Nevin Manimala

Clin Exp Med. 2024 Aug 13;24(1):190. doi: 10.1007/s10238-024-01452-7.

ABSTRACT

Hyperkalaemia is associated with prolonged hospital admission and worse mortality. Hyperkalaemia may also necessitate clinical consults, therapies for hyperkalaemia and high-dependency bed utilisation. We evaluated the ‘hidden’ human and organisational resource utilisation for hyperkalaemia in hospitalised patients. This was a single-centre, observational cohort study (Jan 2017-Dec 2020) at a tertiary-care hospital. The CogStack system (data processing and analytics platform) was used to search unstructured and structured data from individual patient records. Association between potassium and death was modelled using cubic spline regression, adjusted for age, sex, and comorbidities. Cox proportional hazards estimated the hazard of death compared with normokalaemia (3.5-5.0 mmol/l). 129,172 patients had potassium measurements in the emergency department. Incidence of hyperkalaemia was 85.7 per 1000. There were 49,011 emergency admissions. Potassium > 6.5 mmol/L had 3.9-fold worse in-hospital mortality than normokalaemia. Chronic kidney disease was present in 21% with potassium 5-5.5 mmol/L and 54% with potassium > 6.5 mmol/L. For diabetes, it was 20% and 32%, respectively. Of those with potassium > 6.5 mmol/L, 29% had nephrology review, and 13% critical care review; in this group 22% transferred to renal wards and 8% to the critical care unit. Dialysis was used in 39% of those with peak potassium > 6.5 mmol/L. Admission hyperkalaemia and hypokalaemia were independently associated with reduced likelihood of hospital discharge. Hyperkalaemia is associated with greater in-hospital mortality and reduced likelihood of hospital discharge. It necessitated significant utilisation of nephrology and critical care consultations and greater likelihood of patient transfer to renal and critical care.

PMID:39136879 | DOI:10.1007/s10238-024-01452-7

Cell Biol Toxicol. 2024 Aug 13;40(1):69. doi: 10.1007/s10565-024-09902-4.

ABSTRACT

Many persistent organic pollutants (POPs) are suspected endocrine disruptors and it is important to investigate their effects at low concentrations relevant to human exposure. Here, the OECD test guideline #456 steroidogenesis assay was downscaled to a 96-well microplate format to screen 24 POPs for their effects on viability, and testosterone and estradiol synthesis using the human adrenocortical cell line H295R. The compounds (six polyfluoroalkyl substances, five organochlorine pesticides, ten polychlorinated biphenyls and three polybrominated diphenyl ethers) were tested at human-relevant levels (1 nM to 10 µM). Increased estradiol synthesis, above the OECD guideline threshold of 1.5-fold solvent control, was shown after exposure to 10 µM PCB-156 (153%) and PCB-180 (196%). Interestingly, the base hormone synthesis varied depending on the cell batch. An alternative data analysis using a linear mixed-effects model that include multiple independent experiments and considers batch-dependent variation was therefore applied. This approach revealed small but statistically significant effects on estradiol or testosterone synthesis for 17 compounds. Increased testosterone levels were demonstrated even at 1 nM for PCB-74 (18%), PCB-99 (29%), PCB-118 (16%), PCB-138 (19%), PCB-180 (22%), and PBDE-153 (21%). The MTT assay revealed significant effects on cell viability after exposure to 1 nM of perfluoroundecanoic acid (12%), 3 nM PBDE-153 (9%), and 10 µM of PCB-156 (6%). This shows that some POPs can interfere with endocrine signaling at concentrations found in human blood, highlighting the need for further investigation into the toxicological mechanisms of POPs and their mixtures at low concentrations relevant to human exposure.

PMID:39136868 | DOI:10.1007/s10565-024-09902-4

J Gambl Stud. 2024 Aug 13. doi: 10.1007/s10899-024-10352-0. Online ahead of print.

ABSTRACT

Gambling is a well-known leisure activity that leads to significant consequences when consumed excessively. We provide an analysis of the impact of access to faster and more reliable internet connection on gambling. We rely on variations in the rollout of Australia’s largest infrastructure project, National Broadband Network (NBN) installation, to measure internet speed at the postcode level. Using gambling data from the Household, Income and Labour Dynamics in Australia (HILDA) survey, we find that access to high-speed internet is associated with a decline in gambling proxied by the Problem Gambling Severity Index (PGSI). However, a closer look at the various forms of gambling show that internet speed is associated with an increase in online-based gambling activities, which constitute a relatively small proportion of gambling activities that Australians participate in. In contrast, internet speed is associated with a decline in venue-based gambling activities, which constitute a large proportion of gambling activities that occur in Australia, and therefore explains the overall negative effect on gambling. We find that social capital and cognitive functioning are channels through which internet speed influences gambling.

PMID:39136865 | DOI:10.1007/s10899-024-10352-0

Eur Geriatr Med. 2024 Aug 13. doi: 10.1007/s41999-024-01030-w. Online ahead of print.

ABSTRACT

PURPOSE: There is variation in organization of geriatric rehabilitation across Europe. The purpose of this study was to describe the selection criteria for referral to geriatric rehabilitation, care provided, and recovery trajectories of post-COVID-19 patients referred to geriatric rehabilitation in Europe.

METHODS: This observational cohort study included 723 patients in 59 care facilities for geriatric rehabilitation across 10 countries. Patient data were collected from medical records on admission to geriatric rehabilitation (between September 2020 and October 2021), discharge, 6 weeks and 6 months follow-up. The primary and secondary outcomes were recovery in daily functioning (Barthel Index) and Quality of Life (EQ-5D-5L) from admission to discharge. These were examined using linear mixed models with two levels (measurements nested in patients) and country as an independent variable. Random intercept and random linear slope parameters were added when they improved model fit. A survey about organization of geriatric rehabilitation for post-COVID-19 patients was filled out by country coordinators and data were analyzed using descriptive statistics and inductive coding of answers to open questions.

RESULTS: Patients had a mean age of 75.7 years old and 52.4% were male. Many countries used various combinations of the selection criteria, such as functional status, age, frailty, Comprehensive Geriatric Assessment, comorbidities, and cognitive impairments. Most patients received physiotherapy (88.8%) and occupational therapy (69.7%), but there was substantial variance between countries in the percentages of patients that received protein or calorie enriched diets, oxygen therapy, and other treatment components. In all countries, patients showed recovery in daily functioning and quality of life, although there was variation in between countries in rate of recovery. Daily functioning seemed to increase most rapidly in the Czech Republic, Germany, and Russia. The steepest increases in quality of life were seen in the Czech Republic, Germany, and Spain.

CONCLUSION: Post-COVID-19 patients showed recovery during geriatric rehabilitation, albeit at variable rates. The observed variation may be explained by the heterogeneity in selection criteria and care provided. This study highlights the need for harmonization of measurements in geriatric rehabilitation order to perform explanatory research and optimize geriatric rehabilitation throughout Europe to ensure optimal patient recovery.

PMID:39136862 | DOI:10.1007/s41999-024-01030-w

Sci China Life Sci. 2024 Aug 8. doi: 10.1007/s11427-024-2657-y. Online ahead of print.

NO ABSTRACT

PMID:39136859 | DOI:10.1007/s11427-024-2657-y

J Cosmet Dermatol. 2024 Aug 13. doi: 10.1111/jocd.16498. Online ahead of print.

ABSTRACT

BACKGROUND: Rosacea can be seen in many patients nowadays, and the related causes are complex. Despite a certain association between smoking and rosacea being reported by several studies, the actual causality has not been established for the possible bias and confounders.

METHODS: We used Mendelian randomization (MR) to evaluate a potential causal effect of smoking on rosacea risk. Statistics on smoking and rosacea were obtained from the FinnGen project and Neale Lab Consortium. The causal association was assessed by multiple methods including inverse variance weighted (IVW), MR Egger, weighted median, and weighted mode. Furthermore, sensitivity analyses were also conducted to address pleiotropy, along with the leave-one-out method.R version 4.2.3 was applied for the analyses.

RESULTS: The IVW estimation revealed that previous smoking has a deleterious effect on rosacea (odds ratio [OR] = 6.7729, 95% confidence interval [CI] = 1.5691-29.2356, p = 0.0104). By contrast, there was no statistically relationship between current smokers and rosacea (OR = 0.6180, 95% CI = 0.0605-6.3094, p = 0.6847). Results were similar in the analysis based on the weighted median method (previous smoking: OR = 8.6297, 95% CI = 1.0131-73.5071, p = 0.0486; current smoking: OR = 0.2896, 95% CI = 0.0106-7.9132, p = 0.4627). The stability of the causal effect estimates was supported by several sensitivity analyses and the leave-one-out method.

CONCLUSION: Our MR study found support forrosacea risk and previous smoking. Although no evidence was found to increase the risk of rosacea in current smokers, to prevent various diseases associated with smoking, the public should be encouraged to avoid smoking at the very beginning.

PMID:39136194 | DOI:10.1111/jocd.16498

J Gastroenterol Hepatol. 2024 Aug 13. doi: 10.1111/jgh.16685. Online ahead of print.

ABSTRACT

BACKGROUND AND AIM: Currently, the primary treatment modality for patients with colorectal adenocarcinoma (CRA) is radical surgery combined with postoperative adjuvant chemotherapy (PAC). However, many elderly patients decline PAC due to concerns about their underlying physiological condition, and the impact of PAC on the prognosis of elderly patients remains uncertain.

METHODS: We extracted data from the SEER database for CRA patients aged 75 and above between 2010 and 2019. Utilizing propensity score matching (PSM), we stratified the patients into a PAC group and a non-PAC group, enabling us to compare the differences in Kaplan-Meier survival curves between these two groups. Furthermore, through univariate and multivariate Cox regression analyses, we identified the clinical factors that influence the survival of elderly CRA patients and compared the prognostic disparities between the two patient groups within specific subgroups of these clinical factors.

RESULTS: Following PSM, a total of 3668 patients were included and divided into the PAC group and the non-PAC group, with no statistically significant differences observed in crucial clinical characteristics between the two groups. Kaplan-Meier analysis revealed a significantly better prognosis for patients in the PAC group compared with those in the non-PAC group. In addition, age, chemotherapy, TNM staging, gender, and preoperative CEA levels were all identified as important factors affecting patient prognosis. Moreover, PAC provided survival benefits across the majority of levels within the aforementioned subgroups. However, in specific subgroups (age > 90, Grade IV stage, median household income < $40 000), PAC did not confer any survival benefits.

CONCLUSION: PAC can significantly improve the prognosis of elderly CRA patients. Nonetheless, in certain population subsets characterized by specific clinical features, PAC does not provide any survival benefits.

PMID:39136187 | DOI:10.1111/jgh.16685

Dalton Trans. 2024 Aug 13. doi: 10.1039/d4dt01498g. Online ahead of print.

ABSTRACT

A high-temperature synthetic approach is used to prepare a series of pseudo-binary phases-Co_2-xNi_xZn₁₁. In the structures of Co_2-xNi_xZn₁₁, the statistical distribution between Co and Ni that is suggested by compositional analysis is confirmed by combined refinements of X-ray and neutron powder diffraction (NPD) experimental data. The aforementioned phases adopt a body-centered cubic lattice with a noncentrosymmetric space group I4̄3m (217). Their crystal structures comprise two 26-atom γ-brass clusters. Each γ-cluster is made of four sequential polyhedral shells: inner tetrahedron (IT), outer tetrahedron (OT), octahedron (OH), and distorted cuboctahedron (CO). Diffraction experiments and the computations endorse that the OT site is statistically distributed by Co and Ni atoms, while the other three sites (IT, OH, and CO) are occupied by Zn atoms. The density of states (DOS) curve for Co_1.5Ni_0.5Zn₁₁ displays a similar feature as binary Co₂Zn₁₁, whereas the wide pseudo-gap is formed near E_F as Ni-concentration increases in Co_2-xNi_xZn₁₁. Bonding analysis shows that this specific atomic distribution nearly optimizes heteroatomic Co/Ni-Zn contacts in the Co_1.0Ni_1.0Zn₁₁ and Co_0.5Ni_1.5Zn₁₁. The Co_1.7Ni_0.3Zn₁₁ exhibit paramagnetic behavior, whereas Co_0.5Ni_1.5Zn₁₁ shows distinct diamagnetic behavior. With the increase in Ni concentration in the structure of Co_2-xNi_xZn₁₁, Ni atoms gradually substitute the Co atoms at OT sites; hence, magnetic characteristics change from para- to diamagnetism.

PMID:39136138 | DOI:10.1039/d4dt01498g

Hypertension. 2024 Aug 13. doi: 10.1161/HYPERTENSIONAHA.124.23397. Online ahead of print.

ABSTRACT

BACKGROUND: Home blood pressure (BP) is more closely associated with cardiovascular event risk than office BP, but cardiovascular risk prediction based on home BP variability is lacking. This study developed a simple cardiovascular event prediction score, including home BP variability data, from the J-HOP study (Japan Morning Surge-Home Blood Pressure).

METHODS: The J-HOP study extended follow-up from December 2017 to May 2018 generated the study data set (4231 patients). Cardiovascular events included fatal/nonfatal stroke (n=94), coronary heart disease (n=124), heart failure (n=42), and aortic dissection (n=8). Cox proportional hazards models were used to predict overall cardiovascular risk. Potential covariates included age, sex, body mass index, smoking, history of diabetes, statin use, history of cardiovascular disease, total cholesterol:high-density lipoprotein cholesterol ratio, office systolic BP (SBP), mean of morning-evening average (MEave), home SBP, and average real variability of MEave home SBP. A risk score and models were constructed, and model performance was assessed.

RESULTS: Model performance was best when average real variability of MEave SBP was included (C statistic, 0.760). The risk score assigns points for age (5-year bands), sex, cardiovascular disease history, high-density lipoprotein cholesterol, mean MEave home SBP, and average real variability of MEave home SBP. Estimated 10-year cardiovascular risk ranged from ≤0.6% (score ≤0) to >32% (score ≥26). Calibration 2 statistics values for the model (2.66) and risk score (5.29) indicated excellent goodness of fit.

CONCLUSIONS: This simple cardiovascular disease prediction algorithm, including day-by-day home BP variability, could be used as part of a home BP-centered approach to hypertension management in clinical practice.

PMID:39136129 | DOI:10.1161/HYPERTENSIONAHA.124.23397

Intern Med J. 2024 Aug 13. doi: 10.1111/imj.16488. Online ahead of print.

ABSTRACT

BACKGROUND AND AIM: Patients with autoimmune inflammatory rheumatic disease (AIIRD) are at higher risk of severe infections because of their underlying diseases and immunosuppression. Our objective was to elucidate the epidemiological and clinical characteristics of patients with AIIRD presenting with COVID-19 and their relation to disease severity. We explored whether variables, including underlying diagnosis, disease-modifying antirheumatic drugs (DMARDs) and COVID-19 vaccine status, were associated with more severe forms of COVID-19 infection.

METHODS: Between 1 January 2020 and 30 June 2022, 151 patients with AIIRD and COVID-19 infection were analysed using a binary regression model and a multinomial regression model.

RESULTS: The average age was 61.5 years, and average Charlson Comorbidity Index (CCI) was 2.1; 106 (70.2%) patients were diagnosed with rheumatoid arthritis (RA), and 70 (46.4%) patients were receiving prednisolone. In the multivariable logistic regression model, ages between 50 and 69 years (odds ratio (OR) = 5.85; 95% confidence interval (CI) = 1.35-25.25) and older than 70 years (OR = 5.29; 95% CI = 1.21-23.14), prior prednisolone treatment (OR = 7.09; 95% CI = 2.63-19.11) and vaccination status including one and two doses (OR = 0.19; 95% CI = 0.05-0.69) and three and four doses (OR = 0.09; 95% CI = 0.02-0.35) were all statistically significant factors related to changes in the severity level of COVID-19.

CONCLUSION: Severity of COVID-19 infection in patients with AIIRD is affected by age, background steroid use and vaccination status. Factors including sex, comorbidity, diagnosis of AIIRDs and use of DMARDs, including conventional synthetic, biologics and targeted DMARDs, were not significantly associated with COVID-19 severity.

PMID:39136111 | DOI:10.1111/imj.16488