Nevin Manimala

MSMR. 2021 Sep 1;28(9):8-12.

ABSTRACT

This study explored rates of death by suicide by birth cohort including Baby Boomers (1946-1964), Generation X (1965-1980), Millennials (1981-1996), and Generation Z (1997-2012), among active component U.S. Army soldiers during 1 January 2000-4 June 2021. From 1 January 2008 through 4 June 2021, the most likely cluster of suicides, although not statistically significant, was identified between March 2020 and June 2021, which coincided with the coronavirus disease 2019 (COVID-19) pandemic. Since the onset of the COVID-19 pandemic, the Army has observed 55%-82% increases in suicide rates among Millennials, Generation Z, and Generation X compared to 1 year before the pandemic. The largest proportional increase in rates affected the members of Generation X, but the highest rates both before and after the onset of the pandemic affected those in Generation Z. Discussion of the findings introduces theories that have been used to explain psychological states that may predispose to suicidal behavior and posits ways in which Army leaders and organizations may be able to reduce suicide risk among soldiers. The limitations of the study and possible additional inquiries are described.

PMID:34806854

Community Dent Oral Epidemiol. 2021 Nov 22. doi: 10.1111/cdoe.12709. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine income-related inequalities in access to dental services from 1975 to 2018. In Norway, dental care services for adults are privately financed. This may lead to income-related inequalities in access. In the early 1970s, that is, at the beginning of the study period, there were marked inequalities in access to dental services according to personal income. However, from the beginning of the 1970s, there has been a large increase in gross national income per capita in Norway as a result of the growth of the oil and gas industry. This increase in income also meant that people with a low income in 1975 had a rise in their level of income. According to the law of diminishing utility, an increase in income leads to higher consumption of dental services for people with a low level of income compared to people with a high level of income. The study hypothesis is that the inequalities in access to dental services that existed in 1975 became less over time.

METHODS: Statistics Norway collected samples of cross-sectional health survey data for the following years: 1975, 1985, 1995, 2002, 2008, 2012 and 2018. For each sample, individuals 21 years and older were drawn randomly from the non-institutionalized adult population using a two-stage stratified cluster sample technique. Inequalities were measured using the concentration index. The dependent variable was the use of dental services during the last year, and the key independent variable was equivalized household income.

RESULTS: The concentration index for inequalities in use of dental services according to income decreased from 0.10 (95% CI = 0.09, 0.11) in 1975 to 0.04 (95% CI = 0.03, 0.05) in 2018. The decrease was particularly large from 2002 to 2012. This was a period with a large growth in gross national income.

CONCLUSION: People with a low income had a marked increase in their purchasing power from 1975 to 2018. This coincided with an increase in demand for dental care for this low-income group.

PMID:34806803 | DOI:10.1111/cdoe.12709

Vet Ophthalmol. 2021 Nov 22. doi: 10.1111/vop.12956. Online ahead of print.

ABSTRACT

OBJECTIVE: Domestic Cat Hepadnavirus (DCH) is a novel virus recently identified in the domestic cat. Currently, little is known regarding its clinical significance. The hepadnaviridae family includes the Hepatitis B Virus (HBV). Co-infection of HBV and Hepatitis C in humans increases the risk of uveitis. We aimed to determine whether DCH is present in the United Kingdom (UK) and whether DCH warrants investigation as a potential cause of uveitis in cats.

PROCEDURES: Clinical records from the Royal Veterinary College (RVC) and the Animal Health Trust (AHT) were reviewed for feline cases diagnosed with endogenous uveitis. A healthy control group was identified from cats presented to the RVC as blood donors. DNA was extracted from stored blood samples using commercially available kits. Polymerase chain reaction assays were performed to confirm the presence of feline DNA and to detect the presence of DCH DNA using previously described protocols.

RESULTS: Blood samples were available from 65 cats with endogenous uveitis and 43 healthy control cats. Two blood samples from cats with endogenous uveitis tested positive for the presence of DCH DNA. DCH DNA was not detected in the control group. There was no statistically significant difference between the prevalence of DCH between the groups.

CONCLUSIONS: Domestic Cat Hepadnavirus is present in the UK. This study failed to demonstrate a conclusive link between DCH and uveitis in cats, although further studies to investigate an association with other feline diseases are warranted.

PMID:34806802 | DOI:10.1111/vop.12956

Mov Disord. 2021 Nov 22. doi: 10.1002/mds.28864. Online ahead of print.

ABSTRACT

BACKGROUND: White matter hyperintensities (WMHs) have a role in cognitive impairment in normal brain aging, while the effect on Parkinson’s disease (PD) progression is still controversial.

OBJECTIVE: To investigate the longitudinal evolution of micro- and macrostructural damage of cerebral white matter (WM) and its relationship with the clinical picture in PD.

METHODS: A total of 154 PD patients underwent clinical, cognitive, and magnetic resonance imaging (MRI) assessment once a year for up to 4 years. Sixty healthy controls underwent the same protocol at baseline. WMHs were identified and total WMH volume was measured. WMHs were also used as exclusion masks to define normal-appearing white matter (NAWM). Using tract-based spatial statistics, diffusion tensor (DT) MRI metrics of whole-brain WM and NAWM were obtained. Linear mixed-effects models defined the longitudinal evolution and association between variables. WM alterations were tested as risk factors of disease progression using linear regression and Cox proportional hazards models.

RESULTS: At baseline, PD patients showed alterations of all DT MRI measures compared to controls. Longitudinally, DT MRI measures did not vary significantly and no association with clinical variables was found. WMH volume changed over time and was associated with impairment in global cognition, executive functions, and language. Baseline WMH volume was a moderate risk factor for progression to mild cognitive impairment.

CONCLUSIONS: Our study suggests an association between WMHs and cognitive deterioration in PD, whereas WM microstructural damage is a negligible contributor to clinical deterioration. WMHs assessed by MRI can provide an important tool for monitoring the development of cognitive impairment in PD patients. © 2021 International Parkinson and Movement Disorder Society.

PMID:34806799 | DOI:10.1002/mds.28864

Lett Appl Microbiol. 2021 Nov 22. doi: 10.1111/lam.13603. Online ahead of print.

ABSTRACT

Duplex polymerase chain reaction with lateral flow dipsticks (duplex PCR-LFD) was developed for simultaneous detection of beta-lactamase Klebsiella pneumoniae carbapenemase (bla_KPC ) and beta-lactamase New Dehli metallo-beta-lactamase (bla_NDM ) genes in body fluid samples. This method was validated using well-characterized isolates. The assessment of the specificity of duplex PCR-LFD showed that there was no cross-reactivity with other targets. The detection limit of the duplex PCR-LFD assay was 20 CFU/ml for bla_KPC and bla_NDM . Among 177 sterile body fluid samples tested by the duplex PCR-LFD assay, 40 were bla_KPC -positive and five were bla_NDM -positive. The results obtained from 122 corresponding Gram-negative bacteria which were isolated from these clinical samples and tested by duplex PCR-LFD assay showed that there were 37 strains carrying bla_KPC genes in 40 bla_KPC -positive samples and three strains carrying bla_NDM genes in five bla_NDM -positive samples. Statistical analysis indicated that there was no significant difference between the direct detection of bla_KPC and bla_NDM genes in clinical sterile body fluid samples and corresponding clinical isolates. Therefore, duplex PCR-LFD can be effective for the simultaneous detection of bla_KPC and bla_NDM in clinical isolates and directly from clinical samples, which may be helpful for the administration of appropriate antimicrobial treatment.

PMID:34806798 | DOI:10.1111/lam.13603

Lasers Surg Med. 2021 Nov 22. doi: 10.1002/lsm.23495. Online ahead of print.

ABSTRACT

PURPOSE: To conduct keratometry and investigate the ultrastructural changes after microwave thermokeratoplasty (MTK) in rabbit eyes.

METHODS: Eighteen New Zealand rabbits (18 eyes) were recruited for this study. Ten eyes were chosen for slit-lamp photography and corneal topography at 1 day, 1 week, 1 month, 3 months, and 6 months postoperatively. Two rabbits were sacrificed on 1 day, 1 week, 1 month, and 3 months postoperatively. All remaining rabbits were sacrificed at 6 months postoperatively. The cornea was observed using hematoxylin and eosin staining and transmission electron microscopy. Data are expressed as mean ± standard deviation. p value was determined using repeated-measures analysis of variance.

RESULTS: Corneal edema, disorganized corneal collagen fibers in the heated area, and necrotic fibroblasts were observed at 1 day and 1 week postoperatively. At 1 month postoperatively, corneal edema was not observed, and corneal cell morphology was normal. Moreover, corneal collagen fibers in the heated area shrunk and tended to be organized. The K1 and K2 values significantly decreased from 49.0 ± 1.2 D and 50.5 ± 0.9 D preoperatively to 40.3 ± 1.2 D and 43.2 ± 0.8 D 6 months postoperatively, respectively. The corneal thickness was 353.1 ± 9.3 µm preoperatively and 317.8 ± 27.7 µm at 6 months postoperatively; the difference was not statistically significant.

CONCLUSIONS: Corneal keratometry showed flattening after MTK. Moreover, corneal collagen fibers in the heated area shrunk and tended to be organized at 6 months postoperatively. Further studies are required to determine the safety and stability of MTK.

PMID:34806777 | DOI:10.1002/lsm.23495

Biometrics. 2021 Nov 22. doi: 10.1111/biom.13602. Online ahead of print.

ABSTRACT

Spatial partitioning methods correct for non-stationarity in spatially related data by partitioning the space into regions of local stationarity. Existing spatial partitioning methods can only estimate linear partitioning boundaries. This is inadequate for detecting an arbitrarily shaped anomalous spatial region within a larger area. We propose a novel Bayesian functional spatial partitioning (BFSP) algorithm which estimates closed curves that act as partitioning boundaries around anomalous regions of data with a distinct distribution or spatial process. Our method utilizes transitions between a fixed Cartesian and moving polar coordinate system to model the smooth boundary curves using functional estimation tools. Using adaptive Metropolis-Hastings, the BFSP algorithm simultaneously estimates the partitioning boundary and the parameters of the spatial distributions within each region. Through simulation we show that our method is robust to shape of the target zone and region-specific spatial processes. We illustrate our method through the detection of prostate cancer lesions using magnetic resonance imaging. This article is protected by copyright. All rights reserved.

PMID:34806765 | DOI:10.1111/biom.13602

Cochrane Database Syst Rev. 2021 Nov 22;11:CD011499. doi: 10.1002/14651858.CD011499.pub3.

ABSTRACT

BACKGROUND: Resistant hypertension is highly prevalent among the general hypertensive population and the clinical management of this condition remains problematic. Different approaches, including a more intensified antihypertensive therapy, lifestyle modifications or both, have largely failed to improve patients’ outcomes and to reduce cardiovascular and renal risk. As renal sympathetic hyperactivity is a major driver of resistant hypertension, in the last decade renal sympathetic ablation (renal denervation) has been proposed as a possible therapeutic alternative to treat this condition.

OBJECTIVES: We sought to evaluate the short- and long-term effects of renal denervation in individuals with resistant hypertension on clinical end points, including fatal and non-fatal cardiovascular events, all-cause mortality, hospital admissions, quality of life, blood pressure control, left ventricular hypertrophy, cardiovascular and metabolic profile and kidney function, as well as the potential adverse events related to the procedure.

SEARCH METHODS: For this updated review, the Cochrane Hypertension Information Specialist searched the following databases for randomised controlled trials up to 3 November 2020: Cochrane Hypertension’s Specialised Register, CENTRAL (2020, Issue 11), Ovid MEDLINE, and Ovid Embase. The World Health Organization International Clinical Trials Registry Platform (via CENTRAL) and the US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov were searched for ongoing trials. We also contacted authors of relevant papers regarding further published and unpublished work. The searches had no language restrictions.

SELECTION CRITERIA: We considered randomised controlled trials (RCTs) that compared renal denervation to standard therapy or sham procedure to treat resistant hypertension, without language restriction.

DATA COLLECTION AND ANALYSIS: Two authors independently extracted data and assessed study risk of bias. We summarised treatment effects on available clinical outcomes and adverse events using random-effects meta-analyses. We assessed heterogeneity in estimated treatment effects using Chi² and I² statistics. We calculated summary treatment estimates as a mean difference (MD) or standardised mean difference (SMD) for continuous outcomes, and a risk ratio (RR) for dichotomous outcomes, together with their 95% confidence intervals (CI). Certainty of evidence has been assessed using the GRADE approach.

MAIN RESULTS: We found 15 eligible studies (1416 participants). In four studies, renal denervation was compared to sham procedure; in the remaining studies, renal denervation was tested against standard or intensified antihypertensive therapy. Most studies had unclear or high risk of bias for allocation concealment and blinding. When compared to control, there was low-certainty evidence that renal denervation had little or no effect on the risk of myocardial infarction (4 studies, 742 participants; RR 1.31, 95% CI 0.45 to 3.84), ischaemic stroke (5 studies, 892 participants; RR 0.98, 95% CI 0.33 to 2.95), unstable angina (3 studies, 270 participants; RR 0.51, 95% CI 0.09 to 2.89) or hospitalisation (3 studies, 743 participants; RR 1.24, 95% CI 0.50 to 3.11). Based on moderate-certainty evidence, renal denervation may reduce 24-hour ambulatory blood pressure monitoring (ABPM) systolic BP (9 studies, 1045 participants; MD -5.29 mmHg, 95% CI -10.46 to -0.13), ABPM diastolic BP (8 studies, 1004 participants; MD -3.75 mmHg, 95% CI -7.10 to -0.39) and office diastolic BP (8 studies, 1049 participants; MD -4.61 mmHg, 95% CI -8.23 to -0.99). Conversely, this procedure had little or no effect on office systolic BP (10 studies, 1090 participants; MD -5.92 mmHg, 95% CI -12.94 to 1.10). Moderate-certainty evidence suggested that renal denervation may not reduce serum creatinine (5 studies, 721 participants, MD 0.03 mg/dL, 95% CI -0.06 to 0.13) and may not increase the estimated glomerular filtration rate (eGFR) or creatinine clearance (6 studies, 822 participants; MD -2.56 mL/min, 95% CI -7.53 to 2.42). AUTHORS’ CONCLUSIONS: In patients with resistant hypertension, there is low-certainty evidence that renal denervation does not improve major cardiovascular outomes and renal function. Conversely, moderate-certainty evidence exists that it may improve 24h ABPM and diastolic office-measured BP. Future trials measuring patient-centred instead of surrogate outcomes, with longer follow-up periods, larger sample size and more standardised procedural methods are necessary to clarify the utility of this procedure in this population.

PMID:34806762 | DOI:10.1002/14651858.CD011499.pub3

Med J Malaysia. 2021 Nov;76(6):881-883.

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has prompted the medical world to look at factors that may influence outcomes. There have been connections made between vitamin D and COVID-19, as vitamin D has previously been shown to play a role in the maintenance of immune homeostasis.

MATERIALS AND METHODS: We performed a prospective cohort study on 103 patients at Wigan Wrightington and Leigh NHS Foundation Trust looking at serum vitamin D levels of patients with positive COVID-19 swabs. Results were collated and correlations were made to compare vitamin D levels with age; severity of illness; hospital outcomes; and frailty. Comparisons were also made between frailty and outcome.

RESULTS: The results showed that there was a significant statistical difference between vitamin D levels and severity of infection: those who were treated in the intensive care units (ICU) (severe symptoms) had lower vitamin D levels than those treated on the ward (p=0.0446). There was also a correlation between vitamin D levels and frailty: those who were more frail had higher vitamin D levels than fitter patients (P=0.005). Vitamin D and frailty had no effect on hospital outcomes of COVID-19 infection.

CONCLUSION: Ultimately, we concluded that low vitamin D can increase susceptibility of contracting COVID-19, increase severity of infection but does not affect mortality.

PMID:34806677

Med J Malaysia. 2021 Nov;76(6):876-880.

ABSTRACT

INTRODUCTION: The Optimal Health Program (OHP) is a collaborative self-management program that promotes clients to be actively involved in their own healthcare and overall wellbeing. Program Kesihatan Optimum (SANUBARI) is a Malay version of the OHP after a translational process and cultural adaptation by psychiatrists, clinical psychologist and family medicine specialists in 2017. The program is of a low intensity, patient-centred program, advocating self-health management to improve health literacy by enhancing self-efficacy, building strengths and values, and initiating change and planning, ultimately enhancing wellbeing of people. The programme can be used as a form of early psychosocial intervention during the current pandemic in maintaining the general mental wellbeing of COVID-19 patients.

METHODS: This is an open labelled interventional study of a virtual brief psychosocial intervention, called SANUBARI. The program was conducted among COVID-19 patients hospitalized in the COVID-19 wards of two centres from May 2020 until August 2020. Inclusion criteria include patients aged eighteen years and above, diagnosed with COVID-19, medically stable, speaking and reading Bahasa Melayu or English. All study subjects attended two sessions on OHP via telecommunication method and answered questionnaires (General Self-Efficacy (GSE) Scale, Patient Health Questionnaire and Generalized Anxiety Disorder Questionnaire) via computer-assisted self-interview. Data collection was done before the start of the intervention, at the end of the intervention and a month post-intervention.

RESULTS: A total of 37 patients were recruited and more than half of the subjects were males (62.2%), single (75.5%) and from the Malay ethnicity (78.4%). Seventy-three per cent of subjects had received tertiary education, and most of them were students reflecting a higher unemployment status (73%). Most subjects have no comorbid chronic medical illness (89.2%), and none has a comorbid psychiatric illness. Comparison of the GSE score across 3-time points (preintervention, immediate post-intervention and a month postintervention) showed statistically significant improvement in the mean total GSE score immediate and a month postintervention as compared to the pre-intervention; from mean total GSE score of 29.78 pre-intervention to 34.73 (mean difference 4.946, 95% Confidence Interval 95%CI: 3.361, 6.531) immediate post-intervention and 33.08 (mean difference 3.297, 95%CI: 1.211, 5.348) a month post intervention. There was no significant association between the socio-demographic or clinical data, depressive and anxiety symptoms, and changes in GSE scores over three time points.

CONCLUSION: COVID-19 patients improved their self-efficacy levels after the virtual brief OHP intervention, and it maintained a month post-intervention, protecting them from psychological stress and ultimately enhances wellbeing during this coronavirus pandemic.

PMID:34806676