for evidence-based counseling for women with chronic liver disease (LD) who may experience impaired fertility. Currently, the literature on assisted reproductive technology (ART) treatment in women with LD has been limited to a single European case series. We evaluated ART treatment outcomes in LD patients and compared to controls.

METHODS: The retrospective study evaluated women with and without LD who had normal ovarian reserve and underwent ART treatment in a high-volume fertility practice from 2002 to 2021.

RESULTS: We identified 295 women with LD (mean age 37.8 ± 5.2 years) who underwent 1,033 ART treatment cycles; of these women, 115 underwent 186 in vitro fertilization (IVF) cycles. Six (2.0%) women had cirrhosis, eight (2.7%) were post-liver transplantation and 281 (95.3%) had chronic LD, with viral hepatitis (B and C) being the most prevalent. In the subgroup who underwent IVF and embryo biopsy, the median FIB-4 score was 0.81 (0.58, 1.03), and there were no statistically significant differences in response to controlled ovarian stimulation, embryo fertilization rate or ploidy outcome in LD patients compared to controls. In those who subsequently underwent a single thawed euploid embryo transfer to achieve pregnancy, there were no statistically significant differences in rates of clinical pregnancy, clinical pregnancy loss or live birth in LD patients compared to controls.

CONCLUSIONS: To our knowledge, this study is the largest to date to evaluate IVF efficacy in women with LD. Our study demonstrates that patients with LD have similar ART treatment outcomes compared to those without LD.

PMID:36940434 | DOI:10.14309/ajg.0000000000002252