Nevin Manimala

Cureus. 2021 Mar 1;13(3):e13634. doi: 10.7759/cureus.13634.

ABSTRACT

Background On March 3, 2020, the first case of coronavirus disease (COVID-19) was reported by the Ministry of Health, Kingdom of Saudi Arabia. Within days, the government confirmed more cases and adopted lockdown measures with travel restrictions from March to June 2020. A distinctive coronavirus was isolated from 190,823 patients by June 30. The pandemic resulted in a significant risk to public health. The study aimed to evaluate the impact of COVID-19 lockdown on the rate of premature births. Method In this cross-sectional study, we observed premature births at the Neonatal Intensive Care Unit (NICU). The study site is a 1,500-bed teaching hospital, with around 4,500 annual deliveries, 70 beds in level II and level III, and tertiary care NICU. We compared the birth rates among preterm infants between March 1 to June 30, 2017-2019, to the similar calendar months of 2020. Information on nationality, gestational age, and maternal conditions were collected from the medical records. We used the Poisson regression model to assess the preterm birth rate’s temporal trends before lockdown versus during lockdown. Results Among 7,226 total live neonates, we recorded 1,320 preterm infants during the study period of 2017-2020. The preterm birth rate per 1,000 live births during lockdown showed a 23% drop in the overall preterm birth rate with Prevented Fraction of 36% in extremely preterm (<28 weeks gestational age) births and 26% in moderate/late premature (32 weeks to 36 weeks + 6 days gestational age) births. The estimated preterm birth rate among the Saudi expats (15.11/1,000 live births) showed an increased tendency compared to Saudi nationals (odds ratio [OR]=1.07; 95% CI: 0.75-1.52) and was statistically not significant during the strict lockdown. Conclusion There was a significant reduction in the birth rate of extremely preterm and moderate/late preterm infants during lockdown when compared to the preceding three years. A national dataset is required to evaluate the extent of lockdown’s impact on the preterm birth rate.

PMID:33816033 | PMC:PMC8011548 | DOI:10.7759/cureus.13634

Cureus. 2021 Feb 28;13(2):e13619. doi: 10.7759/cureus.13619.

ABSTRACT

Background Multiple sclerosis (MS) is associated with a physical disability and disturbed psychosocial functioning in young people. Many psychological and psychiatric comorbidities have been reported in MS. Objective To determine the frequency of social anxiety disorder (SAD) and obsessive-compulsive disorder (OCD) among MS patients and their relation to MS severity. Methods A cross-sectional survey was conducted in an adult MS cohort. Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and Social Phobia Inventory (SPIN) were used to determine the presence and severity of OCD and SAD. The Statistical Package for the Social Sciences (SPSS) version 22 (IBM Corp., Armonk, NY) was used for statistical analysis. The Mann-Whitney U test and logistic regression were used to assess the association of the two diseases with the severity of MS. Results A total of 145 persons with MS (pwMS) were studied. The mean age was 33.5 (±8.5) years; the mean duration of MS was 7.2 (± 5.1) years. The majority (74.1%) were women; 57.3% were married; 63% had a college education; 50% belonged to the higher middle-class socioeconomic strata. Relapsing-remitting multiple sclerosis was the most common type of MS (92.2%). The mean Expanded Disability Status Scale (EDSS) score was 2.24 (±2.19). SAD was reported by 26.9%, and OCD was reported by 31% of the cohort. PwMS with walking difficulty but not wheelchair-bound had a statistically significant increased risk of SAD (p = 0.036). There was no direct association between MS-related disability and OCD. However, pwMS with SAD were more likely to have concomitant OCD (t=4.68, p-value <0.001, 95% CI: 0.47-1.16). Increasing disability was associated with higher chances of developing social anxiety and, in turn, OCD (t=3.39, p-value <0.001, 95% CI: 0.66-2.52). Conclusions Social anxiety and obsessive-compulsive disorders were present in nearly one-third of pwMS. Impaired walking but not wheelchair dependence was associated with social anxiety. PwMS with SAD were more likely to have obsessive-compulsive disorder.

PMID:33816018 | PMC:PMC8010157 | DOI:10.7759/cureus.13619

Cureus. 2021 Feb 26;13(2):e13577. doi: 10.7759/cureus.13577.

ABSTRACT

OBJECTIVE: Pulmonary vascular resistance (PVR) is a measurement obtained with invasive right heart catheterization (RHC) that is commonly used for management of patients with pulmonary arterial hypertension (PAH). Computed tomography pulmonary angiography (CTPA) is also done as part of the workup for PAH in some cases. The aim of our study was to assess the correlation of contrast dynamic changes in the main pulmonary artery (MPA) on CTPA with PVR obtained with RHC.

METHODS: This is an IRB-approved retrospective study performed in two separate institutions (Medical College of Wisconsin and University of Alabama) between January 2010 and December 2013. During CTPA done as test bolus, serial images are acquired at the level of MPA after intravenous injection of contrast to determine timing of the CT acquisition. Since the PVR changes with the degree of PAH, we hypothesize that will be reflected in the contrast kinetics in MPA. A correlation of standard CT metrics (MPA diameter, right pulmonary artery [PA] diameter, left PA diameter, MPA/aorta ratio, and right ventricle/left ventricle [RV/LV] ratio) and dynamic (full width at half maximum) CTPA parameters in patients with known PAH was performed with PVR obtained from RHC done within 30 days. Statistical analysis was performed by Pearson correlation coefficient.

RESULTS: Among 221 patients in our database, 37 patients fulfilled the selection criteria. There was a strong correlation between full width half maximum (FWHM) and mean pulmonary artery pressure (mPAP) (r=0.69, p value<0.00001), PVR (r=0.8, p value<0.00001) and indexed PVR (PVRI) (r=0.75, p value<0.00001).

CONCLUSION: FWHM obtained from CTPA strongly correlates with RHC parameters and is potentially more helpful than static measurements for follow-up of patients with known PAH to assess response to treatment or progression.

PMID:33815985 | PMC:PMC8009445 | DOI:10.7759/cureus.13577

Cureus. 2021 Feb 25;13(2):e13548. doi: 10.7759/cureus.13548.

ABSTRACT

Background Asthma is a common public health issue in the pediatric population. The prevalence of asthma in children in Saudi Arabia is increasing. All asthmatic children with continuous symptoms should use controller medications. These medications if used correctly by the patients will diminish the symptoms and avoid exacerbations that lead to hospitalization. Perception of parents toward a particular device can affect the adherence rate. Aim Assessing the parental perception about metered-dose inhalers (MDIs) and nebulizers differences among the Saudi population. Methods A cross-sectional study was conducted to assess Parental perception about MDIs and nebulizers among Saudi parents with an asthmatic child. The data were collected from the parents and caregivers by using an online questionnaire and informed consent was obtained. The questionnaire was focused on demographic characteristics, knowledge, perception and practice of treating the asthmatic child. Data were analyzed through the Statistical Package for the Social Sciences (SPSS) version 25 (IBM Corp., Armonk, NY) and the results were considered statistically significant if P < 0.05. Results A total of 1,021 participants included in this study. This study found asthma is predominant in males (64.4%) and the most affected age is between 8 and 14 years (56.3%). More than half of the parents (58.7%) had a bachelor’s degree and above. MDI is the most method used for controlling asthma (32.7%) and the majority of them (70.2%) thought there is a therapeutic difference between MDI and nebulizer. Providing instructions and information on usage MDI was received from 65.2%. Significant relationships were found between the level of satisfaction and receiving enough information about MDI and level of education. Conclusion This study found that asthma is more prevalent in males, where MDI is more common. Majority of the parents had thought that there is a difference in the therapeutic effects between MDI and nebulizer. They believed that nebulizer is more effective, less side effect and cheaper while MDI is easier to use.

PMID:33815971 | PMC:PMC8007121 | DOI:10.7759/cureus.13548

J Wrist Surg. 2021 Apr;10(2):102-110. doi: 10.1055/s-0040-1719039. Epub 2020 Nov 4.

ABSTRACT

Background Distal radius fracture is one of the most common injuries. Poor functional result with restricted wrist motion can be developed when there is intra-articular fibrous tissue development arising from articular step-off and gapping. Objectives The aim of this study is to compare the functional and radiological outcome between arthroscopic-assisted reduction and fluoroscopic reduction in treating unstable intra-articular distal radius fracture. Methods We retrospectively analyzed 12 patients with intraarticular AO type C distal radius fracture treated with arthroscopic-assisted fracture reduction and internal fixation and compared them with another group of 12 patients in which fracture reduction is assessed by fluoroscopy alone (15 males and 9 females, mean age 57.3, range 27-73). The two cohorts were analyzed for differences in radiological parameters including articular stepping and gapping, palmar tilt, radial inclination, ulnar variance as well as functional outcome in range of motion, grip strength, modified mayo wrist score, and Quick Disabilities of the Arm, Shoulder, and Hand (DASH) score at an average of 12.5 months (range 5-26) after surgery. Results Arthroscopic-assisted fracture reduction group has statistically better restoration of articular stepping and gapping, volar tilt and ulnar variance. Range of motion, grip strength, modified mayo wrist score and Quick DASH score also had statistically significant improvement in arthroscopic group. Conclusion Our study showed arthroscopic-assisted technique can precisely restore radiological parameters in highly comminuted distal radius fracture with good functional outcome. Also, associated intra-articular soft tissue injury can be detected and treated simultaneously. Level of Evidence This is a level III, retrospective cohort study.

PMID:33815944 | PMC:PMC8012086 | DOI:10.1055/s-0040-1719039

Am J Cardiovasc Dis. 2021 Feb 15;11(1):164-175. eCollection 2021.

ABSTRACT

OBJECTIVE: To study the effects of coronary revascularization using elective percutaneous coronary intervention (PCI) on autonomic modulation assessed by heart rate variability measurement (HRV) in coronary artery disease (CAD) patients.

METHODS: A single-center prospective cohort study included 100 patients were included undergoing elective PCI excluding those with contraindication to contrast or dual antiplatelet therapy, atrial fibrillation or multiple premature beats, receiving anti-arrhythmic drugs and those who underwent previous PCI or coronary artery bypass graft (CABG). Short-term measurement of time domain parameters (mean, SDNN, RMSSD) and frequency domain parameters (LF component, HF component, LF/HF ratio) of HRV was performed at the same time of the day, pre-PCI, 24 hours and 6 months post-PCI by CheckMyheart™ handheld HRV device. 5-min HRV analysis software was used to interpret the data using standard methods of HRV measurement of the Task Force of The European Society of Cardiology (ESC) and The North American Society of Pacing and Electrophysiology. SYNTAX (SX) score was calculated before PCI and residual SYNTAX (rSS) score was calculated after PCI using SYNTAX score calculator software.

RESULTS: The mean age of the studied population was 56.89±10.75 years with 85% males. HRV time and frequency domain parameters showed a statistically significant improvement at different time intervals (before PCI, 24 hours and 6 months after PCI) (p-value <0.001). HRV time and frequency domain measures showed a statistically significant difference between time and frequency domain HRV parameters 24 hours and 6 months after PCI in patients who had complete revascularization (CR) with those who had incomplete revascularization (IR). (p-value <0.001).

CONCLUSION: Autonomic modulation in CAD patients was improved by coronary revascularization using PCI assessed by serial HRV measurement. Patients with CR had better autonomic modulation than those with IR assessed by HRV 24 and 6 months after PCI.

PMID:33815932 | PMC:PMC8012296

Am J Cardiovasc Dis. 2021 Feb 15;11(1):124-135. eCollection 2021.

ABSTRACT

Conjugated Linoleic Acids (CLA) may have beneficial effects on the prevention of atherosclerosis, but their net effects on circulating levels of lipoprotein (a) [Lp (a)] are unclear. The present study aimed to systematically review and analyze the Randomized Clinical Trials (RCTs) assessing the effects of CLA on circulating Lp (a) concentrations. A literature search of SCOPUS, PubMed-Medline, ISI, Web of Science, and Cochrane library databases was conducted for the relevant RCTs investigating the effects of CLA supplementation on circulating Lp (a) levels, which had been published up to 20 August 2020. Weighted Mean Difference (WMD) and 95% Confidence Intervals (CI) were reported as the summary statistics. Statistical analysis were done with Comprehensive Meta-Analysis (CMA) V2 software (Biostat, NJ). Totally, six studies with 13 treatment arms including 752 subjects were included in the meta-analysis. The results showed a significant increase in circulating Lp (a) levels after CLA supplementation (WMD: 16.68 mg/L, 95% CI: 5.43-27.93; P=0.004) with no evidence of heterogeneity across the studies. In the subgroup analysis, a more significant elevation of Lp (a) levels was observed in the trials lasting for six months or more (WMD: 21.61 mg/L, 95% CI: 9.85-33.37, P<0.001) as well as in those with a supplementation dosage of ≥3.5 g/d (WMD: 26.13 mg/L, 95% CI: 7.02-45.24, P=0.007). These findings were sensitive to one study. It can be concluded that CLA supplementation with a dose of ≥3.5 g/d over a six-month period might significantly increase the circulating Lp (a) concentrations.

PMID:33815928 | PMC:PMC8012289

Am J Cardiovasc Dis. 2021 Feb 15;11(1):93-107. eCollection 2021.

ABSTRACT

The coronavirus disease 19 (COVID-19) pandemic has caused significant morbidity and mortality worldwide and an effective treatment is needed. Chloroquine (CQ) and hydroxychloroquine (HCQ) have shown in vitro antiviral activity against SARS-CoV-2 which causes the disease, but the evidence from in vivo studies so far has been inconclusive.

OBJECTIVE: To evaluate the efficacy and safety of CQ and HCQ in the treatment of COVID-19.

DATA SOURCES: We systematically searched the PubMed, Embase, MEDLINE, Cochrane CENTRAL, CINAHL, Scopus, Joanna Briggs Institute Database, ClinicalTrials.gov, and Chinese Clinical Trial Registry (ChiCTR) for all articles published between 01 January 2020 to 15 September 2020 on CQ/HCQ and COVID-19 using a predefined search protocol; without any language restrictions. A search of grey literature repositories (New York Academy of Medicine Grey Literature and Open Grey), and pre-publication server deposits (medRxIV and bioRxIV) was also performed.

STUDY SELECTION: Randomized clinical trials (RCT) which compared CQ/HCQ to standard supportive therapy in treating COVID-19 were included.

DATA EXTRACTION AND SYNTHESIS: Data were extracted from original publications by four independent reviewers. Risk of bias was assessed using the Cochrane Collaboration’s assessment tool. Data were meta-analyzed using a random-effect models. Results are reported according to PRISMA guidelines. Main Outcome(s) and Measure(s): The primary prespecified efficacy outcome was all-cause mortality. The primary safety outcome was any adverse effect attributed to use of CQ/HCQ.

RESULTS: Eight RCTs were included and pooled in the mortality meta-analysis (6,592 unique participants; mean age = 59.4 years; 42% women). CQ/HCQ did not show any mortality benefit when compared to standard supportive therapy (Pooled Relative Risk [RR] 1.07; 95% CI = 0.97-1.18; I² statistic = 0.00%). Sensitivity and sub-group analyses showed similar findings. Any adverse event was significantly higher in patients randomized to CQ/HCQ (RR = 2.51; 95% CI = 1.53-4.12; n = 1,818 patients), but the risk of developing severe adverse event was not statistically significant (RR = 0.99, 95% CI = 0.53-1.86; n = 6,456 patients).

CONCLUSIONS AND RELEVANCE: Evidence from currently published RCTs do not demonstrate any added benefit for the use of CQ or HCQ in the treatment of COVID-19 patients.

PMID:33815925 | PMC:PMC8012280

Am J Cardiovasc Dis. 2021 Feb 15;11(1):80-86. eCollection 2021.

ABSTRACT

COVID-19 outbreak has brought tremendous psychological pressure to the general population, especially to those with associated cardiovascular disease. An online Patient Health Questionnaire (PHQ-9) survey on consecutive congenital heart disease (CHD) patients, was carried out to determine depression during the Spanish coronavirus disease (COVID-19) quarantine. Two-hundred forty-two out of 407 (59%) CHD patients answered the survey, 123 (51%) had mild defects, 88 (36%) moderate and 31 (13%) great defects, most of them between 18 and 24 years old and 51% were male. Patients were dichotomized to no or mild (PHQ-9 < 10) and moderate to severe (≥ 10) depressive symptoms. Thirty-four (14%) patients showed a PHQ-9 ≥ 10 and 10 of them (29%) were under anxiolytic or antidepressant treatment during the quarantine. During the study period, 9 (4%) patients had COVID-19 symptoms. Patients with a NYHA above 2 (P=0.025), living in houses without garden or balcony (P=0.014), needing psychological/psychiatric evaluation/medication in the previous 12 months or being under anxiolytic/antidepressant treatment during the confinement had, significantly, a PHQ-9 score ≥ 10 (P < 0.001). Being under anxiolytic/antidepressant treatment during the coronavirus pandemic [OR 3.92 (95% CI 1.05-14.66), P=0.043] and having previous psychological/psychiatric evaluation in the previous 12 months to the quarantine [OR 3.82 (95% CI 1.16-12.54), P=0.027] were the only variables that reached statistical significance, in the multivariable analysis, as predictors of a pathological PHQ-9 questionnaire (score ≥ 10). In conclusion depression was frequent during the COVID-19 quarantine among CHD patients, with only a third of them being under anxiolytic or antidepressant treatment. Needing psychological/psychiatric evaluation/treatment during the previous 12 months to the lockdown was a predictive factor for an abnormal PHQ-9 score.

PMID:33815923 | PMC:PMC8012290

J Health Pollut. 2021 Mar 2;11(29):210306. doi: 10.5696/2156-9614-11.29.210306. eCollection 2021 Mar.

ABSTRACT

BACKGROUND: India is the fifth biggest producer of e-waste in the world, discarding 1.7 million tons in 2014. E-waste gets recycled mainly in the informal sector which means activities are largely unaccounted for. Hazardous chemicals and metals are released during recycling processes (lead (Pb) being the most common). Compared to other developing countries, there are few studies from India on the awareness of recyclers of health risks related to e-waste recycling.

OBJECTIVES: The aim of the present study was to assess the knowledge, attitudes, and practices (KAP) of health-related risks and behaviors among e-waste workers/recyclers belonging to the informal sector in Delhi and to determine the concentration of Pb levels in hair samples from a subset of workers from selected recycling sites.

METHODS: A cross-sectional study was conducted in three e-waste informal recycling sites of Delhi: Seelampur, Mustafabad and Mandoli using an interviewer administered questionnaire among 220 e-waste workers. Percentages were presented for each KAP indicator. Analyses were computed using the statistical software STATA 14.2.

RESULTS: It was observed that 24% of participants had knowledge of the meaning of e-waste and 36% knew the chemicals that could be released from e-waste handling. Personal protective equipment (PPE) was used by only 12% of the workers. Twenty-six percent (26%) perceived occupational injuries (cuts or burns) as mild and 20% perceived coughing immediately after work as mild. Explorative analysis showed a link between worker education level and the type of work practices employed. The median level of Pb concentration among hair samples was 8 mg/kg with inter-quartile range between 5.8 to 12.4 mg/kg.

CONCLUSIONS: Knowledge and practices among e-waste workers regarding the health hazards associated with e-waste recycling were poor with little knowledge of or attention to health risks. A comprehensive remediation package covering sensitization and awareness-building strategies of the health risks associated with informal e-waste recycling should be an urgent priority.

PARTICIPANT CONSENT: Obtained.

ETHICS APPROVAL: Ethics approval was obtained from the Institutional Ethical Committee (IEC), Indian Institute of Public Health-Delhi.

COMPETING INTERESTS: The authors declare no competing financial interests.

PMID:33815904 | PMC:PMC8009644 | DOI:10.5696/2156-9614-11.29.210306