Category: Nevin Manimala

Int Urol Nephrol. 2023 Jan 20. doi: 10.1007/s11255-023-03468-6. Online ahead of print.

ABSTRACT

BACKGROUND: In Fabry Disease (FD), although the primary factor initiating kidney damage is glycosphingolipid accumulation, secondary conditions such as increased inflammation and fibrosis may cause this damage to progress. These processes may be induced by immune cells. Therefore, we aimed to investigate the peripheral lymphocyte subgroup analysis of the patients with FD and compare these results with healthy individuals. In addition, we performed T, B, NK, and plasma cell analyses in kidney biopsy materials and compared these kidney biopsy results with the biopsy results of patients whose kidney functions were impaired after 4 years of regular ERT.

MATERIALS AND METHODS: 18 FD and 16 healthy individuals were included in the study. T-B lymphocyte and NK-cell populations were determined. We performed kidney biopsies (KBx) on 13 patients with FD prior to ERT. Of these, 4 patients had rebiopsy after 4 years of regular ERT. Immunohistochemical staining was performed to define immune cell infiltration.

RESULTS: There was no statistically significant difference in terms of total, helper and cytotoxic T-lymphocyte and CD3^–CD16⁺CD56⁺ natural killer (NK)-cell count (p = 0.20; p = 0.12; p = 0.76; p = 0.75, respectively).According to KBx findings prior to ERT, all patients had interstitial fibrosis (IF), podocyte vacuoles (PV), and podocyte inclusion (PI), CD3, CD4, CD8, CD16, and CD56 positivity at different levels. None of the patients had CD19, CD20, and CD138 positivity at the first biopsies. When we compared the first and the second KBx results of the two progressors, we also demonstrated that CD3⁺4⁺T-cells infiltration remained the same, whereas CD8⁺T cells, CD16⁺ and 56⁺NK-cells infiltration were significantly decreased. In contrast, CD20⁺B cells and CD138⁺plasma cell infiltration were significantly increased despite 4 years of ERT (15 fold and sixfold, respectively). The CD20⁺B and CD138⁺ plasma cells and IF were positively correlated with proteinuria.

CONCLUSIONS: The progression of FD nephropathy and proteinuria is increased despite a long-term ERT. Immune cells, primarily B and plasma cells, might cause these unwanted consequences.

PMID:36662386 | DOI:10.1007/s11255-023-03468-6

J Interv Card Electrophysiol. 2023 Jan 20. doi: 10.1007/s10840-023-01478-z. Online ahead of print.

ABSTRACT

PURPOSE: The aim of the present study was to evaluate the outcome of patients underwent subcutaneous implantable cardioverter defibrillator (S-ICD) implantation with the intermuscular (IM) two-incision technique during 3-year follow-up.

METHODS: the study population consisted of 105 consecutive patients (79 male; median 50 [13-77] years) underwent S-ICD implantation with the IM two-incision technique. The composite primary end point of the study consisted of device-related complications and inappropriate shocks (IAS). Secondary end points included the individual components of the primary end point, death from any cause, appropriate therapy, major adverse cardiac events, hospitalization for heart failure, and heart transplantation.

RESULTS: According to the PRAETORIAN score, the risk of conversion failure was classified as low in 99 patients (94.3%), intermediate in 6 (5.7%).Ventricular fibrillation was successfully converted at ≤65 J in 97.4% of patients. During a median follow-up of 39 (16-53) months, 10 patients (9.5%) experienced device-related complications, and 9 (8.5%) patients reported IAS. Lead-associated complications were the most common (5 patients, 4.7%), including 2 cases of lead failure (1.9%). Pocket complications were reported in 2 patients (1.9%). Extra-cardiac oversensing (3.8%) represented the leading cause of IAS. No T-wave oversensing episodes were recorded. Twelve patients (11.4%) experienced appropriate shocks. Eight patients (7.6%) died during follow-up. IAS or device-related complications did not impact on mortality.

CONCLUSIONS: The overall device-related complications and IAS rates over 3 years of follow-up were 9.5% and 8.5%, respectively. According to our findings, the IM two-incision technique allows for optimal positioning of the device achieving a low PRAETORIAN score with a high conversion rate. IM two-incision technique allows low incidence of pocket complications, shifting the type of complications towards lead-related complications, which represent the most common complications. The IM two-incision technique would not seem to impact the occurrence of IAS. Management of complications are safe without impact on the outcome.

PMID:36662384 | DOI:10.1007/s10840-023-01478-z

Am J Clin Dermatol. 2023 Jan 20. doi: 10.1007/s40257-022-00750-8. Online ahead of print.

ABSTRACT

BACKGROUND: The association of alcohol with psoriasis has been inconsistent among studies.

OBJECTIVES: We aimed (1) to determine whether alcohol consumption (by status, frequency, and subtype of alcohol) modulates smoking-related psoriasis risk in postmenopausal women while stratifying for smoking status and pack-years and (2) to evaluate the effect of smoking cessation on psoriasis risk in postmenopausal women.

METHODS: This prospective cohort study included 106,844 postmenopausal women enrolled in the Women’s Health Initiative between 1993 and 1998. Patients diagnosed with psoriasis were identified using fee-for-service Medicare International Classification of Diseases, Ninth Revision, Clinical Modification codes assigned by dermatologists or rheumatologists. Self-administered questionnaires were used to obtain information on demographics, medical history, and smoking and alcohol habits. Hazard ratios from Cox regression models were adjusted for ethnicity, income, body mass index, and history of non-melanoma skin cancer and were stratified on age and on randomization status in the Women’s Health Initiative study components.

RESULTS: In the initial statistical model, past and current alcohol drinkers had higher risks of psoriasis compared with never-drinkers (P-trend < 0.001). This association was not observed after adjusting for cigarette smoking (P-trend: 0.478). The effect of alcohol (by status, frequency, and alcohol subtype) isolated by stratifying the analysis by smoking status (i.e., among never smokers) showed no association with psoriasis. Smoking showed an increasing risk for psoriasis with greater pack-years compared with those who have never smoked (P-trend: < 0.001). Compared to smokers at baseline, past smokers had a lower risk of psoriasis across women who smoked 5-14 cigarettes per day (hazard ratio 0.67, 95% confidence interval 0.51-0.88) and across women who smoked for 5-24 years (hazard ratio 0.65, 95% confidence interval 0.46-0.90).

CONCLUSIONS: These findings indicate that alcohol consumption does not modulate smoking-related psoriasis risk. Cigarette smoking, but not alcohol consumption, is an independent risk factor for psoriasis in postmenopausal women. As greater pack-years was associated with a higher risk of psoriasis and smoking cessation was conversely associated with a lower risk of psoriasis for moderate smokers, a greater emphasis on smoking abstinence and cessation counseling may benefit patients who already have other risk factors for psoriasis.

PMID:36662365 | DOI:10.1007/s40257-022-00750-8

Environ Geochem Health. 2023 Jan 20. doi: 10.1007/s10653-023-01477-z. Online ahead of print.

ABSTRACT

Rapid industrial and agricultural development as well as urbanization affect the water environment significantly, especially in sub-watersheds where the contaminants/constituents present in the pollution sources are complex, and the flow is unstable. Water quality assessment and quantitative identification of pollution sources are the primary prerequisites for improving water management and quality. In this work, 168 water samples were collected from seven stations throughout 2018-2019 along the Laixi River, a vital pollution control unit in the upper reaches of the Yangtze River. Multivariate statistics and positive matrix factorization (PMF) receptor modeling techniques were used to evaluate the characteristics of the river-water quality and reveal the pollution sources. Principal component analysis was employed to screen the crucial parameters and establish an optimized water quality assessment procedure to reduce the analysis cost and improve the assessment efficiency. Cluster analysis further illustrates the spatiotemporal distribution characteristics of river-water quality. Results indicated that high-pollution areas are concentrated in the tributaries, and the high-pollution periods are the spring and winter, which verifies the reliability of the evaluation system. The PMF model identified five and six potential pollution sources in the cold and warm seasons, respectively. Among them, pollution from agricultural activities and domestic wastewater shows the highest contributions (33.2% and 30.3%, respectively) during the cold and warm seasons, respectively. The study can provide theoretical support for pollutant control and water quality improvement in the sub-watershed, avoiding the ecological and health risks caused by the deterioration of water quality.

PMID:36662352 | DOI:10.1007/s10653-023-01477-z

Biol Trace Elem Res. 2023 Jan 20. doi: 10.1007/s12011-023-03559-6. Online ahead of print.

ABSTRACT

The high incidence of demineralization around orthodontic brackets has led to the development of preventive measures. Incorporation of antibacterial or remineralizing agents into orthodontic adhesives is an attractive method. This single-center, split-mouth, randomized controlled clinical trial was conducted to assess the effect of a modified composite containing TiO₂ nanoparticles on the Streptococcus mutans population and to prevent demineralization around orthodontic brackets. Each participant was assigned a random sequence (AB or BA). During the bonding session, the control lateral incisor was bonded with a conventional composite and the contralateral incisor was bonded with a composite containing nano TiO₂ particles (1%weight). The eligibility criteria included the presence of S. mutans in the dental plaque and absence of active caries, fractures or cracks. The S. mutans count in the dental plaque immediately around the brackets was evaluated at baseline and 1, 3, and 6 months after bonding. The specificity of the colonies was determined by PCR. The DIAGNOdent score was assessed at baseline and re-assessed every month up to the sixth month. Salivary samples were collected at T0, T1, and T3 to assess the amount of Ti released from the composite. The cytotoxicity of the modified composites was evaluated using an MTT assay. Participants, examiners, and data analyzers were blinded to the test and intervention groups. Forty-two patients ranging from 12 to 25 years were enrolled in this study. The amount of Ti released into saliva was insignificant and far below the toxic level. There was no significant difference between the S. mutans counts of the studied tooth S. mutans counts at any time point evaluated. DIAGNOdent scores on both sides increased significantly after the first month. However, this increase was higher on the test side (p < 0.001), and a significant difference of 2.6 scores remained throughout the study period. No severe adverse events were observed. Orthodontic composites containing TiO₂ nanoparticles may prevent demineralization induced around brackets during orthodontic treatment. However, the antibacterial effects were not statistically significant.Registration: The protocol was registered with the IRCT.ir (IRCT20140215016582N6).

PMID:36662350 | DOI:10.1007/s12011-023-03559-6

Med Pr. 2023 Jan 20:157603. doi: 10.13075/mp.5893.01303. Online ahead of print.

ABSTRACT

BACKGROUND: Lean Healthcare Management is an innovative approach to process management in healthcare organizations. Despite that the Lean principles have been increasingly recognized worldwide as a tool to boost organizational performance, improve the quality of care and curb waste, the Lean methodology can be difficult to implement in some countries. This study seeks to identify the facilitators of and barriers to the implementation of Lean in the healthcare system in Poland.

MATERIAL AND METHODS: A public consultation was held among 318 representatives of stakeholder groups in the healthcare system in Poland. Data was collected using validated self-administered questionnaires. Statistical analysis was performed using the IBM SPSS Statistics 25 software.

RESULTS: The study revealed that a large share of respondents believed that the awareness of the existing organizational deficiencies in work practices among stakeholders can greatly facilitate the implementation of Lean in the healthcare system in Poland (50.9%, p < 0.05). The main barriers to the deployment of Lean include lack of awareness of the Lean methodology and its benefits (76.1%, p < 0.001); insufficient institutional support (43.7%), and lack of funding for Lean solutions (32.4%).

CONCLUSIONS: Gaps in the medical curricula and education programs for healthcare professionals concerning the latest process management solutions in healthcare should be addressed in order to raise awareness of the benefits of cooperation with and the active involvement of Lean experts in applying “lean” ideas to improve the organizational performance in healthcare. It is also necessary for policy makers to be aware of the benefits of contemporary process management in healthcare and to support its implementation. Med Pr. 2023;74(1).

PMID:36661115 | DOI:10.13075/mp.5893.01303

J Clin Sleep Med. 2023 Jan 20. doi: 10.5664/jcsm.10402. Online ahead of print.

ABSTRACT

STUDY OBJECTIVES: Changes in nasal resistance (NR) during postural changes are influenced by venous filling pressure and autonomic nervous system (ANS) mediation, and heart rate variability (HRV) can reflect changes in the ANS. This study aimed to explore the regulatory mechanisms of NR in patients with obstructive sleep apnea (OSA) during postural changes.

METHODS: Healthy controls (apnea-hypopnea index (AHI) <5 events/h) and patients with OSA were recruited. NR and electrocardiogram (ECG) data were collected in sitting, supine, left-lateral, and right-lateral postures. HRV parameters were obtained by analyzing the ECG data from each posture. Subgroups were divided according to sitting-supine NR changes, and HRV parameters were compared between different postures and groups/subgroups.

RESULTS: In total, thirty-four healthy controls and thirty-nine patients with OSA (mean AHI 34.34±22.44 events/hour) were recruited. During to sitting-supine postural changes, the NR increased in the control group but did not change significantly in the OSA group. None of the ANS-related HRV parameters changed significantly. After the groups were divided into NR-elevated and NR-unchanged subgroups, sympathetic activity-related HRV parameters were higher in the NR-unchanged subgroup but only statistically significant in the OSA group. When comparing the left and right postures, there was no significant change in NR; however, the OSA group had lower parasympathetic activity-related HRV parameters when in the right posture.

CONCLUSIONS: During postural changes from the sitting to supine positions, the total NR increases, and this increment is smaller in patients with OSA. This is likely due to overregulation of sympathetic activity, which may occur in patients with OSA.

PMID:36661101 | DOI:10.5664/jcsm.10402

J Clin Sleep Med. 2023 Jan 20. doi: 10.5664/jcsm.10406. Online ahead of print.

ABSTRACT

STUDY OBJECTIVES: Sleep deficiency can adversely affect the performance of resident physicians resulting in greater medical errors. However, the impact of sleep deficiency on surgical outcomes, particularly among attending surgeons is less clear.

METHODS: Sixty attending surgeons from academic and community departments of surgery or obstetrics and gynecology were studied prospectively using direct observation and self-report to explore the effect of sleep deprivation on patient safety, operating room communication, medical errors, and adverse events while operating under two conditions, Post-Call (defined as >2 hours of nighttime clinical duties) and Non-Post-Call.

RESULTS: Each surgeon contributed up to five surgical procedures post-call and non-post-call yielding 362 cases total (150 Post-Call and 210 Non-Post-Call). Most common were caesarian section and herniorrhaphy. Hours of sleep on the night before the operative procedure were significantly less Post-Call (4.98 ± 1.41) vs. Non-Post-Call (6.68 ± 0.88, p<0.01). Errors were infrequent and not related to hours of sleep or post-call status. However, Non-Technical Skills for Surgeons (NOTSS) ratings demonstrated poorer performance while Post-Call for Situational Awareness, Decision Making and Communication/Teamwork. Fewer hours of sleep also was related to lower ratings for Situational Awareness and Decision Making. Decreased self-reported alertness was observed to be associated with increased procedure time.

CONCLUSIONS: Sleep deficiency in attending surgeons was not associated with greater errors during procedures performed during the next day. However, procedure time was increased suggesting that surgeons were able to compensate for sleep loss by working more slowly. Ratings on non-technical surgical skills were adversely affected by sleep deficiency.

PMID:36661100 | DOI:10.5664/jcsm.10406

Clin Pediatr (Phila). 2023 Jan 20:99228221149551. doi: 10.1177/00099228221149551. Online ahead of print.

ABSTRACT

To understand the psychological effects on behavior of girls with idiopathic central precocious puberty (ICPP) and to explore the role of gonadotropin-releasing hormone analog (GnRHa) in the reversal or blocking of the negative psychological effects on behaviors of girls with ICPP. A total of 100 girls with ICPP diagnosed at the Department of Endocrinology of Jiangxi Children’s Hospital were divided into the treatment group and observation group with 50 cases in each group. The control group consisted of 50 healthy girls examined at our hospital during the same period. The Achenbach Child Behavior Check List ([CBCL] for parents) was used to evaluate the psychological effects on behavior of the girls diagnosed with ICPP and the girls in the control group, and the scores of related behavioral factors were calculated. At the same time, the psychological effects on behaviors of the girls with ICPP treated with GnRHa were followed up. (1) There were 100 girls with ICPP and 30 with behavioral problems. There were 50 normal healthy girls (control group) with 3 cases of behavior problems. Of the 50 girls with ICPP, after treatment, 8 had behavioral issues. The rate of abnormal psychological effects on behavior in the group of girls with ICPP before treatment was significantly higher than in the control group (P < .01), and after treatment, the rate was lower than before treatment (P < .05). (2) The scores of depression, social withdrawal, poor communication, and school discipline violation in the ICPP group were higher than those in the control group, with a statistical significance (P < .01). (3) After 24 months of GnRHa treatment for girls in the ICPP group, the scores of 4 factors, including depression, social withdrawal, poor communication, and violation of discipline in the Achenbach CBCL, were significantly different before and after treatment (P < .05). (1) Girls with ICPP have low self-esteem, low self-confidence, high incidences of psychological effects on behavior problems, manifested in depression, withdrawal, poor communication, discipline violations, and other aspects; (2) GnRHa treatment can reverse the low self-esteem and low self-confidence of girls with ICPP to varying degrees.

PMID:36661073 | DOI:10.1177/00099228221149551

Eur J Public Health. 2023 Jan 20:ckad002. doi: 10.1093/eurpub/ckad002. Online ahead of print.

ABSTRACT

BACKGROUND: Interpretive front-of-pack labels (FoPLs) are supported by World Health Organization as an important policy tool to promote healthy diets. At present, various FoPLs formats co-exist in the European Union (EU). However, as part of the Farm to Fork strategy published in 2020, the European Commission stated that it would propose a single mandatory FoPL. The aim of this study was to analyze Spanish consumers’ preference and objective understanding of Nutri-Score and NutrInform, two FoPLs that are currently the subject of debate in the EU.

METHODS: In a representative sample of 1026 Spanish adults (50% women, mean age ± SD = 46 ± 14 years), objective understanding was assessed by asking participants to identify the healthiest food products in three food categories (breakfast products, breakfast cereals and added fats). The preference dimensions were tested by asking participants about the perceived helpfulness of the FoPL in discriminating the nutritional quality of food products (subjective understanding) and their overall assessment of the FoPL’s ease of use, informativeness, trust and liking (perception).

RESULTS: In terms of objective understanding, Nutri-Score was significantly associated with an increase in consumers’ ability to identify healthier food products across all food categories compared with NutrInform [OR (odds ratio) = 19.1 [14.2-25.7], P < 0.0001]. On the preference dimension, Nutri-Score was perceived as significantly easier to use and was more liked than NutrInform (standardized principal component analysis dimension, respectively, 0.32 ± 1.58 vs. -0.29 ± 1.66, P < 0.0001 and 0.080 ± 1.18 vs. -0.072 ± 1.17, P = 0.039).

CONCLUSIONS: This study provides new evidence to support Nutri-Score in comparison with NutrInform in Spanish consumers, on both objective understanding and preference aspects.

PMID:36661062 | DOI:10.1093/eurpub/ckad002