Nevin Manimala

J Neurosurg. 2024 Dec 27:1-9. doi: 10.3171/2024.7.JNS24906. Online ahead of print.

ABSTRACT

OBJECTIVE: Pharmacoresistant tremors, often seen in Parkinson disease and essential tremor, significantly impair patient quality of life. Although deep brain stimulation has been effective, its invasive nature limits its applicability. MR-guided focused ultrasound (MRgFUS) thalamotomy offers a noninvasive alternative, but its cognitive impacts are not fully understood. This meta-analysis aimed to evaluate the cognitive and emotional effects of unilateral MRgFUS thalamotomy in patients with pharmacoresistant tremors.

METHODS: Adhering to PRISMA guidelines, a comprehensive literature search was conducted across PubMed, Web of Science, and the Cochrane Library. Studies were included if they involved unilateral MRgFUS thalamotomy and assessed cognitive functions pre- and postprocedure. The primary outcomes were changes in cognitive functions and emotional states postthalamotomy.

RESULTS: Of 90 identified articles, 5 met the inclusion criteria, encompassing 112 patients (74 essential tremor, 38 Parkinson disease). The analysis revealed no significant deterioration in cognitive domains or emotional states postprocedure. Statistical heterogeneity among studies was small for cognitive outcomes but moderate for emotional states.

CONCLUSIONS: Unilateral MRgFUS thalamotomy appears to be a safe procedure with respect to cognitive and emotional outcomes in patients with pharmacoresistant tremors. However, the small number of studies and the short-term nature of assessments necessitate caution. Further research, especially on long-term cognitive effects and in the context of bilateral procedures, is essential for a comprehensive understanding of MRgFUS thalamotomy’s neuropsychological impact. Systematic review registration no.: CRD42023491757 (www.crd.york.ac.uk/prospero).

PMID:39729615 | DOI:10.3171/2024.7.JNS24906

J Neurosurg. 2024 Dec 27:1-9. doi: 10.3171/2024.7.JNS24237. Online ahead of print.

ABSTRACT

OBJECTIVE: Periventricular anastomosis (PA), a recently recognized cause of hemorrhage in moyamoya disease, is reducible after bypass surgery. The timing of the reduction, however, remains poorly understood. The objectives of the present study were to demonstrate radiological reduction of PA occurring within 48 hours after surgery and to identify factors associated with reduction.

METHODS: This retrospective cohort study included patients aged 16 years or older who were diagnosed with moyamoya disease and underwent direct bypass surgery. PAs were assessed using sliding thin-slab maximum intensity projection MR angiography images acquired before surgery and on postoperative day 1. The signal ratio of PA, the ratio of the signal value of the medullary artery to that of the brain parenchyma, was measured at the same point on automatically aligned baseline and postoperative images. The location of bypass was defined as either targeted or nontargeted to the PA.

RESULTS: A total of 68 PAs were analyzed. The signal ratio of PA significantly decreased (mean change [95% CI] -0.16 [-0.21 to -0.11]), while that of cerebellar arteries increased (mean change [95% CI] 0.20 [0.09-0.31]). The interrater reliability measurement of the signal ratio change was excellent (intraclass correlation coefficient 0.94). Multivariate linear regression analysis revealed that targeted bypass (regression coefficient [95% CI] -0.1063 [-0.1558 to -0.0569]) and cross-sectional area of the donor artery (regression coefficient [95% CI] -0.1317 [-0.2101 to -0.0534]) were significant factors contributing to signal reduction of the PA. Analysis of the receiver operating characteristic curve revealed that early signal reduction well predicted late-phase reduction (area under the curve 0.78).

CONCLUSIONS: PA could be reduced within 48 hours after direct bypass surgery, suggesting an early preventive effect against hemorrhage. Early reduction, a potential predictor for late-phase reduction, might be promoted by targeted bypass surgery.

PMID:39729585 | DOI:10.3171/2024.7.JNS24237

Cardiol Rev. 2024 Oct 14. doi: 10.1097/CRD.0000000000000803. Online ahead of print.

ABSTRACT

Hypertrophic cardiomyopathy (HCM) is a genetic cardiac disorder characterized by structural and functional abnormalities. Current management strategies, such as medications and septal reduction therapies, have significant limitations and risks. Recently, cardiac myosin inhibitors (CMIs) like mavacamten and aficamten have shown promise as noninvasive treatment options. This meta-analysis aims to evaluate the efficacy and safety of CMIs in HCM patients. PubMed/MEDLINE, Embase, the Cochrane Library, Ovid, and ClinicalTrials.gov were searched for randomized controlled trials (RCTs) that compared CMIs to control treatments in HCM patients from inception till June 15, 2024. A random-effects model was used to pool odds ratios (ORs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes along with the corresponding 95% confidence intervals (CIs). Heterogeneity was assessed using the χ2 test and Higgins I2 statistic, and sensitivity and subgroup analyses were performed. Six RCTs involving 826 patients were included. CMI therapy significantly reduced resting left ventricular outflow tract (LVOT) gradient (MD, -37.64; 95% CI, -46.71 to -28.56), Valsalva LVOT gradient (MD, -46.04; 95% CI, -57.60 to -34.48), post-exercise LVOT peak gradient (MD, -48.64; 95% CI, -68.20 to -28.88), N-terminal pro-b-type natriuretic peptide levels (MD, -1.05; 95% CI, -1.64 to -0.47), and cardiac troponin I levels (MD, -7.96; 95% CI, -12.84 to -3.07). Improvements were observed in peak oxygen consumption (MD, 1.20; 95% CI, 0.23-2.17) and patient-reported outcomes (Kansas City Cardiomyopathy Questionnaire Clinical Summary Score: MD, 6.44; 95% CI, 3.50-9.37), with more patients achieving New York Heart Association class improvement >1 (OR, 4.05; 95% CI, 2.61-6.30). Treatment-emergent adverse events were higher with CMI therapy (OR, 1.45; 95% CI, 1.02-2.05), but serious adverse events and other safety outcomes were comparable in both groups. CMIs, including mavacamten and aficamten, significantly improve clinical outcomes in HCM patients with a manageable safety profile. These results indicate that CMIs offer a promising noninvasive alternative to septal reduction therapies.

PMID:39729579 | DOI:10.1097/CRD.0000000000000803

Int J Methods Psychiatr Res. 2025 Mar;34(1):e70010. doi: 10.1002/mpr.70010.

ABSTRACT

OBJECTIVES: We implemented the first national patient experience survey, with novel patient-reported experience measures (PREMs), in out- and inpatient mental health and substance use services in Finland.

METHODS: The Outpatient Experience Scale (OPES) and the Inpatient Experience Scale (IPES) were co-designed with experts by experience and professionals. The survey was carried out in 2021 in 435 treatment facilities. We applied bi-factor analysis of ordinal indicators to prespecified and exploratory models.

RESULTS: We received 8794 outpatient and 1112 inpatient responses. Both the OPES and the IPES were essentially unidimensional, with high internal consistency (omega 0.98 in both) and strong factor loadings. The Net Promoter Score item was a fairly poor indicator of overall satisfaction. The most positive experiences were related to respect and acceptance, while statements related to receiving information and inclusion of significant others in the treatment process received more critical feedback. The best experience was in integrated mental health and substance use services. Involuntarily admitted patients had the most negative patient experiences.

CONCLUSIONS: The new PREMs proved to work well in measuring patient experience. Service users generally reported positive experiences. The primary service development need is sharing information with patients.

PMID:39729570 | DOI:10.1002/mpr.70010

MCN Am J Matern Child Nurs. 2024 Nov-Dec 01;49(6):332-340. doi: 10.1097/NMC.0000000000001046. Epub 2024 Oct 15.

ABSTRACT

PURPOSE: To describe the relationship between experiencing traumatic childbirth events and burnout.

STUDY DESIGNS AND METHODS: This descriptive cross-sectional study used an anonymous online survey to assess traumatic childbirth event exposure and the three independent constructs of burnout: emotional exhaustion, depersonalization, and personal accomplishment. Participants were a convenience sample of registered nurses, obstetric residents, family medicine residents, and attending obstetricians across five hospitals from December 2020 through June 2021. The traumatic childbirth event questionnaire measured the frequency of traumatic childbirth event exposure, perception of severity, and perceived influence on the participant’s professional practice and personal life.

RESULTS: Data were analyzed from 150 participants. Registered nurses represented the largest percentage of participants (66%). Components of burnout varied according to race and occupation. Asian/Pacific Islanders had significantly higher mean depersonalization scores at 10.1 (SD = 6.0). Resident physicians had the highest emotional exhaustion scores (M = 34.6, SD = 8.8). Traumatic childbirth events perceived influence on practice correlates with personal accomplishments. Yet, no relationship was observed between traumatic childbirth events, emotional exhaustion, and depersonalization. Linear mixed analysis revealed that hospitals account for 7.5% of the variance in emotional exhaustion scores, 11.1% in depersonalization scores, and 1.3% in personal accomplishments scores.

CLINICAL IMPLICATIONS: Maternity clinicians experience burnout at similar rates to those in other specialties. Although traumatic childbirth events are infrequent and not strongly correlated with emotional exhaustion and depersonalization, hospitals should implement effective strategies to support clinicians after such events. Educational interventions can enhance knowledge and resilience, whereas specialized training effectively alleviates burnout. Development of evidence-based strategies that prioritize the wellbeing of clinicians and patients is crucial.

PMID:39729560 | DOI:10.1097/NMC.0000000000001046

Anal Chem. 2024 Dec 27. doi: 10.1021/acs.analchem.4c03513. Online ahead of print.

ABSTRACT

Mass spectrometry (MS)-based metabolomics often rely on separation techniques when analyzing complex biological specimens to improve method resolution, metabolome coverage, quantitative performance, and/or unknown identification. However, low sample throughput and complicated data preprocessing procedures remain major barriers to affordable metabolomic studies that are scalable to large populations. Herein, we introduce PeakMeister as a new software tool in the R statistical environment to enable standardized processing of serum metabolomic data acquired by multisegment injection-capillary electrophoresis-mass spectrometry (MSI-CE-MS), a high-throughput separation platform (<4 min/sample) which takes advantage of a serial injection format of 13 samples within a single analytical run. We performed a rigorous validation of PeakMeister by analyzing 47 cationic metabolites consistently measured in 5,000 serum and 420 quality control samples from the Brazilian National Survey on Child Nutrition (ENANI-2019) comprising a total of 224,983 metabolite peaks acquired in 40 days across three batches over an eight-month period. A migration time index using a panel of 11 internal standards was introduced to correct for large variations in migration times, which allowed for reliable peak annotation, peak integration, and sample position assignment for serum metabolites having two flanking internal standards or a single comigrating stable-isotope internal standard. PeakMeister accelerated data preprocessing times by 30-fold compared to manual processing of MSI-CE-MS data by an experienced analyst using vendor software, while also achieving excellent peak annotation fidelity (median accuracy >99.9%), acceptable intermediate precision (median CV = 16.0%), consistent metabolite peak integration (mean bias = -2.1%), and good mutual agreement when quantifying 16 plasma metabolites from NIST SRM-1950 (mean bias = -1.3%). Reference ranges are also reported for 40 serum metabolites in a national nutritional survey of Brazilian children under 5 years of age from the ENANI-2019 study. MSI-CE-MS in conjunction with PeakMeister allows for rapid and automated processing of large-scale metabolomic studies that tolerate nonlinear migration time shifts without complicated dynamic time warping or effective mobility scale transformations.

PMID:39729551 | DOI:10.1021/acs.analchem.4c03513

Ann Plast Surg. 2024 Dec 18. doi: 10.1097/SAP.0000000000004186. Online ahead of print.

ABSTRACT

INTRODUCTION: YouTube has become a popular source of health information, including plastic surgery. Given the platform’s wide reach and potential influence on patient decisions, this study aimed to assess the quality of information available on YouTube for African audiences seeking plastic surgery procedures.

METHODS: This cross-sectional study extracted data from YouTube videos on plastic surgery relevant to Africa. A search strategy identified videos in English using keywords. The first 50 results for each term were included, with duplicates removed. Next, the metadata of videos published from inception to June 9, 2024, were extracted. Two reviewers independently assessed videos using standardized tools to evaluate reliability (modified DISCERN and JAMA criteria) and engagement (likes-to-views ratio [LVR] and comments-to-views ratio [CVR]). The Mann-Whitney U test was used for unadjusted bivariable comparisons. Then ordinal logistic and beta regression analyses were used to evaluate the primary (modified DISCERN and JAMA scores) and secondary (LVR and CVR) outcomes, with a statistical significance level set at 0.05.

RESULTS: Eight hundred ninety-seven plastic surgery videos were analyzed, and 3.9% were published by African entities. Large subscriber count (coefficient = -6.9e-8, 95% confidence interval [CI] [-1.13e-7, -2.9e-8], P = 0.001), African-authored (coefficient = -0.85, 95% CI [-1.44, -0.25], P = 0.005), and advertising (coefficient = -1.01, 95% CI [-1.63, -0.57], P < 0.001) videos had lower modified DISCERN scores. Advertising videos equally had lower JAMA scores (coefficient = -1.29, 95% CI [-1.83, -0.74], P < 0.001). Academic videos had lower LVR (coefficient = -0.48, 95% CI [-0.66, -0.30], P < 0.001), whereas independent videos had higher LVR (coefficient = 0.40, 95% CI [0.26, 0.54], P < 0.001). Academic videos had lower CVR (coefficient = -0.40, 95% CI [-0.67, -0.13], P = 0.003), whereas videos with other purposes had higher CVR (coefficient = 0.37, 95% CI [0.10, 0.64], P = 0.007).

CONCLUSIONS: This study underscores a potential disparity in the quality of online plastic surgery information based on video sources and purposes.

PMID:39729548 | DOI:10.1097/SAP.0000000000004186

PLoS One. 2024 Dec 27;19(12):e0314940. doi: 10.1371/journal.pone.0314940. eCollection 2024.

ABSTRACT

AIM: This study evaluated the smear layer removal provided by conventional, sonic, and ultrasonic irrigation techniques.

METHODOLOGY: Forty extracted human mandibular first premolars were selected and instrumented using the ProTaper Next System files and 2.5% sodium hypochlorite. Afterward, they were divided into 4 groups (n. 10) according to the irrigation technique used to perform the final irrigation with a chelating solution (17% EDTA): conventional irrigation (CI), passive ultrasonic irrigation (PUI), EndoActivator System (EAS), and Perfect Clean System (PCS). The smear layer removal was determined through a score after evaluating scanning electron microscope images (1.000x) obtained at 1, 5, 8, and 12mm from the working length (WL). Statistical analyses were carried out by the Kruskal-Wallis and Dunn’s tests with a significance level of 5% (P < 0.05).

RESULTS: All irrigation techniques were unable to promote an effective smear layer removal at 1mm from the WL in comparison with the other locations (P < .05). At 5, 8, and 12mm from the WL, no statistically significant differences were observed among CI, PUI, EAS, and PCS (P > 0.05). At 12mm from the WL, statistically significant differences were only identified after comparing PCS and CI (P < .05).

CONCLUSION: The smear layer removal was only efficient at 5, 8, and 12 from the WL with no significant statistical differences among CI, PUI, EAS, and PCS (P > 0.05).

PMID:39729517 | DOI:10.1371/journal.pone.0314940

PLoS One. 2024 Dec 27;19(12):e0313340. doi: 10.1371/journal.pone.0313340. eCollection 2024.

ABSTRACT

BACKGROUND: Participants’ satisfaction is an important factor in securing competitiveness in clinical trials. In many industries, such as healthcare, customer service quality has been analyzed to increase customer satisfaction. However, no study so far has attempted to measure participants’ perceptions of service quality in the clinical trial area and identify its effect on participant satisfaction.

OBJECTIVE: This study examined the experiences and perceptions of clinical trial participants in terms of service quality and identified the factors that impact participant satisfaction in clinical trials.

METHODS: This study used a cross-sectional descriptive and explanatory research design. Data were collected from March 29 to May 26, 2023, via a survey. The survey was conducted with 206 adults participating in clinical trials at two hospitals in Korea. The collected data were analyzed using descriptive statistics, independent t-tests, one-way ANOVA, Pearson’s correlation, and multiple linear regression analysis.

RESULTS: Participants’ perceptions of the service quality and their satisfaction in clinical trials were generally positive. The variables that significantly predicted participant satisfaction in clinical trials included quality of interaction with researchers, physical environment, performance results in clinical trials, changes in health status after participating in the trial, and consideration of discontinuing the trial.

CONCLUSIONS: Participants’ perception of the service quality significantly affected their satisfaction in clinical trials. Thus, all components of service quality should be considered in the overall clinical trial process to increase participants’ satisfaction.

PMID:39729511 | DOI:10.1371/journal.pone.0313340

PLoS One. 2024 Dec 27;19(12):e0315121. doi: 10.1371/journal.pone.0315121. eCollection 2024.

ABSTRACT

BACKGROUND: A minimum acceptable diet for children aged 6-23 months is limited globally, with Ethiopia’s proportion reducing to one in nine. This study was aimed to assess the prevalence of the minimum acceptable diet and associated factors among children aged 6-23 months in Dera town, Oromia, Ethiopia.

METHODS: A community-based cross-sectional study was conducted. Systematic random sampling techniques were used to select the study subjects. The data was coded, entered into Epi-Info version 7, and then exported to SPSS version 24 for analysis. The variance inflation factor and tolerance test are used to check multicollinearity. Descriptive statistics of frequency (%) were used. Hosmer and Lemeshow’s goodness-of-fit test at a P-value > 0.05 is considered the model fit. Bivariate and multivariate logistic regression analyses were computed with a 95% confidence interval, and a P-value < 0.05 was, considered statistically significant.

RESULTS: A total of 430 study subjects were included in this study. The prevalence of a minimum acceptable diet was 36.5% (95% confidence interval (CI): 32, 41%). In the adjusted model, mothers attaining a primary school (adjusted odds ratio (AOR) = 2.7, 95%CI: 1.3, 4.8), college and above education (AOR = 4.3, 95%CI: 1.4, 13), child age between 12-17 months (AOR = 6.2, 95%CI: 2.80, 13.50) and 18-23 months (AOR = 4.61, 95%CI: 2.04, 10.40), ANC visit four or more (AOR = 2.0, 95%CI: 1.2, 3.4), and not feeding breast (AOR = 0.15, 95% CI: 0.07, 0.31) were significantly associated with meeting the minimum acceptable diet.

CONCLUSION: This study showed that the practice of a minimum acceptable diet was low, according to the World Food Program target. Mothers’ educational status, antenatal care visits, age of the child, and breastfeeding were the predictors of the minimum acceptable diet.

PMID:39729498 | DOI:10.1371/journal.pone.0315121