Nevin Manimala

Arch Gerontol Geriatr. 2021 Jul 2;96:104474. doi: 10.1016/j.archger.2021.104474. Online ahead of print.

ABSTRACT

INTRODUCTION: We investigated the efficacy and acceptability of pharmacotherapy for dementia with Lewy bodies (DLB) while simultaneously considering the neuropsychiatric symptoms (NPS), cognitive function, motor symptoms, and acceptability.

METHODS: Electronic databases were searched from inception through June 5, 2019, for randomized controlled trials (RCTs) and open-label trials (OLTs) in patients with DLB. We performed a pairwise conventional meta-analysis (PWMA) and network meta-analysis (NMA) within a frequentist framework. The main outcomes were mean change scores in NPS, general cognition, motor symptoms and acceptability. The effect sizes and odds ratios with 95% confidence intervals (CIs) were calculated. This study was registered with PROSPERO (CRD42018096996).

RESULTS: In total, we included 29 studies (9 RCTs and 20 OLTs). In the NMA with 9 RCTs, both high- (mean difference [MD] 2.00, 95% CIs, 0.69 to 3.31) and low-dose (1.86, 0.58 to 3.15) donepezil were associated with a greater cognitive improvement than placebo. High-dose zonisamide was associated with greater motor symptom improvement ( -4.10, -7.03 to -1.17]). No medications reached statistical significance regarding improving neuropsychiatric symptoms or developing intolerable adverse effects as compared to placebo. In the second NMA, with 29 studies as an exploratory analysis, aripiprazole and yokukansan may be effective for neuropsychiatric symptoms, while levodopa may be associated with cognitive impairment.

CONCLUSIONS: We report the most comprehensive evidence for the selection of pharmacotherapy for treating different clusters of DLB-related symptoms. Due to the limited availability of RCTs on DLB, more well-conducted RCTs are needed for MMA to warrant clinical efficacy in the future.

PMID:34256210 | DOI:10.1016/j.archger.2021.104474

Photodiagnosis Photodyn Ther. 2021 Jul 10:102433. doi: 10.1016/j.pdpdt.2021.102433. Online ahead of print.

ABSTRACT

This study evaluated the action of Antimicrobial Photodynamic Therapy (aPDT) on Enterococcus faecalis and Actinomyces israelii. Samples were taken from the root canal system, at different stages of treatment and bacteria were identified through qPCR. Fifty teeth (incisors, canines, and premolars) with pulp necrosis and periapical lesion diagnosis were randomly selected and divided into 2 groups: Group 1 (G1) – Endodontic Therapy with Mechanical Chemical Preparation (MPQ) and intracanal medication; Group 2 (G2) – Endodontic therapy with MPQ, intracanal medication, and 2 applications of aPDT. APDT was performed with application of 0.005% methylene blue, wavelength of 660 nm, and 90 seconds. Follow-up was performed with an initial x-ray and an x-ray 60 days after the end of treatment. The radiographs were scored evaluated by two examiners to classify periapical repair: total repair, partial repair, doubtful repair, or no repair. Enterococcus faecalis was found more frequently in G1 than G2. Actinomyces israelii was found equally in G1 and G2. Evaluation of the two bacteria between collections 1, 2 and 3, showed that there was no difference, both in G1 and in G2. There was association between the variables group and repair classification in radiographs evaluation. APDT did not promote better results in endodontic treatment, being similar to conventional treatment. However, this study pointed out that molecular methods may not be efficient in detecting bacteria after treatment, and colony-forming units may complement, being an effective quantifying method. Therefore, new studies must be carried out to show the possible effectiveness of aPDT.

PMID:34256171 | DOI:10.1016/j.pdpdt.2021.102433

Neurotoxicol Teratol. 2021 Jul 10:107018. doi: 10.1016/j.ntt.2021.107018. Online ahead of print.

ABSTRACT

Developmental neurotoxicity (DNT) studies could benefit from revisions to study design, data analysis, and some behavioral test methods to enhance reproducibility. The Environmental Protection Agency (EPA) reviewed 69 studies submitted to the Office of Pesticide Program. Two of the behavioral tests identified the lowest observable adverse effect level (LOAEL) 20 and 13 times, respectively, while the other two tests identified the LOAEL only 3 and 4 times, respectively. The EPA review showed that the functional observational battery (FOB) was least effective at detecting the LOAEL, whereas tests of learning and memory (L&M) had methodological shortcomings. Human neurodevelopmental toxicity studies over the past 30 years show that most of the adverse effects are on higher cognitive functions such as L&M. The results of human studies together with structure-function relationships from neuroscience, suggest that tests of working memory, spatial navigation/memory, and egocentric navigation/memory should be added to guideline studies. Collectively, the above suggest that EPA and EU DNT studies would better reflect human findings and be more relevant to children by aligning L&M tests to the same domains that are affected in children, removing less useful methods (FOB), and using newer statistical models to better account for random factors of litter and litter × sex. Common issues in study design and data analyses are discussed: sample size, random group assignment, blinding, elimination of subjective rating methods, avoiding confirmation bias, more complete reporting of species, housing, test protocols, age, test order, and litter effects. Litter in DNT studies should at least be included as a random factor in ANOVA models and may benefit from inclusion of litter × sex as random factors.

PMID:34256163 | DOI:10.1016/j.ntt.2021.107018

Geriatr Nurs. 2021 Jun 21;42(5):998-1005. doi: 10.1016/j.gerinurse.2021.06.020. Online ahead of print.

ABSTRACT

The purpose of this study was to examine the mental health of community-dwelling older adults as they adapted their everyday health behaviors during the COVID-19 pandemic. In response to a telephone survey, 126 older adults described perceived changes in physical and mental health, and adaptations in their everyday health behaviors. Descriptive statistics, bivariate correlations, and multiple regressions revealed that participants experienced changes in mental and physical health, reduced health service access, lower social engagement, and increased coping behaviors. Greater negative social impact of the pandemic was associated with higher levels of COVID-19 distress. Reduced mental health was significantly related to reductions in health service access, health changes, and fewer adaptive coping behaviors. Adaptive coping behaviors were helpful, just as reduced health access and social contact added risk for mental health problems. Suggestions were provided for alleviating mental health needs by increasing social contact and engaging in adaptive coping behaviors.

PMID:34256160 | DOI:10.1016/j.gerinurse.2021.06.020

Geriatr Nurs. 2021 Jun 12;42(5):983-992. doi: 10.1016/j.gerinurse.2021.06.003. Online ahead of print.

ABSTRACT

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has caused the coronavirus diseases 2019 (COVID-19) pandemic, continues to spread rapidly worldwide and is associated with high rates of mortality among older adults, those with comorbidities, and those in poor physiological states. This paper aimed to systematically identify the impact of frailty on overall mortality among older adults with COVID-19. We conducted a systematic review of the literature indexed in 4 databases. A random-effects model with inverse variance-weighted meta-analysis using the odds ratio was used to study the association of frailty levels with clinical outcomes among older adults with COVID-19. Heterogeneity was measured using the I² statistic and Egger’s test. We identified 22 studies that met our inclusion criteria, including 924,520 total patients. Overall, frailty among older adults was associated with high rates of COVID-19-related mortality compared with non-frail older adults (OR [odds ratio]:5.76; 95% confidence interval [95% CI]: 3.85-8.61, I²: 40.5%). Our results show that physical limitations, such as those associated with frailty among older adults, are associated with higher rates of COVID-19-related mortality.

PMID:34256158 | DOI:10.1016/j.gerinurse.2021.06.003

Geriatr Nurs. 2021 Jul 10;42(5):1006-1011. doi: 10.1016/j.gerinurse.2021.06.010. Online ahead of print.

ABSTRACT

This study aimed to examine the relationship between fear of falling in elderly patients who underwent spinal surgery and pain, kinesiophobia, anxiety, depression, and associated factors. The study was a descriptive, cross-sectional design. The research sample consisted of 211 elderly patients who had undergone spinal surgery. The average age of the patients was 66.68 ± 5.57. Of the sample, 83.4% were afraid of falling, and 21.3% were severely afraid of falling. In the study, age (β = 0.115, p = 0.005), being a woman (β = -0.182, p < 0.001), pain (β = 0.269, p < 0.001), risk of falling (β = 0.084, p = 0.49), Hospital Anxiety and Depression Scale-Anxiety (HADS-A) (β = 0.135, p = 0.044), Hospital Anxiety and Depression Scale Anxiety-Depression (HADS-D) (β = 0.382, p < 0.001), and kinesiophobia (β = 0.722, p < 0.001) were statistically significant predictors of fear of falling. This study provided important information about the variables that surgical nurses should pay attention to while evaluating the fear of falling in elderly patients who underwent spinal surgery.

PMID:34256148 | DOI:10.1016/j.gerinurse.2021.06.010

J Vasc Interv Radiol. 2021 Jul 10:S1051-0443(21)01199-4. doi: 10.1016/j.jvir.2021.06.019. Online ahead of print.

ABSTRACT

PURPOSE: To review and compare outcomes of prostatic artery embolization (PAE) with three other minimally-invasive surgical treatments for benign prostatic hyperplasia (BPH), including photo selective vaporization (PVP), prostatic urethral lift (PUL), and water vapor thermal therapy (WV) for the treatment of benign prostatic hyperplasia (BPH).

MATERIALS AND METHODS: A literature review identified 35 publications, which included 2653 patients (studies, patients): PVP (13, 949), PUL (9, 577), WV (3, 330), PAE (10, 728). International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF-5), and Quality of Life (QOL) were recorded at baseline, 6, and 12 months. Meta-analyses, pooling the standardized mean difference between pre and post-treatment scores, were conducted for each modality and time-point to assess the magnitude of a therapy’s effect to yield Pooled Effect Sizes. A negative score indicates IPSS and QOL improvement. A positive score indicates IIEF-5 improvement.

RESULTS: At 6 and 12 months, IPSS and QOL were most improved after PVP, then PAE, PUL, and lastly WV (measured only at 12 months). Between 6 and 12 months, IPSS and QOL improved with PAE, and worsened with PVP and PUL. Only PAE demonstrated statistical improvement of IIEF-5, which improved from 6 to 12 months.

CONCLUSION: PVP and PAE resulted in the largest improvements in IPSS and QOL. Only PAE resulted in improvement of IIEF-5.

PMID:34256123 | DOI:10.1016/j.jvir.2021.06.019

WMJ. 2021 Jul;120(2):152-155.

ABSTRACT

BACKGROUND: The objective of this study was to determine the associations between heart disease, obesity, and demographic factors and increased COVID-19 mortality.

METHODS: We extracted deidentified patient-level data from the Froedtert Health System and Children’s Hospital of Wisconsin and used descriptive statistics and multivariable logistic regression to characterize relationships between heart disease, obesity, age group, sex, race and ethnicity and mortality following COVID-19 diagnosis.

RESULTS: We found heart disease (adjusted odds ratio [AOR] 2.85; 95% CI, 2.11-8.83) and other demographic factors are significant predictors of increased mortality in COVID-19 patients. However, obesity was not a significant predictor of mortality (AOR 1.04; 95% CI, 0.53- 3.10).

DISCUSSION: These unique results indicate some comorbid conditions and patient demographics contribute more strongly to mortality in COVID-19 patients.

PMID:34255958

Eur J Neurol. 2021 Jul 13. doi: 10.1111/ene.15025. Online ahead of print.

ABSTRACT

BACKGROUND: Although body weight variability has been associated with mortality, cardiovascular disease, and dementia, the relationship between body weight variability and Parkinson’s disease (PD) has been rarely studied. We aimed to investigate the longitudinal association between body weight variability and PD incidence.

METHODS: A nationwide population-based, cohort study was conducted using the database from the Health Insurance Review and Assessment Service of the whole Korean population. We analyzed 2,815,135 participants (≥ 40 years old, mean age 51.7 (8.6) years, 66.8% men) without a previous PD diagnosis. We determined individual body weight variability from baseline weight and follow-up visits. We used Cox proportional hazards regression models.

RESULTS: The highest quartile group was associated with increased PD incidence compared with the lowest quartile group after adjustment for confounding factors (hazard ratio (HR), 1.18; 95% confidence interval (CI): 1.08-1.29). In contrast, baseline body mass index, baseline waist circumference, and waist circumference variability were not associated with increased PD incidence. In the body weight loss group, individuals within the quartile of the highest variation in body weight showed a higher HR of PD risk than those within other quartiles (HR, 1.41; 95% CI: 1.18-1.68).

CONCLUSION: Body weight variability, especially weight loss, was associated with higher PD incidence. This finding has important implications for clinicians and supports the need for preventative measures and surveillance for PD in individuals with fluctuating body weight.

PMID:34255908 | DOI:10.1111/ene.15025

Clin Psychol Psychother. 2021 Jul 13. doi: 10.1002/cpp.2644. Online ahead of print.

ABSTRACT

OBJECTIVE: COVID-19 pandemic has been a stressful condition. We explored life changes and health-related consequences of COVID-19 outbreak in Italian health care workers in comparison to the general population.

METHODS: A total of 593 subjects participated to the online CoRonavIruS Health Impact Survey. Life events and changes, physical health, and worries were evaluated referring to 2-week prior the survey. Mood states and daily behavior were retrospectively evaluated referring to 3-month before COVID-19 (T1) and 2-week prior the survey (T2). Student t-test, Mann-Whitney test, and multivariate logistic regression analyses were run.

RESULTS: Five hundred and twenty-one subjects were analyzed (healthcare workers: n= 163, 31.84%; general population: n = 349, 68.16%). Healthcare workers were more likely to report fatigue and have spent more time outside home during the 2-week prior the survey than the general population (x² (df)=266.03(17), p<0.001, R2=0.57). From T1 to T2, healthcare workers had a significant increase in negative mood, worry, restlessness, loneliness, and a decrease in happiness, while subjects from the general population had a statistically significant increase in negative mood, worry, attention, concentration difficulties, and a decrease in happiness, pleasure related to daily activities, time spent outdoors, alcohol use.

CONCLUSION: In the framework of a growing literature on health care workers’ status during the COVID-19 pandemic, the present study allowed to identify fatigue and loneliness as psychosomatic modifiable variables in need of being monitored and, possibly managed, to ameliorate the health status of health care workers.

PMID:34255890 | DOI:10.1002/cpp.2644