Category: Nevin Manimala

Adv Med Educ Pract. 2022 Feb 28;13:189-197. doi: 10.2147/AMEP.S350562. eCollection 2022.

ABSTRACT

BACKGROUND: Academic stress is a common problem among medical students, and the COVID-19 health crisis lockdown further worsened it. High academic stress has a negative impact on students learning and overall performance.

OBJECTIVE: To assess perceived academic stress, causes, and coping strategies among undergraduate pharmacy students during the COVID-19 pandemic.

METHODS: A descriptive cross-sectional study was conducted among undergraduate pharmacy students at the University of Khartoum. Data were collected from randomly selected participants using three validated self-administered questionnaires; perceived stress scale, study habits inventory, and mental health inventory. Data were analyzed using SPSS software, and descriptive statistics and chi-square were employed.

RESULTS: The response rate in our study was 99.6% (251/252). About 87% of the participants were females. The majority of participants (92%) experience academic stress, with a mean score (24.99 ± 5.159), the level of academic stress ranging from low (4.3%), moderate (73.2%), to high (22.5%). Approximately 80% of the percipients reported academic stress during all exam times with a mean score (25.33 ± 4.976). The level of academic stress was significantly associated with participants’ gender (P-value: 0.042), and living conditions (P-value: 0.001). The most common factors that were significantly associated with academic stress were difficulty in remembering all that is studied (66.7%, P=0.006) and worrying about the exams (54.1%, P=0.011). Moreover, the most frequent strategies used to cope with academic stress were praying (84.4%) and maintaining some control over the situation (61.9%).

CONCLUSION: The study revealed a high prevalence of academic stress among percipients. Academic counseling, monitoring of mental status, and implementation of stress reduction programs are highly recommended.

PMID:35250327 | PMC:PMC8896373 | DOI:10.2147/AMEP.S350562

J Pain Res. 2022 Feb 28;15:633-641. doi: 10.2147/JPR.S355227. eCollection 2022.

ABSTRACT

PURPOSE: Ultrasound-guided thoracic paravertebral block (TPVB) has become increasingly popular for postoperative analgesia after thoracic surgery. We designed this prospective, randomized, double-blind, placebo-controlled trial to investigate the effect of TPVB on blood coagulation in patients after thoracoscopic lobectomy.

PATIENTS AND METHODS: Sixty patients scheduled for thoracoscopic lobectomy were randomly allocated to two groups. Patients underwent ultrasound-guided TPVB with 0.33% ropivacaine (T group) or 0.9% saline (C group) at the end of the surgery under general anesthesia. Patient-controlled intravenous analgesia (PCIA) was administered for both group after the surgery. The primary outcome was the thromboelastogram (TEG) parameters before anesthesia (T0), at the end of operation (T1) and in 1 day (T2) and 2 days (T3) after the operation, the second outcomes were the analgesic effect and the amount of intraoperative opioid consumption, operation time, infusion volume, blood loss and urine volume.

RESULTS: The visual analog scale (VAS) scores in group T were lower than group C (P < 0.05). In group T, compared with T0, the R value at T1 and T2 is significantly reduced, and the K value at T1 were significantly shortened, the α-angle and MA value at T1 were significantly increased (P < 0.05). In group C, compared with T0, the R value and K value were significantly shortened, the α-angle and MA value were significantly increased at all postoperative time points (P < 0.05). Compared with group C at the same time point, the R and K values of group T were significantly longer, and the α-angle and MA values were significantly reduced at T2 and T3 points, with statistically significant differences (P<0.05).

CONCLUSION: TPVB is beneficial to improve postoperative hypercoagulability and promote postoperative rehabilitation of patients after thoracoscopic lobectomy.

PMID:35250307 | PMC:PMC8896523 | DOI:10.2147/JPR.S355227

HIV AIDS (Auckl). 2022 Feb 26;14:73-85. doi: 10.2147/HIV.S354716. eCollection 2022.

ABSTRACT

BACKGROUND: Antiretroviral therapy (ART) regimen failure is linked to an increased risk of disease progression and death, while early detection of ART failure can help to prevent the development of resistance. This study aimed to evaluate virological and immunological ART failure and predictors among HIV-positive adult and adolescent clients in southeast Ethiopia.

METHODS: A retrospective cohort study was implemented from January 2016 to November 30, 2020; all HIV-positive nave patients on follow-up during the study period from four hospitals were included. Virological and immunological treatment failure was the primary outcome of the study. Cox proportional hazards regression models were employed for analysis. Hazard ratios with 95% confidence intervals were reported and variables with p-values <0.05 were considered statistically significant predictors of treatment failure.

RESULTS: A total of 641 HIV patients’ charts were reviewed, 62.6% of the study participants were females. Of the total study participants, 18.4% and 15% developed virological and immunological ART regimen treatment failure respectively. The median time to virological failure was 40 months. WHO stage IV [AHR = 4.616; 95% CI: (2.136-9.974)], WHO stage III [AHR = 2.323; 95% CI: (1.317-4.098)], poor adherence to HAART regimen [AHR = 3.097; 95% CI: (1.349-7.108)], and fair adherence [AHR = 2.058; 95% CI: (1.234-3.432)] were significantly associated with virological treatment failure among adolescent and adult study participants in southeast Ethiopia.

CONCLUSION: The prevalence of virological treatment failure was 18.4% (95% CI: 15.4 -21.4) and the prevalence of immunological treatment failure was 15% (95% CI: 11.8-18.4). WHO clinical stage III/IV and non-adherence were independent predictors of virological ART treatment failure. Early management of clinical WHO stages and improving patients’ ART regimen adherence are important to decrease the prevalence of ART regimen treatment failure.

PMID:35250314 | PMC:PMC8892571 | DOI:10.2147/HIV.S354716

Clin Cosmet Investig Dermatol. 2022 Feb 27;15:331-337. doi: 10.2147/CCID.S355329. eCollection 2022.

ABSTRACT

BACKGROUND: Post inflammatory hyperpigmentation (PIH) is a sequela of laser procedures observed commonly in darker-skin individuals. In general, regular UV filters are beneficial in preventing PIH, but the comparison with sunscreen containing anti-inflammatory ingredients remains unexplored.

OBJECTIVE: To compare the efficacy of a sunscreen with anti-inflammatory agent (sunscreen A) in the reduction of PIH after a picosecond laser with that of regular sunscreen (sunscreen B).

METHODS: Fifty-nine acne vulgaris and acne scar patients with skin phototypes III and IV were treated with 1 session of picosecond laser with the microlens array to the whole face. Sunscreens A and B were randomized to be applied on either side of the face. Hyperpigmentation assessed by brown score mode on Visia^®, acne quantity, porphyrins and patient satisfaction were evaluated at baseline, weeks 1, 2, 4 and 6.

RESULTS: Sunscreen A caused a higher reduction of the brown score compared to the other side but there was no statistically significant difference. Interestingly, a significant decrease of inflammatory acne lesions compared with baseline was observed as early as week 2 on the sunscreen A side (weeks 2, 4 and 6; P = 0.017, P = <0.001, and P = <0.001, respectively). Compared with sunscreen B, levels of porphyrins on sunscreen A side were significantly less at weeks 1 and 6 (weeks 1 and 6; P = 0.022 and P = 0.029, respectively).

CONCLUSION: This study demonstrated a tendency towards lower post-laser pigmentation when the sunscreen with anti-inflammatory agents was applied. This product also had an effective outcome as an adjunctive treatment option of acne vulgaris.

THAI CLINICAL TRIALS REGISTRY ID: TCTR20210305004 (URL: http://www.thaiclinicaltrials.org/show/TCTR20210305004).

PMID:35250287 | PMC:PMC8894080 | DOI:10.2147/CCID.S355329

Diabetes Metab Syndr Obes. 2022 Feb 27;15:633-646. doi: 10.2147/DMSO.S347765. eCollection 2022.

ABSTRACT

PURPOSE: To determine statin prescription patterns and associated factors among type 2 diabetes patients attending the diabetic clinic at Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania.

PATIENTS AND METHODS: A hospital-based cross-sectional study involving outpatients was conducted from September 2020 to November 2020. Statin prescription history (both type and dosage) was obtained from patients as well as from the electronic medical records for determination of patterns. Participants were categorized as moderate or high risk for cardiovascular disease whereas prescription patterns were categorized as moderate and high intensity statins. Logistic regression was used to examine association, control confounders and effect modifier whereby p <0.05 was considered statistically significant.

RESULTS: Of 400 patients who were approached for the study, 395 (98.8%) were eligible for statin prescriptions. The mean (±SD) age of the study participants was 58.1±10.3 years, out of which 371 (93.9%) belonged to the age group ≥40 years. Two-thirds(241 61.0%) of the patients were female. About two-thirds(257; 69.4%) of patients had health insurance coverage. Statins were prescribed in 47.3% of the participants. Moderate intensity statin was the only pattern prescribed. In the adjusted model, insurance coverage (OR: 0.056; 95% CI: 0.03-0.12), and hypertension (OR: 0.259; 95% CI: 0.12-0.54) were associated with an increased likelihood of being prescribed a moderate intensity statin.

CONCLUSION: A significant number of patients at MNH diabetic clinic were not on statins despite qualifying for the prescription. The findings call for further studies on reasons for low statin prescription practices in this tertiary facility.

PMID:35250285 | PMC:PMC8894101 | DOI:10.2147/DMSO.S347765

Diabetes Metab Syndr Obes. 2022 Feb 28;15:647-657. doi: 10.2147/DMSO.S350626. eCollection 2022.

ABSTRACT

BACKGROUND: The link between the risk of type 2 diabetes mellitus (T2DM) and vitamin D deficiency has perplexed the medical society due to the controversy in the data available. Saudi Arabia (SA) is a sunny region; however, ample amount of data reported the increased prevalence of vitamin D deficiency along with T2DM. Thus, this study aimed to compare vitamin D deficiency between healthy and T2DM patients in SA, alongside with the risk factors associated with that.

METHODS: A cross-sectional study was conducted in the Medical Unit, Taibah University in Al-Madinah Al-Munawarah, SA, from November 2017 to May 2018. The involved participants were non-diabetics and T2DM men. Measuring vitamin D for T2DM and non-diabetics group was done by trained technicians. Data analysis was done via SPSS.

RESULTS: Sixty-four participants (T2DM group = 32; non-diabetics group = 32) were recruited, and the mean age of T2DM patients was 48.6 ± 10.4, while that of the non-diabetics was 42.4 ± 6.5. The mean of vitamin D level was found higher in the non-diabetic participants than in diabetic patients. There was statistically significant association between vitamin D deficiency and T2DM (P = 0.001). Besides, duration of diabetes was the only factor, found to be positively correlated with vitamin D deficiency in T2DM patients.

CONCLUSION: Early screening for vitamin D serum-level is recommended for T2DM patients in Saudi Arabia. Therefore, early correction of vitamin D levels should be considered, and medical and scientific societies, along with other sectors such as the media, should highlight and increase the awareness of the importance of vitamin D and the seriousness of its deficiency.

PMID:35250286 | PMC:PMC8896538 | DOI:10.2147/DMSO.S350626

J Orthop Res. 2022 Mar 6. doi: 10.1002/jor.25318. Online ahead of print.

ABSTRACT

Forced external rotation is hypothesized as the key mechanism of syndesmotic ankle injuries, inducing a three-dimensional deviation from the normal distal tibiofibular joint alignment. However, current diagnostic imaging modalities are impeded by a two-dimensional assessment, without considering ligamentous stabilizers. Therefore, our aim is three-fold: (1) to construct an articulated statistical shape model of the normal distal tibiofibular joint with inclusion of ligamentous morphometry, (2) to investigate the effect of weightbearing on the distal tibiofibular joint alignment and (3) to detect differences in predicted syndesmotic ligament length of patients with syndesmotic lesions with respect to normative data. Training data comprised non-weightbearing CT scans from asymptomatic controls (N= 76), weightbearing CT scans from patients with syndesmotic ankle injury (N = 13) and their weightbearing healthy contralateral side (N = 13). Path and length of the syndesmotic ligaments were predicted using a discrete element model, wrapped around bony contours. Statistical shape model evaluation was based on accuracy, generalization and compactness. The predicted ligament length in patients with syndesmotic lesions was compared to healthy controls. With respect to the first aim, our presented skeletal shape model described the training data with an accuracy of 0.23 +/- 0.028 mm. Mean prediction accuracy of ligament insertions was 0.53 +/- 0.12 mm. In accordance to the second aim, our results showed an increased tibiofibular diastasis in healthy ankles after weight-bearing. Corcerning our third aim, a statistically significant difference in anterior syndesmotic ligament length was found between ankles with syndesmotic lesions and healthy controls (p = 0.017). There was a significant correlation between presence of syndesmotic injury and the positional alignment beween the distal tibia and fibula (r = 0.873, p < 0,001). Clinical Significance: Statistical shape modelling combined with patient-specific ligament wrapping techniques can facilitate the diagnostic workup of syndesmosic ankle lesions under weightbearing conditions. In doing so, an increased anterior tibiofibular distance was detected, corresponding to an ‘anterior open-book injury’ of the ankle syndesmosis as a result of anterior inferior tibiofibular ligament elongation/rupture. This article is protected by copyright. All rights reserved.

PMID:35249244 | DOI:10.1002/jor.25318

J Clin Pharm Ther. 2022 Mar 6. doi: 10.1111/jcpt.13629. Online ahead of print.

ABSTRACT

WHAT IS KNOWN AND OBJECTIVE: Reports said immunotherapy is effective for the treatment of idiopathic recurrent miscarriage (RM). Immunotherapy is invasive, and lymphocyte therapy carries some risk of infection. Oral immunosuppressants have the advantages of simple administration and convenience; however, there is no statistical analysis of whether they can improve pregnancy outcomes in patients with idiopathic RM.

METHODS: Six databases were searched for studies on oral immunosuppressants and RM; 374 articles were identified. There were two oral immunosuppressants, cyclosporine A and prednisone; two studies were on cyclosporine A and three studies were on prednisone for RM.

RESULTS AND DISCUSSION: In total, 554 RM patients were included in this analysis, including 357 patients who received oral immunosuppressive agents and 197 patients who received basic treatment, placebo, or no treatment. Oral administration of cyclosporine A or prednisolone increases live birth rate (OR = 3.6, 95% CI: 2.1-6.15, p < 0.00001) and ongoing pregnancy rate (OR = 8.82, 95% CI: 2.91-26.75, p = 0.0001) in patients with idiopathic RM. Drug use reduced miscarriage rate (OR = 0.21, 95% CI: 0.08-0.52, p = 0.0007); however, there was significant heterogeneity (I² = 73%) and a moderate-to-severe risk of bias. There was no effect on premature birth rate (OR = 2.26, 95% CI: 0.96-5.31, p = 0.06). This meta-analysis cannot provide a reference for the duration of medication treatment because the selected studies had inconsistent durations.

WHAT IS NEW AND CONCLUSION: We did a statistical analysis and found that oral immunosuppressants (including cyclosporine A or prednisolone) can improve pregnancy outcomes in patients with idiopathic RM, increase live birth rate and ongoing pregnancy rate, and reduce miscarriage rate.

PMID:35249235 | DOI:10.1111/jcpt.13629

J Sleep Res. 2022 Mar 6:e13571. doi: 10.1111/jsr.13571. Online ahead of print.

ABSTRACT

Questionnaires for restless legs syndrome have rarely been validated against face-to-face interviews in the general population. We aimed to validate the modified Norwegian, seven-item Cambridge-Hopkins restless legs syndrome questionnaire and a single diagnostic question for restless legs syndrome. We also aimed to stratify validity at 65 years of age. Among a random sample of 1,201 participants from the fourth wave of the Trøndelag Health Study, 232 (19%) agreed to participate, out of whom 221 had complete data for analyses. Participants completed the questionnaires for restless legs syndrome immediately before attending a face-to-face interview using the latest diagnostic criteria. We calculated sensitivity, specificity, and Cohen’s kappa statistic (κ) of questionnaire- versus interview-based diagnoses. We found acceptable validity of the seven-item modified Cambridge-Hopkins diagnostic questionnaire for restless legs syndrome (κ = 0.37, 95% confidence interval [CI] 0.23-0.51) and good validity of the single diagnostic question (κ = 0.47, 95% CI 0.35-0.58). We also found good validity through the combination of modified Cambridge-Hopkins diagnostic questionnaire for restless legs syndrome items 2 and 5, while item 1 or 2 alone showed only acceptable validity. The single diagnostic question was significantly more valid among those aged <65 years (κ = 0.60 versus κ = 0.26). Both single- and two-item questionnaire-based diagnoses overestimated interview-based restless legs syndrome prevalence. The seven-item modified Cambridge-Hopkins diagnostic questionnaire for restless legs syndrome will be useful for epidemiological studies although low sensitivity may cause underestimation of true restless legs syndrome prevalence in the general population, especially among elderly. Brief questionnaire-based diagnoses of up to three items seem best utilised as an initial screen. Future studies should identify brief and even more valid questionnaire-based diagnoses for restless legs syndrome in order to estimate prevalence accurately in large epidemiological studies.

PMID:35249243 | DOI:10.1111/jsr.13571

CNS Drugs. 2022 Mar 6. doi: 10.1007/s40263-022-00909-1. Online ahead of print.

ABSTRACT

BACKGROUND: Use of muscle relaxants is rapidly increasing in the USA. Little is understood about the role of drug interactions in the known association between muscle relaxants and unintentional traumatic injury, a clinically important endpoint causing substantial morbidity, disability, and death.

OBJECTIVE: We examined potential associations between concomitant drugs (i.e., precipitants) taken with muscle relaxants (affected drugs, i.e., objects) and hospital presentation for unintentional traumatic injury.

METHODS: In a series of self-controlled case series studies, we screened to identify drug interaction signals for muscle relaxant + precipitant pairs and unintentional traumatic injury. We used Optum’s de-identified Clinformatics^® Data Mart Database, 2000-2019. We included new users of a muscle relaxant, aged 16-90 years, who were dispensed at least one precipitant drug and experienced an unintentional traumatic injury during the observation period. We classified each observation day as precipitant exposed or precipitant unexposed. The outcome was an emergency department or inpatient discharge diagnosis for unintentional traumatic injury. We used conditional Poisson regression to estimate rate ratios adjusting for time-varying confounders and then accounted for multiple estimation via semi-Bayes shrinkage.

RESULTS: We identified 74,657 people who initiated muscle relaxants and experienced an unintentional traumatic injury, in whom we studied concomitant use of 2543 muscle relaxant + precipitant pairs. After adjusting for time-varying confounders, 16 (0.6%) pairs were statistically significantly and positively associated with injury, and therefore deemed signals of a potential drug interaction. Among signals, semi-Bayes shrunk, confounder-adjusted rate ratios ranged from 1.29 (95% confidence interval 1.04-1.62) for baclofen + sertraline to 2.28 (95% confidence interval 1.14-4.55) for methocarbamol + lamotrigine.

CONCLUSIONS: Using real-world data, we identified several new signals of potential muscle relaxant drug interactions associated with unintentional traumatic injury. Only one among 16 signals is currently reported in a major drug interaction knowledge base. Future studies should seek to confirm or refute these signals.

PMID:35249204 | DOI:10.1007/s40263-022-00909-1