Category: Nevin Manimala

J Environ Manage. 2023 Dec 14;351:119782. doi: 10.1016/j.jenvman.2023.119782. Online ahead of print.

ABSTRACT

Climate change has intensified the effects of habitat fragmentation in many ecosystems, particularly exacerbated in riparian habitats. Therefore, there is an urgent need to identify keystone connectivity spots to ensure long-term conservation and sustainable management of riparian systems as they play a crucial role for landscape connectivity. This paper aims to identify critical areas for connectivity under two contrasting climate change scenarios (RCP 4.5 and RCP 8.5 models) for the years 2030, 2050 and 2100 and to group these critical areas by similar connectivity in keystone spots for sustainable management. A set of analyses comprising climate analysis, drainage network analysis, configuration of potential riparian habitats, riparian habitat connectivity, data clustering, and statistical analysis within a Spanish river basin (NW Spain) were applied. The node and link connectivity would be reduced under the two climate change scenarios (≈2.5 % and 4.4 % reduction, respectively), intensifying riparian habitat fragmentation. Furthermore, 51 different clusters (critical areas) were obtained and classified in five classes (keystone spots) with similar connectivity across the different scenarios of climate change. Each keystone spot obtained by hierarchical classification was associated with one or more climate scenarios. One of these keystone spots was especially susceptible to the worst climate change scenario. Key riparian connectivity spots will be crucial for the management and restoration of highly threatened riparian systems and to ensure long-term biodiversity conservation.

PMID:38100859 | DOI:10.1016/j.jenvman.2023.119782

J Acquir Immune Defic Syndr. 2023 Dec 14. doi: 10.1097/QAI.0000000000003362. Online ahead of print.

ABSTRACT

BACKGROUND: This study examined the relationships among adiposity, handgrip, physical function, inflammation (i.e., senescence-associated secretory phenotype [SASP] chemokines as biomarkers of aging and frailty), and sex hormones in aging people with HIV (PWH).

METHODS: This cross-sectional exploratory study included 150 PWH aged ≥40 years (67.3% of participants were males). Our measures included: 1) body mass index (BMI) and waist circumference as measures of adiposity; 2) handgrip as a measure of muscle strength; 3) Short Physical Performance Battery as a measure of physical function; 4) interleukin-6, tumor necrosis factor alpha receptor II (TNFRII), high sensitivity C-reactive protein (hsCRP), C-X-C motif chemokine 10 (CXCL10), and C-X3-C motif chemokine ligand 1 aka fractalkine as SASP chemokines; and 5) free testosterone, estradiol, sex hormone binding globulin, and dehydroepiandrosterone (DHEA) as sex hormones. Quantile regression analyses were used to identify relationships among inflammatory markers and hormones with age, adiposity, handgrip, and physical function.

RESULTS: 74% (n=111) of participants were classified as overweight or obese and 53.3% (n=80) presented with abdominal obesity. After controlling for age and sex, BMI was positively associated with estradiol (β=0.043, p<0.01), and waist circumference was positively associated with hsCRP (β=2.151, p<0.01). After controlling for sex, age was positively associated with CXCL10 (β=0.024, p=0.03) and TNFRII (β=2.205, p=0.01). After controlling for age and sex, SPPB was negatively associated with DHEA (β=-0.004, p=0.01); no statistically significant associations were observed for handgrip.

CONCLUSION: Adiposity levels and aging were associated with inflammation (i.e., CXCL10, TNFRII, and hsCRP) among PWH aged 40 years and older.

PMID:38100820 | DOI:10.1097/QAI.0000000000003362

Anesth Analg. 2024 Jan 1;138(1):123-133. doi: 10.1213/ANE.0000000000006734. Epub 2023 Dec 15.

ABSTRACT

BACKGROUND: Guidelines for the evaluation and grading of diastolic dysfunction are available for transthoracic echocardiography (TTE). Transesophageal echocardiography (TEE) is used for this purpose intraoperatively but the level of agreement between these 2 imaging modalities for grading diastolic dysfunction is unknown. We assessed agreement between awake preoperative TTE and intraoperative TEE for grading diastolic dysfunction.

METHODS: In 98 patients undergoing cardiac surgery, key Doppler measurements were obtained using TTE and TEE at the following time points: TTE before anesthesia induction (TTEawake), TTE following anesthesia induction (TTEanesth), and TEE following anesthesia induction (TEEanesth). The primary endpoint was grade of diastolic dysfunction categorized by a simplified algorithm, and measured by TTEawake and TEEanesth, for which the weighted κ statistic assessed observed agreement beyond chance. Secondary endpoints were peak early diastolic lateral mitral annular tissue velocity (e’lat) and the ratio of peak early diastolic mitral inflow velocity (E) to e’lat (E/e’lat), measured by TTEawake and TEEanesth, were compared using Bland-Altman limits of agreement.

RESULTS: Disagreement in grading diastolic dysfunction by ≥1 grade occurred in 43 (54%) of 79 patients and by ≥2 grades in 8 (10%) patients with paired measurements for analysis, yielding a weighted κ of 0.35 (95% confidence interval [CI], 0.19-0.51) for the observed level of agreement beyond chance. Bland-Altman analysis of paired data for e’lat and E/e’lat demonstrated a mean difference (95% CI) of 0.51 (-0.06 to 1.09) and 0.70 (0.07-1.34), respectively, for measurements made by TTEawake compared to TEEanesth. The percentage (95% CI) of paired measurements for e’lat and E/e’lat that lay outside the [-2, +2] study-specified boundary of acceptable agreement was 36% (27%-48%) and 39% (29%-51%), respectively. Results were generally robust to sensitivity analyses, including comparing measurements between TTEawake and TTEanesth, between TTEanesth and TEEanesth, and after regrading diastolic dysfunction by the American Society of Echocardiography (ASE)/European Association of CardioVascular Imaging (EACVI) algorithm.

CONCLUSIONS: There was poor agreement between TTEawake and TEEanesth for grading diastolic dysfunction by a simplified algorithm, with disagreement by ≥1 grade in 54% and by ≥2 grades in 10% of the evaluable cohort. Future studies, including comparing the prognostic utility of TTEawake and TEEanesth for clinically important adverse outcomes that may be a consequence of diastolic dysfunction, are needed to understand whether this disagreement reflects random variability in Doppler variables, misclassification by the changed technique and physiological conditions of intraoperative TEE, or the accurate detection of a clinically relevant change in diastolic dysfunction.

PMID:38100804 | DOI:10.1213/ANE.0000000000006734

Sex Transm Dis. 2023 Dec 13. doi: 10.1097/OLQ.0000000000001909. Online ahead of print.

ABSTRACT

BACKGROUND: The United States has seen a significant rise in syphilis over the past twenty years with a disparate impact on American Indian communities. We conducted a thorough review of the local epidemiology that guided an innovative response to curb the epidemic.

METHODS: We analyzed syphilis data from a hospital in rural Arizona that serves an American Indian population of over 18,000. Testing data was extracted from 2017-2023 with detailed chart reviews of all reactive results since January 2022. Descriptive and comparative statistics were computed using parametric and non-parametric methods where appropriate.

RESULTS: Among 5,888 tested persons, 555 (9.4%) had reactive results and 277 (4.7%) represented new infections. Among new cases, 151 (54.5%) were female and 55 (19.9%) were reinfections. The annualized incidence rate was 10.0 cases per 1000 persons with peak annualized incidence among women ages 30-34 years of 22.6 infections per 1000 persons. During the observation period and after the implementation of programmatic changes in June 2022, there were statistically significant reductions in median time to treatment (-80%), test positivity (-70%), infections (-60%) and no congenital syphilis cases during the observation period.

CONCLUSIONS: We observed significantly elevated syphilis rates in AI/AN persons compared to the general population. Strategic implementation of new policies and practices led to a measurable and meaningful improvement in several epidemic variables and our experience may serve as a model to other communities.

PMID:38100793 | DOI:10.1097/OLQ.0000000000001909

J Neurosurg Spine. 2023 Dec 15:1-8. doi: 10.3171/2023.10.SPINE23806. Online ahead of print.

ABSTRACT

OBJECTIVE: Since its introduction, electrocautery has served as a valuable surgical tool, enabling precise tissue cutting and effective hemostasis in spine surgery. While there have been numerous efforts to elucidate the possible hazardous effects of surgical smoke in various surgical fields, there has been very little discussion in the context of spine surgery. The objective of this study was to measure and conduct a quantitative analysis of the particulate matter (PM) of different sizes and of formaldehyde (HCHO) generated by smoke during spine surgeries.

METHODS: This study included a consecutive series of patients who underwent 1- or 2-level lumbar spinal fusion surgery between June and November 2021. Particle counts were measured using a particle counter, specifically focusing on six different sizes of PM (0.3, 0.5, 1, 2.5, 5, and 10 µm). Additionally, measurements were taken for HCHO in parts per million (ppm). Monopolar cautery was used in the surgical setting. Systematic measurements were conducted at specific time points during the surgical procedures to assess the levels of PM and HCHO. Furthermore, the efficacy of surgical smoke suction was evaluated by comparing the PM levels with and without adjacent placement of suction.

RESULTS: This study involved 35 patients, with measurements of both PM and HCHO taken in 27 cases. The remaining 8 cases had measurements only for PM. In this study, statistically significant quantitative changes in various PM sizes were observed when electrocautery was used during spine surgery (12.3 ± 1.7 vs 1975.7 ± 422.8, 3.4 ± 0.5 vs 250.1 ± 45.7, and 1.9 ± 0.2 vs 78.1 ± 13.3, respectively, for 2.5-, 5-, and 10-µm PM; p < 0.05). The level of HCHO was also significantly higher (0.085 ± 0.006 vs 0.131 ± 0.014 ppm, p < 0.05) with electrocautery use. Utilization of adjacent suction of surgical smoke during electrocautery demonstrated a statistically significant reduction in PM levels.

CONCLUSIONS: The findings of this study highlight the potential surgical smoke-related hazards that spine surgeons may be exposed to in the operating room. Implementing simple interventions, such as utilizing nearby suction, can effectively minimize the amount of toxic surgical smoke and mitigate these risks.

PMID:38100756 | DOI:10.3171/2023.10.SPINE23806

J Neurosurg Pediatr. 2023 Dec 15:1-12. doi: 10.3171/2023.10.PEDS23174. Online ahead of print.

ABSTRACT

OBJECTIVE: Abdominal CSF pseudocysts are an uncommon but challenging complication of ventriculoperitoneal shunts. Pseudocysts consist of a loculated intraperitoneal compartment that inadequately absorbs CSF and may be infected or sterile at diagnosis. The treatment goal is to clear infection if present, reduce inflammation, and reestablish long-term function in an absorptive (intraperitoneal) space. This aim of this paper was to study the efficacy of primary laparoscopic repositioning of the distal shunt catheter for treatment of sterile abdominal CSF pseudocysts.

METHODS: All patients treated for abdominal CSF pseudocysts at Dallas Children’s Health from 1991 to 2021 were retrospectively reviewed. Patient history and pseudocyst characteristics were analyzed, with a primary outcome of pseudocyst recurrence at 1 year.

RESULTS: Of 92 primary pseudocysts, 5 initial treatment strategies (groups) were used depending on culture status, clinical history, and surgeon preference: 1) shunt explant/external ventricular drain (EVD) placement (23/92), 2) distal tubing externalization (13/92), 3) laparoscopic repositioning (35/92), 4) open repositioning (4/92), and 5) other methods such as pseudocyst drainage or direct revision to another terminus (17/92). Seventy pseudocysts underwent shunt reimplantation in the peritoneal space. The 1-year peritoneal shunt survival for groups 1 and 2 combined was 90%, and 62% for group 3. In group 3, 1-year survival was better for those with normal systemic inflammatory markers (100%) than for those with high markers (47%) (p = 0.042). In a univariate Cox proportional hazards model, the risk of pseudocyst recurrence was increased if the most recent abdominal procedure was a nonshunt abdominal surgery (p = 0.012), and it approached statistical significance with male sex (p = 0.054) and elevated inflammatory markers (p = 0.056. Multivariate Cox analysis suggested increased recurrence risk with male sex (p = 0.05) and elevated inflammatory markers (p = 0.06), although the statistical significance threshold was not reached. The length of hospital stay was shorter for laparoscopic repositioning (6 days) than for explantation/EVD placement (21 days) (p < 0.0001). Ultimately, 62% of patients had a peritoneal terminus at the last follow-up, 33% (n = 30) had an extraperitoneal terminus (19 pleura, 8 right heart, and 3 gallbladder), and 5 patients were shunt free.

CONCLUSIONS: Some sterile pseudocysts with normal systemic inflammatory markers can be effectively treated with laparoscopic repositioning, resulting in a significantly shorter hospitalization and modestly higher recurrence rate than shunt explantation.

PMID:38100755 | DOI:10.3171/2023.10.PEDS23174

Ann Med. 2023;55(2):2252439. doi: 10.1080/07853890.2023.2252439. Epub 2023 Dec 15.

ABSTRACT

OBJECTIVE: The purpose of this study was to determine whether a single session of trans-cranial direct current stimulation (tDCS) of the cerebellum and M1 has any advantages over one another or sham stimulation in terms of balance, gait and lower limb function.

METHODS: A total of 66 patients who had experienced their first ever stroke were recruited into three groups for this double-blinded, parallel, randomized, sham-controlled trial: cerebellar stimulation group (CbSG), M1 stimulation group (MSG) and sham stimulation group (SSG). A single session of anodal tDCS with an intensity of 2 mA for a duration of 20 min was administered in addition to gait and balance training based on virtual reality using an Xbox 360 with Kinect. Balance, gait, cognition and risk of fall were assessed using outcome measures before intervention (T0), immediately after intervention (T1) and an hour after intervention (T2).

RESULTS: Across group analysis of all outcome measures showed statistically non-significant results (p > .05) except for Six Minute Walk Test (p value T0 = .003, p value T1 = .025, p value T2 = .016). The training effect difference showed a significant difference in balance, gait and cognition, as well as cerebral and cerebellar stimulation, in comparison to sham stimulation (p < .05). The risk of falls remained unaffected by any stimulation (p > .05).

CONCLUSIONS: In addition to Xbox Kinect-based rehabilitation training, a single session of anodal tDCS to the M1 or cerebellum may be beneficial for improving lower limb function, balance and gait performance.

PMID:38100750 | DOI:10.1080/07853890.2023.2252439

Pediatr Infect Dis J. 2024 Jan 1;43(1):63-68. doi: 10.1097/INF.0000000000004117. Epub 2023 Sep 14.

ABSTRACT

BACKGROUND: Elizabethkingia meningoseptica is an emerging nosocomial pathogen implicated in neonatal sepsis with high mortality and morbidities. However, there is very limited data regarding the characteristics as well as outcomes following this infection, particularly in developing countries.

METHODS: We conducted a retrospective observational study of all infants with culture-positive Elizabethkingia sepsis as part of an outbreak, to study their clinical and epidemiological characteristics, as well as their antimicrobial susceptibility patterns, using a structured proforma from the neonatal intensive care unit database. Analysis was done using descriptive statistics and predictors of mortality and hydrocephalus were also identified.

RESULTS: Of the 21 neonates enrolled, 9 (42.9%) were male, with a mean gestational age and birth weight of 31.7 ± 3.4 weeks and 1320 ± 364 g, respectively. The median (interquartile range) age of onset of illness was 7 (5-12) days. The overall mortality rate was 23.8%, and among survivors, 50% had neurologic complications requiring intervention. Vancomycin and ciprofloxacin were the most used antibiotics for treatment in our series, with a median duration of 26 (17-38) days. On univariate analysis, shock at presentation was significantly associated with increased mortality (P = 0.04) while, seizures (P = 0.04) and elevated cerebrospinal fluid protein levels (P = 0 .01) at onset of illness predicted progressive hydrocephalus in surviving neonates.

CONCLUSION: E. meningoseptica sepsis is associated with high morbidity and mortality. Early diagnosis and prompt initiation of appropriate antibiotics are critical for improving survival and neurodevelopmental outcomes. Though isolation of the organism by environmental surveillance is always not possible, with proper infection control measures, the infection can be controlled.

PMID:38100733 | DOI:10.1097/INF.0000000000004117

Dis Esophagus. 2023 Dec 14:doad069. doi: 10.1093/dote/doad069. Online ahead of print.

ABSTRACT

Stag Beetle Knife (SB Knife) is increasingly being utilized for Zenker’s Diverticulectomy (ZD). Our study assessed the effectiveness and safety of the SB Knife for the management of ZD. Ovid EBM reviews, Ovid Embase, Ovid Medline, ClinicalTrials.gov, Scopus, and Web of Science were searched to identify studies that utilized SB knife for ZD. Pooled proportions (PP) were calculated using the random-effects model. Heterogeneity was evaluated using I2 statistics. A total of 7 studies with 268 patients were included in the final analysis. Dysphagia and regurgitation were the most common clinical symptoms. The mean size of the ZD was 2.8 ± 0.7 cm and 28 (of 148) patients had undergone previous treatments. The PP of technical success was 98% (95% CI: 92.3-99.5; I20) with a mean procedure duration of 26.2 ± 8.3 minutes. The PP of clinical response at first follow-up and relapse after index procedure was 87.9% (95% CI: 81.6-92.3; I219) and 13.5% (95% CI: 9.6-18.6; I22), respectively. At final follow-up, the PP of clinical remission was 96.2% (95% CI: 91-98.4; I230.6) while the PP of procedure failure was 3.6% (95% CI: 1.6-8.1; I20). No severe adverse events (AEs) were noted while using the SB Knife. However, the PP of intraprocedural and postprocedural AEs was 13.2% (95% CI: 9.6-17.8; I20) and 9.3% (95% CI: 5.7-14.9; I2 < 20.9), respectively. SB Knife is highly safe and effective for Zenker’s Diverticulectomy with a failure rate of only 3.6%.

PMID:38100729 | DOI:10.1093/dote/doad069

Chron Respir Dis. 2023 Jan-Dec;20:14799731231222282. doi: 10.1177/14799731231222282.

ABSTRACT

BACKGROUND: Chronic lung diseases, such as chronic obstructive pulmonary disease or asthma, are associated with an increased risk of dementia. However, few data are available regarding the risk of dementia in individuals with bronchiectasis.

OBJECTIVES: To explore the association between bronchiectasis and the risk of incident dementia using a longitudinal population-based cohort.

METHODS: A total of 4,068,560 adults older than 50 years without previous dementia were enrolled from the Korean National Health Insurance Service database in 2009. They were followed up until the date of the diagnosis of dementia or December 31, 2020. The study exposure was the diagnosis of bronchiectasis, and the primary outcome was incident dementia comprising Alzheimer’s disease and vascular dementia.

RESULTS: During the median follow-up duration of 9.3 years, the incidence of all-cause dementia was 1.6-fold higher in individuals with bronchiectasis than in those without bronchiectasis (15.0 vs. 9.3/1000 person-years, p < .001). In the multivariable Cox regression analysis, the risk of all dementia was significantly higher in individuals with bronchiectasis than in those without bronchiectasis (adjusted hazard ratio [aHR] 1.09, 95% confidence interval [CI] 1.04-1.14). In a subgroup analysis by dementia type, individuals with bronchiectasis had an increased risk of Alzheimer’s disease compared to those without bronchiectasis (aHR 1.07, 95% CI 1.01-1.12); the risk of vascular dementia did not significantly differ between the two groups (aHR 1.05, 95% CI 0.90-1.21).

CONCLUSION: Bronchiectasis was associated with an increased risk of dementia, especially Alzheimer’s disease.

PMID:38100725 | DOI:10.1177/14799731231222282