Tag: nevin manimala

Dent Med Probl. 2023 Jan-Mar;60(1):109-119. doi: 10.17219/dmp/149455.

ABSTRACT

BACKGROUND: Rheumatoid arthritis (RA) and periodontitis (PD) are chronic diseases that are associated with connective tissue and bone destruction, which affects the quality of life of the people suffering from these conditions. The identification of social conditions and the determinants of RA and PD would permit the elaboration of policies and strategies based on social reality.

OBJECTIVES: The aim of the present study was to identify the relationship between oral health-related quality of life (OHRQoL) and the indicators of general health and oral health in patients with RA.

MATERIAL AND METHODS: A cross-sectional study involving 59 patients with RA was conducted between 2019 and 2020. Demographic, general health, periodontal, and oral health parameters were collected. In addition, the Oral Health Impact Profile-14 (OHIP-14) questionnaire was administered to each patient. A description of the OHIP-14 dimensions according to different variables was performed. The relationship between OHRQoL and general/oral health indicators was analyzed with logistic and linear regression analyses.

RESULTS: The highest OHIP-14 scores were found in people that were 60 years of age and over, single, had low educational achievements, a low socioeconomic status, were unemployed, and had no health affiliation. In the adjusted model, the prevalence of the impact on OHRQoL was 1.34 (1.10-5.29) times greater in those with erosive RA than in those without, and 2.22 (1.16-29.50) times greater in those who self-reported morning stiffness. Regarding the stage of PD, those with stage IV had a prevalence of the impact on the OHRQoL of 70%, an average extent of 3.4 ±4.5 and a severity score of 11.5 ±22.0, with statistically significant differences.

CONCLUSIONS: The dimensions with the greatest impact on the OHRQoL of patients were physical pain, discomfort and psychological disability. The type of RA and the severity of PD are indicators of worse scores on the OHRQoL scale.

PMID:37023338 | DOI:10.17219/dmp/149455

Dent Med Probl. 2023 Jan-Mar;60(1):99-107. doi: 10.17219/dmp/146771.

ABSTRACT

BACKGROUND: Sjögren’s syndrome (SS) is a common systemic autoimmune disease that affects oral health, and consequently oral health-related quality of life (OHRQoL) due to the involvement of exocrine glands.

OBJECTIVES: The present study aimed to evaluate the oral health-related quality of life and oral health indicators in patients with SS in comparison with healthy individuals.

MATERIAL AND METHODS: In the case and control groups (45 patients and 45 healthy individuals), questions about demographic data, other systemic disorders, medications, the years of infection, xerostomia, as well as inquiries about the quality of life (Oral Health Impact Profile-14 – OHIP-14) were asked. The patients were evaluated clinically, and oral health indicators, including the plaque index (PI), the gingival index (GI), the sulcus bleeding index (SBI), and the number of decayed, missing and filled teeth (DMFT) were assessed on the Ramfjord teeth. Unstimulated saliva samples from both groups were obtained and weighed. The data was analyzed using IBM SPSS Statistics for Windows, v. 24.0. Quantitative variables were compared between the case and control groups with the use of the independent t test or their nonparametric equivalent (the Mann-Whitney test).

RESULTS: The comparison of the quantitative variables between the study groups showed a statistically significant difference in the OHRQoL scores (p = 0.037) and the unstimulated saliva flow rate (p = 0.002) between the case and control groups. Also, there was a statistically significant difference in the DMFT index between patients with primary and secondary SS in the case group (p = 0.048).

CONCLUSIONS: The lower OHRQoL of patients with SS requires more attention and follow-up to solve periodontal and dental problems in this group of patients.

PMID:37023337 | DOI:10.17219/dmp/146771

Altern Ther Health Med. 2023 Apr 7:AT8099. Online ahead of print.

ABSTRACT

OBJECTIVE: Mindfulness-Based Stress Reduction (MBSR) therapy has been very effective intervention across worldwide. Herein we aimed to investigate the effect of MBSR intervention on anxiety, depression among breast cancer patients undergoing postoperative chemotherapy.

METHODS: 225 breast cancer patients in our hospital were divided into two groups, 106 patients in the MBSR group received Mindfulness-Based Stress Reduction intervention, while 111 patients in the control group were given routine nursing. The Self-rating Anxiety Scale (SAS), self-rating depression scale (SDS), and functional assessment of cancer therapy-breast cancer (FACT-B) were used to assess the effect of MBSR intervention on breast cancer patients undergoing postoperative chemotherapy.

RESULTS: There were significant differences in the scores of physiological statuses, social and family status, emotional status, functional status, additional attention and total score after intervention between two groups (P < .05). The difference between SDS and SAS were statistically significant between the two groups (P < .05). The score of SDS and SAS were significantly improved in the MBSR group compared with the control group (P < .05).

CONCLUSION: MBSR therapy could effectively improve the quality of life of patients with breast cancer patients with chemotherapy, mainly focusing on psychological aspects, while the effect of the physiological intervention was not significant.

PMID:37023321

Altern Ther Health Med. 2023 Apr 7:AT7031. Online ahead of print.

ABSTRACT

OBJECTIVE: This study investigated the effects of prenatal yoga on labor pain.

METHODS: A systematic review of articles on prenatal yoga for childbirth pain was conducted, and relevant pain score results data were collected for the meta-analysis. The intervention group was treated with yoga movement, and the control group, with routine prenatal examination. All randomized controlled trials were included, but pregnancies with internal complications were excluded.

RESULTS: A total of 47 references were obtained from PubMed, Embase, the Cochrane database, and ClinicalTrials.gov. After applying the exclusion criteria, five studies were included for the review and meta-analysis. A total of 581 women were enrolled. The SMD value summarized for the four studies was -1.05, and the 95% confidence interval was -1.45 to -0.65, which was statistically significant (z = 5.15; P < .01), suggesting that yoga can significantly reduce labor pain.

CONCLUSIONS: Prenatal yoga can relieve labor pain and is recommended for pregnant women.

PMID:37023315

Altern Ther Health Med. 2023 Apr 7:AT8000. Online ahead of print.

ABSTRACT

Diabetic nephropathy (DN) is the most important cause of chronic renal and end-stage kidney disease in China. Hypertension (HTN) is highly prevalent in individuals with diabetic nephropathy. Arterial HTN affects two-thirds of people with type 2 diabetes (T2D). In these patients, HTN increased the potential of both micro- and macrovascular complications, and the co-occurrence of 2 such principal causes results in a 4-fold increased risk for cardiovascular disease (CVD) when contrasted with normotensive controls without diabetes. Therefore, the results of valsartan and amlodipine tablets combined with alpha-lipoic acid on total antioxidant capacity (T-AOC) need to be investigated. The aim of this study was to analyze the effects of valsartan (VA) and amlodipine tablets combined with alpha-lipoic acid (α-LA) on T-AOC, IL-6 and β2-MG levels in patients with DN. We performed statistical analysis including the chi-square test, independent t-test, paired t-test and Analysis of Variance (ANOVA). Our findings indicate that VA, amlodipine and α-LA has a significant effect in patients with DN.

PMID:37023313

Psychol Serv. 2023 Apr 6. doi: 10.1037/ser0000761. Online ahead of print.

ABSTRACT

The purpose of measurement-based care (MBC) is to detect treatment nonresponse sufficiently early in treatment to adjust treatment plans and prevent failure or dropout. Thus, the potential of MBC is to provide the infrastructure for a flexible, patient-centered approach to evidence-based care. However, MBC is underutilized across the Department of Veterans Affairs (VA) posttraumatic stress disorder (PTSD) specialty clinics, likely because no actionable, empirically determined guidelines for using repeated measurement effectively are currently available to clinicians. With data collected as part of routine care in VA PTSD specialty clinics across the United States in the year prior to COVID-19 (n = 2,182), we conducted a proof-of-concept for a method of generating session-by-session benchmarks of probable patient nonresponse to treatment, which can be visualized alongside individual patient data using the most common measure of PTSD symptoms used in VA specialty clinics, the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (PCL-5). Using survival analysis, we first identified the probability of cases reaching clinically significant change at each session, as well as any significant moderators of treatment response. We then generated a multilevel model with initial symptom burden predicting the trajectory of PCL-5 scores across sessions. Finally, we determined the slowest changing 50% and 60% of all cases to generate benchmarks at each session for each level of the predictor(s) and then assessed the accuracy of these benchmarks at each session for classifying treatment responders and nonresponders. The final models were able to accurately identify nonresponders as early as the sixth session of treatment. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

PMID:37023290 | DOI:10.1037/ser0000761

Ann Fam Med. 2023 Jan 1;(21 Suppl 1). doi: 10.1370/afm.21.s1.3917.

ABSTRACT

Context: Family physicians lack resources to effectively intervene on health-harming legal needs (HHLNs), despite growing calls to address social determinants of health. One promising model is the medical-legal partnership (MLP), which embeds legal screening and referral in clinics, but more evidence is needed prior to broader implementation. Objective: To examine whether an MLP reduces stress, depression, and medical overutilization. Study design: Randomized controlled trial. Setting: Urban, primary care clinic in Houston. Population studied: Low-income individuals, aged 18 or older, who are English or Spanish speaking with positive screens for HHLNs. Intervention: Randomization to an MLP referral or 6-month waitlist. Outcome measures: The primary outcome was perceived stress at 6 months (Perceived Stress Scale (PSS); 0-40 range). Secondary outcomes were depression (Center for Epidemiologic Studies Depression Scale (CES-D); 0-60 range), anxiety (Generalized Anxiety Disorder scale (GAD-7); 0-21 range) and self-reported emergency department, urgent care, and hospital visits. Assessments occurred at 3, 6, and 9 months. Analysis: Generalized linear modeling was used to fit each outcome at 6-months as a function of MLP group, controlling for baseline. Bayesian statistical inference with weakly informative priors and a 75% posterior probability (PP) threshold was used to identify noteworthy differences. Results: One hundred sixty individuals were randomized to intervention (80) and control (80) groups. Analyses did not find meaningful group differences for emergency department visits, urgent care visits, or CES-D. Being in the intervention group was associated with lower PSS scores (18.8 vs. 19.9; PP = 75%) but higher hospitalizations (0.4 vs. 0.3; PP = 78%) and GAD-7 scores (10.3 vs. 6.7; PP=90%). Conclusion: Findings in this trial of an MLP referral were mixed. At 6 months, participants who received an MLP referral appeared to be less stressed but also reported higher anxiety and more hospitalizations.

PMID:37023252 | DOI:10.1370/afm.21.s1.3917

Hematol Oncol Stem Cell Ther. 2023 Apr 4;16(3):186-196. doi: 10.56875/2589-0646.1033.

ABSTRACT

BACKGROUND: The PARP inhibitors (PARPis) olaparib and talazoparib are currently approved for the treatment of deleterious germline BRCA1/2-mutated (gBRCA+) metastatic breast cancer (MBC). These approvals were based on improvements in progression-free survival (PFS) observed in two randomized controlled trials (RCTs). Other PARPis, such as veliparib and niraparib, have also been studied. We conducted this meta-analysis of RCTs to assess the PFS and overall survival (OS) benefits of PARPis in gBRCA + MBC.

METHODS: We performed a systematic search for RCTs using the Cochrane Library, PubMed, Embase, and Web of Science databases up to March 2021. Only phase II and III RCTs evaluating PFS and OS for PARPis alone or in combination with chemotherapy (CT) and comparing the findings with standard CT were included in this meta-analysis. Pooled analysis of the hazard ratio (HR) was performed with RevMan v5.4 using a random effects method.

RESULTS: Five RCTs with a total of 1563 BRCA-mutated MBC patients were included in this meta-analysis. Temozolomide was used in the treatment arm in the BROCADE trial. Since temozolomide has limited effects on breast cancer, this arm was excluded from our meta-analysis. A statistically significant increase in PFS was observed in the PARPi group compared to the standard CT group (HR, 0.64; 95% CI, 0.56-0.74; P < 0.00001). However, the differences in OS did not reach statistical significance (HR, 0.89; 95% CI, 0.77-1.02; P = 0.09). Moreover, differences were not observed in the adverse event profile between the two groups (odds ratio, 1.18; 95% CI, 0.84-1.64; P = 0.33).

CONCLUSION: The results of our meta-analysis confirm the previously reported PFS benefit of PARPis over standard CT. PARPis lead to superior PFS in gBRCA + MBC when used alone or in combination with standard CT. The OS benefit is similar between PARPis and standard CT. Ongoing trials are evaluating the benefits of PARPis in early stage gBRCA + BC.

PMID:37023220 | DOI:10.56875/2589-0646.1033

Health Technol Assess. 2023 Mar;27(5):1-80. doi: 10.3310/PTYJ1146.

ABSTRACT

BACKGROUND: We aimed to compare the clinical effectiveness, cost-effectiveness and complication rates of total ankle replacement with those of arthrodesis (i.e. ankle fusion) in the treatment of end-stage ankle osteoarthritis.

METHODS: This was a pragmatic, multicentre, parallel-group, non-blinded randomised controlled trial. Patients with end-stage ankle osteoarthritis who were aged 50-85 years and were suitable for both procedures were recruited from 17 UK hospitals and randomised using minimisation. The primary outcome was the change in the Manchester-Oxford Foot Questionnaire walking/standing domain scores between the preoperative baseline and 52 weeks post surgery.

RESULTS: Between March 2015 and January 2019, 303 participants were randomised using a minimisation algorithm: 152 to total ankle replacement and 151 to ankle fusion. At 52 weeks, the mean (standard deviation) Manchester-Oxford Foot Questionnaire walking/standing domain score was 31.4 (30.4) in the total ankle replacement arm (n = 136) and 36.8 (30.6) in the ankle fusion arm (n = 140); the adjusted difference in the change was -5.6 (95% confidence interval -12.5 to 1.4; p = 0.12) in the intention-to-treat analysis. By week 52, one patient in the total ankle replacement arm required revision. Rates of wound-healing issues (13.4% vs. 5.7%) and nerve injuries (4.2% vs. < 1%) were higher and the rate of thromboembolic events was lower (2.9% vs. 4.9%) in the total ankle replacement arm than in the ankle fusion arm. The bone non-union rate (based on plain radiographs) in the ankle fusion arm was 12.1%, but only 7.1% of patients had symptoms. A post hoc analysis of fixed-bearing total ankle replacement showed a statistically significant improvement over ankle fusion in Manchester-Oxford Foot Questionnaire walking/standing domain score (-11.1, 95% confidence interval -19.3 to -2.9; p = 0.008). We estimate a 69% likelihood that total ankle replacement is cost-effective compared with ankle fusion at the National Institute for Health and Care Excellence’s cost-effectiveness threshold of £20,000 per quality-adjusted life-year gained over the patient’s lifetime.

LIMITATIONS: This initial report contains only 52-week data, which must therefore be interpreted with caution. In addition, the pragmatic nature of the study means that there was heterogeneity between surgical implants and techniques. The trial was run across 17 NHS centres to ensure that decision-making streams reflected the standard of care in the NHS as closely as possible.

CONCLUSIONS: Both total ankle replacement and ankle fusion improved patients’ quality of life at 1 year, and both appear to be safe. When total ankle replacement was compared with ankle fusion overall, we were unable to show a statistically significant difference between the two arms in terms of our primary outcome measure. The total ankle replacement versus ankle arthrodesis (TARVA) trial is inconclusive in terms of superiority of total ankle replacement, as the 95% confidence interval for the adjusted treatment effect includes both a difference of zero and the minimal important difference of 12, but it can rule out the superiority of ankle fusion. A post hoc analysis comparing fixed-bearing total ankle replacement with ankle fusion showed a statistically significant improvement of total ankle replacement over ankle fusion in Manchester-Oxford Foot Questionnaire walking/standing domain score. Total ankle replacement appears to be cost-effective compared with ankle fusion at the National Institute for Health and Care Excellence’s cost-effectiveness threshold of £20,000 per quality-adjusted life-year gained over a patient’s lifetime based on long-term economic modelling.

FUTURE WORK: We recommend long-term follow-up of this important cohort, in particular radiological and clinical progress. We also recommend studies to explore the sensitivity of clinical scores to detect clinically important differences between arms when both have already achieved a significant improvement from baseline.

TRIAL REGISTRATION: This trial is registered as ISRCTN60672307 and ClinicalTrials.gov NCT02128555.

FUNDING: This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 5. See the NIHR Journals Library website for further project information.

PMID:37022932 | DOI:10.3310/PTYJ1146

IEEE/ACM Trans Comput Biol Bioinform. 2023 Feb 14;PP. doi: 10.1109/TCBB.2023.3242260. Online ahead of print.

ABSTRACT

Recently, the fast development of single-cell RNA-seq (scRNA-seq) techniques has enabled high-resolution transcriptomic statistical analysis of individual cells in heterogeneous tissues, which can help researchers to explore the relationship between genes and human diseases. The emerging scRNA-seq data results in new analysis methods aiming to identify cell-level clustering and annotations. However, there are few methods developed to gain insights into the gene-level clusters with biological significance. This study proposes a new deep learning-based framework, scENT (single cell gENe clusTer), to identify significant gene clusters from single-cell RNA-seq data. We started with clustering the scRNA-seq data into multiple optimal groups, followed by a gene set enrichment analysis to identify classes of over-represented genes. Considering high-dimensional data with extensive zeros and dropout issues, scENT integrates perturbation in the learning process of clustering scRNA-seq data to improve its robustness and performance. Experimental results show that scENT outperformed other benchmarking methods on simulation data. To validate the biological insights of scENT, we applied it to the public experimental scRNA-seq data profiled from patients with Alzheimer’s disease and brain metastasis. scENT successfully identified novel functional gene clusters and associated functions, facilitating the discovery of prospective mechanisms and the understanding of related diseases.

PMID:37022879 | DOI:10.1109/TCBB.2023.3242260