Category: Nevin Manimala

Fetal Diagn Ther. 2021 Apr 6:1-11. doi: 10.1159/000514504. Online ahead of print.

ABSTRACT

INTRODUCTION: This paper aimed to assess the knowledge of healthcare professionals (obstetric and gynecology residents, specialists, and midwives) in the field of perinatal medicine regarding fetal growth diagnosis and management.

METHODS: A questionnaire was created consisting of a set of questions regarding demographic data, methods of growth assessment, and management. It was a handout survey. The results were analyzed with the use of descriptive statistics and χ2 analysis using the program Statistica.

RESULTS: 190 medical professionals have participated in the questionnaire. 86.3% of respondents agreed that pregnancy dating should be modified based on first-trimester ultrasound. 90.9% agreed that III trimester ultrasound has a ±15% margin of error. When asked which growth charts are best fit for assessing growth in a studied population, 10.7% marked standard, 37.4% reference, 26.2% customized, and 26.2% did not know the difference between the three choices. 60.3% stated that they use a growth chart to assess growth and qualify fetuses for monitoring. 70.2% used the 10th centile as a cutoff, 20.1% 5th centile, and 9.7% 3rd centile. Only 40.9% would diagnose fetal growth restriction based on fetal weight only. 28.7% using the 10th centile cutoff, 16.1% 5th centile, and 54.0% 3rd centile. Only a quarter of the respondents were able to name the growth chart or tool that they use for assessment. The most common responses were Yudkin, Hadlock, and online calculators of Fetal Medicina Barcelona and the Fetal Medicine Foundation.

DISCUSSION: A lot of confusion is observed primarily in the aspect of cutoff values for identification, subsequent monitoring, and management of fetal growth restriction. There is a need for extensive training and education in this field and uniform national recommendations.

PMID:33823513 | DOI:10.1159/000514504

Eur J Prev Cardiol. 2020 Nov 5:zwaa049. doi: 10.1093/eurjpc/zwaa049. Online ahead of print.

ABSTRACT

AIMS: Heart failure (HF) is associated with obesity, but the relationship between weight change and HF is inconsistent. We examined the relationship between weight change and the incidence of HF in the Korean population.

DESIGN: Retrospective cohort study design.

METHODS AND RESULTS: A total of 11 210 394 subjects (6 198 542 men and 5 011 852 women) >20 years of age were enrolled in this study. Weight change over 4 years divided into seven categories from weight loss ≥15% to weight gain ≥15%. The hazard ratios (HRs) and 95% confidence intervals for the incidence of HF were analysed. The HR of HF showed a slightly reverse J-shaped curve by increasing weight change in total and >15% weight loss shows the highest HR (HR 1.647) followed by -15 to -10% weight loss (HR = 1.444). When using normal body mass index with stable weight group as a reference, HR of HF decreased as weight increased in underweight subjects and weight gain ≥15% in obesity Stage II showed the highest HR (HR = 2.97). Sustained weight for 4 years in the underweight and obesity Stages I and II increased the incidence of HF (HR = 1.402, 1.092, and 1.566, respectively).

CONCLUSION: Both weight loss and weight gain increased HR for HF. Sustained weight in the obesity or underweight categories increased the incidence of HF.

PMID:33823535 | DOI:10.1093/eurjpc/zwaa049

Int J Pediatr Otorhinolaryngol. 2021 Jan 27;144:110606. doi: 10.1016/j.ijporl.2020.110606. Online ahead of print.

ABSTRACT

INTRODUCTION: Cochlear implantation is a safe surgery for restoration of hearing in profoundly deaf children. Following cochlear implantation, children undergo rehabilitation (or ‘habilitation’ for those without previous hearing). The device is programmed after the surgery, so that the user can hear sounds through it and through rehabilitation training, the heard sounds are made to understand.

OBJECTIVE: Our study was aimed at analysing the role of satellite habilitation centres following cochlear implantation by analysing the outcomes following habilitation and comparing it with the outcomes of the main centre and correlating it with the percentage of attendance of classes. Our study also aims to compare the attendance of implant patients from outside the geographical area of the main centre before and after starting the satellite centre.

MATERIALS AND METHODS: 1004 profoundly deaf children (6 years and below) who had undergone cochlear implantation and completed 12months of habilitation in our institution from July 2013 to December 2019 were retrospectively analysed. The outcomes of all the centres were assessed by comparing the baseline CAP with CAP scores at 12 months and baseline SIR with SIR scores at 12 months. The outcomes of the main centre and satellite centres were also compared. The outcomes were correlated with percentage of attendance of classes.

OBSERVATION: The overall attendance in all the centres was between 75 and 80%. Both main and satellite centres showed statistically significant good outcomes and this correlates with percentage of attendance.

CONCLUSION: Satellite centres for habilitation across the state has greatly helped to improve the attendance of these patients and outcomes. Reduced drop-out rates and improved speech language outcomes can be achieved by starting satellite centres for habilitation post cochlear implantation in developing countries like India.

PMID:33823468 | DOI:10.1016/j.ijporl.2020.110606

J Surg Res. 2021 Apr 3;264:138-148. doi: 10.1016/j.jss.2021.02.020. Online ahead of print.

ABSTRACT

BACKGROUND: Signet ring cell breast carcinoma (SRCBC) is a rare variant of invasive lobular carcinoma and there are no large series characterizing its long-term prognosis.

MATERIALS AND METHODS: The NCDB was queried from 2004-2016 to identify SRCBC patients. Patients were excluded if they had non-invasive tumors, multiple malignancies, or incomplete surgical data. Univariate analysis was performed utilizing chi-squared and Fischer’s Exact tests. Kaplan-Meier and Cox proportional hazard models were used for survival analysis.

RESULTS: 324 patients met inclusion criteria. Patients were mostly White (75.3%), ≥50 years of age (88.2%), female (98.5%), and had a low Charlson-Deyo score (82.7%). 34.5% had Stage IV disease and 78.1% had ER+ tumors. In patients with non-Stage IV disease, 91.5% received surgery: 49.5% had lumpectomy and 50.5% underwent mastectomy. Radiation therapy was used in 40.7% (71.4% with lumpectomy and 35.8% with mastectomy) and 50% received chemotherapy. Significant differences in unadjusted overall survival were seen at 5 and 10 years based on stage (P < 0.001). On multivariate analysis, ER+ patients showed an improved survival (HR 0.5, P < 0.01) but there was no difference in survival if ER+ patients received endocrine therapy (ET) (HR 0.9, P = 0.57). Non-metastatic patients who underwent surgery had improved overall survival compared to those that did not (HR 0.5, P = 0.02), but there was no survival difference based upon type of breast operation (P = 0.8).

CONCLUSION: SRCBC frequently presents at an advanced stage. While ER+ patients appear to have improved survival, there was no clear survival benefit to receiving ET in ER+ patients.

PMID:33823490 | DOI:10.1016/j.jss.2021.02.020

Phys Med Biol. 2021 Apr 6. doi: 10.1088/1361-6560/abf51f. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to investigate the feasibility of different acquisition methods for time-resolved magnetic resonance fingerprinting (TR-MRF) in computer simulation.

METHODS: Extended cardiac-torso (XCAT) phantom is used to generate abdominal T1, T2, and proton density (PD) maps for MRF simulation. The simulated MRF technique consists of an IR-FISP MRF sequence with spiral trajectory acquisition. MRF maps were simulated with different number of repetitions from 1 to 15. Three different methods were used to generate TR-MRF maps: 1) continuous acquisition without delay between MRF repetitions; 2) continuous acquisition with 5 seconds delay between MRF repetitions; 3) triggered acquisition with variable delay between MRF repetitions to allow the next acquisition to start at different respiration phase. After the generation of TR-MRF maps, the image quality indexes including absolute T1 and T2 value, signal-to-noise-ratio (SNR), tumor-to-liver contrast-to-noise ratio (CNR), error in the amplitude of diaphragm motion and tumor volume error were used to evaluate the reconstructed parameter maps. Three volunteers were recruited to test the feasibility of the selected acquisition method.

RESULTS: Dynamic MR parametric maps using three different acquisition methods were estimated. The overall and liver T1 value error, liver SNR in T1 and T2 maps, and tumor SNR from T1 maps from triggered method is statistically significantly better than the other two methods (p-value < 0.05). The other image quality indexes have no significant difference between the triggered method and the other two continuous acquisition methods. All image quality indexes exhibit no significant difference between the acquisition methods with 0 second and 5 seconds delay. The triggered method was successfully performed in three healthy volunteers.

CONCLUSION: TR-MRF technique was investigated using three different acquisition methods in computer simulation where the triggered method showed better performance than the other two methods. The triggered method has been tested successfully in healthy volunteers.

PMID:33823496 | DOI:10.1088/1361-6560/abf51f

J Environ Manage. 2021 Mar 30;288:112403. doi: 10.1016/j.jenvman.2021.112403. Online ahead of print.

ABSTRACT

Water end-use studies disaggregate the quantity and frequency of water uses for various household purposes. Water end-use studies are available but none for India, which is gradually approaching a water-scarce condition from being a water-stressed country at present. This implies a need for incorporating water end-use understanding for augmenting urban recycling plans and strategies. To identify socio-demographic determinants of water end-use consumption for use in targeted urban water management, we focused on the indoor micro-components of bathing, dish-washing, laundering, and cleaning at households across the twin cities of Gujarat, a water-scarce province of India. A mixed-method approach was used for data collection in which questionnaire surveys (estimated or indirect measurements) were coupled with water meters (direct measurements) at households. The twin cities of Gujrat represent a spatial variation in greywater production at homes even at a distance of 30-40 km. Direct measurement showed less total average water consumption in Ahmedabad (83 L/HH/d) than Gandhinagar (105 L/HH/d), while indirect measurement showed indoor average consumption of 427 and 497 L/HH/d in the respective cities. Statistical significance of income, family size, and education was noticed on the water consumption pattern of a household. Besides, the study provides the attitude and practice of users towards water conservation behavior. We present new insights and recommendations for future urban water sustainability that are specific to India and applicable to several south-Asian countries.

PMID:33823433 | DOI:10.1016/j.jenvman.2021.112403

J Environ Manage. 2021 Mar 30;288:112412. doi: 10.1016/j.jenvman.2021.112412. Online ahead of print.

ABSTRACT

This study evaluated the impact of a 50% reduction of filter media depth in Household Slow Sand Filters (HSSFs) on continuous flow to remove physicochemical and microbiological parameters from river water. Furthermore, simple pre-treatment and disinfection processes were evaluated as additional treatments. Two filter models with different filtration layer depths were evaluated: a traditional one with 50 cm media depth (T-HSSF) and a compact one (C-HSSF) with 25 cm. HSSFs were fed with pre-treated river water (24-h water sedimentation followed by synthetic fabric filtration) for 436 days at a constant filtration rate of 0.90 m³ m^-2 day^-1 with a daily production of 48 L day^-1. Sodium hypochlorite (2.0 mg L^-1 of NaOCl 2.5% for 30 min) was used to disinfect the filtered water. Water samples were analysed weekly for parameters such as turbidity, organic matter, colour and E. coli, among others. Removal of protozoan cysts and oocysts by the HSSFs were also evaluated. After pretreatment, turbidity from the HSSF river water was reduced to 13.2 ± 14.6 NTU, allowing the filters to operate. Statistical analysis indicated no significant difference (p > 0.05) between T-HSSF and C-HSSF efficiencies in all evaluated parameters throughout operation time. Hence, media depth reduction did not hinder continuous HSSF performance for almost all the evaluated parameters. However, it may have affected Giardia cysts retaining, which passed through the thinner media on one evaluation day. Disinfection was effective in reducing remaining bacteria from filtered water; however, it was ineffective to inactivate protozoa. The reduction in the filtration layer did not affect the overall filtered water quality or quantity showing that a compact HSSF model may be a viable option for decentralized water treatment.

PMID:33823447 | DOI:10.1016/j.jenvman.2021.112412

J Clin Anesth. 2021 Apr 3;71:110257. doi: 10.1016/j.jclinane.2021.110257. Online ahead of print.

ABSTRACT

STUDY OBJECTIVE: There is no established analgesic method for postoperative total knee arthroplasty. We comprehensively compared the analgesic methods for postoperative total knee arthroplasty.

DESIGN: A network meta-analysis of randomised controlled trials was used to compare 18 interventions, which were ranked by six outcome indices, to select the best modality.

SETTING: Postoperative recovery room and inpatient ward.

PATIENTS: 98 randomised controlled trials involving 7452 patients (ASA I-III) were included in the final analysis.

INTERVENTIONS: Studies that included the use of at least one of the following 12 nerve block(fascia iliaca compartment block (FIB), FNB, cFNB, single femoral nerve block (sFNB), adductor canal block (ACB), sciatic nerve block (SNB), obturator nerve block (ONB), continuous posterior lumbar plexus block (PSOAS), FNB + SNB, ACB + LIA, FNB + LIA, PCA + FNB).

MEASUREMENTS: Pain intensity was compared using Visual Analogue Scale (VAS). Also, postoperative complications, function score, hospital length of stay, morphine consumption and patient satisfaction were measured.

MAIN RESULTS: For visual analogue scale scores, continuous femoral nerve block (FNB) and FNB + sciatic nerve block (SNB) were the the most effective interventions. For reducing postoperative complications, fascia iliaca compartment block, FNB, SNB, and obturator nerve block showed the best results. For reducing postoperative morphine consumption, adductor canal block (ACB) + local infiltration analgesia (LIA) and FNB + SNB were preferred. For function scores (range of motion, Timed-Up-and-Go test), ACB and LIA were optimal choices. For reducing hospital length of stay and patient satisfaction, ACB + LIA and FNB + LIA were best, respectively.

CONCLUSIONS: Peripheral nerve block, especially FNB and ACB, is a better option than other analgesic methods, and its combination with other methods can be beneficial. Peripheral nerve block is a safe and effective postoperative analgesia method. However, our findings can only provide objective evidence. Clinicians should choose the treatment course based on the individual patient’s condition and clinical situation.

PMID:33823459 | DOI:10.1016/j.jclinane.2021.110257

Int J Pediatr Otorhinolaryngol. 2021 Mar 29;144:110699. doi: 10.1016/j.ijporl.2021.110699. Online ahead of print.

ABSTRACT

BACKGROUND: Recent studies have shown that a short lingual frenulum is a potential risk factor for obstructive sleep apnea syndrome (OSAS) in children. A short frenulum leads to abnormal orofacial development and may consequently contribute to sleep-disordered breathing by narrowing the upper airways and increasing the risk of upper-airway collapsibility. The aim of this study was to assess the impact of a short lingual frenulum on the risk of OSAS in children.

METHODS: Children from pre-, primary, secondary, and high school, aged 3-17 years, were included in the study. Parents/guardians were asked to fill in the Pediatric Sleep Questionnaire (PSQ), and then, children at risk of OSAS were enrolled in the study group. A control group was established randomly from patients with negative PSQ results. A physical examination, including measurements of head-forward posture (HFP) and length of the free tongue, inter-incisor distance and subjective high-arched palate evaluation was performed in children from both groups.

RESULTS: A total of 1,500 PSQ questionnaires were distributed, and less than half (713) were returned correctly filled in. In the second part of the study, 135 children were evaluated: 67 in the study group and 68 in the control group. The mean ages were 9.4 ± 3.0 and 9.5 ± 3.1 years, respectively. Children in the study group had significantly shorter lingual frenula, higher HFP measures, and had a higher prevalence of a high-arched palate. Based on statistical analysis, a short lingual frenulum (OR 5.02 [1.58-15.94]).

CONCLUSIONS: The study identified a relationship between a short lingual frenulum and the risk of OSAS in children. Detecting and addressing ankyloglossia in children is necessary before it leads to orofacial changes, malocclusion, and consequently, sleep apnea. Furthermore, OSAS was associated with higher HFP, but no relationship was found between the two parameters.

PMID:33823467 | DOI:10.1016/j.ijporl.2021.110699

J Chromatogr A. 2021 Mar 23;1644:462094. doi: 10.1016/j.chroma.2021.462094. Online ahead of print.

ABSTRACT

We set up an automated screening process to routinely test 10 chiral supercritical fluid chromatography (SFC) methods – five columns combined with two co-solvents – as part of a chiral separation lab workflow. Proprietary software tools enabled automated method screening of racemates, parallel evaluation of the resulting chromatograms for enantiomer separation and report generation. This process is largely automated and resulted in an efficient and reliable lab process with a minimum requirement for human intervention. Screenings were conducted on a test set of 756 racemates that were selected with focus on structural variation and on 2667 proprietary samples from lab routines. Statistical analysis revealed that up to 92% of the tested racemic mixtures could be successfully separated with at least one of the tested conditions of the screening. Process efficiency was further increased by identification of optimal method screening sequence, re-definition of the optimal column set and project-specific adaptations considering reduced structural variation of the analytes. This study illustrates the usefulness of consistent chromatographic data sets to accelerate and facilitate the identification of chiral methods to separate enantiomers by automated processing and statistical analysis.

PMID:33823386 | DOI:10.1016/j.chroma.2021.462094