Nevin Manimala

Am J Gastroenterol. 2022 Jun 17. doi: 10.14309/ajg.0000000000001884. Online ahead of print.

ABSTRACT

INTRODUCTION: The incidence of early-onset colorectal cancer (eoCRC) has been increasing in North America. Debate remains as to whether the trends by topography, histology, stage, or mortality in this population are amenable to intervention from screening.

METHODS: CRC incidence (2000-2017) and mortality (2000-2018) data were obtained from the Canadian Cancer Registry and Vital Statistics. Annual percent changes (APC) in the incidence (topography and histology) and mortality of eoCRC were estimated using Joinpoint Regression. Incidence of late stage CRC (III or IV) versus early stage (I or II) was compared between eoCRC (age 20-49) and eligible screening (age 50-74) groups with Poisson regression.

RESULTS: Among females aged 20-49, the incidence of CRC significantly increased from 2000-2017 in both the distal colon (APC=1.40) and rectum (APC=3.00), while for males aged 20-49, CRC incidence increased in the proximal colon (APC=1.10), distal colon (APC=3.00), and rectum (APC=3.70). Among both males and females aged 20-49, incidence of non-mucinous adenocarcinomas significantly increased (APCs: 1.90 and 2.30, respectively), while mucinous adenocarcinomas decreased for females (APC=-1.60) and remained stable for males. Adults 30 to 49, when diagnosed with CRC, had a significantly higher risk of being diagnosed with a late stage CRC compared to the 50-74 age group. Rectal-cancer mortality increased from 2000-2018 in the eoCRC group (APCs for females and males 3.80 and 3.40, respectively).

DISCUSSION: Emerging data support future modifications to guidelines on screening for eoCRC in Canada. Further research is required on impact, cost-effectiveness, and risk prediction for targeted screening within this group.

PMID:35973186 | DOI:10.14309/ajg.0000000000001884

Am J Gastroenterol. 2022 Jun 17. doi: 10.14309/ajg.0000000000001883. Online ahead of print.

ABSTRACT

BACKGROUND AIMS: Frailty and sarcopenia are common complications of advanced liver disease. Due to associated morbidity/mortality, there have been targeted efforts to prevent and/or improve both by enrolling these patients in focused exercise programs. This review systematically analyzes the data of randomized clinical trials (RCT) on anthropometric, physical fitness, quality of life, and safety outcomes of exercise interventions in patients with advanced liver disease.

METHODS: Two authors independently searched trials on PubMed and EMBASE from inception up to 11/18/2021. A third independent arbitrator adjudicated all disagreements. We qualitatively summarized these outcomes: 1) muscular fitness (maximal inspiratory/expiratory pressures, muscle size, muscle strength, and bioimpedance testing); 2) cardiorespiratory fitness (cardiopulmonary exercise testing, 6-minute walk distance), 3) quality of life, and 4) others (safety or frailty indices).

RESULTS: There were eleven RCTs (4 home-based interventions) with 358 participants. Interventions ranged from 8-14 weeks and included cycling, walking, resistance exercises, balance and coordination training, and respiratory exercises. All described outcomes compared pre- to post-intervention measurements. Nine studies showed statistically significant improvements in at least one physical fitness variable. Ten studies showed statistically significant improvements in at least one muscular fitness variable. Six studies showed statistically significant improvements in at least one quality of life variable. Attrition rates ranged from 5-36% and adherence rates ranged very widely from 14-100%. Only one study reported frailty indices. Notably, no complications of portal hypertension were seen in intervention groups in the nine studies that reported this data.

CONCLUSIONS: A review of eleven randomized clinical trials with 358 participants with advanced liver disease demonstrates that exercise interventions can have favorable outcomes on muscular/cardiorespiratory fitness, and quality of life. While attrition and adherence varied, these interventions appear to be safe in patients with cirrhosis and are well tolerated.

PMID:35973182 | DOI:10.14309/ajg.0000000000001883

Am J Gastroenterol. 2022 Jun 17. doi: 10.14309/ajg.0000000000001878. Online ahead of print.

ABSTRACT

OBJECTIVES: Non-invasive criteria to predict progression of low-risk esophageal varices (EV) in patients with compensated HCV cirrhosis after sustained virological response (SVR) by direct-acting antivirals (DAAs) are lacking. Our aim was to assess the diagnostic performance of RESIST-HCV criteria for EV progression compared to elastography-based criteria (Baveno VI, Expanded Baveno VI and Baveno VII-HCV criteria).

METHODS: All consecutive patients observed at three referral centers with compensated HCV cirrhosis with or without F1 EV who achieved SVR by DAAs were classified at last esophagogastroduodenoscopy (EGDS) as RESIST-HCV Low Risk (LR – i.e. low probability of high-risk varices-HRV) if platelets were >120 x 109/L and serum albumin >3.6 g/dL or RESIST-HCV High Risk (HR-i.e. high probability of HRV) if platelets were <120 x 109/L or serum albumin <3.6 g/dL. Primary outcome was the progression to HRV. Area under the receiver operating characteristic (AUROC) curve and decision curve analysis (DCA) of non-invasive criteria were calculated.

RESULTS: The cohort consisted of 353 patients in Child-Pugh A class (mean age 67.2 years, 53.8% males). During a mean follow-up of 44.2 months, 34 patients (9.6%, 95%CI 6.7%-13.5%) developed HRV. At the last EGDS, 178 patients(50.4%) were RESIST-LR and 175(49.6%) were RESIST-HR. RESIST-HCV criteria showed the highest AUROC (0.70, 95%CI 0.65-0.75), correctly sparing the highest number of EGDS (54.3%), with the lowest false positive rate (45.7%), compared to elastography-based criteria. DCA showed that RESIST-HCV had higher clinical utility than elastography-based criteria.

CONCLUSIONS: Biochemical-based RESIST-HCV criteria are useful to easily predict HRV development after HCV eradication by DAAs in patients with compensated cirrhosis and low-risk EV.

PMID:35973181 | DOI:10.14309/ajg.0000000000001878

J Glob Health. 2022 Aug 17;12:11010. doi: 10.7189/jogh.12.11010.

ABSTRACT

BACKGROUND: The effects of meteorological factors and air pollutants on respiratory diseases (RDs) were various in different populations according to the demographic characteristics, and children were considered a vulnerable population. Previous studies were mainly based in cities with serious air pollution. This study aimed to qualify the lag effects of meteorological factors and air pollution on respiratory diseases among children under 18 years old in Fuzhou.

METHODS: Meteorological data, air pollutants concentrations and hospital admission data of Fujian Maternity and Child Health Hospital between 2015 and 2019 were collected. A Distributed Lag Nonlinear Model (DLNM) was used to evaluate the nonlinear and lagged effect of meteorological factors and air pollutants on daily RDs number. A subgroup analysis was also conducted to evaluate the effect on different sex groups and age groups.

RESULTS: A total number of 796 125 RDs visits was included during the study period. For meteorological factors, lower mean temperature and relative humidity were significantly associated with daily RDs number (peak relative risk (RR) = 1.032 (95% confidence interval (CI) = 1.011-1.053) and 1.021 (95% CI = 1.013-1.029)), while lower wind speed showed a significant association at low range (peak RR = 0.995 (95% CI = 0.992-0.999)). Temperature warming was a significant protective factor for RDs (peak RR = 0.989 (95% CI = 0.986-0.993)). For air pollutants, SO₂, NO₂, PM₁₀ and PM_2.5 were all significantly associated with RDs (peak RR = 1.028 (95% CI = 1.022-1.035), 1.024 (95% CI = 1.013-1.034), 1.036 (95% CI = 1.025-1.047), 1.028 (95% CI = 1.019-1.037)), and the relationship had no threshold. The estimated RR and peak lag day did not change extremely between subgroups.

CONCLUSIONS: The findings provide statistical evidence for the prevention of child RDs. In addition, our findings suggested that even at low concentrations, air pollutants still have negative effects on the respiratory system.

PMID:35973040 | DOI:10.7189/jogh.12.11010

JMIR Form Res. 2022 Aug 9. doi: 10.2196/39772. Online ahead of print.

ABSTRACT

BACKGROUND: The emergence of COVID-19 exacerbated the existing epidemic of opioid use disorder (OUD) across the United States due to the disruption of in-person treatment and support services. Increased use of technology – including telehealth – and the development of new partnerships may facilitate coordinated treatment interventions that comprehensively address the health and well-being of individuals with OUD.

OBJECTIVE: The analysis of this pilot program aimed to determine the feasibility of delivering a COVID-19 telehealth care management program using Short Message Service (SMS) text messages for patients receiving OUD treatment.

METHODS: Eligible individuals were identified from a state-wide opioid treatment program (OTP) network. Those who screened positive for COVID-19 symptoms were invited to connect to care management through a secure, HIPPA-compliant SMS text message. Care management monitoring for COVID-19 was provided for a period of up to 14 days. Monitoring services consisted of daily text messages from the care manager inquiring about: 1) the participant’s physical health in relation to COVID-19 symptoms by confirming their temperature, 2) if the participant was feeling worse since the prior day, and 3) if the participant was experiencing symptoms such as coughing or shortness of breath. If COVID-19 symptoms worsened during this observation period, the care manager was instructed to refer participants to the hospital for acute care services. Feasibility of the telehealth care management intervention was assessed by rates of: 1) adoption in terms of program enrollment; 2) engagement as measured by the number of text message responses per participants; and 3) retention in terms of the number of days participants remained in the program.

RESULTS: Between January and April 2021, OTP staff members referred 21 patients with COVID-19 symptoms and 18 (82%) agreed to be contacted by a care manager. Participants ranged in age from 27-65 years and primarily identified as female (58%) and white (83%). The majority of participants were Medicaid recipients (78%). There were no statistically significant differences in the demographic characteristics between those enrolled and not enrolled in the program. A total of 12 (67%) patients were enrolled in the program with two (11%) opting out of text message communication and choosing instead to speak with a care manager verbally by telephone. The remaining 10 participants answered [median (interquartile range)] 7 (4-10) messages and were enrolled in the program for 9 (7.5-12) days. No participants were referred for acute care services or hospitalized during program enrollment.

CONCLUSIONS: These results demonstrate the feasibility of a novel telehealth intervention to monitor COVID-19 symptoms among OTP patients in treatment for OUD. Further research is needed to determine the applicability of this intervention to monitor patients with comorbid chronic conditions in addition to acceptability among patients and providers using the text messaging modality.

PMID:35973033 | DOI:10.2196/39772

Am J Vet Res. 2022 Aug 18;83(10):ajvr.22.03.0062. doi: 10.2460/ajvr.22.03.0062.

ABSTRACT

OBJECTIVE: To assess the repeatability of equine 18F-sodium fluoride (18F-NaF) positron emission tomography (PET) findings, and to evaluate the ability of PET to monitor the progression of areas of increased radiopharmaceutical uptake (IRU) in the fetlocks of Thoroughbred racehorses.

ANIMALS: 25 racehorses with clinical signs related to fetlock injuries.

PROCEDURES: This study is a prospective, longitudinal clinical study. Twenty-five racehorses (54 fetlocks) underwent three 18F-NaF PET scans 6 weeks apart. The first 18F-NaF PET scan was performed at the start of a 12-week period of rest from racing (lay-up). Areas of IRU in the fetlock joints were quantified using maximal standardized uptake values (SUVmax) and were graded by 2 experienced observers. Statistical comparisons were made between scans to detect changes in IRU grade and SUVmax over time.

RESULTS: Standing PET findings were repeatable, with 131/149 (88%) areas of IRU identified on the initial scans seen again at the 6-week follow-up scan. The palmar/plantar condyles were the sites most commonly presenting with IRU, followed by the proximal sesamoid bones. Overall, 65% of fetlocks demonstrated improvement in IRU grade during the 12-week period of rest from racing. Areas of higher IRU grade took longer to resolve than the lower graded areas.

CLINICAL RELEVANCE: Standing PET findings in the racehorse fetlock were repeatable. The SUV-based grading system may be helpful when determining appropriate lay-up duration for Thoroughbred racehorses. PET may be used to monitor areas of the fetlock involved in catastrophic breakdown injuries in Thoroughbred racehorses.

PMID:35973005 | DOI:10.2460/ajvr.22.03.0062

Am J Vet Res. 2022 Aug 18;83(10):ajvr.22.04.0072. doi: 10.2460/ajvr.22.04.0072.

ABSTRACT

OBJECTIVE: Mesenchymal stromal (stem) cells (MSCs) have been studied to treat many common orthopedic injuries in horses. However, there is limited information available on when and how to use this treatment effectively. The aim of this retrospective study is to report case features, treatment protocols, and clinical outcomes in horses treated with MSCs.

ANIMALS: 65 horses presenting with tendinous, ligamentous, and articular injuries, and treated with MSCs prepared by a single laboratory between 2016 and 2019. Outcome information was available for 26 horses.

PROCEDURES: Signalment, clinical signs, diagnostic methods, treatment protocol features (prior and concurrent therapies, cell origin, dose, application site and number), and effective outcomes were analyzed. The analysis was focused on comparing the effect of different MSC treatment protocols (eg, autologous vs allogeneic) on outcome rather than the effectiveness of MSC treatment.

RESULTS: MSC treatment resulted in 59.1% (clinical lameness) to 76.9% (imaging structure) improvement in horses with diverse ages, breeds, sex, and lesions. The use of other therapeutic methods before MSC application (eg, anti-inflammatories, shockwave, laser, icing, resting, bandage and stack wrap, intra-articular injections, and/or surgical debridement) was shown to be statistically more effective compared to MSCs used as the primary therapeutic procedure (P < .05). Autologous versus allogeneic treatment outcomes were not significantly different.

CLINICAL RELEVANCE: A prospective MSC treatment study with standardization and controls to evaluate the different features of MSC treatment protocols is needed. The various case presentations and treatment protocols evaluated can be used to inform practitioners who are currently using MSCs in clinical practice.

PMID:35973004 | DOI:10.2460/ajvr.22.04.0072

Am J Vet Res. 2022 Aug 18;83(10):ajvr.22.06.0098. doi: 10.2460/ajvr.22.06.0098.

ABSTRACT

OBJECTIVE: To evaluate the sedative and cardiopulmonary effects of various combinations of acepromazine, dexmedetomidine, hydromorphone, and glycopyrrolate, followed by anesthetic induction with propofol and maintenance with isoflurane in healthy dogs.

ANIMALS: 6 healthy adult female Beagles.

PROCEDURES: Dogs were instrumented for hemodynamic measurements while anesthetized with isoflurane. Two hours after recovery, dogs received 1 of 4 IM combinations in a crossover design with 1 week between treatments: hydromorphone (0.1 mg/kg) and acepromazine (0.005 mg/kg; HA); hydromorphone and dexmedetomidine (0.0025 mg/kg; HD); hydromorphone, acepromazine, and dexmedetomidine (HAD); and hydromorphone, acepromazine, dexmedetomidine, and glycopyrrolate (0.02 mg/kg; HADG). Sedation was scored after 30 minutes. Physiologic variables and cardiac index were measured after sedation, after anesthetic induction with propofol, and every 15 minutes during maintenance of anesthesia with isoflurane for 60 minutes (target expired concentration at 760 mm Hg, 1.3%).

RESULTS: Sedation scores were not significantly different among treatments. Mean ± SD cardiac index was significantly higher for the HA (202 ± 45 mL/min/kg) and HADG (185 ± 59 mL/min/kg) treatments than for the HD (88 ± 31 mL/min/kg) and HAD (103 ± 25 mL/min/kg) treatments after sedation and through the first 15 minutes of isoflurane anesthesia. No ventricular arrhythmias were noted with any treatment.

CLINICAL RELEVANCE: In healthy dogs, IM administration of HADG before propofol and isoflurane anesthesia provided acceptable cardiopulmonary function with no adverse effects. This combination should be considered for routine anesthetic premedication in healthy dogs.

PMID:35973002 | DOI:10.2460/ajvr.22.06.0098

PLoS Med. 2022 Aug 16;19(8):e1004060. doi: 10.1371/journal.pmed.1004060. eCollection 2022 Aug.

ABSTRACT

BACKGROUND: Several studies have indicated that universal health coverage (UHC) improves health service utilization and outcomes in countries. These studies, however, have primarily assessed UHC’s peacetime impact, limiting our understanding of UHC’s potential protective effects during public health crises such as the Coronavirus Disease 2019 (COVID-19) pandemic. We empirically explored whether countries’ progress toward UHC is associated with differential COVID-19 impacts on childhood immunization coverage.

METHODS AND FINDINGS: Using a quasi-experimental difference-in-difference (DiD) methodology, we quantified the relationship between UHC and childhood immunization coverage before and during the COVID-19 pandemic. The analysis considered 195 World Health Organization (WHO) member states and their ability to provision 12 out of 14 childhood vaccines between 2010 and 2020 as an outcome. We used the 2019 UHC Service Coverage Index (UHC SCI) to divide countries into a “high UHC index” group (UHC SCI ≥80) and the rest. All analyses included potential confounders including the calendar year, countries’ income group per the World Bank classification, countries’ geographical region as defined by WHO, and countries’ preparedness for an epidemic/pandemic as represented by the Global Health Security Index 2019. For robustness, we replicated the analysis using a lower cutoff value of 50 for the UHC index. A total of 20,230 country-year observations were included in the study. The DiD estimators indicated that countries with a high UHC index (UHC SCI ≥80, n = 35) had a 2.70% smaller reduction in childhood immunization coverage during the pandemic year of 2020 as compared to the countries with UHC index less than 80 (DiD coefficient 2.70; 95% CI: 0.75, 4.65; p-value = 0.007). This relationship, however, became statistically nonsignificant at the lower cutoff value of UHC SCI <50 (n = 60). The study’s primary limitation was scarce data availability, which restricted our ability to account for confounders and to test our hypothesis for other relevant outcomes.

CONCLUSIONS: We observed that countries with greater progress toward UHC were associated with significantly smaller declines in childhood immunization coverage during the pandemic. This identified association may potentially provide support for the importance of UHC in building health system resilience. Our findings strongly suggest that policymakers should continue to advocate for achieving UHC in coming years.

PMID:35972985 | DOI:10.1371/journal.pmed.1004060

PLoS One. 2022 Aug 16;17(8):e0271634. doi: 10.1371/journal.pone.0271634. eCollection 2022.

ABSTRACT

Butter and virgin olive oil (EVOO) are two fats differing in their degree of saturation and insaponifiable fraction. EVOO, enriched in polyphenols and other minority components, exerts a distinct effect on health. Using next generation sequencing, we have studied early and long-term effects of both types of fats on the intestinal microbiota of mice, finding significant differences between the two diets in the percentage of certain bacterial taxa, correlating with hormonal, physiological and metabolic parameters in the host. These correlations are not only concomitant, but most noticeably some of the changes detected in the microbial percentages at six weeks are correlating with changes in physiological values detected later, at twelve weeks. Desulfovibrionaceae/Desulfovibrio/D. sulfuricans stand out by presenting at six weeks a statistically significant higher percentage in the butter-fed mice with respect to the EVOO group, correlating with systolic blood pressure, food intake, water intake and insulin at twelve weeks. This not only suggests an early implication in the probability of developing altered physiological and biochemical responses later on in the host lifespan, but also opens the possibility of using this genus as a marker in the risk of suffering different pathologies in the future.

PMID:35972974 | DOI:10.1371/journal.pone.0271634