Nevin Manimala

Cardiology. 2022 Feb 23. doi: 10.1159/000523718. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with suspected non-ST-elevation acute coronary syndrome (NSTE-ACS) assigned to the ‘observe’ zone of the ESC 0/1-hour algorithm form a heterogeneous group known to have an unfavourable prognosis. We aim to elucidate the clinical characteristics and management of these patients and generate a model that is predictive of a coronary diagnosis at index visit to the emergency department (ED).

METHODS: A retrospective observational cohort study including adult patients presenting to the ED with suspected NSTE-ACS assigned to the ‘observe’ zone of the ESC 0/1-hour algorithm. Multivariable logistic regression analysis was performed for the prediction of a coronary diagnosis. Internal validation was performed using bootstrap resampling.

RESULTS: 750 patients were included; mean age 66±13 years, 35% women, 50% with prior history of coronary artery disease. In 372 (50%) patients a diagnosis was established within 30-days of index presentation, of whom 169 (45%) patients had a coronary-related event. Multivariable logistic regression analysis generated a 12-point risk score incorporating 5 variables for the prediction of such event, including type of angina, chest pain occurring during inspiration, prior history of CAD, ST-segment deviation on electrocardiogram and estimated glomerular filtration rate<60. The final model had an optimism-corrected c-statistic of 0.78 (95% confidence interval [CI] 0.74-0.82). A score <6 ruled out a coronary event in 276 (37%) patients, with a sensitivity and NPV of 90% (95% CI 84-94) and 94% (91-96), respectively.

CONCLUSION: A score <6 identifies patients at low-risk of a coronary diagnosis and can guide clinical decision making in choosing the appropriate diagnostic test.

PMID:35196652 | DOI:10.1159/000523718

Transbound Emerg Dis. 2022 Feb 23. doi: 10.1111/tbed.14495. Online ahead of print.

ABSTRACT

Brucellosis is a zoonotic disease of considerable economic and public health significance globally. Despite the limited bacteriological evidence, a large number of serological works revealed that it is prevalent both in livestock and humans in Ethiopia. The current comprehensive review was carried out to provide apparent pooled seroprevalence (APS) estimates at individual animal and herd levels in livestock, and identify factors causing variability between studies conducted over the last two decades, show the spatial distribution, as well as summarizes Brucella species reported from livestock. It also provides APS of brucellosis in humans and evaluates the public health awareness of zoonotic brucellosis. In this review, systematic and synthetic review approaches were followed to summarize the available information. For the systematic review and meta-analysis, articles were selected based on predefined criteria. Data extracted from these articles were analyzed using meta-analytical approaches to provide APS estimates and in-between study variations for humans and all livestock species considered. Sensitivity analyses and bias assessments were conducted using influence plot analysis and, Egger’s and Begg’s statistics along with funnel plots, respectively. Synthetic review approaches were used to summarize data on isolates and public health awareness. Pooled seroprevalence estimate of brucellosis at national level was 2.6% (95% CI, 2.2-3.0) in cattle, 4% (95% CI, 3.1-5.1) in goats, 3% (95% CI, 2.3-3.9) in sheep and 3% (95% CI, 2.4-3.7) in camels. At a herd level, 16.3% (95% CI, 12.9, 20.5) of cattle, 12.1% (7.1, 19.9) of goat, 13.3% (7.6, 22.1) of sheep and 19.7% (13.8, 27.4) of camel herds in the country had at least one seropositive animal. Cattle in the pastoral/agropastoral production systems had significantly higher (p < 0.05) APS compared to mixed crop-livestock and urban/peri-urban dairy production systems. Pooled seroprevalence of brucellosis in small ruminants (8.3%, 95% CI, 6.3, 10.8) and camels (4.4%, 95% CI, 3.5, 5.6) in Afar were significantly higher (p<0.05) than in other regions. Reports conducted using ELISA and serial Rose Bengal plate test (RBPT)-ELISA had higher (p<0.05) APS estimates than serial RBPT and complement fixation test. Brucella melitensis and B. abortus were reported from goats and cattle, respectively, from three available reports. The APS of brucellosis in humans was 5% (95% CI: 3.3, 7.3). Public awareness of brucellosis was low (18.4%), while, practices that expose humans to Brucella infection were high. Scenario-based control interventions on regions and production systems using one health approach are suggested. This article is protected by copyright. All rights reserved.

PMID:35196417 | DOI:10.1111/tbed.14495

Aust J Rural Health. 2022 Feb 23. doi: 10.1111/ajr.12850. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate whether practice rurality and rural training pathway are associated with general practitioner registrars’ participation in their practice’s after-hours care roster.

DESIGN: A cross-sectional analysis of data (2017-2019) from the Registrar Clinical Encounters in Training study, an ongoing inception cohort study of Australian general practitioner registrars. The principal analyses used logistic regression.

SETTING: Three national general practitioner regional training organisations across 3 Australian states.

PARTICIPANTS: General practitioner registrars in training within regional training organisations.

MAIN OUTCOME MEASURE: Involvement in practice after-hours care was indicated by a dichotomous response on a 6-monthly Registrar Clinical Encounters in Training study questionnaire item.

RESULTS: 1576 registrars provided 3158 observations (response rate 90.3%). Of these, 1574 (48.6% [95% confidence interval: 46.8-50.3]) involved registrars contributing to their practice’s after-hours roster. In major cities, 40% of registrar terms involved contribution to their practice’s after-hours roster; in regional and remote practices, 62% contributed to the after-hours roster. On multivariable analysis, both level of rurality of practice (odds ratio(OR) 1.75, P = .007; and OR 1.74, P = .026 for inner regional and outer regional/remote locations, respectively, versus major city) and rural training pathway of registrar (OR 1.65, P = .008) were significantly associated with more after-hours roster contribution. Other associations were registrars’ later training stage, larger practices and practices not routinely bulk billing. Significant regional variability in after-hours care was identified (after adjusting for rurality).

CONCLUSION: These findings suggest that registrars working rurally and those training on the rural pathway are more often participating in practice after-hours rosters. This has workforce implications, and implications for the educational richness of registrars’ training environment.

PMID:35196416 | DOI:10.1111/ajr.12850

Epilepsia. 2022 Feb 23. doi: 10.1111/epi.17187. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the pharmacokinetics, safety, and tolerability of brivaracetam (BRV) as 15-min intravenous (IV) infusion and bolus (≤2-min injection).

METHODS: EP0065 (ClinicalTrials.gov: NCT03405714) was a Phase 2, multicenter, open-label trial in patients ≥1 month to <16 years of age with epilepsy. Patients received up to 5 mg/kg/day BRV (not exceeding 200 mg/day). Enrollment was sequential by descending age, depending on safety review. Outcomes included BRV plasma concentrations before and after IV administration, treatment-emergent adverse events (TEAEs), and discontinuations due to TEAEs.

RESULTS: Fifty patients were enrolled, received BRV, and completed the trial. Twenty-six patients (52.0%) received 15-min infusions and 24 (48.0%) received bolus injections. Most patients (80.0%) received one IV dose. In the 15-min infusion group, geometric mean (GeoMean) BRV concentrations 15 (±2) min (n = 21) and 3 h (±15 min) (n = 21) post dose were 1903.0 ng/mL (geometric coefficient of variation [GeoCV]: 60.7%) and 1130.3 ng/mL (58.8%), respectively. In the bolus group, GeoMean BRV concentrations 15 (±2) min (n = 19) and 3 h (±15 min) (n = 21) post dose were 1704.8 ng/mL (GeoCV: 74.5%) and 1383.9 ng/mL (85.0%), respectively. Overall, 14 patients (28.0%) had TEAEs (15-min infusion: 8 [30.8%]; bolus: 6 [25.0%]), most commonly (≥5% of patients) somnolence (3 [6.0%]). Ten patients (20.0%) had drug-related TEAEs (15-min infusion: 6 [23.1%]; bolus: 4 [16.7%]). No patients discontinued due to TEAEs, and no deaths occurred.

SIGNIFICANCE: IV BRV (up to 200 mg/day) was well tolerated in patients ≥1 month to <16 years of age, regardless of whether BRV was administered as 15-min infusion or bolus. No unexpected safety or pharmacokinetic differences were observed between patients receiving 15-min infusions or bolus, and plasma concentrations were in the expected range. Safety results were consistent with the known safety profile of oral BRV, with no new safety concerns identified.

PMID:35196395 | DOI:10.1111/epi.17187

J Am Med Inform Assoc. 2022 Feb 21:ocac025. doi: 10.1093/jamia/ocac025. Online ahead of print.

ABSTRACT

In response to the coronavirus disease-19 (COVID-19) pandemic, numerous institutions published COVID-19 dashboards for reporting epidemiological statistics at the county, state, or national level. However, statistics for smaller cities were often not reported, requiring these areas to develop their own data processing pipelines. For under-resourced departments of health, the development of these pipelines was challenging, leading them to rely on nonspecific and often delayed infection statistics during the pandemic. To avoid this issue, the Stamford, Connecticut Department of Health (SDH) contracted with the Columbia Mailman School of Public Health to develop an online dashboard that displays real-time case, death, test, vaccination, hospitalization, and forecast data for their city, allowing SDH to monitor trends for specific demographic and geographic groups. Insights from the dashboard allowed SDH to initiate timely and targeted testing/vaccination campaigns. The dashboard is widely used and highlights the benefit of public-academic partnerships in public health, especially during the COVID-19 pandemic.

PMID:35196368 | DOI:10.1093/jamia/ocac025

PLoS One. 2022 Feb 23;17(2):e0264389. doi: 10.1371/journal.pone.0264389. eCollection 2022.

ABSTRACT

In 2019, a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is transmitted via the airborne route, caused a new pandemic namely, “coronavirus disease 2019” (COVID-19). Although the effectiveness of face masks to prevent the transmission of SARS-CoV-2 is debated, no study has evaluated the virus-blocking efficacy of masks used by patients. We aimed to evaluate this efficacy of masks used by SARS-CoV-2-infected individuals. Data, masks used, and nasopharyngeal swab samples were obtained from these patients. Forty-five paired samples of nasopharyngeal swabs and masks were obtained and processed; the majority of masks were woven. Viral RNAs were amplified using quantitative reverse-transcription polymerase chain reaction and detected only on the inner parts of masks. Median viral load (VL) values of swabs and masks were 1.954×106 and 2,51×103, respectively. Statistically, there was a difference of approximately 1000 RNA copies/mL between swabs and masks and no significant difference in VL values among different types of masks. There were statistically significant differences in VL values between men and women and between symptomatic and asymptomatic patients. Our findings suggest the blocking of virus transmission by different types of masks and reinforce the use of masks by both infected and non-infected individuals.

PMID:35196363 | DOI:10.1371/journal.pone.0264389

PLoS One. 2022 Feb 23;17(2):e0263791. doi: 10.1371/journal.pone.0263791. eCollection 2022.

ABSTRACT

OBJECTIVES: This study examined the association between dog and cat ownership, the onset of disability and all-cause mortality in an older population. Dog and cat owners take more regular exercise and have closer social relationships than non-owners. We further assess the beneficial effects of these moderating variables on the onset of disability and mortality.

METHODS: Dog and cat ownership data were collected from 11233 community-dwelling adults age 65 years and older. These data were matched with data about the onset of disability held by the Japanese long-term care insurance system. Local registry data were used to ascertain all-cause mortality.

RESULTS: During the approximately 3.5 year follow-up period, 17.1% of the sample suffered onset of disability, and 5.2% died. Logistic regression analysis indicated that, compared with a reference group of those who had never owned a dog (odds ratio fixed at 1.0), older adults who were currently dog owners had a significantly lower odds ratio of onset of disability (OR = 0.54 95% CI: 0.37-0.79). Our results further show that regular exercise interacts with dog ownership to reduce the risk of disability. The association of dog and/or cat ownership with all-cause mortality was not statistically significant.

CONCLUSIONS: Dog ownership appears to protect against incident disability among older Japanese adults. Additional benefits are gained from ownership combined with regular exercise. Daily dog care may have an important role to play in health promotion and successful aging.

PMID:35196354 | DOI:10.1371/journal.pone.0263791

PLoS One. 2022 Feb 23;17(2):e0264114. doi: 10.1371/journal.pone.0264114. eCollection 2022.

ABSTRACT

BACKGROUND: Balance impairment in Parkinson’s disease is multifactorial and its changes due to subthalamic stimulation vary in different studies.

OBJECTIVE: We aimed to analyze the combination of predictive clinical factors of balance impairment in patients with Parkinson’s disease treated with bilateral subthalamic stimulation for at least one year.

METHODS: We recruited 24 patients with Parkinson’s disease treated with bilateral subthalamic stimulation and 24 healthy controls. They wore an Opal monitor (APDM Inc.) consisting of three-dimensional gyroscopes and accelerometers in the lumbar region. We investigated four stimulation conditions (bilateral stimulation OFF, bilateral stimulation ON, and unilateral right- and left-sided stimulation ON) with four tests: stance on a plain ground with eyes open and closed, stance on a foam platform with eyes open and closed. Age, disease duration, the time elapsed after implantation, levodopa, and stimulation responsiveness were analyzed. The distance of stimulation location from the subthalamic motor center was calculated individually in each plane of the three dimensions. We analyzed the sway values in the four stimulation conditions in the patient group and compared them with the control values. We explored factor combinations (with age as confounder) in the patient group predictive for imbalance with cluster analysis and a machine-learning-based multiple regression method.

RESULTS: Sway combined from the four tasks did not differ in the patients and controls on a group level. The combination of the disease duration, the preoperative levodopa responsiveness, and the stimulation responsiveness predicted individual stimulation-induced static imbalance. The more affected patients had more severe motor symptoms; primarily, the proprioceptive followed by visual sensory feedback loss provoked imbalance in them when switching on the stimulation.

CONCLUSIONS: The duration of the disease, the severity of motor symptoms, the levodopa responsiveness, and additional sensory deficits should be carefully considered during preoperative evaluation to predict subthalamic stimulation-induced imbalance in Parkinson’s disease.

PMID:35196348 | DOI:10.1371/journal.pone.0264114

PLoS One. 2022 Feb 23;17(2):e0264332. doi: 10.1371/journal.pone.0264332. eCollection 2022.

ABSTRACT

BACKGROUND: Polypharmacy, defined as the concurrent use of ≥5 medications, increases the risk of drug-drug and drug-disease interactions as well as non-adherence to drug therapy. This may have negative health consequences particularly among older adults due to age-related pharmacokinetic and pharmacodynamic changes. This study aims to uncover the occurrence of polypharmacy among older adults in Denmark and investigate how polypharmacy relates to mortality.

METHOD: This nationwide register-based study included 1,338,058 adults aged 65+ years between January 2013 and December 2017 in Denmark. Polypharmacy prevalence was measured at time of inclusion while incidence and the association between polypharmacy and mortality were measured over the five-year follow-up using Cox regression. In an attempt to adjust for confounding by indication, propensity scores with overlap weighting were introduced to the regression model.

RESULTS: At time of inclusion, polypharmacy prevalence was 29% and over the five years follow-up, 47% of the remaining adults transitioned into polypharmacy. Identified risk factors included multimorbidity (2+ morbidities: HR = 3.51; 95% CI = 3.48-3.53), age (95+ years: HR = 2.85; 95% CI = 2.74-2.96), socioeconomic factors (Highest income quartile: HR = 0.81; 95% CI = 0.80-0.81), region of birth region (Non-western migrants: HR = 0.77; 95% CI = 0.75-0.79), marital status (Divorced: HR = 1.10; 95% CI = 1.10-1.12) and year of inclusion (2017: HR = 1.19; 95% CI = 1.19-1.22). Further analyses showed that polypharmacy involves many different drug cocktails with medication for the cardiovascular system (95%), blood and blood-forming organs (69%), alimentary tract and metabolism (61%) and nervous system (54%) contributing the most. After adjustment for propensity scores with OW, both polypharmacy (HR = 3.48, CI95% = 3.41-3.54) and excessive polypharmacy (HR = 3.48, CI95% = 3.43-3.53) increased the risk of death substantially.

CONCLUSION: A considerable proportion of older adults in Denmark were exposed to polypharmacy dependent on health status, socio-economic status, and societal factors. The associated three- to four-fold mortality risk indicate a need for further exploration of the appropriateness of polypharmacy among older adults.

PMID:35196345 | DOI:10.1371/journal.pone.0264332

PLoS One. 2022 Feb 23;17(2):e0263935. doi: 10.1371/journal.pone.0263935. eCollection 2022.

ABSTRACT

OBJECTIVE: To examine the effectiveness and safety of non-pharmacological interventions to reduce bone loss among post-stroke adult patients.

DATA SOURCES: Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database for Systematic Reviews, MEDLINE, CINAHL, ScienceDirect, Scopus, PubMed and PeDRO databases were searched from inception up to 31st August 2021.

METHODS: A systematic review of randomized controlled trials, experimental studies without randomization and prospective cohort studies with concurrent control of non-pharmacological interventions for adult stroke patients compared with placebo or other stroke care. The review outcomes were bone loss, fall and fracture. The Cochrane Risk of Bias Tools were used to assess methodological quality, and Grading of Recommendations, Assessment, Development and Evaluations Framework to assess outcome quality. Synthesis Without Meta-Analysis (SWiM) was used for result synthesis.

RESULTS: Seven studies (n = 453) were included. The methodological and outcome qualities varied from low to moderate. There were statistically significant changes between the intervention and parallel/placebo group in bone mineral density, bone mineral content, cortical thickness and bone turnover markers with specific physical and vibration therapies (p<0.05). Falls were higher in the intervention group, but no fracture was reported.

CONCLUSION: There was low to moderate evidence that physical and vibration therapies significantly reduced bone loss in post-stroke patients at the expense of a higher falls rate. The sample size was small, and the interventions were highly heterogeneous with different duration, intensities and frequencies. Despite osteoporosis occurring with ageing and accelerated by stroke, there were no studies on vitamin D or protein supplementation to curb the ongoing loss. Effective, high-quality non-pharmacological intervention to improve post-stroke bone health is required.

PMID:35196338 | DOI:10.1371/journal.pone.0263935