Category: Nevin Manimala

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

PLoS One. 2023 Jan 30;18(1):e0280657. doi: 10.1371/journal.pone.0280657. eCollection 2023.

ABSTRACT

INTRODUCTION: Most strategies for prevention of venous thromboembolism focus on preventing recurrent events. Yet, primary prevention might be possible through approaches targeting the whole population or high-risk patients. To inform possible prevention strategies, population-based information on the ability of genetic risk scores to identify risk of incident venous thromboembolism is needed.

MATERIALS AND METHODS: We used proportional hazards regression to relate two published genetic risk scores (273-variants versus 5-variants) with venous thromboembolism incidence in the Atherosclerosis Risk in Communities Study (ARIC) cohort (n = 11,292), aged 45-64 at baseline, drawn from 4 US communities.

RESULTS: Over a median of 28 years, ARIC identified 788 incident venous thromboembolism events. Incidence rates rose more than two-fold across quartiles of the 273-variant genetic risk score: 1.7, 2.7, 3.4 and 4.0 per 1,000 person-years. For White participants, age, sex, and ancestry-adjusted hazard ratios (95% confidence intervals) across quartiles were strong [1 (reference), 1.30 (0.99,1.70), 1.85 (1.43,2.40), and 2.58 (2.04,3.28)] but weaker for Black participants [1, 1.05 (0.63,1.75), 1.37 (0.84,2.22), and 1.32 (0.80,2.20)]. The 5-variant genetic risk score showed a less steep gradient, with hazard ratios in Whites of 1, 1.17 (0.89,1.54), 1.48 (1.14,1.92), and 2.18 (1.71,2.79). Models including the 273-variant genetic risk score plus lifestyle and clinical factors had a c-statistic of 0.67.

CONCLUSIONS: In the general population, middle-aged adults in the highest quartile of either genetic risk score studied have approximately two-fold higher risk of an incident venous thromboembolism compared with the lowest quartile. The genetic risk scores show a weaker association with venous thromboembolism for Black people.

PMID:36716319 | DOI:10.1371/journal.pone.0280657

PLoS One. 2023 Jan 30;18(1):e0280744. doi: 10.1371/journal.pone.0280744. eCollection 2023.

ABSTRACT

This prospective quasi-experimental study from the NASAM (National Approach to Standardize and Improve Mechanical Ventilation) collaborative assessed the impact of evidence-based practices including subglottic suctioning, daily assessment for spontaneous awakening trial (SAT), spontaneous breathing trial (SBT), head of bed elevation, and avoidance of neuromuscular blockers unless otherwise indicated. The study outcomes included VAE (primary) and intensive care unit (ICU) mortality. Changes in daily care process measures and outcomes were evaluated using repeated measures mixed modeling. The results were reported as incident rate ratio (IRR) for each additional month with 95% confidence interval (CI). A comprehensive program that included education on evidence-based practices for optimal care of mechanically ventilated patients with real-time benchmarking of daily care process measures to drive improvement in forty-two ICUs from 26 hospitals in Saudi Arabia (>27,000 days of observation). Compliance with subglottic suctioning, SAT and SBT increased monthly during the project by 3.5%, 2.1% and 1.9%, respectively (IRR 1.035, 95%CI 1.007-1.064, p = 0.0148; 1.021, 95% CI 1.010-1.032, p = 0.0003; and 1.019, 95%CI 1.009-1.029, p = 0.0001, respectively). The use of neuromuscular blockers decreased monthly by 2.5% (IRR 0.975, 95%CI 0.953-0.998, p = 0.0341). The compliance with head of bed elevation was high at baseline and did not change over time. Based on data for 83153 ventilator days, VAE rate was 15.2/1000 ventilator day (95%CI 12.6-18.1) at baseline and did not change during the project (IRR 1.019, 95%CI 0.985-1.053, p = 0.2812). Based on data for 8523 patients; the mortality was 30.4% (95%CI 27.4-33.6) at baseline, and decreased monthly during the project by 1.6% (IRR 0.984, 95%CI 0.973-0.996, p = 0.0067). A national quality improvement collaborative was associated with improvements in daily care processes. These changes were associated with a reduction in mortality but not VAEs. Registration The study is registered in clinicaltrials.gov (NCT03790150).

PMID:36716310 | DOI:10.1371/journal.pone.0280744

J Cell Physiol. 2023 Jan 30. doi: 10.1002/jcp.30954. Online ahead of print.

ABSTRACT

Murburn concept constitutes the thesis that diffusible reactive species or DRS are obligatorily involved in routine metabolic and physiological activities. Murzymes are defined as biomolecules/proteins that generate/modulate/sustain/utilize DRS. Murburn posttranslational modifications (PTMs) result because murburn/murzyme functionalism is integral to cellular existence. Cells must incorporate the inherently stochastic nature of operations mediated by DRS. Due to the earlier/inertial stigmatic perception that DRS are mere agents of chaos, several such outcomes were either understood as deterministic modulations sponsored by house-keeping enzymes or deemed as unregulated nonenzymatic events resulting out of “oxidative stress”. In the current review, I dispel the myths around DRS-functions, and undertake systematic parsing and analyses of murburn modifications of proteins. Although it is impossible to demarcate all PTMs into the classical or murburn modalities, telltale signs of the latter are evident from the relative inaccessibility of the locus, non-specificities and mechanistic details. It is pointed out that while many murburn PTMs may be harmless, some others could have deleterious or beneficial physiological implications. Some details of reversible/irreversible modifications of amino acid residues and cofactors that may be subjected to phosphorylation, halogenation, glycosylation, alkylation/acetylation, hydroxylation/oxidation, etc. are listed, along with citations of select proteins where such modifications have been reported. The contexts of these modifications and their significance in (patho)physiology/aging and therapy are also presented. With more balanced explorations and statistically verified data, a definitive understanding of normal versus pathological contexts of murburn modifications would be obtainable in the future.

PMID:36716112 | DOI:10.1002/jcp.30954