Nevin Manimala

Neurourol Urodyn. 2021 Jun 3. doi: 10.1002/nau.24726. Online ahead of print.

ABSTRACT

AIM: Examine the effects of treating underlying neuromuscular dysfunction in chronic pelvic pain (CPP) patients.

METHODS: A retrospective longitudinal study of 200 female and male patients with CPP was performed upon an Institutional Review Board (IRB) approval (IRB# 17-0761). The outpatient protocol consisted of ultrasound-guided trigger point injections to the pelvic floor musculature with peripheral nerve blocks once a week for 6 weeks in an outpatient setting. Pelvic pain and functionality were measured before and after treatment using the Visual Analogue Scale and the Functional Pelvic Pain Scale. Functionality categories assessed were intercourse, bladder, bowel, working, walking, running, lifting, and sleeping.

RESULTS: Pretreatment, mean VAS score was 6.44 (standard deviation [SD] = 2.50; p < 0.05, 95% confidence interval [CI] = 6.09-6.79). Posttreatment mean VAS score was 4.25 (SD = 2.63; p < 0.05, 95% CI = 3.88-4.61). The mean FPPS score before treatment was 10.77 (SD = 6.39; p < 0.05, 95% CI = 9.88-11.65). Posttreatment mean FPPS score was 7.42 (SD = 5.87; p < 0.05, 95% CI = 6.61-8.23). Analysis of subcategories within FPPS indicated statistically significant improvement in the categories of intercourse, working, and sleeping.

CONCLUSION: Findings show the treatment was efficient at decreasing pain in CPP patients. Results show promise for improving overall pelvic functionality, particularly within the categories of intercourse, sleeping, and working.

PMID:34082473 | DOI:10.1002/nau.24726

Aorta (Stamford). 2021 Jun 3. doi: 10.1055/s-0040-1719113. Online ahead of print.

ABSTRACT

BACKGROUND: Connective tissue disorders could contribute to the pathogenesis of both abdominal aortic aneurysms (AAA) and hernias. We tested the hypothesis that hernias in AAA patients contribute to increased severity of the aneurysmal disease.

METHODS: A questionnaire was used to collect information from 195 AAA patients divided into four groups: (1) survivors (n = 22) of ruptured AAA, (2) patients (n = 90) after elective open repair, (3) patients (n = 43) after elective endovascular repair (EVAR), and (4) patients (n = 40) under surveillance of AAA. The control group consisted of 100 patients without AAA whose abdominal computed tomography (CT) scans were examined for the presence of hernias. Mann-Whitney U-test, Chi-squared (χ ²) test, or Fisher’s exact test (as appropriate) were used for statistical analyses. Multivariate logistic regression was used to control for potential confounding variables such as sex and age.

RESULTS: The prevalence of inguinal hernias was significantly higher in the AAA than the control group (25 vs. 9%, p = 0.001) and did not differ between the AAA subgroups (9, 24, 35, and 23% in subgroups 1 through 4, respectively, p = 0.15) based on univariate analysis. The prevalence of inguinal hernias did not differ (p = 0.15) between the two open surgery groups (groups 1 and 2), or when comparing all three operative procedures as a combined group to group 4 (p = 0.73). The prevalences of incisional hernias were 18 and 24% for groups 1 and 2, respectively, with no significant difference (p = 0.39). Inguinal hernia demonstrated a significant association with AAA on multivariate analysis (p = 0.006; odds ratio [OR] = 4.00; 95% confidence interval [CI] = 1.49-10.66).

CONCLUSIONS: Our study confirms previous observations that patients with AAA have a high prevalence of hernias. Our results suggest that hernias do not contribute to increased severity of the aneurysmal disease.

PMID:34082466 | DOI:10.1055/s-0040-1719113

J Am Acad Audiol. 2021 Jun 3. doi: 10.1055/s-0041-1722988. Online ahead of print.

ABSTRACT

BACKGROUND: Research suggests Deaf individuals have longstanding negative perceptions of their interactions with health care providers, primarily due to communication barriers. One way to improve relations would be for audiologists to learn clinically relevant sign language.

PURPOSE: The aim of the study is to gain a better understanding of audiologists’ knowledge of Deaf culture and American Sign Language (ASL) and evaluate motivation for instruction in signing abilities.

RESEARCH DESIGN: A 21-question survey was emailed and advertised in a social media group for audiologists. The survey was divided into four sections: (1) demographics, (2) education of ASL and Deaf culture, (3) experience with ASL and Deaf culture, and (4) motivation to learn clinical signs.

DATA ANALYSIS: Descriptive statistics were analyzed for quantitative analysis of survey responses.

RESULTS: A total of 489 responses were obtained and analyzed. Majority of respondents (82.6%) completed a manual ASL course, though only a third reported exposure to clinically relevant signs (37.4%). The majority of respondents rated their signing abilities at the word level, and knowing somewhere between 5 and 20 signs, expressively (50.5%) and receptively (53.9%). Results illustrate the majority of audiologists (54.5%) feel their clinical signing abilities need to be improved and were either highly (30.9%) or somewhat motivated (42.1%) to do so.

CONCLUSION: Study results suggest that although participants are enrolling in and completing ASL courses, clinical signs are not routinely included. This omission leads to reduced signing ability, potentially harming the provider-patient relationship. The majority of survey respondents reported that they are strongly motivated to improve their signing abilities. Results of the present study suggest there is need for a comprehensive clinical signs resource for audiologists to provide quality patient care to their Deaf patients. At present, there is no known, available tool to help accomplish this need.

PMID:34082464 | DOI:10.1055/s-0041-1722988

J Am Acad Audiol. 2021 Jun 3. doi: 10.1055/s-0041-1728754. Online ahead of print.

ABSTRACT

BACKGROUND: Since the hearing and vestibular organs are close to each other, the correlation between hearing and balance is one of the principal issues, especially in people with hearing loss.

PURPOSE: In this study, the effect of the auditory system on human balance performance was investigated by comparing the balance status of hearing-impaired children in the aided and unaided situations.

RESEARCH DESIGN: In this cross-sectional study a group of children were assigned the task to compare the balance sways in two aided and unaided situations.

STUDY SAMPLING: A total of 90 children aged 7 to 10 years with severe to profound congenital hearing loss and the healthy vestibular system of both genders served as the research population.

DATA COLLECTION AND ANALYSIS: After a complete evaluation of the hearing and vestibular system and validation of the hearing aid performance, body sway was recorded using the pediatric clinical test of sensory interaction for balance in aided and unaided situations in the presence of background noise from the speaker.

RESULTS: According to this study, there was no difference in body sway in aided and unaided situations for conditions 1, 2, and 3. In comparison, in conditions 4, 5, and 6 of the test, there was a statistically significant difference in body sway between aided and unaided situations. However, there was no difference in the sway of the body in aided and unaided situations between girls and boys.

CONCLUSION: According to this study, hearing aids can improve balance in challenging listening environments.

PMID:34082460 | DOI:10.1055/s-0041-1728754

AIDS Rev. 2021 Jun 3. doi: 10.24875/AIDSRev.200001071. Online ahead of print.

ABSTRACT

The safety of using different antiretroviral therapies (ART) in pediatric HIV/AIDS patients is not well-established. Therefore, this study aimed to assess the safety of ART in children. A systematic review of randomized clinical trials (RCTs) was conducted to assess the safety of ART used by pediatric patients living with HIV/AIDS. The electronic search was conducted in PubMed and Scopus, in addition to a manual search. Studies were included if they assessed the safety of ART compared to placebo or another ART. Direct and indirect meta-analyses were conducted regarding safety outcomes. The systematic review included 21 RCTs. The studies included more than 5500 participants, and age ranged from 3 months to 18 years. The drugs evaluated were nucleoside reverse transcriptase inhibitors (NRTI); non-NRTI; and protease inhibitors. The predominant route of infection was vertical. Direct meta-analyses were performed for the outcomes sleep disorders, hepatobiliary disorders, respiratory disorders, hypertransaminasemia, neutropenia, hospitalization, and death. For these outcomes, no statistically significant differences were found. Indirect meta-analyses were performed for the outcomes anemia, gastrointestinal disorders, liver disorders, severe adverse events (AE), AE that led to changes in treatment, fever, and skin manifestations. However, no statistically significant differences were found for these outcomes. In this study, non-significant differences were detected in the safety of different ART used in pediatric individuals. The choice of appropriate therapy should be based on its efficacy and the individual characteristics of each patient.

PMID:34082441 | DOI:10.24875/AIDSRev.200001071

AIDS Rev. 2021 Jun 3. doi: 10.24875/AIDSRev.20000103. Online ahead of print.

ABSTRACT

A new strategy of simplification therapy shown the unique benefits in clinical treatment, by reducing pill burden and avoid drug exposure. To provide more evidence for the strategy, we compared the efficacy and safety of dolutegravir (DTG)-containing simplified dual combination antiretroviral therapy (cART) and traditional triple cART for people living with HIV/AIDS. The meta-analysis of randomized controlled trials compared DTG-containing dual therapy with triple cART. The primary outcome was virologic suppression. The secondary outcomes included CD4T cell recovery, lipids change from baseline, and adverse events (AEs). A total of 7 studies, 4852 patients were eligible, 2423 (49.9%) received DTG-based simplified dual cART, and 2429 (50.1%) received triple cART. The viral suppression rate was 94.7% at 24 weeks, 93.0% at 48 weeks, and 96.6% at 96 weeks in dual cART. The viral suppression rate of dual cART was non-inferior to triple cART at 24 weeks (risk difference [RD], -0.00; 95% confidence interval [CI] -0.02-0.01), at 48 weeks (RD, -0.01; 95% CI -0.02-0.01), and at 96 weeks (RD, -0.01; 95% CI -0.02-0.00). Sub-analysis results were consistent with the overall results. With regard to other outcomes (CD4T counts, lipids, any AEs, and AEs grade ≥ 3), there was no significant statistical difference between the two regimens. DTG-based simplified dual cART was non-inferior to triple cART in terms of efficacy and safety. This finding provides strong support for current consensus guidelines recommended the dual regimen as first-line treatment.

PMID:34082439 | DOI:10.24875/AIDSRev.20000103

Dis Colon Rectum. 2021 Jun 1. doi: 10.1097/DCR.0000000000001986. Online ahead of print.

ABSTRACT

BACKGROUND: Radiation dose schedules for neoadjuvant chemoradiation for rectal cancers differs, with the most common dose schedule using 5040 cGy in 28 fractions.

OBJECTIVES: The aim of this retrospective study was to assess the benefit of higher radiation doses beyond 5040cGy in the context of pathological response and follow up events.

SETTING: Database from a provincial tertiary cancer center in Canada.

PATIENTS: Five hundred eight consecutive rectal cancer patients with locally advanced disease (clinical T3/T4 or N1/N2) who received neoadjuvant chemoradiation followed by surgery were included in this study. Of the 508 patients, 281 received the standard radiation dose of 4500-5040 cGy and 227 received a dose >5040 cGy.

MAIN OUTCOME MEASURE: The postsurgical pathology, late toxicities and follow-up outcomes were analyzed. The outcomes were evaluated in relation to the dose of radiation received.

RESULTS: Data regarding the clinical outcomes were comparable between the 4500-5040 cGy and >5040 cGy radiation groups with pathological complete response rates of 20.9% and 15.4% respectively (p=0.104); distant recurrence rates of 17.4% and 19.4%, respectively (p=0.36); local recurrence rates of 3.2% and 3.5%, respectively (p=0.36); and the median overall survival rates of 61 and 60.5 months respectively (p=0.8). No statistically significant correlation of improvement in outcomes was noted with radiation doses beyond 5040 cGy.

LIMITATIONS: This is a retrospective study.

CONCLUSION: Our study showed that dose escalation beyond the standard dose of 4500-5040cGy failed to achieve meaningful clinical outcomes. See Video Abstract at http://links.lww.com/DCR/B633.

PMID:34082437 | DOI:10.1097/DCR.0000000000001986

Spectrochim Acta A Mol Biomol Spectrosc. 2021 May 21;260:119987. doi: 10.1016/j.saa.2021.119987. Online ahead of print.

ABSTRACT

Six sequential spectrophotometric-based univariate methods were developed and validated for the simultaneous estimation of three novel anticancer drugs vandetanib (VAN), dasatinib (DAS), and sorafenib (SOR) in a mixture, without the requirement for separation. These methods are novel, simple, precise, and accurate. Different steps including zero crossing, ratio-based, and/or derivative spectra were utilized to develop these analytical methods, namely, ratio difference spectrophotometric method, constant center method, successive derivative ratio method, isoabsorptive method, mean centering of the ratio spectra method, and derivative ratio spectrum-zero crossing method. The calibration curve linearity was ranged from 2 to 9, 2-9, and 3-9 μgmL^-1 for VAN, DAS, and SOR, respectively. These established methods were applied for the quantification of the three selected drugs in different biological fluids (spiked human plasma and urine) and pharmaceutical preparations. The aforementioned methods were established for the concurrent estimation of ternary and binary mixtures to enhance the signal-to-noise ratio. The results did not statistically differ from the other reported methods, indicating no significant difference in accuracy and precision at p = 0.05.

PMID:34082354 | DOI:10.1016/j.saa.2021.119987

J Environ Manage. 2021 May 31;293:112890. doi: 10.1016/j.jenvman.2021.112890. Online ahead of print.

ABSTRACT

In reality, economic expansion cannot be paced-up enough. This account for a potential trade-off between income and environmental degradation that is expectedly feasible at a maximum level of income. On this note, the current study looked at the validity of income-environmental degradation (Environmental Kuznets Curve, EKC) hypothesis especially amidst risk to investment in the United States over the period 1984-2017. Considering that the burning of fossil fuels constitutes the largest source of Greenhouse gas (GHG) in the United States, this study employed energy carbon emissions as a proxy for environmental quality and as a dependent variable. While the study employed renewable energy production as additional explanatory variable, it implemented the Autoregressive Distributed Lag (ARDL) technique in addition to a set of cointegration techniques. Importantly, the study found that the EKC hypothesis is valid for the case of the United States but not without a non-significant trade-off of risk to investment. Additionally, renewable energy production exhibits a statistically significant and desirable impact on environmental quality in both the short and long-run. In general, the study posited that while environmental sustainability is achievable at maximum level of income, it is likely attainable at the detriment of risk to investment. Hence, this observation should trigger a potential policy mechanism that minimizes risk to investment in light of the attainment of the country’s sustainable development goals (SDGs).

PMID:34082348 | DOI:10.1016/j.jenvman.2021.112890

J Environ Manage. 2021 May 31;293:112897. doi: 10.1016/j.jenvman.2021.112897. Online ahead of print.

ABSTRACT

Water scarcity poses a real crisis for decision makers of water supply system because satisfying growing demand and, as a result, achieving full consumer satisfaction in different sectors of the system remains a major problem. Therefore, this study develops a dynamic multi-objective model of water supply optimization under different scenarios to improve multisectoral consumer satisfaction. To diminish the negative effects of the water crisis on long-term consumer satisfaction, the performance of the dynamic water supply system is evaluated and optimized, which can change the situation from a state of dissatisfaction to satisfaction. In this regard, to analyze the developed model, a real case study of the Hamoun wetland in southeastern Iran is considered. According to the proposed model, various strategies are performed along with the analysis of two scenarios related to runoff uncertainty in order to investigate the consumer satisfaction status in detail. However, given to the final results, which show the greater impact of the two sensitive factors of reliability and vulnerability on consumer satisfaction, the highest level of dissatisfaction is related to the agricultural sector because it has less reliability and higher vulnerability compared to other sectors. In this regard, by proposing policies such as weight scenarios and demand reduction scheme, the situation of consumer satisfaction has improved much more desirable.

PMID:34082342 | DOI:10.1016/j.jenvman.2021.112897