Category: Nevin Manimala

Nanoscale. 2021 May 17. doi: 10.1039/d0nr06865a. Online ahead of print.

ABSTRACT

DNA has become a powerful platform to design functional nanodevices. DNA nanodevices are often composed of self-assembled DNA building blocks that differ significantly from the structure of native DNA. In this study, we present Flow Force Microscopy as a massively parallel approach to study the nanomechanics of DNA self-assemblies on the single-molecular level. The high-throughput experiments performed in a simple microfluidic channel enable statistically meaningful studies with nanometer scale precision in a time frame of several minutes. A surprisingly high flexibility was observed for a typical construct used in DNA origami, reflected in a persistence length of 10.2 nm, a factor of five smaller than for native DNA. The enhanced flexibility is attributed to the discontinuous backbone of DNA self-assemblies that facilitate base pair opening by thermal fluctuations at the end of hybridized oligomers. We believe that the results will contribute to the fundamental understanding of DNA nanomechanics and help to improve the design of DNA nanodevices with applications in biological analysis and clinical research.

PMID:33999986 | DOI:10.1039/d0nr06865a

PLoS One. 2021 May 17;16(5):e0251886. doi: 10.1371/journal.pone.0251886. eCollection 2021.

ABSTRACT

HYPOTHESIS: There is limited data on the care and outcomes of individuals with both chronic obstructive pulmonary disease (COPD) and lung cancer, particularly in advanced disease. We hypothesized such patients would receive less cancer treatment and have worse outcomes.

METHODS: We analyzed administrative data from the province of Ontario including demographics, hospitalization records, physician billings, cancer diagnosis, and treatments. COPD was defined using the ICES-derived COPD cohort (1996-2014) with data from 2002 to 2014. Descriptive statistics and multivariable analyses were undertaken.

RESULTS: Of 105 304 individuals with lung cancer, 43 375 (41%) had stage data and 36 738 (34.9%) had COPD. Those with COPD were likely to be younger, have a Charlson score ≤ 1, have lower income, to live rurally, and to have stage I/II lung cancer (29.8 vs 26.5%; all p<0.001). For the COPD population with stage I/II cancer, surgery and adjuvant chemotherapy were less likely (56.8 vs. 65.9% and 15.4 vs. 17.1%, respectively), while radiation was more likely (26.0 vs. 21.8%) (p all < 0.001). In the stage III/IV population, individuals with COPD received less chemotherapy (55.9 vs 64.4%) or radiation (42.5 vs 47.5%; all p<0.001). Inhaler and oxygen use was higher those with COPD, as were hospitalizations for respiratory infections and COPD exacerbations. On multivariable analysis, overall survival was worse among those with COPD (HR 1.20, 95% CI 1.19-1.22).

CONCLUSIONS: A co-diagnosis of COPD and lung cancer is associated with less curative treatment in early stage disease, less palliative treatment in late stage disease, and poorer outcomes.

PMID:33999942 | DOI:10.1371/journal.pone.0251886

PLoS One. 2021 May 17;16(5):e0251854. doi: 10.1371/journal.pone.0251854. eCollection 2021.

ABSTRACT

INTRODUCTION: Iodine deficiency disorder a common problem in sub-Saharan Africa (SSA). It affects not only the health of the affected individual but also the economic development of the country. However, to the best of our knowledge, there is a scarcity in literature about the associated factors of iodized salt utilization in sub-Saharan Africa. Therefore, this study aimed to identify both individual and community level determinants of iodized salt utilization in sub-Saharan Africa.

METHODS: This study used the appended datasets of the most recent demographic and health survey from 31 sub-Saharan countries. A total weighted sample of 391,463 households was included in the study. Both bivariable and multivariable multilevel logistic regression were done to determine the associated factors of iodized salt utilization in SSA. P value ≤ 0.05 was used to declare statistically significant variables.

RESULTS: Those households with primary (AOR = 1.53, 95% CI = 1.50-1.57), secondary (AOR = 1.81, 95% CI = 1.76-1.86) and higher education level (AOR = 2.28, 95% CI = 2.17-2.40) had higher odds of iodized salt utilization. Households with middle (AOR = 1.05, 95% CI = 1.02-1.08), richer (AOR = 1.13, 95% CI = 1.09-1.17) and richest wealth index (AOR = 1.23, 95% CI = 1.18-1.28) also had an increased chance of using iodized salt. Households from high community media exposure (AOR = 2.07, 95% CI = 1.71-2.51), high community education level (AOR = 3.78, 95% CI = 3.14-4.56), and low community poverty level (AOR = 1.29, CI = 1.07-1.56) had higher odds of using salt containing iodine.

CONCLUSION: Both individual and community level factors were found to be associated with use of salt containing iodine in sub-Saharan Africa. Education level, media exposure, community poverty level, wealth index, community education, and community media exposure were found to be associated with use of salt containing iodine in SSA. Therefore, to improve the use of iodized salt in the region, there is a need to increase access to media sources and develop the socioeconomic status of the community.

PMID:33999945 | DOI:10.1371/journal.pone.0251854

PLoS One. 2021 May 17;16(5):e0250770. doi: 10.1371/journal.pone.0250770. eCollection 2021.

ABSTRACT

BACKGROUND & AIM: The coronavirus disease 2019 (COVID-19) pandemic has affected the life and work of people worldwide. The present study aimed to evaluate the rhythm disruptions of life, work, and entertainment, and their associations with the psychological impacts during the initial phase of the COVID-19 pandemic.

METHOD: A cross-sectional study was conducted from the 10th to 17th March 2020 in China. A structured e-questionnaire containing general information, the Chinese version of Brief Social Rhythm Scale, and Zung’s self-rating scales of depression and anxiety (SDS and SAS) was posted and collected online through a public media (i.e. EQxiu online questionnaire platform). Scores in sleeping, getting up, and socializing (SGS) rhythm and eating, physical practice, and entertainment (EPE) rhythm were compared among and between participants with different sociodemographic backgrounds including gender, age, education, current occupation, annual income, health status, and chronic disease status. Correlations of SDS and SAS with SGS-scale and EPE-scale were also analyzed.

RESULTS: Overall, 5854 participants were included. There were significant differences in the scores of SGS-scale and EPE-scale among people with different sociodemographic backgrounds. The scores were significantly higher in the groups with female gender, low education level, lower or higher than average income, poor health status, ages of 26-30 years or older than 61 years, nurses and subjects with divorce or widow status. There were also significant differences in SAS and SDS scores among people with different sociodemographic backgrounds (all P< 0.05). The overall prevalence of depression and anxiety was 24.3% and 12.6%, respectively, with nurses having the highest rates of depression (32.94%) and anxiety (18.98%) among the different occupational groups. SGS-scale was moderately correlated with SDS and SAS, and disruption of SGS rhythm was an independent risk factor for depression and anxiety.

CONCLUSION: Social rhythm disruption was independently associated with depression and anxiety. Interventions should be applied to people vulnerable to the rhythm disruption during the COVID-19 pandemic.

PMID:33999924 | DOI:10.1371/journal.pone.0250770

PLoS One. 2021 May 17;16(5):e0251238. doi: 10.1371/journal.pone.0251238. eCollection 2021.

ABSTRACT

To manage the increasing burden of dental diseases, a robust health system is essential. In order to ensure the oral health system operates at an optimal level going into the future, a forecast of the national shortfall of dentists and dental specialists in South Africa (SA) was undertaken. There is currently a shortage of dentists and specialists in SA and given the huge burden of dental diseases, there is a dire need to increase the number of these health care workers. The aim was to determine the projected shortfall of dentists and specialists in each of the nine provinces in SA. The projected shortfall was calculated based on the SA Disability-Adjusted Life Years (DALYs) for each province. The estimate for the evaluation of the Global Burden of Disease (GBD) for SA was obtained from the Institute of Health Metrics and Evaluation (IHME) Global Burden of Disease website. For each province, age standardized DALYs were calculated with mid-year population estimates obtained from Statistics SA 2018. In order to reduce the existing human resources for health (HRH) inequity among the provinces of SA, three scenarios were created focussing on attaining horizontal equity. The best-case scenario estimates a shortfall of 430, 1252 and 1885 dentists and specialists in 2018, 2024 and 2030 respectively. In an optimistic scenario, the national shortfall was calculated at 733, 1540 and 2158 dentists and specialists for the years 2018, 2024 and 2030 respectively. In an aspirational scenario, shortfalls of 853 (2018), 1655 (2024) and 2267 (2030) dentists and specialists were forecasted. Access to oral health services should be ensured through the optimum supply of trained dentists and specialists and the delivery of appropriate oral health services. Thus, the roadmap provided for upscaling the oral health services recognizes the influence of both demand and supply factors on the pursuit of equity.

PMID:33999933 | DOI:10.1371/journal.pone.0251238

PLoS One. 2021 May 17;16(5):e0251796. doi: 10.1371/journal.pone.0251796. eCollection 2021.

ABSTRACT

The progressive aging of the population represents a challenge for society. In particular, a strong increase in the number of people over 90 is expected in the next two decades. As this phenomenon will lead to an increase in illness and age-related dependency, the study of long-lived people represents an opportunity to explore which lifestyle factors are associated with healthy aging and which with the emergence of age-related diseases, especially Alzheimer’s type dementia. The project “Factors associated with healthy and pathologically aging in a sample of elderly people over 90 in the city of Madrid” (MADRID+90) brings together a multidisciplinary research team in neurodegenerative diseases that includes experts in epidemiology, neurology, neuropsychology, neuroimaging and computational neuroscience. In the first phase of the project, a stratified random sampling was carried out according to the census of the city of Madrid followed by a survey conducted on 191 people aged 90 and over. This survey gathered information on demographics, clinical data, lifestyles and cognitive status. Here, the main results of that survey are showed. The second phase of the project aims to characterize individual trajectories in the course of either healthy and pathological aging, from a group of 50 subjects over 90 who will undergo a comprehensive clinical examination comprised of neurological and cognitive testing, MRI and EEG. The ultimate goal of the project is to characterize the biophysical and clinical profiles of a population that tends to receive little attention in the literature. A better understanding of the rapidly increasing group of nonagenarians will also help to design new policies that minimize the impact and future social and economic consequences of rapidly aging societies.

PMID:33999936 | DOI:10.1371/journal.pone.0251796

J Am Acad Orthop Surg. 2021 May 17. doi: 10.5435/JAAOS-D-20-01368. Online ahead of print.

ABSTRACT

INTRODUCTION: Patient dissatisfaction after primary reverse total shoulder arthroplasty (rTSA) has been reported as high as 9%. In patients with excessive thoracic kyphosis, the scapula protracts and tilts anteriorly, which may lead to early impingement with the acromion and loss of forward elevation. The primary purpose of this study was to evaluate the effect of thoracic kyphosis on overhead ROM after rTSA.

METHODS: A prospectively collected shoulder registry was retrospectively reviewed for all patients undergoing primary rTSA with a minimum of 2-year follow-up. Preoperative and latest follow-up ROM (forward elevation, abduction, internal rotation, and external rotation), patient-reported outcome measures (SPADI, SST-12, ASES, UCLA, SF-12, and the visual analog scale), and the Constant score were collected. Postoperative radiographs were evaluated for implant loosening and notching. Patients were separated into three groups according to the thoracic kyphosis angle (<25°, 25 to 45°, and >45°) and also analyzed as a continuous variable. The groups were compared using analysis of variance and chi-square tests as indicated.

RESULTS: Three hundred five shoulders in 279 patients were reviewed at a mean follow-up of 3.9 years (range 2 to 10 years). Female patients and patients with a history of heart disease were statistically more likely to have increased thoracic kyphosis (P < 0.05). After surgery, forward elevation and abduction were similar among all groups (<25: 133°, 25 to 45: 132°, >45: 127°; P = 0.199 and <25: 123°, 25 to 45: 122°, >45: 117°; P = 0.330). All other postoperative ROM measurements and all patient-reported outcome measures were also similar, regardless of measured kyphosis. In addition, no association was observed between the degree of thoracic kyphosis and scapular notching (P = 0.291).

DISCUSSION: Despite thoracic kyphosis being a known risk factor for loss of overhead motion in the native shoulder, shoulders with excessive thoracic kyphosis demonstrated similar overhead ROM at early follow-up after primary rTSA.

LEVEL OF EVIDENCE: III.

PMID:33999909 | DOI:10.5435/JAAOS-D-20-01368

PLoS One. 2021 May 17;16(5):e0249808. doi: 10.1371/journal.pone.0249808. eCollection 2021.

ABSTRACT

Delirium is the most common postsurgical neurological complication and has a variable incidence rate. Laparoscopic surgery, when associated with the Trendelenburg position, can cause innumerable physiological changes and increase the risk of neurocognitive changes. The association of general anesthesia with a spinal block allows the use of lower doses of anesthetic agents for anesthesia maintenance and facilitates better control over postoperative pain. Our primary outcome was to assess whether a spinal block influences the incidence of delirium in oncologic patients following laparoscopic surgery in the Trendelenburg position. Our secondary outcome was to analyze whether there were other associated factors. A total of 150 oncologic patients who underwent elective laparoscopic surgeries in the Trendelenburg position were included in this randomized controlled trial. The patients were randomized into 2 groups: the general anesthesia group and the general anesthesia plus spinal block group. Patients were immediately evaluated during the postoperative period and monitored until they were discharged, to rule out the presence of delirium. Delirium occurred in 29 patients in total (22.3%) (general anesthesia group: 30.8%; general anesthesia plus spinal block: 13.8% p = 0.035). Patients who received general anesthesia had a higher risk of delirium than patients who received general anesthesia associated with a spinal block (odds ratio = 3.4; 95% confidence interval: 1.2-9.6; p = 0.020). Spinal block was associated with reduced delirium incidence in oncologic patients who underwent elective laparoscopic surgeries in the Trendelenburg position.

PMID:33999920 | DOI:10.1371/journal.pone.0249808

J Am Acad Orthop Surg. 2021 May 17. doi: 10.5435/JAAOS-D-21-00078. Online ahead of print.

ABSTRACT

INTRODUCTION: Symptoms of stress, depression, and burnout are prevalent in medicine, adversely affecting physician performance. We investigated real-time measurements of physiological strain in orthopaedic resident and faculty surgeon volunteers and identified potential daily stressors.

METHODS: We performed a prospective blinded cohort pilot study in our academic orthopaedic department. Physicians used a wearable fitness device for 12 weeks to objectively measure heart rate variability (HRV), a documented parameter of overall well-being. Baseline burnout levels were assessed using the Maslach Burnout Inventory questionnaire. Daily surveys inquiring on work responsibilities (clinic, operating room [OR], or “other”) were correlated with physiological parameters of strain. Descriptive statistics and linear mixed effects modeling were used to evaluate bivariate relationships.

RESULTS: Of the 21 participating surgeons, 9 faculty and 12 residents, there was a response rate of 95.2% for the initial burnout survey. Daily surveys were completed for 63.8% (54.9 ± 22.3 days) of the total collection window, and surgeons wore the device for 83.2% of the study (71.6 ± 25.0 days). Residents trended toward lower personal accomplishment and greater psychological detachment on the Maslach Burnout Inventory, with 5 surgeons including 1 faculty surgeon (11.1%) and 4 resident surgeons (33.3%) found to have negatively trending HRV throughout the study period demonstrating higher physiological strain. Time in the OR led to increased next-day HRV (y-intercept = 47.39; B = 4.90; 95% confidence interval, 2.14-7.66; P < 0.001), indicative of lower physiological strain. An increase in device-reported sleep from a surgeon’s baseline resulted in a significant increase in next-day HRV (y-intercept = 50.46; B = 0.64; 95% confidence interval, 0.11-1.17; P = 0.02).

DISCUSSION: Orthopaedic residents, more than faculty, had physiologic findings suggestive of burnout. Time in the OR and increased sleep improved physiological strain parameters. Real-time biometric measurements can identify those at risk of burnout and in need of well-being interventions.

LEVEL OF EVIDENCE: Level III.

PMID:33999882 | DOI:10.5435/JAAOS-D-21-00078

J Am Acad Orthop Surg. 2021 May 17. doi: 10.5435/JAAOS-D-20-01056. Online ahead of print.

ABSTRACT

INTRODUCTION: In the proper age group, there is evidence that total hip arthroplasty (THA) has superior outcomes for the treatment of acetabular fractures compared with open reduction and internal fixation. Studies comparing patient demographics and identifying risk factors for either surgical site infections (SSIs) or periprosthetic joint infections (PJIs) are limited. Therefore, the purpose of this study was to (1) compare baseline demographics of patients who did and did not develop infections and (2) identify risk factors associated with developing either SSIs or PJIs.

METHODS: A retrospective study from 2005 to 2014 was done using a nationwide claims database. The inclusion criteria consisted of patients sustaining an acetabular fracture and treated with THA who developed either SSIs or PJIs within 90 days or 2 years, respectively, whereas patients not developing infections served as control subjects. The final study yielded 13,059 patients within the study (n = 988) and control cohort (n = 12,071). Baseline demographics were compared. A multivariate regression model calculated the odds ratio (OR) associated with development of infections. P value less than 0.002 was considered statistically significant.

RESULTS: The study demonstrated significant differences among the cohorts regarding baseline demographics. The greatest risk factors for SSIs within 90 days were morbid obesity (OR: 1.84, P < 0.0001), pathologic weight loss (OR: 1.64, P < 0.0001), and iron deficiency anemia (OR: 1.59, P = 0.001). An increased risk of PJIs was associated with iron deficiency anemia (OR: 1.97, P < 0.0001), pathologic weight loss (OR: 1.72, P < 0.0001), and morbid obesity (OR: 1.70, P = 0.0001).

CONCLUSION: This study found notable differences between baseline demographics of the cohorts and a myriad of risk factors associated with developing infections after THA for acetabular fractures. This study provides insight into orthopaedic surgeons and other healthcare professionals on the need of properly educating these high-risk patients of the potential consequences which they may encounter after their procedure.

LEVEL OF EVIDENCE: Level III.

PMID:33999867 | DOI:10.5435/JAAOS-D-20-01056