Category: Nevin Manimala

Medicine (Baltimore). 2023 Jan 20;102(3):e32624. doi: 10.1097/MD.0000000000032624.

ABSTRACT

To analyze the clinical effect of standardized nursing for lymphoma patients and the influencing factors of nosocomial infection, a total of 360 diffuse large B-cell lymphoma patients with disease recurrence or progression after first-line treatment were retrospectively selected from our hospital from January 2021 to July 2022. After standardized nursing, the overall infection rate of lymphoma patients was 2.50% (9/360), which was significantly lower than the overall infection rate of our hospital in 2021 (7.44%, 844/11342) (P < .05). The proportion of 3 kinds of pathogenic bacteria detected were G+ bacteria (33.5%), G- bacteria (53.3%), and fungi (13.2%). The pathogenic bacteria genus with the most G+ bacteria is Enterococcus, the pathogenic bacteria genus with the most G+ bacteria is Enterobacteriaceae, and the pathogenic bacteria with the most fungi is Candida albicans. Female infection rate was significantly higher than male (P < .05). There was no significant difference in nosocomial infection among different marital status/fertility status (P > .05). The nosocomial infection of patients with different hospitalization times was statistically significant (P < .05). The duration of hospitalization in the infected group was significantly higher than that in the non-infected group (P < .05). The clinical effect of standardized nursing for lymphoma patients is significant, and the influencing factors of nosocomial infection include patient gender, hospitalization frequency, and hospitalization duration.

PMID:36701737 | DOI:10.1097/MD.0000000000032624

Medicine (Baltimore). 2023 Jan 20;102(3):e32690. doi: 10.1097/MD.0000000000032690.

ABSTRACT

We built a closed-loop management model for patients with fever in a county-level medical community and explored the role of this model in post-coronavirus disease 2019 (COVID-19) epidemic prevention and control. The subjects included 83,791 patients with fever treated in designated hospitals between February 2020 and April 2021. A pre-hospital, in-hospital, and post-hospital management system for patients with fever in the county-level medical community was established to allow the closed-loop management of these patients. SPSS software (version 13.0) was used to analyze the methods of visiting the hospital, nucleic acid detection in the hospital, and location of the patients after the hospital visit. Chi-square tests were used to compare the methods of visiting and location after hospital visits between patients with and without an epidemiological history. The number of patients with fever in the fever clinic showed a logarithm change (R2 = 0.4710), accompanied by seasonal changes. The number of fever patients with an epidemiological history decreased logarithmically monthly (R2 = 0.8876). Among patients with fever, 99.64% sought medical treatment on their own, with relatively low proportions undergoing home quarantine and requiring centralized quarantine special vehicles. After visiting the fever clinics, 98.56% of patients isolated at home or were monitored, with small proportions of patients requiring hospital admission or centralized isolation. However, the proportions of patients with home and centralized isolation with epidemiology were relatively high, accounting for 20.55% and 27.40% of cases, respectively. Compared to the overall population of patients with fever, the difference was statistically significant (χ2 = 48.881, P = .000). The establishment of a closed-loop management model for patients with fever in a county-level medical community strengthened the management of these patients. No local cases occurred in Beilun District between March 2020 and April 2021. In the post-COVID-19 era, all medical institutions in the county-level medical community strengthened infectious disease pre-examination and triage and promoted the formation of a strategic pattern of initial diagnosis at the grassroots level, 2-way referral, upper and lower linkage, and joint epidemic prevention. This management was more conducive to COVID prevention and control by hierarchical management according to the presence or absence of an epidemiological history.

PMID:36701725 | DOI:10.1097/MD.0000000000032690

Medicine (Baltimore). 2023 Jan 20;102(3):e32360. doi: 10.1097/MD.0000000000032360.

ABSTRACT

BACKGROUND: Psoriasis is a chronic, inflammatory, autoimmune skin disease. The aim of this review is to systematically evaluate the efficacy and safety of integrative medicine (East Asian herbal medicine combined with conventional medicine) used to treat inflammatory skin lesions of psoriasis.

METHODS: A comprehensive literature search will be conducted in 3 English databases (PubMed, Cochrane Library, and Embase), 4 Korean databases (Korean Studies Information Service System, Research Information Service System, Oriental Medicine Advanced Searching Integrated System, and Korea Citation Index), 2 Chinese databases (Chinese National Knowledge Infrastructure Database and Wanfang data), and 1 Japanese database (Citation Information by National Institute of Informatics) for randomized controlled trials from their inception until July 29, 2021. Statistical analysis will be performed using R version 4.1.2 and the R studio program using the default settings of the “meta” and “metafor” packages. The primary outcome will be an improvement in the psoriasis area severity index. All outcomes will be analyzed using a random-effects model to produce more statistically conservative results. If heterogeneity is detected in the study, the cause will be identified through sensitivity, meta-regression, and subgroup analyses. Methodological quality will be assessed independently using the revised tool for the risk of bias in randomized trials, version 2.0. The overall quality of evidence will be evaluated according to the Grading of Recommendations Assessment, Development, and Evaluation pro framework.

RESULTS: This study will review all available trials on the same subject and arrive at a more statistically robust conclusion based on a sufficient sample size of participants and additional analysis using data mining techniques will be performed on intervention prescription information in clinical studies collected according to rigorous criteria.

CONCLUSION: We believe that this study will provide useful knowledge on managing inflammatory skin lesions of psoriasis vulgaris using integrative medicine using East Asian herbal medicine.

PMID:36701719 | DOI:10.1097/MD.0000000000032360

Medicine (Baltimore). 2023 Jan 20;102(3):e32467. doi: 10.1097/MD.0000000000032467.

ABSTRACT

BACKGROUND: Recurrent patellar dislocation (RPD) occurs in people who have their own patellofemoral dysplasia and who have not been properly treated after their first patellar dislocation. For RPD where conservative treatment is ineffective, medial patellofemoral ligament (MPFL) reconstruction is the first choice for surgical treatment, but there are various and controversial ways of MPFL reconstruction and fixation. Initially, more scholars adopted the patellar lateral tunneling (PT) approach to contain and stabilize the graft, but with the newer materials and techniques, some experts adopted the lateral patellar anchor fixation (AF) of the graft, which can avoid the collateral damage caused by the patellar lateral tunneling and can obtain the same definite efficacy. Therefore, a meta-analysis must be performed to provide evidence whether there is a difference between AF and PT reconstruction of the MPFL in the treatment of RPD.

METHODS: We will search, with no time restriction, without any restriction of language and status, the time from the establishment of the database to October 2022, on the following databases: PubMed (MEDLINE), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Chinese National Knowledge Infrastructure (CNKI), Wanfang Data (WF), Chinese Scientific Journals Database (VIP), and Chinese databases SinoMed (CBM) electronic databases. The electronic database search will be supplemented by a manual search of the reference lists of included articles. We will apply the risk-of-bias tool of the Cochrane Collaboration for randomized controlled trials to assess the methodological quality. Risk-of-Bias Assessment Tool for Non-randomized Studies was used to evaluate the quality of comparative studies. Statistical analysis will be conducted using RevMan 5.4 software.

RESULTS: This systematic review and meta-analysis will evaluate the functional outcomes of the two fixation modalities, AF and PT, in reconstructing MPFL for RPD.

CONCLUSION: The findings of this study will provide a basis for clinical judgment of whether there is a difference between the two forms of AF and PT reconstructed MPFL for RPD.

PMID:36701716 | DOI:10.1097/MD.0000000000032467

Medicine (Baltimore). 2023 Jan 20;102(3):e32650. doi: 10.1097/MD.0000000000032650.

ABSTRACT

Coronavirus disease (COVID-19) is closely associated with hyperglycemia and a worse prognosis in patients with a previous diagnosis of type 2 diabetes mellitus. A few studies investigated the effects of diabetes treatment regimens in these patients during hospitalization. Here, we evaluate the impact of insulin and non-insulin therapy on glucose control in patients with type 2 diabetes admitted with COVID-19. This is a retrospective study including 359 COVID-19 patients with type 2 diabetes. Patients were divided into 2 groups according to diabetes treatment during hospitalization. The first group included patients treated with insulin only, and the second group patients treated with other antidiabetic agents with or without insulin. Average blood glucose was higher in the insulin-only treatment group (201 ± 66 mg/dL vs 180 ± 71 mg/dL, P = .004), even after excluding mechanically ventilated patients (192 ± 69 vs 169 ± 59 mg/dL, P = .003). In patients with moderate severity of COVID-19, average blood glucose was also significantly higher in the insulin-only treated group (197 ± 76 vs 168 ± 51 mg/dL, P = .001). Most patients (80%) in the combination treatment group received metformin. Moderately affected COVID-19 patients with type 2 diabetes could safely be treated with antihyperglycemic medications with or without insulin.

PMID:36701712 | DOI:10.1097/MD.0000000000032650

Medicine (Baltimore). 2023 Jan 20;102(3):e32669. doi: 10.1097/MD.0000000000032669.

ABSTRACT

BACKGROUND: With the Coronavirus disease 2019 epidemic, wearing a mask has become routine to prevent and control the virus’s spread, especially for healthcare workers. However, the impact of long-term mask wear on the human body has not been adequately investigated. This study aimed to investigate whether Powered Air Purifying Respirators and N95 masks impact the olfaction in healthcare workers.

METHODS: We recruited fifty-six healthcare workers and randomly divided them into 2 groups, wearing a powered air purifying respirator (PAPR) (experiment group, N = 28) and an N95 mask (control group, N = 28). Olfactory discrimination and threshold tests were performed before and after wearing the masks. SPSS 26.0 (SPSS Inc., Chicago, Illinois) software was used for the statistical analyses.

RESULTS: There was a statistical difference in the olfactory threshold test after wearing the mask in both PAPR Group (Z = -2.595, P = .009) and N95 Group (Z = -2.120, P = .034), with no significant difference between the 2 (χ2 = 0.29, P = .589). There was no statistical difference in the discrimination test scores in both 2 groups after wearing the masks.

CONCLUSION: Wearing a mask affects the healthcare workers’ olfaction, especially odor sensitivity. Healthcare workers have a higher olfactory threshold after long-term mask wear, whether wearing PAPRs or N95 masks.

PMID:36701701 | DOI:10.1097/MD.0000000000032669

Ann Fam Med. 2022 Apr 1;(20 Suppl 1). doi: 10.1370/afm.20.s1.3129.

ABSTRACT

Context: Schools are unique sites for nutrition education interventions due to their ability to provide educational activities as well as meals, allowing for observation of behavior change. Nutrition education and physical activity awareness programs implemented in the school setting have the potential to positively impact students’ eating habits. Eating habits are developed at a young age, but few efforts have been made to deliver and assess education interventions in the pre-K through grade 3 age group. Objective: The purpose of this study was to evaluate student food selections before and after a nutrition education intervention was implemented in a Montessori school. Human Subjects Review: Approved as non-regulated research by the UTSW IRB. Study Design: Retrospective exploratory analysis. Setting: A single Montessori community school with students in grades pre-K through grade 3. Instrument: Aggregate lunch food selection data, including total food items offered and total food items left over, via daily production records. Main Outcome Measures: Records were collected from three school years to compare the food acceptability – the percent of food item taken from the total offered – of fruit (F), vegetable (V), F&V, 0% milk, 1% milk, and all milks before and after the implementation of the intervention program. Food acceptability served as a proxy for food consumption. Results: In all years, fruit (82.88%) and all milks (81.74%) were well accepted by students, but vegetables (62.00%) were not. The study found that from year 1 to year 2, there were statistically significant (p <0.0001) decreases in intake in all categories. This trend continued when comparing year 1 to year 3. Conclusions: Prior studies show that even in successful interventions, when vegetable or F&V intake does increase, changes are minimal. These findings corroborate the difficulties prior studies have demonstrated in changing students’ food selections for the better, particularly regarding vegetable consumption. This analysis of production records showed a decline in acceptability of foods over the three years. It is unclear if these changes are directly related to the instructional program, due to the presence of confounding factors. Future studies should attempt to reevaluate nutrition education and subsequently conduct a plate-waste study for a more accurate representation of food consumption before and after an intervention.

PMID:36701673 | DOI:10.1370/afm.20.s1.3129

J Clin Res Pediatr Endocrinol. 2023 Jan 26. doi: 10.4274/jcrpe.galenos.2023.2022-11-16. Online ahead of print.

ABSTRACT

BACKGROUND: Menarche is the endpoint of a sequence of maturational events of female puberty. The timing of menarche is a strongly heritable trait. However, secular trends suggest that lifestyle and environmental factors are important.

OBJECTIVE: To assess the trend in age at menarche (AAM), and its associated factors in Istanbul over the last 12 years.

METHOD: A cross-sectional study was carried out between March and April 2022 on schoolgirls aged 9-18 years. A predesigned and self-administered questionnaire was filled out anonymously by the students. The data of AAM was included in the statistical analysis if the time of AAM is remembered for months and years. A probit model was used to calculate the median AAM. The findings were compared with those from the study performed 12 years ago in the same region of Istanbul.

RESULTS: Among 9000 girls to whom the questionnaire was distributed, 1749 (19.5%) responded. The median AAM of 1374 girls whose AAM information was considered valid was 12.04 years (95% CI 12.01-12.13), 0.7 years lower than was reported 12 years ago (p<0.0001). AAM was correlated positively with maternal AAM, and negatively with body mass index (BMI) SDS and maternal educational status (p<0.0001, <0.0001, 0.002), respectively. There was no correlation between the AAM and birth weight. Girls with BMI percentile ≥85% (n=251) had earlier menarche than the ones with BMI percentile <85% (n=1072) (11.5 vs. 12.1 years, p<0.0001). Among the mother-daughter pairs (n=1162), AAM of girls was 0.91 years (median 0.94 years) earlier than their mothers.

CONCLUSION: The present study demonstrates a significant downward trend in the menarcheal age in Istanbul over the last decade. Our findings support a strong contribution of genetic factors and BMI on AAM.

PMID:36700465 | DOI:10.4274/jcrpe.galenos.2023.2022-11-16

Med Phys. 2023 Jan 26. doi: 10.1002/mp.16242. Online ahead of print.

ABSTRACT

BACKGROUND: The machine-specific reference correction factors ( $k_{Q_{msr},Q_0}^{f_{msr},f_{ref}}$ ) were introduced in International Atomic Energy Agency (IAEA) Technical Report Series 483 (TRS-483) for reference dosimetry of small fields. Several correction factor sets exist for a Leksell Gamma Knife® (GK) Perfexion^TM or Icon^TM . Nevertheless, experiments have not rigorously validated the correction factors from different studies.

PURPOSE: This study aimed to assess the role and accuracy of $k_{Q_{msr},Q_0}^{f_{msr},f_{ref}}$ values in determining the absorbed dose rates to water in the reference dosimetry of Gamma Knife.

METHODS: The dose rates in the 16 mm collimator field of a GK were determined following the international code of practices with three ionization chambers: PTW T31010, PTW T31016 (PTW Freiberg GmbH, New York, NY, USA), and Exradin A16 (Standard Imaging, Inc., Middleton, WI, USA). A chamber was placed at the center of a solid water phantom (Elekta AB, Stockholm, Sweden) using a detector-specific insert. The reference point of the ionization chamber was confirmed using cone-beam CT images. Consistency checks were repeated five times at a GK site and performed once at seven GK sites. Correction factors from six simulations reported in previous studies were employed. Variations in the dose rates and relative dose rates before and after applying the $k_{Q_{msr},Q_0}^{f_{msr},f_{ref}}$ were statistically compared.

RESULTS: The standard deviation of the dose rates measured by the three chambers decreased significantly after any correction method was applied (p = 0.000). When the correction factors of all studies were averaged, the standard deviation was reduced significantly more than when any single correction method was applied (p ≤ 0.030), except for the IAEA TRS-483 correction factors (p = 0.148). Before any correction was applied, there were statistically significant differences among the relative dose rates measured by the three chambers (p = 0.000). None of the single correction methods could remove the differences among the ionization chambers (p ≤ 0.038). After TRS-483 correction, the dose rate of Exradin A16 differed from those of the other two chambers (p ≤ 0.025). After the averaged factors were applied, there were no statistically significant differences between any pairs of chambers according to Scheffe’s post hoc analyses (p ≥ 0.051); however, PTW T31010 differed from PTW 31016 according to Tukey’s HSD analyses (p = 0.040).

CONCLUSION: The $k_{Q_{msr},Q_0}^{f_{msr},f_{ref}}$ significantly reduced variations in the dose rates measured by the three ionization chambers. The mean correction factors of the six simulations produced the most consistent results, but this finding was not explicitly proven in the statistical analyses. This article is protected by copyright. All rights reserved.

PMID:36700450 | DOI:10.1002/mp.16242

Geriatr Psychol Neuropsychiatr Vieil. 2022 Dec 1;20(4):439-456. doi: 10.1684/pnv.2022.1065.

ABSTRACT

CONTEXTE: La population d’octogénaires est hétérogène, avec des sujets robustes et d’autres à risque d’événements indésirables. Dans notre étude, nous comparons la valeur prédictive de deux instruments visant à identifier les sujets à haut risque : le phénotype de fragilité selon Fried et un test de performance physique standardisé.

MÉTHODES: La base de données de l’étude BELFRAIL nous fournit un échantillon représentatif de la population belge d’octogénaires, composé de 567 sujets. Des données sur l’hospitalisation ont été recueillies jusqu’à 3,0 ± 0,25 ans et sur la mortalité jusqu’à 5,1 ± 0,25 ans. Nous avons réalisé et calculé des analyses de survie, des indices de reclassification et des courbes décisionnelles.

RÉSULTATS: Les participants fragiles (phénotype de Fried) ou dans le quartile inférieur (Short Physical Performance Battery – SPPB) ont un risque de mortalité et d’hospitalisation plus élevé. Le C de Harrell et l’aire sous la courbe sont semblables (< 0,70). Les courbes de décision illustrent un bénéfice net supérieur aux stratégies par défaut pour les deux outils. Les indices de reclassification et les courbes décisionnelles ne montrent aucune différence significative entre les instruments.

CONCLUSION: In a cohort of community-dwelling adults 80 years and older a standardized physical performance test was as good as the Fried frailty phenotype in identifying higher risk for adverse outcomes.

BACKGROUND: The population of adults aged 80 years and older is heterogenous with some being robust and others having a higher risk for adverse events. This study compares the predictive value of two tools used to identify older adults who are at higher risk for adverse outcomes: frailty phenotype according to Fried and a standardized physical performance test.

METHODS: The BELFRAIL population-based cohort of 567 community-dwelling adults aged 80 years and older living in Belgium. Fried frailty phenotype and physical performance test (gait, chair stand, standing balance tests and putting on and off a cardigan). The predictive value of the two tools in predicting mortality (up to 5.1 ± 0.25 years), hospitalization (3.0 ± 0.25 years) and decline in activities of daily living (after 1.7 ± 0.21 years) was compared using reclassification statistics and decision curve analysis.

RESULTS: Frail participants according to Fried phenotype and those in the lowest quartile of the physical performance test score had higher risk for mortality and hospitalization. Harrell C and area under operator curve were similar (< 0.70). Reclassification statistics and net benefit in decision curve analysis showed no significant difference between the two tools in identifying higher risk for mortality, hospitalization and functional decline.

PMID:36700437 | DOI:10.1684/pnv.2022.1065