Tag: pubmed

Int J Clin Pract. 2021 Sep 12:e14831. doi: 10.1111/ijcp.14831. Online ahead of print.

ABSTRACT

AIM: To examine the incidence and treatment of acute myocardial infarction (AMI) as well as 30-day and 1-year prognoses of patients in different regions of Hungary. According to the statistical system of the European Union, Hungary can be divided into three major socio-economic regions-west Hungary, central Hungary and east Hungary.

METHODS AND RESULTS: The Hungarian Myocardial Infarction Registry (HUMIR) is a prospective comprehensive and mandatory disease registry for patients with AMI. The total population of Hungary is currently 9.8 million: 39% live in the eastern region (ER), 31% in the Central region (CR) and 30% in the western region (WR). Population over 30 years, the age-standardised incidence of AMI was 177.5 (175.7-179.3) per 100,000 person-year. During hospital treatment, 82.5%-84.6% of patients with ST-elevation (STEMI) and 54.8%-58.8% without ST-elevation (NSTEMI) myocardial infarction underwent PCI. The total ischaemic time of patients with STEMI was shortest in WR (221 minutes) compared to two other regions (CR:225, ER:262 minutes). In the STEMI group, the 30-day mortality rates of males were lowest in the WR (p = 0.03). If PCI was performed, mortality rates for both sexes were lowest in the WR (p < 0.01; p = 0.04). The 1-year mortality rate in the male population who received PCI was lowest in the WR. In the NSTEMI group, the 30-day mortality rate exhibited no differences. Regarding 1-year mortality, those who underwent PCI in the WR showed the lowest mortality.

CONCLUSION: The major regions of Hungary revealed significant differences regarding the incidence, prehospital delay, treatment and mortality of AMI. Logistic regression analysis confirmed the independent prognostic significance of the region on the 30-day mortality of patients with STEMI (Hazard ratio = 0.88, p = 0.0114; CI:0.80-0.97).

PMID:34510670 | DOI:10.1111/ijcp.14831

Pain Pract. 2021 Sep 12. doi: 10.1111/papr.13075. Online ahead of print.

ABSTRACT

OBJECTIVES: Insomnia is a highly prevalent problem among patients with chronic pain. Interdisciplinary pain rehabilitation programs (IPRPs) are a leading treatment option for chronic pain; however, research is limited and existing findings are mixed on the impact of insomnia symptoms on IPRP outcomes and the extent to which insomnia symptoms improve as a result of IPRP treatment.

METHODS: In this study, insomnia and pain-related outcomes following a 10-week IPRP were examined from a relatively large sample (N = 393) of adult patients with varying chronic pain conditions who completed the Insomnia Severity Index (ISI) at program admission and discharge. Both group- and individual-level changes in insomnia severity were examined to evaluate statistically and clinically significant changes in insomnia symptoms, along with the impact of insomnia symptoms on measures of pain, emotional distress, and functioning. Participants were categorized as having no clinically significant insomnia symptoms (NCSI), mild, moderate, or severe insomnia based on ISI scores.

RESULTS: Higher levels of insomnia severity were associated with worse pain, functioning, and emotional distress. Most patients reporting mild, moderate, or severe insomnia symptoms at program admission moved to a lower insomnia symptom category at the time of discharge (62%); however, only 33% of these patients reported a meaningful score reduction (i.e., ISI change ≥ 8 points). In addition, insomnia symptoms had a negative impact on treatment gains related to pain interference and physical health-related quality of life.

DISCUSSION: These findings suggest that usual IPRP care confers overall treatment benefit for individuals with chronic pain and insomnia. However, insomnia symptoms may negatively impact pain treatment outcomes and usual care appears insufficient to address elevated insomnia patients for many patients. Additional insomnia-specific treatment may be warranted for patients with comorbid chronic pain.

PMID:34510698 | DOI:10.1111/papr.13075

Int J Clin Pract. 2021 Sep 12:e14774. doi: 10.1111/ijcp.14774. Online ahead of print.

ABSTRACT

OBJECTIVES: Diagnostic challenges during the corona virus disease (COVID-19) pandemic forced the radiology regulating body to adopt the use of CT Chest as a triage and diagnostic tool, which was subsequently abandoned. The Royal Wolverhampton hospital followed both protocols. Here, we investigate the evidence behind this decision within the context of surgical admissions during the COVID-19 peak in our hospital.

METHODS: Retrospective data collection and analysis of all surgical admissions between the 1st of March to the 31st of May. Data were collected from the radiology and electronic portal looking into patients undergoing CT chest to diagnose the presence of COVID-19 as well as swab results.

RESULTS: Seventy-eight patients fulfilled our inclusion criteria. The scan either confirmed the presence or absence (4, 63 patients) of COVID-19 but was sometimes inconclusive (11 patients). Comparing these to the results of the swabs; CT showed sensitivity 42.86%, Specificity 97.92%, and accuracy 90.91%. In the inconclusive CT report group, chances of having a positive swab result were 45%: None of the scan results changed any of the surgical planning. Lymphocyte count in the context of surgical presentation did not have any statistical significance to predict the presence of COVID-19 (P = .7). Cost implications on our cohort of patients for adding the chest CT is estimated to be around £31 000.

CONCLUSION: CT Thorax during the pandemic was a good negative predictor but had limited diagnostic value and did not change patient management. Newer, faster techniques of PCR swabs and antibody testing would be a better and cheaper alternative.

PMID:34510648 | DOI:10.1111/ijcp.14774

Int J Lang Commun Disord. 2021 Sep 12. doi: 10.1111/1460-6984.12671. Online ahead of print.

ABSTRACT

BACKGROUND: National UK guidance makes recommendations for speech and language therapy staffing levels in critical care and rehabilitation settings. Traumatic spinal cord injury patients often require admission primarily to critical care services within a major trauma centre prior to transfer to a specialist spinal injury unit but may not receive similar levels of care. Dysphagia and communication difficulties are recognised features of cervical spinal cord injury; however, little is known about access to speech and language therapy services to provide rehabilitation and improve outcomes.

AIMS: The aim of this study was to compare the workforce and clinical practices of speech and language therapy services in eight spinal injury units and four major trauma centres in England through an online survey.

METHODS & PROCEDURES: An online survey was created with 26 multiple-choice questions across seven sub-sections, with options for free-text comments. These were sent to a named speech and language therapy contact at each of the specified units. Responses were uploaded into Excel for analyses, which included descriptive statistics and analysis of themes.

OUTCOMES & RESULTS: Responses were received from 92% (11/12) speech and language therapy services invited, which included seven out of eight spinal injury units and all four major trauma centres. No units met national staffing recommendations. Staff in spinal injury units provided an average of 27 h per week input to the unit compared to 80 h in a major trauma centre. Despite caseload variations, speech and language range of therapy involvement and prioritisation process were equivalent. Access to instrumental assessment varied, with less use of Fibreoptic Endoscopic Evaluation of Swallowing in spinal injury units despite its clinical value to the spinal cord injury caseload.

CONCLUSIONS & IMPLICATIONS: Speech and language therapy services delivering post-acute and long-term rehabilitation to spinal cord injury patients are limited by their resources and capacity, which restricts the level of therapy delivered to patients. This may have an impact on clinical outcomes for communication and swallowing impairments. Further evidence is needed of the interventions delivered by speech and language therapists and outcomes will be beneficial alongside benchmarking similar services.

WHAT THIS PAPER ADDS: What is already known on this subject In England, people who sustain a spinal cord injury are admitted to a major trauma centre prior to transfer to a specialist spinal injury unit. Dysphagia and communication impairments are recognised as a complication of cervical spinal cord injury and benefit from speech and language therapy intervention. National recommendations exist for staffing levels, expertise and competencies for speech and language therapists working in critical care and rehabilitation units. What this study adds This study identified variations in the levels of speech and language therapy staffing, seniority, service delivery and access to instrumental assessments for dysphagia between major trauma centres and spinal injury units. None of the services complied with national staffing recommendations. Clinical implications of this study Speech and language therapy services in spinal injury units are often available part-time or have limited access to diagnostic tools which limits the range and intensity of rehabilitation input available. This has clinical implications for outcomes for swallowing and communication as well as long-term consequences for integrating back into community.

PMID:34510665 | DOI:10.1111/1460-6984.12671

Helicobacter. 2021 Sep 12:e12852. doi: 10.1111/hel.12852. Online ahead of print.

ABSTRACT

OBJECTIVE: To update and evaluate the recurrence rate of Helicobacter pylori (H. pylori) eradication therapy in recent 10 years.

METHODS: A systematic search of PubMed, Embase, Cochrane library, and Web of science was performed to identify the studies of recurrence rate of H. pylori published from 2010 to 2019. Stata 15.0 was used for analysis.

RESULTS: A total of 31 studies (16,797 participants) were analyzed. The recurrence rate of H. pylori was 9% (95% CI, 8-11%), and it showed an upward trend with the time elapsed after eradication. The annual recurrence rate was 4%, and there was a stable trend with the time elapsed after eradication. Subgroup analyses showed that the recurrence rate of H. pylori eradication by triple therapy was higher than that of quadruple therapy (14% [95% CI, 9-19] vs 12% [95% CI, 7-17]); urban was higher than that of rural (8% [95% CI, 1-14] vs 5% [95% CI, 1-9]); males were higher than that of females (11% [95% CI, 8-14] vs 10% [95% CI, 7-14]); Europe had the highest recurrence rate (16% [95% CI, -1 to 42]), and Africa had the lowest (1% [95% CI, 0-2]). The recurrence rate ofH. pylori was inversely related to the human development index.

CONCLUSIONS: The recurrence rate of H. pylori showed an increasing trend in recent 10 years, and it is still a knotty public health problem worldwide. The recurrence rate of H. pylori showed an upward trend with the time elapsed after eradication, and the recurrence rate of H. pylori varies by area, gender, and eradication methods.

PMID:34510644 | DOI:10.1111/hel.12852

Vet Radiol Ultrasound. 2021 Sep 12. doi: 10.1111/vru.13017. Online ahead of print.

ABSTRACT

Abdominal ultrasonography is increasingly used as a standard diagnostic test in veterinary practices, however, there is little published information regarding the effects of operator experience on image quality. In this prospective observer agreement study, image quality was assessed for abdominal ultrasound examinations performed by nine sonographers (three general practitioners, three credentialed veterinary technicians, and three board-certified specialists). Each sonographer independently performed abdominal ultrasound examinations on the same group of 4 sedated clinically healthy animals (3 dogs, 1 cat) using the same model machine and standardized presets. Twenty-five organs and anatomical landmarks per exam (26 for male dog) were evaluated. Still images and cine loops were recorded for each one of the organs. The final scoring of image quality for each examination was performed by two board-certified veterinary radiologists in a randomized and blinded fashion. Semiquantitative scoring system was used for each reading: 0 – not seen, 1- seen but poor quality/partial seen, 2 – average/good quality, and 3 – excellent quality. The average score for each animal and sonographer was tallied and sonographer groups and individual sonographers were compared. Scores were assessed for normality and data were ranked transformed prior to statistical analysis. No significant differences were found regarding the completeness and quality scores of sonographers of different experience levels and disciplines when measuring specific standard components of a full abdominal scan. There were no statistical differences between individual sonographers or groups of sonographers. Although not statistically significant, the general practitioner’s group showed the greatest variability of their individual scores.

PMID:34510634 | DOI:10.1111/vru.13017

Breast J. 2021 Sep 12. doi: 10.1111/tbj.14289. Online ahead of print.

ABSTRACT

FinHer regimen is considered a relatively cardiac safe regimen for Her 2 positive breast cancer in resource-limited settings. There is limited data on cardiotoxicity of this regimen. Out of 1200 patients diagnosed with carcinoma breast during the study period, three hundred Her2-positive early-breast cancer patients received FinHer protocol were included. Among the 300 patients, a total of 71 patients (24%) experienced cardiac toxicity including asymptomatic EF loss in 62 patients (21%) and symptomatic LVEF loss in nine patients (3%). Among patients with symptomatic LVEF loss, six patients had symptomatic cardiac toxicity, one patient (0.3%) had symptoms with fall in EF after completion of treatment, one patient (0.3%) had Congestive cardiac failure (CHF); one patient (0.3%) had non-ST elevation myocardial infarction (NSTEMI). Later, trastuzumab was rechallenged in all 62 patients (24%) with asymptomatic LVEF loss and six patients (2%) with symptomatic LVEF loss. One patient with CHF and NSTEMI was not rechallenged. Hypertension and diabetic mellitus which were the two factors found to have risk on univariate logistic regression analysis although it was not statistically significant. None of these patients further experienced cardiac toxicity at 24 months follow-up except one patient. Although FinHer protocol is considered a cardiac safe protocol, cardiotoxicity associated with trastuzumab which can manifest as an asymptomatic decline in LVEF is more than usually expected in a real-world scenario.

PMID:34510637 | DOI:10.1111/tbj.14289

J Magn Reson Imaging. 2021 Sep 12. doi: 10.1002/jmri.27905. Online ahead of print.

ABSTRACT

BACKGROUND: Pseudo-spiral Cartesian sampling with compressed sensing reconstruction has facilitated highly accelerated 4D flow magnetic resonance imaging (MRI) in various cardiovascular structures. However, unlike echo planar imaging (EPI)-accelerated 4D flow MRI, it has not been validated in whole-heart applications.

HYPOTHESIS: Pseudo-spiral 4D flow MRI (PROUD [PROspective Undersampling in multiple Dimensions]) is comparable to EPI in robustness of valvular flow measurements and remains comparable as the undersampling factor is increased and scan time reduced.

STUDY TYPE: Prospective.

POPULATION: Twelve healthy subjects and eight patients with valvular regurgitation.

FIELD STRENGTH/SEQUENCE: 3.0 T; PROUD and EPI 4D flow sequences, 2D flow and balanced steady-state free precession sequences.

ASSESSMENT: Valvular blood flow was quantified using valve tracking. PROUD- and EPI-based measurements of aortic (AV) and pulmonary (PV) flow volumes and left and right ventricular stroke volumes were tested for agreement with 2D MRI-based measurements. PROUD reconstructions with undersampling factors (R) of 9, 14, 28, and 56 were tested for intervalve consistency (per valve, compared to the other valves) and preservation of peak velocities and E/A ratios.

STATISTICAL TESTS: We used repeated measures ANOVA, Bland-Altman, Wilcoxon signed rank, and intraclass correlation coefficients. P < 0.05 was considered statistically significant.

RESULTS: PROUD and EPI intervalve consistencies were not significantly different both in healthy subjects (valve-averaged mean difference [limits of agreement width]: 3.2 ± 0.8 [8.7 ± 1.1] mL/beat for PROUD, 5.5 ± 2.9 [13.7 ± 2.3] mL/beat for EPI, P = 0.07) and in patients with valvular regurgitation (2.3 ± 1.2 [15.3 ± 5.9] mL/beat for PROUD, 0.6 ± 0.6 [19.3 ± 2.9] mL/beat for EPI, P = 0.47). Agreement between EPI and PROUD was higher than between 4D flow (EPI or PROUD) and 2D MRI for forward flow, stroke volumes, and regurgitant volumes. Up to R = 28 in healthy subjects and R = 14 in patients with valvular regurgitation, PROUD intervalve consistency remained comparable to that of EPI. Peak velocities and E/A ratios were preserved up to R = 9.

CONCLUSION: PROUD is comparable to EPI in terms of intervalve consistency and may be used with higher undersampling factors to shorten scan times further.

LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY STAGE: 2.

PMID:34510612 | DOI:10.1002/jmri.27905

Mol Ecol. 2021 Sep 12. doi: 10.1111/mec.16176. Online ahead of print.

ABSTRACT

Whole genome sequencing provides deep insights into the evolutionary history of a species, including patterns of diversity, signals of selection, and historical demography. When applied to closely related taxa with a wealth of background knowledge, population genomics provides a comparative context for interpreting population genetic summary statistics and comparing empirical results with the expectations of population genetic theory. The Galapagos giant tortoises (Chelonoidis spp.), an iconic rapid and recent radiation, offer such an opportunity. Here, we sequenced whole genomes from three individuals of the 12 extant lineages of Galapagos giant tortoise and estimate diversity measures and reconstruct changes in coalescent rate over time. We also compare the number of derived alleles in each lineage to infer how synonymous and non-synonymous mutation accumulation rates correlate with population size and life history traits. Remarkably, we find that patterns of molecular evolution are similar within individuals of the same lineage, but can differ significantly among lineages, reinforcing the evolutionary distinctiveness of the Galapagos giant tortoise species. Notably, differences in mutation accumulation among lineages do not align with simple population genetic predictions, suggesting that the drivers of purifying selection are more complex than is currently appreciated. By integrating results from earlier population genetic and phylogeographic studies with new findings from the analysis of whole genomes, we provide the most in-depth insights to date on the evolution of Galapagos giant tortoises, and identify discrepancies between expectation from population genetic theory and empirical data that warrant further scrutiny.

PMID:34510620 | DOI:10.1111/mec.16176

Phytother Res. 2021 Sep 12. doi: 10.1002/ptr.7280. Online ahead of print.

ABSTRACT

The present study aims to summarize and quantitatively examine the available evidence on the effectiveness of anthocyanin supplementation on liver enzymes among patients with metabolic disorders, by employing a systematic review and meta-analytic approach. Online databases including PubMed/Medline, Scopus, ISI Web of Science, and Cochrane Library were searched up to June 2020 for randomized controlled trials (RCTs) that examined the effect of anthocyanin supplementation on serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) among patients with metabolic disorders. To estimate the overall effect of anthocyanin supplementation, we employed the random-effects model. In total, 12 RCTs were included in the systematic review. Pooled analysis did not show any significant changes in ALT (WMD: -0.92 U/L, 95% CI: -4.19 to 2.35, p = .58; I² = 91.3%) and AST (WMD: -1.22 U/L, 95% CI: -3.43 to 0.99, p = .28; I² = 87.0) concentrations after supplementation with anthocyanin. The dose and duration of supplementation were the potential sources of heterogeneity among most of the trials. However, subgroup analysis showed that the effect is not statistically significant in all subgroups. Overall, in our study, anthocyanin does not have any effect on liver enzyme levels significantly. However, future high-quality studies are still needed to confirm the results.

PMID:34510592 | DOI:10.1002/ptr.7280