Category: Nevin Manimala

Ultrasound Q. 2023 Jan 26. doi: 10.1097/RUQ.0000000000000635. Online ahead of print.

ABSTRACT

This study aims to evaluate the accuracy of the semiautomatic planimetric measurement (SAPM) method and the necessity of manually adjusted boundary measurement in 3-dimensional ultrasound measurement of plaque volume. A total of 50 patients with 82 plaques in the common carotid arteries between December 2020 and March 2021 were included in this study. Two observers measured the 3-dimensional volume of plaque for each patient in 3 different methods (contour tracing method [CTM], SAPM method without manually adjusted boundary [SAPM1], and SAPM method with manually adjusted boundary [SAPM2]). The difference in measurement time between the 3 methods was evaluated by Kruskal-Wallis H test. Intraclass correlation coefficient and 95% confidence interval were used to evaluate the intraobserver and interobserver reliability of the 3 measurement modes. The Bland-Altman analysis was used to assess the agreement, which was expressed as the mean difference with the 95% limits of agreement (LOA). The difference in measurement time between the 3 methods was statistically significant (P < 0.001). Both observers’ intraobserver and interobserver reliability showed well in the 3 methods (all of the intraclass correlation coefficients were >0.75). The mean differences of the plaque volume measurement were 38.17, 26.42, and 11.75 mm3, respectively. The agreement between CTM and SAPM2 was the best, and LOA was -57.00 to 80.51. The agreement between SAPM1 and SAPM2 and the agreement between SAPM1 and CTM were similar, and the LOAs were -126.10 to 202.40 and -158.00 to 210.80, respectively. The SAPM method may be recommended to measure plaque volume in clinical practice.

PMID:36716417 | DOI:10.1097/RUQ.0000000000000635

Am J Forensic Med Pathol. 2023 Jan 25. doi: 10.1097/PAF.0000000000000810. Online ahead of print.

ABSTRACT

Volatile chemicals can be relevant in the determination of the cause and manner of death by forensic pathologists. Isopropanol is a secondary alcohol that is occasionally seen on postmortem toxicology testing. A series of 11 forensic autopsy cases was previously reported in which the presence of isopropanol in the vitreous humor was suspected to be due to postmortem contamination from the body preparation process for tissue procurement.In collaboration with a tissue procurement agency, donor vitreous humor was collected from one eye before body preparation for procurement and from the other eye postpreparation. The specimens underwent testing for volatile substances by headspace gas chromatography.Of the 50 cases, 8 (16%) showed statistically significant changes in the prepreparation and postpreparation isopropanol concentrations. Postpreparation isopropanol concentrations ranged from 5 to 104 mg/dL (median, 18 mg/dL). Seven of the 8 cases had undetectable prepreparation isopropanol, whereas the remaining case had a detectable prepreparation isopropanol.In conclusion, surface contamination of the decedent’s body with chemicals used in body preparation can lead to the passive absorption into the body, resulting in the presence of isopropanol in postmortem toxicology samples. Forensic pathologists need to be aware of this when interpreting postmortem samples after tissue procurement.

PMID:36716410 | DOI:10.1097/PAF.0000000000000810

Am J Forensic Med Pathol. 2023 Jan 27. doi: 10.1097/PAF.0000000000000814. Online ahead of print.

ABSTRACT

Data derived from death certificates (DCs) is an important resource for mortality statistics, disease surveillance, and the creation of public health policies. This study involved the review of COVID-19 DCs occurring during the normal course of DC review for cremation approval purposes in a medical examiner office. During the review process since the occurrence of the pandemic, it was noticed that a significant percentage of COVID-19 DCs being reviewed did not include any comorbid conditions as contributing to death, despite reports, both within the medical literature and within the media, that suggested that most deaths occur in people with known risk factors. The study involved medical record review for COVID-19 DCs that did not list any comorbid conditions. The results indicated that a vast majority of such cases did, in fact, have significant comorbid conditions, such that they should have been listed on the DCs.

PMID:36716405 | DOI:10.1097/PAF.0000000000000814

Dis Colon Rectum. 2023 Jan 24. doi: 10.1097/DCR.0000000000002700. Online ahead of print.

ABSTRACT

BACKGROUND: A subset of chronic anal fissures beget focal infection, leading to concomitant fistula. The optimal management of fissure associated fistula is unknown.

OBJECTIVE: We sought to characterize healing rates and effect of fistulotomy in fissure associated fistula.

DESIGN: Retrospective study.

SETTING: Urban tertiary center.

PATIENTS: Adults who underwent fistulotomy for a fistula associated with a chronic anal fissure. Crohn’s disease, history of lateral internal sphincterotomy, and fistula not amenable to fistulotomy were excluded.

INTERVENTIONS: Patients were managed with fistulotomy. Fissures were otherwise managed conservatively with a step-up approach.

MAIN OUTCOME MEASURES: The primary endpoint was healing, defined as resolution of symptoms and both fistula and fissure wounds within one year. Subgroup analysis compared those who underwent subcutaneous fistulotomy (group A) versus fistulotomy involving anal sphincter fibers (group B).

RESULTS: Twenty-four of 38 patients (63%) patients healed with a median overall follow-up of 6.6 months (4.2-14.1). The overall median time to healing was 4.4 months (2.2-6.0). No clinical or pathologic factors predicted healing. In subgroup analysis, overall subcutaneous fistulotomy healing rates were non-statically lower at 46% (6/13) compared to fistulotomy involving anal sphincter fibers at 72%, (18/25; p = 0.16). There was no difference in time to healing [Subcutaneous fistulotomy 6.7 months (5.2-8.4) vs. Fistulotomy involving sphincter 5.1 months (2.1-7.0); p = 0.36].

LIMITATIONS: Treatment bias, with increased utilization of chemical sphincter relaxing agents in those who did not heal. Not applicable to complex fistulas, Crohn’s disease, or atypical fissures.

CONCLUSIONS: Patients presenting with chronic fissure and associated subcutaneous, intersphincteric, or low transphincteric fistula are successfully managed with fistulotomy. Patients with a subcutaneous fistula tract exhibited non-statistically significant lower rates of healing. See Video Abstract at http://links.lww.com/DCR/C145.

PMID:36716394 | DOI:10.1097/DCR.0000000000002700

J Speech Lang Hear Res. 2023 Jan 30:1-10. doi: 10.1044/2022_JSLHR-22-00296. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with hemorrhagic stroke have high mortality and disability rates. Nevertheless, early rehabilitation interventions can improve their outcomes. We aimed to apply capsaicin atomization as early intervention to patients with hemorrhagic stroke and explore improvements in cough and swallowing functions.

METHOD: Patients with hemorrhagic stroke were randomly divided into the control group, which received routine care, and the intervention group, which underwent the capsaicin solution nebulization scheme in addition to routine care. Differences in the presence/absence of cough reflex and number of coughs in response to capsaicin, the presence/absence of swallowing reflex in response to water, the presence/absence of postswallow residue, substance P (SP) concentration, and pulmonary inflammation between the two groups were determined before and after the intervention.

RESULTS: A total of 53 patients with hemorrhagic stroke were included. Results showed no statistically significant difference in cough reflex in both groups after the intervention (p > .05). The degree of cough in the intervention group was stronger than that in the control group (p = .046). No statistically significant difference was observed in the number of patients with swallowing reflex in response to water between the groups (p > .05). The presence/absence of postswallow residue of the intervention group was stronger than that of the control group (p = .032). No statistically significant difference was observed between the Glasgow Coma Scale scores of the groups after the intervention (p > .05). SP in the intervention group was significantly increased (p = .031). The Clinical Pulmonary Infection Score was significantly lower in the control group, and the difference was statistically significant (p = .028).

CONCLUSIONS: Capsaicin nebulization can help enhance the number of coughs in response to capsaicin, reduce postswallow residue, and increase the level of SP in patients with hemorrhagic stroke and has a positive effect on pulmonary inflammation. This study provides intervention points for cough and swallowing rehabilitation after a hemorrhagic stroke.

SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21956903.

PMID:36716393 | DOI:10.1044/2022_JSLHR-22-00296

Spine (Phila Pa 1976). 2023 Jan 30. doi: 10.1097/BRS.0000000000004586. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective Cohort.

OBJECTIVE: To compare health related quality of life (HRQoL) outcomes between approach techniques for the treatment of multilevel degenerative cervical myelopathy (DCM).

SUMMARY OF BACKGROUND DATA: Both anterior and posterior approaches for the surgical treatment of cervical myelopathy are successful techniques in the treatment of myelopathy. However, the optimal treatment has yet to be determined, especially for multilevel disease, as the different approaches have separate complication profiles and potentially different impacts on HRQoL metrics.

METHODS: Retrospective review of a prospectively managed single institution database of patient reported outcome measures following three- and four-level anterior cervical discectomy and fusion (ACDF) and posterior cervical decompression and fusion (PCDF) for DCM. The electronic medical record was reviewed for patient baseline characteristics and surgical outcomes while preoperative radiographs were analyzed for baseline cervical lordosis and sagittal balance. Univariate and multivariate statistical analyses were performed to compare the two groups.

RESULTS: We identified 153 patients treated by ACDF and 43 patients treated by PCDF. Patients in the ACDF cohort were younger (60.1±9.8 vs. 65.8±6.9 y, P<0.001), had a lower overall comorbidity burden (CCI: 2.25±1.61 vs. 3.07±1.64, P=0.002), and were more likely to have a three-level fusion (79.7% vs. 30.2%, P<0.001), myeloradiculopathy (42.5% vs. 23.3%, P=0.034), and cervical kyphosis (25.7% vs. 7.69%, P=0.027). Patients undergoing an ACDF had significantly more improvement in their neck disability index (NDI) after surgery (-14.28 vs. -3.02, P=0.001), and this relationship was maintained on multivariate analysis with PCDF being independently associated with a worse NDI (+8.83, P=0.025). Patients undergoing an ACDF also experienced more improvement in visual analog score neck pain after surgery (-2.94 vs. -1.47, P=0.025) by univariate analysis.

CONCLUSION: Patients receiving an ACDF for multilevel DCM may experience a HRQoL improvement compared to those receiving a PCDF.

PMID:36716386 | DOI:10.1097/BRS.0000000000004586

Rhinology. 2023 Jan 30. doi: 10.4193/Rhin22.200. Online ahead of print.

ABSTRACT

BACKGROUND: The SYNAPSE study (NCT03085797) demonstrated that mepolizumab decreased nasal polyp (NP) size and nasal obstruction in patients with chronic rhinosinusitis with NP (CRSwNP).

METHODS: SYNAPSE, a randomized, double-blind study, included patients with recurrent, refractory, severe CRSwNP, eligible for repeated surgery despite receiving standard of care (SoC). Patients received 4-weekly mepolizumab 100 mg or placebo subcutaneously plus SoC for 52 weeks. This post hoc analysis further characterized treatment responses and association with patient characteristics. The proportion of patients meeting any and each of five response criteria indicating improvement in disease-specific quality of life, NP size, nasal obstruction, loss of smell, and overall symptoms at Weeks 24 and 52, were assessed in subgroups: 1) no surgery; 2) neither surgery nor systemic corticosteroids (SCS).

RESULTS: Of 407 patients in the intention-to-treat population, 381 and 343 patients had no sinus surgery by Weeks 24 and 52, respectively. More mepolizumab- versus placebo-treated patients without surgery by Weeks 24 and 52 met each response criteria. Of the mepolizumab-treated patients without surgery by Week 24, 109 (55%) responded across ≥ 3 criteria, increasing to 126 (67%) by Week 52. Similar response trends were seen for patients with neither surgery nor SCS by Weeks 24 and 52. At either timepoint, there were no major differences in baseline characteristics between mepolizumab-treated full- (5/5 categories) and non-responders (0/5 categories).

CONCLUSIONS: Most patients who completed SYNAPSE required neither surgery nor SCS use and in addition achieved a progressive and sustained clinical response to mepolizumab underscoring the therapeutic benefits of mepolizumab in severe CRSwNP.

PMID:36716382 | DOI:10.4193/Rhin22.200

West Afr J Med. 2023 Jan 30;40(1):60-66.

ABSTRACT

BACKGROUND: Globally, 36 million people are blind and 217 million people have moderate or severe distance vision impairment. Eighty-nine percent of vision impaired people live in low and middle-income countries. To prevent progression to blindness, there is need for early diagnosis and referral for treatment. At the heart of this are the Family Physicians who are the first port of call for our teeming population.

OBJECTIVE: The main aim of this study is to assess the ophthalmic knowledge base of Family Physicians and level of utilization of skills acquired during the ophthalmology rotation in their day-to-day practice.

METHODS: A cross-sectional descriptive survey was conducted. A self-administered questionnaire was filled by all consenting Family Physicians in 4 hospitals in 2 states. It included self-assessment section on knowledge, ophthalmic skills and open-ended questions on suggestions. On the spot assessment of available ophthalmic equipment was made.

RESULTS: A response rate of 57.9% was obtained. Respondents are graduates from 14 states across the country; mostly in Northern Nigeria 61(87.1%) and 65.6% from University of Jos. There was no statistically significant difference between the level of practice and comfort in managing ophthalmic conditions (p = 0.949). Respondents made suggestions on training, duration and equipment.

CONCLUSION: Despite good rating in managing ophthalmic conditions, only one of the 4 hospitals had ophthalmic equipment. There is a need to objectively measure Family Physicians’ ophthalmic skills to ensure that eye patients seen first by Family Physicians receive appropriate treatment.

PMID:36716338

PLoS One. 2023 Jan 30;18(1):e0281066. doi: 10.1371/journal.pone.0281066. eCollection 2023.

ABSTRACT

BACKGROUND: Birth injury is harm that a baby suffers during the entire birth process. It includes both birth asphyxia and birth trauma. In Ethiopia, birth injury has become the leading cause of neonatal morbidity and mortality, accounting around 28%-31.6% of neonatal mortality. The study aimed to assess the prevalence and factors associated with birth injuries among newborns delivered in public hospitals Addis Ababa, Ethiopia, 2021.

METHODS: Institution based cross-sectional study was conducted from February 15th to April 20th, 2021 in selected public hospitals of Addis Ababa, Ethiopia. Random sampling and systematic random sampling were used. Data was entered by using Epi data version 4.0.2 and exported in to SPSS Software version 25 for analysis. Both bivariate and multivariable logistic regressions analyses were used. Finally P-value <0.05 was used to claim statistically significant.

RESULT: The prevalence of birth injury was 24.7%. In the final model, birth asphyxia was significantly associated with the short height of the mothers (AOR = 10.7, 95% CI: 3.59-32.4), intrapartal fetal distress (AOR = 4.74, 95% CI: 1.81-12.4), cord prolapse (AOR = 7.7. 95% CI: 1.45-34.0), tight nuchal cord (AOR = 9.2. 95% CI: 4.9-35.3), birth attended by residents (AOR = 0.19, 95% CI: 0.05-0.68), male sex (AOR = 3.84, 95% CI: 1.30-11.3) and low birth weight (AOR = 5.28, 95% CI: 1.58-17.6). Whereas, birth trauma was significantly associated with gestational diabetic mellitus (AOR = 5.01, 95% CI: 1.38-18.1), prolonged duration of labor (AOR = 3.74, 95% CI: 1.52-9.20), instrumental delivery (AOR = 10.6, 95% CI: 3.45-32.7) and night time birth (AOR = 4.82, 95% CI: 1.84-12.6).

CONCLUSION: The prevalence of birth injury among newborns has continued to increases and become life-threatening issue in the delivery and neonatal intensive care unit in the study area. Therefore, considering the prevailing factors, robust effort has to be made to optimize the quality obstetric care and follow up and emergency obstetrics team has to be strengthened to reduce the prevalence of birth injury.

PMID:36716337 | DOI:10.1371/journal.pone.0281066

PLoS Comput Biol. 2023 Jan 30;19(1):e1010813. doi: 10.1371/journal.pcbi.1010813. Online ahead of print.

ABSTRACT

The advent of comprehensive synaptic wiring diagrams of large neural circuits has created the field of connectomics and given rise to a number of open research questions. One such question is whether it is possible to reconstruct the information stored in a recurrent network of neurons, given its synaptic connectivity matrix. Here, we address this question by determining when solving such an inference problem is theoretically possible in specific attractor network models and by providing a practical algorithm to do so. The algorithm builds on ideas from statistical physics to perform approximate Bayesian inference and is amenable to exact analysis. We study its performance on three different models, compare the algorithm to standard algorithms such as PCA, and explore the limitations of reconstructing stored patterns from synaptic connectivity.

PMID:36716332 | DOI:10.1371/journal.pcbi.1010813