Tag: pubmed

J Racial Ethn Health Disparities. 2023 Oct 23. doi: 10.1007/s40615-023-01838-5. Online ahead of print.

ABSTRACT

BACKGROUND: Black patients with peripartum cardiomyopathy (PPCM) have disproportionately worse outcomes than White patients, possibly related to variable involvement of cardiovascular specialists in their clinical care. We sought to determine whether race was associated with cardiology involvement in clinical care during inpatient admission and whether cardiology involvement in care was associated with higher claims of guideline-directed medical therapy (GDMT) a week after hospital discharge.

METHODS: Using Optum’s de-identified Clinformatics® Data Mart (CDM), we included Black and White patients’ first hospital admission for PPCM from 2008 to 2021. Cardiology involvement in clinical care was defined as the receipt of attending care from a cardiovascular specialist during admission. GDMT included beta-blockers (BB) for all patients and triple therapy (BB, angiotensin-responsive medications, and mineralocorticoid receptor antagonists) for non-pregnant patients. Logistic regression was used to determine the associations between cardiology involvement in clinical care during admission and (1) patient race and (2) GDMT prescription, adjusting for age and comorbidities.

RESULTS: Among 668 patients (32.6% Black, 67.4% White, 93.3% commercially insured), there was no significant difference in the odds of cardiology involvement in clinical care by race (aOR: 1.41; 95%CI: 0.87-2.33, P=0.17). Inpatient cardiology care was associated with 2.75 times increased odds of having a prescription claim for GDMT (BB) for White patients (aOR: 2.75; 95%CI 1.50-5.06, P=0.001), and the estimated effect size was similar but not statistically significant for Black patients (aOR: 2.20, 95% CI, 0.84-5.71, P=0.11). The interaction between race and cardiology involvement in clinical care was not statistically significant for the receipt of BB prescription. Among 274 non-pregnant patients with PPCM (37.2% Black, 62.8% White), 5.8% received triple GDMT. Of these, none of the Black patients lacking cardiology care had triple GDMT. However, cardiology involvement in care was not significantly associated with triple GDMT for either race.

CONCLUSIONS: Among a commercially insured population within PPCM, race was not associated with cardiology involvement in clinical care during hospitalization. However, cardiology involvement in care was associated with significantly higher odds of prescription claims for BB for only White patients. Additional strategies are needed to support equitable GDMT prescription.

PMID:37870730 | DOI:10.1007/s40615-023-01838-5

Forensic Sci Med Pathol. 2023 Oct 23. doi: 10.1007/s12024-023-00734-y. Online ahead of print.

ABSTRACT

One of the crucial steps in the process of identification of human remains is sex determination of an unknown individual. Sex can be determined using the human skeleton, especially by examining the pelvis and skull. Odontometric analysis and assessment of sexual dimorphism of the human dentition has been less investigated, especially in primary dentition. Hence, this research was designed to verify the presence of sexual dimorphism through odontometric approach in paediatric population of Tamil Nadu, India. The present study was performed on 229 females and 244 males between 3 and 6 years of age. Linear measurements such as maximum mesio distal width, maximum bucco lingual width and clinical crown length were measured in all the primary teeth. Statistical analysis was performed using the Statistical Package for Social Science version 20.0 software (SPSS Inc., Chicago, IL, USA). Mann-Whitney-U test was used to check the statistical significance of the differences observed between males and females. Six equations were derived by discriminant function analysis for practical use. Sexual dimorphism existed in odontometric parameters of primary dentition. The maximum sexual dimorphism was observed in maximum bucco lingual width of 51 and maximum bucco lingual width of 75. The equations derived using discriminant function analysis yielded a jackknife accuracy ranging between 87.5% and 99.8%. These equations may be used to assess the sex from the children of Tamil Nadu, India.

PMID:37870726 | DOI:10.1007/s12024-023-00734-y

J Epidemiol Glob Health. 2023 Oct 23. doi: 10.1007/s44197-023-00154-9. Online ahead of print.

ABSTRACT

OBJECTIVE: To analyze the characteristics of C. auris cases, and to describe the interventions applied for improving the diagnosis and controlling the transmission.

METHOD: Medical records of C. auris cases reported between January 2021 until June 2022 at King Saud Medical City (KSMC), Riyadh, Kingdom of Saudi Arabia have been reviewed. We analyzed the demographic and clinical characteristics of the cases to illustrate the possible contributing factors with C. auris infection. A multidisciplinary committee has been formulated to investigate the potential source of the outbreak among clusters of cases in the intensive care units (ICU). A bundle of mitigation measures has been applied which was successful to contain the outbreak.

RESULTS: During the study period, a total of 129 cases of C. auris were identified, their mean age is 47 ± 22.3 SD, and 72.1% are males. 57% of cases were colonized, all of them were identified through active screening. A number of comorbidities were present including 27.9% were having hypertension, 27.1% with diabetes, 22.5% with COVID-19 and 20.2% with respiratory diseases. The average length of stay before reported positive was 36.23 days. 78.3% of those patients were in the critical care unit, 73.6% with vascular catheter, 88% with urinary catheters and 66.7% with mechanical ventilation. The vast majority of patients were using multiple antibiotics (86%). As per the univariate logistic model, risk factors significantly associated with mortality were (Age, Trauma RTA, ICU, Vascular Access, Foley Catheters, Mechanical Ventilation, Tracheostomy and Endotracheal Tubes) with p values (0.0038, 0.0159, 0.0108, 0.0122, 0.0071, <.0001, 0.0148 and 0.0107), respectively. Multivariate logistic regression showed that having a Foley Catheter was the only statistically significant factor associated with mortality.

CONCLUSION: This retrospective analysis highlights the main characteristics associated with C. auris-infected patients. In addition, it highlights the effectiveness of the bundle of mitigation strategies applied to limit the spread of C. auris in healthcare facilities.

PMID:37870721 | DOI:10.1007/s44197-023-00154-9

J Neurovirol. 2023 Oct 23. doi: 10.1007/s13365-023-01176-6. Online ahead of print.

ABSTRACT

The effectiveness of COVID-19 vaccination is still unclear in individuals with underlying diseases such as HTLV-1 infection. This retrospective cohort study aimed to evaluate the humoral response of COVID-19 vaccines among people living with HTLV-1 (PLHTLV) in northeastern Iran. From December 2021 to October 2022, eighty-six HTLV-1⁺ subjects (50 males and 36 females; 47.7 ± 11.2 years) and 90 HTLV-1 seronegative individuals (age- and sex-matched convenient samples) were enrolled. The humoral immune response was evaluated by measuring different COVID-19 Abs in serum samples at least 28 days after receiving 2^nd or 3^rd doses of COVID-19 vaccines. Throughout all three rounds of immunization, Sinopharm was the most commonly used COVID-19 vaccine across all three immunization rounds. Compared to the HTLV-1^– group, a significantly lower frequency of all four Abs activity was observed among PLHTLV:anti-nucleocapsid (66.3% vs 86.7%, p = 0·001), anti-spike (91.9% vs 98.9%, p = 0·027), RBD (90.7% vs 97.8%, p = 0·043), and neutralizing Abs (75.6% vs 95.5%, p < 0·001). Also, the frequency of all Abs in 28 patients with HAM/TSP was higher than that of 58 asymptomatic carriers, although this difference was statistically significant only in the case of anti-spike Abs (p = 0.002). Notably, PLHTLV-vaccinated against COVID-19 demonstrated significantly lower antibody activities, indicating a reduced humoral immune response to COVID-19 vaccines.

PMID:37870718 | DOI:10.1007/s13365-023-01176-6

Eur Geriatr Med. 2023 Oct 23. doi: 10.1007/s41999-023-00877-9. Online ahead of print.

ABSTRACT

PURPOSE: Dementia and Alzheimer’s disease (AD) pose significant challenges to public health globally with no effective treatment strategies available. Therefore, the research focuses on developing effective prophylaxis to prevent the onset of these diseases. Recent studies have suggested that low-dose aspirin may help reduce the risk of dementia. Nonetheless, evidence regarding the correlation between aspirin consumption and the onset of dementia and AD is limited. This review aims to provide an up-to-date summary of the existing evidence and evaluate the association between aspirin and the onset of dementia and Alzheimer’s disease.

METHODS: A systematic search of PubMed, Embase, Web of Science, PsycINFO, and CINAHL databases was conducted to find eligible studies published until April 2023. A random-effects meta-analysis of the eligible studies was then performed to assess the link between aspirin use and the onset of dementia and Alzheimer’s disease. Additionally, we conducted subgroup analyses to evaluate the overall effect of low-dose (75-100 mg) aspirin consumption on the onset of dementia and AD.

RESULTS: A total of 875 studies were identified, with only 22 meeting the inclusion criteria. There was no statistically significant impact of aspirin consumption on the onset of dementia (HR 1.13, 11 studies) or Alzheimer’s disease (HR 0.91, 3 studies). Additionally, subgroup analysis showed that taking low doses of aspirin (75-100 mg) did not significantly affect the onset of either dementia (HR 0.96, 13 studies) or Alzheimer’s disease (HR 0.85, 2 studies).

CONCLUSIONS: Aspirin use does not decrease the risk of dementia or AD, even when taken in low doses. However, the quality of the studies analyzed was inadequate, with only three randomized controlled trials included in the review. Future high-quality studies are needed to assess the effect of aspirin consumption on these diseases. These findings may assist clinicians in selecting appropriate prophylactic strategies for patients at risk of developing dementia and AD.

PMID:37870707 | DOI:10.1007/s41999-023-00877-9

Biol Trace Elem Res. 2023 Oct 23. doi: 10.1007/s12011-023-03895-7. Online ahead of print.

ABSTRACT

Zinc supplementation has therapeutic effects on cardiovascular disease (CVD) risk factors, including dyslipidemia, hyperglycemia, and inflammation as the main contributors to CVD pathogenesis. Since CVD is a major cause of mortality among people with type 2 diabetes mellitus (T2DM), this study aimed to overview the potential effects of zinc supplementation on CVD risk factors in T2DM patients. To determine appropriate randomized clinical trials (RCTs) investigating the effects of zinc supplementation on CVD risk factors, electronic sources including PubMed, Web of Science, and Scopus were systematically searched until January 2023. The heterogeneity of trials was checked using the I² statistic. According to the heterogeneity tests, random-effects models were estimated, and pooled data were defined as the weighted mean difference (WMD) with a 95% confidence interval (CI). Of the 4004 initial records, 23 studies that met inclusion criteria were analyzed in this meta-analysis. The pooled findings indicated the significant lowering effects of zinc supplementation on triglycerides (TG), total cholesterol (TC), fasting blood glucose (FBG), hemoglobin A1C (HbA1C), and C-reactive protein (CRP), while high-density cholesterol (HDL) concentrations showed an elevation after zinc supplementation. In addition to statistical significance, the effect of zinc supplementation on most of the variables was clinically significant; however, the quality of evidence in the included studies is regarded as low or very low for most variables. Our study demonstrated that zinc supplementation has beneficial effects on glycemic control markers, lipid profile, and CRP levels as a classic marker of inflammation in T2DM. Due to the high degree of heterogeneity between studies and the low rate of quality in them, further well-designed studies are necessitated to strengthen our findings.

PMID:37870684 | DOI:10.1007/s12011-023-03895-7

Environ Sci Pollut Res Int. 2023 Oct 23. doi: 10.1007/s11356-023-30516-6. Online ahead of print.

ABSTRACT

The surge in fossil fuel consumption, culminating in global warming and climate change, compels nations to implement protective measures. Consequently, the concepts of “sustainable growth” and the “green economy” have gained prominence in response to heightened environmental consciousness. In light of these imperatives, nations have embarked on the formulation of sustainable and environmentally conscious policies, with the dual objective of safeguarding the environment and fostering economic growth. These factors have collectively contributed to the growing significance of energy policies within European nations, spurring a burgeoning momentum in research areas pertaining to energy efficiency and energy productivity. While extant literature has demonstrated the positive environmental impact of energy productivity, there exists a paucity of research pertaining to its economic implications. Energy productivity, defined as achieving equivalent or greater output with reduced energy consumption, bears the potential to influence economic output, thereby exerting cascading effects on various facets of the economy, including growth and exports. The principal aim of this study is to highlight that the augmentation of energy productivity can yield not only environmental advantages but also economic benefits. To achieve this objective, we conduct econometric analyses on panel data spanning the years 2000 to 2020 across the 27 member states of the European Union. Specifically, we explore the effects of energy productivity on diverse economic parameters, encompassing economic growth, high technology exports, medium and high technology exports, total exports, and trade volume. Employing the Driscoll-Kraay standard errors estimator, our findings evince that energy productivity exerts statistically significant and positive influences on economic growth, medium and high technology exports, total exports, and trade volume.

PMID:37870672 | DOI:10.1007/s11356-023-30516-6

Eur J Pediatr. 2023 Oct 23. doi: 10.1007/s00431-023-05275-8. Online ahead of print.

ABSTRACT

The optimal duration of antibiotic treatment for the most common bacterial meningitis etiologies in the pediatric population, namely Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis, is not well-established in the literature. Therefore, we aimed to perform an updated meta-analysis comparing shorter versus longer antibiotic treatment in children with meningitis. PubMed, EMBASE, and Cochrane databases were searched for randomized controlled trials (RCTs) that compared shorter (up to 7 days) versus longer (10 days or double the days of the equivalent short course) duration of antibiotic treatment in children with meningitis and reported the outcomes of treatment failure, death, neurologic sequelae, non-neurologic complications, hearing impairment, nosocomial infection, and relapse. Heterogeneity was examined with I² statistics. RevMan 5.4.1 was used for statistical analysis and RoB-2 (Cochrane) for risk of bias assessment. Of 684 search results, 6 RCTs were included, with a cohort of 1333 children ages 3 weeks to 15.5 years, of whom 49.51% underwent a short antibiotic course. All RCTs included monotherapy with ceftriaxone, except one, which added vancomycin as well. No differences were found comparing the short and long duration of therapy concerning treatment failure, relapse, mortality, and neurologic complications at discharge and at follow-up. Conclusion: Because no statistically significant differences were found between groups for the analyzed outcomes, the results of this meta-analysis support shorter therapy. However, generalizing these results to complicated meningitis and infections caused by other pathogens should be made with caution. (PROSPERO identifier: CRD42022369843). What is Known: • Current recommendations on the duration of antibiotic therapy for bacterial meningitis are mostly based on clinical practice. • Defining an optimal duration of antibiotic therapy is essential for antimicrobial stewardship achievement, improving patient outcomes, and minimizing adverse effects. What is New: • There are no differences between shorter versus longer antibiotic treatment duration in regard to treatment failure, relapse, mortality, neurologic complications, and hearing impairment at discharge and at follow-up.

PMID:37870611 | DOI:10.1007/s00431-023-05275-8

Intensive Care Med. 2023 Oct 23. doi: 10.1007/s00134-023-07215-4. Online ahead of print.

ABSTRACT

PURPOSE: Intensive care unit (ICU) hospitalization is challenging for the family members of the patients. Most family members report some level of anxiety and depression, sometimes even resulting in post-traumatic stress disorder (PTSD). An association has been reported between lack of information and PTSD. This study had three aims: to quantify the psychological burden of family members of critically ill patients, to explore whether a website with specific information could reduce PTSD symptoms, and to ascertain whether a website with information about intensive care would be used.

METHOD: A multicenter double-blind, randomized, placebo-controlled trial was carried out in Austria and Switzerland.

RESULTS: In total, 89 members of families of critically ill patients (mean age 47.3 ± 12.9 years, female n = 59, 66.3%) were included in the study. 46 relatives were allocated to the intervention website and 43 to the control website. Baseline Impact of Event Scale (IES) score was 27.5 ± 12.7. Overall, 50% showed clinically relevant PTSD symptoms at baseline. Mean IES score for the primary endpoint (~ 30 days after inclusion, T1) was 24 ± 15.8 (intervention 23.9 ± 17.9 vs. control 24.1 ± 13.5, p = 0.892). Hospital Anxiety and Depression Scale (HADS – Deutsch (D)) score at T1 was 12.2 ± 6.1 (min. 3, max. 31) and did not differ between groups. Use of the website differed between the groups (intervention min. 1, max. 14 vs. min. 1, max. 3; total 1386 “clicks” on the website, intervention 1021 vs. control 365). Recruitment was prematurely stopped in February 2020 due to coronavirus disease 2019 (COVID-19).

CONCLUSION: Family members of critically ill patients often have significant PTSD symptoms and online information on critical illness did not result in reduced PTSD symptoms.

PMID:37870597 | DOI:10.1007/s00134-023-07215-4

J Surg Oncol. 2023 Oct 23. doi: 10.1002/jso.27491. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Patients undergoing breast reconstruction following mastectomy are often admitted overnight. In 2020, our institution implemented a protocol change to discharge clinically stable patients immediately. In this study, we examine the safety of same-day discharge following mastectomy and reconstruction.

METHODS: Our retrospective study included female adults undergoing mastectomy and immediate alloplastic reconstruction from August 2019 to January 2020, before implementation of the same-day discharge protocol, and from March 2020 to September 2021, after the protocol implementation. Independent t-test and chi-square analysis was conducted to examine statistical differences.

RESULTS: Two hundred and eighty-five patients were included. Forty-two patients underwent reconstruction before the protocol change (Group 1) and 243 patients underwent reconstruction after the protocol change (Group 2). Group 2 had a greater percentage of prepectoral implant placement. There was no difference in demographics, complications, readmission, or reoperation. Within Group 2, 157 patients were discharged the same day (Group 2a) and 88 patients required overnight admission (Group 2b). Group 2b had higher body mass index, higher percentage of bilateral mastectomy, and larger mastectomy weights. Despite no differences in complications, Group 2b exhibited higher rates of requiring intravenous antibiotics and reoperation.

CONCLUSIONS: Patients may be safely discharged the same day following mastectomy and alloplastic reconstruction without an increase in complications.

PMID:37869984 | DOI:10.1002/jso.27491