Nevin Manimala

AIDS Behav. 2022 Nov 11. doi: 10.1007/s10461-022-03851-x. Online ahead of print.

ABSTRACT

HIV/HCV prevention among people who inject drugs (PWID) is of key public health importance. We aimed to assess the impact of COVID-19 and associated response measures on HIV/HCV prevention services and socio-economic status of PWID in high-HIV-risk sites. Sites with recent (2011-2019) HIV outbreaks among PWID in Europe North America and Israel, that had been previously identified, were contacted early May 2020. Out of 17 sites invited to participate, 13 accepted. Semi-structured qualitative site reports were prepared covering data from March to May 2020, analyzed/coded and confirmed with a structured questionnaire, in which all sites explicitly responded to all 103 issues reported in the qualitative reports. Opioid maintenance treatment, needle/syringe programs and antiretroviral treatment /hepatitis C treatment continued, but with important reductions and operational changes. Increases in overdoses, widespread difficulties with food and hygiene needs, disruptions in drug supply, and increased homelessness were reported. Service programs rapidly reformed long established, and politically entrenched, restrictive service delivery policies. Future epidemic control measures should include mitigation of negative side-effects on service provision and socio-economic determinants in PWID.

PMID:36367613 | DOI:10.1007/s10461-022-03851-x

Environ Geochem Health. 2022 Nov 11. doi: 10.1007/s10653-022-01429-z. Online ahead of print.

ABSTRACT

Climate change has a significant impact on the intensity and spread of dengue outbreaks. The objective of this study is to assess the number of dengue transmission suitable days (DTSD) in Pakistan for the baseline (1976-2005) and future (2006-2035, 2041-2070, and 2071-2099) periods under Representative Concentration Pathway (RCP4.5 and RCP8.5) scenarios. Moreover, potential spatiotemporal shift and future hotspots of DTSD due to climate change were also identified. The analysis is based on fourteen CMIP5 models that have been downscaled and bias-corrected with quantile delta mapping technique, which addresses data stationarity constraints while preserving future climate signal. The results show a higher DTSD during the monsoon season in the baseline in the study area except for Sindh (SN) and South Punjab (SP). In future periods, there is a temporal shift (extension) towards pre- and post-monsoon. During the baseline period, the top ten hotspot cities with a higher frequency of DTSD are Karachi, Hyderabad, Sialkot, Jhelum, Lahore, Islamabad, Balakot, Peshawar, Kohat, and Faisalabad. However, as a result of climate change, there is an elevation-dependent shift in DTSD to high-altitude cities, e.g. in the 2020s, Kotli, Muzaffarabad, and Drosh; in the 2050s, Garhi Dopatta, Quetta, and Zhob; and in the 2080s, Chitral and Bunji. Karachi, Islamabad, and Balakot will remain highly vulnerable to dengue outbreaks for all the future periods of the twenty-first century. Our findings also indicate that DTSD would spread across Pakistan, particularly in areas where we have never seen dengue infections previously. The good news is that the DTSD in current hotspot cities is projected to decrease in the future due to climate change. There is also a temporal shift in the region during the post- and pre-monsoon season, which provides suitable breeding conditions for dengue mosquitos due to freshwater; therefore, local authorities need to take adaption and mitigation actions.

PMID:36367603 | DOI:10.1007/s10653-022-01429-z

Sex Transm Dis. 2022 Nov 11. doi: 10.1097/OLQ.0000000000001735. Online ahead of print.

ABSTRACT

BACKGROUND: Whether treatment, engagement in partner notification (PN), and PN outcomes differ between clients of internet-based and clinic-based testing services is poorly understood. We compared these outcomes between people diagnosed with chlamydia and/or gonorrhea (CT/GC) through a sexually transmitted infection (STI) clinic service and GetCheckedOnline GCO), an internet based testing service in British Columbia (BC).

METHODS: We conducted a retrospective matched cohort study among CT/GC cases where each case diagnosed through GCO in 2016-2017 was matched to two STI clinic cases by diagnosis, gender, age group, and specimen collection date. Data was collected through chart review with outcomes compared using appropriate statistical tests.

RESULTS: Of 257 GCO and 514 matched clinic cases, case treatment was high and did not differ between GCO (254/257, 98.9%) and clinic (513/514, 99.8%) cases, as was engagement in partner notification (250/257 (97.2%) vs. 496/514 (96.5%)). There was no difference in the proportion of notified partners between GCO (159/270, 58.9%) and clinic cases (253/435, 58.2%) although a greater proportion of partners reported by clinic cases were notified by STI nurses (43/435, 9.9%) vs. GCO cases (6/270, 2.2%).

CONCLUSIONS: GCO clients diagnosed with CT/GC demonstrated similar treatment uptake and engagement in PN to clinic clients, and PN outcomes did not differ. The greater reliance on STI clinic nurses for partner notification among clinic clients may be related to having had an initial in-person testing visit.

PMID:36367543 | DOI:10.1097/OLQ.0000000000001735

World Neurosurg. 2022 Sep 19:S1878-8750(22)01345-6. doi: 10.1016/j.wneu.2022.09.068. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate surgical outcomes and fusion rate following spinal fusion surgery in patients with chronic kidney disease and assess the impact of kidney function.

METHODS: From March 2017 to February 2021, 54 consecutive adult patients with chronic kidney disease who underwent spinal fusion surgery were enrolled. According to the glomerular filtration rate (GFR) categories, 35 and 19 patients were classified into the non-end-stage renal disease (ESRD) group (GFR categories 3a-4; eGFR, 15-59 mL/min/1.73 m²) and ESRD group (GFR category 5; eGFR, <15 mL/min/1.73 m²), respectively.

RESULTS: Baseline characteristics did not differ between the groups. The lumbar and thoracolumbar spines were the most operated. The mean number of fused vertebrae (4.9 ± 2.3 vs. 4.1 ± 2.0, P = 0.122), operative time (228.4 ± 129.6 min vs. 160.5 ± 87.5 min, P = 0.113), and surgical bleeding (743.1 ± 630.5 mL vs. 539.5 ± 384.4 mL, P = 0.354) did not differ between the groups. However, occurrence rates of medical complications (25.7% vs. 52.6%, P = 0.048) and 3-month readmission (8.6% vs. 35.3%, P = 0.045) were significantly different between the groups. While the 3-month mortality (10.5% vs. 2.9%, P = 0.28) and pseudarthrosis rates (35.3% vs. 9.1%, P = 0.047) were higher in the ESRD group, the difference was not statistically significant for the former entity.

CONCLUSIONS: Surgeons should consider the possibility of high morbidity and pseudarthrosis associated with spine surgeries when operating on patients with ESRD.

PMID:36367477 | DOI:10.1016/j.wneu.2022.09.068

J Hazard Mater. 2023 Feb 5;443(Pt A):130218. doi: 10.1016/j.jhazmat.2022.130218. Epub 2022 Oct 20.

ABSTRACT

Although significant headway has been achieved regarding method harmonisation for the analysis of microplastics, analysis and interpretation of control data has largely been overlooked. There is currently no consensus on the best method to utilise data generated from controls, and consequently many methods are arbitrarily employed. This study identified 6 commonly implemented strategies: a) No correction; b) Subtraction; c) Mean Subtraction; d) Spectral Similarity; e) Limits of detection/ limits of quantification (LOD/LOQ) or f) Statistical analysis, of which many variations are possible. Here, the 6 core methods and 45 variant methods (n = 51) thereof were used to correct a dummy dataset using control data. Most of the methods tested were too inflexible to account for the inherent variation present in microplastic data. Only 7 of the 51 methods tested (six LOD/LOQ methods and one statistical method) showed promise, removing between 96.3 % and 100 % of the contamination data from the dummy set. The remaining 44 methods resulted in deficient corrections for background contamination due to the heterogeneity of microplastics. These methods should be avoided in the future to avoid skewed results, especially in low abundance samples. Overall, LOD/LOQ methods or statistical analysis comparing means are recommended for future use in microplastic studies.

PMID:36367473 | DOI:10.1016/j.jhazmat.2022.130218

Kidney Int. 2022 Oct 28:S0085-2538(22)00910-3. doi: 10.1016/j.kint.2022.08.040. Online ahead of print.

ABSTRACT

In FIDELITY, a pre-specified pooled analysis of the FIDELIO-DKD and FIGARO-DKD studies, finerenone was found to improve cardiorenal outcomes in patients with type 2 diabetes, a urine albumin-to creatinine ratio of 30-5000 mg/g, an estimated glomerular filtration rate (eGFR) of 25 ml/min/1.73 m² or more and also receiving optimized renin-angiotensin system blockade treatment. This present analysis focused on the efficacy and safety of finerenone on kidney outcomes. Among 13,026 patients with a median follow-up of three years, finerenone significantly reduced the hazard of a kidney composite outcome (time to kidney failure, sustained 57% or more decrease in eGFR from baseline, or kidney death) by 23% versus placebo (hazard ratio 0.77; 95% confidence interval 0.67-0.88), with a three-year absolute between group difference of (1.7%; 0.7-2.6). Hazard ratios were directionally consistent for a pre-specified baseline eGFR and urine albumin to creatinine ratio categories (P-interaction 0.62 and P-interaction 0.67, respectively), although there was a high degree of uncertainty in the 30-300 mg/g subgroup. Finerenone significantly reduced the hazard of kidney failure by 20% versus placebo (0.80; 0.64-0.99). Adverse events were similar between treatment arms although hyperkalemia, leading to treatment discontinuation, occurred significantly more frequently with finerenone versus placebo (2.4% vs 0.8% and 0.6% vs 0.3% in patients with eGFR under vs 60 ml/min/1.73 m² and over, respectively). Thus, finerenone improved kidney outcomes, reduced the hazard of kidney failure, and is well tolerated in patients with chronic kidney disease and type 2 diabetes.

PMID:36367466 | DOI:10.1016/j.kint.2022.08.040

Radiol Imaging Cancer. 2022 Nov;4(6):e220053. doi: 10.1148/rycan.220053.

ABSTRACT

Purpose To evaluate the short-term safety of a nonmetallic twinkle marker and compare its conspicuity at color Doppler US with that of standard breast biopsy clips and radioactive seeds by using B-mode US in axillary lymph nodes. Materials and Methods This prospective study (November 2020-July 2021) of participants with node-positive breast cancer who completed chemotherapy involved placing a twinkle marker at the time of preoperative radioactive seed localization. A five-point scoring system (1 = easiest, 5 = most difficult) was used to rate the ease of identifying the clip, seed, and twinkle marker on postlocalization sonograms, mammograms, specimen radiographs, and gross pathologic specimens. Descriptive statistics were used. Results Eight women (mean age, 57 years ± 16 [SD]) were enrolled. The median scores for US conspicuity of each device were 3.9 (range, 3.7-5.0) for the radioactive seed, 2.4 (range, 1.0-5.0) for the clip, and 2.0 (range, 1.0-4.3) for the twinkle marker. In six of eight participants, the twinkle marker was the most identifiable at US. The seeds, clips, and twinkle markers were scored “very easy” to identify on seven of eight postlocalization mammograms. The surgeon retrieved all eight twinkle markers 1-3 days after localization. In all 16 interpretations, the seeds, clips, and twinkle markers were rated as very easy to identify on specimen radiographs. The clip was the most difficult device to identify at pathologic examination in all participants, and the twinkle marker was the easiest to identify in seven of eight participants. Conclusion This pilot study demonstrates that the safety and ease of US detection of a twinkling tissue marker may be comparable to a biopsy clip. Keywords: Ultrasonography, US-Doppler, Breast, Localization, Surgery Clinical trial registration no. NCT04674852 © RSNA, 2022.

PMID:36367449 | DOI:10.1148/rycan.220053

J Exp Biol. 2022 Nov 11:jeb.244590. doi: 10.1242/jeb.244590. Online ahead of print.

ABSTRACT

We analysed the trajectories of freely foraging Gymnotus sp., a pulse type gymnotiform weakly electric fish, swimming in a dark arena. We compared the fish’s initial behaviour as it learned the relative location of landmarks and food, to its behaviour after learning was complete, i.e., after time/distance to locate food had reached a minimal asymptotic level. During initial exploration when the fish did not know the arena layout, trajectories included many sharp angle head turns that occurred at nearly completely random intervals. After spatial learning was complete, head turns became far smoother. Interestingly, the fish still did not take a stereotyped direct route to the food but instead took smooth but variable curved trajectories. We measured the fish’s heading angle error (heading angle – heading angle towards food). After spatial learning, the fish’s initial heading angle errors were strongly biased to zero, i.e., the fish mostly turned towards the food. As the fish approached closer to the food, they switched to a random search strategy with a more uniform distribution of heading angle errors.

PMID:36366924 | DOI:10.1242/jeb.244590

Ann Palliat Med. 2022 Nov 2:apm-22-637. doi: 10.21037/apm-22-637. Online ahead of print.

ABSTRACT

BACKGROUND: Palliative care (PC) skills are important when caring for patients with advanced illness in a broad range of settings. Students need to be trained in communication and empathy, both representing essential PC skills. Therefore, creative approaches could promote the understanding of relevant PC skills.

METHODS: In an online lecture about graphic medicine, different medical comics (MC) were used to introduce the field of graphic medicine and to illustrate relevant skills in PC. After the lecture, an online survey was conducted. The survey consisted of each respondent`s sociodemographic profile and a questionnaire on multiple aspects related to the field of MC. Spearman correlation coefficients and Cohen’s effect sizes were used for statistical analysis.

RESULTS: The survey respondents comprised 668 students, 337 female, 326 male and 5 diverse. The results showed that the students had never (27.2%) or had very rarely (31.9%) been involved in with the field of MC. The largest number would rate their interest as somewhat or very interested (58.8%). When considering the use of MC to understand different perspectives, the students mainly rated them as useful (54.6%) or very useful (23.4%). Women had a more positive attitude towards MC than men (P<0.001). Students who placed more importance on PC skills were more likely to recommend the use of MC in general medical education (r=0.11, P=0.005). The majority of the students (58.8%) moderately or strongly agreed on the use of MC as a teaching method in PC.

CONCLUSIONS: After a single lecture on graphic medicine, the students were positive about using MC for teaching PC skills. Since the lecture was short and the majority of the medical students stated that they had not been previously exposed to the field of MC, this study demonstrates that it is promising to further use and evaluate a set of visual and narrative illustrations as a teaching method in PC.

PMID:36366897 | DOI:10.21037/apm-22-637

Clin Transl Sci. 2022 Nov 10. doi: 10.1111/cts.13432. Online ahead of print.

ABSTRACT

Kidney transplantation remains the therapeutic option for patients with end-stage kidney disease. Current immunosuppressive regimens are efficient in combating acute kidney rejection. However, insights into chronic kidney allograft injury remains limited. Simultaneously, pregnancy is more common after kidney transplantation than during dialysis treatment. Due to ethical issues, comprehensive studies on the impact of immunosuppressive regimens on pregnancy are challenging. The study aimed to investigate the proteomic status of lymphocytes obtained from pregnant female rats under immunosuppressive treatment. The experiment involved a group of 10 female, pregnant Wistar rats, five of which were treated with tacrolimus, mofetil mycophenolate, and glucocorticosteroids; five were used as control. The lymphocytes were obtained and analyzed with mass spectrometry. Measurements were processed by a database search in the ProteinPilot software with a cutoff of 1% false discovery rate. The outcomes were verified statistically by a t-test (p value < 0.05) regarding proteins up- and downregulation. A total of 2082 proteins were identified in all experiments. Eight hundred five proteins were quantified in an absolute manner in a data-independent acquisition-total protein approach analysis. Ninety-five proteins were recognized as present at different concentrations in analyzed groups and were annotated to intracellular pathways. The proteins involved in nonsense-mediated decay and L13a-mediated translational silencing of ceruloplasmin expression were recognized as downregulated. The set of proteins clinically identified as acute phase proteins was upregulated. Despite the blockade of adaptive cellular immunity, the lymphocytes in the analyzed group reveal sustained proinflammatory status with decreased ability to regulate translation. This potentially affects pregnancy and immunity.

PMID:36366854 | DOI:10.1111/cts.13432