Category: Nevin Manimala

Eur J Obstet Gynecol Reprod Biol. 2021 Jun 14;263:62-66. doi: 10.1016/j.ejogrb.2021.06.012. Online ahead of print.

ABSTRACT

OBJECTIVE: To learn the influence of obstetrics and gynecology (OB/GYN) female residents’ lifestyle on obstetric and gynecological characteristics compared to women matched by age from the general population.

STUDY DESIGN: A cross-sectional multicenter study including OB/GYN female residents from ten different hospitals in Israel, who completed an internet questionnaire published during 2017-2018, that were compared to women matched by age from the general population. Questions dealt with lifestyle habits, obstetrical and gynecological outcomes. Data are presented as median and inter-quartile range.

RESULTS: During the study period 97 women completed the questionnaire, of them 56 (57.7%) OB/GYN female residents and 41(42.3%) controls. No statistically significant differences were found between the groups regarding age, marital status, gravidity and parity. However, lifestyle characteristics reported by OB/GYN female residents differed compared to controls: OB/GYN female residents found their work more stressogenic [53 (94.6%) vs. 20 (48.8%); p = 0.001], suffered from deprived sleep [42(75.6%) vs. 13(31.8%); p = 0.001], were less punctilious on dental hygiene [13(23.2%) vs. 27(65.8%); p = 0.001] and reported maintaining a less healthy diet [35(62.5%) vs. 15(36.6%); p = 0.003]. Despite these differences, general happiness reported by both groups was comparable (35(62.5%) vs. 27(65.9%) for OB/GYN and control women respectively; p = 0.73). Pregnancy rate was found to be more than double in the resident’s group [30 (53.6%) vs. 9 (22%); p = 0.002], with no differences in the rates of: complications during pregnancy [51(91.1%) vs. 38(92.7%); p = 0.78]; abortions [10 (17.9%) vs. 8 (19.5%); p = 0.84]; augmentation of labor [5 (9%) vs. 7 (17.1%); p = 0.18]; or cesarean deliveries [7(12.5%) vs. 7(17%); p = 0.48]. Logistic regression analysis found both parity and residency as independent variables significantly associated with pregnancy rate [(B = 0.69, p = 0.047), (B = 1.95, p = 0.016), respectively].

CONCLUSION: Although resident women in OB/GYN reported on more adverse lifestyle parameters, comparable obstetric and gynecological outcomes were seen, with residency and parity being independently associated with higher pregnancy rate.

PMID:34167035 | DOI:10.1016/j.ejogrb.2021.06.012

Eur J Obstet Gynecol Reprod Biol. 2021 Jun 12;263:67-71. doi: 10.1016/j.ejogrb.2021.06.009. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate the impact of vaginally prasterone administration on postmenopausal women with genitourinary syndrome of menopause (GSM) affected by overactive bladder syndrome (OAB). A secondary aim of this study was to assess the efficacy of prasterone on VVA and quality of life (QoL).

STUDY DESIGN: Thirty-two postmenopausal women with GSM and referred OAB symptoms received treatment with daily intravaginal prasterone 6.5 mg. We assessed urinary symptoms through approved ICIQ-OAB and ICIQ-UI questionnaires on incontinence. Women were also screened by the Vaginal Health Index (VHI) to investigate the vulvovaginal atrophy (VVA). Quality of life (QoL) was assessed by the SF-12 Health Survey. Each questionnaire was administrated at baseline (T0) and after a 12-week treatment (T1).

RESULTS: Incontinence questionnaires showed improvement at T1 (from 7.8 ± 2.7 to 2.7 ± 2.2, p < 0.001). Even if women referred an improvement of daily urine although the women reported improvement in daily urine leaks, their urine leak amount did not improve statistically significant [T0 (28.6%) Vs T1 (14.3%), p < 0.16]. Prasterone therapy improved significantly the VHI [T1(21 ± 3.7) Vs T0 (10.8 ± 4.1), p < 0.001]. Finally, women had a statistically significant improvement both in Mental [T1(49.9 ± 11.2) Vs T0 (42 ± 9.2), p < 0.009],) and Physical Health [T1(47.1 ± 9.1) Vs T0 (38.6 ± 8.4), p < 0.006], domains of the SF-12 questionnaire. No women referred side effects.

CONCLUSION: Prasterone is an inactive precursor converted into estrogens and androgens into vaginal tissue. It leads to positive effects on VVA through the activation of the vaginal androgen and estrogen receptors. Empirical evidence in this study suggests that intravaginal 6.5 mg prasterone administration could be an effective treatment for postmenopausal women with GMS affected by OAB.

PMID:34167036 | DOI:10.1016/j.ejogrb.2021.06.009

Clin Imaging. 2021 Jun 18;77:276-282. doi: 10.1016/j.clinimag.2021.06.018. Online ahead of print.

ABSTRACT

PURPOSE: Racial and ethnic disparities have exacerbated during the COVID-19 pandemic as the healthcare system is overwhelmed. While Hispanics are disproportionately affected by COVID-19, little is known about ethnic disparities in the hospital settings. This study investigates imaging utilization and clinical outcomes between Hispanic and non-Hispanic COVID-19 patients in the Emergency Department (ED) and during hospitalization.

METHODS: Through retrospective chart review, we included 331 symptomatic COVID-19 patients (mean age 53.2 years) at a metropolitan healthcare system from March to June 2020. Poisson regression was used to compare diagnostic imaging utilization and clinical outcomes between Hispanic and non-Hispanic patients.

RESULTS: After adjusting for confounders, no statistically significant difference was found between Hispanic and non-Hispanic patients for the number of weekly chest X-rays. Results were categorized into four clinical outcomes: ED management (0.16 ± 0.05 vs. 0.14 ± 0.8, p:0.79); requiring inpatient management (1.31 ± 0.11 vs. 1.46 ± 0.16, p:0.43); ICU admission without invasive ventilation (1.4 ± 0.17 vs. 1.35 ± 0.26, p:0.86); and ICU admission and ventilator support (3.29 ± 0.22 vs. 3.59 ± 0.37, p:0.38). There were no statistically significant relative differences in adjusted prevalence rate between ethnic groups for all clinical outcomes (p > 0.05). There was a statistically significant longer adjusted length of stay (days) in non-Hispanics for two subcohorts: inpatient management (8.16 ± 0.31 vs. 9.72 ± 0.5, p < 0.01) and ICU admission without invasive ventilation (10.39 ± 0.57 vs. 13.45 ± 1.13, p < 0.01).

CONCLUSIONS: For Hispanic and non-Hispanic COVID-19 patients in the ED or hospitalized, there were no statistically significant differences in imaging utilization and clinical outcomes.

PMID:34167069 | DOI:10.1016/j.clinimag.2021.06.018

Mult Scler Relat Disord. 2021 Jun 15;53:103082. doi: 10.1016/j.msard.2021.103082. Online ahead of print.

ABSTRACT

BACKGROUND: Multiple sclerosis (MS) is a chronic, demyelinating disease of the central nervous system (CNS). T cells and B lymphocytes are involved in the development of this disease.

METHODS: The following biomarkers were determined in peripheral blood in 28 patients treated with glatiramer acetate (GA) and 21 patients treated with interferon beta 1-a (IFN): IL-10, BAFF, Mx1, IgG, IgG1, IgG2, IgG3 and IgG4 (at baseline and after 6 months of treatment). All participants had confirmed MS diagnosis.

OBJECTIVES: The primary objective is to assess a percentual change of biomarkers after 6 months since the first-line treatment initiation with GA or IFN. The secondary objective is to explore correlations between the baseline biomarkers’ values (levels).

RESULTS: A positive trend was observed in the increase in IL-10 concentration by 30.33 % (IFN) and by 15.65 % (GA). In the IFN group, we observed a statistically significant increase in the BAFF protein concentration by 29.9% (P < 0.001). We found that Mx1 protein levels did not change with the administration of GA, which can be explained by the different mechanisms of action of GA. The serum levels of IgG immunoglobulins and both IgG1 and IgG4 subclasses in both groups of patients were increased. Thus, our data were in accordance with the generally accepted assumption that both IFN and GA are capable of modulating the B cell system.

CONCLUSIONS: Our results suggest that treatment with IFN and GA has a more pronounced influence on the B cell system of MS.

PMID:34166982 | DOI:10.1016/j.msard.2021.103082

Int Emerg Nurs. 2021 Jun 21;57:101015. doi: 10.1016/j.ienj.2021.101015. Online ahead of print.

ABSTRACT

BACKGROUND: Assessment and reassessment of self reported pain intensity scores form the basis of acute pain care in the emergency deprtment (ED), however are frequently undocumented. The effects of not documenting pain assessments on time to first analgesic medication (TTA) and ED length of stay (EDLOS) are unknown.

METHODS: This is a retrospective cross-sectional study to investigate the association between documented evidence of pain intensity scores, TTA and EDLOS in the ED. It also examined the factors associated with the documentation of pain intensity scores. Univariate and multivariable modelling was used on a random sample of presentations.

RESULTS: There were no statistically significant associations between the documented evidence of pain intensity scores and TTA or EDLOS. Modelling suggests that patients were less likely to have documented evidence of pain intensity scores if they were male, were streamed to the fast-track treatment area, had a lower burden of co-morbidities, or when the general departmental workload was increased.

CONCLUSIONS: The documentation of pain intensity scores was not associated with TTA or EDLOS. Some demographic, illness and workload factors are associated with the lack of pain intensity score documentation, however, the effect on patients outcomes needs further investigation.

PMID:34166989 | DOI:10.1016/j.ienj.2021.101015

Eur J Obstet Gynecol Reprod Biol. 2021 Jun 6;263:56-61. doi: 10.1016/j.ejogrb.2021.05.046. Online ahead of print.

ABSTRACT

OBJECTIVE: Pre-eclampsia is associated with an increased risk of future cardiovascular disease. Maladaptive placentation or malperfusion, as well as predisposing cardiovascular or metabolic risk for endothelial dysfunction, contribute to the systemic inflammatory response that establishes the origins of the disease. The purpose of this study was to investigate the relationship between placental size and cardiovascular risk when assessed at six months postpartum in women who experienced pre-eclampsia.

STUDY DESIGN: Maternal clinical and biochemical cardiovascular risk factors were used to categorize preeclamptic women into high vs. low lifetime cardiovascular disease risk profiles at six months postpartum. A multivariable logistic regression model was then used to identify the association between placental weight to birth weight ratio and high lifetime cardiovascular disease risk, adjusting for maternal age, pre-pregnancy BMI, and severity of pre-eclampsia. A p-value of < 0.05 was deemed statistically significant.

RESULTS: 186/216 women with pre-eclampsia who attended the Maternal Health Clinic met inclusion criteria. No significant differences were observed for placental morphometric measurements between women who screened as having a high vs. low lifetime risk profile for cardiovascular disease at six months postpartum. However, using multivariable modelling that controlled for maternal age, pre-pregnancy body mass index, gestational age at delivery, and severity of pre-eclampsia, a low placenta to birth weight ratio (<15%) was associated with an increased odds of high lifetime cardiovascular disease risk (p < 0.009).

CONCLUSION: The findings of the current study identify clinical measurements that can be collected at the time of delivery which may help identify specific women who may benefit most from postpartum cardiovascular risk screening and intervention.

PMID:34167034 | DOI:10.1016/j.ejogrb.2021.05.046

Food Chem. 2021 Jun 1;363:130179. doi: 10.1016/j.foodchem.2021.130179. Online ahead of print.

ABSTRACT

BACKGROUND: Daily variations of macro- and trace-elements in human milk (HM) are not well characterised and sampling protocols are highly variable between studies.

OBJECTIVES: To investigate diurnal and within-feed variation of HM macro- and trace-elements using pre- and post- feed concentrations and to compare infant intake estimates using limited samples with measured 24-hour intake.

METHODS: HM Samples were collected pre- and post- every feed in a 24-hour period from 11 mother-infant dyads. Test-weighing was used to determine the volume of HM consumed in each feed. For macro- and trace-elements within-feed and daily variation was measured. Intake estimated from a morning pre-feed sample was compared to the measured milk intake calculated from every feed over 24-hours. Macro- and trace-elements concentrations were measured using ICP-MS. Linear mixed modelling was used for statistical analysis.

RESULTS: Average intake of HM was 737 ± 63 mL for infants aged 1-6 months and 508 ± 50 for infants aged 6-12 months. Pre- and post-feed HM variation was found for phosphorus, calcium, manganese, iron, copper, zinc, selenium, molybdenum, and iodine (p < 0.05). Variation across 24 h was found for magnesium, phosphorus, potassium, manganese, iron, and selenium (p < 0.05). Estimated intake using morning, pre-feed samples resulted in significantly lower intake when compared to measured milk intake for iron, phosphorus, selenium, and manganese (p < 0.05).

CONCLUSION: Standardised sampling protocols using large sample volumes and multiple collections over 24-hours provide a calculated intake that is more reflective of actual infant HM macro- and trace-elements intake.

PMID:34166949 | DOI:10.1016/j.foodchem.2021.130179

Am J Otolaryngol. 2021 Jun 19;42(6):103134. doi: 10.1016/j.amjoto.2021.103134. Online ahead of print.

ABSTRACT

BACKGROUND: Benign paroxysmal positional vertigo is characterized as brief episodes of vertigo that are exacerbated by the unexpected act of moving to a current provoking location. It is thought to be an otoconia-related balance disorder. Our objectives were to assess the serum concentrations of vitamin D and calcium (total and ionized) in cases with BPPV, determine if low vitamin D levels were regarded as a cause for BPPV relapse, and determine whether vitamin D supplementation would minimize the risk of BPPV relapse.

RESULTS: Sixty cases with BPPV were included in the study; 53 cases had posterior canal BPPV, while seven had lateral canal BPPV. Canalithiasis was the most common type of BPPV pathology. Forty cases had abnormally low levels of vitamin D. There was a statistically significant positive correlation between the mean vitamin D assay for all cases with BPPV and serum calcium. There was statistically significant difference in comparing the relapse of BPPV for group that receive vitamin D after one year follow up.

CONCLUSION: Abnormal vitamin D levels were linked with the incident and relapse of BPPV. Correction of low vitamin D levels was linked with the reduction of the relapse of BPPV.

PMID:34166965 | DOI:10.1016/j.amjoto.2021.103134

Biochem Biophys Res Commun. 2021 Jun 10;567:195-200. doi: 10.1016/j.bbrc.2021.06.023. Online ahead of print.

ABSTRACT

Recombinase polymerase amplification (RPA) is an isothermal reaction that amplifies a target DNA sequence with a recombinase, a single-stranded DNA-binding protein (SSB), and a strand-displacing DNA polymerase. In this study, we optimized the reaction conditions of RPA to detect SARS-CoV-2 DNA and RNA using a statistical method to enhance the sensitivity. In vitro synthesized SARS-CoV-2 DNA and RNA were used as targets. After evaluating the concentration of each component, the uvsY, gp32, and ATP concentrations appeared to be rate-determining factors. In particular, the balance between the binding and dissociation of uvsX and DNA primer was precisely adjusted. Under the optimized condition, 60 copies of the target DNA were specifically detected. Detection of 60 copies of RNA was also achieved. Our results prove the fabrication flexibility of RPA reagents, leading to an expansion of the use of RPA in various fields.

PMID:34166918 | DOI:10.1016/j.bbrc.2021.06.023

Clin Oral Implants Res. 2021 Jun 24. doi: 10.1111/clr.13802. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare fully guided with conventionally guided implant surgery performed by dental students in terms of deviation of actual implant position from an ideal implant position.

MATERIALS AND METHODS: Twenty-five patients in need of 26 straightforward implant-supported single crowns were randomly allocated to a fully guided (FG, n=14) or a conventionally guided (CG, n=12) implant surgery. In the preoperative CBCTs, 3 experienced investigators placed a virtual implant in the ideal position, twice, allowing deviational analysis in the facio-lingual (coronal) and mesio-distal (sagittal) planes for 7 parameters. Facio-lingual crestal deviation, facio-lingual apical deviation, facio-lingual angular deviation, mesio-distal crestal deviation, mesio-distal apical deviation, mesio-distal angular deviation and vertical deviation between the ideal, virtually placed position and actual implant position for the FG- and CG-groups were compared statistically (p<0.05) RESULTS: Statistically significant differences between ideal and actual implant position were only seen for the facio-lingual apical deviation (p= 0.047) and for the facio-lingual angular deviation (p= 0.019), where the CG-group deviated more from the ideal position than the FG-group. The 5 other examined variables did not show any significant differences and none of the implants in the FG-group and CG-group were placed in conflict with the clinical guidelines.

CONCLUSIONS: The present study reported no difference in 5 out of 7 deviational parameters concerning actual implant position in relation to ideal implant position between a FG and CG implant placement protocol performed by dental students. Facio-lingual angular deviation and apical deviation were lower, when a FG protocol was followed. All implants were positioned according to clinical guidelines.

PMID:34166539 | DOI:10.1111/clr.13802