Category: Nevin Manimala

Vet Rec. 2023 Jan 24:e2582. doi: 10.1002/vetr.2582. Online ahead of print.

ABSTRACT

BACKGROUND: The need for proper age determination in puppies has increased enormously due to the growing illegal trade in puppies that are too young to be removed from the litter or too young to have been properly vaccinated against rabies.

METHODS: Dorsopalmar and mediolateral radiographs of the (meta)carpal region, either taken from puppy cadavers or from the Faculty’s patient database, were studied in a cross-sectional study of 252 puppies of various sizes, aged 6-212 days. The appearance and development of ossification centres as a function of age in five regions of interest in the (meta)carpal region were scored using a two- to six-step scoring system based on shape and delineation.

RESULTS: A positive correlation with age was found for all investigated regions. Intra- and interrater agreement between two observers was excellent, except for the distal epiphyses of the metacarpal bones. Postnatal ossification started after the second week of life with the carpal bones, closely followed by the radial trochlea. All ossification centres were present in all puppies from 84 days, except for the sesamoid bone in the tendon of the long abductor muscle of the first digit. Timing of appearance differed significantly between different sized breeds. There were no significant differences between the sexes.

LIMITATIONS: Age distribution was not balanced for all breed size classes.

CONCLUSIONS: The radiographic timing of the appearance and development of ossification centres in the carpal region is a promising method for age estimation in puppies.

PMID:36691858 | DOI:10.1002/vetr.2582

J Osteopath Med. 2023 Jan 25. doi: 10.1515/jom-2022-0177. Online ahead of print.

ABSTRACT

CONTEXT: Rheumatoid arthritis (RA) is a systemic autoimmune disease that commonly affects joints. Although many treatment options exist, the most common, s (DMARDs), have been associated with pulmonary infections. These types of infections (specifically pneumonia) can be detrimental to RA patients. This leads providers to utilize other treatment modalities such as glucocorticoids (GCs). GCs are commonly utilized to treat RA; however, the role of GCs in the onset of pneumonia in RA patients is not fully understood.

OBJECTIVES: The goal of this study was to systematically review and statistically analyze pooled data documenting pneumonia as an adverse event in RA patients on DMARDs as a monotherapy vs RA patients on DMARDs and GCs as combination therapy utilizing the Population, Intervention, Comparison, and Outcomes (PICO) framework.

METHODS: On August 1, 2021, a search was conducted and completed on six databases: Embase, MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, International Pharmaceutical Abstracts (IPA), and ClinicalTrials.gov. A total of 12 researchers were involved with the search and screening of articles (K.E., P.R.; V.A., D.P.C.; C.B., D.C.; T.A., E.S.; S.H., L.B.; K.S., C.S.). Search terms were identified utilizing Medical Subject Headings (MeSH) and Emtree and included “glucocorticoids,” “rheumatoid arthritis,” “pneumonia,” and “respiratory tract infections,” Inclusion criteria included human subjects over the age of 18 with seropositive RA, on a combination of GC (prednisone, methylprednisolone, or prednisolone) with DMARD (methotrexate [MTX], hydroxychloroquine [HCQ], or sulfasalazine [SSZ]) and developed pneumonia of bacterial, viral, or fungal origin. The control groups were on a DMARD monotherapy regimen. Articles were excluded if they were not in English, had less than 20 participants, were case reports or literature reviews, included animal subjects, and did not adhere to the established PICO framework. Five teams of two researchers individually sorted through abstracts of articles based on the inclusion and exclusion criteria. The same teams individually sorted through full-text articles of selected abstracts based on the same criteria. Conflicts between each team were resolved by a separate researcher. Odds ratios were utilized to quantify the effect sizes of combined studies from a random effects model. Chi-square tests and I2 statistics were utilized to analyze heterogeneity.

RESULTS: A total of 3360 articles were identified from all databases, and 416 duplicate articles were removed. Thus, a total of 2944 articles abstracts were screened, of which 2819 articles either did not meet the inclusion criteria or did meet the exclusion criteria. A total of 125 articles were retrieved and assessed for full-text eligibility, of which only three observational articles were included for meta-analysis. Statistical results revealed that patients treated with DMARDs monotherapy are 95% (95% CI: 0.65-0.99) less likely to develop pneumonia compared to patients treated with a DMARD and GCs (p=0.002).

CONCLUSIONS: Our data suggest that RA patients have a higher probability of developing pneumonia on combination therapy with GCs, compared to monotherapy with DMARDs. To our knowledge, our findings are the first to systematically review and statistically evaluate the relationship between the use of GCs and show an increased chance of developing pneumonia.

PMID:36691851 | DOI:10.1515/jom-2022-0177

Disaster Med Public Health Prep. 2023 Jan 24:1-18. doi: 10.1017/dmp.2023.20. Online ahead of print.

ABSTRACT

India has already passed through two waves of the covid-19 pandemic losing many lives. The reason for losing lives may be due to the unpreparedness of the health care system of India for this unprecedented pandemic. To assess the government’s preparedness an Institutional based cross-sectional prospective survey was conducted among the adult population of selected states in India. A self-administered questionnaire having 30-item divided into five sections (demography of the participants, step to create awareness, prevent spread of infection, handle the emergency and prognosis) was distributed online through google survey. The responses were collected in an excel file. SPSS software was used to perform the descriptive statistics and ANOVA. Nearly a quarter of the participants strongly disagree/disagree about the government’s preparedness for the 3^rd wave. Considering their perception it cannot be assured that government is well prepared to handle the emergency. So the government has to maintain emergency fund and develop health infrastructure. Government should take steps to reduce social stigma, prevent spreading of unscientific propagation and make people aware of WHO as the reliable source of information for health emergencies to avoid a human crisis in the future.

PMID:36691775 | DOI:10.1017/dmp.2023.20

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2023 Jan 17. doi: 10.5507/bp.2023.005. Online ahead of print.

ABSTRACT

BACKGROUND: Pulmonary embolism (PE) is a common and potentially life-threatening diagnosis when a certain amount of thrombotic mass obstructs blood flow through the pulmonary circulation. The finding of acute and subacute ischaemic foci on magnetic resonance imaging (MRI) of the brain in a group of patients with this diagnosis in whom we demonstrate the presence of patent foramen ovale (PFO) by transoesophageal echocardiography (TEE) is surprisingly high.

METHODS: A total of 129 patients with a diagnosis of pulmonary embolism (confirmed by computed tomography with contrast agent, CTA) who consented to further examination were examined by transthoracic echocardiography (TTE) and transoesophageal echocardiography (TEE) with contrast agent, underwent magnetic resonance imaging of the brain according to a specific protocol, and underwent a comprehensive baseline laboratory examination.

RESULTS: In our group of 129 patients, we found the presence of PFO in 36.4% (n=47) of them. A total of 5.4% (n=7) patients had asymptomatic acute and subacute ischaemic changes on brain MRI; 6 of them had concomitant PFO. The statistically significant correlation between troponin levels and the presence of pathological findings on MRI and the trend of a similar correlation for NT-proBNP values is also very interesting finding.

CONCLUSIONS: The association between the presence of PFO and the occurrence of symptomatic or asymptomatic findings on brain MRI is a well-known fact (the issue of paradoxical embolism) but the high frequency of acute and subacute lesions on brain MRI in the group of patients with a diagnosis of acute PE is surprising.

PMID:36691764 | DOI:10.5507/bp.2023.005

Gigascience. 2022 Dec 28;12:giac126. doi: 10.1093/gigascience/giac126.

ABSTRACT

BACKGROUND: Single-cell RNA sequencing (scRNA-seq) methods have been advantageous for quantifying cell-to-cell variation by profiling the transcriptomes of individual cells. For scRNA-seq data, variability in gene expression reflects the degree of variation in gene expression from one cell to another. Analyses that focus on cell-cell variability therefore are useful for going beyond changes based on average expression and, instead, identifying genes with homogeneous expression versus those that vary widely from cell to cell.

RESULTS: We present a novel statistical framework, scShapes, for identifying differential distributions in single-cell RNA-sequencing data using generalized linear models. Most approaches for differential gene expression detect shifts in the mean value. However, as single-cell data are driven by overdispersion and dropouts, moving beyond means and using distributions that can handle excess zeros is critical. scShapes quantifies gene-specific cell-to-cell variability by testing for differences in the expression distribution while flexibly adjusting for covariates if required. We demonstrate that scShapes identifies subtle variations that are independent of altered mean expression and detects biologically relevant genes that were not discovered through standard approaches.

CONCLUSIONS: This analysis also draws attention to genes that switch distribution shapes from a unimodal distribution to a zero-inflated distribution and raises open questions about the plausible biological mechanisms that may give rise to this, such as transcriptional bursting. Overall, the results from scShapes help to expand our understanding of the role that gene expression plays in the transcriptional regulation of a specific perturbation or cellular phenotype. Our framework scShapes is incorporated into a Bioconductor R package (https://www.bioconductor.org/packages/release/bioc/html/scShapes.html).

PMID:36691728 | DOI:10.1093/gigascience/giac126

Eur J Heart Fail. 2023 Jan 23. doi: 10.1002/ejhf.2781. Online ahead of print.

ABSTRACT

AIMS: The REDUCE-LAP II trial demonstrated adverse outcomes after interatrial shunt device (IASD) placement in heart failure with preserved ejection fraction (HFpEF) attributed to latent pulmonary vascular disease (PVD). We hypothesized that exercise-stress cardiovascular magnetic resonance (CMR) imaging could provide non-invasive characterisation of cardiac and pulmonary physiology for improved patient selection.

METHODS AND RESULTS: The HFpEF-Stress Trial prospectively enrolled 75 patients with exertional dyspnoea and diastolic dysfunction. Patients underwent rest and exercise-stress right heart catheterisation (RHC), echocardiography and CMR imaging. Pulmonary artery and capillary wedge pressures, cardiac index (CI) and vascular resistance (PVR) were calculated. Latent PVD was defined as increased PVR≥1.74 Wood-Units during exercise-stress. CMR assessed long axis strains (LAS) and filling volumes of all cardiac chambers. Right ventricular (RV) function was further quantified by stroke and peak flow volumes. Patients with latent PVD (n = 24) showed lower RV function (rest TAPSE, p = 0.010; stress RV LAS, p < 0.001) compared to patients without (n = 43). During exercise-stress, RV stroke and peak flow volumes (p < 0.001) were reduced and led to impaired left atrial (p = 0.040) and with a strong statistical trend to impaired ventricular (LV) filling (p = 0.098). This subsequently resulted in reduced LV-CI (p < 0.001) despite preserved LV systolic function (LV LAS p ≥ 0.255). The degree of RV dysfunction during exercise-stress best predicted latent PVD (RV peak flow, AUC rest 0.73 vs. stress 0.89, p = 0.004).

CONCLUSIONS: Latent PVD is a feature of HFpEF and is associated with impaired RV functional reserve, global diastolic filling and LV-CI. This can be quantified by CMR and used to identify patients likely to benefit from IASD implantation.

PMID:36691723 | DOI:10.1002/ejhf.2781

Nurs Manag (Harrow). 2023 Jan 24. doi: 10.7748/nm.2023.e2074. Online ahead of print.

ABSTRACT

BACKGROUND: Front-line nurses caring for patients with coronavirus disease 2019 (COVID-19) experience stressful and traumatic working conditions, which may affect their professional quality of life.

AIM: To identify the effect of COVID-19 on front-line nurses’ professional quality of life, specifically on their levels of compassion satisfaction, burnout and secondary traumatic stress.

METHOD: A descriptive, cross-sectional comparative design was adopted. Data collection tools included self-reported sociodemographic and work-related characteristics and the self-report Professional Quality of Life Scale (ProQOL). Questionnaires (n=200) were distributed by email to two groups of nurses working in a government hospital in Saudi Arabia: front-line nurses who cared for patients with COVID-19 in isolation units; and front-line nurses who cared for patients without COVID-19 in inpatient units.

RESULTS: Completed questionnaires were received from 167 respondents, a response rate of 84%. Moderate levels of compassion satisfaction, burnout and secondary traumatic stress were found regardless of respondents’ involvement in caring for patients with COVID-19. There was no statistically significant difference between the two groups in terms of compassion satisfaction, burnout and secondary traumatic stress.

CONCLUSION: The COVID-19 pandemic presents a new challenge for front-line nurses, necessitating appropriate interventions to avoid burnout and secondary traumatic stress.

PMID:36691712 | DOI:10.7748/nm.2023.e2074

Fundam Clin Pharmacol. 2023 Jan 23. doi: 10.1111/fcp.12873. Online ahead of print.

ABSTRACT

BACKGROUND: Previous estimates to meta-analyze administration error rates were limited by the high statistical heterogeneity, restricting their use.

OBJECTIVES: To investigate sources of heterogeneity in pooled administration error rates in hospitalized adults.

METHODS: We systematically searched scientific databases up to November 2017 for studies presenting error rates/relevant numerical data in hospitalized adults. We conducted separate meta-analyses for the numerators: One Medication Error (OME) (each dose can be correct or incorrect) and Total Number of Errors (TNE) (more than one error per dose could be counted), using the generic inverse variance with a 95%-confidence interval. Heterogeneity was assessed using the I² and Cochran’s Q test.

RESULTS: We meta-analyzed 33 studies. The global pooled analyses based on the OME and TNE numerators showed very high heterogeneity (I² =100%;p<0.00001). For each meta-analysis, subgroup analyses based on study characteristics (countries, wards, population, routes of administration, error detection methods, and medications) yielded results with consistently elevated heterogeneity. Beyond these characteristics, we stratified the studies according to the mean error prevalence level as the threshold. Based on the OME numerator, we identified two subgroups of low (0.15[0.13-0.17];I² =0%;p=0.43) and high (0.26[0.24-0.27];I² =38%;p=0.17) pooled prevalence rates, with controlled heterogeneity. Similarly, for the TNE numerator, we identified two subgroups of low (0.10[0.09-0.10];I² =0%;p=0.76) and high (0.28[0.27-0.29];I² =0%; p=0.89) pooled prevalence rates, with controlled heterogeneity. These subgroups differed regarding the denominators used: Total opportunities for errors versus others (doses, observations, administrations).

CONCLUSION: Calculation methods, specifically the denominator, seem a primary factor in explaining heterogeneity in error rates. Standardizing numerators, denominators, and definitions is necessary.

PMID:36691676 | DOI:10.1111/fcp.12873

J Trop Med. 2023 Jan 14;2023:2831175. doi: 10.1155/2023/2831175. eCollection 2023.

ABSTRACT

BACKGROUND: Food handlers should be screened periodically for intestinal parasitic infections, and they should be treated to reduce intestinal parasite transmission to consumers through contaminated foods and drinks. Therefore, this study aimed to assess the prevalence and associated risk factors of intestinal parasitic infection among food handlers in Woldia town, North-East Ethiopia.

METHOD: A community-basedcross-sectional study was conducted among food handlers in Woldia town, North-East Ethiopia. A structured questionnaire was used to collect sociodemographic characteristics and intestinal parasite-associated risk factors. Microscopic examination of a stool sample was performed using wet-mount and formol-ether concentration techniques. Data were analyzed using SPSS version 20.0 statistical software packages. Bivariate and multivariate analyses were performed to investigate the association between intestinal parasitic infections and associated risk factors. In all comparisons, P value <0.05 was considered as statistically significant.

RESULT: The overall prevalence of intestinal parasitic infection among food handlers in Woldia town was 14.3%. Six different intestinal parasites were detected. The majority of the parasites identified were helminthic infections 37/52 (71%). Ascaris lumbricoides was the most dominant parasite (7.7%), followed by E. histolytica/dispar (2.7%) and G. lamblia (1.4%). Multivariate logistic regression analysis showed that intestinal parasitic infection had a statistically significant association with food handlers’ habits of hand washing without soap after latrine use (P < 0.01), swimming habit (P=0.03), and using a common knife (P < 0.01).

CONCLUSION: This study revealed a relatively high prevalence of intestinal parasites among food handlers in Woldia town. Strict and standard hygienic and sanitary practices should be implemented by food handlers. Moreover, food handlers should be screened for intestinal parasitic infection, and health education should be given periodically.

PMID:36691674 | PMC:PMC9867574 | DOI:10.1155/2023/2831175

Sci Afr. 2023 Mar;19:e01519. doi: 10.1016/j.sciaf.2022.e01519. Epub 2023 Jan 2.

ABSTRACT

A Bayesian joint modeling approach to dynamic prediction of HIV progression and mortality allows individualized predictions to be made for HIV patients, based on monitoring of their CD4 counts. This study aims to provide predictions of patient-specific trajectories of HIV disease progression and survival. Longitudinal data on 254 HIV/AIDS patients who received ART between 2009 and 2014, and who had at least one CD4 count observed, were employed in a Bayesian joint model of disease progression. Different forms of association structure that relate the longitudinal CD4 biomarker and time to death were assessed; and predictions were averaged over the different models using Bayesian model averaging. The individual follow-up times ranged from 1 to 120 months, with a median of 22 months and IQR 7-39 months. The estimates of the association structure parameters from two of the three models considered indicated that the HIV mortality hazard at any time point is associated with the rate of change in the underlying value of the CD4 count. Model averaging the dynamic predictions resulted in only one of the hypothesized association structures having non-zero weight in almost all time points for each individual, with the exception of twelve patients, for whom other association structures were preferred at a few time points. The predictions were found to be different when we averaged them over models than when we derived them from the highest posterior weight model alone. The model with highest posterior weight for almost all time points for each individual gave an estimate of the association parameter of -0.02 implying that for a unit increase in the CD4 count, the hazard of HIV mortality decreases by a factor (hazard ratio) of 0.98. Functional status and alcohol intake are important contributing factors that affect the mean square root of CD4 measurements.

PMID:36691645 | PMC:PMC7614071 | DOI:10.1016/j.sciaf.2022.e01519