Category: Nevin Manimala

J Adolesc. 2021 May 19;89:194-202. doi: 10.1016/j.adolescence.2021.05.005. Online ahead of print.

ABSTRACT

INTRODUCTION: Learning disabilities are due to genetic and/or neurobiological factors that alter brain functioning by affecting one or more cognitive processes related to learning. This study aimed to assess the efficacy of cognitive telerehabilitation in adolescents with learning disabilities to overcome the treatment problems related to the COVID-19 pandemic lockdown.

METHODS: Twenty-four patients diagnosed with Unspecified Learning Disability (mean ± SD age: 18.2 ± 2.9 years; 50% male) were enrolled in this study. The patients were assessed by a neuropsychological evaluation at the beginning and at the end of the program. All patients received cognitive treatment via a specific telehealth app to stimulate the cognitive skills related to learning. The treatment lasted four weeks, with a daily training (lasting up to 60 min), for five days a week.

RESULTS: Our young patients reported a statistically significant improvement in the main cognitive domains that are usually compromised in learning disabilities, including sustained and selective attention, shifting of attention, control of interference, memory and speed of information processing. Moreover, the patients showed a good usability and motivation during the training.

CONCLUSIONS: Our study has shown that telerehabilitation could be a valid tool for the rehabilitation of specific cognitive skills in adolescents with learning difficulties.

PMID:34022448 | DOI:10.1016/j.adolescence.2021.05.005

Spine J. 2021 May 19:S1529-9430(21)00254-0. doi: 10.1016/j.spinee.2021.05.016. Online ahead of print.

ABSTRACT

BACKGROUND CONTEXT: The thoracic spine is a common location for vertebral fractures as well as instrumentation failure after long spinal fusion procedures. The association between those complications and bone mineral density (BMD) are well recognized. Due to the overlying sternum and ribs in the thoracic spine, projectional BMD assessment tools such as dual energy x-ray absorptiometry (DXA) are limited to the lumbar spine. Quantitative computed tomography circumvents several shortcomings of DXA and allows for level-specific BMD measurements. Studies comprehensively quantifying BMD of the entire thoracic spine in patients undergoing spine surgery are limited.

PURPOSE: The objective of this study was: 1) to assess the reliability of thoracic QCT measurements, 2) to determine possible level-specific BMD variation throughout the thoracic spine and 3) to assess the correlation between BMDs of the T1-T12 spinal levels.

STUDY DESIGN/SETTING: Cross-sectional observation study.

PATIENT SAMPLE: Patients undergoing spine surgery from 2016-2020 at a single, academic institution with available preoperative CT imaging of the thoracic spine were included in this study.

OUTCOME MEASURES: The outcome measure was BMD measured by QCT.

METHODS: Patients undergoing spine surgery from 2016-2020 at a single, academic institution with available preoperative CT imaging of the thoracic spine were included in this study. Subjects with previous instrumentation at any thoracic level, concurrent vertebral fractures, a Cobb angle of more than 20 degrees, or incomplete thoracic spine CT imaging were excluded. Asynchronous quantitative computed tomography (QCT) measurements of T1-T12 were performed. To assess inter- and intra-observer reliability, a validation study was performed on 120 vertebrae in 10 randomly selected patients. The interclass correlation coefficient (ICC) was calculated. A pairwise comparison of BMD was conducted and correlations between each thoracic level were evaluated. The statistical significance level was set at p<0.05.

RESULTS: 60 patients (men, 51.7%) met inclusion criteria. The study population was 90% Caucasian with a mean age of 62.2 years and a mean BMI of 30.2 kg/m². The inter- and intra-observer reliability of the thoracic QCT measurements was excellent (ICC of 0.97 and 0.97, respectively). The trabecular BMD was highest in the upper thoracic spine and decreased in the caudal direction (T1 = 182.3 mg/cm³, T2 = 168.1 mg/cm³, T3 = 163.5 mg/cm³, T4 = 164.7 mg/cm³, T5 = 161.4 mg/cm³, T6 = 152.5 mg/cm³, T7 = 143.5 mg/cm³, T8 = 141.3 mg/cm³, T9 = 143.5 mg/cm³, T10 = 145.1 mg/cm³, T11 = 145.3 mg/cm³, T12 = 133.6 mg/cm³). The BMD of all thoracic levels cranial to T6 was statistically higher than the BMD of all levels caudal to T6 (p < 0.001). Nonetheless, significant correlations in BMD among all measured thoracic levels were observed, with a Pearson’s correlation coefficient ranging from 0.74 to 0.97.

CONCLUSIONS: There is significant regional BMD variation in the thoracic spine depending on spinal level. This BMD variation might contribute to several clinically relevant phenomena. First, vertebral fractures occur most commonly at the thoracolumbar junction including T12. In addition to mechanical reasons, these fractures might be partially attributed to thoracic BMD that is lowest at T12. Second, the optimal upper instrumented vertebra (UIV) for stopping long fusions to the sacrum and pelvis is controversial. The BMD of surgically relevant upper thoracic stopping points (T2-T4) was significantly higher than the BMD of lower thoracic stopping points (T10-T12). Besides stress concentration at the relatively mobile lower thoracic segments, the low BMD at these levels might contribute to previously suggested higher rates of junctional failures with short fusions.

PMID:34022462 | DOI:10.1016/j.spinee.2021.05.016

Pediatr Blood Cancer. 2021 May 22:e29098. doi: 10.1002/pbc.29098. Online ahead of print.

ABSTRACT

To ensure external validation of a study population in clinical late-effect studies of childhood cancer, the participation rate must be high. This study investigated demographic data in Nordic late-effect studies and potential factors impacting participation rates such as cancer type, time since diagnosis, and duration of clinical examinations. We found 80 published studies originating from 16 cohorts, with median follow-up of 6.0 years (range 3-14). The overall participation rates ranged from 27% to 100%. The highest participation rates were seen in studies of survivors with solid tumors (92%) and the lowest in hematologic malignancies (67%) and central nervous system tumors (73%). The clinical examination in 10 studies (62.5%) lasted for more than 3 hours. Neither duration of the clinical examination nor time since diagnosis seemed to affect the participation rate. We encourage future studies to describe the recruitment process more thoroughly to improve understanding of the factors influencing participation rates.

PMID:34022113 | DOI:10.1002/pbc.29098

J Complement Integr Med. 2021 May 24. doi: 10.1515/jcim-2020-0507. Online ahead of print.

ABSTRACT

OBJECTIVES: Environmental stimuli in neonatal intensive care units can disrupt the physiological stability and sleep of infants. It is essential to perform nursing interventions to reduce the adverse effects of such stimuli. This study aimed to compare the effect of recorded lullabies and mothers’ live lullabies on physiological responses and sleep duration of preterm infants.

METHODS: This study was a randomized clinical trial. The participants were 90 preterm infants selected using convenience sampling. In the intervention groups, music (recorded lullabies and mother’s live lullabies) was played for 14 days, 20 min a day, while the control group did not receive any intervention. The data were collected using physiological criteria and infant sleep checklists before, during, and after the intervention. The data were analyzed using SPSS software (Version 21.0).

RESULTS: The mean scores of physiological parameters (O2 saturation and heart rate) were not significantly different in the three groups before, during, and after the intervention (p>0.05). However, there was an improvement in O2-saturation and a decrease in the heart rate in two intervention groups. The mean duration of the infants’ overnight sleep was not statistically significant between the groups before the intervention (p>0.05). However, there was a statistically significant difference in the intervention groups after the intervention, (p<0.05), and the infants’ overnight sleep was longer in the recorded-lullaby group than the other two groups.

CONCLUSIONS: Although performing interventions, including recorded lullaby and mother’s live lullaby did not differ significantly with that of the control group in physiological criteria, it can be clinically important. In addition, recorded-lullaby increased the infants’ overnight sleeping. Thus, it is suggested that further studies be conducted to confirm the effect of recorded lullaby and mother’s live lullaby interventions on physiological parameters and sleep duration of hospitalized infants.

PMID:34022122 | DOI:10.1515/jcim-2020-0507

Pediatr Blood Cancer. 2021 May 22:e29127. doi: 10.1002/pbc.29127. Online ahead of print.

ABSTRACT

BACKGROUND: Modern therapeutic advances in high-risk neuroblastoma have improved overall survival (OS), but it is unclear whether these survival gains have been equitable. This study examined the relationship between socioeconomic status (SES) and overall survival (OS) in children with high-risk neuroblastoma and whether SES-associated disparities have changed over time.

PROCEDURE: In this population-based cohort study, children <18 years diagnosed with high-risk neuroblastoma (diagnosis at age ≥12 months with metastatic disease) from 1991 to 2015 were identified through the National Cancer Institute’s Surveillance, Epidemiology, and End Results database. Associations of county-level SES variables and OS were tested with univariate Cox proportional hazards regression. For a subcohort diagnosed after 2007, insurance status was examined as an individual-level SES variable. Multivariable regression analyses with treatment era and interaction terms were performed when SES variables reached near-significance (p ≤ .1) in univariate and bivariate modeling with treatment era.

RESULTS: Among 1217 children, 2-year OS improved from 53.0 ± 3.4% in 1991-1998 to 76.9 ± 2.9% in 2011-2015 (p < .001). In univariate analyses, children in high-poverty counties (hazard ratio [HR] = 1.74, 95% confidence interval [CI] = 1.17-2.60, p = .007), and those with Medicaid (HR = 1.40, 95% CI = 1.05-1.86, p = .02) experienced an increased hazard of death. No interactions between treatment era and SES variables were statistically significant in multivariable analyses, indicating that differences in the OS between SES groups did not change over time.

CONCLUSIONS: Survival disparities among children with high-risk neuroblastoma have not widened over time, suggesting equitable access to and benefit from therapeutic advances. However, children of low SES experience persistently inferior survival. Interventions to narrow this disparity are paramount.

PMID:34022098 | DOI:10.1002/pbc.29127

Drug Test Anal. 2021 May 22. doi: 10.1002/dta.3102. Online ahead of print.

ABSTRACT

The use of cannabidiol in electronic liquids (e-liquids) is becoming increasingly widespread and the current regulations enforced onto nicotine-containing e-liquids are not applicable to cannabidiol-based products. This has led to concerns about the quality of cannabidiol vapes. Articles investigating the reliability of product labelling were reviewed using systematic review criteria. Of 70 e-liquids, 77.1% of the e-liquids tested in the articles were found to have under- or over-estimated the cannabidiol quantities stated in the product labelling. Statistical analysis confirmed that there was a significant difference between the labelled and analysed cannabidiol concentrations (p < 0.05, Mann-Whitney U and Wilcoxon Signed Rank). Inaccuracies in received cannabidiol dosages could lead to an increased risk of adverse reactions or limit the therapeutic effect received, highlighting the benefit of enforcing specific regulations on cannabidiol-based e-liquids to protect consumer safety and guarantee product efficacy.

PMID:34022104 | DOI:10.1002/dta.3102

Pediatr Blood Cancer. 2021 May 22:e29121. doi: 10.1002/pbc.29121. Online ahead of print.

ABSTRACT

BACKGROUND: Naxitamab is a humanized anti-disialoganglioside (GD2) monoclonal antibody approved for treatment of bone/bone marrow refractory high-risk neuroblastoma (HR-NB). Compassionate use (CU) expanded access program at Hospital Sant Joan de Deu permitted treatment of patients in complete remission (CR). We here report the survival, toxicity, and relapse pattern of patients in first or second CR treated with naxitamab and sargramostim (GM-CSF).

PROCEDURE: Seventy-three consecutive patients with HR-NB (stage M at age >18 months or MYCN-amplified stages L1/L2 at any age) were treated in first or second CR. Treatment comprised five cycles of subcutaneous (SC) GM-CSF for 5 days at 250 μg/m² /day (days -4 to 0), followed by naxitamab + SC GM-CSF for 5 days at 500 μg/m² /day (days 1-5). Naxitamab was infused over 30 minutes at 3 mg/kg/day, days 1, 3, and 5, outpatient.

RESULTS: Fifty-five patients were in first CR and 18 in second CR. Seventeen patients had MYCN-amplified NB and 11 detectable minimal residual disease in the bone marrow. Fifty-eight (79.5%) patients completed therapy. Four (5%) experienced grade 4 toxicities and 10 (14%) early relapse. Three-year event-free survival (EFS) 58.4%, 95% CI = (43.5%, 78.4%) and overall survival (OS) 82.4%, 95% CI = (66.8%, 100%). First CR patients 3-year EFS 74.3%, 95% CI = (62.7%, 88.1%), and OS 91.6%, 95% CI = (82.4%, 100%). EFS is significantly different between first and second CR (p = .0029). The pattern of relapse is predominantly (75%) of an isolated organ, mainly bone (54%). Univariate Cox models show prior history of relapse as the only statistically significant predictor of EFS but not OS.

CONCLUSIONS: Consolidation with naxitamab and GM-CSF resulted in excellent survival rates for HR-NB patients in CR.

PMID:34022112 | DOI:10.1002/pbc.29121

J Nurs Manag. 2021 May 22. doi: 10.1111/jonm.13379. Online ahead of print.

ABSTRACT

AIM: To identify the factors affecting nurses’ turnover intention.

BACKGROUND: The shortage of nurses has been a great challenge worldwide and nurses’ turnover may exacerbate the situation.

METHODS: A cross-sectional study was conducted among nurses in six secondary hospitals in China. A model was constructed and structured questionnaires were adopted to measure model variables. Structural equation modeling was used to verify the model.

RESULTS: Totally, 594 valid questionnaires were collected. The final model showed an acceptable fit, 35.0% of the total variation was explained. Nine of the ten pathways were statistically significant. The model verified the contribution of professional value, nursing practice, job stress, and social support to turnover intention and their effects were mediated by job satisfaction and organizational commitment. As hypothesized, there existed a significant effect between job satisfaction and organizational commitment. Unexpectedly, job stress had a greater direct effect on turnover intention than job satisfaction and organizational commitment.

CONCLUSIONS: The structural model provided a feasible model that could explain nurses’ turnover intention in China.

IMPLICATIONS FOR NURSING MANAGEMENT: To prevent the turnover of nurses, administrators and managers should advisably prioritize the effect of job stress, especially in hospitals with similar medical context.

PMID:34022081 | DOI:10.1111/jonm.13379

Clin Exp Dermatol. 2021 May 22. doi: 10.1111/ced.14753. Online ahead of print.

ABSTRACT

BACKGROUND: Linear lesions are fairly common in our day to day practice. However, the appearances can be deceptive which puts dermatologists in a diagnostic dilemma.

AIMS: To study the various clinical presentations, demographic profile of patients and clinico-pathological correlations of dermatoses presenting with a linear distribution.

METHODS: We conducted an institution based cross-sectional, descriptive study on 281 consecutive patients with linear lesions, attending the Dermatology clinic. MedCalc version 11.6 software was used for statistical analysis.

RESULTS: Patients were divided into eight groups : lesions along Blaschko’s lines(n=136), along blood vessels(n=3), along lymphatics(n=3), koebner’s phenomenon(n=24), autoinoculation(n=24), external factors(n=45), infestations(n=2) and others(n=44). Mean age at presentation was 24.50±18.82 years. Male:female ratio was 1.32:1. Commonest complaints were itching/burning in 56.94% patients. Commonest site was upper limb (44.48%); followed by lower limb(30.60%), trunk and abdomen(22.42%), head and neck(19.20%) and genitalia(0.35%). Apart from the common cases, we came across a wide gamut of rare conditions (angiokeratoma circumscriptum neviforme, porokeratotic eccrine ostial and dermal duct nevus, blaschko-linear syringocystadenoma papilliferum, progressive cribriform and zosteriform hyperpigmentation, unilateral nevoid acanthosis nigricans, fixed drug eruption, discoid lupus erythematosus etc.) CONCLUSION: Linear lesions act as diagnostic clues in many dermatological conditions. Therefore, the importance of meticulous examination in clinical dermatology cannot be overemphasized.

PMID:34022084 | DOI:10.1111/ced.14753

Int J Paediatr Dent. 2021 May 22. doi: 10.1111/ipd.12800. Online ahead of print.

ABSTRACT

BACKGROUND: Although single-file rotary systems are accepted in the field of paediatric dentistry in terms of providing time advantage, research works continue due to the variable anatomical structure of the root canal.

AIM: This study aimed to evaluate rotary systems in different kinematics in terms of microcracks and the shaping of the danger zone in primary molars by micro-CT.

DESIGN: The mesial canals of primary molars (n = 30) were used. Root canals in each group (n = 10) were prepared with single-file rotary systems (One Shape®, OS; XP-endo® Shaper, XP-ES; WaveOne Gold, WOG). The images were evaluated for dentin thickness in the danger zone and microcrack formation.

RESULTS: WOG caused the highest dentin reduction in the danger zone area. OS led to significantly less dentin reduction than XP-ES and WOG (P < .05). The XP-ES showed the highest number of microcracks (P < .05). No statistically significant difference was found between WOG and OS (P > .05). In all systems, more microcracks were observed in the middle third than coronal and apical.

CONCLUSION: Within the limitations of this study, the rotary systems were superior to reciprocating in terms of shaping ability in the danger zone. It is thought that further studies with different systems should be designed considering the anatomical variations and chemical composition of primary teeth.

PMID:34022087 | DOI:10.1111/ipd.12800