Category: Nevin Manimala

Clin Transplant. 2021 Jun 8. doi: 10.1111/ctr.14382. Online ahead of print.

ABSTRACT

PURPOSE: The risks and benefits of remote corticosteroid weaning in heart transplant recipients more than two years post-transplant are unknown. We compared outcomes in patients undergoing early and remote steroid weaning after heart transplantation.

METHODS: We performed a retrospective study (range 09/1991- 04/2017). Primary outcomes included short-term and long-term mortality, allograft dysfunction and burden of rejection. Secondary outcomes included impact on hemoglobin A1c, lipid panel, bone scan Tscore, and body mass index.

RESULTS: 63 patients underwent corticosteroid weaning between 2012 and 2017. Outcomes of patients weaned early (n = 34; median time from transplant = 1.1 years) were compared with those weaned late (n = 29; median time from transplant = 4.4 years). 52 (82.5%) patients were successfully weaned off corticosteroids. No statistically significant difference in outcomes was found between the early and late weaning groups (p = 0.20). There were no differences in allograft function (p-value = 0.16), incidence of rejection (p = 0.46) or mortality (p = 0.15). Improvement in metabolic profile was seen in both groups but was not statistically significant.

CONCLUSIONS: In heart transplant recipients remote vs early weaning of corticosteroids is not associated with significant differences in graft function or the incidence of rejection after one-year follow-up. Moreover, there were no significant differences in survival up to three years between the two groups. This article is protected by copyright. All rights reserved.

PMID:34101911 | DOI:10.1111/ctr.14382

Chemistry. 2021 Jun 8. doi: 10.1002/chem.202100268. Online ahead of print.

ABSTRACT

Scientists and students with disabilities have been severely affected by the COVID-19 pandemic, and this must be urgently addressed to avoid further entrenching existing inequalities. The need for rapid decision-making, often by senior colleagues without lived experience of disabilities, can lead to policies which discriminate against scientists with disabilities. This article reflects on disability declaration statistics and research in critical disability studies and social science to explore the challenges experienced by disabled scientists before and during the COVID-19 pandemic and highlights recommendations and examples of good practice to adopt in order to challenge ableism in STEM communities and workplaces. It is vital that disabled staff and students are fully involved in decision making. This is particularly important as we continue to respond to the challenges and opportunities associated with the ongoing COVID-19 pandemic and plan for a post-COVID-19 future. This time of great change can be used as an opportunity to listen, learn, and improve working conditions and access for scientists with disabilities, and by doing so, for everyone.

PMID:34101912 | DOI:10.1002/chem.202100268

J Orthop Res. 2021 Jun 8. doi: 10.1002/jor.25117. Online ahead of print.

ABSTRACT

Previous research suggests more biomechanically demanding tasks (e.g., stair descent, hopping) magnify biomechanical asymmetries compared with walking after anterior cruciate ligament (ACL) reconstruction. However, it is unclear if modifying task-specific constraints, like walking speed also elicits greater biomechanical asymmetries in this population. We examined the effects of manipulating walking speed on ground reaction force (GRF) asymmetries in individuals with ACL reconstruction and uninjured controls. Thirty individuals with ACL reconstruction (Age= 20.6 ± 5.4 yr., body mass index [BMI]= 23.9 ± 3.3 kg/m² ) and fifteen controls (Age= 23.1 ± 4.5 yr., BMI= 23.6 ± 2.7 kg/m² ) were tested on an instrumented treadmill at three speeds (100%, 120%, and 80% self-selected speed). Bilateral vertical and posterior-anterior GRFs were recorded at each speed. GRF asymmetries were calculated by subtracting the uninjured from the injured limb at each percent of stance. Statistical parametric mapping was used to evaluate the effects of speed on GRF asymmetries across stance. We found vertical and posterior GRF asymmetries were exacerbated at faster speeds and reduced at slower speeds in ACL individuals but not controls (p < 0.05). No differences in anterior GRF asymmetries were observed between speeds in either group (p > 0.05). Our results suggest increasing walking speed magnifies GRF asymmetries in individuals with ACL reconstruction. This article is protected by copyright. All rights reserved.

PMID:34101887 | DOI:10.1002/jor.25117

Clin Cardiol. 2021 Jun 8. doi: 10.1002/clc.23663. Online ahead of print.

ABSTRACT

BACKGROUND: Atrial fibrillation (AF) recurrence is common in the 3-month blanking-period after catheter ablation, during which electrical cardioversion (ECV) is usually performed to restore sinus rhythm. Whether ECV can affect the clinical outcome of post-ablation AF patients is inconsistent, however. We aimed to explore the 1-year effect of ECV on AF recurrence and rehospitalization in patients experienced recurrence within 3-month after AF catheter ablation.

METHODS: Patients who experienced recurrence within 3-month after AF catheter ablation procedure were enrolled from the China Atrial Fibrillation Registry (China-AF). A 1:3 Propensity score matching (PSM) method was applying to adjust the confounders between patients who had been treated by ECV or not. Logistic regression models were conducted to evaluate the association of ECV with 1-year AF recurrence and rehospitalization.

RESULTS: In this study, 2961 patients experienced AF recurrence within 3-month after the procedure, and 282 of them underwent successful ECV, 2155 patients did not undergo ECV. One-year AF recurrence rates were 56.4% in ECV group versus 65.4% in non-ECV group (p = .003), and were 55.9% versus 65.9%, respectively, after PSM (adjusted odds ratio [OR] 0.66; 95% confidence interval (CI): 0.49-0.88, p = .005). However, the difference of 1-year rehospitalization rates between two groups were not statistically significant before (ECV group: 23.7% vs. non-ECV group: 22.3%, p = .595) and after PSM (ECV group: 24.4% vs. non-ECV group: 21.6%, adjusted OR1.14; 95% CI 0.81-1.62, p = .451).

CONCLUSIONS: Successful ECV was associated with lower rate of one-year recurrence in patients with early recurrent AF after catheter ablation.

PMID:34101841 | DOI:10.1002/clc.23663

Trans R Soc Trop Med Hyg. 2021 Jun 8:trab085. doi: 10.1093/trstmh/trab085. Online ahead of print.

ABSTRACT

BACKGROUND: Snakebite statistics are lacking in Sudan despite the high estimated burden. In this study we aimed to describe the incidence of snakebite envenomation and death in Sudan and to show the state-wise distribution of snakebite episode.

METHODS: We retrospectively analyzed hospital-based data on snakebite for 2014-2018. Data were obtained from the annual health statistical reports of the Ministry of Health. Descriptive statistics were used to illustrate the results.

RESULTS: A total of 63 160 people were envenomed during 2014-2018 with an average of 12 632 cases/year. The death rate between inpatient cases was 2.5%. The annual incidence was 18- 47 cases/100 000 population. Gadarif state recorded the highest incidence (132/100 000 population) of snakebite envenomation in Sudan whereas Northern state had the least incidence (5/100 000 population). The 15-24 y age group experienced the highest risk of snakebite and males were more exposed to snakebites than females.

CONCLUSIONS: Although hospital-based records underestimate the burden of snakebite, they can still provide an insight regarding the actual numbers. Here, we highlight the at-risk states in Sudan to be targeted for further questionnaire-based epidemiological studies and to guide health authorities to reduce the burden of snakebite envenomation by insuring proper antivenom distribution to the highly affected areas.

PMID:34101816 | DOI:10.1093/trstmh/trab085

J Travel Med. 2021 Jun 9:taab071. doi: 10.1093/jtm/taab071. Online ahead of print.

ABSTRACT

BACKGROUND: In recent years, multiple outbreaks of measles associated with vaccine hesitancy occurred in high-income countries, where measles incidence had previously been low. Most safety data about the measles, mumps and rubella (MMR) vaccine are derived from studies conducted among children, whereas evidence regarding the safety profile of the vaccine in adults is scarce.

METHODS: In 2017, during an outbreak of measles in Europe, Israeli travellers to high-risk locations who were incompletely vaccinated, were urged to complete the two MMR vaccination schedule before their travel. In this prospective cohort study, we analysed adverse events (AEs) of MMR and MMRV (measles, mumps, rubella and varicella) vaccines among these travellers. All participants were followed up using structured questionnaires 2-4 weeks after vaccination.

RESULTS: Seven hundred and eighty-five adult travellers whose median age was 49.2 years were vaccinated and followed up. Any AEs were reported by 25.2% of all participants; 11.6% reported local AEs, and 18.6% reported systemic AEs, none of which were severe. In general, AEs were much more common among female travellers (19.4% of males vs 30.1% of females (P < 0.001)). Local AEs, overall systemic AEs, headache and arthralgia were much more common among females, whereas rates of general malaise and fever were not statistically different between genders. We did not observe any significant differences in the rates of total, local or systemic AEs between the MMR and MMRV vaccines. Higher rates of systemic AEs were observed among participants who were younger and probably immunized once with MMR compared to older vaccines immunized once to measles only and to those who were never immunized.

CONCLUSIONS: The current study demonstrated low rates of systemic AEs and no serious AEs following either MMR or MMRV administration. More AEs were reported among females, and rates of AEs were similar after either MMR or MMRV.

PMID:34101817 | DOI:10.1093/jtm/taab071

Cancer. 2021 Jun 8. doi: 10.1002/cncr.33503. Online ahead of print.

ABSTRACT

BACKGROUND: Defining workup beyond usual clinical practice that may improve treatment outcomes in men with a prostate-specific antigen (PSA) level of ≤4 ng/mL (vs >4 ng/mL) and Gleason score (GS) 9 to 10 prostate cancer (PC) remains to be determined.

METHODS: Between February 25, 1992, and February 25, 2016, 17,632 men with clinical T1-4 PC with a biopsy GS of 6 to 10 underwent radical prostatectomy at a single academic center. Multivariable Fine and Gray regressions were used to evaluate the risk of prostate cancer-specific mortality (PCSM) with an interaction model evaluating the prognostic significance of PSA ≤ 4 ng/mL versus PSA > 4 ng/mL among men with PC with a biopsy GS of 9 to 10 versus ≤8, with adjustments made for the time-dependent use of adjuvant and/or salvage radiation therapy and androgen deprivation therapy (ADT) in addition to known PC prognostic factors.

RESULTS: There was a significant interaction in men with a biopsy GS of 9 to 10 versus ≤8 and a PSA level of ≤4 ng/mL versus >4 ng/mL (adjusted hazard ratio [AHR], 2.87; 95% confidence interval [CI], 1.02-8.08; P = .046). Specifically, among men with a biopsy GS of 9 to 10 and a PSA level of ≤4 ng/mL versus >4 ng/mL, there was a significantly higher rate of PCSM (AHR, 2.59; 95% CI, 1.19-5.67; P = .017); however, there was no significant difference in the risk of PCSM in men with a biopsy GS ≤ 8 and a PSA level of ≤4 ng/mL versus >4 ng/mL (AHR, 0.90; 95% CI, 0.46-1.78; P = .771). Moreover, the time-dependent use of postoperative ADT was also associated with an increased risk of PCSM (AHR, 10.76; 95% CI, 6.88-16.81; P < .0001).

CONCLUSIONS: Some men with PSA ≤ 4 ng/mL and a biopsy GS of 9 to 10 may have pathologic or genetic variants that make them less amenable to a cure with current standards of care. Additional workup assessing for small cell, neuroendocrine, and genetic variants should be considered.

PMID:34101827 | DOI:10.1002/cncr.33503

J Gerontol B Psychol Sci Soc Sci. 2021 Jun 8;76(Supplement_1):S86-S96. doi: 10.1093/geronb/gbab004.

ABSTRACT

OBJECTIVE: To study the role of gender and marital status as risk factors for nursing home entry in the United States.

METHOD: The paper uses data from the Health and Retirement Study, a nationally representative survey of the older population in the United States. Multivariate logit models of the risk of nursing home entry over a 2-year follow-up period were estimated for noninstitutionalized individuals over the age of 65. A multiple imputation procedure was used to explore the sensitivity of the results to alternative assumptions about the data-generating process of missing outcome values.

RESULTS: In an analysis based on complete observations, women exhibited the same risk of nursing home entry as men (risk ratio [RR] = 1.01; CI: 0.90, 1.13). However, after expanding the sample to include information on nursing home use for individuals who died during the follow-up period, women were found to have a statistically lower risk of nursing home entry (RR = 0.85; CI: 0.79, 0.92). The latter result was robust to alternative assumptions about the nature of missing data. The type of sample used in the analysis did not affect the conclusions regarding the role of marital status. Divorced and widowed individuals were found to be at higher risk of nursing home admissions than married individuals in all specifications.

DISCUSSION: The findings clarify the role of gender as a predictor of nursing home admissions and may provide useful prognostic information for clinicians and caregivers regarding nursing home entry risk. The study also sheds light on how conclusions about predictors of nursing home risk obtained from prospective studies with long follow-up periods can be affected by the treatment of missing outcomes due to death or attritions.

PMID:34101810 | DOI:10.1093/geronb/gbab004

Microscopy (Oxf). 2021 Jun 8:dfab021. doi: 10.1093/jmicro/dfab021. Online ahead of print.

ABSTRACT

An automated hologram acquisition system for big-data analysis and for improving the statistical precision of phase analysis has been upgraded with automated particle detection technology. The coordinates of objects in low-magnification images are automatically detected using zero-mean normalized cross-correlation with preselected reference images. In contrast with the conventional scanning acquisitions from the whole area of a microgrid and/or a thin specimen, the new method allows efficient data collections only from the desired fields of view including the particles. The acquisition time of the cubic/triangular nanoparticles that were observed was shortened by about 1/58 that of the conventional scanning acquisition method because of the efficient data collections. The developed technology can improve statistical precision in electron holography with shorter acquisition time and is applicable to the analysis of electromagnetic fields for various kinds of nanoparticles.

PMID:34101814 | DOI:10.1093/jmicro/dfab021

PLoS One. 2021 Jun 8;16(6):e0251338. doi: 10.1371/journal.pone.0251338. eCollection 2021.

ABSTRACT

Cognitive impairment is a common symptom in individuals with Multiple Sclerosis (MS), but meaningful, reliable biomarkers relating to cognitive decline have been elusive, making evaluation of the impact of therapeutics on cognitive function difficult. Here, we combine pathway-based MRI measures of structural and functional connectivity to construct a metric of functional decline in MS. The Structural and Functional Connectivity Index (SFCI) is proposed as a simple, z-scored metric of structural and functional connectivity, where changes in the metric have a simple statistical interpretation and may be suitable for use in clinical trials. Using data collected at six time points from a 2-year longitudinal study of 20 participants with MS and 9 age- and sex-matched healthy controls, we probe two common symptomatic domains, motor and cognitive function, by measuring structural and functional connectivity in the transcallosal motor pathway and posterior cingulum bundle. The SFCI is significantly lower in participants with MS compared to controls (p = 0.009) and shows a significant decrease over time in MS (p = 0.012). The change in SFCI over two years performed favorably compared to measures of brain parenchymal fraction and lesion volume, relating to follow-up measures of processing speed (r = 0.60, p = 0.005), verbal fluency (r = 0.57, p = 0.009), and score on the Multiple Sclerosis Functional Composite (r = 0.67, p = 0.003). These initial results show that the SFCI is a suitable metric for longitudinal evaluation of functional decline in MS.

PMID:34101741 | DOI:10.1371/journal.pone.0251338