Nevin Manimala

J Cardiothorac Vasc Anesth. 2022 Jul 11:S1053-0770(22)00519-5. doi: 10.1053/j.jvca.2022.07.005. Online ahead of print.

ABSTRACT

OBJECTIVES: To identify and quantify the predictors of intraoperative transesophageal echocardiography (TEE) use among the patients undergoing cardiac valve or isolated coronary artery bypass graft (CABG) surgery.

DESIGN: An observational cohort study.

SETTING: This study used the Centers for Medicare and Medicaid Services administrative claims dataset of the beneficiaries undergoing valve or isolated CABG surgery between 2013 to 2015.

PARTICIPANTS: Adults aged ≥65 years of age undergoing cardiac valve or isolated CABG surgery.

INTERVENTIONS: Generalized linear mixed-model (GLMM) analyses were used to examine the relationship between the TEE and patient characteristics, hospital factors, and staffing differences, while accounting for clustering within hospitals. The proportion of variation in TEE use attributable to patient-level characteristics was quantified using odds ratios. Hospital-level factors and staffing differences were quantified using the median odds ratios (MOR) and interval odds ratios (IOR).

MEASUREMENTS AND MAIN RESULTS: Among 261,860 patients (123,702 valve procedures and 138,158 isolated CABG), the GLMM analysis demonstrated that the strongest predictor for intraoperative TEE use was the hospital where the surgery occurred (MOR for TEE of 2.57 in valve and 4.16 in isolated CABG). The TEE staffing variable reduced the previously unexplained across-hospital variability by 9% in valve and 21% in isolated CABG, and hospitals with anesthesiologist TEE staffing (versus mixed) were more likely to use TEE in both valve and CABG (MOR for TEE of 1.21 in valve and 1.84 in isolated CABG).

CONCLUSION: Hospital practice was the strongest predictor for TEE use overall. In isolated CABG surgery, hospitals with anesthesiologist TEE staffing were a primary predictor for TEE use.

PMID:35909042 | DOI:10.1053/j.jvca.2022.07.005

J Plast Reconstr Aesthet Surg. 2022 Jun 17:S1748-6815(22)00323-0. doi: 10.1016/j.bjps.2022.06.007. Online ahead of print.

ABSTRACT

Acute upper limb infections represent a large proportion of on-call referrals and emergency theatre time in plastic surgery. To enable us to maintain effective service provision despite reallocation of hospital resources as a result of COVID-19, and to minimise patient exposure in a hospital setting during the pandemic, we introduced a walk-in clinic and dedicated local anaesthetic (LA) operating theatre for these infections. In this work, we sought to analyse our service changes and resulting patient outcomes. Using electronic records, data from patients presenting with upper extremity infections was collected before the pandemic from 1st January to 30th March 2020, then for a period of three months from 30th March until 30th June 2020, after our changes were implemented. Seventy-two patients were included before 30th March 2020, and 49 patients after. Prior to our changes, most patients underwent surgery (n = 58, 80.6%), requiring overnight admission (n = 64, 88.9%), following mainly general anaesthetic procedures (n = 56, 96.6%). After our service changes, a similar percentage of patients were treated operatively (n = 41, 83.7%), but these procedures mostly utilised LA (n = 37, 90.2%) in the outpatient setting (n = 25, 51.0%). Despite this shift in management approach, no statistically significant difference in readmission rates was calculated between the two groups (p = 0.556) and post-operative complications were fewer in absolute terms. Our results suggest that in many instances, these infections can be managed in an outpatient setting without the need for inpatient care. Selective admission with strict follow-up of patients may be feasible, improving patient experience and reducing resource burden.

PMID:35909036 | DOI:10.1016/j.bjps.2022.06.007

Int J Oral Maxillofac Surg. 2022 Jul 28:S0901-5027(22)00304-6. doi: 10.1016/j.ijom.2022.07.004. Online ahead of print.

ABSTRACT

Dentoskeletal changes in minimally invasive surgically assisted rapid palatal expansion (SARPE) were evaluated using cone beam computed tomography (CBCT). This was a prospective study of 30 patients who underwent minimally invasive SARPE performed under local anaesthesia plus sedation by the same surgeon, in an ambulatory setting. Pre- and postoperative CBCT images were obtained for each patient. A statistically significant increase in the linear transverse dimensions of the maxilla occurred systematically. In the canine region, a mean increase of 5.84 mm occurred at the apex level and 7.82 mm at the crown level. These dimensions were 4.83 mm and 7.68 mm, respectively, in the molar region. The cross-sectional area of the maxilla increased by a mean 12.9 mm² at the palate level and 23.3 mm² at the crown level. Dental inclination to the buccal aspect was detected (mean 6.1° at the canines and 8.4° at the first molars). The alveolar process tipped buccally 10° at the molar level. Nasal width increased a mean of 3.0 mm at the canine level. Through a three-dimensional analysis, this study found that minimally invasive SARPE was effective in the correction of transverse maxillary discrepancies> 5 mm in non-growing patients. Although dental inclination to the buccal aspect occurred, significant expansion of the maxilla at the skeletal and dentoalveolar levels was confirmed.

PMID:35909027 | DOI:10.1016/j.ijom.2022.07.004

Foot Ankle Surg. 2022 Jul 13:S1268-7731(22)00134-5. doi: 10.1016/j.fas.2022.07.003. Online ahead of print.

ABSTRACT

BACKGROUND: Various fixation methods have been described for Akin osteotomy, based on using metal implants or transosseous sutures. The aim of this study was to evaluate radiological outcomes and complications of closing wedge Akin osteotomy based on a crossed suture configuration of the joint capsule rather than using implants. The null hypothesis is that a crossed suture has comparable radiological results to other techniques, with no additional complications.

METHODS: It’s a retrospective study. Patients who underwent Akin osteotomy fixed either with implant or joint capsule suture between 2015 and 2018 were included. Distal articular set angle corrections in pre- and postoperative anteroposterior foot x-rays were calculated by 2 observers. Complications, such as pain, infection, non-union and need of surgery revision, was compared at 1 year follow-up.

RESULTS: 89 patients, 30 in the implant group and 59 in the suture group. Mean distal articular set angle corrections were 6.43 (SD 5.54) and 7.36 (SD 5.48) degrees in the implant and suture groups, respectively, without statistically significant differences (p 0.454). Complications were 2 local pain and 1 wound infection cases in the suture and implant groups, respectively (p 0.138, p 0.197).

CONCLUSION: Akin osteotomy with suture fixation yields comparable radiological results to metal implant fixation methods without increasing the associated complications.

PMID:35909025 | DOI:10.1016/j.fas.2022.07.003

Gynecol Oncol. 2022 Jul 28:S0090-8258(22)00510-8. doi: 10.1016/j.ygyno.2022.07.025. Online ahead of print.

ABSTRACT

OBJECTIVE: Endosalpingiosis is a poorly understood condition of ectopic epithelium resembling the fallopian tubes. It has been described as an incidental pathology finding, a disease similar to endometriosis, and in association with malignancy. The objective of this study is to determine if endosalpingiosis (ES) has an increased association with gynecologic malignancy when compared to endometriosis (EM).

METHODS: This is a retrospective case-control analysis of patients with a histologic diagnosis of endosalpingiosis or endometriosis at three affiliated academic hospitals between 2000 and 2020. All ES patients were included, and 1:1 matching was attempted to obtain a comparable cohort of EM patients. Demographic and clinical data were obtained, and statistical analysis was performed.

RESULTS: A total of 967 patients (515 ES and 452 EM) were included. ES patients were significantly older than EM patients (median age 52 vs 48 years, p < 0.001). The ES group had significantly more cancer diagnoses at surgery than the EM group (40.1% vs 18.1%, p < 0.001); this difference persisted in a sub-analysis excluding patients with known or suspected malignancy (20.9% vs 5.6%, p < 0.001). ES patients had lower overall survival (10-year freedom from death: 77.0% vs 90.5%, p < 0.001). After adjusting for confounders, multivariable analysis showed that ES patients had increased cancer diagnosed at surgery (OR = 2.48, p < 0.001) and greater risk of death (OR = 1.69, p = 0.017).

CONCLUSIONS: Endosalpingiosis was found concurrently with malignancy in 40% of cases, and this effect was preserved in multi-variable and sub-group analyses. Further research consisting of longer follow-up and exploration of molecular relationships between ES and cancer are forthcoming.

PMID:35909004 | DOI:10.1016/j.ygyno.2022.07.025

Arch Bronconeumol. 2022 Jul 20:S0300-2896(22)00492-6. doi: 10.1016/j.arbres.2022.07.006. Online ahead of print.

NO ABSTRACT

PMID:35908987 | DOI:10.1016/j.arbres.2022.07.006

Nihon Koshu Eisei Zasshi. 2022 Jul 29. doi: 10.11236/jph.21-118. Online ahead of print.

ABSTRACT

Objectives Some young adults often tend to perceive interpersonal relationships and social interactions as stressful, and as such, avoid them. Seeking help from parents and interactions with neighbors during childhood are known to be important in forming positive impressions of people, thereby influencing help-seeking behavior in adulthood. However, it remains unclear how these experiences are related and how they influence interpersonal relationships in adulthood. This study aimed to investigate whether childhood experience(s) of social interactions in the community has any modifying effect on the association between seeking support from parents in childhood and avoidance of interpersonal relationships in adulthood.Methods Data pertaining to 1,274 individuals (aged 18 to 39 years) were collected from a questionnaire survey conducted in 2018 by Nagoya City of Japan. Modified Poisson regression analyses were performed to estimate the prevalence ratio of current avoidance of interpersonal relationships depending on the experience(s) of seeking help from a parent (father/mother analyzed respectively) and participating in community events in childhood. Data were stratified according to gender, and adjusted for age, parents’ educational background, mother’s working status in childhood, subjective recognition of economic status in childhood and seeking help from the other parent. Effect estimates were calculated to evaluate the existence of any modifying effect.Results No modifying effect of participating in community events in childhood was seen in the association between experience of seeking help from the father and current avoidance of interpersonal relationships, in either gender. Regarding experience of seeking help from the mother, a modifying effect was seen in men. Among men who had sought help from their mother, those who had participated in community events were less likely to avoid interpersonal relationships in adulthood.Conclusion In order to reduce the tendency to avoid interpersonal relationships in adulthood, childhood experiences of seeking help from the mother and participating in community events may be important, particularly for men. In addition to appropriate parental support, promoting interactive events for children in communities may mitigate the problem of poor social skills later in life.

PMID:35908927 | DOI:10.11236/jph.21-118

Biol Pharm Bull. 2022;45(8):1198-1202. doi: 10.1248/bpb.b22-00136.

ABSTRACT

Trastuzumab (herceptin) is an effective drug for human epidermal growth factor receptor type 2 (HER2)-positive cancer. However, cardiotoxicity remains a serious complication. In our previous genome-wide association study (GWAS), we identified potential associations for five single nucleotide polymorphisms (SNPs) with trastuzumab-induced cardiotoxicity in a Japanese population. To validate this association, here we performed replication studies using Japanese and Singaporean case-control cohorts (Japan: 6 cases and 206 controls; Singapore: 22 cases and 178 controls). Although none of the SNPs showed a statistically significant association with trastuzumab-induced cardiotoxicity, we show that three (rs8032978, rs7406710 and rs9316695) and four (rs8032978, rs7406710, rs28415722 and rs11932853) SNPs had an effect in the same direction in the Japanese and the Singaporean cohort, respectively, as that in our previous study. Combining the previous study with the current replication studies, we find a strong association for two SNPs, rs8032978 and rs7406710, with trastuzumab-induced cardiotoxicity (P_combined = 4.92 × 10^-5 and 5.50 × 10^-5, respectively). These data suggest that rs8032978 and rs7406710 could be predictive markers of trastuzumab-induced cardiotoxicity in Japanese and Singaporean populations, and support their potential use in clinical risk assessment. These findings offer a first step toward the development of clinically available markers for the potential risk of trastuzumab-induced cardiotoxicity as well as an improved understanding of the pathogenesis of this complication.

PMID:35908902 | DOI:10.1248/bpb.b22-00136

Jpn J Infect Dis. 2022 Jul 29. doi: 10.7883/yoken.JJID.2022.181. Online ahead of print.

ABSTRACT

Candidemia is an important clinical condition that prolongs the period of hospitalization and increases morbidity, mortality, and hospital costs. In this retrospective study, we aimed to evaluate the epidemiological and microbiological characteristics of patients with candidemia, between January 2013 and December 2019. Two hundred forty-one candidemia episodes were observed in the 230 patients, of whom 45% were female. The median age was 63 and 53.9% of the episodes were in the ICU. Frequently observed predisposing factors for candidemia included the use of antibiotics (71.3%), urinary catheterization (56.3%), Central venous catheter placement (50.3%), total parenteral nutrition (47.9%), solid-organ malignancy (46%), a surgical intervention (48.6%), chemotherapy (37%), steroid treatment (25.5%). The crude mortality rate was 52.7%. A significant difference was found between survivors and non-survivors (p = 0.007) with the Charlson comorbidity index. However, no statistically significant association was found between mortality and age, sex, surgical intervention, catheter-related candidemia, or Candida spp. The most frequently isolated Candida spp. was C. albicans (51%). Overall resistance to fluconazole, voriconazole, caspofungin, micafungin and flucytosine was 3.7%, 0%, 2.5%, 1.8%,1.8%, respectively. Consequently, there is a need for tests that yield higher success rates and rapid in diagnosis candidemia and local epidemiological data for antifungal resistance.

PMID:35908875 | DOI:10.7883/yoken.JJID.2022.181

Clin Respir J. 2022 Jul 31. doi: 10.1111/crj.13529. Online ahead of print.

ABSTRACT

INTRODUCTION: Cough is one of the most common presenting symptoms of COVID-19, which can persist for weeks or months.

OBJECTIVE: The goal of this study was to evaluate the effectiveness of gabapentin (GBT) alone and in combination with montelukast (MTL) for improving cough.

METHODS: In this open-label randomized controlled clinical trial, eligible cases were patients hospitalized with moderate to severe COVID-19 who had cough with a Breathlessness, Cough, and Sputum Scale (BCSS) score of at least 2 based on its cough subscale. The participants were randomly assigned to three groups including two experimental groups and one control group. The first and second experimental groups received GBT and GBT/MTL, respectively, whereas the control group received dextromethorphan (DXM). Treatment duration was 5 days in all groups. Before and after the interventions, the severity of cough was evaluated using BCSS scale and Visual Analog Scale (VAS).

RESULTS: A total of 180 patients were included; GPT, GPT/MTL, and DXM consisted of 76, 51, and 53 patients, respectively. There was no significant difference between the three groups in terms of age, gender, and comorbidities (P > 0.05). Regarding BCSS and VAS scores, there was significant reduction from the baseline values in all groups (P < 0.0001), with the change rate being significantly higher in DXM group. The amount of reduction of BCSS in the GPT/MTL group was significantly more than the GPT group, whereas there was no significant difference between the two groups regarding VAS score. Although the duration of hospitalization differed between the groups with the GPT/MTL group having the shortest duration, the difference was statistically significant only between the GPT and GPT/MTL groups (P < 0.0001).

CONCLUSION: GPT, both alone and in combination with MTL, improves cough frequency and severity in hospitalized patients with COVID-19, with the combination being more efficacious. This regimen may be useful in patients who cannot tolerate opioids.

PMID:35908849 | DOI:10.1111/crj.13529