Tag: nevin manimala

Clin Nutr ESPEN. 2023 Jun;55:277-284. doi: 10.1016/j.clnesp.2023.03.018. Epub 2023 Mar 29.

ABSTRACT

BACKGROUND: The mainstay of modern medical therapy for intestinal failure (IF) is parenteral nutrition (PN). The Intestinal Rehabilitation Program (IRP) goal is enhancing nutritional outcomes for patients receiving total parenteral nutrition (TPN), optimizing/transitioning patients from TPN to enteral nutrition (EN), achieving enteral autonomy, monitoring growth and development. The objective of this study is to describe nutritional and clinical outcomes for children undergoing intestinal rehabilitation during 5 years of the program.

METHODS: Retrospective chart review for children from birth to <18 years old with IF who were on TPN from July 2015 to Dec 2020 or to the endpoint of the study when they either weaned from TPN during the 5 year period or continued TPN by Dec 2020 and participated at our IRP.

RESULTS: The mean age of the cohort was 2.4 years (±4.22), 53% male. The 3 most common diagnosis were necrotizing enterocolitis (28%), gastroschisis (14%) and intestinal atresia (14%). Nutritional data including days/hours per week on TPN, glucose infusion rate, amino acids, total EN calories, % of total nutrition received from TPN and EN per day all showed statistically significant differences. Our program showed 0% intestinal failure associated liver disease (IFALD), 0% mortality, 100% survival, 41% patients were weaned from TPN (13/32) with mean of 39 months (±32).

CONCLUSION: Early referral to a center that can offer IRP, such as ours can lead to tremendous positive clinical outcomes and help patients with intestinal failure avoid transplant as shown in our study.

PMID:37202057 | DOI:10.1016/j.clnesp.2023.03.018

Clin Nutr ESPEN. 2023 Jun;55:238-243. doi: 10.1016/j.clnesp.2023.03.020. Epub 2023 Mar 28.

ABSTRACT

OBJECTIVE: Metabolic syndrome (MetS) has become a major health problem across the globe. Various investigations have been conducted to find the underlying lifestyle-related causes of MetS. Modifiable dietary factors are specifically the center of interest, including the macronutrient composition of the regimen. We aimed to study the association between a low-carbohydrate diet score (LCDS) with MetS and its components in a Kavarian population, located in the center of Iran.

METHODS: The present study is a cross-sectional investigation conducted on a healthy sub-sample of PERSIAN Kavar cohort meeting our inclusion criteria (n = 2225). General, dietary, anthropometric, and laboratory data were obtained for each individual using validated questionnaires and measurements. Possible associations between LCDS and MetS and its components were verified using relevant statistical analyses, including analysis of variance and covariance (ANOVA and ANCOVA) and logistic regression. P-values <0.05 were considered as significant.

RESULTS: Compared with the lowest LCDS tertiles, those who were assigned to the upper tertiles had lower chance of MetS, after adjusting for potential confounders (OR: 0.66; 95% CI: 0.51-0.85). Moreover, those who assigned to the top LCDS tertile had 23% (OR: 0.77; 95% CI: 0.60-0.98) and 24% (OR: 0.76; 95% CI: 0.60-0.98) lower odds of abdominal adiposity and abnormal glucose homeostasis, respectively.

CONCLUSION: We observed a protective effect of low-carbohydrate diet against metabolic syndrome and its components, including abdominal obesity and abnormal glucose homeostasis. However, these initial findings need to be confirmed, especially in the format of clinical trials to ensure causality.

PMID:37202052 | DOI:10.1016/j.clnesp.2023.03.020

Clin Nutr ESPEN. 2023 Jun;55:230-237. doi: 10.1016/j.clnesp.2023.03.016. Epub 2023 Mar 28.

ABSTRACT

BACKGROUND: The absorption of vitamin D occurs via two main pathways: first, through the biosynthesis in the skin under the exposure of UV from sunlight; and second, through the intake of certain foods. However, its levels can be influenced by both genetic and environmental factors, which can generate changes such as vitamin D deficiency (hypovitaminosis D), a condition that black adults have a high potential to suffer from.

OBJECTIVE: The aim of this work is to study the association of skin color (self-reported: black, brown and white), food consumption, and the BsmI polymorphism in the vitamin D receptor gene (VDR) on serum levels of vitamin D in a group of adults.

METHODS: This was a cross-sectional analytical study. Individuals in the community were invited to participate in the research and, After signing the informed consent, a structured questionnaire was applied containing identification data, self-declaration of race/color, and nutritional data (Food frequency questionnaire (FFQ) and 24 h); afterwards, blood was collected for biochemical analysis, vitamin D was measured by Chemiluminescence and RT-PCR was used to evaluate the BsmI polymorphism of the VDR gene. Data was analyzed using a statistical program (SPSS 20.0) and differences between groups using p < 0.05.

RESULTS: A total of 114 persons was evaluated between black, brown and white individuals. It was found that a large part of the sample presents hypovitaminosis D, and blacks stand out with an average serum vitamin D level of 15.9 ng/dL. The group demonstrated that dietary intake of vitamin D is low, with the present study is a pioneer in associating the polymorphism of the VDR gene (BsmI) with the consumption of foods that are considered to have a higher content of vitamin D in their composition.

CONCLUSION: The VDR gene does not represent a risk factor for the consumption of vitamin D in this sample, and it was found that the self-declaration of “black” skin color was an independent risk factor for low serum levels of vitamin D.

PMID:37202051 | DOI:10.1016/j.clnesp.2023.03.016

Clin Nutr ESPEN. 2023 Jun;55:109-115. doi: 10.1016/j.clnesp.2023.03.001. Epub 2023 Mar 11.

ABSTRACT

BACKGROUND: Enhanced recovery after surgery (ERAS®) pathways aim to improve patient outcomes by applying multimodal practices before, during, and after operative procedures. Compared with standard care before ERAS, we investigated whether compliance to ERAS guidelines for nutritional care, preoperative oral carbohydrate loading and postoperative oral nutrition, was associated with a decrease in hospital length of stay (LOS) after pancreaticoduodenectomy, distal pancreatectomy, hepatectomy, radical cystectomy, and head and neck tumor resection with reconstruction.

METHODS: Compliance to ERAS nutrition recommendations was evaluated. Post-ERAS cohort was retrospectively analyzed. Pre-ERAS cohort consisted of case matched patients one year before ERAS: age more than or less than 65 years, body mass index (BMI) more than greater than or less than 30 kg/m², diabetes mellitus, sex, and procedure. Each cohort consisted of 297 patients. Binary linear regressions evaluated the incremental effect of postoperative nutrition timing and preoperative carbohydrate loading on LOS. Multivariate regressions adjusted for postoperative complications.

RESULTS: Compliance with preoperative carbohydrate loading for the post-ERAS cohort was 81.7%. Mean hospital LOS was significantly shorter for the post-ERAS cohort compared with pre-ERAS cohort (8.3 vs 10.0 days, p < 0.001). By procedure, LOS was significantly shorter for patients undergoing pancreaticoduodenectomy (p = 0.003), distal pancreatectomy (p = 0.014), and head and neck procedures (p = 0.024). Early postoperative oral nutrition was associated with a 3.75-day shorter LOS (p < 0.001); no nutrition was associated with a 3.29-day longer LOS (p < 0.001).

CONCLUSION: Compliance with ERAS protocols for specific nutritional care practices was associated with a statistically significant decrease in LOS without subsequent increases in 30-day readmission rates and positive financial impact. These findings suggest that ERAS guidelines for perioperative nutrition are a strategic pathway to improved patient recovery and value-based care in surgery.

PMID:37202034 | DOI:10.1016/j.clnesp.2023.03.001

Psychiatry Res Neuroimaging. 2023 May 9;333:111655. doi: 10.1016/j.pscychresns.2023.111655. Online ahead of print.

ABSTRACT

Clinicians often face a dilemma in diagnosing bipolar disorder patients with complex symptoms who spend more time in a depressive state than a manic state. The current gold standard for such diagnosis, the Diagnostic and Statistical Manual (DSM), is not objectively grounded in pathophysiology. In such complex cases, relying solely on the DSM may result in misdiagnosis as major depressive disorder (MDD). A biologically-based classification algorithm that can accurately predict treatment response may help patients suffering from mood disorders. Here we used an algorithm to do so using neuroimaging data. We used the neuromark framework to learn a kernel function for support vector machine (SVM) on multiple feature subspaces. The neuromark framework achieves up to 95.45% accuracy, 0.90 sensitivity, and 0.92 specificity in predicting antidepressant (AD) vs. mood stabilizer (MS) response in patients. We incorporated two additional datasets to evaluate the generalizability of our approach. The trained algorithm achieved up to 89% accuracy, 0.88 sensitivity, and 0.89 specificity in predicting the DSM-based diagnosis on these datasets. We also translated the model to distinguish responders to treatment from nonresponders with up to 70% accuracy. This approach reveals multiple salient biomarkers of medication-class of response within mood disorders.

PMID:37201216 | DOI:10.1016/j.pscychresns.2023.111655

Semin Arthritis Rheum. 2023 May 4;61:152211. doi: 10.1016/j.semarthrit.2023.152211. Online ahead of print.

ABSTRACT

OBJECTIVE: Interleukin-1 (IL-1) inhibitors are approved for treating familial Mediterranean fever (FMF) that is resistant to colchicine. However, continued concomitant treatment with colchicine is imperative, as it is the only drug proven to prevent secondary amyloidosis. We aimed to compare the adherence to colchicine between patients with colchicine-resistant FMF (crFMF) who were treated with IL-1 inhibitors and patients with colchicine-sensitive FMF (csFMF) who were treated only with colchicine.

METHODS: The databases of Maccabi Health Services, a 2.6-million-member state-mandated health provider in Israel were searched for patients with FMF diagnosis. The medication possession ratio (MPR), calculated from the day of the first colchicine purchase (index date) until the last colchicine purchase was the main outcome measure. Patients with crFMF were matched in a 1:4 ratio to patients with csFMF.

RESULTS: The final cohort included 4526 patients. Of them, 108 (2.4%) were with crFMF, and were matched to 432 with csFMF. The total mean MPR in each of the matched groups was similar (78.9 ± 41.4 and 82.5 ± 80.6, respectively, P = 0.5). Statistically significant differences in MPR were not found between the groups according to age or duration of colchicine use. However, adherence to colchicine was insufficient (MPR<80%) among more than 50% of the patients in both groups.

CONCLUSION: In contrast to initial concerns, adherence to colchicine was similar between patients with crFMF and csFMF. However, in both groups, adherence to colchicine was poor. Education of both caregivers and patients is essential to increase adherence.

PMID:37201215 | DOI:10.1016/j.semarthrit.2023.152211

Drug Metab Pers Ther. 2023 May 19. doi: 10.1515/dmpt-2023-0008. Online ahead of print.

ABSTRACT

OBJECTIVES: Development of the secondary to ACEI cough leads to discontinuation of the drugs of this group. Assessing the safety of the ACEIs with further development of customized approaches for their administration is a major scientific and practical problem. The objective of this study was to assess the association of the genetic markers with the development of the adverse drug reaction in the form of secondary to enalapril dry cough in the patients with essential arterial hypertension.

METHODS: Study involved 113 patients with the secondary to enalapril cough and 104 patients without development of the secondary to enalapril adverse drug reaction.

RESULTS: The patients carriers of the genotype AA rs2306283 of gene SLCO1B1 had 2-fold higher odds of developing the dry cough than those with the genotypes AG and GG (ОR=2.01, 95%CI=1.10-3.66, р=0.023). Similarly, the patients heterozygous for rs8176746 of gene АВО had 2.3-fold higher odds of developing the ADR in the form of dry cough than the carriers of the genotypes GG and TT (ОR=2.30, 95%CI=1.24-4.29, р=0.008).

CONCLUSIONS: Statistically significant association between the development of the ADR in the form of secondary to enalapril dry cough and polymorphisms rs2306283 of gene SLCO1B1 and rs8176746 of gene ABO was revealed.

PMID:37201212 | DOI:10.1515/dmpt-2023-0008

Eur J Cardiovasc Nurs. 2023 May 18:zvad048. doi: 10.1093/eurjcn/zvad048. Online ahead of print.

ABSTRACT

AIMS: Women are underrepresented in cardiovascular trials. We sought to explore the proportional representation of women in contemporary cardiovascular research and the factors (barriers and enablers) that affect their participation in cardiovascular studies.

METHODS AND RESULTS: Multiple electronic databases were searched between January 2011 and September 2021 to identify papers that defined underrepresentation of women in cardiovascular research and/or reported sex-based differences in participating in cardiovascular research and/or barriers for women to participate in cardiovascular research. Data extraction was undertaken independently by two authors using a standardised data collection form. Results were summarised using descriptive statistics and narrative synthesis as appropriate.From 548 identified papers, 10 papers were included. Of those, four were conducted prospectively and six were retrospective studies. Five of the retrospective studies involved secondary analysis of trial data including over 780 trials in over 1.1 million participants. Overall, women were reported to be underrepresented in heart failure, coronary disease, myocardial infarction and arrhythmia trials, compared to men. Barriers to participation included lack of information and understanding of the research, trial-related procedures, the perceived health status of the participant and patient-specific factors including travel, childcare availability and cost. A significantly higher likelihood of research participation was reported by women following a patient educational intervention.

CONCLUSIONS: This review has highlighted the underrepresentation of women in a range of cardiovascular trials. Several barriers to women’s participation in cardiovascular studies were identified. Researchers could mitigate against these in future trial planning and delivery to increase women’s participation in cardiovascular research.

REGISTRATION: The protocol was published on the public Open Science Framework (OSF) platform on 13th August 2021 (no registration reference provided) and can be accessed at https://osf.io/ny4fd/.

PMID:37201192 | DOI:10.1093/eurjcn/zvad048

Patient Prefer Adherence. 2023 May 12;17:1247-1255. doi: 10.2147/PPA.S408781. eCollection 2023.

ABSTRACT

PURPOSE: This study examined the mediating effect of medication adherence self-efficacy (MASE) on the relationship between drug attitude (DA) and medication adherence (MA) in patients with early psychosis.

PATIENTS AND METHODS: A total of 166 patients, aged 20 years or older, and who had received treatment within 5 years of their initial psychotic episode at a University Hospital outpatient center, participated in the study. Data were analyzed using descriptive statistics, t-tests, one-way analysis of variance, Pearson’s correlation coefficients, and multiple linear regression. Additionally, a bootstrapping test was conducted to determine the statistical significance of the mediating effect. All study procedures adhered to Strengthening the reporting of observational studies in epidemiology (STROBE) guidelines.

RESULTS: This study found a significant correlation between MA and DA (r=0.393, p<0.001), and between MA and MASE (r=0.697, p<0.001). MASE had a partial mediating effect on the association between DA and MA. The model that integrated both DA and MASE accounted for 53.4% of the variation in MA. Bootstrapping analysis indicated that MASE was a significant partial parameter (lower limit confidence interval [CI] 0.114; upper limit CI 0.356). Further, 64.5% of the study participants were either currently enrolled in college or had higher levels of education.

CONCLUSION: These findings could potentially lead to a more personalized approach to medication education and adherence, considering the unique DA and MASE of each patient. By identifying the mediating effect of MASE on the relationship between DA and MA, healthcare providers could tailor interventions to enhance the ability of patients with early psychosis to adhere to prescribed medication regimens.

PMID:37201154 | PMC:PMC10187643 | DOI:10.2147/PPA.S408781

Front Cell Infect Microbiol. 2023 May 2;13:1180714. doi: 10.3389/fcimb.2023.1180714. eCollection 2023.

ABSTRACT

INTRODUCTION: Intestinal colonization by Multi-Drug Resistant Organisms (MDROs) can pose a threat on the health of critically ill patients. The extent of colonization by these organisms is related to previous antibiotic treatments and their ability to cause infections among adult patients. The aim of this study is to determine the relationship between the intestinal Relative Loads (RLs) of selected antibiotic resistance genes, antibiotic consumption and extra-intestinal spread among critically ill pediatric patients.

METHODS: RLs of bla _{CTX-M-1-Family}, bla _OXA-1, bla _OXA-48 and bla _VIM were determined in 382 rectal swabs obtained from 90 pediatric critically ill patients using qPCRs. The RLs were compared to the patients’ demographics, antibiotic consumption, and detection of MDROs from extra-intestinal sites. 16SrDNA metagenomic sequencing was performed for 40 samples and clonality analyses were done for representative isolates.

RESULTS AND DISCUSSION: 76 (74.45%) patients from which 340 (89.01%) rectal swabs were collected had at least one swab that was positive for one of the tested genes. Routine cultures did not identify carbapenemases in 32 (45.1%) and 78 (58.2%) swabs that were positive by PCR for bla _OXA-48 and blaVIM, respectively. RLs of above 6.5% were associated with extra-intestinal spread of blaOXA-48-harboring MDROs. Consumption of carbapenems, non-carbapenem β-lactams, and glycopeptides were statistically associated with testing negative for bla _{CTX-M-1-Family} and bla _OXA-1 while the consumption of trimethoprim/sulfamethoxazole and aminoglycosides was associated with testing negative for blaOXA-48 (P<0.05). In conclusion, targeted qPCRs can be used to determine the extent of intestinal dominance by antibiotic resistant opportunistic pathogens and their potential to cause extra-intestinal infections among a critically ill pediatric population.

PMID:37201116 | PMC:PMC10188119 | DOI:10.3389/fcimb.2023.1180714