Category: Nevin Manimala

Hernia. 2023 Apr 24. doi: 10.1007/s10029-023-02771-6. Online ahead of print.

ABSTRACT

INTRODUCTION: Evaluating groin pain still evades many clinicians at times as they have difficulty determining the cause of pain when no true hernia exists. This study’s aim was to evaluate a simple and novel scoring system which is reproducible, to help determine whether conservative measures or surgery is recommended for the management of groin pain attributable to inguinal disruption.

MATERIAL & METHODS: A retrospective analysis of all patients from 2018 to 2020 that underwent surgery or conservative management for inguinal disruption with at least a 1-year follow-up were evaluated. The scoring system is based on MRI and ultrasound imaging as well as clinical findings, with scores given from – 2 to + 2 based on the defined findings listed. A maximum total of four points scored for each assessment was used. Sensitivity and specificity analysis was conducted for each potential score cut off point.

RESULTS: A total of 172 patients were evaluated with 33 patients (19%) undergoing conservative management and 139 patients (81%) undergoing surgery. The median SPoRT score for the surgery group was 2.0 (1.0, 3.0), and – 1.0 (- 3.0, 0.0) in the physiotherapy group which was a significant difference (p < 0.001). An optimal cut off of ≤ 0 for physio and ≥ 1 for surgery was established, yielding a sensitivity of 90.9% (95% CI 75.7%-98.1%), a specificity of 89.2% (95% CI 82.8%-93.8%) and an area under the curve (AUC) of 0.936 (95% CI 0.874-0.997).

DISCUSSION: SPoRT score of ≤ 0 can recommend a patient should undergo conservative measures or physiotherapy as a mainstay of treatment with a score of ≥ 1 recommending surgery. Further validation of the score is necessary.

PMID:37093340 | DOI:10.1007/s10029-023-02771-6

Urolithiasis. 2023 Apr 24;51(1):77. doi: 10.1007/s00240-023-01442-6.

ABSTRACT

A retrospective study was performed on 200 patients who underwent miniaturized percutaneous nephrolithotomy (mini-PCNL) or retrograde intrarenal surgery (RIRS) for 10-20 mm sized lower pole renal calculi to investigate the relationship between computed tomography (CT) attenuation of calculi and surgical outcomes. CT was used to examine the location, size, and CT attenuation values of the calculi. Additionally, the operation time, hospital stay, hemoglobin (Hb) reduction, stone-free rate (SFR), and complication rate were also meticulously documented and subjected to comparative analysis. Complications were assessed using the Clavien-Dindo grading system. We observed no significant differences in hospitalization data and follow-up outcomes, except for a longer hospital stay and higher Hb drops in patients receiving mini-PCNL. Statistical analysis revealed an association between CT attenuation and operation time. Compared with mini-PCNL, RIRS could reduce bleeding, hospital stay, surgery time, and complications for 10-20 mm sized lower pole kidney stones with CT values < 1000 HU. RIRS resulted in longer operation time and lower stone-free rates despite shorter hospital stays and less bleeding than mini-PCNL for stones with CT values > 1000 HU. Therefore, selecting an appropriate surgical method based on CT attenuation might improve outcomes. For patients with stone attenuation values < 1000 HU, RIRS is the recommended option. When stone attenuation values > 1000 HU, the surgical method should be chosen based on the patient’s individual situation.

PMID:37093335 | DOI:10.1007/s00240-023-01442-6

Environ Monit Assess. 2023 Apr 24;195(5):606. doi: 10.1007/s10661-023-11236-3.

ABSTRACT

Precipitation is one of the most significant components for the basin’s hydrological cycle. Numerous features of a basin’s water circulation may be affected by the chronological, geographical, and seasonal fluctuation of precipitation. It could be an important factor that influences hydrometeorological phenomena including floods and droughts. In this research, the innovative trend risk analysis (ITRA), innovative trend pivot analysis (ITPAM), and trend polygon star (TPS) methodologies of visualizing precipitation data are used to detect precipitation changes at six stations in Algeria’s Wadi Ouahrane basin from 1972 to 2018. ITRA graphs show the direction of the precipitation trend (increasing-decreasing) and the trend risk class. Disparities in the polygons generated by the arithmetic mean and standard deviation ITPAM graphs demonstrate variations in precipitation seasonally and in the seasonal precipitation trends (increasing or decreasing) between sites. The TPS maps depict monthly variations in precipitation and highlight the autumn and spring transitions between the dry and wet seasons.

PMID:37093324 | DOI:10.1007/s10661-023-11236-3

Int J Cardiovasc Imaging. 2023 Apr 24. doi: 10.1007/s10554-023-02828-8. Online ahead of print.

ABSTRACT

BACKGROUND: Left atrial (LA) strain is a robust measure of LA function and is a useful parameter to assess left ventricular filling pressure. While initially considered as a “load-independent” parameter of LA function, later studies have found that acute changes in LA preload may affect LA reservoir and contractile strains. Acute alterations in blood pressure (BP) induces a change in left ventricular (LV) filling pressure without imposing a volume load, thus providing an opportunity to assess the effects of the change in LA afterload on LA mechanics. This study aims to understand the effect of acute BP changes on LA strain.

METHODS: A total of 40 patients admitted to the emergency department with hypertensive urgency were included. All patients underwent a comprehensive echocardiographic examination including measurement of LA reservoir, conduit and contractile strains. A repeat set of measurements were obtained after BP lowering.

RESULTS: Average drop in mean BP following intervention was 18.1 ± 5.4%. LV end-systolic and end-diastolic volumes, as well as maximum and minimum LA volumes were decreased significantly after BP reduction. The absolute increases in reservoir and contractile strains were 2.3 ± 4.7% (7.9% ± 13.8% relative to baseline) and 2.5 ± 3.3% (13.5 ± 19.0% relative to baseline), respectively, with both changes being statistically significant (p = 0.003 for reservoir and p < 0.001 for contractile strains). There were no significant changes in conduit strain after BP intervention (p = 0.79). The change in both LA reservoir and contractile strains were more evident in those with a previous diagnosis of hypertension and those with a smaller degree of change in mean BP after intervention.

CONCLUSION: In patients with an acute hypertension, lowering BP leads to an acute improvement in LA reservoir and contractile strains. Thus, acute changes in systemic BP should be considered when LA mechanics are evaluated.

PMID:37093309 | DOI:10.1007/s10554-023-02828-8

Neurosurg Rev. 2023 Apr 24;46(1):95. doi: 10.1007/s10143-023-02005-4.

ABSTRACT

The objective of the study is to improve the results of patients undergoing lumbar spine surgery who are at high risk for anesthesia and/or surgical complications. Two independent groups were compared: the study group (SG, n = 40) (standardized neuroanesthetic protocol with multimodal analgesia) and the control group (CG, n = 40) (intravenous anesthesia based on propofol and fentanyl). The data were collected using prospective observation of early and long-term results of lumbar fusion. After 24 months, the level of functional state and quality of life were studied. Patients in the SG did not have statistically significant changes in intraoperative hemodynamics; the best indicators of cognitive functions were noted. The effectiveness of the SG compared with the CG was confirmed by a statistically significantly lower amount of perioperative opioid drugs required (p = 0.01) and a minimal level of incisional pain (p < 0.05). An intergroup comparison of the adverse effects of anesthesia revealed a significantly lower number in the SG (n = 4) compared to the CG (n = 16) (p = 0.004). The number of postoperative surgical complications was comparable (p = 0.72). Intergroup comparison showed improved ODI, SF-36, and the Macnab scale at 24 months after surgery in the SG compared to the CG (p < 0.05). Long-term clinical results correlated with the level of incisional pain in the first three postoperative days. Our standardized neuroanesthetic protocol ensured effective treatment of postoperative incisional pain, significantly decreased the perioperative use of opioids, reduced adverse anesthesia events, and improved long-term clinical results in patients with high risk factors for anesthetic complications who undergoing open lumbar spine surgery.

PMID:37093302 | DOI:10.1007/s10143-023-02005-4

Surg Endosc. 2023 Apr 24. doi: 10.1007/s00464-023-10048-3. Online ahead of print.

ABSTRACT

BACKGROUND: Nonagenarian patients are an age group in progressive growth. In this age group, indications for surgical procedures, including cholecystectomy, will be increasingly frequent, as biliary pathology and its complications are frequent in this population group. The main objective of this study was to analyze the safety and outcomes of laparoscopic cholecystectomy in patients older than 90 years.

METHODS: A retrospective observational cohort study was designed. This study involved 600 patients that were classified in 4 age groups for analysis (under 50 years, 50-69 years, 70-89 years, and over 90 years). Demographic, clinical, paraclinics, surgical, and outcome variables were compared according to age group. A multivariate analysis, which included variables considered clinically relevant, was performed to identify factors associated with mortality and complications classified with the Clavien-Dindo scale.

RESULTS: The patients evaluated had a median age of 65.0 (IQR 34.0) years and there was a female predominance (61.8%). A higher complication rate, conversion rate, subtotal cholecystectomy rate, and prolonged hospital stay were found in nonagenarians. The overall mortality rate was 1.6%. Mortality in the age group over 90 years was 6.8%. Regression models showed that age over 90 years (RR 4.6 CI95% 1.07-20.13), presence of cholecystitis (RR 8.2 CI95% 1.29-51.81), and time from admission to cholecystectomy (RR 1.2 CI95% 1.10-1.40) were the variables that presented statistically significant differences as risk factors for mortality.

CONCLUSION: Cholecystectomy in nonagenarian patients has a higher rate of complications, conversion rate, subtotal cholecystectomy rate, and mortality. Therefore, an adequate perioperative assessment is necessary to optimize comorbidities and improve outcomes. Also, it is important to know the greatest risk for informed consent and choose the surgical equipment and schedule of the procedure.

PMID:37093280 | DOI:10.1007/s00464-023-10048-3

J Enzyme Inhib Med Chem. 2023 Dec;38(1):2202357. doi: 10.1080/14756366.2023.2202357.

ABSTRACT

In this article, emulsomes (EMLs) were fabricated to encapsulate the N-(5-nitrothiazol-2-yl)-carboxamido derivatives (3a–3g) in an attempt to improve their biological availability and antiviral activity. Next, both cytotoxicity and anti-SARS-CoV-2 activities of the examined compounds loaded EMLs (F3a–g) were assessed in Vero E6 cells via MTT assay to calculate the CC₅₀ and inhibitory concentration 50 (IC₅₀) values. The most potent 3e-loaded EMLs (F3e) elicited a selectivity index of 18 with an IC₅₀ value of 0.73 μg/mL. Moreover, F3e was selected for further elucidation of a possible mode of action where the results showed that it exhibited a combination of virucidal (>90%), viral adsorption (>80%), and viral replication (>60%) inhibition. Besides, molecular docking and MD simulations towards the SARS-CoV-2 Mpro were performed. Finally, a structure-activity relationship (SAR) study focussed on studying the influence of altering the size, type, and flexibility of the α-substituent to the carboxamide in addition to compound contraction on SARS-CoV-2 activity.HighlightsEmulsomes (EMLs) were fabricated to encapsulate the N-(5-nitrothiazol-2-yl)-carboxamido derivatives (3a–3g).The most potent 3e-loaded EMLs (F3e) showed an IC₅₀ value of 0.73 μg/mL against SARS-CoV-2.F3e exhibited a combination of virucidal (>90%), viral adsorption (>80%), and viral replication (>60%) inhibition.Molecular docking, molecular dynamics (MD) simulations, and MM-GBSA calculations were performed.Structure-activity relationship (SAR) study was discussed to study the influence of altering the size, type, and flexibility of the α-substituent to the carboxamide on the anti-SARS-CoV-2 activity.

PMID:37092260 | DOI:10.1080/14756366.2023.2202357

Expert Syst Appl. 2023 Sep 1;225:120103. doi: 10.1016/j.eswa.2023.120103. Epub 2023 Apr 17.

ABSTRACT

The sanitary emergency caused by COVID-19 has compromised countries and generated a worldwide health and economic crisis. To provide support to the countries’ responses, numerous lines of research have been developed. The spotlight was put on effectively and rapidly diagnosing and predicting the evolution of the pandemic, one of the most challenging problems of the past months. This work contributes to the existing literature by developing a two-step methodology to analyze the transmission rate, designing models applied to territories with similar pandemic behavior characteristics. Virus transmission is considered as bacterial growth curves to understand the spread of the virus and to make predictions about its future evolution. Hence, an analytical clustering procedure is first applied to create groups of locations where the virus transmission rate behaved similarly in the different outbreaks. A curve decomposition process based on an iterative polynomial process is then applied, obtaining meaningful forecasting features. Information of the territories belonging to the same cluster is merged to build models capable of simultaneously predicting the 14-day incidence in several locations using Evolutionary Artificial Neural Networks. The methodology is applied to Andalusia (Spain), although it is applicable to any region across the world. Individual models trained for a specific territory are carried out for comparison purposes. The results demonstrate that this methodology achieves statistically similar, or even better, performance for most of the locations. In addition to being extremely competitive, the main advantage of the proposal lies in its complexity cost reduction. The total number of parameters to be estimated is reduced up to 93.51% for the short term and 93.31% for the mid-term forecasting, respectively. Moreover, the number of required models is reduced by 73.53% and 58.82% for the short- and mid-term forecasting horizons.

PMID:37090447 | PMC:PMC10108563 | DOI:10.1016/j.eswa.2023.120103

Spat Stat. 2023 Jun;55:100729. doi: 10.1016/j.spasta.2023.100729. Epub 2023 Mar 14.

ABSTRACT

The basic homogeneous SEIR (susceptible-exposed-infected-removed) model is a commonly used compartmental model for analysing infectious diseases such as influenza and COVID-19. However, in the homogeneous SEIR model, it is assumed that the population of study is homogeneous and, one cannot incorporate individual-level information (e.g., location of infected people, distance between susceptible and infected individuals, vaccination status) which may be important in predicting new disease cases. Recently, a geographically-dependent individual-level model (GD-ILM) within an SEIR framework was developed for when both regional and individual-level spatial data are available. In this paper, we propose to use an SEIR GD-ILM for each health region of Manitoba (central Canadian province) population to analyse the COVID-19 data. As different health regions of the population under study may act differently, we assume that each health region has its own corresponding parameters determined by a homogeneous SEIR model (such as contact rate, latent period, infectious period). A Monte Carlo Expectation Conditional Maximization (MCECM) algorithm is used for inference. Using estimated parameters we predict the infection rate at each health region of Manitoba over time to identify highly risk local geographical areas. Performance of the proposed approach is also evaluated through simulation studies.

PMID:37089455 | PMC:PMC10103593 | DOI:10.1016/j.spasta.2023.100729

J Cataract Refract Surg. 2023 May 1;49(5):499-503. doi: 10.1097/j.jcrs.0000000000001138.

ABSTRACT

PURPOSE: To assess whether there are added risks when performing intraocular lens (IOL) exchange in the setting of an open posterior capsule (OPC) when compared with a closed posterior capsule (CPC) IOL exchange.

SETTING: Private practice, Los Angeles, California.

DESIGN: Nonrandomized and unmasked retrospective chart review.

METHODS: Eyes undergoing IOL exchange solely to relieve optical symptoms, with open or intact posterior capsules, were included. Eyes undergoing IOL exchange due to IOL malposition or dislocation were excluded. Eyes with preexisting, uncontrolled glaucoma and inflammation and eyes with a visual potential worse than 20/40 (Snellen) were also excluded. The main outcome measures were the postoperative complications compared between the OPC and CPC groups.

RESULTS: 90 eyes of 75 patients undergoing IOL exchange were included in this study; 38/90 eyes had an OPC, and 52/90 eyes had a CPC. 3/38 in the OPC group and 2/52 in the CPC group experienced worsening intraocular pressure control. 1/38 in the OPC group experienced chronic inflammation. 2/38 in the OPC group and 2/52 in the CPC group experienced cystoid macular edema. 1/52 in the CPC group experienced a retinal tear. Statistically or clinically significant differences in postoperative complications between the OPC and CPC groups were not found.

CONCLUSIONS: In the hands of an experienced surgeon, IOL exchange with an OPC appear red to be just as safe as IOL exchange with a CPC; when deemed necessary, experienced surgeons may perform an IOL exchange safely in the presence of an OPC.

PMID:37088935 | DOI:10.1097/j.jcrs.0000000000001138