Nevin Manimala

Nurs Ethics. 2023 Nov 30:9697330231218344. doi: 10.1177/09697330231218344. Online ahead of print.

ABSTRACT

Background: Clinical ethics support instruments aim to support healthcare professionals in dealing with moral challenges in clinical practice. CURA is a relatively new instrument tailored to the wishes and needs of healthcare professionals in palliative care, especially nurses. It aims to foster their moral resilience and moral competences.Aim: To investigate the effects of using CURA on healthcare professionals regarding their Moral Resilience and Moral Competences.Design: Single group pre-/post-test design with two questionnaires.Methods: Questionnaires used were the Rushton Moral Resilience Scale measuring Moral Resilience and the Euro-MCD, measuring Moral Competences. Respondents mainly consisted of nurses and nurse assistants who used CURA in daily practice. Forty-seven respondents contributed to both pre- and post-test with 18 months between both tests. Analysis was done using descriptive statistics and Wilcoxon signed rank tests. This study followed the SQUIRE checklist.Ethical considerations: This study was approved by the Institutional Review Board of Amsterdam UMC. Informed consent was obtained from all respondents.Results: The total Moral Resilience score and the scores of two subscales of the RMRS, that is, Responses to Moral Adversity and Relational Integrity, increased significantly. All subscales of the Euro-MCD increased significantly at posttest. Using CURA more often did not lead to significant higher scores on most (sub) scales.Conclusion: This study indicates that CURA can be used to foster moral resilience and moral competences of healthcare professionals. CURA therefore is a promising instrument to support healthcare professionals in dealing with moral challenges in everyday practice.

PMID:38031920 | DOI:10.1177/09697330231218344

Rev Esp Enferm Dig. 2023 Nov 30. doi: 10.17235/reed.2023.10051/2023. Online ahead of print.

ABSTRACT

BACKGROUND: Older adults are increasing in number and frequently seeking hospital care for acute illness. We aimed to measure the utilization and safety of ERCP in patients aged 85 and older in our hospital.

METHODS: This is a single-site, retrospective, observational and descriptive study. We obtained data about admissions and ERCP utilization from our hospital database. We reviewed medical and procedural records of patients aged 85 or older who underwent ERCP for choledocholithiasis between 2013 and 2019. We evaluated technical and medical adverse events after ERCP.

RESULTS: 494 ERCP for choledocholithiasis were performed during this period and 154 (31%) were aged 85 or older. We identified 567 (4.8%) admissions for biliary tract diseases in the older population, and 27% of cases had required ERCP. In older patients, the rate of technical adverse events was around 10%. There was no statistical difference between the older and younger groups regarding technical complications (8.8 vs 9.7%; p=0.7). Besides, in 36% of cases, a medical event, decompensated comorbidity or geriatric syndromes appeared after ERCP. The overall mortality for any cause at six months was nearly 20%, and the survival rate was significantly lower in patients who develop adverse events (technical or medical).

CONCLUSIONS: Our hospital experiences frequent utilization of ERCP by patients aged 85 and older. Although technical adverse event rates are similar to those of younger adults, medical events appear frequently. We plan to strengthen our care plans for older adults and hope to reduce the medical complications experienced post ERCP.

PMID:38031917 | DOI:10.17235/reed.2023.10051/2023

Cancer Biol Ther. 2023 Dec 31;24(1):2279241. doi: 10.1080/15384047.2023.2279241. Epub 2023 Nov 30.

ABSTRACT

Cyclin-dependent Kinase 2 (CDK2) inhibition prevents supernumerary centrosome clustering. This causes multipolarity, anaphase catastrophe and apoptotic death of aneuploid cancers. This study elucidated how CDK2 antagonism affected centrosome stoichiometry. Focused ion beam scanning electron microscopy (FIB-SEM) and immunofluorescent imaging were used. Studies interrogated multipolar mitosis after pharmacologic or genetic repression of CDK2. CDK2/9 antagonism with CYC065 (Fadraciclib)-treatment disordered centrosome stoichiometry in aneuploid cancer cells, preventing centrosome clustering. This caused ring-like chromosomes or multipolar cancer cells to form before onset of cell death. Intriguingly, CDK2 inhibition caused a statistically significant increase in single centrioles rather than intact centrosomes with two centrioles in cancer cells having chromosome rings or multipolarity. Statistically significant alterations in centrosome stoichiometry were undetected in other mitotic cancer cells. To confirm this pharmacodynamic effect, CDK2 but not CDK9 siRNA-mediated knockdown augmented cancer cells with chromosome ring or multipolarity formation. Notably, engineered gain of CDK2, but not CDK9 expression, reversed emergence of cancer cells with chromosome rings or multipolarity, despite CYC065-treatment. In marked contrast, CDK2 inhibition of primary human alveolar epithelial cells did not confer statistically significant increases of cells with ring-like chromosomes or multipolarity. Hence, CDK2 antagonism caused differential effects in malignant versus normal alveolar epithelial cells. Translational relevance was confirmed by CYC065-treatment of syngeneic lung cancers in mice. Mitotic figures in tumors exhibited chromosome rings or multipolarity. Thus, CDK2 inhibition preferentially disorders centrosome stoichiometry in cancer cells. Engaging this disruption is a strategy to explore against aneuploid cancers in future clinical trials.

PMID:38031910 | DOI:10.1080/15384047.2023.2279241

Clin J Pain. 2023 Nov 30. doi: 10.1097/AJP.0000000000001182. Online ahead of print.

ABSTRACT

OBJECTIVES: The understanding of the role that cognitive and emotional factors play in how an individual recovers from a whiplash injury, is important. Hence, we sought to evaluate if pain-related cognitions (self-efficacy beliefs, expectation of recovery, pain catastrophizing, optimism, and pessimism) and emotions (kinesiophobia) are longitudinally associated with the transition to chronic whiplash associated disorders (WAD) in terms of perceived disability, and perceived recovery at 6 and 12-months.

METHODS: One-hundred and sixty-one participants with acute or subacute WAD were included. The predictors were: self-efficacy beliefs, expectation of recovery, pain catastrophizing, optimism, and pessimism, pain intensity, and kinesiophobia. The two outcomes were the dichotomized scores of perceived disability and recovery expectations at six and twelve months. Stepwise regression with bootstrap resampling was performed to identify the predictors most strongly associated with the outcomes, and the stability of such selection.

RESULTS: Baseline perceived disability, pain catastrophizing, and expectation of recovery were the most likely to be statistically significant, with an overage frequency of 87.2%, 84.0%, and 84.0%, respectively.

DISCUSSION: Individuals with higher expectation of recovery and lower levels of pain catastrophizing and perceived disability at baseline, have higher perceived recovery and perceived disability at 6 and 12-months. These results have important clinical implications as both factors are modifiable via health education approaches.

PMID:38031848 | DOI:10.1097/AJP.0000000000001182

J Atten Disord. 2023 Nov 30:10870547231211024. doi: 10.1177/10870547231211024. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the improvement of ADHD related symptoms in school-aged children ages 5 to 12 in treatment with a monobloc appliance (MOA) for Sleep Disordered Breathing (SDB).

METHODS: A retrospective review of questionnaire scores of ADHD symptoms from school-aged children being treated with a MOA for SDB. Data was obtained from parent survey questionnaires of 40 school-aged children in three dental offices in treatment with an MOA for SDB showing symptoms of ADHD yet to be confirmed with a formal diagnosis between 2019 and 2021. ADHD symptom scores were ascertained by a parent survey questionnaire completed at the initial visit before MOA treatment, and 2 to 6 months, and 7+ months during MOA treatment.

RESULTS: At the 7+ month endpoint, 17 of the 28 (61%) children ages 5 to 12 saw at least a 1-point drop in the sum of their questionnaire scores indicating an improvement in ADHD symptoms after initiating treatment with an MOA. Although there was a reduction of the overall average symptom score from the initial visit to 2 to 6 months (M = 4.06, SD ± 1.55), a statistically significant improvement in ADHD symptoms occurred at the 7+ month endpoint (M = 15.29, SD ± 4.50) during MOA treatment.

CONCLUSIONS: Treatment with an MOA may be highly effective in addressing the dual pathologies of SDB and ADHD in school-age children ages 5 to 12.

PMID:38031843 | DOI:10.1177/10870547231211024

Pediatr Endocrinol Diabetes Metab. 2023;29(3):143-155. doi: 10.5114/pedm.2023.131162.

ABSTRACT

INTRODUCTION: Atherosclerosis, a precursor to cardiovascular disease (CVD), is deeply intertwined with lipid metabolism. The metabolic process in the Down syndrome (DS) population remain less explored. Aim of the study: This study examines the lipid profiles of DS in comparison to their siblings (CG), aiming to uncover potential atherosclerotic and CVD risks.

MATERIAL AND METHODS: The study included 42 people with DS (mean age 14.17 years) and the CG – 20 individuals (mean age 15.92 years). Anthropometric measurements: BMI, BMI SDS, and TMI were calculated. Lipid profile (LP) and metabolomics were determined.

RESULTS: LP: DS display significantly reduced HDL (DS vs. CG: 47±10 vs. 59 ±12 mg/dl; p = 0.0001) and elevated LDL (104 ±25 vs. 90 ±22 mg/dl; p = 0.0331). Triglycerides, APO A1, and APO B/APO A1 ratio corroborate with the elevated risk of CVD in DS. Despite no marked differences in: TCH and APO B, the DS group demonstrated a concerning BMI trend. Of 31 identified metabolites, 12 showed statistical significance (acetate, choline, creatinine, formate, glutamine, histidine, lysine, proline, pyroglutamate, threonine, tyrosine, and xanthine). However, only 8 metabolites passed the FDR validation (acetate, creatinine, formate, glutamine, lysine, proline, pyroglutamate, xanthine).

CONCLUSIONS: Down syndrome individuals show distinct cardiovascular risks, with decreased HDL and increased LDL levels. Combined with metabolomic disparities and higher BMI and TMI, this suggests an increased atherosclerosis risk compared to controls.

PMID:38031830 | DOI:10.5114/pedm.2023.131162

Pediatr Endocrinol Diabetes Metab. 2023;29(3):134-142. doi: 10.5114/pedm.2023.131513.

ABSTRACT

INTRODUCTION: Down syndrome (DS), a common genetic disorder, leads to various physical, cognitive, and developmental challenges. The supplementary copy of chromosome 21 introduces an abundance of genes, which potentially can influence metabolic irregularities. The aim of the study is to conduct a comprehensive comparative assessment of oxidative stress indicators (TAS, TOS, OSI), BMI, fasting glucose, and insulin levels, HOMA-IR among children and adolescents with DS in contrast to their non-DS siblings.

MATERIAL AND METHODS: and the control group (CG) comprised 20 individuals, siblings of SG (mean age 15.92 years). Anthropometric measurements were conducted. TAS, TOS, fasting glucose, and insulin were assessed. BMI, BMI SDS, OSI and HOMA-IR were calculated.

RESULTS: SG vs. CG: BMI – overweight (29,19% vs. 15%), obese (19,05% vs. 5%); TAS (1.92 mmol/l vs. 1.79 mmol/l (p = 0.0015)); TOS (51.52 mmol/l vs. 33.05 mmol/l (p = 0.014)); OSI (2475.02 vs. 1949,75 (p = 0.038)); no significant differences in fasting glucose, insulin and HOMA-IR. Statistically significant correlations in SG: TOS and BMI, BMI SDS, HOMA-IR; OSI and BMI, BMI SDS, HOMA-IR; HOMA-IR and BMI SDS; fasting insulin and BMI PC; in CG: TAS and BMI; fasting glucose and fasting insulin.

CONCLUSIONS: The research results indicate differences in metabolic processes between the group of individuals with DS compared to the CG, despite shared environmental conditions. The presence of an additional copy of chromosome 21 may contribute to the occurrence of metabolic disorders. These findings emphasize the need for further research that will lead to a better understanding of these relationships and contribute to the development of effective therapeutic strategies.

PMID:38031829 | DOI:10.5114/pedm.2023.131513

Pediatr Endocrinol Diabetes Metab. 2023;29(3):128-133. doi: 10.5114/pedm.2023.132025.

ABSTRACT

INTRODUCTION: Proper control of blood glucose in children with type 1 diabetes has a direct effect on their metabolism and quality of life by reducing the risk of complications. The use of probiotics may have a beneficial effect on glucose levels.

PURPOSE: The aim of this study was to evaluate the effect of oral consumption of probiotics on glycosylated haemoglobin in children with type 1 diabetes.

MATERIAL AND METHODS: In this single-blind randomized controlled clinical trial, 52 children with type 1 diabetes were studied. We created 2 groups of 26 individuals each. The probiotic group received a daily probiotic capsule for 90 days, in addition to routine insulin therapy. The control group received only insulin therapy. Blood samples were taken to measure HbA1c, fasting plasma glucose, and lipid profiles at the beginning and end of the trial.

RESULTS: The study showed that HbA1c was high in both groups, but this increase was lower in the probiotic group than in the control group. This difference was not statistically significant. The mean level of fasting plasma glucose in the probiotic group was significantly reduced compared to the control group (p = 0.016).

CONCLUSIONS: According to the results of our study, consumption of oral probiotics has no significant effect on HbA1c levels in children with type 1 diabetes mellitus.

PMID:38031828 | DOI:10.5114/pedm.2023.132025

Diabetes Obes Metab. 2023 Nov 30. doi: 10.1111/dom.15380. Online ahead of print.

ABSTRACT

AIM: To assess the potential heterogeneity in cardiovascular (CV), renal and safety outcomes of canagliflozin between Whites and Asians, as well as these outcomes in each subgroup.

MATERIALS AND METHODS: The CANVAS Program enrolled 10 142 patients with type 2 diabetes, comprising 78.34% Whites and 12.66% Asians. CV, renal and safety outcomes were comprehensively analysed using Cox regression models, while intermediate markers were assessed using time-varying mixed-effects models. Racial heterogeneity was evaluated by adding a treatment-race interacion term.

RESULTS: Canagliflozin showed no significant racial disparities in the majority of the CV, renal and safety outcomes. The heterogeneity (p = .04) was observed on all-cause mortality, with reduced risk in Whites (hazard ratio 0.84; 95% confidence interval 0.71-0.99) and a statistically non-significant increased risk in Asians (hazard ratio 1.64; 95% confidence interval 0.94-2.90). There was a significant racial difference in acute kidney injury (p = .04) and a marginally significant racial heterogeneity for the composite of hospitalization for heart failure and CV death (p = .06) and serious renal-related adverse events (p = .07).

CONCLUSION: Canagliflozin reduced CV and renal risks similarly in Whites and Asians; however, there was a significant racial discrepancy in all-cause mortality. This distinction may be attributed to the fact that Asian patients exhibited diminished CV protection effects and more renal adverse events with canagliflozin, potentially resulting from the smaller reductions in weight and uric acid. These findings highlight the importance of investigating the impact of race on treatment response to sodium-glucose cotransporter-2 inhibitors and provide more precise treatment strategies.

PMID:38031821 | DOI:10.1111/dom.15380

Arch Pathol Lab Med. 2023 Nov 28. doi: 10.5858/arpa.2023-0002-OA. Online ahead of print.

ABSTRACT

CONTEXT.—: Pleural effusion cytology has been widely used in the investigation of pathologic fluid accumulation in pleural spaces. However, up to one-tenth of the cases were not given a definitive diagnosis. These cases have largely been neglected in the bulk of the literature.

OBJECTIVE.—: To provide real-world data on indefinite diagnoses including “atypia of uncertain significance” (AUS) and “suspicious for malignancy” (SFM) in pleural effusion cytology and to investigate pathologists’ practice patterns on using these diagnostic categories.

DESIGN.—: We reported the diagnoses of 51 675 cases. Descriptive statistics and correlation coefficients were used to analyze the relationships between different diagnostic categories and pathologists’ practice patterns and possible explanatory variables.

RESULTS.—: The diagnoses AUS and SFM were reported in 4060 cases (7.86%) and 1554 cases (3.01%) in the cohort, respectively. The mean rates for these indefinite diagnoses varied up to 3-fold between pathologists. Correlations were found between AUS and SFM, as well as between indefinite diagnoses and negative for malignancy (NFM). No correlations were found between pathologists’ years of experience or case volume and the rates of indefinite diagnosis or diagnostic certainty.

CONCLUSIONS.—: A real-world baseline for the rates of indefinite diagnoses in pleural effusion cytology is provided in this large retrospective study. Pathologists show significant variation in their use of indefinite diagnostic categories, and the tendency to use these ambiguous terms was not correlated with individuals’ experience or case volume. How to untangle the intertwined relationship between the uncertainty of indefinite diagnoses and that of NFM requires future prospective studies.

PMID:38031811 | DOI:10.5858/arpa.2023-0002-OA