Category: Nevin Manimala

J Prim Care Community Health. 2021 Jan-Dec;12:21501327211018559. doi: 10.1177/21501327211018559.

ABSTRACT

PURPOSE: The purpose of the present study was to investigate body mass index, multi-morbidity, and COVID-19 Risk Score as predictors of severe COVID-19 outcomes.

PATIENTS: Patients from this study are from a well-characterized patient cohort collected at Mayo Clinic between January 1, 2020 and May 23, 2020; with confirmed COVID-19 diagnosis defined as a positive result on reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assays from nasopharyngeal swab specimens.

MEASURES: Demographic and clinical data were extracted from the electronic medical record. The data included: date of birth, gender, ethnicity, race, marital status, medications (active COVID-19 agents), weight and height (from which the Body Mass Index (BMI) was calculated, history of smoking, and comorbid conditions to calculate the Charlson Comorbidity Index (CCI) and the U.S Department of Health and Human Services (DHHS) multi-morbidity score. An additional COVID-19 Risk Score was also included. Outcomes included hospital admission, ICU admission, and death.

RESULTS: Cox proportional hazards models were used to determine the impact on mortality or hospital admission. Age, sex, and race (white/Latino, white/non-Latino, other, did not disclose) were adjusted for in the model. Patients with higher COVID-19 Risk Scores had a significantly higher likelihood of being at least admitted to the hospital (HR = 1.80; 95% CI = 1.30, 2.50; P < .001), or experiencing death or inpatient admission (includes ICU admissions) (HR = 1.20; 95% CI = 1.02, 1.42; P = .028). Age was the only statistically significant demographic predictor, but obesity was not a significant predictor of any of the outcomes.

CONCLUSION: Age and COVID-19 Risk Scores were significant predictors of severe COVID-19 outcomes. Further work should examine the properties of the COVID-19 Risk Factors Scale.

PMID:34024181 | DOI:10.1177/21501327211018559

Foot Ankle Int. 2021 May 22:10711007211003565. doi: 10.1177/10711007211003565. Online ahead of print.

ABSTRACT

BACKGROUND: Minimally invasive (MI) surgery is becoming increasingly popular in the treatment of hallux valgus (HV). The scarf osteotomy is an effective procedure with a track record in open HV surgery. We adapted this effective osteotomy to MI surgery as a novel technique never reported before. The aim of this study was to compare the clinical and radiologic outcomes of patients who underwent open or MI scarf.

METHODS: Between 2017 and 2018, 58 patients were randomized to either open or MI scarf to treat HV deformity. Prospective patient-reported outcome measures and weightbearing radiographs were obtained. Data included the AOFAS score, radiologic angular correction, operative time, fluoroscopy radiation dose, and postoperative pain on visual analog scale (VAS).

RESULTS: The mean follow-up was of 21 (range, 12-38) months. Radiologic measurements (postoperative hallux valgus angle, first-to-second intermetatarsal angle, and distal metaphyseal articular angle) were similar in both groups and showed statistically significant improvement from preoperative measures. The mean operative time for the MI group was 16.7 vs 26.1 minutes in the open group, a statistically significant difference. Radiation exposure was 14 times higher in the MI group when compared to the open group (mean: 34 vs 2.4 mGy/cm², P < .001). There were no major complications in either group.

CONCLUSIONS: The MI scarf provides a clinically and radiologically equivalent outcome to open scarf for the treatment of HV with reduced operative time and immediate postoperative VAS for pain but is associated with a small increase in radiation exposure.

LEVEL OF EVIDENCE: Level I, randomized controlled trial.

PMID:34024185 | DOI:10.1177/10711007211003565

Proc Inst Mech Eng H. 2021 May 22:9544119211018112. doi: 10.1177/09544119211018112. Online ahead of print.

ABSTRACT

Head-first compressive impacts occur in motorcycle crashes and may result in serious to fatal neck injuries to riders. Equipment to protect the riders’ necks from these injuries are available in the market; however, their effectiveness in reducing injury risk is not clear, either due to the lack of scientific evidences or assessment with any prevalently accepted standard. This paper presents a finite element ligamentous neck model, developed as a computationally efficient tool, for future use in the computational phase of assessment process of neck protective equipment. The 3D cervical spine was generated using the mean statistical dimensions of vertebrae and proposed constitutive models, provided in the scientific literature. Ligaments, for the vertebra-vertebra and Hybrid III head-vertebra ligamentous joints, were introduced with the aid of published anatomical descriptions. For validation, the response of the head-neck system under compressive loadings and the flexion-extension bending stiffness of the neck at the segment level were compared against experimental data. The advanced CORrelation and Analysis (CORA) algorithm was applied on the validation responses to assess biofidelity of the model. The results indicate that the model is functional and meets ISO/TR9790 standard as a “good” biofidelic model.

PMID:34024218 | DOI:10.1177/09544119211018112

J Prim Care Community Health. 2021 Jan-Dec;12:21501327211018354. doi: 10.1177/21501327211018354.

ABSTRACT

BACKGROUND: Health disparities have become apparent since the beginning of the COVID-19 pandemic. When observing racial discrimination in healthcare, self-reported incidences, and perceptions among minority groups in the United States suggest that, the most socioeconomically underrepresented groups will suffer disproportionately in COVID-19 due to synergistic mechanisms. This study reports racially-stratified data regarding the experiences and impacts of different groups availing the healthcare system to identify disparities in outcomes of minority and majority groups in the United States.

METHODS: Studies were identified utilizing PubMed, Embase, CINAHL Plus, and PsycINFO search engines without date and language restrictions. The following keywords were used: Healthcare, raci*, ethnic*, discriminant, hosti*, harass*, insur*, education, income, psychiat*, COVID-19, incidence, mortality, mechanical ventilation. Statistical analysis was conducted in Review Manager (RevMan V.5.4). Unadjusted Odds Ratios, P-values, and 95% confidence intervals were presented.

RESULTS: Discrimination in the United States is evident among racial groups regarding medical care portraying mental risk behaviors as having serious outcomes in the health of minority groups. The perceived health inequity had a low association to the majority group as compared to the minority group (OR = 0.41; 95% CI = 0.22 to 0.78; P = .007), and the association of mental health problems to the Caucasian-American majority group was low (OR = 0.51; 95% CI = 0.45 to 0.58; P < .001).

CONCLUSION: As the pandemic continues into its next stage, efforts should be taken to address the gaps in clinical training and education, and medical practice to avoid the recurring patterns of racial health disparities that become especially prominent in community health emergencies. A standardized tool to assess racial discrimination and inequity will potentially improve pandemic healthcare delivery.

PMID:34024164 | DOI:10.1177/21501327211018354

Clin Appl Thromb Hemost. 2021 Jan-Dec;27:10760296211017238. doi: 10.1177/10760296211017238.

ABSTRACT

This clinical study compares 2 hemostatic agents, a novel combination powder (CP) (HEMOBLAST^™ Bellows) and an established polysaccharide starch powder (PP) (Arista^™ AH) to assess the usefulness of CP. Retrospective comparative analysis of CP (July 2018 to July 2019, 68 patients) to PP (January 2011 to January 2013, 94 patients) in cardiothoracic patients was performed using linear regression models adjusting for age, sex, and procedure type for the endpoints: blood loss; protamine to skin closure time (hemostasis time); chest tube output and blood products required 48 hours postoperatively; ICU stay; postoperative comorbidities; and 30 day mortality. 162 patients (108 M: 54 F) underwent 162 cardiothoracic surgical procedures including: transplantation (n = 44), placement of ventricular assist device (n = 87), and others (n = 31). Use of CP compared to PP (Estimated Mean Difference [95% CI], P-value) produced significant reductions: blood loss (mL) (-886.51 [-1457.76, -312.26], P = 0.003); protamine to skin closure time (min) (-16.81 [-28.03, -5.59], P = 0.004); chest tube output (48 hrs, mL) (-445.76 [-669.38, -222.14], P < 0.001); packed red blood cell transfusions (units) (-0.98 [-1.56, -0.4], P = 0.001); and postoperative comorbidities (-0.31 [-0.55, -0.07], P = 0.012). There were no differences in the ICU stay (4.07 [-2.01, 10.15], P = 0.188) or 30-day mortality (0.57 [0.20, 1.63], P = 0.291). The use of CP in complex cardiothoracic operations resulted in improved hemostasis and significant clinical benefits in blood loss, transfusion requirements, morbidity, and time in operating room.

PMID:34024165 | DOI:10.1177/10760296211017238

Eur J Ophthalmol. 2021 May 22:11206721211019580. doi: 10.1177/11206721211019580. Online ahead of print.

ABSTRACT

PURPOSE: To assess the variability of silicone oil (SO) particles released across syringes from the same lot and the role of different needle gauges.

MATERIALS AND METHODS: Four syringe models and six needle models were assessed for SO release. About 50 microliters of a buffer solution were loaded into the syringe, needle or syringe/needle setup. The data were analyzed by imaging flow cytometry with fluorescently labeling for SO.

RESULTS: All syringe models had a high coefficient of variation in SO release across syringes from the same lot. The amount of SO was significantly greater in the syringe when the needle was attached. SO particles with the BD 30G needle attached to the syringe were statistically greater than the 27G counterpart (p = 0.005). None of the other comparisons was statistically different. Finally, the number of SO particles was higher in the syringe/needle setup than in needles only (p = 0.0024).

CONCLUSION: We found a high variability in SO content across syringes from the same lot. Additionally, there was no clear association between needle gauge and the number of SO particles, as well as their coefficient of variation. Finally, the needles accounted for a small number of SO particles in comparison to the combined syringe-needle setup.

PMID:34024140 | DOI:10.1177/11206721211019580

Foot Ankle Int. 2021 May 22:10711007211004191. doi: 10.1177/10711007211004191. Online ahead of print.

ABSTRACT

BACKGROUND: Chronic ankle instability is a common condition that can be treated with lateral ankle ligament repair. These procedures have a reported success rate greater than 85% in the literature, but little has been reported about the differences in postoperative outcomes between males and females. The purpose of this study was to evaluate sex-specific outcomes following lateral ankle ligament repair.

METHODS: In this systematic review and meta-analysis, we used Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria to search for articles on electronic databases and included studies in which study participants underwent primary lateral ligament repair and sex-specific outcomes were evaluated. Functional postoperative outcomes for males and females were recorded and statistically analyzed.

RESULTS: Out of 2768 studies, 7 (0.25%) met inclusion criteria and were analyzed in this review. These studies included 618 patients (402 males [65%] and 216 females [35%]) who underwent primary lateral ligament repair for ankle instability. Karlsson score (P = .1582) and American Orthopaedic Foot & Ankle Society (AOFAS) score (P = .1586) analyses found no statistically significant difference between males and females. Postoperative success rate-defined as a “good” or “excellent” Karlsson score (>81)-was not found to be significantly different between males and females (P = .9374).

CONCLUSION: There was no difference in postoperative mean Karlsson scores, AOFAS scores, or success rates between males and females who underwent primary lateral ankle ligament repair.

LEVEL OF EVIDENCE: Level IV, therapeutic.

PMID:34024152 | DOI:10.1177/10711007211004191

Foot Ankle Int. 2021 May 24:10711007211003871. doi: 10.1177/10711007211003871. Online ahead of print.

ABSTRACT

BACKGROUND: No studies have compared early vs conventional postoperative weightbearing following suture bridge Achilles tendon reattachment. We, therefore, evaluated postoperative functional outcomes in these patients.

METHODS: We collected data on 49 patients who underwent surgical treatment of insertional Achilles tendinopathy using a central Achilles tendon-splitting approach and reattachment with suture bridge technique by a single surgeon. Functional outcomes were measured by a visual analog scale (VAS) for pain, Foot and Ankle Ability Measure (FAAM), and Short Form Health Survey (SF-36) at 3, 6, and 12 months postoperatively. The differences in outcomes were analyzed using multiple linear regression.

RESULTS: Eighteen and 31 patients underwent the conventional and accelerated protocols, respectively; their corresponding mean ages were similar, 53 and 57 years, as were all other baseline characteristics. The mean scores (conventional vs accelerated group) for VAS for pain, FAAM, and SF-36 in the conventional group at 3 months postoperatively were 4 ± 1 vs 3 ± 1 points, 53 ± 8 vs 68 ± 3 points, and 57 ± 15 vs 67 ± 10 points (P < .05 for each comparison). There were no statistically significant differences between the groups at 6 and 12 months postoperatively. All patients could perform the single heel raise test at 6 months, and none experienced complications.

CONCLUSION: In this small study, short-term functional outcomes were better in the accelerated group. More data are needed before the accelerated program can be recommended.

LEVEL OF EVIDENCE: Level II, prospective comparative study.

PMID:34024153 | DOI:10.1177/10711007211003871

Clin Exp Reprod Med. 2021 May 18. doi: 10.5653/cerm.2020.04091. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to compare the pregnancy outcomes of in vitro fertilization with embryo transfer between embryos cultured in a time-lapse monitoring system (TLS) and those cultured in a conventional incubator (CI).

METHODS: The medical records of 250 fertilized embryos from 141 patients undergoing infertility treatment with assisted reproductive technology at a tertiary hospital from June 2018 to May 2020 were reviewed. The study population was divided into TLS and CI groups at a 1 to 1 ratio (125 embryos per group). The primary outcome was the live birth rate.

RESULTS: The TLS group had a significantly higher clinical pregnancy rate (46.4% vs. 27.2%, p=0.002), implantation rate (27.1% vs. 12.0%, p=0.004), and live birth rate (32.0% vs. 18.4%, p=0.013) than the CI group. Furthermore, subgroup analyses of the clinical pregnancy rate and live birth rate in the different age groups favored the TLS group. However, this difference only reached statistical significance in the live birth rate in women aged over 40 years and the clinical pregnancy rate in women aged 35-40 years (p=0.048 and p=0.031, respectively). The miscarriage rate, cleavage rate, and blastocyst rate were comparable.

CONCLUSION: TLS application improved the live birth rate, implantation rate, and clinical pregnancy rate, particularly in the advanced age group in this study, while the other reproductive outcomes were comparable. Large randomized controlled trials are needed to further explore the ramifications of these findings, especially in different age groups.

PMID:34024081 | DOI:10.5653/cerm.2020.04091

Clin Nurs Res. 2021 May 22:10547738211018316. doi: 10.1177/10547738211018316. Online ahead of print.

ABSTRACT

Women giving birth in in-patient maternity units are required to complete certain education. The aim of this study was to investigate the effects of prompting on post-partum women’s education engagement (time from assignment to completion) while testing the feasibility of staff nurses assisting in research. A quasi-experimental design was used with 141 women allocated by admission date to one of three groups (usual care and two intervention) between September 2014 and December 2015. Intervention group I women were quickest to engage in their education and had the shortest length of stay. Significance was found for academic attainment (df = 1, F = 6.218, p = .014), partial eta squared = 0.053 and R² = 0.124. Women who had attended college engaged more quickly in all groups than those who had not. This statistically significant finding indicates how nurses can identify patients needing more assistance. Nurses reported no adverse effects on care.

PMID:34024137 | DOI:10.1177/10547738211018316