Nevin Manimala

Georgian Med News. 2022 Nov;(332):22-28.

ABSTRACT

It has been more than 34 months since the severe acute respiratory syndrome coronavirus 2 that causes the COVID-19 pandemic emerged. However, understanding of COVID-19 is still evolving, and COVID-19 statistics are dynamic. The purpose of this study was to investigate the pattern of distribution of COVID-19 in the six continents by the end of October 2022 and compare it to the end of 2020 and 2021. Online data of distribution was successfully recruited from the “Worldometer” website. By the end of October 2022, nearly 6.8 billion COVID-19 tests have been performed, resulting in around 636 million cases detected, while about 6.6 million deaths were registered. The year 2021 was worse than 2020, while the first 10 months of 2022 witnessed the largest number of detected cases (55% of all cases recorded). The distribution of deaths and cases has not been consistent between continents. The number of cases/deaths is proportional to the number of tests performed. The largest share of tests was carried out in Europe (41%), while fewer tests were conducted in Africa (1.6%), and therefore, fewer cases and deaths were recorded. In conclusion, between countries, as well as across continents, the number of COVID-19 cases/deaths/tests and the case-fatality rate vary significantly, and over time, which suggest considerable uncertainty over the exact COVID-19 statistics worldwide. The definition of suspected cases should be clear, appropriate, and internationally standardized. Only when an international standard is agreed upon will we be able to make fair comparisons.

PMID:36701773

J Osteopath Med. 2023 Jan 27. doi: 10.1515/jom-2022-0127. Online ahead of print.

ABSTRACT

CONTEXT: Lymphatic treatments are gentle and passive techniques believed to enhance movement of lymph back into the central circulatory system. Animal studies provide supportive evidence, yet there are few studies in humans.

OBJECTIVES: The aim of this study is to investigate whether the osteopathic pedal pump protocol reduces volume in the lower limbs of healthy subjects.

METHODS: A total of 30 first- and second-year medical students were recruited. Subjects were excluded from participating if they had acute asthma, chronic obstructive pulmonary disease (COPD), congestive heart failure, active infections, fractures of the lower extremities, or metastatic cancer. A within-subjects study design with pre- and posttreatment measurement of lower limb volume was utilized. Pretreatment lower limb volume measurements were obtained utilizing a volumetric water gauge prior to myofascial thoracic inlet release and a 5 min pedal lymphatic pump protocol treatment. Posttreatment lower limb measurements were taken immediately following the protocol treatment. A telephone interview was conducted 2-3 days after the treatment to assess the participants’ experience of the treatment and whether the treatment elicited a subjective change from baseline. A paired t test was utilized to determine the statistical significance of volume displacement posttreatment.

RESULTS: The mean change of pretreatment to posttreatment lower limb volume was -45.63 mL with a standard deviation of 37.65 mL. The change between the pretreatment and posttreatment volume measurements was statistically significant (p<0.001). The minimum displacement was +19 mL, and the maximum displacement was -167 mL. The majority of participants perceived the treatment as effective and enjoyable, were likely to recommend it to others, and were willing to have it performed on them at routine office visits if there was a need.

CONCLUSIONS: The osteopathic pedal pump technique, when utilized on those without leg lymphedema, reduces lower limb volume as measured by the volumetric water gauge. Further studies are warranted, especially in persons with excess lower-extremity edema, lymphedema or venous stasis.

PMID:36701752 | DOI:10.1515/jom-2022-0127

J Athl Train. 2023 Jan 27. doi: 10.4085/1062-6050-0233.22. Online ahead of print.

ABSTRACT

Previous studies commonly utilized a multi-select checklist method to assess an athlete’s ability to recognize true sports-related concussion (SRC) signs and symptoms (S&S) amongst incorrect distractor options. However, this may overinflate the evaluation of participants’ knowledge since the multi-select method does not test athletes’ ability to retrieve knowledge from their long-term memory. To test this hypothesis, an online survey was sent to registered members of the Japan Lacrosse Association (n=8,530) to examine differences in reported SRC S&S by an open-ended question and multi-select formats. We also examined whether previous exposure to SRC education and a history of SRC influenced athletes’ SRC S&S knowledge. The number and proportions of responses by participants were calculated using descriptive statistics. Pearson’s correlation was used to analyze the relationship between scores from two question formats. Unpaired sample t-tests were used to compare mean scores of each question format by previous SRC education and history of diagnosed SRC. Odds ratio was calculated to express the relationship between the proportion of correct answers by question format per symptom. The response rate of the survey was 35.9% (n=3,065) and revealed that scores from two question formats were correlated (r=0.34, 95%CI=0.31, 0.37; p<0.001). For both question formats, athletes with previous exposure to SRC education and a history of SRC reported a greater number of correct answers; however, the mean differences were trivial. In conclusion, researchers and clinicians should acknowledge the difference between multi-select (recognition) and open-ended (free recall) when assessing one’s understanding of SRC and managing athletes with a suspected SRC.

PMID:36701744 | DOI:10.4085/1062-6050-0233.22

Medicine (Baltimore). 2023 Jan 20;102(3):e32728. doi: 10.1097/MD.0000000000032728.

ABSTRACT

BACKGROUND: This paper aimed to comprehensively evaluate the effectiveness and safety of Inclisiran in treating hyperlipidemia through an overview of systematic reviews (SRs).

METHODS: The Cochrane Library, EMBASE, PubMed, CNKI, WANGFANG database, VIP database, ClinicalTrials.gov, and ICRT were searched electronically to collect SRs and meta-analysis of Inclisiran in hyperlipidemia treatment from the establishment of the database till May 2022. Two researchers independently screened the relevant literature, then the assessment of multiple systematic reviews tool was made into assess the methodological quality of the included studies. Data extracted were used to perform the study through RevMan5.3 software. The grading of recommendations assessment, development, and evaluation tool was used to grade the quality of the evidence of the outcomes included in the SRs. Prospero ID: CRD 42022326845.

RESULTS: A total of 10 relevant SRs were included, involving 7 randomized controlled trials. The assessment results of the assessment of multiple systematic reviews tool suggested that the quality of the SRs included needed to be improved. The reduced level of low-density lipoprotein cholesterol of the experimental group was lower than the control group, and the difference in the amount of effectiveness was statistically significant (MD = -50.13, 95%CI: -56.2 to -44.06, P < .00001). The grading of recommendations assessment, development, and evaluation results showed that out of 27 outcomes, 8 were high-quality, 3 were of medium quality, 6 were of low quality, and 10 were of the most inferior quality.

CONCLUSION: 300mg Inclisiran with 2 injections a year has the best therapeutic effect, which can significantly reduce low-density lipoprotein cholesterol and total cholesterol, and increase high-density lipoprotein cholesterol levels in patients with hyperlipidemia. Inclisiran has a favorable safety profile, with no significant difference in the incidence of adverse reactions compared to a placebo. Most of the adverse effects were associated with the reaction on the injection site.

PMID:36701738 | DOI:10.1097/MD.0000000000032728

Medicine (Baltimore). 2023 Jan 20;102(3):e32624. doi: 10.1097/MD.0000000000032624.

ABSTRACT

To analyze the clinical effect of standardized nursing for lymphoma patients and the influencing factors of nosocomial infection, a total of 360 diffuse large B-cell lymphoma patients with disease recurrence or progression after first-line treatment were retrospectively selected from our hospital from January 2021 to July 2022. After standardized nursing, the overall infection rate of lymphoma patients was 2.50% (9/360), which was significantly lower than the overall infection rate of our hospital in 2021 (7.44%, 844/11342) (P < .05). The proportion of 3 kinds of pathogenic bacteria detected were G+ bacteria (33.5%), G- bacteria (53.3%), and fungi (13.2%). The pathogenic bacteria genus with the most G+ bacteria is Enterococcus, the pathogenic bacteria genus with the most G+ bacteria is Enterobacteriaceae, and the pathogenic bacteria with the most fungi is Candida albicans. Female infection rate was significantly higher than male (P < .05). There was no significant difference in nosocomial infection among different marital status/fertility status (P > .05). The nosocomial infection of patients with different hospitalization times was statistically significant (P < .05). The duration of hospitalization in the infected group was significantly higher than that in the non-infected group (P < .05). The clinical effect of standardized nursing for lymphoma patients is significant, and the influencing factors of nosocomial infection include patient gender, hospitalization frequency, and hospitalization duration.

PMID:36701737 | DOI:10.1097/MD.0000000000032624

Medicine (Baltimore). 2023 Jan 20;102(3):e32690. doi: 10.1097/MD.0000000000032690.

ABSTRACT

We built a closed-loop management model for patients with fever in a county-level medical community and explored the role of this model in post-coronavirus disease 2019 (COVID-19) epidemic prevention and control. The subjects included 83,791 patients with fever treated in designated hospitals between February 2020 and April 2021. A pre-hospital, in-hospital, and post-hospital management system for patients with fever in the county-level medical community was established to allow the closed-loop management of these patients. SPSS software (version 13.0) was used to analyze the methods of visiting the hospital, nucleic acid detection in the hospital, and location of the patients after the hospital visit. Chi-square tests were used to compare the methods of visiting and location after hospital visits between patients with and without an epidemiological history. The number of patients with fever in the fever clinic showed a logarithm change (R2 = 0.4710), accompanied by seasonal changes. The number of fever patients with an epidemiological history decreased logarithmically monthly (R2 = 0.8876). Among patients with fever, 99.64% sought medical treatment on their own, with relatively low proportions undergoing home quarantine and requiring centralized quarantine special vehicles. After visiting the fever clinics, 98.56% of patients isolated at home or were monitored, with small proportions of patients requiring hospital admission or centralized isolation. However, the proportions of patients with home and centralized isolation with epidemiology were relatively high, accounting for 20.55% and 27.40% of cases, respectively. Compared to the overall population of patients with fever, the difference was statistically significant (χ2 = 48.881, P = .000). The establishment of a closed-loop management model for patients with fever in a county-level medical community strengthened the management of these patients. No local cases occurred in Beilun District between March 2020 and April 2021. In the post-COVID-19 era, all medical institutions in the county-level medical community strengthened infectious disease pre-examination and triage and promoted the formation of a strategic pattern of initial diagnosis at the grassroots level, 2-way referral, upper and lower linkage, and joint epidemic prevention. This management was more conducive to COVID prevention and control by hierarchical management according to the presence or absence of an epidemiological history.

PMID:36701725 | DOI:10.1097/MD.0000000000032690

Medicine (Baltimore). 2023 Jan 20;102(3):e32360. doi: 10.1097/MD.0000000000032360.

ABSTRACT

BACKGROUND: Psoriasis is a chronic, inflammatory, autoimmune skin disease. The aim of this review is to systematically evaluate the efficacy and safety of integrative medicine (East Asian herbal medicine combined with conventional medicine) used to treat inflammatory skin lesions of psoriasis.

METHODS: A comprehensive literature search will be conducted in 3 English databases (PubMed, Cochrane Library, and Embase), 4 Korean databases (Korean Studies Information Service System, Research Information Service System, Oriental Medicine Advanced Searching Integrated System, and Korea Citation Index), 2 Chinese databases (Chinese National Knowledge Infrastructure Database and Wanfang data), and 1 Japanese database (Citation Information by National Institute of Informatics) for randomized controlled trials from their inception until July 29, 2021. Statistical analysis will be performed using R version 4.1.2 and the R studio program using the default settings of the “meta” and “metafor” packages. The primary outcome will be an improvement in the psoriasis area severity index. All outcomes will be analyzed using a random-effects model to produce more statistically conservative results. If heterogeneity is detected in the study, the cause will be identified through sensitivity, meta-regression, and subgroup analyses. Methodological quality will be assessed independently using the revised tool for the risk of bias in randomized trials, version 2.0. The overall quality of evidence will be evaluated according to the Grading of Recommendations Assessment, Development, and Evaluation pro framework.

RESULTS: This study will review all available trials on the same subject and arrive at a more statistically robust conclusion based on a sufficient sample size of participants and additional analysis using data mining techniques will be performed on intervention prescription information in clinical studies collected according to rigorous criteria.

CONCLUSION: We believe that this study will provide useful knowledge on managing inflammatory skin lesions of psoriasis vulgaris using integrative medicine using East Asian herbal medicine.

PMID:36701719 | DOI:10.1097/MD.0000000000032360

Medicine (Baltimore). 2023 Jan 20;102(3):e32467. doi: 10.1097/MD.0000000000032467.

ABSTRACT

BACKGROUND: Recurrent patellar dislocation (RPD) occurs in people who have their own patellofemoral dysplasia and who have not been properly treated after their first patellar dislocation. For RPD where conservative treatment is ineffective, medial patellofemoral ligament (MPFL) reconstruction is the first choice for surgical treatment, but there are various and controversial ways of MPFL reconstruction and fixation. Initially, more scholars adopted the patellar lateral tunneling (PT) approach to contain and stabilize the graft, but with the newer materials and techniques, some experts adopted the lateral patellar anchor fixation (AF) of the graft, which can avoid the collateral damage caused by the patellar lateral tunneling and can obtain the same definite efficacy. Therefore, a meta-analysis must be performed to provide evidence whether there is a difference between AF and PT reconstruction of the MPFL in the treatment of RPD.

METHODS: We will search, with no time restriction, without any restriction of language and status, the time from the establishment of the database to October 2022, on the following databases: PubMed (MEDLINE), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Chinese National Knowledge Infrastructure (CNKI), Wanfang Data (WF), Chinese Scientific Journals Database (VIP), and Chinese databases SinoMed (CBM) electronic databases. The electronic database search will be supplemented by a manual search of the reference lists of included articles. We will apply the risk-of-bias tool of the Cochrane Collaboration for randomized controlled trials to assess the methodological quality. Risk-of-Bias Assessment Tool for Non-randomized Studies was used to evaluate the quality of comparative studies. Statistical analysis will be conducted using RevMan 5.4 software.

RESULTS: This systematic review and meta-analysis will evaluate the functional outcomes of the two fixation modalities, AF and PT, in reconstructing MPFL for RPD.

CONCLUSION: The findings of this study will provide a basis for clinical judgment of whether there is a difference between the two forms of AF and PT reconstructed MPFL for RPD.

PMID:36701716 | DOI:10.1097/MD.0000000000032467

Medicine (Baltimore). 2023 Jan 20;102(3):e32650. doi: 10.1097/MD.0000000000032650.

ABSTRACT

Coronavirus disease (COVID-19) is closely associated with hyperglycemia and a worse prognosis in patients with a previous diagnosis of type 2 diabetes mellitus. A few studies investigated the effects of diabetes treatment regimens in these patients during hospitalization. Here, we evaluate the impact of insulin and non-insulin therapy on glucose control in patients with type 2 diabetes admitted with COVID-19. This is a retrospective study including 359 COVID-19 patients with type 2 diabetes. Patients were divided into 2 groups according to diabetes treatment during hospitalization. The first group included patients treated with insulin only, and the second group patients treated with other antidiabetic agents with or without insulin. Average blood glucose was higher in the insulin-only treatment group (201 ± 66 mg/dL vs 180 ± 71 mg/dL, P = .004), even after excluding mechanically ventilated patients (192 ± 69 vs 169 ± 59 mg/dL, P = .003). In patients with moderate severity of COVID-19, average blood glucose was also significantly higher in the insulin-only treated group (197 ± 76 vs 168 ± 51 mg/dL, P = .001). Most patients (80%) in the combination treatment group received metformin. Moderately affected COVID-19 patients with type 2 diabetes could safely be treated with antihyperglycemic medications with or without insulin.

PMID:36701712 | DOI:10.1097/MD.0000000000032650

Medicine (Baltimore). 2023 Jan 20;102(3):e32669. doi: 10.1097/MD.0000000000032669.

ABSTRACT

BACKGROUND: With the Coronavirus disease 2019 epidemic, wearing a mask has become routine to prevent and control the virus’s spread, especially for healthcare workers. However, the impact of long-term mask wear on the human body has not been adequately investigated. This study aimed to investigate whether Powered Air Purifying Respirators and N95 masks impact the olfaction in healthcare workers.

METHODS: We recruited fifty-six healthcare workers and randomly divided them into 2 groups, wearing a powered air purifying respirator (PAPR) (experiment group, N = 28) and an N95 mask (control group, N = 28). Olfactory discrimination and threshold tests were performed before and after wearing the masks. SPSS 26.0 (SPSS Inc., Chicago, Illinois) software was used for the statistical analyses.

RESULTS: There was a statistical difference in the olfactory threshold test after wearing the mask in both PAPR Group (Z = -2.595, P = .009) and N95 Group (Z = -2.120, P = .034), with no significant difference between the 2 (χ2 = 0.29, P = .589). There was no statistical difference in the discrimination test scores in both 2 groups after wearing the masks.

CONCLUSION: Wearing a mask affects the healthcare workers’ olfaction, especially odor sensitivity. Healthcare workers have a higher olfactory threshold after long-term mask wear, whether wearing PAPRs or N95 masks.

PMID:36701701 | DOI:10.1097/MD.0000000000032669