Category: Nevin Manimala

Cardiovasc Interv Ther. 2022 Feb 9. doi: 10.1007/s12928-021-00833-z. Online ahead of print.

ABSTRACT

In this real-world, retrospective cohort study of 9753 patients in Japan prescribed dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI), we investigated DAPT duration and determined factors associated with early DAPT discontinuation and with event rates in patients who discontinued DAPT. The study period was April 1, 2012-March 31, 2018; endpoints comprised composite efficacy [death, myocardial infarction (MI), and stroke] and bleeding (intracranial, gastrointestinal, and requiring transfusion) endpoints. Overall, 68.8% of patients were continuing DAPT at 3 months post-PCI. Patients without major efficacy or safety events within 3 months after index PCI were included in a landmark analysis set (LAS; n = 7056), and categorized as DAPT ≥ 3 months (continuation) versus < 3 months (discontinuation). In the two LAS analysis groups, there was no difference in the composite bleeding endpoint (P = 0.067), although the incidence of the composite efficacy endpoint was higher in the discontinuation group (P < 0.001). In multivariate regression analysis, age ≥ 75 years, minor bleeding after PCI, history of cerebral infarction, history of cerebral or gastrointestinal bleeding, atrial fibrillation, dialysis, and anticoagulant use after PCI were associated with early DAPT discontinuation. Acute coronary syndrome, history of MI, kidney disorder, and anticoagulant use after PCI were associated with the composite efficacy endpoint in the discontinuation group. In conclusion, early DAPT discontinuation is more likely in patients at high bleeding risk, but may influence the occurrence of ischemic events in these patients. Determination of DAPT duration should take into account potential ischemic risk, even in patients at high bleeding risk.

PMID:35141843 | DOI:10.1007/s12928-021-00833-z

Appl Health Econ Health Policy. 2022 Feb 10. doi: 10.1007/s40258-022-00716-1. Online ahead of print.

ABSTRACT

BACKGROUND: The current healthcare system is challenged with a large and rising demand for obstructive sleep apnoea (OSA) services. A paradigm shift in OSA management is required to incorporate the preferences of diagnosed patients and individuals at high risk of OSA.

OBJECTIVES: This study aimed to provide empirical evidence of the values and preferences of individuals diagnosed with OSA and high-risk populations regarding distinct OSA care pathway features.

METHODS: A discrete choice experiment was undertaken in two groups: those with a formal diagnosis of OSA (n = 421) and those undiagnosed but at high risk of having OSA (n = 1033). Participants were recruited from a large cross-sectional survey in Australia. The discrete choice experiment approach used mixed-logit regression models to determine preferences relating to eight salient features of the OSA management pathway, i.e. initial assessment provider, sleep study setting, diagnosis costs, waiting times, results interpretation, treatment options, provider of ongoing care and frequency of follow-up visits.

RESULTS: The findings indicate that all eight attributes investigated were statistically significant factors for respondents. Generally, both groups preferred low diagnostic costs, fewer follow-up visits, minimum waiting time for sleep study results and sleep specialists to recommend treatment. Management of OSA in primary care was acceptable to both groups and was the most preferred option by the high-risk group for the initial assessment, sleep study testing and ongoing care provision.

CONCLUSIONS: The discrete choice experiment results offer a promising approach for systematic incorporation of patient and high-risk group preferences into the future design and delivery of care pathways for OSA management.

PMID:35141851 | DOI:10.1007/s40258-022-00716-1

J Gastrointest Surg. 2022 Feb 9. doi: 10.1007/s11605-022-05265-5. Online ahead of print.

ABSTRACT

BACKGROUND: Routine placement of a feeding jejunostomy tube (FJT) following esophagectomy remains controversial due to the risk of complications including small bowel obstruction (SBO). This study aimed to evaluate FJT placement following esophagectomy.

METHODS: This retrospective cohort study included consecutive 229 patients undergoing thoracoscopic esophagectomy between January 2010 and June 2020. Short-term outcomes, postoperative nutritional status, incidence of SBO, and long-term outcomes were compared between patients according to FJT placement.

RESULTS: The total operative duration was significantly longer in the FJT group compared to the no FJT group (P < 0.0001); however, no differences in overall or severe postoperative morbidity were observed. Body weight loss at discharge was significantly attenuated in patients with FJT (5% vs 7%, P = 0.001). Serum cholinesterase levels were significantly higher in patients with FJT (P = 0.002), while no difference was observed in serum albumin levels. At 6-month follow-up, no statistically significant differences were observed in serological markers or percentage body weight. The incidence of SBO was significantly higher in the FJT group (P = 0.006). The 5-year incidence of SBO was 12%. Patients in the FJT group had higher progression-free and overall survival compared to patients in the no FJT group (P = 0.041 and P = 0.033, respectively). A similar trend toward better survival in the FJT group was observed after propensity score matching.

CONCLUSIONS: Routine placement of FJT significantly improves postoperative nutritional status and may contribute to improved long-term survival but is associated with increased long-term risk of SBO.

PMID:35141836 | DOI:10.1007/s11605-022-05265-5

Environ Sci Pollut Res Int. 2022 Feb 10. doi: 10.1007/s11356-022-18919-3. Online ahead of print.

ABSTRACT

The traditional literature has explored various factors including, but not limited to, trade openness, financial development, energy consumption, foreign direct investment, globalization, and per capita income that significantly contribute to carbon emissions. However, the current study identifies aggregate domestic consumption spending as a novel driver of carbon dioxide, employing the data for the period of 1973-2018 in Pakistan. To this end, we develop the theoretical framework to illustrate the link between aggregate domestic consumption spending and carbon dioxide emissions and deploy autoregressive distributed lag (ARDL), asymmetric ARDL, and the threshold non-linear ARDL (NARDL) techniques. The results of the ARDL method suggest that only in the short run, aggregate domestic consumption spending significantly affects carbon dioxide emissions. Furthermore, the findings of the NARDL approach reveal that the positive and negative shocks significantly deteriorate and ameliorate the environmental quality by increasing and decreasing the pollution, respectively, in the short and long run. Even though the outcome of the threshold NARDL technique supports the results of the aforementioned approaches, the novelty of the current study is to find out the threshold in aggregate domestic consumption spending, which carries a significant role in determining the carbon emissions in both periods. Besides, we infer that fossil fuels energy and trade openness also degrade the Pakistani climate by boosting atmospheric pollution. Additionally, the application of the asymmetric Granger causality test validates the results by asserting the casual relationship between aggregate domestic consumption spending and carbon dioxide emissions. Based on the results, we suggest the authorities to start to promote the deployment of green products publicly to obtain green and sustainable development.

PMID:35141829 | DOI:10.1007/s11356-022-18919-3

Environ Sci Pollut Res Int. 2022 Feb 10. doi: 10.1007/s11356-022-19069-2. Online ahead of print.

ABSTRACT

To investigate the causative component for certain health outcomes, the associations between the properties of ambient particles and cause-specific mortality (all-cause, cardiovascular, and respiratory-related mortality) measured in Seoul, Korea, from January 1, 2013, to December 31, 2016, were evaluated with a quasi-Poisson generalized additive model (GAM). The total mass of PM₁₀ and PM_2.5 moderately affected respiratory-related mortality but had almost no impact on all-cause and cardiovascular-related mortality. Among PM_2.5 mass compositions, ammonium sulfate, which is in generally 300-500 nm as a secondary species, showed the most statistically significant effect on respiratory-related mortality at lag 4 (p < 0.1) but not for other mortalities. However, from the size-selective investigations, cardiovascular-related mortality was impacted by particle number concentrations (PNCs), particle surface concentrations (PSCs), and particle volume concentrations (PVCs) in the size range from 50 to 200 nm with a statistically significant association, particularly at lag 1, suggesting that mass is not the only way to examine mortality, which is likely because mass and chemical composition concentrations are generally controlled by larger-sized particles. Our study suggests that the size-specific mortality and/or impacts of size-resolved properties on mortalities need to be evaluated since smaller particles get into the body more efficiently, and therefore, more diverse size-dependent causes and effects can occur.

PMID:35141828 | DOI:10.1007/s11356-022-19069-2

J Mother Child. 2022 Feb 9. doi: 10.34763/jmotherandchild.20212502.d-21-00021. Online ahead of print.

ABSTRACT

BACKGROUND: Corona virus disease (COVID-19) is an infectious disease caused by the novel corona virus known as severe acute respiratory syndrome corona virus 2 (SARS Cov-2). Physiological changes occurring during pregnancy can have a positive or negative effect on the disease progression. The objective of the study was to evaluate the maternal and neonatal outcomes in pregnant women with COVID-19 compared to pregnant women without COVID-19 and to determine its influence on the healthcare system.

MATERIAL AND METHODS: This was a retrospective analytical study conducted at a tertiary care hospital in Odisha, India, over 3 months, from 1 September 2020 until 30 November 2020. Results were compared in both groups.

RESULTS: Three hundred and three (303) women delivered, out of whom 92 were COVID-19 positive. Incidence of COVID-19 positivity was 30.3% with 93.47% asymptomatic patients. The majority of the patients were 26-35years of age. Average gestational age at delivery for both groups was 37-40 weeks. COVID-19 positivity was seen more in primigravidas than in multigravidas. Comorbidities such as GDM/type 2 DM, PIH, PROM, APH and jaundice were similar in both groups and statistically non-significant, whereas association of anaemia and hypothyroidism were statistically significant (p<0.05) in the positive group. A single maternal death was reported in the positive group. There was an increase in Caesarean section (p=0.002) with higher incidence of preterm births and lowbirth weights in the positive group. Only 3 babies tested positive for COVID-19, so vertical transmission probability was low. Overall, all babies were healthy and the majority of women were discharged without any complications.

CONCLUSION: There was no significant effect of the infection on maternal and fetal outcomes, but further studies and long-term follow-up is needed to look for any delayed effects on the babies and mothers.

PMID:35139602 | DOI:10.34763/jmotherandchild.20212502.d-21-00021

Anesth Pain Med (Seoul). 2021 Oct;16(4):368-376. doi: 10.17085/apm.21035. Epub 2021 Oct 14.

ABSTRACT

BACKGROUND: Epidural block placement in pediatric patients is technically challenging for anesthesiologists. The use of ultrasound (US) for the placement of an epidural catheter has shown promise. We compared landmark-guided and US-guided lumbar or lower thoracic epidural needle placement in pediatric patients.

METHODS: This prospective, randomized, comparative trial involved children aged 1-6 years who underwent abdominal and thoracic surgeries. Forty-five children were randomly divided into two groups using a computer-generated random number table, and group allocation was performed by the sealed opaque method into either landmark-guided (group LT) or real-time ultrasound-guided (group UT) epidural placement. The primary outcome was a comparison of the procedure time (excluding US probe preparation). Secondary outcomes were the number of attempts (re-insertion of the needle), bone contacts, needle redirection, skin-to-epidural distance using the US in both groups, success rate, and complications.

RESULTS: The median (interquartile range) time to reach epidural space was 105.5 (297.0) seconds in group LT and 143.0 (150) seconds in group UT (P = 0.407). While the first attempt success rate was higher in the UT group (87.0% in UT vs. 40.9% in LT; P = 0.004), the number of bone contacts, needle redirections, and procedure-related complications were significantly lower.

CONCLUSIONS: The use of US significantly reduced needle redirection, number of attempts, bone contact, and complications. There was no statistically significant difference in the time to access the epidural space between the US and landmark technique groups.

PMID:35139618 | DOI:10.17085/apm.21035

Acta Ortop Mex. 2021 Jul-Aug;35(4):311-316.

ABSTRACT

OBJECTIVE: Clinical and functional evaluation of patients with Lisfranc lesion without work or sport cause and treated in our center.

MATERIAL AND METHODS: Thirteen patients with Lisfranc lesion without occupational or sports causes were divided into two groups, high-energy and low-energy injuries. Were analyzed the return to work and sports activity prior to the injury and the use of footwear and insoles after the injury. Also were assessed AOFAS and EVA postoperative score and posterior complications after lesion recovery.

RESULTS: High-energy group included 7 patients who underwent surgery on an average of 7.3 days. Of the total of patients, 4 presented post-surgical sequelae. Of these patients, one patient was unable to return to their previous work activity and two patients were unable to practice the usual sports activity. The AOFAS was 79.4 and EVA 2.8. In the low energy group, we found six patients operated on 5.6 days on average. All of them were able to return to their previous work and sports activity. The AOFAS were 84.8 and the EVA 1.6. Statistically significant differences were not observed in any of the variables studied.

CONCLUSION: Patients with Lisfranc injury out of laboral or sports background present good clinical and functional results.

PMID:35139588

Rev Bras Ginecol Obstet. 2022 Feb 9. doi: 10.1055/s-0042-1742411. Online ahead of print.

ABSTRACT

OBJECTIVE: To analyze whether acetylsalicylic (ASA) intake modifies the mean uterine arteries pulsatility index (UtA-PI) at the 2^nd or 3^rd trimester in a cohort of pregnant women with abnormal mean UtA-PI at between 11 and 14 weeks of gestation.

METHODS: This is a retrospective cohort study. Singleton pregnancies with abnormal mean UtA-PI at between 11 and 14 weeks of gestation were studied. The participants were divided into 3 groups: 1) If the participant did not take ASA during pregnancy; 2) If the participant took ASA before 14 weeks of gestation; and 3) If the participant took ASA after 14 weeks of gestation. The mean UtA-PI was evaluated at the 2^nd and 3^rd trimesters, and it was considered to improve when it decreased below the 95^th percentile. The prevalence ratio (PR) and the number needed to treat (NNT) were calculated.

RESULTS: A total of 72 participants with a mean UtA-PI > 95^th percentile at the 1^st trimester of gestation were evaluated. Out of the 18 participants who took ASA, 8 participants started it before 14 weeks of gestation and 10 after. A total of 33.3% of these participants had improved the mean UtA-PI at the 2^nd and 3^rd trimesters of gestation, although it was not statistically significant (p = 0.154). The prevalence ratio was 0.95 (95% confidence interval [CI]: 0.31-1.89), but between the 1^st and 2^nd trimesters of gestation, the PR was 0.92 (95%CI: 0.21-0.99) and it was statistically significant.

CONCLUSION: The present work demonstrates a modification of the mean UtA-PI in participants who took ASA compared with those who did not. It is important to check if ASA can modify the normal limits of uterine arteries because this could have an impact on surveillance.

PMID:35139575 | DOI:10.1055/s-0042-1742411

Acta Ortop Mex. 2021 Jul-Aug;35(4):305-310.

ABSTRACT

INTRODUCTION: The hallux valgus is a very frequent and complex orthopedic pathology. It involves the bone and soft tissue structures of the first toe. There are multiple techniques described for the alignment of the first toe. All technics aim to restore the normal angulation of the toe while using a stable osteotomy through a painless surgical procedure. The minimal invasive techniques have been growing in acceptance since the year 2000, as a viable surgical alternative to treat this pathology.

MATERIAL AND METHODS: We included patients with a diagnostic of mild or moderate hallux valgus on whom a minimal invasive procedure was performed to correct the deformity of the first toe. We performed a distal Reverdin/Isham osteotomy on the first metatarsal and an akin osteotomy in the proximal phalanx, a lateral capsular release and a abductor tenotomy. These patients were followed for 24 months after their surgery.

RESULTS: Our patients had an adequate correction angular correction, for a distal osteotomy. They had a good pain control, with an adequate mobility in the postoperative period. The patients presented an adequate personal satisfaction, 87% of them had good results. We found an important and statistically significant improvement in the Kitaoka scale.

CONCLUSION: The minimal invasive technics for the correction of mild or moderated hallux valgus are a good alternative. Our patients are satisfied with the functional, and cosmetic results.

PMID:35139587