Nevin Manimala

Dig Liver Dis. 2021 Dec 10:S1590-8658(21)00853-7. doi: 10.1016/j.dld.2021.11.013. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: The accurate differential diagnosis between autoimmune pancreatitis (AIP) and pancreatic ductal adenocarcinoma (PDAC) is clinically important. We aimed to determine significant MRI features for differentiating AIP from PDAC, including assessment of diffusion-weighted imaging (DWI).

METHODS: We performed a systematic search using three databases. The pooled diagnostic odds ratio was calculated using a bivariate random effects model to determine significant MRI features for differentiating AIP from PDAC. The pooled sensitivity and specificity were calculated. The qualitative systematic review for DWI assessment was performed.

RESULTS: Of nine studies (775 patients), multiple main pancreatic duct (MPD) strictures, absence of upstream marked MPD dilatation, peripancreatic rim, and duct penetration sign were significant MRI features for differentiating AIP from PDAC. Absence of MPD dilatation had the highest pooled sensitivity (87%, 95% CI=68-96%), whereas peripancreatic rim had the highest pooled specificity (100%, 95% CI=88-100%). Of 12 studies evaluating DWI, seven reported statistically significant differences in apparent diffusion coefficient (ADC) values between AIP and PDAC; however, four reported lower ADC values in AIP than in PDAC, but three reported the opposite result.

CONCLUSION: The four significant MRI features can be useful to differentiate AIP from PDAC, but DWI assessment might be limited.

PMID:34903501 | DOI:10.1016/j.dld.2021.11.013

J Plast Reconstr Aesthet Surg. 2021 Nov 14:S1748-6815(21)00561-1. doi: 10.1016/j.bjps.2021.11.022. Online ahead of print.

ABSTRACT

BACKGROUND: Complex regional pain syndrome (CRPS) is a neuropathic pain condition with no universally recognised treatment. The study evaluates the efficacy of a therapeutic protocol consisting of oral citalopram and lidocaine injections in patients affected by CRPS.

METHODS: Between January 2010 and December 2014, 150 consecutive patients with CRPS were enrolled in the study and randomly assigned into three groups: group one – lidocaine injection and oral citalopram; group two – lidocaine injection and oral placebo; and group three – injective and oral placebo. The Impairment Sum Score (ISS) was used to assess the severity of CRPS before, as well as at regular intervals after treatment commenced. Statistical significance (p < 0.05) was determined by paired t-tests.

RESULTS: The combined treatment proved to be more effective (ISS 47.6 to 12.6) than local anaesthetic alone (ISS 47.5 to 21.5) and to placebo (ISS 47.2 to 29.9).

CONCLUSION: This study indicates that CRPS may be managed with well-tolerated association of oral citalopram and lidocaine injections.

PMID:34903493 | DOI:10.1016/j.bjps.2021.11.022

Braz J Otorhinolaryngol. 2021 Nov 15:S1808-8694(21)00185-3. doi: 10.1016/j.bjorl.2021.10.004. Online ahead of print.

ABSTRACT

INTRODUCTION: Learning disability has a significant relevance and can generate negative social impacts on the future of an individual if not corrected in time. Phoniatrics is an area of otorhinolaryngology responsible for evaluating, diagnosing, and referring these cases for therapy and/or complementing the multidisciplinary diagnosis.

OBJECTIVE: To evaluate in school-aged children the association between the application of a set of tests used in the phoniatric assessment and complaints of academic difficulties. To identify which tests would show the main association with academic performance when applied individually.

METHODS: Blind, cross-sectional study, subdivided into 4 stages. In the 1st stage, 66 children in the third year of elementary school were submitted to the set of tests of skills applied by the phoniatrician; in the 2nd stage, the physician asked the educators about complaints of academic difficulties regarding the students; in the 3rd stage the students’ Portuguese language school grade was obtained and in the 4th stage an analysis was made between the data.

RESULTS: The educator identified complaints of academic difficulties in 27.2% of the 66 students. There was a statistically significant association between academic difficulties and the following tests of skills: dictation of words and pseudowords, dictation of words, dictation of pseudowords, rhyming, phonemic synthesis, and in the reading test; fluency, intonation and comprehension of the text and morals were analyzed in the reading test. In the multivariate logistic regression analysis, the tests selected to comprise the final model, showing greater association with the academic difficulty complaint were: dictation of words, intonation in reading and comprehension of the morals of the story.

CONCLUSION: The tests identified as the most relevant in identifying academic difficulties were dictation of words, intonation in reading and comprehension of the morals of the story. However, the other tests that were part of the phoniatric consultation allowed the observation of the individual and their functioning abilities, leading to a better assessment of the case, regarding aspects not directly related to the pedagogical one.

PMID:34903473 | DOI:10.1016/j.bjorl.2021.10.004

Chin J Traumatol. 2021 Nov 20:S1008-1275(21)00185-1. doi: 10.1016/j.cjtee.2021.11.004. Online ahead of print.

ABSTRACT

PURPOSE: No therapeutic consensus has been established about proximal ruptures of the rectus femoris muscle. The objective of this literature review is to determine a therapeutic course of action.

METHODS: We conducted a literature review on the PubMed database using the following keywords (in French and English, respectively): “quadriceps/quadriceps”, “droit antérieur/rectus femoris”, “proximal/proximal”, “chirurgie/surgical”, “avulsion/avulsion”. We collected 266 articles, 36 of them were selected, which were related to our topic: proximal rupture of the anterior rectus femoris. Patients with a proximal rupture of the rectus femoris, minor or major patient of traumatic origin were included in this study. Patients injured at another lesion level, or non-traumatic lesions of the proximal rectus femoris (tendinitis without ruptures, tumor or others) were excluded. For each patient, the indications, the type of treatment and the functional result were analyzed, with the time to recovery and the level of recovery from sports and professional activities (same sport/profession or not, same level or not) as the main criterion of judgment. Fisher exact test was used for statistical comparison.

RESULTS: The aims of conservative treatment are to be pain free for the patient, to fight hematoma and to rehabilitate the injury as quickly as possible. The surgical techniques are varied, with most consisting of either a reinsertion of the musculo-tendon stump or a resection of the scar tissue with myo-tendino-aponeurotic suture in place. The functional results are good for the majority of the treatments proposed, but the conservative treatment has a shorter recovery time (3 months vs. 4 months for the best surgical results). Highly displaced bone avulsion is the only indication for first-line surgical treatment.

CONSLUSION: The main disadvantage of conservative treatment is the risk of residual pain beyond 3 months (10%), justifying an MRI to guide secondary surgical treatment. We propose a treatment plan for proximal rupture of the proximal rectus femoris rupture.

PMID:34903464 | DOI:10.1016/j.cjtee.2021.11.004

J Cardiothorac Vasc Anesth. 2021 Nov 12:S1053-0770(21)00978-2. doi: 10.1053/j.jvca.2021.11.012. Online ahead of print.

ABSTRACT

OBJECTIVE: Current guidelines consider obesity to be a relative contraindication to venoarterial extracorporeal membrane oxygenation (VA-ECMO) for refractory cardiogenic shock. The authors investigated the effect of body mass index (BMI) on clinical outcomes in patients treated with VA-ECMO for cardiogenic shock.

DESIGN: This was a retrospective and observational study.

SETTING: University hospital.

PARTICIPANTS: The study comprised 150 adult patients who underwent VA-ECMO for cardiogenic shock.

MEASUREMENTS AND MAIN RESULTS: The primary outcome was intensive care unit (ICU) mortality. Of the 150 included patients, 10 were underweight (BMI < 18.5 kg/m²), 62 were normal weight (BMI = 18.5-24.9 kg/m²), 34 were overweight (BMI = 25.0-29.9 kg/m²), 34 were obese class I (BMI = 30.0-34.9 kg/m²), and 10 were obese class II (BMI = 35.0-39.9 kg/m²). All-cause ICU mortality was 62% (underweight, 70%; normal weight, 53%; overweight, 65%; class I obese, 71%; class II obese, 70%). After multivariate logistic regression, BMI was not associated with ICU mortality (adjusted odds ratio [aOR] 0.99 [0.92-1.07], p = 0.8). Analysis by BMI category showed unfavorable mortality trends in underweight patients (aOR 3.58 [0.82-19.6], p = 0.11) and class I obese patients (aOR 2.39 [0.95-6.38], p = 0.07). No statistically significant differences were found among BMI categories in the incidences of complications.

CONCLUSION: The results suggested that BMI alone should not be considered an exclusion criterion for VA-ECMO. The unfavorable trend observed in underweight patients could be the result of malnutrition.

PMID:34903457 | DOI:10.1053/j.jvca.2021.11.012

Gait Posture. 2021 Oct 8:S0966-6362(21)00525-7. doi: 10.1016/j.gaitpost.2021.10.002. Online ahead of print.

NO ABSTRACT

PMID:34903442 | DOI:10.1016/j.gaitpost.2021.10.002

J Perianesth Nurs. 2021 Dec 10:S1089-9472(21)00316-6. doi: 10.1016/j.jopan.2021.08.008. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to determine the effect of progressive relaxation exercises on physiological parameters, pain, anxiety, and serum cortisol levels in patients undergoing colorectal cancer surgery.

DESIGN: This study is a randomized controlled study and has been registered at the Clinical Trial Registry Center (ID: NCT04731428).

METHODS: The study was conducted on 63 patients (experimental group = 31, control group = 32), who were scheduled for elective laparoscopic-colorectal surgery in the general surgery clinic of a university hospital in Istanbul between March 2018 and May 2019 and met the inclusion criteria. The patients in the experimental group were given progressive relaxation exercises for 15 minutes preoperatively and on postoperative days 1, 2, and 3 after breathing exercise training. The routine treatments and care process of the patients in the control group were maintained. The preoperative and postoperative pain and anxiety levels of both groups were evaluated. Blood pressure, heart rate and respiratory rate, oxygen saturation, and serum cortisol levels were measured at certain time intervals before and after the relaxation exercise.

FINDINGS: The patients in the experimental group had lower postoperative pain and anxiety levels and a lower rate of using opioid analgesic on postoperative day 0 compared to the control group. Progressive relaxation exercise had no statistically significant effect on serum cortisol or physiological parameters (P > .05).

CONCLUSIONS: Progressive relaxation exercise did not affect cortisol levels and vital signs but decreased pain and anxiety, and relatively increased tissue oxygenation, appearing an effective, safe, and practicable nursing intervention.

PMID:34903440 | DOI:10.1016/j.jopan.2021.08.008

Aust Crit Care. 2021 Dec 10:S1036-7314(21)00169-7. doi: 10.1016/j.aucc.2021.11.001. Online ahead of print.

ABSTRACT

BACKGROUND: The severity of muscle weakness after critical illness is very heterogeneous. To identify those patients who may maximally benefit from early exercises would be highly valuable. This implies an assessment of physical capacities, comprised at least of strength measurement and functional tests.

OBJECTIVES: The objective of this study was to investigate the relationship between muscle strength and functional tests in an intensive care unit (ICU) setting.

METHODS: Adults with ICU length of stay ≥2 days were included. Handgrip strength (HG) and maximal isometric quadriceps strength (QS) were assessed using standardised protocols as soon as patients were alert and able to obey commands. At the same time, their maximal level of mobilisation capabilities and their autonomy were assessed using ICU Mobility Scale (ICU-MS) and Barthel Index, respectively.

RESULTS: Ninety-three patients with a median age of 64 [57-71.5] years, body mass index of 26.4 [23.4-29.6] kg/m², and Simplified Acute Physiology Score II of 33 [27.7-41] were included. Absolute and relative QS were, respectively, 146.7 [108.5-196.6] N and 1.87 [1.43-2.51] N/kg. HG was 22 [16-31] kg. The ICU-MS score was 4 [1-5]. A significant positive correlation was observed between HG and absolute QS (r_s = 0.695, p < 0.001) and between HG and relative QS (r_s = 0.428, p < 0.001). The ICU-MS score correlated with HG, with a weak positive relationship (r_s = 0.215, p = 0.039), but not with QS. The ICU-MS score did not statistically differ between the weakest and strongest patients for absolute or relative QS, but was lower in patients with the lowest HG values (p = 0.01). A weak positive correlation was observed between the Barthel Index and muscle strengths (maximum r_s = 0.414, p < 0.001).

CONCLUSIONS: The present results suggest that, during ICU stay, there is no strong association between muscle strength and functional test such as the ICU-MS or Barthel Index. Muscle dynamometry and functional tests are probably complementary tools for physical capacities quantification.

PMID:34903433 | DOI:10.1016/j.aucc.2021.11.001

J Adolesc Health. 2021 Dec 10:S1054-139X(21)00556-5. doi: 10.1016/j.jadohealth.2021.10.030. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study is to (1) examine the prevalence of human papillomavirus (HPV) vaccination in adolescents and young adults in the U.S., including those who had a dental visit in the last year but not a medical visit and (2) to determine an association between last visit to the dentist and HPV vaccination status.

METHODS: We conducted a cross-sectional study using data from the National Health and Nutrition Examination Survey from 2015 to 2018, including participants 9-26 years. Descriptive statistical analyses were conducted to characterize the study population and calculate the prevalence of HPV vaccination in adolescents and young adults, including those who had a dental visit in the last year but not a medical visit. Logistic regression analyses were performed to examine the association between last visit to the dentist and HPV vaccination status.

RESULTS: In total, 38.6% of participants were vaccinated for HPV, with higher prevalence of vaccination in those with the following characteristics: female, older age, higher income, higher education level, and having medical insurance. Participants who had a dental visit in the last year had an HPV vaccination rate of 40.8%. Of those who had a dental visit and were not vaccinated for HPV, 12.5% did not have a medical visit. Having a dental visit in the last year increased the odds of being vaccinated for HPV (odds ratio 1.69, confidence interval 1.26-2.28).

CONCLUSIONS: Dentists see a significant number of adolescents and young adults who are unvaccinated for HPV in a given year and could serve as an access point for HPV vaccine delivery in the future.

PMID:34903425 | DOI:10.1016/j.jadohealth.2021.10.030

Am J Orthod Dentofacial Orthop. 2021 Dec 11:S0889-5406(21)00755-1. doi: 10.1016/j.ajodo.2020.10.031. Online ahead of print.

ABSTRACT

INTRODUCTION: Various treatment modalities exist to improve and correct Class I malocclusion. This study was conducted to evaluate the outcomes of nonextraction (NE), premolar extraction (PME), and mandibular incisor extraction (MIE) treatment modalities in subjects presenting with Class I malocclusion.

METHODS: A cross-sectional study was conducted at a tertiary care hospital using pretreatment and posttreatment dental casts along with intraoral photographs of 90 orthodontic subjects. These subjects were divided equally into NE, PME, and MIE groups and scored using the Index of Orthodontic Treatment Need, Index of Complexity, Outcome, and Need (ICON), and peer assessment rating (PAR) indexes. Nonparametric tests were run to compare pretreatment and posttreatment scores and to evaluate the percentage and categorical changes for the treatment modalities. Pairwise comparisons were performed using the Mann-Whitney U test.

RESULTS: Statistically significant differences (P ≤0.001) were seen between the pretreatment and posttreatment scores for all modalities. Statistically significant improvements were seen between the 3 treatment modalities for the PAR (P = 0.010) and ICON (P = 0.003) indexes. Significant categorical improvements were found for the Aesthetic Component (AC) (P = 0.012) among the 3 groups. Pairwise comparison revealed significant differences between the NE and MIE groups (ICON, P = 0.001; AC, P = 0.018) and PME and MIE groups (PAR, P = 0.002; ICON, P = 0.007; AC, P = 0.007).

CONCLUSIONS: Posttreatment scores of all indexes were reduced, with significant differences found among the treatment modalities for all except the Dental Health Component index. The pairwise comparison revealed suboptimal occlusal results with the MIE group. Good occlusal and esthetic treatment outcomes were achieved with the PME and NE groups.

PMID:34903420 | DOI:10.1016/j.ajodo.2020.10.031