Nevin Manimala

Nurse Educ Today. 2021 Sep 11;107:105143. doi: 10.1016/j.nedt.2021.105143. Online ahead of print.

ABSTRACT

BACKGROUND: Research has confirmed a lack of knowledge regarding the risks of unused medications including diversion, misuse, or accidental overdose among health care professionals (Abdulmajeed, 2020). Nurses and pharmacists are often who patients interact with the most regarding medications; therefore, early education on proper storage and disposal is vital (Bowen, Rotz, Patterson, & Sen, 2017; Celio, Ninane, Bugnon, & Schneider, 2018).

OBJECTIVES: The study’s objective is to explore safe drug storage and disposal knowledge, attitudes, and practices of professional pharmacy (Pharm.D.) and nursing students.

DESIGN: This research is an exploratory cross-sectional study from May to September 2019.

METHODS: An anonymous online survey was administered to a purposive sample of Pharm.D. and nursing students who were 18 years and older and enrolled in the site’s accredited Pharm.D. and nursing programs (N = 210). Responses were analyzed using descriptive statistics.

RESULTS: Common disposal methods reported by students of their personal medications such as pills and liquids included discarding medications with the household trash (range 30% to 55%) and medication disposal products/bag (range 19% to 28%). More than half of the participants (50.4%) had unused prescription medication at home, 35% kept the medication for later use, and almost 20% of the participants reported sharing personal medications with others.

CONCLUSION: Although the majority of student participants had adequate knowledge of the appropriate methods for safe drug disposal, few reported using them for their own personal medications. The findings suggest there is a disconnect between the participants’ knowledge of the appropriate methods of safe drug storage and disposal in a professional setting and their own practices. Further research is needed to explore and address the reasons for this disconnect. Additionally, findings from this research will assist in the development of and/or the improvement of interdisciplinary educational materials among pharmacy and nursing students.

PMID:34583239 | DOI:10.1016/j.nedt.2021.105143

Mult Scler Relat Disord. 2021 Sep 21;56:103274. doi: 10.1016/j.msard.2021.103274. Online ahead of print.

ABSTRACT

BACKGROUND: multiple sclerosis (MS) is a complex disease sustained by several pathogenic mechanisms. As such, combination therapy strategies, targeting a range of disease mechanisms, might represent the ideal therapeutic approach. Here we investigated the efficacy of curcumin, a naturally occurring poly-phenolic phytochemical with potent anti-inflammatory and antioxidant properties, in subjects under treatment with IFN β-1a, to test the effects of this combination therapy on clinical and MRI parameters of inflammation and neurodegeneration in relapsing MS (RMS).

METHODS: eighty active RMS were prospectively enrolled, randomized (1:1) to either the IFN-curcumin or the IFN-placebo group and followed up longitudinally with clinical and MRI assessments for 24 months. Primary endpoint was the efficacy of curcumin versus placebo as add-on therapy on new/enlarging T2 lesions in RMS subjects under treatment with subcutaneous IFN β-1a 44 mcg TIW. Efficacy on clinical parameters (relapses and disability progression), other MRI parameters of inflammation (T1 Gd-enhancing lesions, combined unique active-CUA lesions) and neurodegeneration (T1-hypointense lesions, grey matter loss and white matter microstructural damage) as well as safety and tolerability of curcumin were explored as secondary endpoints.

RESULTS: ten subjects dropped out from the study by month 12 (6 in the IFN-curcumin group and 4 in the IFN-placebo group), and 27 by month 24 (11 in the IFN-curcumin group and 16 in the IFN-placebo group). Although no between-group difference was present in terms of proportion of subjects free from new/enlarging T2 lesions, a lower proportion of patients with CUA lesions was noted at month 12 in the IFN-curcumin group in comparison with the IFN-placebo group (7.5% vs 17.5%, χ² test p= 0.0167). This result was not confirmed at month 24. The statistical analysis failed to reveal any difference between the two treatment groups – IFN-curcumin and IFN-placebo – in terms of relapses, disability progression, other MRI metrics of inflammation and MRI changes suggestive of ongoing neurodegeneration. No difference in the rate and nature of adverse events was observed between the two treatment groups.

CONCLUSION: Although the study drop-out rate was too high to allow definite conclusions, our findings suggest that curcumin might add to IFN β-1a efficacy on radiological signs of inflammation in MS, while it did not seem to exert any neuroprotective effect as assessed by clinical and MRI parameters. (NCT01514370).

PMID:34583214 | DOI:10.1016/j.msard.2021.103274

Nutr Res. 2021 Aug 23;94:25-33. doi: 10.1016/j.nutres.2021.08.003. Online ahead of print.

ABSTRACT

The impact of myosteatosis on the outcomes of digestive malignancies has gained great attention recently. However, studies on the impact of myosteatosis show inconsistent results. We conducted a meta-analysis to clarify the relationship between myosteatosis and the overall survival of digestive cancer patients. The systematic literature search was conducted on PubMed/MEDLINE, Web of Science, and Embase from inception through March 27, 2021. Meta-analysis was performed using the random-effects model. Out of 3451 studies screened, 47 studies including 21,194 patients passed the screening criteria. The average prevalence of myosteatosis was 46.4%. Patients with myosteatosis had 44% increased mortality risk compared with non-myosteatosis patients (HR: 1.44, 95% CI: 1.33-1.55, P < .05). The predictive value of myosteatosis held regardless of country zone, study design, statistical model, Newcastle-Ottawa Scale (NOS) scores, treatment, sample size, and tumor stage. Nevertheless, the predictive value of myosteatosis was only evident for patients with esophagogastric cancers, cholangiocarcinoma/pancreatic cancers, or colorectal cancers. Overall, the results of this meta-analysis were robust based on sensitivity, subgroup, meta-regression, and trial sequential analyses and suggested that myosteatosis predicted worse overall survival (OS) in digestive malignancies patients.

PMID:34583210 | DOI:10.1016/j.nutres.2021.08.003

Atherosclerosis. 2021 Sep 23;335:62-67. doi: 10.1016/j.atherosclerosis.2021.09.026. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: The association of plasma trimethylamine N-oxide (TMAO) with atherosclerotic cardiovascular disease (ASCVD), diabetes mellitus (DM) and its determinants, as well as the role of TMAO as a predictor for short and long-term mortality, is still under discussion. We investigated associations between four plasma metabolites of the TMAO pathway and different clinical manifestations of atherosclerosis, diabetes determinants, and risk of short and long-term mortality in patients with stable ASCVD, acute myocardial infarction (AMI), cardiogenic shock (CS), and DM in three independent cohorts.

METHODS: TMAO and its dietary precursors were simultaneously quantified by liquid chromatography-tandem mass spectrometry in a total of 2655 participants of the German Leipzig Research Center for Civilization Diseases (LIFE)-Heart study, LIFE-Adult study, and the European Culprit Lesion Only PCI versus Multivessel PCI in Cardiogenic Shock (CULPRIT-SHOCK) multicenter trial. Associations with ASCVD manifestations, metabolic syndrome, 30-day mortality of patients with AMI and CS, and long-term mortality of subjects with suspected coronary artery disease (CAD) were analyzed.

RESULTS: TMAO plasma levels were not independently associated with stable ASCVD. Elevated TMAO plasma concentrations were independently associated with obesity (odds ratio, 1.23; p < 0.01) and DM (odds ratio, 1.37; p < 0.001) in LIFE-Heart. The latter association was confirmed in LIFE-Adult. We found no association of TMAO plasma levels with short-term mortality in patients with AMI and CS. However, TMAO plasma levels were independent predictors of long-term mortality in patients with suspected CAD (hazard ratio, 1.24; p < 0.05).

CONCLUSIONS: Potential proatherogenic mechanisms of TMAO seem to have no short-term effect in AMI. Presented associations with diabetes mellitus and obesity suggest that TMAO might have a functional role in metabolic syndrome.

PMID:34583200 | DOI:10.1016/j.atherosclerosis.2021.09.026

Gait Posture. 2021 Sep 20;90:415-421. doi: 10.1016/j.gaitpost.2021.09.185. Online ahead of print.

ABSTRACT

BACKGROUND: Understanding the kinematic characteristics of relapse clubfoot compared to successfully treated clubfoot could aid early identification of a relapse and improve treatment planning. The usage of a multi segment foot model is essential in order to grasp the full complexity of the multi-planar and multi-joint deformity of the clubfoot.

RESEARCH QUESTION: The purpose of this study was to identify differences in foot kinematics, using a multi-segment foot model, during gait between patients with Ponseti treated clubfoot with and without a relapse and age-matched healthy controls.

METHODS: A cross-sectional study was carried out including 11 patients with relapse clubfoot, 11 patients with clubfoot and 15 controls. Gait analysis was performed using an extended Helen Hayes model combined with the Oxford Foot Model. Statistical analysis included statistical parametric mapping and discrete analysis of kinematic gait parameters of the pelvis, hip, knee, ankle, hindfoot and forefoot in the sagittal, frontal and transversal plane.

RESULTS: The relapse group showed significantly increased forefoot adduction in relation with the hindfoot and the tibia. Furthermore, this group showed increased forefoot supination in relation with the tibia during stance, whereas during swing increased forefoot supination in relation with the hindfoot was found in patients with relapse clubfoot compared with non-relapse clubfoot.

SIGNIFICANCE: Forefoot adduction and forefoot supination could be kinematic indicators of relapse clubfoot, which might be useful in early identification of a relapse clubfoot. Subsequently, this could aid the optimization of clinical decision making and treatment planning for children with clubfoot.

PMID:34583148 | DOI:10.1016/j.gaitpost.2021.09.185

Emergencias. 2021 Oct;33(5):368-373.

ABSTRACT

OBJECTIVES: To analyze the association between the perceived care demand in the emergency call center of Castilla La Mancha (and hospital and ICU admissions for COVID-19, as well as their temporal characteristics, to explore its potential capacity as a predictive tool for COVID hospital admissions.

MATERIAL AND METHODS: Retrospective observational study on the daily calls made to the emergency call center of Castilla La Mancha, both calls to 112 and those made to COVID line, in the period between March 1 and October 14, 2020. The data were analyzed by codes “diarrhea”, “dyspnea”, “fever” and “general discomfort” that were used as predictor variables, and their relationship with hospital admissions and ICU admissions.

RESULTS: A total of 831,943 calls were received at the CLM emergency call center through 112, with a maximum on March 13, 2020 with 10,582 calls. On COVID line, a total of 208,803 calls were received in that period, with a maximum on March 15 with 23,744. A statistically significant relationship was found between the regulation codes studied (specific symptoms) and the number of calls with hospital admissions and ICU admissions, with a predictive capacity of 2 weeks in relation to occupancy peaks. The codes with the greatest relationship were “general malaise” and “diarrhea”.

CONCLUSION: We have found an association between the number of calls to a CCUE due to dyspnea, fever, general discomfort, diarrhea and the number of calls with hospital admissions and ICU for COVID-SARS-2 2 weeks in advance, mainly due to general discomfort and diarrhea. The design of predictive expert systems and their automation using artificial intelligence could be part of the preparation, planning and anticipation programs of health systems in the near future in the event of future pandemics.

PMID:34581530

Integr Environ Assess Manag. 2021 Sep 28. doi: 10.1002/ieam.4525. Online ahead of print.

ABSTRACT

Trace elements like copper and zinc are supplemented in swine feeds to suppress bacteria and/or promote growth. Due to the low absorption rates, trace elements are greatly concentrated in swine feces, posing a potential risk to soil environment and human health if applied to agricultural fields. In the present study, the concentrations of six trace elements (Cu, Zn, As, Cd, Pb, and Cr) in pig feed and feces were evaluated by sample analysis and gathering data from literature. The feed-to-feces and feces-to-compost enrichment factors of the trace elements were determined to back-calculate safe concentrations in feed needed to meet permissible trace element concentrations in organic fertilizer. The Cu and Zn concentrations in feeds were highest, being statistically significantly higher in starter pig feeds than in grower-finisher feeds. Copper exceeded feed limits mainly in the feeds of finisher pigs and sows, while exceedance for Zn occurred in almost all feed samples. Concentrations above the limits were also observed for Pb and Cr impurities in mineral feed supplements. The highest Cu and Zn concentrations in feces were observed for starter pigs. Moreover, significant enrichment of trace elements from feeds to feces was found, with enrichment factors determined of 4.68-6.11 for Cu, 3.43-4.60 for Zn, 2.30-3.12 for As, 2.89-4.63 for Cd, 2.45-5.00 for Pb, and 3.32-5.00 for Cr, respectively. On this basis, the recommended calculated limits for Cu, Zn, As, Cd, Pb, and Cr in the feeds for different ages of pigs were 41-53, 130-175, 2-3, 0.3-0.5, 5-10, and 15-23 mg/kg, respectively. Priority index calculations and the calculated recommended limits for feeds indicated that Cu in starter pig feeds and Cd in starter and breeding pig feeds should be prioritized for reduction to enable feces composts to be utilised safely in agricultural land amendment. This article is protected by copyright. All rights reserved.

PMID:34581489 | DOI:10.1002/ieam.4525

Stat Med. 2021 Sep 28. doi: 10.1002/sim.9208. Online ahead of print.

ABSTRACT

In this article, we discuss an extension of the classical negative binomial cure rate model with piecewise exponential distribution of the time to event for concurrent causes, which enables the modeling of monotonic and non-monotonic hazard functions (ie, the shape of the hazard function is not assumed as in traditional parametric models). This approach produces a flexible cure rate model, depending on the choice of time partition. We discuss local influence on this negative binomial power piecewise exponential model. We report on Monte Carlo simulation studies and application of the model to real melanoma and leukemia datasets.

PMID:34581460 | DOI:10.1002/sim.9208

Cardiol J. 2021 Sep 28. doi: 10.5603/CJ.a2021.0108. Online ahead of print.

ABSTRACT

BACKGROUND: Myocardial reperfusion is the main target of treatment in patients with ST-segment elevation myocardial infarction (STEMI). The intracoronary administration of cangrelor bolus could favor a higher local drug concentration, favoring an earlier thrombotic resolution and a reduced distal micro-embolization.

METHODS: Seventy-one patients undergoing primary percutaneous coronary intervention (PCI) for STEMI: 37 treated with intracoronary and 34 with intravenous bolus administration of cangrelor. The primary endpoint was ST-elevation reduction (STR) ≥ 50% after 30 min from the end of the PCI. Other explorative reperfusion indices investigated were: STR ≥ 50% at 24 hours, STR ≥ 70% at 30 min, Thrombolysis In Myocardial Infarction frame count and the QT dispersion (QTd). Moreover, acute and subacute stent thrombosis, bleeding events and 30-day mortality have been evaluated.

RESULTS: More frequent STR ≥ 50% was observed in the intravenous cangrelor bolus group as compared to the intracoronary administration at 30 min (71.9% vs. 45.5%; p = 0.033), the difference was maintained 24 hours after PCI (87.1% vs. 63.6%; p = 0.030). STR ≥ 70% at 30 min was statistically more frequent in the intravenous bolus administration cohort (66.7% vs. 28.6% p = 0.02). At multivariable analysis, intravenous cangrelor administration was significantly related to STR ≥ 50% (odds ratio: 3.586; 95% confidence interval: 1.134-11.335; p = 0.030). The incidence of Bleeding Academic Research Consortium 3-5 bleedings was 15.5% and mortality was 4.2% without any significant difference between the two groups.

CONCLUSIONS: In conclusion the results of the study do not show any advantages in the administration of intracoronary bolus of cangrelor in patients affected by STEMI and treated with primary PCI.

PMID:34581427 | DOI:10.5603/CJ.a2021.0108

Cardiol J. 2021 Sep 28. doi: 10.5603/CJ.a2021.0109. Online ahead of print.

ABSTRACT

BACKGROUND: Several scoring systems have been developed in order to predict percutaneous coronary intervention (PCI) result of chronic total occlusion (CTO). The scores principally include anatomic and clinical variables. Operator experience is a decisive factor for achieving successful result. We sought to assess the real impact of operator growing experience on CTO-PCI success.

METHODS: The angiographic and clinical variables of CTO-PCIs performed in our center between May 2007 and April 2021 were collected, and variables with potential association with procedural result were thoroughly reviewed. The influence of operator experience based on the number of previous CTO-PCIs was statistically assessed. A scoring system with combination of anatomic variables and operator experience was devised.

RESULTS: A total of 540 PCIs in 457 patients were performed in our institution. The scoring model was developed from the derivation set (2/3 of the cohort). The final variables in logistic regression model were CTO length ≥ 20 mm, blunt stump, vessel tortuosity > 45o and operator experience < 100 PCIs. The model showed good performance in the derivation set (area under curve [AUC]: 0.768; confidence interval [CI]: 0706-0.830; p < 0.001) with no significant shrinkage in the validation set (AUC: 0.704; CI: 0.613-0.796; p < 0.001).

CONCLUSIONS: This new score (E-CTO score) adequately predict the probability of CTO-PCI failure. The model includes a variable representing operator experience along with other anatomic variables.

PMID:34581426 | DOI:10.5603/CJ.a2021.0109