Nevin Manimala

Rev Port Cardiol. 2022 Aug;41(8):681-688. doi: 10.1016/j.repc.2021.05.017. Epub 2022 May 28.

ABSTRACT

INTRODUCTION AND OBJECTIVES: Lifestyle changes are frequently insufficient to reduce cardiovascular (CV) risk in patients with dyslipidemia. This study aims to characterize the long-term evolution of lipid profile and CV risk of patients under primary prevention.

METHODS: A retrospective study was performed of outpatients at a Portuguese cardiovascular risk clinic with ≥2 CV risk factors, followed for ≥2 years between 1995 and 2015. Statin therapy had been initiated early, in accordance with the clinic’s practice. After written informed consent was obtained, sociodemographic and clinical characteristics were collected from medical charts, at baseline and last visit. Changes in lipid profile and CV risk scores were estimated. Associations between HDL-C or LDL-C changes and gender, age, observation time and treatments were assessed through bivariate analysis and multiple linear regression models.

RESULTS: Out of 516 participants with mean follow-up of 11.4±4.3 years, 56.6% were female and 91.5% received statins. Lipid profile showed statistically significant improvement, including median changes in LDL-C and HDL-C of -77.0 mg/dl and +19 mg/dl, respectively. CV risk also showed statistically significant improvements according to all scores. Statin therapy resulted in a mean HDL-C increase of 7.4 mg/dl (independently of gender and other treatments) and a mean LDL-C reduction of 51.8 mg/dl (irrespective of age and other treatments).

CONCLUSION: Results from this long-term real-life study indicate that primary prevention, specifically early and continuous therapy with intermediate-intensity statins as an add-on to lifestyle interventions, was important in obtaining consistent and adequate metabolic correction in patients with additional risk factors.

PMID:36073267 | DOI:10.1016/j.repc.2021.05.017

Epilepsia. 2022 Sep 8. doi: 10.1111/epi.17407. Online ahead of print.

ABSTRACT

OBJECTIVE: Thyroid hormone abnormalities have been linked to antiseizure medications (ASMs). Oxcarbazepine is considered safer than carbamazepine because it induces the hepatic P-450 metabolic enzymes less than the carbamazepine. However, limited data exist for the influence of oxcarbazepine on thyroid function in children and adolescents. The objective of this study was to determine the effect of oxcarbazepine on thyroid function in these patients.

METHODS: A total of 162 pediatric patients with epilepsy who started oxcarbazepine for the first time between April 2003 and May 2020 were enrolled. The longitudinal effects of oxcarbazepine for thyroid functions were confirmed using general estimating equations.

RESULTS: Serum triiodothyronine (T3), thyroxine (T4), and free thyroxine (fT4) levels significantly decreased during 5 years of follow-up (all P < 0.001). In particular, T3 and fT4 levels were steeply reduced in the first 2 years of oxcarbazepine treatment. There was no significant change in thyroid-stimulating hormone during oxcarbazepine treatment.

SIGNIFICANCE: Serum T3, T4, and fT4 levels significantly decreased during oxcarbazepine use, and this change was maintained during the treatment period. In patients receiving oxcarbazepine, it is recommended that periodic thyroid function testing should be performed, especially within the first two years after starting this ASM. Our results indicate that oxcarbazepine-induced hypothyroidism does not appear to be accompanied by a significant increase in TSH, and consequently might be missed if TSH alone is monitored as a measure of thyroid dysfunction.

PMID:36073252 | DOI:10.1111/epi.17407

Nan Fang Yi Ke Da Xue Xue Bao. 2022 Aug 20;42(8):1250-1255. doi: 10.12122/j.issn.1673-4254.2022.08.19.

ABSTRACT

OBJECTIVE: To investigate the value of HBV RNA for predicting the therapeutic effect of long-term entecavir (ETV) antiviral therapy in patients with chronic hepatitis B (CHB).

METHODS: Serum samples were collected from 59 CHB patients treated with ETV for 96 or 108 months. HBV RNA levels, HBV DNA levels, and serological marker (HBeAg) levels were measured at baseline and 3, 6, 9, 12, 36, 72, and 96 (or 108) months during the therapy.

RESULTS: Although HBV RNA level decreased after 12 and 36 months of ETV antiviral therapy, no significance changes occurred in HBV RNA negative conversion rate (P>0.05). After 72 months of treatment or longer, 33 patients had HBV RNA levels lower than 100 copies/mL, and among them 29 patients had HBV RNA levels lower than the detection limit, and HBV RNA negative conversion rate was statistically significant (P < 0.05). A lower HBV RNA level was associated with a higher HBeAg negative conversion rate (P < 0.05). Age and HBV RNA level were positively correlated with HBeAg negative conversion rate (P < 0.05).

CONCLUSION: Prolonged ETV antiviral therapy results in better clearance of HBV RNA and a higher negative conversion rate in CHB patients. The length of antiviral therapy and age are positively correlated with the negative conversion rate of HBV RNA, and earlier administration of the antiviral treatment achieves better therapeutic effect. Serum HBV RNA level can be used as an indicator for predicting conversion to negative HBeAg in CHB patients receiving ETV therapy.

PMID:36073226 | DOI:10.12122/j.issn.1673-4254.2022.08.19

Expert Opin Drug Metab Toxicol. 2022 Sep 8. doi: 10.1080/17425255.2022.2122813. Online ahead of print.

ABSTRACT

INTRODUCTION: Three psychotropic drug classes, benzodiazepines, antiepileptic drugs (AEDs) and antidepressants (ADs), whether used in treatment or overdose, may be associated with respiratory aspiration. Polypharmacy was defined by counting suspected drugs from these classes or two others, antipsychotics and opioids. The confounding effects of polypharmacy were considered in this study.

AREAS COVERED: VigiBase records of respiratory aspiration associated with benzodiazepines, AEDs, and/or ADs from inception until September 5, 2021, were reviewed. VigiBase, the World Health Organization’s global pharmacovigilance database, uses a statistical signal for associations called the information component (IC).

EXPERT OPINION: The ICs (and IC₀₂₅) were benzodiazepines 2.8 (and 2.6), AEDs 1.6 (and 1.5), and ADs 1.4 (and 1.3). The cases of respiratory aspiration associated with at least one drug from these 3 classes included: 1) 553 cases absent any known overdose (2.8±1.7 drugs) and 2) 347 overdose cases (2.9±1.8 drugs). Little support for the association of respiratory aspiration and benzodiazepine, AED or AD monotherapy in therapeutic dosages was found. Studies of the association between benzodiazepine monotherapy and respiration aspiration are needed in geriatric patients. ADs added to other medications increased lethality in all cases of respiratory aspiration including those associated with overdose, polypharmacy and/or major medical problems.

PMID:36073179 | DOI:10.1080/17425255.2022.2122813

J Chem Theory Comput. 2022 Sep 8. doi: 10.1021/acs.jctc.2c00314. Online ahead of print.

ABSTRACT

Sampling the minimum energy path (MEP) between two minima of a system is often hindered by the presence of an energy barrier separating the two metastable states. As a consequence, direct sampling based on molecular dynamics or Markov Chain Monte Carlo methods becomes inefficient, the crossing of the energy barrier being associated to a rare event. Augmented sampling methods based on the definition of collective variables or reaction coordinates allow us to circumvent this limitation at the price of an arbitrary choice of the dimensionality reduction algorithm. We couple the statistical sampling techniques, namely, metadynamics and invertible neural networks, with autoencoders so as to gradually learn the MEP and the collective variable at the same time. Learning is achieved through a succession of two steps: statistical sampling of the most probable path between the two minima and redefinition of the collective variable from the updated data points. The prototypical Mueller potential with nearly orthogonal minima is employed to demonstrate the ability of such coupling to unravel a complex MEP.

PMID:36073162 | DOI:10.1021/acs.jctc.2c00314

Dtsch Arztebl Int. 2022 Sep 5;(Forthcoming):arztebl.m2022.0256. doi: 10.3238/arztebl.m2022.0256. Online ahead of print.

ABSTRACT

BACKGROUND: It has been observed that the Medical Service (Medizinischer Dienst, an auditing body of the German statutory health insurance system) is more likely to audit the bill for a hospitalization in a psychosomatic clinic if the patient carries a secondary diagnosis of obesity.

METHODS: In an exploratory study, we retrospectively analyzed 771 datasets collected in 2019 as part of the standard documentation of acute psychosomatic hospitalizations.

RESULTS: In 2019, the Medical Service audited bills for psychosomatic hospitalizations much more often in obese than in non-obese patients (odds ratio [OR] 2.499; 95% confidence interval [1.69; 3.69]). This was accounted for by a very high audit rate for patients with a secondary diagnosis of grade 3 obesity (OR = 3.972 [2.30; 6.86]). The audit categories “quality of coding” and “possible incorrect admission” were examined.

CONCLUSION: Treatments of markedly obese inpatients that incurred greater expenses presumably led to a higher hospitalization audit rate as an automatic consequence of the auditing algorithms used. An unintentional statistical discrimination arose from the unjustified linkage of the audit category “quality of coding” of the secondary diagnosis (obesity) with the audit category “possible incorrect admission” with regard to the main diagnosis. Similar effects may be occurring with economically relevant secondary diagnoses in other areas of medicine as well.

PMID:36073157 | DOI:10.3238/arztebl.m2022.0256

Afr J Prim Health Care Fam Med. 2022 Aug 26;14(1):e1-e3. doi: 10.4102/phcfm.v14i1.3397.

ABSTRACT

After four decades of the HIV epidemic, women from sub-Saharan Africa remain at a differentially high risk of acquisition. The Joint United Nations Programme on HIV and AIDS (UNAIDS) statistics show that the majority of HIV infections occur in this population and region. Evidence from previous humanitarian crises demonstrated adverse maternal consequences as a result of neglect for the provision of essential maternal, sexual and reproductive health services. The ongoing COVID-19 pandemic has had a similar effect, including an additional risk of HIV acquisition amongst women in sub-Saharan Africa. The COVID-19 pandemic has aggravated the risk of sub-Saharan Africa women to HIV infection because of a multitude of factors including child marriages, teenage pregnancies, dropping out of school, increase in incidence of sexual and gender-based violence and reduced access to preventive and treatment services for HIV and sexually transmitted infections. These include provision of care for rape and sexual and gender-based violence victims and provision of pre-exposure and postexposure prophylaxis for HIV and other STIs. Failure to urgently restore and maintain robust HIV prevention and treatment during the ongoing COVID-19 pandemic poses a risk of reversing the gains made over the years in reducing the incidence and morbidity from HIV amongst the population of sub-Saharan Africa women. There is need for an urgent and robust discourse to formulate effective interventions for protecting women and girls living in sub-Saharan Africa from an aggravated risk of HIV infection during the ongoing COVID-19 pandemic and other future humanitarian crises.

PMID:36073132 | DOI:10.4102/phcfm.v14i1.3397

Afr J Prim Health Care Fam Med. 2022 Aug 22;14(1):e1-e8. doi: 10.4102/phcfm.v14i1.3595.

ABSTRACT

AbstractBackground: Carers of people with dementia (PWD) face a myriad of challenges. As dementia prevalence surges in the sub-Saharan population, the provision of data on the met and unmet needs of caregivers has become paramount.

AIM: This study aimed to identify the needs of carers of older adults living with dementia in Ghana.

SETTING: This study was conducted in Kumasi, Ghana, among participants ≥ 18 years old, serving as carers for PWD.

METHODS: This was a multicentre cross-sectional study involving carers of patients (≥ 50 years) with dementia. The authors administered the Carer’s Needs Assessment for Dementia (CNA-D) questionnaire, containing 18 problem areas with interventions for each problem area. Pearson’s correlation analysis was performed to establish a relationship between demographic characteristics, problem areas and intervention score.

RESULTS: Fifty participants were recruited with a mean age of 48.8 (± 16.9) years, 72.0% were female participants and 98.0% were family members of PWD. The problem area most frequently identified as no/mild problem was ‘legal issues’ (92.0%, n = 46), and ‘lack of information about dementia’ was assessed as severe (48.0%, n = 24). The commonest unmet need was ‘printed information material’ (84.0%, n = 42), and the commonest met need was ‘diagnosis and treatment of carer by a general practitioner’ (42.0%, n = 21). There was a statistically negative correlation between age of carer and number of unmet needs (r = -0.308, p = 0.011) and a positive correlation between problem area score and number of unmet needs (r = 0.308, p = 0.030).

CONCLUSION: Effective public education and provision of information on dementia to carers are essential interventions needed to equip them in performing their roles.Contribution: Carers in this study revealed that they lacked information on dementia but their commonest met need was accessibility to their general practitioner. This highlights the importance of promoting knowledge and awareness of dementia among primary care practitioners.

PMID:36073124 | DOI:10.4102/phcfm.v14i1.3595

Onderstepoort J Vet Res. 2022 Aug 4;89(1):2007. doi: 10.4102/ojvr.v89i1.2007.

ABSTRACT

Vaccination is an important disease prevention and control measure; however, vaccine adoption by livestock farmers in Tanzania is still low. This cross-sectional study examined the challenges to vaccine use faced by livestock owners and animal health professionals (AHPs) in Tanzania. A questionnaire was administered to 216 households that kept small ruminants and poultry and 19 AHPs’ data were collected electronically via the survey platform Qualtrics, and descriptive statistics were performed. Households with poultry reported vaccinating mostly against Newcastle disease (91.7%), fowl pox (48.1%) and Gumboro disease (37.0%), whilst households with small ruminants reported contagious caprine pleuropneumonia (62.2%), sheep and goat pox (17.1%), foot-and-mouth disease (7.3%) and peste des petits ruminants (7.3%). The households’ decision to vaccinate was mostly influenced by knowledge of diseases (82.4%), disease history on the farm (69.4%) and vaccine price (63.4%). Most households (54.6%) experienced challenges when purchasing vaccines, including high vaccine cost (78.0%), long distance from vaccine source (61.0%) and vaccine unavailability (21.2%). The findings suggest that improving the knowledge of livestock owners regarding the priority diseases and the benefits of vaccination, establishing more vaccine suppliers, improving vaccine distribution and access and training AHPs and households on appropriate vaccine storage and handling are necessary to improve vaccine adoption and ensure vaccine quality and effectiveness.

PMID:36073111 | DOI:10.4102/ojvr.v89i1.2007

Leuk Lymphoma. 2022 Sep 7:1-4. doi: 10.1080/10428194.2022.2115842. Online ahead of print.

NO ABSTRACT

PMID:36070601 | DOI:10.1080/10428194.2022.2115842