Nevin Manimala

Neurologist. 2023 Jun 27. doi: 10.1097/NRL.0000000000000507. Online ahead of print.

ABSTRACT

BACKGROUND: A pilot randomized trial evaluating whether a social support intervention improves adherence to home blood pressure (BP) monitoring among patients with cerebrovascular disease.

METHODS: Subjects with ischemic stroke, intracerebral hemorrhage, or transient ischemic attack within 5 years with BP >140/90, were given a centrally monitored home BP cuff and asked to check their BP twice a day for 90 ± 7 days. Subjects received text and/or email reminders for missed measurements and weekly reports on adherence/BP control. Subjects were randomized 1:1 to a social support intervention, in which close personal contact also received all study-related education and communications. The primary outcome was the proportion of requested measurements completed. A secondary outcome was a change in BP over time.

RESULTS: Thirty-three subjects were enrolled, 15 in the control arm and 18 in the social support arm. The social support arm completed a greater proportion of BP measurements at day 30 (88% vs 78%), day 60 (72% vs 54%), and day 83 (60% vs 40%), but none of these differences were statistically significant (P > 0.05). Comparing the first 7 days of BP readings to the last 7 days across subjects, there was a nonsignificant decrease in BP over time (systolic BP = -2.8 mm Hg, P = 0.29 and diastolic BP = -1.7, P = 0.36). The social support intervention did not modify the change in BP over time.

CONCLUSION: A social support intervention may increase adherence to home BP monitoring. This pilot study provides important preliminary data to inform the design of larger more definitive trials utilizing self-monitoring of BP in patients with cerebrovascular disease.

PMID:37582619 | DOI:10.1097/NRL.0000000000000507

ACR Open Rheumatol. 2023 Aug 15. doi: 10.1002/acr2.11588. Online ahead of print.

ABSTRACT

OBJECTIVE: In a study of physical and cognitive functioning among predominantly Black individuals with systemic lupus erythematosus (SLE), we compared remotely administered physical and cognitive performance assessments to those collected in person.

METHODS: A subset of participants who completed an in-person visit in our parent study from 2021 to 2022 (n = 30) were recruited to complete a second, remote visit within 28 days. Physical performance (measured by a modified Short Physical Performance Battery [SPPB]; range 0-12; subscale ranges 0-4; higher = better performance) and cognitive performance (episodic and working memory adjusted t-scores, measured using NIH Toolbox) were measured at both visits. Mean scores were compared using paired t-tests; intraclass correlation coefficients (ICCs) were obtained from two-way mixed effects models. Linear and logistic models were used to estimate stratified associations between performance measures and related outcomes.

RESULTS: Participants were primarily female (93.3%) and Black (93.3%). In-person versus remote overall SPPB (8.76 vs. 9.43) and chair stand (1.43 vs. 1.90) scores were statistically significantly lower. t-Scores for episodic memory (47.27 vs. 49.53) and working memory (45.37 vs. 47.90) were lower for in-person versus remote visits. The ICC for overall SPPB indicated good agreement (0.76), whereas the ICCs for episodic (0.49) and working memory (0.57) indicated poor-moderate agreement. Associations between assessments of performance with related outcomes were similar and did not statistically significantly differ by modality of visit.

CONCLUSION: To possibly expand and diversify pools of participants in studies of physical and cognitive performance in SLE, remote administration of assessments should be considered for future research.

PMID:37582606 | DOI:10.1002/acr2.11588

J Korean Med Sci. 2023 Aug 14;38(32):e248. doi: 10.3346/jkms.2023.38.e248.

ABSTRACT

The pediatric population with comorbidities is a high-risk group for severe coronavirus disease 2019 (COVID-19). As of January 2023, the COVID-19 vaccination rate for at least two doses among Korean children 5-11 years is low at 1.1%. We summarized the COVID-19 vaccination status for the pediatric population (5-17 years) with comorbidities through July 2022 using the National Health Insurance Service database. Pediatric patients with comorbidities had higher vaccination rates than the general pediatric population (2.4% vs. 1.1% in 5-11-year-olds [P < 0.001], 76.5% vs. 66.1% in 12-17-year-olds [P < 0.001]). However, there were substantial differences according to comorbidity category, and the 2-dose vaccination rate was lowest among children with immunodeficiency in all age groups (1.1% in 5-11-year-olds, 51.2% in 12-17-year-olds). The COVID-19 vaccination rate among Korean children has remained stagnant at a low proportion despite ongoing outreach. Thus, more proactive strategies are needed alongside continuous surveillance.

PMID:37582498 | DOI:10.3346/jkms.2023.38.e248

J Am Vet Med Assoc. 2023 Aug 15:1-8. doi: 10.2460/javma.23.03.0135. Online ahead of print.

ABSTRACT

OBJECTIVE: To report the short- and long-term outcomes of laparoscopic adrenalectomy (LA) for resection of unilateral adrenal masses and to document risk factors for conversion and peri- and postoperative morbidity.

ANIMALS: 255 client-owned dogs.

METHODS: Dogs were included if LA was attempted for resection of a unilateral adrenal mass. Medical records were evaluated and relevant data were reported, including complications, conversion, perioperative death, and long-term outcomes. Signalment, clinicopathological data, and surgical experience were factors statistically evaluated for possible associations with capsular penetration during surgery, conversion, surgical time, duration of hospital stay, death prior to discharge, mass recurrence, and survival time.

RESULTS: 155 dogs had left-sided tumors, and 100 had right-sided tumors. Conversion to an open approach was performed in 9.4% of cases. Capsular penetration (19.2%) and major hemorrhage (5.4%) were the most prevalent intraoperative complications. Of the dogs operated on, 94.9% were discharged from the hospital. Lesion side, portion of the gland affected, and surgeon experience influenced surgical time. Conversion rate increased with increasing body condition score and lesion size. Risk of death prior to discharge increased with increasing lesion size. Risk of conversion and death prior to discharge were lower when performed by more experienced surgeons. Capsular penetration during LA increased the risk of tumor recurrence.

CLINICAL RELEVANCE: LA for resection of unilateral adrenal masses is associated with excellent outcomes in experienced centers. Surgeons with greater experience with LA have lower surgical times, conversion rates, and risk of death prior to discharge.

PMID:37582487 | DOI:10.2460/javma.23.03.0135

J Am Med Dir Assoc. 2023 Aug 12:S1525-8610(23)00645-X. doi: 10.1016/j.jamda.2023.07.016. Online ahead of print.

ABSTRACT

OBJECTIVES: Deprescribing reduces polypharmacy in older adults. A thorough study of the effect of deprescribing interventions on clinical outcomes in older adults is presently lacking. As a result, we evaluated the impact of deprescribing on clinical outcomes in older patients.

DESIGN: Meta-analysis and systematic review of randomized controlled trials (RCTs). PubMed, EMBASE, and Cochrane Library were searched from the time of creation to March 2023.

SETTING AND PARTICIPANTS: Randomized controlled trial with participants at least 60 years old.

MEASURES: Mortality, falls (number of fallers), hospitalization rates, emergency department visits, medication adherence, HRQoL (health-regulated quality of life), incidence of ADR (adverse drug reactions), PIM (potentially inappropriate medication), and PPO (potentially prescription omission) were evaluated in the meta-analysis.

RESULTS: A total of 32 RCTs (18,670 patients) were included. Deprescribing interventions significantly reduced proportions of older adults with PIM, PPO, and the incidence of ADRs. The interventions group also improved medication compliance.

CONCLUSIONS AND IMPLICATIONS: Compared to routine care, deprescribing interventions significantly improve clinical outcome indicators for older adults.

PMID:37582482 | DOI:10.1016/j.jamda.2023.07.016

Int J Antimicrob Agents. 2023 Aug 13:106952. doi: 10.1016/j.ijantimicag.2023.106952. Online ahead of print.

ABSTRACT

INTRODUCTION: Molnupiravir and nirmatrelvir/ritonavir are antivirals used to prevent progression to severe SARS-CoV-2 infections, which reduce both hospitalization and mortality rates. Nirmatrelvir/ritonavir was authorised in Europe in December 2021, while molnupiravir is not yet licensed in Europe as of February 2022. Molnupiravir may be an alternative to nirmatrelvir/ritonavir, because it displays less frequent drug-drug interactions and contraindications. A caveat connected to molnupiravir derives from the mode of action inducing viral mutations. In clinical trials on patients without haematological malignancy, mortality rate reduction of molnupiravir appeared less pronounced than that of nirmatrelvir/ritonavir. Little is known about the comparative efficacy of the two drugs in patients with haematological malignancy at high-risk of severe COVID-19. Thus, we here assess the effectiveness of molnupiravir compared to nirmatrelvir/ritonavir in our cohort of patients with haematological malignancies.

METHODS: Clinical data of patients treated either with molnupiravir or nirmatrelvir/ritonavir monotherapy for COVID-19 were retrieved from the EPICOVIDEHA registry. Patients treated with molnupiravir were matched by sex, age (±10 years), and baseline haematological malignancy severity to controls treated with nirmatrelvir/ritonavir.

RESULTS: A total of 116 patients receiving molnupiravir for the clinical management of COVID-19 were matched to an equal number of controls receiving nirmatrelvir/ritonavir. In each of the groups, 68 (59%) patients were male; with a median age of 64 years (IQR 53-74) for molnupiravir recipients and 64 years (IQR 54-73) for nirmatrelvir/ritonavir recipients; 57% (n=66) of the patients had controlled baseline haematological malignancy, 13% (n=15) stable, and 30% (n=35) had active disease at COVID-19 onset in each of the groups. During COVID-19 infection, one third of patients from each group were admitted to hospital. Although a similar proportion of vaccinated patients was observed in both groups (molnupiravir n=77, 66% vs nirmatrelvir/ritonavir n=87, 75%), those treated with nirmatrelvir/ritonavir had more often received four doses (n=27, 23%) as compared to patients treated with molnupiravir (n=5, 4%, p<0.001). No differences were detected in COVID-19 severity (p=0.39) or hospitalization (p=1.0). No statistically significant differences were identified in overall mortality rate (p=0.78) or in survival probability (d30 p=0.19, d60 p=0.67, d90 p=0.68, last day of follow up p=0.68). In all patients, deaths were either attributed to COVID-19 or the infection contributed to death as per treating physician’s judgement.

CONCLUSIONS: In high-risk patients with haematological malignancies and COVID-19, molnupiravir showed rates of hospitalization and mortality comparable to those of nirmatrelvir/ritonavir in this matched-pair analysis. Molnupiravir appears to be a plausible alternative to nirmatrelvir/ritonavir for COVID-19 treatment in patients with haematological malignancy.

PMID:37582478 | DOI:10.1016/j.ijantimicag.2023.106952

Sci Total Environ. 2023 Aug 13:166278. doi: 10.1016/j.scitotenv.2023.166278. Online ahead of print.

ABSTRACT

Mineralogical investigations on fluvial sedimentary sequences could provide historical environmental information on the effects of human activities and natural events. This study aims to identify the provenance, mineralogical distribution mechanism, and environmental significance of sediments of the Yellow River based on topographic analysis, statistics, weathering and recycling indices. In total, 107 samples were collected from sedimentary sequences in the source area, and the upper, middle, and lower reaches and analyzed for grain size, major elements, and mineral composition. The results showed that the climate conditions were cold and arid, where weak hydrolysis under continental weathering and strong erosion accelerated physical weathering. Clay minerals primarily originated from the Tibetan Plateau, whereas the middle and lower reaches received input of aeolian deposits from Northern China. Quartz and feldspar in the middle and lower reaches may derive from the source area and upper reaches. Meanwhile, calcite and dolomite formed through diagenesis, with loess input from the Chinese Loess Plateau. Regarding heavy minerals, the dominant determinative factors of pyrite were post-depositional diagenesis and leaching. Hematite and amphibole primarily formed through magnetite conversion and contribution from regional sources, respectively. Moreover, the mineral distribution mechanism significantly affected the mobility and distribution of geochemical elements through diagenesis and alteration. The findings are instrumental in reconstructing the environmental evolution of large-scale watersheds across multiple climatic zones.

PMID:37582450 | DOI:10.1016/j.scitotenv.2023.166278

Chest. 2023 Aug 13:S0012-3692(23)05274-1. doi: 10.1016/j.chest.2023.08.013. Online ahead of print.

ABSTRACT

BACKGROUND: Pulmonary involvement is the leading cause of death in systemic sclerosis (SSc) and may manifest as interstitial lung disease (ILD), pulmonary arterial hypertension (PAH), or in combination of both (ILD-pulmonary hypertension (PH)). Aim of this analysis was to determine prevalence, clinical characteristics, and survival of these different forms within the registry of the German Network for Systemic Sclerosis (DNSS).

RESEARCH QUESTION: Does SSc-associated ILD with or without PH affect survival differently and are there any risk factors that have an additional impact?

STUDY DESIGN AND METHODS: Clinical data of 5,831 SSc patients were collected in the DNSS registry, Kaplan-Meier estimates were used to compare overall survival (OS) in patients with SSc-ILD with PH (ILD-PH) and without PH (ILD-w/o-PH) to patients without pulmonary involvement and those with PAH. The Cox proportional hazard model was used to analyze the influence of pulmonary involvement and other potential predictors on patient survival.

RESULTS: Clinical data of 3,257 patients with a mean follow-up years of 3.45±1.63 have been included in our analysis. At baseline, ILD was present in 34.5%, while PH (w/o-ILD) had a lower prevalence with 4.5%. At the end of follow-up, 47.6% of SSc patients had ILD, 15.2% ILD-PH, and 6.5% PAH. ILD was more frequent in the diffuse cutaneous form (57.3%), while PAH did not differ significantly between SSc subtypes. Significant differences in baseline characteristics between PAH vs. ILD-PH vs. ILD-w/o-PH were found for age at diagnosis, gender, SSc-subsets, antibody-status, FVC, DLCO and therapy. OS at 5 years was 96.4% for patients without pulmonary involvement and differed significantly between patients with ILD-w/o-PH, PAH, being worst in patients with ILD-PH. Female gender (HR 0.3), a higher BMI (HR 0.9) and higher DLCO values (HR 0.98) were associated with a lower mortality risk.

INTERPRETATION: ILD is the most prevalent pulmonary involvement in SSc, while the combination of ILD and PH is associated with the most detrimental survival.

PMID:37582424 | DOI:10.1016/j.chest.2023.08.013

Neuroimage. 2023 Aug 13:120327. doi: 10.1016/j.neuroimage.2023.120327. Online ahead of print.

ABSTRACT

Selective use of new information is crucial for adaptive decision-making. Combining a gamble bidding task with assessing cortical responses using functional near-infrared spectroscopy (fNIRS), we investigated potential effects of information valence on behavioral and neural processes of belief and value updating during uncertainty reduction in young adults. By modeling changes in the participants’ expressed subjective values (i.e., value updating) using a Bayesian model, we dissociated processes of (i) updating beliefs about statistical properties of the gamble, (ii) updating values of a gamble based on new information about its winning probabilities, as well as (iii) expectancy violation. The results showed that participants used new information to update their beliefs and values about the gambles in a quasi-optimal manner, as reflected in the selective updating only in situations with reducible uncertainty. Furthermore, their updating was valence-dependent: information indicating an increase in winning probability was underweighted, whereas information about a decrease in winning probability was updated in good agreement with predictions of the Bayesian decision theory. Results of model-based and moderation analyses showed that this valence-dependent asymmetry was associated with a distinct contribution of expectancy violation, besides belief updating, to value updating after experiencing new positive information regarding winning probabilities. In line with the behavioral results, we replicated previous findings showing involvements of frontoparietal brain regions in the different components of updating. Furthermore, this study provided novel results suggesting a valence-dependent recruitment of brain regions. Individuals with stronger oxyhemoglobin responses during value updating was more in line with predictions of the Bayesian model while integrating new information that indicates an increase in winning probability. Taken together, this study provides first results showing expectancy violation as a contributing factor to valence-dependent updating during uncertainty reduction and suggests limitations of normative Bayesian decision theory.

PMID:37582418 | DOI:10.1016/j.neuroimage.2023.120327

Gynecol Endocrinol. 2023 Aug 8;39(1):2245479. doi: 10.1080/09513590.2023.2245479.

ABSTRACT

OBJECTIVE: To develop a model to identify women likely to be severely impacted by vulvovaginal atrophy (VVA), based on their experience of symptoms and non-clinical factors.

METHODS: Multivariate statistics and machine-learning algorithms were used to develop models using data from a cross-sectional, observational, multinational European survey. A set of independent variables were chosen to assess subjective VVA severity and its impact on daily activities.

RESULTS: A final composite model was selected that included three categories of variables: clinical severity, patient demographics/clinical characteristics and Day-to-Day Impact of Vaginal Aging (DIVA) variables related to emotion/mood, impact on lifestyle and frequency of sex. The model accurately classified 71% of women. Three DIVA variables (feeling bad about yourself, desire/interest in sex, physical comfort related to sitting) explained much of the variation in the dependent variable of the model. Over 90% of the impact of VVA relates to certain psychosocial and behavioral aspects that can be identified without the need to consider physical signs/symptoms.

CONCLUSION: Non-clinical factors can contribute significantly to the overall VVA burden.Questions used in developing the composite model could form the basis of an instrument to help screen women prior to clinical consultation and improve VVA management.

PMID:37582396 | DOI:10.1080/09513590.2023.2245479