Category: Nevin Manimala

Otol Neurotol. 2021 Jun 25. doi: 10.1097/MAO.0000000000003163. Online ahead of print.

ABSTRACT

OBJECTIVE: To describe a new stapedotomy in which is removed only the stapes head not the entire stapes superstructure and its long-term results.

STUDY DESIGN: Prospective study.

PATIENTS: The study was started on January 2015 and ended on September 2020. Seventy patients with otosclerosis were included in the study. They underwent stapedotomy from January 2015 to April 2016. The main follow-up for the study group was (5.1 yrs). The study group was divided into two groups (A and B) according the short hearing results (1 yr) and long hearing results (5.1 yrs). Group A including short hearing results. Group B including long hearing results. For all patients in groups A and B, the surgeon (M.G.), microscope, the anesthesia (local), the approach (transcanal), the prostheses (piston-type), and the new stapedotomy (removal of the stapes head only and not of the entire stapes superstructure), were identical.

RESULTS: No patients exhibited postoperative dizziness or worsening of bone conduction. Cutting the stapes neck never caused bleeding or footplate complications. The average time to perform the new stapedotomy was 15 minutes. Air-bone gap (ABG) closure to within 10 dB was achieved in 66 of 70 (94.28%) cases in group A and in 65 of 70 (92.85%) cases in group B. This difference was not statistically significant.

CONCLUSION: The Malafronte’s stapedotomy is an easy, safety, minimally invasive, and fast surgical technique. Its hearing outcomes are good and stable over time.

PMID:34172650 | DOI:10.1097/MAO.0000000000003163

J Glaucoma. 2021 Jun 24. doi: 10.1097/IJG.0000000000001903. Online ahead of print.

ABSTRACT

PRECIS: A small increase in optic nerve head vessel density (VD), but not macular VD, in the evening compared to the morning is observed in healthy subjects.

PURPOSE: To evaluate the diurnal variation of the macular and optic nerve head (ONH) vessel density (VD) in healthy eyes as measured with optical coherence tomography angiography (OCT-A).

METHODS: In this prospective study of healthy individuals older than 18 years old, VD parameters, including macular whole image vessel density (wiVD), parafoveal vessel density (pfVD), ONH whole image vessel density (ONH-wiVD), ONH whole image capillary density (ONH-wiCD), circumpapillary vessel density (cpVD), and circumpapillary capillary density (cpCD), were measured with OCT-A at four time points throughout the day (8 AM, 12 PM, 4 PM, and 8 PM).

RESULTS: Twenty nine healthy eyes were included from 15 subjects (mean age: 30.9 years). After adjustment for age and mean ocular perfusion pressure (MOPP), a significant positive rate of change was found for cpVD (0.05%/hour; P=0.027). In contrast, macular VD changes were not significantly different. When comparing morning (8 AM and 12 PM) and evening (4 PM and 8 PM) measurements, there were small, but statistically significant, increases for all ONH measurements. The greatest increase was found for cpVD (0.58%; P=0.022). Significant but small increases in mean arterial pressure and MOPP were also observed.

CONCLUSIONS: There was a small increase in ONH VD, but not macular VD, in the evening compared to the morning in healthy human eyes. As the observed difference was within the measurement variability, our results suggest the timing of OCT-A examination does not affect retinal VD measurements.

PMID:34172629 | DOI:10.1097/IJG.0000000000001903

J Glaucoma. 2021 Jun 24. doi: 10.1097/IJG.0000000000001904. Online ahead of print.

ABSTRACT

PRECIS: We retrospectively reviewed records of patients prescribed latanoprostene bunod to assess its efficacy and safety in a real-world clinical setting. Latanoprostene bunod was efficacious in lowering intraocular pressure and had a favorable safety profile.

PURPOSE: To evaluate the usage of latanoprostene bunod 0.024%, the first topical nitric oxide donating prostaglandin analog for reducing intraocular pressure, in clinical practice.

PATIENTS AND METHODS: Retrospective review identified patients prescribed latanoprostene bunod by 5 glaucoma specialists at an academic center from 1/2018-11/2019. 56 patients (102 eyes) met inclusion criteria of an intraocular pressure measured at the visit latanoprostene bunod was prescribed and at 2 visits ≥7 days after beginning treatment, with no surgeries, lasers or medication changes during follow-up. Main outcome measures were intraocular pressure, number of ocular medications, and adverse effects.

RESULTS: Intraocular pressure (mean±standard deviation mmHg) at the visit latanoprostene bunod was prescribed was 16.2±4.3 on 3.2±1.5 glaucoma medications. IOP at most recent visit was 13.7±3.8 on 3.2±1.6 medications. Mean intraocular pressure reduction was 2.1±3.5 (P<0.0001) at first follow-up, after 38.7±36.5 days, and 2.5±3.3 (P<0.0001) at last follow-up, after 235.9±160.8 days. Pressure decreased ≥2▒mmHg in 60%, ≥3▒mmHg in 46%, and ≥4▒mmHg in 34% of eyes. All patients received latanoprostene bunod as replacement for a prostaglandin analog or latanoprost/netarsudil fixed-dose combination. 43 patients remained on latanoprostene bunod throughout the follow-up period. 7 were discontinued for insufficient pressure control, 4 for adverse effects including pain and itching, and 2 for financial reasons.

CONCLUSIONS: In two years of clinical use of latanoprostene bunod, patients exhibited intraocular pressure reductions that were statistically significant overall and clinically meaningful in 60% of patients. Latanoprostene bunod was well-tolerated and may be more efficacious than traditional prostaglandin analogs.

PMID:34172630 | DOI:10.1097/IJG.0000000000001904

Shock. 2021 Jun 24. doi: 10.1097/SHK.0000000000001827. Online ahead of print.

ABSTRACT

INTRODUCTION: Early diagnosis and treatment can reduce the risk of organ failure and mortality in systemic inflammatory conditions. Heart rate variability (HRV) has potential for early identification of the onset of systemic inflammation, as it may detect changes in sympathetic nervous system activity resulting from the developing inflammatory response before clinical signs appear. With the use of new methodologies, we investigated the onset and kinetics of HRV changes as well as several inflammatory parameters and symptoms during experimental human endotoxemia, a model of systemic inflammation in humans in vivo.

MATERIAL AND METHODS: Healthy volunteers were intravenously administered lipopolysaccharide (LPS, n = 15) or placebo (n = 15). HRV was determined using a wireless wearable device, and parameters low to high frequency (LF:HF) ratio, root mean square of the successive differences (RMSSD), and standard deviation of normal-to-normal R-R intervals (SDNN)were calculated through 1-min-rolling 6-minute windows. Plasma cytokine levels and flu-like symptoms and vital signs were serially assessed.

RESULTS: The increase in LF:HF ratio, reflecting sympathetic predominance, was more pronounced in the LPS group compared to the placebo group, with the difference becoming statistically significant 65 minutes following LPS administration (1.63 [1.42-1.83] vs. 1.28 [1.11-1.44], p = 0.005). Significant between-group differences in RMSSD and SDNN were observed from 127 and 140 minutes post-LPS administration onwards, respectively. Plasma cytokine levels showed significant between-group differences staring 60 minutes post-LPS. For symptom score, heart rate, temperature and diastolic blood pressure, significant differences compared with the placebo group were observed at 90, 118, 120, and 124 minutes post-LPS, respectively.

CONCLUSION: In a controlled human model of systemic inflammation, elevations in the LF:HF ratio followed very shortly after elevations in plasma cytokine levels and preceded onset of flu-like symptoms and alterations in vital signs. HRV may represent a promising non-invasive tool for early detection of a developing systemic inflammatory response.

PMID:34172613 | DOI:10.1097/SHK.0000000000001827

J Addict Med. 2021 Jun 24. doi: 10.1097/ADM.0000000000000874. Online ahead of print.

ABSTRACT

OBJECTIVE: During the COVID-19 pandemic, states have had to confront a drug overdose problem associated with the pandemic. The objective of this study was to identify the impact of the COVID-19 pandemic on the opioid epidemic in the state of Ohio by describing the changes in the quarterly opioid overdose deaths (OOD) over the last 10 years.

METHODS: This longitudinal study included OOD data from death records obtained through the Ohio Department of Health. Temporal trend analysis and visualizations were performed on the OOD death rate per 100,000 quarterly from 2010 to 2020. Age, sex, and ethnicity were also analyzed.

RESULTS: The OOD rate of 11.15 in Q2 of 2020 was statistically equivalent to the previous peak level of 10.87 in Q1 of 2017. There was a significant increase in the OOD rate from Q1 to Q2 of 2020 and a significant difference between the actual Q2 of 2020 OOD rate and the predicted OOD rate. The poisoning indicator fentanyl was present in 94% of OOD during Q2 of 2020. The total number of OOD remains highest in the White population. There was no significant difference between the actual and predicted OOD rates in the Black population of Q2 of 2020 based on the trend line. However, the OOD rate of 14.29 in Q2 of 2020 was significantly higher than the previous peak level of 8.34 in Q2 of 2017. The Q2 of 2020 OOD rates for 18 to 39 and 40+ age groups were significantly higher from what would be expected from the trend predictions.

CONCLUSIONS: Based on these findings, Ohio has entered a COVID19 pandemic mediated fourth wave in the opioid epidemic. These findings further suggest that as efforts are made to address the worldwide COVID-19 pandemic, states need to maintain their vigilance toward combating the local opioid epidemic.

PMID:34172625 | DOI:10.1097/ADM.0000000000000874

Int J Clin Pract. 2021 Jun 25:e14573. doi: 10.1111/ijcp.14573. Online ahead of print.

ABSTRACT

BACKGROUND: A minimally invasive approach has been adopted to treat benign cystic nodules in recent years, with ethanol ablation (EA) being used as a more common method in routine treatment. For this study, we aimed to investigate the change of nodule volumes and cosmetic scores before and after EA in benign thyroid nodules and the effectiveness of treatment. Therefore, ultrasound data and cosmetic scores of pure cystic, mixed-type and spongy-type benign thyroid nodules undergoing EA in the last two years were reviewed retrospectively.

METHODS: Archive scanning was performed for all cases that were proven benign by fine-needle aspiration biopsy (FNAB) and who underwent EA. In all 46 patients included in the study, thyroid FNAB was performed. Ultrasound images were available to assess the size and volumes at pretreatment and 3 and 6 months after EA. The cosmetic scores obtained before the procedure and at 6 months after EA were compared.

RESULTS: There was a statistically significant difference when the sizes and volumes of the nodules were compared at pretreatment, 3 months and 6 months follow-up (p<0.001). The mean pretreatment cosmetic score was 3.09, and at 6 months, it was 1.20, with a statistically significant difference (p<0.001).

CONCLUSIONS: Recently, a minimally invasive approach has been adopted in the treatment of benign cystic nodules, with ethanol ablation becoming more common in routine treatment. Therefore, ethanol ablation is very valuable in minimizing complications that may arise from surgery.

PMID:34171155 | DOI:10.1111/ijcp.14573

Cell Physiol Biochem. 2021 Jun 26;55(3):344-363. doi: 10.33594/000000381.

ABSTRACT

BACKGROUND/AIMS: Acute kidney injury (AKI) is a public health burden with increasing morbidity, mortality and health care cost. It is associated with increased risk for the development of chronic kidney disease and death. Acute tubular necrosis (ATN) is the most common cause of AKI. Apoptosis and tissue necrosis play an important role in ATN. Galectin 3 (GAL-3), a beta galactoside binding lectin, is known to have a role in inflammation, apoptosis and oxidative stress but its role in cisplatin induced acute tubular necrosis is not clearly elucidated.

METHODS: Male C57B6-J and C57BL-6 -GAL-3 knock-out mice were used to induce ATN using cisplatin mouse model of acute tubular necrosis. GAL-3 expression, apoptotic, necrotic and necroptotic proteins in kidneys were measured using standard histologic, immunohistochemical, and enzyme-linked immunosorbent assay techniques. Data were presented as mean ± S.E. Statistically significant differences (p<0.05) was calculated between experimental groups and corresponding control groups by one-way analysis of variance.

RESULTS: There was a significant increase in GAL-3 in kidneys of cisplatin treated GAL-3 wild mice when compared with its control mice. In addition, there were significant higher percentage of ATN, higher levels of plasma urea and creatinine, and higher levels of cathepsin B and cathepsin D, in kidneys of cisplatin-treated GAL-3 KO mice than cisplatin-treated GAL-3 wild mice. Likewise, there were significant higher levels of necroptosis proteins RIPK1, RIPK3, and MLKL in kidneys of cisplatin-treated GAL-3 KO mice than cisplatin-treated GAL-3 wild mice. Moreover, there were significant higher levels of kidney pro-apoptotic proteins; cleaved caspase-3, cleaved PARP, TRAIL and FAS in cisplatin treated GAL-3 KO mice when compared with cisplatin treated GAL-3 wild mice.

CONCLUSION: GAL-3 can affect cell survival and death through its interaction with necroptotic, apoptotic and pro-survival proteins in renal tubules during cisplatin-induced acute tubular necrosis.

PMID:34171186 | DOI:10.33594/000000381

Int J Clin Pract. 2021 Jun 25:e14575. doi: 10.1111/ijcp.14575. Online ahead of print.

ABSTRACT

Successful management of psychiatric disorders is affected by patient perspectives and several barriers, i.e., conceptual, psychological, social, or logistic reasons that can decrease patient adherence to therapy. In this perspective, pharmacists have a vital role in identifying patients in need of help and in dealing with barriers. The aim of this study was to investigate perspectives of patients diagnosed with psychiatric disorders, living in rural areas in Jerash, Jordan, regarding their awareness about their conditions, including religious and cultural factors, adherence to their treatment and related barriers, with special focus on pharmacist’s role. This cross-sectional survey study was conducted in Jordan from August to November 2019. A validated questionnaire was administered by two pharmacy students via a structured interview with patients waiting for their appointment in the psychiatric clinic. Data were analyzed using the Statistical Package for the Social Sciences. One hundred twenty patients (age 39.4±9.5, 66.7% males) completed the questionnaire. Most of them (71.0%) reported adherence to their medications, and 47.5% reported complete control of their symptoms with treatment. Most patients (59.2%) reported that they perceive their psychiatric problem in terms of religious faith as being counted for their favor in the Hereafter, and 52.5% of them always/usually looked at themselves positively and unaffected by their psychiatric problem; with both factors correlating significantly with better treatment adherence (p < 0.045 and p < 0.001; respectively). Barriers affecting adherence included mainly suffering from adverse effects (31.9%) and being unconvinced that they needed a medication (23.3%). Only 14.2% of patients reported that they refer to the pharmacist to get information about their medications. This study shows suboptimal symptom control of psychiatric patients in Jerash. Nonadherence is an issue, with barriers identified. Positive religious and self-image perspectives correlated with better adherence. Patient referral to pharmacists is minimal and needs to be optimized.

PMID:34171149 | DOI:10.1111/ijcp.14575

J Adv Nurs. 2021 Jun 25. doi: 10.1111/jan.14930. Online ahead of print.

ABSTRACT

AIMS: Secondary prevention of coronary heart disease is of utmost importance to facilitate people to achieve health outcomes and behaviours. This study was to investigate the effect of a nursing intervention based on Cox’s interaction model of client health behaviour to improve health outcomes and behaviours of secondary prevention of coronary heart disease.

DESIGN: This study is a cluster randomised controlled trial.

METHODS: Participants were recruited between August and November 2019 in two community settings in Hengyang city, Hunan province, China. Participants in the intervention group received a nursing intervention based on Cox’s interaction model of client health behaviour and routine health education, while those in the control group received routine health education only. The outcome variables included selfߚmanagement, physical activity, medication compliance, anxiety, sexual knowledge, the ability to identify sexual health education needs, blood pressure, body mass index (BMI), and lowߚdensity lipoprotein cholesterol (LDLߚC). The influential statistical tests applied to analyse the data included χ² tests and t tests.

RESULTS: Seventyߚseven participants completed this study. Compared with the control group (n = 40), the intervention group (n = 37) showed statistically significant better health outcomes and behaviours regarding selfߚmanagement, physical activity (except for high energy consumption), medication compliance, anxiety, sexual knowledge, the ability to identify sexual health education needs, systolic blood pressure, BMI, and LDLߚC. However, there was no statistically significant difference in diastolic blood pressure and high energy consumption for physical activity.

CONCLUSION: A wellߚdeveloped nursing intervention based on Cox’s interaction model of client health behaviour could successfully improve health outcomes and behaviours of secondary prevention of coronary heart disease. Such an intervention may be incorporated into community healthcare practice by nurses to improve patient care.

IMPACT: This study provides a valuable insight to facilitate further development of effective nursing interventions to improve secondary prevention of coronary heart disease in community settings.

PMID:34171133 | DOI:10.1111/jan.14930

Spec Care Dentist. 2021 Jun 25. doi: 10.1111/scd.12621. Online ahead of print.

ABSTRACT

AIMS: To compare the dental caries prevalence using the International Caries Detection and Assessment System (ICDAS) and the caries risk by Caries Management by Risk Assessment (CAMBRA) in individuals with cerebral palsy (CP) and normoactives (NAs).

METHODS AND RESULTS: Sixty children and adolescents aged 6-12 years (30 CP/30 NA) were clinically evaluated by one calibrated examiner using two-digit ICDAS criteria and converted into components of dmf/DMF indices: d2mf2/D2MF2 (enamel and dentin lesions) and d3mf3/D3MF3 (dentin lesions). An adapted CAMBRA was used for risk classification. The mean d2mf2s/d2mf2t and D2MF2S/D2MF2T for CP were 17.0 ± 16.8/7.5 ± 4.3 and 10.7 ± 17.6/5.3 ± 5.8, respectively, and for NA were 17.2 ± 16.9 /6.9 ± 4.8 and 11.1 ± 11.7/5.5 ± 4.7, respectively. The mean d3mf3s/d3mf3t and D3MF3S/D3MF3T for CP were 10.1 ± 16.7/3.0 ± 4.1 and 4.9 ± 15.6/0.2 ± 0.4, respectively, while for NA the mean values were 9.8 ± 13.0/3.5 ± 3.8 and 2.1 ± 5.7/0.9 ± 2.0, respectively. There were no statistically differences for caries prevalence and risk in both groups (p > 0.05).

CONCLUSIONS: Dental caries was highly prevalent in CP and NA children and adolescents. Enamel and dentin lesions and high caries risk were the most common condition.

PMID:34171134 | DOI:10.1111/scd.12621