Tag: nevin manimala

Pathophysiology. 2021 Aug 31;28(3):387-399. doi: 10.3390/pathophysiology28030026.

ABSTRACT

Hepatocellular carcinoma (HCC) remains an important form of cancer-related morbidity and mortality in the U.S. and worldwide. Previous U.S.-based studies on survival suggest ethnic disparities in HCC patients, but the complex interplay of multiple factors that contribute are still incompletely understood. Here we considered the influences of risk factors contributing towards HCC survival, including ethnic background, over ten years at a premier academic medical center with a majority (57.20%) African American (AA) population. Retrospective HCC data were collected from 2008-2018 at LSUHSC-Shreveport, an urban tertiary medical center. Data included demographics, comorbidities, liver disease characteristics, and tumor parameters. Statistical analysis was performed using Chi Square and one-way ANOVA. Results: 229 HCC patients were identified (male 78.6%). The mean HCC age at diagnosis was 61 years (SD = 7.3). Compared to non-Hispanic Caucasians (42.7%), AA patients (57.2% of total) were older at presentation, had more frequent diabetes/dyslipidemia/NAFLD (45 (34.3%) compared with 19 (19.3%) in non-Hispanic Caucasians, p = 0.02), and had a larger HCC burden at diagnosis. We conclude that compared to white patients, despite having similar BMI and MELD scores and rates of portal vein thrombosis, AA patients with HCC in our cohort were older at presentation, had a significantly increased incidence of modifiable metabolic risk factors including diabetes, higher AFP values, increased incidence of gallstones, and larger sized HCCs, and were more likely to be outside Milan criteria. These findings have important prognostic and diagnostic implications for developing a more targeted HCC surveillance program.

PMID:35366282 | DOI:10.3390/pathophysiology28030026

Pathophysiology. 2022 Mar 7;29(1):92-105. doi: 10.3390/pathophysiology29010009.

ABSTRACT

The clinical manifestations associated with COVID-19 disease is mainly due to a dysregulated host response related to the overexpression of inflammatory markers. Until recently, only remdesivir had gained FDA approval for COVID-19 hospitalized patients and there are currently no evidence-based therapeutic options or options for prevention of complications that have been established. Some medical treatments such as antivirals, antibacterials, antithrombotics, antipyretics, corticosteroids, interleukin inhibitors, monoclonal antibodies, convalescent plasma, immunostimulants, and vitamin supplements have been utilized. However, there are limited data to support their effectiveness. Hence, this study was attempted to identify and evaluate the effectiveness of antibacterials and antivirals used for COVID-19 using a retrospective cross-sectional approach based on the medical records of adult patients in four hospitals. The number of antibacterials was calculated in defined daily dose (DDD) per 100 bed-days unit. Both mixed-logit regression and analysis of covariance were used to determine the effectiveness of the aforementioned agents in relation to COVID-19 outcome and patients’ length of stay. The model was weighed accordingly and covariates (e.g., age) were considered in the model. Heart disease was found to be the most common pre-existing condition of COVID-19 hospitalized patients in this study. Azithromycin, an antibacterial in the Watch category list, was used extensively (33-65 DDD per 100 bed-days). Oseltamivir, an antiviral approved by the FDA for influenza was the most prescribed antiviral. In addition, favipiravir was found to be a significant factor in improving patients’ COVID-19 outcomes and decreasing their length of stay. This study strongly suggests that COVID-19 patients’ received polypharmacy for their treatment. However, most of the drugs used did not reach statistical significance in improving the patients’ condition or decreasing the length of stay. Further studies to support drug use are needed.

PMID:35366292 | DOI:10.3390/pathophysiology29010009

Pathophysiology. 2021 Jul 20;28(3):328-338. doi: 10.3390/pathophysiology28030022.

ABSTRACT

Decline in normal physiological pulmonary function has been attributed to premorbid conditions such as prehypertension. Research evidence suggests that physical activity reduces age-related decline in pulmonary function and improves the efficiency of the lungs in prehypertensive patients. However, there is a scarcity of data evidence relating to isometric exercise and pulmonary function. Furthermore, the interrelationship between the intensity and duration of isometric exercise and pulmonary function in these patients is still uncertain. Therefore, this study was undertaken to investigate the effect of isometric handgrip exercise on pulmonary function capacity in adults with prehypertension. To determine the effectiveness of isometric handgrip exercise on pulmonary function capacity in adults with prehypertension. A quasi experiment using a pre- and post-exercise method was carried out in two out-patients hospital settings. The sample comprised 192 sedentary pre-hypertensive subjects, aged between 30-50 years, that were randomly distributed into three groups of 64 participants each. The subjects performed, for 24 consecutive days, an isometric handgrip exercise at 30% Maximum Voluntary Contraction (M.V.C.). At the end of the 24 days, group one (GP1) discontinued, while group two (GP2) continued the exercise protocol for another 24 consecutive days and group three (GP3) continued with the exercise protocol for another 24 consecutive days but at 50% M.V.C. Determinants of lung function (outcomes) were Forced Expiratory Volume in 1 s (FEV1), Forced Vital Capacity (FVC), FEV1/FVC Ratio and Peak Expiratory Flow Rate (PEFR). The study shows that there was no statistically significant difference in the pre- and post-exercise outcomes for FEV1, FVC, FEV1/FVC Ratio and PEFR after 24 days for group 1. In group 2, there was a statistically significant difference in the FVC [(mean = 0.12 ± 0.12), (p = 0.002)], FEV1 [(mean = 0.15 ± 0.17), (p = 0.003)] and PEF [(mean = 0.85 ± 0.35), (p = 0.001)] after 48 days. In group 3, there was a statistically significant difference (p = 0.001) in all the outcomes assessed after 48 days. There was a between groups difference in favour of group 2 compared with group 1 for outcomes of FEV1 [(mean = 0.142 ± 0.68), (p = 0.005)] and PEF [(mean = 0.83 ± 0.19), (p = 0.0031)]. There was statistically significant difference in favour of group 3 compared to group 2, by increasing the exercise intensity from 30% to 50% M.V.C., for outcomes of FVC [mean change = 0.10 ± 0.052), (p = 0.005)], FEV1/FVC [mean change = 3.18 ± 0.75), (p = 0.017)] and PEF [(mean change = 0.86 ± 0.35), (p = 0.001)] after 48 days. Isometric handgrip exercise (after 48 days at 30% to 50% M.V.C.) improves outcomes of pulmonary function capacity in adults with prehypertension. Meanwhile, duration and/or increase in intensity of the isometric effort significantly contributed to the affects attained.

PMID:35366278 | DOI:10.3390/pathophysiology28030022

Environ Sci Pollut Res Int. 2022 Apr 2. doi: 10.1007/s11356-022-19975-5. Online ahead of print.

ABSTRACT

For nations already facing pollution issues, fossil fuel energy consumption is deteriorating living standards. Though prevailing infrastructure makes fossil fuel energy use feasible for production, it still pollutes our environment. This study in the domain of environment and development assesses the impact of fossil fuel energy consumption on the infant mortality rate in 15 Asian economies during 1996 and 2019. The living standards are assessed using infant mortality rate, while non-linear fossil fuel energy consumption is used with gross capital formation, employment, and preprimary education as independent variables. The feasible generalized least square method evaluates the effects. The study concludes that fossil fuel energy consumption follows a U-shaped relationship explaining infant mortality. The results point out that over-consumption of fossil fuel energy is deteriorating the living standards considering low air quality levels in Asian economies.

PMID:35366207 | DOI:10.1007/s11356-022-19975-5

Pathophysiology. 2021 Dec 20;28(4):544-550. doi: 10.3390/pathophysiology28040035.

ABSTRACT

Sarcoidosis (SC) is a granulomatous disease of an unknown origin. The most common SC-related neurological complication is a small fiber neuropathy (SFN) that is often considered to be the result of chronic inflammation and remains significantly understudied. This study aimed to identify the clinical and histological correlates of small fiber neuropathy in sarcoidosis patients. The study was performed in 2018-2019 yy and included 50 patients with pulmonary sarcoidosis (n = 25) and healthy subjects (n = 25). For the clinical verification of the SFN, the “Small Fiber Neuropathy Screening List” (SFN-SL) was used. A punch biopsy of the skin was performed followed by enzyme immunoassay analysis with PGP 9.5 antibodies. Up to 60% of the sarcoidosis patients reported the presence of at least one complaint, and it was possible that these complaints were associated with SFN. The most frequent complaints included dysfunctions of the cardiovascular and musculoskeletal systems and the gastrointestinal tract. A negative, statistically significant correlation between the intraepidermal nerve fiber density (IEND) and SFN-SL score was revealed. In patients with pulmonary sarcoidosis, small fiber neuropathy might develop as a result of systemic immune-mediated inflammation. The most common symptoms of this complication were dysautonomia and mild sensory dysfunction.

PMID:35366250 | DOI:10.3390/pathophysiology28040035

Breast Cancer Res Treat. 2022 Apr 2. doi: 10.1007/s10549-022-06571-x. Online ahead of print.

ABSTRACT

PURPOSE: This case-control study assesses the independent roles of reproductive history, postmenopausal hormonal therapy (HT), socioeconomic status (SES), and occupational physical activity on the risk of breast cancer (BC).

METHODS: Odds ratios (OR) were estimated from conditional logistic multivariate regression model in a data set of 19,253 Finnish women diagnosed with BC between 1994 and 2013 and 96,265 age-matched population controls.

RESULTS: Both pre- and postmenopausal white-collar workers had significantly increased risk of ductal and lobular BC as compared to manual workers. Moderate occupational physical activity reduced risk of lobular BC by 14%. There was a transient increase in the risk of BC observed after each birth followed by a protective effect starting some years after the delivery. As the number of children increased, the short-term excess risk was lower and protective effect was observed earlier. Continuous estrogen-progestin therapy (EPT) significantly increased the risk of both ductal and lobular BC and the magnitude of risk was directly proportional to duration of use (OR for 5+ years of use 2.26, 95% confidence interval 2.12-2.42). Monthly EPT for 5+ years increased the risk (OR 1.32, 95% CI 1.20-1.45). Users of estradiol plus levonorgestrel intrauterine system devices showed ORs of 1.56 (95% CI 1.45-1.69) and 2.18 (95% CI 1.81-2.64) for ductal and lobular BC, respectively.

CONCLUSION: This study concludes that pregnancy has a dual effect on BC risk, with a transient increase in risk followed by a long-term protective effect. The SES and HT have a large effect on BC risk while occupational physical activity has only a small independent effect.

PMID:35366162 | DOI:10.1007/s10549-022-06571-x

Int Urol Nephrol. 2022 Apr 2. doi: 10.1007/s11255-022-03188-3. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed at comparing the prevalence of cognitive frailty and explore the differences in the influencing factors between elderly and middle-young patients receiving maintenance hemodialysis (MHD).

METHODS: In this cross-sectional study, the frailty phenotype, mini-mental state examination, and clinical dementia rating were used to assess the current status of cognitive frailty in 852 patients receiving MHD from four hospitals in Lianyungang City and Xuzhou City, Jiangsu Province, China; the influencing factors were then analyzed for statistical significance.

RESULTS: Of the total 852 patients receiving MHD, 340 were classified into an elderly group (≥ 60 years) and 512 into a middle-young group (< 60 years). The prevalence of cognitive frailty was 35.9% and 8.8%, respectively. The results of multivariate logistic regression analysis showed that the independent factors of cognitive frailty were age (P < 0.001), education level (P = 0.010), nutritional status (P = 0.001), serum albumin level (P = 0.010), calf circumference (P = 0.024), and social support level (P < 0.001) in the elderly group and comorbidity status (P = 0.037), education level (P < 0.001), nutritional status (P = 0.008), serum creatinine level (P = 0.001), waist circumference (P < 0.001), and depression (P = 0.006) in the middle-young group.

CONCLUSION: The prevalence of cognitive frailty was significantly higher in the elderly group than in the middle-young group, and the influencing factors differed between the two populations.

PMID:35366144 | DOI:10.1007/s11255-022-03188-3

J Psycholinguist Res. 2022 Apr 2. doi: 10.1007/s10936-022-09863-x. Online ahead of print.

ABSTRACT

In recent years large datasets of lexical processing times have been released for several languages, including English, French, Spanish, and Dutch. Such datasets have enabled us to study, compare, and model the global effects of many psycholinguistic measures such as word frequency, orthographic neighborhood (ON) size, and word length. We have compiled and publicly released a frequency and ON dictionary of 64,546 words and 1800 plausible NWs from a language that has been relatively little studied by psycholinguists: Persian. We have also collected visual lexical decision reaction times for 1800 Persian words and nonwords. Persian offers an interesting psycholinguistic environment for several reasons, including that it has few long words and has resultantly dense orthographic neighborhoods. These characteristics provide us with an opportunity to contrast how these factors affect lexical access by comparing them to several other languages. The results suggest that sensitivity to word length and orthographic neighbourhood may reflect the statistical structure of a particular language, rather than being a universal element of lexical processing. The dictionary and LDRT data are available from https://osf.io/tb4m6/ .

PMID:35366147 | DOI:10.1007/s10936-022-09863-x

Int Ophthalmol. 2022 Apr 2. doi: 10.1007/s10792-022-02273-x. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the results of surgical management of glaucoma following different keratoplasty techniques.

METHODS: Medical records of 628 cases who underwent keratoplasty were reviewed. One hundred and eighty-eight patients (29.9%) who developed post-keratoplasty glaucoma were evaluated. Patients who could not be controlled with maximal medical treatment and underwent glaucoma surgery were included in this study. Trabeculectomy, Ahmed glaucoma valve (AGV) implantation or diode laser cyclophotocoagulation (DLC) were applied.

RESULTS: Glaucoma surgery was performed in 55 (29.3%) patients who had uncontrolled post-keratoplasty glaucoma. In penetrating keratoplasty group (n = 42), DLC was applied to 30 (71.4%) eyes, AGV to 11 (26.2%) eyes, and trabeculectomy in 1 (2.4%) eye. In Descemet’s membrane endothelial keratoplasty group (n = 8), DLC was applied to 4 (50%) eyes, trabeculectomy for 3 (37.5%) eyes and AGV for 1 (12.5%) eye. In deep anterior lamellar keratoplasty group (n = 5), DLC was applied to 2 (40%) eyes, trabeculectomy to 2 (40%) eyes and AGV to 1 (20%) eye. While a statistically significant decrease was found in intraocular pressure (IOP) and anti-glaucomatous medication after surgery (p < 0.05 for each), no significant difference was found in best corrected visual acuity (BCVA). During follow-up, DLC was applied as re-glaucoma surgery in 19 (34.5%) cases. A significant reduction in IOP together with number of anti-glaucomatous medications was found with re-operation; however, a significant decrease in BCVA was noted (p < 0.05 for each).

CONCLUSION: Glaucoma surgeries after keratoplasty are effective in decreasing IOP and the number of anti-glaucomatous medication. While BCVA doesn’t change after the first glaucoma surgery, after re-operation significant decrease may occur.

PMID:35366139 | DOI:10.1007/s10792-022-02273-x

Eur Radiol. 2022 Apr 2. doi: 10.1007/s00330-022-08766-8. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of the study was to evaluate the effect of an interactive training program on the learning curve of radiology residents for bladder MRI interpretation using the VI-RADS score.

METHODS: Three radiology residents with minimal experience in bladder MRI served as readers. They blindly evaluated 200 studies divided into 4 subsets of 50 cases over a 3-month period. After 2 months, the first subset was reassessed, resulting in a total of 250 evaluations. An interactive training program was provided and included educational lessons and case-based practice. The learning curve was constructed by plotting mean agreement as the ratio of correct evaluations per batch. Inter-reader agreement and diagnostic performance analysis were performed with kappa statistics and ROC analysis.

RESULTS: As for the VI-RADS scoring agreement, the kappa differences between pre-training and post-training evaluation of the same group of cases were 0.555 to 0.852 for reader 1, 0.522 to 0.695 for reader 2, and 0.481 to 0.794 for reader 3. Using VI-RADS ≥ 3 as cut-off for muscle invasion, sensitivity ranged from 84 to 89% and specificity from 91 to 94%, while the AUCs from 0.89 (95% CI:0.84, 0.94) to 0.90 (95% CI:0.86, 0.95). Mean evaluation time decreased from 5.21 ± 1.12 to 3.52 ± 0.69 min in subsets 1 and 5. Mean grade of confidence improved from 3.31 ± 0.93 to 4.21 ± 0.69, in subsets 1 and 5.

CONCLUSION: An interactive dedicated education program on bladder MRI and the VI-RADS score led to a significant increase in readers’ diagnostic performance over time, with a general improvement observed after 100-150 cases.

KEY POINTS: • After the first educational lesson and 100 cases were interpreted, the concordance on VI-RADS scoring between the residents and the experienced radiologist was significantly higher. • An increase in the grade of confidence was experienced after 100 cases. • We found a decrease in the evaluation time after 150 cases.

PMID:35366122 | DOI:10.1007/s00330-022-08766-8