Nevin Manimala

BMC Infect Dis. 2023 Nov 7;23(1):766. doi: 10.1186/s12879-023-08778-9.

ABSTRACT

BACKGROUND: In recent years, observational studies have been conducted to investigate the potential impact of vitamins on sepsis. However, many of these studies have produced inconsistent results. Our Mendelian randomization (MR) study aims to evaluate the causality between vitamins and sepsis from a genetic perspective.

METHODS: Our MR study was designed following the STROBE-MR guidelines. Genetic instrumental variables for vitamins including folate, vitamin B12, B6, A (Retinol), C, D, and K were obtained from previous genome-wide association studies (GWAS) and MR studies. Five different sepsis severity levels were included in the analysis. The genetic instrumental variables were screened for potential confounders using PhenoScanner V2. MR analysis was performed using MR-egger, inverse-variance weighted multiplicative random effects (IVW-RE), inverse-variance weighted multiplicative fixed-effects (IVW-FE), and wald ratio methods to assess the relationship between vitamins and sepsis. Sensitivity analysis was performed using the MR-egger_intercept method, and the MR-PRESSO package and Cochran’s Q test were used to evaluate the heterogeneity of the instrumental variables.

RESULTS: Our MR study found no statistically significant association between vitamins and sepsis risk, regardless of the type of vitamin (P-value > 0.05). The odds ratios (ORs) for folate, vitamin B6, vitamin B12, vitamin A, vitamin D, vitamin K, and vitamin C were 1.164 (95% CI: 0.895-1.514), 0.987 (95% CI: 0.969-1.005), 0.975 (95% CI: 0.914-1.041), 0.993 (95% CI: 0.797-1.238), 0.861 (95% CI: 0.522-1.42), 0.955 (95% CI: 0.86-1.059), and 1.049 (95% CI: 0.911-1.208), respectively. Similar results were observed in subgroups of different sepsis severity levels.

CONCLUSIONS: Our MR study found no evidence of a causal association between vitamins and sepsis risk from a genetic perspective. Further randomized controlled trials are necessary to confirm these results.

PMID:37936083 | DOI:10.1186/s12879-023-08778-9

BMC Anesthesiol. 2023 Nov 7;23(1):365. doi: 10.1186/s12871-023-02333-4.

ABSTRACT

BACKGROUND: To investigate the effects of a single injection technique with ultrasound-guided superficial cervical fascia block combined with brachial plexus block in clavicular surgery.

METHODS: Forty patients, 25 males and 15 females, aged 18-85 years with ASA class I or II underwent unilateral clavicular fracture internal fixation. The patients were randomly divided into a superficial cervical plexus block group (group S, n = 20) and a superficial cervical fascia block group (group F, n = 20). First, the brachial plexus of the intermuscular sulcus of all patients was blocked with an ultrasound-guided injection of one injection with 15ml 0.33% ropivacaine 15ml in both groups. Second, the superficial cervical plexus was blocked by another injection of 5-8ml 0.33% ropivacaine in group S, and the superficial cervical fascia was blocked by an injection with 5-8ml 0.33% ropivacaine in Group F. We evaluated operation time, onset time of anaesthesia, effective time and the grades of nerve block effect in the two groups. Additionally, we evaluated the incidences of local anaesthetic poisoning, hoarseness, dyspnoea, and postoperative nausea and vomiting, and the number of patients requiring remedial analgesia within 24 h. Repeated measurements were analysed by repeated data analysis of variance, and count data were compared by the χ2 test. A P value < 0.05 was considered statistically significant.

RESULTS: The operation time and onset time in Group F were significantly shorter than those in group S (P < 0.05); the effect of intraoperative block was better than that in group S (P < 0.05), and the effective time was significantly longer in group F than in group S (P < 0.05). However, no severe case of dyspnoea, local anaesthetic poisoning or hoarseness after anaesthesia occurred in either of two groups. There was no significant difference in the rate of postoperative salvage analgesia or that of postoperative nausea and vomiting between the two groups.

CONCLUSIONS: The application of the single injection technique with ultrasound-guided superficial cervical fascia block combined with brachial plexus block in clavicular surgery is beneficial because it shortens the operation time, has a faster onset, produces a more effective block and prolongs the longer analgesia time.

TRIAL REGISTRATION: Chinese Clinical Trial Registry- ChiCTR2200064642(13/10/2022).

PMID:37936081 | DOI:10.1186/s12871-023-02333-4

BMC Pregnancy Childbirth. 2023 Nov 7;23(1):773. doi: 10.1186/s12884-023-06073-8.

ABSTRACT

BACKGROUND: Although the majority of pregnancies with preeclampsia are characterised by elevated blood pressure, preeclampsia is often associated with nephrotic syndrome with similar symptoms such as high proteinuria and bilateral lower limb oedema. In this study, we compared the maternal-foetal outcomes of pregnant women with preeclampsia in a population with nephrotic syndrome and explored the factors that contribute to the corresponding outcomes and disease development.

METHODS: A total of 90 pregnant women were included in this study, of whom 30 had nephrotic syndrome and were diagnosed with preeclampsia during pregnancy, and 60 had nephrotic syndrome alone. Descriptive statistical analyses of baseline data were performed to analyse the effect of combined preeclampsia on maternal and foetal pregnancy outcomes using unadjusted and adjusted logistic regression models.

RESULTS: In this study, the baseline data of the two study populations demonstrated no differences except for the history of caesarean section and 24-h proteinuria results, which were significantly different (P < 0.05). The risk of preterm birth in the nephrotic syndrome with preeclampsia group was 8.25 (95% CI:3.041-22.084 P < 0.05); for a low birth weight, the risk was 6.00 (95% CI:2.302-15.638 P < 0.05); for foetal distress,the risk was 5.667 (95% CI:2.070-15.514 P < 0.05); and the risk of foetal birth restriction was 7.429 (95% CI: 2.642-20.885 P < 0.05). A risk-based analysis of adverse maternal outcomes yielded a risk of miscarriage of 2.200 (95% CI: 0.584-8.291; P > 0.05). After adjusting the model for each outcome, significant risks of preterm labour, foetal birth restriction, and low birth weight were revealed (P < 0.05).

CONCLUSION: Combined preeclampsia has a significantly higher risk of adverse pregnancy outcomes for the foetus.Therefore, the prevention and control of eclampsia in pregnant women should be improved to ensure maternal and neonatal health.

PMID:37936071 | DOI:10.1186/s12884-023-06073-8

BMC Anesthesiol. 2023 Nov 7;23(1):364. doi: 10.1186/s12871-023-02330-7.

ABSTRACT

BACKGROUND: Acute kidney injury (AKI) is a frequent complication of cardiac surgery that poses significant risks for both the development of chronic kidney diseases and mortality. Our previous study illustrated that heightened expression levels of faecal and plasma indole metabolites before the operation were associated with ischemic AKI. In this study, we aimed to validate the supposition that plasma indole-3-aldehyde (I3A) could serve as a predictive biomarker for AKI in patients undergoing cardiac surgery.

METHODS: This statistical reanalysis utilized AKI metabolomic data from patients scheduled for cardiac surgery between April 2022 and July 2022 in two tertiary hospitals. Faecal and blood samples were prospectively collected before surgery within 24 h, and variables related to the preoperative, intraoperative, and postoperative periods were recorded. AKI diagnosis was based on the Kidney Disease Improving Global Outcomes criteria.

RESULTS: In this study, 55 patients who underwent cardiac surgery were analyzed, and 27 of them (49.1%) developed postoperative AKI. Before surgery, these patients had significantly higher levels of faecal indole metabolites, including skatole, trans-3-indoleacrylic acid, and 5-methoxyindoleacetic acid. The plasma I3A, clinical model that considered perioperative and intraoperative variables, and their combination had area under the receiver operating characteristic curve (ROC) values of 0.79 (95% CI 0.67-0.91), 0.78 (95% CI 0.66-0.90), and 0.84 (95% CI 0.74-0.94) for predicting AKI, respectively. Furthermore, by utilizing net reclassification improvement and integrated discrimination improvement, plasma I3A showed significant improvements in risk reclassification compared to the clinical model alone.

CONCLUSIONS: The dysregulation of gut microbiota metabolism in patients scheduled for cardiac surgery can result in an increase in indoles from tryptophan metabolism, which may be associated with postoperative acute kidney injury (AKI). This suggests that indoles may serve as a predictive biomarker for AKI in patients undergoing cardiac surgery.

PMID:37936070 | DOI:10.1186/s12871-023-02330-7

BMC Nephrol. 2023 Nov 7;24(1):328. doi: 10.1186/s12882-023-03379-9.

ABSTRACT

BACKGROUND: Infection after a kidney transplant is a serious cause of morbidity and mortality. Weighing the risks and benefits of immunosuppression is of paramount importance for patient wellbeing and transplant survival.

METHODS: This is a prospective observational study exploring the variety of bacterial, viral and fungal infections occurring within the first year of living related kidney transplantation in a young transplant cohort. Fifty-one kidney transplant recipients (KTR) between the age of 18 and 45 who had a kidney transplant between Jan 2020 and Jan 2022 were enrolled and followed up for one year. Primary outcome was the occurrence of infection.

RESULTS: Twenty-four patients (47%) recorded a collective 33 episodes of infection. Seven patients had repeated infections and 17 had single infections. Twenty-seven patients had an uneventful year with no infections recorded. Commonest infection was lower urinary tract infection (UTI) (27.3%) followed by SARS-COV2 and Herpes Zoster (15.2%). The commonest pathogens causing lower UTI were Escherichia coli (E coli) (21.2%) and Klebsiella (18.2%). Median Tacrolimus level was (7.8) ng/ml in KTR with infection and (8.95) ng/ml in KTR without infection, p = 0.21. Median Haemoglobin (IQR) was (10.2) g/dl (7.8-14) gm/dl in KTR with infection compared to (10.8) g/dl (7.3-15.3) in KTR without infection odds ratio (OR) = 0.78, confidence interval (CI) (0.5-1.1); p = 0.16.In KTR with infection 25% had donors above the age of 60 compared to 11% in KTR without infection ( OR 2.6,CI (0.5-12), p = 0.2). Post transplant diabetes (PTDM) occurred in (25%) in KTR with infection compared to those without, but that was not statistically significant p = 0. 365.In KTR without infection, 59.3% had a preemptive transplant compared to 20.8% in the group with infection (OR = 0.18; 95% CI: 0.052-0.631; p = 0.007). Median tacrolimus was 7.8 ng/ml in KTR with single infection compared to 7.7 ng/ml in KTR with repeated infections.

CONCLUSION: This study shows that the commonest infection occurring in the first-year post kidney transplant was lower urinary tract infection followed by SARS-COV2 and Herpes Zoster. There was no difference in trough tacrolimus or haemoglobin levels between KTR who developed infection with those who did not.

PMID:37936062 | DOI:10.1186/s12882-023-03379-9

Environ Sci Pollut Res Int. 2023 Nov 8. doi: 10.1007/s11356-023-30715-1. Online ahead of print.

ABSTRACT

In the recent times, one of the most crucial tasks related to water resources is the treatment of polluted water. This study reports the development of a functionalized nanofibrous membrane with enhanced filtration performance, heavy metal removal, and photocatalytic dye degradation for the effective treatment of contaminated water. The nanofibrous mats were developed by the process of electrospinning using a polymeric solution of polyacrylonitrile (PAN) reinforced with curcumin-multiwalled carbon nanotube (C-MWCNT) conjugate. The experimental trials for membrane fabrication were adapted based on the design of experiments (DoE) approach by making use of the Box-Behnken design (BBD) for a three-variable system, a component of response surface methodology (RSM). The three variable parameters selected for optimization of the electrospinning process were the dopant concentration (in weight percentage), the flow rate (in millilitre per hour), and the spinning time (in hours), respectively, and a total of 15 fibrous membranes were fabricated. The SEM analysis of the fabricated membranes revealed alterations in the surface morphology of the fibrous mats with variations in the electrospinning parameters. The infrared spectrum of the fibrous mats, validated the incorporation C-MWCNT conjugate in PAN, thereby confirming the formation of PAN/C-MWNCNT membrane. The mean flow pore size and breaking force of the PAN/C-MWCNT membranes was also obtained using a universal testing machine (UTM) and porometer, respectively. To choose the best membrane for efficient filtration experiments, the performance of each of the prepared membranes was assessed in terms of solute rejection percentage (SR%), permeate flux (PF), and pure water flux (PWF). The statistical analysis of the assessed parameters in accordance with the membranes prepared was done using the MINITAB software, and the three-dimensional (3D) surface plots were constructed using the STATISTICA software to visualize and validate the relation between each of the electrospinning parameters and the corresponding membrane performance characteristics. Similarly, the potential of the electrospun membranes for efficient heavy metal ion removal and photocatalysis were also tested independently and the optimal electrospinning parameters were determined for the same. Based on the results, it was observed that the PAN/C-MWCNT membranes could serve as potential candidates for the treatment of polluted water.

PMID:37936040 | DOI:10.1007/s11356-023-30715-1

Environ Sci Pollut Res Int. 2023 Nov 8. doi: 10.1007/s11356-023-30564-y. Online ahead of print.

ABSTRACT

To achieve ambitious energy-climate targets, all EU member states have introduced policies to support the market introduction of renewable energy sources (RES) generation. Motivated to close the gap of the merit order effect (MOE) in less mature Central and South East European electricity markets, we empirically confirm economic theory predictions that in the short run, an increase in RES generation reduces electricity prices. The merit order effect is initially econometrically confirmed and quantified. Different econometric model specifications are estimated to differentiate the MOE caused by wind and solar generation and to differentiate the MOE on high-load and low-load days. In addition, we simulate the adjustment of the realised day-ahead electricity prices to the no-RES generation scenario. Modern statistical methods are applied to bridge the gap in the limited public data availability to solve simulation models used in the power system or agent-based simulations. A family of data mining algorithms is applied for the merit order estimation used in the dynamic adaptation of the generation mix to the omitted RES generation. The estimated energy imbalance caused by the excluded RES generation is therefore compensated by the additional conventional generation dispatch according to the estimated power plant merit order. The estimated supply curves for each generation technology assist the reasoning behind the established MOE in econometric models. Based on our findings, policymakers should prioritise policies that facilitate the integration of RES into their electricity markets, which would in turn accelerate energy transition. With increasingly growing shares of renewables in the system, the governments need to rethink the support scheme, where the emphasis should be placed on efficiently integrating renewables in the power system by taking into account temporal and spatial dimensions.

PMID:37936033 | DOI:10.1007/s11356-023-30564-y

Acta Diabetol. 2023 Nov 8. doi: 10.1007/s00592-023-02206-9. Online ahead of print.

ABSTRACT

AIMS: The association between gestational diabetes mellitus (GDM) and common carotid artery (CCA) intima-media thickness (IMT) is still controversial. This systematic review and meta-analysis was performed to assess the correlation between GDM and CCA-IMT in and after pregnancy.

METHODS: PubMed and EMBASE databases were systematically reviewed on April 2023. Studies measuring CCA-IMT in both pregnant women with GDM and women with previous history of GDM (pGDM) vs. healthy controls were included. The subtotal and overall standardized mean differences (SMDs) of CCA-IMT were calculated using the random-effect model.

RESULTS: Nineteen studies with a total of 302 GDM and 861 pGDM women were analyzed. The average value of CCA-IMT measured in GDM/pGDM (0.59 ± 0.12 mm) was slightly increased in comparison to the accepted reference limits of IMT according to age classes. Substantial heterogeneity was detected for the studies involving both GDM and pGDM women, with an overall statistic I² of 86.0% (p < 0.001). Large SMDs were obtained for the studies conducted on both GDM and pGDM women, with an overall SMD of 0.89 (95%CI 0.63-1.15, p < 0.001). Egger’s test for a regression intercept gave a p-value of 0.37, indicating no publication bias. On meta-regression analysis, all potential confounders (number of patients, age at pregnancy, body mass index, measuring time, follow-up duration and GDM criteria) were not significantly associated with effect modification.

CONCLUSIONS: GDM in and after pregnancy is independently associated with subclinical atherosclerosis. The association between GDM and carotid remodeling is potentially mediated by the longstanding underlying risk.

PMID:37936027 | DOI:10.1007/s00592-023-02206-9

Matern Child Health J. 2023 Nov 7. doi: 10.1007/s10995-023-03815-0. Online ahead of print.

ABSTRACT

OBJECTIVES: The current study intends to measure parents’ perceptions of newborn and toddler physical activity.

METHODS: A Cross-sectional study was conducted at the pediatric clinic at a University Hospital in Riyadh. The parents or guardians of children 0 to 3 years of age, healthy infants, and toddlers who visited the vaccination and pediatric clinic at a University Hospital in Riyadh, were recruited. The Parental Perceptions of Physical Activity Scale (PPPAS) was translated into the Arabic language. The Chi-square test was applied to observe the association between categorical variables. P value < 0.05 was considered to be statistically significant.

RESULTS: A total of 383 parents were recruited. There was a significant association observed between physical activity and income, employment, and education. A significant association was observed between the following perceptions; the child enjoys physical activity, it increases the child’s fitness level, the strength of the muscles, flexibility, and life span, improves happiness, keeps the child active, and provides a sense of achievement, and decrease future weight problems.

CONCLUSION FOR PRACTICE: The study determined that parental inclination towards engaging in a physical activity intervention for their infants, as well as identifying any concerns that may impact their children’s adherence to physical activity was satisfied.

PMID:37936024 | DOI:10.1007/s10995-023-03815-0

Ann Surg Oncol. 2023 Nov 7. doi: 10.1245/s10434-023-14376-5. Online ahead of print.

ABSTRACT

BACKGROUND: Minimally invasive liver resections (MILR) offer potential benefits such as reduced blood loss and morbidity compared with open liver resections. Several studies have suggested that the impact of cirrhosis differs according to the extent and complexity of resection. Our aim was to investigate the impact of cirrhosis on the difficulty and outcomes of MILR, focusing on major hepatectomies.

METHODS: A total of 2534 patients undergoing minimally invasive major hepatectomies (MIMH) for primary malignancies across 58 centers worldwide were retrospectively reviewed. Propensity score (PSM) and coarsened exact matching (CEM) were used to compare patients with and without cirrhosis.

RESULTS: A total of 1353 patients (53%) had no cirrhosis, 1065 (42%) had Child-Pugh A and 116 (4%) had Child-Pugh B cirrhosis. Matched comparison between non-cirrhotics vs Child-Pugh A cirrhosis demonstrated comparable blood loss. However, after PSM, postoperative morbidity and length of hospitalization was significantly greater in Child-Pugh A cirrhosis, but these were not statistically significant with CEM. Comparison between Child-Pugh A and Child-Pugh B cirrhosis demonstrated the latter had significantly higher transfusion rates and longer hospitalization after PSM, but not after CEM. Comparison of patients with cirrhosis of all grades with and without portal hypertension demonstrated no significant difference in all major perioperative outcomes after PSM and CEM.

CONCLUSIONS: The presence and severity of cirrhosis affected the difficulty and impacted the outcomes of MIMH, resulting in higher blood transfusion rates, increased postoperative morbidity, and longer hospitalization in patients with more advanced cirrhosis. As such, future difficulty scoring systems for MIMH should incorporate liver cirrhosis and its severity as variables.

PMID:37936020 | DOI:10.1245/s10434-023-14376-5