Category: Nevin Manimala

Isr Med Assoc J. 2021 May;23(5):286-290.

ABSTRACT

BACKGROUND: Consent rates for organ donation remain one of the most important factors determining the number of organs available for transplantation. Trauma casualties constitute a substantial part of the deceased organ donor pool and have unique characteristics that distinguish them from the general donor population. However, this group has not been extensively studied.

OBJECTIVES: To identify donor factors associated with positive familial consent for solid organ donation among trauma casualties.

METHODS: This retrospective study included all trauma casualties who were admitted to the Rabin Medical Center, Beilinson hospital, during the period from January 2008 to December 2017, who were potential organ donors. Data collected included demographic features, the nature of the injury, surgical interventions, and which organs were donated. Data was collected from the Rabin Medical Center Trauma Registry.

RESULTS: During the study period 24,504 trauma patients were admitted and 556 died over their hospital course. Of these 76 were potential donors, of whom 32 became actual donors and donated their organs. Two factors showed a statistically significant correlation to donation, namely female gender (P = 0.018) and Jewish religion of the deceased (P = 0.032).

CONCLUSIONS: Only a small group of in hospital trauma deaths were potential solid organ donors (13.7%) and less than half of these became actual donors. Consent rates were higher when the deceased was female or Jewish.

PMID:34024044

Eur Spine J. 2021 May 23. doi: 10.1007/s00586-021-06868-3. Online ahead of print.

ABSTRACT

PURPOSE: The molecular mechanism behind pain in degenerative disc disease (DDD) and chronic low back pain (LBP) patients is largely unknown. This present study examines the association of LBP and disability to mediators of the inflammatory cascade, as indexed by mRNA gene expression of pro-inflammatory cytokine markers in the intervertebral disc (IVD).

METHODS: Biopsies of the annulus fibrosus (AF) and the nucleus pulposes (NP) from patients with DDD undergoing 1-2 level fusion surgery at L4/L5 or L5/S1 were obtained from total of 34 patients [9 M, 25 F] with average age of 53 [32-63]. The mRNA expression of TNF-α, IL-1β, and IL-6 in the AF and NP was analyzed using quantitative real-time polymerase chain reaction (RT-qPCR), and the expression level of these markers was correlated to the visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores (0-100) for pain and disability.

RESULTS: We report a statistically significant positive correlation between pain intensity (VAS score) and the expression of TNF-α in both the AF (r = 0.54, p = 0.001) and NP (r = 0.40, p = 0.02), similarly with IL-1β in AF (r = 0.37, p = 0.02) and IL-6 in NP (r = 0.40, p = 0.02). In addition, we found significant positive correlation observed between disability score (ODI) and expression of IL-6 in both AF (r = 0.36, p = 0.03) and NP (r = 0.41, p = 0.01).

CONCLUSION: We conclude that the intensity of LBP and disability is associated with the level of inflammation in the disc.

PMID:34023967 | DOI:10.1007/s00586-021-06868-3

Environ Sci Pollut Res Int. 2021 May 22. doi: 10.1007/s11356-021-14479-0. Online ahead of print.

ABSTRACT

The investigation of sediment transport in tropical rivers is essential for planning effective integrated river basin management to predict the changes in rivers. The characteristics of rivers and sediment in the tropical region are different compared to those of the rivers in Europe and the USA, where the median sediment size tends to be much more refined. The origins of the rivers are mainly tropical forests. Due to the complexity of determining sediment transport, many sediment transport equations were recommended in the literature. However, the accuracy of the prediction results remains low, particularly for the tropical rivers. The majority of the existing equations were developed using multiple non-linear regression (MNLR). Machine learning has recently been the method of choice to increase model prediction accuracy in complex hydrological problems. Compared to the conventional MNLR method, machine learning algorithms have advanced and can produce a useful prediction model. In this research, three machine learning models, namely evolutionary polynomial regression (EPR), multi-gene genetic programming (MGGP) and M5 tree model (M5P), were implemented to model sediment transport for rivers in Malaysia. The formulated variables for the prediction model were originated from the revised equations reported in the relevant literature for Malaysian rivers. Among the three machine learning models, in terms of different statistical measurement criteria, EPR gives the best prediction model, followed by MGGP and M5P. Machine learning is excellent at improving the prediction distribution of high data values but lacks accuracy compared to observations of lower data values. These results indicate that further study needs to be done to improve the machine learning model’s accuracy to predict sediment transport.

PMID:34023993 | DOI:10.1007/s11356-021-14479-0

Odontology. 2021 May 23. doi: 10.1007/s10266-021-00617-0. Online ahead of print.

ABSTRACT

Oral diseases such as periodontitis can have a more negative influence on the quality of life of obese than in normal-weight patients. The objective of the present study was to assess the impact of one-stage full-mouth disinfection (OSFMD) therapy on the oral health-related quality of life (OHRQL) of obese and non-obese individuals with periodontitis. Fifty-five obese and thirty-nine non-obese patients were evaluated. The questionnaires oral impacts on daily performance (OIDP) and oral health and quality of life (OHQoL) were given to all patients at baseline and 6 months after periodontal treatment by the OSFMD protocol. For statistical analysis, Chi-square, the two-factor repeated-measures ANOVA, and correlation tests were used. At baseline, mean global OHQoL and OIDP scores were similar for both groups (p > 0.05). At 6 months, OSFMD resulted in OHQoL and OIDP global scores improvements in both groups (p < 0.05), with no significant difference between groups. The most impaired activity at baseline was eating and cleaning teeth for both groups. Periodontal parameters were associated with worse values in the OHQoL and OIDP questionnaires only in obese patients. In conclusion, OSFMD yielded similar improvements in overall OHRQL in both obese and non-obese individuals. Periodontal parameters were associated with a worse quality of life in obese patients. Periodontal treatment can be an important component to improve the OHRQL of obese individuals, and clinicians should expect similar results as those obtained with non-obese patients.

PMID:34023952 | DOI:10.1007/s10266-021-00617-0

Int Arch Occup Environ Health. 2021 May 22. doi: 10.1007/s00420-021-01715-w. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate whether there is an increased risk for noise-induced hearing loss at high altitude rsp. in hypobaric hypoxia.

METHODS: Thirteen volunteers got standard audiometry at 125, 250, 500, 750, 1000, 1500, 2000, 3000, 4000, 6000, and 8000 Hz before and after 10 min of white noise at 90 dB. The system was calibrated for the respective altitude. Measurements were performed at Kathmandu (1400 m) and at Gorak Shep (5300 m) (Solo Khumbu/Nepal) after 10 days of acclimatization while on trek. Temporary threshold shift (TTS) was analyzed by descriptive statistics and by factor analysis.

RESULTS: TTS is significantly more pronounced at high altitudes. Acclimatization does not provide any protection of the inner ear, although it increases arterial oxygen saturation.

CONCLUSION: The thresholds beyond which noise protection is recommended (> 80 dB) or necessary (> 85 dB) are not sufficient at high altitudes. We suggest providing protective devices above an altitude of 1500 m (“ear threshold altitude”) when noise level is higher than 75 dB and using them definitively above 80 dB. This takes the individual reaction on hypobaric hypoxia at high altitude into account.

PMID:34023963 | DOI:10.1007/s00420-021-01715-w

Int Health. 2021 May 22:ihab026. doi: 10.1093/inthealth/ihab026. Online ahead of print.

ABSTRACT

BACKGROUND: Application of chemotherapeutics in cancer patients may provide an immunosuppressive milieu, favourable for parasitic infections. Giardia duodenalis is an important zoonotic intestinal parasite responsible for diarrhoea in humans worldwide.

METHODS: The present systematic review and meta-analysis was conducted to estimate the prevalence of G. duodenalis and respective odds ratios (ORs) in cancer patients around the globe. Four online databases-PubMed, Scopus, Web of Science and Google Scholar-were carefully explored for relevant literature without time limitation until 28 November 2020. Meta-analysis was done based on a random effects model to pool the estimations and define 95% confidence intervals (CIs).

RESULTS: The overall weighted prevalence of G. duodenalis infection in cancer patients was calculated to be 6.9% (95% CI 0.5 to 9.3) globally, based on data from 32 studies. Although not statistically significant, eight case-control studies revealed that cancer patients were 1.24 times (95% CI 0.66 to 2.31; p=0.501) more exposed to G. duodenalis infection than healthy controls. Moreover, the prevalence of infection was not significantly associated with quantitative variables, including publication year (regression coefficient -0.0135, p=0.578), sample size (regression coefficient -0.0007, p=0.074) and human development index (regression coefficient -1.6263, p=0.419). Also, subgroup analysis of the pooled G. duodenalis infection was performed for publication year, World Health Organization regions, countries, continents, cancer types and country income.

CONCLUSIONS: Altogether, the epidemiology of G. duodenalis infection and its associated risk factors in immunocompromised individuals, especially cancer patients, is still open to question and deserves comprehensive investigations.

PMID:34022771 | DOI:10.1093/inthealth/ihab026

Clin Imaging. 2021 May 18;78:194-200. doi: 10.1016/j.clinimag.2021.05.007. Online ahead of print.

ABSTRACT

BACKGROUND: The use of the ethiodized oil- Lipiodol in conventional trans-arterial chemoembolization (cTACE) ensures radiopacity to visualize drug delivery in the process of providing selective drug targeting to hepatic cancers and arterial embolization. Lipiodol functions as a carrier of chemo drugs for targeted therapy, as an embolic agent, augmenting the drug effect by efflux into the portal veins as well as a predictor for the tumor response and survival.

PURPOSE: To prospectively evaluate the role of 3D quantitative assessment of intra-procedural Lipiodol deposition in liver tumors on CBCT immediately after cTACE as a predictive biomarker for the outcome of cTACE.

MATERIALS & METHODS: This was a post-hoc analysis of data from an IRB-approved prospective clinical trial. Thirty-two patients with hepatocellular carcinoma or liver metastases underwent contrast enhanced CBCT obtained immediately after cTACE, unenhanced MDCT at 24 h after cTACE, and follow-up imaging 30-, 90- and 180-days post-procedure. Lipiodol deposition was quantified on CBCT after cTACE and was characterized by 4 ordinal levels: ≤25%, >25-50%, >50-75%, >75%. Tumor response was assessed on follow-up MRI. Lipiodol deposition on imaging, correlation between Lipiodol deposition and tumor response criteria, and correlation between Lipiodol coverage and median overall survival (MOS) were evaluated.

RESULTS: Image analysis demonstrated a high degree of agreement between the Lipiodol deposition on CBCT and the 24 h post-TACE CT, with a Bland-Altman plot of Lipiodol deposition on imaging demonstrated a bias of 2.75, with 95%-limits-of-agreement: -16.6 to 22.1%. An inverse relationship between Lipiodol deposition in responders versus non-responders for two-dimensional EASL reached statistical significance at 30 days (p = 0.02) and 90 days (p = 0.05). Comparing the Lipiodol deposition in Modified Response Evaluation Criteria in Solid Tumors (mRECIST) responders versus non-responders showed a statistically significant higher volumetric deposition in responders for European Association for the Study of the Liver (EASL)-30d, EASL-90d, and quantitative EASL-180d. The correlation between the relative Lipiodol deposition and the change in enhancing tumor volume showed a negative association post-cTACE (30-day: p < 0.001; rho = -0.63). A Kaplan-Meier analysis for patients with high vs. low Lipiodol deposition showed a MOS of 46 vs. 33 months (p = 0.05).

CONCLUSION: 3D quantification of Lipiodol deposition on intra-procedural CBCT is a predictive biomarker of outcome in patients with primary or metastatic liver cancer undergoing cTACE. There are spatial and volumetric agreements between 3D quantification of Lipiodol deposition on intra-procedural CBCT and 24 h post-cTACE MDCT. The spatial and volumetric agreement between Lipiodol deposition on intra-procedural CBCT and 24 h post-cTACE MDCT could suggest that acquiring MDCT 24 h after cTACE is redundant. Importantly, the demonstrated relationship between levels of tumor coverage with Lipiodol and degree and timeline of tumor response after cTACE underline the role of Lipiodol as an intra-procedural surrogate for tumor response, with potential implications for the prediction of survival.

PMID:34022765 | DOI:10.1016/j.clinimag.2021.05.007

Eur J Cancer. 2021 May 19;151:201-210. doi: 10.1016/j.ejca.2021.03.051. Online ahead of print.

ABSTRACT

PURPOSE: Induction chemotherapy (ICT) with cisplatin (P), 5-FU (F) and taxanes (T) is a therapeutical option in patients suffering from locally advanced or unresectable stage III or IV squamous cell carcinoma of the head and neck (SCCHN). The role of ICT is controversial, and toxicity and/or delay of radiotherapy (RT) may reduce the potential benefit of this treatment regimen. Here, we report the results of a randomised phase II trial comparing TPF with TP + cetuximab (C).

PATIENTS AND METHODS: In this trial, 100 patients with locally advanced stage III or IV SCCHN were included in the analysis. Patients were randomly assigned to either TPF-ICT (N = 49) or TPC-ICT (N = 51), both followed by RT + C. The primary end-point of the study was overall response rate (ORR) three months after RT + C was finished.

RESULTS: On an intention-to-treat basis, the ORR (complete remission + partial remission) was 74.5% in the TPC arm compared with 63.3% in the TPF arm (p = 0.109). OS was similar in both arms 400 days after treatment was initiated (86.1% [95% confidence interval {CI}, 73.0-93.1%] in the TPC arm and 78.5% [95% CI, 63.7-87.8%] in the TPF arm). TPC resulted in slightly less serious adverse events and in less haematological, but more skin toxicities. Two patients randomised in the TPC arm died during ICT and RT. Four patients in the TPF arm died after completion of RT. No delay from the end of ICT to RT + C was observed. A total of 83.1% of patients (80% in the TPC arm; 86% in the TPF arm) received RT without dose reduction and/or modification.

CONCLUSION: TPC-containing ICT for patients with locally advanced SCCHN was found to be an effective and tolerable one-day regimen. Further prospective evidence from larger trials is warranted.

PMID:34022697 | DOI:10.1016/j.ejca.2021.03.051

J Infect Public Health. 2021 Mar 18;14(6):751-756. doi: 10.1016/j.jiph.2021.03.006. Online ahead of print.

ABSTRACT

BACKGROUND: The infection of Corona Virus Disease (Covid-19) is challenging health problems worldwide. COVID-19 pandemic is spreading all over the world with the number of infected cases increased to 54.4 million with 1.32 million deaths. Different types of statistical models have been developed to predict viral infection and multiple studies have compared the performance of these predictive models, but results were not consistent. This study aimed to develop and provide easy to use model to predict the Covid-19 infection severity in the patients and to help understanding the patient’s condition.

METHODS: This study analyzed simulated data obtained from the large database for 340 patients with an active Covid-19 infection. The study identified predictors of Covid-19 outcomes that may be measured in two different ways: the total T-cell levels in the blood with T-cell subsets and number of cells in the blood infected with virus. All measures are relatively unobtrusive as they only require a blood sample, however there is a significant laboratory cost implications for measuring the number of cells infected with virus. This study used methodological approach using two different methods showing how multiple regression and logistic regression can be used in the context of Covid-19 longitudinal data to develop the prediction models.

RESULTS: This study has identified the predictors of Covid-19 infection outcomes and developed prediction models. In the regression model of Total_T Cell, the predictors BMI, comorbidity and Total_Tcell were all associated with increased levels of infection severity (p < 0.001). For BMI, the mean % of unhealthy cells increased by 0.42 (95% CI 0.24 to 0.60) and comorbidity predictor has on average 8.3% more unhealthy liver cells than without comorbidity (95% CI – 2.9%-1.29%). The results of multivariate logistic regression model predicting the Covid-19 Infection severity were promising. The significant predictors were observed such as Age (OR 0.95, p = 0.02, 95% CI: 0.91-0.99), Helper T_cells (OR O.93, p = 0.03, 95% CI: 0.87-0.99), Basic_Tcell (OR 1.11, p = 0.001, 95% CI: 1.06-1.71) and Comorbidity (OR 0.41, p = 0.05, 95% CI: 0.16-1.07).

CONCLUSIONS: In this study recommendation has been provided to clinical researchers on the best way to use the various Covid-19 infections measures along with identifying other possible predictors of Covid-19 infection. It is imperative to monitor closely the T-cell subsets using prediction models that might provide valuable information about the patient’s condition during the treatment process.

PMID:34022732 | DOI:10.1016/j.jiph.2021.03.006

Eur Neuropsychopharmacol. 2021 May 19;51:1-6. doi: 10.1016/j.euroneuro.2021.04.016. Online ahead of print.

ABSTRACT

Escitalopram is a selective serotonin reuptake inhibitor (SSRIs) antidepressant, drug that is currently used as first-line agents for the treatment of depression and it is also used in the treatment of other psychiatric disorders. The main goal of this study was to identify which brain areas are affected by escitalopram administration. This study was carried out on male Wistar rats that received escitalopram daily over 14 days and that were studied by 2-deoxy-2[¹⁸F]fluoro-D-glucose ([¹⁸F]FDG)-PET on the last day of treatment. Computed tomography (CT) images were acquired immediately before each PET scan and the main effects of drug administration were elucidated by Statistical Parametric Mapping. The results obtained indicated that repeated exposure to escitalopram increased metabolic activity in the retrosplenial and posterior cingulate cortices, while it decreased such activity in the ventral hippocampus, cerebellum, brainstem and midbrain regions, including the raphe nuclei and ventral tegmental area. Therefore, repeated exposure to escitalopram alters the activity of several brain areas closely related to the serotonergic system, and previously identified as key regions in the antidepressant effect induced by SSRIs. Furthermore, some of the changes found, such as the dampened metabolism in the ventral tegmental area, are similar to changes that have been described after treating with other fast-acting antidepressant approaches.

PMID:34022746 | DOI:10.1016/j.euroneuro.2021.04.016