Tag: pubmed

Thromb Haemost. 2022 Jan 27. doi: 10.1055/a-1753-2748. Online ahead of print.

ABSTRACT

In certain clinical situations, it is necessary to determine whether clinically relevant plasma levels of direct oral anticoagulants (DOACs) are present. We examined whether qualitative testing of DOACs in urine samples can exclude DOAC plasma concentrations of >30 ng/mL. This prospective single centre cohort study included consecutive patients treated with an oral direct factor Xa inhibitor (DXI) (apixaban, n=31, rivaroxaban, n=53) and direct thrombin inhibitor (DTI) (dabigatran, n=44). We aimed to define the negative predictive value (NPV) and other statistical parameters of detecting DXIs and DTIs by DOAC Dipstick at plasma concentrations of >30 ng/mL. We also determined the best-fit threshold plasma levels using chromogenic substrate assays by logistic regression analysis. Between July 2020 and July 2021, 128 eligible patients (mean age 66 years, 55 females) were included into the study. The NPVs and sensitivities for DXI and DTI of DOAC Dipstick were 100% at >30 ng/ml plasma, for specificities 6% and 21% and for positive predictive values 62% and 72%, respectively. All diagnostic statistical tests improved to values between 86% and 100% at best fitting plasma thresholds of >14 ng/mL for DXI and >19 ng/mL for DTI. Visual analysis using the DOAC Dipstick was 100% in agreement with that of the optoeletronic DOASENSE Reader for all three DOACs. DOAC Dipstick testing can reliably exclude the presence of DOACs in urine samples at best fitting thresholds of >14 and >19 ng/mL in plasma. The performance of the DOAC Dipstick at detecting lower DOAC concentrations in plasma requires confirmation.

PMID:35088395 | DOI:10.1055/a-1753-2748

J Racial Ethn Health Disparities. 2022 Jan 27. doi: 10.1007/s40615-022-01241-6. Online ahead of print.

ABSTRACT

PURPOSE: Underrepresented minority student recruitment initiatives from medical school admissions and diversity offices can bring equity for those learners underrepresented in medicine. Measuring growth of the applicant pool helps determine the impact of such initiatives in helping diversify the healthcare workforce.

AIM: The authors evaluated underrepresented minority applicant pool growth at the Brody School of Medicine to determine whether predominantly White institutions or historically Black colleges and universities have accounted for the most growth in minority applicants in recent years.

METHODS: Outreach outcomes across the state were obtained by comparing applicant and matriculant demographics. Data on all applicants and matriculants were retrieved from the school’s institutional records and classified according to student self-identification as underrepresented minority. Using Chi-square tests, authors aimed to determine whether the proportion of minority students increased among applicants and matriculants since 2016, the year of restructuring outreach. In further analysis, the number of graduates from historically Black colleges and universities as compared to minority graduates from predominantly White schools was evaluated.

RESULTS: The authors identified 7,848 applicants and 654 matriculants over the evaluation period. The proportion of learners identifying as underrepresented minority increased from 17% before 2016 (622/3,672) to 20% after 2016 (835/4,176; p = 0.001). The proportion of applicants who did not graduate from a historically Black college or university increased slightly after 2016 (89% of underrepresented minority applicants before 2016 vs. 92% of underrepresented minority applicants after 2016), but this increase was not statistically significant (p = 0.097).

CONCLUSION: Applicant growth has been more significant for underrepresented minority applicants from predominantly White institutions. Graduates of targeted historically Black colleges and universities who applied to Brody School of Medicine were better prepared, resulting in increased chances of admission.

PMID:35088390 | DOI:10.1007/s40615-022-01241-6

Brain Imaging Behav. 2022 Jan 28. doi: 10.1007/s11682-021-00601-w. Online ahead of print.

ABSTRACT

This study aimed to systematically review the literature to identify clinical studies assessing neuroplasticity changes induced by or associated with bruxism or a tooth-clenching task using neurophysiological techniques. Searches were performed in five electronic databases (PubMed, EMBASE, Scopus, Web of Science, and Google Scholar) in April 2020. This review included clinical studies using neurophysiological techniques to assess neuroplasticity changes in healthy participants before and after a tooth-clenching task or comparing bruxers and non-bruxers. The quality assessment was performed with the Joanna Briggs Institute tool and Grading of Recommendations Assessment, Development, and Evaluation. Meta-analyses were conducted with studies reporting similar comparisons regarding masseter motor evoked potential amplitude and signal change outcomes. Of 151 articles identified in the searches, nine were included, and five proceeded to meta-analysis. Included studies presented moderate to very low methodological quality. From these included studies, eight evaluated bruxers and non-bruxers, of which five of them observed brain activity differences between groups, and three found no differences. Even so, all studies have suggested distinct difference in the central excitability between bruxers and non-bruxers, the meta-analysis revealed no statistically significant differences (P > 0.05). It appears that bruxism seems, indeed, to be associated with distinct differences in the neural pathways related to the control of the jaw-closing muscles, but that considerable variability in terms of classification of bruxism and assessment of neuroplasticity hamper a definite conclusion. Future research projects should take these concerns into consideration in order to further the understanding of bruxism physiology and pathophysiology.

PMID:35088353 | DOI:10.1007/s11682-021-00601-w

Int Ophthalmol. 2022 Jan 28. doi: 10.1007/s10792-021-02185-2. Online ahead of print.

ABSTRACT

PURPOSE: To assess the peripapillary retinal nerve fiber layer (RNFL) and macular choroidal thickness (CT) of children who have Type 1 diabetes mellitus (DM), both with and without vitamin D deficiency (VDD).

METHODS: The prospective, case-control study herein comprised that included 46 children with DM and VDD (Group 1), 42 children with DM and normal vitamin D levels (Group 2), and 73 healthy children (Control group). The peripapillary RNFL thickness and macular CT were measured at three different points (subfoveal, 1500 μm nasal, and 1500 μm temporal from the fovea) and compared.

RESULTS: The subfoveal, 1500 μm nasal, and 1500 μm temporal CT values were determined to be lower in the patients in Group 1 and Group 2 when compared to those in the Control group (P < 0.001). The same parameters were determined to be lower in the patients in Group 1 when compared to those in Group 2, although this difference was not found to be statistically significant (P > 0.05). In all of the quadrants, the RNFL thickness was determined to be similar between the groups, with P > 0.05 for all of the groups, except for the nasal quadrant (P = 0.031). In the correlation analysis of the patients in Group 1, it was revealed that a positive correlation existed between the CT and the vitamin D levels (P < 0.05).

CONCLUSION: The choroids of pediatric diabetic children were thinner when compared to those of healthy children. The alterations in these parameters were more prominent in subjects who were determined to have lower levels of vitamin D.

PMID:35088355 | DOI:10.1007/s10792-021-02185-2

Environ Sci Pollut Res Int. 2022 Jan 28. doi: 10.1007/s11356-021-18246-z. Online ahead of print.

ABSTRACT

Environmental exposure to vanadium has been on the increase in recent time. This metal is a known toxicant. The current study was conducted to investigate the reproductive toxicity of sodium metavanadate (SMV) in male African giant rats. Administration of SMV was done intraperitoneally daily for 14 consecutive days at a dosage of 3 mg/kg body weight. Sterile water was administered to the control group. Serum reproductive hormones, sperm reserve and quality as well as testicular ultrastructural changes following SMV treatment were analysed. Results showed SMV-exposed AGR group had statistically decreased concentrations of testosterone (4.7 ng/ml), FSH (3.4 IU/L) and LH (3.8 IU/L). Also, SMV-treated group had statistically decreased sperm motility and mass activity with increased percentage of abnormal morphophenotypes of spermatozoa and upregulation of P53 immunopositive cells. Ultrastructural study revealed vacuolation of germ and Sertoli cells cytoplasm and nucleus, and mitochondrial swelling and vacuolations were also observed. There was severe disintegration of the seminiferous tubules, atrophy and degeneration of myeloid cells and apoptosis of the Leydig, Sertoli and germ cells. In conclusion, intraperitoneal SMV exposure exerts severe adverse effects on some serum reproductive hormones, reduction in the sperm reserve and quality, apoptosis and degenerative changes of the Leydig, Sertoli and germ cells which can lead to infertility.

PMID:35088257 | DOI:10.1007/s11356-021-18246-z

J Osteopath Med. 2022 Jan 27. doi: 10.1515/jom-2021-0214. Online ahead of print.

ABSTRACT

CONTEXT: With the rise of the Delta variant of SARS-CoV-2 and the low vaccination rates in the United States, mitigation strategies to reduce the spread of SARS-CoV-2 are essential for protecting the health of the general public and reducing strain on healthcare facilities. This study compares US counties with and without mask mandates and determines if the mandates are associated with reduced daily COVID-19 infection. US counties have debated whether masks effectively decrease COVID-19 cases, and political pressures have prevented some counties from passing mask mandates. This article investigates the utility of mask mandates in small US counties.

OBJECTIVES: This study aims to analyze the effectiveness of mask mandates in small US counties and places where the population density may not be as high as in larger urban counties and to determine the efficacy of countywide mask mandates in reducing daily COVID-19 infection.

METHODS: The counties studied were those with populations between 40,000 and 105,000 in states that did not have statewide mask mandates. A total of 38 counties were utilized in the study, half with and half without mask mandates. Test counties were followed for 30 days after implementing their mask mandate, and daily new SARS-CoV-2 infection was recorded during this timeframe. The counties were in four randomly selected states that did not have statewide mask mandates. The controls utilized were from counties with similar populations to the test counties and were within the same state as the test county. Controls were followed for the same 30 days as their respective test county. Data were analyzed utilizing t-test and difference-in-difference analyses comparing counties with mask mandates and those without.

RESULTS: These data showed statistically significant lower averages of SARS-CoV-2 daily infection in counties that passed mask mandates when compared with counties that did not. The difference-in-difference analysis revealed a 16.9% reduction in predicted COVID-19 cases at the end of 30 days.

CONCLUSIONS: These data support the effectiveness of mask mandates in reducing SARS-CoV-2 infection spread in small US counties where the population density may be less than in urban counties. Small US counties that are considering passing mask mandates for the population can utilize these data to justify their policy considerations.

PMID:35086185 | DOI:10.1515/jom-2021-0214

Diagnosis (Berl). 2022 Jan 27. doi: 10.1515/dx-2021-0136. Online ahead of print.

ABSTRACT

OBJECTIVES: Podcasts have emerged as an efficient method for widespread delivery of educational clinical reasoning (CR) content. However, the impact of such podcasts on CR skills has not been established. We set out to determine whether exposure to expert reasoning in a podcast format leads to enhanced CR skills.

METHODS: This is a pseudo-randomized study of third-year medical students (MS3) to either a control group (n=22) of pre-established online CR modules, or intervention group (n=26) with both the online modules and novel CR podcasts. The podcasts were developed from four “clinical unknown” cases presented to expert clinician educators. After completing these assignments in weeks 1-2, weekly history and physical (H&P) notes were collected and graded according to the validated IDEA rubric between weeks 3-7. A longitudinal regression model was used to compare the H&P IDEA scores over time. Usage and perception of the podcasts was also assessed via survey data.

RESULTS: Ninety control and 128 intervention H&Ps were scored. There was no statistical difference in the change of average IDEA scores between intervention (0.92, p=0.35) and control groups (-0.33, p=0.83). Intervention participants positively received the podcasts and noted increased discussion of CR principles from both their ward (3.1 vs. 2.4, p=0.08) and teaching (3.2 vs. 2.5, p=0.05) attendings.

CONCLUSIONS: This is the first objective, pseudo-randomized assessment of CR podcasts in undergraduate medical education. While we did not demonstrate significant improvement in IDEA scores, our data show that podcasts are a well-received tool that can prime learners to recognize CR principles.

PMID:35086184 | DOI:10.1515/dx-2021-0136

Oncology. 2022 Jan 27. doi: 10.1159/000522204. Online ahead of print.

ABSTRACT

BACKGROUND: With an estimated 1.8 million deaths, lung cancer is one of the widely reported malignancies, with substantial morbidity and mortality rates. Thymidylate synthase (TS) is an important drug target for platinum-based doublet chemotherapy as it is the only de novo source of thymidylate production in the cell. TS polymorphisms in the 5’UTR of Thymidylate synthase enhancer region (TSER) 2R/3R and 3′- UTR 1494del6 are investigated in this study.

METHODS: A total of 700 lung cancer patients with platinum-based doublet chemotherapy were recruited in this study. TSER (2R/3R) and TS 1494del6 polymorphisms in North Indian lung cancer patients were examined, and statistical analysis was performed.

RESULTS: According to our findings, patients with the wild genotype (2R/2R) for the TSER polymorphism had a longer median survival time as compared to patients harboring the mutant type genotype (3R/3R) [MST=9.77 vs. 7.57 months; p=0.04]. On the contrary, patients with the mutant 14946del6 polymorphism (-6/-6) had a longer survival time than patients with the wild-type genotype (+6/+6) [MST=7.23 vs. 9 months]. Further, our findings elucidated that the patients with heterozygous genotype (2R3R) for TSER polymorphism had a 2.30-fold increased risk of developing leukopenia (AOR=2.30, 95% CI=0.96-5.52; p=0.05). A substantial risk of 5.14-fold constipation was found in heterozygous genotype (2R3R) when intermediate grade 2 toxicity was compared with low toxicity (grade 1) (p=0.007).An increased risk of nausea/vomiting was observed in patients with mutant genotype (-6/-6bp) for 1494 ins/del6 polymorphism compared to patients with wild-type genotype (+6/+6bp) (AOR= 2.77; 95%CI=1.10-6.96, p=0.03).

CONCLUSION: According to our findings, TSER and the 1494del6 polymorphism may operate as a prognostic marker in lung cancer patients receiving platinum-based chemotherapy. Furthermore, TS polymorphisms may influence the onset of platinum-related toxicity, such as hematological and gastrointestinal toxicity. These findings might facilitate therapeutic decisions for individualized therapy in lung cancer patients.

PMID:35086099 | DOI:10.1159/000522204

Acad Med. 2022 Jan 25. doi: 10.1097/ACM.0000000000004607. Online ahead of print.

ABSTRACT

PURPOSE: Using electrocardiogram (ECG) interpretation as an example of a widely taught diagnostic skill, the authors conducted a systematic review and meta-analysis to demonstrate how research evidence on instruction in diagnosis can be synthesized to facilitate improvement of educational activities (instructional modalities, instructional methods, and interpretation approaches), guide the content and specificity of such activities, and provide direction for research.

METHOD: The authors searched PubMed/MEDLINE, EMBASE, Cochrane CENTRAL, PsycInfo, CINAHL, ERIC, and Web of Science databases through February 21, 2020, for empirical investigations of ECG interpretation training enrolling medical students, residents, or practicing physicians. They appraised study quality with the Medical Education Research Study Quality Instrument and pooled standardized mean differences (SMDs) using random effects meta-analysis.

RESULTS: Of 1,002 articles identified, 59 were included (enrolling 17,251 participants). Among 10 studies comparing instructional modalities, 8 compared computer-assisted and face-to-face instruction, with pooled SMD 0.23 (95% CI, 0.09, 0.36) indicating a small, statistically significant difference favoring computer-assisted instruction. Among 19 studies comparing instructional methods, 5 evaluated individual versus group training (pooled SMD 0.35 favoring group study [95% CI, 0.06, 0.63]); 4 evaluated peer-led versus faculty-led instruction (pooled SMD 0.38 favoring peer instruction [95% CI, 0.01, 0.74]); and 4 evaluated contrasting ECG features (e.g., QRS width) from 2 or more diagnostic categories versus routine examination of features within a single ECG or diagnosis (pooled SMD 0.23 not significantly favoring contrasting features [95% CI, -0.30, 0.76]). Eight studies compared ECG interpretation approaches, with pooled SMD 0.92 (95% CI, 0.48, 1.37) indicating a large, statistically significant effect favoring more systematic interpretation approaches.

CONCLUSIONS: Some instructional interventions appear to improve learning in ECG interpretation; however, many evidence-based instructional strategies are insufficiently investigated. The findings may have implications for future research and design of training to improve skills in ECG interpretation and other types of visual diagnosis.

PMID:35086115 | DOI:10.1097/ACM.0000000000004607

J Phys Condens Matter. 2022 Jan 27. doi: 10.1088/1361-648X/ac4f7e. Online ahead of print.

ABSTRACT

We demonstrate theoretically the possibility of spinodal de-wetting in heterostructures made of light-atom liquids (hydrogen, helium, and nitrogen) deposited on suspended graphene. Extending our theory of film growth on two-dimensional materials to include analysis of surface instabilities via the hydrodynamic Cahn-Hilliard-type equation, we characterize in detail the spatial and temporal scales of the resulting spinodal de-wetting patterns. Both linear stability analysis and direct numerical simulations of the surface hydrodynamics show micron-sized (generally material dependent) patterns of “dry” regions. The physical reason for the development of such instabilities on graphene can be traced back to the inherently weak van der Waals interactions between atomically thin materials and atoms in the liquid. Thus two-dimensional materials could represent a new theoretical and technological platform for studies of spinodal de-wetting.

PMID:35086067 | DOI:10.1088/1361-648X/ac4f7e