Fat mass: a novel digital biomarker for remote monitoring that may indicate risk for malnutrition and new complications in decompensated cirrhosis

BACKGROUND

Cirrhosis is associated with sarcopaenia and fat wasting, which drive decompensation and mortality. Currently, nutritional status, through body composition assessment, is not routinely monitored in outpatients. Given the deleterious outcomes associated with poor nutrition in decompensated cirrhosis, there is a need for remotely monitoring this to optimise community care.

METHODS

A retrospective analysis was conducted on patients monitored remotely with digital sensors post hospital discharge, to assess outcomes and indicators of new cirrhosis complications. 15 patients had daily fat mass measurements as part of monitoring over a median 10 weeks, using a Withing's bioimpedance scale. The Clinical Frailty Score (CFS) was used to assess frailty and several liver disease severity scores were assessed.

RESULTS

73.3% (11/15) patients were male with a median age of 63 (52-68). There was a trend towards more severe liver disease based on CLIF-Consortium Acute Decompensation (CLIF-C AD) scores in frail patients vs. those not frail (53 vs 46, p = 0.072). When the cohort was split into patients who gained fat mass over 8 weeks vs. those that lost fat mass, the baseline CLIF-C AD scores and WBC were significantly higher in those that lost fat (58 vs 48, p = 0.048 and 11.2 × 109 vs 4.7 × 109, p = 0.031).

CONCLUSIONS

This proof-of-principle study shows feasibility for remote monitoring of fat mass and nutritional reserve in decompensated cirrhosis. Our results suggest fat mass is associated with greater severity of acute decompensation and may serve as an indicator of systemic inflammatory response. Further prospective studies are required to validate this digital biomarker.

Non-surgical organ preservation in laryngeal and hypopharyngeal cancers: an audit from the clinic

BACKGROUND

There is increasing concern regarding efficacy of organ preservation protocol in laryngeal and hypopharyngeal cancers.

METHOD

This study retrospectively assessed disease-related and functional outcomes of 191 patients with non-metastatic laryngeal or hypopharyngeal squamous cell carcinoma treated with curative intent (radiotherapy with or without chemotherapy).

RESULTS

Seventy-six patients (39.8 per cent) had a primary cancer in the larynx, and 115 patients (60.2 per cent) had a primary cancer in the hypopharynx. The median follow up was 39 months. The 3-year time to progression, overall survival, local control and laryngectomy free survival was 56.2 per cent, 76.3 per cent, 73.2 per cent and 67.2 per cent, respectively. At the time of analysis, 83 patients (43.5 per cent) were alive and disease free at their last follow up and did not require tube feeding or tracheostomy. The laryngo-oesophageal dysfunction-free survival was 61 per cent at 3 years.

CONCLUSION

Organ conservation protocols remain the standard of treatment in appropriately selected patients with laryngeal and hypopharyngeal cancers.

Primary Perspectives in Meme Utilization as a Digital Driver for Medical Community Engagement and Education Mobilization: Pre-Post Study

BACKGROUND

Memes have gone "viral," gaining increasing prominence as an effective communications strategy based on their unique ability to engage, educate, and mobilize target audiences in a call to action through a cost-efficient and culturally relevant approach. Within the medical community in particular, visual media has evolved as a means to influence clinical knowledge transfer. To this end, the GetWaivered (GW) project has leveraged memes as part of a behavioral economics toolkit to address one of the most critical public health emergencies of our time-the 20-year opioid epidemic. As part of a multidimensional digital awareness campaign to increase Drug Enforcement Administration (DEA)-X waiver course registration, GW investigated the results of meme usage in terms of impressions, website traffic, and ultimately user acquisition, as determined by web-based training enrollment and attendance outcomes.

OBJECTIVE

The objective of this study was to determine the efficacy of implementing humor-based promotional content versus the traditional educational model, and how the translation of the increase in engagement would increase the participant count and website traffic for GW's remote DEA-X waiver training.

METHODS

The approach to this study was based on 2 time frames (pre- and postcampaign). During April-July 2021, we developed a campaign via advertisements on Facebook, Twitter, Instagram, and the GW website to expand outreach. These memes targeted medical professionals with the ability to prescribe buprenorphine. The time frame of this campaign measured engagement metrics and compared values to preceding months (January-March 2021) for our GetWaivered website and social media pages, which translated to registrants for our remote DEA-X waiver training.

RESULTS

By the end of July 2021, a total of 9598 individuals had visited the GW website. There was an average of 79.3 visitors per day, with the lowest number of daily visitors being 0 and the highest being 575.

CONCLUSIONS

The use of memes may provide a medium for social media engagement (likes, comments, and shares) while influencing viewers to pursue a proposed action, such as e-training registration.

Analyzing opioid-use disorder websites in the United States: An optimized website usability study

Background

As the United States continues to tackle the opioid epidemic, it is imperative for digital healthcare organizations to provide Internet users with accurate and accessible online resources so that they can make informed decisions with regards to their health.

Objective

The primary objectives were to adapt and modify a previously established usability methodology from literature, apply this modified methodology in order to perform usability analysis of opioid-use-disorder (OUD)-related websites, and make important recommendations that OUD-related digital health organizations may utilize to improve their online presence.

Methods

A list of 208 websites (later refined) was generated for usability testing using a modified Google Search methodology. Four keywords were chosen and used in the search: “DEA-X Waiver Training”, “opioid-use-disorder (OUD) Initiatives”, “Buprenorphine Assisted Treatment”, and “Opioid-Use Disorder Websites”. Usability analysis was performed concurrently with optimization of the methodology. OUD websites were analyzed and scored on several usability categories established by previous literature.

Results

“DEA-X Waiver Training” yielded websites that scored the highest average in “Accessibility” (0.84), while “Opioid-Use Disorder Websites” yielded websites that scored the highest average in “Content Quality” (0.67). “Buprenorphine Assisted Treatment” yielded websites that scored the highest average across “Marketing” (0.52), “Technology” (0.89), “General Usability” (0.69), and “Overall Usability” (0.68). “Technology” and “Marketing” were the highest and lowest scoring usability categories, respectively. T-test analysis revealed that each usability, except “Marketing” had a pair of one or more keywords that were significantly different with a p-value that was equal to or less than 0.05.

Conclusions

Based on the study findings, we recommend that digital organizations in the OUD space should improve their “General Usability” score by making their websites easier to find online. Doing so, may allow users, especially individuals in the OUD space, to discover accurate information that they are seeking. Based on the study findings, we also made important recommendations that OUD-related digital organizations may utilize in order to improve website usability as well as overall reach.

Microtubule motor transport in the delivery of melanosomes to the actin-rich apical domain of the retinal pigment epithelium

Melanosomes are motile, light-absorbing organelles that are present in pigment cells of the skin and eye. It has been proposed that melanosome localization, in both skin melanocytes and the retinal pigment epithelium (RPE), involves melanosome capture from microtubule motors by an unconventional myosin, which dynamically tethers the melanosomes to actin filaments. Recent studies with melanocytes have questioned this cooperative capture model. Here, we test the model in RPE cells by imaging melanosomes associated with labeled actin filaments and microtubules, and by investigating the roles of different motor proteins. We found that a deficiency in cytoplasmic dynein phenocopies the lack of myosin-7a, in that melanosomes undergo fewer of the slow myosin-7a-dependent movements and are absent from the RPE apical domain. These results indicate that microtubule-based motility is required for the delivery of melanosomes to the actin-rich apical domain and support a capture mechanism that involves both microtubule and actin motors.

Spectroscopic investigation on the production of clay bricks with SCBA waste

In this paper, the effect of sugarcane bagasse ash (SCBA) addition to the brick making clay has been analyzed using spectroscopic techniques. For that, mixtures of brick making clay (BMC) with sugarcane bagasse ash (SCBA) in proportions of 0-20 wt.% were hydraulic uniaxially pressed and sintered at temperatures of 800-1100 °C. The partial replacement of the brick making clay with SCBA was studied with chemical and mineralogical analyzes (XRF and X-ray diffraction). The quantitative estimation of minerals was made by FTIR analysis. The results of FT-IR reveal that kaolinite, quartz, and lignin are predominant, whereas, cellulose and calcite are in moderate levels. In addition, magnetite and hematite are found in trace level. The overall results reveal that the brick making clay substituted with 15 wt.% of SCBA can open up a new path for the fabrication of quality bricks at low cost.

An insight on electrospun-nanofibers-inspired modern drug delivery system in the treatment of deadly cancers

This review gives an insight into the process of electrospinning, its essential parameters, the types of drug incorporation and the works reported on common dreadful cancers.

Review: physico-chemical modification as a versatile strategy for the biocompatibility enhancement of biomaterials

Physico-chemical modification induced improvement in biocompatibility of materials.

Gallic acid: prospects and molecular mechanisms of its anticancer activity

Gallic acid (GA) is a phenolic acid found in many dietary substances. It is a natural compound found in gallnuts, sumac, witch-hazel, clove, tealeaves, oak bark, sundew and other plants. Edibles like blackberry, hot chocolate, common walnut and Indian gooseberry contain GA.

Prospects of common biomolecules as coating substances for polymeric biomaterials

The concept of using common biomolecules like proteins, carbohydrates,etc., for improving the biocompatibility seems rational and effective because of the bio-friendly surface that they present, remains closer in mimicking the innate environment.

Synthesis of Some New Isoxazoline Derivatives of Chalconised Indoline 2-one as a Potential Analgesic, Antibacterial and Anthelmimtic Agents

A series of novel 1[5”-(2”’-substituted phenyl)-4”,5”’-dihydro isoxazole-3”-yl]-3-[(4 substituted phenyl)imino]1-3-dihydro-2H-indole-2-one were synthesized from different substituted chalconised indole-2,3-dione was prepared from the different chalconised Isatin. The structures of the compounds were elucidated by elemental and spectral (IR, ¹H NMR, and MS) analysis. The synthesized compounds were screened for their analgesic activity by the acetic acid induced Writhing method and in vitro antimicrobial activity against the Gram-positive bacteria—Staphylococcus aureus and the Gram-negative bacteria—Pseudomonas auroginosa, Pseudomonas mirabilis, and E. coli by the cup plate agar diffusion method. Compounds 6a₁, 6a₃, 6b₃, and 6b₂ were found to be active against bacteria. The compounds 6a₁, 6b₃, and 6a₃ show a significant analgesic activity. Synthesized compounds also screened for anthelmintic activity against Pheretima posthuma. Compounds 6a₁, 6b₁, and 6b₃ show significant anthelmintic activity.

Quality of care among type 2 diabetes mellitus patients residing in an urban slum of Chennai Corporation -- a community-based cross-sectional study

Despite the high prevalence, serious long term complications and established evidence based guidelines for management of diabetes mellitus the quality of care is still deficient in developed and developing countries. So a study of these factors and their influence on the quality of care is necessary to tackle diabetes in the community. The objectives of the study were to assess the quality of care in type 2 diabetes patients of 35 years and above age group and to identify the factors associated with it. It is a community-based cross-sectional study done among urban slum people of Chennai, in which 323 adults with type 2 diabetes were interviewed in the above said age group. Variables like age, sex, income, duration of diabetes, healthcare delivery of choice, treatment prescribed, compliance to treatment, family history of diabetes, presence of comorbid illnesses and quality of care indicators were studied and appropriate statistical analysis was carried out. Only 26 adults (8%) received good quality of care in this study. The adults who received good quality of care were among male sex (p < 0.005), high income group (p < 0.001), patients with good compliance to treatment (p < 0.001) and those who preferred private health facility for treatment (p < 0.001). The present current study indicates very low quality of care among this community. The management of diabetes in our setting was suboptimal and even the minimum achievable goals were not reached.