Nevin Manimala

J Orthop Surg Res. 2024 Dec 31;19(1):896. doi: 10.1186/s13018-024-05339-x.

ABSTRACT

BACKGROUND: Anterior cervical corpectomy and fusion (ACCF) is a standard surgical procedure for cervical spondylosis with spinal cord compression (CSWSCC), especially in patients with intensity on T2-weighted imaging high signal (T2WIHS). The titanium mesh cage (TMC) utilized in this procedure is essential in stabilizing the spine; however, the optimal slotting width of the TMC remains unclear.

OBJECTIVE: This study aimed to investigate the impact of TMC slotting width on the clinical and radiological outcomes of ACCF in patients with spinal cord compression type cervical spondylosis with intensity on T2WIHS (CST2WIHS).

METHODS: We retrospectively analyzed 69 patients who underwent single-level ACCF between December 2010 and October 2021. The patients were divided into narrower (< 2 mm) and wider (> 2 mm) groups based on the slotting width of the TMC. The Neck Disability Index (NDI) and Japanese Orthopedic Association (JOA) scores were used to assess clinical outcomes. Radiological outcomes included cervical lordosis (CL), functional spinal unit (FSU) height, transverse decompression range (TDR), spinal canal area (SCA), TMC alignment, and subsidence and fusion rates.

RESULTS: Patients in both groups exhibited significant postoperative improvement in NDI and JOA scores (P < 0.05). Radiologically, patients in the wider slotting group exhibited better decompression, evidenced by a larger TDR (P < 0.01) and smaller postoperative SCA (P < 0.01) than the narrow group. Regarding CL, FSU height, TMC alignment, subsidence, or fusion rates, the groups did not differ significantly. Although statistically non-significant, patients in the wider group exhibited a trend towards improvement in spinal cord signal intensity than those in the narrower group.

CONCLUSION: The study demonstrated that a wider TMC slotting width offers superior decompression and may improve postoperative spinal cord signal; it does not compromise spinal stability or fusion outcomes. These findings indicate that slotting width should be carefully considered in ACCF procedures to optimize decompression and spinal cord recovery.

PMID:39741291 | DOI:10.1186/s13018-024-05339-x

BMC Gastroenterol. 2024 Dec 31;24(1):482. doi: 10.1186/s12876-024-03574-4.

ABSTRACT

BACKGROUND: Percutaneous Endoscopic Gastrostomy (PEG) tube insertion, a routine procedure for long-term enteral nutrition, serves as a crucial intervention for patients who are incapable of tolerating oral intake or meeting adequate nutritional requirements. PEG tube placement carries complications like bleeding and infection. Impact of PEG tubes on the 30-day and long-term mortality in HIV patients is unknown. Despite the ongoing utilization of PEG tubes in HIV patients, a comprehensive exploration of its outcomes is yet to be explored. We intended to study the impact of HIV positive status on post-PEG mortality and review other PEG tube related complications.

METHODS: Our study comprised a total of 639 PEG tubes placed on 461 unique patients, from which 85 patients (n = 18%) were HIV positive. We reviewed all these PEG tube patients at our institution and compared their complications and mortality outcome between the two groups of HIV positive as against HIV negative.

RESULTS: Our findings reveal a statistically significant increase (p-value 0.001) in post-PEG insertion site bleeding in the HIV group (15.3%) compared to the non-HIV group (4.5%). This difference occurred despite no notable variations in laboratory parameters such as platelet count and (international normalized ratio), as well as similar usage of anticoagulant or antiplatelet medications between the two groups. Notably, the 1-year mortality rate in the HIV group stands at 37.6% (p < 0.001), contrasting sharply with the non-HIV group’s rate of 17.8%.

CONCLUSION: This study underscores the need for heightened vigilance and tailored management strategies when considering PEG tube procedures in the context of HIV, given the observed elevated bleeding risks and increased 1-year mortality rates in this patient population. Further research is warranted to elucidate the underlying factors contributing to these outcomes, facilitating the development of targeted interventions to optimize the care of HIV patients undergoing PEG placement.

PMID:39741264 | DOI:10.1186/s12876-024-03574-4

BMC Psychiatry. 2024 Dec 31;24(1):962. doi: 10.1186/s12888-024-06434-3.

ABSTRACT

BACKGROUND: Major depressive disorder (MDD) is a highly prevalent mental disorder with devastating consequences that often first manifest during adolescence. Anhedonia has emerged as one of the most promising symptoms of adolescent MDD, which means a longer time to remission， fewer depression-free days, and also increased risk of suicide ideas or actions. Research has shown that at least two-thirds of depressed adolescents have significant sleep-onset or sleep-maintenance problems. However, the association between sleep disorder and anhedonia, and the potential mediators are less understood.

METHODS: This is a cross-sectional study that includes 200 adolescents suffered from MDD between the ages of 12-17. We use Spearman’s test to explore the relationship among main variables. To evaluate the mediating effects of stress, we applied regression models and used bootstrap method to validate the significance of effects.

RESULTS: Significant correlation exists among sleep disorder, stress, and anhedonia (P<0.05).The direct effect of sleep disorder on anhedonia was 0.214 (95% CI: 1.5235, 6.2073), while the total effect was 0.295 (95% CI: 2.9683, 7.6924). The indirect effect of sleep disorder on anhedonia mediated by stress was 0.081 (95% CI: 0.5842, 2.5268). Robustness of the regression analysis results has been verified by bootstrap test.

CONCLUSIONS: Our finding suggested a positive correlation between sleep disturbance and anhedonia in adMDD. Stress partially mediated the relationship between sleep disorder and anhedonia. Due to the deleterious effects of anhedonia on depressed adolescents, these findings provide impetus to investigate further the causal relationship between sleep problems and anhedonia.

TRIAL REGISTRATION: ChiCTR2200060176(Registration Date: 21/05/2022).

PMID:39741263 | DOI:10.1186/s12888-024-06434-3

BMC Oral Health. 2024 Dec 31;24(1):1577. doi: 10.1186/s12903-024-05379-z.

ABSTRACT

BACKGROUND: Orthodontic treatment involves manipulation of tooth position that can temporarily lead to occlusal interferences capable of inducing bruxism. The objectives of this study were to determine the self-reported incidence of bruxism and its association with factors such as facial type, divergence, skeletal and dental malocclusions in orthodontic patients.

MATERIALS AND METHODS: 80 patients who underwent a minimum of six months of orthodontic treatment were surveyed using a validated self-reported bruxism questionnaire for the presence or absence of bruxism. Data regarding patients’ facial type, divergence, skeletal and dental malocclusions were measured and collected from the patients’ orthodontic records. Binomial logistic regression analysis was used to assess the association of these factors with bruxism.

RESULTS: About 45% of the orthodontic patients reported bruxism after the commencement of orthodontic treatment. The median age of the sample was 19.8 (17.7, 24.3) years and 60% of them were women. Binomial logistic regression analysis showed an insignificant association of gender and age with bruxism. When analyzing the association with facial type, divergence, skeletal and dental malocclusion no statistically significant association was found. However, patients with hypodivergent face [odds ratio (OR) = 2.4; 95% confidence interval (CI) = 0.7-8.5] and dental class III [OR = 4.0; 95% CI = 0.3-51.0] were more likely to report bruxism after the initiation of orthodontic treatment. A statistically significant association was found with jaw fatigue or soreness upon awakening (28.7%), clenching (27.5%) and grinding (25%) in the bruxism group (p-value ≤ 0.001). Teeth and gum soreness were also significantly associated with bruxism, affecting 25% of the orthodontic patients (p-value ≤ 0.001). On the contrary, nocturnal grinding (10%) and temporal headaches (21.3%) were negatively correlated with bruxism.

CONCLUSIONS: There is a risk of bruxism among orthodontic patients, with 45% of them reporting bruxism following the initiation of treatment. Patients with bruxism commonly reported jaw fatigue or soreness upon awakening, clenching, grinding, teeth and gum soreness. Factors such as facial type, facial divergence, skeletal and dental malocclusions have no impact on the onset of bruxism during orthodontic treatment.

PMID:39741259 | DOI:10.1186/s12903-024-05379-z

BMC Psychiatry. 2024 Dec 31;24(1):960. doi: 10.1186/s12888-024-06390-y.

ABSTRACT

BACKGROUND: Problematic Internet use (PIU) is a growing concern in modern society. There is a limitation of epidemiologic data related to PIU. This is due to a lack of consensus on the definition and variability of assessment tools of PIU. PIU has been linked to a range of negative outcomes including depression, anxiety, social isolation, and poor academic or work performance. Resident physicians are at risk of exhibiting problematic internet use due to the high stress of academic demands, social isolation, long working hours, busy schedules, and internet access. There is limited research on this topic and targeting resident physicians in Ethiopia. This study aimed to determine the PIU prevalence and associated factors among resident physicians in SPHMMC, Ethiopia.

METHODS: An institutional-based cross-sectional study was conducted from September 1, 2023, to November 25, 2023, at St. Paul’s Hospital Millennium Medical College (SPHMMC). This study included 417 physician residents who were selected using multistage sampling techniques, and Young’s Internet addiction test was used to assess PIU. To look for associations, logistic regression analysis, both binary and multivariable, was performed, and a p-value of < 0.05 was used to determine statistical significance.

RESULTS: 414 participants were included in this study, with a response rate of 99.3%. The prevalence of PIU was 46.6%, with a 95% CI of 41.7-51.6%. The multivariable logistic regression model revealed that using the Internet for five or more hours per day (AOR: 1.84, 95% CI = 1.14, 2.99), having less than 7 h of actual sleep per night (AOR: 2.16, 95% CI = 1.03, 4.53), and having depression (AOR: 7.98, 95% CI = 2.47, 25.78) were significantly positively associated with PIU. In addition, factors such as being married (AOR: 0.42, 95% CI = 0.19, 0.91) and residents of the obstetrics and gynecology department (AOR: 0.32, 95% CI = 0.13, 0.81) were negatively associated with PIU.

CONCLUSION: This study revealed high PIU use among resident physicians at SPHMMC. Factors such as using the Internet for five or more hours per day, having less than seven hours of actual sleep per night, and having depression were found to be risk factors for PIU. On the other hand, being married and residents of the obstetrics and gynecology department were protective factors. Thus, creating awareness among medical residents about healthy tech habits and involving policymakers to develop guidelines for healthy internet use and awareness campaigns to reduce the impact of PIU is recommended.

PMID:39741254 | DOI:10.1186/s12888-024-06390-y

BMC Pregnancy Childbirth. 2024 Dec 31;24(1):889. doi: 10.1186/s12884-024-06912-2.

ABSTRACT

OBJECTIVE: To study the implementation value of abdominal B-ultrasound combined with cervical cerclage in the prevention and treatment of recurrent late abortion.

METHODS: From October 2020 to December 2023, 196 pregnant patients who had a history of late abortions at our institution were chosen. They were divided into groups based on the treatments used. In the observational team, 98 instances received abdominal B-ultrasound along with cervical cerclage, while 98 instances in the controlling team underwent traditional conservative treatment. Vaginal flora, inflammatory factor levels, labor outcomes, uterine artery parameters, and adverse effects were observed in both groups of pregnant women.

RESULTS: Comparing the detection of vaginal flora between the two groups, the difference was not statistically significant (P > 0.05); the detection values of WBC, neutrophil percentage and neutrophil absolute value in the observation group were lower than those in the control group (P < 0.05). The recurrent late abortion rate (4.08%) and premature delivery rate (16.33%) were lower than those of the control group, and the full-term delivery rate (79.59%) and total fetal survival rate (93.88%) were higher than those of the control group, and the difference was statistically significant (P < 0.05). The resistance index (RI) and pulsatility index (PI) of pregnant women with abortion were higher than those of live birth pregnant women. The RI and PI of group A (pregnant women with recurrent late abortion) at 7, 12, 24 and 32 weeks of gestation were also higher than those of group B (pregnant women without recurrent late abortion), and the difference was statistically significant (P < 0.05). At 7 weeks of gestation, there was no statistical difference between the observation and control groups in terms of RI and PI (P > 0.05)0.12 By 32 weeks of gestation, the RI and PI were lower in the observation group than in the control group (P < 0.05)0.13 In the observation group, the RI and PI were lower than in the control group (P < 0.05). The incidence of gestational hypertension, gestational diabetes mellitus, and eclampsia were significantly lower in the observation group compared to the control group (P < 0.05).

CONCLUSION: Abdominal ultrasound combined with cervical cerclage reduces the risk of miscarriage by improving the hemodynamic status of the uterus and placenta, and also optimizes the pregnancy environment by reducing the inflammatory response in the uterine cavity, which has important clinical applications in the prevention and treatment of late recurrent spontaneous abortion.

PMID:39741251 | DOI:10.1186/s12884-024-06912-2

Int J Emerg Med. 2024 Dec 31;17(1):204. doi: 10.1186/s12245-024-00798-9.

ABSTRACT

BACKGROUND: Elevated initial serum lactate (iSL) levels are frequently employed to assess trauma severity, but their predictive value for mortality and morbidity remains inconsistent. We evaluated the association of iSL with mortality and morbidity at Puerto Rico Trauma Hospital (PRTH).

METHODS: This IRB-approved retrospective study included trauma patients ≥ 18 years with iSL measured within the first 48 h of admission to PRTH (July 2014-June 2019). Patients were classified as normal (4.5-19.8 mg/dL) or elevated (≥ 19.9 mg/dL) iSL levels. Group comparisons were conducted using t-tests, Wilcoxon rank-sum tests, Pearson’s chi-squared, or Fisher’s exact tests. Associations were evaluated with regression and ROC analyses.

RESULTS: Among 536 patients, 54.3% had elevated iSL levels. Initially, elevated iSL was associated with in-hospital mortality (OR: 2.18, 95%CI: 1.36-3.51, p < 0.001), traumatic intensive care unit (TICU) admission (OR: 2.06, 95%CI: 1.46-2.92, p < 0.001), and need for mechanical ventilation (MV) (OR: 2.80, 95%CI: 1.97-3.98, p < 0.001). However, adjusted analyses showed no significant associations (Mortality-AOR: 1.72, 95%CI: 0.97-3.04, p = 0.06; TICU-AOR: 1.11, 95%CI: 0.71-1.75, p = 0.65; MV-AOR: 1.49, 95%CI: 0.89-2.49, p = 0.13). Both iSL (AUC: 0.59, 95%CI: 0.54-0.64) and ISS (AUC: 0.59, 95%CI: 0.54-0.64) demonstrated limited ability to predict mortality, with no statistically significant difference between them (p > 0.99). Patients with elevated iSL experienced prolonged hospital and TICU stays and severe injuries.

CONCLUSIONS: Elevated iSL levels may not independently predict mortality, TICU admission, or the need for MV in trauma patients. However, their rapid availability supports their use alongside other clinical markers to guide trauma care decision-making and improve trauma outcomes.

PMID:39741239 | DOI:10.1186/s12245-024-00798-9

BMC Womens Health. 2024 Dec 31;24(1):677. doi: 10.1186/s12905-024-03530-0.

ABSTRACT

BACKGROUND: We aimed to analyze the correlation between serum lipid levels [total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C)] and recurrence after uterine fibroids (UF) resection, and explore the predictive value of serum lipid levels in determining recurrence after myomectomy.

METHODS: In this retrospective cohort study, 323 patients undergoing first myomectomy who came from Li Huili Hospital, Ningbo Medical Center between December 2019 and January 2023 were included. The primary endpoint was the recurrence of UF within 12 months following surgery. Univariate and multivariate logistic regression analyses were adopted to evaluate the association between four serum lipid parameters and the risk of UF recurrence. All included patients were randomly assigned to the training group for nomogram development and the testing group for nomogram validation, with a ratio of 7:3. Receiver operator characteristic, calibration curves, and decision curve analysis were used to assess the predicting performance of constructed nomograms.

RESULTS: Totally, 98 developed the recurrence of UF within 12 months following surgery. Multivariate logistic regression analyses indicated that high levels of TC [odds ratio (OR) = 9.98, 95% confidence interval (CI): 4.28-23.30], LDL-C (OR = 11.31, 95% CI: 4.66-27.47) and HDL-C (OR = 2.37, 95% CI: 1.21-4.64) were associated with recurrence of UF risk. The association between TG level and UF recurrence risk did not statistical significance (P > 0.05). Four online prediction nomograms by integrating serum lipid levels and clinical features for predicting the risk of recurrence of UF were developed (TC-model, TG-model, LDL-C-model and HDL-C-model). Through verification, these models may have good prediction performance for predicting the recurrence of UF risk.

CONCLUSION: This study developed and validated prediction nomograms for predicting the risk of UF recurrence. These nomograms can provide individual risk assessment for UF recurrence.

PMID:39741237 | DOI:10.1186/s12905-024-03530-0

BMC Pulm Med. 2024 Dec 31;24(1):638. doi: 10.1186/s12890-024-03439-2.

ABSTRACT

BACKGROUND: During the COVID-19 pandemia, the imaging test of choice to diagnose COVID-19 pneumonia as chest computed tomography (CT). However, access was limited in the hospital setting and patients treated in Primary Care (PC) could only access the chest x-ray as an imaging test. Several scientific articles that demonstrated the sensitivity of lung ultrasound, being superior to chest x-ray [Cleverley J et al., BMJ 370, 202013] and comparable to CT scan [Tung-Chen Y et al., Ultrasound Med Biol 46:2918-2926, 2020], promoted the incorporation of this technique in the assessment of COVID-19 patients in PC. [Pérez J et al., Arch. Bronconeumol 56:27-30, 2020; Gargani L et al., Eur Heart J Cardiovasc Imaging 21:941-8, 2020, Soldati G et al., J Ultrasound Med 39:1459, 2020] A prior study in our territory (Lleida, Spain) was designed to predict complications (hospital admission) of COVID-19 pneumonia in PC patients, being different patterns of Lung ultrasounds (LUS) risk factors for hospital admission. [Martínez Redondo J et al., Int J Environ Res Public Health 18:3481, 2021] The rationale for conducting this study lies in the urgent need to understand the determinants of severity and prognosis in COVID-19 patients with interstitial pneumonia, according to its lung ultrasound patterns. This research is crucial to provide a deeper understanding of how these pre-existing ultrasound patterns related to disease progression influence the medical treatment.

METHODS: The objective of the study is to generate predictive models of lung ultrasound patterns for the prediction of lung areas characteristics associated with hospitalizations and admissions to the Intensive Care Unit (ICU) associated with COVID-19 disease, using ultrasound, sociodemographic and medical data obtained through the computerized medical history.

RESULTS: A single relevant variable has been found for the prediction of hospitalization (number of total regions with potentially pathological presence of B lines) and one for the prediction of ICU admission (number of regions of the right lung with potentially pathological presence of B lines). In both cases it has been determined that the optimal point for classification was 2 or more lung affected areas. Those areas under the curve have been obtained with good predictive capacity and consistency in both cohorts.

CONCLUSIONS: The results of this study will contribute to the determination of the ultrasound prognostic value based on the number of lung areas affected, the presence of pulmonary condensation or the irregularity of pleural effusion patterns in COVID-19 patients, being able to be extended to other lung viral infections with similar patterns.

PMID:39741236 | DOI:10.1186/s12890-024-03439-2

BMC Ophthalmol. 2024 Dec 31;24(1):554. doi: 10.1186/s12886-024-03823-w.

ABSTRACT

BACKGROUND: Prostaglandin analogs are first-line treatments for open-angle glaucoma due to their proven efficacy in reducing intraocular pressure. Despite their topical administration, systemic adverse drug Events (ADEs) have been reported. This study investigates the systemic ADEs associated with topical prostaglandin analogs using the United States Food and Drug Administration (USFDA) Adverse Drug Event Reporting System (AERS) database.

METHODS: The USFDA AERS database was queried for reports on prostaglandin analogs from March 2004 to March 2024 in this retrospective pharmacovigilance study. Data were deduplicated and analyzed using disproportionality analysis with both frequentist and Bayesian approaches. Reports on systemic ADEs where topical prostaglandin analogs were the primary suspect were included. Statistical analysis was performed using descriptive statistics and the chi-square test for categorical variables.

RESULTS: A total of 30,853 reports were analyzed, predominantly involving latanoprost and bimatoprost, with most patients being elderly and female. In general, hypersensitivity reactions were the most common systemic adverse events reported with prostaglandin analogs. Varied systemic adverse events were observed within the class as latanoprost was linked to conditions like angina pectoris, atrial tachycardia and Meniere’s disease, bimatoprost to lentigo maligna melanoma, and tafluprost to labyrinthitis and skin discoloration. Notably, tafluprost had a significantly higher occurrence of death compared to other prostaglandin analogs, yet the causal relationship has not been established for this association due to unavailability of critical data on temporality and potential confounders including concomitant diseases/drugs and severity of the disease.

CONCLUSION: Prostaglandin analogs are associated with systemic ADEs, particularly in elderly and female patients. The most reported systemic adverse event was hypersensitivity reactions for the class and cardiac events for latanoprost. Tafluprost was observed with higher mortality statistically, yet causal relationship could not be established in the absence of details on the potential confounders. The findings emphasize the need for continuous monitoring of adverse reactions, and consideration of patient-specific factors when prescribing these medications.

PMID:39741235 | DOI:10.1186/s12886-024-03823-w