Nevin Manimala

Sci Total Environ. 2023 May 19:164299. doi: 10.1016/j.scitotenv.2023.164299. Online ahead of print.

ABSTRACT

The abundance and distribution of microplastics has largely increased during last years and the respective implications on the environment and human health is an emerging field in research. In addition, recent studies in the enclosed Mediterranean Sea in Spain and Italy have shown an extended occurrence of microplastics (MPs) in different sediments of environmental samples. This study is focused on the quantification and the characterization of MPs in the Thermaic Gulf in northern Greece. Briefly, samples from different environmental compartments such as seawater, local beaches and seven commercially available fish species collected and analyzed. MPs particles extracted and classified by size, shape, colour and polymer type. A total of 28,523 microplastic particles recorded in the surface water samples, with their numbers ranging from 189 to 7714 particles per sample. The mean concentration of MPs recorded on the surface water was 1.9 ± 2 items/m³ or 750,846 ± 838,029 items/km². Beach sediment sample analysis revealed 14,790 microplastic particles, of which 1825 were large microplastics (LMPs, 1-5 mm) and 12,965 were small microplastics (SMPs, <1 mm). Furthermore, beach sediment samples showed a mean concentration of 733.6 ± 136.6 items/m², with the concentration of LMPs being 90.5 ± 12.4 items/m² and the concentration of SMPs being 643 ± 132 items/m². Concerning fish deposition, microplastics were detected in intestines and mean concentrations per species ranged from 1.3 ± 0.6 to 15.0 ± 1.5 items/individual. The differences in microplastic concentrations between species were statistically significant (p < 0.05) and showed that mesopelagic fish contained the highest concentrations, followed by epipelagic species. The most common size fraction found in the data-set was 1.0-2.5 mm, and polyethylene and polypropylene were the most abundant polymer types recorded. This is the first detailed investigation of MPs in Thermaic Gulf, which raises concerns on their potential negative effects.

PMID:37211124 | DOI:10.1016/j.scitotenv.2023.164299

Am J Obstet Gynecol MFM. 2023 May 19:101027. doi: 10.1016/j.ajogmf.2023.101027. Online ahead of print.

ABSTRACT

OBJECTIVE: We aimed to conduct a systematic review and meta-analysis to assess clinical characteristics related to pathologically proven placenta accreta spectrum (PAS) without placenta previa.

DATA SOURCES: A literature search of PubMed, the Cochrane database, and Web of Science was performed from inception to September 7, 2022.

STUDY ELIGIBILITY CRITERIA: The primary outcomes were invasive placenta (including increta or percreta), blood loss, hysterectomy, and antenatal diagnosis. Additionally, maternal age, assisted reproductive technology, previous cesarean section, and previous uterine procedures were investigated as potential risk factors. The inclusion criteria were studies evaluating the clinical presentation of pathologically diagnosed PAS without placenta previa.

STUDY APPRAISAL AND SYNTHESIS METHODS: Study screening was conducted after duplicates were identified and removed. The quality of each study and the publication bias were assessed. Forest plots and I² statistics were calculated for each study outcome for each group. The main analysis was a random-effects analysis.

RESULTS: Among 2598 studies that were initially retrieved, five were included in the review. With the exception of one study, four studies could be included in the meta-analysis. This meta-analysis showed that PAS without placenta previa was associated with a less risk of invasive placenta (OR, 0.24; 95% CI, 0.16-0.37), blood loss (MD, -1.19; 95% CI, -2.09 to -0.28) and hysterectomy (OR, 0.11; 95% CI, 0.02-0.53), and more difficult to diagnose prenatally (OR, 0.13; 95% CI, 0.04-0.45) than PAS with placenta previa. Additionally, assisted reproductive technology and a previous uterine procedure were strong risk factors for PAS without placenta previa, while previous cesarean section was a strong risk factor for PAS with placenta previa.

CONCLUSIONS: The differences in clinical aspects of PAS with and without placenta previa need to be understood.

PMID:37211089 | DOI:10.1016/j.ajogmf.2023.101027

Am J Obstet Gynecol MFM. 2023 May 19:101026. doi: 10.1016/j.ajogmf.2023.101026. Online ahead of print.

ABSTRACT

BACKGROUND: Induction of labor is a common intervention in obstetrics worldwide. Foley catheter is commonly used mechanical method for labor induction in nulliparous women with an unfavorable cervix at term. We hypothesize that a higher volume of FC (80 ml vs. 60 ml) will shorten the induction-delivery interval for labor induction in nulliparous women at term with an unfavorable cervix with simultaneous use of vaginal misoprostol.

OBJECTIVE: To evaluate the effect of trans-cervical foley catheter (80 vs. 60 ml) with simultaneous use of vaginal misoprostol on the induction-delivery interval in nulliparous women at term with an unfavorable cervix for IOL.

STUDY DESIGN: In this double-blind, single-center, randomized controlled trial, nulliparous women with a term singleton gestation with the unfavorable cervix were randomized to either group 1 [FC (80 ml) simultaneously with vaginal misoprostol 25µg every 4h] or group 2 [FC (60ml) with vaginal misoprostol 25µg every 4h]. The primary outcome was induction-delivery interval. Secondary outcomes were duration of the latent phase of labor, number of doses of vaginal misoprostol required, mode of delivery, and maternal & neonatal morbidity. Analyses were based on the intention-to-treat method. A sample size of 100 women per group (n=200) was selected.

RESULTS: Between September 2021 to September 2022, 200 nulliparous women at term with an unfavorable cervix were randomized to labor induction with either Foley catheter (80 ml vs. 60 ml) & vaginal misoprostol. Induction delivery interval (in min) was statistically significantly shorter in Foley catheter (80 ml) (median [IQR]; 604 [524-719] vs. 846 [596-990], [p<0.001]). Median time to labor onset (in min) (240 [120-300] vs. 360 [180-600], p<0.001) was also shorter in group 1 (80ml). The number of doses of misoprostol required for labor induction was statistically significantly less than with 80ml (mean±SD; 1.4±0.7 vs. 2.4±1.3, p<0.001). There was no statistically significant difference in the mode of delivery (n) (vaginal delivery; 69 vs. 80 OR; 0.55[1.1-0.3], p=0.104 & cesarean section; 29 vs. 17 OR; 0.99[3-9-1], p=0.063 respectively). The relative risk of delivery within 12h with 80ml was 2.4 [95% CI 1.68-3.43], with p-value <0.001. Maternal & neonatal morbidity was similar across the two groups.

CONCLUSION: Foley catheter (80ml) simultaneously with vaginal misoprostol significantly shortens the induction-delivery interval (p<0.001) in nulliparous women at term with an unfavorable cervix, as compared to Foley catheter 60 ml & vaginal misoprostol.

CLINICAL TRIAL REGISTRATION: The trial was registered prospectively in the Clinical Trial Registry of India (CTRI) www.ctri.nic.in (registration number CTRI/2021/09/036921, date; 28-09-2021).

PMID:37211088 | DOI:10.1016/j.ajogmf.2023.101026

J Affect Disord. 2023 May 19:S0165-0327(23)00692-4. doi: 10.1016/j.jad.2023.05.051. Online ahead of print.

ABSTRACT

BACKGROUND: Repetitive Transcranial magnetic stimulation (rTMS) combined with antidepressants benefited adults with depression while its efficacy and safety in children and adolescents with depression remain controversial.

METHODS: We searched PubMed, Embase, the Cochrane Library, Web of Science, CINAHL, LILACS, PsycINFO, CNKI, Wanfang Data Knowledge Service Platform, a Chinese Biology Medical disc database, and relevant clinical registration databases for randomized controlled trials from their inception to October 18, 2022. The efficacy of the treatment was assessed by changes in depression rating scale scores. Safety was assessed by the incidence of adverse events. Heterogeneity was determined using the Cochrane Q statistics and I² statistics. Publication bias was assessed by Egger’s test.

RESULTS: Eighteen studies from 10 datasets (1396 patients, 64.7 % female, age range from 8 to 24 years old). The pooled mean-endpoint scores of the depression scale for rTMS combined with the antidepressant group were significantly lower than those of sham combined with the antidepressant group both in two weeks (MD = -4.68, 95 % CI: [-6.66, -2.69]; I² = 91 %; P < 0.05) and four weeks (MD = -5.53, 95 % CI: [-9.90, -1.16]; I² = 98 %; P < 0.05). There were no differences in safety (OR = 0.64, 95 % CI: [0.20, 2.04]; I² = 64 %; P = 0.45) and acceptability between the two groups (3/70 vs 3/70).

LIMITATION: Heterogeneity was found in this study due to the limited number of original studies included.

CONCLUSION: rTMS combined with antidepressants enhanced the efficacy of the antidepressant medication. The safety and acceptability of the two groups were comparable. These findings may help guide future research and clinical practice.

PMID:37211054 | DOI:10.1016/j.jad.2023.05.051

J Affect Disord. 2023 May 19:S0165-0327(23)00665-1. doi: 10.1016/j.jad.2023.05.030. Online ahead of print.

ABSTRACT

BACKGROUND: Neuropsychiatric symptoms (NPS) and cognitive impairment are highly prevalent among persons with HIV (PWH). We examined the effect of the most common NPS, depression and anxiety, on cognitive change among PWH and compared these associations to those among persons without HIV (PWoH).

METHODS: Participants included 168 PWH and 91 PWoH who completed baseline self-report measures of depression (Beck Depression Inventory-II) and anxiety (Profile of Mood States [POMS] – Tension-anxiety subscale) and completed a comprehensive neurocognitive evaluation at baseline and at 1-year follow-up. Demographically-corrected scores from 15 neurocognitive tests were used to calculate global and domain-specific T-scores. Linear mixed-effects models examined the effect of depression and anxiety and their interaction with HIV-serostatus and time on global T-scores.

RESULTS: There were significant depression-by-HIV and anxiety-by-HIV interactions on global T-scores such that, among PWH only, greater depressive and anxiety symptoms at baseline related to worse global T-scores across visits. Non-significant interactions with time suggest stability in these relationships across visits. Follow-up analyses examining cognitive domains revealed that both the depression-by-HIV and the anxiety-by-HIV interactions were driven by learning and recall.

LIMITATIONS: Follow-up was limited to one-year and there were fewer PWoH than PWH, creating a differential in statistical power.

CONCLUSION: Findings suggest that anxiety and depression have stronger links to worse cognitive functioning in PWH than PWoH, particularly learning and memory, and that these associations seem to persist for at least one-year.

PMID:37211052 | DOI:10.1016/j.jad.2023.05.030

Eur Heart J. 2023 May 21:ehad344. doi: 10.1093/eurheartj/ehad344. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: The PARAGLIDE-HF trial demonstrated reductions in natriuretic peptides with sacubitril/valsartan compared with valsartan in patients with heart failure (HF) with mildly reduced or preserved ejection fraction who had a recent worsening HF event, but was not adequately powered to examine clinical outcomes. PARAGON-HF included a subset of PARAGLIDE-HF-like patients who were recently hospitalized for HF. Participant-level data from PARAGLIDE-HF and PARAGON-HF were pooled to better estimate the efficacy and safety of sacubitril/valsartan in reducing cardiovascular and renal events in HF with mildly reduced or preserved ejection fraction.

METHODS: Both PARAGLIDE-HF and PARAGON-HF were multicenter, double-blind, randomized, active-controlled trials of sacubitril/valsartan vs. valsartan in patients with HF with mildly reduced or preserved left ventricular ejection fraction (LVEF >40% in PARAGLIDE-HF and ≥45% in PARAGON-HF). In the pre-specified primary analysis, we pooled participants in PARAGLIDE-HF (all of whom were enrolled during or within 30 days of a worsening HF event) with a ‘PARAGLIDE-like’ subset of PARAGON-HF (those hospitalized for HF within 30 days). We also pooled the entire PARAGLIDE-HF and PARAGON-HF populations for a broader context. The primary endpoint for this analysis was the composite of total worsening HF events (including first and recurrent HF hospitalizations and urgent visits) and cardiovascular death. The secondary endpoint was the pre-specified renal composite endpoint for both studies (≥50% decline in estimated glomerular filtration rate from baseline, end-stage renal disease, or renal death).

RESULTS: Compared with valsartan, sacubitril/valsartan significantly reduced total worsening HF events and cardiovascular death in both the primary pooled analysis of participants with recent worsening HF (n=1,088; rate ratio [RR] 0.78; 95% confidence interval [CI] 0.61-0.99; P=0.042) and in the pooled analysis of all participants (n=5,262; RR 0.86; 95% CI: 0.75-0.98; P=0.027). In the pooled analysis of all participants, first nominal statistical significance was reached by day 9 after randomization and treatment benefits were larger in those with LVEF ≤60% (RR 0.78; 95% CI 0.66-0.91) compared with those with LVEF >60% (RR 1.09; 95% CI 0.86-1.40; Pinteraction=0.021). Sacubitril/valsartan was also associated with lower rates of the renal composite endpoint in the primary pooled analysis (hazard ratio [HR] 0.67; 95% CI 0.43-1.05; P=0.080) and the pooled analysis of all participants (HR 0.60; 95% CI 0.44-0.83; P=0.002).

CONCLUSIONS: In pooled analyses of PARAGLIDE-HF and PARAGON-HF, sacubitril/valsartan reduced cardiovascular and renal events among patients with HF with mildly reduced or preserved ejection fraction. These data provide support for use of sacubitril/valsartan in patients with HF with mildly reduced or preserved ejection fraction, particularly among those with an LVEF below normal, regardless of care setting.

PMID:37210743 | DOI:10.1093/eurheartj/ehad344

J Math Biol. 2023 May 21;86(6):94. doi: 10.1007/s00285-023-01929-1.

ABSTRACT

In this paper, we revisit a predator-prey model with specialist and generalist predators proposed by Hanski et al. (J Anim Ecol 60:353-367, 1991) , where the density of generalist predators is assumed to be a constant. It is shown that the model admits a nilpotent cusp of codimension 4 or a nilpotent focus of codimension 3 for different parameter values. As the parameters vary, the model can undergo cusp type (or focus type) degenerate Bogdanov-Takens bifurcations of codimension 4 (or 3). Our results indicate that generalist predation can induce more complex dynamical behaviors and bifurcation phenomena, such as three small-amplitude limit cycles enclosing one equilibrium, one or two large-amplitude limit cycles enclosing one or three equilibria, three limit cycles appearing in a Hopf bifurcation of codimension 3 and dying in a homoclinic bifurcation of codimension 3. In addition, we show that generalist predation stabilizes the limit cycle driven by specialist predators to a stable equilibrium, which clearly explains the famous Fennoscandia phenomenon.

PMID:37210699 | DOI:10.1007/s00285-023-01929-1

J Gerontol A Biol Sci Med Sci. 2023 May 21:glad130. doi: 10.1093/gerona/glad130. Online ahead of print.

ABSTRACT

BACKGROUND: Understanding fall circumstances can help researchers better identify causes of falls and develop effective and tailored fall prevention programs. This study aims to describe fall circumstances among older adults from quantitative data using conventional statistical approaches and qualitative analyses using a machine learning approach.

METHODS: The MOBILIZE Boston Study enrolled 765 community-dwelling adults aged 70 years and older in Boston, Massachusetts. Occurrence and circumstances of falls (i.e., locations, activities, and self-reported causes of falls) were recorded using monthly fall calendar postcards and fall follow-up interviews with open- and close-ended questions during a 4-year period. Descriptive analyses were used to summarize circumstances of falls. Natural language processing was used to analyze narrative responses from open-ended questions.

RESULTS: During the 4-year follow up, 490 participants (64%) had at least one fall. Among 1,829 falls, 965 falls occurred indoors and 804 falls occurred outdoors. Commonly reported activities when the fall occurred were walking (915, 50.0%), standing (175, 9.6%), and going down stairs (125, 6.8%). The most commonly reported causes of falls were slip or trip (943, 51.6%) and inappropriate footwear (444, 24.3%). Using qualitative data, we extracted more detailed information on locations and activities, and additional information on obstacles related to falls and commonly reported scenarios such as “lost my balance and fell”.

CONCLUSIONS: Self-reported fall circumstances provide important information on both intrinsic and extrinsic factors contributing to falls. Future studies are warranted to replicate our findings and optimize approaches to analyzing narrative data on fall circumstances in older adults.

PMID:37210687 | DOI:10.1093/gerona/glad130

Pediatr Cardiol. 2023 May 21. doi: 10.1007/s00246-023-03178-x. Online ahead of print.

ABSTRACT

Single ventricle patients eligible for Fontan completion undergo pre-Fontan catheterization for hemodynamic and anatomic assessment prior to surgery. Cardiac magnetic resonance imaging may be used to evaluate pre-Fontan anatomy, physiology, and collateral burden. We describe our center’s outcomes in patients undergoing pre-Fontan catheterization combined with cardiac magnetic resonance imaging. A retrospective review of patients undergoing pre-Fontan catheterization from 10/2018 to 04/2022 at Texas Children’s Hospital was performed. Patients were divided into 2 groups: combined cardiac magnetic resonance imaging and catheterization (combined group) and those who underwent catheterization only (catheterization only group). There were 37 patients in the combined group and 40 in the catheterization only group. Both groups were similar in age and weight. Patients undergoing combined procedures received less contrast, and experienced less in-lab time, fluoroscopy time and catheterization procedure time. Median radiation exposure was lower in the combined procedure group but was not statistically significant. Intubation and total anesthesia times were higher in the combined procedure group. Patients undergoing a combined procedure were less likely to have collateral occlusion performed than in the catheterization only group. Bypass time, intensive care unit length of stay, and chest tube duration were similar in both groups at the time of Fontan completion. Combined pre-Fontan assessment decreases catheterization procedure and fluoroscopy time associated with cardiac catheterization at the expense of longer anesthetic times, and results in similar Fontan outcomes compared to when cardiac catheterization alone is utilized.

PMID:37210685 | DOI:10.1007/s00246-023-03178-x

Andrology. 2023 May 21. doi: 10.1111/andr.13463. Online ahead of print.

ABSTRACT

BACKGROUND: Cryptorchidism is considered to be one of the most common causes of non-obstructive azoospermia. There are several surgical techniques to retrieve sperm in these patients. Microdissection testicular sperm extraction (m-TESE) is a recent sperm retrieval technique which is considered to be a safe, non-blind, and feasible method.

OBJECTIVES: This study aimed to investigate sperm retrieval rate by mTESE method in patients who have undergone orchidopexy due to bilateral cryptorchidism.

MATERIALS AND METHODS: In this retrospective study, 56 ex-cryptorchid patients who underwent mTESE due to post orchidopexy azoospermia, were included. Patients with hypogonadotropic hypogonadism, Klinefelter syndrome, azoospermia factors (AZF) microdeletion, or chromosomal translocation were excluded from the study. Data were obtained from medical files.

RESULTS: Sperm retrieval rate (SRR) in this study was 46%. Patients were divided into two groups of negative (n = 30) and positive (n = 26) based on the sperm extraction outcomes. There was no statistically significant difference between two groups regarding the mean age at mTESE, mean age at orchidopexy, testicular size, and serum testosterone concentration. However, testicular location, histological patterns, FSH, and LH level showed to have statistically significant relation with sperm retrieval results. But, according to our logistic regression, none of the included variable in the model including FSH, LH, Histopathology, and Testis location have a significant effect on the presence of the sperm.

DISCUSSION: In the present study, SRR was significantly higher in patients with scrotal testis and low level of FSH and LH.

CONCLUSIONS: Performing mTESE could be recommended in ex-cryptorchid patients with post orchidopexy NOA. Preoperative testicular biopsy seems to be unnecessary while clinical criteria can perfectly define NOA. This article is protected by copyright. All rights reserved.

PMID:37210678 | DOI:10.1111/andr.13463