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Small and Large Bowel Anatomy is Associated with Enteral Autonomy in Infants with Short Bowel Syndrome: A retrospective cohort study

JPEN J Parenter Enteral Nutr. 2023 Dec 7. doi: 10.1002/jpen.2587. Online ahead of print.

ABSTRACT

BACKGROUND: Achievement of enteral autonomy (EA) is the ultimate treatment goal in pediatric intestinal failure. We aimed to assess predictors of EA in pediatric short bowel syndrome (SBS) and explore the impact of residual small bowel (SB) and large bowel (LB) length on EA.

METHODS: A retrospective cohort study was performed on infants <12 months (n=367, six centers) with SBS referred between 2010 and 2015. The cohort was stratified based on achievement of EA. Statistical testing completed using t test, Chi Square, Cox Proportional Hazards regression model and Kaplan-Meier analysis.

RESULTS: EA was achieved in 229 patients. In the multivariable analysis, percentage of residual LB (HR=1.02; 95% CI 1.01-1.02) and SB (HR= 1.01; 95% CI 1.01-1.02) length, presence of ICV (HR= 2.02; 95% CI 1.41-2.88), and not coming from a high-volume transplantation center (HR= 2.42; 95% CI 1.68-3.49) were positively associated with EA, while a negative association was seen with the presence of stoma at the time when shortest remnant was documented (HR= 0.72; 95% CI 0.52-1.00). EA achievement was significantly different between the anatomical subgroups (Log-rank test p<0.001) with EA rate of 80.4% in infants with ≥ 50% SB and LB (median time – 209 days); 62.5% with ≥ 50% SB and<50% LB (397 days); 58.3% with <50% SB and ≥ 50% LB (1192 days), 25.9% with < 50% SB and LB. NEC was not associated with a better achievement of EA (NEC vs. other etiologies; Log-rank test p = 0.33).

CONCLUSIONS: Overall 62% of infants with IF secondary to SBS achieved EA over a mean time of follow-up of 2.3 years. A colon length of >50% can compensate for the loss of small bowel (<50%) and account for similar EA rates as in children with residual SB>50%. This article is protected by copyright. All rights reserved.

PMID:38062898 | DOI:10.1002/jpen.2587

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SAFE technique to improve Nerve-Sparing in Robotic-Assisted Radical Prostatectomy

BJU Int. 2023 Dec 7. doi: 10.1111/bju.16238. Online ahead of print.

ABSTRACT

BACKGROUND: Radical Prostatectomy is the standard of care for localized prostate cancer. Despite the introduction of minimally invasive surgery and a better understanding of the anatomy, erectile dysfunction still represents a challenge.

OBJECTIVE: To provide a summary of our initial experience and assess the impact of the SAFE (Saline-Assisted Fascial Exposure) technique on erectile function, urinary continence, and oncologic outcomes after Robotic-Assisted Radical Prostatectomy SETTING, AND PARTICIPANTS: From January 2021 to July 2022, we included patients with a baseline SHIM ≥17 and a high probability of extracapsular extension, ranging from 21% to 73%, as per Martini et al’s. nomogram. A propensity score matching was carried out at a ratio of 1:2 between patients who underwent RALP + SAFE (33) and RALP alone (66). The descriptive statistical analysis is presented SURGICAL PROCEDURE: The SAFE technique was performed using two approaches, transrectal guided by microultrasound or transperitoneal. Its principle entails a low-pressure injection of saline solution in the periprostatic fascia to achieve an atraumatic dissection of the neural hammock.

MEASUREMENTS: Potency was defined as a SHIM score ≥ 17. Continence as 0 pads per day.

RESULTS AND LIMITATIONS: At follow-up intervals of 6, 13, 26, and 52 weeks, the SHIM score differed significantly between the two groups, favoring the RALP + SAFE (p 0.01, p<0.001, p<0.001, and 0.01, respectively). These results remained significant when the mean SHIM was assessed. As shown by the cumulative incidence curve, EF rates were higher in the RALP + SAFE compared to the RALP alone group (log-rank p<0.001). The baseline SHIM and use of the SAFE technique were independent predictors of EF recovery.

CONCLUSIONS: The use of the SAFE technique led to better SHIM scores at 6, 13, 26, and 52 weeks after RALP in patients at high risk of ECE who underwent a partial NS procedure.

PMID:38062880 | DOI:10.1111/bju.16238

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Skeletal muscle atrophy in clinical and preclinical models of chronic kidney disease: A systematic review and meta-analysis

J Cachexia Sarcopenia Muscle. 2023 Dec 7. doi: 10.1002/jcsm.13400. Online ahead of print.

ABSTRACT

Patients with chronic kidney disease (CKD) are often regarded as experiencing wasting of muscle mass and declining muscle strength and function, collectively termed sarcopenia. The extent of skeletal muscle wasting in clinical and preclinical CKD populations is unclear. We evaluated skeletal muscle atrophy in preclinical and clinical models of CKD, with multiple sub-analyses for muscle mass assessment methods, CKD severity, sex and across the different preclinical models of CKD. We performed a systematic literature review of clinical and preclinical studies that measured muscle mass/size using the following databases: Ovid Medline, Embase and Scopus. A random effects meta-analysis was utilized to determine standard mean difference (SMD; Hedges’ g) between healthy and CKD. Heterogeneity was evaluated using the I2 statistic. Preclinical study quality was assessed via the Systematic Review Centre for Laboratory Animal Experimentation and clinical studies quality was assessed via the Newcastle-Ottawa Scale. This study was registered in PROSPERO (CRD42020180737) prior to initiation of the search. A total of 111 studies were included in this analysis using the following subgroups: 106 studies in the primary CKD analysis, 18 studies that accounted for diabetes and 7 kidney transplant studies. Significant atrophy was demonstrated in 78% of the preclinical studies and 49% of the clinical studies. The random effects model demonstrated a medium overall SMD (SMD = 0.58, 95% CI = 0.52-0.64) when combining clinical and preclinical studies, a medium SMD for the clinical population (SMD = 0.48, 95% CI = 0.42-0.55; all stages) and a large SMD for preclinical CKD (SMD = 0.95, 95% CI = 0.76-1.14). Further sub-analyses were performed based upon assessment methods, disease status and animal model. Muscle atrophy was reported in 49% of the clinical studies, paired with small mean differences. Preclinical studies reported significant atrophy in 78% of studies, with large mean differences. Across multiple clinical sub-analyses such as severity of CKD, dialysis modality and diabetes, a medium mean difference was found. Sub-analyses in both clinical and preclinical studies found a large mean difference for males and medium for females suggesting sex-specific implications. Muscle atrophy differences varied based upon assessment method for clinical and preclinical studies. Limitations in study design prevented conclusions to be made about the extent of muscle loss with disease progression, or the impact of dialysis. Future work would benefit from the use of standardized measurement methods and consistent clinical staging to improve our understanding of atrophy changes in CKD progression, and analysis of biological sex differences.

PMID:38062879 | DOI:10.1002/jcsm.13400

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A critical look at adjusted fetal weights in rats

Birth Defects Res. 2023 Dec 8. doi: 10.1002/bdr2.2278. Online ahead of print.

ABSTRACT

BACKGROUND: A new derived (i.e., calculated) endpoint of developmental toxicology has appeared in a very few studies since 1990. This endpoint is adjusted mean live fetal weight per litter or adjusted fetal weight. Given our lack of familiarity with the endpoint, we evaluated the basis, prevalence, methods, and usefulness in embryo-fetal developmental toxicity (EFDT) studies in rats.

METHODS: Literature searches were performed with key terms using PubMed and Google Scholar. Major textbooks were consulted but lack of any mention of the endpoint. Unpublished EFDT data, which are readily available online, were utilized to test adjustment methods.

RESULTS: Pertinent information on factors that influence fetal weight goes back a century. Four papers utilizing rats were found in which fetal weights were adjusted using either statistical or formula-based methods to adjust fetal weights. Only one study showed a clear benefit to the endpoint when there was a marked decrease in live litter size; this pointed to situations in which the new endpoint might be useful. The lone formula-based adjustment method was found to be lacking adequate testing and justifications. A new experimental alternative formula-based adjustment is shown to produce results very similar to statistical methods.

CONCLUSIONS: From this assessment, we recommend that adjusted fetal weight should not be a routine endpoint at this time. However, there are likely cases where this derived endpoint could aid interpretation. We encourage other investigators to examine previous EFDT study data to establish guidance on the use of adjusted mean live fetal weights.

PMID:38062877 | DOI:10.1002/bdr2.2278

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Development and validation of chemometric-assisted spectrophotometric models for efficient quantitation of a binary mixture of supportive treatments in COVID-19 in the presence of its toxic impurities: a comparative study for eco-friendly assessment

BMC Chem. 2023 Dec 7;17(1):177. doi: 10.1186/s13065-023-01089-9.

ABSTRACT

The use of sustainable solvents has increased significantly in recent years due to advancements in green analytical methods. The number of impurities in the drug substance determines how safe the finished product is. Therefore, during the whole medication planning process, contaminants need to be closely watched. Using chemometric models, the concentrations of hyoscine N-butyl bromide (HYO) and paracetamol (PAR) were determined in the presence of three PAR impurities [P-nitrophenol (PNP), P-aminophenol (PAP), and P-chloroacetanilide (PCA), as well as DL-tropic acid (TRO) as a HYO impurity]. It was possible to isolate and measure these dangerous impurities. Fever and spasms associated with COVID-19 are reported to be considerably reduced when PAR and HYO are taken together. Artificial neural networks, principal component regression, multivariate curve resolution-alternating least squares, and partial least squares are the four chemometric-assisted spectrophotometric models that were created and verified. All of the proposed methods’ quantitative analytical potency was assessed using recoveries%, root mean square error of prediction, and standard error of prediction. For PAR, HYO, PNP, PCA, TRO, and PAP, respectively, the indicated approaches were used in the ranges of 4.00-8.00, 16.00-24.00, 1.00-5.00, 0.40-0.80, 4.00-12.00, and 2.00-6.00 µg/mL. They are able to get around difficulties like collinearity and spectral overlaps. After statistical testing, there was no discernible difference between the recommended methods and the published one. The degree of greenness of the established models was evaluated using three different green assessment methods. In the presence of their harmful impurities, PAR and HYO could be identified using the recommended methods.

PMID:38062478 | DOI:10.1186/s13065-023-01089-9

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Prevalence of G6PD deficiency and submicroscopic malaria parasites carriage in malaria hotspot area in Northwest, Tanzania

Malar J. 2023 Dec 7;22(1):372. doi: 10.1186/s12936-023-04801-1.

ABSTRACT

BACKGROUND: The use of primaquine for mass drug administration (MDA) is being considered as a key strategy for malaria elimination. In addition to being the only drug active against the dormant and relapsing forms of Plasmodium vivax, primaquine is the sole potent drug against mature/infectious Plasmodium falciparum gametocytes. It may prevent onward transmission and help contain the spread of artemisinin resistance. However, higher dose of primaquine is associated with the risk of acute haemolytic anaemia in individuals with a deficiency in glucose-6-phosphate dehydrogenase. In many P. falciparum endemic areas there is paucity of information about the distribution of individuals at risk of primaquine-induced haemolysis at higher dose 45 mg of primaquine.

METHODS: A retrospective cross-sectional study was carried out using archived samples to establish the prevalence of G6PD deficiency in a malaria hotspot area in Misungwi district, located in Mwanza region, Tanzania. Blood samples collected from individuals recruited between August and November 2010 were genotyped for G6PD deficiency and submicroscopic parasites carriage using polymerase chain reaction.

RESULTS: A total of 263 individuals aged between 0 and 87 were recruited. The overall prevalence of the X-linked G6PD A- mutation was 83.7% (220/263) wild type, 8% (21/263) heterozygous and 8.4% (22/263) homozygous or hemizygous. Although, assessment of the enzymatic activity to assign the phenotypes according to severity and clinical manifestation as per WHO was not carried out, the overall genotype and allele frequency for the G6PD deficiency was 16.4% and 13. 2%, respectively. There was no statistically significant difference in among the different G6PD genotypes (p > 0.05). Out of 248 samples analysed for submicroscopic parasites carriage, 58.1% (144/248) were P. falciparum positive by PCR. G6PD heterozygous deficiency were associated with carriage of submicroscopic P. falciparum (p = 0.029).

CONCLUSIONS: This study showed that 16.4% of the population in this part of North-western Tanzania carry the G6PD A- mutation, within the range of 15-32% seen in other parts of Africa. G6PD gene mutation is widespread and heterogeneous across the study area where primaquine would be valuable for malaria control and elimination. The maps and population estimates presented here reflect potential risk of higher dose of primaquine being associated with the risk of acute haemolytic anaemia (AHA) in individuals with a deficiency in glucose-6-phosphate dehydrogenase and call further research on mapping of G6PD deficiency in Tanzania. Therefore, screening and education programmes for G6PD deficiency is warranted in a programme of malaria elimination using a higher primaquine dose.

PMID:38062464 | DOI:10.1186/s12936-023-04801-1

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Prioritizing a research agenda on built environments and physical activity: a twin panel Delphi consensus process with researchers and knowledge users

Int J Behav Nutr Phys Act. 2023 Dec 7;20(1):144. doi: 10.1186/s12966-023-01533-y.

ABSTRACT

BACKGROUND: The growth of urban dwelling populations globally has led to rapid increases of research and policy initiatives addressing associations between the built environment and physical activity (PA). Given this rapid proliferation, it is important to identify priority areas and research questions for moving the field forward. The objective of this study was to identify and compare research priorities on the built environment and PA among researchers and knowledge users (e.g., policy makers, practitioners).

METHODS: Between September 2022 and April 2023, a three-round, modified Delphi survey was conducted among two independent panels of international researchers (n = 38) and knowledge users (n = 23) to identify similarities and differences in perceived research priorities on the built environment and PA and generate twin ‘top 10’ lists of the most important research needs.

RESULTS: From a broad range of self-identified issues, both panels ranked in common the most pressing research priorities including stronger study designs such as natural experiments, research that examines inequalities and inequities, establishing the cost effectiveness of interventions, safety and injuries related to engagement in active transportation (AT), and considerations for climate change and climate adaptation. Additional priorities identified by researchers included: implementation science, research that incorporates Indigenous perspectives, land-use policies, built environments that support active aging, and participatory research. Additional priorities identified by knowledge users included: built environments and PA among people living with disabilities and a need for national data on trip chaining, multi-modal travel, and non-work or school-related AT.

CONCLUSIONS: Five common research priorities between the two groups emerged, including (1) to better understand causality, (2) interactions with the natural environment, (3) economic evaluations, (4) social disparities, and (5) preventable AT-related injuries. The findings may help set directions for future research, interdisciplinary and intersectoral collaborations, and funding opportunities.

PMID:38062460 | DOI:10.1186/s12966-023-01533-y

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Assessment of post-COVID-19 fatigue among female survivors 2 years after hospital discharge: a nested case-control study

BMC Public Health. 2023 Dec 7;23(1):2455. doi: 10.1186/s12889-023-17382-0.

ABSTRACT

BACKGROUND: Fatigue is a common symptom of long COVID syndrome. Compared to male survivors, females have a higher incidence of post-COVID fatigue. Therefore, long-term follow-up is necessary to understand which groups of females are more vulnerable to post-COVID fatigue.

METHODS: This is a nested case-control study of female COVID-19 survivors who were discharged from two designated hospitals in Wuhan, China in 2020, and received 2-year follow-up from March 1 to April 6, 2022. All patients completed the Checklist Individual Strength-subscale subjective fatigue (CIS-fatigue), a chronic obstructive pulmonary disease (COPD) assessment test (CAT), and the Hospital Anxiety and Depression Scale (HADS; including the HADS-Anxiety [HADS-A] and the HADS-Depression [HADS-D]). Individuals with CIS-fatigue scores of 27 or higher were classified as cases. The risk factors for fatigue was analysed with multivariable logistic regression analysis.

RESULTS: A total of 899 female COVID-19 survivors were enrolled for analysis, including 47 cases and 852 controls. Compared with controls, cases had higher CAT, HADS-A and HADS-D scores, and showed a higher prevalence of symptoms, including anxiety (cases vs. controls, 44.7% vs. 4.0%, p < 0.001), chest tightness (21.2% vs. 2.3%, p < 0.001), dyspnoea (19.1% vs. 0.8%, p < 0.001) and so on. In multivariable logistic regression analysis, age (OR, 1.03; 95% CI, 1.01-1.06; p = 0.02) and cerebrovascular disease (OR, 11.32; 95% CI, 2.87-43.00; p < 0.001) were risk factors for fatigue. Fatigue had a statistically significant moderate correlation with depression (r = 0.44, p < 0.001), but not with CAT ≥ 10.

CONCLUSION: Female COVID-19 patients who had cerebrovascular disease and older age have higher risk of fatigue. Patients with fatigue have higher CAT scores, and are more likely to have concurrent depression.

PMID:38062429 | DOI:10.1186/s12889-023-17382-0

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Spatiotemporal variations of “triple-demic” outbreaks of respiratory infections in the United States in the post-COVID-19 era

BMC Public Health. 2023 Dec 7;23(1):2452. doi: 10.1186/s12889-023-17406-9.

ABSTRACT

BACKGROUND: The US confronted a “triple-demic” of influenza, respiratory syncytial virus (RSV), and COVID-19 in the winter of 2022, leading to increased respiratory infections and a higher demand for medical supplies. It is urgent to analyze these epidemics and their spatial-temporal co-occurrence, identifying hotspots and informing public health strategies.

METHODS: We employed retrospective and prospective space-time scan statistics to assess the situations of COVID-19, influenza, and RSV in 51 US states from October 2021 to February 2022, and from October 2022 to February 2023, respectively. This enabled monitoring of spatiotemporal variations for each epidemic individually and collectively.

RESULTS: Compared to winter 2021, COVID-19 cases decreased while influenza and RSV infections significantly increased in winter 2022. We found a high-risk cluster of influenza and COVID-19 (not all three) in winter 2021. In late November 2022, a large high-risk cluster of triple-demic emerged in the central US. The number of states at high risk for multiple epidemics increased from 15 in October 2022 to 21 in January 2023.

CONCLUSIONS: Our study offers a novel spatiotemporal approach that combines both univariate and multivariate surveillance, as well as retrospective and prospective analyses. This approach offers a more comprehensive and timely understanding of how the co-occurrence of COVID-19, influenza, and RSV impacts various regions within the United States. Our findings assist in tailor-made strategies to mitigate the effects of these respiratory infections.

PMID:38062417 | DOI:10.1186/s12889-023-17406-9

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Using of non-pharmacological pain methods, and the perceived barriers, among nurses in critical care unit in Palestine

BMC Nurs. 2023 Dec 7;22(1):467. doi: 10.1186/s12912-023-01635-9.

ABSTRACT

BACKGROUND: Pain is alleviated in one of the two common approaches, pharmacological or non-pharmacological intervention. Using non-pharmacological methods may have beneficial effect and priority on decreasing patients’ level of pain and decreasing the side effects of pharmacological methods in ICU patients. This study aimed to assess ICU Palestinian nurses use and barriers of non-pharmacological pain management.

METHODS: A quantitative descriptive cross-sectional design was used to collect responses from a convenient sample of 215 nurses working in six hospitals in Plaestine. The timeframe for data collection was from August 2022 to December 2022. This study had three instrument packages. The first part is demographic data. The second is a tool that used 4-point Likert scale to examine ICU nursing use of non-pharmacological pain methods and it consisted of 16 items. The third is six items of perceived barriers to use non-pharmacological pain methods. All statistical procedures were analyzed using Statistical Package of Social Science (SPSS) version 28.

RESULTS: More than two-thirds of the nurses used non-pharmacological pain methods in ICU. 60% of the nurses have high levels of use, 10.2% have very high levels. The two highest perceived barriers to use nonpharmacological method were the lack of time, workload, and patient instability with 83.7% (n = 180), and 77.2% (n = 166), respectively. Demographic variables were not significantly associated with the use of non-pharmacological pain management methods, except age.

CONCLUSION: Adopting culturally sensitive non-pharmacological pain methods to decrease ICU patients’ level of pain, may positively reflected on patients’ outcome and on healthcare system. Developing, implementing and continuous monitoring of guidelines regarding using nonpharmacological for nurses and physicians are recommended which will be reflected positively on patients’ outcomes. Great efforts to overcome the barriers of lack of time and workload is impertive to increase the clinical usage of nonpharmacological pain methods.

PMID:38062405 | DOI:10.1186/s12912-023-01635-9