Nevin Manimala

Am J Rhinol Allergy. 2022 Nov 13:19458924221139019. doi: 10.1177/19458924221139019. Online ahead of print.

ABSTRACT

BACKGROUND: Caudal pneumatization of the pterygoid process may impact endonasal exposure of the lateral recess of sphenoid sinus (LRSS).

OBJECTIVES: This study aims to explore the implications of a pneumatized pterygoid process for an endonasal transpterygoid approach to the LRSS and to define strategies regarding the preservation or sacrifice of the vidian nerve.

METHODS: Dissection of the LRSS (11 sides) was performed on 6 cadaveric specimens, preselected for the radiographic presence of an LRSS. In addition, the dimensions of the LRSS were measured on the deidentified CT images of 120 patients (240 sides). The sphenoid sinus was subdivided into 3 categories: Type 1 (no identifiable LRSS), Type 2 (lateral pneumatization of the greater wing above the vidian canal), and Type 3 (pneumatization of both the greater wing and the pterygoid process).

RESULTS: On the cadaveric specimens, a Type 2 pneumatization often allowed access to the LRSS above the level of the vidian canal; thus, sparing the vidian neurovascular bundle. In Type 3 pneumatization, a frontal corridor through the pterygoid base could be created to reach the LRSS with preservation of the vidian nerve. Extreme Type 3 pneumatization, however, required the transposition or sacrifice of the vidian nerve to facilitate a full direct access to the superolateral LRSS. Measurements on CT images revealed that the extent of caudal pneumatization of the pterygoid process had no statistically significant correlation with the superolateral extension of the lateral recess in patients with Type 3 LRSS (P > .05).

CONCLUSION: Pneumatization of the LRSS toward a caudal or superolateral direction may develop independent from each other. Caudal pneumatization of the pterygoid process seems to variably impact the endonasal exposure of the LRSS.

PMID:36373591 | DOI:10.1177/19458924221139019

Am J Rhinol Allergy. 2022 Nov 13:19458924221137982. doi: 10.1177/19458924221137982. Online ahead of print.

ABSTRACT

BACKGROUND: Nasal adhesions (NAs) are a known complication of nasal airway surgery. Even minor NAs can lead to significant postoperative nasal airway obstruction (NAO). Division of such NAs often provides much greater relief than anticipated.

OBJECTIVE: We examine the impact of NAs at various anatomical sites on nasal airflow and mucosal cooling using computational fluid dynamics (CFD) and multiple test subjects.

METHODS: CT scans of healthy adult subjects were used to construct three-dimensional nasal airway computational models. A single virtual 2.5 mm diameter NA was placed at one of five sites commonly seen following NAO surgery within each nasal cavity bilaterally, resulting in 10 NA models and 1 NA-free control for each subject. CFD analysis was performed on each NA model and compared with the subject’s NA-free control model.

RESULTS: 4 subjects were recruited to create 44 computational models. The NAs caused the airflow streamlines to separate, leading to a statistically significant increase in mucosal temperature immediately downstream to the NAs (wake region). Changes in the mucosal temperature in the wake region of the NAs were most prominent in anteriorly located NAs with a mean increase of 1.62 °C for the anterior inferior turbinate NAs (P < .001) and 0.63 °C for the internal valve NAs (P < .001).

CONCLUSION: NAs result in marked disruption to airflow patterns and reduced mucosal cooling on critical surfaces, particularly in the wake region. Reduced wake region mucosal cooling may be a contributing factor to the exaggerated perception of nasal obstruction experienced by patients with NAs.

PMID:36373577 | DOI:10.1177/19458924221137982

Clin Infect Dis. 2022 Nov 14:ciac892. doi: 10.1093/cid/ciac892. Online ahead of print.

ABSTRACT

BACKGROUND: Cytomegalovirus (CMV) infection is associated with increased mortality in PWH. It is less clear whether CMV infection is still associated with mortality when routinely screened and adequately treated.

METHODS: This retrospective cohort study recruited 1003 hospitalized HIV-infected adults with CD4 cell counts of less than 200 cells/μL from 2017-2021. Blood CMV DNA was routinely measured and CMV DNAemia was treated if end-organ disease occurred. CMV viral load was categorized into below the limit of quantification (BLQ; < 500 IU/mL), low viral load (LVL; 500-10000 IU/mL), and high viral load (HVL; ≥ 10000 IU/mL) groups. We compared the 182-day all-cause mortalities among different groups.

RESULTS: The median CD4 cell count of the patients was 33 cells/μL (IQR, 13-84). The prevalence of CMV DNAemia was 39.8% (95%CI, 36.7%-42.9%) and was significantly associated with CD4 cell count. The 182-day all-cause mortality was 9.9% (95%CI, 8.0%-11.7%). Univariable analysis showed that, compared to BLQ, LVL and HVL were associated with 1.73-fold and 3.81-fold increased risks of mortality, respectively (P = 0.032 and P < 0.001). After adjustment for pre-defined confounding factors, HVL but not LVL was still associated increased risk of mortality (adjusted hazard ratio 2.63; 95%CI, 1.61-4.29; P < 0.001). However, for patients on effective anti-retroviral therapy, the impact of HVL on 182-day mortality was not statistically significant (P = 0.713).

CONCLUSIONS: High CMV viral load in hospitalized PWH was associated with higher mortality, even when early identified by screening. Optimalization of the management for those patients needs to be explored in future studies.

PMID:36373575 | DOI:10.1093/cid/ciac892

Asian Cardiovasc Thorac Ann. 2022 Nov 13:2184923221138505. doi: 10.1177/02184923221138505. Online ahead of print.

ABSTRACT

INTRODUCTION: An abdominal aortic aneurysm (AAA) is a life-threatening abnormal dilation of the abdominal aorta that can be repaired either endovascularly or with open surgery. However, endovascular aortic repair (EVAR) has become the main treatment modality for AAA due to its more optimal results. EVAR devices can either be standard, fenestrated, or branched, with fenestrated EVAR (FEVAR) seemingly achieving superior prospects. Although EVAR is associated with excellent outcomes, it still carries a risk of certain complications requiring reintervention or ‘rescue’. Several commercial EVAR devices are available on the global market, nevertheless, the Fenestrated Anaconda developed by Terumo Aortic can be considered the superior device due to the wide range of endovascular solutions that it offers along with its unique custom-made approach, excellent results and its highly promising potential to be used as a ‘rescue’ device for failed competitor endografts.

MATERIALS AND METHODS: The current study represents a 9-year cross-sectional international analysis of a custom-made Fenestrated Anaconda™ device. For the statistical analysis, SPSS 28 for Windows and R were utilised. Pearson Chi-square analysis was used to assess differences in cumulative distribution frequencies between select variables. Statistical significance for all two-tailed tests was set at p < 0.05.

RESULTS: Out of 5058 EVARs performed using the Fenestrated Anaconda, 2987 (59%) were ‘rescue’ procedures for migrated Gore (n = 252) and Medtronic (n = 2735) devices. The Fenestrated Anaconda™ was indicated as the reintervention device either due to unsuitable/complex anatomy for the competitor (n = 2411) or based on surgeon preference (n = 576). Overall, the Fenestrated Anaconda was utilised to rescue 3466 (68.5%) failed previous EVARs using competitor devices. Yet, the primary endovascular solution offered by the Fenestrated Anaconda was FEVAR (91.3%), with 112 (2.2%) devices using custom-made iliac stents.

DISCUSSION: The use of the Fenestrated Anaconda endograft as a ‘rescue’ device to salvage failed competitor devices is well-established in the literature with excellent clinical outcomes achieved. The evidence in the literature also highlights the distinctive custom-made approach that the Fenestrated Anaconda offers which enables it to treat extremely complex aortic anatomy.

PMID:36373569 | DOI:10.1177/02184923221138505

Circ Heart Fail. 2022 Nov 14:e009772. doi: 10.1161/CIRCHEARTFAILURE.122.009772. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with cancer (patients with a history of cancer) with advanced heart failure are increasing, but unlikely to be transplanted, and left ventricular assist device (LVAD) is an alternative strategy. This study investigates the characteristics and outcomes of patients with cancer undergoing durable LVAD.

METHODS: Adult patients with a history of cancer who received LVADs were identified from INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) registry: 2008 and 2017. Characteristics and outcomes between patients with cancer and those without cancer were compared, and subgroup analyses of cancer therapy-induced cardiomyopathy (CCM) and non-CCM were also conducted.

RESULTS: Overall, 1273 (6.5%) patients had a history of cancer, including 289 (22.7%) with CCM and 984 (77.3%) with non-CCM as the primary reason for heart failure. Patients with cancer had shorter median survival (3.72 versus 3.97 years, log-rank P=0.002), and multivariable Cox and competing risk regressions revealed that a history of cancer was associated with reduced survival (hazard ratio, 1.14 [95% CI, 1.04-1.26]; P=0.005; subdistribution hazard ratio, 1.24 [95% CI, 1.13-1.36]; P<0.001) and decreased incidence of heart transplantation. There was no significant difference in mortality between patients with CCM-induced heart failure and patients without cancer. Patients with cancer experienced an increased risk of bleeding, and age, INTERMACS profile, albumin, dialysis, and blood urea nitrogen were associated with mortality in these patients.

CONCLUSIONS: A history of cancer is associated with mildly reduced survival, lower incidence of heart transplantation, and increased risk of bleeding after LVAD, whereas the survival in patients with cancer with CCM-induced heart failure is similar to those without cancer. LVAD implantation in patients with cancer is very well possible.

PMID:36373549 | DOI:10.1161/CIRCHEARTFAILURE.122.009772

Foot Ankle Int. 2022 Nov 14:10711007221128562. doi: 10.1177/10711007221128562. Online ahead of print.

ABSTRACT

BACKGROUND: Isolated Weber B, AO (Association for the Study of Internal Fixation) type 44B ankle fractures with no fracture to the medial side are the most common type of ankle fracture and may be treated with internal fixation or without surgery.This study aimed to determine if surgery is superior to nonsurgical management for the treatment of these fractures after a minimum 5-year follow-up.

METHODS: Design: A pragmatic, multicenter, single-masked, randomized controlled trial with minimum 5-year follow-up. Setting/participants/interventions: Participants between 18 and 65 years with AO type 44B ankle fracture and minimal talar shift were recruited from 22 hospitals in Australia and New Zealand. Participants willing to be randomized were randomly allocated to undergo surgical fixation followed by mobilization in a walking boot for 6 weeks. Those treated nonsurgically were managed in a walking boot for 6 weeks. Outcome assessors were masked for the treatment allocation. Primary outcomes: Patient-reported ankle function using the American Academy of Orthopaedic Surgeons Foot and Ankle Outcomes Questionnaire (FAOQ) and the physical component summary (PCS) of the SF-12v2 General Health Survey at 12 months postinjury and at minimum 5 years post injury. Primary analysis was intention-to-treat.

RESULTS: Of the 160 (80 surgical, 80 nonoperative) randomized patients included in the CROSSBAT analysis, 77 (40 surgical, 37 nonoperative) were followed up for repeat analysis at minimum 5-year follow-up (mean 7.3 years, range 5.1-8.9). This cohort demonstrated that surgery was not associated with clinically or statistically significant differences compared to nonoperative management for the FAOQ (51.7 vs 49.6; mean difference 2.1, 95% CI -2.1 to 6.2, P = .95), or the PCS (51.5 vs 49.1; mean difference 2.3, 95% CI -2.0 to 6.7, P = .54). The surgical cohort had a higher rate of any adverse events (odds ratio 3.7, 95% CI 1.2-11.6, P = .04).

CONCLUSION: The results of this study suggest that surgical management is not superior to nonsurgical management in type B ankle (fibula) fractures with minimal talar shift over a 5-year period and is associated with increased adverse events.

LEVEL OF EVIDENCE: Level II, randomized clinical trial.

PMID:36373545 | DOI:10.1177/10711007221128562

J Microsc. 2022 Nov 14. doi: 10.1111/jmi.13152. Online ahead of print.

ABSTRACT

Optical coherence tomography (OCT) has shown to be a valuable imaging tool in the field of ophthalmology, and it is becoming increasingly relevant in the field of neurology. Several OCT image segmentation methods have been developed previously to segment retinal images, however sophisticated speckle noises with low-intensity restrictions, complex retinal tissues, and inaccurate retinal layer structure remain a challenge to perform effective retinal segmentation. Hence, in this research, complicated speckle noises are removed by using a novel Far-flung ratio algorithm in which pre-processing has been done to treat the speckle noise thereby highly decreasing the speckle noise through new similarity and statistical measures. Additionally, a novel haphazard walk and inter-frame flattening algorithms have been presented to tackle the weak object boundaries in OCT images. These algorithms are effective at detecting edges and estimating minimal weighted paths to better diverge, which reduces the time complexity. In addition, the segmentation of OCT images is made simpler by using a novel N-ret layer segmentation approach that executes simultaneous segmentation of various surfaces, ensures unambiguous segmentation across neighboring layers, and improves segmentation accuracy by using two grey scale values to construct data. Consequently, the novel work outperformed the OCT image segmentation with 98.5% of accuracy. This article is protected by copyright. All rights reserved.

PMID:36373509 | DOI:10.1111/jmi.13152

ANZ J Surg. 2022 Nov 14. doi: 10.1111/ans.18146. Online ahead of print.

ABSTRACT

BACKGROUND: Native skin flap necrosis is a potentially devastating complication following skin-sparing or nipple-sparing mastectomy with a reported incidence of as high as 30%. Treatment depends on the depth and extent of tissue necrosis and can range from dressings to surgical debridement and further reconstruction. This can have implications on patient physical and psychological wellbeing as well as cost of treatment. This study aims to identify and appraise cost-effective non-surgical adjuncts for the prevention of native skin flap necrosis.

METHODS: A systematic review was performed using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement and structured around existing recommended guidelines. A search of MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature and ClinicalTrials.gov was performed with the medical subject headings ‘mastectomy’ and ‘flap necrosis’. After exclusion, 12 articles were selected for review and analysed.

RESULTS: A total of 8439 mastectomies were performed on 7895 patients. Preventative non-surgical adjuncts that demonstrated statistically significant reduction in mastectomy flap necrosis included topical nitroglycerin ointment (P = 0.000), closed-Incision negative pressure wound therapy (P = 0.000), topical dimethylsulfoxide ointment (P = 0.03), oral cilostazol (P = 0.032), and local heat pre-conditioning (P = 0.047).

CONCLUSIONS: This study identifies multiple adjuncts that may aid in preventing mastectomy skin flap necrosis, especially in high-risk patients. Further studies could aim to define standardized protocols and compare the various adjuncts in different circumstances.

PMID:36373495 | DOI:10.1111/ans.18146

Nurs Open. 2022 Nov 14. doi: 10.1002/nop2.1472. Online ahead of print.

ABSTRACT

AIM: The aim of this study was to determine the digital detox programme’s impact on the electronic screen syndrome among preparatory school students.

DESIGN: A quasi-experimental pre- and posttest group was used.

METHODS: Two preparatory governmental schools.

SAMPLE: purposive sample consists of 105 students.

TOOLS: Two tools used for data collection: Student’s datasheet and Electronic Screen Addiction Scale. The data collection period took six months, from September 2021 to February 2022.

RESULTS: The high rate of screen addiction among students dropped to 14.3% in the posttest compared with 20.0% in the pre-test. Moreover, the students’ proportion with moderate screen addiction dropped from 65.7% on the pre-test to 43.8% on the posttest. Furthermore, screen addiction students with lower levels were about 41.9% in the posttest and 14.3% in the pre-test.

CONCLUSIONS: There was a highly statistically significant difference between school students’ total electronic screen scores in the pre- and posttest. A preventive care programme is recommended for high school children and helps raise screen addiction’s awareness and its negative consequences.

PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

PMID:36373487 | DOI:10.1002/nop2.1472

Emerg Microbes Infect. 2022 Nov 14:1-73. doi: 10.1080/22221751.2022.2146535. Online ahead of print.

ABSTRACT

How much the vaccine contributes to the induction and development of neutralizing antibodies (NAbs) of breakthrough cases relative to those unvaccinated-infected cases is not fully understood. We conducted a prospective cohort study and collected serum samples from 576 individuals who were diagnosed with SARS-CoV-2 Delta strain infection, including 245 breakthrough cases and 331 unvaccinated-infected cases. NAbs were analyzed by live virus microneutralization test and transformation of NAb titer. NAbs titers against SARS-CoV-2 ancestral and Delta variant in breakthrough cases were 7.8-fold and 4.0-fold higher than in unvaccinated-infected cases, respectively. NAbs titers in breakthrough cases peaked at the second week after onset/infection. However, the NAbs titers in the unvaccinated-infected cases reached their highest levels during the third week. Compared to those with higher levels of NAbs, those with lower levels of NAbs had no difference in viral clearance duration time (P>0.05), did exhibit higher viral load at the beginning of infection/maximum viral load of infection. NAb levels were statistically higher in the moderate cases than in the mild cases (P<0.0001). Notably, in breakthrough cases, NAb levels were highest longer than 4 months after vaccination (Delta strain: 53118.2 U/mL), and lowest in breakthrough cases shorter than 1 month (Delta strain: 7551.2 U/mL). Cross-neutralization against the ancestral strain and the current circulating isolate (Omicron BA.5) was significantly lower than against the Delta variant in both breakthrough cases and unvaccinated-infected cases. Our study demonstrated that vaccination could induce immune responses more rapidly and greater which could be effective in controlling SARS-CoV-2.

PMID:36373485 | DOI:10.1080/22221751.2022.2146535