Nevin Manimala

Disaster Med Public Health Prep. 2024 Mar 11:1-14. doi: 10.1017/dmp.2024.38. Online ahead of print.

ABSTRACT

INTRODUCTION: The mass gathering event (MGE) industry is growing globally, including in countries such as Canada. MGEs have been associated with a greater prevalence of injury and illness when compared to daily life events, despite most participants having few comorbidities. As such, adequate health, safety, and emergency medical planning is required. However, there is no single entity regulating these concerns for MGEs resulting in the responsibility for health planning lying with event organizers. This study aims to compare the legislative requirements for MGE medical response systems in the 13 provinces and territories of Canada.

METHODS: This study is a cross-sectional descriptive analysis of Canadian legislation. Lists of publicly available legislative requirements were obtained via the emergency medical services directors and Health Ministries. Descriptive statistics were performed to compare legislation.

RESULTS: Of the 13 provinces and territories, 10 responded. For the missing three, a law library review confirmed the absence of specific legislation. Most (n=6, 60%) provinces and territories referred to provisions in their Public Health laws. Four confirmed that MGE medical response was a municipal or local concern to be addressed by the event organizers.

CONCLUSION: No provinces could list specific legislation guiding safety, health, and medical response for MGE.

PMID:38465378 | DOI:10.1017/dmp.2024.38

J Vitreoretin Dis. 2023 Dec 23;8(2):131-137. doi: 10.1177/24741264231216795. eCollection 2024 Mar-Apr.

ABSTRACT

Purpose: To assess the visual and anatomic outcomes of eyes that had secondary scleral buckle (SB) surgery after unsuccessful pneumatic retinopexy (PR) for rhegmatogenous retinal detachment (RRD). Methods: A retrospective study, performed over a 12-year period, comprised patients who had secondary SB procedures after failed primary PR. Clinical parameters (eg, best-corrected visual acuity [BCVA], lens status, macula status, details of RRD and subretinal fluid) were assessed at presentation, before additional procedures, and at follow-up (6 months, 1 year, and last visit). Statistical comparisons were made using Brown-Forsythe and Welch analysis-of-variance tests, with significance levels set at P < .05. Results: Fifty-four eyes with adequate follow-up were included. Forty-four (81.5%) of 54 eyes had successful retinal reattachment with secondary SB alone. The remaining eyes had subsequent pars plana vitrectomy (PPV). Patients presenting with macula-on RRD who had successful secondary SB had no statistically significant change in BCVA from baseline (mean final, 0.23 ± 0.25 logMAR [Snellen 20/34]; P = .999). There was a statistically significant improvement in BCVA in patients presenting with macula-off RRD who had successful secondary SB (mean final, 0.32 ± 0.36 logMAR [20/42]; P < .001 and mean change, -1.06 ± 0.85 logMAR). Ten patients presenting with macula-off RRD who had failed secondary SB had a significant improvement in the final BCVA (mean final, 0.22 ± 0.28 logMAR [20/33]; P = .044), despite the need for an additional PPV to achieve reattachment. Conclusions: Secondary SB remains a good option for RRD repair after unsuccessful PR and may avoid the need for PPV.

PMID:38465366 | PMC:PMC10924597 | DOI:10.1177/24741264231216795

J Vitreoretin Dis. 2024 Jan 2;8(2):138-143. doi: 10.1177/24741264231218509. eCollection 2024 Mar-Apr.

ABSTRACT

Purpose: To evaluate the risk factors for the development of concurrent or delayed-onset rhegmatogenous retinal detachment (RRD) related to endophthalmitis as well as the anatomic and visual outcomes with subsequent RRD repair. Methods: In this retrospective case study, a 2-tailed t test (continuous) and Fisher exact test were used to determine statistical significance of the observed findings. The relative risk (RR) and 95% CIs were calculated to assess statistical significance. Results: Of the 170 patients included, 22 were found to have a concurrent or subsequent RRD. Initial treatment with pars plana vitrectomy (PPV) (RR, 3.544; 95% CI, 1.650-7.614), aphakia (RR, 4.150; 95% CI, 1.434-12.011), endogenous endophthalmitis (RR, 2.684; 95% CI, 1.065-6.764), and posterior synechiae (RR, 3.026; 95% CI, 1.408-6.505) were statistically significant risk factors for RRD. Anatomically successful repair was achieved in 77.7% of patients. Conclusions: In addition to preexisting risk factors, the initial treatment of endophthalmitis may be a significant risk factor for RRD development, with a higher incidence of subsequent RRD in patients who have PPV as the initial treatment for endophthalmitis.

PMID:38465361 | PMC:PMC10924589 | DOI:10.1177/24741264231218509

Nat Sci Sleep. 2024 Mar 6;16:247-261. doi: 10.2147/NSS.S430024. eCollection 2024.

ABSTRACT

OBJECTIVE: We investigated maternal and paternal sleep evolution from 3 to 36 months postpartum, their interrelations and predictors in the SEPAGES cohort.

METHODS: Sleep information (night sleep duration [NSD], weekend daytime sleep duration [DSD] and subjective sleep loss [SSL]) was collected by self-administered questionnaires at 3, 18, 24 and 36 months postpartum in the SEPAGES French cohort that included 484 mothers and 410 fathers. Group-based multi-trajectory modelling was used to identify maternal, paternal and couple sleep multi-trajectory groups among 188 couples reporting sleep data for at least 2 time points. Multinomial logistic regression was used to assess associations between parental sleep multi-trajectories and early characteristics such as sociodemographic, chronotypes, child sex, birth seasonality or breastfeeding duration.

RESULTS: We identified three maternal (M1-M3), paternal (F1-F3) and couple (C1-C3) sleep multi-trajectory groups with similar characteristics: a group with short NSD and high SSL prevalence (M1, F2, C2), a group with long NSD but medium SSL prevalence (M2, F3, C3) and a group with long NSD and low SSL prevalence (M3, F1, C1). Mothers with the shortest NSD (M1) were less likely to have a partner with long NSD (F2). As compared with long NSD and low SSL prevalence (C1), couples with short NSD and high SSL prevalence (C2) were less likely to have had a first child born in the autumn and fathers in C2 had a later chronotype.

CONCLUSION: We identified distinct sleep multi-trajectory groups for mothers, fathers and couples from 3- to 36-month postpartum. Sleep patterns within couples were homogeneous.

PMID:38465330 | PMC:PMC10924785 | DOI:10.2147/NSS.S430024

J Multidiscip Healthc. 2024 Mar 4;17:971-980. doi: 10.2147/JMDH.S451008. eCollection 2024.

ABSTRACT

BACKGROUND: Preoperative patient education is pivotal in improving patient outcomes during the perioperative phase, involving a thorough explanation of what patients can expect. This enhances adherence and reduces perioperative anxiety. In orthopedics, carpal tunnel syndrome, a common and painful hand condition, is effectively managed through surgical release under local anesthesia. Inadequate counseling before such procedures may intensify intraoperative anxiety and increase pain responses. Thus, this research aims to investigate the effects of comprehensive preoperative counseling on various parameters in carpal tunnel release surgery.

METHODS: A case-control study design was adopted for this study. A retrospective analysis of patients who underwent carpal tunnel release surgery was performed. These patients were categorized into two distinct groups: one group received comprehensive counseling during their clinic visits, while the other group reported receiving less effective counseling. Evaluation encompassed patient-related factors, disease-related aspects, and perioperative variables for both groups.

RESULTS: The study comprised 681 participants, with 526 (77.2%) being females, 421 (61.8%) undergoing surgery on the right side, and 519 (76.2%) employed in non-manual occupations. Moreover, 559 (82.1%) were non-smokers, while approximately two-thirds of the cohort had both diabetes and hypertension. The average age of participants was 52 years, and they reported a mean functional disability score of 7.2 out of 10. The comprehensive preoperative counseling group consisted of 333 patients, while the other group included 348 patients. The analysis revealed statistically significant differences between the two groups, including reduced intra-procedural anxiety (p = 0.043), decreased intraoperative pain (p = 0.005), lower rates of wound complications (p = 0.022), and improved self-reported pain relief (p = 0.3).

CONCLUSION: Our study emphasizes the crucial role of preoperative counseling in improving patient experiences during perioperative care, leading to reduced anxiety, milder pain responses, fewer complications, decreased reliance on postoperative pain medication, and increased self-reported pain relief.

LEVEL OF EVIDENCE: Level III, Case-control retrospective study.

PMID:38465327 | PMC:PMC10921890 | DOI:10.2147/JMDH.S451008

Vet Res Forum. 2024;15(2):89-95. doi: 10.30466/vrf.2023.2000526.3855. Epub 2024 Feb 15.

ABSTRACT

Borrelia species are spirochetes transmitted by ticks that are important in human and animals. In most countries, there is still no molecular epidemiology of borreliosis in ruminants. This study was aimed to evaluate the existence of Borrelia spp. DNA in the blood samples of small ruminants using polymerase chain reaction (PCR) method in West Azerbaijan Province, Iran. To detect Borrelia spp. DNA, about 1,018 ruminants (456 goats and 562 sheep) blood samples were examined from different bioclimatic regions in West Azerbaijan province, Iran. The DNA extracting and PCR were conducted. In sheep, the following prevalence rates were respectively obtained for the 16S rRNA, 5S – 23S rRNA and ospA genes: 3.55% (20/562), 2.13% (12/562) and 0.88% (5/562). And so, the prevalence rates of the genes in goats were 0.87% (4/456) for 5S – 23S rRNA gene, 1.75% (8/456) for 16S rRNA gene and 0.65% (3/456) for ospA gene. The prevalence of Borrelia spp. was significantly different in small ruminants based on the farms and localities. The sheep and goats in humid areas (north of West Azerbaijan) were infected statistically more than those in sub-humid areas (south of West Azerbaijan). It is demonstrated that host species like sheep and goats may have a key role in natural Lyme disease cycles and other borreliosis diseases in Iran.

PMID:38465324 | PMC:PMC10924296 | DOI:10.30466/vrf.2023.2000526.3855

Am J Reprod Immunol. 2024 Mar;91(3):e13832. doi: 10.1111/aji.13832.

ABSTRACT

PROBLEM: Excisional surgery for cervical intraepithelial neoplasia is a risk factor for preterm birth in subsequent pregnancies. However, the underlying mechanisms of this association remain unclear. We previously showed that cervical MUC5B, a mucin protein, may be a barrier to ascending pathogens during pregnancy. We thus hypothesized that hyposecretion of cervical MUC5B is associated with preterm birth after cervical excisional surgery.

METHOD OF STUDY: This prospective nested case-control study (Study 1) included pregnant women who had previously undergone cervical excisional surgery across 11 hospitals. We used proteomics to compare cervicovaginal fluid at 18-22 weeks of gestation between the preterm and term birth groups. In another case-control analysis (Study 2), we compared MUC5B expression in nonpregnant uterine tissues between 15 women with a history of cervical excisional surgery and 26 women without a history of cervical surgery.

RESULTS: The abundance of MUC5B in cervicovaginal fluid was significantly decreased in the preterm birth group (fold change = 0.41, p = .035). Among the 480 quantified proteins, MUC5B had the second highest positive correlation with gestational age at delivery in the combined preterm and term groups. The cervicovaginal microbiome composition was not significantly different between the two groups. Cervical length was not correlated with gestational age at delivery (r = 0.18, p = .079). Histologically, the MUC5B-positive area in the nonpregnant cervix was significantly decreased in women with a history of cervical excisional surgery (0.85-fold, p = .048). The distribution of MUC5B-positive areas in the cervical tissues of 26 women without a history of cervical excisional surgery differed across individuals.

CONCLUSIONS: This study suggests that the primary mechanism by which cervical excisional surgery causes preterm birth is the hyposecretion of MUC5B due to loss of the cervical glands.

PMID:38462543 | DOI:10.1111/aji.13832

Drug Alcohol Rev. 2024 Mar 10. doi: 10.1111/dar.13833. Online ahead of print.

ABSTRACT

INTRODUCTION: The aim of this paper was to examine the client and psychosocial characteristics associated with polydrug use in patients with alcohol misuse as their primary drug of concern (PDC) seeking treatment from substance use treatment centres.

METHODS: Self-report surveys were undertaken with clients attending 1 of 34 community-based substance use treatment centres across Australia with alcohol as their PDC. Survey items included client’s socio-demographic characteristics, level of alcohol dependence, use of other drugs including tobacco, health and wellbeing factors including health-related quality of life. The factors associated with polydrug use (alcohol use concurrent with at least one other drug) were examined.

RESULTS: In a sample of 1130 clients seeking treatment primarily for alcohol problems, 71% reported also using another drug. The most frequently used drug was tobacco (50%) followed by cannabis (21%) and benzodiazepines (15%). Excluding tobacco use, 35% of participants reported polydrug use. Factors associated with any polydrug use were younger age, lower education levels, lower levels of mental health related quality of life and housing risk (i.e., risk of eviction or experienced homelessness in past 4 weeks). When tobacco was excluded, factors associated with polydrug use were age, lower physical and mental health-related quality of life, and housing risk.

DISCUSSION AND CONCLUSIONS: Most adults seeking treatment for alcohol misuse as their PDC reported using another drug in addition to alcohol. Treatment services should be designed accordingly to maximise the likelihood of treatment engagement and success.

PMID:38462541 | DOI:10.1111/dar.13833

Nihon Hoshasen Gijutsu Gakkai Zasshi. 2024 Mar 11. doi: 10.6009/jjrt.2024-1408. Online ahead of print.

ABSTRACT

PURPOSE: To investigate whether deep learning with high-pass filtering can be used to effectively reduce motion artifacts in magnetic resonance (MR) images of the liver.

METHODS: The subjects were 69 patients who underwent liver MR examination at our hospital. Simulated motion artifact images (SMAIs) were created from non-artifact images (NAIs) and used for deep learning. Structural similarity index measure (SSIM) and contrast ratio (CR) were used to verify the effect of reducing motion artifacts in motion artifact reduction image (MARI) output from the obtained deep learning model. In the visual assessment, reduction of motion artifacts and image sharpness were evaluated between motion artifact images (MAIs) and MARIs.

RESULTS: The SSIM values were 0.882 on the MARIs and 0.869 on the SMAIs. There was no statistically significant difference in CR between NAIs and MARIs. The visual assessment showed that MARIs had reduced motion artifacts and improved sharpness compared to MAIs.

CONCLUSION: The learning model in this study is indicated to be reduced motion artifacts without decreasing the sharpness of liver MR images.

PMID:38462509 | DOI:10.6009/jjrt.2024-1408

Acta Anaesthesiol Scand. 2024 Mar 10. doi: 10.1111/aas.14408. Online ahead of print.

ABSTRACT

BACKGROUND: Moderate or severe postoperative pain is common despite advances in surgical technique and perioperative analgesia. This study aimed to assess the prevalence and severity of postoperative pain following procedures requiring anaesthesia and identify factors associated with increased risk of postoperative pain.

METHODS: Surgical patients ≥18 years of age were prospectively questioned on level of current pain on a numerical rating scale (NRS) from 0 to 10 in the post-anaesthesia care unit (PACU) and on resting, active and worst pain experienced in the first 24 h postoperatively. Clinical data was obtained from medical records. Descriptive statistics were applied, and predictors of worst pain assessed as moderate/severe (NRS $\ge$ 5) on postoperative day one were assessed using multivariable logistic regression.

RESULTS: Of 438 included participants, moderate/severe pain occurred in 29% on the day of surgery and 70% described their worst pain as moderate/severe on postoperative day one. Procedures with the highest incidence of moderate/severe pain on the day of surgery were gynaecology-, plastic-, abdominal-, breast-, and orthopaedic procedures. On postoperative day one, patients undergoing vascular-, orthopaedic-, and abdominal operations most commonly rated their worst pain as moderate/severe. Female sex (OR = 2.15, 95% Cl 1.21-3.88, p = .010), chronic preoperative pain (OR = 4.20, 95% Cl 2.41-7.51, p < .001), undergoing a major procedure (OR = 2.07, 95% Cl 1.15-3.80, p = .017), and any intraoperative remifentanil administration (OR = 2.16, 95% Cl 1.20-3.94, p = .01) had increased odds of rating the worst pain as moderate/severe. Increased age (OR = 0.66 per 10 years (95% Cl 0.55-0.78, p < .001)) and undergoing breast-, gynaecology-, otolaryngology-, and neurosurgery (OR = 0.15-0.34, p < .038) was associated with lower odds of moderate/severe pain on postoperative day one.

DISCUSSION: In our cohort, patients rated their current pain in the PACU similarly to other studies. However, the ratio of patients rating the worst pain experienced as moderate/severe on postoperative day one was relatively high. The identified patient- and procedural-related factors associated with higher odds of postoperative pain highlight a subgroup of patients who may benefit from enhanced perioperative monitoring and pain management strategies.

PMID:38462497 | DOI:10.1111/aas.14408