Nevin Manimala

Eur Rev Med Pharmacol Sci. 2022 Oct;26(20):7695-7704. doi: 10.26355/eurrev_202210_30046.

ABSTRACT

OBJECTIVE: The majority of children experience a mild course of acute Coronavirus Disease 2019 (COVID-19). Only few studies have looked at long-term recovery from COVID-19 infection in children. The purpose of this study was to identify the predictors of long-COVID by performing a thorough analysis of the clinical, laboratory, and demographic characteristics of children with COVID-19.

PATIENTS AND METHODS: Between August and October 2021, data were obtained retrospectively from the medical records of 251 children diagnosed with COVID-19 at a tertiary single-center hospital. The prognostic effects of admission-related factors were compared between patients who experienced long-lasting symptoms and those who did not.

RESULTS: Long-COVID symptoms were noted in 12.4% of patients. Joint pain (7.6%), lumbago (4.8%), and headache (3.2%) were the most common symptoms. The mean onset of long-COVID symptoms was 1.35±0.49 months. The onset of long-COVID symptoms was 4 weeks after initial diagnosis in 64.5% of patients and 4-8 weeks later in 35.5% of the patients. The mean duration of long-COVID symptoms was 5.32±2.51 months. Children with long-COVID had higher leukocytes, neutrophils, monocytes, basophils, platelets, and D-dimer when compared with patients without long-COVID (p < 0.001). Leukocytes, neutrophils, monocytes, platelets, and D-dimer had the highest AUC in the ROC analysis (0.694, 0.658, 0.681, 0.667, and 0.612, respectively) and were statistically significant.

CONCLUSIONS: Despite the majority of children with COVID-19 having mild or asymptomatic acute disease, the majority of long-COVID symptoms were associated with functional impairment between 1 and 9 months after the start of the infection. Increased leukocytes, monocytes, neutrophils, platelets, and D-dimer appear to be the most powerful laboratory predictors for long-COVID and monitoring these predictors may assist clinicians to identify and follow-up patients with higher risk for long-COVID.

PMID:36314341 | DOI:10.26355/eurrev_202210_30046

Eur Rev Med Pharmacol Sci. 2022 Oct;26(20):7667-7678. doi: 10.26355/eurrev_202210_30043.

ABSTRACT

OBJECTIVE: Activation of the PI3K/AKT/mTOR pathway in patients with HER2-positive breast cancer is associated with acquired resistance to trastuzumab. This randomized controlled trial (RCTs) meta-analysis was designed to evaluate the clinical efficacy and safety of PI3K/Akt/mTOR inhibitors in combination with trastuzumab in HER2-positive breast cancer.

MATERIALS AND METHODS: We searched on Web of Knowledge, PubMed, Embase, Cochrane, CNKI, and ClinicalTrials.Gov for RCTs comparing PI3K/Akt/mTOR inhibitors plus trastuzumab vs. standard trastuzumab treatments. Pooled estimates of progression-free survival (PFS), pathologic complete response (pCR), and incidence of adverse events were determined.

RESULTS: 5 studies out of 610 were found to be eligible and were included in our analysis (n=1,548 participants). PI3K/Akt/mTOR inhibitors combination with trastuzumab treatments resulted in a statistically significant increase in PFS compared with conventional trastuzumab therapy (HR 0.82; 95% CI: 0.76-0.90; p<0.00001). The new combination treatment was more effective on hormone receptor-negative patients (HR 0.73; 95% CI: 0.58-0.93; p=0.010). In addition, the combination of PI3K/Akt/mTOR inhibitors with trastuzumab slightly increased the risk of some adverse events, such as neutropenia, leukopenia, fatigue, and anemia.

CONCLUSIONS: The combination treatments of PI3K/Akt/mTOR inhibitors and trastuzumab for PI3K/Akt/mTOR inhibitors combined with trastuzumab treatments for patients with HER2-positive breast cancer can improve median progression-free survival while increasing the incidence of adverse events. It is still controversial based on the current evidence. Due to the limited number and quality of included studies, more high-quality studies are needed for further analysis.

PMID:36314338 | DOI:10.26355/eurrev_202210_30043

Eur Rev Med Pharmacol Sci. 2022 Oct;26(20):7594-7599. doi: 10.26355/eurrev_202210_30034.

ABSTRACT

OBJECTIVE: The aim of the study was to investigate the existence of neuroendocrine cells and to compare the density of those in normal ovarian tissue, endometriotic and non-endometriotic benign ovarian cysts.

PATIENTS AND METHODS: Twenty patients with the diagnosis of endometrioma and 30 control subjects consisting of ovarian serous cystadenoma (n=10), ovarian mucinous cystadenoma (n=10) and normal ovarian tissue (n=10) were included. The tissues were prepared and assessed according to staining density by using the H-score method.

RESULTS: Tissues with mucinous cystadenoma were significantly more stained with PAS and VanGieson, when compared to women with endometrioma. Macrophage deposition was higher in cyst samples with endometrioma and in normal ovarian tissue when compared to serous cystadenoma and mucinous cystadenoma. Normal ovarian tissue was significantly more stained with PGP9.5, NSE and SYN when compared to endometrioma and non-endometriotic benign ovarian cyst. PGP9.5 staining was higher in normal ovarian tissue when compared with endometriotic lesions (p<.001). Endometrioma samples were significantly more stained with p53 when compared to non-endometriotic cysts and normal ovarian tissue. c-Kit staining was mild and not statistically significant among all groups.

CONCLUSIONS: During endometrioma transformation, expression intensity of neuroendocrine markers decreases compared to normal ovarian tissue and other benign ovarian cysts.

PMID:36314331 | DOI:10.26355/eurrev_202210_30034

Eur Rev Med Pharmacol Sci. 2022 Oct;26(20):7541-7549. doi: 10.26355/eurrev_202210_30025.

ABSTRACT

OBJECTIVE: The aim of the current study was to describe the alternation pattern of cerebral and ocular blood flow velocities (BFVs) in symptomatic patients with unilateral carotid stenosis after carotid endarterectomy.

PATIENTS AND METHODS: 20 symptomatic patients underwent carotid endarterectomy for ≥ 50% unilateral carotid stenosis. Cerebral and ocular hemodynamics were evaluated by Transcranial Doppler (TCD) and Color Doppler imaging (CDI), respectively, first preoperatively, then during the following several days after carotid endarterectomy before discharge, and finally two to sixteen months later.

RESULTS: Statistically significant improvements in the BFVs were recorded in the ipsilateral anterior cerebral artery (ACA), middle cerebral artery (MCV) and short posterior ciliary artery (SPCA) during the following several days after carotid endarterectomy. Preoperative retrograde flows of the ipsilateral ophthalmic artery (OA) in two patients returned to anterograde direction immediately following carotid endarterectomy. At the follow-up of two to sixteen months, the BFVs of the ipsilateral ACA, MCA and SPCA tended to decline and were no longer statistically significant from the preoperative values.

CONCLUSIONS: Carotid endarterectomy significantly increased the flow velocities of ipsilateral cerebral anterior circulation and OA branching artery in patients with unilateral carotid stenosis early after surgery. At the long-term follow-up, the flow velocities in the ipsilateral hemisphere had the tendency to reduce and approach the preoperative level.

PMID:36314325 | DOI:10.26355/eurrev_202210_30025

Eur Rev Med Pharmacol Sci. 2022 Oct;26(20):7514-7521. doi: 10.26355/eurrev_202210_30022.

ABSTRACT

OBJECTIVE: Acute pancreatitis (AP) is one of the diseases that surgical clinics deal with the most. While mortality rates are approximately 1% in all cases, this rate may increase to 15% in pancreatic necrosis cases. Therefore, early diagnosis and treatment are very important in necrotizing pancreatitis. Our aim in this study is to present the guiding effectiveness of procalcitonin and immature granulocyte ratios (IG%) in planning the early diagnosis and treatment of acute necrotizing pancreatitis.

PATIENTS AND METHODS: 582 patients hospitalized in our clinic with the diagnosis of acute pancreatitis were included in this study. All patients were divided into two groups as acute edematous pancreatitis (AEP) and acute necrotizing pancreatitis (ANP) according to tomography results. White blood cell (WBC) count, procalcitonin, IG%, C-reactive protein (CRP), amylase and lipase, albumin, CRP/albumin levels were recorded. The differences between the two groups were analyzed statistically.

RESULTS: According to the results of contrast-enhanced abdominal tomography (CECT), 525 patients were diagnosed with AEP and 57 with ANP. WBC, CRP, procalcitonin, IG and CRP/albumin were found to be significantly higher in ANP patients when compared to AEP (p<0.0001). According to the ROC analysis result, procalcitonin (AUROC: 0.999), IG% (AUROC: 0.995), WBC count (AUROC: 0.841), CRP (AUROC: 0.947), albumin (AUROC: 0.862), and CRP/albumin (AUROC: 0.946) ratio were markers that could be used for early prediction of ANP.

CONCLUSIONS: Early diagnosis of ANP can reduce morbidity and mortality. Procalcitonin and IG% levels can be easily accessible and effective markers in the early diagnosis of ANP and in the planning of treatment.

PMID:36314322 | DOI:10.26355/eurrev_202210_30022

Eur Rev Med Pharmacol Sci. 2022 Oct;26(20):7454-7460. doi: 10.26355/eurrev_202210_30014.

ABSTRACT

OBJECTIVE: This study used the Sniffin’ Sticks test battery to evaluate olfactory function in employees of a bakery exposed to flour dust.

SUBJECTS AND METHODS: The study enrolled 43 individuals with exposure (i.e., to flour) plus 41 healthy volunteers as controls. Olfactory function was assessed in these subjects through the use of the Sniffin’ Sticks test battery. The overall score was calculated by adding up the scores for each of the 12 separate odors. A score of 6 or less was deemed anosmia, from 7 to 10 hyposmia, and a score of 11 or 12 was taken to indicate no impairment of olfaction.

RESULTS: There was a statistically significant difference between the scores obtained in the exposure group (10.09±2.29) and the control group (10.73±2.07), the exposure group having a lower score (p<0.05). Within the exposure group, men and women did not score differently (p>0.05). Furthermore, in this group, the overall score did not correlate significantly with age, sex, length of employment, or use of tobacco or alcohol use (p>0.05). Using the scheme employed in this study, 9.3% of the exposed workers were anosmic, compared to 9.8% in the controls, whereas 34.9% of baker workers were hyposmic, compared to just 14.6% of the controls. Thus, our study shows that impairment of the ability to smell was present in 44.2% of individuals exposed occupationally to flour dust.

CONCLUSIONS: This study reveals that being exposed to flour dust reduces the ability to smell normally. In order to minimize the impact of being exposed, workplaces should ensure adequate ventilation and provide workers with protective facemasks.

PMID:36314315 | DOI:10.26355/eurrev_202210_30014

Eur Rev Med Pharmacol Sci. 2022 Oct;26(20):7344-7348. doi: 10.26355/eurrev_202210_30003.

ABSTRACT

OBJECTIVE: An interaction between hereditary and environmental variables is thought to be the cause of keratoconus, a progressive ectatic corneal condition. The identification of risk factors is necessary since they are currently the subject of intense debate and are crucial to the management and prevention of the disease. The objective of this study is to gain a better understanding of the risk factors associated with the onset and progression of keratoconus. It would be valuable for both eye care professionals and patients in Saudi Arabia.

PATIENTS AND METHODS: Patients seeking eye care at Qassim University eye clinic were included in this study. Participants were divided into: cases (with keratoconus) and control (without keratoconus but with other ocular problems). Keratoconus diagnoses of the participants were made by the attending optometrists or ophthalmologists. Multivariate logistic analyses were performed to identify the risk factors for keratoconus. Moreover, by performing logistic regression and CART analysis, supervised learning algorithms were developed to predict the likelihood of keratoconus based on the risk factors.

RESULTS: There were 75 keratoconus patients and 75 control. The CART model to predict the chances of keratoconus occurrence has an accuracy of 73%. Our prediction model can be a baseline model for future risk factor analysis studies that will be done in the Middle Eastern region. The models can be better trained by refining the risk factor quality and also by increasing the keratoconus population in the study. Including clinical parameters in the prediction models would result in complex as well as models with better prediction accuracy.

CONCLUSIONS: Clinical ocular parameters including the corneal topographic variables have to be obtained to better correlate the risk factors with specific changes or the subtypes of the keratoconus. Complex diseases like keratoconus require machine learning models apart from statistical analysis for association and causation. Machine learning models would not only predict the disease but also provide insight into how the risk factors interact with each other.

PMID:36314304 | DOI:10.26355/eurrev_202210_30003

Diabetes Obes Metab. 2022 Oct 31. doi: 10.1111/dom.14911. Online ahead of print.

ABSTRACT

AIMS: Co-management of weight and glycemia is critical yet challenging in type 1 diabetes (T1D). We evaluated the effect of a hypocaloric low carbohydrate, hypocaloric moderate low fat, and Mediterranean diet without calorie restriction on weight and glycemia in young adults with T1D and overweight or obesity.

MATERIALS AND METHODS: We implemented a nine-month Sequential, Multiple Assignment, Randomized Trial pilot among adults aged 19-30 years with T1D for ≥1 year and BMI 27-39.9 kg/m² . Re-randomization occurred at 3- and 6-months if the assigned diet was not acceptable or not effective. We report results from the initial three-month diet period and rerandomization statistics prior to shutdowns due to COVID-19 for primary (weight, hemoglobin A1c [HbA1c], percent of time below range [%TBR] <70 mg/dL) and secondary outcomes (body fat percentage [BFP], percent of time in range [70-180 mg/dL], and %TBR <54 mg/dL). Models adjusted for design, demographic, and clinical covariates tested changes in outcomes and diet differences.

RESULTS: Adjusted weight and HbA1c (n=38) changed by -2.7 kg (95%CI -3.8, -1.5, p<0.0001) and -0.91 percentage points (95%CI -1.5, -0.30, p=0.005), respectively, while adjusted BFP remained stable, on average (p=0.21). Hypoglycemia indices remained unchanged, on average, following adjustment (n=28, p>0.05). Variability in all outcomes, including weight change, was considerable (57.9% were re-randomized primarily due to loss of <2% body weight). No outcomes varied by diet.

CONCLUSIONS: Three months of a diet, irrespective of macronutrient distribution or caloric restriction, resulted in weight loss while improving HbA1c levels without increasing hypoglycemia in adults with T1D. This article is protected by copyright. All rights reserved.

PMID:36314293 | DOI:10.1111/dom.14911

Skin Res Technol. 2022 Oct 31. doi: 10.1111/srt.13225. Online ahead of print.

ABSTRACT

BACKGROUND: Radiofrequency (RF) devices have been used for skin rejuvenation and treating skin laxity. It may also be effective for senile purpura (SP) based on its action of promoting neocollagenesis with minimal epidermal damage. This study aimed to evaluate the efficacy and safety of microneedle RF for treating SP of the forearms in elderly.

MATERIAL AND METHODS: In this prospective study, 23 patients who underwent a single session of microneedle RF device (GENIUS, Lutronic Co., Korea) therapy for SP were enrolled. Histopathological features were assessed 1 week before and 8 weeks after therapy. The total amount of collagen and elastic fibers were measured using the computer vision method, and epidermal thickness and the number of blood vessels were analyzed using ImageJ. The clinical improvements were evaluated by blinded evaluators and the patients using investigator global assessment (IGA) and patient global assessment (PGA), respectively. Data regarding the number of purpuric lesions and the size of the largest lesion were collected via a telephone survey.

RESULTS: The total amount of collagen and elastic fibers, and mean epidermal thickness tended to improve after RF treatments, although they did not reach statistical significance. The locally estimated scatterplot smoothing curve showed decreasing tendency in both size and number of purpuras as weeks progressed. PGA showed very satisfied in 65% of patients and IGA showed 39% near-total improvement and 43% marked improvement. There were no serious adverse events.

CONCLUSIONS: Microneedle RF therapy induces remodeling of dermal circumstances with minimal epidermal impairment. It may be a promising therapeutic option for SP.

PMID:36314292 | DOI:10.1111/srt.13225

Nanoscale. 2022 Oct 31. doi: 10.1039/d2nr04668g. Online ahead of print.

ABSTRACT

Designing nano-engineered particles capable of the delivery of therapeutic and diagnostic agents to a specific target remains a significant challenge. Understanding how interactions between particles and cells are impacted by the physicochemical properties of the particle will help inform rational design choices. Mathematical and computational techniques allow for details regarding particle-cell interactions to be isolated from the interwoven set of biological, chemical, and physical phenomena involved in the particle delivery process. Here we present a machine learning framework capable of elucidating particle-cell interactions from experimental data. This framework employs a data-driven modelling approach, augmented by established biological knowledge. Crucially, the model of particle-cell interactions learned by the framework can be interpreted and analysed, in contrast to the ‘black box’ models inherent to other machine learning approaches. We apply the framework to association data for thirty different particle-cell pairs. This library of data contains both adherent and suspension cell lines, as well as a diverse collection of particles. We consider hyperbranched polymer and poly(methacrylic acid) particles, from 6 nm to 1032 nm in diameter, with small molecule, monoclonal antibody, and peptide surface functionalisations. Despite the diverse nature of the experiments, the learned models of particle-cell interactions for each particle-cell pair are remarkably consistent: out of 2048 potential models, only four unique models are learned. The models reveal that nonlinear saturation effects are a key feature governing particle-cell interactions. Further, the framework provides robust estimates of particle performance, which facilitates quantitative evaluation of particle design choices.

PMID:36314284 | DOI:10.1039/d2nr04668g