Nevin Manimala

P R Health Sci J. 2023 Mar;42(1):3-9.

ABSTRACT

OBJECTIVE: The mortality rate of schizophrenia patients is higher than that of the general population; cardiovascular disease (CVD) is their leading cause of death. This issue must be studied since people with schizophrenia are disproportionately burdened with CVD. Therefore, our goal was to identify the prevalence of CVD and other comorbidities, stratified by age and gender, in patients with schizophrenia living in Puerto Rico.

METHODS: A retrospective, case-control, descriptive study was conducted. Subjects in this study were admitted to Dr. Federico Trilla’s hospital from 2004 through 2014 for both psychiatric- and non psychiatric conditions. The sample populations were stratified by the confounding variables of tobacco use and alcohol abuse, and the resulting stratification was analyzed with the Cochran-Mantel-Haenszel method.

RESULTS: A higher frequency of CVDs was noted in the patients with schizophrenia compared to those in the control group. Although hypertension was the most frequent pathology encountered in both groups, ischemic heart disease was approximately four times more frequent in the patients with schizophrenia. CVD represented 58.4% and 52.7% in the schizophrenia and non-schizophrenia groups, respectively, although a statistically significant difference was not observed. The prevalence of malignancies in patients without schizophrenia was higher than in patients with schizophrenia. Moreover, the prevalence of asthma was 10.9% in the control group compared to 5.3% in the schizophrenia group.

CONCLUSION: These findings should motivate a systematic approach to prioritizing the aggressive management, early diagnosis, and prevention of comorbid risk factors in patients with schizophrenia.

PMID:36941092

Neuropsychopharmacol Rep. 2023 Mar 20. doi: 10.1002/npr2.12327. Online ahead of print.

ABSTRACT

INTRODUCTION: Selective serotonin reuptake inhibitors are considered the drugs, whose effectiveness in viral pandemics has been studied. The aim of this study was to evaluate of adding fluoxetine to the treatment regimen of patients with COVID-19 pneumonia.

METHODS: This study was a double-blind randomized placebo controlled clinical trial .36 patients in the fluoxetine and 36 patients in the placebo group were enrolled. Patients in the intervention group were first treated with fluoxetine 10 mg for 4 days and then the dose of 20 mg was continued for 4 weeks. Data analysis was conducted using SPSS V. 22.0.

RESULTS: There was no statistically significant difference between the two groups in terms of clinical symptoms at the beginning of the study and also the score of anxiety and depression, oxygen saturation at the time of hospitalization, mid-hospitalization and discharge periods. The need for mechanical ventilator support (p = 1.00), the need for admission in the intensive care unit (ICU) (p = 1.00), rate for mortality (p = 1.00), and discharge with relative recovery (p = 1.00) were not significantly different between the two groups. The distribution of CRP within the study groups showed a significant decrease during different time periods (p = 0.001), and although there was no statistically significant difference between the two groups on the first day (p = 1.00) and at discharge (p = 0.585), mid-hospital CRP showed a significant decrease in the fluoxetine group (p = 0.032).

CONCLUSION: Fluoxetine resulted in a faster reduction of patients’ inflammation without association with depression and anxiety.

PMID:36941089 | DOI:10.1002/npr2.12327

Neurology. 2023 Mar 20:10.1212/WNL.0000000000207200. doi: 10.1212/WNL.0000000000207200. Online ahead of print.

ABSTRACT

ObjectiveTo analyze the prevalence and associated clinical characteristics of apathy in sporadic cerebral amyloid angiopathy and investigate whether apathy was associated with disease burden and disconnections of key structures in the reward circuit through a structural and functional multi-modal neuroimaging approach.MethodsThirty-seven probable sporadic cerebral amyloid angiopathy participants without symptomatic intracranial hemorrhage or dementia (mean age, 73.3 ± 7.2, % male = 59.5%) underwent a detailed neuropsychological evaluation, including measures of apathy and depression, and a multimodal MR neuroimaging study. A multiple linear regression analysis was used to assess the association of apathy with conventional small vessel disease neuroimaging markers. A voxel-based morphometry with a small volume correction within regions previously associated with apathy and a whole-brain tract-based spatial statistics were done to identify differences in the gray matter and white matter between the apathetic and the non-apathetic groups. Gray matter regions significantly associated with apathy were further evaluated for their functional alterations as seeds in the seed-based resting-state functional connectivity analysis. Potential confounders, namely, age, gender, and measures of depression were entered as covariates in all analyses.ResultsA higher composite small vessel disease marker score (CAA-SVD) was associated with a higher degree of apathy (standardized coefficient = 1.35 (0.07 – 2.62), adjusted R² = 27.90, p = 0.04). Lower gray matter volume of the bilateral orbitofrontal cortices was observed in the apathetic group than the non-apathetic group (F = 13.20, family-wise error corrected p = 0.028). The apathetic group demonstrated a widespread decrease in white matter microstructural integrity compared to the non-apathetic group. These tracts connect key regions within and between related reward circuits. Finally, there was no significant functional alterations between the apathetic and the non-apathetic groups.ConclusionsOur findings revealed the orbitofrontal cortex as a key region in the reward circuit associated with apathy in sporadic cerebral amyloid angiopathy, independent from depression. Apathy was shown to be associated with a higher CAA-SVD score and an extensive disruption of white matter tracts, which suggested that a higher burden of CAA pathology and the disruption in large-scale white matter networks may underlie manifestations of apathy.

PMID:36941070 | DOI:10.1212/WNL.0000000000207200

Comp Med. 2023 Mar 20. doi: 10.30802/AALAS-CM-22-000018. Online ahead of print.

ABSTRACT

Methicillin-resistant Staphylococcus aureus (MRSA) remains a significant problem for human and animal health and can negatively affect the health status of macaques and other nonhuman primates (NHP) in research colonies. However, few publications provide guidance on the prevalence, genotype, or risk factors for macaques with MRSA and even fewer on how to effectively respond to MRSA once identified in a population. After having a clinical case of MRSA in a rhesus macaque, we sought to determine the MRSA carrier prevalence, risk factors, and genotypes of MRSA in a population of research NHPs. Over a 6-wk period in 2015, we collected nasal swabs from 298 NHPs. MRSA was isolated from 28% (n = 83). We then reviewed each macaque’s medical record for a variety of variables including animal housing room, sex, age, number of antibiotic courses, number of surgical interventions, and SIV status. Analysis of these data suggests that MRSA carriage is associated with the room location, age of the animal, SIV status, and the number of antibiotic courses. We used multilocus sequence typing and spa typing on a subset of MRSA and MSSA isolates to determine whether the MRSA present in NHPs was comparable with common human strains. Two MRSA sequence types were predominant: ST188 and a novel MRSA genotype, neither of which is a common human isolate in the United States. We subsequently implemented antimicrobial stewardship practices (significantly reducing antimicrobial use) and then resampled the colony in 2018 and found that MRSA carriage had fallen to 9% (26/285). These data suggest that, as in humans, macaques may have a high carrier status of MRSA despite low clinically apparent disease. Implementing strategic antimicrobial stewardship practices resulted in a marked reduction in MRSA carriage in the NHP colony, highlighting the importance of limiting antimicrobial use when possible.

PMID:36941053 | DOI:10.30802/AALAS-CM-22-000018

Ann Intern Med. 2023 Mar 21. doi: 10.7326/M22-3350. Online ahead of print.

ABSTRACT

BACKGROUND: Patients hospitalized with COVID-19 have an increased incidence of thromboembolism. The role of extended thromboprophylaxis after hospital discharge is unclear.

OBJECTIVE: To determine whether anticoagulation is superior to placebo in reducing death and thromboembolic complications among patients discharged after COVID-19 hospitalization.

DESIGN: Prospective, randomized, double-blind, placebo-controlled clinical trial. (ClinicalTrials.gov: NCT04650087).

SETTING: Done during 2021 to 2022 among 127 U.S. hospitals.

PARTICIPANTS: Adults aged 18 years or older hospitalized with COVID-19 for 48 hours or more and ready for discharge, excluding those with a requirement for, or contraindication to, anticoagulation.

INTERVENTION: 2.5 mg of apixaban versus placebo twice daily for 30 days.

MEASUREMENTS: The primary efficacy end point was a 30-day composite of death, arterial thromboembolism, and venous thromboembolism. The primary safety end points were 30-day major bleeding and clinically relevant nonmajor bleeding.

RESULTS: Enrollment was terminated early, after 1217 participants were randomly assigned, because of a lower than anticipated event rate and a declining rate of COVID-19 hospitalizations. Median age was 54 years, 50.4% were women, 26.5% were Black, and 16.7% were Hispanic; 30.7% had a World Health Organization severity score of 5 or greater, and 11.0% had an International Medical Prevention Registry on Venous Thromboembolism risk prediction score of greater than 4. Incidence of the primary end point was 2.13% (95% CI, 1.14 to 3.62) in the apixaban group and 2.31% (CI, 1.27 to 3.84) in the placebo group. Major bleeding occurred in 2 (0.4%) and 1 (0.2%) and clinically relevant nonmajor bleeding occurred in 3 (0.6%) and 6 (1.1%) apixaban-treated and placebo-treated participants, respectively. By day 30, thirty-six (3.0%) participants were lost to follow-up, and 8.5% of apixaban and 11.9% of placebo participants permanently discontinued the study drug treatment.

LIMITATIONS: The introduction of SARS-CoV-2 vaccines decreased the risk for hospitalization and death. Study enrollment spanned the peaks of the Delta and Omicron variants in the United States, which influenced illness severity.

CONCLUSION: The incidence of death or thromboembolism was low in this cohort of patients discharged after hospitalization with COVID-19. Because of early enrollment termination, the results were imprecise and the study was inconclusive.

PRIMARY FUNDING SOURCE: National Institutes of Health.

PMID:36940444 | DOI:10.7326/M22-3350

Am J Gastroenterol. 2023 Mar 20. doi: 10.14309/ajg.0000000000002252. Online ahead of print.

ABSTRACT

OBJECTIVES: There is a need for evidence-based counseling for women with chronic liver disease (LD) who may experience impaired fertility. Currently, the literature on assisted reproductive technology (ART) treatment in women with LD has been limited to a single European case series. We evaluated ART treatment outcomes in LD patients and compared to controls.

METHODS: The retrospective study evaluated women with and without LD who had normal ovarian reserve and underwent ART treatment in a high-volume fertility practice from 2002 to 2021.

RESULTS: We identified 295 women with LD (mean age 37.8 ± 5.2 years) who underwent 1,033 ART treatment cycles; of these women, 115 underwent 186 in vitro fertilization (IVF) cycles. Six (2.0%) women had cirrhosis, eight (2.7%) were post-liver transplantation and 281 (95.3%) had chronic LD, with viral hepatitis (B and C) being the most prevalent. In the subgroup who underwent IVF and embryo biopsy, the median FIB-4 score was 0.81 (0.58, 1.03), and there were no statistically significant differences in response to controlled ovarian stimulation, embryo fertilization rate or ploidy outcome in LD patients compared to controls. In those who subsequently underwent a single thawed euploid embryo transfer to achieve pregnancy, there were no statistically significant differences in rates of clinical pregnancy, clinical pregnancy loss or live birth in LD patients compared to controls.

CONCLUSIONS: To our knowledge, this study is the largest to date to evaluate IVF efficacy in women with LD. Our study demonstrates that patients with LD have similar ART treatment outcomes compared to those without LD.

PMID:36940434 | DOI:10.14309/ajg.0000000000002252

Am J Gastroenterol. 2023 Mar 20. doi: 10.14309/ajg.0000000000002250. Online ahead of print.

ABSTRACT

OBJECTIVES: We examined the relationship between a prior history of gestational diabetes mellitus (pGDM) and risk of incident nonalcoholic fatty liver disease (NAFLD) and investigated the effect of insulin resistance or development of diabetes as mediators of any association.

METHODS: We performed a retrospective cohort study of 64,397 Korean parous women without NAFLD. The presence of, and the severity of NAFLD at baseline and follow-up were assessed using liver ultrasonography. Cox proportional hazards models were used to determine adjusted hazard ratios (aHRs) for incident NAFLD according to a self-reported GDM history, adjusting for confounders as time-dependent variables. Mediation analyses were performed to examine whether diabetes or insulin resistance may mediate the association between pGDM and incident NAFLD.

RESULTS: During a median follow-up of 3.7 years, 6,032 women developed incident NAFLD (of whom 343 had moderate-to-severe NAFLD). Multivariable aHRs (95% confidence intervals) comparing women with time-dependent pGDM to the reference group (no pGDM) was 1.46 (1.33-1.59) and 1.75 (1.25-2.44) for incident overall NAFLD and moderate-to-severe NAFLD, respectively. These associations remained significant in analyses restricted to women with normal fasting glucose <100 mg/dl or that excluded women with prevalent diabetes at baseline or incident diabetes during follow-up. Diabetes and insulin resistance (HOMA-IR) each mediated <10% of the association between pGDM and overall NAFLD development.

CONCLUSIONS: A prior history of GDM is an independent risk factor for NAFLD development. Insulin resistance, measured by HOMA-IR, and development of diabetes each explained only <10% of the association between GDM and incident NAFLD.

PMID:36940424 | DOI:10.14309/ajg.0000000000002250

Am J Gastroenterol. 2023 Mar 20. doi: 10.14309/ajg.0000000000002258. Online ahead of print.

ABSTRACT

IntroductionIntrahepatic cholangiocarcinoma (iCCA) is a primary liver malignancy with poor prognosis. Current prognostic methods are most accurate for patients with surgically-resectable disease. However, a significant proportion of patients with iCCA are not surgical candidates. We aimed to develop a generalizable staging system based on clinical variables to determine prognosis of all iCCA patients.MethodsThe derivation cohort included 436 patients with iCCA seen between 2000 and 2011. For external validation, 249 patients with iCCA seen from 2000 to 2014 were enrolled. Survival analysis was performed to identify prognostic predictors. All-cause mortality was the primary end-point.ResultsEastern Cooperative Oncology Group (ECOG) status, tumor number, tumor size, metastasis, albumin, and CA 19-9 were incorporated into a 4-stage algorithm. Kaplan Meier estimates for 1-year survival were 87.1% (95%CI 76.1-99.7), 72.7% (95%CI 63.4-83.4), 48.0% (95%CI 41.2-56.0) and 16% (95%CI 11-23.5), respectively for stages I, II, III, and IV. Univariate analysis yielded significant differences in risk of death for stages II (HR:1.71; 95%CI 1.0-2.8), III (HR:3.32; 95%CI 2.07-5.31), and IV (HR:7.44; 95%CI 4.61-12.01) compared to stage I (reference). Concordance indices showed the new staging system was superior to the TNM staging for predicting mortality in the derivation cohort, p-value <0.0001. In the validation cohort however, the difference between the 2 staging systems was not significant.DiscussionThe proposed independently-validated staging system uses non-histopathologic data to successfully stratify patients into four stages. This staging system has better prognostic accuracy compared to the TNM staging and can assist physicians and patients in treatment of iCCA.

PMID:36940423 | DOI:10.14309/ajg.0000000000002258

J Osteopath Med. 2023 Mar 21. doi: 10.1515/jom-2021-0102. Online ahead of print.

ABSTRACT

CONTEXT: The language proficiencies of Michigan State University College of Osteopathic Medicine (MSUCOM) medical students are unknown. As of 2015, approximately 8% (or roughly 25 million) of the US population over the age of five were considered “limited English proficient”. Research indicates, however, that it is valuable to patients to be able to communicate in their primary language with their primary care physician. If medical students’ language proficiencies were known, the medical school curriculum could be adapted to leverage or enhance a student’s language proficiencies, preparing students to serve in communities where their patients language proficiencies align.

OBJECTIVES: The aim of this pilot study was to survey MSUCOM medical students in order to assess their language proficiencies with two goals in mind: first, to develop medical school curriculum that would leverage student’s language proficiencies, and second, to encourage student placement within diverse communities throughout the state of Michigan where these physicians-in-training speak or understand the primary language of the local community to better serve patients.

METHODS: For this cross-sectional descriptive pilot study, a short, author-created survey was sent to 1,226 osteopathic medical students (OMS-I to OMS-IV) at MSUCOM. Participants were asked questions pertaining to language proficiency, number of languages spoken, prior exposure to education abroad, and demographic information. All participant data were only reported in grouped, collective, de-identified terms. Descriptive statistical analyses (frequencies, percentages) were calculated utilizing SPSS Version 25 software.

RESULTS: Over the course of several months, 698 (58.7%) current MSUCOM medical students participated in the study. Of those students, 382 (54.7%) responded that they were multilingual. The top three second languages reported spoken were: English 332 (47.6%), Spanish 169 (24.2%), and Arabic 64 (9.2%). In addition, 249 (37.2%) said they had prior exposure to education abroad, and 177 (26.4%) said they had lived in another country for more than 6 months.

CONCLUSIONS: The majority, 382 (54.7%), of the MSUCOM students who participated in the survey have some degree of multilingual capabilities. The student population at MSUCOM may benefit from completing primary care rotations in diverse communities within the state of Michigan. Likewise, the communities throughout Michigan may benefit from having bilingual and multilingual medical students serve in their medical facilities. Further research on the efficacy of leveraging language skills in various communities, as well as broadening the population sample, is warranted to refine and validate the observed pilot study results.

PMID:36940418 | DOI:10.1515/jom-2021-0102

Acad Med. 2023 Mar 17. doi: 10.1097/ACM.0000000000005212. Online ahead of print.

ABSTRACT

Translational research is a data-driven process that involves transforming scientific laboratory- and clinic-based discoveries into products and activities with real-world impact to improve individual and population health. Successful execution of translational research requires collaboration between clinical and translational science researchers, who have expertise in a wide variety of domains across the field of medicine, and qualitative and quantitative scientists, who have specialized methodologic expertise across diverse methodologic domains. While many institutions are working to build networks of these specialists, a formalized process is needed to help researchers navigate the network to find the best match and to track the navigation process to evaluate an institution’s unmet collaborative needs. In 2018, a novel analytic resource navigation process was developed at Duke University to connect potential collaborators, leverage resources, and foster a community of researchers and scientists. This analytic resource navigation process can be readily adopted by other academic medical centers. The process relies on navigators with broad qualitative and quantitative methodologic knowledge, strong communication and leadership skills, and extensive collaborative experience. The essential elements of the analytic resource navigation process are as follows: (1) strong institutional knowledge of methodologic expertise and access to analytic resources, (2) deep understanding of research needs and methodologic expertise, (3) education of researchers on the role of qualitative and quantitative scientists in the research project, and (4) ongoing evaluation of the analytic resource navigation process to inform improvements. Navigators help researchers determine the type of expertise needed, search the institution to find potential collaborators with that expertise, and document the process to evaluate unmet needs. Although the navigation process can create a basis for an effective solution, some challenges remain, such as having resources to train navigators, comprehensively identifying all potential collaborators, and keeping updated information about resources as methodologists join and leave the institution.

PMID:36940408 | DOI:10.1097/ACM.0000000000005212