Nevin Manimala

BMC Womens Health. 2023 Dec 2;23(1):642. doi: 10.1186/s12905-023-02810-5.

ABSTRACT

BACKGROUND: Migraine is a typical cripple issue of the brain identified with cerebral pain which is an indication of numerous health conditions. About 18% of women (27 million) and 6% of men (10 million) are afflicted by migraine in the United States. Based on a case-control study, to explore the different risk factors, causing migraine in females and examine the association between risk factors and migraine.

METHODS: A sample of 1055 individuals were selected in different areas of Lahore from September 2019 to March 2020. The information was obtained by using the direct interview method and questionnaire method. Descriptive analysis, bivariate analysis and binary logistic regression analysis were carried out in data analysis.

RESULTS: Among 1055 individuals 740 cases and 315 controls were included. In a binary logistic regression model, physical activities, stress, summer season, menstruation and morning were the risk factors that cause migraine and these were found to be positively significant with the odds ratios and 95% confidence interval of odds ratios (1.399; 1.122-1.746), (1.510; 1.187-1.922), (1.595; 1.374-1.851), (1.513; 1.247-1.836) and (1.309; 1.028-1.665) respectively. Nausea, isolation and back head pain were caused by migraine and these were found positively significant with the odds ratios and 95% confidence interval of odds ratios(1.290; 1.122-1.484), (1.882; 1.617-2.190) and (1.285; 1.123-1.471) respectively.

CONCLUSIONS: Stress, physical Activities and Menstruation increase the risk of migraine but weight loss, Breakfast, lunch, thirst, injury and Second trimester during pregnancy reduce the risk of migraine.

PMID:38042798 | DOI:10.1186/s12905-023-02810-5

BMC Infect Dis. 2023 Dec 2;23(1):848. doi: 10.1186/s12879-023-08845-1.

ABSTRACT

BACKGROUND: Lymphopenia is defined as a decrease below normal value (often 1.0 x 10⁹ cells/L) of blood circulating lymphocyte count. In the general population, lymphopenia is associated with an increased risk of hospitalisation secondary to infection, independent of traditional clinical risk factors. In hospital, lymphopenia is associated with increased risk of healthcare-associated infection and mortality. By summarising lymphopenia’s prevalence and impact on clinical outcomes, we can identify an at-risk population and inform future studies of immune dysfunction following severe illness.

METHODS: Peer-reviewed search strategy was performed on three databases. Primary objective was to summarise the pooled prevalence of lymphopenia. Primary outcome was infection including pre-existing lymphopenia as a risk factor for admission with infection and as an in-hospital risk factor for healthcare-associated infection. Secondary outcomes were length of stay and mortality. Mortality data extracted included in-hospital, 28/30-day (‘early’), and 90-day/1-year (‘late’) mortality. Meta-analysis was carried out using random-effects models for each outcome measure. Heterogeneity was assessed using I² statistic. Joanna Briggs Institute checklist for cohort studies was used to assess risk of bias. The protocol was published on PROSPERO.

RESULTS: Fifteen observational studies were included. The pooled prevalence of lymphopenia in all-cause hospitalisations was 38% (CI 0.34-0.42, I²= 97%, p< 0.01). Lymphopenia was not associated with an infection diagnosis at hospital admission and healthcare associated infection (RR 1.03; 95% CI 0.26-3.99, p=0.97, I² = 55% and RR 1.31; 95% CI 0.78-2.20, p=0.31, I²=97%, respectively), but was associated with septic shock (RR 2.72; 95% CI 1.02-7.21, p=0.04, I² =98%). Lymphopenia was associated with higher in-hospital mortality and higher ‘early’ mortality rates (RR 2.44; 95% CI 1.71-3.47, p < 0.00001, I² = 89% and RR 2.05; 95% CI 1.64-2.56, p < 0.00001, I² = 29%, respectively). Lymphopenia was associated with higher ‘late’ mortality (RR 1.59; 1.33-1.90, p < 0.00001, I² = 0%).

CONCLUSIONS: This meta-analysis demonstrates the high prevalence of lymphopenia across all-cause hospitalisations and associated increased risk of septic shock, early and late mortality. Lymphopenia is a readily available marker that may identify immune dysfunctional patients. Greater understanding of immune trajectories following survival may provide insights into longer-term poor clinical outcomes.

PMID:38042792 | DOI:10.1186/s12879-023-08845-1

BMC Health Serv Res. 2023 Dec 2;23(1):1346. doi: 10.1186/s12913-023-10374-1.

ABSTRACT

BACKGROUND: There is a need for scalable clinician education in rational medication prescribing and rational ordering of pathology and imaging to help improve patient safety and enable more efficient utilisation of healthcare resources. Our wider study evaluated the effectiveness of a multifaceted education intervention for general practitioners (GPs) in rational prescribing and ordering of pathology and imaging tests, in the context of Australia’s online patient-controlled health record system, My Health Record (MHR), and found evidence for measurable behaviour change in pathology ordering among participants who completed the educational activities. This current study explored the mechanisms of behaviour change brought about by the intervention, with a view to informing the development of similar interventions in the future.

METHODS: This mixed methods investigation used self-reported questionnaires at baseline and post-education on MHR use and rational prescribing and test ordering. These were analysed using multi-level ordinal logistic regression models. Semi-structured interviews pre- and post-intervention were also conducted and were analysed thematically using the COM-B framework.

RESULTS: Of the 106 GPs recruited into the study, 60 completed baseline and 37 completed post-education questionnaires. Nineteen participants were interviewed at baseline and completion. Analysis of questionnaires demonstrated a significant increase in confidence using MHR and in self-reported frequency of MHR use, post-education compared with baseline. There were also similar improvements in confidence across the cohort pre-post education in deprescribing, frequency of review of pathology ordering regimens and evidence-based imaging. The qualitative findings showed an increase in GPs’ perceived capability with, and the use of MHR, at post-education compared with baseline. Participants saw the education as an opportunity for learning, for reinforcing what they already knew, and for motivating change of behaviour in increasing their utilisation of MHR, and ordering fewer unnecessary tests and prescriptions.

CONCLUSIONS: Our education intervention appeared to provide its effects through providing opportunity, increasing capability and enhancing motivation to increase MHR knowledge and usage, as well as rational prescribing and test ordering behaviour. There were overlapping effects of skills acquisition and confidence across intervention arms, which may have contributed to wider changes in behaviour than the specific topic area addressed in the education.

TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ACTRN12620000010998) (09/01/2020).

PMID:38042789 | DOI:10.1186/s12913-023-10374-1

J Mech Behav Biomed Mater. 2023 Oct 24;150:106156. doi: 10.1016/j.jmbbm.2023.106156. Online ahead of print.

ABSTRACT

INTRODUCTION: To develop a calcium silicate (CaSi)-based cement containing dimethyl sulfoxide (DMSO) and cement deliver device for new root canal filling technique, and to assess the flow behavior, leakage, and root canal filling quality of CaSi containing DMSO.

METHODS: CaSi containing DMSO (CSC-DMSO) and CaSi containing PEG (CSC-PEG) were prepared, and the flow characteristics of both cements were compared in gypsum and resin channels using a high-speed camera. Eight root canals were obturated by CSC-DMSO or CSC-PEG using a cement delivery device, and root canal filling quality was assessed in terms of filling length using periapical radiographs. The filling length was evaluated by ‘apico-coronal extension,’ measuring length in reference to apical constriction. Microleakage was measured for thirty human molars that were randomly filled with CSC-DMSO, CSC-PEG, or gutta-percha and AH plus. Preliminary obturation of CSC-DMSO with cement delivery device in human teeth was analyzed in terms of filling length and void, using periapical radiographs. Statistical analysis was performed with the Kruskal Wallis test for simulated root canal fillings and one-way ANOVA for leakage test.

RESULTS: The flow speed of CSC-DMSO reduced in gypsum channels compared to resin channels, but CSC-PEG did not exhibit significant differences in the channels. The median absolute value of apico-coronal extension was significantly lower in CSC-DMSO compared to CSC-PEG (p < 0.05). Microleakage did not statistically differ between the groups (p > 0.05). In the preliminary obturation, the mean apico-coronal extension of CSC-DMSO was -0.297 ± 0.724 mm, while CSC-PEG was not feasible due to excess apical extrusions.

CONCLUSIONS: CSC-DMSO could be considered as an alternative filling material for root canal obturation.

PMID:38041883 | DOI:10.1016/j.jmbbm.2023.106156

Phys Med Biol. 2023 Dec 2. doi: 10.1088/1361-6560/ad11a4. Online ahead of print.

ABSTRACT

The delivery efficiency is the bottleneck of spot-scanning proton arc therapy (SPArc) because of the numerous energy layers (EL) ascending switches. This study aims to develop a new algorithm to mitigate the need for EL ascending via water equivalent thickness (WET) sector selection followed by particle swarm optimization (SPArc- particle swarm).&#xD;Approach. SPArc- particle swarm divided the full arc trajectory into the optimal sectors based on the K-means clustering analysis of the relative mean WET. Within the sector, particle swarm optimization was used to minimize the total energy switch time, optimizing the energy selection integrated with EL delivery sequence and relationship. This novel planning framework was implemented on the open-source platform matRad (Department of Medical Physics in Radiation Oncology, German Cancer Research Center-DKFZ). Three representative cases (brain, liver, and prostate cancer) were selected for testing purposes. Two kinds of plans were generated: SPArc_seq and SPArc-particle swarm. The plan quality and delivery efficiency were evaluated.&#xD;Main results. With a similar plan quality, the delivery efficiency was significantly improved using SPArc-particle swarm compared to the SPArc_seq. More specifically, it reduces the number of EL ascending switching compared to the SPArc_seq (from 21 to 7 in the brain case, from 21 to 5 in the prostate case, from 21 to 6 in the liver case), leading to 16-26% beam delivery time (BDT) reducing in the SPArc treatment. &#xD;Significance. A novel planning framework SPArc-particle swarm could significantly improve the delivery efficiency, which paves the roadmap towards routine clinical implementation. &#xD.

PMID:38041874 | DOI:10.1088/1361-6560/ad11a4

Am J Clin Pathol. 2023 Dec 2:aqad159. doi: 10.1093/ajcp/aqad159. Online ahead of print.

ABSTRACT

OBJECTIVES: National societies recommend against performing routine daily laboratory testing without a specific indication. Unnecessary testing can lead to patient harm, such as hospital-acquired anemia. The objective of this study was to reduce repeat complete blood counts (CBCs) after initial testing.

METHODS: This was a quality improvement initiative implemented across 11 safety net hospitals in New York City. A best practice advisory (BPA) was implemented that asked the user to remove a CBC if the last 2 CBCs within 72 hours had normal white blood cell and platelet counts and unchanged hemoglobin levels. The outcome measure was the rate of CBCs per 1000 patient days preintervention (January 8, 2020, to December 22, 2020) to postintervention (December 23, 2020, to December 7, 2021). The process measure was the acceptance rate of the BPA, defined as the number of times the repeat CBC order was removed through the BPA divided by the total number of times the BPA triggered.

RESULTS: Across 11 hospitals, repeat CBC testing decreased by 12.3% (73.05 to 64.04 per 1000 patient days, P < .001). Six of the 11 hospitals exhibited statistically significant decreases, ranging from a 10% to 48.9% decrease of repeat CBCs. The overall BPA action rate was 20.0% (24,029 of 119,944 repeat CBCs).

CONCLUSIONS: This low-effort, electronic health record-based intervention can effectively reduce unnecessary laboratory testing.

PMID:38041859 | DOI:10.1093/ajcp/aqad159

Bratisl Lek Listy. 2024;125(1):59-63. doi: 10.4149/BLL_2023_137.

ABSTRACT

INTRODUCTION: HBeAg-negative chronic HBV infection is defined by viremia < 2,000 IU/ml (or < 20,000 IU/ml), normal ALT activity and minimal liver fibrosis. Some patients do not meet all the criteria and belong to the so-called grey zone. The aim of the work was to analyse a group of patients with asymptomatic chronic HBV infection, divide them according to the levels of HBV DNA during follow-up and to compare the clinical and laboratory parameters of the patients within the groups.

METHODS: We retrospectively analysed patients with HBeAg-negative chronic HBV infection examined in the Centre for Viral Hepatitis of the Department of Infectology in Košice, Slovakia, from September 2018 to December 2021. Patients were divided into three groups based on HBV DNA levels ​​during long-term follow-up ( 2,000 IU/ ml). We evaluated selected demographic, anamnestic and laboratory data (HBV DNA, ALT, fibrosis stage).

RESULTS: Of the 280 enrolled patients, 160 were men (57.1 %), the average age was 48.0 years, and the mean length of follow-up was 4.7 years. HBV DNA levels ​​were consistently 2,000 IU/ml in 62 patients. 165 patients had normal ALT activity, 74 had fluctuating ALT activity, and permanently increased ALT in 41 patients. 139 patients underwent transient elastography examination, 16 of them had stage F2 fibrosis, two stage F3 and 1 had cirrhosis. When comparing the three groups divided according to HBV DNA, patients with fluctuating HBV DNA had the longest follow-up, but patients with HBV DNA permanently over 2,000 IU/ml were the youngest and the highest proportion of them had elevated ALT activity. 165 patients (58.9%) met the extended criteria of asymptomatic carriers, 115 were in the grey zone.

CONCLUSION: Patients with HBeAg-negative chronic HBV infection often have fluctuating HBV DNA and ALT values ​​during follow-ups. Statistically significantly higher proportion of abnormal ALT activity in patients with HBV DNA > 2,000 IU/ml may suggest higher risk of adverse outcomes. Initiation of treatment in such patients is not always necessary unless they also meet the other indication criteria for treatment. The exact definition of the grey zone is currently absent (Tab. 2, Fig. 2, Ref. 16).

PMID:38041848 | DOI:10.4149/BLL_2023_137

Bratisl Lek Listy. 2024;125(1):50-54. doi: 10.4149/BLL_2024_009.

ABSTRACT

OBJECTIVE: This study estimated delirium incidence in Slovak COVID-19 patients, explored treatment associations and examined the impact on hospitalization and mortality.

BACKGROUND: The COVID-19 pandemic caused by SARS-CoV-2 has significantly affected global health. Delirium, a severe form of acute brain dysfunction, is common in hospitalized patients, including those with COVID-19.

METHODS: A retrospective study analyzed data from 474 hospitalized patients with confirmed SARS-CoV-2 infection in Kosice, Slovakia. Delirium was diagnosed using standardized ICD-10 criteria. Statistical analyses examined associations between delirium, psychiatric symptoms, treatment modalities, hospitalization duration, and mortality.

RESULTS: 29.54 % (140 patients) had delirium. Insomnia, anxiety, and delirium were prevalent psychiatric symptoms. Delirium patients had higher insomnia, anxiety, somnolence, agitation, and aggression rates. Treatments like high-flow nasal oxygen, glucocorticoids, antibiotics, and anakinra were associated with higher delirium incidence. Delirium was more common with antipsychotic use (tiapride, quetiapine, haloperidol), while citalopram seemed protective. No significant associations were found with mortality. Patients using benzodiazepines, hypnotics, or tiapride had longer hospital stays.

CONCLUSION: This study provides insights into delirium incidence in Slovak COVID-19 patients, treatment associations, and the importance of managing psychiatric symptoms and treatment choices for optimal outcomes (Tab. 6, Ref. 33).

PMID:38041846 | DOI:10.4149/BLL_2024_009

Bratisl Lek Listy. 2024;125(1):17-23. doi: 10.4149/BLL_2024_004.

ABSTRACT

AIMS: The aim of the presented study was to determine the distribution of HBV genotypes and their influence on selected parameters in patients in eastern Slovakia.

METHODS: The study includes 202 patients with confirmed chronic HBV infection or hepatitis. For each patient, basic demographic data, and serum samples were collected. The degree of liver fibrosis was determined by transient elastography. The obtained data were evaluated statistically.

RESULTS: Out of a total of 202 patients, 96.0 % of the patients were from the EU region and 27 patients (13.4 %) self-identified as Roma ethnic group. The most common genotype among our patients was genotype A (n = 104; 51.5 %), followed by genotype D (n = 76; 37.6 %) and A/D (n = 13; 6.4 %). In patients from the EU region, genotypes A and D predominated statistically significantly (p < 0.0001). Due to a low number of patients with other genotypes, in the subsequent analysis, we only compared patients with HBV genotypes A or D. Patients with genotypes D and A/D significantly more often mention tattoos as a possible risk factor for disease transmission compared to patients with genotype A (p = 0.043). Subsequently, we divided patients into two groups – treated and untreated. The level of qHBsAg was significantly higher in untreated patients with genotypes A (p < 0.0001). The influence of HBV genotypes on other laboratory parameters was not confirmed in our study.

CONCLUSION: This is the first HBV genotypes study from Slovakia. We suggest that HBV genotypes may play a role in the virus-host relationship Keywords: chronic hepatitis B, genotypes, hepatitis B virus, prognostic factors, distribution.

PMID:38041841 | DOI:10.4149/BLL_2024_004

J Magn Reson Imaging. 2023 Dec 2. doi: 10.1002/jmri.29162. Online ahead of print.

ABSTRACT

BACKGROUND: Pancreatic ductal adenocarcinoma (PDA) is the third leading cause of cancer-related death in the United States. However, early response assessment using the current approach of measuring changes in tumor size on computed tomography (CT) or MRI is challenging.

PURPOSE: To investigate the feasibility of hyperpolarized (HP) [1-¹³ C]pyruvate MRI to quantify metabolism in the normal appearing pancreas and PDA, and to assess changes in PDA metabolism following systemic chemotherapy.

STUDY TYPE: Prospective.

SUBJECTS: Six patients (65.0 ± 7.6 years, 2 females) with locally advanced or metastatic PDA enrolled prior to starting a new line of systemic chemotherapy.

FIELD STRENGTH/SEQUENCE: 3-T, T1-weighted gradient echo, metabolite-selective ¹³ C echoplanar imaging.

ASSESSMENT: Time-resolved HP [1-¹³ C]pyruvate data were acquired before (N = 6) and 4-weeks after (N = 3) treatment initiation. Pyruvate metabolism, as quantified by pharmacokinetic modeling and metabolite area-under-the-curve ratios, was assessed in manually segmented PDA and normal appearing pancreas ROIs (N = 5). The change in tumor metabolism before and 4-weeks after treatment initiation was assessed in primary PDA (N = 2) and liver metastases (N = 1), and was compared to objective tumor response defined by response evaluation criteria in solid tumors (RECIST) on subsequent CTs.

STATISTICAL TESTS: Descriptive tests (mean ± standard deviation), model fit error for pharmacokinetic rate constants.

RESULTS: Primary PDA showed reduced alanine-to-lactate ratios when compared to normal pancreas, due to increased lactate-to-pyruvate or reduced alanine-to-pyruvate ratios. Of the three patients who received HP [1-¹³ C]pyruvate MRI before and 4-weeks after treatment initiation, one patient had a primary tumor with early metabolic response (increase in alanine-to-lactate) and subsequent partial response according to RECIST, one patient had a primary tumor with relatively stable metabolism and subsequent stable disease by RECIST, and one patient had metastatic PDA with increase in lactate-to-pyruvate of the liver metastases and corresponding progressive disease according to RECIST.

DATA CONCLUSION: Altered pyruvate metabolism with increased lactate or reduced alanine was observed in the primary tumor. Early metabolic response assessed at 4-weeks after treatment initiation correlated with subsequent objective tumor response assessed using RECIST.

LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY: Stage 2.

PMID:38041836 | DOI:10.1002/jmri.29162