Category: Nevin Manimala

J Vasc Access. 2021 Jul 13:11297298211031339. doi: 10.1177/11297298211031339. Online ahead of print.

ABSTRACT

To determine the effect of Trendelenburg position on the diameter or cross-section area of the internal jugular vein (IJV) a systematic review and metanalysis was performed. Studies that evaluated the cross-sectional area (CSA) and anteroposterior (AP) diameter of the right internal jugular vein (RIJV) with ultrasonography in supine and any degree of head-down tilt (Trendelenburg position) were analyzed. A total of 22 articles (613 study subjects) were included. A >5° Trendelenburg position statistically increases RIJV CSA and AP diameter. Further inclination from 10° does not statistically benefit IJV size. This position should be recommended for CVC placement, when patient conditions allow it, and US-guided cannulation is not available.

PMID:34254560 | DOI:10.1177/11297298211031339

Turk J Pediatr. 2021;63(3):490-494. doi: 10.24953/turkjped.2021.03.016.

ABSTRACT

BACKGROUND: Mutations in the KCNJ11 gene, which encodes the Kir6.2 subunit of the ATP-sensitive potassium channel, often result in neonatal diabetes.

CASE: In this report, we describe a 10-year-old girl who is heterozygous for a new missense mutation in the KCNJ11 gene and whose treatment was successfully switched from insulin to sulfonylurea (glibenclamide) therapy when she was one month old. 10-year data on a low-dose of glibenclamide monotherapy showed excellent glycaemic control with no reports of severe hypoglycaemia and microvascular complications.

CONCLUSION: An early genetic diagnosis of neonatal diabetes mellitus is highly beneficial because early switch from insulin to sulfonylurea is safe, avoids unnecessary insulin therapy and promotes sustained improvement of glycaemic control on long-term follow-up.

PMID:34254494 | DOI:10.24953/turkjped.2021.03.016

Nurs Ethics. 2021 Jul 13:969733021999751. doi: 10.1177/0969733021999751. Online ahead of print.

ABSTRACT

BACKGROUND: Euthanasia is a controversial issue in many countries. However, there is little evidence about attitudes of nurses and nursing students toward euthanasia.

RESEARCH AIMS: The present study aimed to compare nurses and nursing students’ attitudes toward euthanasia.

RESEARCH DESIGN: This is a descriptive cross-sectional study.

PARTICIPANTS AND RESEARCH CONTEXT: Using census sampling, 390 nurses and 125 nursing students were enrolled in this study.

METHODS: Data were collected using a socio-demographic questionnaire and Euthanasia Attitude Scale that included 20 items that sought to record participants’ level of agreement with euthanasia based on a Likert-type scale.

ETHICAL CONSIDERATIONS: Objectives of the study were stated for all samples, and emphasized the confidentiality of their specifics and responses, and informed written consent was obtained from all participants.

FINDINGS: The mean score of nurses and nursing students’ attitudes about euthanasia was 3.14 ± 0.26 and 3.22 ± 0.24 out of 5, respectively. The majority of nurses (n = 250, 65.78%) and nursing students (n = 97, 80.83%) had a positive attitude toward euthanasia. There was a significant statistical difference between the attitudes of nurses and nursing students to euthanasia (p = .005).

DISCUSSION: The results indicated that the majority of students and nurses had a positive attitude regarding euthanasia.

CONCLUSION: It was recommended to conduct more studies on euthanasia in Iran.

PMID:34254542 | DOI:10.1177/0969733021999751

Gynecol Endocrinol. 2021 Jul 13:1-5. doi: 10.1080/09513590.2021.1948527. Online ahead of print.

ABSTRACT

AIM OF THE STUDY: To compare a multicentric surgical experience on ovarian teratomas in childhood with the current management trends.

DESIGN: A retrospective multicentric pediatric ovarian teratomas surgically treated between January 2000 and August 2020 at four Italian institutions. PubMed database was used to search for Reviews and Systematic Reviews published between January 2010 and August 2020: 15 manuscripts reported 3633 ovarian neoplasms in pediatric age, 1219 (33,5%) of which were ovarian teratomas.

RESULTS: A hundred-ten patients with a mean age at diagnosis of 11.8 years were enrolled. Mature cystic teratomas accounted for the 90% of the masses. At surgery, 78 were oophorectomies and 32 were ovary sparing surgeries. Laparoscopy occurred in 16.3% of the surgeries.As regarding the current management trends, the mean age at diagnosis was 11.9 years and 80.5% of the cases were represented by mature teratomas. Of 430 procedures, 331 were oophorectomies while 99 were ovary sparing surgeries and laparoscopy was performed in 23.8% of cases.

CONCLUSIONS: Ovary-sparing surgery with laparoscopic approach is increasingly offered as standard treatment for benign masses that fit the criteria for mature teratomas, in the attempt to achieve the best compromise between the preservation of fertility and the prevention of recurrences. Awareness should be raised among pediatric surgeons to reduce unnecessary radical surgery.

PMID:34254550 | DOI:10.1080/09513590.2021.1948527

Turk J Pediatr. 2021;63(3):482-489. doi: 10.24953/turkjped.2021.03.015.

ABSTRACT

BACKGROUND: The study aimed to examine the effect of early hyperglycemia on the morbidity/mortality of very low birth weight premature infants.

METHODS: This retrospective study included all premature infants with gestational age ≤32 gestational weeks, hospitalized at the Department of Intensive Neonatal Care, Clinical Center Kragujevac, during the period 2017-2019. Hyperglycemia was defined as glycemia of ≥12 mmol/l in one measurement, or > 10 mmol/l in two measurements, at repeated intervals of 2-4 hours. Glycemia was determined from capillary blood, using a gas analyzer of Gem Premier 3000, during the first 7 days of life. Continuous intravenous insulin infusion was administered after ineffective glucose restriction at glycemic values of > 14 mmol/l.

RESULTS: Patients with normoglycemia (41/72 (56.94%)) and hyperglycemia (31/72 (43.06%)) did not differ in gender, gestational age, mode of delivery and antenatal administration of steroids, while birth weight had a tendency to be lower in the hyperglycemic group (p=0.052). Hyperglycemia was significantly associated with a low APGAR score at the fifth minute (p=0.048), necrotizing enterocolitis (p=0.011), and shorter duration of mechanical ventilation (p=0.006). Hyperglycemia was associated with significantly more frequent fatal outcomes (35.5%) when compared with the normoglycemic group (4.9%). Accordingly, these patients required inotropic (r=0.036) and insulin therapy (r < 0.001) more often. Retinopathy of prematurity, bronchopulmonary dysplasia and sepsis did not correlate with hyperglycemia in our study. Intraventricular hemorrhage of the first degree was more often associated with normoglycemia in premature infants on prolonged mechanical ventilation while more severe intracranial hemorrhage was more common in the hyperglycemic group but did not result in statistical significance due to the small number of patients.

CONCLUSIONS: Monitoring glucose levels in the blood of very low birth weight premature infants is clinically important because abnormalities in glucose homeostasis can have serious short-term and long-term consequences.

PMID:34254493 | DOI:10.24953/turkjped.2021.03.015

Sci Rep. 2021 Jul 12;11(1):14282. doi: 10.1038/s41598-021-93344-z.

ABSTRACT

Block cipher has been a standout amongst the most reliable option by which data security is accomplished. Block cipher strength against various attacks relies on substitution boxes. In literature, extensively algebraic structures, and chaotic systems-based techniques are available to design the cryptographic substitution boxes. Although, algebraic and chaotic systems-based approaches have favorable characteristics for the design of substitution boxes, but on the other side researchers have also pointed weaknesses in these approaches. First-time multilevel information fusion is introduced to construct the substitution boxes, having four layers; Multi Sources, Multi Features, Nonlinear Multi Features Whitening and Substitution Boxes Construction. Our proposed design does not hold the weakness of algebraic structures and chaotic systems because our novel s-box construction relies on the strength of true random numbers. In our proposed method true random numbers are generated from the inevitable random noise of medical imaging. The proposed design passes all the substitution box security evaluation criteria including Nonlinearity, Bit Independence Criterion (BIC), Strict Avalanche Criterion (SAC), Differential Approximation Probability (DP), Linear Approximation Probability (LP), and statistical tests, including resistance to Differential Attack, Correlation Analysis, 2D, 3D histogram analysis. The outcomes of the evaluation criteria validate that the proposed substitution boxes are effective for block ciphers; furthermore, the proposed substitution boxes attain better cryptographic strength as compared to very recent state-of-the-art techniques.

PMID:34253755 | DOI:10.1038/s41598-021-93344-z

Sci Rep. 2021 Jul 12;11(1):14323. doi: 10.1038/s41598-021-93253-1.

ABSTRACT

Tracking studies of juveniles are rare compared to those of adults, and consequently little is known about the influence of intrinsic and extrinsic factors on activity during this critical life stage. We used hourly GPS data, collected from 66 Antarctic fur seal pups from birth until moulting, to investigate the explanatory power of multiple individual-based and environmental variables on activity levels. Pups were sampled from two nearby breeding colonies of contrasting density during two subsequent years, and a two-state hidden Markov model was used to identify modalities in their movement behaviour, specifically ‘active’ and ‘inactive’ states. We found that movement was typified by central place exploration, with active movement away from and subsequent return to a location of inactivity. The probability of such directed exploration was unaffected by several factors known to influence marine mammal movement including sex, body condition, and temperature. Compared to pups born at the high-density colony, pups at low-density were more active, increased their activity with age, and transitioned earlier into the tussock grass, which offers protection from predators and extreme weather. Our study illustrates the importance of extrinsic factors, such as colony of birth, to early-life activity patterns and highlights the adaptive potential of movement.

PMID:34253749 | DOI:10.1038/s41598-021-93253-1

Sci Rep. 2021 Jul 12;11(1):14304. doi: 10.1038/s41598-021-92692-0.

ABSTRACT

Colorectal cancer (CRC) is a common cause of cancer-related deaths worldwide. The CRC mRNA gene expression dataset containing 644 CRC tumor and 51 normal samples from the cancer genome atlas (TCGA) was pre-processed to identify the significant differentially expressed genes (DEGs). Feature selection techniques Least absolute shrinkage and selection operator (LASSO) and Relief were used along with class balancing for obtaining features (genes) of high importance. The classification of the CRC dataset was done by ML algorithms namely, random forest (RF), K-nearest neighbour (KNN), and artificial neural networks (ANN). The significant DEGs were 2933, having 1832 upregulated and 1101 downregulated genes. The CRC gene expression dataset had 23,186 features. LASSO had performed better than Relief for classifying tumor and normal samples through ML algorithms namely RF, KNN, and ANN with an accuracy of 100%, while Relief had given 79.5%, 85.05%, and 100% respectively. Common features between LASSO and DEGs were 38, from them only 5 common genes namely, VSTM2A, NR5A2, TMEM236, GDLN, and ETFDH had shown statistically significant survival analysis. Functional review and analysis of the selected genes helped in downsizing the 5 genes to 2, which are VSTM2A and TMEM236. Differential expression of TMEM236 was statistically significant and was markedly reduced in the dataset which solicits appreciation for assessment as a novel biomarker for CRC diagnosis.

PMID:34253750 | DOI:10.1038/s41598-021-92692-0

BMJ Qual Saf. 2021 Jul 12:bmjqs-2020-012729. doi: 10.1136/bmjqs-2020-012729. Online ahead of print.

ABSTRACT

BACKGROUND: Internationally, patient and public involvement (PPI) is core policy for health service quality improvement (QI). However, authentic QI partnerships are not commonplace. A lack of patient and staff capability to deliver successful partnerships may be a barrier to meaningful QI collaboration.

OBJECTIVES: The research questions for this scoping review were: What is known regarding the capabilities required for healthcare staff and patients to effectively partner in QI at the service level?; and What is known regarding the best practice learning and development strategies required to build and support those capabilities?

METHODS: A six-stage scoping review was completed. Five electronic databases were searched for publications from January 2010 to February 2020. The database searches incorporated relevant terms for the following concepts: capabilities for PPI in healthcare QI; and best practice learning and development strategies to support those capabilities. Data were analysed using descriptive statistics and qualitative content analysis.

RESULTS: Forty-nine papers were included. Very little peer-reviewed literature focused explicitly on capabilities for QI partnerships and thus implicit paper content was analysed. A Capability framework for successful partnerships in healthcare quality improvement was developed. It includes knowledge, skills and attitudes across three capability domains: Personal Attributes; Relationships and Communication; and Philosophies, Models and Practices, and incorporates 10 capabilities. Sharing power and leadership was discussed in many papers as fundamental and was positioned across all of the domains. Most papers discussed staff and patients’ co-learning (n=28, 57.14%). Workshops or shorter structured training sessions (n=36, 73.47%), and face-to-face learning (n=34, 69.38%) were frequently reported.

CONCLUSION: The framework developed here could guide individualised development or learning plans for patient partners and staff, or could assist organisations to review learning topics and approaches such as training content, mentoring guidelines or community of practice agendas. Future directions include refining and evaluating the framework. Development approaches such as self-reflection, communities of practice, and remote learning need to be expanded and evaluated.

PMID:34253682 | DOI:10.1136/bmjqs-2020-012729

Sci Rep. 2021 Jul 12;11(1):14285. doi: 10.1038/s41598-021-92811-x.

ABSTRACT

Pancreatic duct stenting is a well-established method for reducing post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. However, there is no consensus on the optimal type of plastic stent. This study aimed to evaluate the feasibility and safety of a new 4-Fr plastic stent for pancreatic duct stenting. Forty-nine consecutive patients who placed the 4-Fr stent into the pancreatic duct (4Fr group) were compared with 187 consecutive patients who placed a conventional 5-Fr stent (control group). The primary outcome was technical success. Complications rate, including post-ERCP pancreatitis (PEP) were the secondary outcomes. Propensity score matching was introduced to reduce selection bias. The technical success rate was 100% in the 4Fr group and 97.9% in the control group (p = 0.315). Post-ERCP amylase level was significantly lower in the 4-Fr group than the control group before propensity score matching (p = 0.006), though without statistical significance after propensity score matching (p = 0.298). The rate of PEP in the 4Fr group (6.1%) was lower than the control group (15.5%), though without statistical significance before (p = 0.088) and after (p = 1.00) propensity score matching. Pancreatic duct stenting using a novel 4-Fr plastic stent would be at least similar or more feasible and safe compared to the conventional plastic stent.

PMID:34253746 | DOI:10.1038/s41598-021-92811-x