Nevin Manimala

Neuroradiology. 2023 Jul 24. doi: 10.1007/s00234-023-03201-1. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the ability of neurite orientation dispersion and density imaging (NODDI) for detecting white matter (WM) microstructural abnormalities in minimal hepatic encephalopathy (MHE).

METHODS: Diffusion-weighted images, enabling the estimation of NODDI and diffusion tensor imaging (DTI) parameters, were acquired from 20 healthy controls (HC), 22 cirrhotic patients without MHE (NHE), and 15 cirrhotic patients with MHE. Tract-based spatial statistics were used to determine differences in DTI (including fractional anisotropy [FA] and mean/axial/radial diffusivity [MD/AD/RD]) and NODDI parameters (including neurite density index [NDI], orientation dispersion index [ODI], and isotropic volume fraction [ISO]). Voxel-wise analyses of correlations between diffusion parameters and neurocognitive performance determined by Psychometric Hepatic Encephalopathy Score (PHES) were completed.

RESULTS: MHE patients had extensive NDI reduction and rare ODI reduction, primarily involving the genu and body of corpus callosum and the bilateral frontal lobe, corona radiata, external capsule, anterior limb of internal capsule, temporal lobe, posterior thalamic radiation, and brainstem. The extent of NDI and ODI reduction expanded from NHE to MHE. In both MHE and NHE groups, the extent of NDI change was quite larger than that of FA change. No significant intergroup difference in ISO/MD/AD/RD was observed. Tissue specificity afforded by NODDI revealed the underpinning of FA reduction in MHE. The NDI in left frontal lobe was significantly correlated with PHES.

CONCLUSION: MHE is characterized by diffuse WM microstructural impairment (especially neurite density reduction). NODDI can improve the detection of WM microstructural impairments in MHE and provides more precise information about MHE-related pathology than DTI.

PMID:37486421 | DOI:10.1007/s00234-023-03201-1

Hum Vaccin Immunother. 2023 Jul 24:2234792. doi: 10.1080/21645515.2023.2234792. Online ahead of print.

ABSTRACT

Immunoprofiling has become a crucial tool for understanding the complex interactions between the immune system and diseases or interventions, such as therapies and vaccinations. Immune response biomarkers are critical for understanding those relationships and potentially developing personalized intervention strategies. Single-cell data have emerged as a promising source for identifying immune response biomarkers. In this review, we discuss the current state-of-the-art methods for immunoprofiling, including those for reducing the dimensionality of high-dimensional single-cell data and methods for clustering, classification, and prediction. We also draw attention to recent developments in data integration.

PMID:37485833 | DOI:10.1080/21645515.2023.2234792

Disaster Med Public Health Prep. 2023 Jul 24;17:e436. doi: 10.1017/dmp.2023.100.

ABSTRACT

OBJECTIVE: In Turkey, which is a land of disasters, it is vital for nurses to be prepared before a disaster, and to exhibit an effective attitude and behavior during it. Having a large number of casualties during a disaster may cause inadequacies in receiving basic health care in the hospital.

METHODS: This study was conducted in a descriptive and cross-sectional style to determine the disaster preparedness and preparedness perceptions of nurses. Data were collected with the Personal Information Form and Nurses’ Perception of Disaster Preparedness Scale (NPDPS).

RESULTS: Nurses’ disaster experience, drill experience, and perusal of the disaster plan positively affected the perception of disaster. The disaster preparedness of the institution positively affected the perception of disaster preparation. A significant difference was determined between the requests for information regarding disaster education and NPDPS. A statistically significant relationship was found between terrorist attacks, earthquake exposure, and the total scale score of NPDPS.

CONCLUSIONS: Consequently, nurses and health institutions, whose responsibilities become graver in disasters, have duties such as providing treatment and medical support. Therefore, it was suggested that disaster nursing and disaster management should have been included in the in-service training of nurses.

PMID:37485823 | DOI:10.1017/dmp.2023.100

CNS Neurosci Ther. 2023 Jul 23. doi: 10.1111/cns.14378. Online ahead of print.

ABSTRACT

AIMS: To compare the children’s sleep electroencephalogram according to their intellectual profile.

METHODS: Children were grouped according to their Wechsler Intelligence Scale for Children (WISC) scores (17 with normal intelligence quotient [IQ, NIQ] and 24 with high IQ [HIQ]). Comparisons of spectral power between groups and its relationship with WISC scores were assessed using analyses of variance and linear regression models, adjusted for age and sex.

RESULTS: Children with HIQ had more rapid eye movement (REM) sleep, especially late at night, and more power in slow-frequency bands during REM sleep than those with NIQ. There were also positive associations between the processing speed index and the spectral power in β bands in NREM sleep, and with the spectral power in α, σ, β, and γ bands in REM sleep, with different associations between groups.

CONCLUSION: The enhanced power in slow bands during REM sleep in children with HIQ overlaps with that of typical REM sleep oscillations thought to be involved in emotional memory consolidation. The dissimilar relationships between spectral power and WISC scores in NIQ and HIQ groups may underlie functional differences in brain activity related to cognitive efficiency, questioning the direction of the relationship between sleep and cognitive functioning.

PMID:37485816 | DOI:10.1111/cns.14378

Vet Surg. 2023 Jul 24. doi: 10.1111/vsu.13995. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the impact of variables on use and preference of common laparoscopic instruments.

STUDY DESIGN: Online survey.

SAMPLE POPULATION: Surgeons (n = 140) with 3 years or more laparoscopic experience.

METHODS: Electronic survey distributed via specialty group LISTSERVEs and Facebook groups. Responses collected included surgeon attributes, preferences, and surgical practice data. Statistical analysis was performed using Fishers exact, ANOVA, Tukey Kramer honestly significant difference (HSD) test, linear regression, and logistic regression.

RESULTS: Ninety-eight of 140 respondents answered instrument-related questions and the completion rate of these questions was 76%: 48% of females and 49% of males responded to the survey. The median glove size of respondents was size 7 (range, 5.5 to 8.5). Closing laparoscopic Babcock forceps (p = .018), rotating cup biopsy forceps (p = .003), and manipulating endoscopic staplers (p < .001) were more difficult for surgeons with smaller glove sizes. The median difficulty score for the endoscopic stapler was 4/10 and the median percentage of time this was found difficult was 25%. Reusable instruments were preferred over disposable single-use instruments. The pistol grip was preferred for grasping and retracting (54/98, 55%) and fine dissection (46/96, 48%), while the axial grip was preferred for suturing and knot tying (61/98, 62%).

CONCLUSION: Surgeons with smaller glove sizes (<6.5) experience more difficulty when using common laparoscopic instruments. The endoscopic stapler was the most difficult to use.

CLINICAL SIGNIFICANCE: When purchasing laparoscopic instrumentation, surgeons should review all available options in handle size and design to improve ergonomics during minimally invasive procedures.

PMID:37485785 | DOI:10.1111/vsu.13995

Rev Med Virol. 2023 Jul 23:e2473. doi: 10.1002/rmv.2473. Online ahead of print.

ABSTRACT

Our study is aimed to access the efficacy and safety outcomes for coronavirus disease 2019 (COVID-19) patients treated with Paxlovid. According to inclusion and exclusion criteria, databases were used to retrieve articles from 1 January 2020 to 1 January 2023. Article screening, quality evaluation and data extraction were completed and cross-checked. The meta-analysis and trial sequential analysis (TSA) were conducted using RevMan, StataMP, and TSA software. A total of 42 original articles were included. Overall meta-analysis results showed that for death, hospitalisation, death or hospitalisation, emergency department (ED) visit, intensive care unit (ICU) admission, and extra oxygen requirement outcomes, every odds ratio (OR) was <1 and p < 0.05. For rebound outcome, the OR was >1 and p > 0.05. For adverse events (AEs) outcome, the OR was >1 and p < 0.05. In conclusion, Paxlovid effectively reduced the risks of death, hospitalisation, death or hospitalisation, ED visit, ICU admission, and extra oxygen requirement. There was no significant statistical difference considering rebound, but people should pay attention to possible AEs. However, for rebound and AEs outcomes, observations in certain subgroups suggested conclusions contrary to the overall meta-analysis. Trial sequential analysis indicated these two outcomes have a risk of false negative or false positive conclusions, so additional original studies are needed for further validation.

PMID:37485774 | DOI:10.1002/rmv.2473

J Neuroendocrinol. 2023 Jul 4. doi: 10.1111/jne.13319. Online ahead of print.

ABSTRACT

The mTOR-inhibitor everolimus has been approved for the treatment of advanced neuroendocrine tumors (NETs) but is associated with relevant toxicities in clinical practice. Hence, optimal treatment sequencing and the impact of dose reductions have yet to be clarified. This retrospective analysis assessed patients with advanced, well-differentiated NET treated with everolimus at the Medical University of Vienna. The primary objective was to evaluate the efficacy of everolimus in a real-world cohort. A total of 52 patients treated with everolimus for advanced NET grade 1 (G1) or G2 (or typical or atypical carcinoid) 2010-2021 were included in this analysis. The most common sites of origin were pancreas (44%) and lung (29%). The initial dose was decided by the treating physician based on clinical assessment and 25 patients (48%) each were started at 10 mg/day and 5 mg/day. Median progression-free survival (PFS) following everolimus in the overall cohort was 9.8 months (95% CI: 4.3-15.3), with a statistically significant PFS difference (p = .03) between NET G1/typical carcinoids (42.9 months) and NET G2/atypical carcinoids (8.9 months). PFS was numerically but not significantly shorter in patients treated with a reduced dose (7.5 months vs. 12.4 months, p = .359). Even in this mixed full/half dose cohort, 93% developed treatment-related side effects (mostly grade I, no grade IV), 63% had dose reductions or interruptions, and five stopped due to toxicity. Median survival following treatment was 40.9 months (95% CI: 21.5-60.3) and no difference with regard to dosing was observed (p = .517). These data from an unselected patient cohort show long-term outcomes similar to those reported in the pivotal studies. Comparing everolimus starting dose, median PFS did not significantly differ for patients treated at a lower dose. While this finding is limited by the sample size and warrants prospective verification, initiating therapy at a reduced dose might be practicable and safe in a distinct subset of patients.

PMID:37485760 | DOI:10.1111/jne.13319

Dent Traumatol. 2023 Jul 23. doi: 10.1111/edt.12871. Online ahead of print.

ABSTRACT

BACKGROUND/AIM: Mandibular condylar fractures represent 25%-35% of all mandibular fractures. Despite profound research, there is still a controverse debate about treating these fractures conservatively or by open reduction and internal fixation (ORIF). The aim of this study is to analyse the outcome after open and closed treatment of extracapsular mandibular condyle fractures regarding general characteristics, post-treatment malocclusion, facial nerve palsy (FNP), maximum mouth opening (MMO) and parotid complications.

METHODS: A retrospective cohort of 377 fractures (350 open, 27 closed treatment) was reviewed by reference to clinical and radiological pre- and postoperative documentation. Follow-up period was 12 months. Pearsons’ chi-square-test, correlations, Kruskal-Wallis test and t-test were carried out for statistical analysis.

RESULTS: The dominant type of fracture was type II in Spiessl and Schroll classification (50.1%). In the open treated fractures, the most common approach was retromandibular transparotid (91.7%). Post-treatment malocclusion occurred in 18.0% and was significantly increased in bilateral fractures (p = .039), in luxation fractures (p = .016) and in patients with full dentition (p = .004). After open reduction and internal fixation (ORIF), temporary FNP was documented in 7.1% whereas a permanent paresis occurred in 1.7%. FNP was significantly associated with high fractures (p = .001), comminution (p = .028) and increased duration of surgery (p = .040). Parotid complications were significantly associated with revision surgery (p = .009). Post-treatment reduction of MMO mainly occurred in female patients (p < .001) as well as in patients with bilateral fractures (p < .001), high fractures (p = .030) and concomitant mandibular (p = .001) and midfacial fractures (p = .009).

CONCLUSION: Malocclusion seems to be the most frequent long-term complication after open reduction and osteosynthesis of extracapsular mandibular condyle fractures. We suggest ORIF by a transparotid approach to be an appropriate treatment with a low complication rate regarding especially FNP for extracapsular fractures of the mandibular condyle.

PMID:37485754 | DOI:10.1111/edt.12871

J Adv Nurs. 2023 Jul 23. doi: 10.1111/jan.15789. Online ahead of print.

ABSTRACT

AIMS: Healthcare waste production is a significant contributor to carbon emissions, negatively impacting the environment. Ineffective healthcare waste disposal results in greater measures to manage it which is costly to both the environment and healthcare organizations. This study aimed to improve waste management in a tertiary maternity hospital. Specifically, the impact of a midwife-led intervention to improve waste segregation, staff knowledge and attitudes and waste management-related costs was investigated.

DESIGN: A multi-method study including pre- and post-intervention staff waste management knowledge and attitude surveys and waste audits of bins located on the postnatal ward.

METHODS: The intervention included education sessions, posters and signage by waste bins and monthly newsletters distributed throughout 2021 to raise staff awareness of correct waste segregation processes. Pre- and post-intervention surveys were distributed in early 2021 and early 2022, respectively. The waste audits occurred on three occasions, January, July and December of 2021. The waste audit included total waste in kilograms (kg), waste in kg by segregation and identification of correct and incorrect segregation. Waste audit and quantitative staff survey data were analysed using descriptive statistics and chi square. Qualitative data from the staff surveys were analysed using content analysis.

RESULTS: Knowledge and attitudes to waste management were similar across pre- and post-intervention staff surveys. Knowledge of accurate allocation of specific items to waste streams was variable with errors identified in both the pre- and post-surveys. Waste audit data showed reductions in clinical waste at each measurement, with a 71.2% decrease in clinical waste from baseline to the final audit. Accuracy of waste segregation also improved from the baseline to final audit, resulting in a 48% reduction in waste management costs.

CONCLUSION: The midwife-led initiative improved waste segregation and achieved the associated waste management cost reduction.

IMPACT: A midwifery-led initiative to address waste production and segregation on a maternity ward had a positive impact on waste segregation practices and associated waste management costs. The existence of change champions along with in-service sessions, posters and newsletters to raise awareness of correct waste segregation resulted in a 71% reduction of incorrect items being placed in clinical waste bins. Challenges such as COVID-19 pressures and workload made it difficult for midwives to engage in waste management education and effective waste segregation.

PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Implementing clinician-led waste management interventions across hospital wards while addressing workload issues are likely to have significant cost benefits for organisations and minimise the environmental impacts of healthcare settings.

PMID:37485721 | DOI:10.1111/jan.15789

Thorac Res Pract. 2023 Jul;24(4):186-193. doi: 10.5152/ThoracResPract.2023.22114.

ABSTRACT

OBJECTIVE: Patients with chronic obstructive pulmonary disease are among the most risky groups for Coronavirus Disease 2019. The study was conducted with a case-control group design in order to determine the coronavirus disease 2019 infection-related characteris- tics of chronic obstructive pulmonary disease patients with and without inhaler training.

MATERIAL AND METHODS: A total of 106 patients, being case group (n = 53) and control group (n = 53), were included in the study sample through purposive and simple random sampling methods. While the control group did not receive training, the case group received inhaler training in 2017-2018. Inhaler training was conducted face-to-face using the demonstration method. Patients were evaluated according to their coronavirus disease 2019 (approved by a physician positive polymerase chain reaction) status from the beginning of the pandemic to the time they were included in the study (June 2021).

RESULTS: The rate of incorrect inhaler use was determined to be 39.6% of the patients in the control group, which is statistically differ- ent from the case group (P < .001). It was also determined that 17.9% of the patients in the study sample had contracted coronavirus disease 2019. It was found that the presence of symptoms for at least 1 month following the negative polymerase chain reaction result was significantly higher in the control group (P = .018). It was determined that the case group patients were more careful compared to the control group in terms of coronavirus disease 2019 measures (P < .031). The patients in the case group reported that inhaler medicines were also effective in protecting against other respiratory system diseases (P = .006).

CONCLUSION: Few patients with chronic obstructive pulmonary disease have been infected. It was concluded that the coronavirus disease 2019 symptoms lasted longer in the control group than in the case group.

PMID:37485707 | DOI:10.5152/ThoracResPract.2023.22114