Category: Nevin Manimala

Female Pelvic Med Reconstr Surg. 2021 Apr 1;27(4):230-237. doi: 10.1097/SPV.0000000000000912.

ABSTRACT

OBJECTIVE: To evaluate national trends in major adverse cardiovascular and cerebrovascular events (MACCE) in female pelvic reconstructive surgery (FPRS).

METHODS: Data from the National Inpatient Sample was used to identify women undergoing FPRS between 2012 and 2016. Demographic, procedural, and comorbidity data were collected. Patients were stratified into those with and without MACCE (defined as all-cause mortality, cardiac arrest, myocardial infarction (MI) and acute ischemic stroke). Descriptive statistics are expressed as medians and interquartile ranges. Pairwise analysis was performed using Wilcoxon rank-sum or Fisher exact test as appropriate. Multivariable logistic regression was used to identify independent risk factors for MACCE.

RESULTS: During the study period, 53,540 patients underwent FPRS. The rate of MACCE was 4.8 per 1000 surgeries; MI, 3.7; acute ischemic stroke, 0.6; cardiac arrest, 0.4; and all-cause mortality, 0.3. Patients experiencing MACCE were more likely to have major preexisting cardiovascular comorbidities, coagulopathy, neurologic disease (ND), and diabetes and were more likely to undergo robotic colpopexy (20.7% vs 9.6%, P < 0.001), vaginal colpopexy (32.0% vs 28.5%, P = 0.04), and to receive a blood transfusion (8.2% vs 2.5%, P < 0.001).On logistic regression, preexisting coagulopathy was the strongest predictor of MACCE (adjusted odds ratio [aOR], 5.53; 95% confidence interval [CI], 2.39-12.78), followed by blood transfusion (aOR, 4.84; 95% CI, 1.89-12.45), congestive heart failure (aOR, 3.61; 95% CI, 1.56-8.37), ND (aOR, 3.14; 95% CI, 1.23-8.06), and electrolyte abnormalities (aOR, 1.99; 95% CI, 1.05-3.99).

CONCLUSION: Major adverse cardiovascular and cerebrovascular events after FPRS is a rare event, with MI being the most common manifestation. Preexisting ND, congestive heart failure, coagulopathy, electrolyte disturbances, and perioperative transfusions are strongly associated with MACCE.

PMID:33770806 | DOI:10.1097/SPV.0000000000000912

Phys Ther Sport. 2021 Mar 8;49:204-213. doi: 10.1016/j.ptsp.2021.03.001. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this review was to synthesize the current understanding relating to the risks of lower body functional asymmetry with injury in athletic populations.

METHODS: An iterative data mining and sampling approach was used to construct a search phrase from key words, which were used to identify studies within SPORTdiscus, Medline and Academic Search Complete databases. Additional references were sourced from the reference lists of these articles.

RESULTS: After screening, 31 papers were reviewed, from an initial search identifying 302 possible studies. A total of 6228 participants were involved in the studies, of which soccer players were the most observed sporting demographic (n = 2171). Of the 31 studies reviewed eight found no statistical association between lower limb asymmetry and injury risk, 10 studies provided partial statistically significant evidence and a further 10 provided statistically significant statistical links.

CONCLUSION: Overall moderate to lower quality evidence for functional asymmetry as a risk factor for injury in sport was observed. While the possibility of a relationship between lower limb functional asymmetry and injury risk cannot be ruled out, further higher quality investigations, adopting standardised methodologies, is required.

PMID:33770741 | DOI:10.1016/j.ptsp.2021.03.001

Cognition. 2021 Mar 23;212:104469. doi: 10.1016/j.cognition.2020.104469. Online ahead of print.

ABSTRACT

Researchers across cognitive science, economics, and evolutionary biology have studied the ubiquitous phenomenon of social learning-the use of information about other people’s decisions to make your own. Decision-making with the benefit of the accumulated knowledge of a community can result in superior decisions compared to what people can achieve alone. However, groups of people face two coupled challenges in accumulating knowledge to make good decisions: (1) aggregating information and (2) addressing an informational public goods problem known as the exploration-exploitation dilemma. Here, we show how a Bayesian social sampling model can in principle simultaneously optimally aggregate information and nearly optimally solve the exploration-exploitation dilemma. The key idea we explore is that Bayesian rationality at the level of a population can be implemented through a more simplistic heuristic social learning mechanism at the individual level. This simple individual-level behavioral rule in the context of a group of decision-makers functions as a distributed algorithm that tracks a Bayesian posterior in population-level statistics. We test this model using a large-scale dataset from an online financial trading platform.

PMID:33770743 | DOI:10.1016/j.cognition.2020.104469

Psychiatriki. 2021 Mar 26. doi: 10.22365/jpsych.2021.013. Online ahead of print.

ABSTRACT

Atrial fibrillation (AF) is a common sustained cardiac arrhythmia, which is expected to expand enormously due to population ageing. The aim of the present study was to explore the significance of AF patients’ needs and the associated factors as well as the impact of anxiety and depression on these needs. The sample of the study included 215 AF hospitalized patients. Data were collected by the completion of a questionnaire which, in addition to patients’ characteristics, it also included the Hospital Anxiety and Depression Scale (HADS) and the questionnaire “Needs of hospitalized patients with coronary artery disease”, that is evaluating the significance of the following 6 categories of needs: a) for support and guidance, b) for information from medical and nursing staff, c) for communication with other patients and family, d) for individualization of care and participation, e) to trust the medical and nursing staff and f) to meet emotional and physical needs. The statistical significance level was p< 0.05. Of the 215 participants, 68.4% were men and 67.5% were > 60 years old. Moreover, 47.5% of the participants experienced anxiety and 29.5% depression. The need for support, to be informed and to trust the medical and nursing staff considered to be of high significance by the patients (median 29,20 and 6, respectively). Anxiety and depression were significantly associated with all patients’ needs (p<0.05) apart from the need to meet the emotional and physical needs and the need to trust the medical and nursing staff, which were not associated with anxiety levels. In terms of patients’ needs, those who reported to be little or not at all informed about their disease considered of a higher significance the need for support and guidance (p=0.030), the need to be informed and to trus the medical and nursing staff (p=0.001 and p=0.012, respectively) and the need for communication with other patients and family (p=0.007). The need for individualization of care and participation in it, was considered more significant by patients aged >70 years and those having no children (p=0.039 and p=0.029, respectively) while the need for communication with other patients and family was considered more significant by women (p=0.028). The present findings emphasize the importance of providing care tailored to meet the needs of AF patients who experience anxiety and depression.

PMID:33770750 | DOI:10.22365/jpsych.2021.013

J Electrocardiol. 2021 Mar 16;66:48. doi: 10.1016/j.jelectrocard.2021.03.002. Online ahead of print.

NO ABSTRACT

PMID:33770647 | DOI:10.1016/j.jelectrocard.2021.03.002

J Environ Radioact. 2021 Mar 23;233:106571. doi: 10.1016/j.jenvrad.2021.106571. Online ahead of print.

ABSTRACT

The geographic variation of terrestrial radiation can be exploited in epidemiological studies of the health effects of protracted low-dose exposure. Various methods have been applied to derive maps of this variation. We aimed to construct a map of terrestrial radiation for Switzerland. We used airborne γ-spectrometry measurements to model the ambient dose rates from terrestrial radiation through a Bayesian mixed-effects model and conducted inference using Integrated Nested Laplace Approximation (INLA). We predicted higher levels of ambient dose rates in the alpine regions and Ticino compared with the western and northern parts of Switzerland. We provide a map that can be used for exposure assessment in epidemiological studies and as a baseline map for assessing potential contamination.

PMID:33770702 | DOI:10.1016/j.jenvrad.2021.106571

J Neurol Sci. 2021 Mar 20;424:117410. doi: 10.1016/j.jns.2021.117410. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to investigate the prevalence and factors associated with oral anticoagulant undertreatment of atrial fibrillation (AF) among a cohort of rural patients with stroke outcomes and examine how undertreatment may influence a patient’s one-year survival after stroke.

METHODS: This retrospective cohort study examined ischemic stroke patients with pre-stroke AF diagnosis from September 2003 to May 2019 and divided them into proper treatment and undertreatment group. Analysis included chi-square test, variance analysis, Kruskal-Wallis test, logistic regression, Kaplan-Meier estimator, and Cox proportional-hazards model.

RESULTS: Out of 1062 ischemic stroke patients with a pre-stroke AF diagnosis, 1015 patients had a CHA₂DS₂-VASc score ≥2, and 532 (52.4%) of those were undertreated. Median time from AF diagnosis to index stroke was significantly lower among undertreated patients (1.9 years vs. 3.6 years, p < 0.001). Other thromboembolism, excluding stroke, TIA, and myocardial infarction (OR 0.41, p < 0.001), the number of encounters per year (OR 0.90, p < 0.001), and the median time between AF diagnosis and stroke event (OR 0.86, p < 0.001) were negatively associated with undertreatment. Kaplan-Meier estimator showed no statistical difference in the one-year survival probability between groups (log-rank test, p = 0.29), while the Cox-Hazard model showed that age (HR 1.05, p < 0.001) and history of congestive heart failure (HR 1.88, p < 0.001) increased the risk of mortality.

CONCLUSIONS: More than half of our rural stroke patients with a pre-index AF diagnosis were not on guideline-recommended treatment. The study highlights a large care gap and an opportunity to improve AF management.

PMID:33770707 | DOI:10.1016/j.jns.2021.117410

Waste Manag. 2021 Mar 23;126:191-200. doi: 10.1016/j.wasman.2021.03.009. Online ahead of print.

ABSTRACT

Countries’ growth along with the need to protect the environment has made waste management a major global concern. In this study, a detailed analysis is carried out of the current situation in 41 countries belonging to the OECD and/or the European Union, in order to identify the most sustainable practices that could be successfully implemented in other nations with similar characteristics. Cluster analysis is used to detect homogeneous groups, shedding light on the possible connection between environmental policies and waste treatment. Contingency tables are employed to determine the relationship between the effectiveness of the policies adopted and two indicators of sustainable practices: material recycling and waste generation. The study is conducted using statistical information from the Sustainable Governance Indicators project and the OECD, with data referring to 2018. Five internally homogeneous groups of countries have been identified, where Israel, Turkey and USA have the lowest participation and compliance in environmental policies. Also, the results show that countries with a high degree of participation in environmental treaties (Croatia, Denmark, Finland, France, Germany, Japan, Luxembourg, the Netherlands, Norway, Spain, Sweden, Switzerland) are making great progress, reducing the use of landfills in favour of other, more environmentally friendly options. Moreover, the contingency tables confirm that the effectiveness of policies translates into a clear trend towards recycling and, to some extent, reduces waste generation.

PMID:33770617 | DOI:10.1016/j.wasman.2021.03.009

Cytokine. 2021 Mar 23;142:155487. doi: 10.1016/j.cyto.2021.155487. Online ahead of print.

ABSTRACT

Advanced breast cancer frequently metastasizes to the skeleton causing major mobility issues and hazards to quality of life. To manage osteolytic bone metastasis, bone-modifying agents and chemotherapy are recommended as the standard of care. Here, we investigated serologic biomarkers that might be associated with prognosis in breast cancer patients treated with zoledronic acid (ZA) and taxane-based chemotherapy. We collected serum samples from breast cancer patients with bone metastasis who received taxane plus ZA as palliative treatment. Fourteen biomarkers of angiogenesis, immunogenicity, and apoptosis were assessed, and the correlation between serum cytokine levels and patient’s prognosis was statistically analyzed. Sixty-six patients were enrolled, and samples from 40 patients were analyzed after laboratory quality control. Patients with low baseline PDGF-AA, high IFN-γ, low MCP-2, low TGF-β1, and low TNF-α were significantly associated with longer progression-free survival (PFS). Decreasing VEGF and TNF-α and increasing FGF-2 and PDGF-AA in the early treatment phase indicated longer PFS. In univariate and multivariate analyses, low TGF-β1 and TNF-α and high IFN-γ at baseline were associated with a significantly low hazard ratio for disease progression. Further, we designed a risk score with TGF-β1, TNF-α, and IFN-γ levels, which could prognosticate patients for PFS. In conclusion, serum cytokine level, such as TGF-β1, TNF-α, and IFN-γ, could be a potential prognostic biomarker for breast cancer patients with bone metastasis treated with ZA and taxane-based chemotherapy.

PMID:33770643 | DOI:10.1016/j.cyto.2021.155487

J Electrocardiol. 2021 Feb 25;66:38-42. doi: 10.1016/j.jelectrocard.2021.02.009. Online ahead of print.

ABSTRACT

AIMS: Right Bundle Branch Block (RBBB) has been reported in 5-11% of the acute myocardial infarctions (AMI), and it could be the only electrocardiographic abnormality in this group of patients. We investigated the mortality in patients with AMI and the presence of RBBB.

MATERIALS AND METHODS: A retrospective cohort study was conducted between January 2011 to December 2017 at a university hospital in Bogotá, Colombia. Records were obtained from all patients who presented at the emergency department with AMI; patients with early transfer and incomplete follow-up were excluded.

RESULTS: 1015 patients were included, the mean age was 66 years, 67% of the patients were men, and 38% had STEMI. RBBB was documented in 8% of patients and LBBB in 4% of patients. In-hospital mortality was higher in the group of patients with RBBB vs. patients without RBBB (8.64% vs. 3.74%, p = 0.034). The percentage of patients with Killip ≥II classification was higher in patients with new RBBB vs. patients with old or unknown duration RBBB (23% vs. 13%, p = 0.216).

CONCLUSIONS: In patients with AMI, the presence of RBBB was associated with a statistically significant increase of in-hospital mortality.

PMID:33770645 | DOI:10.1016/j.jelectrocard.2021.02.009