Tag: nevin manimala

J Am Med Dir Assoc. 2023 Aug 12:S1525-8610(23)00645-X. doi: 10.1016/j.jamda.2023.07.016. Online ahead of print.

ABSTRACT

OBJECTIVES: Deprescribing reduces polypharmacy in older adults. A thorough study of the effect of deprescribing interventions on clinical outcomes in older adults is presently lacking. As a result, we evaluated the impact of deprescribing on clinical outcomes in older patients.

DESIGN: Meta-analysis and systematic review of randomized controlled trials (RCTs). PubMed, EMBASE, and Cochrane Library were searched from the time of creation to March 2023.

SETTING AND PARTICIPANTS: Randomized controlled trial with participants at least 60 years old.

MEASURES: Mortality, falls (number of fallers), hospitalization rates, emergency department visits, medication adherence, HRQoL (health-regulated quality of life), incidence of ADR (adverse drug reactions), PIM (potentially inappropriate medication), and PPO (potentially prescription omission) were evaluated in the meta-analysis.

RESULTS: A total of 32 RCTs (18,670 patients) were included. Deprescribing interventions significantly reduced proportions of older adults with PIM, PPO, and the incidence of ADRs. The interventions group also improved medication compliance.

CONCLUSIONS AND IMPLICATIONS: Compared to routine care, deprescribing interventions significantly improve clinical outcome indicators for older adults.

PMID:37582482 | DOI:10.1016/j.jamda.2023.07.016

Int J Antimicrob Agents. 2023 Aug 13:106952. doi: 10.1016/j.ijantimicag.2023.106952. Online ahead of print.

ABSTRACT

INTRODUCTION: Molnupiravir and nirmatrelvir/ritonavir are antivirals used to prevent progression to severe SARS-CoV-2 infections, which reduce both hospitalization and mortality rates. Nirmatrelvir/ritonavir was authorised in Europe in December 2021, while molnupiravir is not yet licensed in Europe as of February 2022. Molnupiravir may be an alternative to nirmatrelvir/ritonavir, because it displays less frequent drug-drug interactions and contraindications. A caveat connected to molnupiravir derives from the mode of action inducing viral mutations. In clinical trials on patients without haematological malignancy, mortality rate reduction of molnupiravir appeared less pronounced than that of nirmatrelvir/ritonavir. Little is known about the comparative efficacy of the two drugs in patients with haematological malignancy at high-risk of severe COVID-19. Thus, we here assess the effectiveness of molnupiravir compared to nirmatrelvir/ritonavir in our cohort of patients with haematological malignancies.

METHODS: Clinical data of patients treated either with molnupiravir or nirmatrelvir/ritonavir monotherapy for COVID-19 were retrieved from the EPICOVIDEHA registry. Patients treated with molnupiravir were matched by sex, age (±10 years), and baseline haematological malignancy severity to controls treated with nirmatrelvir/ritonavir.

RESULTS: A total of 116 patients receiving molnupiravir for the clinical management of COVID-19 were matched to an equal number of controls receiving nirmatrelvir/ritonavir. In each of the groups, 68 (59%) patients were male; with a median age of 64 years (IQR 53-74) for molnupiravir recipients and 64 years (IQR 54-73) for nirmatrelvir/ritonavir recipients; 57% (n=66) of the patients had controlled baseline haematological malignancy, 13% (n=15) stable, and 30% (n=35) had active disease at COVID-19 onset in each of the groups. During COVID-19 infection, one third of patients from each group were admitted to hospital. Although a similar proportion of vaccinated patients was observed in both groups (molnupiravir n=77, 66% vs nirmatrelvir/ritonavir n=87, 75%), those treated with nirmatrelvir/ritonavir had more often received four doses (n=27, 23%) as compared to patients treated with molnupiravir (n=5, 4%, p<0.001). No differences were detected in COVID-19 severity (p=0.39) or hospitalization (p=1.0). No statistically significant differences were identified in overall mortality rate (p=0.78) or in survival probability (d30 p=0.19, d60 p=0.67, d90 p=0.68, last day of follow up p=0.68). In all patients, deaths were either attributed to COVID-19 or the infection contributed to death as per treating physician’s judgement.

CONCLUSIONS: In high-risk patients with haematological malignancies and COVID-19, molnupiravir showed rates of hospitalization and mortality comparable to those of nirmatrelvir/ritonavir in this matched-pair analysis. Molnupiravir appears to be a plausible alternative to nirmatrelvir/ritonavir for COVID-19 treatment in patients with haematological malignancy.

PMID:37582478 | DOI:10.1016/j.ijantimicag.2023.106952

Sci Total Environ. 2023 Aug 13:166278. doi: 10.1016/j.scitotenv.2023.166278. Online ahead of print.

ABSTRACT

Mineralogical investigations on fluvial sedimentary sequences could provide historical environmental information on the effects of human activities and natural events. This study aims to identify the provenance, mineralogical distribution mechanism, and environmental significance of sediments of the Yellow River based on topographic analysis, statistics, weathering and recycling indices. In total, 107 samples were collected from sedimentary sequences in the source area, and the upper, middle, and lower reaches and analyzed for grain size, major elements, and mineral composition. The results showed that the climate conditions were cold and arid, where weak hydrolysis under continental weathering and strong erosion accelerated physical weathering. Clay minerals primarily originated from the Tibetan Plateau, whereas the middle and lower reaches received input of aeolian deposits from Northern China. Quartz and feldspar in the middle and lower reaches may derive from the source area and upper reaches. Meanwhile, calcite and dolomite formed through diagenesis, with loess input from the Chinese Loess Plateau. Regarding heavy minerals, the dominant determinative factors of pyrite were post-depositional diagenesis and leaching. Hematite and amphibole primarily formed through magnetite conversion and contribution from regional sources, respectively. Moreover, the mineral distribution mechanism significantly affected the mobility and distribution of geochemical elements through diagenesis and alteration. The findings are instrumental in reconstructing the environmental evolution of large-scale watersheds across multiple climatic zones.

PMID:37582450 | DOI:10.1016/j.scitotenv.2023.166278

Chest. 2023 Aug 13:S0012-3692(23)05274-1. doi: 10.1016/j.chest.2023.08.013. Online ahead of print.

ABSTRACT

BACKGROUND: Pulmonary involvement is the leading cause of death in systemic sclerosis (SSc) and may manifest as interstitial lung disease (ILD), pulmonary arterial hypertension (PAH), or in combination of both (ILD-pulmonary hypertension (PH)). Aim of this analysis was to determine prevalence, clinical characteristics, and survival of these different forms within the registry of the German Network for Systemic Sclerosis (DNSS).

RESEARCH QUESTION: Does SSc-associated ILD with or without PH affect survival differently and are there any risk factors that have an additional impact?

STUDY DESIGN AND METHODS: Clinical data of 5,831 SSc patients were collected in the DNSS registry, Kaplan-Meier estimates were used to compare overall survival (OS) in patients with SSc-ILD with PH (ILD-PH) and without PH (ILD-w/o-PH) to patients without pulmonary involvement and those with PAH. The Cox proportional hazard model was used to analyze the influence of pulmonary involvement and other potential predictors on patient survival.

RESULTS: Clinical data of 3,257 patients with a mean follow-up years of 3.45±1.63 have been included in our analysis. At baseline, ILD was present in 34.5%, while PH (w/o-ILD) had a lower prevalence with 4.5%. At the end of follow-up, 47.6% of SSc patients had ILD, 15.2% ILD-PH, and 6.5% PAH. ILD was more frequent in the diffuse cutaneous form (57.3%), while PAH did not differ significantly between SSc subtypes. Significant differences in baseline characteristics between PAH vs. ILD-PH vs. ILD-w/o-PH were found for age at diagnosis, gender, SSc-subsets, antibody-status, FVC, DLCO and therapy. OS at 5 years was 96.4% for patients without pulmonary involvement and differed significantly between patients with ILD-w/o-PH, PAH, being worst in patients with ILD-PH. Female gender (HR 0.3), a higher BMI (HR 0.9) and higher DLCO values (HR 0.98) were associated with a lower mortality risk.

INTERPRETATION: ILD is the most prevalent pulmonary involvement in SSc, while the combination of ILD and PH is associated with the most detrimental survival.

PMID:37582424 | DOI:10.1016/j.chest.2023.08.013

Neuroimage. 2023 Aug 13:120327. doi: 10.1016/j.neuroimage.2023.120327. Online ahead of print.

ABSTRACT

Selective use of new information is crucial for adaptive decision-making. Combining a gamble bidding task with assessing cortical responses using functional near-infrared spectroscopy (fNIRS), we investigated potential effects of information valence on behavioral and neural processes of belief and value updating during uncertainty reduction in young adults. By modeling changes in the participants’ expressed subjective values (i.e., value updating) using a Bayesian model, we dissociated processes of (i) updating beliefs about statistical properties of the gamble, (ii) updating values of a gamble based on new information about its winning probabilities, as well as (iii) expectancy violation. The results showed that participants used new information to update their beliefs and values about the gambles in a quasi-optimal manner, as reflected in the selective updating only in situations with reducible uncertainty. Furthermore, their updating was valence-dependent: information indicating an increase in winning probability was underweighted, whereas information about a decrease in winning probability was updated in good agreement with predictions of the Bayesian decision theory. Results of model-based and moderation analyses showed that this valence-dependent asymmetry was associated with a distinct contribution of expectancy violation, besides belief updating, to value updating after experiencing new positive information regarding winning probabilities. In line with the behavioral results, we replicated previous findings showing involvements of frontoparietal brain regions in the different components of updating. Furthermore, this study provided novel results suggesting a valence-dependent recruitment of brain regions. Individuals with stronger oxyhemoglobin responses during value updating was more in line with predictions of the Bayesian model while integrating new information that indicates an increase in winning probability. Taken together, this study provides first results showing expectancy violation as a contributing factor to valence-dependent updating during uncertainty reduction and suggests limitations of normative Bayesian decision theory.

PMID:37582418 | DOI:10.1016/j.neuroimage.2023.120327

Gynecol Endocrinol. 2023 Aug 8;39(1):2245479. doi: 10.1080/09513590.2023.2245479.

ABSTRACT

OBJECTIVE: To develop a model to identify women likely to be severely impacted by vulvovaginal atrophy (VVA), based on their experience of symptoms and non-clinical factors.

METHODS: Multivariate statistics and machine-learning algorithms were used to develop models using data from a cross-sectional, observational, multinational European survey. A set of independent variables were chosen to assess subjective VVA severity and its impact on daily activities.

RESULTS: A final composite model was selected that included three categories of variables: clinical severity, patient demographics/clinical characteristics and Day-to-Day Impact of Vaginal Aging (DIVA) variables related to emotion/mood, impact on lifestyle and frequency of sex. The model accurately classified 71% of women. Three DIVA variables (feeling bad about yourself, desire/interest in sex, physical comfort related to sitting) explained much of the variation in the dependent variable of the model. Over 90% of the impact of VVA relates to certain psychosocial and behavioral aspects that can be identified without the need to consider physical signs/symptoms.

CONCLUSION: Non-clinical factors can contribute significantly to the overall VVA burden.Questions used in developing the composite model could form the basis of an instrument to help screen women prior to clinical consultation and improve VVA management.

PMID:37582396 | DOI:10.1080/09513590.2023.2245479

Anasthesiol Intensivmed Notfallmed Schmerzther. 2023 Jul;58(7-08):436-447. doi: 10.1055/a-1977-7297. Epub 2023 Aug 15.

ABSTRACT

According to data from the German Federal Statistical Office, 424635 patients died in hospitals across Germany in 2020. That is 43% of all deaths. Deaths occur everywhere in hospitals – not just in palliative care units – and caring for the dying is considered a basic task of medical practice 1. The German Medical Association has published principles for end-of-life care and the S3 guideline on palliative medicine also provides instructions on what end-of-life care should look like. However, there is often uncertainty as to what the care of the dying should look like in concrete terms. The following explanations are intended to convey how ideal end-of-life care should be designed and provide concrete assistance and suggestions as to how this can also succeed outside a palliative care unit.

PMID:37582354 | DOI:10.1055/a-1977-7297

J Breath Res. 2023 Aug 15. doi: 10.1088/1752-7163/acf066. Online ahead of print.

ABSTRACT

In order to prevent long-term immunity-related complications after lung transplantation, close monitoring of immunosuppressant levels using therapeutic drug monitoring (TDM) is paramount. Novel electronic nose (eNose) technology may be a non-invasive alternative to the current invasive procedures for TDM. We investigated the diagnostic and categorization capacity of eNose breathprints for Tacrolimus trough blood plasma levels (TACtrough) in lung transplant recipients (LTR).&#xD;Method: We performed eNose measurements in stable LTR attending the outpatient clinic. We evaluated 1) the correlation between eNose measurements and TACtrough, 2) the diagnostic capacity of eNose technology for TACtrough, and 3) the accuracy of eNose technology for categorization of TACtrough into three clinically relevant categories (low: <7 µg/mL, medium: 7 – 10 µg/mL, and high: >10 µg/mL).&#xD;Results: A total of 186 measurements from 86 LTR were included. There was a weak but statistically significant correlation (r = 0.21, p = 0.004) between the eNose measurements and TACtrough. The root mean squared error of prediction (RMSEP) for the diagnostic capacity was 3.186 in the training and 3.131 in the validation set. The accuracy of categorization ranged between 45-63% for the training set and 52-69% in the validation set. &#xD;Conclusion: There is a weak correlation between eNose breathprints and TACtrough in LTR. However, the diagnostic as well as categorization capacity for TACtrough using eNose breathprints is too inaccurate to be applicable in TDM. &#xD.

PMID:37582348 | DOI:10.1088/1752-7163/acf066

Endocr Connect. 2023 Aug 1:EC-23-0314. doi: 10.1530/EC-23-0314. Online ahead of print.

ABSTRACT

CONTEXT: In individuals with hypothyroidism and overweight, levothyroxine substitution therapy is often expected to cause weight loss due to its effect on resting energy expenditure. However, despite levothyroxine-induced enhancement of resting energy expenditure, fat mass loss is rarely seen after levothyroxine substitution therapy. The mechanism behind this conundrum is unknown.

OBJECTIVE: To assess the effect of levothyroxine therapy on hunger sensations and ad libitum food intake in individuals with hypothyroidism.

DESIGN AND SETTING: Prospective cohort study of 18 newly diagnosed hypothyroid women (thyroid-stimulating hormone (TSH) >10 mU/L). Participants were investigated at diagnosis, after normalization of TSH (<4.0 mU/L), and after six months of successful treatment. Eighteen age and body mass index-matched healthy controls were also included.

INTERVENTION: Hypothyroid individuals were treated with levothyroxine according to European Thyroid Association guidelines.

MAIN OUTCOMES: Changes in hunger sensation were assessed using visual analog scales (cm) before and during a standardized mixed meal test, and food intake was measured during a subsequent ad libitum meal (g).

RESULTS: After six months of levothyroxine therapy, mean resting energy expenditure was increased by 144 kcal/day (10%) (P < 0.001). Weight loss was comprised of 0.8 kg fat-free mass while fat mass remained unchanged. Fasting hunger sensation increased from a mean of 4.5 (SD 2.2) cm to 5.5 (SD 2.2) cm (P = 0.047). The numerical increase in ad libitum meal intake did not reach statistical significance.

CONCLUSION: Our data suggest that levothyroxine-induced hunger may be a culprit in the lack of fat mass loss from levothyroxine therapy.

PMID:37582332 | DOI:10.1530/EC-23-0314

Zhonghua Wei Chang Wai Ke Za Zhi. 2023 Jul 25;26(7):689-696. doi: 10.3760/cma.j.cn441530-20221125-00493.

ABSTRACT

Objective: To assess the effectiveness of transanal drainage tube (TDT) in reducing the incidence of anastomotic leak following anterior resection in patients with rectal cancer. Methods: We conducted a systematic search for relevant studies published from inception to October 2022 across multiple databases, including PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang, and VIP. Meta-analysis was performed using Review Manager 5.4 software. The primary outcomes included total incidence of anastomotic leak, grade B and C anastomotic leak rates, reoperation rate, anastomotic bleeding rate, and overall complication rate. Results: Three randomized controlled trials involving 1115 patients (559 patients in the TDT group and 556 in the non-TDT group) were included. Meta-analysis showed that the total incidences of anastomotic leak and of grade B anastomotic leak were 5.5% (31/559) and 4.5% (25/559), respectively, in the TDT group and 7.9% (44/556) and 3.8% (21/556), respectively, in the non-TDT group. These differences are not statistically significant (P=0.120, P=0.560, respectively). Compared with the non-TDT group, the TDT group had a lower incidence of grade C anastomotic leak (1.6% [7/559] vs. 4.5% [25/556]) and reoperation rate (0.9% [5/559] vs. 4.3% [24/556]), but a higher incidence of anastomotic bleeding (8.2% [23/279] vs. 3.6% [10/276]). These differences were statistically significant (P=0.003, P=0.001, P=0.030, respectively). The overall complication rate was 26.5%(74/279) in the TDT group and 27.2% (75/276) in the non-TDT group. These differences are not statistically significant (P=0.860). Conclusions: TDT did not significantly reduce the total incidence of anastomotic leak but may have potential clinical benefits in preventing grade C anastomotic leak. Notably, placement of TDT may increase the anastomotic bleeding rate.

PMID:37583027 | DOI:10.3760/cma.j.cn441530-20221125-00493