Nevin Manimala

J Osteopath Med. 2023 Nov 3. doi: 10.1515/jom-2022-0165. Online ahead of print.

ABSTRACT

CONTEXT: Osteopathic medical schools have traditionally placed a heavy emphasis on the field of primary care. While graduating osteopathic students continue to pursue family medicine, internal medicine, and pediatrics at higher rates than their allopathic counterparts, it is unknown whether students feel that surgical rotations are held to similar standards.

OBJECTIVES: The purpose of this study was to assess osteopathic medical student opinions of the quality of their surgical clerkships and to determine if good or poor experiences influenced their decision to continue pursuing surgery.

METHODS: After Institutional Review Board approval, a voluntary and anonymous Qualtrics survey was sent to all nationally registered members of the American College of Osteopathic Surgeons, Medical Student Section (ACOS-MSS) in their final 2 years of medical school. Analyses were conducted utilizing R statistical software.

RESULTS: A total of 345 responses were recorded from the Qualtrics survey sent to 2182 ACOS students from the national registry (response rate of 15.8 %). Students who found a mentor during their surgical rotations were more likely to consider a surgical career after they completed their rotations (odds ratio [OR]=1.43, p=0.003). Students at academic sites had more opportunities for research than those at community hospitals (p=0.019). Most students responded that they were still considering surgery as a career after rotation completion; a significant portion (OR=0.36, p<0.001) responded that they were no longer interested.

CONCLUSIONS: Medical students are most likely to review a surgical rotation favorably if they can connect with a mentor while on rotation. Osteopathic medical schools may benefit from instituting mentorship programs for students interested in surgery, as well as ensuring that their students have ample opportunity for research.

PMID:37920968 | DOI:10.1515/jom-2022-0165

Epilepsia Open. 2023 Nov 3. doi: 10.1002/epi4.12859. Online ahead of print.

ABSTRACT

OBJECTIVE: Thinning of the peripapillary retinal nerve fiber layer (p-RNFL), as measured by optical coherence tomography (OCT), was recently introduced as a promising marker for cerebral neuronal loss in people with epilepsy (PwE). However, its clinical implication remains to be elucidated. We thus aimed to (1) systematically characterize the extent of the retinal neuroaxonal loss in a broad spectrum of unselected PwE and (2) to evaluate the main clinical determinants.

METHODS: In this prospective study, a spectral-domain OCT evaluation was performed on 98 well-characterized PwE and 85 healthy controls (18-55 years of age). All inner retinal layers and the total macula volume were assessed. Group comparisons and linear regression analyses with stepwise backwards selection were performed to identify relevant clinical and demographic modulators of the retinal neuroaxonal integrity.

RESULTS: PwE (age: 33.7±10.6 years; 58.2% female) revealed a significant neuroaxonal loss across all assessed retinal layers (global pRNFL, p=0.001, Δ=4.24μm; macular RNFL, p<0.001, Δ=0.05mm³ ; ganglion cell inner plexiform layer, GCIP, p<0.001, Δ=0.11mm³ ; inner nuclear layer, INL, p=0.03, Δ=0.02mm³ ) as well as significantly reduced total macula volumes (TMV, p<0.001, Δ=0.18mm³ ) compared to healthy controls (age: 31.2±9.0 years; 57.6% female). The extent of retinal neuroaxonal loss was associated with the occurrence and frequency of tonic-clonic seizures and the number of anti-seizure medications, and was most pronounced in male patients.

SIGNIFICANCE: PwE presented an extensive retinal neuroaxonal loss, affecting not only the peripapillary but also macular structures. The non-invasive and economic measurement via OCT bears the potential to establish as a practical tool to inform patient management, as the extent of the retinal neuroaxonal loss reflects aspects of disease severity and sex-specific vulnerability.

PMID:37920967 | DOI:10.1002/epi4.12859

Lakartidningen. 2023 Nov 3;120:23068.

ABSTRACT

Statistics from the Swedish Social Insurance Agency show a sharp increase in the number of sick leave cases with the diagnoses Concussion, S06.0, and Postconcussional syndrome, F07.2, between the years 2010 and 2022. The reason for the increase has not been established and needs further investigation. One possible reason is that the acute phase treatment recommendations of individuals with mild traumatic brain injury have changed during the relevant time period. Future guidelines must ensure that treatment and management recommendations are based on controlled studies of an adequate population and that treatment outcomes are continuously evaluated.

PMID:37920952

Neuroradiol J. 2023 Nov 3:19714009231212368. doi: 10.1177/19714009231212368. Online ahead of print.

ABSTRACT

BACKGROUND: Percutaneous cement discoplasty (PCD) is a minimally invasive procedure. We aim to explore the efficacy and indication(s) of PCD in patients with degenerative disc disease (DDD).

METHODS: The search was conducted across Ovid MEDLINE, Ovid Embase, and PubMed. Data on study design, patient demographics, pre- and post-procedure Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores, and complications were extracted. Inclusion criteria focused on adult patients with degenerative spinal diseases treated with cement discoplasty. The overall effect size was evaluated using a forest plot, and heterogeneity was assessed using the I² statistic and chi-squared test.

RESULTS: The search strategy yielded six studies, which included 336 patients (73.8% female, 26.2% male) with a mean average age of 74.6 years. VAS scores were reported in all studies, showing a significant difference between pre- and post-PCD pain scores (Weighted Mean Difference [WMD]: -3.45; 95% CI: -3.83, -3.08; I² = 15%; P < .001). ODI scores were reported in 83% of studies, with a significant difference between pre- and post-PCD scores (WMD: -22.22; 95% CI: -25.54, -18.89; I² = 61%; p < .001). Complications reported included infections, thrombophlebitis, vertebral fractures, disc extrusion, and the need for further operations.

CONCLUSIONS: The analysis showed clinically significant improvements in pain and functional disability based on VAS and ODI scores. However, due to methodological limitations and a high risk of bias, the validity and generalizability of the findings are uncertain. Despite these issues, the results provide preliminary insights into PCD’s potential efficacy and can guide future research to address current limitations.

PMID:37920948 | DOI:10.1177/19714009231212368

Trop Doct. 2023 Nov 3:494755231210724. doi: 10.1177/00494755231210724. Online ahead of print.

ABSTRACT

Existing literature on factors triggering leprosy reactions is based only on case reports and case series, and thus probably gives a biased view. We undertook a case-control study to investigate such purported trigger factors in 42 leprosy reaction patients and 40 non-reactional controls, and the cost of investigations required for the same. Detailed history, clinical evaluation and investigations for triggers were carried out. Infections (typhoid, dental caries) were the most common triggers found, followed by pregnancy. Trigger factors were commoner in the type 2 reaction (T2R) group compared to type 1 (T1R) reaction group. There was however no statistical difference between the two groups. The average estimated cost of investigations was higher in the reactional group and this difference was statistically significant. Hence, except for essential investigations required for initiating steroids, an extensive battery of investigations is unjustified unless the medical history suggests a definitive infective trigger.

PMID:37920941 | DOI:10.1177/00494755231210724

Osong Public Health Res Perspect. 2023 Oct;14(5):388-417. doi: 10.24171/j.phrp.2023.0033. Epub 2023 Sep 19.

ABSTRACT

BACKGROUND: Patients with coronavirus disease 2019 (COVID-19) present with a variety of oral manifestations. Therefore, we conducted a systematic review to estimate the prevalence of oral lesions among COVID-19 patients.

METHODS: An extensive literature search of several electronic bibliographic databases (PubMed, Scopus, Science Direct, Litcovid) was conducted to retrieve all articles published in the English language from January 1, 2020 to March 31, 2023 that reported the prevalence of oral manifestations among COVID-19 patients. A meta-analysis of pooled prevalence was performed using Jamovi ver. 2.3 (2022). The I2 and Q statistics were used to assess heterogeneity between studies, and p-values <0.01 were considered statistically significant.

RESULTS: In total, 79 studies with data from 13,252 patients were included. The articles were predominantly published in 2020 (n=33), and Italy was the most common country (n=14). Most of the affected patients more than 50 years old and women (56.6%). The most common sites of involvement were the tongue (n=65), followed by the oral mucosa (n=37) and lips (n=19). High heterogeneity was found between studies. The most common oral manifestation was taste alteration, followed by xerostomia and ulceration, showing pooled prevalence rates of 48%, 35%, and 21%, respectively.

CONCLUSION: COVID-19 patients show various oral manifestations that may help clinicians identify the disease promptly. Recognition of the signs and symptoms of COVID-19 is critical for an early diagnosis and better prognosis.

PMID:37920896 | DOI:10.24171/j.phrp.2023.0033

Diabetes Obes Metab. 2023 Nov 3. doi: 10.1111/dom.15326. Online ahead of print.

ABSTRACT

AIM: To investigate the sex-specific causality of body compositions in type 2 diabetes and related glycaemic traits using Mendelian randomization (MR).

MATERIALS AND METHODS: We leveraged sex-specific summary-level statistics from genome-wide association studies for three adipose deposits adjusted for body mass index and height, including abdominal subcutaneous adipose tissue, visceral adipose tissue (VATadj) and gluteofemoral adipose tissue (GFATadj), measured by MRI (20 038 women; 19 038 men), and fat mass-adjusted appendicular lean mass (ALMadj) (244 730 women; 205 513 men) in the UK Biobank. Sex-specific statistics of type 2 diabetes were from the Diabetes Genetics Replication and Meta-analysis Consortium and those for fasting glucose and insulin were from the Meta-analyses of Glucose and Insulin-related Traits Consortium. Univariable and multivariable MR (MVMR) were performed. We also performed MR analyses of anthropometric traits and genetic association analyses using individual-level data of body composition as validation.

RESULTS: Univariable MR analysis showed that, in women, higher GFATadj and ALMadj exerted a causally protective effect on type 2 diabetes (GFATadj: odds ratio [OR] 0.59, 95% confidence interval [CI; 0.50, 0.69]; ALMadj: OR 0.84, 95% CI [0.77, 0.91]) and VATadj to be riskier in glycaemic traits. MVMR showed that GFATadj retained a robust effect on type 2 diabetes (OR 0.57, 95% CI [0.42, 0.77]; P = 2.6 × 10^-4 ) in women, while it was nominally significant in men (OR 0.58, 95% CI [0.35, 0.96]; P = 3.3 × 10^-2 ), after adjustment for ASATadj and VATadj. MR analyses of anthropometric measures and genetic association analyses of glycaemic traits confirmed the results.

CONCLUSIONS: Body composition has a sex-specific effect on type 2 diabetes, and higher GFATadj has an independent protective effect on type 2 diabetes in both sexes.

PMID:37920887 | DOI:10.1111/dom.15326

Vox Sang. 2023 Nov 3. doi: 10.1111/vox.13551. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Donor characteristics have been implicated in transfusion-related adverse events. Uncertainty remains about whether sex, and specifically pregnancy history of the blood donor, could affect patient outcomes. Whether storage duration of the blood product could be important for patient outcomes has also been investigated, and a small detrimental effect of fresh products remains a possibility. Here, we hypothesize that fresh red blood cell products donated by ever-pregnant donors are associated with mortality in male patients.

MATERIALS AND METHODS: We used data from a cohort study of adult patients receiving a first transfusion between 2005 and 2015 in the Netherlands. The risk of death after receiving a transfusion from one of five exposure categories (female never-pregnant stored ≤10 days, female never-pregnant stored >10 days, female ever-pregnant stored ≤10 days, female ever-pregnant stored >10 days and male stored for ≤10 days), compared to receiving a unit donated by a male donor, which was stored for >10 days (reference), was calculated using a Cox proportional hazards model.

RESULTS: The study included 42,456 patients who contributed 88,538 person-years in total, of whom 13,948 died during the follow-up of the study (33%). Fresh units (stored for ≤10 days) from ever-pregnant donors were associated with mortality in male patients, but the association was not statistically significant (hazard ratio 1.39, 95% confidence interval 0.97-1.99). Sensitivity analyses did not corroborate this finding.

CONCLUSION: These findings do not consistently support the notion that the observed association between ever-pregnant donor units and mortality is mediated by blood product storage.

PMID:37920882 | DOI:10.1111/vox.13551

Ther Adv Neurol Disord. 2023 Oct 31;16:17562864231207161. doi: 10.1177/17562864231207161. eCollection 2023.

ABSTRACT

BACKGROUND: Combination therapy with antiseizure medications (ASMs) is a rational strategy if monotherapy cannot effectively control seizures, thereby aiming to improve tolerance and treatment persistence.

OBJECTIVES: To compare the efficacy of different ASM combinations among patients.

DESIGN: Patients with epilepsy on monotherapy who had a second ASM added as concomitant two-drug therapy from January 2009 to May 2019 in the Chang Gung Research Database, Taiwan, were included in the analysis.

METHODS: ASM combinations were compared based on their primary mechanism of action (MoA) which are as follows: gamma-aminobutyric acid receptor (G), sodium channel blocker (SC), synaptic vesicle protein 2A (SV2), calcium channel blocker (C), and multiple mechanisms (M). Treatment persistence was compared, and the predictors of persistence were analyzed.

RESULTS: In total, 3033 patients were enrolled in this study. Combined ASMs with different MoAs had significantly longer treatment persistence than ASMs with similar MoAs, specifically SC and M combinations. Patients receiving combined ASMs with different MoAs were less likely to discontinue treatment [adjusted hazards ratio: 0.83 (95% CI: 0.75-0.93), p < 0.001]. Among all combinations, the SC + SV2 combination had the longest treatment persistence (mean ± SD: 912.7 ± 841.6 days). Meanwhile, patients receiving the G combination had a higher risk of treatment discontinuation than those receiving the SC + SV2 combination. Underlying malignancies were associated with an increased risk of treatment discontinuation across all MoA categories. Male patients receiving the SC, SV2, and M combinations were more likely to discontinue treatment than female patients. Moreover, patients with renal disease were more likely to discontinue treatment with the SV2 combinations.

CONCLUSION: ASM combinations with different MoAs had superior efficacy and tolerability to ASM combinations with similar MoAs, particularly SC and M combinations. In our cohort, factors associated with treatment discontinuation included underlying malignancy, male sex, and renal disease. These findings may provide valuable insights into the use of ASM combinations if monotherapy cannot adequately control seizures.

PMID:37920860 | PMC:PMC10619360 | DOI:10.1177/17562864231207161

Med Acupunct. 2023 Oct 1;35(5):246-250. doi: 10.1089/acu.2023.0003. Epub 2023 Oct 17.

ABSTRACT

OBJECTIVES: In sports, recovery after exercise is a very important process for athletes. Several studies have shown that the rate of an athletes recovery can be increased by several modalities, one of which is acupuncture. This study was conducted to learn how press-tack needle acupuncture reduces blood lactic-acid levels after sports students exercise.

MATERIALS AND METHODS: This was a randomized controlled trial. Twenty-four sports students were divided into 2 groups: (1) an acupuncture group (n = 12) and (2) a control group (n = 12). In each acupuncture group member press-tack needles were attached on PC-6 Neiguan and ST-36 Zusanli 30 minutes before doing high-intensity exercise. Measurement of lactic-acid levels was performed at 5 minutes and at 30 minutes after exercise.

RESULTS: The mean levels of lactic acid at 5 minutes after exercise in the acupuncture group were higher (p = 0.028), compared to the control group. The mean levels of lactic acid at 30 minutes after exercise in the acupuncture group was lower (p = 0.572) than in the control group. The mean reduction of lactic acid levels in the acupuncture group from 5 minutes after exercise to 30 minutes after exercise was statistically higher (p = 0.007) than in the control group.

CONCLUSIONS: Press-tack needle acupuncture affects reduction of lactic-acid levels after high-intensity physical exercise. Further studies are needed to investigate the more-detailed biochemical mechanisms.This trial was registered at ClinicalTrials.gov (ID: NCT04892784).

PMID:37920859 | PMC:PMC10618804 | DOI:10.1089/acu.2023.0003