Nevin Manimala

Cureus. 2022 Apr 2;14(4):e23759. doi: 10.7759/cureus.23759. eCollection 2022 Apr.

ABSTRACT

Background Airway compromise and respiratory failure are feared complications of angioedema leading to intensive care unit (ICU) admission. However, few of these patients decompensate. There is a paucity of tools that predict airway compromise in patients with angioedema, and it is unclear if automatic triage to the ICU is warranted. We analyzed patients admitted to our tertiary center ICU with angioedema for “airway watch” to find a way to triage those at greatest risk of respiratory decompensation. Methods We performed a retrospective review of patients with angioedema admitted to our ICU between 2017 and 2020. Data collected included demographics, comorbidities, nasopharyngolaryngoscopy (NPL) findings, need for intubation, and length of stay. Descriptive analysis and subsequent ANOVA or T-test statistical analysis was performed to determine the relationships between individual variables and outcomes. Categorical variables were compared using Pearson’s Chi-squared test or Fisher’s exact test where applicable. Continuous variables were compared using a Mann-Whitney U test. Results Of 134 patients admitted to our ICU, 63 (47%) required intubation, primarily in the emergency department (92.1%). Of those who required intubation, 61.9% had abnormal NPL findings in contrast to 25.35% of patients who did not require intubation (p<0.0001). Normal NPL findings had a negative predictive value for requiring intubation of 86.5%. Abnormal NPL findings had a positive predictive value for requiring intubation of 68.4%. Conclusion While airway compromise is a serious complication of angioedema, there is scant evidence to support triage to the ICU for those not intubated immediately. The majority of patients with angioedema who required intubation had abnormal NPL findings, and the majority of those with normal NPL findings did not require intubation. This suggests that NPL findings in patients with angioedema can help with triage to the ICU.

PMID:35518546 | PMC:PMC9064709 | DOI:10.7759/cureus.23759

Cureus. 2022 Apr 13;14(4):e24108. doi: 10.7759/cureus.24108. eCollection 2022 Apr.

ABSTRACT

BACKGROUND: Endoscopy is a rapidly developing discipline with new techniques and procedures being introduced each year. The consenting process is central to patient perception; using information videos as additional tools to aid consent and improve the quality of care in endoscopy is not well established. Our aim was to develop, implement and validate the use of patient educational videos to improve patients’ satisfaction and experience in endoscopy.

METHODS AND ANALYSIS: This was a prospective service quality improvement study. Eligible patients were invited to watch the educational videos in addition to standard practice. We compared this group with a matched cohort of patients who were receiving standard care of postal information leaflets. Patient satisfaction was measured through the validated Gastrointestinal Endoscopy Satisfaction Questionnaire (GESQ).

RESULTS: Patients in the intervention group scored four questions relating to pre-procedural information significantly higher than the control (p=0.038). The total mean GESQ score was also higher in the intervention group compared to the control, however this was not statistically significant (p=0.397). The intervention group had significantly lower cancellation rate (4%) compared to the control group (20%), p=0.023.

CONCLUSIONS: Patients who watched educational videos were more satisfied with pre-procedural information in the consenting period than those who did not. Further research is still needed to determine if they reduce patient anxiety. Meanwhile, it would be appropriate to implement these videos into routine practice as a cost-effective method of improving patient satisfaction.

PMID:35518531 | PMC:PMC9065946 | DOI:10.7759/cureus.24108

Cureus. 2022 Apr 4;14(4):e23809. doi: 10.7759/cureus.23809. eCollection 2022 Apr.

ABSTRACT

Introduction Malignancy, tuberculosis, and non-tubercular pleural infections account for most exudative pleural effusion. Pleural fluid cytology, biochemical tests and even pleural fluid cell block studies may fail to yield a diagnosis in certain cases. Medical thoracoscopy is the gold standard for the diagnosis of unexplained pleural effusions. However, access to medical thoracoscopy may be limited, particularly in developing countries. Also, certain patients may not be fit to undergo the procedure because of medical conditions. An ultrasound-guided pleural biopsy is an option in such conditions. The present study is intended to compare the diagnostic yield and complications of both methods of pleural biopsy in undiagnosed exudative pleural effusion under a randomized controlled trial. Method After fulfilling all the inclusion criteria, participants were randomized to either ultrasound-guided closed pleural biopsy or thoracoscopic-guided pleural biopsy groups. The primary outcome was to compare the diagnostic yield of ultrasound-guided Tru-Cut® (Newtech Medical Devices, Faridabad, India) closed pleural biopsy versus thoracoscopic pleural biopsy, and the secondary outcomes were to compare the complications rate, duration of the procedure, and hospital stay in the patients undergoing ultrasound-guided pleural biopsy versus thoracoscopic pleural biopsy, and predictors of a positive biopsy result in both groups. Result A total of 118 patients with pleural effusion were screened; 39 of them who were eligible, randomized into the ultrasound group (20 patients) and the thoracoscopic group (19 patients). The median age of participants was 53.5 (50-58) years and 55 (45-64) years in the ultrasound and thoracoscopic groups, respectively. Pleural fluid cell count, protein, adenosine deaminase (ADA), and lactate dehydrogenase (LDH) were similar in both groups, although pleural fluid glucose was low in the ultrasound group. Diagnostic yield was 90% (18/20) and 94.7% (18/19) in the ultrasound and thoracoscopic groups, respectively, which was statistically non-significant (p=0.963). The median duration of hospital stay was 9.5 (5.3-27) days and 15 (12-22) days in ultrasound and thoracoscopic groups respectively. The thoracoscopic group had a more prolonged stay compared to the ultrasound group, but it was statistically non-significant (p=0.09). The duration of the procedure was significantly longer in the thoracoscopic group 90 (85-105) minutes, in comparison to ultrasound 47.5 (41.3-55) minutes (p=0.001). No major complications were seen in both groups. Subcutaneous emphysema was the most common complication in the thoracoscopic group (10%), followed by hemorrhage (5.3%), and respiratory failure (5.3%). Hypotension was the only complication in the ultrasound group (5%). The rate of complications was significantly higher in the thoracoscopic group (p<0.01). Conclusion Ultrasound-guided closed pleural biopsy is as good as thoracoscopic pleural biopsy in undiagnosed exudative pleural effusion. It was associated with a shorter procedure duration, a shorter hospital stay, and fewer complications as compared to thoracoscopic biopsy. Both the procedures were safe in experienced hands and a hospital setup, but the thoracoscopic pleural biopsy was associated with complications.

PMID:35518519 | PMC:PMC9067329 | DOI:10.7759/cureus.23809

Int J Gen Med. 2022 Apr 29;15:4495-4503. doi: 10.2147/IJGM.S361468. eCollection 2022.

ABSTRACT

PURPOSE: Recent studies have focused on whether kidney injury molecule-1 (KIM-1) might serve as a marker of acute kidney tubular injury. Our study analyzed the levels of KIM-1 in the healthy population of different ages to explore the correlation between KIM-1 and age. Moreover, we constructed a model to predict kidney age.

METHODS: A cross-sectional study was conducted by Huashan Hospital, Shanghai, China, between April 2020 and December 2020. KIM-1 and other kidney biomarkers were measured in 176 healthy individuals ranging from 26 to 91 years old. Statistical correlated analyses for urinary KIM-1, creatinine (uCREA), potassium (K), sodium (Na) and chlorine (Cl), plasmic renin, angiotensin-2 (AngII) and aldosterone (ALD), and serum microalbuminuria (MALB), β2-microglobulin (B2MG), cystatin C (CYSC), urea nitrogen (BUN), creatinine (CREA), and glucose (GLU) were performed to assess the correlation between age and kidney biomarkers. All variables were selected as independent variables for the prediction of age by multiple linear regression.

RESULTS: KIM-1 positively correlated with age in kidney healthy people (r = 0.41, p < 0.05), whether among females (r = 0.51, p < 0.05) or males (r = 0.27, p < 0.05). It was much related to K (r = 0.34), B2MG (r = 0.28), and CL (r = 0.23). The predicted model was constructed with eGFR, Cl, ALD, CYSC, KIM-1, BUN, GLU and AngII, reaching an adjusted R² of 69.5% and a standard error of the estimated 7.84 years.

CONCLUSION: The level of urinary KIM-1 increases with age in healthy people. The model constructed by KIM-1 and the other 7 biomarkers can predict kidney age in healthy people.

PMID:35518515 | PMC:PMC9064178 | DOI:10.2147/IJGM.S361468

Int J Exerc Sci. 2022 Mar 1;15(4):526-540. eCollection 2022.

ABSTRACT

The purpose of this study was to compare a periodized versus a non-periodized protocol of kettlebell (KTB) swings over six weeks on strength, power, and muscular endurance. Twenty-eight high intensity functional training (HIFT) practitioners were assigned to non-periodized (NPG = 11), periodized (PG = 11), or control groups (CG = 6). NPG used the same load (20 kg) throughout the training period while the PG used a step loading progression (with an added four kilograms every two weeks). Measures of strength and muscular endurance in the deadlift exercise, and power in the countermovement jump were assessed before and after six weeks. A two-way ANOVA was used to verify pre- to post-test differences in strength, power, and muscular endurance. An analysis of the effect size was also incorporated. For strength and power, statistical differences from pre- to post-test were found for both the NPG (p < 0.001; 1-RM improvement = 8.7%; jump height improvement = 8.7%) and PG (p < 0.001; 1-RM improvement = 7.8%; jump height improvement = 10.1%), with no difference between groups. For muscular endurance, only the PG showed significant differences from pre- to post-test (p = 0.013; muscular endurance improvement = 23.8%). In conclusion, when the goal is to increase strength and power performances in HIFT practitioners, periodized and non-periodized KTB models appear to be equally effective, and this can simplify the strength coach’s practice in programming KTB swing training periods. For muscular endurance, the addition of KTB swing on a periodized basis seems to be a more effective strategy.

PMID:35518365 | PMC:PMC9022701

Front Genet. 2022 Apr 19;13:858005. doi: 10.3389/fgene.2022.858005. eCollection 2022.

ABSTRACT

To test the equality of several independent multinomial distributions, the chi-square test for count data is applied. The existing test can be applied when complete information about the data is available. The complex process, such as DNA count, the existing test under classical statistics may mislead. To overcome the issue, the modification of the chi-square test for multinomial distribution under neutrosophic statistics is presented in this paper. The modified form of the chi-square test statistic under indeterminacy/uncertainty is presented and applied using the DNA count data. From the DNA count data analysis, simulation, and comparative studies, the proposed test is found to be informative, springy, and good as compared with the existing tests.

PMID:35518359 | PMC:PMC9061958 | DOI:10.3389/fgene.2022.858005

Front Neurol. 2022 Apr 19;13:854846. doi: 10.3389/fneur.2022.854846. eCollection 2022.

ABSTRACT

BACKGROUND AND AIMS: Besides the crucial role in the treatment of acute ischemic stroke (AIS), mechanical thrombectomy represents a unique opportunity for researchers to study the retrieved clots, with the possibility of unveiling biological patterns linked to stroke pathophysiology and etiology. We aimed to develop a shotgun proteomic approach to study and compare the proteome of formalin-fixed paraffin-embedded (FFPE) cardioembolic and large artery atherosclerotic (LAA) clots.

METHODS: We used 16 cardioembolic and 15 LAA FFPE thrombi from 31 AIS patients. The thrombus proteome was analyzed by label-free quantitative liquid chromatography-tandem mass spectrometry (LC-MS/MS). MaxQuant v1.5.2.8 and Perseus v.1.6.15.0 were used for bioinformatics analysis. Protein classes were identified using the PANTHER database and the STRING database was used to predict protein interactions.

RESULTS: We identified 1,581 protein groups as part of the AIS thrombus proteome. Fourteen significantly differentially abundant proteins across the two etiologies were identified. Four proteins involved in the ubiquitin-proteasome pathway, blood coagulation or plasminogen activating cascade were identified as significantly abundant in LAA clots. Ten proteins involved in the ubiquitin proteasome-pathway, cytoskeletal remodeling of platelets, platelet adhesion or blood coagulation were identified as significantly abundant in cardioembolic clots.

CONCLUSION: Our results outlined a set of 14 proteins for a proof-of-principle characterization of cardioembolic and LAA FFPE clots, advancing the proteome profile of AIS human thrombi and understanding the pathophysiology of ischemic stroke.

PMID:35518205 | PMC:PMC9062453 | DOI:10.3389/fneur.2022.854846

Eplasty. 2022 Apr 12;22:e9. eCollection 2022.

ABSTRACT

BACKGROUND: Melanoma is the third most common skin cancer and the leading cause of skin cancer mortality. This study sought to investigate trends in melanoma incidence, mortality, and burden of disease.

METHODS: The authors assessed the records of the Global Burden of Disease Study 2017 to extract information about the incidence, mortality, and disability adjusted life years (DALY) related to melanoma during 1990-2017 in the US and other countries based on their socio-demographic index (SDI).

RESULTS: Melanoma incidence in the US increased 1.6 times, although the difference was not statistically significant. For patients over the age of 60, the incidence was significantly increased by 1.72 to 164.6 times. Mortality was relatively stable during the study period; however, it was increased for patients over 65 years of age (range: 1.03 to 70 times), although not statistically significant. Mortality-to-incidence ratio was decreased, but the difference was not statistically significant. For patients over 75 years of age, DALYs were statistically significantly increased by 1.34 to 1.71 times.

CONCLUSIONS: This study highlights differences in melanoma incidence and mortality from 1990-2017. Physicians involved in melanoma care should be aware of these changes in order to anticipate care needs.

PMID:35518191 | PMC:PMC9038229

EClinicalMedicine. 2022 Apr 28;47:101399. doi: 10.1016/j.eclinm.2022.101399. eCollection 2022 May.

ABSTRACT

BACKGROUND: Existing evidence suggests that some individuals from ethnic minority backgrounds are at increased risk of suicide compared to their majority ethnic counterparts, whereas others are at decreased risk. We aimed to estimate the absolute and relative risk of suicide in individuals from ethnic minority backgrounds globally.

METHODS: Databases (Medline, Embase, and PsycInfo) were searched for epidemiological studies between 01/01/2000 and 3/07/2020, which provided data on absolute and relative rates of suicide amongst ethnic minority groups. Studies reporting on clinical or specific populations were excluded. Pairs of reviewers independently screened titles, abstracts, and full texts. We used random effects meta-analysis to estimate overall, sex, location, migrant status, and ancestral origin, stratified pooled estimates for absolute and rate ratios. PROSPERO registration: CRD42020197940.

FINDINGS: A total of 128 studies were included with 6,026,103 suicide deaths in individuals from an ethnic minority background across 31 countries. Using data from 42 moderate-high quality studies, we estimated a pooled suicide rate of 12·1 per 100,000 (95% CIs 8·4-17·6) in people from ethnic minority backgrounds with a broad range of estimates (1·2-139·7 per 100,000). There was weak statistical evidence from 51 moderate-high quality studies that individuals from ethnic minority groups were more likely to die by suicide (RR 1·3 95% CIs 0·9-1·7) with again a broad range amongst studies (RR 0·2-18·5). In our sub-group analysis we only found evidence of elevated risk for indigenous populations (RR: 2·8 95% CIs 1·9-4·0; pooled rate: 23·2 per 100,000 95% CIs 14·7-36·6). There was very substantial heterogeneity (I² > 98%) between studies for all pooled estimates.

INTERPRETATION: The homogeneous grouping of individuals from ethnic minority backgrounds is inappropriate. To support suicide prevention in marginalised groups, further exploration of important contextual differences in risk is required. It is possible that some ethnic minority groups (for example those from indigenous backgrounds) have higher rates of suicide than majority populations.

FUNDING: No specific funding was provided to conduct this research. DK is funded by Wellcome Trust and Elizabeth Blackwell Institute Bristol. Matthew Spittal is a recipient of an Australian Research Council Future Fellowship (project number FT180100075) funded by the Australian Government. Rebecca Musgrove is funded by the NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC-2016-003).

PMID:35518122 | PMC:PMC9065636 | DOI:10.1016/j.eclinm.2022.101399

Infect Drug Resist. 2022 Apr 29;15:2315-2323. doi: 10.2147/IDR.S344763. eCollection 2022.

ABSTRACT

INTRODUCTION: The pandemic of coronavirus disease-2019 has fundamentally changed the physician-patient relationship due to health care workers’ being at high risk of getting COVID-19 infection from their patients. Therefore, healthcare workers are a priority to be protected and prevent transmission within a healthcare setting.

OBJECTIVE: To assess the actual and perceived personal safety of healthcare workers practicing in public hospitals.

METHODS AND MATERIALS: A descriptive cross-sectional study design was done among 361 health professionals in West Shoa. A simple random sampling technique was used to select representative respondents. Data was collected by a pretested, self-administered questionnaire. The collected data was entered into EPI-Info and exported to STATA for analysis. Descriptive statistics were used to present the data.

RESULTS: A total of 361 healthcare workers responded to the question with a 97% response rate. The median age of the study participants was 29. Of the total participants, access to personal protective equipment was: hand sanitizer 322 (89.2%), disposable gloves 285 (78.9%), face mask 280 (77.6%), KN95 face mask 163 (45.2%) and facial protective shields 112 (31%). One hundred sixty-nine (46.8%) of the study participants reported that their hospital has personal safety policies and procedures. One hundred sixty-one (44%) reported that they perceived no support, while only 35 (9.7%) participants reported that they perceived full support from their hospital. Furthermore, the participants perceived that their local concerned bodies took fewer necessary measurements to defend physical integrity in the workplace (mean 2.86 SD = 3.34).

CONCLUSION: There are many healthcare workers who have limited access to the majority of essential PPE. The majority of study participants perceived limited support from their health facilities, hospitals and local concerned bodies. Therefore, hospitals and local public health authorities should increase access to PPE to protect healthcare workers.

PMID:35517898 | PMC:PMC9064055 | DOI:10.2147/IDR.S344763