Category: Nevin Manimala

Asian J Psychiatr. 2022 Apr 11;73:103118. doi: 10.1016/j.ajp.2022.103118. Online ahead of print.

ABSTRACT

BACKGROUND: Mood-incongruent psychosis during bipolar disorder has been associated with poor outcomes. However, it remains unknown whether this is secondary to persistent affective or psychotic symptoms or both.

METHOD: Sixty-eight patients with bipolar disorder between the ages of 16 and 45 were recruited during their first psychiatric hospitalization for mania. These patients were evaluated using structured and semi-structured clinical interview then followed longitudinally. Outcomes during the first twenty-four months of follow-up were compared between patients with mood-incongruent psychosis and those without (i.e., patients with mood-congruent psychosis or no psychosis) during the index manic episode. Specifically, ratings of the percent of weeks during follow-up with the duration of mood incongruent psychotic symptom, any psychotic symptom, affective syndromes, and scores of global outcomes were compared.

RESULTS: Comparing the 24-month follow-up results between the two groups, patients with mood incongruent psychotic symptoms had a lower global functional rating scale, efficacy index, while the duration of mood incongruent psychotic symptom, any psychotic symptom, and complete affective symptom showed statistically significant differences between the two groups. There were also statistically significant differences between the two groups in the duration of mood stabilizers, and antidepressants use, typical antipsychotics, and atypical antipsychotics. Partial correlation analysis reveals the scores of the global assessment of functioning scale (GAF) after 24 months showed a significant negative correlation with the length of time of incongruent psychotic symptoms. Still, the correlation was intermediate (correlation coefficients less than 0.5，r² = -0.471, P < 0.001).

CONCLUSION: Mood-incongruent psychosis that occurs during the first manic episode appears to predict an increased likelihood of persistent psychotic symptoms during the subsequent twenty-four months. This persistence of psychosis is associated with a worse overall course of illness than patients without mood-incongruent psychosis.

LIMITATIONS: These results apply to a relatively short outcome period, and the sample size is relatively small.

PMID:35468481 | DOI:10.1016/j.ajp.2022.103118

Breast. 2022 Apr 18;64:29-34. doi: 10.1016/j.breast.2022.04.007. Online ahead of print.

ABSTRACT

BACKGROUND: To date, it remains unclear which patients with breast cancer (BC) benefit from post-mastectomy radiotherapy (PMRT). Cheng et al. developed and validated a scoring system based on 4 prognostic factors for locoregional recurrence (LRR) to identify patients in need for PMRT. These factors include age, estrogen receptor status, lymphovascular status and number of affected axillary lymph nodes.

PURPOSE: To validate the scoring system for LRR in BC developed by Cheng et al. by using an independent BC database.

METHODS AND MATERIALS: We retrospectively identified 1989 BC cases, treated with mastectomy (ME) with or without PMRT at the University Hospitals Leuven between 2000 and 2007. The primary endpoint was 5-year locoregional control rate with and without PMRT, according to the LRR score.

RESULTS: Median follow-up time was 11.4 years. After excluding patients with missing variables 1103 patients were classified using the LRR scoring system: 688 (62.38%) patients were at low risk of recurrence (LRR score 0-1), 335 (30.37%) patients were at intermediate risk of recurrence (LRR score 2-3) and 80 (7.25%) patients were at high risk of recurrence (LRR score ≥4). 5-year locoregional control rates with and without PMRT were 99.20% versus 99.21% (p = 0.43) in the low-risk group; 98.24% versus 85.74% (p < 0.0001) in the intermediate-risk group and 96.87% versus 85.71% (p = 0.10) in the high-risk group respectively.

CONCLUSION: Our validation of the LRR scoring system suggests it can be used to point out patients that would benefit from PMRT. We recommend further validation of this scoring system by other independent institutions before application in clinical practice.

PMID:35468477 | DOI:10.1016/j.breast.2022.04.007

Mar Pollut Bull. 2022 Apr 22;179:113671. doi: 10.1016/j.marpolbul.2022.113671. Online ahead of print.

ABSTRACT

Metal contamination has never been assessed in Ampullae of Lorenzini. This study employed Rhizoprionodon lalandii, as an ecotoxicological model to investigate potential metal accumulation in Ampullae of Lorenzini jelly. No differences between sexes were observed regarding jelly metal concentrations at Rio das Ostras (RJ) or Santos (SP). Statistically significant correlations were noted between total lengths (TL) and condition factors and several metals at both sampling sites, demonstrating the potential for Chondrichthyan sensory capacity disruption and possible effects on foraging success. Maternal metal transfer to Ampullae jelly was confirmed. Rhizoprionodon lalandii is thus, a good model to assess Ampullae of Lorenzini contamination, as this electrosensory organ seems to be highly vulnerable to metal contamination.

PMID:35468471 | DOI:10.1016/j.marpolbul.2022.113671

J Electrocardiol. 2022 Apr 18;72:120-127. doi: 10.1016/j.jelectrocard.2022.04.001. Online ahead of print.

ABSTRACT

PURPOSE: Cardiac resynchronization therapy (CRT) reduces ventricular activation times and electrical dyssynchrony, however the effect on repolarization is unclear. In this study, we sought to investigate the effect of CRT and left ventricular (LV) remodeling on dispersion of repolarization using electrocardiographic imaging (ECGi).

METHODS: 11 patients with heart failure and electrical dyssynchrony underwent ECGi 1-day and 6-months post CRT. Reconstructed epicardial electrograms were used to create maps of activation time, repolarization time (RT) and activation recovery intervals (ARI) and calculate measures of RT, ARI and their dispersion. ARI was corrected for heart rate (cARI).

RESULTS: Compared to baseline rhythm, LV cARI dispersion was significantly higher at 6 months (28.2 ± 7.7 vs 36.4 ± 7.2 ms; P = 0.03) but not after 1 day (28.2 ± 7.7 vs 34.4 ± 6.8 ms; P = 0.12). There were no significant differences from baseline to CRT for mean LV cARI or RT metrics. Significant LV remodeling (>15% reduction in end-systolic volume) was an independent predictor of increase in LV cARI dispersion (P = 0.04) and there was a moderate correlation between the degree of LV remodeling and the relative increase in LV cARI dispersion (R = -0.49) though this was not statistically significant (P = 0.12).

CONCLUSION: CRT increases LV cARI dispersion, but this change was not fully apparent until 6 months post implant. The effects of CRT on LV cARI dispersion appeared to be dependent on LV reverse remodeling, which is in keeping with evidence that the risk of ventricular arrhythmia after CRT is higher in non-responders compared to responders.

PMID:35468456 | DOI:10.1016/j.jelectrocard.2022.04.001

Nurse Educ Today. 2022 Apr 19;113:105373. doi: 10.1016/j.nedt.2022.105373. Online ahead of print.

ABSTRACT

BACKGROUND: In the coronavirus disease-impacted era, many medical institutions have not permitted clinical practice at hospitals or have operated their training on a restricted basis. The effective strategy for improving therapeutic communication and team cooperation as a nursing core competency is required.

OBJECTIVES: The study aimed to verify the effects of simulation problem-based learning on nursing students’ communication skills, communication attitudes, and team efficacy.

DESIGN: Non-equivalent control group pretest-posttest design.

SETTINGS: A university in South Korea.

PARTICIPANTS: Nursing students who were classified as advanced beginners were randomly allocated to the control group (n = 46) or the experimental group (n = 47).

METHODS: The experimental group’s students participated in the simulation problem-based learning for cesarean section maternity nursing. The control group’s students participated in a conventional type of maternity nursing clinical practice. The communication skills, communication attitudes, and team efficacy were measured by using a self-reported questionnaire.

RESULTS: As compared with the pretest, the communication attitudes increased significantly (t = 2.41, p = .020) in the posttest for the experimental group. The communication skills (t = 1.47, p = .150) and team efficacy (F = 3.30, p = .073) were not statistically significant.

CONCLUSIONS: The simulation problem-based learning in clinical practice is recommended to improve communication attitudes for nursing students and to apply the learned knowledge in simulated nursing situations through experiential learning. Future research is particularly needed the standardized educational program to identify the long-term effects in various cases and settings.

PMID:35468458 | DOI:10.1016/j.nedt.2022.105373

Ecotoxicol Environ Saf. 2022 Apr 22;237:113542. doi: 10.1016/j.ecoenv.2022.113542. Online ahead of print.

ABSTRACT

Existing evidence has showed that exposure to polycyclic aromatic hydrocarbons (PAHs) increases the risk of many chronic diseases. Given the close connection between aging (a major risk factor) and chronic diseases, however, very few studies have evaluated the association between PAHs and aging. Furthermore, whether modifiable healthy lifestyle could attenuate the detrimental effect of PAHs on aging remains unknown. Therefore, we conducted this study, aiming to: (1) examine the associations of urinary monohydroxy polycyclic aromatic hydrocarbons (OH-PAHs) and lifestyle with Phenotypic Age Acceleration (PhenoAge.Accel), a novel aging measure that captures morbidity and mortality risk; and (2) evaluate the potential interaction effects of OH-PAHs and lifestyle on PhenoAge.Accel. Cross-sectional data of 2,579 participants (aged 20-84 years, n = 1,292 females) from the National Health and Nutrition Examination Survey for years 2001-2010 were analyzed. A lifestyle index was constructed based on five components (drinking, smoking, body mass index, physical activity, and diet), ranging from 0 to 5. We calculated PhenoAge.Accel using algorithms developed previously. General linear regression models were used to examine the associations. We observed strong associations of OH-PAHs and lifestyle with PhenoAge.Accel. For instance, one unit increase in ∑NAP (sum of 1- and 2-hydroxynaphthalene) was associated with 0.37 year (95% confidence interval [CI]: 0.26, 0.48) increase in PhenoAge.Accel. We did not observe statistically significant interaction effects between OH-PAHs and lifestyle on PhenoAge.Accel. After stratified by sex, we observed strong associations as well as statistically significant interactions of OH-PAHs and lifestyle with PhenoAge.Accel among females. In conclusion, both OH-PAHs and lifestyle were independently associated with phenotypic aging and there were statistically significant interactions between OH-PAHs and lifestyle on phenotypic aging among females. The findings highlight the importance of adherence to a healthy lifestyle to attenuate the detrimental effects of exposures to PAHs on phenotypic aging among females.

PMID:35468442 | DOI:10.1016/j.ecoenv.2022.113542

Ecotoxicol Environ Saf. 2022 Apr 22;237:113537. doi: 10.1016/j.ecoenv.2022.113537. Online ahead of print.

ABSTRACT

Both long-term exposure to air pollution and abnormal fasting blood glucose (FBG) are linked to dyslipidemia prevalence. However, the joint role of air pollution and FBG on dyslipidemia remains unknown clearly. In this study, we aimed to test whether abnormal FBG could enhance the risks of long-term exposure to air pollutants on dyslipidemia in general Chinese adult population. The present study recruited 8917 participants from 4 cities in Hebei province, China. Participants’ individual exposure to air pollutants was evaluated by the Empirical Bayesian Kriging statistical model in ArcGIS10.2 geographic information system. Dyslipidemia was defined according to Guidelines for the Prevention and Treatment of Dyslipidemia in Chinese Adults. Subjects were grouped into normal, prediabetes, diabetes according to FBG level. Generalized linear models were applied to analyze the interaction of air pollutants and FBG on dyslipidemia prevalence. The prevalence of dyslipidemia was 43.83% in our investigation. After adjusting all covariates, we found the risk of four air pollutants (PM_2.5, PM₁₀, NO₂, SO₂) on dyslipidemia prevalence was stronger as higher FBG level, and the adjusted odd ratio of interaction (OR_inter (95% CI)) between PM_2.5, PM₁₀, NO₂, SO₂ and FBG levels on dyslipidemia was 1.171 (1.162, 1.189), 1.119 (1.111, 1.127), 1.124 (1.115, 1.130), 1.107 (1.098, 1.115), respectively. Stratified analyses indicated the modifying effects of FBG on the association of air pollution with dyslipidemia were stronger among male, less than 65 years old, overweight/obesity (all P_inter<0.1). Our study concluded that high FBG levels strengthened the risk of long-term exposure to air pollution on dyslipidemia, especially more noticeable in male, less than 65 years old, overweight.

PMID:35468441 | DOI:10.1016/j.ecoenv.2022.113537

J Psychiatr Res. 2022 Apr 18;151:78-85. doi: 10.1016/j.jpsychires.2022.03.066. Online ahead of print.

ABSTRACT

Despite the established effectiveness of evidence-based PTSD treatments, not everyone responds the same. Specifically, some individuals respond early while others respond minimally throughout treatment. Our ability to predict these trajectories at baseline has been limited. Predicting which individuals will respond to a certain type of treatment can significantly reduce short- and long-term costs and increase the ability to preemptively match individuals with treatments to which they are most likely to respond. In the present study, we examined whether veterans’ responses to a 3-week Cognitive Processing Therapy-based intensive PTSD treatment program could be accurately predicted prior to the first session. Using a sample of 432 veterans, and a wide range of demographic and clinical data collected during intake, we assessed six machine learning and statistical methods and their ability to predict fast and minimal responders prior to treatment initiation. For fast response classification, gradient boosted models (GBM) had the highest AUC-PR (0.466). For minimal response classification, elastic net (EN) had the highest mean CV AUC-PR (0.628). Using the best performing classifiers, we were able to predict both fast and minimal responders prior to starting treatment with relatively high AUC-ROC of 0.765 (GBM) and 0.826 (EN), respectively. These results may inform treatment modifications, although the accuracy may not be sufficient for clinicians to base inclusion/exclusion decisions entirely on the classifiers. Future research should evaluate whether these classifiers can be expanded to predict to which treatment type(s) an individual is most likely to respond based on various clinical, circumstantial, and biological features.

PMID:35468429 | DOI:10.1016/j.jpsychires.2022.03.066

Arthritis Care Res (Hoboken). 2022 Apr 25. doi: 10.1002/acr.24903. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the cost-utility and cost-effectiveness of a group-based outpatient physical therapy intervention delivered six-weeks after primary total knee replacement (TKR) compared with usual care, alongside the Activity-orientated REhabilitation following kNee Arthroplasty (ARENA) multi-centre randomised controlled trial.

METHODS: The economic analyses were performed from the perspective of the health and social care payer. We collected resource use for health and social care and productivity losses, and patient outcomes for 12 months after surgery to derive costs and quality-adjusted life-years (QALYs). Results were expressed in incremental cost-effectiveness ratios (ICERs), and incremental net monetary benefit statistics (INMBs) for a society willing-to-pay £20,000 per QALY gained, with sensitivity analyses to model specification and perspective.

RESULTS: ARENA physical therapy classes cost, on average, £179 (SD=£39) per patient. Treatment in the year following surgery cost, on average, £1,739 (95%CI -£742, £4,221) per patient in the intervention group (n=89), an additional £346 (95%CI £38, £653) compared with usual care (n=91, £1,393;95%CI -£780, £3568). QALY benefits were 0.0506 higher (95%CI 0.009, 0.09) in the intervention group, corresponding to an additional 19 days in perfect health. The ICER for the intervention was £6,842 per QALY gained and the INMB was £665 (, 95%CI £139, £1,191) with a 92% probability of being cost-effective, and no less than 73% in all sensitivity analysis scenarios.

CONCLUSION: The addition of group-based outpatient physical therapy classes to usual care improves quality-of-life and is a cost-effective treatment option following TKR for a society willing-to-pay £20,000 per QALY gained.

PMID:35468266 | DOI:10.1002/acr.24903

Ultrasound Obstet Gynecol. 2022 Apr 25. doi: 10.1002/uog.24918. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess whether pregnancy associated plasma protein-A (PAPP-A) improves or provides equivalent screening performance as placental growth factor (PlGF) when screening for preterm preeclampsia (PE) at 11-13 weeks METHODS: This is a secondary analysis of a non-intervention screening study of 6546 singleton pregnancies prospectively screened for preterm PE in the first trimester between December 2016 and June 2018. Patient-specific risks for preterm PE were estimated by maternal history, mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), PlGF and PAPP-A. A competing risks model with biomarker expressed in multiple of expected median (MoM) was used. All women and clinicians were unaware of the risk for preterm PE. Effectiveness when screening for preterm PE with and without PAPP-A and PlGF was assessed using the difference in the area under receiver operational curves (AUC). McNemar test was used to compare detection rate at a fixed false positive rate (FPR) of 10%.

RESULTS: 37 women developed preterm PE. The AUC and detection rate at 10% FPR using PlGF in conjunction with history, MAP and UtA-PI were 0.854 and 59.46%, respectively. Corresponding figures when replacing PlGF by PAPP-A or adding PAPP-A to PlGF were 0.813 and 54.05%, and 0.855 and 59.46%. Statistically, non-significant differences were noted in AUC when replacing PlGF with PAPP-A (ΔAUC=0.04; p=0.095) or adding PAPP-A (ΔAUC=0.002; p=0.423). However, on an individual case basis, screening using PlGF in conjunction with MAP and UtA-PI identified three (8.1%) additional pregnancies which developed preterm PE not identified by replacing PlGF with PAPP-A. Adding PAPP-A to history and other biomarkers did not identify any additional pregnancies.

CONCLUSION: On an individual case basis, adopting a screening strategy of using PAPP-A instead of PlGF results in an observed loss of detection consistent with the literature. This article is protected by copyright. All rights reserved.

PMID:35468236 | DOI:10.1002/uog.24918