Nevin Manimala

AIDS Patient Care STDS. 2023 Mar 24. doi: 10.1089/apc.2022.0220. Online ahead of print.

ABSTRACT

HIV and other sexually transmitted infections (STIs) are on the rise nationally and internationally. The coronavirus 2019 (COVID-19) pandemic drove a shift toward telemedicine and prioritization of symptomatic treatment over asymptomatic screening. The impact in safety-net settings, which faced disproportionate baseline STI/HIV rates rooted in structural inequities, and where many patients lack telemedicine resources, is not yet known. This study describes the impact of COVID-19 on STI/HIV testing at an urban safety-net hospital. We used descriptive statistics to compare hospital-wide chlamydia, gonorrhea, syphilis, and HIV testing volume and positivity rates in the following periods: prepandemic (July 1, 2019-February 29, 2020), peak-pandemic (March 1, 2020-May 31, 2020), and postpeak (June 1, 2020-August 31, 2021). STI and HIV test volume dropped sharply in March 2020. STI testing during the peak-pandemic period was 42% of prepandemic baseline (mean 1145 vs. 2738 tests/month) and nadired in April 2020 (766 tests/month). Similarly, peak-pandemic HIV testing was 43% of prepandemic baseline (mean 711 vs. 1635 tests/month) and nadired in April 2020 with 438 tests/month, concentrated in emergency department and inpatient settings. STI and HIV testing rates did not return to baseline for a full year. STI and HIV test positivity rates were higher in the peak-pandemic period compared with the prepandemic baseline. Given the precipitous decline in STI and HIV testing during the pandemic, safety-net settings should develop low-barrier alternatives to traditional office-based testing to mitigate testing gaps, high positivity rates, and associated morbidity.

PMID:36961407 | DOI:10.1089/apc.2022.0220

Telemed J E Health. 2023 Mar 24. doi: 10.1089/tmj.2022.0536. Online ahead of print.

ABSTRACT

Background: There is growing interest in the incorporation of video consultations in primary care. Remote medical devices used for remote physical examinations are a new complementary addition to these consultations and may increase their effectiveness. This study examines a social behavioral-technological model by the factors predicting the acceptance of video consultation with or without a technological medical device, their perceived ease of use (PEU), and their perceived usefulness (PU), as well as social behavioral factors: trust and shared decision making. Methods: We conducted an online survey among patients who had visited a physician during 2021 and had the option to receive video consultations with or without remote medical devices. Structural equation modeling was applied to assess the proposed model of predicting the extent of future telemedicine use. Results: Among the 1,198 patient responders, the intention to use telemedicine video consultation had a significant positive association with trust, shared decision making, PEU, and PU and with high socioeconomic constructs. The intention to use telemedicine video consultation with a medical device had a significant positive association with shared decision making, PEU, and PU. The statistical results suggest a good fit with the proposed models. Conclusions: The proposed social behavioral-technological model demonstrated that to successfully adopt video consultations and new remote medical devices in primary care, there is a need for trust and shared decision making to be established in patient-physician relationships.

PMID:36961399 | DOI:10.1089/tmj.2022.0536

Ther Hypothermia Temp Manag. 2023 Mar 24. doi: 10.1089/ther.2022.0048. Online ahead of print.

ABSTRACT

Hypoxic-ischemic encephalopathy (HIE) and associated multiorgan injury are significant causes of morbidity and mortality in term and near-term neonates. Therapeutic hypothermia (TH) is the current standard of care for neuroprotection in neonates with HIE. In our experience, the majority of babies born with HIE were found in nontertiary care facilities in our region, where effective methods of cooling during transport to tertiary care centers are desirable. Most centers initiate passive TH at referral hospitals, while active cooling is typically initiated during transport. The objective of this study was to evaluate the effectiveness of three methods of cooling during transport of neonates with HIE in southern Alberta. In this prospective cohort study, 186 neonates with HIE were transported between January 2013 and December 2021. Among the 186 neonates, 47 were passively cooled, 36 actively cooled with gel packs, and 103 cooled with a servo-controlled cooling device. The clinical characteristics were comparable for the three groups, with no difference in adverse events. Fifteen neonates (8%) died and 54 neonates (29%) suffered radiologically determined brain injury. Servo-controlled cooling was found to be superior to other methods in maintaining a target temperature without significant fluctuation during transport and with temperature in the target range on arrival at tertiary care facilities. The rate of overcooling was also lower in the servo-controlled group compared with other groups. There were no statistically significant differences between the groups in relation to mortality and brain MRI changes associated with HIE. Adjusting for GA, 10-minute Apgar score, base excess, HIE stage, and need for intubation during transport, passive cooling increased the odds of temperature fluctuation outside the range by 12-fold and gel pack cooling by 13-fold compared with servo-controlled cooling. The use of servo-controlled TH devices should be the preferred practice wherever feasible. (REB17-1334_REN3).

PMID:36961391 | DOI:10.1089/ther.2022.0048

Mol Ecol Resour. 2023 Mar 24. doi: 10.1111/1755-0998.13789. Online ahead of print.

ABSTRACT

Understanding the evolutionary consequences of anthropogenic change is imperative for estimating long-term species resilience. While contemporary genomic data can provide us with important insights into recent demographic histories, investigating past change using present genomic data alone has limitations. In comparison, temporal genomics studies, defined herein as those that incorporate time series genomic data, leverage museum collections and repeated field sampling to directly examine evolutionary change. As temporal genomics is applied to more systems, species, and questions, best practices can be helpful guides to make the most efficient use of limited resources. Here, we conduct a systematic literature review to synthesize the effects of temporal genomics methodology on our ability to detect evolutionary changes. We focus on studies investigating recent change within the past 200 years, highlighting evolutionary processes that have occurred during the past two centuries of accelerated anthropogenic pressure. We first identify the most frequently studied taxa, systems, questions, and drivers, before highlighting overlooked areas where further temporal genomic studies may be particularly enlightening. Then, we provide guidelines for future study and sample designs while identifying key considerations that may influence statistical and analytical power. Our aim is to provide recommendations to a broad array of researchers interested in using temporal genomics in their work.

PMID:36961384 | DOI:10.1111/1755-0998.13789

Am J Clin Oncol. 2023 Mar 24. doi: 10.1097/COC.0000000000001001. Online ahead of print.

ABSTRACT

OBJECTIVES: There is little data describing the outcomes for patients who develop local recurrences after stereotactic body radiation therapy (SBRT), a standard-of-care treatment for patients with early-stage non-small cell lung cancer. One emerging option is salvage lobectomy. We investigated trends in the use of salvage lobectomy after SBRT and described patient outcomes using a nationally representative sample.

METHODS: This is a retrospective study using the National Cancer Database of patients with non-small cell lung cancer diagnosed from 2004 to 2017. We used descriptive statistics to describe patients who underwent salvage lobectomy. Kaplan-Meier analysis was used to estimate overall survival (OS). Cox proportional modeling was used to identify factors associated with OS.

RESULTS: We identified 276 patients who underwent salvage lobectomy. Ninety-day mortality was 0%. The median survival time for the cohort was 50 months (95% CI, 44 to 58). Median follow-up was 65 months (Interquartile Range: 39 to 96). The factors associated with decreased OS include squamous cell histology (hazard ratio (HR)=1.72, P=0.005) and high grade (1.50, P=0.038). Increased OS was associated with lobectomy performed between 3 and 6 months after SBRT (HR=0.53, P=0.021), lobectomy performed >6 months after SBRT (HR=0.59, P=0.015), and female sex (HR=0.56, P=0.004).

CONCLUSIONS: Salvage lobectomy after local failures of SBRT was associated with no perioperative mortality and favorable long-term outcomes. Our data suggest that lobectomy performed within 3 months of SBRT is associated with worse OS.

PMID:36961366 | DOI:10.1097/COC.0000000000001001

Psychosom Med. 2023 Mar 15. doi: 10.1097/PSY.0000000000001192. Online ahead of print.

ABSTRACT

OBJECTIVE: Sexual and physical abuse are highly prevalent among women living with HIV (WLWH) and are risk factors for development of mental health and substance use disorders (MHDs, SUDs), and cognitive and medical co-morbidities. We examined empirically-derived patterns of trauma, MHD, and SUD, and associations with later cognitive and health outcomes.

METHODS: 1027 WLWH (average age = 48.6 years) in the Women’s Interagency HIV Study completed the World Mental Health-Composite International Diagnostic Interview during 2010-2013 to identify MHDs, SUDs, and age at onset of sexual and physical abuse. Then, cognitive impairment, cardiovascular/metabolic conditions, and HIV disease outcomes were assessed for up to 8.8 years. Latent class analysis (LCA) identified patterns of co-occurring trauma, MHDs, and/or SUDs. Generalized estimating equations determined associations between these patterns and mid-life cognitive and medical outcomes.

RESULTS: Six distinct profiles emerged: no/negligible sexual/physical trauma, MHD, or SUD (39%); preadolescent/adolescent sexual trauma with anxiety and SUD (22%); SUD only (16%); MHD + SUD only (12%); early childhood sexual/physical trauma only (6%); and early childhood sexual/physical trauma with later MHD + SUD (4%). Profiles including early childhood trauma had the largest number of mid-life conditions (i.e., cognitive, cardiovascular, HIV-related). Preadolescent/adolescent sexual trauma with anxiety and SUD predicted both global and domain-specific cognitive decline. Only SUD without trauma predicted lower CD4, while childhood trauma with MHD + SUD predicted increased CD8.

CONCLUSIONS: WLWH have complex multisystem profiles of abuse, MHD, and/or SUD that predict midlife cognitive, metabolic/cardiovascular, and HIV outcomes. Understanding the interplay between these factors over time can identify risks and personalize preventative and treatment interventions.

PMID:36961349 | DOI:10.1097/PSY.0000000000001192

Bioinformatics. 2023 Mar 24:btad154. doi: 10.1093/bioinformatics/btad154. Online ahead of print.

ABSTRACT

SUMMARY: HiCube is a lightweight web application for interactive visualization and exploration of diverse types of genomics data at multiscale resolutions. Especially, HiCube displays synchronized views of Hi-C contact maps and three-dimensional (3D) genome structures with user-friendly annotation and configuration tools, thereby facilitating the study of 3D genome organization and function.

AVAILABILITY AND IMPLEMENTATION: HiCube is implemented in Javascript and can be installed via NPM. The source code is freely available at GitHub (https://github.com/wmalab/HiCube).

SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

PMID:36961339 | DOI:10.1093/bioinformatics/btad154

Eur J Cardiothorac Surg. 2023 Mar 24:ezad102. doi: 10.1093/ejcts/ezad102. Online ahead of print.

ABSTRACT

OBJECTIVES: The optimal treatment for acute type A aortic dissection (AAAD) with thrombosed false lumen (T-FL) of the ascending aorta remains controversial. This study aimed to the evaluate clinical outcomes of initial medical treatment (IMT) and the effectiveness of thoracic endovascular aortic repair (TEVAR) for AAAD with T-FL.

METHODS: We retrospectively analysed 60 AAAD with T-FL patients. Emergent aortic repair was performed in 33 patients and IMT was selected in 27 uncomplicated patients with ascending aortic diameter < 50 mm and ascending T-FL thickness ≤ 10 mm.

RESULTS: Among the 27 patients who received IMT, 14 had intramural haematoma at admission; however, new ulcer-like projections appeared in 7 (50%) during hospitalization. Before discharge, 12 (44%) were treated with only medical treatment and 15 (56%) required delayed aortic repair including TEVAR in 8 and open repair in 7. The median interval from onset to delayed repair was 9 days and significantly more patients received TEVAR compared to those receiving emergent repair (53% vs 21%; P = 0.043). Between TEVAR (n = 15) and open repair (n = 33), one (7%) 30-day mortality occurred in TEVAR, whereas no in-hospital mortality occurred in open repair. During the median follow-up time of 24.8 months, no aorta-related death was observed and there were no statistically significant differences in the freedom rate from aortic events (TEVAR: 92.8%/3 years vs open repair: 88.4%/3 years; P = 0.871).

CONCLUSIONS: Our management with a combination of emergent aortic repair, IMT, and delayed aortic repair for AAAD with T-FL achieved favourable clinical outcomes. In the selected Japanese patients, IMT with repeated MDCT could detect a new intimal tear which could be closed by TEVAR in some cases and TEVAR for this pathology resulted in acceptable early and mid-term outcomes. Further investigations are required to validate the safety and efficacy of this management.

PMID:36961338 | DOI:10.1093/ejcts/ezad102

Rheumatology (Oxford). 2023 Mar 24:kead138. doi: 10.1093/rheumatology/kead138. Online ahead of print.

ABSTRACT

OBJECTIVES: To investigate the association between decreased serum IgG levels caused by remission-induction immunosuppressive therapy of antineutrophil cytoplasmic antibody-associated vasculitis (AAV) and the development of severe infections.

METHODS: We conducted a retrospective cohort study of patients with new-onset or severe relapsing AAV enrolled in the J-CANVAS registry, which was established at 24 referral sites in Japan. The minimum serum IgG levels up to 24 weeks and the incidence of severe infection up to 48 weeks after treatment initiation were evaluated. After multiple imputations for all explanatory variables, we performed the multivariate analysis using a Fine-Gray model to assess the association between low IgG (the minimum IgG levels < 500 mg/dl) and severe infections. In addition, the association was expressed as a restricted cubic spline (RCS) and analysed by treatment subgroups.

RESULTS: Of 657 included patients (microscopic polyangiitis, 392; granulomatosis with polyangiitis, 139; eosinophilic granulomatosis with polyangiitis, 126), 111 (16.9%) developed severe infections. The minimum serum IgG levels were measured in 510 patients, of whom 77 (15.1%) had low IgG. After multiple imputations, the confounder-adjusted hazard ratio of low IgG for the incidence of severe infections was 1.75 (95% confidence interval: 1.03-3.00). The RCS revealed a U-shaped association between serum IgG levels and the incidence of severe infection with serum IgG 946 mg/dl as the lowest point. Subgroup analysis showed no obvious heterogeneity between treatment regimens.

CONCLUSION: Regardless of treatment regimens, low IgG after remission-induction treatment was associated with the development of severe infections up to 48 weeks after treatment initiation.

PMID:36961329 | DOI:10.1093/rheumatology/kead138

Pol J Vet Sci. 2023 Mar;26(1):91-98. doi: 10.24425/pjvs.2023.145010.

ABSTRACT

The aim of the present study was to determine the effects of Luteolin (LUT) on semen quality, oxidative stress, apoptosis, acrosomal integrity, mitochondrial membrane potential and dead sperm ratio in rabbits. Ejaculates from six New Zealand rabbits were collected, evaluated and pooled. The pooling was divided into five groups as control (no additive) LUT 25 µM, LUT 50 µM, LUT 100 µM and LUT 200 µM and LUT added. It was then filled into a falcon tube with Tris-based extender at a final concentration of approximately 35 x 106 spermatozoa. Diluated rabbit semen samples were drawn into frozen and thawed. Frozen semen straws were thawed at 37°C in 30 seconds. According to our findings, no statistical difference was found between all doses of luteolin and the control group in the CASA (computer assisted sperm analysis) analysis performed at 4°C. However, total motility, progressive motility and rapid sperm percentage were found to be higher in the frozen and thawed rabbit semen at a dose of LUT 50 µM compared to the other groups (p⟨0.05). While amplitude of lateral head displacement (ALH) and beat cross-frequency (BCF) values were found at the lowest dose of LUT 200 µM, a statistically significant difference was observed between the other groups. When the flow cytometry results were examined, no statistical difference was found between the rate of dead sperm, acrosomal integrity, mitochondrial membrane potential and apoptosis rate. Morever, the H2 O2 percentage was found to be lower in all experimental groups compared to the control group (p⟨0.001). In conclusion, the addition of LUT in long-term storage of rabbit semen provided a protective effect for spermatozoa with its antioxidative properties against damage caused by cryopreservation.

PMID:36961262 | DOI:10.24425/pjvs.2023.145010