Category: Nevin Manimala

J Perinat Med. 2021 Jul 20. doi: 10.1515/jpm-2021-0142. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of the study was to evaluate the effect of the brain-sparing effect (BSE) of fetal growth restriction (FGR) in newborn germinal matrix/intraventricular hemorrhage (GM/IVH).

METHODS: A total of 320 patients who delivered prior to the 34th gestational week were analyzed from data records. 201 patients were divided into two groups according to cerebro-placental ratio (CPR): early fetal growth restriction (FGR) with abnormal CPR group (n=104) and appropriate for gestational age with normal Doppler group (control) (n=97). Using the normal middle cerebral artery (MCA) Doppler as a reference, multivariate logistic regression analysis was used to assess the association between the BSE and the primary outcome.

RESULTS: The rate of Grade I-II Germinal matrix/intraventricular hemorrhage (GM/IVH) was 31(29.8%) in the group possessing early FGR with abnormal CPR and 7(7.2%) in the control group, showing a statistically significant difference. The rate of grade III-IV GM/IVH was 7(6.7%) in the group possessing early FGR with abnormal CPR and 2 (2.1%) in the control group, showing no statistically significant difference. We found that gestational age at delivery <32 weeks was an independent risk factor for GM/IVH. In addition, we found that other variables such as the presence of preeclampsia, fetal weight percentile <10, emergency CS delivery, 48-h completion after the first steroid administration and 24-h completion rate after MgSO₄ administration were not independently associated with the primary outcome.

CONCLUSIONS: Our results indicate that the rate of GM-IVH was increased in the group possessing early FGR with abnormal CPR; however, multivariate logistic regression analysis showed that BSE was not an independent risk factor for GM/IVH.

PMID:34284527 | DOI:10.1515/jpm-2021-0142

J Perinat Med. 2021 Jul 20. doi: 10.1515/jpm-2021-0082. Online ahead of print.

ABSTRACT

OBJECTIVES: To investigate association between latency after preterm premature rupture of membranes (PPROM) and perinatal outcomes at moderately and late preterm gestation.

METHODS: National perinatal registry-based cohort study using data for the period 2013-2018. Singleton pregnancies with non-malformed fetuses in cephalic presentation complicated by PPROM at 32⁺⁰-36⁺⁶ weeks were included. Associations between latency period and perinatal mortality, neonatal respiratory distress syndrome (RDS), early onset neonatal infection (EONI), and cesarean section were assessed using multiple logistic regression, adjusting for potential confounders (labor induction, maternal body-mass-index, maternal age, antenatal corticosteroids, and small-for-gestational-age). p<0.05 was considered statistically significant.

RESULTS: Of 3,017 pregnancies included, 365 (12.1%) had PPROM at 32⁺⁰-33⁺⁶ weeks and 2,652 (87.9%) at 34⁺⁰-36⁺⁶ weeks. Among all cases, 2,540 (84%) had latency <24 h (group A), 305 (10%) 24-47 h (group B), and 172 (6%) ≥48 h (group C). Longer latency was associated with higher incidence of EONI (adjusted odds ratio [aOR] 1.350; 95% confidence interval [CI] 0.900-2.026 for group B and aOR 2.500; 95% CI 1.599-3.911 for group C) and higher rate of caesarean section (aOR 2.465; 95% CI 1.763-3.447 for group B and aOR 1.854; 95% CI 1.172-2.932 for group C). Longer latency was not associated with rates of RDS (aOR 1.160; 95% CI 0.670-2.007 for group B and aOR 0.917; 95% CI 0.428-1.966 for group C).

CONCLUSIONS: In moderately to late PPROM, increased latency is associated with higher risk of EONI and cesarean section with no reduction in RDS.

PMID:34284530 | DOI:10.1515/jpm-2021-0082

J Reconstr Microsurg. 2021 Jul 20. doi: 10.1055/s-0041-1731765. Online ahead of print.

ABSTRACT

BACKGROUND: Surgical drains are routinely used following autologous reconstruction, but are often cited as the leading cause of peri-operative discomfort. This study defined routine drain use duration and assessed the risk factors for prolonged breast and abdominal drain use during microvascular breast reconstruction, measures which have never previously been defined.

METHODS: Patients who underwent an abdominal microvascular free flap were included. Demographics, comorbidities, and operation-related characteristics were retrospectively collected in a prospectively maintained database. Statistical analysis utilized chi-square independent t-test, and linear regression analyses.

RESULTS: One hundred forty-nine patients comprising 233 breast flaps were included. Average breast and abdominal drain duration were 12.9 ± 3.9 and 17.7 ± 8.2 days, respectively. Prolonged breast and abdominal drain duration were defined as drain use beyond the 75^th percentile at 14 and 19 days, respectively. Multivariable regression revealed hypertension was associated with an increased breast drain duration by 1.4 days (p = 0.024), axillary dissection with 1.7 days (p = 0.026), African-American race with 3.1 days (p < 0.001), Hispanic race with 1.6 days (p = 0.029), return to the OR with 3.2 days (p = 0.004), and each point increase in BMI with 0.1 days (p = 0.028). For abdominal drains, each point increase in BMI was associated with an increased abdominal drain duration by 0.3 days (p = 0.011), infection with 14.4 days (p < 0.001), and return to the OR with 5.7 days (p = 0.007).

CONCLUSION: Elevated BMI, hypertension, and axillary dissection increase risk for prolonged breast drain requirement in autologous reconstruction. African-American and Hispanic populations experience prolonged breast drain requirement after controlling for other factors, warranting further study.

PMID:34284504 | DOI:10.1055/s-0041-1731765

Exp Clin Endocrinol Diabetes. 2021 Jul 20. doi: 10.1055/a-1523-7562. Online ahead of print.

ABSTRACT

AIMS: To collect and analyse representative data of structural and process quality in the management of diabetic emergencies in Germany in 2020.

METHODS: A standardised questionnaire comprising detailed items concerning clinically relevant parameters on the structural and process quality of out-of-hospital management of diabetic emergencies was sent nationwide to medical directors of emergency medical service districts (EMSDs). Results were compared with those from a similar study conducted in 2001.

RESULTS: The return rate of the questionnaires represented 126 EMSDs, serving a total population of > 40.1 million. Only 4% of ambulances carried glucagon (6% in 2001). In 2020, blood glucose determination increased significantly to 71% of all emergency interventions and to 29% of suspected cardiac emergencies (24% and 15%, respectively, in 2001). In 100% of EMSDs severe hypoglycaemia (SH) was treated by paramedics by administering intravenous dextrose before the arrival of a doctor compared to 63% in 2001. The potential value of nasal glucagon was acknowledged by 43% of responders. In selected patients, treatment of SH was conducted without hospital admission in 78% of EMDs (60% in 2001). Fifty-three percent of medical directors acknowledged the need for further training in diabetic emergencies (47% in 2001). Cooperation for medical education between emergency teams and a diabetes centre was reported by 14% (41% in 2001).

CONCLUSION: Structural and process quality of the management of diabetic emergencies in Germany has improved considerably since 2001. Persisting deficiencies could be improved by providing better medical equipment in ambulances and ongoing education to the entire emergency teams.

PMID:34284506 | DOI:10.1055/a-1523-7562

Nucl Med Commun. 2021 Jul 19. doi: 10.1097/MNM.0000000000001459. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate the relationship between volumetric parameters calculated using semiautomatic quantification of lesions detected in 68Ga-labeled prostate-specific membrane antigen PET-computed tomography (68Ga-PSMA PET/CT) and clinical characteristics in prostate cancer (PCa) patients with biochemical recurrence.

METHODS: A total of 85 consecutive PCa patients with biochemical recurrence who underwent 68Ga-PSMA PET/CT at our institution from January 2019 to March 2020 were retrospectively assessed. 68Ga-PSMA PET/CT-derived volumetric parameters, including whole-body PSMA tumor volume (wbPSMA-TV) and whole-body total lesion PSMA (wbTL-PSMA), as well as the established maximum and mean standardized uptake value (SUVmax and SUVmean), were calculated for each patient. All PET-derived parameters were analyzed for correlation with prostate-specific antigen (PSA) levels and for association with Gleason scores.

RESULTS: Eighty-five patients with a mean age of 68.9 ± 7.8 years (range, 47-83 years) and a mean PSA level of 40.9 ± 92.1 ng/ml (range, 0.2-533.2 ng/ml) were analyzed. Volumetric parameters, that is, wbPSMA-TV and wbTL-PSMA, demonstrated a statistically significant correlation with PSA levels (r = 0.403 and r = 0.556, respectively, all at P < 0.001) and only the means of wbTL-PSMA were significantly different between the Gleason score groups (P < 0.05).

CONCLUSIONS: The results of our study indicate that 68Ga-PSMA PET/CT might be a valuable tool for the detection and follow-up of recurrence in PCa patients. 68Ga-PSMA PET/CT-derived quantitative volumetric parameters demonstrated a highly significant correlation with changes in PSA levels. Larger prospective studies are needed to help reveal the full potential of parameters such as PSMA-TV and TL-PSMA derived from PET imaging with 68Ga-PSMA.

PMID:34284438 | DOI:10.1097/MNM.0000000000001459

J Trauma Acute Care Surg. 2021 Jul 20. doi: 10.1097/TA.0000000000003363. Online ahead of print.

ABSTRACT

BACKGROUND: Traumatic brain injury is a global burden. We aimed to perform a meta-analysis to determine the efficacy of amantadine for cognitive performance after traumatic brain injury.

METHODS: The systematic review was prospectively registered on the PROSPERO website under the registration number CRD42017080044. We used PRISMA Guidelines to report the steps of meta-analysis. The search included electronic databases (PubMed, PsycINFO, Embase, Cochrane Library databases, CENTRAL, ProQuest and ClinicalTrials.gov trial registry). Critical care medicine journals and clinical neurology specialty were searched using www.scimagojr.com. No publication date restriction. Two authors assessed studies’ relevance and extracted data. Studies were assessed for quality using the Cochrane risk of bias tool. Data were analyzed using Comprehensive Meta-Analysis Program Versions 2.0 and 3.0.

RESULTS: 26 studies out of 3440 records were included in the systematic review, of which only 14 clinical trials and 6 observational studies were included in the meta-analysis. Amantadine significantly enhanced the cognitive function relative to control group (SMD 0.50; 95% CI 0.33 – 0.66; p < 0.001, 16 studies, 1127 participants, low certainty evidence). Consistent significant difference in favor of amantadine relative to control group (SMD = 0.79; 95% CI 0.34 – 1.24, very low certainty evidence) for cohort studies versus SMD = 0.40; 95% CI 0.25 – 0.56, moderate certainty evidence) for RCTS. Starting amantadine in the first week after TBI had a significant effect on improving cognitive function (SMD = 0.97; 95% CI 0.45 – 1.49, 16 studies, 1127 participants, low certainty). Amantadine showed a better effect when administered for less than one month (SMD = 0.83; 95% CI: 0.56 – 1.11, low certainty) and to patients below 18 years of age (SMD = 0.66; 95% CI: 0.32 – 0.99, low certainty) or to patients with less severe traumatic brain injury (SMD = 0.40; 95% CI 0.18 – 0.62, low certainty). No statistically significant difference existed between amantadine and the control concerning the adverse events (OR 1.74; 95% CI 0.88 – 3.44; p = 0.11, moderate certainty). Meta-regression of the different clinical parameters; onset of treatment, age and severity of traumatic brain injury showed a statistically significant relation between onset of treatment and the effect size of amantadine. The relation between the other two parameters and the effect size of amantadine showed a marginal statistical significance.

CONCLUSION: Amantadine may improve the cognitive function when used after TBI. Further research with high validity is needed to reach a solid conclusion about the use of amantadine in traumatic brain injury.

LEVEL OF EVIDENCE: Systematic review/ meta-analysis, level III.

PMID:34284464 | DOI:10.1097/TA.0000000000003363

J Trauma Acute Care Surg. 2021 Jul 20. doi: 10.1097/TA.0000000000003365. Online ahead of print.

ABSTRACT

BACKGROUND: Patient-reported outcomes are important for understanding recovery after burn injury, benchmarking service delivery and measuring the impact of interventions. PROMIS-29 domains have been validated for use among diverse populations though not among burn survivors. The purpose of this study was to examine validity and reliability of PROMIS-29 scores in this population.

METHODS: PROMIS-29 scores of physical function, anxiety, depression, fatigue, sleep disturbance, ability to participate in social roles, and pain interference were evaluated for validity and reliability in adult burn survivors. Unidimensionality, floor and ceiling effects, internal consistency, and reliability were examined. Differential item functioning (DIF) was used to examine bias with respect to demographic and injury characteristics. Correlations with measures of related constructs (Community Integration Questionnaire, Satisfaction with Life Scale, Post-Traumatic Stress Checklist-Civilian, and Veteran’s Rand-12) and known-group differences were examined.

RESULTS: 876 burn survivors with moderate to severe injury from 6 months-20 years post burn provided responses on PROMIS-29 domains. Participant ages ranged from 18-93 years at time of assessment; mean years since injury was 3.4. All PROMIS domain scores showed high internal consistency (Cronbach’s α = 0.87-0.97). There was a large ceiling effect on ability to participate in social roles (39.7%) and physical function (43.3%). One-factor confirmatory factor analyses supported unidimensionality (all CFI >0.95). We found no statistically significant bias (DIF). Reliability was high (>0.9) across trait levels for all domains except sleep, which reached moderate reliability (>0.85). All known-group differences by demographic and clinical characteristics were in the hypothesized direction and magnitude except burn size categories.

CONCLUSIONS: The results provide strong evidence for reliability and validity of PROMIS-29 domain scores among adult burn survivors. Reliability of the extreme scores could be increased and the ceiling effects reduced by administering PROMIS-43, which includes 6 items per domain, or by administering by computerized adaptive testing.

LEVEL OF EVIDENCE: This is a Level III psychometric analysis of prospectively collected survey data.

PMID:34284470 | DOI:10.1097/TA.0000000000003365

Urol Int. 2021 Jul 20:1-7. doi: 10.1159/000517374. Online ahead of print.

ABSTRACT

BACKGROUND: Patients hospitalized due to gross hematuria frequently complete evaluation in the outpatient setting. The use of office flexible cystoscopy during hospitalization may lead to prompt diagnosis and treatment but can be limited due to low visualization and artifacts that can hamper diagnostic ability.

OBJECTIVE: The objective of this study was to assess flexible cystoscopy findings and yield performed in patients hospitalized due to gross hematuria.

METHODS: Medical records of patients who underwent flexible cystoscopy while hospitalized during September 2018-December 2019 were reviewed. Cystoscopic findings were categorized into (1) suspicious mass in the bladder or prostate, (2) nonsuspicious changes in the bladder, and (3) nondiagnostic exam. Descriptive statistics were used to report the clinical characteristics of the study cohort and the findings of cystoscopy. Univariate logistic regression analyses were used to identify predictors of malignant findings.

RESULTS: The study cohort consisted of 69 patients (median age of 76 years). Initial cystoscopy findings were suspicious for malignancy in 26/69 patients (38%), nonsuspicious for malignancy in 34/69 patients (49%), and nondiagnostic in 9/69 patients (13%). The median follow-up time was 9 months (range 4-14 months). Twenty patients (29%) were diagnosed with malignancy (sensitivity of 75% and specificity of 78%). The procedure led to either diagnosis or treatment of 39 patients (57%). However, in 30 patients (43%), the initial cystoscopy did not aid in the diagnosis, led to misdiagnoses, or required a follow-up cystoscopy. On univariate analyses, none of the precystoscopy variables were predictive of bladder malignancy.

CONCLUSION: Flexible cystoscopy in the setting of acute hematuria requiring hospitalization did not lead to diagnosis or treatment in over 40% of cases. In this setting, consideration should be given to performing an upfront cystoscopy under anesthesia.

PMID:34284410 | DOI:10.1159/000517374

Menopause. 2021 Jul 19. doi: 10.1097/GME.0000000000001818. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of the present study was to analyze the effects of dance practice on body composition, metabolic profile, functional fitness, and self-image/self-esteem in postmenopausal women.

METHODS: A total of 36 postmenopausal participants (mean age 57 years) danced three times per week for 90 minutes each day and were evaluated before and after 16 weeks. The parameters evaluated were body composition (body fat and lean mass), blood lipids, functional fitness, self-image, and self-esteem.

RESULTS: Statistical analysis was done using Student t test for paired samples and the Wilcoxon test with P values less than 0.05 considered statistically significant. Lower triglycerides (baseline = 156.5 ± 17.0 mg/dL; after 16-weeks = 131.5 ± 12.9 mg/dL; P < 0.01), higher high-density lipoprotein cholesterol (baseline = 55.4 ± 15.9 mg/dL; after 16 weeks = 60.0 ± 15.4 mg/dL; P < 0.001), and higher total cholesterol (baseline = 199.5 ± 26.8 mg/dL; after 16 weeks = 211.8 ± 35.7 mg/dL; P < 0.01) levels were observed in postmenopausal women. Dance intervention improved coordination (baseline = 8.6 ± 2.6; after 16 weeks = 6.7 ± 1.6; P < 0.001), agility (baseline = 55.9 ± 8.8; after 16 weeks = 64.1 ± 8.3; P < 0.001), and aerobic capability (baseline = 446.8 ± 63.4; after 16 weeks = 377.4 ± 53.8; P < 0.001). Classification of general function fitness index (GFFI) was considered regular at baseline (GFFI of 200-299), but improved after 16 weeks of dance practice (GFFI of 300-399, P < 0.001).

CONCLUSION: The 16-week dance intervention was effective in improving not only the lipid profile and functional fitness of postmenopausal women, but also self-image and self-esteem.

PMID:34284435 | DOI:10.1097/GME.0000000000001818

J Surg Res. 2021 Jul 16;268:40-58. doi: 10.1016/j.jss.2021.06.045. Online ahead of print.

ABSTRACT

BACKGROUND: Immersive virtual reality (iVR) simulators provide accessible, low cost, realistic training adjuncts in time and financially constrained systems. With increasing evidence and utilization of this technology by training programs, clarity on the effect of global skill training should be provided. This systematic review examines the current literature on the effectiveness of iVR for surgical skills acquisition in medical students, residents, and staff surgeons.

METHODS: A literature search was performed on MEDLINE, EMBASE, CENTRAL, Web of Science and PsycInfo for primary studies published between January 1, 2000 and January 26, 2021. Two reviewers independently screened titles, abstracts, and full texts, extracted data, and assessed quality and strength of evidence using the Medical Education Research Quality Instrument (MERSQI) and Cochrane methodology. Results were qualitatively synthesized, and descriptive statistics were calculated.

RESULTS: The literature search yielded 9650 citations, with 17 articles included for qualitative synthesis. The mean (SD) MERSQI score was 11.7 (1.9) out of 18. In total, 307 participants completed training in four disciplines. Immersive VR-trained groups performed 18% to 43% faster on procedural time to completion compared to control (pooled standardized mean difference = -0.90 [95% CI=-1.33 to -047, I²=1%, P < 0.0001]). Immersive VR trainees also demonstrated greater post-intervention scores on procedural checklists and greater implant placement accuracy compared to control.

CONCLUSIONS: Immersive VR incorporation into surgical training programs is supported by high-quality, albeit heterogeneous, studies demonstrating improved procedural times, task completion, and accuracy, positive user ratings, and cost-effectiveness.

PMID:34284320 | DOI:10.1016/j.jss.2021.06.045