Category: Nevin Manimala

Int J Gen Med. 2022 Jan 4;15:45-52. doi: 10.2147/IJGM.S342087. eCollection 2022.

ABSTRACT

BACKGROUND: Measuring portal vein diameter (PVD) is a feasible method of detecting portal vein hypertension, which is a primary and fatal complication of chronic liver disease (CLD) and is usually diagnosed very late. However, there is a paucity of morphometric information on portal vein diameter in the Ethiopian population. Hence, it is important to determine the portal vein diameter among adults with and without chronic liver disease.

PURPOSE: The study aimed to identify how PVD is affected by age, sex, and anthropometric measurements in patients with and without CLD.

METHODS: A cross-sectional study was conducted among 220 participants (110 CLD patients and 110 controls) who have visited the radiology unit at selected Hospitals. Patients with CLD were selected consecutively as they present while controls were selected by a systematic sampling technique. A structured questionnaire was used to collect the data. Correlation and independent t-test were used to assess the relations. A statistically significant association was declared at P-value <0.05.

RESULTS: Mean portal vein diameter for CLD patients was 17.03±1.97 mm with a range of 12.8-20.8mm and 10.79±1.27mm with a range of 7.70-13.25mm for the control group. Age, weight, and body mass index had a positive correlation with portal vein diameter in both groups. The mean portal vein diameter increased by 21.34% during deep inspiration in the control group.

CONCLUSION: The mean portal vein diameter among patients with CLD was higher than that of the control group. A significant gender-based difference was recorded in the portal vein diameter of the control group only. Ultrasonography is a non-invasive, readily available diagnostic tool for portal vein pathology.

RECOMMENDATION: It is recommended for clinicians to take into consideration age, sex and anthropometric measurements while measuring PVD.

PMID:35046700 | PMC:PMC8760923 | DOI:10.2147/IJGM.S342087

Diabetes Metab Syndr Obes. 2022 Jan 10;15:103-109. doi: 10.2147/DMSO.S341364. eCollection 2022.

ABSTRACT

BACKGROUND: Recurrence of high-risk diabetic feet, after wound, healing is a common challenge among diabetic patients. Continuous use of an offloading device significantly prevents recurrence of high-risk diabetic feet, although patient adherence is imperative to ensuring this therapy’s clinical efficacy. In this study, we explored clinical outcomes of patients with a high-risk diabetic foot who had been prescribed with custom-molded offloading footwear under different adherence conditions.

METHODS: A total of 48 patients (17 females and 31 males) with high-risk diabetic feet, who had been with prescribed offloading footwear in 13 medical centers across 4 cities, were enrolled in the current study. The patients were assigned into either continuous offloading therapy (COT, n = 31) or interrupted offloading therapy (IOT, n = 17) groups, according to their adherence to the therapy. All patients were followed up monthly, and differences in recurrence, amputation, and deaths between the groups were analyzed at 4 months after therapy.

RESULTS: Forty-eight patients met our inclusion criteria and were therefore included in the final analysis. Among them, 31 were stratified into the COT group and adhered to offloading therapy throughout the study period, whereas 17 were grouped as IOT and exhibited interrupted adherence to offloading therapy. We found statistically significant differences in recurrence rates (0 vs 38.46%, p < 0.01), amputation (0 vs 11.76%, p < 0.01), and deaths (0% vs 5.88%, p < 0.01) between the groups during follow-up.

CONCLUSION: Patients’ adherence is imperative to efficacy of custom-molded offloading footwear during treatment of high-risk diabetic foot. Further studies are needed to elucidate the role of improved design of the offloading device and the need for enhanced patient education for improved adherence.

PMID:35046681 | PMC:PMC8759996 | DOI:10.2147/DMSO.S341364

J Inflamm Res. 2022 Jan 8;15:153-162. doi: 10.2147/JIR.S344282. eCollection 2022.

ABSTRACT

BACKGROUND: Complement plays a pivotal role in the immune response to infection. Several studies demonstrated complement activation in sepsis, yet little is known of the relationship of complement terminal pathway activation and the clinical characteristics of sepsis patients. Therefore, we investigated serum C5, soluble C5b-9 (sC5b-9), and soluble CD59 (sCD59) and their relation to organ failure in sepsis patients in the intensive care unit (ICU).

METHODS: In this prospective cohort study, all available patients admitted to the adult ICUs between June 2020 and January 2021 were included. Patients were divided into sepsis and non-sepsis groups according to the Sepsis-3 criteria, serum samples from both groups were investigated for the levels of C5, sC5b-9, and sCD59 using commercial sandwich ELISA kits.

RESULTS: We analyzed 79 serum samples, 36 were from sepsis patients. We found that sepsis patients had significantly lower C5 (83.6± 28.4 vs 104.4± 32.0 µg/mL, p = 0.004) and higher sCD59 (380.7± 170.5 vs 288.9± 92.5 ng/mL, p = 0.016). sC5b-9, although higher in sepsis patients, did not reach statistical significance (1.5± 0.8 µg/mL vs 1.3± 0.7 µg/mL, p = 0.293). Sepsis patients who died during their ICU stay had significantly higher sCD59 compared to those who survived (437.0 ± 176.7 vs 267.8 ± 79.7 ng/mL, p = 0.003, respectively). Additionally, C5 and sCD59 both correlated to SOFA score in the sepsis group (r_s = -0.44, P = 0.007 and = 0.43, P = 0.009, respectively), and a similar correlation was not found in the non-sepsis group.

DISCUSSION: In sepsis patients, levels of C5 and sCD59, but not sC5b-9, correlated to the severity of organ damage measured by SOFA. A similar correlation was not found in non-sepsis patients. This indicated that organ damage associated with sepsis led to a more pronounced terminal pathway activation than in non-sepsis patients, it also indicated the potential of using C5 and sCD59 to reflect sepsis severity.

PMID:35046691 | PMC:PMC8760944 | DOI:10.2147/JIR.S344282

J Asthma Allergy. 2022 Jan 11;15:35-51. doi: 10.2147/JAA.S335960. eCollection 2022.

ABSTRACT

PURPOSE: The impact of pertussis in individuals with asthma is not fully understood. We estimated the incidence, health care resource utilization (HCRU), and direct medical costs (DMC) of pertussis in patients with asthma.

PATIENTS AND METHODS: In this retrospective cohort study, the incidence rate of pertussis (identified using diagnostic codes) among individuals aged ≥50 years with an asthma diagnosis was assessed during 2009-2018 using Clinical Practice Research Datalink and Hospital Episode Statistics databases. HCRU and DMC were compared – between patients with diagnoses of asthma and pertussis (asthma+/pertussis+) and propensity score-matched patients with a diagnosis of asthma without pertussis (asthma+/pertussis-) – in the months around the pertussis diagnosis (-6 to +11).

RESULTS: Among 687,105 individuals, 346 had a reported pertussis event (incidence rate: 9.6/100,000 person-years of follow-up; 95% confidence interval: 8.6-10.7). HCRU and DMC were assessed among 314 asthma+/pertussis+ patients and 1256 matched asthma+/pertussis- controls. Baseline HCRU was similar in both cohorts, but increases were observed in the asthma+/pertussis+ cohort from -6 to -1 month before to 2-5 months after diagnosis. Rates of accident and emergency visits, general practitioner (GP)/nurse visits, and GP prescriptions were 4.3-, 3.1-, and 1.3-fold, respectively, in the asthma+/pertussis+ vs asthma+/pertussis- cohorts during the month before diagnosis; GP/nurse visit rates were 2.0- and 1.2-fold during 0-2 and 2-5 months after diagnosis, respectively (all p<0.001). DMC was 1.9- and 1.6-fold during the month before and 2 months from diagnosis, respectively, in the asthma+/pertussis+ vs asthma+/pertussis- cohorts (both p<0.001). During months -1 to +11, DMC in the asthma+/pertussis+ cohort was £370 higher than in the asthma+/pertussis- controls.

CONCLUSION: A pertussis diagnosis among adults aged ≥50 years with asthma resulted in significant increases in HCRU and DMC across several months around diagnosis, suggesting lengthy diagnosis times and highlighting the need for prevention strategies.

PMID:35046668 | PMC:PMC8760990 | DOI:10.2147/JAA.S335960

Thromb Haemost. 2022 Jan 19. doi: 10.1055/a-1745-0420. Online ahead of print.

ABSTRACT

INTRODUCTION: Inherited afibrinogenemia is a very rare disease characterized by complete absence of fibrinogen in the circulation and an increased risk in both thrombosis and bleeding. Infusion of fibrinogen concentrate (FC) is the main approach for prevention and management of bleeding; however, it has been reported to carry a thrombotic risk.

METHODS: We investigated the impact of a standard dose (40-100 mg/kg) of FC infusion on the thrombin generation (TG) parameters and the fibrin clot structure formed in plasma samples of patients with afibrinogenemia. Blood samples were collected from 20 patients before (T0) and 1 hour after infusion of FC (T1). TG was studied with Calibrated Automated Thrombography. Fibrin clot structure was assessed with turbidimetry and scanning electron microscopy (SEM).

RESULTS: FC infusions (mean Clauss fibrinogen plasma level 1.21 g/L at T1) led to a statistically significant increase in endogenous thrombin potentials (ETP) (p<0.0001) and thrombin peaks (p=0.02). Nevertheless, when compared to healthy controls, patients’ T1 lag times were longer (p=0.002), ETP values were lower (p=0.0003), and thrombin peaks were lower (p<00001). All fibrin polymerization parameters (turbidimetry) obtained at T1 were comparable to those of patients with inherited hypofibrinogenemia matched for fibrinogen plasma levels.

CONCLUSIONS: In summary, fibrinogen infusion with a standard dose of FC increased but did not correct TG and led to formation of fibrin clots similar to those of patients with hypofibrinogenemia. All in all, our results do not support to biological evidence of hypercoagulability induced by FC in patients with afibrinogenemia.

PMID:35045578 | DOI:10.1055/a-1745-0420

J Pediatr Gastroenterol Nutr. 2022 Jan 18. doi: 10.1097/MPG.0000000000003383. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the efficacy of transanal irrigation (TAI) in pediatric patients with Neurogenic Bowel Dysfunction (NBD) who were treatment naïve to catheter-based TAI using Peristeen® device (Coloplast).

METHODS: Prospective recruitment of patients with NBD who were unsatisfied with their bowel regimen or had no bowel regimen in place, were assessed using the Neurogenic Bowel Dysfunction score (NBDS) before initiating treatment (Time 0) with Peristeen®. NBDS scores were reassessed twice: within the first 6 months (Time 1) of initiation of Peristeen® and again after greater than 6 months of usage with Peristeen® (Time 2).

RESULTS: Over a 26 month period, 104 patients with NBD were enrolled. Mean age was 10.6 years ± 4.7 (range 3-18 years). The NBDS at Time 1 had an average reduction of 14 points from the original score. A similar trajectory was seen at Time 2, with an average reduction of 13 points from original score. There was a statistically significant decrease of 14 points, p < 0.001 at Time 1 and this response was sustained at Time 2 with a statistically significant decrease in scores from initiation by 13 points, p < 0.001. Improved patient satisfaction and quality of life with Peristeen® was seen at Time 1 and Time 2.

CONCLUSION: Our results suggest that Peristeen® can improve quality of life in pediatric patients with NBD. Significant improvement in NBDS occurred in our pediatric patients with NBD when initiated on Peristeen®. Lower scores were seen at both Time 1 and Time 2, which indicated an improvement in their overall NBD.

An infographic is available for this article at:http://links.lww.com/MPG/C658.

PMID:35045561 | DOI:10.1097/MPG.0000000000003383

Am J Perinatol. 2022 Jan 19. doi: 10.1055/a-1745-1348. Online ahead of print.

ABSTRACT

OBJECTIVE: A recent study leveraging machine learning methods found that postpartum hemorrhage (PPH) can be predicted accurately at the time of labor admission in the U.S. Consortium for Safe Labor (CSL) dataset, with a C-statistic as high as 0.93. These CSL models were developed in older data (2002-2008) and used an estimated blood loss (EBL) of ≥1000 mL to define PPH. We sought to externally validate these models using a more recent cohort of births where blood loss was measured using quantitative blood loss (QBL) methods.

STUDY DESIGN: Using data from 5,261 deliveries between February 1, 2019 to May 11, 2020 at a single tertiary hospital, we mapped our electronic health record (EHR) data to the 55 predictors described in previously published CSL models. PPH was defined as QBL ≥1000 mL within 24 hours after delivery. Model discrimination and calibration of the four CSL models were measured using our cohort. In a secondary analysis, we fit new models in our study cohort using the same predictors and algorithms as the original CSL models.

RESULTS: The original study cohort had a substantially lower rate of PPH, 4.8% (7,279/228,438) vs. 25% (1,321/5,261), possibly due to differences in measurement. The CSL models had lower discrimination in our study cohort, with a C-statistic as high as 0.57 (logistic regression). Models refit in our study cohort achieved better discrimination, with a C-statistic as high as 0.64 (random forrest). Calibration improved in the refit models as compared to the original models.

CONCLUSION: The CSL models’ accuracy was lower in a contemporary EHR where PPH is assessed using QBL. As institutions continue to adopt QBL methods, further data are needed to understand the differences between EBL and QBL to enable accurate prediction of PPH.

PMID:35045573 | DOI:10.1055/a-1745-1348

Orthop Nurs. 2022 Jan-Feb 01;41(1):15-20. doi: 10.1097/NOR.0000000000000815.

ABSTRACT

BACKGROUND: Orthopaedic procedures such as total hip and total knee replacements carry a significant risk of postoperative anemia, necessitating allogenic blood transfusions (ABTs), and an increased hospital length of stay.

AIM: Our aim was to investigate whether the implementation of a local protocol designed to detect and treat preoperative anemia resulted in reduced ABT rates and a shorter duration of length of hospital stay (LOS).

METHODS: We retrospectively audited 683 patients undergoing primary hip and knee replacements. We collated data for all patients about hospital length of stay and blood transfusions received. Both descriptive statistics and univariate analysis were performed.

RESULTS: Approximately 21.6% of the cohort within the study who were anemic at preoperative clinic had a significantly increased median LOS of 2 days (p < .001) and an increased packed red cell transfusion rate compared with non-anemic patients (26.1% vs. 2.21%, p < 001). However, treatment of preoperative anemia did not show any significant difference in transfusion rates compared with patients who did not receive corrective treatment. The median LOS was higher by 1 day in the treated group compared with the nontreated cohort (p = .005).

CONCLUSION: There is significant evidence to suggest that preoperative anemia can increase LOS and increase the risk of requiring postoperative blood transfusions. However, anemia should be regarded as a characteristic that can add to the outcome in a cumulative manner, as opposed to an isolated factor. Further research is needed on how to better manage preoperative anemia in order to improve patients’ outcomes.

PMID:35045537 | DOI:10.1097/NOR.0000000000000815

J Pediatr Gastroenterol Nutr. 2022 Jan 18. doi: 10.1097/MPG.0000000000003384. Online ahead of print.

ABSTRACT

OBJECTIVE: Non-alcoholic fatty liver disease (NAFLD) represents a spectrum of disease characterized by accumulation of fat in the liver and is associated with co-morbidities linked to metabolic syndrome. The prevalence of NAFLD in children has increased in the U.S. over time and with marked racial differences observed in geographically limited studies. This study aims to provide a current, nation-wide analysis of temporal trends of pediatric NAFLD-related hospitalizations and associated co-morbidities as well as assess for racial/ethnic disparities.

METHODS: A cross-sectional study was conducted using the National Inpatient Sample (NIS) from 2004 – 2018 and included NAFLD-associated hospitalizations of children aged 0-17 years of age based on ICD-9/10 diagnosis codes. Rates and patient characteristics analyzed via descriptive statistics and associations via survey logistic regression. Temporal trends assessed via joinpoint regression.

RESULTS: There was an overall increase in pediatric NAFLD-associated hospitalizations with an average annual percent change (AAPC) of 6.6 with highest rates among Hispanic patients (AAPC = 11.1) compared to NH-White (AAPC = 4.1) and NH-Black (AAPC = 2.1). Analysis of race/ethnicity and NAFLD hospitalization showed an increased association in Hispanic patients (OR = 1.64, 95% CI = 1.51-1.77) and a decreased association in Non-Hispanic (NH)-Black patients (OR = 0.49, 95% CI = 0.45-0.54) when compared to NH-White patients.

CONCLUSION: Utilizing a nation-wide database we demonstrated significant increases in NAFLD-associated hospitalizations with highest prevalence and rates seen in Hispanic patients. In addition, gender and comorbidities showed notable correlation to these hospitalization rates displaying the need for further studies on these relationships and highlights the potential for interventions aimed at high-risk groups.

An infographic is available for this article at:http://links.lww.com/MPG/C656.

PMID:35045557 | DOI:10.1097/MPG.0000000000003384

Orthop Nurs. 2022 Jan-Feb 01;41(1):4-12. doi: 10.1097/NOR.0000000000000814.

ABSTRACT

There is ample research demonstrating improved patient outcomes when using an enhanced recovery program. However, the literature reporting the impact of preoperative education alone prior to hip and knee arthroplasty is conflicting. With the number of these surgical procedures expected to increase in the next few years, the identification of strategies that positively impact outcomes is important. The aim of this study was to evaluate immediate postoperative physical therapy (PT) performance following a total hip or knee arthroplasty in patients who attended a preoperative education class compared with those who did not. This study was a retrospective chart review of 707 hip and knee arthroplasty patients, comparing outcomes based on preoperative educational session attendance. Demographics, comorbidities, length of stay (LOS), discharge disposition, and PT performance were collected from the chart review. Patients who attended the preoperative education class had significantly greater ambulation distances (p < .001), greater degrees of knee flexion (p < .001), and greater degrees of hip flexion (p = .012) on postoperative Day 1. Both hip (p < .001) and knee (p < .001) patients who attended the class had a significantly shorter LOS. The cost benefit analysis indicated a savings of $921.57 in direct costs per knee arthroplasty in those who attended a class. Patients who received preoperative education had greater mobility in the immediate postoperative period and reduced LOS for both hip and knee arthroplasties. Based on this study’s results, preoperative education is effective in improving outcomes and reducing the cost of hip and knee arthroplasties.

PMID:35045535 | DOI:10.1097/NOR.0000000000000814