Category: Nevin Manimala

Pediatrics. 2023 Mar 16:e2022059172. doi: 10.1542/peds.2022-059172. Online ahead of print.

ABSTRACT

BACKGROUND: Lesbian, gay, bisexual, and other sexual minority (LGB+) girls are more likely than heterosexual girls to be pregnant during adolescence. Nonetheless, LGB+ inclusive pregnancy prevention programming is lacking.

METHODS: Between January 2017 and January 2018, 948, 14 to 18 year-old cisgender LGB+ girls were enrolled in a national randomized controlled trial. Girls were assigned either to Girl2Girl or an attention-matched control group. They were recruited via social media and enrolled over the telephone. The 5-month intervention consisted of a 7-week program (4-12 text messages sent daily) and a 1-week booster delivered 12 weeks later. Longitudinal models of protected sex events had a negative binomial distribution and a log link function. Longitudinal models examining use of birth control assumed a Bernoulli distribution of the outcome variable and a logit link function. Models adjusted for baseline rate of the outcome, age, and a time-varying indicator of sexual experience.

RESULTS: Girl2Girl participants had higher rates of protected penile-vaginal sex events over time compared with controls. Girl2Girl participants also were more likely than control participants to report use of birth control other than condoms. Models of abstinence and pregnancy rates did not suggest statistically significant group differences across time. However, effect sizes were in the small to medium range and point estimates favored Girl2Girl versus control in both cases.

CONCLUSIONS: Girl2Girl is associated with sustained pregnancy preventive behaviors for LGB+ girls through 12 months postintervention. Text messaging could be considered as a viable method to increase access to sexual health programming to adolescents nationally.

PMID:36924134 | DOI:10.1542/peds.2022-059172

Hosp Pediatr. 2023 Mar 16:e2022006914. doi: 10.1542/hpeds.2022-006914. Online ahead of print.

ABSTRACT

OBJECTIVES: Bronchiolitis is a leading cause of pediatric hospitalization. Treatment focuses on supportive care including supplemental oxygen for hypoxemia. High-flow nasal cannula (HFNC) has emerged as a modality to provide respiratory support with or without supplemental oxygen. At a freestanding children’s hospital, inappropriate supplemental oxygen was frequently used. This study aimed to decrease the proportion of patients started on supplemental oxygen without documented hypoxemia from ∼90% to <70% and the proportion of patients weaned from HFNC without supplemental oxygen to nasal cannula with supplemental oxygen from ∼23% to <10%.

METHODS: A multidisciplinary taskforce was convened to develop an evidence-based protocol for HFNC usage. Data collection was obtained among patients aged <2 years admitted with bronchiolitis from September 2018 to September 2021. Institution-wide protocol changes occurred in November 2019 and October 2020, with ongoing education and evaluation. Data were summarized using statistical process control charts.

RESULTS: Following implementation of a revised protocol in October 2020, the percentage of patients without documented hypoxemia (defined as an oxygen saturation <90% on pulse oximetry) who were inappropriately started on supplemental oxygen decreased from a baseline of 90.2% to 57.2%. At the same time, the percentage of patients weaned from HFNC without nasal cannula oxygen decreased from a baseline of 23.1% to 4.7%.

CONCLUSIONS: Using supplemental oxygen in the absence of hypoxemia in bronchiolitis is an example of low-value care. Implementation of focused, standardized protocols with concurrent education can feasibly decrease inappropriate and unnecessary use of supplemental oxygen in children with bronchiolitis.

PMID:36924126 | DOI:10.1542/hpeds.2022-006914

J Eur Acad Dermatol Venereol. 2023 Mar 16. doi: 10.1111/jdv.19050. Online ahead of print.

ABSTRACT

BACKGROUND: Photodynamic therapy (PDT) is used to treat cutaneous cancers. It may induce cell death through direct and indirect means, including apoptosis, inflammation, and certain immune mechanisms, with the depth of penetration as a potential modifying factor.

OBJECTIVES: To examine the pathways of apoptosis in the intralesional PDT of basal cell carcinoma (BCC) and intraepidermal squamous cell carcinoma (Bowen’s disease).

METHODS: Sixteen patients with superficial or nodular BCC and Bowen’s disease were treated with intralesional aminolevulinic acid-PDT. Biopsies were taken at baseline and 24 h post-PDT and sections were examined by immunohistochemistry for expression of markers of apoptosis. such as caspase 3, involved in the intrinsic apoptotic pathway, granzyme B, a caspase-independent apoptotic mediator, and the proapoptotic markers BAX and BAK RESULTS: Apoptotic cells stained with TUNEL showed statistically significant staining at 24 h post PDT (p<0,01 in both BCC and Bowen’s lesions). Caspase 3 (p<0.01 in BCC and p<0.05 in Bowen’s) and granzyme B (p<0.01 in BCC and p<0.01 in Bowen’s) were significantly increased at 24 h post-PDT. BAX expression was apparently raised compared to baseline in Bowen’s lesions at 24 h post-PDT, whereas Bak was upregulated both in BCC and Bowen’s disease at baseline and at 24 h post-PDT.

CONCLUSION: Intralesional PDT induces apoptosis in BCC and Bowen’s disease via common and alternative apoptotic pathways involving granzyme B. Proapoptotic factors Bak in both BCC and Bowen and Bax in Bowen’s disease appear to increase by intralesional PDT at 24 hours.

PMID:36924124 | DOI:10.1111/jdv.19050

Rev Med Virol. 2023 Mar 16:e2439. doi: 10.1002/rmv.2439. Online ahead of print.

ABSTRACT

Until now, the treatment protocols for COVID-19 have been revised multiple times. The use and approval of therapeutic monoclonal antibodies (mAbs) for COVID-19 treatment represent exceptional achievements in modern science, technology and medicine. SARS-CoV-2 Omicron evasion of pre-existing immunity represents a serious public health problem nowadays. This systematic review with meta-analysis provided comprehensive and up-to-date evidence of the clinical efficacy of therapeutic anti-SARS-CoV-2 mAbs against Omicron subvariants in COVID-19 patients and included 10 articles. The prevalence of hospitalisation among Omicron-positive patients treated with anti-SARS-CoV-2 mAbs was 2.8% (89/3169) while it controls (Omicron-positive patients treated with other therapies) 11% (154/1371). There was a statistically significantly different number of hospitalisations between the two studied groups in favour of the anti-SARS-CoV-2 mAbs treated group. (OR = 0.56, 95% CI OR = 0.41-0.77, p < 0.001, respectively). Eight deaths (0.30%) out of 2619 Omicron-positive patients occurred in the anti-SARS-CoV-2 mAbs treated group, while in the control group (Omicron-positive patients treated with other therapies), 27 patients died out of 1401 (1.93%). There was a significantly different number of deaths between the two studied groups in favour of Omicron-positive patients treated with anti-SARS-CoV-2 mAbs (OR = 0.38, 95% CI OR = 0.17-0.85, p = 0.020). Using sotrovimab in treating Omicron-positive patients indicated a reduction of hospitalisation and mortality for 49% and 89% in favour of sotrovimab, respectively (OR = 0.51, 95% CI OR = 0.34-0.79, p = 0.002; OR = 0.11, 95% CI OR = 0.03-0.39, p = 0.001). We could only provide evidence of the positive impact in reducing hospitalisation and mortality rates when anti-SARS-CoV-2 mAbs were used to treat patients infected with Omicron variants BA.1 or BA.2 and not on other Omicron variants.

PMID:36924087 | DOI:10.1002/rmv.2439

Acad Radiol. 2023 Mar 13:S1076-6332(23)00057-0. doi: 10.1016/j.acra.2023.01.041. Online ahead of print.

ABSTRACT

RATIONALE AND OBJECTIVES: Blood supply is vital for sound callus formation. The tibial nutrient artery (TNA) is the main diaphyseal artery nurturing the tibial shaft. The objective is to investigate the impact of TNA canal (TNAC) injury on the development of atrophic, oligotrophic, and hypertrophic nonunion in patients with tibial shaft fractures.

MATERIALS AND METHODS: Between January 2010 and December 2020, patients with a nonunion of a tibial shaft fracture were retrospectively included. Two readers independently evaluated the integrity of the TNAC and classified nonunion type. A multinomial regression model was utilized to evaluate if a TNAC injury has an impact on the type of nonunion.

RESULTS: From an initial set of 385 patients with the diagnosis of a nonunion of the lower leg, a total of 60 patients could be finally included in the study. Most patients were males (78%), diabetic (95%), smokers (73%), and had an American Society of Anesthesiologists (ASA) score of 2 (72%). TNAC injury was noted in 24 patients (40%): an iatrogenic TNAC injury was observed in 13 (22%) patients, a traumatic TNAC injury in 11 (18%) patients. Most patients had a hypertrophic nonunion (29 patients (48%)), followed by an oligotrophic nonunion (24 patients (40%)) and lastly an atrophic nonunion (seven patients (11%)). The multinomial regression model showed that there was no impact of TNAC injury on the development of a specific type of non-union (p = 0.798 for oligotrophic vs. atrophic nonunion; p = 0.943 for hypertrophic vs. atrophic nonunion). Furthermore, patients were about four times more likely to develop an oligotrophic/hypertrophic nonunion rather than atrophic one (odds ratio 3.75 and 4.25, respectively), regardless of the presence of a TNAC injury.

CONCLUSION: In the evaluated patient cohort with tibial shaft fractures, we could not find a statistically significant association between TNAC injury and type of nonunion. However, patients were almost four times more likely to develop oligotrophic or hypertrophic nonunion rather than an atrophic one although common risk factors for impaired (micro)vascular blood supply were highly prevalent in the study group. Multicenter studies with a larger number of atrophic nonunions are warranted to further evaluate this result.

PMID:36922344 | DOI:10.1016/j.acra.2023.01.041

ISA Trans. 2023 Mar 6:S0019-0578(23)00099-X. doi: 10.1016/j.isatra.2023.03.001. Online ahead of print.

ABSTRACT

This paper concentrates on the fixed-time consensus control problem with preserved connectivity for periodically disturbed nonlinear multi-agent systems with limited communication ranges. The dynamics model of the considered multi-agent systems is general, in which the periodically time-varying disturbance appears in the unknown system function in a nonlinear fashion. The Fourier series expansion-radial basis function neural network-based approximator is incorporated to describe the unknown disturbed functions. In consideration of the limited communication ranges, a unified error transformation is utilized to preserve the initial connectivity. Then, via the backstepping method, a consensus control scheme is recursively constructed to guarantee that the consensus errors fall into a small region around the origin in fixed time, and the connectivity preservation is ensured simultaneously. In simulation part, the consensus trajectories, consensus errors and the results of connectivity preservation are provided. The simulation results demonstrate the capability of the proposed control strategy in achieving connectivity-preserving consensus in fixed time.

PMID:36922336 | DOI:10.1016/j.isatra.2023.03.001

Curr Pharm Teach Learn. 2023 Mar 13:S1877-1297(23)00023-0. doi: 10.1016/j.cptl.2023.02.023. Online ahead of print.

ABSTRACT

INTRODUCTION: Student well-being is a growing area of interest, though existing literature assessing multiple areas of well-being is lacking. This study aimed to evaluate the well-being of pharmacy students corresponding to three well-being domains (physical health, mental health, personal well-being and burnout) and identify characteristics associated with these domains.

METHODS: An online survey adapted from various instruments was disseminated to pharmacy students from 11 pharmacy programs. Survey responses were compared using basic descriptive statistics, and Pearson’s chi-Square was used for association analyses.

RESULTS: Eight hundred thirty-six students from responded to the survey (24.3% response rate). For physical health, 59.3% of students reported sleeping <7 hours per night and 60.4% reported exercising 1 to 5 hours per week. For mental health, 24.8% of students screened positive for depression and 42% screened positive for anxiety. Lastly, 65.9% of students were at risk for decreased well-being and 63.7% for burnout. Based on association analyses, gender and pharmacy year were associated with screening positive for anxiety and burnout, gender was associated with decreased well-being, and relationship status was associated with screening positive for depression.

CONCLUSIONS: This study revealed pharmacy students are at risk for lack of sleep and exercise, depression or anxiety, decreased well-being, and burnout. Also, several characteristics were found to be associated with these negative well-being outcomes. Although response rate and participant demographics could impact the generalizability of these findings, findings further increase awareness about student well-being and inform pharmacy programs supporting well-being by better understanding student risks.

PMID:36922330 | DOI:10.1016/j.cptl.2023.02.023

J Am Soc Cytopathol. 2023 Feb 13:S2213-2945(23)00012-1. doi: 10.1016/j.jasc.2023.02.001. Online ahead of print.

ABSTRACT

INTRODUCTION: Cytology is an option for triaging human papillomavirus (HPV)-positive women. The interpretation of cytologic slides requires expertise and financial resources that are not always available in resource-limited settings. A solution could be offered by manual preparation and digitization of slides on site for real-time remote cytologic diagnosis by specialists. In the present study, we evaluated the operational feasibility and cost of manual preparation and digitization of thin-layer slides and the diagnostic accuracy of screening with virtual microscopy.

MATERIALS AND METHODS: Operational feasibility was evaluated on 30 cervical samples obtained during colposcopy. The simplicity of the process and cellularity and quality of digitized thin-layer slides were evaluated. The diagnostic accuracy of digital versus glass slides to detect cervical intraepithelial neoplasia grade 2 or worse was assessed using a cohort of 264 HPV-positive Cameroonian women aged 30 to 49 years. The histologic results served as the reference standard.

RESULTS: Manual preparation was found to be feasible and economically viable. The quality characteristics of the digital slides were satisfactory, and the mean cellularity was 6078 squamous cells per slide. When using the atypical squamous cells of undetermined significance or worse threshold for positivity, the diagnostic performance of screening digital slides was not significantly different statistically compared with the same set of slides screened using a light microscope (P = 0.26).

CONCLUSIONS: We have developed an innovative triage concept for HPV-positive women. A quality-ensured telecytologic diagnosis could be an effective solution in areas with a shortage of specialists, applying a same day “test-triage-treat” approach. Our results warrant further on-site clinical validation in a large prospective screening trial.

PMID:36922319 | DOI:10.1016/j.jasc.2023.02.001

Injury. 2023 Feb 27:S0020-1383(23)00186-9. doi: 10.1016/j.injury.2023.02.053. Online ahead of print.

ABSTRACT

BACKGROUND/AIM: Contact-sports are known to have higher risk of orofacial injuries due to the bodily contact with other players or equipment. Kabaddi is a traditional contact-sport of India that has gained an international recognition. There is a paucity of data regarding prevalence of traumatic dental and orofacial injuries among the Kabaddi players. Hence this study aimed to assess the prevalence, distribution and pattern of orofacial injuries among the Kabaddi players of Delhi and NCR region.

MATERIAL AND METHODS: This observational cross-sectional study was designed as per the best practices of epidemiology and reported as per the STROBE guidelines. The sample size was calculated as 440 and comprised of 10-18 years old players of either gender. Cluster random sampling was performed and the information was collected by one-calibrated evaluator by using a self-designed proforma. The injuries were classified as per standard criteria and the description of each episode was recorded. Statistical analysis was performed using the Statistical software-STATA-version-14(StataCorpLLC,Texas,USA).

RESULTS: Total of 393 players were included in the study (Males-295, Females-98) with majority of them between 15 and 18 years of age. The prevalence of traumatic episode was 49.11% and the prevalence orofacial-trauma was 44.02%.The frequency of extraoral-injuries was higher when compared to the intraoral injuries, with orbit(26.67%) being the commonest-site. Most of the players had not received adequate emergency treatment in the first incident which had improved in the second.

CONCLUSIONS: The prevalence of traumatic orofacial injuries in 10-18 years old Kabaddi players of Delhi-NCR region was found to be 44.02% while the prevalence of traumatic episodes was 49.11%. The prevalence of dental injuries was 5.1%. Majority of the players perceived that Kabaddi can lead to orofacial-injuries.

PMID:36922269 | DOI:10.1016/j.injury.2023.02.053

Chin J Traumatol. 2023 Feb 24:S1008-1275(23)00017-2. doi: 10.1016/j.cjtee.2023.02.003. Online ahead of print.

ABSTRACT

PURPOSE: Electric scooters (e-scooters) have become an increasingly popular mode of public transportation in recent years. As the incidence of related injuries rises, it is important to understand specific fracture patterns unique to e-scooters and electric bikes (e-bikes) to help guide management. The purpose of this study was to review the prevalence and describe specific fracture patterns of e-scooter and e-bike related injuries at the busiest level 1 trauma center in the borough of Manhattan.

METHODS: Chart review to determine mechanism of injury was performed on all patients for whom an orthopedic consult was requested from 1/1/2021 to 12/31/2021. All patients whose injuries were sustained due to an e-scooter or e-bike were further reviewed for demographics, injury characteristics including fracture pattern, and definitive injury management. Any patients who had an orthopedic consult placed for a reason other than an acute injury were excluded. Descriptive statistics are reported as frequencies (percentages) for categorical variables and means for continuous variables.

RESULTS: Of the 1815 orthopedic consults requested, 1357 (74.8%) were for acute injury management. Of those with acute injuries, 119 (8.8%) sustained 136 e-scooter or e-bike related injuries. There were 92 (77.3%) males at an average age of (33.8 ± 15.7) years. Approximately one-fifth of all patients presented in June 2021 (26, 21.8%). There was a 9.2% rate of open fractures. The 136 injuries were evenly split between the upper and lower extremities, with 57 (47.9%) upper extremity, 57 (47.9%) lower extremity injuries, and 5 (4.2%) concomitant upper and lower extremity injuries. The most common fracture patterns were ankle fractures (16, 11.7%), followed by tibial shaft (14, 10.2%), tibial plateau (13, 9.5%), and radial head fractures (11, 8.0%). There was a 33.3% incidence of associated posterior malleolar fractures in the spiral tibial shaft fractures, 31.0% of posterior malleolar involvement and 18.8% of isolated vertical medial malleolar fractures in the ankle fractures, and 61.5% of posterior comminution in the tibial plateau fractures.

CONCLUSION: E-scooter and e-bike related injuries have a high incidence of tibial shaft fractures, ankle fractures, tibial plateau fractures, and radial head fractures. There should be a high index of suspicion for posterior and medial involvement in lower extremity fractures sustained due to e-scooter or e-bikes. Identifying specific fracture patterns seen in e-scooter and e-bike related mechanisms will help guide management of these injuries.

PMID:36922264 | DOI:10.1016/j.cjtee.2023.02.003