Nevin Manimala

West Afr J Med. 2021 Jun 26;38(6):526-530.

ABSTRACT

BACKGROUND: Abdominal myomectomy is a treatment modality for uterine fibroids. Its outcome depends on related variables which include the size, number and location of the fibroids, age of the patient, surgery and method used to secure haemostasis.

OBJECTIVE: To determine the outcomes of abdominal myomectomies and related variables in a fertility centre in South-south Nigeria.

METHODS: A retrospective study of the records of all cases of abdominal myomectomies performed between August 1, 2010 and July 31, 2017. Medical records of the 146 patients who had abdominal myomectomy during the period under review were retrieved and relevant data extracted. Information collected included the presence or absence of intra-abdominal adhesions, duration of tourniquet use, number and weight of enucleated fibroid seedlings, intraoperative blood loss, complications and the number of patients who achieved pregnancy after myomectomy. Data were analyzed using ANALYSE IT® statistical package.

RESULTS: 146 patients underwent myomectomy during the period under review. The age range of the patients was 28-56 years (median 41 years). Almost all the patients (94.5%) had tourniquets applied to the uterus for hemostasis. The number of fibroids enucleated ranged from 1 to 154 and weighed between 0.02 and 2.8kg. Blood loss ranged from 100 to1500mls, 17.4% had post-operative fever, and one patient had bowel injury. Thirty-one patients (32.3%) who subsequently had in vitro fertilisation treatment achieved conception.

CONCLUSION: Fibroids, weighing >0.5kg, are associated with increased blood loss during abdominal myomectomy, and a previous myomectomy significantly increases the risk of adhesions. Careful patient selection and meticulous surgical techniques are necessary to avoid morbidity in this setting with a high rate of large uterine fibroids.

PMID:34174179

West Afr J Med. 2021 Jun 26;38(6):520-525.

ABSTRACT

BACKGROUND: Poor medication adherence in HIV treatment is a public health problem as it leads to increased morbidity and mortality, as well as the development of drug resistance. There is limited information on the determinants of adherence among people living with HIV/AIDS especially in sub-Saharan Africa. This study aimed at assessing the determinants of adherence to HAART among people living with HIV/AIDS in Lagos State, Nigeria.

METHODS: A descriptive cross-sectional survey was conducted among 302 respondents selected from three public health facilities across the state. The study instrument was an interviewer-administered questionnaire adapted from the Medication Adherence Report Scale (MARS). Data analysis was performed using Epi Info software. Logistic regression analysis was used to identify the determinants of adherence. Level of significance for all the tests was set at p-value <0.05.

RESULTS: Seventy percent of respondents reported being adherent to medication. There were statistically significant associations between respondents’ age, having children, good knowledge of HIV and medication adherence. In addition, it was observed that the type of anti-retroviral (ARV) drug schedule, never missing an appointment, belonging to a support group and disclosure of status were associated with HAART adherence. Controlling for other variables, those that had disclosed their status were twice as likely to adhere to HIV medication (aOR: 2.3; 95% CI: 1.1-4.8). Also, those who had never missed a clinic appointment were three times more likely to adhere to prescribed medication (aOR: 3.4; 95% CI: 1.7-6.5).

CONCLUSION: Disclosure of HIV status and clinic attendance were key determinants of adherence among patients on HAART in Lagos, Nigeria.

PMID:34174178

Liver Int. 2021 Jun 26. doi: 10.1111/liv.14995. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: With the growing number of treated hepatitis C patients, the current “one size fits all” HCC surveillance strategies for patients with advanced fibrosis represents a great burden on healthcare systems. An individualized HCC risk strategy incorporates the dynamic changes of HCC risk are lacking.

METHODS: This single-center observational study included 3075 patients, with advanced fibrosis (≥ F3) who achieved SVR following DAAs at Egyptian Liver research institute and hospital (ELRIAH) with follow up period (range 6-72 months). The performance of a recently developed GES HCC risk stratification score was calculated pre- and post-treatment using Harrell’s c statistic. Times to HCC and cumulative incidences were calculated with Kaplan-Meier method and compared using log-rank (Mantel-Cox) test.

RESULTS: Pre-treatment GES score stratified patients into low (60.4%), intermediate (23.4%), and (16.2%) high-risk score where 5-year cumulative incidences of HCC were 1.66%, 4.45% and 7.64 respectively. Harrell’s c statistic was 0.801. Post-treatment GES score stratified patients into low (57.4%), intermediate (30.7%) and (11.9%) high-risk score where 5-year cumulative incidences of HCC were 1.35%,3.49% and 11.09% respectively. The cumulative HCC incidence increased significantly with higher scores (p<0.001). Harrell’s c statistic was 0.818. Using pretreatment and post treatment GES score, GES algorithm was developed with higher predictive value. The cumulative HCC incidence increased significantly with higher scores (p<0.001). Harrell’s c statistic was 0.832.

CONCLUSION: A dynamic algorithm incorporating both pre and post-GES scores have better performance and predictive value compared to only pre-treatment assessments. The proposed algorithm would help stratify those who need intensive or being excluded from screening.

PMID:34174150 | DOI:10.1111/liv.14995

Am J Transplant. 2021 Jun 26. doi: 10.1111/ajt.16732. Online ahead of print.

ABSTRACT

Primary hyperoxaluria (PH) is a metabolic defect that results in oxalate over-production by the liver and leads to kidney failure due to oxalate nephropathy. As oxalate tissue stores are mobilized after transplantation, the transplanted kidney is at risk of recurrent disease. We evaluated surveillance kidney transplant biopsies for recurrent calcium oxalate (CaOx) deposits in 37 kidney transplants (29 simultaneous kidney and liver [K/L] transplants and 8 kidney alone [K]) in 36 PH patients and 62 comparison transplants. Median follow-up post-transplant was 9.2 years (IQR: [5.3, 15.1]). Recurrence of CaOx crystals in surveillance biopsies in PH at any time post-transplant was 46% overall (41% in K/L, 62% in K). Higher CaOx crystal index, which accounted for biopsy sample size, was associated with higher plasma and urine oxalate following transplant (p<0.01 and p<0.02, respectively). There was a trend toward higher graft failure among PH patients with CaOx crystals on surveillance biopsies compared with those without [HR 4.43 (0.88, 22.35), p=0.07]. CaOx crystal deposition is frequent in kidney transplants in PH patients. Avoidance of high plasma oxalate and reduction of CaOx crystallization may decrease the risk of recurrent oxalate nephropathy following kidney transplantation in patients with PH. This study was approved by the IRB at Mayo Clinic.

PMID:34174139 | DOI:10.1111/ajt.16732

BJU Int. 2021 Jun 26. doi: 10.1111/bju.15527. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess the role of music in reducing the pain and anxiety associated with flexible cystoscopy using a blinded trial design.

PATIENTS AND METHODS: A patient blinded randomised control trial of music during flexible cystoscopy was performed comparing the pain, measured by visual analogue scale (VAS), anxiety, measured by the state trait anxiety inventory (STAI), and vital signs of 109 patients across two public hospitals in New South Wales, Australia. The purpose and hypothesis of the study was concealed from patients until after results had been collected.

RESULTS: No statistically significant differences were detected between the Non-Music and Music groups in VAS pain score (2.04±1.94 vs 2.10±1.90, P=0.86), change in STAI anxiety score (4.87±9.87 vs 6.8±11.07, P=0.33) or post procedural vital signs (HR 74±14 vs 72±13, P=0.66, SBP 144±20 vs 141±19, P=0.47) between the two groups.

CONCLUSION: Music does not appear to decrease perceived pain or anxiety when used during flexible cystoscopy. These findings may differ from the literature due to a number of factors, most significantly blinding of participants, but also potentially due to the ethnic makeup of the study population or lack of choice of music.

PMID:34174137 | DOI:10.1111/bju.15527

Reprod Domest Anim. 2021 Jun 26. doi: 10.1111/rda.13981. Online ahead of print.

ABSTRACT

The results of most studies show the beneficial effect of milking automation on production parameters of dairy cows, but its effect on fertility traits is debatable. Therefore, a study was undertaken to predict cow fertility – services per conception (SC) and calving interval (CI) – based on automatic milking system (AMS) data collected in the periparturient period subdivided into second and first week before calving, 1-4, 5-7, 8-14, 15-21 and 22-28 days of lactation. SC and CI were predicted using daily indicators such as concentrate intake, number of milkings, cow box time, milking time, milking speed, colostrum and milk yield, composition, temperature and electrical conductivity. The study material was derived from the AMS management system and from the SYMLEK milk recording system. The analysis covered data for 16,329 milkings of 398 Polish Holstein-Friesian (PHF) cows, which were used in 3 AMS herds. The collected numerical data were statistically analysed by correlation analysis in parallel with decision tree technique (SAS statistical package). The present study showed that due to the low, mostly non-significant coefficients of correlation between AMS data collected between 2 weeks before and 4 weeks after calving, it is not possible to predict cow fertility based on single traits. It has been established that the decision tree method may help breeders, already during the postcalving period, to choose the level of factors associated with AMS milking, which will ensure good fertility of cows in a herd. The most favourable number of services per conception are to be expected from cows that were milked <1.6 times per day from 1 to 4 days of lactation and electrical conductivity of their colostrum did not exceed 69 mS during that time. In turn, shortest CI (366 days) will be characteristic of the cows whose average daily colostrum yield did not exceed 20.2 kg and their daily concentrate intake from 8 to 14 days of lactation was at least 5.0 kg.

PMID:34174127 | DOI:10.1111/rda.13981

Int J Clin Pract. 2021 Jun 26:e14577. doi: 10.1111/ijcp.14577. Online ahead of print.

ABSTRACT

BACKGROUND/AIM: Subclinical hypothyroidism (SCH) is defined as high thyroid-stimulating hormone (TSH) and normal thyroxine (T4) levels. Data on the effects of early substitution with levothyroxine on psychophysical health in SCH are not consistent enough to support its general administration. The aim of this study was to examine the effect of 3-month levothyroxine (LT4) treatment on cardiovascular function in symptomatic SCH with TSH <10 mIU/L.

METHODS: Anthropometric, biochemical, electro- and echocardiographic indices were measured in 35 patients with persistent symptomatic SCH (4 mIU/L < TSH <10 mIU/L; mean ± SD: 7.0 ± 2.1 mIU/L) and 40 healthy controls at baseline and three months after the euthyroid state had been achieved on LT4 for SCH group, or three months of follow-up for controls.

RESULTS: The analyses showed a significant reduction in body weight (p=0.030), systolic and diastolic blood pressure (p=0.024, p=0.019), TSH (p<0.001), and thyroid peroxidase antibodies (TPO Ab) (p<0.001) on LT4 in the SCH group. There was a statistically significant decrease in end-systolic (ESV) and end-diastolic volumes (EDV) (p<0.001, p<0.001, respectively) after LT4 treatment. LT4 therapy significantly increased values of ejection fraction (EF), global longitudinal, circumferential and radial strains (p<0.001, p<0.001, p<0.001, respectively).

CONCLUSIONS: Our study confirmed an echocardiographic improvement of cardiac structure and function in treated individuals. Findings suggest the role of electrocardiographic and echocardiographic examination in objective monitoring for LT4 therapeutic effects.

PMID:34174124 | DOI:10.1111/ijcp.14577

Reprod Domest Anim. 2021 Jun 26. doi: 10.1111/rda.13983. Online ahead of print.

ABSTRACT

Retention of fetal membranes (RFM) is a major reproductive disorder in dairy cows. An appropriate immune response is important for a physiological expulsion of the fetal membranes at parturition. Our study aims to provide a deeper insight into characteristics of fetal and maternal macrophages in bovine term placenta. We used transmission electron microscopy (TEM), immunohistochemistry and semi-quantitative RT-PCR to provide a deeper insight into characteristics of fetal and maternal macrophages in bovine term placenta. Semi-quantitative RT-PCR was used to define macrophage polarization in fetal and maternal compartments of normal term placenta. Gene expression of factors involved in M1-polarization [interferon regulatory factor-5 (IRF5), interleukin (IL)-12A, IL12B] and in M2-polarization (IL10) were studied. Ultrastructurally, fetal macrophages showed an irregular shape and large vacuoles, whereas the maternal macrophages were spindle shaped. By immunohistochemistry macrophages were identified by a strong staining with the lysosomal marker Lysosome-associated membrane glycoprotein 1 (LAMP-1), while myofibroblast in the maternal stroma were positive for alpha-smooth muscle actin. We used the LAMP-1 marker to compare the density of fetal stromal macrophages in placentas of cows with RFM and in controls, but no statistically significant difference was observed. RT-PCR showed a higher expression of all studied genes in the maternal compartment of the placenta and generally a higher expression of M1-, compared to M2-associated genes. Our results indicated that at parturition placental macrophages predominantly show the pro-inflammatory M1-polarization. The higher expression of all the target genes in the maternal compartment may denote that maternal macrophages in bovine term placenta are more frequent than fetal macrophages.

PMID:34174122 | DOI:10.1111/rda.13983

Clin Oral Implants Res. 2021 Jun 26. doi: 10.1111/clr.13803. Online ahead of print.

ABSTRACT

OBJECTIVES: Purpose of this experimental in-vivo investigation was to evaluate the influence of modifying the implant surface by adding a monolayer of multi-phosphonate molecules on the de novo bone formation and osseointegration.

MATERIAL AND METHODS: The study was designed as an animal pre-clinical trial with intra-animal control and two healing periods, 2 and 8 weeks, to compare implants with an identical macro-design but with two different surfaces. Eight female Beagle dogs participated in the study. Control implants had a moderately rough surface combining sandblasting and acid etching; test implants had an additional monophosphonate layer covalently bonded to titanium. Histologic and radiographic (microCT) outcome variables were evaluated.

RESULTS: The first bone to implant contact (fBIC) was located more coronally for the test implants at the first (0.065 mm (95%CI = -0.82, 0.60)) and second healing milestones (0.17 mm (95%CI = -0.9, 0.55)). Most coronal BIC of the test implants displayed a higher percentage of osseointegration, + 6.33% and + 13.38% after 2 and 8 weeks, respectively; however the differences were not statistically significant. The microCT examination did not show any BIC difference.

CONCLUSIONS: The monophosphonate layer coating demonstrated clinical, histological and radiographic results similar to the control surface.

PMID:34174121 | DOI:10.1111/clr.13803

Genet Epidemiol. 2021 Jun 26. doi: 10.1002/gepi.22419. Online ahead of print.

ABSTRACT

In the analysis of gene expression data, when there are two or more disease conditions/groups (e.g., diseased and normal, responder and nonresponder, and multiple stages/subtypes), differential analysis has been extensively conducted to identify key differences and has important implications. Network analysis takes a system perspective and can be more informative than that limited to simple statistics such as mean and variance. In differential network analysis, a common practice is to first estimate a gene expression network for each condition/group, and then spectral clustering can be applied to the network difference(s) to identify key genes and biological mechanisms that lead to the differences. Compared to “simple” analysis such as regression, differential network analysis can be more challenging with the significantly larger number of parameters. In this study, taking advantage of the increasing popularity of multidimensional profiling data, we develop an assisted analysis strategy and propose incorporating regulator information to improve the identification of key genes (that lead to the differences in gene expression networks). An effective computational algorithm is developed. Comprehensive simulation is conducted, showing that the proposed approach can outperform the benchmark alternatives in identification accuracy. With the The Cancer Genome Atlas lung adenocarcinoma data, we analyze the expressions of genes in the KEGG cell cycle pathway, assisted by copy number variation data. The proposed assisted analysis leads to identification results similar to the alternatives but different estimations. Overall, this study can deliver an efficient and cost-effective way of improving differential network analysis.

PMID:34174112 | DOI:10.1002/gepi.22419