Category: Nevin Manimala

J Intellect Disabil Res. 2023 Mar 7. doi: 10.1111/jir.13023. Online ahead of print.

ABSTRACT

BACKGROUND: There is evidence that psychotropic medications are overprescribed and overused to manage behaviours of concern for people with intellectual disabilities. Disability support workers and support staff lack education and training on the administration and safety of psychotropic medication use. This study aimed to test the applicability and preliminary efficacy of SPECTROM, an education programme developed in the UK, in an Australian context.

METHODS: The training comprises two parts: Module 1 encompasses psychotropic medications, their use and side effects. Module 2 focuses on non-pharmacological interventions for supporting people with behaviours of concern. Thirty-three participants attended the training course and completed pre-training and post-training surveys on the Psychotropic Knowledge Questionnaire and Management of Aggression and Violence Attitude Scale-Revised at four time points: pre-training, 2 weeks, 3 months and 5 months post-training.

RESULTS: Psychotropic Knowledge Questionnaire scores showed statistically significant post-training improvement at all post-training time points (P < 0.05). Management of Aggression and Violence Attitude Scale-Revised scores were high at pre-training and did not change significantly at any of the post-training survey time points. A 2-week post-training feedback questionnaire reported 80% agreement that the training programme was appropriate, useful and valid. Only 36% of participants completed questionnaires at all time points.

CONCLUSIONS: SPECTROM training increased staff knowledge of psychotropic medications, yet loss of participants was high. Further refinement of the applicability of the training for the Australian context and evaluation of the feasibility of implementation, clinical and cost-effectiveness of the programme are required.

PMID:36880447 | DOI:10.1111/jir.13023

Int J Dermatol. 2023 Mar 7. doi: 10.1111/ijd.16619. Online ahead of print.

ABSTRACT

BACKGROUND: Dating back to the mid-1500s, maggot debridement therapy (MDT) has been a viable treatment modality for chronic wounds. In early 2004, the sterile larvae of Lucilia sericata received FDA approval for medical marketing for neuropathic, venous, and pressure ulcers, traumatic or surgical wounds, and nonhealing wounds that have not responded to standard care. However, it currently remains an under-utilized therapy. The proven efficacy of MDT begs the question if this treatment modality should be considered as a first-line option for all or a subset of chronic lower extremity ulcers.

OBJECTIVE: This article aims to address the history, production, and evidence of MDT and discuss future considerations for maggot therapy in the healthcare field.

METHODS: A literature search using the PubMed database was conducted using keywords, such as wound debridement, maggot therapy, diabetic ulcers, venous ulcers, among others.

RESULTS: MDT reduced short-term morbidity in non-ambulatory patients with neuroischemic diabetic ulcers and comorbidity with peripheral vascular disease. Larval therapy was associated with statistically significant bioburden reductions against both Staphylococcus aureus and Pseudomonas aeruginosa. Faster time to debridement was achieved when chronic venous or mixed venous and arterial ulcers were treated with maggot therapy versus hydrogels.

CONCLUSIONS: The literature supports the use of MDT in decreasing the significant costs of treating chronic lower extremity ulcers, with emphasis on those of diabetic origin. Additional studies with global standards for reporting outcomes are necessary to substantiate our results.

PMID:36880424 | DOI:10.1111/ijd.16619

New Phytol. 2023 Mar 7. doi: 10.1111/nph.18859. Online ahead of print.

ABSTRACT

The black nectar produced by Melianthus flowers is thought to serve as a visual attractant to bird pollinators, but the chemical identity and synthesis of the black pigment are unknown. A combination of analytical biochemistry, transcriptomics, proteomics, and enzyme assays was used to identify the pigment that gives Melianthus nectar its black color and how it is synthesized. Visual modeling of pollinators was also used to infer a potential function of the black coloration. High concentrations of ellagic acid and iron give the nectar its dark black color, which can be recapitulated through synthetic solutions containing only ellagic acid and iron(III). The nectar also contains a peroxidase that oxidizes gallic acid to form ellagic acid. In vitro reactions containing the nectar peroxidase, gallic acid, hydrogen peroxide, and iron(III) fully recreate the black color of the nectar. Visual modeling indicates that the black color is highly conspicuous to avian pollinators within the context of the flower. Melianthus nectar contains a natural analog of iron-gall ink, which humans have used since at least medieval times. This pigment is derived from an ellagic acid-Fe complex synthesized in the nectar and is likely involved in the attraction of passerine pollinators endemic to southern Africa.

PMID:36880409 | DOI:10.1111/nph.18859

Asia Pac J Clin Oncol. 2023 Mar 7. doi: 10.1111/ajco.13949. Online ahead of print.

ABSTRACT

AIM: Peritoneal dissemination of infiltrative appendiceal tumors is a rare and poorly understood phenomenon. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a well-recognized treatment option for selected patients. Neoadjuvant systemic chemotherapy (NAC) has been shown to be associated with improved overall survival (OS) in colorectal peritoneal metastases but little is known of the impact of this from an appendiceal adenocarcinoma perspective.

METHOD: A prospective database of 294 patients with advanced appendiceal primary tumors undergoing CRS ± HIPEC between June 2009 and December 2020 was reviewed. Baseline characteristics and long-term outcomes were compared between patients with adenocarcinoma who received neoadjuvant chemotherapy or upfront surgery.

RESULTS: Eighty-six (29%) patients were histologically diagnosed with an appendiceal cancer. These included intestinal-type adenocarcinoma (11.6%), mucinous adenocarcinoma (43%), and goblet cell adenocarcinoma (GCA) or signet ring cell adenocarcinoma (SRCA) (45.4%). Twenty-five (29%) of these underwent NAC, of which eight (32%) exhibited some degree of radiological response. There was no statistical difference in OS at 3 years between the NAC and upfront surgery groups (47.3% vs. 75.8%, p = 0.372). Appendiceal histology subtypes, particularly GCA and SRCA (p = 0.039) and peritoneal carcinomatosis index >10 (p = 0.009), were factors independently associated with worse OS.

CONCLUSION: Administration of NAC did not appear to prolong OS in the operative management of disseminated appendiceal adenocarcinomas. GCA and SRCA subtypes display a more aggressive biological phenotype.

PMID:36880398 | DOI:10.1111/ajco.13949

Clin Pharmacol Drug Dev. 2023 Mar 7. doi: 10.1002/cpdd.1232. Online ahead of print.

ABSTRACT

In the 10-week, phase 2 CLARITY study of patients with major depressive disorder, adjunctive therapy to antidepressants with pimavanserin 34 mg once daily statistically significantly improved the Hamilton Depression Rating Scale (HAMD-17) total score (primary endpoint) and Sheehan Disability Scale (SDS) score (secondary endpoint) versus placebo. This analysis characterized the exposure-response (E-R) relationships of pimavanserin in this CLARITY patient population. Exposure measures were estimated for each patient based on population-pharmacokinetic empirical Bayesian estimates. E-R models were developed to describe exposure-efficacy (HAMD-17, SDS, and Clinical Global Impression-Improvement [CGI-I] scale) and exposure-safety relationships (Karolinska Sleepiness Scale [KSS], Massachusetts General Hospital Sexual Functioning Inventory [MGH-SFI], and adverse events [AEs] of headache, sedation, and somnolence) relationships. For the primary efficacy endpoint (HAMD-17 scores), a sigmoid maximum-effect model described the time course of response, and a linear function of pimavanserin exposure was statistically significant. HAMD-17 scores decreased steadily over time following placebo and pimavanserin treatment; separation from placebo increased as peak pimavanserin plasma concentration (C_max ) increased. At median pimavanserin C_max (34-mg dose), the reduction from baseline in HAMD-17 scores was -11.1 and -13.5 at weeks 5 and 10, respectively. Relative to placebo, the model predicted comparable reductions in HAMD-17 scores at weeks 5 and 10. Similar improvements in favor of pimavanserin were detected with SDS, CGI-I, MGH-SFI, and KSS scores. No E-R relationship was found for AEs. E-R modeling predicted a relationship between higher pimavanserin exposure and improvement in HAMD-17 score and improvement across multiple secondary efficacy endpoints.

PMID:36880278 | DOI:10.1002/cpdd.1232

J Clin Endocrinol Metab. 2023 Mar 6:dgad122. doi: 10.1210/clinem/dgad122. Online ahead of print.

ABSTRACT

BACKGROUND: Stress triggers a cascade of reactions that alter the organism’s dynamic steady state. There is a scarcity of interventional studies that show cortisol variability on stress over time in groups of patients with chronic noncommunicable diseases and comorbidities.

PURPOSE: In this research, we aimed to examine salivary cortisol changes in the cognitive stress response of patients with Hypertension and Diabetes Mellitus (HT & DM) and patients with Hypertension (HT) and to determine the differences between them.

METHODS: The research was conducted by solving an arithmetic task as a stress test in 62 patients with HT&DM and HT that are being treated in the outpatient clinic of Medical Pharmacology and Clinical Pharmacology Department in Istanbul University, Istanbul Medical Faculty Hospital.

RESULTS: There was no statistically significant difference among HT&DM and HT groups on systolic and diastolic blood pressure (BP) values (p = 0.331 and p = 0.058). When measured by repeated ANOVA, salivary cortisol level [F (1.842, 60) = 8.771, p < 0.0001], systolic blood pressure [F (2.185, 60) = 12.080, p < 0.0001], diastolic blood pressure [F (2.793, 60) = 6.043, p = 0.001] and the heart rate [F (2.073, 60) = 13.259, p < 0.0001] were statistically significant for the main effect (time), while the effect of the group*time interaction factor was statistically not significant (p = 0.773; p = 0.751; p = 0.713 and p = 0.506, respectively).

MAIN CONCLUSIONS: In conclusion, the arithmetic problem-solving task used in the HT&DM and HT patients were found to be useful as an acute stress test in the laboratory environment. There was no statistically significant difference was found in terms of group*time interaction factor between the HT&DM and HT groups, however the salivary cortisol and BP values increased significantly after acute stress within each group.

PMID:36880261 | DOI:10.1210/clinem/dgad122

J Fish Biol. 2023 Mar 7. doi: 10.1111/jfb.15369. Online ahead of print.

ABSTRACT

Otolith shape analysis has been one of the most used approaches to study population structure in the last decades. Currently, two sets of shape descriptors are used to perform otolith shape analysis, namely Elliptic Fourier descriptor (EFd), which focuses on the overall otolith shape differences, and Discrete Wavelet descriptor (DWd), which is sensible to local differences along the otolith contour. Here, we conduct a comparative analysis of the performance of both descriptors in reconstructing the population structure and connectivity patterns in a small pelagic fish species with a wide geographical distribution and fast growth rate, the European sardine Sardina pilchardus (Walbaum, 1792), for the first time. A combination of each otolith shape descriptor and shape indices was explored using multivariate statistical methods. The two otolith shape descriptors showed similar, although limited overall classification success associated with the population dynamic characteristics of the species. Both descriptors point to migration among adjacent areas, such as northern Atlantic locations, eastern Mediterranean, and even across well-defined physical obstacles, such as the Strait of Gibraltar, among Atlantic and western Mediterranean locations. Both descriptors supported the division of the populations of Mediterranean waters into three main groups but slightly differed in the Atlantic waters groups limits. A comparison of present results with those from previous otolith shape analysis studies using EFd on a decadal time scale revealed differences in the population structure and connectivity patterns compared to the earlier period. These differences may be attributed to changes in environmental variables leading to changes in population dynamics but can also be the result of the sardine biomass sharp decrease that occurred in the last decade.

PMID:36880257 | DOI:10.1111/jfb.15369

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2023 Jan;35(1):77-81. doi: 10.3760/cma.j.cn121430-20220624-00600.

ABSTRACT

OBJECTIVE: To investigate the prognostic value of the ratio of veno-arterial carbon dioxide partial pressure difference to arterio-venous oxygen content difference (Pv-aCO₂/Ca-vO₂) in children with primary peritonitis-related septic shock.

METHODS: A retrospective study was conducted. Sixty-three children with primary peritonitis-related septic shock admitted to department of intensive care unit of the Children’s Hospital Affiliated to Xi’an Jiaotong University from December 2016 to December 2021 were enrolled. The 28-day all-cause mortality was the primary endpoint event. The children were divided into survival group and death group according to the prognosis. The baseline data, blood gas analysis, blood routine, coagulation, inflammatory status, critical score and other related clinical data of the two groups were statistics. The factors affecting the prognosis were analyzed by binary Logistic regression, and the predictability of risk factors were tested by the receiver operator characteristic curve (ROC curve). The risk factors were stratified according to the cut-off, Kaplan-Meier survival curve analysis compared the prognostic differences between the groups.

RESULTS: A total of 63 children were enrolled, including 30 males and 33 females, the average age (5.6±4.0) years old, 16 cases died in 28 days, with mortality was 25.4%. There were no significant differences in gender, age, body weight and pathogen distribution between the two groups. The proportion of mechanical ventilation, surgical intervention, vasoactive drug application, and procalcitonin, C-reactive protein, activated partial thromboplastin time, serum lactate (Lac), Pv-aCO₂/Ca-vO₂, pediatric sequential organ failure assessment, pediatric risk of mortality III in the death group were higher than those in the survival group. Platelet count, fibrinogen, mean arterial pressure were lower than those in the survival group, and the differences were statistically significant. Binary Logistic regression analysis showed that Lac and Pv-aCO₂/Ca-vO₂ were independent risk factors affecting the prognosis of children [odds ratio (OR) and 95% confidence interval (95%CI) were 2.01 (1.15-3.21), 2.37 (1.41-3.22), respectively, both P < 0.01]. ROC curve analysis showed that the area under curve (AUC) of Lac, Pv-aCO₂/Ca-vO₂ and their combination were 0.745, 0.876 and 0.923, the sensitivity were 75%, 85% and 88%, and the specificity were 71%, 87% and 91%, respectively. Risk factors were stratified according to cut-off, and Kaplan-Meier survival curve analysis showed that the 28-day cumulative probability of survival of Lac ≥ 4 mmol/L group was lower than that in Lac < 4 mmol/L group [64.29% (18/28) vs. 82.86% (29/35), P < 0.05]. Pv-aCO₂/Ca-vO₂ ≥ 1.6 group 28-day cumulative probability of survival was less than Pv-aCO₂/Ca-vO₂ < 1.6 group [62.07% (18/29) vs. 85.29% (29/34), P < 0.01]. After a hierarchical combination of the two sets of indicator variables, the 28-day cumulative probability of survival of Pv-aCO₂/Ca-vO₂ ≥ 1.6 and Lac ≥ 4 mmol/L group significantly lower than that of the other three groups (Log-rank test, χ² = 7.910, P = 0.017).

CONCLUSIONS: Pv-aCO₂/Ca-vO₂ combined with Lac has a good predictive value for the prognosis of children with peritonitis-related septic shock.

PMID:36880243 | DOI:10.3760/cma.j.cn121430-20220624-00600

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2023 Jan;35(1):23-27. doi: 10.3760/cma.j.cn121430-20220114-00063.

ABSTRACT

OBJECTIVE: To systematically evaluate the distribution characteristics of traditional Chinese medicine (TCM) syndromes in adult influenza patients and to provide a basis for the TCM syndrome differentiation of influenza.

METHODS: The CNKI, CBM, Wanfang, VIP, PubMed, Embase, Cochrane Library databases were searched to collect cross-sectional studies on the distribution pattern of TCM syndromes in adult patients with influenza. The risk of bias assessment tool for cross-sectional studies developed by the Joanna Briggs Institute (JBI) evidence-based health care center was used to evaluate the literature quality, and the Stata 15.1 software was used to conduct a Meta-analysis of the pooled effect sizes of the included studies.

RESULTS: A total of 11 studies with 4 367 influenza patients were included. Quality assessment results of JBI showed that the risk bias was higher in the sample size calculation, and the description of sampling modalities and response rate was unclear. There were 17 influenza syndromes after specification, and a single group rate Meta-analysis was performed of the syndromes with ≥ 50 incident cases showed that there were 9 syndromes with an incidence ≥ 10% and statistical significance, the top 5 syndromes were syndrome of wind and heat invading the defense [n = 1 583, RATE = 34.3%, 95% confidence interval (95%CI) was 22.2%-46.3%], syndrome of exterior cold and interior heat (n = 1 122, RATE = 36.1%, 95%CI was 21.2%-51.1%), syndrome of wind-cold fettering the exterior (n = 860, RATE = 19.4%, 95%CI was 10.7%-28.0%), syndrome of heat and toxin in the lung (n = 217, RATE = 17.1%, 95%CI was 9.1%-25.0%), and syndrome of disease involving both defense phase and qi phase (n = 184, RATE = 38.8%, 95%CI was 14.2%-63.5%). The results of the subgroup analysis in different geographical regions showed that the frequency of distribution of syndrome of wind and heat invading the defense and heat and toxin in the lung was higher in the South (RATE: 36.5%, 18.6%) than in the North (RATE: 30.9%, 15.4%), and the frequency of distribution of syndrome of wind-cold fettering the exterior and exterior cold and interior heat in the North (RATE: 23.8%, 40.1%) was higher than that in the South (RATE: 15.7%, 32.3%).

CONCLUSIONS: There are 9 common TCM syndromes of influenza, including wind and heat invading the defense syndrome, exterior cold and interior heat syndrome, wind-cold fettering the exterior syndrome, heat and toxin in the lung syndrome, disease involving both defense phase and qi phase syndrome, wind and heat complicated by dampnessinvading the surface syndrome, wind and cold complicated by dampnessinvading the surface syndrome, defense phase syndrome and dampness and heatinvading the surface syndrome, which can provide a reference for the TCM syndrome differentiation and treatment of influenza.

PMID:36880233 | DOI:10.3760/cma.j.cn121430-20220114-00063

Cancer Med. 2023 Mar 7. doi: 10.1002/cam4.5702. Online ahead of print.

ABSTRACT

BACKGROUND: Hepatocellular carcinoma (HCC) is a common cancer threatening the public health globally. Although HCC has been associated with the telomere length (TL), the causal relationship between them is not well understood. Therefore, we attempted to explore the linear causal relationship between TL and HCC through Mendelian randomization (MR) analysis among Asian and European populations.

METHODS: The summary statistics of TL-associated single nucleotide polymorphisms (SNPs) were obtained from a genome-wide association study (GWAS) in the Asian population (N = 23,096). The data of TL-associated SNPs in the European population (N = 472,174) and the GWAS summary statistics of HCC in the Asian population (1866 cases, 195,745 controls) as well as the European population (168 cases, 372,016 controls) were downloaded from the public GWAS database. Two-sample MR was performed using inverse variance weighting (IVW), weighted median estimate, MR-Egger regression, weighted-mode estimate, and simple-mode estimate methods. Sensitivity analysis was performed to text the primary results’ robustness.

RESULTS: Nine SNPs associated with TL in Asian populations and 98 SNPs in European populations were selected as instrumental variables. No linear causal relationship between heritable TL and the HCC risk was recorded in the Asian (IVW analysis odds ratio [OR] = 1.023, 95% confidence interval [CI] 0.745, 1.405, p = 0.887) and European populations (IVW analysis OR = 0.487, 95% CI 0.180, 1.320, p = 0.157). Other methods also achieved similar outcomes. Sensitivity analysis was performed and revealed no heterogeneity and horizontal pleiotropy.

CONCLUSIONS: No linear causal association was recorded between heritable TL and HCC in Asian and European populations.

PMID:36880214 | DOI:10.1002/cam4.5702