Category: Nevin Manimala

Thromb Res. 2021 Oct 21;208:66-70. doi: 10.1016/j.thromres.2021.10.004. Online ahead of print.

ABSTRACT

BACKGROUND: Isolated distal deep vein thrombosis (IDDVT) is a common subtype of deep vein thrombosis (DVT). Consensus guidelines provide conflicting recommendations for IDDVT management; some recommend anticoagulant treatment, while others suggest serial compression ultrasonography (CUS) monitoring for patients not at “high risk” of proximal extension. The purpose of this study was to describe outcomes of serial CUS-monitored IDDVT and identify risk factors for proximal thrombus extension or anticoagulant treatment initiation.

METHODS: A retrospective descriptive study was conducted using electronic data from University of Utah Health. Adult subjects with objectively confirmed, serial CUS-monitored IDDVT were included. Subjects were followed for 30 days for occurrence of a composite outcome of proximal thrombus extension or anticoagulant treatment initiation. Descriptive statistics were used to summarize characteristics of the study population. Characteristics were compared across outcome groups using inferential statistics.

RESULTS: A total of 182 subjects were included, with 53 subjects (29.1%) experiencing the composite outcome. Of these, 12 (22.6%) experienced proximal thrombus extension and 41 (77.4%) initiated anticoagulant treatment. A prior history of venous thromboembolism (VTE) was significantly higher in those who experienced the composite outcome than in those who did not.

CONCLUSIONS: Our results suggest that 70% of patients with serial CUS-monitored IDDVT did not experience thrombus extension or require anticoagulant treatment within 30 days of diagnosis, regardless of risk factors for proximal extension. Serial CUS monitoring may be a useful management strategy for IDDVT. A history of VTE may identify patients more likely to experience proximal thrombus extension or require anticoagulation.

PMID:34717132 | DOI:10.1016/j.thromres.2021.10.004

Nurse Educ Today. 2021 Oct 23;108:105184. doi: 10.1016/j.nedt.2021.105184. Online ahead of print.

ABSTRACT

BACKGROUND: Complex physiological processes are often difficult for midwifery students to comprehend when using traditional teaching and learning approaches. Face to face instructional workshops using simulation have had some impact on improving understanding. However, in the 21st century new technologies offer the opportunity to provide alternative learning approaches.

AIM: To investigate the impact of using three-dimensional (3D) visualisation in midwifery education on student’s experience of learning, and retention of knowledge at three points in time.

DESIGN: A pilot study involving a two-armed parallel Randomised Controlled Trial (RCT) comparing the retention of knowledge scores between the control and intervention groups.

SETTING: An Australian University in the Northern Territory.

PARTICIPANTS: The sample included second year Bachelor of Midwifery students (n = 38). All received traditional midwifery education before being randomly allocated to either the intervention (n = 20) or control (n = 18) group.

METHODS: A new immersive virtual environment was introduced to complement existing traditional midwifery education on the third stage of labour. This intervention was evaluated using a demographic survey and multiple-choice questionnaire to collect baseline information via Qualtrics. To measure change in knowledge and comprehension, participants completed the same multiple-choice knowledge questionnaire at three time points; pre, immediately post and at 1 month post intervention. In addition, the intervention group completed a 3D student satisfaction survey.

RESULTS: Baseline knowledge scores were similar between the groups. A statistically significant increase in knowledge score was evident immediately post intervention for the intervention group, however there was no significant difference in knowledge score at one month.

CONCLUSIONS: The results support the creation of further three-dimensional visualisation teaching resources for midwifery education. However, a larger randomised controlled study is needed to seek generalisation of these findings to confirm enhanced student learning and retention of knowledge post 3DMVR, beyond the immediate exposure time.

PMID:34717099 | DOI:10.1016/j.nedt.2021.105184

J Hepatobiliary Pancreat Sci. 2021 Oct 30. doi: 10.1002/jhbp.1067. Online ahead of print.

ABSTRACT

BACKGROUND: Pancreatoduodenectomy (PD) is an only curative therapy for distal cholangiocarcinoma (dCC). There has been no study to compare outcomes between minimally invasive pancreatoduodenectomy (MIPD) and open pancreatoduodenectomy (OPD) for dCC. The aim of the study is to compare the two operation types for dCC in terms of postoperative and oncologic outcomes.

METHODS: Data from 426 patients who underwent MIPD (n=91) or OPD (n=335) for dCC from January 2012 to December 2019 at two tertiary hospitals were retrospectively reviewed. After 1:2 propensity score matching, postoperative and oncologic outcomes were compared.

RESULTS: MIPD group showed more favorable results than OPD group in terms of blood loss (MIPD vs. OPD, 250[150-400] vs. 400[200-600], ml, p<0.001), and length of hospital stay (19.8±11.3 vs. 26.6±14.3, days, p<0.001). OPD group showed more favorable results than MIPD group in terms of operation time (MIPD vs. OPD, 457±70 vs. 398±85, min., p<0.001), and harvested lymph nodes (14.9±7.8 vs. 20.7±11.5, p<0.001). There was no statistical difference between the 2 groups in the R0 resection rate and complications. In long-term survival analysis, there was no significant difference between the 2 groups.

CONCLUSION: MIPD showed comparable postoperative complications and long-term oncologic survival with OPD in the treatment of dCC.

PMID:34717038 | DOI:10.1002/jhbp.1067

Clin Transplant. 2021 Oct 30:e14456. doi: 10.1111/ctr.14456. Online ahead of print.

ABSTRACT

Histologic findings on 1-year biopsies such as inflammation with fibrosis and transplant glomerulopathy predict renal allograft loss by 5 years. However, almost half of the patients with graft loss have a 1-year biopsy that is either normal or has only interstitial fibrosis. The goal of this study was to determine if there was a gene expression profile in these relatively normal 1-year biopsies that predicted subsequent decline in renal function. Using transcriptome microarrays we measured intragraft mRNA levels in a retrospective Discovery cohort (170 patients with a normal/minimal fibrosis 1-year biopsy, 54 with progressive decline in function/graft loss and 116 with stable function) and developed a nested 10-fold cross-validated gene classifier that predicted progressive decline in renal function (positive predictive value = 38 ± 34%%; negative predictive value = 73 ± 30%, c-statistic = 0.59). In a prospective, multicenter Validation cohort (270 patients with Normal/Interstitial Fibrosis [IF]), the classifier had a 20% positive predictive value, 85% negative predictive value and 0.58 c-statistic. Importantly, the majority of patients with graft loss in the prospective study had 1-year biopsies scored as Normal or IF. We conclude predicting graft loss in many renal allograft recipients (i.e. those with a relatively normal 1-year biopsy and eGFR >40) remains difficult. This article is protected by copyright. All rights reserved.

PMID:34717009 | DOI:10.1111/ctr.14456

Eur J Neurol. 2021 Oct 30. doi: 10.1111/ene.15159. Online ahead of print.

ABSTRACT

OBJECTIVE: Subcortical vascular cognitive impairment (SVCI) is characterized by the presence of cerebral small vessel disease (CSVD) markers. Some SVCI patients also show Alzheimer’s disease and cerebral amyloid angiopathy (CAA) markers. However, the effects of these imaging markers on long-term clinical outcomes have not yet been established. The present study, therefore, aimed to determine how these imaging markers influence functional disability and/or mortality.

METHODS: We recruited 194 participants with SVCI from the memory clinic and followed them up. All participants underwent brain MRI at baseline, and 177 (91.2%) participants underwent beta-amyloid (Aβ) PET. We examined the occurrence of ischemic or hemorrhagic strokes. We also evaluated functional disability and mortality using the modified Rankin scale. To determine the effects of imaging markers on functional disability or mortality, we used the Fine and Gray competing regression or the Cox regression analysis.

RESULTS: During a 8.6-year follow-up period, 46 of 194 (23.7%) patients experienced a stroke, 110 (56.7%) patients developed functional disabilities and 75 (38.6%) died. Aβ positivity (subdistribution hazard ratio [SHR] = 2.73), larger white matter hyperintensity (WMH) volume (SHR = 3.11) and ≥3 microbleeds (SHR = 2.29) at baseline were independent predictors of functional disability regardless of the occurrence of stroke. Larger WMH volume (hazzard ratio [HR] = 2.07) was an independent predictor of mortality.

CONCLUSIONS: Our findings suggest that diverse imaging markers may predict long-term functional disability and mortality in patients with SVCI, which in turn may provide clinicians with a more insightful understanding of the long-term outcomes of SVCI.

PMID:34716964 | DOI:10.1111/ene.15159

Int J Numer Method Biomed Eng. 2021 Oct 30:e3543. doi: 10.1002/cnm.3543. Online ahead of print.

ABSTRACT

One difficulty in solving the Poisson-Nernst-Planck (PNP) equations used for studying the ion transport in channel proteins is the possible convection-dominant problem in the Nernst-Planck equations. In this paper, to overcome this issue, considering the general mixed boundary conditions of concentration functions on the interface, a novel stabilized finite volume element method based on the standard weak formulation to solve the steady-state PNP equations is proposed and analyzed. Numerical tests on four ion-channel proteins served as benchmark with varying boundary conditions in a certain range show that the new stabilized technique not only improves the robustness of the new PNP solver, but also makes the computed maximal concentration values much more reasonable. This article is protected by copyright. All rights reserved.

PMID:34716987 | DOI:10.1002/cnm.3543

J Oral Rehabil. 2021 Oct 30. doi: 10.1111/joor.13275. Online ahead of print.

ABSTRACT

BACKGROUND: Burning mouth syndrome (BMS) is a chronic disorder characterized by pain in the oral cavity without clinically evident causative lesions. The etiology of this condition is poorly understood, and treatment can be challenging.

METHOD: A retrospective review of the medical records of 82 patients with BMS was performed. Data on demographics, BMS associated symptoms, symptoms’ intensity score (NRS: 0-10) and response to treatment with topical clonazepam were extracted from clinical notes based on a standardized clinical questionnaire. Differences in the symptoms’ intensity score between patients with or without concomitant anxiety/depression or systemic psychogenic medication use were analyzed using the Wilcoxon signed rank test.

RESULTS: Among the entire cohort, the median symptoms’ intensity score at baseline was 4.5 and 3.0 at first follow-up, a statistically significant improvement (p <0.001; 95% CI). Among the subjects with anxiety/depression and those who were prescribed systemic psychogenic medications, the median symptoms’ intensity score at baseline was 5.0 and 3.0 at first follow up, a statistically significant improvement (p<0.001; 95% CI). Among those without anxiety/depression, the symptoms’ intensity score at baseline was 4.0 and 2.0 at first follow up, a statistically significant improvement (p< 0.05; 95% CI). The median symptoms’ intensity score for those who were not on any psychogenic medications at baseline was 4.0 and 2.0 at first follow up, a statistically significant improvement (p<0.001; 95% CI).

CONCLUSIONS: Clinicians are encouraged to prescribe topical clonazepam for BMS regardless of concomitant use of systemic psychogenic medications or comorbid mood disorders as it is an efficacious management approach in the presence or absence of these potentially complicating factors.

PMID:34716948 | DOI:10.1111/joor.13275

Colorectal Dis. 2021 Oct 30. doi: 10.1111/codi.15973. Online ahead of print.

ABSTRACT

Fahim et al. (1) report increased mortality after open colorectal cancer surgery (HR1.26). Is this conclusion validated by the presented data? The explanation of decision process regarding type of surgery is probably not sufficient, as at the end of the analysed period (2018) only 4% patients had open surgery. With such a low percentage of patients having open surgery comparison with laparoscopic surgery group is difficult.

PMID:34716955 | DOI:10.1111/codi.15973

J Clin Ultrasound. 2021 Oct 30. doi: 10.1002/jcu.23095. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate correlation and agreement between T2*-weighted magnetic resonance imaging (T2*-wMRI), acoustic radiation force impulse elastography (ARFI-e) measurement results of liver and plasma ferritin levels (PFLs) in children with β-thalassemia major (β-TM).

METHODS: The study included 40 pediatric patients (aged 64-216 months; 14 girls, 26 boys) receiving blood transfusion and chelation therapy. To detect the severity of liver iron overload (LIO) and concomitant parenchymal fibrosis, T2*-wMRI and ARFI-e measurements were performed from the right lobe segments. Student’s t-test, Mann-Whitney U, ANOVA, Spearman’s test and ICC were used for statistical analysis.

RESULTS: After the measurements of T2*-wMRI, patients were grouped as normal in 4 (10%), mild in 11 (27.5%), moderate in 21 (52.5%), and severe in 4 (10%) cases in terms of LIO. Combined moderate and severe groups had significantly higher ARFI-e and PFL values than the combination of other groups (p = .001, p = .040). The ARFI-e measurements of boys were found to be significantly higher than those of girls (p = .023). A strong negative correlation between T2*-wMRI and ARFI-e and a moderate negative correlation between T2*-wMRI and PFL were detected (p;r = 0.001;-0.606, p;r = 0.009; -0.407). A strong positive correlation was found between ARFI-e values and PFL (p;r = 0.001; 0.659). The optimal cut-off value of ARFI-e to predict liver fibrosis because of moderate&severe LIO was determined to be 1.29 M/s (80% sensitivity and 88% specificity). A moderate agreement was observed between the T2*-wMRI and ARFI-e methods [ICC: 0.680, 95% CI: (0.470 to 0.817)].

CONCLUSION: Given the strong correlation and moderate agreement between ARFI-e and T2*-wMRI, ARFI -e could be used to monitor LIO in children with β-TM.

PMID:34716933 | DOI:10.1002/jcu.23095

Health Promot J Austr. 2021 Oct 30. doi: 10.1002/hpja.551. Online ahead of print.

ABSTRACT

ISSUE ADDRESSED: Many university students have unhealthy dietary intakes. The food environment on university campuses is a potentially important contributor to students’ diet. This study aimed to describe on-campus food purchasing behaviours; satisfaction with the cost and availability of foods and beverages on-campus; and preferences for the on-campus food environment, in a sample of Australian university students.

METHODS: An online cross-sectional survey of 409 students at the [blinded for peer review] was conducted in 2017-2018. The survey assessed on-campus purchasing behaviours (frequency of purchase and expenditure), satisfaction with the cost and availability of foods, preferences for the on-campus food environment, and socio-demographics (e.g. age, domestic/international student). Results are reported as basic descriptive statistics.

RESULTS: The majority of students (94%) purchased food or beverages on-campus, with 59% purchasing at least once per week. Satisfaction with the availability of foods was low (35.8% satisfied with the types of main meals available, and 48.5% for snacks), however 72.8% were satisfied with types of beverages available. The majority of students were not satisfied with the cost of food and beverages (<40%). The top rated preferences for changes to the on-campus food environment were healthier options, higher quality food, and cheaper food.

CONCLUSION: Overall, the findings demonstrate strong support from students for healthier and cheaper food to be made available on-campus. SO WHAT?: There are two main factors of concern with regards to university food environments; the healthiness of food and beverage options and their cost. These should be key considerations of any future strategies aiming to improve university food environments.

PMID:34716937 | DOI:10.1002/hpja.551