Category: Nevin Manimala

Anatol J Cardiol. 2021 Nov;25(11):781-788. doi: 10.5152/AnatolJCardiol.2021.71080.

ABSTRACT

OBJECTIVE: In this study, we aimed to compare major adverse cardiac and cerebrovascular events (MACCE), defined as a composite of death, stroke, myocardial infarction and symptom-induced revascularization, and mortality within one year of randomization between two strategies; complete revascularization including non-culprit lesions percutaneous coronary intervention (PCI) during primary PCI (PPCI) versus complete revascularization during the same hospital admission in patients with multi-vascular coronary artery disease (MVD) presenting with ST-elevation myocardial infarction (STEMI) uncomplicated by cardiogenic shock.

METHODS: We randomized in a 1: 1 manner 100 patients with MVD and STEMI uncomplicated by cardiogenic shock who had undergone successful culprit-lesion PCI to either a strategy of complete revascularization with PCI of angiographically significant non-culprit lesions in the index PPCI procedure or to a strategy of complete revascularization during a second procedure that took place during the same hospital admission.

RESULTS: The first primary outcome was death within a timeframe of one year and the second a composite of MACCE within a year following complete revascularization. Of the total number of patients monitored, 4% in each of the two groups was associated with the first primary outcome (p=0.984) and the second primary outcome in 6% (p=0.970). There was no statistical difference between outcomes in the two groups.

CONCLUSION: Among patients with MVD and STEMI uncomplicated by cardiogenic shock, there was no difference regarding outcomes when using a strategy of complete revascularization of non-culprit lesions during PPCI or the same hospital admission.

PMID:34734811 | DOI:10.5152/AnatolJCardiol.2021.71080

Orthopedics. 2021 Nov 8:1-6. doi: 10.3928/01477447-20211101-06. Online ahead of print.

ABSTRACT

Orthopedic sports medicine surgeons are especially vulnerable to litigation, largely because of high patient expectations in the setting of complex surgeries. Understanding the factors associated with litigation may reduce physician risk as well as optimize patient satisfaction and outcomes. We used a national medicolegal database to search for medical malpractice verdicts and out-of-court settlements involving common sports injuries and their surgical management between January 1, 2000, and January 1, 2018. Univariate analysis was performed to identify predictors of case outcome and monetary awards. We identified 777 cases, but only 328 met the inclusion criteria. Of the 328 cases included in our study, 231 (70.4%) resulted in a defendant verdict, 75 (22.9%) resulted in a plaintiff verdict, and 22 (6.7%) resulted in a settlement. The most common reason for litigation was intraoperative error (183 cases, 55.8%). No statistically significant difference was found between monetary awards for plaintiff verdicts vs settlements (mean award of $1.29 million and $0.72 million, respectively, P=.07). Cases in which the plaintiff claimed neurovascular injury were significantly more likely to result in a higher monetary award (mean award of $2.37 million, P=.02). Cases involving an incorrect surgical site were significantly less likely to result in a defendant outcome, with 7 of 12 cases (58.3%) leading to a plaintiff outcome (P=.047). With more than two-thirds of cases resulting in a defendant verdict, many suits result in a favorable outcome for practitioners. Intraoperative error is the most common reason for litigation, and neurovascular injury resulted in the highest monetary payouts. Vigilance to avoid these events may improve patient outcomes and decrease liability to practitioners. [Orthopedics. 202x;xx(x):xx-xx.].

PMID:34734778 | DOI:10.3928/01477447-20211101-06

Orthopedics. 2021 Nov 8:1-5. doi: 10.3928/01477447-20211101-08. Online ahead of print.

ABSTRACT

Adhesive taping is commonly used to reinforce wound closure and approximate minor lacerations. Recently, tissue adhesives such as 2-octylcyanoacrylate have gained popularity because of their high tensile strength, bacteriostatic properties, and spontaneous peeling. We sought to evaluate the cosmetic result of upper extremity incisions closed primarily by subcuticular suture, randomizing the application of tissue adhesive vs adhesive taping to different halves of the same surgical incision. Subjects were recruited from patients undergoing common procedures at the senior surgeon’s hand surgery clinic. After primary closure, we applied either quarter-inch adhesive tape or tissue adhesive to the proximal and distal aspects of the wounds, based on a preoperative randomization protocol. We assessed the scars at approximately 3 months (range, 2-5 months). Subjects completed a validated scar assessment questionnaire, and a blinded photograph was obtained to allow 2 independent surgeons to assess the scar. Mean age was 63 years (SD, 11.8 years; range, 21-88 years); 56% of patients were women, and 44% were men. Most of the incisions were open carpal tunnel release and thumb carpometacarpal arthroplasty (14 each). Adhesive taping showed a better overall mean score based on evaluation by the hand surgeons, a finding that was statistically significant. The greatest differences were observed between color and size, but no subcategories were significantly different. Patients reported nonstatistical, but slightly better overall cosmetic outcomes with adhesive taping rather than tissue adhesive. Adhesive strips provide a modest but significant improvement in cosmetic outcomes vs more expensive tissue adhesive. Future evaluation of closure methods that evaluate cost, speed of application, suture technique, and dressing will optimize scar appearance. [Orthopedics. 202x;4x(x):xx-xx.].

PMID:34734780 | DOI:10.3928/01477447-20211101-08

J Nurs Manag. 2021 Nov 4. doi: 10.1111/jonm.13503. Online ahead of print.

ABSTRACT

AIMS: To measure registered nurses’, registered midwives, nursing and midwifery students’ current levels of knowledge, attitude and practices related to intimate partner violence.

BACKGROUND: Nurses and midwives whether registered or students need to be confident and competent in identifying and responding to intimate partner violence.

DESIGN: A cross-sectional survey METHODS: Data were collected through online surveys using the Physician Readiness to Manage Intimate Partner Violence Survey. Descriptive and inferential statistics were used to analyse the data.

RESULTS: Nursing and midwifery students were less knowledgeable and prepared than nurses and midwives. Midwives had more positive attitudes compared with nurses towards women experiencing intimate partner violence.

CONCLUSIONS: Heath care institutions, and regulatory bodies should provide resources and support to nursing and midwifery professionals. Personal experiences of domestic abuse and professional experience of supporting victims of domestic abuse/intimate partner violence affected practitioner’s abilities to identify and manage intimate partner violence.

IMPLICATIONS FOR NURSING MANAGEMENT: Nurse and midwifery managers can ensure that clinical and organizational policies and protocols are revisited and updated regularly, and that interdisciplinary collaboration are promoted and emphasized for prompt identification and management of intimate partner violence.

PMID:34734662 | DOI:10.1111/jonm.13503

Semin Dial. 2021 Nov 4. doi: 10.1111/sdi.13036. Online ahead of print.

ABSTRACT

BACKGROUND: It is necessary to assess the association between the preoperative indicators and the maturation and survival of arteriovenous fistula (AVF).

METHODS: We retrospectively identified 236 patients with a new AVF created between 2016 and 2018 in our Dialysis Center.

RESULTS: Multivariate Logistic regression showed that preoperative arterial diameter (odds ratio [OR] = 1.452, 95% confidence interval [CI] [1.233, 1.710], p < 0.001), preoperative venous diameter (OR = 1.296, 95% CI [1.166, 1.477], p < 0.001), left ventricular ejection fraction (LVEF) (OR = 1.187, 95% CI [1.103, 1.277], p < 0.001), and diabetes mellitus (OR = 0.245, 95% CI [0.107, 0.560], p = 0.01) were independent influential factors for AVF maturation. Two years after the AVF surgery follow-up, multivariate Cox proportional-hazards model showed that the preoperative arterial diameter (OR = 0.510, 95% CI [0.320, 0.813], p = 0.005), preoperative venous diameter (OR = 0.940, 95% CI [0.897, 0.985], p = 0.010) and diabetes mellitus (OR = 1.785, 95% CI [1.117, 2.855], p = 0.016) was prognostic factors of AVF survival. The Kaplan-Meier method showed that the primary survival of AVF in patients with different preoperative arterial diameter was statistically significant (log-rank χ² = 15.415, p < 0.001), while the secondary survival was not statistically significant (log-rank χ² = 0.131, p = 0.717).

CONCLUSION: In our cohort, the preoperative arterial and venous diameter and diabetes mellitus were independent influential factors for AVF maturation and prognostic factors of AVF survival. However, the preoperative LVEF only associated with the maturation of AVF. Meanwhile, smaller arterial diameter (≤2.15 mm) was associated with AVF maturation failure, but did not impact secondary survival of AVF.

PMID:34734660 | DOI:10.1111/sdi.13036

Acta Otorhinolaryngol Ital. 2021 Oct;41(5):474-480. doi: 10.14639/0392-100X-N1048.

ABSTRACT

OBJECTIVES: To evaluate mean surgical time, incidence of soft tissue reactions, implant survival and intraoperative complications in both minimally invasive ponto surgery (MIPS) and the linear incision with tissue preservation technique (LT).

METHODS: A retrospective review was carried out on 48 bone anchored hearing system (BAHS) patients between 2014 and 2019: 13 patients had undergone LT and formed one group, while 35 patients had undergone MIPS and formed the second group. Mean surgical time, intraoperative complications, implant loss and skin reaction were assessed at each post-operative examination. The Mann-Whitney U test was used for statistical analysis.

RESULTS: The difference in the mean surgical time of 15 mins for MIPS and 36 mins for LT was statistically significant. No intraoperative complications were reported and implant survival was 100% in both groups. The incidence of adverse skin reactions was 7.7% for the LT group and 0% for the MIPS group at first follow-up examination.

CONCLUSIONS: Surgical mean time is shorter for MIPS, making this procedure more suitable for local anaesthesia and more cost effective. Moreover, both LT and MIPS demonstrate good surgical outcomes in terms of skin reactions according to Holgers score and equally excellent implant survival.

PMID:34734584 | DOI:10.14639/0392-100X-N1048

Ortop Traumatol Rehabil. 2021 Oct 31;23(5):349-360. doi: 10.5604/01.3001.0015.4353.

ABSTRACT

BACKGROUND: The hip joint is one of the most important joints in the human body. Although its multiaxial movements account for many benefits, they also render the hip one of the most hard-working joints. Injuries to the hip joint and thigh often occur as a result of a fall. According to epidemiologic data, such falls are most frequent in the elderly, particularly in osteoporosis sufferers.

MATERIAL AND METHODS: The “Services” component of the Statistics API version 1.0 provided by the National Health Fund (NHF) was used in order to evaluate the number of hospitalizations due to hip joint and thigh injuries. Information on the number of patients was obtained in a number of stages. The first stage involved determination of hip and thigh injuries as the main diagnosis. Then, the billing products which made possible settlement for hospitalization of patients with the selected diagnoses were chosen. The last stage consisted in the extraction of relevant medical data sets from the “Services” component of the NHF Sta-tistics API, which made possible this analysis.

RESULTS: According to the NHF reporting data, over the four-year period of interest there were approx. 42,000 hospitalizations per year. The most frequent causes of hospitalization were fractures of the neck of the femur (S72.0) and trochanteric fractures (S72.1), accounting for approx. 48% and 36% of all hospital stays, respectively.

CONCLUSIONS: 1. Hip injuries constitute a significant health problem in Poland (approx. 42,000 hospitalizations per year). 2. The most frequent causes of hospitalization are injuries in the form of fractures of the neck of the femur or trochanteric fractures (corresponding to the ICD-10 codes S72.0 and S72.1, respectively). 3. It appears advisable to develop a tool to enable medical service providers to adjust their services to patients’ changing needs. This tool could em-ploy open-access data on injuries published in the NHF Statistics API.

PMID:34734560 | DOI:10.5604/01.3001.0015.4353

Ortop Traumatol Rehabil. 2021 Oct 31;23(5):335-339. doi: 10.5604/01.3001.0015.4348.

ABSTRACT

BACKGROUND: Developmental dysplasia of the hip (DDH) is a developmental disorder which is reported to be associated with hip instability. When untreated, it can lead to irreversible joint damage. DDH is known to be a multifactorial disease involving genetic, mechanical and environmental factors. The greatest causative potential is attributed to the genetic component. Growth Differentiation Factor 5 (GDF5) is among the most studied genes associated with processes of regeneration and maintenance of joints. The aim of this work was to analyse the association of SNP rs143383 in the GDF5 gene and the occurrence of DDH, along with association with various contributing factors in the Caucasian population.

MATERIAL AND METHODS: A total of 118 samples were analysed for the presence of the mutation. DNA was isolated from all individuals from peripheral blood. SNP rs143383 in the GDF5 gene was genotyped using the TaqMan assay. A standard chi-square test was used to compare allele and genotype distributions in patients and healthy controls.

RESULTS: The association analysis of genotypes of DDH and rs143383 revealed a significant association. Also, the association of GDF5 and selected contributing factors was statistically significant in female gender (p=0.002), family history (p&lt;0.001), count of pregnancy (p=0.009), laterality of hip involvement and initial US examination.

CONCLUSIONS: 1. The results indicate an important effect of rs143383 polymorphism in the GDF5 gene on DDH development. 2. However, our results also suggest that rs143383 is not the only contributing factor in the genetic component of DDH.

PMID:34734566 | DOI:10.5604/01.3001.0015.4348

Oral Health Prev Dent. 2021 Jan 7;19(1):603-608. doi: 10.3290/j.ohpd.b2259135.

ABSTRACT

PURPOSE: To investigate the influence of pretreating demineralised enamel with an infiltrant on the margin integrity of Class V like composite restorations on primary teeth bonded with different adhesives.

MATERIALS AND METHODS: Forty specimens from primary molars were demineralised and circular class-V-like cavities were prepared. The cavities were treated with a universal adhesive (Scotchbond Universal Adhesive, 3M Oral Care), applied either in self-etch (SE) or etch-and-rinse mode (ER) mode. In groups SE-I and ER-I, the demineralised margins were pretreated with a caries infiltrant (Icon, DMG) prior to adhesive application. The cavities were restored with a nanofilled composite material and thermocycled. Marginal integrity was evaluated using SEM, and the percentage of continuous margin was statistically analysed.

RESULTS: Specimens treated with the caries infiltrant followed by the adhesive showed similar marginal continuity as the adhesive alone.

CONCLUSIONS: Pretreatment of demineralised primary enamel with a caries infiltrant before applying a universal adhesive does not influence the marginal integrity of composite fillings.

PMID:34734520 | DOI:10.3290/j.ohpd.b2259135

Neoplasma. 2021 Nov 4:210603N745. doi: 10.4149/neo_2021_210603N745. Online ahead of print.

ABSTRACT

Recently, change in the GNG13 expression has been shown to result in multiple congenital malformations and sexual reversal, and it was also found in the brain. The aim of this study was to measure the expression levels in epithelial ovarian cancer (EOC) and breast cancer (BC) and assess their value as a potential prognostic marker. The correlation of GNG13 protein expression was detected by immunohistochemistry (IHC) in 119 EOC and 125 BC tissues. Assessment of the associations between GNG13 levels and various clinicopathological features was identified, the relationship between GNG13 and prognosis in BC and EOC patients was analyzed using online resources of Oncomine and Kaplan-Meier plotter. Protein expression levels of GNG13 were both significantly lower in BC and EOC compared with normal tissues (p < 0.0001 and p < 0.001, respectively). Among the clinicopathological characteristics of BC, tumor grade (p = 0.001) and TNM stage (p = 0.001) were significantly associated with low expression of Gng13. While in EOC, low expression of GNG13 was significantly related to FIGO stage (p = 0.001), presence of metastasis (p = 0.001), and CA125 (p = 0.001). Our data suggest that GNG13 expression maybe as a new inhibitor, which can strongly inhibit metastasis and partially attenuates tumor growth in EOC and BC.

PMID:34734529 | DOI:10.4149/neo_2021_210603N745