Category: Nevin Manimala

J Surg Res. 2021 May 24;266:311-318. doi: 10.1016/j.jss.2021.03.063. Online ahead of print.

ABSTRACT

BACKGROUND: Atypical ductal hyperplasia (ADH) is a benign epithelial proliferative lesion with histologic features resembling those seen in low grade ductal carcinoma in situ (DCIS). Surgical excision of the biopsy site is the standard management approach. The objective of this study was to determine the upgrade rate from ADH on stereotactic breast biopsies to DCIS or invasive carcinoma (IC) in our institution. We also sought to identify clinical, pathologic and radiologic predictive factors associated with risk of upgrade.

MATERIALS AND METHODS: Clinical charts, mammograms and pathology reports were reviewed for all women with a stereotactic breast biopsy showing ADH and subsequent surgery at our institution between 2008 and 2018. When available, mammograms were re-reviewed by a radiologist for this study.

RESULTS: 295 biopsies were analyzed in 290 patients. Mean age was 56 y old. Upgrade rate was 10.5% of which 7.5% were DCIS and 3.1% IC. Mammograms were reviewed by a radiologist in 161 patients from 2013 to 2018. In this subset of patients, the rate of upgrade was 8.7% (4.35% DCIS and 4.35% IC). A statistically significant difference he largest size of the microcalcification clusters on mammogram was observed between the upgraded and the non-upgraded subgroups (14.2 mm versus 8.9 mm, P = 0.03) CONCLUSIONS: The evaluation of the largest size of microcalcification clusters on mammogram as a cut-off feature could be considered to choose between an observational versus a surgical approach. This large series provides contemporary data to assist informed decision making regarding the treatment of our patients.

PMID:34044175 | DOI:10.1016/j.jss.2021.03.063

Psychiatry Res. 2021 May 13;302:113992. doi: 10.1016/j.psychres.2021.113992. Online ahead of print.

ABSTRACT

AIMS: To examine the pathways explaining the association between bullying victimisation and suicidal behaviours among school-based adolescents.

METHODS: We used data from the Global School-based Student Health Survey from 90 countries conducted between 2003 and 2017. We applied multivariate regression and generalised structural equation models to examine the pathways.

RESULTS: Of 280,076 study adolescents, 32.4% experienced bullying and 12.1%, 11.1% and 10.9% reported suicidal ideation, suicidal planning and suicidal attempt, respectively. Adolescents who experienced bullying had higher rates of hunger (8.7% vs 5.0%), drinking soft drinks (44.0% vs 40.2%), truancy (35.8% vs 22.7%), smoking (14.0% vs 6.9%), alcohol consumption (19.9% vs 11.8%), peer victimisation (54.0% vs 25.6%), peer conflict (47.4% vs 20.1%), sleep disturbance (13.7% vs 5.6%), loneliness (18.1% vs 7.6%), no close friends (7.5% vs 5.2%), lack of peer support (64.9% vs 53.3%), lack of parental connectedness (67.0% vs 60.4%) and less parental bonding (64.1% vs 55.2%). Nearly one-fourth (18.7%) of the total association between bullying and suicidal ideation was mediated by loneliness. Similarly, sleep disturbances and alcohol consumption also mediated 4 to 9% of the association between bullying and suicidal behaviours.

CONCLUSION: This study suggests targeted policies and early implementation of interventional strategies focusing on addressing loneliness, sleep disturbance and alcohol consumption to reduce the risk of adverse suicidal behaviours among adolescents.

PMID:34044201 | DOI:10.1016/j.psychres.2021.113992

J AAPOS. 2021 May 24:S1091-8531(21)00111-7. doi: 10.1016/j.jaapos.2021.01.007. Online ahead of print.

ABSTRACT

PURPOSE: To assess the risk of vision-threatening anterior segment ischemia (ASI) among retinopathy of prematurity (ROP) patients treated with anti-VEGF followed by laser photocoagulation.

METHODS: The medical records of all infants treated for threshold ROP with laser photocoagulation with and without prior anti-VEGF injections from January 1, 2002, through December 2018 at Mayo Clinic were retrospectively reviewed for the prevalence of vision-threatening ASI.

RESULTS: A total of 241 eyes of 122 infants were included. Mean gestational age was 25.1 weeks (range, 22.9-28.7); mean birth weight was 687.6 g (range, 360-1310 g). Of the 54 eyes (27 patients) treated with anti-VEGF prior to laser, 4 developed ASI (including corneal edema, cataracts, and choroidal effusion) compared with 2 of the 187 eyes (95 patients) treated with laser therapy alone (P = 0.008). Infants receiving both anti-VEGF and laser had a younger gestational age at birth (24.5 vs 25.3 weeks; P < 0.001) and lower birth weight (591.4 g vs 715.0 g; P < 0.001) than those who received laser alone. In multivariate analysis, early gestational age at birth was associated with development of ASI (P = 0.03); the association with anti-VEGF treatment (P = 0.07) fell short of statistical significance.

CONCLUSIONS: The prevalence of vision-threatening ASI was higher among infants treated with intravitreal anti-VEGF followed by laser compared to those treated with laser alone. Further investigation is warranted to confirm this finding and identify potential factors for decreasing the risk of ASI.

PMID:34044115 | DOI:10.1016/j.jaapos.2021.01.007

Surg Infect (Larchmt). 2021 May 26. doi: 10.1089/sur.2020.397. Online ahead of print.

ABSTRACT

Background: The role of negative pressure wound therapy (NPWT) in the management of open chest wounds is unclear. Our aim was to determine the safety and efficacy of NPWT compared with conventional therapy for open chest wounds. Methods: Ten patients with infected open chest wounds were included in a prospective trial of NPWT after surgical debridement. Their outcomes were compared with those of 11 control patients treated during the same period with surgical debridement and open chest packing only. The control group data were obtained by retrospective review of medical records. Results: The median duration of NPWT was eight days (range 2-29 days), with closure in eight patients (80%). Two patients having NPWT had unveiling of occult pleural fistulas leading to early discontinuation. The patients having NPWT had a shorter median time to closure (7 versus 18 days; p = 0.071) and shorter initial (median 6 versus 20 days; p = 0.026) and total (median 6 versus 25 days; p = 0.024) hospital length of stay. Control patients had higher rates of new-onset atrial fibrillation (46% versus 0; p = 0.035) and septic shock (64% versus 10%; p = 0.024). The chest was either closed or healing at the time of the last visit in 100% of the NPWT patients versus 73% of control patients (p = 0.28). The 1-year survival estimates were 90% for the NPWT patients and 80% for the control patients (p = 0.69). Conclusion: Negative pressure wound therapy is feasible and safe for open infected chest wounds in selected patients compared with open packing alone and may reduce hospital stay duration and major complication rates.

PMID:34042543 | DOI:10.1089/sur.2020.397

Expert Opin Drug Saf. 2021 May 27. doi: 10.1080/14740338.2021.1935864. Online ahead of print.

ABSTRACT

BACKGROUND: Dalbavancin is a semisynthetic lipoglycopeptide antimicrobial agent with activity against Gram-positive bacteria including anaerobes.

RESEARCH DESIGN AND METHODS: Meta-analysis of randomized control trials and large case series (more than 20 patients), were identified by searching Pubmed and Cochrane databases through December 14, 2020.

RESULTS: 3,073 patients from 6 RCTs met the inclusion criteria in acute bacterial skin and skin-structure infections, catheter-related infections and osteomyelitis. Treatment emergent adverse effects were described in 30.6% dalbavancin patients, and 38.1% patients with other treatments. Our meta-analysis supports favorable results for dalbavancin treatment (OR 0.79; 95%CI 0.66-0.94; p = 0.01). 2.74% dalbavancin patients had to discontinue treatment versus 2.49% patients on other antibiotics. 4.80% dalbavancin patients versus 5.30% patients with other treatments had severe adverse events. 0.31% in the dalbavancin group and 0.95% receiving other antibiotics died. There was no statistically significant difference in severe adverse effects with OR 0.77; 95% CI 0.52-1.14; p=0.19. Dalbavancin therapy was shown to have statistically significant lower mortality rate (OR 0.26; 95% CI 0.07-0.90; p = 0.03). Observational studies reported few side effects but included a heterogeneous population of patients concerning their diagnosis and the duration of antibiotic treatment.

CONCLUSIONS: Dalbavancin has comparable safety profile relative to other antibiotics and is well-tolerated.

PMID:34042549 | DOI:10.1080/14740338.2021.1935864

J Palliat Med. 2021 May 25. doi: 10.1089/jpm.2019.0563. Online ahead of print.

ABSTRACT

Background: Physician Assistants (PAs) are increasingly likely to work in clinical areas where family conference skills are needed, but there is currently a lack of family conference education in PA program curricula. Objectives: To (1) describe a novel interprofessional education (IPE) event for PA students and chaplain residents; (2) examine whether participating in the IPE event is associated with improvements in attitudes and knowledge regarding interprofessional teams; and (3) describe participant perceptions about the event. Design: Two cohorts of PA students and chaplain residents completed a required interprofessional simulation activity involving a critically ill patient and a family conference. All participants completed pre- and postsimulation activity questionnaires. Bivariate tests were utilized to analyze the quantitative data. Setting/Subjects: Over two years, 171 PA students and 20 chaplain residents completed the activity at a school of medicine in the United States. Measurements: Pre- and postactivity measurements included role-specific questions plus overlapping sections regarding roles and responsibilities of the other discipline, comfort facilitating end-of-life discussions, and the value of IPE. Results: For PA students, there was a statistically significant increase for all questionnaire items. The largest effect size increases were in PA students’ confidence in provider-patient communication at the end of life (Cohen’s d > 1.1). Chaplain data demonstrated increases in knowledge of the PA role and likelihood of consulting with PAs in the future. Conclusion: This simulation event improved participant attitudes and knowledge relating to interprofessional interactions in the setting of an end-of-life family conference, and may contribute to more effective collaboration between PAs and chaplains in the clinical setting.

PMID:34042524 | DOI:10.1089/jpm.2019.0563

Neuroradiol J. 2021 May 27:19714009211019380. doi: 10.1177/19714009211019380. Online ahead of print.

ABSTRACT

BACKGROUND: The internal maxillary artery and extracranial middle meningeal artery are vitally important. Anatomical studies of the relationship of between them using computed tomography angiography are rare.

MATERIAL AND METHODS: This study assessed 75 cases involving 150 sides. And the vascular diameters and lengths of the internal maxillary artery and middle meningeal artery were measured using a GE workstation. The distance between the zygomatic arch midpoint and the internal maxillary artery, the angle between the internal maxillary artery and middle meningeal artery were measured, and the middle meningeal artery branch and internal maxillary artery aneurysm were recorded. The internal maxillary artery course classifications were recorded. All of these parameters were statistically analysed.

RESULTS: Ages ranged from 18 to 72 (average 40.2) years, and there were 30 women (40%, 30/75) and 45 men (60%, 45/75). Internal maxillary artery length from its origin to middle meningeal artery origin was 1.37 ± 0.59 cm. The extracranial middle meningeal artery length was 1.79 ± 0.48 cm. The vessel diameters of internal maxillary artery origin, middle meningeal artery origin, and middle meningeal artery at the skull base were 2.93 ± 0.52 mm, 1.58 ± 0.43 mm, and 1.33 ± 0.43 mm, respectively. Among the 150 sides of internal maxillary artery course type, there were 138 superficial (92%, 138/150) and 12 (8%, 12/150) deep course cases. The angle between the internal maxillary artery and middle meningeal artery was 116.2 ± 35.76°.

CONCLUSIONS: The findings of this study elucidate the imaging features of the internal maxillary artery and extracranial middle meningeal artery and their relationships, which are helpful for the extracranial-intracranial bypass and endovascular treatment via the internal maxillary artery and middle meningeal artery.

PMID:34042531 | DOI:10.1177/19714009211019380

Can J Nurs Res. 2021 May 27:8445621211014421. doi: 10.1177/08445621211014421. Online ahead of print.

ABSTRACT

OBJECTIVES: The study aimed to describe and compare nurses’ perceptions of role conflict by professional designation [registered nurse (RN) vs registered practical nurse (RPN)] in three primary areas of practice (emergency department, medical unit, and surgical unit).

METHODS: This analysis used data (n = 1,981) from a large cross-sectional survey of a random sample of RNs and RPNs working as staff nurses in acute care hospitals in Ontario, Canada. Role conflict was measured by the Role Conflict Scale.

RESULTS: A total of 1,981 participants (RN = 1,427, RPN = 554) met this study’s eligibility criteria and provided complete data. In general, RN and RPN mean total scale scores on role conflict hovered around the scale’s mid-point (2.72 to 3.22); however, RNs reported a higher mean score than RPNs in the emergency department (3.22 vs. 2.81), medical unit (2.95 vs 2.81) and surgical unit (2.90 vs 2.72). Where statistically significant differences were found, the effect sizes were negligible to medium in magnitude with the largest differences noted between RNs and RPNs working in the emergency department.

CONCLUSIONS: The results suggest the need to implement strategies that diminish role conflict for both RNs and RPNs.

PMID:34042538 | DOI:10.1177/08445621211014421

Genet Test Mol Biomarkers. 2021 May 27. doi: 10.1089/gtmb.2020.0342. Online ahead of print.

ABSTRACT

Background: The aim of this study was to investigate associations between polymorphisms in the Lysyl oxidase (LOX) gene with susceptibility to cancer. The role of LOX in carcinogenesis prompted several association studies in various cancer types; however the outcomes of these studies have inconsistent. Thus, we performed a meta-analysis to obtain more precise estimates. Materials and Methods: A literature search yielded 14 articles from which we examined five cancer groups: breast, bone, lung, gastrointestinal, and gynecological cancers. For each cancer group, pooled odds ratios (ORs) and confidence intervals (95% CIs) were calculated using standard genetic models. High significance (p-value for association [p^a] < 0.00001), homogeneity (I² = 0%), and high precision of effects (CI difference [CID] <1.0 [upper CI – lower CI]) comprised the three criteria for strength of evidence. We used sensitivity analysis to assess robustness of the outcomes. Results: We generated 28 comparisons from which 13 were significant (p^a < 0.05), indicating increased risk, (OR >1.00) found in all cancer groups except breast (p^a = 0.10-0.91). Of the 13, three met all criteria (core) for strength of evidence (p^a < 0.00001, CIDs 0.49-0.56 and I² = 0%), found in dominant/codominant models of gynecological cancers (ORs 1.52-1.62, 95% CIs 1.26-1.88) and codominant model of lung cancer (OR 1.44, 95% CI 1.19-1.74). These three were deemed robust. Conclusion: Based on the three core outcomes, associations of LOX 473G/A with lung, ovarian, and cervical cancers indicate 1.4-1.6-fold increased risks, underpinned by robustness and high statistical power at the aggregate level.

PMID:34042515 | DOI:10.1089/gtmb.2020.0342

Environ Sci Technol. 2021 May 27. doi: 10.1021/acs.est.1c01167. Online ahead of print.

ABSTRACT

In highly industrialized, densely populated parts of Central Europe, mobilization of legacy Zn pollution from forest ecosystems may negatively affect the quality of water resources. To test this hypothesis, we determined the ⁶⁶Zn/⁶⁴Zn isotope ratios of 15 Zn reservoirs and fluxes in an acidified, spruce die-back affected mountain-slope catchment in northern Czech Republic. The δ⁶⁶Zn values of precipitation, organic horizon, and runoff were statistically indistinguishable. In contrast, δ⁶⁶Zn values of bedrock orthogneiss and mineral soil were significantly different from δ⁶⁶Zn values of runoff. The magnitude of within-site Zn isotope fractionations appeared to be relatively small. Despite the large potential source of Zn in bedrock, runoff exported mostly young pollutant Zn that had been temporarily stored in the organic horizon. This conclusion was corroborated by comparing Zn input-output mass balances in the polluted northern catchment and in a relatively unpolluted catchment situated 250 km to the south. Seven-times higher Zn export via runoff at the northern site was controlled by a combination of 10-times higher atmospheric Zn input and five-times higher DOC leaching, compared to the southern site. In industrial areas, atmospherically deposited Zn is leached from headwater catchments in a direct analogy to leaching of highly toxic pollutant Pb.

PMID:34042419 | DOI:10.1021/acs.est.1c01167