Nevin Manimala

Low Urin Tract Symptoms. 2022 Feb 15. doi: 10.1111/luts.12429. Online ahead of print.

ABSTRACT

OBJECTIVES: This study investigated male voiding dysfunction (VD) or lower urinary tract function in rectal cancer (RC) patients after laparoscopic or open total mesorectal excision with pelvic autonomic nerve preservation (PANP).

METHODS: One hundred and eighty-seven male RC patients admitted between January 2016 and May 2019 were enrolled in this study, 112 of whom underwent laparoscopic total mesorectal excision (LTME) and 75 underwent open total mesorectal excision (OTME). The International Prostatic Symptom Score (IPSS) was compared between the two groups.

RESULTS: The postoperative IPSS in patients with RC was elevated on day 7 and gradually decreased during the first month after surgery. Compared with the OTME group, the IPSS scores decreased less in the LTME group at week 1, and months 1 and 3 postoperatively (6.82 ± 2.13 vs 10.15 ± 3.86, 5.70 ± 2.45 vs 7.21 ± 2.0, and 5.01 ± 2.09 vs 5.75 ± 2.55, respectively; P < 0.05). The VD rate was significantly lower in the LTME group than the OTME group at 1, 2, and 3 weeks postoperatively (21.4% vs 26.8%,13.4% vs 25.3%, and 9.8% vs18.6%, respectively; P < 0.05); however, there was no major difference in the incidence of VD 6 months postoperatively between the two groups (P > 0.05). VD was more frequent in the OTME group than the LTME group 6 months postoperatively, but the difference was not statistically significant (odds ratio = 1.857, 95% CI, 0.964-3.645, P = 0.064).

CONCLUSIONS: LTME may be superior to OTME with respect to PANP of lower urinary tract function in males with RC.

PMID:35170222 | DOI:10.1111/luts.12429

Int J Rheum Dis. 2022 Feb 15. doi: 10.1111/1756-185X.14303. Online ahead of print.

ABSTRACT

AIM: To determine the prevalence and risk factors for uveitis in spondyloarthritis (SpA) patients.

METHODS: A total of 225 patients who fulfilled Assessment of Spondyloarthritis International Society classification criteria for axial and peripheral SpA were enrolled. The diagnosis of uveitis was confirmed by an ophthalmologist. From medical records and from clinical evaluation associated information like disease duration, and human leukocyte antigen B27 was collected. Relevant laboratory tests were done and disease severity was assessed using Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score – erythrocyte sedimentation rate and C-reactive protein. Characteristics of uveitis positive and uveitis negative groups were compared. Multivariate logistic regression analysis was done for the risk factors, and P values <.05 were considered significant.

RESULTS: Prevalence of uveitis was 18.7%. The disease duration was 9.3 ± 7 years and 5.4 ± 4.5 years in uveitis and no uveitis groups respectively (P ≤ .001). Family history of SpA was positive in 45.2% in the uveitis group (P ≤ .001). The frequency of axial SpA was 92.9% and 73.8% in the uveitis and no uveitis groups respectively (P ≤ .008). The mean BASDAI was 2.4 ± 1.9 and 3.3 ± 2.8 in uveitis and no uveitis groups respectively (P = .050). In multivariate logistic regression analysis, among the selected variables, family history of SpA (odds ratio [OR] =3.697; 95% CI =1.616-8.457; P = .002) and duration of disease (OR =1.089; 95% CI =1.004-1.181; P = .039) were independently associated with the occurrence of uveitis.

CONCLUSIONS: The prevalence of uveitis was 18.7%. The family history and the disease duration of SpA were independently associated with uveitis.

PMID:35170215 | DOI:10.1111/1756-185X.14303

Environ Microbiol. 2022 Feb 15. doi: 10.1111/1462-2920.15919. Online ahead of print.

ABSTRACT

Botrytis cinerea is a broad-host-range necrotrophic phytopathogen responsible for serious diseases in leading crops. To facilitate infection, B. cinerea secretes a large number of effectors that induce plant cell death. In screening secretome data of B. cinerea during infection stage, we identified a phytotoxic protein (BcSSP2) that can also induce immune resistance in plants. BcSSP2 is a small, cysteine-rich protein without any known domains. Transient expression of BcSSP2 in leaves caused chlorosis that intensifies with time and eventually leads to death. Point mutations in eight of 10 cysteine residues abolished phytotoxicity, but residual toxic activity remained after heating treatment, suggesting contribution of unknown epitopes to protein phytotoxicity. The expression of bcssp2 was low during the first 36 h after inoculation and increased sharply upon transition to late infection stage. Deletion of bcssp2 did not cause statistically significant changes in lesions size on bean and tobacco leaves. Further analyses indicated that the phytotoxicity of BcSSP2 is negatively regulated by the receptor-like kinases BAK1 and SOBIR1. Collectively, our findings show that BcSSP2 is an effector protein that toxifies the host cells, but is also recognized by the plant immune system.

PMID:35170184 | DOI:10.1111/1462-2920.15919

Dermatol Ther. 2022 Feb 16:e15384. doi: 10.1111/dth.15384. Online ahead of print.

ABSTRACT

A role of human papilloma virus (HPV) vaccines as a therapy for genital warts was suggested, nevertheless; it has not been established in clinical trials and has yet to be determined. To evaluate a potential benefit of intralesional injection of bivalent HPV (Cervarix) vaccine as a treatment for anogenital warts versus topical podophyllin resin 25%. Forty four patients with anogenital warts were included in the study, 22 patients received intralesional Cervarix every 2 weeks until clearance of lesions or for a maximum of 5 sessions. The other 22 patients received topical podophyllin resin 25% twice weekly until complete resolution or for a maximum of four weeks. Follow up was done for 6 months. Dermatology life quality index (DLQI) was measured. Complete clearance of warts was achieved in 10 patients (45.5%) in Cervarix group vs 6 patients (27.3%) in Podophyllin group. The difference was statistically insignificant. No recurrence of warts was reported in Cervarix group while 2 patiens (33.3%) showed recurrence in Podophyllin group. Both treatments were well tolerated. All patients reported significant improvement of their DLQI. Intralesional Cervarix is a promising modality showing higher rates of complete response, high safety, and no recurrence. This article is protected by copyright. All rights reserved.

PMID:35170176 | DOI:10.1111/dth.15384

J Magn Reson Imaging. 2022 Feb 16. doi: 10.1002/jmri.28107. Online ahead of print.

ABSTRACT

BACKGROUND: Fast 78-second multicontrast echo-planar MRI (EPIMix) has shown good diagnostic performance for detecting infarctions at a comprehensive stroke center, but its diagnostic performance has not been evaluated in a prospective study at a primary stroke center.

PURPOSE: To prospectively determine whether EPIMix was noninferior in detecting ischemic lesions compared to routine clinical MRI.

STUDY TYPE: Prospective cohort study.

POPULATION: A total of 118 patients with acute MRI and symptoms of ischemic stroke.

FIELD STRENGTH AND SEQUENCE: A 3 T. EPIMix (echo-planar based: T1-FLAIR, T2-weighted, T2-FLAIR, T2*, DWI) and routine clinical MRI sequences (T1-weighted fast spin echo, T2-weighted PROPELLER, T2-weighted-FLAIR fast spin echo, T2* gradient echo echo-planar, and DWI spin echo echo-planar).

ASSESSMENT: Three radiologists, blinded for clinical information, assessed signs of ischemic lesions (DWI↑, ADC↓, and T2/T2-FLAIR↑) on EPIMix and routine clinical MRI, with disagreements solved in consensus with a fourth reader to establish the reference standard.

STATISTICAL TESTS: Diagnostic performance including sensitivity and specificity against the reference standard was evaluated. EPIMix sensitivity was tested for noninferiority compared to the reference standard using Nam’s restricted maximum likelihood estimation (RMLE) Score. A P-value < 0.05 was considered statistically significant.

RESULTS: Of 118 patients (mean age 62 ± 16 years, 58% males), 25% (n = 30) had MRI signs of acute infarcts. EPIMix was noninferior with 97% (95% CI 83-100) sensitivity for reader 1, 100% (95% CI 88-100) sensitivity for reader 2, and 90% (95% CI 88-98) sensitivity for reader 3 vs. 93% (95% CI 78-99) sensitivity for readers 1 and 2 and 90% (95% CI 74-98) for reader 3 on routine clinical MRI. Specificity was 99% (95% CI 94-100) for reader 1, 100% (95% CI 96-100) for reader 2, and 98% (95% CI 92-100) for reader 3 on EPIMix vs. 100% (95% CI 96-100) for all readers on routine clinical MRI.

CONCLUSION: EPIMix was noninferior to routine clinical MRI for the diagnosis of acute ischemic stroke.

EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 2.

PMID:35170134 | DOI:10.1002/jmri.28107

J Paediatr Child Health. 2022 Feb 16. doi: 10.1111/jpc.15907. Online ahead of print.

ABSTRACT

AIM: The transition from paediatric to adult care for patients with inflammatory bowel disease (IBD) is associated with an increased risk of treatment non-adherence, hospitalizations and emergency department (ED) use. We established a new young adult IBD clinic (YAC) in Melbourne to capture this at-risk population. We aimed to assess patient satisfaction as well as clinical outcomes.

METHODS: All patients who attended the YAC between its inception in November 2016 and November 2018 were recruited to our YAC group, 61 patients in total. A control group was selected from the pre-existing adult clinic (AC) at our service, 34 patients in total. IBD-related ED (IBD-ED) visits were collected for all patients. We compared IBD-ED visits in the 2 years before and after attending the clinic for the first time. Patient satisfaction was assessed using the IBD-Patient Satisfaction Questionnaire.

RESULTS: There was an overall decrease in IBD-ED visits between the pre-clinic and post-clinic periods in both the YAC (42.9% reduction) and AC (69.2% reduction) (P < 0.001). Patient satisfaction was high amongst both services with YAC patients indicating higher satisfaction with communication (P = 0.015).

CONCLUSION: There was a reduction in IBD-ED visits in both the YAC and the AC, high patient satisfaction, and statistically higher satisfaction with communication in the YAC. We speculate the importance of a YAC is to capture those patients in the peri-transitional period at risk of being lost to follow-up or not previously referred for specialist care.

PMID:35170119 | DOI:10.1111/jpc.15907

Crim Behav Ment Health. 2022 Feb 15. doi: 10.1002/cbm.2230. Online ahead of print.

ABSTRACT

BACKGROUND: As incarcerated populations report significantly higher prevalence rates for psychological distress than community populations, it is important to have an evidence-based perspective on what reduces psychological distress among people in prison or jail.

AIMS: To examine effects of mindfulness-based interventions (MBIs) on psychological distress, including anxiety, depressive symptoms, stress and overall psychological distress, and on mindfulness in incarcerated populations.

METHODS: This systematic review and meta-analysis of randomised controlled trials (RCTs) involved a comprehensive search within the PubMed, CINAHL, PsycINFO, and SCOPUS databases to identify relevant RCTs. The quality of the included RCTs was assessed using the Cochrane Collaboration risk of bias tool. Depending on I² statistic values for heterogeneity, either a random effects model or fixed effects model was used. Subgroup analyses for each outcome were conducted to see whether effects differed when compared MBIs to active control groups, provided with other comparable interventions, or passive control groups, provided with no intervention (i.e., treatment as usual [TAU] control groups or waiting list controls).

RESULTS: Thirteen RCTs met the eligibility criteria. Meta-analyses showed moderate effects of MBIs on depressive symptoms and overall psychological distress, large effects on stress, and small effects on anxiety and mindfulness. The overall risk of bias across studies was unclear. Fewer studies were conducted to compare effects of MBIs to other interventions than TAU.

CONCLUSIONS: Future high-quality studies comparing MBIs to other active interventions are needed to understand better whether the former are comparable or superior to other evidence-based treatments in decreasing distress and improving mindfulness in incarcerated populations and/or in which circumstances one may be preferable to the other.

PMID:35170107 | DOI:10.1002/cbm.2230

J Adv Nurs. 2022 Feb 15. doi: 10.1111/jan.15182. Online ahead of print.

ABSTRACT

AIM: To gain insight into which elements of the interpersonal care relationship (IPCR) are perceived as occurring (less) frequently and as (not) disturbing from the perspective of hospitalized older patients.

DESIGN: A cross-sectional study in three Belgian hospitals.

METHODS: A convenience sample of patients aged 75 years or older admitted to a non-geriatric ward were recruited between May 2017 and April 2019. The Interpersonal Geriatric care relationship (InteGer) tool was used to identify elements of the IPCR and was completed by the researchers through structured patient interviews.

RESULTS: The mean total scale score for frequency was 3.74 (SD 1.51) [range 0-12]. On subscale level, the highest mean score was in the accessibility and the lowest mean score in the humanization subscale. Statistically significant differences between the hypothesized and experienced disturbance were observed in 18 of the 30 items. Ten items score in the category ‘no action needed’ (not occurring, not disturbing), nine items in the category ‘remain attentive for patient experiences’ (occurring, not disturbing), 10 items in the category ‘further analyses or monitoring needed’ (not occurring, disturbing) and one item in the category ‘urgent action needed’ (occurring and disturbing).

CONCLUSION: Participants report mostly positive experiences related to the four subscales of the InteGer, that is, humanization, attentiveness, interest and accessibility. Insights from this study provide important opportunities in the context of care optimization for each category with the main focus on items with high experienced disturbance.

IMPACT: The InteGer can be used for monitoring IPCR and formulating action points at ward and hospital level to further improve the IPCR and quality of care.

PMID:35170094 | DOI:10.1111/jan.15182

Acta Paediatr. 2022 Feb 16. doi: 10.1111/apa.16292. Online ahead of print.

ABSTRACT

Asthma prevalence in Australian children is amongst the highest in the world. Monoclonal antibody treatments (biologics) are the fifth step in the Global Initiative for Asthma guidelines to treat severe asthma. Our retrospective cohort study aimed to evaluate the effect of biologics for children with severe asthma, assess adherence and explore attitudes toward home administration using prefilled injection devices. We collected data for paediatric patients receiving biologics to compare asthma-related outcomes six-months pre and post initiation of therapy. Participant and parent surveys assessed perceived change in asthma control and attitudes to home injections. Eleven patients were recruited. Six-months post biologic treatment there were significant reductions in mean exhaled nitric oxide (-40ppb, p<0.05) and asthma control questionnaire 5 (ACQ-5) (-1.7, p<0.05). The mean number of hospitalisations and OCS courses were also less, although not statistically significant (p=0.53 and 0.17 respectively). There were no notable changes in mean percent-predicted FEV1, FVC or FEV1/FVC. 80% of patients and carers perceived slightly or much better asthma control on biologics and 80% of carers indicated they would be slightly or much happier with home-based injections. We conclude that biologics can improve asthma control. Whilst health-centre injections adherence is high, carers are interested in home injections.

PMID:35170088 | DOI:10.1111/apa.16292

Int J Geriatr Psychiatry. 2022 Mar;37(3). doi: 10.1002/gps.5695.

ABSTRACT

OBJECTIVE: Delirium is a common postoperative complication of hip fracture. Various methods exist to detect delirium as a reference standard. The goal of this study was to characterize the properties of the measures obtained in a randomized controlled trial, to document their relationship to the Diagnostic and Statistical Manual of Mental Disorders:Text Revision based diagnosis of postoperative delirium by a consensus panel, and to describe the method in detail to allow replication by others.

METHODS: A secondary analysis of the randomized trial STRIDE (A Strategy to Reduce the Incidence of Postoperative Delirium in Elderly Patients) was conducted. Delirium assessments were performed in 200 consecutive hip fracture repair patients ≥65 years old. Assessors underwent extensive training in delirium assessment and the final delirium diagnosis was adjudicated by a consensus panel of three physicians with expertise in delirium assessment.

RESULTS: A total of 680 consensus panel delirium diagnoses were completed. There were only 19 (2.8%, 19/678) evaluations where the delirium adjudication by the consensus panel differed from delirium findings by the Confusion Assessment Method (CAM). In 16 (84%, 16/19) of the cases, CAM was negative but the consensus panel diagnosed the patient as having delirium based on all of the available information including the CAM.

CONCLUSION: The consensus panel diagnosis was more sensitive compared to CAM alone, however the magnitude of the difference was not large. When assessors are well trained and delirium assessments are closely supervised throughout the study, CAM may be adequate for delirium diagnosis in a clinical trial. Future studies are needed to test this hypothesis.

PMID:35170079 | DOI:10.1002/gps.5695