Category: Nevin Manimala

Diabetes Care. 2023 May 1:dc222331. doi: 10.2337/dc22-2331. Online ahead of print.

ABSTRACT

OBJECTIVE: In this study we aim to unravel genetic determinants of coronary heart disease (CHD) in type 2 diabetes (T2D) and explore their applications.

RESEARCH DESIGN AND METHODS: We performed a two-stage genome-wide association study for CHD in Chinese patients with T2D (3,596 case and 8,898 control subjects), followed by replications in European patients with T2D (764 case and 4,276 control subjects) and general populations (n = 51,442-547,261). Each identified variant was examined for its association with a wide range of phenotypes and its interactions with glycemic, blood pressure (BP), and lipid controls in incident cardiovascular diseases.

RESULTS: We identified a novel variant (rs10171703) for CHD (odds ratio 1.21 [95% CI 1.13-1.30]; P = 2.4 × 10-8) and BP (β ± SE 0.130 ± 0.017; P = 4.1 × 10-14) at PDE1A in Chinese T2D patients but found only a modest association with CHD in general populations. This variant modulated the effects of BP goal attainment (130/80 mmHg) on CHD (Pinteraction = 0.0155) and myocardial infarction (MI) (Pinteraction = 5.1 × 10-4). Patients with CC genotype of rs10171703 had >40% reduction in either cardiovascular events in response to BP control (2.9 × 10-8 < P < 3.6 × 10-5), those with CT genotype had no difference (0.0726 < P < 0.2614), and those with TT genotype had a threefold increase in MI risk (P = 6.7 × 10-3).

CONCLUSIONS: We discovered a novel CHD- and BP-related variant at PDE1A that interacted with BP goal attainment with divergent effects on CHD risk in Chinese patients with T2D. Incorporating this information may facilitate individualized treatment strategies for precision care in diabetes, only when our findings are validated.

PMID:37125963 | DOI:10.2337/dc22-2331

Orbit. 2023 May 1:1-6. doi: 10.1080/01676830.2023.2204493. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the effect of botulinum toxin (BTX) and partial orbital lobe dacryoadenectomy (POLD) on the main lacrimal gland functions using the direct assessment of its secretory activity.

METHODS: A pilot study involving 14 subjects (mean age, 42.16 years) with proximal bicanalicular block (n = 9) or complete punctal effacement (n = 5) received either intraglandular 2.5 units of BTX (n = 7) or underwent the POLD procedure (n = 7). Dynamic assessment of tear secretion from the palpebral lobes was performed as per standard protocols. The parameters studied included Schirmer I, changes in the glandular outflow, and the neurosensory secretory lag.

RESULTS: Schirmer I values showed a mean reduction of 5.25 mm (range, 2-8 mm) following BTX injection, and mean tear flow decreased from 1.46 $\mu l/min$ to 1.11 $\mu l/min$ (P = 0.15). The POLD group showed a significant mean reduction of 0.45 $\mu l/min$ in mean tear flow at 1 month (P = 0.03) and 0.32 $\mu l/min$ at 3 months of follow-up (P = 0.20). However, there was no statistically significant change of the Schirmer values in the POLD group at 3 months.

CONCLUSION: Direct assessment of lacrimal gland function can be used to monitor changes following the gland therapies. Although POLD shows a significant reduction in short term, significant surgical improvisation would be needed for it to be effective in long term. A larger study is ongoing to further our understanding.

PMID:37125960 | DOI:10.1080/01676830.2023.2204493

Otolaryngol Head Neck Surg. 2023 May 1. doi: 10.1002/ohn.359. Online ahead of print.

ABSTRACT

OBJECTIVE: (1) To measure the change in auditory and vestibular symptoms following superior canal dehiscence (SCD) surgery, and (2) to determine differences in clinical features and surgical outcomes between superior canal dehiscence syndrome (SCDS) patients with primarily auditory or vestibular complaints.

STUDY DESIGN: Retrospective cohort study.

SETTING: Single surgeon series at the tertiary academic medical center from 2002 to 2021.

METHODS: Retrospective review of SCDS patients who underwent surgical repair. (1) Patients were administered a standardized symptom questionnaire at preoperative and follow-up visits, and results were compared with paired statistical testing. (2) Patients were divided into 2 cohorts based on either auditory or vestibular chief complaint and differences in demographic, clinical, and outcome variables were examined.

RESULTS: Our study included 113 patients with 118 operated ears. Twenty-seven patients (24%) had radiographic bilateral dehiscence. 10/11 auditory symptoms (91%) and 5/8 vestibular symptoms (63%) solicited on the questionnaire improved significantly with surgery, except for nonpulsatile tinnitus, sense of imbalance, positional dizziness, and oscillopsia. Analyses stratified by chief complaint (auditory vs vestibular) revealed overall similar characteristics and surgical outcomes. Patients with chief vestibular complaints underwent surgery at an earlier age (45.5 vs 53.9 years, p < 0.05).

CONCLUSION: SCD surgery alleviates a wide range of auditory and vestibular symptoms. Overall, we did not find significant differences between patients with chief auditory versus vestibular complaints, and both groups benefited from surgery. Symptoms are not directly linked to third-window physiology and certain vestibular symptoms may be more likely to persist. Bilateral dehiscence may play an important role in persistent symptoms as well.

PMID:37125629 | DOI:10.1002/ohn.359

Work. 2023 Apr 26. doi: 10.3233/WOR-220360. Online ahead of print.

ABSTRACT

BACKGROUND: Many studies have evaluated physical activity and fatigue. However, a causal relationship between physical activity, fatigue and balance in healthcare workers has not been established.

OBJECTIVE: To evaluate the activity levels, fatigue, and dynamic balance of health workers who work actively or in a desk job in many different units in the hospital.

METHODS: 72 Health workers from two different groups participated in the study, 37 were active workers (AW), and 35 were desk workers (DW) at the Diyarbakir Gazi Yaşargil Training and Research Hospital. Participants were given a Sociodemographic Information Form, an International Physical Activity Questionnaire (IPAQ), and a 30-s Chair Stand Test (30-s CST) with a Modified Borg Scale (MBS) before starting work in the morning and at the end of work.

RESULTS: 69.4% of the study participants were female, and 54.2% were between 20 and 30 years old. It was found that the values of moderate physical activity, walking, and total physical activity were significantly higher in active workers than desk workers (p = 0.000). There was no statistically significant difference between the means of work start and after work fatigue of both groups (p > 0.05). A statistically significant difference was found when the starting and finishing work values of the dynamic balance tests of the groups were compared (p = 0.006).

CONCLUSION: It was found that the level of physical activity and dynamic balance of individuals working at desk jobs was significantly lower than that of the active group.

PMID:37125601 | DOI:10.3233/WOR-220360

Work. 2023 Apr 25. doi: 10.3233/WOR-220238. Online ahead of print.

ABSTRACT

BACKGROUND: Burnout syndrome has been extensively studied in different health science professions. It has been less studied in physiotherapy than in professions such as medicine. Moreover, it is not known how the working condition influences this syndrome.

OBJECTIVE: The main objective of this study was to compare the burnout index between contract and freelance physiotherapists in the private sector in the Community of Madrid, Spain.

METHODS: A cross-sectional study was performed with 174 participants divided into 2 groups; one group was composed of contract physiotherapists (n = 87) and the other group was composed of freelance physiotherapists (n = 87). A Mann-Whitney U test was performed for comparison between the groups. Spearman’s correlation coefficient was used to analyze the correlations between the burnout syndrome index and the secondary variables.

RESULTS: There were statistically significant differences when comparing the groups, with a large effect size for the burnout index with a higher rate among contract physiotherapists (78 [71-84.75]) than in freelance physiotherapists (61.5 [55-72.75]).There were also significant differences in the type of patients treated, number of patients treated per day, time spent per patient, and the annual salary range between the contract and freelance physiotherapists.

CONCLUSION: Contract physiotherapists who participated in this study had a significantly higher burnout syndrome index than freelance physiotherapists. Other socio-occupational variables were also found to be related to the burnout syndrome index in freelance physiotherapists and contract physiotherapists. The results of this study could be of interest for new occupational health strategies to reduce the burnout index in contract physiotherapists.

PMID:37125600 | DOI:10.3233/WOR-220238

Work. 2023 Apr 25. doi: 10.3233/WOR-220229. Online ahead of print.

ABSTRACT

BACKGROUND: The management and analysis of work ability risks is important to support well-being at work and requires multidimensional competence. Competence evaluation in Occupational Health Care professionals’ (OHCP) practice is essential for their professional development and promotion of quality of care.

OBJECTIVE: To describe OHCPs’ self-reported competence level to manage and analyze work ability risks.

METHODS: A descriptive, cross-sectional study design was applied. The data were collected electronically from May to June 2018 using the Comp-WARMA instrument (scale 1 = poor – 4 = excellent) from Occupational Health Care professionals working in Finnish private medical centers (n = 169, response rate of 10%). The data were analyzed statistically.

RESULTS: The levels of knowledge and skills of OHCP in work ability risk management and analysis were mainly at good level (3.22 on average), but some deficient were still identified. The knowledge and skills of the work ability risk management and analysis were associated with the number of customer organizations they worked with, their attendance of supplementary training regarding work ability risk management and analysis, their amount of work experience, their type of employment, age, and gender.

CONCLUSION: OHCP self-reported competence levels in work ability risk management and analysis was at good level. There is a need for development in all areas of work ability risk management and analysis. OHCP could benefit from in-service education on work ability risk management and analysis. Further validation of the Comp-WARMA instrument in larger sample is needed.

PMID:37125599 | DOI:10.3233/WOR-220229

Technol Health Care. 2023 Apr 27. doi: 10.3233/THC-230300. Online ahead of print.

ABSTRACT

BACKGROUND: Cone-beam computed tomography (CBCT) could be more beneficial in clinical situations that involve the determination of root canal morphology.

AIM: The aim of the study was to ascertain the prevalence of radix molaris (paramolaris-RP and entomolaris-RE) in a subpopulation of Saudi Arabia using CBCT.

METHOD: A total of 700 CBCT scans of mandibular permanent first molars were included in this study. All CBCT scans were interpreted by two trained dentists and an endodontist. Mandibular permanent first molars with fully developed roots and closed apices were only included. Computed Tomography scans were obtained from the dental college record. The anatomic characteristics which were checked included: the prevalence of radix molaris in both RE and RP and the prevalence of radix molaris according to the patient’s gender and age. All CBCT images were processed and reconstructed using OnDemand3DTM imaging software.

RESULTS: Of the 700 patients included, 651 (93.0%) did not have radix molaris, 46 (6.6%) had radix entomolaris and 3 (0.4%) had radix paramolaris in the study group. There was no statistically significant difference between the genders and age in the incidence of RE and RP (P-value < 0.05).

CONCLUSION: The study showed that RE prevalence is more compared to RP in the first lower molars in the population studied. It is important to identify extra roots and associated canals to perform successful root canal treatment and avoid failure.

PMID:37125592 | DOI:10.3233/THC-230300

Technol Health Care. 2023 Apr 27. doi: 10.3233/THC-220908. Online ahead of print.

ABSTRACT

BACKGROUND: Research on the genetic mechanisms of hypertension has been a hot topic in the cardiovascular field.

OBJECTIVE: To study the correlation between senile hypertension and traditional Chinese medicine (TCM) constitution and lipoprotein lipase (LPL) gene polymorphism and to provide the theoretical basis for TCM prevention and treatment of hypertension.

METHODS: The elderly population in communities in Shanghai (hypertensive: 264 cases; non-hypertensive: 159 cases) was taken as the research object. Essential data and information on TCM constitution were collected. The LPL gene mutation was detected using the second-generation sequencing method. Statistical analysis was performed to clarify the relationship between hypertension and senile hypertension. The correlation of TCM constitution with risk factors and LPL gene polymorphisms was studied.

RESULTS: The primary TCM constitutions in the hypertension group were phlegm-dampness constitution (51.52%), yin-deficiency constitution (17.42%), balanced constitution (15.53%), and yin-deficiency (9.43%). Logistic regression analysis showed that the phlegm-dampness constitution (P< 0.05, OR = 2.587) and yin-deficiency constitution (P< 0.01, OR = 2.693) were the risk constitutions of hypertension in the elderly. A total of 37 LPL gene mutation loci (SNP: 22; new discovery: 15) were detected in the LPL gene, and the mutation rates of rs254, rs255, rs3208305, rs316, rs11570891, rs328, rs11570893, and rs13702 were relatively high, which were 26.24%, 26.24%, 16.08%, 14.66%, 13.24%, 12.06%, and 10.64%. In the phlegm-dampness group, the proportion of rs254 CC type, rs255 TT type, and rs13702 TT type in the hypertensive group (77.21%, 77.21%, and 93.38%) was higher than that in the non-hypertensive group (56.41%, 56.41%, and 82.05%), The difference was statistically significant (P< 0.05).

CONCLUSION: The phlegm-dampness constitution and yin-deficiency constitution are the risk factors of hypertension in the elderly; in the phlegm-dampness population, rs254 CC type, rs255 TT type, and rs13702 TT type are the risk factors for elderly hypertension.

PMID:37125587 | DOI:10.3233/THC-220908

Technol Health Care. 2023 Apr 27. doi: 10.3233/THC-220700. Online ahead of print.

ABSTRACT

BACKGROUND: Internet-related technologies have rapidly developed and started to impact the traditional medical practices, which combined wireless communication technology as well as “cloud service” technology with electronic fetal heart monitoring have become a mainstream tendency.

OBJECTIVE: To investigate the clinical application value of remote fetal heart rate monitoring mode (RFHRM) on late pregnancy during the coronavirus disease (COVID-19) pandemic.

METHODS: From March 2021 to February 2022, we recruited 800 cases of pregnant women received prenatal examination at the Anhui Province Maternity and Child Healthcare Hospital. These pregnant women were randomly divided into two groups: the control group (n= 400), which was given traditional management, and the observation group (n= 400), which received remote monitoring technology on this basis. The two groups were compared with neonatal asphyxia, pregnancy outcomes, Edinburgh postnatal depression scale (EPDS), prenatal examination expenses and total time consumption.

RESULTS: There were no statistically significant differences between the groups in pregnancy outcome and neonatal outcome (P> 0.05). However, total EPDS score of 12.5% pregnant women in TPE group were higher than 12. The TPE group had significantly higher mean EPDS scores compared with the RFHRM group (7.79 ± 3.58 vs 5.10 ± 3.07; P< 0.05). The results showed a significant difference in maternity expenses (2949.83 ± 456.07 vs 2455.37 ± 506.67; P< 0.05) and total time consumption (42.81 ± 7.60 vs 20.43 ± 4.16; P< 0.05) between the groups.

CONCLUSION: Remote fetal heart rate monitoring via Internet served as an innovative, acceptable, safe and effective reduced-frequency prenatal examination model without affecting the outcome of perinatology of pregnant women with different risk factors.

PMID:37125583 | DOI:10.3233/THC-220700

Technol Health Care. 2023 Apr 27. doi: 10.3233/THC-220697. Online ahead of print.

ABSTRACT

BACKGROUND: The microsurgical treatment of paraclinoid aneurysms can be challenging due to the anatomical structures that surround them.

OBJECTIVE: This study compared the clinical and angiographic outcomes of unruptured paraclinoid aneurysms treated with Enterprise (EP) stents and low-profile visualized intraluminal support (LVIS) stents.

METHODS: A retrospective analysis of the clinical and radiological data from 133 patients with 139 unruptured paraclinoid aneurysms, who received an EP or an LVIS stent between January 2017 and June 2021 at Taizhou People’s Hospital, was performed. Immediate postoperative and follow-up angiographic results were analyzed retrospectively using the Raymond-Roy occlusion classification (RROC). Any complications following the procedure and the patients’ clinical outcomes were noted.

RESULTS: Enterprise stents were used for stent-assisted coiling in 64 patients with 68 aneurysms and LVIS stents were used in 69 patients with 71 aneurysms. Both groups exhibited an increase in the proportion of aneurysms meeting the criteria for RROC class I, but the LVIS group demonstrated a higher rate of aneurysms meeting the class I criteria compared with the EP group, both on immediate postoperative angiography (45.1% vs. 11.8%, p< 0.001) and on follow-up angiography (94.9% vs. 80.6%, p= 0.025). Procedure-related complications were experienced by 9.4% of patients in the EP group (one coil prolapse, two parent artery occlusions, and three thromboembolic events), and 8.7% of patients in the LVIS group (three stent-related thrombosis and three thromboembolic events). There were no statistically significant differences between the two groups in relation to perioperative complications (p= 0.746) or favorable clinical outcomes (p= 0.492).

CONCLUSION: A greater proportion of aneurysms in the LVIS group met the criteria for RROC class I compared with the EP group. There is no significant difference in procedural complications or clinical outcomes between EP and LVIS stents. Although no aneurysm recurrence was observed during the short follow-up period, continued monitoring is required.

PMID:37125582 | DOI:10.3233/THC-220697