Category: Nevin Manimala

J Allergy Clin Immunol Pract. 2021 Jun;9(6):2551-2552. doi: 10.1016/j.jaip.2021.03.026.

NO ABSTRACT

PMID:34112495 | DOI:10.1016/j.jaip.2021.03.026

J Natl Med Assoc. 2021 Jun 7:S0027-9684(21)00078-X. doi: 10.1016/j.jnma.2021.05.007. Online ahead of print.

ABSTRACT

Racial tensions continue to ignite social unrest in the United States. Structural racism is increasingly recognized as a public health issue. It is therefore necessary to continue addressing the interaction of race and medicine, including anesthesiology. While many may overlook the impact that racial discrimination has had on the development of anesthesiology, understanding pain through a racialized lens has always been entwined with this medical specialty since its origins. Considering the first public demonstration of ether anesthesia in 1846 occurred 15 years before the American Civil War (1861-1865), it is naïve to pretend that anesthesia has been insulated from racial prejudice. We increasingly recognize the effects of variables, such as housing and education, which are important as social determinants of health. Across ethnic and racial lines, statistically significant differences persist in pain assessment and analgesia delivery. To understand these irregularities without relying on unsupported theories, we must challenge our current understanding of race in medicine. By reviewing the history of anesthesia through a racialized lens, we may better explore our biases and develop strategies towards racially equitable care. This article focuses on anesthesia’s roots on the plantation in the American South, the medical perpetuation of racial disparities, and the challenges we face in healthcare today.

PMID:34112524 | DOI:10.1016/j.jnma.2021.05.007

Rev Esp Cir Ortop Traumatol. 2021 Jul-Aug;65(4):285-293. doi: 10.1016/j.recote.2021.04.010.

ABSTRACT

BACKGROUND AND AIM: Total knee arthroplasty (TKA) is a frequent intervention that can associate significant blood loss. There are several methods to avoid transfusions. One of the most relevant is tranexamic acid (TXA). Our purpose is to analyse the efficacy in terms of blood savings, transfusion needs, functional results, and cost-effectiveness of intra-articular (IA) administration in TKA.

MATERIALS AND METHODS: We conducted a retrospective analysis of historical cohorts (75 patients each) between January 2015 and December 2016. We included 150 patients (59,3% women) with a mean age of 73,58 years. The intervention consisted of administering 2 g of IA TXA with a contact time of 30 min. Demographic data, preoperative haematological status, surgery data, estimated total blood loss (ETBL), need for transfusion, functional results, and cost analysis were collected. The level of statistical significance was p ≤ 0,05.

RESULTS: The incidence of transfusion was 17,33% in the control group and 5,33% in the TXA group (p = 0,039), with a relative risk reduction of 78,3%. The TXA cohort showed a reduction in ETBL (p < 0,0005), units transfused (p = 0,019) and length of stay (p = 0,004). All early functional parameters also improved, including a 10° improvement in both flexion and extension (p < 0,0005). The use of IA TXA resulted in savings of 337,78 € per patient.

CONCLUSIONS: In our experience, the administration of IA TXA in TKA is a cost-effective and efficient measure in terms of blood savings and immediate postoperative functional improvement.

PMID:34112449 | DOI:10.1016/j.recote.2021.04.010

Environ Microbiol. 2021 Jun 10. doi: 10.1111/1462-2920.15617. Online ahead of print.

ABSTRACT

Hot springs integrate hydrologic and geologic processes that vary over short- and long-term time scales. However, the influence of temporal hydrologic and geologic change on hot spring biodiversity is unknown. Here, we coordinated near-weekly, cross-seasonal (~140 days) geochemical and microbial community analyses of three widely studied hot springs with local precipitation data in Yellowstone National Park. One spring (‘HFS’) exhibited statistically significant, coupled microbial and geochemical variation across seasons that was associated with recent precipitation patterns. Two other spring communities, ‘CP’ and ‘DS’, exhibited minimal to no variation across seasons. Variability in the seasonal response of springs is attributed to differences in the timing and extent of aquifer recharge with oxidized near-surface water from precipitation. This influx of oxidized water is associated with changes in community composition, and in particular, the abundances of aerobic sulfide-/sulfur-oxidizers that can acidify waters. During sampling, a new spring formed after a period of heavy precipitation and its successional dynamics were also influenced by surface water recharge. Collectively, these results indicate that changes in short-term hydrology associated with precipitation can impact hot spring geochemistry and microbial biodiversity. These results point to potential susceptibility of certain hot springs and their biodiversity to sustained, longer-term hydrologic changes.

PMID:34111905 | DOI:10.1111/1462-2920.15617

Rofo. 2021 Jun 10. doi: 10.1055/a-1382-8482. Online ahead of print.

ABSTRACT

PURPOSE: To investigate whether a humanoid robot in a clinical radiological setting is accepted as a source of information in conversations before MRI examinations of patients. In addition, the usability and the information transfer were compared with a tablet.

METHODS: Patients were randomly assigned to a robot or tablet group with their consent prior to MRI. The usability of both devices was compared with the extended System Usability Scale (SUS) and the information transfer with a knowledge query. Reasons for refusal were collected by a non-responder questionnaire.

RESULTS: At the University Hospital Halle 117 patients were included for participation. There was no statistically significant difference in gender and age. Of 18 non-responders, 4 refused to participate partly because of the robot; for another 3 the reason could not be clarified. The usability according to SUS score was different with statistical significance between the groups in the mean comparison and was one step higher for the tablet on the adjective scale. There was no statistically significant difference in knowledge transfer. On average, 8.41 of 9 questions were answered correctly.

CONCLUSION: This study is the first application, in a clinical radiological setting, of a humanoid robot interacting with patients. Tablet and robot are suitable for information transfer in the context of MRI. In comparison to studies in which the willingness to interact with a robot in the health care sector was investigated, the willingness is significantly higher in the present study. This could be explained by the fact that it was a concrete use case that was understandable to the participants and not a hypothetical scenario. Thus, potentially high acceptance for further specific areas of application of robots in radiology can be assumed. The higher level of usability perceived in the tablet group can be explained by the fact that here the interface represents a form of operation that has been established for years in all population groups. More frequent exposure to robots could also improve the response in the future.

KEY POINTS: · patients accept humanoid robots in clinical radiologic situations. · at present they can only convey information as well as an inexpensive tablet. · future systems can relieve the burden on personnel..

CITATION FORMAT: · Stoevesandt D, Jahn P, Watzke S et al. Comparison of Acceptance and Knowledge Transfer in Patient Information Before an MRI Exam Administered by Humanoid Robot Versus a Tablet Computer: A Randomized Controlled Study. Fortschr Röntgenstr 2021; DOI: 10.1055/a-1382-8482.

PMID:34111898 | DOI:10.1055/a-1382-8482

Stat Med. 2021 Jun 10. doi: 10.1002/sim.9008. Online ahead of print.

ABSTRACT

In medical research, the development of mediation analysis with a survival outcome has facilitated investigation into causal mechanisms. However, studies have not discussed the death-truncation problem for mediators, the problem being that conventional mediation parameters cannot be well defined in the presence of a truncated mediator. In the present study, we systematically defined the completeness of causal effects to uncover the gap, in conventional causal definitions, between the survival and nonsurvival settings. We propose a novel approach to redefining natural direct and indirect effects, which are generalized forms of conventional causal effects for survival outcomes. Furthermore, we developed three statistical methods for the binary outcome of survival status and formulated a Cox model for survival time. We performed simulations to demonstrate that the proposed methods are unbiased and robust. We also applied the proposed method to explore the effect of hepatitis C virus infection on mortality, as mediated through hepatitis B viral load.

PMID:34111901 | DOI:10.1002/sim.9008

Stat Med. 2021 Jun 10. doi: 10.1002/sim.9104. Online ahead of print.

ABSTRACT

Response adaptive randomization (RAR) is appealing from methodological, ethical, and pragmatic perspectives in the sense that subjects are more likely to be randomized to better performing treatment groups based on accumulating data. However, applications of RAR in confirmatory drug clinical trials with multiple active arms are limited largely due to its complexity, and lack of control of randomization ratios to different treatment groups. To address the aforementioned issues, we propose a Response Adaptive Block Randomization (RABR) design allowing arbitrarily prespecified randomization ratios for the control and high-performing groups to meet clinical trial objectives. We show the validity of the conventional unweighted test in RABR with a controlled type I error rate based on the weighted combination test for sample size adaptive design invoking no large sample approximation. The advantages of the proposed RABR in terms of robustly reaching target final sample size to meet regulatory requirements and increasing statistical power as compared with the popular Doubly Adaptive Biased Coin Design are demonstrated by statistical simulations and a practical clinical trial design example.

PMID:34111902 | DOI:10.1002/sim.9104

Gynecol Obstet Invest. 2021 Jun 10:1-6. doi: 10.1159/000515894. Online ahead of print.

ABSTRACT

OBJECTIVE: Our main objective was to assess the association between the markers p16 and Ki-67 and recurrence of disease in patients previously treated for cervical high-grade squamous intraepithelial lesion (HSIL).

DESIGN: This is a case-control study at the National Cancer Institute conducted between 2005 and 2015. Of the patients with a pathologically confirmed diagnosis of HSIL, 107 cases were selected. They were divided into 2 groups: 28 cases with recurrence after treatment and a control group of 79 patients without recurrence. We identified clinical, pathological, and treatment variables.

METHODS: Two experienced pathologists performed immunohistochemical analysis of biomarkers; they agreed on their interpretation, and we calculated the odds ratios (ORs) associated with recurrence. For group comparisons, we used the Wilcoxon signed-rank, χ2, or Fisher’s exact test, depending on the type of variable. We conducted logistic regression models to estimate ORs and determine the factors associated with recurrence. The recurrence-free period was defined as the time frame between conization and either recurrence of disease or the last date the patient was seen. We used Kaplan-Meier plots to visualize survival curves and log-rank tests to compare the curves. We established a p value <0.05 as statistically significant.

RESULTS: After pathologists performed immunohistochemical analysis, they achieved an agreement level of 83.7% for p16 and 60% for Ki-67. We did not find an association between recurrence and either p16 expression (p = 0.69) or the percentage of Ki-67 expression (p = 0.71). The recurrence-free period analysis did not reveal a difference in p16 expression (p = 0.57) nor in the percentage of Ki-67 expression in the 3-tiered scale (p = 0.56).

LIMITATIONS: Our main limitation was a reduced sample size.

CONCLUSION: We found no association between p16 and Ki-67 positivity and the risk of recurrence in previously treated HSIL.

PMID:34111875 | DOI:10.1159/000515894

Retina. 2021 Jun 8. doi: 10.1097/IAE.0000000000003233. Online ahead of print.

ABSTRACT

PURPOSE: To identify the incidence of, risk factors for, and outcomes of posterior segment complications (PSC) after Boston type 1 keratoprosthesis (KPro) implantation.

METHODS: Retrospective, consecutive case series of KPro procedures at the Stein Eye Institute. Data regarding ocular history, intraoperative details, postoperative management, and outcomes were collected. Eyes with at least one PSC (PSC Group) were compared with eyes without PSC (No PSC Group) and risk factors for PSC were determined.

RESULTS: 95 PSC occurred in 69/169 eyes (40.8%), at a mean of 20.1 months after KPro implantation (0.01 complications/eye-month). The median follow-up after KPro implantation was 44.0 months (range 3.0 – 174.4). The most common PSC were epiretinal membrane (ERM, 16.6%), cystoid macular edema (CME, 12.4%), vitritis (11.2%) and retinal detachment (RD, 9.5%). Previous RD repair, concomitant intraocular lens removal, postoperative aphakia and vitritis were risk factors for RD. Postoperative infectious keratitis was a risk factor for ERM, CME and vitritis. PSC Group had a significantly higher rate of eyes failing to maintain visual acuity ≥ 20/200 (HR = 2.28; 95%CI = 1.35 – 3.85) and KPro retention failure rate (HR = 1.66; 95%CI = 0.95 – 2.91).

CONCLUSION: PSC occur in approximately 40% of eyes after KPro implantation, resulting in reduced visual outcomes and KPro retention.

PMID:34111883 | DOI:10.1097/IAE.0000000000003233

Retina. 2021 Jun 7. doi: 10.1097/IAE.0000000000003234. Online ahead of print.

ABSTRACT

PURPOSE: Retinal vascular abnormalities (RVA) have been recently described in patients with neurofibromatosis type 1 (NF1) as vascular tortuosity, best visible on infrared imaging. This study assessed clinical RVA’s characteristics in a large series of children with NF1.

METHODS: This retrospective observational study was conducted in children (0 – 18 years old) with an NF1 diagnosis. Using near infrared imaging, RVAs were classified according to the nature of vessels involvement and their degree of tortuosity.

RESULTS: Retinal imaging from 140 children, with a median age of 8.8 [1.5 – 18] years, were included; 52 (37.1%) patients (81 eyes) exhibited RVAs. These RVAs comprised 96% (50/52) of simple vascular tortuosity and 17% (9/52) of cork-screw pattern. Cork-screw pattern involved only small veins, while simple vascular tortuosity could affect both arteries and veins. No statistically significant age correlation was observed, but evolution of RVAs from simple vascular tortuosity to cork-screw pattern was observed in 5 cases.

CONCLUSION: Retinal vascular abnormalities occurred in 37.1% of children with NF1. These abnormalities may result from NF1 promoting localised tortuosity in both small arteries and veins, while only small second or tertiary order venules evolve to highly tortuous pattern.

PMID:34111884 | DOI:10.1097/IAE.0000000000003234