Category: Nevin Manimala

World J Emerg Surg. 2021 Oct 13;16(1):52. doi: 10.1186/s13017-021-00398-5.

ABSTRACT

BACKGROUND: Recent studies have reported promising outcomes of non-operative treatment for uncomplicated appendicitis; however, the preoperative prediction of complicated appendicitis is challenging. We developed models by incorporating fat stranding (FS), which is commonly observed in perforated appendicitis.

MATERIAL AND METHODS: We reviewed the data of 402 consecutive patients with confirmed acute appendicitis from our prospective registry. Multivariate logistic regression was performed to select clinical and radiographic factors predicting complicated acute appendicitis in our model 1 (involving backward elimination) and model 2 (involving stepwise selection). We compared c statistics among scoring systems developed by Bröker et al. (in J Surg Res 176(1):79-83. https://doi.org/10.1016/j.jss.2011.09.049 , 2012), Imaoka et al. (in World J Emerg Surg 11(1):1-5, 2016), Khan et al. (in Cureus. https://doi.org/1010.7759/cureus.4765 , 2019), Kim et al. (in Ann Coloproctol 31(5):192, 2015), Kang et al. (in Medicine 98(23): e15768, 2019), Atema et al. (in Br J Surg 102(8):979-990. https://doi.org/10.1002/bjs.9835 , 2015), Avanesov et al. (in Eur Radiol 28(9):3601-3610, 2018), and Kim et al. (in Abdom Radiol 46:1-12, 2020). Finally, we examined our models by performing the integrated discrimination improvement (IDI) test.

RESULTS: Among enrolled patients, 64 (15.9%) had complicated acute appendicitis. We developed new 10-point scoring models by including the following variables: C-reactive protein, neutrophil to lymphocyte ratio, and computed tomography features of FS, ascites, and appendicolith. A cutoff score of ≥ 6 exhibited a high sensitivity of 82.8% and a specificity of 82.8% for model 1 and 81.3% and 82.3% for model 2, respectively, with c statistics of 0.878 (model 1) and 0.879 (model 2). Compared with the model developed by Bröker et al. which included C-reactive protein and the abdominal pain duration (c statistic: 0.778), the models developed by Atema et al. (c statistic: 0.826, IDI: 5.92%, P = 0.0248), H.Y Kim et al. (c statistics: 0.838, IDI: 13.82%, P = 0.0248), and our two models (IDI: 18.29%, P < 0.0001) demonstrated a significantly higher diagnostic accuracy.

CONCLUSION: Our models and the scoring systems developed by Atema et al. and Kim et al. were validated to have a high diagnostic accuracy; moreover, our models included the lowest number of variables.

PMID:34645500 | DOI:10.1186/s13017-021-00398-5

J Ovarian Res. 2021 Oct 13;14(1):135. doi: 10.1186/s13048-021-00885-y.

ABSTRACT

BACKGROUND: The polycystic ovary syndrome (PCOS) is the most common endocrine associated with insulin resistance, even in the absence of overweight. The global lipid profile of the follicular fluid in PCOS with normal weight as yet has not been investigated. The objection of this pilot study was to explore the changes of lipids in the follicular fluid of PCOS with normal weight.

METHODS: Follicular fluid samples were collected from patients who underwent IVF, including normal-weight women without PCOS (control group, n = 10) and normal-weight women with PCOS (PCOS group, n = 8). A lipidomic analysis was performed by high performance liquid chromatography/ mass spectrometry (HPLC-MS). Multidimensional statistical analysis was performed to disclose the global differences between the two groups. Further, differential lipid analysis between the two groups was performed by Fold Change Analysis (FC Analysis) and T-test to screen potential markers.

RESULTS: All 812 species of 32 subclasses of lipids were identified by lipidomics analysis. 108 kinds of lipids were considered as the potential candidate differential metabolites with the score of variable importance in the project (VIP) more than 1 by the orthogonal partial least squares discriminant analysis. 32 lipids were significantly different between the PCOS group and the control group simultaneously with FC > 1.5 or FC < 0.67, p-value < 0.05 and VIP value > 1. These differential species of lipid belong to lipid subclasses including triglycerides (TG), phosphatidylethanolamines (PE) and phosphatidylinositols (PI).

CONCLUSION: The identified differential lipids in the follicular fluid may be considered as candidate biomarkers as well as therapeutic targets of PCOS with normal-weight.

PMID:34645507 | DOI:10.1186/s13048-021-00885-y

Child Care Health Dev. 2021 Oct 13. doi: 10.1111/cch.12918. Online ahead of print.

ABSTRACT

BACKGROUND: To evaluate the published literature on the use of antioxidants in improving developmental outcomes in children with DS.

METHODS: The systematic review included interventional studies (randomized controlled trials (RCTs) and quasi-RCTs (q-RCTs)) of children aged 0 to 18 years diagnosed with DS who received antioxidants to improve developmental outcomes. Studies were excluded if they were interventional studies with non-random allocation or lack of control group, or non-interventional studies including observational studies, systematic and narrative review articles, editorials, and commentaries. Studies were also excluded if data from participants with DS was included as part of a larger group of participants (e.g. children with intellectual disability) and the data could not be separated for subgroup analysis, or if outcomes did not assess developmental domains (e.g. reported biochemical markers only). The review included children with other conditions associated with developmental disability, only when data for children with DS were separately reported.

RESULTS: Eleven RCTs and q-RCTs fulfilled the eligibility criteria with 683 participants with Down syndrome ranging in age from newborns to 17 years. Nine studies did not show any statistically significant clinical benefit of using antioxidants. Three studies were included in a meta-analysis comparing changes in the effect sizes (post and pre-intervention) in Global Developmental Quotient (GDQ) between the intervention and control groups.

CONCLUSION: This review concludes that it is likely that the results are valid and suggest that the use of Antioxidant has no improvement in GDQ for children with DS. It is also unclear if any benefit exists for other developmental domains.

PMID:34644809 | DOI:10.1111/cch.12918

Arq Bras Cardiol. 2021 Oct 8:S0066-782X2021005017204. doi: 10.36660/abc.20200929. Online ahead of print.

ABSTRACT

BACKGROUND: To date, copaiba oil’s systemic effects have never documented in Cor pulmonale induced by monocrotaline.

OBJECTIVES: To investigate copaiba oil’s effects in peripheral markers of oxidative stress in rats with Cor pulmonale.

METHODS: Male Wistar rats (170±20g, n=7/group) were divided into four groups: control (CO), monocrotaline (MCT), copaiba oil (O), and monocrotaline+copaiba oil (MCT-O). MCT (60 mg/kg i.p.) was administered, and after one week, treatment with copaiba oil (400 mg/kg/day-gavage-14 days) was begun. Echocardiography was performed and, later, trunk blood collection was performed for oxidative stress evaluations. Statistical analysis: two-way ANOVA with Student-Newman-Keuls post-hoc test. P values<0.05 were considered significant.

RESULTS: Copaiba oil reduced pulmonary vascular resistance and right ventricle (RV) hypertrophy (Fulton index (mg/mg): MCT-O=0.39±0.03; MCT=0.49±0.01), and improved RV systolic function (RV shortening fraction, %) in the MCT-O group (17.8±8.2) as compared to the MCT group (9.4±3.1; p<0.05). Moreover, in the MCT-O group, reactive oxygen species and carbonyl levels were reduced, and antioxidant parameters were increased in the peripheral blood (p<0.05). Conclusions: Our results suggest that copaiba oil has an interesting systemic antioxidant effect, which is reflected in the improvements in function and RV morphometry in this Cor pulmonale model. Cor pulmonale attenuation promoted by copaiba oil coincided with a reduction in systemic oxidative stress.

PMID:34644790 | DOI:10.36660/abc.20200929

Arq Bras Cardiol. 2021 Oct 8:S0066-782X2021005018202. doi: 10.36660/abc.20200672. Online ahead of print.

ABSTRACT

BACKGROUND: Ischemic heart disease has attracted much attention due to its high mortality rates, treatment costs and the increasing morbidity in the young population. Strategies for reperfusion have reduced mortality. However, reperfusion can lead to cardiomyocyte death and subsequent irreversible myocardial damage. At present, the timely and targeted treatment of ischemia-reperfusion (I/R) injury is often lacking.

OBJECTIVES: To evaluate if dexmedetomidine (DEX) has a protective effect in myocardiual I/R and explore the possible mechanism behind it.

METHODS: Rat hearts were perfused with a Langendorff perfusion system, and randomly assigned to five groups: control group, perfused with Krebs-Henseleit (K-H) solution for 205 minutes without ischemia; and four test groups that underwent 40 minutes of global ischemia and 120 min of reperfusion. The DEX group, the yohimbine (YOH) group and the DEX + YOH group were perfused with DEX (10 nM), YOH (1 μM) or the combination of DEX and YOH prior to reperfusion, respectively. Cardiac hemodynamics, myocardial infarct size, and myocardial histology were evaluated. The expression of glucose-related protein 78 (GRP78), protein kinase R-like ER kinase (PERK), phosphorylated PERK, eukaryotic initiation factor 2α (eIF2α), phosphorylated eIF2α, activating transcription factor 4 (ATF4), and CCAAT/enhancer-binding protein homologous protein (CHOP) were assessed. P<0.05 was considered to indicate a statistically significant difference.

RESULTS: DEX preconditioning improved the cardiac function of I/R hearts, reduced myocardial infarction, myocardial apoptosis, and the expression of GRP78, p-PERK, eIF2α, p-eIF2α, ATF4 and CHOP.

CONCLUSIONS: DEX pretreatment reduced myocardial I/R injury by suppressing apoptosis, which was induced by the PERK pathway.

PMID:34644786 | DOI:10.36660/abc.20200672

Arq Bras Cardiol. 2021 Oct 8:S0066-782X2021005018203. doi: 10.36660/abc.20200752. Online ahead of print.

ABSTRACT

BACKGROUND: Doxorubicin (DOX) is frequently used to treat many types of cancers, despite its dose-dependent cardiotoxicity. Alternatively, resveratrol is a polyphenol that has shown useful cardioprotective effects in many heart dysfunction models.

OBJECTIVE: This study investigated whether resveratrol treatment in pregnant rats protects against doxorubicin-induced toxicity in offspring cardiomyocytes.

METHODS: Wistar rats (n=8) were supplemented with dietary resveratrol during pregnancy. Upon the offspring’s birth, hearts (9-11) were used to obtain the primary culture of cardiomyocytes. DOX-induced cardiotoxicity and the effects of resveratrol supplementation were evaluated by oxidative stress markers, such as dichlorofluorescein diacetate oxidation, decrease in the activity of antioxidant enzymes, and oxidation of total sulfhydryl content, in addition to cell viability evaluation, DNA damage generation, and DNA damage repair response. A value of p<0.05 was considered statistically significant.

RESULTS: Neonatal cardiomyocytes from resveratrol supplemented rats exhibiting an increase (p<0.01) in cell viability and lower (p<0.0001) apoptotic/necrotic cells after DOX treatment, which correlates with the activities of antioxidant enzymes and dichlorofluorescein production. Moreover, resveratrol protected cardiomyocytes from DOX-induced DNA damage, showing a decrease (p<0.05) in DNA breaks induced by oxidative stress, evaluated by the activity of DNA-repair enzymes endonuclease III and formamidopyrimidine glycosylase. Supplementation with resveratrol increased (p<0.05) the expression of the repair protein Sirt6 in the cardiomyocytes of the pups.

CONCLUSION: This research indicates that supplementation with resveratrol during the gestational period has a notable cardioprotective effect on the offspring’s heart against DOX-induced toxicity, which may well be due to its antioxidant function, and the increase in the DNA damage repair response.

PMID:34644787 | DOI:10.36660/abc.20200752

Arq Bras Cardiol. 2021 Oct 8:S0066-782X2021005017202. doi: 10.36660/abc.20200475. Online ahead of print.

ABSTRACT

BACKGROUND: In 2007, the United States Food and Drug Administration mandated safety reviews of commercially available echocardiographic contrast agents (ECA), following reports of death. During the past years, different studies have proven the safety of ECA, but there have been few studies on SonoVue®.

OBJECTIVES: To evaluate the safety of SonoVue® during pharmacological stress echocardiography (PSE), by analyzing the incidence of allergic reactions and comparing groups regarding the appearance of arrhythmia, minor side effects and adverse events.

METHODS: In this observational, prospective study, 2346 patients underwent PSE, and they were divided into the following 2 groups: group 1 with ECA (n = 1099) and group 2 without ECA (n = 1247). Patients were evaluated during PSE, at 24 hours, and at 30 days. Statistical significance was defined as p < 0.05.

RESULTS: Group 1 had fewer minor side effects, such as headache (5/0.5% versus 19/1.5%, p = 0.012) and less reactive hypertension (3/0.3% versus 19/1.5%, p = 0.002); fewer arrhythmias, such as ventricular extrasystoles (180/16.4% versus 247/19.8%, p = 0.032) and paroxysmal supraventricular tachycardia (2/0.2% versus 15/1.2%, p = 0.003); and no adverse events, such as acute myocardial infarction (AMI) or death. In group 2, 1 patient had AMI in < 24 hours (1/01%), and there were 2 deaths in < 30 days (2/0.1%). SonoVue®-related urticaria was seen in 3 (0.3%) patients, without anaphylactic reaction.

CONCLUSION: SonoVue® demonstrated safety during PSE. No cases of death, AMI, or anaphylactic reaction were observed. There was a lower incidence of minor side effects and arrhythmias in the group that received ECA, as well as a low incidence of mild allergic reactions.

PMID:34644784 | DOI:10.36660/abc.20200475

Epidemiol Serv Saude. 2021 Oct 8;30(4):e2021167. doi: 10.1590/S1679-49742021000400013. eCollection 2021.

ABSTRACT

OBJECTIVE: To evaluate the completeness and concordance of infant deaths from congenital syphilis in the Metropolitan Region of Sao Paulo, Brazil, between 2010 and 2017.

METHODS: This was a descriptive study based on linkage between the Mortality Information System (SIM) and the Live Birth Information System (SINASC). Deaths with mention of congenital syphilis in multiple causes of death were analyzed. The completeness of 11 SIM variables was analyzed and SINASC was adopted as the reference. The Kappa statistic was used to analyze concordance.

RESULTS: There were 134 recorded congenital syphilis deaths, 132 of which were linked. 67 had congenital syphilis as the underlying cause, while 65 involved multiple causes of death, indicating underestimated congenital syphilis mortality. After linkage, the number of variables with excellent completeness increased from two to ten.

CONCLUSION: Linking SIM with SINASC data improved completeness. The magnitude of congenital syphilis mortality was found to be underestimated, and the use of multiple causes improved its measurement.

PMID:34644778 | DOI:10.1590/S1679-49742021000400013

Arq Bras Cardiol. 2021 Oct 8:S0066-782X2021005017201. doi: 10.36660/abc.20200399. Online ahead of print.

ABSTRACT

BACKGROUND: Long-term prognosis post-acute coronary syndrome (ACS) in secondary care is not well-known. The severity of coronary artery disease (CAD) as a predictor of long-term mortality was evaluated in a community hospital in Brazil.

OBJECTIVE: We aimed to compare short and long-term prognosis after an ACS event according to severity of obstructive disease in patients attended in a secondary community hospital from prospective CAD cohort in Brazil (the Strategy of Registry of Acute Coronary Syndrome, ERICO study).

METHODS: Survival analyses were performed by Kaplan-Meier curves and Cox proportional hazard models (hazard ratios (HR) with respective 95% confidence interval (CI) to evaluate cumulative all-cause, CVD and CAD mortality according the coronary artery obstruction: no-obstruction (reference group), 1-vessel-disease, 2-vessel-disease, multivessel-disease) among 800 adults from an ERICO study during a 4-year-follow-up. HR are presented as crude and further adjusted for potential confounders from 180 days to 4-year follow-up after ACS. A p-value <0.05 was considered statistically significant.

RESULTS: Poorer survival rates were detected among individuals with multivessel-disease (all-cause, CVD and CAD, p-log rank< 0.0001). After multivariate adjustments, multivessel-disease |(HR; 2.33 (CI 95%; 1.10-4.95)) and 1-vessel-disease obstructed (HR; 2.44 (CI 95%; 1.11-5.34)) had the highest risk for all-cause mortality compared to those with no obstruction at 4-year follow-up.

CONCLUSIONS: Not only multivessel-disease, but also 1-vessel-disease patients showed a high long-term mortality risk post-ACS. These findings highlight the importance of having a better approach in the treatment and control of cardiovascular risk even in apparently low-risk individuals attended to in secondary care.

PMID:34644783 | DOI:10.36660/abc.20200399

Cad Saude Publica. 2021 Oct 8;37(10):e00084819. doi: 10.1590/0102-311X00084819. eCollection 2021.

ABSTRACT

Health literacy (HL) assumes individuals’ knowledge, motivation, and competencies to access, understand, evaluate, and apply health information to make judgments and decisions in daily life, related to healthcare, prevention of diseases, and health promotion to maintain or improve quality of life. The study aimed to measure the level of HL and associated factors: sex, age, schooling, income, skin color, self-rated health status, type of diabetes, and presence of comorbidities. The authors assessed 107 adults with diabetes followed at a public outpatient clinic in the city of Rio de Janeiro, Brazil. The sample did not include first-time patients, patients without a diagnosis of diabetes, or with visual or hearing impairment. HL was assessed with the Brazilian version of the European Health Literacy Survey (HLS-EU-BR). Simple and multiple ordinal logistic regression models were constructed, considering four levels of HL as the dependent variables. The associations were expressed as odds ratios (OR). Approximately 95% of the sample showed poor or limited HL (94.8%; 95%CI: 90.3-99.3). Female gender, older age, and lower schooling were associated with lower odds of excellent HL. In the adjusted model, only schooling remained statistically significant in its effect on HL (adjusted OR = 0.41; 95%CI: 0.17-0.98; p < 0.05). Schooling was the characteristic most strongly related to level of HL.

PMID:34644752 | DOI:10.1590/0102-311X00084819