Nevin Manimala

BMJ Open. 2022 Nov 25;12(11):e064673. doi: 10.1136/bmjopen-2022-064673.

ABSTRACT

OBJECTIVE: Antenatal care (ANC) is crucial to protecting the health of pregnant women and their unborn children; however, the uptake of ANC among pregnant women in low and middle-income countries (LMICs) is suboptimal. One popular strategy to increase the uptake of health services, including ANC visits, are conditional cash transfer (CCT) programmes. CCT programmes require beneficiaries to comply with certain conditionalities in order to receive a financial sum. A systematic review was carried out to determine whether CCT programmes have a positive impact on ANC uptake in LMIC populations.

METHODS: Electronic databases CENTRAL, MEDLINE, Embase, Maternity and Infant Care and Global Health were searched from database inception to 21 January 2022. Reference checking and grey literature searches were also applied. Eligible study designs were randomised controlled trials, controlled before-after studies and interrupted time series analysis. Risk of bias assessments were undertaken for each study by applying the Risk of Bias 2 tool and the Risk of Bias in Non-randomised Studies of Interventions tool.

RESULTS: Out of 1534 screened articles, 18 publications were included for analysis. Eight studies reported statistically non-significant results on all reported outcomes. Seven studies demonstrated statistically significant positive effects ranging from 5.5% to 45% increase in ANC service uptake. A further three studies reported small but statistically significant impact of CCT on the use of ANC services in both positive (2.5% increase) and negative (3.7% decrease) directions. Subanalysis of results disaggregated by socioeconomic status (SES) indicated that ANC attendance may be more markedly improved by CCT programmes in low SES populations; however, results were inconclusive.

CONCLUSION: Our evidence synthesis presented here demonstrated a highly heterogeneous evidence base pertaining to the impact of CCTs on ANC attendance. More high-powered studies are required to elucidate the true impact of CCT programmes on ANC uptake, with particular focus on the barriers and enablers of such programmes in achieving intended outcomes.

PMID:36428017 | DOI:10.1136/bmjopen-2022-064673

BMJ Open. 2022 Nov 25;12(11):e060169. doi: 10.1136/bmjopen-2021-060169.

ABSTRACT

OBJECTIVES: The main objective was to investigate 5-year outcomes in patients with knee osteoarthritis, randomised to one of two non-surgical treatments.

SETTING: Two outpatient clinics.

PARTICIPANTS: At baseline, 100 patients with radiographic and symptomatic knee osteoarthritis not found eligible for knee replacement (KR) were included. Main exclusion criteria were average score above 75 of the Knee injury and Osteoarthritis Outcome Score (KOOS) subscales pain, symptoms, function of daily living and quality of life; KOOS₄ and average knee pain the previous week greater than 60 mm on a 100 mm visual analogue scale.

INTERVENTIONS: Patients were randomised to supervised non-surgical treatment consisting of patient education, supervised exercise, weight loss, insoles, and pain medication (the MEDIC treatment) or written advice. The 12-week MEDIC treatment included patient education, neuromuscular exercise, insoles and a dietary weight loss programme and/or pain medication if needed and written advice consisted of two leaflets.

PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome was 5-year mean change for KOOS₄. Secondary outcomes included KOOS subscales, self-reported health, usage of pain medication and self-reported physical activity.

RESULTS: Thirty-nine (78%) and 36 (72%) from the MEDIC and written advice groups responded at 5 years. There were no between-group differences in KOOS₄ (difference 5.3 (95% CI -1.5 to 12.1) or any secondary outcomes. However, the 95% CI included the minimal clinically important difference for the main outcome.Seventy-six percent of the MEDIC group and 66% of the written advice group experienced clinically important improvements in KOOS₄.Fifteen patients (30%) from the MEDIC group and 17 (34%) from the written advice group received KR in the index knee. Undergoing KR did not result in a statistically significant greater improvement in KOOS₄ (difference 6.1 (95% CI -1.1 to 13.4).

CONCLUSIONS: No statistically significant differences between supervised non-surgical treatment and written advice were demonstrated at 5 years. Most patients experienced clinically important improvements, irrespective of initial treatment strategy or KR.

TRIAL REGISTRATION NUMBER: NCT01535001; ClinicalTrials.gov.

PMID:36428014 | DOI:10.1136/bmjopen-2021-060169

Taiwan J Obstet Gynecol. 2022 Nov;61(6):984-988. doi: 10.1016/j.tjog.2021.01.034.

ABSTRACT

OBJECTIVE: To assess whether chronic endometritis (CE) affects embryo implantation in patients with repeated implantation failure (RIF).

MATERIALS AND METHODS: We retrospectively analyzed 126 RIF patients who were never diagnosed with CE and received no prior antibiotic therapy. Endometrial specimens obtained by endometrial scratching during mid-luteal phase were immunostained by CD138, a hallmark plasmacyte marker, to identify CE. Pregnancy outcome in RIF patients who underwent IVF-ET frozen-embryo within transfers 6 months after endometrial scratching was compared between women with and without CE.

RESULTS: The prevalence of CE in patients with RIF was found to be 11.9% (15/126). Moreover, a significantly reduced clinical pregnancy rate was observed in RIF patients with CE (20% vs. 46.85%; p = 0.04). The live birth rate also exhibited a decreasing trend in RIF patients with CE, although there was no statistically significant difference (20% vs. 41.58%; p = 0.109).

CONCLUSIONS: CE may be involved in the failure of embryo implantation and reduced clinical pregnancy outcome in patients with RIF.

PMID:36428002 | DOI:10.1016/j.tjog.2021.01.034

Taiwan J Obstet Gynecol. 2022 Nov;61(6):960-964. doi: 10.1016/j.tjog.2022.06.013.

ABSTRACT

OBJECTIVE: Our aim in this study is to determine the relationship between TPOAb positivity and pregnancy outcomes in the subclinical hypothyroid patient group.

MATERIALS AND METHODS: This study was started with 21,321 pregnant women, but after the exclusion criteria, 11,387 pregnant women were included int his study. Demographic characteristics of each patient group included in the study, such as age, bodymass index (BMI), and laboratory parameters such as complete blood count (hemogram), liver and kidney function tests, type of delivery, birth weight, neonatal intensive care admission, 1st and 5th minute APGAR scores, glucose tolerance test results, whether there was high blood pressure during pregnancy, whether there was premature rupture of membranes were recorded from the hospital information system and patient files.

RESULTS: Pregnant women with subclinical hypothyroidism were divided into groups according to their TPOAb status. When maternal and neonatal outcomes were evaluated between groups; Among these four groups there was a statistically significant difference only in impaired glucose tolerance (IGT) antibody groups with and without subclinical hypothyroidism according to their positivity (p < 0.01). When the euthyroid TPOAb negative group was taken as reference, the risk of impaired and TPOAb positive groups (OR: 1.210; 95% CI: 0.936-1.563; P = 0.145), impaired in the group with subclinical hypothyroidism but TPOAb positivity glucose tolerance 1.358(OR: 1.358); 95% CI: 1.042-1.770; P = 0.023) fold increased by 3.556 (OR: 3.556) in the group with subclinical hypothyroidism and TPOAb positivity; (95% CI: 2.37-5.343; p < 0,001).

CONCLUSION: In ourstudy, there was a significant difference only in terms of IGT between the Groups with and without subclinical hypothyroidism, depending on whether they were positive for TPOAb or not. Therefore, studies in volving larger patient groups are needed.

PMID:36427998 | DOI:10.1016/j.tjog.2022.06.013

Andrology. 2022 Nov 25. doi: 10.1111/andr.13346. Online ahead of print.

ABSTRACT

BACKGROUND: Prostate biopsy represents one of the most frequently performed urologic procedures worldwide and therefore presupposes knowledge on potential effects like on erectile function, especially in extensive or repeated biopsies. The robotic assisted biopsy system (Mona Lisa) offers a minimal invasive approach via only two incision points ensuring maximal accuracy combined with protection of the neurovascular bundle of the prostate.

OBJECTIVE: Our purpose was to analyse the impact of of robotic-assisted transperineal biopsy of the prostate on erectile function.

METHODS: Our prospective study analyses the outcomes of 210 patients, who had undergone minimal-invasive, transperineal robotic assisted biopsy of the prostate at the University Hospital Basel from January 2020 – March 2023 and provided sufficient data. Of these, 157 (74.8%) were included in final analysis.

RESULTS: Mean (range) age, prostate volume, PSA and IIEF-5 score at baseline were 63.8 years (46.1 – 83.6), 46.4 ml (9 – 310), 13.2 ng/ml (0.2 – 561) and 18.8 points (6 – 25), respectively. EF before and one month after intervention was assessed with the IIEF-5 questionnaire for the whole cohort. No significant change of IIEF-5 was observed for the whole cohort with a mean (± SD) decrease of 0.4 (± 3.1) points. Except for patients > 69 years, subgroup analysis revealed no change of IIEF-5 in statistically significant manner for all subgroups. Number of biopsy cores (< 20 and ≥ 20), previous biopsies and active surveillance showed no significant influence.

CONCLUSION: Our results suggest that the minimally invasive and highly precise robotic technique can spare erectile function without limiting the extent of biopsy and without compromising diagnostic accuracy. This article is protected by copyright. All rights reserved.

PMID:36427333 | DOI:10.1111/andr.13346

Sci Adv. 2022 Nov 25;8(47):eabq4609. doi: 10.1126/sciadv.abq4609. Epub 2022 Nov 25.

ABSTRACT

Tumor vasculature is a key component of the tumor microenvironment that can influence tumor behavior and therapeutic resistance. We present a new imaging biomarker, quantitative vessel tortuosity (QVT), and evaluate its association with response and survival in patients with non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitor (ICI) therapies. A total of 507 cases were used to evaluate different aspects of the QVT biomarkers. QVT features were extracted from computed tomography imaging of patients before and after ICI therapy to capture the tortuosity, curvature, density, and branching statistics of the nodule vasculature. Our results showed that QVT features were prognostic of OS (HR = 3.14, 0.95% CI = 1.2 to 9.68, P = 0.0006, C-index = 0.61) and could predict ICI response with AUCs of 0.66, 0.61, and 0.67 on three validation sets. Our study shows that QVT imaging biomarker could potentially aid in predicting and monitoring response to ICI in patients with NSCLC.

PMID:36427313 | DOI:10.1126/sciadv.abq4609

IEEE Trans Neural Netw Learn Syst. 2022 Nov 25;PP. doi: 10.1109/TNNLS.2022.3223212. Online ahead of print.

ABSTRACT

The feature representation learning process greatly determines the performance of networks in classification tasks. By combining multiscale geometric tools and networks, better representation and learning can be achieved. However, relatively fixed geometric features and multiscale structures are always used. In this article, we propose a more flexible framework called the multiscale dynamic curvelet scattering network (MSDCCN). This data-driven dynamic network is based on multiscale geometric prior knowledge. First, multiresolution scattering and multiscale curvelet features are efficiently aggregated in different levels. Then, these features can be reused in networks flexibly and dynamically, depending on the multiscale intervention flag. The initial value of this flag is based on the complexity assessment, and it is updated according to feature sparsity statistics on the pretrained model. With the multiscale dynamic reuse structure, the feature representation learning process can be improved in the following training process. Also, multistage fine-tuning can be performed to further improve the classification accuracy. Furthermore, a novel multiscale dynamic curvelet scattering module, which is more flexible, is developed to be further embedded into other networks. Extensive experimental results show that better classification accuracies can be achieved by MSDCCN. In addition, necessary evaluation experiments have been performed, including convergence analysis, insight analysis, and adaptability analysis.

PMID:36427283 | DOI:10.1109/TNNLS.2022.3223212

Rev Esc Enferm USP. 2022 Nov 25;56:e20220146. doi: 10.1590/1980-220X-REEUSP-2022-0146en. eCollection 2022.

ABSTRACT

OBJECTIVE: to identify the rate of reactive treponemal and non-treponemal tests in pregnant women during childbirth and to analyze the factors associated with this seroreactivity.

METHOD: this is a cross-sectional, quantitative study with secondary sources of sociodemographic and clinical data on 2,626 pregnant women treated at a public maternity hospital in the interior of São Paulo, in 2020. For statistical analysis, Fisher’s exact test, Mann-Whitney test and the logistic regression model were used. A difference of p < 0.05 was considered statistically significant.

RESULTS: the rate of seropositivity for syphilis among pregnant women in this series was 2.74%. Among the groups with positive and non-reactive tests, marital status, occupation, place of residence and use of licit drugs indicated significant differences, but, in the final model, only unmarried marital status was associated with reactive tests (Odds Ratio: 0.169; Confidence Interval: 0.04-0.72; and p: 0.016).

CONCLUSION: in this study, unmarried marital status was the only independent factor associated with seroreactivity for syphilis. Therefore, it is necessary to create strategies aimed at women in this condition, potentially reducing the rate of congenital syphilis.

PMID:36427270 | DOI:10.1590/1980-220X-REEUSP-2022-0146en

Brain Behav. 2022 Nov 25:e2829. doi: 10.1002/brb3.2829. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of this study was to explore simultaneous brain network responses to electroacupuncture stimulation (EAS) at scalp acupoints by accounting for placebo effects.

MATERIALS AND METHODS: Sixty healthy subjects were recruited and randomly divided into two groups: Group 1 and Group 2. Functional magnetic resonance imaging (fMRI) was performed in Group 1 with sham acupuncture stimulation at acupoints Shenting (GV24) and Touwei (ST8) without EAS. Group 2 underwent verum EAS at the same acupoints during fMRI. Independent component analysis was used to analyze the fMRI data. Full-factor statistical analysis was used to compare the differences in fMRI data between the two groups and evaluate the changes in functional connectivity in brain networks after verum electrical stimulation (Group 1 [after sham electrical current stimulation – before sham electrical current stimulation] – Group 2 [after verum electrical current stimulation – before verum electrical current stimulation]) (p <.001, extent threshold k = 20 voxels).

RESULTS: Six brain networks were identified. Significant increased functional connectivity was observed in the right and left executive control networks, sensorimotor network, and attention network, while decreased functional connectivity was mainly found in the default mode network. There were no statistically significant differences in the salience network.

CONCLUSIONS: fMRI with simultaneous EAS provides a method to explore brain network responses due to EAS at scalp acupoints. The networks responsible for cognition are differentially activated by EAS in a coordinated manner.

PMID:36427258 | DOI:10.1002/brb3.2829

Cochrane Database Syst Rev. 2022 Nov 25;11:CD011335. doi: 10.1002/14651858.CD011335.pub3.

ABSTRACT

BACKGROUND: Cognitive deficits are common in people who have received cranial irradiation and have a serious impact on daily functioning and quality of life. The benefit of pharmacological and non-pharmacological treatment of cognitive deficits in this population is unclear. This is an updated version of the original Cochrane Review published in Issue 12, 2014.

OBJECTIVES: To assess the effectiveness of interventions for preventing or ameliorating cognitive deficits in adults treated with cranial irradiation.

SEARCH METHODS: For this review update we searched the Cochrane Register of Controlled Trials (CENTRAL), MEDLINE via Ovid, Embase via Ovid, and PsycInfo via Ovid to 12 September 2022.

SELECTION CRITERIA: We included randomised controlled (RCTs) trials that evaluated pharmacological or non-pharmacological interventions in cranial irradiated adults, with objective cognitive functioning as a primary or secondary outcome measure.

DATA COLLECTION AND ANALYSIS: Two review authors (MK, JD) independently extracted data from selected studies and carried out a risk of bias assessment. Cognitive function, fatigue and mood outcomes were reported. No data were pooled.

MAIN RESULTS: Eight studies met the inclusion criteria and were included in this updated review. Six were from the original version of the review, and two more were added when the search was updated. Nineteen further studies were assessed as part of this update but did not fulfil the inclusion criteria. Of the eight included studies, four studies investigated “prevention” of cognitive problems (during radiotherapy and follow-up) and four studies investigated “amelioration” (interventions to treat cognitive impairment as a late complication of radiotherapy). There were five pharmacological studies (two studies on prevention and three in amelioration) and three non-pharmacological studies (two on prevention and one in amelioration). Due to differences between studies in the interventions being evaluated, a meta-analysis was not possible. Studies in early radiotherapy treatment phase (five studies) Pharmacological studies in the “early radiotherapy treatment phase” were designed to prevent or ameliorate cognitive deficits and included drugs used in dementia (memantine) and fatigue (d-threo-methylphenidate hydrochloride). Non-pharmacological studies in the “early radiotherapy treatment phase” included a ketogenic diet and a two-week cognitive rehabilitation and problem-solving programme. In the memantine study, the primary cognitive outcome of memory at six months did not reach significance, but there was significant improvement in overall cognitive function compared to placebo, with similar adverse events across groups. The d-threo-methylphenidate hydrochloride study found no statistically significant difference between arms, with few adverse events. The study of a calorie-restricted ketogenic diet found no effect, although a lower than expected calorie intake in the control group complicates interpretation of the results. The study investigating the utility of a rehabilitation program did not carry out a statistical comparison of cognitive performance between groups. Studies in delayed radiation or late effect phase (four studies) The “amelioration” pharmacological studies to treat cognitive complications of radiotherapy included drugs used in dementia (donepezil) or psychostimulants (methylphenidate and modafinil). Non-pharmacological measures included cognitive rehabilitation and problem solving (Goal Management Training). These studies included patients with cognitive problems at entry who had “stable” brain cancer. The donepezil study did not find an improvement in the primary cognitive outcome of overall cognitive performance, but did find improvement in an individual test of memory, compared to placebo; adverse events were not reported. A study comparing methylphenidate with modafinil found improvements in cognitive function in both the methylphenidate and modafinil arms; few adverse events were reported. Another study comparing two different doses of modafinil combined treatment arms and found improvements across all cognitive tests, however, a number of adverse events were reported. Both studies were limited by a small sample size. The Goal Management Training study suggested a benefit of the intervention, a behavioural intervention that combined mindfulness and strategy training, on executive function and processing speed. There were a number of limitations across studies and few were without high risks of bias.

AUTHORS’ CONCLUSIONS: In this update, limited additional evidence was found for the treatment or amelioration of cognitive deficits in adults treated with cranial irradiation. As concluded in the original review, there is supportive evidence that memantine may help prevent cognitive deficits for adults with brain metastases receiving cranial irradiation. There is supportive evidence that donepezil, methylphenidate and modafinil may have a role in treating cognitive deficits in adults with brain tumours who have been treated with cranial irradiation; patient withdrawal affected the statistical power of these studies. Further research that tries to minimise the withdrawal of consent, and subsequently reduce the requirement for imputation procedures, may offer a higher certainty of evidence. There is evidence from only a single small study to support non-pharmacological interventions in the amelioration of cognitive deficits. Further research is required.

PMID:36427235 | DOI:10.1002/14651858.CD011335.pub3