Nevin Manimala

Am J Cardiovasc Dis. 2021 Feb 15;11(1):124-135. eCollection 2021.

ABSTRACT

Conjugated Linoleic Acids (CLA) may have beneficial effects on the prevention of atherosclerosis, but their net effects on circulating levels of lipoprotein (a) [Lp (a)] are unclear. The present study aimed to systematically review and analyze the Randomized Clinical Trials (RCTs) assessing the effects of CLA on circulating Lp (a) concentrations. A literature search of SCOPUS, PubMed-Medline, ISI, Web of Science, and Cochrane library databases was conducted for the relevant RCTs investigating the effects of CLA supplementation on circulating Lp (a) levels, which had been published up to 20 August 2020. Weighted Mean Difference (WMD) and 95% Confidence Intervals (CI) were reported as the summary statistics. Statistical analysis were done with Comprehensive Meta-Analysis (CMA) V2 software (Biostat, NJ). Totally, six studies with 13 treatment arms including 752 subjects were included in the meta-analysis. The results showed a significant increase in circulating Lp (a) levels after CLA supplementation (WMD: 16.68 mg/L, 95% CI: 5.43-27.93; P=0.004) with no evidence of heterogeneity across the studies. In the subgroup analysis, a more significant elevation of Lp (a) levels was observed in the trials lasting for six months or more (WMD: 21.61 mg/L, 95% CI: 9.85-33.37, P<0.001) as well as in those with a supplementation dosage of ≥3.5 g/d (WMD: 26.13 mg/L, 95% CI: 7.02-45.24, P=0.007). These findings were sensitive to one study. It can be concluded that CLA supplementation with a dose of ≥3.5 g/d over a six-month period might significantly increase the circulating Lp (a) concentrations.

PMID:33815928 | PMC:PMC8012289

Am J Cardiovasc Dis. 2021 Feb 15;11(1):93-107. eCollection 2021.

ABSTRACT

The coronavirus disease 19 (COVID-19) pandemic has caused significant morbidity and mortality worldwide and an effective treatment is needed. Chloroquine (CQ) and hydroxychloroquine (HCQ) have shown in vitro antiviral activity against SARS-CoV-2 which causes the disease, but the evidence from in vivo studies so far has been inconclusive.

OBJECTIVE: To evaluate the efficacy and safety of CQ and HCQ in the treatment of COVID-19.

DATA SOURCES: We systematically searched the PubMed, Embase, MEDLINE, Cochrane CENTRAL, CINAHL, Scopus, Joanna Briggs Institute Database, ClinicalTrials.gov, and Chinese Clinical Trial Registry (ChiCTR) for all articles published between 01 January 2020 to 15 September 2020 on CQ/HCQ and COVID-19 using a predefined search protocol; without any language restrictions. A search of grey literature repositories (New York Academy of Medicine Grey Literature and Open Grey), and pre-publication server deposits (medRxIV and bioRxIV) was also performed.

STUDY SELECTION: Randomized clinical trials (RCT) which compared CQ/HCQ to standard supportive therapy in treating COVID-19 were included.

DATA EXTRACTION AND SYNTHESIS: Data were extracted from original publications by four independent reviewers. Risk of bias was assessed using the Cochrane Collaboration’s assessment tool. Data were meta-analyzed using a random-effect models. Results are reported according to PRISMA guidelines. Main Outcome(s) and Measure(s): The primary prespecified efficacy outcome was all-cause mortality. The primary safety outcome was any adverse effect attributed to use of CQ/HCQ.

RESULTS: Eight RCTs were included and pooled in the mortality meta-analysis (6,592 unique participants; mean age = 59.4 years; 42% women). CQ/HCQ did not show any mortality benefit when compared to standard supportive therapy (Pooled Relative Risk [RR] 1.07; 95% CI = 0.97-1.18; I² statistic = 0.00%). Sensitivity and sub-group analyses showed similar findings. Any adverse event was significantly higher in patients randomized to CQ/HCQ (RR = 2.51; 95% CI = 1.53-4.12; n = 1,818 patients), but the risk of developing severe adverse event was not statistically significant (RR = 0.99, 95% CI = 0.53-1.86; n = 6,456 patients).

CONCLUSIONS AND RELEVANCE: Evidence from currently published RCTs do not demonstrate any added benefit for the use of CQ or HCQ in the treatment of COVID-19 patients.

PMID:33815925 | PMC:PMC8012280

Am J Cardiovasc Dis. 2021 Feb 15;11(1):80-86. eCollection 2021.

ABSTRACT

COVID-19 outbreak has brought tremendous psychological pressure to the general population, especially to those with associated cardiovascular disease. An online Patient Health Questionnaire (PHQ-9) survey on consecutive congenital heart disease (CHD) patients, was carried out to determine depression during the Spanish coronavirus disease (COVID-19) quarantine. Two-hundred forty-two out of 407 (59%) CHD patients answered the survey, 123 (51%) had mild defects, 88 (36%) moderate and 31 (13%) great defects, most of them between 18 and 24 years old and 51% were male. Patients were dichotomized to no or mild (PHQ-9 < 10) and moderate to severe (≥ 10) depressive symptoms. Thirty-four (14%) patients showed a PHQ-9 ≥ 10 and 10 of them (29%) were under anxiolytic or antidepressant treatment during the quarantine. During the study period, 9 (4%) patients had COVID-19 symptoms. Patients with a NYHA above 2 (P=0.025), living in houses without garden or balcony (P=0.014), needing psychological/psychiatric evaluation/medication in the previous 12 months or being under anxiolytic/antidepressant treatment during the confinement had, significantly, a PHQ-9 score ≥ 10 (P < 0.001). Being under anxiolytic/antidepressant treatment during the coronavirus pandemic [OR 3.92 (95% CI 1.05-14.66), P=0.043] and having previous psychological/psychiatric evaluation in the previous 12 months to the quarantine [OR 3.82 (95% CI 1.16-12.54), P=0.027] were the only variables that reached statistical significance, in the multivariable analysis, as predictors of a pathological PHQ-9 questionnaire (score ≥ 10). In conclusion depression was frequent during the COVID-19 quarantine among CHD patients, with only a third of them being under anxiolytic or antidepressant treatment. Needing psychological/psychiatric evaluation/treatment during the previous 12 months to the lockdown was a predictive factor for an abnormal PHQ-9 score.

PMID:33815923 | PMC:PMC8012290

J Health Pollut. 2021 Mar 2;11(29):210306. doi: 10.5696/2156-9614-11.29.210306. eCollection 2021 Mar.

ABSTRACT

BACKGROUND: India is the fifth biggest producer of e-waste in the world, discarding 1.7 million tons in 2014. E-waste gets recycled mainly in the informal sector which means activities are largely unaccounted for. Hazardous chemicals and metals are released during recycling processes (lead (Pb) being the most common). Compared to other developing countries, there are few studies from India on the awareness of recyclers of health risks related to e-waste recycling.

OBJECTIVES: The aim of the present study was to assess the knowledge, attitudes, and practices (KAP) of health-related risks and behaviors among e-waste workers/recyclers belonging to the informal sector in Delhi and to determine the concentration of Pb levels in hair samples from a subset of workers from selected recycling sites.

METHODS: A cross-sectional study was conducted in three e-waste informal recycling sites of Delhi: Seelampur, Mustafabad and Mandoli using an interviewer administered questionnaire among 220 e-waste workers. Percentages were presented for each KAP indicator. Analyses were computed using the statistical software STATA 14.2.

RESULTS: It was observed that 24% of participants had knowledge of the meaning of e-waste and 36% knew the chemicals that could be released from e-waste handling. Personal protective equipment (PPE) was used by only 12% of the workers. Twenty-six percent (26%) perceived occupational injuries (cuts or burns) as mild and 20% perceived coughing immediately after work as mild. Explorative analysis showed a link between worker education level and the type of work practices employed. The median level of Pb concentration among hair samples was 8 mg/kg with inter-quartile range between 5.8 to 12.4 mg/kg.

CONCLUSIONS: Knowledge and practices among e-waste workers regarding the health hazards associated with e-waste recycling were poor with little knowledge of or attention to health risks. A comprehensive remediation package covering sensitization and awareness-building strategies of the health risks associated with informal e-waste recycling should be an urgent priority.

PARTICIPANT CONSENT: Obtained.

ETHICS APPROVAL: Ethics approval was obtained from the Institutional Ethical Committee (IEC), Indian Institute of Public Health-Delhi.

COMPETING INTERESTS: The authors declare no competing financial interests.

PMID:33815904 | PMC:PMC8009644 | DOI:10.5696/2156-9614-11.29.210306

J Health Pollut. 2021 Feb 25;11(29):210303. doi: 10.5696/2156-9614-11.29.210303. eCollection 2021 Mar.

ABSTRACT

BACKGROUND: There is no safe level of human exposure to lead (Pb). Detecting common early symptoms of low threshold Pb poisoning can help to prevent the damaging effects of higher doses and chronic low dose exposures. Panel beaters or auto body mechanics are exposed to Pb through their occupational duties.

OBJECTIVES: The present study aimed to determine common early symptoms associated with lower threshold Pb poisoning among roadside and organized panel beaters in Enugu Metropolis, Nigeria.

METHODS: This was a comparative cross-sectional study of 428 panel beaters in Enugu metropolis. A multi-stage sampling method was used to select 214 respondents each from the roadside and organized sectors. A semi-structured interviewer-administered questionnaire was used for data collection. Samples were collected under aseptic procedures. Blood Pb samples were extracted using the conventional wet acid digestion method and analyzed using a flame atomic absorption spectrometer (wavelength 283.3 nm). Comparative analysis was performed using the chi – square and Mann-Whitney U test. Statistical significance was set at P < 0.05.

RESULTS: Median Pb levels were 3.0 ug/dL and 16.0 ug/dL among roadside and organized panel beaters, respectively, with a significant difference. Numbness of limbs (P = 0.010) and fatigue (χ² = 5.294, P = 0.023) were found to be associated with roadside panel beaters, while weakness (χ² = 6.185, P = 0.019) and fatigue (χ² = 4.206, P = 0.046) were associated with organized panel beaters.

CONCLUSIONS: Nonspecific constitutional symptoms were common early symptoms of Pb poisoning irrespective of workplace occupational practices. These symptoms will help in early detection and control of occupational lead exposures.

PARTICIPANT CONSENT: Obtained.

ETHICS APPROVAL: Ethics approval was obtained from the Health Research Ethics Committee of the University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu.

COMPETING INTERESTS: The authors declare no competing financial interests.

PMID:33815901 | PMC:PMC8009647 | DOI:10.5696/2156-9614-11.29.210303

J Health Pollut. 2021 Mar 2;11(29):210211. doi: 10.5696/2156-9614-11.29.210211. eCollection 2021 Mar.

ABSTRACT

BACKGROUND: The Nepalese government announced a nationwide lockdown beginning on March 24, 2020 as an attempt to restrain the spread of COVID-19. The prohibition in flight operations and movement of vehicles, factory shutdowns and restriction in people’s movement due to the lockdown led to a significant reduction in the amounts of pollutants degrading air quality in many countries.

OBJECTIVES: The present study aimed to analyze changes in particulate matter (PM) emissions and the air quality index (AQI) of six cities in Nepal i.e., Damak, Simara, Kathmandu, Pokhara, Nepalgunj and Surkhet due to the nationwide lockdown in response to the COVID-19 outbreak.

METHODS: Daily PM concentrations of each of the six study cities from January 24 to September 21, 2020 were obtained from the World Air Quality Index project (https://aqicn.org) and analyzed using R Studio software. The drop percentage was calculated to determine the change in PM_2.5 and PM₁₀ concentration during different time periods. Independent sample Mann-Whitney U tests were performed to test the significance of differences in mean concentration for each site during the lockdown period (24 March-24 July 2020) and its corresponding period in 2019. Similarly, the significance of differences in mean concentrations between the lockdown period and the period immediately before lockdown (23 January-23 March) was also examined using the same test.

RESULTS: During the lockdown period, in overall Nepal, AQI_PM2.5 and AQI_PM10 were within the moderate zone for the maximum number of days. As a result of the lockdown, the highest immediate and final drop of PM_2.5 was observed in Damak (26.37%) and Nepalgunj (80.86%), respectively. Similarly, the highest immediate drop of PM₁₀ was observed in Surkhet (37.22%) and finally in Nepalgunj (81.14%). Analysis with the Mann-Whitney U test indicated that for both PM types, all sites showed a statistically significant (p < 0.05) difference in mean concentrations during lockdown and the corresponding period in 2019.

CONCLUSIONS: The present study explored the positive association between vehicular movement and PM emissions, highlighting the need for alternative fuel sources to improve air quality and human health.

COMPETING INTERESTS: The authors declare no competing financial interests.

PMID:33815898 | PMC:PMC8009645 | DOI:10.5696/2156-9614-11.29.210211

Aust Endod J. 2021 Apr 4. doi: 10.1111/aej.12512. Online ahead of print.

ABSTRACT

The root fracture resistance (RFR) of premolars extracted from diabetic patients and the effect of biomaterials: white mineral trioxide aggregate (WMTA) and WMTA+Na₂ HPO₄ as an additive, on enhancing RFR were evaluated. Diabetic and non-diabetic teeth were divided into 4 subgroups (n = 5): root canals were obturated with WMTA, WMTA+Na₂ HPO₄ , gutta-percha and one unfilled (control). A plunger (1 mm diameter) applied a downward compressive load with crosshead speed of 1 mm min^-1 on the specimens mounted on resin blocks, and the ultimate force to fracture was measured. The mean RFR values of diabetic specimens were significantly lower. The lowest and highest means of RFR were recorded in the control and WMTA, in normal group and the control and WMTA+Na₂ HPO₄ in the diabetic group, respectively. The RFR in diabetic patients was significantly lower, indicating their higher susceptibility to fracture under vertical forces. The use of WMTA (with or without Na₂ HPO₄ ) for obturation enhances the RFR.

PMID:33813800 | DOI:10.1111/aej.12512

J Appl Microbiol. 2021 Apr 4. doi: 10.1111/jam.15096. Online ahead of print.

ABSTRACT

AIMS: The aim of this study was to isolate and characterize staphylococcal isolates from diabetic foot ulcers (DFU) in Jordanian patients.

METHODS AND RESULTS: Selected aerobic pathogens recovered from DFU specimens and patients’ nares with a focus on staphylococci were investigated. Antimicrobial susceptibilities and the prevalence of methicillin-resistant staphylococci (MRS) were determined. SCCmec types and toxigenic characteristics were analyzed and spa typing was performed for methicillin-resistant Staphylococcus aureus (MRSA) isolates. The relationship between toxigenic characteristics of MRSA and the Wagner ulcer grading system was statistically analyzed. A total number of 87 DFU patients were recruited for the study. The DFU cultures were polymicrobial. Members of the genus Staphylococcus were the most common among DFU-associated isolates found in 48.3% (n= 42) of all patients enrolled. Coagulase-negative staphylococci (CoNS) comprised 63.3% of staphylococci isolated from DFUs predominated by Staphylococcus epidermidis in both DFU (7.6%) and nares (39.2%). S. aureus was isolated from DFUs and nares in 14.2% and 9.8%, respectively, while 93% and 70% of these isolates were MRSA. Most of MRSA carried SCCmec type IV (76.2%) while SCCmec elements were non-typeable in most methicillin resistant coagulase negative staphylococci (MR-CoNS) (61.9%). The most frequent MRSA spa type was t386 (23.8%). Most MRSA and MR-CoNS exhibited resistance towards aminoglycosides, fluoroquinolones, and macrolides and susceptibility towards vancomycin, mupirocin and linezolid. No association was found between the possession of pvl, tst, sea, and hlg toxins and Wagner ulcer grading system (P- value > 0.05).

CONCLUSIONS: This analysis of Jordanian DFU culture demonstrated its polymicrobial nature with predominance of Staphylococcus spp.

SIGNIFICANCE AND IMPACT OF STUDY: This study is the first of its type to assess the microbiology of DFU among Jordanian patients. The results will help in the appropriate application of antimicrobial chemotherapy in the management of DFU.

PMID:33813786 | DOI:10.1111/jam.15096

J Clin Hypertens (Greenwich). 2021 Apr 4. doi: 10.1111/jch.14246. Online ahead of print.

ABSTRACT

Prehypertension is a risk factor for cardiovascular disease (CVD) and all-cause mortality. However, it is unclear whether prehypertension combined with diabetes associate with a higher risk for cardiovascular disease and all-cause mortality. The purpose of this study was to explore the relationship between prehypertension and the risk of CVD and all-cause mortality was different among individuals with or without diabetes. In the prospective community-based Kailuan study, 67 344 participants without hypertension or a history of CVD at baseline (2006) were included. Prehypertension was defined as systolic blood pressure of 120-139 mmHg or diastolic blood pressure of 80-89 mmHg. The outcomes were CVD and all-cause mortality were followed up through December 31, 2017. We performed Cox proportional hazards models to evaluate the relationships between prehypertension and CVD and all-cause mortality by diabetes status. During a median follow-up of 11.03 years, 2981 CVD events and 4655 all-cause mortality occurred. After adjusting age, sex, and other factors, the associations of prehypertension with risk of CVD and all-cause mortality were significant in participants without diabetes (hazard ratio and 95% confidence interval: 1.54 [1.38-1.71] and 1.27 [1.17-1.38]), but not in participants with diabetes (1.20 [0.93-1.56] and 0.88 [0.73-1.07]). The interactions between prehypertension and diabetes for the risk of CVD and all-cause mortality were all significant (all p < .05). Prehypertension was only associated with an increased risk for CVD and all-cause mortality in non-diabetes participants. Diabetes modifies the relation of prehypertension with the risk of CVD and all-cause mortality.

PMID:33813784 | DOI:10.1111/jch.14246

Pediatr Transplant. 2021 Apr 3:e14018. doi: 10.1111/petr.14018. Online ahead of print.

ABSTRACT

BACKGROUND: The clinical course of SARS-CoV-2 in the pediatric kidney transplant population is not well described.

METHODS: We performed a retrospective cohort study of a pediatric kidney transplant population at a New York transplant center. Baseline characteristics and clinical course of patients with SARS-CoV-2 positivity (Ab or PCR) were described, and comparison between COVID-positive and COVID-negative transplant patients was performed.

RESULTS: Twenty-two patients had COVID-19 IgG testing performed, eight of whom also had PCR testing. 23% of our cohort had evidence of COVID-19 infection. Four patients had positive IgG only, and one patient had a positive PCR. All five patients with a positive COVID test were female. Two patients had COVID-19 symptoms, which were mild. Of the symptomatic patients, one had a positive PCR at time of symptoms, while the other had a negative PCR during symptoms but subsequently had positive IgG. As compared to patients with COVID-19 negative results, those with COVID-19 positivity were significantly more likely to have a known COVID-19 exposure, and were also more likely to be female. There was no significant difference in time from transplant between the groups. Those in the COVID-positive group had higher baseline antimetabolite dose and CNI troughs, although these did not reach statistical significance.

CONCLUSIONS: Pediatric kidney transplant recipients are at risk for development of COVID-19 infection. While this population may be more at risk for SARS-CoV-2 infection due to their immunosuppressed status, their clinical course appears mild and similar to a healthy pediatric population.

PMID:33813782 | DOI:10.1111/petr.14018