Tag: nevin manimala

Dis Esophagus. 2023 Dec 14:doad069. doi: 10.1093/dote/doad069. Online ahead of print.

ABSTRACT

Stag Beetle Knife (SB Knife) is increasingly being utilized for Zenker’s Diverticulectomy (ZD). Our study assessed the effectiveness and safety of the SB Knife for the management of ZD. Ovid EBM reviews, Ovid Embase, Ovid Medline, ClinicalTrials.gov, Scopus, and Web of Science were searched to identify studies that utilized SB knife for ZD. Pooled proportions (PP) were calculated using the random-effects model. Heterogeneity was evaluated using I2 statistics. A total of 7 studies with 268 patients were included in the final analysis. Dysphagia and regurgitation were the most common clinical symptoms. The mean size of the ZD was 2.8 ± 0.7 cm and 28 (of 148) patients had undergone previous treatments. The PP of technical success was 98% (95% CI: 92.3-99.5; I20) with a mean procedure duration of 26.2 ± 8.3 minutes. The PP of clinical response at first follow-up and relapse after index procedure was 87.9% (95% CI: 81.6-92.3; I219) and 13.5% (95% CI: 9.6-18.6; I22), respectively. At final follow-up, the PP of clinical remission was 96.2% (95% CI: 91-98.4; I230.6) while the PP of procedure failure was 3.6% (95% CI: 1.6-8.1; I20). No severe adverse events (AEs) were noted while using the SB Knife. However, the PP of intraprocedural and postprocedural AEs was 13.2% (95% CI: 9.6-17.8; I20) and 9.3% (95% CI: 5.7-14.9; I2 < 20.9), respectively. SB Knife is highly safe and effective for Zenker’s Diverticulectomy with a failure rate of only 3.6%.

PMID:38100729 | DOI:10.1093/dote/doad069

Chron Respir Dis. 2023 Jan-Dec;20:14799731231222282. doi: 10.1177/14799731231222282.

ABSTRACT

BACKGROUND: Chronic lung diseases, such as chronic obstructive pulmonary disease or asthma, are associated with an increased risk of dementia. However, few data are available regarding the risk of dementia in individuals with bronchiectasis.

OBJECTIVES: To explore the association between bronchiectasis and the risk of incident dementia using a longitudinal population-based cohort.

METHODS: A total of 4,068,560 adults older than 50 years without previous dementia were enrolled from the Korean National Health Insurance Service database in 2009. They were followed up until the date of the diagnosis of dementia or December 31, 2020. The study exposure was the diagnosis of bronchiectasis, and the primary outcome was incident dementia comprising Alzheimer’s disease and vascular dementia.

RESULTS: During the median follow-up duration of 9.3 years, the incidence of all-cause dementia was 1.6-fold higher in individuals with bronchiectasis than in those without bronchiectasis (15.0 vs. 9.3/1000 person-years, p < .001). In the multivariable Cox regression analysis, the risk of all dementia was significantly higher in individuals with bronchiectasis than in those without bronchiectasis (adjusted hazard ratio [aHR] 1.09, 95% confidence interval [CI] 1.04-1.14). In a subgroup analysis by dementia type, individuals with bronchiectasis had an increased risk of Alzheimer’s disease compared to those without bronchiectasis (aHR 1.07, 95% CI 1.01-1.12); the risk of vascular dementia did not significantly differ between the two groups (aHR 1.05, 95% CI 0.90-1.21).

CONCLUSION: Bronchiectasis was associated with an increased risk of dementia, especially Alzheimer’s disease.

PMID:38100725 | DOI:10.1177/14799731231222282

Mod Rheumatol. 2023 Dec 8:road109. doi: 10.1093/mr/road109. Online ahead of print.

ABSTRACT

OBJECTIVES: : Assess real-world, long-term safety/effectiveness of mepolizumab for eosinophilic granulomatosis with polyangiitis (EGPA) in Japan.

METHODS: : MARS (GSK ID:213684/NCT04551989) is an ongoing 96-week study of patients with EGPA who received 4-weekly mepolizumab 300 mg subcutaneously for ≥96 weeks before study entry (baseline) and continued treatment. This interim analysis included safety from baseline to Week 48 (observation period) and clinical outcomes before mepolizumab and during the observation period.

RESULTS: : Of 118 patients enrolled, 29% (34/118) experienced adverse events (AEs) of which 13% (15/118) experienced serious AEs; none were considered mepolizumab-related. Median oral corticosteroid (OCS) dose decreased from 6.9 (pre-mepolizumab) to 3.0 (baseline) and 2.0 mg/day (Weeks 45-48); the proportion of patients receiving no OCS increased from 8% to 32% and 38%, respectively. Patients experiencing clinical symptoms decreased from 94% (pre-mepolizumab) to 73% (baseline) and 67% (Week 48). During the observation period, 5% of patients experienced EGPA relapse; rates of EGPA-related hospitalisations, EGPA-related emergency room/unscheduled visits and asthma exacerbations were 0.05, 0.09 and 0.08 event/person-year, respectively.

CONCLUSIONS: : Results of mepolizumab treatment for ≥144 weeks (before baseline plus observation) were consistent with the known safety profile and allowed OCS dose reduction while improving disease control versus pre-treatment among patients with EGPA.

PMID:38100679 | DOI:10.1093/mr/road109

J Phys Chem A. 2023 Dec 15. doi: 10.1021/acs.jpca.3c06244. Online ahead of print.

ABSTRACT

In a recent study [J. Chem. Theory Comput. 2021, 17, 1457-1468], some of us examined the accuracy of magnetizabilities calculated with density functionals representing the local density approximation (LDA), generalized gradient approximation (GGA), meta-GGA (mGGA), as well as global hybrid (GH) and range-separated (RS) hybrid functionals by assessment against accurate reference values obtained with coupled-cluster theory with singles, doubles, and perturbative triples [CCSD(T)]. Our study was later extended to local hybrid (LH) functionals by Holzer et al. [J. Chem. Theory Comput. 2021, 17, 2928-2947]; in this work, we examine a larger selection of LH functionals, also including range-separated LH (RSLH) functionals and strong-correlation LH (scLH) functionals. Holzer et al. also studied the importance of the physically correct handling of the magnetic gauge dependence of the kinetic energy density (τ) in mGGA calculations by comparing the Maximoff-Scuseria formulation of τ used in our aforementioned study to the more physical current-density extension derived by Dobson. In this work, we also revisit this comparison with a larger selection of mGGA functionals. We find that the newly tested LH, RSLH, and scLH functionals outperform all of the functionals considered in the previous studies. The various LH functionals afford the seven lowest mean absolute errors while also showing remarkably small standard deviations and mean errors. Most strikingly, the best two functionals are scLHs that also perform remarkably well in cases with significant multiconfigurational character, such as the ozone molecule, which is traditionally excluded from statistical error evaluations due to its large errors with common density functionals.

PMID:38100678 | DOI:10.1021/acs.jpca.3c06244

Int J Pharm Compd. 2023 Nov-Dec;27(6):503-511.

ABSTRACT

Maintaining the microbial quality of the environment is crucial in pharmaceutical institutions, especially community pharmacies, since they have a direct relationship with patients. The sterility of the environmental surfaces of pharmacies can be maintained by proper cleaning and disinfecting. Microbial contamination is the primary reason for product spoilage or deterioration. The present study was carried out to assess the sanitation practices of pharmacies on the maintenance of cleanliness followed by isolation and identification of microorganisms from surface and air samples of selected pharmacies. All the pharmacies followed daily sanitization practices in the pharmacy premises and surrounding environment. However, only 20% of the pharmacies cleaned their equipment daily. In total, 33 bacterial species were identified from the pharmacies. Of these, 31 were Gram-positive (29 coagulase-negative staphylococci) and 2 Streptococcus spp., while 2 were Gram-negative (Pseudomonas aeruginosa and Proteus vulgaris). The colony-forming unit count of air samples after one-hour exposure under uni-directional air flow was less than 20 except from one pharmacy which was 59. Significant statistical associations were not observed between the presence of separate extemporaneous preparation rooms, separate counseling places, type of disinfectant, spillage management, and the growth of organisms in the pharmaceutical products and complaints received for spoiled products. However, some pharmacies under investigation were confirmed to have had poor sterility-control practices since they showed the growth of fastidious organisms both Gram-negative bacilli and Gram-positive cocci of which the latter was in more abundance.

PMID:38100668

Am J Hosp Palliat Care. 2023 Dec 15:10499091231213359. doi: 10.1177/10499091231213359. Online ahead of print.

ABSTRACT

Background: Opioid therapy is critical for pain relief for most hospice patients but may be limited by adverse side effects. Combining medical cannabis with opioids may help mitigate adverse effects while maintaining effective pain relief. Aim: This single-arm study investigated the impact of combined medical cannabis/opioid therapy on pain relief, opioid dose, appetite, respiratory function, well-being, nausea, and adverse events in hospice inpatients. Design: Adult hospice inpatients using scheduled oral, parenteral, or transdermal opioids for pain were administered standardized oral medical cannabis, 40 mg CBD/1.5 mg THC or 80 mg CBD/3 mg THC. Descriptive statistics detailed demographic and clinical baseline characteristics, the Mann-Whitney test compared outcomes, and the longitudinal mixed effects regression model analyzed longitudinal effects of combined therapy. Setting/Participants: Sixty-six inpatients at The Connecticut Hospital, Inc. were assessed over 996 treatment days; average age was 68.2 ± 12.9 years, 90.9% were white. Cancer was the most common diagnosis. Results: The medical cannabis/opioid combination showed a significant longitudinal reduction in pain intensity (P = .0029) and a non-significant trend toward lower opioid doses. Well-being, appetite, nausea, and respiratory function showed non-statistically significant changes. Three patients (4.5%) experienced minor, reversible adverse events potentially related to medical cannabis. No serious or life-threatening adverse events were seen. Conclusion: Combination medical cannabis/opioid therapy showed statistically significant pain relief and may have the potential for reducing opioid dose and mitigating opioid toxicity, offering a safe pain management alternative to opioids alone for patients in end-of-life care settings, and warrants further investigation in larger controlled trials.

PMID:38100655 | DOI:10.1177/10499091231213359

Eur J Emerg Med. 2023 Dec 13. doi: 10.1097/MEJ.0000000000001108. Online ahead of print.

ABSTRACT

BACKGROUND AND IMPORTANCE: Traumatic cardiac arrest is associated with poor prognosis, and timely evidence-based treatment is paramount for increasing survival rates. Physician-staffed helicopter emergency medical service use in major trauma has demonstrated improved outcomes. However, the sparsity of data highlights the necessity for a comprehensive understanding of the epidemiology of traumatic cardiac arrest.

OBJECTIVES: The primary objective of the present study was to evaluate survival and return of spontaneous circulation (ROSC) and to investigate the characteristics of patients with traumatic cardiac arrest assessed by the Danish HEMS.

DESIGN: This was a population-based cohort study based on data from the Danish helicopter emergency medical service database.

SETTINGS AND PARTICIPANTS: The study included all patients assessed by the Danish helicopter emergency medical services between 2016 and 2021.

OUTCOME MEASURES AND ANALYSIS: Data were analysed using descriptive statistics, non-parametric testing and logistic regression analyses. Descriptive analysis of prehospital interventions included cardiopulmonary resuscitation, defibrillation, airway management, administration of blood products, and thoracic decompression. The primary outcome was 30-day survival, and the key secondary outcome was prehospital ROSC.

MAIN RESULTS: A total of 223 patients with TCA were included. The median age was 54 years (IQR 34-68), and the majority were males. Overall, 23% of patients achieved prehospital ROSC, and the 30-day survival rate was 4%. Factors associated with an increased likelihood of ROSC were an initial shockable cardiac rhythm, odds ratio (OR) of 3.78 (95% CI 1.33-11.00) and endotracheal intubation, OR 7.10 (95% CI 2.55-22.85).

CONCLUSION: This study highlights the low survival rates observed among patients with traumatic cardiac arrest assessed by helicopter emergency medical services. The findings support the positive impact of an initial shockable cardiac rhythm and endotracheal intubation in improving the likelihood of ROSC. The study contributes to the limited literature on traumatic cardiac arrests assessed by physician-staffed helicopter emergency services. Finally, the findings emphasise the need for further research to understand and improve outcomes in this subgroup of cardiac arrest.

PMID:38100645 | DOI:10.1097/MEJ.0000000000001108

J Med Virol. 2023 Dec;95(12):e29276. doi: 10.1002/jmv.29276.

ABSTRACT

Chikungunya virus (CHIKV) is an arbovirus (Togaviridae family, Alphavirus genus) that was first identified in 1953 in Tanzania. In 2014, the Asian and East/Central/South/African (ECSA) genotypes were identified in Brazil, although the genotype that spread the most in the following years across the Brazilian territory was the ECSA. The clinical symptoms associated with the infection caused by CHIKV include mainly fever, myalgia, headache, and arthralgia. In infections caused by other arboviruses (such as the ones caused by Dengue and West Nile viruses), changes in biochemical markers are often observed. This study aims to evaluate the biochemical markers profile of kidney and liver injury in acute patients infected with CHIKV. Two groups of correlations were found between the variables analyzed, namely, one between liver enzymes (r = 0.91), and another for kidney markers (r = 0.54-0.66). A significant elevation in the percentage of altered creatinine in CHIKV-infected patients was observed, followed by uric acid and AST. Altogether, in 8 different comparisons, it was possible to observe statistically significant differences between the levels of the markers when compared to the manifestation of symptoms (presence and absence). These noticeable changes in marker measurements could potentially be connected to the range of clinical symptoms seen in the disease.

PMID:38100636 | DOI:10.1002/jmv.29276

Int J Surg. 2023 Dec 14. doi: 10.1097/JS9.0000000000000990. Online ahead of print.

ABSTRACT

BACKGROUND: Conversional bariatric surgery inherently has less weight loss (WL) compared to primary procedures. Adjunctive use of the GLP-1analogue, liraglutide with conversional Roux-en-RYGB Gastric Bypass (cRYGB) may maximize the WL benefits of surgery.

MATERIAL AND METHODS: This single-center randomized double-blind placebo-controlled trial included 80 patients randomized into two groups; the liraglutide group (40 patients) who received daily injections of liraglutide, and the placebo group (40 patients) who received normal saline starting at 6-weeks from cRYGB and continued for 6 months. After discontinuing the drugs at 6 months and unblinding, the patient were followed up to 12 months. The endpoints were percentage of total weight loss (%TWL) and percentage of excess weight loss (%EWL), and changes in the metabolic biomarkers, and complications within 30 and 90 days according to the global outcome benchmark (GOB) stratification.

RESULTS: In total, 38 patients in the liraglutide group and 31 in the placebo group completed the 24 weeks. Liraglutide group experienced better WL with a significantly higher mean %TWL at one month (10.27±1.39 vs. 8.41±2.08), at 6 weeks (12.65±1.77 vs. 10.47±2.23), at 6 months (18.29 ±1.74vs. 15.58 ±1.65), and at 12 months 24.15±2.35 versus 22.70±2.13 (all P<0.001). For %EWL, this was also significantly higher in the liraglutide group at all time points. A %TWL of>20% at 6 months of treatment was recorded in 6 (15.8%) patients in the liraglutide group and none in the placebo group (P=0.029). Both groups had comparable changes in metabolic biomarkers. Adverse events were recorded in 11 (27.5%) patients in the liraglutide, with no adverse events in the placebo group (P<0.001). Both groups had Clavien-Dindo scores I and II (5.0% and 2.5%), and GOB values indicated that 90.0% and 97.5% were low-risk patients.

CONCLUSION: Adjunctive use of liraglutide with cRYGB gives significantly higher WL and resolution of associated medical problems.

PMID:38100630 | DOI:10.1097/JS9.0000000000000990

Cancer. 2023 Dec 15. doi: 10.1002/cncr.35135. Online ahead of print.

ABSTRACT

Although cure rates remain low and effective screening strategies are elusive, the recent advances in systemic therapies over the past year highlighted in this review have prolonged survival for women with ovarian cancer. In 2022, the first antibody-drug conjugate for platinum-resistant ovarian cancer received accelerated US Food and Drug Administration (FDA) approval. Confirmatory studies examining the efficacy of mirvetuximab and other antibody-drug conjugates are underway. In the upfront setting, the first data establishing an overall survival benefit from poly(ADP-ribose) polymerase inhibitor maintenance was demonstrated after a 7-year follow-up period. In contrast, long-term updates from poly(ADP-ribose) polymerase inhibitor trials in the noncurative setting reported survival detriments, and the FDA withdrew the respective indications. Several trials attempted to improve upon the standard of care for platinum-sensitive ovarian carcinoma and those with rare ovarian cancer histologies (carcinosarcoma, clear cell carcinoma) but failed to demonstrate a clinically or statistically meaningful benefit. This leaves the open question of how to further optimize systemic therapy for advanced ovarian carcinoma to improve long-term survival and cure rates.

PMID:38100616 | DOI:10.1002/cncr.35135