Nevin Manimala

Am J Hypertens. 2022 Jun 15:hpac072. doi: 10.1093/ajh/hpac072. Online ahead of print.

ABSTRACT

BACKGROUND: Previous studies have reported that lean hypertensives have worse clinical outcomes than obese hypertensives. Other studies have shown that obesity confers pharmacological resistance to antihypertensive therapy. We explored whether the higher prescribed doses of antihypertensive medications in obese hypertensives were adequate for the attainment of similar on-treatment blood pressure (BP) compared to their leaner counterparts.

METHODS: A retrospective electronic health record review was undertaken in a de-identified database (N=851; predominately African American and female from an urban referral hypertension cohort. Median follow-up was 11.3 months (95% confidence interval (CI) (11.0, 11.5). Body mass index (BMI) kg/m2 was categorized as either below or above or equal to 30. Antihypertensive therapeutic intensity score (TIS) was the total daily antihypertensive dose/maximum United States Food and Drug Administration (USFDA) approved daily dose, summed across all hypertensive drugs. General linear models were used to estimate the statistical significance of continuous variables across BMI categories.

RESULTS: At baseline, systolic blood pressure (SBP) was similar between groups (p = 0.14), though it was 2.7 mm higher in the highest BMI group. Antihypertensive therapeutic intensity score (TIS) was greater in the highest BMI category at both baseline and at the end of follow-up (both P < 0.001). After covariate adjustment end of follow-up SBP and diastolic blood pressure (DBP) were higher in the obese compared to the non-obese group by 3.4 (0.6-6.1) /1.8 (0.1-3.53) mm Hg (p = 0.02, p = 0.04).

CONCLUSIONS: Attained on-treatment BP is higher in obese than non-obese hypertensives despite greater prescription of antihypertensive medications. Whether even more prescription of medications or other interventions will equalize BP responses relative to non-obese hypertensives merits further study.

PMID:35704857 | DOI:10.1093/ajh/hpac072

Acta Anaesthesiol Scand. 2022 Jun 15. doi: 10.1111/aas.14105. Online ahead of print.

ABSTRACT

BACKGROUND: Tracheostomies are commonly utilized in ICU patients due to prolonged mechanical ventilation, upper airway obstruction or surgery in the face/neck region. However, practices regarding timing of placement and utilization vary. This study provides a nationwide overview of tracheostomy utilization and outcomes in the ICU over a 14-year period.

METHODS: A retrospective study including all patients that received a tracheostomy during their ICU stay in Iceland between 2007-2020. Data was retrieved from hospital charts on admission cause, comorbidities, indication for tracheostomy insertion, duration of mechanical ventilation before and after tracheostomy placement, extubation attempts, complications, length of ICU and hospital stay and survival. Descriptive statistics were provided, and survival analysis was performed using Cox regression.

RESULTS: A total of 336 patients (median age 64 years, 33% females) received a tracheostomy during the study period. The most common indication for tracheostomy insertion was respiratory failure, followed by neurological disorders. The median duration of mechanical ventilation prior to tracheostomy insertion was nine days and at least one extubation had been attempted in 35% of the cases. Percutaneous tracheostomies were 32%. The overall rate of complications was 25% and the most common short-term complication was bleeding (5%). In-hospital mortality was 33%, and one-and five-year mortality rate was 40% and 60%, respectively.

CONCLUSIONS: We describe a whole-nation practice of tracheostomies. A notable finding is the relatively uncommon attempts of extubation prior to tracheostomy. Future work should focus on standardization in assessing the need for tracheostomy, including various patient characteristics and the role of extubation attempts prior to tracheostomy placement.

PMID:35704855 | DOI:10.1111/aas.14105

Am Fam Physician. 2022 Jun 1;105(6):577-579.

NO ABSTRACT

PMID:35704805

Hum Vaccin Immunother. 2022 Jun 15:1-10. doi: 10.1080/21645515.2022.2066424. Online ahead of print.

ABSTRACT

Sublingual immunotherapy (SLIT) is a well-tolerated, safe, and effective approach to treating allergic rhinitis (AR). Oralair® is a five-grass pollen SLIT tablet containing natural pollen allergens from five of the major grass species responsible for seasonal AR due to grass pollen allergy. Recommended use is in a pre-coseasonal regimen, starting daily treatment approximately 4 months before the start of the pollen season, with treatment then continued daily throughout the season; treatment should continue for 3-5 y. Clinical efficacy and safety of Oralair® in patients with grass pollen-induced AR has been demonstrated in a comprehensive clinical development program of randomized controlled trials. Effectiveness has been substantiated in subsequent observational studies with sustained efficacy following treatment cessation and a favorable level of adherence, quality of life, benefit, and satisfaction for the patients. Supportive evidence for a benefit in reducing the risk or delaying the development of allergic asthma is emerging.

PMID:35704772 | DOI:10.1080/21645515.2022.2066424

Clin Lab. 2022 Jun 1;68(6). doi: 10.7754/Clin.Lab.2021.210853.

ABSTRACT

BACKGROUND: Nowadays, novel antimicrobial strategies are being developed which focus on debilitating, rather than killing the microorganisms. In this regard, anti-biofilm therapy is one of the important ways to combat bacterial infections. Therefore, the aim of the current study was to evaluate the anti-biofilm activity of Carvacrol against E. faecalis by means of its effects on biofilm formation as well as on the gene expression levels of the two biofilm related genes, Epa and Esp.

METHODS: A total of 40 clinical strains of E. faecalis were collected from three hospitals in Tehran, Iran during 2020. These isolates were confirmed by biochemical and genotypic methods. Antibacterial and anti-biofilm activity of Carvacrol essence were determined according the standard protocol. Finally, expression level of the biofilm related genes (Epa and Esp) were evaluated before and after the treatment with Carvacrol.

RESULTS: A total of 14 isolates were considered as strong biofilm producers and were used for analysis. Carvacrol essence showed the best antibacterial activity at 2,500 μg/mL concentration against all the isolates, the biofilm formation capacity was decreased by Carvacrol essence, and it was statistically significant (p < 0.05). Expression levels of the Esp gene were decreased in 5 isolates while increased in 3 isolates following the Carvacrol treatment. Ex-pression levels of the EpaI gene was significantly decreased (p < 0.05) in 4 isolates following the Carvacrol treatment.

CONCLUSIONS: In conclusion, the results presented in this study suggest that carvacrol extract exhibits significant antimicrobial and anti-biofilm properties against E. faecalis, even against vancomycin resistant isolates.

PMID:35704732 | DOI:10.7754/Clin.Lab.2021.210853

Clin Lab. 2022 Jun 1;68(6). doi: 10.7754/Clin.Lab.2021.210821.

ABSTRACT

BACKGROUND: Leukemia stem cells (LSCs) have been demonstrated to be more therapy-resistant than leukemic blast cells reflecting measurable residual disease (MRD). CD34+CD38- cell frequency is an independent factor for relapse prediction and could therefore be used in the future to improve MRD assessment in acute myeloid leukemia (AML). This protocol is designed to enable accurate and reproducible immunophenotypic detection of measurable residual stem cell disease necessary for proper therapeutic decision and report their prognostic value in AML patients.

METHODS: Fifty-four Novo AML adult patients diagnosed in the onco-hematology service of the “20 August 1953” Hospital in Casablanca. We analyzed phenotype and frequency of CD45dim CD34+CD38- cells in bone marrow samples from patients with AML and non-myeloid malignancies using six-color flow cytometry and a simple one-tube essay.

RESULTS: For evaluation of leukemic stem cells, our gate strategy was based on the selection of CD34+CD38 – stem cells and leukemia associated immunophenotype approach. Positivity of CD123 or/and aberrant expression of primitive markers CD117 and HLA DR on stem cells discriminate leukemia stem cells from normal hematopoietic stem cells. We reported a statistically significant difference between expressions of primitive markers (CD117 and HLA DR) on leukemic stem cells. In addition, the frequency of LSCs after complete remission in post-induction was persistent in 50% of AML patients.

CONCLUSIONS: Overall, we show that CD34+CD38-CD123+ as a basic phenotype, with aberrant phenotype detection of HLA DR and CD117 markers on stem cells, contributes to detecting LSCs which indicates the poor prognosis.

PMID:35704721 | DOI:10.7754/Clin.Lab.2021.210821

J Clin Psychiatry. 2022 Jun 13;83(4):21m14055. doi: 10.4088/JCP.21m14055.

ABSTRACT

Objective: To examine the incidence and predictors of suicide attempts and deaths in the year after psychiatric hospitalization.

Methods: A population-based dataset was used to develop a cohort of individuals 18 years or older admitted with a mental disorder (defined by ICD-10 codes) from 2005 to 2016 (n = 26,975) in Manitoba, Canada. Using Cox regression, hazard ratios were calculated for each covariate among those who attempted and died by suicide in the year following hospitalization, while adjusting for confounders.

Results: In the year following hospitalization for a mental disorder, 0.7% of the individuals died by suicide and 3.5% attempted suicide. Statistically significant risk factors for suicide in the year after discharge from psychiatric hospitalization included male sex (hazard ratio [HR], 1.47; 95% confidence interval [CI], 1.10-1.97) and urban location (HR, 1.37; 95% CI, 1.02-1.85) and for attempting suicide included female sex (HR, 0.63; 95% CI, 0.55-0.72), living rurally (HR, 0.66; 95% CI, 0.58-0.75), a previous mental disorder (HR, 1.63; 95% CI, 1.38-1.92), justice involvement (HR, 1.48; 95% CI, 1.28-1.70), and being on income assistance (HR, 1.17; 95% CI, 1.01-1.35) (P < .05 for all). Age (HR, 0.99; 95% CI, 0.99-0.99) (P < .05) was associated with a reduced rate of suicide attempts.

Conclusions: Further research into interventions to address the identified risk factors for suicide in the recently discharged population is critical to improve management.

PMID:35704710 | DOI:10.4088/JCP.21m14055

PLoS Negl Trop Dis. 2022 Jun 15;16(6):e0010390. doi: 10.1371/journal.pntd.0010390. Online ahead of print.

ABSTRACT

BACKGROUND: Leishmaniases are neglected tropical diseases that inflict great burden to poor areas of the globe. Intense research has aimed to identify parasite genetic signatures predictive of infection outcomes. Consistency of diagnostic tools based on these markers would greatly benefit from accurate understanding of Leishmania spp. population genetics. We explored two chromosomal loci to characterize a population of L. braziliensis causing human disease in Northeast Brazil.

METHODOLOGY/PRINCIPAL FINDINGS: Two temporally distinct samples of L. braziliensis were obtained from patients attending the leishmaniasis clinic at the village of Corte de Pedra: (2008-2011) primary sample, N = 120; (1999-2001) validation sample, N = 35. Parasites were genotyped by Sanger’s sequencing of two 600 base pairs loci starting at nucleotide positions 3,074 and 425,451 of chromosomes 24 and 28, respectively. Genotypes based on haplotypes of biallelic positions in each locus were tested for several population genetic parameters as well as for geographic clustering within the region. Ample geographic overlap of genotypes at the two loci was observed as indicated by non-significant Cusick and Edward’s comparisons. No linkage disequilibrium was detected among combinations of haplotypes for both parasite samples. Homozygous and heterozygous genotypes displayed Hardy-Weinberg equilibrium (HWE) at both loci in the two samples when straight observed and expected counts were compared by Chi-square (p>0.5). However, Bayesian statistics using one million Monte-Carlo randomizations disclosed a less robust HWE for chromosome 24 genotypes, particularly in the primary sample (p = 0.04). Fixation indices (Fst) were consistently lower than 0.05 among individuals of the two samples at both tested loci, and no intra-populational structuralization could be detected using STRUCTURE software.

CONCLUSIONS/SIGNIFICANCE: These findings suggest that L. braziliensis can maintain stable populations in foci of human leishmaniasis and are capable of robust genetic recombination possibly due to events of sexual reproduction during the parasite’s lifecycle.

PMID:35704664 | DOI:10.1371/journal.pntd.0010390

J Osteopath Med. 2022 Jun 15. doi: 10.1515/jom-2022-0027. Online ahead of print.

ABSTRACT

CONTEXT: Evidence-based medicine (EBM) is the application of scientific evidence while treating a patient. To date, however, there is very little evidence describing how residents in emergency medicine understand and incorporate EBM into practice.

OBJECTIVES: The aim of this study was to determine EBM theoretical and quantitative knowledge in emergency medicine residents in community hospital-based training programs.

METHODS: A sample of emergency medicine residents from nine hospitals was enrolled to complete a cross-sectional assessment of EBM skills from April 2021 through June 2021. Performance on the Fresno Test of Evidence-Based Medicine (FTEBM) was assessed utilizing descriptive statistics, t tests, and one-way analysis of variance.

RESULTS: A total of 50.8% (124/244) of current emergency medicine residents completed the FTEBM during the study period. No significant difference on FTEBM scores was noted between the different types of medical degrees (DO vs. MD) (p=0.511), holding an advanced research degree (p=0.117), or between each postgraduate year of training (p=0.356). The mean score of those residents who rated their knowledge of EBM as average or higher was 36.0% (32.8-39.1%). The mean score of those residents who rated their programs as having an “average” or higher institutional focus on EBM was 34.9% (32.2-37.6%).

CONCLUSIONS: Participating emergency medicine residents show an incomplete understanding of EBM both in theory and applied computations despite rating themselves as having an average understanding. Emergency medicine residencies would be well suited to implement a standardized EBM curriculum that focuses on longitudinal reinforcement of key concepts needed for the practicing physician.

PMID:35704661 | DOI:10.1515/jom-2022-0027

PLoS One. 2022 Jun 15;17(6):e0269359. doi: 10.1371/journal.pone.0269359. eCollection 2022.

ABSTRACT

Oral health is a critical component of human health but is sometimes forgotten, particularly during humanitarian crises. This research aimed to ascertain the state of oral health among Rohingya refugees living in one of the largest refugee camps and evaluate their knowledge and practice of oral health. A multicenter cross-sectional survey was conducted among 477 participants from July to September 2021 using a structured questionnaire. There were 34 Rohingya camps and out of those 14 camps were accessible for data collection. The study participants were between 18-82 years residing in the refugee camps under Cox’s Bazar. The majority of participants (53.88%) were female and between the ages of 25 and 45. Around 46.12% of respondents did not have basic oral health knowledge, while 53.67% were in need of dental care. Nearly half of the participants demonstrated poor oral health practices. Participants’ age and educational level were positively associated with oral health knowledge (p = 0.02 and p<0.001). Furthermore, the knowledge level was positively associated with oral health practice (p = .025). Participants with a history of teeth pain and discomfort in the last 12 months were ten times more likely to seek treatment (OR = 9.93, CI: 5.591-17.64). The study indicated a growing demand for dental care among Rohingya refugees staying in Bangladesh. To reduce the severity of oral health issues, use of minimally invasive restorative procedures can be suggested in camps. New oral health promotion campaigns should be emphasized and proper education, ideally in their original language, can be beneficial.

PMID:35704660 | DOI:10.1371/journal.pone.0269359