Tag: nevin manimala

Eur J Prev Cardiol. 2022 Aug 3:zwac148. doi: 10.1093/eurjpc/zwac148. Online ahead of print.

ABSTRACT

BACKGROUND: There are several risk scores designed to predict mortality in patients with heart failure (HF).

AIM: To assess performance of risk scores validated for mortality prediction in patients with acute HF (AHF) and chronic HF.

METHODS: MEDLINE and Scopus were searched from January 2015 to January 2021 for studies which internally or externally validated risk models for predicting all-cause mortality in patients with AHF and chronic HF. Discrimination data were analyzed using C-statistics, and pooled using generic inverse-variance random-effects model.

RESULTS: Nineteen studies (n = 494,156 patients; AHF:24,762; chronic HF mid-term mortality:62,000; chronic HF long-term mortality:452,097) and 11 risk scores were included. Overall, discrimination of risk scores was good across the three subgroups: AHF mortality (C-statistic:0.76, [0.68-0.83]), chronic HF mid-term mortality (1 year; C-statistic:0.74, [0.68-0.79]) and chronic HF long-term mortality (≥2 years; C-statistic:0.71, [0.69-0.73]). MEESSI-AHF (C-statistic:0.81, [0.80-0.83]) and MARKER-HF (C-statistic:0.85, [0.80-0.89]) had excellent discrimination for AHF and chronic HF mid-term mortality respectively, whereas MECKI had good discrimination (C-statistic:0.78, [0.73-0.83]) for chronic HF long-term mortality relative to other models. Overall, risk scores predicting short-term mortality in patients with AHF did not have evidence of poor calibration (Hosmer-Lemeshow p > 0.05). However, risk models predicting mid-term and long-term mortality in patients with chronic HF varied in calibration performance.

CONCLUSIONS: Majority of recently validated risk scores showed good discrimination for mortality in patients with HF. MEESSI-AHF demonstrated excellent discrimination in patients with AHF, and MARKER-HF and MECKI displayed excellent discrimination in patients with chronic HF. However, modest reporting of calibration and lack of head-to-head comparisons in same populations warrant future studies.

PMID:35919956 | DOI:10.1093/eurjpc/zwac148

Ann Pharmacother. 2022 Aug 2:10600280221113092. doi: 10.1177/10600280221113092. Online ahead of print.

ABSTRACT

OBJECTIVES: To review the characteristics, efficacy, safety, pharmacoeconomics, and place in therapy of upadacitinib, a Janus kinase (JAK) inhibitor, in the treatment of rheumatoid arthritis (RA).

DATA SOURCES: PubMed (January 2003-May 2022) was searched using upadacitinib and ABT-494.

STUDY SELECTION AND DATA EXTRACTION: Human studies published in peer-reviewed publications in English were the primary sources for efficacy and safety data.

DATA SYNTHESIS: In randomized, double-blind, controlled clinical studies, upadacitinib demonstrated statistically significant improvement in RA symptoms as monotherapy and in combination with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) when compared with csDMARD monotherapy or to adalimumab or abatacept in combination with csDMARD therapy in patients with RA. American College of Rheumatology 20% response rates were 68% to 79% for upadacitinib monotherapy and 64% to 84% for upadacitinib plus csDMARD therapy, compared with 28% to 59% for csDMARD-only therapy and 63% to 74% for biologic DMARD (bDMARD) plus csDMARD therapy. Long-term extension studies demonstrated similar findings. Upadacitinib had similar rates of serious infections, herpes zoster, major cardiovascular events, and venous thromboembolic events as other JAK inhibitors. Upadacitinib was similar in cost to tofacitinib and twice as high as baricitinib based on current estimated costs to patients, but actual costs may vary.

RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: Upadacitinib is an alternative therapy to other JAK inhibitors and bDMARDs in patients with moderate to severe RA who have had an inadequate response to a tumor necrosis factor inhibitor alone or in combination with a csDMARD.

CONCLUSIONS: Upadacitinib is an effective JAK inhibitor for use in RA.

PMID:35919945 | DOI:10.1177/10600280221113092

Mod Rheumatol. 2022 Aug 3:roac079. doi: 10.1093/mr/roac079. Online ahead of print.

ABSTRACT

OBJECTIVES: To elucidate the longitudinal relationship between bone mineral density (BMD) at baseline and the change of bone marrow lesion (BML) during a two-year follow-up period (2YFU).

METHODS: Seventy-eight female participants (Mean age: 54.9 ± 9.6) without radiographic knee osteoarthritis were eligible. Based on right-knee MRI, maximum BML area (BMLa) was calculated by tracing BML border. The change in BMLa was defined using the following formula: [2YFU] – [Baseline] = ΔBMLa. Positive ΔBMLa was defined as enlarged; negative ΔBMLa was defined as regressed. Dual-energy X-ray absorptiometry was performed to measure the BMD of distal radius. Young adult mean [YAM (%)] of the BMD was used for statistical analysis. Linear regression analysis was conducted with ΔBMLa as the dependent variable and YAM as the independent variable. ROC curve and logistic regression analysis were conducted for YAM to predict the prevalence of BML enlargement or regression.

RESULTS: Twenty-six (33.3%) patients had enlarged BMLa, 12 (15.4%) participants showed regressing BMLa, and 40 (51.3%) patients remained stable. YAM was negatively associated with ΔBMLa (β: – 0.375, P=0.046). The best predictor of BML enlargement risk was 85% YAM; this cut-off could predict the prevalence of BML enlargement (Odds ratio: 8.383, P=0.025).

CONCLUSIONS: Lower BMD could predict BML enlargement during a two-year follow-up period.

PMID:35919930 | DOI:10.1093/mr/roac079

J Evid Based Med. 2022 Aug 2. doi: 10.1111/jebm.12484. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the reporting quality of single-patient (N-of-1) trials and protocols based on the CONSORT Extension for N-of-1 trials (CENT) statement and the standard protocol items: recommendations for interventional trials (SPIRIT) extension and elaboration for N-of-1 trials (SPENT) checklist to examine the factors that influenced reporting quality.

METHODS: Four electronic databases were searched to identify N-of-1 trials and protocols from 2015 to 2020. Quality was assessed by two reviewers. We calculated the overall scores based on binary responses in which “Yes” was scored as 1 (if the item was fully reported), and “No” was scored as 0 (if the item was not clearly reported or not definitely stated).

RESULTS: A total of 78 publications (55 N-of-1 trials and 23 protocols) were identified. The mean reporting score (SD) of the N-of-1 trials and protocols were 29.24 (0.89) and 29.61 (1.83), respectively. For the items related to outcomes, sample size, allocation concealment protocol, and informed consent materials, the reporting quality was low. Our results showed that the year of publication (t = -0.793, p = 0.872 for the trials and t = 1.352, p = 0.623 for the protocols) and the impact factor of the journal (t = 1.416, p = 0.619 for the trials and t = 0.359, p = 0.667 for the protocols) were not factors associated with better reporting quality.

CONCLUSION: With the publication of the CENT 2015 statement and the SPENT 2019 checklist, authors should adhere to the relevant reporting guidelines and improve the reporting quality of N-of-1 trials and protocols.

PMID:35919928 | DOI:10.1111/jebm.12484

Geriatr Gerontol Int. 2022 Aug 2. doi: 10.1111/ggi.14435. Online ahead of print.

ABSTRACT

AIM: To investigate the association between the total score of the Kihon checklist (t-KCL score) and functional disability over an 8-year follow-up period, and to examine whether the t-KCL score in the basic model with risk factors contributes to the incremental predictive ability for functional disability among older adults.

METHODS: We followed 2209 older adults aged ≥65 years without functional disability at baseline. The t-KCL score was determined using a baseline survey questionnaire. Functional disability was defined based on information from long-term care certifications. The association between the t-KCL score and functional disability was examined using the Cox proportional hazards model. The incremental predictive ability of the t-KCL score for functional disability was evaluated by the difference of the C-statistic, category-free net reclassification improvement (NRI), and integrated discrimination improvement (IDI).

RESULTS: The median follow-up period was 7.8 years, and 557 participants developed functional disability. The adjusted hazard ratio (95% confidence interval [CI]) of functional disability for a 1-point increase of the t-KCL score was 1.08 (1.06-1.10). Adding the t-KCL score to the basic model significantly improved the C-statistic (95% CI) from 0.747 (0.728-0.768) to 0.760 (0.741-0.781). When the t-KCL score was added to the basic model, the NRI and IDI were 0.187 (95% CI: 0.095-0.287) and 0.020 (95% CI: 0.012-0.027), respectively.

CONCLUSIONS: The t-KCL score had an independent positive association with functional disability over an 8-year follow-up. Furthermore, adding the t-KCL score to the basic model improved the predictive ability for functional disability. Geriatr Gerontol Int 2022; ••: ••-••.

PMID:35919927 | DOI:10.1111/ggi.14435

J Osteopath Med. 2022 Aug 2. doi: 10.1515/jom-2021-0296. Online ahead of print.

ABSTRACT

CONTEXT: Health-related quality of life (HRQOL) represents a new approach for guiding chronic pain management because it is patient-centered and more likely to be understood and accepted by patients.

OBJECTIVES: To assess the value and utility of an eHealth intervention for patients with chronic low back pain (CLBP) that was primarily based on HRQOL measures and to measure the clinical outcomes associated with its use.

METHODS: A randomized controlled trial was conducted within the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION Pain Research Registry) using participants screened from November 2019 through February 2021. A total of 331 registry participants within the 48 contiguous states and the District of Columbia met the eligibility criteria, which included having CLBP and HRQOL deficits. Almost three-fourths of the participants were enrolled after onset of the COVID-19 pandemic. The participants were randomized to an eHealth intervention for HRQOL or wait list control. The primary outcome measures involved HRQOL based on the Patient-Reported Outcomes Measurement Information System (PROMIS), including the SPADE cluster (Sleep disturbance, Pain interference with activities, Anxiety, Depression, and low Energy/fatigue) and each of its five component scales. Secondary outcome measures involved low back pain intensity and back-related functioning. Changes over time for each outcome measure reported by participants in each treatment group were compared utilizing the student’s t-test for statistical significance and Cohen’s d statistic for clinical importance. Outcomes were reported as between-group differences in change scores and the d statistic, with positive values favoring the experimental treatment group.

RESULTS: There were no significant differences between the experimental and control treatment groups for changes over time in any primary outcome measure. The d statistic (95% confidence interval) for the difference between the experimental and control treatment groups on the SPADE cluster was 0.04 (-0.18-0.25). The corresponding d statistics for the SPADE scales ranged from -0.06 (-0.27 to 0.16) for anxiety to 0.11 (-0.10 to 0.33) for sleep disturbance. There were also no significant or clinically important differences between the experimental and control treatment groups on the secondary outcome measures. Additionally, in subgroup analyses involving participants treated by osteopathic vs allopathic physicians, no significant interaction effects were observed.

CONCLUSIONS: The eHealth intervention studied herein did not achieve statistically significant or clinically important improvements in any of the primary or secondary outcome measures. However, the validity and generalizability of the findings may have been limited by the unforeseen onset and impact of the COVID-19 pandemic shortly after beginning the trial.

PMID:35918787 | DOI:10.1515/jom-2021-0296

Phonetica. 2022 Aug 3. doi: 10.1515/phon-2022-2021. Online ahead of print.

ABSTRACT

Post-focus compression (PFC), in which words following focus are compressed in F ₀ and intensity, is recently found to be effective in encoding focus. Recent studies find that PFC is present in Egyptian, Hijazi and Lebanese Arabic, and hence they are classified as +PFC languages. However, there are languages from the same family language which differ mainly in terms of the presence and absence of PFC. The current study investigated the production and perception of prosodic focus marking in Makkan Arabic, an under-researched Arabic dialect. Systematic acoustic analyses and statistical tests show that (a) the on-focus word is realized by expanding the excursion size, increasing the F ₀ and strengthening the intensity of its stressed syllable, (b) information and contrastive focus are not prosodically distinguishable, (c) Makkan Arabic lacks PFC, and (d) focus recognition is low compared to Hijazi Arabic (+PFC), Taiwanese and Taiwan Mandarin (other -PFC languages). The new findings, taken together with recent findings, suggest that (1) the prosodic encoding of focus is different across Arabic dialects productively and perceptually, and (2) the on-focus raising is not a sufficient factor in recognizing prosodic cues to focus. These results contribute to broadening our understanding of different prosodic focus markings cross-linguistically and cross-dialectally.

PMID:35918784 | DOI:10.1515/phon-2022-2021

Trop Med Health. 2022 Aug 2;50(1):50. doi: 10.1186/s41182-022-00443-2.

ABSTRACT

BACKGROUND: Awareness about obstetric fistula and its concomitant factors is central to efforts to eliminate obstetric fistula in sub-Saharan Africa. We, therefore, assessed the magnitude of obstetric fistula awareness and its associated factors among women of reproductive age in sub-Saharan Africa.

METHODS: Data for the study were extracted from the most recent Demographic and Health Surveys of 14 countries in sub-Saharan Africa. We included 185,388 women aged 15-49 years in this study. Percentages were used to summarise the prevalence of obstetric fistula awareness across the 14 countries studied. We adopted a multivariable multilevel binary logistic regression to examine the factors associated with obstetric fistula awareness in sub-Saharan Africa. We presented the results of the regression analysis using adjusted odds ratios with their 95% confidence intervals. Statistical significance was set at p < 0.05.

RESULTS: The average prevalence of obstetric fistula awareness was 37.9%, ranging from 12.8% in Gambia to 63.9% in Uganda. Awareness of obstetric fistula was low among never married and cohabiting women compared to married women. Compared with women with parity 4 or more, those with no birth had the lowest odds of obstetric fistula awareness. The study also showed that obstetric fistula awareness was lower among women who were working, those who are not exposed to mass media, those in the poorest wealth category, those who have never had sex, and those in communities with low literacy level. The study however found that the odds of obstetric fistula awareness increased with age and education, and was higher in urban areas compared to rural areas. Women, who had ever terminated a pregnancy were more likely to be aware of obstetric fistula compared to those who had never terminated a pregnancy.

CONCLUSION: The study demonstrated a low awareness of obstetric fistula among women in sub-Saharan Africa. Educative and sensitisation interventions should incorporate the factors identified in the present study during its implementation. To raise women’s awareness of obstetric fistula, there is the need for sub-Saharan African countries to consciously raise community literacy rate, increase access to mass media platforms and invest intensively in formal education for women.

PMID:35918762 | DOI:10.1186/s41182-022-00443-2

Eur J Med Res. 2022 Aug 2;27(1):138. doi: 10.1186/s40001-022-00768-y.

ABSTRACT

PURPOSE: Stroke is a significant cause of disability worldwide and is considered a disease caused by long-term exposure to lifestyle-related risk factors. These risk factors influence the first event of stroke and recurrent stroke events, which carry more significant risks for more severe disabilities. This study specifically compared the risk factors and neurological outcome of patients with recurrent ischemic stroke to those who had just experienced their first stroke among patients admitted to the Hospital.

PATIENTS AND METHODS: We observed and analyzed 300 patients’ data who met the inclusion and exclusion criteria. This retrospective observational study was conducted on consecutive acute ischemic stroke patients admitted to the top referral hospital, West Java, Indonesia. The data displayed are epidemiological characteristics, NIHSS score at admission and discharge, and the type and number of risk factors. Data were then analyzed using appropriate statistical tests.

RESULTS: Most patients had more than one risk factor with hypertension as the most frequent (268 subjects or 89.3%). In patients who experienced ischemic stroke for the first time, the average National Institutes of Health Stroke Scale (NIHSS) score was lower (6.52 ± 3.55), and the alteration of NIHSS score was higher (1.22 ± 2.26) than those with recurrent stroke (6.96 ± 3.55) for NIHSS score and 1.21 ± 1.73 for alteration of NIHSS score). We processed the data with statistical analysis and showed a positive correlation between age (P < 0.05) and the number of risk factors (P < 0.001) in the recurrent ischemic stroke group.

CONCLUSIONS: Age and the number of risk factors correlate with recurrent ischemic strokes.

PMID:35918760 | DOI:10.1186/s40001-022-00768-y

J Transl Med. 2022 Aug 2;20(1):345. doi: 10.1186/s12967-022-03555-9.

ABSTRACT

OBJECTIVE: We and others have previously demonstrated that the size-selection enrichment method could remarkably improve fetal fraction (FF) in the early gestational age (GA, 12-13 weeks), suggesting that 9 or 10 weeks should not be used as a threshold for GA in size-selection noninvasive prenatal screening (NIPS). Here, we assessed whether this method was reliable for detecting fetal chromosomal aneuploidy at the earliest GA (6-8 weeks).

METHODS: Size-selection NIPS for fetal chromosomal aneuploidy was applied to 208 pregnancy plasma samples (102 male and 106 female fetuses), while the 169 pregnancy samples with male fetuses also underwent standard NIPS. Multivariable linear regression models were used to evaluate the association between fold-change of FF and experimental factors.

RESULTS: The sensitivity of the cell-free DNA (cfDNA) test in detecting aneuploidy was 100% when screened with FF enrichment, whereas the sensitivity of the same patients was only 62.5% (5/8) without FF enrichment. In the 102 pregnancy samples with male fetuses, FF increased from 6.1% to 15.7%, and the median increase in FF was 2.8-fold with enrichment. Moreover, there was a trend toward an increasing success rate of the cfDNA test from 6 to 13 weeks of gestation, especially when the test success rate reached 100% after 7 weeks with FF enrichment. Multivariate linear regression analysis demonstrated that a lower initial FF, shorter cfDNA size, increased body mass index (BMI), and later GA were all independent predictors of a higher fold-change of FF. Compared with ≤ 120 bp cfDNA fragments, the mean fold-change of FF differences was 0.820 for 121-125 bp, 0.229 for 126-130 bp, – 0.154 for 131-135 bp, – 0.525 for 136-140 bp and – 0.934 for > 140 bp (P_trend < 0.0001), suggesting that fold-change of FF significantly decreased with cfDNA fragments > 125 bp. These results were statistically significant after adjusting for confounding factors in the models for fold-change of FF.

CONCLUSIONS: The FF enrichment method is a reasonable strategy to detect fetal chromosomal aneuploidy in early pregnancy loss with reduced false negatives and increased test success rate after 7 weeks of GA and should be recommended for patients with early pregnancy loss.

PMID:35918754 | DOI:10.1186/s12967-022-03555-9