Tag: nevin manimala

Eur J Prev Cardiol. 2023 Sep 14:zwad300. doi: 10.1093/eurjpc/zwad300. Online ahead of print.

ABSTRACT

BACKGROUND: Obesity is a major risk factor for atrial fibrillation (AF). Compared to stable weight, gaining weight was associated with a higher risk of incident AF in observational studies. The results, however, are conflicting regarding weight loss and risk of AF. This study aimed to assess the association between five-year weight changes and risk of incident AF.

METHODS: The study was based on participants from the Danish Diet, Cancer and Health cohort. Body mass index (BMI) was assessed at a baseline examination and at a second examination five years later. Diagnoses of AF and comorbidities were retrieved from the Danish National Patient Registry.

RESULTS: In total, 43,758 participants without prior AF were included. The median age was 61 years and 54% were female. During a median follow-up of 15.7 years, 5,312 individuals had incident AF (incidence rate 8.6/1,000 person-years). Compared to stable weight, weight gain between 2.5 to 5 BMI units (kg/m2) was associated with a higher risk of AF (HR 1.24, 95% CI 1.09-1.41). Weight gain of 5 or more BMI units (kg/m2) was associated with a HR of 1.95 (95% CI 1.48-2.56) of incident AF. However, there was no statistically significant association between weight loss and risk of AF.

CONCLUSIONS: Five-year weight gain was associated with greater risk of AF compared with stable weight in the Danish Diet, Cancer and Health cohort. There was no statistically significant association between weight loss and risk of AF.

PMID:37708406 | DOI:10.1093/eurjpc/zwad300

J Neurosurg. 2023 Sep 8:1-10. doi: 10.3171/2023.7.JNS231133. Online ahead of print.

ABSTRACT

OBJECTIVE: The use of stent-assisted coiling (SAC) in acute subarachnoid hemorrhage cases is associated with higher incidence rates of bleeding and ischemic complications. The aim of this study was to evaluate the safety and efficacy of the SAC technique in the treatment of ruptured intracranial aneurysms (RIAs).

METHODS: A retrospective analysis was conducted on patients with RIAs treated with SAC or coiling alone (CA). Univariate analysis compared clinical information between the two groups. Propensity score matching was used to select patients for comparison and analyze surgical complications, prognosis, and imaging outcomes in both groups.

RESULTS: A total of 394 aneurysms were included, and 272 aneurysms remained after application of propensity score matching, with an equal distribution of 136 cases in both the SAC and CA groups. There was no statistically significant difference in the immediate postoperative outcomes between the two groups (63.2% of SAC patients achieved class 1 on the Raymond-Roy occlusion classification scale vs 58.8% of CA patients, difference [95% CI] 4.4% [-0.076 to 0.163]; 33.1% achieved class 2 vs 38.2%, 5.1% [-0.065 to 0.170]; 3.7% achieved class 3 vs 2.9%, 0.8% [-0.047 to 0.062], p = 0.506). At the 1-year follow-up, the SAC group exhibited higher rates of complete occlusion (59.5% vs 42.4%, 17.1% [0.040-0.294]) and stability (24.0% vs 19.2%, 4.8% [-0.061 to 0.156]), while experiencing lower rates of improvement (12.4% vs 22.4%, 10.0% [0.001-0.201]) and recanalization (4.1% vs 16.0%, 11.9% [0.036-0.120]), with statistically significant differences in these outcomes (p < 0.001). No significant disparities were observed in clinical outcomes in terms of modified Rankin Scale (mRS) scores at discharge (76.5% vs 77.2% had mRS score 0-2, 0.7% [-0.098 to 0.113]; 23.5% vs 22.8% had mRS score 3-6, 0.7% [-0.098 to 0.113], p = 0.886) and 1-year follow-up (90.8% vs 92.2% had mRS score 0-2, 1.4% [-0.063 to 0.091]; 9.2% vs 7.8% had mRS score 3-6, 1.4% [-0.063 to 0.091], p = 0.683). Intraoperative rupture occurred more frequently in the SAC group compared with the CA group, although the difference was not statistically significant (5.1% vs 2.9%, 2.2% [-0.035 to 0.081], p = 0.356). The SAC group demonstrated a higher incidence of intraoperative thrombosis, but the difference was not statistically significant (8.1% vs 2.9%, 5.2% [-0.010 to 0.117], p = 0.063). Postoperative thrombosis in the SAC group was 3 times higher, but this difference was not statistically significant (6.6% vs 2.2%, 4.4% [-0.013, 0.106], p = 0.076). The surgery-related mortality rates did not differ significantly between the two groups (4.4% vs 5.9%, 1.5% [-0.048 to 0.077], p = 0.583).

CONCLUSIONS: Although stent treatment for RIA results in some incidents of complications, it is safe and effective. Besides, the SAC group showed better vascular imaging results compared with the CA group.

PMID:37708395 | DOI:10.3171/2023.7.JNS231133

Ann Am Thorac Soc. 2023 Sep 14. doi: 10.1513/AnnalsATS.202305-394OC. Online ahead of print.

ABSTRACT

RATIONALE: Cardiopulmonary exercise testing (CPET) is the gold standard to evaluate exertional breathlessness, a common and disabling symptom. However, interpretation of breathlessness responses to CPET is limited by a scarcity of normative data.

OBJECTIVES: We aimed to develop normative reference equations for breathlessness intensity (Borg 0-10 category-ratio [CR10]) response in men and women aged ≥40 years during CPET, in relation to power output (W), rate of oxygen uptake (V’O2), and minute ventilation (V’E).

METHODS: Analysis of ostensibly healthy people aged ≥40 years undergoing a symptom-limited incremental cycle CPET (10 W/min) in the Canadian Cohort Obstructive Lung Disease (CanCOLD) study. Participants had <5 pack-years smoking, normal lung function and exercise capacity. The probability of each Borg CR10 breathlessness intensity rating by W, V’O2 or V’E (as absolute or relative value [% of predicted max]) was predicted using ordinal multinomial logistic regression. Model performance was evaluated by fit, calibration, discrimination (c-statistic), and externally validated in an independent sample (n=86) of healthy Canadian adults.

RESULTS: We included 156 participants (43% women) from CanCOLD; mean age 65 (range 42-91) years, mean body mass index 26.3 (SD 3.8) kg/m2. Reference equations were developed for females and males separately, accounting for age and/or body mass. Model performance was high across all equations, including in the validation sample (c-statistic males: 0.81-0.92; females: 0.81-0.96).

CONCLUSION: Normative reference equations are provided to compare exertional breathlessness intensity ratings between individuals or groups, and to identify and quantify abnormal breathlessness responses (score > upper limit of normal) during CPET.

PMID:37708387 | DOI:10.1513/AnnalsATS.202305-394OC

Opt Lett. 2023 Sep 15;48(18):4909-4912. doi: 10.1364/OL.500487.

ABSTRACT

Relying on Feynman-Kac path-integral methodology, we present a new statistical perspective on wave single-scattering by complex three-dimensional objects. The approach is implemented on three models-Schiff approximation, Born approximation, and rigorous Born series-and familiar interpretative difficulties such as the analysis of moments over scatterer distributions (size, orientation, shape, etc.) are addressed. In terms of the computational contribution, we show that commonly recognized features of the Monte Carlo method with respect to geometric complexity can now be available when solving electromagnetic scattering.

PMID:37707934 | DOI:10.1364/OL.500487

JMIR Hum Factors. 2023 Sep 14;10:e50232. doi: 10.2196/50232.

ABSTRACT

BACKGROUND: Telehealth can optimize access to specialty care for patients with atrial fibrillation (AF). Virtual AF care, however, may not fit with the complex needs of patients with AF.

OBJECTIVE: This study aims to explore the correlation among attitudes toward health care technologies, self-efficacy, and telehealth satisfaction as part of the future planning of virtual AF clinic care.

METHODS: Patients with AF older than 18 years from an urban-based, highly specialized AF clinic who had an upcoming telehealth visit were invited to participate in a web-based survey. The survey asked about demographic characteristics; use of technology; general, computer, and health care technology self-efficacy (HTSE) and health care technology attitudes, using a validated 30-item tool; and telehealth satisfaction questionnaire using a validated 14-item questionnaire. Data were analyzed with descriptive statistics, correlational analyses, and linear regression modeling.

RESULTS: Participants (n=195 of 579 invited, for a 34% response rate) were primarily older, male, and White, had postsecondary schooling or more, and had high self-reported overall and mental health ratings. A variety of technologies were used in their daily lives and for health care, with the majority of technologies comprising desktop and laptop computers, smartphones, and tablets. Self-efficacy and telehealth satisfaction questionnaire scores were high overall, with male participants having higher general self-efficacy, computer self-efficacy, HTSE, and technology attitude scores. After controlling for age and sex, only HTSE was significantly related to individuals’ attitudes toward health care technology. Both general self-efficacy and attitude toward health care technology were positively related to telehealth satisfaction.

CONCLUSIONS: Consistent with a previous study, only HTSE significantly influenced attitudes toward health care technology. This finding confirms that, in this regard, self-efficacy is not a general perception but is domain specific. Considering participants’ predominant use of the telephone for virtual care, it follows that general self-efficacy and attitude toward health care technology were significant contributors to telehealth satisfaction. Given our patients’ frequent use of technology and high computer self-efficacy and HTSE scores, the use of video for telehealth appointments could be supported.

PMID:37707881 | DOI:10.2196/50232

J Patient Saf. 2023 Sep 15. doi: 10.1097/PTS.0000000000001161. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of the study was to construct and validate a reduced set of high-performance triggers for identifying adverse events (AEs) via electronic medical records (EMRs) review in primary care (PC).

METHODS: This was a cross-sectional descriptive study for validating a diagnostic test. The study included all 262 PC centers of Madrid region (Spain). Patients were older than 18 years who attended their PC center over the last quarter of 2018. The randomized sample was n = 1797. Main measurements were as follows: (a) presence of each of 19 specific computer-identified triggers in the EMR and (b) occurrence of an AE. To collect data, EMR review was conducted by 3 doctor-nurse teams. Triggers with statistically significant odds ratios for identifying AEs were selected for the final set after adjusting for age and sex using logistic regression.

RESULTS: The sensitivity (SS) and specificity (SP) for the selected triggers were: ≥3 appointments in a week at the PC center (SS = 32.3% [95% confidence interval {CI}, 22.8%-41.8%]; SP = 92.8% [95% CI, 91.6%-94.0%]); hospital admission (SS = 19.4% [95% CI, 11.4%-27.4%]; SP = 97.2% [95% CI, 96.4%-98.0%]); hospital emergency department visit (SS = 31.2% [95% CI, 21.8%-40.6%]; SP = 90.8% [95% CI, 89.4%-92.2%]); major opioids prescription (SS = 2.2% [95% CI, 0.0%-5.2%]; SP = 99.8% [95% CI, 99.6%-100%]); and chronic benzodiazepine treatment in patients 75 years or older (SS = 14.0% [95% CI, 6.9%-21.1%]; SP = 95.5% [95% CI, 94.5%-96.5%]).The following values were obtained in the validation of this trigger set (the occurrence of at least one of these triggers in the EMR): SS = 60.2% (95% CI, 50.2%-70.1%), SP = 80.8% (95% CI, 78.8%-82.6%), positive predictive value = 14.6% (95% CI, 11.0%-18.1%), negative predictive value = 97.4% (95% CI, 96.5%-98.2%), positive likelihood ratio = 3.13 (95% CI, 2.3-4.2), and negative likelihood ratio = 0.49 (95% CI, 0.3-0.7).

CONCLUSIONS: The set containing the 5 selected triggers almost triples the efficiency of EMR review in detecting AEs. This suggests that this set is easily implementable and of great utility in risk-management practice.

PMID:37707868 | DOI:10.1097/PTS.0000000000001161

Lupus. 2023 Sep 14:9612033231202843. doi: 10.1177/09612033231202843. Online ahead of print.

ABSTRACT

BACKGROUND: We present clinical, biochemical, and histopathological characteristics and treatment outcomes of biopsy proven childhood lupus nephritis (LN) from a low/middle income setting treated in the current era of increased use of Mycophenolate Mofetil (MMF) and biologics.

METHODS: Retrospective observational study of children (1-18 years) with biopsy proven LN treated from 01.01.2010 to 31.01.2020.

RESULTS: 60 children met our inclusion criteria (80%, n = 48 were females). The median age at diagnosis was 11 (IQR: 9-12) years. The most common extra-renal manifestation was mucocutaneous (n = 54, 90%) and the most common kidney manifestation was edema (n = 50, 83.3%). The median 24-h urinary protein excretion was 1117.8 (IQR: 795.4-1941.7) mg/m²/day with 67% (n = 40) having nephrotic range proteinuria (>1000 mg/m²/day). 75% (n = 45) children had eGFR <90 mL/min/1.73 m² (median eGFR = 71; IQR: 56-90 mL/min/1.73 m²). Anti-Nuclear Antibody was positive in all, both complement three and four were low in 82% (n = 49) and anti-double stranded DNA antibodies were positive in 63% (n = 38). 85% (n = 51) had proliferative LN with majority being class IV (57%, n = 34). All children received steroids for induction therapy. MMF was given as the sole induction agent in 48% (n = 29) and cyclophosphamide in 27% (n = 16). Rituximab was added in 17% (n = 10) as a rescue agent. Median follow up duration was 50 (IQR: 28-82) months. Six children (10%) died as a result of serious infections and none of them had shown complete response (CR). Out of the 52 children who had a follow up duration of at least 2 years, CR was achieved in 46 children (88%) and partial response (PR) or no response (NR) in three children (6%) each. Although children who were in CR/PR at last follow up had lower proteinuria, higher eGFR, and lower histopathology activity index at onset; low numbers in the NR group precluded us from subjecting them to any statistical correlation tests. 36% (n = 22) of children developed 36 episodes of renal flares with overall incidence of 0.14/person-year.

CONCLUSION: Our study on a contemporary cohort of childhood LN highlights the importance of achieving CR and its feasibility.

PMID:37707867 | DOI:10.1177/09612033231202843

J Acquir Immune Defic Syndr. 2023 Oct 1;94(2S):S47-S52. doi: 10.1097/QAI.0000000000003262.

ABSTRACT

BACKGROUND: Creating empathetic health care professionals is critical to addressing the health equity challenges of today, particularly because it relates to vulnerable populations.

METHODS: To assess the impact of the Johns Hopkins Center for AIDS Research Generation Tomorrow Summer Health Disparities Scholars (GTSHDS) program on students’ empathy toward individuals living with substance use disorder and differential impact on empathy related to the COVID-19 pandemic, the Attitudes towards Mental Illness Questionnaire (AMIQ), an assessment of stigmatizing attitudes, was administered. Preprogram and postprogram participation AMIQ survey data were compared using paired t tests to explore changes within the program year. Unpaired t tests were used to characterize differences between the mean scores across the 2 student cohorts.

RESULTS: Both GTSHDS cohorts displayed postprogram increase in empathy. Mean 2019 cohort AMIQ scores shifting from -1.4 (SD 2.01) to -0.8 (SD 2.35) (P = 0.54), and the 2022 cohort shifting from -3.67 (SD 2.01) to -3 (SD 1.61) (P = 0.79). On average, individual scores improved by 2.2 (SD 1.65) points in the 2019 cohort and 2.4 (SD 1.86) points in the 2022 cohort (P = 0.83). Although these were not statistically significant, they suggested a trend toward more empathy.

CONCLUSIONS: Preliminary data suggest that programs such as GTSHDS that expose students to various aspects of health care principles can prepare future health care professionals in a manner that may reduce health care disparities. Future research with larger population sizes is needed to understand the impacts of the curriculum on empathy and related concepts to achieving health equity.

PMID:37707848 | DOI:10.1097/QAI.0000000000003262

Invest Ophthalmol Vis Sci. 2023 Sep 1;64(12):26. doi: 10.1167/iovs.64.12.26.

ABSTRACT

PURPOSE: Albinism is a group of genetic disorders that includes several conditions related to a defect in melanin production. There is a broad phenotypic and genotypic variability between the different forms. The aim of this study was to assess the ophthalmologic characteristics according to patients’ genotypes in a cohort followed in the Reference Center for oculocutaneous albinism (OCA) of Bordeaux University Hospital, France.

METHODS: A retrospective observational study was conducted in a cohort of patients with OCA seen in consultation in the ophthalmology department between 2017 and 2021 in whom a genetic analysis was performed.

RESULTS: In total, 127 patients with OCA were included in this study and matched with the results of the genetic analysis. In the population aged over 6 years, there was no statistical difference in binocular visual acuity between the OCA1, OCA2, and OCA4 forms (P = 0.27). There was difference in ametropia between the three forms (P = 0.003). A two-by-two comparison using the Bonferroni correction showed a significant difference in ametropia between the OCA2 and OCA4 forms (P = 0.007) and between the OCA1 and OCA2 forms (P = 0.0075). Regardless of the form, most patients (75.4%) had grade 4 foveal hypoplasia. There was no association between the grade of foveal hypoplasia and the gene involved (P = 0.87).

CONCLUSIONS: We described a genotype-phenotype correlation for the three most represented forms of albinism in our cohort. This study allowed assessing the degree of visual deficiency in young children with OCA.

PMID:37707835 | DOI:10.1167/iovs.64.12.26

JAMA Oncol. 2023 Sep 14. doi: 10.1001/jamaoncol.2023.3748. Online ahead of print.

ABSTRACT

IMPORTANCE: Requiring personalized genetic counseling may introduce barriers to cancer risk assessment, but it is unknown whether omitting counseling could increase distress.

OBJECTIVE: To assess whether omitting pretest and/or posttest genetic counseling would increase distress during remote testing.

DESIGN, SETTING, AND PARTICIPANTS: Making Genetic Testing Accessible (MAGENTA) was a 4-arm, randomized noninferiority trial testing the effects of individualized pretest and/or posttest genetic counseling on participant distress 3 and 12 months posttest. Participants were recruited via social and traditional media, and enrollment occurred between April 27, 2017, and September 29, 2020. Participants were women aged 30 years or older, English-speaking, US residents, and had access to the internet and a health care professional. Previous cancer genetic testing or counseling was exclusionary. In the family history cohort, participants had a personal or family history of breast or ovarian cancer. In the familial pathogenic variant (PV) cohort, participants reported 1 biological relative with a PV in an actionable cancer susceptibility gene. Data analysis was performed between December 13, 2020, and May 31, 2023.

INTERVENTION: Participants completed baseline questionnaires, watched an educational video, and were randomized to 1 of 4 arms: the control arm with pretest and/or posttest genetic counseling, or 1 of 3 study arms without pretest and posttest counseling. Genetic counseling was provided by phone appointments and testing was done using home-delivered saliva kits.

MAIN OUTCOMES AND MEASURES: The primary outcome was participant distress measured by the Impact of Event Scale 3 months after receiving the results. Secondary outcomes included completion of testing, anxiety, depression, and decisional regret.

RESULTS: A total of 3839 women (median age, 44 years [range 22-91 years]), most of whom were non-Hispanic White and college educated, were randomized, 3125 in the family history and 714 in the familial PV cohorts. In the primary analysis in the family history cohort, all experimental arms were noninferior for distress at 3 months. There were no statistically significant differences in anxiety, depression, or decisional regret at 3 months. The highest completion rates were seen in the 2 arms without pretest counseling.

CONCLUSIONS AND RELEVANCE: In the MAGENTA clinical trial, omitting individualized pretest counseling for all participants and posttest counseling for those without PV during remote genetic testing was not inferior with regard to posttest distress, providing an alternative care model for genetic risk assessment.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02993068.

PMID:37707822 | DOI:10.1001/jamaoncol.2023.3748