Nevin Manimala

J Acquir Immune Defic Syndr. 2021 Feb 26. doi: 10.1097/QAI.0000000000002679. Online ahead of print.

ABSTRACT

BACKGROUND: Volatility in sexual contact rates has been recognized as an important factor influencing HIV transmission dynamics. One-time partnerships may be particularly important given the potential to quickly accumulate large number of contacts. Yet, empirical data documenting individual variation in contact rates remains rare. This study provides much needed data on temporal variation in one-time partners to better understand behavioral dynamics and improve the accuracy of transmission models.

METHODS: Data for this study from a longitudinal cohort study of young men who have sex with men (MSM) and transgender women in Chicago. Participants provided sexual network data every 6-months for 2 years. A series of random effects models examined variation in one-time partnership rates and disaggregated within and between associations of exposure variables. Exposure variables included prior number of one-time partners, number of casual partners, and having a main partner.

RESULTS: Results indicated substantial between and within person variation in one-time partners. Casual partnerships were positively associated and main partnerships negatively association with one-time partnership rates. There remained a small positive association between prior one-time partnerships and the current number of one-time partnerships.

CONCLUSIONS: Despite the preponderance of a low number of one-time partners, substantial variation in one-time partnership rates exists among young MSM and transgender women. Accordingly, focusing on high contact rate individuals alone may be insufficient to identify periods of highest risk. Future studies should utilize these estimates to more accurately model how volatility impacts HIV transmission and better understand how this variation influences intervention effectiveness.

PMID:33675616 | DOI:10.1097/QAI.0000000000002679

J Neurol Phys Ther. 2021 Feb 24. doi: 10.1097/NPT.0000000000000349. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: Individuals with benign paroxysmal positional vertigo (BPPV) are frequently referred to physical therapy for management, but little is known on how reliable therapists are at diagnosing BPPV. The purpose of the study was to examine the agreement between physical therapists in identifying nystagmus and diagnosing BPPV.

METHODS: Thirty-eight individuals with complaints of positional vertigo, 19 from each of 2 clinics (clinics 1 and 2) that specialize in vestibular rehabilitation, had eye movements recorded using video goggles during positioning tests including supine-to-sit, supine roll, and Dix-Hallpike tests. Three therapists from each of the clinics independently observed videos, documented nystagmus characteristics of each testing position, and made a diagnosis for each case. Kappa (κ) statistics were calculated between therapists within each clinic for nystagmus identification and diagnosis.

RESULTS: Clinic 1 therapists demonstrated substantial to almost perfect agreement in identifying nystagmus during positional tests (κ = 0.68-1, P < 0.005). Clinic 2 therapists showed moderate to almost perfect agreement for presence of nystagmus (κ = 0.57-1, P < 0.005). Therapists at both sites had almost perfect agreement of diagnosis side, canal, and mechanism (κ = 0.81-1, P < 0.005).

DISCUSSION AND CONCLUSION: Therapists utilized observations from multiple positional tests to determine diagnoses. This was evident by occasional disagreement in nystagmus presence and characteristics, but agreement in diagnosis, including ruling out BPPV. The results may not be generalizable to all physical therapists or therapists’ ability to diagnose central and atypical nystagmus presentations. Experienced physical therapists demonstrated strong agreement in diagnosing common forms of BPPV.Video Abstract available for more insight from the authors (see the Video Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A340).

PMID:33675601 | DOI:10.1097/NPT.0000000000000349

J Dig Dis. 2021 Mar 6. doi: 10.1111/1751-2980.12980. Online ahead of print.

ABSTRACT

AIM: Adiponectin is an adipokine that is involved in regulating hepatic fat and glucose metabolism, and also has anti-steatotic, anti-inflammatory and anti-fibrotic effects. How these different activities impact the development and progression of NAFLD is not well understood. The aim of this study was to evaluate both liver and serum adiponectin levels in patients with and without NAFLD and determine any clinical correlations.

METHODS: Liver tissue and serum samples were collected from patients undergoing liver biopsy between April 2014 and July 2020, and categorized based on histopathologic diagnosis into hepatic steatosis (HS), non-alcoholic steatohepatitis (NASH), and hepatitis control (HC). Luminex® xMAP assay was performed on both liver and serum samples to measure adiponectin levels. Statistical analysis compared liver adiponectin (LA) and serum adiponectin (SA) levels between groups.

RESULTS: 48 participants were included in the analysis with 4 in HS, 15 in NASH, and 29 in HC groups. The mean LA level was lowest in the HS group was 68.6% lower than that in the NASH group and 80.6% lower than that in the HC group (p=0.036). The mean SA level was 3.61 μg/ml for NAFLD group was significantly lower than that in the HC group, 7.51 μg/ml (p=0.001).

CONCLUSION: Adiponectin levels are lower in NAFLD compared to HC in both serum and in liver tissue. LA levels in HS patients were significantly lower than those both in NASH and HC groups, suggesting that adiponectin is related to inflammation in the liver, and probably reflects a role in pathogenesis of NAFLD. This article is protected by copyright. All rights reserved.

PMID:33675573 | DOI:10.1111/1751-2980.12980

Ther Apher Dial. 2021 Mar 6. doi: 10.1111/1744-9987.13641. Online ahead of print.

ABSTRACT

INTRODUCTION: The specific tool for cardiovascular risk assessment in hemodialysis population has not yet been proposed, despite high prevalence of cardiovascular morbidity and mortality in clinically asymptomatic patients. Coronary artery calcium score (CACS), as a reliable predictor of future cardiovascular events, might be a valuable approach. We sought to evaluate coronary artery calcification burden and its association with clinical and laboratory parameters in asymptomatic patients who recently initiated hemodialysis.

METHODS: The cross-sectional study included 60 asymptomatic patients receiving chronic hemodialysis for no longer than 48 months. CACS was assessed by cardiac computed tomography. Intima-media thickness (IMT) of both common carotid and femoral arteries were measured using ultrasonography.

RESULTS: The mean total CACS was 160.50 (443). Patients’ age correlated significantly with CACS (σ=0.367; p=0.004), carotid (σ=0.375; p=0.004) and femoral IMT (σ=0.323; p=0.013). Patients with CACS=0 were significantly younger than patients with CACS >400: 52.4±7.91 vs. 63.88±8.37 years old, respectively (p=0.034). In patients receiving dialysis for longer than 24 months CACS, femoral and carotid IMT were higher than in those dialysed for less than 24 months; however none has reached significance. There was a significant positive correlation between CACS and right (σ=0.312; p=0.018) and left (σ=0.521; p<0.001) femoral IMT, while not with carotid. CACS showed significant negative correlation with the serum iron (σ=-0.351; p=0.007).

CONCLUSION: Calcification burden varies significantly in asymptomatic patients in early years of dialysis. It correlates with patients’ age and tends to increase with dialysis vintage. Femoral IMT might be useful for cardiovascular risk stratification in asymptomatic patients who recently initiated hemodialysis. This article is protected by copyright. All rights reserved.

PMID:33675568 | DOI:10.1111/1744-9987.13641

Health Soc Care Community. 2021 Mar 6. doi: 10.1111/hsc.13277. Online ahead of print.

ABSTRACT

Suicide in adolescents constitutes a public health problem throughout the world. The objective of this study was to identify the prevalence of suicidal behaviour in a public middle school in Mexico and to implement appropriate educational interventions in the school and community contexts. Our work took place from September 2017 to July 2018. We conducted a quasi-experimental, mixed-methodology study with 12-year-old students in first year of middle school (n = 29), using an educational intervention approach within the frame of the Life Skills Education methodology. We included family members and academic staff in the study with the view of sensitising them to suicidal behaviour. At the community level, we worked with the adolescent and adult populations to form ‘gatekeepers’ (guardians). We administered a questionnaire on psychosocial indicators of depression and suicide risk to 383 students in their first-to-third years of middle school. Other questionnaires were applied, and life skills focus groups (FGs) were organised with the educational intervention participants. The questionnaires addressed suicidal behaviour in adolescents, alcohol consumption, life skills and prosociality. Prevalence of attempted suicide cases came to 14.1% (95 CI% 10.7-17.9), the average age of those who reported having hurt themselves with the purpose of taking their lives was 12.9 years, 75% of those who had attempted suicide were female and 64.8% had consumed alcohol. The educational intervention with students achieved a statistically significant increase in the life skills of participants, specifically as regards self-awareness and overall scores. The family members in the FGs developed greater awareness of suicidal behaviour, and the adolescents engaged at the community level significantly broadened (p < .05) their knowledge of depression. In developing countries such as Mexico, it is essential not only to increase the number of interventions for preventing suicidal behaviour in adolescents, but also to improve instruments for measuring the extent of the problem.

PMID:33675567 | DOI:10.1111/hsc.13277

J Magn Reson Imaging. 2021 Mar 6. doi: 10.1002/jmri.27586. Online ahead of print.

ABSTRACT

BACKGROUND: In preclinical models of multiple sclerosis (MS), both adiabatic T_1rho (T_1ρadiab ) and relaxation along a fictitious field (RAFF) imaging have demonstrated potential to noninvasively characterize MS.

PURPOSE: To evaluate the feasibility of whole brain T_1ρadiab and RAFF imaging in healthy volunteers and patients with MS.

STUDY TYPE: Single institutional clinical trial.

SUBJECTS: About 38 healthy volunteers (24-69 years) and 21 patients (26-59 years) with MS. Five healthy volunteers underwent a second MR examination performed within 8 days. Clinical disease severity (The Expanded Disability Status Scale [EDSS] and The Multiple Sclerosis Severity Score [MSSS]) was evaluated at baseline and 1-year follow-up (FU).

FIELD STRENGTH/SEQUENCE: RAFF in second rotating frame of reference (RAFF2) was performed at 3 T using 3D-fast-field echo with magnetization preparation, RF amplitude of 11.74 μT while the corresponding value for T_1ρadiab was 13.50 μT. T₁ -, T₂ -, and FLAIR-weighted images were acquired with reconstruction voxel size 1.0 × 1.0 × 1.0 mm³ .

ASSESSMENT: The parametric maps of T_1ρadiab and RAFF2 (T_RAFF2 ) were calculated using a monoexponential model. Semi-automatic segmentation of MS lesions, white matter (WM), and gray matter (GM), and WM tracks was performed using T₁ -, T₂ -, and FLAIR-weighted images.

STATISTICAL TESTS: Regression analysis was used to evaluated correlation of T_1ρadiab and T_RAFF2 with age and disease severity while a Friedman test followed by Wilcoxon Signed Rank test for differences between tissue types. Short-term repeatability was evaluated on voxel level.

RESULTS: Both T_1ρadiab and T_RAFF2 demonstrated good short-term repeatability with relative differences on voxel level in the range of 6.1%-11.9%. Differences in T_1ρadiab and T_RAFF2 between the tissue types in MS patients were significant (P < 0.05). T_1ρadiab and T_RAFF2 correlated (P < 0.001) with baseline EDSS/MSSM and disease progression at FU (P < 0.001).

DATA CONCLUSION: Whole brain T_1ρadiab and T_RAFF2 at 3 T was feasible with significant differences in T_1ρadiab and T_RAFF2 values between tissues time and correlation with disease severity.

EVIDENCE LEVEL: 1 TECHNICAL EFFICACY: Stage 1.

PMID:33675564 | DOI:10.1002/jmri.27586

J Ultrasound Med. 2021 Mar 6. doi: 10.1002/jum.15690. Online ahead of print.

ABSTRACT

OBJECTIVE: Society for Maternal-Fetal Medicine guidelines for diagnosing fetal growth restriction (FGR) have broadened the definition to include abdominal circumference (AC) <10^th percentile for gestational age (GA) regardless of estimated fetal weight (EFW). We aimed to compare the ability of three definitions of FGR to predict small for gestational age (SGA) neonates and adverse outcomes.

METHODS: We performed a secondary analysis of a prospective cohort of patients who underwent assessment of fetal growth between GA of 26 and 36 weeks. We compared three definitions of FGR: EFW <10^th percentile; AC <10^th percentile; either EFW or AC <10^th percentile. The primary outcome was successful prediction of neonatal SGA. Secondary outcomes included a composite adverse neonatal outcome (CANO). We further compared these definitions of FGR using area under receiver operative curves (AUC) to measure their discriminatory abilities.

RESULTS: About 1054 women met inclusion criteria. Ninety-one (8.6%) had EFW <10^th percentile, 122 (11.6%) had AC <10^th percentile, and 137 (12.9%) had either EFW or AC <10^th percentile. SGA was seen in 139 (13.2%); CANO was seen in 139 (13.2%). Ability for detecting neonatal SGA was significantly better when the definition included both EFW or AC <10^th percentile compared to either variable independently. The AUC were: 0.74, 0.73, 0.69; P = .0003. There was no statistical significance in ability for predicting CANO (AUC 0.51, 0.51, 0.50; P = .7447).

CONCLUSIONS: Addition of AC as a criterion for diagnosing FGR improves our ability to predict neonatal SGA compared to using EFW alone. All three definitions were poorly predictive of neonates at risk for adverse outcomes.

PMID:33675562 | DOI:10.1002/jum.15690

J Am Geriatr Soc. 2021 Mar 6. doi: 10.1111/jgs.17065. Online ahead of print.

ABSTRACT

BACKGROUND/OBJECTIVES: Rates of traumatic brain injury (TBI) among older adults and treatment of this population in nursing homes are increasing. The objective of this study is to examine differences in the quality of care and outcomes of older adults with TBI in rural and urban settings by (1) comparing the rates of successful community discharge; and (2) reasons for not achieving successful discharge among patients in rural and urban environments.

DESIGN: Retrospective national cohort study of skilled nursing facility (SNF) patients using Medicare inpatient claims linked with Minimum Data Set assessments. Demographic, health, and facility characteristics were compared between rural and urban settings using descriptive statistics. Logistic regression with state random effects was used to identify characteristics that predicted successful discharge.

SETTING: U.S. skilled nursing facilities (n = 11,771).

PARTICIPANTS: Medicare beneficiaries aged 66 and older discharged to a SNF following hospitalization for TBI between 2011 and 2015 (n = 61,021).

MEASUREMENTS: Successful community discharge defined as discharge from SNF within 100 days of admission and remaining in the community for ≥30 days without dying or admission to an inpatient healthcare facility.

RESULTS: Unadjusted rates of successful discharge were significantly lower for patients in rural settings compared with patients in urban settings (52.1% vs 58.5%, p < 0.01). Patients in rural settings had lower adjusted odds (odds ratio 0.84, 95% confidence interval = 0.80-0.89) of successful discharge. Reasons for not discharging successfully differed between rural and urban settings with rural patients less likely to discharge from SNF within 100 days though also less likely to be rehospitalized within 30 days of SNF discharge.

CONCLUSION: Given the low overall rate of successful community discharge and worse outcomes among rural patients, further research to explore interventions to improve SNF care and discharge planning in this population is warranted.

PMID:33675540 | DOI:10.1111/jgs.17065

Int J Cancer. 2021 Mar 6. doi: 10.1002/ijc.33547. Online ahead of print.

ABSTRACT

Gene expression profiling can be used for predicting survival in multiple myeloma (MM) and identifying patients who will benefit from particular types of therapy. Some germline single nucleotide polymorphisms (SNPs) act as expression quantitative trait loci (eQTLs) showing strong associations with gene expression levels. We performed an association study to test whether eQTLs of genes reported to be associated with prognosis of MM patients are directly associated with measures of adverse outcome. Using the Genotype-Tissue Expression (GTEx) portal, we identified a total omultiplf 16 candidate genes with at least one eQTL SNP associated with their expression with p<10^-7 either in EBV-transformed B-lymphocytes or whole blood. We genotyped the resulting 22 SNPs in 1,327 MM cases from the International Multiple Myeloma rESEarch (IMMEnSE) consortium and examined their association with overall survival (OS) and progression free survival (PFS), adjusting for age, sex, country of origin and disease stage. Three polymorphisms in two genes (TBRG4-rs1992292, TBRG4-rs2287535, ENTPD1-rs2153913) showed associations with (OS) at P<0.05, with the former two also associated with PFS. The associations of two polymorphisms in TBRG4 with OS were replicated in 1277 MM cases from the International Lymphoma Epidemiology (InterLymph) Consortium. A meta-analysis of the data from IMMEnSE and InterLymph (2579 cases) showed that TBRG4-rs1992292 is associated with OS (HR=1.14, 95%C.I. 1.04-1.26, p=0.007). In conclusion, we found biologically a plausible association between a SNP in TBRG4 and OS of MM patients.

PMID:33675538 | DOI:10.1002/ijc.33547

Int Urol Nephrol. 2021 Mar 6. doi: 10.1007/s11255-021-02805-x. Online ahead of print.

ABSTRACT

PURPOSE: Intradialytic hypotension (IDH) is a serious complication in dialysis patients. Diuretics might reduce the incidence of IDH by decreasing ultrafiltration. However, the effect of diuretics on IDH in maintenance dialysis patients is still unclear.

METHODS: We searched Medline, Embase, the Cochrane Library, China National Knowledge Infrastructure and clinical trials registries from 1945 to May 2019. Randomized controlled trials (RCTs) or observational studies about IDH in maintenance dialysis with diuretics were included.

RESULTS: Seven studies including 28,226 patients were included, of which 4 were RCTs involving mineralocorticoid receptor antagonists (MRAs) and 3 were observational studies involving loop diuretics. There was a trend that a lower incidence rate of IDH in maintenance dialysis patients who used loop diuretics than control, although the result was not statistically significant (OR 0.65, 95% CI 0.34-1.22, P = 0.18). Similarly, lower incidence rate of all-cause mortality (OR 0.92, 95% CI 0.87-0.99; P = 0.02) and cardiovascular (CV) mortality (OR 0.86, 95% CI 0.75-0.99, P = 0.03) in dialysis patients who used loop diuretics than control. On the contrary, there were no significant difference in the incidence of IDH (OR 1.35, 95% CI 0.78-2.34, P = 0.29) and all-cause mortality (OR 0.73, 95% CI 0.26-2.01; P = 0.54) and CV mortality (OR 0.57, 95% CI 0.14-2.25; P = 0.42) in maintenance dialysis patients who used MRAs compared with control.

CONCLUSION: Loop diuretics, but not MRAs, might have a potential benefit to reduce the incidence rate of IDH, all-cause mortality and CV mortality. More high-quality studies are needed to strengthen the arguments.

PMID:33675484 | DOI:10.1007/s11255-021-02805-x