Category: Nevin Manimala

Acta Biomed. 2021 Nov 3;92(5):e2021311. doi: 10.23750/abm.v92i5.10438.

ABSTRACT

BACKGROUND: SARS-CoV-2 infection has become a global public health concern globally. Even though Healthcare Workers (HCWs) are supposedly at increased risk for SARS-CoV-2 infection, to date no pooled evidence has been collected.

MATERIALS AND METHODS: We searched online electronic databases (PubMed, Embase, medRxiv.org for pre-prints) for all available contribution (up to May 20, 2019). Two Authors independently screened articles and extracted the data. The pooled prevalence of SARS-CoV-2 was analyzed using the random-effects model. The possible sources of heterogeneity were analyzed through subgroup analysis, and meta-regression.

RESULTS: The overall pooled prevalence of SARS-CoV-2 was 3.5% (95%CI 1.8-6.6) for studies based on molecular assays, 5.5% (95%CI 2.1-14.1) for studies based on serological assays, and 6.5% (95%CI 2.5-15.6) for point-of-care capillary blood tests. Among subgroups, serological tests identified higher risk for SARS-CoV-2 seropositivity in physicians than in nurses (OR 1.436, 95%CI 1.026 to 2.008). Regression analysis indicated the possible presence of publication bias only for molecular tests (t -3.3526, p-value 0.002648).

CONCLUSIONS: The overall pooled prevalence of SARS-CoV-2 was lower than previously expected, but available studies were affected by significant heterogeneity, and the molecular studies by significant publication bias. Therefore, further high-quality research in the field is warranted.

PMID:34738585 | DOI:10.23750/abm.v92i5.10438

Acta Biomed. 2021 Nov 3;92(5):e2021176. doi: 10.23750/abm.v92i5.11200.

ABSTRACT

PURPOSE: Anal Fissure (AF) is the second most frequent proctological disease in Italy. Chronic AF (CAF) most common located at the posterior anal commissure (CAPF). CAPF are thought to be associated with hypertonic internal anal sphincter (IAS) but manometric findings showed that a normotonic IAS is present in the 20-40%. Sphincterotomy is often recommended as treatment of choice for CAF independently from IAS tone; nevertheless, this approach appears less logical for CAF with normotonic IAS, as in those cases there’s a higher risk of post-operative anal incontinence. The aim of this study is to evaluate the results of fissurectomy and anoplasty with V-Y cutaneous advancement flap, as treatment for patients suffering from CAPF without hypertonic IAS.

METHODS: We enrolled 30 patients affected by CAPF without IAS hypertonia. All patients were followed up for 2 years after the surgical procedure, with evaluation of anal continence, recurrence rate and maximum resting pressure, maximum squeeze pressure, ultraslow wave activity.

RESULTS: All patients healed within 40 days after surgery. We didn’t observe any “de novo” post-operative anal incontinence cases. We reported 2 cases of recurrences, within 18 months from surgery, all healed after conservative therapy. We didn’t record statistically significant differences in pre- and post-operative manometry findings.

CONCLUSION: At 2 years after the surgical procedure we achieved good results, these evidences shows that sphincter preserving procedures are more suitable for CAPF without hypertonic IAS.

PMID:34738577 | DOI:10.23750/abm.v92i5.11200

Acta Biomed. 2021 Nov 3;92(5):e2021227. doi: 10.23750/abm.v92i5.11179.

ABSTRACT

BACKGROUND AND AIMS: Assessment of wounds morphology can be considered, in the everyday medical activity, the first step for the correct pathway of diagnosis. Authors present a pilot study focused on the statistical analysis of 32 cases of wounds measurements conducted by both the traditional method (paper ruler) both the digital smartphone analysis.

MATERIALS AND METHODS: 32 lesions were morphologically evaluated. All the enrolled patients were evaluated by both the traditional method (paper ruler) both a digital smartphone analysis based on the app imitoMeasure. The extracted data were compared to the traditional measurements and a statistical analysis was based on intraclass correlation coefficients (ICC).

RESULTS: Three morphological parameters were evaluated: width (expressed in cm), length (expressed in cm) and area (expressed in cm2). The area (expressed in cm2) was found to be the less comparable, but the data were close in this case, too.

CONCLUSION: The present study shows that the digital measuring systems should be easily addressed as versatile tools that could be applied in daily clinical practice in the future.

PMID:34738578 | DOI:10.23750/abm.v92i5.11179

J Biomol Struct Dyn. 2021 Nov 5:1-21. doi: 10.1080/07391102.2021.1994876. Online ahead of print.

ABSTRACT

Diabetes is one of the leading causes of death globally as per World Health Organization 2019. To cope up with side effects of current diabetes therapy, researchers have found several novel targets for the treatment of diabetes. Currently, dipeptidyl peptidase IV (DPP IV) has emerged as a target in modulating the diabetes physiology. In the present work, various 3D-Quantitative structure activity relationship (QSAR) techniques namely comparative molecular field analysis (CoMFA), comparative molecular similarity indices analysis, topomer CoMFA and molecular hologram QSAR are used to explore the structural requirements of triazole derivatives as DPP IV inhibitors. Different models generated by 3D QSAR studies had acceptable statistical values for further prediction of molecules. From the contour maps of QSAR results, important structural features are deduced. Substitutions on N₁ and N₂ of triazole ring with H-bond donor group enhances the biological activity. Aliphatic side chain, less bulky group, H-bond donor group and -COOH group on N₃ of triazole ring are vital for the DPP IV inhibition. Moreover, electron withdrawing side chain on the triazole ring improves the biological activity. Further, novel triazole derivatives were designed and docking results of these compounds proved the efficiency of the developed 3D QSAR model. In future, results of this study may provide promising DPP IV inhibitors for the treatment of diabetes. Communicated by Ramaswamy H. Sarma.

PMID:34738504 | DOI:10.1080/07391102.2021.1994876

Vopr Virusol. 2021 Nov 4;66(5):368-382. doi: 10.36233/0507-4088-76.

ABSTRACT

INTRODUCTION: A significant increase in the incidence of various forms of herpesvirus infection (HVI) determines the need to search for new approaches to the modification of one of the basic antiviral drugs aciclovir (ACV) and its dosage forms to improve their biopharmaceutical characteristics and increase the effectiveness of therapy. In this aspect, an innovative organic germanium complex with aciclovir (OGCA) is promising.The aim of the study was to assess the antiviral activity of OGCA against the herpes simplex virus (HSV) (human herpes virus, HHV) on the HVI models both in vitro and in vivo.

MATERIAL AND METHODS: We studied the activity of OGCA in a therapeutic regimen against HSV-1 (HHV-1) (Kl strain), HSV-2 (HHV-2) (VN strain) using virological and statistical research methods in the in vitro model of HVI on Vero cell culture and the model of genital herpes (GH) caused by HHV-2 (VN strain) in male guinea pigs (Canis porcellus).

RESULTS AND DISCUSSION: It was found OGCA inhibits the replication of HHV-1 and HHV-2 in Vero cells, and has anti-HHV activity in the GH model in male guinea pigs, leading to a decrease in the severity and duration of the disease, the intensity and duration of viral shedding. The most pronounced activity was detected when preparation was applied topically 5 times a day for 5 days at the early stages of infection (3% gel). The delayed use of OGCA (48 hours after infection) also had statistically significant efficacy compared to commercial reference drugs containing aciclovir or its pro-drugs: aciclovir (5% cream), AIL (acyclovir+interferon alfa-2b+lidocaine, 3% ointment), penciclovir (1% cream). OGCA significantly reduced the number of days of the pathogen shedding, as well as its infectivity, compared to animals in the control group and ones receiving placebo. The activity of OGCA, apparently, is due to its improved biopharmaceutical characteristics compared to aciclovir, as well as the presence of a number of biological activities of its constituent components.

CONCLUSION: The results of the study allow us to consider OGCA as the basis for the development of antiviral agents for the treatment of HVI.

PMID:34738452 | DOI:10.36233/0507-4088-76

Bioresour Technol. 2021 Oct 28;344(Pt B):126239. doi: 10.1016/j.biortech.2021.126239. Online ahead of print.

ABSTRACT

The palm oil mill effluent (POME) from palm milling oil activities is discharged into various water bodies which poses several environmental problems including turbidity, increases COD and BOD, adds oil and grease, increases total nitrogen, and other pollutants. Therefore, it requires effective treatment to remove the pollutants before disposal. The objective was to critically discuss the performance of POME pretreatments along with their limitations. To offer a coverage on the present less efficient technologies, the opportunities and challenges of advanced pretreatments that combine magnetic materials and natural composites as adsorbents are comprehensively reviewed here. Moreover, potential of various magnetic materials for POME pretreatment has been described. Several existing pretreatment methods such as physical pretreatments, chemical pretreatments, coagulation-flocculation, and adsorption can remove pollutant content from POME with certain limitations and the use of magnetic composite adsorbents can enhance the treatment efficiency.

PMID:34737137 | DOI:10.1016/j.biortech.2021.126239

Child Abuse Negl. 2021 Oct 30;122:105374. doi: 10.1016/j.chiabu.2021.105374. Online ahead of print.

ABSTRACT

BACKGROUND: Although child physical abuse is missed more frequently in community (CEDs) vs. pediatric emergency departments (PEDs), little information exists describing how evaluations of high-risk injuries differ between these settings.

OBJECTIVES: To determine differences in evaluations of infants for abuse between a PED and CEDs and whether a child abuse guideline reduced these differences.

PARTICIPANTS AND SETTING: Infants presenting to one PED (n = 162) and three CEDs (n = 159) with 3 injury categories: 1) Injuries for which the American Academy of Pediatrics recommends skeletal survey (SS) testing (infants <5-months with an oral injury or bruising, <9-months with a non-skull fracture, and < 12-months with an intracranial hemorrhage); 2) an oral injury or high-risk bruising in older infants; and 3) multiple types of high-risk injuries.

METHODS: We assessed differences in SS testing and child protective services (CPS) reporting between the PED and CEDs before and after implementation of a child abuse guideline.

RESULTS: The median (IQR) age was 4 months (2-7). Before guideline implementation, infants with injuries in categories 1 and 2 had an increased odds of SS testing in the PED vs. the CEDs (Category 1: aOR 2.83, 95% CI: 1.01-8.10; Category 2: aOR 10.1, CI: 1.2-88.0) and CPS reporting (Category 1: aOR 7.96, CI: 2.3-26.7; Category 2: aOR 12.0, CI: 1.4-103.5). After guideline implementation, there were no statistically significant differences in testing and reporting for any injury category.

CONCLUSIONS: Implementation of a child abuse guideline minimized differences between a PED and CEDs in the evaluation of infants with injuries concerning for abuse.

PMID:34737120 | DOI:10.1016/j.chiabu.2021.105374

J Psychiatr Res. 2021 Oct 21;144:331-337. doi: 10.1016/j.jpsychires.2021.10.032. Online ahead of print.

ABSTRACT

To assess whether patient-controlled admissions (PCA) to psychiatric hospital wards have an effect on total health care costs in the short term and longer term compared with patients receiving treatment as usual (TAU). Based on Danish register data and using coarsened exact matching, patients who signed a contract for PCA during 2013-2016 were matched on observables with a control group of TAU patients identified from psychiatric registers. As primary outcome patients’ expenditure was explored in 6-monthly intervals over the first 12 months, and as secondary outcome over the 12-24 month period after index month. To control for unobservable selection a quasi-experimental difference-in-difference design was applied on the matched population using the principle of intention to treat. 414 PCA patients (out of 423 available) were successfully matched with 7181 never exposed TAU patients (out of 67,331 available). Total healthcare costs for PCA patients were €8887 (95% CI 708-17,067) higher per month than unexposed TAU patients in the first six months after index. Monthly psychiatric costs were €8922 (95% CI 708-17,067) higher for PCA patients than for TAU patients. These differences persisted, in the next three six-monthly periods, albeit were not statistically significant, in the second six-monthly period after index. In conclusion, driven by the psychiatric costs, implementing PCA increased the total healthcare costs in the short term compared with TAU. More research of the impact on health care costs in a broader and long-term perspective is still needed.

PMID:34737122 | DOI:10.1016/j.jpsychires.2021.10.032

World Neurosurg. 2021 Nov 1:S1878-8750(21)01672-7. doi: 10.1016/j.wneu.2021.10.160. Online ahead of print.

ABSTRACT

BACKGROUND: Spine surgeons are usually exposed to high work load and demanding work conditions. While the relationship between pharmacological neuroenhancement (PNE) and resilience, i.e. the ability to recover from stress, as well as perceived stress and resilience enhancing factors has been investigated in the general population, less is known about the impact of those factors in spine surgeons. The study aimed to close that gap by investigating the relationship between PNE use and resilience, perceived stress or resilience enhancing factors in spine surgeons.

METHODS: We conducted a cross-sectional survey in a sample of N = 582 spine surgeons in German speaking countries (Austria, Germany, Switzerland). Potentially predictive variables as well as the use of PNE were assessed by self-report questionnaires. We conducted stepwise logistic regression with backward elimination to assess the relationship between PNE use, perceived stress, resilience and resilience enhancing factors.

RESULTS: Lifetime prevalence for PNE use was 5,7%, with highest prevalence rates for antidepressants (2,6%). Each additional unit on the perceived stress scale increased the risk for PNE use (OR: 2.271, 95% CI: .1.363-3.785, p: .002). No statistically significant results were found for the individual ability to recover from stress or resilience enhancing factors.

CONCLUSIONS: Spine surgeons with higher levels of stress seem to be more prone to non-medical use of PNE. Tailored interventions may improve the ability to cope with high perceived stress and prevent the use of PNE. Further research should examine the efficacy of those interventions on the prevention of PNE in spine surgeons.

PMID:34737099 | DOI:10.1016/j.wneu.2021.10.160

Spine J. 2021 Nov 1:S1529-9430(21)00980-3. doi: 10.1016/j.spinee.2021.10.020. Online ahead of print.

ABSTRACT

BACKGROUND CONTEXT: Computer-aided diagnosis with artificial intelligence (AI) has been used clinically, and ground truth generalizability is important for AI performance in medical image analyses. The AI model was trained on one specific group of older adults (aged≧60) has not yet been shown to work equally well in a younger adult group (aged 18-59).

PURPOSE: To compare the performance of the developed AI model with ensemble method trained with the ground truth for those aged 60 years or older in identifying vertebral fractures (VFs) on plain lateral radiographs of spine (PLRS) between younger and older adult populations.

STUDY DESIGN/SETTING: Retrospective analysis of PLRS in a single medical institution PATIENT SAMPLE OUTCOME MEASURES: Accuracy, sensitivity, specificity, and interobserver reliability (kappa value) were used to compare diagnostic performance of the AI model and subspecialists’ consensus between the two groups.

METHODS: Between January 2016 and December 2018, the ground truth of 941 patients (one PLRS per person) aged 60 years and older with 1101 VFs and 6358 normal vertebrae was used to set up the AI model. The framework of the developed AI model includes: object detection with You Only Look Once Version 3 (YOLOv3) at T0-L5 levels in the PLRS, data pre-preprocessing with image-size and quality processing, and AI ensemble model (ResNet34, DenseNet121, and DenseNet201) for identifying or grading VFs. The reported overall accuracy, sensitivity and specificity were 92%, 91% and 93%, respectively, and external validation was also performed. Thereafter, patients diagnosed as VFs and treated in our institution during October 2019 to August 2020 were the study group regardless of age. In total, 258 patients (339 VFs and 1725 normal vertebrae) in the older adult population (mean age 78 ±10.4; range, 60-106) were enrolled. In the younger adult population (mean age 36 ± 9.43; range, 20-49), 106 patients (120 VFs and 728 normal vertebrae) were enrolled. After identification and grading of VFs based on the Genant method with consensus between two subspecialists’, VFs in each PLRS with human labels were defined as the testing dataset. The corresponding CT or MRI scan was used for labeling in the PLRS. The bootstrap method was applied to the testing dataset.

RESULTS: The model for clinical application, Digital Imaging and Communications in Medicine (DICOM) format, is uploaded directly (available at: http://140.113.114.104/vght_demo/svf-model (grading) and http://14 0.113.114.104/vght demo/svf-model2 (labeling). Overall accuracy, sensitivity and specificity in the older adult population were 93.36% (95% CI 93.34%-93.38%), 88.97% (95% CI 88.59%-88.99%) and 94.26% (95% CI 94.23%-94.29%), respectively. Overall accuracy, sensitivity and specificity in the younger adult population were 93.75% (95% CI 93.7%-93.8%), 65.00% (95% CI 64.33%-65.67%) and 98.49% (95% CI 98.45%-98.52%), respectively. Accuracy reached 100% in VFs grading once the VFs were labeled accurately. The unique pattern of limbus-like VFs, 43 (35.8%) were investigated only in the younger adult population. If limbus-like VFs from the dataset were not included, the accuracy increased from 93.75% (95% CI 93.70%-93.80%) to 95.78% (95% CI 95.73%-95.82%), sensitivity increased from 65.00% (95% CI 64.33%-65.67%) to 70.13% (95% CI 68.98%-71.27%) and specificity remained unchanged at 98.49% (95% CI 98.45%-98.52%), respectively. The main causes of false negative results in older adults were patients’ lung markings, diaphragm or bowel airs (37%, n=14) followed by type I fracture (29%, n=11). The main causes of false negatives in younger adults were limbus-like VFs (45%, n=19), followed by type I fracture (26%, n=11). The overall kappa between AI discrimination and subspecialists’ consensus in the older and younger adult populations were 0.77 (95% CI, 0.733-0.805) and 0.72 (95% CI, 0.6524-0.80), respectively.

CONCLUSIONS: The developed VF-identifying AI ensemble model based on ground truth of older adults achieved better performance in identifying VFs in older adults and non-fractured thoracic and lumbar vertebrae in the younger adults. Different age distribution may have potential disease diversity and implicate the effect of ground truth generalizability on the AI model performance.

PMID:34737066 | DOI:10.1016/j.spinee.2021.10.020