Nevin Manimala

J Med Internet Res. 2024 Feb 19;26:e51749. doi: 10.2196/51749.

ABSTRACT

BACKGROUND: Given the global shortage of child psychiatrists and barriers to specialized care, remote assessment is a promising alternative for diagnosing and managing attention-deficit/hyperactivity disorder (ADHD). However, only a few studies have validated the accuracy and acceptability of these remote methods.

OBJECTIVE: This study aimed to test the agreement between remote and face-to-face assessments.

METHODS: Patients aged between 6 and 17 years with confirmed Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnoses of ADHD or autism spectrum disorder (ASD) were recruited from multiple institutions. In a randomized order, participants underwent 2 evaluations, face-to-face and remotely, with distinct evaluators administering the ADHD Rating Scale-IV (ADHD-RS-IV). Intraclass correlation coefficient (ICC) was used to assess the reliability of face-to-face and remote assessments.

RESULTS: The participants included 74 Japanese children aged between 6 and 16 years who were primarily diagnosed with ADHD (43/74, 58%) or ASD (31/74, 42%). A total of 22 (30%) children were diagnosed with both conditions. The ADHD-RS-IV ICCs between face-to-face and remote assessments showed “substantial” agreement in the total ADHD-RS-IV score (ICC=0.769, 95% CI 0.654-0.849; P<.001) according to the Landis and Koch criteria. The ICC in patients with ADHD showed “almost perfect” agreement (ICC=0.816, 95% CI 0.683-0.897; P<.001), whereas in patients with ASD, it showed “substantial” agreement (ICC=0.674, 95% CI 0.420-0.831; P<.001), indicating the high reliability of both methods across both conditions.

CONCLUSIONS: Our study validated the feasibility and reliability of remote ADHD testing, which has potential benefits such as reduced hospital visits and time-saving effects. Our results highlight the potential of telemedicine in resource-limited areas, clinical trials, and treatment evaluations, necessitating further studies to explore its broader application.

TRIAL REGISTRATION: UMIN Clinical Trials Registry UMIN000039860; http://tinyurl.com/yp34x6kh.

PMID:38373022 | DOI:10.2196/51749

J Med Econ. 2024 Feb 19:1-20. doi: 10.1080/13696998.2024.2320604. Online ahead of print.

ABSTRACT

AIMS: Two randomized clinical trials, REDUCE and RESPECT, demonstrated that patent foramen ovale (PFO) closure in combination with antithrombotic therapy was more effective for the prevention of recurrent ischemic stroke compared with antithrombotic therapy alone. The aim of this study was to determine the relative efficacy and safety of the PFO closure devices used in REDUCE (HELEX and CARDIOFORM Septal Occluders) compared with the device used in RESPECT (Amplatzer PFO Occluder).

METHODS: An unanchored matching-adjusted indirect comparison (MAIC) of the PFO closure arms of the REDUCE and RESPECT trials was performed using patient-level data from REDUCE weighted to match baseline characteristics from RESPECT. Comparisons of the following outcomes were made between the devices assessed in the trials: risk of recurrent ischemic stroke; recurrent ischemic stroke one year after randomization; any serious adverse event (SAE) related to the procedure or device; and atrial fibrillation or atrial flutter as an SAE related to the procedure or device.

RESULTS: After conducting the MAIC, baseline characteristics were well-matched between the two trials. Compared to RESPECT, PFO closure using the devices from REDUCE resulted in a hazard ratio of 0.46 (95% confidence interval [CI] 0.15-1.43; p = 0.17) for the risk of recurrent stroke. For the recurrence of stroke after one year, SAE related to the procedure or device, and atrial fibrillation or atrial flutter as SAE related to the procedure or device, the MAIC resulted in a rate difference of -0.68 (95%CI -2.06-0.70; p = 0.34), -1.29 (95%CI -3.82-1.25; p = 0.32), and -0.19 (95%CI -1.16-0.78; p = 0.71), respectively. These findings were consistent across scenario analyses.

CONCLUSIONS: This MAIC analysis found no statistically significant differences in efficacy and safety outcomes between PFO closure with the HELEX and CARDIOFORM Septal Occluders versus the Amplatzer PFO Occluder, as used in the REDUCE and RESPECT trials.

PMID:38373018 | DOI:10.1080/13696998.2024.2320604

Top Stroke Rehabil. 2024 Feb 19:1-10. doi: 10.1080/10749357.2024.2318096. Online ahead of print.

ABSTRACT

BACKGROUND: The goal of post-stroke early rehabilitation is to regain ambulation, standing and balance.

OBJECTIVE: The purpose of this study was to investigate the effects of vestibular and somatosensory rehabilitation in addition to early rehabilitation on balance in patients with early subacute stroke.

DESIGN AND SETTING: A randomized controlled trial was conducted at a university hospital.

METHODS: The study was included 52 hemiplegic hospitalized early suacute stroke patients. The experimental group (n: 30), was applied with vestibular and somatosensorial rehabilitation together with early rehabilitation. Vestibular exercises, included Cawthorne-Cooksey exercises, stimulate the vestibulo-ocular and vestibulo-spinal reflex. Somatosensory exercises, which included Frenkel exercises, stimulate the sensory proprioception and somatosensory systems. The control group (n: 22) patients with early subacute stroke were treated with the early rehabilitation program only. The balance parameters of the patients were evaluated with the Korebalance System, Functional Reach Test, Postural Assessment Scale for Stroke, and Functional Ambulation Scale.

RESULTS: The mean age of the patients was 67.32 ± 9.46 years, and the mean number of days that had passed since the stroke occurred was7.90 ± 7.26. In calculating the balance scores, statistically significant differences were observed in the experimental and control groups, with a statistically greater improvement in the rehabilitation group. Statistically significant differences were determined between the groups in respect of the balance scores.

CONCLUSIONS: Based on these findings, the use of vestibular and somatosensory rehabilitation can be recommended for better functioning of the compensatory mechanism of early subacute-stroke hemiplegic patients in early ambulation, and this can lead to considerably improved standing and dynamic upper and lower body balance.

PMID:38373015 | DOI:10.1080/10749357.2024.2318096

Cardiovasc Res. 2024 Feb 19:cvae034. doi: 10.1093/cvr/cvae034. Online ahead of print.

ABSTRACT

Chronic low degree inflammation is a hallmark of atherosclerotic cardiovascular disease. To assess the effect of lipid-lowering therapies (LLTs) on C-reactive protein (CRP), a biomarker of inflammation, we conducted a meta-analysis according to the PRISMA guidelines. Databases were searched from inception to July 2023. Inclusion criteria were: (1) randomized controlled trials (RCTs) in human, phase II, III or IV; (2) English language; (3) comparing the effect of lipid-lowering drugs vs placebo; (4) reporting the effects on CRP levels; (5) with intervention duration of more than 3 weeks; (6) and sample size (for both intervention and control group) over than 100 subjects. The between-group (treatment-placebo) CRP absolute mean differences and 95% confidence intervals (95%CI) were calculated for each drug class separately. A total of 171,668 subjects from 53 RCTs were included. CRP levels (mg/L) were significantly decreased by statins (-0.65 [-0.87 to -0.43], bempedoic acid (-0.43 [-0.67 to -0.20]), ezetimibe (-0.28 [-0.48 to -0.08]), and omega-3 fatty acids (omega3FAs, -0.27 [-0.52 to -0.01]). CRP was reduced by -0.40 (-1.17 to 0.38) with fibrates, although not statistically significant. A slight increase of CRP concentration was observed for PCSK9 inhibitors (0.11 [0.07 to 0.14]) and CETP inhibitors (0.10 [0.00 to 0.21]), the latter being not statistically significant. Meta-regression analysis did not show a significant correlation between changes in CRP and LDL-C or TG. Statins, bempedoic acid, ezetimibe, and omega3FAs significantly reduce serum CRP concentration, independently of LDL-C reductions. The impact of this anti-inflammatory effect in terms of cardiovascular prevention needs further investigation.

PMID:38373008 | DOI:10.1093/cvr/cvae034

JAMA Netw Open. 2024 Feb 5;7(2):e2356609. doi: 10.1001/jamanetworkopen.2023.56609.

ABSTRACT

IMPORTANCE: In resource-constrained settings where the neonatal mortality rate (NMR) is high due to preventable causes and health systems are underused, community-based interventions can increase newborn survival by improving health care practices.

OBJECTIVES: To develop and evaluate the effectiveness of a community-based maternal and newborn care services package to reduce perinatal and neonatal mortality in rural Pakistan.

DESIGN, SETTING, AND PARTICIPANTS: This cluster randomized clinical trial was conducted between November 1, 2012, and December 31, 2013, in district Rahim Yar Khan in the province of Punjab. A cluster was defined as an administrative union council. Any consenting pregnant resident of the study area, regardless of gestational age, was enrolled. An ongoing pregnancy surveillance system identified 12 529 and 12 333 pregnancies in the intervention and control clusters, respectively; 9410 pregnancies were excluded from analysis due to continuation of pregnancy at the end of the study, loss to follow-up, or miscarriage. Participants were followed up until the 40th postpartum day. Statistical analysis was performed from January to May 2014.

INTERVENTION: A maternal and newborn health pack, training for community- and facility-based health care professionals, and community mobilization through counseling and education sessions.

MAIN OUTCOMES AND MEASURES: The primary outcome was perinatal mortality, defined as stillbirths per 1000 births and neonatal death within 7 days per 1000 live births. The secondary outcome was neonatal mortality, defined as death within 28 days of life per 1000 live births. Systematic random sampling was used to allocate 10 clusters each to intervention and control groups. Analysis was conducted on a modified intention-to-treat basis.

RESULTS: For the control group vs the intervention group, the total number of households was 33 188 vs 34 315, the median number of households per cluster was 3092 (IQR, 3018-3467) vs 3469 (IQR, 3019-4075), the total population was 229 155 vs 234 674, the mean (SD) number of residents per household was 6.9 (9.5) vs 6.8 (9.6), the number of males per 100 females (ie, the sex ratio) was 104.2 vs 103.7, and the mean (SD) number of children younger than 5 years per household was 1.0 (4.2) vs 1.0 (4.3). Altogether, 7598 births from conrol clusters and 8017 births from intervention clusters were analyzed. There was no significant difference in perinatal mortality between the intervention and control clusters (rate ratio, 0.86; 95% CI, 0.69-1.08; P = .19). The NMR was lower among the intervention than the control clusters (39.2/1000 live births vs 52.2/1000 live births; rate ratio, 0.75; 95% CI, 0.58-0.95; P = .02). The frequencies of antenatal visits and facility births were similar between the 2 groups. However, clean delivery practices were higher among intervention clusters than control clusters (63.2% [2284 of 3616] vs 13.2% [455 of 3458]; P < .001). Chlorhexidine use was also more common among intervention clusters than control clusters (55.9% [4271 of 7642] vs 0.3% [19 of 7203]; P < .001).

CONCLUSIONS AND RELEVANCE: This pragmatic cluster randomized clinical trial demonstrated a reduction in NMR that occurred in the background of improved household intrapartum and newborn care practices. However, the effect of the intervention on antenatal visits, facility births, and perinatal mortality rates was inconclusive, highlighting areas requiring further research. Nevertheless, the improvement in NMR underscores the effectiveness of community-based programs in low-resource settings.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01751945.

PMID:38372998 | DOI:10.1001/jamanetworkopen.2023.56609

JAMA Netw Open. 2024 Feb 5;7(2):e2356787. doi: 10.1001/jamanetworkopen.2023.56787.

ABSTRACT

IMPORTANCE: Despite decades of neuroimaging studies reporting brain structural and functional alterations in depression, discrepancies in findings across studies and limited convergence across meta-analyses have raised questions about the consistency and robustness of the observed brain phenotypes.

OBJECTIVE: To investigate the associations between 6 operational criteria of lifetime exposure to depression and functional and structural neuroimaging measures.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study analyzed data from a UK Biobank cohort of individuals aged 45 to 80 years who were enrolled between January 1, 2014, and December 31, 2018. Participants included individuals with a lifetime exposure to depression and matched healthy controls without indications of psychosis, mental illness, behavior disorder, and disease of the nervous system. Six operational criteria of lifetime exposure to depression were evaluated: help seeking for depression; self-reported depression; antidepressant use; depression definition by Smith et al; hospital International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis codes F32 and F33; and Composite International Diagnostic Interview Short Form score. Six increasingly restrictive depression definitions and groups were defined based on the 6 depression criteria, ranging from meeting only 1 criterion to meeting all 6 criteria. Data were analyzed between January and October 2022.

MAIN OUTCOMES AND MEASURES: Functional measures were calculated using voxel-wise fractional amplitude of low-frequency fluctuation (fALFF), global correlation (GCOR), and local correlation (LCOR). Structural measures were calculated using gray matter volume (GMV).

RESULTS: The study included 20 484 individuals with lifetime depression (12 645 females [61.7%]; mean [SD] age, 63.91 [7.60] years) and 25 462 healthy controls (14 078 males [55.3%]; mean [SD] age, 65.05 [7.8] years). Across all depression criteria, individuals with lifetime depression displayed regionally consistent decreases in fALFF, LCOR, and GCOR (Cohen d range, -0.53 [95% CI, -0.88 to -0.15] to -0.04 [95% CI, -0.07 to -0.01]) but not in GMV (Cohen d range, -0.47 [95 % CI, -0.75 to -0.12] to 0.26 [95% CI, 0.15-0.37]). Hospital ICD-10 diagnosis codes F32 and F33 (median [IQR] difference in effect sizes, -0.14 [-0.17 to -0.11]) and antidepressant use (median [IQR] difference in effect sizes, -0.12 [-0.16 to -0.10]) were criteria associated with the most pronounced alterations.

CONCLUSIONS AND RELEVANCE: Results of this cross-sectional study indicate that lifetime exposure to depression was associated with robust functional changes, with a more restrictive depression definition revealing more pronounced alterations. Different inclusion criteria for depression may be associated with the substantial variation in imaging findings reported in the literature.

PMID:38372997 | DOI:10.1001/jamanetworkopen.2023.56787

JAMA Netw Open. 2024 Feb 5;7(2):e2356863. doi: 10.1001/jamanetworkopen.2023.56863.

ABSTRACT

IMPORTANCE: While epinephrine and advanced airway management (AAM) (supraglottic airway insertion and endotracheal intubation) are commonly used for out-of-hospital cardiac arrest (OHCA), the optimal sequence of these interventions remains unclear.

OBJECTIVE: To evaluate the association of the sequence of epinephrine administration and AAM with patient outcomes after OHCA.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed the nationwide, population-based OHCA registry in Japan and included adults (aged ≥18 years) with OHCA for whom emergency medical services personnel administered epinephrine and/or placed an advanced airway between January 1, 2014, and December 31, 2019. The data analysis was performed between October 1, 2022, and May 12, 2023.

EXPOSURE: The sequence of intravenous epinephrine administration and AAM.

MAIN OUTCOMES AND MEASURES: The primary outcome was 1-month survival. Secondary outcomes were 1-month survival with favorable functional status and prehospital return of spontaneous circulation. To control imbalances in measured patient demographics, cardiac arrest characteristics, and bystander and prehospital interventions, propensity scores and inverse probability of treatment weighting (IPTW) were performed for shockable and nonshockable initial rhythm subcohorts.

RESULTS: Of 259 237 eligible patients (median [IQR] age, 79 [69-86] years), 152 289 (58.7%) were male. A total of 21 592 patients (8.3%) had an initial shockable rhythm, and 237 645 (91.7%) had an initial nonshockable rhythm. Using IPTW, all covariates between the epinephrine-first and AAM-first groups were well balanced, with all standardized mean differences less than 0.100. After IPTW, the epinephrine-first group had a higher likelihood of 1-month survival for both shockable (odds ratio [OR], 1.19; 95% CI, 1.09-1.30) and nonshockable (OR, 1.28; 95% CI, 1.19-1.37) rhythms compared with the AAM-first group. For the secondary outcomes, the epinephrine-first group experienced an increased likelihood of favorable functional status and prehospital return of spontaneous circulation for both shockable and nonshockable rhythms compared with the AAM-first group.

CONCLUSIONS AND RELEVANCE: These findings suggest that for patients with OHCA, administration of epinephrine before placement of an advanced airway may be the optimal treatment sequence for improved patient outcomes.

PMID:38372996 | DOI:10.1001/jamanetworkopen.2023.56863

Isotopes Environ Health Stud. 2024 Feb 19:1-19. doi: 10.1080/10256016.2024.2316584. Online ahead of print.

ABSTRACT

We investigated the stable isotope hydrology of Sable Island, Nova Scotia, Canada over a five year period from September, 2017 to August, 2022. The δ²H and δ¹⁸O values of integrated monthly precipitation were weakly seasonal and ranged from -66 to -15 ‰ and from -9.7 to -1.9 ‰, respectively. Fitting these monthly precipitation data resulted in a local meteoric water line (LMWL) defined by: δ²H = 7.22 ± 0.21 · δ¹⁸O + 7.50 ± 1.22 ‰. Amount-weighted annual precipitation had δ²H and δ¹⁸O values of -36 ± 11 ‰ and -6.1 ± 1.4 ‰, respectively. Deep groundwater had more negative δ²H and δ¹⁸O values than mean annual precipitation, suggesting recharge occurs mainly in the winter, while shallow groundwater had δ²H and δ¹⁸O values more consistent with mean annual precipitation or mixing of freshwater with local seawater. Surface waters had more positive values and showed evidence of isolation from the groundwater system. The stable isotopic compositions of plant (leaf) water, on the other hand, indicate plants use groundwater as their source. Fog had δ²H and δ¹⁸O values that were significantly more positive than those of local precipitation, yet had similar ¹⁷O-excess values. δ²H values of horsehair from 4 individuals lacked seasonality, but had variations typical to those of precipitation on the island. Differences in mean δ²H values of horsehair were statistically significant and suggest variations in water use may exist between spatially disparate horse communities. Our results establish an important initial framework for ongoing isotope studies of feral horses and other wildlife on Sable Island.

PMID:38372972 | DOI:10.1080/10256016.2024.2316584

Psychooncology. 2024 Feb;33(2):e6306. doi: 10.1002/pon.6306.

ABSTRACT

OBJECTIVE: Hematopoietic stem cell transplantation (HSCT) is considered an integral part of therapy in many hematological and non-hematological malignancies. The procedure can be highly stressful for patients. The primary objective of this study was to compare stress assessments in HSCT patients, depending on their stress coping style (CS) and type of treatment (autologous vs. allogeneic HSCT).

METHODS: A short longitudinal study was conducted between May 2021 and June 2023 among patients with hematological cancers undergoing HSCT. The study involved four time points: the day of admission to hospital – T1, the day before HSCT – T2, 6 days after HSCT – T3, and the day of discharge – T4. Participants completed the Coping Inventory for Stressful Situations (CISS) on T1, and the Distress Thermometer (DT) on T1-T4. Descriptive statistics and a repeated measures ANOVA were conducted.

RESULTS: A total of 128 participants completed the study: 54.2% female, mean age 48.7 years. They were divided into: (1) five groups based on their CS: task-oriented, emotion-oriented, avoidance-oriented, mix-oriented, differential-oriented; (2) two groups based on treatment type. The analyses showed significant differences in stress between the CS study groups (p = 0.001). The emotion-oriented group had the highest stress levels during the hospitalization period. There was also a significant time effect (p < 0.001): stress levels increased during the hospitalization period, peaking 6 days after HSCT, and decreased at discharge.

CONCLUSIONS: Stress levels depend on coping styles and time points during the hospitalization period, which should be taken into account in planning psychological interventions for HSCT patients.

PMID:38372968 | DOI:10.1002/pon.6306

Updates Surg. 2024 Feb 19. doi: 10.1007/s13304-024-01755-0. Online ahead of print.

ABSTRACT

Ventral abdominal wall incisional hernia is defined as a defect in the musculo-fascial layers of the abdominal wall in the region of the postoperative scar. There is a slight increase in the incidence of incisional hernia in the female gender. The higher percentage of incisional hernia in females might be due to laxity of abdominal wall muscles after multiple pregnancies and also an increased incidence of obesity in females. To assess incisional hernia repair using two different techniques: on-lay mesh and sub-lay mesh, as regards operative time, postoperative recurrence, wound infection, seroma, hematoma, and flap necrosis. Pubmed, Web of Science, and Scopus were searched on 15 March 2022. The keywords incisional hernia, sub-lay mesh on-lay mesh, retromuscular mesh, and polypropylene. According to our results, there is a statistical difference between onlay and sublay regarding intra-operative time as sublay mesh is more time-consuming. Regarding postoperative complications, there is no statistical difference in recurrence, seroma, hematoma, flap necrosis, and infection but there is a statistical difference regarding in hospital stay as patients with sub-lay repair stays less than only.

PMID:38372955 | DOI:10.1007/s13304-024-01755-0