Nevin Manimala

Pak J Med Sci. 2024 Dec;40(12PINS Suppl):S25-S31. doi: 10.12669/pjms.40.12(PINS).11111.

ABSTRACT

OBJECTIVES: To determine the effect of Bilateral Subthalamic Nucleus (STN) Deep Brain Stimulation (DBS) on drug reduction for Parkinson’s disease (PD) in a low-middle-income country.

METHODS: This retrospective cohort study included 49 patients following interview based questionnaires who underwent bilateral STN DBS at the Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, Pakistan over five years (July 30, 2018 to June 29, 2023). Patients meeting the inclusion and exclusion criteria (49 patients) were selected and the effect of bilateral STN DBS on drug reduction was evaluated.

RESULTS: Following bilateral STN for Parkinsons Disease Levodopa equivalent daily dose (LEDD) and Unified Parkinson’s Disease Rating Scale (UPDRS)-III results were statistically significant, with a P-value of 0.0001. Effect of DBS on UPDRS-IV was 0.2751, which is statistically insignificant. LEDD reduced by 55.03% (P<0.0001), UPRS-III improved by 80.49% (P<0.0001), and UPDRS-IV improved by 1% (P<0.0001). Time spent with dyskinesia reduced by 17.54% (P<0.0001), whereas time spent off period reduced 22.44% (P<0.0001).

CONCLUSION: When the disease is in its early stages and has not yet manifested advanced Parkinsons symptoms, bilateral STN DBS is an effective treatment option. It considerably reduces the need for levodopa and significantly improves the motor symptoms of rigidity, tremors, and bradykinesia.

PMID:39703974 | PMC:PMC11654648 | DOI:10.12669/pjms.40.12(PINS).11111

Pak J Med Sci. 2024 Dec;40(12PINS Suppl):S55-S62. doi: 10.12669/pjms.40.12(PINS).11116.

ABSTRACT

OBJECTIVES: To assess the knowledge, attitude and perception of post-graduate residents of neurosciences towards research ethics (RE) and research ethics committees (RECs).

METHODS: This prospective cross-sectional survey-based study was conducted by the Punjab Institute of Neurosciences, targeting post-graduate neuroscience residents throughout Pakistan during January and February, 2024. An English-language general questionnaire, designed to assess knowledge, attitudes, and perceptions of RE and RECs, was adapted to reflect local conditions. The collected responses were analyzed using the Statistical Package for Social Sciences (SPSS) to determine measures of central tendency, percentages, and frequencies.

RESULTS: Out of 241 residents, 64.3% were males. Sixty-eight percent respondents were from neurosurgery and 32% were from the field of neurology. Approximately 47% responses were from the province of Punjab. More than half (51.5%) of participants acknowledged the existence of a REC within their institution. A similar proportion (52.3%) claimed familiarity with ethical guidelines for research involving human subjects, only a slight majority (48.5%) demonstrated awareness of the specific functions carried out by RECs. Meanwhile, 44.5% expressed concerns that undergoing review by a REC could potentially delay research and pose additional challenges for researchers. Additionally, 27.4% of respondents admitted to considering the fabrication of data or results as acceptable.

CONCLUSION: Our research uncovered a significant correlation between participants’ perceptions of RE and RECs and their comprehension of ethical principles. These findings indicate that medical postgraduates with a deeper understanding or awareness of research ethics principles and RECs tend to hold more robust attitudes toward these aspects.

PMID:39703966 | PMC:PMC11654657 | DOI:10.12669/pjms.40.12(PINS).11116

Patient Prefer Adherence. 2024 Dec 14;18:2545-2557. doi: 10.2147/PPA.S503087. eCollection 2024.

ABSTRACT

BACKGROUND: Understanding medication adherence and its relationship with quality of life (QoL) is essential for improving health outcomes in patients with heart failure (HF).

OBJECTIVE: This study aimed to investigate the predictors of poor quality of life and its relationship with medication adherence among patients with heart failure.

METHODS: A cross-sectional correlational study was performed on 229 patients with HF receiving care at the Cardiac Center of King Salman Specialist Hospital from March to June 2024. Data were collected using a structured questionnaire comprising patient demographics, the Minnesota Living with Heart Failure Questionnaire (MLHFQ) to assess QoL, and the General Medication Adherence Scale (GMAS) to measure medication adherence.

RESULTS: The mean medication adherence score among patients with heart HF was 17.53 ± 6.94. The level of adherence was moderate among most patients (47.2%), high (29.7%), and poor (23.1%). Regarding QoL, the mean total score for overall QoL was 42.16 ± 20.53. Specifically, the mean scores were 15.24 ± 8.65 and 10.53 ± 5.82 for the physical and emotional dimensions of QoL, respectively. More than half of the patients experienced poor QoL, while moderate QoL was observed in 31.9% and good QoL in 17% of patients. Furthermore, there were moderate negative correlations between medication adherence and physical QoL (r= -0.51), emotional QoL (r = -0.59), and overall QoL (r = -0.59), all of which were statistically significant (p <0.001).

CONCLUSION: Moderate-to-poor levels of medication adherence and QoL were found among HF patients receiving care in Hail City. Therefore, interventions to improve medication adherence among patients with HF must be prioritized to enhance health outcomes and QoL. It is also crucial to address the factors that negatively influence medication adherence to overcome the barriers that hinder optimal medication adherence.

PMID:39703933 | PMC:PMC11656328 | DOI:10.2147/PPA.S503087

PeerJ. 2024 Dec 16;12:e18652. doi: 10.7717/peerj.18652. eCollection 2024.

ABSTRACT

OBJECTIVE: This systematic review and meta-analysis aims to evaluate the effectiveness and safety of Angio-Seal and StarClose vascular closure devices (VCDs) in achieving hemostasis after interventional surgery.

METHODS: Randomized controlled trials (RCTs) and observational studies comparing Angio-Seal and StarClose were identified through systematic searches. Data on vascular closure success rate, complication rates, hematoma formation, pseudoaneurysm, arterial occlusion, and surgical intervention were extracted and pooled using a random effects model.

RESULTS: Nine studies met the inclusion criteria, total 5,466 patients. The meta-analysis revealed a slight, statistically significant difference in the success rate of vascular closure in favor of Angio-Seal (risk ratio (RR) 1.05, 95% confidence interval (CI) [1.00-1.09], p = 0.03). No significant difference was found in the overall complication rate, hematoma formation, pseudoaneurysm, arterial occlusion, or surgical intervention.

CONCLUSIONS: Angio-Seal demonstrated a slightly higher success rate in vessel closure compared to StarClose. Both devices had a comparable safety profile with no significant differences in major complications.

PMID:39703921 | PMC:PMC11657189 | DOI:10.7717/peerj.18652

PeerJ. 2024 Dec 16;12:e18684. doi: 10.7717/peerj.18684. eCollection 2024.

ABSTRACT

OBJECTIVE: To investigate the current status of knowledge, attitude, and practice (KAP) of healthcare professionals in stroke-related departments of primary-level tertiary hospitals regarding the prevention and treatment of hemiplegic shoulder pain, and to analyze influencing factors. This aims to provide a reference for further training, guidance, and management of hemiplegic shoulder pain.

METHODS: A total of 123 healthcare professionals from stroke-related departments of two tertiary hospitals in a county-level city in Zhejiang province were selected as the research subjects from March 6, 2023, to March 14, 2023. Written informed consent was obtained from all study participants prior to their inclusion in the study. A questionnaire survey was conducted to assess their KAP status on the prevention and treatment of hemiplegic shoulder pain, and statistical analysis was performed using SPSS 23.

RESULTS: The scores for knowledge (29.97 ± 9.94), attitude (27.7 ± 2.81), and behavior (29.86 ± 7.86) among the 123 healthcare professionals indicated that department and position were influencing factors for KAP (P < 0.05).

CONCLUSION: The overall KAP of healthcare professionals in stroke-related departments of primary hospitals regarding the prevention and treatment of hemiplegic shoulder pain needs improvement. Strengthening relevant knowledge and skills training is necessary to reduce the incidence of hemiplegic shoulder pain and improve patients’ quality of life.

PMID:39703917 | PMC:PMC11657197 | DOI:10.7717/peerj.18684

PeerJ. 2024 Dec 16;12:e18679. doi: 10.7717/peerj.18679. eCollection 2024.

ABSTRACT

BACKGROUND: Cerebral palsy (CP) covers a wide range of causes and symptoms. It is characterized by persistent motor and postural dysfunction caused by a non-progressing pathological lesion of the immature brain. Development of fine motor skills, such as the ability to manipulate objects with smaller muscles, is crucial for a child’s development. It is evident that there is a lack of hand grip strength (HGS) and quality of life (QoL) data in children with CP compared to typically developed (TD) children. Understanding the relationship between these factors might help facilitate healthcare provision and provide insight into rehabilitation programs. The aim of this study is to investigate the relationship between HGS and health-related quality of life (HRQoL) in children with CP compared to TD children.

METHODS: An experimental cross-sectional study was conducted and 60 children (30 CP and 30 TD) were chosen; age, gender, height, weight, body mass index, preferred hand, number of siblings, school attendance, and housing type data were collected. HGS was measured using a standard hand dynamometer, and HRQoL was measured using the KIDSCREEN-10 item questionnaire.

RESULTS: There was a statistically significant main effect of gender on the average HGS, F (1, 56) = 24.09, p < 0.001, and the KIDSCREEN-10 sum score, F (1, 56) = 8.66, p < 0.001, and the main effect of group on the KIDSCREEN-10 sum score, F (1, 56) = 17.64, p < 0.001. A significant correlation between HGS and the KIDSCREEN-10 sum score in the CP group (r = 0.35, p = 0.03), and the TD group (r = 0.56, p = 0.001).

CONCLUSION: HGS was lower in children with CP, and girls had significantly lower HGS compared to boys in both groups, CP and TD children. HRQoL was significantly lower in children with CP, with boys reporting higher HRQoL on the KIDSCREEN-10 questionnaire compared to girls. Our data showed that the higher the KIDSCREEN-10 sum score is, the stronger the HGS of children in both groups. The results of this study indicate that hand grip strength may significantly impact the QoL of children with CP. A correlation between HGS and HRQoL points to the importance of improving strength in children with CP through interventions and directed rehabilitation programs.

PMID:39703915 | PMC:PMC11657191 | DOI:10.7717/peerj.18679

J Nutr Sci. 2024 Dec 16;13:e94. doi: 10.1017/jns.2024.84. eCollection 2024.

ABSTRACT

Renal sinus fat (RSF) crucially influences metabolic regulation, inflammation, and vascular function. We investigated the association between RSF accumulation, metabolic disorders, and nutritional status in obese individuals with hypertension. A cross-sectional study involved 51 obese hypertensive patients from Salamat Specialized Community Clinic (February-September 2022). Basic and clinical information were collected through interviews. Data included anthropometrics, blood pressure, number of antihypertensive medications, body composition (bioelectrical impedance analysis), dietary intake (semi-quantitative 147-item food frequency questionnaire), and blood samples. Renal sinus fat was measured via ultrasonography. Statistical analyses included Pearson correlation, binary logistic regression, and linear regression. RSF positively correlated with abdominal visceral adipose tissue (VAT) area (P = 0.016), systolic blood pressure (SBP) (P = 0.004), and diastolic blood pressure (DBP) (P = 0.005). A strong trend toward a positive association was observed between antihypertensive medications and RSF (P = 0.062). In linear regression, RSF was independently associated with abdominal VAT area, SBP, and DBP after adjusting for confounders. After considering other risk factors, RSF volume relates to prescribed antihypertensive medications, hypertension, and central fat accumulation in obese hypertensive subjects. These findings suggest the need for further investigations into whether RSF promotes metabolic disorders.

PMID:39703900 | PMC:PMC11658955 | DOI:10.1017/jns.2024.84

J Nutr Sci. 2024 Dec 17;13:e95. doi: 10.1017/jns.2024.86. eCollection 2024.

ABSTRACT

Although dietary factors have been examined as potential risk factors for liver cancer, the evidence is still inconclusive. Using a diet-wide association analysis, our research evaluated the associations of 126 foods and nutrients on the risk of liver cancer in a Chinese population. We obtained the diet consumption of 72,680 women in the Shanghai Women’s Health Study using baseline dietary questionnaires. The association between each food and nutrient and liver cancer risk was quantified by Cox regression model. A false discovery rate of 0.05 was used to determine the foods and nutrients which need to be verified. Totally 256 incident liver cancer cases were identified in 1,267,391 person-years during the follow-up duration. At the statistical significance level (P ≤ 0.05), higher intakes of cooked wheaten foods, pear, grape and copper were inversely associated with liver cancer risk, while spinach, leafy vegetables, eggplant and carrots showed the positive associations. After considering multiple comparisons, no dietary variable was associated with liver cancer risk. Similar findings were seen in the stratification, secondary and sensitivity analyses. Our findings observed no significant association between dietary factors and liver cancer risk after considering multiple comparisons in Chinese women. More evidence is needed to explore the associations between diet and female liver cancer occurrence.

PMID:39703897 | PMC:PMC11658938 | DOI:10.1017/jns.2024.86

Injury. 2024 Dec 11:112084. doi: 10.1016/j.injury.2024.112084. Online ahead of print.

ABSTRACT

PURPOSE: We compare the treatment and outcomes of penetrating and blunt splenic trauma at Major Trauma Centres (MTC) within the UK.

METHODS: Data obtained from the national Trauma Audit Research Network database identified all eligible splenic injuries admitted to MTC within England between 01/01/17-31/12/21. Demographics, mechanism of injury, splenic injury classification, associated injuries, treatment, and outcomes were compared.

RESULTS: Penetrating injuries accounted for 5.9 % (235/3958) of splenic injuries, compared to blunt at 94.1 % (3723/3958). Most penetrating injuries (91.5 %, 215/235) resulted from stabbing. There was a statistically significant difference in first treatment between penetrating and blunt splenic injuries (p < 0.001), but similar trends between GSW and stab injuries. Most penetrating injuries were managed conservatively (68.9 %,162/235), with 10.6 % (25/235) embolized compared to 13.2 % (491/3723) for blunt splenic injury. More penetrating injuries (20.4 %, 48/235) underwent splenectomy compared to blunt injuries (8.8 %, 326/3723). Those receiving embolization after penetrating trauma had an 8.0 % (2/25) 30-day mortality compared with blunt at 8.6 % (42/491) and compared with 2.1 % (1/48) and 12.3 % (40/326) of those who received splenectomy in the penetrating and blunt groups, respectively. 8 out of the 25 penetrating trauma patients who underwent embolisation (32.0 %) required splenectomy due to embolisation failure compared to 5.3 % (26/491) in the blunt trauma group.

CONCLUSION: A trend is seen towards the use of operative management in penetrating splenic trauma. There is a high splenic embolisation failure rate (32.0 %) in penetrating trauma although mortality for those embolised was similar to the blunt injury group.

PMID:39701904 | DOI:10.1016/j.injury.2024.112084

J Pediatr Urol. 2024 Dec 3:S1477-5131(24)00617-X. doi: 10.1016/j.jpurol.2024.11.021. Online ahead of print.

ABSTRACT

Randomized controlled trials (RCTs) are at the top of the pyramid of evidence as they offer the best answer on the efficacy of a new treatment. RCTs are true experiments in which participants are randomly allocated to receive a certain intervention (experimental group) or a different intervention (comparison group), or no treatment at all (control or placebo group). Randomization, along with other methodological features such as blinding and allocation concealment, safeguard against biases. This review will focus on parallel group RCT design as it is the most common design in the field of Pediatric Urology. RCTs can be designed using a superiority, equivalency, or non-inferiority hypothesis, and are usually preceded by a pilot, where the trial protocol is implemented in a small number of patients, mimicking the larger, definitive study. Even though regarded as the best available option to bring out scientific data, RCTs might be prone to mislead. If RCTs are small and underpowered, a difference of even one single event between groups, may completely change the trial results. To safeguard against RCTs weakness, a fragility concept of statistical significance was developed and called the Fragility Index (FI). RCTs may not be appropriate, ethical, or feasible for all surgical interventions. They may have limitations such as prohibitive cost and unrealistic large sample sizes. Nearly 60 % of surgical research questions cannot be answered by RCTs. Therefore, clinical practice should be based on the best available evidence on a given topic, regardless of the study design. However, even in these situations, conclusions drawn from observational studies must be interpreted with caution.

PMID:39701869 | DOI:10.1016/j.jpurol.2024.11.021