Category: Nevin Manimala

BMC Endocr Disord. 2023 May 6;23(1):102. doi: 10.1186/s12902-023-01352-z.

ABSTRACT

BACKGROUND: Around 6.5% of the population in the United Kingdom has been diagnosed with diabetes. It is associated with several long-term consequences and higher hospitalization rates.

AIM: To examine the profile of hospital admissions related to diabetes mellitus and the prescription rates of antidiabetic medications in England and Wales.

METHOD: This is an ecological study that was conducted for the period between April 1999 and April 2020 using publicly available hospitalisation data in England and Wales. Hospital admission data for patients of all ages was extracted from Hospital Episode Statistics in England and the Patient Episode Database for Wales. The difference between admission rates in 1999 and 2020, as well as the difference between diabetes mellitus medication prescription rates in 2004 and 2020, were assessed using the Pearson Chi-squared test. A Poisson regression model with robust variance estimation was used to examine the trend in hospital admissions.

RESULTS: A total of 1,757,892 diabetes mellitus hospital admissions were recorded in England and Wales during the duration of the study. The hospital admission rate for diabetes mellitus increased by 15.2%. This increase was concomitant with an increase in the antidiabetic medication prescribing rate of 105.9% between 2004 and 2020. Males and those in the age group of 15-59 years had a higher rate of hospital admission. The most common causes of admissions were type 1 diabetes mellitus related complications, which accounted for 47.1% of all admissions.

CONCLUSION: This research gives an in-depth overview of the hospitalization profile in England and Wales during the previous two decades. In England and Wales, people with all types of diabetes and related problems have been hospitalized at a high rate over the past 20 years. Male gender and middle age were significant determinants in influencing admission rates. Diabetes mellitus type 1 complications were the leading cause of hospitalizations. We advocate establishing preventative and educational campaigns to promote the best standards of care for individuals with diabetes in order to lower the risk of diabetes-related complications.

PMID:37149604 | DOI:10.1186/s12902-023-01352-z

BMC Med Educ. 2023 May 6;23(1):317. doi: 10.1186/s12909-023-04316-y.

ABSTRACT

BACKGROUND: This study aimed to evaluate the current state of academic burnout among Chinese college students and its influencing factors.

METHODS: A cross-sectional study of 22,983 students was conducted using structured questionnaires and the Maslach Burnout Inventory General Survey on sociodemographic characteristics, educational process, and personal aspects. Multiple variables were statistically evaluated using logistic regression analysis.

RESULTS: The total score of the students’ academic burnout was 40.73 (± 10.12) points. The scores for the reduced personal accomplishment, emotional exhaustion, and cynicism were 23.63 (± 6.55), 11.20 (± 6.05), and 5.91 (± 5.31), respectively. Students with academic burnout accounted for 59.9% (13,753/22,983). Male students had higher burnout scores than female students, upper-grade students had higher burnout scores than lower-grade students, and students who smoked had higher burnout than non-smokers during the school day.

CONCLUSIONS: More than half of students experienced academic burnout. Gender, grade, monthly living expenses, smoking, parents’ education level, study and life pressures, and the current degree of professional knowledge interest significantly impacted academic burnout. An effective wellness program and an annual long-term burnout assessment may sufficiently reduce student burnout.

PMID:37149602 | DOI:10.1186/s12909-023-04316-y

Malar J. 2023 May 6;22(1):149. doi: 10.1186/s12936-023-04577-4.

ABSTRACT

BACKGROUND: Millions of dollars have been spent in fighting malaria in Namibia. However, malaria remains a major public health concern in Namibia, mostly in Kavango West and East, Ohangwena and Zambezi region. The primary goal of this study was to fit a spatio-temporal model that profiles spatial variation in malaria risk areas and investigate possible associations between disease risk and environmental factors at the constituency level in highly risk northern regions of Namibia.

METHODS: Malaria data, climatic data, and population data were merged and Global spatial autocorrelation statistics (Moran’s I) was used to detect the spatial autocorrelation of malaria cases while malaria occurrence clusters were identified using local Moran statistics. A hierarchical Bayesian CAR model (Besag, York and Mollie’s model “BYM”) known to be the best model for modelling the spatial and temporal effects was then fitted to examine climatic factors that might explain spatial/temporal variation of malaria infection in Namibia.

RESULTS: Average rainfall received on an annual basis and maximum temperature were found to have a significant spatial and temporal variation on malaria infection. Every mm increase in annual rainfall in a specific constituency in each year increases annual mean malaria cases by 0.6%, same to average maximum temperature. The posterior means of the time main effect (year t) showed a visible slightly increase in global trend from 2018 to 2020.

CONCLUSION: The study discovered that the spatial temporal model with both random and fixed effects best fit the model, which demonstrated a strong spatial and temporal heterogeneity distribution of malaria cases (spatial pattern) with high risk in most of the Kavango West and East outskirt constituencies, posterior relative risk (RR: 1.57 to 1.78).

PMID:37149600 | DOI:10.1186/s12936-023-04577-4

BMC Med Educ. 2023 May 6;23(1):315. doi: 10.1186/s12909-023-04300-6.

ABSTRACT

INTRODUCTION: Clinical practice of dentistry entails the use of indirect vision using a dental mirror. The Mirrosistant is a device that helps dental students become proficient with use of indirect vision mirror operation. This study aimed to explore the role of the Mirrosistant on students’ performance with the virtual simulation dental training system.

MATERIALS AND METHODS: A total of 72 dental students were equally assigned to the Control group and the Experimental group. Subsequently, Mirrosistant was used to conduct a series of mirror training exercises in the Experimental group. The training consisted of tracing the edge and filling in the blank of the prescribed shape, as well as preparing the specified figure on raw eggs using indirect vision via Mirrosistant. Next, both groups were examined using the SIMODONT system, a virtual reality dental trainer, for mirror operation. In addition, a five-point Likert scale questionnaire was used to assess student feedback by using Mirrosistant.

RESULTS: The mirror operation examination conducted by the SIMODONT system revealed that mirror training using Mirrosistant had statistically improved students’ performances (score: 80.42 ± 6.43 vs. 69.89 ± 15.98, P = 0.0005) and shorten their performance time of mirror operation (time of seconds: 243.28 ± 132.83 vs. 328.53 ± 111.89, P = 0.0013). Furthermore, the questionnaire survey indicated that the participants had positive attitudes toward the mirror training using Mirrosistant. Most students believed that the mirror training device could improve their perceptions of direction and distance, as well as their sensations of dental operation and dental fulcrum.

CONCLUSION: Mirror training using Mirrosistant can enhance dental students’ mirror perceptual and operational skills on virtual simulation dental training system.

PMID:37149587 | DOI:10.1186/s12909-023-04300-6

BMC Musculoskelet Disord. 2023 May 6;24(1):358. doi: 10.1186/s12891-023-06444-4.

ABSTRACT

PURPOSE: Choosing a suitable surgical approach is crucial and challenging for type C pilon fractures. This article aims to explore the clinical efficacy of the medial malleolar window approach for varus-type tibial pilon fractures.

METHODS: A retrospective analysis was conducted on 38 patients with type C varus-type pilon fractures treated between May 2018 and June 2021. In total, 16 cases underwent surgical treatment through the medial malleolar window approach and 22 cases were treated with the traditional anteromedial approach combined with a posterior approach. The operation time, hospitalization time, fracture healing time, the American Orthopedic Foot and Ankle score, Visual Analogue Scale, and complications were recorded to comprehensively evaluate the clinical efficacy of the technique. Fracture reduction quality was evaluated using the criteria proposed by Burwell and Charnley.

RESULTS: All patients were followed up. No patients presented delayed union or nonunion. Compared with the conventional approach, the medial malleolar window approach had the advantage of better clinical effect recovery and better fracture reduction (P < 0.05). Meanwhile, the medial malleolar window approach had a shorter operation time, although the statistics suggest no significant difference with the control group. No implant exposure or infection occurred. There was good wound healing at two weeks after surgery in all but two cases. Local wound edge necrosis developed in one case in the medial malleolar window approach group, and the wound could not be closed at one stage in another case in the conventional group because of excessive tension, requiring secondary closure.

CONCLUSION: The medial malleolar window approach provides excellent exposure to type C pilon fractures, allowing for satisfactory fracture reduction and functional rehabilitation. The medial window approach is recommended for varus-type pilon fractures, which can effectively avoid a posterior incision and reduce the operation time.

PMID:37149577 | DOI:10.1186/s12891-023-06444-4

BMC Musculoskelet Disord. 2023 May 6;24(1):356. doi: 10.1186/s12891-023-06471-1.

ABSTRACT

BACKGROUND: The bacterial source of surgical-site infections (SSIs) can have either endogenous and/or exogenous origins, and some studies have revealed that endogenous transmission is an important pathway for SSIs in orthopedic surgery. However, since the frequency of SSIs is low (0.5-4.7%), screening all surgery patients is labor-intensive and cost-prohibitive. The goal of this study was to better understand how to improve the efficacy of nasal culture screening in preventing SSIs.

METHODS: Nasal cultures for 1616 operative patients over a 3-year period were evaluated for the presence of nasal bacterial microbiota and the species identity. We also investigated the medical factors that influence colonization and evaluated the ratio of agreement between nasal cultures and SSI-causing bacteria.

RESULTS: In a survey of 1616 surgical cases, 1395 (86%) were normal microbiota (NM), 190 (12%) were MSSA carriers, and 31 (2%) were MRSA carriers. The risk factors for MRSA carriers were significantly higher than the NM group in patients with a history of hospitalization (13 [41.9%], p = 0.015), patients who had been admitted to a nursing facility (4 [12.9%], p = 0.005), and patients who were > 75 years of age (19 [61.3%], p = 0.021). The incidence of SSIs was significantly higher in the MSSA group (17/190 [8.4%]) than the NM group (10/1395 [0.7%], p = 0.00). The incidence of SSIs in the MRSA group (1/31 [3.2%]) tended to be higher than that in the NM group, but there was no statistically significant difference (p = 0.114). The concordance rate between causative bacteria of SSI and species present in nasal cultures was 53% (13/25 cases).

CONCLUSIONS: The results of our study suggest screening patients with a history of past hospitalization, a history of admission in a long-term care facility, and older than 75 to reduce SSIs.

TRIAL REGISTRATION: This study was approved by the institutional review board of the authors’ affiliated institutions (the ethics committee of Sanmu Medical Center, 2016-02).

PMID:37149570 | DOI:10.1186/s12891-023-06471-1

BMC Med Educ. 2023 May 6;23(1):316. doi: 10.1186/s12909-023-04286-1.

ABSTRACT

BACKGROUND: Selecting an empiric antimicrobial regimen can be difficult for early learners and misuse of antibiotics can lead to adverse events and antimicrobial resistance. There have been few interventions that have focused on improving antibiotic decision making, as a form of therapeutic reasoning, for post-graduate trainees. We describe here an approach to aid internal medicine interns in their therapeutic reasoning, particularly when it comes to diagnosing and empirically treating infections.

METHODS: The PEST (pathology, epidemiology, severity, treatment) model was created as a four-step approach to therapeutic reasoning and choosing an appropriate antimicrobial regimen for a given infectious disease syndrome. In February 2020, we conducted two independent teaching sessions for interns on the PEST approach. We assessed pre-and post-teaching responses to five clinical vignette-based questions. Results were presented as a percentage of interns who chose an appropriate antibiotic and provided sufficient therapeutic reasoning as defined by using at least three out of the four PEST criteria. Statistical analysis occurred via Fischer’s exact test to determine the level of statistical significance between responses.

RESULTS: Twenty-seven interns participated in the activity. At baseline, several interns had incorporated aspects of the PEST approach in their pre-teaching responses. Ten interns commented on the usefulness of such a systematic approach. While there was no statistically significant difference in antibiotic selection, the teaching session demonstrated a trend towards significance in improving therapeutic reasoning as defined by the PEST strategy.

CONCLUSION: Our results suggested an improvement in using a structured cognitive tool such as the PEST approach to reinforce therapeutic reasoning, but the method did little to improve antibiotic selection. Some interns used select “PEST” concepts prior to the intervention suggesting that the PEST approach may enhance prior knowledge or clinical reasoning skills. Continued incorporation of the PEST approach using a case-based framework may solidify conceptual and practical knowledge of antimicrobial selection. Further studies are needed to assess the impact of such teaching interventions.

PMID:37149569 | DOI:10.1186/s12909-023-04286-1

BMC Surg. 2023 May 6;23(1):112. doi: 10.1186/s12893-023-01999-4.

ABSTRACT

OBJECTIVE: The management of paravebous sinus meningiomas that invade major venous sinuses is a subject of debate, particularly concerning the necessity of complete resection of the tumor and reconstruction of the venous sinus. This article aims to demonstrate the outcomes of total removal of the lesion (including the invading venous sinus portion) and the effects of restoring or not restoring venous circulation in terms of recurrence of the tumor, mortality, and post-operative complications.

METHODS: The authors conducted a study involving 68 patients with paravebous sinus meningiomas. Of the 60 parasagittal meningiomas, 23 were located in the anterior third, 30 in the middle third, and 7 in the posterior third. Additionally, 3 lesions were located in the sinus confluence area, and 5 in the transverse sinus. All patients underwent surgery, and the degree of venous sinus involvement was classified into six types. For type I meningiomas, the outer layer of the sinus wall was stripped off. For types II to VI, two strategies were employed: non-constitutional, wherein the tumor and affected venous sinuses were removed without repair, and reconstructive, wherein the tumor was completely removed and the venous sinuses were sutured or repaired. Karnofsky Performance Status (KPS) scale and Magnetic Resonance Venography (MRV) were utilized to assess the outcomes of the surgical procedures.

RESULTS: The study group of 68 patients underwent complete tumor resection in 97.1%, with sinus reconstruction attempted in 84.4% of cases with sinus wall and sinus cavity invasion. The recurrence rate of this group was 5.9%, with follow-up ranging from 33 to 57 months. It was found that the recurrence rate was significantly higher in cases with incomplete resection than in those with complete resection. The overall mortality rate was 4.4%, with all cases resulting from malignant brain swelling due to the failure to perform venous reconstruction after resectioning of the meningioma type VI. Furthermore, 10.3% of patients experienced worsening symptoms of neurological deficits or complete loss of neurological function, with a significantly higher incidence in those without venous reconstruction than in the venous reconstruction group (P < 0.0001, Fisher test). No statistically significant pre-operative and post-operative KPS differences were observed in patients with type I to V. However, in patients with type VI (who did not receive venous reconstruction), the post-operative KPS score was significantly worse.

CONCLUSION: The results of this study suggest the necessity of a complete resection of the tumor, including the invasive venous sinus component, as the recurrence rate was found to be relatively low at 5.9%. Moreover, patients who did not undergo venous reconstruction showed significant deterioration in their clinical condition compared to other subgroups, thus highlighting the importance of venous sinus reconstruction.

PMID:37149562 | DOI:10.1186/s12893-023-01999-4

J Comp Physiol B. 2023 May 7. doi: 10.1007/s00360-023-01490-9. Online ahead of print.

ABSTRACT

The gill oxygen limitation hypothesis (GOLH) suggests that hypometric scaling of metabolic rate in fishes is a consequence of oxygen supply constraints imposed by the mismatched growth rates of gill surface area (a two-dimensional surface) and body mass (a three-dimensional volume). GOLH may, therefore, explain the size-dependent spatial distribution of fish in temperature- and oxygen-variable environments through size-dependent respiratory capacity, but this question is unstudied. We tested GOLH in the tidepool sculpin, Oligocottus maculosus, a species in which body mass decreases with increasing temperature- and oxygen-variability in the intertidal, a pattern consistent with GOLH. We statistically evaluated support for GOLH versus distributed control of [Formula: see text] allometry by comparing scaling coefficients for gill surface area, standard and maximum [Formula: see text] ([Formula: see text]_,Standard and [Formula: see text]_,Max, respectively), ventricle mass, hematocrit, and metabolic enzyme activities in white muscle. To empirically evaluate whether there is a proximate constraint on oxygen supply capacity with increasing body mass, we measured [Formula: see text]_,Max across a range of Po₂s from normoxia to P_crit, calculated the regulation value (R), a measure of oxyregulatory capacity, and analyzed the R-body mass relationship. In contrast with GOLH, gill surface area scaling either matched or was more than sufficient to meet [Formula: see text] demands with increasing body mass and R did not change with body mass. Ventricle mass (b = 1.22) scaled similarly to [Formula: see text]_,Max (b = 1.18) suggesting a possible role for the heart in the scaling of [Formula: see text]_,Max. Together our results do not support GOLH as a mechanism structuring the distribution of O. maculosus and suggest distributed control of oxyregulatory capacity.

PMID:37149515 | DOI:10.1007/s00360-023-01490-9

Lifetime Data Anal. 2023 May 7. doi: 10.1007/s10985-023-09598-4. Online ahead of print.

ABSTRACT

Clustered and multivariate failure time data are commonly encountered in biomedical studies and a marginal regression approach is often employed to identify the potential risk factors of a failure. We consider a semiparametric marginal Cox proportional hazards model for right-censored survival data with potential correlation. We propose to use a quadratic inference function method based on the generalized method of moments to obtain the optimal hazard ratio estimators. The inverse of the working correlation matrix is represented by the linear combination of basis matrices in the context of the estimating equation. We investigate the asymptotic properties of the regression estimators from the proposed method. The optimality of the hazard ratio estimators is discussed. Our simulation study shows that the estimator from the quadratic inference approach is more efficient than those from existing estimating equation methods whether the working correlation structure is correctly specified or not. Finally, we apply the model and the proposed estimation method to analyze a study of tooth loss and have uncovered new insights that were previously inaccessible using existing methods.

PMID:37149514 | DOI:10.1007/s10985-023-09598-4