Category: Nevin Manimala

NMR Biomed. 2023 Sep 23:e5040. doi: 10.1002/nbm.5040. Online ahead of print.

ABSTRACT

The purpose of this study is to investigate the use of ultrashort echo time (UTE) magnetic resonance imaging (MRI) techniques (T1 and magnetization transfer [MT] modeling) for imaging of the Achilles tendons and entheses in patients with psoriatic arthritis (PsA) compared with asymptomatic volunteers. The heels of twenty-six PsA patients (age 59 ± 15 years, 41% female) and twenty-seven asymptomatic volunteers (age 33 ± 11 years, 47% female) were scanned in the sagittal plane with UTE-T1 and UTE-MT modeling sequences on a 3-T clinical scanner. UTE-T1 and macromolecular proton fraction (MMF; the main outcome of MT modeling) were calculated in the tensile portions of the Achilles tendon and at the enthesis (close to the calcaneus bone). Mann-Whitney-U tests were used to examine statistically significant differences between the two cohorts. UTE-T1 in the entheses was significantly higher for the PsA group compared with the asymptomatic group (967 ± 145 vs. 872 ± 133 ms, p < 0.01). UTE-T1 in the tendons was also significantly higher for the PsA group (950 ± 145 vs. 850 ± 138 ms, p < 0.01). MMF in the entheses was significantly lower in the PsA group compared with the asymptomatic group (15% ± 3% vs. 18% ± 3%, p < 0.01). MMF in the tendons was also significantly lower in the PsA group compared with the asymptomatic group (17% ± 4% vs. 20% ± 5%, p < 0.01). Percentage differences in MMF between the asymptomatic and PsA groups (-16.6% and -15.0% for the enthesis and tendon, respectively) were higher than the T1 differences (10.8% and 11.7% for the enthesis and tendon, respectively). The results suggest higher T1 and lower MMF in the Achilles tendons and entheses in PsA patients compared with the asymptomatic group. This study highlights the potential of UTE-T1 and UTE-MT modeling for quantitative evaluation of entheses and tendons in PsA patients.

PMID:37740595 | DOI:10.1002/nbm.5040

J Radiat Res. 2023 Sep 22:rrad069. doi: 10.1093/jrr/rrad069. Online ahead of print.

ABSTRACT

To investigate radiation-induced cytopenia and establish predictive nomograms for hematological toxicity, we reviewed 3786 patients aged 18 or older who received radiation monotherapy between 2010 and 2021 for non-hematologic malignancies. We collected data on patient background, treatment content and hematologic toxicities for 12 weeks after the start of radiotherapy. The patients were randomly divided into training and test groups in 7:3 ratio. In the training group, we conducted ordered logistic regression analysis to identify predictive factors for neutropenia, lymphocytopenia, anemia and thrombocytopenia. Nomograms to predict Grade 2-4 cytopenia were generated and validated in the test group. Grade 3 or higher hematologic toxicities were observed in 9.7, 44.6, 8.3 and 3.1% of patients with neutropenia, lymphocytopenia, anemia and thrombocytopenia, respectively. We identified six factors for neutropenia grade, nine for lymphocytopenia grade and six for anemia grade with statistical significance. In the analysis of thrombocytopenia, the statistical model did not converge because of a small number of events. Nomograms were generated using factors with high predictive power. In evaluating the nomograms, we found high area under the receiver operating characteristic curve values (neutropenia; 0.75-0.85, lymphopenia; 0.89-0.91 and anemia; 0.85-0.86) in predicting Grade 2-4 cytopenia in the test group. We established predictive nomograms for neutropenia, leukocytopenia and anemia and demonstrated high reproducibility when validated in an independent cohort of patients.

PMID:37740569 | DOI:10.1093/jrr/rrad069

Orthop Surg. 2023 Sep 22. doi: 10.1111/os.13863. Online ahead of print.

ABSTRACT

BACKGROUND: Iliosacral screw insertion by computer-assisted navigation gradually became the main technique in some hospitals, but the expensive price limited the extensive application. But other techniques such as 3D printed template was used to place iliosacral screw as novel method. This study was to compare the efficiency of percutaneous iliosacral screw placement by using patient-specific template and computer-assisted navigation.

METHODS: Total of 58 patients from September 2017 to September 2021 with sacral injury were treated operatively with percutaneous screw technique, which was selected for this retrospective analysis and divided into two groups (template and computer-assisted navigation). There were 31 patients in template group and 27 patients in computer-assisted navigation group. The surgical details (operation time, blood loss, number of screw placements, and number of fluoroscopies), complications, radiographic and clinical results were recorded. The quality of reduction was assessed by the Matta scoring system. T-test and rank-sum test was used in this study.

RESULTS: Operation time in template group was less (33.97 ± 16.61 < 60.31 ± 11.46 min, p < 0.01), but the preoperative preparation time was more (6.35 ± 1.60 > 5.41 ± 1.58, p < 0.05). The quality of reduction in both groups was no difference (p = 0.352). A patient was complicated with gluteal vessel injury in operation in navigation group, which was treated with ligation, but the same injury was not observed in template group. The related surgical data of patient with gluteal injury was ignored in statistical analysis.

CONCLUSION: Both of the two techniques could improve surgical efficiency, the operation time in template was less than computer-assisted navigation group, but the preoperative preparation time was more.

PMID:37740552 | DOI:10.1111/os.13863

Dev Med Child Neurol. 2023 Sep 22. doi: 10.1111/dmcn.15757. Online ahead of print.

ABSTRACT

AIM: To investigate the prevalence of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in a population-based birth cohort and correlate the findings with prenatal and perinatal factors. We hypothesized that children born preterm, having experienced preeclampsia or maternal overweight, would have an increased risk of ADHD or ASD.

METHOD: A Swedish cohort of 2666 children (1350 males, 1316 females) has been followed from birth with parental and perinatal data. The National Board of Health and Welfare’s registries were used to collect data regarding perinatal status and assigned diagnoses at the age of 12 years.

RESULTS: The prevalence of ADHD and ASD was 7.6% and 1.1% respectively. Maternal obesity early in pregnancy resulted in a three-fold increased risk of ADHD in the child. Similarly, paternal obesity resulted in a two-fold increased risk. The association was significant also when adjusted for sex, preterm birth, smoking, and lower educational level. The prevalence of ASD was too low for statistically relevant risk factor analyses.

INTERPRETATION: Our results corroborate earlier findings regarding prevalence and sex ratio for both ADHD and ASD. Maternal body mass index and preterm birth were correlated with an ADHD diagnosis at the age of 12 years.

PMID:37740541 | DOI:10.1111/dmcn.15757

Am J Sports Med. 2023 Sep 22:3635465231198051. doi: 10.1177/03635465231198051. Online ahead of print.

ABSTRACT

BACKGROUND: During the early evolution of femoroacetabular impingement (FAI) treatment, undercorrection of femoral deformity was a leading cause of hip arthroscopy failures. As the pendulum has swung, overresection of femoral deformity has increased in prevalence as a cause of persistent hip pain after arthroscopy. Computed tomography (CT) scans are increasingly being used in hip arthroscopy for preoperative planning purposes and may allow for improved 3-dimensional (3D) assessment of complex femoral deformities after previous femoroplasty.

PURPOSE: To assess whether CT scans provide additional utility over standard radiographs in understanding proximal femoral morphology in patients being evaluated for revision hip arthroscopy after previous femoroplasty in the setting of FAI.

STUDY DESIGN: Cohort study (Diagnosis); Level of evidence, 3.

METHODS: Preoperative CT scans and standard radiographs were obtained in 80 patients who underwent revision hip arthroscopy for FAI. The anteroposterior and Dunn radiographic views were used to assess patients for residual proximal femoral deformity and were compared with the CT scan views using a commercially available software program. Determinations of underresection were made using alpha angle, while overresection was determined according to a previously described technique. Chi-square tests were performed to determine statistical significance between radiographic and CT classifications of overresection, underresection, and concomitant over- and underresection. A kappa value was calculated to determine the agreement between measurements on the radiographs and CT scans.

RESULTS: There were 30 patients (37.5%) for whom the CT scans revealed information about femoral morphology that was not detected on the radiographs. The kappa value of agreement was 0.28 between CT and radiographic measurements. Underresected cams were detected in 30 patients (37.5%) on CT scans versus 17 patients (21.3%) on radiographs (P = .024). Overresected cams were detected in 31 patients (38.8%) on CT scans versus 14 patients (17.5%) on radiographs (P = .0049). Concomitant areas of under- and overresection were detected in 12 patients (15.0%) on CT scans versus 3 patients (3.8%) on radiographs (P = .027).

CONCLUSION: CT scans with 3D planning software may be more sensitive than traditional radiographic views at detecting aberrant proximal femoral anatomy in the setting of failed FAI surgery. The use of 3D planning software may be considered as an adjunctive tool to better understand complex deformity in the proximal femur for the planning of revision hip arthroscopy.

PMID:37740538 | DOI:10.1177/03635465231198051

Inflamm Bowel Dis. 2023 Sep 22:izad204. doi: 10.1093/ibd/izad204. Online ahead of print.

ABSTRACT

BACKGROUND: Vascular disease and cognitive impairment have been increasingly documented in inflammatory bowel disease (IBD), and both have been individually correlated with changes in brain structure. This study aimed to determine if both macro- and microstructural brain changes are prevalent in IBD and whether alterations in brain structure mediate the relationship between vascular disease and cognitive functioning.

METHODS: Eighty-four IBD participants underwent multimodal magnetic resonance imaging. Volumetric and mean diffusivity measures of the thalamus, hippocampus, normal-appearing white matter, and white matter lesions were converted to age- and sex-adjusted z scores. Vascular comorbidity was assessed using a modified Framingham Risk Score and cognition was assessed using a battery of neuropsychological tests. Test scores were standardized using local regression-based norms. We generated summary statistics for the magnetic resonance imaging metrics and cognitive tests, and these were examined using canonical correlation analysis and linear regression modeling.

RESULTS: Greater vascular comorbidity was negatively correlated with thalamic, normal-appearing white matter, and white matter lesion volumes. Higher Framingham Risk Score were also correlated with lower processing speed, learning and memory, and verbal fluency. Increased vascular comorbidity was predictive of poorer cognitive functioning, and this effect was almost entirely mediated (94.76%) by differences in brain structure.

CONCLUSIONS: Vascular comorbidity is associated with deleterious effects on brain structure and lower cognitive functioning in IBD. These findings suggest that proper identification and treatment of vascular disease is essential to the overall management of IBD, and that certain brain areas may serve as critical targets for predicting the response to therapeutic interventions.

PMID:37740523 | DOI:10.1093/ibd/izad204

J Prim Care Community Health. 2023 Jan-Dec;14:21501319231198942. doi: 10.1177/21501319231198942.

ABSTRACT

AIM: Low- and middle-income countries represent nearly 85% of all cervical cancer cases worldwide; thereby, it is extremely important to identify methods to improve the screening process. Therefore, this study aimed to summarize the primary characteristics of studies on accessibility, coverage, patient preferences, and factors associated with patient satisfaction or acceptance of colposcopy in primary healthcare.

METHODS: A search strategy, based on MeSH, Emtree, and free terms, was run through 5 databases (PubMed, Scopus, Embase, Ovid/Medline, and Web of Science). EndNote 20.1 © and Rayyan QCRI © were used for screening. A preset datasheet was used for data extraction.

RESULTS: The systematic search retrieved 1127 references, and after removing duplicates, screening the titles and abstracts, and reviewing the full text, 7 studies were included. The interrater reliability was 77.73% (kappa statistic = 0.1842). Most studies estimated the proportion of women that sought for colposcopy after a previous screening test for human papilloma virus. One study identifies barriers to colposcopy examination in women at risk of developing cervical cancer. Three studies assessed the decentralization of colposcopy from a tertiary healthcare center to a primary care center. Pap smear was the most common first-line screening test, followed by liquid-based cytology sample and visual inspection with acetic acid.

CONCLUSION: Only a few countries have investigated the use of colposcopy in primary care. Thus, barriers and the care structure for this implementation to be successful in reducing cervical cancer incidence and mortality should be identified.

PMID:37740513 | DOI:10.1177/21501319231198942

Nutr Clin Pract. 2023 Sep 22. doi: 10.1002/ncp.11074. Online ahead of print.

ABSTRACT

BACKGROUND: The prevalence of a high comorbidity burden in patients who suffered an acute myocardial infarction (AMI) is increasing with the aging population, and the nutrition status also may be a predictor of clinical outcomes for these patients. This study aimed to investigate the relationship between the comorbidity burden and the characteristics of the bioelectrical impedance vector analysis (BIVA) in patients post-AMI.

METHODS: This prospective observational cohort study was conducted with adult patients who were hospitalized with AMI. Pre-existing comorbidities were assessed by the Charlson comorbidity index (CCI) adjusted by age, and anthropometric and BIVA characteristics were evaluated after the hemodynamic stabilization. All patients were followed-up until hospital discharge, and their length of stay was observed.

RESULTS: A total of 184 patients (75% were males; mean age, 60.2 ± 12.3 years) were included. The most common comorbidities were dyslipidemia (73.9%), hypertension (62%), and type 2 diabetes (34.2%). A higher CCI (≥3) was associated with sex (P = 0.008) and age (P < 0.001). Regarding BIVA, statistically significant differences were detected between sex (P < 0.001), age (P < 0.001), and CCI (P = 0.003), with longer vectors in female, older adults, and those with CCI ≥ 3.

CONCLUSION: Finding a relationship between BIVA and CCI suggests the first identified coherent differences, potentially correlated with diseases, representing a first contribution to support this type of assessment. Therefore, with BIVA, healthcare professionals may monitor abnormalities and adopt preventive nutrition care measures on patients post-AMI to improve their clinical status.

PMID:37740504 | DOI:10.1002/ncp.11074

J Prim Care Community Health. 2023 Jan-Dec;14:21501319231199014. doi: 10.1177/21501319231199014.

ABSTRACT

BACKGROUND AND OBJECTIVE: Meta-analysis of randomized controlled trials have demonstrated the efficacy of telemedicine in blood pressure (BP) management when compared to conventional care. We initiated a hypertension telehealth clinic in our urban primary care clinic and through this study aim to evaluate the strengths and limitations of telemedicine in hypertension (HTN) control. The primary outcome of the study is to identify the proportion of patients with improved HTN. Secondary outcomes included identifying: predictors for lower BP, predictors of missing telehealth appointments, and comorbid conditions that are more likely to necessitate use of more than 1 antihypertensive medication.

METHODS AND ANALYSIS: Patients seen in the HTN telehealth clinic from May 1st, 2022 to October 31st, 2022 were identified. A retrospective chart review was done to compare the BP during in-person visit prior to first telehealth visit, telehealth visit home BP readings and last recorded in-office BP on chart at end of study period. Descriptive statistical analysis, Chi Square test, and multivariable logistic regression was used to analyze data.

RESULTS: Of the 234 appointments, 83% were conducted and 154 patients were seen. A remarkable decrease in percentage of patients with BP >140/90 was seen when comparing in-office visit BP to first telehealth visit home BP, 72% versus 45% respectively. No remarkable difference was noted in percentage of patients with BP >140/90 when comparing first telehealth visit home BP to last in-office BP recorded on chart, 45% and 41% respectively. Patients with diabetes had lower odds of missing appointments, adjusted odds ratio (aOR): 0.34 ([0.12-0.91], P = .03). Patients with partners were more likely to have lower BP at the telehealth visit, aOR:3.2 ([1.15-9.86], P = .03) while patients with obstructive sleep apnea (OSA) (aOR 0.27 ([0.08-0.77], P = .02) and CAD, aOR 0.24 ([0.06-0.8], P = .03) were less likely to have lower BP.

CONCLUSION: The study demonstrated telemedicine as a great tool to prevent overtreatment of hypertension as significant difference between in-office BP and home BP during telehealth visits was noted. We did not see a significant change in blood pressure when comparing home BP at first telehealth visit to the last in-person clinic BP at end of study period.

PMID:37740500 | DOI:10.1177/21501319231199014

Int J Phytoremediation. 2023 Sep 22:1-15. doi: 10.1080/15226514.2023.2256412. Online ahead of print.

ABSTRACT

In this study, bamboo waste (BW) was subjected to pyrolysis-assisted ZnCl₂ activation to produce mesoporous activated carbon (BW-AC), which was then evaluated for its ability to remove cationic dyes, specifically methylene blue (MB) and crystal violet (CV), from aqueous environments. The properties of BW-AC were characterized using various techniques, including potentiometric-based point of zero charge (pH_pzc), scanning electron microscopy with energy dispersive X-rays (SEM-EDX), X-ray diffraction (XRD), gas adsorption with Brunauer-Emmett-Teller (BET) analysis, infrared (IR) spectroscopy. To optimize the adsorption characteristics (BW-AC dosage, pH, and contact time) of PBW, a Box-Behnken design (BBD) was employed. The BW-AC dose of 0.05 g, solution pH of 10, and time of 8 min are identified as optimal operational conditions for achieving maximum CV (89.8%) and MB (96.3%) adsorption according to the BBD model. The dye removal kinetics for CV and MB are described by the pseudo-second-order model. The dye adsorption isotherms revealed that adsorption of CV and MB onto BW-AC follow the Freundlich model. The maximum dye adsorption capacities (q_max) of BW-AC for CV (530 mg/g) and MB (520 mg/g) are favorable, along with the thermodynamics of the adsorption process, which is characterized as endothermic and spontaneous. The adsorption mechanism of CV and MB dyes by BW-AC was attributed to multiple contributions: hydrogen bonding, electrostatic forces, π-π attraction, and pore filling. The findings of this study highlight the potential of BW-AC as an effective adsorbent in wastewater treatment applications, contributing to the overall goal of mitigating the environmental impact of cationic dyes and ensuring the quality of water resources.

PMID:37740456 | DOI:10.1080/15226514.2023.2256412