Nevin Manimala

J Sex Med. 2021 Dec;18(12):2005-2011. doi: 10.1016/j.jsxm.2021.09.016.

ABSTRACT

BACKGROUND: Erectile dysfunction is one of many conditions associated with depression, but few studies exist to establish the risk of major depressive disorder (MDD) in the large population of men with erectile dysfunction, and it is unclear whether erectile dysfunction (ED) treatment is associated with decreased rates of MDD.

AIM: We determined the risk of major depressive disorder in men with erectile dysfunction and evaluated whether treatment of ED with phosphodiesterase-5 inhibitor or penile prosthesis is associated with a lower risk of developing major depressive disorder.

METHODS: We reviewed a large, retrospective, cohort that utilized electronic health record data collected by the TriNetX Research Network, a global federated database that provides healthcare data for analysis. We performed multiple comparisons: men with ED against men without ED; men with ED treated with phosphodiesterase-5 inhibitors against untreated ED patients, and of men with ED who received penile prosthesis against those who did not. We assessed major depressive disorder (ICD-10-CM F32-F33) as a primary outcome and used propensity score matching to control for ethnicity, race, type 2 diabetes mellitus (E11), essential hypertension (I10), acute myocardial infarction (I21), chronic ischemic heart disease (I25), cerebral infarction (I63), overweight and obesity (E66), personal history of nicotine (Z87.891), hypogonadism (E29.1), and alcohol related disorders (F10).

OUTCOMES: We assessed new diagnosis of major depressive disorder (F32-F33) within a 3-year time window following index event of ED diagnosis, visit to healthcare organization, or ED treatment with phosphodiesterase-5 inhibitor or penile prosthesis as the primary outcome.

RESULTS: ED was associated with major depressive disorder both before and after (OR 2.00, 95% CI 1.94-2.06) controlling for confounding variables through propensity score matching. Men who received ED therapies had lower rates of depression compared to those who did not, whether they were treated with phosphodiesterase-5 inhibitor (0.80, 0.77-0.83) or penile prosthesis (0.73, 0.60-0.89).

STRENGTHS AND LIMITATIONS: Strengths include a large sample size and robust statistical techniques. Limitations include lack of detailed information regarding clinical severity and socioeconomic factors.

CLINICAL IMPLICATIONS: Our findings indicate that clinicians should consider evaluating depressive symptoms among men with erectile dysfunction and counsel them regarding the risk of developing major depressive disorder.

CONCLUSIONS: Erectile dysfunction is associated with major depressive disorder, but treatment is associated with decreased rates of MDD. S Nackeeran, A Havanur, J Ory, et al. Erectile Dysfunction is a Modifiable Risk Factor for Major Depressive Disorder: Analysis of a Federated Research Network. J Sex Med 2021;18:2005-2011.

PMID:34857255 | DOI:10.1016/j.jsxm.2021.09.016

Clin Nutr ESPEN. 2021 Dec;46:532-538. doi: 10.1016/j.clnesp.2021.08.007. Epub 2021 Sep 9.

ABSTRACT

BACKGROUND AND AIMS: European and North American guidelines on Parenteral Nutrition (PN) and large Randomized Controlled Trials give divergent advices on nutritional therapeutic strategies for critically ill patients. We therefore investigated differences in therapeutic strategies of clinicians between European and Non-European Intensive Care Units (ICU) regarding start day of PN, preferred route of administration and prescription of total energy targets over the years.

METHODS: In this study 16,032 patients from 1389 different ICUs were included. Data collection was performed in 28 different European and Non-European ICUs from 2007 to 2018 via nutritionDay, a worldwide-standardized one-day multinational cross-sectional audit.

RESULTS: In this analysis an abrupt delay in PN start days was observed in 2011 (7.64 days (4.31; 19.97); p = 0.001) and 2012 (6.41 days (3.1; 9.72); p = 0.001), which was significantly reversed within the following years until 2018. In European, compared to Non-European countries PN prescription was increased (27% versus 13%). Patients from North-America received significantly less kcal per day compared to Europe (-4.3 kcal kg^-1 (-6.9; -1.6); p = 0.001).

CONCLUSIONS: Our study provides further evidence on transatlantic discrepancies in nutritional therapy of ICU patients. Regular audits, such as nutritionDay are substantial for self-reflection of clinical daily practice of intensivists. It is time for worldwide consensus in nutritional therapy by developing worldwide guidelines and supporting standardization in nutrition care of critically ill patients.

PMID:34857246 | DOI:10.1016/j.clnesp.2021.08.007

Zhonghua Yi Xue Za Zhi. 2021 Dec 7;101(45):3724-3729. doi: 10.3760/cma.j.cn112137-20210416-00919.

ABSTRACT

Objective: To investigate the effect of the cortical bone trajectory (CBT) screw fixation combined with midline lumbar fusion (MIDLF) for adjacent spondylopathy after posterior lumbar interbody fusion. Methods: A retrospective analysis was conducted in 16 patients, including 9 males and 7 females, with a mean age of (68±6) years, who underwent revision surgery for adjacent spondylopathy after posterior lumbar fusion surgery using CBT combined with MIDLF technology in Sir Run Run Shaw Hospital, Zhejiang University from May 2013 to August 2019. The reasons for revision were radiculalgia in 4 cases, intermittent claudication in 10 cases and protrusive dissociate in 2 cases. Eleven cases had 1 segment fused in the first operation, while the other 5 cases received fusion in 2 segments. The average interval time between the first operation and the revision operation was (7.5±2.0) years. For the levels underwent revision, 1 case was L_2/3, 6 cases were L_3/4, 7 cases were L_4/5 and 2 cases were L₅/S₁. Before the operation, all the patients took X-rays scans of the thoracic and lumbar spine. CT and MRI scans were also performed. The operation time, intraoperative bleeding, surgical complications, visual analog scale (VAS) of low back and leg pain before the operation and at each follow-up were all recorded. Oswestry disability index (ODI) questionnaire was used to evaluate the functional improvement of patients after the operation. Results: All operations were completed successfully. The operation time was 120-240 (170±30) mins, intraoperative bleeding was 100-280 (220±45) ml. One case had a slight split in the isthmus, and the screw was inserted smoothly after adjusting the insertion point. In one case, the cerebrospinal fluid leaked during the operation and was successfully treated with conservative methods including no pillow supine treatment and strengthened anti-infection. The average follow-up time was of (19.5±1.3) months. The VAS of low back pain was 2.9±1.7 before the operation and it was 1.8±0.5 at the last follow-up, and the difference was statistically significant (P<0.01). The VAS of leg pain was 5.9±1.5 before the operation and it was 1.5±0.4 at the last the follow-up (P<0.01). The ODI score was 34.5±3.2 preoperatively and it decreased to 12.6±4.2 at the last follow-up, the difference was statistically significant (P<0.01). Conclusion: CBT technique combined with MIDLF for the adjacent-segment disease after posterior lumbar interbody fusion is minimally invasive and convenient, with good clinical effects. This technique can be used as an option for the revision of adjacent spondylopathy.

PMID:34856700 | DOI:10.3760/cma.j.cn112137-20210416-00919

Zhonghua Er Ke Za Zhi. 2021 Dec 2;59(12):1048-1054. doi: 10.3760/cma.j.cn112140-20210703-00549.

ABSTRACT

Objective: To summarize the clinical characteristics of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and compare the differences in efficacy of different disease-modifying drugs. Methods: An ambispective cohort study was conducted in 42 children diagnosed with MOGAD at Department of Pediatrics, Peking University First Hospital from January 2012 to March 2021 and conducted long-term follow-up to analyze clinical phenotypes and compare the efficacy of different disease-modifying drugs such as rituximab, mycophenolate mofetil and azathioprine. Kruskal-Wallis H test was used to compare the annual relapse rate of disease-modifying drugs at different times, expanded disability status scale (EDSS) score at the last follow-up, and Wilcoxon rank test was used to compare the annual relapse rate before and after modified disease therapy. The Log-rank (Mantel-Cox) survival curve was used to compare the relapse rate of different disease-modifying drugs. Results: Of the 42 cases, 22 were male and 20 were female, with the age at disease onset of 5.96 (2.33-12.90) years. The disease duration was 4.46 (1.25-13.00) years at the last follow-up with 161 clinical acute attacks. Acute disseminated encephalomyelitis (ADEM) was the most common phenotype of first attack and all attacks during disease course ((60% (25/42) for first attack, 38% (61/161) for all attacks). The most common clinical syndrome was neuromyelitis optica spectrum disorders (NMOSD) (50%, 21/42). Of the 42 children, 5 (12%) showed encephalitis and 6 (14%) combined with anti-N-methyl-D-aspartate receptor (NMDAR) antibody overlap syndrome. The most commonly involved areas of brain magnetic resonance imaging (MRI) were subcortical white matter (71%, 88/124), cortex (26%, 32/124) and periventricular white matter (25%, 32/124). Spinal cord MRI was most frequently involved in cervical (70%, 16/23) and thoracic (61%, 14/23) medulla, and 43% (10/23) longitudinally extensive transeverse myelitis. Disease-modifying drugs were used in 34 patients. The annual relapse rate after treatment with rituximab, mycophenolate mofetil and azathioprine decreased (all P<0.05) and there was no statistically significant difference in the annual relapse proportion among the groups (P=0.307). Conclusions: The most common clinical attack of first and all of MOGAD in children is ADEM, and the most common clinical syndrome is NMOSD. Rituximab, mycophenolate mofetil and azathioprine can reduce the annual relapse rate, but it is not clear effect of which treatment is better.

PMID:34856664 | DOI:10.3760/cma.j.cn112140-20210703-00549

Child Care Health Dev. 2021 Dec 2. doi: 10.1111/cch.12936. Online ahead of print.

ABSTRACT

BACKGROUND: Parental and caregivers hygiene related knowledge, attitude, and practice are compelling factors in the prevention of stunting and malnutrition among the aboriginal children in Malaysia, which are highly modifiable. This study was conducted to explore the knowledge, attitude and practice related to hygiene among primary caregivers of the under three aboriginal (known as Orang Asli) children community in Malaysia.

METHODS: A total of 166 primary caregivers of the under three children of the aboriginal community in Kuala Langat district, Selangor were recruited. Data related to caregivers’, child’s and environmental factors were collected using a validated and reliable questionnaire, with knowledge, attitude and practice being the dependent variables. IBM Statistical Package for Social Science (SPSS) version 25.0 was used to analyse the data. Pearson’s correlation was conducted to identify the relationship between continuous data. Multiple linear regression analysis was performed to determine the relationship between knowledge, attitude, and practice related to hygiene, as well as the predictors.

RESULTS: The mean scores for knowledge, attitude, and practice related to hygiene were 6.91 (2.12), 23.67 (3.16), 29.97 (3.55) and 43.05 (4.41) respectively. Significant moderate positive correlations were found between attitude and hygiene practice (r=0.445, p<0.001). Self-efficacy was significantly correlated with attitude (r=0.442, p<0.001) and practice (r=0.557, p<0.001), with increase attitude (B=0.281, 95% CI: 0.126-0.435) and practice (B= 0.318, 95% CI:0.106-0.530) scores were expected with increasing self-efficacy.

CONCLUSION: Moderate mean scores for hygiene related knowledge, attitude and practice were observed in this study, with self-efficacy being a significant predictor for both hygiene related attitude and practice, but not knowledge. The self-efficacy of the caregivers should be sustained through continuous health education and counselling, to ensure improved hygiene practice. Future related research should consider the mediating role of self-efficacy on attitude and practice.

PMID:34856635 | DOI:10.1111/cch.12936

Eur J Dent. 2021 Dec 2. doi: 10.1055/s-0041-1735798. Online ahead of print.

ABSTRACT

OBJECTIVE: This study sought to investigate the toothbrush-dentifrice abrasion of dental sealants.

MATERIALS AND METHODS: Weight loss (∆W) and depth loss (∆D) were used as abrasion indicators. Sealant samples from nine products were soaked in dentifrice slurry and abraded by using a toothbrushing machine with a brushing force of 300 g. The mean percentages of ∆W and mean values of ∆D after 24,000 and 48,000 strokes of brushing were compared by using paired t-test. A comparison of these mean values among sealant products was performed by using one-way ANOVA and multiple comparison analysis (Scheffe’s test).

RESULTS: Abrasive wear was observed in all sealants. Teethmate F-1 (Kuraray Noritake, Tokyo, Japan)-a fluoride-releasing unfilled sealant-exhibited the maximum abrasive wear, with ∆W and ∆D values of 1.14% ± 0.37% and 12.84 ± 4.28 µm, respectively. Delton (Dentsply Sirona, Charlotte, North Carolina, United States), a light-cured unfilled sealant, showed the minimum abrasive wear, with ∆W and ∆D values of 0.41% ± 0.09% and 2.93 ± 1.23 µm, respectively. No statistical differences were observed among unfilled sealants except when compared with Teethmate F-1. Similarly, no differences were observed when comparing among filled sealants and flowable composite.

CONCLUSION: Abrasive wear occurred in all sealants after brushing with dentifrice. Almost all unfilled sealants showed less wear compared with both filled sealants and flowable composite. However, the low abrasive values of all sealants after brushing with dentifrice implied that there is no clinical significance to this finding.

PMID:34856628 | DOI:10.1055/s-0041-1735798

Endoscopy. 2021 Dec 2. doi: 10.1055/a-1659-3514. Online ahead of print.

ABSTRACT

BACKGROUND : Following endoscopic resection of early-stage Barrett’s esophageal adenocarcinoma (BEA), further oncologic management then fundamentally relies upon the accurate assessment of histopathologic risk criteria, which requires there to be sufficient amounts of submucosal tissue in the resection specimens. METHODS : In 1685 digitized tissue sections from endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) performed for 76 early BEA cases from three experienced centers, the submucosal thickness was determined, using software developed in-house. Neoplastic lesions were manually annotated. RESULTS : No submucosa was seen in about a third of the entire resection area (mean 33.8 % [SD 17.2 %]), as well as underneath cancers (33.3 % [28.3 %]), with similar results for both resection methods and with respect to submucosal thickness. ESD results showed a greater variability between centers than EMR. In T1b cancers, a higher rate of submucosal defects tended to correlate with R1 resections. CONCLUSION : The absence of submucosa underneath about one third of the tissue of endoscopically resected BEAs should be improved. Results were more center-dependent for ESD than for EMR. Submucosal defects can potentially serve as a parameter for standardized reports.

PMID:34856621 | DOI:10.1055/a-1659-3514

Am J Perinatol. 2021 Dec 2. doi: 10.1055/s-0041-1740214. Online ahead of print.

ABSTRACT

OBJECTIVE: Patients admitted for preterm prelabor rupture of membranes are more likely to have risk factors for postpartum depression, including preterm delivery, low-birthweight infants, and a stressful life event. However, there is a paucity of data characterizing the development of postpartum depression in this population. We aim to evaluate the incidence of and describe risk factors for postpartum depression among patients admitted with preterm prelabor rupture of membranes.

STUDY DESIGN: This is a retrospective cohort study of patients admitted for preterm prelabor rupture of membranes in a single health system between 2013 and 2019. Patients who developed depression were compared with patients who did not develop depression. Demographic, antepartum/intrapartum/postpartum, and neonatal characteristics were compared. Bivariate statistics were used to compare outcomes and logistic regression was used to estimate adjusted odds ratios.

RESULTS: Of 132 included patients with preterm prelabor rupture of membranes, 25 (18.9%) had postpartum depression. Factors significantly (p < 0.05) associated with postpartum depression included history of depression, anxiety, or any prior mental health condition. Earlier admission gestational age, rupture of membranes < 28 weeks, earlier delivery gestational age, neonatal morbidity, and neonatal necrotizing enterocolitis also were significantly associated with postpartum depression. Latency, maternal postpartum length of stay, and neonatal intensive care unit length of stay were not significantly associated. In regression models, only a history of depression (odds ratio [OR], 11.89; 95% confidence interval [CI], 2.78-50.95) and neonatal morbidity (OR, 5.01; 95% CI, 1.15-21.89) remained associated with postpartum depression.

CONCLUSION: Postpartum depression occurred in nearly one in five patients with preterm prelabor rupture of membranes. Pre-existing depression and adverse neonatal outcomes strongly predicted postpartum depression. There is an urgent need to prioritize maternal mental health among patients with preterm prelabor rupture of membranes in the peripartum period. Further research is needed to identify optimal resources for mitigating the risk of postpartum depression in this cohort.

KEY POINTS: · After PPROM, postpartum depression is common.. · Maternal depression and neonatal morbidity are risk factors for PPD.. · Hospital admission permits intervention for PPD..

PMID:34856616 | DOI:10.1055/s-0041-1740214

Am J Perinatol. 2021 Dec 2. doi: 10.1055/s-0041-1740212. Online ahead of print.

ABSTRACT

OBJECTIVE: The primary objective of this study was to evaluate coronavirus 2019 (COVID-19) pandemic-related changes in the antenatal utilization of high-risk obstetric services. Our secondary objective was to characterize change in stillbirth rate during the pandemic.

STUDY DESIGN: This is a retrospective, observational study performed at a single, tertiary care center. Maternal-Fetal Medicine (MFM) visits, ultrasounds, and antenatal tests of fetal well-being during the pandemic epoch (2020), which spans the first 12 weeks of the year to include pandemic onset and implementation of mitigation efforts, were compared with the same epoch of the three preceding years visually and using general linear models to account for week and year effect. An analysis of stillbirth rate comparing the pandemic time period to prepandemic was also performed.

RESULTS: While there were decreased MFM visits and antenatal tests of fetal well-being during the pandemic epoch compared with prepandemic epochs, only the decrease in MFM visits by year was statistically significant (p < 0.001). The stillbirth rate during the pandemic epoch was not significantly different when compared with the prepandemic period and accounting for both week (p = 0.286) and year (p = 0.643) effect.

CONCLUSION: The COVID-19 pandemic resulted in a significant decrease in MFM visits, whereas obstetric ultrasounds and antenatal tests of fetal well-being remained unchanged. While we observed no change in the stillbirth rate compared with the prepandemic epoch, our study design and sample size preclude us from making assumptions of association. Our findings may support future work investigating how changes in prenatal care for high-risk obstetric patients influence perinatal outcomes.

KEY POINTS: · MFM visits significantly decreased during the COVID-19 pandemic epoch.. · The overall stillbirth rate during the COVID-19 pandemic epoch was not significantly changed.. · Larger studies are needed to capitalize on these changes to evaluate rare outcomes such as stillbirth..

PMID:34856612 | DOI:10.1055/s-0041-1740212