Tag: nevin manimala

J Am Acad Dermatol. 2023 Jul 24:S0190-9622(23)02395-2. doi: 10.1016/j.jaad.2023.06.059. Online ahead of print.

NO ABSTRACT

PMID:37495174 | DOI:10.1016/j.jaad.2023.06.059

J Thorac Cardiovasc Surg. 2023 Jul 24:S0022-5223(23)00624-4. doi: 10.1016/j.jtcvs.2023.07.019. Online ahead of print.

ABSTRACT

INTRODUCTION: Right heart output in heart failure can be compensated through increasing systemic venous pressure. We determined whether this “Passive Cardiac Output” magnitude can predict LVAD outcomes.

METHODS: Retrospective review of 383 patients who received a continuous flow LVAD at the University of Michigan from 2012 to 2021. Pre-LVAD cardiac output driven by venous pressure was determined by dividing right atrial by mean pulmonary artery pressure, multiplied by total cardiac output. Normalization to body surface area derives the “Passive Cardiac Index (PasCI)”. Youden J statistics identified the PasCI threshold which predicted LVAD death by 2 years.

RESULTS: Increased preoperative PasCI was associated with reduced survival (HR=2.27, P<0.01), and increased risk of right ventricular failure (RVF) (HR=3.46, P=0.04). Youden analysis showed that a preoperative PasCI >0.5 (n=226) predicted LVAD death (P=0.10). Patients with Passive CI >0.5 had poorer survival (P=0.02), with a trend toward more heart failure readmission days (45.09+67.64 vs 35.13+45.02 days, P=0.084) and increased gastrointestinal bleeding (29.2% vs 20.4%, P=0.052). Additionally, of the 97 patients who experienced readmissions for heart failure, those with pre-LVAD implantation Passive CI >0.5 were more likely to have >1 readmission (P= 0.05).

CONCLUSIONS: While right heart output can be augmented by raising venous pressure, this negatively impacts end-organ function and increases heart failure readmission days. Patients with a pre-LVAD PasCI >0.5 have worse post-LVAD survival and increased RVF. Utilizing the PasCI metric in isolation or incorporation into a predictive model may improve the management of LVAD candidates with RV dysfunction.

PMID:37495169 | DOI:10.1016/j.jtcvs.2023.07.019

J Pharmacol Toxicol Methods. 2023 Jul 24:107299. doi: 10.1016/j.vascn.2023.107299. Online ahead of print.

ABSTRACT

The cardiovascular safety pharmacology (SP) study conducted to satisfy ICH S7A and S7B has commonly used a cross-over study design where each animal receives all treatments. In an increasing number of cases, cross-over designs are not possible and parallel studies have to be used. These can seldom be as large as 8 animals/treatment to match an n = 8 cross-over. Animals in parallel designs receive only one treatment. Parallel studies will have a different sensitivity to detect changes. This sensitivity is a critical question in using nonclinical QTc evaluations to support an integrated proarrhythmic risk assessment under the newly released ICH E14/S7B Q&As. The current analysis used a study large enough (n = 48) to be analyzed both as a parallel and as a cross-over design to directly compare the performance of the two experimental designs coupled to different statistical models, while all other study conduct aspects were the same. A total of 48 nonhuman primates (NHP) received 2 different treatments twice: vehicle, moxifloxacin (80 mg/kg), vehicle, moxifloxacin (80 mg/kg). Post-dose QTc interval data were recorded for 48 h for each treatment. Data were analyzed using 12 animals randomly selected for each treatment in a parallel design or as an n = 48 animal cross-over study. Different statistical models were used. The primary endpoint was the residual deviation (sigma) from the models applied to hourly time intervals. The sigma was used to determine the minimal detectable difference (MDD) for the study design-statistical model combination. Two statistical models were applicable to either study design. They gave similar sigma and resulting MDD values. In cross-over designs, the individual animal identification (ID) can be used in the statistical model. This enabled the smallest MDD value. Simple statistical models for analysis were identified: Treatment + Baseline for parallel designs and Treatment + ID for cross-over designs. The statistical sensitivity of NHP parallel study designs is reasonable (MDD for n = 6 of 12.7 ms), and in combination with testing exposures higher than likely to be necessary in man could be used in an integrated risk assessment. Where sensitivity of the NHP in vivo QTc assessment is critical, the cross-over design enabled a higher sensitivity (MDD 12.2 ms for n = 4; 8 ms for n = 8).

PMID:37495163 | DOI:10.1016/j.vascn.2023.107299

Sci Total Environ. 2023 Jul 24:165740. doi: 10.1016/j.scitotenv.2023.165740. Online ahead of print.

ABSTRACT

BACKGROUND: Inorganic arsenic (iAs) is a widespread toxic metalloid. It is well-known that iAs metabolism and its toxicity are mediated by polymorphisms in AS3MT and other genes. However, studies during pregnancy are scarce. We aimed to examine the role of genetic polymorphisms in AS3MT, GSTO2, N6AMT1, MTHFR, MTR, FTCD, CBS, and FOLH1 in iAs methylation efficiency during pregnancy.

METHODS: The study included 541 pregnant participants from the INMA (Environment and Childhood) Spanish cohort. Using high-performance liquid chromatography coupled to inductively coupled plasma-tandem mass, we measured arsenic (iAs and the metabolites monomethylarsonic acid (MMA) and dimethylarsinic acid (DMA)) in urine samples collected during the first trimester. iAs methylation efficiency was determined based on relative concentrations of the As metabolites in urine (%MMA, %DMA, and %iAs). Thirty-two single nucleotide polymorphisms (SNPs) in nine genes were determined in maternal DNA; AS3MT haplotypes were inferred. We assessed the association between genotypes/haplotypes and maternal As methylation efficiency using multivariate linear regression models.

RESULTS: The median %MMA and %DMA were 5.3 %, and 89 %, respectively. Ancestral alleles of AS3MT SNPs (rs3740393, rs3740390, rs11191453, and rs11191454) were significantly associated with higher %MMA, %iAs, and lower %DMA. Pregnant participants with zero copies of the GGCTTCAC AS3MT haplotype presented a higher %MMA. Statistically significant associations were also found for the FOLH1 SNP rs202676 (β 0.89 95%CI: 0.24, 1.55 for carriers of the G allele vs. the A allele).

CONCLUSIONS: Our study shows that ancestral alleles in AS3MT polymorphisms were associated with lower As methylation efficiency in early pregnancy and suggests that FOLH1 also plays a role in As methylation efficiency. These results support the hypothesis that As metabolism is multigenic, being a key element for identifying susceptible populations.

PMID:37495132 | DOI:10.1016/j.scitotenv.2023.165740

World Neurosurg. 2023 Jul 24:S1878-8750(23)01023-9. doi: 10.1016/j.wneu.2023.07.083. Online ahead of print.

ABSTRACT

BACKGROUND: Pain relief in lumbar disc hernias is a challenging condition. This study retrospectively compared particulate steroids, methylprednisolone acetate (mid-term effective), against betamethasone acetate (Long-term effective) on ultrasound-guided caudal epidural injection for lumbar disc herniation (LDH).

METHODS: A total of 40 patients with L4-5 and/or L5-S1 disc herniation were treated with ultrasound-guided caudal epidural injection between September 2021 and June 2022. Nine-teen patients who were given methylprednisolone acetate (group A) as a steroid and a total of 21 patients who were used betamethasone acetate (Group B) were retrospectively collected, and their pain levels and functional improvement were compared retrospectively before, immediately after, and 3 weeks after the injection in terms of the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) as the efficacy value.

RESULTS: There was no statistically significant difference between the groups regarding age, gender, and BMI (p >0.05). In group A, pre-op VAS was 8.84 ± 0.76, immediate post-op period 3.10 ± 1.37, and post-op 3rd week was 4.73 ± 2.32. In group B, the pre-op VAS was 8.76 ±0.76, the post-op early period was 3.14 ± 1.27, and the post-op 3rd week was 3.12 ± 1.30. In group A pre-op ODI was 49.84 ± 9.11 and post-op 3rd week was 22.84 ± 6.44. In group B, the pre-op ODI was 46.71 ± 16.15 and post-op 3rd week was 30.80 ± 17.65. Significant changes were observed in the reduction of VAS values after the procedure in both groups during the early postoperative period and the third week (p-value < 0.05). However, a significant difference was not found between the changes in VAS values between the groups (p-value > 0.005). Similarly, significant changes were observed in the decrease of ODI values after the procedure in both groups during the early postoperative period and the third week (p-value < 0.05). However, no significant difference was observed in the ODI scores between the two groups.

CONCLUSIONS: No significant difference was observed between betamethasone and methylprednisolone. Both steroid groups showed a substantial improvement in the preoperative pain scores of the patients.

PMID:37495099 | DOI:10.1016/j.wneu.2023.07.083

Ann Vasc Surg. 2023 Jul 24:S0890-5096(23)00529-0. doi: 10.1016/j.avsg.2023.07.099. Online ahead of print.

ABSTRACT

OBJECTIVES: Since their inception, Integrated Vascular Surgery Residency (IVSR) programs have expanded widely and attracted highly competitive medical students by offering a more focused approach to learning both open surgical and endovascular techniques. However, despite substantial modifications to the training paradigm, a shortage of vascular surgeons is still projected through 2050. We aimed to gather and analyze fourth-year medical students’ knowledge and perceptions of vascular surgery (VS) to further inform strategies for recruiting future vascular surgeons.

METHODS: We sent anonymous electronic questionnaires to fourth-year medical students at seven allopathic and three osteopathic medical schools, with questions detailing demographics, specialty preferences, and exposure to and perceptions of VS. Descriptive statistics were obtained, and responses were compared between students applying to surgical (SS) and non-surgical specialties (NSS).

RESULTS: 211 of 1,764 (12%) participants responded (56% female). 56% reported VS exposure, most commonly during the third year. 64 (30%) planned to apply to SS. 57% of respondents reported knowledge of the management of vascular disease, and 56% understood procedures performed by vascular surgeons. Ranking the importance of factors in choosing specialties, SS selected “experiences gained during medical school rotations” (p < 0.05), “types and/or variety of treatment modalities used in this field” (p < 0.001), and “interest in the pathology or disease processes treated” (p < 0.05) as highest priorities. NSS preferred “lifestyle (work-life balance) as an attending” (p < 0.001). Only 7% of all respondents believed vascular surgeons have a good work-life balance, with a larger percentage of SS (p < 0.001) agreeing. Stratified by gender, female students rated “limited ability of childbirth during residency and/or postponement of family plans” (p < 0.05), “gender-related concerns, such as discrimination at work or unfair career possibilities” (p < 0.001), and “fear of unfair competition” (p < 0.05) as potential negative aspects of VS careers. 55% of respondents believed the IVSR makes VS more appealing.

CONCLUSIONS: Medical students perceive poor quality of life and work-life balance as deterring factors to a career in VS. Opportunities exist to educate students on the pathologies treated, procedures performed, and attainable quality of life available in our field. We should also continue to develop recruitment strategies to stimulate student interest and increase early exposure in VS.

PMID:37495096 | DOI:10.1016/j.avsg.2023.07.099

Chemosphere. 2023 Jul 24:139613. doi: 10.1016/j.chemosphere.2023.139613. Online ahead of print.

ABSTRACT

The assessment of the nutritional status of plants is traditionally performed by wet-digestion methods using oven-dried and ground samples. This process requires sampling, takes time, and it is non-environmentally friendly. Agricultural and environmental science have been greatly benefited by in-field, ecofriendly methods, and real-time element measurements. This work employed the portable X-ray fluorescence spectrometry (pXRF) to analyze intact and fresh leaves of crops aiming to assess the effect of water content and leaf surface (adaxial and abaxial) on pXRF results. Also, pXRF data were used to predict the real concentration of macro- and micronutrients. Eight crops (bean, castor plant, coffee, eucalyptus, guava tree, maize, mango, and soybean) with contrasting water contents were used. Intact leaf fragments (∼2 × 2 cm), fresh or oven-dried (60 °C) were obtained to be analyzed via pXRF on both adaxial and abaxial surface. Conventional wet-digestion method was also performed on powdered material to obtain the concentration of macro- and micronutrients via ICP-OES. The data were subjected to descriptive statistics, principal component analysis (PCA) and random forest (RF) algorithm regression. RF was used to predict the real concentration of macro- and micronutrients based on pXRF measurements obtained directly on intact leaves. Water content had a significant effect on pXRF results. However, a positive correlation between the concentration of macro- and micronutrients obtained via pXRF directly on intact leaves and conventional analysis performed on powdered samples was obtained. PCA analysis allowed a clear differentiation of crops based on elemental composition. The concentrations of macro- and micronutrients were very accurately predicted via RF. Even elements not detected by pXRF (N and B) were satisfactory predicted. From this pilot study, it is possible to concluded that pXRF is feasible for in-field assessment of nutritional status of plants. Further studies are needed to obtain specific and robust calibrations for each crop.

PMID:37495047 | DOI:10.1016/j.chemosphere.2023.139613

Am J Ophthalmol. 2023 Jul 24:S0002-9394(23)00285-4. doi: 10.1016/j.ajo.2023.07.005. Online ahead of print.

ABSTRACT

PURPOSE: Examine the relationship between diabetic retinopathy (DR) and depression in the United States.

DESIGN: Retrospective cross-sectional study.

METHODS: National Health and Nutrition Examination Survey (NHANES) participants between 2005-2008 (ages 40-85) were included. Prevalence of major depression among DR stages as determined by retinal imaging was estimated. Multivariable models assessed associations between depression and DR.

RESULTS: Depression was more common among those with moderate to severe DR (16%) than those with no DR (7%), mild non-proliferative diabetic retinopathy (NPDR, 6%), or proliferative DR (5%). In a model with DR stages that adjusted for demographic factors, there was an association between moderate to severe DR and depression (OR 2.46, 95% CI: 1.03-5.85).

CONCLUSION: Depression was more prevalent in moderate to severe NPDR than in those with no DR, mild NPDR, or proliferative DR. This relationship is statistically significant after adjustment for demographic factors.

PMID:37495007 | DOI:10.1016/j.ajo.2023.07.005

Appl Clin Inform. 2023 May;14(3):575-584. doi: 10.1055/s-0043-1769912. Epub 2023 Jul 26.

ABSTRACT

BACKGROUND: In Taiwan, the number of confirmed cases of coronavirus disease 2019 (COVID-19) has risen significantly in May 2021. The second wave of the epidemic occurred in May 2022. mHealth (mobile health, social media communities) and eHealth (electronic health, Hospital Information System) can play an important role in this pandemic by minimizing the spread of the virus, leveraging health care providers’ time, and alleviating the challenges of medical education.

OBJECTIVES: This study aimed to describe the process of using mHealth and eHealth to build a medicalized quarantine hotel (MQH) and understand the physical and mental impact of COVID-19 on patients admitted to the MQH.

METHODS: In this retrospective observational study, data from 357 patients who stayed at the MQH were collected and their psychological symptoms were assessed using an online Brief Symptom Rating Scale (BSRS). Descriptive statistics, independent sample t-test, univariate analysis of variance, and multiple linear regression analysis were performed.

RESULTS: The patients’ mean age was 35.5 ± 17.6 years, and 52.1% (n = 186) of them were males. Altogether, 25.2% (n = 90) of the patients had virtual visits. The average duration of the hotel stay was 6.8 ± 1.4 days, and five patients (0.01%) were transferred to the hospital. The three most common symptoms reported were cough (39%), followed by the sore throat (22.8%), and stuffy/runny nose (18.9%). Most patients achieved a total BSRS score of 0 to 5 points (3,569/91.0%), with trouble falling asleep (0.65 ± 0.65), feeling tense or high-strung (0.31 ± 0.66), and feeling down or depressed (0.27 ± 0.62) scoring highest. The BSRS score was the highest on the first day. The sex of the patients was significantly related to the BSRS score (p < 0.001).

CONCLUSION: mHealth and eHealth can be used to further monitor an individual’s physiological and psychological states. Early intervention measures are needed to improve health care quality.

PMID:37494971 | DOI:10.1055/s-0043-1769912

Water Res. 2023 Jul 16;243:120372. doi: 10.1016/j.watres.2023.120372. Online ahead of print.

ABSTRACT

Wastewater surveillance has proved to be a valuable tool to track the COVID-19 pandemic. However, most studies using wastewater surveillance data revolve around establishing correlations and lead time relative to reported case data. In this perspective, we advocate for the integration of wastewater surveillance data with dynamic within-host and between-host models to better understand, monitor, and predict viral disease outbreaks. Dynamic models overcome emblematic difficulties of using wastewater surveillance data such as establishing the temporal viral shedding profile. Complementarily, wastewater surveillance data bypasses the issues of time lag and underreporting in clinical case report data, thus enhancing the utility and applicability of dynamic models. The integration of wastewater surveillance data with dynamic models can enhance real-time tracking and prevalence estimation, forecast viral transmission and intervention effectiveness, and most importantly, provide a mechanistic understanding of infectious disease dynamics and the driving factors. Dynamic modeling of wastewater surveillance data will advance the development of a predictive and responsive monitoring system to improve pandemic preparedness and population health.

PMID:37494742 | DOI:10.1016/j.watres.2023.120372