Nevin Manimala

Transpl Infect Dis. 2024 Dec 28:e14430. doi: 10.1111/tid.14430. Online ahead of print.

ABSTRACT

INTRODUCTION: With reports of expanding epidemiology of blastomycosis across the United States, the purpose of this study was to evaluate the incidence and outcomes associated with blastomycosis in solid organ transplant (SOT) and hematopoietic cell transplant (HCT) recipients.

METHODS: We conducted a retrospective case series of adult SOT and HCT recipients at a tertiary care medical center between January 1, 2005 and September 30, 2023. Cases were defined as culture-proven blastomycosis. We performed descriptive statistical analysis to evaluate diagnosis, management, and outcomes (mortality) of blastomycosis in SOT.

RESULTS: The cumulative incidence of blastomycosis was 0.11% with a median time to infection following transplant of 743 days. Of the 19 cases, the majority of patients were SOT recipients (90%). Supratherapeutic immunosuppression within 30 days of diagnosis was observed in 42% of cases with documented drug monitoring. Urine antigen testing was highly sensitive (100%). Fourteen (73.7%) patients received induction therapy with liposomal amphotericin B followed by azole therapy for a minimum of 12 months. Despite appropriate treatment, 1-year mortality was high at 26.3%, with attributable mortality of 21.1%.

CONCLUSIONS: While rates of blastomycosis remain low among SOT and HCT recipients, infection is associated with poor posttransplant outcomes. Antigen testing can aid in timely assessment of disease severity and initiation of appropriate therapy. Among survivors, no relapses were observed while on lifelong secondary suppression. Future studies should aim to better define risk factors associated with developing blastomycosis and establish effective strategies for prevention.

PMID:39731672 | DOI:10.1111/tid.14430

Int Urol Nephrol. 2024 Dec 28. doi: 10.1007/s11255-024-04346-5. Online ahead of print.

ABSTRACT

PURPOSE: With the increasing demand for dialysis, there is a growing emphasis on patient-centered care. This study investigated patients’ satisfaction levels with peritoneal dialysis (PD) and hemodialysis (HD) care in Iran.

METHODS: A cross-sectional multicenter study was conducted among 346 patients with chronic kidney disease (CKD) covered by the Iran Health Insurance Organization who received dialysis services from October to December 2022 across the country. Data were gathered using a self-made questionnaire through telephone interviews. Data analysis included descriptive statistics, t tests, ANOVA, and linear logistic regression using R software.

RESULTS: Patients reported high satisfaction with doctors and nurses, health care facilities, and costs. PD patients had higher overall satisfaction (P < 0.001) and were more satisfied with costs (P < 0.001), while HD patients reported greater satisfaction with doctor and nurse behavior (P = 0.012). Significant factors associated with satisfaction included marital status (P = 0.012), insurance coverage duration (P = 0.027), dialysis type (P < 0.001), and time to dialysis initiation (P = 0.027). Doctor and nurse behavior had the greatest impact on satisfaction (P < 0.001).

CONCLUSION: While patients were generally satisfied with the care provided, the findings revealed areas for improvement, particularly regarding the availability of medical centers and costs among dialysis patients. Focusing on patient education, communication, and supportive insurance policies has the potential to significantly enhance patient satisfaction and improve quality of life for dialysis patients.

PMID:39731644 | DOI:10.1007/s11255-024-04346-5

Clin Oral Investig. 2024 Dec 28;29(1):33. doi: 10.1007/s00784-024-06126-y.

ABSTRACT

OBJECTIVE: To evaluate the 36-month clinical performance of Single Bond Universal Adhesive (SBU; 3M ESPE, Germany) in non-carious cervical lesions (NCCLs) using different modes of adhesion according to the FDI criteria. The primary outcome was the retention loss of the restorations, while the secondary outcomes included marginal staining, marginal adaptation, post-operative sensitivity and tooth vitality, recurrence of caries erosion and abfraction, and tooth integrity, all evaluated according to the FDI criteria.

MATERIALS AND METHODS: In this study, the SBU Adhesive was applied to 246 NCCLs of 25 patients using different modes of adhesion: Self-etch (SE), selective-enamel-etching (SLE), and etch-and-rinse (ER). All lesions were restored with the same nanohybrid resin composite. The restorations were evaluated at the 1st, the 6th, 12th, 18th, and 36th month using the FDI criteria. The differences between SE, SLE, and ER groups were tested using the Kruskal-Wallis and Mann-Whitney U tests where a value of p < 0.05 was accepted as a criterion for statistical significance.

RESULTS: After 36-month the recall rate was 96%. The retention loss rates were 29.33% for SE, 16.66% for SLE, and 3.89% for ER modes. Interactions between time periods and adhesive modes were found to be statistically significant (p < 0.05) for all FDI criteria. ER mode performed significantly better than SE mode for marginal staining, marginal adaptation and recurrence of caries, erosion and abfraction criteria after the 36th month (p < 0.05). There was no statistically significant difference between SE and SLE mode (p > 0.05), nor between SLE and ER mode (p > 0.05).

CONCLUSIONS: After the 36-month evaluation of all adhesive modes used in the study, restorations performed with the ER adhesion mode were clinically good (2), while those performed with the SE adhesion mode and SLE adhesion mode were clinically satisfactory (3) according to the FDI criteria. The primary outcome, retention loss, was significantly lower in the ER mode compared to SE and SLE modes. For secondary outcomes, the ER mode showed better performance in marginal staining, marginal adaptation, and the recurrence of caries, erosion, and abfraction highlighting its clinical advantages for mid-term success in non-carious cervical lesions.

CLINICAL RELEVANCE: Restorations performed with the SE adhesion mode of universal adhesives exhibit clinically acceptable behavior after 36 months of evaluation, although with less success than those performed with the ER adhesion mode.

CLINICAL TRIAL REGISTRATION: Clinical trials number- NCT06227715, Clinical trials link: https://clinicaltrials.gov/study/NCT06227715.

PMID:39731636 | DOI:10.1007/s00784-024-06126-y

Pediatr Surg Int. 2024 Dec 28;41(1):51. doi: 10.1007/s00383-024-05945-0.

ABSTRACT

BACKGROUND: Burns in children are often complex injuries, leading to prolonged length of stay (LOS) and significant morbidity. LOS in pediatric intensive care units (PICUs) is a key measure for evaluating illness severity, clinical outcomes, and quality of care. Accurate prediction of LOS is vital for improving care planning and resource allocation. There is limited data for predicting LOS in severely burned children in PICU. This study aims to identify significant factors associated with prolonged PICU stays and offer a simple LOS-predicting model.

METHODS: This historical cohort study included all patients < 18 years, admitted for severe burn injuries to Israel’s largest tertiary hospital PICU, from 2015 to 2020. Statistical analyses were conducted to identify factors linked to prolonged LOS and a predictive model was designed.

RESULTS: The study included 39 pediatric burn patients and identified several factors associated with longer PICU stays. Patients with LOS of ˃7 days (i.e.-“long LOS”) had significantly higher %TBSA (33.11 ± 17.87% vs. 16.67 ± 7.98%, p < 0.001. During the first 24 and 48 h, the “long LOS” group had lower minimal systolic blood pressure (SBP) (70.67 ± 17.49 mmHg vs. 84.38 ± 16.73 mmHg, p = 0.015 and 69.39 mmHg ± 16.44 vs. 81.10 mmHg ± 19.67, p = 0.018). Although serum lactate levels were higher in the “long LOS” group, the difference was not significant, and platelet counts in this group were significantly lower during the first 48 h (184 K/µL vs. 264.5 K/µL, p = 0.003). A predictive model based on %TBSA, SBP, lactate, and platelet count was developed, demonstrating 100% specificity and positive predictive value for predicting LOS over 7 days in severely burned children.

CONCLUSIONS: Key clinical indicators at PICU admission in severely burned children were associated with LOS > 7 days. The resulting predictive model, although requiring further validation in multi-site studies, offers a promising tool for enhancing care planning in this population.

PMID:39731634 | DOI:10.1007/s00383-024-05945-0

Lasers Med Sci. 2024 Dec 28;40(1):2. doi: 10.1007/s10103-024-04261-2.

ABSTRACT

To compare the efficacy and safety of low-power holmium laser enucleation of the prostate (LP-HoLEP) with plasma kinetic resection of prostate (PKRP). Sixty-three patients treated with transurethral LP-HoLEP (observation group) and 68 patients treated with transurethral PKRP (control group) at Beijing Hospital of Traditional Chinese Medicine from November 2019 to November 2022 were retrospectively compared with regard to operation duration, intra-operative blood loss, prostate resection ratio, postoperative bladder irrigation time, postoperative indwelling urinary catheter time, postoperative urinary incontinence incidence, International Prostate Symptom Scale (IPSS), maximum urine flow rate (Qmax), and residual urine volume (RUV). In both groups, postoperative IPSS, Qmax, and RUV were significantly improved compared to preoperative values (P < 0.05). Comparing the observation group to the control group, the intra-operative blood loss were (59.6 ± 18.1) and (173.1 ± 85.3) ml, respectively (t = -10.350, P < 0.01); the prostate resection ratios were (81.2 ± 4.6) % and (56.7 ± 9.7)%, respectively (t = 18.230, P < 0.01); the postoperative bladder irrigation time was (39.1 ± 9.6) h and (49.7 ± 6.0) h, respectively (t = -7.623, P < 0.01); and the postoperative indwelling urinary catheter time was (111.5 ± 19.4) h and (120.4 ± 12.8) h, respectively (t = -3.125, P < 0.01). Comparing the observation group to the control group, the operation duration was (76.2 ± 18.6) and (83.0 ± 32.4) min, respectively, with no statistical difference (t = -1.226, P = 0.208); the postoperative urinary incontinence incidence was 12.7% and 8.8%, respectively and there was no statistical difference (χ² = 0.514, P = 0.473). LP-HoLEP offers excellent surgical efficacy and safety. LP-HoLEP is superior to PKRP in intra-operative blood loss, postoperative bladder irrigation time, and postoperative indwelling urinary catheter time, and can enucleate more hyperplastic glands.

PMID:39731626 | DOI:10.1007/s10103-024-04261-2

Neurosurg Rev. 2024 Dec 28;48(1):11. doi: 10.1007/s10143-024-03159-5.

ABSTRACT

Delayed cerebral ischemia, one of the most common complications following aneurysmal subarachnoid hemorrhage, was strongly related to poor patient outcomes. However, there are currently no clear guidelines to provide clinical guidance for post-craniotomy management. Our research aims to explore the association between cumulative blood pressure exposure during the early brain injury phase and the occurrence of delayed cerebral infarction and rebleeding following surgical aneurysm clipping. All baseline characteristics of the patients were meticulously recorded. We collected blood pressure data 25 times in 48 h after surgery for subsequent analysis. Cumulative blood pressure exposure is calculated by the product of the time spent below a specific blood pressure threshold and the cumulative exposure time. The principal outcome is the incidence of Delayed Cerebral Infarction, while the secondary outcome pertains to postoperative rebleeding. Logistic regression was utilized to examine the relationship. The cumulative exposure to mean arterial pressure at and below 85 mmHg demonstrated a significant association with DCI occurrence. However, no significant statistical correlation was found between hypertensive exposure and rebleeding events. The results from the sensitivity analysis remained consistent, and the lack of significant interactions further supports the robustness of the study findings. The identified threshold of 85 mmHg could potentially represent a critical blood pressure management parameter for post-surgical aneurysm clipping patients. These findings merit further investigation through larger prospective clinical trials.

PMID:39731615 | DOI:10.1007/s10143-024-03159-5

Acta Diabetol. 2024 Dec 28. doi: 10.1007/s00592-024-02399-7. Online ahead of print.

ABSTRACT

AIMS: There is a potential association between oxidative stress and the development of diabetic kidney disease (DKD). The Oxidative Balance Score (OBS), derived from dietary and lifestyle factors, acts as a comprehensive marker of oxidative stress. Research examining the relationship between OBS and DKD is scarce. This study aims to evaluate the association between OBS and the risk of DKD among U.S. adults.

METHODS: This study enrolled 6,725 eligible participants from the U.S. population through the National Health and Nutrition Examination Survey (2005-2020). Patients with DKD were defined as those with diabetes who had a urinary albumin-to-creatinine ratio ≥ 30 mg/g and/or an estimated glomerular filtration rate < 60 mL/min/1.73 m². The OBS consists of 20 composite scores derived from dietary and lifestyle factors. To assess the potential relationship between OBS and DKD, weighted logistic regression and restricted cubic spline statistical approaches were employed.

RESULTS: The risk of DKD was inversely correlated with OBS, dietary OBS, and lifestyle OBS (p < 0.05). Compared to the lowest quartile of OBS, the adjusted odds ratios (OR) for OBS, lifestyle OBS and dietary OBS, and DKD in the highest quartile were 0.58 (95% CI: 0.48-0.70), 0.64 (95% CI: 0.51-0.81), and 0.57 (95% CI: 0.46-0.70), respectively. A substantial nonlinear relationship between lifestyle OBS and DKD was identified using the RCS curve (p for nonlinearity = 0.0081), which appeared as an inverted ‘L’ shape. Using the two-piecewise logistic regression model, a turning point in lifestyle OBS was identified at a score of 3 (p < 0.001).

CONCLUSIONS: Among the American population, OBS and DKD are significantly negatively correlated, suggesting that maintaining a higher OBS may reduce the risk of developing DKD.

PMID:39731593 | DOI:10.1007/s00592-024-02399-7

Graefes Arch Clin Exp Ophthalmol. 2024 Dec 28. doi: 10.1007/s00417-024-06722-4. Online ahead of print.

ABSTRACT

PURPOSE: To compare the precision of the arithmetic mean of surgically induced astigmatism (M-SIA) and the centroid of surgically induced astigmatism (C-SIA) in estimating SIA when predicting the power and axis of toric IOLs under different circumstances.

METHODS: 120 eyes of 99 patients undergoing toric IOL replacement in a simple cataract surgery were included in the retrospective study. The predicted position of toric IOL was calculated by Z Calc online calculator and Barrett Toric Calculator with M-SIA (0.4D) or C-SIA (0.1D). Position prediction error (PPE, the difference between the predicted position of toric IOL and the ideal position of toric IOL), its absolute value (PPE-Abs) and △PPE (the difference between absolute value of PPE calculated by C-SIA and by M-SIA using the same toric calculator) were used to evaluate the precision in estimate of SIA.

RESULTS: Statistical significance in mean PPE and mean PPE-Abs was found in the group M-Barrett. The orientation of corneal astigmatism and eye laterality were influential to mean PPE while gender was not. △PPE was below 0 in both toric calculators. Significant difference in △PPE was seen between groups with different corneal astigmatism when all eyes were OS, as well as between groups with different eye laterality when all eyes were with WTR astigmatism.

CONCLUSIONS: We did not find a significant difference between M-SIA and C-SIA in estimating the SIA of the patients undergoing small-incision cataract surgery combined with toric IOL implantation. M-SIA was not recommended in Barrett Toric Calculator. The orientation of corneal astigmatism and the incision on the cornea should be considered when choosing between M-SIA and C-SIA.

KEY MESSAGES: WHAT IS KNOWN? : Either the arithmetic mean of surgically induced astigmatism (M-SIA) or the centroid of surgically induced astigmatism (C-SIA) of a cohort was used to estimate the position of toric IOLs before the surgery. The size and site of corneal incision could influence the orientation and the magnitude of SIA. WHAT IS NEW? : When calculating the axis of toric IOLs with Barrett Toric Calculator, arithmetic mean of SIA (M-SIA) was not recommended for estimate. The orientation of corneal astigmatism could influence the estimate of SIA. We created several novel variables that could be used to indirectly evaluate the stability of toric IOLs and the prognosis of patients.

PMID:39731587 | DOI:10.1007/s00417-024-06722-4

Psychiatr Danub. 2024 Dec;36(3-4):403-404.

NO ABSTRACT

PMID:39731527

J Pediatr Psychol. 2024 Dec 28:jsae103. doi: 10.1093/jpepsy/jsae103. Online ahead of print.

ABSTRACT

OBJECTIVE: Adolescents and young adults with chronic diseases face unique challenges during the college years and may consume alcohol and other substances to cope with stressors. This study aimed to assess the patterns of substance use and to determine psychosocial correlates of these behaviors among college youth with type 1 diabetes (T1D).

METHODS: College youth with T1D were recruited via social media and direct outreach into a web-based study. Participants answered validated questions about substance use, and they completed validated screeners of depressive and anxiety symptoms (PHQ-2 and GAD-2), illness acceptance (ICQ), interpersonal support (ISEL), and grit (Grit scale). Descriptive statistics, bivariate analyses, and multivariable regression evaluated substance use behaviors as a function of psychosocial factors while adjusting for age and sex.

RESULTS: Alcohol (84.06%) and marijuana (41.30%) were the most common substances reported. In bivariate analyses, depressive symptoms were positively associated (p = .01) and illness acceptance was inversely associated (p = .02) with marijuana use. Higher grit scores were inversely associated with marijuana use (p < .001) and prescription drug misuse (p = .04). The significant associations between marijuana use and depressive symptoms (adjusted odds ratio [AOR] 1.31, 95% confidence interval [CI] 1.04-1.66), illness acceptance (AOR 0.96, 95% CI 0.91-0.99), and grit (AOR 0.32, 95% CI 0.17-0.60) persisted after adjustment for age and sex.

CONCLUSIONS: Substance use is prevalent among college youth with T1D. While psychosocial factors such as depressive symptoms may confer an increased risk, illness acceptance and grit may be protective-especially against marijuana use. Providers should address both positive and negative psychosocial factors to mitigate substance use in this population.

PMID:39731516 | DOI:10.1093/jpepsy/jsae103