Nevin Manimala

Spine (Phila Pa 1976). 2023 Mar 13. doi: 10.1097/BRS.0000000000004619. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective review of prospectively collected multi-surgeon data.

OBJECTIVE: Examine the rate, clinical impact, predictors of subsidence after expandable MI-TLIF cage.

SUMMARY OF BACKGROUND DATA: Expandable cage technology has been adopted in minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) to reduce the risks and optimize outcomes. Although subsidence is of particular concern when using expandable technology as force required to expand the cage can weaken the endplates, its rates, predictors, and outcomes lack evidence.

METHODS: Patients who underwent 1 or 2 level MI-TLIF using expandable cages for degenerative lumbar conditions and had a follow-up of>1 year were included. Preop and immediate, early, and late postoperative radiographs were reviewed. Subsidence was determined if the average anterior/posterior disc height decreased by>25% compared to the immediate postoperative value. Patient reported outcomes were collected and analyzed for differences at the early (<6 mo) and late (>6 mo) timepoints. Fusion was assessed by 1-year postop CT.

RESULTS: 148 patients were included (mean age 61 y, 86% 1-level, 14% 2-level). 22 (14.9%) demonstrated subsidence. Although statistically not significant, patients with subsidence were older, lower bone mineral density, and had higher BMI and comorbidity burden. Operative time was significantly higher (P=0.02) and implant width was lower (P<0.01) for subsided patients. VAS-Leg was significantly lower for subsided patients compared to non-subsided patients at a>6 m time point. Long-term (> 6m) patient acceptable symptom state (PASS) achievement rate was lower for subsided patients (53% vs. 77%), although statistically not significant (P=0.065). No differences existed in complication, reoperation, or fusion rates.

CONCLUSIONS: 14.9% of patients experienced subsidence predicted by narrower implants. Although subsidence did not have a significant impact on most PROMs and complication, reoperation, or fusion rates, patients had lower VAS-Leg and PASS achievement rate at the>6-month timepoint.

LEVEL OF EVIDENCE: 4.

PMID:36940252 | DOI:10.1097/BRS.0000000000004619

PLoS One. 2023 Mar 20;18(3):e0282946. doi: 10.1371/journal.pone.0282946. eCollection 2023.

ABSTRACT

AIMS AND OBJECTIVES: Studies have shown that the COVID-19 pandemic has taken a toll on individuals who interact with patients with SARS-CoV-2 but focused largely on clinicians in acute care settings. This qualitative descriptive study aimed to understand the experiences and well-being of essential workers across settings during the pandemic.

BACKGROUND: Multiple studies of the well-being of individuals who have cared for patients during the pandemic have included interviews of clinicians from acute care settings and revealed high levels of stress. However, other essential workers have not been included in most of those studies, yet they may also experience stress.

METHODS: Individuals who participated in an online study of anxiety, depression, traumatic distress, and insomnia, were invited to provide a free-text comment if they had anything to add. A total of 2,762 essential workers (e.g., nurses, physicians, chaplains, respiratory therapists, emergency medical technicians, housekeeping, and food service staff, etc.) participated in the study with 1,079 (39%) providing text responses. Thematic analysis was used to analyze those responses.

RESULTS: Four themes with eight sub-themes were: Facing hopelessness, yet looking for hope; Witnessing frequent death; Experiencing disillusionment and disruption within the healthcare system, and Escalating emotional and physical health problems.

CONCLUSIONS: The study revealed major psychological and physical stress among essential workers. Understanding highly stressful experiences during the pandemic is essential to identify strategies that ameliorate stress and prevent its negative consequences. This study adds to the research on the psychological and physical impact of the pandemic on workers, including non-clinical support personnel often overlooked as experiencing major negative effects.

RELEVANCE TO CLINICAL PRACTICE: The magnitude of stress among all levels of essential workers suggests the need to develop strategies to prevent or alleviate stress across disciplines and all categories of workers.

PMID:36940223 | DOI:10.1371/journal.pone.0282946

PLoS One. 2023 Mar 20;18(3):e0283329. doi: 10.1371/journal.pone.0283329. eCollection 2023.

ABSTRACT

BACKGROUND: Social anxiety disorder (SAD) is prevalent among children and adolescents. Cognitive-behavioural therapy (CBT) has been used as the first-line treatment. However, evaluation of CBT conducted in a school setting has been scarce.

OBJECTIVES: This study aims to review the CBT and its effectiveness in the school setting for children and adolescents with SAD or social anxiety symptoms. Quality assessment on individual studies was conducted.

METHODS: Studies were identified through the search in PsycINFO, ERIC, PubMed and Medline targeting CBT conducted in a school setting with an aim to treat children and adolescents with SAD or social anxiety symptoms. Randomised controlled trials and quasi-experimental studies were selected.

RESULTS: A total of 7 studies met the inclusion criteria. Five studies were randomised controlled trials, and two were quasi-experimental studies with 2558 participants aged 6-16 years from 138 primary schools and 20 secondary schools. There were minor effects to reduce social anxiety symptoms for children and adolescents at post-intervention in 86% of the selected studies. Friend for Life (FRIENDS), Super Skills for Life (SSL) and Skills for Academic and Social Success (SASS) conducted in school were more effective than the control conditions.

CONCLUSIONS: There is a lack of quality of the evidence for FRIENDS, SSL and SASS, due to inconsistencies on the outcome assessments, statistical analyses, and the fidelity measures adopted in individual studies. Insufficient school funding and workforce with relevant health background, and the low level of parental involvement in the intervention would be the major challenges in school-based CBT for children and adolescents with SAD or social anxiety symptoms.

PMID:36940221 | DOI:10.1371/journal.pone.0283329

PLoS Pathog. 2023 Mar 20;19(3):e1011230. doi: 10.1371/journal.ppat.1011230. Online ahead of print.

ABSTRACT

In Brazil, Leishmania braziliensis is the main causative agent of the neglected tropical disease, cutaneous leishmaniasis (CL). CL presents on a spectrum of disease severity with a high rate of treatment failure. Yet the parasite factors that contribute to disease presentation and treatment outcome are not well understood, in part because successfully isolating and culturing parasites from patient lesions remains a major technical challenge. Here we describe the development of selective whole genome amplification (SWGA) for Leishmania and show that this method enables culture-independent analysis of parasite genomes obtained directly from primary patient skin samples, allowing us to circumvent artifacts associated with adaptation to culture. We show that SWGA can be applied to multiple Leishmania species residing in different host species, suggesting that this method is broadly useful in both experimental infection models and clinical studies. SWGA carried out directly on skin biopsies collected from patients in Corte de Pedra, Bahia, Brazil, showed extensive genomic diversity. Finally, as a proof-of-concept, we demonstrated that SWGA data can be integrated with published whole genome data from cultured parasite isolates to identify variants unique to specific geographic regions in Brazil where treatment failure rates are known to be high. SWGA provides a relatively simple method to generate Leishmania genomes directly from patient samples, unlocking the potential to link parasite genetics with host clinical phenotypes.

PMID:36940219 | DOI:10.1371/journal.ppat.1011230

J Phys Chem B. 2023 Mar 20. doi: 10.1021/acs.jpcb.2c08631. Online ahead of print.

ABSTRACT

The adenine-thymine tautomer (A*-T*) has previously been discounted as a spontaneous mutagenesis mechanism due to the energetic instability of the tautomeric configuration. We study the stability of A*-T* while the nucleobases undergo DNA strand separation. Our calculations indicate an increase in the stability of A*-T* as the DNA strands unzip and the hydrogen bonds between the bases stretch. Molecular Dynamics simulations reveal the time scales and dynamics of DNA strand separation and the statistical ensemble of opening angles present in a biological environment. Our results demonstrate that the unwinding of DNA, an inherently out-of-equilibrium process facilitated by helicase, will change the energy landscape of the adenine-thymine tautomerization reaction. We propose that DNA strand separation allows the stable tautomerization of adenine-thymine, providing a feasible pathway for genetic point mutations via proton transfer between the A-T bases.

PMID:36939840 | DOI:10.1021/acs.jpcb.2c08631

Birth. 2023 Mar 20. doi: 10.1111/birt.12718. Online ahead of print.

ABSTRACT

BACKGROUND: Cesarean birth (CB) rates have increased over recent years with concerns over differences between these rates in migrant communities compared with the rates among women in their receiving country. This review aimed at summarizing the available literature regarding the incidence of CB among migrants in Europe.

METHODS: A systematic search of four electronic databases was carried out, including CINAHL, MEDLINE, Scopus, and Maternity and Infant Care. Identified studies were screened and their quality assessed. Meta-analysis was undertaken using Rev Man 5.4 where sufficient data were available. Otherwise, data were synthesized narratively.

RESULTS: From the 435 records identified in searches, 21 papers were included. Analysis shows that overall CB rates were significantly lower for Syrian refugee women compared with women in their receiving country (Turkey) and higher for Iranian migrants than women in their host country. Emergency CB rates were significantly higher for migrant women from “Sub Saharan Africa” and the “South East Asia, Asia and Pacific” region than rates in the receiving country. Statistical significance was not found between other populations.

CONCLUSIONS: This review highlights differences between CB rates in certain migrant groups in comparison with women native to their host country, which merits further investigation for potential explanations. We also identified a need to standardize definitions and population groupings to enable more meaningful analysis. This review also highlights a substantial lack of data on CB rates between different population groups that could negatively impact the provision of care.

PMID:36939837 | DOI:10.1111/birt.12718

J Med Internet Res. 2023 Mar 20;25:e42896. doi: 10.2196/42896.

ABSTRACT

BACKGROUND: In recent years, more and more studies have shown that internet-based health management can help patients with hypertension control their blood pressure. However, there is a lack of similar research in China.

OBJECTIVE: We designed this study to clarify the impact of long-term internet-based health management on the control of clinical parameters in patients with hypertension. These results are also expected to identify the relevant factors affecting the control of clinical parameters in hypertension more accurately toward developing more targeted health management strategies.

METHODS: This was a longitudinal study of internet-based health management in the five provinces of northwest China. The inclusion criteria were aged ≥18 years and no serious cognitive disease or mental disorder. After collecting the physical examination data of 8567 people in the five northwest provinces in 2013, we conducted online health management (including diet, exercise, and behavior) and follow-up. In the physical examination in 2013, 1008 new patients with hypertension were identified, who were divided into a good blood pressure control group and poor blood pressure control group. Physical examination and a questionnaire survey were conducted every 2 years to understand the changes of health management on the subjects’ health-related behaviors. We then analyzed the changes of clinical indicators related to hypertension and the influencing factors related to blood pressure control in patients with hypertension. All statistical analyses were performed using R software (version 4.1.2) and a P value <.05 was considered statistically significant.

RESULTS: A total of 8567 people met the inclusion criteria and underwent health management. Self-comparison showed that after 4 years of health management, the smoking cessation rate and amount of exercise significantly increased (both P<.001). The low-density lipoprotein-cholesterol levels also increased (P=.005), whereas the high-density lipoprotein-cholesterol levels decreased (P=.007). The newly discovered patients with hypertension in 2013 were further screened. After 4 years of health management, their smoking cessation rate increased significantly (P=.03) and the amount of exercise increased but not significantly (P=.08). In terms of clinical indicators, the diastolic blood pressure considerably decreased (P<.001) and the systolic blood pressure slightly decreased (P=.13). The correlation analysis of blood pressure control in patients with new-onset hypertension showed that gender (female) and changing relevant factors according to health management behaviors (BMI; cereals and potatoes intake; fish, livestock meat, and eggs intake; fruit intake; and physical activity) were the protective factors of blood pressure control.

CONCLUSIONS: Internet-based health management has a significant and long-term effect on blood pressure control in patients with hypertension.

PMID:36939826 | DOI:10.2196/42896

Somatosens Mot Res. 2023 Mar 20:1-7. doi: 10.1080/08990220.2023.2188931. Online ahead of print.

ABSTRACT

PURPOSE/AIM: This study aimed to investigate the predictors of temporomandibular disorders (TMD) in desk-bound engineers.

MATERIALS AND METHODS: The Fonseca Anamnestic Index (FAI), The Visual Analogue Scale (VAS), The Neck Pain and Disability Scale (NPDS), Neck Bournemouth Questionnaire (NBQ) and The Fremantle Neck Awareness Questionnaire-Turkish (FreNAQ-T) were used for TMD severity, pain, disability, neck awareness.

RESULTS: The study was conducted with 208 desk-bound engineers. Mild-to-severe TMD was detected in 78.9% of the subjects. Intensity of pain at rest and during activity was higher in female engineers compared to male engineers (p = 0.002 and <0.01, respectively) and mean FAI, NBQ, NPDS and FreNAQ-T scores were also higher than that of male engineers (p = 0.005, 0.005, 0.006 and 0.016, respectively). FAI, VAS, NPDS, NBQ and FreNAQ-T were found to be correlated with each other (p < 0.05). A statistically significant contribution to the regression model was observed for the variables gender, daily duration of computer use, neck pain at rest, and NBQ (p = 0.043, p = 0.043, p = 0.031 and p = 0.003, respectively). NBQ was identified as the most influential variable in this model, followed by neck pain at rest.

CONCLUSIONS: Temporomandibular disorders are common among desk-bound engineers and are associated with neck pain, disability, and neck awareness. For this reason, it is important to take preventive and protective ergonomic approaches at the personal and institutional levels in desk-bound engineers.

PMID:36939816 | DOI:10.1080/08990220.2023.2188931

JMIR Med Educ. 2023 Mar 20;9:e42639. doi: 10.2196/42639.

ABSTRACT

BACKGROUND: The potential for digital health technologies, including machine learning (ML)-enabled tools, to disrupt the medical profession is the subject of ongoing debate within biomedical informatics.

OBJECTIVE: We aimed to describe the opinions of final-year medical students in Ireland regarding the potential of future technology to replace or work alongside general practitioners (GPs) in performing key tasks.

METHODS: Between March 2019 and April 2020, using a convenience sample, we conducted a mixed methods paper-based survey of final-year medical students. The survey was administered at 4 out of 7 medical schools in Ireland across each of the 4 provinces in the country. Quantitative data were analyzed using descriptive statistics and nonparametric tests. We used thematic content analysis to investigate free-text responses.

RESULTS: In total, 43.1% (252/585) of the final-year students at 3 medical schools responded, and data collection at 1 medical school was terminated due to disruptions associated with the COVID-19 pandemic. With regard to forecasting the potential impact of artificial intelligence (AI)/ML on primary care 25 years from now, around half (127/246, 51.6%) of all surveyed students believed the work of GPs will change minimally or not at all. Notably, students who did not intend to enter primary care predicted that AI/ML will have a great impact on the work of GPs.

CONCLUSIONS: We caution that without a firm curricular foundation on advances in AI/ML, students may rely on extreme perspectives involving self-preserving optimism biases that demote the impact of advances in technology on primary care on the one hand and technohype on the other. Ultimately, these biases may lead to negative consequences in health care. Improvements in medical education could help prepare tomorrow’s doctors to optimize and lead the ethical and evidence-based implementation of AI/ML-enabled tools in medicine for enhancing the care of tomorrow’s patients.

PMID:36939809 | DOI:10.2196/42639

Phenomics. 2022 Sep 29;2(6):430-437. doi: 10.1007/s43657-022-00072-z. eCollection 2022 Dec.

ABSTRACT

Owing to the susceptibility of conventional observational studies to confounding factors and reverse causation, the causal association between cardiac function and frailty is unclear. We aimed to investigate whether cardiac function has causal effects on frailty. In this study, a two-sample Mendelian randomization (MR) study was conducted using genetic variants associated with cardiac function assessed by magnetic resonance imaging phenotypes as instrumental variables. Genetic variants associated with cardiac function by magnetic resonance imaging (including seven cardiac function phenotypes) and the frailty index (FI) were obtained from two large genome-wide association studies. MR estimates from each genetic instrument were combined using inverse variance weighted (IVW), weighted median, and MR‒Egger regression methods. We found that the increase in genetically determined stroke volume (beta – 0.13, 95% CI – 0.16 to – 0.10, p = 1.39E-6), rather than other cardiac phenotypes, was associated with lower FI in MR analysis of IVW after Bonferroni correction. Sensitivity analyses examining potential bias caused by pleiotropy or reverse causality revealed similar findings (e.g., intercept [SE], – 0.008 [0.011], p = 0.47 by MR‒Egger intercept test). The leave-one-out analysis indicated that the association was not driven by single nucleotide polymorphisms. No evidence of heterogeneity was found among the genetic variants (e.g., MR‒Egger: Q statistic = 14.4, p = 0.156). In conclusion, we provided evidence that improved cardiac function could contribute to reducing FI. These findings support the hypothesis that enhancing cardiac function could be an effective prevention strategy for frailty.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s43657-022-00072-z.

PMID:36939795 | PMC:PMC9712899 | DOI:10.1007/s43657-022-00072-z