Nevin Manimala

Turk J Gastroenterol. 2023 Aug 21. doi: 10.5152/tjg.2023.23226. Online ahead of print.

ABSTRACT

BACKGROUND/AIMS: Non-variceal upper gastrointestinal bleeding is a well-established complication of non-steroidal anti-inflammatory drugs and anti-thrombotics. Both medication groups are frequently used by older populations and increase the incidence of non-var- iceal upper gastrointestinal bleeding; however, their impact on etiology and outcomes of non-variceal upper gastrointestinal bleeding has not been well defined. We aimed to compare the etiology and outcomes of non-variceal upper gastrointestinal bleeding in older patients who use anti-thrombotics and non-steroidal anti-inflammatory drugs or do not use either of them.

MATERIALS AND METHODS: This is a single-center prospective study of patients older than 65 years with non-variceal upper gastrointesti- nal bleeding. Endoscopic findings, laboratory values, blood transfusion, endoscopic treatment, re-bleeding, and 30-day mortality rates were recorded.

RESULTS: A total of 257 patients (median age 77.7 ± 8.2, 59% male) were included. Re-bleeding occurred in 25 (10%) and the 30-day mortality rate was 40 (16%). There was no statistically significant difference between patients using anti-thrombotics, non-steroidal anti-inflammatory drugs or non-users for blood transfusion (P = .46), endoscopic hemostasis (P = .39), re-bleeding (P = .09), and 30-day mortality (P = .45). Peptic ulcer was the most common etiology in all groups (124, 48%). Although the incidence of peptic ulcer was similar between drug users and anti-thrombotic users (P = .75), the incidence of peptic ulcer was significantly higher in patients using non-steroidal anti-inflammatory drugs than in patients who did not use drugs (P = .05). When the patients were analyzed as using anti- thrombotic drugs or non-steroidal anti-inflammatory drugs or neither, no statistically significant difference was found between ulcer location, ulcer number, and ulcer size.

CONCLUSION: Non-variceal upper gastrointestinal bleeding increasingly occurs in older populations with several comorbidities; non- steroidal anti-inflammatory drugs or anti-thrombotics do not seem to change the clinical outcomes among older patients with non- variceal upper gastrointestinal bleeding.

PMID:37603303 | DOI:10.5152/tjg.2023.23226

Turk J Gastroenterol. 2023 Aug 21. doi: 10.5152/tjg.2023.22827. Online ahead of print.

ABSTRACT

BACKGROUND/AIMS: The aim of this study is to evaluate the efficiency for educational purposes by evaluating the videos published on YouTube channel, which is an open source video sharing platform, for robotic right hemicolectomy procedure.

MATERIALS AND METHODS: We searched YouTube website to choose video clips that included information about robotic right hemicolec- tomy for right colon cancer. All videos were analyzed according to the criteria like quality of videos, quality of teaching, and modified Laparoscopic Surgery Video Educational Guidelines.

RESULTS: There were 16 complete mesocolic excision and 56 noncomplete mesocolic excision videos in the study. According to the Likert scale, calculated complete mesocolic excision scores were analyzed better than the noncomplete mesocolic excision group and this difference was statistically significant (P < .0001). The teaching quality scores of complete mesocolic excision videos were higher than noncomplete mesocolic excision group and this result was statistically significant (P = .02). The videos were scored according to the modified Laparoscopic Surgery Video Educational Guideline, and the score difference was statistically significant between complete mesocolic excision and noncomplete mesocolic excision videos (P < .001). The video power index was higher (mean 5.52 ± 15.56 vs. mean 1.66 ± 3.41) in the complete mesocolic excision group, but there was no statistically significant difference between the 2 groups (P = .086).

CONCLUSIONS: Most of the robotic right hemicolectomy videos on the YouTube platform are insufficient in terms of educational capaci- ties. Complete mesocolic excision-containing videos are slightly superior in this respect to noncomplete mesocolic excision videos, as considering a new technique can make video presenters more attentive. In our opinion, if the images presented to the video platforms are to be used for educational purposes, they must undergo a certain evaluation and screening process.

PMID:37603300 | DOI:10.5152/tjg.2023.22827

J Chem Theory Comput. 2023 Aug 21. doi: 10.1021/acs.jctc.3c00254. Online ahead of print.

ABSTRACT

Enhanced sampling techniques have revolutionized molecular dynamics (MD) simulations, enabling the study of rare events and the calculation of free energy differences in complex systems. One of the main families of enhanced sampling techniques uses physical degrees of freedom called collective variables (CVs) to accelerate a system’s dynamics and recover the original system’s statistics. However, encoding all the relevant degrees of freedom in a limited number of CVs is challenging, particularly in large biophysical systems. Another category of techniques, such as parallel tempering, simulates multiple replicas of the system in parallel, without requiring CVs. However, these methods may explore less relevant high-energy portions of the phase space and become computationally expensive for large systems. To overcome the limitations of both approaches, we propose a replica exchange method called OneOPES that combines the power of multireplica simulations and CV-based enhanced sampling. This method efficiently accelerates the phase space sampling without the need for ideal CVs, extensive parameters fine tuning nor the use of a large number of replicas, as demonstrated by its successful applications to protein-ligand binding and protein folding benchmark systems. Our approach shows promise as a new direction in the development of enhanced sampling techniques for molecular dynamics simulations, providing an efficient and robust framework for the study of complex and unexplored problems.

PMID:37603295 | DOI:10.1021/acs.jctc.3c00254

Aging Clin Exp Res. 2023 Aug 21. doi: 10.1007/s40520-023-02530-8. Online ahead of print.

ABSTRACT

BACKGROUND: Previous studies have suggested that antihypertensive drugs may play a role in the treatment of osteoarthritis, but these studies may be limited by confounding factors and lead to biased results. Therefore, we conducted a Mendelian randomization study to investigate the effects of blood pressure and antihypertensive drugs on osteoarthritis.

METHODS: We used published large-scale genome-wide association data and applied univariate and multivariate Mendelian randomization methods. The main analysis model was inverse variance weighting, and the reliability of the results was tested using MR-Egger intercept analysis, Cochran’s Q test, and leave-one-out analysis. We comprehensively evaluated the relationship between systolic blood pressure, diastolic blood pressure, 12 antihypertensive drugs, and osteoarthritis. We also conducted verification in the independent queue of UK Biobank and built a simple linear regression model to obtain an independent comparison.

RESULTS: We found no evidence that systolic and diastolic blood pressure significantly affected osteoarthritis. However, among antihypertensive drugs, we observed a significant positive correlation between potassium-preserving diuretics and aldosterone antagonists and all osteoarthritis (OR: 0.560, 95% CI 0.406-0.772, P = 0.0004). Sensitivity analysis showed no horizontal pleiotropy or heterogeneity, and the leave-one-out analysis demonstrated the reliability of the results. This result was replicated with nominally statistical significance in the validation cohort and exhibited significant correlation in the linear regression analysis.

CONCLUSIONS: Our study suggested that controlling the protein targets of potassium-sparing diuretics and aldosterone antagonists may have beneficial results for osteoarthritis. These findings provide valuable medication strategies for the control of hypertension in patients with osteoarthritis.

PMID:37603265 | DOI:10.1007/s40520-023-02530-8

Anat Sci Int. 2023 Aug 21. doi: 10.1007/s12565-023-00740-8. Online ahead of print.

ABSTRACT

It is difficult to obtain specific information regarding the trigeminal ganglion (TG), especially pediatric TG. The aim of present study was to determine the parameters of the TG and assist in the neuroablative treatment of trigeminal neuralgia (TN). Thirty-seven sides of cadaver heads that had undergone gross anatomical examination were included, with 29 sides of adults and 8 sides of infants. The distance and angles were measured among 12 points, with nine points adjacent to the TG and three points on the foramen ovale (FO). The three points on FO were represented as three different surgical approaches for TN: posterior FO approach (PFO), lateral FO approach (LFO), and anterior FO approach (AFO). A high similarity was found in pediatric TG. No statistical difference was detected in either the distance or the angles between the 12 points. Statistical difference was found in adult heads in some of the distances, which included PFO to point 5 (17.97 ± 3.35 mm in the left and 15.52 ± 2.28 mm in the right; p = 0.03) and LFO to point 5 and point 8. Moreover, the angle for PFO to point 5 showed a statistically significant difference (60.10 ± 14.02 in the left and 46.63 ± 10.48 in the right; p = 0.01). These findings revealed that surgical neuroablation for patients with TN should be performed more carefully when the PFO or LFO approach is adopted, with a precise preoperative evaluation to avoid corneal complications. Two safety radiofrequency rhizotomy points are also presented to deal with two different kinds of TN.

PMID:37603209 | DOI:10.1007/s12565-023-00740-8

J Genet Eng Biotechnol. 2023 Aug 21;21(1):87. doi: 10.1186/s43141-023-00540-7.

ABSTRACT

BACKGROUND: Polycystic ovary syndrome is a common multifactorial endocrinopathy disorder affecting 5-15% of reproductive women worldwide. The CYP19 gene encodes key enzyme aromatase involved in androgen-to-estrogen conversion which plays a crucial role in the pathophysiology of the syndrome. Very few studies have been done in the Indian population; hence, we investigated whether CYP19 gene rs2414096 SNP is associated with PCOS and hyperandrogenism susceptibility in Karnataka women.

METHODS: Three-hundred subjects including 150 PCOS and 150 age-matched controls were involved in the current case-control study. Sex hormones and biochemical estimation were performed by ELISA. Sanger sequencing and PCR-RFLP were used to genotype the SNP rs2414096. Genotypic-phenotypic association was studied. Statistical analysis was performed.

RESULTS: The GG genotype was more common in patients, while the GA genotype was more common in control women. LH/FSH was significantly increased in GG genotype in PCOS when compared with AA and GA genotypes. Variations of CYP19 rs2414096 were not statistically significant with PCOS.

CONCLUSION: CYP19 rs2414096 polymorphism was not associated with PCOS; however, the homozygous wild GG genotype may exhibit reduced aromatase activity with subsequent hyperandrogenism implicating endocrine abnormalities.

PMID:37603197 | DOI:10.1186/s43141-023-00540-7

Arch Osteoporos. 2023 Aug 21;18(1):109. doi: 10.1007/s11657-023-01316-9.

ABSTRACT

Randomized clinical trials and observational studies on the implementation of clinical governance models, in patients who had experienced a fragility fracture, were examined. Literature was systematically reviewed and summarized by a panel of experts who formulated recommendations for the Italian guideline.

PURPOSE: After experiencing a fracture, several strategies may be adopted to reduce the risk of recurrent fragility fractures and associated morbidity and mortality. Clinical governance models, such as the fracture liaison service (FLS), have been introduced for the identification, treatment, and monitoring of patients with secondary fragility fractures. A systematic review was conducted to evaluate the association between multidisciplinary care systems and several outcomes in patients with a fragility fracture in the context of the development of the Italian Guidelines.

METHODS: PubMed, Embase, and the Cochrane Library were investigated up to December 2020 to update the search of the Scottish Intercollegiate Guidelines Network. Randomized clinical trials (RCTs) and observational studies that analyzed clinical governance models in patients who had experienced a fragility fracture were eligible. Three authors independently extracted data and appraised the risk of bias in the included studies. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Effect sizes were pooled in a meta-analysis using random-effects models. Primary outcomes were bone mineral density values, antiosteoporotic therapy initiation, adherence to antiosteoporotic medications, subsequent fracture, and mortality risk, while secondary outcomes were quality of life and physical performance.

RESULTS: Fifteen RCTs and 62 observational studies, ranging from very low to low quality for bone mineral density values, antiosteoporotic initiation, adherence to antiosteoporotic medications, subsequent fracture, mortality, met our inclusion criteria. The implementation of clinical governance models compared to their pre-implementation or standard care/non-attenders significantly improved BMD testing rate, and increased the number of patients who initiated antiosteoporotic therapy and enhanced their adherence to the medications. Moreover, the treatment by clinical governance model respect to standard care/non-attenders significantly reduced the risk of subsequent fracture and mortality. The integrated structure of care enhanced the quality of life and physical function among patients with fragility fractures.

CONCLUSIONS: Based on our findings, clinicians should promote the management of patients experiencing a fragility fracture through structured and integrated models of care. The task force has formulated appropriate recommendations on the implementation of multidisciplinary care systems in patients with, or at risk of, fragility fractures.

PMID:37603196 | DOI:10.1007/s11657-023-01316-9

Eur Geriatr Med. 2023 Aug 21. doi: 10.1007/s41999-023-00852-4. Online ahead of print.

ABSTRACT

CONTEXT: The assessment of decision-making ability of older adults with cognitive impairment is a complex challenge that geriatricians often face in relation to risk-taking situations (driving, aging in place, financial decisions, etc.). However, there are no clear and consensual practice guidelines. An overview of current practices and needs seemed necessary.

METHODS: We co-created and conducted an online survey to describe practice and knowledge, among European geriatricians. The survey was structured in 3 parts: a description of the professional’s practice regarding cognitive impairment, a specific questionnaire about everyday risky decision-making evaluation and an investigation of the clinician’s knowledge about relevant ethical and legal recommendations. Each part consisted of both multiple choice and open questions, analyzed through descriptive statistics and qualitative analysis methods.

RESULTS: Based on the responses of 123 geriatricians across Europe, our survey showed that clinical interview is the cornerstone of geriatric assessment of decision-making ability of patients with mild to moderate dementia. When faced with risk-taking dilemma situations, geriatricians tend to favor a context of safety above autonomy, but they can support risky decision-making if it is consistent with the patient’s previous lifestyle, depending on the degree of risk to self and others, on the decision-making ability assessed, and if there is some form of shared decision-making.

CONCLUSION: Assessing decision-making ability is challenging for geriatricians, who in our study relied more on their clinical interview and global cognitive tests than more in-depth evaluations. Supporting independent decision-making, when associated with risk-taking, requires better detection and anticipation shared with the patient environment.

PMID:37603190 | DOI:10.1007/s41999-023-00852-4

Clin Oral Investig. 2023 Aug 21. doi: 10.1007/s00784-023-05209-6. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the treatment efficacy of fluoride toothpaste alone and those of adjunctive use of resin infiltration, sodium fluoride varnish, and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on white spot lesions (WSLs).

MATERIALS AND METHODS: Seventy-nine patients (356 teeth) with WSLs after orthodontic treatment were randomly allocated into four groups. The WSLs of the participants received resin infiltration only at baseline, and the other groups received fluoride varnish, CPP-ACP mousse, and placebo treatment every 6 months, respectively. A toothpaste containing 1400 ppm fluoride and toothbrushes were distributed to all participants, and oral hygiene instructions were provided. Photos of the teeth with WSL were taken to compare the change between groups which was measured by ImageJ software.

RESULTS: Twelve months later, different degrees of reduction in the area of WSLs were observed in all groups. The percentage of lesion area reduction in WSLs in the resin infiltration group was 46.6%, which was significantly higher than that in fluoride varnish group (26.6%), CPP-ACP group (28.6%), and control group (29.8%), and the differences were statistically significant (p < 0.001).

CONCLUSIONS: This study shows that after 1-year follow-up, the use of fluoride toothpaste, with or without the use of fluoride varnish or CPP-ACP, can reduce the area of WSLs. While resin infiltration can immediately improve dental aesthetics and continuously improved in 12 months, resin infiltration group showed much better results than other groups.

TRIAL REGISTRATION: Clinical Trials Registration Number: ChiCTR2000032516.

CLINICAL SIGNIFICANCE: The use of fluoride toothpaste, with or without adjunctive use of fluoride varnish and CPP-ACP, can reduce the area of WSLs, while resin infiltration treatment has additional effect and can immediately improve dental aesthetics.

PMID:37603170 | DOI:10.1007/s00784-023-05209-6

Clin Oral Investig. 2023 Aug 21. doi: 10.1007/s00784-023-05212-x. Online ahead of print.

ABSTRACT

OBJECTIVES: Different platelet-rich fibrin (PRF) protocols exist and are known to differ in resulting mechanical and bioactive properties. Centrifugation parameters may also influence drug release, in particular antibiotics, when using PRF as a bio-carrier. We thus evaluated three common protocols regarding effects on the bio-carrier properties.

MATERIALS AND METHODS: In a prospective trial comprising 33 patients, we compared different protocols for PRF as a bio-carrier for ampicillin/sulbactam (SAM). Blood samples were taken shortly after a single dose of ampicillin/sulbactam (2 g/1 g) was administered to patients intravenously. PRF was obtained by centrifugation and three protocols were used: protocol A (1300 rpm, 8 min, RCF-max = 208 g), B (2300 rpm, 12 min, RCF-max = 652 g), and C (1500 rpm, 14 min, RCF-max = 276 g). The antibacterial activity of PRF was investigated against five oral species in vitro, based on agar diffusion methodology.

RESULTS: The study demonstrates that a single dose of SAM is sufficient to reach high concentrations in PRF in all protocols (150 µg/ml), which is comparable to the plasma SAM concentration. Antibacterial activity was inferred from the diameter of inhibition zones seen in agar diffusion tests using PRF discs. Protocol B resulted in the largest inhibition zones. One-way ANOVA revealed statistically improved results for protocol B for some bacteria.

CONCLUSIONS: The study provides valuable data on PRF antibiotic enrichment, notably SAM. A single dose of SAM is sufficient to reach clinically relevant concentrations in PRF.

CLINICAL RELEVANCE: These findings potentially extend the application of PRF, for example in patients with osteonecrosis of the jaw or in oral surgery (e.g., stick bone).

PMID:37603167 | DOI:10.1007/s00784-023-05212-x