Category: Nevin Manimala

J Foot Ankle Surg. 2023 Feb 18:S1067-2516(23)00029-7. doi: 10.1053/j.jfas.2023.02.005. Online ahead of print.

ABSTRACT

Total ankle arthroplasty has become popular in the last few years. The lateral transfibular approach is an alternative to the traditional anterior approach. The purpose of this study was to evaluate our 50 first and consecutive clinical and radiological outcomes of transfibular total ankle replacements (Trabecular Metal Total Ankle^R Zimmer Biomet, Warsaw, IN) with a follow-up of at least 3 years. This retrospective study included 50 patients. The main indication was post-traumatic osteoarthritis (n = 41). The mean age was 59 (range = 39-81). All patients were followed for at least 36 months postoperatively. Patients were assessed with the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle Hindfoot Score and Visual analog scale (VAS) preoperatively and postoperatively. Range of motion and radiological measures were assessed as well. Postoperatively, patients demonstrated statistically significant improvement in the AOFAS score from 32 (range = 14-46) to 80 (range = 60-100) (p < .01) and VAS from 7.8 (range = 6.1-9.7) to 1.3 (range = 0-6) (p < .01). The average total range of motion increased significantly from 19.8° to 29.2° of plantarflexion and 6.8° to 13.5° of dorsiflexion. Alignment measured by alpha, beta, and gamma angles was satisfactorily achieved. No patient demonstrated any radiographic evidence of tibial or talar lucency at the final follow-up. Five patients (10%) experienced delayed wound healing. One patient (2%) developed a postoperative prosthetic infection. One patient (2%) developed fibular pseudoarthrosis and 2 patients (4%) suffered impingement. Two patients (4%) needed surgery for symptomatic fibular hardware. This study found excellent clinical and radiological results of transfibular total ankle replacement. This is a safe and effective option that allows the correction of sagittal and coronal malalignment.

PMID:36941143 | DOI:10.1053/j.jfas.2023.02.005

J Foot Ankle Surg. 2023 Feb 16:S1067-2516(23)00032-7. doi: 10.1053/j.jfas.2023.02.002. Online ahead of print.

ABSTRACT

Hindfoot osteoarthritis (OA) or deformity involving the ankle and subtalar joint is a disabling condition. Tibiotalocalcaneal (TTC) fusion is an effective salvage option in pathologies where total ankle replacement is contraindicated. The purpose of this study is to compare the union rate of the ankle joint in proximal static versus dynamically locked retrograde intramedullary nail fixation for tibiotalocalcaneal arthrodesis. An institutional review board-approved comprehensive chart and radiographic review was performed. TTC arthrodesis performed in patients with OA, post-traumatic arthritis, or deformity corrected by retrograde nail were included. Patients with Charcot arthropathy, failed joint replacement, neuropathy, or avascular necrosis were excluded. The primary outcome was ankle joint union with secondary measure of mean time to fusion. A total of 60 patients met inclusion criteria with 30 in the static group (SG) and 30 in the dynamic group (DG). The average age of the static group (SG) and dynamic group (DG) was 56.9 and 54.1 years, respectively. Mean body mass index was 34.03 kg/m² for SG and 33.43 kg/m² for DG. The union rate of the ankle joint was slightly higher in the DG but not statistically significant [SG 83.3%, DG 86.6%, p > .05 (p = .83)]. Time to fusion (TTF) in SG was 111.6 days compared to 97.2 days in DG. Dynamically locked intramedullary nails allow continued compression across the arthrodesis site as fusions remodel. Time to union and union rate of the ankle joint was superior in the dynamic group but this was not statistically significant. In this cohort, union rates were excellent in both groups, and no statistically significant difference was seen in the number of nonunions.

PMID:36941141 | DOI:10.1053/j.jfas.2023.02.002

J Surg Educ. 2023 Feb 27:S1931-7204(23)00071-5. doi: 10.1016/j.jsurg.2023.02.014. Online ahead of print.

ABSTRACT

OBJECTIVE: This study was designed to assess the effects of the coronavirus disease pandemic on job satisfaction (JS) and burnout among surgical sub-specialty residents.

DESIGN: This is a retrospective, observational, survey-based study. We administered a web-based questionnaire to surgical sub-specialty residents, and results were compared to a prior study in 2016. The questionnaire included elements on demographics, JS, burnout, and self-care habits. Basic statistical analyses were used to compare data from 2020 and 2016.

SETTING: This study takes place at Robert Wood Johnson University Hospital, a single mid-sized New Jersey-based academic institution.

PARTICIPANTS: This survey was sent to all obstetrics and gynecology and general surgery residents from every postgraduate year based out of our institution. The survey was sent to a total of 50 residents across the 2 programs. Forty total residents responded to the survey, with a response rate of 80%.

RESULTS: JS was significantly higher in 2020 than 2016 (p < 0.001). There were no differences between postgraduate years for 2020 or 2016 in emotional exhaustion (p = 0.29, p = 0.75), personal accomplishment (p = 0.88, p = 0.26), or depersonalization (p = 0.14, p = 0.59) burnout scores. A total of 0% of residents in 2020 worked fewer than 61 hours per week. Residents in 2020 exercised more (40.0% vs 21.6%), had similar alcohol usage (60%), and had similar diets to residents in 2016. Residents in 2020 were less likely to regret their specialty (7.5% vs 21.6%), consider changing residencies (30.0% vs 37.8%), or consider a career change (15.0% vs 45.9%).

CONCLUSIONS: JS scores were significantly higher during the coronavirus disease pandemic. The cancellation of elective surgeries led to a lighter workload for surgical residents. Residents were uncertain of their role during the pandemic, however, new stressors encouraged residents to seek alternative methods for personal wellness.

PMID:36941138 | DOI:10.1016/j.jsurg.2023.02.014

FEMS Microbiol Ecol. 2023 Mar 20:fiad031. doi: 10.1093/femsec/fiad031. Online ahead of print.

ABSTRACT

There is a clear need for global monitoring initiatives to evaluate the risks of antibiotic resistance genes (ARGs) towards human health. Therefore, not only ARG abundances within a given environment, but also their potential mobility, hence their ability to spread to human pathogenic bacteria needs to be quantified. We developed a novel, sequencing-independent method for assessing the linkage of an ARG to a mobile genetic element by statistical analysis of multiplexed droplet digital PCR (ddPCR) carried out on environmental DNA sheared into defined, short fragments. This allows quantifying the physical linkage between specific ARGs and mobile genetic elements, here demonstrated for the sulfonamide ARG sul1 and the Class 1 integron integrase gene intI1. The method’s efficiency is demonstrated using mixtures of model DNA fragments with either linked and unlinked target genes: Linkage of the two target genes can be accurately quantified based on high correlation coefficients between observed and expected values (R2) as well as low mean absolute errors (MAE) for both target genes, sul1 (R2 = 0.9997, MAE = 0.71%, n = 24) and intI1 (R2 = 0.9991, MAE = 1.14%, n = 24). Furthermore, we demonstrate that adjusting the fragmentation length of DNA during shearing allows controlling rates of false positives and false negative detection of linkage. The presented method allows rapidly obtaining reliable results in a labor- and cost-efficient manner.

PMID:36941120 | DOI:10.1093/femsec/fiad031

J Pediatr Orthop. 2023 Mar 17. doi: 10.1097/BPO.0000000000002392. Online ahead of print.

ABSTRACT

BACKGROUND: Best Practice Guidelines (BPGs) regarding antibiotic prophylaxis in early-onset scoliosis (EOS) patients were published in September 2019. Recommendations included using intravenous cefazolin and topical vancomycin for all index procedures, plus gram-negative coverage for neuromuscular patients. Guideline adherence is unknown. This study aimed to characterize antibiotic prophylaxis at the time of index growth-friendly procedures and assess changes in practice patterns over time.

MATERIALS AND METHODS: This retrospective review of data collected through a multicenter study group included EOS patients undergoing index growth-friendly procedures between January 2018 and March 2021, excluding revisions, lengthenings, and tetherings. Demographics, clinical measurements, intraoperative antibiotics, and 90-day complications were recorded. Descriptive and univariate statistics were utilized. Antibiotic prophylaxis from April 2018 through September 2019 and October 2019 through March 2021 were compared with evaluate change after BPG publication.

RESULTS: A total of 562 patients undergoing growth-friendly procedures were included. The most common scoliosis types included neuromuscular (167, 29.7%), syndromic (134, 23.8%), and congenital (97, 17.3%). Most index procedures involved magnetically controlled growing rods (417, 74%) followed by vertical expandable prosthetic titanium rib or traditional growing rods (105, 19%). Most patients received cefazolin alone at index procedure (310, 55.2%) or cefazolin with an aminoglycoside (113, 20.1%). Topical antibiotics were used in 327 patients (58.2%), with most receiving vancomycin powder. There was increased use of cefazolin with an aminoglycoside after BPG publication (16% vs. 25%) (P=0.01). Surgical site infections occurred in 12 patients (2.1%) within 90 days of index procedure, 10 pre-BPGs (3%), and 2 post-BPGs (0.9%), with no significant difference in surgical site infection rate by type of antibiotic administered (P>0.05).

CONCLUSIONS: Historical variability exists regarding antibiotic prophylaxis during index growth-friendly procedures for EOS. There continues to be variability following BPG publication; however, this study found a significant increase in antibiotic prophylaxis against gram-negative bacteria after BPG publication. Overall, greater emphasis is needed to decrease variability in practice, improve compliance with consensus guidelines, and evaluate BPG efficacy.

LEVEL OF EVIDENCE: Level III-retrospective.

PMID:36941112 | DOI:10.1097/BPO.0000000000002392

Women Health. 2023 Mar 20:1-12. doi: 10.1080/03630242.2023.2188097. Online ahead of print.

ABSTRACT

How individuals perceive and cope with stressful situations may determine their level of anxiety or depression. The identification of coping strategies (CS) in pregnancy could help prevent depression and anxiety (D&A), and their consequent effects on the health of the mother and the baby. A cross-sectional descriptive correlational study was conducted to identify the CS most commonly used by pregnant women in a Spanish population and to evaluate the association of these CS with D&A. A consecutive sample of 282 pregnant women over 18 years of age were recruited when attended midwife consultations and through snowball sampling between December 2019 and January 2021 in the Basque public health system. CS were measured using the RevisedPrenatal Coping Inventory (NuPCI) questionnaire, assigning the score to an avoidant, preparatory or spiritual scale. Cutoff points were established to categorize anxiety and depressive symptomatology, using the STAI-S and EPDS scales. Multivariate logistic regression models were constructed to analyze the association between CS and D&A. The results show that the higher the score on the avoidance subscale, the higher the likelihood of having an anxiety disorder (OR: 8.88 (95 percent Confidence Interval [CI] 4.26-20.1), and depressive symptoms (OR: 8.29 (95 percent CI 4.24-17.4). Multiparous women are more likely to have anxiety (OR: 3.41 (95 percent CI 1.58-7.5) or depressive symptomatology (OR: 4.1 (95 percent CI 2.04-8.53) during pregnancy. These results highlight the need to consider the evaluation of CS used during pregnancy to tailor the care provided, but further studies on the implementation and effectiveness of interventions are needed.

PMID:36941108 | DOI:10.1080/03630242.2023.2188097

P R Health Sci J. 2023 Marzo;42(1):63-69.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the effect of support given to pregnant women during labor on their perception of childbirth and their breastfeeding self-efficacy.

METHODS: This descriptive and relational study was conducted with 331 primigravid women who had a vaginal delivery in a maternity unit from December 15, 2018, to March 15, 2020. Data were collected using a descriptive characteristics form prepared by the researcher and based on the relevant literature, the Scale of Women’s Perception for Supportive Care Given During Labor (SWPSCDL), the Perception of Birth Scale (POBS), and the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF).” The data were analyzed using descriptive statistics, a t test, a variance test, and Pearson’s correlation.

RESULTS: The mean total SWPSCDL, POBS, and BSES-SF scores of the participating women were 102.19 (±14.99), 54.75 (±9.39), and 76.24 (±11.37), respectively. A positive correlation was found between supportive care for women during delivery and both women’s perceptions of childbirth and breastfeeding efficacy. In addition, training given in antenatal classes positively increased the perception of support during delivery among the women.

CONCLUSION: Supportive care given during delivery had a positive effect on the perception of childbirth and on breastfeeding self-efficacy. Interventions to encourage more couples to participate in training given at antenatal classes and to improve the working conditions of midwives working in delivery rooms would contribute to the support that pregnant women require during delivery and would provide a more positive delivery experience for these women.

PMID:36941101

P R Health Sci J. 2023 Mar;42(1):50-56.

ABSTRACT

OBJECTIVE: This study aimed to explore how umbilical cord separation time and microbial colonization are affected by umbilical cord clamping distance.

METHODS: The randomized controlled study included 99 healthy newborns and was conducted at a hospital in Kahramanmaras, Turkey. The newborns were randomly divided into 3 groups: intervention group I (cord length: 2 cm); intervention group II (cord length: 3 cm; control group (not measured). On postpartum day 7, a sample of the umbilical cord was taken to assess microbial colonization. The mothers were contacted via mobile phone on the 20th day for an at-home follow-up. The data were analyzed by applying Pearson’s chi-square test, Fisher’s exact test, a 1-way analysis of variance test, and Tukey’s post hoc Honest Significant Difference test.

RESULTS: The mean umbilical cord separation time of the newborns was found to be 6.9 (±2.1) days in the intervention group I, 8.8 (±2.9) days in the intervention group II, and 9.5 (±3.4) days in the control group. The difference between the groups was statistically significant (P < .01). Microbial colonization was detected in 5 of the newborns, across the groups; no significant differences were found between the groups (P > .05).

CONCLUSION: In this study, it was determined that clamping the umbilical cord from a distance of 2 cm in vaginally delivered full-term newborns contributed to the shortening of the cord fall time and did not affect microbial colonization.

PMID:36941099

P R Health Sci J. 2023 Mar;42(1):35-42.

ABSTRACT

OBJECTIVE: Evidence supports the local application of non-steroidal antiinflammatory drugs such as dexketoprofen trometamol (DXT) for pain management, but little is known about the potential antinociceptive effect of chlorhexidine gluconate (CHX) and its possible synergistic effect when combined with DXT. The aim of this study was to evaluate the local effect of a DXT-CHX combination using isobolographic analysis in a formalin pain model in rats.

MATERIALS AND METHODS: Briefly, 60 female Wistar rats were used for the formalin test. Individual dose effect curves were obtained using linear regression. For each drug, the percentage of antinociception and median effective dose (ED50; 50% of antinociception) were calculated, and drug combinations were prepared using the ED50s for DXT (phase 2) and CHX (phase 1). The ED50 of the DXT-CHX combination was determined, and an isobolographic analysis was performed for both phases.

RESULTS: The ED50 of local DXT was 5.3867 mg/mL in phase 2 and for CHX was 3.9233 mg/mL in phase 1. When the combination was evaluated, phase 1 showed an interaction index (II) of less than 1, indicating synergism but without statistical significance. For phase 2, the II was 0.3112, with a reduction of 68.88% in the amounts of both drugs to obtain the ED50; this interaction was statistically significant (P < .05).

CONCLUSION: DXT and CHX had a local antinociceptive effect and exhibited synergistic behavior when combined in phase 2 of the formalin model.

PMID:36941097

P R Health Sci J. 2023 Mar;42(1):3-9.

ABSTRACT

OBJECTIVE: The mortality rate of schizophrenia patients is higher than that of the general population; cardiovascular disease (CVD) is their leading cause of death. This issue must be studied since people with schizophrenia are disproportionately burdened with CVD. Therefore, our goal was to identify the prevalence of CVD and other comorbidities, stratified by age and gender, in patients with schizophrenia living in Puerto Rico.

METHODS: A retrospective, case-control, descriptive study was conducted. Subjects in this study were admitted to Dr. Federico Trilla’s hospital from 2004 through 2014 for both psychiatric- and non psychiatric conditions. The sample populations were stratified by the confounding variables of tobacco use and alcohol abuse, and the resulting stratification was analyzed with the Cochran-Mantel-Haenszel method.

RESULTS: A higher frequency of CVDs was noted in the patients with schizophrenia compared to those in the control group. Although hypertension was the most frequent pathology encountered in both groups, ischemic heart disease was approximately four times more frequent in the patients with schizophrenia. CVD represented 58.4% and 52.7% in the schizophrenia and non-schizophrenia groups, respectively, although a statistically significant difference was not observed. The prevalence of malignancies in patients without schizophrenia was higher than in patients with schizophrenia. Moreover, the prevalence of asthma was 10.9% in the control group compared to 5.3% in the schizophrenia group.

CONCLUSION: These findings should motivate a systematic approach to prioritizing the aggressive management, early diagnosis, and prevention of comorbid risk factors in patients with schizophrenia.

PMID:36941092