Category: Nevin Manimala

J Vet Cardiol. 2021 May 13;36:89-98. doi: 10.1016/j.jvc.2021.05.001. Online ahead of print.

ABSTRACT

INTRODUCTION: The objective of this retrospective study was to describe the indications, complications, and long-term outcomes in a group of cats that received an epicardial pacing (EP) system.

ANIMALS: Twenty client-owned cats.

MATERIALS AND METHODS: Medical records were reviewed for signalment, presenting complaint, primary electrocardiogram (ECG) diagnosis, presence of structural heart disease, presence of congestive heart failure (CHF), presence of major or minor complications, and survival time.

RESULTS: The majority of cats were presented for syncope (n = 11), and the most common ECG diagnosis was advanced second-degree atrioventricular block (n = 9). Fifteen cats (15/20, 75%) had one or more major or minor complications. One cat died in the perioperative period as a result of a major complication. None of the variables evaluated were associated with a statistically significant increase in the occurrence of major or minor complications. The most common major complication was loss of ventricular capture (seven instances in six cats), which was successfully treated in all cases by increasing pacemaker output or replacing both the lead and the pulse generator. The most common minor complications were arrhythmias (n = 7) and sensing issues (n = 8). The overall median survival time (MST) was 948 days. No statistical difference in survival time was identified between cats that experienced a major complication and those that did not.

CONCLUSIONS: Although complications were common in this feline population after EP, major and minor complications were successfully treated.

PMID:34118563 | DOI:10.1016/j.jvc.2021.05.001

Health Place. 2021 Jun 9;70:102600. doi: 10.1016/j.healthplace.2021.102600. Online ahead of print.

ABSTRACT

The use of planning policy to manage and create a healthy food environment has become a popular policy tool for local governments in England. To date there has been no evaluation of their short-term impact on the built environment. We assess if planning guidance restricting new fast food outlets within 400 m of a secondary school, influences the food environment in the local authority of Newcastle Upon Tyne, UK. We have administrative data on all food outlets in Newcastle 3 years pre-intervention 2012-2015, the intervention year 2016, and three years’ post-intervention 2016-2019. We employ a difference-in-difference approach comparing postcodes within the school fast food outlet exclusion zone to those outside the fast-food exclusion zones. In the short term (3 years), planning guidance to limit the number of new fast-food outlets in a school exclusion zone did not have a statistically significant impact on the food environment when compared with a control zone.

PMID:34118573 | DOI:10.1016/j.healthplace.2021.102600

Colloids Surf B Biointerfaces. 2021 Jun 2;205:111897. doi: 10.1016/j.colsurfb.2021.111897. Online ahead of print.

ABSTRACT

Polydopamine (PDA), also known as synthetic melanin, is widely used as a biomimetic anchoring layer for the modification of various solid substrates. PDA is utilized for a wide range of biomedical, sensing and tribological applications, even though the polymer’s precise covalent structure has not been completely revealed yet. Even more, it is not evident to which extent the chemical nature of the substrate, on which the layer is formed, influences and predetermines the covalent structure of resulting PDA. In this contribution, we have studied the growth of PDA using various surface-sensitive techniques such as spectroscopic ellipsometry, atomic force microscopy and X-ray photoelectron spectroscopy. We supplemented grazing angle attenuated total reflection FTIR spectroscopy with multivariate statistical analysis to further gain analytical power. We have particularly focused on the effects of polymerization time and substrate on the PDA structure. We found notable differences in the chemical composition of PDA formed on gold and on surfaces terminated with oxides/reactive hydroxides such as silicon and N-dopped-TiO₂ in the early stages of the layer formation. At the later stages of layer formation, a merely unified chemical structure was observed independently on the type of substrate.

PMID:34118533 | DOI:10.1016/j.colsurfb.2021.111897

Liver Transpl. 2021 Jun 12. doi: 10.1002/lt.26205. Online ahead of print.

ABSTRACT

BACKGROUND: Computed tomography (CT) derived body metrics such as skeletal muscle index (SMI), psoas muscle index (PMI), and subcutaneous fat index (ScFI) are measurable components of sarcopenia, frailty, and nutrition. While these body metrics are advocated in adults for predicting postoperative outcomes after liver transplantation (LT), little is known about the value in pediatric populations. This study assessed the relation between preoperative CT-based body metrics and postoperative short-term outcomes in pediatric LT recipients.

METHODS: Patients aged 0-18 years who underwent a primary LT were retrospectively included (N=101, median age 0.5 years, range 0.2-17.1). SMI, PMI, and ScFI were derived from preoperative axial CT slices. Postoperative outcomes and complications within 90 days were correlated with the CT-based body metrics. To classify postoperative infections, the Clavien-Dindo (CD) classification was used. Subgroup analyses were performed for age groups (<1, 1-10, and >10 years old). An optimal threshold for test performance was defined using Youden’s J-statistic and receiver operating characteristic curve as appropriate.

RESULTS: ScFI was significantly (P=0.001) correlated with moderate to severe postoperative infections (CD grade 3-5) in children <1 year old, with the optimal ScFI threshold being ≤27.1 cm² /m² (sensitivity 80.4% and specificity 77.8%). A weak negative correlation between SMI and the total duration of hospital stay (R=-0.33, P=0.010) and intensive care unit stay (R=-0.32, P 0.013) was observed in children <1 year old. No other associations between CT-based body metrics and postoperative outcomes were shown.

CONCLUSIONS: In children <1 year old with cirrhotic liver disease undergoing LT, pre-operative CT-based body metrics were correlated with moderate to severe postoperative infections (ScFI), and with longer duration of hospital and ICU stay (SMI), and thus can be considered important tools for pre-LT risk assessment.

PMID:34118133 | DOI:10.1002/lt.26205

J Adv Nurs. 2021 Jun 12. doi: 10.1111/jan.14920. Online ahead of print.

ABSTRACT

AIM: This study aims to provide economic evidence of the cost-effectiveness of employing specialist Parkinson’s nurses in a regional community in Australia.

STUDY DESIGN: This retrospective study utilized hospital service usage data to compare outcomes for people with Parkinson’s disease before and after the employment of a specialist Parkinson’s nurse in a regional community.

METHODS: A representative sample was drawn from the target population of people with a diagnosis of Parkinson’s admitted to a regional hospital over a 4-year period (2013-2014 and 2016-2017). A multiple regression approach and cost-benefit analysis were used to examine hospital costs related to length of stay based on hospital records. All costs were attributed to resource allocation according to service category and the national funding system. Quantitative data were analysed using Strata Analytics.

RESULTS: Statistical findings demonstrated a reduction in hospital length of stay ranging from 0.37 (AUD$1924) to 0.755 day (AUD$3926) after the establishment of the specialist Parkinson’s nurse. The cost-benefit analysis showed a net dollar benefit, or savings in hospital costs, of up to $8600.00 per person over a 3-year period, as a result of the specialist Parkinson’s nurse intervention.

CONCLUSION: The statistical results show significant cost benefits associated with reduced length of hospital stay following introduction of the specialist Parkinson’s nurse. These findings support advocacy for sustainable specialist Parkinson’s nurse positions and have the potential to inform and influence policy and systemic changes within the health care system.

IMPACT: The benefits of embedding specialist nursing services for people with Parkinson’s disease in primary health settings include the direct impact on the potential to avoid hospital admissions due to worsening symptoms, improving quality of life for the person with Parkinson’s and slowing the trajectory of the disease. Additional benefits are increased access to specialist services and reduced family caregiver burden.

PMID:34118161 | DOI:10.1111/jan.14920

J Adv Nurs. 2021 Jun 12. doi: 10.1111/jan.14915. Online ahead of print.

ABSTRACT

AIMS: This study systematically reviews the literature regarding preoperative stoma site marking and discusses the effectiveness of the procedure on complication rates, self-care deficits and health-related quality of life (HRQOL).

DESIGN: Systematic review and meta-analysis.

DATA SOURCE: Our review was conducted following the PRISMA guidelines. PubMed, EMBASE, Cochrane and CINAHL databases were searched to obtain articles published in English. Articles were also retrieved from Korean databases as well. Our last search was conducted on 2 June 2019.

REVIEW METHODS: Two reviewers independently selected relevant studies, evaluated their methodological quality and extracted data. Experimental and observational studies were included. Our main focus was on complication rates, self-care deficits and HRQOL. We conducted meta-analysis using the statistical software spss 25.0 and Stata 13.0.

RESULTS: Of the 1,039 articles reviewed, 20 were included for review, and 19 were used for quantitative synthesis. Preoperative stoma site marking reduced complication rates (odds ratio [OR]: 0.47; 95% confidence interval [CI]: 0.36-0.62; I² : 70.6%), lowered self-care deficits (OR: 0.34; 95% CI: 0.18-0.64; I² : 0%), and increased HRQOL (standardized mean difference, 1.05; 95% CI: 0.70-1.40; I² : 0%). Quality appraisal results for both the individual studies and the studies overall were excellent. The possibility of publication bias was low.

CONCLUSIONS: Our findings indicate that preoperative stoma site marking improves patient outcomes: stoma-related complication rates and self-care deficits decrease and HRQOL rises. For this reason, preoperative stoma site marking should be a mandatory procedure in clinical settings. The practice should also be supported by policymakers and healthcare expert associations.

IMPACT: Preoperative stoma site marking reduces overall complication rates by 53% and skin problems by 59%. Preoperative stoma site marking also improves self-care and health-related quality of life. We recommend that preoperative stoma site marking should be a mandatory procedure in clinical settings.

PMID:34118170 | DOI:10.1111/jan.14915

Liver Transpl. 2021 Jun 12. doi: 10.1002/lt.26209. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: The Affordable Care Act (ACA) expanded Medicaid around the same time that direct-acting antivirals (DAAs) became widely available for the treatment of hepatitis C virus (HCV). However, there is significant variation in Medicaid HCV treatment eligibility criteria between states. We explored the combined effects of Medicaid expansion and leniency of HCV coverage under Medicaid on liver outcomes.

METHODS: We assessed state-level end-stage liver disease (ESLD) mortality, listings for liver transplant (LT), and listing-to-death ratio (LDR) for adults 25-64 years old using data from UNOS and CDC WONDER. States were divided into four nonoverlapping groups based on expansion status on January 1, 2014 (expansion versus non-expansion) and leniency of Medicaid HCV coverage (lenient versus restrictive coverage). Joinpoint regression analysis evaluated for significant changes in slope over time (joinpoints) during the pre-expansion (2009-2013) and post-expansion (2014-2018) time periods.

RESULTS: We found significant changes in annual percent change (APC) for population-adjusted ESLD deaths between 2014-2015 in all cohorts except for the non-expansion/restrictive cohort, in which deaths increased at the same APC from 2009-2018 (APC +2.5% [95% CI 1.8, 3.3]). In the expansion/lenient coverage cohort, deaths increased at an APC of +2.6% (95% CI 1.8, 3.5) until 2014 and then tended to decrease at an APC of -0.4% (95% CI -1.5, 0.8). LT listings tended to decrease over time for all cohorts. For LDR, only the expansion/lenient and expansion/restrictive cohorts had statistically significant joinpoints.

CONCLUSION: Improvements in ESLD mortality and LDR were associated with both Medicaid expansion and leniency of HCV coverage under Medicaid. These findings argue for the implementation of more lenient and widespread public health insurance to improve liver disease outcomes, including mortality.

PMID:34118120 | DOI:10.1002/lt.26209

J Int AIDS Soc. 2021 Jun;24(6):e25726. doi: 10.1002/jia2.25726.

ABSTRACT

INTRODUCTION: Since the beginning of the HIV epidemic in resource-rich countries, Pneumocystis jirovecii pneumonia (PjP) is one of the most frequent opportunistic AIDS-defining infections. The Collaboration of Observational HIV Epidemiological Research Europe (COHERE) has shown that primary Pneumocystis jirovecii Pneumonia (PjP) prophylaxis can be safely withdrawn in patients with CD4 counts of 100 to 200 cells/µL if plasma HIV-RNA is suppressed on combination antiretroviral therapy. Whether this holds true for secondary prophylaxis is not known, and this has proved difficult to determine due to the much lower population at risk.

METHODS: We estimated the incidence of secondary PjP by including patient data collected from 1998 to 2015 from the COHERE cohort collaboration according to time-updated CD4 counts, HIV-RNA and use of PjP prophylaxis in persons >16 years of age. We fitted a Poisson generalized additive model in which the smoothed effect of CD4 was modelled by a restricted cubic spline, and HIV-RNA was stratified as low (<400), medium (400 to 10,000) or high (>10,000copies/mL).

RESULTS: There were 373 recurrences of PjP during 74,295 person-years (py) in 10,476 patients. The PjP incidence in the different plasma HIV-RNA strata differed significantly and was lowest in the low stratum. For patients off prophylaxis with CD4 counts between 100 and 200 cells/µL and HIV-RNA below 400 copies/mL, the incidence of recurrent PjP was 3.9 (95% CI: 2.0 to 5.8) per 1000 py, not significantly different from patients on prophylaxis in the same stratum (1.9, 95% CI: 0.1 to 3.7).

CONCLUSIONS: HIV viraemia importantly affects the risk of recurrent PjP. In virologically suppressed patients on ART with CD4 counts of 100 to 200/µL, the incidence of PjP off prophylaxis is below 10/1000 py. Secondary PjP prophylaxis may be safely withheld in such patients. While European guidelines recommend discontinuing secondary PjP prophylaxis only if CD4 counts rise above 200 cells/mL, the latest US Guidelines consider secondary prophylaxis discontinuation even in patients with a CD4 count above 100 cells/µL and suppressed viral load. Our results strengthen and support this US recommendation.

PMID:34118121 | DOI:10.1002/jia2.25726

Andrologia. 2021 Jun 12:e14121. doi: 10.1111/and.14121. Online ahead of print.

ABSTRACT

Our study aimed to assess for predictors of varicocele-associated pain and whether it predicts semen parameters after microsurgical varicocelectomy. We assessed all men diagnosed with a varicocele by two surgeons from 2017 to 2020, excluding those who did not undergo surgical treatment. Patients were stratified based on the presence of pain at clinical assessment, and these groups were compared. Logistic regression models were utilised to assess for predictors of pain. A total of 313 men were included, with relatively similar proportions completed by both surgeons (48.2% and 51.8%). A total of 98 (31.3%) had typical varicocele-associated pain at the time of assessment. The pain group was younger than the no pain group (30.5 versus. 35.0, respectively, p < .01), and those with pain had greater varicocele grades (p = .008). Although not statistically different, there was a greater portion of left-sided only varicoceles in the pain group (p = .09). No significant differences were demonstrated between sperm concentration, motility, volume or morphology pre-operatively, or post-operatively between groups. Younger age and varicocele grade were predictive of varicocele-associated pain. In conclusion, almost 1/3 of men presented with varicocele-associated pain. Pain does not predict response to varicocelectomy, but these men tend to be younger, and have higher grade varicoceles.

PMID:34118088 | DOI:10.1111/and.14121

J Int AIDS Soc. 2021 Jun;24(6):e25747. doi: 10.1002/jia2.25747.

ABSTRACT

INTRODUCTION: Vaginal rings are a promising approach to provide a woman-centred, long-acting HIV prevention strategy. Prior trials of a 25 mg dapivirine (DPV) ring have shown a favourable safety profile and approximately 30% risk reduction of HIV-1 infection. Extended duration rings replaced every three months may encourage user adherence, improve health service efficiency and reduce cost overall. We evaluated safety, pharmacokinetics, adherence and acceptability of two three-month rings with different DPV dosages, compared with the monthly DPV ring.

METHODS: From December 2017 to October 2018, MTN-036/IPM-047 enrolled 49 HIV-negative participant in Birmingham, Alabama and San Francisco, California into a phase 1, randomized trial comparing two extended duration (three-month) rings (100 or 200 mg DPV) to a monthly 25 mg DPV ring, each used over 13 weeks, with follow-up completed in January 2019. Safety was assessed by recording adverse events (AEs). DPV concentrations were quantified in plasma, cervicovaginal fluid (CVF) and cervical tissue, at nominal timepoints. Geometric mean ratios (GMRs) relative to the comparator ring were estimated from a regression model.

RESULTS: There were no differences in the proportion of participants with grade ≥2 genitourinary AEs or grade ≥3 AEs in the extended duration versus monthly ring arms (p = 1.0). Plasma and CVF DPV concentrations were higher in the extended duration rings compared to the monthly ring. Plasma GMRs were 1.31 to 1.85 and 1.41 to 1.86 and CVF GMRs were 1.45 to 2.87 and 1.74 to 2.60 for the 100 and 200 mg ring respectively. Cervical tissue concentrations were consistently higher in the 200 mg ring (GMRs 2.36 to 3.97). The majority of participants (82%) were fully adherent (ring inserted at all times, with no product discontinuations/outages) with no differences between the monthly versus three-month rings. Most participants found the ring acceptable (median = 8 on 10-point Likert scale), with a greater proportion of participants reporting high acceptability (9 or 10) in the 25 mg arm (73%) compared with the 100 mg (25%) and 200 mg (44%) arms (p = 0.01 and p = 0.15 respectively).

CONCLUSIONS: The extended duration DPV rings were well-tolerated and achieved higher DPV concentrations compared with the monthly DPV ring. These findings support further evaluation of three-month DPV rings for HIV prevention.

PMID:34118115 | DOI:10.1002/jia2.25747