Category: Nevin Manimala

JAMA Netw Open. 2022 May 2;5(5):e2213643. doi: 10.1001/jamanetworkopen.2022.13643.

ABSTRACT

IMPORTANCE: The evidence base for the association between montelukast and adverse neuropsychiatric outcomes is mixed and inconclusive. Several methodological limitations have been identified in the evidence base on the safety of montelukast in observational studies.

OBJECTIVE: To investigate the association between new montelukast exposure and 1-year incident neuropsychiatric diagnoses with improved precision and control for baseline confounders.

DESIGN, SETTING, AND PARTICIPANTS: This propensity score-matched cohort study was conducted using electronic health records from 2015 to 2019 in the TriNetX Analytics Network patient repository of more than 51 million patients from 56 health care organizations, mainly in the US. Included patients were those aged 15 to 64 years at index prescription for montelukast or for control prescription who had a history of asthma or allergic rhinitis. After propensity score matching for various baseline confounders, including comorbidities and dispensed prescription medicines, we included 154 946 patients, of whom 77 473 individuals were exposed to montelukast. Patients were followed up for 12 months. Data were analyzed from June through November 2021.

EXPOSURES: New dispensed prescription for leukotriene receptor antagonist montelukast or control medication.

MAIN OUTCOMES AND MEASURES: Incident neuropsychiatric diagnoses at 12 months identified using International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes.

RESULTS: There were 72 490 patients with asthma (44 726 [61.7%] women; mean [SD] age at index prescription, 35 [15] years) and 82 456 patients with allergic rhinitis (54 172 [65.7%] women; mean [SD] age at index prescription, 40 [14] years). In patients exposed to montelukast, the odds ratio [OR] for any incident neuropsychiatric outcome was 1.11 (95% CI, 1.04-1.19) in patients with asthma and 1.07 (95% CI, 1.01-1.14) in patients with allergic rhinitis compared with patients who were unexposed. The highest OR was for anxiety disorders (OR, 1.21; 95% CI, 1.05-1.20) among patients with asthma exposed to montelukast and insomnia (OR, 1.15; 95% CI, 1.05-1.27) among patients with allergic rhinitis exposed to montelukast.

CONCLUSIONS AND RELEVANCE: This study found that patients with asthma or allergic rhinitis had increased odds of adverse neuropsychiatric outcomes after montelukast initiation. These findings suggest that clinicians should consider monitoring potential adverse mental health symptoms during montelukast treatment, particularly in individuals with a history of mental health or sleep problems.

PMID:35608857 | DOI:10.1001/jamanetworkopen.2022.13643

JAMA Netw Open. 2022 May 2;5(5):e2213540. doi: 10.1001/jamanetworkopen.2022.13540.

ABSTRACT

IMPORTANCE: Prior studies on the association between fine particulate matter with diameters 2.5 μm or smaller (PM2.5) and probability of death have not applied multilevel analysis disaggregating data for US census tract, states, and counties, nor tested its interaction by socioeconomic status (SES). Such an approach could provide a more refined identification and targeting of populations exposed to increased risk from PM2.5.

OBJECTIVE: To assess the association between PM2.5 and age-specific mortality risk (ASMR) using disaggregated data at the census tract level and evaluate such association according to census tract SES.

DESIGN, SETTING, AND PARTICIPANTS: This nationwide cross-sectional study used a linkage of 3 different data sets. ASMR for the period of 2010 to 2015 was obtained from the National Center for Health Statistic, SES data covering a period from 2006 to 2016 came from the American Community Survey, and mean PM2.5 exposure levels from 2010 to 2015 were derived from well-validated atmospheric chemistry and machine learning models. Data were analyzed in April 2021.

EXPOSURES: The main exploratory variable was mean census tract-level long-term exposure to PM2.5 from 2010 to 2015.

MAIN OUTCOMES AND MEASURES: The primary outcome was census tract-level ASMR. Multilevel models were used to quantify the geographic variation in ASMR at levels of census tract, county, and state. Additional analysis explored the interaction of SES in the association of ASMR with PM2.5 exposure.

RESULTS: Data from 67 148 census tracts nested in 3087 counties and 50 states were analyzed. The association between exposure to PM2.5 and ASMR varied substantially across census tracts. The magnitude of such association also varied across age groups, being higher among adults and older adults. Census tracts accounted for most of the total geographic variation in mortality risk (range, 77.0%-94.2%). ASMR was higher in deciles with greater PM2.5 concentration. For example, ASMR for age 75 to 84 years was 54.6 per 1000 population higher in the decile with the second-highest PM2.5 concentration than in the decile with the lowest PM2.5 concentration. The ASMR, PM2.5 concentrations, and magnitude of the association between both were higher in the census tracts with the lowest SES.

CONCLUSIONS AND RELEVANCE: This cross-sectional study found that census tracts with lower SES presented higher PM2.5 concentrations. ASMR and air pollution varied substantially across census tracts. There was an association between air pollution and ASMR across all age groups in the United States. These findings suggest that equitable public policies aimed at improving air quality are needed and important to increase life expectancy.

PMID:35608861 | DOI:10.1001/jamanetworkopen.2022.13540

Hum Vaccin Immunother. 2022 May 24:2069960. doi: 10.1080/21645515.2022.2069960. Online ahead of print.

ABSTRACT

BACKGROUND: Health professionals’ willingness to accept the COVID-19 vaccine is very important, and evidence suggests that only a limited proportion of health-care workers were ready to accept a COVID-19 vaccine, which is very low when compared with the risk of the disease. This study aimed to assess health professionals’ acceptability and associated factors in Wollega University referral hospital, Western Ethiopia.

METHODS: An institution-based cross-sectional study was conducted among health-care workers in Wollega University referral hospital from March 26-28, 2021. The data were collected by using a self-administered questionnaire. Epi-data version 3.2 was used for data entry, and STATA version 14 was used for data analysis. The binary logistic regression model was employed to determine factors associated with the acceptability of the COVID-19 vaccine. Adjusted Odds Ratio (AOR) with 95% confidence intervals was computed and statistical significance was declared at a 5% level (p-value <.05).

RESULTS: A total of 191 health professionals have participated in the study. The study indicates that 65.4% (95% CI: 58.6%, 72.2%) of health professionals had the willingness to receive the COVID-19 vaccine if available. Age of health professionals (AOR = 3.58, 95% CI: 1.38, 8.38), knowledge of the COVID-19 vaccine (AOR = 2.98, 95% CI: 1.22, 7.23), and perception of COVID 19 vaccine (AOR = 5.71, 95% CI: 2.50, 13.00) were significantly associated with vaccine acceptability.

CONCLUSIONS AND RECOMMENDATIONS: Nearly, two-thirds of health professionals were willing to accept the COVID-19 vaccine, which is low. In general, continuous communication and health education have to be provided to enhance overall awareness of the COVID-19 vaccine.

PMID:35608849 | DOI:10.1080/21645515.2022.2069960

Ann Bot. 2022 May 24:mcac065. doi: 10.1093/aob/mcac065. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Tree growth in plateau forests is critically limited by harsh climatic conditions. Many mathematical statistics have been used to identify the relationship between tree growth and climatic factors, but there is still uncertainty regarding the relative importance of these factors across different regions. We tested major climatic limits at 30 sites to provide insights into the main climatic limits for juniper trees (Juniperus tibetica Kom.) across the southern Tibetan Plateau.

METHODS: We analysed the linear and nonlinear relationships between tree growth and climatic factors using Pearson correlation statistics and a process-based forward Vaganov-Shashkin-Lite (VS-Lite) model, respectively. These relationships were used to identify the strength of the influence of different climatic factors throughout junipers’ growing season and to identify the main climatic factors limiting tree growth.

KEY RESULTS: The growth of juniper trees began in April and ended in October in the study area. The radial growth of juniper trees was limited by the soil moisture throughout the summer (June to August) of the current year at 24 sampling sites and limited by temperature at the six extra sites on the southern Tibetan Plateau.

CONCLUSIONS: Soil moisture limited juniper growth at the majority of sites. The temperature in the current summer limited the growth of juniper trees at a few sampling sites in the western part of the study area. Local climate conditions may contribute to different limiting factors in the growth response of trees on the southern Tibetan Plateau. These findings may contribute to the understanding of divergent forest dynamics and to sustainable forest management under future climate scenarios.

PMID:35608820 | DOI:10.1093/aob/mcac065

Int Urol Nephrol. 2022 May 24. doi: 10.1007/s11255-022-03200-w. Online ahead of print.

ABSTRACT

PURPOSE: To explore the gender differences in survival under different treatments in localized muscle-invasive bladder cancer (MIBC), and to find clinical strategies to improve the poor prognosis of female with bladder cancer (BC).

METHODS: Patients with localized MIBC were collected in the SEER database from 2010 to 2016 to analyze the gender differences in clinical characteristics. Propensity score matching was used to balance the effects of confounding factors. Kaplan-Meier method and Cox proportional hazards regression model were performed to compare the overall survival (OS) and cancer-specific survival (CSS) of patients between different treatment subgroups.

RESULTS: The entire cohort included 13,272 T2N0M0 MIBC patients, with a male-to-female incidence of 3:1. Compared with male patients, females had a higher age of onset and more blacks. There were more female patients undergoing bladder-sparing surgery (BSS) alone, and the OS and CSS were worse than those in males. The gender difference showed statistical significance in the BSS group, but not in the radical cystectomy (RC) group.

CONCLUSION: The survival of localized MIBC patients can be affected by treatments. Multi-modality treatment and RC may improve the survival prognosis of female patients.

PMID:35608804 | DOI:10.1007/s11255-022-03200-w

Drug Saf. 2022 May 24. doi: 10.1007/s40264-022-01180-5. Online ahead of print.

ABSTRACT

INTRODUCTION: The inclusion of herbal medicinal products and herbal supplements in pharmacovigilance systems is important because a systematic approach of collecting and analyzing adverse drug reactions related to these products will help practitioners, patients, and regulators to gain more knowledge and prevent harm.

OBJECTIVE: We aimed to categorize the adverse drug reaction reports on herbal medicinal products and herbal supplements submitted to the Pharmacovigilance Centre Lareb between 1991 and February 2021 on the basis of their regulatory status, herbs included, and adverse drug reactions involved.

METHODS: We categorized products on the basis of their registration status and herbal ingredients. The products were then categorized according to the Herbal Anatomical Therapeutic Chemical Classification System. We used descriptive statistics in Microsoft Excel 2019. Pivot tables were used for the analysis and presentation of the data.

RESULTS: Until February 2021, a total of 789 reports of herbal medicinal products and herbal supplements were received by Lareb. In these reports, a total of 823 herbal products were labeled as suspect. These products caused a total of 1727 adverse drug reactions. Of the 823 products, 229 were registered as a medicine, and 594 were on the market as a herbal supplement. Of the 823 herbal products, 522 reports concerned single-herb products, 256 reports concerned combination products, 27 reports concerned vitamin products containing herbal ingredients, and 18 reports concerned product issues. Approximately 15% of reports concerned serious adverse drug reactions, and adulterated products harbored a high risk of causing serious adverse drug reactions.

CONCLUSIONS: Analysis of the herbal medicinal products and herbal supplements in the Dutch pharmacovigilance database revealed a variety of suspected herbal ingredients. The reports provide insight into the variety of herbal products used in the Netherlands and the adverse reactions associated with their use. Pharmacovigilance of herbal products is essential to ensure their safe use.

PMID:35608783 | DOI:10.1007/s40264-022-01180-5

Ann Surg Oncol. 2022 May 24. doi: 10.1245/s10434-022-11839-z. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with sentinel lymph node-positive (SLN+) melanoma are increasingly undergoing active nodal surveillance over completion lymph node dissection (CLND) since the Second Multicenter Selective Lymphadenectomy Trial (MSLT-II). Adherence to nodal surveillance in real-world practice remains unknown.

METHODS: In a retrospective cohort of SLN+ melanoma patients who underwent nodal surveillance at a single institution from July 2017 through April 2021, this study evaluated adherence to nodal surveillance ultrasound (US). Adherence to nodal US was compared with adherence to other surveillance methods based on receipt of adjuvant therapy. Early recurrence data were reported using descriptive statistics.

RESULTS: Among 109 SLN+ patients, 37 (34%) received US surveillance at recommended intervals. Of the 72 (66%) non-adherent patients, 16 were lost to follow-up, and 33 had planned follow-up at an outside institution without available records. More patients had a minimum of bi-annual clinic visits (83%) and cross-sectional imaging (53%) compared to those who were adherent with nodal US. The patients who received adjuvant therapy (60%) had fewer ultrasounds (p < 0.01) but more exams (p < 0.01) and a trend toward more cross-sectional imaging (p = 0.06). Of the overall cohort, 26 patients (24%) experienced recurrence at a median follow-up period of 15 months. Of these recurrences, 10 were limited to the SLN basin, and all of these isolated nodal recurrences were resectable.

CONCLUSIONS: Pragmatic challenges to real-world delivery of nodal surveillance remain after MSLT-II, and adjuvant therapy appears to be associated with a decreased likelihood of US adherence. Understanding US utility alongside cross-sectional imaging will be critical as increasingly more patients undergo nodal surveillance and adjuvant therapy.

PMID:35608800 | DOI:10.1245/s10434-022-11839-z

Environ Sci Pollut Res Int. 2022 May 24. doi: 10.1007/s11356-022-20651-x. Online ahead of print.

ABSTRACT

Within the scope of the present study, the marble cutting waste, which is an industrial waste of different sizes (< 75 µm and < 150 µm), was incorporated into the clay structure at various rates and a total of 36 series bricks were produced. The brick mixtures were prepared by the semi-dry molding method and the brick specimens were sintered for three temperatures (850 °C, 950 °C, and 1050 °C). The fired bricks containing marble cutting waste with a lower particle size (75 µm) have higher compressive strength. However, all samples produced can meet the relevant standard requirements in terms of compressive strength. Thermal conductivity decreased from 1.008 to 0.775 W/mK with the incorporation of marble cutting waste, a decrease of approximately 23.11%. The effects of grain size, firing temperature, and marble cutting waste concentration on the quadratic model were statistically determined by variance analysis (ANOVA). According to statistical findings, the order of importance of design factors for brick properties (except for compressive strength) is marble cutting waste > firing temperature > particle size. For compressive strength, the most dominant factor is amount of marble cutting waste, followed by particle size and firing temperature, respectively. Consequently, the results suggest that marble cutting waste does not need to be reduced to smaller particle sizes to improve the fired clay brick properties.

PMID:35608771 | DOI:10.1007/s11356-022-20651-x

Radiol Med. 2022 May 24. doi: 10.1007/s11547-022-01502-8. Online ahead of print.

ABSTRACT

OBJECTIVES: The present study aims to investigate the role of the first magnetic resonances (MRI) following radio-chemotherapy (RT-CT) in patients diagnosed with high-grade glioma.

METHODS: We retrospectively recorded radiological evaluations following RT-CT, symptoms related to disease progression (avoiding any sign due to radiotherapy or chemotherapy) and the change of therapeutic strategy.

RESULTS: In March 2021, at data analysis, the data of 149 patients diagnosed with high-grade glioma and treated between May 2013 and July 2020 were retrieved for the present analysis. Two out of 122 (1.6%), 5 out of 106 (4.7%) and 8 out of 92 (8.6%) asymptomatic patients received the diagnosis of disease recurrence at the time of the first, second and third MRI, respectively. Otherwise, 16 out of 27 (59.2%), 16 out of 24 (66.6%) and 13 out of 16 (82.2%) symptomatic patients changed their therapy after the first, second and third MRI, respectively. Among patients that experienced radiological signs of distant progression, 10 out of 14 were symptomatic and changed their therapy.

CONCLUSIONS: MRIs performed by 6 months after the end of RT-CT lead to change treatment strategy mostly in symptomatic patients.

PMID:35608757 | DOI:10.1007/s11547-022-01502-8

Neurol Sci. 2022 May 24. doi: 10.1007/s10072-022-06136-2. Online ahead of print.

ABSTRACT

INTRODUCTION: Evidence is emerging about an extra-pulmonary involvement of SARS-CoV-2, including the nervous system. Autonomic dysfunction in patients recovering from acute coronavirus disease 2019 (COVID-19) has been recently described. Dysautonomic symptoms have been reported in the acute phase of the disease, but clear evidence is lacking, especially in the non-critical forms of the infection.

OBJECTIVE: The aim of this study is to assess the prevalence of dysautonomia in acute, non-critically ill COVID-19 patients.

METHODS: In this observational, cross-sectional study, we compared 38 non-critically ill patients with acute COVID-19 (COVID + group) to 38 healthy volunteers (COVID – group) in order to assess the prevalence of signs and symptoms of dysautonomia through the administration of the composite autonomic symptom score 31 (COMPASS-31) and an active standing test. Comparisons between groups were performed by means of both univariate and multivariate analyses.

RESULTS: The prevalence of orthostatic hypotension was significantly higher in the COVID + group. Higher total scores of COMPASS-31 were observed in the COVID + group than controls. Significant differences between groups emerged in the secretomotor, orthostatic intolerance, and gastrointestinal COMPASS-31 domains. All these results maintained the statistical significance after the adjustment for concomitant drugs with a known effect on the autonomic nervous system assumed by the study participants, except for the differences in the gastrointestinal domain of COMPASS-31.

CONCLUSION: Our results suggest that an autonomic dysfunction could be an early manifestation of COVID-19, even in the contest of mild forms of the infection.

PMID:35608736 | DOI:10.1007/s10072-022-06136-2