Nevin Manimala

Acta Obstet Gynecol Scand. 2022 Nov 22. doi: 10.1111/aogs.14476. Online ahead of print.

ABSTRACT

INTRODUCTION: In the Netherlands, the sentinel lymph node procedure protocol consists of preoperative lymphoscintigraphy combined with intraoperative blue dye for identifying sentinel lymph nodes in early vulvar squamous cell carcinoma. This study aimed at investigating the role of early and late lymphoscintigraphy.

MATERIAL AND METHODS: From January 2015 to January 2019, early and late lymphoscintigraphies of 52 women were retrospectively analyzed. Lymphoscintigraphy was performed 30 minutes (early) and 2.5-4 hours (late) after vulvar injection of ^99m Tc-labeled nanocolloid. We calculated the concordance correlation coefficient (CCC) between number of sentinel lymph nodes detected on both images using the Lins concordance coefficient and correlated with clinicopathological data.

RESULTS: Thirty-four women had a midline tumor and 18 had a lateral tumor. Detection rates with early and late scintigraphy were 88.5% and 98.1%, respectively. Median number of detected nodes was 1.0 (0-7) and 2.0 (0-7). Good statistical correlation between number of sentinel lymph nodes detected on early and late imaging was found (CCC = 0.76) in most patients. In 18 women (35%) a mismatch occurred: a higher number of nodes was detected on late imaging. In 11 of 18 women re-injection was performed because no sentinel lymph nodes were visualized on early images. Late imaging and intraoperative detection showed a good statistical correlation (CCC = 0.61). One woman showed an isolated groin recurrence despite negative sentinel lymph nodes.

CONCLUSIONS: This study showed good statistical correlations between early and late scintigraphy in most patients. However, in 35% of women late scintigraphy detected more nodes. In case of poor visualization after the first scintigraphy, re-injection should be considered. Late scintigraphy is probably helpful in confirming successful re-injection and in showing deviating lymph flow in women with failed mapping after the first injection and successful re-injection. Because missing metastatic sentinel lymph nodes often leads to a poor prognosis, we prefer optimal correlations between imaging and intraoperative identification. Hence, late scintigraphy cannot be safely omitted.

PMID:36412099 | DOI:10.1111/aogs.14476

ANZ J Surg. 2022 Nov 22. doi: 10.1111/ans.18164. Online ahead of print.

ABSTRACT

BACKGROUND: Effective pain control is crucial to postoperative recovery and is affected by biopsychosocial factors. This study aimed to evaluate how non-English primary language, gender, and marital status may influence pain, length of stay, and mortality after general surgery.

METHODS: Consecutive general surgical admissions over a two-year period to two tertiary hospitals were included. Multivariable logistic regression analyses were conducted to evaluate the relationship between non-English primary language, gender, and marital status, and pain scores, length of stay, and in-hospital mortality. Explanatory variables that were controlled for in these analyses included age, birth country, whether a religion was specified, socioeconomic percentile, Charlson comorbidity index, and time of admission.

RESULTS: A total of 12 846 general surgery patients were included. When controlling for the aforementioned variables, including having a specified religion and being born overseas, having a non-English primary language was significantly independently associated with lower pain scores (odds ratio 0.61, 95% CI 0.52-0.71, P < 0.001). Female gender was independently associated with an increased likelihood of higher pain scores (odds ratio 1.09, 95% CI 1.01-1.18, P = 0.024) and a lower likelihood of prolonged length of stay (odds ratio 0.88, 95% CI 0. 80-0.95, P = 0.002). None of the evaluated variables had a statistically significant association with in-hospital mortality.

CONCLUSIONS: This study is the first to characterize an association between general surgery patients with a non-English primary language and lower levels of postoperative pain. It was also found that female gender was associated with higher postoperative pain but lower length of hospital stay.

PMID:36412097 | DOI:10.1111/ans.18164

Int J Lang Commun Disord. 2022 Nov 22. doi: 10.1111/1460-6984.12823. Online ahead of print.

ABSTRACT

BACKGROUND: Much has been written about the changes in use and perspectives of telepractice among speech and language therapists (SLTs) during the global COVID-19 pandemic. However, no long-term study has been done to examine whether there is a permanent shift in attitudes towards telepractice as the world adjusts to new norms and endemic COVID-19.

AIMS: To compare the speech telepractice use and perspectives of SLTs at two time points of the pandemic: during and after the height of the pandemic.

METHODS & PROCEDURES: Two online surveys were distributed a year apart among SLTs in Singapore. The first survey was disseminated during an initial lockdown period in 2020 and the second survey was done in 2021 when Singapore was starting to reduce strict quarantine and safe-distancing regulations. These surveys were distributed via communication channels of the local speech therapy association. A total of 115 and 71 responses to the survey were collected in 2020 and 2021, respectively. Responses were captured and analysed using descriptive statistics and statistical analysis while qualitative content analysis was used to derive key themes from open-ended questions.

OUTCOMES & RESULTS: Telepractice use across all age groups and client types peaked at the height of the pandemic. Even as lockdown measures were eased, telepractice utilization was still higher than what it was before the pandemic. Dysphagia management was the only area where SLTs reduced their use of telepractice during the stabilization phase. After more experience with telepractice during the height of the pandemic, SLTs acknowledged the benefit of being able to use a wide range of media through telepractice and were less worried about not having the resources or knowledge to set up telepractice. SLTs also reported increased confidence in providing telepractice, which was reflected in their willingness to continue to provide telepractice even after the pandemic ends.

CONCLUSIONS & IMPLICATIONS: The increase in use of telepractice during this pandemic is likely to be sustained as a majority of respondents believed they would continue to provide this mode of service delivery even after the pandemic ends. However, clinicians will still have to assess for client suitability, as clients with more complex medical or behavioural issues may still require in-person therapy. Additionally, dysphagia management via telepractice will still be limited given that swallow presentations may be more variable. Lastly, although generic resources are helpful for clinicians, the long-term sustainability of telepractice can be boosted by the sharing of resources that are suitable for the local context.

WHAT THIS PAPER ADDS: What is already known on this subject Current studies have examined telepractice use and perspectives of SLTs before and during the COVID-19 pandemic. Despite the evidence for the efficacy of telepractice, uptake was low due to perceived lack of training and resources. Although more clinicians provided telepractice during the pandemic, many still doubted its efficacy over in-person therapy and most studies concluded that longer term studies are required to ascertain if SLTs will continuing providing telepractice after the pandemic. What this paper adds to existing knowledge This study shows that there is a definitive shift in perspectives in favour of telepractice after the pandemic, as clinicians continued to provide telepractice across most service areas even without lockdown restrictions. The previous challenges of insufficient resources, knowledge and privacy concerns were reduced with more experience in providing telepractice. Although client suitability remained a major barrier, more clinicians saw benefits of easy access to therapy and range of resources used as benefits that they could harness from telepractice. What are the potential or actual clinical implications of this work? A majority of respondents stated that they are more confident in providing telepractice and would want to continue providing this service delivery mode after the pandemic, so more training and resources suitable for the local contexts can be provided by national associations to sustain this. More research and resources can be gathered to make telepractice more efficacious for dysphagia management and clients who may be deemed unsuitable for telepractice.

PMID:36412089 | DOI:10.1111/1460-6984.12823

J S Afr Vet Assoc. 2022 Nov 8. doi: 10.36303/JSAVA.516. Online ahead of print.

ABSTRACT

Refractometric total proteins are commonly used in practice as a quick and inexpensive way to measure total protein concentration in bodily fluids. Little information is available about how the operator performing the measurement affects the results. The aim of our study was to determine the inter- and intra-operator variability of refractometric total proteins measured on canine plasma using a temperature-compensated handheld refractometer. A pooled sample of canine lithium-heparin plasma was created using leftover samples from dogs presented to our hospital. The sample was then divided into three aliquots. Total proteins of these aliquots were measured by veterinary nurses, interns, residents and specialists working at our hospital. Statistical analysis revealed excellent inter-operator (ICC 0.99, CI 95%: 0.971-1.00) and intra-operator (ICC 0.997, CI 95%: 0.990- 0.999) variability. Having different operators measuring refractometric total plasma proteins in practice should not affect the results. This suggests different operators can be used when monitoring total plasma proteins of a patient over time and when designing a study that involves this test.

PMID:36412080 | DOI:10.36303/JSAVA.516

Allergy. 2022 Nov 22. doi: 10.1111/all.15588. Online ahead of print.

NO ABSTRACT

PMID:36412075 | DOI:10.1111/all.15588

J Med Virol. 2022 Nov 22. doi: 10.1002/jmv.28316. Online ahead of print.

ABSTRACT

To characterize the clinical features of long COVID, 286 patients who received care in our outpatient clinic for long COVID from May 2021 through December 2021 were surveyed. The recovery periods of each symptom and the key factors contributing to early recovery were statistically analysed. The median age of the patients was 35.8 years, with 137 men and 149 women. The median number of symptoms was 2.8. The most frequent symptoms were respiratory manifestations (52.1%), followed by fatigue (51.4%). Respiratory symptoms, fatigue and headache/arthralgia were major complaints in the initial phase, whereas hair loss was a major complaint in the late phase, suggesting that the chief complaint of patients with long COVID may vary temporally. The best treatment outcome was observed for pulmonary symptoms, and hair loss had the worst outcome. COVID-19 severity, the number of manifestations and delay in starting treatment exerted a negative effect on the recovery period of long COVID. In addition, a smoking habit was an independent risk factor for slowing the recovery period from long COVID. This study provides insights into the clinical course of each manifestation and therapeutic options with a more certain future of long COVID to meet the unmet medical needs. This article is protected by copyright. All rights reserved.

PMID:36412057 | DOI:10.1002/jmv.28316

Pest Manag Sci. 2022 Nov 22. doi: 10.1002/ps.7292. Online ahead of print.

ABSTRACT

BACKGROUND: Sugar beet is threatened by virus yellows, a disease complex vectored by aphids that reduces sugar content. We present an analysis of Myzus persicae population dynamics with and without neonicotinoid seed treatment. We use six years’ yellow water trap and field-collected aphid data and two decades of 12.2 m suction-trap aphid migration data. We investigate both spatial synchrony and forecasting error to understand the structure and spatial scale of field counts and why forecasting aphid migrants lacks accuracy. Our aim is to derive statistical parameters to inform regionwide pest management strategies.

RESULTS: Spatial synchrony, indicating the coincident change in counts across the region over time, is rarely present and is best described as stochastic. Uniquely, early season field populations in 2019 did show spatial synchrony to 90 km compared to the overall average weekly correlation length of 23 km. However, 70% of the time series were spatially heterogenous, indicating patchy between-field dynamics. Field counts lacked the same seasonal trend and did not peak in the same week. Forecasts tended to under-predict mid-season log₁₀ counts. A strongly negative correlation between forecasting error and the proportion of zeros was shown.

CONCLUSION: Field populations are unpredictable and stochastic, regardless of neonicotinoid seed treatment. This outcome presents a problem for decision-support that cannot usefully provide a single regionwide solution. Weighted permutation entropy inferred that M. persicae 12.2 m suction-trap time series had moderate to low intrinsic predictability. Early warning using a migration model tended to predict counts at lower levels than observed. This article is protected by copyright. All rights reserved.

PMID:36412050 | DOI:10.1002/ps.7292

Eval Health Prof. 2022 Nov 22:1632787221141504. doi: 10.1177/01632787221141504. Online ahead of print.

ABSTRACT

This study aims to compare caffeine intake and physical activity levels in university students with severe and ineffective fatigue and examine the relationship between them. A total of 647 (F:527; M:120) university students were included in this cross-sectional study. Individuals’ socio-demographic information, severity of fatigue (Fatigue Severity Scale (FSS)), amount of caffeine intake and physical activity level (International Physical Activity Questionnaire-Short Form (IPAQ-SF)) were evaluated. It was determined that 56.5% of the university students (age: 21.21 ± 2.57) participating in the study had severe fatigue. Caffeine intake and physical activity level of students with severe fatigue were statistically significantly lower than those with ineffective fatigue (p < 0.05). In addition, there was a weak negative correlation between fatigue and caffeine intake (r = -0.157; p < 0.001) and physical activity level (r = -0.096; p < 0.017). There was a significant positive correlation between caffeine intake and physical activity (r = 0.143; p < 0.001). This study showed that a significant portion of university students have severe fatigue. In addition, individuals with severe fatigue have decreased caffeine intake and lower physical activity levels. To reduce fatigue, caffeine intake in safe doses should be encouraged in accordance with the individual’s metabolic and physiological parameters. In addition, physical activity counseling should be given to encourage physical activity.

PMID:36412049 | DOI:10.1177/01632787221141504

J Nurs Scholarsh. 2022 Nov 21. doi: 10.1111/jnu.12841. Online ahead of print.

ABSTRACT

INTRODUCTION: Since the COVID-19 pandemic, an increase in fentanyl-combined drugs has led to a surge in opioid overdose deaths in the United States. Higher opioid overdose mortality rates are problematic in rural communities, and there are few prevention, treatment, and recovery resources for individuals experiencing opioid use disorder.

METHOD: This exploratory project aimed to investigate a hands-on naloxone training for rural clinicians and staff. Rural clinicians and staff at two behavioral health centers were recruited to participate in a 30-min lecture and 30-min hands-on intranasal naloxone training using a low-fidelity mannequin. A pre-post opioid knowledge questionnaire, rubric based on the Substance Abuse and Mental Health Services Administration toolkit, and investigator-generated survey were used to evaluate opioid knowledge and response, demonstration of intranasal naloxone administration, and participants’ perceptions of the training. Enrollment characteristics were summarized using descriptive statistics and paired t-tests were used to assess mean differences.

RESULTS: Of the nine participants in the project, seven (87.5%) were female and six (75.0%) were Black. Four participants assumed a therapist role, attained a MS or MA degree, and had 5 or more years of experience working in healthcare. The total mean rubric score for all participants was 96.0 (SD = 8.8). No significant pre-post mean differences among opioid knowledge, overdose risk, and overdose response categories were found, all p > 0.05. However, post-intervention mean scores were slightly higher in all categories except overdose risk. Most participants (77.8%) responded that they felt comfortable handling an opioid situation and teaching the training to community members. Open-ended responses indicated that participants liked the demonstrations, examples used, hands-on nature of the training, and the presentation materials.

CONCLUSION: A hands-on naloxone training is beneficial for training rural clinicians and staff to respond to opioid overdose. This training may be a promising solution to reduce response time between recognition of opioid symptoms and administration of the life-saving medication, naloxone. Future studies should examine the efficacy of this training in larger samples with the inclusion of rural interdisciplinary teams, trusted community leaders, and family and friends of those impacted by opioid use disorder.

CLINICAL RELEVANCE: This innovative hands-on naloxone training is designed for rural clinicians and residents who are most likely to witness individuals experiencing opioid toxicity. The primary goal is to reduce response time between recognition of signs and symptoms and administration of the life-saving medication, Naloxone.

PMID:36411494 | DOI:10.1111/jnu.12841

Phytother Res. 2022 Nov 21. doi: 10.1002/ptr.7670. Online ahead of print.

ABSTRACT

The mechanism of SARS-CoV-2 spike protein-mediated perturbations of metabolic pathways and modulation of antcin A, a steroid-like compound isolated from Taiwanofungus camphoratus, are not studied. Here, we investigated the metabolic alteration by SARS-CoV-2 spike protein and the regulatory effect of antcin A on SARS-CoV-2 spike protein-induced metabolic changes in the Phorbol 12-myristate 13-acetate (PMA)-induced human monocytes (THP-1) using proton nuclear magnetic resonance (¹ H-NMR) and MetaboAnalyst 5.0 software. The cytotoxic potential of SARS-CoV-2 spike protein, antcin A, and dexamethasone was assessed by MTT assay. The metabolomic perturbations and their relation to human coronaviruses’ receptors were evaluated by qPCR. This study indicated that the altered metabolites mediated by SARS-CoV-2 protein, such as methionine, phosphoenolpyruvic acid, canadine, glutamine, ethanolamine, and phenylalanine, were significantly reversed by antcin A. In addition, antcin A significantly inhibited SARS-CoV-2 spike protein-mediated up-regulation of TLR-4 and ACE2 receptors, while GRP78 inhibition was not statistically significant. This is the first study to use ¹ H-NMR to investigate SARS-CoV-2 spike protein-induced metabolomic changes in PMA-induced THP-1 cells. Antcin A significantly reversed metabolomic alters while dexamethasone failed to fix them. Therefore, we believe that antcin A could be a potential candidate for therapeutic agents for viral infections related to a metabolic abnormality.

PMID:36411492 | DOI:10.1002/ptr.7670