Nevin Manimala

J Trace Elem Med Biol. 2021 Aug 14;68:126839. doi: 10.1016/j.jtemb.2021.126839. Online ahead of print.

ABSTRACT

BACKGROUND: Research to date suggests that nickel affects not only the metabolism of vitamin B12 but also folates and thus may affect hematopoiesis processes.

OBJECTIVE: The aim of the study was to examine the relationship of nickel (Ni) status to red blood cell (RBC) parameters and serum vitamin B12, folate and homocysteine concentrations in the course of normal pregnancy and in pregnant women with anemia.

METHODS: The study included fifty-three pregnant women recruited to the study from the Lower Silesia region of Poland, 17 % of whom developed anemia. Nickel concentration was determined in urine, whole blood and food samples by atomic absorption spectrometry. At the same time as the food and urine samples were taken, blood was also collected for the determination of RBC parameters and serum vitamin B12, homocysteine and folate concentrations.

RESULTS: The median reported Ni intake, and the urinary and whole blood nickel contents for the studied pregnant women for the first trimester were respectively – 162.46 μg/day, 3.98 μg/L and 3.32 μg/L; for the second trimester – 110.48 μg/day, 6.86 μg/L and 1.04 μg/L; and for the third trimester – 132.20 μg/day, 3.41 μg/L and 0.70 μg/L. With regard to Ni concentration in whole blood (p = 0.0204) and in urine (p = 0.0003), the differences in the values for individual trimesters were statistically significant. The whole blood Ni level was significantly higher (9.28 vs 3.62 μg/L, p = 0.0114), while the concentration of homosysteine was significantly lower (4.09 vs 5.04 μmol/L, p = 0.0165) in pregnant women with anemia compared to those without anemia. The whole blood Ni concentration was negatively correlated with almost all RBC parameters in non-anemic pregnant women.

CONCLUSIONS: Ni status changes with the development of normal pregnancy, and in the case of anemia, an increase in Ni concentration in whole blood is observed. The demonstrated correlations between the Ni status in pregnant women and RBC parameters as well as serum vitamin B12 and folate concentrations suggest that nickel is associated with the methionine-folate cycle, iron homeostasis and bacterial synthesis of vitamin B12 in humans.

PMID:34418745 | DOI:10.1016/j.jtemb.2021.126839

Appl Radiat Isot. 2021 Aug 13;176:109894. doi: 10.1016/j.apradiso.2021.109894. Online ahead of print.

ABSTRACT

The aim of this letter is to suggest new semi-empirical formulae for the prediction of (n,d) cross sections with a neutron energy of 14-15 MeV. In this context, the cross sections are calculated using systematic that is function only of the reaction Q-value and mass number A. The (n,d) reactions are analyzed by using the systematics based on the statistical theory. Thus, the present semi-empirical formulae compared with the cross section data in literature give a good fit for the prediction of the (n,d) cross sections at 14-15 MeV.

PMID:34418727 | DOI:10.1016/j.apradiso.2021.109894

J Psychosom Res. 2021 Aug 6;149:110596. doi: 10.1016/j.jpsychores.2021.110596. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Using the Common Sense Model (CSM), this study aimed to examine the extent to which illness beliefs, coping styles, self-efficacy, and mindfulness mediate this relationship.

METHODS: Two hundred and sixty-one adults (198 females; 169 with Crohn’s Disease) with IBD participated in this cross-sectional study. Measures used in this study were the short Crohn’s Disease Activity Index, Ulcerative Colitis Lichtiger Index, Inflammatory Bowel Disease Questionnaire, New General Self-Efficacy Scale, Carver Brief COPE scale, Mindful Attention Awareness Scale, Brief Illness Perceptions Questionnaire, and the Depression and Anxiety Stress Scales.

RESULTS: Using structural equation modelling, the final model indicated IBD symptoms had a significant direct influence only on illness perceptions (β = 0.66, p < .001). In turn, illness perceptions had a significant direct influence on depression and anxiety (β = 0.34, p < .001) and QoL (β = -0.67, p < .001), and was also linked to higher maladaptive coping (β = 0.28, p < .001) and lower self-efficacy (β = -0.49, p < .001), but not with mindfulness or adaptive coping (p > .05). Maladaptive coping (β = 0.46, p < .001) and mindfulness (β = 0.23, p < .001) were linked with increased distress. QoL was influenced by distress (β = -0.40, p < .001).

CONCLUSIONS: Consistent with the predictions of the CSM, the relationships between IBD symptoms and depression and anxiety, and between IBD symptoms and quality of life, are statistically mediated via psychological variables including illness perceptions and maladaptive coping.

PMID:34418720 | DOI:10.1016/j.jpsychores.2021.110596

Am J Emerg Med. 2021 Aug 10;50:278-282. doi: 10.1016/j.ajem.2021.07.063. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study was to investigate the effect of compression on the Visual Analog Scale (VAS) score following the application of 3-in-1 femoral nerve block (FNB), used for pain palliation in patients with hip fractures.

METHODS: This was a randomized controlled trial study on application of pressure versus no pressure following FNB in patients with hip fractures. Their VAS scores were recorded and an ultrasound-guided 3-in-1 FNB was performed as a standardized procedure. After the procedure, patients were randomized into two groups and a weight with 2 kg pressure was applied to the treated area in one group. After 30 min, VAS scores were recorded again. VAS scores of all patients recorded before and after the procedure, and post-procedural VAS scores of pressure-applied and no pressure-applied groups were statistically compared.

RESULTS: 34 patients were included in this study with 17 patients falling in the compression group (group C), and the remaining half in the non-compression group (group NC). The pre-procedural mean VAS scores were 9.35 (95% CI; 8.95-9.76)), while the post-procedural mean VAS scores dropped to 2.35 (95% CI; 1.65-3.06) in group C. The pre-procedural mean VAS score was 9.12 (95% CI; 8.64-9.59), while the post-procedural mean VAS score was 5.06 (95% CI; 4.09-6.03) in group NC. When the average reductions in VAS score following the procedure were compared, the mean difference between the two groups was calculated to be 2.94 (95% CI; 1.69-4.19) which favours group C. This difference was statistically significant (p < 0.001).

CONCLUSION: Our study shows that, the application of simple compression after 3-in-1 FNB in patients with hip fractures provides a significant reduction in VAS scores.

PMID:34418719 | DOI:10.1016/j.ajem.2021.07.063

Am J Emerg Med. 2021 Aug 16;50:264-269. doi: 10.1016/j.ajem.2021.08.035. Online ahead of print.

ABSTRACT

BACKGROUND: Unintentional injury remains the leading cause of death for adults worldwide. We aimed to investigate the rates and distribution of dead on arrival (DOA) patients according to emergency medical services (EMS) mode of transport (MoT), EMS transport time (TT), injury severity score (ISS), and type of injury.

METHODS: This retrospective study utilized de-identified incident-based data from the American College of Surgeons Trauma Quality Improvement Program Participant Use File (ACS-TQIP PUF) dataset (2013-2018) to study Adult DOA patients. DOA was defined according to the data point, “arrived with no signs of life and did not recover”. Patients with unknown vitals and patients with no EMS vitals at the scene (HR = 0, RR = 0, and SBP = 0) were excluded to identify DOAs who died during transport. The DOAs included for analysis were sorted into three groups based on injury severity score [low (ISS < 15), intermediate (ISS = 15-24), and severe (ISS ≥ 25)] and subdivided according to injury type (blunt vs. penetrating), EMS Mode of transport and transport times. Statistical significance was defined as p < 0.05.

RESULTS: The majority of the evaluated 6030 adult DOA patients were male (73.3%) and 18-64 years of age (79.6%). Most patients sustained blunt injuries (58.2%), and the most common mechanism of injury was motor vehicle collisions (MVCs). Patients who traveled by helicopter EMS (HEMS) experienced less deaths than those traveling by ground EMS (GEMS) despite transporting more severely injured patients over longer time intervals. Median HEMS TTs were greater than their GEMS counterparts for blunt and penetrating injuries across all ISS groups but were associated with fewer deaths.

CONCLUSION: Helicopter emergency medical service use with intermediate and severely injured patients with penetrating injuries is associated with a reduced number of DOAs. Future studies should prospectively investigate EMS performance to confirm the findings identified in this retrospective analysis. Additionally, other factors affecting pre-hospital EMS performance (e.g., geographic variations, weather-related characteristics, in-flight interventions/procedures) should be investigated. Finally, the results of this study highlight the need for standardized HEMS utilization triage criteria.

PMID:34418717 | DOI:10.1016/j.ajem.2021.08.035

Eur J Obstet Gynecol Reprod Biol. 2021 Aug 11;265:30-38. doi: 10.1016/j.ejogrb.2021.07.038. Online ahead of print.

ABSTRACT

OBJECTIVE: Following the publication of several high quality randomized controlled trials regarding the comparison of similar laparoscopic gynecologic procedures being performed with or without robotic assistance, we aimed to perform a systematic review to identify any differences in patient safety and expected incidence of complications in these procedures.

DATA SOURCES: Articles on ClinicalTrials.Gov, Embase, MEDLINE, PubMed, Scopus, and Web of Science databases were retrieved and screened for eligibility up to April 1st 2021.

METHODS OF STUDY SELECTION: In addition to meeting our screening algorithm, we included studies that met all the following: randomized control trials (RCT), enrolling patients for indicated laparoscopic gynecologic procedures, and comparing Robotic Surgery (RS) with Laparoscopic Surgery (LS) in terms of safety or complications.

TABULATION, INTEGRATION, AND RESULTS: Data was pooled as mean difference (MD) or risk ratio (RR) with a 95% confidence interval (CI). Ultimately, six studies were included in this meta-analysis. Pooled data revealed that RS and LS have similar risk for intraoperative complications (RR = 0.87; 95% CI [0.23, 3.36], P = 0.84), postoperative complications (RR = 1.07; 95% CI [0.57, 2.01], P = 0.83), significant intraoperative hemorrhage (RR = 1.40; 95% CI [0.59, 3.34], P = 0.44), postoperative hemorrhage (RR = 0.43; 95% CI [0.15, 1.22], P = 0.11), vaginal cuff dehiscence (RR = 1.13; 95% CI [0.24, 5.41], P = 0.88), postoperative wound infection, urinary tract infection, and urinary bladder or ureteral injury. RS had “surgeon declared” lower estimated blood loss (MD = 85.27; 95% CI [46.45, 124.09], P < 0.00001) and shorter postoperative hospital stay (MD = 1.20; 95% CI [0.38, 2.01], P = 0.004).

CONCLUSION: There was a statistically significant decrease in hospital stay and “surgeon declared” blood loss seen in the RS group. There was no statistically significant increase in risk of developing other postoperative complications between the LS and R groups.

PMID:34418694 | DOI:10.1016/j.ejogrb.2021.07.038

J Stroke Cerebrovasc Dis. 2021 Aug 18;30(10):106050. doi: 10.1016/j.jstrokecerebrovasdis.2021.106050. Online ahead of print.

ABSTRACT

INTRODUCTION: Exercise therapy and neuromuscular electrical stimulation (NMES) during the initial 14 days after stroke may benefit recovery of gait. We aimed to determine whether poststroke NMES of vastus medial and tibial muscles during exercise therapy is more effective than exercise therapy alone.

MATERIALS AND METHODS: In this proof-of-concept randomised trial patients with first-ever acute ischemic stroke and a leg paresis (40-85 years of age) were randomised (1:1) to 10 min of daily NMES + exercise therapy or exercise therapy alone. Primary outcome was the between-group difference in change in 6 min Walk Test (6MWT) at 90 days post stroke estimated with a mixed regression model. Secondary outcomes included 10 m Walk Test, Fugl-Meyer Motor Assessment, Guralnik Timed Standing Balance, Sit to Stand, Timed Up and Go, EQ-5D-5L, Montreal Cognitive Assessment and Becks Depression Inventory.

RESULTS: 50 stroke survivors (25 in each group) with a mean age of 67 years (range 43-83) were included. An insignificant between-group difference in change of 28.3 m (95%CI -16.0 to 72.6, p = 0.23, adjusted for baseline) in 6MWT at 90-days follow-up was found, in favour of the NMES group. All secondary outcomes showed no statistically significant between-group difference. The conclusion was that adding NMES to exercise therapy had no effect on poststroke walking distance measured by the 6 MWT or any of the secondary outcomes.

CONCLUSIONS: In this proof-of-concept RCT, we demonstrated that NMES in addition to exercise therapy during the first 14 days after onset of ischemic stroke did not improve walking distance or any of the secondary outcomes. Future studies with a longer trial period, stratifying patients into subgroups with comparable patterns of expected spontaneous recovery – if possible within 48 h post stroke, and greater sample size, than in this study are suggestions of how rehabilitation research could go on exploring the potential for NMES as an amplifier in stroke recovery.

PMID:34418670 | DOI:10.1016/j.jstrokecerebrovasdis.2021.106050

Cancer Epidemiol. 2021 Aug 18;74:102006. doi: 10.1016/j.canep.2021.102006. Online ahead of print.

ABSTRACT

INTRODUCTION: Childhood brain tumours (CBTs) are the second most common type of cancer in individuals aged 0-24 years globally and cause significant morbidity and mortality. CBT aetiology remains poorly understood, however previous studies found higher CBT incidence in high-income countries (HIC) compared to low-middle income countries (LMIC), suggesting a positive relationship between incidence and wealth.

MATERIALS & METHODS: Aggregated data from Cancer Incidence in Five Continents (CI5) were used to explore CBT epidemiology. Incidence rate ratios (IRR) compared CBT rates between twenty-five geographically and economically diverse countries. The relationship between incidence and economic development was explored using linear regression models and Spearman’s rank correlation tests. Trends in CBT incidence between 1978 and 2012 were investigated using average annual percentage changes (AAPC).

RESULTS: CBT incidence was highest in North America and lowest in Africa. CBT incidence rates increased significantly with increasing GDP per capita (p = 0.006). Gini index was significantly negatively associated with CBT incidence. Incidence decreased with increasing income inequality within countries, indicated by higher Gini indices (p = 0.040). Increasing and decreasing CBT incidence trends were observed within individual countries, although only Italy (p = 0.02) and New Zealand (p < 0.005) experienced statistically significant changes over time.

CONCLUSIONS: The excess disease found in HIC may be explained by environmental risk factor exposure increasing CBT risk in wealthy populations. However, systematic limitations of substandard cancer detection and reporting in LMIC may mean incidence disparities result from misinformation bias rather than genuine differences in risk factor exposure. Further research is required to comprehensively describe CBT epidemiology and explain study findings.

PMID:34418666 | DOI:10.1016/j.canep.2021.102006

Epilepsy Behav. 2021 Aug 18;123:108247. doi: 10.1016/j.yebeh.2021.108247. Online ahead of print.

ABSTRACT

OBJECTIVE: The effect of vagus nerve stimulation (VNS), an important auxiliary therapy for treating drug-resistant epilepsy (DRE), on autonomic nerve function is still controversial. Heart rate variability is a widely used indicator of autonomic nerve function. To clarify the relationship between VNS and heart rate variability (HRV), we performed a meta-analysis to systematically evaluate the effect of VNS on HRV in patients with epilepsy.

METHODS: We performed a systematic review by searching the following online databases: PubMed, Web of Science, EMBASE and the Cochrane Library. The key search terms were “vagal nerve stimulation,” “epilepsy” and “heart rate variability”. Other features of VNS in patients with epilepsy include postoperative changes in low-frequency (LF), high-frequency (HF) and low-frequency/high-frequency (LF/HF) heart rate variability, which were used as evaluation indices, and the Newcastle-Ottawa Quality Assessment Scale and Stata 14.0 statistical software were used for literature quality evaluation and meta-analysis.

RESULTS: Twelve studies published in English were obtained, and 229 patients with epilepsy who underwent VNS were ultimately included after elimination of duplicate articles and those that did not meet the inclusion criteria. Regarding LF heart rate variability, in the response subgroup, patients with DRE with VNS presented a lower value (-0.58) before surgery than after surgery, with a 95% confidence interval (CI) ranging from -1.00 to -0.15. For HF heart rate variability, patients with DRE with VNS had a lower value (-0.45) before surgery than after surgery in the response subgroup, with a 95% CI ranging from -0.74 to -0.17. No differences were found for LF/HF values or the LF and HF values of other subgroups.

CONCLUSION: VNS has little effect on the balance of sympathetic and parasympathetic nerve activity and would not be expected to cause cardiovascular autonomic dysfunction in patients with DRE. For patients with DRE, VNS can control seizures and has little effect on autonomic nervous function.

PMID:34418640 | DOI:10.1016/j.yebeh.2021.108247

Epilepsy Behav. 2021 Aug 18;123:108259. doi: 10.1016/j.yebeh.2021.108259. Online ahead of print.

ABSTRACT

OBJECTIVE: Depression and anxiety disorders are common among patients with epilepsy (PWE). These comorbidities have been shown to influence prognosis and may have a greater impact on quality of life than seizure control. Despite guideline recommendations and expert consensus to regularly screen for and treat both conditions, there is evidence that they are underdiagnosed and undertreated. Our goal was to test a novel screening method to determine if it would increase the rate of detecting and treating depression and anxiety disorders among PWE.

METHOD: The Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and the Brief Epilepsy Anxiety Survey Instrument (brEASI) were selected as validated screening instruments for depression and anxiety disorders, respectively. They were sent via an electronic medical record-linked patient portal to all patients of four epileptologists 48 h prior to their clinic appointment. We evaluated whether this increased the rate of detecting and treating depression and anxiety disorders relative to a historical control group.

RESULTS: A total of 563 patients were included of whom 351 were sent the screening instruments. 62.7% of patients completed the screening instruments of whom 47.7% screened positive for either depression only (16.4%), anxiety disorders only (5.5%) or both (25.9%); a statistically significant increase relative to the control group. There was also a significantly increased proportion of patients for whom treatment was initiated for depression (p < 0.01), anxiety disorders (p < 0.01), or both (p < 0.01).

CONCLUSIONS: We identified an easily applicable and efficient means of enhancing detection and treatment rates for depression and anxiety disorders among PWE in a busy clinic setting.

PMID:34418639 | DOI:10.1016/j.yebeh.2021.108259