Category: Nevin Manimala

Biomark Med. 2023 Jan 20. doi: 10.2217/bmm-2022-0216. Online ahead of print.

ABSTRACT

Aim: This meta-analysis aimed to investigate the clinical value of calprotectin in rheumatoid arthritis (RA) patients. Methods: The data regarding blood calprotectin levels in RA patients were retrieved from PubMed, Embase, Web of Science and Cochrane databases. Results: Thirty-one eligible articles were included. Calprotectin was increased in RA patients compared with healthy controls (mean difference [MD] = 1.48, 95% CI: 1.16-1.79). Calprotectin was positively associated with C-reactive protein (correlation coefficient [CC] = 0.58, 95% CI: 0.53-0.63) and disease activity score (CC = 0.48, 95% CI: 0.38-0.58) in RA patients. Interestingly, calprotectin showed an increased trend in RA responders compared with nonresponders, but without statistical significance (MD = 0.38, 95% CI: -0.09-0.85). Conclusion: Blood calprotectin relates to disease risk, inflammation and activity in RA patients.

PMID:36661047 | DOI:10.2217/bmm-2022-0216

Ann Surg. 2023 Jan 20. doi: 10.1097/SLA.0000000000005799. Online ahead of print.

ABSTRACT

OBJECTIVE: To analyze risk and patterns of locoregional failure (LRF) in patients of the RAPIDO trial at five years.

SUMMARY BACKGROUND DATA: Multimodality treatment improves local control in rectal cancer. Total neoadjuvant treatment (TNT) aims to improve systemic control while local control is maintained. At three years, LRF rate was comparable between TNT and chemoradiotherapy in the RAPIDO trial.

METHODS: 920 patients were randomized between an experimental (EXP, short-course radiotherapy, chemotherapy, and surgery) and a standard-care group (STD, chemoradiotherapy, surgery, and optional post-operative chemotherapy). LRF, including early LRF (eLRF) (no resection except for organ preservation/R2 resection) and locoregional recurrence (LRR) after an R0/R1 resection, were analyzed.

RESULTS: Totally, 460 EXP and 446 STD patients were eligible. At 5.6 years (median follow-up), LRF was detected in 54/460 (12%) and 36/446 (8%) patients in the EXP and STD groups, respectively (P=0.07), in which EXP patients were more often treated with 3D-CRT (P=0.029). In the EXP group, LRR was detected more often (44/431 (10%) vs. 26/428 (6%); P=0.027), with more often a breached mesorectum (9/44 (21%) vs. 1/26 (4); P=0.048). The EXP treatment, enlarged lateral lymph nodes, positive circumferential resection margin, tumor deposits, and node positivity at pathology were significant predictors for developing LRR. Location of the LRRs was similar between groups. Overall survival after LRF was comparable (HR 0.76 (95%CI 0.46-1.26); P=0.29).

CONCLUSION: The EXP treatment was associated with an increased risk of LRR whereas the reduction in disease-related treatment failure and distant metastases remained after 5 years. Further refinement of the TNT in rectal cancer is mandated.

PMID:36661037 | DOI:10.1097/SLA.0000000000005799

Hum Reprod. 2023 Jan 20:dead005. doi: 10.1093/humrep/dead005. Online ahead of print.

ABSTRACT

STUDY QUESTION: Does sperm cryopreservation influence the reproductive outcomes of normozoospermic patients in oocyte donation cycles?

SUMMARY ANSWER: After controlling for confounders, the use of cryopreserved semen from normozoospermic patients does not affect pregnancy and live birth rates after elective ICSI.

WHAT IS KNOWN ALREADY: Sperm cryopreservation by slow freezing is a common practice in ART. While frozen-thawed semen typically presents reduced motility and vitality, its use for ICSI is generally considered adequate in terms of reproductive outcomes. Nevertheless, most studies comparing reproductive outcomes between fresh and cryopreserved sperm include patients with severe male factor (testicular sperm, oligo-, and/or asthenozoospermia) or women of advanced maternal age, where the altered quality of the gametes can partially mask the full effect of freezing/thawing.

STUDY DESIGN, SIZE, DURATION: The study included a retrospective cohort of 7969 couples undergoing their first oocyte donation cycle between January 2013 and December 2019 in one large clinic, using normozoospermic semen from the male partner. All cycles involved elective ICSI, fresh oocytes, and a fresh embryo transfer, either at cleavage or blastocyst stage. Two study groups were established based on the sperm status: fresh (n = 2865) and cryopreserved (n = 5104).

PARTICIPANTS/MATERIALS, SETTING, METHODS: A slow freezing protocol was used for all sperm cryopreservation. Sperm washing, capacitation, and selection prior to ICSI were performed identically for fresh and frozen-thawed samples, using pellet swim-up. Fertilization rate (FR), pregnancy (biochemical and ongoing), and live birth rates were compared between study groups using univariate and multivariate regression analyses.

MAIN RESULTS AND THE ROLE OF CHANCE: Male and female age, sperm concentration and motility after ejaculation, and number of oocytes inseminated were similar between cycles using fresh or cryopreserved sperm. Analysis by Student’s t-test did not indicate a significant difference in FR between fresh and cryopreserved sperm (P = 0.0591); however, after adjusting for confounders, this difference reached statistical significance: 74.65% FR for fresh (CI 95%: 73.92-75.38) versus 73.66% for cryopreserved sperm (CI 95%: 73.11-74.20), P = 0.0334. The adjusted regression analysis revealed higher odds of biochemical pregnancy when using fresh sperm (odds ratio (OR): 1.143, P = 0.0175), but no significant effects of sperm cryopreservation were observed for ongoing pregnancy (OR: 1.101, P = 0.0983) and live birth (OR: 1.082, P = 0.1805).

LIMITATIONS, REASONS FOR CAUTION: Caution should be exerted when extrapolating these results to different protocols for sperm cryopreservation and selection, or to IVM, advanced maternal age and classical IVF cycles, which were excluded from analysis. Owing to the retrospective nature of the study, some uncontrolled for variables may affect the results.

WIDER IMPLICATIONS OF THE FINDINGS: Sperm cryopreservation does not affect pregnancy and live birth rates in normozoospermic patients, and although it may lower FR s slightly, this would not be clinically relevant. In line with previous studies that included patients with an apparent male or female factor, sperm cryopreservation is a safe and convenient technique.

STUDY FUNDING/COMPETING INTEREST(S): The study received no external funding and all authors have no conflicts of interest to declare.

TRIAL REGISTRATION NUMBER: N/A.

PMID:36661036 | DOI:10.1093/humrep/dead005

J Pak Med Assoc. 2022 Oct;72(10):2086-2089. doi: 10.47391/JPMA.273.

ABSTRACT

The aim of this study was to determine whether there is a decrease or an increase in the volume of different regions of the brain by comparing brain morphometry ofpatients diagnosed with Fibromyalgia Syndrome and healthy control subjects. The study included 23 female patients who were diagnosed with fibromyalgia, and 18 females, age-matched healthy subjects. Structural Mitral Regurgitation data was processed using Surface-Based Morphometry (SBM) on the Freesurfer 6.0 programme (http://surfer.nmr.mgh.harvard.edu). As a result of the surface-based analyses, a statistically significant reduction was determined in the Fibromyalgia Syndrome patient group in some brain region. A statistically signficant increase was determined in the FMS patient group with respect to the left anterior occipital sulcus volume, left inferior temporal gyrus thickness and left anterior occipital sulcus area. The results of this study showed that FMS affected brain morphometry through the brain central pain mechanisms and the normal brain morphology was changed because of atrophy in some areas and hypertrophy in some areas.

PMID:36661003 | DOI:10.47391/JPMA.273

J Pak Med Assoc. 2022 Oct;72(10):1977-1982. doi: 10.47391/JPMA.3848.

ABSTRACT

OBJECTIVE: To assess the changes in children’s oral health-related quality of life following the treatment of severely affected molar-incisor hypomineralisation with Glass Hybrid Restorative System (GH) after selective caries removal.

METHODS: The observational cross-sectional study was conducted at the Marmara University, School of Dentistry, Department of Pediatric Dentistry, Istanbul, Turkey.. Children aged 11-14 years (n = 55) who were diagnosed with MIH and had finished their dental treatment from November 2018 to December 2019, were included. The children’s MIH-affected teeth were treated with GH after SCR. Participants answered the Child Perceptions Questionnaire (CPQ11?14) prior to their dental treatment and 6 months after the treatment.

RESULTS: Of the fifty-five patients, 40 patients (24 girls-16 boys) completed baseline and follow-up data. The mean age of the children was 11.85 ±1.02 years. The overall CPQ score ranged from 3-83 (average 33.27 ± 16.46) at baseline and 0-61 (average 11.67 ± 11.21) at follow up. The emotional well-being among children was the highest score at baseline. A significant decrease (p < 0.001) in the mean values was observed for both the overall CPQ scores and for the scores of the oral symptoms, functional limitations, and social-emotional well-being limitation. All subdomains showed large effect sizes and oral symptom limitation domain presented the greatest effect. Wilcoxon Rank test was used to determine the statistical significance of the changes and the magnitude of change was determined by calculating and classifying the effect size.

CONCLUSIONS: Restorative treatment with GH following selective caries removal positively influenced the oral health-related quality of life of children with severe molar-incisor hypomineralisation.

PMID:36660984 | DOI:10.47391/JPMA.3848

J Pak Med Assoc. 2022 Oct;72(10):1942-1946. doi: 10.47391/JPMA.2134.

ABSTRACT

OBJECTIVE: To study the level of physical activity of Pakistani labourers in Saudi Arabia, and to find its relationship with body mass index.

METHODS: The observational study was conducted inside the Pakistan Embassy in Riyadh, Saudi Arabia, from October 2017 to March 2018, and comprised Pakistani males aged 22-60 years doing unskilled and semi-skilled jobs. Body mass index was calculated, and the level of physical activity was assessed using the short form of International Physical Activity Questionnaire. Data was analysed using SPSS 20.

RESULTS: There were 130 subjects with mean age of 33.53±7.9 years. There were 109(83.8%) subjects aged <40 years, and 21(16.2%) were aged >40 years. Mean body mass index of the sample was 26.13±5.29kg/m². Overall, 71(54.6%) participants were insufficiently active having energy expenditure <600 metabolic equivalent of task in minutes per week. No statistically significant result was found when total energy expenditure was considered (p>0.05), but significant result was found for energy expenditure due to ‘walk alone’ (p<0.05). Significant correlation was found between profession and overall energy expenditure and job-related energy expenditure. Significant but weak positive correlation was found between body mass index and walk-related energy expenditure (r=0.279), (p<0.001).

CONCLUSIONS: Mean body mass index of the sample was high compared to South Asian cut-off values, and the level of physical activity was very low, but the findings failed to show an inverse relationship between physical activity level and body mass index.

PMID:36660979 | DOI:10.47391/JPMA.2134

J Pak Med Assoc. 2022 Oct;72(10):1913-1920. doi: 10.47391/JPMA.22-99.

ABSTRACT

OBJECTIVES: To analyse the geospatial and temporal distribution of disease and injury burden and factors that influence health care seeking behaviour in thirty-six districts of Punjab in Pakistan.

METHODS: Utilizing the district level-Pakistan Social and Living Standards Measurement survey data for 2010-2015 from the Pakistan Bureau of Statistics and Human Development Index (HDI) data for the years 2011-2015 from the United Nations Development Programme; choropleth maps were created based on the district level proportions of population reporting having been sick or injured and having sought health consultations for all three waves of PSLM surveys and based on HDI for the years 2011, 2013 and 2015 for the Punjab districts. Spatial cluster analysis of having been sick or injured and having sought health consultations for three waves of PSLM was conducted.

RESULTS: For the years (2010-11), (2012-13) and (2014-15) respectively; the mean proportions of population that reported being sick or injured were (7.36±2.23), (6.99±2.33), and (5.70±1.72). The corresponding mean proportions that sought health consultation were (96.11±2.92), (96.05±2.26) and (96.82±2.15) respectively. Having sought health consultation in years (2010-11) and (2012-13), having been sick/injured in (2010-11), and human development index of 2013 as well as 2015 were statistically significant determinants of having sought consultation in the last wave of (2014-15) (p<0.05).

CONCLUSIONS: Findings show a decline in the reported disease and injury burden between 2010 and 2015 but constant rates of seeking health care. HDI and having sought care previously are the major determinants of subsequent health consultation in Punjab. Future studies need to focus on how these results can be utilized to health inequalities in Pakistan.

PMID:36660975 | DOI:10.47391/JPMA.22-99

J Pak Med Assoc. 2022 Oct;72(10):2034-2037. doi: 10.47391/JPMA.4644.

ABSTRACT

OBJECTIVE: To examine the association of tinnitus distress, tinnitus magnitude and psychopathological symptoms among patients with ear-related problems.

METHODS: The cross-sectional study was conducted from December 1, 2020, to June 30, 2021, at the Hearing and Balance Clinic, Rawalpindi, Pakistan, in collaboration with the National Institute of Psychology, Quaid-i-Azam University, Islamabad, Pakistan, and comprised adult tinnitus patients of either gender. All patients underwent ear examination and audiological evaluations for tinnitus matching. Psychological assessment was done using the Tinnitus Magnitude Index, the Tinnitus Reaction Questionnaire and the Symptoms Check List-90. Data was analysed using SPSS 21.

RESULTS: Of the 159 subjects, 97(61%) were male and 62(39%) were females. The overall mean age was 47.94±17.47 years. Patients showed statistically significant tendency to develop psychopathological symptoms, including somatisation, phobic anxiety, depression and paranoid ideation (p<0.05). Additionally, significant gender differences were also observed (p<0.05).

CONCLUSIONS: There was a high prevalence of tinnitus distress along with psychopathological symptoms among tinnitus patients.

PMID:36660973 | DOI:10.47391/JPMA.4644

Womens Health (Lond). 2023 Jan-Dec;19:17455057221147380. doi: 10.1177/17455057221147380.

ABSTRACT

BACKGROUND: There are persistent racial/ethnic disparities in the occurrence of severe maternal morbidity. Patient-centered medical home care has the potential to address disparities in maternal outcomes.

OBJECTIVES: To examine (1) the association between receiving patient-centered medical home care and severe maternal morbidity outcomes and (2) the interaction of race/ethnicity on patient-centered medical home status and severe maternal morbidity.

DESIGN/METHODS: Using 2007 to 2016 data from the Medical Expenditures Panel Survey, we conducted a cross-sectional study to estimate the association between receipt of care from a patient-centered medical home and the occurrence of severe maternal morbidity, and racial-specific (White, Black, Asian, Other) relative risks of severe maternal morbidity. Our study used race as a proxy measure for exposure racism. We identified mothers (⩾15 years) who gave birth during the study period. We identified patient-centered medical home qualities using 11 Medical Expenditures Panel Survey questions and severe maternal morbidities using medical claims, and calculated generalized estimating equation models to estimate odds ratios of severe maternal morbidity and 95% confidence intervals.

RESULTS: Among all mothers who gave birth (N = 2801; representing 5,362,782 US lives), only 25% received some exposure patient-centered medical home care. Two percent experienced severe maternal morbidity, and this did not differ statistically (p = 0.11) by patient-centered medical home status. However, our findings suggest a 85% decrease in the risk of severe maternal morbidity among mothers who were defined as always attending a patient-centered medical home (odds ratios: 0.15; 95% confidence interval:0.01-1.87; p = 0.14) and no difference in the risk of severe maternal morbidity among mothers who were defined as sometimes attending a patient-centered medical home (odds ratios: 1.00; 95% confidence interval:0.16-6.42; p = 1.00). There was no overall interaction effect in the model between race and patient-centered medical home groups (p = 0.82), or ethnicity and patient-centered medical home groups (p = 0.62) on the severe maternal morbidity outcome.

CONCLUSION: While the rate of severe maternal morbidity was similar to US rates, few mothers received care from a patient-centered medical home which may be due to underreporting. Future research should further investigate the potential for patient-centered medical home-based care to reduce odds of severe maternal morbidity across racial/ethnic groups.

PMID:36660909 | DOI:10.1177/17455057221147380

J Pak Med Assoc. 2022 Oct;72(10):2019-2024. doi: 10.47391/JPMA.4438.

ABSTRACT

OBJECTIVE: To compare the efficacy of only dietary recommendations, zinc, probiotics and combination therapies in children admitted with acute gastroenteritis.

METHODS: The comparative, prospective, double-blind, placebo-controlled study was conducted from October 2020 to April 2021 at the Paediatric Emergency Service after approval from the ethics review committee of Diyarbakir Gazi Yasargil Training and Research Hospital, Turkey, and comprised infants with a diagnosis of acute gastroenteritis who were divided into four groups. Only appropriate dietary recommendations were given to the control group 1, while group 2 was given a single probiotic containing bifidobacterium breve, bifidobacterium bifidum, bifidobacterium infantis and bifidobacterium longum strains. Group 3 was given zinc and group 4 was given probiotics and zinc. Demographic data of the patients, admission complaints, physical examination findings, dehydration degrees, and laboratory findings were recorded and analysed.

RESULTS: Of the 132 subjects, 79 (59.8%) were males. The overall mean age was 27.5±3.6 months. There were 22 (16.7%) patients in group 1, 34 (25.8%) in group 2, 28 (21.2%) in group 3, and 48 (36.4%) in group 4. The mean duration time to diarrhoea termination was 84.5±10.7 hours (range: 79-89 hours) in group 1, 73.05±6.8 hours (range: 70.5-75.4 hours) in group 2, 80.1±10.3 hours (range: 76-84 hours) in group 3, and 43.5±9.6 hours (range: 46-48 hours) in group 4. Group 4 outcome was statistically significant (p<0.001).

CONCLUSIONS: The efficiency of combined treatment with probiotics and zinc was found to be significantly better in the treatment of childhood acute gastroenteritis.

PMID:36660970 | DOI:10.47391/JPMA.4438