Nevin Manimala

J Minim Access Surg. 2024 Oct 9. doi: 10.4103/jmas.jmas_272_23. Online ahead of print.

ABSTRACT

INTRODUCTION: Laparoscopic myomectomy is a commonly performed operation with fast recovery and excellent results. However, haemorrhagic nature of the operation mandates us to use variety of vasoconstrictive and uterotonic agents. Amongst which, one of them is vasopressin. It is a synthetic antidiuretic hormone analogue which has been in common use as a vasoconstrictive agent in various surgical procedures including laparoscopic myomectomy.

METHODS: A meta-analysis of randomised controlled trials published from 2013 to 2023 (10 years) comparing the use of vasopressin against other drug or placebo or different doses of vasopressin was performed. The outcome measures were intraoperative blood loss, need for blood transfusion, difference in the haemoglobin (Hb) and haematocrit (Hct).

RESULTS: We identified 176 articles through the study search, amongst which 12 articles were included for the meta-analysis. There was a significant heterogeneity in the studies with moderate risk of bias in eight studies and low risk of bias in four studies. Compared to placebo, vasopressin showed significantly lower odds need of blood transfusion (odds ratio [OR] 0.28, 95% confidence interval [CI]: 0.13-0.61, P = 0.002) and significantly lower pre-post fall in Hb (OR -3.12, 95% CI: -4.63–1.60, P < 0.0001). However, there was no statistically significant difference in intraoperative blood loss (OR -0.56 (95% CI: -2.04-0.92, P = 0.46) and pre-post fall in Hct (OR -0.94, 95% CI: -1.96-0.07, P > 0.05). Compared to other drug (epinephrine, misoprostol and octreotide acetate), vasopressin showed no significant superiority in controlling blood loss (P > 0.05). Even the two doses of vasopressin (dilute vs. concentrated) showed no statistically significant difference between surgical blood loss and need for blood transfusion (P > 0.05).

CONCLUSION: Vasopressin is an efficacious drug to be used for controlling blood loss, decreasing blood transfusion requirement and maintaining Hb and Hct during laparoscopic myomectomy.

PMID:39724600 | DOI:10.4103/jmas.jmas_272_23

J Craniofac Surg. 2024 Oct 7. doi: 10.1097/SCS.0000000000010683. Online ahead of print.

ABSTRACT

Digital orthodontics has been integrated into NasoAlveolar Molding (NAM) therapy to overcome challenges in the conventional NAM method. This study introduced an individualized Digital NAM (iDNAM) and evaluated the changes in the alveolar ridges and nasolabial morphology after iDNAM treatment. Prospective data were collected from 15 infants with complete unilateral cleft lip and palate who underwent iDNAM therapy. An intraoral-and-nasolabial scan was used to create a virtual setup model and plate generation. A total of 2 plates were required under the iDNAM treatment protocol. The first iDNAM plate has a specific interior and exterior design to allow continuous force application with minimal plate adjustment. After an intermediate scan, a nasal stent was meticulously incorporated into the second plate for nasal molding. To activate the nasal stent, a silicone molding extension was used instead of manually adding acrylic. The alveolar cleft gap was significantly reduced by 7.48 ± 2.06 mm. On the cleft side, statistically significant increases occurred in nostril height, columellar length, and nasal base-columellar angle (2.08 ± 0.63 mm, 2.58 ± 0.28 mm, and 22.29 ± 0.88 degrees, respectively). By using 2 serial plates, iDNAM improved the alveolar cleft gap and the nasal morphology in complete unilateral cleft lip and palate. An addition of a nasal extension to the second iDNAM plate presents a challenge as accurate positioning is required for appropriate activation force. The iDNAM plate design and nasal activation protocol reduce the need for chairside adjustment and the number of appointments.

PMID:39724597 | DOI:10.1097/SCS.0000000000010683

Int J Surg. 2024 Oct 7. doi: 10.1097/JS9.0000000000002113. Online ahead of print.

ABSTRACT

BACKGROUND: One of the most important surgical steps during thyroidectomy is the safe ligation of vessels. In fact, it is crucial to avoid postoperative bleeding and nerves’ injury. The “clamp and tie” technique was first introduced in the 19th century. Since then, a lot of other techniques have been adopted to facilitate the safe ligation and sectioning of thyroidal vessels; however, one of the most relevant advances is the introduction of energy-based devices (EBDs), which occurred three decades ago.

PURPOSE: The aim of this systematic review and meta-analysis is to evaluate the safety and effectiveness of sutureless FOCUS harmonic scalpel (second generation EBDs) versus conventional clamps-and-tie technique) in total thyroidectomy.

RESULTS: This systematic review and meta-analysis represent the largest comparison in literature between the thyroidectomy procedure with the second-generation Advanced Harmonic Scalpel Ultrasonic Focus (UAS FOCUS) versus the conventional Clamp-and-Tie (CT) technique: as a matter of fact, it includes 43 randomized controlled trials (RCTs) and a total of 10.361 patients. The incidence of transient recurrent laryngeal nerve was statistically lower in patients undergoing UAS (3.99%) rather than CT (5.23%) (RR 0.79, 95% CI 0.63 to 0.99). The incidence of transient hypocalcemia was 11.3% in patients who underwent thyroidectomy with UAS FOCUS and 15.4% in those who underwent thyroidectomy with CT.

CONCLUSION: Sutureless EBD is associated with a lower risk of damage to the laryngeal nerves and parathyroid glands. The rate of hypocalcemia and nerve paresis is indeed lower due to less thermic damage. Sutureless EBD can also diminish the rate of postoperative bleeding and cervical hematoma, a rare but potentially fatal complication.

PMID:39724591 | DOI:10.1097/JS9.0000000000002113

Invest Radiol. 2024 Oct 9. doi: 10.1097/RLI.0000000000001123. Online ahead of print.

ABSTRACT

OBJECTIVE: This systematic review and meta-analysis investigated the added value of DWI compared with the structured assessment of BI-RADS criteria using the Kaiser score.

MATERIALS AND METHODS: Articles published in English until May 2024 were included. Two independent reviewers extracted data on the characteristics of studies evaluating the added value of DWI to distinguish benign from malignant breast lesions compared with structured assessment of the BI-RADS criteria. Using bivariate random-effects models, the sensitivity and specificity were calculated. I2 statistics, Deek’s funnel plot asymmetry test for publication bias, and meta-regression were applied for the data analysis.

RESULTS: Five studies comprising 1005 malignant and 846 benign lesions were eligible for data synthesis. The pooled sensitivity and specificity estimates of structured BI-RADS assessment were 95.7% (95% confidence interval [CI], 92.6%-97.5%) and 68.7% (95% CI, 60.9%-75.6%), respectively. Adding DWI to the structured BI-RADS assessment achieved a pooled sensitivity of 94.4% (95% CI, 90.5%-96.7%) and a pooled specificity of 74.9% (95% CI, 68.8%-80.2%). Adding DWI to the structured BI-RADS assessment significantly changed neither the sensitivity (P = 0.52) nor the specificity (P = 0.20).

CONCLUSIONS: This systematic review and meta-analysis revealed only a limited, statistically nonsignificant added value of DWI compared with the structured assessment of BI-RADS criteria using the Kaiser score.

PMID:39724588 | DOI:10.1097/RLI.0000000000001123

Eur J Cancer Prev. 2024 Oct 1. doi: 10.1097/CEJ.0000000000000925. Online ahead of print.

ABSTRACT

Triple-negative breast cancer (TNBC) is a complex and diverse group of malignancies. Invasive ductal carcinoma (IDC) is the predominant pathological subtype and is closely linked to the ominous potential for distant metastasis, a pivotal factor that significantly influences patient outcomes. In light of these considerations, the present study was conceived with the objective of developing a nomogram model. This model was designed to predict the prognosis observed in IDC with distant metastasis in TNBC. This was a retrospective study based on the SEER database. Data of 9739 IDC-TNBC patients diagnosed from 2010 to 2020 were included in our study. Independent risk factors were screened by univariate and multivariate Cox regression analyses successively, which were used to develop a nomogram model predicting for prognosis. Cox multivariable analysis showed statistical significance in bone metastasis, liver metastasis, surgery, and chemotherapy. Incorporating statistically significant variables, as well as clinically significant age, lung metastasis, and brain metastasis into the construction of the prediction model, the C-indexes of the training group and validation group were 0.702 (0.663-0.741) and 0.667 (0.600-0.734), respectively, while the calibration curves were all close to the ideal 45° reference line, and decision curve analysis curves show excellent net benefit in the predictive model. The prognostic prediction model developed in this study demonstrated enhanced predictive accuracy, enabling a more precise evaluation of mortality risks associated with IDC with distant metastasis in TNBC.

PMID:39724567 | DOI:10.1097/CEJ.0000000000000925

Adv Neonatal Care. 2024 Dec 26. doi: 10.1097/ANC.0000000000001220. Online ahead of print.

ABSTRACT

BACKGROUND: Neonatal advanced practice providers (APPs) often work prolonged hours in high-acuity neonatal intensive care units (NICUs). It is imperative to understand how fatigue affects the APP’s ability to react quickly following long shifts. There is a lack of data on the effects of shift length and fatigue on neonatal APP job performance and clinical decision-making.

PURPOSE: The purpose of this study was to describe the variation in shift length, knowledge-based competency, personal well-being, and behavioral alertness for neonatal APPs.

METHODS: This study evaluated neonatal APPs before and after a clinical shift. Provider well-being was assessed during the pre-survey. Pretest-posttest surveys evaluated neonatal APP’s psychomotor vigilance skills and knowledge. Participants completed an online, anonymous questionnaire to answer a series of knowledge-based questions before and after their shift, along with a psychomotor vigilance test (PVT). A paired t test analysis evaluated the pre- and post-shift PVT values and knowledge-based test scores.

RESULTS: Overall, 61 pre-surveys and 42 post-surveys were completed; 36 were matched by participants pre- to post-survey. The mean between pre- and post-knowledge-based questions was statistically significant, with higher posttest scores. There was no statistical difference noted in the paired t test analysis of the PVT values.

IMPLICATIONS FOR PRACTICE AND RESEARCH: The small sample size may limit the generalizability of findings, but these results may indicate that shift length does not affect psychomotor vigilance or knowledge-based competency. It is vital that future work assess the associations between APP shift length, fatigue, and critical decision-making.

PMID:39724563 | DOI:10.1097/ANC.0000000000001220

Alcohol Alcohol. 2024 Nov 18;60(1):agae088. doi: 10.1093/alcalc/agae088.

ABSTRACT

AIMS: Structured clinical interviewing is considered the gold standard in psychiatric diagnosis. The Diagnostic Assessment Research Tool (DART) is a novel modularized, non-copywritten, semi-structured interview; however, no studies have examined the psychometric properties of its alcohol use disorder (AUD) module. The primary aims of this study were to: (i) validate the factor structure of the DART AUD module and (ii) examine measurement invariance across several key demographic and subgroup factors.

METHODS: Participants were community members in Hamilton, Canada and Boston, USA who self-identified as making a significant AUD recovery attempt (N = 499). Internal reliability was examined via the Kuder-Richardson 20 statistic, and correlations between symptom count and drinking quantity/frequency were examined. Then, symptom-level data were included in a confirmatory factor analysis to examine model fit of a single hypothesized factor structure. Finally, measurement invariance analyses were conducted for sex, age, ethnicity (White vs. racialized), and study site.

RESULTS: This study found evidence for adequate internal reliability (rKR20 = 0.75), and symptom scores correlated with drinking quantity and frequency (r = 0.16-0.43). Confirmatory factor analysis results suggested excellent fit for the unidimensional one-factor AUD model (χ2 = 0.09, confirmatory factor index = 0.99, Tucker Lewis index = 0.99, standardized root mean square residual = 0.06, root mean square error of approximation = 0.02). Measurement invariance analyses revealed that the factor structure was equivalent between sex, age, ethnicity, and study site.

CONCLUSIONS: Findings provide strong evidence for the psychometric validity of the DART AUD module and support its use in research and clinical practice. The DART represents a credible alternative to other diagnostic interviewing tools for AUD.

PMID:39724543 | DOI:10.1093/alcalc/agae088

J Am Acad Orthop Surg. 2024 Dec 24. doi: 10.5435/JAAOS-D-24-00353. Online ahead of print.

ABSTRACT

INTRODUCTION: Gender-affirming hormone therapy (GAHT) is a cornerstone of gender-affirming care for transgender and gender diverse (TGD) patients, with a direct biological role on bone metabolism. However, a paucity of data describes how GAHT influences fracture rate over time. The study’s primary objective was to describe the 5-year all-cause fracture incidence rate (IR) among TGD patients initiating estrogen-based GAHT (E-GAHT) or testosterone-based GAHT (T-GAHT), compared with TGD patients not using GAHT (non-GAHT).

METHODS: This retrospective cohort study of TGD adults aged 18 to 65 years used insurance data from the Merative MarketScan Commercial Database (MarketScan) from January 1, 2009, to December 31, 2019. The main outcome was IR (IR with 95% confidence intervals [CIs]) of all-cause fracture after up to 5 years of follow-up. The IR ratio was estimated by comparing E-GAHT and T-GAHT groups with the non-GAHT group. Cox proportional hazards regression models estimated the hazard ratio (HR) of fracture after adjusting for age, comorbidity status using Charlson Comorbidity Index (CCI), recent fractures, and study start year.

RESULTS: Nine thousand six hundred ninety-six TGD adults (E-GAHT [n = 1,131]; T-GAHT [n = 1,046]; non-GAHT [n = 7,519]) were identified using clinical and enrollment criteria. No differences in age (mean age [SD], 33.4 [13.2] years, 30.8 [11.7] years, and 33.2 [13.6] years, respectively) and CCI (percent with CCI = 0 [%CCI = 3+]; 86.7% [2.2%], 84.9% [1.4%], and 85.3% [1.9%]) were observed by group. The fracture IR was 13.9 (95% CI, 9.1 to 18.8) for E-GAHT, 15.3 (95% CI, 10.1 to 20.4) for T-GAHT, and 19.2 (95% CI, 16.9 to 21.4) for non-GAHT. Compared with non-GAHT, the crude IR ratio and fully adjusted HR was 0.73 (95% CI, 0.51 to 1.04) and 0.71 (95% CI, 0.49 to 1.02), respectively, for E-GAHT and 0.80 (95% CI, 0.56 to 1.14) and 0.78 (95% CI, 0.55 to 1.12), respectively, for T-GAHT.

CONCLUSION: Based on United States commercial claims data, the use of GAHT was not associated with 5-year all-cause fracture IR.

LEVEL OF EVIDENCE: III.

PMID:39724520 | DOI:10.5435/JAAOS-D-24-00353

Clin Neuropsychol. 2024 Dec 26:1-15. doi: 10.1080/13854046.2024.2445269. Online ahead of print.

ABSTRACT

Objective: To determine the clinical utility of teleneuropsychology (teleNP) services in screening for cognitive concerns in a population of children and adolescents presenting with long COVID. Method: This cross-sectional study evaluated 76 pediatric patients (64% female, M_age = 13.48, SD = 2.97, range = 5 to 18 years) with long COVID referred for a neuropsychological evaluation due to persistent cognitive symptoms following their COVID infection. Of these 76 patients, 33 were tested in person, while 43 were tested via teleNP at home. Patients were administered a brief testing battery designed for use in-person or through teleNP services. Tests administered included the WASI-II (Intellectual Functioning), D-KEFS Verbal Fluency (Executive Functioning/Shifting), Oral Version of the Symbol Digit Modalities Test (Processing Speed), ChAMP List (Learning and Memory), WAIS-IV/WISC-V Digit Span (Working Memory), and TEA-Ch Score and Score DT (Sustained Auditory Attention and Divided Attention). Differences in scores between those evaluated in-person or teleNP were computed using analyses of variance and Bayesian statistics across measures. Differences in the proportion of those scoring in the below average range (< 9^th percentile) were also computed. Results: Findings revealed similar performance for patients tested in-person and patients tested by teleNP modality across measures. Conclusions: The present study provides preliminary evidence for the clinical utility of teleNP services in pediatric long COVID patients on a cognitive screening battery. These results lend support for expanding teleNP services to pediatric patients with long COVID to assess neurocognitive functioning, which is particularly important given scarcity of specialty long COVID clinics.

PMID:39723582 | DOI:10.1080/13854046.2024.2445269

J Psychosoc Oncol. 2024 Dec 26:1-15. doi: 10.1080/07347332.2024.2444276. Online ahead of print.

ABSTRACT

PURPOSE: Young adults report challenges concerning cancer–related cognitive impairment (CRCI). This study aimed to: (1) describe cognition in young adults post-cancer treatment using self-report and performance-based measures, and (2) examine associations between cognition and relevant disease-related, psychological, and lifestyle (physical activity; PA) factors.

METHODS: Forty-six young adults (M_age = 31.4 ± 5.4 years; 91.3% female) completed web-based questionnaires and neuropsychological tests; data were analyzed via descriptive statistics and bivariate correlations.

RESULTS: Most (60.9%) self-reported clinically meaningful CRCI and displayed poorer executive functioning and processing speed (but not working memory) than normative data. Disease-related factors, psychological factors, and PA had null-to-moderate (rs = -0.32-0.28), small-to-large (rs = -0.74-0.77), and trivial-to-moderate (rs = -0.16 – 0.36) correlations with cognition (respectively), with differences in magnitude between self–reported and objective cognition.

CONCLUSION: The observed correlations warrant further exploration in larger prospective studies, and trials should investigate causative mechanisms and specific PA parameters.

PMID:39723581 | DOI:10.1080/07347332.2024.2444276