Nevin Manimala

Osteoarthritis Cartilage. 2021 Jun 23:S1063-4584(21)00808-6. doi: 10.1016/j.joca.2021.06.002. Online ahead of print.

ABSTRACT

OBJECTIVE: We evaluated whether patient-reported outcome trajectories (i.e., changes over time) differed by intraoperative compartmental cartilage lesion pattern over 4-6 years following arthroscopic meniscal surgery.

METHODS: In this ancillary study of the Knee Arthroscopy Cohort Southern Denmark cohort, we intraoperatively categorized cartilage lesions as isolated patellofemoral, isolated tibiofemoral, or combined patellofemoral/tibiofemoral. Participants completed the Knee injury and Osteoarthritis Outcome Score (KOOS) pre-operatively, at 3 and 12 months, and at 4-6 years post-operatively and reported overall satisfaction at final follow-up. Our main outcome was KOOS₄ (grand mean of four subscale means). We evaluated whether KOOS₄ scores changed over time according to cartilage lesion patterns using adjusted mixed linear regression. We also estimated probability of treatment satisfaction using logistic regression.

RESULTS: Of 630 participants with complete cartilage scores, 280 (44%) were women, mean (standard deviation) age was 49 (13) years, and BMI was 27.3 (4.4) kg/m². KOOS₄ scores at baseline were slightly lower in all lesion groups compared to the no lesion group, yet only the combined group was statistically significantly lower. KOOS₄ trajectories were similar across cartilage lesion patterns, but by final follow-up, adjusted mean KOOS₄ scores were 6.8 (95% CI 2.2, 11.4) to 9.8 (1.1, 18.5) points lower in groups with cartilage lesions compared to the no lesion group. Probability of patient-reported satisfaction did not differ statistically by group.

CONCLUSIONS: Though KOOS₄ scores were slightly lower in groups with arthroscopically assessed cartilage lesions compared to the no lesion group, trajectories were similar across all groups.

PMID:34174456 | DOI:10.1016/j.joca.2021.06.002

Osteoarthritis Cartilage. 2021 Jun 23:S1063-4584(21)00810-4. doi: 10.1016/j.joca.2021.06.004. Online ahead of print.

ABSTRACT

OBJECTIVE: Current global guidelines regarding the first-line analgesics (acetaminophen, topical or oral non-steroidal anti-inflammatory drugs [NSAIDs]) for knee osteoarthritis remain controversial and their comparative risk-benefit profiles have yet to be adequately assessed.

DESIGN: Pubmed, Embase, Cochrane Library, and Web of Science were searched from database inception to March 2021 for randomized controlled trials (RCTs) comparing acetaminophen, topical NSAIDs and oral NSAIDs directly or indirectly in knee osteoarthritis. Bayesian network meta-analyses were conducted. A propensity-score matched cohort study was also conducted among patients with knee osteoarthritis in The Health Improvement Network database.

RESULTS: 122 RCTs (47,113 participants) were networked. Topical NSAIDs were superior to acetaminophen (standardized mean difference [SMD]=-0.29, 95% credible interval [CrI]: -0.52 to -0.06) and not statistically different from oral NSAIDs (SMD=0.03, 95% CrI: -0.16 to 0.22) for function. It had lower risk of gastrointestinal adverse effects (AEs) than acetaminophen (relative risk [RR]=0.52, 95%CrI: 0.35 to 0.76) and oral NSAIDs (RR=0.46, 95%CrI: 0.34 to 0.61) in RCTs. In real-world data, topical NSAIDs showed lower risks of all-cause mortality (hazard ratio [HR]=0.59, 95% confidence interval [CI]: 0.52 to 0.68), cardiovascular diseases (HR=0.73, 95%CI: 0.63 to 0.85) and gastrointestinal bleeding (HR=0.53, 95%CI: 0.41 to 0.69) than acetaminophen during the one-year follow-up (n=22,158 participants/group). A better safety profile was also observed for topical than oral NSAIDs (n=14,218 participants/group).

CONCLUSIONS: Topical NSAIDs are more effective than acetaminophen but not oral NSAIDs for function improvement in people with knee osteoarthritis. Topical NSAIDs are safer than acetaminophen or oral NSAIDs in trials and real-world data.

PMID:34174454 | DOI:10.1016/j.joca.2021.06.004

West Afr J Med. 2021 Jun 26;38(6):531-536.

ABSTRACT

BACKGROUND: The burden of birth defects is disproportionately higher in developing countries.

OBJECTIVES: This study assessed the knowledge of risk factors and prevention of birth defects among ante-natal clinic attendees at the University College Hospital, Ibadan, Oyo State, Nigeria.

METHODS: This was a cross-sectional study among 415 mothers who presented at the antenatal clinic. A semi-structured questionnaire was used to obtain information on respondents’ socio-demographic profile, pregnancy, birth history, knowledge on prevention and risk factors for birth defects. Descriptive statistics was used to present results, independent t-test and ANOVA were used to determine the factors associated with mean of overall knowledge of birth defects. Test statistics was done at a 5% level of statistical significance.

RESULTS: The mean age of the women was 31.7 ± 4.8 years. Overall, 93 (22.4%) of the women were above 35 years, 118 (29.9%) were skilled workers and 343 (84.9%) had tertiary education. More than half (219, 52.8%) of the respondents had good knowledge of birth defects (56.4% had good knowledge of prevention and 66.0% had good knowledge of risk factors). Antenatal clinic attendees in their first trimester had higher mean overall knowledge score (8.3 ± 4.9) compared to those in second (7.9 ± 4.5) and third (7.9 ± 4.9) trimesters but this was not statistically significant (p=0.873). However, respondents in skilled/ semi-skilled occupation (8.62) had a significantly higher mean knowledge score compared with those in unskilled occupation/ unemployed (7.33) (p=0.005).

CONCLUSION: Knowledge of birth defects is relatively low among women. To reduce the occurrence and severity of birth defects, there is a need to educate mothers on the knowledge, prevention and importance of screening for birth defects.

PMID:34174180

West Afr J Med. 2021 Jun 26;38(6):526-530.

ABSTRACT

BACKGROUND: Abdominal myomectomy is a treatment modality for uterine fibroids. Its outcome depends on related variables which include the size, number and location of the fibroids, age of the patient, surgery and method used to secure haemostasis.

OBJECTIVE: To determine the outcomes of abdominal myomectomies and related variables in a fertility centre in South-south Nigeria.

METHODS: A retrospective study of the records of all cases of abdominal myomectomies performed between August 1, 2010 and July 31, 2017. Medical records of the 146 patients who had abdominal myomectomy during the period under review were retrieved and relevant data extracted. Information collected included the presence or absence of intra-abdominal adhesions, duration of tourniquet use, number and weight of enucleated fibroid seedlings, intraoperative blood loss, complications and the number of patients who achieved pregnancy after myomectomy. Data were analyzed using ANALYSE IT® statistical package.

RESULTS: 146 patients underwent myomectomy during the period under review. The age range of the patients was 28-56 years (median 41 years). Almost all the patients (94.5%) had tourniquets applied to the uterus for hemostasis. The number of fibroids enucleated ranged from 1 to 154 and weighed between 0.02 and 2.8kg. Blood loss ranged from 100 to1500mls, 17.4% had post-operative fever, and one patient had bowel injury. Thirty-one patients (32.3%) who subsequently had in vitro fertilisation treatment achieved conception.

CONCLUSION: Fibroids, weighing >0.5kg, are associated with increased blood loss during abdominal myomectomy, and a previous myomectomy significantly increases the risk of adhesions. Careful patient selection and meticulous surgical techniques are necessary to avoid morbidity in this setting with a high rate of large uterine fibroids.

PMID:34174179

West Afr J Med. 2021 Jun 26;38(6):520-525.

ABSTRACT

BACKGROUND: Poor medication adherence in HIV treatment is a public health problem as it leads to increased morbidity and mortality, as well as the development of drug resistance. There is limited information on the determinants of adherence among people living with HIV/AIDS especially in sub-Saharan Africa. This study aimed at assessing the determinants of adherence to HAART among people living with HIV/AIDS in Lagos State, Nigeria.

METHODS: A descriptive cross-sectional survey was conducted among 302 respondents selected from three public health facilities across the state. The study instrument was an interviewer-administered questionnaire adapted from the Medication Adherence Report Scale (MARS). Data analysis was performed using Epi Info software. Logistic regression analysis was used to identify the determinants of adherence. Level of significance for all the tests was set at p-value <0.05.

RESULTS: Seventy percent of respondents reported being adherent to medication. There were statistically significant associations between respondents’ age, having children, good knowledge of HIV and medication adherence. In addition, it was observed that the type of anti-retroviral (ARV) drug schedule, never missing an appointment, belonging to a support group and disclosure of status were associated with HAART adherence. Controlling for other variables, those that had disclosed their status were twice as likely to adhere to HIV medication (aOR: 2.3; 95% CI: 1.1-4.8). Also, those who had never missed a clinic appointment were three times more likely to adhere to prescribed medication (aOR: 3.4; 95% CI: 1.7-6.5).

CONCLUSION: Disclosure of HIV status and clinic attendance were key determinants of adherence among patients on HAART in Lagos, Nigeria.

PMID:34174178

Liver Int. 2021 Jun 26. doi: 10.1111/liv.14995. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: With the growing number of treated hepatitis C patients, the current “one size fits all” HCC surveillance strategies for patients with advanced fibrosis represents a great burden on healthcare systems. An individualized HCC risk strategy incorporates the dynamic changes of HCC risk are lacking.

METHODS: This single-center observational study included 3075 patients, with advanced fibrosis (≥ F3) who achieved SVR following DAAs at Egyptian Liver research institute and hospital (ELRIAH) with follow up period (range 6-72 months). The performance of a recently developed GES HCC risk stratification score was calculated pre- and post-treatment using Harrell’s c statistic. Times to HCC and cumulative incidences were calculated with Kaplan-Meier method and compared using log-rank (Mantel-Cox) test.

RESULTS: Pre-treatment GES score stratified patients into low (60.4%), intermediate (23.4%), and (16.2%) high-risk score where 5-year cumulative incidences of HCC were 1.66%, 4.45% and 7.64 respectively. Harrell’s c statistic was 0.801. Post-treatment GES score stratified patients into low (57.4%), intermediate (30.7%) and (11.9%) high-risk score where 5-year cumulative incidences of HCC were 1.35%,3.49% and 11.09% respectively. The cumulative HCC incidence increased significantly with higher scores (p<0.001). Harrell’s c statistic was 0.818. Using pretreatment and post treatment GES score, GES algorithm was developed with higher predictive value. The cumulative HCC incidence increased significantly with higher scores (p<0.001). Harrell’s c statistic was 0.832.

CONCLUSION: A dynamic algorithm incorporating both pre and post-GES scores have better performance and predictive value compared to only pre-treatment assessments. The proposed algorithm would help stratify those who need intensive or being excluded from screening.

PMID:34174150 | DOI:10.1111/liv.14995

Am J Transplant. 2021 Jun 26. doi: 10.1111/ajt.16732. Online ahead of print.

ABSTRACT

Primary hyperoxaluria (PH) is a metabolic defect that results in oxalate over-production by the liver and leads to kidney failure due to oxalate nephropathy. As oxalate tissue stores are mobilized after transplantation, the transplanted kidney is at risk of recurrent disease. We evaluated surveillance kidney transplant biopsies for recurrent calcium oxalate (CaOx) deposits in 37 kidney transplants (29 simultaneous kidney and liver [K/L] transplants and 8 kidney alone [K]) in 36 PH patients and 62 comparison transplants. Median follow-up post-transplant was 9.2 years (IQR: [5.3, 15.1]). Recurrence of CaOx crystals in surveillance biopsies in PH at any time post-transplant was 46% overall (41% in K/L, 62% in K). Higher CaOx crystal index, which accounted for biopsy sample size, was associated with higher plasma and urine oxalate following transplant (p<0.01 and p<0.02, respectively). There was a trend toward higher graft failure among PH patients with CaOx crystals on surveillance biopsies compared with those without [HR 4.43 (0.88, 22.35), p=0.07]. CaOx crystal deposition is frequent in kidney transplants in PH patients. Avoidance of high plasma oxalate and reduction of CaOx crystallization may decrease the risk of recurrent oxalate nephropathy following kidney transplantation in patients with PH. This study was approved by the IRB at Mayo Clinic.

PMID:34174139 | DOI:10.1111/ajt.16732

BJU Int. 2021 Jun 26. doi: 10.1111/bju.15527. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess the role of music in reducing the pain and anxiety associated with flexible cystoscopy using a blinded trial design.

PATIENTS AND METHODS: A patient blinded randomised control trial of music during flexible cystoscopy was performed comparing the pain, measured by visual analogue scale (VAS), anxiety, measured by the state trait anxiety inventory (STAI), and vital signs of 109 patients across two public hospitals in New South Wales, Australia. The purpose and hypothesis of the study was concealed from patients until after results had been collected.

RESULTS: No statistically significant differences were detected between the Non-Music and Music groups in VAS pain score (2.04±1.94 vs 2.10±1.90, P=0.86), change in STAI anxiety score (4.87±9.87 vs 6.8±11.07, P=0.33) or post procedural vital signs (HR 74±14 vs 72±13, P=0.66, SBP 144±20 vs 141±19, P=0.47) between the two groups.

CONCLUSION: Music does not appear to decrease perceived pain or anxiety when used during flexible cystoscopy. These findings may differ from the literature due to a number of factors, most significantly blinding of participants, but also potentially due to the ethnic makeup of the study population or lack of choice of music.

PMID:34174137 | DOI:10.1111/bju.15527

Reprod Domest Anim. 2021 Jun 26. doi: 10.1111/rda.13981. Online ahead of print.

ABSTRACT

The results of most studies show the beneficial effect of milking automation on production parameters of dairy cows, but its effect on fertility traits is debatable. Therefore, a study was undertaken to predict cow fertility – services per conception (SC) and calving interval (CI) – based on automatic milking system (AMS) data collected in the periparturient period subdivided into second and first week before calving, 1-4, 5-7, 8-14, 15-21 and 22-28 days of lactation. SC and CI were predicted using daily indicators such as concentrate intake, number of milkings, cow box time, milking time, milking speed, colostrum and milk yield, composition, temperature and electrical conductivity. The study material was derived from the AMS management system and from the SYMLEK milk recording system. The analysis covered data for 16,329 milkings of 398 Polish Holstein-Friesian (PHF) cows, which were used in 3 AMS herds. The collected numerical data were statistically analysed by correlation analysis in parallel with decision tree technique (SAS statistical package). The present study showed that due to the low, mostly non-significant coefficients of correlation between AMS data collected between 2 weeks before and 4 weeks after calving, it is not possible to predict cow fertility based on single traits. It has been established that the decision tree method may help breeders, already during the postcalving period, to choose the level of factors associated with AMS milking, which will ensure good fertility of cows in a herd. The most favourable number of services per conception are to be expected from cows that were milked <1.6 times per day from 1 to 4 days of lactation and electrical conductivity of their colostrum did not exceed 69 mS during that time. In turn, shortest CI (366 days) will be characteristic of the cows whose average daily colostrum yield did not exceed 20.2 kg and their daily concentrate intake from 8 to 14 days of lactation was at least 5.0 kg.

PMID:34174127 | DOI:10.1111/rda.13981

Int J Clin Pract. 2021 Jun 26:e14577. doi: 10.1111/ijcp.14577. Online ahead of print.

ABSTRACT

BACKGROUND/AIM: Subclinical hypothyroidism (SCH) is defined as high thyroid-stimulating hormone (TSH) and normal thyroxine (T4) levels. Data on the effects of early substitution with levothyroxine on psychophysical health in SCH are not consistent enough to support its general administration. The aim of this study was to examine the effect of 3-month levothyroxine (LT4) treatment on cardiovascular function in symptomatic SCH with TSH <10 mIU/L.

METHODS: Anthropometric, biochemical, electro- and echocardiographic indices were measured in 35 patients with persistent symptomatic SCH (4 mIU/L < TSH <10 mIU/L; mean ± SD: 7.0 ± 2.1 mIU/L) and 40 healthy controls at baseline and three months after the euthyroid state had been achieved on LT4 for SCH group, or three months of follow-up for controls.

RESULTS: The analyses showed a significant reduction in body weight (p=0.030), systolic and diastolic blood pressure (p=0.024, p=0.019), TSH (p<0.001), and thyroid peroxidase antibodies (TPO Ab) (p<0.001) on LT4 in the SCH group. There was a statistically significant decrease in end-systolic (ESV) and end-diastolic volumes (EDV) (p<0.001, p<0.001, respectively) after LT4 treatment. LT4 therapy significantly increased values of ejection fraction (EF), global longitudinal, circumferential and radial strains (p<0.001, p<0.001, p<0.001, respectively).

CONCLUSIONS: Our study confirmed an echocardiographic improvement of cardiac structure and function in treated individuals. Findings suggest the role of electrocardiographic and echocardiographic examination in objective monitoring for LT4 therapeutic effects.

PMID:34174124 | DOI:10.1111/ijcp.14577