Category: Nevin Manimala

Age Ageing. 2021 Dec 6:afab233. doi: 10.1093/ageing/afab233. Online ahead of print.

ABSTRACT

OBJECTIVE: to develop a user-friendly prediction tool of 1-year mortality for patients with hip fracture, in order to guide clinicians and patients on appropriate targeted preventive measures.

DESIGN: population-based cohort study from 2011 to 2017 using nationwide data from the Danish Hip Fracture Registry.

SUBJECTS: a total of 28,791 patients age 65 and above undergoing surgery for a first-time hip fracture.

METHODS: patient-related prognostic factors at the time of admission were assessed as potential predictors: Nursing home residency, comorbidity (Charlson Comorbidity Index [CCI] Score), frailty (Hospital Frailty Risk Score), basic mobility (Cumulated Ambulation Score), atrial fibrillation, fracture type, body mass index (BMI), age and sex. Association with 1-year mortality examined by determining the cumulative incidence, applying univariable logistic regression and assessing discrimination (area under the receiver operating characteristics curve [AUROC]). The final model (logistic regression) was utilised on a development cohort (70% of patients). Discrimination and calibration were assessed on the validation cohort (remaining 30% of patients).

RESULTS: all predictors showed an association with 1-year mortality, but discrimination was moderate. The final model included nursing home residency, CCI Score, Cumulated Ambulation Score, BMI and age. It had an acceptable discrimination (AUROC 0.74) and calibration, and predicted 1-year mortality risk spanning from 5 to 91% depending on the combination of predictors in the individual patient.

CONCLUSIONS: using information obtainable at the time of admission, 1-year mortality among patients with hip fracture can be predicted. We present a user-friendly chart for daily clinical practice and provide new insight regarding the interplay between prognostic factors.

PMID:34923589 | DOI:10.1093/ageing/afab233

Eur J Anaesthesiol. 2021 Dec 17. doi: 10.1097/EJA.0000000000001649. Online ahead of print.

ABSTRACT

BACKGROUND: Postoperative emergence agitation remains a significant challenge in paediatric anaesthesia. Although short-lived, it may cause harm to the patient and negative experiences for all. Differentiating agitation, delirium and pain is difficult. Electroencephalography allows precise titration of anaesthetic depth, and heart rate variability monitoring permits immediate intervention regarding nociception and pain. We examined if one of these measures could be used to reduce postoperative agitation in an unselected paediatric day surgical population.

OBJECTIVE: The primary outcome was postoperative agitation with a Richmond Agitation-Sedation Scale greater than 0. Secondary outcomes were: length of stay, postoperative nausea and vomiting, fentanyl and propofol consumption, pain scores and use of postoperative analgesics.

DESIGN: A randomised, single-blinded study constituting children aged 1 to 6 years, undergoing minor general day surgical procedures.

SETTING: Paediatric day surgical department 29th March 2019 to 12th June 2020.

PATIENTS: Ninety-eight children (ASA 1 or 2) were enrolled, and 93 children were included in the final analysis.

INTERVENTIONS: Children received standard monitoring (n=31), standard monitoring plus either Narcotrend (n=31), or Anaesthesia Nociception Index monitoring (n=31). Sevoflurane or fentanyl was titrated immediately according to monitor thresholds.

RESULTS: Kaplan-Meier analysis yielded a statistically significant difference between the groups (P = 0.016) with the lowest agitation levels in the Anaesthesia Nociception Index group, intermediate levels in the control group and the highest agitation levels in the Narcotrend monitored group. Intergroup pairwise comparison however, showed no difference. The Anaesthesia Nocioception Index group received slightly more fentanyl (P = 0.277). The control group patients had the highest pain scores despite receiving more caudal blocks and the Narcotrend group had more sevoflurane adjustments. Other secondary outcomes were comparable.

CONCLUSION: Children in the Anaesthesia Nociception Index group were the least agitated with the highest fentanyl doses, without increasing the length of stay in the PACU or postoperative nausea and vomiting.

CLINICAL REGISTRATION: The study was registered in RedCAP online trial database 1/11/2018 trial registration nr. OP720. https://open.rsyd.dk/OpenProjects/openProject.jsp?openNo=720&lang=da.

PMID:34923564 | DOI:10.1097/EJA.0000000000001649

Blood Cancer J. 2021 Dec 18;11(12):203. doi: 10.1038/s41408-021-00586-1.

ABSTRACT

Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) is a rare B-cell malignancy associated with excellent survival. However, some patients experience histological transformation into aggressive large B-cell lymphoma. Population-based data on transformation in patients with NLPHL is limited. We conducted a nationwide population-based study to estimate the risk of transformation and relative survival in patients diagnosed with NLPHL in Finland between 1995 and 2018. We identified a total of 453 patients (median age, 48 years; 76% males) with the incident NLPHL from the Finnish Cancer Registry. The cumulative incidence of transformation was 6.3% (95% CI, 4.2-9.6) at 10 years. After adjusting for sex, age and year of diagnosis, transformation was associated with a substantially increased risk of death (HR 8.55, 95% CI 4.49-16.3). Ten-year relative survival was 94% (95% CI, 89%‒100%). The patients diagnosed at a later calendar year had lower excess risk of death (HR, 0.38 per 10-year increase; 95% CI, 0.15‒0.98). We conclude that while the 10-year relative survival for the patients with NLPHL was excellent in this large population-based cohort for the entire study period, transformation resulted in a substantially increased mortality compared with the patients without transformation. Our results also suggest a reduction in excess mortality over time.

PMID:34923571 | DOI:10.1038/s41408-021-00586-1

Spine (Phila Pa 1976). 2021 Dec 17. doi: 10.1097/BRS.0000000000004315. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective longitudinal study.

OBJECTIVE: The main goal of this study was to measure the disability after AIS correction, according to the LIV.

SUMMARY OF BACKGROUND DATA: Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine that may require surgical correction. If the upper and lower instrumented levels (UIV and LIV) of these fusions are defined by the characteristics of the curve, the long-term consequences of the LIV choices are still partially unknown.

METHODS: This retrospective longitudinal study collected demographic, radiologic (Lenke classification, Cobb’s angle) and surgical data (approach, LIV, UIV) on 116 patients operated for AIS fusion on a specialized pediatric spine center were collected. All participants answered SRS30, SF12, lumbar and leg pain Visual Analogue Scales (VAS) at last follow-up. Statistical analysis between LIV (T12L1, L2, L3 or L4L5) and clinical data at last follow-up was realized.

RESULTS: The mean follow-up was 87 months. The mean increase of back pain VAS per UIV level was 9 mm. No statistically significant difference between the different LIV were found, for SRS30 or SF12 MCS (mental component scale). There was a statistically significant difference between L3 UIV and L4L5 UIV for SF-12 PCS (physical component scale); (p = 0,03).

CONCLUSION: The long-term consequences of LIV choice mostly affect levels distal to L3. If the LIV is mostly defined by the characteristics of the curve, one level caudally corresponds to +9 mm of back pain VAS at 7 years of follow-up. Surgeons may be aware of the long-term consequence of LIV choice and patients be informed.Level of Evidence: 4.

PMID:34923547 | DOI:10.1097/BRS.0000000000004315

Tech Hand Up Extrem Surg. 2021 Dec 20. doi: 10.1097/BTH.0000000000000376. Online ahead of print.

ABSTRACT

Historically, distal biceps tendon repair through the tension slide technique (TST) using a cortical button has yielded the strongest published repair measured by observed gap formation in both cyclic and maximal load to failure. The modified tension slide technique (MTST) was developed in order to provide the surgeon with a technically simpler and biomechanically more effective way to reduce gap formation and consistently seat/bottom-out the tendon within the bone tunnel through a more direct line of pull. In order to compare the biomechanics of the MTST to the TST, we used 24 matched bovine extensor tendons, and conducted maximal load to failure and cyclical load to failure testing using an Instron 5566 machine. The mean maximal load to failure for the MTST was 444 N versus 229 N for the TST (P<0.004) while no gap formation was observed in either group after cyclic load testing. These findings indicate that the MTST has a statistically significant increased load to gap formation of ∼2-fold in comparison to TST. In the MTST both limbs of suture are passed back through the tendon, before button implantation, eliminating the “operating in a hole” effect required in the TST, and making for a simpler surgical procedure.

PMID:34923560 | DOI:10.1097/BTH.0000000000000376

Dermatol Surg. 2021 Dec 16. doi: 10.1097/DSS.0000000000003348. Online ahead of print.

ABSTRACT

BACKGROUND: Bilobed transposition flaps are prone to pincushioning (trapdooring), whereby contraction of the flap over the wound bed may produce an unsatisfactory functional and aesthetic outcome. There are several proposed methods to prevent this, but there is currently no clear consensus on the ideal technique.

OBJECTIVE: To compare primary lobe pexing sutures versus intraoperative triamcinolone (TAC) injection as methods to prevent pincushioning in bilobed transposition flaps.

MATERIAL AND METHODS: A retrospective chart review of bilobed flap reconstructions identified from the Mohs micrographic surgery database at a single tertiary center in New Zealand.

RESULTS: Three hundred forty-two patients met the inclusion criteria: 37 received pexing sutures, 42 intraoperative TAC, and 263 no additional intervention. The most defect common location was the nasal tip (43.6%), followed by the ala (20.8%). Ninety-three participants (27.2%) developed pincushioning at a median 35 days postoperatively. Participants receiving no intervention had a 30.8% pincushioning rate. The TAC group had a 23.8% pincushioning rate (p = .358), and the pexing group had a 5.5% pincushioning rate (p = .001).

CONCLUSION: Participants receiving primary lobe pexing sutures had a statistically significantly lower rate of pincushioning than those receiving no intervention. Intraoperative TAC injections appeared to have little impact on pincushioning.

PMID:34923529 | DOI:10.1097/DSS.0000000000003348

Dermatol Surg. 2021 Dec 14. doi: 10.1097/DSS.0000000000003353. Online ahead of print.

ABSTRACT

BACKGROUND: Pain assessment plays an important role in dermatologic surgery. The numeric rating scale (NRS), visual analog scale (VAS), verbal rating scale (VRS), and Faces Pain Scale (FPS) are commonly used scales for pain measurement. Conflicting evidence exists regarding the use of each. Prompt pain recognition and treatment during procedures result in higher patient satisfaction.

OBJECTIVE: Determine the most applicable scale for acute pain measurement in dermatologic surgery.

MATERIALS AND METHODS: This systematic review was performed in accordance with PRISMA-Supplemental Digital Content 4, http://links.lww.com/DSS/A976 (PROSPERO; CRD42018091058). PubMed, Cochrane, EMBASE, Scopus, and Web of Science were searched between April 24, 2018, and May 06, 2018. The search query consisted of pain, pain measurement (NRS, VAS, VRS, and FPS), and assessment/comparison. The inclusion criteria included English language literature with primary/secondary outcome objectives directly comparing ≥2 pain scales in acute pain (age: 13+). Study end points included interscale correlations, patient preferences, provider preferences, study author recommendations, and failure rates.

RESULTS: Eight hundred seven studies were retrieved: A total of 42 studies were included. The visual analog scale (n = 42) was most studied, followed by NRS (n = 29), VRS (n = 27), and FPS (n = 11). 93.1% studies showed a high statistical correlation between VAS and NRS. Patients preferred NRS (n = 8/11), followed by FPS (n = 3/11), VRS (n = 2/11), and VAS (n = 1/11). Study authors recommended NRS/VAS (n = 8/19), VRS (n = 6/19), and FPS (n = 1/19). Providers preferred NRS (n = 2/3) and VRS (n = 1/3). The visual analog scale had the highest failure rate (n = 11/12).

CONCLUSION: The numeric rating scale is most applicable for dermatologic surgery because of reported patient and provider preferences, lowest failure rates, and most frequent study author recommendations.

PMID:34923536 | DOI:10.1097/DSS.0000000000003353

Retina. 2021 Dec 15. doi: 10.1097/IAE.0000000000003378. Online ahead of print.

ABSTRACT

PURPOSE: To compare the choroidal characteristics between the eyes of patients with and without hereditary transthyretin amyloidosis (hTTRA).

METHODS: Case-control observational study with choroidal thickness and vasculature evaluation by Optical Coherence Tomography with Enhanced Depth Imaging protocol (OCT-EDI) of the macula.

RESULTS: The study included 332 eyes: 166 eyes of hTTRA patients and 166 eyes of healthy patients. Mean age was similar between groups (p=0.979). For hTTRA patients, on average, in all sectors analysed (in the full 5mm-width image (G) and also in 1mm-width central (C), nasal (N), and temporal (T) sectors), there was a higher stromal area (SA), a lower choroidal thickness (CT) and a lower choroidal vascularity index (CVI), compared to the control group. The linear mixed models revealed no differences according to the systemic treatment groups.

CONCLUSION: hTTRA patients showed statistically significant differences in choroidal characteristics, compared to eyes without pathology. These age-related and statistically significant changes compared to the healthy eyes may help in the future to better monitor the systemic hTTRA disease and complement other systemic evaluations, including on clinical trials to analyse more objective the results of new therapies.

PMID:34923509 | DOI:10.1097/IAE.0000000000003378

J Pediatr Orthop. 2021 Dec 20. doi: 10.1097/BPO.0000000000002032. Online ahead of print.

ABSTRACT

BACKGROUND: Femoral fractures are the most common cause of fracture-related admissions. Unplanned return to the operating room (UpROR) is a major event and imposes a substantial burden on the family and health care system. The purpose of this study was to determine the incidence of complications and early UpROR during the first 6 months following treatment of femoral fractures and their risk factors.

METHODS: In an institutional review board-approved study, a retrospective review of all patients who were treated for a femoral fracture during a 10-year period at a pediatric tertiary care center was performed. Patients less than 18 years old with a diaphyseal fracture and complete records were included, and nondiaphyseal or pathologic fractures, as well as underlying metabolic or genetic disorders, were excluded. All clinic visits in the first 6 months after treatment were reviewed, and all complications and UpRORs were extracted. Patients were grouped based on their age (below 5, 5 to 11, above 11 y old) at initial treatment, and statistical tests were used to infer differences between groups.

RESULTS: Overall, 841 fractures in 832 patients were included, with a mean age of 5.5±4.8 years fracture, of which 72% were male. A total of 106 complications (12.6%) and 45 UpRORs (5.3%) were encountered during the study period. Patients with and without UpROR had similar demographics and injury and treatment characteristics. Loss of reduction was the most common reason for UpROR (58%), followed by implant-related complications. Flexible nails had the highest risk of UpROR among patients who were initially treated surgically (P=0.03).

CONCLUSIONS: Our findings indicate that children under the age of 5 years have a 5% risk of UpROR in the first 6 months after the fracture, mainly for repeat spica casting due to loss of reduction. Patients aged 5 years or older have an ∼6% risk of UpROR, mainly related to complications of flexible nails. The findings of this study are important when consulting families on different treatments of diaphyseal femoral fractures.

LEVEL OF EVIDENCE: Therapeutic level III-retrospective cohort study.

PMID:34923506 | DOI:10.1097/BPO.0000000000002032

West Afr J Med. 2021 Nov 30;Vol. 38(11):1101-1107.

ABSTRACT

BACKGROUND: Fertility is an important component of population change and has attracted the interest of scholars and policy makers. Nigeria’s population growth rate has been driven by high fertility, which has fallen in the last few decades but not as rapidly as the fall of the crude death rate. Men and their kinsmen are the decision-makers on issues relating to reproductive health such as timing of the next birth, number of children and when to stop childbearing while their women cooperate. We determined the reproductive behaviors of men in Doka community in Kaduna State Nigeria.

METHODOLOGY: A cross-sectional descriptive community based study of 320 men was conducted.

RESULTS: The mean age±SD of the male respondents was 40 (±14.2) years. The average age at first marriage among men was 23.32 (±4.62 years), the contraceptive use among men was 10(3.2%). Above a third 118 (37.9%) of men were in polygamous union. There was a statistically significant increase in the mean number of living children as the age of men increased (p=0.001). The mean number of children ever fathered was significantly associated with the educational status of men (p=0.03).

CONCLUSION: we found a very low contraceptive use, high number of desired children as well as living children among the men. Government should enlighten married men on the importance of contraceptive use for birth control as well as the social and economic implications of having too many children.

PMID:34922410