Nevin Manimala

J Am Geriatr Soc. 2022 Jun 16. doi: 10.1111/jgs.17926. Online ahead of print.

ABSTRACT

INTRODUCTION: Growing evidence suggests that impairment in rest-activity rhythms may be a risk factor for cognitive decline and impairment in the aging population. However, previous studies included only a limited set of rest-activity metrics and produced mixed findings. We studied a comprehensive set of parametric and nonparametric characteristics of rest-activity rhythms in relation to mild cognitive impairment (MCI) and probable dementia in a cohort of older women.

METHODS: The prospective analysis included 763 women enrolled in two ancillary studies of the Women’s Health Initiative (WHI): the WHI Memory Study-Epidemiology of Cognitive Health Outcomes and Objective Physical Activity and Cardiovascular Health studies. The association between accelerometry-based rest-activity parameters and centrally adjudicated MCI and probable dementia were determined using Cox regression models adjusted for sociodemographic characteristics, lifestyle factors, and comorbidities.

RESULTS: Overall, the results support a prospective association between weakened rest-activity rhythms (e.g., reduced amplitude and overall rhythmicity) and adverse cognitive outcomes. Specifically, reduced overall rhythmicity (pseudo F statistic), lower amplitude and activity level (amplitude/relative amplitude, mesor, and activity level during active periods of the day [M10]), and later activity timing (acrophase and midpoint of M10) were associated with a higher risk for MCI and probable dementia. Women with lower amplitude and mesor also exhibited faster cognitive decline over follow-up.

CONCLUSION: Weakened rest-activity rhythms may be predictive markers for cognitive decline, MCI, and dementia among older women.

PMID:35708069 | DOI:10.1111/jgs.17926

Curr Opin Ophthalmol. 2022 Jun 16. doi: 10.1097/ICU.0000000000000852. Online ahead of print.

ABSTRACT

PURPOSE OF REVIEW: The aim of this study was to review the existing literature and investigate the role of microbiologic culture and histopathologic examination of corneal biopsies in the management of infectious keratitis.

RECENT FINDINGS: Corneal biopsy continues to be a significantly useful tool in the diagnosis and tailored management of infectious keratitis. Several techniques can be employed for tissue collection, handling and processing to optimize diagnostic yield and maximize safety, including emerging femtosecond laser-assisted biopsy.

SUMMARY: Corneal opacities represent a significant cause of global blindness, and infectious keratitis is the most common cause. Organism identification in progressive infectious keratitis is essential for proper management. However, microbiological culture alone has a high rate of false-negative results. Records from the Bascom Palmer Eye Institute were retrospectively searched for patients between 1 January 2015, and 31 December 2019, who underwent corneal biopsy, therapeutic keratoplasty or endothelial graft removal for infectious keratitis and had specimens bisected and submitted for evaluation with both microbiologic culture and histopathologic examination. Detection of bacteria, fungus and mycobacteria was not statistically different between culture and histopathology. Microbiology and histopathology are complementary methods for the identification of causative microorganisms in corneal specimens with presumed infectious keratitis.

PMID:35708051 | DOI:10.1097/ICU.0000000000000852

Eur J Phys Rehabil Med. 2022 Jun 14. doi: 10.23736/S1973-9087.22.07549-9. Online ahead of print.

ABSTRACT

OBJECTIVES: People with Parkinson’s Disease (PD) have difficulty participating in exercise. The primary objective of this pilot randomized controlled trial (RCT) was to determine if 8 weeks (2x per week) of bilateral exoskeleton (Exo) exercise results in positive changes in cognition and participation in adults with PD compared to exercising without an exoskeleton (Nxo) or wait-list control (Con).

DESIGN: Open-label, parallel, pilot randomized controlled trial.

SETTING: Neurorehabilitation clinic in a large urban centre.

SUBJECTS: Adults 50-85 years old with a confirmed diagnosis of PD.

INTERVENTIONS: Eight weeks of twice-weekly combined aerobic, strength and mobility exercise or waitlist control. Participants were randomly assigned to exercise with no exoskeleton (Nxo), exercise with the exoskeleton (Exo), or waitlist control (Con).

METHODS: Primary endpoints were change in cognitive function (SCOPA-COG) and mood. Secondary endpoints were change in gait speed, six-minute walk test (6MWT), freezing of gait, balance, and PDspecific health and quality of life outcomes. Safety endpoint was analysis of adverse events (AE).

RESULTS: Forty participated in the trial (Exo, n=13; Nxo, n=14; Con, n=13). Significant improvement in the Memory & Learning domain of the SCOPA-COG (p=.014) and 6MWT (p=.008) were detected for the Exo group compared to the Nxo and/or Con group. No other statistically significant between-groups effects were found. There were no serious or unanticipated AE.

CONCLUSIONS: Functional exercise with a low-profile overground exoskeleton showed promising results for improving memory and gait endurance in people with PD across HY stages I-IV.

CLINICAL REHABILITATION IMPACT: Exoskeletons can improve participation in high-intensity exercise.

PMID:35708047 | DOI:10.23736/S1973-9087.22.07549-9

Minerva Gastroenterol (Torino). 2022 Jun 15. doi: 10.23736/S2724-5985.22.03220-X. Online ahead of print.

ABSTRACT

BACKGROUND: Life expectancy and the number of ultra-octogenarians increased significantly, thus making crucial the appropriateness of several endoscopic procedures in elderly patients. The aim of our study was to provide a retrospective analysis of the efficacy and safety of capsule endoscopy in patients aged over 80 years.

METHODS: In this single-centre study, 900 patients underwent capsule endoscopy between 2002 and 2015 for different indications; of these 106 patients aged ≥80 years (group A) and 99 patients aged 40-60 years (control group B) were retrospectively selected.

RESULTS: Occult gastrointestinal bleeding accounted for 62.1% of all indications for capsule endoscopy in group B, compared to 95.2% in group A (p<0.001). Although not statistically significant, the diagnostic yield was higher in group A (71%) vs. group B (62%). The percentages of reaching the cecum and the median gastric transit time were uniform within the two groups. In contrast, small bowel transit time was longer in group A vs. B. Small bowel preparation was similar in the two groups. The exam was generally well tolerated in both groups, with capsule aspiration being one of the main adverse events, which occurred in two elderly patients.

CONCLUSIONS: Our data expand previous findings confirming that capsule endoscopy can be performed safely even in very old patients and show that the diagnostic yield is similar to that of younger patients.

PMID:35708039 | DOI:10.23736/S2724-5985.22.03220-X

Minerva Pediatr (Torino). 2022 Jun 15. doi: 10.23736/S2724-5276.22.06777-5. Online ahead of print.

ABSTRACT

BACKGROUND: Due to the COVID-19 pandemic, rates of well-child visit (WCV) attendance have significantly decreased. We wanted to see how a parent’s positive diagnosis for COVID-19 affected a child’s WCV attendance along with other factors. Therefore, we hypothesized that in families with at least 1 positive COVID-19 diagnosis, the rates of WCV attendance would be lower than in families that have not experienced COVID-19.

METHODS: Using National Health Interview Survey (NHIS) data from 2020, we analyzed sample adult responses for the sample child to questions about last WCV attendance. We included children whose parents completed the survey during quarters 3 and 4 of 2020. The outcome of this study was WCV attendance in the past 12 months with the exposure of interest being parental diagnosis of COVID-19.

RESULTS: In our sample (N=1,413), 91% of children attended a WCV in the past 12 months, and 5% had a parent with a positive COVID-19 diagnosis. On adjusted analysis, there was a negative but not statistically significant association between a parent with a positive COVID-19 diagnosis and WCV attendance (OR=0.32; 95% CI: 0.09, 1.20; p=0.092).

CONCLUSIONS: Nationwide, there has been a significant decrease in children attending recommended WCVs since the start of the pandemic. Having a parent test positive for COVID-19 may contribute to decreases in WCV attendance in traditional medical office settings. Alternative options exist that may improve WCV attendance; these include telemedicine or virtual visits, as well as visits completed in non-traditional settings such as mobile health clinics and school-based clinics. Further expansion of these options for WCVs must still take into account health disparities that exist among marginalized communities.

PMID:35708034 | DOI:10.23736/S2724-5276.22.06777-5

Infect Dis (Lond). 2022 Jun 16:1-10. doi: 10.1080/23744235.2022.2083672. Online ahead of print.

ABSTRACT

BACKGROUND: Bloodstream infections (BSI) occur frequently and are associated with severe outcomes. In this study we aimed to investigate proportions of patients that received discordant empirical antimicrobial therapy and its association to mortality.

METHODS: A retrospective cohort study model was undertaken to outline BSI in an intensive care, single centre, and low antimicrobial resistance prevalence setting. We used descriptive statistics to delineate proportions of patients that received discordant empirical antimicrobial therapy, and a correlation model and a logistic regression model to calculate the association with mortality and predictors of receiving discordant therapy, respectively.

RESULTS: From 2014 to 2018 we included 270 BSI episodes, of which one third were hospital-acquired. Gram negative, Gram positive, and anaerobic pathogens were detected in 49.0%, 45.3% and 5.7% respectively. The proportion of isolates that conferred extended-spectrum beta-lactamase (ESBL) properties were 5.9% among enterobactereales, and no methicillin-resistant Staphylococcus aureus isolates were detected. Empirical antimicrobial therapy for community-acquired (CA) and hospital-acquired (HA) BSI were discordant at day 0 in 6.5% and 24.4%, respectively (p<.001). Discordant therapy was significantly associated with mortality at day 28 (p=.041). HA-onset BSI, enterococcal BSI and BSI of intraabdominal origin were statistically significant predictors of receiving discordant therapy.

CONCLUSION: A significant proportion of HA-BSI did not receive effective antimicrobial therapy and this was significantly associated with mortality. The results underscore the need for more accurate diagnostic tools, improved communication between the microbiological laboratory and the clinicians, and antimicrobial stewardship measures.

PMID:35708021 | DOI:10.1080/23744235.2022.2083672

J Clin Lab Anal. 2022 Jun 16:e24558. doi: 10.1002/jcla.24558. Online ahead of print.

ABSTRACT

BACKGROUND: Mitochondrial DNA (MtDNA) exposed to the extracellular space due to cell death and stress has immunostimulatory properties. However, the clinical significance of circulating MtDNA in maintenance hemodialysis (MHD) patients and the precise mechanism of its emergence have yet to be investigated.

METHODS: This cross-sectional study consisted of 52 MHD patients and 32 age- and sex-matched healthy controls. MHD patients were further categorized into high and low circulating cell-free MtDNA (ccf-MtDNA) groups based on the median value. Copy number of MtDNA was quantified using TaqMan-based qPCR. Plasma cytokines were measured using ELISA kits. Reactive oxygen species (ROS) and mitochondrial membrane potential (Δψm) in peripheral blood mononuclear cells (PBMCs) were detected using DCFH-DA or JC-1 staining.

RESULTS: The copy numbers of ccf-MtDNA in patients with MHD were higher than those in healthy controls, and these alterations were correlated with changes of cytokines TNF-α and IL-6. Adjusted model in multivariate analysis showed that the presence of anuria and longer dialysis vintage were independently associated with higher levels of ccf-MtDNA. Meanwhile, although not statistically significant, an inverse correlative trend between urinary MtDNA and ccf-MtDNA was observed in patients with residual urine. Afterward, using PBMCs as surrogates for mitochondria-rich cells, we found that patients in the high ccf-MtDNA group exhibited a significantly higher ROS production and lower Δψm in cells.

CONCLUSIONS: Our data suggested that changes in ccf-MtDNA correlate with the degree of inflammatory status in MHD patients, and that the excessive MtDNA may be caused by mitochondrial dysfunction and reduced urinary MtDNA excretion.

PMID:35708020 | DOI:10.1002/jcla.24558

Hypertension. 2022 Jun 16:101161HYPERTENSIONAHA12219362. doi: 10.1161/HYPERTENSIONAHA.122.19362. Online ahead of print.

ABSTRACT

BACKGROUND: Approximately 3 to 4 billion people worldwide are exposed to household air pollution, which has been associated with increased blood pressure (BP) in pregnant women in some studies.

METHODS: We recruited 3195 pregnant women in Guatemala, India, Peru, and Rwanda and randomly assigned them to intervention or control groups. The intervention group received a gas stove and fuel during pregnancy, while the controls continued cooking with solid fuels. We measured BP and personal exposure to PM_2.5, black carbon and carbon monoxide 3× during gestation. We conducted an intention-to-treat and exposure-response analysis to determine if household air pollution exposure was associated with increased gestational BP.

RESULTS: Median 24-hour PM_2.5 dropped from 84 to 24 μg/m³ after the intervention; black carbon and carbon monoxide decreased similarly. Intention-to-treat analyses showed an increase in systolic BP and diastolic BP in both arms during gestation, as expected, but the increase was greater in intervention group for both systolic BP (0.69 mm Hg [0.03-1.35]; P=0.04) and diastolic BP (0.62 mm Hg [0.05-1.19]; P=0.03). The exposure-response analyses suggested that higher exposures to household air pollution were associated with moderately higher systolic BP and diastolic BP; however, none of these associations reached conventional statistical significance.

CONCLUSIONS: In intention-to-treat, we found higher gestational BP in the intervention group compared with controls, contrary to expected. In exposure-response analyses, we found a slight increase in BP with higher exposure, but it was not statistically significant. Overall, an intervention with gas stoves did not markedly affect gestational BP.

PMID:35708015 | DOI:10.1161/HYPERTENSIONAHA.122.19362

Soft Matter. 2022 Jun 16. doi: 10.1039/d2sm00473a. Online ahead of print.

ABSTRACT

Nanoscale phenomena such as surface hydration and the molecular layering of liquids under strong nanoscale confinement play a critical role in liquid-mediated surface adhesion that is not accounted for by available models, which assume a uniform liquid density with or without considering surface forces and associated disjoining pressure effects. This work introduces an alternative theoretical description that via the potential of mean force (PMF) considers the strong spatial variation of the liquid number density under nanoscale confinement. This alternative description based on the PMF predicts a dual effect of surface hydration by producing: (i) strong spatial oscillations of the local liquid density and pressure and, more importantly, (ii) a configuration-dependent liquid-solid surface energy under nanoscale confinement. Theoretical analysis and molecular dynamics simulations for the case of an axisymmetric water bridge with nanoscale heights show that the latter hydration effect is critical for the accurate prediction of the surface energy and adhesion forces when a small volume of liquid is nanoscopically confined by two surfaces approaching contact.

PMID:35708007 | DOI:10.1039/d2sm00473a

Eur J Prev Cardiol. 2022 Jun 16:zwac123. doi: 10.1093/eurjpc/zwac123. Online ahead of print.

ABSTRACT

AIMS: Sleep disorders are associated with increased risk of cardiometabolic diseases in observational studies, but the causality remains unclear. In this study, we leveraged two-sample Mendelian randomization (MR) analyses to assess the causal associations of self-reported daytime napping, daytime sleepiness, and other sleep phenotypes with cardiometabolic diseases including ischemic stroke (IS), coronary artery disease (CAD), heart failure (HF), and type 2 diabetes mellitus (T2DM).

METHODS: We selected genetic variants as instrumental variables for self-reported daytime napping, daytime sleepiness, morning person, insomnia, short sleep duration, and long sleep duration from European-descent genome-wide association studies (GWASs). Summary statistics for cardiometabolic diseases originated from four different GWASs with a total of 2,500,086 participants. We used the inverse-variance weighted method to explore the role of self-reported sleep phenotypes on the etiology of cardiometabolic diseases in the main analyses, followed by several sensitivity analyses for robustness validation.

RESULTS: Genetically predicted self-reported daytime napping (T2DM: OR, 1.56 [95% CI, 1.21-2.02]), insomnia (IS: OR, 1.07 [1.04-1.11]; CAD: OR, 1.13 [1.08-1.17]; HF: OR, 1.10 [1.07-1.14]; T2DM: OR, 1.16 [1.11-1.22]) and short sleep duration (CAD: OR, 1.37 [1.21-1.55]) were causally associated with elevated risk of cardiometabolic diseases. Moreover, genetically determined self-reported daytime sleepiness (CAD: OR, 2.05 [1.18-3.57]; HF: OR, 1.82 [1.15-2.87]) and morning person (HF: 1.06 OR, [1.01-1.11]) had potential detrimental effect on cardiometabolic risks.

CONCLUSIONS: Self-reported daytime napping, insomnia, and short sleep duration had causal roles in the development of cardiometabolic diseases, while self-reported daytime sleepiness and morning person was the potential risk factor for cardiometabolic diseases.

PMID:35707994 | DOI:10.1093/eurjpc/zwac123