Tag: nevin manimala

J Prim Care Community Health. 2023 Jan-Dec;14:21501319231208517. doi: 10.1177/21501319231208517.

ABSTRACT

BACKGROUND: The highest prescribing rates for antibiotics occur in primary care, therefore, ambulatory care pharmacist interventions could play a major role in preventing overuse and misuse of antibiotics. Delegated pharmacists in the SJC primary care setting guided 3 activities with a goal of positively impacting prescribing patterns: monthly webinars provided by Agency for Healthcare Research and Quality (AHRQ), quarterly reporting to physicians of antibiotic prescribing patterns, and development of a clinical decision-making support tool for antibiotic prescribing.

METHODS: Retrospective, observational data was collected to evaluate antibiotic prescribing patterns in patients diagnosed with acute sinusitis both before initiatives were implemented (July 1, 2019 through June 30, 2020) and after the initiatives were implemented (April 1, 2022 through June 30, 2022).

RESULTS: A total of 675 patients were diagnosed with acute bacterial sinusitis during the specified time frame. Of these, 138 patients were excluded. A total of 279 antibiotics were prescribed in the preintervention group out of 298 patient encounters (93.6%) and 225 antibiotics were prescribed in the post-intervention group out of 244 patient encounters (92.9%) (p = .26). Although the primary outcome was not statistically significant, a significant reduction in patients treated with fluoroquinolones was noted, with 59/298 (20%) of those being prescribed in the pre-intervention group and 20/244 (8%) in the post intervention group (P = .02).

CONCLUSIONS: While pharmacist-led antimicrobial stewardship interventions in primary care did not result in a decrease in the overall prescription of antibiotics for acute sinusitis, our study did reveal a notable reduction in the use of fluoroquinolones. This finding highlights a promising avenue for expanding the role of ambulatory care pharmacists.

PMID:37933555 | DOI:10.1177/21501319231208517

J Prim Care Community Health. 2023 Jan-Dec;14:21501319231201227. doi: 10.1177/21501319231201227.

ABSTRACT

INTRODUCTION/OBJECTIVES: Annually, HPV infections result in $775 million in direct medical costs and approximately 46 000 new cases of HPV-associated cancers. Safe and highly effective vaccines have been available to prevent HPV for children/adolescents since 2006. Vaccination rates remain low, especially in rural areas. Parental attitudes and beliefs affect HPV vaccination rates.

METHODS: We developed, tested, and administered a survey that asked how parents and healthcare providers interacted about the HPV vaccine following a healthcare visit with an age-eligible child, as part of a multicomponent randomized controlled trial designed to improve HPV vaccination rates in rural Oregon. The 21-item survey assessed parents’ information-seeking behavior, knowledge about HPV cancer risk reduction, the HPV vaccine series, and their vaccine confidence.

RESULTS: Forty-three participants (59.7%) were in the intervention group; 29 (40.3%) were controls. Over 90% of healthcare visits were illness, injury, sports physical, or well-child visits (n = 67 or 93.1%), and 6.9% of visits were vaccine-specific. No statistically significant differences were found between study groups for healthcare visits. Over half the parents reported having discussions about HPV and the HPV vaccine (54.5%) with their care providers, 31.3% had recently learned about HPV, HPV risks, and the HPV vaccine prior to the visit, 83.1% were knowledgeable about cancers associated with HPV, and 79.2% were considering vaccinating their child(ren), which did not differ between study groups.

CONCLUSIONS: Knowledge about HPV-related cancers and consideration for vaccinating children was higher than expected, but not associated with the intervention tested.

PMID:37933546 | DOI:10.1177/21501319231201227

Mol Ecol. 2023 Nov 7. doi: 10.1111/mec.17192. Online ahead of print.

ABSTRACT

The question of how interactions between the gut microbiome and vertebrate hosts contribute to host adaptation and speciation is one of the major problems in current evolutionary research. Using bacteriome and mycobiome metabarcoding, we examined how these two components of the gut microbiota vary with the degree of host admixture in secondary contact between two house mouse subspecies (Mus musculus musculus and M. m. domesticus). We used a large data set collected at two replicates of the hybrid zone and model-based statistical analyses to ensure the robustness of our results. Assuming that the microbiota of wild hosts suffers from spatial autocorrelation, we directly compared the results of statistical models that were spatially naive with those that accounted for spatial autocorrelation. We showed that neglecting spatial autocorrelation can strongly affect the results and lead to misleading conclusions. The spatial analyses showed little difference between subspecies, both in microbiome composition and in individual bacterial lineages. Similarly, the degree of admixture had minimal effects on the gut bacteriome and mycobiome and was caused by changes in a few microbial lineages that correspond to the common symbionts of free-living house mice. In contrast to previous studies, these data do not support the hypothesis that the microbiota plays an important role in host reproductive isolation in this particular model system.

PMID:37933543 | DOI:10.1111/mec.17192

Omega (Westport). 2023 Nov 7:302228231212650. doi: 10.1177/00302228231212650. Online ahead of print.

ABSTRACT

Nurses’ perceptions of resuscitated patients may affect their care, and this has not been investigated in previous literature. The aim of this study was to explore nurses’ perceptions towards resuscitated patients. In this descriptive-qualitative study seventeen clinical nurses participated using purposive sampling. In-depth, semi-structured interviews were conducted and data were analyzed by conventional content analysis. Four main categories emerged: Injured, undervalued, problematic, and destroyer of resources. Participants considered resuscitated patients to have multiple physical injuries, which are an important source of legal problems and workplace violence, and they believed that these patients will eventually die. Resuscitated patients are considered forgotten and educational cases. Iranian nurses have a strong negative perception towards resuscitated patients. Improving the quality of cardiopulmonary resuscitation, improving the knowledge and skills of personnel in performing resuscitation, and supporting managers and doctors to nurses in the post-resuscitation period can change the attitude of nurses and improve post-resuscitation care.

PMID:37933524 | DOI:10.1177/00302228231212650

J Cosmet Dermatol. 2023 Nov 7. doi: 10.1111/jocd.16065. Online ahead of print.

ABSTRACT

BACKGROUND: The major diagnostic criterion for the giant congenital melanocytic nevus (GCMN) is a size larger than 20 cm in diameter. However, the histopathological origin, pathogenesis, and GCMN progression are not yet completely clear. Unlike other medium or small superficial lesions, histomorphological evaluation is significant for GCMN pathological classification, malignant transformation assessment, and early detection of prognosis.

AIMS: This study aimed to investigate the pathological features of GCMN, including its satellite lesions.

PATIENTS/METHODS: Twenty-three giant naevi and seventeen “satellite lesions” were collected from children aged 1 to 10 in Shanghai Ninth People’s Hospital from 2018 to 2020. A histological study was conducted to evaluate their histological appearance. All the data observed and recorded data were statistically analyzed.

RESULTS: In 23 cases of GCMN primary nevus, nevus cells were mainly distributed in the dermal region, with melanocyte proliferation and the presence of nevus nests at the dermal-epidermal junction. However, in satellite nevus, a junctional growth pattern was noted. Additionally, other histopathologic features, including epidermal contour, cell morphology, and architecture disorder also showed significant differences between primary nevus and satellite nevus.

CONCLUSIONS: We demonstrated that the congenital pattern of the main nevus is more obvious than one of the satellite nevus, suggesting that the satellite nevus and the main nevus may occur slightly later than the main nevus. “Satellite nevus” happens as a result of a separate genetic event.

PMID:37933518 | DOI:10.1111/jocd.16065

Acta Med Acad. 2023 Aug;52(2):119-133. doi: 10.5644/ama2006-124.412.

ABSTRACT

OBJECTIVE: This cross-sectional study determines the impact of the pandemic lockdowns on physical activity, and evaluates the factors associated with physical activity cessation on students and personnel of eight Greek Higher Education Institutions.

MATERIALS AND METHODS: A total of 6,380 volunteer participants completed a survey reporting their physical activity levels and perceptions during the COVID-19 pandemic. The survey was made available through an online platform.

RESULTS: Both the conduct and intensity of physical activity were significantly reduced from the pre-pandemic era to the second lockdown (P<0.001). Walking was the most frequently selected type of physical activity, in all periods except for the second lockdown. Loss of interest (52.4%) was the main, self-reported factor for cessation of physical activity. Females had a 31% lower probability of ceasing physical activity during lockdowns.

CONCLUSION: The conduct and intensity of physical activity decreased significantly during the pandemic. Female gender, annual checkup attendance, and specific physical activity types during the pre-pandemic era were associated with a reduction in the risk of pausing physical activity during lockdowns. Lockdowns may be implemented in future health crises, hence measures for maintaining the physical activity of the general population, such as online group sessions and support from healthcare professionals, should be prepared.

PMID:37933509 | DOI:10.5644/ama2006-124.412

Acta Med Acad. 2023 Aug;52(2):112-118. doi: 10.5644/ama2006-124.411.

ABSTRACT

OBJECTIVES: The aim of this study was to compare the stress response produced during elective CS for the first and second time. For that goal, cortisol blood levels before, during and after childbirth were measured.

MATERIALS AND METHODS: We performed this prospective observational study during the period of September 2020 to September 2021. Blood samples were taken from all participants at three different stages. A statistical analysis was performed to compare the CS1 (first elective Caesarean) and CS2 (second elective Caesarean) groups.

RESULTS: At every stage, the levels of cortisol were statistically higher in the CS1 group than in the CS2 group. Therefore, CS2 generates a significantly less stressful response than CS1. Between stages, in CS2 cortisol was lowered at a faster rate than in CS1, meaning the stress response initiated was present for a longer time period in the CS1 group.

CONCLUSION: A second elective caesarean section is a safe procedure that does not place an unnecessary burden upon the mother. This is an important fact that practitioners can rely upon while designing the ideal management of a pregnant woman for the stressful environment of birth.

PMID:37933508 | DOI:10.5644/ama2006-124.411

Platelets. 2023 Dec;34(1):2264978. doi: 10.1080/09537104.2023.2264978. Epub 2023 Nov 7.

ABSTRACT

Platelets contribute to COVID-19 clinical manifestations, of which microclotting in the pulmonary vasculature has been a prominent symptom. To investigate the potential diagnostic contributions of overall platelet morphology and their α-granules and mitochondria to the understanding of platelet hyperactivation and micro-clotting, we undertook a 3D ultrastructural approach. Because differences might be small, we used the high-contrast, high-resolution technique of focused ion beam scanning EM (FIB-SEM) and employed deep learning computational methods to evaluate nearly 600 individual platelets and 30 000 included organelles within three healthy controls and three severely ill COVID-19 patients. Statistical analysis reveals that the α-granule/mitochondrion-to-plateletvolume ratio is significantly greater in COVID-19 patient platelets indicating a denser packing of organelles, and a more compact platelet. The COVID-19 patient platelets were significantly smaller -by 35% in volume – with most of the difference in organelle packing density being due to decreased platelet size. There was little to no 3D ultrastructural evidence for differential activation of the platelets from COVID-19 patients. Though limited by sample size, our studies suggest that factors outside of the platelets themselves are likely responsible for COVID-19 complications. Our studies show how deep learning 3D methodology can become the gold standard for 3D ultrastructural studies of platelets.

PMID:37933490 | DOI:10.1080/09537104.2023.2264978

Clin Exp Dent Res. 2023 Nov 7. doi: 10.1002/cre2.800. Online ahead of print.

ABSTRACT

OBJECTIVES: Endocrinal variations within an individual impact the electrolyte composition, pH, and flow-rate (FR) of saliva. The aim of this study was to evaluate the gender-specific differences and the effect of combined estrogen-progestin oral contraceptives (COCs) on FR, pH, and electrolyte concentrations in the parotid saliva (PS) of a group of healthy adults.

MATERIAL AND METHODS: Stimulated PS was collected from 20 healthy adults using a Lashley cup; 11 males, 8 females, and 1 female undertaking combined contraceptive therapy (levonorgestrel/ethinyloestradiol 0.1 mg + 0.02 mg). FR and pH were recorded for each saliva sample. Electrolytes concentrations (Na⁺ , Ca²⁺ , K⁺ , Mg²⁺ ) were measured using inductively coupled plasma optical emission spectrometer (ICP-OES). Statistical analysis was performed, and the significance level was set at p < .05.

RESULTS: PS FR varied from 0.13 to 0.42 mL/min in females not taking any medication and from 0.08 to 0.5 mL/min in males not taking any medication. PS pH of females and males not taking any medication ranged from 6.23 to 7.50 and from 6.15 to 7.55. PS pH and FR of the female taking COCs were 6.5 and 0.1 mL/min. PS pH, FR, and electrolytes concentrations (Ca²⁺ , Na⁺ , K⁺ , Mg²⁺ ) were not statistically significantly different between females and males not taking any medication. PS concentrations of Ca²⁺ and Na⁺ were significantly higher in the females taking COCs than in the females not taking any medication. Whereas, concentrations of K⁺ and Mg²⁺ did not differ significantly between the females taking COCs and the females not taking any medication.

CONCLUSIONS: There are no significant gender-specific differences in PS flow rate, pH, and electrolyte concentrations of Na⁺ , Ca²⁺ , Mg²⁺ , and K⁺ . Combined hormonal oral contraceptive has a significant effect on PS flow rate, pH, Ca²⁺ , and Na⁺ concentrations. Whereas the PS concentration of K⁺ and Mg²⁺ are not influenced by COCs. These results warrant further investigation.

PMID:37933471 | DOI:10.1002/cre2.800

J Endovasc Ther. 2023 Nov 7:15266028231209236. doi: 10.1177/15266028231209236. Online ahead of print.

ABSTRACT

OBJECTIVE: The article aimed to compare the efficiency and safety of atherectomy plus balloon angioplasty (BA) with BA alone for the treatment of infrapopliteal arterial disease.

METHODS: According to the inclusion and exclusion criteria, PubMed, Embase, and Cochrane Library database were searched for studies comparing atherectomy plus angioplasty and angioplasty alone in treating infrapopliteal artery lesions until November 2022. The endpoints included technical success, primary patency, clinically-driven target lesion revascularization (CD-TLR), periprocedural complications, distal embolization, target limb major amputation, and all-cause mortality.

RESULTS: Ten studies met the requirements of our meta-analysis, including 7723 patients in the atherectomy plus BA group and 2299 patients in the BA alone group. The meta-analysis showed that atherectomy plus BA was associated with reduced CD-TLR (odds ratio [OR]: 0.51, 95% confidence interval [CI]: 0.34, 0.78, p=0.002) and target limb major amputation (OR: 0.43, 95% CI: 0.19, 1.01, p=0.05) at 12-month follow-up. No statistically significant difference was found in technical success, primary patency, periprocedural complications, distal embolization, or all-cause mortality. Subgroup analysis found a higher rate of primary patency at 6 and 12 months (6 months: OR: 2.26, 95% CI: 1.11, 4.60, p=0.02; 12 months: OR: 2.38, 95% CI: 1.16, 4.86, p=0.02), and lower rates of CD-TLR (OR: 0.45, 95% CI: 0.25, 0.82, p=0.009) and target limb major amputation (OR: 0.43, 95% CI: 0.19, 1.01, p=0.05) at 12 months in patients treated with atherectomy plus drug-coated balloon (DCB) but not in patients treated with atherectomy plus plain old balloon angioplasty (POBA).

CONCLUSIONS: This meta-analysis suggests that compared with BA alone, atherectomy plus BA may reduce the need for CD-TLR and the incidence of target limb major amputation at 12-month follow-up in the treatment of infrapopliteal artery occlusive lesions, even though there are no significant advantages in technical success, primary patency, periprocedural complications, distal embolization, or all-cause mortality. To go further, atherectomy plus DCB shows significant benefits in primary patency, CD-TLR, and target limb major amputation rate but atherectomy plus POBA does not’. However, due to the limitations of this article, more randomized controlled trials (RCTs) are needed to confirm these conclusions.

CLINICAL IMPACT: According to our research, atherectomy combined with BA has the advantages of higher primary patency rate, lower CD-TLR and target limb significant amputation rate in treating infrapopliteal artery occlusive lesions, which may replace the current mainstream surgical method —BA alone. For the clinician, although the surgery may take longer, it will significantly improve the prognosis and quality of life of patients and hold considerable significance for the management of patients with infrapopliteal arterial disease. Based on the characteristics of infrapopliteal artery disease, this study explored the feasibility of atherectomy combined with BA for infrapopliteal artery disease. Moreover, we found that atherectomy combined with DCB had better clinical efficacy, which should be the innovation of this study.

PMID:37933456 | DOI:10.1177/15266028231209236