Nevin Manimala

Muscle Nerve. 2022 Jul 23. doi: 10.1002/mus.27681. Online ahead of print.

ABSTRACT

INTRODUCTION/AIMS: We studied COVID-19 vaccination-related adverse events (ADEs) 7-days post-vaccination in patients with idiopathic inflammatory myopathies (IIMs) and other systemic autoimmune and inflammatory disorders (SAIDs).

METHODS: 7-day vaccine ADEs were collected in an international patient self-reported e-survey. Descriptive statistics and multivariable regression were performed.

RESULTS: 10,900 respondents [1227 IIMs; 4640 SAIDs; 5033 healthy controls (HCs), median age 42 (IQR 30-55) years, 74% female, 45% Caucasian, 69% completely vaccinated] were analysed. 76.3% IIMs patients reported minor and 4.6% major ADEs. Patients with active IIMs reported more frequent major [OR 2.7 (1.04-7.3)] and minor [OR 1.5 (1.1-2.2)] ADEs than inactive IIMs. Rashes were more frequent in IIMs [OR-2.3(1.2-4.2)] than HCs. ADEs were not impacted by steroid dose, although hydroxychloroquine and intravenous/subcutaneous immunoglobulins were associated with a higher risk of minor ADEs [OR 1.9 (1.1-3.3), OR 2.2 (1.1-4.3)]. Overall, ADEs were less frequent in inclusion body myositis (IBM) and BNT162b2 (Pfizer) vaccine recipients DISCUSSION: 7-day post-vaccination ADEs were comparable in patients with IIMs, SAIDs, and HCs, except for a higher risk of rashes in IIMs. Patients with DM, active disease may be at higher risk, and IBM patients at lower risk of specific ADEs. Overall, the benefit of preventing severe COVID-19 through vaccination likely outweighs the risk of vaccine-related ADEs Our results may inform future guidelines regarding COVID-19 vaccination in patients with SAIDs, and specifically in IIMs. Studies to evaluate long-term outcomes and disease flares are needed to shed more light on developing future COVID-19 vaccination guidelines. This article is protected by copyright. All rights reserved.

PMID:35869701 | DOI:10.1002/mus.27681

Pharmacotherapy. 2022 Jul 22. doi: 10.1002/phar.2722. Online ahead of print.

ABSTRACT

BACKGROUND: Vancomycin is commonly used to treat methicillin-resistant Staphylococcus aureus infections and is known to cause nephrotoxicity. Previous Vancomycin Consensus Guidelines recommended targeting trough concentrations but the 2020 Guidelines suggest monitoring vancomycin area under the curve (AUC) given the reduced risk of acute kidney injury (AKI) at similar levels of efficacy. This meta-analysis compares vancomycin-induced AKI incidence using AUC-guided dosing strategies versus trough-based monitoring.

METHODS: Literature was queried from Medline (Ovid), Web of Science, and Google Scholar from database inception through November 5, 2021. Interventional or observational studies reporting the incidence of vancomycin-induced AKI between AUC- versus trough-guided dosing strategies were included. In the primary analysis, the Vancomycin Consensus Guidelines definition for AKI was used if reported; otherwise, the Risk, Injury, and Failure; and Loss, and End-stage kidney disease (RIFLE) or Kidney Disease Improving Global Outcomes (KDIGO) definitions were used. The incidence of nephrotoxicity was evaluated between the two strategies using a Mantel-Haenszel random-effects model, and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Subgroup analyses for adjusted ORs and AKI definitions were performed. Heterogeneity was identified using Cochrane’s Q test and I² statistics.

RESULTS: A total of 10 studies with 4,231 patients were included. AUC-guided dosing strategies were associated with significantly less vancomycin-induced AKI than trough-guided strategies [OR 0.625, 95% CI (0.469 – 0.834), p=0.001; I² =25.476]. A subgroup analysis of three studies reporting adjusted ORs yielded similar results [OR 0.475, 95% CI (0.261 – 0.863), p=0.015]. Stratification by AKI definition showed a significant reduction in AKI with the Vancomycin Consensus Guidelines definition [OR 0.552, 95% CI (0.341 – 0.894), p=0.016] but failed to find significance in the alternative definitions.

CONCLUSIONS: AUC-guided dosing strategies are associated with a lower incidence of vancomycin-induced AKI versus trough-guided dosing strategies (GRADE, low). Limitations included the variety of AKI definitions and the potential for confounding bias.

PMID:35869689 | DOI:10.1002/phar.2722

Eur J Dent Educ. 2022 Jul 22. doi: 10.1111/eje.12837. Online ahead of print.

ABSTRACT

INTRODUCTION: Dentistry professionals may experience significantly higher occupational stress than other health professionals and dentistry academics may have specific work content and context sources of stress.

AIMS: To identify common sources of occupational stress, and how these are associated with wellbeing, in dentistry academics.

METHODS: A cross-sectional online survey with staff in Dentistry departments in Australia and New Zealand. Assessment included 23-items from five general domains of occupational stress from the NIOSH – Generic Job Stress Questionnaire, a 23-item list of sources of stress and the 22-item Psychological General Well-Being Index. Analyses used descriptive statistics and multiple linear regression.

RESULTS: 107 respondents (average age 50±11.7 years, 56.8% men) completed the survey. Leading sources of occupational stress were job future, time pressure at work, work overload, and administration demands. A multiple linear regression model significantly predicted wellbeing, F(8,77)=13.141, p=.000, adj.R² =.53, but there were no significant associations for any of the specific sources of stress.

CONCLUSION: The combination of time pressure, workload and responsibility, job dissatisfaction, low social support, and uncertain job future was inversely associated with wellbeing among these dentistry academics. Future studies should consider the development and evaluation of interventions to address these concerns.

PMID:35869687 | DOI:10.1111/eje.12837

Eur J Dent Educ. 2022 Jul 22. doi: 10.1111/eje.12839. Online ahead of print.

ABSTRACT

INTRODUCTION: The aim of this study was to evaluate the correlations of cognitive and non-cognitive dental school admission factors with interview ratings provided by faculty and student interviewers.

METHODS: Interviewees for the 2019-2021 admissions cycles underwent a 90-minute period consisting of two 45-minute interviews and received two interview scores ranging from 1.0 to 2.3. Regression models were utilized to evaluate factors associated with interviewer type and admission status, The correlation strength between faculty and student interview scores was assessed.

RESULTS: A total of 177 applicants were interviewed, and 69 students were admitted over two admission cycles. Admitted students received higher interview ratings compared to non-admitted applicants after adjusting for cognitive and non-cognitive admission factors (average difference=-0.068; 95%CI=-0.123, -0.014). No statistically significant relationship was found between any cognitive admissions factor and interview score. However, having prior leadership role experiences was associated with better faculty score, after adjusting for student interviewee score. There was a strong linear correlation (r= 0.92) between faculty and student interview scores, with 0.809 change in faculty score with each additional student interview score (95%CI=0.735, 0.883).

CONCLUSION: The relationship between faculty and student scores was linear and strongly correlated, suggesting that faculty and student interviewers were comparable in their interview scoring. Leadership experience and potential could be advantageous qualities that improve faculty interviewer ratings. However, having a mix of faculty and Student interviewers may promote evaluation of candidates from different aspects, as students are familiar with the learning environment in dental school and may provide a unique perspective on an applicant’s background and suitability for the program.

PMID:35869683 | DOI:10.1111/eje.12839

Eur J Dent Educ. 2022 Jul 22. doi: 10.1111/eje.12838. Online ahead of print.

ABSTRACT

The purpose of this study was to evaluate if patients at one dental education institution received appropriate care based on their periodontal diagnosis in a timely manner. This study used a retrospective design to evaluate data from July 2018 to February 2020. The patient records were screened to determine if patients received a periodontal diagnosis, whether the diagnosis followed the 2018 AAP Classification Guidelines, and if appropriate preventive and therapeutic procedures were completed in a timely manner. In addition, the type or year of dental student providing the procedure was also recorded. Data was analyzed using descriptive statistics and a chi square test. A total of 612 charts were generated for review and 157 met the inclusion criteria and were evaluated. Results revealed that more than half (56.7%) of the patient records did not demonstrate a periodontal diagnosis and another 10.8% did not follow current AAP Classification Guidelines. Most patients (n=125, 79.6%) had a comprehensive periodontal assessment performed, while 32 (20.4%) had no comprehensive periodontal charting information recorded. Further, of the 157 records reviewed, 96 (61.1%) had no periodontal treatment specified. A statistically significant difference with a modest association was found between type of dental student and year based on periodontal diagnosis (Fisher’s Exact Test value = 20.72, p=0.001, Cramer’s V = 0.25). Documentation of key clinical information, diagnostic conclusions, and treatment rendered requires curriculum review. Further studies are warranted to determine if similar findings exist among other dental school education programs.

PMID:35869677 | DOI:10.1111/eje.12838

Scand J Gastroenterol. 2022 Jul 22:1-4. doi: 10.1080/00365521.2022.2099761. Online ahead of print.

ABSTRACT

Objective: To evaluate the value of new gastric cancer screening score system for risk assessment of gastric precancerous lesions.Methods: A total of 520 patients were enrolled after the examination of endoscopy at Endoscopy Center, Department of Gastroenterology, from June 2018 to December 2021. The patients were divided into three groups according to age, gender, serum helicobacter pylori antibody test, pepsinogen I (PGI), pepsinogen II (PGII), pepsinogen I/II ratio (PGR) and gastrin-17 test results before endoscopy: Group A defined as low-risk group (0-11 points), Group B defined as middle-risk group (12-16 points), Group C defined as high-risk group (17-23 points). The detection rates of gastric cancer and atrophic gastritis in three groups were analyzed. According to the range and degree of atrophy/intestinal metaplasia, patients were divided into five groups on the basis of OLGA/OLGIM staging system. The levels of PG I, PG II and PGR were compared between different groups, and the correlation between new gastric cancer screening score system and OLGA/OLGIM staging system were evaluated. Statistical analysis was accomplished by ANOVA, chi-square test and Gamma coefficient analysis.Results: A total of 520 patients were enrolled. 268 patients were classified into group A,222 patients into group B and 30 patients into group C, respectively. According to the pathological results, 281 cases were non-atrophic gastritis, 230 cases atrophic gastritis and 9 cases gastric cancer. For OLGA staging system, 281 patients were divided into stage-0 group, 121 patients into stage-I group, 72 patients into stage-II group, 33 patients into stage-III group and 13 patients into stage-IV groups. The PGI and PGR level correlated inversely with the rising OLGA stages (F = 3.028, p = .016, F = 6.036, p < .001). For OLGIM staging system, 252 patients were divided into stage-0 group, 137 patients into stage-I group, 80 patients into stage-II group, 36 patients into stage-III group and 15 patients into stage-IV group. The PGR level correlated inversely with the rising OLGIM stages (F = 3.466, p＝.007). The detection rates of gastric cancer and atrophic gastritis in Group C were much higher than other groups. (X² = 14.727, p < .001; X² = 51.280, p < .001). Gamma coefficient analysis showed significant correlations between OLGA/OLGIM and the new gastric cancer screening score system (p < .001).Conclusions: The new gastric cancer screening score system is closely linked with histological OLGA/OLGIM staging system in the risk assessment of gastric precancerous lesions. The role of new gastric cancer screening score system in future gastric precancerous lesions screening and high risk population identifying was promising.

PMID:35868004 | DOI:10.1080/00365521.2022.2099761

Psychophysiology. 2022 Jul 22:e14155. doi: 10.1111/psyp.14155. Online ahead of print.

ABSTRACT

The concealed information test (CIT) relies on bodily reactions to stimuli that are hidden in mind. However, people can use countermeasures, such as purposely focusing on irrelevant things, to confound the CIT. A new method designed to prevent countermeasures uses rapid serial visual presentation (RSVP) to present stimuli on the fringe of awareness. Previous studies that used RSVP in combination with electroencephalography (EEG) showed that participants exhibit a clear reaction to their real first name, even when they try to prevent such a reaction (i.e., when their name is concealed information). Because EEG is not easily applicable outside the laboratory, we investigated here whether pupil size, which is easier to measure, can also be used to detect concealed identity information. In our first study, participants adopted a fake name, and searched for this name in an RSVP task, while their pupil sizes were recorded. Apart from this fake name, their real name and a control name also appeared in the task. We found pupil dilation in response to the task-irrelevant real name, as compared to control names. However, while most participants showed this effect qualitatively, it was not statistically significant for most participants individually. In a second study, we preregistered the proof-of-concept methodology and replicated the original findings. Taken together, our results show that the current RSVP task with pupillometry can detect concealed identity information at a group level. Further development of the method is needed to create a valid and reliable concealed identity information detector at the individual level.

PMID:35867974 | DOI:10.1111/psyp.14155

PLoS Comput Biol. 2022 Jul 22;18(7):e1009996. doi: 10.1371/journal.pcbi.1009996. eCollection 2022 Jul.

ABSTRACT

Collateral circulation in the circle of Willis (CoW), closely associated with disease mechanisms and treatment outcomes, can be effectively investigated using one-dimensional-zero-dimensional hemodynamic simulations. As the entire cardiovascular system is considered in the simulation, it captures the systemic effects of local arterial changes, thus reproducing collateral circulation that reflects biological phenomena. The simulation facilitates rapid assessment of clinically relevant hemodynamic quantities under patient-specific conditions by incorporating clinical data. During patient-specific simulations, the impact of clinical data uncertainty on the simulated quantities should be quantified to obtain reliable results. However, as uncertainty quantification (UQ) is time-consuming and computationally expensive, its implementation in time-sensitive clinical applications is considered impractical. Therefore, we constructed a surrogate model based on machine learning using simulation data. The model accurately predicts the flow rate and pressure in the CoW in a few milliseconds. This reduced computation time enables the UQ execution with 100 000 predictions in a few minutes on a single CPU core and in less than a minute on a GPU. We performed UQ to predict the risk of cerebral hyperperfusion (CH), a life-threatening condition that can occur after carotid artery stenosis surgery if collateral circulation fails to function appropriately. We predicted the statistics of the postoperative flow rate increase in the CoW, which is a measure of CH, considering the uncertainties of arterial diameters, stenosis parameters, and flow rates measured using the patients’ clinical data. A sensitivity analysis was performed to clarify the impact of each uncertain parameter on the flow rate increase. Results indicated that CH occurred when two conditions were satisfied simultaneously: severe stenosis and when arteries of small diameter serve as the collateral pathway to the cerebral artery on the stenosis side. These findings elucidate the biological aspects of cerebral circulation in terms of the relationship between collateral flow and CH.

PMID:35867968 | DOI:10.1371/journal.pcbi.1009996

J Clin Oncol. 2022 Jul 22:JCO2200229. doi: 10.1200/JCO.22.00229. Online ahead of print.

ABSTRACT

PURPOSE: The androgen receptor (AR) is expressed (+) in a subset of salivary gland cancers (SGCs). This phase II trial evaluated the efficacy of the antiandrogen enzalutamide in AR+ SGC.

METHODS: Patients with locally advanced/unresectable or metastatic AR+ SGCs were enrolled. Enzalutamide (160 mg) was given orally once daily. The primary end point was the best overall response rate per RECIST v1.1 within eight cycles. Confirmed responses in ≥ 5 of 41 patients would be considered promising. Secondary end points were progression-free survival, overall survival, and safety.

RESULTS: Forty-six patients were enrolled; 30 (65.2%) received prior systemic therapy, including 13 (28.3%) with AR-targeted drugs. Of seven (15.2%) partial responses (PRs), only two (4.3%) were confirmed per protocol and counted toward the primary end point. Twenty-four patients (52.2%) had stable disease; 15 (32.6%) had progression of disease as best response. Twenty-six patients (56.5%) experienced tumor regression in target lesions; 18 (39.1%) had partial response/stable disease ≥ 6 months. Tumor regressions were observed in female patients (5 of 6 [83.3%]) and those who received prior AR- (6 of 13 [46.2%]) or human epidermal growth factor receptor 2-targeted therapies (5 of 8 [62.5%]). Three patients remained on treatment at data cutoff (duration, 32.2-49.8 months). The median progression-free survival was 5.6 months (95% CI, 3.7 to 7.5); the median overall survival was 17.0 months (95% CI, 11.8 to 30.0). The most common adverse events were fatigue, hypertension, hot flashes, and weight loss. Total and free testosterone levels increased by a mean of 61.2% and 48.8%, respectively, after enzalutamide.

CONCLUSION: Enzalutamide demonstrated limited activity in AR+ SGC, failing to meet protocol-defined success in part because of a lack of response durability. Strategies to enhance the efficacy of antiandrogen therapy are needed.

PMID:35867947 | DOI:10.1200/JCO.22.00229

Blood Coagul Fibrinolysis. 2022 Jul 22. doi: 10.1097/MBC.0000000000001152. Online ahead of print.

ABSTRACT

Bleeding disorders are causes of great concern and panic for parents and primary care providers. Lack of knowledge and awareness on appropriate screening tests and factor product preparation contributed to potential diagnostic delays, increased complications, and economic costs. This study aimed to determine and compare the approach of primary care physicians (including general practitioners) and emergency physicians with a questionnaire including simulation-based cases on hemophilia. This simulation and two-stage questionnaire study was conducted with 244 participants. Before-after questionnaires, two case simulations, a brief presentation, and statistical analysis were performed. Participants mostly preferred tests, such as prothrombin time (PT) or partial thromboplastin time (PTT) to bleeding time for primary hemostasis (PT/PTT n: 192, 84.2%, bleeding time n: 94, 41.2%). Similar results were found for secondary hemostasis (bleeding time n: 144, 63.4%). There was a lack of knowledge in the management of simulation-based cases of acute hemorrhagic complications and factor product preparation (complication case: correct n: 100, 55.2%; initial doses correct n: 56, 43.4%, factor preparing correct n: 37, 49.3%, factor admission correct n: 36, 24.3%). All changed significantly, after the presentation (P = 0.000). Our study shows that there is probably a lack of knowledge of diagnostic investigations and appropriate factor product preparation with possible consequences for patients and economics.

PMID:35867946 | DOI:10.1097/MBC.0000000000001152