Nevin Manimala

Am J Transplant. 2022 Mar 18. doi: 10.1111/ajt.17032. Online ahead of print.

ABSTRACT

Donor infection affects organ utilization, especially the infections by multidrug-resistant bacteria, which may have disastrous outcomes. We established a rat model, inoculated with Escherichia coli (E. coli) or carbapenem-resistant Klebsiella pneumoniae (CRKP), to investigate whether hypothermic machine perfusion (HMP), normothermic machine perfusion (NMP), or static cold storage (SCS) combined with antibiotic (AB) could eliminate the bacteria. E. coli or CRKP-infected kidneys were treated with cefoperazone-sulbactam and tigecycline, respectively. The HMP+AB and NMP+AB treatments had significant therapeutic effects on E. coli or CRKP infection compared with the SCS+AB treatment. The bacterial load of CRKP-infected kidneys in the HMP+AB (22050±2884 CFU/g vs. 1900±400 CFU/g, p=0.007) and NMP+AB groups (25433±2059 CFU/g vs. 500±458 CFU/g, p=0.002) were significantly reduced, with no statistically significant difference between both groups. Subsequently, the CRKP-infected kidneys of the HMP+AB and SCS+AB groups were transplanted. The rats in the SCS+AB group were severe infected and euthanized on day 4 post-transplant. By contrast, the rats in the HMP+AB group were in good condition. In conclusion, HMP and NMP combined with AB seems to be efficient approaches to decrease bacterial load of infected kidneys. This might lead to higher utilization rates of donors with active infection.

PMID:35303398 | DOI:10.1111/ajt.17032

Eur J Heart Fail. 2022 Mar 18. doi: 10.1002/ejhf.2489. Online ahead of print.

ABSTRACT

BACKGROUND: Ferric carboxymaltose (FCM) improves left ventricular (LV) function in heart failure with reduced ejection fraction (HFrEF). Yet, the effect of FCM on right ventricular (RV) function remains insufficiently elucidated.

METHODS: This is a predefined analysis of the IRON-CRT trial in which symptomatic HFrEF patients with iron deficiency and reduced LV ejection (LVEF) despite optimal medical therapy and cardiac resynchronization therapy (CRT) underwent 1:1-randomization to FCM or placebo in a double blind fashion. RV function was measured as the change from baseline to 3-month follow-up of RV fractional area change (FAC), TAPSE and RV S’, systolic pulmonary artery pressure (SPAP) and its coupling to the RV (TAPSE/SPAP-ratio). The RV-contractile reserve was measured as the change in TAPSE during incremental pacing at 70, 90 and 110 Bpm.

RESULTS: A total of 75 patients underwent randomization and received FCM(n= 37) or placebo(n=38). At baseline 72.5% had RV dysfunction and 70% had RV dilatation. At 3-month follow-up patients receiving FCM had a significant improvement in RV FAC (Placebo=-2.2%[-4.9%-+0.6%] vs FCM=+4.1%[+1.4%-+6.9%], p=0.002) and TAPSE (placebo=-0.19mm[-0.85mm-+0.48mm] vs FCM=+0.98mm[+0.28mm-+1.62mm], p=0.020), but not RV S’. Patients receiving FCM had a numerically lower SPAP (p=0.073) and significant improvement in TAPSE/SPAP-ratio (placebo= +0.002[-0.046-+0.051] vs FCM= +0.097[+0.048-+0.146], p=0.008). At baseline both groups had diminished RV-contractile reserve during incremental pacing, which was attenuated at 3-month follow-up in the FCM group (p=0.004). Patients manifesting more RV function improvement were more likely to exhibit higher degrees of LVEF-improvement (p<0.05 for all).

CONCLUSIONS: Treatment with FCM in HFrEF patients results in an improvement in RV function and structure and improves the RV-contractile reserve.

PMID:35303390 | DOI:10.1002/ejhf.2489

Health Promot J Austr. 2022 Mar 18. doi: 10.1002/hpja.597. Online ahead of print.

ABSTRACT

ISSUE ADDRESSED: Socio-economic spatial patterning of fast-food outlets can result in disparities in the availability and access of food across geographic areas, contributing to health inequalities. This study investigated whether area-level socio-economic disparities exist in fast-food availability across the Perth metropolitan region of Western Australia.

METHODS: Fast-food outlet locations were sourced from Perth Local Governments in 2018/2019. All Perth suburbs (n=328) were allocated a decile ranking based on the Australian Bureau of Statistics Socio-Economic Index for Areas with decile 1 indicating relatively greater disadvantage and decile 10 indicating a relative lack of disadvantage. Zero-inflated negative binomial regression models, adjusted for suburb area and population density, were used to investigate the association between area-level disadvantage decile and availability of fast-food outlets.

RESULTS: A socio-economic gradient was identified; for every unit increase in disadvantage decile (i.e., a reduction in relative disadvantage), the count of fast-food outlets decreased by 6% (p<0.01), and the count of the “top ranking” fast-food chains (i.e., McDonalds, KFC, Hungry Jacks and Red Rooster) decreased by 10% (p < 0.001).

CONCLUSIONS: Consistent with evidence internationally and from within Australia, socio-economic spatial patterning of fast-food outlet availability was shown to exist in Perth, with greater fast-food availability in areas with more relative socio-economic disadvantage. SO WHAT?: To address health inequities associated with fast-food consumption, policy and practice changes are needed that manage fast-food outlet proliferation in areas of greater socio-economic disadvantage.

PMID:35303384 | DOI:10.1002/hpja.597

Orthod Craniofac Res. 2022 Mar 18. doi: 10.1111/ocr.12569. Online ahead of print.

ABSTRACT

OBJECTIVES: This systematic review and meta-analysis aimed to evaluate the effectiveness of using maxillary protraction during different stages of the dentition by assessing changes in the jaws and inclination of incisors.

MATERIALS AND METHODS: MEDLINE (PubMed), Embase, Cochrane, Web Of Science, China National Knowledge Infrastructure, and Wanfang Databases were searched without time limitations up to the 15th January 2022. Google Scholar was used to search grey literature. We included cohort studies that compared the effect of maxillary protraction by analyzing primary outcomes and were grouped in age-related conditions. Mean differences and 95% confidence intervals were used for statistical analysis, followed by Grading of Recommendations Assessment, Development and Evaluation analysis.

RESULTS: Six studies were finally included. The heterogeneity test showed P≥0.1 and I² ≤50%, and a fixed-effect model was applied. Patients in the early treatment group (ETG) were mainly in the early-mixed dentition stage, while patients in the late-treatment group (LTG) were in the late-mixed and early-permanent dentition stage. Meta-analysis showed that there were no statistical differences (P>0.05) between the ETG and LTG groups in terms of SNA (the angle composed by point Sella-Nasion-Subspinale), SNB (the angle composed by point Sella-Nasion-Supramentale), ANB (the angle composed by point Subspinale-Nasion-Supramentale), Wits, U1/SN (the angle composed by the axis of upper incisors and Sella-Nasion plane), and L1/MP (the angle composed by the axis of lower incisors and the mandibular plane).

CONCLUSION: Our analysis showed that maxillary protraction applied in the late-mixed or early-permanent dentition stage did not cause different effects on the maxillary growth, the correction of the intermaxillary relationship, the inhibition of mandibular growth, and dental tipping of skeletal class III patients when compared with that in the early-mixed dentition stage. Collectively, these data provide a theoretical basis for widening the applicable age period of maxillary protraction and choosing the best treatment opportunity for children patients after a comprehensive assessment.

PMID:35303382 | DOI:10.1111/ocr.12569

J Sci Food Agric. 2022 Mar 18. doi: 10.1002/jsfa.11881. Online ahead of print.

ABSTRACT

BACKGROUND: Probiotics and prebiotics are widely used as natural feed additives in the nutrition of farm animals, including poultry. The using of this type of preparations has a positive effect on animal welfare, human health and the environment. High potential is attributed to preparations combining probiotics and prebiotics, called synbiotics. The aim of the research was to confirm the beneficial effects of synbiotics on turkey’s performance and the number of dominant intestinal microbiota. In addition, we also investigated the concentration of organic acids (lactic acid, fatty acids: short chain – SCFA and branched chain – BCFA) in the excreta of turkeys.

RESULTS: The synbiotic supplementation of turkey’s caused statistically significant (P < 0.05) differences in body weight of animals and European Production Efficiency Factor (EPEF) compared to control group after 15 weeks of rearing. The administration of the synbiotics resulted in a significant (P < 0.05) reduction in the count of potential pathogens (Clostridium spp., Clostridium coccoides and Escherichia coli), while a significant (P < 0.05) increase in the count of beneficial microorganisms (lactobacilli and Bifidobacterium spp.) in the excreta of turkeys. Result of the synbiotic supplementation, the SCFAs and lactic acid concentration were significantly (P < 0.05) increased, while the BCFAs concentration were decreased.

CONLUSION: The results showed a beneficial influence of the synbiotics on the animal’s performance, the dominant intestinal microbiota, and the fatty acids profile in the excreta of turkeys. The developed synbiotics can be effectively used in turkey’s nutrition. This article is protected by copyright. All rights reserved.

PMID:35303378 | DOI:10.1002/jsfa.11881

Am J Hematol. 2022 Mar 18. doi: 10.1002/ajh.26540. Online ahead of print.

NO ABSTRACT

PMID:35303371 | DOI:10.1002/ajh.26540

Vet Rec. 2022 Mar;190(6):e1384. doi: 10.1002/vetr.1384.

ABSTRACT

BACKGROUND: Since 2013, badger culling has been part of the UK Government’s strategy for controlling bovine tuberculosis (bTB) within a high-risk area (HRA) in England. Government surveillance data now enables an examination of bTB herd incidence and prevalence, its headline indicators, within and outside cull areas over the period 2009-2020.

METHODS: Analysis compared herd incidence and prevalence data from within and outside badger culling areas. A range of models (GLMs, GLMMs, GAMs and GAMMs) were used to analyse incidence and prevalence in culled and unculled areas using frequentist and Bayesian approaches. Change in incidence across ten county areas within the HRA for the period 2010-2020 was also compared.

RESULTS: Analyses based on Defra published data using a variety of statistical methodologies did not suggest that badger culling affected herd bTB incidence or prevalence over the study period. In 9 of 10 counties, bTB incidence peaked and began to fall before badger culling commenced.

LIMITATIONS: There are limitations around the data available on culling location, temporal information and other confounding factors. As such, further analysis of any future datasets that may be released on bTB levels in areas where badger culling has been implemented is warranted.

CONCLUSION: This examination of government data obtained over a wide area and a long time period failed to identify a meaningful effect of badger culling on bTB in English cattle herds. These findings may have implications for the use of badger culling in current and future bTB control policy.

PMID:35303326 | DOI:10.1002/vetr.1384

Fam Med. 2022 Mar;54(3):221-225. doi: 10.22454/FamMed.2022.864395.

ABSTRACT

BACKGROUND AND OBJECTIVES: Family physicians play a crucial role in addressing the opioid epidemic. We studied a novel peer-review opioid prescribing educational intervention for family medicine residents that incorporates guided instruction from an interdisciplinary care team.

METHODS: We used a mixed-methods study design in the setting of a family medicine residency program in the Midwestern United States. Residents participated in small group, peer-to-peer discussions of patients chronically prescribed opioids with guidance and input from faculty, a pharmacist, and pharmacy students. Discussions followed a structured approach to evaluation based on guidelines, and written recommendations were given to the patients’ resident primary care physician (PCP). For each patient, we reviewed electronic medical records to assess whether PCPs implemented the written recommendations. We used one-way analyses of variance to determine the statistical significance of changes made. The principal investigator interviewed seven participating residents to survey their satisfaction with the curriculum and collated suggestions for improvement.

RESULTS: Over a 3-year period, we reviewed 59 patients as part of the intervention; of these, 53 had complete records reviewed for this study. Patients’ morphine milligram equivalent dosage (MME) declined modestly (P=.035). The number and proportion of recommendations implemented was correlated with the decline in MME (P=.004 and P=.013, respectively). Interviewed residents unanimously evaluated the curriculum positively, citing that the structured approach helped align their practices with guidelines.

CONCLUSIONS: The guided peer-review intervention effectively decreased chronic opioid use among patients, and residents positively evaluated the curriculum.

PMID:35303305 | DOI:10.22454/FamMed.2022.864395

Fam Med. 2022 Mar;54(3):216-220. doi: 10.22454/FamMed.2022.698419.

ABSTRACT

BACKGROUND AND OBJECTIVES: HIV preexposure prophylaxis (PrEP) has been purposefully incorporated into our family medicine resident training within existing didactic lectures, readings, and routine office visit precepting. This mixed-methods evaluation assesses training strategies for PrEP use via survey and drug use evaluation (DUE).

METHODS: We surveyed 80 current and former family medicine residents (2014-2018) about their exposure to training components, self-reported confidence and competency in PrEP use, and practice behaviors reflecting CDC guidelines for patient eligibility and testing. In addition, we conducted a DUE of patients receiving PrEP from 2012-2018 for adherence to CDC guidelines. We report results with descriptive statistics, with χ2 analysis for group comparisons.

RESULTS: Survey response rate was 56.3%. Among respondents, 46.7% have prescribed PrEP and 55.5% self-assessed as competent to prescribe PrEP, with the majority (84%) rating precepting as most effective for building competence. Those self-assessed as competent were more likely to endorse practice behaviors reflecting CDC guidelines for monitoring PrEP (P&lt;.05). DUE identified 68 patients; 98.5% men who have sex with men. No women with recent sexually transmitted infections, nor persons who inject drugs (PWID) received PrEP. Initial testing completion ranged from 79.4% (HIV) to 54.4% (hepatitis B). Follow-up testing completion ranged from 41.5% (HIV) to 26.4% (syphilis).

CONCLUSIONS: Residents rated precepting as the most effective training. However, DUE demonstrated that PrEP underuse, as well as suboptimal testing, limited experiential training on CDC guidelines. Curricular updates should further emphasize appropriate patient selection for PrEP, including women, minorities, and PWID, as well as robust testing, to continue expanding PrEP access.

PMID:35303304 | DOI:10.22454/FamMed.2022.698419

Curr Nutr Rep. 2022 Mar 18. doi: 10.1007/s13668-022-00405-4. Online ahead of print.

ABSTRACT

PURPOSE OF REVIEW: Drug-resistant epilepsy represents around one-quarter of epilepsies worldwide. Although ketogenic diets (KD) have been used for refractory epilepsy since 1921, the past 15 years have witnessed an explosion of KD use in the management of epilepsy. We aimed to review evidence from randomized controlled trials (RCTs) regarding the efficacy and safety of KD in drug-resistant epilepsy in children and adolescents.

RECENT FINDINGS: A literature search was performed in the Pubmed, Cohrane, Scopus, ClinicalTrials.gov, and Google Scholar databases. Predefined criteria were implemented regarding data extraction and study quality. Data were extracted from 14 RCTs in 1114 children and adolescents aged from 6 months to 18 years. Primary outcome was seizure reduction after the intervention. In 6 out of the 14 studies, there was a statistical significant seizure reduction by > 50% in the KD-treated group compared with the control group over a follow-up of 3-4 months. Secondary outcomes were adverse events, seizure severity, quality of life, and behavior. Gastrointestinal symptoms were the most frequent adverse events. Serious adverse events were rare. We conclude that the KD is an effective treatment for drug-resistant epilepsy in children and adolescents. Accordingly, RCTs investigating long-term impact, cognitive and behavioral effects, and cost-effectiveness are much anticipated.

PMID:35303283 | DOI:10.1007/s13668-022-00405-4