Nevin Manimala

Food Sci Technol Int. 2024 Jul 21:10820132241264443. doi: 10.1177/10820132241264443. Online ahead of print.

ABSTRACT

The combination of Saccharomyces cerevisiae and Rhizopus oligosporus liquid inoculum has been successfully used to ferment soybeans into tempeh that contains β-glucan. However, using the liquid inoculum of these two microbes as a starter is impractical; so, developing an instant tempeh dry inoculum in powdered form, called the Mosaccha inoculum powder, for ease of use is necessary. This study aimed to determine the best concentration of instant Mosaccha inoculum powder to produce high-quality Mosaccha tempeh. The study used a Complete Randomized Block Design with seven different levels of instant Mosaccha inoculum powder percentage, ranging from 0.3% to 1.8% (w/w). A commercial tempeh inoculum, RAPRIMA, amounting to 0.2%, was used as control. Then, the microbiological (total mold and total yeast) and sensory (color, aroma, texture, and taste) properties were evaluated. The data obtained was analyzed statistically using analysis of variance (ANOVA) and Honestly Significant Difference (HSD) tests at the 5% level. The results showed that the percentage of instant Mosaccha inoculum powder significantly affected the microbiological and sensory properties of Mosaccha tempeh. A concentration of Mosaccha inoculum powder between 0.6% to 1.8% could produce good quality Mosaccha tempeh, but the best Mosaccha tempeh was produced with 1.5% instant Mosaccha inoculum powder, which met the Indonesian National Standards (SNI) 3144:2015, had a very favorable taste, and contained 0.49% β-glucan. Therefore, Mosaccha inoculum in powdered form can be developed and used as a starter in making high-quality tempeh that contains β-glucan.

PMID:39033430 | DOI:10.1177/10820132241264443

Can J Psychiatry. 2024 Jul 21:7067437241262967. doi: 10.1177/07067437241262967. Online ahead of print.

ABSTRACT

INTRODUCTION: Amphetamine-type stimulants (ATSs) are related to significant harm worldwide, with limited effective pharmacological treatments for ATS use disorder (ATSUD). Modafinil has been explored as a potential treatment for ATSUD. This systematic review and meta-analysis (PROSPERO ID: CRD42023388487) aimed to evaluate the efficacy and safety of modafinil for the treatment of ATSUD.

METHODS: A comprehensive search of major indexing sources and trial registries, from inception to search date, was conducted on February 15, 2023, and updated on October 31, 2023. Eligible studies were randomized placebo-controlled trials (RCTs) of modafinil in individuals meeting the criteria for the Diagnostic and Statistical Manual of Mental Disorders, fourth and fifth editions, diagnoses of ATSUD. Eligible studies were assessed for risk of bias, using the Cochrane Risk of Bias tool. The primary outcome included the effect of modafinil on ATS use. Secondary outcomes included retention in treatment, ATS craving, treatment discontinuation due to adverse events (AEs), and serious AEs. Subgroup analysis by modafinil dose was conducted where appropriate. Risk ratio (RR) or Peto’s odds ratio (OR) was calculated for the meta-analysis of dichotomous variables and standardized mean difference (SMD) was calculated for the random-effect meta-analysis of continuous variables.

RESULTS: Five RCTs (N = 451 participants) were included. Modafinil did not significantly impact ATS use (RR = 0.99; 95% CI, 0.97 to 1.02; p = 0.655), retention in treatment (RR = 1.02; 95% CI, 0.91 to 1.14; p = 0.799), ATS craving (SMD = -0.36; 95% CI, -1.19 to 0.47; p = 0.398), or treatment discontinuation due to AEs (Peto’s OR = 0.48; 95% CI, 0.20 to 1.14; p = 0.100). These results were consistent across subgroup analyses. More episodes of serious AEs were reported in the modafinil group than in the placebo group, at higher doses (Peto’s OR = 4.80; 95% CI, 1.18 to 19.56, p = 0.029).

CONCLUSION: There is currently no evidence suggesting that modafinil has a statistically significant effect on efficacy outcomes in populations with ATSUD. Continued research into effective treatments and harm reduction strategies for ATSUD is essential.

PMID:39033427 | DOI:10.1177/07067437241262967

J Hosp Med. 2024 Jul 21. doi: 10.1002/jhm.13462. Online ahead of print.

ABSTRACT

BACKGROUND: Secure electronic messaging is increasingly being utilized for communications in healthcare settings. While it likely increases efficiency, it has also been associated with interruptions, high message volumes, and risk of errors due to multitasking.

OBJECTIVES: We aimed to characterize patterns of secure messaging among hospitalists to understand the volume of messages, message patterns, and impact on hospitalist workload.

METHODS: This was a retrospective cross-sectional study of Epic Secure Chat secure electronic messages received and sent by hospitalists from April 1 to April 30, 2023 at a large academic medical center. Number of conversations per day, number of chats sent and accessed per hour, and average minutes between when a chat was sent and accessed (lag time) were analyzed using a Pearson correlation coefficient test. Measures were plotted against patient volume and time of day.

RESULTS: Hospitalists sent or received an average of 130 messages per day with an average of 13 messages sent or received per hour. The median lag time was 39 s. There was a statistically significant correlation between hospital medicine morning census and number of conversations per day, number of chats sent per hour, and number of chats accessed per hour, but census did not impact lag time.

CONCLUSION: Secure messaging volumes may be higher than previously reported, which may affect hospitalist workload and workflow and have unintended effects on interruptions, multitasking, and medical errors. Additional work should be done to better understand local messaging patterns and opportunities to optimize volume of work and distractions.

PMID:39033420 | DOI:10.1002/jhm.13462

Hisp Health Care Int. 2024 Jul 21:15404153241264770. doi: 10.1177/15404153241264770. Online ahead of print.

ABSTRACT

Aims: The aims of this study were to examine the association of social network size with severe tooth loss and the number of missing teeth among Hispanic adults with diabetes in the United States and to assess whether the association varied by glycemic control. Methods: Data obtained from 1,007 adults who participated in the Hispanic Community Health Study were analyzed. Structural social support was measured with the Social Network Index (SNI), which assessed network size and frequency of social contacts. Tooth loss was measured by a count of the number of missing teeth and categorically as severe tooth loss (<9 remaining teeth). Descriptive statistical analyses were conducted to examine the sample characteristics. Logistic and negative binomial regression analyses were performed to examine the independent association between SNI and tooth loss and to test whether the association was modified by the glycemic target. Results: The prevalence of severe tooth loss was 5.91%. For each one-unit increase in SNI, the expected log count of the number of missing teeth was reduced by 3.3% (p-value: 0.037). Conclusions: In this study, a larger social network size was associated with fewer missing teeth among Hispanic persons living with diabetes. Further examination of social support and oral health is warranted.

PMID:39033412 | DOI:10.1177/15404153241264770

Int J Low Extrem Wounds. 2024 Jul 21:15347346241264602. doi: 10.1177/15347346241264602. Online ahead of print.

ABSTRACT

Vein diseases are one of the most common civilization diseases. The most advanced form chronic venous insufficiency are venous leg ulcers. The study included 40 patients, 20 male (50%) and 20 female (50%) in age between 52 and 88 years (mean age: 68.00 ± 8.55 years) with venous leg ulcers lasting 12.50 ± 5.45 months. Patients were distributed randomly in a double-blind study into two equal groups including 20 patients each (group 1-polarized light therapy and group 2-sham exposure). Patients from both groups received routine pharmacological treatment, specialistic medical dressings and compression therapy. In addition, patients were exposed to a cycle of polarized light therapy procedures or to sham exposures (30 procedures performed in two series of 15 procedures). Wound surface area was evaluated by computerized planimetry and pain intensity was assessed with the use of Visual Analog Scale (VAS) before and after therapy (2.5 months). The analysis showed a statistically significant reduction of surface ulcers area between groups 1 and 2. The median (IQR) size of wounds in group 1 was 2.4 (1.95-2.9) cm², in group 2; 2.8 (2.6-3.1) cm² (p = 0.038). The level of pain (VAS) after treatment was assessed in group 1, median (IQR): 2 (2-3) points, in group 2 4.5 (4-5) points; and the observed difference was also statistically significant (p < 0.001). In group 1, after treatment, the area of ulcers decreased-median (IQR): 33.05 (28.7-41.48) %, in group 2 by 18.99 (15-24.4) % (p < 0.001). In group 1, the pain intensity measured using the VAS scale decreased with a median (IQR): 71.42 (61.25-71.42) %, in group 2: 37.5 (28.57-50) % (p < 0.001). Complex therapy with polarized light therapy added to standard care was more effective than standard care alone in reducing of ulcers surface area and intensity of pain ailments in patients with chronic venous leg ulcers.

PMID:39033399 | DOI:10.1177/15347346241264602

Disabil Rehabil. 2024 Jul 21:1-16. doi: 10.1080/09638288.2024.2380475. Online ahead of print.

ABSTRACT

PURPOSE: Social rehabilitation of aggression following an Acquired Brain Injury (ABI) is critically important for persons with ABI due to increased vulnerability of criminal behaviour related to post-injury changes in functioning. This review presents findings from studies that evaluated aggression interventions in both community and forensic populations of people with ABI.

METHODS: We searched PsycINFO, EMBASE, SocINDEX, CINAHL and Medline databases for studies published between 1^st January 2000 and 15^th October 2023.

RESULTS: There were 15 studies (14 community-based, one forensic) that met inclusion criteria. Pharmacological management (6) was largely ineffective and anger management interventions (6) presented with inconsistent effectiveness. Emotion regulation (1) may be effective for externalised aggression. Both mindfulness and transcranial direct current stimulation (1) were effective, and the results of a forensic peer group approach (1) were not tested for statistical significance. There was variability in the measurement of aggression, injury severity, and cognitive impairment.

CONCLUSIONS: Whilst community interventions for aggression in persons with ABI are prevalent, findings for effectiveness have been mixed and there is a paucity of evaluated interventions in forensic samples. Further research is needed to unravel the complex interplay of factors contributing to aggression and develop effective social rehabilitation for persons with ABI.

PMID:39033395 | DOI:10.1080/09638288.2024.2380475

Acta Radiol. 2024 Jul 21:2841851241263066. doi: 10.1177/02841851241263066. Online ahead of print.

ABSTRACT

Spinal bone lesions encompass a wide array of pathologies, spanning from benign abnormalities to aggressive malignancies, such as diffusely localized metastases. Early detection and accurate differentiation of the underlying diseases is crucial for every patient’s clinical treatment and outcome, with radiological imaging being a core element in the diagnostic pathway. Across numerous pathologies and imaging techniques, deep learning (DL) models are progressively considered a valuable resource in the clinical setting. This review describes not only the diagnostic performance of these models and the differing approaches in the field of spinal bone malignancy recognition, but also the lack of standardized methodology and reporting that we believe is currently hampering this newly founded area of research. In line with their established and reliable role in lesion detection, this publication focuses on both computed tomography and magnetic resonance imaging, as well as various derivative modalities (i.e. SPECT). After conducting a systematic literature search and subsequent analysis for applicability and quality using a modified QUADAS-2 scoring system, we confirmed that most of the 14 identified studies were plagued by major limitations, such as insufficient reporting of model statistics and data acquisition, a lacking external validation dataset, and potentially biased annotation. Although we experienced these limitations, we nonetheless conclude that the potential of these methods shines through in the presented results. These findings underline the need for more stringent quality controls in DL studies, as well as model development to afford increased insight and progress in this promising novel field.

PMID:39033391 | DOI:10.1177/02841851241263066

Intensive Crit Care Nurs. 2024 Jul 19;84:103770. doi: 10.1016/j.iccn.2024.103770. Online ahead of print.

ABSTRACT

BACKGROUND: Pain management of sedated and ventilated patients in intensive care units lacks consistency.

OBJECTIVES: To investigate nurses’ training, governance, practices, knowledge and attitudes relating to pain management in consideration of published guidelines and explore nurses’ perspectives.

METHODS: A survey design, using an online questionnaire with free text responses, was employed. Quantitative and qualitative data from nurses working across different hospitals were collated and saved on Qualtrics platform. Quantitative data were analysed non-parametrically and narrative responses thematically. CROSS and SRQR reporting guidelines were adhered to.

OUTCOME MEASURES: Demographics, training, governance, clinical practice, knowledge, and attitudes.

RESULTS/FINDINGS: 108 nurses participated with ninety-two completed surveys analysed. Analgesia was used to complete nursing tasks regardless of comfort needs (n = 49, 53.3 %). Changes in vital signs prompted opioid administration (n = 48, 52.1 %). Choice of analgesia depended on doctor’s preference (n = 63, 68.5 %). Non-opioid therapy was administered before opioids (n = 42, 45.7 %). Sedatives were used to alleviate agitation(n = 50,54.3 %). No statistically significant difference in nurses’ knowledge existed between hospitals. Weak positive relationship: r = [0.081], p = [0.441] between “knowledge scores” and “years of ICU experience” and weak negative relationship r = [-0.119], p = [0.260] between “knowledge scores” and “hours of clinical practice” was detected. Lack of training, resources, policies, high patient acuity and casual employment were acknowledged barriers to pain management. Two overarching themes emerged from narrative responses: “Pain assessment, where is it?” And “Priorities of critical illness.”

CONCLUSION: The study uncovered pain management situation and examined nurses’ demographics, training, governance, practices, knowledge and attitudes. Narrative responses highlighted barriers to pain management.

IMPLICATIONS FOR CLINICAL PRACTICE: Health organisations should provide education, institute governance and develop policies to inform pain management. Nurses’ role encompasses updating knowledge, adhering to interventions and overcoming biases. This subsequently manifests as improvement in patient outcomes.

PMID:39032213 | DOI:10.1016/j.iccn.2024.103770

Clin Genitourin Cancer. 2024 Jun 22;22(5):102144. doi: 10.1016/j.clgc.2024.102144. Online ahead of print.

ABSTRACT

BACKGROUND: Inflammation plays a crucial role in tumor development and progression, with inflammatory markers showing promise in predicting cancer prognosis. However, their significance in muscle-invasive bladder cancer (MIBC), especially in the context of neoadjuvant chemotherapy (NAC), remains poorly understood. This study aims to evaluate the prognostic utility of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune inflammation index (SII), and derived neutrophil-to-lymphocyte ratio (dNLR) for overall survival (OS) in bladder cancer (BC) patients undergoing radical cystectomy (RC) in the NAC era.

PATIENTS AND METHODS: A retrospective review analyzed prospectively-collected data from our institutional BC registry, covering patients with MIBC undergoing RC with curative intent from March 1st, 2016, to December 31st, 2022. Blood samples were collected preoperatively to calculate NLR, PLR, SII, and dNLR. OS was defined from surgery to last follow-up or death. Statistical analyses included ROC curves, Kaplan-Meier Curves, and Cox proportional hazards regression models.

RESULTS: A total of 187 patients with median duration follow-up of 14.7 month were included in this study and 50.8% experienced death. NAC was administered in 50.3% of cases. The ideal cut-off for dichotomizing NLR, PLR, SII, and dNLR was 1.76, 104.30, 410.66, and 1.30, respectively. In multivariable analysis each of these biomarkers emerged as an independent prognostic factor for predicting OS. The results showed a correlation between higher NLR, PLR, SII, and dNLR levels and a deterioration in OS.

CONCLUSION: Elevated values of these inflammatory markers indicate poorer survival, highlighting their potential as indicators of disease aggressiveness. Identifying patients with elevated markers can help healthcare providers personalize treatment strategies, improving patient outcomes and survival rates.

PMID:39032203 | DOI:10.1016/j.clgc.2024.102144

Clin Genitourin Cancer. 2024 Jun 24;22(5):102143. doi: 10.1016/j.clgc.2024.102143. Online ahead of print.

ABSTRACT

INTRODUCTION: The renin-angiotensin system (RAS) has been demonstrated to modulate cell proliferation, desmoplasia, angiogenesis and immunosuppression. We examined the association of RAS inhibitors (RASi)-namely angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB)-with neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC) preceding radical cystectomy (RC).

PATIENTS AND METHODS: We retrospectively investigated concurrent RASi use with NAC prior to RC in 302 patients with MIBC from 3 academic institutions. Outcomes included pathologic complete response (pCR) and overall survival (OS). Pathologic features, performance status (PS), clinical stage, type/number of cycles of NAC, and toxicities were collected.

RESULTS: Overall pCR rate was 26.2% and 5-year OS was 62%. Concurrent ACEi intake with NAC approached significance for association with pCR (odds ratio [OR] = 1.71; 95% CI, 0.94-3.11; P = .077). Patients with cT3/4N0-N1 disease receiving ACEi had higher pCR rates (30.8% vs. 17.7%, P = .056) than those not on ACEi. Female sex had a statistically significant favorable interaction for pCR with ACEi intake (P = .044). ACEi intake was not associated with OS, while pCR, PS and lower clinical stage were significantly associated with improved OS.

CONCLUSION: ACEi intake is potentially associated with increased pCR in patients with MIBC receiving NAC prior to RC, and this association is more pronounced in patients with higher clinical stage of disease at the initiation of therapy and female sex. Our data suggest the potential relevance of the RAS as a therapeutic target in aggressive MIBC.

PMID:39032202 | DOI:10.1016/j.clgc.2024.102143