Nevin Manimala

Gerontology. 2022 Jul 22:1-12. doi: 10.1159/000525581. Online ahead of print.

ABSTRACT

INTRODUCTION: Data on frailty frequency are heterogeneous and mostly based on cross-sectional studies. Little is known about frailty development and progression over time. Our aim was to conduct a systematic analysis of frailty prevalence and incidence in a large cohort of older adults and to evaluate the association with incident disability, in order to tackle the current paucity and fragmentation of longitudinal data on frailty.

METHODS: As secondary analysis of the Italian Longitudinal Study on Aging (ILSA) population-based cohort (n = 5,632, 65-84), frailty status was operationalized according to Fried criteria (n = 2,457). Weighted prevalence and incidence rates were calculated at each ILSA wave (T0 1992-1993, T1 1995-1996, T2 2000-2001). The association with incident disability in Activities of Daily Living (ADL) or Instrumental Activities of Daily Living (IADL) was investigated through Cox proportional hazard models, controlling for possible confounders.

RESULTS: Prevalence of frailty and pre-frailty at baseline (mean age 71.6 years; women 58.9%) were 4.0% (95% confidence interval [CI]: 3.4-4.6) and 44.6% (95% CI: 43.1-46.1), respectively. Incidence rates per 1,000 person-years for the T0-T1 interval were 7.3 (95% CI: 5.2-9.3) for frailty and 83.7 (95% CI: 73.6-93.8) for pre-frailty. Prevalence and incidence of frailty, and to a lesser degree of pre-frailty, were overall higher for women and increased with age, yet no increasing trend with advancing age was detected for pre-frailty incidence. Frailty incidence rates were significantly higher among pre-frail than non-frail individuals at follow-up entry. After full adjustment, being frail markedly increased the risk of incident disability in ADL (hazard ratio [HR] 3.58, 95% CI: 1.97-6.52) and IADL (HR 2.56, 95% CI: 1.58-4.16) over a 4-year period.

DISCUSSION/CONCLUSION: According to our findings, frailty is common among older people and is a strong and independent predictor of disability. Further research on factors and characteristics related to frailty progression, and especially remission, over time is crucial to calibrate effective public health preventive measures.

PMID:35871516 | DOI:10.1159/000525581

Clin Transl Sci. 2022 Jul 24. doi: 10.1111/cts.13378. Online ahead of print.

ABSTRACT

It is unclear whether activated partial thromboplastin time (APTT) is predictive of survival in acute pancreatitis(AP) patients. Our study aimed to investigate the relationship between APTT and short-term prognosis in AP. From the Medical Information Mart for Intensive Care (MIMIC)-IV database, a total of 844 patients with AP were randomly divided into the training cohort (n=591) and the validation cohort (n=253) at a ratio of 7:3. Based on their APTT values, the patients were divided into the normal and high groups. The primary outcome of this study was 30- and 60-day survival. Kaplan-Meier survival analysis and Cox regression models were used to analyze associations between groups and outcomes. The training and validation cohort matched well on all parameters(P > 0.05). In terms of 30- and 60-day survival, Kaplan-Meier survival curves from both training and validation cohorts demonstrated a lower survival probability for patients in the high APTT group than the normal group(Log-rank P <0.05). In the training cohort, patients in the high APTT group had a statistically significantly higher risk of death than those in the normal group after controlling for possible confounders in Cox regression(P < 0.05). For the high APTT group, the hazard ratios (95% CI) were 1.63(1.10, 2.61) (P=0.035) and 1.49(1.01, 2.38) (P=0.041), respectively. APTT performed as well as BISAP, Ranson, APACHE II models in predicting 30- and 60-day survival in patients with AP. The results above have been verified in the validation cohort. Prolonged APTT in patients with AP may increase the risk of short-term death.

PMID:35871496 | DOI:10.1111/cts.13378

Dermatol Ther. 2022 Jul 24:e15730. doi: 10.1111/dth.15730. Online ahead of print.

ABSTRACT

Bleomycin is a known chemotherapeutic agent which its beneficial effects have been recently shown in the treatment of keloids and hypertrophic scars, however, it is unclear how effective it is in comparison with corticosteroids. To compare the safety and efficacy of intralesional bleomycin vs. intralesional triamcinolone in the treatment of hypertrophic scars and keloids. 60 patients were divided into two groups and treated by intralesional injection of triamcinolone (20 mg/mL) or bleomycin (1.5 IU/mL). The treatments were repeated every 3 weeks until the lesions flattened or for a maximum of 6 sessions. The clinical improvement was evaluated using the Japan Scar Workshop scar scale (JSS) and the physician global assessment of flattening of the lesions. Side effects were also noted and recorded 55 patients completed the study, 4 patients from the bleomycin group and 1 patient from the triamcinolone group dropped out of the study. In both groups, the total JSS scores decreased significantly after treatment compared to baseline (P < 0.001); however, the difference between groups was not statistically significant after treatment (P = 0.052). Moreover, the degree of flattening of the lesions was comparable between groups (p = 0.933). Side effects in the triamcinolone group were Hypopigmentation(55.2%), atrophy(51.7%), and telangiectasia(41.4%) and in bleomycin group included persistent pain after injection (61.5%) ulceration (69.2%), hyperpigmentation(76.9%), and secondary infection (34.6%). Intralesional bleomycin (1.5 IU/mL) is effective as triamcinolone(20 mg/mL) in the treatment of keloids and hypertrophic scars, however, bleomycin should be used carefully, due to adverse events such as pain, ulceration, and hyperpigmentation. This article is protected by copyright. All rights reserved.

PMID:35871490 | DOI:10.1111/dth.15730

Dermatol Ther. 2022 Jul 24:e15729. doi: 10.1111/dth.15729. Online ahead of print.

ABSTRACT

There are no standard protocols for peristomal skin care in children with percutaneous endoscopic gastrostomy (PEG) tubes. This clinical study aimed to evaluate the efficacy of topical sucralfate as a prophylactic intervention in the peristomal wound reaction (PWR)/infection-associated PEG insertion in children. This study was a randomized, single-blind, controlled trial recruiting child under 18 years old who submitted for PEG insertion. Patients were randomly divided to receive topical sucralfate + peristomal wound care (intervention) or peristomal wound care alone (control). In the intervention group, the participants used topical 4% sucralfate cream four times a day for two months. Participants were assessed using the total peristomal infection score and PWR grading system at baseline week 1, and monthly up to five months after the initiation of the study. Forty-four children after PEG insertion were randomly assigned to two groups. Baseline characteristics of both groups were statistically similar (P > 0.05). Friedman test demonstrated statistically significant differences in grades of PWR during the follow-up period in the control group (P = 0.01); while there was not significantly different in the intervention group (P = 0.47). This finding suggests that the intervention had a prophylaxis effect. Also, there were statistically differences in the score of erythema (P = 0.001) and exudate (P = 0.06) at the seven-time points in the control group. Topical 4% sucralfate can be considered an affordable and available prophylactic treatment for reducing the PWR/infection associated with PEG insertion in children. The trial was registered in the Iranian registry of clinical trials (http://www.irct.ir; registration no.: IRCT20131119015455N3). This article is protected by copyright. All rights reserved.

PMID:35871473 | DOI:10.1111/dth.15729

J Diabetes Investig. 2022 Jul 24. doi: 10.1111/jdi.13889. Online ahead of print.

ABSTRACT

OBJECTIVE: To explore the differences of serum fibroblast growth factors-21 (FGF-21) levels in pregnant women with normal glucose tolerance (NGT) and gestational diabetes mellitus (GDM), and to analyze the relationship between FGF-21 and glucose and lipid metabolic indicators, leptin, RBP-4 and adiponectin in GDM, in order to provide basis for the prevention and treatment of GDM.

METHODS: Total of 120 women were included,and divided into NGT group (58 cases) and GDM group (62 cases) according to the OGTT results. General information were recorded, height, weight and blood pressure, blood glucose, lipids, insulin, FGF-21, leptin, RBP-4 and adiponectin were measured, and body mass index (BMI),homeostasis model assessment-IR (HOMA-IR), homeostasis model assessment-β (HOMA-β), area under glucose curve (AUCG) were calculated. T test, person analysis and multiple linear regression analysis were used to evaluate the differences and related factors of FGF-21 in GDM.

RESULTS: The pre-pregnancy BMI, pregnancy BMI, weight gain during pregnancy and FGF-21 levels were higher in GDM group, while there were no statistically significant differences in Letptin, retinol binding protein 4 (RBP-4) and adiponectin. Correlation analysis suggested that FGF-21 level was correlated with age, pre-pregnancy BMI, weight gain during pregnancy, high density liptein cholesterol (HDL-c), Leptin, RBP-4 and adiponectin,and the results of multiple linear regression indicated that serum FGF-21 was related to pre-pregnancy BMI, weight gain during pregnancy, leptin, RBP-4 and adiponectin in GDM.

CONCLUSIONS: There were higher serum FGF-21 levels in GDM, which might be related to pre-pregnancy BMI, weight gain during pregnancy, Leptin, RBP-4 and adiponectin.

PMID:35871469 | DOI:10.1111/jdi.13889

Dermatol Ther. 2022 Jul 24:e15732. doi: 10.1111/dth.15732. Online ahead of print.

ABSTRACT

Microneedling is a common cosmetic procedure for improvement of wrinkles, acne, scars, and other conditions. Various microneedle (MN) patches have been developed as home care therapy for wrinkles and skin texture. Most of them are made of soluble and absorbable needles. To evaluate the efficacy and safety of non-absorbable magnesium (Mg) MN patches on under-eye wrinkles. A total of 20 subjects aged 27 to 58 years was enrolled in the study. The subjects applied Mg MN patches on the under-eye wrinkle area for one to two hours every other night for 12 weeks. The evaluation comprised grading by clinicians, measuring the wrinkle index with a facial analyzer, and measuring the dermal thickness of the under-eye area with ultrasonography. Any adverse events and discomfort were addressed during the study. The application of Mg MN patches on under-eye areas showed improvements in under-eye grading scale, wrinkle index, and dermal thickness after 12 weeks. The mean grading scale significantly improved after eight weeks of application (p < 0.01). The wrinkle index showed significant improvement after 12 weeks on the right under-eye area (p < 0.05). The dermal thickness of the under-eye area tended to increase, but no statistically significant changes were observed. Non-absorbable Mg MN patches can be used for under-eye wrinkles with minimal discomfort. This article is protected by copyright. All rights reserved.

PMID:35871464 | DOI:10.1111/dth.15732

J Glob Health. 2022 Jul 25;12:13001. doi: 10.7189/jogh.12.13001.

ABSTRACT

BACKGROUND: Pre-pandemic research found a connection between alcohol consumption and reduced physical distancing among strangers. Understanding the association between alcohol consumption at social gatherings and observance of COVID-19 restrictions can help inform policy related to the safe operation of public spaces where alcohol is typically consumed, as well as guidance related to the safe conduct of social events in private spaces.

METHODS: We conducted a rapid review using adapted systematic review methods to explore the association between alcohol consumption in social gatherings and compliance with COVID-19 public health measures and produced a narrative synthesis of our findings. We ran searches in eleven health-related databases (MEDLINE, PubMed, CINAHL, Scopus, Embase (Ovid), ProQuest Public Health, ProQuest Coronavirus, Global Health (Ovid), WHO COVID-19 literature database, PsycInfo (Ovid) and ASSIA) between July 9, 2021, and July 31, 2021. We assessed methodological quality using the relevant Joanna Briggs Institute (JBI) checklists. This review was conducted and reported in accordance with PRISMA-P guidelines.

RESULTS: We identified 7936 studies from the searches. After title, abstract and full-text review, three cross-sectional studies were eligible for inclusion. One study found that people who adhered strongly to physical distancing rules were engaged in about 40% fewer weekly drinks and 60% fewer heavy episodic drinking occasions in a week than people who adhered poorly to physical distancing rules (P < 0.01). One study found that people who reported low-risk alcohol consumption patterns had a higher chance of adhering to hand hygiene measures than those who reported high-risk alcohol consumption (odds ratio (OR) = 4.24, 95% confidence interval (CI) = 1.08-16.64). No other statistically significant results on patterns of alcohol consumption and compliance with individual public health measures or with non-pharmaceutical interventions (NPIs) were found. The direction of effect between alcohol consumption and non-adherence to NPIs and the effect of confounding factors has not been established. The quality of studies found was low to moderate, with risk of recall bias and selection bias due to study design; and the extent to which those studies can be generalised beyond their original settings may be limited.

CONCLUSIONS: Despite existing evidence suggesting an association between alcohol consumption, reduced physical distancing, and increased social interaction, we found few studies of variable quality exploring the relationship between alcohol consumption and compliance with public health measures. A possible association between higher-risk alcohol behaviours and lower compliance with certain NPIs was suggested, but the direction of effect is unknown, and further studies are required to confirm this finding.

PMID:35871429 | DOI:10.7189/jogh.12.13001

J Glob Health. 2022 Jul 25;12:05028. doi: 10.7189/jogh.12.05028.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has been shown to cause enormous psychological burden among health care workers, including first responders. However, psychological well-being of first responders, essential in the fight against COVID-19 pandemic, has often been ignored. We performed the first meta-analysis to explore the prevalence of 1) depression, 2) anxiety, and 3) stress among first responders for medical emergencies during the COVID-19 pandemic.

METHODS: A comprehensive search was conducted in Embase, CINAHL, Web of Science, PsychInfo, PubMed, and the WHO COVID-19 database from 2020. The Freeman-Tukey double-arcsine transformation model in R-software determined the pooled prevalence and Comprehensive Meta-Analysis for associated factors of depression, anxiety, and stress with corresponding 95% confidence intervals (CI). The Cochrane Q, τ², and I² statistics were used to examine heterogeneity. Sub-group analysis was conducted to identify moderator variables.

RESULTS: We identified 765 records, from which 17 studies were included with 8096 first responders. The pooled prevalence was 31% (95% CI = 21%-41%) for depression; 67% (95% CI = 64%-70%) for mild depression, 24% (95% CI = 17%-31%) for moderate depression, and 16% (95% CI = 4%-34%) for severe depression. The pooled prevalence for anxiety was 32% (95% CI = 20%-44%); 60% (95% CI = 46%-73%) for mild anxiety, 27% (95% CI = 14%-42%) for moderate anxiety, and 14% (95% CI = 7%-22%) for severe anxiety. The pooled prevalence for stress was 17% (95% CI = 4%-34%); 58% (95% CI = 38%-77%) for mild stress, 22% (95% CI = 5%-44%) for moderate stress, and 19% (95% CI = 5%-37%) for severe stress. The prevalence of depression was 37% (95% CI = 25%-52%) for paramedics, 28% (95% CI = 12%-54%) for EMS personnel and 22% (95% CI = 13%-33%) for police. Similarly, the prevalence of anxiety was 38% (95% CI = 20%-60%) for paramedics, 28% (95% CI = 11%-53%) for EMS personnel, and 19% (95% CI = 10%-32%) for police. Married responders were likely at risk for depression (1.50, 95% CI = 1.26-1.78) and anxiety (1.94, 95% CI = 1.62-2.33), while unmarried responders were less likely at risk for depression (0.67, 95% CI = 0.56-0.79) and anxiety (0.50, 95% CI = 0.43-0.63).

CONCLUSIONS: High prevalence of depression, anxiety, and stress during the COVID-19 pandemic among first responders for medical emergencies emphasizes the need for monitoring their psychological well-being. Early assessment and management of mild depression, anxiety, and stress among first responders are crucial in preventing progression into moderate and severe types.

PMID:35871411 | DOI:10.7189/jogh.12.05028

Cancer Med. 2022 Jul 24. doi: 10.1002/cam4.5062. Online ahead of print.

ABSTRACT

OBJECTIVE: Poly ADP-ribose polymerase inhibitors (PARPis) have significantly improved clinical effects in gynecological oncology. However, PARPis could also induce severe organ system toxicities, including the hematological system. Our study aimed to extensively characterize the hematological toxicities of PARPis based on the real-world data.

METHODS: Disproportionality analysis was used to evaluate the association between PARPis and hematotoxicity adverse events. Data were extracted from the US FDA Adverse Event Reporting System (FAERS) database between January 2015 and September 2021. The characteristics of PARPi-associated hematological toxicities, and the onset time and fatality proportion were further analyzed.

RESULTS: Out of 24,045 adverse events reports, 4088 hematotoxicity reports (17.00%) were analyzed, with a median age of 64.95 (interquartile range [IQR] 51-71) years. All PARPis were detected with positive safety signals of hematological toxicities in four detection methods. Unexpected significant adverse events such as lymphadenopathy, lymphoedema, and metastases to lymph nodes might also occur. The median time-to-onset was 28 (IQR 10-101) days and the fatality proportion of hematological toxicities with PARPis was 8.76%, with a statistical difference in different PARPis.

CONCLUSION: Hematological toxicities caused by PARPis preferred to occur early and might result in serious outcomes. Early identification and response to the PARPi-related hematological toxicities were important and further basic research were needed to confirm the mechanism of results in this study.

PMID:35871395 | DOI:10.1002/cam4.5062

Eur J Haematol. 2022 Jul 24. doi: 10.1111/ejh.13834. Online ahead of print.

ABSTRACT

OBJECTIVES: The benefits and risks of thromboprophylaxis usage in patients with advanced cancer at the end of their lives remains unknown, especially with the lack of randomized studies. This study aimed to describe the clinical use of thromboprophylaxis in those patients under palliative care.

METHODS: A retrospective cohort study. It was performed on patients admitted to the Palliative care centre.

RESULTS: 719 patients were enrolled in the study. The mean age was 62.97 (13.65) years. venous thromboembolism (VTE) incidence was 5.4%(n=39). At the time of admission, 31.29% (n=225) of patients were on thromboprophylaxis. At death time, 17.5%(n=126) of patients were on thromboprophylaxis (41.3%on primary and 58.7%on secondary thromboprophylaxis). The incidence of clinically suspected fatal VTE was 6.5%(n=47). Surprisingly, clinically suspected VTE was higher statistically in patients with thromboprophylaxis rather than in non-thromboprophylaxis (p value<0.001). By using linear regression, only higher PPI scores on admission were independent negative predictors of length of stay [OR:4.429, 95%CI:5.460-3.398, p value<0.001]. The development of clinically suspected fatal VTE, whatever the status of thromboprophylaxis, did not affect the length of stay.

CONCLUSIONS: Thromboprophylaxis does not decrease the risk of clinically suspected fatal VTE n patients with advanced disease in their terminal phase. Patients with poor performance status and a short prognosis are unlikely to benefit from thromboprophylaxis.

PMID:35871389 | DOI:10.1111/ejh.13834