Tag: pubmed

Eur J Hybrid Imaging. 2022 Nov 21;6(1):26. doi: 10.1186/s41824-022-00145-2.

ABSTRACT

BACKGROUND: Recent neuroimaging studies have demonstrated pathological mechanisms related to cerebral neuroplasticity in chronic low back pain (CLBP). Few studies have compared cerebral changes between patients with and without pain in the absence of an experimentally induced stimulus. We investigated the neurobiological substrates associated with chronic low back pain using [^99mTc]Tc-ECD brain SPECT and correlated rCBF findings with the numeric rating scale (NRS) of pain and douleur neuropathique en 4 questions (DN4). Ten healthy control volunteers and fourteen patients with neuropathic CLBP due to lumbar disc herniation underwent cerebral SPECT scans. A quantitative comparison of rCBF findings between patients and controls was made using the Statistical Parametric Mapping (SPM), revealing clusters of voxels with a significant increase or decrease in rCBF. The intensity of CLBP was assessed by NRS and by DN4.

RESULTS: The results demonstrated an rCBF increase in clusters A (occipital and posterior cingulate cortex) and B (right frontal) and a decrease in cluster C (superior parietal lobe and middle cingulate cortex). NRS scores were inversely and moderately correlated with the intensity of rCBF increase in cluster B, but not to rCBF changes in clusters A and C. DN4 scores did not correlate with rCBF changes in all three clusters.

CONCLUSIONS: This study will be important for future therapeutic studies that aim to validate the association of rCBF findings with the pharmacokinetic and pharmacodynamic profiles of therapeutic challenges in pain.

PMID:36404393 | DOI:10.1186/s41824-022-00145-2

Diabet Med. 2022 Nov 20:e15008. doi: 10.1111/dme.15008. Online ahead of print.

ABSTRACT

AIMS: To examine health behaviours and risk factors in women with pre-existing diabetes or previous gestational diabetes mellitus who are planning pregnancy.

METHODS: Health behaviour, risk factor and demographic data obtained from a digital pregnancy planning advisory tool (Tommy’s charity UK) were analysed. Descriptive statistical analysis was performed, stratified by diabetes type.

RESULTS: Data from 84,359 women, including 668 with type 1 diabetes, 707 with type 2 diabetes, and 1,785 with previous gestational diabetes obtained over a 12-month period (September 2019-September 2020) were analysed. 65%, 95%CI (61,68%) of women with type 2 diabetes and 46%, 95%CI (43,48%) with previous gestational diabetes were obese (BMI ≥30kg/m² ), compared with 26%, 95%CI (26,26%) without diabetes. Use of folic acid supplements was low; 41%, 95%CI (40,41%) of women without diabetes and 42%, 95%CI (40,45%) with previous gestational diabetes reported taking folic acid (any dose) while 47%, 95%CI (43,50%) women with type 1 diabetes and 44%, 95%CI (40,47%) women with type 2 diabetes respectively reported taking the recommended dose (5mg). More women with type 1 diabetes and type 2 diabetes reported smoking (20%, 95%CI (17,23%) and 23%, 95%CI (20,26%) respectively) and taking illicit/recreational drugs (7%, 95%CI (6,10%) and 9%, 95% CI (7,11%)) compared to women without diabetes (smoking 17%, 95% CI (16,17%), drug use 5%, 95%CI (5,5%)). Alcohol consumption, low levels of physical activity and of fruit and vegetable intake were also evident.

CONCLUSIONS: This study highlights the potential of online pregnancy planning advisory tools to reach high-risk women and emphasises the need to improve pre-pregnancy care for women with pre-existing diabetes and previous gestational diabetes, many of whom are actively seeking advice. It is also the first to describe pre-pregnancy health behaviours in women with previous gestational diabetes.

PMID:36404391 | DOI:10.1111/dme.15008

Animal Model Exp Med. 2022 Nov 20. doi: 10.1002/ame2.12291. Online ahead of print.

ABSTRACT

BACKGROUND: Type 2 diabetes (T2D) is a polygenic metabolic disease, characterized by high fasting blood glucose (FBG). The ability of cranberry (CRN) fruit to regulate glycemia in T2D patients is well known. Here, a cohort of 13 lines of the genetically diverse Collaborative Cross (CC) mouse model was assessed for the effect of non-dialyzable material (NDM) of cranberry extract in lowering fasting blood glucose.

METHODS: Eight-week-old mice were maintained on either a standard chow diet (control group) or a high-fat diet (HFD) for 12 weeks, followed by injections of intraperitoneal (IP) NDM (50 mg/kg) per mouse, three times a week for the next 6 weeks. Absolute FBG (mg/dl) was measured bi-weekly and percentage changes in FBG (%FBG) between weeks 0 and 12 were calculated.

RESULTS: Statistical analysis showed a significant decrease in FBG between weeks 0 and 12 in male and female mice maintained on CHD. However, a non-significant increase in FBG values was observed in male and female mice maintained on HFD during the same period. Following administration of NDM during the following 6 weeks, the results show a variation in significant levels of FBG lowering between lines, male and female mice and under the different diets.

CONCLUSION: The results suggest that the efficacy of NDM treatment in lowering FGB depends on host genetic background (pharmacogenetics), sex of the mouse (pharmacosex), and diet (pharmacodiet). All these results support the need for follow-up research to better understand and implement a personalized medicine approach/utilization of NDM for reducing FBG.

PMID:36404387 | DOI:10.1002/ame2.12291

Drugs Aging. 2022 Nov 21. doi: 10.1007/s40266-022-00987-2. Online ahead of print.

ABSTRACT

BACKGROUND: Foundational therapies in heart failure improve clinical outcomes in heart failure with a reduced ejection fraction (HFrEF). Underuse of these life-prolonging heart failure therapies, such as sacubitril-valsartan, is common in older adults and has been associated with worse clinical outcomes. Characterizing the early benefits seen with these therapies might help increase their uptake in older adults.

OBJECTIVE: We applied several methods to estimate the time to benefit of an HFrEF therapy, using sacubitril-valsartan as a case study.

METHODS: PARADIGM-HF was a randomized controlled study on sacubitril-valsartan versus enalapril in stable, ambulatory HFrEF patients (n = 8399). The primary endpoint, a composite of death from cardiovascular causes or a first hospitalization for heart failure, was significantly reduced (sacubitril-valsartan (21.8%) versus enalapril (26.5%), hazard ratio (HR) 0.80 (95% confidence interval [CI] 0.73-0.87). We extracted and tabulated the Kaplan-Meier (KM) curves of the primary endpoint. An individual patient dataset was then reconstructed. The following methods were applied to explore the time to benefit of sacubitril-valsartan versus enalapril: visual estimation of the point of divergence of the KM curves, statistical process control (SPC), unadjusted landmark analyses using Cox proportional hazards analysis with 30-day increments until significance was persistently achieved, and comparing the survival probabilities of the extracted life tables.

RESULTS: Six raters visually estimated the time to benefit at a median of 60 days (interquartile range 38-10 days). Using SPC we found an early benefit from 28 days on, using the longest predefined control period of 28 days. An absolute risk reduction of 1 and 2% was found after 59 and 250 days, respectively. The reconstructed dataset provided a similar HR of 0.8004 (95% CI 0.7331-0.8739). Landmark analyses persistently showed statistical significance from 390 days and later. Survival probabilities differed from 35 days onward.

CONCLUSION: Using multiple approaches, the earliest benefit of sacubitril-valsartan compared to enalapril in stable HFrEF was found at about 1 month after initiation.

PMID:36404386 | DOI:10.1007/s40266-022-00987-2

Arch Public Health. 2022 Nov 21;80(1):239. doi: 10.1186/s13690-022-00997-x.

ABSTRACT

BACKGROUND: Studies have identified various determinants of unmet need for contraception. These determinants cut across individual, household, community, and health facility levels. Despite this evidence, there remains a lack of information regarding differentials in the prevalence and determinants of unmet need for contraception among women in the low-priority segments (such as women of advanced reproductive age and women living with disabilities) and high-priority segments (such as adolescents, young adults, and unmarried women) for family planning demand generation, hence this study.

METHODS: The study design is cross-sectional. The study analyzed merged data from the individual, and persons recode of the 2018 Nigeria Demographic and Health Survey (NDHS). The samples analyzed are 5,147 women in the high-priority segment and 7,536 women in the low-priority segment. The outcome variable in the study was unmet need for contraception. The explanatory variables were selected at the individual, household, community, and facility levels. Statistical analyzes were performed using Stata 14. Three multilevel mixed-effects regression models were fitted. Model 1 was the empty model, while Model 2 included the sets of individual, household, and community variables. Model 3 controlled for the facility-level variables.

RESULTS: Findings show a higher prevalence of unmet need for contraception among women in the family planning low-priority segment compared to women in the family planning high-priority segment. Religion and desired family size were the two individual characteristics that significantly predicted the unmet need for contraception among women in the two segments. Sexual autonomy was the only household characteristic that predicted unmet need for contraception in both segments. There were differences in the community characteristics that predicted unmet need for contraception among women in the two segments.

CONCLUSION: The prevalence of unmet need for contraception is not the same among women in low and high family planning priority segments. The determinants also differ among women in the two segments. Though, women in different family planning segments have the same contraceptive needs of avoiding pregnancy when not needed, however, getting the needs satisfied requires that existing programs be further examined to develop initiatives that will resonate with each segment of reproductive-age women.

PMID:36404339 | DOI:10.1186/s13690-022-00997-x

J Cardiovasc Magn Reson. 2022 Nov 21;24(1):65. doi: 10.1186/s12968-022-00890-0.

ABSTRACT

BACKGROUND: Cardiovascular magnetic resonance (CMR) is an important diagnostic test used in the evaluation of patients with heart failure (HF). However, the demographics and clinical characteristics of those undergoing CMR for evaluation of HF are unknown. Further, the impact of CMR on subsequent HF patient care is unclear. The goal of this study was to describe the characteristics of patients undergoing CMR for HF and to determine the extent to which CMR leads to changes in downstream patient management by comparing pre-CMR indications and post-CMR diagnoses.

METHODS: We utilized the Society for Cardiovascular Magnetic Resonance (SCMR) Registry as our data source and abstracted data for patients undergoing CMR scanning for HF indications from 2013 to 2019. Descriptive statistics (percentages, proportions) were performed on key CMR and clinical variables of the patient population. The Fisher’s exact test was used when comparing categorical variables. The Wilcoxon rank sum test was used to compare continuous variables.

RESULTS: 3,837 patients were included in our study. 94% of the CMRs were performed in the United States with China, South Korea and India also contributing cases. Median age of HF patients was 59.3 years (IQR, 47.1, 68.3 years) with 67% of the scans occurring on women. Almost 2/3 of the patients were scanned on 3T CMR scanners. Overall, 49% of patients who underwent CMR scanning for HF had a change between the pre-test indication and post CMR diagnosis. 53% of patients undergoing scanning on 3T had a change between the pre-test indication and post CMR diagnosis when compared to 44% of patients who were scanned on 1.5T (p < 0.01).

CONCLUSION: Our results suggest a potential impact of CMR scanning on downstream diagnosis of patients referred for CMR for HF, with a larger potential impact on those scanned on 3T CMR scanners.

PMID:36404335 | DOI:10.1186/s12968-022-00890-0

J Cardiovasc Magn Reson. 2022 Nov 21;24(1):64. doi: 10.1186/s12968-022-00889-7.

ABSTRACT

BACKGROUND: Despite advancements in percutaneous coronary intervention, a significant proportion of ST-elevation myocardial infarction (STEMI) survivors develop long-term adverse left ventricular (LV) remodelling, which is associated with poor prognosis. Adverse remodelling is difficult to predict, however four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) can measure various aspects of LV intra-cavity flow beyond LV ejection fraction and is well equipped for exploring the underlying mechanical processes driving remodelling. The aim for this study was to compare acute 4D flow CMR parameters between patients who develop adverse remodelling with patients who do not.

METHODS: Fifty prospective ‘first-event’ STEMI patients underwent CMR 5 days post-reperfusion, which included cine-imaging, and 4D flow for assessing in-plane kinetic energy (KE), residual volume, peak-E and peak-A wave KE (indexed for LV end-diastolic volume [LVEDV]). All subjects underwent follow-up cine CMR imaging at 12 months to identify adverse remodelling (defined as 20% increase in LVEDV from baseline). Quantitative variables were compared using unpaired student’s t-test. Tests were deemed statistically significant when p < 0.05.

RESULTS: Patients who developed adverse LV remodelling by 12 months had significantly higher in-plane KE (54 ± 12 vs 42 ± 10%, p = 0.02), decreased proportion of direct flow (27 ± 9% vs 11 ± 4%, p < 0.01), increased proportion of delayed ejection flow (22 ± 9% vs 12 ± 2, p < 0.01) and increased proportion of residual volume after 2 consecutive cardiac cycles (64 ± 14 vs 34 ± 14%, p < 0.01), in their acute scan.

CONCLUSION: Following STEMI, increased in-plane KE, reduced direct flow and increased residual volume in the acute scan were all associated with adverse LV remodelling at 12 months. Our results highlight the clinical utility of acute 4D flow in prognostic stratification in patients following myocardial infarction.

PMID:36404326 | DOI:10.1186/s12968-022-00889-7

BMC Endocr Disord. 2022 Nov 21;22(1):288. doi: 10.1186/s12902-022-01188-z.

ABSTRACT

INTRODUCTION: The importance of genetic and dietary factors in occurrence and progression of chronic diseases such as metabolic syndrome (MetS) has been established. However, complex interrelationships, including direct and indirect effects of these variables are yet to be clarified. So, our aim was to investigate the mediating role of glycemic indices in the relationship between CARTPT rs2239670 polymorphism, socio-demographic and psychological factors and metabolic risk factors and the presence of MetS in adults with obesity.

METHODS: In a cross-sectional study of 288 apparently healthy adults with obesity aged 20-50 years, dietary glycemic index (GI) and glycemic load (GL) were measured using a validated semi-quantitative food frequency questionnaire (FFQ). Biochemical parameters, blood pressure and anthropometric indicators were assayed by standard methods. Genotyping was carried out by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. Structural equation modeling (SEM) was used in the statistical analysis.

RESULTS: CARTPT rs2239670 had a positive direct effect on MetS (B = 0.037 ± 0.022; P = 0.043) and, on the other hand, this variant was found to be indirectly associated with MetS presence through mediation of GI (B = 0.039 ± 0.017; P = 0.009). CARTPT was a significant predictor of both dietary GI and GL (B = 1.647 ± 0.080 and B = 3.339 ± 0.242, respectively). Additionally, glycemic indicators appeared to mediate the association of age and gender with LDL-C (B = 0.917 ± 0.332; P = 0.006) and HDL (B = 1.047 ± 0.484; P = 0.031), respectively. GI showed a positive relationship with LDL-C (P = 0.024) in men and similar relationships were found between GL and LDL-C (P = 0.050) and cholesterol (P = 0.022) levels in women.

CONCLUSION: The SEM findings suggest a hypothesis of the mediating effect of glycemic indices in the relationship between genetic susceptibility to obesity and MetS presence. Our findings need to be confirmed with large prospective studies.

PMID:36404325 | DOI:10.1186/s12902-022-01188-z

BMC Womens Health. 2022 Nov 21;22(1):462. doi: 10.1186/s12905-022-02055-8.

ABSTRACT

BACKGROUND: Cervical cancer is a global public health problem & is the fourth leading cause of cancer morbidity and mortality. Abnormal cervical lesion is common in commercial sex workers and is at a higher risk of developing cervical cancer due to multiple sexual partners besides other factors. Intention is an important predictor of behavior and is an initiative to transform their desire into action. Therefore, this study aimed to assess the predictors of intention to receive cervical cancer screening among commercial sex workers in Gondar city, northwest Ethiopia.

METHODS: A community-based cross-sectional study was conducted from March 27 to May 25, 2021, in Gondar city, northwest Ethiopia. A total of 425 commercial sex workers selected using convenience sampling techniques were included in the study. Linear regression with robust standard errors was carried out to identify predictors of intention to receive cervical cancer screening. A 95% confidence interval and a p-value of less than 0.05 were used to declare statistical significance.

RESULTS: A total of 393 commercial sex workers participated in the study with a response rate of 92.4%. The mean age of the participants was 27.68 ± 6.62. The median (interquartile range) of intention was 4 (3-4.25). The theory of planned behaviour variables explained 38.51% of the variance in intention to receive cervical cancer screening. Direct subjective norm (β = 0.09), 95% CI (0.05, 0.13)), direct Attitude (β = 0.09, 95% CI (0.04, 0.13)), past behaviour (β = 0.27; 95% CI (0.09, 0.46), and positive HIV status (β = 0.26; 95% CI (0.06, 0.46) were significant predictors of intention.

CONCLUSIONS: Commercial sex workers’ intention to undergo cervical cancer screening was high. The theory of planned behavior showed adequate utility in predicting commercial sex workers’ intention to receive cervical cancer screening. Participant’s attitudes, subjective norm, past behavior, and positive HIV status were important factors affecting their intention to receive cervical cancer screening. Thus, interventions aimed at enhancing commercial sex workers’ cervical cancer screening behavior should target creating positive social pressure and attitudinal change towards cervical cancer screening.

PMID:36404309 | DOI:10.1186/s12905-022-02055-8

BMC Womens Health. 2022 Nov 21;22(1):465. doi: 10.1186/s12905-022-02034-z.

ABSTRACT

BACKGROUND: As postmenopausal osteoporotic fractures can cause higher rates of disability and mortality in women; it is essential to analyze the factors associated with primary and recurrent fractures in postmenopausal osteoporosis (PMOP) patients.

METHODS: Retrospective analysis of 2478 PMOP patients aged ≥ 50 years who attended the Shanghai General Hospital from January 2007 to December 2016, including 1239 patients with no fractures and 1239 patients with histories of fractures (1008 in the primary fracture group and 231 in the re-fracture group). All patients’ basic clinical data, serum biochemical and bone metabolic markers, bone mineral density (BMD), and other indicators were recorded uniformly. Comparing the differences between the clinical characteristics of patients with primary and recurrent fractures, as well as the differences in the clinical characteristics of patients with primary and recurrent fractures in combination with different diseases, further analyses the risk factors for primary and recurrent fractures in PMOP patients. SPSS.26 was used for statistical analysis.

RESULTS: Compared to the unfractured group, the fractured group was older and had lower height and bone mineral density (all P < 0.01), with the re-fractured group having lower BMD at each key site than the primary fracture group (all P < 0.01). Analysis of the combined disease subgroups showed that serum BGP levels were lower in the primary and re-fracture patients with diabetes than in the non-diabetic subgroup (P < 0.05), and serum CTX levels were lower in the re-fracture group with diabetes than in the primary fracture group with diabetes (P < 0.05). Patients with recurrent fractures with cardio-vascular diseases had lower BMD than the subgroup without cardio-vascular diseases (P < 0.05) and also had lower BMD than the group with primary fractures with cardio-vascular diseases (P < 0.05). Multiple logistic regression analysis showed that advanced age, overweight, low lumbar spine and total hip BMD were risk factors for primary and recurrent fractures; and comorbid chronic liver and kidney diseases were risk factors for primary fractures.

CONCLUSION: PMOP patients with advanced age, overweight, low bone mineral density, and comorbid chronic liver and kidney diseases are at greater risk of fractures and require early intervention to reduce fractures occurrence. Moreover, those who are elderly, overweight, and have low bone density should also be aware of the risk of re-fractures.

PMID:36404305 | DOI:10.1186/s12905-022-02034-z