Tag: statistics

J Glaucoma. 2022 Jul 19. doi: 10.1097/IJG.0000000000002075. Online ahead of print.

ABSTRACT

PURPOSE: To understand the feasibility, utility and efficacy of a low-cost model for performing anterior chamber angle gonioscopy and micro-surgery on human corneo-scleral tissues in wet lab on resident skill enhancement.

METHODS: Post-keratoplasty residual corneo-scleral rims and/or the expired donor corneo-scleral buttons were included for the purpose of this study. Initially, inverted rims were used to demonstrate the basic angle anatomy on a slit lamp bio-microscope. Central hazy cornea was then replaced with an artificial cornea and an artificial anterior chamber to simulate indirect gonioscopy, direct gonioscopy, goniotomy and other angle-based surgeries. Direct gonioscopy and goniotomy exercises (as a means to simulate intra-operative gonioscopy and other angle-based surgeries respectively) were evaluated quantitatively, and the rest qualitatively.

RESULTS: A total of 65 residents were included in the exercise. The mean age was 26.69±1.74 years. Amongst these, 55 ophthalmology residents performed the basic examination, that is, slit lamp mounted angle anatomy examination (n=55) and artificial chamber mounted indirect gonioscopic examination through artificial cornea (n=55). In the second exercise, 10 glaucoma fellows performed the direct gonioscopic and the goniotomy exercises on artificial chamber. The fellows demonstrated a statistically significant improvement in interpretation and surgical skill enhancement concurrent with reduction in time taken with increasing number of attempts (P<0.05). In the third simulation exercise, micro-stent placement within the Schlemm’s canal, sub-conjunctival space, and the supra-choroidal space was re-produced successfully on multiple occasions.

CONCLUSIONS: The residual human corneo-scleral rims proved to be an important resource for teaching both the basic examination skills as well as those required for transitioning to advanced intraoperative gonioscopy and goniotomy skills. These low cost, easy to adapt models can be incorporated within the curriculum for improved glaucoma training of both the residents and the glaucoma fellows.

PMID:35882034 | DOI:10.1097/IJG.0000000000002075

Bol Med Hosp Infant Mex. 2022;79(3):161-169. doi: 10.24875/BMHIM.21000155.

ABSTRACT

BACKGROUND: Chronic lymphocytic thyroiditis or Hashimoto’s thyroiditis is the most frequent cause of acquired hypothyroidism in children. An association between low levels of 25-hydroxyvitamin D (25OH vitamin D) and the development of the disease have been detected. The aim of this study was to describe 25OH vitamin D levels in patients aged 5 to 18 years with a diagnosis of Hashimoto’s thyroiditis in three pediatric endocrinology outpatient centers in Medellín, Colombia.

METHODS: We conducted a cross-sectional observational study with retrospective data collection. We evaluated the sociodemographic characteristics, diagnoses, presence of comorbidities, and frequency of vitamin D deficiency.

RESULTS: Sixty patients were included. The 25OH vitamin D levels were sufficient in 65% of the cases according to the Institute of Medicine (IOM) criteria and in 10% of the cases according to the Endocrine Society criteria. Serum calcium and phosphorus values were normal in 53% and 45% of the patients, respectively. All patients had normal magnesium and parathyroid hormone levels. No differences were found in the exploratory analysis when comparing 25OH vitamin D levels, thyroid antibody levels, and thyroid volume.

CONCLUSIONS: In this chronic lymphocytic thyroiditis population, we did not find an increased prevalence of vitamin D deficiency according to IOM or the Endocrine Society criteria compared with previous data from the general population. No statistically significant differences were found in the exploratory analysis.

PMID:35882020 | DOI:10.24875/BMHIM.21000155

Neuroreport. 2022 Jul 5. doi: 10.1097/WNR.0000000000001807. Online ahead of print.

ABSTRACT

OBJECTIVES: 3-dimensional multiple object tracking (3D-MOT) and the useful field of view (UFOV) both claim to measure and train cognitive abilities, such as selective and divided attention implicated in driving safety. 3D-MOT is claimed to improve even young adult cognitive ability. If true, one would expect to observe the transfer of 3D-MOT training to UFOV performance mediated by way of shared underlying cognitive mechanisms.

METHODS: We test this notion by assessing whether ten 30-min sessions of 3D-MOT training spread across 5 weeks improves UFOV performance relative to an active control group trained on a visual task and a challenging puzzle game (participants aged between 23 and 33 years old).

RESULTS: The 3D-MOT training group exhibited significantly improved UFOV performance whereas the active control group exhibited only a small, statistically nonsignificant improvement in the task.

CONCLUSIONS: This suggests that 3D-MOT and UFOV performance are likely dependent on overlapping cognitive abilities and helps support the assertion that these abilities can be trained and measured even in young adults. Such training could have implications for improving driver safety in both young and older adults.

PMID:35882017 | DOI:10.1097/WNR.0000000000001807

J Pediatr Gastroenterol Nutr. 2022 Jul 25. doi: 10.1097/MPG.0000000000003569. Online ahead of print.

ABSTRACT

OBJECTIVES: Known as pediatric medical traumatic stress (PMTS), posttraumatic stress symptoms from medical experiences have not been explored in children with chronic gastrointestinal diseases. This cross-sectional study of children and adolescents with inflammatory bowel disease, chronic pancreatitis and cystic fibrosis, aimed to: 1) estimate the prevalence of medical potentially traumatic events (PTEs) and PMTS, 2) explore potential risk factors for PMTS, and 3) explore potential consequences of PMTS.

METHODS: This cross-sectional study used validated, self-report measures to evaluate PTEs and PMTS. Descriptive statistics and regression analyses were used to achieve study objectives.

RESULTS: Over two-thirds of children reported a medical PTE (91 of 132, 69%). Forty-eight had PMTS symptoms (36%). PMTS was associated with medication burden, emergency and intensive care visits, and parent posttraumatic stress disorder in multivariate analysis. Potential consequences associated with PMTS included school absenteeism, home opioid use, poor quality of life, and parent missed work.

CONCLUSIONS: A substantial portion of our cohort reported medical PTEs and PMTS. The exploratory analysis identified potential associations between PMTS and illness factors, parent posttraumatic stress disorder, and functional impairments. Further studies of PMTS detection, prevention and treatment are integral to optimizing these children’s health and quality of life.An infographic is available for this article at: http://links.lww.com/MPG/C881.

PMID:35881966 | DOI:10.1097/MPG.0000000000003569

Menopause. 2022 Jul 26. doi: 10.1097/GME.0000000000002007. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the effects of prasterone compared with hyaluronic acid on symptoms of mild to moderate urinary urgency in women with genitourinary syndrome of menopause.

METHODS: This is an observational prospective cohort study. A total of 58 postmenopausal women were enrolled (from December 2019 to May 2021). Overactive Bladder Screener questionnaire, Patient Global Impression of Improvement questionnaire, International Consultation on Incontinence Questionnaire-Short Form, and International Quality of Life questionnaire were used.

RESULTS: Fifty-eight women, 29 (50%) and 29 (50%), were treated with prasterone and hyaluronic acid for 12 weeks, respectively. At the end of the study, 26 (89.7%) versus 3 (10.3%) women reported an improvement (Patient Global Impression of Improvement score ≤3) of the symptoms in the prasterone versus hyaluronic acid group. According to the International Consultation on Incontinence Questionnaire-Short Form, no statistically significant difference was recorded before treatment between the prasterone and hyaluronic acid groups (median, 12 [6-12] vs 11 [8-12]; P = 0.8). Conversely, a statistically significant difference was recorded after treatment between the two groups (median, 8 [5-11] vs 10 [8-11]; P = 0.03). According to the International Quality of Life, a statistically significantly lower median score was recorded in the prasterone compared with the hyaluronic acid group, before (73 [interquartile range {IQR}, 55-81] vs 89 [IQR, 67-94]; P < 0.01) and after (78 [IQR, 65-86] vs 87 [IQR, 72-99]; P = 0.04) treatment.

CONCLUSIONS: The current observational study supports the hypothesis that prasterone might improve the severity of urinary urge incontinence in this set of women. However, these results need to be confirmed in further studies with a controlled design and a larger population.

PMID:35881944 | DOI:10.1097/GME.0000000000002007

Menopause. 2022 Jul 26. doi: 10.1097/GME.0000000000002000. Online ahead of print.

ABSTRACT

IMPORTANCE: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality for menopausal individuals. Flow-mediated dilation (FMD), a surrogate marker of CVD, improves with aerobic exercise training in healthy and nonhealthy cohorts. However, systematic evaluation and precise estimate of this effect for menopausal individuals are unknown.

OBJECTIVE: We conducted a systematic review with meta-analysis to evaluate the influence of exercise training on FMD in postmenopausal individuals.

EVIDENCE REVIEW: Studies were identified from systematic search of major electronic databases (PubMed, ScienceDirect, and Cochrane Library) from inception to February 2021. Healthy, postmenopausal individuals were included, following an aerobic exercise intervention assessing FMD. A random-effects meta-analysis was used to calculate a pooled effect size (mean difference [MD]) with 95% confidence interval. Heterogeneity was assessed using I2 statistics. Metaregression was used to assess the association between changes in FMD and physical characteristics (eg, blood pressure, age, baseline FMD) and intervention details (metabolic equivalents and change in maximal oxygen uptake [ΔV˙o2max]). For variables that significantly correlated, a multiple metaregression model was used to assess the accounted variance in between-study ΔFMD%. Study quality was assessed using the National Heart, Lung, and Blood Institute assessment tool.

FINDINGS: Nine studies, including 11 interventions (6 controlled interventions and 5 pre-post interventions; N = 182), with age range of 52 ± 4 to 64 ± 7 years underwent quantitative pooling of data. Exercise training significantly improved ΔFMD% (MD, 0.99; 95% confidence interval, 0.46-1.52; P < 0.001). Between-study heterogeneity was large and statistically significant (I2 = 93.8%, P < 0.001). Post hoc analysis based on study design identified significant heterogeneity in the MD in ΔFMD% between controlled and pre-post study interventions (P < 0.05). According to multiple metaregression, diastolic and systolic blood pressure and ΔV˙o2max significantly predicted ΔFMD% (Q = 15.74, df = 3, P < 0.01, R2 = 0.72).

CONCLUSIONS AND RELEVANCE: Aerobic exercise training improves FMD for postmenopausal individuals, and this observation was greater among controlled versus pre-post interventions. A higher resting blood pressure and the greatest ΔV˙o2max yielded the largest improvements in FMD.

PMID:35881939 | DOI:10.1097/GME.0000000000002000

Med Sci Sports Exerc. 2022 Jul 19. doi: 10.1249/MSS.0000000000003005. Online ahead of print.

ABSTRACT

PURPOSE: The objective of the present study was to evaluate the implementation of the program in real life and the evolution of the QoL in breast cancer patients after 3 months of supervised PA in real-life and to determine the factors associated with changes in various QoL dimensions.

METHODS: This prospective cohort study was carried out in female patients with breast cancer diagnosed within a maximum of 3 years. QoL and physical exertion intensity during the supervised PA sessions were assessed by the QLQ-C30 and Borg scale, respectively. Statistical analyzes comparing QoL scores between the start and the end of supervised PA program were assessed using paired Student’s t tests. Multivariate analysis was performed by linear regression with only variables with a p-value <0.15 in univariate model.

RESULTS: A total of 93 patients were included in the analyzes. There was a significant improvement of social functioning at T3 (∆ = 11.5; p < 0.001). The improvement of social functioning was significantly and independently associated to the BORG improvement (β = 2.66 ± 1.31, p = 0.046), chemotherapy (β = 11.03 ± 5.45, p = 0.046), hormone therapy (β = -13.91 ± 5.51, p = 0.013), social isolation (β = -14.81 ± 6.55, p = 0.026) and comorbidities (β = -15.32 ± 5.59, p = 0.007).

CONCLUSIONS: We observed a real enthusiasm and need among patients for practicing physical activity supervised by a sport trainer near their home. The increase in the intensity of exercise over time contributes to the improvement of the QoL, especially on the social functioning. These results, consistent with previous literature, reinforce the importance of exercise intensity on many dimensions of QoL. In addition, patients expressed great satisfaction with the supervised program, resulting in a strong desire to maintain long-term physical activity.

PMID:35881932 | DOI:10.1249/MSS.0000000000003005

Am J Health Syst Pharm. 2022 Jul 26:zxac190. doi: 10.1093/ajhp/zxac190. Online ahead of print.

ABSTRACT

DISCLAIMER: In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

PURPOSE: Patients on hemodialysis have a high risk of medication-related problems. Studies using deprescribing algorithms to reduce the number of inappropriate medications in this population have been published, but none have used a patient-partnership approach. Our study evaluated the impact of a similar intervention with a patient-partnership approach.

METHODS: The objective was to describe the implementation of a pharmacist-led intervention with a patient-partnership approach using deprescribing algorithms and its impact on the reduction of inappropriate medications in patients on hemodialysis. Eight algorithms were developed by pharmacists and nephrologists to assess the appropriateness of medications. Pharmacists identified patients taking targeted medications. Following patient enrollment, pharmacists assessed medications with patients and applied the algorithms. With patient consent, deprescription was suggested to nephrologists if applicable. Specific data on each targeted medication were collected at 4 and 16 weeks. Descriptive statistics were used to examine the effects of the deprescribing intervention.

RESULTS: Of 270 patients, 256 were taking at least one targeted medication. Of the 122 patients taking at least one targeted medication who were approached to participate, 66 were included in the study. At enrollment, these patients were taking 252 targeted medications, of which 59 (23.4%) were determined to be inappropriate. Deprescription was initiated for 35 of these 59 medications (59.3%). At 4 weeks, 33 of the 59 medications (55.9%) were still deprescribed, while, at 16 weeks, 27 of the 59 medications (45.8%) were still deprescribed. Proton pump inhibitors and benzodiazepines or Z-drugs were the most common inappropriate medications, and allopurinol was the most deprescribed medication.

CONCLUSION: A pharmacist-led intervention with a patient-partnership approach and using deprescribing algorithms reduced the number of inappropriate medications in patients on hemodialysis.

PMID:35881917 | DOI:10.1093/ajhp/zxac190

J Cardiovasc Pharmacol. 2022 Jun 27. doi: 10.1097/FJC.0000000000001321. Online ahead of print.

ABSTRACT

Bradycardia and QTc interval prolongation on the ECG have been reported with remdesivir (Veklury®), an antiviral drug recently approved for treating severely ill COVID-19 patients. The objective was to evaluate the effects of remdesivir on cardiac electrophysiology ex vivo and in vivo. Ex vivo: Langendorff retroperfusion experiments were performed on isolated hearts from male Hartley guinea pigs (n=23, total) exposed to either remdesivir 3, 10 or 30 µmol/L to assess drug-induced prolongation of monophasic action potential duration measured at 90% repolarization (MAPD90). In vivo: ECG recordings using wireless cardiac telemetry were performed in guinea pigs (n=6) treated with daily i.p. doses of remdesivir 5 mg/kg on Day 1 and 2.5 mg/kg on Days 2-10. Ex vivo remdesivir (3, 10 and 30 µmol/L) had no statistically significant effect on MAPD90, while pacing the hearts at basic stimulation cycle lengths of 200 or 250 ms, or when the hearts were not paced and beating at their intrinsic heart rate. In a second set of similar ex vivo experiments, remdesivir 10 µmol/L did not potentiate the MAPD90-prolonging effects of dofetilide 20 nmol/L (n=4) hearts). In vivo remdesivir caused small but statistically significant prolongations of the RR and QTcF intervals at Day 1 (5 mg/kg) and at Day 10 (2.5 mg/kg). No ventricular arrhythmias were ever observed under the effect of remdesivir. Remdesivir causes bradycardia and mild QTc prolongation, which nonetheless, could be of clinical relevance in many hospitalized COVID-19 patients concomitantly treated with multiple drugs.

PMID:35881906 | DOI:10.1097/FJC.0000000000001321

J Cardiovasc Pharmacol. 2022 Jul 12. doi: 10.1097/FJC.0000000000001331. Online ahead of print.

ABSTRACT

BACKGROUND: Modulation of the inflammatory response is a promising therapeutic strategy in acute myocardial infarction. The novel approach is based upon the anti-inflammatory and cytoprotective properties mediated by the engagement of the Low-Density Lipoprotein Related Protein 1 (LRP1) receptor. SERPIN Peptide 16 (SP16) is a synthetic, selective LRP1 agonist. We herein present the results of a study with a single subcutaneous administration of SP16 in 10 patients with STEMI, to appraise its safety and tolerability and explore the effects on the acute inflammatory response, infarct size, and cardiac function.

METHODS: Ten patients with ST-segment elevation myocardial infarction (STEMI) were enrolled within 12 hours of symptoms onset and 6 hours of percutaneous coronary intervention (PCI) in a single-center, single-arm, open-label study of a single subcutaneous administration of SP16 (0.2 mg/kg). Serial clinical biomarkers and echocardiography data were collected up to 12 months. The data are presented separately for the treatment group and compared with historical controls from a placebo-treated arm in a recently completed clinical trial (N=28) with similar enrollment criteria.

RESULTS: All ten patients with STEMI received subcutaneous administration of SP16, 381 [272 to 478] minutes after PCI, without any treatment-related adverse events. The area under the curve (AUC) for C reactive protein (CRP) was 133 [46 to 528] mg•day/L in the SP16 treated group versus 286 [141 to 581] mg•day/L in the historical placebo-treated group (p=0.161). The AUC for creatine kinase-myocardial band (CK-MB) was 1,432 [675 to 3,089] ng•day/mL in the SP16-treated group versus 2,367 [830 to 4,750] ng•day/mL in the historical placebo-treated patients (p=0.428). Left ventricular ejection fraction (LVEF) was 46% [39 to 54] at baseline and 51% [46 to 58] at 1 year follow up in SP16 treated patients (interval change 5% [-0.3% to +9%] p=0.05) and 44% [38% to 56%] at baseline and 53% [43% to 59%] at 1 year follow up in historical placebo-treated patients (interval change 3% [-5% to 10%], p=0.305).

CONCLUSION: A single subcutaneous administration of SP16, a synthetic targeted LRP1 agonist, was safe and well tolerated in patients with STEMI. A trend toward reduction in the inflammatory response and infarct size with SP16 was noted; however, the sample size for this study was not based upon formal statistical criteria. More extensive studies are planned to determine the clinical efficacy of SP16 in STEMI.

PMID:35881895 | DOI:10.1097/FJC.0000000000001331