Nevin Manimala

Arch Cardiol Mex. 2022;92(4):469-475. doi: 10.24875/ACM.21000348.

ABSTRACT

INTRODUCTION: Oxygen saturation and lactate are markers of tissue hypoxia; they are obtained from central venous and mixed venous sample of the pulmonary artery. The simultaneous behavior of these parameters in the postoperative period of cardiac surgery is unknown.

OBJECTIVE: To characterize the lactate and oxygen saturation of the venous-arterial circuit of the postoperative patient from cardiac surgery.

METHODS: Design: Analytical cross-sectional. In consecutive patients after cardiac surgery, serum lactate and oxygen saturation of the venous-arterial circuit were obtained. The variables were reported with median (25.75 percentiles). They were analyzed with Kruskal-Wallis ANOVA and respective adjustment, Spearman correlation, the descriptive Bland-Altman statistic and intraclass correlation coefficient (95% confidence interval). A p < 0.05 was considered significant.

RESULTS: 244 blood samples from 61 patients were studied. Women 30 (49%). (Oxygen saturation) [lactate] were: arterial 98 (95.3, 99.4%) and 1.7 (1.1, 2.1); peripheral venous 85 (75.4, 94%) and [1.9 (1.35, 2.3)]; central venous 68.8 (58.74, 70.2%) and 1.8 (1.3, 2.3); mixed central venous 66.8 (61.2, 73.1%) and 1.8 (1.3, 2.2), p < 0.05. The best intraclass correlation coefficient for oxygen saturation were from central vein to mixed central vein 0.856 (0.760,0.914); and lactate: 0.954 (0.923, 0.972).

CONCLUSIONS: The oxygen saturation differs in the venous-arterial circuit unlike lactate where they are similar. The best values of the intraclass correlation coefficient for lactate and oxygen saturation were those obtained in central vein and mixed central vein.

PMID:36413688 | DOI:10.24875/ACM.21000348

Am J Clin Oncol. 2022 Dec 1;45(12):534-536. doi: 10.1097/COC.0000000000000955. Epub 2022 Nov 22.

ABSTRACT

Novel toxicity metrics that account for all adverse event (AE) grades and the frequency of may enhance toxicity reporting in clinical trials. The Toxicity Index (TI) accounts for all AE grades and frequencies for categories of interest. We evaluate the feasibility of using the TI methodology in 2 prospective anal cancer trials and to evaluate whether more conformal radiation (using Intensity Modulated Radiation Therapy) results in improved toxicity as measured by the TI. Patients enrolled on NRG/RTOG 0529 or nonconformal RT enrolled on the 5-Fluorouracil/Mitomycin arm of NRG/RTOG 9811 were compared using the TI. Patients treated on NRG/RTOG 0529 had lower median TI compared with patients treated with nonconformal RT on NRG/RTOG 9811 for combined GI/GU/Heme/Derm events (3.935 vs 3.996, P=0.014). The TI methodology is a feasible method to assess all AEs of interest and may be useful as a composite metric for future efforts aimed at treatment de-escalation or escalation.

PMID:36413683 | DOI:10.1097/COC.0000000000000955

Am J Clin Oncol. 2022 Dec 1;45(12):501-505. doi: 10.1097/COC.0000000000000952. Epub 2022 Nov 14.

ABSTRACT

OBJECTIVES: The best fractionation for stereotactic body radiotherapy (SBRT) in renal cell carcinoma (RCC) metastases has not been well defined. In addition, the literature on outcomes using 5-fraction SBRT in the setting of osseous metastases has not been well reported.

MATERIALS AND METHODS: Thirty-nine patients with 69 RCC osseous metastases were treated using 5-fraction SBRT at a single institution using 2 dose-fractionation schemes. Overall survival and local-control (LC) outcomes of the 2 fractionation schemes were studied using Kaplan-Meier curves.

RESULTS: Of the 69 lesions included in the study, 20 were treated with 30 grays (Gy) in 5 fractions and 49 were treated with 40 Gy in 5 fractions. The median age of patients at diagnosis was 58.4 years. The 1-year LC rate for all treated lesions was 85.5% (59/69) with an LC of 90% (18/20) for lesions receiving 30 Gy and 83.7% (41/49) in lesions receiving 40 Gy. There was no statistically significant difference in 1-year LC rate between the 2 fractionation schemes (P-value, 0.553).

CONCLUSIONS: Patients with osseous RCC metastases undergoing 5 fractions of SBRT had favorable LC outcomes. There was no difference in survival or LC between the 40 Gy and 30 Gy treatment arms.

PMID:36413679 | DOI:10.1097/COC.0000000000000952

Dimens Crit Care Nurs. 2023 Jan-Feb 01;42(1):22-32. doi: 10.1097/DCC.0000000000000557.

ABSTRACT

BACKGROUND: Although the body of knowledge related to Cardiac Surgery Unit Advanced Life Support (CSU-ALS) guideline has grown over the last 10 years, there is no existing literature examining the impact of this training on patient mortality outcomes.

OBJECTIVES: This article describes one institution’s experience related to patient mortality outcomes following a rigorous training program following the CSU-ALS guideline. Because of the small numbers associated with cardiac arrests after cardiac surgery (0.7%-8%), statistical significance was not a goal.

METHODS: A quasi-experimental design was used to compare mortality outcomes before and after CSU-ALS training. One hundred percent of the staff were trained in the initial year, and 85% to 90% of the staff maintained competency in the following years. The author used 10 years of retrospective data to compare mortality rates 4 years before and 6 years after the intervention.

RESULTS: The retrospective data showed a decrease in the percentage of failure-to-rescue rate in the intervention group (control 16% vs intervention 2%). Fisher exact testing implies that the observed frequencies were not significantly different from the expected frequencies (P = .072 and P = .135). Because of the small sample size, statistical significance could not be established.

DISCUSSION: This institution experienced an extremely positive track record in outcomes despite its inability to prove a statistically significant correlation to the CSU-ALS training. The overall observed and self-reported confidence level of the staff during the study period was outside the project scope but deserves mention and further research.

PMID:36413642 | DOI:10.1097/DCC.0000000000000557

Europace. 2022 Nov 23:euac213. doi: 10.1093/europace/euac213. Online ahead of print.

ABSTRACT

AIMS: Three Tesla (T) magnetic resonance imaging (MRI) provides critical imaging information for many conditions. Owing to potential interactions of the magnetic field, it is largely withheld from patients with cardiac implantable electronic devices (CIEDs). Therefore, we assessed the safety of 3T MRI in patients with ‘3T MRI-conditional’ and ‘non-3T MRI-conditional’ CIEDs.

METHODS AND RESULTS: We performed a retrospective single-centre analysis of clinically indicated 3T MRI examinations in patients with conventional pacemakers, cardiac resynchronization devices, and implanted defibrillators from April 2020 to May 2022. All CIEDs were interrogated and programmed before and after scanning. Adverse events included all-cause death, arrhythmias, loss of capture, inappropriate anti-tachycardia therapies, electrical reset, and lead or generator failure during or shortly after MRI. Changes in signal amplitude and lead impedance were systematically assessed. Statistics included median and interquartile range. A total of 132 MRI examinations were performed on a 3T scanner in 97 patients. Thirty-five examinations were performed in patients with ‘non-3T MRI-conditional’ CIEDs. Twenty-six scans were performed in pacemaker-dependent patients. No adverse events occurred during or shortly after MRI. P-wave or R-wave reductions ≥ 50 and ≥ 25%, respectively, were noted after three (2.3%) scans, all in patients with ‘3T MRI-conditional’ CIEDs. Pacing and shock impedance changed by ± 30% in one case (0.7%). Battery voltage and stimulation thresholds did not relevantly change after MRI.

CONCLUSION: Pending verification in independent series, our data suggest that clinically indicated MRI scans at 3T field strength should not be withheld from patients with cardiac pacemakers or defibrillators.

PMID:36413601 | DOI:10.1093/europace/euac213

PLoS Comput Biol. 2022 Nov 22;18(11):e1010650. doi: 10.1371/journal.pcbi.1010650. eCollection 2022 Nov.

ABSTRACT

Network science has increasingly become central to the field of epidemiology and our ability to respond to infectious disease threats. However, many networks derived from modern datasets are not just large, but dense, with a high ratio of edges to nodes. This includes human mobility networks where most locations have a large number of links to many other locations. Simulating large-scale epidemics requires substantial computational resources and in many cases is practically infeasible. One way to reduce the computational cost of simulating epidemics on these networks is sparsification, where a representative subset of edges is selected based on some measure of their importance. We test several sparsification strategies, ranging from naive thresholding to random sampling of edges, on mobility data from the U.S. Following recent work in computer science, we find that the most accurate approach uses the effective resistances of edges, which prioritizes edges that are the only efficient way to travel between their endpoints. The resulting sparse network preserves many aspects of the behavior of an SIR model, including both global quantities, like the epidemic size, and local details of stochastic events, including the probability each node becomes infected and its distribution of arrival times. This holds even when the sparse network preserves fewer than 10% of the edges of the original network. In addition to its practical utility, this method helps illuminate which links of a weighted, undirected network are most important to disease spread.

PMID:36413581 | DOI:10.1371/journal.pcbi.1010650

PLoS One. 2022 Nov 22;17(11):e0277933. doi: 10.1371/journal.pone.0277933. eCollection 2022.

ABSTRACT

BACKGROUND: Potato is a staple food and a main crop of Bangladesh. Climate plays an important role in different crop production all over the world. Potato production is influenced by climate change, which is occurring at a rapid pace according to time and space.

OBJECTIVE: The main objective of this research is to observe the variation in potato production based on the discrepancy of the variability in the spatial and temporal domains. The research is based on secondary data on potato production from different parts of Bangladesh and five major climate variables for the last 17 years ending with 2020.

METHODS: Bayesian Spatial-temporal modelling for linear, analysis of variance (ANOVA), and auto-Regressive models were used to find the best-fitted model compared with the independent Error Bayesian model. The Watanabe-Akaike information criterion (WAIC) and Deviance Information Criterion (DIC) were used as the model choice criteria and the Markov Chain Monte Carlo (MCMC) method was implemented to generate information about the prior and posterior realizations.

RESULTS: Findings revealed that the ANOVA model under the Spatial-temporal framework was the best model for all model choice and validation criteria. Results depict that there is a significant impact of spatial and temporal variation on potato yield rate. Besides, the windspeed does not show any influence on potato production, however, temperature, humidity, rainfall, and sunshine are important components of potato yield rate in Bangladesh.

CONCLUSION: It is evident that there is a potential impact of climate change on potato production in Bangladesh. Therefore, the authors believed that the findings will be helpful to the policymakers or farmers in developing potato varieties that are resilient to climate change to ensure the United Nations Sustainable Development Goal of zero hunger.

PMID:36413573 | DOI:10.1371/journal.pone.0277933

PLoS One. 2022 Nov 22;17(11):e0277882. doi: 10.1371/journal.pone.0277882. eCollection 2022.

ABSTRACT

BACKGROUND: Little is known about olfactory changes in pediatric COVID-19. It is possible that children under-report chemosensory changes on questionnaires, similar to reports in adults. Here, we aim to describe COVID-19-related olfactory dysfunction in outpatient children. We hypothesized that children with COVID-19 will demonstrate abnormal olfaction on smell-identification testing at a higher rate than children with negative COVID-19 testing.

METHODS: A prospective cross-sectional study was undertaken from June 2020-June 2021 at a tertiary care pediatric hospital. A consecutive sample of 205 outpatients aged 5-21 years undergoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) PCR testing were approached for this study. Patients with prior olfactory dysfunction were excluded. Participants were given a standard COVID-19 symptom questionnaire, a Smell Identification Test (SIT) and home-odorant-based testing within 2 weeks of COVID-19 testing. Prior to study enrollment, power calculation estimated 42 patients to determine difference in rates of SIT results between groups. Data were summarized with descriptive statistics.

RESULTS: Fifty-one patients underwent smell identification testing (23 positive (45%) and 28 negative (55%) for COVID-19; mean age 12.7 years; 60% female). 92% of all patients denied subjective change in their sense of smell or taste but only 58.8% were normosmic on testing. There was no difference in screening questionnaires or SIT scores between COVID-19 positive and negative groups.

CONCLUSIONS: Unlike adults, there was no statistical difference in olfactory function between outpatient COVID-19 positive and negative children. Our findings suggest a discrepancy between objective and patient-reported olfactory function in pediatric patients, and poor performance of current screening protocols at detecting pediatric COVID-19.

PMID:36413561 | DOI:10.1371/journal.pone.0277882

PLoS One. 2022 Nov 22;17(11):e0277875. doi: 10.1371/journal.pone.0277875. eCollection 2022.

ABSTRACT

INTRODUCTION: During the COVID-19 pandemic, healthcare workers had a high workload and were exposed to multiple psychosocial stressors. However, a knowledge gap exists about the levels of burnout among Bangladeshi frontline doctors during this COVID-19 pandemic. The study investigated burnout syndrome (BOS) among frontline doctors in two public secondary and tertiary care hospitals in Chattogram, Bangladesh.

MATERIALS & METHODS: This cross-sectional study involved frontline doctors working at two hospitals treating COVID-19 and non-COVID patients from June to August 2020. A self-administered questionnaire that included Maslach Burnout Inventory for Human Services Survey (MBI-HSS) was used to capture demographic and workplace environment information. ANOVA and t-test were used to determine the statistical differences in the mean values of the three dimensions of MBI-HSS. Scores for three domains of burnout: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA) were calculated. Post-hoc analysis was done to identify the significant pair-wise differences when the ANOVA test result was significant. Multiple logistic regression was performed to determine the influence of factors associated with BOS.

RESULTS: A total of 185 frontline doctors were invited to participate by convenience sampling, and 168 responded. The response rate was 90.81%. The overall prevalence of BOS was 55.4% (93/168) (95% CI: 47.5% to 63.0%). Moderate to high levels of EE was found in 95.8% of the participants. High DP and reduced PA were observed in 98.2% and 97% of participants. Younger age (25-29 years), being female, and working as a medical officer were independently associated with high levels of burnout in all three domains. EE was significantly higher in females (P = 0.011). DP was significantly higher in medical officers, those at earlier job periods, and those working more than 8 hours per day.

CONCLUSION: During the COVID-19 outbreak, BOS was common among Bangladeshi frontline doctors. Females, medical officers, and younger doctors tended to be more susceptible to BOS. Less BOS was experienced when working in the non-COVID ward than in the mixed ward.

PMID:36413560 | DOI:10.1371/journal.pone.0277875

PLoS One. 2022 Nov 22;17(11):e0277678. doi: 10.1371/journal.pone.0277678. eCollection 2022.

ABSTRACT

OBJECTIVE: To evaluate the sleep quality by self-reported questionnaires and polysomnography (PSG) among early kidney transplant recipients (KTRs) and to further explore their correlation.

DESIGN: This was a prospective and cross-sectional analysis of the sleep characteristics among early kidney transplant recipients through an objective and subjective measurement.

PARTICIPANTS: Patients with end stage renal disease on the transplant waiting list and after kidney transplantation were from a major organ transplantation center in Southern China (n = 83).

PRIMARY AND SECONDARY OUTCOME MEASUREMENTS: Objective outcomes: PSG, noise and light. Subjective outcomes: demographic and clinical questionnaires, self-reported pain and Richards Campbell sleep questionnaire (RCSQ). After agreement with the informed consent, participants first completed demographic and clinical questionnaires, then worn the PSG within 5-10 days after kidney transplantation. Both noise, light and self-reported pain were monitored during sleep. After completion of PSG, the RCSQs were filled out next morning.

RESULTS: A total of 298 patients were recruited and 83 participants were finally analyzed. The total RCSQ mean score was 51.0±18.9mm. The prevalence of poor sleep quality among early KTRs was 45.1%. Most of PSG characteristics were significantly correlated with their corresponding RCSQ items. And the total RCSQ scores were significantly correlated with the number of awakenings, the N2 percentage and the total sleep time (r = 0.79, 0.47 and 0.40, P<0.05) respectively. Noise was a statistically significant factor affecting the subjective sleep quality.

CONCLUSIONS: The sleep quality in early KTRs measured by both PSG and RCSQ exhibits consistency with each other. Sleep disruption always remains a substantial problem and is affected by self-reported noise among early KTRs. The RCSQ is easily applicable and interpretable so that it can be used for future daily clinical practice.

PMID:36413558 | DOI:10.1371/journal.pone.0277678