Nevin Manimala

Am J Perinatol. 2021 Nov 30. doi: 10.1055/a-1709-5036. Online ahead of print.

ABSTRACT

OBJECTIVE: ABO incompatibility is a common cause of neonatal indirect hyperbilirubinemia. The direct antiglobulin test (DAT) can identify infants developing hemolytic disease. This study aims to evaluate the significance of DAT positivity among neonates with ABO incompatibility.

STUDY DESIGN: This retrospective study included 820 neonates with blood group A or B who were born to blood group O mothers. The study group consisted of neonates (n = 79) who had positive DAT, and the control group consisted of infants (n = 741) who had negative DAT. Demographic and clinical data of the neonates regarding jaundice were collected and compared statistically.

RESULTS: The bilirubin level at 24 hours of life (study group 8 ± 2.6 mg/dl, control group 6 ± 2.2 mg/dl, p < 0.001) and the highest bilirubin level (study group 12.7 ± 3.6 mg/dl, control group 10.4 ± 4.2 mg/dl, p < 0.001) were higher in infants with positive DAT. In the study group 37 (46.8%) infants and in the control group 83 (11.2%) infants received PT in the nursery (p < 0.001). In neonates with positive DAT; direct bilirubin level, duration of hospitalization, and PT in the nursery were higher (p = 0.002, p < 0.001, and p < 0.001), whereas hemoglobin level was lower (p < 0.001).

CONCLUSION: In neonates with ABO incompatibility, a positive DAT is a risk factor for developing significant hyperbilirubinemia. Close follow-up of newborn infants with ABO incompatibility is crucial for early detection and treatment of neonatal jaundice to avoid early and late complications.

PMID:34847590 | DOI:10.1055/a-1709-5036

J Am Acad Audiol. 2021 Jul;32(7):464-468. doi: 10.1055/s-0041-1730960. Epub 2021 Nov 30.

ABSTRACT

BACKGROUND: Some viral infections can cause congenital or acquired unilateral or bilateral hearing loss. It is predicted that the coronavirus disease 2019 (COVID-19) virus, which can affect many systems in the body, may also have a negative effect on hearing.

PURPOSE: This study evaluated the effects of COVID-19 infection on pure-tone average.

RESEARCH DESIGN: A case-control study.

MATERIALS AND METHODS: A total of 104 volunteers (48 control, 56 experimental group) who applied to the ENT clinic of Adıyaman University Training and Research Hospital were included in this study. After the detailed clinical examination and medical history, 13 volunteers of the experimental group and 5 volunteers from the control group were excluded from the study. In this way, each group consisted of 43 volunteers. While the experimental group consisted of patients who did not have any hearing problems before but had COVID-19. The control group consisted of healthy volunteers who did not have any hearing problems and were not infected with COVİD-19. Audiological test was applied to all volunteers to determine their pure-tone average. On the data obtained, it was analyzed whether COVID-19 affects the pure-tone average and how it changes according to variables such as age and gender.

RESULTS: The evaluation of the 43 (50.0%) COVID-19-positive patients and 43 (50.0%) healthy controls showed no significant differences (p > 0.05) at 250 and 500 Hz, whereas at 4000, 6000, and 8000 Hz, the two groups differed significantly. In addition, significant differences were found in the left and right ears at 1000 and 2000 Hz (p < 0.05). The differences between the two groups in the pure-tone average of the left and right ear were statistically significant (p < 0.05). However, there were no significant sex-based differences in the pure-tone average between males and females (p > 0.05) CONCLUSION: The pure-tone average of COVID-19 positive patients was significantly worse than those of the healthy control group. Thus, COVID-19 should also be considered in patients presenting with unexplained hearing loss. Further studies should investigate the effects of COVID-19 on hearing and the underlying pathophysiology.

PMID:34847586 | DOI:10.1055/s-0041-1730960

J Am Acad Audiol. 2021 Jul;32(7):405-419. doi: 10.1055/s-0041-1728771. Epub 2021 Nov 30.

ABSTRACT

BACKGROUND: Self-reported hearing aid outcomes among older adults are variable and important to improve. The extent of the role of auditory processing in long-term hearing aid outcomes is not well understood.

PURPOSE: To determine how auditory processing abilities are related to self-reported hearing aid satisfaction and benefit along with either aided audibility alone or exploratory factors suggested by previous literature.

RESEARCH DESIGN: Descriptive analyses and multiple regression analyses of cross-sectional self-reported outcomes.

STUDY SAMPLE: Adult participants, >60 years (n = 78), fitted with bilateral hearing aids to treat symmetric, mild to moderate sensorineural hearing loss.

DATA COLLECTION AND ANALYSIS: Participants were recruited from a single audiology clinic to complete a series of questionnaires, behavioral assessments, and obtain data from their hearing aids, including real ear measures and data logging of hearing aid use. Multiple linear regressions were used to determine the amount of variance explained by predictive factors in self-reported hearing aid satisfaction and benefit. The primary predictive factors included gap detection threshold, spatial advantage score, dichotic difference score, and aided audibility. Exploratory factors included personality, self-efficacy, self-report of disability, and hearing aid use. All interpretations of statistical significance used p < 0.05. Effect sizes were determined using Cohen’s f ² with a medium effect suggesting clinical relevance.

RESULTS: Gap detection threshold was a statistically significant predictor in both primary regression models with a medium effect size for satisfaction and a small effect size for benefit. When additional exploratory factors were included in the regression models with auditory processing abilities, gap detection and self-efficacy were both significant predictors of hearing aid satisfaction with medium effect sizes, explaining 10 and 17% of the variance, respectively. There were no medium effect sizes found for other predictor variables in either the primary or exploratory hearing aid benefit models. Additional factors were statistically significant in the models, explaining a small amount of variance, but did not meet the medium effect size criterion.

CONCLUSION: This study provides initial evidence supporting the incorporation of measures of gap detection ability and hearing aid self-efficacy into clinical practice for the interpretation of postfitting long-term hearing aid satisfaction.

PMID:34847582 | DOI:10.1055/s-0041-1728771

Eur J Pediatr Surg. 2021 Nov 30. doi: 10.1055/s-0041-1739424. Online ahead of print.

ABSTRACT

INTRODUCTION: Sacrospinal anomalies that may accompany anorectal malformations may cause fecal and urinary incontinence despite proper anomaly treatment. The sacral ratio has been suggested in the determination of both the prognosis in terms of incontinence and the need for further examination for sacrospinal anomalies. The normal and clinically decisive values of sacral ratio are given differently in publications. We aimed to determine the distribution of the sacral ratio in children under 12 months and to develop the sacral ratio percentile card that will enable one to give an age-independent parametric result in clinical evaluations.

MATERIALS AND METHODS: The files of patients under 1 year of age who had anteroposterior direct radiography including pelvis were reviewed retrospectively. Sacral ratio was studied for 360 patients, 30 patients per month. Percentile card was developed with LMS software and reference values were used as 1, 2, 3, 4, and 10%.

RESULTS: The lowest sacral ratio value was 0.514 and the highest value was 0.936. There was no statistical difference between the mean sacral ratio of the cases when they were classified on a monthly basis (p = 0.191). Low percentile values were found slightly different at first 4 months of age.

CONCLUSION: Although the mean of sacral ratio does not change significantly during the first year of life, values that are considered pathological for patients are within different percentile limits depending on age. Instead of using sacral ratio with some clinically decisive values, we think that parametric evaluation with the help of the percentile card will increase its clinical value.

PMID:34847576 | DOI:10.1055/s-0041-1739424

Drug Alcohol Depend. 2021 Nov 17;230:109180. doi: 10.1016/j.drugalcdep.2021.109180. Online ahead of print.

ABSTRACT

BACKGROUND: Our goal was to describe specific patterns associated with co-prescriptions of gabapentin, opioids, and benzodiazepines among disabled Medicare beneficiaries.

METHODS: Using 2013-2015 Medicare data, we conducted a retrospective cohort study among fee-for-service disabled beneficiaries continuously enrolled in Medicare Parts A, B, and D. The index date was defined as the earliest fill date for a gabapentin, opioid, or benzodiazepine prescription. Monotherapy, dual therapy, and tri-therapy were defined as utilization of one, two, and three medication classes, respectively. Augmentation was defined as a prescription for a different medication class in addition to prescription for initial medication; switching referred to a change in prescription for a different medication class with no subsequent fills of initial medication. We used descriptive statistics, Kaplan Meier analyses and Cox proportional hazards to examine the association between initial therapy and monotherapy, dual therapy, tri-therapy, switching and augmentation.

RESULTS: Among 151,552 disabled beneficiaries, gabapentin initiators were more likely to augment therapy (50.1%) when compared to opioid (28.7%) and benzodiazepine (38.7%) users. When compared to opioid initiators, the risk of augmentation (HR[95%CI]: 1.85[1.82-1.89]) and switching (1.62 [1.51-1.73]) was significantly higher among gabapentin initiators. Risk of augmentation was also significantly higher among beneficiaries with co-morbid pain and mental health conditions (p < 0.01). Overall, the majority of beneficiaries augmented and switched within 2-months and 4-months after initiating therapy, respectively.

CONCLUSIONS: Given safety concerns associated with gabapentin, opioids, and benzodiazepines, it is imperative that the benefits and risks of co-prescribing these medications be examined comprehensively, especially for those in vulnerable sub-groups.

PMID:34847506 | DOI:10.1016/j.drugalcdep.2021.109180

J Clin Anesth. 2021 Nov 27;77:110596. doi: 10.1016/j.jclinane.2021.110596. Online ahead of print.

ABSTRACT

STUDY OBJECTIVE: To develop individualized dynamic predictions for the occurrence of acute kidney injury (AKI) during the first postoperative week after cardiac surgery.

DESIGN: Observational retrospective cohort study.

SETTING: Single university teaching hospital in Madrid, Spain.

PATIENTS: 3960 cases of major cardiac surgery performed from January 2002 to December 2013.

MEASUREMENTS: Baseline demographic and clinical characteristics, intraoperative risk factors, and repeated postoperative estimated glomerular filtration rates (eGFR). The primary outcome was AKI during the first postoperative week (stage 1 or higher of the Acute Kidney Injury Network). The dataset was split in two random samples (exploratory and validation). By combining time-to-event outcomes (AKI), and longitudinal data (repeated postoperative eGFR), we developed two different joint models for patients with normal and high baseline levels of serum creatinine (sCr).

MAIN RESULTS: AKI occurred in 1105 patients (31%, 95% confidence interval [CI] 29.5-32.5) in the exploratory sample and 128 (32.2%, 95% CI 27.6-36.8) in the validation sample. For high baseline sCr patients, the risk of an AKI event was associated with the eGFR trajectory (hazard ratio [HR] 0.91, 95% CI 0.90-0.92), as well as with age, and cardiopulmonary bypass time. The normal baseline sCr model incorporated the same covariates and intraoperative transfusion. In this second model, the risk of an AKI event was associated with both the eGFR trajectory (HR 0.91, 95% CI 0.91-0.92, for the current value of eGFR), and with its slope at that point (HR 0.96, 95% CI 0.94-0.99). So AKI risk decreased when the eGFR values increased, in accordance with the speed of this rise. Internal validation showed good discrimination and calibration of both joint models. The AUCs were always higher than 0.7.

CONCLUSIONS: The joint models obtained combining both patient risk factors and postoperative eGFR values, are useful to predict individualized risk of cardiac surgery-associated AKI. Predictions can be updated as new information is gathered.

PMID:34847490 | DOI:10.1016/j.jclinane.2021.110596

Nucl Med Biol. 2021 Nov 11;104-105:22-27. doi: 10.1016/j.nucmedbio.2021.11.002. Online ahead of print.

ABSTRACT

INTRODUCTION: ⁴⁴Sc is of great interest as a positron emission tomography (PET) radionuclide due to its suitable nuclear characteristics: E_β⁺max = 1.47 MeV, branching ratio 94.3% and convenient half-life of 3.97 h. Here, ⁴⁴Sc was produced via the widely used reaction ⁴⁴Ca (p,n)⁴⁴Sc using natural calcium as a target.

METHODS: The irradiation was performed at TRIUMF using the 13 MeV cyclotron. The separation consisted of a combination of DGA branched resin and Dowex 50Wx8 (200-400 mesh). The distribution coefficients of Sc³⁺ on Dowex 50Wx8 (NH₄⁺ form, 200-400 mesh) with ammonium α-hydroxyisobutyrate (pH = 4.8) medium were determined in this study.

RESULTS AND CONCLUSION: The tested scheme allows both a reliable separation of ⁴⁴Sc from the target material as well as from the other competitive metals and a final fraction with high specific activity. The achieved radiochemical yield was 95 ± 3%.

PMID:34847480 | DOI:10.1016/j.nucmedbio.2021.11.002

Waste Manag. 2021 Nov 27;138:19-29. doi: 10.1016/j.wasman.2021.11.034. Online ahead of print.

ABSTRACT

The objective of this study was to evaluate the impacts of leachate co-treatment on a full-scale municipal WWTPby comparing plant performance at varying levels of leachate contributions and hydraulic loadings.Leachate BOD:COD ratio was 0.08 ± 0.07 and indicated a stabilized, old matrix and concentrations of zinc, iron, aluminum, chloride and sulfate were 0.174, 38, 1.47, 1803 and 119.1 mg/L, respectively. The average volumetric leachate ratio (VLR%) was approximately 0.01% corresponding to a daily volume of 30 m³ but reaching a maximum of 270 m³(VLR% = 0.1%) and fluctuating on a daily-basis. A cluster analysis revealed 5 VLR% groupings that were used for subsequent analyses:no leachate, 0 < Low ≤ 0.001, 0.001 < Medium ≤ 0.02, 0.02 < High ≤ 0.05, 0.05 < Very high ≤ 0.2. Treated effluent concentrations of TKN, ammonia, fecal coliforms (FC),E. coli(EC), TSS and TP experienced atrend where effluent quality was improved at low and medium VLR%compared to no leachate addition, but deteriorated in high and very high VLR%.Treated effluent UVT% and EC were not statistically significantly different at varying VLR%, but FC was.Plant hydraulic had a significant impact on removal rates.Ammonia removals and nitrite concentrations improved inhigh flow conditions, whileTP, BOD and cBODremovals deteriorated. Finally,VLR%, leachate COD, TKN ammonia, chloride and arsenic had significant relationships with plant performance. Thus,for leachate with comparable age and strength, VLR% should not exceedlow to medium contributions(0 and 0.02%)during co-treatment at this WWTP.

PMID:34847466 | DOI:10.1016/j.wasman.2021.11.034

Comp Immunol Microbiol Infect Dis. 2021 Nov 17;80:101719. doi: 10.1016/j.cimid.2021.101719. Online ahead of print.

ABSTRACT

A retrospective antimicrobial resistance study of nontyphoidal Salmonella enterica isolates from India during 1990-2017 was conducted to study the microbial susceptibility to antibiotics. A total of 271 Salmonella enterica isolates from poultry (n = 146), farm animals (n = 55) and environmental sources (n = 70) were tested for susceptibility using 15 antimicrobial drugs. The drug classes include aminoglycosides, phenicols, cephalosporins, penicillins, carbapenems, fluoroquinolones, and sulphonamide-trimethoprim. Study revealed that overall, 133 (49.08%) of 271 isolates were resistant to ≥ 1 antimicrobial drugs and 81 (29.89%) out of 271 isolates were multidrug resistant (resistance to ≥ 3 drugs). Majority (68.96%) of Typhimurium serovars (n = 87) were susceptible to all antibiotics tested, whereas only 5% Kentucky serovars (n = 40) were pan susceptible. All the drugs revealed decreasing trend of susceptibility from 1990 towards 2017 except cephalosporins and carbapenems. Statistical analysis of association between time period and antimicrobial resistance revealed a significance of < 0.05. Molecular detection of genetic determinants associated with antimicrobial resistance revealed the presence of genes like class I integrons, sul1, sul2, catIII, cmlA, dfrA, bla_TEM, bla_AmpC in the resistant isolates. Furthermore, plasmid mediated quinolone resistant determinants like qnrD and qnrS were also reported in the current study.

PMID:34847457 | DOI:10.1016/j.cimid.2021.101719

J Health Econ. 2021 Nov 16;81:102554. doi: 10.1016/j.jhealeco.2021.102554. Online ahead of print.

ABSTRACT

We analyze data from the Minnesota Twin Registry (MTR), combined with the Socioeconomic Survey of Twins (SST), and new mortality data, and contribute to two bodies of literature. First, we demonstrate a beneficial causal effect of education on health and longevity in contrast to other twin-based studies of the US population, which show little or no effect of education on health. Second, we present evidence that is consistent with parental compensation through education for differences in their children’s endowments that predict health, but find no evidence that parents reinforce differences in endowments that predict earnings. We argue that there is a bias towards detecting reinforcement both in this paper and in the literature. Despite this bias, we still find statistical evidence of compensating behavior. We account for observed and unobserved confounding factors, sample selection bias, and measurement error in education.

PMID:34847444 | DOI:10.1016/j.jhealeco.2021.102554