Tag: nevin manimala

Farm Hosp. 2022 May 19;46(4):203-207.

ABSTRACT

OBJECTIVE: Given poor medication adherence in severe asthma is difficult to evaluate in daily practice, using at least two methods concurrently is recommended. We aimed to determine the prevalence of nonadherence to inhalers using the Test of Adherence to Inhalers questionnaire and the medication possession ratio obtained from the pharmacy refill data in patients with severe asthma treated with anti-interleukin-5 biologics and to evaluate their concordance.

METHOD: This was a cross-sectional retrospective observational study of 53 patients with severe asthma recruited from the severe asthma unit of a tertiary hospital in Madrid from June to December 2020. We registered demographic data, comorbidities and concomitant therapy for sthma. Nonadherence was defined as pharmacy refill data < 80% and/or Test of Adherence to Inhalers questionnaire results < 50. Concordance was assessed by determining the Cohen’s kappa statistic. Results: The median age was 61 years (interquartile range 51.8-67.0), and 33 (61%) were women. According to the pharmacy refill data lack of adherence to the primary inhaler was 58.5%. However, when using the Test of Adherence to Inhalers questionnaire, it was 22.6%. Combining both methods, 17% of patients were considered to have nonadherence to inhalers. Likewise, when identifying nonadherence by either of these methods, it reached a prevalence of 64.2%. The pharmacy refill data and Test of Adherence to Inhalers questionnaire agreed in 53.1% and disagreed in 46.9% of patients (k = 0.137; 95% confidence interval -0.057 to 0.331; p = 0.318).

CONCLUSIONS: We observed a higher prevalence of non-adherence to inhalers in patients with severe asthma treated with anti-interleukin-5 biologics. The agreement between the Test of Adherence to Inhalers questionnaire and the pharmacy refill data is lower when evaluating nonadherence in patients with severe asthma treated with anti-interleukin-5 biologics. The pharmacy refill data detect a higher proportion of nonadherence compared with the Test of Adherence to Inhalers questionnaire.

PMID:36183217

Trop Med Int Health. 2022 Oct 2. doi: 10.1111/tmi.13824. Online ahead of print.

ABSTRACT

INTRODUCTION: Tuberculosis (TB) patients on the National Tuberculosis Elimination Program (NTEP) treatment protocol receive daily doses without health professional-supervised drug intake as during the previous directly observed treatment short-course (DOTS) regimen. We aimed to measure the level of adherence to anti-tubercular treatment (ATT) and the reasons for non-adherence among drug-sensitive TB patients on a daily-dose regimen in South India.

METHODS: A cross-sectional study was conducted among TB patients who received ATT as part of the standard treatment protocol in NTEP. Patients were interviewed to capture their understanding of TB, adherence, and the reason for non-adherence to ATT using validated instruments. Urine drug metabolite testing was performed using the High-Performance Liquid Chromatography (HPLC) technique to confirm adherence.

RESULTS: A total of 488 patients were recruited for the study. 64.8% of patients had “good knowledge” about TB and ATT. According to the subjective report, 63.7% of patients were adherent, but urine drug metabolite testing revealed 53.4% adherence. A statistically significant difference (p<0.05) exists between subjective and objective adherence measures. Patient-reported reasons for non-adherence were side effects of ATT (18.6%), loss of daily wages (15.0%), and forgetfulness (10.0%), among others.

CONCLUSIONS: Nearly half of the patients were non-adherent to the daily dosing regimen. Adherence as reported by the patients is unreliable, and urine testing could be used in routine care to assess adherence. This article is protected by copyright. All rights reserved.

PMID:36183194 | DOI:10.1111/tmi.13824

Pediatr Pulmonol. 2022 Oct 2. doi: 10.1002/ppul.26170. Online ahead of print.

ABSTRACT

BACKGROUND: Peripheral airway impairment (PAI) has been shown to have a close association to risk of uncontrolled asthma in children. However, clear methods have not been established for the clinician to select IOS reference equations best suited for their population. Our study aimed to develop a practical external validation analytic approach for the clinician to determine which of the available reference equations best predicts uncontrolled asthma for their patients.

METHODS: This is a post-hoc analyses of data collected at baseline in a RCT that occurred from March 2016-March 2018. The study population consisted of 227 children, ages 4 to 18 years, with moderate to severe asthma. Discrimination and calibration predictive performance of available and suitable IOS equations were assessed by using uncontrolled asthma as the criterion outcome. Discrimination statistics of accuracy, sensitivity, and specificity served as the primary performance indicators. Rank scores were determined by the number of acceptable limit thresholds met for these measures (>=60%, >=50%, and >=60%, respectively) across IOS metrics (R5, R5-R20, AX, and X5) resulting in a total possible score of 12.

RESULTS: External validity assessment determined the rank order of best to worst equations as being Gochicoa-Rangel (rank score=10)>Nowowiejska (rank score=9)>Assumapcao (rank score=6)>Amra (rank score=2). Gochicoa-Rangel reference equations provided the best option for universal application with accuracy of 73.1%, 72.2%, 76.7%, and 66.2% for R5, R5-R20, AX, and X5, respectively.

CONCLUSIONS: External validation, particularly discrimination in asthmatic children, offers the clinician a practical approach to selecting the most suitable predictive equations for their patients. This article is protected by copyright. All rights reserved.

PMID:36183193 | DOI:10.1002/ppul.26170

Neurosurg Focus. 2022 Oct;53(4):E4. doi: 10.3171/2022.7.FOCUS2269.

ABSTRACT

OBJECTIVE: The objective of this study was to compare the relative safety and effectiveness of invasive monitoring with subdural electrodes (SDEs) and stereoelectroencephalography (sEEG) in pediatric patients with drug-resistant epilepsy.

METHODS: A retrospective cohort study was performed in 176 patients who underwent invasive monitoring evaluations at UPMC Children’s Hospital of Pittsburgh between January 2000 and September 2021. To examine differences between SDE and sEEG groups, independent-samples t-tests for continuous variables and Pearson chi-square tests for categorical variables were performed. A p value < 0.1 was considered statistically significant.

RESULTS: There were 134 patients (76%) in the SDE group and 42 (24%) in the sEEG group. There was a difference in the proportion with complications (17.9% in the SDE group vs 7.1% in the sEEG group, p = 0.09) and resection (75.4% SDE vs 21.4% sEEG, p < 0.01) between SDE and sEEG patients. However, there was no observable difference in the rates of postresection seizure freedom at 1-year clinical follow-up (60.2% SDE vs 75.0% sEEG, p = 0.55).

CONCLUSIONS: These findings reveal a difference in rates of surgical complications and resection between SDEs and sEEG. Larger prospective, multi-institutional pediatric comparative effectiveness studies may further explore these associations.

PMID:36183187 | DOI:10.3171/2022.7.FOCUS2269

Neurosurg Focus. 2022 Oct;53(4):E11. doi: 10.3171/2022.7.FOCUS22276.

ABSTRACT

OBJECTIVE: This study aims to glean patient and caregiver perspectives surrounding deep brain stimulation (DBS) in children and youth through an analysis of patterns of social media usage.

METHODS: The authors performed a comprehensive search of the Twitter Application Programming Interface (API) database for all tweets about DBS use in children and youth, with no date restriction. Data pertaining to each tweet were extracted for analysis. Results were analyzed using qualitative and quantitative methodologies. These included thematic analysis of tweets, accounts, and descriptive statistics. Sentiment analysis of extracted tweets was also performed. A multivariable regression model was used to identify predictors of higher engagement metrics (likes, retweets, and quotes).

RESULTS: A comprehensive search of the Twitter database yielded 877 tweets from 816 unique accounts meeting study inclusion criteria. Most tweets were from patients or caregivers, researchers, or news media outlets. The most common themes among analyzed tweets were research discussing novel findings (45.2%) or personal experiences of patients or caregivers (27.4%). Sentiment analysis showed that 54.5% of tweets were positive, 35.1% were neutral, and 10.4% were negative. The presence of pictures or videos increased the tweet engagement count by an average of 10.5 (95% CI 7.3-13.6). Tweets about personal patient experiences (β = 6, 95% CI 0.95-12) and tweets tagging other accounts (β = 3.2, 95% CI 0.63-5.8) were also significantly associated with higher engagement metrics.

CONCLUSIONS: The current study is the first to assess patient and caregiver perspectives surrounding pediatric DBS through a comprehensive analysis of social media usage. Given the nascent field, social media presents an opportunity to share experiences and promote patient and healthcare professional education surrounding pediatric DBS.

PMID:36183184 | DOI:10.3171/2022.7.FOCUS22276

Neurosurg Focus. 2022 Oct;53(4):E2. doi: 10.3171/2022.7.FOCUS22338.

ABSTRACT

OBJECTIVE: Racial and ethnic disparities in healthcare have gained significant importance since the Institute of Medicine published its report on disparities in healthcare. There is a lack of evidence on how race and ethnicity affect access to advanced treatment of pediatric medically intractable epilepsy. In this context, the authors analyzed the latest Kids’ Inpatient Database (KID) for racial/ethnic disparities in access to surgical treatment of epilepsy.

METHODS: The authors queried the KID for the years 2016 and 2019 for the diagnosis of medically intractable epilepsy.

RESULTS: A total of 29,292 patients were included in the sample. Of these patients, 8.9% (n = 2610) underwent surgical treatment/invasive monitoring. The mean ages in the surgical treatment and nonsurgical treatment groups were 11.73 years (SD 5.75 years) and 9.5 years (SD 6.16 years), respectively. The most common insurance in the surgical group was private/commercial (55.9%) and Medicaid in the nonsurgical group (47.7%) (p < 0.001). White patients accounted for the most common population in both groups, followed by Hispanic patients. African American patients made up 7.9% in the surgical treatment group compared with 12.9% in the nonsurgical group. African American (41.1%) and Hispanic (29.9%) patients had higher rates of emergency department (ED) utilization compared with the White population (24.6%). After adjusting for all covariates, the odds of surgical treatment increased with increasing age (OR 1.06, 95% CI 1.053-1.067; p < 0.001). African American race (OR 0.513, 95% CI 0.443-0.605; p < 0.001), Hispanic ethnicity (OR 0.681, 95% CI 0.612-0.758; p < 0.001), and other races (OR 0.789, 95% CI 0.689-0.903; p = 0.006) had lower surgical treatment odds compared with the White population. Medicaid/Medicare was associated with lower surgical treatment odds than private/commercial insurance (OR 0.603, 0.554-0.657; p < 0.001). Interaction analysis revealed that African American (OR 0.708, 95% CI 0.569-0.880; p = 0.001) and Hispanic (OR 0.671, 95% CI 0.556-0.809; p < 0.001) populations with private insurance had lower surgical treatment odds than White populations with private insurance. Similarly, African American patients, Hispanic patients, and patients of other races with nonprivate insurance also had lower surgical treatment odds than their White counterparts after adjusting for all other covariates.

CONCLUSIONS: Based on the KID, African American and Hispanic populations had lower surgical treatment rates than their White counterparts, with higher utilization of the ED for pediatric medically intractable epilepsy.

PMID:36183182 | DOI:10.3171/2022.7.FOCUS22338

Neurosurg Focus. 2022 Oct;53(4):E8. doi: 10.3171/2022.7.FOCUS22296.

ABSTRACT

OBJECTIVE: Hypothalamic hamartoma (HH) is a rare, nonmalignant, heterotopic developmental malformation that consists of a mixture of normal neurons and glial cells. Resection of HHs has been associated with high rates of mortality and morbidity. Therefore, minimally invasive ablation methods could be the best treatment option for HH. The most frequently used minimally invasive options for HH ablation are radiofrequency thermocoagulation (RFT), laser ablation (LA), and stereotactic radiosurgery.

METHODS: To investigate three minimally invasive procedures in the treatment of refractory seizures related to HH, the authors conducted a systematic search in March 2022 in the MEDLINE, Embase, Scopus, and Web of Science databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Seizure freedom was the primary outcome of interest. The authors defined seizure freedom as Engel class I or International League Against Epilepsy class 1 or 2 or as the reported term “seizure freedom.” The secondary outcome was long-term complications reported in studies. Both random- and fixed-effects models were used to calculate the pooled proportion of seizure freedom and complication rate with 95% confidence intervals. A modified version of the Joanna Briggs Institute (JBI) Critical Appraisal to assess the risk of bias was used.

RESULTS: The authors included 15 studies with 422 patients (RFT, n = 190; LA, n = 171; and Gamma Knife Radiosurgery [GKRS], n = 61). Generally, the mean incidences of overall seizure freedom after minimally invasive procedures were 77% (95% CI 0.74-0.81) and 68% (95% CI 0.57-0.79) using fixed- and random-effects models, respectively. The mean incidence of overall seizure freedom after RFT was 69% (95% CI 0.63-0.75), and the mean incidences of overall seizure freedom after LA and GKRS were 87% (95% CI 0.82-0.92) and 44% (95% CI 0.32-0.57), respectively. The total complication rate with minimally invasive procedures was 13% (95% CI 0.01-0.26). The complication rate in each treatment was as follows: 5% (95% CI 0.0-0.12) for RFT, 20% (95% CI 0.0-0.47) for LA, and 22% (95% CI 0-0.65) for GKRS. Meta-regression analysis showed an association between older age and higher complication rates in the LA group.

CONCLUSIONS: In this meta-analysis, LA showed superiority in seizure freedom over the other two methods. The complication rate associated with RFT was less than those in the other two methods; however, this difference was not statistically significant.

PMID:36183177 | DOI:10.3171/2022.7.FOCUS22296

Neurosurg Focus. 2022 Oct;53(4):E6. doi: 10.3171/2022.7.FOCUS21731.

ABSTRACT

OBJECTIVE: In the histopathological examination of treatment-resistant epilepsy, focal cortical dysplasia (FCD) is the most common diagnosis in the pediatric group. FCD is classified histopathologically according to the International League Against Epilepsy (ILAE) classification. In the last decade since the ILAE classification has been released, molecular genetic studies have revealed mTOR pathway-related mutations as a major etiology. The objective of this study was to determine the incidence of FCD in treatment-resistant epilepsy patients, explore histomorphological and immunohistochemical features, examine clinicopathological correlation, demonstrate mTOR pathway activation using a pS6 antibody immunohistochemically, and try to introduce a candidate for possible targeted therapies.

METHODS: Paraffin blocks and slides of tissue from patients with treatment-resistant epilepsy were reexamined retrospectively. Histopathological subtypes of FCD were determined according to the ILAE classification. NeuN and neurofilament H (NF-H) staining were performed, and additionally a pS6 antibody was used to demonstrate mTOR pathway activation.

RESULTS: In 32 cases diagnosed with FCD, or 17.5% of 183 surgical epilepsy materials, there were no significant differences in the statistical analysis of clinical variables between the ILAE FCD subtypes. Recommended antibody NeuN revealed microcolumnar alignment in the FCD type Ia and IIIa groups and the loss of lamination in the type Ib group. Another recommended antibody, NF-H, was not found to be useful in discriminating between normal and dysmorphic neurons. pS6 expression, showing mTOR pathway activation, was observed in dysmorphic neurons and balloon cells in all FCD type II cases.

CONCLUSIONS: Significant pS6 expression in FCD type II represents the genomic nature of the disease noted in the literature. Nevertheless, the known MTOR gene and mTOR pathway-related mutations remain behind proportionally to explain the mTOR pathway activation in all FCD type II cases. Clinicopathologically and genetically integrated classification and usage of mTOR pathway inhibitors in treatment are expected as a recent evolution.

PMID:36183176 | DOI:10.3171/2022.7.FOCUS21731

Immunology. 2022 Oct 1. doi: 10.1111/imm.13586. Online ahead of print.

ABSTRACT

Not only are many Mycobacteria pathogens, but they can act as strong nonspecific immunopotentiators, generating beneficial effects on the pathogenesis of some diseases. However, there has been no direct evidence of the effect of mycobacterial species on colorectal cancer (CRC). Herein, we showed that there may be a meaningful inverse correlation between the incidence of tuberculosis and CRC based on global statistics and that heat-killed M. tuberculosis and live M. bovis (BCG strain) could ameliorate CRC development. In particular, using a fecal microbiota transplantation and a comparison between separate housing and cohousing, we demonstrated that the gut microbiota is involved in the protective effects. The microbial alterations can be elucidated by the modulation of antimicrobial activities including those of the Reg3 family genes. Furthermore, interleukin-22 production by T helper cells contributed to the anti-inflammatory activity of Mycobacteria. Our results revealed a novel role of Mycobacteria involving gut microbial alterations in dampening inflammation-associated CRC and an immunological mechanism underlying the interaction between microbes and host immunity. This article is protected by copyright. All rights reserved.

PMID:36183156 | DOI:10.1111/imm.13586

Dermatol Ther. 2022 Oct 1:e15888. doi: 10.1111/dth.15888. Online ahead of print.

ABSTRACT

BACKGROUND: Atrophic acne scars are the most common cutaneous seqaule of acne vulgaris, representing 80-90% of all acne scars. Ablative fractional carbon dioxide (FCO2) laser is the gold standard treatment for atrophic scars. Additionally, platelet-rich plasma (PRP) is suggested to accelerate the healing process and collagen synthesis. The aim of the present systematic review and meta-analysis was to determine the efficacy and safety of PRP combined with Ablative FCO2 laser in the treatment of moderate to severe atrophic acne scars.

METHODS: Randomized controlled trials (RCTs) that have compared PRP in combination with ablative FCO2 laser to ablative FCO2 laser alone with respect to the efficacy and safety measures were included. We have systematically explored Embase, Medline, and CENTRAL databases via Ovid. The outcomes that our systematic review saught to evaluate were clinical improvement, patient satisfaction, and Goodman and Baron’s qualitative acne scar score. The dichotomous outcomes were presented as odds ratio (OR) while the continuous outcomes were presented as standardized mean difference (SMD).

RESULTS: 11 RCTs that represents 313 participants were included. The combined use of laser and PRP showed a statistically significant clinical improvement and patient satisfaction compared to the use of laser alone (OR=2.56, 95% CI 1.37 to 4.78 and OR=3.38, 95% CI 1.80 to 6.34, respectively). Also, a significant improvement in Goodman and Baron’s score was achieved by combining PRP with laser (SMD = -0.40, 95% CI -0.65 to -0.14).

CONCLUSION: The combined treatment of laser and PRP was highly synergistic, effective, and safe in treating moderate to severe atrophic acne scars. This article is protected by copyright. All rights reserved.

PMID:36183145 | DOI:10.1111/dth.15888