Nevin Manimala

S D Med. 2023 May;76(5):198-207.

ABSTRACT

INTRODUCTION: Data on long-term outcomes and subjective patient symptom improvement following primary native tissue pelvic organ prolapse repair is limited. Our primary aim was to evaluate the long-term prolapse recurrence and retreatment rates of women who have undergone native tissue prolapse repair. Our secondary aim was to evaluate subjective patient improvement in pelvic floor symptoms and quality of life 7 to 10 years after surgery.

METHODS: This retrospective cohort study included patients who had undergone primary prolapse repair surgery including a hysterectomy and native tissue repair by a single surgeon at a tertiary pelvic floor center from 2009 to 2013. The Pelvic Floor Distress Inventory was distributed to subjects before and 7 to 10 years after surgery and preand post-operative survey results were compared. Subjects were asked if they had symptom recurrence and if they required retreatment.

RESULTS: One hundred twelve of the 204 distributed surveys were returned, yielding a 54.9% response rate. 8.6% of subjects reported prolapse symptom recurrence. 1.9% of subjects were retreated with a pessary. No subjects required additional prolapse repair surgery. 77.1% of subjects had improved PFDI-20 scores following surgery with an average improvement of 46.21 points. Statistically significant score improvements were also observed on PFDI-20 subsections.

CONCLUSIONS: Primary pelvic organ prolapse repair utilizing native tissue results in low recurrence and retreatment rates. Patients can expect long-term clinical improvement in pelvic floor disorders and quality of life following prolapse surgery. Definitions of surgical success should be based on subjective patient symptoms and quality of life measures.

PMID:37603869

Am J Drug Alcohol Abuse. 2023 Aug 21:1-11. doi: 10.1080/00952990.2023.2238322. Online ahead of print.

ABSTRACT

Background: A set of evidence-based alcohol control policy measures was adopted in the period 2016-2020 in Lithuania. The present study fills a knowledge gap on how changes in alcohol control policy are associated with attitudes toward different alcohol policy measures.Objective: This study aims to explore whether support for key alcohol control policy measures in Lithuania declined following implementation of alcohol control measures.Methods: Data came from the Standard European Alcohol Survey. Two representative surveys with the same questionnaire, were conducted in Lithuania in 2015 (N = 1513, 51.7% female, response rate was 38.9%) and 2020 (N = 1015, 50.6% female, response rate was 38.0%). Multi-stage stratified probability sampling was applied. Surveys were carried out using computer-assisted face-to-face interviews, descriptive statistics and multiple logistic regression analyses was applied. We used a binomial logistic regression analysis and the Pearson chi-square test.Results: There was a significant decline in a proportion of respondents who agreed that the number of alcohol selling places should be kept low (OR: 0.84, p = .032), alcohol prices should be kept high (OR: 0.83, p = .027), and the police should be allowed to randomly check whether the driver is sober (OR: 0.65, p < .001). The proportion of respondents who agree that individuals are responsible enough with their drinking significantly declined (OR: 0.76, p = .003).Conclusion: Support for restrictions on alcohol-selling points, increase in alcohol price, and random alcohol testing of drivers declined following the adoption of new alcohol control policy measures. Our findings might be beneficial for policy-makers planning alcohol control policies and information campaigns.

PMID:37603857 | DOI:10.1080/00952990.2023.2238322

J Clin Oncol. 2023 Aug 21:JCO2301420. doi: 10.1200/JCO.23.01420. Online ahead of print.

NO ABSTRACT

PMID:37603826 | DOI:10.1200/JCO.23.01420

Int J Neuropsychopharmacol. 2023 Aug 21:pyad051. doi: 10.1093/ijnp/pyad051. Online ahead of print.

ABSTRACT

BACKGROUND: The clinical debut of schizophrenia is frequently a first episode of psychosis (FEP). As such, there is considerable interest in identifying associations between biological markers and clinical or cognitive characteristics that help predict the progression and outcome of FEP patients. Previous studies showed that high prolactin, low oxytocin and high homocysteine are factors associated with FEP 6 months after diagnosis, at which point plasma levels were correlated with some clinical and cognitive characteristics.

METHODS: We re-examined 75 patients 12 months after diagnosis to measure the evolution of these molecules and to assess their association with clinical features.

RESULTS: At follow-up, FEP patients had lower prolactin levels than at baseline, and patients treated with risperidone or paliperidone had higher prolactin levels than patients who received other antipsychotic agents. By contrast, no changes in oxytocin and homocysteine plasma levels were observed between the baseline and follow-up. In terms of clinical features, we found that plasma prolactin and homocysteine levels were correlated with the severity of the psychotic symptoms in male FEP patients, suggesting that they might be factors associated with psychotic symptomatology but only in men. Together with oxytocin, these molecules may also be related to sustained attention, verbal ability and working memory cognitive domains in FEP patients.

CONCLUSION: This study suggests that focusing on prolactin, oxytocin and homocysteine at a FEP may help select adequate pharmacological treatments and develop new tools to improve the outcome of these patients, where sex should also be borne in mind.

PMID:37603404 | DOI:10.1093/ijnp/pyad051

JMIR Form Res. 2023 Aug 21;7:e48332. doi: 10.2196/48332.

ABSTRACT

BACKGROUND: Digital health care apps have been widely used for managing chronic conditions such as diabetes mellitus and hypertension, providing promising prospects for enhanced health care delivery, increased patient engagement, and improved self-management. However, the impact of integrating these apps within hospital systems for managing such conditions still lacks conclusive evidence.

OBJECTIVE: We aimed to investigate the real-world effectiveness of using hospital-linked digital health care apps in lowering blood pressure (BP) and blood glucose levels in patients with hypertension and diabetes mellitus.

METHODS: Nationwide multicenter data on demographic characteristics and the use of a digital health care app from 233 hospitals were collected for participants aged 20 to 80 years in South Korea between August 2021 and June 2022. We divided the participants into 2 groups: 1 group consisted of individuals who exclusively used the digital health app (control) and the other group used the hospital-linked digital health app. All the patients participated in a 12-week digital health care intervention. We conducted a comparative analysis to assess the real-world effectiveness of the hospital-linked digital health app. The primary outcome was the differences in the systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG) level, and postprandial glucose (PPG) level between baseline and 12 weeks.

RESULTS: A total of 1029 participants were analyzed for the FBG level, 527 participants were analyzed for the PPG level, and 2029 participants for the SBP and DBP were enrolled. After 12 weeks, a hospital-linked digital health app was found to reduce SBP (-5.4 mm Hg, 95% CI -7.0 to -3.9) and DBP (-2.4 mm Hg, 95% CI -3.4 to -1.4) in participants without hypertension and FBG level in all participants (those without diabetes, -4.4 mg/dL, 95% CI -7.9 to -1.0 and those with diabetes, -3.2 mg/dL, 95% CI -5.4 to -1.0); however, there was no statistically significant difference compared to the control group (using only digital health app). Specifically, participants with diabetes using a hospital-linked digital health app demonstrated a significant decrease in PPG after 12 weeks (-10.9 mg/dL, 95% CI -31.1 to -5.3) compared to those using only a digital health app (P=.006).

CONCLUSIONS: Hospital-linked digital interventions have greatly improved glucose control for diabetes compared with using digital health technology only. These hospital-linked digital health apps have the potential to offer consumers and health care professionals cost-effective support in decreasing glucose levels when used in conjunction with self-monitoring.

PMID:37603401 | DOI:10.2196/48332

J Biol Dyn. 2023 Dec;17(1):2249024. doi: 10.1080/17513758.2023.2249024.

ABSTRACT

Dengue fever creates more than 390 million cases worldwide yearly. The most effective way to deal with this mosquito-borne disease is to control the vectors. In this work we consider two weapons, the endosymbiotic bacteria Wolbachia and predators of mosquito larvae, for combating the disease. As Wolbachia-infected mosquitoes are less able to transmit dengue virus, releasing infected mosquitoes to invade wild mosquito populations helps to reduce dengue transmission. Besides this measure, the introduction of predators of mosquito larvae can control mosquito population. To evaluate the impact of the predators on Wolbachia spreading dynamics, we develop a stage-structured five-dimensional model, which links the predator-prey dynamics with the Wolbachia spreading. By comparatively analysing the dynamics of the models without and with predators, we observe that the introduction of the predators augments the number of coexistence equilibria and impedes Wolbachia spreading. Some numerical simulations are presented to support and expand our theoretical results.

PMID:37603352 | DOI:10.1080/17513758.2023.2249024

Blood Adv. 2023 Aug 22;7(16):4671-4675. doi: 10.1182/bloodadvances.2023010482.

NO ABSTRACT

PMID:37603350 | DOI:10.1182/bloodadvances.2023010482

JAMA Netw Open. 2023 Aug 1;6(8):e2330024. doi: 10.1001/jamanetworkopen.2023.30024.

ABSTRACT

IMPORTANCE: Evidence of the association between income fluctuation and risk of type 2 diabetes (T2D) is scarce.

OBJECTIVE: To investigate whether sustained low or high income and income changes are associated with incidence of T2D.

DESIGN, SETTING, AND PARTICIPANTS: In this population-based cohort study, more than 7.8 million adults without T2D aged 30 to 64 years from a nationally representative sample from the Korean Health Insurance Service database were enrolled in 2012 and followed up to 2019 (median follow-up, 6.3 years [IQR, 6.1-6.6 years]).

EXPOSURES: Twenty quantiles of monthly health insurance premiums determined income levels. Income quartiles were annually analyzed from 2008 to 2012. Beneficiaries of the Medical Aid Program were regarded as those with very low income. A decrease in income was indicated as a reduction of 25% or more in income compared with income in the previous year.

MAIN OUTCOMES AND MEASURES: The primary outcome was incident T2D based on the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes E11 to E14, 1 or more claims of antidiabetic medication, or a fasting glucose level of 126 mg/dL or higher. Multivariable Cox proportional hazards models were used to assess the association of low- or high-income status and income changes with incidence of T2D.

RESULTS: Of 7 821 227 participants (mean [SD] age, 46.4 [9.3] years; 54.9% men), 359 931 (4.6%) developed T2D at least 1 year after enrollment. Individuals who repeatedly experienced low and very low income for 5 years showed 22% (hazard ratio [HR], 1.22 [95% CI, 1.21-1.23]) and 57% (1.57 [95% CI, 1.53-1.62]) higher T2D risk compared with those who never experienced low and very low income, respectively. In contrast, individuals who were repeatedly in high-income quartiles showed lower T2D risk compared with those who never experienced high income (HR, 0.86 [95% CI, 0.85-0.86]). The number of income decreases was associated with elevated T2D risk (≥2 vs 0 income decreases: HR, 1.08 [95% CI, 1.06-1.11]; P < .001 for trend). When income quartile status was compared between 2008 and 2012, individuals who experienced an income increase had lowered T2D risk, while those who experienced an income decrease had elevated T2D risk in each income quartile group.

CONCLUSIONS AND RELEVANCE: This cohort study found that individuals who experienced sustained low-income status or an income decrease had elevated T2D risk, while those who had sustained high-income status or an income increase had lowered T2D risk.

PMID:37603333 | DOI:10.1001/jamanetworkopen.2023.30024

Adv Skin Wound Care. 2023 Sep 1;36(9):481-485. doi: 10.1097/ASW.0000000000000016.

ABSTRACT

OBJECTIVE: To study the effect of liquid dressing and ostomy powder on the treatment of incontinence-associated dermatitis (IAD).

METHODS: The authors searched PubMed, Web of Science, CNKI (China National Knowledge Internet), and Google Scholar databases for literature through July 28, 2022. After literature screening, two investigators independently extracted data from the included studies and applied the Newcastle-Ottawa Scale to assess the quality of the included studies. The χ2-based Q statistic test and the I2 statistic were used to measure the heterogeneity of the included studies. Publication bias was measured with funnel plots and the Egger test. Sensitivity analysis was conducted by eliminating each study one by one.

RESULTS: Four high-quality studies were included in the meta-analysis, involving a total of 307 participants. The meta-analysis results showed that compared with traditional care, treatment with liquid dressing and ostomy powder significantly improved the effective rate (pooled odds ratio, 21.42; 95% CI, 8.58 to 53.44), shortened the healing time (pooled mean difference, -10.73; 95% CI, -12.92 to -8.54), and reduced the recurrence rate (pooled mean difference, -2.03; 95% CI, -2.30 to -1.77) of IAD. Among the included studies, no publication bias was detected. Sensitivity analysis results confirmed the robustness of the pooled estimates.

CONCLUSIONS: Treatment with liquid dressing and ostomy powder has clinical value for patients with IAD.

PMID:37603316 | DOI:10.1097/ASW.0000000000000016

J Laparoendosc Adv Surg Tech A. 2023 Aug 21. doi: 10.1089/lap.2023.0085. Online ahead of print.

ABSTRACT

Background: Hilar cholangiocarcinoma (HCCA) has a high degree of malignancy and poor prognosis, and the best long-term prognosis can only be achieved by radical resection. However, the surgical steps are complicated, and the operating space is limited, making it hard to complete laparoscopically. So our team proposes a new surgical approach for laparoscopic left-liver-first anterior radical modular orthotopic right hemihepatectomy (Lap-Larmorh). In this way, we can simplify the operation steps and reduce the difficulty. Materials and Methods: We recorded and analyzed the clinical data of 26 patients with type IIIa HCCA, who underwent laparoscopic radical resection in our department from December 2018 to January 2023. According to the laparoscopic surgical approach, we divided the patients into the new approach (NA) group (n = 14) using the Lap-Lamorh and the traditional approach (TA) group (n = 12) not using the Lap-Lamorh. Results: All surgeries in this study were completed laparoscopically with no conversion to open surgery. The operation time in the NA group and TA group had statistically significant differences, which was 372.5 (332.8, 420.0) minutes versus 423.5 (385.8, 498.8) minutes (P = .019). The two groups showed no significant difference in other characteristics (P > .05). Only 1 patient suffered from transient liver failure due to portal vein thrombosis. Patients with pleural effusion or ascites were cured by catheter drainage and enhanced nutrition. Conclusion: Lap-Larmorh reduces the difficulty of serving the vessels at the second and third hepatic hilum by splitting the right and left livers early intraoperatively. The new approach is more suitable for the narrow space of laparoscopic surgery and reflects the no-touch principle of oncology.

PMID:37603304 | DOI:10.1089/lap.2023.0085