Nevin Manimala

Matern Child Nutr. 2021 Oct 8:e13277. doi: 10.1111/mcn.13277. Online ahead of print.

ABSTRACT

Anaemia in women of reproductive age (WRA) can be effectively addressed if supported by a better understanding of the spatial variations, magnitude, severity and distribution of anaemia. This study aimed to map the subnational spatial distribution of anaemia (any, moderate and severe forms) among WRA in Ethiopia. We identified and mapped (any, moderate and severe) anaemia hotspots in WRA (n = 14,923) at the subnational level and identified risk factors using multilevel logistic regression. Kulldorff scan statistics were used to identify hotspot regions. Ordinary kringing was used to predict the anaemia prevalence in unmeasured areas. The overall anaemia prevalence increased from 16.6% in 2011 to 23.6% in 2016, a rise that was mostly related to the widening of existing hotspot areas. The primary clusters of (any) anaemia were in Somali and Afar regions. The horn of the Somali region represented a cluster of 330 km where 10% of WRA were severely anaemic. The Oromia-Somali border represented a significant cluster covering 247 km, with 9% severe anaemia. Population-dense areas with low anaemia prevalence had high absolute number of cases. Women education, taking iron-folic-acid tablets during pregnancy and birth-delivery in health facilities reduced the risk of any anaemia (P < 0.05). The local-level mapping of anaemia helped identify clusters that require attention but also highlighted the urgent need to study the aetiology of anaemia to improve the effectiveness and safety of interventions. Both relative and absolute anaemia estimates are critical to determine where additional attention is needed.

PMID:34624171 | DOI:10.1111/mcn.13277

Eur J Pain. 2021 Oct 8. doi: 10.1002/ejp.1875. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Although Interdisciplinary Multimodal Pain Treatment (IMPT) programs share a biopsychosocial approach to increase the wellbeing of patients with chronic pain, substantial variation in content and duration have been reported. In addition, it is unclear to what extent any favorable health outcomes are maintained over time. Therefore, our first aim was to identify and analyze the change over time of patient related outcome measures in cohorts of patients who participated in IMPT programs. Our second aim was to acquire insight into the heterogeneity of IMPT programs.

DATABASES AND DATA TREATMENT: The study protocol was registered in Prospero under CRD42018076093. We searched Medline, Embase, PsycInfo and Cinahl from inception to May 2020. All study selection, data extraction and risk of bias assessments were independently performed by two researchers. Study cohorts were eligible if they included adult patients with chronic primary musculoskeletal pain for at least 3 months. We assessed the change over time, by calculating pre-post, post-follow-up and pre-follow-up contrasts for seven different patient-reported outcome domains. To explore the variability between the IMPT programs, we summarized the patient characteristics and treatment programs using the intervention description and replication checklist.

RESULTS: The majority of the 72 included patient cohorts significantly improved during treatment. Importantly, this improvement was generally maintained at follow-up. In line with our expectations and with previous studies, we observed substantial methodological and statistical heterogeneity.

CONCLUSIONS: This study shows that participation in an IMPT program is associated with considerable improvements in wellbeing that are generally maintained at follow-up. The current study also found substantial heterogeneity in dose and treatment content, which suggests different viewpoints on how to optimally design an IMPT program.

PMID:34624159 | DOI:10.1002/ejp.1875

Clin Oral Implants Res. 2021 Oct 8. doi: 10.1111/clr.13868. Online ahead of print.

ABSTRACT

OBJECTIVES: to compare gingival tissue healing at surgically manipulated periodontal sites and at sites receiving implants and healing abutments with machined (MS) vs. laser-microtextured (LMS) surface placed with one-stage protocol .

MATERIAL AND METHODS: Twenty-four non smoking patients each received two implants with one-stage protocol in a split mouth design on the same jaw. In each patient, one implant with a MS collar and one immediate healing abutment with a MS, and one implant with a LMS collar and one immediate healing abutment with a LMS were used. Soft tissues healing at surgically manipulated periodontal tissues (T+) and at non-surgically manipulated periodontal tissues (T-) at MS implant sites and at LMS implant sites were compared by means of clinical and biochemical parameters at baseline and at 1-2-3-4-6-8 and 12 weeks.

RESULTS: PD and BoP mean values were statistically higher in MS than LMS implant sites (p<0.05) . During early healing phase (1-4 weeks), MS and LMS peri-implant tissues and periodontal tissues at T(+) showed no statistically significant difference in crevicular fluid volume changes (p>0.05). Between 6 and 12 weeks, compared to T(+), no statistical significant difference in crevicular fluid volume and IL-6 and IL-1β concentrations were noted in LMS implant sites (p>0.05), while statistically significantly higher mean values were noted in MS implant sites (p<0.05).

CONCLUSIONS: Compared T(+) and T(-), both MS and LMS implant sites presented a higher pro-inflammatory state in the early phase after surgery (1-4 weeks). At 12 weeks only MS implant sites kept a higher pro-inflammatory state state, while at LMS implant sites it becomes similar to T(+) and T(-).

PMID:34624157 | DOI:10.1111/clr.13868

Int J Clin Pract. 2021 Oct 8:e14961. doi: 10.1111/ijcp.14961. Online ahead of print.

ABSTRACT

AIM: We aimed to investigate the effect of short-term pirfenidone treatment on prolonged COVID-19 pneumonia.

METHOD: Hospital files of patients hospitalized with a diagnosis of critical COVID-19 pneumonia between November 2020 and March 2021 were retrospectively reviewed. Chest computed tomography images taken both before treatment and 2 months after treatment, demographic characteristics and laboratory parameters of patients receiving pirfenidone+methylprednisolone (n=13) and only methylprednisolones (n=9) were recorded. Pulmonary function tests were performed after the second month of the treatment. CT involvement rates were determined by machine learning.

RESULTS: A total of 22 patients, 13 of whom (59.1%) were using methylprednisolone + pirfenidone and 9 of whom (40.9%) were using only methylprednisolone were included. When the blood gas parameters and pulmonary function tests of the patients were compared at the end of the second month, it was found that the FEV1, FEV1%, FVC, and FVC% values were statistically significantly higher in the methylprednisolone + pirfenidone group compared to the methylprednisolone group (p=0.025, p=0.012, p=0.026, and p=0.017, respectively). When the rates of change in CT scans at diagnosis and second month of treatment were examined, it was found that the involvement rates in the methylprednisolone + pirfenidone group were statistically significantly decreased (p<0.001).

CONCLUSION: Antifibrotic agents can reduce fibrosis that may develop in the future. These can also help dose reduction and/or non-use strategy for methylprednisolone therapy, which has many side effects. Further large series and randomized controlled studies are needed on this subject.

PMID:34624155 | DOI:10.1111/ijcp.14961

Hepatology. 2021 Oct 8. doi: 10.1002/hep.32183. Online ahead of print.

ABSTRACT

BACKGROUND & AIMS: The risk factors of cholelithiasis have not been clearly identified, especially for total cholesterol. Here, we try to identify these causal risk factors.

APPROACH & RESULTS: We obtained genetic variants associated with the exposures at the genome-wide significance (p < 5×10^-8 ) level from corresponding genome-wide association studies (GWAS). Summary-level statistical data for cholelithiasis were obtained from FinnGen and UK Biobank (UKB) consortia. Both univariable and multivariable Mendelian randomization (MR) analyses were conducted to identify causal risk factors of cholelithiasis. Results from FinnGen and UKB were combined using fixed effect model. In FinnGen, the odds of cholelithiasis increased per 1-SD increase of body mass index (BMI) (OR = 1.631, P = 2.16 x 10^-7 ), together with body fat percentage (OR = 2.108, P = 4.56 x 10^-3 ) and fasting insulin (OR = 2.340, P = 9.09 x 10^-3 ). The odds of cholelithiasis would also increase with lowering of total cholesterol (OR = 0.789, P = 8.34 x 10^-5 ) and low-density lipoprotein cholesterol (LDL-C) (OR = 0.792, P = 2.45×10^-4 ). However, LDL-C was not significant in multivariable MR. In UKB, the results of BMI, body fat percentage, total cholesterol and LDL-C were replicated. In meta-analysis, the liability to type 2 diabetes mellitus and smoking could also increase the risk of cholelithiasis. Besides, there were no associations with other predominant risk factors.

CONCLUSIONS: Our MR study corroborated the risk factors of cholelithiasis from previous MR studies. Furthermore, lower total cholesterol level could be a novel independent risk factor.

PMID:34624136 | DOI:10.1002/hep.32183

Fam Med. 2021 Oct;53(9):766-772. doi: 10.22454/FamMed.2021.292421.

ABSTRACT

BACKGROUND AND OBJECTIVES: Current literature on review of applicant social media (SoMe) content for resident recruitment is scarce. With the recent increase in the use of privacy settings, and the cost of the recruitment process, the aim of this study was to describe the practice and outcomes of review of applicant SoMe in resident recruitment and its association with program director or program characteristics.

METHODS: This study was part of the 2020 Council of Academic Family Medicine’s Educational Research Alliance (CERA) annual survey of family medicine residency program directors (PDs) in the United States.

RESULTS: The overall response rate for the survey was 39.8% (249/626). About 40% of PDs reported reviewing applicant SoMe content. The majority (88.9%) of programs did not inform applicants of their SoMe review practices. The most common findings of SoMe review were that the content raised no concerns (38/94; 40.4%) or was consistent with the application material (34/94; 36.2%). Forty PDs (17.0%) have ever moved an applicant up or down the rank list based on SoMe review. Review of applicant SoMe was not statistically associated with program size, program type, PD age, PD SoMe use, or program SoMe use.

CONCLUSIONS: SoMe review has not become routine practice in family medicine resident recruitment. The outcome of SoMe review was mostly consistent with the applicant profile without any concerns and only very few changed the ranking order. This calls for more studies to explore the value of SoMe review for resident selection regarding its effect on future performance.

PMID:34624124 | DOI:10.22454/FamMed.2021.292421

Fam Med. 2021 Oct;53(9):760-765. doi: 10.22454/FamMed.2021.415039.

ABSTRACT

BACKGROUND AND OBJECTIVES: Antiretroviral treatment has transformed human immunodeficiency virus (HIV) infection into a chronic disease. Prior research demonstrated a discrepancy between preparation to provide HIV care and current provision among recent residency graduates. Our study aimed to describe characteristics related to preparedness and provision of HIV care, and to identify the associations between physician and practice characteristics with current provision of HIV care among those prepared.

METHODS: We obtained data from the 2016 through 2019 American Board of Family Medicine (ABFM) National Family Medicine Graduate Survey. Our main outcome was self-reported provision of HIV care. Bivariate statistics compared differences in personal and practice characteristics with self-reported preparation for HIV care, then among those prepared, provision of HIV care. We used logistic regression to determine associations between HIV care, among those prepared, with practice and personal characteristics.

RESULTS: The response rate was 68.7% and our final sample size was 6,740 respondents. Only 25% of respondents reported preparedness in residency, and 44% of them reported current provision. Among those prepared, female gender (OR=0.604; 95% CI, 0.494-0.739) was associated with lower odds of practicing HIV care. Those working in high HIV prevalence areas (OR=1.718; 95% CI, 1.259-2.344) and in Northeast census region (OR=1.557; 95% CI, 1.137-2.132) had higher odds of providing HIV care.

CONCLUSIONS: Fewer than half of those prepared in residency reported currently providing HIV care. Working in a high HIV prevalence area was associated with higher odds of providing HIV care, which suggests early-career family physicians are responding to community needs.

PMID:34624123 | DOI:10.22454/FamMed.2021.415039

Oper Dent. 2021 Oct 8. doi: 10.2341/20-198-L. Online ahead of print.

ABSTRACT

This study aimed to evaluate the cementation and mechanical behavior of flared root canals restored with CAD/CAM milled glass fiber post-and-core systems. Sixty-six endodontically treated human canines with a flared root canal were divided into three different groups according to the type of post: GPF received prefabricated posts; GREL received relined glass fiber posts, and GMILLED received CAD/CAM milled glass fiber posts. Cementation was performed with self-adhesive resin cement. The samples were submitted to x-ray microcomputed tomography analysis for the analysis of voids and gaps. The roots were sectioned and submitted to the push-out bond strength test. The load-to-fracture was evaluated in post-and-core systems. GMILLED presented lower void and lower gap volumes when compared to GPF and GREL. On the load-to-fracture test, GREL presented statistically significant higher values than GMILLED. GPF values had no statistically significant difference from the two other groups. On the push-out bond strength test, GPF presented statistically significant lower values when compared to GREL and GMILLED. The most common failure pattern was between dentin and cement in all groups. CAD/CAM milled glass fiber post-and-core systems presented an enhanced adaptation of glass fiber posts to flared root canal systems. Their results were comparable to relined posts in bond strength, while load-to-fracture-results for GMILLED were lower than those for GPF.

PMID:34624118 | DOI:10.2341/20-198-L

Blood. 2020 Oct 8:blood.2021012081. doi: 10.1182/blood.2021012081. Online ahead of print.

ABSTRACT

Burkitt lymphoma (BL) is an aggressive lymphoma type that is currently treated by intensive chemoimmunotherapy. Despite the favorable clinical outcome of the majority of BL patients, chemotherapy-related toxicity and disease relapse remain as major clinical challenges, emphasizing the need for innovative therapies. Using genome-scale CRISPR-Cas9 screens, we identified B-cell receptor (BCR) signaling, specific transcriptional regulators and one-carbon metabolism as vulnerabilities in BL. We focused on serine hydroxymethyltransferase 2 (SHMT2), a key enzyme in one-carbon metabolism. Inhibition of SHMT2 by either knockdown or pharmacological compounds induced anti-BL effects in vitro and in vivo. Mechanistically, SHMT2 inhibition led to a significant reduction of intracellular glycine and formate levels, which inhibited the mTOR pathway and thereby triggered autophagic degradation of the oncogenic transcription factor TCF3. As a consequence, this led to a collapse of tonic B-cell receptor signaling, which is controlled by TCF3 and is essential for BL cell survival. In terms of clinical translation, we furthermore identified drugs such as methotrexate that synergized with SHMT inhibitors (SHMT2i). Overall, our study has uncovered the dependency landscape in BL, identified and validated SHMT2 as a drug target and revealed a mechanistic link between SHMT2 and the transcriptional master regulator TCF3, opening up new perspectives for innovative therapies.

PMID:34624079 | DOI:10.1182/blood.2021012081

PLoS One. 2021 Oct 8;16(10):e0258377. doi: 10.1371/journal.pone.0258377. eCollection 2021.

ABSTRACT

BACKGROUND: There is currently no validated risk prediction model for recurrent events among patients with acute ischemic stroke (AIS) and atrial fibrillation (AF). Considering that the application of conventional risk scores has contextual limitations, new strategies are needed to develop such a model. Here, we set out to develop and validate a comprehensive risk prediction model for stroke recurrence in AIS patients with AF.

METHODS: AIS patients with AF were collected from multicenter registries in South Korea and Japan. A developmental dataset was constructed with 5648 registered cases from both countries for the period 2011‒2014. An external validation dataset was also created, consisting of Korean AIS subjects with AF registered between 2015 and 2018. Event outcomes were collected during 1 year after the index stroke. A multivariable prediction model was developed using the Fine-Gray subdistribution hazard model with non-stroke mortality as a competing risk. The model incorporated 21 clinical variables and was further validated, calibrated, and revised using the external validation dataset.

RESULTS: The developmental dataset consisted of 4483 Korean and 1165 Japanese patients (mean age, 74.3 ± 10.2 years; male 53%); 338 patients (6%) had recurrent stroke and 903 (16%) died. The clinical profiles of the external validation set (n = 3668) were comparable to those of the developmental dataset. The c-statistics of the final model was 0.68 (95% confidence interval, 0.66 ‒0.71). The developed prediction model did not show better discriminative ability for predicting stroke recurrence than the conventional risk prediction tools (CHADS2, CHA2DS2-VASc, and ATRIA).

CONCLUSIONS: Neither conventional risk stratification tools nor our newly developed comprehensive prediction model using available clinical factors seemed to be suitable for identifying patients at high risk of recurrent ischemic stroke among AIS patients with AF in this modern direct oral anticoagulant era. Detailed individual information, including imaging, may be warranted to build a more robust and precise risk prediction model for stroke survivors with AF.

PMID:34624070 | DOI:10.1371/journal.pone.0258377