Nevin Manimala

Eur J Orthop Surg Traumatol. 2023 Aug 13. doi: 10.1007/s00590-023-03680-1. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this prospective randomized controlled trial was to compare the clinical outcome and the survival rate of total knee arthroplasty between CT- and MRI-based patient-specific instrumentation 5 years after initial surgery.

METHODS: At a mean follow-up of 5.8 years (SD 0.3), 98 patients (64% women, loss to follow-up 28%) were included in this analysis. To assess the differences in clinical outcome, patients fulfilled PROMs preoperatively and at each follow-up moment. At final follow-up, the Forgotten Joint Score was adjusted.

RESULTS: At final follow-up, no new patients underwent revision surgery in both groups. Regarding the clinical outcome, no statistically significant difference between the groups was found. The Forgotten Joint Score was only performed at final follow-up and showed no significant difference between both groups.

CONCLUSION: At mid-term follow-up, survival rates between CT- and MRI-based patient-specific instrumentation did not show a significant difference. Regarding clinical outcome, only the EQ-5D-VAS (p < 0.040) showed a statistically significant difference over time, in favor of the MRI-group.

LEVEL OF EVIDENCE: Level I.

PMID:37573271 | DOI:10.1007/s00590-023-03680-1

Trans R Soc Trop Med Hyg. 2023 Aug 12:trad053. doi: 10.1093/trstmh/trad053. Online ahead of print.

ABSTRACT

BACKGROUND: To assess the seroprevalence and risk factors of Toxoplasma gondii infection in pregnant women at the Debre Markos Referral Hospital, northwest Ethiopia.

METHODS: A facility-based cross-sectional study was undertaken among pregnant women from March 2020 to May 2021. Sociodemographic and clinical data were collected from randomly selected participants. Five millilitres of blood was collected and an enzyme-linked immunosorbent assay kit was used to test for T. gondii immunoglobulin G (IgG) antibodies. A logistic regression model was computed to identify the risk factors. The adjusted odds ratio (aOR) was estimated along with the 95% confidence interval (CI). A statistically significant association was defined as p<0.05.

RESULTS: T. gondii IgG antibody positivity was found in 38.8% (n=132) of 340 pregnant women. Contact with cats (AOR 2.5 [95% CI 1.5 to 4.2]), eating raw/undercooked meat (AOR 5.7 [95% CI 3.2 to 10.3]), consuming unwashed vegetables (AOR 4.1 [95% CI 2.1 to 8.0]), a history of abortion (AOR 1.9 [95% CI 1.1 to 3.3]) and drinking water sources (AOR 2.5 [95% CI 1.2 to 5.2]) demonstrated a statistically significant association with T. gondii infection.

CONCLUSIONS: Toxoplasmosis was found to be fairly common in pregnant mothers. Proper cat excreta disposal, not eating raw/undercooked meat, maintaining hand cleanliness and following environmental sanitation protocols could be important to decrease T. gondii infection.

PMID:37571984 | DOI:10.1093/trstmh/trad053

Eur J Clin Invest. 2023 Aug 12:e14075. doi: 10.1111/eci.14075. Online ahead of print.

ABSTRACT

BACKGROUND: To investigate the potential of radiomic features and dual-source dual-energy CT (DECT) parameters in differentiating between benign and malignant mediastinal masses and predicting patient outcomes.

METHODS: In this retrospective study, we analysed data from 90 patients (38 females, mean age 51 ± 25 years) with confirmed mediastinal masses who underwent contrast-enhanced DECT. Attenuation, radiomic features and DECT-derived imaging parameters were evaluated by two experienced readers. We performed analysis of variance (ANOVA) and Chi-square statistic tests for data comparison. Receiver operating characteristic curve analysis and Cox regression tests were used to differentiate between mediastinal masses.

RESULTS: Of the 90 mediastinal masses, 49 (54%) were benign, including cases of thymic hyperplasia/thymic rebound (n = 10), mediastinitis (n = 16) and thymoma (n = 23). The remaining 41 (46%) lesions were classified as malignant, consisting of lymphoma (n = 28), mediastinal tumour (n = 4) and thymic carcinoma (n = 9). Significant differences were observed between benign and malignant mediastinal masses in all DECT-derived parameters (p ≤ .001) and 38 radiomic features (p ≤ .044) obtained from contrast-enhanced DECT. The combination of these methods achieved an area under the curve of .98 (95% CI, .893-1.000; p < .001) to differentiate between benign and malignant masses, with 100% sensitivity and 91% specificity. Throughout a follow-up of 1800 days, a multiparametric model incorporating radiomic features, DECT parameters and gender showed promising prognostic power in predicting all-cause mortality (c-index = .8 [95% CI, .702-.890], p < .001).

CONCLUSIONS: A multiparametric approach combining radiomic features and DECT-derived imaging biomarkers allows for accurate and noninvasive differentiation between benign and malignant masses in the anterior mediastinum.

PMID:37571983 | DOI:10.1111/eci.14075

Am Surg. 2023 Aug 12:31348231192070. doi: 10.1177/00031348231192070. Online ahead of print.

ABSTRACT

BACKGROUND: Central venous line (CVL) placement in children is often necessary for treatment and may be complicated by central line-associated bloodstream infection (CLABSI). We hypothesize that line type and clinical and demographic factors at line placement impact CLABSI rates.

METHODS: This is a single-institution case-control study of pediatric patients (≤18 years old) admitted between January 1, 2015, and December 31, 2019. Case patients had a documented CLABSI. Control patients had a CVL placed during the study period and were matched by sex and age in a 2:1 ratio. Bivariate and multivariate logistic regression analysis was performed.

RESULTS: We identified 78 patients with a CLABSI and 140 patients without a CLABSI. After controlling for pertinent covariates, patients undergoing tunneled or non-tunneled CVL had higher odds of CLABSI than those undergoing PICC (OR 2.51, CI 1.12-5.64 and OR 3.88, CI 1.06-14.20 respectively), and patients undergoing port placement had decreased odds of CLABSI compared to PICC (OR .05, CI 0.01-.51). There were lower odds of CLABSI when lines were placed for intravenous medications compared to those placed for solid tumor malignancy (OR .15, CI .03-.79). Race and age were not statistically significant risk factors.

DISCUSSION: Central lines placed for medication administration compared to solid tumors, PICC compared to tunneled and non-tunneled central lines, and ports compared to PICC were associated with lower odds of CLABSI. Future improvement efforts should focus on PICC and port placement in appropriate patients to decrease CLABSI rates.

PMID:37571962 | DOI:10.1177/00031348231192070

J Res Health Sci. 2023 Jun;23(2):e00584. doi: 10.34172/jrhs.2023.119.

ABSTRACT

BACKGROUND: Pregnant women are vulnerable to oral disease due to physiological, hormonal, and dietary alterations. The aim of the present study was to evaluate the impact of the educational program according to the Health Promotion Model (HPM) on the oral health prevention behavior of pregnant women.

STUDY DESIGN: A randomized controlled trial.

METHODS: This study was performed on 105 pregnant women visiting health centers located in Arak from February to November 2022. The subjects were randomly assigned to intervention (n=54) and control (n=51) groups. A reliable and valid questionnaire according to HPM constructs was used to collect the data. The pre-test was conducted in the groups. The intervention group received the educational program in 9 educational sessions (from 12 to 24 weeks of pregnancy). Then, the post-test was conducted in the 36th week of pregnancy in the groups. Finally, the data were analyzed by SPSS software (version 18) and using independent t-test, paired t-test, and Chi-square test.

RESULTS: There were statistically significant differences between the intervention and control groups regarding perceived benefits (24.68±3.63 vs. 26.57±3.67, P=0.009), perceived barriers (7.31±3.14 vs. 5.81±3.59, P=0.025), positive affect (10.50±1.66 vs. 11.29±1.34, P=0.009), negative affect (1.59±0.223 vs. 1.40±1.51, P=0.006), commitment to the action plan (4.05±1.92 vs. 4.77±1.50, P=0.034), and tooth brushing time (2.29±0.72 vs. 2.74±0.48, P<0.001). However, no significant difference was observed regarding the tooth brushing frequency (2.05±0.58 vs. 2.07±0.66, P=0.901) after the intervention. The brushing time for 2-3 minutes in the intervention group increased from 51.85% to 75.92% after the intervention.

CONCLUSION: HPM-based education was effective in promoting the duration of tooth brushing in pregnant women. However, it had no effect on the tooth brushing frequency.

PMID:37571955 | DOI:10.34172/jrhs.2023.119

J Res Health Sci. 2023 Jun;23(2):e00581. doi: 10.34172/jrhs.2023.116.

ABSTRACT

BACKGROUND: Determining suburban area crashes’ risk factors may allow for early and operative safety measures to find the main risk factors and moderating effects of crashes. Therefore, this paper has focused on a causal modeling framework.

STUDY DESIGN: A cross-sectional study.

METHODS: In this study, 52524 suburban crashes were investigated from 2015 to 2016. The hybrid-random-forest-generalized-path-analysis technique (HRF-gPath) was used to extract the main variables and identify mediators and moderators.

RESULTS: This study analyzed 42 explanatory variables using a RF model, and it was found that collision type, distinct, driver misconduct, speed, license, prior cause, plaque description, vehicle maneuver, vehicle type, lighting, passenger presence, seatbelt use, and land use were significant factors. Further analysis using g-Path demonstrated the mediating and predicting roles of collision type, vehicle type, seatbelt use, and driver misconduct. The modified model fitted the data well, with statistical significance ( χ²₃₀ =81.29, P<0.001) and high values for comparative-fit-index and Tucker-Lewis-index exceeding 0.9, as well as a low root-mean-square-error-of-approximation of 0.031 (90% confidence interval: 0.030-0.032).

CONCLUSION: The results of our study identified several significant variables, including collision type, vehicle type, seatbelt use, and driver misconduct, which played mediating and predicting roles. These findings provide valuable insights into the complex factors that contribute to collisions via a theoretical framework and can inform efforts to reduce their occurrence in the future.

PMID:37571952 | DOI:10.34172/jrhs.2023.116

J Res Health Sci. 2022 Dec;22(4):e00568. doi: 10.34172/jrhs.2022.103.

ABSTRACT

BACKGROUND: This study aimed to investigate the effects of biopsychosocial interventions on non-specific chronic low back pain (NSCLBP) and disabilities caused by it among Students.

STUDY DESIGN: A two-group pretest-posttest randomized clinical trial.

METHODS: The statistical population of the study was female students enrolled at the first-stage secondary school in Hamadan, Iran. A total of 200 students were selected through cluster sampling and randomized into two groups of intervention and control. The primary evaluation was performed by the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ), the Health-Related Quality of Life (SF-36), the International Physical Activity Questionnaire-Short Form (IPAQ-S), the World Health Organization Disability Assessment Schedule (WHODAS), and the visual analogue scale (VAS). Upon developing and implementing the biopsychosocial model-based interventions for ten weekly two-hour sessions, the secondary evaluation was fulfilled, and the extracted data were analyzed using the IBM SPSS version 21.

RESULTS: The independent-group t-test results revealed that the mean scores of quality of life (QOL) and physical activity significantly elevated in the intervention group, compared to the control. In addition, the mean value of disabilities, the amount of disorder in the lumbar region, and the VAS scores in the intervention group substantially declined compared to the control group.

CONCLUSION: The significant variations in the biopsychosocial factors demonstrated that the development of some interventions based on the bio-psychosocial model (BPSM) could help manage the NSCLBP and its ensuing disabilities. Therefore, the BPSM-based interventions could be exploited to minimize musculoskeletal disorders (MSDs) in students.

PMID:37571939 | DOI:10.34172/jrhs.2022.103

J Res Health Sci. 2022 Dec;22(4):e00564. doi: 10.34172/jrhs.2022.99.

ABSTRACT

BACKGROUND: Road traffic injuries (RTIs) are one of the most critical factors that endanger human health. More specifically, head and neck injuries are the main causes of deaths and disabilities among motorcyclists. This study aimed to investigate the predictive factors of helmet use behavior among motorcyclists based on the theory of planned behavior (TPB).

STUDY DESIGN: This study followed the cross-sectional design.

METHODS: This study was conducted on randomly selected 730 motorcyclist employees in Qom, Iran, in 2021. The data collection tool was a self-administered researcher-made questionnaire, including items on demographic characteristics, history of RTIs, and constructs of TPB. Data were analyzed using descriptive summary statistics, analysis of variance, independent samples t test, Pearson correlation coefficient, and structural equation modeling (SEM).

RESULTS: In this study, only 9.8% of the participants reported that they always used a helmet while riding a motorcycle. About 60% reported a history of a motorcycle crash, and 11.5% had a history of head injuries. The direct effect of attitude, subjective norms, and perceived behavioral control on the intention to use a helmet were statistically significant, explaining 59% of the variation in behavioral intention (intention to use a helmet) (R²=0.59). Moreover, perceived behavioral control and behavioral intention had significant effects on helmet use behavior (R²=0.26).

CONCLUSION: The prevalence of helmet use among the studied population was very low. Moreover, TPB was useful in identifying the determinants of behavior and especially behavioral intention of helmet use among motorcyclists.

PMID:37571935 | DOI:10.34172/jrhs.2022.99

Acta Oncol. 2023 Aug 12:1-7. doi: 10.1080/0284186X.2023.2245552. Online ahead of print.

ABSTRACT

BACKGROUND: Adjuvant radiotherapy (RT) after breast-conserving surgery for DCIS lowers the relative local recurrence risk by half. To identify a low-risk group with the minimal benefit of RT could avoid side effects and spare costs. In this study, the outcome was compared for different RT-strategies using data from the randomized SweDCIS trial.

MATERIAL AND METHODS: Five strategies were compared in a Swedish setting: RT-to-none or all, RT to high-risk women defined by DCISionRT, modified Radiation Therapy Oncology Group (RTOG) 9804 criteria, and Swedish Guidelines. Ten-year recurrence risks and cost including adjuvant RT and local recurrence treatment cost were calculated.

RESULTS: The mean age at recurrence was 64.4 years (36-90) and the mean cost for treating a recurrence was $21,104. In the SweDCIS cohort (n = 504), 59 women developed DCIS, and 31 invasive recurrence. Ten-year absolute local recurrence risk (invasive and DCIS) according to different strategies varied between 18.6% (12.5-23.6%) and 7.8% (5.0-12.6%) for RT-to-none or to-all, with an additional cost of $2614 US dollars per women and $24,201 per prevented recurrence for RT-to-all. The risk differences between other strategies were not statistically significant, but the larger proportion receiving RT, the fewer recurrences. DCISionRT spared 48% from RT with 8.1% less recurrences compared to RT-to-none, and a cost of $10,534 per prevented recurrence with additional cost depending on the price of the test. RTOG 9804 spared 39% from RT, with 9.7% less recurrences, $9525 per prevented recurrence and Swedish Guidelines spared 13% from RT, with 10.0% less recurrences, and $21,521 per prevented recurrence.

CONCLUSION: It seems reasonable to omit RT in pre-specified low-risk groups with minimal effect on recurrence risk. Costs per prevented recurrence varied more than two-fold but which strategy that could be considered most cost-effective needs to be further evaluated, including the DCISionRT-test price.

PMID:37571927 | DOI:10.1080/0284186X.2023.2245552

Br J Haematol. 2023 Aug 12. doi: 10.1111/bjh.19009. Online ahead of print.

ABSTRACT

In fetal/neonatal alloimmune thrombocytopenia (FNAIT), maternal alloantibodies against paternal human platelet antigens (HPA) cross the placenta and lead to platelet destruction. The extent of thrombocytopenia varies among neonates, and inflammation may constitute an important trigger. A set of stable inflammatory markers was measured in serum samples from neonates with low platelet counts, of which n = 50 were diagnosed with FNAIT due to anti-HPA-1a antibodies and n = 50 were thrombocytopenic without detectable maternal HPA antibodies. Concentrations of C-reactive protein, soluble CD14, procalcitonin, and sFlt-1 did not differ between the two cohorts. There was no correlation between C-reactive protein or soluble CD14 and the platelet count, but a negative correlation between procalcitonin concentrations and the neonatal platelet count in both cohorts. sFlt-1 concentration and the platelet count were correlated in FNAIT cases exclusively. None of the inflammatory markers was statistically different between cases with and without intracranial haemorrhage. We were unable to identify systemic inflammation as a relevant factor for thrombocytopenia in FNAIT. The antiangiogenic enzyme sFlt-1, released by the placenta, did correlate with the platelet count in FNAIT cases. Our findings may give rise to the hypothesis that placental inflammation rather than systemic inflammation modulates disease severity in FNAIT.

PMID:37571926 | DOI:10.1111/bjh.19009