Nevin Manimala

Surg Laparosc Endosc Percutan Tech. 2022 Jul 6. doi: 10.1097/SLE.0000000000001071. Online ahead of print.

ABSTRACT

BACKGROUND: Although many studies have investigated control of postoperative pain, inadequacy of treatment still remains. In this study, we aimed to identify a method with the capacity to minimize abdominal and right shoulder pain after laparoscopic cholecystectomy.

MATERIALS AND METHODS: A total of 684 subjects, 77% (n=527) female and 23% (n=157) male, were included in this study. A T-drain was prescribed for patients requiring bile duct exploration and patients with acute cholecystitis were excluded from the study. Subjects were classified into groups as follows: Group 1: control group without drain and intraperitoneal analgesics; Group 2: a drain was placed but no intraperitoneal analgesic was applied; Group 3: no drain was placed and intraperitoneal subhepatic bupivacaine was applied; and Group 4: drain was placed and intraperitoneal subhepatic bupivacaine was applied. Parietal pain and visceral pain were evaluated with visual analog scale (VAS).

RESULTS: A drain was present in 51.9% (n=355) of the cases. A statistically significant difference was found between the preoperative pulse rate measurements of the cases according to the groups (P=0.009; <0.01). Subhepatic bupivacaine was administered in 50.1% (n=355) of the cases. A statistically significant difference was found between the second, fourth, sixth, 12th, and 24th hour VAS scores of the cases according to the groups [2 h VAS scores (mean±SD): Group 1: 3.58±1.07, Group 2: 3.86±1.12, Group 3: 1.20±0.67, and Group 4: 1.50±1.21 (P<0.001)]; [4 h VAS scores (mean±SD): Group 1: 2.55±1.26, Group 2: 2.87±1.14, Group 3: 1.66±1.06, and Group 4: 2.02±1.23 (P<0.001)]; [6 h VAS scores (mean±SD): Group 1: 2.50±0.91, Group 2: 2.53±1.14, Group 3: 1.66±1.06, and Group 4: 2.02±1.23 (P<0.001)]; [12 h VAS scores (mean±SD): Group 1: 3.24±1.2, Group 2: 3.49±1.14, Group 3: 2.83±0.98, and Group 4 : 2.99±1.36 (P<0.001)]; and [24 h VAS scores (mean±SD): Group 1: 3.75±0.99, Group 2: 4.01±0.91, Group 3: 3.61±1.34, and Group 4: 4.01±1.08 (P<0.001)].

CONCLUSION: Bupivacaine spraying reduces postoperative abdominal pain, while drain placement minimizes shoulder pain by reducing CO2 remaining under the diaphragm.

PMID:35797664 | DOI:10.1097/SLE.0000000000001071

J Thorac Imaging. 2022 Jun 17. doi: 10.1097/RTI.0000000000000660. Online ahead of print.

ABSTRACT

PURPOSE: Chest tube placement and subsequent removal is a routine step in patient management after cardiovascular surgery. The purpose of this retrospective study is to determine the necessity of routine chest radiography following chest tube removal in order to detect potential complications in pediatric patients after cardiovascular surgery.

MATERIALS AND METHODS: We retrospectively reviewed the hospital records of all consecutive children up to 5 years of age who had cardiovascular surgery at our hospital between January 2015 and December 2020. Two radiologists independently evaluated routine chest radiographs performed 4 hours following chest tube removal for the presence of potential complications. In all post chest tube removal chest radiographs that demonstrated a complication, the patient’s medical record was investigated in order to determine if there was an associated clinical or laboratory test abnormality, and if the radiographically detected complication led to a change in patient management. Inter-rater agreement between the 2 reviewers was evaluated with κ statistics.

RESULTS: We identified 147 children (73 [49.7%] male and 74 [50.3%] female; mean age=13.8 mo old; range 0 to 60 mo) who met the inclusion criteria. Complications were detected on routine chest radiograph after chest tube removal in 10 patients (6.8%) including pneumothorax (n=5, 3.4%), pleural effusion (n=3, 2%), pneumomediastinum (n=1, 0.7%), and pneumopericardium (n=1, 0.7%). No clinical or laboratory abnormalities were present in all children affected with radiographically detected complications on routine chest radiograph 4 hours after chest tube removal, and there was no need for intervention in any affected patients. There was high inter-rater κ agreement between the 2 independent reviewers for detecting complications on chest radiographs after chest tube removal (κ=0.94).

CONCLUSION: Our study shows that routine chest radiograph performed shortly after chest tube removal may not be necessary for the safe management of asymptomatic children after cardiovascular surgery because complications are rare and do not require intervention. In addition, obviating performance of this routine chest radiograph following chest tube removal will lead to a substantial decrease in exposure to unnecessary ionizing radiation in children who undergo frequent radiographs and lower medical costs.

PMID:35797657 | DOI:10.1097/RTI.0000000000000660

Spine (Phila Pa 1976). 2022 Jul 1. doi: 10.1097/BRS.0000000000004392. Online ahead of print.

ABSTRACT

STUDY DESIGN: This was a single-center prospective randomized controlled study.

OBJECTIVE: To compare the efficacy of endoscopic facet joint denervation with that of the percutaneous technique in terms of pain, functional disability, and quality of life in patients with low back pain.

SUMMARY OF BACKGROUND DATA: Different controlled studies in patients with low back pain have shown short-term benefits from percutaneous facet joint denervation. Observational studies have demonstrated that endoscopic facet joint denervation may be more effective. As the superiority of the endoscopic technique has not been clearly demonstrated in previous studies, a prospective randomized controlled study was conducted.

METHODS: For this study, 40 patients with low back pain lasting more than 6 months duration and at least 50% pain reduction on the visual analog scale (VAS) after medial branch block under fluoroscopy, were assigned randomly to receive percutaneous or endoscopic facet joint denervation. The primary outcome was pain, as indicated by Visual Analog Scale (VAS). Secondary outcomes were functional disability, as assessed by the Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RDQ), and quality of life, as assessed by the Short Form Health Survey (SF-36).

RESULTS: After the intervention, the pain level decreased significantly in both groups (P<0.001); however, the effect was still significant in the endoscopic group and diminished to lower than the statistical significance in the percutaneous group after 12 months. The ODI and RDQ scores also improved significantly in both groups (P<0.001). However, the ODI and RDQ were significantly better (P<0.001) in the endoscopic group after 12 months. In the SF-36, we observed significant improvement in both groups 3 months after the intervention. The effect decreased after six months in the percutaneous group and was predominantly not demonstrable after 12 months, whereas in the endoscopic group there was still a strong significant improvement on all scales (P<0.001) after 12 months.

CONCLUSION: Percutaneous and endoscopic facet joint denervation reduced pain and improved functionality and quality of life. However, the effects decreased or disappeared in the percutaneous group after 12 months, whereas there was still a strong significant improvement in the endoscopic group.

PMID:35797653 | DOI:10.1097/BRS.0000000000004392

Surg Laparosc Endosc Percutan Tech. 2022 Jul 1. doi: 10.1097/SLE.0000000000001068. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess titanium clip-dental floss traction-assisting endoscopy in patients with difficulty in cannulation into the papilla located at the lower, left or right side of the periampullary diverticulum.

MATERIALS AND METHODS: Sixty-eight patients who had difficulty in cannulation into the papilla located at the lower, left, or right side of the periampullary diverticulum upon endoscopic retrograde cholangiopancreatography (ERCP) were recruited at Taizhou Hospital from July 2016 to June 2020. A random number table was used to divide the patients into an intervention (with titanium clip-dental floss traction) group and a control group (n=34 in each group). Patients in both groups underwent ERCP. The cannulation time, cannulation success rate, incidence of postprocedural complications after ERCP, hospitalization time, and hospitalization expenses in the 2 groups were compared.

RESULT: The cannulation time was 15.3±4.1 minutes in the intervention group, which was less than that in the control group (25.7±6.5 min). The cannulation success rate was 77±12.1% in the intervention group, which was higher than that in the control group (43±16.7%). Postprocedural complications occurred in 2 patients in the intervention group and 6 patients in the control group, with no significant differences. The hospitalization time and expenses were 3.8±2.6 days and 11.1±6 thousand yuan in the intervention group, respectively, and 6.1±3.7 days and 18.2±8 thousand yuan in the control group, respectively. The differences were statistically significant (P<0.05).

CONCLUSION: Titanium clip-dental floss traction-assisting endoscopy achieved excellent efficacy in patients with difficulty in cannulation into the papilla located at the lower, left or right side of the periampullary diverticulum. The cannulation success rate was improved after treatment, with good safety and prognosis.

PMID:35797640 | DOI:10.1097/SLE.0000000000001068

J Thorac Imaging. 2022 Jul 8. doi: 10.1097/RTI.0000000000000666. Online ahead of print.

ABSTRACT

PURPOSE: Previous studies have shown positive effects of intensive low-density lipoprotein (LDL)-lowering therapy on atheroma volume using invasive intravascular ultrasound. This study describes the changes in coronary plaque composition on coronary computed tomography angiography in patients treated with proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors.

MATERIALS AND METHODS: In this prospective study, coronary plaques were analyzed using third-generation dual-source computed tomography before and after 1 year of PCSK9-inhibitor treatment. Plaque markers included total plaque volume (TPV), calcified plaque volume (CPV), noncalcified plaque volume (NCPV), lumen volume and vessel volume (VV), minimal luminal area (MLA), minimal lumen diameter (MLD), corrected coronary opacification, eccentricity, remodeling index, and functional plaque parameters. Primary endpoint was defined as change in TPV; the secondary endpoint was TPV or CPV regression or nominal change in plaque parameters.

RESULTS: We analyzed 74 coronary plaques in 23 patients (60±9 y, 65% male). After 1 year of PCSK9-inhibitor treatment, LDL was reduced from 148 to 66 mg/dL (P<0.0001). Significant changes were found for VV (196 to 215 mm3, P=0.0340), MLA (3.1 to 2.6 mm2, P=0.0413), and MLD (1.7 to 1.4 mm, P=0.0048). TPV, CPV, NCPV, lumen volume, and functional plaque parameters did not change significantly (P>0.05).

CONCLUSIONS: Coronary artery plaque analysis by coronary computed tomography angiography highlights that LDL lowering therapy affects plaque composition. The primary endpoint of TPV change was not reached; however, VV, MLA, and MLD changed significantly.

PMID:35797638 | DOI:10.1097/RTI.0000000000000666

J Thorac Imaging. 2022 Jun 22. doi: 10.1097/RTI.0000000000000664. Online ahead of print.

ABSTRACT

PURPOSE: Computed tomography pulmonary angiography (CT-PA) is frequently used in the diagnostic workup of pulmonary embolism (PE), even in highly radiosensitive patient populations. This study aims to assess CT-PA with reduced z-axis coverage (compared with a standard scan range covering the entire lung) for its sensitivity for detecting PE and its potential to reduce the radiation dose.

MATERIALS AND METHODS: We retrospectively analyzed 602 consecutive CT-PA scans with definite or possible PE reported. A reduced scan range was defined based on the topogram, where the cranial slice was set at the top of the aortic arch and the caudal slice at the top of the lower hemidiaphragm. Locations of emboli in relation to the reduced scan range were recorded.

RESULTS: We included 513 CT-PA scans with definite acute PE in statistical analysis. Patients’ median age was 66 (52 to 77) years, 46% were female. Median dose length product was 270.8 (111.3 to 503.9) mGy*cm. Comparing the original and reduced scan ranges, the mean scan length was significantly reduced by 48.0±8.6% (26.8±3.0 vs. 13.9±2.6 cm, P<0.001). Single emboli outside the reduced range in addition to emboli within were found in 15 scans (2.9%), while only 1 scan (0.2%) had an embolus outside the reduced range and none within it. The resulting sensitivity of CT-PA with reduced scan range was 99.81% (95% confidence interval: 98.74%-99.99%) for detecting any PE.

CONCLUSION: A reduced scan length in CT-PA, as defined above, would substantially decrease radiation dose while maintaining diagnostic accuracy for detecting PE.

PMID:35797627 | DOI:10.1097/RTI.0000000000000664

J Patient Saf. 2022 Jul 6. doi: 10.1097/PTS.0000000000001058. Online ahead of print.

ABSTRACT

BACKGROUND: Social distancing has been recommended by the Centers for Disease Control and Prevention to avoid exposure to SARS-CoV-2 (Epidemiol Prev 2020;44:353-362).Cancer patients on or after active therapy seem to be more prone to COVID being symptomatic and life-threatening. When evaluating cancer patients’ risk of acquiring COVID, it is essential to know the behavior of cancer patients that will affect their risk of exposure. However, it is not known to what degree social distancing is practiced by cancer patients compared with noncancer patients and what factors lead to the decision to distance oneself.

METHOD: After a pilot phase using patients’ MyChart messaging, links to the electronic questionnaires were texted to patients using Twillio. Responses were stored on REDCap (Vanderbilt University, Nashville, TN). Six questions about their social distancing behavior and mask wearing were posed and responses were compared between cancer and noncancer patients. Demographics, comorbidities, and a questionnaire about anxiety (Generalized Anxiety Disorder 7-item scale) were recorded. To assess differences between cancer and noncancer groups, Bonferroni-corrected χ2 tests and proportions confidence intervals were used.

RESULTS: The pilot survey was sent in mid-2020 and the full survey followed in January 2021 during a high community COVID incidence. Three hundred eighty-seven cancer patients (32.4% responded) and 503 noncancer patients (22.9% responded) completed the survey. Questions about leaving their houses, driving, shopping, friends, and family indicated that patients with cancer are more cautious (P < 0.001). Cancer patients were up to 20% more likely to distance themselves. No difference was seen in wearing a mask-both groups wore approximately 90% of the time. Most respondents were female (63% versus 71%). Cancer patients were older (>60 y, 69% versus 45%) and less likely to work (52% versus 31%) or less likely to be White collar workers (21% versus 38%). In both groups, 54% marked “not at all anxious.”

CONCLUSIONS: Cancer patients’ responses revealed a distancing behavior that would likely lower the risk exposure to SARS-CoV-2. It is unclear which of the demographic differences would account for this behavior, although remarkably anxiety was not a clear motivating factor. The high acceptance of masks is encouraging. Early publications during the pandemic and patient education suggesting a higher COVID risk for cancer patients may have reduced risk prone behavior. Considering COVID’s impact on the vulnerable cancer population and uncertainty in immunosuppressed patients about clearing the virus or adequately responding to a vaccine, further studies about health behavior and health promotion during the pandemic are needed.

PMID:35797588 | DOI:10.1097/PTS.0000000000001058

Psychosom Med. 2022 Jun 28. doi: 10.1097/PSY.0000000000001099. Online ahead of print.

ABSTRACT

OBJECTIVES: Prior studies have suggested reciprocal relationships between cognitive function and adiposity, but this has not been investigated with population representative datasets. The purpose of this study was to examine the association between cognitive function and adiposity in a large population-based sample of middle-aged and older adults. It was hypothesized that better scores on tests of cognitive function would be associated with lower adiposity and this association would be primarily mediated through lifestyle behavior and physical health status.

METHODS: Using data from the Canadian Longitudinal Study on Aging (N = 30,097), we tested our hypotheses using three indicators of cognitive function (animal fluency, Stroop interference, and men reaction time) and four indicators of adiposity (body mass index [BMI], total fat mass, waist circumference and waist-hip ratio). Hierarchical multivariable linear regression modeling was conducted followed by tests for moderation by socioeconomic status and mediation through diet, physical activity, hypertension and diabetes status.

RESULTS: All measures of cognitive indicators were significantly associated with adiposity after adjusting for confounders. In general, superior performance on animal fluency, Stroop and reaction time tasks were associated with lower adiposity by most metrics. Stroop interference was associated with lower adiposity across all metrics, including BMI (b = 0.04, 95% CI 0.06, 0.01), total fat mass (b = 19.35, 95% CI 8.57, 30.12), waist circumference (b = 33.83, 95% CI 10.08, 57.58), and waist-hip ratio (b = 0.13,95% CI 0.01, 0.24). These associations were more substantial for moderate- and high-income sub-populations. Mediational analyses suggested that the above effects were mediated through lifestyle behavior (e.g., diet and physical activity) and physical health conditions (e.g., diabetes and diet).

CONCLUSIONS: Reliable associations exist between cognitive function and adiposity in middle-aged and older adults. The associations appear to be mediated through lifestyle behavior and physical health conditions.

PMID:35797581 | DOI:10.1097/PSY.0000000000001099

J Pediatr Gastroenterol Nutr. 2022 Jul 6. doi: 10.1097/MPG.0000000000003552. Online ahead of print.

ABSTRACT

AIM: To compare presenting symptoms, comorbidities, disease, and treatment characteristics of a black pediatric eosinophilic esophagitis (EoE) group to a non-black pediatric EoE group.

METHODS: A retrospective chart review consisting of pediatric patients diagnosed with EoE between the years of 2010 and 2018 at a single urban pediatric hospital system comprising 143 black pediatric patients compared with 142 non-black pediatric patients with similar distribution of age and sex.

RESULTS: Both groups were majority male and the median age of diagnosis between the black and non-black group was 5.1 and 6.7 years-old, respectively. Comorbidities more commonly seen in the black group included food allergies, atopic dermatitis, asthma, and allergic rhinitis. Black patients were more likely to present with failure to thrive (FTT)/poor growth whereas non-black patients were more likely to present with abdominal pain. There was no statistically significant difference between the groups in achieving remission using current therapies. The black group had higher rates of non-adherence to medical therapies.

CONCLUSION: This is the largest study to date comparing a black versus non-black pediatric EoE population. The black population had more atopic comorbidities and failure to thrive at presentation and had significantly more issues with non-adherence. This new knowledge describing EoE in a minority population will hopefully improve awareness, diagnosis, and management of EoE in this population.

PMID:35797567 | DOI:10.1097/MPG.0000000000003552

Wounds. 2022 Apr;34(4):E34-E36.

ABSTRACT

OBJECTIVE: This is the second of 3 planned articles reporting on a prospective, multicenter, randomized controlled trial assessing the efficacy of fish skin graft in the management of diabetic foot ulcers in comparison with the standard of care (collagen alginate dressing).

MATERIALS AND METHODS: The primary end point of this prospective randomized trial is the number of closed wounds at 12 weeks.

RESULTS: As of the time of this writing, 94 patients had completed the protocol. At 12-week follow-up, healing was achieved in 63.0% of index ulcers (29 of 46 patients) in the acellular fish skin graft group compared with 31.3% in the control group (15 of 48 patients) (P =.0036). In both groups, the mean time to healing was 7 weeks. The median number of applications of the fish skin graft to achieve healing was 6.

CONCLUSION: A clinically and statistically significant difference in healing was observed between patients treated with acellular fish skin graft and those treated with a collagen alginate dressing. The data support the completion of this prospective randomized trial.

PMID:35797557