Tag: nevin manimala

J Arthroplasty. 2023 Jun 26:S0883-5403(23)00674-5. doi: 10.1016/j.arth.2023.06.036. Online ahead of print.

ABSTRACT

BACKGROUND: Patient-reported antibiotic allergy often leads to different prophylactic antibiotic regimens. The aim of the present study was to compare causative bacteria and their antibiotic resistance profiles in patients developing a periprosthetic joint infection (PJI) based on preoperative prophylactic antibiotic regimens in primary total hip (THA) and primary total and unicompartmental knee arthroplasty (TKA/UKA).

METHODS: We reviewed all cases of PJI occurring after primary THA and primary TKA/UKA, between 2011 and 2020 in a tertiary referral hospital. The standard preoperative prophylactic antibiotic for primary joint arthroplasty was cefuroxime and recommended second-line agent was clindamycin. Patients were divided by the replaced joint and analyzed independently. The PJI-causative bacteria and their antibiotic susceptibility were collected from the microbiological database.

RESULTS: In the THA group, culture-positive PJI was detected in 61 of 3,123 (2.0%) cefuroxime-administered cases and 6 of 206 (2.9%) non-cefuroxime-administered cases. In the TKA/UKA group, culture positive PJI was identified in 21 of 2455 (0.9%) cefuroxime-administered cases and in 3 of 211 (1.4%) non-cefuroxime administered cases. The most commonly isolated bacteria in both groups were coagulase negative staphylococci (CNS). There were no statistically significant differences of pathogen spectrum depending on the preoperative antibiotic regimen detected. Antibiotic resistance of isolated bacteria was significantly different in 4 of 27 (14.8%) analyzed antibiotics in THA and in 3 of 22 (13.6%) analyzed antibiotics in TKA/UKA. In all cohorts, a high occurrence of oxacillin-resistant CNS (50.0 to 100.0%) and clindamycin-resistant CNS (56.3 to 100.0%) has been observed.

CONCLUSIONS: The use of the second-line antibiotic did not influence the pathogen spectrum or antibiotic resistance. However, an alarmingly high proportion of CNS strains was resistant to clindamycin.

PMID:37380142 | DOI:10.1016/j.arth.2023.06.036

J Arthroplasty. 2023 Jun 26:S0883-5403(23)00671-X. doi: 10.1016/j.arth.2023.06.033. Online ahead of print.

ABSTRACT

BACKGROUND: Prosthetic joint infection(PJI) is a devastating complication of total hip arthroplasty (THA). This study aimed to determine if the anterior surgical approach (AP) influenced the incidence of early PJI in THA compared to posterior approach (PP).

METHODS: Record linkage was performed between state-wide hospitalization data and a national joint replacement registry to identify unilateral THA performed via the AP or PP. Complete data on 12,605 AP and 25,569 PP THAs were obtained. Propensity score matching (PSM) was undertaken to match covariates between the two approaches. Outcomes were the 90-day PJI hospital readmission rate (using narrow and broad definitions) and 90-day PJI revision rate (defined as component removal or exchange).

RESULTS: The raw PJI readmission rate for AP was lower than PP (0.8 vs 1.1%, respectively). In the PSM analysis, there was no statistically significant difference in PJI readmission rate between approaches using narrow or broad definition of PJI readmission. In terms of revision for infection, both methods showed AP had a significantly lower rate than PP, with an adjusted Odds Ratio (OR) of 0.47 (95% Confidence Interval (CI) 0.30, 0.75) for the 1:1 nearest neighbor method and 0.50 (95%CI 0.32, 0.77) for the subclassification method.

CONCLUSIONS: After addressing known confounders, there was no significant difference in the 90-day hospital readmission rate for hip PJI between approaches. There was a significantly reduced 90-day PJI revision rate for AP. The difference in revision may reflect differences in the surgical management of PJI between hip approaches rather than a difference in the underlying rate of infection.

PMID:37380141 | DOI:10.1016/j.arth.2023.06.033

Arch Phys Med Rehabil. 2023 Jun 26:S0003-9993(23)00364-7. doi: 10.1016/j.apmr.2023.06.007. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate physical activity levels of individuals with ataxia and correlate fitness to ataxia severity.

DESIGN: Observational study SETTING: : Outpatient ataxia clinic in a large, tertiary, urban hospital in the US.

PARTICIPANTS: Individuals with cerebellar ataxia (n=42).

INTERVENTION: Not applicable.

MAIN OUTCOME MEASURE: Participants were classified as sedentary or physically active using the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Maximal oxygen consumption (VO₂max) as an indicator of fitness level was measured, and ataxia severity was determined by the Scale for the Assessment and Rating of Ataxia (SARA). Mixed effect models were used to correlate ataxia severity to fitness levels.

RESULTS: Most participants (28 out of 42) lived sedentary lifestyles, and these individuals had poor fitness levels (only 67.3% of their predicted measure). The main barriers to physical activity included lack of energy, lack of time, and fear of falling. There were no differences in age, sex, disease type, disease duration, ataxia severity, fatigue level, and medication use between sedentary and active groups. Measures of VO₂max, maximal work, maximal heart rate, and anerobic threshold demonstrated statistically significant differences between groups whereas maximal respiratory rate and expired ventilation/carbon dioxide production were similar between groups. When adjusting for age, sex, functional mobility status, and disease duration, ataxia severity was inversely correlated with fitness level in the sedentary group. There was no relationship between ataxia severity and fitness level in the fourteen individuals who were physically active.

CONCLUSIONS: Lower fitness levels were associated with more ataxia symptoms in the sedentary group. This relationship was not seen in individuals who were more active. Given the poor health outcomes associated with low fitness, physical activity should be encouraged in this population.

PMID:37380120 | DOI:10.1016/j.apmr.2023.06.007

J Clin Epidemiol. 2023 Jun 26:S0895-4356(23)00160-9. doi: 10.1016/j.jclinepi.2023.06.013. Online ahead of print.

ABSTRACT

OBJECTIVE: To synthesise the current literature on the use of surrogate endpoints, including definitions, acceptability, and limitations of surrogate endpoints, and guidance for their design/reporting, into trial reporting items.

STUDY DESIGN AND SETTING: Literature was identified through searching bibliographic databases (until March 1^st, 2022) and grey literature sources (until May 27^th, 2022). Data were thematically analysed into four categories: (1) definitions, (2) acceptability, (3) limitations and challenges, and (4) guidance, and synthesised into reporting guidance items.

RESULTS: After screening, 90 documents were included: 79% (n=71) had data on definitions, 77% (n=69) on acceptability, 72% (n=65) on limitations and challenges, and 61% (n=55) on guidance. Data were synthesised into 17 potential trial reporting items: explicit statements on the use of surrogate endpoint(s) and justification for their use (items 1-6); methodological considerations, including whether sample size calculations were informed by surrogate validity (items 7-9); reporting of results for composite outcomes containing a surrogate endpoint (item 10); discussion and interpretation of findings (items 11-14); plans for confirmatory studies, collecting data on the surrogate endpoint and target outcome, and data sharing (items 15-16); and informing trial participants about using surrogate endpoints (item 17).

CONCLUSION: The review identified and synthesised items on the use of surrogate endpoints in trials; these will inform the development of the SPIRIT-SURROGATE and CONSORT-SURROGATE extensions.

PMID:37380118 | DOI:10.1016/j.jclinepi.2023.06.013

J Affect Disord. 2023 Jun 26:S0165-0327(23)00796-6. doi: 10.1016/j.jad.2023.06.030. Online ahead of print.

ABSTRACT

OBJECTIVES: Evaluate differences in sustained attention (SAT) and associated neurofunctional profiles between bipolar disorder type I (BD), attention-deficit/hyperactivity disorder (ADHD), and healthy comparison (HC) youth.

METHODS: Adolescent participants, aged 12-17 years, with BD (n = 30) and ADHD (n = 28) and HC adolescents (n = 26) underwent structural and functional magnetic resonance imaging (fMRI) while completing a modified Continuous Performance Task-Identical Pairs task. Attentional load was modifying in this task using three levels of image distortion (0 %, 25 % and 50 % image distortion). Task related fMRI activation and performance measures: perceptual sensitivity index (PSI); response bias (RB) and response time (RT); were calculated and compared between groups.

RESULTS: BD participants displayed lower perceptual sensitivity index (0 % p = 0.012; 25 % p = 0.015; 50 % p = 0.036) and higher values of response bias across levels of distortion (0 % p = 0.002, 25 % p = 0.001, and 50 % p = 0.008) as compared to HC. No statistically significant differences were observed for PSI and RB between BD and ADHD groups. No difference in RT were detected. Between-group and within-group differences in task related fMRI measures were detected in several clusters. In a region of interest (ROI) analysis of these clusters comparing BD and ADHD confirmed differences between these two groups.

CONCLUSIONS: Compared with HC, BD participants displayed SAT deficits. Increased attentional load revealed that BD participants had lower activation in brain regions associated with performance and integration of neural processes in SAT. ROI analysis between BD and ADHD participants shows that the differences were likely not attributable to ADHD comorbidity, suggesting SAT deficits were distinct to the BD group.

PMID:37380109 | DOI:10.1016/j.jad.2023.06.030

J Heart Lung Transplant. 2023 Jun 26:S1053-2498(23)01920-4. doi: 10.1016/j.healun.2023.06.013. Online ahead of print.

ABSTRACT

BACKGROUND: Reasons for women’s increased probability to experience adverse events (AEs) after left ventricular assist device (LVAD) implantation compared with men’s remain uncertain. We explored the role of psychosocial risk in the experience of AEs in women and men.

METHODS: INTERMACS patients receiving a primary continuous-flow LVAD between 7/2006 and 12/2017, median follow-up 13.6 months, were included (n=20123, 21.3% women). Time-to-event was calculated with cumulative incidence functions for 10 types of AEs separately (e.g., infection, device malfunction), each time accounting for the competing outcomes death, heart transplant and device explant due to recovery. Event-specific Cox proportional hazard models were run with a binary psychosocial risk variable (including: substance abuse, psychiatric diagnoses, limited social support, limited cognition, repeated noncompliance), controlled for covariates.

RESULTS: Psychosocial risk was more prevalent in men than in women (21.4% vs. 17.5%, p <.001). Seven out of ten AEs were more likely in women than in men (e.g., infection 44.5% vs. 39.2%, p <.001). The association of psychosocial risk with each AE was either stronger in women than in men (e.g., device malfunction HR_adj 1.29, 95% CI [1.06-1.56] vs. HR_adj 1.10, 95% CI [0.97-1.25]; rehospitalization HR_adj 1.15, 95% CI [1.02-1.29] vs. HR_adj 1.03, 95% CI [0.97-1.10]) or similar between sexes.

CONCLUSIONS: Independent of clinical parameters, the presence of psychosocial risk is associated with increases in AEs. This suggests that early modification of psychosocial risk factors may have the potential to lower the risk for AEs in this patient population.

PMID:37380090 | DOI:10.1016/j.healun.2023.06.013

Am J Prev Med. 2023 Jun 26:S0749-3797(23)00277-5. doi: 10.1016/j.amepre.2023.06.014. Online ahead of print.

ABSTRACT

INTRODUCTION: This study examines the association between prior incarceration and health insurance status and whether living in a state adopting the Affordable Care Act (ACA) Medicaid expansion moderates this relationship.

METHODS: Data are from the National Longitudinal Study of Adolescent to Adult Health (Wave I [1993-1994]; Wave IV [2008] and Wave V [2016-2018]; n = 8,965). Multiple logistic regression with multiplicative interaction terms were performed to assess the relationship between previous incarceration and ACA Medicaid expansion on (a) being insured and (b) being on public health insurance. Analyses were performed in 2023.

RESULTS: Findings demonstrate a positive and statistically significant interaction in the association between previous incarceration and living in a state with ACA Medicaid expansion on having public health insurance (OR = 2.402; 95% CI = 1.257, 4.588).

CONCLUSIONS: The ACA Medicaid expansion was associated with a greater likelihood of public health insurance coverage for formerly incarcerated persons in the United States. These findings suggest that Medicaid expansion could be critical in improving health insurance coverage among formerly incarcerated individuals who are a population that is more likely to be uninsured.

PMID:37380089 | DOI:10.1016/j.amepre.2023.06.014

J Biol Chem. 2023 Jun 26:104973. doi: 10.1016/j.jbc.2023.104973. Online ahead of print.

ABSTRACT

Prostate cancer (PCa) is initially regulated by the androgen receptor (AR), a ligand-activated, transcription factor (hormone-sensitive PCa (HSPC)), but eventually become androgen-refractory or castration-resistant (CRPC) because of mechanisms that bypass the AR, including ErbB3, a member of the epidermal growth factor receptor (EGFR) family. ErbB3 is synthesized in the cytoplasm and transported to the plasma membrane for ligand binding and dimerization, where it regulates downstream signaling, but nuclear forms are reported. Here, we demonstrate in prostatectomy samples that ErbB3 nuclear localization is observed in malignant, but not benign prostate. and that cytoplasmic (but not nuclear) ErbB3 correlated positively with AR expression but negatively with AR transcriptional activity. In support of the latter, androgen depletion upregulated cytoplasmic, but not nuclear ErbB3, while in vivo studies showed that castration suppressed ErbB3 nuclear localization in HSPC, but not CRPC tumors. In vitro treatment with the ErbB3 ligand heregulin-1β (HRG) induced ErbB3 nuclear localization, which was androgen-regulated in HSPC but not in CRPC. In turn, HRG upregulated AR transcriptional activity in CRPC but not in HSPC cells. Positive correlation between ErbB3 and AR expression was demonstrated in AR-null PC-3 cells where stable transfection of AR restored HRG-induced ErbB3 nuclear transport, while AR knockdown in LNCaP reduced cytoplasmic ErbB3. Mutations of ErbB3’s kinase domain did not affect its localization but was responsible for cell viability in CRPC cells. Taken together, we conclude that AR expression regulated ErbB3 expression, its transcriptional activity suppressed ErbB3 nuclear translocation, and HRG binding to ErbB3 promoted it.

PMID:37380074 | DOI:10.1016/j.jbc.2023.104973

J Cardiol. 2023 Jun 26:S0914-5087(23)00157-0. doi: 10.1016/j.jjcc.2023.06.012. Online ahead of print.

ABSTRACT

BACKGROUND: Iron deficiency in patients with heart failure (HF) is underdiagnosed and undertreated. The role of intravenous (IV) iron is well-established to improve quality of life measures. Emerging evidence also supports its role in preventing cardiovascular events in patients with HF.

METHODOLOGY: We conducted a literature search of multiple electronic databases. Randomized controlled trials that compared IV iron to usual care among patients with HF and reported cardiovascular (CV) outcomes were included. Primary outcome was the composite of first heart failure hospitalization (HFH) or CV death. Secondary outcomes included HFH (first or recurrent), CV death, all-cause mortality, hospitalization for any cause, gastrointestinal (GI) side effects, or any infection. We performed trial sequential and cumulative meta-analyses to evaluate the effect of IV iron on the primary endpoint, and on HFH.

RESULTS: Nine trials enrolling 3337 patients were included. Adding IV iron to usual care significantly reduced the risk of first HFH or CV death [risk ratio (RR) 0.84; 95 % confidence interval (CI) 0.75-0.93; I² = 0 %; number needed to treat (NNT) 18], which was primarily driven by a reduction in the risk of HFH of 25 %. IV iron also reduced the risk of the composite of hospitalization for any cause or death (RR 0.92; 95 % CI 0.85-0.99; I² = 0 %; NNT 19). There was no significant difference in the risk of CV death, all-cause mortality, adverse GI events, or any infection among patients receiving IV iron compared to usual care. The observed benefits of IV iron were directionally consistent across trials and crossed both the statistical and trial sequential boundaries of benefit.

CONCLUSION: In patients with HF and iron deficiency, the addition of IV iron to usual care reduces the risk of HFH without affecting the risk of CV or all-cause mortality.

PMID:37380069 | DOI:10.1016/j.jjcc.2023.06.012

Am J Perinatol. 2023 Jun 28. doi: 10.1055/a-2115-0147. Online ahead of print.

ABSTRACT

BACKGROUND: To determine whether objectively measured Sleep-Disordered Breathing (SDB) during pregnancy is associated with an increased risk of adverse neonatal outcomes in a cohort of nulliparous individuals.

METHODS: Secondary analysis of the nuMom2b- sleep disordered breathing substudy was performed. Individuals underwent in-home sleep studies for SDB assessment in early- (6-15 weeks’ gestation) and mid-pregnancy (22-31 weeks’ gestation). SDB was defined as an apnea-hypopnea index ≥5 events/hour at either time point. Primary outcome was a composite outcome of respiratory distress syndrome, transient tachypnea of the newborn, or receipt of respiratory support, treated hyperbilirubinemia or hypoglycemia, large-for-gestational age (LGA), seizures treated with medications or confirmed by electroencephalography, confirmed sepsis, or neonatal death. Individuals were categorized into 1) early pregnancy SDB (6-15 weeks’ gestation), 2) new onset mid-pregnancy SDB (22-31 weeks’ gestation), and 3) no SDB. Log-binomial regression was used to calculate adjusted risk ratios (RR) and 95% confidence intervals (CI) representing the association. Adjustments were made for maternal age, chronic hypertension, pregestational diabetes, progesterone use and Body Mass Index (BMI), new onset mid-pregnancy SDB to establish if a relationship was still present.

RESULTS: Among 2,106 participants, 3% percent (n=75) had early pregnancy SDB and 5.7% (n=119) developed new onset mid-pregnancy SDB. The incidence of the primary outcome was higher in offspring of individuals with early- (29.3%) and new onset mid- pregnancy SDB (30.3%) compared to individuals with no SDB (17.8%). After adjustment for maternal age, chronic hypertension, pregestational diabetes, progesterone use and BMI, new onset mid-pregnancy SDB conferred increased risk (RR=1.42, 95% CI: 1.05, 1.92), where there was no longer statistically significant association between early pregnancy SDB and the primary outcome.

CONCLUSION: New Onset, Mid- pregnancy SDB is independently associated with neonatal morbidity.

PMID:37380034 | DOI:10.1055/a-2115-0147