Nevin Manimala

Kidney Res Clin Pract. 2022 Jun 21. doi: 10.23876/j.krcp.22.023. Online ahead of print.

ABSTRACT

BACKGROUND: Hemodialysis (HD) patients are more vulnerable to viral epidemics, experiencing higher mortality rates compared to individuals without chronic kidney disease (CKD). This retrospective cohort study sought to demonstrate clinical outcomes and associated factors among coronavirus disease 2019 (COVID-19) confirmed Korean HD patients.

METHODS: From February 2020 to November 2021, the COVID-19 Task Force Team collected clinical data for HD patients with confirmed COVID-19 via a self-report survey of nephrologists. The composite outcome included in-hospital mortality, admission to the intensive care unit (ICU), and use of mechanical ventilation. Risk factors associated with clinical outcomes were analyzed among HD patients and compared to those of individuals without CKD using the COVID-19 database from the Korea Disease Control and Prevention Agency.

RESULTS: A total of 380 HD patients from 206 facilities were diagnosed with COVID-19. Fever (49.5%) and cough (25.7%) were the two most common initial symptoms. The overall in-hospital fatality rate was 22.4% and even higher among ICU admission cases (64.7%). Non-survivors were older, more frequently developed shortness of breath, and were more likely to come from a nursing hospital. Compared to the age- and sex-matched non-CKD population, HD patients showed greater risk of in-hospital mortality (hazard ratio, 2.07; 95% confidence interval, 1.56-2.75; p < 0.001) and composite outcome (hazard ratio, 3.50; 95% confidence interval, 2.56-4.77; p < 0.001).

CONCLUSION: HD patients have a greater risk of in-hospital mortality and morbidity from COVID-19. Special attention should be paid to COVID-19 HD patients when they are older or present with symptoms.

PMID:35791744 | DOI:10.23876/j.krcp.22.023

Anatol J Cardiol. 2022 Jul;26(7):559-566. doi: 10.5152/AnatolJCardiol.2022.1136.

ABSTRACT

BACKGROUND: It is unknown whether the novel POT-side-POT technique is more useful than the commonly preferred kissing balloon inflation in patients with non-complex coro- nary bifurcation lesions treated with a single-stent strategy. The aim of this study was to compare the efficacy of POT-side-POT and kissing balloon inflation techniques in one- stent strategy for non-complex coronary bifurcation lesions.

METHODS: In this study, 283 patients were retrospectively analyzed (POT-side-POT group, n = 149; KBI group, n = 134). Primary endpoints of the study were defined as follows: in- hospital and 30-day mortality, contrast-induced acute kidney injury, stent thrombosis, side branch dissection, and need for side-branch stenting. Characteristics of patients at baseline were balanced by using propensity score inverse probability weighting.

RESULTS: Procedure time (minute, 30.6 ± 8.5 vs. 34.3 ± 11.6; P = .003) and contrast volume (milliliter, 153.7 ± 42.4 vs. 171.1 ± 58.2; P = .004) were significantly lower in POT-side-POT group. Besides, side branch residual stenosis and number of patients with >50% side branch residual stenosis remained significantly higher in POT-side-POT group both in general and true bifurcation subgroup analysis (20.3 ± 19.8% vs. 16.5 ± 16.4%, P=.022; 11.9% vs. 5.7%, P = .013 and 24.1 ± 23.2% vs. 18.8 ± 18.7%, P = .033; 17.6% vs. 6.6%, P = .005; respectively). Combined clinical adverse outcomes were similar between groups. Side branch dissection (10.2% vs. 20.1%, P = .001) and need for side branch stenting (12.6% vs. 19%, P=.040) reached statistically significance in kissing balloon inflation group after adjustment.

CONCLUSION: POT-side-POT may be a simple and safe technique with a shorter procedure time and lower incidence of adverse clinical events in non-complex coronary bifurcationlesions treated with single-stent strategy.

PMID:35791712 | DOI:10.5152/AnatolJCardiol.2022.1136

Cardiol Young. 2022 Jul 6:1-7. doi: 10.1017/S1047951122002189. Online ahead of print.

ABSTRACT

INTRODUCTION: The present study aimed to investigate the outcomes of psychiatric symptoms and family functions on treatment adherence in children, in addition to sociodemographic characteristics and clinical factors related to the disease.

MATERIAL AND METHOD: The research sample consisted of 43 children who were followed up with rheumatic heart disease diagnosis during the study. Clinical features were obtained from the patient files. The family assessment device evaluating family functioning and the strengths and difficulties questionnaire scale to screen emotional and behavioural problems in children were used.

RESULTS: Considering the regularity of treatment in our patients, there were 31 (72%) patients adherent to secondary prophylaxis regularly, 7 (6.9%) patients were partially adherent, and 5 (11.6%) patients non-adherent. Patients were divided into treatment adherent (Group 1) and non-adherent (Group 2). There was no statistically significant impact on treatment adherence whether the patients receive enough information, lifestyle, fear of developing adverse effects, fear of addiction, lack of health insurance, difficulties in reaching the drug or hospital. However, the fear of syringes on treatment adherence had an effect statistically significantly (p = 0.047). Forgetting to get a prescription and/or take the drug when the time comes was statistically higher in the non-adherent group (p = 0.009). There was no statistically significant effect of psychosocial factors on treatment adherence between groups.

DISCUSSION: Providing an effective active recall system, involving primary care workers, providing training on the disease and its management, and a comprehensive pain management programme can improve the process, especially for cases where secondary prophylaxis is missed.

PMID:35791698 | DOI:10.1017/S1047951122002189

Clin Shoulder Elb. 2022 Jun 14. doi: 10.5397/cise.2021.00598. Online ahead of print.

ABSTRACT

BACKGROUND: This study was designed to evaluate and compare the diagnostic value of magnetic resonance imaging (MRI) and indirect magnetic resonance arthrography (I-MRA) imaging with those of arthroscopy and each other.

METHODS: This descriptive-analytical study was conducted in 2020. All patients who tested positive for labrum lesions during that year were included in the study. The patients underwent conservative treatment for 6 weeks. In the event of no response to conservative treatment, MRI and I-MRA imaging were conducted, and the patients underwent arthroscopy to determine their ultimate diagnosis and treatment plan. Imaging results were assessed at a 1-week interval by an experienced musculoskeletal radiologist. Image interpretation results and arthroscopy were recorded in the data collection form.

RESULTS: Overall, 35 patients comprised the study. Based on the kappa coefficient, the results indicate that the results of both imaging methods are in agreement with the arthroscopic findings, but the I-MRA consensus rate is higher than that of MRI (0.612±0.157 and 0.749±0.101 vs. 0.449±0.160 and 0.603±0.113). The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of MRI in detecting labrum tears were 77.77%, 75.00%, 91.30%, 50.00%, and 77.14%, respectively, and those of I-MRA were 88.88%, 75.00%, 92.30%, 66.66%, and 85.71%.

CONCLUSIONS: Here, I-MRA showed higher diagnostic value than MRI for labral tears. Therefore, it is recommended that I-MRA be used instead of MRI if there is an indication for potential labrum lesions.

PMID:35791684 | DOI:10.5397/cise.2021.00598

Int J Neurosci. 2022 Jul 6:1-9. doi: 10.1080/00207454.2022.2098737. Online ahead of print.

ABSTRACT

PURPOSE OF THE STUDY: Previous studies have established that telomere length is associated with Multiple sclerosis(MS). However, confounding factors and reverse causality bias can impair observational research. Here, we conducted a two-sample MR study to see if telomere length is causally linked to MS using publically available GWAS summary statistics.

MATERIALS AND METHODS: We screened 13 independent single-nucleotide polymorphisms (SNPs) related to leukocyte telomere length in a recent genome-wide association meta-analysis, which was available for 78,592 samples of European ancestry. The summary statistics for MS were from the latest meta-analyses conducted by the International Multiple Sclerosis Genetics Consortium (IMSGC), which included 115,803 European participants (47,429 MS, 68,374 controls).

RESULTS: We found that leukocyte telomere length and MS are correlated (IVW estimate of odds ratio (OR): 2.13 per 1-SD increase in genetically determined telomere length, 95% confidence interval (CI): 1.55-2.92, P =3.18 × 10-6).

CONCLUSION: Our MR study supported that leukocyte telomere length and MS have a positive causal relationship. Further researches are warranted to elucidate the physiological mechanism.

PMID:35791675 | DOI:10.1080/00207454.2022.2098737

Int J Health Plann Manage. 2022 Jul 6. doi: 10.1002/hpm.3506. Online ahead of print.

ABSTRACT

INTRODUCTION: Recognition of the relevance of violence against health workers in their work place has been growing around the world. In Mozambique, workplace violence in the health sector needs better documentation. Therefore, this article is part of a study that describes the typology and the perceived impact of violence against health care workers in their workplace at the Lichinga Provincial Hospital and at the Health Centre of the City of Lichinga in 2019.

METHOD: This was an observational, descriptive, cross-sectional study. The study was carried out in a simple random sample of health workers victims of violence at the Provincial Hospital and the Health Centre of the City of Lichinga, in the Province of Niassa in northern Mozambique. The questionnaire applied was adapted from the original developed by the International Labour Organization, the International Council of Nurse, the World Health Organization and Public Services International and applied in Maputo, Mozambique during 2002. Statistical analysis was carried out with Statistical Package for the Social Sciences 20.0 and WinPepi 11.65.

RESULTS: Two hundred and 60 healthcare workers (HCW) were selected to participate, 180 agreed, 145 had inclusion criteria and five gave up participating in the study during the consent procedure. Thus, a total of 140 HCW answered the questionnaire. Predominant types of violence were: verbal threat/aggression 34% (n = 62/180); moral pressure/bullying/mobbing 30% (n = 54/180); ethnic discrimination 9% (n = 16/180); against personal property 6% (n = 10/180); physical 4% (n = 8/180); sexual harassment 4% (n = 8/180). One hundred and 37 victims reported 154 episodes of violence, where 7% (n = 13/180) reported more than one type of violence. Most victims reported no reaction (55%, n = 76/137) and few said that they confronted the offender (16%, n = 22/137, particularly victims of sexual harassment, 38%, n = 3/8). Most HCW reported non-existence (39%, n = 54/137) or unawareness (32%, n = 44/137) of procedures to report violence within the Institution. Most (80%, n = 33/41) of those knowing about the procedures, knew how to use them. More than half (55%; n = 76/137) of HCW said that they were discouraged to report acts of violence.

CONCLUSIONS: Like for previous studies in Mozambique and elsewhere in Africa, the study confirms: a relatively high prevalence, a reluctance to talk about the issue and unawareness about procedures on how to report incidents. The findings reconfirm the necessity for the development and implementation of procedures to address violence incidents towards HCW, to develop support services for victims of health workplace violence. Like elsewhere in Africa, successive health workforce plans in Mozambique have failed to address this issue.

PMID:35791672 | DOI:10.1002/hpm.3506

Vox Sang. 2022 Jul 6. doi: 10.1111/vox.13330. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: This sub-study of the FIBRES trial sought to examine the patterns of ABO-compatible cryoprecipitate administration and to identify adverse consequences of ABO-incompatible cryoprecipitate.

MATERIALS AND METHODS: This was a post hoc analysis of data collected from the FIBRES randomized clinical trial comparing fibrinogen concentrate with cryoprecipitate in the treatment of bleeding related to hypofibrinogenemia after cardiac surgery. The primary outcome was the percentage of administered cryoprecipitate that was ABO-compatible. Secondary outcomes were adverse events at 28 days. A follow-up survey was distributed to the FIBRES participating sites to examine the rationale behind the identified cryoprecipitate ABO-matching practice patterns.

RESULTS: A total of 363 patients were included: 53 (15%) received ABO-incompatible cryoprecipitate and 310 (85%) received ABO-compatible cryoprecipitate. There was an increased incidence of post-operative anaemia in the ABO-incompatible group (15; 28.3%) in comparison to the ABO-compatible (44; 14.2%) group (p = 0.01) at 28 days, which was unrelated to haemolysis, without a significant difference in transfusion requirement. In the multivariable logistic regression models accounting for clustering by site, there was no observed statistically significant association between the administration of ABO-incompatible cryoprecipitate and any other adverse outcomes. Nine out of 11 sites did not have a policy requiring ABO-matched cryoprecipitate.

CONCLUSION: This sub-study demonstrated that most cryoprecipitate administered in practice is ABO-compatible, despite the absence of guidelines or blood bank policies to support this practice. A signal towards increased risk of post-operative anaemia may be explained by higher rates of urgent surgery (vs. elective) in the ABO-incompatible group. Future studies should prospectively examine the impact of ABO-compatible versus incompatible cryoprecipitate to conclusively establish if there is a meaningful clinical impact associated with the administration of ABO-incompatible cryoprecipitate.

PMID:35791670 | DOI:10.1111/vox.13330

Aliment Pharmacol Ther. 2022 Jul 6. doi: 10.1111/apt.17125. Online ahead of print.

ABSTRACT

BACKGROUND: The global prevalence of inflammatory bowel disease (IBD) is increasing. However, population-level data are scarce for Asian populations.

AIMS: To outline and compare paediatric and adult IBD incidence and prevalence data in Korea, describe prescription patterns, and analyse outcomes of anti-tumour necrosis factor (anti-TNF) use in a nationally representative cohort.

METHODS: IBD was identified based on the presence of Rare and Intractable Disease diagnosis codes for Crohn’s disease (CD) and ulcerative colitis (UC). We calculated age-based prevalence and incidence, and examined prescription patterns. We used Cox proportional hazard model to calculate the hazard ratio (HR) for undergoing surgery.

RESULTS: The prevalence of CD increased between 2006 and 2015, particularly among teenagers aged 10-19 years (12.7-35.5 patients per 100,000 people). The use of anti-TNF agents increased from 3.2% to 22.9% in paediatric CD patients. Early use of an anti-TNF agent increased 25-fold in CD patients. Further, CD patients aged 0-14 years were most likely to undergo fistulectomy (HR, 2.63; 95% confidence interval [CI], 1.73-3.97). Children with UC had a higher risk of undergoing surgery (HR, 3.01; 95% CI, 1.33-6.83) than adults. Early use of an anti-TNF agent in CD patients was associated with lower odds of surgery than late-stage use.

CONCLUSION: These data demonstrate that the prevalence of IBD has increased over time, especially among paediatric patients. Given the magnitude of paediatric IBD disease burden, a multi-faceted approach is needed for early detection and vigilant monitoring to aim for better prognosis.

PMID:35791668 | DOI:10.1111/apt.17125

BMJ Open. 2022 Jul 4;12(7):e058546. doi: 10.1136/bmjopen-2021-058546.

ABSTRACT

OBJECTIVES: Physical activity (PA) plays a significant role in the treatment of type two diabetes (T2D). This study evaluated the effectiveness of PA counselling in primary healthcare (PHC) on clinical outcome measures in patients with T2D, comparing them with a registry-based controls.

SETTING: The study was carried out in North Karelia, Finland, among PHC clients who have been diagnosed with T2D in 2016-2018.

PARTICIPANTS: The study population consisted of patients aged 19-87 years diagnosed with T2D (n=1803). Altogether 546 patients were referred to the PA educator of whom 521 participated the counselling. In totally 1382 sex, age, time of diagnosis and intervention time-matched controls were used to see the effect of intervention.

INTERVENTIONS: Patients with T2D followed up in PHC were offered to participate in PA counselling provided by trained PA educators. The number of counselling sessions and their content were tailored according to patients needs and willingness to participate. To assess the effects of PA to management of T2D clinical outcome measures such as weight and Haemoglobin A1c (HbA1c) and lipid levels were assessed using data from electronic patient records. Each patient was followed up from records at least for a year.

RESULTS: Weight and body mass index (BMI) decreased in both groups and mean yearly changes did not differ between the groups. HbA1c levels declined in the intervention and increased in the control group with statistically significant difference in the mean yearly change between the groups (p=0.001). The low-density lipoprotein declined in both groups. The decline was bigger in the intervention group, but the difference did not quite reach the statistical significance (p=0.096).

CONCLUSIONS: This study shows that PA counselling in PHC offers significant benefits in the treatment outcomes of T2D although no significant declines were not observed in the weight or BMI.

PMID:35788078 | DOI:10.1136/bmjopen-2021-058546

BMJ Open. 2022 Jul 4;12(7):e052630. doi: 10.1136/bmjopen-2021-052630.

ABSTRACT

OBJECTIVES: This study aimed to examine the association of high-sensitivity C reactive protein (hsCRP) with mortality risk and the attenuated effect of non-communicable disease history (NCD _history ) on the association.

DESIGN: Prospective cohort study.

SETTING: Health Examinees cohort.

PARTICIPANTS: A total of 41 070 men and 81 011 women aged ≥40 years were involved (follow-up: 6.8 years).

OUTCOME MEASURES: Data and cause of death occurring until 31 December 2015 were confirmed by death statistics from the National Statistical Office. We conducted advanced analysis after stratification by NCD _history and sensitivity analysis after excluding death before 1 or 2 years from recruitment. Cox proportional hazard and restricted cubic spline models were used to assess the association.

RESULTS: The association between serum hsCRP and risk of all-cause mortality was observed with strong linearity in both genders and was not influenced by NCD _history . The association of serum hsCRP with risk of cancer mortality was not observed in women with NCD _history , but the association with risk of cardiovascular disease (CVD) mortality was predominantly observed in men with NCD _history .

CONCLUSIONS: This study suggests a dose-response association of hsCRP with mortality risk, including cancer and CVD mortality, in Koreans with low serum hsCRP, although the association with cancer and CVD mortality risk could be influenced by gender and NCD _history .

PMID:35788076 | DOI:10.1136/bmjopen-2021-052630