Category: Nevin Manimala

Rom J Anaesth Intensive Care. 2022 Sep 25;28(1):29-35. doi: 10.2478/rjaic-2021-0005. eCollection 2021 Jul.

ABSTRACT

OBJECTIVE: In the last few years there is a trend of transiting from the continuous epidural infusion (CEI) method for epidural analgesia to a new method – programmed intermittent epidural analgesia (PIEB). This change improves the quality of epidural analgesia, thanks to an increased spread of the anaesthetic in the epidural space and higher maternal satisfaction. Nevertheless, we must make sure that such change of method does not lead to worse obstetric and neonatal outcomes.

MATERIALS AND METHODS: This is a retrospective observational case control study. We compared several obstetrical outcomes between the CEI and PIEB groups, such as the rates of instrumental delivery, rates of caesarean section, duration of first and second stages of labour well as APGAR scores. We further segmented the subjects and examined them in groups of nulliparous and multiparous parturients.

RESULTS: 2696 parturients were included in this study: 1387 (51.4%) parturients in the CEI group and 1309 (48.6%) parturients in the PIEB group. No significant difference was found in instrumental or caesarean section delivery rates between groups. This result held even when the groups were differentiated between nulliparous and multiparous. No differences were revealed regarding first and second stage duration or APGAR scores.

CONCLUSION: Our study demonstrates transition from the CEI to the PIEB method does not lead to any statistically significant effects on either obstetric or neonatal outcomes.

PMID:36846539 | PMC:PMC9949009 | DOI:10.2478/rjaic-2021-0005

Rom J Anaesth Intensive Care. 2022 Sep 25;28(1):25-28. doi: 10.2478/rjaic-2021-0004. eCollection 2021 Jul.

ABSTRACT

BACKGROUND: The procedures of introducing an airway by intubation are associated with increased risk of aerosolisation of SARS-CoV-2 virus, posing a high risk to the personnel involved. Newer and novel methods such as the intubation box have been developed to increase the safety of healthcare workers during intubation.

METHODS DESIGN: In this study, 33 anaesthesiologist and critical care specialists intubated the trachea of the airway manikin (US Laerdal Medical AS™) 4 times using a King Vision^® videolaryngoscope and TRUVIEW PCD™ videolaryngoscope (with and without an intubation box as described by Lai). Intubation time was primary outcome. Secondary outcomes were first-pass intubation success rate, percentage of glottic opening (POGO) score and peak force to maxillary incisors.

RESULTS: Intubation time and the number of times a click was heard during tracheal intubation were considerably higher in both groups when an intubation box was used (Table 1). When comparing the two laryngoscopes, the King Vision^® videolaryngoscope enabled much less time to intubate than did the TRUVIEW laryngoscope, both with and without the intubation box. (P<0.001) In both laryngoscope groups, first-pass successful intubation was higher without the intubation box, although the difference was statistically insignificant. POGO score was not affected by intubation box but a higher score was observed with King Vision^® laryngoscope (Tables 1,2).

CONCLUSION: This study indicates that use of an intubation box makes intubation difficult and increases the time needed to perform it. King Vision^® videolaryngoscope results in lesser intubation time and better glottic view as compared to TRUVIEW laryngoscope.

PMID:36846538 | PMC:PMC9949008 | DOI:10.2478/rjaic-2021-0004

Health Sci Rep. 2023 Feb 22;6(2):e1124. doi: 10.1002/hsr2.1124. eCollection 2023 Feb.

ABSTRACT

INTRODUCTION: The interplay between social determinants of health (SDOH) and hospitalization is significant as targeted interventions can improve the social status of the individuals. This interrelation has been historically overlooked in health care. In the present study, we reviewed studies in which the association between patient-reported social risks and hospitalization rate was assessed.

METHOD: We performed a scoping literature review of articles published until September 1, 2022 without time limit. We searched PubMed, Embase, Web of Science, Scopus, and Google Scholar to find relevant studies using terms representing “social determinants of health” and “hospitalization.” Forward and backward reference checking was done for the included studies. All studies that used patient-reported data as a proxy of social risks to determine the association between social risks and hospitalization rates were included. The screening and data extraction processes were done independently by two authors. In case of disagreement, senior authors were consulted.

RESULTS: Our search process retrieved a total of 14,852 records. After the duplicate removal and screening process, eight studies met the eligibility criteria, all of which were published from 2020 to 2022. The sample size of the studies ranged from 226 to 56,155 participants. All eight studies investigated the impact of food security on hospitalization, and six investigated economic status. In three studies, latent class analysis was applied to divide participants based on their social risks. Seven studies found a statistically significant association between social risks and hospitalization rates.

CONCLUSION: Individuals with social risk factors are more susceptible to hospitalization. There is a need for a paradigm shift to meet these needs and reduce the number of preventable hospitalizations.

PMID:36846535 | PMC:PMC9944244 | DOI:10.1002/hsr2.1124

Health Sci Rep. 2023 Feb 22;6(2):e1054. doi: 10.1002/hsr2.1054. eCollection 2023 Feb.

ABSTRACT

INTRODUCTION: According to the World Health Organization, 11% of all children are born prematurely, representing 15 million births annually. An extensive analysis on preterm birth, from extreme to late prematurity and associated deaths, has not been published. The authors characterize premature births in Portugal, between 2010 and 2018, according to gestational age, geographic distribution, month, multiple gestations, comorbidities, and outcomes.

METHODS: A sequential, cross-sectional, observational epidemiologic study was conducted, and data were collected from the Hospital Morbidity Database, an anonymous administrative database containing information on all hospitalizations in National Health Service hospitals in Portugal, and coded according to the ICD-9-CM (International Classification of Diseases), until 2016, and ICD-10 subsequently. Data from the National Institute of Statistics was utilized to compare the Portuguese population. Data were analyzed using R software.

RESULTS: In this 9-year study, 51.316 births were preterm, representing an overall prematurity rate of 7.7%. Under 29 weeks, birth rates varied between 5.5% and 7.6%, while births between 33 and 36 weeks varied between 76.9% and 81.0%. Urban districts presented the highest preterm rates. Multiple births were 8× more likely preterm and accounted for 37%-42% of all preterm births. Preterm birth rates slightly increased in February, July, August, and October. Overall, respiratory distress syndrome (RDS), sepsis, and intraventricular hemorrhage were the most common morbidities. Preterm mortality rates varied significantly with gestational age.

CONCLUSION: In Portugal, 1 in 13 babies was born prematurely. Prematurity was more common in predominantly urban districts, a surprise finding that warrants further studies. Seasonal preterm variation rates also require further analysis and modelling to factor in heat waves and low temperatures. A decrease in the case rate of RDS and sepsis was observed. Compared with previously published results, preterm mortality per gestational age decreased; however, further improvements are attainable in comparison with other countries.

PMID:36846533 | PMC:PMC9945543 | DOI:10.1002/hsr2.1054

OTA Int. 2023 Feb 21;6(1):e223. doi: 10.1097/OI9.0000000000000223. eCollection 2023 Mar.

ABSTRACT

OBJECTIVES: Surgical site infections in orthopaedic trauma are a significant problem with meaningful patient and health care system-level consequences. Direct application of antibiotics to the surgical field has many potential benefits in reducing surgical site infections. However, to date, the data regarding the local administration of antibiotics have been mixed. This study reports on the variability of prophylactic vancomycin powder use in orthopaedic trauma cases across 28 centers.

METHODS: Intrawound topical antibiotic powder use was prospectively collected within three multicenter fracture fixation trials. Fracture location, Gustilo classification, recruiting center, and surgeon information were collected. Differences in practice patterns across recruiting center and injury characteristics were tested using chi-square statistic and logistic regression. Additional stratified analyses by recruiting center and individual surgeon were performed.

RESULTS: A total of 4941 fractures were treated, and vancomycin powder was used in 1547 patients (31%) overall. Local administration of vancomycin powder was more frequent in open fractures 38.8% (738/1901) compared with closed fractures 26.6% (809/3040) (P < 0.001). However, the severity of the open fracture type did not affect the rate at which vancomycin powder was used (P = 0.11). Vancomycin powder use varied substantially across the clinical sites (P < 0.001). At the surgeon level, 75.0% used vancomycin powder in less than one-quarter of their cases.

CONCLUSIONS: Prophylactic intrawound vancomycin powder remains controversial with varied support throughout the literature. This study demonstrates wide variability in its use across institutions, fracture types, and surgeons. This study highlights the opportunity for increased practice standardization for infection prophylaxis interventions.

LEVEL OF EVIDENCE: Prognostic-III.

PMID:36846524 | PMC:PMC9953039 | DOI:10.1097/OI9.0000000000000223

J Diabetes Res. 2023 Feb 16;2023:8898958. doi: 10.1155/2023/8898958. eCollection 2023.

ABSTRACT

Diabetes mellitus is a disease with no cure that can cause complications and even death. Moreover, over time, it will lead to chronic complications. Predictive models have been used to identify people with a tendency to develop diabetes mellitus. At the same time, there is limited information regarding the chronic complications of patients with diabetes. Our study is aimed at creating a machine-learning model that will be able to identify the risk factors of a diabetic patient developing chronic complications such as amputations, myocardial infarction, stroke, nephropathy, and retinopathy. The design is a national nested case-control study with 63,776 patients and 215 predictors with four years of data. Using an XGBoost model, the prediction of chronic complications has an AUC of 84%, and the model has identified the risk factors for chronic complications in patients with diabetes. According to the analysis, the most crucial risk factors based on SHAP values (Shapley additive explanations) are continued management, metformin treatment, age between 68 and 104 years, nutrition consultation, and treatment adherence. But we highlight two exciting findings. The first is a reaffirmation that high blood pressure figures across patients with diabetes without hypertension become a significant risk factor at diastolic > 70 mmHg (OR: 1.095, 95% CI: 1.078-1.113) or systolic > 120 mmHg (OR: 1.147, 95% CI: 1.124-1.171). Furthermore, people with diabetes with a BMI > 32 (overall obesity) (OR: 0.816, 95% CI: 0.8-0.833) have a statistically significant protective factor, which the paradox of obesity may explain. In conclusion, the results we have obtained show that artificial intelligence is a powerful and feasible tool to use for this type of study. However, we suggest that more studies be conducted to verify and elaborate upon our findings.

PMID:36846513 | PMC:PMC9949947 | DOI:10.1155/2023/8898958

J Clin Exp Hepatol. 2023 Feb 14. doi: 10.1016/j.jceh.2023.02.001. Online ahead of print.

ABSTRACT

BACKGROUND AND AIM: COVID-19 pandemic has strained several healthcare resources across the world. While Liver transplantation (LT) is the only curative therapy for patients with end stage liver disease, we aimed to determine the clinical outcome of patients waitlisted for DDLT during COVID-19 pandemic.

METHODS: A retrospective comparative observational study of adult patients waitlisted for DDLT from January 2019 to January 2022 at our liver unit (Dr Rela Institute and Medical Center, Chennai, Tamil Nadu, India) was carried out. Patient demographics, disease etiology, MELD Na (Model for end stage liver disease sodium) score were calculated for all patients listed during the study period. Clinical event was defined as number of DDLT, death in the absence of transplant and patients awaiting liver transplantation were compared. Statistical analysis was performed with SPSS V24.0.

RESULTS: 310 patients were waitlisted for DDLT, of whom 148, 63 and 99 patients listed during 2019, 2020 and 2021 (till January 2022), respectively. 22 (53.6%), 10 (24.3%) and 9 (21.9%) patients underwent DDLT in the year 2019, 2020 and 2021 (P=0.000). 137 patients (44.19%) died on the DDLT waitlist of whom 41 (29.9%), 67 (48.9%) and 29 (21.1%) in the year 2019, 2020 and 2021 (P=0.000), respectively. Waitlist mortality was significantly higher during the COVID first wave.

CONCLUSION: COVID-19 pandemic has significantly impacted patients waitlisted for DDLT in India. With limited access to healthcare facilities and decreased organ donation rates during the pandemic, there was a considerable reduction in the patients waitlisted for DDLT, lesser number of patients underwent DDLT, higher waitlist mortality during the pandemic year. Efforts to improve organ donation in India should be strongly implemented.

PMID:36846504 | PMC:PMC9937687 | DOI:10.1016/j.jceh.2023.02.001

Educ Inf Technol (Dordr). 2023 Feb 22:1-24. doi: 10.1007/s10639-023-11601-2. Online ahead of print.

ABSTRACT

Artificially intelligent robots as teachers (AI teachers) have attracted extensive attention due to their potential to relieve the challenge of global teacher shortage and realize universal elementary education by 2030. Despite mass production of service robots and discussions about their educational applications, the study of full-fledged AI teachers and children’s attitudes towards them is quite preliminary. Here, we report a new AI teacher and an integrated model to assess how pupils accept and use it. Participants included students from Chinese elementary schools via convenience sampling. Questionnaires (n = 665), descriptive statistics and structural equation modeling based on software SPSS Statistics 23.0 and Amos 26.0 were carried out in data collection and analysis. This study first developed an AI teacher by coding a lesson design, course contents and Power Point with script language. Based on the popular Technology Acceptance Model and Task-Technology Fit Theory, this study identified key determinants of the acceptance, including robot use anxiety (RUA), perceived usefulness (PU), perceived ease of use (PEOU) and robot instructional task difficulty (RITD). Moreover, this study found that pupils’ attitudes towards the AI teacher, which could be predicted by PU, PEOU and RITD, were generally positive. It is also found that the relationship between RITD and acceptance was mediated by RUA, PEOU and PU. This study holds significance for stakeholders to develop independent AI teachers for students.

PMID:36846493 | PMC:PMC9944412 | DOI:10.1007/s10639-023-11601-2

Eur Phys J Spec Top. 2023 Feb 17:1-10. doi: 10.1140/epjs/s11734-023-00791-y. Online ahead of print.

ABSTRACT

Recent studies have focused on the similarity between SARS Cov-2 and various viruses from the Coronaviridae family (such as MERS Cov, SARS Cov and Bat Cov RaTG13) to uncover the mystery of SARS Cov-2. Specifically, some studies identified that the SARS Cov-2 is closely related to Bat Cov RaTG13 (a SARS-related coronavirus found in bats) rather than the other viruses in that family. These studies are mainly focusing on the biological techniques to show the similarity between the SARS Cov-2 and other viruses. Examining proteins is not easy for common researchers unless for biologists. To rectify this flaw, we have to convert the protein to one of the known formats, which are easy to understand. Consequently, this study uses viral structural proteins to analyse the relationship between SARS Cov-2 and the rest of the coronavirus with the help of mathematical and statistical parameters and explores the various graph representations of MERS Cov, SARS Cov, Bat Cov RaTG13 and SARS Cov-2 structural proteins, such as zig-zag curve, Protein Contact Map ( $\mathrm{PCM}$ ) and Chaos Game Representation ( $\mathrm{CGR}$ ). Though these graph interpretations are visually similar, a slight variation between the graphs reflects their structural and functional differences. Thus, we use an elegant parameter known as the fractal dimension to observe their minor changes. According to the nature of the graph, we employ different types of fractal dimensions, namely mass dimension and box dimension. Furthermore, we perform the similarity tests with normalized cross-correlation and cosine similarity to assess the comparability of the $\mathrm{PCM}$ and $\mathrm{CGR}$ graphs. The acquired $C{C}_n$ values are near the sequence identity between SARS Cov-2 and MERS Cov, SARS Cov, Bat Cov RaTG13.

PMID:36846473 | PMC:PMC9936937 | DOI:10.1140/epjs/s11734-023-00791-y

Curr Res Food Sci. 2022 Nov 12;6:100386. doi: 10.1016/j.crfs.2022.11.005. eCollection 2023.

ABSTRACT

The biodiversity of Ecuadorian stingless bees is almost 200 species. Traditional pot-honey harvest in Ecuador is mostly done from nests of the three genera selected here Geotrigona Moure, 1943, Melipona Illiger, 1806, and Scaptotrigona Moure, 1942. The 20 pot-honey samples collected from cerumen pots and three ethnic honeys “abeja de tierra”, “bermejo”, and “cushillomishki” were analyzed for qualitative and quantitative targeted ¹H-NMR honey profiling, and for the Honey Authenticity Test by Interphase Emulsion (HATIE). Extensive data of targeted organic compounds (41 parameters) were identified, quantified, and described. The three honey types were compared by ANOVA. Amino acids, ethanol, hydroxymethylfurfural, aliphatic organic acids, sugars, and markers of botanical origin. The number of phases observed with the HATIE were one in Scaptotrigona and three in Geotrigona and Melipona honeys. Acetic acid (19.60 ± 1.45 g/kg) and lactic acid (24.30 ± 1.65 g/kg) were particularly high in Geotrigona honey (in contrast to 1.3 g/kg acetic acid and 1.6 g/kg lactic acid in Melipona and Scaptotrigona), and with the lowest fructose + glucose (18.39 ± 1.68) g/100g honey compared to Melipona (52.87 ± 1.75) and Scaptotrigona (52.17 ± 0.60). Three local honeys were tested using PCA (Principal Component Analysis), two were assigned with a correct declared bee origin, but “bermejo” was not a Melipona and grouped with the Scaptotrigona cluster. However after HCA (Hierarchical Cluster Analysis) the three honeys were positioned in the Melipona–Scaptotrigona cluster. This research supports targeted ¹H-NMR-based profiling of pot-honey metabolomics approach for multi-parameter visualization of organic compounds, as well as descriptive and pertained multivariate statistics (HCA and PCA) to discriminate the stingless bee genus in a set of Geotrigona, Melipona and Scaptotrigona honey types. The NMR characterization of Ecuadorian honey produced by stingless bees emphasizes the need for regulatory norms. A final note on stingless bee markers in pot-honey metabolites which should be screened for those that may extract phylogenetic signals from nutritional traits of honey. Scaptotrigona vitorum honey revealed biosurfactant activity in the HATIE, originating a fingerprint Honey Biosurfactant Test (HBT) for the genus in this set of pot-honeys.

PMID:36846470 | PMC:PMC9947262 | DOI:10.1016/j.crfs.2022.11.005