Category: Nevin Manimala

World Neurosurg. 2022 Jun 2:S1878-8750(22)00770-7. doi: 10.1016/j.wneu.2022.05.130. Online ahead of print.

ABSTRACT

Ping-pong fractures (PPF) have become less frequent and no definite predictors to determine which fractures will elevate spontaneously and which should undergo surgical treatment have not been clearly defined. Herein, the authors present a revision of the literature, in which 54 papers were included, with a total of 228 children studied. Patients who underwent surgery accounted for 30%; elevation through obstetrical vacuum or other aspiration systems was applied in 30%, spontaneous resolution occurred in 40%; in 4 patients percutaneous microscrew elevation was applied. Overall, in 96.4% of patients the outcome was favorable since we found no significant increase in the incidence of post-traumatic seizures or neurologic sequelae with no significant differences between treated patients and spontaneous elevation. Statistical analysis showed no significant differences among the different treatment methods (P=0.53). Our results suggest that simple compound PPFs without brain compression, hematomas or dural tears could benefit from conservative management. In cases of non-spontaneous resolution after 6 months, operative strategies should be performed, considering that there is no evidence of differences between vacuum elevation and surgical elevation.

PMID:35660672 | DOI:10.1016/j.wneu.2022.05.130

J Glob Antimicrob Resist. 2022 Jun 2:S2213-7165(22)00132-1. doi: 10.1016/j.jgar.2022.05.027. Online ahead of print.

ABSTRACT

BACKGROUND: The Mycobacterium avium complex (MAC), comprising a series of subspecies, has a worldwide distribution, with differences in drug susceptibility among subspecies. This study aimed to assess the composition of MAC and susceptibility differences among subspecies in mainland China.

METHODS: A total of 287 MAC clinical strains were included in the study. Multitarget sequences were applied to accurately identify subspecies, and a microdilution method was used to evaluate minimum inhibitory concentrations (MICs) among subspecies using Sensititre SLOMYCO plates.

RESULTS: M. intracellular (N=169), M. avium (N=52), M. chimaera (N=22), M. marseillense (N=25), M. colombiense (N=14), M. yongonense (N=4), M. vulneris (N=3) and M. timonense (N=2) were isolated from MAC. Clarithromycin, amikacin and rifabutin showed lower MIC₅₀ and MIC₉₀ values than other drugs, and the resistance rates of clarithromycin, amikacin, linezolid and moxifloxacin were 6.3%, 10.5%, 51.9% and 46.3%, respectively. The resistance rates of clarithromycin and moxifloxacin in the initial treatment group were significantly lower than those in the retreatment group (4.09% vs. 12.94%; 30.41% vs. 75.29%; p<0.05). Drug susceptibility differences were observed in clarithromycin and moxifloxacin among the 5 major subspecies (p<0.05); however, those statistically significant differences disappeared when MACs were divided into two groups according to previous anti-TB treatment history.

CONCLUSIONS: This study revealed that MAC, primarily comprising M. intracellulare, was susceptible to clarithromycin, amikacin and rifabutin. Drug susceptibility among subspecies did not exhibit intrinsic differences in our study. Previous anti-TB treatment patients are more resistant to drugs; thus, attention should be given to those patients in the clinic.

PMID:35660663 | DOI:10.1016/j.jgar.2022.05.027

Neurosci Lett. 2022 Jun 2:136705. doi: 10.1016/j.neulet.2022.136705. Online ahead of print.

ABSTRACT

Since 1967, spinal cord stimulation (SCS) has been used to manage chronic intractable pain of the trunk and limbs. Low-intensity, paresthesia-free, 10 kHz SCS has demonstrated statistically- and clinically-superior long-term pain relief compared to conventional SCS. 10 kHz SCS has been proposed to operate via selective activation of inhibitory interneurons in the superficial dorsal horn. In contrast, 40 Hz SCS is presumed to operate largely via dorsal column fiber activation. To determine if these mechanisms may be implemented synergistically, we examined the effect of each type of stimulation both independently and simultaneously on putatively inhibitory and putatively excitatory neurons in the superficial dorsal horn. When 10 kHz SCS was applied relatively caudally to the measured spinal segment, simultaneous with 40 Hz SCS applied relatively rostrally to that spinal segment, inhibitory interneurons demonstrated a median increase of 26 spikes/s compared to their baseline firing rates. Median firing rate increases of inhibitory interneurons were 8.7 and 5.1 spikes/s during 40 Hz SCS applied rostrally and 10 kHz SCS applied caudally, respectively. By comparison, the median firing rate of excitatory interneurons increased by 4.1 spikes/s during simultaneous 40 Hz SCS applied rostrally and 10 kHz SCS applied caudally. Median firing rate increases of excitatory interneurons were 13 and 0.8 spikes/s during 40 Hz SCS applied rostrally and 10 kHz SCS applied caudally, respectively. This suggests that simultaneously applying 10 kHz SCS caudally and 40 Hz SCS rostrally may provide greater pain relief than either type of SCS alone by increasing the firing rates of inhibitory interneurons, albeit with greater excitatory interneuron activation.

PMID:35660650 | DOI:10.1016/j.neulet.2022.136705

Exp Gerontol. 2022 Jun 2:111865. doi: 10.1016/j.exger.2022.111865. Online ahead of print.

ABSTRACT

BACKGROUND: We hypothesized that factors related to malnutrition, namely low muscle mass, appetite loss, and adiposity, are associated with frailty and pre-frailty in community-dwelling older adults.

AIMS: To identify the prevalence of frailty and pre-frailty in a Brazilian convenience sample and test the association between these conditions and malnutrition-related factors.

METHODS: This is a cross-sectional analysis of an ongoing community project. We studied 106 older adults (≥60 years old). Frailty (dependent variable) was screened using the FRAIL-BR scale. The independent variables were appetite loss (AL), screened from the SNAQ questionnaire; sarcopenia risk, investigated by SARC-F; body adiposity, estimated by the body mass index (BMI); visceral adiposity, estimated by waist circumference (WC) and the combination of these two indicators. The associations were investigated using multinomial logistic regression models.

MAIN RESULTS: We found, from our sample, 30.2 % pre-frail and 31.1 % frail participants. The frail and pre-frail were older than the non-frail; the frail ones presented a higher proportion of sarcopenia risk and a higher proportion of AL. From the multiple regression models, frailty conditions showed significant association with the AL (OR = 0.68; p = 0.012 and OR = 0.64; p = 0.009 for pre-frail and frail, respectively) and with sarcopenia risk (OR = 3.24; p = 0.001 and OR = 5.34; p < 0.011 for pre-frail and frail respectively). The adiposity indicated by waist circumference, and age, remained in the final model only as adjusting variables but without statistical significance.

CONCLUSIONS: in our convenience sample of older adults, frailty and pre-frailty showed significant association with appetite loss and sarcopenia risk, but not with adiposity indicators. Future studies are needed to better understand our findings.

PMID:35660640 | DOI:10.1016/j.exger.2022.111865

Khirurgiia (Mosk). 2022;(6):116-126. doi: 10.17116/hirurgia2022061116.

ABSTRACT

OBJECTIVE: To compare the outcomes of thermal and mechanochemical endovenous ablative techniques in patients with varicose veins.

MATERIAL AND METHODS: We searched the PubMed, EMBASE and Cochrane Library databases for studies devoted to mechanochemical and thermal endovenous ablative techniques from inception until July 2021. The primary outcome was anatomical success. Secondary endpoints were intraoperative pain syndrome, complications, modification of disease severity and quality of life.

RESULTS: This meta-analysis enrolled 10 comparative studies and 1.252 participants after truncal ablations. The follow-up period ranged from 4 weeks to 36 months. With regard to overall anatomical success, 245 out of 267 (91.8%) patients after mechanochemical ablation and 249 out of 266 (93.6%) patients after thermal ablation had favorable results after a month (low-quality evidence; odds ratio [OR] 0.79; 95% CI 0.40-1.55). No statistical heterogeneity was identified (χ²=1.48; df=2; p=0.48; I²=0%). Further analysis identified different incidence of total occlusion after 12 months or later (OR 0.36; 95% CI 0.11-1.21; p=0.05; I²=68%). Mechanochemical ablation resulted less intraoperative pain. Mean difference was -1.3 (95% CI -2.53- -0.07; p=0.00001). MOCA was followed by fewer incidence of nerve injury, hematoma, deep vein thrombosis and phlebitis. There were more cases of skin pigmentation compared to thermal ablation (low-quality evidence, p>0.05). Subsequent assessment of disease severity identified significant between-group difference of means (-0.64 (95% CI -1.82-0.53; p=0.004) and -0.16 (95% CI -0.43-0.11; p=0.005) after 6 and 12 months, respectively). Further assessment of quality of life revealed no between-group differences. These data were characterized by moderate methodological quality.

CONCLUSION: Mechanochemical ablation is as effective as standard TA within the first postoperative month. However, this approach is associated with lesser anatomical success after 12 months. In most studies, pain syndrome was less severe in case of mechanochemical ablation. These data suggest that mechanochemical ablation is a safe alternative for varicose veins. However, further large-scale trials are required to define the role of MOCA.

PMID:35658143 | DOI:10.17116/hirurgia2022061116

Khirurgiia (Mosk). 2022;(6):88-101. doi: 10.17116/hirurgia202206188.

ABSTRACT

OBJECTIVE: Comparative assessment of immediate and long-term results of robot-assisted and conventional endoscopic technologies in the Russian Federation.

MATERIAL AND METHODS: Searching for primary trials devoted to robot-assisted (RAE) and traditional video endoscopic (TVE) surgeries in the Russian Federation was carried out in the e-library and CENTRAL Cochrane databases. We used the recommendations of the Center for Expertise and Quality Control of Medical Care (2017, 2019) and the current version of the Cochrane Community Guidelines (2021). These guidelines define the features of meta-analysis of non-randomized comparative studies. Review Manager 5.4 software was used for statistical analysis.

RESULTS: We enrolled 26 Russian-language primary sources (3111 patients) including 1174 (38%) ones in the RAE group and 1937 (62%) patients in the TVE group. There were no randomized controlled trials in the Russian Federation, and all primary studies were non-randomized. We found no significant between-group differences in surgery time, incidence of intraoperative complications, intraoperative blood loss in thoracic surgery, urology and gynecology, conversion rate, postoperative hospital-stay, postoperative morbidity (in abdominal surgery, urology and gynecology), postoperative mortality. We observed slightly lower intraoperative blood loss for RAE in abdominal surgery and lower incidence of postoperative complications in robot-assisted thoracic surgery. These results can be compromised by methodological quality of comparative studies, significant heterogeneity and systematic errors.

CONCLUSION: Currently, we cannot confirm the benefits of robot-assisted technologies, since this approach does not worsen or improve treatment outcomes. Further high-quality studies are needed.

PMID:35658141 | DOI:10.17116/hirurgia202206188

Khirurgiia (Mosk). 2022;(6):27-31. doi: 10.17116/hirurgia202206127.

ABSTRACT

OBJECTIVE: To analyze creatine phosphokinase as a predictor of destructive cholecystitis.

MATERIAL AND METHODS: We analyzed 105 patients with various clinical variants of acute calculous cholecystitis (catarrhal, phlegmonous, gangrenous), and comparable age, gender and comorbidities. The study included patients with gallstone disease and gallbladder inflammation aged 30-7 years who underwent laparoscopic cholecystectomy, open cholecystectomy, cholecystectomy through mini-laparotomy. We excluded patients with gallstone disease complicated by mechanical jaundice aged under 30 years and over 70 years old. Control group consisted of 35 patients with exacerbation of chronic calculous cholecystitis. Creatinine phosphokinase (CPK) was analyzed at admission by standard kinetic colorimetric method in all patients with suspected acute cholecystitis. Statistical analysis of data was carried out using the SPSS Statistics 7.0 software in compliance with the principles of statistical analysis adopted for research in biology and medicine.

RESULTS: CPK level was 257.7±27.9 U/L (p<0.05) in patients with acute calculous cholecystitis that is 3.5 times higher than in the control group. We found an increase of concentration of this enzyme depending on severity of gallbladder wall destruction.

CONCLUSION: Analysis of serum creatine phosphokinase can be included in the algorithm of preoperative examination to study the prospects of this approach for predicting severity of acute cholecystitis.

PMID:35658133 | DOI:10.17116/hirurgia202206127

J Med Internet Res. 2022 Jun 1. doi: 10.2196/38443. Online ahead of print.

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, there have been increased reports of racial biases against Asian Americans (AsAs) and Native Hawaiians and Pacific Islanders (NHPIs). However, the extent to which different AsA and NHPI groups perceive and/or experience first-hand or being a witness to such experiences) associated with COVID-19 has negatively affected people of their race has not received much attention.

OBJECTIVE: We used data from the COVID-19 Effects on the Mental and Physical Health of Asian Americans and Pacific Islanders Survey Study (COMPASS), a nationwide, multi-lingual, community-based survey to empirically examine racial bias beliefs on AsAs and NHPIs as related to the COVID-19 pandemic and the factors associated with these beliefs.

METHODS: COMPASS participants were AsA and NHPI adults who were able to speak English, Chinese (Cantonese or Mandarin), Korean, Samoan, or Vietnamese and who resided in the United States (US) during the time of the survey (October 2020-May 2021). Participants completed the survey online, by phone, or in-person. The Coronavirus Racial Bias Scale (CRBS) was used to assess COVID-19 related racial bias beliefs towards AsAs and NHPIs. Participants were asked to rate the degree to which they agree with 9 statements on a 5-point Likert scale (i.e., “1 strongly disagree” to “5 strongly agree”). Higher score indicated greater degree of agreement with coronavirus racial bias beliefs. Multivariable linear regression was used to examine associations of demographic, health, and COVID-19 related characteristics with perceived racial bias.

RESULTS: A total of 5,068 participants completed the survey (mean age=45.4 years old; range: 18-97). Overall, 74% agreed or strongly agreed to one or more of the COVID-19 racial bias beliefs in the past 6 months (during the COVID-19 pandemic). Across the 9 racial bias beliefs, participants scored on the average 2.59 (SD=0.96; range 1-5). Adjusted analyses revealed that compared to Asian Indians, those who are ethnic Chinese, Filipino, Hmong, Japanese, Korean, Vietnamese, and other/multi-cultural had significantly higher mean CRBS scores whereas no significant differences were found among NHPIs. Non-heterosexual participants had a statistically significant higher mean CRBS scores compared to heterosexual participants. Compared to participants who were 60 years or older, those who were younger (<30, 30-39, 40-49, and 50-59 years) had significantly higher mean CRBS scores. US born participants had significantly higher mean CRBS scores than those who were foreign-born, whereas those with limited English proficiency (relative to those reporting no limitation) had lower mean CRBS scores.

CONCLUSIONS: Many COMPASS participants reported racial bias beliefs due to the COVID-19 pandemic. Relevant sociodemographic contexts, pre-existing and COVID-specific factors across individual, community and society levels were associated with perceived racial bias of “being Asian” during the pandemic. Findings underscore the importance of addressing the burden of racial bias on AsA and NHPI communities among other COVID-19 related sequalae.

PMID:35658091 | DOI:10.2196/38443

Med Care. 2022 Jun 6. doi: 10.1097/MLR.0000000000001742. Online ahead of print.

ABSTRACT

BACKGROUND: Persons with multimorbidity (≥2 chronic conditions) face an increased risk of poor health outcomes, especially as they age. Psychosocial factors such as social isolation, chronic stress, housing insecurity, and financial insecurity have been shown to exacerbate these outcomes, but are not routinely assessed during the clinical encounter. Our objective was to extract these concepts from chart notes using natural language processing and predict their impact on health care utilization for patients with multimorbidity.

METHODS: A cohort study to predict the 1-year likelihood of hospitalizations and emergency department visits for patients 65+ with multimorbidity with and without psychosocial factors. Psychosocial factors were extracted from narrative notes; all other covariates were extracted from electronic health record data from a large academic medical center using validated algorithms and concept sets. Logistic regression was performed to predict the likelihood of hospitalization and emergency department visit in the next year.

RESULTS: In all, 76,479 patients were eligible; the majority were White (89%), 54% were female, with mean age 73. Those with psychosocial factors were older, had higher baseline utilization, and more chronic illnesses. The 4 psychosocial factors all independently predicted future utilization (odds ratio=1.27-2.77, C-statistic=0.63). Accounting for demographics, specific conditions, and previous utilization, 3 of 4 of the extracted factors remained predictive (odds ratio=1.13-1.86) for future utilization. Compared with models with no psychosocial factors, they had improved discrimination. Individual predictions were mixed, with social isolation predicting depression and morbidity; stress predicting atherosclerotic cardiovascular disease onset; and housing insecurity predicting substance use disorder morbidity.

DISCUSSION: Psychosocial factors are known to have adverse health impacts, but are rarely measured; using natural language processing, we extracted factors that identified a higher risk segment of older adults with multimorbidity. Combining these extraction techniques with other measures of social determinants may help catalyze population health efforts to address psychosocial factors to mitigate their health impacts.

PMID:35658116 | DOI:10.1097/MLR.0000000000001742

Colorectal Dis. 2022 Jun 3. doi: 10.1111/codi.16194. Online ahead of print.

ABSTRACT

AIM: There are discrepancies in the guidelines on preparation for colorectal surgery. While intravenous antibiotics (IV) are usually administered, the use of mechanical bowel preparation (MBP) and/or oral antibiotics (OA) is controversial. A recent network meta-analysis (NMA) demonstrated that the addition of OA reduced incisional surgical site infections (iSSIs) by more than 50%. We aimed to perform a NMA including only the highest quality randomized clinical trials (RCTs) in order to determine the ranking of different treatment strategies and assess these RCTs for methodological problems that may affect the conclusions of the NMAs.

METHOD: A NMA was performed according to PRISMA guidelines. RCTs of adult patients undergoing elective colorectal surgery with appropriate antibiotic cover and with at least 250 participants recruited, clear definition of endpoints and duration of follow-up extending beyond discharge from hospital were included. The search included Medline, Embase, Cochrane and SCOPUS databases. Primary outcomes were iSSI and anastomotic leak (AL). Statistical analysis was performed in Stata v.15.1 using frequentist routines.

RESULTS: Ten RCTs including 5107 patients were identified. Treatments compared IV (2218 patients), IV + OA (460 patients), MBP + IV (1405 patients), MBP + IV + OA (538 patients) and OA (486 patients). The likelihood of iSSI was significantly lower for IV + OA (rank 1) and MBP + IVA + OA (rank 2), reducing iSSIs by more than 50%. There were no differences between treatments for AL. Methodological issues included differences in definition, assessment and frequency of primary endpoint infections and the limited number of participants included in some treatment options.

CONCLUSION: While this NMA supports the addition of OA to IV to reduce iSSI it also highlights unanswered questions and the need for well-designed pragmatic RCTs.

PMID:35658069 | DOI:10.1111/codi.16194