Category: Nevin Manimala

Scand J Public Health. 2021 Sep 13:14034948211041814. doi: 10.1177/14034948211041814. Online ahead of print.

ABSTRACT

AIMS: Diabetes requires complex self-management. Due to this complexity, social disparities exist in the self-management of type 1 diabetes. Various pathways to describe associations between socio-economic factors and health outcomes have been suggested. We sought to elucidate the potential of health literacy and social support to reduce social disparities in diabetes self-management.

METHODS: Questionnaire responses were linked to data from electronic medical records, yielding a study population of 1186 people with type 1 diabetes. Mediation analyses using adjusted linear regressions were used to establish pathways between self-reported educational attainment, social support, functional health literacy and clinically obtained measures of glycaemic control.

RESULTS: We found evidence of an association between education and glycated haemoglobin, partially mediated by functional health literacy and social support. However, the direct association between social support and glycaemic control was not statistically significant.

CONCLUSIONS: Whilst both functional health literacy and social support play a role in glycaemic control, our findings did not explain the main impact of social disparities on glycaemic control. Interventions to reduce disparities in glycaemic control related to educational attainment should focus beyond functional health literacy and social support.

PMID:34515582 | DOI:10.1177/14034948211041814

Curr Med Res Opin. 2021 Sep 13:1. doi: 10.1080/03007995.2021.1980776. Online ahead of print.

ABSTRACT

OBJECTIVES: Inhalative anesthesia is of common use, but is generally known to potentiate postoperative nausea and vomiting (PONV). With an internal change of anesthesia regimen from total intravenous anesthesia (TIVA) to isoflurane (in terms of myocardial protection) in cardiac anesthesia a higher incidence of PONV was to be expected. Therefore, we evaluated the incidence of PONV after the simultaneous implementation of PONV prophylaxis.

METHODS: The incidence of PONV, prospectively assessed in 197 cardiac surgery patients (68y ± 10.4, 66.5% male) having isoflurane plus dual PONV prophylaxis with dexamethasone and droperidol, was compared with previous data of 190 controls (67y ± 9.6, 71% male) having TIVA without and with single or dual PONV prophylaxis (n = 64 dexamethasone and droperidol, n= 25 dexamethasone, n = 101 only TIVA), and the Apfel-scoring (0-4 depending on PONV-risk). DRKS00014275. Statistics: Chi²-test, p < 0.05 (Bonferroni).

RESULTS: The incidence of PONV under isoflurane with antiemetic prophylaxis was 20.8% (95% confidence interval (CI) 15.4; 27.4) compared to 30.5% (95%CI 24; 37.6) under TIVA (p = 0.029; dexamethasone and droperidol 23.4% (95%CI 13.8; 35.7); dexamethasone 32% (95%CI 14.9; 53.5); only TIVA 34.7% (95%CI 25.5; 44.8)), but was not lower in high-risk patients than predicted according to Apfel-scoring 4 (71.4 vs. 78%).

CONCLUSION: In cardiac anesthesia, the use of isoflurane is not at the expense of PONV when using a risk-independent two-drug-prophylaxis. It is even beneficial resulting surprisingly in a lower incidence of PONV than under TIVA unless with and without prophylaxis. Patients with the highest risk for PONV and receiving isoflurane should receive a third antiemetic prophylactic drug.

PMID:34515599 | DOI:10.1080/03007995.2021.1980776

Interv Neuroradiol. 2021 Sep 13:15910199211038207. doi: 10.1177/15910199211038207. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aims at exploring the 3-month outcome predicting ability of delayed neurological improvement and the cause of delayed neurological improvement.

MATERIALS AND METHODS: Early neurological improvement and delayed neurological improvement were calculated to represent the neurological improvements. Good functional outcome was defined as a 90-day modified Rankin Scale score 0-2. We used multivariant logistic regression to explore the influential factors of good functional outcome as well as delayed neurological improvement. We applied net reclassification improvement and integrated discrimination improvement to assess the quantitative improvement of the predictive model.

RESULTS: Early neurological improvement was observed in 50 (23%) patients and delayed neurological improvement exhibited in 67 (30%) patients. Early neurological improvement and delayed neurological improvement were both independent predictive factors to good functional outcome. In the basic model (adjusted for age, admission glucose level, baseline National Institute of Health Stroke Scale, and complications and number of retrieval attempts), early neurological improvement and delayed neurological improvement statistically improved the predictive ability (early neurological improvement: net reclassification improvement = 0.34, 95% confidence interval, 95% confidential interval (0.06, 0.69); integrated discrimination improvement = 0.05, p < 0.001; delayed neurological improvement: net reclassification improvement = 0.79, 95% confidential interval (0.47, 1.12); integrated discrimination improvement = 0.14, p < 0.001) delayed neurological improvement could predict clinical outcomes more accurately than early neurological improvement (early neurological improvement vs. delayed neurological improvement: integrated discrimination improvement = 0.09, p < 0.001). Moreover, delayed neurological improvement was affected by hypertension (odds ratio = 0.40, 95% CI (0.18, 0.88), p = 0.02), early neurological improvement (odds ratio = 20.10, 95% confidential interval (8.24, 19.02), p < 0.001), number of retrieval attempts (odds ratio = 0.39, 95% confidential interval (0.24, 0.66), p < 0.001), and complication (odds ratio = 0.25, 95% confidential interval (0.12, 0.54), p < 0.001).

CONCLUSIONS: Delayed neurological improvement could predict clinical outcomes more accurately than early neurological improvement. Hypertension, early neurological improvement, numbers of retrieval attempts, and complications were all predicting factors to delayed neurological improvement.

PMID:34515554 | DOI:10.1177/15910199211038207

Int J Low Extrem Wounds. 2021 Sep 13:15347346211043602. doi: 10.1177/15347346211043602. Online ahead of print.

ABSTRACT

Ingrown toenails are a common reason for referral to orthopedics and podiatry clinics. Recurrence and infection are common complications in ingrown toenail surgery. This study investigates the effect of an electrocautery matrixectomy on the recurrence and clinical outcomes in the Winograd technique applied in ingrown toenail surgery and whether prophylactic antibiotic use is necessary for these surgeries. One hundred forty-three patients who underwent surgery for ingrown toenails were analyzed retrospectively. Eighty-two patients underwent the Winograd procedure with electrocautery matrixectomy, whereas 61 patients underwent the Winograd procedure. While 78 patients were given prophylactic antibiotics, 65 patients were not. Patient satisfaction was evaluated with a surgical satisfaction questionnaire (SSQ). A visual analog score was used to evaluate the pain. Recurrence was observed in 3 toenails in the Winograd and electrocautery groups, while recurrence was observed in 9 toenails in the Winograd group (P = .018). In both groups, there was no statistically significant difference between the infection rates between patients who took antibiotics and those who did not (P > .05). There was no statistically significant difference between the groups in terms of SSQ scores (P > .05). It was observed that the surgery performed had a positive effect on pain, and this effect was statistically highly significant in both groups (P < .05). The outcomes of the present study suggest that the addition of an electrocautery matrixectomy to the Winograd technique in the surgical treatment of symptomatic Ingrown toenails may decrease recurrence rates. Additionally, this study showed that oral antibiotics, when used in addition to Ingrown toenail surgery, do not reduce postoperative morbidity.

PMID:34515568 | DOI:10.1177/15347346211043602

Biopreserv Biobank. 2021 Sep 9. doi: 10.1089/bio.2021.0054. Online ahead of print.

ABSTRACT

Seminal plasma has several components that protect the sperm cells and assist in the fertilization process. In contrast, the exact role carried out by seminal plasma during the cooling of canine semen remains controversial. Moreover, concerning the long estrus period, the possibility to store chilled semen at 5°C for more than 72 hours and maintain good sperm quality for additional inseminations could increase fertilization rates. Thus, this study aimed to evaluate the seminal plasma influence on quality and oxidative stress of the extended canine semen stored at 5°C for 7 days. Three ejaculate pools from eight healthy dogs were collected by digital manipulation of the penis. The sperm kinetics, sperm vitality (eosin/nigrosin stain), integrity of plasma and acrosomal membranes, morphology, superoxide and hydrogen peroxide production, mitochondrial potential, lipid peroxidation, and oxygen reactive species production (induced and spontaneous thiobarbituric acid [thiobarbituric acid reactive substances, TBARS] assay) were evaluated every 48 hours (M0, M48, M96, and M168) until 7 days (168 hours) in cooled extended (TRIS egg yolk) semen of dogs at 5°C with (+SP) or without (-SP) autologous seminal plasma. No statistical difference was found for sperm kinetics in cooled samples with +SP and -SP during the experimental time period, except for the progressive motility of +SP samples that was higher at M48 than M96 (p = 0.023). The seminal plasma did not influence any other evaluated sperm characteristics. Finally, our results demonstrated that the presence or lack of seminal plasma during cooling the semen of dogs does not influence sperm quality at 5°C. Moreover, the components of the semen extender may contribute to maintaining good sperm quality and low reactive oxygen species production during the long period of the dog’s semen cooling, even after semen centrifugation.

PMID:34515526 | DOI:10.1089/bio.2021.0054

Cartilage. 2021 Sep 13:19476035211025815. doi: 10.1177/19476035211025815. Online ahead of print.

ABSTRACT

OBJECTIVE: Case reports of severe acute localized reactions (SALR) following intraarticular (IA) hyaluronic acid (HA) injections for knee osteoarthritis (OA) have been described. We compared surrogate SALR measures between patients using hylan G-F 20 and specific non-hylan G-F 20 HA products.

DESIGN: Knee OA patients were identified from the Optum Clinformatics dataset (January 2006 to June 2016), stratified into hylan G-F 20 and non-hylan G-F 20 HA users, matched by single or multiple injection products. Occurrences of surrogate SALR measures including inflammation/infection, intraarticular corticosteroid (CS) injections, arthrocentesis/aspiration, arthrotomy/incision and drainage, and arthroscopy were evaluated within 3 days post-HA.

RESULTS: Based on 694,404 HA injections, inflammation/infection rate was rare within 3 days of HA (up to 0.03%), with no statistical differences between hylan G-F 20 and non-hylan G-F 20 groups (matched by single or multiple injection products). The risk of knee arthrotomy/incision and drainage, arthroscopy, or arthrocentesis for hylan G-F 20 (2 mL) 3 weekly injection patients was lower than Hyalgan/Supartz and Orthovisc patients, but greater than Euflexxa patients. Overall, we found that Hylan G-F 20 (2 mL) 3 weekly injection had lower SALR rates compared to Hyalgan/Supartz and Orthovisc. However, Hylan G-F 20 (2 mL) 3 weekly injection had slightly higher rates of SALR when compared to Euflexxa. Among the single injection products, Hylan G-F 20 (6 mL) single injection had lower rates of SALR than Monovisc and Gel-One.

CONCLUSIONS: This study shows no clear correlation between avian-derived or cross-linked products and SALR and provides evidence against avian-derived products or crosslinking as a source for these reactions.

PMID:34515539 | DOI:10.1177/19476035211025815

Int Angiol. 2021 Sep 13. doi: 10.23736/S0392-9590.21.04725-8. Online ahead of print.

ABSTRACT

BACKGROUND: Red cell distribution width (RDW) reflecting impaired erythropoyesis, has been associated with poor prognosis and mortality in several conditions. The aim of this study was to determine the relationship between RDW and the 5-year survival after the endovascular repair of abdominal aortic aneurysms (EVAR) and its ability to improve the discriminative power of a survival predictive score.

METHODS: Retrospective analysis of 284 patients undergoing EVAR at a single centre. The pattern of relationship between RDW and survival was assessed with penalized smoothing splines. Categorized RDW values were added to a predictive score based in standard preoperative variables, whose improvement in discriminative power was calculated on the basis of changes in the C-statistics and the continuous Net Reclassification Index (c-NRI).

RESULTS: The survival rate at 5 years was 66.2% and was independently associated with hemoglobin (HR=0.85,p<0.004), statin intake (HR=0.54,p<0.004), heart failure (HR=2.53,p<0.018), atrial fibrillation (HR=2.53,p<0.000) and the non-revascularized coronary artery disease (HR=2.15, p<0.005). The relationship between RDW values and 5-year survival was linear. RDW-CV and RDW-SD were categorized to cut-off values of ≥15% (n=83,29.2%) and ≥50 fL (n=82, 28.9%) that were independently associated with poorer 5-year survival rates (HR=2.03,CI95%=1.29-3.19,p=0.002 and HR=1.89, CI95%=1.21-2.95,p=0.005, respectively). The addition of the RDW CV or the RDW-SD to the baseline predictive score significantly improved the c-NRI (0.437,p<0.001 and 0.442,p<0.001, respectively).

CONCLUSIONS: High preoperative RDW levels were linear and adversely related to 5-year survival after EVAR, improved the discriminative power of a predictive score based in standard preoperative variables and may help in decision-making at the time of surgical planning.

PMID:34515451 | DOI:10.23736/S0392-9590.21.04725-8

Telemed J E Health. 2021 Sep 9. doi: 10.1089/tmj.2021.0320. Online ahead of print.

ABSTRACT

Background: The COVID-19 pandemic prompted health organizations to use telemedicine as an option to continue providing medical services. There is no telemedicine patient satisfaction survey validated in Spanish. Aim of the study: To develop and validate a telemedicine patient satisfaction survey and know the level of satisfaction with this type of consultation implemented at Hospital Clinica Nova during the COVID-19 pandemic. Methods: This was a qualitative study implemented in a private hospital in Monterrey, Mexico, of patients who attended telemedicine from April to August 2020. Content validity was obtained by a two-round Delphi study with the participation of 11 experts. We conducted six patient interviews for the apparent validity of the items. The questionnaire was administered to 120 patients for statistical analysis. We made an item reduction by interitem and item-total correlation analyses, stability validation by a test-retest, a test of reliability by Cronbach’s alpha, and extraction of factors by a factorial analysis. Results: We obtained a validated nine-item questionnaire, eight items on a Likert scale (range 1-7), and one for a Net Promoter Score (NPS). Two factors explained the structure of the questionnaire and it had an Cronbach alpha = 0.86. The mean population satisfaction score was 6.35 and 43% in NPS. Discussion: In general, good satisfaction results were obtained, and most patients considered telemedicine as good as face-to-face consultation. Conclusions: The scale developed was valid and reliable for the hospital population. However, due to the characteristics of the items, it may apply to other Spanish-speaking health organizations that use telemedicine for patient care.

PMID:34515522 | DOI:10.1089/tmj.2021.0320

Minerva Pediatr (Torino). 2021 Sep 13. doi: 10.23736/S2724-5276.21.06385-0. Online ahead of print.

ABSTRACT

BACKGROUND: Therapeutic stays are a phenomenon of temporary reception of unaccompanied foreign children from contaminated areas in Belarus, Ukraine and Russia. Aim of the study was to analyze the physical and mental health status of children in therapeutic stays in Italy and the possible presence of a state of child abuse and neglect.

METHODS: The survey was conducted on a total of 55 children, 25 of which belonging to the treatment group composed of 25 Belarusian children in temporary stays in Italy, and the remaining 30 to the control group composed of 30 italian children. Data were collected between July, 2019 and July, 2020. The evaluation included a careful medical history, an accurate physical examination and an interview, focusing on several factors that can be use as indicators of child maltreatment, intended as physical and emotional neglect.

RESULTS: The survey was conducted on a total of 55 children, 25 of which belonging to the treatment group, and the remaining 30 to the control group. Of the 25 children in the treatment group, 8 (32%) are male and 17 (68%) are female, while of the 30 children in the control group, 14 (47%) are male and 16 are female (53%). For each child, we considered the body-mass index (BMI), the presence of dental caries, and the showing of learning disabilities or hypoacusis. These parameters can be used as indicators of child maltreatment. The analysis of BMI in the two groups shows that the BMI in the treatment group is significantly lower than the BMI in the control group (p=0.004). In the treatment group 7 (28%) children showed some form of caries whereas in the control group no forms of caries were detected. This result itself shows quite a relevant trend, and to have a quantitative measure of its statistical significancy, we performed a permutation test. The results show that the incidence of dental caries in the treatment group is significantly higher than in the control group (p=0.0023). We used the same procedure to analyse data on the presence of learning disabilities or hypoacusis. The p-values we obtained are not significant, but the results still seem to show that there might be a trend of a higher incidence of learning disabilities and hypoacusis in the treatment group, and an extensive study with a larger sample might shed more light on the topic.

CONCLUSIONS: This study shows that there are indications that suggest a higher risk of child maltreatment in the group of Belarusian children, where maltreatment is understood as physical and emotional neglect to which children are subjected in the institutions and in the group homes where they live. Despite showing only partially significant results, our work could be a starting point for more extensive studies on the topic. These future studies could be extended to other larger samples and other potential maltreatment factors could be evaluated.

PMID:34515445 | DOI:10.23736/S2724-5276.21.06385-0

Int Angiol. 2021 Sep 13. doi: 10.23736/S0392-9590.21.04693-9. Online ahead of print.

ABSTRACT

BACKGROUND: Telangiectasias are dilated blood vessels on the skin that develop progressively as a consequence of several diseases, including chronic venous disease. The skin blood flow has differences compared to the rest of the circulatory system. These vessels have a permanent vasoconstrictor tone that can respond to vasoconstriction/vasodilation stimulative substances and higher or lower temperatures. This study aims to investigate any possible telangiectasias vasoconstriction or vasodilation in response to temperature changes.

METHODS: This is a clinical trial with 26 outpatients of vascular surgery with telangiectasias in the lower limbs. We used direct skin digital microscopy to obtain telangiectasias images at room temperature and after the thermal stimulus with cold pads. These photographs were processed using AmScopeAmLite and the capillary diameter and area were measured in Adobe Illustrator. The data collected was analyzed in SPSS Statistics with a paired t-test for the telangiectasias area and a Wilcoxon matched-pairs signed-rank test for the telangiectasias diameter.

RESULTS: In comparison to telangiectasias measures at room temperature, we found a statistically significant decrease in the diameter (median of -0.04 mm; interquartile range: -0.10 mm to -0.01 mm; p <0.001) and area (mean of -26.54 mm2; 95% Confidence interval (-36.31, -16.76) mm2; p <0.001 in response to the cold stimulus.

CONCLUSIONS: Telangiectasias respond to cold patch application with a significantly statistical microscale quantifiable vasoconstriction. This intervention has the potential to improve the current state of telangiectasias sclerotherapy due to its mechanism helping to stabilize the applied foam. We speculate that topic cold used as a neoadjuvant treatment could improve the efficiency, stability, and other outcomes of sclerotherapy. Also, complementary use of topical cold stimulus application may be of interest in the therapeutic management of telangiectasias.

PMID:34515449 | DOI:10.23736/S0392-9590.21.04693-9