Tag: nevin manimala

Ann Cardiothorac Surg. 2024 Mar 29;13(2):155-164. doi: 10.21037/acs-2023-afm-15. Epub 2023 Aug 29.

ABSTRACT

BACKGROUND: CONVERGE was a prospective, multicenter, randomized controlled trial that evaluated the safety of Hybrid Atrial Fibrillation Convergent (HC) and compared its effectiveness to endocardial catheter ablation (CA) for the treatment of persistent atrial fibrillation (PersAF) and longstanding PersAF (LSPAF). In 2020, we reported that CONVERGE met its primary safety and effectiveness endpoints. The primary objective of the present study is to report CONVERGE trial results for quality of life (QOL) and Class I/III anti-arrhythmic drug (AAD) utilization following HC.

METHODS: Eligible patients had drug-refractory symptomatic PersAF or LSPAF and a left atrium diameter ≤6.0 cm. Enrolled patients were randomized 2:1 to receive HC or CA. Atrial Fibrillation Severity Scale (AFSS) and the 36-Item Short Form Health Survey (SF-36) were assessed at baseline and 12 months; statistical comparison was performed using paired t-tests. AAD utilization at baseline through 12 and 18 months post-procedure was evaluated; statistical comparison was performed using McNemar’s tests.

RESULTS: A total of 153 patients were treated with either HC (n=102) or CA (n=51). Of the 102 HC patients, 38 had LSPAF. AFSS and SF-36 Mental and Physical Component scores were significantly improved at 12 months versus baseline with HC overall and for the subset of LSPAF patients treated with either HC or CA. The proportion of HC patients (n=102) who used Class I /III AADs at 12 and 18 months was significantly less (33.3% and 36.3%, respectively) than baseline (84.3%; P<0.001). In LSPAF patients who underwent HC (n=38), AADs use was 29.0% through 18 months follow-up versus 71.1% at baseline (P<0.001).

CONCLUSIONS: HC reduced AF symptoms, significantly improved QOL, and reduced AAD use in patients with PersAF and LSPAF.

CLINICALTRIALSGOV IDENTIFIER: NCT01984346.

PMID:38590997 | PMC:PMC10998972 | DOI:10.21037/acs-2023-afm-15

Cureus. 2024 Apr 8;16(4):e57814. doi: 10.7759/cureus.57814. eCollection 2024 Apr.

ABSTRACT

Background Microsatellite instability (MSI) is a genetic condition caused by errors in DNA repair genes that cause colorectal cancer (CRC). The literature contradicts the frequency of MSI in sporadic CRCs and its effect on prognosis. This study investigated the distribution of clinicopathologic features and the relationship between MSI and survival outcomes. Methodology This is a retrospective study of 101 consecutive cases of CRC and immunohistochemical studies. All cases were retrospectively reviewed and reevaluated by histological grade, lymphovascular invasion, perineural invasion, tumor borders, dirty necrosis, tumor-infiltrating lymphocytes (TILs), Crohn’s-like lymphoid reaction, mucinous and medullary differentiation, and tumoral budding from pathological slides. An immunohistochemical study was performed in appropriate blocks for using MLH-1, MSH-2, MSH-6, and PMS-2. We collected the clinical stage, pathological tumor stage, lymph node metastasis, age, sex, tumor diameter, distant metastasis, localization, and survival information from patients’ clinical data. Results There was no statistically significant difference between the two groups regarding age, gender, tumor diameter, histological grade, tumor border, dirty necrosis, TILs, N and M stage, perineural and lymphovascular invasion, mucinous differentiation, medullary differentiation, and tumor budding characteristics of the patients. The MSI-H group was more frequently located in the right colon and transverse colon (p < 0.001), and the T stage was higher among them than in the MSI-L group (p = 0.014). Upon multivariate regression analysis, MSI status had no significant effect on survival time. Age and stage N and M were independent prognostic factors for colon cancer prognosis. Conclusions Our study presented the distribution of clinicopathological features and their relationship with MSI for 101 regional CRC patients. MSI status was detected by immunohistochemistry. Identifying MSI in CRCs may help personalize therapy planning. As the distribution of the features may vary from population to population, further investigations are needed on this topic.

PMID:38590982 | PMC:PMC11000436 | DOI:10.7759/cureus.57814

Cureus. 2024 Apr 6;16(4):e57700. doi: 10.7759/cureus.57700. eCollection 2024 Apr.

ABSTRACT

Background The aim of this study is to emphasize the need to be careful in terms of internal organ injuries in patients with isolated transverse process fracture (ITPF), and to investigate the effectiveness of corset use in controlling acute pain. Methods This is a retrospective study including 72 patients with only transverse process fractures secondary to trauma, who were admitted to the Emergency Department of Sakarya University Research and Training Hospital between January 2020 and October 2022. The radiological diagnoses were collected from spinal vertebral computed tomography images. Twelve patients were excluded from the study due to exclusion criteria. Sixty patients with ITPF were included in the comparison group. All patients were divided into two groups. The group with no lumbar corset (LC) included those who were discharged with analgesic and muscle relaxant treatment without a brace (n = 33). The LC+ group (n = 27) included those who received rigid lumbosacral orthosis in addition to analgesic and muscle relaxant treatment. Pain levels of all cases in both groups were evaluated with Visual Analog Scale scores on the day of trauma, the first week, the first month, and the sixth month. Results A total of 25 cases had one ITPF, 25 had two, 17 had three, and five patients had four or more ITPFs. The hospitalization rate was the highest among patients with four or more ITPFs (40%). Although the hospitalization rates according to the number of ITPFs were not statistically significant (p = 0.528), there was a clinical significance regarding increasing hospitalization rates with the increasing number of ITPFs. The hospitalization rates were 12%, 16%, 17.6%, and 40% in patients with one, two, three, and four or more ITPFs, respectively. Conclusion ITPFs should be treated conservatively. Concomitant organ injuries must be ruled out before treatment. Medical treatment without a lumbar corset could be used as a cost-effective choice.

PMID:38590980 | PMC:PMC11000033 | DOI:10.7759/cureus.57700

Cureus. 2024 Apr 1;16(4):e57390. doi: 10.7759/cureus.57390. eCollection 2024 Apr.

ABSTRACT

Background Social media, notably YouTube (Google LLC, Mountain View, California, United States), has transformed global communication and access to information. In Saudi Arabia, with high internet usage, YouTube influencers play a significant role in shaping health attitudes and behaviors. This study investigates the impact of YouTube influencers on health behaviors among Saudi Arabian residents, considering the unique cultural and socio-demographic context. Methods We conducted a community-based cross-sectional study in Saudi Arabia. We surveyed a convenience sample of 703 young Saudi participants from September 2022 to March 2023. Data collection utilized an anonymous online questionnaire distributed via popular social media platforms. The questionnaire covered sociodemographic information, health habits, perceptions of influencers, and their impact on health attitudes. Descriptive statistics, including percentages, frequencies, means, and standard deviations, were employed to summarize participant characteristics and health-related variables. Pearson’s chi-square test was utilized to compare response variables among different groups. Results Findings show significant gender disparities in health habits, with males more likely to smoke but females less physically active (p<0.01). Influencers were perceived as encouraging healthy habits by 71.7% of participants, yet 55.6% also believed they promoted unhealthy habits. Positive outcomes included dietary improvements (62.6%) and smoking cessation (20.5%). People preferred healthcare influencers the most (66.8%), followed by sports and fashion influencers. Conclusions This study highlights YouTube influencers’ substantial influence on health behaviors in Saudi Arabia. It suggests the potential for influencers, especially in healthcare, to contribute positively to public health. Viewer discernment is essential due to varying influencer impacts. These findings underscore the complex role of YouTube influencers in shaping health behaviors and suggest avenues for targeted health interventions.

PMID:38590976 | PMC:PMC11000030 | DOI:10.7759/cureus.57390

Lupus Sci Med. 2024 Apr 8;11(1):e001096. doi: 10.1136/lupus-2023-001096.

ABSTRACT

OBJECTIVE: To develop an improved score for prediction of severe infection in patients with systemic lupus erythematosus (SLE), namely, the SLE Severe Infection Score-Revised (SLESIS-R) and to validate it in a large multicentre lupus cohort.

METHODS: We used data from the prospective phase of RELESSER (RELESSER-PROS), the SLE register of the Spanish Society of Rheumatology. A multivariable logistic model was constructed taking into account the variables already forming the SLESIS score, plus all other potential predictors identified in a literature review. Performance was analysed using the C-statistic and the area under the receiver operating characteristic curve (AUROC). Internal validation was carried out using a 100-sample bootstrapping procedure. ORs were transformed into score items, and the AUROC was used to determine performance.

RESULTS: A total of 1459 patients who had completed 1 year of follow-up were included in the development cohort (mean age, 49±13 years; 90% women). Twenty-five (1.7%) had experienced ≥1 severe infection. According to the adjusted multivariate model, severe infection could be predicted from four variables: age (years) ≥60, previous SLE-related hospitalisation, previous serious infection and glucocorticoid dose. A score was built from the best model, taking values from 0 to 17. The AUROC was 0.861 (0.777-0.946). The cut-off chosen was ≥6, which exhibited an accuracy of 85.9% and a positive likelihood ratio of 5.48.

CONCLUSIONS: SLESIS-R is an accurate and feasible instrument for predicting infections in patients with SLE. SLESIS-R could help to make informed decisions on the use of immunosuppressants and the implementation of preventive measures.

PMID:38589223 | DOI:10.1136/lupus-2023-001096

J Epidemiol Community Health. 2024 Apr 8:jech-2023-221753. doi: 10.1136/jech-2023-221753. Online ahead of print.

ABSTRACT

BACKGROUND: In utero exposure to maternal cancer and cancer treatment might influence the child’s cognitive development. This study investigated if exposure to maternal cancer during fetal life impacted school performance and educational achievement as adults.

METHODS: This nationwide retrospective cohort study identified all live-born children in Denmark between January 1978 and December 2013. Exposure was defined as maternal cancer diagnosis during pregnancy. Four partly overlapping birth cohorts were constructed depending on the outcome of interest: (1) receiving special educational support for birth years 2001-2013; (2) grade point average (GPA) at the final exams after 10th grade for 1986-2003; (3) educational achievement at 20 years for 1978-1998; and (4) education at 30 years for 1978-1988. Logistic and linear models were adjusted for birth year, maternal age, maternal education and maternal death.

RESULTS: The estimated probability of receiving special educational support was similar in the exposed group and the reference (adjusted OR 0.96; 95% CI 0.46 to 1.77, non-significant). The GPA did not statistically differ (0.13 grade points; 95% CI -0.18 to 0.45, non-significant). The achieved educational levels were similar for the exposed group and the reference at 20 years, with an adjusted OR of 1.07 (95% CI 0.82 to 1.40) for low versus medium educational level, and at 30 years with an adjusted OR of 0.73 (95% CI 0.35 to 1.50) for low versus high educational level and of 1.07 (95% CI 0.66 to 1.72) for medium versus high educational level.

CONCLUSION: Our findings did not indicate poorer performance in compulsory school nor impairment of adult educational achievement after exposure to maternal cancer in utero.

PMID:38589221 | DOI:10.1136/jech-2023-221753

Arch Dis Child Fetal Neonatal Ed. 2024 Apr 8:fetalneonatal-2024-326963. doi: 10.1136/archdischild-2024-326963. Online ahead of print.

NO ABSTRACT

PMID:38589207 | DOI:10.1136/archdischild-2024-326963

Indian J Tuberc. 2024 Apr;71(2):185-194. doi: 10.1016/j.ijtb.2023.05.013. Epub 2023 May 16.

ABSTRACT

Tuberculous pericarditis (TBP) is a relatively uncommon but potentially fatal extrapulmonary manifestation of tuberculosis. Despite its severity, there is no universally accepted gold standard diagnostic test for TBP currently. The objective of this study is to compare the diagnostic accuracy of the most commonly used tests in terms of specificity, sensitivity, negative predictive value (NPV), and positive predictive value (PPV), and provide a summary of their diagnostic accuracies. A comprehensive literature review was performed using Scopus, MEDLINE, and Cochrane central register of controlled trials, encompassing studies published from start to April 2022. Studies that compared Interferon Gamma Release Assay (IGRA), Xpert MTB/RIF, Adenosine Deaminase levels (ADA), and Smear Microscopy (SM) were included in the analysis. Bayesian random-effects model was used for statistical analysis and mean and standard deviation (SD) with 95% confidence intervals were calculated using the absolute risk (AR) and odds ratio (OR). Rank probability and heterogeneity were determined using risk difference and Cochran Q test, respectively. Sensitivity and specificity were evaluated using true negative, true positive, false positive, and false negative rates. Area under the receiver operating characteristic (AUROC) was calculated for mean and standard error. A total of seven studies comprising 16 arms and 618 patients were included in the analysis. IGRA exhibited the highest mean (SD) sensitivity of 0.934 (0.049), with a high rank probability of 87.5% for being the best diagnostic test, and the AUROC was found to be 94.8 (0.36). On the other hand, SM demonstrated the highest mean (SD) specificity of 0.999 (0.011), with a rank probability of 99.5%, but a leave-one-out analysis excluding SM studies revealed that Xpert MTB/RIF ranked highest for specificity, with a mean (SD) of 0.962 (0.064). The diagnostic tests compared in our study exhibited similar high NPV, while ADA was found to have the lowest PPV among the evaluated methods. Further research, including comparative studies, should be conducted using a standardized cutoff value for both ADA levels and IGRA to mitigate the risk of threshold effect and minimize bias and heterogeneity in data analysis.

PMID:38589123 | DOI:10.1016/j.ijtb.2023.05.013

Indian J Tuberc. 2024 Apr;71(2):170-178. doi: 10.1016/j.ijtb.2023.04.026. Epub 2023 Apr 29.

ABSTRACT

BACKGROUND: Since, Vitamin D [1α,25(OH)₂D)] enhances antimicrobial activity of Innate immunity and modulate Adaptive immune responses, simultaneously, so it play a potential role for balanced immune activity against Mycobacterium tuberculosis and restricting tissue injuries within the TB patients.(Chun et al., 2011) 9 We aimed to determine the role of adjunct Vitamin D treatment on the outcome of pulmonary tuberculosis patients and evaluated the effect of Vitamin D administration on Differential Leucocyte Count, Erythrocyte Sedimentation Rate, serum Adenosine deaminase, serum C- reactive protein, Oxygen saturation (SpO2) and Body Weight in Vitamin D deficient pulmonary tuberculosis patients.

METHODS: We conducted a prospective, interventional, randomized, double blind, parallel group, active controlled clinical trial. Newly diagnosed Vitamin D deficient pulmonary tuberculosis patients were randomly assigned to intervention group (received standard anti-tubercular treatment with adjunct Vitamin D3) and control group (received standard anti-tubercular treatment without adjunct Vitamin D3). Total four doses [each dose of 2.5 mg (100000 IU)] of Vitamin D3 were given, orally. First dose was given within 7 days of starting anti-tubercular treatment and second, third, fourth dose were given at 2, 4 and 6 weeks respectively. At the time of enrollment, we measured all baseline characteristics. During follow-up, we measured the study variables and monitored adverse events at 2, 4, 6, 8 and 12 weeks. Our safety parameter was serum corrected calcium level to assess the risk of hypercalcemia.

RESULTS: Total 130 pulmonary TB patients, 65 patients in each group, were analyzed. Our study results showed that decrease in Neutrophil count was statistically significant with small effect sizes at every time point of measurement and increase in Lymphocyte count was statistically significant with small and moderate effect sizes at 4, 6 and 8 week for intervention group than for control group. Decrease in erythrocyte sedimentation rate was statistically significant with small effect sizes at 6 and 8 week, decrease in serum adenosine deaminase and serum C- reactive protein was statistically significant with moderate effect sizes at 4, 6 and 8 week for intervention group than for control group. Increase in Oxygen saturation was statistically significant at 4 week with small effect size and increase in body weight was statistically significant with small effect sizes for intervention group than for control group. No case of hypercalcemia was reported.

CONCLUSION: Our findings suggest a potential role of adjunctive Vitamin D3 to accelerate resolution of inflammatory responses and improvement in clinical outcomes of pulmonary TB patients.

TRIAL REGISTRATION: This trial is registered with Clinical Trials Registry – INDIA (http://ctri.nic.in) with CTRI Number – CTRI/2021/11/037914.

PLACE OF STUDY: Room Number 27, first floor out-patients department (OPD) and inpatient Wards, fourth floor, Department of Respiratory Medicine, Uttar Pradesh University of Medical Sciences, Saifai, Etawah (U.P.), INDIA.

PMID:38589121 | DOI:10.1016/j.ijtb.2023.04.026