Nevin Manimala

Zhonghua Yu Fang Yi Xue Za Zhi. 2021 Apr 6;55(4):521-527. doi: 10.3760/cma.j.cn112150-20200331-00481.

ABSTRACT

Objective: The purpose of this study was to investigate the IgG antibody levels of whooping cough, diphtheria, and tetanus in pregnant women in Nanshan District. Methods: From January to March 2019, 495 pregnant women who met the inclusion criteria in a hospital in Nanshan District, Shenzhen were selected as the survey subjects. The enzyme-linked immunosorbent assay was used to detect serum levels of pertussis, diphtheria, and tetanus IgG antibodies and we compared the differences in antibody levels of pregnant women with different characteristics. Results: The maternal age was (29.23±4.08) years old. The geometric mean concentration of pertussis antibody was 2.589 (1.172-4.953) IU/ml, 1.01% (5 cases) of pregnant women had pertussis antibody concentration ≥ 40 IU/ml, and 75.15% (372 cases) of pregnant women had pertussis antibody concentration<5 IU/ml. The GMC value and antibody positive rate of diphtheria in pregnant women were 0.024(0.009-0.065) IU/ml and 72.53% (359 cases), respectively. The GMC value and antibody positive rate of tetanus in pregnant women were 0.014 (0.006-0.034) IU/ml and 53.74% (266 cases), respectively. There was no statistical difference in the antibody level and antibody positive rate among pregnant women of diphtheria and tetanus, respectively. Conclusion: The concentration of antibodies against pertussis, diphtheria, and tetanus in pregnant women are all at a low level, which is not enough to protect themselves from disease infection.

PMID:33858066 | DOI:10.3760/cma.j.cn112150-20200331-00481

Zhonghua Yu Fang Yi Xue Za Zhi. 2021 Apr 6;55(4):471-477. doi: 10.3760/cma.j.cn112150-20210203-00119.

ABSTRACT

Objective: To evaluate the clinical effects of orthokeratology lens on children with myopic anisometropia. Methods: Retrospective case series study. The data of 226 myopic anisometropia children, (10.83±1.56)years old, including 95 males and 131 females, fitted with orthokeratology(OK) lens in Beijing Tongren Hospital from June 2017 to June 2019 were collected. According to the lens wearing condition and baseline anisometropia, they were divided into four groups: group A1 with an average age of (10.68±1.66) years (bilateral OK lens wearing with low anisometropia, 1.0 D≤SE difference<2.5 D, 50 males and 61 females), group A2 with an average age of (11.24±1.38) years (bilateral OK lens wearing with moderate and high anisometropia, SE difference≥2.5 D, 10 males and 23 females), group B1 with an average age of (10.79±1.51) years (unilateral OK lens wearing with low anisometropia, 1.0 D≤SE difference<2.5 D, 17 males and 21 females) and group B2 with an average age of (10.97±1.60) years (unilateral OK lens wearing with moderate and high anisometropia, SE difference≥2.5 D, 18 males and 26 females). After wearing OK lens for one year, the changes of axial length(AL) and AL difference were observed and statistically analyzed. Results: (1) AL changes: after wearing OK-lens for one year, AL of each eye increased. In group A1, the AL of the more myopic eyes and the less myopic eyes increased by (0.20±0.21) mm and (0.24±0.22) mm respectively, and the difference was statistically significant (t=-3.208, P=0.002); in group A2, the AL growth of the more myopic eyes and the less myopic eyes were (0.04±0.11) mm and (0.17±0.14) mm, and the difference was statistically significant (t=-5.545, P<0.001). In group B1, the AL elongation of the more myopic eyes and the less myopic eyes were (0.14±0.21) mm and (0.39±0.23) mm, and in group B2, the AL growth of the more myopic eyes and the less myopic eyes were (0.11±0.14) mm and (0.54±0.24) mm, with statistically significant differences(t=-6.533, -11.643; all P<0.001). There was a linear correlation between AL elongation and age of the more myopic eyes and the less myopic eyes in group A1(corrected R²=0.208, 0.237) and group A2 (corrected R²=0.169, 0.360). There was no linear correlation of the more myopic eyes and the less myopic eyes between AL change and age or baseline myopia in group B1 (F=0.514, 1.205;P=0.602, 0.312) and group B2 (F=0.841, 0.056; P=0.439, 0.946). (2)Change of AL difference: after wearing OK lens for one year, the changes of AL difference in groupA1, A2, B1 and B2 were (-0.04±0.14) mm,(-0.13±0.13) mm,(-0.26±0.24) mm and (-0.43±0.25) mm, and the decrease of AL difference in moderate and high anisometropia groups were greater than that in low anisometropia groups (t =-3.211, -3.180; P=0.002, 0.002).There was a linear correlation between the reduction of AL difference and baseline anisometropia in group A1, A2 and B2 (corrected R²=0.099, 0.149, 0.230), and there was no linear relationship between the decrease of AL difference and the baseline anisometropia in group B1 (F=0.014, P=0.908). Conclusions: Orthokeratology could effectively control the progression of myopia and to treat anisometropia. The effect of myopia control was better in the older binocular OK lens wearers, and for the patients with greater baseline anisometropia, the treatment effect of anisometropia was better.

PMID:33858058 | DOI:10.3760/cma.j.cn112150-20210203-00119

Anaesthesia. 2021 Apr 15. doi: 10.1111/anae.15481. Online ahead of print.

NO ABSTRACT

PMID:33858027 | DOI:10.1111/anae.15481

J Infect Dis. 2021 Apr 15:jiab205. doi: 10.1093/infdis/jiab205. Online ahead of print.

ABSTRACT

BACKGROUND: Respiratory viral infections are common and potentially devastating to patients with underlying lung disease. Diagnosing viral infections often requires invasive sampling, and interpretation often requires specialized laboratory equipment. Here, we test the hypothesis that a breath test could diagnose influenza and rhinovirus infections using an in vitro model of the human airway.

METHODS: Cultured primary human tracheobronchial epithelial cells were infected with either Influenza A H1N1 or Rhinovirus 1B and compared with healthy control cells. Headspace volatile metabolite measurements of cell cultures were made at 12 h timepoints post-infection using a thermal desorption-gas chromatography-mass spectrometry method.

RESULTS: Based on 54 compounds, statistical models distinguished VOC profiles of influenza- and rhinovirus-infected cells from healthy counterparts. Area under the curve values were 0.94 for influenza, 0.90 for rhinovirus, and 0.75 for controls. A regression analysis predicted how many hours prior cells became infected with a root mean square error of 6.35 h for influenza- and 3.32 h for rhinovirus-infected cells.

CONCLUSIONS: Volatile biomarkers released by bronchial epithelial cells could not only be used to diagnose whether cells were infected, but also the timing of infection. Our model supports the hypothesis that a breath test could serve to diagnose viral infections.

PMID:33858010 | DOI:10.1093/infdis/jiab205

PLoS One. 2021 Apr 15;16(4):e0249874. doi: 10.1371/journal.pone.0249874. eCollection 2021.

ABSTRACT

BACKGROUND: Attainment of healthcare in respectful and dignified manner is a fundamental right for every woman regardless of the individual status. However, social exclusion, poor psychosocial support, and demeaning care during childbirth at health facilities are common worldwide, particularly in low- and middle-income countries. We concurrently examined how women with varying socio-demographic characteristics are treated during childbirth, the effect of women’s empowerment on mistreatment, and health services factors that contribute to mistreatment in secondary-level public health facilities in Pakistan.

METHODS: A cross-sectional survey was conducted during August-November 2016 among 783 women who gave birth in six secondary-care public health facilities across four contiguous districts of southern Sindh. Women were recruited in health facilities and later interviewed at home within 42 days of postpartum using a WHO’s framework-guided 43-item structured questionnaire. Means, standard deviation, and average were used to describe characteristics of the participants. Multivariable linear regression was applied using Stata 15.1.

RESULTS: Women experiencing at least one violation of their right to care by hospital staff during intrapartum care included: ineffective communication (100%); lack of supportive care (99.7%); loss of autonomy (97.5%); failure of meeting professional clinical standards (84.4%); lack of resources (76.3%); verbal abuse (15.2%); physical abuse (14.8%); and discrimination (3.2%). Risk factors of all three dimensions showed significant association with mistreatment: socio-demographic: primigravida and poorer were more mistreated; health services: lesser-education on birth preparedness and postnatal care leads to higher mistreatment; and in terms of women’s empowerment: women who were emotionally and physically abused by family, and those with lack of social support and lesser involvement in joint household decision making with husbands are more likely to be mistreated as compared to their counterparts. The magnitude of relationship between all significant risk factors and mistreatment, in the form of β coefficients, ranged from 0.2 to 5.5 with p-values less than 0.05.

CONCLUSION: There are glaring inequalities in terms of the way women are treated during childbirth in public health facilities. Measures of socio-demographic, health services, and women’s empowerment showed a significant independent association with mistreatment during childbirth. At the health system level, there is a need for urgent solutions for more inclusive care to ensure that all women are treated with compassion and dignity, complemented by psychosocial support for those who are emotionally disturbed and lack social support.

PMID:33858009 | DOI:10.1371/journal.pone.0249874

Anesth Analg. 2021 May 1;132(5):1223-1230. doi: 10.1213/ANE.0000000000005446.

ABSTRACT

BACKGROUND: Sleep disorders affect up to 25% of the general population and are associated with increased risk of adverse perioperative events. The key sleep medicine topics that are most important for the practice of anesthesiology have not been well-defined. The objective of this study was to determine the high-priority sleep medicine topics that should be included in the education of anesthesia residents based on the insight of experts in the fields of anesthesia and sleep medicine.

METHODS: We conducted a prospective cross-sectional survey of experts in the fields of sleep medicine and anesthesia based on the Delphi technique to establish consensus on the sleep medicine topics that should be incorporated into anesthesia residency curricula. Consensus for inclusion of a topic was defined as >80% of all experts selecting “agree” or “strongly agree” on a 5-point Likert scale. Responses to the survey questions were analyzed with descriptive statistical methods and presented as percentages or weighted mean values with standard deviations (SD) for Likert scale data.

RESULTS: The topics that were found to have 100% agreement among experts were the influence of opioids and anesthetics on control of breathing and upper airway obstruction; potential interactions of wake-promoting/hypnotic medications with anesthetic agents; effects of sleep and anesthesia on upper airway patency; and anesthetic management of sleep apnea. Less than 80% agreement was found for topics on the anesthetic implications of other sleep disorders and future pathways in sleep medicine and anesthesia.

CONCLUSIONS: We identify key topics of sleep medicine that can be included in the future design of anesthesia residency training curricula.

PMID:33857964 | DOI:10.1213/ANE.0000000000005446

J Nerv Ment Dis. 2021 Apr 15. doi: 10.1097/NMD.0000000000001348. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with psychiatric disorders (as well as general medical conditions) often describe their lives in terms of suffering. Although suffering is honored as a central focus of physicians’ concerns, it is not even indexed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Generally connoting severe, prolonged distress, suffering can be distinguished from pain, depression, and anxiety. The aims of this article are to consider whether attending to suffering per se in psychiatric patients merits attention independent of other commonly assessed psychiatric symptoms such as anxiety, depression, and conventional distress, and how targeting suffering per se might add value to psychiatric patient care.

METHODS: Sources for this article were obtained via a selective literature search in PubMed using the terms “suffering” in the title and the terms “psychiatric disorder,” “mental illness,” “assessment,” “measurement,” “scale,” “existential suffering,” and “unbearable suffering.” Articles of interest were followed up using a snowball technique to examine “similar articles” and “cited by” titles to find additional pertinent articles.

RESULTS: Definitions of suffering in the medical literature stress its subjectivity, particularity, complexity, and connection to a wide variety of noxious sensations, as well as real and anticipated deficits, losses, and thwarted motivations. These can affect the entire spectrum of universal human needs, from basic biological issues through intrapsychic, interpersonal, and social issues, encompassing existential concerns of meaning, purpose, and transcendence. Based on these factors, a definition of suffering in patients with psychiatric disorders is proposed. Although efforts to measure suffering have been limited and numerous gaps in the literature are evident, several scales may offer suitable bases for the study of suffering in patients with psychiatric disorders.

CONCLUSIONS AND IMPLICATIONS: Ascertaining sources of suffering may require new types of inquiry and additional time. Well-described, evidence-informed strategies and time-honored psychotherapy techniques are available for addressing the numerous concerns that contribute to suffering. Patients with psychiatric disorders whose distinct, multidimensional sources of suffering are identified, acknowledged, and addressed may experience better treatment quality, greater treatment satisfaction, and possibly better outcomes than those whose clinicians’ attention is limited to conventional psychiatric signs and symptoms.

PMID:33857957 | DOI:10.1097/NMD.0000000000001348

Menopause. 2021 Apr 12. doi: 10.1097/GME.0000000000001774. Online ahead of print.

ABSTRACT

OBJECTIVE: To predict the age at natural menopause (ANM).

METHODS: Cox models with time-dependent covariates were utilized for ANM prediction using longitudinal data from 47 to 55-year-old women (n = 279) participating in the Estrogenic Regulation of Muscle Apoptosis study. The ANM was assessed retrospectively for 105 women using bleeding diaries. The predictors were chosen from the set of 32 covariates by using the lasso regression (model 1). Another easy-to-access model (model 2) was created by using a subset of 16 self-reported covariates. The predictive performance was quantified with c-indices and by studying the means and standard deviations of absolute errors (MAE ± SD) between the predicted and observed ANM.

RESULTS: Both models included alcohol consumption, vasomotor symptoms, self-reported physical activity, and relationship status as predictors. Model 1 also included estradiol and follicle-stimulating hormone levels as well as SD of menstrual cycle length, while model 2 included smoking, education, and the use of hormonal contraception as additional predictors. The mean c-indices of 0.76 (95% CI 0.71-0.81) for model 1 and 0.70 (95% CI 0.65-0.75) for model 2 indicated good concordance between the predicted and observed values. MAEs of 0.56 ± 0.49 and 0.62 ± 0.54 years respectively for model 1 and 2 were clearly smaller than the MAE for predicted sample mean (1.58 ± 1.02).

CONCLUSIONS: In addition to sex hormone levels, irregularity of menstrual cycle, and menopausal symptoms, also life habits and socioeconomic factors may provide useful information for ANM prediction. The suggested approach could add value for clinicians’ decision making related to the use of contraception and treatments for menopausal symptoms in perimenopausal women.

Video Summary:http://links.lww.com/MENO/A743.

PMID:33857956 | DOI:10.1097/GME.0000000000001774

Urol Int. 2021 Apr 15:1-8. doi: 10.1159/000506652. Online ahead of print.

ABSTRACT

INTRODUCTION: The purpose of this article is to evaluate the efficacy and safety of prestenting (PS) versus non-PS (NPS) of flexible ureteroscopy (fURS) to treat large upper urinary stones.

METHODS: We conducted a systematic literature research of PubMed, Ovid, Scopus (up to August 2019), and citation lists to identify eligible studies. All studies comparing PS versus NPS of fURS were included. Data were analyzed using the Cochrane Collaboration’s Review Manager (RevMan) 5.3 software.

RESULTS: Overall, 7 studies including 3,145 patients (PS 1,408; NPS 1,737) were included in this article. PS group was associated with older age (weighted mean difference [WMD] 0.91 year; p < 0.001) and more male patients (odds ratio [OR] 1.34; p < 0.001). There were no statistical differences between PS and NPS in BMI (WMD 0.34 kg/m2; p = 0.13), stone size (WMD 0.13 mm; p = 0.77), and operative time (WMD 0.44 min; p = 0.86). Compared with NPS, PS showed better initial success rate (OR 4.04; p < 0.001) and higher SFR (OR 1.64; p < 0.001). There were no statistical differences for complications (OR 0.84; p = 0.42) and Clavien-Dindo score ≥3 complications (OR 1.04; p = 0.93).

CONCLUSION: PS could improve initial success rate and avoid secondary general anesthesia for first ureteral access sheath failed patients. PS could provide better SFR than NPS in the treatment of large upper urinary stones with fURS.

PMID:33857952 | DOI:10.1159/000506652

Complement Med Res. 2021 Apr 15:1-10. doi: 10.1159/000516026. Online ahead of print.

ABSTRACT

INTRODUCTION: Individualized homeopathy (IH) in atopic dermatitis (AD) remained under-researched.

OBJECTIVE: We aimed at evaluating efficacy of IH in AD.

METHODS: A double-blind, randomized, placebo-controlled, short-term, preliminary trial was conducted in an Indian homeopathy hospital. Patients were randomized to either IH (n = 30) or identical-looking placebo (n = 30) using computerized randomization and allocation. Outcomes were patient-oriented scoring of AD (PO-SCORAD; primary end point), Dermatological Life Quality Index (DLQI) score, and AD burden score for adults (ADBSA; secondary end points), measured monthly for 3 months. An intention-to-treat sample was analyzed after adjusting baseline differences.

RESULTS: On PO-SCORAD, improvement was higher in IH against placebo, but nonsignificant statistically (pmonth 1 = 0.433, pmonth 2 = 0.442, pmonth 3 = 0.229). Secondary outcomes were also nonsignificant – both DLQI and ADBSA (p > 0.05). Four adverse events (diarrhea, injury, common cold) were recorded.

CONCLUSIONS: There was a small, but nonsignificant direction of effect towards homeopathy, which renders the trial inconclusive. A properly powered robust trial is indicated.

PMID:33857943 | DOI:10.1159/000516026