Tag: pubmed

J Diabetes Complications. 2024 Jul 16;38(9):108810. doi: 10.1016/j.jdiacomp.2024.108810. Online ahead of print.

ABSTRACT

AIM: To determine the association between atherogenic markers, such as total cholesterol/high density lipoprotein cholesterol ratio (TC/HDL-C), triglycerides/HDL-C ratio (TG/HDL-C), and triglycerides-glucose index (TyG), and the risk of 1-year amputation in adults with diabetic foot in a tertiary level hospital.

METHODS: Retrospective cohort study conducted in 162 adult patients with diabetic foot. The outcome was amputation, defined as “primary amputation in patients’ clinical history after their first hospitalization due to foot ulcer.”. The cutoff point was determined using Youden’s J statistic. The relative risk (RR) was presented as an association measure.

RESULTS: A TyG index of >9.4 [RR: 1.64 (1.10-2.45)] was associated with a high risk of amputation after 1-year in adults with diabetic foot. However, while a TC/HDL ratio of >4.69 [RR: 1.38 (0.94-2.03)] and a TG/HDL-C ratio > 3.57 [RR: 1.35 (0.89-2.06)] did not show associations with risk of amputation after 1-year.

CONCLUSIONS: Only a TyG index of >9.4 was associated with an increased risk of 1-year amputation in adults with diabetic foot. Future studies with larger samples and a longitudinal design may provide more robust evidence and a better understanding of clinical implications.

PMID:39042958 | DOI:10.1016/j.jdiacomp.2024.108810

J Oncol Pharm Pract. 2024 Jul 23:10781552241263832. doi: 10.1177/10781552241263832. Online ahead of print.

ABSTRACT

INTRODUCTION: Hypersensitivity reactions (HSR) are a known adverse effect of paclitaxel, occurring in approximately 10% of patients, typically during the first or second infusion of the medication. Corticosteroids, histamine-1 and histamine-2 receptor antagonists are given prior to paclitaxel infusions to reduce the incidence of HSR. There are limited data that suggest administration of cetirizine given prior to a platinum infusion as secondary prophylaxis may reduce HSR rates.

METHODS: The objective of this study was to assess the impact of a novel paclitaxel hypersensitivity prevention protocol including high-dose cetirizine administered 12 and 6 h prior to paclitaxel infusion on the rate of HSR compared to a historical control. The primary objective was the rate of HSR of any grade after the first cycle of paclitaxel. Secondary outcomes included grade of infusion reaction and incidence of severe HSR.

RESULTS: A total of 104 patients were included for analysis in the cetirizine group and 124 in the control group. Hypersensitivity reactions occurred in 37 (16.2%) patients in the overall population, and no statistical difference was observed between groups. (13.46% vs 18.55%; p = 0.23). Numerically more grade 3-4 HSRs occurred in the control group than the treatment group (30.77% vs 69.23; p = 0.51).

CONCLUSIONS: The addition of cetirizine to paclitaxel infusions resulted in numerically lower rates of HSR and a reduction in severity of grade 3-4 HSRs. Future studies with more robust compliance data and a larger patient population would be needed to appropriately assess the efficacy of our novel treatment regimen.

PMID:39042936 | DOI:10.1177/10781552241263832

J Oncol Pharm Pract. 2024 Jul 23:10781552241264553. doi: 10.1177/10781552241264553. Online ahead of print.

ABSTRACT

INTRODUCTION: Nigeria is a low-middle income country located in sub-Saharan Africa. Although cancer burden has continued to increase over time, there is a lack of pharmacists who specialize in oncology providing pharmaceutical care. The objectives of this study were to understand the perception of hematology/oncology pharmacy practice in Nigeria as well as the unmet education needs.

METHOD: This is a cross-sectional survey conducted in December 2023. Pharmacists who were active members of various pharmacy organizations in Nigeria were invited to complete the survey. The survey focused on the perceptions of training needs in oncology pharmacy, current challenges and opportunities, as well as resources and support needed. Descriptive statistics were utilized for the data analysis.

RESULTS: Of the 263 responders, the largest group fell between 25 and 34 years old (35%), over half received a Bachelor of Pharmacy as their highest degree (53%), and majority did not receive any oncology pharmacy training as part of their education (73%). Many respondents strongly agreed that pharmacists in Nigeria need specialized training to better serve cancer patients (79%). Cancer therapeutics and chemotherapy pharmacology were more prioritized compared to other training needs (mean (SD): 2.63(1.95) and 2.69(1.64), respectively). The main challenge that respondents faced was a lack of relevant skills and knowledge in oncology pharmacy (mean (SD): 2.23(1.53)). More than a fourth of the respondents were aware about the board certification process (28.8%), citing overcoming the cost barrier as the main obstacle for taking the board examination (mean (SD): 1.92 (1.38)). Respondents preferred online courses and onsite specialty training (75%) as the mode of training to address unmet needs.

CONCLUSION: Despite the challenges and unmet education needs in hematology/oncology clinical practice, Nigerian pharmacists are very willing to expand their knowledge and improve their skills in patient care. The findings of this study can inform policy makers, healthcare administrators, and pharmacy educators in developing global partnerships among pharmacy organizations which employ targeted strategies like sponsorships to address such unmet needs.

PMID:39042932 | DOI:10.1177/10781552241264553

World J Pediatr Congenit Heart Surg. 2024 Jul 23:21501351241258231. doi: 10.1177/21501351241258231. Online ahead of print.

ABSTRACT

BACKGROUND: The optimal approach to patent ductus arteriosus management during systemic-to-pulmonary artery shunt placement is currently unknown. The purpose of this study is to examine the outcomes of variable strategies for patent ductus arteriosus management during Blalock-Taussig-Thomas shunt surgery.

METHODS: A retrospective cohort study of infants who underwent shunt placement was performed, comparing those who had the ductus ligated with those who had the ductus left open. Indicators of low cardiac output syndrome, development of necrotizing enterocolitis, and secondary outcomes such as resuscitation events were examined.

RESULTS: Thirty-six infants were included all of whom had their shunt placed via median sternotomy. Twenty infants had their ductus ligated at the time of the shunt, and they were compared with 16 infants whose ductus was left open. There was no statistical difference in preoperative baseline characteristics, including corrected gestational age, age in days, weight, mechanical ventilation, vasoactive use, heterotaxy, and gastrointestinal anomalies. There was also no statistical difference in postoperative indicators of low cardiac output, including urine production, total fluids given, renal injury, maximum lactate, and vasoactive-inotropic score. Three patients had postoperative renal injury, and all were in the ligated duct group. There was also no statistical difference in any secondary outcomes, including the development of necrotizing eneterocolitis, resuscitation events, reinterventions, length of intubation, total length of stay, and mortality.

CONCLUSIONS: This study provides evidence that variable management of the ductus during shunt placement does not significantly impact outcomes. Leaving the ductus open allows for a potential rescue source of pulmonary blood flow and does not appear to increase the risk of postoperative low cardiac output.

PMID:39042925 | DOI:10.1177/21501351241258231

J Pediatr Endocrinol Metab. 2024 Jul 24. doi: 10.1515/jpem-2024-0235. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the association between perinatal and obstetric factors as potential triggers for the early onset of T1DM.

METHODS: This was a retrospective cohort study enrolling 409 patients diagnosed with T1DM, in Bauru, São Paulo, Brazil, from 1981 to 2023. Data were retrieved from medical records, regarding sociodemographic parameters as age, sex, ethnicity, and socioeconomic status. Perinatal and obstetric factors as delivery type, gestational age, filiation order, length of exclusive breastfeeding, maternal age, maternal and fetal blood types, and occurrence of maternal gestational diabetes were also analyzed. An adapted survival analysis was employed to gauge the impact of each assessed variable at the age of T1DM diagnosis.

RESULTS: The median age of T1DM diagnosis was 10.3 years with an interquartile range between 6.4 and 15.5 years. Delivery type and filiation order were the only factors statistically significantly associated with an early age at T1DM diagnosis. Patients who were born through cesarean section and who were firstborns showed a 28.6 and 18.0 % lower age at T1DM diagnosis, respectively, compared to those born through vaginal delivery and those that were nonfirstborns.

CONCLUSIONS: Being born by cesarean section and being firstborn showed to be statistically significant factors to determine an early T1DM diagnosis.

PMID:39042913 | DOI:10.1515/jpem-2024-0235

Am J Drug Alcohol Abuse. 2024 Jul 23:1-8. doi: 10.1080/00952990.2024.2380463. Online ahead of print.

ABSTRACT

Background: Innovative analytic approaches to drug studies are needed to understand better the co-use of opioids with non-opioids among people using illicit drugs. One approach is the Bayesian kernel machine regression (BKMR), widely applied in environmental epidemiology to study exposure mixtures but has received far less attention in substance use research.Objective: To describe the utility of the BKMR approach to study the effects of drug substance mixtures on health outcomes.Methods: We simulated data for 200 individuals. Using the Vale and Maurelli method, we simulated multivariate non-normal drug exposure data: xylazine (mean = 300 ng/mL, SD = 100 ng/mL), fentanyl (mean = 200 ng/mL, SD = 71 ng/mL), benzodiazepine (mean = 300 ng/mL, SD = 55 ng/mL), and nitazene (mean = 200 ng/mL, SD = 141 ng/mL) concentrations. We performed 10,000 MCMC sampling iterations with three Markov chains. Model diagnostics included trace plots, r-hat values, and effective sample sizes. We also provided visual relationships of the univariate and bivariate exposure-response and the overall mixture effect.Results: Higher levels of fentanyl and nitazene concentrations were associated with higher levels of the simulated health outcome, controlling for age. Trace plots, r-hat values, and effective sample size statistics demonstrated BKMR stability across multiple Markov chains.Conclusions: Our understanding of drug mixtures tends to be limited to studies of single-drug models. BKMR offers an innovative way to discern which substances pose a greater health risk than other substances and can be applied to assess univariate, bivariate, and cumulative drug effects on health outcomes.

PMID:39042906 | DOI:10.1080/00952990.2024.2380463

JMIR Med Educ. 2024 Jul 23;10:e52818. doi: 10.2196/52818.

ABSTRACT

BACKGROUND: The rapid evolution of ChatGPT has generated substantial interest and led to extensive discussions in both public and academic domains, particularly in the context of medical education.

OBJECTIVE: This study aimed to evaluate ChatGPT’s performance in a pulmonology examination through a comparative analysis with that of third-year medical students.

METHODS: In this cross-sectional study, we conducted a comparative analysis with 2 distinct groups. The first group comprised 244 third-year medical students who had previously taken our institution’s 2020 pulmonology examination, which was conducted in French. The second group involved ChatGPT-3.5 in 2 separate sets of conversations: without contextualization (V1) and with contextualization (V2). In both V1 and V2, ChatGPT received the same set of questions administered to the students.

RESULTS: V1 demonstrated exceptional proficiency in radiology, microbiology, and thoracic surgery, surpassing the majority of medical students in these domains. However, it faced challenges in pathology, pharmacology, and clinical pneumology. In contrast, V2 consistently delivered more accurate responses across various question categories, regardless of the specialization. ChatGPT exhibited suboptimal performance in multiple choice questions compared to medical students. V2 excelled in responding to structured open-ended questions. Both ChatGPT conversations, particularly V2, outperformed students in addressing questions of low and intermediate difficulty. Interestingly, students showcased enhanced proficiency when confronted with highly challenging questions. V1 fell short of passing the examination. Conversely, V2 successfully achieved examination success, outperforming 139 (62.1%) medical students.

CONCLUSIONS: While ChatGPT has access to a comprehensive web-based data set, its performance closely mirrors that of an average medical student. Outcomes are influenced by question format, item complexity, and contextual nuances. The model faces challenges in medical contexts requiring information synthesis, advanced analytical aptitude, and clinical judgment, as well as in non-English language assessments and when confronted with data outside mainstream internet sources.

PMID:39042876 | DOI:10.2196/52818

JMIR Res Protoc. 2024 Jul 23;13:e56277. doi: 10.2196/56277.

ABSTRACT

BACKGROUND: Potentially inappropriate medication remains a significant concern in general practices, particularly in the context of overactive bladder (OAB) treatment for individuals aged 65 years and older. This study focuses on the exploration of alternative options for treating OAB and the deprescribing of anticholinergic drugs commonly used in OAB. The research aims to comprehensively evaluate the efficiency of deprescribing through a mixed methods approach, combining quantitative assessment and qualitative exploration of perceptions, experiences, and potential barriers among patients and health care personnel.

OBJECTIVE: This study aims to evaluate the efficiency and safety of the intervention in which health care staff in primary care encourage patients to participate in deprescribing their drugs for OAB. In addition, we aim to identify factors contributing to or obstructing the deprescribing process that will drive more informed decisions in the field of deprescribing and support effective and safe treatment of patients.

METHODS: The drugs for overactive bladder in primary care (DROP) study uses a rigorous research design, using a randomized controlled trial (RCT) with an embedded sequential explanatory mixed methods approach. All general practices within the North Denmark Region will be paired based on the number of general practitioners (GPs) and urban or rural locations. The matched pairs will be randomized into intervention and control groups. The intervention group will receive an algorithm designed to guide the deprescribing of drugs for OAB, promoting appropriate medication use. Quantitative data will be collected from the RCT including data from Danish registries for prescription analysis. Qualitative data will be obtained through interviews and focus groups with GPs, staff members, and patients. Finally, the quantitative and qualitative findings are merged to understand deprescribing for OAB comprehensively. This integrated approach enhances insights and supports future intervention improvement.

RESULTS: The DROP study is currently in progress, with randomization of general practices underway. While they have not been invited to participate yet, they will be. The inclusion of GP practices is scheduled from December 2023 to April 2024. The follow-up period for each patient is 6 months. Results will be analyzed through an intention-to-treat analysis for the RCT and a thematic analysis for the qualitative component. Quantitative outcomes will focus on changes in prescriptions and symptoms, while the qualitative analysis will explore experiences and perceptions.

CONCLUSIONS: The DROP study aims to provide an evidence-based intervention in primary care that ensures the deprescription of drugs for OAB when there is an unfavorable risk-benefit profile. The DROP study’s contribution lies in generating evidence for deprescribing practices and influencing best practices in health care.

TRIAL REGISTRATION: ClinicalTrials.gov NCT06110975; https://clinicaltrials.gov/study/NCT06110975.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/56277.

PMID:39042875 | DOI:10.2196/56277

J Occup Environ Hyg. 2024 Jul 23:1-6. doi: 10.1080/15459624.2024.2371904. Online ahead of print.

ABSTRACT

Occupational noise exposure continues to be a prevalent hazard in many industries. While the proliferation of noise dosimeters and wearable devices has made it easier to assess a worker’s exposure to noise, many employees exposed to hazardous (i.e., >85 dBA) levels of noise may go their entire career without ever having their personal noise levels measured. In contrast to other occupational exposures, noise is easily perceived by the individual exposed, allowing them to develop subjective judgments regarding its characteristics. To determine whether such self-reported exposures to occupational noise are associated with hearing loss, this analysis used audiometric data and self-reported occupational exposure to loud noise from the National Health and Nutrition Examination Survey (NHANES), which has collected such data from 1999 to May 2020. Linear and logistic regressions models found a statistically significant association between self-reported noise exposure and worsened hearing at the 3, 4, 6, and 8 kHz hearing frequency as well as an elevated odds ratio for the development of hearing loss greater than 25 dB at the 2, 3, and 4 kHz audiometric frequencies. The results of this analysis suggest that in the absence of exposure measurements, workers are likely able to detect exposure to hazardous levels of noise. In these instances, additional measurements should be collected to determine if the workers should be enrolled in a hearing conservation program.

PMID:39042873 | DOI:10.1080/15459624.2024.2371904

J Vet Dent. 2024 Jul 23:8987564241264036. doi: 10.1177/08987564241264036. Online ahead of print.

ABSTRACT

Veterinary studies documenting the effect of endodontic treatment on tooth fracture resistance are scarce. The objective of this ex vivo study was to evaluate the effects of mesial access preparation and restoration, as well as pulp chamber access, instrumentation, obturation, and restoration, on the fracture resistance and characteristics of canine teeth in dogs. Sixty-five dog canine teeth were divided into 4 groups: 1. Standard endodontic treatment through a mesial access only; 2. Treatment as per group 1, adding an incisal access, instrumentation and obturation of the pulp chamber, and restoration of the access; 3. Treatment as per group 2, without pulp chamber obturation or restoration of the incisal access; and 4. Untreated teeth. The fracture resistance and characteristics of each group were documented using axial compression testing, angled 45° disto-occlusal to the long axis of the crown. The maximum force prior to fracture in groups 1, 3, and 4 were not statistically different, demonstrating that restored mesial and incisal accesses with pulp chamber instrumentation did not statistically affect fracture resistance. However, obturated and restored group 2 teeth demonstrated decreased fracture resistance compared to all other groups (P < .001). Additionally, 26.7% of group 1 teeth sustained complicated crown fractures, while 100% of group 2 teeth fractured within the obturation or restorative materials, preventing pulp exposure in these cases. Although the cause and clinical importance of decreased tooth fracture resistance following pulp chamber obturation and restoration remains unknown, it may provide protective value for maintaining a coronal seal in the event of tooth fracture.

PMID:39042869 | DOI:10.1177/08987564241264036