Nevin Manimala

Hand (N Y). 2024 Mar 22:15589447241235343. doi: 10.1177/15589447241235343. Online ahead of print.

ABSTRACT

BACKGROUND: Thumb metacarpophalangeal (MP) fusion is generally successful; however, complications have been reported to occur in 0% to 30% of cases, whereas nonunion rates vary by method but, overall, are reported to occur in 0% to 15% of cases. Many fixation techniques have been described, but there is no consensus on the optimal fusion technique. Our goal was to compare complication and union rates of different thumb MP arthrodesis techniques.

METHODS: We performed a retrospective review of patients who underwent primary thumb MP fusion between 2000 and 2022. Patients who underwent revision fusion, fusion for infection, or amputation were excluded. Fusions of MP joints of other fingers were also excluded. Data collection consisted of demographic data, complications, time to fusion, rate of delayed union and rate of nonunion. Five different fusion constructs were evaluated during our study period: staples, Kirschner wires (K-wires), cerclage, K-wires with cerclage, and intramedullary screw.

RESULTS: Forty-seven patients underwent fusion with staples, 16 with K-wires, 14 with cerclage, 9 with K-wires and cerclage, and 6 with an intramedullary screw. The individual complication and nonunion rates differed significantly among the groups with the intramedullary screw group having a statistically higher rate of nonunion (P = .004). Furthermore, smoking, diabetes, and being overweight were associated with nonunions.

CONCLUSION: Union rates were significantly lower in patients treated with an intramedullary screw and those who are smokers, diabetics, and/or overweight. Caution should be exercised when using intramedullary screw fixation for MP fusion, especially in patients with these comorbidities.

PMID:38516828 | DOI:10.1177/15589447241235343

Laryngoscope. 2024 Mar 22. doi: 10.1002/lary.31398. Online ahead of print.

ABSTRACT

OBJECTIVES: Obstructive sleep apnea (OSA) is usually assessed at discrete and infrequent timepoints. Wearable consumer sleep technologies (CST) may allow for more granular and longitudinal assessments of OSA therapy responses and OSA-related symptoms.

METHODS: In this case series, we enrolled hypoglossal nerve stimulator (HGNS) patients who had an effective treatment response for an 8-week study using a wearable CST. Participants started with “HGNS-on,” were randomized to turn off HGNS therapy during either week 4 or 5 (“HGNS-off”), followed by a return to therapy, “HGNS-resume.” Participants completed validated symptom questionnaires assessing sleepiness, insomnia symptoms, functional status, and overall sleep health (Satisfaction, Alertness, Timing, Efficiency, and Duration, SATED) each week. CST metrics and survey scores were compared between HGNS treatment phases. Associations between CST metrics and survey scores were assessed.

RESULTS: Seven participants with a total of 304 nights of CST data showed no statistically significant changes in total sleep time (TST), wake time after sleep onset, or sleep efficiency (SE) across the study periods. During HGNS-off, survey scores indicated significantly worsened OSA-related symptom scores. Two participants had significantly higher heart rate variability (HRV) during HGNS-off (by 3.3 and 6.3 ms) when compared to HGNS active therapy periods. Amongst CST metrics, SATED scores correlated with TST (r = 0.434, p < 0.0001), HRV (r = -0.486, p < 0.0001), and SE (r = 0.320, = 0.0014). In addition, FOSQ-10 scores correlated with average HR during sleep (r = -0.489, p < 0.001).

CONCLUSION: A 1-week HGNS therapy withdrawal period impacted OSA-related sleep symptoms. Sleep-related metrics measured by a wearable CST correlated with symptom scores indicating potental value in the use of CSTs for longitudinal sleep-tracking in OSA patients.

LEVEL OF EVIDENCE: 4 Laryngoscope, 2024.

PMID:38516821 | DOI:10.1002/lary.31398

Am Surg. 2024 Mar 22:31348241241624. doi: 10.1177/00031348241241624. Online ahead of print.

ABSTRACT

OBJECTIVE: To retrospectively apply the Geriatric Trauma Outcome (GTO) score to the patient population of a rural South Central Appalachian level 1 trauma center and identify the potential utility of the GTO score in guiding goals of care discussions.

METHODS: Trauma registry data was extracted for 5,627 patients aged 65+ from 2017 to 2021. GTO score was calculated for each patient. Descriptive statistics were calculated for age, Injury Severity Score (ISS), GTO score, receipt of red blood cells, discharge status, and code status. A simple logistic regression model was used to determine the relationship between GTO score and discharge status. The probability of mortality was then calculated using GTO score, and the distribution of code status among patients with ≤50, 51-75%, and >75% probability of mortality was examined.

RESULTS: For every 10-point increase in GTO score, odds of mortality increased by 79% (OR = 1.79; P < .001). Patients had an estimated 50% probability of mortality with a GTO score of 156, 75% with 174, and 99% with a score of 234, respectively. Seventeen patients had a GTO score associated with >75% probability of mortality. Of those 17 patients, four retained a full code status.

CONCLUSIONS: Our analysis demonstrates that the GTO score is a validated measure in a rural setting and can be an easily calculated metric to help determine a geriatric patient’s probability of mortality following a trauma. The results of our study also found that GTO score can be used to inform goals of care discussions with patients.

PMID:38516793 | DOI:10.1177/00031348241241624

Circ Genom Precis Med. 2024 Mar 22:e004312. doi: 10.1161/CIRCGEN.123.004312. Online ahead of print.

ABSTRACT

BACKGROUND: Heart failure is heterogeneous syndrome with persistently high mortality. Nuclear magnetic resonance spectroscopy enables high-throughput metabolomics, suitable for precision phenotyping. We aimed to use targeted metabolomics to derive a metabolic risk score (MRS) that improved mortality risk stratification in heart failure.

METHODS: Nuclear magnetic resonance was used to measure 21 metabolites (lipoprotein subspecies, branched-chain amino acids, alanine, GlycA, ketone bodies, glucose, and citrate) in plasma collected from a heart failure community cohort. The MRS was derived using LASSO penalized Cox regression and temporal validation. The association between the MRS and mortality and whether risk stratification was improved over the Meta-Analysis Global Group in Chronic Heart Failure clinical risk score and NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels were assessed.

RESULTS: The study included 1382 patients (median age, 78 years, 52% men, 43% reduced ejection fraction) with a 5-year survival rate of 48% (95% CI, 46%-51%). The MRS included 9 metabolites measured. In the validation data set, a 1 SD increase in the MRS was associated with a large increased rate of death (hazard ratio, 2.2 [95% CI, 1.9-2.5]) that remained after adjustment for Meta-Analysis Global Group in Chronic Heart Failure score and NT-proBNP (hazard ratio, 1.6 [95% CI, 1.3-1.9]). These associations did not differ by ejection fraction. The integrated discrimination and net reclassification indices, and Uno’s C statistic, indicated that the addition of the MRS improved discrimination over Meta-Analysis Global Group in Chronic Heart Failure and NT-proBNP.

CONCLUSIONS: This MRS developed in a heart failure community cohort was associated with a large excess risk of death and improved risk stratification beyond an established risk score and clinical markers.

PMID:38516784 | DOI:10.1161/CIRCGEN.123.004312

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2024 Mar 21. doi: 10.5507/bp.2024.010. Online ahead of print.

ABSTRACT

BACKGROUND AND AIM: In a previous follow-up of glaucoma patients taking carteolol or latanoprost, we found a greater progression of visual field changes with the prostaglandin than the betablocker. In the present study we compared the impact of carteolol and latanoprost on peripapillary vessel density in newly diagnosed primary open-angle glaucoma (POAG) patients.

METHODS: The study consisted of two groups of POAG patients. There were 46 patient eyes treated with carteolol (Carteol LP 2%) in the first group and 52 eyes treated with latanoprost (Xalatan 0.005%) in the second. Intraocular pressure (IOP), vessel density (VD) and visual field were assessed in all patients. VD was measured peripapillary by optical coherence tomography angiography (OCTA) with the Avanti RTVue XR in eight segments: Inferior Temporal – IT (1); Temporal Inferior -TI (2); Temporal Superior – TS (3); Superior Temporal – ST (4); Superior Nasal – SN (5); Nasal Superior – NS (6); Nasal Inferior – NI (7) and Inferior Nasal – IN (8). The measurements were compared before and after three months of treatment. The visual field was examined with a fast threshold glaucoma program using a Medmont M 700 instrument from Medmont International Pty Ltd. and only when a diagnosis of POAG was done. The overall defect (OD) was assessed.

RESULTS: Before treatment, there was no difference between groups in either OD or VD. After treatment, there was a decrease in IOP in both groups. In the carteolol-treated group, the mean decrease was 5.8 mmHg and in the latanoprost-treated eyes, the mean decrease was 7 mmHg. The difference was not statistically significant (P=0.133). After treatment with carteolol, there was a statistically significant increase in VD in segments 4, 5 and 6. After latanoprost treatment, VD was statistically significantly improved only in segment 5. A greater increase in VD values was found in eyes treated with carteolol than in eyes treated with latanoprost.

CONCLUSION: Carteolol had a better effect on vessel density than latanoprost.

PMID:38516775 | DOI:10.5507/bp.2024.010

Nurs Crit Care. 2024 Mar 22. doi: 10.1111/nicc.13068. Online ahead of print.

ABSTRACT

BACKGROUND: Delirium commonly occurs in paediatric patients with acute critical illness and negatively affects clinical outcomes. Variations in delirium knowledge levels and its management have been noted among nurses.

AIMS: This study investigated nurses’ experiences and knowledge levels regarding paediatric delirium. Additionally, we aimed to assess the gap between knowledge levels and practical experiences with paediatric delirium.

STUDY DESIGN: This cross-sectional descriptive study conveniently sampled paediatric nurses from a university hospital in South Korea between September 2022 and March 2023. Nursing experiences with paediatric delirium and delirium knowledge levels were measured using structured survey questionnaires. Delirium knowledge was scored 0 to 47, and higher scores indicated higher levels of delirium-related knowledge. Data were analysed using descriptive statistics and presented as mean, standard deviation, frequency and percentage.

RESULTS: A total of 127 paediatric nurses participated in this study; 40.2% had experience with 1-5 delirium cases in the previous year, and 86.6% (n = 110) had never used assessment tools for paediatric delirium assessment. The mean total delirium knowledge score was 34.45 ± 5.4; the mean scores of knowledge regarding aetiology, signs and symptoms and nursing management of delirium were 8.93 ± 1.31, 13.24 ± 2.81 and 12.3 ± 2.7, respectively. Interventions associated with a lower level of delirium-related knowledge and a lower performance rate included avoiding restraint use and maintaining hydration and electrolyte levels. Interventions associated with a higher level of delirium-related knowledge but a lower rate of performance comprised providing orientation, offering emotional support, allowing participants to stay with family members and administering medications to manage delirium.

CONCLUSIONS: Although nurses working in paediatric units exhibited high rate of delirium nursing care, there was the gap between their delirium-related knowledge and practice. Nurses need to be aware of the insufficient part of delirium care, and paediatric delirium education should be reinforced.

RELEVANCE TO CLINICAL PRACTICE: Preventing, assessing and systematically managing paediatric delirium is crucial, and considering the study results, delirium education among nurses is needed.

PMID:38516768 | DOI:10.1111/nicc.13068

Am J Biol Anthropol. 2024 Mar 22:e24932. doi: 10.1002/ajpa.24932. Online ahead of print.

ABSTRACT

OBJECTIVES: Ecogeographic variation in human nasal anatomy has historically been analyzed on skeletal morphology and interpreted in the context of climatic adaptations to respiratory air-conditioning. Only a few studies have analyzed nasal soft tissue morphology, actively involved in air-conditioning physiology.

MATERIALS AND METHODS: We used in vivo computer tomographic scans of (N = 146) adult individuals from Cambodia, Chile, Russia, and Spain. We conducted (N = 438) airflow simulations during inspiration using computational fluid dynamics to analyze the air-conditioning capacities of the nasal soft tissue in the inflow, functional, and outflow tract, under three different environmental conditions: cold-dry; hot-dry; and hot-humid. We performed statistical comparisons between populations and sexes.

RESULTS: Subjects from hot-humid regions showed significantly lower air-conditioning capacities than subjects from colder regions in all the three conditions, specifically within the isthmus region in the inflow tract, and the anterior part of the internal functional tract. Posterior to the functional tract, no differences were detected. No differences between sexes were found in any of the tracts and under any of the conditions.

DISCUSSION: Our statistical analyses support models of climatic adaptations of anterior nasal soft tissue morphology that fit with, and complement, previous research on dry skulls. However, our results challenge a morpho-functional model that attributes air-conditioning capacities exclusively to the functional tract located within the nasal cavity. Instead, our findings support studies that have suggested that both, the external nose and the intra-facial soft tissue airways contribute to efficiently warming and humidifying air during inspiration. This supports functional interpretations in modern midfacial variation and evolution.

PMID:38516761 | DOI:10.1002/ajpa.24932

Pak J Biol Sci. 2024 Jan;27(2):100-107. doi: 10.3923/pjbs.2024.100.107.

ABSTRACT

&lt;b&gt;Background and Objective:&lt;/b&gt; The rapid development of Kendari City as the capital of Southeast Sulawesi Province has led to changes in land use patterns, particularly an increase in built-up areas, which threaten environmental stability. Rapid population growth contributes to rising carbon dioxide emissions, impacting air quality. Green spaces like Baruga Forest are ideal for environmental balance and bioservation. This study aims to identify the diversity of Collembola species in Baruga Forest, Kendari and understand the environmental factors influencing their presence. &lt;b&gt;Materials and Methods:&lt;/b&gt; Collembola was collected in the Baruga Forest using a Berlese funnel, then identified and classified based on the family by counting the number of individuals in each taxonomic group. The diversity of Collembola was measured using the Shannon-Wiener index, while the evenness of individual distribution in each family was assessed using an evenness index. Additionally, environmental parameters such as air temperature, air humidity and soil pH were measured. The collected data were analyzed using descriptive statistical analysis. &lt;b&gt;Results:&lt;/b&gt; The research results indicate that there are 75 individuals of Collembola belonging to the class Entognatha. The dominant order observed is Entomobryomorpha, consisting of three families: Oncopoduridae with 60 individuals, Isotomidae with 7 individuals and Orchesellidae with 5 individuals. Additionally, there is the order Symphypleona, represented by a single family, Bourletiellidae, with one individual. The biodiversity index (H’) yielded a moderate value of 0.622, where the most significant contribution comes from the genus Isotomidae. Meanwhile, the evenness index (E) indicates a uniform distribution among the various genera of Collembola. &lt;b&gt;Conclusion:&lt;/b&gt; Observed variations in temperature, humidity and soil pH changes underscore the need for ongoing management and conservation of Baruga Forest to maintain the diversity of Collembola species and the sustainability of the ecosystem in Baruga Forest.

PMID:38516751 | DOI:10.3923/pjbs.2024.100.107

Pak J Biol Sci. 2024 Jan;27(2):59-68. doi: 10.3923/pjbs.2024.59.68.

ABSTRACT

&lt;b&gt;Background and Objective:&lt;/b&gt; The liver is one of the organs that play an essential role in the human body, including supporting metabolism, immune functions, digestive system, detoxification, storage of vitamins and other functions. This investigation aimed to study the protective effects of black seed and lettuce oil against hepatotoxicity as induced by paracetamol in experimental rats. &lt;b&gt;Materials and Methods:&lt;/b&gt; Twenty male Sprague-Dawley albino rats weighing 150±5 g were divided randomly into four groups (5 rats each) and distributed as follows; 1st group was controlled negative (C -ve group), 2nd group controlled positive (orally administered with 500 mg/kg b.wt., paracetamol), 3rd and 4th groups were orally administered with black seed oil and lettuce oil at a dose of 1 mL/kg b.wt., each) as a preventive dose. All rats were sacrificed and blood was collected for biochemical analysis and then statistically analyzed. &lt;b&gt;Results:&lt;/b&gt; The rat administered with black seed and lettuce oils enhanced body weight gain, food intake and feed efficiency ratio. Moreover, exhibited a significant reduction in the liver enzymes AST, ALT, ALP and TBIL. Meanwhile, black seed and lettuce oils significantly improved kidney functions, lipid profiles and some immune biomarkers including creatine kinase (CK), Creatine Kinase-MB (CK-MB) and Lactate Dehydrogenase (LDH). &lt;b&gt;Conclusion:&lt;/b&gt; This study revealed that the oils of black seed (&lt;i&gt;Nigella sativa&lt;/i&gt;) and lettuce (&lt;i&gt;Lactuca sativa&lt;/i&gt;) have a protective role in improving body weight gain, food intake, feed efficiency ratio, liver enzymes, kidney functions, lipid profiles and some immune biomarkers against paracetamol-induced hepatotoxicity in experimental rats.

PMID:38516747 | DOI:10.3923/pjbs.2024.59.68

Radiat Prot Dosimetry. 2024 Mar 21:ncae060. doi: 10.1093/rpd/ncae060. Online ahead of print.

ABSTRACT

Passive diffusion radon monitoring devices were exposed to a range of radon concentrations and their variations. The experimental results, backed up by the statistical analysis, showed that the radon concentration had virtually no effect on the final integrated exposure results, with the exception for the very low concentration. Therefore, it was proven that such devices are truly integrated exposure devices.

PMID:38516732 | DOI:10.1093/rpd/ncae060