Nevin Manimala

PLoS One. 2021 Sep 21;16(9):e0257621. doi: 10.1371/journal.pone.0257621. eCollection 2021.

ABSTRACT

BACKGROUND: Hepatitis B virus (HBV) infection is a significant global public health problem. Health care providers and medical students in developing countries including Ethiopia are at an increased risk of contracting HBV due to the high burden of this infection. The most effective way of prevention against HBV infection is vaccination of health care providers. However, there is a paucity of data on the HBV vaccination coverage among students of health science in Ethiopia. Therefore, this study aimed to determine HBV vaccination coverage and associated factors, level of knowledge, attitudes, and practices (KAP) towards HBV among students of medicine and health science at Wolkite University.

MATERIALS AND METHODS: A cross-sectional study was conducted at Wolkite University among 417 study participants from November to December 2020. The study participants were recruited by using a simple random sampling technique. Data were collected using a self-administered structured questionnaire and analyzed using SPSS version 21. A binary logistic regression model was used to determine the factors associated with full-dose vaccination status. Statistical significance was set at P-value <0.05.

RESULTS: Out of the 417 study participants, 5.8% (95%CI: 3.8-7.9) received a full-dose of the HBV vaccine in this study. Unavailability and high cost of the vaccine were frequently mentioned reasons for not being vaccinated against HBV. About 73.6%, 36.2%, and 47% of participants had good knowledge, positive attitudes, and good practices towards HBV, respectively. Being male gender (AOR: 8.8; 95%CI: 2.9-27), rural residence (AOR: 3.6; 95%CI:1.2-10.6), positive attitude (AOR: 0.44; 95%CI: 0.1-1.1), good practice (AOR: 0.17; 95%CI: 0.05-0.5), medicine department (AOR: 5.9; 95%CI: 1.2-29), being second-year student (AOR: 11.7; 95%CI: 2.7-50.9), third-year student (AOR: 19; 95%CI: 4.25-45), and fourth-year student (AOR: 27; 95%CI: 5.8-56) were significantly associated factors with full-dose vaccination status.

CONCLUSION: Our study revealed that only small proportions (5.8%) of study participants received full-dose HBV vaccination. Vaccinations of students before starting clinical attachments, provisions of training for students on infection prevention mechanism and universal precautions particularly on HBV, increasing the uptake of the HBV vaccine, creating awareness on attitude and practice of students towards HBV to enhance uptake of the vaccine are recommended.

PMID:34547021 | DOI:10.1371/journal.pone.0257621

PLoS One. 2021 Sep 21;16(9):e0252883. doi: 10.1371/journal.pone.0252883. eCollection 2021.

ABSTRACT

BACKGROUND: Alzheimer’s disease (AD) is a major neurocognitive disorder identified by memory loss and a significant cognitive decline based on previous level of performance in one or more cognitive domains that interferes in the independence of everyday activities. The accuracy of imaging helps to identify the neuropathological features that differentiate AD from its common precursor, mild cognitive impairment (MCI). Identification of early signs will aid in risk stratification of disease and ensures proper management is instituted to reduce the morbidity and mortality associated with AD. Magnetic resonance imaging (MRI) using structural MRI (sMRI), functional MRI (fMRI), diffusion tensor imaging (DTI), and magnetic resonance spectroscopy (1H-MRS) performed alone is inadequate. Thus, the combination of multiparametric MRI is proposed to increase the accuracy of diagnosing MCI and AD when compared to elderly healthy controls.

METHODS: This protocol describes a non-interventional case control study. The AD and MCI patients and the healthy elderly controls will undergo multi-parametric MRI. The protocol consists of sMRI, fMRI, DTI, and single-voxel proton MRS sequences. An eco-planar imaging (EPI) will be used to perform resting-state fMRI sequence. The structural images will be analysed using Computational Anatomy Toolbox-12, functional images will be analysed using Statistical Parametric Mapping-12, DPABI (Data Processing & Analysis for Brain Imaging), and Conn software, while DTI and 1H-MRS will be analysed using the FSL (FMRIB’s Software Library) and Tarquin respectively. Correlation of the MRI results and the data acquired from the APOE genotyping, neuropsychological evaluations (i.e. Montreal Cognitive Assessment [MoCA], and Mini-Mental State Examination [MMSE] scores) will be performed. The imaging results will also be correlated with the sociodemographic factors. The diagnosis of AD and MCI will be standardized and based on the DSM-5 criteria and the neuropsychological scores.

DISCUSSION: The combination of sMRI, fMRI, DTI, and MRS sequences can provide information on the anatomical and functional changes in the brain such as regional grey matter volume atrophy, impaired functional connectivity among brain regions, and decreased metabolite levels specifically at the posterior cingulate cortex/precuneus. The combination of multiparametric MRI sequences can be used to stratify the management of MCI and AD patients. Accurate imaging can decide on the frequency of follow-up at memory clinics and select classifiers for machine learning that may aid in the disease identification and prognostication. Reliable and consistent quantification, using standardised protocols, are crucial to establish an optimal diagnostic capability in the early detection of Alzheimer’s disease.

PMID:34547018 | DOI:10.1371/journal.pone.0252883

PLoS One. 2021 Sep 21;16(9):e0257492. doi: 10.1371/journal.pone.0257492. eCollection 2021.

ABSTRACT

Viruses have been implicated in cancer development in both humans and animals. The role of viruses in cancer is typically to initiate cellular transformation through cellular DNA damage, although specific mechanisms remain unknown. Silent and long-term viral infections need to be present, in order to initiate cancer disease. In efforts to establish a causative role of viruses, first is needed to demonstrate the strength and consistency of associations in different populations. The aim of this study was to determine the association of bovine leukemia virus (BLV), a causative agent of leukemia in cattle, with breast cancer and its biomarkers used as prognosis of the severity of the disease (Ki67, HER2, hormonal receptors) in Colombian women. An unmatched, observational case-control study was conducted among women undergoing breast surgery between 2016-2018. Malignant samples (n = 75) were considered as cases and benign samples (n = 83) as controls. Nested-liquid PCR, in-situ PCR and immunohistochemistry were used for viral detection in blood and breast tissues. For the risk assessment, only BLV positive samples from breast tissues were included in the analysis. BLV was higher in cases group (61.3%) compared with controls (48.2%), with a statistically significant association between the virus and breast cancer in the unconditional logistic regression (adjusted-OR = 2.450,95%CI:1.088-5.517, p = 0.031). In this study, BLV was found in both blood and breast tissues of participants and an association between breast cancer and the virus was confirmed in Colombia, as an intermediate risk factor.

PMID:34547016 | DOI:10.1371/journal.pone.0257492

PLoS One. 2021 Sep 21;16(9):e0257312. doi: 10.1371/journal.pone.0257312. eCollection 2021.

ABSTRACT

PURPOSE: To mitigate the health risks that result from low health literacy and difficulty identifying patients with insufficient health literacy, health organizations recommend physicians apply health literacy universal precaution communication skills when communicating with all patients. Our aim was to assess how health literacy universal precautions are delivered in routine GP consultations, and explore whether there were differences in how GPs used universal precaution approaches according to areas of deprivation in England.

METHODS: This was a mixed methods study using video and interview data. Ten physicians conducted 217 consultations in primary care settings with adults over 50 years old between July 2017 and March 2018 in England. Eighty consultations (N = 80) met the inclusion criteria of new or persisting problems. Descriptive quantitative analysis of video-recorded consultations using an observation tool and qualitative thematic analysis of transcribed scripts. Meta-themes explored differences in physicians’ communication by areas of deprivation.

RESULTS: Descriptive statistics showed physicians used a caring tone of voice and attitude (n = 73, 91.3%) and displayed comfortable body language (n = 69, 86.3%) but infrequently demonstrated profession-specific health literacy universal precaution communication skills, such as the teach-back technique (n = 3, 3.8%). Inferences about physicians’ communication from qualitative analysis converged with the quantitative findings. Differences in physicians’ communication varied according to areas of deprivation.

CONCLUSIONS: Physicians need health literacy universal precautions communication skills to improve population health.

PMID:34547015 | DOI:10.1371/journal.pone.0257312

J Bone Joint Surg Am. 2021 Sep 21. doi: 10.2106/JBJS.21.00346. Online ahead of print.

ABSTRACT

BACKGROUND: Operative management for end-stage knee osteoarthritis (OA) primarily consists of arthroplasty. Total knee arthroplasty (TKA) is the so-called gold standard for multicompartmental OA. In selected patients, specifically those with unicompartmental OA and no definite contraindications, realignment osteotomies and unicompartmental knee arthroplasty (UKA) are viable options. UKA offers several advantages over TKA, including preservation of both cruciate ligaments, faster recovery, and less osseous resection. The purpose of this study was to determine the survivorship of UKAs and risk factors for all-cause revision surgery in patients with a minimum follow-up of 10 years in a large population-based database.

METHODS: We performed a population-based cohort study using linked administrative databases in Ontario, Canada. We identified all UKAs performed from January 2002 through December 2006. All patients had a minimum 10-year follow-up. Demographic data and outcomes were summarized using descriptive statistics. We used a Cox proportional hazards model with the Fine and Gray method accounting for competing risks such as death to analyze the effect of surgical and patient factors on the risk of revision of UKA.

RESULTS: A total of 4,385 patients were identified as having undergone primary UKA from 2002 through 2006 in Ontario. Of these patients, 779 underwent revision surgery, for a cumulative risk for all-cause revision of 16.5% at 10 years (95% confidence interval [CI]: 15.4% to 17.7%). Mechanical loosening was the reason for 83.4% of all revisions. Male sex, diabetes, an age younger than 50 years, and cementless implants were significant risk factors for revision surgery. Residence in a rural or urban setting, income quintile, discharge destination, and type of OA were not associated with the risk of revision. Survivorship at 1, 5, 10, and 15 years was 97.2%, 90.5%, 83.5%, and 81.9%, respectively.

CONCLUSIONS: This study demonstrated a >80% long-term survivorship for UKA based on a large administrative database sample and identified important risk factors for failure including male sex, younger age, diabetes, and cementless fixation. This study found rates of survivorship similar to those previously reported in the literature, while identifying key risk factors for failure. Patient selection has always been identified as a key factor in ensuring successful UKA, and the risk factors identified in this study may help guide decision-making for surgeons and patients dealing with unicompartmental knee OA.

LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

PMID:34547009 | DOI:10.2106/JBJS.21.00346

Menopause. 2021 Sep 20. doi: 10.1097/GME.0000000000001859. Online ahead of print.

NO ABSTRACT

PMID:34547002 | DOI:10.1097/GME.0000000000001859

J Pediatr Gastroenterol Nutr. 2021 Oct 1;73(4):437-443. doi: 10.1097/MPG.0000000000003185.

ABSTRACT

Neutrophil to lymphocyte ratio has been examined among several studies regarding Henoch Schonlein purpura patients with gastrointestinal involvement. The current meta-analysis aims to evaluate neutrophil to lymphocyte ratio differences between Henoch Schonlein purpura patients with and without gastrointestinal manifestations.An extensive search of the available literature was done using MEDLINE (1966-2020), Clinicaltrials.gov (2008-2020), Cochrane Central Register of Controlled Trials (CENTRAL) (1999-2020) and Google Scholar (2004-2020) databases and statistical analysis was mainly conducted using RevMan 5.3 software.The current meta-analysis is based on data from six studies. Neutrophil to lymphocyte ratio was higher in Henoch Schonlein patients with gastrointestinal involvement than those without with a mean difference of 0.88 (95% confidence interval [CI]: 0.55, 1.22 [P < 10-5, I2 = 8%]). Low heterogeneity (I2) was observed between the included studies. Subgroup analysis, leave one out meta-analysis and meta-regression analysis were performed which led to the lowering of I2 to 0.The findings of our meta-analysis suggest that the neutrophil to lymphocyte ratio could serve as a marker of gastrointestinal involvement in patients with Henoch Schonlein purpura; however, most of the included studies are case-control, therefore future cohort studies should clarify the value of this marker.

PMID:34546994 | DOI:10.1097/MPG.0000000000003185

Minerva Obstet Gynecol. 2021 Sep 21. doi: 10.23736/S2724-606X.21.04941-1. Online ahead of print.

ABSTRACT

OBJECTIVE: We aimed to evaluate the fetal cardiac functions with myocardial performance index( MPI) in gestational diabetes mellitus (GDM).

MATERIALS AND METHODS: In this study, 35 patients who were diagnosed with GDM and 35 pregnant without glucose intolerance and their babies were evaluated. Fetal echocardiographic, biometric measurements, umbilical artery pulsatility indices (UAPI) and ductus venosus pulsatility indices (DVPI) measurements were performed to evaluate fetal well-being between the groups.

RESULTS: There was no statistically significant difference between the groups in terms of UAPI, DVPI, systolic functions, the mode of delivery and 5-minute APGAR scores (p = 0.849, p = 0.485, p = 0.770, p=0.060, p=0.587). There was statistically significant difference between the isovolumetric relaxation time and isovolumetric contraction time of groups (p=0.006, p = 0.03). The MPI results were statistically different between the groups (p = 0.000). Postpartum need for hospitalization was more frequently observed in GDM than the control group (p = 0.014).

DISCUSSION AND CONCLUSIONS: MPI, which is independent of the ventricular anatomy and fetal heart rate, showing both diastolic and systolic functions, was found significantly higher in GDM. We recommend perform MPI measurement routinely to fetal cardiac functions in GDM.

PMID:34546022 | DOI:10.23736/S2724-606X.21.04941-1

Minerva Endocrinol (Torino). 2021 Sep 21. doi: 10.23736/S2724-6507.21.03397-2. Online ahead of print.

ABSTRACT

BACKGROUND: Over the past decade, there has been increasing interest in exploring the relationship between overweight, obesity and vertebral fractures. Nonetheless, available data from studies on the relationship between overweight, obesity and vertebral fractures remains controversial.

METHODS: A systematic search was performed in the PubMed and Cochrane Library databases. We selected relevant literature by using these keywords: fracture, vertebral fracture, vertebral compression fracture, overweight, obese, obesity. The retrieval mainly collected publicly published observational studies on the correlation between overweight, obesity and vertebral fractures, excluding the literature that did not meet the inclusion criteria. Meta-analysis for the data extracted from all the included literatures was performed by STATA 12.0 to summarize test performance with forest plots and assess the heterogeneity.

RESULTS: Ten studies, including 1,024,181 subjects satisfied the predefined eligibility criteria. The results showed that the overweight (25.0≤ body mass index (BMI) ≤29.9 kg/m2) and obesity (BMI ≥30.0kg/m2) were associated with a decreased risk of vertebral fractures, respectively. The pooled RR is 0.86 [95% CI: 0.79, 0.95] and 0.81[95% CI:0.74-0.90] with no evidence of statistical heterogeneity. However, the relationship between overweight/obesity (BMI ≥25 kg/m2) and vertebral fractures is not statistically significant.

CONCLUSIONS: This study showed that overweight and obesity might decrease the risk of vertebral fractures, respectively. However, we did not observe a significant association between overweight/obesity (BMI≥25 kg/m2) and vertebral fractures.

PMID:34546017 | DOI:10.23736/S2724-6507.21.03397-2

Swiss Med Wkly. 2021 Sep 17;151:w30030. doi: 10.4414/smw.2021.w30030. eCollection 2021 Sep 13.

ABSTRACT

The Federal Statistical Office publishes weekly national and regional mortality reports online for Switzerland for the age groups 0 to <65 and 65+ years, which refer to deaths up to 9 days prior to the publication date. In addition to observed numbers of death events, expected numbers are reported, which allows detection of periods of excess mortality and its quantification. As with previous periods of excess mortality, in 2020 the monitoring detected and quantified excess mortality during the two waves of the SARS-CoV-2 epidemic in Switzerland. During the year, the epidemic resulted in well over 10% more deaths than expected, mainly in individuals aged 65 years and above. Because of the profound impact of the epidemic, interest in the weekly mortality publication and its underlying methodology increased sharply. From inquiries and from newspaper and tabloid publications on the matter it became abundantly evident that the principles of the mortality monitoring were not well understood in general; mortality monitoring was even regularly confused with cause of death statistics. The present article therefore aims at elucidating the methodology of national mortality monitoring in Switzerland and at putting it into its public health context.

PMID:34546014 | DOI:10.4414/smw.2021.w30030