Category: Nevin Manimala

World Neurosurg. 2023 Jul 24:S1878-8750(23)01023-9. doi: 10.1016/j.wneu.2023.07.083. Online ahead of print.

ABSTRACT

BACKGROUND: Pain relief in lumbar disc hernias is a challenging condition. This study retrospectively compared particulate steroids, methylprednisolone acetate (mid-term effective), against betamethasone acetate (Long-term effective) on ultrasound-guided caudal epidural injection for lumbar disc herniation (LDH).

METHODS: A total of 40 patients with L4-5 and/or L5-S1 disc herniation were treated with ultrasound-guided caudal epidural injection between September 2021 and June 2022. Nine-teen patients who were given methylprednisolone acetate (group A) as a steroid and a total of 21 patients who were used betamethasone acetate (Group B) were retrospectively collected, and their pain levels and functional improvement were compared retrospectively before, immediately after, and 3 weeks after the injection in terms of the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) as the efficacy value.

RESULTS: There was no statistically significant difference between the groups regarding age, gender, and BMI (p >0.05). In group A, pre-op VAS was 8.84 ± 0.76, immediate post-op period 3.10 ± 1.37, and post-op 3rd week was 4.73 ± 2.32. In group B, the pre-op VAS was 8.76 ±0.76, the post-op early period was 3.14 ± 1.27, and the post-op 3rd week was 3.12 ± 1.30. In group A pre-op ODI was 49.84 ± 9.11 and post-op 3rd week was 22.84 ± 6.44. In group B, the pre-op ODI was 46.71 ± 16.15 and post-op 3rd week was 30.80 ± 17.65. Significant changes were observed in the reduction of VAS values after the procedure in both groups during the early postoperative period and the third week (p-value < 0.05). However, a significant difference was not found between the changes in VAS values between the groups (p-value > 0.005). Similarly, significant changes were observed in the decrease of ODI values after the procedure in both groups during the early postoperative period and the third week (p-value < 0.05). However, no significant difference was observed in the ODI scores between the two groups.

CONCLUSIONS: No significant difference was observed between betamethasone and methylprednisolone. Both steroid groups showed a substantial improvement in the preoperative pain scores of the patients.

PMID:37495099 | DOI:10.1016/j.wneu.2023.07.083

Ann Vasc Surg. 2023 Jul 24:S0890-5096(23)00529-0. doi: 10.1016/j.avsg.2023.07.099. Online ahead of print.

ABSTRACT

OBJECTIVES: Since their inception, Integrated Vascular Surgery Residency (IVSR) programs have expanded widely and attracted highly competitive medical students by offering a more focused approach to learning both open surgical and endovascular techniques. However, despite substantial modifications to the training paradigm, a shortage of vascular surgeons is still projected through 2050. We aimed to gather and analyze fourth-year medical students’ knowledge and perceptions of vascular surgery (VS) to further inform strategies for recruiting future vascular surgeons.

METHODS: We sent anonymous electronic questionnaires to fourth-year medical students at seven allopathic and three osteopathic medical schools, with questions detailing demographics, specialty preferences, and exposure to and perceptions of VS. Descriptive statistics were obtained, and responses were compared between students applying to surgical (SS) and non-surgical specialties (NSS).

RESULTS: 211 of 1,764 (12%) participants responded (56% female). 56% reported VS exposure, most commonly during the third year. 64 (30%) planned to apply to SS. 57% of respondents reported knowledge of the management of vascular disease, and 56% understood procedures performed by vascular surgeons. Ranking the importance of factors in choosing specialties, SS selected “experiences gained during medical school rotations” (p < 0.05), “types and/or variety of treatment modalities used in this field” (p < 0.001), and “interest in the pathology or disease processes treated” (p < 0.05) as highest priorities. NSS preferred “lifestyle (work-life balance) as an attending” (p < 0.001). Only 7% of all respondents believed vascular surgeons have a good work-life balance, with a larger percentage of SS (p < 0.001) agreeing. Stratified by gender, female students rated “limited ability of childbirth during residency and/or postponement of family plans” (p < 0.05), “gender-related concerns, such as discrimination at work or unfair career possibilities” (p < 0.001), and “fear of unfair competition” (p < 0.05) as potential negative aspects of VS careers. 55% of respondents believed the IVSR makes VS more appealing.

CONCLUSIONS: Medical students perceive poor quality of life and work-life balance as deterring factors to a career in VS. Opportunities exist to educate students on the pathologies treated, procedures performed, and attainable quality of life available in our field. We should also continue to develop recruitment strategies to stimulate student interest and increase early exposure in VS.

PMID:37495096 | DOI:10.1016/j.avsg.2023.07.099

Chemosphere. 2023 Jul 24:139613. doi: 10.1016/j.chemosphere.2023.139613. Online ahead of print.

ABSTRACT

The assessment of the nutritional status of plants is traditionally performed by wet-digestion methods using oven-dried and ground samples. This process requires sampling, takes time, and it is non-environmentally friendly. Agricultural and environmental science have been greatly benefited by in-field, ecofriendly methods, and real-time element measurements. This work employed the portable X-ray fluorescence spectrometry (pXRF) to analyze intact and fresh leaves of crops aiming to assess the effect of water content and leaf surface (adaxial and abaxial) on pXRF results. Also, pXRF data were used to predict the real concentration of macro- and micronutrients. Eight crops (bean, castor plant, coffee, eucalyptus, guava tree, maize, mango, and soybean) with contrasting water contents were used. Intact leaf fragments (∼2 × 2 cm), fresh or oven-dried (60 °C) were obtained to be analyzed via pXRF on both adaxial and abaxial surface. Conventional wet-digestion method was also performed on powdered material to obtain the concentration of macro- and micronutrients via ICP-OES. The data were subjected to descriptive statistics, principal component analysis (PCA) and random forest (RF) algorithm regression. RF was used to predict the real concentration of macro- and micronutrients based on pXRF measurements obtained directly on intact leaves. Water content had a significant effect on pXRF results. However, a positive correlation between the concentration of macro- and micronutrients obtained via pXRF directly on intact leaves and conventional analysis performed on powdered samples was obtained. PCA analysis allowed a clear differentiation of crops based on elemental composition. The concentrations of macro- and micronutrients were very accurately predicted via RF. Even elements not detected by pXRF (N and B) were satisfactory predicted. From this pilot study, it is possible to concluded that pXRF is feasible for in-field assessment of nutritional status of plants. Further studies are needed to obtain specific and robust calibrations for each crop.

PMID:37495047 | DOI:10.1016/j.chemosphere.2023.139613

Am J Ophthalmol. 2023 Jul 24:S0002-9394(23)00285-4. doi: 10.1016/j.ajo.2023.07.005. Online ahead of print.

ABSTRACT

PURPOSE: Examine the relationship between diabetic retinopathy (DR) and depression in the United States.

DESIGN: Retrospective cross-sectional study.

METHODS: National Health and Nutrition Examination Survey (NHANES) participants between 2005-2008 (ages 40-85) were included. Prevalence of major depression among DR stages as determined by retinal imaging was estimated. Multivariable models assessed associations between depression and DR.

RESULTS: Depression was more common among those with moderate to severe DR (16%) than those with no DR (7%), mild non-proliferative diabetic retinopathy (NPDR, 6%), or proliferative DR (5%). In a model with DR stages that adjusted for demographic factors, there was an association between moderate to severe DR and depression (OR 2.46, 95% CI: 1.03-5.85).

CONCLUSION: Depression was more prevalent in moderate to severe NPDR than in those with no DR, mild NPDR, or proliferative DR. This relationship is statistically significant after adjustment for demographic factors.

PMID:37495007 | DOI:10.1016/j.ajo.2023.07.005

Appl Clin Inform. 2023 May;14(3):575-584. doi: 10.1055/s-0043-1769912. Epub 2023 Jul 26.

ABSTRACT

BACKGROUND: In Taiwan, the number of confirmed cases of coronavirus disease 2019 (COVID-19) has risen significantly in May 2021. The second wave of the epidemic occurred in May 2022. mHealth (mobile health, social media communities) and eHealth (electronic health, Hospital Information System) can play an important role in this pandemic by minimizing the spread of the virus, leveraging health care providers’ time, and alleviating the challenges of medical education.

OBJECTIVES: This study aimed to describe the process of using mHealth and eHealth to build a medicalized quarantine hotel (MQH) and understand the physical and mental impact of COVID-19 on patients admitted to the MQH.

METHODS: In this retrospective observational study, data from 357 patients who stayed at the MQH were collected and their psychological symptoms were assessed using an online Brief Symptom Rating Scale (BSRS). Descriptive statistics, independent sample t-test, univariate analysis of variance, and multiple linear regression analysis were performed.

RESULTS: The patients’ mean age was 35.5 ± 17.6 years, and 52.1% (n = 186) of them were males. Altogether, 25.2% (n = 90) of the patients had virtual visits. The average duration of the hotel stay was 6.8 ± 1.4 days, and five patients (0.01%) were transferred to the hospital. The three most common symptoms reported were cough (39%), followed by the sore throat (22.8%), and stuffy/runny nose (18.9%). Most patients achieved a total BSRS score of 0 to 5 points (3,569/91.0%), with trouble falling asleep (0.65 ± 0.65), feeling tense or high-strung (0.31 ± 0.66), and feeling down or depressed (0.27 ± 0.62) scoring highest. The BSRS score was the highest on the first day. The sex of the patients was significantly related to the BSRS score (p < 0.001).

CONCLUSION: mHealth and eHealth can be used to further monitor an individual’s physiological and psychological states. Early intervention measures are needed to improve health care quality.

PMID:37494971 | DOI:10.1055/s-0043-1769912

Water Res. 2023 Jul 16;243:120372. doi: 10.1016/j.watres.2023.120372. Online ahead of print.

ABSTRACT

Wastewater surveillance has proved to be a valuable tool to track the COVID-19 pandemic. However, most studies using wastewater surveillance data revolve around establishing correlations and lead time relative to reported case data. In this perspective, we advocate for the integration of wastewater surveillance data with dynamic within-host and between-host models to better understand, monitor, and predict viral disease outbreaks. Dynamic models overcome emblematic difficulties of using wastewater surveillance data such as establishing the temporal viral shedding profile. Complementarily, wastewater surveillance data bypasses the issues of time lag and underreporting in clinical case report data, thus enhancing the utility and applicability of dynamic models. The integration of wastewater surveillance data with dynamic models can enhance real-time tracking and prevalence estimation, forecast viral transmission and intervention effectiveness, and most importantly, provide a mechanistic understanding of infectious disease dynamics and the driving factors. Dynamic modeling of wastewater surveillance data will advance the development of a predictive and responsive monitoring system to improve pandemic preparedness and population health.

PMID:37494742 | DOI:10.1016/j.watres.2023.120372

J Perinat Neonatal Nurs. 2023 Jul-Sep 01;37(3):252-260. doi: 10.1097/JPN.0000000000000697.

ABSTRACT

BACKGROUND: In light of the complex advances in neonatal intensive care units (NICU), it is essential that healthcare providers (HCPs) are equipped with the appropriate skills to effectively communicate between disciplines to provide safe, quality care. However, many HCPs acknowledge that they are not confident in their ability to communicate effectively with peers.

PURPOSE AND DESIGN: This study aimed to identify perceived barriers and facilitators of communication among HCPs in a NICU setting. This study took place in a 60-bed NICU that utilized multiple disciplines of HCPs. Using a qualitative, cross-sectional design, 2 surveys were administered, namely, a demographic survey with open-ended questions and the Safety Attitudes Questionnaire (SAQ).

RESULTS: Findings indicated inverse relationships in age/experience and perceptions of management. Total SAQ scores ranged from 45 to 77 (N = 28, M = 62.47, SD = 9.40). The SAQ highlight that total scores above 75 correspond with positive perceptions of safety in the NICU.

CONCLUSION: The statistical evidence derived from this study contributes to the evaluation of HCP-perceived communication barriers and facilitators. The identification of perceived barriers and facilitators of communication in an ICU setting may serve as a distinct, evidence-based foundation to develop interventions that emphasize the value of communication.

PMID:37494694 | DOI:10.1097/JPN.0000000000000697

Neuropsychopharmacol Hung. 2023 Jun 1;25(2):82-91.

ABSTRACT

The beneficial effects of yoga have been researched for decades, and in many countries it is also used in health care to maintain physical and mental health. Its effectiveness in the treatment of stress and anxiety, as well as in achieving a relaxed state, is supported by numerous studies. In the present research, our aim was to investigate the direct and subclinical effects of yoga on participants practicing it at least 10 minutes a day for two weeks. 25 average population, healthy participants were included between the ages of 18 and 30. We used the Smith Relaxation States Inventory (SRSI3) and its disposition-measuring version (SRSI3d), which examine 19 relaxation states (R-states) presumably related to relaxation, divided into 4 categories: basic relaxation, mindfulness, positive energy and transcendence. During the statistical analyses, the test values measured at the beginning of the research, before the first practice, were compared with the values taken directly after the last practice using the Wilcoxon test. Bonferroni correction was used to correct the fi rst-order error that increases when testing several hypotheses simultaneously. Immediately after practicing yoga, the participants were significantly more relaxed (M0=2.74, M1=4.24, p<0.0001), experienced more awareness (M0=2.71, M1=2.89, p<0.0001) and positive energy (M0=3.88, M1=4.81, p<0.0001) and also in the long term they experienced significantly more relaxation (M0=3.12, M1=3.94, p<0.0001), awareness (M0=3.41, M1=4.40, p<.0001), positive energy (M0=4.39, M1=5.14, p<0.001) and transcendence (M0=3.23, M1=4.05, p=0.001). Based on our results, yoga can be an effective additional tool in maintaining and improving health, but also in improving the condition and quality of life of mental and somatic patients.

PMID:37494675

Diabetes. 2023 Jul 26:db220852. doi: 10.2337/db22-0852. Online ahead of print.

ABSTRACT

Immunomodulation combined with antigen therapy holds great promise to arrest autoimmune type 1 diabetes, but clinical translation is hampered by a lack of prognostic biomarkers. Lowdose anti-CD3 plus Lactococcus lactis (L. lactis) bacteria secreting proinsulin and IL-10 reversed new-onset disease in non-obese diabetic (NOD) mice, yet some mice were resistant to the therapy. Using microRNA (miRNA) profiling, six miRNAs (i.e., miR-34a-5p, miR-125a- 3p, miR-193b-3p, miR-328, miR-365-3p, and miR-671-3p) were identified as differentially expressed in plasma of responder versus non-responder mice before study entry. After validation and stratification in an independent cohort, plasma miR-193b-3p and miR-365-3p combined with age and glycemic status at study entry had the best power to predict with high sensitivity and specificity poor response to the therapy. These miRNAs were highly abundant in pancreas infiltrating neutrophils and basophils with a pro-inflammatory and activated phenotype. Here, a set of miRNAs and disease-associated parameters are presented as predictive signature for the L. lactis-based immunotherapy outcome in new-onset type 1 diabetes, hence allowing targeted recruitment of future trial participants and accelerated trial execution.

PMID:37494666 | DOI:10.2337/db22-0852

WMJ. 2023 Jul;122(3):164-170.

ABSTRACT

INTRODUCTION: Availability of inpatient pediatric services declined across the United States from 2008 through 2018, with rural areas experiencing steepest declines. Despite the movement of pediatric care to children’s centers, most children are still cared for in community hospitals nationally. Assessing the availability and providers of inpatient pediatric care in Wisconsin is an important step in ensuring the health care needs of children in the state continue to be met.

METHODS: A cross-sectional survey was distributed to Wisconsin hospitals to determine pediatric services and physician workforce. The response rate was 130/138 (94%), including 56/58 (97%) critical access hospitals. Results of specific inpatient pediatric subdivisions were analyzed by descriptive statistics.

RESULTS: Hospitals that provide inpatient newborn care are mostly staffed by pediatricians and family physicians, while critical access hospitals are staffed by family physicians. Hospitals with neonatal intensive care units are staffed by neonatologists, with telemedicine utilized in critical access hospitals. Hospitals with general pediatric admissions are staffed by pediatricians or family physicians, while critical access hospitals are staffed by family physicians. Hospitals with pediatric intensive care units are staffed by pediatric intensivists.

CONCLUSIONS: Despite workforce disparities and shortages, hospitals across Wisconsin, including many critical access hospitals, continue to provide inpatient pediatric services. Family physicians play a major role in the pediatric health care delivery in Wisconsin hospitals. Robust inpatient pediatric training of family physicians may enable rural health authorities to continue addressing the gaps that persist in inpatient pediatric care accessibility.

PMID:37494645