Nevin Manimala

Int J Clin Pharm. 2022 Nov 15. doi: 10.1007/s11096-022-01506-4. Online ahead of print.

ABSTRACT

BACKGROUND: Older adults (≥ 65 years) with cancer receiving palliative care often have other health conditions requiring multiple medications.

AIM: To describe and assess the appropriateness of prescribing for older adults with cancer in the last seven days of life in an inpatient palliative care setting.

METHOD: Retrospective observational study of medical records for 180 patients (60.6% male; median age: 74 years; range 65-94 years) over a two-year period. Medication appropriateness was assessed using: STOPPFrail, OncPal deprescribing guideline and criteria for identifying Potentially Inappropriate Prescribing in older adults with Cancer receiving Palliative Care (PIP-CPC).

RESULTS: 94.5% of patients had at least one other health condition (median 3, IQR 2-5). The median number of medications increased from five (IQR 3-7) seven days before death, to 11 medications on the day of death (IQR 9-15). The prevalence of PIP varied depending on the tool used: STOPPFrail (version 1: 17.2%, version 2: 19.4%), OncPal (12.8%), PIP-CPC (30%). However, the retrospective nature of the study limited the applicability of the tools. Increasing number of medications had a statistically significant effect on risk of PIP across all tools (STOPPFrail (version 1: 1.29 (1.13-1.37), version 2: 1.30 (1.16-1.48)); OncPal 1.13 (1.01-1.27); PIP-CPC 0.70 (0.61-0.82)).

CONCLUSION: This study found that the number of medications prescribed to older adults with cancer increased as time to death approached, and the prevalence of PIP varied with the application of different tools. The study also highlights the difficulties of examining PIP in this patient cohort.

PMID:36378404 | DOI:10.1007/s11096-022-01506-4

Emerg Radiol. 2022 Nov 15. doi: 10.1007/s10140-022-02100-x. Online ahead of print.

ABSTRACT

PURPOSE: The increased utilization, and potential overutilization, of computed tomography pulmonary angiography (CTPA) is a well-recognized issue within emergency departments (EDs). The objective of this study is to determine the impact of performance feedback reports on CTPA ordering behavior among ED physicians.

METHODS: We conducted a prospective study of the impact of individualized performance feedback reports on the ordering behavior of physicians working at two high-volume community EDs in Ontario, Canada. We generated individualized reports (or “Dashboards”) for each ED physician containing detailed feedback and peer comparison for each physician’s CTPA ordering. Our baseline pre-intervention period was January 1 to December 31, 2018, and our intervention period was January 1, 2019, to December 31, 2021. We tracked individual and group ordering behavior through the study period. Our primary outcomes are impact of feedback on (1) overall group ordering rate and (2) overall diagnostic yield. Secondary analysis was done to determine the impact of the intervention on those physicians with the highest CTPA utilization rate.

RESULTS: There was no statistically significant difference in the diagnostic yield of the included physicians in either of the years of the intervention period. There was a statically significant increase in the utilization rate for CTPA from 2018 to 2020 and 2021 from 5.9 to 7.9 and 11.4 CTPAs per 1000 ED visits respectively (p < 0.5).

CONCLUSION: Our study found no consistent significant impact of individualized feedback and peer comparison on physician ordering of CTPAs. This points to a potentially greater impact of environmental and institutional factors, as opposed to physician-targeted quality improvement measures, on physician ordering behavior.

PMID:36378395 | DOI:10.1007/s10140-022-02100-x

Environ Sci Pollut Res Int. 2022 Nov 15. doi: 10.1007/s11356-022-23966-x. Online ahead of print.

ABSTRACT

Of the many environmental factors that modulate the phytoextraction of elements, little has been learnt about the role of metal interactions. The study aimed to show how different concentrations of Cu, Pb and Zn in the cultivation medium influenced the biomass, plant development and phytoextraction abilities of Acer platanoides L. seedlings. Additionally, the impact on the content and distribution of Ca, K, Mg and Na in plant parts was studied with an analysis of phenols. Plants treated with a mixture of two metals were characterised by lower biomass of leaves and higher major elements content jointly than those grown in the salt of one element. Leaves of A. platanoides cultivated in Pb₅ + Zn₁, Pb₁ + Zn₁ and Pb₁ + Zn₅ experimental systems were characterised by specific browning of their edges. The obtained results suggest higher toxicity to leaves of Pb and Zn present simultaneously in Knop solution than Cu and Pb or Cu and Zn, irrespective of the mutual ratio of the concentrations of these elements. Antagonism of Cu and Zn concerning Pb was clearly shown in whole plant biomass when one of these elements was in higher concentration (5 mmol L^-1) in solution. In the lowest concentrations (1 mmol L^-1), there was a synergism between Cu and Zn in plant roots. Plants exposed to Zn₅, Cu₁ + Pb₅, Pb₅ + Zn₁ and Cu₁ + Zn₁ were characterised by higher total phenolic content than the rest plants. Both the presence and the concentration of other elements in the soil are significant factors that modulate element uptake, total phenolic content, and plant development.

PMID:36378369 | DOI:10.1007/s11356-022-23966-x

Int J Biometeorol. 2022 Nov 15. doi: 10.1007/s00484-022-02404-0. Online ahead of print.

ABSTRACT

Leishmaniasis is a vector-borne disease of which the transmission is highly influenced by climatic factors, whereas the nature and magnitude differ between geographical regions. The effects of climatic variables on leishmaniasis in Sri Lanka are poorly investigated. The present study focused on time-series analysis of leishmaniasis cases reported from Sri Lanka with selected climatic variables. Variance stabilized time series of leishmaniasis patients of entire Sri Lanka and major districts from 2014 to 2018 was fitted to autoregressive integrated moving average (ARIMA) models. All the possible models were generated by assigning different values for autoregression and moving average terms using a function written in R statistical program. The top ten models with the lowest Akaike information criterion (AIC) values were selected by writing another function. These models were further evaluated using RMSE and MAPE error parameters to select the optimal model for each area. Cross-autocorrelation analyses were performed to assess the associations between climate and the leishmaniasis incidence. Most associated lags of each variable were integrated into the optimal models to determine the true effects imposed. The optimal models varied depending on the area. SARIMA (0,1,1) (1,0,0)₁₂ was optimal for the country level. All the forecasts were within the 95% confidence intervals. Humidity was the most notable factor associated with leishmaniasis, which could be attributed to the positive impacts on sand fly activity. Rainfall showed a negative impact probably as a result of flooding of sand fly larval habitats. The ARIMA-based models performed well for the prediction of leishmaniasis in the short term.

PMID:36378349 | DOI:10.1007/s00484-022-02404-0

Environ Manage. 2022 Nov 15. doi: 10.1007/s00267-022-01748-y. Online ahead of print.

ABSTRACT

It has been argued that gender affects climate change response especially among farming communities yet literature is scant on gender perspectives of response. In recognition of this, the study examined responses with the associated challenges and opportunities across gender in the South East (SE) Nigeria. A mixed research approach including a participatory research approach (PRA), field observation and household questionnaire survey was used to collect data. The survey sample included 300 (150 men and women each) farm household heads from six villages in the region. Data were analyzed and presented using principal component analysis (PCA), non-parametric and descriptive statistics. The study found that men and women-headed households differed in their use of strategies like migration from affected areas and livelihood diversification (p < 0.05). Women have more challenges of insufficient improved farming knowledge than men. The challenges for men were majorly insufficient technologies like mechanization. Components of these challenges include technology, environmental-related challenges among others. Response opportunities for men and women include digital/mobile telecommunications and learning by doing respectively. Compared to men, women had less participation in opportunities for the development of human capital through training (p < 0.05). The study recommends that more opportunities should be provided for the training of farmers especially women on climate change response.

PMID:36378319 | DOI:10.1007/s00267-022-01748-y

Quintessence Int. 2022 Nov 15;0(0):2-8. doi: 10.3290/j.qi.b3512065. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine the minimum volume of infiltrative anesthetic required for pain-free mini-implant placement in the maxillary buccal region by comparing the efficacy of 1.0 mL with 0.5 mL of 2% lignocaine with 1:200,000 epinephrine during mini-implant placement.

METHOD AND MATERIALS: This splitmouth study involved 19 healthy patients without systemic disease, recent history of allergy, or medications within the age group of 17 to 28 years belonging to both sexes requiring bilateral buccal mini-implants in the posterior maxilla. Lignocaine 2% with 1:200,000 epinephrine (0.5 mL and 1.0 mL) was randomly injected between the right and left side 30 minutes apart for each consecutive patient. Mini-implants were placed 5 minutes after the administration of the infiltrative anesthetic. The pain response was evaluated during mini-implant placement (T1), and 5 minutes (T2) and 10 minutes (T3) after mini-implant placement on both sides using a pain-rating scale. Descriptive statistics and a factorial repeated-measure analysis of variance were calculated for pain response, sex, and side of the jaw.

RESULTS: At T1, T2, and T3, 1.0 mL of anesthetic had a lesser pain score by 1.00, 1.00, and 0.58, respectively, compared to 0.5 mL, with 95% confidence intervals of 0.43 to 1.57 (P = .001), 0.49 to 1.51 (P = .000), and 0.08 to 1.08 (P = .024), respectively.

CONCLUSIONS: 1.0 mL of 2% lignocaine with 1:200,000 epinephrine administered submucosally appears to provide better anesthesia than 0.5 mL during and after insertion of mini-implants. This study will help the operator administer the correct volume of infiltrative anesthetic thereby improving pain response, alleviating patient anxiety, and providing a better patient experience during and immediately after mini-implant placement.

PMID:36378301 | DOI:10.3290/j.qi.b3512065

Quintessence Int. 2022 Nov 15;0(0):2-11. doi: 10.3290/j.qi.b3512239. Online ahead of print.

ABSTRACT

OBJECTIVES: The objective of this study was to analyze the success of primary molar pulpectomy with a minimum of 1 year and up to 4 years follow-up with focus on the treatment setting (general anesthesia, sedation, local anesthesia alone).

METHOD AND MATERIALS: Data were retrieved from 92 patients’ records between 2012 and 2020. The pulpectomy treatment using calcium-hydroxide/iodoform paste was performed under general anesthesia (n = 45), nitrous oxide sedation (n = 21), or local anesthesia alone (n = 39). Bivariate and multivariate analyses were performed.

RESULTS: The overall success of pulpectomy was 59.5% 4 years post-treatment. The 4-years clinical success rate was clinically relevantly higher under general anesthesia (78.6% vs 57.1% under nitrous oxide sedation, 43.8% with local anesthesia only) and in the mandibular arch (70.8% vs 38.5% in the maxillary arch). This could be related to the strict case selection under sedation and especially general anesthesia. Despite statistically significant differences in the bivariate analysis for most outcomes and follow-up periods, this was not the case in multivariate regression.

CONCLUSION: Pulpectomy performed in primary molars offers a successful long-term treatment option especially with a strict case selection as under general anesthesia.

PMID:36378300 | DOI:10.3290/j.qi.b3512239

Eur J Clin Pharmacol. 2022 Nov 15. doi: 10.1007/s00228-022-03420-0. Online ahead of print.

ABSTRACT

PURPOSE: We assessed the impact of plasma trough concentrations of abiraterone (ABI) and its metabolite Δ4-abiraterone (D4A) and related polymorphisms on adverse events (AEs) in patients with metastatic prostate cancer who received abiraterone acetate (AA).

METHODS: This prospective study enrolled patients with advanced prostate cancer treated with AA between 2016 and 2021. Plasma trough concentrations of ABI and D4A were measured using high-performance liquid chromatography. The impact of HSD3B1 rs1047303, SRD5A2 rs523349, and cytochrome P450 family 3A member 4 rs2242480 polymorphisms on plasma concentrations of ABI and D4A and the incidence of AEs were also assessed.

RESULTS: In 68 patients treated with AA, the median ABI and D4A concentrations were 18.1 and 0.94 ng/mL, respectively. The high plasma trough concentration of ABI (≥ 20.6 ng/mL) was significantly associated with the presence of any AE and its independent risk factor based on multivariable analysis (odds ratio, 7.20; 95% confidence interval (CI): 2.20-23.49). Additionally, a high plasma trough concentration of ABI was an independent risk factor of time to withdraw AA (hazard ratio, 4.89; 95% CI: 1.66-14.38). The risk alleles of three polymorphisms were not statistically associated with the ABI and D4A concentrations and the incidence of AEs.

CONCLUSIONS: The plasma trough concentration of ABI is associated with the presence of AEs and treatment failure after AA administration. ABI concentration monitoring may be useful in patients with prostate cancer who received AA.

PMID:36378297 | DOI:10.1007/s00228-022-03420-0

Knee Surg Sports Traumatol Arthrosc. 2022 Nov 15. doi: 10.1007/s00167-022-07227-5. Online ahead of print.

ABSTRACT

PURPOSE: Given the improved accuracy of robot-assisted surgery, robotic-arm assisted functionally aligned total knee arthroplasty (RFA-TKA) aims to preserve the native pre-arthritic knee biomechanics, to achieve balanced flexion-extension gaps. The purpose of this study was to compare the accuracy of the implant position and short-term clinical outcomes of patients who underwent RFA-TKA vs. mechanically aligned total knee arthroplasty with manual technique (MA-TKA).

METHODS: A prospectively collected database was reviewed retrospectively for patients who underwent primary TKA. Sixty patients who underwent RFA-TKA between February 2020 and July 2020 were included in the RFA-TKA group. Sixty patients who underwent MA-TKA were included via 1:1 matching for age, sex, and body mass index based on the RFA-TKA group. For radiological evaluation, knee X-rays were used to assess the functional knee phenotype and implant position accuracy by measuring the coronal and sagittal alignment, and these measurements were compared between the two groups. Patient demographic characteristics and patient-reported outcomes including Knee Society scores, Western Ontario and McMaster Universities Arthritis Index, and forgotten joint score-12 were compared between the groups.

RESULTS: Statistically significant differences were observed in postoperative 2-year clinical outcomes in favor of RFA-TKA group which showed greater accuracy in the tibial component sagittal alignment than MA-TKA (1.0 ± 2.3 vs. 0.7 ± 1.6, respectively; P < 0.001). However, outliers in the component positions were more common in the MA-TKA group, which was statistically significant for the femoral coronal and tibial sagittal alignments (P = 0.017 and 0.015, respectively).

CONCLUSIONS: Functional alignment in TKA could be accurately obtained with the assistance of a robotic arm, and the results showed greater 2 year postoperative patient-reported outcome and satisfaction than mechanically aligned TKA using manual instruments.

LEVEL OF EVIDENCE: III.

PMID:36378291 | DOI:10.1007/s00167-022-07227-5

Abdom Radiol (NY). 2022 Nov 15. doi: 10.1007/s00261-022-03732-w. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to evaluate the technical and clinical success rates of transcatheter arterial embolization (TAE) for subcapsular hematoma of the liver.

METHODS: Between January 2010 and March 2022, 34 patients underwent TAE for subcapsular hematomas of the liver. The causes of subcapsular hematoma were liver tumor rupture (n = 12), trauma (n = 12), iatrogenic complications (n = 9), and spontaneous bleeding (n = 1). The technical and clinical success rates of TAE, blood test results after TAE and additional treatments were evaluated. The patients were divided into either with or without retrograde segmental or lobar portal venous flow on angiography. Technical and clinical success rates and blood test results after TAE were compared between the two groups.

RESULTS: Technical and clinical success rates were 94.1% and 73.5%, respectively. Six patients died within one month of TAE. A repeat TAE was performed in three patients. Surgical removal and hemostasis for subcapsular hematoma were done in four patients. One patient had liver failure. The retrograde portal venous flow was observed in 18 patients. The difference in technical and clinical success rates and blood test results after TAE between the two groups was statistically insignificant.

CONCLUSION: TAE is an effective and safe treatment for subcapsular hematomas of the liver. The success rates of TAE and liver damage due to TAE did not differ between patients with and without retrograde portal venous flow.

PMID:36378282 | DOI:10.1007/s00261-022-03732-w