Category: Nevin Manimala

Acta Psychiatr Scand. 2023 Apr 26. doi: 10.1111/acps.13561. Online ahead of print.

ABSTRACT

INTRODUCTION: Use of antipsychotic drugs, especially second-generation agents, has been suggested to cause acute pancreatitis in multiple case reports; however, such an association has not been corroborated by larger studies. This study examined the association of antipsychotic drugs with risk of acute pancreatitis.

METHODS: Nationwide case-control study, based on data from several Swedish registers and including all 52,006 cases of acute pancreatitis diagnosed in Sweden between 2006 and 2019 (with up to 10 controls per case; n = 518,081). Conditional logistic regression models were used to calculate odds ratios (ORs) in current and past users of first-generation and second-generation antipsychotic drugs (dispensed prescription <91 and ≥91 days of the index date, respectively) compared with never users of such drugs.

RESULTS: In the crude model, first-generation and second-generation antipsychotic drugs were associated with increased risk of acute pancreatitis, with slightly higher ORs for past use (1.58 [95% confidence interval 1.48-1.69] and 1.39 [1.29-1.49], respectively) than for current use (1.34 [1.21-1.48] and 1.24 [1.15-1.34], respectively). The ORs were largely attenuated in the multivariable model-which included, among others, alcohol abuse and the Charlson comorbidity index-up to the point where only a statistically significant association remained for past use of first-generation agents (OR 1.18 [1.10-1.26]).

CONCLUSION: There was no clear association between use of antipsychotic drugs and risk of acute pancreatitis in this very large case-control study, indicating that previous case report data are most likely explained by confounding.

PMID:37100434 | DOI:10.1111/acps.13561

Acta Psychiatr Scand. 2023 Apr 26. doi: 10.1111/acps.13556. Online ahead of print.

NO ABSTRACT

PMID:37100433 | DOI:10.1111/acps.13556

Int J Sports Physiol Perform. 2023 Apr 26:1-8. doi: 10.1123/ijspp.2022-0458. Online ahead of print.

ABSTRACT

BACKGROUND: The development and influence of physical capabilities and game action performance over the course of the season are a big challenge for coaches and players.

PURPOSE: The aims of the present study were to examine (1) the seasonal changes in the physical capabilities (mechanical and kinematic) and game-performance indicators in top-level men volleyball players and (2) the relationship between these physical capabilities and game-performance indicators in official matches.

METHODS: Eleven top-level players participated. Players were physically tested 3 times during the season. Before each test, players’ match performance (11 sets) was analyzed according to the level of opposition and match location. The percentage of change, statistical differences over the season (Friedman and Wilcoxon tests), and associations between variables (Spearman r) were calculated (P < .05) among mechanical (force-velocity profile during vertical jump and bench press), kinematic (jump height and spike ball speed), and game action performance features (coefficient, efficacy, and percentage of errors in serve, attack, and block).

RESULTS: The theoretical maximal force and velocity during vertical jump and bench press, respectively; the peak spike ball speed; and the serve efficacy significantly increased over the season. Moreover, there was a significant reduction in serve errors as the jump height increased (r = -.44; P = .026), as well as a significant increase in serve errors as the peak spike ball speed increased (r = -.62; P = .001).

CONCLUSION: These findings reveal how the physical and game action performance variables evolve and interact during the season. This may help coaches and trainers to monitor and analyze the most relevant volleyball performance factors.

PMID:37100426 | DOI:10.1123/ijspp.2022-0458

Global Spine J. 2023 Apr 26:21925682231172431. doi: 10.1177/21925682231172431. Online ahead of print.

NO ABSTRACT

PMID:37100407 | DOI:10.1177/21925682231172431

Environ Anal Health Toxicol. 2023 Mar;38(1):e2023006-0. doi: 10.5620/eaht.2023006. Epub 2023 Mar 23.

ABSTRACT

Recent studies reported bisphenol A (BPA) and propyl paraben (PrP) are found in human urine, blood, and breast milk samples as well as in food, packaging, socks, and clothes. This means that the two chemicals co-exist in consumer products, and humans are exposed simultaneously to the mixture chemicals. However, the studies on the mixture effects of the two chemicals on human health are not enough. This study was designed to elucidate the effects of orally administered PrP, BPA, and their mixture effects on the uterotrophic response using ovariectomized rats. In addition, the correlation between the uterotrophic response and tissue concentrations of the two chemicals was studied to investigate whether one chemical has any effect on the absorption, distribution, or excretion of the other chemical. Histopathology, hematology, and plasma biochemistry analysis were also performed to evaluate the chemicals’ toxicological effects in the treated rats. Although a significant increase in uterus weight (absolute and relative) was observed in the positive chemical (17β-estradiol) treated group, there were no statistical differences in the uterus weight between the vehicle control and the chemical-treated groups. However, a slight increase in the endometrial glands and a change in the cuboidal to columnar epithelium of the endometrial epithelium were observed in the mixture-treated group. There was no significant toxicity in all treated groups by the hematology and plasma biochemistry analysis results. The results of tissue distribution showed that BPA was mostly detected in the liver while PrP was not detected in most tissues, and the BPA level was higher when the rats were treated with PrP than without PrP, suggesting that PrP may increase the absorption of BPA after oral administration.

PMID:37100401 | DOI:10.5620/eaht.2023006

Curr Probl Cardiol. 2023 Apr 24:101746. doi: 10.1016/j.cpcardiol.2023.101746. Online ahead of print.

ABSTRACT

AIM: This study aimed to assess the association between aortic valve calcification and lipoprotein (a).

METHODS: We searched PUBMED, WOS, and SCOPUS databases. Inclusion criteria were any controlled clinical trials or observational studies that reported the level of Lipoprotein A in patients with aortic valve calcifications, excluding case reports, editorials and animal studies. RevMan software (5.4) was used to perform the meta-analysis.

RESULTS: After complete screening, 7 studies were included with a total number of 446179 patients included in the analysis. The pooled analysis showed a statistically significant association between the incidence of aortic valve calcium and increased levels of lipoprotein (a) compared with controls (SMD = 1.71, 95% CI = 1.04 to 2.38, p-value < 0.00001).

CONCLUSION: This meta-analysis showed a statistically significant association between the incidence of aortic valve calcium and increased levels of lipoprotein (a) compared with controls. Patients with high levels of lipoprotein (a) are at increased risk of developing aortic valve calcification. Medications targeting lipoprotein (a) in future clinical trials may be useful in primary prevention of aortic valve calcification in high risk patients.

PMID:37100357 | DOI:10.1016/j.cpcardiol.2023.101746

Am J Infect Control. 2023 Apr 24:S0196-6553(23)00335-8. doi: 10.1016/j.ajic.2023.04.165. Online ahead of print.

ABSTRACT

BACKGROUND: Surgical site infection (SSI) surveillance is a labor-intensive endeavor. We present the design and validation of an algorithm for SSI detection after hip replacement surgery, and a report of its successful implementation in four public hospitals in Madrid, Spain.

METHODS: We designed a multivariable algorithm, AI-HPRO, using natural language processing (NLP) and extreme gradient-boosting to screen for SSI in patients undergoing hip replacement surgery. The development and validation cohorts included data from 19661 healthcare episodes from four hospitals in Madrid, Spain.

RESULTS: Positive microbiological cultures, the text variable “infection”, and prescription of clindamycin were strong markers of SSI. Statistical analysis of the final model indicated high sensitivity (99.18%) and specificity (91.01%) with a F1-score of 0.32, AUC of 0.989, accuracy of 91.27% and NPV of 99.98%.

DISCUSSION: Implementation of the AI-HPRO algorithm has reduced surveillance time from 975 person/hours to 63.5 person/hours and has permitted an 88.95% reduction in total volume of clinical records to be reviewed manually. The model presents a higher NPV (99.98%) than algorithms relying on NLP alone (94%) or NLP and logistic regression (97%).

CONCLUSIONS: This is the first report of an algorithm combining NLP and extreme gradient-boosting to permit accurate, real-time orthopedic SSI surveillance.

PMID:37100291 | DOI:10.1016/j.ajic.2023.04.165

Spine J. 2023 Apr 24:S1529-9430(23)00171-7. doi: 10.1016/j.spinee.2023.04.013. Online ahead of print.

ABSTRACT

BACKGROUND CONTEXT: Surgical invasiveness indices have been established for general spine surgery (surgical invasiveness index [SII]), spine deformity, and metastatic spine tumors; however, a specific index for thoracic spinal stenosis (TSS) has not been developed.

PURPOSE: To develop and validate a novel invasiveness index incorporating TSS-specific factors for open posterior TSS surgery, which may facilitate the prediction of operative duration and intraoperative blood loss, and the stratification of surgical risk.

STUDY DESIGN: A retrospective observational study.

PATIENT SAMPLE: Overall, 989 patients who underwent open posterior TSS surgeries at our institution during the past 5 years were included.

OUTCOME MEASURES: The operation duration, estimated blood loss, transfusion status, major surgical complications, length of hospital stay, and medical expenses.

METHODS: We retrospectively analyzed the data of 989 consecutive patients who underwent posterior surgery for TSS between March 2017 and February 2022. Among them, 70% (n = 692) were randomly placed in a training cohort, and the remaining 30% (n = 297) automatically constituted the validation cohort. Multivariate linear regression models of operative time and log-transformed estimated blood loss were created using TSS-specific factors. Beta coefficients derived from these models were used to construct a TSS invasiveness index (TII). The ability of the TII to predict surgical invasiveness was compared with that of the SII and assessed in a validation cohort.

RESULTS: The TII was more strongly correlated with operative time and estimated blood loss (P < 0.05) and explained more variability in operative time and estimated blood loss than the SII (P < 0.05). The TII explained 64.2% of operative time and 34.6% of estimated blood loss variation, whereas the SII explained 38.7% and 22.5%, respectively. In further verification, the TII was more strongly associated with transfusion rate, drainage time, and length of hospital stay than SII (P < 0.05).

CONCLUSION: By incorporating TSS-specific components, the newly developed TII more accurately predicts the invasiveness of open posterior TSS surgery than the previous index.

PMID:37100245 | DOI:10.1016/j.spinee.2023.04.013

Arthroscopy. 2023 Apr 24:S0749-8063(23)00304-3. doi: 10.1016/j.arthro.2023.03.028. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate symptom duration and its relationship to patient reported outcomes and survivorship following hip arthroscopy in adolescents.

METHODS: Patients ≤18 at time of primary hip arthroscopy for FAI between January 2011 and September 2018 were included. Exclusion criteria consisted of history of previous ipsilateral hip surgery, presence of osteoarthritis or dysplasia on preoperative radiographs, previous hip fracture, or history of slipped capital femoral epiphysis or Legg-Calve-Perthes disease. Minimum 2-year patient-reported outcomes (modified Harris Hip Score (mHHS), Hip Outcome Score (HOS)-Activities of Daily Living (ADL), HOS-Sport Scale (SSS), Short Forms 12 (SF-12)), minimum clinically significant difference (MCID) and patient acceptable symptom state (PASS) rates, and revision surgery rates, were compared based on symptom duration.

RESULTS: Two-year minimal follow-up was obtained for 111 patients (134 hips) (80%), including 74 females and 37 males with mean age of 16.4±1.1 (range: 13.0-18.0). The mean symptom duration was 17.2±15.2 months (range: 43 days to 6.0 years). Ten patients (11 hips), 6 females (7 hips) and 4 males, required revision surgery at an average of 2.3±1.0 years (range, 0.9 to 4.3 years). At a mean follow-up of 4.8±2.2 years (range, 2 to 10 years), there were statistically significant improvements in all PROs (p<.05 for all). Symptom duration showed no significant correlation to post-operative scores (correlation coefficient range: -0.162 to -.078, p>0.05 for all). Symptom duration <12 months versus >12 months or as a continuous variable was not a predictor for requiring revision surgery or achieving MCID/PASS (95% Confidence Interval crosses 1 for all).

CONCLUSION: In an adolescent cohort of symptomatic FAI patients who underwent hip arthroscopy, there is no difference in patient reported outcome measures when analyzing symptom duration by arbitrary time intervals or as a continuous variable.

PMID:37100216 | DOI:10.1016/j.arthro.2023.03.028

Arthroscopy. 2023 Apr 24:S0749-8063(23)00303-1. doi: 10.1016/j.arthro.2023.03.027. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study is to 1) report on trends in immediate procedure reimbursement, patient out-of-pocket expenditures, and surgeon reimbursement in hip arthroscopy 2) compare trends in ambulatory surgery centers (ASC) versus outpatient hospitals (OH) utilization, 3) quantify the cost differences (if any) associated with ASC versus OH settings, and 4) determine the factors that predict ASC utilization for hip arthroscopy.

METHODS: The cohort for this descriptive epidemiology study was any patient over 18 years identified in the IBM MarketScan Commercial Claims Encounter database who underwent an outpatient hip arthroscopy, identified by Current Procedural Terminology codes, in the U.S. from 2013 to 2017. Immediate procedure reimbursement, patient out-of-pocket expenditure, and surgeon reimbursement were calculated, and a multivariable model was utilized to determine the influence of specific factors on these outcome variables. Statistically significant p-values were less than 0.05 and significant standardized differences were more than 0.1.

RESULTS: The cohort included 20,335 patients. An increasing trend in ASC utilization was observed (p=0.001), and ASC utilization for hip arthroscopy was 32.4% in 2017. Patient out-of-pocket expenditures for femoroacetabular impingement surgery increased 24.3% over the study period (p=0.003), which was higher than the rate for immediate procedure reimbursement (4.2%, p=0.007). ASCs were associated with $3310 (28.8%, p=0.001) reduction in immediate procedure reimbursement and $47 (6.2%, p=0.001) reduction in patient out-of-pocket expenditure per hip arthroscopy.

CONCLUSION: ASCs provide a significant cost difference for hip arthroscopy. While there is an increasing trend towards ASC utilization, it remains relatively low at 32.4% in 2017. Thus, there are opportunities for expanded ASC utilization, which is associated with significant immediate procedure reimbursement difference of $3,310 and patient out-of-pocket expenditure difference of $47 per hip arthroscopy case, ultimately benefiting healthcare systems, surgeons and patients alike.

PMID:37100212 | DOI:10.1016/j.arthro.2023.03.027