Category: Nevin Manimala

Cochrane Database Syst Rev. 2021 Nov 22;11:CD011499. doi: 10.1002/14651858.CD011499.pub3.

ABSTRACT

BACKGROUND: Resistant hypertension is highly prevalent among the general hypertensive population and the clinical management of this condition remains problematic. Different approaches, including a more intensified antihypertensive therapy, lifestyle modifications or both, have largely failed to improve patients’ outcomes and to reduce cardiovascular and renal risk. As renal sympathetic hyperactivity is a major driver of resistant hypertension, in the last decade renal sympathetic ablation (renal denervation) has been proposed as a possible therapeutic alternative to treat this condition.

OBJECTIVES: We sought to evaluate the short- and long-term effects of renal denervation in individuals with resistant hypertension on clinical end points, including fatal and non-fatal cardiovascular events, all-cause mortality, hospital admissions, quality of life, blood pressure control, left ventricular hypertrophy, cardiovascular and metabolic profile and kidney function, as well as the potential adverse events related to the procedure.

SEARCH METHODS: For this updated review, the Cochrane Hypertension Information Specialist searched the following databases for randomised controlled trials up to 3 November 2020: Cochrane Hypertension’s Specialised Register, CENTRAL (2020, Issue 11), Ovid MEDLINE, and Ovid Embase. The World Health Organization International Clinical Trials Registry Platform (via CENTRAL) and the US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov were searched for ongoing trials. We also contacted authors of relevant papers regarding further published and unpublished work. The searches had no language restrictions.

SELECTION CRITERIA: We considered randomised controlled trials (RCTs) that compared renal denervation to standard therapy or sham procedure to treat resistant hypertension, without language restriction.

DATA COLLECTION AND ANALYSIS: Two authors independently extracted data and assessed study risk of bias. We summarised treatment effects on available clinical outcomes and adverse events using random-effects meta-analyses. We assessed heterogeneity in estimated treatment effects using Chi² and I² statistics. We calculated summary treatment estimates as a mean difference (MD) or standardised mean difference (SMD) for continuous outcomes, and a risk ratio (RR) for dichotomous outcomes, together with their 95% confidence intervals (CI). Certainty of evidence has been assessed using the GRADE approach.

MAIN RESULTS: We found 15 eligible studies (1416 participants). In four studies, renal denervation was compared to sham procedure; in the remaining studies, renal denervation was tested against standard or intensified antihypertensive therapy. Most studies had unclear or high risk of bias for allocation concealment and blinding. When compared to control, there was low-certainty evidence that renal denervation had little or no effect on the risk of myocardial infarction (4 studies, 742 participants; RR 1.31, 95% CI 0.45 to 3.84), ischaemic stroke (5 studies, 892 participants; RR 0.98, 95% CI 0.33 to 2.95), unstable angina (3 studies, 270 participants; RR 0.51, 95% CI 0.09 to 2.89) or hospitalisation (3 studies, 743 participants; RR 1.24, 95% CI 0.50 to 3.11). Based on moderate-certainty evidence, renal denervation may reduce 24-hour ambulatory blood pressure monitoring (ABPM) systolic BP (9 studies, 1045 participants; MD -5.29 mmHg, 95% CI -10.46 to -0.13), ABPM diastolic BP (8 studies, 1004 participants; MD -3.75 mmHg, 95% CI -7.10 to -0.39) and office diastolic BP (8 studies, 1049 participants; MD -4.61 mmHg, 95% CI -8.23 to -0.99). Conversely, this procedure had little or no effect on office systolic BP (10 studies, 1090 participants; MD -5.92 mmHg, 95% CI -12.94 to 1.10). Moderate-certainty evidence suggested that renal denervation may not reduce serum creatinine (5 studies, 721 participants, MD 0.03 mg/dL, 95% CI -0.06 to 0.13) and may not increase the estimated glomerular filtration rate (eGFR) or creatinine clearance (6 studies, 822 participants; MD -2.56 mL/min, 95% CI -7.53 to 2.42). AUTHORS’ CONCLUSIONS: In patients with resistant hypertension, there is low-certainty evidence that renal denervation does not improve major cardiovascular outomes and renal function. Conversely, moderate-certainty evidence exists that it may improve 24h ABPM and diastolic office-measured BP. Future trials measuring patient-centred instead of surrogate outcomes, with longer follow-up periods, larger sample size and more standardised procedural methods are necessary to clarify the utility of this procedure in this population.

PMID:34806762 | DOI:10.1002/14651858.CD011499.pub3

Biometrics. 2021 Nov 22. doi: 10.1111/biom.13602. Online ahead of print.

ABSTRACT

Spatial partitioning methods correct for non-stationarity in spatially related data by partitioning the space into regions of local stationarity. Existing spatial partitioning methods can only estimate linear partitioning boundaries. This is inadequate for detecting an arbitrarily shaped anomalous spatial region within a larger area. We propose a novel Bayesian functional spatial partitioning (BFSP) algorithm which estimates closed curves that act as partitioning boundaries around anomalous regions of data with a distinct distribution or spatial process. Our method utilizes transitions between a fixed Cartesian and moving polar coordinate system to model the smooth boundary curves using functional estimation tools. Using adaptive Metropolis-Hastings, the BFSP algorithm simultaneously estimates the partitioning boundary and the parameters of the spatial distributions within each region. Through simulation we show that our method is robust to shape of the target zone and region-specific spatial processes. We illustrate our method through the detection of prostate cancer lesions using magnetic resonance imaging. This article is protected by copyright. All rights reserved.

PMID:34806765 | DOI:10.1111/biom.13602

Med J Malaysia. 2021 Nov;76(6):876-880.

ABSTRACT

INTRODUCTION: The Optimal Health Program (OHP) is a collaborative self-management program that promotes clients to be actively involved in their own healthcare and overall wellbeing. Program Kesihatan Optimum (SANUBARI) is a Malay version of the OHP after a translational process and cultural adaptation by psychiatrists, clinical psychologist and family medicine specialists in 2017. The program is of a low intensity, patient-centred program, advocating self-health management to improve health literacy by enhancing self-efficacy, building strengths and values, and initiating change and planning, ultimately enhancing wellbeing of people. The programme can be used as a form of early psychosocial intervention during the current pandemic in maintaining the general mental wellbeing of COVID-19 patients.

METHODS: This is an open labelled interventional study of a virtual brief psychosocial intervention, called SANUBARI. The program was conducted among COVID-19 patients hospitalized in the COVID-19 wards of two centres from May 2020 until August 2020. Inclusion criteria include patients aged eighteen years and above, diagnosed with COVID-19, medically stable, speaking and reading Bahasa Melayu or English. All study subjects attended two sessions on OHP via telecommunication method and answered questionnaires (General Self-Efficacy (GSE) Scale, Patient Health Questionnaire and Generalized Anxiety Disorder Questionnaire) via computer-assisted self-interview. Data collection was done before the start of the intervention, at the end of the intervention and a month post-intervention.

RESULTS: A total of 37 patients were recruited and more than half of the subjects were males (62.2%), single (75.5%) and from the Malay ethnicity (78.4%). Seventy-three per cent of subjects had received tertiary education, and most of them were students reflecting a higher unemployment status (73%). Most subjects have no comorbid chronic medical illness (89.2%), and none has a comorbid psychiatric illness. Comparison of the GSE score across 3-time points (preintervention, immediate post-intervention and a month postintervention) showed statistically significant improvement in the mean total GSE score immediate and a month postintervention as compared to the pre-intervention; from mean total GSE score of 29.78 pre-intervention to 34.73 (mean difference 4.946, 95% Confidence Interval 95%CI: 3.361, 6.531) immediate post-intervention and 33.08 (mean difference 3.297, 95%CI: 1.211, 5.348) a month post intervention. There was no significant association between the socio-demographic or clinical data, depressive and anxiety symptoms, and changes in GSE scores over three time points.

CONCLUSION: COVID-19 patients improved their self-efficacy levels after the virtual brief OHP intervention, and it maintained a month post-intervention, protecting them from psychological stress and ultimately enhances wellbeing during this coronavirus pandemic.

PMID:34806676

Med J Malaysia. 2021 Nov;76(6):881-883.

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has prompted the medical world to look at factors that may influence outcomes. There have been connections made between vitamin D and COVID-19, as vitamin D has previously been shown to play a role in the maintenance of immune homeostasis.

MATERIALS AND METHODS: We performed a prospective cohort study on 103 patients at Wigan Wrightington and Leigh NHS Foundation Trust looking at serum vitamin D levels of patients with positive COVID-19 swabs. Results were collated and correlations were made to compare vitamin D levels with age; severity of illness; hospital outcomes; and frailty. Comparisons were also made between frailty and outcome.

RESULTS: The results showed that there was a significant statistical difference between vitamin D levels and severity of infection: those who were treated in the intensive care units (ICU) (severe symptoms) had lower vitamin D levels than those treated on the ward (p=0.0446). There was also a correlation between vitamin D levels and frailty: those who were more frail had higher vitamin D levels than fitter patients (P=0.005). Vitamin D and frailty had no effect on hospital outcomes of COVID-19 infection.

CONCLUSION: Ultimately, we concluded that low vitamin D can increase susceptibility of contracting COVID-19, increase severity of infection but does not affect mortality.

PMID:34806677

Med J Malaysia. 2021 Nov;76(6):799-803.

ABSTRACT

INTRODUCTION: Thalassemia is the most common heritable haematological disorder in Malaysia. Hypothyroidism is one of the complications of the transfusion dependent thalassemia (TDT) patients as a result of iron overload.

MATERIALS AND METHODS: All registered TDT patients attending Haematology day care, Hospital Pulau Pinang from January 2019 to January 2020 were included in the study. Hypothyroidism was defined according to TSH and FT4, or based on the history of treatment for diagnosed hypothyroidism.

RESULTS: There were 51 TDT patients, with 24 (47%) males and 27 (53%) females. Most of the patients were Malays (27, 53%) followed with Chinese (23, 45%) and Indonesian (1, 2%). Beta thalassemia major and HbE beta thalassaemia accounted for 35 (68.8%) and 14 (27.5%) TDT patients respectively, while two (3.9%) were HbH Constant Spring. Eleven (21.6%) had hypothyroidism; of which seven (63.6%) had central hypothyroidism, three (27.3%) had subclinical hypothyroidism, the remaining one (9.1%) had primary hypothyroidism. Three (27.3%) had concomitant hypogonadism, one (9.1%) had hypocortisolism and another (9.1%) had both diabetes mellitus and hypogonadism. There was no statistical relationship between the prevalence of hypothyroidism and age, serum ferritin, splenectomy history and iron chelation therapy.

CONCLUSION: High prevalence of central hypothyroidism is reported. Measurement of both TSH and FT4 is recommended as initial screening for thyroid dysfunction among patient with TDT.

PMID:34806663

Med J Malaysia. 2021 Nov;76(6):865-869.

ABSTRACT

INTRODUCTION: This study aimed to determine the coverage of tetanus toxoid vaccination (TT) among pregnant women in Cambodia, and its association with health services and pregnancy factors.

METHODS: A cross-sectional study was conducted by utilising the data from the Cambodia Demographic Health Survey (CDHS). The records of 5901 pregnant women who fulfilled the inclusion criteria were reviewed. Multiple logistic regression was used to identify the association on the influence of health services and pregnancy factors on incomplete TT vaccination while controlling other covariates. Adjusted odds ratio (aOR) and 95% confidence interval (95%CI) was reported.

RESULTS: More than one-third of the respondents had incomplete TT vaccination (38.25%, 95%CI: 37.00, 39.48%). Health services as well as pregnancy factors were statistically associated with incomplete TT vaccination such as received antenatal care (ANC) from other health personnel beside midwife (aOR=1.83; 95%CI: 1.49, 2.24), had <ANC visits (aOR=1.76; 95%CI: 1.53, 2.03), being late for the first ANC visit (aOR=1.65; 95%CI: 1.41, 1.92), unwanted pregnancy (aOR=1.30; 95%CI: 1.11, 1.51), aged ≥30 years at delivery (aOR=1.45; 95%CI: 1.15, 1.46) while controlling other factors like; including age, occupation, husband’s age, occupation, financial status, maternal age at delivery, birth order, wanted pregnancy and accessing health facility.

CONCLUSION: More than one-third of pregnant women in Cambodia had not completed tetanus toxoid vaccination. Health services and pregnancy related factors had significance role on incomplete tetanus toxoid vaccination.

PMID:34806674

J Xray Sci Technol. 2021 Nov 18. doi: 10.3233/XST-211033. Online ahead of print.

ABSTRACT

BACKGROUND: The inflammatory indexes of children with Takayasu arteritis (TAK) usually tend to be normal immediately after treatment, therefore, CT angiography (CTA) has become an important method to evaluate the status of TAK and sometime is even more sensitive than laboratory test results.

OBJECTIVE: To evaluate image quality improvement in CTA of children diagnosed with TAK using a deep learning image reconstruction (DLIR) in comparison to other image reconstruction algorithms.

METHODS: hirty-two TAK patients (9.14±4.51 years old) underwent neck, chest and abdominal CTA using 100 kVp were enrolled. Images were reconstructed at 0.625 mm slice thickness using Filtered Back-Projection (FBP), 50%adaptive statistical iterative reconstruction-V (ASIR-V), 100%ASIR-V and DLIR with high setting (DLIR-H). CT number and standard deviation (SD) of the descending aorta and back muscle were measured and contrast-to-noise ratio (CNR) for aorta was calculated. The vessel visualization, overall image noise and diagnostic confidence were evaluated using a 5-point scale (5, excellent; 3, acceptable) by 2 observers.

RESULTS: There was no significant difference in CT number across images reconstructed using different algorithms. Image noise values (in HU) were 31.36±6.01, 24.96±4.69, 18.46±3.91 and 15.58±3.65, and CNR values for aorta were 11.93±2.12, 15.66±2.37, 22.54±3.34 and 24.02±4.55 using FBP, 50%ASIR-V, 100%ASIR-V and DLIR-H, respectively. The 100%ASIR-V and DLIR-H images had similar noise and CNR (all P > 0.05), and both had lower noise and higher CNR than FBP and 50%ASIR-V images (all P < 0.05). The subjective evaluation suggested that all images were diagnostic for large arteries, however, only 50%ASIR-V and DLIR-H met the diagnostic requirement for small arteries (3.03±0.18 and 3.53±0.51).

CONCLUSION: DLIR-H improves CTA image quality and diagnostic confidence for TAK patients compared with 50%ASIR-V, and best balances image noise and spatial resolution compared with 100%ASIR-V.

PMID:34806646 | DOI:10.3233/XST-211033

J Postgrad Med. 2021 Nov 17. doi: 10.4103/jpgm.JPGM_1345_20. Online ahead of print.

ABSTRACT

AIM: To determine the risk factors affecting outcome at the end of 90 days of post-angiogram-negative subarachnoid hemorrhage (SAH).

METHODS: Non-traumatic SAH cases were reviewed from the case records of patients who had reported to the Department of Neurology of a tertiary care hospital and 50 angio-negative SAH cases were included after excluding all the cases with known cause of hemorrhage after doing computed tomography angiography (CTA)/digital subtraction angiography (DSA). The presence of hypertension, diabetes mellitus, coronary artery disease (CAD), history of alcohol and smoking, and various scales like Hunt and Hess Scale (HHS), World Federation of Neurological Surgeons (WFNS), and Fisher scale had been recorded at admission. The outcome was assessed at 90 days post-SAH using the Modified Rankin Scale (mRS).

STATISTICAL ANALYSES: The association between the outcome and the factors was assessed using the Pearson Chi-Square test and the risk factors/predictors of outcome were assessed using logistic regression.

RESULTS: The following variables were important risk factors for predicting poor outcome of angio-negative SAH (mRS 3 to 6): hypertension (P = 0.011), diabetes mellitus (P = 0.032), being an alcoholic (P = 0.019), HHS grade 4 to 5 (P < 0.01), and WFNS grade 4 to 5 (P < 0.01). On multivariate regression analysis, hypertension (P = 0.032) was an independent predictor of unfavorable outcome.

CONCLUSIONS: At time of admission, presence of hypertension, diabetes mellitus, history of alcohol consumption, and poor grades of HHS and WFNS scale are predictors of poor outcome of angio-negative SAH.

PMID:34806656 | DOI:10.4103/jpgm.JPGM_1345_20

Technol Health Care. 2021 Nov 12. doi: 10.3233/THC-219001. Online ahead of print.

ABSTRACT

BACKGROUND: Many statistics reveal that violin players suffer most often from musculoskeletal disorders compared to musicians of other instrument groups. A common phenomenon, especially observed in violin beginners, is the tendency to elevate the right shoulder during playing the violin. This can probably lead to serious disorders in long-term practice with repetitive movements.

OBJECTIVE: For this reason, this study investigated the relationship between the right shoulder elevation and the force in the right glenohumeral joint during violin playing. It was hypothesized that the forces in the right glenohumeral joint are higher during playing with the right shoulder raised compared to playing in normal posture.

METHODS: Motion capture data from four experienced violinists was recorded and processed by means of musculoskeletal simulation to get the force and elevation angle while playing with raised shoulder and in normal position.

RESULTS: The results indicate that the absolute values of the resulting force, as well as the forces in the mediolateral, inferosuperior, and anteroposterior directions, are higher in playing the violin with the shoulder raised than in a normal posture.

CONCLUSIONS: Elevating the right shoulder while playing the violin may pose a potential problem.

PMID:34806631 | DOI:10.3233/THC-219001

J Xray Sci Technol. 2021 Nov 14. doi: 10.3233/XST-211022. Online ahead of print.

ABSTRACT

OBJECTIVE: To invastgate feasibility of low-dose contrast agent in cerebral computed tomography angiography (CTA) to alleviate side effects.

METHOD: Siemens’ Somatom Definition AS+CT scanner, Heine’s blood pressure monitor G7-M237 (BP cuff) and Ultravist contrast agent (370 mg Iodine/ml) are used. CTA is acquired using following scan parameters including slice thickness of 1mm, image acquisition parameters of 128×0.6 mm, pitch size of 0.8 mm, 175 effective mAs, 120 kVp tube voltage, scan delay time of 3 seconds, and the scan time of 4 seconds. This study is conducted by securing the IV route in the left antecubital vein before injection of contrast agent, wrapping BP cuff around the branchial artery of the opposite right arm after setting the pressure to 200 mmHg. Then, the injection rate of the contrast agent is fixed at 4.5 cc/sec and contrast agent was injected in three different amounts (70, 80, and 100 cc). Bp cuff is released from this moment when HU value reachs 100.

RESULT: In this study, the mean HU values measured from common carotid artery are 412.45±5.89 when injecting 80cc contrast agent and using BP cuff and 399.64±5.51 when injecting 100 cc contrast agenet and not using BP cuff, respectively. In middle cerebral artery M1, the mean HU values are 325.23±38.29 when injecting 80cc contrast agent and using BP cuff and 325.00±30.63 when injecting 100cc contrast agent blood and not using pressure cuff, respectively. Difference of mean HU values is not statistically significant (p > 0.05) with and without using BP cuff.

CONCLUSION: This study demonstrates that reducing amount of contrast agent is possible when the right brachial artery is compressed using BP cuff. Study results indicate that reducing 20% injection of contrast agent in CT cerebrovascular angiography can still yield comparable imaging results with conventional contrast angent usage, which implies that less side effects are expected with a contrast agent injection. Thus, this study can serve as a reference for potential reducing side effect during CT cerebrovascular angiography.

PMID:34806645 | DOI:10.3233/XST-211022