Nevin Manimala

J Pediatr Urol. 2023 Aug 12:S1477-5131(23)00320-0. doi: 10.1016/j.jpurol.2023.08.005. Online ahead of print.

ABSTRACT

INTRODUCTION: Although most pediatric urologists do not perform clamp circumcisions in boys older than 3 months or heavier than 5.5 kg, there are no universally accepted guidelines on the optimal patient age or weight.

OBJECTIVE: To compare outcomes of office circumcision within and outside these traditional patient parameters.

METHODS: This is a retrospective review of circumcisions performed by a single surgeon from 2019 to 2022. Demographics reviewed include age and weight at time of circumcision, gestational weeks at birth, as well as post-procedure: bleeding, planned and unplanned visits, adhesions/concealment, and interventions related to the circumcision. “Active Bleeding” was defined as bleeding occurring after discharge requiring intervention with pressure, sutures, or cautery. “All Bleeding” included Active Bleeding, and cases where bleeding was controlled at home with pressure, stopped by the time of arrival at clinic or emergency department, and immediate bleeding after circumcision controlled before discharge.

RESULTS: During the study period, 773 Gomco circumcisions were performed. A total of 603 patients (78%) had post-procedure evaluation 2 weeks after circumcision. 574 patients (74%) were less than 5.5 kg and 199 (26%) over. Only age corrected for gestation was used in the study: 658 (85%) were younger than 3 months and 115 (15%) older. There was no significant difference in Active Bleeding based on weight (p = 0.3819) or age (p = 0.2798), and no difference in All Bleeding based on weight (p = 0.2072). There was a significant difference (p = 0.0258) in All Bleeding based on age. There was also a significant difference in unexpected visits based on weight (p = 0.0258) and age (p = 0.0131). With regards to adhesions, there was no statistical significant differences when comparing weight or age. However, older and heavier boys had significantly more concealment (5% vs <1%).

DISCUSSION: Our study showed Active Bleeding rates 0.5-0.9% higher in the older and heavier group, although the difference did not reach statistical significance. We found a significantly increased rate of unexpected post-procedure visits of around 3.5-4.7% in those patients older than 3 months and heavier than 5.5 kg. Also, post -procedure concealment was significantly increased in the older and heavier boys. Modifications of the dressing for high risk groups could reduce the risk of bleeding, and efforts on pre-circumcision education of the families might ameliorate unexpected visits. Exlcuding patients with hidden penis or performing penoscrotal skin tacking at the time of the gomco circumcision could decrease concealment rates in the higher risk patients.

CONCLUSIONS: Gomco clamp circumcision is safe in patients over 5.5 kg and older than 3 months, with a less than 1% higher risk of bleeding, which in the current study was controlled without the need for general anesthesia or transfusions. Broadening the inclusion criteria for office clamp circumcisions could reduce costs and make the procedure available to patients who cannot afford to have the surgery under general anesthesia.

PMID:37633823 | DOI:10.1016/j.jpurol.2023.08.005

Surgery. 2023 Aug 24:S0039-6060(23)00429-4. doi: 10.1016/j.surg.2023.07.002. Online ahead of print.

ABSTRACT

BACKGROUND: Bariatric surgery is an effective intervention that causes a series of metabolic changes related to inflammatory processes; however, the variation of biomarkers related to these processes is not entirely understood. Our objective was to investigate the variation of modulation and expression of biomarkers associated with inflammation in patients who underwent bariatric surgery.

METHODS: We searched the MEDLINE (via PubMed), EMBASE (via Elsevier), Cochrane Central Register of Controlled Trials, Latin American and Caribbean Literature on Health Sciences (via virtual health library), Cumulative Index to Nursing and Allied Health Literature (via EBSCO), Web of Science core collection, and Scopus (via Elsevier) databases, and the gray literature was examined from inception to January 2022. Three pairs of reviewers performed data screening, extraction, and quality assessment independently. Meta-analysis with random effects models was used for general, subgroup, and sensitivity analyses. The I² statistic was used to assess heterogeneity between studies.

RESULTS: In total, 96 articles were included in this systematic review; of these, 87 studies met the criteria for the meta-analysis, involving 3,533 participants. Five biomarkers were included in the meta-analysis (tumor necrosis factor alpha; interleukin 6; leptin; interleukin 1 beta, and lipopolysaccharides). Only leptin showed a significant decrease in the first month after surgery (mean difference -20.71; [95% confidence interval: -28.10 to -13.32, P < .0001; I² = 66.7%), with moderate heterogeneity. The 12 months after surgery showed a significant decrease in tumor necrosis factor alpha (mean difference -0.89; [95% confidence interval: -1.37 to -0.42], P = .0002; I² = 94.7%), interleukin 6 (mean difference -1.62; [95% confidence interval: -1.95 to -1.29], P < .0001; I² = 94.9%), leptin (mean difference -28.63; [95% confidence interval: -34.02 to -23.25], P < .0001; I² = 92.7%), and interleukin 1 beta (mean difference -2.46; [95% confidence interval: -4.23 to -0.68], P = .006; I² = 98.3%), all with high heterogeneity. The type of surgery did not show significant differences for the biomarkers at the first month and 12 months, and the results have not changed with high-quality studies. In the 12-month measurement, variations in tumor necrosis factor alpha and leptin were associated with body mass index.

CONCLUSION: The findings of this meta-analysis suggest that Roux-en-Y gastric bypass and sleeve gastrectomy bariatric surgeries are associated with a significant reduction in leptin at 1 month after bariatric surgical intervention and tumor necrosis factor alpha, leptin, and interleukin 1 beta after 12 months.

PMID:37633813 | DOI:10.1016/j.surg.2023.07.002

J Surg Educ. 2023 Aug 24:S1931-7204(23)00300-8. doi: 10.1016/j.jsurg.2023.08.005. Online ahead of print.

ABSTRACT

OBJECTIVE: Examine the applicant experience after introduction of program signaling for the 2023 obstetrics and gynecology (OBGYN) residency application cycle.

DESIGN: Responses to an online survey of OBGYN applicants participating in the 2023 match who participated in residency program signaling were compared to responses from a similar survey conducted in 2022. Demographic information included personal and academic background and how applicants and advisors communicated with programs. Numbers of applications and interviews, second look visits, away rotations, manner of contact, and timing of communication was compared. Statistical analysis included ANOVA for interval data, and χ2 and Kruskal-Wallis tests for categorical data.

RESULTS: A total of 711 of 2631 (27%) applicants responded in 2022 and 606 of 2492 (24.3%) responded in 2023. Approximately 2/3 of gold signals and 1/3 of silver signals led to an interview. There was no change in number of applications or interviews per applicant, but there was a broader distribution of interviews per applicant in 2023. Applicants in 2023 were less likely to engage in preinterview communication or do an away rotation to indicate interest in a program. There was decreased communication between applicants and programs after signaling was introduced. Informal communication continued to differ by racial and medical school background. Applicants from DO programs and international medical graduates (IMG) had more communication with programs than MD applicants but received fewer interview invitations. Fewer Black and Latin(x)/Hispanic applicants had faculty reach out to residency programs on their behalf compared to White and Asian applicants. There were differences in the number of interviews received based on racial and ethnic identity.

CONCLUSIONS: In the first year after implementation of program signaling, there was a decrease in preinterview communication and a broader distribution of interviews among applicants. Further efforts to create standard means of program communication may help to begin leveling the uneven playing field for applicants.

PMID:37633809 | DOI:10.1016/j.jsurg.2023.08.005

J Voice. 2023 Aug 25:S0892-1997(23)00230-8. doi: 10.1016/j.jvoice.2023.07.021. Online ahead of print.

ABSTRACT

BACKGROUND: The objective is to study vocal outcomes following laser-assisted sulcus release (LASR), having documented the length and depth of the sulcus intraoperatively. LASR performed for superficial and deep sulci were included.

STUDY DESIGN: Retrospective, observational.

METHODS: The preoperative and 3-month postoperative and post voice-therapy Voice Handicap Index 10 (VHI), Grade-Roughness-Breathiness-Asthenia-Strain of the voice (GRBAS), Maximum Phonation Time (MPT), Fundamental Frequency (FO), and stroboscopy findings were noted retrospectively from our voice clinic records of LASR patients. Intraoperative sulci length and depth details were noted from records. Patients with coexisting lesions, surgically tackled, were excluded.

RESULTS: In a total of 14 patients, 21 superficial sulci and eight deep sulci were operated by LASR. The average preoperative VHI improved from 25.3 to 9.9, GRBAS from 10.6 to 3.5, and MPT from 7.6 to 12.3 seconds. The preoperative average FO was 235.9 Hz in 12 patients (no pick-up in two) with a postoperative 248.4 Hz. Using the Mann-Whitney U test, we found a statistically significant improvement in MPT, VHI, and GRBAS of the patients. There was no significant improvement in the FO of the patients. There was no postoperative voice deterioration in any patient. A preoperative phonatory gap was found in all patients, which postoperatively was absent in 10, markedly decreased in three, present in one with stroboscopy revealing an improvement in mucosal wave amplitude in 13 patients. In four patients with deep bilateral sulci where the LASR had been ligament deep, VHI improved from 26 to 13.3, GRBAS from 12 to 6.5, and MPT from 4.3 to 9.5 seconds. Using the Mann-Whitney U test, all three parameters were significantly improved.

CONCLUSION: A statistically significant vocal improvement in VHI, GRBAS, and MPT was observed at 3 months, in superficial and deep sulci, operated by LASR. LASR is a simple, quick, and easily replicable surgery. Larger multi-centric studies with long-term follow-up are recommended.

PMID:37633801 | DOI:10.1016/j.jvoice.2023.07.021

Perit Dial Int. 2023 Aug 26:8968608231193240. doi: 10.1177/08968608231193240. Online ahead of print.

ABSTRACT

BACKGROUND: This multi-institutional, observational study examined whether the outcomes after peritoneal dialysis (PD) catheter placement in Japan meet the audit criteria of the International Society for Peritoneal Dialysis (ISPD) guideline and identified factors affecting technique survival and perioperative complications.

METHODS: Adult patients who underwent first PD catheter placement for end-stage kidney disease between April 2019 and March 2021 were followed until PD withdrawal, kidney transplantation, transfer to other facilities, death, 1 year after PD start or March 2022, whichever came first. Primary outcomes were time to catheter patency failure and technique failure, and perioperative infectious complications within 30 days of catheter placement. Secondary outcomes were perioperative complications. Appropriate statistical analyses were performed to identify factors associated with the outcomes of interest.

RESULTS: Of the total 409 patients, 8 who underwent the embedded catheter technique did not have externalised catheters. Of the 401 remaining patients, catheter patency failure occurred in 25 (6.2%). Technical failure at 12 months after PD catheter placement calculated from cumulative incidence function was 15.3%. On Cox proportional hazards model analysis, serum albumin (hazard ratio (HR) 0.44; 95% confidence interval (CI) 0.27-0.70) and straight type catheter (HR 2.14; 95% CI 1.24-3.69) were the independent risk factors for technique failure. On logistic regression analysis, diabetes mellitus was the only independent risk factor for perioperative infectious complications (odds ratio 2.70, 95% CI 1.30-5.58). The occurrence rate of perioperative complications generally met the audit criteria of the ISPD guidelines.

CONCLUSION: PD catheter placement in Japan was proven to be safe and appropriate.

PMID:37632293 | DOI:10.1177/08968608231193240

Clin Teach. 2023 Aug 26:e13629. doi: 10.1111/tct.13629. Online ahead of print.

ABSTRACT

PURPOSE OF THE ARTICLE: Health professions graduate students have experienced substantial increases in stress and anxiety in recent years. This can result in decreased academic performance, poor retention, and burnout. Interventions to help students cope are therefore a critical need for academic institutions. The current study sought to demonstrate the effectiveness of a brief multimodal intervention in reducing student distress.

METHOD: The study was a randomised controlled design that evaluated a brief intervention of cognitive-behavioural therapy, mindfulness, and healthy lifestyle choices. The Depression Anxiety Stress Scale-21 was administered to participants at baseline and two post-intervention time points. Control participants did not participate in any intervention. Participants were recruited from graduate students in first-year classes within the School of Health Professions at UT Southwestern Medical Center.

RESULTS: Analysis revealed an overall mild to moderate decline in Depression Anxiety Stress Scale-21 total scores over three assessment periods for both treatment and control groups, with no statistical differences noted between groups; however, the treatment group’s scores declined approximately 6 weeks before the control participants’ scores declined.

CONCLUSION: The pattern of change in the two groups suggests that our intervention facilitated the reduction in student anxiety more quickly than would have occurred normally and with sustained results.

PMID:37632285 | DOI:10.1111/tct.13629

Biomed Chromatogr. 2023 Aug 26:e5718. doi: 10.1002/bmc.5718. Online ahead of print.

ABSTRACT

We present a GC-MS metabolomics workflow for analyzing metabolites in urine samples infected with schistosomiasis. Schistosomiasis, a neglected tropical disease, affects 85% of the global population, with the majority residing in Sub-Saharan Africa. The workflow utilized in this study involved the utilization of the AMDIS freeware, Metab R for pre-processing, and multivariate statistical classification through partial least squares-discriminant analysis (PLS-DA). This classification aimed to categorize volatile metabolites found in urine samples from humans infected with schistosomiasis. All samples were collected from individuals in Botswana. A solid-phase microextraction-fused silica fiber was used to adsorb volatile metabolites from the urine samples and inserted into the GC-MS injection port for data acquisition. The acquired data were then subjected to AMDIS auto-deconvolution, Metab R pre-processing, and statistical evaluation for metabolite mining. A total of 12 metabolites, including 3-chloropropionic acid and heptadecyl ester with an AMDIS match factor of 96% at an approximated amount of 0.35% and cyclohexylamine with an AMDIS match factor of 100% and approximated amount of 0.39%, were identified. PLS-DA was used for the classification of the metabolites. The method showed good sensitivity and specificity as indicated by the receiver operating characteristic measured by the areas under the curves. Results indicated that metabolomics is a useful tool for mining metabolites because of the variance in metabolite composition of infected and non-infected urine samples.

PMID:37632284 | DOI:10.1002/bmc.5718

J Cosmet Dermatol. 2023 Aug 26. doi: 10.1111/jocd.15970. Online ahead of print.

ABSTRACT

BACKGROUND: A previous injection algorithm termed the “Toxin Lift” was recently introduced and described volume increases in the midface following neuromodulator treatments of the jawline. Increase in midfacial volume due to soft tissue repositioning could also affect the severity of infraorbital hollows.

OBJECTIVE: The objective is therefore to evaluate whether the severity of infraorbital hollows can be improved by injecting neuromodulators in the supra-mandibular segment of the platysma.

MATERIALS AND METHODS: A total of 35 volunteers (11 males/24 females) with a mean age of 39.8 (9.6) years and a mean BMI of 25.2 (5.2) kg/m² were investigated. Bilateral infraorbital regions were evaluated via clinical assessment and semi-quantitative 3D imaging. The applied injection technique targeted the platysma via four injection points administering 5 I.U. per injection point resulting in a total of 20 I.U. per facial side.

RESULTS: Volume increase of the infraorbital region was 0.13 cc at 15 days (p = 0.001) and was 0.02 cc at 30 days (p = 0.452) whereas the skin displacement in cranial direction was 0.54 mm at 15 days (p < 0.001) and was 0.31 mm at 30 days (p < 0.001). Clinical evaluation revealed a highly statistically significant improvement of the tear trough, palpaebromalar groove, and of the lid-cheek junction when compared to baseline with all p < 0.001.

CONCLUSION: The results of this clinical prospective interventional analysis revealed that the “Toxin Lift” injection technique is capable to improve the clinical appearance of infraorbital hollows. The effects can be explained by the concepts of facial biomechanics.

PMID:37632259 | DOI:10.1111/jocd.15970

Perfusion. 2023 Aug 26:2676591231198366. doi: 10.1177/02676591231198366. Online ahead of print.

ABSTRACT

Targeted oxygen delivery during cardiopulmonary bypass (CPB) has received significant attention due to its influence on patient outcomes, especially in mitigating acute kidney injury. While it has gained popularity in select institutions, there remains a gap in establishing it globally across multiple centers. The purpose of this investigation was to describe the development of a quality improvement process of targeted oxygen delivery during CPB across hospitals throughout the United States. A systematic approach to utilize oxygen delivery index (DO₂i) as a key performance indicator within hospitals serviced by a national provider of perfusion services. The process included a review of the current literature on DO₂i, which yielded a target nadir value (272 mL/min/m²) and an area under the curve (DO₂i²⁷²AUC) cut off of 632. All data is displayed on a dashboard with results categorized across multiple levels from system-wide to individual clinician performance. From January 2020 through December 2022, DO₂i data from 91 hospitals and 11,165 coronary artery bypass graft procedures were collected. During this period the monthly proportion of DO₂i measurements above the target nadir DO₂i²⁷² ranged from 60.5% to 78.4% with a mean+/-SD of 70.8 +/- 4.2%. Binary logistic regression for the first 7 months following monthly DO₂i performance reporting has shown a statistically significant positive linear trend in the probability of achieving the target DO₂i²⁷² (p < .001), with a crude increase of approximately 7.8% for DO₂i²⁷²AUC, and a 73.8% success rate (p < .001). A survey was sent to all individuals measuring oxygen delivery during CPB to assess why a target DO₂i²⁷² could not be reached. The two most common responses were an ‘inability to improve CPB flow rates’ and ‘restrictive allogeneic red blood cell transfusion policies’. This study demonstrates that targeting a minimum level of oxygen delivery can serve as a key performance indicator during CPB using a structured quality improvement process.

PMID:37632252 | DOI:10.1177/02676591231198366

Acta Obstet Gynecol Scand. 2023 Aug 26. doi: 10.1111/aogs.14668. Online ahead of print.

ABSTRACT

INTRODUCTION: Vulvar lichen sclerosus (VLS) occurs in at least one in 900 girls. There is limited knowledge as to what extent the disease persists in adulthood and what the repercussions in adulthood may be. The aim of this study is to evaluate the long-term consequences of VLS diagnosed in childhood or adolescence.

MATERIAL AND METHODS: The population of females histologically diagnosed with VLS in childhood or adolescence in the Netherlands between 1991 and 2015 was identified through the national pathology database. Histological specimens were retrieved and re-evaluated. Potential participants for whom the diagnosis was reconfirmed and who are now adults, were then traced and surveyed. Descriptive statistics were calculated and compared with the literature. Main outcome measures are the demographics of the cohort, their scores on standardized quality of life (QoL) and sexuality questionnaires and answers to additional questions regarding patients’ experience with the disease. The questionnaires used were the Dermatology Life Quality Index (DLQI), the Skindex-29, the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale-Revised (FSDS-R). Secondary outcome measures include obstetric history and histological features found in the original tissue specimens.

RESULTS: A total of 81 women participated, median age 29.0 years, median follow-up from childhood diagnosis 19.5 years. Both QoL and sexuality were somewhat affected in 51.9% of cases. Less than half (45%) reported having regular check-ups. Forty-five (56%) reported symptoms within the past year; of those with symptoms, 14 (31%) were not under surveillance. Cesarean section rate (14.5%) was comparable to the general population, and there were more high-grade obstetric anal sphincter injuries with vaginal deliveries than expected. Sixteen respondents (20%) were not aware of the childhood diagnosis prior to this study.

CONCLUSIONS: Symptoms due to VLS are reported by most adults diagnosed as juveniles. QoL and sexuality are affected and correlate to recent symptoms. VLS as a juvenile does not preclude a vaginal delivery. Women diagnosed with VLS in childhood or adolescence are often lost to follow-up.

PMID:37632250 | DOI:10.1111/aogs.14668