Category: Nevin Manimala

Am J Trop Med Hyg. 2021 Jul 19:tpmd210266. doi: 10.4269/ajtmh.21-0266. Online ahead of print.

ABSTRACT

Annually, about 2.7 million snakebite envenomings occur worldwide, primarily affecting those living in rural regions. Effective treatment exists but is scarce, and traditional treatments are commonly used. To inform context-specific policies in Kenya, this study aimed to determine the health-seeking behavior and the health, social, and economic burden of snakebites in rural communities. Nonprobability sampling was used to survey 382 respondents from four snakebite-endemic counties, from February to August 2020, using a structured questionnaire. Descriptive statistics, Fisher’s exact tests, binary logistic regressions, and Mantel-Haenszel tests were used for analysis. Life-time experience with snakebites included 13.1% of respondents who reported being personally bitten and 37.4% who reported knowing of a community member being bitten. Respondents reported death after a snakebite in 9.1% of bitten community members and in 14.6% of bitten family members. Risk of snakebite was not significantly associated with sex, educational level, or occupation. Snakebite victims were most often walking (38%) or farming (24%) when bitten. Of those bitten, 58% went to a health facility, 30% sought traditional treatment, and 12% first went to a traditional healer before visiting a facility. Significant differences existed in perceptions on the financial consequences of snakebites among those who had been personally bitten and those who had observed a snakebite. Most commonly mentioned preventive measures were wearing shoes and carrying a light in the dark. Community engagement, including engagement with traditional healers, is needed to reduce snakebites. This should be done through education and sensitization to improve used preventive measures and effective health-seeking behavior.

PMID:34280130 | DOI:10.4269/ajtmh.21-0266

PLoS Genet. 2021 Jul 19;17(7):e1009665. doi: 10.1371/journal.pgen.1009665. Online ahead of print.

ABSTRACT

Wright’s inbreeding coefficient, FST, is a fundamental measure in population genetics. Assuming a predefined population subdivision, this statistic is classically used to evaluate population structure at a given genomic locus. With large numbers of loci, unsupervised approaches such as principal component analysis (PCA) have, however, become prominent in recent analyses of population structure. In this study, we describe the relationships between Wright’s inbreeding coefficients and PCA for a model of K discrete populations. Our theory provides an equivalent definition of FST based on the decomposition of the genotype matrix into between and within-population matrices. The average value of Wright’s FST over all loci included in the genotype matrix can be obtained from the PCA of the between-population matrix. Assuming that a separation condition is fulfilled and for reasonably large data sets, this value of FST approximates the proportion of genetic variation explained by the first (K – 1) principal components accurately. The new definition of FST is useful for computing inbreeding coefficients from surrogate genotypes, for example, obtained after correction of experimental artifacts or after removing adaptive genetic variation associated with environmental variables. The relationships between inbreeding coefficients and the spectrum of the genotype matrix not only allow interpretations of PCA results in terms of population genetic concepts but extend those concepts to population genetic analyses accounting for temporal, geographical and environmental contexts.

PMID:34280184 | DOI:10.1371/journal.pgen.1009665

PLoS Med. 2021 Jul 19;18(7):e1003707. doi: 10.1371/journal.pmed.1003707. eCollection 2021 Jul.

ABSTRACT

BACKGROUND: Angiotensin receptor blockers (ARBs) may have protective effects against dementia occurrence in patients with hypertension (HTN). However, whether telmisartan, an ARB with peroxisome proliferator-activated receptor γ (PPAR-γ)-modulating effects, has additional benefits compared to other ARBs remains unclear.

METHODS AND FINDINGS: Between 1997 and 2013, 2,166,944 type 2 diabetes mellitus (T2DM) patients were identified from the National Health Insurance Research Database of Taiwan. Patients with HTN using ARBs were included in the study. Patients with a history of stroke, traumatic brain injury, or dementia were excluded. Finally, 65,511 eligible patients were divided into 2 groups: the telmisartan group and the non-telmisartan ARB group. Propensity score matching (1:4) was used to balance the distribution of baseline characteristics and medications. The primary outcome was the diagnosis of dementia. The secondary outcomes included the diagnosis of Alzheimer disease and occurrence of symptomatic ischemic stroke (IS), any IS, and all-cause mortality. The risks between groups were compared using a Cox proportional hazard model. Statistical significance was set at p < 0.05. There were 2,280 and 9,120 patients in the telmisartan and non-telmisartan ARB groups, respectively. Patients in the telmisartan group had a lower risk of dementia diagnosis (telmisartan versus non-telmisartan ARBs: 2.19% versus 3.20%; HR, 0.72; 95% CI, 0.53 to 0.97; p = 0.030). They also had lower risk of dementia diagnosis with IS as a competing risk (subdistribution HR, 0.70; 95% CI, 0.51 to 0.95; p = 0.022) and with all-cause mortality as a competing risk (subdistribution HR, 0.71; 95% CI, 0.53 to 0.97; p = 0.029). In addition, the telmisartan users had a lower risk of any IS (6.84% versus 8.57%; HR, 0.79; 95% CI, 0.67 to 0.94; p = 0.008) during long-term follow-up. Study limitations included potential residual confounding by indication, interpretation of causal effects in an observational study, and bias caused by using diagnostic and medication codes to represent real clinical data.

CONCLUSIONS: The current study suggests that telmisartan use in hypertensive T2DM patients may be associated with a lower risk of dementia and any IS events in an East-Asian population.

PMID:34280191 | DOI:10.1371/journal.pmed.1003707

J Med Internet Res. 2021 Jul 9. doi: 10.2196/28975. Online ahead of print.

ABSTRACT

BACKGROUND: The use of the Internet and web-based platforms to obtain public health information and manage health-related issues has become widespread in this digital age. The practice is so pervasive that the first reaction to obtaining health information is to ‘google it.’ As SARS-CoV-2 broke out in Wuhan, China, in December 2019, and quickly spread worldwide, people flocked to the Internet to learn about the novel coronavirus and the disease, COVID-19. Lagged response by governments and public health agencies to prioritize the Internet and the World Wide Web to disseminate information about the coronavirus outbreak and building trust gave room for others to quickly populate the social media, online blogs, news outlets, and websites with misinformation and conspiracy theories about the COVID-19 pandemic resulting in people’s deviant behaviors towards public health safety measures.

OBJECTIVE: To determine what people learned about the COVID-19 pandemic through “web search;” examine any association between what people learned about COVID-19 and behavior towards the public health guidelines; and analyze the impact of misinformation and conspiracy theories about the COVID-19 pandemic on people’s behavior towards public health measures.

METHODS: This paper undertakes an infodemiology study using the Google trends worldwide search index covering the first six months after the SARS-CoV-2 outbreak (January 1st, to June 30th, 2020) when the public scrambled for information about the pandemic. Data analysis employed statistical trends, correlation and regression, principal component analysis, and predictive models.

RESULTS: (i). The principal components analysis identifies two latent variables comprising past coronavirus epidemics (pastCoVepidemics) and the ongoing COVID-19 pandemic (presCoVpandemic). Both principal components (PCs) were utilized significantly to learn about SARS-CoV-2 and COVID-19 and explained 88.78% variability. (ii). Three (3) PCs fuelled misinformation about COVID-19 [Misinformation(“Biological Weapon,” “VirusHoax,” “CommonCold,” “COVID-19Hoax,” “ChinaVirus”); ConspTheory1(“@5G”); ConspTheory1(“IngestBleach”)]. These PCs explained 84.85% of the variability, (iii). Two (2) PCs identified two components of public health measures [PubHealthMes1(“Social Distancing,” “WashHand,” “Isolation,” “Quarantine.”); PubHealthMes2(“WearMask”), which explained 84.7% of the variability. (iv). Based on the PCA results, log-linear, and predictive models [ConspTheory1(@5G)] is identified as a predictor of people’s behavior towards public health measures (PubHealthMes2). Although (r=0.83), (r=-0.11) for Misinformation(COVID-19Hoax, VirusHoax, CommonCold, and more) and ConspTheory2 (Ingestbleach), respectively, with PubHealthMes1(social dist, handwash, isolation, and more), both were not statistically significant with (p=0.267), (p=0.13), respectively.

CONCLUSIONS: Several studies focus on the impacts of social media and related platforms on spreading misinformation and conspiracy theories. This study provides the first empirical evidence to the mainly anecdotal discourse on the use of web search to learn about SARS-CoV-2 and COVID-19.

PMID:34280117 | DOI:10.2196/28975

J Med Internet Res. 2021 Jul 14. doi: 10.2196/30709. Online ahead of print.

ABSTRACT

BACKGROUND: In response to the COVID-19 pandemic, experts in mental health science emphasized the importance of developing and evaluating approaches to support and maintain the mental health of older adults.

OBJECTIVE: To assess whether a group-based exercise program relative to a personal exercise program (both delivered online) and wait-list control (WLC) can improve the psychological health of previously low active older adults during the early stages of the COVID-19 pandemic.

METHODS: The Seniors COvid-19 Pandemic and Exercise (SCOPE) Trial was a 3-arm, parallel randomized controlled trial conducted between May and September 2020 in which low active older adults (aged ≥ 65 years) were recruited via media outlets and social media. After baseline assessments, consented participants were randomized to one of two 12-week exercise programs (delivered online by older adult instructors) or a waitlist control condition. 241 older adults (n= 187 women) provided baseline measures (via online questionnaires), were randomized (Ngroup = 80, Npersonal = 82 Ncontrol = 79), and completed measures every two weeks for the duration of the trial. The trial’s primary outcome was psychological flourishing. Secondary outcomes included global measures of mental and physical health, life satisfaction and depression symptoms.

RESULTS: The results of latent growth modeling revealed no intervention effects for flourishing, life satisfaction, or depression symptoms (Ps> .05). Participants in the group condition displayed improved mental health relative to WLC participants over the first 10 weeks (ES = .288 to .601), and although the week 12 effect (ES = .375) was in the same direction the difference was not statistically significant (P >. 05). Participants in the personal condition displayed improved mental health, when compared to WLC participants, in the same medium effect size range (ES = .293 to .565) over the first 8 weeks, and while the effects were of a similar magnitude at weeks 10 (ES = .455) and 12 (ES = .258) they were not statistically significant (P >.05). In addition, participants in the group condition displayed improvements in physical health when compared to the WLC (ES = .079 to .496) across all 12 weeks of the study following baseline. No differences were observed between the personal exercise condition and WLC for physical health (P>.05).

CONCLUSIONS: There were no intervention effects for the trial’s primary outcome, psychological flourishing. It is possible that the high levels of psychological flourishing at baseline may have limited the extent to which those indicators could continue to improve further through intervention (i.e., potential ceiling effects). However, the intervention effects for mental and physical health point to the potential capacity of low-cost and scalable at-home programs to support the mental and physical health of previously inactive adults in the COVID-19 pandemic.

CLINICALTRIAL: ClinicalTrials.gov Identifier: NCT04412343, https://clinicaltrials.gov/ct2/show/NCT04412343.

PMID:34280121 | DOI:10.2196/30709

J Pain Palliat Care Pharmacother. 2021 Jul 19:1-13. doi: 10.1080/15360288.2021.1883789. Online ahead of print.

ABSTRACT

We evaluated the economic impact associated with preoperative meloxicam IV 30 mg vs placebo administration among adult total knee arthroplasty (TKA) recipients enrolled in Phase IIIB NCT03434275 trial. Data on total hospital costs and length of stay (LOS) obtained from the trial were compared between meloxicam IV 30 mg and placebo groups. Patients in the meloxicam IV 30 mg vs placebo group (n = 93 vs 88) incurred an adjusted $2,266 (95% CI: -$1,035, $5,116; p = 0.1689) lower total hospital costs and an adjusted 8.6% (95% confidence interval [CI]: -2.0%, 18.1%; p = 0.1082) shorter LOS. While statistically non-significant, based on 95% CIs, the results from this sub-study may suggest a favorable impact associated with meloxicam IV 30 mg on hospital costs and LOS.

PMID:34280067 | DOI:10.1080/15360288.2021.1883789

J Med Internet Res. 2021 Jun 9. doi: 10.2196/29576. Online ahead of print.

ABSTRACT

BACKGROUND: In general, early intervention based on early diagnosis of the disease is considered to be very important for improving the health outcome. However, there is still not enough evidence of how medical care that is based on the early diagnosis of confirmed cases can affect the COVID-19 treatment outcomes.

OBJECTIVE: Accordingly, we aimed to investigate the effects of the duration from the onset of clinical symptoms to confirmation on the duration to the resolution of COVID-19 (release from quarantine).

METHODS: For preliminary data collection, we performed data crawling to extract data from social networks, blogs, and official websites operated by local governments. We collected data from the 4,002 confirmed cases from 33cities reported until May 31, 2020, for whom sex and age information could be verified. Subsequently, 2,494 patients with unclear symptom onset date and 1,349 patients who had not been released or had no data about the release date were excluded. Thus, 159 patients were finally included in this study. To investigate whether rapid confirmation reduces the prevalence period, we divided the duration from symptoms to confirmation (S2C) into quartiles, 1Q, 2Q, 3Q, and 4Q, of ≤1, ≤3, ≤6, and ≥7 days. We investigated the duration from symptoms to release (S2R) and confirmation to release (C2R) according to these quartiles. Furthermore, we performed multiple regression analysis to investigate the effects of rapid confirmation after symptom onset on the treatment period, duration of prevalence, and the duration until the release from isolation.

RESULTS: We performed multiple regression analysis to investigate the association between rapid confirmation after symptom onset and the total prevalence period (faster release from isolation). S2C showed a negative association with C2R (T-value = -3.58; p<0.001) and a positive association with S2R (T-value = 5.86; p<0.001) that were statistically significant.

CONCLUSIONS: Duration from symptom onset to the confirmation date is an important variable for predicting prevalence, and these results support the hypothesis that rapid S2C could reduce S2R.

PMID:34280114 | DOI:10.2196/29576

J Med Chem. 2021 Jul 19. doi: 10.1021/acs.jmedchem.1c00890. Online ahead of print.

ABSTRACT

Selective cyclooxygenase (COX)-2 inhibitors have been extensively studied for colorectal cancer (CRC) chemoprevention. Celecoxib has been reported to reduce the incidence of colorectal adenomas and CRC but is also associated with an increased risk of cardiovascular events. Here, we report a series of gut-restricted, selective COX-2 inhibitors characterized by high colonic exposure and minimized systemic exposure. By establishing acute ex vivo ¹⁸F-FDG uptake attenuation as an efficacy proxy, we identified a subset of analogues that demonstrated statistically significant in vivo dose-dependent inhibition of adenoma progression and survival extension in an APC^min/+ mouse model. However, in vitro-in vivo correlation analysis showed their chemoprotective effects were driven by residual systemic COX-2 inhibition, rationalizing their less than expected efficacies and highlighting the challenges associated with COX-2-mediated CRC disease chemoprevention.

PMID:34279934 | DOI:10.1021/acs.jmedchem.1c00890

Genet Test Mol Biomarkers. 2021 Jul;25(7):504-514. doi: 10.1089/gtmb.2020.0093.

ABSTRACT

Objective: This study was designed to analyze the expression of CSNK1D in hepatocellular carcinoma (HCC) and investigate the relationship between the expression of CSNK1D and the prognosis of HCC patients. Methods: The CSNK1D and alpha-fetoprotein (AFP) expression levels in patients with HCC and their corresponding clinical data were downloaded from The Cancer Genome Atlas (TCGA) and sorted with a Perl program. CSNK1D and AFP expression differences in liver tissue and liver cancer were compared and analyzed, based on the online database human cancer metastasis database, the relationships between the expression levels of CSNK1D and AFP and the proliferation and metastases of HCC were explored. The immunohistochemical data obtained from the Human Protein Atlas Database further verified the differences in the expression levels of CSNK1D and AFP in liver tissues and liver cancer tissues. Through Kaplan-Meier survival analysis, the effects of CSNK1D and AFP expression levels on the prognosis of patients with HCC were investigated, and the influences of and patients’ gender, age and grades of cancer cells, tumor size, the status of lymph node metastasis, distant metastasis, and tumor stage on the expression of CSNK1D were analyzed with R language. The influence of differential expressions of CSNK1D on survival time was compared and the prognostic factors influencing the survival of HCC patients were statistically explored by univariate analysis and multivariate analysis. The potential influencing mechanism of CSNK1D on the prognosis of HCC patients was explored by Gene Set Enrichment Analysis (GSEA) enrichment. Results: The expression level of CSNK1D and AFP in cancer foci was significantly higher than that in normal tissues, However, in the same patient, the expression levels of AFP in paracarcinoma tissues and cancer tissues showed no significant difference. The expression level of CSNK1D in HCC with distant metastases was higher than that in those without metastasis, but the expression level of AFP in metastatic HCC was lower than that in those HCC without metastases. In immunohistochemical tests, CSNK1D was moderately positive in normal liver tissues, slightly positive in normal bile duct tissues, and highly positive in HCC. AFP was slightly positive in normal liver tissues and negative in HCC, but it was not detected in normal intrahepatic bile duct tissue. Survival analysis results suggested that the higher expression level of CSNK1D corresponded to the shorter survival period, whereas the expression level of AFP showed no significant influence on survival time. The expression level of CSNK1D was not correlated with gender, age, the status of lymph node metastasis status, or distant metastasis of patients. The main factors influencing the expression level of CSNK1D included tumor size, cancer cell grade, and tumor stage. The expression levels of CSNK1D in T2 and T3 were higher than that in T1. The expression levels of CSNK1D in G3 and G4 were higher than that in G1. The expression levels of CSNK1D in Stage II and Stage III were higher than that in Stage I. Univariate analysis suggested that tumor size, cell grade, distant metastasis, clinical stage, and CSNK1D expression level were the prognostic factors influencing the survival of patients. Multivariate analysis suggested that CSNK1D expression level was an independent factor influencing the prognosis of HCC patients. GSEA enrichment analysis indicated that CSNK1D mainly affected the prognosis of HCC patients through cell cycle, WNT signaling pathway, amino acid degradation metabolism, and other pathways. Conclusion: CSNK1D is an independent influencing factor for the prognosis of HCC patients and has the potential to be developed as a potential therapeutic target for HCC, and better than AFP in predicting the prognosis of HCC.

PMID:34280005 | DOI:10.1089/gtmb.2020.0093

Neuro Endocrinol Lett. 2021 Jul 19;42(3):200-212. Online ahead of print.

ABSTRACT

BACKGROUND: Emotionally unstable personality disorder (EUPD) is a challenging condition with a prevalence of 20% in inpatient services. Psychotherapy is the preferred treatment; nevertheless, off-license medications are widely used.

OBJECTIVES: To identify socio-demographics, clinical and service-delivery characteristics of people with EUPD admitted to inpatient services between 1st January 2017 and 31st December 2018.

METHODS: A retrospective review using data from patients’ records. Individuals, age 18-65 were included. Statistical analysis was conducted by the Mann-Whitney-Wilcoxon test and Chi-squared test with Yates’s continuity correction.

RESULTS: Of 1646 inpatients, 201 (12.2%); had the diagnosis of EUPD; 133 (66.0%) women, 68 (44.0%). EUPD was significantly (P < .001) more prevalent in women (18.2%) than men (7.4%). EUPD patients were significantly (P < .001) younger (32.2 years) than patients without EUPD (46 years), and had significantly (P < .001) more admissions (1.74) than patients without EUPD (1.2 admission). 70.5% of patients had one and 17.0% two Axis-I psychiatric co-morbidities. Substance use was significantly (P < .001) more often in men (57.3%) than in women (28.5%). Significantly (P = 0.047) more women (68.4%) than men (53.0%) reported sexual abuse. 87.5% used polypharmacy. Antidepressants were significantly (P = 0.02) often prescribed to women (76.6%) than men (69.1%). Significantly (P = 0.02) more women (83.5%) than men (67.6%) were on antipsychotics. 57.2% of the patients were on anxiolytics, 40.0% on hypnotics and 25.8% on mood stabilisers.

CONCLUSION: EUPD is a complex condition with widespread comorbidity. The term EUPD, Borderline Personality Disorder is unsuitable, stigmatising and too simplistic to reflect the nature, gravity and psychopathology of this syndrome.

PMID:34279863