Category: Nevin Manimala

Acta Anaesthesiol Scand. 2022 Jul 30. doi: 10.1111/aas.14118. Online ahead of print.

ABSTRACT

BACKGROUND: The effects of glucocorticoids may include both genomic and rapid nongenomic effects. The potential rapid analgesic effect during surgery has not previously been investigated. We aimed to explore the effect of dexamethasone on intraoperative infusion rate of remifentanil in patients undergoing total knee arthroplasty surgery under general anaesthesia.

METHODS: In this post-hoc subgroup analysis we included patients randomized in the DEX-2-TKA trial, who were operated under total intravenous anaesthesia with remifentanil and propofol. Trial medication, intravenous dexamethasone 24 mg or placebo, was administered immediately after anaesthesia onset. The primary outcome was the median weight-corrected infusion rate of remifentanil during surgery. Secondary outcomes included median weight-corrected infusion rate of propofol, median intraoperative bispectral index, and time spent in the post anaesthesia care unit.

RESULTS: Eighty-seven patients were included in the analysis of the primary outcome. A significantly higher remifentanil infusion rate was observed in the dexamethasone group compared with the placebo group, p=0.02. None of the secondary outcomes resulted in statistically significant differences between groups.

CONCLUSION: This explorative post-hoc analysis of the randomized DEX-2-TKA trail showed that patients undergoing total knee arthroplasty surgery under general anaesthesia and who received dexamethasone, seemed to have a higher remifentanil infusion rate compared with patients who received placebo. The clinical implications of the potentially increased remifentanil infusion rate need to be validated and explored further. This article is protected by copyright. All rights reserved.

PMID:35908167 | DOI:10.1111/aas.14118

Drug Saf. 2022 Jul 30. doi: 10.1007/s40264-022-01213-z. Online ahead of print.

ABSTRACT

INTRODUCTION: The recurrence rates of immediate adverse drug reactions (ADRs) to the alternative radiocontrast media (RCM) are not well known. Previous studies suggest selection of alternative RCM considering carbamoyl side chains; however, its usefulness for preventing the recurrence of ADRs has not been clearly verified.

OBJECTIVE: The aim of this study was to verify the recurrence rate of immediate ADRs according to the alternative RCM.

METHOD: This retrospective study analyzed 6420 contrast-enhanced computed tomography (CT) cases of 2009 patients registered in the ADR system from 861,664 CT cases in a single tertiary hospital between 2015 and 2020. Iohexol, iopromide, iobitridol, and iopamidol were used for CT. According to the carbamoyl side chains present, iohexol belongs to group 1, iopromide belongs to groups 1 and 2, iobitridol belongs to group 2, and iopamidol belongs to group 3.

RESULTS: Replacing iobitridol with iopamidol (odds ratio [OR] 2.595, 95% confidence interval [CI] 1.48-4.550) or iopromide (OR 3.354, 95% CI 1.420-7.926) as the subsequent RCM was associated with increased recurrence, while replacing iopamidol with iobitridol (OR 0.506, 95% CI 0.282-0.908) and iopromide with iohexol (OR 0.355, 95% CI 0.177-0.711) was associated with decreased recurrence. Other changes did not influence the recurrence of ADRs.

CONCLUSIONS: The recurrence of immediate ADRs increased in certain RCM combinations of preceding and subsequent CT scans, and the RCMs did not show cross-reactivity. Therefore, the clinical benefit of the alternative RCM considering cross-reactivity is limited. This result suggests that the side chains of RCM do not have an important role in the recurrence of immediate ADRs.

PMID:35908149 | DOI:10.1007/s40264-022-01213-z

Spine Deform. 2022 Jul 30. doi: 10.1007/s43390-022-00547-z. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate clinical and radiographic outcomes after surgical scoliosis correction and posterior instrumented fusion in SMF patients.

METHODS: A single-center medical database was reviewed to identify MF patients who presented with scoliosis from 2000 to 2015. Patients who underwent spinal fusion surgery were included. Demographic, operative and clinical data were reviewed, and the preoperative, postoperative, and latest follow-up radiographic parameters were compared.

RESULTS: Twelve patients were identified (2 males, 10 females) with an average age at surgery of 14.4 ± 2.6 years. Comorbidities were found in 84.6%. Most patients (90.9%) presented with a right thoracic curve. The average preoperative Cobb angle was 75.6 ± 15.5 degrees. Posterior instrumented spinal fusion was performed in all patients (1 hook/pedicular screw and 11 pedicle screws only). The average follow-up period was 6.8 ± 3.1 years. The mean postoperative Cobb angle after surgery and at the final follow-up was 33.4 ± 18.0 degrees and 35.5 ± 18.4 degrees, respectively. There was a statistically significant difference among the preoperative and postoperative Cobb angles (p < 0.001), but no significant difference among the sagittal angles. Two perioperative complications including superficial wound infection and broken rods were observed.

CONCLUSIONS: Posterior scoliosis correction and instrumented spinal fusion resulted in a satisfactory outcome in MF patients. Perioperative complications are not uncommon; however, no neurological complication or spinal decompensation was observed in this study.

LEVEL OF EVIDENCE: IV.

PMID:35908146 | DOI:10.1007/s43390-022-00547-z

J Mol Model. 2022 Jul 30;28(8):239. doi: 10.1007/s00894-022-05234-4.

ABSTRACT

Plants from the Garcinia genus have been used worldwide due to their therapeutic properties. Among the various metabolites isolated from this genus, 7-epi-clusianone, a tetraprenylated benzophenone, stands out for its wide range of identified biological activities. This benzophenone can exist in five tautomeric forms, although the benzene-d₆ and chloroform-d₃ solution nuclear magnetic resonance (NMR) spectra revealed only two tautomeric forms (B and C) in equilibrium, with concentration ratio depending on the solvent in which the spectrum was obtained. Calculated energy values suggested that tautomeric forms B and E would be prevalent in benzene-d₆ solution, in contrast to the experimental data. Considering this conflicting result, we employed the statistical DP4 + method based on ¹³C and ¹H NMR chemical shift calculations, in the gas phase and in benzene-d₆ solution, to confirm that the B and C tautomeric forms of 7-epi-clusianone are the most prevalent in the experimental conditions.

PMID:35908141 | DOI:10.1007/s00894-022-05234-4

Support Care Cancer. 2022 Jul 30. doi: 10.1007/s00520-022-07289-8. Online ahead of print.

ABSTRACT

BACKGROUND: Breast cancer (BC) patients face various physical and psychological challenges. The mutual impacts of patients and caregivers on each other show the need for further supportive care from the community and family. This study aimed to identify the predictors of the direct and indirect relationships of the duration of cancer (CANCERT) and care time (CARET) with the supportive care needs (SCN) of the patients and the quality of life (QOL) of their family caregivers.

METHODS: This descriptive study included 150 patients and their caregivers in Iran. Data were collected using the Supportive Care Needs Survey-Short Form (SCNS-SF34), the Caregiver Quality of Life Index-Cancer (CQOLC) scale, and a socio-demographic checklist. The data were then analyzed in SPSS-24 and Lisrel-8.8 software using descriptive statistics and path analysis.

RESULTS: The mean age of the patients and caregivers was 45.76 ± 10.44 and 43.46 ± 9.5, respectively. The majority of patients (96%) were in stages II and III of the disease. There was no statistically significant relationship between cancer stages with SCN of the patients and also caregivers’ QOL (P > 0.05). Based on the test results, the CANCERT was positively correlated with the patients’ care and support needs (SN) in total effect (β = 0.24). The patients’ sexuality needs had the highest negative correlation with their CANCERT in the direct path (β = – 0.27) and had the highest negative correlation with psychological needs in the indirect path (β = – 0.174). The CARET (hours per day) had positive correlation with health systems and information needs in both the direct (β = 0.26) and indirect paths (β = 0.15). The highest positive correlation with physical needs was in the direct path (β = 0.34). The caregivers’ QOL had a negative and direct relationship with the CANCERT (β = – 0.19), and there was a positive and direct relationship between CARET and the caregivers’ QOL (β = 0.18).

CONCLUSIONS: The correlations obtained from this study are not necessarily strong, yet they are important and should be noticed and tested in the future studies. The present findings reveal the need to provide comprehensive care, planning to provide supportive care, and counseling to both BC patients and their family caregivers, especially when the duration of the disease is prolonged.

PMID:35908140 | DOI:10.1007/s00520-022-07289-8

Prog Orthod. 2022 Jul 31;23(1):25. doi: 10.1186/s40510-022-00420-9.

ABSTRACT

BACKGROUND: Estimating skeletal maturation and growth potential is essential for developing adolescents’ best orthodontic treatment plan. The purpose of this study was to compare the duration of adolescent growth peak in subjects of skeletal classes I and III using the cervical vertebral maturation (CVM) method.

METHODS: This retrospective cross-sectional study included 116 Iranian subjects (skeletal class I = 68, skeletal class III = 48) aged 8-16 years old and without previous orthodontic treatments. Using Steiner and Wits analyses, two independent examiners traced pre-treatment lateral cephalograms to determine the subjects’ skeletal relationship. The skeletal maturation was then assessed using Baccetti’s CVM method. The onset and duration of adolescent growth peak (interval of CS3-CS4) were compared between two skeletal classes and two genders using independent samples t test.

RESULTS: In skeletal class I and III subjects, the adolescent peak had a mean duration of 1.62 (± 1.33) and 2.00 (± 1.27) years, respectively. The average difference of 0.38 years (4.6 months) between the two groups was statistically significant (p < 0.001). Furthermore, the onset age of adolescent growth peak was 11.91 (± 1.32) and 12.08 (± 1.31) years old in class I and III subjects, respectively. This age difference was not statistically significant (p = 0.630). Males’ adolescent growth peak occurred 1.44 years later (p < 0.001) and lasted 0.20 years less (p < 0.001).

CONCLUSIONS: The adolescent growth peak started at a similar age in class I and III subjects, but the latter experienced the peak for 4.6 months longer. Moreover, females had an earlier and more extended adolescent growth peak.

PMID:35908119 | DOI:10.1186/s40510-022-00420-9

Knee Surg Sports Traumatol Arthrosc. 2022 Jul 30. doi: 10.1007/s00167-022-07052-w. Online ahead of print.

ABSTRACT

PURPOSE: The recovery of strength is a key element in successfully returning to sports after ACL reconstruction. The type of anaesthesia has been suspected an influential factor in the post-operative recovery of muscle function.

METHODS: In this retrospective analysis, n = 442 consecutive patients undergoing primary isolated ACL reconstruction using a hamstring autograft were analysed by pre- and post-operative isokinetic tests in a single orthopaedic centre. These were subdivided into four cohorts: (1) general anaesthesia (n = 47), (2) general anaesthesia with prolonged (48 h) on-demand femoral nerve block (n = 37), (3) spinal anaesthesia (n = 169) and (4) spinal anaesthesia with prolonged (48 h) on-demand femoral nerve block (n = 185). Primary outcome was the change from pre- to post-operative isokinetic strength during knee extension and flexion.

RESULTS: Using one-way ANOVA, there was no significant influence of the type of anaesthesia. The main effect of anaesthesia on change in extension forces was not significant, and effect sizes were very small (n.s.). Similarly, the main effect of anaesthesia on change in flexion forces was statistically not significant (n.s.).

CONCLUSIONS: The findings of this study support the interpretation that the type of anaesthesia has no significant effect on the ability to recover thigh muscle strength 6 months after isolated hamstring ACL reconstruction. With regard to the recovery of athletic performance and return-to-sports testing criteria, there is no reason to avoid regional anaesthesia.

LEVEL OF EVIDENCE: III.

PMID:35908113 | DOI:10.1007/s00167-022-07052-w

Biomech Model Mechanobiol. 2022 Jul 30. doi: 10.1007/s10237-022-01618-w. Online ahead of print.

ABSTRACT

In this study, the biomechanical role of intraluminal thrombus (ILT) in an abdominal aortic aneurysm (AAA) is investigated. The implications of ILT in AAA are controversial in literature. Previous studies have demonstrated that ILT provides a biomechanical advantage by decreasing wall stress, whereas other studies have associated ILT with inhibiting oxygen transport and inducing aortic wall weakening. Therefore, we sought to explore the connection between ILT, mechanical stresses, and oxygen flow in different geometries of patient-specific aneurysms with varying ILT morphologies. The objective is to investigate the extent to which ILT influences the prediction of aneurysmal wall stresses that are associated with rupture, as well as oxygen concentrations to measure tissue oxygen deprivation. Three patient-specific AAA geometries are considered, and two models, one with ILT and one without ILT, are created for each patient to assess the effect of ILT presence. A fluid-structure interaction approach is used to couple the blood flow, wall deformation, and oxygen mass transport. Results are presented for hemodynamics patterns, wall stress measures, and oxygen metrics within the arterial wall. While ILT is found to reduce wall stress, simulations confirm that ILT decreases oxygen transport within the tissue significantly, leading to wall hypoxia.

PMID:35908098 | DOI:10.1007/s10237-022-01618-w

Skeletal Radiol. 2022 Jul 30. doi: 10.1007/s00256-022-04141-2. Online ahead of print.

ABSTRACT

OBJECTIVE: The effect of diabetes on adhesive capsulitis (AC) and its impact on the outcomes of ultrasound (US)-guided hydrodistension of the glenohumeral joint are still unclear. We aimed to identify predictors of US-guided hydrodistension outcomes, while assessing the performance of the method in diabetic compared to non-diabetic patients.

MATERIALS AND METHODS: A total of 135 patients with AC who underwent US-guided hydrodistension were prospectively included. Demographics and factors linked to chronic inflammation and diabetes were recorded and patients were followed-up for 6 months. Functionality and pain were evaluated with the Disabilities of the Arm, Shoulder and Hand (DASH) and the Visual Analogue Scale (VAS) score. Statistical analysis was performed with Mann-Whitney U test, linear, and binary logistic regression.

RESULTS: Diabetes was identified in 25/135 patients (18.5%). Diabetic patients had worse DASH and VAS score at presentation (P < 0.0001) and presented with a higher grade of AC (P < 0.0001) and lower range of motion (P < 0.01) compared to non-diabetics. Higher DASH (P = 0.025) and VAS scores (P = 0.039) at presentation were linked to worse functionality at 6 months. Presence and duration of diabetes, and the number of hydrodistension repeats, correlated with worse VAS and DASH scores at 6 months. The number of procedure repeats was the only independent predictor of complete pain resolution at 6 months (OR 0.418, P = 003).

CONCLUSION: Diabetes is linked to more severe AC at presentation and worse outcomes in patients undergoing US-guided hydrodistension. In resistant cases, repeating the intervention is independently linked to worse outcomes for at least 6 months post-intervention.

PMID:35908089 | DOI:10.1007/s00256-022-04141-2

Sci Rep. 2022 Jul 30;12(1):13132. doi: 10.1038/s41598-022-17263-3.

ABSTRACT

Evaporation is the primary aspect causing water loss in the hydrological cycle; therefore, water loss must be precisely measured. Evaporation is an intricate nonlinear process occurring as a result of several climatic aspects. The purpose of this research is to assess the feasibility of using Random Forest (RF) and two deep learning techniques, namely convolutional neural network (CNN), and deep neural network (DNN) to accurately estimate monthly pan evaporation rates. Month-based weather data gathered from four Malaysian weather stations during the 2000-2019 timeframe was used to train and evaluate the models. Several input attributes (predictor variables) were investigated to select the most suitable variables for machine learning models. Every approach was tested with several models, each with a different set of model aspects and input parameter combinations. The formulated ML approaches were benchmarked against two commonly used empirical methods: Stephens & Stewart and Thornthwaite. Model outcomes were assessed using standard statistical measures to determine their effectiveness in predicting evaporation. The results indicated that the three ML models developed in the study performed better than empirical models and could significantly improve the precision of monthly Ep estimates even with the identical input sets. The performance assessment metrics also show that the formulated CNN approach was acceptable for modelling monthly water loss due to evaporation with a higher degree of accuracy than other ML frameworks explored in this study. In addition, the CNN framework outperformed other AI techniques evaluated for the same areas using identical data inputs. The investigation’s findings in relation to the various performance criteria show that the proposed CNN model is capable of capturing the highly non-linearity of evaporation and could be regarded as an effective tool to predict evaporation.

PMID:35908080 | DOI:10.1038/s41598-022-17263-3