Nevin Manimala

JMIR Aging. 2022 Sep 22. doi: 10.2196/40357. Online ahead of print.

ABSTRACT

BACKGROUND: Care partners of people living with dementia may benefit from online education. We developed iGeriCare, an award-winning internet-based platform with 12 multimedia e-learning lessons about dementia.

OBJECTIVE: Our objective was to evaluate users’ perceptions of impact.

METHODS: From March 17, 2021-May 16, 2022, data were collected upon lesson completion. We used the content-validated Information Assessment Method for patients and the public (IAM4all) adapted for dementia care partners. The IAM4all questionnaire assesses outcomes of online consumer health information. Responses were collected using SurveyMonkey and data was analyzed using IBM SPSS Statistics (v.28).

RESULTS: 409 responses were collected, with 95% of survey respondents completing the survey. 179 of 409 (43.8%) identified as a family or friend care partner, and 84 of 409 (20.5%) as an individual concerned they may have mild cognitive impairment (MCI) or dementia. 380 of 409 (92.9%) identified the lesson as relevant or very relevant, and 403 of 409 (98.5%) understood the lesson well or very well. Over half of respondents felt they were motivated to learn more, taught something new, or validated in what they do, while some felt reassured or that the lesson refreshed their memory. 401 of 409 (98.0%) said they would use the information; in particular, to better understand something, discuss the information with someone else, do things differently, or do something.

CONCLUSIONS: Users identified iGeriCare as relevant, beneficial, and that they would use the information. To our knowledge, this is the first time the IAM4all has been used to assess patient and caregiver feedback on internet-based dementia education resources. A randomized controlled trial to study feasibility and impact on caregiver knowledge, self-efficacy, and burden is in progress.

PMID:36150051 | DOI:10.2196/40357

Ann Plast Surg. 2022 Oct 1;89(4):451-458. doi: 10.1097/SAP.0000000000003300.

ABSTRACT

BACKGROUND: Although the angiosome concept is a well-accepted theory, unexpected necrosis suggests that other factors can influence the flap survival. Our study uses the rat model to explore the flow capacity of the choke vessels across 2 angiosomes.

METHODS: The medioventral line of Sprague-Dawley rats’ abdominal flap was equally divided into 4 sections, which were preserved in 7 different groups (n = 6/group): A, no dissection; B to D, preserve the inferior 1/4, 2/4, and 3/4 sections; E to G, preserve the superior 1/4, 2/4, and 3/4 sections. The ratio (%) of the survival area of the distal/proximal territory was calculated. Indocyanine green, lead-oxide gel imaging, hematoxylin and eosin, and CD31 histology tests were performed.

RESULTS: Compared with 96.0 ± 1.4% flap survival in group A, groups B, C, and D had distal territory flap loss (34.8% ± 4.1%, 65.0% ± 3.7%, and 94.3% ± 3.1% respectively). Group E lost the majority of the distal territory (3.5% ± 2.4%), whereas groups F and G (15.5% ± 3.8% and 79.2% ± 3.3%, respectively) had larger flap survival. Except for groups A and D, each of the other 2 groups showed statistically significant results (P < 0.001). Indocyanine green indicated no blood flow at the superior 1/4 part. Lead-oxide gel and histology showed that the choke vessels residing along the medioventral line had no significant difference.

CONCLUSIONS: Choke vessels do not carry blood flow equally. Two categories of choke vessels-“resting” and “active”-are proposed. The “active” form has variable flow carrying capabilities when the flap is harvested in different designs.

PMID:36149984 | DOI:10.1097/SAP.0000000000003300

Ann Plast Surg. 2022 Oct 1;89(4):385-390. doi: 10.1097/SAP.0000000000003286.

ABSTRACT

BACKGROUND: Although many fixation methods are used alone or in combination for craniosynostosis, only few studies have compared the effectiveness and long-term results of these methods.

METHOD: In this study, patients in whom suture or resorbable plate-screw system was used for fixation were evaluated in terms of postoperative results and complications. The data of patients who underwent surgery for craniosynostosis between 2002 and 2019 were retrospectively reviewed and evaluated.

RESULTS: A total of 70 patients, 41 in the suture group and 29 in the resorbable plate-screw group, were included in the study. Whitaker classification was used for head shape evaluation, and anthropometric head circumference measurements were performed in all patients in the preoperative and postoperative periods. In the postoperative period, all patients were compared in terms of the operation time, transfusion requirement, discharge, follow-up period, and complications according to the chosen fixation method.The mean age, postoperative complication rates, anthropometric head circumference measurements, and Whitaker scores of both groups were found to be statistically similar. Although the resorbable plate-screw group had a longer follow-up period, the operation time was longer in the suture group. Furthermore, the suture group had lower transfusion requirement and earlier discharge from the hospital than the resorbable plate-screw group.

CONCLUSIONS: If fixation with suture is chosen in suitable patients, in addition to the low patient cost, this method can be safely applied in centers with limited logistical possibilities, because of the results and complication rates being similar to fixation with resorbable plate-screws.

PMID:36149978 | DOI:10.1097/SAP.0000000000003286

Ann Plast Surg. 2022 Oct 1;89(4):353-357. doi: 10.1097/SAP.0000000000003264. Epub 2022 Aug 9.

ABSTRACT

Women with labial hypertrophy may opt for labiaplasty. The aim of the study was to analyze the complications, long-term follow-up of clinical outcomes and satisfaction in this population over the past 10 years.All women who underwent labiaplasty with or without clitoral hood reduction at our center between January 2008 and August 2020 were retrospectively identified. Retrospective study was conducted, recording follow-up outcomes, motivations, techniques, postoperative complications, reasons requiring reoperation, and surgical satisfaction concerned different clinical characteristics. A concrete analysis of each specific outcome and a detailed knowledge of these procedures were performed.A total of 52.41% reported functional impairment, 20.25% cited aesthetics complains, and 27.34% were motivated by both the previously mentioned reasons. Women undergoing surgical correction sometimes mixed with various psychological aspects. A total of 91.06% reported that they were moderately (6.04%) or extremely (85.02%) satisfied with the outcomes after surgery, and 37 (8.94%) reported dissatisfied. Revision surgery was needed in a small number of patients (n = 7 of 414 patients, 1.69%) because of undesirable appearance. The most common complication in our patients was asymmetry (6.28%). Women requested labiaplasty in the last 2 reasons or procedures or without psychological distress were more likely feel satisfied with the results (satisfaction rate >90%). There was a significant difference in satisfaction among the 3 concerns as well as between the 2 kinds of psychological conditions (P < 0.05). Satisfaction of patients with aesthetic complains compared with the other 2 worries was significantly lower (P < 0.05). There was no significant difference among the 3 procedures in this comparison group (P > 0.05). In addition, satisfaction in labiaplasty with or without clitoral hoodoplasty, neither of which was statistically different (P > 0.05). Patients aged 30 to 39 years reported the lowest satisfaction in comparison with the other age groups.Labiaplasty of the labia minora is the most commonly performed genital cosmetic surgery procedure. This study on 414 patients demonstrated that it is associated with a high degree of patient satisfaction and low morbidity and provided evidence of safety and effectiveness preliminary, indicating that the procedure may be regarded as safe.

PMID:36149975 | DOI:10.1097/SAP.0000000000003264

PLoS One. 2022 Sep 23;17(9):e0275070. doi: 10.1371/journal.pone.0275070. eCollection 2022.

ABSTRACT

With the advent of single cell/nucleus RNA sequencing (sc/snRNA-seq), the field of cell phenotyping is now a data-driven exercise providing statistical evidence to support cell type/state categorization. However, the task of classifying cells into specific, well-defined categories with the empirical data provided by sc/snRNA-seq remains nontrivial due to the difficulty in determining specific differences between related cell types with close transcriptional similarities, resulting in challenges with matching cell types identified in separate experiments. To investigate possible approaches to overcome these obstacles, we explored the use of supervised machine learning methods-logistic regression, support vector machines, random forests, neural networks, and light gradient boosting machine (LightGBM)-as approaches to classify cell types using snRNA-seq datasets from human brain middle temporal gyrus (MTG) and human kidney. Classification accuracy was evaluated using an F-beta score weighted in favor of precision to account for technical artifacts of gene expression dropout. We examined the impact of hyperparameter optimization and feature selection methods on F-beta score performance. We found that the best performing model for granular cell type classification in both datasets is a multinomial logistic regression classifier and that an effective feature selection step was the most influential factor in optimizing the performance of the machine learning pipelines.

PMID:36149937 | DOI:10.1371/journal.pone.0275070

PLoS Negl Trop Dis. 2022 Sep 23;16(9):e0010722. doi: 10.1371/journal.pntd.0010722. Online ahead of print.

ABSTRACT

BACKGROUND: Shigella infections cause inflammation, which has been hypothesized to mediate the associations between Shigella and child development outcomes among children in low-resource settings. We aimed to assess whether early life inflammation and Shigella infections affect school-aged growth and cognitive outcomes from 6-8 years of age.

METHODOLOGY/PRINCIPAL FINDINGS: We conducted follow-up assessments of anthropometry, reasoning skills, and verbal fluency in 451 children at 6-8 years of age in the Brazil, Tanzania, and South Africa sites of MAL-ED, a longitudinal birth cohort study. We estimated the associations between Shigella burden and inflammation with linear growth at 2, 5, and 6-8 years of age, and with the cognitive test scores using linear regression and adjusting for potential confounding variables. We also assessed whether inflammation mediated the associations between Shigella and school-aged outcomes using a regression-based approach to mediation analysis. A high prevalence of Shigella was associated with a 0.32 (95% CI: 0.08, 0.56) z-score lower height-for-age z-score (HAZ) at 6-8 years compared to a low prevalence of Shigella. Intestinal inflammation had a smaller association with HAZ at 6-8 years. Shigella burden had small and consistently negative associations with cognitive outcomes in Brazil and Tanzania, but not South Africa, and the estimates were not statistically significant. Systemic inflammation was strongly associated with lower verbal fluency scores in Brazil (semantic fluency z-score difference: -0.57, 95% CI: -1.05, -0.10; phonemic fluency z-score difference: -0.48, 95% CI: -0.93, -0.03). There was no evidence that intestinal inflammation mediated the association between Shigella and HAZ or cognitive outcomes.

CONCLUSIONS/SIGNIFICANCE: While Shigella infections were consistently associated with long-term deficits in linear growth, the estimates of the negative associations between Shigella and cognitive outcomes were imprecise and only observed in the Brazil and Tanzania sites. Systemic inflammation was strongly associated with lower semantic and phonemic fluency scores in Brazil only, highlighting the site-specificity of effects.

PMID:36149931 | DOI:10.1371/journal.pntd.0010722

PLoS Pathog. 2022 Sep 23;18(9):e1010848. doi: 10.1371/journal.ppat.1010848. Online ahead of print.

ABSTRACT

Aneuploidy causes system-wide disruptions in the stochiometric balances of transcripts, proteins, and metabolites, often resulting in detrimental effects for the organism. The protozoan parasite Leishmania has an unusually high tolerance for aneuploidy, but the molecular and functional consequences for the pathogen remain poorly understood. Here, we addressed this question in vitro and present the first integrated analysis of the genome, transcriptome, proteome, and metabolome of highly aneuploid Leishmania donovani strains. Our analyses unambiguously establish that aneuploidy in Leishmania proportionally impacts the average transcript- and protein abundance levels of affected chromosomes, ultimately correlating with the degree of metabolic differences between closely related aneuploid strains. This proportionality was present in both proliferative and non-proliferative in vitro promastigotes. However, as in other Eukaryotes, we observed attenuation of dosage effects for protein complex subunits and in addition, non-cytoplasmic proteins. Differentially expressed transcripts and proteins between aneuploid Leishmania strains also originated from non-aneuploid chromosomes. At protein level, these were enriched for proteins involved in protein metabolism, such as chaperones and chaperonins, peptidases, and heat-shock proteins. In conclusion, our results further support the view that aneuploidy in Leishmania can be adaptive. Additionally, we believe that the high karyotype diversity in vitro and absence of classical transcriptional regulation make Leishmania an attractive model to study processes of protein homeostasis in the context of aneuploidy and beyond.

PMID:36149920 | DOI:10.1371/journal.ppat.1010848

PLoS One. 2022 Sep 23;17(9):e0275086. doi: 10.1371/journal.pone.0275086. eCollection 2022.

ABSTRACT

BACKGROUNDS: Micronutrient deficits in women of reproductive age have been linked to poor pregnancy outcomes. The most common micronutrient deficits in women are iron and folate. The World Health Organization recommends daily oral iron and folic acid supplementation (IFAS) as part of routine antenatal care to lower the risk of maternal anemia and adverse pregnancy outcomes. However, the effectiveness of the supplementation relies on client’s strict adherence. The aim of this study was to determine time- to- non-adherence to IFAS and associated factors among pregnant women in Hosanna Town, South Ethiopia.

METHODS: A community based cross sectional study design was employed from May 15-June11, 2021. Data were entered into Epi-Data version 3.1 and exported to SPSS version 23 for analysis. The Cox regression hazard model was applied. The threshold of statistical significance was declared at a p-value <0.05 and adjusted hazard ratios (AHRs) with corresponding 95% confidence intervals were used to report.

RESULT: The median time-to-non-adherence was 74 days (95 percent CI: 65.33-82.67). After adjusting for the confounders, age (AHR = 1.05, 95% CI: 1.01-1.09), education status (AHR = 2.43 95%CI 1.34-4.40, AHR 3.00, 95% CI: 2.09-4.31, AHR 1.91, 95% CI: 1.32-2.77), household’s wealth index (AHR = 1.73, 95% CI: 1.19-2.51, AHR = 1.64, 95% CI:1.15-2.35), and counseling at service delivery (AHR = 2.53, 95% CI: 1.88-3.41) were independent predictors of time to non-adherence to IFAS among pregnant women.

CONCLUSION: The median time to non-adherence was short and women became non-adherent before the recommended duration. Improving women’s education and counseling pregnant women on IFAS during pregnancy would make a change.

PMID:36149913 | DOI:10.1371/journal.pone.0275086

PLoS One. 2022 Sep 23;17(9):e0275032. doi: 10.1371/journal.pone.0275032. eCollection 2022.

ABSTRACT

BACKGROUND: Though initiation of insulin results in a significant change in glycemic levels, treating patients without significant hypoglycemic events remains difficult in diabetes patients initiated with different insulin-based regimens. This study assessed the association of hypoglycemic incidence and glycemic control between NPH and premixed insulin regimens in patients with type 2 diabetes mellitus (T2DM).

METHODS: This was a retrospective observational study in patients with T2DM who were treated with insulin-based therapy from 2015 to 2020 at the University of Gondar Comprehensive Specialized hospital. Average fasting blood glucose (FBG) between NPH and premixed insulin regimens was compared using an independent t-test. The Association of NPH and premixed insulin regimens with hypoglycemic incidences and glycemic control was examined by a logistic regression model. P < 0.05 was statistically significant.

RESULTS: From 405 participants, more than half (55.3%) were males with a mean age of 59.2(±9.1) years. Baseline mean HbA1C and FBG levels were 12.73(±1.1) % and 347.7(±48.5) mg/dl, respectively. Within a one-year follow-up period of insulin initiation, the rate of hypoglycemia was 13.1%. The incidence of hypoglycemia was significantly higher in patients initiated with premixed insulin compared with NPH insulin regimens (P < 0.001). After one year of insulin initiation, HbA1C decreased from 12.7 to 7.6 and from 12.8 to 7.3% and FBG levels decreased from 347.5 to 160.7 and from 348.2 to 147.3 mg/dl following initiation of NPH and premixed insulin, respectively. Patients treated with premixed-based insulin were found more likely to achieve target FBG compared with patients treated with NPH insulin regimens after one year of initiation (P = 0.02).

CONCLUSION: Premixed insulin-based regimen has found to have a higher hypoglycemic incidence, but a better level of glycemic control compared to NPH insulin-based therapy. Therefore, patients initiated with premixed insulin need to be highly vigilant and motivated to recognize the symptoms of hypoglycemia.

PMID:36149907 | DOI:10.1371/journal.pone.0275032

PLoS One. 2022 Sep 23;17(9):e0270545. doi: 10.1371/journal.pone.0270545. eCollection 2022.

ABSTRACT

INTRODUCTION: Voluntary medical male circumcision (VMMC) remains an effective biomedical intervention for HIV prevention in high HIV prevalence countries. In South Africa, United States Agency for International Development VMMC partners provide technical assistance to the Department of Health, at national and provincial levels in support of the establishment of VMMC sites as well as in providing direct VMMC services at site level since April 2012. We describe the outcomes of the Right to Care (RTC) VMMC program implemented in South Africa from 2012 to 2017.

METHODS: This retrospective study was undertaken at RTC supported facilities across six provinces. Young males aged ≥10 years who presented at these facilities from 1 July 2012 to 31 September 2017 were included. Outcomes were VMMC uptake, HIV testing uptake and rate of adverse events (AEs). Using a de-identified observational database of these clients, summary statistics of the demographic characteristics and outcomes were calculated.

RESULTS: There were a total 1,001,226 attendees of which 998,213 (99.7%) were offered VMMC and had a median age of 15 years (IQR = 12-23 years). Of those offered VMMC, 99.6% (994,293) consented, 96.7% (965,370) were circumcised and the majority (46.3%) were from Gauteng province. HIV testing uptake was 71% with a refusal rate of 15%. Of the newly diagnosed HIV positives, 64% (6,371 / 9,972) referrals were made. The rate of AEs, defined as bleeding, infection, and insufficient skin removal) declined from 3.26% in 2012 to 1.17% in 2017. There was a reduction in infection-related AEs from 2,448 of the 2,602 adverse events (94.08%) in 2012 to 129 of the 2,069 adverse events (6.23%) in 2017.

CONCLUSION: There was a high VMMC uptake with a decline in AEs over time. Adolescent men contributed the most to the circumcised population, an indication that the young population accesses medical circumcision more. VMMC programs need to implement innovative demand creation strategies to encourage older males (20-34 years) at higher risk of HIV acquisition to get circumcised for immediate impact in reduction of HIV incidence. HIV prevalence in the total population increased with increasing age, notably in clients above 25 years.

PMID:36149904 | DOI:10.1371/journal.pone.0270545