Nevin Manimala

Nutr Diet. 2021 Mar 10. doi: 10.1111/1747-0080.12665. Online ahead of print.

ABSTRACT

AIM: The aim of this study was to explore patient satisfaction with hospital foodservice in the Swedish setting, using a validated instrument, adding this context to the existing body of research.

METHODS: The study was carried out at three hospitals employing cyclic menus and conventional cook-serve foodservice systems with centralised tray assemblies and hot-trolley distributions to the wards for service. Patient satisfaction was explored using a translated version of the validated Acute Care Hospital Foodservice Patient Satisfaction Questionnaire. Groups were compared with Mann-Whitney U-test and Kruskal Wallis test with a set significance level of P < .05.

RESULTS: Questionnaires from 439 patients were included in the analysis. The majority (80%) reported an overall satisfaction of “good” or “very good.” Questions related to Staff and Service received mostly the highest possible ratings, while questions related to Food Quality and Meal Size had slightly lower ratings and higher variation. Comparisons between groups showed that differences were small even when statistically significant. Low appetite and a long hospital stay had an adverse effect on overall satisfaction and food quality-related questions. Men and younger patients reported more often being hungry after and between meals.

CONCLUSIONS: Hospital foodservice faces the challenge of catering to multiple patient needs. Monitoring patient satisfaction is crucial to ensure that foodservice operations remain evidence based. The Acute Care Hospital Foodservice Patient Satisfaction Questionnaire provided a general overview that indicated foodservice areas with potential for improvement, although patient satisfaction overall was high. However, patient satisfaction is a complex measure and reflexivity is required when interpreting empirical results.

PMID:33691342 | DOI:10.1111/1747-0080.12665

Pharmacology. 2021 Mar 10:1-7. doi: 10.1159/000513377. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: When choosing a cytoreduction method for patients suffering from essential thrombocythemia (ET), it is important to know the safety profile of the medicine used. Few articles have been published about the effects of hydroxycarbamide (hydroxyurea, HU) and anagrelide (ANA) on renal function in ET patients. This study is the largest analysis of nephrotoxicity of cytoreductive drugs used in ET therapy so far, which additionally includes risk factors for the progression of kidney disease and coexisting genetic mutation.

EXPERIMENTAL APPROACH: The retrospective study included 310 patients diagnosed with ET. Demographic data, comorbidities, Cr, and estimated glomerular filtration rate (eGFR) were all taken into account prior to diagnosis and after 6 months of HU and ANA treatment.

KEY RESULTS: A statistically significant difference was found between Cr and eGFR levels at baseline and after 6 months of treatment (p < 0.001). The applied treatment (HU and ANA) had the greatest impact on kidney function. ANA significantly increased the risk of worsening renal function in contrary to hydroxycarbamide after 6 months of treatment (eGFR change: median +1 mL/min/1.73 m2 [interquartile range (IQR) (-4)-(+7)] in the HU group vss. median -13 mL/min/1.73 m2 [IQR (-18)-(-6)] in the ANA group, odds ratio [OR] 7.92 95% confidence interval [95% CI] [4.17-15.08], p < 0.001). Lowering of eGFR <60 mL/min/1.73 m2 occurred in 31 patients (31.0%) from the ANA group and 10 people (4.8%) treated with HU (p = 0.000). In 1 patient from the ANA group, >50% decrease in eGFR was observed. The chance for an increase in Cr levels was higher in people with pre-existing arterial hypertension (OR 1.92 CI = 95% [1.21-3.05], p = 0.006). Sex, type of mutation found (JAK2 V617F or CALR), and previous renal impairment did not affect renal function after 6 months of treatment. In addition, there was no difference in the efficacy of ET treatment between HU and ANA (p = 0.998).

CONCLUSIONS AND IMPLICATIONS: The observations indicate that ANA should be used in patients with ET with great caution and taking into account the risk of worsened kidney function.

PMID:33691325 | DOI:10.1159/000513377

Psychother Psychosom. 2021 Mar 10:1-7. doi: 10.1159/000514331. Online ahead of print.

ABSTRACT

INTRODUCTION: The long-lasting threat of COVID-19 makes it necessary to explore strategies to improve coping skills which enable us to master a balanced life in the face of adversity.

OBJECTIVE: To unravel the most challenging aspects of COVID-19 in a nonclinical adult population and identify predictors of lost balance and consequent allostatic overload (AO). We examined the role of regular, moderate-intensity formula aerobic exercise (312 meridian exercise) in preventing allostatic overload through increasing well-being.

METHODS: An online survey was conducted to measure CO-VID-related allostatic overload according to clinimetric criteria. The Psychosocial Index (PSI), Kellner’s Symptom Questionnaire (KSQ), short Depression Anxiety Stress Scales (DASS-21), Public Health Surveillance Well-Being Scale -(PHS-WB), and Whiteley-7 were used to explore mental health characteristics. Univariate statistics logistic regression analysis and a general linear model were used.

RESULTS: According to 442 valid answers, 217 adults practiced physical exercise (PE) frequently (fPE, 3-5 times/every day) while 120 did it less regularly (1-2 times/week), and 105 did not exercise/practiced irregularly (controls). Restriction-related stressors were most challenging, resulting in AO in 29% (n = 128) of the sample. The main predictors were additional stressors (p = 0.005) and anxiety symptoms (p < 0.001). The prevalence of AO was lower (p = 0.018) in the fPE group when compared to controls. KSQ distress symptoms were also lower in fPE (p < 0.0001), while total well-being was increased (p < 0.001) after adjusting for sex, age, and number of chronic diseases. According to the PHS-WB, both physical and mental well-being were higher (p = 0.003 and p = 0.004, respectively) in fPE.

CONCLUSIONS: Frequent moderate exercise is associated with better mental and physical well-being and a lower prevalence of AO.

PMID:33691321 | DOI:10.1159/000514331

J Neural Eng. 2021 Mar 10. doi: 10.1088/1741-2552/abed82. Online ahead of print.

ABSTRACT

OBJECTIVE: Responsive Neurostimulation (RNS) is an effective treatment for controlling seizures in patients with drug-resistant focal epilepsy who are not suitable candidates for resection surgery. A lack of tools for detecting and characterizing potential response biomarkers, however, contributes to a limited understanding of mechanisms by which RNS improves seizure control. We developed a method to quantify ictal frequency modulation, previously identified as a biomarker of clinical responsiveness to RNS.

APPROACH: Frequency modulation is characterized by shifts in power across spectral bands during ictal events, over several months of neurostimulation. This effect was quantified by partitioning each seizure pattern into segments with distinct spectral content and measuring the extent of change from the baseline distribution of spectral content using the squared Earthmover’s distance.

MAIN RESULTS: We analyzed intracranial electroencephalography data from 13 patients who received RNS therapy, six of whom exhibited frequency modulation on expert evaluation. Patients in the frequency modulation group had, on average, significantly larger and more sustained changes in their squared Earthmover’s distances (mean = 13.97×10-3 ± 1.197×10-3). In contrast, those patients without expert-identified frequency modulation exhibited statistically insignificant or negligible distances (mean = 4.994×10-3 ± 0.732×10-3).

SIGNIFICANCE: This method is the first step towards a quantitative, feedback-driven system for systematically optimizing RNS stimulation parameters, with an ultimate goal of truly personalized closed-loop therapy for epilepsy.

PMID:33691289 | DOI:10.1088/1741-2552/abed82

Mult Scler Relat Disord. 2021 Mar 2;51:102875. doi: 10.1016/j.msard.2021.102875. Online ahead of print.

ABSTRACT

BACKGROUND: No evidence of disease activity (NEDA) is a composite surrogate assessing the responsiveness to various disease-modifying treatments (DMTs) in patients with relapsing and remitting multiple sclerosis (RRMS), addressing clinical as well as radiological disease activity. Despite the rising prevalence of multiple sclerosis in Saudi Arabia (SA), there is a lack of evidence focusing on this important aspect in the management of RRMS. This study aimed to identify the prevalence of NEDA-3 status achievement in patients with RRMS on DMTs (mainly the interferon) and to describe the factors affecting its attainment.

METHOD: This was a retrospective, cross-sectional study carried out at King Fahd University Hospital after obtaining institutional ethical approval. The electronic records of 119 patients diagnosed with RRMS were reviewed. Clinical manifestations at initial presentation, relapse after starting treatment, disability progression, and development of new lesions on follow-up magnetic resonance imaging were all documented to assess NEDA-3 status. Data were analyzed using Statistical Package for Social Sciences, version 22.

RESULTS: NEDA-3 status was achieved in 41 (33.6%) patients. The female-to-male ratio for all patients was 1.5:1. Interferon (IFN) was the most commonly prescribed DMT. NEDA-3 status was achieved in 30.9% of patients receiving IFN. Mean baseline Expanded Disability Status Scale in patients who did not achieve NEDA-3 was 2.8±1.8. Patients with ataxia (P = <0.001), sphincter disturbances (P=0.002) and infra-tentorial brain lesions (P=0.03) were less likely to achieve NEDA-3 status. Involvement of pyramidal, cerebellar and more than one system at initial presentation was more frequent in patients who could not achieve NEDA-3 status (P=0.002) CONCLUSION: Less than one third of total patients on IFN as DMT could achieve NEDA-3 status in our cohort of patients which is in agreement with the literature published in the West. We could not properly asses NEDA-3 status for other DMTs in our center due to the very small sample size of patients on these DMTs, and recommend future studies including larger number of patients on DMTs other than IFN. Significant differences were identified between the two groups of patients with respect to attainment of NEDA-3 status, which requires further verification by multicenter prospective studies.

PMID:33691260 | DOI:10.1016/j.msard.2021.102875

EBioMedicine. 2021 Mar 7;65:103262. doi: 10.1016/j.ebiom.2021.103262. Online ahead of print.

ABSTRACT

BACKGROUND: The coronavirus disease-19 (COVID-19) pandemic has cost lives and economic hardships globally. Various studies have found a number of different factors, such as hyperinflammation and exhausted/suppressed T cell responses to the etiological SARS coronavirus-2 (SARS-CoV-2), being associated with severe COVID-19. However, sieving the causative from associative factors of respiratory dysfunction has remained rudimentary.

METHODS: We postulated that the host responses causative of respiratory dysfunction would track most closely with disease progression and resolution and thus be differentiated from other factors that are statistically associated with but not causative of severe COVID-19. To track the temporal dynamics of the host responses involved, we examined the changes in gene expression in whole blood of 6 severe and 4 non-severe COVID-19 patients across 15 different timepoints spanning the nadir of respiratory function.

FINDINGS: We found that neutrophil activation but not type I interferon signaling transcripts tracked most closely with disease progression and resolution. Moreover, transcripts encoding for protein phosphorylation, particularly the serine-threonine kinases, many of which have known T cell proliferation and activation functions, were increased after and may thus contribute to the upswing of respiratory function. Notably, these associative genes were targeted by dexamethasone, but not methylprednisolone, which is consistent with efficacy outcomes in clinical trials.

INTERPRETATION: Our findings suggest neutrophil activation as a critical factor of respiratory dysfunction in COVID-19. Drugs that target this pathway could be potentially repurposed for the treatment of severe COVID-19.

FUNDING: This study was sponsored in part by a generous gift from The Hour Glass. EEO and JGL are funded by the National Medical Research Council of Singapore, through the Clinician Scientist Awards awarded by the National Research Foundation of Singapore.

PMID:33691247 | DOI:10.1016/j.ebiom.2021.103262

Accid Anal Prev. 2021 Mar 7;154:106067. doi: 10.1016/j.aap.2021.106067. Online ahead of print.

ABSTRACT

Countries scoring high on the Democracy Index developed by The Economist Intelligence Unit have fewer traffic fatalities per 100,000 inhabitants than countries scoring low on this index. The statistical relationship between democracy score and fatalities per 100,000 inhabitants is statistically highly significant and robust with respect to control for potentially confounding factors. A similar relationship exists between democracy score and the number of traffic fatalities per 100,000 motor vehicles. The statistical relationship between level of democracy and level of road safety is strong, although the analyses reported in this paper do not justify a causal interpretation of the relationship. Changes over time in government effectiveness (one of the indicators of the World Governance Index developed by the World Bank) are weakly associated with changes in road safety performance.

PMID:33691228 | DOI:10.1016/j.aap.2021.106067

Food Chem. 2021 Feb 19;352:129325. doi: 10.1016/j.foodchem.2021.129325. Online ahead of print.

ABSTRACT

The milk-coagulating enzyme, rennet, is widely used in cheese making. Recently stabilization of rennet, especially in accelerated cheese ripening, has received considerable interest. As we know encapsulation is one of the enzyme immobilization methods, which could increase enzyme stability. In this study, the effects of alginate, chitosan and, CaCl₂ on rennet encapsulation were evaluated and optimized using RSM. Under the optimal conditions alginate, chitosan, and CaCl₂ were 0.04%, 0.1%, and 0.1% respectively. At the optimum point, encapsulation efficiency, particle size, and zeta potential were evaluated to be 61.8%, 323 nm, and 25 mV, respectively. The effect of temperature and pH on the enzyme activity was evaluated, and the results showed that encapsulated enzyme had higher activity at various pH and temperature in comparison with the free enzyme. Also, the enzyme release data in all pH values were fitted to Korsmeyer-Peppas model and the n exponent indicated that the release mechanism was Fickian. The electrostatic interactions between enzyme, alginate, and chitosan were confirmed by infrared spectroscopy. No statistical difference was found between the K_m and V_max of encapsulated and free enzymes.

PMID:33691212 | DOI:10.1016/j.foodchem.2021.129325

J Pharm Biomed Anal. 2021 Feb 17;198:113984. doi: 10.1016/j.jpba.2021.113984. Online ahead of print.

ABSTRACT

Epimedium herb is a well-known traditional Chinese medicine (TCM) that is used for treating kidney-yang deficiency, impotence and rheumatism, and flavonoids are the main active ingredients. The leaves and rhizomes of Epimedium herb are two separate kinds of medicinal materials with different functional indications and clinical applications. This study aimed to comprehensively analyze the chemical components of different parts of the herb from three Epimedium species (Epimedium sagittatum, E. pubescens and E. myrianthum) by using ultra high-performance liquid chromatography coupled with photo-diode array and quadrupole time-of-flight mass spectrometry (UHPLC-PDA-Q-TOF/MS) and multivariate statistical analysis to clarify the differences. Firstly, the workflow of UHPLC-Q-TOF/MS combined with UNIFI informatics was developed for characterizing the chemical compounds in different parts of Epimedium herb. Based on the exact mass information, the fragmentation characteristics and the retention times of compounds, all chromatographic peaks (74 chemical components) were identified. Secondly, 21 potential chemical markers for differentiating different parts of Epimedium herb were selected through PCA and PLS-DA analysis. The characteristic components in the leaves included flavonoids with Anhydroicaritin (type A, C-4′ linked methoxy) as the backbone, and the characteristic components in the stems and rhizomes were Magnoline and flavonoids with Demethylanhydroicaritin (type B, C-4′ linked hydroxyl) as the backbone. Thirdly, the UHPLC-PDA combined with heatmap visualization was employed to clarify the distribution of chemical components with high content in different parts of Epimedium herb. The results showed clear differences in the contents of chemical components in leaves, stems and rhizomes. The levels of flavonoids with Anhydroicaritin backbone were high in the leaves, and levels of flavonoids with Demethylanhydroicaritin backbone were high in the rhizomes. The levels of Magnoline in stems and rhizomes were higher than that in leaves. The contents of most of the compounds in stems remained low. The leaves and the other two parts (stems and rhizomes) can be distinguished by qualitative and semi-quantitative analysis of Magnoline and Epimedoside A (type B backbone). These results indicated that the different plant parts of Epimedium herb can be quickly and accurately distinguished by this method, establishing a foundation for the application of Epimedium herb.

PMID:33691203 | DOI:10.1016/j.jpba.2021.113984

Early Hum Dev. 2021 Mar 3;156:105345. doi: 10.1016/j.earlhumdev.2021.105345. Online ahead of print.

ABSTRACT

BACKGROUND: The long-term associations between early receptive/expressive lexical skills and later language/pre-literacy skills require clarification.

AIMS: To study the association between and predictive values of early receptive/expressive lexical skills and language/pre-literacy skills at 5;0 years, and to examine the language profiles at 5;0 years of children with weak receptive language/expressive lexical skills at 2;0 years.

PARTICIPANTS AND METHODS: The participants were 66 monolingual children. Their lexical skills were measured using the Finnish short-form version of the MacArthur-Bates Communicative Development Inventories at 1;6 and 2;0 years. Receptive language skills were measured at 2;0 years using the Reynell Developmental Language Scales III. A broader assessment at 5;0 years measured lexical, phonological, morphological and pre-literacy skills.

RESULTS: Significant associations between receptive/expressive lexical skills at 1;6 years and language and pre-literacy skills at 5;0 years were found. Both receptive language and expressive lexical development measured at 2;0 years were greatly and relatively evenly associated with language and pre-literacy skills at 5;0 years. Lexicon/language variables at 1;6 years and 2;0 years had statistically significant predictive values for general language and pre-literacy scores at 5;0 years. The best models that included early lexical predictors explained 20-34% of later language/literacy outcome. Weak skills at 2;0 years proposed vulnerability in language and pre-literacy skills at 5;0 years.

CONCLUSIONS: Language and pre-literacy skills at 5;0 years can to some extent be explained by early receptive language and/or expressive lexical development. Further assessment and/or follow-up is important for children who have had weak language/lexical skills at 2;0 years.

PMID:33691196 | DOI:10.1016/j.earlhumdev.2021.105345