Category: Nevin Manimala

Pediatr Surg Int. 2024 Dec 28;41(1):51. doi: 10.1007/s00383-024-05945-0.

ABSTRACT

BACKGROUND: Burns in children are often complex injuries, leading to prolonged length of stay (LOS) and significant morbidity. LOS in pediatric intensive care units (PICUs) is a key measure for evaluating illness severity, clinical outcomes, and quality of care. Accurate prediction of LOS is vital for improving care planning and resource allocation. There is limited data for predicting LOS in severely burned children in PICU. This study aims to identify significant factors associated with prolonged PICU stays and offer a simple LOS-predicting model.

METHODS: This historical cohort study included all patients < 18 years, admitted for severe burn injuries to Israel’s largest tertiary hospital PICU, from 2015 to 2020. Statistical analyses were conducted to identify factors linked to prolonged LOS and a predictive model was designed.

RESULTS: The study included 39 pediatric burn patients and identified several factors associated with longer PICU stays. Patients with LOS of ˃7 days (i.e.-“long LOS”) had significantly higher %TBSA (33.11 ± 17.87% vs. 16.67 ± 7.98%, p < 0.001. During the first 24 and 48 h, the “long LOS” group had lower minimal systolic blood pressure (SBP) (70.67 ± 17.49 mmHg vs. 84.38 ± 16.73 mmHg, p = 0.015 and 69.39 mmHg ± 16.44 vs. 81.10 mmHg ± 19.67, p = 0.018). Although serum lactate levels were higher in the “long LOS” group, the difference was not significant, and platelet counts in this group were significantly lower during the first 48 h (184 K/µL vs. 264.5 K/µL, p = 0.003). A predictive model based on %TBSA, SBP, lactate, and platelet count was developed, demonstrating 100% specificity and positive predictive value for predicting LOS over 7 days in severely burned children.

CONCLUSIONS: Key clinical indicators at PICU admission in severely burned children were associated with LOS > 7 days. The resulting predictive model, although requiring further validation in multi-site studies, offers a promising tool for enhancing care planning in this population.

PMID:39731634 | DOI:10.1007/s00383-024-05945-0

Lasers Med Sci. 2024 Dec 28;40(1):2. doi: 10.1007/s10103-024-04261-2.

ABSTRACT

To compare the efficacy and safety of low-power holmium laser enucleation of the prostate (LP-HoLEP) with plasma kinetic resection of prostate (PKRP). Sixty-three patients treated with transurethral LP-HoLEP (observation group) and 68 patients treated with transurethral PKRP (control group) at Beijing Hospital of Traditional Chinese Medicine from November 2019 to November 2022 were retrospectively compared with regard to operation duration, intra-operative blood loss, prostate resection ratio, postoperative bladder irrigation time, postoperative indwelling urinary catheter time, postoperative urinary incontinence incidence, International Prostate Symptom Scale (IPSS), maximum urine flow rate (Qmax), and residual urine volume (RUV). In both groups, postoperative IPSS, Qmax, and RUV were significantly improved compared to preoperative values (P < 0.05). Comparing the observation group to the control group, the intra-operative blood loss were (59.6 ± 18.1) and (173.1 ± 85.3) ml, respectively (t = -10.350, P < 0.01); the prostate resection ratios were (81.2 ± 4.6) % and (56.7 ± 9.7)%, respectively (t = 18.230, P < 0.01); the postoperative bladder irrigation time was (39.1 ± 9.6) h and (49.7 ± 6.0) h, respectively (t = -7.623, P < 0.01); and the postoperative indwelling urinary catheter time was (111.5 ± 19.4) h and (120.4 ± 12.8) h, respectively (t = -3.125, P < 0.01). Comparing the observation group to the control group, the operation duration was (76.2 ± 18.6) and (83.0 ± 32.4) min, respectively, with no statistical difference (t = -1.226, P = 0.208); the postoperative urinary incontinence incidence was 12.7% and 8.8%, respectively and there was no statistical difference (χ² = 0.514, P = 0.473). LP-HoLEP offers excellent surgical efficacy and safety. LP-HoLEP is superior to PKRP in intra-operative blood loss, postoperative bladder irrigation time, and postoperative indwelling urinary catheter time, and can enucleate more hyperplastic glands.

PMID:39731626 | DOI:10.1007/s10103-024-04261-2

Neurosurg Rev. 2024 Dec 28;48(1):11. doi: 10.1007/s10143-024-03159-5.

ABSTRACT

Delayed cerebral ischemia, one of the most common complications following aneurysmal subarachnoid hemorrhage, was strongly related to poor patient outcomes. However, there are currently no clear guidelines to provide clinical guidance for post-craniotomy management. Our research aims to explore the association between cumulative blood pressure exposure during the early brain injury phase and the occurrence of delayed cerebral infarction and rebleeding following surgical aneurysm clipping. All baseline characteristics of the patients were meticulously recorded. We collected blood pressure data 25 times in 48 h after surgery for subsequent analysis. Cumulative blood pressure exposure is calculated by the product of the time spent below a specific blood pressure threshold and the cumulative exposure time. The principal outcome is the incidence of Delayed Cerebral Infarction, while the secondary outcome pertains to postoperative rebleeding. Logistic regression was utilized to examine the relationship. The cumulative exposure to mean arterial pressure at and below 85 mmHg demonstrated a significant association with DCI occurrence. However, no significant statistical correlation was found between hypertensive exposure and rebleeding events. The results from the sensitivity analysis remained consistent, and the lack of significant interactions further supports the robustness of the study findings. The identified threshold of 85 mmHg could potentially represent a critical blood pressure management parameter for post-surgical aneurysm clipping patients. These findings merit further investigation through larger prospective clinical trials.

PMID:39731615 | DOI:10.1007/s10143-024-03159-5

Acta Diabetol. 2024 Dec 28. doi: 10.1007/s00592-024-02399-7. Online ahead of print.

ABSTRACT

AIMS: There is a potential association between oxidative stress and the development of diabetic kidney disease (DKD). The Oxidative Balance Score (OBS), derived from dietary and lifestyle factors, acts as a comprehensive marker of oxidative stress. Research examining the relationship between OBS and DKD is scarce. This study aims to evaluate the association between OBS and the risk of DKD among U.S. adults.

METHODS: This study enrolled 6,725 eligible participants from the U.S. population through the National Health and Nutrition Examination Survey (2005-2020). Patients with DKD were defined as those with diabetes who had a urinary albumin-to-creatinine ratio ≥ 30 mg/g and/or an estimated glomerular filtration rate < 60 mL/min/1.73 m². The OBS consists of 20 composite scores derived from dietary and lifestyle factors. To assess the potential relationship between OBS and DKD, weighted logistic regression and restricted cubic spline statistical approaches were employed.

RESULTS: The risk of DKD was inversely correlated with OBS, dietary OBS, and lifestyle OBS (p < 0.05). Compared to the lowest quartile of OBS, the adjusted odds ratios (OR) for OBS, lifestyle OBS and dietary OBS, and DKD in the highest quartile were 0.58 (95% CI: 0.48-0.70), 0.64 (95% CI: 0.51-0.81), and 0.57 (95% CI: 0.46-0.70), respectively. A substantial nonlinear relationship between lifestyle OBS and DKD was identified using the RCS curve (p for nonlinearity = 0.0081), which appeared as an inverted ‘L’ shape. Using the two-piecewise logistic regression model, a turning point in lifestyle OBS was identified at a score of 3 (p < 0.001).

CONCLUSIONS: Among the American population, OBS and DKD are significantly negatively correlated, suggesting that maintaining a higher OBS may reduce the risk of developing DKD.

PMID:39731593 | DOI:10.1007/s00592-024-02399-7

Graefes Arch Clin Exp Ophthalmol. 2024 Dec 28. doi: 10.1007/s00417-024-06722-4. Online ahead of print.

ABSTRACT

PURPOSE: To compare the precision of the arithmetic mean of surgically induced astigmatism (M-SIA) and the centroid of surgically induced astigmatism (C-SIA) in estimating SIA when predicting the power and axis of toric IOLs under different circumstances.

METHODS: 120 eyes of 99 patients undergoing toric IOL replacement in a simple cataract surgery were included in the retrospective study. The predicted position of toric IOL was calculated by Z Calc online calculator and Barrett Toric Calculator with M-SIA (0.4D) or C-SIA (0.1D). Position prediction error (PPE, the difference between the predicted position of toric IOL and the ideal position of toric IOL), its absolute value (PPE-Abs) and △PPE (the difference between absolute value of PPE calculated by C-SIA and by M-SIA using the same toric calculator) were used to evaluate the precision in estimate of SIA.

RESULTS: Statistical significance in mean PPE and mean PPE-Abs was found in the group M-Barrett. The orientation of corneal astigmatism and eye laterality were influential to mean PPE while gender was not. △PPE was below 0 in both toric calculators. Significant difference in △PPE was seen between groups with different corneal astigmatism when all eyes were OS, as well as between groups with different eye laterality when all eyes were with WTR astigmatism.

CONCLUSIONS: We did not find a significant difference between M-SIA and C-SIA in estimating the SIA of the patients undergoing small-incision cataract surgery combined with toric IOL implantation. M-SIA was not recommended in Barrett Toric Calculator. The orientation of corneal astigmatism and the incision on the cornea should be considered when choosing between M-SIA and C-SIA.

KEY MESSAGES: WHAT IS KNOWN? : Either the arithmetic mean of surgically induced astigmatism (M-SIA) or the centroid of surgically induced astigmatism (C-SIA) of a cohort was used to estimate the position of toric IOLs before the surgery. The size and site of corneal incision could influence the orientation and the magnitude of SIA. WHAT IS NEW? : When calculating the axis of toric IOLs with Barrett Toric Calculator, arithmetic mean of SIA (M-SIA) was not recommended for estimate. The orientation of corneal astigmatism could influence the estimate of SIA. We created several novel variables that could be used to indirectly evaluate the stability of toric IOLs and the prognosis of patients.

PMID:39731587 | DOI:10.1007/s00417-024-06722-4

Psychiatr Danub. 2024 Dec;36(3-4):403-404.

NO ABSTRACT

PMID:39731527

J Pediatr Psychol. 2024 Dec 28:jsae103. doi: 10.1093/jpepsy/jsae103. Online ahead of print.

ABSTRACT

OBJECTIVE: Adolescents and young adults with chronic diseases face unique challenges during the college years and may consume alcohol and other substances to cope with stressors. This study aimed to assess the patterns of substance use and to determine psychosocial correlates of these behaviors among college youth with type 1 diabetes (T1D).

METHODS: College youth with T1D were recruited via social media and direct outreach into a web-based study. Participants answered validated questions about substance use, and they completed validated screeners of depressive and anxiety symptoms (PHQ-2 and GAD-2), illness acceptance (ICQ), interpersonal support (ISEL), and grit (Grit scale). Descriptive statistics, bivariate analyses, and multivariable regression evaluated substance use behaviors as a function of psychosocial factors while adjusting for age and sex.

RESULTS: Alcohol (84.06%) and marijuana (41.30%) were the most common substances reported. In bivariate analyses, depressive symptoms were positively associated (p = .01) and illness acceptance was inversely associated (p = .02) with marijuana use. Higher grit scores were inversely associated with marijuana use (p < .001) and prescription drug misuse (p = .04). The significant associations between marijuana use and depressive symptoms (adjusted odds ratio [AOR] 1.31, 95% confidence interval [CI] 1.04-1.66), illness acceptance (AOR 0.96, 95% CI 0.91-0.99), and grit (AOR 0.32, 95% CI 0.17-0.60) persisted after adjustment for age and sex.

CONCLUSIONS: Substance use is prevalent among college youth with T1D. While psychosocial factors such as depressive symptoms may confer an increased risk, illness acceptance and grit may be protective-especially against marijuana use. Providers should address both positive and negative psychosocial factors to mitigate substance use in this population.

PMID:39731516 | DOI:10.1093/jpepsy/jsae103

Laryngoscope. 2024 Dec 28. doi: 10.1002/lary.31973. Online ahead of print.

ABSTRACT

OBJECTIVE: Repositioning and fixation of the posterior septal angle (PSA) relative to the anterior nasal spine (ANS) is a well-known maneuver performed during rhinoplasty. Suture techniques through the periosteum along with transosseous drilling through the spine are the two most common fixation methods. We report on how nasal airway patency varies as a function of technique and patient demographic factors.

METHODS: A retrospective analysis was performed on patients who underwent PSA repositioning and stabilization during rhinoplasty due to caudal septal deformities. Nasal Obstruction Symptom Evaluation (NOSE) scales were measured pre- and post-operation to evaluate functional outcomes.

RESULTS: 207 patients with either mobile or immobile PSA underwent ANS fixation secured with either a suture passed through the periosteum of the ANS or with the creation of a drill hole through the ANS. In all patients regardless of clinical or demographic groupings, postoperative NOSE scores were significantly decreased when compared to preoperative scores (p < 0.05). Preoperative NOSE score, fixation method, sex, functional versus cosmetic, age, follow-up period, and graft site did not independently affect the postoperative NOSE score. Though the differences between primary and revision outcomes were statistically significant, patients in both groups reported significant improvements in postoperative NOSE scores that deescalated their symptoms from “severe” to “mild.”

CONCLUSION: Repositioning and fixation of the PSA improve patient outcomes. However, there is no significant difference between fixation methods on final NOSE scores. Septal fixation with consideration for patient anatomy allows for effective treatment.

LEVEL OF EVIDENCE: 4 Laryngoscope, 2024.

PMID:39731513 | DOI:10.1002/lary.31973

Ann Med. 2025 Dec;57(1):2443041. doi: 10.1080/07853890.2024.2443041. Epub 2024 Dec 28.

ABSTRACT

OBJECTIVE: To explore the differences of conventional ultrasound characteristics, elastic imaging parameters and clinicopathological characteristics of distinct molecular subtypes of breast cancer in young women, and to identify imaging parameters that exhibited significant associations with each molecular subtype.

METHODS: We performed a retrospective analysis encompassing 310 young women with breast cancer. Observations were made regarding the ultrasonography and elastography characteristics of the identified breast lesions. Subsequently, based on immunohistochemistry results patients were classified into five distinct molecular subtypes: luminal A, luminal B (HER2-), luminal B (HER2+), HER2+, and triple-negative breast cancer (TNBC). Clinical, pathological, and ultrasound imaging features were compared among these subtypes using binary logistic regression analysis.

RESULTS: Statistically significant differences were observed in various parameters across the five molecular subtypes (p < 0.05), including tumor size, morphology, margins, calcification, posterior echo features, blood flow (Adler grading), and tumor hardness. Specifically, luminal A subtype exhibited propensity for spiculated margins, lower blood flow grading, and decreased hardness; luminal B subtype was characterized by angular margins; HER2+ subtype manifested higher blood flow grading, calcification, and elevated hardness. Conversely, TNBC subtype displayed smooth margins, absence of calcification, and heightened hardness.

CONCLUSION: Specific molecular subtypes of breast cancer have unique ultrasonic and elastic imaging characteristics.

PMID:39731510 | DOI:10.1080/07853890.2024.2443041

Ann Med. 2025 Dec;57(1):2447404. doi: 10.1080/07853890.2024.2447404. Epub 2024 Dec 28.

ABSTRACT

BACKGROUND: To analyse the epidemiological characteristics of orthopaedic trauma patients and thereby optimize healthcare resource allocation and improve treatment efficiency.

MATERIALS AND METHODS: Relying on the hospital information system (HIS) database, we retrospectively analysed the epidemiological characteristics of orthopaedic trauma inpatients in our hospital between 2013 and 2022, including patient demographic information, causes of injury, location of injury and hospitalization costs.

RESULTS: The median age of the patients was 36 (26-47) years old; the age stratification of the patients was highest in the proportion of patients aged 40-50 years old (29.23%); hypertension was the most common among the patients’ comorbidities (1.29%); patients’ occupation was highest in heavy labourers such as farmers and workers, about 63.04% (n = 13923); patients’ admissions were mainly in the form of emergencies (n = 16875, 76.41%); and patients’ median hospitalization time was 7 (5, 12) days. The highest percentage of the cause of injury was due to exposure to inanimate mechanical forces (75.4%), followed by falls (16.14%) and traffic accidents (6.49%). The highest percentage of cause of injury in all age groups was due to inanimate mechanical force, and the percentage of patients with falls increased with age, and there was a positive correlation between age groups and the percentage of patients with falls (r = 0.964, p < 0.01). The highest percentage of patients with injuries to the upper extremities was about 74%. The distribution of injury sites in all age groups was highest in the upper extremities. Age was positively correlated with trunk injuries (r = 0.469, p = 0.203). The median hospitalization cost for patients over a 10-year period was approximately $1,100.

CONCLUSIONS: By analysing the epidemiological characteristics of patients, a general profile of local orthopaedic trauma patients was established, which can help in the development of disease prevention and interventions.

PMID:39731507 | DOI:10.1080/07853890.2024.2447404