Nevin Manimala

PLoS One. 2021 May 25;16(5):e0252057. doi: 10.1371/journal.pone.0252057. eCollection 2021.

ABSTRACT

BACKGROUND: There is no effective therapy for the severe acute respiratory syndrome by coronavirus 2 (SARS-CoV2) responsible for the Coronavirus disease 2019 (Covid-19). To date, dexamethasone has shown a decrease in mortality in patients who require oxygen, especially those with invasive mechanical ventilation. However, it is unknown if another corticosteroid can be used, the optimal dose and its duration, to achieve a better clinical outcome. The objective of the study was to compare the differences in clinical outcome and laboratory results in hospitalized patients with severe SARS-CoV2 Pneumonia treated with dexamethasone at 6 mg doses versus patients treated with high-dose methylprednisolone.

MATERIALS AND METHODS: Ambispective cohort study with survival analysis of 216 patients diagnosed with severe Covid-19 pneumonia confirmed by polymerase chain reaction for SARS-CoV2 by Berlin protocol, who were hospitalized in a high-complexity clinic in Medellín, Colombia. The patients should also have supplementary oxygen and radiological confirmation of Pneumonia by chest tomography. Sample size was not calculated since the total population that met the inclusion criteria was evaluated. 111 patients were treated with the institutional protocol with intravenous dexamethasone 6 mg QD for seven to 10 days if they required oxygen. Since September 15, 2020, the hospitalization protocol of the clinic was modified by the Infectious Diseases and Pulmonology service, recommending a high dose of methylprednisolone of 250 to 500 mg every day for three days with a subsequent change to oral prednisone 50 mg every day for 14 days. The protocol was not applied in the intensive care unit, where dexamethasone continued to be administered. The clinical outcome and differences in laboratory results of the patients who received dexamethasone vs. the prospective cohort that received methylprednisolone from September 15 to October 31, 2020, were evaluated. Follow-up was carried out by outpatient consultation one month after discharge or by telephone, inquiring about readmission or living-dead status.

RESULTS: 216 patients had Covid-19 pneumonia documented by ground-glass imaging and alveolar pressure / inspired oxygen fraction (PaFi) less than 300. 111 patients received dexamethasone (DXM) and 105 received methylprednisolone (MTP). Patients in the DXM group evolved to severe ARDS in a higher proportion (26.1% vs 17.1% than the MTP group). Upon completion 4 days of treatment with parenteral corticosteroid, laboratory markers of severity decreased significantly in the group that received MTP, CRP 2.85 (2.3-3.8) vs 7.2 (5.4-9.8), (p-value < 0.0001), D-dimer 691 (612-847) vs 1083 (740-1565) (p-value = 0.04) and DHL 273 (244-289) vs 355 (270.6-422) (p-value = 0.01). After starting the corticosteroid, transfer to the intensive care unit (4.8% vs. 14.4%) and mortality (9,5% vs. 17.1%) was lower in the group that received MTP. Recovery time was shorter in patients treated with MTP, three days (3-4) vs. DXM 6 days (5-8) (p-value < 0.0001). At 30-day follow-up, 88 (92.6%) were alive in MTP vs 58 (63.1%) of those who received dexamethasone.

CONCLUSIONS: In this study, the treatment of severe Covid-19 Pneumonia with high-dose methylprednisolone for three days followed by oral prednisone for 14 days, compared with 6 mg dexamethasone for 7 to 10 days, statistically significantly decreased the recovery time, the need for transfer to intensive care and the severity markers C-reactive protein (CRP), D-dimer and LDH. Randomized controlled studies with methylprednisolone are required to corroborate its effect, and studies in a population hospitalized in intensive care wards.

PMID:34033648 | DOI:10.1371/journal.pone.0252057

Med Sci Sports Exerc. 2021 May 24. doi: 10.1249/MSS.0000000000002699. Online ahead of print.

ABSTRACT

INTRODUCTION: Physical activity has beneficial effects on both cardiovascular and neurocognitive parameters, and these 2 modalities are known to interact at rest. However, findings on their interaction during exercise are inconclusive.

PURPOSE: Therefore, this longitudinal study aimed to investigate the effects of different forms of exercise (training period, marathon race, recovery period) on both parameters and their interaction.

METHODS: We included 100 marathon runners (MA) (mean [SD] age: 43.6 [10.0] years, 80 male) and 46 age- and sex-matched sedentary controls (SC, for baseline comparison). Over the 6-month study period with 6 visits (12 and 2 weeks before the marathon; immediately, 24 hours, 72 hours and 12 weeks after the marathon), we assessed cognitive parameters by evaluating 1-to 3-back d prime, the d2 task, and the Trail Making Test A (TMTA) and B (TMTB); retinal vessel parameters by assessing arteriolar-to-venular ratio (AVR), central retinal arteriolar and venular equivalents (CRAE/CRVE).

RESULTS: In the long-term analysis, 3-back d prime correlated positively with AVR (P = 0.024, B = 1.86,SE = 0.824) and negatively with CRVE (P = 0.05,B = -0.006,SE = 0.003) and TMTB correlated negatively with CRAE (P = 0.025,B = -0.155,SE = 0.069), even after correcting for age and systolic blood pressure as possible confounders. Acute effects were inconsistent with maximal cognitive improvement 24 hours after the marathon. AVR was significantly smaller in SC compared to MA.

CONCLUSION: Chronic exercise seems to prime the central nervous system for acute, intensive bouts of exercise. Our findings indicate a possible relationship between cognitive performance in high-demand tasks and retinal vasculature and support the idea of a neuroplastic effect of exercise.

PMID:34033620 | DOI:10.1249/MSS.0000000000002699

Menopause. 2021 May 24. doi: 10.1097/GME.0000000000001804. Online ahead of print.

ABSTRACT

OBJECTIVE: The incidence of carpal tunnel syndrome (CTS) is higher in women, and peaks around the age of menopause. Therefore, we investigated whether bilateral oophorectomy is associated with an increased risk of severe CTS.

METHODS: We included all of the 1,653 premenopausal women who underwent bilateral oophorectomy for a nonmalignant indication between 1988 and 2007, and a random sample of 1,653 age-matched referent women who did not undergo bilateral oophorectomy in Olmsted County, MN. Diagnoses of CTS assigned to women over their entire lifetime were identified in these two cohorts. The risk of de novo severe CTS after bilateral oophorectomy (or index date) was evaluated using Cox proportional hazards models adjusted for potential confounders.

RESULTS: Bilateral oophorectomy was associated with an increased risk of severe CTS (adjusted hazard ratio 1.65, 95% confidence interval 1.20-2.25). The risk was suggestively greater in women with lower body mass index, nulliparity, and with a benign ovarian indication for oophorectomy (nonsignificant interactions). We did not observe a protective effect of estrogen therapy after the oophorectomy. The findings were similar in secondary analyses considering the incidence of CTS of any severity or idiopathic CTS.

CONCLUSIONS: The risk of severe CTS, common in perimenopausal women, is increased after bilateral oophorectomy. The association may be causal or due to confounding. Therefore, the precise biological mechanisms explaining the association and the absence of a mitigating effect of estrogen therapy should be further investigated.

PMID:34033605 | DOI:10.1097/GME.0000000000001804

AIDS. 2021 May 24. doi: 10.1097/QAD.0000000000002955. Online ahead of print.

ABSTRACT

OBJECTIVE: Peripheral neuropathies in HIV-infected patients are highly debilitating because of neuropathic pain and physical disabilities. We defined prevalence and associated predictive variables for peripheral neuropathy subtypes in a cohort of persons living with HIV (PWH).

DESIGN: Adult PWH in clinical care were recruited to a longitudinal study examining neurological complications.

METHODS: Each subject was assessed for symptoms and signs of peripheral neuropathy and demographic, laboratory and clinical variables. Univariate, multiple logistic regression and machine learning analyses were performed by comparing patients with and without peripheral neuropathy.

RESULTS: Three patient groups were identified: those with peripheral neuropathies (PNP, n = 111) that included HIV-associated distal sensory polyneuropathy (DSP, n = 90) or mononeuropathy (MNP, n = 21), and those without neuropathy (NNP, n = 408). Univariate analyses showed multiple variables differed significantly between the NNP and PNP groups including age, estimated HIV-1 duration, education, employment, neuropathic pain, peak viral load, polypharmacy, diabetes, cardiovascular disorders, AIDS, and prior neurotoxic nucleoside antiretroviral drug exposure. Classification algorithms distinguished those with PNP, all with area under the receiver operating characteristic curve (AUROC) values of >0.80. Random forest models showed greater accuracy and AUROC values compared with the multiple logistic regression analysis. Relative importance plots showed that the foremost predictive variables of PNP were HIV-1 duration, peak plasma viral load, age, and low CD4 T-cell levels.

CONCLUSIONS: PNP in HIV-1 infection remains common affecting 21.4% of patients in care. Machine learning models uncovered variables related to PNP that were undetected by conventional analyses, emphasizing the importance of statistical algorithmic approaches to understanding complex neurological syndromes.

PMID:34033588 | DOI:10.1097/QAD.0000000000002955

J Med Internet Res. 2021 Apr 16. doi: 10.2196/27132. Online ahead of print.

ABSTRACT

BACKGROUND: Perinatal mental health symptoms commonly remain underdiagnosed and undertreated in maternity care settings in the UK, with outbreaks of disease, like the coronavirus (COVID-19) pandemic, further disrupting access to adequate mental health support. Digital technologies may offer an innovative way to support the mental health needs of women and their families throughout the perinatal period, as well as assist midwives in the recognition of perinatal mental health concerns. However, little is known about the acceptability and perceived benefits and barriers to using such technologies.

OBJECTIVE: To conduct a mixed methods evaluation of the current state of perinatal mental healthcare provision in the UK, as well as users’ (women and partners) and midwives’ interest in using a digital mental health assessment throughout the perinatal period.

METHODS: Eight hundred and twenty-nine women, 103 partners, and 90 midwives participated in the study, which entailed completing an online survey. Quantitative data were explored using descriptive statistics. Open-ended response data were first investigated using thematic analysis. Resultant themes were then mapped onto the components of the Capability, Opportunity, and Motivation Model of Behavior (COM-B model) and summarized using descriptive statistics.

RESULTS: The provision of adequate perinatal mental healthcare support was limited, with experiences varying significantly across respondents. There was a strong interest in using a digital mental health assessment to screen, diagnose, and triage perinatal mental health concerns, particularly among women and midwives. The digital assessment was seen to be well placed within maternity healthcare settings, with in-person only and blended care (i.e., in-person and remote support) approaches being preferred by women and partners in the event of further care being advised. Identified benefits and barriers mainly related to physical opportunity (e.g., accessibility), psychological capability (e.g., cognitive skills) and automatic motivation (e.g., emotions).

CONCLUSIONS: This study provides proof-of-concept support for the development and implementation of a digital mental health assessment to inform clinical decision-making in the assessment of perinatal mental health concerns in the UK.

PMID:34033582 | DOI:10.2196/27132

IEEE Trans Cybern. 2021 May 25;PP. doi: 10.1109/TCYB.2021.3070677. Online ahead of print.

ABSTRACT

Recently, the correlation filter (CF) and Siamese network have become the two most popular frameworks in object tracking. Existing CF trackers, however, are limited by feature learning and context usage, making them sensitive to boundary effects. In contrast, Siamese trackers can easily suffer from the interference of semantic distractors. To address the above problems, we propose an end-to-end target-insight correlation network (TICNet) for object tracking, which aims at breaking the above limitations on top of a unified network. TICNet is an asymmetric dual-branch network involving a target-background awareness model (TBAM), a spatial-channel attention network (SCAN), and a distractor-aware filter (DAF) for end-to-end learning. Specifically, TBAM aims to distinguish a target from the background in the pixel level, yielding a target likelihood map based on color statistics to mine distractors for DAF learning. SCAN consists of a basic convolutional network, a channel-attention network, and a spatial-attention network, aiming to generate attentive weights to enhance the representation learning of the tracker. Especially, we formulate a differentiable DAF and employ it as a learnable layer in the network, thus helping suppress distracting regions in the background. During testing, DAF, together with TBAM, yields a response map for the final target estimation. Extensive experiments on seven benchmarks demonstrate that TICNet outperforms the state-of-the-art methods while running at real-time speed.

PMID:34033563 | DOI:10.1109/TCYB.2021.3070677

IEEE Trans Biomed Eng. 2021 May 25;PP. doi: 10.1109/TBME.2021.3083580. Online ahead of print.

ABSTRACT

Despite there being studies that have investigated the effects of human augmentation using a knee exoskeleton, comparing different assistance schemes on a single knee exoskeleton has not been studied. Using a light-weight, low-profile bilateral knee exoskeleton system, this study examined and compared the biomechanical effects of three common assistance strategies (biological torque, impedance, and proportional myoelectric controllers) exhibiting different levels of flexibility for the user to control the assistance. Nine subjects walked on a 15% gradient incline surface at 1.1 m/s in the three powered conditions and with the exoskeleton unpowered. All the assistance strategies significantly reduced the metabolic cost of the users compared to the unpowered condition by 3.0% on average across strategies (p < 0.05), led by the significant reduction in the biological knee kinetic effort and knee extensor muscle activation (p < 0.05). Between assistance strategies, the metabolic cost and biomechanics displayed no statistically significant differences. The metabolic and biomechanical results indicate that powered extension assistance during early stance can improve performance compared to the unpowered condition. However, the users ability to control the assistance may not be significant for human augmentation when walking on an inclined surface with a knee exoskeleton.

PMID:34033531 | DOI:10.1109/TBME.2021.3083580

J Urol. 2021 May 25:101097JU0000000000001895. doi: 10.1097/JU.0000000000001895. Online ahead of print.

ABSTRACT

INTRODUCTION: Prediction of potency recovery following RARP is useful for better patient counselling and post-operative treatment strategies. In this study we propose a pre-operative and post-operative nomogram to predict post-operative potency recovery following RARP.

MATERIALS AND METHODS: Patients from development set (n=6502) were selected to develop the nomograms, and patients in validation set (n=2706) were used for validation. Cox regression models were fitted on the development cohort to predict potency recovery after RARP using as prognostic factors the covariates selected. Two nomograms were drawn using the regression coefficients of the pre- and post-operative Cox models.

RESULTS: The discrimination ability of the pre-operative model was evaluated on the development cohort using the ROC curves estimated at 3, 6, 12, and 24 months. The AUC at these time points was 0.726, 0.734, 0.754, and 0.778, respectively. The AUCs of the post-operative model at 3, 6, 12, and 24 months were 0.746, 0.756 and 0.777, and 0.801, respectively. Pre- and post-operative predictive models were validated using a separate set of 2706 patients. The AUCs of the pre-operative model at 3, 6, 12, and 24 months were 0.789, 0.772, 0.768, and 0.778, respectively. The ROC curves of the post-operative model at 3, 6, 12, and 24 months with AUCs of 0.807, 0.797, 0.793, and 0.798, respectively. Along with age and pre-operative sexual function, NS technique determines the potency outcomes justifying better AUC for post-operative model vs the pre-operative model.

CONCLUSION: The above nomograms help us to predict with good accuracy the probability of potency recovery within 3, 6,12- and 24-months following surgery taking into consideration pre-operative and post-operative factors. This is a novel tool for the care giver to predict realistic expectation of potency outcomes to the patients, while preoperative and immediate post-operative counselling.

PMID:34033495 | DOI:10.1097/JU.0000000000001895

Arch Endocrinol Metab. 2021 May 18;64(5):575-583. doi: 10.20945/2359-3997000000223.

ABSTRACT

OBJECTIVE: This study aimed to establish the utility values of different health states associated with diabetic retinopathy in a Brazilian sample to provide input to model-based economic evaluations.

METHODS: This cross-sectional study was performed in a sample of patients with type 2 diabetes mellitus (T2D) who underwent teleophthalmology screening at a primary care service from 2014 to 2016. Five diabetic retinopathy health states were defined: absent, non-sight-threatening, sight-threatening, and bilateral blindness. Utility values were estimated using the Brazilian EuroQol five dimensions (EQ-5D) tariffs. Descriptive statistics were calculated. Analysis of covariance was performed to adjust the utility values for potential confounders.

RESULTS: The study included 206 patients. The mean (± standard deviation [SD]) utility value was 0.765 ± 0.19 (95% confidence interval [CI], 0.740-0.790). The adjusted mean utility value was 0.748 (95% CI, 0.698-0.798) in patients without diabetic retinopathy, 0.752 (95% CI, 0.679-0.825) in those with non-sight-threatening state, 0.628 (95% CI, 0.521-0.736) in those with sight-threatening state, and 0.355 (95% CI, 0.105-0.606) in those with bilateral blindness. A significant utility decrement was found between patients without diabetic retinopathy and those with a sight-threatening health state (0.748 vs. 0.628, respectively, p = 0.04).

CONCLUSION: The findings suggest that a later diabetic retinopathy health state is associated with a decrement in utility value compared with the absence of retinopathy in patients with T2D. The results may be useful as preliminary input to model-based economic evaluations. Further research is needed to investigate the impact of diabetic retinopathy on health-related quality of life in a sample more representative of the Brazilian population.

PMID:34033298 | DOI:10.20945/2359-3997000000223

Arch Endocrinol Metab. 2021 May 18;64(5):567-574. doi: 10.20945/2359-3997000000237.

ABSTRACT

OBJECTIVE: Prematurity and low birth weight predispose preterm infants to cardiovascular disease in later life. Is the metabolic profile of these children impacted by the relation between birth weight and gestational age (GA)? This study aimed to evaluate whether the relationship between birth weight and GA of preterm infants has a positive correlation with the metabolic profile from birth to the sixth month of corrected age.

METHODS: This is a longitudinal, prospective study with a cohort of 70 preterm and 54 term infants, who were enrolled in the study and shared into two groups: Appropriate for GA (AGA) and Small for GA (SGA), both classified at birth by Fenton and Kim curves. Longitudinal evaluation of anthropometry measures and blood samples of total cholesterol, glucose, triglycerides, and insulin were collected at birth, NICU discharge, and the sixth month of corrected age. Data were analyzed using descriptive and inferential statistical analysis (ANOVA, Fisher test, Shapiro-Wilk, and Cochran test). The effect size was 0.15, power was 0.92, and confidence interval 95%.

RESULTS: No significant statistical differences were observed in relation to biochemical tests between AGA and SGA groups. However, a significant increase in triglyceride results above the reference values for age in the SGA group was observed throughout the follow-up.

CONCLUSION: Changes observed in the preterm infant metabolic profile show no correlation with adequacy of birth weight. Preterm lipid profile requires continuous evaluation at follow-up, due to the increased cardiovascular risk in later life.

PMID:34033297 | DOI:10.20945/2359-3997000000237