Category: Nevin Manimala

Clin Neurol Neurosurg. 2023 Jan 20;226:107609. doi: 10.1016/j.clineuro.2023.107609. Online ahead of print.

ABSTRACT

OBJECTIVE: This study compared the impact of the combination therapy of onabotulinum toxin A and greater occipital nerve block (GoNT-A) with onabotulinum toxin A monotherapy (BoNT-A) based on its efficacy and safety in relation to the quality of life of adult chronic migraine (CM) patients.

BACKGROUND: Prophylactic treatment of CM is still difficult and complex. Combination treatments do not have an evidence base yet.

METHODS: This retrospective study included 85 patients. For greater occipital nerve block (GONB), 4 ml of the solution prepared using 1 ml of 0.5% bupivacaine and 3 ml of saline on both sides were bilaterally applied to 30 patients. For BoNT-A treatment, a total of 155 units of onabotulinum toxin A (BOTOX®) was intramuscularly injected into 31 specific points around the head and neck in 27 patients. Both protocols were similarly applied to 28 patients for GoNT-A treatment. MIDAS and HIT-6 scores were evaluated to measure patients’ quality of life three months after the treatment.

RESULTS: When MIDAS and HIT-6 score groups were statistically compared, both GONB and GoNT-A applications showed a statistically significant reduction compared to the BoNT-A application (p < 0.05). The decrease in the MIDAS and HIT-6 scores of GONB and GoNT-A applications did not show a statistical difference (p > 0.05).

CONCLUSION: The combination of BoNT-A and GONB was superior to BoNT-A applied as monotherapy. Alternately, no significant difference was found between GONB therapy and combination therapy in all data. Combination treatments were well tolerated.

PMID:36731164 | DOI:10.1016/j.clineuro.2023.107609

Top Cogn Sci. 2023 Feb 2. doi: 10.1111/tops.12640. Online ahead of print.

ABSTRACT

This article discusses the possibility of practitioners who mistake organic memory loss for dissociative amnesia. It starts with the case of a young man with complete retrograde amnesia due to a traumatic head injury. Because he did not show any gross neurological abnormalities, a neurologist thought his amnesia had a psychological origin. An extensive neuropsychological examination revealed that the man did have an organic reason for his amnesia. Next, the existence of dissociative memory loss as well as isolated organic retrograde amnesia is considered. While cases of organic memory loss are well-documented, there is hardly any evidence for dissociative amnesia. It is argued that organic memory loss might be mistakenly taken for dissociative amnesia. In line with the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, practitioners are advised to rule out the possibility of organic memory loss, before diagnosing a patient with dissociative amnesia.

PMID:36731123 | DOI:10.1111/tops.12640

J Craniofac Surg. 2022 Aug 10. doi: 10.1097/SCS.0000000000008810. Online ahead of print.

ABSTRACT

The authors attempt to approach hemifacial microsomia with macroscopic techniques and look for a link between clinical manifestations with pathogenesis. In this study, for the first time mandibular medullary cavities as essential parts of the mandible were intravitally measured based on the 3-dimensional models. A total of 153 patients were included. The 3-dimensional models of patients’ mandibles were reconstructed and medullary cavity volumes (mm3) were measured. The ratio of medullary cavity volume to mandible volume was calculated to determine the proportion of the marrow in the bone. Statistical significance was found in mandible volumes (P<0.001) and medullary cavity volumes (P<0.001) on different sides. Medullary cavity volumes were significantly related to mandible volumes on both sides (both P<0.001). Medullary cavity volumes on the nonaffected and affected side were both in correlation with age but in different degrees (r=0.214, P=0.008 versus r=0.170, P=0.036). The ratios of medullary cavity volume and the mandible were significantly different (P<0.001) on 2 sides. The volume ratio on the nonaffected side correlated to age while this correlation did not exist on the affected side (r=0.195, P=0.016 versus r=0.129, P=0.112). A smaller medullary cavity found on the affected side could lead to a reduced amount of bone marrow cells and consequently reduced osteogenic and hematopoietic potential. This could result in abnormal bone formation on the affected side of mandible. Proportions of marrow in bone on the affected side irrelevant to patients’ ages signify a poorer potential of expansion. This may explain a higher reluctancy of growth in affected mandibular sides.

PMID:36731104 | DOI:10.1097/SCS.0000000000008810

Cornea. 2022 Sep 29. doi: 10.1097/ICO.0000000000003112. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study was to evaluate characteristics and outcomes of pediatric phlyctenulosis at a tertiary care center in the United States.

METHODS: A retrospective cohort study of phlyctenulosis diagnosis in patients younger than 18 years was conducted. Demographics, presenting features, treatment regimens, and outcomes were analyzed.

RESULTS: Seventy patients (95 eyes) with phlyctenulosis were identified. Fifty-four patients (77.1%) were Hispanic, which was greater than the center’s proportion of pediatric patients identifying as Hispanic (53.8%, P < 0.0001). Common comorbidities included adjacent external/lid disease (82.9%), allergic/atopic disease (18.6%), and viral infections (8.6%). Nine patients had tuberculosis testing which was negative in all cases. Five patients had vitamin A testing which revealed deficiency in 1 patient. Treatment regimens were diverse and included varying combinations of topical and systemic medications. Complications included corneal scarring (27.4%), corneal neovascularization (40.0%), amblyopia (16.8%), corneal perforation (3.2%), and severe limbal stem-cell deficiency (1.1%). 26.3% of affected eyes had final visual acuity worse than 20/40. Differences in rates of corneal complications between Hispanic and non-Hispanic patients were not statistically significant, although severe corneal complications including perforation occurred only in the Hispanic group.

CONCLUSIONS: This study presents a modern cohort of phlyctenulosis at a tertiary center in the United States and includes a larger proportion of Hispanic patients than expected. Phlyctenulosis carries high corneal morbidity and may frequently result in reduced visual acuity. Similar rates of corneal complications were seen in Hispanic versus non-Hispanic patients, but severe corneal complications were seen only in the Hispanic group.

PMID:36731094 | DOI:10.1097/ICO.0000000000003112

J Craniofac Surg. 2022 Sep 6. doi: 10.1097/SCS.0000000000008990. Online ahead of print.

ABSTRACT

AIM: The aim of this study is to examine the effects of the burr used for hump reduction and osteoplasty on cochlear function.

MATERIALS AND METHODS: The design of this study was prospective, randomized, and controlled. Twenty patients who underwent burr-assisted septorhinoplasty were included in the study group. The control group consisted of 20 patients who underwent septoplasty. Pure tone audiometry, distortion product otoacoustic emission test, and tympanometry were performed to determine the auditory functions.

RESULTS: No significant difference was observed between the bone conduction thresholds of the right and left ears in both groups, except for a single frequency (1000 Hz in the left ear) in the control group. There was no significant difference between the 2 groups’ air conduction thresholds at frequencies of 500, 1000, 2000, 4000, 6000, and 8000 Hz preoperatively and postoperatively. In addition, the study and control group did not differ significantly in signal-to-noise ratio measurements at frequencies of 500, 1000, 2000, and 4000 Hz. The comparison of preoperative and postoperative otoacoustic emission measurement results of the study group revealed a statistically significant difference only at the frequencies of 2000 Hz in the right ear and 500 Hz in the left ear. Despite those differences, otoacoustic emissions were still present at those frequencies postoperatively.

CONCLUSIONS: Our study showed that using burrs during rhinoplasty slightly impacts hearing, but it does not cause significant hearing loss. Burr-assisted rhinoplasty appears to be a safe operation regarding the auditory functions.

PMID:36731089 | DOI:10.1097/SCS.0000000000008990

Acad Med. 2022 Sep 20. doi: 10.1097/ACM.0000000000004987. Online ahead of print.

ABSTRACT

PURPOSE: To develop and validate the Residency Community Well-Being (RCWB) instrument, a novel instrument to measure the subjective community well-being of an individual residency program, and to explore differences in RCWB scores between demographic groups.

METHOD: An initial questionnaire to measure a residency program’s community well-being was developed after literature review. Items were pilot tested, and the questionnaire was reviewed by experts in the fields of residency education, survey design, and sociology. The questionnaire was administered electronically between March and July 2021 to U.S. residents in 18 specialties recruited through convenience and snowball sampling using social media, a listserv, and personal emails to residency program leaders. Three previously validated instruments were administered as well to examine criterion validity: the Professional Fulfillment Index, the Brief Inventory of Thriving, and a single-item burnout measure. Data were analyzed with descriptive statistics, and exploratory factor analysis was performed using principal axis factoring with direct oblimin rotation to reduce the items and identify subscales.

RESULTS: Of the 366 participants who opened and started the survey, 219 completed it (completion rate: 59.8%). Most respondents were women (133, 60.7%), 26-30 years old (132, 60.3%), and White (149, 68.0%). Three subscales emerged with 18 items: program leadership, structures, and practices (PLSP); resident interpersonal relationships (RIR); and resident mistreatment (RM). The Cronbach’s alphas were 0.96 for PLSP, 0.92 for RIR, 0.82 for RM, and 0.95 for the overall RCWB. RCWB score positively correlated with professional fulfillment (r = .52, P < .001) and thriving (r = .45, P < .001) and inversely correlated with burnout (r = -.39, P < .001).

CONCLUSIONS: The RCWB instrument demonstrates strong internal consistency and content and criterion validity that shows that a residency program’s subjective community well-being is primarily composed of program leadership quality, supportive interpersonal relationships, and the absence of mistreatment.

PMID:36731081 | DOI:10.1097/ACM.0000000000004987

Cornea. 2022 Sep 17. doi: 10.1097/ICO.0000000000003118. Online ahead of print.

ABSTRACT

PURPOSE: We aimed to compare the rate of 6-month endothelial cell loss (ECL) and 6-month graft survival in eyes that did not require a postoperative rebubble with eyes that did require a postoperative rebubble after Descemet membrane endothelial keratoplasty (DMEK) surgery.

METHODS: A consecutive series of DMEK surgeries performed from September 2013 to March 2020 was retrospectively analyzed. Eyes that did not require a rebubble for graft detachment were compared with eyes with 1 rebubble and eyes with 2 or more rebubbles for 6-month ECL and graft survival. A subanalysis of the rebubble rate for different indications for transplantation was also performed.

RESULTS: One thousand two hundred ninety-eight eyes were included in this study. The 6-month ECL for eyes with no rebubbles, 1 rebubble, and ≥2 rebubbles was 29.3% ± 16.2% (n = 793), 36.4% ± 18.6% (n = 97, P = 0.001), and 50.1% ± 19.6% (n = 28, P < 0.001), respectively. The 6-month graft survival rate for eyes with no rebubbles, 1 rebubble, and ≥2 rebubbles was 99.5%, 97.8% (P = 0.035), and 81.8% (P < 0.001), respectively. When compared to the rebubble rate for DMEK for Fuchs dystrophy (156/1165 eyes = 13.4%), the rebubble rates were statistically higher for DMEK for failed penetrating keratoplasty (28.5%, P = 0.021) and pseudophakic bullous keratopathy (28.0%, P = 0.036).

CONCLUSIONS: Eyes undergoing any rebubble procedure in the postoperative period after DMEK have an increased risk of endothelial cell loss and graft failure at 6 months postoperative. DMEK in eyes for failed penetrating keratoplasty and failed DMEK had the highest rebubble rate, with the former reaching statistical significance.

PMID:36731078 | DOI:10.1097/ICO.0000000000003118

Nurs Educ Perspect. 2022 Aug 31. doi: 10.1097/01.NEP.0000000000001042. Online ahead of print.

ABSTRACT

AIM: This study examined the impact of a therapy dog intervention on baccalaureate nursing student test anxiety.

BACKGROUND: Nursing student test anxiety may hinder academic performance and program outcomes. Considering this negative impact, it is essential to implement anxiety-reducing strategies. Interaction with therapy dogs is linked with test anxiety reduction; however, minimal studies have explored this topic.

METHOD: A pretest/posttest quasi-experimental design was used to examine the impact of a therapy dog intervention on test anxiety. Repeated measures included the State-Trait Anxiety Inventory, heart rate, and cortisol levels. The multisite convenience sample included 91 junior-level prelicensure BSN students.

RESULTS: The intervention had a statistically significant impact on test anxiety reduction, noted by a decrease in State-Trait Anxiety Inventory scores, heart rate, and salivary cortisol levels (p = .00).

CONCLUSION: Therapy dog interactions are an effective strategy to reduce test anxiety. The findings from this study may assist educators to implement future interventions.

PMID:36731074 | DOI:10.1097/01.NEP.0000000000001042

J Nurs Care Qual. 2022 Sep 8. doi: 10.1097/NCQ.0000000000000647. Online ahead of print.

ABSTRACT

BACKGROUND: Inconsistent and nonstandardized patient handoffs can increase the risk of adverse events. Using change theory may promote adoption of effective handoff processes.

LOCAL PROBLEM: A Midwest emergency department (ED) had no standardized practice for shift change handoffs. Previous handoff quality improvement efforts had been unsuccessful.

METHODS: A pre/postintervention pilot project design was used. Nurses’ compliance with the new handoff protocol was evaluated.

INTERVENTIONS: Using Diffusion of Innovation (DOI) theory, an evidence-based shift change protocol was designed and implemented, which included a comprehensive handoff tool specific to the ED.

RESULTS: Four elements in the new shift change process saw statistically significant improvements after implementation, including discussion of the patient’s illness severity (P = .001), synthesis of the patient’s care (P < .001), completing a bedside safety checklist (P < .001), and providing a formal transition-of-care process (P < .001).

CONCLUSIONS: Using DOI theory may improve the adoption of new shift change practices.

PMID:36731061 | DOI:10.1097/NCQ.0000000000000647

Int J Gynecol Pathol. 2022 Oct 10. doi: 10.1097/PGP.0000000000000884. Online ahead of print.

ABSTRACT

In this study, we compared the placental T-cadherin staining intensity of pregnant women with placenta percreta (PP) and asymmetrical fetal growth restriction (FGR) compared with healthy control pregnancies. Placental T-cadherin levels of the placenta of 86 pregnant women in total, 25 with FGR, 30 with healthy pregnant subjects, and 31 with PP, were examined using monoclonal anti-T-cadherin (CDH13) antibody for immunohistochemical examination. In immunohistochemistry, H-scores were used for each group to compare the expression of T-cadherin in extravillous trophoblast (EVT) cells. T-cadherin H-score of EVTs was highest in the FGR group and the lowest in the PP group. The difference in H-score between the FGR group and the control group was not statistically significant (P=0.344). The difference between the PP group and the other 2 groups was significant (P<0.0001). Multivariable linear regression analysis with a stepwise elimination method was performed in order to identify demographic and clinical parameters with significant effects on the T-cadherin H-score of EVTs. The estimation results identified only the disease group as a significant predictor of the H-score of EVTs (R2=0.340, P<0.0001). The highest T-cadherin H-score of EVTs was found in the FGR group and the lowest in the PP group. The low T-cadherin H-score values in the PP group suggest that low T-cadherin EVTs may be associated with increased placental invasion. Likewise, despite the statistical insignificance, a higher T-cadherin H-score of EVTs in FGR compared with controls implies a decreased invasiveness of the placenta in FGR.

PMID:36731049 | DOI:10.1097/PGP.0000000000000884