Nevin Manimala

Clin Otolaryngol. 2024 Feb 28. doi: 10.1111/coa.14148. Online ahead of print.

ABSTRACT

OBJECTIVES: Paediatric feeding difficulties are common, affecting up to 25% of otherwise healthy children, symptoms include food refusal, gagging, choking, and excessive mealtime duration. These symptoms are commonly described in pre-operative discussions about tonsillectomy. This prospective study explores the impact of tonsillectomy on paediatric feeding difficulties.

DESIGN: This prospective cohort study invited caregivers of children undergoing tonsillectomy to complete a PediEAT questionnaire about their children’s feeding behaviours, pre and post-operatively. The study was completed in two phases with 9 questions administered in phase 1 and three additional questions added for phase 2. A free text comments box was also provided. Responses were graded from 0 to 5, where 0 is ‘never a problem’ and 5 is ‘always a problem’ with eating behaviours.

SETTING: The study was conducted at our institution, a tertiary paediatric ENT unit.

PARTICIPANTS: Children aged between 6 months – 7 years undergoing tonsillectomy for any indication were invited to participate.

MAIN OUTCOME MEASURES: Changes to the Pedi-EAT scores pre and post operatively were the main outcome measure.

RESULTS: 102 participants were recruited between January 2020 and January 2022. The mean age of participants was 4.1 years, 87% had a concurrent adenoidectomy. The mean time to completion of post-operative questionnaire was 23 weeks after surgery. 9 of the 12 questions showed a statistically significant improvement in post-operative scores using a paired student t-test (p < 0.05). The most significant improvements related to ‘gets tired from eating and is not able to finish’ (1.49 pre-op, 0.91 post op, p < 0.01) and ‘eats food that needs to be chewed’ (1.4 pre-op, 0.72 post-op, p < 0.01). 13% of participants only underwent tonsillectomy and this group also showed a statistically significant improvement in fatigue during eating (p < 0.05).

CONCLUSION: Symptoms of fatigue during eating and avoidance of food requiring mastication are most likely to improve following tonsillectomy in children.

PMID:38415339 | DOI:10.1111/coa.14148

East Mediterr Health J. 2024 Jan 21;30(1):68-76. doi: 10.26719/emhj.24.006.

ABSTRACT

BACKGROUND: Some review papers and meta-analyses have investigated seroprevalence and fatality trends of the Crimean-Congo hemorrhagic fever (CCHF), but it is not clear if its seroprevalence is increasing.

AIM: To investigate the trend in the seroprevalence of CCHF.

METHODS: We conducted a secondary analysis of the results of a meta-analysis of the seroprevalence of CCHF published in 2019. We used a multilevel mixed effects Poisson regression to find the predictors of seropositivity. To explain the magnitude effect, we reported an incidence rate ratio (IRR) with a 95% confidence interval (CI). We conducted multilevel modeling using Stata 14 for data analysis.

RESULTS: In the fixed effects model, time was significantly associated with increased seropositivity (IRR = 1.025, 95% CI = 1.021-1.030), and no significant association was found for local sampling (IRR = 1.026, 95% CI = 0.988-1.065). In the mixed effects model, random intercepts of the country and parallel of latitude were applied as 3 levels of the model (prevalence rate of each study, nested within countries and latitude parallel). Accordingly, time was significantly associated with a reduction of seropositivity (IRR = 0.899, 95% CI = 0.891-0.907), and local sampling was significantly associated with increased seropositivity (IRR = 2.477, 95% CI = 2.316-2.649).

CONCLUSION: Despite reporting increasing trends for seroprevalence of CCHF in previous reviews and the fixed effects model of the present study, the secondary mixed effects modeling showed a decreasing trend. The multilevel generalized model is recommended for such temporal and spatial designs in the future.

PMID:38415338 | DOI:10.26719/emhj.24.006

East Mediterr Health J. 2024 Jan 21;30(1):32-45. doi: 10.26719/emhj.24.003.

ABSTRACT

BACKGROUND: Tuberculosis (TB) is a major cause of morbidity and mortality globally. Understanding its epidemiology and burden is critical for targeted interventions.

AIM: To highlight the prevalence, incidence and treatment outcomes of TB in Egypt during the last 2 decades.

METHODS: For this systematic review and meta-analysis, we searched Medline/PubMed, ResearchGate, Google Scholar, and Scopus databases. We searched the local databases for unpublished studies, and the reports of international agencies, applying clear inclusion and exclusion criteria. The search covered prevalence; incidence; treatment outcomes; age, gender and residence of patients; and type of TB. Data were analyzed using STATA version 16.0. Pooled estimates with 95% confidence interval (CI) were calculated using a random effects model. Odds ratio (OR) with 95% CI was used as effect measures for related variables. Heterogeneity across studies was assessed using the I² statistic with sub-group analysis.

RESULTS: A total of 23 studies from 22 governorates, out of 27 governorates, involving a 139 597 study population met the eligibility requirements with no publication bias. The pooled prevalence was 8.70 (95% CI: 5.80-12.41, I² = 92.7%) and the pooled incidence was 9.10 (95% CI: 6.65-14.86, I² = 95.5%) per 100 000 population. About 82.6% of cases showed cured/completed treatment, 4.4% failure of treatment, and 3.9% died. In the subgroup analyses, the odds of TB prevalence were higher among males than females (2.05; 95% CI: 1.44-3.28), among those living in rural than in urban areas (1.29; 95% CI: 0.61-1.97), in Upper Egypt and Greater Cairo than in Lower Egypt and Delta Region (1.85; 95% CI: 0.97-4.15). The odds of pulmonary TB prevalence were higher than the extrapulmonary TB (2.43; 95% CI: 1.63-5.71). The odds of the treatment cases who were cured/completed (1.04; 95% CI: 0.96-1.51), failed (1.71; 95% CI: 1.35-2.73), and died (1.12; 95% CI: 0.87-1.60) were higher in Lower Egypt than in Upper Egypt.

CONCLUSION: TB incidence decreased in Egypt over the last two decades, but treatment outcomes were unsatisfactory, with variations across the different regions. To achieve TB eradication in Egypt, efforts should be made to sustain the TB control strategy by improving treatment outcomes and intensifying case finding and surveillance reporting.

PMID:38415334 | DOI:10.26719/emhj.24.003

East Mediterr Health J. 2024 Jan 21;30(1):22-31. doi: 10.26719/emhj.24.001.

ABSTRACT

BACKGROUND: Hepatitis C affects nearly 58 million people worldwide, the majority of whom live in the Eastern Mediterranean Region. There is limited data about hepatitis C disease or its knowledge in the United Arab Emirates (UAE).

AIM: This study assessed knowledge about hepatitis C and barriers to screening for it in the UAE.

METHODS: This exploratory, descriptive, cross-sectional study evaluated 1083 participants using a convenience sampling method. Participants aged 18 and above, literate in English or Arabic, were included in the study. The validated questionnaire was administered online and distributed across social media platforms from November 2020 to February 2021 and responses were analysed using Python.

RESULTS: Mean knowledge score was 11.83 (SD = 7.28). Knowledge was average with 57.52% (n = 489 of 850) of respondents achieving a moderate knowledge score, but poor awareness about treatment options were noted. Only 54.12% (n = 460 of 850) were aware that treatment was possible and 24.10% (n = 205 of 850) knew that there was no vaccine for hepatitis C. Field of work (P < 0.001), marital status (P < 0.001) and perceived knowledge (P < 0.001) were statistically significant predictors of knowledge score. Lack of insurance coverage for testing and limited knowledge about hepatitis C were identified as the most common barriers to getting tested.

CONCLUSION: The UAE community has moderate knowledge about hepatitis C but a poor understanding of available preventive and treatment options. Targeted outreach programmes, particularly for high-risk groups, are needed to improve community awareness of hepatitis C.

PMID:38415333 | DOI:10.26719/emhj.24.001

Mov Disord. 2024 Feb 28. doi: 10.1002/mds.29679. Online ahead of print.

ABSTRACT

BACKGROUND: One of the characteristics of parkinsonian tremor is that its amplitude decreases with movement. Current models suggest an interaction between basal ganglia (BG) and cerebello-thalamo-cortical circuits in parkinsonian tremor pathophysiology.

OBJECTIVE: We aimed to correlate central oscillation in the BG with electromyographic activity during re-emergent tremor in order to detect changes in BG oscillatory activity when tremor is attenuated by movement.

METHODS: We performed a prospective, observational study on consecutive parkinsonian patients who underwent deep brain stimulation surgery and presented re-emergent tremor. Coherence analysis between subthalamic nucleus/globus pallidus internus (STN/GPi) tremorous activity measured by microrecording (MER) and electromyogram (EMG) from flexor and extensor wrist muscles during rest, posture, and re-emergent tremor pause was performed during surgery. The statistical significance level of the MER-EMG coherence was determined using surrogate data analysis, and the directionality of information transfer between BG and muscle was performed using entropy transfer analysis.

RESULTS: We analyzed 148 MERs with tremor-like activity from 6 patients which were evaluated against the simultaneous EMGs, resulting in 296 correlations. Of these, 26 presented a significant level of coherence at tremor frequency, throughout rest and posture, with a complete EMG stop in between. During the pause, all recordings showed sustained MER peaks at tremor frequency (±1.5 Hz). Information flows preferentially from BG to muscle during rest and posture, with a loss of directionality during the pause.

CONCLUSIONS: Our results suggest that oscillatory activity in STN/GPi functionally linked to tremor sustains firing frequency during re-emergent tremor pause, thus suggesting no direct role of the BG circuit on tremor attenuation due to voluntary movements. © 2024 International Parkinson and Movement Disorder Society.

PMID:38415321 | DOI:10.1002/mds.29679

Interv Neuroradiol. 2024 Feb 28:15910199241235431. doi: 10.1177/15910199241235431. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the prognostic values of hyperdense sign on pretreatment non-contrast head CT scan for successful recanalization (mTICI ≥2b) and 90-day good functional outcome (mRs 0-2) in patients with acute ischemic stroke undergoing mechanical thrombectomy (MT).

METHODS: Literature search on PubMed, EMBASE, and Cochrane databases from inception up to 1 November 2023 was conducted. Twelve studies which reported hyperdense sign, recanalization and clinical outcomes were included in qualitative synthesis and meta-analysis.

RESULTS: Pooled analysis demonstrated a statistically significant association between successful recanalization and hyperdense sign-positive patients who underwent MT (odd ratios (OR) = 1.47, 95% confidence interval (CI) = 1.03-2.10, p = 0.04). No statistically significant association was demonstrated between presence of hyperdense sign and good functional outcome (OR = 1.04, 95% CI: 0.72-1.49, p = 0.85) or symptomatic intracranial hemorrhage sICH (OR: 1.80, 95% CI 0.72-4.47, p = 0.21).

CONCLUSIONS: This meta-analysis demonstrated that pre-intervention hyperdense sign on CT imaging might be useful in prediction of successful recanalization after MT.

PMID:38415302 | DOI:10.1177/15910199241235431

BMC Complement Med Ther. 2024 Feb 27;24(1):103. doi: 10.1186/s12906-024-04407-3.

ABSTRACT

BACKGROUND: Natural health products (NHP) are an important part of the healthcare system. They are mainly non-prescription and sold over the counter, which requires active decision making by the consumer. Within the framework of the Complementary and Alternative Healthcare Model, this study aims to identify factors that influence NHP usage, in particular related to concentration and cognition (CC), a topic that concerns all ages and social classes within the population.

METHODS: Data were collected by means of a representative online survey (n = 1,707) in Germany in April 2022. Three user groups were defined: NHPCC users, who used NHP for CC (12 month prevalence); nCC-NHP users, who used NHP but not for CC indications (12 month prevalence); and past NHP users, who have used NHP but not within the previous 12 months. Independent influencing variables were categorized into predisposing, enabling, need, and health service use factors. Data were analyzed with descriptive statistics, inferential statistics, and binary logistic regression models to compare NHPCC users to nCC-NHP users (model 1) and to past NHP users (model 2).

RESULTS: A higher share of NHPCC and nCC-NHP users compared to past NHP users were women, self-medicated with NHP, and used information about NHP provided by health professionals or on product. Their openness-to-change value orientation was more pronounced than of past users. Compared to nCC-NHP and past NHP users, the probability of being an NHPCC user increased if an individual had more difficulties in daily attention and memory performance, made use of health professionals and literature to seek information about NHP, and used NHP for health support and illness prevention. Additionally, a female gender, NHP self-medication, and having higher values of self-transcendence were significant indicators for NHPCC usage compared to past NHP usage.

CONCLUSION: NHP manufacturers, health professionals, and policymakers should be aware of the factors that lead to NHP consumption decisions and consider them in the development and optimization of healthcare strategies as well as in the marketing and communication strategies of companies producing NHP, in particular for CC. The current study can contribute to characterizing the target groups and to defining the aims and communication channels of such campaigns.

PMID:38414023 | DOI:10.1186/s12906-024-04407-3

Reprod Health. 2024 Feb 27;21(1):29. doi: 10.1186/s12978-024-01759-4.

ABSTRACT

BACKGROUND: Endometriosis is a chronic disease affecting 6-10% of women worldwide. Sexual dysfunction has been reported in a significant percentage of these patients. Thus, the present study will be conducted to design, implement, and determine the effectiveness of an interventional program to improve the sexual function of women with endometriosis.

MATERIALS AND METHODS: This mixed-methods study will be carried out in three phases with a sequential exploratory approach. In the first phase (qualitative study) participants will be selected by purposive sampling in Isfahan, Iran. The data will be collected through in-depth interviews and field notes and analyzed using conventional content analysis. The interventional program will be designed in the second phase based on the results of the qualitative study and literature review and using the Delphi method and panel of experts. The interventional program will be implemented at the individual level in the third phase to investigate its effect on improving women’s sexual function. This phase includes quasi-experimental research, in which the pre- and post-intervention data will be collected from the intervention and control groups using the FSFI questionnaire and analyzed by descriptive and inferential statistical methods. Ultimately, a suitable interventional program will be presented by combining the data obtained in the qualitative and quantitative phases of the research.

CONCLUSION: Conducting the present study, along with the design and implementation of an appropriate, native, and culturally sensitive interventional program, can contribute to improving the sexual function of women with endometriosis and enhancing the quality of sexual relations between couples.

PMID:38414010 | DOI:10.1186/s12978-024-01759-4

Int Breastfeed J. 2024 Feb 27;19(1):15. doi: 10.1186/s13006-024-00621-4.

ABSTRACT

BACKGROUND: Early and exclusive breastfeeding may reduce neonatal and post-neonatal mortality in low-resource settings. However, prelacteal feeding (PLF), the practice of giving food or liquid before breastfeeding is established, is still a barrier to optimal breastfeeding practices in many South Asian countries. We used a prospective cohort study to assess the association between feeding non-breastmilk food or liquid in the first three days of life and infant size at 3-5 months of age.

METHODS: The analysis used data from 3,332 mother-infant pairs enrolled in a randomized controlled trial in northwestern rural Bangladesh conducted from 2018 to 2019. Trained interviewers visited women in their households during pregnancy to collect sociodemographic data. Project staff were notified of a birth by telephone and interviewers visited the home within approximately three days and three months post-partum. At each visit, interviewers collected data on breastfeeding practices and anthropometric measures. Infant length and weight measurements were used to produce length-for-age (LAZ), weight-for-age (WAZ), and weight-for-length (WLZ) Z-scores. We used multiple linear regression to assess the association between anthropometric indices and PLF practices, controlling for household wealth, maternal age, weight, education, occupation, and infant age, sex, and neonatal sizes.

RESULTS: The prevalence of PLF was 23%. Compared to infants who did not receive PLF, infants who received PLF may have a higher LAZ (Mean difference (MD) = 0.02 [95% CI: -0.04, 0.08]) score, a lower WLZ (MD=-0.06 [95% CI: -0.15, 0.03]) score, and a lower WAZ (MD=-0.02 [95% CI: -0.08, 0.05]) score at 3-5 months of age, but none of the differences were statistically significant. In the adjusted model, female sex, larger size during the neonatal period, higher maternal education, and wealthier households were associated with larger infant size.

CONCLUSION: PLF was a common practice in this setting. Although no association between PLF and infant growth was identified, we cannot ignore the potential harm posed by PLF. Future studies could assess infant size at an earlier time point, such as 1-month postpartum, or use longitudinal data to assess more subtle differences in growth trajectories with PLF.

TRIAL REGISTRATION: ClinicalTrials.gov: NCT03683667 and NCT02909179.

PMID:38413997 | DOI:10.1186/s13006-024-00621-4

Ital J Pediatr. 2024 Feb 27;50(1):34. doi: 10.1186/s13052-024-01609-w.

ABSTRACT

BACKGROUND: The effect of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) virus in the neonatal period on developing brain is still unknown. This study aims to investigate the long-term neurodevelopmental outcomes of newborns exposed to SARS-CoV-2 & Delta variant.

METHODS: At a tertiary referral center, a prospective observational cohort research was carried out. All babies who were equal to or more than 34 gestational weeks gestation and were admitted to the NICU between January 2021 and January 2022 due to SARS-CoV-2 infection (Delta – or Delta +) were included in the study. Infants who were hospitalized for non-SARS-CoV-2 reasons at similar dates and who had no history of invasive mechanical ventilation were incorporated as a control group using a 2:1 gender and gestational age match. Thirty infants were assigned to the study group and sixty newborns to the control group based on the sample size calculation. These toddlers’ neurodevelopment was evaluated between the ages of 18 and 24 months using the Bayley-II scale.

RESULTS: We enrolled 90 infants. SARS-CoV-2-positive infants had poorer psychomotor development index (PDI) scores and significantly greater mildly delayed performances (MDPs) at 18-24 months (PDI p = 0.05, MDPs p = 0.03, respectively). Delta variant showed statistically significant lower MDI and PDI scores (MDI p=0.03, PDI p=0.03, respectively). A smaller head circumference of SARS-CoV-2-positive toddlers was detected in the first year (p < 0.001), which improved at the second age.

CONCLUSION: SARS-CoV-2-positive neonates revealed lower PDI scores and greater MDPs at 18th-24th months. The effect is most noticeable in Delta variant. Longer-term examination of neurodevelopmental outcomes and reevaluation of these children between the ages of 5 and 12 are critical.

PMID:38413995 | DOI:10.1186/s13052-024-01609-w