Tag: nevin manimala

Childs Nerv Syst. 2021 Nov 13. doi: 10.1007/s00381-021-05413-3. Online ahead of print.

ABSTRACT

INTRODUCTION: Pyogenic ventriculitis is a severe infection of the central nervous system with serious and often irreversible consequences in the quality of life of patients. Its treatment is difficult due to the impossibility of achieving sterility of cerebrospinal fluid (CSF) and the physiological characteristics promptly. Several treatment options have been described, from prolonged antibiotic treatments to placement of ventricular drains with continuous irrigation and puncture reservoirs. We propose an aggressive and minimally invasive treatment with neuroendoscopic lavage (NEL).

METHODS: Retrospective and descriptive study. We analyzed the NEL performed in our hospital for pyogenic ventriculitis between 2011 and 2020. A total of 16 patients were found; 2 of them lost follow-up, so they were not included. All patients had a diagnosis of pyogenic ventriculitis, either due to the macroscopic characteristics of the CSF or due to imaging criteria. Between 1 and 3 NEL were performed per patient until obtaining sterility and normalization of protein and cell counts of CSF.

RESULTS: The average age was 38 months (2 months to 16 years). Ten patients were female and 4 were male. Sixty-four percent of germs in cultures corresponded to gram-negative and polymicrobial flora. The average number of days until the first sterile CSF post-NEL was 3.8 days (0 to 10 days). The NEL produced a significant improvement in the characteristics of the CSF compared to the pre-NEL. The mean pre-NEL of CSF protein levels was 907 mg/dl (123-4510 mg/dl) compared with the post-NEL of 292 mg/dl (38-892 mg/dl) with a p-value = 0.0076. Regarding cellularity, statistically significant results were also achieved (p-value = 0.0011) with a pre-surgical cellularity of 665 elements/mm³ (4-3090 elements/mm³) compared with 57 elements/mm³ (0-390 elements/mm³) post-NEL. Of the patients, 85.7% had a shunt prior to the onset of ventriculitis and the average number of days until the new shunt was 36.56 days (17-79 days), with a total hospitalization days ranging from 22 to 170.

CONCLUSIONS: NEL allows rapid sterilization of CSF, decreasing the deleterious effect of infection in the CNS more rapidly compared to other types of conventional treatment.

PMID:34775525 | DOI:10.1007/s00381-021-05413-3

Clin Oral Investig. 2021 Nov 13. doi: 10.1007/s00784-021-04279-8. Online ahead of print.

ABSTRACT

OBJECTIVES: The main objective of this study was to enhance the blockage of dentinal tubules using nanobioglass in the presence of diode (980 nm) and Nd:YAG lasers in order to reduce permeability and dentin hypersensitivity.

MATERIALS AND METHODS: Thirty-six dentinal samples were randomly divided into 6 subgroups (n = 6): (A) control, (B) diode laser (980 nm, 3-W), (C) Nd:YAG laser (1064, 1.0-W), (D) nanobioglass, (E) nanobioglass + diode laser (980 nm), (F) nanobioglass + Nd:YAG laser. The average number of open dentinal tubules was qualitatively and quantitatively evaluated by scanning electron microscopy (SEM). Data were evaluated by SPSS software version 22, Kruskal-Wallis test, and Mann-Whitney tests with Bonferoni’s correction (α = 0.008).

RESULTS: Based on the results of Mann-Whitney test, there was a significant difference in the mean number of open dentinal tubules between the control group and the other groups (p < 0.008). However, the difference among the other groups was not statistically significant (p > 0.008).

CONCLUSIONS: Findings of this study showed that high-power laser radiation, such as Nd:YAG and diode (980 nm) alone or with nanobioglass, has a significant effect on the blockage of dentinal tubules.

CLINICAL RELEVANCE: Introduction of non-invasive methods with long-term and lasting effect on reducing pain and discomfort caused by dentin hypersensitivity.

PMID:34775517 | DOI:10.1007/s00784-021-04279-8

Pharmacogenomics J. 2021 Nov 13. doi: 10.1038/s41397-021-00261-5. Online ahead of print.

ABSTRACT

No biomarkers are available to predict patients at risk of developing hypertension induced by VEGF-pathway inhibitors. This study aimed to identify predictive biomarkers of hypertension induced by these drugs using a discovery-replication approach. The discovery set included 140 sorafenib-treated patients (TARGET study) genotyped for 973 SNPs in 56 genes. The most statistically significant SNPs associated with grade ≥2 hypertension were tested for association with grade ≥2 hypertension in the replication set of a GWAS of 1039 bevacizumab-treated patients from four clinical trials (CALGB/Alliance). In the discovery set, rs444904 (G > A) in PIK3R5 was associated with an increased risk of sorafenib-induced hypertension (p = 0.006, OR = 3.88 95% CI 1.54-9.81). In the replication set, rs427554 (G > A) in PIK3R5 (in complete linkage disequilibrium with rs444904) was associated with an increased risk of bevacizumab-induced hypertension (p = 0.008, OR = 1.39, 95% CI 1.09-1.78). This study identified a predictive marker of drug-induced hypertension that should be evaluated for other VEGF-pathway inhibitors.ClinicalTrials.gov Identifier:NCT00073307 (TARGET).

PMID:34775477 | DOI:10.1038/s41397-021-00261-5

JAMA Cardiol. 2021 Nov 14. doi: 10.1001/jamacardio.2021.5010. Online ahead of print.

ABSTRACT

IMPORTANCE: Atrial fibrillation (AF) is the most common arrhythmia. Although patients have reported that various exposures determine when and if an AF event will occur, a prospective evaluation of patient-selected triggers has not been conducted, and the utility of characterizing presumed AF-related triggers for individual patients remains unknown.

OBJECTIVE: To test the hypothesis that n-of-1 trials of self-selected AF triggers would enhance AF-related quality of life.

DESIGN, SETTING, AND PARTICIPANTS: A randomized clinical trial lasting a minimum of 10 weeks tested a smartphone mobile application used by symptomatic patients with paroxysmal AF who owned a smartphone and were interested in testing a presumed AF trigger. Participants were screened between December 22, 2018, and March 29, 2020.

INTERVENTIONS: n-of-1 Participants received instructions to expose or avoid self-selected triggers in random 1-week blocks for 6 weeks, and the probability their trigger influenced AF risk was then communicated. Controls monitored their AF over the same time period.

MAIN OUTCOMES AND MEASURES: AF was assessed daily by self-report and using a smartphone-based electrocardiogram recording device. The primary outcome comparing n-of-1 and control groups was the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) score at 10 weeks. All participants could subsequently opt for additional trigger testing.

RESULTS: Of 446 participants who initiated (mean [SD] age, 58 [14] years; 289 men [58%]; 461 White [92%]), 320 (72%) completed all study activities. Self-selected triggers included caffeine (n = 53), alcohol (n = 43), reduced sleep (n = 31), exercise (n = 30), lying on left side (n = 17), dehydration (n = 10), large meals (n = 7), cold food or drink (n = 5), specific diets (n = 6), and other customized triggers (n = 4). No significant differences in AFEQT scores were observed between the n-of-1 vs AF monitoring-only groups. In the 4-week postintervention follow-up period, significantly fewer daily AF episodes were reported after trigger testing compared with controls over the same time period (adjusted relative risk, 0.60; 95% CI, 0.43- 0.83; P < .001). In a meta-analysis of the individualized trials, only exposure to alcohol was associated with significantly heightened risks of AF events.

CONCLUSIONS AND RELEVANCE: n-of-1 Testing of AF triggers did not improve AF-associated quality of life but was associated with a reduction in AF events. Acute exposure to alcohol increased AF risk, with no evidence that other exposures, including caffeine, more commonly triggered AF.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03323099.

PMID:34775507 | DOI:10.1001/jamacardio.2021.5010

Med Sci Monit. 2021 Nov 14;27:e933381. doi: 10.12659/MSM.933381.

ABSTRACT

BACKGROUND Little is known of the changes in lung radiographic characteristics over time in patients recovering from COVID-19. This study analyzed the clinical features and temporal lung radiographic changes in patients with moderate and severe COVID-19 pneumonia who did not require invasive mechanical ventilation during the acute and convalescent periods. MATERIAL AND METHODS The data of 25 patients with COVID-19 pneumonia from January 29, 2020, to November 24, 2020, who did not require invasive mechanical ventilation and who were followed up were retrospectively collected. The 25 patients were divided into severe and moderate groups. Clinical characteristics and computed tomography (CT) manifestations were compared. A total of 121 consecutive thin-slice CT scans were collected at 4 weeks, 2 months, and 5 months after admission to evaluate lung abnormalities in the patients. The CT score was used to assess disease severity. RESULTS The severe group had a lower rate of nucleic acid conversion within 10 days of admission and higher D-dimer, creatine kinase, and lactate dehydrogenase values. In the severe group, hospital stay was longer and hospitalization costs were higher. The average CT score of the severe group peaked in the second week, while the moderate group peaked in the first week and then decreased over time. There were no statistically significant differences in the average CT score between the 2 groups at the 5-month follow-up. CONCLUSIONS The pulmonary lesions of patients recovering from COVID-19 and who do not require invasive mechanical ventilation were gradually absorbed and resolved over time.

PMID:34775462 | DOI:10.12659/MSM.933381

J Sport Rehabil. 2021 Nov 13:1-10. doi: 10.1123/jsr.2021-0082. Online ahead of print.

ABSTRACT

CONTEXT: Competitive cross-country runners train at much higher loads and with greater demands than recreational runners, posing a unique set of physiological and psychological challenges. Thus, identification of factors influencing health and nutritional choices in male cross-country runners is needed to help combat energy-related health issues.

PURPOSE: To assess male college cross-country runners’ perspectives regarding sport-related health and the factors impacting their eating behaviors.

DESIGN: Cross-sectional survey.

PARTICIPANTS/METHODS: The Runner’s Health Choices Questionnaire was distributed to male college cross-country runners. Responses were analyzed using quantitative descriptive statistics.

RESULTS: One hundred nineteen runners completed the survey. Runners reported a diverse range of factors impacting eating and health behaviors from athletic performance enhancement to enjoyment of food. Less than 6% of athletes ranked athletic trainer, registered dietitian, or physician as often consulted for nutrition/health information. However, 75% of runners said they would be somewhat likely or very likely to make dietary or health changes if given new or additional information by a health care provider.

CONCLUSION: Male cross-country runners appear to try to balance a global desire to be healthy with individual preferences. Athletes may be receptive to nutritional education that utilizes a biopsychosocial model with mental and psychological health support, and intentional effort is needed to support runners’ overall health.

PMID:34773919 | DOI:10.1123/jsr.2021-0082

Drug Alcohol Depend. 2021 Oct 29;229(Pt A):109148. doi: 10.1016/j.drugalcdep.2021.109148. Online ahead of print.

ABSTRACT

BACKGROUND: There is evidence that social support can improve the ability of an individual with alcohol use disorder to manage relapses. However, the role of families and friends in this context is debated as family history and co-drinking are also risk factors for initiating alcohol drinking or maintaining addictive behaviours.

AIM: To quantitatively evaluate whether the hospital discharge location (in company or alone) after an alcohol dependence hospitalisation can influence the risk of relapses and whether this impact is modified by socioeconomic deprivation.

METHODS: A cohort of 1141 patients hospitalised for the first time for alcohol dependence in Scotland between 2010 and 2019 was derived from a routine healthcare database. Relapses were defined as recurrent alcohol-related hospitalisation. Survival analysis was undertaken to compare the risk of relapse for different discharge locations and socioeconomic deprivation groups.

RESULTS: On average, living in company of others was associated with a significant lower risk of relapses compared to living alone (HR: 0.84 95%CI: 0.71-0.99). This association differed across socioeconomic groups, being greater for those living in areas with the highest level of socioeconomic deprivation (HR: 0.76 95%CI: 0.57-1.01) and lower elsewhere. While this effect was not statistically significant (p = 0.056), its extent varied based on how we defined our cohort: it was not detectable when we expanded the cohort to all individuals with alcohol use disorders.

CONCLUSION: Home settings and the environment where individuals reside should be considered as significant psychosocial factors when clinicians design therapies and hospital discharge planning for patients with alcohol dependence.

PMID:34773887 | DOI:10.1016/j.drugalcdep.2021.109148

Pathol Res Pract. 2021 Oct 26;228:153668. doi: 10.1016/j.prp.2021.153668. Online ahead of print.

ABSTRACT

Synovial sarcoma (SS) is a malignant soft tissue neoplasm harboring SS18-SSX fusion gene and is histologically characterized by spindle cells and epithelial components. Some investigations have demonstrated that desmoplastic reaction (DR) is an independent prognostic factor of cancers. However, it remains unknown whether DR is of predictive value for the prognosis of synovial sarcoma patients. Here, we reviewed the clinical and histological findings of 88 patients with SS. We defined DR as hyalinized collagenous structures and classified the degree of DR as follows: none, mild, moderate, and severe. Overall, 23 SS cases (24%) showed moderate or severe DR histologically. Statistically, the cases with moderate or severe degree of DR showed poorer prognosis than those with no or mild DR (local recurrence: P = 0.0059, distant metastasis: P = 0.0002, tumor death: P = 0.0382). The findings of the study suggest that the DR of synovial sarcoma could be an important prognostic factor.

PMID:34773915 | DOI:10.1016/j.prp.2021.153668

Clin Nutr. 2021 Oct 9;40(12):5771-5780. doi: 10.1016/j.clnu.2021.10.002. Online ahead of print.

ABSTRACT

BACKGROUND: High blood pressure (BP) constitutes a common and serious medical condition which is rising globally, and is among preventable factors for cardiovascular, renal, brain and other diseases. Modifiable risk factors of high BP include unhealthy dietary patterns, presence of obesity, excess alcohol consumption and lack of physical activity. Data in regard to the different types of diets show that Mediterranean diet (MD) is associated with healthy levels of BP. In this study we aimed to investigate the impact of the level of adherence to MD in BP.

AIMS-METHODS: A systematic literature search (up to 08.2021) in PubMed, Scopus, Embase, Web of Science, Cochrane and Google Scholar databases was conducted, and 54 observational studies were included.

RESULTS: Systolic blood pressure (SBP) was found to be lower in the high adherence to MD group SMD: -0.08, (95%CI: -0.15, -0.02) whereas no differences regarding diastolic blood pressure (DBP) were observed between the high and low adherence to MD groups [SMD: -0.07, (95%CI: -0.13, 0.00)]. Mean DBP of all included studies for both high and low adherence groups were in healthy levels (<90 mmHg).

CONCLUSIONS: Higher adherence to MD could positively influence SBP, but further research is needed in this field due to the heterogeneous definitions of low/high adherence and the type of studies used (observational).

PMID:34773865 | DOI:10.1016/j.clnu.2021.10.002

J Clin Anesth. 2021 Nov 10;76:110579. doi: 10.1016/j.jclinane.2021.110579. Online ahead of print.

NO ABSTRACT

PMID:34773870 | DOI:10.1016/j.jclinane.2021.110579