Tag: nevin manimala

Emerg Med Australas. 2023 Oct 2. doi: 10.1111/1742-6723.14320. Online ahead of print.

ABSTRACT

OBJECTIVES: Despite significant treatment advances in paediatric diabetes management, ED presentations for potentially preventable (PP) complications such as diabetic ketoacidosis (DKA) remains a major issue. We aimed to examine the characteristics, rates and trends of diabetes-related ED presentations and subsequent admissions in youth aged 0-19 years from 2008 to 2018.

METHODS: Data were obtained from the Victorian Emergency Minimum Dataset and the National Diabetes Register. A diabetes-related ED presentation is defined using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification diagnosis codes. ‘Non-preventable’ presentations were the number of youths with newly diagnosed diabetes, and the remaining are classified as PP diabetes-related presentations. Poisson regression model was used to examine the trends in incidence rate and prevalence.

RESULTS: Four thousand eight hundred and seventy-two (59%) of 8220 presentations were PP, 4683 (57%) were for DKA whereas 6200 (82%) required hospital admission. Diabetes-related ED presentations decreased from 38.4 to 27.5 per 100 youth with diabetes per year between 2008 and 2018 (β = -0.04; confidence interval [CI] -0.04 to -0.03; P < 0.001). Females, those aged 0-4 years and rural youth had higher rates of ED presentations than males, older age groups and metropolitan youth. DKA presentations decreased from 20.1 presentations per 100 youth with diabetes in 2008-2009 to 14.9 presentations per 100 youth with diabetes in 2017-2018. The rate of DKA presentations was 68% higher in rural areas compared to metropolitan areas (incidence rate ratio 1.68; CI 1.59-1.78; P < 0.001).

CONCLUSIONS: Although the rates of diabetes-related ED presentations declined, PP diabetes-related presentations and subsequent hospitalisation remain high. Patient level research is required to understand the increased DKA presentations in rural youth.

PMID:37783473 | DOI:10.1111/1742-6723.14320

Am J Trop Med Hyg. 2023 Oct 2:tpmd230048. doi: 10.4269/ajtmh.23-0048. Online ahead of print.

ABSTRACT

Tuberculosis (TB) is the leading cause of death among people living with HIV (PLWH). Limited TB knowledge has been associated with delayed TB diagnosis and low adherence to TB treatment. A cross-sectional study was conducted among PLWH at the largest HIV-referral center in Lima, Peru, to describe TB knowledge among PLWH and potential associated sociodemographic factors. Participants answered a self-administered survey on TB knowledge, which consisted of five questions about TB cure, transmission, treatment, symptoms, and prevention. Of 179 PLWH enrolled, most participants did not know that isoniazid (85%) and antiretrovirals (78%) are preventive measures for TB, and 56 (31.3%) knew that TB can be asymptomatic in PLWH. We did not find statistical differences in TB knowledge based on gender, education, marital status, and time on HIV care. We identified important gaps in TB knowledge among PLWH. Addressing these gaps could empower PLWH to reduce their TB risk.

PMID:37783463 | DOI:10.4269/ajtmh.23-0048

Sci Total Environ. 2023 Sep 30:167514. doi: 10.1016/j.scitotenv.2023.167514. Online ahead of print.

ABSTRACT

Acrylamide is an organic compound classified as probably carcinogenic to humans because of sufficient evidence in animals but not in humans. Other health risks associated with acrylamide intake are still not fully elucidated. We aimed to study the relationship between acrylamide dietary intake and mortality in the E3N (Etude Epidémiologique auprès de femmes de l’Education Nationale) French cohort. We studied 72,585 women of the E3N prospective cohort, which completed a food frequency questionnaire in 1993. The E3N food consumption database and the food contamination database obtained from the second French total diet study were used to estimate participants’ average daily acrylamide dietary intake. We estimated the associations between acrylamide dietary intake and all-cause or cause-specific mortality using Cox proportional hazard models. During follow-up (1993-2014), we identified 6441 deaths. The mean acrylamide dietary intake was 32.6 μg/day, with coffee consumption as principal contributor (48.6 %). In the fully adjusted model, we found a non-linear association between acrylamide dietary intake and all-cause mortality and a linear positive association with cardiovascular disease (HR per one STD increment [95%CI]: 1.11 [1.02; 1.21]), all-cancer (HR [95%CI]: 1.05 [1.01; 1.10]) and lung cancer (HR [95%CI]: 1.22 [1.09; 1.38]) mortality, while we observed no association with breast (HR [95%CI]: 0.94 [0.86; 1.03]) and colorectal (HR [95%CI]: 1.12 [0.97; 1.29]) cancer mortality. We highlighted an interaction between acrylamide dietary intake and smoking status in the models for all-cause and all-cancer mortality: when stratifying on smoking status, statistically significant positive associations were observed only in current smokers. This study on a large prospective cohort following >70,000 women for over 20 years suggests that higher acrylamide dietary intakes are associated with an increased risk of mortality. Therefore, it is essential to keep reducing acrylamide contamination and prevent dietary intake of acrylamide, especially among smokers.

PMID:37783439 | DOI:10.1016/j.scitotenv.2023.167514

Orthop Traumatol Surg Res. 2023 Sep 30:103695. doi: 10.1016/j.otsr.2023.103695. Online ahead of print.

ABSTRACT

INTRODUCTION: Clinical studies have indicated reduced reliance on blocking screws with the introduction of polyaxial locking nails, yet the biomechanical superiority of polyaxial locking over blocking screws remains unverified, specifically for distal dia-metaphyseal femur fractures.

HYPOTHESIS: We hypothesized that the combination of multiaxial locking using three screws and parallel locking reinforced by two blocking screws would result in superior outcomes compared to utilizing only parallel locking with two screws and one blocking screw.

MATERIALS AND METHODS: Third-generation custom-made femur models representing AO/OTA 32 A1.2 dia-metaphyseal comminuted oblique fractures were divided into four groups (n=10/group). Group A employed distal fixation with three 4.5-mm polyaxial screws. Group B used two parallel locking screws and two blocking screws, Group C used two parallel locking screws and one blocking screw, and Group D used only two parallel screws. Specimens underwent axial and torsional load testing to assess fatigue strength, ultimate strength, axial stiffness (N/mm), torsional stiffness (N·mm/deg), axial load to failure (N), torsional load to failure (N·mm), coronal and sagittal angulations, and fracture site collapse.

RESULTS: Group C exhibited statistically superior torsional stiffness compared to Groups B and D (P=0.039 and P=0.034, respectively). Axial load to failure was highest in Group B and lowest in Group D (P=0.032). Group C demonstrated the highest torsional strength, while Group B exhibited the lowest (P=0.006). Coronal displacement was greatest in Group B, while Group A showed the highest resistance (P=0.009). Group A demonstrated the greatest resistance to fracture site collapse, with the weakest specimens observed in Groups B and C (P=0.01).

DISCUSSION: The performance of a single laterally positioned blocking screw is comparable to using two blocking screws. Medial positioning of a second blocking screw is unnecessary for stability enhancement. Multiaxial locking prevents fracture site collapse and coronal plane angulation more effectively than other methods. Multiaxial locking and/or parallel screws with a single laterally positioned blocking screw provide superior stiffness and stability for treating unstable dia-metaphyseal distal femoral fractures.

LEVEL OF EVIDENCE: N/A.

PMID:37783426 | DOI:10.1016/j.otsr.2023.103695

Eur J Pharm Sci. 2023 Sep 30:106601. doi: 10.1016/j.ejps.2023.106601. Online ahead of print.

ABSTRACT

The aim of this work is to develop a novel simultaneous in vitro dissolution – in situ perfusion system (SDPS) as a potential tool to evaluate the in vivo performance of solid oral formulation in rat. The innovative nitrendipine (NTD) tablet of Bayotensin mite® made in Germany was used as reference listed drug (RLD), and five generic products from Chinese market were compared with RLD using the in vitro dissolution test method specified by the orange book and the SDPS method developed in this study. Four self-prepared NTD tablets with different proportions of microcrystalline cellulose/starch were employed to investigate the discriminatory ability of the SDPS for formulation. In addition, the predictivity of the SDPS in relation to data from in vivo pharmaceutics studies was evaluated. The 45-min dissolution test and multiple-pH dissolution profiles of generic product 1 and 2 have no difference compared with the RLD, but their dissolution profiles from the SDPS showed statistically significant differences. A biexponential formula successfully described the concentration profiles of self-prepared formulations in SDPS experiments. The k_dis (0.08 ± 0.01 ∼ 0.2 ± 0.03 min^-1) and k_a (about 2.30 × 10^-3 min^-1) values calculated by the formulas of F1-F3 suggested that the used excipients had no effect on the intestinal absorption of NTD, and it might be the property of active pharmaceutical ingredient that led to the difference among the generics. Furthermore, the in vivo rat pharmacokinetics study results of F1-F3 showed a good correlation (R² = 0.99) with the SDPS data. In summary, the SDPS is a promising tool to detect the unexpected quality changes of pharmaceutical products in weakly regulated markets, facilitate formulation screening, and potentially reduce animal testing for estimating the in vivo absorption behavior of solid oral formulations. The absorption performance of generic drugs in vivo should be further investigated.

PMID:37783379 | DOI:10.1016/j.ejps.2023.106601

J Oral Maxillofac Surg. 2023 Sep 14:S0278-2391(23)01118-7. doi: 10.1016/j.joms.2023.09.008. Online ahead of print.

ABSTRACT

BACKGROUND: The use of cannabis in the general population has steadily increased over recent years and there is limited literature regarding the anesthetic implications of chronic cannabis use, particularly in the setting of outpatient anesthesia.

PURPOSE: To determine whether chronic cannabis users undergoing deep sedation or general anesthesia during ambulatory procedures require more anesthetic agents than nonusers.

STUDY DESIGN, SETTING, AND SAMPLE: A retrospective cohort study of subjects undergoing deep sedation or general anesthesia at the Oklahoma University Oral and Maxillofacial Surgery Clinic from January to December 2022 was performed. The inclusion criteria were duration of anesthetic procedure between 15 to 40 minutes, use of propofol, fentanyl, ketamine, and midazolam, and extraction of at least 2 teeth. The exclusion criterion was patients undergoing adjunctive procedures other than extractions during sedation.

PREDICTOR VARIABLE: Cannabis use status was grouped as users and nonusers. A user was defined as a subject who self-reported any regular use of cannabis.

OUTCOME VARIABLE: The primary outcome variable was the amount of intravenous anesthetic agents administered. Secondary outcome variables included the length of the procedure and the number of teeth extracted.

COVARIATES: Age, sex, and the senior-most resident involved in the sedation.

ANALYSES: IBM SPSS was utilized to perform descriptive statistics, paired t-tests, ANOVA, and multivariate linear regression. A level of significance of 5% (P < .05) was used for all analyses.

RESULTS: Four hundred and ninety nine subjects were identified, 189 met the inclusion criteria, and 57 reported using cannabis. The mean age of nonusers was 28.2 ± 7.8 years and that of users was 26.6 ± 6.4 years (P = .09). Females represented 71.9% of nonusers and 72.7% of users. Cannabis users received significantly more propofol (117.5 mg ± 71.3 vs 152.5 mg ± 101.8; P = .004), midazolam (4.7 mg ± 1.0 vs 5.1 mg ± 1.5; P = .01), ketamine (40.2 mg ± 15.7 vs 46.1 mg ± 16.9; P = .01), and fentanyl (75.2 μg ± 26.3 vs 88.6 μg ± 32.8; P = .002) than nonusers, despite extracting a similar number of teeth (4.5 ± 3.1 vs 4.4 ± 3.5; P = .37) in a similar amount of time (25.5 ± 7.3 vs 27.3 ± 7.8; P = .06).

CONCLUSION AND RELEVANCE: Cannabis users required more propofol, midazolam, ketamine, and fentanyl than non-cannabis users during outpatient oral and maxillofacial surgery procedures.

PMID:37783364 | DOI:10.1016/j.joms.2023.09.008

Transplant Cell Ther. 2023 Sep 30:S2666-6367(23)01573-7. doi: 10.1016/j.jtct.2023.09.019. Online ahead of print.

ABSTRACT

Outcomes following allogeneic hematopoietic cell transplant (allo-HCT) for Chronic Myeloid Leukemia (CML) with post-transplant cyclophosphamide (PTCy) utilising an unrelated donor (UD) or mismatched related donor (MMRD) remain unknown. We report on a retrospective comparison of PTCy based allo-HCT from an UD, non-PTCy allo-HCT from an UD and PTCy allo-HCT from a MMRD. Inclusion criteria were adult patients with CML undergoing first allo-HCT between 2012 to 2019 from an UD with either PTCy or non-PTCy GvHD prophylaxis and MMRD using PTCy. Primary endpoint was GvHD relapse-free survival (GRFS). A total of 1341 patients were included (82% in the non-PTCy UD cohort). With a median follow-up of 34.9 months, the 3-year GRFS was 43%, 37% and 39% in the non-PTCy UD, PTCy-UD and PTCy MMRD cohorts, respectively (p=0.15). In multivariable analyses, there were no significant differences between the three cohorts regarding OS, PFS, RI and NRM. Factors independently associated with worse OS in the overall cohort were KPS<90 (HR 1.86, 95%CI, 1.41-2.45; p<0.001), older age (HR 1.24, 95%CI, 1.11-1.38; p<0.001) and disease stage (compared to CP1) blast phase HR 2.25, 95% CI, 1.60-3.16; p<0.001, accelerated phase HR 1.63, 95% CI, 1.05-2.54; p=0.03 and CP>2 HR 1.58, 95% CI, 1.15-2.17; p=0.005. These results suggest that allo-HCT in CML utilizing either an UD or MMRD with a PTCy GvHD-based prophylaxis are feasible transplant platforms and that the disease stage at allo-HCT remains a major prognostic factor, highlighting the importance to closely monitor CML patients and propose transplantation when indicated, when still in CP1.

PMID:37783337 | DOI:10.1016/j.jtct.2023.09.019

Am J Prev Med. 2023 Sep 30:S0749-3797(23)00385-9. doi: 10.1016/j.amepre.2023.09.024. Online ahead of print.

ABSTRACT

INTRODUCTION: The Coronavirus Disease 2019 (COVID-19) pandemic has disproportionately impacted workers in certain industries and occupations. The infection risk for SARS-CoV-2 and future respiratory viruses in the workplace is a significant concern for workers, employers, and policymakers. The current study describes the differences in COVID-19 mortality by sex and industry/occupation among working-age U.S. residents in 49 states and New York City.

METHODS: The 2021 National Vital Statistics System (NVSS) public use multiple-cause-of-death data for U.S. decedents aged 15‒64 years (working-age) with information on usual industry and occupation were analyzed in 2022. Age-standardized COVID-19 death rates for selected demographic characteristics and adjusted proportional mortality ratios (PMRs) were estimated by sex and by usual industry and occupation.

RESULTS: In 2021, 133,596 (14.3%) U.S. decedents aged 15‒64 years had COVID-19 listed as the underlying cause of death; the highest COVID-19 death rate was among persons aged 55‒64 years (172.4/100,000 population) and males (65.5/100,000 population). Among males, American Indian or Alaskan Native and among females, Black or African American had the highest death rates. Hispanic males had higher age-adjusted death rates than Hispanic females. Working-age male decedents in the public administration (PMR=1.39) and management of companies & enterprises industries (PMR=1.39) and community and social services occupations (PMR=1.68) and female decedents in the utilities industry (PMR=1.20) and protective services occupation (PMR=1.18) had the highest PMRs.

CONCLUSIONS: COVID-19 death rates and PMRs varied by sex, industry, and occupation groups. These findings underscore the importance of workplace public health interventions, which could protect workers and their communities.

PMID:37783282 | DOI:10.1016/j.amepre.2023.09.024

Am J Obstet Gynecol MFM. 2023 Sep 30:101170. doi: 10.1016/j.ajogmf.2023.101170. Online ahead of print.

ABSTRACT

BACKGROUND: Prenatal screening of congenital anomalies is an important component of maternity care with continual advances in screening technology. However, few recent studies have investigated the overall effectiveness of a systematic policy of prenatal screening for congenital anomalies, such as in France where an ultrasound per trimester is recommended for all pregnant individuals.

OBJECTIVE: To assess the proportion and the type of congenital anomalies that are not detected during pregnancy.

STUDY DESIGN: The study population included all singleton fetuses and newborns with congenital anomalies from the Paris Registry of Congenital Malformations (remaPAR) from 2001 to 2021. The Registry includes all live births and stillbirths ≥22 weeks of gestation, and terminations of pregnancy for fetal anomaly at any gestational age with congenital anomalies diagnosed prenatally until discharge home from hospital after birth. The prevalence of postnatally detected congenital anomalies was estimated overall and for five-year intervals within the study period. We also reported the proportion of postnatal detection by subgroups of congenital anomalies according to the EUROCAT classification.

RESULTS: Of the 16,602 malformed singleton fetuses and newborns, 32.7% were detected postnatally. This percentage was 11.9% for those with severe anomalies. The postnatal detection rate decreased from 34.3% in 2001-2005 to 27.8% in 2016-2021 (P<0.001). Anomalies most frequently detected postnatally were genital anomalies (n=969, 87.0%), followed by ear, neck and face anomalies (n=71, 78.0%), eye anomalies (n=154, 74.0%) and limb anomalies (n=1,802, 68.4%). Anomalies of the kidney and urinary tract (n=219, 7.1%) and the abdominal wall (n=37, 8.7%) were least likely to be detected after birth. Among the anomalies classified as severe, postnatal detection rates were highest for limb reduction defects (n=142, 40.6%), complete transposition of great arteries (n=31, 17.6%) and diaphragmatic hernia (n=26, 17.2%).

CONCLUSION: Despite improvement of prenatal screening over a 20-year period, our results show that there is still a margin for improvement in prenatal diagnosis of congenital anomalies.

PMID:37783275 | DOI:10.1016/j.ajogmf.2023.101170

Lancet Child Adolesc Health. 2023 Sep 29:S2352-4642(23)00224-9. doi: 10.1016/S2352-4642(23)00224-9. Online ahead of print.

NO ABSTRACT

PMID:37783222 | DOI:10.1016/S2352-4642(23)00224-9