Nevin Manimala

J Craniomaxillofac Surg. 2021 Nov 15:S1010-5182(21)00243-2. doi: 10.1016/j.jcms.2021.11.006. Online ahead of print.

ABSTRACT

The study aims to assess the influence on mortality of motorcycle road accidents, caused by injuries to the head, chest, abdomen, face, skin, pelvis and extremities. Road motorcycle accidents consecutively admitted to Level I Trauma Center were retrospectively analyzed. Each body site involvement was classified through Abbreviated Injury Score (AIS-98), and Comprehensive Facial Injury (CFI) score; Injury Severity Score (ISS) was also calculated. The data collected were subjected to a descriptive analysis and inferential statistic, with uni- and multivariate analysis; mortality was the main outcome examined. 1862 patients were studied. Limbs (53.9%) and Head (53.8%) are the most involved body site, facial trauma regards 19.4% of the sample. Only 4.4% of Facial injuries occurred as isolated, 71.6% were associated to Head involvement. The overall mortality was 4.6% and 80.0% of dead patients were affected by Head injury. Multivariate analysis shows that head (OR=3.06, p <0.0001), thoracic (OR=1.82, p <0.0001) and abdominal trauma (OR=1.41, p =0.019) are predicting the risk of death. Facial trauma does not directly influence mortality and, however severe and distracting it may be, becomes secondary to the management of frequently associated brain injuries. Severity scores targeted to the risk of death, such as AIS and AIS-derived, are ineffective in describing the true characteristics of facial injuries. The CFI score has been shown to predict the weight of surgical treatment and the outcome of the hospital stay, therefore its use is recommended.

PMID:34802885 | DOI:10.1016/j.jcms.2021.11.006

Curr Probl Diagn Radiol. 2021 Nov 3:S0363-0188(21)00166-3. doi: 10.1067/j.cpradiol.2021.09.004. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: Rhino-orbital-cerebral mucormycosis has emerged as a major opportunistic infection in patients with COVID-19. High clinical suspicion and prompt imaging are crucial for early diagnosis and management. Our study evaluates imaging characteristics of patients with COVID-19 associated Rhino-orbital-cerebral Mucormycosis (CA-ROCM) in a tertiary care hospital in India.

MATERIALS AND METHODS: A retrospective analysis of clinical and imaging data of patients with CA-ROCM who presented between December 2020 to June 2021 was performed. All patients had microbiologically or histologically proven sino-nasal mucormycosis along with documented SARS-CoV-2 positive RT-PCR test and/or classical lung imaging features of COVID-19 infection. The extent of sinus involvement, bony erosions, extra-sinus soft tissue extension, orbital-intracranial invasion, perineural spread, and vascular complications were assessed.

RESULTS: Fifty patients were included for the final analysis. Diabetes was the most common associated comorbidity. Seven patients presented with stage I disease, 18 patients with stage II, and 25 patients with stage III disease. The stage of disease showed a positive statistical correlation with HbA1c levels using Pearson’s correlation. The common imaging features were “Black turbinate sign” and nonenhancing sino-nasal mucosa (82%), orbital involvement (76%), and diffusion restriction in the optic nerve (24%). Intracranial involvement was seen as perineural extension into the brain (42%), cerebritis (30%), and internal carotid artery involvement (16%).

CONCLUSIONS: CA-ROCM is an acute invasive fungal sinusitis with an aggressive clinical course. Black-turbinate sign and peri-antral soft tissue infiltration are early features, whereas extra-nasal tissue infarction, optic nerve diffusion restriction, and vascular invasion are seen with advanced disease.

PMID:34802841 | DOI:10.1067/j.cpradiol.2021.09.004

J Hand Surg Am. 2021 Nov 18:S0363-5023(21)00618-3. doi: 10.1016/j.jhsa.2021.09.023. Online ahead of print.

ABSTRACT

PURPOSE: We evaluated the impact of angled derotational Kirschner wires (K-wires) on fracture gap reduction with variable-pitch headless screws.

METHODS: Fully threaded variable-pitch headless screws (20 and 28 mm) were inserted into “normal” bone models of polyurethane blocks. In separate trials, derotational K-wires were inserted at predetermined angles of 0°, 15°, 30°, and 40° and compared with each other, with no K-wire as a control. Fluoroscopic images taken after each screw turn were analyzed. The optimal fracture gap closure, initial screw push-off, and screw back-out gap creation were determined and compared at various derotational K-wire angles.

RESULTS: Initial screw push-off due to screw insertion and screw back-out gap creation were not significantly affected by the angle of the derotational K-wire. With a 20-mm screw, only a 40° derotational K-wire led to significantly less gap closure compared with control and with 0°, 15°, and 30° derotational K-wires. It led to an approximately 60% decrease in gap closure compared with no K-wire. With the 28-mm screw, compared with no K-wire, 15° and 30° derotational K-wires led to statistically significant decreases in gap closure (approximately 25%), whereas a 40° derotational K-wire led to an approximately 60% decrease. With the 28-mm screw, the 40° derotational K-wire also led to a statistically significant smaller gap closure when compared with 0°, 15°, and 30° derotational K-wires.

CONCLUSIONS: A derotational K-wire placed in parallel to the planned trajectory of a headless compression screw does not affect fracture gap closure. With greater angulation of the derotational K-wire, the fracture gap is still closed, but less tightly.

CLINICAL RELEVANCE: Derotational K-wires can help prevent fracture fragment rotation during headless compression screw insertion. At small deviations from parallel (≤30°), fracture gap closure achieved by the screw is minimally affected. At greater angles (ie, 40°), fracture gap closure may be substantially reduced, preventing fracture compression.

PMID:34802813 | DOI:10.1016/j.jhsa.2021.09.023

Vaccine. 2021 Nov 18:S0264-410X(21)01474-2. doi: 10.1016/j.vaccine.2021.11.029. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with advanced chronic kidney disease should be vaccinated against hepatitis B. In observational studies vitamin D insufficiency is associated with a reduced seroconversion rate. The effect of cholecalciferol supplementation on hepatitis B vaccination response in haemodialysis patients with vitamin D insufficiency is unknown.

METHODS: In this randomized open label pilot study 40 unvaccinated haemodialysis patients with 25(OH)D insufficiency (<30 ng/mL) were enrolled. In the supplementation group, we administered cholecalciferol orally in a dose of 28,000 IU weekly for a maximum of 12 weeks. Hepatitis B vaccination (HBvaxPRO 40 µg i.m. months 0, 1, 6) was performed after achieving a 25(OH)D level >30 ng/mL or after completing three months of supplementation despite failure to achieve the target level. In the control group, patients were vaccinated immediately after randomization. Anti-hepatitis B-antibody titer (anti-HBs) was measured eight weeks after completing the vaccination course.

RESULTS: Thirty-seven (26 male, 11 female) patients aged 65 (13.5) years underwent randomization with 17 patients allocated to the control group and 20 patients included in the supplementation group. After 12 weeks of cholecalciferol supplementation, mean (SD) 25(OH)D concentration increased from 15.0 (8.0) to 31.0 (7.1) ng/mL, but remained unchanged in the control group (14.0 (7.1) to 11.6 (7.5) mg/mL). Neither the number of patients with seroconversion (anti-HBs titer ≥ 10 IU/L; n = 6 (35.3%) vs n = 3 (27.3%), p = 0.704), nor the number of patients with seroprotection (anti-HBs titer >100 IU/L; n = 4 (23.5%) vs n = 2 (18.2%) differed between treatment groups. Cholecalciferol supplementation was safe without treatment-related adverse events.

CONCLUSION: In this small pilot study, high-dose oral cholecalciferol supplementation did not improve the hepatitis B vaccination response in haemodialysis patients with vitamin D insufficiency. This clinical trial was registered within EudraCT (EudraCT number 2011-004621-26).

PMID:34802788 | DOI:10.1016/j.vaccine.2021.11.029

Soc Sci Med. 2021 Nov 6:114543. doi: 10.1016/j.socscimed.2021.114543. Online ahead of print.

ABSTRACT

Black and other socially disadvantaged children are disproportionately burdened by high rates of pediatric asthma. Intraurban variation in environmental risk factors and limited access to high-resolution health data make it difficult to identify vulnerable patients, communities, or the immediate exposures that may contribute to pediatric asthma exacerbation. This article presents a novel, interdisciplinary health disparities research and intervention strategy applied to the problem of pediatric asthma in Kansas City. First, address-level electronic health records from a major children’s hospital in the Kansas City region are used to map the distribution of asthma encounters in 2012 at a high spatial resolution. Census tract Environmental Justice Screening Method (EJSM) indicators are then developed to scan for patterns in both the population health risks and vulnerabilities that may contribute to the burden of asthma in different communities. A Bayesian Profile Regression cluster analysis is used to systematically explore the complex relationships between census tract EJSM indicators and pediatric asthma incidence rates, helping to identify population characteristics and risk factors associated with both high and low rates of pediatric asthma throughout the region. The EJSM scanning exercise and BPR analysis demonstrate that each community faces a distinct set of risks and vulnerabilities that can contribute to the rate of acute pediatric asthma acute care encounters, providing targets for research and intervention. It is clear, however, that different forms of social disadvantage are driving high rates of pediatric asthma, which is closely tied to uneven development patterns and racial residential segregation. The results provide a starting point for designing place-based health disparities research and intervention strategies catered to the unique needs of vulnerable patients and communities; disparities-focused research and intervention strategies that leverage local knowledge and resources through community-based practices.

PMID:34802780 | DOI:10.1016/j.socscimed.2021.114543

Auris Nasus Larynx. 2021 Nov 18:S0385-8146(21)00253-4. doi: 10.1016/j.anl.2021.10.010. Online ahead of print.

ABSTRACT

OBJECTIVE: To analyze the preoperative patterns of caloric test, eye tracking test (ETT), and optokinetic pattern (OKP) in patients with acoustic neuroma (AN) and compare them with the postoperative patterns of ETT and OKP results METHODS: A total of 166 patients with AN (102 women; mean age: 41 years, range: 11-79 years) who were being treated at our hospital between 2013 and 2016 were enrolled. Preoperatively, a detailed history was taken regarding the presence of subjective symptoms of equilibrium dysfunction, and the patients underwent caloric test, ETT, and OKP. They were classified into three groups based on the preoperative ETT and OKP results as follows: Group A, normal ETT and OKP; Group B, either ETT or OKP was abnormal; and Group C, both ETT and OKP were abnormal. All patients were evaluated for subjective symptoms of vestibular dysfunction and were also grouped based on the tumor size on imaging. All surgeries were performed by a neurosurgeon using the lateral suboccipital retrosigmoid approach. About one month later after surgery, postoperatively ETT was performed on 150 patients and OKP was performed on 148 patients. The preoperative and postoperative ETT and OKP results were compared. The same two specialists analyzed the postoperative ETT and OKP findings as improved, unchanged, or worse. Student t-test was used for statistical analysis and a P-value of <0.05 was considered to indicate a statistically significant difference.

RESULTS: The average canal paresis(CP) % was 65.8%. No correlation was found between tumor size and CP%. The other side, the average tumor size in each group was 26.6 mm, 28.7 mm, and 37.8 mm in the Group A, B, and C, respectively. The average tumor size in Group C was significantly greater than those of Group A and B (P<0.01). The presence of gait disturbance in Group C was significantly higher than the other groups (P<0.01). The other side, abnormal ETT and OKP were seen in 32.5% and 31.9% of all patients, respectively. ETT and OKP results improved postoperatively in 67.4% and 68.9% of these patients.

CONCLUSIONS: Abnormal ETT and OKP results showed positive correlations with the tumor size and presence of subjective symptoms. Further, dysfunction of cerebellum and brain stem owing to tumor compression was observed to recover in many cases after surgery.

PMID:34802775 | DOI:10.1016/j.anl.2021.10.010

Child Abuse Negl. 2021 Nov 6:105393. doi: 10.1016/j.chiabu.2021.105393. Online ahead of print.

ABSTRACT

BACKGROUND: COVID-19 is a global crisis that has added fear, uncertainty, and stress to parents. Parents are going through several challenges related to school closure, financial insecurity and working remotely. These stressors are affecting the mental health of parents.

OBJECTIVES: This study aimed to observe major stressors along with the impact of COVID-19 on parental concerns and practices during lockdown.

PARTICIPANTS: Sample (N = 923) was selected through purposive sampling from parents attending Out Patients Departments of hospitals in three provincial capital cities of Pakistan having a high burden of COVID-19, i.e. Lahore, Karachi and Peshawar. Parents having at least one child younger than 18 years were included in the study.

METHODS: A quantitative design was used using a COVID-19 Parenting Response Scale (α = 0.74). It was used as a self-administered tool for parents who knew how to read and write Urdu/English language, however it was conducted as a structured interview for those who could not read/write. Data was analyzed by applying descriptive statistics (frequency, mean, percentage), independent sample t-test and Pearson Product Moment Correlation.

RESULTS: Findings of the current study showed several stressful factors for parents during COVID-19 pandemic, mainly financial burden, children’s education, uncertainty of the situation, and many others. The study also suggests an association of parental concerns during COVID-19 with parenting practices.

CONCLUSION: COVID-19 pandemic presents a global crisis not only of the health of the people but also on family relations and mental well-being. Findings of this research indicate the need for targeted and accessible interventions for mental health of parents especially during these challenging circumstances so that they can cope with the challenges in an effective way and be able to take care of their children better.

PMID:34802747 | DOI:10.1016/j.chiabu.2021.105393

J Dairy Sci. 2021 Nov 18:S0022-0302(21)01036-5. doi: 10.3168/jds.2021-20900. Online ahead of print.

ABSTRACT

Milk and dairy products are abundantly consumed in all cultures, but unprocessed products can harbor pathogenic microorganisms that can cause serious health risks for its consumers. To avoid this, it is necessary to process the products. Ozonation is a clean technique that has antimicrobial power due to its oxidation potential, reducing the microorganisms and limiting the production of enzymes, but the effectiveness of ozone treatment can be affected by the temperature, pH, additives, humidity, and the amount of organic matter around the cells. The goal of this systematic review was to analyze whether the use of ozone could improve the microbiological quality of dairy products and whether it could be used as an antimicrobial technique. Six databases (PubMed, Scielo, CAPES, Science Direct, Science Core Collection, and PLOS) were used in this research, with 2 independent reviewers selecting articles up to November 21, 2020, with experiments that used ozone as an antimicrobial in dairy products. A total of 731 articles were found, but only 9 were selected. The remainder were excluded according to the following criteria: was not related to the main theme; was a review; did not contain microbiological analysis; did not mention the concentration of gas and time of the ozone treatment; and was not an experiment. Important points were noted in quality criteria, which resulted in the need to standardize the methodology applied in research to improve the quality of the experiments. Studies were carried out with many different samples of milk, but the best results in reducing the microorganism count were obtained from samples containing low levels of fat.

PMID:34802746 | DOI:10.3168/jds.2021-20900

Mayo Clin Proc. 2021 Nov 18:S0025-6196(21)00624-8. doi: 10.1016/j.mayocp.2021.08.006. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate a potential association between beta-blocker exposure and survival in patients with transthyretin amyloid cardiomyopathy (ATTR-CM).

METHODS: In this real-world prospective registry of 128 consecutive patients with ATTR-CM recruited in 7 institutions in Galicia (Spain), survival of 65 patients who received beta blockers on registry enrollment was compared with that of 63 untreated controls by means of both unweighted Cox regression and Cox regression with inverse probability of treatment weighting. Tolerance to and adverse effects of beta blockers were recorded. Median study follow-up was 520 days.

RESULTS: Patients with ATTR-CM who received beta blockers showed statistically significant lower all-cause mortality than untreated controls as evaluated by either unweighted Cox regression (hazard ratio, 0.31; 95% CI, 0.12 to 0.79) or Cox regression with inverse probability of treatment weighting (hazard ratio, 0.18; 95% CI, 0.08 to 0.41; P<.001). Several sensitivity analyses confirmed the internal validity of these results. The overall frequency of beta-blocker suspension due to adverse effects was 25% (95% CI, 15.5% to 34.5%).

CONCLUSION: In this real-world, prospective, multi-institutional registry, patients with ATTR-CM who received beta blockers had lower all-cause mortality than untreated controls.

PMID:34802727 | DOI:10.1016/j.mayocp.2021.08.006

ISA Trans. 2021 Nov 10:S0019-0578(21)00550-4. doi: 10.1016/j.isatra.2021.10.029. Online ahead of print.

ABSTRACT

This paper proposes the tuning approach of the event-triggered controller (ETCTA) for the robotic system stabilization task where the reduction of the stabilization error and the data broadcasting of the control update are simultaneously considered. This approach is stated as a dynamic optimization problem, and the best controller parameters are obtained by using fourteen different bio-inspired optimization algorithms. The statistics results reveal that, among the tested bio-inspired optimization algorithms, the most reliable algorithm in the proposed tuning problem is the differential evolution variant DE/Best/1/Exp. The obtained result is validated both in numerical simulation as well as using a laboratory prototype. The simulation results indicate that the obtained control parameters can also deal with disturbances and reference changes not considered in the ETCTA’s optimization problem formulation without significantly worsening the control design objective. Experimental results disclose that the proposed event-triggered control tuning approach provides the best trade-off between the number of control signal updates and the position error among other tuning approaches, decreasing the data broadcasting of the control update by around 86.33% with a non-significant increase in the stabilization error of around 26.53%.

PMID:34802703 | DOI:10.1016/j.isatra.2021.10.029