Author: Nevin Manimala

J Med Case Rep. 2021 Mar 23;15(1):128. doi: 10.1186/s13256-021-02715-7.

ABSTRACT

BACKGROUND: We present a minimal skin wound abdominal hysterectomy for patients with leiomyomas and describe the characteristics of this technique. The skin wound was made as small as possible, with a maximum length of 6 cm.

METHODS: In addition to introducing minimal skin wound abdominal hysterectomy, we retrospectively analyzed the medical records of 82 patients treated with minimal skin wound abdominal hysterectomy exclusively by two experts at Maruyama Memorial General Hospital between January 2013 and December 2016. Relationships between the leiomyoma characteristics and the difficulty of this operation, as estimated by operation time and blood loss, were statistically investigated.

RESULTS: First, we introduce a case in which we performed minimal skin wound abdominal hysterectomy on a 46-year-old Japanese patient with multiple leiomyomas (maximum 8 cm in diameter). Then, we assessed the impacts of the leiomyoma characteristics on the difficulty of this operation. On multivariate analysis, the number of leiomyomas significantly affected operation difficulty. Other characteristics of the target leiomyoma showed no effect. Additionally, higher body mass index also made the operation more difficult.

CONCLUSIONS: Although multiple leiomyomas can make this procedure difficult, minimal skin wound abdominal hysterectomy is safe and effective for use in many cases.

PMID:33752748 | DOI:10.1186/s13256-021-02715-7

Clin Exp Pediatr. 2021 Mar 19. doi: 10.3345/cep.2020.01438. Online ahead of print.

ABSTRACT

BACKGROUND: Over the past few decades, various goals have been defined to reduce the mortality of children caused by acute lower respiratory infections (ALRI) worldwide. However, few spatial studies to date have reported on ALRI deaths.

PURPOSE: We aimed to assess the spatial modeling of mortality from ALRI in children under 5 years of age during 2000-2017 using a global data.

METHODS: The data on the mortality of children under 5 years old caused by ALRI were initially obtained from the official website of the World Health Organization. The income status of their home countries was also gathered from the Country Income Groups (World Bank Classification) website and divided into five categories. After that, in the ArcGIS 10.6 environment, a database was created and the statistical tests and related maps were extracted. The Global Moran’s I Statistic, Getis-Ord Gi statistic, and geographically weighted regression were used for the analyses. In this study, higher Z-scores indicated the hot spots, while lower Z-scores indicated the cold spots.

RESULTS: In 2000-2017, child mortality showed a downward trend from 17.6 per 100000 children to 8.1 and had a clustered pattern. Hot spots were concentrated in Asia in 2000 but shifted toward African countries by 2017. A cold spot that formed in Europe in 2007 showed an ascending trend by 2017. Based on the results of geographically weighted regression test, the regions identified as the hot spots of mortality from ALRI in children under 5 years old were among the middle-income countries (R2 = 0.01, adjusted R2 = 8.77).

CONCLUSION: While the total number of child deaths in 2000-2017 has decreased, the number of hot spots has increased among countries. This study also concluded that, during the study period, Central and Western Africa countries became the main new hot spots of deaths from ALRI.

PMID:33752281 | DOI:10.3345/cep.2020.01438

Rom J Intern Med. 2021 Mar 22. doi: 10.2478/rjim-2021-0012. Online ahead of print.

ABSTRACT

INTRODUCTION: Pure extra-thoracic sarcoidosis is rare and poorly characterized in the literature. Herein we present features of pure extra-thoracic sarcoidosis, in comparison with sarcoidosis with intra-thoracic involvement, in a population from the south of Tunisia.

METHODS: Retrospective, descriptive and comparative study of the patients presenting systemic sarcoidosis and attending the Department of Internal Medicine at the Hedi Chaker University Hospital, Sfax, Tunisia, for 21 years, from January1996 to December2016.

RESULTS: Twenty-four patients presented pure extra-thoracic sarcoidosis (30% of the cases of systemic sarcoidosis). There was a female predominance (79%). The mean age was 50 years. The main features were polyadenopathies (10 patients:41,7%), cutaneous involvement (10 patients:41,6%), inflammatory polyarthralgia (8 cases:33.3%), general symptoms (6 patients:25%), uveitis (6cases:25%), cholestasis (3cases) and kidney involvement (2cases). Lymphopenia, hypercalcemia, and hypercalciuria were observed each one in 12.5% of the cases, and high angiotensin converting enzyme (ACE) level in 38,5% of the cases. The histological proof was required in all the patients. Statistically significant associations identified were mainly hepatic involvement with general symptoms (p=0.035), peripheral lymphadenopathies (p=0.035) and kidney damage (p=0.022), and cutaneous involvement with articular manifestations (p=0.032). Systemic corticosteroids were used in half of the cases, with a good outcome in 21 cases, and recurrence in two cases. One patient was lost to follow up. The comparison to the form with mediastino-pulmonary involvement showed less lymphadenopathies(p=0.001), less lymphopenia (p=0.006), and less frequent use of corticosteroids(p=0.044).

CONCLUSION: Our series was characterized by the frequency of the pure extra-thoracic form and the diversity of the systemic manifestations.

PMID:33752271 | DOI:10.2478/rjim-2021-0012

Clin Respir J. 2021 Mar 22. doi: 10.1111/crj.13364. Online ahead of print.

ABSTRACT

OBJECTIVE: The impact on executive function performance of sleep-related disorders in asthmatic children has been scarcely studied in community settings. The aims of the present study were to assess the prevalence of sleep-related breathing disorders (SRBD) in children with intermittent or mild persistent asthma in primary care settings, and to examine possible correlations with measures of executive function.

METHODS: We performed a case-control study including 76 children with asthma (intermittent or mild persistent), and 85 healthy controls. The parents of both patients and controls completed the Pediatric Seep Questionnaire (PSQ), and the Behavior Rating Inventory of Executive Function (BRIEF) questionnaire.

RESULTS: We did not find any statistically significant differences regarding the scales of PSQ. Additionally, there were no statistical differences between asthmatic children and controls regarding the scales of the BRIEF questionnaire. In both asthmatic children and controls the score of the scale of obstructive sleep related breathing disorder was significantly correlated with the T scores of the two composite scales (BRI and MI) and the Global Executive Composite (GEC).

CONCLUSION: In children with intermittent or mild persistent asthma under the care of private general paediatricians there were no statistically significant differences regarding subjective SBD compared to healthy controls. Also there were no statistical differences between asthmatic children and controls regarding behavioral correlates of executive function during everyday life.

PMID:33752268 | DOI:10.1111/crj.13364

Clin Physiol Funct Imaging. 2021 Mar 22. doi: 10.1111/cpf.12700. Online ahead of print.

ABSTRACT

BACKGROUND: Multi-frequency bioelectrical impedance analysis (MF-BIA) offers enhanced body composition outcomes in a time efficient manner. The accuracy of stand-up MF-BIA compared against a four-compartment (4C) criterion lacks evidence.

OBJECTIVES: To validate a stand-up MF-BIA compared to a 4C criterion for fat mass (FM), fat free mass (FFM), and body fat percentage (%fat).

SUBJECTS/METHODS: Eighty-two healthy (32% men) normal weight (BMI: 18.5 – 24.9 kg/m² ) young adults were measured for body composition determined from a stand-up MF-BIA and 4C model. Validity statistics included total error (TE) and standard error of the estimate (SEE) to examine prediction error between methods.

RESULTS: For the total sample, prediction error was the highest for %fat (TE=4.2 %; SEE=3.9 %) followed by FM (TE=2.4 kg; SEE=2.2 kg) and FFM (TE=2.4 kg; SEE=2.2 kg). In men, %fat (TE=2.5 %; SEE=2.2 %) and FM (TE=1.9 kg; SEE=1.6 kg) were ideal; FFM was similar to FM (TE=1.9 kg; SEE=1.6 kg). In women, %fat (TE=4.7 %; SEE=4.4 %) ranged from good to fairly good, and FM was very good to excellent (TE=2.6 kg; SEE=2.4 kg); FFM was similar to FM (TE=2.6 kg; SEE=2.3 kg).

CONCLUSIONS: Stand-up MF-BIA may overestimate %fat and FM, and underestimate FFM compared to a 4C model. FM and FFM estimates from MF-BIA demonstrate good agreement to a 4C model and may be a practical measure of body composition in normal weight adults. The highest error was seen in %fat for both sexes, with greater error in women.

PMID:33752260 | DOI:10.1111/cpf.12700

BJU Int. 2021 Mar 22. doi: 10.1111/bju.15399. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the accuracy and completeness of surgeon reported radical prostatectomy outcome data across a national health system by comparison with a national dataset gathered independently from clinicians directly involved in patient care.

PATIENTS AND METHODS: Data submitted by surgeons to the British Association of Urological Surgeons (BAUS) radical prostatectomy audit for all men undergoing radical prostatectomy between 2015 and 2016 was assessed by cross linkage to the National Prostate Cancer Audit (NPCA) database. Specific data-items collected in both databases were selected for comparison analysis. Data completeness and agreement were assessed by percentages and Cohen’s kappa statistic.

RESULTS: Data from 4,707 men in the BAUS and NPCA databases were matched for comparison. Compared with the NPCA, dataset completeness was higher in the BAUS dataset for type of nerve sparing procedure (92% vs 42%) and post-operative margin status (89% vs 48%) but lower for readmission (87% vs 100%) and Charlson score (80% vs 100%). For all other variables assessed completeness was comparable. Agreement and data reliability was high for most variables. However despite good agreement the inter-cohort reliability was poor for Readmission, M stage and Charlson score (κ< 0.30).

CONCLUSIONS: For the first time in urology we show that surgeon reported data from the BAUS radical prostatectomy audit can reliably be used to benchmark peri-operative radical prostatectomy outcomes. For co-morbidity data, to assist with risk analysis, and longer term outcomes NPCA routinely collected data provides a more comprehensive source.

PMID:33752249 | DOI:10.1111/bju.15399

Cardiovasc Res. 2021 Mar 22:cvab111. doi: 10.1093/cvr/cvab111. Online ahead of print.

ABSTRACT

AIMS: Free fatty acid receptor 4 (Ffar4) is a G-protein coupled receptor for endogenous medium/long-chain fatty acids that attenuates metabolic disease and inflammation. However, the function of Ffar4 in the heart is unclear. Given its putative beneficial role, we hypothesized that Ffar4 would protect the heart from pathologic stress.

METHODS AND RESULTS: In mice lacking Ffar4 (Ffar4KO), we found that Ffar4 is required for an adaptive response to pressure overload induced by transverse aortic constriction (TAC), identifying a novel cardioprotective function for Ffar4. Following TAC, remodeling was worsened in Ffar4KO hearts, with greater hypertrophy and contractile dysfunction. Transcriptome analysis 3-days post-TAC identified transcriptional deficits in genes associated with cytoplasmic phospholipase A2α signaling and oxylipin synthesis as well as reduction of oxidative stress in Ffar4KO myocytes. In cultured adult cardiac myocytes, Ffar4 induced production of the eicosapentaenoic acid (EPA)-derived, pro-resolving oxylipin 18-hydroxyeicosapentaenoic acid (18-HEPE). Furthermore, activation of Ffar4 attenuated cardiac myocyte death from oxidative stress, while 18-HEPE rescued Ffar4KO myocytes. Systemically, Ffar4 maintained pro-resolving oxylipins and attenuated autoxidation basally, and increased pro-inflammatory and pro-resolving oxylipins, including 18-HEPE, in high density lipoproteins post-TAC. In humans, Ffar4 expression decreased in heart failure, while the signaling-deficient Ffar4 R270H polymorphism correlated with eccentric remodeling in a large clinical cohort paralleling changes observed in Ffar4KO mice post-TAC.

CONCLUSIONS: Our data indicate that Ffar4 in cardiac myocytes responds to endogenous fatty acids, reducing oxidative injury, and protecting the heart from pathologic stress, with significant translational implications for targeting Ffar4 in cardiovascular disease.

PMID:33752243 | DOI:10.1093/cvr/cvab111

Obstet Gynecol. 2021 Mar 22. doi: 10.1097/AOG.0000000000004382. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the comparative effectiveness and potential harms of cervical ripening in the outpatient compared with the inpatient setting, or different methods of ripening in the outpatient setting alone.

DATA SOURCES: Searches for articles in English included MEDLINE, EMBASE, CINAHL, Cochrane Library, ClinicalTrials.gov, and reference lists (up to August 2020).

METHODS OF STUDY SELECTION: Using predefined criteria and DistillerSR software, 10,853 citations were dual-reviewed for randomized controlled trials (RCTs) and cohort studies of outpatient cervical ripening using prostaglandins and mechanical methods in pregnant women at or beyond 37 weeks of gestation.

TABULATION, INTEGRATION, AND RESULTS: Using prespecified criteria, study data abstraction and risk of bias assessment were conducted by two reviewers, random-effects meta-analyses were conducted and strength of evidence was assessed. We included 30 RCTs and 10 cohort studies (N=9,618) most generalizable to women aged 25-30 years with low-risk pregnancies. All findings were low or insufficient strength of evidence and not statistically significant. Incidence of cesarean delivery was not different for any comparison of inpatient and outpatient settings, or comparisons of different methods in the outpatient setting (most evidence available for single-balloon catheters and dinoprostone). Harms were inconsistently reported or inadequately defined. Differences were not found for neonatal infection (eg, sepsis) with outpatient compared with inpatient dinoprostone, birth trauma (eg, cephalohematoma) with outpatient compared with inpatient single-balloon catheter, shoulder dystocia with outpatient dinoprostone compared with placebo, maternal infection (eg, chorioamnionitis) with outpatient compared with inpatient single-balloon catheters or outpatient prostaglandins compared with placebo, and postpartum hemorrhage with outpatient catheter compared with inpatient dinoprostone. Evidence on misoprostol, hygroscopic dilators, and other outcomes (eg, perinatal mortality and time to vaginal birth) was insufficient.

CONCLUSION: In women with low-risk pregnancies, outpatient cervical ripening with dinoprostone or single-balloon catheters did not increase cesarean deliveries. Although there were no clear differences in harms when comparing outpatient with inpatient cervical ripening, the certainty of evidence is low or insufficient to draw definitive conclusions.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42020167406.

PMID:33752219 | DOI:10.1097/AOG.0000000000004382

Hum Hered. 2021 Mar 22:1-3. doi: 10.1159/000515200. Online ahead of print.

ABSTRACT

It is plausible that variants in the ACE2 and TMPRSS2 genes might contribute to variation in COVID-19 severity and that these could explain why some people become very unwell whereas most do not. Exome sequence data was obtained for 49,953 UK Biobank subjects, of whom 82 had tested positive for SARS-CoV-2 and could be presumed to have severe disease. A weighted burden analysis was carried out using SCOREASSOC to determine whether there were differences between these cases and the other sequenced subjects in the overall burden of rare, damaging variants in ACE2 or TMPRSS2. There were no statistically significant differences in weighted burden scores between cases and controls for either gene. There were no individual DNA sequence variants with a markedly different frequency between cases and controls. Whether there are small effects on severity, or whether there might be rare variants with major effect sizes, would require studies in much larger samples. Genetic variants affecting the structure and function of the ACE2 and TMPRSS2 proteins are not the main explanation for why some people develop severe symptoms in response to infection with SARS-CoV-2. This research was conducted using the UK Biobank Resource.

PMID:33752217 | DOI:10.1159/000515200

Dig Dis. 2021 Mar 22. doi: 10.1159/000516021. Online ahead of print.

ABSTRACT

BACKGROUND: Although esophageal squamous cell carcinoma is more likely to develop in patients with any risk factor (male, drinking, or smoking), it is sometimes detected in patients with very low risk factors (female, non-drinking, and non-smoking). We examined the endoscopic features of superficial esophageal squamous carcinoma in patients with very low risk factors.

METHODS: In this single-center case-control study, 666 patients with 666 superficial esophageal squamous carcinoma lesions were divided into 2 groups: those with very low risk factors (very-low-risk group, n = 34) and those with any risk factors (any-risk group, n = 632). After case-control selection at a 1:5 ratio, the very-low-risk group comprised 34 patients and the any-risk group comprised 170 patients. We compared the baseline characteristics, endoscopic findings, and treatment results (including pathological diagnosis) between the two groups.

RESULTS: There were no statistically significant differences between the two groups in age, tumor size, tumor location, tumor morphology, or treatment results (including tumor depth and lymphovascular invasion). A longitudinal lesion with an attachment of white keratinized epithelium was more likely to be detected in the very-low-risk group than any-risk group (61.8% versus 17.6%, respectively; P < 0.001).

CONCLUSIONS: Esophageal squamous cell carcinoma in patients with very low risk factors is rare but can be encountered in daily practice. A longitudinal lesion with an attachment of white keratinized epithelium is its main characteristic, which is slightly different from that of patients with any risk factors.

PMID:33752198 | DOI:10.1159/000516021