Category: Nevin Manimala

J Am Heart Assoc. 2023 Jan 25:e024975. doi: 10.1161/JAHA.121.024975. Online ahead of print.

ABSTRACT

Background Uncontrolled blood pressure (BP) remains a leading cause of death in the United States. The American Medical Association developed a quality improvement program to improve BP control, but it is unclear how to efficiently implement this program at scale across multiple health systems. Methods and Results We conducted BP MAP (Blood Pressure Measure Accurately, Act Rapidly, and Partner With Patients), a comparative effectiveness trial with clinic-level randomization to compare 2 scalable versions of the quality improvement program: Full Support (with support from quality improvement expert) and Self-Guided (using only online materials). Outcomes were clinic-level BP control (<140/90 mm Hg) and other BP-related process metrics calculated using electronic health record data. Difference-in-differences were used to compare changes in outcomes from baseline to 6 months, between intervention arms, and to a nonrandomized Usual Care arm composed of 18 health systems. A total of 24 safety-net clinics in 9 different health systems underwent randomization and then simultaneous implementation. BP control increased from 56.7% to 59.1% in the Full Support arm, and 62.0% to 63.1% in the Self-Guided arm, whereas BP control dropped slightly from 61.3% to 60.9% in the Usual Care arm. The between-group differences-in-differences were not statistically significant (Full Support versus Self-Guided=+1.2% [95% CI, -3.2% to 5.6%], P=0.59; Full Support versus Usual Care=+3.2% [-0.5% to 6.9%], P=0.09; Self-Guided versus Usual Care=+2.0% [-0.4% to 4.5%], P=0.10). Conclusions In this randomized trial, 2 methods of implementing a quality improvement intervention in 24 safety net clinics led to modest improvements in BP control that were not statistically significant. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03818659.

PMID:36695297 | DOI:10.1161/JAHA.121.024975

Saudi J Gastroenterol. 2023 Jan 23. doi: 10.4103/sjg.sjg_368_22. Online ahead of print.

ABSTRACT

CONCLUSIONS: The results of this study provide an overview of the variations in microbiota diversity present in Saudi IBD patients compared to healthy controls.

RESULTS: The key finding was three negative bacterial biomarkers, Paraprevotellaceae, the Muribaculaceae families of Bacteroidetes phylum, and the Leuconostocaceae family of Firmicutes phylum, which had a higher relative abundance in healthy individuals compared to IBD patients. It was also found that primary microbiota signatures at certain genera and species levels, including Prevotella copri, Bifidobacterium adolescentis, Ruminococcus callidus, Coprococcus sp., Ruminococcus gnavus, Dorea formicigenerans, Leuconostoc, Dialister, Catenibacterium, Eubacterium biforme, and Lactobacillus mucosae, were absent in almost all IBD patients, while Veillonella dispar was absent in all healthy individuals.

METHODS: After obtaining an informed consent, fecal samples were collected from 11 participants with IBD (patients) and 10 healthy individuals (controls). The bacterial components of the microbial population were identified by next-generation sequencing of partial 16S rRNA. Statistically significant dissimilarities were observed between samples for all metrics.

BACKGROUND: Inflammatory bowel disease (IBD) is a chronic intestinal inflammatory condition attributed to a complex interaction between imbalances in the gut microbiome, environmental conditions, and a deregulated immune response. The aim of the study was to investigate the composition of the gut microbiome of Saudi patients with IBD.

PMID:36695274 | DOI:10.4103/sjg.sjg_368_22

Lung India. 2023 Jan-Feb;40(1):24-32. doi: 10.4103/lungindia.lungindia_251_22.

ABSTRACT

BACKGROUND: Asthma is defined as a chronic inflammatory disorder of the airways, characterized by bronchial hyper-responsiveness and variable airflow obstruction, that is often reversible either spontaneously or with treatment. Impulse oscillometry is a newer diagnostic modality for asthma. It is based on the measurement of sound waves reflected by airway resistance.

OBJECTIVES: The aim of this article is to study the role of impulse oscillometry in diagnosis and follow-up of bronchial asthma.

METHODS: Fifty-five clinically diagnosed bronchial asthma patients were evaluated with spirometry and impulse oscillometry before and after 3 months of inhaled treatment. The sensitivity to diagnose and follow-up was compared using proper statistical tests.

RESULTS: Impulse oscillometry was superior to spirometry in diagnosing bronchial asthma and also in accessing the treatment response after 3 months.

CONCLUSION: Impulse oscillometry is superior in predicting bronchial asthma and its parameters are also more sensitive in accessing treatment response. It can replace spirometry as it is easy to perform and effort independent.

PMID:36695255 | DOI:10.4103/lungindia.lungindia_251_22

J Minim Access Surg. 2023 Jan 9. doi: 10.4103/jmas.jmas_205_22. Online ahead of print.

ABSTRACT

CONTEXT: Competence in flexible endoscopy is essential for all surgeons during this era of minimal access surgery. However, fewer surgeons have expertise in endoscopy due to a lack of training and interest. The Indian Association of Gastrointestinal Endo Surgeons devised a short-structured training course in the art and science of endoscopy.

AIMS: This study aimed to find the impact of the endoscopy training course (Endoscopic Fellowship of Indian Association of Gastrointestinal Endo Surgeons [EFIAGES]) in improving the endoscopic skill of surgeons.

SETTINGS AND DESIGN: Twenty-two-part electronic survey forms were sent to all 375 candidates who took the course between 2016 and 2019 for this retrospective observational study.

SUBJECTS AND METHODS: The following outcome measures were noted, namely technical competence in endoscopy before the course, delegate feedback about the course modules, volume of endoscopies before and after the course and quality indicators such as reaching up to duodenum (D2) and caecum before and after the course.

STATISTICAL ANALYSIS USED: Statistical analysis of the impact of the course was done using Chi-square test.

RESULTS: Responses from 262 out of a total of 375 candidates were received. Seventy-seven per cent of trainees were pleased with content and mode of conduct of the course. The quality indicator of gastroscopy with the ability to reach D2 in 90% of the caseload was achieved by only 28% of trainees before the EFIAGES. This increased to 72% of candidates after the course and similar results were seen with colonoscopy also. Most of the candidates noted a distinct improvement in their endoscopic navigation skills subsequent to the course.

CONCLUSIONS: Endoscopy skill transfer was possible with a short-structured endoscopy course. The surgical fraternity should realise the importance of endoscopy skills in the current era of surgical practice.

PMID:36695244 | DOI:10.4103/jmas.jmas_205_22

Ann Afr Med. 2023 Jan-Mar;22(1):117-123. doi: 10.4103/aam.aam_21_22.

ABSTRACT

BACKGROUND: Many factors have been proposed to be associated with the severity of disease and mortality in COVID-19. Vitamin D had recently been reviewed as one of these factors.

AIM AND OBJECTIVES: To evaluate the association between Vitamin D and the disease severity and mortality in COVID-19.

MATERIALS AND METHODS: After approval from Institutional Ethics Committee, this prospective cohort study was carried out in selected tertiary care teaching medical institutes of Central India. Participants were COVID-19 patients of the age group of 18 years and above admitted during the study period. They were categorized into four groups as asymptomatic (Group A), mild (Group B), moderate (Group C), and severe (Group D) based on clinical symptoms, respiratory rate, oxygen saturation, and chest imaging. Serum level of Vitamin 25(OH) D was measured using chemiluminescent immunoassay. The outcome of the disease was classified as recovery and death during hospitalization. The association of sociodemographic and medical characteristics with treatment outcome was studied using an appropriate statistical test. A full logistic regression model was built for the assessment of the relationship between treatment outcomes with Vitamin D level. Further, one receiver operating characteristic curve was developed to examine the prognostic significance of Vitamin D levels in COVID-19 patients.

RESULTS: Out of 748 enrolled patients, 44 (5.88%), had severe disease (Group D). A total of 721 cases (96.39%) recovered and were discharged, whereas 27 (3.61%) died during hospitalization. Mean Vitamin D level was found to be significantly different in discharged patients compared to those who were deceased. Increasing age-adjusted odds ratio (AOR) (95% confidence interval [CI]=1.07 [1.02-1.12]), known hypertension AOR (95%CI) = 3.38 (1.13-10.08), and diabetes mellitus AOR (95%CI) =28.5 (6.04-134.13) were found to be significant predictors of death among COVID-19 patients. Increasing Vitamin D level was found to be protective against COVID-19-related death (AOR (95% CI = 0.87 [0.80-0.94]).

CONCLUSION: Vitamin D was significantly associated with the disease severity and mortality in COVID-19.

PMID:36695233 | DOI:10.4103/aam.aam_21_22

Ann Afr Med. 2023 Jan-Mar;22(1):107-111. doi: 10.4103/aam.aam_13_22.

ABSTRACT

INTRODUCTION: As per the World Health Organization, in 2005, more than 180 million people had diabetes worldwide. This figure will be more than double by 2030. Neuropathy is common and late complication of diabetes mellitus (DM). Sensory neural hearing loss which is severe at higher frequencies has been reported in Type 2 DM patients. Auditory nerve tract damage increases the latency and reduces the amplitude of the response. Evoked potential recordings evaluate the neural pathways in the central nervous system. Brainstem auditory evoked potentials (BAEP) localize anatomic structures using different waves and detect acoustic and central neuropathy (CN). Hence, brainstem evoked response of audiometry (BERA) is used widely in clinical set up.

AIMS: PRIMARY: 1. To record BERA waves in normal subjects with normal blood sugar levels (hemoglobin A₁C [HbA1C] <5.4. 2. To record BERA waves in Type 2 DM patients. (HbA1C >6.5).

SECONDARY: To study the BERA parameters with the normal subjects with blood sugar subjects and compare them with Type 2 DM patients.

MATERIALS AND METHODS: n = 30, Type 2 DM patients between the age of 35-50 years of either sex were chosen from the Diabetic Clinic of GMC, Aurangabad, Maharashtra. HbA₁C test for glycemic control and BERA waves to assess CN were recorded. n = 30 normal subjects with normal blood sugar with age and sex-matched above tests were performed.

STATISTICAL ANALYSIS: Unpaired Student’s t-test.

RESULTS: Mean ± Standard deviation of the absolute latency and interpeak latency of BERA waves at 2, 4, and 6 KHz at 80 dB in Type 2 DM patients were delayed and found to be significant as compared to control group.

CONCLUSION: The above study explains that if BAEP is recorded at higher frequencies like 6 KHz and at 80 dB, CN involvement can be detected earlier in diabetic patients. Hence, it is recommended to carry out BERA in diabetic patients at least once in a year.

PMID:36695231 | DOI:10.4103/aam.aam_13_22

Ann Afr Med. 2023 Jan-Mar;22(1):94-100. doi: 10.4103/aam.aam_178_21.

ABSTRACT

BACKGROUND: Epidemiological data on Hospital-Acquired Pneumonia (HAP) are scarce inside Intensive Care Units (ICUs).

AIM: This study aims to quantify the incidence of HAP, determine the predictors of HAP, calculate HAP-related mortality risk ratio as well as pinpoint the different risk factors contributing to mortality.

SUBJECTS AND METHODS: A prospective longitudinal study was conducted at a governmental hospital’s general ICUs over 12 months. We included adult patients admitted for at least 72 h before signs appear. We utilized a logistic regression model for fatality outcome and cox proportional hazard model for HAP outcome.

RESULTS: Of 356 patients, 133 patients developed Ventilated-Acquired Pneumonia (VAP), 76 patients with Non-Ventilated HAP (NV-HAP), as well as 147 patients did not acquire HAP. The incidence of HAP was 28 cases of HAP per 1000 person-days, as well as the mortality rate was 74 per 100 days, while the Attributable Risk Percentage (ARP) was 85%. This high fatality rate was clarified by independent predictors as reintubation (odds ratio [OR] = 8.99, P < 0.001), ICU duration ≥5 days (OR = 7.29, P = 0.02), HAP outcome (OR = 6.49, P = 0.001), diabetes mellitus (DM) (OR = 2.98, P = 0.004), APACHE II ≥17 (OR = 2.76, P = 0.004), as well as neurological diseases (OR = 2.20, P = 0.03). The most common independent HAP predictors were Pseudomonas aeruginosa (Hazard Ratio [HR] = 2.27, P < 0.001), Klebsiella pneumoniae (HR = 1.81, P = 0.003), tracheostomy (HR = 1.72, P = 0.04), and APACHE II ≥17 (HR = 1.54, P = 0.04).

CONCLUSION: High incidence rate of HAP was linked with P. aeruginosa, K. pneumoniae, tracheostomy, and APACHE II ≥17. Furthermore, a high mortality rate was strongly correlated with reintubation, duration in ICU ≥5 days, HAP outcome, DM, APACHE II ≥17, and neurological diseases.

PMID:36695229 | DOI:10.4103/aam.aam_178_21

Ann Afr Med. 2023 Jan-Mar;22(1):45-48. doi: 10.4103/aam.aam_211_21.

ABSTRACT

INTRODUCTION: Shoulder capsulitis (SC) is a common musculoskeletal complication in patients with diabetes. It can be particularly disabling. It is often overlooked by clinicians. The aim of this study is to evaluate the prevalence of retractile capsulitis and to identify the risk factors in a population of Moroccan diabetic patients.

MATERIALS AND METHODS: We realised a cross-sectional study including patients with diabetes mellitus (DM). We recorded the demographic and diabetic characteristics of our patients. SC and vascular complications were assessed by clinical and para-clinical investigations. The prevalence of SC was calculated. The factors associated with SC were evaluated by suitable statistical tests.

RESULTS: Three hundred and Sixty-five patients were included; 84.9% had Type 2 DM (T2DM). The mean age of the participants was 52.6 ± 13.6. Shoulder capsulitis was present in 12.6% of patients. In statistical analysis, age >50 years (P = 0.001), T2DM (P = 0.03), duration of progression >10 years (P = 0.03), dyslipidemia (P = 0.013) and macrovascular complications (P = 0.009) were associated with an increased frequency of SC.

CONCLUSION: This study shows that the prevalence of SC is higher in diabetic patients. Therefore, inclusion of this pathology in the global management of the diabetic patient is necessary.

PMID:36695221 | DOI:10.4103/aam.aam_211_21

Ann Afr Med. 2023 Jan-Mar;22(1):18-32. doi: 10.4103/aam.aam_223_21.

ABSTRACT

OBJECTIVE: The objective is to determine the prevalence of kidney disease (KD) risk factors and their knowledge among Nigerians aged 15-64 living in the Mainland and Island metropolitan districts of Lagos State, South West Nigeria.

MATERIALS AND METHODS: A total of 1171 respondents between 15 and 64 years of age were recruited for the measurements of prevalence and knowledge of KD risk factors using a structured questionnaire. Descriptive, bivariate, and logistic regression statistical analyses were employed.

RESULTS: The respondents’ mean age was 33.83 ± 11.54, with a male-to-female ratio of 0.54:0.46. Respondents without KD have lower knowledge of KD risk factors (38.26; 37.27‒39.25) than those with KD (45.00; 38.84‒50.16) with an overall knowledge score of 38.39 (37.41‒39.36). The prevalent risk factors include indiscriminate use of analgesics and frequent use of traditional remedies (P < 0.05). Knowledge predictors of KD risk factors among respondents were older age (≥30 years) (with KD-Adjusted Odds Ratio (AOR) 1.06: 95% confidence interval [CI]: 0.82‒1.98; without KD-AOR 2.10: 95% CI: 1.52‒2.25) and chronic ailments (with KD-AOR 1.51: 95% CI: 0.28‒2.93; without KD-AOR 3.03: 95% CI: 0.04‒7.49).

CONCLUSION: The study revealed a lower knowledge of KD risk factors exists in respondents without KD, but the prevalence of risk factors was higher among both cohorts of respondents. Therefore, concerted efforts should be made to sensitize strategic public health programs to expand accurate and adequate awareness and understanding of KD risk factors and their implications for well-being, and to possibly avoid the risk of the disease later in life.

PMID:36695218 | DOI:10.4103/aam.aam_223_21

Ann Afr Med. 2023 Jan-Mar;22(1):11-17. doi: 10.4103/aam.aam_241_21.

ABSTRACT

BACKGROUND: One of the commonest and most frequently said, quoted and understood by even the least educated elements of our society is the neurological symptom of headache. The commonly diagnosed and studied headaches are Migraine and Tension type headache [TTH]. Headache has the power to reduce the very essence of a peaceful life and produce a disability in a person.

AIMS AND OBJECTIVES: The aim of our study is to approach the subject with view of correlation of quality of sleep with the disability associated with migraine and compare it to TTH.

MATERIALS AND METHODS: For the same a cross-sectional study design was adopted and a consecutive sampling procedure was adopted. The sample was subjected to basic socio-demography, VAS, PSQI and HDI. Statistical analysis was done on the collected data.

RESULTS: Based on scales the results were evaluated using appropriate statistical methods. It was observed that there was a higher female preponderance in both migraine and TTH, there was severe disability associated and both headaches cause poor sleep quality.

CONCLUSION: The current study concludes that headache is a debilitating illness which causes significant disability to a person.

PMID:36695217 | DOI:10.4103/aam.aam_241_21