Nevin Manimala

Eur Eat Disord Rev. 2022 Aug 13. doi: 10.1002/erv.2944. Online ahead of print.

ABSTRACT

OBJECTIVE: This systematic review aimed to highlight the usefulness of the clinical examination of the oral cavity for the diagnostic suspicion of anorexia (AN) and bulimia nervosa (BN), being of main interest to the paediatric dentist and paediatrician due to the early onset of symptoms in Eating Disorders (EDs).

METHOD: A systematic search, applying PICO question, was carried out in biomedical and other electronic databases from 2005 to 2020. Both case reports and case series of patients under 65 years of age with AN and BN were included. Data were extracted and statistically analysed.

RESULTS: A sample of 111 studies was obtained (n = 192; 92.78% female). The most prevalent diagnosis was restrictive type AN (n = 110; 57.29%). Only 16 (8.33%) patients had been clinically examined at the oral cavity, indicating the presence or absence of oral manifestations (OM) and showing dental erosion (n = 10) as the most frequent.

CONCLUSION: There is a lack of information about the oral examination of anorexic and bulimic patients. Dental erosion and other oral manifestations can help us to make an early ED diagnosis. Clinical observation and basic erosive wear examination (BEWE) Index are necessary steps to detect and record any anomaly in oral cavity during the evaluation of these patients.

PMID:35962774 | DOI:10.1002/erv.2944

Liver Int. 2022 Aug 13. doi: 10.1111/liv.15396. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: To report 5-year outcomes of the CERTITUDE study.

METHODS: An observational study in patients with liver transplantation (LTx) that compared long-term impact of immunosuppression (with/without a calcineurin inhibitor) on renal function, cancers, major cardiovascular events (MACE), and other safety parameters. All patients completing the 6-month SIMCER study were recruited and analyzed according to treatment received at randomization and actual treatment received during follow-up.

RESULTS: Of the 143 enrolled patients, 119 completed the 5-year follow-up (everolimus [EVR], n=55; tacrolimus [TAC], n=64). The mean absolute change in estimated glomerular filtration rate was not statistically different between both groups (TAC, -15.53 mL/min/1.73 m² and EVR, -14.56 mL/min/1.73 m² ). In the treatment subgroups based on actual treatment received, renal function was preserved better in the EVR subgroup compared with other subgroups (P=0.051). Treated biopsy-proven acute rejection was higher in the EVR group (15.4% vs 6.4%); however, the majority of events were mild in severity. MACE occurred in 9.2% vs 14.1% of patients in the EVR and TAC groups, respectively (P=0.370). De novo cancer was reported in 14 and 5 patients in EVR and TAC groups, respectively. Hepatocellular carcinoma (HCC) recurrence was observed in TAC group alone (n=4). Adverse events and treatment discontinuation due to adverse event were higher in the EVR group.

CONCLUSIONS: The CERTITUDE study demonstrated that EVR- and TAC-based regimens have a comparable efficacy, safety, and tolerability up to 5 years post-LTx.

PMID:35962772 | DOI:10.1111/liv.15396

Acad Emerg Med. 2022 Aug 13. doi: 10.1111/acem.14581. Online ahead of print.

ABSTRACT

OBJECTIVES: Adjunct therapy with anticholinergic agents has been proposed to reduce the incidence of extrapyramidal side effects such as akathisia following treatment with neuroleptics or metoclopramide. This systematic review assessed the effectiveness of anticholinergic agents to prevent neuroleptic or metoclopramide-induced akathisia in people presenting to the ED with benign headache.

METHODS: Eight electronic databases and grey literature were searched to identify randomized controlled trials involving adult patients presenting to the ED with primary headache treated with neuroleptic or metoclopramide. Study selection, data extraction and quality assessment were completed by two independent reviewers. Individual or pooled meta-analysis of dichotomous outcomes were calculated as relative risks (RR) with 95% confidence intervals (CI) using a random effects model. Heterogeneity was assessed using the I² statistic.

RESULTS: A total of 1032 studies were screened, of which two studies were included in the review. Both studies provided patients with diphenhydramine following treatment with neuroleptics or metoclopramide. Treatment with diphenhydramine did not reduce the incidence of akathisia compared to treatment with placebo (RR = 0.83; 95% CI: 0.43, 1.61, I² =0%). The impact of diphenhydramine on pain relief, need for rescue medications, and relief of other extrapyramidal side effects were reported in one of the two studies, with no significant differences noted in any outcomes compared to patients treated with placebo.

CONCLUSION: This review found insufficient evidence to recommend the use of diphenhydramine as an adjunct therapy to prevent akathisia in ED patients treated with neuroleptics or metoclopramide for primary headache. This finding relies on the results of two small RCTs with incomplete outcome reporting. Additional high-quality studies are needed to better understand the clinical efficacy of agents with anticholinergic properties in the ED management of patients with primary headaches.

PMID:35962748 | DOI:10.1111/acem.14581

Wiad Lek. 2022;75(6):1781-1788. doi: 10.36740/WLek202207131.

ABSTRACT

OBJECTIVE: The aim: To analyze the peculiarities of media reform in the system of promoting a healthy lifestyle of Ukraine, to disclose the foreign experience of denationalization of print media.

PATIENTS AND METHODS: Materials and methods: The theoretical and methodological basis and materials of the research consist of the scientific works of leading scientists on the issues of promoting a healthy lifestyle of Ukrainian print media and the possibilities of promotingthis process in social media in accordance with international practice, information from open registers, and interviews with editorial staff.

CONCLUSION: Conclusions: Having investigated the process of reforming the media, which is designed to promote a healthy lifestyle, we can draw the following conclusions that a significant part of modern Ukrainian media in one way or another reveals the problems of forming the basic principles of a healthy lifestyle for children and youth. The print media not only ensure freedom of speech, the development of democracy, the formation of perfect information society, but also contribute to the promotion of a healthy lifestyle, the ideology of changing the attitude of the individual and society to personal health. According to the results of the survey, 85 % of the media of the Ternopil region were successfully reformed. Taking into account the statistics, we note that the district editions of the Ternopil region, which expressed a desire to reform, were ready to go through all the procedures provided by the legislation of Ukraine.

PMID:35962698 | DOI:10.36740/WLek202207131

J Appl Lab Med. 2022 Aug 13:jfac063. doi: 10.1093/jalm/jfac063. Online ahead of print.

ABSTRACT

BACKGROUND: 5-alpha reductase (5-AR) enzyme is responsible for conversion of testosterone to dihydrotestosterone (DHT) in humans, which subserves various functions. The aim of the study was to establish a normal reference interval (RI) for blood levels of the enzyme 5-AR.

METHODS: We conducted a prospective study on 150 boys, 75 of whom underwent circumcision for various benign conditions or for religious reasons (Group A/controls) and 75 suffering from hypospadias of variable severity (Group B/cases). The plasma levels of 5-AR were measured by enzyme-linked immunosorbent assay (ELISA) in all 150 boys and correlated with the severity of hypospadias.

RESULTS: The 5-AR levels in Group A ranged from 14.6 to 17.3 ng/mL. The enzyme levels decreased in value with increasing severity of hypospadias in Group B (P-value <0.01 – statistically significant). The levels of the enzyme in this group ranged from 0.6 ng/mL (in the most severe variety of hypospadias) to 11.5 ng/mL (mild variety of hypospadias).

CONCLUSIONS: There is no record of RI values of 5-AR in the literature. The RI of 5-AR needs to be determined by conducting more studies globally. Its levels falls considerably with clinical severity of hypospadias, reinforcing the importance of the enzyme in the development of male external genitalia.

PMID:35962645 | DOI:10.1093/jalm/jfac063

Iran J Kidney Dis. 2022 Jul;16(4):259-265.

ABSTRACT

INTRODUCTION: SARS-CoV-2 infection have been reported to have a greater mortality rate in adults receiving dialysis, as compared to general population. Hence, vaccination is very important in this vulnerable population group, in order to achieve an acceptable level of immunity. The aim of this study was to compare the level of anti-SARS-CoV-2 anti-spike protein receptor-binding domain IgG neutralizing antibody before and after vaccination with two doses of Sinopharm® vaccine, in patients undergoing hemodialysis.

METHODS: Ninety patients on maintenance in-center hemodialysis received two doses of Sinopharm® COVID-19 vaccine with an interval of about 28 days. Anti-SARS-CoV-2 anti-spike protein receptor-binding domain IgG (Anti-RBD) neutralizing antibody was measured with an ELISA kit. All statistical analyses were performed by SPSS-26 software.

RESULTS: The absolute mean (± SE) change in antibody titer following full-scheduled vaccination was 8.98 ± 1.49 µg/mL. The rate of seroconversion was 31.1% after two doses of vaccine. In addition, the rate of seroconversion was higher in those with a history of COVID-19 than in those without a history of COVID-19.

CONCLUSION: The administration of booster doses, doubling of the dose in each episode of vaccination schedule as well as combination of different vaccine platforms are recommended to increase COVID-19 vaccine efficacy in hemodialysis patients. DOI: 10.52547/ijkd.7024.

PMID:35962641

Iran J Kidney Dis. 2022 Jul;16(4):252-258.

ABSTRACT

INTRODUCTION: The aim of this study was to investigate the expression of aquaporin 1 (AQP-1), AQP-3 and vascular endothelial growth factor A (VEGF-A) in peritoneal tissues of patients without kidney disease, chronic kidney disease at stages 5 (CKD 5) and patients on prolonged peritoneal dialysis with ultrafiltration failure (PDUFF), and elucidate the possible mechanism of peritoneal dialysis ultrafiltration failure.

METHODS: Peritoneal specimens were collected from the following patient groups at Xianju People’s hospital: CKD 5, PD-UFF and normal control groups. Routine staining and immunohistochemical analyses were performed on samples obtained from the three groups.

RESULTS: The expression of AQP-1 and AQP-3 on peritoneal mesothelial cells, peritoneal vessels and in the interstitium was significantly lower in the PD-UFF group than the CKD 5 and control groups (P < .01), while no statistically significant difference was found between the CKD 5 and control groups (P > .05). In contrast, VEGF-A expression was significantly higher in peritoneal mesothelial cells, peritoneal vessels and the interstitium in the PD-UFF group than the CKD 5 and control groups (P < .01). No statistically significant difference was found between the CKD 5 and control groups (P > .05).

CONCLUSION: AQP-1 and AQP-3 expression levels decrease in peritoneal mesothelial cells and the vascular interstitium of patients with a prolonged peritoneal dialysis course, while VEGF-A expression gradually increases. The formation of peritoneal neovascularization and the decrease in AQP expression may be primarily associated with peritoneal dialysis ultrafiltration failure. DOI: 10.52547/ijkd.6928.

PMID:35962640

Iran J Kidney Dis. 2022 Jul;16(4):246-251.

ABSTRACT

INTRODUCTION: Kidney biopsy is a procedure of choice for the diagnosis of many kidney diseases. In children it is performed with the use of sedatives. The aim of this study was to compare the combination of propofol/fentanyl with midazolam/ketamine for sedation in pediatric patients undergoing kidney biopsy.

METHODS: In this double-blinded clinical trial, seventeen children, candidate of kidney biopsy were included and randomized into two groups. One group received Midazolam/Ketamine with doses of 30 to 50 μg/kg and 0.25 to 1 mg/kg, and the other group were sedated with propofol/fentanyl combination in doses of 0.5 to 1 mg/kg and 0.5 to 1 mg/kg, respectively. Administration time, medication doses, total procedure time, need for analgesic use after the procedure, and patient relaxation, with no agitation during and after the biopsy were recorded.

RESULTS: Nine patients received midazolam/ketamine and eight received propofol/fentanyl. None of them experienced vomiting or itching after sedation. There were no meaningful differences in qualitative variables of the need for pain relief between two groups. Regarding the distribution of pain at the time of sedation, and 1, 3, 6, and 24 hours after sedation, there was no significant statistical difference between the two groups. There was also no significant statistical difference between the two groups, regarding patients’ relaxation during, and 1, 3, 6, and 24 hours after biopsy.

CONCLUSION: There was no statistically significant difference between the degree of sedation and the analgesic effect of the two regimens in the two groups. DOI: 10.52547/ijkd.6982.

PMID:35962639

J Sch Health. 2022 Aug 13. doi: 10.1111/josh.13228. Online ahead of print.

ABSTRACT

BACKGROUND: In South Carolina (SC), 42% of youth are overweight or obese. Two sets of modifiable behaviors contributing to obesity are physical activity (PA) and dietary habits. School-based interventions have successfully improved these behaviors. The purpose of this study was to identify SC public school personnel perspectives on the most common barriers and facilitators to regular PA and healthy eating behaviors in schools.

METHODS: A needs assessment survey was conducted with school personnel statewide. There were 17 questions on the survey that addressed: (1) demographic information about participants’ educational backgrounds, (2) barriers to regular PA and healthy eating behaviors in schools, and (3) facilitators to regular PA and healthy eating behaviors in schools. Univariate and bivariate descriptive statistical analyses were performed using IBM SPSS Statistics 27.

RESULTS: Participants (N = 1311) indicated insufficient time for regular PA (n = 514, 39.2%) and limited access to healthy foods for healthy eating (n = 271, 20.7%) as main barriers. The primary facilitators were support from administrators for regular PA (n = 264, 20.1%) and support from cafeteria staff for healthy eating (n = 234, 17.8%). Further analyses explored how factors compared based on roles in schools, academic levels, and school district classifications.

CONCLUSIONS: Results suggest that overarching barriers and facilitators to school-based interventions addressing childhood obesity exist, so common strategies to mitigate challenges and maximize supports can be used in schools. Future studies are needed to examine how decreasing barriers and enhancing facilitators affect the implementation and outcomes of these school-based interventions.

PMID:35962619 | DOI:10.1111/josh.13228

BJU Int. 2022 Aug 13. doi: 10.1111/bju.15870. Online ahead of print.

ABSTRACT

OBJECTIVES: To investigate the timing of the clinical presentation of various types of bacille Calmette-Guérin (BCG) infections in a Finnish population of patients with bladder cancer treated with BCG instillation therapy.

MATERIALS AND METHODS: We identified patients with a history of post-instillation BCG infection from 1996-2016 using the Finnish Cancer Registry and the Finnish National Infectious Diseases Registry. We categorised infections as systemic if the infection was found in the non-urogenital system and genitourinary if the infection affected the urogenital tract. We calculated the time interval between the last BCG instillation and the presentation of the infection. The infection was considered late if the time interval was one year or more.

RESULTS: A total of 100 patients with BCG infection were identified during the study period. Thirty-nine (39%) infections presented as systemic and 61 (61%) were in the genitourinary tract. The majority of the systemic infections presented rapidly after the last instillation, while five (13%) presented after a latency of one year or more. The presentation of genitourinary infections was more heterogeneous, with 12 (20%) presenting as late infections.

CONCLUSION: This study confirms the concept of early and late infection types, especially among systemic infections. However, late infections appeared to be rarer than previously described. Urologists should be aware of the possibility of late BCG infection if patients develop symptoms even several years after the BCG regimen.

PMID:35962611 | DOI:10.1111/bju.15870