Nevin Manimala

J Pediatr Surg. 2021 Oct 29:S0022-3468(21)00738-7. doi: 10.1016/j.jpedsurg.2021.10.027. Online ahead of print.

ABSTRACT

INTRODUCTION: Ileal pouch-anal anastomosis (IPAA) following colectomy for ulcerative colitis (UC) achieves restoration of intestinal continuity with potential return of continence. It is undertaken relatively infrequently in children. We aimed to investigate the national frequency of IPAA in paediatric UC and report outcomes useful for surgeon/centre benchmarking.

METHODS: Hospital Episode Statistics data were obtained for all admissions in England (1997-2015) in children (< 18 years) who underwent IPAA for UC using OPCS-4 procedural codes. Surgeon specialty, readmission, and reoperation rates were identified. Data are median (interquartile range).

RESULTS: UC was diagnosed in 7604 children in whom 346 (4.6%) underwent IPAA at age 15 [13-17] years. Laparoscopy was used in 55 (15.9%) cases and in the most recent 10 years more commonly by specialist paediatric surgeons (SPS) than general surgeons (GS) (34.3%vs14.7%, p = 0.001). National frequency of IPAA ranged from 12 to 34 annually. Where specialty was available, 95/342 (57%) cases were undertaken by GS and 147/342 (43%) cases by SPS. The proportion of cases undertaken by SPS increased significantly compared to GS over the study period, p = 0.0003. Post-operative length of stay was 8 [6-11] days. During the index admission, unplanned return to theatre was required in 25/346 (7.2%). Following discharge 58 (16.8%) were readmitted within 30 days. Overall return to theatre rate within 30 days of pouch surgery was 11.0% (38/346).

CONCLUSION: IPAA for UC within childhood is undertaken infrequently in England, with a shift towards SPS undertaking surgery. These data can be used by surgeons to benchmark outcomes.

LEVEL OF EVIDENCE: IV.

PMID:34865832 | DOI:10.1016/j.jpedsurg.2021.10.027

Food Res Int. 2021 Dec;150(Pt A):110711. doi: 10.1016/j.foodres.2021.110711. Epub 2021 Sep 9.

ABSTRACT

Streptococcus (S.) thermophilus, an indispensable dairy starter, has been used in autochthonous as well as industrial milk fermentation. However, the genetic architecture underlying S. thermophilus traits and phenotypes is largely unknown. Here, we sequenced 185 S. thermophilus strains, isolated from natural fermented dairy products of China and Mongolia and used comparative genomic and genome wide association study to provide novel point for genetic architecture underlying its traits and phenotypes. Genome analysis of S. thermophilus showed association of phylogeny with environmental and phenotypic features and revealed clades with high acid production potential or with substantial genome decay. A few S. thermophilus isolated from areas with high chloramphenicol emissions had a chloramphenicol-resistant gene CatB8. Most importantly, we defined a growth score and identified a missense mutation G1118698T located at the gene AcnA that were both predictive of acidification capability of S. thermophilus. Our findings provide novel insight in S. thermophilus genetic traits, antibiotic resistant and predictive of acidification capability which both may had huge help in culture starter screening.

PMID:34865746 | DOI:10.1016/j.foodres.2021.110711

J Vasc Nurs. 2021 Dec;39(4):134-139. doi: 10.1016/j.jvn.2021.09.003. Epub 2021 Oct 20.

ABSTRACT

BACKGROUND: The pain experienced after subcutaneous injections can also disturb the comfort of the individual. An individual who experiences pain may refuse treatment by experiencing anxiety for subsequent injections.

OBJECTIVE: This experimental study was conducted to compare the effects of standard injection application and manual pressure application use on injection pain and comfort level of having an subcutaneous injection.

METHODS: This study was carried out on a single sample group with pre-post design. The individuals in the sample group constituted both the control and intervention groups of the study. In the sample group, subcutaneous injection was applied to the upper outer side of the right and left arms by the same nurse by applying standard application and manual pressure, and then the pain and comfort levels were determined using the VAS and Comfort Scale.

RESULTS: It was determined that the mean pain scores of the SC injection application performed by applying manual pressure were statistically significantly lower than the SC injection application using the standard method. Again, it was determined that the mean comfort score of SC injection applied by applying manual pressure was statistically higher (p<0.05).

CONCLUSION: It has been determined that manual pressure application is a more effective method in reducing pain due to subcutaneous injection compared to the standard application. It was determined that as the pain experienced by the individuals due to subcutaneous injection application decreased, their comfort level increased. In line with these results, it is recommended that health professionals, especially nurses, use non-pharmacological methods with proven efficacy more frequently to relieve pain in SC injection, follow the developments in this field and put them into practice.

PMID:34865724 | DOI:10.1016/j.jvn.2021.09.003

J Vasc Nurs. 2021 Dec;39(4):108-113. doi: 10.1016/j.jvn.2021.07.007. Epub 2021 Aug 22.

ABSTRACT

BACKGROUND: Chronic venous disease (CVD) is a common, long-term disease that has a variety of symptoms, signs and decreases the patients’ quality of life (QoL) of the patients. The aim of this study was to evaluate QoL, symptoms, and physical activity level of CVD patients with early stages (C₁ and C₂ classes).

METHODS: The sample of this study composed of 40 patients diagnosed with CVD. The data were collected by face-to-face interview method in the cardiovascular surgery outpatient clinic. Participants were diagnosed with duplex ultrasound (DUS). A personal information form, venous insufficiency epidemiological and economic study-quality of life/symptoms (VEINS-QOL/Sym), and international physical activity questionnaire were used to assess the participants.

RESULTS: According to DUS results, 23 participants had unilateral CVD, 17 participants had bilateral CVD. Thirty-six of these limbs were stage C₂ according to CEAP, twenty one were stage C_3. The patients with CVD had low QoL and physical activity level, also moderate pain intensity. Pain, swelling, restless leg, heavy legs, night cramps, and itching were more common symptoms. There was no statistical difference between unilateral/bilateral CVD patients in QoL scores, physical activity level, and pain intensity (p˃0.05).

CONCLUSION: There was no difference between the extent and severity of the disease and QoL, physical activity level, variety of symptoms. To increase the physical activity level and to evaluate the quality of life may be important for the management of the disease from the early stages of the disease (C₁ and C₂ classes).

PMID:34865720 | DOI:10.1016/j.jvn.2021.07.007

J Dance Med Sci. 2021 Dec 5. doi: 10.12678/1089-313X.031522h. Online ahead of print.

ABSTRACT

BACKGROUND: Monitoring heart rate is one of the most common methods used to quantify internal training load (ITL) in athletes. The aim of this study was to determine whether subjective measurements can be used as a simple, non-invasive, and inexpensive method for assessing ITL in pre-professional contemporary dancers.

METHOD: A total of 16 first-year contemporary dance students participated in this study. Students wore heart rate monitors during 56 training sessions. After each session, students completed the rate of perceived exertion (RPE) scale and teachers completed the rate of observed exertion (ROE) scale. For each session, we calculated the session-RPEs (sRPE), session-ROEs (sROE), and heart-rate-derived ITLs [i.e., Banister TRaining IMPulse method (TRIMP) and Edwards TRIMP]. Pearson correlation coefficients were calculated to determine the association between sRPE, sROE, Banister TRIMP, and Edwards TRIMP.

RESULTS: Between-individual correlation between Banister TRIMP and subjective dancers’ (sRPE) and teachers’ perceptions (sROE) were moderate (r = .49, p < 0.01) to large (r = .57, p < 0.01). Between-individual correlations between Edwards TRIMP and the subjective perceptions (sRPE and sROE) were very large (r = .74, p < 0.01; and r = .79, p < 0.01). There was a statistically significant large (r = 0.52, p < 0.01) to almost perfect (r = 0.93, p < 0.01) within-individual correlation between the sRPE and the two measured TRIMP methods. There was a statistically significant small (r = .29, p < 0.01) to almost perfect (r = .92, p < 0.01) within-individual correlation between the sROE and the two measured TRIMP methods.

CONCLUSION: The results of this study suggest that the sRPE is a simple, non-invasive, inexpensive, and valid method for quantifying ITL in pre-professional dancers.

PMID:34865682 | DOI:10.12678/1089-313X.031522h

BJPsych Open. 2021 Dec 6;8(1):e7. doi: 10.1192/bjo.2021.1064.

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) has had a disproportionate impact on people with intellectual disability (PwID). PwID are at higher risk of mental illness and receive psychotropic prescribing ‘off licence’ also, to manage distress behaviour. The lockdown and reduction of multidisciplinary face-to-face appointments had an impact on care delivery, the recourse possibly being psychotropic prescribing. It is imperative to comprehend the influence the pandemic had on psychotropic prescribing patterns to enable future planning.

AIMS: The aim was to understand the impact of the pandemic by comparing psychotropic prescribing patterns during the England lockdown with the prescribing patterns before lockdown in specialist urban and rural psychiatric services for PwID.

METHOD: Data was collected from Cornwall (rural) and London (urban) intellectual disability services in England as a service evaluation project to rationalise psychotropic prescribing. PwID in both services open across January 2020 to January 2021 were included. Baseline patient demographics including age, gender, ethnicity, intellectual disability level and neurodevelopmental and psychological comorbidities were collected. Baseline psychotropic prescribing and subsequent % change for each psychotropic group for the two services was compared using Pearson’s chi-square and z-statistic (two tailed) with significance taken at P < 0.05.

RESULTS: The two centres London (n = 113) and Cornwall (n = 97) were largely comparable but for baseline differences in terms of presence of severe mental illness (37 v. 86, P < 0.001), challenging behaviour (44 v. 57, P < 0.05) and attention-deficit hyperactivity disorder (37 v. 3, P < 0.001). There was an overall increase in psychotropic prescribing during lockdown in urban as compared with rural settings (11% v. 2%).

CONCLUSIONS: The pandemic caused an increase in psychotropic prescribing associated with lockdown severity and urban settings. Team structures could have played a role.

PMID:34865678 | DOI:10.1192/bjo.2021.1064

Br J Nutr. 2021 Dec 6:1-25. doi: 10.1017/S0007114521004840. Online ahead of print.

ABSTRACT

This research evaluates the prevalence of inadequate folate status in early pregnancy, the pattern of prenatal folic acid (FA) supplementation and associated factors in Spanish pregnant women from the ECLIPSES study, which included 791 participants prior gestational week 12. A cross-sectional evaluation of red blood cell (RBC) folate levels was performed at recruitment and used to calculate the prevalence of folate deficiency (RBC folate<340 nmol/L) and insufficiency (RBC folate<906 nmol/L). Sociodemographic and lifestyle data, as well as information on prenatal FA supplementation were recorded. Descriptive and multivariate statistical analyses were performed. The prevalence of folate deficiency and insufficiency were 9.6% and 86.5%, respectively. Most of women used prenatal FA supplements but only 6.3% did so as recommended. Supplementation with FA during the periconceptional period abolished folate deficiency and reduced folate insufficiency. Prenatal folic acid supplementation with ≥1000 µg/d in periconceptional time and pregnancy planning increased RBC folate levels. The main risk factor for folate insufficiency in early pregnancy were getting prenatal FA supplementation out of the periconceptional time (OR 3.32, 95%CI 1.02-15.36), while for folate deficiency they were young age (OR 2.02, 95%CI 1.05-3.99), and smoking (OR 2.39, 95%CI 1.30-4.37). In addition, social and ethnic differences according to folate status were also identified. As conclusion, periconceptional FA use is crucial for achieving optimal folate levels in early pregnancy. Pregnancy planning should focus on young women, smokers, those with low consumption of folate-rich foods, low socioeconomic status or from ethnic minorities.

PMID:34865663 | DOI:10.1017/S0007114521004840

J Pharm Health Care Sci. 2021 Dec 6;7(1):44. doi: 10.1186/s40780-021-00228-5.

ABSTRACT

BACKGROUND: Human immune deficiency virus (HIV) increases the susceptibility to primary infection or reinfection and the risk of tuberculosis (TB) reactivation for patients with latent TB. There was no current report on the rate of active TB infection among HIV-1 infected patients in our teaching and referral hospital. Therefore, this study was aimed to determine the prevalence and factors associated with active TB infection among HIV-1 infected patients.

METHODS: Hospital-based retrospective cross-sectional study was conducted at the Anti-Retroviral Therapy (ART) chronic follow-up clinic. Systematic random sampling was used to include the patients. A structured questionnaire was used to collect data. Data were analyzed using SPSS version 25. Descriptive statistics were used to describe the findings and multivariate logistic regression was performed to identify factors associated with active TB infection.

RESULT: 150 HIV-1 infected patients (female 54.7%) were included. The median (interquartile range, IQR) age of the patients was 33.5 (25.7, 40.0) years. Twenty-six (17.3%) of the patients had developed active TB infection, which was independently associated with the WHO clinical stage III and IV (AOR: 9.67, 95% confidence interval (CI); 2.21-42.37), p = 0.003). The use of isoniazid preventive therapy (IPT) (AOR: 0.123, 95CI; 0.034-0.44, p = 0.001) and having good adherence to ART medications (AOR: 0.076, 95CI; 0.007-0.80, p = 0.032) was associated with the reduced risk of active TB infection among HIV-1 infected patients.

CONCLUSIONS: Advanced WHO clinical stages increased the risk of active TB infection, while the use of IPT and good adherence to ART medications reduced the risk of active TB infection. Therefore, patients with advanced WHO clinical stage should be screened for TB infection, and starting IPT for the candidate patients should be strengthened to reduce the burden of active TB incidence. ART medication adherence should also be supported.

PMID:34865659 | DOI:10.1186/s40780-021-00228-5

Zhen Ci Yan Jiu. 2021 Nov 25;46(11):914-20. doi: 10.13702/j.1000-0607.201141.

ABSTRACT

OBJECTIVE: To observe the effect of electroacupuncture (EA) of “Shuigou” (GV26) on the activities of sonic hedgehog(Shh) signaling molecules (Shh, Ptch, Smo，Gli and Gli2) in ischemic brain tissues in rats with cerebral ischemia (CI), so as to explore its mechanisms underlying improvement of CI.

METHODS: Male Wistar rats were randomly divided into blank control group(n=10), sham operation group (n=90), model group(n=90) and EA group (n=90). The CI model was established by occlusion of the right middle cerebral artery (MCAO). According to the postoperative time points of MCAO, the later three groups were further divided into 1, 3, 6, 9, 12 and 24 h, and 3, 7 and 12 d subgroups, with 10 rats in each subgroup. EA (15 Hz, 2 mA) was applied to GV26 for 20 min. The 1 h to 24 h subgroups were treated immediately after modeling, the 3-12 d subgroups treated one time a day. The neurological severity score (NSS, 0 to 18 points) was used to evaluate the rats’ neurological function, and TTC staining was employed to assess the cerebral ischemic volume (percentage of cerebral infarct volume, CIV). Western blot was employed to detect the expression of Shh, Ptch, Smo, Gli1 and Gli2 proteins in the ischemic cerebral tissue.

RESULTS: Compared with the sham operation group, the NSS scores of the model group increased at all time points (P<0.01). The percentages of CIV of the model group from 3 h to 12 d were obviously higher than those of the sham operation group (P<0.01). The NSS scores at 3, 7 and 12 d and the percentages of CIV at 1, 3, 7 and 12 d after MCAO were significant lower in the EA group than in the model group (P<0.05). The protein expression levels of Shh from 12 h to 12 d (i.e. 12 h, 24 h, 3, 7 and 12 d), Ptch from 6 h to 12 d, Smo from 9 h to 12 d, Gli1 at 9 h, 12 h, and from 3 d to 12 d, Gli2 at 6, 9 and 12 h, and 3 d were significantly higher in the model group than in the sham operation group (P<0.05, P<0.01), while those of Shh at 3, 7 and 12 d, Ptch from 24 h to 7 d, Smo from 12 h to 7 d, Gli1 from 24 h to 7 d, Gli2 at 12 h, 3 and 7 d were significantly higher in the EA group than in the model group (P<0.05, P<0.01). No statistical significances were found between the sham operation and the blank control groups in all the indexes mentioned above (P>0.05).

CONCLUSION: EA of GV26 can improve neurological function and reduce infarct volume in MCAO rats, which may be related to its function in up-regulating the activities of Shh signaling pathway in the ischemic cerebral tissues.

PMID:34865327 | DOI:10.13702/j.1000-0607.201141

BJOG. 2021 Dec 5. doi: 10.1111/1471-0528.17041. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate quality of life (QoL) and association with surgical complexity and disease burden after surgical resection for advanced ovarian cancer in centres with variation in surgical approach DESIGN: Prospective multicentre observational study SETTING: United Kingdom, Kolkata, India, and Melbourne, Australia gynaecological cancer surgery centres.

PARTICIPANTS: Patients undergoing surgical resection for late stage ovarian cancer. Exposure Low, intermediate or high Surgical Complexity Score (SCS) surgery MAIN OUTCOMES AND MEASURES: Primary: EORTC-QLQ-C30 Global score change. Secondary: EORTC OV28, progression free survival.

RESULTS: Patients’ pre-operative disease burden and SCS varied between centres, confirming differences in surgical ethos. QoL response rates were 90% up to 18 months. Mean change from the pre-surgical baseline in the EORTC QLQ-C30 was 3.4 (SD 1.8, n=88) in the low, 4.0 (SD 2.1, n=55) in the intermediate and 4.3 (SD 2.1, n=52) in the high SCS group after 6 weeks (p=0.048) and 4.3 (SD 2.1, n=51), 5.1 (SD 2.2, n=41) and 5.1 (SD 2.2, n=35) respectively after 12 months (p=0.133). In a repeated measures model, there were no clinically or statistically meaningful differences in EORTC QLQ-C30 global scores between the three SCS groups, p= 0.840 but there was a small statistically significant improvement in all groups over time (p<0.001). The high SCS group experienced small to moderate decreases in physical (p=0.004), role (p=0.016) and emotional (p=0.001) function at 6 weeks post-surgery which resolved by 6-12 months.

CONCLUSIONS AND RELEVANCE: Global QoL of patients undergoing low, intermediate, and high SCS surgery improved at 12 months post operation and was no worse in patients undergoing extensive surgery.

PMID:34865316 | DOI:10.1111/1471-0528.17041