Category: Nevin Manimala

Epilepsy Behav. 2021 Feb 24;117:107809. doi: 10.1016/j.yebeh.2021.107809. Online ahead of print.

ABSTRACT

INTRODUCTION: The aim of the study was to determine the impact of a comprehensive inpatient treatment program for persons with epilepsy and intellectual disability (ID) on the concerns of relatives and caregivers, quality of life (QoL), and global health and clinical aspects, assessed by a questionnaire for relatives and caregivers.

METHODS: We performed an open, controlled pre/post study in inpatients with epilepsy and ID or acquired brain damage treated for at least 14 days in a tertiary referral center for epilepsy. Questionnaires were administered to relatives/professional caregivers shortly before admission and 6 months after discharge for the treatment group (TG). The control group (CG) was recruited from the waiting list; questionnaires were answered at the time of application for treatment and 3-6 months later. The questionnaire was the GEOS-43G, the German version of the Glasgow Epilepsy Outcome Scale (GEOS-35), which was extended by eight additional questions from the GEOS-90. Furthermore, QoL, global health, and clinical aspects were assessed using a short questionnaire. Generalized estimation equations (GEEs) were used for statistical analyses.

RESULTS: One-hundred and eight subjects were evaluable in the TG, and 90 in the CG. Concerns about seizures, injuries/risks, medical treatment, diagnostic issues, and the GEOS-43G total score decreased significantly in the TG in contrast to the CG. For the TG, improvements were also significant for global QoL, global health, efficacy, tolerability of AEDs, and for seizure frequency. Caregivers reported larger improvements compared to relatives.

CONCLUSION: The evaluation of the relatives and caregivers in our study indicates that inpatient treatment in a specialized center with a dedicated multi-professional program led to significant improvements regarding the concerns of relatives or caregivers, and in the QoL and related aspects in persons with epilepsy and ID. This shows that specialized inpatient treatment may be helpful for persons with epilepsy and ID.

PMID:33639437 | DOI:10.1016/j.yebeh.2021.107809

Am J Otolaryngol. 2021 Feb 20;42(4):102994. doi: 10.1016/j.amjoto.2021.102994. Online ahead of print.

ABSTRACT

PURPOSE: Analyze Extrusion&Exposion (E&E), its implications in the functional, anatomical results and subjective discomfort in OSA patients treated with Barbed Reposition Pharyngoplasty (BRP).

MATERIALS AND METHODS: 488 patients treated with BRP or multilevel TORS. Stratafix wire was used in 230 patients, V-Loc in 258. E&E, timing and localization evaluated at follow-up. Polygraphy used to assess the impact of E&E on functional results, PPOPS questionnaire used for subjective discomfort.

RESULTS: E&E in the entire group was 18,4%, with significant difference between Stratafix and V-Loc wire (p = 0,002), but not between BRP alone and multilevel surgery (p = 0,68). 28,9% of extrusion happened within the first seven days, 76,7% between seven days and two months, 5,5% after two months. Symptomatic clinical profile has been seen in 62,2%, asymptomatic one in 37,8% of patients. 35,5% of E&E were localized in tonsillar bed, 46,7% in soft palate and 20% in other sites. Mean delta-AHI of E&E patients was -15,87 ± 16.82 compared with one of those who did not have E&E was -16.34 ± 22,77 (p = 0,38). Mean PPOPS of 183 patients analyzed was 12,32 ± 4,96. Mean PPOPS of extruded group was 12,94 ± 4,68 and 11,92 ± 5,11 in not extruded one (p = 0,166).

CONCLUSIONS: E&E are suture-type sensitive (V-Loc > Stratafix), reported more frequent when BRP is performed alone than BRP-TORS with no statistical significance. 76,7% of the E&E occur after patient discharge and within 2 months. About half of the E&E were localized in soft palate. There is no need to fear Extrusion&Exposition because it does not affect in a negative way subjective and PSG outcome.

PMID:33639448 | DOI:10.1016/j.amjoto.2021.102994

J Surg Res. 2021 Feb 24;263:53-56. doi: 10.1016/j.jss.2021.01.029. Online ahead of print.

ABSTRACT

BACKGROUND: Fatigue is a common presenting symptom in primary hyperparathyroidism (PHPT). Although fatigue alone is not currently an indication for parathyroidectomy, it can have a significant detrimental effect on quality of life. The purpose of this study was to determine if there are underlying differences in demographic or disease characteristics in patients with PHPT who present with fatigue compared with those who do not.

METHODS: We reviewed a prospective database of 2197 patients undergoing parathyroidectomy for PHPT by three endocrine surgeons from 2001 to 2019. Patients were divided into two groups based on the presence or absence of fatigue as a presenting symptom. Objective measures of disease severity were then compared between groups.

RESULTS: A total of 1379 (63%) patients presented with fatigue. Patients presenting with fatigue were more likely to be female and to have a prior fracture, lower preoperative serum calcium (Ca), and normocalcemic PHPT. There were no statistically significant differences between groups in age, body mass index, history of nephrolithiasis, or preoperative serum parathyroid hormone levels. Patients presenting with fatigue were also more likely to have smaller parathyroid glands and multiglandular disease. No statistically significant differences were detected in postoperative serum Ca and parathyroid hormone levels, or cure or recurrence rates.

CONCLUSIONS: Patients with PHPT who report fatigue as a presenting symptom present with more complex disease as manifested by a higher incidence of multiglandular disease and normocalcemic PHPT. Despite this, surgical cure is equivalent to other patients. Therefore, fatigue should be a discrete indication for parathyroidectomy in PHPT.

PMID:33639369 | DOI:10.1016/j.jss.2021.01.029

J Surg Res. 2021 Feb 24;263:89-101. doi: 10.1016/j.jss.2021.01.027. Online ahead of print.

ABSTRACT

BACKGROUND: Delirium is a common complication in intensive care unit (ICU) patients, and it can significantly increase the length of hospital stay and cost. Dexamethasone is widely used in various inflammatory diseases and must be used with caution in critically ill patients. Previous studies have shown that the effect of corticosteroid use on the development of delirium in critically ill patients is still controversial, and there is inconclusive conclusion about the effect of dexamethasone on delirium in such patients. Therefore, this study aimed to confirm the effect of dexamethasone use and the dose on the incidence of delirium and patient prognosis in critically ill patients through a large cohort study.

METHODS: A retrospective cohort study was conducted using data extracted from the Medical Information Mart for Intensive Care III database, which is a large and freely available database of all 46,476 patients who visited Beth Israel Deaconess Medical Center in Boston, Massachusetts, USA and were admitted to the ICU between 2001 and 2012. The primary outcome was the development of delirium, using multivariate logistic regression analysis to reveal the relationship between dexamethasone and delirium. Secondary endpoints were in-hospital mortality, ICU mortality, total length of stay, and length of ICU stay, and the relationship between dexamethasone and prognosis was assessed with Cox proportional hazards models. Propensity score matching with 1:1 grouping was used to eliminate the effect of confounders on both cohorts. The locally weighted scatter plot smoothing technique was used to investigate the dose correlation between dexamethasone and outcomes, subgroup analysis was used to account for heterogeneity, and different correction models and propensity matching analysis were used to eliminate potential confounders.

RESULTS: Finally, 38,509 patients were included, and 2204 (5.7%) used dexamethasone. No significant statistical difference was observed in basic demographic information after propensity score matching between the two study groups. A significantly higher incidence of delirium (5.0% versus 3.4%, P < 0.001), increased in-hospital mortality (14.9% versus 10.3%, P < 0.001), ICU mortality (9.0% versus 7.5%, P = 0.008), and longer length of stay and ICU stay were observed in patients taking dexamethasone compared with those not taking dexamethasone. Multivariate logistic and Cox regression analyses confirmed that dexamethasone was significantly associated with delirium (adjusted odds ratio = 1.48, 95% confidence interval [CI] = 1.09-2.00, P = 0.012), in-hospital mortality (adjusted hazard ratio = 1.19, 95% CI = 1.02-1.40, P = 0.032), and ICU mortality (adjusted hazard ratio = 1.62, 95% CI = 1.22-2.15, P = 0.001). Compared with critically ill patients using high-dose dexamethasone, the risk of delirium was lower in the dose less than the 10 mg group, and patients using 10-14 mg may be associated with a lower risk of in-hospital death and the least ICU mortality, length of hospital stay, and ICU stay.

CONCLUSIONS: This study demonstrated that the use of dexamethasone in critically ill patients exacerbated the occurrence of delirium while increasing the risk of in-hospital death, ICU death, and length of hospital stay, with a lower risk of delirium and a shorter total length of hospital stay with low-dose dexamethasone than with larger doses.

PMID:33639374 | DOI:10.1016/j.jss.2021.01.027

Soc Sci Med. 2021 Feb 16;274:113765. doi: 10.1016/j.socscimed.2021.113765. Online ahead of print.

ABSTRACT

RATIONALE AND OBJECTIVE: Research has documented a robust mental health advantage among Asian and Latino immigrants to the United States relative to the native-born. The current investigation extended this line of research, asking whether Middle Eastern immigrants to the United States enjoy a similar mental health advantage.

METHODS: Drawing on pooled cross-sections from the 2007-2018 National Health Interview Surveys, we used OLS regression to examine psychological distress in Middle Eastern immigrants relative to both native-born Whites and immigrants from other global regions. We used statistical interactions to assess whether gender and period differences are contingent on region of birth.

RESULTS: Findings reveal that the average level of psychological distress is higher among Middle Eastern immigrants than among both U.S.-born Whites and immigrants from other regions. Despite changing circumstances of migration for Middle Easterners and implementation in the United States of anti-immigrant policies, we see no evidence that distress increased more among immigrants compared to native-born Whites. Results point to greater psychological distress among Middle Eastern women than their native-born White counterparts and women from other immigrant groups, as well as Middle Eastern men. In contrast, psychological distress levels for Middle Eastern and native-born White men were indistinguishable, suggesting that the Middle Eastern mental health disadvantage in the United States is borne solely by women.

CONCLUSIONS: Results show that the mental health advantage enjoyed by some immigrant groups does not extend to Middle Eastern women, contradicting the healthy migrant model and challenging the assumption of a uniform mental health advantage across immigrant groups.

PMID:33639394 | DOI:10.1016/j.socscimed.2021.113765

Soc Sci Med. 2021 Feb 20;274:113779. doi: 10.1016/j.socscimed.2021.113779. Online ahead of print.

ABSTRACT

RATIONALE: Severe acute respiratory syndrome Coronavirus 2 (SARS CoV-2), the virus that causes COVID-19, and consequent social distancing directives have been observed to negatively impact social relationships but the impact of these changes on the quality of social relationships at a population level has not been explored.

OBJECTIVE: To evaluate changes in social relationships in a U.S. population sample during a time of social distancing.

METHODS: We deployed a matched, longitudinal survey design of the National Institutes of Health Adult Social Relationship Scales to assess the social aspects of emotional support, instrumental support, friendship, loneliness, perceived hostility, and perceived rejection from a time without social distancing (February 2018) to a time where social distancing directives were active (May 2020). Changes in social relationships were compared using paired t-tests, and generalized linear regression models were constructed to identify subpopulations experiencing differential changes in each subdomain of social relationships during social distancing.

RESULTS: Within our sample population, individuals experienced an increased sense of emotional support, instrumental support, and loneliness, and decreased feelings of friendship and perceived hostility during a period of social distancing. Individuals with low self-rated health experienced a decreased sense of emotional support, and females experienced increased feelings of loneliness compared with males.

CONCLUSIONS: Social distancing measurably impacts social relationships and may have a disproportionate impact on females and individuals with lower self-rated health. If novel emergent infectious diseases become more commonplace, social interventions may be needed to mitigate the potential adverse impact of social distancing on social relationships.

PMID:33639395 | DOI:10.1016/j.socscimed.2021.113779

J Thromb Haemost. 2021 Feb 27. doi: 10.1111/jth.15283. Online ahead of print.

ABSTRACT

BACKGROUND: Thrombocytopenia and thrombosis are prominent in coronavirus disease 2019 (COVID-19), particularly amongst critically ill patients; however, the mechanism is unclear. Such critically ill COVID-19 patients may be suspected of heparin-induced thrombocytopenia (HIT), given similar clinical features.

OBJECTIVES: Investigate the presence of platelet-activating anti-PF4/heparin antibodies in critically ill COVID-19 patients suspected of HIT.

PATIENTS/METHODS: We tested 10 critically ill COVID-19 patients suspected of HIT for anti-PF4/heparin antibodies and functional platelet activation in the serotonin release assay (SRA). Anti-human CD32 antibody (IV.3) was added to the SRA to confirm FcγRIIA involvement. Additionally, SARS-CoV-2 antibodies were measured using an in-house ELISA. Finally, von Willebrand factor (VWF) antigen and activity were measured along with ADAMTS13 activity and the presence of anti-ADAMTS13 antibodies.

RESULTS: HIT was excluded in all samples based on anti-PF4/heparin antibody and SRA results. Notably, 6 COVID-19 patients demonstrated platelet activation by the SRA that was inhibited by FcγRIIA receptor blockade, confirming an immune complex (IC)-mediated reaction. Platelet activation was independent of heparin but inhibited by both therapeutic and high dose heparin. All 6 samples were positive for antibodies targeting the receptor binding domain (RBD) or the spike protein of the SARS-CoV-2 virus. These samples also featured significantly increased VWF antigen and activity, which was not statistically different from the 4 COVID-19 samples without platelet activation. ADAMTS13 activity was not severely reduced, and ADAMTS13 inhibitors were not present, thus ruling out a primary thrombotic microangiopathy.

CONCLUSIONS: Our study identifies platelet-activating ICs as a novel mechanism that contributes to critically ill COVID-19.

PMID:33639037 | DOI:10.1111/jth.15283

Crit Rev Eukaryot Gene Expr. 2021;31(1):71-78. doi: 10.1615/CritRevEukaryotGeneExpr.2021037483.

ABSTRACT

The present study was conducted to investigate the molecular mechanism of propofol in inhibiting the proliferation of mouse cardiac fibroblasts (CFs) induced by angiotensin II (Ag II). The ventricles of SPF mice from Kunming were cultured for the second to third generation of CFs under aseptic condition. On the basis of the different adding conditions, the mice were divided into five groups: (1) control group: no drug were added; (2) Ag II group: 100 nmol/L Ag II were added; (3) 10 μmol/L propofol + 100 nmol/L Ag II group; (4) 30 μmol/L propofol + 100 nmol/L Ag II group; (5) 50 μmol/L propofol + 100 nmol/L Ag II group. The effects of propofol on the proliferation of CFs induced by Ag II, the expression of CFs ET-1, the activity of NADPH oxidase and the formation of ROS were analyzed. In addition, our study also explored the potential role of Akt-eNOS-nitric oxide pathway regarding the inhibition of proliferation of Ag II induced CFs by propofol. We found that the proliferation of CFs, the secretion of ET-1, the activity of NADPH oxidase and the level of intracellular ROS and fibronectin expression were significantly increased after CFs exposure to Ag II for 24 h. The abovementioned indexes decreased significantly in CFs after treated with propofol for 24 h (10, 30, or 50 μmol/L) with significant statistical difference (P < 0.05). Akt and eNOS siRNA transfection significantly decreased the levels of Akt and eNOS protein, respectively. Blocking pathway of Akt-eNOS-nitric oxide decreased the inhibitory effect of propofol on Ag II-induced cell proliferation of CFs. Propofol exerts effect in inhibiting ET-1 and fibronectin expression and the formation of ROS induced by Ag II. Moreover, Akt-eNOS-nitric oxide signaling pathway may be involved in the effect of propofol on the proliferation of CFs induced by Ag II.

PMID:33639057 | DOI:10.1615/CritRevEukaryotGeneExpr.2021037483

Int J Med Mushrooms. 2021;23(2):29-41. doi: 10.1615/IntJMedMushrooms.2021037630.

ABSTRACT

Recent research focuses on exploring natural resources to improve the management of type 2 diabetes and to reduce the precarious health effects of synthetic drugs. This investigation aimed to appraise the antihyperglycemic potential of hydroalcoholic (70% ethanol) extracts of Inonotus pachyphloeus, Phellinus allardii, Ph. fastuosus, Ph. gilvus, Ph. sanfordii, and Ph. torulosus. Antihyperglycemic potential was screened using an in vitro inhibition of enzymatic starch digestion assay model. The amount of glucose liberation was determined using the 3,5-dinitrosalicylic acid method. Mushroom extracts showed a concentration-dependent inhibition of α-amyalse and α-glucosidase and a consequent decrease in glucose liberation. Extracts of Ph. fastuosus (half-maximal inhibitory concentration [IC50] = 27.33 ± 1.45 mg/mL) and Ph. sanfordii (IC50 = 30.33 ± 0.88 mg/mL) causing comparable inhibition of α-amyalse and α-glucosidase and decreased glucose liberation were evaluated in vivo through oral starch tolerance and oral glucose tolerance tests using Wistar albino rats. Acarbose (10 mg/kg body weight) was used as a positive control. The extracts of Ph. fastuosus and Ph. sanfordii (100, 200, and 400 mg/kg body weight) showed a dose-dependent decrease in blood glucose concentration, and this decrease was greater in starch-fed rats than in glucose-loaded rats. Ph. fastuosus and Ph. sanfordii extracts (200 and 400 mg/kg body weight) significantly reduced postprandial hyperglycemic peaks in rats challenged with excess starch and glucose. This decrease was statistically comparable to acarbose with Ph. fastuosus extract (400 mg/kg body weight). Thus, it may be concluded that the antihyperglycemic effect of Ph. fastuosus and Ph. sanfordii is mediated by inhibition of starch digestion (inhibition of α-amylase and α-glucosidase). Hence, Ph. fastuosus and Ph. sanfordii can be developed as natural antidiabetic drugs after detailed pharmacological studies.

PMID:33639079 | DOI:10.1615/IntJMedMushrooms.2021037630

Int Nurs Rev. 2021 Feb 27. doi: 10.1111/inr.12666. Online ahead of print.

ABSTRACT

AIM: To examine the modifiable predictors and the level of workplace social capital, transformational leadership, emotional intelligence and organizational justice among registered nurses in Chinese hospitals.

BACKGROUND: Workplace social capital is a relational network developed among nurses and other healthcare professionals that provides social support, and gives value to their working lives. Internationally, cultivating high levels of social capital is critical as it can help improve nurse satisfaction and care, and address nurse turnover. However, knowledge of factors influencing nurses’ workplace social capital is limited in China.

METHODS: In this cross-sectional, descriptive predictive study, 344 registered nurses were randomly selected from three urban Chinese hospitals in Zhejiang province. Five standard instruments were applied to collect data. Descriptive statistics were used to present the level of the variables and stepwise multiple regression was performed to identify the predictors of nurses’ workplace social capital.

RESULTS: Among eight potential factors, transformational leadership and emotional intelligence positively predicted workplace social capital. Nurses perceived the overall level of workplace social capital, emotional intelligence and unit managers’ transformational leadership as high, and the overall level of organizational justice as moderate.

DISCUSSION: Enhancing unit managers’ transformational leadership and nurses’ emotional intelligence was found to positively influence the development of workplace social capital. Although it is not a predictor of workplace social capital, nurses’ organizational justice should be improved due to its importance and current unsatisfactory level.

CONCLUSION AND IMPLICATIONS FOR NURSING AND HEALTH POLICY: Nursing and health policymakers need to consider the enhancement of transformational leadership and emotional intelligence when implementing policies to improve nurses’ workplace social capital, nursing retention and job satisfaction.

PMID:33639024 | DOI:10.1111/inr.12666