Tag: pubmed

Stroke. 2024 Dec 20. doi: 10.1161/STROKEAHA.124.048654. Online ahead of print.

ABSTRACT

BACKGROUND: We aimed to develop and validate a protein risk score for ischemic stroke (IS) risk prediction and to compare its predictive capability with IS clinical risk factors and IS polygenic risk score.

METHODS: The prospective cohort study included 53 029 participants from UKB-PPP (UK Biobank Pharmaceutical Proteomics Project). IS protein risk score was calculated as the weighted sum of proteins selected by the least absolute shrinkage and selection operator regression. The discrimination ability of models was assessed by C statistic. IS risk factors included age, sex, smoking, waist-to-hip ratio, antihypertensive medication use, systolic and diastolic blood pressure, coronary heart disease, diabetes, total cholesterol/high-density lipoprotein cholesterol ratio, and estimated glomerular filtration rate. Polygenic risk score was computed using identified susceptibility variants.

RESULTS: After exclusions, 38 060 participants from England were randomly divided into the training set and the internal validation set in a 7:3 ratio, and 4970 participants from Scotland/Wales were assigned as the external validation set. Of 43 030 participants included (mean age, 59.0 years; 54.0% female), 989 incident IS occurred during a median follow-up of 13.6 years. In the training set, IS protein risk score was constructed using 17 out of 2911 proteins. In the internal validation set, compared with the basic model (age and sex: C statistic,0.720 [95% CI, 0.691-0.749]), IS protein risk score had the highest predictive performance for IS risk (C statistic, 0.765 [95% CI, 0.736-0.793]), followed by clinical risk factors of IS (C statistic, 0.753 [95% CI, 0.725-0.781]), and IS polygenic risk score (C statistic, 0.730 [95% CI, 0.701-0.759]). The top 5 proteins with the largest absolute coefficients in the IS protein risk score, including GDF15 (growth/differentiation factor 15), PLAUR (urokinase plasminogen activator surface receptor), NT-proBNP (N-terminal pro-B-type natriuretic peptide), IGFBP4 (insulin-like growth factor-binding protein 4), and BCAN (brevican core protein), contributed most of the predictive ability of the IS protein risk score, with a cumulative C statistic of 0.761 (95% CI, 0.733-0.790). These results were verified in the external validation cohort.

CONCLUSIONS: A simple model, including age, sex, and the IS protein risk score (or only the top 5 proteins) had a good predictive performance for IS risk.

PMID:39704077 | DOI:10.1161/STROKEAHA.124.048654

J Eval Clin Pract. 2025 Feb;31(1):e14282. doi: 10.1111/jep.14282.

ABSTRACT

OBJECTIVE: This study aimed to adapt the 6-Item Self-Efficacy Scale for Chronic Disease Management (SEMDC-6S) to women with endometriosis in the Turkish population and to evaluate its validity and reliability.

METHODS: This methodological study comprised of 200 women with endometriosis. The construct validity of the scale was tested using the confirmatory factor analysis methods. The reliability of the scale was tested using Cronbach’s alpha coefficient, item-total score correlations and test-retest reliability analysis.

RESULTS: It was determined that the SEMDC-6S consisted of six items and one subscale. In the confirmatory factor analysis, the fit index values of the scale were found to be acceptable. The intraclass correlation coefficient of test-retest reliability was 0.95, and Cronbach’s alpha coefficient was 0.76.

CONCLUSION: The Turkish version of the SEMDC-6S is a valid and reliable tool for assessing the self-efficacy of women with endometriosis.

PMID:39704074 | DOI:10.1111/jep.14282

Circ Arrhythm Electrophysiol. 2024 Dec 20:e013351. doi: 10.1161/CIRCEP.124.013351. Online ahead of print.

ABSTRACT

BACKGROUND: Patients undergoing first-time atrial fibrillation (AF) ablation can benefit from targeting non-pulmonary vein (PV) triggers. Preprocedural identification of high-risk individuals can guide planning of ablation strategy. This study aimed to create a preprocedural screening tool to identify patients at risk of non-PV triggers during first-time AF ablation.

METHODS: All patients who underwent first-time AF ablation at the Hospital of the University of Pennsylvania between 2018 and 2022 were identified. Those who underwent non-PV trigger provocative maneuvers or had spontaneous non-PV trigger firing were included. Non-PV triggers were defined as non-PV ectopic beats triggering AF or sustained focal atrial tachycardia that occurred spontaneously, after AF cardioversion, or after standard provocative maneuvers. The provocative maneuvers included incremental isoproterenol infusion (3, 6, 12, and 20-30 µg/min) and an atrial burst pacing protocol. Risk factors associated with non-PV triggers in a stepwise multivariable logistic regression model with backward elimination were used to create a risk score.

RESULTS: In all, 163 (8.0%) of 2038 patients had non-PV triggers during first-time AF ablation. Based on the multivariable model, we created a risk score using female sex (1 point; odds ratio [OR], 1.90 [95% CI, 1.36-2.67]), sinus node dysfunction (1 point; OR, 1.84 [95% CI, 1.04-3.24]), prior cardiac surgery (1 point; OR, 2.26 [95% CI, 1.45-3.53]), moderate to severe left atrial enlargement (2 points; OR, 3.43 [95% CI, 2.46-4.79]), and cardiac sarcoidosis/amyloidosis (4 points; OR, 7.24 [95% CI, 3.03-17.33]). Internal validation using bootstrap resampling showed an optimism-adjusted C statistic of 0.715 (95% CI, 0.678-0.751). Among all first-time AF ablations, 68.1% of procedures were low-risk for non-PV triggers (scores 0-1, 4.3% risk), 17.8% were intermediate-risk (score 2, 10.5% risk), and 14.1% were high-risk (score ≥3, 22.6% risk).

CONCLUSIONS: A preprocedural screening tool can classify patients based on their risk of non-PV triggers during first-time AF ablation. This risk score can guide operators to identify patients who would benefit most from adjunctive non-PV trigger testing. However, further validation is needed to confirm these findings.

PMID:39704068 | DOI:10.1161/CIRCEP.124.013351

J Med Virol. 2024 Dec;96(12):e70128. doi: 10.1002/jmv.70128.

ABSTRACT

The high prevalence of cytomegalovirus (CMV) after kidney transplantation, along with its significant morbidity, mortality, and financial burden, makes it a serious infectious complication. This retrospective observational study aimed to determine the incidence of CMV infection and recurrence in renal transplant recipients during the era of immunosuppression (IS), and to identify modifiable predictors of CMV infection. A total of 233 patients were screened for CMV disease incidence and predictors and were prospectively followed. The incidence of CMV disease was found to be 14.6% (95% CI, 11.7%-18%), with no recurrence observed. Multivariate analysis revealed that factors such as CMV serostatus and a positive B-cell crossmatch at transplantation were associated with an increased risk of CMV. Specifically, patients with a positive B-cell crossmatch had a threefold higher risk of developing CMV compared to those with a negative crossmatch (p = 0.025). This association is a novel finding and should be considered when assessing risks and complications in patients. There was a lower incidence of CMV infection among kidney transplant recipients within the first 2-5 years after transplantation. A positive B-cell crossmatch at the time of transplantation was strongly associated with an increased risk of developing CMV disease.

PMID:39704062 | DOI:10.1002/jmv.70128

Eur J Orthod. 2024 Dec 4;47(1):cjae068. doi: 10.1093/ejo/cjae068.

ABSTRACT

OBJECTIVES: The purpose of this retrospective study was to compare the dento-skeletal changes observed in growing Class III patients treated with the Face Mask Protocol (FMP) with and without Bite Block (BB).

MATERIALS: Thirty subjects (12 f, 18 m) who underwent FM/BB therapy were compared to a matched group (FM) of 29 patients (15 f, 14 m) treated without BB. All patients were evaluated before treatment (T0), at the end of active treatment (T1), and at a post-pubertal follow-up observation (T2). A control group (CG) of 20 subjects (10 f, 10 m) with untreated Class III disharmony was used for the comparison of post-pubertal changes. Intergroup statistical comparisons were performed with the independent samples t-test (P < .05).

RESULTS: The comparison between treated samples showed a significant improvement of SN^GoGn (FM/BB vs FM, -2.1°), Overbite (FM/BB vs FM, +1.2 mm), and vertical position of lower molars FM/BB vs FM, -3 mm). When compared with the controls, both treated groups revealed a significant improvement of SNA (FM/BB, +1.8°; FM +2.1°), ANB (FM/BB +1.6°, FM +2.4°), gonial angle (FM/BB -4.9°; FM -4°), incisor inclination (Upper, FM/BB +1.7°, FM +2.3°; Lower, FM/BB -2.5°, FM -2.7°), and Overjet (FM/BB +3.2 mm; FM +4 mm). Improvement of SN^GoGn (-2.1°), Overbite (+1.8 mm), and vertical position of lower molars (-3.8 mm) were observed when FM/BB was compared with CG.

LIMITATIONS: Limitations are related to the difficulty to recruit a larger contemporary long-term control group due to ethical reasons.

CONCLUSION: Both FM protocols induced favorable changes in the treatment of Class III malocclusion with a good post-pubertal stability. The BB allows a more efficient control of the vertical skeletal relationship.

PMID:39704016 | DOI:10.1093/ejo/cjae068

Adv Clin Exp Med. 2024 Dec 20. doi: 10.17219/acem/197425. Online ahead of print.

ABSTRACT

Mental health diagnostics is undergoing a transformation, with a shift away from traditional categorical systems like the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and the International Classification of Diseases, 11th Revision (ICD-11), and toward innovative frameworks like the Hierarchical Taxonomy of Psychopathology (HiTOP) and the Research Domain Criteria (RDoC). These emerging models prioritize dimensional and biobehavioral approaches in order to overcome limitations such as oversimplification, comorbidity and heterogeneity. This editorial explores the challenges of implementing these paradigms, such as the need for empirical validation, interdisciplinary collaboration and clinician training. It highlights the importance of advanced tools, biomarkers and technological integration to improve precision in diagnosis and treatment. Future research directions include creating reliable dimensional assessment methods, conducting longitudinal studies and fostering interdisciplinary networks. By bridging traditional and emerging frameworks, the field can progress toward personalized, biologically informed mental health treatment. This transition necessitates collaboration among researchers, clinicians and policymakers to improve diagnostic accuracy and treatment outcomes for those affected by mental health disorders.

PMID:39704003 | DOI:10.17219/acem/197425

J Glob Health. 2024 Dec 20;14:04236. doi: 10.7189/jogh.14.04236.

ABSTRACT

BACKGROUND: Numerous studies have investigated the efficacy of probiotics in treating acute and persistent diarrhoea. However, probiotics have not been established as a recommended management option for diarrhoeal illness by the World Health Organization (WHO). Therefore, we conducted a systematic review of randomised controlled trials to assess the efficacy of probiotics for the management of acute and persistent diarrhoea in children.

METHODS: A systematic search on PubMed, CINAHL, Wiley Cochrane Library, Scopus, Clinicaltrials.gov, and WHO International Clinical Trials Registry Platform (ICTRP) was performed. All studies published in the year 2000 and onwards that assessed the use of probiotics in the management of acute and persistent diarrhoea in children aged 0-10 years were included. The risk of bias was assessed using the Cochrane Risk of Bias II (RoB-2) tool and the quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. This review was commissioned by WHO for revision of their guidelines for childhood diarrhoea management.

RESULTS: The review included 98 studies with a total of 17 236 participants. Studies were categorised based on the WHO definition of diarrhoea or author-specified definition. In studies considering the WHO definition of diarrhoea, the probiotics group was more likely to achieve clinical cure (risk ratio = 1.12 (95% confidence interval (CI) = 1.01, 1.24, studies = 14)) and reduce the duration of diarrhoea (mean difference = -13.27 hours (95% CI = -16.72, -9.83, studies = 33)) than the control group in children with acute diarrhoea. However, the effect size was small, and statistical heterogeneity was very high, leading to low certainty of evidence. In children with persistent diarrhoea, probiotics reduced the duration of diarrhoea by 95 hours (mean difference = -96.45 (95% CI = -110.53, -82.37, studies = 2)), but the certainty of the evidence was very low.

CONCLUSIONS: The results from this systematic review suggest low certainty of evidence for the effect of probiotics on clinical cure and duration of diarrhoea in children. There was significant diversity in the genus, species, dosages, and duration of treatment in the trial and administration. High levels of heterogeneity reduced the certainty of evidence. Large-scale randomised clinical trials are needed to evaluate specific probiotic strains and doses. In addition, cost-effective analysis studies are needed to be explored in future research.

REGISTRATION: The protocol for this review was registered with the International Prospective Register of Systematic Reviews (PROSPERO: CRD42023449200).

PMID:39703988 | DOI:10.7189/jogh.14.04236

J Glob Health. 2024 Dec 20;14:05039. doi: 10.7189/jogh.14.05039.

ABSTRACT

BACKGROUND: The resilience of Peru´s health system was weakened by a political crisis that started in 2016 and was further challenged by the coronavirus 2019 (COVID-19) pandemic. We assessed the indirect impact of the pandemic on the utilisation of essential maternal and child health (MCH) services in Peru at national and subnational levels.

METHODS: We assessed the trends in MCH services utilisation and the percentage change from 2018 to 2021, using routine health facility data. We used an interrupted time series analysis to quantify the impact of COVID-19 on the utilisation of health services.

RESULTS: The utilisation of most maternal and child health services dropped dramatically in 2020 after the outbreak. However, we observed a quick recovery in 2021, with service utilisation fairly similar or higher to the pre-pandemic period (2018-2019). The decrease was higher in the utilisation of antenatal care visit one or more (incidence rate ratio (IRR) = 0.79; 95% CI = 0.74-0.83) and antenatal care visits four or more (IRR= 0.76; 95% = 0.74-0.79) in 2020. The IRR showed a drop of 5, 6, 9, and 13% in the utilisation of skilled birth attendances, institutional deliveries, caesarean sections and postnatal care visits within two days of childbirth, respectively in 2020 in comparison to pre-pandemic service utilisation. In 2020 the utilisation decreased in all three natural regions, with the Rainforest being the most affected. In 2021 there was a recovery in all natural regions.

CONCLUSIONS: The pandemic decreased the utilisation of essential maternal and child health services in Peru. This highlights the need to preserve the resilience of a health system both at central and local levels, to face more successfully future pandemics.

PMID:39703982 | DOI:10.7189/jogh.14.05039

Pak J Med Sci. 2024 Dec;40(12PINS Suppl):S25-S31. doi: 10.12669/pjms.40.12(PINS).11111.

ABSTRACT

OBJECTIVES: To determine the effect of Bilateral Subthalamic Nucleus (STN) Deep Brain Stimulation (DBS) on drug reduction for Parkinson’s disease (PD) in a low-middle-income country.

METHODS: This retrospective cohort study included 49 patients following interview based questionnaires who underwent bilateral STN DBS at the Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, Pakistan over five years (July 30, 2018 to June 29, 2023). Patients meeting the inclusion and exclusion criteria (49 patients) were selected and the effect of bilateral STN DBS on drug reduction was evaluated.

RESULTS: Following bilateral STN for Parkinsons Disease Levodopa equivalent daily dose (LEDD) and Unified Parkinson’s Disease Rating Scale (UPDRS)-III results were statistically significant, with a P-value of 0.0001. Effect of DBS on UPDRS-IV was 0.2751, which is statistically insignificant. LEDD reduced by 55.03% (P<0.0001), UPRS-III improved by 80.49% (P<0.0001), and UPDRS-IV improved by 1% (P<0.0001). Time spent with dyskinesia reduced by 17.54% (P<0.0001), whereas time spent off period reduced 22.44% (P<0.0001).

CONCLUSION: When the disease is in its early stages and has not yet manifested advanced Parkinsons symptoms, bilateral STN DBS is an effective treatment option. It considerably reduces the need for levodopa and significantly improves the motor symptoms of rigidity, tremors, and bradykinesia.

PMID:39703974 | PMC:PMC11654648 | DOI:10.12669/pjms.40.12(PINS).11111

Pak J Med Sci. 2024 Dec;40(12PINS Suppl):S55-S62. doi: 10.12669/pjms.40.12(PINS).11116.

ABSTRACT

OBJECTIVES: To assess the knowledge, attitude and perception of post-graduate residents of neurosciences towards research ethics (RE) and research ethics committees (RECs).

METHODS: This prospective cross-sectional survey-based study was conducted by the Punjab Institute of Neurosciences, targeting post-graduate neuroscience residents throughout Pakistan during January and February, 2024. An English-language general questionnaire, designed to assess knowledge, attitudes, and perceptions of RE and RECs, was adapted to reflect local conditions. The collected responses were analyzed using the Statistical Package for Social Sciences (SPSS) to determine measures of central tendency, percentages, and frequencies.

RESULTS: Out of 241 residents, 64.3% were males. Sixty-eight percent respondents were from neurosurgery and 32% were from the field of neurology. Approximately 47% responses were from the province of Punjab. More than half (51.5%) of participants acknowledged the existence of a REC within their institution. A similar proportion (52.3%) claimed familiarity with ethical guidelines for research involving human subjects, only a slight majority (48.5%) demonstrated awareness of the specific functions carried out by RECs. Meanwhile, 44.5% expressed concerns that undergoing review by a REC could potentially delay research and pose additional challenges for researchers. Additionally, 27.4% of respondents admitted to considering the fabrication of data or results as acceptable.

CONCLUSION: Our research uncovered a significant correlation between participants’ perceptions of RE and RECs and their comprehension of ethical principles. These findings indicate that medical postgraduates with a deeper understanding or awareness of research ethics principles and RECs tend to hold more robust attitudes toward these aspects.

PMID:39703966 | PMC:PMC11654657 | DOI:10.12669/pjms.40.12(PINS).11116