Category: Nevin Manimala

Clin Exp Rheumatol. 2021 Dec 10. Online ahead of print.

ABSTRACT

OBJECTIVES: We investigated the association of SLE flares with patient-reported outcomes (PRO) and healthcare resource utilisation (HCRU) using real-world data.

METHODS: Rheumatologists from the USA, France, Germany, Spain, Italy provided demographic, clinical, and HCRU data for patients with SLE, who provided PRO data. “Flaring” was defined as ≥1 rheumatologist-reported flare in the past 12 months. Demographic/clinical data were analysed descriptively, and findings compared statistically by flaring status. Logistic regression estimated a propensity score for flaring based on ethnicity, disease duration, and severity at diagnosis. Propensity score-matched flaring and non-flaring patients were compared for their HCRU, PROs, income loss and treatment satisfaction.

RESULTS: Physicians (n=263) provided data for 1,278 patients (408 flaring/870 non-flaring); 729 patients (241 flaring/488 non-flaring) provided matched patient data. Patients had a mean 2.1 flares in the previous 12 months. Propensity score matched analyses indicated worse outcomes and greater HCRU in the past 12 months in flaring than non-flaring patients: EuroQoL 5D-3L Utility Index: 0.72 vs. 0.83; Functional Assessment of Chronic Illness Therapy-Fatigue scale: 30.06 vs. 36.48; Work Productivity and Activity Impairment Index: absenteeism 5.87% vs. 2.53% / presenteeism 33.44% vs. 19.16% / overall work impairment 35.98% vs. 20.66% / total activity impairment 42.47% vs. 30.23%; healthcare consultations (8.10 vs. 6.41), hospitalisations (24.26 vs. 7.63), emergency department visits (20.83 vs. 4.19), tests (46.59 vs. 38.90); current medications (2.76 vs. 2.19) (all p<0.001 except absenteeism, p=0.004).

CONCLUSIONS: Similar flaring SLE patients had worse PROs and higher HCRU than non-flaring patients, underscoring the need for more effective strategies and treatments to alleviate or prevent flaring.

PMID:34905485

Asia Pac J Ophthalmol (Phila). 2021 Nov-Dec 01;10(6):579-589. doi: 10.1097/APO.0000000000000464.

ABSTRACT

PURPOSE: To evaluate the prevalence and risk factors for the development of any and referable diabetic eye disease in a multi-ethnic New Zealand population with diabetes mellitus attending a regional retinal screening service.

METHODS: Retrospective observational cohort study of people living with diabetes who attended the Auckland Regional Diabetic Retinal Screening Programme 2006-2018 inclusive (n = 41,786).

RESULTS: Any retinopathy/maculopathy was present at first screening for 48.2% [95% confidence interval (CI): 45.8%-50.6%] / 37.8% (95% CI: 35.5%- 40.1%) of people with Type 1 and 25% (95% CI: 24.6%-25.4%) / 21.9% (95% CI: 21.5%-22.3%) with Type 2 diabetes. Referable retinopathy at baseline screening was 4.4% (95% CI: 3.6%-5.3%) and 1.6% (95% CI: 1.5%-1.7%) among people with Type 1 and Type 2 diabetes mellitus, respectively. After 4 years, cumulative incidence for referable retinopathy /referable maculopathy was 12/36 per 1000 people with Type 1 and 2.4/16 per 1000 people with Type 2 diabetes. Independent hazards for disease progression varied for the diabetes cohort types but baseline grade, duration of diabetes, and HbA1c were common to all.

CONCLUSIONS: Referable diabetic eye disease at the first screening and after 4 years of follow-up is uncommon. Lengthening of the screening intervals for people with no or mild diabetic eye disease at first screening assessment could be considered.

PMID:34905518 | DOI:10.1097/APO.0000000000000464

J Can Dent Assoc. 2021 Oct;87:l12.

ABSTRACT

OBJECTIVES: This investigation aimed to determine whether fluoride concentration in water at the user endpoint remains the same as at the adjusted source, i.e., water treatment facilities.

METHODS: Daycares in Alberta, Canada, were used as the endpoint to measure fluoride concentration. They were randomly selected from a list of 400 licensed daycares provided by the Ministry of Children’s Services. All water samples collected from the daycares were sent to the accredited Alberta Centre for Toxicology (ACFT) for analysis within 7 days of collection. ACFT used ion chromatography to determine fluoride concentration levels. Statistics analyses were conducted using the software SPSS 25.

RESULTS: Water samples were collected from 141 daycares in 35 municipalities. In municipalities that adjust fluoride content, public water is supplied by 8 Alberta Environment & Parks regulated water systems. Fluoride concentration in water samples examined at the endpoint ranged from 0.58 mg/L to 0.79 mg/L. The differences between fluoride concentration at the water treatment facilities and the daycares ranged from -0.03 to 0.22 mg/L.

CONCLUSIONS: This study confirms that the concentration of fluoride adjusted at water treatment facilities in Alberta is maintained at endpoints at the approximate optimal level of 0.7 mg/L.

PMID:34905477

J Can Dent Assoc. 2021 Sep;87:l11.

ABSTRACT

OBJECTIVES: In most North American jurisdictions, guidelines for use of biologic indicators (BIs) in general dental practice have recommended testing at least weekly. However, in 2011, Alberta mandated a change to daily testing, and other provinces have adopted similar protocols. This study of general dental practices in Alberta assessed factors related to implementation of the changed requirement.

METHODS: A survey of 705 randomly selected dental offices queried factors related to implementation of the daily BI testing protocol, including the number of positive test results. We compared findings to analogous data from external laboratory BI tests obtained on a weekly or monthly basis over the preceding 10 years.

RESULTS: The response rate was a 32.6%. The survey results indicated almost complete compliance with the daily testing requirement and a universal shift to in-office testing. A commensurate 76-fold increase in testing was accompanied by a 15-fold decrease in positive results compared with previous laboratory data. However, although not statistically significant, more offices identified defective sterilizer function through internal testing compared with less-frequent external laboratory testing (5.7% vs 3.2%). The offices reporting positive test results had a significantly higher mean number of repeat positive tests (internal 3.1, SD 1.9 vs. external 1.1, SD 0.11).

CONCLUSIONS: The daily testing requirement was accompanied by a concomitant universal shift from external laboratory to internal office testing. A large decline in the rate of positive testing results was observed, although possibly more offices identified defective sterilizer function.

PMID:34905475

Mol Pain. 2021 Jan-Dec;17:17448069211052171. doi: 10.1177/17448069211052171.

ABSTRACT

Acute pain that is associated with herpes zoster (HZ) can become long-lasting neuropathic pain, known as chronic post-herpetic neuralgia (PHN), especially in the elderly. HZ is caused by the reactivation of latent varicella-zoster virus (VZV), whereas PHN is not attributed to ongoing viral replication. Although VZV infection reportedly induces neuronal cell fusion in humans, the pathogenesis of PHN is not fully understood. A genome-wide association study (GWAS) revealed significant associations between PHN and the rs12596324 single-nucleotide polymorphism (SNP) of the heparan sulfate 3-O-sulfotransferase 4 (HS3ST4) gene in a previous study. To further examine whether this SNP is associated with both PHN and VZV reactivation, associations between rs12596324 and a history of HZ were statistically analyzed using GWAS data. HZ was significantly associated with the rs12596324 SNP of HS3ST4, indicating that HS3ST4 is related to viral replication. We investigated the influence of HS3ST4 expression on VZV infection in cultured cells. Fusogenic activity after VZV infection was enhanced in cells with HS3ST4 expression by microscopy. To quantitatively evaluate the fusogenic activity, we applied cytotoxicity assay and revealed that HS3ST4 expression enhanced cytotoxicity after VZV infection. Expression of the VZV glycoproteins gB, gH, and gL significantly increased cytotoxicity in cells with HS3ST4 expression by cytotoxicity assay, consistent with the fusogenic activity as visualized by fluorescence microscopy. HS3ST4 had little influence on viral genome replication, revealed by quantitative real-time polymerase chain reaction. These results suggest that HS3ST4 enhances cytotoxicity including fusogenic activity in the presence of VZV glycoproteins without enhancing viral genome replication.

PMID:34904858 | DOI:10.1177/17448069211052171

Bratisl Lek Listy. 2021;122(12):892-899. doi: 10.4149/BLL_2021_145.

ABSTRACT

INTRODUCTION: Deterioration of vascular responses is the crucial event in the initiation of cardiovascular problems in hypertension (HT) and diabetes mellitus (DM). A well-known oral antidiabetic, sitagliptin, has pleiotropic effects besides improving glycemic state in type-2 DM. This study aimed to investigate the therapeutic effect of sitagliptin on blood pressure with previously unassessed parameters of well-known pathophysiological processes and especially at the microRNA (miRNA) level where there are many unknowns.

METHODS: N-nitro-L-arginine methyl ester (L-NAME)-induced HT model was performed on nondiabetic male rats. Four groups (including 7 rats in each) were formed: normotensives, sitagliptin-treated, HT and sitagliptin-treated HT. Asymmetric dimethylarginine (ADMA), intercellular adhesion molecule-1 (ICAM-1) and tyrosine hydroxylase (TH), HT related miRNAs were evaluated. In-vitro vessel responses were observed.

RESULTS: L-NAME led to a significant increase in blood pressure. Hypertensives exhibited significantly increased contractile responses, consistent with increased ADMA, ICAM-1. Sitagliptin decreased TH levels but not statistically significantly. The new side of the study was the miRNA-21 and miRNA-155 expressions were in line with other parameters in both the HT and sitagliptin-treated HT groups.

CONCLUSION: Sitagliptin may control comorbidities, especially HT and introduces new targets to alleviate vascular responses. The new knowledge is; sitagliptin may show these effects through microRNAs (Tab. 2, Fig. 6, Ref. 46).

PMID:34904852 | DOI:10.4149/BLL_2021_145

Bratisl Lek Listy. 2021;122(12):861-865. doi: 10.4149/BLL_2021_139.

ABSTRACT

OBJECTIVES: The study focused on the relationship between routine clinical characteristics and anti-SARS-CoV-2 specific antibodies in a pilot sample of healthcare workers (HCWs) having suffered COVID-19. The aim was to investigate the existence of readily available predictors of antibodies against COVID-19.

METHODS: As part of the recognition of COVID-19 as an occupational disease in 152 HCWs with the mean age of 43.2 years, personal, anthropometric and anamnestic data related to the disease as well as anti-spike immunoglobulin (Ig) levels were obtained. Through descriptive statistics, correlation and regression analyses, relationships of all variables and Ig levels, especially seropositivity of IgG, were investigated.

RESULTS: The mean interval between the symptom onset and the determination of antibodies was 58 days. IgG seropositivity and IgM seropositivity were noted in 82 % and 49 % of HCWs, respectively. Symptom duration was the only statistically significant predictor of IgG seropositivity. With each day of symptom duration, the probability of IgG seropositivity increased from 1.078 to 1.092 times (p < 0.05). If symptoms lasted longer than 17 days, a majority (almost 80 %) of the subjects demonstrated seropositivity in the following months. CONCLUSION: The presence of IgG immunity may be assumed from symptom duration. Such easy recognizing of seropositive patients may be a useful tool, e.g. in vaccination strategies (Tab. 3, Fig. 1, Ref. 28).

PMID:34904847 | DOI:10.4149/BLL_2021_139

Bratisl Lek Listy. 2021;122(12):880-883. doi: 10.4149/BLL_2021_143.

ABSTRACT

BACKGROUND: The aim of this study is to determine the role of hematological parameters – neutrophil/lymphocyte, platelet/lymphocyte, and monocyte/lymphocyte ratios – in the diagnosis of aseptic loosening after total knee arthroplasty.

METHODS: This study retrospectively analyzed the data of 244 patients who had primary total knee arthroplasty and 66 patients with aseptic loosening developed after total knee arthroplasty. The white blood cell counts, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, monocyte/lymphocyte ratio and c-reactive protein levels in both groups were determined using the results of venous blood samples collected during preoperative preparation and compared between the groups.

RESULTS: Our study findings reveal that the monocyte/lymphocyte ratio of the group with aseptic loosening was statistically significantly different from that of the patient group who had primary total knee arthroplasty (p=0.02). Furthermore, although c-reactive protein levels are not high enough to suggest systemic inflammation, the difference between the groups is statistically significant (p=0.01).

CONCLUSIONS: No hematological parameter that could be used in the diagnosis of aseptic loosening has been defined in the literature so far. This study demonstrated that the monocyte/lymphocyte ratio could be a helpful parameter in the diagnosis of aseptic loosening (Tab. 1, Fig. 1, Ref. 28).

PMID:34904850 | DOI:10.4149/BLL_2021_143

J Adv Nurs. 2021 Dec 13. doi: 10.1111/jan.15130. Online ahead of print.

ABSTRACT

AIMS: To evaluate the effectiveness of technology-based interventions in reducing psychological morbidities such as depressive symptomology, anxiety, burden and improving quality of life and self-efficacy in informal caregivers of stroke survivors.

DESIGN: A systematic review and meta-analysis.

DATA SOURCES: An extensive search was systematically undertaken at CENTRAL, PubMed, Embase, Scopus, CINHAL, Web of Science and PsycInfo until January 2021. Grey literature and dissertations were searched in Google Scholar, ProQuest & Scholarbank@NUS. Studies involving registered trials were retrieved from Clinicaltrials.gov and CENTRAL, respectively.

REVIEW METHODS: Two reviewers independently screened the trials, conducted quality appraisal and extracted the data. Quality of the studies included in the review was assessed using Cochrane Risk of bias tool. Meta-analysis was conducted using RevMan 5.4. Narrative synthesis was performed for studies where results could not be pooled statistically. The results were reported abiding Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

RESULTS: This review included 15 trials with a total of 1276 informal caregivers of stroke survivors. Eleven trials were included in the meta-analysis. Subgroup analyses revealed that technology-based interventions with structured educational programs were statistically significant in reducing depressive symptoms (d = -0.27, 95% CI [-0.49 to -0.05], p = .02). Technology-based interventions with structured educational programs <3-month revealed significant effects (d = -0.31, 95% CI [-0.49 to -0.13], p = .0009). Results of narrative synthesis reported technology-based intervention with face-to-face training minimized depressive symptoms of informal caregivers. Notably, there were no statistically significant effects on anxiety, burden, quality of life and self-efficacy outcomes.

CONCLUSION: Technology-based interventions had beneficial effects in alleviating depressive symptoms among informal caregivers.

IMPACT: Technology-based interventions serve as a support mechanism for informal caregivers of stroke survivors who face time-constrains. Further high-quality randomized controlled trials are warranted to elucidate sustainability, optimal format and dosage of intervention.

PMID:34904746 | DOI:10.1111/jan.15130

Cancer J. 2021 Nov-Dec 01;27(6):423-427. doi: 10.1097/PPO.0000000000000551.

ABSTRACT

BACKGROUND: Metastatic soft tissue sarcoma (STS) patients may benefit from local ablative treatments due to modest efficacy of systemic chemotherapy. However, use of stereotactic body radiotherapy (SBRT) is controversial because of presumed radioresistance of STS.

METHODS: Patients treated with SBRT for oligometastatic and oligoprogressive metastatic STS were retrospectively reviewed to assess results in terms of local control (LC), disease-free survival (DFS), and overall survival (OS). Incidence and grade of adverse events were reported. Statistical analysis was performed to identify variables correlated with outcome and toxicity.

RESULTS: Forty patients were treated with SBRT to a median biologic effective dose (BED) of 105 (66-305) Gy5 to 77 metastases. Two-year LC, DFS, and OS were 67%, 23%, and 40%. Improved LC was shown in patients receiving a BED >150 Gy5 (hazard ratio [HR], 3.9; 95% confidence interval [CI], 1.6-9.7; P = 0.028). A delay >24 months between primary tumor diagnosis and onset of metastases was associated with improved DFS (HR, 0.46; 95% CI, 0.22-0.96; P = 0.01) and OS (HR, 0.48; 95% CI, 0.23-0.99; P = 0.03). No toxicity grade ≥3 was observed.

CONCLUSIONS: Stereotactic body radiotherapy is effective in metastatic STS with a benign toxicity profile. A BED >150 Gy5 is required to maximize tumor control rates. Metastatic relapse >24 months after diagnosis is correlated to improved survival.

PMID:34904803 | DOI:10.1097/PPO.0000000000000551