Nevin Manimala

JAMA Netw Open. 2022 Jun 1;5(6):e2219217. doi: 10.1001/jamanetworkopen.2022.19217.

ABSTRACT

IMPORTANCE: The continued harm of Black individuals in the US by law enforcement officers calls for reform of both law enforcement officers and structural racism embedded in communities.

OBJECTIVE: To examine the association between county characteristics and racial and ethnic disparities in legal intervention injuries.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective, cross-sectional study was conducted among 27 671 patients presenting to California hospitals from January 1, 2016, to December 31, 2019, with legal intervention injuries (defined as any injury sustained as a result of an encounter with any law enforcement officer) as identified by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes.

MAIN OUTCOMES AND MEASURES: Legal intervention injuries were classified by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision external cause of injury code Y35. Expected injury counts were calculated for each county by multiplying statewide median rates of injury per capita for each age-racial and ethnic group, and then observed to expected injury ratios were measured. The association between county injury ratio, percentage of Black individuals, and residential segregation (measured using an index of dissimilarity) was modeled, stratifying by race and ethnicity.

RESULTS: A total of 27 671 patients (24 159 male patients [87.3%]; 1734 Asian and Pacific Islander [6.3%], 5049 Black [18.2%], 11 250 Hispanic [40.7%], and 9638 White [34.8%]; mean [SD] age, 34.2 [12.5] years) presented with legal intervention injuries in California from 2016 to 2019. Observed to expected injury ratios ranged from 0 to 7 for Black residents and from 0 to 5 for White residents. High observed to expected injury ratios for Black residents (408 observed vs 60 expected; ratio = 7) were clustered around San Francisco Bay Area counties and corresponded with a higher proportion of Black residents. High observed to expected injury ratios for White residents (57 observed vs 11 expected; ratio = 5) clustered around rural northern California counties and corresponded with higher mean percentage of residents with income below the federal poverty level and fewer urban areas.

CONCLUSIONS AND RELEVANCE: This study suggests that residential segregation may be associated with increased legal intervention injury rates for Black residents of California counties with a large percentage of Black residents. Reform efforts to address racial and ethnic disparities in these injuries should carefully consider and address the legacy of discriminatory policies that has led to segregated communities in California and the United States.

PMID:35767261 | DOI:10.1001/jamanetworkopen.2022.19217

JAMA Netw Open. 2022 Jun 1;5(6):e2219225. doi: 10.1001/jamanetworkopen.2022.19225.

ABSTRACT

IMPORTANCE: Fetal life and infancy might be critical periods for predisposing individuals to develop cardiovascular disease in adulthood.

OBJECTIVE: To examine the associations of fetal and infant weight growth patterns with early markers of arterial health.

DESIGN, SETTING, AND PARTICIPANTS: This population-based prospective cohort study was conducted from early fetal life onward among 4484 offspring of women in Rotterdam, the Netherlands, delivering between April 1, 2002, and January 31, 2006. Statistical analysis was performed between January 1 and August 31, 2021.

EXPOSURES: Estimated fetal weight was measured in the second and third trimester. Data on weight and gestational age at birth were collected from midwives. Infant weight was measured at 6, 12, and 24 months.

MAIN OUTCOMES AND MEASURES: The common carotid intima-media thickness (cIMT) and carotid distensibility were measured as early markers of arterial health.

RESULTS: Follow-up measurements were available for 4484 children (2260 girls [50.4%]; median age, 9.7 years [95% range, 9.3-10.5 years]; and 2578 [57.5%] of Dutch ethnicity). Gestational age at birth was not associated with markers of arterial health. A 500-g-higher birth weight was associated with increased cIMT (standard deviation score [SDS], 0.08 mm [95% CI, 0.05-0.10 mm]) and a lower carotid distensibility (SDS, -0.05 × 10-3 kPa-1; [95% CI, -0.08 to -0.03 × 10-3 kPa-1]). Compared with children with a birth weight of 2500 to 4500 g, those weighing more than 4500 g had the lowest carotid distensibility (difference in SDS, -0.22 × 10-3 kPa-1 [95% CI, -0.42 to -0.02 × 10-3 kPa-1]). Conditional regression analyses showed that higher third-trimester fetal weight and birth weight were associated with increased cIMT (difference in SDS: third-trimester fetal weight, 0.08 mm [95% CI, 0.04-0.12 mm]; birth weight, 0.05 mm [95% CI, 0.01-0.09 mm]) and that higher weight at 6, 12, and 24 months was associated with increased cIMT (difference in SDS: 6 months, 0.05 mm [95% CI, 0.01-0.10 mm]; 12 months, 0.06 mm [95% CI, 0.02-0.10 mm]; and 24 months, 0.07 mm [95% CI, 0.03-0.11 mm]) and lower carotid distensibility (difference in SDS: 6 months, -0.04 × 10-3 kPa-1 [95% CI, -0.09 to -0.001 × 10-3 kPa-1]; 12 months, -0.05 × 10-3 kPa-1 [95% CI, -0.09 to -0.01 × 10-3 kPa-1]; and 24 months, -0.10 × 10-3 kPa-1 [95% CI, -0.15 to -0.06 × 10-3 kPa-1]). Compared with children with normal fetal and infant growth, children with normal fetal growth that was followed by accelerated infant growth had the highest cIMT (SDS, 0.19 mm [95% CI, 0.07-0.31 mm]) and lowest carotid distensibility (SDS, -0.16 × 10-3 kPa-1 [95% CI, -0.28 to -0.03 × 10-3 kPa-1]). The observed associations were largely explained by childhood body mass index.

CONCLUSIONS AND RELEVANCE: In this cohort study of 4484 children aged approximately 10 years, higher fetal and infant weight growth patterns were associated with early markers of impaired arterial health. Childhood body mass index seemed to be involved in the underlying pathways of the observed associations.

PMID:35767260 | DOI:10.1001/jamanetworkopen.2022.19225

JAMA Dermatol. 2022 Jun 29. doi: 10.1001/jamadermatol.2022.2360. Online ahead of print.

ABSTRACT

IMPORTANCE: Tumor necrosis factor-α inhibitor (TNFi)-associated psoriasis is a rare adverse event following TNFi treatment. Data on the risk of developing TNFi-associated psoriasis when treated with TNFi are sparse.

OBJECTIVE: To investigate the associated risk between new-onset psoriasis and TNFi treatment compared with nonbiologic conventional treatment.

DESIGN, SETTING, AND PARTICIPANTS: Using Danish national registries (1995-2018), this cohort study included patients with inflammatory bowel disease (IBD) and/or rheumatoid arthritis (RA) who received either conventional therapy or TNFi treatment. Patients may not have been diagnosed with psoriasis prior to initiation of treatment. Patients were followed up for up to 5 years. Cox regression models with robust variance were used to compare the risk of developing any type of psoriasis, nonpustular psoriasis, and pustular psoriasis. Patients receiving conventional therapy were used as reference. Data analysis was performed from January 1995 to December 2018.

EXPOSURES: For the present study, the term conventional therapy was used for the nonbiological therapy. For biological therapy, a distinction was made between TNFi treatment and non-TNFi biological therapy.

MAIN OUTCOMES AND MEASURES: The outcome of psoriasis was defined as a registered International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code of psoriasis and/or having 2 consecutive prescriptions of topical vitamin D analogues.

RESULTS: The study included 109 085 patients, of which 62% were female. Median (IQR) age was 50 (34-64) years. Of the included patients, 108 024 received conventional therapy and 20 910 received TNFi treatment. During follow-up, 1471 (1.4%) patients developed any type of psoriasis, of which 1332 developed nonpustular psoriasis, 127 patients developed palmoplantar pustulosis, and 12 patients developed generalized pustulosis. The incidence rates for developing any type of psoriasis per 1000 patient-years were 3.0 (95% CI, 2.9-3.2) for conventional therapy and 7.8 (95% CI, 7.5-8.9) for TNFi. During treatment with TNFi, the hazard ratio was 2.12 (95% CI, 1.87-2.40; P < .001) for developing nonpustular psoriasis and 6.50 (95% CI, 4.60-9.23; P < .001) for pustular psoriasis compared with conventional treatment. Exposure needed for 1 additional patient to be harmed was 241 patient-years for any type of TNFi-associated psoriasis, 342 patient-years for nonpustular psoriasis, and 909 patient-years for pustular psoriasis.

CONCLUSIONS AND RELEVANCE: In a Danish nationwide cohort of patients with immune-mediated inflammatory diseases treated with TFNi or conventional treatment and no history of psoriasis, in TFNi-treated patients, nonpustular types of psoriasis constituted the most events, whereas pustular types of psoriasis had the highest relative risk. Although the risk of new-onset psoriasis increased for both nonpustular and pustular types of psoriasis in TFNi-treated patients, the absolute risk remained modest at 241 patient-years of exposure need for 1 additional event and an estimated absolute risk difference around 5 per 1000 patient-years, indicating that the approach to treatment of patients in need of TNFi treatment should not change.

PMID:35767240 | DOI:10.1001/jamadermatol.2022.2360

Scand J Clin Lab Invest. 2022 Jun 29:1-7. doi: 10.1080/00365513.2022.2092900. Online ahead of print.

ABSTRACT

BACKGROUND: Improving tissue perfusion can improve clinical outcomes in surgical patients, where monitoring may aid clinicians in detecting adverse conditions and guide interventions. Transcutaneous monitoring (TCM) of oxygen (tcpO₂) and carbon dioxide (tcpCO₂) is a well-proven technology and could potentially serve as a measure of local circulation, perfusion and metabolism, but the clinical use is not thoroughly explored. The purpose of this proof-of-concept study was to investigate whether TCM of blood gasses could detect changes in perfusion during major vascular surgery.

METHODS: Ten patients with peripheral arterial disease scheduled for lower limb major arterial revascularization under general anaesthesia were consecutively included. TcpO₂ and tcpCO₂ were continuously recorded from anaesthesia induction until skin closure with a TCM monitor placed on both legs and the thorax. Peripheral oxygen saturation was kept ≥94% and mean arterial blood pressure ≥65 mmHg. The primary outcomes were changes in tcpO₂ and tcpCO₂ related to arterial clamping and declamping during the procedure and analyzed by paired statistics.

RESULTS: Femoral artery clamping resulted in a significant decrease in tcpO₂ (-2.1 kPa, IQR-4.2; -0.8), p=.017)), followed by a significant increase in response to arterial declamping (5.5 kPa, IQR 0-7.3), p=.017)). Arterial clamping resulted in a statistically significant increase in tcpCO₂ (0.9 kPa, IQR 0.3-5.4), p=.008)) and a significant decrease following declamping (-0.7 kPa, IQR -2.6; -0.2), p=.011)).

CONCLUSION: Transcutaneous monitoring of oxygen and carbon dioxide is a feasible method for detection of extreme changes in tissue perfusion during arterial clamping and declamping, and its use for improving patient outcomes should be explored. Clinical Trials identifier: NCT04040478. Registered on July 31, 2019.

PMID:35767233 | DOI:10.1080/00365513.2022.2092900

J Magn Reson Imaging. 2022 Jun 29. doi: 10.1002/jmri.28328. Online ahead of print.

ABSTRACT

BACKGROUND: Left ventricular (LV) strain measurements can be derived using cardiac MRI from routinely acquired balanced steady-state free precession (bSSFP) cine images.

PURPOSE: To compare the interfield strength agreement of global systolic strain, peak strain rates and artificial intelligence (AI) landmark-based global longitudinal shortening at 1.5 T and 3 T.

STUDY TYPE: Prospective.

SUBJECTS: A total of 22 healthy individuals (mean age 36 ± 12 years; 45% male) completed two cardiac MRI scans at 1.5 T and 3 T in a randomized order within 30 minutes. FIELD STRENGTH/SEQUENCE: bSSFP cine images at 1.5 T and 3 T.

ASSESSMENT: Two software packages, Tissue Tracking (cvi42, Circle Cardiovascular Imaging) and QStrain (Medis Suite, Medis Medical Imaging Systems), were used to derive LV global systolic strain in the longitudinal, circumferential and radial directions and peak (systolic, early diastolic, and late diastolic) strain rates. Global longitudinal shortening and mitral annular plane systolic excursion (MAPSE) were measured using an AI deep neural network model.

STATISTICAL TESTS: Comparisons between field strengths were performed using Wilcoxon signed-rank test (P value < 0.05 considered statistically significant). Agreement was determined using intraclass correlation coefficients (ICCs) and Bland-Altman plots.

RESULTS: Minimal bias was seen in all strain and strain rate measurements between field strengths. Using Tissue Tracking, strain and strain rate values derived from long-axis images showed poor to fair agreement (ICC range 0.39-0.71), whereas global longitudinal shortening and MAPSE showed good agreement (ICC = 0.81 and 0.80, respectively). Measures derived from short-axis images showed good to excellent agreement (ICC range 0.78-0.91). Similar results for the agreement of strain and strain rate measurements were observed with QStrain.

CONCLUSION: The interfield strength agreement of short-axis derived LV strain and strain rate measurements at 1.5 T and 3 T was better than those derived from long-axis images; however, the agreement of global longitudinal shortening and MAPSE was good.

EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 2.

PMID:35767224 | DOI:10.1002/jmri.28328

Int Urol Nephrol. 2022 Jun 29. doi: 10.1007/s11255-022-03269-3. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the usefulness of E-PASS score to predict postoperative complications after laparoscopic nephrectomy.

METHODS: Between 2008 and 2020, 424 patients (179 patients: simple nephrectomy, 158 patients: radical nephrectomy, 87 patients: donor nephrectomy) who underwent laparoscopic nephrectomy in our clinic, were included in the study. Patient groups separated according to the presence of postoperative complications were compared retrospectively regarding demographic, clinical, intraoperative, and postoperative data, comorbidities, and E-PASS scores (PRS, SSS, and CRS). The relationship between postoperative complications and E-PASS scores was examined.

RESULTS: Postoperative complications occurred in 43 (10.1%) of the patients. Age, previous abdominal/retroperitoneal surgery, radical nephrectomy rate of surgeries, operation time, amount of bleeding, need for blood transfusion, rate of conversion from laparoscopic surgery to open surgery, hospitalization time, E-PASS PRS, SSS, and CRS were statistically significantly higher in the group with postoperative complications. The cutoff value of the E-PASS CRS was – 0.2996 to predict the development of postoperative complications (AUC = 0.706; 95% CI 0.629-0.783; p < 0.001). According to multivariate analysis, presence of previous abdominal/retroperitoneal surgery (OR 2.977; 95% CI 1.502-5.899; p = 0.002), laparoscopic radical nephrectomy (OR 2.518; 95% CI 1.224-5.179; p = 0.012), conversion from laparoscopic surgery to open surgery (OR 4.869; 95% CI 1.046-22.669; p = 0.044) and E-PASS CRS > – 0.2996 (OR 2.816; 95% CI 1.321-6.004; p = 0.007) were found to be independent risk factors predicting postoperative complications.

CONCLUSION: The E-PASS scoring system is an effective and convenient system for predicting postoperative complications after laparoscopic nephrectomy.

PMID:35767201 | DOI:10.1007/s11255-022-03269-3

Aging Clin Exp Res. 2022 Jun 29. doi: 10.1007/s40520-022-02170-4. Online ahead of print.

ABSTRACT

AIM: Human herpesvirus 6 (HHV-6) is neurophilic, and its relationship with Alzheimer’s disease (AD) remains controversial. This study aimed to examine the relationships between HHV-6 and cognitive abilities in elderly people aged 60 years or above from communities in Shenzhen.

METHODS: We recruited participants from 10 community health service centers in Shenzhen. Participants were divided into case and control groups according to Mini-Mental State Examination (MMSE) scale standards and were included in this study with 1:1 matching based on sex and age (± 3 years). The HHV-6 gene was detected by real-time fluorescent quantitative PCR, and the HHV-6 copy number was quantified.

RESULTS: A total of 580 participants (cases, n = 290; controls, n = 290), matched for gender and age was included in this study. A positive HHV-6 test was not associated with a significant difference in global cognitive performance (OR_adjusted = 1.651, 95% CI = 0.671-4.062). After adjusting for gender, age, education, Pittsburgh Sleep Quality Index (PSQI) score, homocysteine (Hcy) and glycosylated hemoglobin (HbA1c), the results of multiple linear regression showed that there was a statistically negative correlation between HHV-6 copy number and orientation (β_adjusted = -0.974, p = 0.013), attention and calculation (β_adjusted = -1.840, p < 0.001), and language (β_adjusted = -2.267, p < 0.001). The restricted cubic spline (RCS) model results showed that there was a nonlinear dose-response relationship between HHV-6 log10-transformed copies and orientation (p_overall = 0.003, p_nonliner = 0.045), attention and calculation (p_overall < 0.001, p_nonliner < 0.001), and language (p_overall < 0.001, p_nonliner = 0.016).

CONCLUSIONS: HHV-6 infection significantly associated with orientation, attention and calculation, and language in elderly individuals.

PMID:35767152 | DOI:10.1007/s40520-022-02170-4

Breast Cancer Res Treat. 2022 Jun 29. doi: 10.1007/s10549-022-06657-6. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to identify oncologist-reported barriers and motivators in addressing long-term effects with breast cancer survivors.

METHODS: This study is a secondary analysis of data from a survey of U.S. medical oncologists (n = 217) about breast cancer survivorship care in clinical practice. Using both closed- and open-ended questions, we asked oncologists to report barriers and motivators they perceived in addressing long-term effects with breast cancer patients. Descriptive statistics were used to summarize and rank items endorsed by oncologists in analyses of quantitative data; content analysis was used to identify salient categories of barriers and motivators in qualitative data.

RESULTS: Key barriers to managing physical long-term effects included lack of time during appointments (n = 128 oncologists, 59%) and perceived lack of evidence-based interventions (n = 89, 41%). With respect to psychosocial effects, oncologists reported lack of knowledge (n = 88, 40.6%) and challenges making referrals to mental health providers (n = 115, 53%). From the qualitative data, three distinct barrier categories emerged: “Competing priorities during brief appointments;” “Discussing long-term effects-Who? What? When?;” and “Beyond my expertise and comfort level.” Two motivator categories emerged: “I owe it to them;” and “Giving people a life worth living.”

CONCLUSION: Oncologists’ key motivators for addressing long-term effects were focused on professional values, relationships with survivors, and their commitment to prioritizing patients’ quality of life. Future efforts should leverage oncologists’ professional and interpersonal motivators to enhance the delivery of survivorship care for breast cancer.

PMID:35767127 | DOI:10.1007/s10549-022-06657-6

Eur Spine J. 2022 Jun 29. doi: 10.1007/s00586-022-07277-w. Online ahead of print.

ABSTRACT

PURPOSE: To measure the pedicle dimensions in high grade lytic spondylolisthesis (HGL) and to classify them, which helps the spine surgeon in proper selection of pedicle screws.

METHODS: A study of CT scans in 100 consecutive patients between Jan 2017 and April 2021 diagnosed as single-level HGL on standing radiographs. Pedicle height (PH), Pedicle width (PW), Differential pedicle height (DPH), Screw length (SL) and Transverse pedicle angle (TPA) were measured and analyzed. PH and PW were classified into four grades as-grade A less than 5.0 mm, grade B between 5.0 and 6.0 mm, grade C between 6.0 and 7.0 mm, and grade D above 7.0 mm.

RESULTS: 5 males and 95 females with mean age of 49.1 years. PH in 44% lytic vertebra were grade A, B (less than 6 mm) and the rest 56% had grade C, D (greater than 6 mm). PH averaged 6.6 mm in grade 3 HGL, 5.61 mm in grade 4 HGL. Change in PW, SL and TPA was not statistically significant with regards to grade or level of listhesis. A total of 37 cases were noted to have DPH (25 cases had a difference < 2 mm and 12 had a difference > 2 mm).

CONCLUSION: 44% of the PH in lytic vertebra was grade A and B (less than 6 mm) that stresses the importance of pre-op CT assessment and planning the appropriate screw dimensions. Change in PH was statistically significant with regards to the grade of listhesis (P-value < 0.01). Differential pedicle height also need to be looked for.

PMID:35767112 | DOI:10.1007/s00586-022-07277-w

Support Care Cancer. 2022 Jun 29. doi: 10.1007/s00520-022-07245-6. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study was to study the nutritional profile of node-negative and node-positive patients undergoing treatment for head and neck squamous cell cancer (HNSCC).

METHODS: This prospective cohort study was conducted between 2018 and 2020. Patients diagnosed with HNSCC, planned for treatment, were enrolled after written informed consent. In node-negative (N0) and node-positive (N +) cohorts of patients, nutritional status was determined using anthropometric measures and Subjective Global Assessment (SGA) scale pre-treatment, and during and after treatment. Statistical analysis was performed using SPSS version 22. Data was analyzed using parametric and non-parametric tests, and p value of 0.05 was considered significant.

RESULTS: In total, 161 patients were analyzed, 73 N0 and 88 N + cohorts. Pre-treatment, 9.6 to 20.4% patients in N0 and 23.9 to 32.8% patients in N + cohorts were malnourished. Incidence of malnutrition at completion of treatment was 40.8 to 52.5% overall, 20.5 to 41.1% N0, and 39.5 to 62.8% N + . Mean reduction in weight (11.1% ± 7.82 vs 6.26% ± 8.3, p = 0.000), mean reduction in BMI (2.57 ± 1.87 vs 1.29 ± 1.62, p = 0.000), median reduction in MUAC (2 cm vs 1 cm, p = 0.000), and median increase in SGA score (13 vs 6, p = 0.000) were higher in multi-modality as compared to those in a single-modality treatment. Similar findings were noted in N0 and N + cohorts.

CONCLUSION: As compared to N0, N + patients had higher burden of malnutrition at diagnosis, and more worsening of nutritional parameters during treatment. More decline in nutritional status was seen in patients receiving multi-modality as compared to single-modality treatment.

PMID:35767086 | DOI:10.1007/s00520-022-07245-6