Nevin Manimala

Low Urin Tract Symptoms. 2022 Jan 23. doi: 10.1111/luts.12425. Online ahead of print.

ABSTRACT

OBJECTIVE: We designed this study to investigate the potential use of N-acetylcysteine (NAC) as an adjunct to alpha-blockers in the treatment of category III chronic prostatitis (CP).

METHODS: Sixty-three men with category III CP with a National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) total score of 15 or more were randomized to either the NAC treatment group or the placebo treatment group. Besides tamsulosin at a dose of 0.4 mg once daily, participants based on their allocation group received NAC or placebo at a dose of 600 mg twice daily for 12 weeks. The efficacy of the medications was assessed by measuring changes in the NIH-CPSI total score and its subscales, including pain, urinary symptoms, and quality of life.

RESULTS: Based on the general linear model analysis of the data, over the 12-week treatment, NAC+tamsulosin was statistically superior to placebo+tamsulosin in reducing the total NIH-CPSI score, pain subscore, and quality-of-life subscore (P value <.001). Further, after 12 weeks, more patients in the NAC+tamsulosin group than in the placebo+tamsulosin group met the responder criterion, defined as a decrease of at least 6 points in the NIH-CPSI total score (65.6% vs 29.0%). A more favorable outcome was also noted in the NAC+tamsulosin group regarding the number of patients reporting moderate or marked improvement in symptoms (62.5% vs 25.80%). No significant difference was seen between the groups concerning changes in urinary symptoms.

CONCLUSIONS: Our study provided clinical evidence that men with category III CP might benefit from NAC treatment. Further studies are needed for the validation of these findings.

PMID:35068061 | DOI:10.1111/luts.12425

Int J Nurs Pract. 2022 Jan 23:e13038. doi: 10.1111/ijn.13038. Online ahead of print.

ABSTRACT

AIM: The aim of this work is to identify the pressure ulcer risk profiles of hospitalized patients with reference to Braden Scale subscales.

METHODS: A total of 2996 hospitalized Portuguese participants were screened using the Braden Scale. A hierarchical and nonhierarchical cluster analysis was conducted, with ethical approval.

RESULTS: Five risk profiles (clusters) based on the first risk assessments were identified. Regarding the Braden Scale total score, two profiles with high risk and three profiles with low risk of pressure ulcer development were identified. All clusters were statistically significantly different in terms of sociodemographic and clinical variables. When the first and the last risk assessments were compared, all the clusters improved the Braden Scale total score on the last risk assessment, except Cluster 4 (low-risk category). Clusters 3, 4 and 5, which were classified as low risk, decreased in several Braden subscales at the last risk assessment.

CONCLUSIONS: The classification of low risk may misguide the early identification of patients with individual risk factors. Increasing the awareness of health care professionals for the importance of risk assessment of each Braden subscale is necessary for pressure ulcer prevention. We recommend the implementation of strategies for early identification of patients at risk at local and national levels.

PMID:35068026 | DOI:10.1111/ijn.13038

Head Neck. 2022 Jan 23. doi: 10.1002/hed.26982. Online ahead of print.

ABSTRACT

BACKGROUND: Dysphagia is common following treatment for head and neck cancer (HNC) and intervention to improve swallowing function is warranted. This study aimed to evaluate the efficacy of the Shaker head-lift exercise (HLE) to improve dysphagia in HNC patients.

METHODS: Patients treated for HNC with radiochemotherapy and with subsequent dysphagia were randomly assigned to intervention (HLE, n = 25) and control (standard dysphagia management, n = 27) groups. Videofluoroscopic evaluation of penetration-aspiration, initiation, residue, movement of selected structures, and self-perceived swallowing function, before and after 8 weeks of treatment, were compared.

RESULTS: Although adherence to training was high, no statistically significant differences in objectively measured swallowing function between the groups or within-group changes were found. Self-perceived swallowing function improved in the intervention group.

CONCLUSIONS: In this HNC population, neither HLE nor standard dysphagia management improved objectively measured swallowing function as evaluated after 8 weeks. Future research focusing on finding effective interventions for dysphagia is warranted.

PMID:35068016 | DOI:10.1002/hed.26982

J Orthop Res. 2022 Jan 24. doi: 10.1002/jor.25267. Online ahead of print.

ABSTRACT

The first goal of this study was to develop reliable three-dimensional definitions of alignment for the ankle, subtalar, and hindfoot joints. These alignments are based on three-dimensional morphological features derived from renderings of the bones obtained from weightbearing computer tomography. The second goal was to establish a database quantifying the alignment of the ankle, subtalar, and hindfoot joints in a healthy population during weightbearing bilateral standing. This level 1 study was performed on 95 normal subjects in which random subjects were recruited into a control group. Weightbearing computed tomography scans of the leg were collected in neutral, bilateral, standing posture. In 30 of the subjects, both the left and right leg was scanned. Six alignment parameters for each joint were calculated from morphological measurements conducted on three-dimensional renderings of the bones. Intra- and intertester reliability was assessed from repeated measurements by several testers. Analysis of variance statistics of the alignment parameters showed no statistical differences due to age, gender, or foot side. Intraclass correlation coefficient analysis showed excellent inter- and intratester reliability. It was concluded that the alignment process is comprehensive and reliable. Therefore, without classification by gender or age, it may be used as a foundation for quantifying abnormal alignment associated with various ankle deformities. Clinical significance: The alignment methodology and control database may be used to diagnose ankle, subtalar, and hindfoot misalignment. It can also serve as basis for surgical planning designed to restore normal alignment in various hindfoot pathologies, such as ankle realignment in total ankle replacement.

PMID:35067973 | DOI:10.1002/jor.25267

Aust Dent J. 2022 Jan 24. doi: 10.1111/adj.12896. Online ahead of print.

ABSTRACT

Oral lichen planus (OLP) is a chronic inflammatory disease of the oral mucosa having no clear aetiology or pathogenesis. The influence of psychological disturbances on OLP has been widely discussed but still bears the controversy. This study aimed at assessing scientific evidence between the OLP and psychological alterations of the patient. We searched seven important databases for studies on OLP and psychological factors (anxiety, depression, stress, sleep disorders, etc.) published between 1 January 2000, and 1 October 2020. Case-control and cross-sectional studies were incorporated into this study. The meta-analysis used a random-effects model assessed by using the I² statistic. Dichotomous variables used the odds ratio and 95% confidence interval (CI), and continuous variables used the mean difference with 95% CI. Finally, 26 studies were included in the review. A meta-analysis of 13 studies showed there was a significant association of OLP with anxiety, depression and stress compared with healthy controls. Certain personality characteristics and sleep disorders also influence the patient of OLP. Therefore, psychological and psychiatric examinations should be carried out routinely for patients with OLP and improve the prognosis of the disease. © 2022 Australian Dental Association.

PMID:35067951 | DOI:10.1111/adj.12896

J Med Virol. 2022 Jan 23. doi: 10.1002/jmv.27619. Online ahead of print.

ABSTRACT

The public health interventions to mitigate COVID-19 could also potentially reduce the global activity of influenza. However, this strategy’s impact on other common infectious diseases is unknown. We collected the data of ten respiratory infectious (RI) diseases, influenza-like illnesses (ILI), and seven gastrointestinal infectious (GI) diseases during 2015-2020 in China and applied two proportional tests to check the differences in the yearly incidence and mortality, and case fatality rates (CFRs) over the years 2015-2020. The results showed that the overall RI activity decreased by 7.47%, from 181.64 in 2015-2019 to 168.08 per 100,000 in 2020 (p < 0.001); however, the incidence of influenza was seen to have a 16.08% escalation (p < 0.001). On the contrast, average weekly ILI percentage and positive influenza virus rate decreased by 6.25% and 61.94% respectively in 2020 compared to the previous five years (all p < 0.001). The overall incidence of GI decreased by 45.28%, from 253.73 in 2015-2019 to 138.84 in 2020 per 100,000 (p < 0.001), and with the greatest decline seen in hand, foot, and mouth disease (HFMD) (64.66%; p < 0.001). The mortality and CFRs from RI increased by 128.49% and 146.95%, respectively, in 2020, compared to 2015-2019 (p < 0.001). However, the mortality rates and CFRs of seven GI decreased by 70.56% and 46.12%, respectively (p < 0.001). In conclusion, China’s COVID-19 elimination/containment strategy is very effective in reducing the incidence rates of RI and GI, and ILI activity, as well as the mortality and CFRs of GI diseases. This article is protected by copyright. All rights reserved.

PMID:35067944 | DOI:10.1002/jmv.27619

J Dermatol. 2022 Jan 24. doi: 10.1111/1346-8138.16292. Online ahead of print.

ABSTRACT

Hydroxychloroquine (HCQ) is the first-line systemic treatment for cutaneous lupus erythematosus (CLE). Whole blood HCQ concentration (WBHCQ) was found to correlate with CLE severity among Caucasians. However, studies on Asians are scarce. We aim to explore the relationship of WBHCQ with CLE disease activity among multi-racial Malaysians and the factors associated with WBHCQ. A cross-sectional study targeting patients with CLE was conducted from 1 June till 30 November 2019. Disease activity was assessed using Cutaneous Lupus Erythematosus Disease Area and Severity Index – Activity Score (CLASI-AS). Blood was analyzed for WBHCQ concentration using a high-performance liquid chromatography technique. Statistical analysis was done using R studio version 1.2.1335. A total of 88 subjects (male : female, 4.5:1) with a median age of 41 years old were recruited. The median duration CLE was 5 years. The majority had acute cutaneous lupus (n = 45, 51.1%). The median WBHCQ was 946.8 ng/mL. Indians were found to have the highest WBHCQ (median ± interquartile range [IQR], 1515.4 ± 1494.8 ng/mL). Males had a lower WBHCQ (median ± IQR, 733.5 ± 573.8 ng/mL) than females (995.5 ± 925.1 ng/mL). However, no statistically significant association between race and sex with WBHCQ was demonstrable (p = 0.247, p = 0.066). No correlation was demonstrated between WBHCQ and CLASI-AS (r = -0.02, p = 0.851). A positive correlation was found between HCQ dosage (ideal bodyweight) and WBHCQ (r = 0.24, p = 0.027). No other factors were found associated with WBHCQ. Indians and females were observed to have higher WBCHQ; however, no significant correlation was identified. Further study is required to confirm the finding.

PMID:35067938 | DOI:10.1111/1346-8138.16292

Pulm Ther. 2022 Jan 24. doi: 10.1007/s41030-022-00182-z. Online ahead of print.

ABSTRACT

INTRODUCTION: Alpha-1 antitrypsin (AAT) deficiency is an autosomal co-dominant genetic condition that predisposes individuals to pulmonary and hepatic disease, and in severe cases is treated with augmentation by intravenous infusion. Our aim was to assess patient reluctance to transition to self-administered augmentation of alpha-1-antitrypsin, during the pandemic of SARS-CoV-2.

METHODS: A phone questionnaire was administered to 22 patients with severe alpha-1-antitrypsin deficiency who were currently receiving AAT augmentation therapy. Inclusion criteria included patients [Formula: see text] 18 years old, diagnosed with AATD, and receiving intravenous AAT protein augmentation therapy. Information was gathered regarding demographics, perspectives on transitioning to self-administered treatment, and anxiety and depression prevalence. Results were collected anonymously using REDCap. Joint and marginal statistical analysis was done to quantify links between participants’ willingness to transition to self-infusion and correlations with sex, age, years of therapy, anxiety, and depression.

RESULTS: Of 22 patients, 14 were male and eight were female. Ages ranged from 36 to 79 years, with an average of 62.5. Genotypes were ZZ (14), MZ (3), and SZ (2) among others. Average length of intravenous augmentation was 9.5 years. The majority, 16 participants, were aware self-infusion was an option. Eight participants were willing to consider transitioning to self-infusion if trained and educated. Eight patients reported that fear of COVID-19 transmission influenced their decision-making. Above-normal anxiety, and depression scores, were found in four, and six patients, respectively. Neither sex, age, years of treatment, anxiety, or depression were found to be associated with willingness to consider self-infusion therapy.

CONCLUSIONS: Although there are many reasons AATD patients may benefit from AAT self-infusion, including decreased exposure to SARS-CoV-2, the majority preferred home nurse-infused therapy.

PMID:35067906 | DOI:10.1007/s41030-022-00182-z

Eat Weight Disord. 2022 Jan 24. doi: 10.1007/s40519-021-01351-w. Online ahead of print.

ABSTRACT

PURPOSE: Medical students have a higher risk of developing psychological issues, such as feeding and eating disorders (FEDs). In the past few years, a major increase was observed in the number of studies on the topic. The goal of this review was to estimate the prevalence risk of FEDs and its associated risk factors in medical students.

METHODS: Nine electronic databases were used to conduct an electronic search from the inception of the databases until 15^th September 2021. The DerSimonian-Laird technique was used to pool the estimates using random-effects meta-analysis. The prevalence of FEDs risk in medical students was the major outcome of interest. Data were analyzed globally, by country, by research measure and by culture. Sex, age, and body mass index were examined as potential confounders using meta-regression analysis.

RESULTS: A random-effects meta-analysis evaluating the prevalence of FEDs in medical students (K = 35, N = 21,383) generated a pooled prevalence rate of 17.35% (95% CI 14.15-21.10%), heterogeneity [Q = 1528 (34), P = 0.001], τ² = 0.51 (95% CI 0.36-1.05), τ = 0.71 (95% CI 0.59-1.02), I² = 97.8%; H = 6.70 (95% CI 6.19-7.26). Age and sex were not significant predictors. Body mass index, culture and used research tool were significant confounders.

CONCLUSION: The prevalence of FEDs symptoms in medical students was estimated to be 17.35%. Future prospective studies are urgently needed to construct prevention and treatment programs to provide better outcomes for students at risk of or suffering from FEDs.

LEVEL OF EVIDENCE: Level I, systematic review and meta-analysis.

PMID:35067859 | DOI:10.1007/s40519-021-01351-w

Heart Fail Rev. 2022 Jan 24. doi: 10.1007/s10741-021-10207-5. Online ahead of print.

ABSTRACT

As our therapeutic armamentarium for HFpEF is insufficient, research has been focusing on the potential beneficial effect of existing pharmaceutical regimens on this specific patient population. A series of RCTs have recently examined the impact of various pharmaceutical treatments with proven benefit in HFrEF, on the improvement of symptoms of HFpEF patients. This systematic review and meta-analysis comprised studies of adult patients with HFpEF and evaluated the impact of different cardiovascular acting medication on cardiorespiratory fitness, reflected by peak VO₂ values measured during CPET. The primary outcome was difference between groups in the change of peak VO₂ (ΔpeakVO₂). Literature search involved PubMed/MEDLINE, Scopus and Web of Science databases. Our search identified 3634 records and 19 studies were included in qualitative analysis; 12 studies with 1341 patients were finally included in primary outcome analysis. ΔpeakVO₂ between baseline and study-end did not significantly change after treatment with spironolactone, ivabradine, sildenafil, or oral inorganic nitrate and neither did difference in 6MWT distance after treatment with spironolactone. Spironolactone led to statistically significant reduction in E/E’ ratio study-end values (WMD – 1.64, 95%CI – 2.42 to – 0.86, I² = 87%, p < 0.0001), as well as to a significant increase in MLHFQ values (WMD 0.75, 95%CI 0.02 to 1.48, I² = 0%, p = 0.65), indicating deterioration in HRQoL among HFpEF patients. A series of established cardiovascular acting medication in HFrEF seems not to confer significant benefit in peak VO₂ and 6MWT distance in HFpEF. Spironolactone is associated with improvements in diastolic function and with a significant deterioration in HRQoL of this population.

PMID:35067835 | DOI:10.1007/s10741-021-10207-5