Nevin Manimala

J Math Biol. 2023 Apr 13;86(5):74. doi: 10.1007/s00285-023-01885-w.

ABSTRACT

The transmission dynamics of HIV are closely tied to the duration and overlap of sexual partnerships. We develop an autonomous population model that can account for the possibilities of an infection from either a casual sexual partner or a long-term partner who was either infected at the start of the partnership or has been newly infected since the onset of the partnership. The impact of the long-term partnerships on the rate of infection is captured by calculating the expected values of the rate of infection from these extended contacts. The model includes three stages of infectiousness: acute, chronic, and virally suppressed. We calculate HIV incidence and the fraction of new infections attributed to casual contacts and long-term partnerships allowing for variability in condom usage, the effect of achieving and maintaining viral suppression, and early intervention by beginning HAART during the acute phase of infection. We present our results using data on MSM HIV transmission from the CDC in the U.S. While the acute stage is the most infectious, the majority of the new infections will be transmitted by long-term partners in the chronic stage when condom use is infrequent as is common in long-term relationships. Time series analysis of the solution, as well as parameter sensitivity analysis, are used to determine effective intervention strategies.

PMID:37052718 | DOI:10.1007/s00285-023-01885-w

Cardiovasc Intervent Radiol. 2023 Apr 13. doi: 10.1007/s00270-023-03425-x. Online ahead of print.

ABSTRACT

PURPOSE: Osteolytic metastatic lesions in the femoral head and neck are traditionally treated with intramedullary long nailing (IM) or hemiarthroplasty (HA). Recovery, surgical complications, and medical co-morbidities delay oncologic care. This study sought to elucidate the comparative efficacy of percutaneous ablation-osteoplasty-reinforcement-internal fixation (AORIF), IM, and HA in stabilizing osteolytic lesions in the femoral head and neck.

METHODS: A retrospective study of 67 patients who underwent IM, AORIF, or HA for osteolytic femoral head and neck lesions was performed. Primary outcome was assessed using a combined pain and ambulatory score (Range 1-10: 1 = bedbound, 10 = normal ambulation) at first follow-up (~ 2 weeks). Surgical complications associated with each treatment were compared.

RESULTS: Sixty-seven patients (mean age, 65 ± 13, 36 men and 31 women) underwent IM (40), AORIF (19), and HA (8) with a mean follow-up of 9 ± 11 months. Two patients in the IM group (5%), three in the AORIF group (16%), and none in the HA (0%) group required revision procedures. AORIF demonstrated superior early improvement in combined pain and ambulatory function scores by 3.0 points [IQR = 2.0] (IM p = 0.0008, HA p = 0.0190). Odds of post-operative complications was 10.3 times higher in HA than IM (95% confidence interval 1.8 to 60.3). Future revision procedures were not found to be statistically significant between AORIF and IM (p = 0.234).

CONCLUSIONS: A minimally invasive interventional skeletal procedure for focal femoral head and neck osteolytic lesions may serve as an effective alternative treatment to traditional surgical approaches, conferring a shorter recovery time and fewer medical complications.

PMID:37052716 | DOI:10.1007/s00270-023-03425-x

Eur J Orthop Surg Traumatol. 2023 Apr 13. doi: 10.1007/s00590-023-03553-7. Online ahead of print.

ABSTRACT

PURPOSE: It remains unknown if cephalomedullary nail (CMN) length has an impact on pain and opioid use following fixation. Given the lack of level I evidence favoring a specific CMN length to prevent adverse surgical outcomes, we investigated if CMN length impacts acute postoperative pain and opioid use. The authors hypothesize that the use of longer CMNs results in increased pain scores and morphine milligram equivalents (MME) intake during the 0-24 h (h) and 24-36 h postoperative period.

METHODS: A retrospective chart review was performed from 2010 to 2020 of patients ≥ 65 years-old who underwent CMN for IT fractures and fractures with subtrochanteric extension (STE). We compared patients who received short and long CMNs using numeric rating scale (NRS) pain scores and MME intake at 0-24 h and 24-36 h postoperatively.

RESULTS: 330 patients receiving short (n = 155) and long (n = 175) CMNs met criteria. CMN length was found to not be associated with higher pain scores in the early postoperative phase. However, patients with long CMNs received higher MME from 0-24 h (25.4% estimated mean increase, p value = 0.02) and 24-36 h (22.3% estimated mean increase, p value = 0.04) postoperatively, even after adjusting for covariates, gender, and age.

CONCLUSION: Patients with long CMNs received greater MME postoperatively. Additionally, differences in pain and MME were not significantly different between patients with and without STE, suggesting our findings were not influenced by this pattern. These results suggest longer CMNs are associated with higher acute postoperative opioid intake among patients with IT fractures.

LEVEL OF EVIDENCE: Therapeutic level III.

PMID:37052677 | DOI:10.1007/s00590-023-03553-7

Eur J Pediatr. 2023 Apr 13. doi: 10.1007/s00431-023-04918-0. Online ahead of print.

ABSTRACT

To examine the impact of pneumococcal conjugate vaccines (PCV) on the occurrence of recurrent acute otitis media (rAOM) among infants diagnosed with an early acute otitis media (AOM) episode. Retrospective cohort study of pediatric patients with a first episode of AOM at an age < 2 months. Data included clinical, demographic, and microbiological findings at the first AOM episode. In addition, a 5-year follow-up after the patient’s first episode was completed from the medical records. This information included documentation of rAOM episodes and complications of AOM (hearing loss, speech disturbance, mastoiditis, and tympanic membrane perforation) and of ear-related surgical procedures (ventilation tube placement, adenoidectomies, and mastoid surgery). Two groups were studied: patients diagnosed between 2005 and 2009 (representing the unvaccinated group, group 1) and those diagnosed in 2010-2014 (the vaccinated group, group 2). A total of 170 infants were diagnosed with a first AOM episode at an age < 2 months; 81 of them belonged to group 1 and 89 to group 2. Streptococcus pneumoniae was isolated in the middle-ear fluid in the first AOM episode in 48.1% of the patients in group 1 and in 30.3% in group 2 (P = 0.0316). 49/81 (60.5%) infants in group 1 were diagnosed with rAOM versus 39/80 (43.8%) in group 2 (P = 0.0298). No statistical differences were found between the groups with respect to long-term complications or need for surgery later in life. Conclusion: Our study showed a significant decrease in the occurrence of rAOM in infants diagnosed with AOM during the first 2 months of life and timely immunized with PCVs following this initial AOM episode. What is Known: • 30% of children experience recurrent AOM (rAOM) at the first year of life. The earlier the age of the first AOM, the greater the risk for future complications. • After the introduction of PCVs, the overall pneumococcal AOM incidence declined. We investigated the future effect of PCVs on rAOM occurrence, when administered after the first AOM episode. What is New: • A retrospective cohort of 170 infants with a first AOM episode at an age <2 months and followed for 5 years, showed a significant decrease (28.0%) of rAOM in immunized infants following the initial AOM episode. • Our findings supplement previous data suggesting that the widespread PCVs use prevents rAOM by preventing early AOM and emphasize the importance of timely administration of the PCVs.

PMID:37052673 | DOI:10.1007/s00431-023-04918-0

Clin Oral Investig. 2023 Apr 13. doi: 10.1007/s00784-023-04995-3. Online ahead of print.

ABSTRACT

BACKGROUND: The relationship between the anatomy of the interradicular space and success in regenerative therapy of furcation defects is discussed in this paper. The goal of this retrospective, multicenter clinical study is to clinically evaluate the relationship between the interradicular conformation and regenerative therapy success with the use of a novel measurement method.

METHODS: One hundred thirty-eight radiographs of mandibular molars with furcation defects that had been treated with regenerative therapy were collected from six clinical centers. Data on the type of therapy and clinical parameters before and after treatment (follow-up of at least 12 months) were collected. The radiographs (before surgery and at least 12 months postoperatively) were measured with a visual evaluation method by a blind operator using graphics software.

RESULTS: Success, defined as a reduction in horizontal and vertical furcation involvement, decrease in probing depths, and increase in clinical attachment level, was statistically assessed on 138 regenerated molars sites and were related to clinical variables such as age, sex, center, and treatment. No correlation was found between success in regenerative therapy and the conformation of the interradicular space, measured with a visual ratio method and a standard linear measurement. At the univariate analysis, the parameters that had a correlation with success were center, extent of furcation involvement, treatment, and sex. The use of enamel matrix derivative (EMD) seemed to be the most favorable therapy, with increase in CAL gain and reduction of vertical or horizontal furcation involvement.

CONCLUSIONS: The regenerative outcome was not significantly influenced by the anatomy of furcation. The center, the degree of furcation involvement, sex, and treatment (EMD) were significantly associated with higher success of periodontal regeneration.

PMID:37052671 | DOI:10.1007/s00784-023-04995-3

Arch Orthop Trauma Surg. 2023 Apr 13. doi: 10.1007/s00402-023-04877-z. Online ahead of print.

ABSTRACT

INTRODUCTION: This study prospectively investigated the pain response and physiological parameters [heart rate (HR) and oxygen saturation (SpO₂)] during sequential casting in bilateral clubfoot. Additionally, it explored the role of non-nutritive sucking and human care contact on the observed responses during casting.

METHODS: Subjects were allotted to control group (Group A with no intervention) and two intervention groups (Group B: non-nutritive sucking intervention, Group C: human care contact intervention). Neonatal Infant Pain Score (NIPS), heart rate (HR), and oxygen saturation (SpO₂) were used to assess the response.

RESULTS: The three groups matched in age and gender characteristics of the participants. Pain response was noted across all groups. The left foot demonstrated a statistically significant preexisting tachycardia which rose further during casting (p < 0.01). Intergroup comparisons revealed that the alteration for NIPS during casting was in following sequence (Group A > C > B, p < 0.00001). The effect of interventions offered in Group B and C lasted in the post-cast period as well (B > C).

CONCLUSION: The clubfoot child exhibited moderate pain response during casting of both feet. A tachycardia was noted prior to initiation of second cast which further exaggerated with subsequent cast. Pacifier (non-nutritive sucking) intervention produced better control of pain response than human care contact during casting for both feet.

PMID:37052665 | DOI:10.1007/s00402-023-04877-z

Eur J Psychotraumatol. 2023;14(1):2158428. doi: 10.1080/20008066.2022.2158428.

ABSTRACT

Background: The International Trauma Questionnaire (ITQ) is a standardized and validated measure aligned with the 11th version of the International Classification of Diseases (ICD-11) diagnostic criteria to assess post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (CPTSD). It has been translated into 25 different languages, but is yet to be translated into Dari and validated for use in the Afghan population.Objective: This study aimed (1) to translate and culturally adapt the ITQ for use in Dari; (2) to assess the construct validity and composite reliability of ICD-11 PTSD and CPTSD using the Dari ITQ; and (3) to examine the concurrent, convergent, and discriminant validity of the Dari ITQ.Method: The Dari ITQ was validated through the completion of a set of standardized measures by 305 Afghan asylum seekers and refugees in Austria. Factorial analyses and psychometric properties of the Dari ITQ were assessed using confirmatory factor analysis (CFA), bivariate correlations, and multivariate regression.Results: Asylum seekers showed significantly higher levels of ICD-11 CPTSD symptomatology and probable diagnoses of ICD-11 PTSD, Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) PTSD, anxiety, depression, and psychological distress in comparison to refugees. CFA results supported the two-factor second-order model comprised of the PTSD and disturbances in self-organization (DSO) as the best fit to the data. The psychometric adequacy of this model in the Dari ITQ was evidenced by high factor loadings and excellent internal reliability. The Dari ITQ showed satisfactory concurrent, convergent, and discriminant validity.Conclusion: The current study supports the statistical validity and cultural sensitivity of the Dari ITQ in identifying symptoms of ICD-11 PTSD and CPTSD among Afghan asylum seekers and refugees.

PMID:37052110 | DOI:10.1080/20008066.2022.2158428

Eur J Psychotraumatol. 2023;14(1):2179278. doi: 10.1080/20008066.2023.2179278.

ABSTRACT

Background: Childhood maltreatment (CM) is a common psychological stressor associated with multiple mental disorders. While CM is associated with vulnerability to depression and anxiety, little is known about the specific mechanism underlying this relationship.Objective: This study aimed to investigate the white matter (WM) of healthy adults with CM and their relationships with depression and anxiety to provide biological evidence for the development of mental disorders in subjects with childhood trauma.Methods: The CM group included 40 healthy adults with CM. The non-CM group included 40 healthy adults without CM. Diffusion tensor imaging (DTI) data were collected, and tract-based spatial statistics (TBSS) were applied to the whole brain to assess WM differences between the two groups; post-hoc fibre tractography was used to characterise the developmental differences; and mediation analysis was used to assess the relationships among the Child Trauma Questionnaire (CTQ) results, DTI indices, and depression and anxiety scores.Results: Relative to the non-CM group, the CM group revealed significantly lower fractional anisotropy (FA) in the right posterior corona radiata (PCR-R), right anterior corona radiata (ACR-R), left super corona radiata (SCR-L), anterior thalamic radiation (ATR), and right posterior limb of the internal capsule (PLIC-R). Additionally, shorter fibre bundles passed through the PCR-R, ACR-R, and ATR in the CM group compared with the non-CM group. Besides, the length of the ACR-R mediated the relationship between CM and trait anxiety.Conclusions: The alteration of white matter microstructure associated with childhood trauma in healthy adults may reflect biomarkers of childhood trauma. Besides, an alteration of WM microstructure in healthy adults with CM mediates the association between CM and trait anxiety, which may represent the vulnerability to developing mental disorders after childhood trauma experiences.

PMID:37052100 | DOI:10.1080/20008066.2023.2179278

Eur J Psychotraumatol. 2023;14(1):2178762. doi: 10.1080/20008066.2023.2178762.

ABSTRACT

Background: Although trauma exposure (TE) is a transdiagnostic risk factor for many psychiatric disorders, not everyone who experiences TE develops a psychiatric disorder. Resilience may explain this heterogeneity; thus, it is critical to understand the etiologic underpinnings of resilience.Objective: The present study sought to examine the genetic underpinnings of psychiatric resilience using genome-wide association studies (GWAS), genome-wide complex trait analysis (GCTA), and polygenic risk score (PRS) analyses.Method: Participants were 6,634 trauma exposed college students attending a diverse, public university in the Mid Atlantic. GWAS and GCTA analyses were conducted, and using GWAS summary statistics from large genetic consortia, PRS analyses examined the shared genetic risk between resilience and various phenotypes.Results: Results demonstrate that nine single-nucleotide polymorphisms (SNPs) met the suggestive of significance threshold, heritability estimates for resilience were non-significant, and that there is genetic overlap between resilience and AD, as well as resilience and PTSD.Conclusion: Mixed findings from the present study suggest additional research to elucidate the etiological underpinnings of resilience, ideally with larger samples less biased by variables such as heterogeneity (i.e. clinical vs. population based) and population stratification. Genetic investigations of resilience have the potential to elucidate the molecular bases of stress-related psychopathology, suggesting new avenues for prevention and intervention efforts.

PMID:37052082 | DOI:10.1080/20008066.2023.2178762

Eur J Psychotraumatol. 2023;14(1):2181602. doi: 10.1080/20008066.2023.2181602.

ABSTRACT

Background: In low- and middle- income countries (LMICs) trauma exposure among youth is high, but mental health services are critically under-resourced. In such contexts, abbreviated trauma treatments are needed.Objective: To evaluate the efficacy of an abbreviated eight-session version of Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) for improving posttraumatic stress disorder (PTSD) and depression symptoms in a sample of South African adolescents.Method: 75 trauma-exposed adolescents (21 males, 54 females; mean age = 14.92, range = 11-19) with posttraumatic stress disorder (PTSD) symptoms were randomly assigned to eight sessions of TF-CBT or to usual services. At baseline, post-treatment and three-month follow-up, participants completed the Child PTSD Symptom Scale for DSM 5 (CPSS-5) and the Beck Depression Inventory II (BDI-II). The trial is registered on the Pan African Trial Registry (PACTR202011506380839).6.Results: 95% of TF-CBT participants completed treatment while only 47% of TAU participants accessed treatment. Intention-to-treat analyses found that the TF-CBT group had a significantly greater reduction in CPSS-5 PTSD symptom severity at post-treatment (Cohen’s d = 0. 60, p < .01) and three-month follow-up (Cohen’s d = 0.62, p < . 01), and a greater reduction in the proportion of participants meeting the CPSS-5 clinical cut-off for PTSD at both time points (p = .02 and p = .03, respectively). There was also a significantly greater reduction in depression symptom severity in the TF-CBT group at post-treatment (Cohen’s d = 0.51, p = .03) and three-month follow-up (Cohen’s d = 0.41, p = .05), and a greater reduction in the proportion of TF-CBT participants meeting the BDI clinical cut-off for depression at both time points (p = .02 and p = .03, respectively).Conclusion: The findings provide preliminary evidence of the efficacy of an abbreviated eight-session version of TF-CBT for reducing PTSD and depression symptoms in a LMIC sample of adolescents with multiple trauma exposure.

PMID:37052081 | DOI:10.1080/20008066.2023.2181602