Nevin Manimala

Environ Geochem Health. 2021 Jun 15. doi: 10.1007/s10653-021-01007-9. Online ahead of print.

ABSTRACT

Present study was carried out to explore heavy metals pollution and potential ecological risk factors associated with agriculture soil irrigated with industrial effluents of Hayatabad industrial estate, Peshawar (HIEP) and Gadoon industrial estate, Sawabi (GIES) of Khyber-Pakhtunkhwa, Pakistan through multivariate geo-statistical tools. Diverse statistical tools like cluster analysis (HC) and principal component analysis (PCA), along with geo-statistical approaches were applied to highlight the geogenic and anthropogenic sources of pollution. The results indicated that concentration of heavy metals in target areas was significantly higher than control. Both soils had significant to moderate enrichment of heavy metals, while Gadoon soil had moderate to considerable ecological risk factor. The geo accumulation indices (Igeo) tendency for heavy metals in both target soil (Gadoon and Hayatabad) were the same. The Pb concentration of both target areas falls in the extremely severely polluted category because of the excessive presence of industries producing lead-containing products. Hence, this study indicated that the majority of toxic heavy metals contributed to soil pollution in the studied areas are coming from industrial and commercial activities.

PMID:34131852 | DOI:10.1007/s10653-021-01007-9

Support Care Cancer. 2021 Jun 16. doi: 10.1007/s00520-021-06334-2. Online ahead of print.

ABSTRACT

PURPOSE: Haematopoietic stem cell transplantation (HSCT) is potentially lifesaving. However, it comes with negative consequences such as impaired physical functioning, fatigue and poor quality of life. The aim of this systematic review and meta-analysis is to determine the effect of exercise and nutrition interventions to counteract negative consequences of treatment and improve physical functioning in patients receiving HSCT.

METHODS: This systematic review and meta-analysis included randomised controlled trials from three electronic databases between 2009 and 2020. The trials included adult patients receiving HSCT and an exercise or nutrition intervention. Study selection, bias assessment and data extraction were independently performed by two reviewers. Physical functioning outcomes were meta-analysed with a random-effects model.

RESULTS: Thirteen studies were included using exercise interventions (n = 11) and nutrition interventions (n = 2); no study used a combined intervention. Meta-analysis of the trials using exercise intervention showed statistically significant effects on 6-min walking distance (standardised mean difference (SMD) 0.41, 95% CI: 0.14-0.68), lower extremity strength (SMD 0.37, 95% CI 0.12-0.62) and global quality of life (SMD 0.27, 95% CI: 0.08-0.46).

CONCLUSION: Our physical functioning outcomes indicate positive effects of exercise interventions for patients receiving HSCT. Heterogeneity of the exercise interventions and absence of high-quality nutrition studies call for new studies comparing different types of exercise studies and high quality studies on nutrition in patients with HSCT.

PMID:34131848 | DOI:10.1007/s00520-021-06334-2

Support Care Cancer. 2021 Jun 15. doi: 10.1007/s00520-021-06353-z. Online ahead of print.

ABSTRACT

PURPOSE: The family of leukemia patients, due to their caring role, often feels psychological distress. A practical need-based program carefully considers the set of requirements of nursing service recipients. This paper illustrates the efficacy of a designed family-need-based program on relieving stress, anxiety, and depression of family caregivers of leukemia patients.

METHODS: In this controlled trial, sixty-four family caregivers of leukemia patients referring to a medical center in Iran were recruited by convenience sampling and randomly divided into study and control groups. The study group attended a designed need-based program. The control group did not receive the intervention. Stress, anxiety, and depression of both groups were simultaneously measured and compared in three time-points using the scale of stress, anxiety, and depression (DASS-42). Data were analyzed using descriptive and inferential statistics.

RESULTS: Before the program, the average scores of stress, anxiety, and depression were 31.16 ± 4.14, 21.37 ± 6.31, and 27.56 ± 4.24 for the study group and 31.09 ± 4.48, 20.34 ± 6.56, and 28.78 ± 4.72 for the control group. After the program, the average scores of stress, anxiety, and depression were 10.56 ± 3.37, 6.75 ± 2.99, and 7.37 ± 2.76 for the study group and 34.87 ± 2.51, 23.65 ± 4.96, and 32.56 ± 3.49 for the control group, respectively. Results of the independent t test indicated no considerable difference before the program (P > 0.05) and a significant difference after the program (P < 0.001) between the two groups.

CONCLUSION: This family-need-based program can decrease the level of stress, anxiety, and depression of the family caregivers of leukemia patients and may potentially alleviate the psychological distress of family caregivers over their caring role.

PMID:34131846 | DOI:10.1007/s00520-021-06353-z

Support Care Cancer. 2021 Jun 15. doi: 10.1007/s00520-021-06350-2. Online ahead of print.

ABSTRACT

PURPOSE: Morphine infusion through Intrathecal Drug Delivery System (IDDS) is widely used to relieve refractory cancer pain. However, continuous escalation of morphine dose caused by opioid tolerance and/or progress of cancer was commonly observed. Combining morphine with medications of different analgesic mechanisms is applied to blunt the rate of morphine increase. The purpose of this study was to determine the analgesic efficacy and safety of combining gabapentin with morphine after IDDS implantation.

METHODS: This study compared patients that received IDDS implantation from January 1, 2017 to November 10, 2018 in our institute. Key outcomes included change in mean pain score, dose of morphine used in patients, percentage of patients with 30% and 50% reduction in mean pain score, Patient Global Impression of Change scores, breakthrough pain characters and side effects.

RESULTS: 34 patients in the combination group (morphine + gabapentin) and 40 patients in the monotherapy group(morphine)were analyzed. The results showed that both therapy groups achieved similar analgesic efficacy, demonstrated by Numerical rating scale (2.42 ± 0.88 vs 2.57 ± 0.85; Combination vs Monotherapy), PGIC and responder status. Mean daily dose of morphine was significantly lower in combination group compared to monotherapy group (3.54 ± 1.29 mg vs 4.64 ± 1.28 mg, P = 0.007). More patients experienced dizziness and somnolence after receiving combination therapy compared to morphine-alone treatment although no statistical significance was found (P = 0.49).

CONCLUSION: Addition of gabapentin achieved similar analgesic efficacy with lower dose of morphine compared to morphine alone accompanying with higher incidence of dizziness and somnolence.

PMID:34131845 | DOI:10.1007/s00520-021-06350-2

Int J Clin Pract. 2021 Jun 15:e14534. doi: 10.1111/ijcp.14534. Online ahead of print.

ABSTRACT

OBJECTIVE: The present study aimed to determine the factors affecting the use of cleaning products at the home environment and the frequency of problems during the COVID-19 pandemic.

MATERIALS AND METHODS: This cross-sectional research was performed online between 30.08.2020 and 15.09.2020. The population of the study consisted of adults aged between 18 and 80 years, affected by the COVID-19 pandemic. Data collection forms (Introductory Information and Risk Perception Form and Cleaning Products Usage Characteristics Form) were shared through Web2 tools. The questionnaire study was completed with 674 participants between the ages of 18 and 80 years in Turkey. Descriptive statistics and classification tree were used in the analysis of the data. Statistical significance was accepted as p≤0.01 in all analyses.

RESULTS: During the pandemic period compared to the pre-pandemic period, it was observed that the frequency of cleaning (69.3%) and the amount of cleaning product usage (74.2%) increased significantly and the frequency of problems related to the use of cleaning products was found as 46.9%. The most common reported problems were skin disturbances (68%) and shortness of breath (23%). It was determined that the history of contact with the COVID-19 patient, the perceived risk of COVID-19 infection and risky cleaning behavior were predictive in determining the risk of experiencing problems related to cleaning products. The amount of bleach consumed per month among who did experience problems was higher than those who did not experience problems and was associated with the perceived risk of COVID-19 infection.

CONCLUSION: In the COVID-19 pandemic, human beings have been found to increase the frequency of cleaning and using cleaning products. In order to reduce the negative effects of chemicals used for cleaning on human and environmental health, the trainings to be given by the teams providing primary health care services can be effective as well as general education activities for community groups.

PMID:34129746 | DOI:10.1111/ijcp.14534

J Cosmet Dermatol. 2021 Jun 15. doi: 10.1111/jocd.14289. Online ahead of print.

ABSTRACT

BACKGROUND: All scoring systems used in Alopecia Areata (AA) focus mainly on scalp and cannot assess the severity or treatment response when AA involves the beard hair, eyebrows or eyelashes.

AIM: This study describes and assesses the reliability of a new scoring system ‘Alopecia Areata Severity Index’ (AASI) for measuring the severity of AA of scalp, beard and upper face.

METHODS: Scalp hair, beard hair, upper face (eyebrows and eyelashes) were individually assessed and the severity of AA was scored from 0 to 100 (0-50 in case of upper face). AASI score was then calculated as a sum of all these individual scores as AASI= AASI (scalp)+AASI (upper face)+AASI (beard)+. To test the inter-observer reliability of AASI score, 25 patients with varying severity of AA were scored by 4 trained dermatologists. Repeat scoring was performed after one week to test for intra-observer reliability.

RESULTS: Excellent inter-rater as well as intra-observer reliability was observed with Chronbach’s alpha value of 0.999 (CI = 0.989-1.000). The intra-observer correlation coefficient with average measure was 0.999 (CI = 0.990- 1.000) with statistically significant F test <0.005.

CONCLUSION: AASI score is a reliable scoring system to assess the severity of AA in patients with involvement of one or more areas of the body.

PMID:34129730 | DOI:10.1111/jocd.14289

J Cosmet Dermatol. 2021 Jun 15. doi: 10.1111/jocd.14296. Online ahead of print.

ABSTRACT

BACKGROUND: Lidocaine/tetracaine 7%/7% peel cream (L/T-pC) is very effective in reducing pain in several dermatological procedures, such as hair or tattoo laser removal or conventional photodynamic therapy associated pain. Fractional laser resurfacing (FLR) is an effective treatment strategy for facial skin ageing. The main drawback of FLR is the procedure-associated pain. So far, no controlled data are available regarding the efficacy of L/T-pC in reducing pain during a full facial microablative FLR session in subjects with facial skin ageing.

AIM: To assess the clinical efficacy of L/T-pC in reducing pain during microablative FLR treatment in subjects with facial skin ageing. We conducted a prospective, randomised, parallel-group, controlled, single-blind trial, performed in out-patients attending to a Laser Clinic for facial skin ageing treatment.

SUBJECTS AND METHODS: A total of 30 subjects (4 men, 26 women; mean age 42±10 years; range 28-57) with mild to moderate facial skin ageing (Glogau score ≥2), suitable for FLR treatment, were enrolled after their written informed consent. Participants were randomised to L/T-pC application (45 min before the laser treatment with the removal of the cream just before the starting of laser session) (n=20) or to control (emollient cream; n=10). FLR was performing using a fractional microablative CO₂ laser (Smartxide DOT 2 Deka, Calenzano, Italy) using a pulse power of 18 W (range 15-20) and pulse duration of 1.5 msec. The primary endpoint was the comparison of the mean visual-analogue score (VAS) values between the two groups using a 10-cm scale (0= no pain; 10: the most severe pain). The VAS score was measured just after the FLR session. Effective anaesthesia (percentage of subjects with a VAS score ≤3) and the assessment of local tolerability and safety of the peel cream were the secondary trial endpoints.

RESULTS: All the enrolled subjects concluded the trial. In the L/T-pC group the VAS mean score was 3.0±1.2. In the control group the VAS mean score was 8.6±0.5, representing a 65% reduction of the VAS score in the active treated group vs. controls. The difference between the two groups was statistically significant (p=0.0001; Mann-Whitney test) with an absolute difference of -5±0.4 cm; 95%CI of the difference: from -4.6 to -6.4 cm). Adequate anaesthesia (VAS score≤3) was reported in 80% of subjects in the active group vs. 0% in the control arm. The cream was very tolerated. One subject in the active group manifested moderate/severe oedema in the cream application area, subsiding in 6 hours. No other side effects were reported.

CONCLUSION: The application of L/T pC 7%/7% peel cream before a fractional laser resurfacing session significantly reduced the procedure-associated pain with good tolerability and safety profile.

PMID:34129728 | DOI:10.1111/jocd.14296

Hepatology. 2021 Jun 15. doi: 10.1002/hep.32014. Online ahead of print.

ABSTRACT

We greatly appreciate Shi and colleague for their interest in our work ⁽¹⁾ . An important question they raise is whether our sample size is large enough with sufficient statistical power to predict the 6-week death or further bleeding in patients with Child-Pugh B cirrhosis and acute variceal bleeding.

PMID:34129697 | DOI:10.1002/hep.32014

J Athl Train. 2021 Jun 15. doi: 10.4085/1062-6050-0262.21. Online ahead of print.

ABSTRACT

CONTEXT: It is currently unclear how different pitching roles affect arm injury risk in professional pitchers.

OBJECTIVE: 1) Investigate the differences in arm injury hazard between professional baseball starting and relief pitchers; 2) Separately investigate elbow and shoulder injury hazard between professional baseball starting and relief pitchers.

STUDY DESIGN: Prospective cohort Setting: Minor League Baseball (MiLB) from 2013-2019 Patients or Other Participants: Pitchers Main Outcome Measures: Pitchers were followed for the entire MiLB season and athletic exposures (AE’s) and injuries were recorded. Risk ratios and risk difference were calculated between starting and relieving MiLB pitchers. A cox survival analysis was then performed in relation to time to arm injury between starting and relieving MiLB pitchers. Subgroup analyses were performed for elbow and shoulder.

RESULTS: 297 pitchers were included with a total of 85,270 player days recorded. Arm injury incidence was 11.4 arm injuries per 10,000 AE’s. Starting pitchers demonstrated greater risk ratio (1.2 (95% CI: 1.1-1.3)) and risk difference (13.6 (95% CI: 5.6-21.6)) and hazard of arm injury (2.4 (95% CI: 1.5-4.0)) compared to relief pitchers. No differences were observed for hazard of elbow injury between starting and relief pitchers (1.9 (95% CI: 0.8-4.2)). Starting pitchers demonstrated greater hazard of shoulder injury compared to relief pitchers (3.8 (95% CI: 2.0-7.1)).

CONCLUSIONS: Starting pitchers demonstrated almost two and a half times greater hazard of arm injury compared to relief pitchers. Subgroup analyses demonstrated that starters exhibited greater hazard of shoulder injury compared to relievers; but, no differences were observed for hazard of elbow injury. However, due to the wide confidence intervals, these subgroup analyses should be interpreted with caution. Clinicians may need to consider cumulative exposure and fatigue and how these factors relate to different pitching roles when assessing pitching arm injury risk.

PMID:34129678 | DOI:10.4085/1062-6050-0262.21

J Athl Train. 2021 Jun 15. doi: 10.4085/1062-6050-0185.21. Online ahead of print.

ABSTRACT

(STATE-XXX = Wisconsin).

ABSTRACT: Objective: To describe the incidence of COVID-19 in STATE-XXX high school athletes, and to investigate the relationship of COVID-19 incidence with sport and face mask use.Design: Retrospective survey.Setting: High schools across STATE-XXX during September, 2020.Participants: Athletic directors representing 30,074 high school athletes with and without SARS-CoV-2.Independent Variables: COVID-19 rates among athletes, counties, and STATE-XXX, school instruction type (virtual vs in-person), sport type, face mask use.Main Outcome Measurements: Reported athlete case rates compared to their county’s general population. Associations between COVID-19 incidence and sport type and face mask use, adjusting for each school’s county incidence using multivariable negative binomial regression models.Results: COVID-19 incidence rates for 207 of 244 responding schools were 32.6 cases per 100,000 player-days. Reported case rates for athletes in each county were positively correlated with the county’s general population case rates (β=1.14±0.20, r=0.60, p<0.001). One case (0.5%) was attributed to sport contact by the reporting schools. No difference was identified between team and individual sports (incidence rate ratio (IRR)=1.03 [95% CI=0.49-2.2], p=0.93) or between non-contact and contact sports (IRR=0.53 [0.23-1.3], p=0.14). Outdoor sports had a lower incidence rate than indoor sports, although this did not reach statistical significance (IRR=0.52 [0.26-1.1], p=0.07). There were no significant associations between COVID-19 incidence and face mask use during play for those sports with greater than 50 schools reporting on face mask use (p>0.05 for all).Conclusions: Incidence of reported COVID-19 among high school athletes was related to county incidence and most cases were attributed to non-sport contact. A lower COVID-19 incidence in outdoor sports approached statistical significance. The lack of a significant benefit of face mask use may be due to relatively low rates of COVID-19 in STATE-XXX during September 2020. Further research is needed to better define COVID-19 transmission risk factors during adolescent sport participation.

PMID:34129671 | DOI:10.4085/1062-6050-0185.21