Category: Nevin Manimala

Vasc Specialist Int. 2021 Mar 31;37(1):29-36. doi: 10.5758/vsi.210003.

ABSTRACT

PURPOSE: Native arteriovenous fistula (AVF) is the first choice for hemodialysis access; however, the maturation failure rate remains high. Hence, balloon-assisted maturation (BAM) is increasingly being used to overcome maturation failure. This study evaluated the outcomes of BAM and compared the differences between radial-cephalic (RC) and brachial-cephalic (BC) AVF.

MATERIALS AND METHODS: Between January 2013 and December 2017, 1,622 new AVFs were created. BAM was considered if the AVF did not satisfy the criteria for hemodynamic maturation (6-mm diameter and 500-mL/min flow rate within 8 weeks after the operation).

RESULTS: Of the 1,622 AVFs, BAM was performed in 142 patients (8.75%). There were 92 RC and 50 BC AVFs. Multivariate analyses revealed that ipsilateral central vein catheter history was the sole risk factor for maturation failure after BAM. Oneyear functional primary patency (FPP) and functional secondary patency (FSP) in RC AVFs were higher than those in BC AVFs without statistical significance (FPP, RC vs. BC: 70.9% vs. 50.9%, P=0.099; FSP, 95.5% vs. 81.1%, P=0.146). Further, based on the multivariate analysis, the independent risk factors for FPP in the RC and BC AVFs were the number of BAMs (odds ratio [OR], 3.05; 95% confidence interval [CI], 1.11-8.37; P=0.03) and age (OR, 1.04; 95% CI, 1.00-1.07; P=0.04), respectively.

CONCLUSION: BAM is a relatively good salvage method with tolerable patency. However, the risk factors for patency and the outcomes of BAM differ between RC and BC AVFs.

PMID:33795551 | DOI:10.5758/vsi.210003

Dermatol Surg. 2021 Apr 1;47(4):462-466. doi: 10.1097/DSS.0000000000002787.

ABSTRACT

BACKGROUND: Preoperative patient screening has been evaluated in many surgical specialties as a way to improve the overall patient experience. Current data are limited regarding patient screening for dermatologic procedures. The goal of preoperative screening is to identify patients at risk for poor outcomes and tailor the treatment plan to ensure a greater overall patient experience.

OBJECTIVE: To investigate the association between psychological comorbidities and acute postoperative pain in patients treated with Mohs micrographic surgery (MMS).

MATERIALS AND METHODS: Subjects were recruited from a single center, single provider, uniformed service MMS practice, and asked to complete preoperative and postoperative questionnaires for scheduled MMS. Outcome variables included anticipated pain, actual pain after MMS, duration of pain, and medications used for pain.

RESULTS: Mohs micrographic surgery was well tolerated. There were no significant differences in anticipated or reported pain, or in medication use between cohorts. Significant differences in pain were noted with closure technique with complex surgical repairs generating the greatest pain across groups.

CONCLUSION: Mohs micrographic surgery is well tolerated by patients, both with and without psychological comorbidities. Our results show no statistically significant differences, suggesting a limited role for preoperative screening as a tool to guide pain management after MMS.

PMID:33795564 | DOI:10.1097/DSS.0000000000002787

Dermatol Surg. 2021 Apr 1;47(4):e106-e110. doi: 10.1097/DSS.0000000000002815.

ABSTRACT

BACKGROUND: Wide excision (WE) is generally considered to be the most common treatment for recurrent hidradenitis suppurativa. When performed, excision is followed by decisions regarding best options for management of the surgical defect. Different reconstructive strategies (RSs) have been used, with varying rates of recurrence.

OBJECTIVE: To provide an up-to-date systematic review of the complete literature for different RS after WE and their recurrence rates.

METHODS: A systematic literature search of the complete available literature and a meta-analysis of proportions were performed on the included studies.

RESULTS: Of a total of 1,813 retrieved articles, 79 were included in the analysis. Most were retrospective analyses, with only one randomized controlled trial (RCT) and 7 prospective analyses. The RS described were divided into primary closure (PC), secondary intention healing (SIH), skin graft (SG), and fasciocutaneous flaps (FCF). The average estimated recurrence for PC was 22.0% (95% confidence interval [CI], 8.0%-40.0%), for SIH 11.0% (95% CI, 5.0%-20.0%), for SG 2.0% (95% CI, 0.0%-5.0%), and for FCF 2.0% (95% CI, 1.0%-5.0%) (p < .001). Hidradenitis suppurativa below the umbilicus was significantly associated with overall recurrence (p = .006). Quality of evidence was poor, and the reporting of results was mostly heterogeneous.

CONCLUSION: After WE, PC has the highest recurrence rates, whereas SG and FCF have the lowest rates. There is a need for more RCTs and guidelines, to be able to report uniformly on treatment outcomes.

PMID:33795566 | DOI:10.1097/DSS.0000000000002815

Saudi Med J. 2021 Apr;42(4):411-418. doi: 10.15537/smj.2021.42.4.20200674.

ABSTRACT

OBJECTIVES: To determine the relationship between fear of falling (FOF) and upper extremity muscle strength.

METHODS: This cross-sectional study included 112 hospitalized, mobile patients. Forty-seven (42%) were males and 65 (58%) were females, and the mean age was 72.3. The study was carried out between September 2018 and September 2019 at Balikli Rum Hospital Nursing Homes, Istanbul, Turkey. Patients were tested using geriatric tools (such as Mini-Mental State Examination) and physical tests such as handgrip, key pinch and 6-meter up and go tests.

RESULTS: The average annual falling number of elderly people with FOF was statistically significantly higher than that in those without FOF (p=0.001). Right handgrip, left handgrip, right key pinch, and left key-pinch mean values in elderly individuals with FOF were statistically significantly lower than those without FOF (p< 0.001, p< 0.001, p< 0.001, p< 0.001, respectively).

CONCLUSION: The measurement of upper extremity strength could be a predicting parameter of FOF.

PMID:33795497 | DOI:10.15537/smj.2021.42.4.20200674

Saudi Med J. 2021 Apr;42(4):419-427. doi: 10.15537/smj.2021.42.4.20200630.

ABSTRACT

OBJECTIVES: To assess the prevalence and characteristics of Autism Spectrum Disorder (ASD)-affected children attending autistic centers in 2 major cities in Saudi Arabia.

METHODS: A cross-sectional study, including ASD centers and schools (37 centers) in Makkah and Jeddah, Saudi Arabia was conducted between January and March 2020. Data were collected from records and parents of children with ASD using a questionnaire on sociodemographic, family history, consanguinity, severity, and maternal risk factors.

RESULTS: All centers in Makkah and Jeddah participated, with a total of 1,023 ASD children. The prevalence of ASD was 2.618 per 1,000 children for Jeddah, 3.68 per 1,000 children for Makkah and 2.81 per 1,000 children for both Jeddah and Makkah. There was no statistically significant relationship between the severity of ASD and sociodemographic, family and maternal risk factors. However, there was statistically significant relationship between severe ASD and ASD family history (p=0.029, OR: 3.46 and 95% CI 1.14 to 10.5).

CONCLUSIONS: The prevalence of ASD in Makkah and Jeddah was lower than the global prevalence of ASD. Individuals with a family history of ASD were more likely to have more severe ASD.

PMID:33795498 | DOI:10.15537/smj.2021.42.4.20200630

Zhonghua Yi Shi Za Zhi. 2021 Jan 28;51(1):50-55. doi: 10.3760/cma.j.cn112155-20200225-00022.

ABSTRACT

Chuugoku Isekikou (, Catalogue of Chinese Medical Literature) has high value in the history of Chinese and Japanese medicine. Through the collation and statistics of the sources of medical books included in this book, this paper sums up the sources of medical books included by the famous Japanese doctors Tanba and his son, who compiled this book. We found nearly 60 percent medical books from Chinese bibliographies and Local Gazetteers. Based on the analysis of all kinds of relevant literature, we studied the rules and compilation ideas of the process of Tanba’s collection medical books, and then discovered the contents of the medical books were mainly prescription treatment, not incloud the book of immortal,sexual skill or veterinarian. We also discovered the arrangement of Isekikou was mainly time, and other factors were considered comprehensively.

PMID:33794584 | DOI:10.3760/cma.j.cn112155-20200225-00022

Neurosurg Focus. 2021 Apr;50(4):E13. doi: 10.3171/2021.1.FOCUS201000.

ABSTRACT

Craniosynostosis is the premature fusion of the skull. There are two forms of treatment: open surgery and minimally invasive endoscope-assisted suturectomy. Candidates for endoscopic treatment are less than 6 months of age. The techniques are equally effective; however, endoscopic surgery is associated with less blood loss, minimal tissue disruption, shorter operative time, and shorter hospitalization. In this study, the authors aimed to evaluate the impact of race/ethnicity and insurance status on age of presentation/surgery in children with craniosynostosis to highlight potential disparities in healthcare access. Charts were reviewed for children with craniosynostosis at two tertiary care hospitals in New York City from January 1, 2014, to August 31, 2020. Clinical and demographic data were collected, including variables pertaining to family socioeconomic status, home address/zip code, insurance status (no insurance, Medicaid, or private), race/ethnicity, age and date of presentation for initial consultation, type of surgery performed, and details of hospitalization. Children with unknown race/ethnicity and those with syndromic craniosynostosis were excluded. The data were analyzed via t-tests and chi-square tests for statistical significance (p < 0.05). A total of 121 children were identified; 62 surgeries were performed open and 59 endoscopically. The mean age at initial presentation of the cohort was 6.68 months, and on the day of surgery it was 8.45 months. Age at presentation for the open surgery cohort compared with the endoscopic cohort achieved statistical significance at 11.33 months (SD 12.41) for the open cohort and 1.86 months (SD 1.1473) for the endoscopic cohort (p < 0.0001). Age on the day of surgery for the open cohort versus the endoscopic cohort demonstrated statistical significance at 14.19 months (SD 15.05) and 2.58 months (SD 1.030), respectively. A statistically significant difference between the two groups was noted with regard to insurance status (p = 0.0044); the open surgical group comprised more patients without insurance and with Medicaid compared with the endoscopic group. The racial composition of the two groups reached statistical significance when comparing proportions of White, Black, Hispanic, Asian, and other (p = 0.000815), with significantly more Black and Hispanic patients treated in the open surgical group. The results demonstrate a relationship between race and lack of insurance or Medicaid status, and type of surgery received; Black and Hispanic children and children with Medicaid were more likely to present later and undergo open surgery.

PMID:33794493 | DOI:10.3171/2021.1.FOCUS201000

Endocr Relat Cancer. 2021 Mar 1:ERC-20-0496.R1. doi: 10.1530/ERC-20-0496. Online ahead of print.

ABSTRACT

Differentiated thyroid cancer (DTC) represents the most common form of thyroid neoplasms and is becoming increasingly prevalent. Evidence suggests a possible relationship between DTC diagnosis and subsequent atrial fibrillation (AF). If confirmed, this may present an alarming health risk (AF) in an otherwise condition with a relatively good prognosis (DTC). The aim of this systematic review and meta-analysis is to provide for the first time a pooled estimate of AF incidence in DTC patients in comparison to healthy controls. A detailed search in electronic databases, clinical trial registries and grey literature was performed to identify studies reporting the incidence of AF in DTC patients. Newcastle-Ottawa quality assessment scale was used to assess study quality. We used a random effects (RE) generalized linear mixed model (GLMM) in pooling of individual studies and also calculated a prediction interval for the estimate of a new study. Six observational studies met the eligibility criteria, which included totally 187,754 patients with DTC and 199,770 healthy controls. The median follow-up period was 4.3 to 18.8 years; the incidence rate of AF was 4.86 (95% CI, 3.29 to 7.17, I2= 96%) cases per 1000 person-years, while the incidence rate ratio was 1.54(95%CI, 1.44 to 1.65, I2 = 0%, 95%PI, 1.33 to 1.78).This is the first meta-analysis to confirm that patients with DTC are at a high risk for developing AF, which may be attributed to a state of iatrogenic hyperthyroidism due to long-term thyrotropin suppression therapy.

PMID:33794503 | DOI:10.1530/ERC-20-0496

Korean J Anesthesiol. 2021 Apr;74(2):115-119. doi: 10.4097/kja.20582. Epub 2021 Mar 24.

ABSTRACT

General medical journals such as the Korean Journal of Anesthesiology (KJA) receive numerous manuscripts every year. However, reviewers have noticed that the tables presented in various manuscripts have great diversity in their appearance, resulting in difficulties in the review and publication process. It might be due to the lack of clear written instructions regarding reporting of statistical results for authors. Therefore, the present article aims to briefly outline reporting methods for several table types, which are commonly used to present statistical results. We hope this article will serve as a guideline for reviewers as well as for authors, who wish to submit a manuscript to the KJA.

PMID:33794566 | DOI:10.4097/kja.20582

Sci Total Environ. 2021 Mar 24;781:146688. doi: 10.1016/j.scitotenv.2021.146688. Online ahead of print.

ABSTRACT

The lakes on the Yangtze Plain, a critical source of freshwater and fisheries for hundreds of millions of people in China, have lost a considerable portion of their surface area due to reclamation since the 1950s. Landsat satellites can provide long-term collections of high-resolution images and thus offer great potential for hindcasting the lake reclamations of aquaculture zones and their long-term impacts on the lacustrine water color. Using Landsat observations from 1984 to 2018 and a Forel-Ule index (FUI) model, we studied the water color dynamics of 61 lakes on the Yangtze Plain. Three distinct change patterns were found among the 61 examined lakes, and 25 of the 61 lakes showed statistically significant changes in the annual hue angle values (P < 0.05). We further collected environmental parameter datasets (runoff, normalized difference vegetation index (NDVI), and wind speed) and a lacustrine reclamation dataset, and measured the concentrations of chlorophyll-a (Chl-a) and dissolved organic carbon (DOC) from two field trips. We investigated their correlations with water color change from different facets. The results showed that the long-term water color in 33 of the 61 lakes exhibited significant correlations with environmental factors. The reclaimed aquaculture zones in this region have caused differences in the water color between the reclaimed area and that in adjacent natural waters. The Chl-a and DOC levels derived from field surveys further confirmed that reclaimed aquaculture zones increased light-absorbing materials in the water and may deteriorate water quality. This study is an important step forward in understanding the water quality changes in lake ecosystems affected by human impacts and natural variability.

PMID:33794461 | DOI:10.1016/j.scitotenv.2021.146688