Category: Nevin Manimala

Curr Probl Cardiol. 2023 Apr 28:101772. doi: 10.1016/j.cpcardiol.2023.101772. Online ahead of print.

ABSTRACT

BACKGROUND: Systemic arterial hypertension (SAH) is one of the principal risk factors for developing cardiovascular disease. When a hypertensive woman becomes pregnant, new hemodynamic condition is installed, with addition from chronic pressure overload to chronic volume overload. This new hemodynamic condition can provide greater myocardial hypertrophy(LVH), whose postpartum evolution has been little studied in the literature.

OBJECTIVES: To evaluate LVH in hypertensive women in the third trimester of pregnancy and six months postpartum and to establish which clinical variables are associated with elevated risk of LVH.

METHODS: Prospective longitudinal study including 41 pregnant women beyond 35 gestational weeks and with previous SAH. They were submitted to clinical and echocardiographic evaluation at the gestational period and six months postpartum.

STATISTICAL ANALYSIS: multivariate logistic regression with the exposures most strongly associated with maintenance of hypertrophy in univariate analysis. Significance level:p<0.05.

RESULTS: The mean age was 29±6.2 years. The majority of the women were white(85.4%). Before pregnancy 23(59%) women used anti-hypertensive drugs and 28(71.8%) used during pregnancy. At the end of gestation, all women presented LVH, 79% maintained hypertrophy six months postpartum. In multivariate analysis, exposures significantly associated with hypertrophy maintenance: systolic blood pressure(SBP) at the end of gestation, OR=1.16(1.03-1.30);p=0.013 and SBP increase at six months postpartum in relation to end of gestation, OR=22.9(1.8-294);p=0.016.

CONCLUSIONS: In hypertensive pregnant women, LVH frequency is elevated at the end of pregnancy, and recovery frequency of this hypertrophy, at six months postpartum, is very low. The increase of SBP six months postpartum was associated with maintenance of hypertrophy.

PMID:37121455 | DOI:10.1016/j.cpcardiol.2023.101772

Curr Probl Cardiol. 2023 Apr 28:101776. doi: 10.1016/j.cpcardiol.2023.101776. Online ahead of print.

ABSTRACT

Pulmonary hypertension (PH) is a progressive disease with a high morbidity and mortality. The treatment is based on the type of PH. Prognosis still remains poor despite the use of different medications. Pulmonary artery denervation (PADN) has been studied as a novel therapeutic option in these patients. PUBMED, EMBASE and COCHRANE databases were searched by two investigators until January 2023. Information was analyzed for the following outcomes: 6-minute walk distance (6MWD), mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR) and cardiac output. Subgroup analysis comparing pre and post PADN in different PH groups was done. Statistical analysis was performed with the Review Manager version 5.4 This meta- analysis included 6 controlled trials and 6 single-arm prospective studies with a total of 616 patients. Our pooled analysis showed a significant reduction in mPAP [WMD -6.51, 95% CI (-9.87, -3.15), p = 0.0001], PVR [WMD -3.69, 95% CI (-6.74, -0.64), p = 0.02] and increased cardiac output [WMD -0.37, 95% CI (0.08, 0.65), p = 0.01]. Subgroup analysis pre and post PADN demonstrated a significant improvement in 6MWD in the WHO group 1 [WMD 99.53, 95% CI (19.60, 179.47), p = 0.01], group 2 [WMD: 69.96, 95% CI (36.40, 103.51), p = <0.0001] and group 4 [WMD: 99.54, 95% CI (21.80, 177.28), p = 0.01]. This meta-analysis supports PADN as a therapeutic option for patients with PH, regardless of group class. Further randomized trials are still needed to evaluate safety and efficacy.

PMID:37121454 | DOI:10.1016/j.cpcardiol.2023.101776

Biol Psychiatry Cogn Neurosci Neuroimaging. 2023 Apr 28:S2451-9022(23)00102-7. doi: 10.1016/j.bpsc.2023.04.007. Online ahead of print.

ABSTRACT

OBJECTIVE: Integrating multiple neuroimaging modalities to identify clusters of individuals, and then associating these clusters with psychopathology, is a promising approach for understanding neurobiological mechanisms that underlie psychopathology and the extent to which these features are associated with clinical symptoms.

METHOD: We leveraged neuroimaging data from T1-weighted, diffusion-weighted, and resting-state functional magnetic resonance images from the Adolescent Brain and Cognitive Development Study (N=8035) and used Similarity Network Fusion and spectral clustering to identify subgroups of participants. We examined neuroimaging measures as a function of clustering profiles using one, two, or three imaging modalities (i.e., data combinations), calculated the stability of the clustering assignment in each respective data combination, and compared the consistency of clusters across different data combinations. We then compared the extent to which clusters were associated with overall psychopathology, at the baseline assessment, and two-yearly follow-up visits.

RESULTS: Each data combination resulted in optimal clusters, ranging from two to four subgroups for each data combination. Clusters were stable across sub-sampling of the ABCD cohort. Widespread structural measures (surface area, fractional anisotropy, and mean diffusivity) were important features contributing to clustering across different data combinations. Five of the seven data combinations were associated with overall psychopathology, at baseline and over time (d=0.08-0.41). Generally, lower global cortical volume and surface area, widespread reduced fractional anisotropy, and increased radial diffusivity were associated with increased overall psychopathology.

CONCLUSION: Profiles constructed from neuroimaging data combinations are associated with concurrent and future psychopathology trajectories.

PMID:37121399 | DOI:10.1016/j.bpsc.2023.04.007

Chest. 2023 Apr 28:S0012-3692(23)00635-9. doi: 10.1016/j.chest.2023.04.034. Online ahead of print.

ABSTRACT

BACKGROUND: The ability of high-definition (HD) videobronchoscopy to detect airway involvement in sarcoidosis was not evaluated previously.

RESEARCH QUESTION: What is the role of HD videobronchoscopy in the identification of sarcoidosis-associated airway abnormalities (AA)? What are the patterns of AA more commonly observed and more frequently associated with the detection of granulomas in endobronchial biopsy (EBB)?

STUDY DESIGN AND METHODS: In this prospective, international, multicenter cohort study, consecutive patients with suspected sarcoidosis underwent airway inspection with a HD videobronchoscope and EBB using a standardized workflow. AA were classified according to six patterns defined “a priori”: nodularity, cobblestoning, thickening, plaque, increased vascularity, and miscellaneous. We assessed diagnostic yield of EBB, prevalence of AA, diagnostic yield of EBB and interobserver agreement for different patterns of AA.

RESULTS: AA were identified in 64/134 (47.8%) sarcoidosis patients, with nodularity (23, 17.2%), plaque (19, 14.2%) and increased vascularity (19, 14.2%) being the most prevalent. The diagnostic yield of EBB was 36.6%. AA were significantly more prevalent in patients with than in those without non-necrotizing granulomas in EBB (67.4% VS 36.5%, P=0.001). Likewise, parenchymal disease on CT was significantly more common in patients with than in those without non-necrotizing granulomas in EBB (79.6% VS 54.1%, P=0.003). On a per-lesion analysis, non-necrotizing granulomas were seen especially in EBB taken from areas of cobblestoning (9/10, 90%) and nodularity (17/29, 58.6%). The overall diagnostic yield of random EBB was low (31/134, 23.1%). The interobserver agreement for the different patterns of AA was fair (Fleiss k=0.34).

INTERPRETATION: In a population with a large prevalence of white Europeans, HD videobronchoscopy detected AA in approximately half of sarcoidosis patients. The diagnostic yield of EBB was higher in patients with parenchymal involvement on CT and in those with airway abnormalities, especially if manifesting as cobblestoning and nodularity.

CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov, identifier NCT4743596.

PMID:37121391 | DOI:10.1016/j.chest.2023.04.034

Cryobiology. 2023 Apr 28:S0011-2240(23)00031-7. doi: 10.1016/j.cryobiol.2023.04.002. Online ahead of print.

ABSTRACT

This study focused on the biomechanical properties and microstructural changes in dentin of teeth in different age groups after cryopreserved for different durations. Ninety third molars from three age groups (youth group, middle-age group, and elderly group), were collected and randomly divided into three groups according to freezing time at -196 °C (7 days, 30 days, and 90 days). Control group was shored at ordinary temperature. After rewarming, the compressive strength and elastic modulus of the dentin were measured with an electronic universal tester. Scanning electron microscopy was used to evaluate the microstructure of dentin after cryopreservation. After cryopreservation, the compressive strength of the teeth in each experimental group was not significantly different from control group. With the increase of freezing time and age, dentin’s elastic modulus showed a decreasing trend. There were statistically significances between the control group and freezing 90d group, freezing 7d and 90d group, youth and middle-aged group, youth and elderly group (P < 0.05). Both freezing time and age factors were significant for the elastic modulus of dentin(P＜0.05). There was no interaction effect for age and freezing time. In transverse sections of scanning electron microscopy, the dentinal tubule became narrower, partially occluded, and more easily adhered to impurities in the long freezing time and elderly group. In longitudinal sections, with freezing time and age, the inner wall of the dentinal tubules became rough especially in the aged group cryopreserved for 90 days. No significant microcracks exited in any of the longitudinal sections of dentin.

PMID:37121387 | DOI:10.1016/j.cryobiol.2023.04.002

Ann Epidemiol. 2023 Apr 28:S1047-2797(23)00082-0. doi: 10.1016/j.annepidem.2023.04.017. Online ahead of print.

ABSTRACT

PURPOSE: A strength of SuperLearner is that it may accommodate key interactions between model variables without a priori specification. In prior research, protective associations between fruit intake and preeclampsia were stronger when estimated using SuperLearner with targeted maximum likelihood estimation (TMLE) compared with multivariable logistic regression without any interaction terms. We explored whether heterogeneity (i.e., differences in the effect estimate due to interactions between fruit intake and covariates) may partly explain differences in estimates from these two models.

METHODS: Using a US prospective pregnancy cohort (2010-2013, n=7781), we estimated preeclampsia risk differences (RDs) for higher versus lower fruit density using multivariable logistic regression and included 2-way statistical interactions between fruit density and each of the 25 model covariates. We compared the RDs with those from SuperLearner with TMLE (gold standard) and logistic regression with no interaction.

RESULTS: From the logistic regression models with 2-way statistical interactions, 48% of the preeclampsia RDs were ≤-0.02 (closer to SuperLearner with TMLE estimate); 40% equaled -0.01 (same as logistic regression with no interaction estimate); the minority were at or crossed the null.

CONCLUSIONS: Our exploratory analysis provided preliminary evidence that heterogeneity may partly explain differences in estimates from logistic regression versus SuperLearner with TMLE.

PMID:37121376 | DOI:10.1016/j.annepidem.2023.04.017

Urology. 2023 Apr 28:S0090-4295(23)00374-6. doi: 10.1016/j.urology.2023.04.017. Online ahead of print.

ABSTRACT

OBJECTIVES: To examine the extent to which the urologist performing biopsy contributes to variation in prostate cancer detection during fusion-guided prostate biopsy.

METHODS: All men in the Michigan Urological Surgery Improvement Collaborative (MUSIC) clinical registry who underwent fusion biopsy at Michigan Medicine from August 2017 to March 2019 were included. The primary outcomes were clinically significant cancer detection rate (defined as Gleason Grade ≥ 2) in targeted cores and clinically significant cancer detection on targeted cores stratified by PI-RADS score. Bivariate and multivariable logistic regression analyses were performed.

RESULTS: A total of 1,133 fusion biopsies performed by five providers were included. When adjusting for patient age, PSA, race, family history, prostate volume, clinical stage, and PI-RADS score, there was no significant difference in targeted clinically significant cancer detection rates across providers (range = 38.5-46.9%, adjusted p-value = 0.575). Clinically significant cancer detection rates ranged from 11.1-16.7% in PI-RADS 3 (unadjusted p = 0.838), from 24.6-43.4% in PI-RADS 4 (adjusted p = 0.003), and from 69.4-78.8% in PI-RADS 5 (adjusted p = 0.766) lesions.

CONCLUSIONS: There was a statistically significant difference in clinically significant prostate cancer detection in PI-RADS 4 lesions across providers. These findings suggest that even among experienced providers, variation at the urologist level may contribute to differences in clinically significant cancer detection rates within PI-RADS 4 lesions. However, the relative impact of biopsy technique, radiologist interpretation, and MR acquisition protocol requires further study.

PMID:37121355 | DOI:10.1016/j.urology.2023.04.017

Environ Res. 2023 Apr 28:116022. doi: 10.1016/j.envres.2023.116022. Online ahead of print.

ABSTRACT

BACKGROUND: Studies which analyse the joint effect of acoustic or chemical air pollution variables and different meteorological variables on neuroendocrine disease are practically nonexistent. This study therefore sought to analyse the impact of air pollutants and environmental meteorological variables on daily unscheduled admissions due to endocrine and metabolic diseases in the Madrid Region from January 01, 2013 to December 31, 2018.

MATERIAL AND METHODS: We conducted a longitudinal, retrospective, ecological study of daily time series analysed by Poisson regression, with emergency neuroendocrine-disease admissions in the Madrid Region as the dependent variable. The independent variables were: mean daily concentrations of PM₁₀, PM_2.5, NO₂ and O₃; acoustic pollution; maximum and minimum daily temperatures; hours of sunlight; relative humidity; wind speed; and air pressure above sea level. Estimators of the statistically significant variables were used to calculate the relative risks (RRs).

RESULTS: A statistically significant association was found between the increase in temperatures in heat waves, RR: 1.123 95% CI (1.001-1.018), and the number of emergency admissions, making it the main risk factor. An association between a decrease in sunlight and an increase in hospital admissions, RR: 1.005 95% CI (1.002 1.008), was likewise observed. Similarly, ozone, in the form of mean daily concentrations in excess of 44 μg/m³, had an impact on admissions due to neuroendocrine disease, RR: 1.010 95% CI (1.007-1.035). The breakdown by sex showed that in the case of women, NO₂ was also a risk factor, RR: 1.021 95% CI (1.007-1.035).

CONCLUSION: The results obtained in this study serve to identify risk factors for this disease, such as extreme temperatures in heat waves, O₃ or NO₂. The robust association found between the decrease in sunlight and increase in hospital admissions due to neuroendocrine disease serves to spotlight an environmental factor which has received scant attention in public health until now.

PMID:37121348 | DOI:10.1016/j.envres.2023.116022

Ann Vasc Surg. 2023 Apr 28:S0890-5096(23)00245-5. doi: 10.1016/j.avsg.2023.04.024. Online ahead of print.

ABSTRACT

BACKGROUND: Failure to rescue (FtR), or inpatient death following complication, is a publicly reported hospital quality measure. Previous work has demonstrated significant variation in the proportion of frail patients across hospitals. However, frailty is not incorporated into risk-adjustment algorithms for hospital quality comparisons and risk adjustment is made by comorbidity scores. Our aim was to assess the impact of frailty on FtR quality measurement and as a means of risk adjustment.

STUDY DESIGN: Patients undergoing open or endovascular aneurysm repair or lower extremity bypass in the Vascular Quality Initiative (VQI) at centers performing > 25 vascular procedures annually (2003-2019) were included. Multivariable logistic regression evaluated in-hospital death using scaled hierarchical modeling clustering at the center-level. Center FtR observed/expected (O/E) ratios were compared with expected values adjusted for either standard comorbidity profiles or frailty as measured by the VQI Risk Analysis Index (RAI). Centers were divided into quartiles using VQI-linked American Hospital Association data to describe the hospital characteristics of centers whose ranks changed.

RESULTS: A total of 63,143 patients (213 centers) were included; 1,630 patients (2.58%) were classified as FtR. After accounting for center-level variability, frailty was associated with FtR [scaled odds ratio 1.9 (1.8-2.0), p<0.001]. The comorbidity-centric and frailty-based models performed similarly in predicting FtR with C-statistics of 0.85 (0.84-0.86) and 0.82 (0.82-0.84), respectively. Overall changes in ranking based on O/E ratios were not statistically significant (p=0.48). High and low performing centers had similar ranking using comorbidity-centric and frailty-based methods; however, centers in the middle of the performance spectrum saw more variability in ranking alterations. Forty-nine (23%) of hospitals improved their ranking by 5 or more positions when using frailty vs comorbidity risk adjustment. The centers in Quartile 4, those who performed the highest number of vascular procedures annually, experience on average a significant improvement in hospital ranking when frailty was used for risk adjustment, whereas centers performing the fewest number of vascular procedures and the lowest proportion of vascular surgery cases annually (Quartile 1) saw a significant worsening of ranking position (all p < 0.05). However, total number of surgical procedures annually, total hospital beds, for-profit status and teaching hospital status were not significantly associated with changes in rank.

CONCLUSION: A simple frailty-adjusted model has similar predictive abilities as a comorbidity-focused model for predicting a common quality metric that influences reimbursement. In addition to distilling the risk-adjustment algorithm to a few variables, frailty can be assessed preoperatively to develop quality improvement efforts for rescuing frail patients. Centers treating a greater proportion of frail patients and those who perform higher volumes of vascular surgery benefit from a risk adjustment strategy based on frailty.

PMID:37121337 | DOI:10.1016/j.avsg.2023.04.024

Eur J Obstet Gynecol Reprod Biol. 2023 Apr 18;285:153-158. doi: 10.1016/j.ejogrb.2023.04.012. Online ahead of print.

ABSTRACT

OBJECTIVE(S): To measure the success rate of primary medical therapy in managing retained products of conception (RPOC) in women with secondary postpartum haemorrhage (PPH) and to identify factors associated with need for surgical management.

STUDY DESIGN: Postpartum patients presenting to a tertiary women’s hospital Emergency Department between July 2020 and December 2022 with secondary PPH and evidence of RPOC on ultrasound were recruited. Clinical information relating to the presentation was collected prospectively. Antenatal and intrapartum data were collected from medical record and Birthing Outcome System database review. The primary outcome was the success of medical management for RPOC, defined by the implementation of medical or expectant management without subsequent need for surgical intervention.

RESULTS: Forty-one patients with RPOC underwent primary medical or expectant management. Twelve patients (29%) were managed successfully with medical management, while twenty-nine (71%) proceeded to surgical management. Medical management involved antibiotics (n = 37, 90%), prostaglandin E1 analogue (n = 14, 34%) and other uterotonics (n = 3, 7%). A greater endometrial thickness on ultrasound was significantly associated with a requirement for secondary surgical intervention (p < 0.05). There was an association approaching statistical significance between a higher sonographic volume of RPOC and the failure of medical management (p = 0.07). There was no statistically significant association between the mode of delivery or the number of days postpartum with the success of medical management.

CONCLUSION(S): For patients presenting with secondary PPH and sonographic RPOC, over two thirds required surgical management. Increased endometrial thickness was associated with an increased requirement for surgical management.

PMID:37120911 | DOI:10.1016/j.ejogrb.2023.04.012