Category: Nevin Manimala

J Plast Reconstr Aesthet Surg. 2023 Apr 18;83:172-179. doi: 10.1016/j.bjps.2023.04.039. Online ahead of print.

ABSTRACT

BACKGROUND: Postoperative bleeding requiring reoperation is an untoward event in breast surgery. Topical tranexamic acid (TXA) has been routinely used to reduce the risk of postoperative bleeding in some surgical fields. In breast surgery, it is not routinely used owing to scarce information. We investigated whether the intraoperatively applied topical TXA reduces the incidence of postoperative hematoma in reduction mammaplasty surgeries.

METHODS: This retrospective, single-center cohort study comprises of 415 consecutive patients who underwent reduction mammaplasty between 2019 and 2021. The prophylactic use of topically applied TXA (20 mg/ml) was implemented as a part of the hospital protocol in November 2020. The patients who were rinsed with TXA before the wound closure were compared with those who were not rinsed. The results were analyzed using statistical tests, two-sided Pearson’s Chi-Square and Fisher’s exact tests.

RESULTS: Topical TXA significantly reduced the number of postoperative hematomas requiring evacuation (p = 0.008). In the non-TXA control group, 12 (5.8%) hematomas were observed out of 208 patients. In the topical TXA group, only one (0.6%) hematoma occurred among the 168 patients. A tendency towards fewer wound infections, seromas, and other minor wound-healing problems can also be seen in the topical TXA group (ns). No adverse events of topical TXA were detected.

CONCLUSIONS: The incidence of postoperative hematomas decreased to a tenth after the introduction of topical TXA in reduction mammaplasty surgeries. This simple procedure may save patients from reoperations owing to bleeding. Randomized controlled trials are warranted.

PMID:37276736 | DOI:10.1016/j.bjps.2023.04.039

J Plast Reconstr Aesthet Surg. 2023 Apr 19;83:155-164. doi: 10.1016/j.bjps.2023.04.050. Online ahead of print.

ABSTRACT

BACKGROUND: The field of facial vascularized composite allotransplantation (fVCA) is still new and a limited number of patients have undergone the procedure. This has led to a lack of understanding about the impact of fVCA rejection on standard laboratory markers (e.g., CBC, BMP, CRP) for the acute management of these patients. It is not clear if rejection elicits a systemic inflammatory response that influences common inflammatory markers such as WBC and CRP. A comprehensive understanding of changes in these markers could help in the management of fVCA patients in the acute setting.

METHODS: The medical records of 8 fVCA patients with a total of 9 transplants were reviewed retrospectively, and data on standard laboratory values (CBC, BMP, LFTs, CRP) and vital signs were extracted. To examine the relationship between laboratory values and rejection status, linear mixed models were used to analyze the data, taking into account their longitudinal nature (repeated measures).

RESULTS: A statistically significant relationship was found between the Banff grade of rejection and the relative number of basophils in the patient’s blood during rejection (p = 0.005). In addition, in patients with clinical signs of rejection (e.g., facial erythema, edema) and skin biopsy showing Banff ≥ II, CRP was found to be significantly elevated (p = 0.03). The WBC count remained stable during rejection, and the relative number of neutrophils was lower at the time of rejection, indicating possible consumption at the site of rejection.

CONCLUSION: During fVCA rejection, most standard laboratory parameters and vital signs appear to be stable. However, the levels of CRP and basophils were elevated during rejection, while the neutrophil count was lower. Leukocytosis can likely be used as a marker of microbial infection in fVCA patients, as WBC does not seem to increase at the time of allograft rejection.

PMID:37276734 | DOI:10.1016/j.bjps.2023.04.050

J Plast Reconstr Aesthet Surg. 2023 Apr 17;83:109-116. doi: 10.1016/j.bjps.2023.04.005. Online ahead of print.

ABSTRACT

BACKGROUND: The expanded forehead flap has its unique advantage in nasal reconstruction. The authors present their 12-year experience with nasal reconstruction with an expanded forehead flap. The esthetic and functional outcomes were assessed with long-term subjective and objective evaluations.

METHODS: A retrospective analysis was conducted of consecutive patients who underwent nasal reconstruction with the expanded forehead flap from 2009 to 2021 performed by the senior author (F.F.). Data were collected and analyzed regarding defect characteristics, processes of treatment, and complications. Subjective esthetic and functional outcomes were assessed through questionnaires FACE-Q (Face Questionnaire) and NOSE (Nasal Obstruction Symptom Evaluation). The objective esthetic outcome was assessed by a senior resident through the viewing of clinical photographs.

RESULTS: One hundred and fifty-five patients underwent nasal reconstruction with an expanded forehead flap. The average expansion period was 174 days, and the injection volume was 685.7 ml. There were 15 complications. One hundred and eight patients (69.6%) were satisfied, and 19 patients (12.2%) were very satisfied with the outcome. The differences between postoperative and preoperative scores of FACE-Q were statistically significant (p < 0.01). Sixty-nine percent of patients complained of bilateral eyebrow asymmetry, 27.1% of patients reported partial recovery of frontal deformity with dissatisfaction, and 2.6% of patients considered not recovered at all. The results of 78 patients (50.3%) were considered “satisfied,” and 41 patients (26.5%) were considered “very satisfied” by objective evaluation.

CONCLUSION: Nasal reconstruction with an expanded forehead flap was a safe technique with good esthetic outcomes. Although problems with the asymmetry of the eyebrows and frontal deformation were presented, the influence was minimal and well-accepted by most patients.

PMID:37276728 | DOI:10.1016/j.bjps.2023.04.005

Thromb Res. 2023 May 13;228:54-60. doi: 10.1016/j.thromres.2023.05.008. Online ahead of print.

ABSTRACT

BACKGROUND: Even though antithrombotic therapy has probably little or even negative effects on the well-being of people with cancer during their last year of life, deprescribing antithrombotic therapy at the end of life is rare in practice. It is often continued until death, possibly resulting in excess bleeding, an increased disease burden and higher healthcare costs.

METHODS: The SERENITY consortium comprises researchers and clinicians from eight European countries with specialties in different clinical fields, epidemiology and psychology. SERENITY will use a comprehensive approach combining a realist review, flash mob research, epidemiological studies, and qualitative interviews. The results of these studies will be used in a Delphi process to reach a consensus on the optimal design of the shared decision support tool. Next, the shared decision support tool will be tested in a randomised controlled trial. A targeted implementation and dissemination plan will be developed to enable the use of the SERENITY tool across Europe, as well as its incorporation in clinical guidelines and policies. The entire project is funded by Horizon Europe.

RESULTS: SERENITY will develop an information-driven shared decision support tool that will facilitate treatment decisions regarding the appropriate use of antithrombotic therapy in people with cancer at the end of life.

CONCLUSIONS: We aim to develop an intervention that guides the appropriate use of antithrombotic therapy, prevents bleeding complications, and saves healthcare costs. Hopefully, usage of the tool leads to enhanced empowerment and improved quality of life and treatment satisfaction of people with advanced cancer and their care givers.

PMID:37276718 | DOI:10.1016/j.thromres.2023.05.008

J Infect Public Health. 2023 May 30;16(8):1220-1229. doi: 10.1016/j.jiph.2023.05.032. Online ahead of print.

ABSTRACT

BACKGROUND: Institutions must have access to antibiograms to monitor changes in antimicrobial resistance and direct empirical antibiotic therapy. The first facility-specific cumulative antibiogram was launched in the ICU in 2019. Consequently, many antibiogram-operation-related actions have been adopted in the institution based on reported data. This study aimed to analyze the cumulative antibiogram reports for multiple intensive care units (ICUs) for 2020, and compare the antimicrobial susceptibility testing (AST) patterns between the 2019 and 2020 years in an academic medical center.

METHODS: This cross-sectional study was performed of routine bacterial culture and AST data extracted from a laboratory information system in a 2252-bed capacity hospital. Only the first diagnostic isolate of a given species per patient per year was included in the study. Interpretation and reporting were done in accordance with the applicable Clinical and Laboratory Standards Institute and European Committee on Antimicrobial Susceptibility Testing guidelines.

RESULTS: Of the 46,791 clinical isolates, the Gram-negative bacilli isolation rate witnessed a significant increase: 35,670 isolates in 2020 versus. 33,652 isolates in 2019. Klebsiella pneumoniae showed a statistically significant increase, mainly in pediatric, emergency, and cardiothoracic ICUs (p < 0.001). Neonatal and pediatric ICUs showed statistically significant increases in Pseudomonas aeruginosa and Proteus mirabilis isolates (p < 0.001). A statistically significant decrease was noted in the prevalence of Acinetobacter, Escherichia coli, Burkholderia cepacia, and Enterobacter cloacae. The sensitivities of K. pneumoniae and E. coli to imipenem and tigecycline significantly improved (p < 0.001). The sensitivity to colistin was significantly decreased (p < 0.001). The sensitivity of P. aeruginosa isolates to colistin and carbapenems was improved (p < 0.001). We reported a statistically significant decrease in all Gram-positive cocci (11,121 in 2020 versus. 11,528 in 2019). Staphylococcus aureus showed a statistically significant increase (p < 0.001), particularly in the medical ICU.

CONCLUSION: The high susceptibility rates of Enterobacteriaceae toward colistin and tigecycline, should be cautiously considered in empiric therapy while looking for alternatives. The majority of isolates of Gram-positive cocci were coagulase negative staphylococci (CONS), we still need to confirm whether they are true pathogens or commensals before considering anti-staphylococcal agents in the empirical therapy. We underscored some corrective actions that might have improved the susceptibility rates, such as antibiotic cycling.

PMID:37276716 | DOI:10.1016/j.jiph.2023.05.032

Mar Pollut Bull. 2023 Jun 3;192:115103. doi: 10.1016/j.marpolbul.2023.115103. Online ahead of print.

ABSTRACT

Elemental composition, multivariate statistical analyses with the absolute principal component score-multiple linear regression (APCS-MLR) model, and different pollution indices in Upper and Lower Southwestern Ganges-Brahmaputra-Meghna (GBM) delta sediments were studied to characterize pollution, ecological risk and quantify potential toxic element sources of the area. Toxic metals concentrations were higher in Lower Delta and individual pollution indices showed Upper Delta was moderately polluted by arsenic, chromium, cobalt, copper and lead, and Lower Delta was moderately-strongly polluted by the same metals. Synergistic indices include Potential Ecological, Toxic, Nemerow, and Pollution Risk indices in Upper and Lower Delta sediment ranged from 47.17-128.07, 2.03-12.19, 29.92-65.42, 0.28-1.62, and 69.17-246.90, 8.00-13.47, 20.53-152.92, 1.18-1.58, indicated low and moderate risk pollution, respectively. Statistical models represent the metals dominantly originated from nature for Upper Delta, and both natural and anthropogenic activities contributed to Lower Delta sediment. The study found that the modern deposit in Lower Delta became more contaminated and thus enhanced ecological risk.

PMID:37276710 | DOI:10.1016/j.marpolbul.2023.115103

Hear Res. 2023 Jun 1;435:108820. doi: 10.1016/j.heares.2023.108820. Online ahead of print.

ABSTRACT

Optical coherence tomography has become the most popular approach to experimental measures of sound-induced vibrations within the mammalian cochlea. Because it is relatively easy to use and works in the unopened cochlea, the measurement of vibratory tuning curves has become highly reliable, and averaging data from multiple animals in different experimental cohorts is now possible. Here I tested a modern statistical approach to compare cohorts for differences in the magnitude and phase of vibration. A linear mixed-effect approach with first, second, third, and fourth-order models to fit the data was tested. The third-order model best fit both the magnitude and phase data without having terms that did not contribute substantively to improving the R² or the p-value for the independent variables. It identified a difference between cohorts of mice that were different and no difference between cohorts that should not be different. Thus, this approach provides a way to simply compare a full set of tuning curves between cohorts. While further analyses by the investigator will always be needed to study specific details related to the study hypothesis, this statistical technique provides a simple way for the cochlear physiologist to perform an initial assessment of whether the cohorts are same or different.

PMID:37276685 | DOI:10.1016/j.heares.2023.108820

J Biomech. 2023 May 26;155:111658. doi: 10.1016/j.jbiomech.2023.111658. Online ahead of print.

ABSTRACT

People with unilateral transfemoral amputation using socket prostheses are at increased risk for developing osteoarthritis in both the residual hip and intact lower-limb joints. Osseointegrated prostheses are a surgical alternative to socket prostheses that directly attach to the residual femur via a bone-anchored implant, however their multi-joint loading effect is largely unknown. Our objective was to establish how osseointegrated prostheses influence joint loading during walking. Motion capture data (kinematics, ground reaction forces) were collected from 12 participants at baseline, with socket prostheses, and 12-months after prosthesis osseointegration during overground walking at self-selected speeds. Subject-specific musculoskeletal models were developed at each timepoint relative to osseointegration. Internal joint moments were calculated using inverse dynamics, muscle and joint reaction forces (JRFs) were estimated with static optimization. Changes in internal joint moments, JRFs, and joint loading-symmetry were compared using statistical parametric mapping (p≤ 0.05) before and after osseointegration. Amputated limb hip flexion moments and anterior JRFs decreased during terminal stance (p = 0.002, <0.001; respectively), while amputated limb hip abduction moments increased during mid-stance (p < 0.001), amputated hip rotation moment changed from internal to external throughout early stance (p < 0.001). Intact limb hip extension and knee flexion moments (p = 0.028, 0.032; respectively), superior and resultant knee JRFs (p = 0.046, 0.049; respectively) decreased during the loading response following prosthesis osseointegration. These results may indicate that the direct loading transmission of these novel prostheses create a more typical mechanical environment in bilateral joints, which is comparable with loading observed in able-bodied individuals and could decrease the risk of development or progression of osteoarthritis.

PMID:37276681 | DOI:10.1016/j.jbiomech.2023.111658

Food Chem. 2023 May 30;425:136489. doi: 10.1016/j.foodchem.2023.136489. Online ahead of print.

ABSTRACT

Melons (Cucumis melo L.) are highly popular due to its delicate and delightful flavor in the worldwide. However, the flavor of the melon juice was easily affected by thermal treatments and unpleasant cooking smell during production process. Sugarcane (Saccharum officinarum) juice is a proven nutritious beverage with high levels of antioxidants, polyphenols, and other beneficial nutrients. Due to its low sugar content, combined with sugarcane, muskmelon-sugarcane blend juice gives an appealing and exotic drink. The research was planned to evaluate the effect of thermo-sonication (20 kHz, 70% amplitude, 5, 10 and 15 min) and microwave (90 °C, 400 W, 120 sec) on physicochemical parameters including pH, titratable acidity, total soluble solids (TSS), total phenolic contents (TPC), total flavonoid contents (TFC) and antioxidant capacity of muskmelon and sugarcane juice blend, during storage of 90 days at refrigeration (4±1 °C). The statistical results showed that synergism of sonication and microwave treatments had a significant (p ≤ 0.05) influence on pH, TSS, titratable acidity, TPC, TFC and antioxidant capacity. T₃ (15 min of sonication and 120 s of microwave) showed the maximum TSS (12.00±0.40 °B), pH (5.07±0.02), TPC (484.33±10.41 mg GAE/100 mL), TFC (261.73±11.32 mg CE/100 mL), and antioxidant activity (381.62±17.72 µg AAE/100 mL), as compared to untreated samples. Thermosonication for 15 min caused maximum retention of TPC, TFC and antioxidant capacity of blend juice during 90 days of storage, whereas in untreated samples these parameters were found highly decreased during storage. Thus, sonication and microwave can be recommended as an alternative to both conventional pasteurization processes and chemical preservatives.

PMID:37276674 | DOI:10.1016/j.foodchem.2023.136489

Chaos. 2023 Jun 1;33(6):063121. doi: 10.1063/5.0138150.

ABSTRACT

The May-Leonard model was introduced to examine the behavior of three competing populations where rich dynamics, such as limit cycles and nonperiodic cyclic solutions, arise. In this work, we perturb the system by adding the capability of global mutations, allowing one species to evolve to the other two in a linear manner. We find that for small mutation rates, the perturbed system not only retains some of the dynamics seen in the classical model, such as the three-species equal-population equilibrium bifurcating to a limit cycle, but also exhibits new behavior. For instance, we capture curves of fold bifurcations where pairs of equilibria emerge and then coalesce. As a result, we uncover parameter regimes with new types of stable fixed points that are distinct from the single- and dual-population equilibria characteristic of the original model. On the contrary, the linearly perturbed system fails to maintain heteroclinic connections that exist in the original system. In short, a linear perturbation proves to be significant enough to substantially influence the dynamics, even with small mutation rates.

PMID:37276577 | DOI:10.1063/5.0138150