Nevin Manimala

BMJ Open. 2023 Aug 7;13(8):e069208. doi: 10.1136/bmjopen-2022-069208.

ABSTRACT

OBJECTIVES: The emergency department (ED) represents a place and moment of opportunity to provide interventions to improve long-term asthma outcomes, but feasibility, effectiveness and mechanisms of impact are poorly understood. We aimed to review the existing literature on interventions that are delivered in the ED for adults and adolescents, targeting asthma outcomes beyond the ED, and to code the interventions according to theory used, and to understand the barriers and facilitators to their implementation.

METHODS: We systematically searched seven electronic databases and research registers, and manually searched reference lists of included studies and relevant reviews. Both quantitative and qualitative studies that reported on interventions delivered in the ED which aimed to improve asthma outcomes beyond management of the acute exacerbation, for adolescents or adults were included. Methodological quality was assessed using the Mixed Methods Appraisal Tool and informed study interpretation. Theory was coded using the Theoretical Domains Framework. Findings were summarised by narrative synthesis.

RESULTS: 12 articles were included, representing 10 unique interventions, including educational and medication-based changes (6 randomised controlled trials and 4 non-randomised studies). Six trials reported statistically significant improvements in one or more outcome measures relating to long-term asthma control, including unscheduled healthcare, asthma control, asthma knowledge or quality of life. We identified limited use of theory in the intervention designs with only one intervention explicitly underpinned by theory. There was little reporting on facilitators or barriers, although brief interventions appeared more feasible.

CONCLUSION: The results of this review suggest that ED-based asthma interventions may be capable of improving long-term outcomes. However, there was significant variation in the range of interventions, reported outcomes and duration of follow-up. Future interventions would benefit from using behaviour change theory, such as constructs from the Theoretical Domains Framework.

PROSPERO REGISTRATION NUMBER: CRD 42020223058.

PMID:37550032 | DOI:10.1136/bmjopen-2022-069208

BMJ Open. 2023 Aug 7;13(8):e069858. doi: 10.1136/bmjopen-2022-069858.

ABSTRACT

INTRODUCTION: The purpose of TheShinISS-Vax|Flu study is to examine the association between influenza vaccines and adverse events requiring hospital admission or emergency care during the influenza vaccination campaigns 2021/2022 and 2022/2023 in Italy.

METHODS AND ANALYSIS: This is a Self-Controlled Case Series multiregional study using linked routinely collected data from regional healthcare databases of the participating regions. Study participants will be persons aged ≥6 months, unvaccinated or who have received influenza vaccine during the influenza vaccination campaigns in the seasons 2021/2022 and 2022/2023 in Italy and who have experienced the outcome of interest for the first time during the study period (1 September 2021-30 June 2022 and 1 September 2022-30 June 2023 for the first and second vaccination campaigns, respectively). Risk periods will be specifically defined for each outcome and further subdivided into periods of 7 days. The exposures will be the first or second dose of the influenza vaccines administered during the two vaccination campaigns. Statistical analysis will be conducted separately for the data of the two campaigns. Exposure risk period will be compared with baseline risk period defined as any time of observation out of the risk periods. The modified SCCS method will be applied to handle event-dependent exposure and mortality and fitted using unbiased estimating equations to estimate relative incidences and excess of cases per 100 000 vaccinated by dose, age, sex and type of vaccine. Calendar period will be included as time-varying confounder in the model, where appropriate.

ETHICS AND DISSEMINATION: The study received the approval from the National ethics committee for clinical trials of public research bodies and other national public institutions (PRE BIO CE n.0036723, 23/09/2022). Results will be published in peer-reviewed journals and reports in accordance with the publication policies of the Italian National Institute of Health and of the Italian Medicines Agency.

PMID:37550029 | DOI:10.1136/bmjopen-2022-069858

BMJ Open. 2023 Aug 7;13(8):e069176. doi: 10.1136/bmjopen-2022-069176.

ABSTRACT

INTRODUCTION: There is an urgent need to determine the safety, effectiveness and cost-effectiveness of novel antiviral treatments for COVID-19 in vaccinated patients in the community at increased risk of morbidity and mortality from COVID-19.

METHODS AND ANALYSIS: PANORAMIC is a UK-wide, open-label, prospective, adaptive, multiarm platform, randomised clinical trial that evaluates antiviral treatments for COVID-19 in the community. A master protocol governs the addition of new antiviral treatments as they become available, and the introduction and cessation of existing interventions via interim analyses. The first two interventions to be evaluated are molnupiravir (Lagevrio) and nirmatrelvir/ritonavir (Paxlovid).

ELIGIBILITY CRITERIA: community-dwelling within 5 days of onset of symptomatic COVID-19 (confirmed by PCR or lateral flow test), and either (1) aged 50 years and over, or (2) aged 18-49 years with qualifying comorbidities. Registration occurs via the trial website and by telephone. Recruitment occurs remotely through the central trial team, or in person through clinical sites. Participants are randomised to receive either usual care or a trial drug plus usual care. Outcomes are collected via a participant-completed daily electronic symptom diary for 28 days post randomisation. Participants and/or their Trial Partner are contacted by the research team after days 7, 14 and 28 if the diary is not completed, or if the participant is unable to access the diary. The primary efficacy endpoint is all-cause, non-elective hospitalisation and/or death within 28 days of randomisation. Multiple prespecified interim analyses allow interventions to be stopped for futility or superiority based on prespecified decision criteria. A prospective economic evaluation is embedded within the trial.

ETHICS AND DISSEMINATION: Ethical approval granted by South Central-Berkshire REC number: 21/SC/0393; IRAS project ID: 1004274. Results will be presented to policymakers and at conferences, and published in peer-reviewed journals.

TRIAL REGISTRATION NUMBER: ISRCTN30448031; EudraCT number: 2021-005748-31.

PMID:37550022 | DOI:10.1136/bmjopen-2022-069176

Ann Rheum Dis. 2023 Aug 7:ard-2023-224543. doi: 10.1136/ard-2023-224543. Online ahead of print.

ABSTRACT

OBJECTIVES: To update the EULAR recommendations for the use of imaging modalities in primary large vessel vasculitis (LVV).

METHODS: A systematic literature review update was performed to retrieve new evidence on ultrasound, MRI, CT and [¹⁸F]-fluorodeoxyglucose positron emission tomography (FDG-PET) for diagnosis, monitoring and outcome prediction in LVV. The task force consisted of 24 physicians, health professionals and patients from 14 countries. The recommendations were updated based on evidence and expert opinion, iterating until voting indicated consensus. The level of agreement was determined by anonymous votes.

RESULTS: Three overarching principles and eight recommendations were agreed. Compared to the 2018 version, ultrasound is now recommended as first-line imaging test in all patients with suspected giant cell arteritis, and axillary arteries should be included in the standard examination. As an alternative to ultrasound, cranial and extracranial arteries can be examined by FDG-PET or MRI. For Takayasu arteritis, MRI is the preferred imaging modality; FDG-PET, CT or ultrasound are alternatives. Although imaging is not routinely recommended for follow-up, ultrasound, FDG-PET or MRI may be used for assessing vessel abnormalities in LVV patients with suspected relapse, particularly when laboratory markers of inflammation are unreliable. MR-angiography, CT-angiography or ultrasound may be used for long-term monitoring of structural damage, particularly at sites of preceding vascular inflammation.

CONCLUSIONS: The 2023 EULAR recommendations provide up-to-date guidance for the role of imaging in the diagnosis and assessment of patients with LVV.

PMID:37550004 | DOI:10.1136/ard-2023-224543

BJGP Open. 2023 Aug 7:BJGPO.2023.0087. doi: 10.3399/BJGPO.2023.0087. Online ahead of print.

ABSTRACT

BACKGROUND: Alcohol and smoking brief interventions (BI) in general practice have been shown to be effective in lowering alcohol- and smoking-related harm.

AIM: Assess prevalence of self-reported BI receipt among increasing/higher risk drinkers and past-year smokers in Great Britain (GB) and associations between intervention receipt and socioeconomic position.

DESIGN & SETTING: Monthly population-based survey in England, Scotland, and Wales. The study comprised 47,799 participants (15,573 increasing/higher risk drinkers (AUDIT-C score ≥5), 7791 past-year smokers) surveyed via telephone in 2020-2022 (during the COVID-19 pandemic). All data were self-reported.

METHOD: Prevalence of self-reported BI receipt was assessed descriptively; associations between receipt and socioeconomic position were analysed using logistic regression.

RESULTS: Among adults in GB, 32.2% (95% CI 31.8-32.7) reported increasing/higher risk drinking and 17.7% (95% CI 17.3-18.1) past-year smoking. Among increasing/higher risk drinkers, 58.0% (95% CI 57.1-58.9) consulted with a general practitioner in the past year, and of these, 4.1% (95% CI 3.6-4.6) reported receiving BIs. Among past-year smokers, 55.8% (95% CI 54.5-57.1) attended general practice in the past year. Of these, 41.0% (95% CI 39.4-42.7) stated receiving BIs. There was a tendency for socioeconomically disadvantaged patients to receive more alcohol (adjusted odds ratio (aOR) 1.38; 95% CI 1.10-1.73) or smoking BIs (aOR 1.11; 95% CI 0.98-1.26), but for the latter the results were statistically non-significant. Results did not differ notably by nation within GB.

CONCLUSION: BIs in general practice are more common for smoking than for alcohol, but for alcohol a greater proportion is delivered to socioeconomically disadvantaged increasing/higher risk drinkers.

PMID:37549977 | DOI:10.3399/BJGPO.2023.0087

J Radiat Res. 2023 Aug 7:rrad055. doi: 10.1093/jrr/rrad055. Online ahead of print.

ABSTRACT

The purpose of this study was to estimate the internal dose of radiation in Japanese macaques (aka Nihonzaru or snow monkey) due to the Fukushima nuclear power plant accident. Images of a male Japanese macaque weighing ~10 kg were acquired using a multi-slice computed tomography (CT) scan with a 64-row segment detector. The CT images were used to create voxel phantoms of the bones, bone marrow, brain, eyes, heart, lungs, stomach, liver, spleen, pancreas, kidneys, intestines, bladder, testes, thyroid and miscellaneous tissue. The Particle and Heavy Ion Transport System (PHITS) Monte Carlo code was used to calculate the internal exposure rate conversion factors for 134Cs, 137Cs and 131I isotopes for the created voxel phantoms with a statistical precision higher than 1%. The PHITS-calculated energy deposits were compared with those for rhesus monkeys. The results showed that the fractions of energy deposits for β-radiation in different organs were almost identical between the two species. For γ-radiation, there was excellent agreement in the self-absorption rate with the approximate curve of the Japanese macaque, with an average deviation of 2%. The maximum deviation of 12% was for the kidney, which has two organs, so the error with the approximate curve is slightly larger due to the energy loss created between organs.

PMID:37549961 | DOI:10.1093/jrr/rrad055

Physiol Rep. 2023 Aug;11(15):e15762. doi: 10.14814/phy2.15762.

ABSTRACT

Loss of estrogen as a result of aging, pelvic cancer therapy, genetics, or eating disorders affects numerous body systems including the reproductive tract. Specifically, a chronic hypoestrogenic state fosters debilitating vaginal symptoms like atrophy, dryness, and dyspareunia. Current treatment options, including vaginal estrogen and hyaluronan (HA), anecdotally improve symptoms, but rectifying mechanisms are largely understudied. In order to study the hypoestrogenic vaginal environment, in particular the extracellular matrix (ECM), as well as understand the mechanisms behind current treatments and develop new therapies, we characterized a reliable and reproducible animal model. Bilateral ovariectomies (OVX) were performed on 9-week-old CD1 mice. After 1 month of estrogen loss due to ovarian removal, a phenotype that is similar to human vaginal tissue in an estrogen reduced state was noted in mice compared to sham-operated controls. The uterine to body weight ratio decreased by 80% and vaginal epithelium was significantly thinner in OVX compared to sham mice. Estrogen signaling was altered in OVX, but submucosal ERα localization did not reach statistical differences. HA localization in the submucosal area was altered and CD44 expression decreased in OVX mice. Collagen turn-over was altered following OVX. The inflammation profile was also disrupted, and submucosal vaginal CD45⁺ and F4/80⁺ cell populations were significantly reduced in the OVX mice. These results show altered cellular and molecular changes due to reduced estrogen levels. Developing new treatments for hypoestrogenic vaginal symptoms rely on better understanding of not only the cellular changes, but also the altered vaginal ECM environment. Further studies using this mouse model has the potential to advance women’s vaginal health treatments and aid in understanding the interplay between organ systems in both healthy, aged, and diseased states.

PMID:37549960 | DOI:10.14814/phy2.15762

Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2023 Jul;37(7):562-569. doi: 10.13201/j.issn.2096-7993.2023.07.010.

ABSTRACT

Objective:To investigate the distribution of allergens in patients with allergic rhinitis （AR） in Ningxia, and provide theoretical data for the prevention and treatment of AR in this region. Methods:A total of 1664 patients diagnosed with AR in the Otorhinolaryngology Head and Neck Surgery Department of Yinchuan First People’s Hospital Outpatient Clinic from January 2018 to December 2021 were retrospectively collected. Use the allergen sIgE antibody detection kit （immunoblotting method） to detect inhalation and ingestion allergens in patients.Results: ①Among all AR patients, 1 158 cases were detected positive, resulting in the detection rate was 69.59%; ②The detection rate of inhalation allergen was 65.87%, and the detection rate of ingestion allergen was 19.83%; ③Mugwort was the most sensitive allergen, and 76.32% of the patients having a positive grade ≥3; ④Out of the patients, 294 cases （25.39%） were allergic to only one allergen, 244 cases （21.07%） were allergic to two allergens, and 620 cases （53.54%） were allergic to three or more allergens; ⑤During different seasons, the highest number of positive allergens detected was in the summer, with 968 cases （83.59%）. Mugwort was the main allergen during this season （69.01%）. After the COVID-19 epidemic, the total positive rate of sIgE tests in AR patients decreased compared to before, and the difference was statistically significant （P<0.001）; ⑥Mugwort, dog epithelium, mold combination, egg, peanut, soybean, Marine fish combination and fruit combination all showed statistically significant differences between different gender groups （P<0.05）; ⑦Common ragweed, mugwort, dust mite combination, cockroach, egg, milk, Marine fish combination, shrimp, fruit combination and nut combination all showed statistically significant differences among different age groups （P<0.05）; ⑧There were statistically significant differences in hay dust among different ethnic groups （P<0.05）. Conclusion:Artemisia argyi is the main allergen in Ningxia, and the distribution characteristics of different allergens are influenced by treatment season, the COVID-19 epidemic, gender, age, ethnicity, and other factors, showing certain distribution patterns and rules.

PMID:37549949 | DOI:10.13201/j.issn.2096-7993.2023.07.010

J Phys Chem Lett. 2023 Aug 7:7198-7207. doi: 10.1021/acs.jpclett.3c01554. Online ahead of print.

ABSTRACT

Exploration of singlet fission (SF) materials is vital for enhancing the photoelectric conversion efficiency of photovoltaic devices, and the development of an effective screening means is in great demand. In this work, we for the first time propose a promising dual-descriptor strategy to predict the SF energetics (ΔE_SF) from ground-state electronic properties, the gap (Gap_HL) and exchange energy (K_HL) between the highest occupied and lowest unoccupied molecular orbitals (HOMO and LUMO), where Gap_HL plays a dominant role and K_HL acts as a correction. This strategy is statistically verified through exploring the effect of N-doping on the electronic/energetic properties of the N-doped tetracene derivatives and isomers. Several rules of thumb are suggested, and the reliability of this strategy is validated by comparison with experiments. This work proposes a novel strategy for exploring SF chromophores with insights into the SF energetics from ground-state properties and certainly has fundamental interest and generality in exploring efficient SF-capable materials.

PMID:37549938 | DOI:10.1021/acs.jpclett.3c01554

J Oral Pathol Med. 2023 Aug 7. doi: 10.1111/jop.13471. Online ahead of print.

ABSTRACT

BACKGROUND: Mucolox™ is a mucosal drug delivery system that prolongs the contact time between the oral mucosa and topical corticosteroids, potentially reducing the need for multiple applications daily. This study aimed to assess the clinical efficacy and tolerability of dexamethasone 0.5 mg/5 mL solution in Mucolox™ for the management of oral inflammatory ulcerative diseases.

METHODS: Participants were randomly assigned to receive dexamethasone 0.5 mg/5 mL in Mucolox™ (Mucolox™ arm) or dexamethasone 0.5 mg/5 mL solution (standard arm) and instructed to swish/gargle for 5 min three times daily. Changes from pre- to posttreatment patient’s sensitivity score (0-10 on a visual analog scale), reticulation/erythema/ulceration score, and oral health-related quality of life were evaluated at baseline and at the end of the study period.

RESULTS: Twenty nine patients (75% females) with a median age of 58 years (range 18-79) were enrolled and randomly allocated to the Mucolox™ or standard arm. One subject was excluded. Although statistically significant in both arms, the pre- to posttreatment sensitivity score reduction was higher in the Mucolox™ arm (6.3 vs. 4.4-point reduction). Both arms showed a decrease in the reticulation/erythema/ulceration score between the two visits (7.2 vs. 4.7 [Mucolox™ arm]; 8.0 vs. 4.8 [standard arm]; p > 0.05). Mucolox™ in dexamethasone 0.5 mg/5 mL solution was better tolerated when taste and level of comfort were considered.

CONCLUSIONS: Both treatments were effective in the management of oral inflammatory ulcerative diseases. Dexamethasone 0.5 mg/5 mL in Mucolox™ was better tolerated and was slightly better in controlling patients’ oral sensitivity. Larger studies are needed to confirm these findings in oral inflammatory ulcerative diseases patients.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04540133.

PMID:37549933 | DOI:10.1111/jop.13471