Category: Nevin Manimala

Arch Ital Urol Androl. 2023 Mar 15. doi: 10.4081/aiua.2023.11238. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate a possible relationship between a history of congenital penile curvature (CPC) and Peyronie’s disease (PD), and to characterize the psychological profile of patients suffering from PD, with or without concomitant CPC.

METHODS: We included 519 patients with Peyronie’s disease (PD), of which 73 were found to have underlaying CPC. As a comparator population, we selected 2166 patients without PD, referring to our tertiary care clinic. In this population we detected 15 subjects with CPC. All patients completed the GAD-7 (Generalized-Anxiety-Disorder – 7 questions) and the PHQ-9 (Patient-Health-Questionnaire – 9 questions) questionnaires.

RESULTS: The overall prevalence of CPC in PD-patients was 14.07%, compared to a prevalence of 0.69% in the non-PD control population (p < 0.00001). Moderate-to-severe anxiety was found to be present in 89.4% of all PD-patients. Significantly higher proportions of patients with CPC associated with PD showed severe anxiety, compared to patients with PD alone (57.5% vs. 36.7%, respectively, p = 0.0008). Moderate- severe depression was found to be present in 57.8% of all PD- patients. Significantly higher proportions of PD patients with a history of CPC showed severe depression, compared to patients with PD alone (13.6% vs. 3.36%, respectively, p < 0.0002). GAD-7 median scores were significantly higher in patients with more severe penile curvatures (> 45°; p = 0.029). We did not detect a statistically significant difference between PHQ-9 medi- an scores based on the severity of PD (p = 0.53). Analysis of PHQ-9 and GAD-7 median scores showed significantly worse depressive and anxious symptoms in younger patients (p < 0.001 and p = 0.0013, respectively).

CONCLUSIONS: The presence of congenital-penile-curvature may represent a risk factor for the subsequent onset of Peyronie’s disease. Moderate/severe anxiety and moderate/severe depression were reported in a high fraction of cases. Anxiety was significantly higher in patients with more severe penile-curvatures, and depression was present independently of the degree of penile curvature. Depression and anxiety were found to be more severe in younger subjects.

PMID:36924365 | DOI:10.4081/aiua.2023.11238

Cancer Med. 2023 Mar 16. doi: 10.1002/cam4.5804. Online ahead of print.

ABSTRACT

BACKGROUND: Increasing attention has been paid to the survival of endometrial cancer (EC) patients, but the non-cancer causes of death from EC are rarely reported. This study primarily aimed to investigate the non-cancer causes of death in patients with EC.

METHODS: The study collected relevant data, including age, tumour stage and treatment mode, on patients diagnosed with endometrial malignancies from 2000 to 2015 in the Surveillance, Epidemiology, and End Results (SEER) Programme. We analysed the standardised mortality ratio (SMR) to determine the cause of death.

RESULTS: The study included 135,831 patients with EC. During the follow-up, 46,604 (34.3%) patients died, of whom 42.9%, 15.6% and 41.5% died of EC, other cancers and non-cancer causes, respectively. As the diagnosis time increased, the number of EC-associated mortalities gradually decreased. The most common non-cancer causes of death were heart disease, cerebrovascular disease and diabetes. Regarding the general population of the United States, patients with EC died of heart disease (SMR: 1.06; 95% confidence interval [CI]: 1.03-1.09), diabetes (SMR: 1.56; 95% CI: 1.47-1.65) and septicaemia (SMR: 1.40; 95% CI: 1.28-1.52), which were statistically significant.

CONCLUSIONS: For patients with EC, the number of deaths from non-cancer causes (mainly heart disease, cerebrovascular disease and diabetes mellitus) is equivalent to that of EC. In addition, compared with the general population, EC survivors have a higher risk of death from sepsis and diabetes. These discoveries support how survivors can avoid future-related health risks. By doing this, clinicians can improve the quality of life and chances of the survival of patients with EC.

PMID:36924355 | DOI:10.1002/cam4.5804

Prim Health Care Res Dev. 2023 Mar 16;24:e20. doi: 10.1017/S1463423623000087.

ABSTRACT

AIM: This developmental study tested the feasibility of training pharmacy staff on the psychologically informed environments (PIE) approach to improve the delivery of care.

BACKGROUND: Community pharmacies provide key services to people who use drugs (PWUD) through needle exchange services, medication-assisted treatment and naloxone distribution. PWUD often have trauma backgrounds, and an approach that has been demonstrated to work well in the homeless sector is PIEs.

METHODS: Bespoke training was provided by clinical psychologists and assessed by questionnaire. Staff interviews explored changes made following PIE training to adapt the delivery of care. Changes in attitude of staff following training were assessed by questionnaire. Peer researchers interviewed patient/client on observed changes and experiences in participating pharmacies. Staff interviews were conducted six months after training to determine what changes, if any, staff had implemented. Normalisation process theory (NPT) provided a framework for assessing change.

FINDINGS: Three pharmacies (16 staff) participated. Training evaluation was positive; all participants rated training structure and delivery as ‘very good’ or ‘excellent’. There was no statistically significant change in attitudes. COVID-19 lockdowns restricted follow-up data collection. Staff interviews revealed training had encouraged staff to reflect on their practice and communication and consider potentially discriminatory practice. PIE informed communication skills were applied to manage COVID-19 changes. Staff across pharmacies noted mental health challenges for patients. Five patients were interviewed but COVID-19 delays in data collection meant changes in delivery of care were difficult to recall. However, they did reflect on interactions with pharmacy staff generally. Across staff and patient interviews, there was possible conflation of practice changes due to COVID-19 and the training. However, the study found that training pharmacy teams in PIE was feasible, well received, and further development is recommended. There was evidence of the four NPT domains to support change (coherence, cognitive participation, collective action and reflexive monitoring).

PMID:36924346 | DOI:10.1017/S1463423623000087

Med Sci Sports Exerc. 2023 Mar 10. doi: 10.1249/MSS.0000000000003164. Online ahead of print.

ABSTRACT

PURPOSE: Previous research has focused on device-based measures of activity compensation, with little understanding of how children perceive potential compensatory responses to activity or inactivity, or whether these change following periods of activity or inactivity. The aim of this study was to (a) explore the alignment between children’s self-reported usual compensation and compensation recall following experimental conditions; and (b) examine sex differences.

METHODS: In total, 360 children (47% boys) participated in at least one of three experimental conditions over six weeks (a) restricted physical activity (PA; indoor play); (b) imposed moderate-to vigorous PA (MVPA; sports class); and (c) imposed light PA (LPA; standing lesson). Prior to the first condition, children reported their ‘usual compensation’ behavior to examples of restricted/imposed PA and 2-3 days after each experimental condition they completed a recall measure of their compensation following the condition. Multilevel regression models were conducted to determine whether children’s perceptions of ‘usual compensation’ score were associated with recalled compensation score following imposed or restricted physical activity. Additional models were fitted for sex-specific associations.

RESULTS: Overall and among girls, the usual compensation score was positively associated with the compensatory recall score for the additional MVPA and LPA conditions (p < 0.0005; e.g., they thought they would usually compensate for additional MVPA and then perceived that they compensated following additional MVPA). A negative association was seen in the restricted activity condition among girls (p = 0.03). All associations in the boys’ analyses were statistically non-significant.

CONCLUSIONS: These findings suggest some alignment between children’s self-reported usual compensation and compensation recall following imposed changes to routine activity. Future research should consider device-measured comparisons and identify characteristics of children at-risk of activity compensation in future interventions.

PMID:36924338 | DOI:10.1249/MSS.0000000000003164

J Endourol. 2023 Mar 16. doi: 10.1089/end.2022.0819. Online ahead of print.

ABSTRACT

OBJECTIVE: to apply the Reverse Systematic Review (RSR) to compare three radical prostatectomies (RP) techniques: open (RRP), laparoscopic (LRP), and robotic (RARP) in relation to oncological outcomes: positive surgical margin (PSM) and biochemical recurrence rate (BCR).

EVIDENCE ACQUISITION: a search was carried out in 8 databases between 2000 and 2020 through SR studies referring to RRP, LRP, or RARP (80 SR). All references used in these SRs were captured referring to 1,724 reports. Preoperative and oncological outcomes were compared and correlated among RRP, LRP, and RARP.

EVIDENCE SYNTHESIS: 559 (32.4%) reports for RRP, 413 (23.9%) for LRP, and 752 (43.7%) for RARP, and a total of 1,353,485 patients were found. Regarding PSM, 284 reports were collected for RRP, 324 for LRP, and 499 for RARP, with rates of 23.6%, 20.7%, and 19.2%, respectively, and only the RRP with a statistical difference (P<0.001). Using a non-linear regression model, the BCR rate was correlated with follow-up time at 1, 2, 3, 5, 7, and 10 years: 10%, 15%, 18%, 20%, 23 %, and 38% for RRP; 6%, 9%, 13%, 20%, 23%, 10% for LRP; 8%, 12%, 16%, 23%, 27%, 19% for RARP. The absence of long-term work for RARP prevented more accurate projections of BCR.

CONCLUSIONS: RSR proved to be effective in generating a population and heterogeneous sample capable of demonstrating better oncological results for minimally invasive surgery (LRP and RARP) compared to RRP. It demonstrated the maturity of temporal follow-up data for RRP and LRP and the impact of lack of late follow-up from RARP studies on the long-term rate of BC.

PMID:36924303 | DOI:10.1089/end.2022.0819

Thyroid. 2023 Mar 16. doi: 10.1089/thy.2022.0600. Online ahead of print.

ABSTRACT

BACKGROUND: The relationship between isolated hypothyroxinemia (IH) in pregnancy and adverse pregnancy outcomes is controversial, with no consensus on the need for treatment.

METHODS: We conducted a systematic review and meta-analysis examining adverse pregnancy and neonatal outcomes in women with isolated hypothyroxinemia (IH) in pregnancy. We searched PubMed, Embase, Web of Science and the Cochrane Central Register of Controlled Trials for publications from inception to December 2022. Randomized clinical trials and cohort studies were included. Random effects meta-analyses were used to estimate pooled relative risks (RRs) for each outcome.

RESULTS: We included 21 articles, of which 19 investigated the relationship between IH and maternal and neonatal outcomes and 4 investigated the efficacy of LT4 treatment. Compared with euthyroid pregnancies, IH pregnancies were associated with an increased risk of preterm birth (RR 1.35 [CI 1.16-1.56]; I2 = 9%), premature rupture of membranes (RR 1.41 [CI 1.08-1.84]; I2 = 0%), gestational diabetes (RR 1.34 [CI 1.07-1.67]; I2 = 76%), macrosomia (RR 1.62 [CI 1.31-2.02]; I2 = 42%), and fetal distress (RR 1.72 [CI 1.15-2.56]; I2 = 0%). However, no statistically significant differences were noted in adverse outcomes according to LT4 treatment status.

CONCLUSIONS: There is evidence suggesting that that IH in pregnancy may be associated with an increased risk of adverse pregnancy and neonatal outcomes. However, it is unclear whether LT4 may mitigate the risk of these adverse outcomes.

PMID:36924297 | DOI:10.1089/thy.2022.0600

CNS Neurosci Ther. 2023 Mar 16. doi: 10.1111/cns.14169. Online ahead of print.

ABSTRACT

AIMS: To estimate the proportions of specific hypometabolic patterns and their association with neuropsychiatric symptoms (NPS) in patients with cognitive impairment (CI).

METHODS: This multicenter study with 1037 consecutive patients was conducted from December 2012 to December 2019. ¹⁸ F-FDG PET and clinical/demographic information, NPS assessments were recorded and analyzed to explore the associations between hypometabolic patterns and clinical features by correlation analysis and multivariable logistic regression models.

RESULTS: Patients with clinical Alzheimer’s disease (AD, 81.6%, 605/741) and dementia with Lewy bodies (67.9%, 19/28) mostly had AD-pattern hypometabolism, and 76/137 (55.5%) of patients with frontotemporal lobar degeneration showed frontal and anterior temporal pattern (FT-P) hypometabolism. Besides corticobasal degeneration, patients with behavioral variant frontotemporal dementia (36/58), semantic dementia (7/10), progressive non-fluent aphasia (6/9), frontotemporal lobar degeneration and amyotrophic lateral sclerosis (3/5), and progressive supranuclear palsy (21/37) also mostly showed FT-P hypometabolism. The proportion of FT-P hypometabolism was associated with the presence of hallucinations (R = 0.171, p = 0.04), anxiety (R = 0.182, p = 0.03), and appetite and eating abnormalities (R = 0.200, p = 0.01) in AD.

CONCLUSION: Specific hypometabolic patterns in FDG-PET are associated with NPS and beneficial for the early identification and management of NPS in patients with CI.

PMID:36924296 | DOI:10.1111/cns.14169

AIDS Res Hum Retroviruses. 2023 Mar 16. doi: 10.1089/AID.2022.0117. Online ahead of print.

ABSTRACT

Presentation to care with advanced HIV disease (AHD) is a significant problem in Sub-Saharan Africa. We evaluated factors associated with immune recovery among individuals presenting to care with AHD in Zimbabwe. We conducted a retrospective evaluation of outcomes among adult (>18 years old) individuals with AHD (CD4 count ≤ 200 cells/mm3) receiving care at 18 outpatient primary care clinics in Harare, Zimbabwe. Baseline and 12-month CD4 count data were extracted from medical records. CD4 count recovery (defined as CD4 count > 200 cells/mm3) after 12 months on NNRTI-based antiretroviral therapy (ART) regimen was determined and factors associated with CD4 count recovery were established using logistic regression. All statistical analysis was performed on SPSS v23. A total of 1338 participant records were included in the analysis. The median interquartile range (IQR) age was 37 (30-43) years and 52% were females. The baseline median (IQR) CD4 count was 50 (28-75) cells/mm3 and was significantly lower among patients with history of cryptococcal meningitis compared to those without (25(10-52) vs 52(32-77), respectively; p=0.0009). The median (IQR) CD4 count at 12 months after ART initiation increased from 50 (28-75) at baseline to 180 (92-290) cells/mm3. Immune recovery with a CD4 count > 200 cells/mm3, was observed in 181/417 (43%). Male gender and low baseline CD4 count were strong predictors of poor immunological recovery on ART. Immunological recovery following ART initiation was 43% among individuals with AHD. Male patients are most vulnerable to persistent immunological failure.

PMID:36924288 | DOI:10.1089/AID.2022.0117

AIDS Res Hum Retroviruses. 2023 Mar 16. doi: 10.1089/AID.2022.0076. Online ahead of print.

ABSTRACT

Epidemiological results have shown that some factors such as co-infection of SARS-COV-2 and HIV is associated with COVID-19 severity, rates of hospitalization, and mortality. Thus, this meta-analysis aims to assess the odds ratio of hospitalization rate, mortality and average standardized difference of CD4 counts in COVID-19/ HIV co-infection patients vs control group.This meta-analysis was examined by PRISMA-P checklist. Studies were obtained from online databases such as Science direct, Pub med, Scopus, Web of Science, and Google scholar using Mesh و Non-Mesh keywords. NOS checklist was used to assess the quality of studies. According to the random effect models, the odds ratio of hospitalization, mortality, and average standardized difference of CD4 counts was estimated. Data analysis was performed using Stata ver.14 software. By the use of strict inclusion criteria, 8 initial studies entered into the meta-analysis. The odds ratio of hospitalization and mortality rates in COVID-19 patients with HIV was 1.67(95% CI: 0.76, 3.71) and 0.80 (95% CI: 0.57, 1.11) times higher than that of the control group. In this meta-analysis, there was no observed a statistically significant difference in the rate of hospitalization, mortality and CD4 counts in COVID-19 patients with HIV and the control group. However, the hospitalization rate in COVID-19/ HIV co-infection patients was 67% higher than the control group. The similarity results between two groups can probably be attributed to some factors, such as the low number of COVID-19/ HIV co-infection patients and the presence of random error, HIV patients receiving antiretroviral therapy, and early hospitalization in COVID-19/ HIV co-infection patients.

PMID:36924275 | DOI:10.1089/AID.2022.0076

Stat Methods Med Res. 2023 Mar 16:9622802231163334. doi: 10.1177/09622802231163334. Online ahead of print.

ABSTRACT

Unmeasured baseline information in left-truncated data situations frequently occurs in observational time-to-event analyses. For instance, a typical timescale in trials of antidiabetic treatment is “time since treatment initiation”, but individuals may have initiated treatment before the start of longitudinal data collection. When the focus is on baseline effects, one widespread approach is to fit a Cox proportional hazards model incorporating the measurements at delayed study entry. This has been criticized because of the potential time dependency of covariates. We tackle this problem by using a Bayesian joint model that combines a mixed-effects model for the longitudinal trajectory with a proportional hazards model for the event of interest incorporating the baseline covariate, possibly unmeasured in the presence of left truncation. The novelty is that our procedure is not used to account for non-continuously monitored longitudinal covariates in right-censored time-to-event studies, but to utilize these trajectories to make inferences about missing baseline measurements in left-truncated data. Simulating times-to-event depending on baseline covariates we also compared our proposal to a simpler two-stage approach which performed favorably. Our approach is illustrated by investigating the impact of baseline blood glucose levels on antidiabetic treatment failure using data from a German diabetes register.

PMID:36924264 | DOI:10.1177/09622802231163334