Tag: nevin manimala

J Viral Hepat. 2021 May 1. doi: 10.1111/jvh.13529. Online ahead of print.

ABSTRACT

We compared the care cascades of Hepatitis C (HCV) mono-infected and HCV/HIV co-infected patients screened in a universal Emergency Department (ED) HCV screening program. This was a retrospective review of program data collected between June 6, 2018 and December 31, 2019. HIV and HCV status, linkage to care and treatment outcomes were abstracted from the program-screening database. Descriptive statistics were used to characterize the population. Group comparisons (HCV mono-infected vs. HIV/HCV co-infected) were compared using Chi-square. There were 116,596 adult (age 18 y and above) patient visits, representing 62,001 unique individuals. Of these, 17,676 (28.5%) received an HCV antibody test. We identified 418 evaluable patients (2.4%) with active HCV (HCV RNA positive). Of these, 337 (81%) were HCV mono-infected, 58 (14%) were HCV/HIV co-infected and 23 (5%) had unknown HIV status. Among the 418 evaluable patients 174 (41%) were linked to care and 94 (22.5%) achieved sustained virologic response (SVR).There were no significant differences between HCV mono-infected and HCV/HIV co-infected groups at any step of the care cascade (diagnosed and aware, linked to care, medications prescribed or SVR). Universal HCV screening in the ED identified a large number of patients with active HCV infection, of which 14% were co-infected with HIV. While there were no differences in the care cascades between mono and co-infected patients, linkage and treatment outcomes were low in both groups. Barriers to linkage to care and treatment after ED diagnosis should be further investigated and addressed to improve public health outcomes.

PMID:33932240 | DOI:10.1111/jvh.13529

Pharmacotherapy. 2021 May 1. doi: 10.1002/phar.2530. Online ahead of print.

ABSTRACT

BACKGROUND: Observational studies comparing ticagrelor and prasugrel in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) have yielded contradictory results, but these studies often did not consider differential censoring (e.g., for treatment switching or insurance disenrollment) or confounding by time-dependent factors.

OBJECTIVE: Our objective was to conduct a comparative effectiveness and safety analysis of ticagrelor and prasugrel in patients who underwent PCI after being hospitalized for an ACS.

METHODS: This study used the Optum’s de-identified Clinformatics® Data Mart Database and included patients aged 18 years or older with an index hospital admission between May 2012 and September 2015, a diagnosis of ACS managed with PCI, and treatment with either ticagrelor or prasugrel. The primary composite outcome was defined as the first occurrence of all-cause death, myocardial infarction (MI), or ischemic stroke. The secondary composite outcome included the first occurrence of gastrointestinal (GI) bleed, intracranial hemorrhage (ICH), or other major bleeds requiring hospitalization. Weighted Cox proportional hazard models and robust variance estimation were implemented to adjust for baseline comorbidities, time-varying exposure, time-dependent confounders, and differential censoring.

RESULTS: Included in the analysis were 2,559 patients initiated on ticagrelor and 4,456 patients initiated on prasugrel following PCI. Patients initiated on ticagrelor were 10% more likely to have eligibility disenrollment (Ticagrelor: 57%, Prasugrel: 47%, P<.01) and 7 percentage-points more likely to switch medication (Ticagrelor: 35%, Prasugrel: 28%, P<.01). After adjusting for multiple factors, including time-varying exposure and censoring imbalance, ticagrelor was associated with a higher risk of all-cause death, MI, or stroke when compared to prasugrel (Hazard ratio (HR): 1.33; 95% CI: 1.04-1.68). Similarly, ticagrelor was associated with a higher risk in bleeding events when compared with prasugrel (HR: 1.61; 95% CI: 1.19-2.17).

CONCLUSION: When compared with ticagrelor, prasugrel use following PCI for ACS was associated with a lower risk of death, MI, or stroke, as well as a reduced risk of major bleeding.

PMID:33932252 | DOI:10.1002/phar.2530

J Cancer Educ. 2021 May 1. doi: 10.1007/s13187-021-02012-3. Online ahead of print.

ABSTRACT

African American women are disproportionately impacted by breast cancer, including triple-negative disease, at a young age. Yet most public health research in breast cancer focuses on women of screening age. This study identified the specific breast cancer educational needs of African American women below the recommended screening age. Data were collected through 30 key informant interviews with young African American women breast cancer survivors (diagnosed between 18 and 45), family members of African American women diagnosed between 18-45 years, and community organization leaders and healthcare providers who work with young African American women impacted by breast cancer. Data were coded and analyzed by multiple team members using template analysis. The analysis identified four overarching themes reflecting breast cancer educational needs of young African American women. Although most Breast Cancer Knowledge and Perceived Risk educational needs were consistent with those of older women, there were specific needs involving Cultural Reluctance in Health Disclosures and Breast Cancer Risk Reduction. With regard to Healthcare Provider Relationships, participants stated a need for younger women to be particularly proactive in advocating for their health, as providers may be dismissive about cancer concerns due to young age. Though breast cancer in younger women is statistically improbable, there are educational needs specific to young African American women involving self-advocacy and family history. Findings have implications for developing interventions guiding young women to advocate for themselves in medical encounters and in their families, as well as for teaching medical providers how to counsel the young women regarding breast cancer.

PMID:33932194 | DOI:10.1007/s13187-021-02012-3

Environ Sci Pollut Res Int. 2021 May 1. doi: 10.1007/s11356-021-14140-w. Online ahead of print.

ABSTRACT

Bisphenol A (BPA) leads to ROS production that considered the core of different inflammatory and chronic obstructive pulmonary diseases. As a natural antioxidant, lycopene plays a significant role in the prevention of many chronic diseases. This study aimed to investigate the possible protective role of lycopene against BPA-induced lung alterations using morphometric, histological, immunohistochemical and biochemical methods. Forty rats aged 3 months were divided into four groups (n=10): control group, lycopene group comprising rats that received lycopene by gavage (10 mg/kg /day) for 30 days, BPA group comprising rats that received BPA by gavage (50 mg/kg/day) for 30 days and lycopene + BPA group. On the 30th day, blood and lung tissue samples were collected for biochemical, histological and immunohistochemical studies. Morphometrical and statistical analyses were performed. The BPA group revealed significantly elevated IL-1B, IL-6, MDA and NO, and it showed significantly reduced IL-10, SOD, CAT and GSH when compared to the control and lycopene + BPA groups. Upon histopathological and immunohistochemical examination, lycopene supplementation improved the BPA-induced alveolar collapse, lymphocytic infiltration, extravasated RBCs and fibrosis. The lycopene + BPA group showed significantly reduced mean percentage of 8-OHdG immunopositive and mean area percentages of Bax and caspase 3 immunopositive cells and significantly reduced mean area percentage of Bcl2 immunopositive cells as compared with the BPA group. Lycopene is a protective agent against BPA-induced lung injury because of its anti-apoptotic, anti-inflammatory and antioxidant effects, as confirmed by biochemical and histological studies.

PMID:33932206 | DOI:10.1007/s11356-021-14140-w

Environ Sci Pollut Res Int. 2021 May 1. doi: 10.1007/s11356-021-14160-6. Online ahead of print.

ABSTRACT

Louhajang River, Bangladesh, which crosses Tangail as a densely industrialized and urbanized city, supplies water for different purposes. This study reports the levels of pH, electrical conductivity (EC), and some toxic heavy metals in 40 water samples collected during the summer and winter seasons from Louhajang River. The winter season reported higher levels of the examined parameters than the summer season with significant variation (p < 0.05) for all parameters, with the exception of Cd. The metal contents were assessed against local and international standards for drinking, irrigation, and aquatic life purposes where different trends were observed. The heavy metal evaluation index and the ecological risk index reported low to moderate risks. The spatial distribution of metal contents assigned hot spots in some sites along the riverbed. The health risk assessment for three population categories, i.e., adult male, adult female, and children, was examined. Cr and Cd recorded hazard index > 1 in all cases, indicating possible non-cancer risk. The total carcinogenic risk values during both seasons were > 1.0 × 10^-6, indicating possible cancer risk. The adopted collection of different approaches (comparison against standard levels of toxicants, statistical analysis, spatial distribution, and health risk assessment) successfully demonstrates a whole picture of the environmental status of Louhajang River, Bangladesh.

PMID:33932212 | DOI:10.1007/s11356-021-14160-6

Eur Arch Otorhinolaryngol. 2021 May 1. doi: 10.1007/s00405-021-06836-z. Online ahead of print.

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a contagious disease whose symptoms and risk factors are newly described. Some allergic diseases, including asthma, have been defined as risk factors for a poor outcome in COVID-19. We aimed to investigate the role of another allergic disease-allergic rhinitis-in the severity of COVID-19.

METHODS: This case-control study was conducted at Sakarya Educational and Research Hospital, Toyota Hospital and Yenikent State Hospital between March 18, 2020 and August 30, 2020. The study included a case group of 125 randomly selected patients who had been diagnosed with allergic rhinitis in advance of having COVID-19 and a control group of 125 patients without allergic rhinitis who were diagnosed with COVID-19. We evaluated all participants’ statuses regarding smoking, symptoms, and hospitalization, as well as the length of their hospitalization and the number of their comorbidities.

RESULTS: There were no statistically significant differences between the two groups regarding percentage of asymptomatic patients (p = 0.27), presence of smoking (p = 0.068), hospitalization status (p = 0.79), and hospitalization length (p = 0.55). From each group, two patients needed care in an intensive care unit (ICU). One patient from the case group and two from the control group died due to COVID-19.

CONCLUSION: We found that allergic rhinitis did not affect the severity of COVID-19. However, we recommend that the literature be augmented with further studies on the COVID-19 prognosis of patients who have allergic rhinitis.

PMID:33932179 | DOI:10.1007/s00405-021-06836-z

Egypt Heart J. 2021 May 1;73(1):40. doi: 10.1186/s43044-021-00163-8.

ABSTRACT

BACKGROUND: Conflicting data were found regarding the anemia’s effect on percutaneous coronary intervention (PCI) outcomes. We directed our study to investigate anemia’s effect on clinical in-stent restenosis (ISR) following PCI.

RESULTS: A prospective multi-center cohort study was performed on 470 consecutive participants undergoing elective PCI. We classified the participants into two groups: group 1 who were anemic and group 2 who were non-anemic as a control group. At 1, 3, 6, and 12 months by clinic visits, we followed up with the patients to assess anemia’s clinical ISR effect. We found that 20% of the patients undergoing PCI had anemia. Anemic patients showed a statistically significant higher rate of impaired renal function and diabetes and a higher percentage of the female gender. Multivariate regression analysis for major adverse cardiovascular events (MACEs) after adjusting for confounding factors revealed that anemia represents a more risk on MACE (adjusted hazard ratio (HR) was 4.13; 95% CI 2.35-7.94; p value < 0.001) and carries a higher risk upon clinical ISR (adjusted HR was 3.51; 95% CI 1.88-7.16; p value < 0.001) over 12 months of follow-up.

CONCLUSION: Anemic patients going through PCI are generally females, diabetics, and have renal impairment. Anemia might be considered another indicator for clinical ISR and is fundamentally associated with an increased MACE incidence.

PMID:33932182 | DOI:10.1186/s43044-021-00163-8

CPT Pharmacometrics Syst Pharmacol. 2021 May 1. doi: 10.1002/psp4.12635. Online ahead of print.

ABSTRACT

The CYP2D6 enzyme exhibits large interindividual differences in metabolic activity. Patients are commonly assigned a CYP2D6 phenotype based on their CYP2D6 genotype, but there is a lack of consensus on how to translate genotypes into phenotypes, causing inconsistency in genotype-based dose recommendations. The aim of this study was to quantify and compare the impact of different CYP2D6 genotypes and alleles on CYP2D6 metabolism using a large clinical dataset. A population pharmacokinetic (popPK) model of tedatioxetine and its CYP2D6-dependent metabolite was developed based on pharmacokinetic data from 578 subjects. The CYP2D6-mediated metabolism was quantified for each subject based on estimates from the final popPK model and CYP2D6 activity scores were calculated for each allele using multiple linear regression. The activity scores estimated for the decreased function alleles were 0.46 (CYP2D6*9), 0.34 (CYP2D6*10), 0.01 (CYP2D6*17), 0.65 (CYP2D6*29) and 0.21 (CYP2D6*41). The CYP2D6*17 and CYP2D6*41 alleles were thus associated with the lowest CYP2D6 activity, although only the difference to the CYP2D6*9 allele was shown to be statistically significant (P = 0.02 and P = 0.05, respectively). The study provides new in vivo evidence of the enzyme function of different CYP2D6 genotypes and alleles. Our findings suggest that the activity score assigned to the CYP2D6*41 should be revisited, while CYP2D6*17 appears to exhibit substrate-specific behaviour. Further studies are needed to confirm the findings and to improve the understanding of CYP2D6 genotype-phenotype relationships across substrates.

PMID:33932135 | DOI:10.1002/psp4.12635

Langenbecks Arch Surg. 2021 May 1. doi: 10.1007/s00423-021-02178-w. Online ahead of print.

ABSTRACT

PURPOSE: It has been reported that there are left and right hepatic arterial arcades via the blood vessels around the hilar bile duct; therefore, when the hilar bile duct is preserved, hepatic artery reconstruction may not be necessary. We compared the short-term and long-term outcomes in patients with distal cholangiocarcinoma who underwent pancreatoduodenectomy (PD) with right hepatic artery resection without right hepatic artery reconstruction (RHAR group) with those patients who underwent conventional PD.

METHODS: All data were retrospectively collected from patient records. A 1:4-propensity score-matched case-control study was conducted in patients with distal cholangiocarcinoma who received treatment at Tokyo Women’s Medical University from February 1985 to April 2015.

RESULTS: There was no statistical difference in the overall morbidity rate between the two groups. No patient in the RHAR group (10 patients) had liver failure, liver abscess, or cholangitis in the postoperative period; one patient died postoperatively because of a bleeding pseudoaneurysm in the gastroduodenal artery. The PD group (40 patients) had a significantly better median time regarding the recurrence (34 vs. 11 months, p=0.027) and 5-year disease-free survival (35% vs. 10%, p=0.027) rates than the RHAR group, which may be attributed to the presence of a more severe disease in patients in the RHAR group.

CONCLUSION: We concluded that pancreaticoduodenectomy with right hepatic artery resection without reconstruction has a comparable overall morbidity rate with that of a conventional pancreaticoduodenectomy surgery and may be performed as an alternative procedure when tumor invasion of the right hepatic artery is suspected.

PMID:33932159 | DOI:10.1007/s00423-021-02178-w

Bull Math Biol. 2021 May 1;83(6):65. doi: 10.1007/s11538-021-00899-z.

ABSTRACT

The mountain pine beetle (MPB) is among the most destructive eruptive forest pests in North America. A recent increase in the frequency and severity of outbreaks, combined with an eastward range expansion towards untouched boreal pine forests, has spurred a great interest by government, industry and academia into the population ecology of this tree-killing bark beetle. Modern approaches to studying the spread of the MPB often involve the analysis of large-scale, high-resolution datasets on landscape-level damage to pine forests. This creates a need for new modelling tools to handle the unique challenges associated with large sample sizes and spatial effects. In two companion papers (Koch et al. in Environ Ecol Stat. https://doi.org/10.1007/s10651-020-00456-2 , 2020a; J R Soc Interface 17(170):20200434, 2020b), we explain how the computational challenges of dispersal and spatial autocorrelation can be addressed using separable kernels. In this paper, we use these ideas to capture nonstationary patterns in the dispersal flights of MPB. This facilitates a landscape-level inference of subtle properties of MPB attack behaviour based on aerial surveys of killed pine. Using this model, we estimate the size of the cryptic endemic MPB population, which formerly has been measurable only by means of costly and time-intensive ground surveys.

PMID:33932176 | DOI:10.1007/s11538-021-00899-z