Nevin Manimala

Emerg Microbes Infect. 2021 Aug 17:1-50. doi: 10.1080/22221751.2021.1969868. Online ahead of print.

ABSTRACT

INTRODUCTION: A common trait among RNA viruses is their high capability to acquire genetic variability due to viral and host mechanisms. Next-generation sequencing (NGS) analysis enables deep study of the viral quasispecies in samples from infected individuals.

METHODS: In this study, the viral quasispecies complexity and single nucleotide polymorphisms of the SARS-CoV-2 spike gene of coronavirus disease 2019 (COVID-19) patients with mild or severe disease was investigated using next-generation sequencing (Illumina platform).

RESULTS: SARS-CoV-2 spike variability was higher in patients with long-lasting infection. Most substitutions found were present at frequencies lower than 1%, and had an A → G or T → C pattern, consistent with variants caused by adenosine deaminase acting on RNA-1 (ADAR1). ADAR1 affected a small fraction of replicating genomes, but produced multiple, mainly non-synonymous mutations.

CONCLUSIONS: ADAR1 editing during replication rather than the RNA-dependent RNA polymerase (nsp12) was the predominant mechanism generating SARS-CoV-2 genetic variability. However, the mutations produced are not fixed in the infected human population, suggesting that ADAR1 may have an antiviral role, whereas nsp12-induced mutations occurring in patients with high viremia and persistent infection are the main source of new SARS-CoV-2 variants.

PMID:34402744 | DOI:10.1080/22221751.2021.1969868

Neuropsychol Dev Cogn B Aging Neuropsychol Cogn. 2021 Aug 17:1-12. doi: 10.1080/13825585.2021.1962794. Online ahead of print.

ABSTRACT

The current study investigated whether memory self-efficacy and beliefs about the controllability of memory abilities relate to older adults’ perceptions of the difficulty and effectiveness of various strategies for improving their everyday memory. One hundred and fifteen older adults (ages 65-89) completed the Personal Beliefs about Memory Instrument to evaluate their beliefs about their own memory abilities and the Memory Strategies Questionnaire to assess perceptions of the difficulty and effectiveness of utilizing six different strategic approaches for optimizing memory function. Results showed that memory-self efficacy related to older adults’ perceptions of how difficult various memory strategies are to implement, whereas control beliefs related to perceptions of memory strategy effectiveness. These results advance our understanding of how memory beliefs influence older adults’ selection of approaches to improve their everyday memory abilities.

PMID:34402742 | DOI:10.1080/13825585.2021.1962794

J Reprod Infant Psychol. 2021 Aug 17:1-17. doi: 10.1080/02646838.2021.1959538. Online ahead of print.

ABSTRACT

INTRODUCTION: Unintended pregnancy is a risk factor for less maternal-fetal attachment (MFA) and low levels of psychological well-being. This study was conducted to determine the effect of an MFA-based training programme on maternal anxiety, depression and worries following an unintended pregnancy.

METHODS: This randomised clinical trial was conducted on 68 women with an unintended pregnancy in north of Iran during 2018-2019. Participants were allocated to the trained and control groups through simple randomisation. The trained group received the MFA-based training for three 90-min sessions. Demographic questionnaire, London measure of unplanned pregnancy, Cranley’s MFA scale, Edinburgh postnatal depression, Spielberger anxiety and prenatal distress questionnaires were used. Data were analysed by descriptive statistics, chi square, Fisher’s exact test, independent and paired-samples t-tests, Mann-Whitney U, analysis of covariance, and multivariate analysis of variance.

RESULTS: After the intervention, the mean MFA, anxiety and depression scores were not significantly different between the trained and control groups Worry was significantly decreased in the trained group (p = 0.001) and increased in the control group (p = 0.03).

DISCUSSION: Although the MFA-based training could not significantly improve MFA, maternal anxiety and depression, it has been effective on worry in women with the unintended pregnancies.

PMID:34402709 | DOI:10.1080/02646838.2021.1959538

Ann Coloproctol. 2021 Aug 11. doi: 10.3393/ac.2020.01060.0151. Online ahead of print.

ABSTRACT

PURPOSE: This study was aimed to assess the feasibility of laparoscopic rectal surgery, comparing quality of surgical specimen, morbidity, and mortality.

METHODS: Prospectively acquired data from consecutive patients undergoing laparoscopic surgery for rectal cancer, at 2 minimally invasive colorectal units, operated by the same team was included. Locally advanced rectal tumors were identified as T3B or T4 with preoperative magnetic resonance imaging scans. All the patients were operated on by the same team. The 1:1 propensity score matching was performed to create a perfect match in terms of tumor height.

RESULTS: Total of 418 laparoscopic resections were performed, out of which 109 patients had locally advanced rectal cancer (LARC) and were propensity score matched with non-LARC (NLARC) patients. Median operation time was higher for the LARC group (270 minutes vs. 250 minutes, P=0.011). However, conversion to open surgery was done in 5 vs. 2 patients (P=0.445), reoperation in 8 vs. 7 (P=0.789), clinical anastomotic leak was found in 3 vs. 2 (P=0.670), and 30-day mortality rates was 2 vs. 1 (P>0.999) between LARC and NLARC, respectively. Readmission rate was higher in the NLARC group (33 patients vs. 19 patients, P=0.026), due to stoma-related issues. There was no statistically significant difference in the R0 resection between the 2 groups (99 patients in LARC vs. 104 patients in NLARC, P=0.284).

CONCLUSION: This study demonstrates that standardized approach to laparoscopy is safe and feasible in LARC. Comparable postoperative short-term clinical and pathological outcomes were seen between LARC and NLARC groups.

PMID:34399445 | DOI:10.3393/ac.2020.01060.0151

Thromb Haemost. 2021 Aug 16. doi: 10.1055/a-1588-8867. Online ahead of print.

ABSTRACT

OBJECTIVE: We evaluated stroke risk in patients with single timepoint screen-detected atrial fibrillation (AF) and the effect of oral anticoagulants (OAC).

METHODS: Consecutive patients aged ≥65 years attending medical outpatient clinics were prospectively enrolled for AF-screening using handheld single-lead ECG (AliveCor) from 12/2014 to 12/2017 (NCT02409654). Repeated screening was performed in patients with >1 visit during this period. Three cohorts were formed, screen-detected AF, clinically-diagnosed AF and no AF. Ischemic stroke risk was estimated using adjusted sub-distribution hazard ratios (aSHR) from multivariate regression and no AF as reference, and stratified according to OAC use.

RESULTS: Of 11,972 subjects enrolled, 2,238 (18.7%) had clinically-diagnosed AF at study enrollment. The yield of screen-detected AF on initial screening was 2.3% (n=223/9,734). AF was clinically-diagnosed during follow-up in 2.3% (n=216/9,440) and during subsequent screening in 71 initially screen-negative patients. Compared to no AF, patients with screen-detected AF without OAC treatment had the highest stroke risk (aSHR 2.63; 95% confidence interval 1.46-4.72), while aSHR for clinically-diagnosed AF without OAC use was 2.01 (1.54-2.62). Among screen-detected AF the risk of stroke was significantly less with OAC (no strokes in 196 person-years) compared with those not given OAC (12 strokes in 429 person-years), p=0.01.

CONCLUSION: The prognosis of single timepoint ECG screen-detected AF is not benign. The risk of stroke is high enough to warrant OAC use, and reduced by OAC.

PMID:34399432 | DOI:10.1055/a-1588-8867

J Neural Eng. 2021 Aug 16. doi: 10.1088/1741-2552/ac1deb. Online ahead of print.

ABSTRACT

Phase-amplitude coupling (PAC) is the association of the amplitude of a high-frequency oscillation with the phase of a low-frequency oscillation. In neuroscience, this relationship provides a mechanism by which neural activity might be coordinated between distant regions. The dangers and pitfalls of assessing phase-amplitude coupling with commonly used statistical measures have been well-documented. The limitations of these measures include: (i) response to non-oscillatory, high-frequency, broad-band activity, (ii) response to high-frequency components of the low-frequency oscillation, (iii) adhoc selection of analysis frequency-intervals, and (iv) reliance upon data shuffling to assess statistical significance.

OBJECTIVE: To address issues (i)-(iv) by introducing a nonparametric multitaper estimator of phase-amplitude coupling.

APPROACH: In this work, a multitaper phase-amplitude coupling estimator is proposed that addresses these issues. Specifically, issue (i) is addressed by replacing the analytic signal envelope estimator computed using the Hilbert transform with a multitaper estimator that down-weights non-sinusoidal activity using a classical, multitaper super-resolution technique. Issue (ii) is addressed by replacing coherence between the low-frequency and high-frequency components in a standard PAC estimator with multitaper partial coherence, while issue (iii) is addressed with a physical argument regarding meaningful neural oscillation. Finally, asymptotic statistical assessment of the multitaper estimator is introduced to address issue (iv).

MAIN RESULTS: Multitaper estimates of phase-amplitude coupling are introduced. Their efficacy is demonstrated in simulation and on human intracranial recordings obtained from epileptic patients.

SIGNIFICANCE: This work facilitates a more informative statistical assessment of phase-amplitude coupling, a phenomena exhibited by many neural systems, and provides a basis upon which further nonparametric multitaper-related methods can be developed.

PMID:34399415 | DOI:10.1088/1741-2552/ac1deb

Nutrition. 2021 Jun 24;91-92:111393. doi: 10.1016/j.nut.2021.111393. Online ahead of print.

ABSTRACT

OBJECTIVE: The aims of this study were to assess the effectiveness of a low-carbohydrate high-fat (LCHF) diet with and without a time-restricted feeding (TRF) protocol on weight loss and participating in three sequential dietary interventions (standard calorie-deficit diet, LCHF, and LCHF + TRF) on weight loss outcomes.

METHODS: Data from 227 adults from the Wharton Medical Clinic (WMC) were analyzed using a unidirectional case crossover design. Data was imputed for 154 patients to create a pseudo-sample in which everyone participated in three dietary interventions: standard calorie restriction, LCHF, and LCHF + TRF.

RESULTS: Patients lost an average of 11.1 ± 1.3 kg (9.8 ± 1.1%) after three sequential dietary interventions (P < 0.0001). Patients lost a statistically significant amount of weight from the standard WMC, LCHF, and LCHF+TRF diets (P < 0.05). With and without adjustment for age, sex, body mass index at the start of the dietary protocol, and treatment time, patients lost a similar amount of weight regardless of the dietary intervention (P > 0.05). Approximately 78.6% of patients achieved ≥5% weight loss with at least one of the diets.

CONCLUSION: Patients can lose a similar amount of weight regardless of the diet they are following. Approximately 78.9% of patients achieved 5% weight loss with at least one of the diets and lost an average 11.1 kg (or 9.8%). This is nearly double what has been previously reported for one dietary intervention. Thus, participating in sequential diets may be associated with greater absolute weight loss, and likelihood of achieving a clinically significant weight loss.

PMID:34399399 | DOI:10.1016/j.nut.2021.111393

Sleep Med. 2021 Jul 30;85:313-316. doi: 10.1016/j.sleep.2021.07.036. Online ahead of print.

ABSTRACT

BACKGROUND: There is a critical gap in identifying effective interventions for children with obstructive sleep apnea (OSA) who do not tolerate continuous positive airway pressure therapy. Positional OSA (POSA) is a common clinical phenotype whereby OSA occurs predominantly while sleeping in supine position. POSA may be amenable to treatment with a positional device, a belt worn around the chest with cushions on the back to prevent supine positioning, but no data exists in children. The primary aim of this study was to evaluate the efficacy of positional device therapy for the treatment of POSA in children.

METHODS: This observational study included children aged 4-18 years with POSA and an obstructive apnea-hypopnea index (OAHI) ≥ 5 events/hour on baseline polysomnogram (PSG) who underwent a second PSG to evaluate the efficacy of a positional device. The primary outcome was the change in OAHI.

RESULTS: Ten children were included (8 male, median age 11.2 years, median body mass index z-score 1.6). Compared to the baseline PSG, PSG data obtained while using a positional device showed a reduced median (interquartile range) OAHI (15.2 [8.3-25.6] versus 6.7 [1.0-13.7] events/hour respectively; p = 0.004) and percentage of total sleep time in supine position (54.4 [35.0-80.6]% versus 4.2 [1.1-25.2]% respectively; p = 0.04). Despite observed improvements in the oxygen desaturation index, these results were not statistically significant.

SIGNIFICANCE AND CONCLUSIONS: In this novel pilot study, positional device therapy was effective for the treatment of POSA. Positional device therapy may potentially change clinical practice as a cost-efficient and non-invasive treatment option for POSA.

PMID:34399395 | DOI:10.1016/j.sleep.2021.07.036

Theriogenology. 2021 Aug 8;173:202-210. doi: 10.1016/j.theriogenology.2021.07.026. Online ahead of print.

ABSTRACT

Most old, intact male dogs usually have prostate disorders, especially benign prostatic hypertrophy and prostatitis with or without abscesses, and concurrent cystitis. The successful treatment of dogs with prostatitis concurrent with cystitis has relied on choosing an appropriate antimicrobial drug based on a bacterial culture and drug sensitivity testing. The objective of the study was to compare the prevalence of bacterial species and results of drug susceptibility testing of bacteria that were isolated from the prostatic fluids and urine samples that were collected from dogs with both prostatitis and cystitis. One hundred and sixty intact male dogs, who presented with both diseases, were recruited for the study. The disease diagnoses were based on clinical history notes, physical examinations, abdominal ultrasonography, prostatic fluid cytology, urinalysis and bacterial cultures from both prostatic fluid and urine samples. The bacterial culture results demonstrated that the major species that were detected in either the prostatic fluid or urine samples were Staphylococcus spp., Escherichia coli, Pseudomonas spp., Streptococcus spp., Proteus mirabilis and Klebsiella pneumoniae. Staphylococcus spp. (26.5 %, 43/162) and Escherichia coli (26.1 %, 12/46) were the most prevalent species from the prostatic fluid and urine samples, respectively. Statistical tests revealed that there were no significantly different prevalence levels among the isolated bacteria between the prostatic fluid and urine samples. Imipenem and gentamicin were the most potent antimicrobial drugs tested against the bacterial isolates in the present study. However, the administration of imipenem to treat prostatitis and cystitis in dogs was of concern. Interestingly, there were no significant differences in the antimicrobial drug susceptibility trends between the prostatic fluid and urine samples. Based on these results, a urine sample might be considered as an optional sample for bacterial cultures and antimicrobial drug susceptibility testing when it is not possible to collect a prostatic fluid sample.

PMID:34399384 | DOI:10.1016/j.theriogenology.2021.07.026

J Surg Res. 2021 Aug 13;268:363-370. doi: 10.1016/j.jss.2021.06.073. Online ahead of print.

ABSTRACT

OBJECTIVE: Laparoscopic appendectomy is a common operation that is frequently performed by junior surgical residents. We investigated the effect of a structured training program on the proficiency of junior residents in acquiring skills necessary in this operation.

DESIGN AND PARTICIPANTS: This is a randomized pilot trial. Between December 2014 and July 2018, twenty junior residents were recruited for this study. 11 were randomized to receive a structured training program of supervised, task-specific training. Each resident subsequently performed ten cases of laparoscopic appendectomy with their performance assessed for the last 5. The GOALS scale was used as the primary endpoint. Secondary endpoints were perioperative outcomes. The effect of intervention on these outcomes were evaluated assuming a linear mixed effect multi-level model. The study was single-blinded as the assessors did not know which group each resident belonged to.

RESULTS: There were no statistically significant differences in the total GOALS score or any of its individual domains. After adjusting for the number of operations done within the trial, the mean difference between the total GOALS score was 0.07 (95% CI -0.76 to 0.90, P=0.866). Blood loss, hospital stay and postoperative complication rates were similar. There was suggestion of a shorter operative time (effect estimate -9.03, 95% CI -19.56 to 1.50) in the intervention arm although statistical significance was not achieved. No avoidable adverse events due to this study were recorded.

CONCLUSION: Structured training program did not significantly improve surgical performance and outcomes in laparoscopic appendectomy in this pilot trial. Despite these findings, residents can still potentially mount their learning curves in laparoscopy earlier in a safe environment with such a program which is especially important in the era of minimally invasive surgery.

PMID:34399358 | DOI:10.1016/j.jss.2021.06.073