Nevin Manimala

Indian J Dermatol Venereol Leprol. 2021 [SEASON];87(4):491-497. doi: 10.25259/IJDVL_248_19.

ABSTRACT

BACKGROUND: Sensitive and definitive diagnostic tests are required for timely treatment of leprosy and to control its transmission.

AIM: In the present study, we report the development of loop-mediated isothermal amplification assay using six primers targeting the RLEP gene sequence uniquely present in Mycobacterium leprae.

METHODS: Tissue punch samples (n = 50) and slit aspirates (n = 50) from confirmed cases of leprosy (M. leprae positive by quantitative polymerase chain reaction), reporting at the Department of Dermatology, Safdarjung Hospital, New Delhi, were analyzed using newly developed closed tube loop-mediated isothermal amplification assay. The sensitivity and specificity; positive predictive value, negative predictive value and accuracy were calculated using MedCalc statistical software.

RESULTS: The loop-mediated isothermal amplification assay specifically amplified M. leprae genomic DNA with an analytical sensitivity of 100 fg. About 47 Out of the 50 quantitative polymerase chain reactions confirmed M. leprae positive tissue samples, 47 were positive by loop-mediated isothermal amplification assay (sensitivity 94%; 95% confidence interval 83.5%-98.8%) while only 31/50 were positive by histopathology (sensitivity 62%; 95% confidence interval 47.2%-75.4%) . Using slit aspirate samples of these 50 patients, 42 were positive by both quantitative polymerase chain reaction and loop-mediated isothermal amplification assay (sensitivity 84%; 95% confidence interval 70.9%-92.8%) while only 23/50 (sensitivity 46%; 95% confidence interval 31.8%-60.7%) were positive by microscopy.

LIMITATIONS: In the present study, the leprosy patient cohort was not uniform, as it comprised a lower number of paucibacillary cases (22%) compared to multibacillary (78%) cases.

CONCLUSION: Loop-mediated isothermal amplification assay established here provides a rapid and accurate diagnostic test for leprosy in terms of sensitivity and specificity. The assay is simple to perform in comparison with other molecular techniques (polymerase chain reaction/quantitative polymerase chain reaction) and has potential for field applicability.

PMID:34219438 | DOI:10.25259/IJDVL_248_19

Indian J Dermatol Venereol Leprol. 2021 [SEASON];87(4):483-490. doi: 10.25259/IJDVL_681_19.

ABSTRACT

BACKGROUND: Epileptic seizures were noted as one of the most overlooked manifestations in syphilis; therefore a few clinicians are concerned about the relationship between epilepsy and syphilis. Our study sought to clarify the prevalence and clinical features of epileptic seizures in patients with syphilis.

METHODS: We retrieved relevant articles from different databases, using the keywords “syphilis and epilepsy” and then performed statistical analysis to characterize the relationship between these diseases.

RESULTS: Forty one articles were included in this study: eight described the prevalence of syphilis and epilepsy and the remaining 33 were case reports on syphilis with epileptic seizures. The meta-analysis included 1252 patients with syphilis. The pooled estimate of proportion of prevalence (95% confidence interval) was 0.1384 (0.0955-0.2005), and the proportion and heterogeneity showed different degrees of change among three subgroups. The systematic review included 46 cases of syphilis with epileptic seizures. Thirty two (80%) patients had motor seizures, among whom 20 (62.5%) had tonic-clonic seizures. In addition, 30 (75%) patients had impaired awareness and 18 (45%) had status seizures. Twenty five (62.5%) patients were 35-55 years of age, and 77.5% of the included patients were men. Thirty seven (97.4%) patients were seizure-free after anti-syphilis treatment.

LIMITATIONS: Research in this field has been conducted for a relatively short period and publication bias may exist. Furthermore, some patients with syphilis and epileptic seizures may not have received a clear diagnosis.

CONCLUSION: The proportion of prevalence was 0.1384. Most of the included patients were 35-55 years of age and had impaired awareness and motor seizures. Many patients with syphilis and epileptic seizure showed full recovery or the development of minor neurological sequelae, and nearly all patients were seizure-free after timely anti-syphilis treatment.

PMID:34219436 | DOI:10.25259/IJDVL_681_19

Liver Int. 2021 Jul 5. doi: 10.1111/liv.15005. Online ahead of print.

ABSTRACT

BACKGROUND&AIMS: PPAR-γ agonists decrease hepatic/visceral fat (VF) and improve necroinflammation despite subcutaneous (SC) fat weight-gain. Understanding the impact of changes in VF, VF-to-SC distribution (VF/SC) and adiponectin levels in relation to histological improvement after weight-loss or pioglitazone is relevant as novel PPAR-γ agonists are being developed for treating NASH.

METHODS: Fifty-five patients with NASH received a -500 kcal/day hypocaloric diet and were randomized (double-blind) to pioglitazone (45 mg/d) or placebo for 6-months. Before and after treatment patients underwent a liver biopsy and measurement of hepatic/peripheral glucose fluxes, hepatic/adipose tissue-IR and, in thirty-five patients, hepatic and VF/SC-fat was measured by magnetic resonance spectroscopy/imaging. Data were examined by multivariable statistical analyses combined with machine-learning techniques (PLS-DA).

RESULTS: Both pioglitazone (despite weight-gain) and placebo (if weight-loss) reduced steatosis but only pioglitazone ameliorated necroinflammation. Using machine-learning PLS-DA showed that the treatment differences induced by a PPAR-γ agonist vs. placebo on metabolic variables and liver histology could be best explained by the increase in adiponectin and a decrease in VF/SC, and to a lesser degree, improvement in OGTT-glucose concentrations and ALT. Decrease in steatosis and disease activity score (ballooning plus lobular inflammation) kept a close relationship with an increase in adiponectin (r=-0.71 and r=-0.44, p< 0.007, respectively) and reduction in VF/SC (r=0.41 and r=0.37, p<0.03, respectively).

CONCLUSIONS: Reduction in VF and improved VF/SC-distribution, combined with an increase in adiponectin, mediate the histological benefits of PPAR-γ action, highlighting the central role of fat metabolism and its distribution on steatohepatitis disease activity in patients with NASH.

PMID:34219361 | DOI:10.1111/liv.15005

Clin Implant Dent Relat Res. 2021 Jul 4. doi: 10.1111/cid.13029. Online ahead of print.

ABSTRACT

BACKGROUND: Although full-arch immediately loaded rehabilitations are widely used nowadays, little information is available on which implant/abutment connection is the most suitable in this type of treatment.

PURPOSE: The aim of the present multicentric split-mouth clinical trial was to compare the clinical outcomes of two different implant-abutment connections applied in full-arch immediate loading rehabilitations: external hexagon connection (EHC) versus internal hexagon connection (IHC).

MATERIALS AND METHODS: Twenty patients were rehabilitated with immediately loaded fixed full-arch rehabilitations. All the implants presented the same macro- and micro-topography but different implant/abutment connection. IHC were used in one randomly selected side of the jaw and EHC in the other side. Outcome measures were implant survival rate, peri-implant marginal bone loss (MBL), plaque index (PI), probing depth (PD), and bleeding on probing (BoP) evaluated at 3, 6, 12, and 36-month post-loading. Any technical and biological complication was recorded. Kaplan-Meier procedure and linear mixed model were used to perform statistical analysis.

RESULTS: Forty-three EHC and 40 IHC implants were inserted. No patients dropped out and two implants failed in the first 6 months. The CSR was 97.7% for EHC and 97.5% for IHC implants. No statistically significant differences were found among the two groups for any of the parameters at any time point. At the 36-month follow-up visit a slight difference was found in MBL with a mean value of 1.7 mm in the EHC and of 1.9 mm in the IHC group (p = 0.355). No biologic complications were identified. Seven loosed abutment screws were identified in the entire follow-up period, two in the EHC, and five in the IHC group without a statistically significant difference (p = 0.394).

CONCLUSIONS: After 36 months in function, both internal and external hexagon connections provided good clinical outcomes and were not associated with any significant difference.

PMID:34219356 | DOI:10.1111/cid.13029

Health Econ. 2021 Jul 5. doi: 10.1002/hec.4376. Online ahead of print.

ABSTRACT

We examine the effects of policies aimed at restricting the use of false identification to purchase alcohol on traffic fatalities involving alcohol-impaired underage drivers. We find that the implementation of policies that incentivize alcohol retailers to adopt ID scanners reduces traffic fatalities from accidents involving 16-18 year old drivers with a BAC >0, but we do not find that similar policies like vertical ID laws lead to statistically significant changes in traffic fatalities involving underage impaired drivers. A back-of-the-envelope calculation suggests that if all remaining states passed ID scanner laws, the reduction in underage alcohol-related fatal accidents would generate over $400 million in annual economic benefits.

PMID:34219319 | DOI:10.1002/hec.4376

J Clin Nurs. 2021 Jul 4. doi: 10.1111/jocn.15940. Online ahead of print.

ABSTRACT

AIMS AND OBJECTIVES: To investigate healthcare personnel’s working conditions in relation to risk behaviours for organism transmission.

BACKGROUND: Healthcare personnel’s behaviour is often influenced by working conditions that in turn can impact the development of healthcare-associated infections. Observational studies are scarce, and further understanding of working conditions in relation to behaviour is essential for the benefit of the healthcare personnel and the safety of the patients.

DESIGN: A mixed-methods convergent design.

METHODS: Data were collected during 104 h of observation at eight hospital units. All 79 observed healthcare personnel were interviewed. Structured interviews covering aspects of working conditions were performed with the respective first-line manager. The qualitative and quantitative data were collected concurrently and given equal priority. Data were analysed separately and then merged. The study follows the GRAMMS guidelines for reporting mixed-methods research.

RESULTS: Regardless of measurable and perceived working conditions, risk behaviours frequently occurred especially missed hand disinfection. Healthcare personnel described staffing levels, patient-level workload, physical factors and interruptions as important conditions that influence infection prevention behaviours. The statistical analyses confirmed that interruptions increase the frequency of risk behaviours. Significantly higher frequencies of risk behaviours also occurred in activities where healthcare personnel worked together, which in the interviews was described as a consequence of caring for high-need patients.

CONCLUSIONS: These mixed-methods findings illustrate that healthcare personnel’s perceptions do not always correspond to the observed results since risk behaviours frequently occurred regardless of the observed and perceived working conditions. Facilitating the possibility for healthcare personnel to work undisturbed when needed is essential for their benefit and for patient safety.

RELEVANCE FOR CLINICAL PRACTICE: The results can be used to enlighten healthcare personnel and managers and when designing future infection prevention work.

PMID:34219318 | DOI:10.1111/jocn.15940

J Magn Reson Imaging. 2021 Jul 4. doi: 10.1002/jmri.27816. Online ahead of print.

ABSTRACT

BACKGROUND: Signal-to-noise ratio (SNR) is used to evaluate the performance of magnetic resonance (MR) imaging systems. Accurate and consistent estimations are needed to routinely use SNR to assess coils and image reconstruction techniques.

PURPOSE: To identify a reliable and practical method for SNR estimation in multiple-coil reconstructions.

STUDY TYPE: Technical evaluation and comparison.

SUBJECTS/PHANTOM: A uniform phantom and four healthy volunteers: 35, 38, 39 y/o males, 25 y/o female.

FIELD STRENGTH/SEQUENCE: Two-dimensional multislice gradient-echo pulse sequence at 3 T and 7 T.

ASSESSMENT: Reference-standard SNR was calculated from 100 multiple replicas. Six SNR methods were compared against it: difference image (DI), analytic array combination (AC), pseudo-multiple-replica (PMR), generalized pseudo-replica (GPR), smoothed image subtraction (SIS), and DI with temporal instability correction (TIC). The assessment was repeated for different multiple-coil reconstructions.

STATISTICAL TESTS: SNR methods were evaluated in terms of relative deviation (RD) and normalized mutual information (NMI) with respect to the reference-standard, using a linear regression (0.05 significance level) to assess how different factors affect accuracy.

RESULTS: Average RD (phantom) for DI, AC, PMR, GPR, SIS, and TIC was 7.9%, 6%, 6.7%, 10.1%, 40%, and 14.6%, respectively. RD increased with acceleration. SNR maps with AC were the most similar to the reference standard (NMI = 0.358). Considering all brain regions of interest, average RD for all SNR methods varied 96% among volunteers but remained approximately 10% for AC, PMR, and GPR, whereas it was more than 30% for DI, SIS, and TIC. RD was mainly affected by image reconstruction (beta = 12) for AC and SNR entropy for SIS (beta = 19).

DATA CONCLUSION: AC provided accurate and robust SNR estimation. PMR and GPR are more generally applicable than AC. DI and TIC should be used only at low acceleration factors, when an additional noise-only scan cannot be acquired. SIS is a single-acquisition alternative to DI for generalized autocalibrating partial parallel acquisition (GRAPPA) reconstructions.

EVIDENCE LEVEL: 1 TECHNICAL EFFICACY: Stage 1.

PMID:34219312 | DOI:10.1002/jmri.27816

Eur J Cancer Care (Engl). 2021 Jul 5:e13487. doi: 10.1111/ecc.13487. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this work is to explore anxiety and depression status prior to radiotherapy in patients with nasopharyngeal carcinoma (NPC) and its effect on acute radiation toxicities.

METHODS: A total of 267 NPC patients were enrolled between August 2013 and September 2016. The anxiety and depression status of the patients prior to radiotherapy was evaluated using the Hospital Anxiety and Depression Scale. Acute radiation toxicities were assessed weekly and recorded according to the Common Terminology Criteria for Adverse Events version 4.0. Logistic regression analysis was used to identify the predictive factors for acute radiation toxicities.

RESULTS: The rates of anxiety and depression status prior to radiotherapy were 35.2% and 25.5%, respectively. Anxiety was a significant predictor of vomiting (P = 0.001, OR = 2.874) and dysphagia (P = 0.029, OR = 2.080). Depression was a significant predictor of dysgeusia (P = 0.030, OR = 2.957). In addition, age was a significant predictor of dysphagia (P = 0.001, OR = 1.131).

CONCLUSIONS: Anxiety and depression status prior to radiotherapy aggravate acute radiation toxicities in patients with NPC. Assessment of the anxiety and depression status and appropriate interventions should be an integral part of treatment to relieve radiation injury during intensity-modulated radiotherapy.

PMID:34219307 | DOI:10.1111/ecc.13487

J Magn Reson Imaging. 2021 Jul 5. doi: 10.1002/jmri.27817. Online ahead of print.

ABSTRACT

BACKGROUND: Biliary phosphatidylcholine (PtdC) concentration plays a role in the pathogenesis of bile duct diseases. In vivo phosphorus-31 magnetic resonance spectroscopy (³¹ P-MRS) at 7 T offers the possibility to assess this concentration noninvasively with high spectral resolution and signal intensity.

PURPOSE: Comparison of PtdC levels of cholangiopathic patient groups to a control group using a measured T₁ relaxation time of PtdC in healthy subjects.

STUDY TYPE: Case control.

SUBJECTS: Two patient groups with primary sclerosing cholangitis (PSC, 2f/3 m; age: 43 ± 7 years) and primary biliary cholangitis (PBC, 4f/2 m; age: 57 ± 6 years), and a healthy control group (CON, 2f/3 m; age: 38 ± 7 years). Ten healthy subjects for the assessment of the T₁ relaxation time of PtdC.

FIELD STRENGTH/SEQUENCE: A 3D phase-encoded pulse-acquire ³¹ P-MRSI sequence for PtdC quantification and a 1D image-selected in vivo ³¹ P spectroscopy for T₁ estimation at 7 T, and a T2-weighted half-Fourier single-shot turbo spin echo MRI sequence for volumetry at 3 T.

ASSESSMENT: Calculation of gallbladder volumes and PtdC concentration in groups using hepatic gamma-adenosine triphosphate signal as an internal reference and correction for insufficient relaxation of PtdC with a T₁ value assessed in healthy subjects.

STATISTICAL TESTS: Group comparison of PtdC content and gallbladder volumes of the PSC/PBC and CON group using Student’s t-tests with a significance level of 5%.

RESULTS: PtdC T₁ value of 357 ± 85 msec in the gallbladder. Significant lower PtdC content for the PSC group, and for the female subgroup of the PBC group compared to the CON group (PSC/CON: 5.74 ± 0.73 mM vs. 9.64 ± 0.97 mM, PBC(f)/CON: 5.77 ± 1.44 mM vs. 9.64 ± 0.97 mM). Significant higher gallbladder volumes of the patient groups compared to the CON group (PSC/CON: 66.3 ± 15.8 mL vs. 20.9 ± 2.2 mL, PBC/CON: 49.8 ± 18.2 mL vs. 20.9 ± 2.2 mL).

DATA CONCLUSION: This study demonstrated the application of a ³¹ P-MRSI protocol for the quantification of PtdC in the human gallbladder at 7 T. Observed differences in PtdC concentration suggest that this metabolite could serve as a biomarker for specific hepatobiliary disorders.

LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY STAGE: 3.

PMID:34219305 | DOI:10.1002/jmri.27817

Clin Oral Implants Res. 2021 Jul 4. doi: 10.1111/clr.13805. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the outcome after extensive lateral guided bone regeneration using deproteinized bovine bone mineral (DBBM) with or without autogenous bone chips in a canine model of chronic horizontal alveolar ridge defect.

MATERIALS AND METHODS: The second, third and fourth lower premolars of both sides were extracted, and the buccal bone walls were completely removed in five beagle dogs. After 4 weeks, DBBM particles mixed with autogenous bone chips at a ratio of 1:1 were grafted at one side (DBBM/Auto group), while DBBM particles alone were grafted at the contralateral side (DBBM group). The graft materials on both sides were covered by a resorbable collagen membrane and fixation pins. Microcomputed tomographic volume and histomorphometric analyses were performed at 16 weeks post-surgery.

RESULTS: The ridges of both groups were recovered horizontally, but new bone formation beyond the original ridge contour at the defect site was not found. The DBBM group exhibited a larger total radiographic augmented volume and new bone volume compared with the DBBM/Auto group, but the differences were minimal (p > 0.05). Histologically, the regenerated area and new bone area were also slightly larger without any statistical significance in the DBBM group than in the DBBM/Auto group (p > 0.05).

CONCLUSION: The addition of autogenous bone chips to DBBM for lateral ridge augmentation may confer no advantage over grafting DBBM alone with respect to both space maintenance and de novo bone formation in dogs.

PMID:34219293 | DOI:10.1111/clr.13805