Nevin Manimala

J Foot Ankle Surg. 2022 Dec 17:S1067-2516(22)00353-2. doi: 10.1053/j.jfas.2022.12.001. Online ahead of print.

ABSTRACT

Regarding the treatment of ankle arthritis, the choice of arthroscopic ankle arthrodesis (AAA) or open ankle arthrodesis (OAA) remains controversial. To guide clinical decision-making, we conducted a meta-analysis on the optimal treatment of ankle arthrodesis. We identified eligible studies published from June 1, 1969 to June 1, 2020 using the Cochrane Library, PubMed, OVID, Embase, and Medline searched the references of relevant studies. Randomized and non-randomized studies that compared outcomes of AAA and OAA were included. After the methodologic assessment, available data were extracted and statistically reviewed. The primary outcomes were overall complications rate, tourniquet time, length of the hospital stay, non-union rate, and rate to fusion. The secondary outcomes were delayed union and postoperative infection rate. We included 9 studies comparing arthroscopic and open in patients with ankle arthrodesis, comprising 467 participants. AAA had the advantage of demonstrating a lower overall complication rate (odds ratio [OR], 0.44 [95% confidence interval [CI], 0.26-0.73]; p = .002), shorter intraoperative tourniquet time (mean difference [MD], -16.49 [95% CI, -23.51 to -9.46]; p < .001), shorter length of the hospital stay (MD -1.75, 95% CI -1.94 to -1.2, p < .001),lower non-union rate (OR, -0.07 [95% CI, -0.13 to -0.02]; p <.01) and higher rate to fusion (OR, 4.2 [95% CI, 1.96-8.99]; p < .001) in comparison with OAA. Yet, no significant differences were found in delayed union (OR, 0.46 [95% CI, 0.10-2.04]; p = .30) and postoperative infection rate (OR, 0.45 [95% CI, 0.17-1.15]; p = .09) between the groups. Our results suggest that arthroscopic ankle arthrodesis is superior to open ankle arthrodesis alone in the treatment of ankle arthritis based on the overall complication rate, intraoperative tourniquet time, length of the hospital stay, non-union rate and rate to fusion. However, further high-quality randomized controlled trials with appropriate blinding methods are needed to confirm the findings.

PMID:36588066 | DOI:10.1053/j.jfas.2022.12.001

Auris Nasus Larynx. 2022 Dec 30:S0385-8146(22)00231-0. doi: 10.1016/j.anl.2022.12.003. Online ahead of print.

ABSTRACT

OBJECTIVES: Olfactory neuroblastoma (ONB), also known as esthesioneuroblastoma, is a rare malignant neoplasm of the nasal vault and anterior skull base. The results of treatment for ONB are relatively good; however, regional and distant metastases can develop several years after definitive treatment. This study aimed to validate the treatment modality of ONB for oncological outcomes, especially for regional recurrence.

METHODS: We retrospectively reviewed the medical records of 22 patients diagnosed with ONB at Kyoto University Hospital between 2009 and 2020. Descriptive statistics were calculated, and Kaplan-Meier curves were used.

RESULTS: The median follow-up time was 58.2 months. One (4.5%) patient was clinically node positive, (cN+) and the remaining 21 (95.5%) were clinically node negative (cN0) at presentation. Eighteen patients underwent an endoscopic endonasal approach (EEA) for primary resection, and the remaining four patients underwent a combined EEA and transcranial approach. Elective neck dissection was not performed for 21 patients with cN0 ONB, whereas unilateral neck dissection with removal of ipsilateral lateral retropharyngeal node was performed for one patient with cN+ ONB. Postoperative radiotherapy without concurrent chemotherapy was performed only at the primary tumor bed for 21 patients with cN0 ONB, and at the primary tumor bed and bilateral neck for one patient with cN+ ONB. The 5-year overall, disease-specific, and disease-free survival rates were 94.1%, 100%, and 69.6%, respectively. No patients developed local recurrence, but 6 (27.2%) patients experienced recurrence with a median time to recurrence of 36.4 months, including four and two patients who initially developed regional recurrences and bone metastases, respectively. Five (22.7%) patients had delayed neck recurrence. The salvage rate was only 60.0% in the five patients who had delayed neck recurrence. Regarding the level of delayed neck recurrence, 4 (18.2%) patients had lateral retropharyngeal lymph node metastases.

CONCLUSION: Patients with ONB have excellent survival outcomes after endoscopic surgical resection of the primary lesion with postoperative radiotherapy only to the primary tumor bed. Despite excellent survival, delayed neck recurrence, including the lateral retropharyngeal lymph node, remains high. Because salvage surgery for lateral retropharyngeal lymph node recurrence is sometimes technically difficult, it may be better to extend the field of postoperative radiotherapy from the primary tumor bed only to include bilateral lateral retropharyngeal lymph node regions in patients with clinically N0 ONB. Further prospective studies with a large number of patients are needed to determine the extent of postoperative radiotherapy.

PMID:36588056 | DOI:10.1016/j.anl.2022.12.003

Nurs Outlook. 2022 Dec 30:101905. doi: 10.1016/j.outlook.2022.12.001. Online ahead of print.

ABSTRACT

BACKGROUND: Medicare billing codes introduced in 2015 reimburses primary care providers for non-face-to-face, chronic care management (CCM) services rendered by clinical staff.

PURPOSE: The purpose of this manuscript was to describe provider trends in billed CCM services and identify factors associated with CCM utilization.

METHODS: Observational study using Medicare Public Use Files, 2015 to 2018. General, family, geriatric, and internal medicine physicians, nurse practitioners (NPs), and physician assistants (PAs) with billed primary care services were included. Multivariable analyses modeled associations between the CCM services and type of provider, adjusting for year, primary care services, practice, and patient characteristics.

FINDINGS: Among 140,465 physicians and 141,118 NPs/PAs, CCM services increased each year, yet remained underutilized: 2% to 7% of physicians and 0.3% to 1.3% of NPs/PAs billed CCM in 2018. Increases in beneficiaries (p < .0001), percentage of dually enrolled (p = .0134), and primary care services (p < .0001) predicted higher CCM utilization.

DISCUSSION: CCM utilization reflects practice-based efforts to improve patient access to care by enhancing care delivery.

PMID:36588042 | DOI:10.1016/j.outlook.2022.12.001

Eur Urol Focus. 2022 Dec 30:S2405-4569(22)00294-2. doi: 10.1016/j.euf.2022.12.010. Online ahead of print.

NO ABSTRACT

PMID:36588010 | DOI:10.1016/j.euf.2022.12.010

J Oral Maxillofac Surg. 2022 Dec 29:S0278-2391(22)01105-3. doi: 10.1016/j.joms.2022.12.008. Online ahead of print.

ABSTRACT

PURPOSE: A recently proposed modification of the sagittal split osteotomy (SSO) of the mandible places the horizontal medial cut ‘low and short’ of the lingula. The purpose of the study was to answer the following clinical question: “Among patients undergoing mandibular setback procedures (≤ 8 mm) via SSO, does the placement of the medial horizontal osteotomy below the lingula (infralingular), when compared to placement above the lingula (supralingular), results in different neurosensory, bite force, and range of motion outcomes?”

MATERIALS AND METHODS: This was a single-center, double-blind, parallel-group study among patients undergoing mandibular setback by SSO (≤ 8 mm), between January 2021 and September 2022. Patients were randomly allocated in a ratio of 1:1 to the supralingular (control) and the infralingular (study) group. Primary outcome variables included neurosensory disturbance of the inferior alveolar nerve based on clinical neurosensory testing and severity graded using Zuniga and Essick’s protocol, bite force, and maximum mouth opening evaluated postoperatively during the first week (T1), first month (T2), and third month (T3) of follow-up. Secondary outcome measures included the incidence of a bad split and distal segment interferences intraoperatively. Association between the variables was assessed using Pearson chi-squared test or Fisher’s exact test based on the expected observations. A P value of ≤.05 was considered statistically significant.

RESULTS: A total of 29 patients (58 osteotomies) were included in the study. Group 1 consisted of 15 patients (9 females and 6 males) with a mean age of 26.4 years. Group 2 consisted of 14 patients (8 females and 6 males) with a mean age of 25.9 years. Patients with severe neurosensory disturbance of the inferior alveolar nerve were more common in group 2 (n = 15, 53.6%) than group 1 (n = 4, 13.3%) at T1 (P value = .0001) and insignificant between the two groups at T2 (P value = .63) and T3 (P value = .99). Comparison of maximum mouth opening between the two groups at T1 (P value = .535), T2 (P value = .934), and T3 (P value = .703) and bite force at T1 (P = .324), T2 (P = .113), and T3 (P = .811) was not significant.

CONCLUSION: Both SSO techniques have similar clinical outcomes among patients having mandibular setbacks (≤ 8 mm) for the variables studied.

PMID:36587932 | DOI:10.1016/j.joms.2022.12.008

J Oral Maxillofac Surg. 2022 Dec 29:S0278-2391(22)01104-1. doi: 10.1016/j.joms.2022.12.007. Online ahead of print.

ABSTRACT

PURPOSE: Facial trauma requiring operative care increases during the summer and fall months, which is colloquially referred to as “trauma season.” The purpose of this study is to determine if there is a quantifiable and statistically significant yearly periodicity of operative facial trauma volume.

MATERIALS AND METHODS: To confirm the existence and quantify the magnitude of trauma season, we conducted a retrospective cohort study. The Plastic Surgery divisional billing database was queried for Current Procedural Terminology (CPT) codes related to acute facial trauma. The outcome variable is monthly CPT code volume and calendar month is the predictor. Monthly CPT volume was tabulated for 120 consecutive months. Raw data were plotted as a time series and transformed as a ratio to the moving average. Autocorrelation was applied to the transformed dataset to detect yearly periodicity. Multivariable modeling quantified the proportion of volume variability (R²) attributable to yearly periodicity. Subanalysis assessed presence and strength of periodicity in 4 age groups. Patient identifiers, demographic information, surgeon, and date of surgery were collected as covariates.

RESULTS: One thousand six hundred fifty eight CPT codes obtained through Plastic Surgery billing records were included. Mean age at presentation was 32.5 ± 16.3 years (range = 85.05). Monthly trauma-related CPT volume was highest in June-September and lowest in December-February. Time series analysis revealed yearly oscillation, in addition to a growth trend. Autocorrelation revealed statistically significant positive and negative peaks at a lag of 12 and 6 months, respectively, confirming the presence of yearly periodicity. Multivariable linear modeling revealed R² attributable to periodicity of 0.23 (P = .008). Periodicity was strongest in younger populations and weaker in older populations. R² = 0.25 for ages 0-17 years, R² = 0.18 for ages 18-44 years, R² = 0.16 for ages 45-64 years, and R² = 0.034 for ages ≥ 65 years.

CONCLUSION: Operative facial trauma volumes peak in the summer and early fall and reach a winter nadir. This periodicity is statistically significant and accounts for 23% of overall trauma volume variability at our Level 1 trauma hospital. Younger patients drive the majority of this effect. Our findings have implications for operative block time and personnel allocation, in addition to expectation management over the course of the year.

PMID:36587931 | DOI:10.1016/j.joms.2022.12.007

Braz J Infect Dis. 2022 Dec 30:102734. doi: 10.1016/j.bjid.2022.102734. Online ahead of print.

ABSTRACT

BACKGROUND: Human Papillomavirus (HPV) is the main etiological factor for the development of cervical cancer. HPV 18 is the second most frequent type, accounting for up to 65% of all cases. HPV intratypic variation may influence the potential for progression to invasive cancer. The aim of this study was to evaluate the prevalence of human papillomavirus 18 intratypic variants in cervical cancer samples from women in the state of Maranhão, Brazil.

METHODS: The study included 118 women over 18 years of age with a diagnosis of cervical cancer. Tumor fragments were collected and subjected to DNA extraction and Polymerase Chain Reaction (PCR) for HPV detection using the PGMY09/11 and GP+5/6 primers. Positive samples were submitted to automated sequencing for viral genotyping. To determine the HPV 18 lineages, positive samples were submitted to PCR, using specific primers to amplify the LCR and E6 regions of HPV 18 virus.

RESULTS: HPV was present in 88 women (73.3%). Of those, 48 (54%) were HPV 16, the most prevalent, followed by 12 (13.6%) HPV 18. Histologically, squamous cell carcinoma was predominant (79.1%). Among the HPV 18 variants identified, 10 (80%) belonged to lineage A, and sublineages A1, A2, A3, and A4. Two (29%) HPV 18 B variant was also detected, with the sublineages B1 and B2. In this study, the C variant was not found. There was no statistically significant association between the HPV 18 lineages found and sociodemographic and lifestyle variables (p > 0.05).

CONCLUSIONS: A higher frequency of HPV 16 and 18 were found in women with cervical cancer in the state of Maranhão, Brazil, with a high prevalence of the lineage A among women with HPV 18.

PMID:36587927 | DOI:10.1016/j.bjid.2022.102734

Chemosphere. 2022 Dec 29:137702. doi: 10.1016/j.chemosphere.2022.137702. Online ahead of print.

ABSTRACT

This study aims to investigate the spatiotemporal trends and impact of COVID-19 lockdowns to the profile of physiochemical parameters in the influent of wastewater treatment plants (WWTPs) around Brisbane, Australia. One 24-hr composite influent sample was collected from 10 WWTPs and analyzed for a range of physiochemical parameters per week (i.e., chemical oxygen demand (COD), total organic carbon (TOC), total nitrogen (TN), total phosphorus (TP), ammonia, volatile suspended solid (VSS)) and per month (i.e., Ni and Cr) from 2012 to 2020, including the period of COVID-19 lockdowns in the region. The catchments studied were urban, with a mix of domestic and industrial activities contributing towards the contaminant profile. Statistical analysis identified that industrial and commercial land use, as well as population size had a large impact to the parameter loads and profile. Per capita mass loads of Cr in one catchment were 100 times higher than in others from one industrial point source. TP demonstrated a potential monotonic decrease over time due to practical reduction policies that have been implemented for phosphorous content in household detergents, except for one catchment where trade waste from food manufacturing industries contributed to an overall increase of 6.9%/year TP. The COVID-19 lockdown (March-April 2020) posed different impact on different catchments, either decrease (7-61%) or increase (2-40%) of most parameter loads (e.g., COD, TOC, TN, TP, VSS, Ammonia), which was likely driven by catchment characteristics (i.e., the proportion of residential, commercial, and industrial land uses). This study enhances our understanding of spatiotemporal trend of contaminants in the catchments for further effective source control.

PMID:36587913 | DOI:10.1016/j.chemosphere.2022.137702

J Affect Disord. 2022 Dec 29:S0165-0327(22)01423-9. doi: 10.1016/j.jad.2022.12.063. Online ahead of print.

ABSTRACT

OBJECTIVES: Despite growing emphasis on the benefits of physical activity for promoting mental health, inclusion of muscle-strengthening (MS) (e.g., body-weight exercises, resistance machines) activities is limited. Notably, few studies collectively assess MS behavioural frequency, duration, and intensity. To address the gap, the current study examined associations between frequency (days), intensity (rating of perceived exertion in relation to repetitions in reserve [RPE/RIR]), and duration (minutes per typical session) of MS activities on anxiety, depression, and mental well-being.

METHOD: A cross-sectional study of 601 participants (Mean age = 30.92 years [SD = 12.70]; 57.7 % female) across Ireland was conducted. Participants completed a self-report questionnaire containing MS instruments previously used, or adapted from valid and reliable measures (i.e., International Physical Activity Questionnaire IPAQ, RPE/RIR), alongside, the Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-8 (PHQ-8) and the Mental Health Continuum- Short Form (MHC-SF). A multivariate regression model was tested in MPLUS, using dummy coding for MS frequency in relation to no activity (i.e., 0-days) non-adherence (i.e., 1-day), adherence (i.e., 2-days) and enhanced adherence (i.e., ≥3 days) to the MS public health guidelines, with the mental health variables representing the dependent variables. Intensity and duration were specified in the model as continuous variables; gender and age were included as statistical controls.

RESULTS: Three or more days engaged in MS activities was associated with fewer anxiety (β = -0.12, p < .05) and depression (β = -0.14, p < .01) symptoms. Increased intensity had a negative association with anxiety (β = -0.10, p < .05) and depression (β = -0.15, p < .001). Unexpectedly, adherence to the MS guidelines (2-days) did not predict any of the mental health outcomes, whereas 1-day of MS activity was associated with fewer depression symptoms (β = -0.11). No effects were observed for mental well-being, and MS duration exerted a null effect across all mental health outcomes.

CONCLUSION: Higher frequency and intensity of MS activities may protect against anxiety and depression symptoms. Doing some MS activities (at least 1-day) is likely more beneficial than none for depression. Evidence-based, MS interventions may help curb mental illness rates, and future longitudinal, intervention-based research could consider inclusion of MS frequency, intensity and duration variables to enhance efforts to identify at-risk groups and trends within physical activity and mental illness surveillance.

PMID:36587908 | DOI:10.1016/j.jad.2022.12.063

J Affect Disord. 2022 Dec 29:S0165-0327(22)01501-4. doi: 10.1016/j.jad.2022.12.140. Online ahead of print.

ABSTRACT

BACKGROUND: Alcohol use disorder (AUD) is exceedingly common among individuals with bipolar disorder and schizophrenia. However, studies on alcohol use in psychiatric illness rely largely on population surveys with limited representation of severe mental illness (SMI); schizophrenia, bipolar disorder.

METHODS: Using data from the Genomic Psychiatry Cohort (GPC) (Pato MT, 2013), associations of bipolar disorder and schizophrenia with alcohol use problems were examined in a diverse US based sample, considering the influence of self-described race (African Ancestry (AA), European Ancestry (EA), or Latinx Ancestry (LA)), sex, and tobacco use. Participants answered alcohol use problem items derived from the CAGE instrument, yielding a summed “probable” alcohol use disorder (pAUD) risk score.

RESULTS: This study included 1952 individuals with bipolar disorder with psychosis (BDwP), 409 with bipolar disorder without psychosis (BD), 9218 with schizophrenia (SCZ), and 10,416 unaffected individuals. We found that SMI (BDwP, BD, SCZ) was associated with elevated AUD risk scores (B = 0.223, p < 0.001), an association which was strongest in females, particularly those of AA and LA, and in tobacco users. Schizophrenia was associated with the greatest increase in pAUD score (B = 0.141, p < 0.001). pAUD risk scores were increased among participants with bipolar disorder, with greater increases in BDwP (B = 0.125, p < 0.001) than in BD without psychosis (B = 0.027, p < 0.001).

LIMITATIONS: Limitations include reliance on self-report data, screening items for AUD, voluntary recruitment bias, and differences in race/sex distribution between groups, which were statistically adjusted for in analytic models.

CONCLUSIONS: SMI is associated with risk for AUD, particularly among females from racial minority groups, smokers, and those with psychotic disorders.

PMID:36587907 | DOI:10.1016/j.jad.2022.12.140