Category: Nevin Manimala

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

Wound Manag Prev. 2021 Jun;67(6):27-40.

ABSTRACT

BACKGROUND: Pressure injury is a common problem for patients undergoing surgery and is a significant quality indicator for perioperative care.

PURPOSE: To determine the rate of intraoperative pressure injuries and evaluate risk factors in surgical patients.

METHODS: A descriptive study was conducted from May to December 2019 among consecutive patients older than 18 years of age undergoing a nonemergent (planned) surgical procedure lasting longer than 2 hours in a hospital in Turkey. Patients with a history of preoperative pressure injury were not eligible for participation. Data collected included demographic and clinical information, preoperative Braden Scale scores, and 3S Intraoperative Risk Assessment Scale scores. The presence of a pressure injury was evaluated immediately postoperatively and 24 hours postoperatively. Descriptive statistics, chi-square, Student t test, Mann-Whitney U test, one-way analysis of variance, and the Kruskal-Wallis test were used for postoperative skin integrity and factors affecting the risk of pressure injury in the intraoperative period.

RESULTS: The 164 participants ranged in age from 18 to 80 years (mean, 51.58 ± 15.96 years). The most common procedures were orthopedic (47, 28.7%), the mean Braden Scale score was 19.96 ± 1.81, and the mean 3S Intraoperative Risk Assessment Scale score was 17.92 ± 3.03. Immediately postoperatively, 64.0% of patients had blanchable erythema and 6.7% had a stage 1 pressure injury. Also immediately postoperatively, noblanchable erythema was found to be affected by comorbidities, long hospitalization time before surgery, long operation time, American Society of Anesthesiologists score of II, lithotomy position, low body temperature, hypotension during surgery, and wetness under the gluteal and sacral area during surgery. In the skin assessment conducted 24 hours after surgery, 4.9% of patients had blanchable erythema.

CONCLUSIONS: The majority of patients (95.1%) did not show signs of a pressure injury during the time of the study (24 hours). Additional and longer-term studies are warranted.

PMID:34284347

Kidney Blood Press Res. 2021 Jul 20:1-7. doi: 10.1159/000517316. Online ahead of print.

ABSTRACT

INTRODUCTION: Orthostatic hypotension (OH) affects 5-20% of the population. Our study investigates the presence of OH in diabetic nephropathy (DNP) patients and the factors affecting OH in comparison with nondiabetic chronic kidney disease (NDCKD) patients.

METHOD: Patients presented to the nephrology clinic, and those who consented were included in the study. DNP was defined by kidney biopsy and/or clinical criteria. NDCKD patients of the same sex, age, and eGFR were matched to DNP patients. Demographic parameters and medications were obtained from the records. OH was determined by Mayo clinic criteria. The same researcher used an electronic device to measure blood pressure (BP). All samples were taken and analyzed the same day for biochemical and hematologic parameters and albuminuria.

RESULTS: 112 (51 F, 61 M, mean age: 62.56 ± 9.35 years) DNP and 94 (40 F, 54 M, mean age: 62.23 ± 10.08 years) NDCKD patients were included. There was no significant difference between DNP and NDCKD groups in terms of OH prevalence (70.5 vs. 61.7%, p = 0.181). Male patients had significantly higher OH prevalence than female patients (74.7 vs. 60.0%, p = 0.026). There was no significant difference in change in systolic BP between the groups (24.00 [10.00-32.00] mm Hg vs. 24.00 [13.75-30.25] mm Hg, p = 0.797), but the change in diastolic BP was significantly higher in the DNP group (8.00 [2.00-13.00] mm Hg vs. 6.00 [2.00-9.00] mm Hg, p = 0.025). In the DNP group, patients with OH had significantly higher uric acid levels than those without OH (7.18 ± 1.55 vs. 6.36 ± 1.65 mg/dL, p = 0.017). And, 73.7% of patients on calcium channel blockers developed OH (p = 0.015), and OH developed in 80.6% of 36 patients on alpha-blockers (p = 0.049).

CONCLUSION: OH prevalence is very high in CKD, and etiology of CKD does not have a statistically significant effect on the frequency of OH, despite a difference that could be meaningful clinically. Therefore, patients with CKD are checked for OH, with or without concurrent diabetes mellitus. Evaluation of postural BP changes should be a part of nephrology practice.

PMID:34284392 | DOI:10.1159/000517316

Seizure. 2021 Jul 13;91:339-345. doi: 10.1016/j.seizure.2021.07.012. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess the efficiency and safety profiles of levetiracetam and (fos)phenytoin (phenytoin or fosphenytoin) for second-line treatment of seizures by performing a meta-analysis of RCTs.

METHODS: We systematically searched PubMed, Embase, Cochrane, FDA.gov, and ClinicalTrials.gov for RCTs (published before July 31, 2020; no language restrictions). Two independent reviewers screened abstracts and titles against inclusion and exclusion criteria published previously in the PROSPERO: CRD42020202736. Eleven studies fulfilled the established criteria. We assessed pooled data by using a random-effects model. Quality analysis was performed by using version 2 of the Cochrane risk-of-bias tool (RoB 2). RevMan v.5.3 was used to perform statistical analyses, and publication bias (egger’s test) was assessed with Stata MP v.14.0.

RESULTS: Levetiracetam was similar to (fos)phenytoin in seizure termination rate (risk ratio [RR] 0.94; 95% CI 0.87 to 1.01), time of seizure termination (mean difference [MD] 0.44; -0.60 to 1.49), and drug resistance ([RR] 1.12, 0.86 to 1.45). The safety outcome showed a significant statistical difference between fosphenytoin group and levetiracetam group ([RR] 1.44, 1.14 to 1.81), while there was no significant difference observed between phenytoin treatment and levetiracetam treatment ([RR] 1.26, 0.99 to 1.60).

CONCLUSION: Levetiracetam was similar to (fos)phenytoin in cessation rate convulsive status epilepticus, and drug resistance, while it was superior (fos)phenytoin in pooled safety outcome. Further exploration is still needed as to whether it is the first choice for second-line drugs.

PMID:34284302 | DOI:10.1016/j.seizure.2021.07.012

J Environ Radioact. 2021 Jul 17;237:106702. doi: 10.1016/j.jenvrad.2021.106702. Online ahead of print.

ABSTRACT

Pu distribution coefficient K_d variation was experimentally determined and examined in natural soil samples considering the type of soil, particle size, pH, the concentration of macroelements and organic matter content. This research was carried out with sand, silty sand, peat, clayey sand and clayey loam samples by applying ²³⁶Pu tracer in flow-through column tests. Due to relatively short contact time of 0.5-40 h the tests are considered as have not reached equilibrium state and represent the fast-moving contaminants retardation processes closer to field conditions. Every soil sample was fractionated into two particle size fractions: ≤0.25 mm and 0.25 ÷ 0.5 mm. Analysis revealed that K_d of Pu is higher for the smaller soil particle fraction (≤0.25 mm). The experimental study with 1.6, 4, 6 and 9 pH tracer solution revealed a tendency of elevated K_d when 4 pH and 6 pH solutions were applied, but obtained K_d values were not correlated with initial soil pH due to high buffering capacity of soils. This study shows a very significant influence (r = 0.98) of organic matter content on the Pu distribution coefficient. The K_d of Pu for the fine fraction of peat soil with high organic matter content (67%) reached maximum values of 6597 L/kg and 6200 L/kg when tracer solution was applied of pH = 4 and pH = 6, respectively. In comparison, the minimum K_d value of 3.9 L/kg was obtained for the coarse silty sand fraction with the lowest organic matter content of 1.3% at tracer pH = 1.6. A statistically reliable high correlations of r = 0.95 and 0.94 were also observed between K_d and specific soil elements Mg and Pb content in soils, respectively. The content of Fe in soils was significantly correlated (r = 0.67) with the K_d values of plutonium as well. However, the organic matter content in soils appeared to be the governing factor determining good correlations and causing the highest K_d of Pu values.

PMID:34284309 | DOI:10.1016/j.jenvrad.2021.106702

Epidemics. 2021 Jul 13;36:100483. doi: 10.1016/j.epidem.2021.100483. Online ahead of print.

ABSTRACT

INTRODUCTION: Most countries are dependent on nonpharmaceutical public health interventions such as social distancing, contact tracing, and case isolation to mitigate COVID-19 spread until medicines or vaccines widely available. Minimal research has been performed on the independent and combined impact of each of these interventions based on empirical case data.

METHODS: We obtained data from all confirmed COVID-19 cases from January 7th to February 22nd 2020 in Zhejiang Province, China, to fit an age-stratified compartmental model using human contact information before and during the outbreak. The effectiveness of social distancing, contact tracing, and case isolation was studied and compared in simulation. We also simulated a two-phase reopening scenario to assess whether various strategies combining nonpharmaceutical interventions are likely to achieve population-level control of a second-wave epidemic.

RESULTS: Our study sample included 1,218 symptomatic cases with COVID-19, of which 664 had no inter-province travel history. Results suggest that 36.5 % (95 % CI, 12.8-57.1) of contacts were quarantined, and approximately five days (95 % CI, 2.2-11.0) were needed to detect and isolate a case. As contact networks would increase after societal and economic reopening, avoiding a second wave without strengthening nonpharmaceutical interventions compared to the first wave it would be exceedingly difficult.

CONCLUSIONS: Continuous attention and further improvement of nonpharmaceutical interventions are needed in second-wave prevention. Specifically, contact tracing merits further attention.

PMID:34284227 | DOI:10.1016/j.epidem.2021.100483

Clin Neurophysiol. 2021 Jun 12;132(9):2163-2175. doi: 10.1016/j.clinph.2021.05.020. Online ahead of print.

ABSTRACT

OBJECTIVE: Many studies have examined the effectiveness of transcranial direct current stimulation (tDCS) on human pain perception in both healthy populations and pain patients. Nevertheless, studies have yielded conflicting results, likely due to differences in stimulation parameters, experimental paradigms, and outcome measures. Human experimental pain models that utilize indices of pain in response to well-controlled noxious stimuli can avoid many confounds present in clinical data. This study aimed to assess the robustness of tDCS effects on experimental pain perception among healthy populations.

METHODS: We conducted three meta-analyses that analyzed tDCS effects on ratings of perceived pain intensity to suprathreshold noxious stimuli, pain threshold and tolerance.

RESULTS: The meta-analyses showed a statically significant tDCS effect on attenuating pain-intensity ratings to suprathreshold noxious stimuli. In contrast, tDCS effects on pain threshold and pain tolerance were statistically non-significant. Moderator analysis further suggested that stimulation parameters (active electrode size and current density) and experimental pain modality moderated the effectiveness of tDCS in attenuating pain-intensity ratings.

CONCLUSION: The effectiveness of tDCS on attenuating experimental pain perception depends on both stimulation parameters of tDCS and the modality of experimental pain.

SIGNIFICANCE: This study provides some theoretical basis for the application of tDCS in pain management.

PMID:34284252 | DOI:10.1016/j.clinph.2021.05.020

Eur J Obstet Gynecol Reprod Biol. 2021 Jul 4;264:76-82. doi: 10.1016/j.ejogrb.2021.06.047. Online ahead of print.

ABSTRACT

OBJECTIVES: Pregnancies and births following assisted reproductive treatment (ART) are related to an increased risk for adverse perinatal outcomes. The aim of this retrospective cohort study at a University Hospital with a tertiary perinatal center was the combined risk analysis of singleton and twin pregnancies after ART in comparison to spontaneously conceived pregnancies.

STUDY DESIGN: Maternal and fetal risks were analyzed in subgroups after spontaneous conception (N = 14,233) and ART (N = 785) during the 6-year study period from 2014 to 2019. Odds ratios for perinatal risks between the groups were calculated and adjusted for maternal age and gestational week at birth using a matched control analysis. Subgroups of preterm delivery were compared.

RESULTS: The overall maternofetal risks after ART are higher than after spontaneous conception. Maternal risks after ART are mainly related to higher maternal age (p < 0.001). Preterm delivery and neonatal complications are more frequent in twins than in singletons (p < 0.001), but no statistically significant differences were seen in comparison in the subgroup of twins due to conception. Higher maternal age and body mass index did not increase the risk of preterm birth in twin pregnancies.

CONCLUSIONS: Maternal risks in pregnancies after ART are mainly influenced by maternal age. The strongest risk factor in ART pregnancies is a multiple pregnancy. Every 5th pregnancy after ART was a twin pregnancy with higher risks for preterm delivery, maternal hospitalization and adverse neonatal outcome (p < 0.001). Advanced maternal age in ART cannot be altered, but twin pregnancies can be actively avoided using the single embryo transfer strategy.

PMID:34284271 | DOI:10.1016/j.ejogrb.2021.06.047

Cells Dev. 2021 Jul 17:203723. doi: 10.1016/j.cdev.2021.203723. Online ahead of print.

ABSTRACT

The neural tube is the precursor of the central nervous system. Its early formation and growth are known to be extremely biased along the anteroposterior (AP) axis. Several mechanisms including addition of cells from the tail bud, lateral pressure from surrounding tissues and oriented cell divisions have been proposed to contribute to this biased growth. Here we show that, contrary to what has been found in posterior regions encompassing the tail bud region, the growth of the anterior trunk neural tube is slower along the AP direction than in the other axes. We found that this is due to anchorage of the neural tube to the matrix which favors apicobasal elongation at the expense of AP growth. In addition, as the neural tube develops, we found a moderate slowdown of cell proliferation that could account for the overall reduction of the pace of 3D growth in the same time window. However, as we found no preferred orientation of cell division, changes in cell cycle pace are unlikely to directly contribute to the observed AP-hindered growth of neural tube. Overall, these data indicate that neural tube growth is not intrinsically positively biased along the AP axis. Rather it switches from AP-favored to AP-hindered regimes between the most posterior and anterior trunk neural tube regions.

PMID:34284169 | DOI:10.1016/j.cdev.2021.203723

Environ Pollut. 2021 Jul 16;288:117802. doi: 10.1016/j.envpol.2021.117802. Online ahead of print.

ABSTRACT

This study investigates changes in air quality conditions during the restricted COVID-19 lockdown period in 2020 across 21 metropolitan areas in the Middle East and how these relate to surface urban heat island (SUHI) characteristics. Based on satellite observations of atmospheric gases from Sentinel-5, results indicate significant reductions in the levels of atmospheric pollutants, particularly nitrogen dioxide (NO₂), sulfur dioxide (SO₂), and carbon monoxide (CO). Air quality improved significantly during the middle phases of the lockdown (April and May), especially in small metropolitan cities like Amman, Beirut, and Jeddah, while it was less significant in “mega” cities like Cairo, Tehran, and Istanbul. For example, the concentrations of NO₂ in Amman, Beirut, and Jeddah decreased by -56.6%, -43.4%, and -32.3%, respectively, during April 2020, compared to April 2019. Rather, there was a small decrease in NO₂ levels in megacities like Tehran (-0.9%) and Cairo (-3.1%). Notably, during the lockdown period, there was a decrease in the mean intensity of nighttime SUHI, while the mean intensity of daytime SUHI experienced either an increase or a slight decrease across these locations. Together with the Gulf metropolitans (e.g. Kuwait, Dubai, and Muscat), the megacities (e.g. Tehran, Ankara, and Istanbul) exhibited anomalous increases in the intensity of daytime SUHI, which may exceed 2 °C. Statistical relationships were established to explore the association between changes in the mean intensity and the hotspot area in each metropolitan location during the lockdown. The findings indicate that the mean intensity of SUHI and the spatial extension of hotspot areas within each metropolitan had a statistically significant negative relationship, with Pearson’s r values generally exceeding – 0.55, especially for daytime SUHI. This negative dependency was evident for both daytime and nighttime SUHI during all months of the lockdown. Our findings demonstrate that the decrease in primary pollutant levels during the lockdown contributed to the decrease in the intensity of nighttime SUHIs in the Middle East, especially in April and May. Changes in the characteristics of SUHIs during the lockdown period should be interpreted in the context of long-term climate change, rather than just the consequence of restrictive measures. This is simply because short-term air quality improvements were insufficient to generate meaningful changes in the region’s urban climate.

PMID:34284210 | DOI:10.1016/j.envpol.2021.117802