Category: Nevin Manimala

Indian J Otolaryngol Head Neck Surg. 2021 Jun;73(2):188-192. doi: 10.1007/s12070-020-02329-3. Epub 2021 Jan 7.

ABSTRACT

Facial nerve identification is considered to be a crucial step in parotid surgery as inadvertent injury to the nerve will lead to facial paralysis. Multiple landmarks are described in literature to identify the facial nerve during parotid surgery but controversies remain as the consistency and accuracy of these landmarks vary. Numerous studies exist in literature but they fail to address a single landmark that is most reliable to identify the facial nerve during parotid surgery. The purpose of this study is to find reliable landmarks for identification of the main trunk of facial nerve during parotid surgery by evidence gathered by cadaveric dissection and intraoperative study during parotid surgery and develop a systematic approach to identify the facial nerve trunk. This prospective study included 41 cadavers (82 parotid regions) and 20 patients with parotid pathology who underwent parotidectomy. We evaluated the feasibility of our C-M-S technique to identify the main trunk of facial nerve in both anatomical and surgical study. The relationship of landmarks (tragal pointer, tympanomastoid suture, superior border of posterior belly of digastric muscle) to the facial nerve trunk was assessed and the shortest distance between them from the facial trunk was measured using a slide caliper. The measurements were compared between the anatomical and surgical study. The main trunk of facial nerve was successfully identified in all cases using C-M-S technique in both anatomical and surgical study. Distance of facial nerve trunk to tragal pointer was more in the cadaveric sample (13.04 ± 5.238 mm) compared to live patients (9.95 ± 3.967 mm) with statistically significant difference (p = 0.036). The mean distance of tympanomastoid suture and posterior belly of digastric muscle to the facial nerve trunk was similar in anatomical and surgical study with p value of 0.877 and 0.083 respectively. The tympanomastoid suture, posterior belly of digastric muscle and tragal pointer are the most useful landmarks for facial nerve identification during parotid surgery. In our study we found that the tympanomastoid suture line is the most consistent landmark present in all our cases and being closest to the facial nerve trunk in both anatomical and surgical study. Further we recommend using the “C-M-S technique” in order to locate the main trunk of the facial nerve.

PMID:34150593 | PMC:PMC8163908 | DOI:10.1007/s12070-020-02329-3

Zhonghua Wei Chang Wai Ke Za Zhi. 2021 Jun 25;24(6):505-512. doi: 10.3760/cma.j.cn.441530-20210226-00084.

ABSTRACT

Objective: Transanal total mesorectal excision (taTME) was a very hot topic in the first few years since its appearance, but now more introspections and controversies on this procedure have emerged. One of the reasons why the Norwegian Ministry of Health stopped taTME was the high incidence of postoperative anastomotic leak. In current study, the incidence and risk factors of anastomotic leak after taTME were analyzed based on the data registered in the Chinese taTME Registry Collaborative (CTRC). Methods: A case-control study was carried out. Between November 15, 2017 and December 31, 2020, clinical data of 1668 patients undergoing taTME procedure registered in the CTRC database from 43 domestic centers were collected retrospectively. After excluding 98 cases without anastomosis and 109 cases without complete postoperative complication data, 1461 patients were finally enrolled for analysis. There were 1036 males (70.9%) and 425 females (29.1%) with mean age of (58.2±15.6) years and mean body mass index of (23.6±3.8) kg/m(2). Anastomotic leak was diagnosed and classified according to the International Study Group of Rectal Cancer (ISREC) criteria. The risk factors associated with postoperative anastomotic leak cases were analyzed. The impact of the cumulative number of taTME surgeries in a single center on the incidence of anastomotic leak was evaluated. As for those centers with the number of taTME surgery ≥ 40 cases, incidence of anastomic leak between 20 cases of taTME surgery in the early and later phases was compared. Results: Of 1461 patients undergoing taTME, 103(7.0%) developed anastomotic leak, including 71 (68.9%) males and 32 (31.1%) females with mean age of (59.0±13.9) years and mean body mass index of (24.5±5.7) kg/m(2). The mean distance between anastomosis site and anal verge was (2.6±1.4) cm. Thirty-nine cases (37.9%) were classified as ISREC grade A, 30 cases (29.1%) as grade B and 34 cases (33.0%) as grade C. Anastomotic leak occurred in 89 cases (7.0%,89/1263) in the laparoscopic taTME group and 14 cases (7.1%, 14/198) in the pure taTME group. Multivariate analysis showed that hand-sewn anastomosis (P=0.004) and the absence of defunctioning stoma (P=0.013) were independently associated with anastomotic leak after taTME. In the 16 centers (37.2%) which performed ≥ 30 taTME surgeries with cumulative number of 1317 taTME surgeries, 86 cases developed anastomotic leak (6.5%, 86/1317). And in the 27 centers which performed less than 30 taTME surgeries with cumulative number of 144 taTME surgeries, 17 cases developed anastomotic leak (11.8%, 17/144). There was significant difference between two kinds of center (χ(2)=5.513, P=0.019). Thirteen centers performed ≥ 40 taTME surgeries. In the early phase (the first 20 cases in each center), 29 cases (11.2%, 29/260) developed anastomotic leak, and in the later phase, 12 cases (4.6%, 12/260) developed anastomotic leak. The difference between the early phase and the later phase was statistically significant (χ(2)=7.652, P=0.006). Conclusion: The incidence of anastomotic leak after taTME may be reduced by using stapler and defunctioning stoma, or by accumulating experience.

PMID:34148315 | DOI:10.3760/cma.j.cn.441530-20210226-00084

Res Synth Methods. 2021 Jun 20. doi: 10.1002/jrsm.1505. Online ahead of print.

ABSTRACT

In meta-analysis based on continuous outcome, estimated means and corresponding standard deviations from the selected studies are key inputs to obtain a pooled estimate of the mean and its confidence interval. We often encounter the situation that these quantities are not directly reported in the literatures. Instead, other summary statistics are reported such as median, minimum, maximum, quartiles, and study sample size. Based on available summary statistics, we need to estimate estimates of mean and standard deviation for meta-analysis. We developed a R Shiny code based on approximate Bayesian computation (ABC), ABCMETA, to deal with this situation. In this article, we present an interactive and user-friendly R Shiny application for implementing the proposed method (named ABCMETAapp). In ABCMETAapp, users can choose an underlying outcome distribution other than the normal distribution when the distribution of the outcome variable is skewed or heavy tailed. We show how to run ABCMETAapp with examples. ABCMETAapp provides a R Shiny implementation. This method is more flexible than the existing analytical methods since estimation can be based on five different distribution (Normal, Lognormal, Exponential, Weibull, and Beta) for the outcome variable. This article is protected by copyright. All rights reserved.

PMID:34148300 | DOI:10.1002/jrsm.1505

Aust J Rural Health. 2021 Jun 20. doi: 10.1111/ajr.12720. Online ahead of print.

ABSTRACT

OBJECTIVE: To describe the pattern of prescribing long-acting reversible contraception by Australian general practitioner registrars across different classifications of rurality/urbanicity.

METHODS: A study nested within the Registrar Clinical Encounters in Training ongoing cohort study of Australian general practitioner registrars’ in-consultation experience.

DESIGN: A cross-sectional analysis of Registrar Clinical Encounters in Training data collected 2010-2017. Type of contraception prescribed by general practitioner registrars to women aged 12-55 for contraception-related indications was documented. Chi-square statistical analysis was performed to assess association of specific long-acting reversible contraception methods with rurality/urbanicity.

SETTING/PARTICIPANTS: General practitioner registrars enrolled in the Australian General Practice Training program in regional training providers/organisations participating in Registrar Clinical Encounters in Training.

MAIN OUTCOME MEASURES: Long-acting reversible contraception was defined as etonogestrel implant, copper intrauterine device, levonorgestrel intrauterine device and medroxyprogesterone injection.

RESULTS: In all 1737 registrars recorded 4073 registrar rounds of data from 2010 to 2017 (response rate 96%). Type of long-acting reversible contraception prescribed differed significantly across Australian Statistical Geography Standards classification of rurality (Pearson’s χ² = 17, P = .002). Women living in outer regional/remote/very remote regions are prescribed proportionately more medroxyprogesterone injection and less levonorgestrel intrauterine device compared to major cities/inner regional areas.

CONCLUSIONS: Long-acting reversible contraception methods prescribed differ across different classifications of rurality. Women living in more rural/remote regions might have access difficulties for the levonorgestrel intrauterine device.

PMID:34148268 | DOI:10.1111/ajr.12720

Aust J Rural Health. 2021 Jun 20. doi: 10.1111/ajr.12716. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess and compare rates of severe on-farm injury for older (> 50 years) and younger (15-49 years) cohorts, on NSW farms.

DESIGN: Descriptive retrospective epidemiological study of the New South Wales Trauma Registry (Institute of Trauma and Injury Management – ITIM) for persons injured on a farm.

SETTING: New South Wales, Australia.

PARTICIPANTS: Cases involving persons (≥15 years), with data on the NSW Trauma Registry (2012-16).

MAIN OUTCOME MEASURES: Comparison of injury rates and severity between younger (15-49 years) and older (50+ years) cohorts over the 2012-16 period based on Injury Severity Scores (ISS).

RESULTS: Older males are injured at a rate that is roughly 18% higher than younger males and 13% higher than the overall injury rate. Older individuals also have significantly longer hospital stays post-injury (P = 0.01), with this being most pronounced for older men (P < 0.01). There was no statistically significant difference in ISS demonstrated between the age cohorts (P = 0.64), except for younger women having higher median ISS than their older female counterparts (P = 0.02).

CONCLUSION: Overall, the general trends displayed support the contention that older males are more likely to incur a severe on-farm injury than their younger counterparts. This provides support for a preventative focus targeting older farmers in NSW.

PMID:34148277 | DOI:10.1111/ajr.12716

Int Forum Allergy Rhinol. 2021 Jun 20. doi: 10.1002/alr.22828. Online ahead of print.

NO ABSTRACT

PMID:34148294 | DOI:10.1002/alr.22828

Aggress Behav. 2021 Jun 19. doi: 10.1002/ab.21984. Online ahead of print.

ABSTRACT

In this study, we examine whether youth who are exposed to more weapons violence are subsequently more likely to behave violently with weapons. We use data collected with a 3-cohort, 4-wave, 10-year longitudinal study of 426 high-risk youth from Flint, Michigan, who were second, fourth, or ninth-graders in 2006-2007. The data were obtained from individual interviews with the youth, their parents, and their teachers, from archival school and criminal justice records, and from geo-coded criminal offense data. These data show that early exposure to weapons violence significantly correlates at modest levels with weapon carrying, weapon use or threats-to-use, arrests for weapons use, and criminally violent acts 10 years later. Multiple regression analyses, controlling for children’s initial aggressiveness, intellectual achievement, and parents’ income, education, and aggression, reveal statistically significant independent 10-year effects: (1) more early exposure to weapon use within the family predicts more using or threatening to use a gun; (2) more cumulative early violent video game playing predicts more gun using or threatening to use weapons, and normative beliefs that gun use is acceptable; (3) more cumulative early exposure to neighborhood gun violence predicts more arrests for a weapons crime; and (4) more cumulative early exposure to movie violence predicts more weapon carrying. We argue that youth who observe violence with weapons, whether in the family, among peers, or through the media or video games, are likely to be infected from exposure with a social-cognitive-emotional disease that increases their own risk of behaving violently with weapons later in life.

PMID:34148248 | DOI:10.1002/ab.21984

Aliment Pharmacol Ther. 2021 Jun 20. doi: 10.1111/apt.16467. Online ahead of print.

ABSTRACT

BACKGROUND: Central neuromodulators are an effective treatment for irritable bowel syndrome (IBS) but may be used less frequently than other therapies.

AIMS: To survey gastroenterologists in the United States (US) about their use of neuromodulators in patients with IBS.

METHODS: A 23-question survey was distributed to gastroenterologists in the United States. Comparisons in prescribing practices were conducted between (a) gastroenterologists who were “high prescribers” versus “low prescribers” of neuromodulators in patients with IBS and (b) gastroenterologists and “gastroenterology experts” in the use of neuromodulators using descriptive statistics and multivariable logistic regression analyses.

RESULTS: The 525 gastroenterologists who were surveyed used neuromodulators for a median range of 21%-30% of their patients with IBS. Neuromodulators were described as extremely/very important in managing IBS by 55% of clinicians. Significant predictors of high-prescribing behaviour were academic versus clinical practice setting (odds ratio [OR] 2.60 [95% CI 1.61-4.20]), disorders of brain-gut interaction focused practice (OR 4.80 [2.60-8.84]), and greater perceived effectiveness of neuromodulators (OR 2.75 [1.30-5.84]). Compared to gastroenterologists, experts prescribed neuromodulators to a higher percentage of their patients with IBS (41%-50% vs 21%-30%; P = 0.019) and more frequently found neuromodulators effective (70% vs 27%; P = 0.003). However, concern about side effects was the most common barrier to neuromodulator use (59%).

CONCLUSIONS: The majority of US gastroenterologists believe central neuromodulators are important in treating IBS, and 27% believe they are effective in most patients. High prescribers are in academic practice, focus in IBS and perceive central neuromodulators as effective. Education is needed to improve gastroenterologists’ prescribing behaviour.

PMID:34148256 | DOI:10.1111/apt.16467

J Card Surg. 2021 Jun 20. doi: 10.1111/jocs.15765. Online ahead of print.

ABSTRACT

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has been a worldwide challenge, and efforts to “flatten the curve,” including restrictions imposed by policymakers and medical societies, have forced a reduction in the number of procedures performed in the Brazilian Health Care System. The aim of this study is to evaluate the outcomes of coronary artery bypass graft (CABG) from 2008 to 2020 in the SUS and to assess the impacts of the COVID-19 pandemic in the number of procedures and death rate of CABG performed in 2020 through the database DATASUS.

METHODS: This study is based on publicly available material obtained from DATASUS, the Brazilian Ministry of Health’s data processing system, on numbers of surgical procedures and death rates. Only isolated CABG procedures were included in our study. We used the TabNet software from the DATASUS website to generate reports.

RESULTS: We identified 281,760 CABG procedures performed from January 2008 to December 2020. The average number of procedures until the end of 2019 was of 22,104. During 2020 there was a 25% reduction CABG procedures, to 16,501. There was an increase in the national death rate caused by a statistical significant increase in death rates in Brazil’s Southeast and Central-west regions.

CONCLUSION: The COVID-19 pandemic remains a global challenge for Brazil’s health care system. During the year of 2020 there was a reduction in access to CABG related to an increase in the number of COVID-19 cases. There was also an increase in the national CABG death rate.

PMID:34148261 | DOI:10.1111/jocs.15765

J Cancer Educ. 2021 Jun 20. doi: 10.1007/s13187-021-02056-5. Online ahead of print.

ABSTRACT

Co-infection with HIV/HPV and bio-behavioral risk factors (e.g., immunodeficiency, un-protected sex) increase likelihood for developing anal and other HPV-associated cancers among people living with HIV/AIDS (PLWHA). We explored knowledge, attitudes, and health communication regarding HPV-associated anal cancers among HIV/AIDS service organization (ASO) employees/volunteers delivering non-clinical services to PLWHA. Participants (n=59) were recruited from six ASOs located in the South United States Census region and completed a 118-item self-administered survey. For current analyses, outcome measures were knowledge, attitudes, and health communication regarding anal cancer. Descriptive statistics assessed outcome measures which were subsequently dichotomized into binary variables (i.e., high/favorable or low/unfavorable). Fisher’s exact test examined associations between outcome measures and ASO employees/volunteers’ sex/sexual orientation (i.e., heterosexual female, heterosexual male, LGBTI female, LGBTI male). Mean age for ASO employees/volunteers was 45.5 years (±13.5 SD). Participants were heterosexual females (45.7%), LGBTI males (27.3%), heterosexual males (13.5%), and LGBTI females (13.5%). Almost half (44.8%) had not heard about anal Pap screening and 39.0% did not think HPV can cause anal cancer. Overall, 73.9% had low knowledge scores. Participants (47.4%) were unsure or believed HPV vaccinations were non-protective against anal cancer while 94.9% had favorable health communication behaviors. Knowledge regarding anal cancer being linked to HPV (p=0.006) and health information seeking on anal cancer (p=0.000) were statistically significantly different by sex/sexual orientation. Fostering increased knowledge, favorable attitudes, and improved health communication behaviors among ASO employees/volunteers could facilitate dissemination and promotion of anal cancer prevention strategies (anal Pap screenings, HPV vaccinations) among PLWHA.

PMID:34148218 | DOI:10.1007/s13187-021-02056-5