Nevin Manimala

Am J Obstet Gynecol. 2023 Sep 29:S0002-9378(23)00721-4. doi: 10.1016/j.ajog.2023.09.092. Online ahead of print.

ABSTRACT

BACKGROUND: Though cesarean delivery is the most common surgery performed in the United States, prescribing practices for analgesia vary. Strategies to manage postpartum pain have mostly focused on the immediate postpartum period when patients are still admitted to the hospital. At discharge, most providers prescribe a fixed number of opioid tablets. Most patients do not use all the opioids they are prescribed at hospital discharge. This leads to an excess of opioids in the community which can ultimately lead to misuse and diversion.

OBJECTIVE: To determine if a transition from universal opioid prescribing to a personalized, patient specific protocol decreases morphine equivalents prescribed at hospital discharge after cesarean delivery, while adequately controlling pain.

STUDY DESIGN: This is a prospective cohort study of patients undergoing cesarean delivery before and after implementation of a personalized opioid prescribing practice at time of hospital discharge. Each patient was prescribed scheduled ibuprofen and acetaminophen, with a prescription for oxycodone tablets equal to 5 times the morphine equivalents used in the 24 hours prior to discharge, calculated via an electronic order set. The prior traditional cohort were routinely prescribed 30 tablets of acetaminophen-codeine 300-30 milligrams. The primary outcome was morphine equivalents prescribed at discharge. A hotline to address pain control issues after discharge was established, and calls, emergency room visits, and re-admissions were examined. Statistical analyses included chi-square and Wilcoxon rank-sum with a P-value < 0.05 considered statistically significant.

RESULTS: 412 patients underwent cesarean delivery in the 6 weeks after initiation of the personalized prescribing protocol and were compared to 367 patients prior to the change. The median morphine equivalents prescribed at discharge was lower with personalized prescribing (37.5 [1^st quartile 0, 3^rd quartile 75] vs 135 [135, 135], P < 0.001). 176 (43%) patients were not prescribed opioids at discharge which was a substantial change as all 367 patients in the traditional cohort received opioids at discharge (P < 0.001). Nine hotline phone calls were received; none required additional opioids after a 24 hour trial of scheduled ibuprofen, which none had taken prior to the call. 11 (2.7%) patients presented to the emergency room for pain evaluation, of which none required re-admission or an outpatient prescription of opioids.

CONCLUSION: A personalized protocol for opioid prescriptions after cesarean delivery decreased total morphine equivalents and number of opioid tablets at discharge, without hospital re-admissions or need for rescue opioid prescriptions after discharge. Opioids released into our community will be reduced by over 90,000 tablets per year, without demonstrable adverse effect.

PMID:37778679 | DOI:10.1016/j.ajog.2023.09.092

J Shoulder Elbow Surg. 2023 Sep 29:S1058-2746(23)00712-7. doi: 10.1016/j.jse.2023.08.029. Online ahead of print.

ABSTRACT

BACKGROUND: The Walch classification is commonly utilized by surgeons when determining the treatment of osteoarthritis (OA). However, its utility in prognosticating patient clinical state before and after TSA remains unproven. We assessed the prognostic value of the modified Walch glenoid classification on preoperative clinical state and postoperative clinical and radiographic outcomes in total shoulder arthroplasty (TSA).

METHODS: A prospectively-collected, multi-center database for a single-platform TSA system was queried for patients with rotator cuff-intact OA and minimum 2 year follow-up after anatomic and reverse TSA (aTSA, rTSA). Differences in patient-reported outcome scores (PROMS) [SST, ASES, SPADI, VAS Pain, Shoulder Function score], combined patient-reported and clinical-input scores (Constant, UCLA, SAS), active range of motion (ROM) values (forward elevation [FE], abduction, external rotation [ER], internal rotation [IR], and radiographic outcomes (humeral and glenoid radiolucency line rates, scapula notching rate) were stratified and compared by glenoid deformity type per the Walch classification for aTSA and rTSA cohorts. Comparisons were performed to assess the ability of the Walch classification to predict the preop, postop, and improved state after TSA.

RESULTS: 1,008 TSAs were analyzed including 576 aTSA and 432 rTSA. Comparison of outcomes between Walch glenoid types resulted in 15 pairwise comparisons of 12 clinical outcome metrics, yielding 180 total Walch glenoid pairwise comparisons for each clinical state (preoperative, postoperative, improvement). Of the 180 possible pairwise Walch glenoid type / metric comparisons studied for aTSA and rTSA cohorts, <6% and < 2% significantly differed in aTSA and rTSA cohorts, respectively. Significant differences based on Walch type were seen after adjustment for multiple pairwise comparisons in the aTSA cohort for FE and ER preoperatively, the Constant score postoperatively, and for abduction, FE, ER, Constant score, and SAS score for pre- to postoperative improvement. In the rTSA cohort, significant differences were only seen in abduction and Constant score both postoperatively and for pre- to postoperative improvement. There were no statistically significant differences in humeral lucency rate, glenoid lucency rate (aTSA), scapular notching rate (rTSA), complication rates, or revision rates between Walch glenoid types after TSA.

CONCLUSION: Although useful for describing degenerative changes to the glenohumeral joint, we demonstrate a weak association between preoperative glenoid morphology according to the Walch classification and clinical state when evaluating patients undergoing TSA for rotator cuff-intact OA. Alternative glenoid classification systems or predictive models should be considered to provide more precise prognoses for patients undergoing TSA for rotator cuff-intact OA.

PMID:37778653 | DOI:10.1016/j.jse.2023.08.029

Vet J. 2023 Sep 29:106031. doi: 10.1016/j.tvjl.2023.106031. Online ahead of print.

ABSTRACT

Bovine respiratory disease (BRD) is one of the leading causes of mortality and morbidity in calves across diverse management systems. Despite expert opinion often citing the influence of housing environment on the level of respiratory disease in calf groups, there have been few reviews of environmental factors that predispose to BRD. This systematic review was undertaken to identify the measurable environmental variables associated with respiratory disease in housed preweaned calves. To achieve this Pubmed, CAB Direct and Scopus databases were searched. To be considered for inclusion, publications had to be fully published in English, published before 24 November, 2022 and include at least one measurable/ manipulated environmental variable and a standardized method of BRD detection. Twelve publications were included in this review. These examined a wide range of risk factors including air microbial count (four publications), air particulate matter (one publication); air endotoxins (one publication) and air ammonia (four publications). From the included publications, a statistically significant relationship to BRD was identified in 2/4 examining air microbial count, 1/1 examining air particulate matter, 1/1 examining air endotoxins and 2/4 examining air ammonia. This review indicated a paucity of evidence from the peer-review literature demonstrating a significant association between the many investigated exposure factors and BRD occurrence. An optimal environment for housed calves could not be clearly identified in this review.

PMID:37778652 | DOI:10.1016/j.tvjl.2023.106031

Hellenic J Cardiol. 2023 Sep 29:S1109-9666(23)00187-2. doi: 10.1016/j.hjc.2023.09.016. Online ahead of print.

NO ABSTRACT

PMID:37778638 | DOI:10.1016/j.hjc.2023.09.016

World Neurosurg. 2023 Sep 29:S1878-8750(23)01378-5. doi: 10.1016/j.wneu.2023.09.110. Online ahead of print.

ABSTRACT

OBJECTIVE: Cervical stability may deteriorate and kyphotic spinal deformities may develop in cervical spondylotic myelopathy (CSM) after laminectomy or laminoplasty. This study aimed to investigate the therapeutic efficacy of the “bilateral osteoligamentous decompression via unilateral hemilaminectomy approach (UHBOLD)” technique in CSM patients.

METHODS: The study included 34 adult patients who underwent UHBOLD surgery for CSM between 2016 and 2022. A record was made for all patients of age, gender, number of operated levels, preoperative and postoperative long-term follow-up VAS scores, Nurick grade values and mJOA scores, kyphosis angles measured on X-ray, and spinal canal areas measured on T2-weighted MR axial images.

RESULTS: Preoperative VAS scores of the patients were 6 (4-9), Nurick grade values were 3 (2-5), mJOA scores were 10.50±3.42, kyphosis angles were -13.34±13.69 degrees and spinal canal areas were 87.11±28.30 mm². In postoperative long-term follow-up of these patients, VAS scores were 2 (1-5), Nurick grade values were 1 (0-5), mJOA scores were 13.94±3.09, kyphosis angles were -15.07±12.78 degrees and spinal canal areas were 149.65±42.57 mm². A statistically significant difference was determined between the preoperative and the postoperative long-term follow-up VAS scores, Nurick grade values, mJOA scores, and spinal canal areas (p<0.001). Kyphosis angles were not different (p=0.198) and no instability was observed in any patient in long-term follow-up.

CONCLUSIONS: The UHBOLD technique performed in multilevel CSM patients did not cause any change in cervical lordosis angle in long-term follow-up, did not cause cervical kyphotic deformity or cervical instability, and significantly improved Nurick grade values, and VAS and mJOA scores.

PMID:37778625 | DOI:10.1016/j.wneu.2023.09.110

World Neurosurg. 2023 Sep 29:S1878-8750(23)01374-8. doi: 10.1016/j.wneu.2023.09.107. Online ahead of print.

ABSTRACT

OBJECTIVE: Microvascular decompression (MVD) as a treatment for trigeminal neuralgia (TGN) has high success rate but is associated with risks of complication. This study analyzes Twitter to provide insights into discussions surrounding MVD for patients with TGN.

METHODS: A Twitter search performed in April 2022 yielded 491 tweets from 426 accounts. Tweets and accounts were classified thematically, and descriptive statistics were used for various social media metrics. Using a natural language processing machine learning algorithm, sentiment analysis (SA) was performed to evaluate patient perspectives before and after surgery, and a multivariate regression model was used to identify predictors of higher engagement metrics (likes, retweets, quote tweets, replies).

RESULTS: Most accounts were patients, caregivers and other members of the public (70%). The most encountered themes were research (47%) and personal experiences (33.4%). SA of tweets about patient experiences showed that 40.2% of tweets were positive, 31.1% were neutral and 28.7% were negative. Negative tweets decreased significantly in post-operative tweets and mostly discussed complications or failure of surgery (63%). On multivariate analysis, only inclusion of media (photo or video) in a Tweet was associated with higher engagement metrics.

CONCLUSION: This study provides a comprehensive review of Twitter use discussing MVD in TGN and is the first to assess patient satisfaction after treatment using SA. The data presented on patient perspectives on social media could help physicians establish direct lines of communication with patients, fostering a more patient-focused care.

PMID:37778624 | DOI:10.1016/j.wneu.2023.09.107

World Neurosurg. 2023 Sep 29:S1878-8750(23)01375-X. doi: 10.1016/j.wneu.2023.09.108. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to assess the impact of the workshops organized during Neuroendocon 23 on the perspective and confidence of neurosurgeons toward endoscopy in an LMIC.

METHODS: Neuroendocon 23 had cranial and spinal endoscopy cadaveric workshops with 30 delegates each. A pre and post-workshop survey was disseminated among the delegates, and statistical analysis was performed with SPSS (version 26) using p<0.05.

RESULTS: A total of 24 delegates (40%) consented to participate in the study, with only one female respondent (4.17%). After the cranial endoscopy workshop, there was an increase in the level of confidence of delegates in cranial endoscopic approaches (p <0.001). Similarly, after the spine endoscopy workshop, the respondents had increased confidence in managing spine conditions with the endoscopic approach (p = 0.040), to the extent that they preferred the endoscopic over the microsurgical technique (p <0.001). All respondents (n = 24, 100%) believed that endoscopy should be promoted in LMICs and integrated into residency curricula.

CONCLUSION: Cranial and spinal endoscopy cadaveric workshops could be the first step in stimulating the interest of neurosurgeons in endoscopy.

PMID:37778622 | DOI:10.1016/j.wneu.2023.09.108

Math Biosci. 2023 Sep 29:109084. doi: 10.1016/j.mbs.2023.109084. Online ahead of print.

ABSTRACT

Discrete time, spatially extended models play an important role in ecology, modelling population dynamics of species ranging from micro-organisms to birds. An important question is how’bottom up’, individual-based models can be approximated by’top down’ models of dynamics. Here, we study a class of spatially explicit individual-based models with contest competition: where species compete for space in local cells and then disperse to nearby cells. We start by describing simulations of the model, which exhibit large-scale discrete oscillations and characterise these oscillations by measuring spatial correlations. We then develop two new approximate descriptions of the resulting spatial population dynamics. The first is based on local interactions of the individuals and allows us to give a difference equation approximation of the system over small dispersal distances. The second approximates the long-range interactions of the individual-based model. These approximations capture demographic stochasticity from the individual-based model and show that dispersal stabilizes population dynamics. We calculate extinction probability for the individual-based model and show convergence between the local approximation and the non-spatial global approximation of the individual-based model as dispersal distance and population size simultaneously tend to infinity. Our results provide new approximate analytical descriptions of a complex bottom-up model and deepen understanding of spatial population dynamics.

PMID:37778619 | DOI:10.1016/j.mbs.2023.109084

Eur J Pharmacol. 2023 Sep 29:176090. doi: 10.1016/j.ejphar.2023.176090. Online ahead of print.

ABSTRACT

BACKGROUND: Intestinal ischemia/reperfusion injury (IRI) is a multifactorial, complex pathophysiological process in clinical settings. In recent years, intestinal IRI has received increasing attention due to increased morbidity and mortality. To date, there are no effective treatments. Dexmedetomidine (DEX), a highly selective α₂-adrenergic receptor agonist, has been demonstrated to be effective against intestinal IRI. In this systematic review and meta-analysis, we evaluated the efficacy and potential mechanisms of DEX as a treatment for intestinal IRI in animal models.

METHODS: Five databases (PubMed, Embase, Web of Science, Cochrane Library, and Scopus) were searched until March 15, 2023. Using the SYRCLE risk bias tool, we assessed methodological quality. Statistical analysis was conducted using STATA 12 and R 4.2.2. We analyzed the related outcomes (mucosa damage-related indicators; inflammation-relevant markers, oxidative stress markers) relied on the fixed or random-effects models.

RESULTS: There were 15 articles including 18 studies included, and 309 animals were involved in the studies. Compared to the model groups, DEX improved intestinal IRI. DEX decreased Chiu’s score and serum diamine oxidase (DAO) level. DEX reduced the level of inflammation-relevant markers (interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF)-α). DEX also improved oxidative stress (decreased malondialdehyde (MDA), increased superoxide dismutase (SOD)).

CONCLUSIONS: DEX’s effectiveness in ameliorating intestinal IRI has been demonstrated in animal models. Antioxidation, anti-inflammation, anti-apoptotic, anti-pyroptosis, anti-ferroptosis, enhancing mitophagy, reshaping the gut microbiota, and gut barrier protection are possible mechanisms. However, in light of the heterogeneity and methodological quality of these studies, further well-designed preclinical studies are warranted before clinical implication.

PMID:37778612 | DOI:10.1016/j.ejphar.2023.176090

Environ Res. 2023 Sep 29:117279. doi: 10.1016/j.envres.2023.117279. Online ahead of print.

ABSTRACT

Mental disorders among children and adolescents pose a significant global challenge. The exposome framework covering the totality of internal, social and physical exposures over a lifetime provides opportunities to better understand the causes of and processes related to mental health, and cognitive functioning. The paper presents a conceptual framework on exposome, mental health, and cognitive development in children and adolescents, with potential mediating pathways, providing a possibility for interventions along the life course. The paper underscores the significance of adopting a child perspective to the exposome, acknowledging children’s specific vulnerability, including differential exposures, susceptibility of effects and capacity to respond; their susceptibility during development and growth, highlighting neurodevelopmental processes from conception to young adulthood that are highly sensitive to external exposures. Further, critical periods when exposures may have significant effects on a child’s development and future health are addressed. The paper stresses that children’s behaviour, physiology, activity pattern and place for activities make them differently vulnerable to environmental pollutants, and calls for child-specific assessment methods, currently lacking within today’s health frameworks. The importance of understanding the interplay between structure and agency is emphasized, where agency is guided by social structures and practices and vice-versa. An intersectional approach that acknowledges the interplay of social and physical exposures as well as a global and rural perspective on exposome is further pointed out. To advance the exposome field, interdisciplinary efforts that involve multiple scientific disciplines are crucial. By adopting a child perspective and incorporating an exposome approach, we can gain a comprehensive understanding of how exposures impact children’s mental health and cognitive development leading to better outcomes.

PMID:37778607 | DOI:10.1016/j.envres.2023.117279