Tag: nevin manimala

Rev Med Inst Mex Seguro Soc. 2023 May 2;61(3):342-347.

ABSTRACT

BACKGROUND: Acute kidney injury (AKI) is frequent in sepsis (25 to 51%), with high mortality (40 to 80%) and long-term complications. Despite its importance we do not have accessible markers in intensive care. In other entities (post-surgical and COVID-19) the neutrophil/lymphocyte and platelet (N/LP) ratio has been associated with acute kidney injury; however, this relationship has not been studied in a pathology with a severe inflammatory response such as sepsis.

OBJECTIVE: To demonstrate the association between N/LP with AKI secondary to sepsis in intensive care.

MATERIAL AND METHODS: Ambispective cohort study in patients over 18 years who were admitted to intensive care with a diagnosis of sepsis. The N/LP ratio was calculated from admission up to the seventh day and up to the diagnosis of AKI and outcome. Statistical analysis was performed with chi squared test, Cramer’s V and multivariate logistic regression.

RESULTS: Out of the 239 patients studied, the incidence of AKI developed in 70%. 80.9% of patients with N/LP ratio > 3 had AKI (p < 0.0001, Cramer’s V 0.458, OR 3.05, 95% CI 1.602-5.8) and increased renal replacement therapy (21.1 vs. 11.1%, p = 0.043).

CONCLUSION: N/LP ratio > 3 has a moderate association with AKI secondary to sepsis in the intensive care unit.

PMID:37216673

Environ Sci Technol. 2023 May 22. doi: 10.1021/acs.est.2c06535. Online ahead of print.

ABSTRACT

Epidemiological evidence regarding the effects of prenatal exposure to perfluoroalkyl substances (PFASs) on neurodevelopment in children is inconclusive. In 449 mother-child pairs from the Shanghai-Minhang Birth Cohort Study, we measured the concentrations of 11 PFASs in maternal plasma samples obtained at 12-16 weeks of gestation. We assessed children’s neurodevelopment at 6 years of age by the fourth edition of the Chinese Wechsler Intelligence Scale for Children and Child Behavior Checklist for ages 6-18. We evaluated the association between prenatal exposure to PFASs and children’s neurodevelopment and the effect modification of maternal dietary factors during pregnancy and the child’s sex. We found that prenatal exposure to multiple PFASs was associated with increased scores for attention problems, and the individual effect of perfluorooctanoic acid (PFOA) was statistically significant. However, no statistically significant association between PFASs and cognitive development was observed. Additionally, we found the effect modification of maternal nut intake and child’s sex. In conclusion, this study suggests that prenatal exposure to PFASs was associated with more attention problems, and maternal nut intake during pregnancy may alter the potential effect of PFASs. However, these findings were exploratory because of multiple testing and the relatively small sample size.

PMID:37216669 | DOI:10.1021/acs.est.2c06535

Rev Med Inst Mex Seguro Soc. 2023 May 2;61(3):335-341.

ABSTRACT

BACKGROUND: Adequate glycemic control improves the prognosis of patients hospitalized for pneumonia associated with severe COVID-19.

OBJECTIVE: To evaluate the impact of hyperglycemia (HG) on the prognosis of patients hospitalized for severe pneumonia associated with COVID-19 in unvaccinated patients.

MATERIAL AND METHODS: Prospective cohort study. We included patients hospitalized from August 2020 to February 2021, with severe COVID-19 pneumonia, not vaccinated against SARS-CoV-2. Data was collected from admission to discharge. We used descriptive and analytical statistics according to the data distribution. ROC curves were used to determine the cut-off points with the highest predictive performance for HG and mortality, with the IBM SPSS program, version 25.

RESULTS: We included 103 patients, 32% women, 68% men, age 57 ± 13 years; 58% were admitted with HG (191, IQR 152-300 mg/dL) and 42% with normoglycemia (NG < 126 mg/dL). Mortality was higher in HG at admission 34 (56.7%) than in NG 13 (30.2%) (p = 0.008). HG was associated with diabetes mellitus 2 and neutrophilia (p < 0.05). The risk of death increases 1.558 times (95% CI 1.118-2.172) if HG is at admission and 1.43 times (95% CI 1.14-1.79) during hospitalization. Maintaining NG throughout the hospitalization contributed independently to survival (RR = 0.083 [95% CI 0.012-0.571], p = 0.011).

CONCLUSION: HG significantly impacts prognosis by increasing mortality more than 50% during hospitalization for COVID-19.

PMID:37216668

Ann Intern Med. 2023 May 23. doi: 10.7326/M22-3116. Online ahead of print.

ABSTRACT

BACKGROUND: Recently, validated clinical decision rules have been developed that avoid unnecessary use of computed tomographic pulmonary angiography (CTPA) in patients with suspected pulmonary embolism (PE) in the emergency department (ED).

OBJECTIVE: To measure any resulting change in CTPA use for suspected PE.

DESIGN: Retrospective analysis.

SETTING: 26 European EDs in 6 countries.

PATIENTS: Patients with CTPA performed for suspected PE in the ED during the first 7 days of each odd month between January 2015 and December 2019.

MEASUREMENTS: The primary end points were the CTPAs done for suspected PE in the ED and the number of PEs diagnosed in the ED each year adjusted to an annual census of 100 000 ED visits. Temporal trends were estimated using generalized linear mixed regression models.

RESULTS: 8970 CTPAs were included (median age, 63 years; 56% female). Statistically significant temporal trends for more frequent use of CTPA (836 per 100 000 ED visits in 2015 vs. 1112 in 2019; P < 0.001), more diagnosed PEs (138 per 100 000 in 2015 vs. 164 in 2019; P = 0.028), a higher proportion of low-risk PEs (annual percent change [APC], 13.8% [95% CI, 2.6% to 30.1%]) with more ambulatory management (APC, 19.3% [CI, 4.1% to 45.1%]), and a lower proportion of intensive care unit admissions (APC, -8.9% [CI, -17.1% to -0.3%]) were observed.

LIMITATION: Data were limited to 7 days every 2 months.

CONCLUSION: Despite the recent validation of clinical decision rules to limit the use of CTPA, an increase in the CTPA rate along with more diagnosed PEs and especially low-risk PEs were instead observed.

PRIMARY FUNDING SOURCE: None specific for this study.

PMID:37216659 | DOI:10.7326/M22-3116

Rev Esc Enferm USP. 2023 May 22;57:e20220329. doi: 10.1590/1980-220X-REEUSP-2022-0329en. eCollection 2023.

ABSTRACT

OBJECTIVE: To analyze the knowledge of Primary Education teachers regarding asthma and learn about their experiences with the exacerbation of symptoms at school.

METHOD: Sequential explanatory mixed study. In the quantitative stage, the Newcastle Asthma Knowledge Questionnaire and the characterization instrument were applied. Data analyzed by descriptive and inferential statistics. The production of qualitative data occurred from written statements analyzed using the deductive content analysis method.

RESULTS: Two hundred and seven teachers, mostly women (92%) and working in public schools (82%). As for knowledge, 132 (63.8%) had unsatisfactory performance. The questions with the lowest rates of correct answers were about medications used regularly and during the attacks. Teachers with higher scores had less time in the occupation (p = 0.017) and had been diagnosed with asthma (p = 0.006). In the qualitative stage, 35 teachers participated and the statements corroborated the quantitative findings, especially in relation to the knowledge gap and feeling of greater safety among asthmatic teachers.

CONCLUSION: Teachers showed insufficient knowledge and reported fear and unpreparedness in the face of the situation.

PMID:37216653 | DOI:10.1590/1980-220X-REEUSP-2022-0329en

Alzheimers Dement. 2023 May 22. doi: 10.1002/alz.13157. Online ahead of print.

ABSTRACT

INTRODUCTION: Understanding longitudinal plasma biomarker trajectories relative to brain amyloid changes can help devise Alzheimer’s progression assessment strategies.

METHODS: We examined the temporal order of changes in plasma amyloid-β ratio ( ${A\beta }_{42}/{A\beta }_{40}$ ), glial fibrillary acidic protein (GFAP), neurofilament light chain (NfL), and phosphorylated tau ratios ( $\text{p-tau181}/A{\beta }_{42}$ , $\text{p-tau231}/A{\beta }_{42}$ ) relative to ¹¹ C-Pittsburgh compound B (PiB) positron emission tomography (PET) cortical amyloid burden (PiB-/+). Participants (n = 199) were cognitively normal at index visit with a median 6.1-year follow-up.

RESULTS: PiB groups exhibited different rates of longitudinal change in ${A\beta }_{42}/{A\beta }_{40}\left(\beta =5.41\times {10}^{–4},\mathrm{SE}=1.95\times {10}^{–4},p=0.0073\right)$ . Change in brain amyloid correlated with change in GFAP (r = 0.5, 95% CI = [0.26, 0.68]). The greatest relative decline in ${A\beta }_{42}/{A\beta }_{40}$ (-1%/year) preceded brain amyloid positivity by 41 years (95% CI = [32, 53]).

DISCUSSION: Plasma ${A\beta }_{42}/{A\beta }_{40}$ may begin declining decades prior to brain amyloid accumulation, whereas p-tau ratios, GFAP, and NfL increase closer in time. HIGHLIGHTS Plasma ${A\beta }_{42}/{A\beta }_{40}$ declines over time among PiB- but does not change among PiB+. Phosphorylated-tau to Aβ₄₂ ratios increase over time among PiB+ but do not change among PiB-. Rate of change in brain amyloid is correlated with change in GFAP and neurofilament light chain. The greatest decline in ${A\beta }_{42}/{A\beta }_{40}$ may precede brain amyloid positivity by decades.

PMID:37216632 | DOI:10.1002/alz.13157

JCO Oncol Pract. 2023 May 22:OP2200721. doi: 10.1200/OP.22.00721. Online ahead of print.

ABSTRACT

PURPOSE: Acute care events (ACEs), comprising emergency department visits and hospitalizations, are a priority area for reduction in oncology. Prognostic models are a compelling strategy to identify high-risk patients and target preventive services, but have yet to be broadly implemented, partly because of challenges with electronic health record (EHR) integration. To facilitate EHR integration, we adapted and validated the previously published PRediction Of Acute Care use during Cancer Treatment (PROACCT) model to identify patients at highest risk for ACEs after systemic anticancer treatment.

METHODS: A retrospective cohort of adults with a cancer diagnosis starting systemic therapy at a single center between July and November 2021 was divided into development (70%) and validation (30%) sets. Clinical and demographic variables were extracted, limited to those in structured format in the EHR, including cancer diagnosis, age, drug category, and ACE in prior year. Three logistic regression models of increasing complexity were developed to predict risk of ACEs.

RESULTS: Five thousand one hundred fifty-three patients were evaluated (3,603 development and 1,550 validation). Several factors were predictive of ACEs: age (in decades), receipt of cytotoxic chemotherapy or immunotherapy, thoracic, GI or hematologic malignancy, and ACE in the prior year. We defined high-risk as the top 10% of risk scores; this population had 33.6% ACE rate compared with 8.3% for the remaining 90% in the low-risk group. The simplest Adapted PROACCT model had a C-statistic of 0.79, sensitivity of 0.28, and specificity of 0.93.

CONCLUSION: We present three models designed for EHR integration that effectively identify oncology patients at highest risk for ACE after initiation of systemic anticancer treatment. By limiting predictors to structured data fields and including all cancer types, these models offer broad applicability for cancer care organizations and may offer a safety net to identify and target resources to this high risk.

PMID:37216627 | DOI:10.1200/OP.22.00721

AIDS Care. 2023 May 22:1-8. doi: 10.1080/09540121.2023.2215529. Online ahead of print.

ABSTRACT

HIV/AIDS prevalence in sub-Saharan Africa remains an issue of concern and young women are disproportionately affected by the disease. Premarital HIV testing is one of the key strategies used in HIV prevention since heterosexual sex remains the primary mode of HIV transmission in sub-Saharan Africa. This study uses the 2016 Ethiopia Demographic and Health Survey to examine the association between premarital HIV testing and the ability to negotiate sexual relations among married women aged 15 to 49 years (N = 3,672). Women’s ability to negotiate sexual relations was measured using two variables: the ability to refuse sex and the ability to ask for a condom during intercourse. Descriptive statistics, bivariate, and multiple logistic regression analyses were performed. Only 24.1% of the women had premarital HIV testing. Approximately 46.5% and 32.3% of women reported that they could refuse sexual intercourse and ask their partner to use a condom, respectively. In the multivariable model, having a premarital HIV test was positively associated with the ability to refuse sex odds ratio (95% confidence interval) 1.82 (1.38, 2.41; p < 0.001) and the ability to ask for a condom 2.30 (1.55, 3.41; p < 0.001). Premarital HIV testing can improve women’s sexual negotiation ability and possibly prevent future HIV infection.

PMID:37216612 | DOI:10.1080/09540121.2023.2215529

Am J Gastroenterol. 2023 May 22. doi: 10.14309/ajg.0000000000002334. Online ahead of print.

ABSTRACT

BACKGROUND: /Aims-Chronic isolated terminal ileitis(TI) may be seen in Crohn’s disease(CD) and Intestinal tuberculosis(ITB) in addition to other etiologies that may be managed symptomatically. We developed a revised algorithm to distinguish patients with a specific etiology from a non specific etiology.

METHODS: Patients with chronic isolated TI following-up from 2007 to 2022 were retrospectively reviewed. A specific(ITB or CD) diagnosis was made based on standardized criteria and other relevant data was collected. Using this cohort, validation of a previously suggested algorithm was conducted. Further, based on the results of a univariate analysis, a multivariate analysis with bootstrap validation was used to develop a revised algorithm.

RESULTS: We included 153 patients(mean age-36.9+14.6 years, males-70%, median duration-1.5 years, range:0-56 years) with chronic isolated TI of whom 109(71.2%) received a specific diagnosis(CD-69, ITB-40). On multivariate regression and validation statistics with a combination of clinical, laboratory, radiological and colonoscopic findings, an optimism corrected c-statistic of 0.975 and 0.958 was obtained with and without histopathological findings respectively. Revised algorithm, based on these, showed a sensitivity, specificity, positive and negative predictive value, and overall accuracy of 98.2%(95%CI:93.5 – 99.8), 75.0%(95%CI:59.7 – 86.8), 90.7%(95%CI:85.4 – 94.2), 94.3%(95%CI:80.5 – 98.5) and 91.5%(95%CI:85.9 – 95.4), respectively. This was more sensitive and specific than the previous algorithm(accuracy 83.9%, sensitivity 95.5%, and specificity 54.6%).

CONCLUSION: We developed a revised algorithm and a multi-modality approach to stratify patients with chronic isolated TI into specific and non-specific etiologies with an excellent diagnostic accuracy which could potentially avoid missed diagnosis and unnecessary side effects of treatment.

PMID:37216605 | DOI:10.14309/ajg.0000000000002334

Mycologia. 2023 May 22:1-19. doi: 10.1080/00275514.2023.2205331. Online ahead of print.

ABSTRACT

Optimization of xylanase and cellulase production by a newly isolated Aspergillus fumigatus strain grown on Stipa tenacissima (alfa grass) biomass without pretreatment was carried out using a Box-Behnken design. First, the polysaccharides of dried and ground alfa grass were characterized using chemical methods (strong and diluted acid). The effect of substrate particle size on xylanase and carboxymethylcellulase (CMCase) production by the selected and identified strain was then investigated. Thereafter, experiments were statistically planned with a Box-Behnken design to optimize initial pH, cultivation temperature, moisture content, and incubation period using alfa as sole carbon source. The effect of these parameters on the two enzyme production was evaluated using the response surface method. Analysis of variance was also carried out, and production of the enzymes was expressed using a mathematical equation depending on the influencing factors. The effects of individual, interaction, and square terms on production of both enzymes were represented using the nonlinear regression equations with significant R² and P-values. Xylanase and CMCase production levels were enhanced by 25% and 27%, respectively. Thus, this study demonstrated for the first time the potential of alfa as a raw material to produce enzymes without any pretreatment. A set of parameter combinations was found to be effective for the production of xylanase and CMCase by A. fumigatus in an alfa-based solid-state fermentation.

PMID:37216583 | DOI:10.1080/00275514.2023.2205331