Nevin Manimala

Cancer Med. 2024 Oct;13(20):e70318. doi: 10.1002/cam4.70318.

ABSTRACT

BACKGROUND: Despite remarkable progress in contemporary medical technology and enhanced survival outcomes for various cancer types, pancreatic cancer (PC) continues to stand out as a particularly deadly gastrointestinal malignancy. Given a persistent rise in both incidence and the corresponding mortality rates of PC globally, evaluations of PC burden by sex are of great importance. Here, we used the illness-death multi-state model (IDM) to forecast the prevalence of PC through the year 2040.

METHODS: IDM was established based on obtainable data to predict the future prevalence of PC on global, regional, and national scales from 2019 to 2040. Analyses were also performed regarding sex and 95% confidence intervals (CIs) are presented for all estimates.

RESULTS: The projected prevalence rate for 2040 is anticipated to be 6.093 ([95% CI 5.47-6.786] per 100,000) worldwide, indicating a significant increase of 31.45% since 1990, and a 12.29% increase since 2019. The estimated average annual increase since 2020 was 0.5%. Considering sex differences, females are expected to have a steeper slope in prevalence rate than males. Intriguingly, when considering the percentage changes between the periods of 2019-2040 and 1990-2019 for both sexes, females exhibited 29% and 11% increase relative to males (2.6-fold greater increase).

CONCLUSIONS: By 2040, it is predicted that the prevalence of PC will increase globally, with women being at higher risk of developing the disease. Considering the percentage changes, regions with lower socioeconomic status are anticipated to face a greater risk of experiencing PC compared to other geographical areas.

PMID:39440551 | DOI:10.1002/cam4.70318

Ann Afr Med. 2024 Oct 23. doi: 10.4103/aam.aam_203_23. Online ahead of print.

ABSTRACT

AIMS: We have compared sealing pressure, usability, and complications of two second-generation supraglottic airway devices-Baska® mask and I-gel.

SETTINGS AND DESIGNS: The study design involves prospective randomized controlled trial.

MATERIALS AND METHODS: The study was undertaken involving 44 patients of the American Society of Anesthesiologists physical status I and II, aged 20-70 years, who underwent surgical procedures of short duration under general anesthesia. Patients were randomly categorized into two groups of 22 each: Group B (Baska® mask) and Group I (I-gel). The main objective was to compare oropharyngeal leak pressure (OLP).

STATISTICAL ANALYSIS: Continuous variables were compared between the two groups using an unpaired t-test. Categorical variables were compared using the Chi-square test and insertion attempts using Fisher’s exact test.

RESULTS: Group B had significantly higher mean OLP (32.22 ± 2.52 cmH2O vs. 26.18 ± 2.42 cmH2O, P < 0.001). In Group I, 97.1% of patients had very easy insertion (Grade 1), 2.9% had easy insertion (Grade 2) and Group B had very easy insertion in 50% of patients, easy in 36.4%, and difficult in 13.6% of patients (P = 0.009). Group B took a longer time for successful insertion than Group I (39.89 ± 7.15 s vs. 28.19 ± 3.29 s, P < 0.001).

CONCLUSION: For positive pressure ventilation, both I-gel and Baska® masks proved to be successful, with I-gel being easier and quicker to insert. It is possible to employ the Baska® mask with superior seal pressures as an alternative to endotracheal intubation in elective surgeries if there are no patient contraindications.

PMID:39440544 | DOI:10.4103/aam.aam_203_23

Future Sci OA. 2024 Dec 31;10(1):2413827. doi: 10.1080/20565623.2024.2413827. Epub 2024 Oct 23.

ABSTRACT

Aim: Platelet-rich plasma (PRP), enriched with multiple growth factors, is a promising adjunctive therapy for diabetic foot ulcers (DFUs). As a classic anti-platelet drug for diabetic patients, the effects of aspirin on the content of growth factors in PRP remains unclear.Methods: Our study enrolled diabetic patients who were currently taking or not taking aspirin as the research subjects, with healthy volunteers as the control. PRP from these individuals was activated with glucose calcium and thrombin. Growth factors levels in PRP activated supernatant (PRP-AS) and wound healing ability of platelet gel (PG) in the full-thickness skin defect diabetic mouse model were compared.Results: We found the level of growth factors in PRP-AS derived from two groups of diabetic patients were not statistically different, whereas both lower than that from healthy volunteers. Similarly, we found better wound healing ability of PG from healthy volunteers than those from diabetic patients, but no difference between the two groups of diabetic patients in the mouse model.Discussion: Aspirin does not interfere with autologous PRP therapy when using calcium gluconate and thrombin as agonists. However considering the content of growth factors, PRP from healthy volunteers is a preferable option for promoting DFU repair.

PMID:39440536 | DOI:10.1080/20565623.2024.2413827

Ann Afr Med. 2024 Oct 23. doi: 10.4103/aam.aam_145_21. Online ahead of print.

ABSTRACT

OBJECTIVES: The novel SARS-CoV-2 outbreak disrupted businesses globally and created fears in the general public and among health-care professionals. Almost universally, considerations about the coronavirus pandemic and its effects became priority in the daily operations of businesses, leaving hitherto pressing concerns in the back stage. Early in the pandemic, the management of University of Benin Teaching Hospital set up a Business Continuity Team which undertook an evaluation of the perceptions of mid-level hospital managers about their departments’ and units’ risks and vulnerabilities in the face of the ongoing pandemic.

METHODS: A modified International Labour Organization (ILO) risk profile self-assessment tool which focused on “people,” “processes,” “profits,” and “partnerships” was used to assess mid-level managers’ perceptions of their respective departments’ and units’ risks and vulnerabilities, consequent on the COVID-19 pandemic. Responses were obtained from heads of departments and units using an online survey. Final scores were divided into terciles (three equal groups) in respect of perceived risks and adverse outcomes of the COVID-19 pandemic. Scores in the lower tercile were grouped as low risk/vulnerability, the middle group of scores as medium risk/vulnerability, and scores in the upper tercile as high risk/vulnerability.

RESULTS: Responses were obtained from 35 (49.3%) of the 71 clinical and nonclinical departments and units in the hospital. Fifteen of these (42.9%) were clinical. Nineteen (54.2%) departments were assessed to be at high risk/vulnerability, 9 (47.4%) of which were clinical. Twelve (34.3%) departments were assessed to be at medium risk/vulnerability – 4 (33.3%) of them, clinical. No department was assessed to be at low risk. The highest risk ratings were in the domains of “profits” and “partnerships:” 54 (84.4%) mid-level managers assessed their departments and units to be at high risk of the negative impacts of the coronavirus pandemic with respect to “profits” and 51 (79.7%) with respect to “partnerships.”

CONCLUSION: Mid-level managers in clinical and nonclinical departments and units assessed their departments and units to be at medium and high risk of the negative impacts of the COVID-19 pandemic, using the ILO’s modified tool. Our findings enabled the management of the hospital and the Business Continuity Team to address the specific areas of concerns that were highlighted, develop contingency plans, and frame risk communication during the pandemic, with a view to fostering increased sense of safety in the workforce. This approach to risk assessment is repeatable, and we recommended it to other hospitals in Africa.

PMID:39440533 | DOI:10.4103/aam.aam_145_21

Ann Afr Med. 2024 Oct 23. doi: 10.4103/aam.aam_160_23. Online ahead of print.

ABSTRACT

BACKGROUND: Inguinal hernia repair is a common surgical procedure, with laparoscopic techniques offering advantages over open surgery. The extended Totally Extraperitoneal (eTEP) technique provides a larger working space compared to the traditional Totally Extraperitoneal (TEP) approach, potentially improving outcomes.

MATERIAL AND METHODS: A prospective study was conducted comparing eTEP and TEP techniques for inguinal hernia repair at Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune. Forty patients (20 in each group) aged 15-65 with uncomplicated inguinal hernias were included. Surgical procedures were performed based on patient preference. Data on surgical duration, pain scores, hospital stay, and complications were collected and analyzed using statistical methods.

RESULTS: eTEP surgery had a significantly shorter mean duration (48.70 ± 7.505 minutes) compared to TEP surgery (74.20 ± 7.78 minutes; P = 0.00). Patients undergoing eTEP experienced lower mean pain scores (3.75 ± 0.55) compared to those undergoing TEP (5.15 ± 0.745; P = 0.00). Hospital stay following eTEP surgery was shorter (1.70 ± 0.657 days) than following TEP surgery (3.65 ± 1.137 days; P = 0.00). eTEP had lower incidences of hematoma and surgical emphysema but higher seroma complications. TEP surgeries were associated with more post-operative complications and a higher likelihood of requiring conversion to open surgery.

DISCUSSION: The eTEP technique offers several advantages over TEP, including shorter surgical duration, less post-operative pain, and shorter hospital stays. However, TEP had more complications related to seroma. Individual patient factors and surgeon experience should guide the choice of technique.

CONCLUSION: The eTEP technique appears to be a promising option for inguinal hernia repair, offering advantages over TEP in terms of surgical outcomes. However, further studies are needed to evaluate long-term outcomes and complication rates comprehensively.

PMID:39440530 | DOI:10.4103/aam.aam_160_23

Epidemiol Infect. 2024 Oct 23;152:e131. doi: 10.1017/S0950268824001365.

ABSTRACT

Inappropriate antibiotic use is a key driver of antibiotic resistance and one that can be mitigated through stewardship. A better understanding of current prescribing practices is needed to develop successful stewardship efforts. This study aims to identify factors that are associated with human cases of enteric illness receiving an antibiotic prescription. Cases of laboratory-confirmed enteric illness reported to the FoodNet Canada surveillance system between 2015 and 2019 were the subjects of this study. Laboratory data were combined with self-reported data collected from an enhanced case questionnaire that included demographic data, illness duration and symptoms, and antibiotic prescribing. The data were used to build univariable logistic regression models and a multivariable logistic regression model to explore what factors were associated with a case receiving an antibiotic prescription. The final multivariable model identified several factors as being significantly associated with cases being prescribed an antibiotic. Some of the identified associations indicate that current antibiotic prescribing practices include a substantial level of inappropriate use. This study provides evidence that antibiotic stewardship initiatives targeting infectious diarrhoea are needed to optimize antibiotic use and combat the rise of antibiotic resistance.

PMID:39440529 | DOI:10.1017/S0950268824001365

Adv Sci (Weinh). 2024 Oct 23:e2410041. doi: 10.1002/advs.202410041. Online ahead of print.

ABSTRACT

The application of quantum-dot light-emitting diodes (QLEDs) is hindered by efficiency roll-off at high current densities. Factors contributing to this roll-off include Auger recombination, electric field-induced quenching, Joule heating, and electron leakage into the hole transport layer. However, a method to quantitatively attribute the contribution of each factor to roll-off has not yet been available, leaving the primary cause of roll-off unidentified. This work addresses this gap using electrically pumped transient absorption spectroscopy, which measures the accumulated electrons and electric field in quantum dots (QDs). This study also introduces a method to quantify electron leakage in QLEDs using this spectroscopic technique. Based on the spectroscopic experimental results, the contribution of each factor to roll-off is quantified. A green QLED with a peak external quantum efficiency (EQE) of 26.8% is studied as an example. The EQE declines to 20.5% at a current density of 354 mA cm^-2, where field-induced quenching accounts for 5% of the efficiency roll-off, and electron leakage contributes 95%. Contributions from Auger recombination and heat-induced quenching are negligible. This work demonstrates strong correlations between roll-off and electron leakage amplitude using statistical data obtained in multiple QLEDs, confirming that electron leakage is the primary factor in EQE roll-off.

PMID:39440522 | DOI:10.1002/advs.202410041

Infect Control Hosp Epidemiol. 2024 Oct 23:1-5. doi: 10.1017/ice.2024.157. Online ahead of print.

ABSTRACT

OBJECTIVE: Assess healthcare workers’ (HCW) attitudes toward universal masking, and gowns and gloves used as part of transmission-based precautions.

DESIGN: Cross-sectional survey.

SETTING: Academic, tertiary care medical center in Baltimore, Maryland.

PARTICIPANTS: HCW who work in patient care areas and have contact with patients.

METHODS: In May 2023, a 15-question web-based survey was distributed by the hospital’s communications team via email. The survey contained questions to assess HCW perceptions of universal masking policies prior to the availability of COVID-19 vaccines and at the time of the survey, and the use of gowns and gloves for transmission-based precautions. Descriptive statistics were used to summarize data. Differences in agreement with universal masking over time, level of agreement with gown and glove policies, and with all PPE types across respondent characteristics were assessed.

RESULTS: 257 eligible respondents completed the survey. Nurses and patient care technicians (43%) and providers (17%) were the most commonly reported roles. Agreement with universal mask use decreased from 84% early in the pandemic to 55% at the time of the survey. 70% and 72% of HCW agreed masks protect themselves and others, respectively. 63% expressed any level of annoyance with mask wearing, the most often due to communication challenges or physical discomfort. 75% agreed with gown use for antibiotic-resistant bacteria compared with 90% for glove use.

CONCLUSIONS: The majority of HCW agree with the use of PPE to prevent pathogen transmission in the healthcare setting. Agreement with universal mask use for patient care shifted during the COVID-19 pandemic.

PMID:39440514 | DOI:10.1017/ice.2024.157

Acta Orthop Belg. 2024 Jun;90(2):335-342. doi: 10.52628/90.2.11791.

ABSTRACT

Main reasons for prolonged hospital stay after total knee arthroplasty (TKA) are postoperative nausea and vomiting (PONV) and pain. Having a positive effect on both PONV and pain, perioperative administration of corticosteroids might improve rehabilitation and reduce length of hospital stay (LOS) after TKA. Aim of this review is to determine the effect of different corticosteroid dosages on PONV, pain, and LOS in TKA. A systematic search for articles comparing dosage effects of corticosteroids regarding PONV, pain, and LOS after primary unilateral TKA was conducted using EMBASE, PubMed publisher, MEDLINE, Cochrane, Google scholar, and Web-of-Science for articles published from inception to March 17, 2022. 16 studies were included involving 2352 TKA procedures. Most studies showed reduced pain scores in corticosteroid groups and some described better pain reduction in high-dose groups. All studies showed reduced PONV in the corticosteroid groups. LOS was similar in most studies comparing placebo and perioperative corticosteroids. Only one study reported increased infection rates and intramuscular venous thrombosis in the corticosteroid group. Concluding, current literature on corticosteroids use in TKA is highly variable in type, dosage, and timing of administering medication. Overall, corticosteroids mostly reduce pain and PONV with limited effects on LOS after TKA. Only minimal statistically significant and clinically relevant benefits were found in perioperative high-dose corticosteroids compared to low-dose. Given the short follow-up in most studies, it is not possible to evaluate safety of high-dose corticosteroids.

PMID:39440510 | DOI:10.52628/90.2.11791

Acta Orthop Belg. 2024 Jun;90(2):293-302. doi: 10.52628/90.2.10403.

ABSTRACT

INTRODUCTION: In 2019, the French College of Orthopaedic and Traumatology (CFCOT) made the AOTrauma course entitled “Basic Principles of Fracture Treatment” mandatory for all orthopaedic residents during the first year of their educational program i.e. during the SOCLE phase (common base phase). The objective of the evaluation was to determine which factors influenced the results of the practical work, according to the characteristics of the students and their experiences in laparoscopy or in arthroscopy in the operating theatre or on the simulator for arthroscopy.

MATERIAL AND METHODS: In 2019 a total of 121 residents were included, corresponding to the full promotion. They filled out a preliminary questionnaire giving information on their general characteristics. Eight different workshops were evaluated. The grading of skills was as follows: “A” for “acquired”, “B” for “in progress” and “C” for “not acquired”. The data was collected on a computerized spreadsheet. The statistical analysis used the Welch test, the Chi2 test and the Fisher test.

RESULTS: The average “A” percentage across all workshops was 87.8%. Factors predictive of a good result were experience in laparoscopy as the main operator (p = 0.014) and male sex (p = 0.014). We observed that the residents who had not performed arthroscopy in clinical practice had done more training on simulators than the others (p = 0.044). Residents who had performed at least one arthroscopy as a main operator were predominantly female (p < 0.001).

DISCUSSION: The interest of this study lies in the novelty of the analysis of the results of a whole promotion of residents in the SOCLE phase in osteosynthesis simulation.

CONCLUSION: This novel evaluation deserves to be repeated by refining the evaluation tools before and during the course. It allowed us to know the weak points of the students during the simulated learning.

PMID:39440506 | DOI:10.52628/90.2.10403