Tag: pubmed

Vaccine. 2023 Jun 30:S0264-410X(23)00616-3. doi: 10.1016/j.vaccine.2023.05.055. Online ahead of print.

ABSTRACT

BACKGROUND: A limited amount of information is available about the immunogenicity of the quadrivalent inactivated influenza vaccine among human immunodeficiency virus (HIV)-infected individuals, especially in low and middle-income countries (LMICs).

METHODS: HIV-infected adults and HIV-uninfected adults received a dose of quadrivalent inactivated influenza vaccine including strains of H1N1, H3N2, BV and BY. Enzyme-linked immunosorbent assay (ELISA) and hemagglutination-inhibition assay (HAI) were used to determine IgA, IgG antibody concentration and geometric mean titers (GMT) at day 0 and day 28, respectively. Associated factors contributing to seroconversion or GMT changes were analyzed using simple logistic regression model.

RESULTS: A total of 131 HIV-infected and 55 HIV-uninfected subjects were included in the study. In both HIV-infected and uninfected arms, IgG and IgA against influenza A and B all increased significantly at day 28 after receiving QIV (P < 0.001). GMTs of post-vaccination at day 28 showed that HIV-infected persons with CD4 + T cell counts ≤ 350 cells/mm³ were statistically less immunogenic to all strains of QIV than HIV-uninfected ones (P < 0.05). HIV-infected participants with CD4 + T cell counts ≤ 350 cells/mm³ were less likely to achieve seroconversion to QIV (H1N1, BY and BV) than HIV-uninfected individuals at day 28 after vaccination (P < 0.05). Compared with HIV-infected patients with baseline CD4 + T cell counts ≤ 350 cells/mm³, individuals with baseline CD4 + T cell counts > 350 cell/mm³ seemed more likely to generate antibody responses to H1N1 (OR:2.65, 95 %CI: 1.07-6.56) and BY (OR: 3.43, 95 %CI: 1.37-8.63), and showed a higher probability of seroconversion to BY (OR: 3.59, 95 %CI: 1.03-12.48). Compared with nadir CD4 + T cell count ≤ 350 cell/mm³, individuals with nadir CD4 + T cell count > 350 cell/mm³ showed a higher probability of seroconversion to H1N1(OR: 3.15, 95 %CI: 1.14-8.73).

CONCLUSION: Influenza vaccination of HIV-infected adults might be effective despite variable antibody responses. HIV-positive populations with CD4 + T cell counts ≤ 350 are less likely to achieve seroconversion. Further vaccination strategies could be developed for those with low CD4 T cell counts.

PMID:37394372 | DOI:10.1016/j.vaccine.2023.05.055

Dig Liver Dis. 2023 Jun 30:S1590-8658(23)00700-4. doi: 10.1016/j.dld.2023.06.004. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Defecation Disorders (DD) are a frequent cause of refractory chronic constipation. DD diagnosis requires anorectal physiology testing. Our aim was to evaluate the accuracy and Odds Ratio (OR) of a straining question (SQ) and a digital rectal examination (DRE) augmented by abdomen palpation on predicting a DD diagnosis in refractory CC patients.

METHODS: Two hundred and thirty-eight constipated patients were enrolled. Patients underwent SQ, augmented DRE and balloon evacuation test before entering the study and after a 30-day fiber/laxative trial. All patients underwent anorectal manometry. OR and accuracy were calculated for SQ and augmented DRE for both dyssynergic defecation and inadequate propulsion.

RESULTS: “Anal Muscles” response was associated to both dyssynergic defecation and inadequate propulsion, with an OR of 13.6 and 5.85 and an accuracy of 78.5% and 66.4%, respectively. “Failed anal relaxation” on augmented DRE was associated with dyssynergic defecation, with an OR of 21.4 and an accuracy of 73.1%. “Failed abdominal contraction” on augmented DRE was associated with inadequate propulsion with an OR >100 and an accuracy of 97.1%.

CONCLUSIONS: Our data support screening constipated patients for DD by SQ and augmented DRE to improve management and appropriateness of referral to biofeedback.

PMID:37394370 | DOI:10.1016/j.dld.2023.06.004

Med Clin (Barc). 2023 May 9:S0025-7753(23)00241-5. doi: 10.1016/j.medcli.2023.04.020. Online ahead of print.

ABSTRACT

INTRODUCTION: We previously reported an increase in respiratory mortality in 2020 in Spain after COVID-19. It is unclear if this rise is sustained in the longer-term. We aimed to determine whether respiratory mortality in 2021 in Spain returned to pre-pandemic levels.

MATERIAL AND METHODS: In an observational, large study using official National Institute of Statistics data, we explored deaths due to respiratory diseases, that is, all causes of death by the standard WHO list of diseases of the respiratory system plus COVID-19, tuberculosis and lung cancer. Using the latest available official data of Spain, we analyzed changes in the mortality pattern in Spain from January 2019 to December 2021. We endorsed STROBE guidance for observational research.

RESULTS: There were 98,714 deaths due to respiratory diseases in 2021 in Spain, corresponding to 21.9% of all deaths, becoming second in the ranking of causes of death. Respiratory diseases mortality in Spain has not returned to pre-pandemic levels in 2021, still with an increase of 30.3% (95% CI 30.2-30.4) compared to rates in 2019. All respiratory-specific causes of death decreased in 2021, except for lung cancer, that increased in women and decreased in men compared to 2019 (both p<0.05). In a multivariate analysis some established risk factors for respiratory diseases mortality were confirmed, such as male gender and older age; further, an association with reduced mortality in rural Spain was observed, still with a large geographical variability.

CONCLUSIONS: The COVID-19 pandemic has had a lasting impact on deaths due to respiratory diseases and certain specific causes of death in 2021, and it has disproportionately affected certain regions.

PMID:37394353 | DOI:10.1016/j.medcli.2023.04.020

Brachytherapy. 2023 Jun 30:S1538-4721(23)00079-X. doi: 10.1016/j.brachy.2023.06.002. Online ahead of print.

ABSTRACT

PURPOSE: Brachytherapy irradiation carries risks of both bleeding and venous thromboembolism (VTE). No screening or management recommendations for VTE in this setting have been developed. Our study aims to understand the incidence of VTE, compile published anticoagulation guidelines, and call for future guidelines to address thromboprophylaxis in this population.

METHODS AND MATERIALS: A retrospective, single institution study of patients undergoing brachytherapy irradiation between 2012 and 2022 was undertaken. We analyzed 2 cohorts: 87 patients undergoing brachytherapy with an inpatient admission, and 66 patients assessed for risk of VTE or bleeding after discharge from an inpatient admission for brachytherapy. Caprini risk scores were calculated for each patient, and statistical analyses were performed.

RESULTS: Eighty-seven patients were included, and 25% had a VTE diagnosis. Forty-seven (54%) of patients included underwent brachytherapy as definitive treatment of cervical cancer, and 16 (18%) received brachytherapy irradiation to treat recurrent endometrial cancer. In the cohort of 66 patients assessed for risk of VTE or bleeding after brachytherapy discharge, 23 (34.8%) were discharged with thromboprophylaxis, and 43 (65.2%) were discharged without thromboprophylaxis. None of the patients discharged on thromboprophylaxis were diagnosed with a VTE within 90 days of discharge after brachytherapy, whereas 3 of 43 (7%) discharged without thromboprophylaxis were diagnosed with a VTE, OR and 95% CI: 0.25 (0.01-5.29), p = 0.37. Of the 23 patients discharged on thromboprophylaxis, 1 was readmitted for bleeding OR and 95% CI: 5.8 (0.22-155.18), p = 0.29. The median Caprini score was 11.

CONCLUSIONS: VTE is a common occurrence in patients undergoing brachytherapy. Patients undergoing brachytherapy irradiation who require inpatient admission represent a unique population, and specialty organizations should develop consensus recommendations to address these clinical challenges.

PMID:37394350 | DOI:10.1016/j.brachy.2023.06.002

Am J Surg. 2023 Jun 29:S0002-9610(23)00279-9. doi: 10.1016/j.amjsurg.2023.06.026. Online ahead of print.

ABSTRACT

BACKGROUND: Given the variability in abdominal physiology and hernia presentation between sexes, better comprehension of sex-related differences in outcomes would tailor surgical approach and counseling regarding postoperative outcomes. This meta-analysis aims to appraise the effect of sex on the outcomes of ventral hernia repair.

METHODS: A literature search in PubMed, EMBASE and Cochrane selected studies comparing outcomes of ventral hernia repair between sexes. Postoperative outcomes were assessed by pooled and meta-analysis. Statistical analysis was performed using RevMan 5.4.

RESULTS: We screened 3128 studies, reviewed 133, and included 18 observational studies, which encompassed 220,799 patients following ventral hernia repair. Postoperative chronic pain was significantly higher in female (OR 1,9; 95% CI 1,64-2,2; p < 0,001). There were no significant differences in complications, readmission, or recurrence rates between females and males.

CONCLUSION: Female sex is associated with a higher risk of postoperative chronic pain following ventral hernia repair.

PMID:37394348 | DOI:10.1016/j.amjsurg.2023.06.026

J Formos Med Assoc. 2023 Jun 30:S0929-6646(23)00244-9. doi: 10.1016/j.jfma.2023.06.016. Online ahead of print.

ABSTRACT

OBJECTIVE: In patients with atrial fibrillation (AF) and end-stage renal disease (ESRD), oral anticoagulants are contraindicated, and left atrial appendage occlusion (LAAO) is an alternative treatment. However, the efficacy of thromboembolic prevention using LAAO in these patients has rarely been reported in Asian populations. To our knowledge, this is the first long-term LAAO study in patients with AF undergoing dialysis in Asia.

METHODS: In this study, 310 patients (179 men) with a mean age of 71.3 ± 9.6 years and mean CHA2DS2-VASc 4.2 ± 1.8 were consecutively enrolled at multiple centers in Taiwan. The outcomes of 29 patients with AF and ESRD undergoing dialysis who underwent LAAO were compared to those without ESRD. The primary composite outcomes were stroke, systemic embolization, or death.

RESULTS: No difference in mean CHADS-VASc score was noted between patients with versus without ESRD (4.1 ± 1.8 vs. 4.6 ± 1.9, p = 0.453). After a mean follow-up of 38 ± 16 months, the composite endpoint was significantly higher in patients with ESRD (hazard ratio, 5.12 [1.4-18.6]; p = 0.013) than in those without ESRD after LAAO therapy. Mortality was also higher in patients with ESRD (hazard ratio, 6.6 [1.1-39.7]; p = 0.038). The stroke rate was numerically higher in patients with versus without ESRD, but the difference was not statistically significant (hazard ratio, 3.2 [0.6-17.7]; p = 0.183). Additionally, ESRD was associated with device-related thrombosis (odds ratio, 6.15; p = 0.047).

CONCLUSIONS: Long-term outcomes of LAAO therapy may be less favorable in patients with AF undergoing dialysis, possibly because of the poor condition of patients with ESRD.

PMID:37394333 | DOI:10.1016/j.jfma.2023.06.016

Cardiovasc Revasc Med. 2023 Jun 17:S1553-8389(23)00661-9. doi: 10.1016/j.carrev.2023.06.015. Online ahead of print.

NO ABSTRACT

PMID:37394318 | DOI:10.1016/j.carrev.2023.06.015

Nurse Educ Today. 2023 Jun 23;128:105890. doi: 10.1016/j.nedt.2023.105890. Online ahead of print.

ABSTRACT

BACKGROUND: In undergraduate nursing grading practice is generally avoided as it is considered educationally flawed.

OBJECTIVES: To test an innovative online grading practice tool (GPT) in undergraduate nurse education. To model the determinants of the final practice grade in four areas of clinical competence and in one cohort analysis the relationship between final practice grade and each area of clinical competence and an OSCE grade.

DESIGN: A cross-sectional study.

PARTICIPANTS: A convenience sample of 782 nursing students from one Higher Education Institution in the North-East of England were included. The sample involved two sequential cohorts of final-year students with 391 students in each cohort.

METHODS: A specifically designed online grading practice tool (GPT) composed of thirty-six objectives equally divided across four areas of clinical competence. The GPT was applied to two consecutive student cohorts on completion of their final practice learning placement.

RESULTS: There was a statistically significant difference in the mean final practice grade between the two cohorts. In the overall sample, regression modelling showed that all four areas of student assessment contributed equally to the final grade. Analysis by cohort showed that in Cohort 1 clinical thinking and professionalism had the most influence on the final grade with person-centered care and patient safety most strongly impacting on the final grades of Cohort 2. In Cohort 2 there is no statistically significant correlation between final practice grade, each area of clinical competence and an OSCE grade.

CONCLUSIONS: Practice learning is fundamental to how students develop professional awareness and learn to nurse. Findings from a novel grading practice tool applied in undergraduate nursing reveal how effectively the tool works. Nurse educators must be responsive to the realities of learning in practice and explore new ways of assessing clinical competence.

PMID:37393651 | DOI:10.1016/j.nedt.2023.105890

Food Chem. 2023 Jun 19;427:136641. doi: 10.1016/j.foodchem.2023.136641. Online ahead of print.

ABSTRACT

To characterize the key odorants of floral aroma green tea (FAGT) and reveal its dynamic evolution during processing, the volatile metabolites in FAGT during the whole processing were analyzed by integrated volatolomics techniques, relative odor activity value (rOAV), aroma recombination, and multivariate statistical analysis. The volatile profiles undergone significant changes during processing, especially in the withering and fixation stages. A total of 184 volatile compounds were identified (∼53.26% by GC-MS). Among them, 7 volatiles with rOAV > 1 were identified as characteristic odorants of FAGT, and most of these compounds reached the highest in withering stage. According to the formation pathways, these key odorants could be divided into four categories: fatty acid-derived volatiles, glycoside-derived volatiles, amino acid-derived volatiles, and carotenoid-derived volatiles. Our study provides a comprehensive strategy to elucidate changes in volatile profiles during processing and lays a theoretical foundation for the targeted processing of high-quality green tea.

PMID:37393635 | DOI:10.1016/j.foodchem.2023.136641

Gynecol Oncol. 2023 Jun 30;176:1-9. doi: 10.1016/j.ygyno.2023.06.017. Online ahead of print.

ABSTRACT

OBJECTIVE: Women are experiencing growing rates of incarceration at twice the pace of that for men. Additionally, one-third will be older than 55 years of age by the end of the decade. Women who are incarcerated experience a higher prevalence of gynecologic malignancies and present with higher stage disease, which may be contributing to the greater mortality from cancer than the age-adjusted US population. Limited access to guideline-recommended screening and prevention and resource limitations across correctional facilities may result in gynecologic cancer disparities. Reasons for delayed gynecologic cancer care in prisons remain underexplored. Therefore, we sought to identify contributors to delayed gynecologic cancer care among women experiencing incarceration.

METHODS: Women at a single tertiary center in the Southeastern U.S. who were incarcerated and were diagnosed with a gynecologic cancer during 2014-2021 were identified in the electronic medical record. Note text was extracted and contributors to delay were identified and categorized using the RADaR method. Descriptive statistics were used to assess quantitative data.

RESULTS: 14 patients were identified with a total of 14,879 text excerpts. Data reduction was performed to identify excerpts that were relevant to the central research question resulting in 175 relevant note excerpts. Delays prior to the tertiary care visit included patient and institutional contributors. Delays during transition from the tertiary center to prison included discharge planning and loss to follow-up during/after incarceration. Transportation, authorization, and restraints were concrete contributors. Abstract contributors included communication, and the patient’s emotional experience.

CONCLUSIONS: We identify myriad contributors to delayed or fractured gynecologic cancer care in women experiencing incarceration. The impact of these issues warrants further study and intervention to improve care.

PMID:37393632 | DOI:10.1016/j.ygyno.2023.06.017