Nevin Manimala

Heliyon. 2023 Aug 16;9(8):e19209. doi: 10.1016/j.heliyon.2023.e19209. eCollection 2023 Aug.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has directly affected specially nurses, not only those on the front lines but also nurse managers.

AIMS: To assess and compare stress levels of nurse managers before and during the pandemic, and to identify predictive factors.

METHOD: Cross-sectional studies were carried out in two moments, before and during pandemic. 102 manager nurses were recruited before the sanitary crisis (2018) and 87 during the health crisis (2020). Perceived stress was measured with the Perceived Stress Scale-14 and quality of professional life, job demands, motivation and managerial support were assessed with the Professional Quality of Life Questionnaire. Socio-demographic and job-related variables were also analysed. Statistical analysis was performed using student’s t-test, correlations and multiple regression analysis.

RESULTS: The majority of nurse managers were women, married, who worked the morning shift. 78.2% managed nursing personnel who worked with COVID patients. They suffered a significant increase in both job demands and perceived stress level in the pandemic. Job demands, working in shifts morning, being young and being unmotivated were predictors of perceived stress level according to multiple linear regression analysis.

CONCLUSION: Perceived stress was greatest during the COVID-19 pandemic. Both, before and during the pandemic, job demands are central predictors of nurse managers’ general perceived stress. It is necessary to adapt the workplace to personal characteristics of the nurse manager and increase actions to enhance their motivation and reduce their job demands to prevent stress.

PMID:37664725 | PMC:PMC10469051 | DOI:10.1016/j.heliyon.2023.e19209

Neurocirugia (Astur : Engl Ed). 2023 Sep-Oct;34(5):256-267. doi: 10.1016/j.neucie.2022.11.025.

ABSTRACT

OBJECTIVE: The purpose of this study is to analyze a series of patients with intradural extramedullary tumors (IDEM) and assess factors that may modify or determine the final long term outcome and management.

MATERIALS AND METHODS: Single Center, retrospective study of a series of surgical patients with IDEM lesions from our Institution operated between 2010 and 2021. Patients with less than 6 months of follow up were excluded. Several preoperative demographics, clinical, imaging and surgical features, as well as histopathology, recurrence and adjuvancy were assessed. Patients’ final clinical outcome was categorized using the McCormick scale.

RESULTS: A total of 203 patients with a mean follow-up of 30.50 months (range 6-130) were included. 57.64% of the analyzed population was female and the mean age was 50.51 years. The most frequent location of the tumors was dorsal (34.98%) followed by the lumbar region (32.02%). Total resection was achieved in 84.24% of cases, and the most frequent histopathology was Schwannoma (36.45%), followed by Meningioma (30.05%). Pain was the most usual initial symptom (63.05%). In our analysis, functional outcome after surgery was associated with statistical significance with preoperative McCormick grade, tumor type, EOR and postoperative complications such as hematoma and sphincter involvement.

CONCLUSION: The management of these lesions depends on many factors. It is worthy of mention that clinical presentation, EOR, histopathology and postoperative complications have shown significant prognostic value for the final outcome. Early treatment with the intention of achieving GTR when possible, using carefully tailored approaches, should be considered before the onset of significant symptoms.

PMID:37661156 | DOI:10.1016/j.neucie.2022.11.025

Mayo Clin Proc. 2023 Sep;98(9):1347-1352. doi: 10.1016/j.mayocp.2023.05.001.

ABSTRACT

Patients with advanced emphysema frequently experience severe dyspnea that is inadequately treated with medical therapy alone. Over the past 4 years, we have seen increased usage of bronchoscopic lung volume reduction (BLVR) with endobronchial valves. Success of the procedure is dependent on patient selection because it is not necessarily appropriate for all patients with severe emphysema. (Table 1) The purpose of this review is to highlight the selection process at a single institution. We also discuss the influence of this process on outcomes. Between March 1, 2019, and October 12, 2021, 2402 patients were referred to a dedicated chronic obstructive pulmonary disease clinic at Mayo Clinic – Rochester, whereas 161 patients were subsequently referred for multidisciplinary BLVR review. Of those patients, 53 (32.9%) were selected to receive valves and 35 (21.7%) ultimately underwent the procedure. The main reasons for exclusion included an incompatible quantitative computed tomography analysis (n=37, 34.3%), presence of pulmonary nodule or active malignancy (n=14, 13.0%), or need for completion of pulmonary rehabilitation (n=9, 8.3%). Full or partial (>70%) target lobe collapse was observed in 58.6% of patients who received valves. Those with collapse experienced statistically significant improvements in spirometric measures. Twelve patients experienced a pneumothorax (34.3%), with 10 patients requiring thoracostomy tube placement and prolonged hospitalization (median, 11 days; range, 4-39 days). Nineteen patients required a secondary procedure within the first year. The study highlights how a multidisciplinary approach to the BLVR selection process enables individualization of a complex procedure and enhances the exclusion of inappropriate candidates.

PMID:37661143 | DOI:10.1016/j.mayocp.2023.05.001

Mayo Clin Proc. 2023 Sep;98(9):1297-1309. doi: 10.1016/j.mayocp.2023.05.029.

ABSTRACT

OBJECTIVE: To identify specific causes of death and determine the prevalence of noncardiovascular (non-CV) deaths in an exercise test referral population while testing whether exercise test parameters predict non-CV as well as CV deaths.

PATIENTS AND METHODS: Non-imaging exercise tests on patients 30 to 79 years of age from September 1993 to December 2010 were reviewed. Patients with baseline CV diseases and non-Minnesota residents were excluded. Mortality through January 2016 was obtained through Mayo Clinic Records and the Minnesota Death Index. Exercise test abnormalities included low functional aerobic capacity (ie, less than 80%), heart rate recovery (ie, less than 13 beats/min), low chronotropic index (ie, less than 0.8), and abnormal exercise electrocardiogram (ECG) of greater than or equal to 1.0 mm ST depression or elevation. We also combined these four abnormalities into a composite exercise test score (EX_SCORE). Statistical analyses consisted of Cox regression adjusted for age, sex, diabetes, hypertension, obesity, current and past smoking, and heart rate-lowering drug.

RESULTS: The study identified 13,382 patients (females: n=4736, 35.4%, 50.5±10.5 years of age). During 12.7±5.0 years of follow-up, there were 849 deaths (6.3%); of these 162 (19.1%) were from CV; 687 (80.9%) were non-CV. Hazard ratios for non-CV death were significant for low functional aerobic capacity (HR, 1.42; 95% CI, 1.19 to 1.69; P<.0001), abnormal heart rate recovery (HR, 1.36; 95% CI, 1.15 to 1.61; P<.0033), and low chronotropic index (HR, 1.49; 95% CI, 1.26 to 1.77; P<.0001), whereas abnormal exercise ECG was not significant. All exercise test abnormalities including EX_SCORE were more strongly associated with CV death versus non-CV death except abnormal exercise ECG.

CONCLUSION: Non-CV deaths predominated in this primary prevention cohort. Exercise test abnormalities not only predicted CV death but also non-CV death.

PMID:37661140 | DOI:10.1016/j.mayocp.2023.05.029

Reumatol Clin (Engl Ed). 2023 Aug-Sep;19(7):363-373. doi: 10.1016/j.reumae.2022.10.003.

ABSTRACT

BACKGROUND AND AIMS: Systemic inflammatory diseases could act as an unfavorable condition in which epicardial adipose tissue (EAT) becomes harmful to cardiovascular health. The objectives were: (a) to quantitatively compare the presence of EAT between patients with systemic inflammatory diseases and controls; (b) to analyze the association between EAT and subclinical atheromatosis in individuals with systemic inflammatory diseases.

METHODS: Studies that have quantified EAT in a population with systemic inflammatory diseases compared to a control group, or that describe the association between EAT and the presence of subclinical atheromatosis in patients with systemic inflammatory diseases were included. A quantitative analysis was performed for the first objective. This systematic review was performed according to PRISMA guidelines.

RESULTS: Twenty-one studies including 1448 patients with systemic inflammatory diseases, were considered eligible for this study. Patients with systemic inflammatory disease have a higher volume (MD: 10.4cm³ [1.8-19.1]; p<0.01), higher thickness (MD: 1.0mm [0.8-1.2]; p<0.01), and a statistically non-significant higher area (MD: 3.1cm² [1.0-5.2]; p=0.46) of EAT compared to the control group. Most studies reported a significant association between EAT and subclinical atheromatosis in patients with different systemic inflammatory diseases.

CONCLUSION: This study demonstrated that EAT is increased in patients with systemic inflammatory diseases compared with healthy controls, and that EAT measurement is closely correlated with subclinical atherosclerosis in these patients. The causality of this association should be tested in prospective studies.

PMID:37661114 | DOI:10.1016/j.reumae.2022.10.003

Reumatol Clin (Engl Ed). 2023 Aug-Sep;19(7):358-362. doi: 10.1016/j.reumae.2022.12.006.

ABSTRACT

BACKGROUND: Systemic lupus erythematosus (SLE) is an autoimmune disease in which the immune system abnormally reacts against cells and tissues leading to inflammation. Epigenetic alterations, including DNA methylation and histone modification, have critical effects on autoimmune disease and SLE pathogenesis via dysregulation of critical genes.

AIMS: The purpose of this study was to evaluate the epigenetic-related gene expression of DNA methyltransferase (DNMT) and histone deacetylase 1 (HDAC1) in Iranian patients with SLE.

METHODS: This matched case-control study included 16 people with SLE and 16 healthy people who were referred to the Rafsanjani rheumatology clinic, in southeast Iran. The expression of DNMT and HDAC1 genes was measured through a real-time PCR assay of blood samples.

RESULTS: DNMT gene expression did not differ significantly between SLE and healthy groups (P=0.21). In contrast, HDAC1 gene expression was enhanced in the SLE group, but this enhancement failed to reach statistical significance (P=0.94).

CONCLUSION: The results of this study suggest that overexpression of HDAC1 could serve as a diagnostic for SLE disease. Additional studies with larger sample sizes are required to confirm our findings. Evaluation of other genes related to SLE disease is essential and may help to make an accurate diagnosis of the disease.

PMID:37661113 | DOI:10.1016/j.reumae.2022.12.006

J Immunother Cancer. 2023 Sep;11(9):e007552. doi: 10.1136/jitc-2023-007552.

ABSTRACT

BACKGROUND: ONCOS-102, an oncolytic adenovirus expressing granulocyte-macrophage colony-stimulating factor, can alter the tumor microenvironment to an immunostimulatory state. Combining ONCOS-102 with standard-of-care chemotherapy for malignant pleural mesothelioma (MPM) may improve treatment outcomes.

METHODS: In this open-label, randomized study, patients with unresectable MPM received intratumoral ONCOS-102 (3×10¹¹ virus particles on days 1, 4, 8, 36, 78, and 120) and pemetrexed plus cisplatin/carboplatin (from day 22), or pemetrexed plus cisplatin/carboplatin alone. The primary endpoint was safety. Overall survival (OS), progression-free survival, objective response rate, and tumor immunologic activation (baseline and day 36 biopsies) were also assessed.

RESULTS: In total, 31 patients (safety lead-in: n=6, randomized: n=25) were enrolled. Anemia (15.0% and 27.3%) and neutropenia (40.0% and 45.5%) were the most frequent grade ≥3 adverse events (AEs) in the ONCOS-102 (n=20) and chemotherapy-alone (n=11) cohorts. No patients discontinued ONCOS-102 due to AEs. No statistically significant difference in efficacy endpoints was observed. There was a numerical improvement in OS (30-month OS rate 34.1% vs 0; median OS 20.3 vs 13.5 months) with ONCOS-102 versus chemotherapy alone in chemotherapy-naïve patients (n=17). By day 36, ONCOS-102 was associated with increased T-cell infiltration and immune-related gene expression that was not observed in the control cohort. Substantial immune activation in the tumor microenvironment was associated with survival at month 18 in the ONCOS-102 cohort.

CONCLUSIONS: ONCOS-102 plus pemetrexed and cisplatin/carboplatin was well tolerated by patients with MPM. In injected tumors, ONCOS-102 promoted a proinflammatory environment, including T-cell infiltration, which showed association with survival at month 18.

PMID:37661097 | DOI:10.1136/jitc-2023-007552

J Acad Nutr Diet. 2023 Sep 1:S2212-2672(23)01494-6. doi: 10.1016/j.jand.2023.08.131. Online ahead of print.

ABSTRACT

BACKGROUND: Research on feeding in early childhood has focused primarily on parent-child dyadic interactions, despite parents enacting these practices within the complex dynamic of the family system.

OBJECTIVE: Using a sibling design, this study aimed to assess how parents may adapt their food parenting practices for siblings in response to differences in their eating behaviours.

DESIGN: A cross-sectional online survey was conducted between October and December 2022.

PARTICIPANTS/SETTING: Data were collected from parents (97.5% females) in Australia with two children aged 2 to 5 years (n=336 parents, n=672 children).

MAIN OUTCOME MEASURES: Survey items were completed for each sibling, and included four subscales of the Children’s Eating Behaviour Questionnaire (CEBQ) and seven subscales of the Feeding Practices and Structure Questionnaire-28 (FPSQ-28).

STATISTICAL ANALYSES PERFORMED: Multiple linear regression models examined associations between within-sibling pair differences in child eating behaviours and food parenting practices, adjusting for differences in child body mass index z-score (BMIz), age, gender, and early feeding method.

RESULTS: Within-sibling pair differences in eating behaviours were associated with differences in some food parenting practices. For the fussier sibling, parents reported using more control-based practices, including persuasive feeding, reward for eating, and reward for behaviour, and less of the structure-based practice, family meal settings (ps<0.001). Similar directions of associations were found for persuasive feeding, reward for eating, and family meal settings with siblings who were slower eaters or more satiety responsive (ps<0.007); however, no significant differences in reward for behaviour were observed in relation to sibling differences in these eating behaviours. For the more food responsive sibling, parents reported using more control-based practices, including reward for behaviour and overt restriction (ps<0.002).

CONCLUSIONS: Within families, parents may adapt certain practices in response to differences in their children’s eating behaviours. Interventions promoting responsive feeding should be designed to acknowledge the integral role of siblings in shaping parents’ feeding decisions.

PMID:37661083 | DOI:10.1016/j.jand.2023.08.131

J Affect Disord. 2023 Sep 1:S0165-0327(23)01125-4. doi: 10.1016/j.jad.2023.08.138. Online ahead of print.

ABSTRACT

BACKGROUND: Studies have shown that family function is associated with emotional behavior problems. However, the underlying relationship mechanisms between family function and emotional behavior problems in children and adolescents is not fully understood. Therefore, the purpose of this study is to explore the mediating effect of resilience and the moderating effect of sleep quality using a moderated mediation model.

METHODS: 6363 children and adolescents in grades four to nine were surveyed in some areas of Anhui Province, China. Family function, resilience, sleep quality, and emotional behavior problems were measured through a self-administered questionnaire. All data analysis was by performed by SPSS 23.0.

RESULTS: The results showed that family function was negatively associated with emotional behavior problems (r = -0.307, p < 0.01). Resilience partially mediated the relationship between family function and emotional behavior problems (indirect effect = -0.108, accounted for 38.4 %). Sleep quality moderated the relationship between family function and resilience (β = -0.039, P < 0.001).

CONCLUSION: Resilience and sleep quality respectively played a mediating and moderating effect in the relationship between family function and emotional behavior problems. These findings suggest that we should pay attention to the family function of children and adolescents in time, improve their resilience and sleep quality, so as to effectively reduce the occurrence of emotional behavior problems.

PMID:37661061 | DOI:10.1016/j.jad.2023.08.138

J Foot Ankle Surg. 2023 Sep 1:S1067-2516(23)00218-1. doi: 10.1053/j.jfas.2023.08.013. Online ahead of print.

ABSTRACT

Whether secondary to deformity, traumatic injury, infection, neoplasm, or ischemic disease, the transmetatarsal amputation provides a functional means of limb preservation prior to major proximal amputation. With similar readmission rates following inpatient and outpatient surgery, prevention of an unnecessary admission among vulnerable patients, specifically geriatrics, proves beneficial. This investigation examines differences among geriatric patients admitted and not requiring readmission following outpatient transmetatarsal amputation. An ACS NSQIP database analysis following filtering for CPT 28805, specific for transmetatarsal amputations, was performed among geriatric patients. Patient demographic, medical history, operative characteristics, and social/functional determinants were compared between the no admission and readmission cohorts. The threshold for statistical significance was set at p ≤ 0.05. Overall, a 19% readmission rate was reported among geriatric patients who underwent an outpatient transmetatarsal amputation. No statistically significant difference among patient demographics, past medical history, or surgical presentation was found between cohorts. Geriatric patients that maintained some level of functional dependence were 3.41 times more likely to be readmitted than the non-readmission cohort (p = 0.006). Among geriatric patients undergoing outpatient transmetatarsal amputation, function status should be taken into account prior to surgery. Greater consideration should also be given to patients who do not maintain independence during their activities of daily living. As the population continues to age, recognizing social circumstances associated with the geriatric population proves important in preventing readmission.

PMID:37661019 | DOI:10.1053/j.jfas.2023.08.013