Category: Nevin Manimala

PLoS Negl Trop Dis. 2022 Oct 11;16(10):e0010832. doi: 10.1371/journal.pntd.0010832. Online ahead of print.

ABSTRACT

BACKGROUND: Dengue is not included explicitly in the WHO Integrated Management of Childhood Illness (IMCI) algorithm. However, the assessment, classification and management of dengue has been incorporated into several IMCI country adaptations. We aimed to evaluate the dengue algorithms incorporated into IMCI guidelines and discuss the need for harmonization, including an extension of the age range for IMCI.

METHODS: This study included three steps. First, we investigated dengue algorithms incorporated into five Southeast-Asian (Myanmar, Philippines, Vietnam, Indonesia, Cambodia) country IMCI guidelines through a desk-based analysis. Second, we conducted an expert survey to elicit opinions regarding the integration of dengue and extension of the age range in IMCI. Third, we compared our findings with data from a large multicentric prospective study on acute febrile illness.

RESULTS: We found considerable heterogeneity between the country specific IMCI guidelines in the dengue algorithms as well as classification schemes. Most guidelines did not differentiate between diagnostic algorithms for the detection of dengue versus other febrile illness, and warning signs for progression to severe dengue. Our expert survey resulted in a consensus to further integrate dengue in IMCI and extend the age range for IMCI guidelines beyond 5 years of age. Most of the interviewees responded that their country had a stand-alone clinical guideline for dengue, which was not integrated into the IMCI approach and considered laboratory testing for dengue necessary on day three of consecutive fever. Using data from a large multicentric study of children 5-15 years of age, we could confirm that the likelihood of dengue increased with consecutive fever days. However, a significant proportion of children (36%) would be missed if laboratory testing was only offered on the third consecutive day of fever.

CONCLUSIONS: This study supports the extension of the IMCI age range beyond 5 years of age as well as the inclusion of dengue relevant content in the algorithm. Because of the challenge of distinguishing dengue from other febrile illnesses, simple laboratory testing (e.g., full blood count) should be offered at an early stage during the course of the illness. Testing only children with consecutive fever over 3 days may lead to an underdiagnosis of dengue among those with acute febrile illness in children 5-15 years of age. In addition, specific laboratory testing for dengue should be made available to peripheral health facilities.

PMID:36219610 | DOI:10.1371/journal.pntd.0010832

PLoS One. 2022 Oct 11;17(10):e0275344. doi: 10.1371/journal.pone.0275344. eCollection 2022.

ABSTRACT

OBJECTIVES: Tuberculosis (TB) is an infectious disease that causes thousands of deaths in Bangladesh. Bangladesh is one of the 30 high TB burden countries. In this study, we aimed to assess the knowledge, practices, and attitude toward TB, and to determine the factors associated with them among people who have internet access in Bangladesh. Design, Setting, and Participant: A web-based anonymous cross-sectional survey was conducted from May 20 to August 10, 2021, among people (age> = 18 years) who have internet access in Bangladesh. A comprehensive consent statement was included at the beginning of the survey and informed consent was taken.

OUTCOME MEASURES: This study’s outcomes of interest were respondents’ adequate knowledge, good practices, and positive attitudes toward TB and were coded binarily. The association between respondents’ socio-demographic factors and knowledge, attitude, and practices toward TB was inspected using the Chi-square test and Multivariable logistic regression model.

RESULTS: Among 1,180 respondents, 58.64% were males, and 62.37% were married. The majority of the participants (78.28%) were aged between 18 to 44 years. Overall adequate knowledge, favorable attitudes, and good practices about TB were found respectively in 47.8%, 44.75%, and 31.19% of the people with internet access in Bangladesh. Almost the same sets of associated factors were found to influence adequate knowledge, favorable attitudes, and good practices toward TB among social media users in Bangladesh. Males, young, unmarried, social media users with higher education, and urban social media users were more likely to have adequate knowledge, favorable attitudes, and good practices toward TB.

CONCLUSION: Policymakers need to design programs and interventions to improve knowledge, attitudes, and practices toward TB in Bangladesh with a particular focus on females, young and older people, people who live in rural areas, and illiterate/less educated people. Social media can be a powerful medium for disseminating scientific facts on TB and other diseases.

PMID:36219607 | DOI:10.1371/journal.pone.0275344

Stroke Vasc Neurol. 2022 Sep 2:svn-2022-001816. doi: 10.1136/svn-2022-001816. Online ahead of print.

ABSTRACT

BACKGROUND: Cerebral small vessel disease (SVD) causes lacunar strokes (25% of all ischaemic strokes), physical frailty and cognitive impairment and vascular and mixed dementia. There is no specific treatment to prevent progression of SVD.

METHODS: The LACunar Intervention Trial-2 is an investigator-initiated prospective randomised open-label blinded-endpoint phase II feasibility study assessing cilostazol and isosorbide mononitrate for preventing SVD progression. We aimed to recruit 400 patients with clinically evident lacunar ischaemic stroke and randomised to cilostazol, isosorbide mononitrate, both or neither, in addition to guideline secondary ischaemic stroke prevention, in a partial factorial design. The primary outcome is feasibility of recruitment and adherence to medication; key secondary outcomes include: drug tolerability; recurrent vascular events, cognition and function at 1 year after randomisation; and safety (bleeding, falls, death). Data are number (%) and median (IQR).

RESULTS: The trial commenced on 5 February 2018 and ceased recruitment on 31 May 2021 with 363 patients randomised, with the following baseline characteristics: average age 64 (56.0, 72.0) years, female 112 (30.9%), stroke onset to randomisation 79.0 (27.0, 244.0) days, hypertension 267 (73.6%), median blood pressures 143.0 (130.0, 157.0)/83.0 (75.0, 90.0) mm Hg, current smokers 67 (18.5%), educationally achieved end of school examinations (A-level) or higher 118 (32.5%), modified Rankin scale 1.0 (0.0, 1.0), National Institutes Health stroke scale 1.0 (1.4), Montreal Cognitive Assessment 26.0 (23.0, 28.0) and total SVD score on brain imaging 1.0 (0.0, 2.0). This publication summarises the baseline data and presents the statistical analysis plan.

SUMMARY: The trial is currently in follow-up which will complete on 31 May 2022 with results expected in October 2022.

TRIAL REGISTRATION NUMBER: ISRCTN14911850.

PMID:36219567 | DOI:10.1136/svn-2022-001816

J Crohns Colitis. 2022 Oct 11:jjac151. doi: 10.1093/ecco-jcc/jjac151. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Rectovaginal fistula occurs in up to 10-20% of women with Crohn’s disease, significantly affecting their quality of life. We sought to determine outcomes of single and repeat operative interventions.

METHODS: A retrospective review of all adult patients with a Crohn’s related rectovaginal fistula who underwent an operation between 1995 to 2021 was performed. Data collected included patient demographics, Crohn’s related medical treatment, surgical intervention, postoperative outcomes, and fistula outcomes.

RESULTS: A total of 166 patients underwent 360 operations; mean age was 42.8 (+/-13.2) years. Thirty-four (20.7%) patients were current and 58 (35.4%) former smokers. The most commonly performed procedure was a local approach (n=160, 44.5%) using fibrin glue, fistulotomy/fistulectomy or seton placement, followed by a transvaginal/transanal approach (n=113, 31.4%) with an advancement flap repair (including Martius advancement flap) and episoproctotomy, a transabdominal approach (n=98, 27.2%) including proctectomy or redo anastomosis and finally gracilis muscle interposition (n=8, 2.2%). The median number of operative interventions per patient was 2 (1.0-3.0) procedures. The overall fistula healing rate per patient was 71.7% (n=119) at a median follow-up of 5.5 (1.2-9.8) years. Factors that impaired healing included former smoking (OR 0.52 95%, CI 0.31 – 0.87, p=0.014) and seton insertion (OR 0.42 95%, CI 0.21-0.83, p=0.012).

CONCLUSION: Over two-thirds of Crohn’s related rectovaginal fistulas can achieve closure with multiple surgical interventions. Smoking and seton usage negatively impact healing rates and should be avoided.

PMID:36219575 | DOI:10.1093/ecco-jcc/jjac151

J Crohns Colitis. 2022 Oct 11:jjac150. doi: 10.1093/ecco-jcc/jjac150. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Most pharmaceutical clinical trials for inflammatory bowel disease (IBD) are placebo-controlled and require effect size estimation for a drug relative to placebo. We compared expected effect sizes in sample size calculations (SSCs) to actual effect sizes in IBD clinical trials.

METHODS: MEDLINE, EMBASE, CENTRAL, and the Cochrane library were searched from inception to March 26, 2021, to identify placebo-controlled induction studies for luminal Crohn’s disease (CD) and ulcerative colitis (UC) that reported an SSC and a primary endpoint of clinical remission/response. Expected effects were subtracted from actual effects, and interquartile ranges (IQRs) for each corresponding median difference were calculated. Linear regression was used to assess whether placebo or drug event rate misspecifications were responsible for these differences.

RESULTS: Of eligible studies, 36.9% (55/149) were excluded because of incomplete SSC reporting, yielding 94 studies (46 CD, 48 UC). Treatment effects were overestimated in CD for remission (-12.6% [IQR: -16.3% to -1.6%]), in UC for remission (-10.2% [IQR: -16.5% to -5.6%]), and in CD for response (-15.3% [IQR: -27.1% to -5.8%]). Differences observed were due to overestimated drug event rates, whereas expected and actual placebo event rates were similar. A meta-regression demonstrated associations between overestimated treatment effect sizes and several trial characteristics: isolated ileal disease, longer CD duration, extensive colitis (UC), single-centre, phase 2, no endoscopic endpoint component (UC).

CONCLUSION: Overestimation of IBD therapy efficacy rates resulted in smaller-than-expected treatment effects. These results should be used to inform SSCs and trial design for IBD drug development.

PMID:36219564 | DOI:10.1093/ecco-jcc/jjac150

J Nurs Manag. 2022 Oct 11. doi: 10.1111/jonm.13869. Online ahead of print.

ABSTRACT

AIM: This study aimed to investigate the Integrating Sustainability Development Education Program in Nursing to Challenge Practice Among Nursing Interns in Health Care.

BACKGROUND: The combination of sustainable development and climate change in health care delivery benefits from the apparent environmental changes.

SUBJECTS AND METHODS: The quasi-experimental, cross-sectional, comparative study included 160 nursing interns who completed the intervention. Both genders were assigned to Saudi (N=80) and Egyptian nursing interns (N=80). Data were collected through a self-administered questionnaire, including The Sustainability Consciousness Questionnaire and the Sustainability Attitudes in Nursing Survey.

RESULTS: A statistically significant difference was found between student nurses’ knowledge, attitude, and behavior during pre intervention and post intervention, as well as in student nurses’ sustainability development dimension effectiveness after than before program implementation.

CONCLUSION: The program had a significant effect on all sustainability development domains and a large effect on total sustainability development during post intervention. This study recommended that educational programs can upgrade sustainability development and challenge practice levels.

IMPLICATIONS FOR NURSING MANAGEMENT: Sustainable development is the future of management and is the next phase of management innovation. Sustainability, in the context of healthcare, is about progress in high-quality patient care delivery for all by promoting the three elements of sustainable development: environmental, social, and financial. Nurses play a significant leadership role in addressing environmental sustainability and climate change.

PMID:36219534 | DOI:10.1111/jonm.13869

J Magn Reson Imaging. 2022 Oct 11. doi: 10.1002/jmri.28477. Online ahead of print.

ABSTRACT

BACKGROUND: To standardize renal functional magnetic resonance imaging (MRI), it is important to understand the influence of side-to-side variation, regional variation within the organ, and hydration states in MRI and to search for variables that are not affected by those variations.

PURPOSE: To assess MRI-based biomarkers for characterizing the kidney in healthy volunteers while considering variations in anatomic factors and hydration states.

STUDY TYPE: Prospective.

SUBJECTS: Twenty-five healthy volunteers (15 females and 10 males, median age 25 years).

FIELD STRENGTH/SEQUENCE: 3.0 T intravoxel incoherent motion diffusion-weighted imaging, arterial spinning labeling imaging, blood oxygenation level dependent imaging, and three-dimensional MR elastography.

ASSESSMENT: Functional variables were measured before and after water challenge. Regions of interest were manually drawn by two investigators (JC and ZZ, with 8- and 5-year experiences in abdominal radiology) in the cortex, the medulla, and the entire kidney. The medulla/cortex ratio was calculated.

STATISTICAL TESTS: Paired t-test or Wilcoxon signed rank test; interobserver correlation coefficient; repeatability coefficients; Spearman’s correlation; significance level: P < 0.05.

RESULTS: Diffusion parameters were only subject to regional variation. R2*, RBF, and renal stiffness (RS) showed regional variation, side variation, and dependence on hydration states. For each side and hydration state, the cortex showed significantly higher standard apparent diffusion coefficient (sADC), higher true diffusion (D), lower R2*, and lower RS than the medulla. For each region at baseline, the left kidney showed significantly higher R2*, higher RS, and lower renal blood flow (RBF) than the right kidney. For each region and side, RS and RBF increased significantly while R2* decreased significantly after water intake. After introducing the intrinsic regional difference, significantly higher medulla/cortex ratio of RS remained after water intake except for RS@90 Hz in the right kidney.

DATA CONCLUSION: Renal multiparametric MRI quantifications were affected by regional variation, side variation, and hydration states.

LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY: Stage 1.

PMID:36219465 | DOI:10.1002/jmri.28477

Wounds. 2022 Sep;34(9):229-235.

ABSTRACT

INTRODUCTION: Diabetic foot ulcers usually are hard to heal, and amputation is sometimes necessary. Wound bed preparation helps promote the normal healing process, and debridement is fundamental to improving the wound microenvironment. Hydrogel enriched with sodium alginate and vitamins A and E is a new treatment that can aid in debridement and WBP.

OBJECTIVE: This study evaluates the efficacy of the autolytic debridement promoted by hydrogel in the healing of DFU.

MATERIALS AND METHODS: This was a single-blind randomized controlled trial with a 12-week follow-up period. Twenty-six patients were randomized into either the control group (cleaning and a simple dressing) or the experimental group (hydrogel treatment). Nineteen patients completed the trial. The wound area, healing, and wound severity classification based on PUSH were evaluated, and microscopic evaluation of the presence of inflammatory infiltrate and collagen production was performed.

RESULTS: The average patient age, duration of the open wound, and presence of diabetes were similar between the groups. The initial wound area was larger in the experimental group than in the control group, however. No statistically significant differences were found in any of the outcomes (lesion area and PUSH subscores) between the groups. Histological analysis demonstrated a reduction in the inflammatory infiltrate in the experimental group; however, there was no increase in collagen production.

CONCLUSIONS: The use of enriched hydrogel was found to be of no benefit compared with conventional dressings in the management of DFU.

PMID:36219460

J Feline Med Surg. 2022 Oct 11:1098612X221121899. doi: 10.1177/1098612X221121899. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of this study was to develop guidelines for the optimal location of drill entry and exit points for insertion of a transcondylar screw across the feline humeral condyle.

METHODS: Multiplanar reconstruction of feline elbow CT scans performed between 2016 and 2021 at one referral institution were reviewed. The optimum medial and lateral epicondylar entry and exit points for transcondylar screw placement were determined. These values were normalised to the humeral condylar diameter (HCD) for each elbow to determine the transcondylar screw placement guidelines. These guidelines were applied to each elbow and tolerance angles were determined in the transverse and frontal plane CT images to determine the safe corridor for screw placement.

RESULTS: Twenty elbows from 12 cats were evaluated in this study. The guidelines for transcondylar screw placement were as follows: the medial entry/exit point was 0.38 × HCD cranial and 0.16 × HCD distal to the medial epicondyle, and the lateral entry/exit point was 0.3 × HCD cranial and 0.16 × HCD distal to the lateral epicondyle. Tolerance angles were statistically significantly (P <0.05) larger in both frontal (34.5% larger) and transverse (21.1% larger) planes when drilled from a lateral to medial direction compared with drilling from a medial to lateral direction.

CONCLUSIONS AND RELEVANCE: The guidelines determined from this study may aid clinicians in the placement of humeral transcondylar screws in cats. Where possible, drilling from a lateral to medial direction is recommended owing to the higher tolerance angles reducing the likelihood of articular surface damage. Further studies are warranted to determine whether these guidelines are clinically useful and result in the safe insertion of a transcondylar screw in the clinical setting.

PMID:36219455 | DOI:10.1177/1098612X221121899

Pharm Biol. 2022 Dec;60(1):1994-2001. doi: 10.1080/13880209.2022.2128825.

ABSTRACT

CONTEXT: Brassica incana Ten. (Brassicaceae) is an edible plant with very limited available information. Previous studies have demonstrated the polyphenolic profile and the antioxidant and cytotoxic properties of the leaf and flowering top hydroalcoholic extracts.

OBJECTIVE: The volatile composition and the antidiabetic and anti-obesity potential of B. incana leaf and flowering top extracts have been investigated.

MATERIAL AND METHODS: The volatile characterization of the extracts was attained by HS-SPME-GC/MS analysis. The antidiabetic and anti-obesity potential was investigated spectrophotometrically in vitro by the ability to modulate pancreatic lipase and α-glucosidase at different concentrations using orlistat and acarbose as reference drugs. The inhibition of advanced glycation end-products (AGEs) was measured with aminoguanidine as reference and the antioxidant activity with the xanthine/xanthine oxidase system and Trolox for comparative purposes.

RESULTS: Several volatiles belonging to different chemical classes were identified, being sulphur compounds the most abundant in both leaf and flowering top extracts (56.33% and 64.40% of all volatiles). Although the leaf extract showed lower IC₅₀ values in most of the assays (0.968 and 1.921 mg/mL for α-glucosidase; 0.192 and 0.262 mg/mL for AGEs; 0.022 and 0.038 mg/mL for superoxide scavenging), there were no statistically significant differences between both samples. These extracts showed a similar behaviour to Trolox in the xanthine oxidase assay (IC₅₀ values of 0.022 mg/mL for leaf extract; 0.038 mg/mL for flowering top and 0.028 for Trolox).

CONCLUSIONS: Leaves and flowering tops from B. incana can be used as sources of functional compounds that could act as antidiabetic and anti-obesogenic agents.

PMID:36219451 | DOI:10.1080/13880209.2022.2128825