Nevin Manimala

Int Orthop. 2022 Nov 14. doi: 10.1007/s00264-022-05631-7. Online ahead of print.

ABSTRACT

PURPOSE: This study proposes machine learning to analyze the risk factors of the collapse in patients with non-traumatic hip osteonecrosis of the femoral head.

METHODS: We collected data of 900 consecutive patients (634 males) with bilateral (428) or unilateral non-traumatic osteonecrosis diagnosed before collapse (at stage I or stage II). The follow-up was average five years (3 to 8 years). A total of 50 variables related to the osteonecrosis were included in the study. The osteonecroses were randomly divided into a training set (80%) and a validation set (20%) with a similar percentage of hips with collapse in the two groups. Machine learning (ML) algorithms were trained with the selected variables. Performance was evaluated and the different factors (variables) for collapse were ranked with Shapley values. The primary outcome was prediction of occurrence of collapse from automated inventory systems.

RESULTS: In this series of patients, the accuracy with machine learning for predicting collapse within three years follow-up was 81.2%. Accuracies for predicting collapse within six to 12-24 months were 54.2%, 67.3%, and 71.2%, respectively, demonstrating that the accuracy is lower for a prevision in the short term than for the mid-term. Despite none of the risk-factors alone achieving statistical significance for prediction, the system allowed ranking the different variables for risk of collapse. The highest risk factors for collapse were sickle cell disease, liver, and cardiac transplantation treated with corticosteroids, osteonecrosis volume > 50% of the femoral head. Cancer (such as leukemia), alcohol abuse, lupus erythematosus, Crohn’s disease, pemphigus vulgaris treated with corticosteroids, and osteonecrosis volume between 40 and 50% were medium risk factors for collapse. Familial cluster of collapse, HIV infection, chronic renal failure, nephrotic syndrome, and renal transplantation, when treated with corticosteroids, stage II, osteonecrosis volume between 30 and 40%, chemotherapy, hip pain with VAS > 6, and collapse progression on the contralateral side, were also significant but lowest risk factors. A heat map is proposed to illustrate the ranking of the combinations of the different variables. The highest risk of collapse is obtained with association of various risks factors.

CONCLUSION: This study, for the first time, demonstrated prediction of collapse and ranking of factors for collapse with a machine learning system. This study also shows that collapse is due to a multifactorial risk factors.

PMID:36374346 | DOI:10.1007/s00264-022-05631-7

Eur Arch Otorhinolaryngol. 2022 Nov 14. doi: 10.1007/s00405-022-07745-5. Online ahead of print.

ABSTRACT

PURPOSE: The current study aims to evaluate gender variations in the efferent auditory system functioning in the ANSD population and compare them to normal hearing persons using contralateral suppression of spontaneous OAE (SOAEs).

METHODS: For the current study, a total of 54 ears were considered prospectively. 27 ears with normal hearing (NH) sensitivity were in group I, while 27 ears with ANSD were in group II. All of the subjects had a regular audiological examination followed by synchronised SOAE recordings with and without broadband noise (in the contralateral ear) at 50 dB SPL and statistical analysis was carried out.

RESULTS: Wilcoxon signed rank test revealed a significant decrease in SOAE amplitude with contralateral noise stimulation in NH, while no such trend was observed in ANSD. However, contralateral SOAE stimulation resulted in significant high-frequency shifts for both the ANSD and NH groups in the noise condition. In the comparison of gender effects on SOAE amplitude and frequency shifts using Mann-Whitney, no significant gender differences were seen. The lack of gender differences in SOAE suppression is explained based on global standing wave theory and local oscillator theory.

CONCLUSIONS: Contralateral effect of noise on SOAE shows frequency shifts, but not amplitude shifts both of which are not affected by gender effects.

PMID:36374345 | DOI:10.1007/s00405-022-07745-5

Eur Spine J. 2022 Nov 14. doi: 10.1007/s00586-022-07452-z. Online ahead of print.

ABSTRACT

PURPOSE: Adolescent idiopathic scoliosis (AIS) is believed to be caused by genetic, neurological, osseous growth anomalies, histological variables including muscle fiber percentage and core structure changes, metabolic and hormonal dysfunction, vestibular dysfunction, and platelet microarchitecture. The objective of this study was to contribute to the determination of the cause of AIS by analyzing the changes in pineal gland volume in AIS cases.

METHODS: Study (AIS) and control group were each comprised of 26 patients who met the inclusion requirements. Scoliosis radiograph and MRI of the pineal glands were used for radiological examinations. The distribution of age, gender, Risser grading for skeletal radiological development, and sexual maturation according to Tanner categorization were uniform and statistically insignificant between groups.

RESULTS: When the pineal gland volumes of the cases were evaluated according to age, the AIS group was found to have significantly reduced pineal gland volumes in all age groups. The pineal gland volume was found to be 38.1% lower in the AIS group compared to the control group (p˂0.001). In the AIS group, patients aged 13 years had the lowest pineal gland volume (77.2 ± 13.86 mm³), while patients aged 15 years had the highest volume (97.9 ± 16.47 mm³).

CONCLUSION: Changes in pineal gland volume support the role of the pineal gland in the etiopathogenesis of AIS.

PMID:36374335 | DOI:10.1007/s00586-022-07452-z

Nutr Hosp. 2022 Nov 14. doi: 10.20960/nh.04120. Online ahead of print.

ABSTRACT

INTRODUCTION: when peripheral tissues don’t respond well to insulin action, it is defined as insulin resistance (IR). Many methods and indices are available for the estimation of IR, among them the homeostasis model assessment of insulin resistance (HOMA-IR) involves fasting plasma glucose and insulin. Nevertheless, the TyG index has a methodological advantage over the HOMA-IR because it requires only measurements provided by routine laboratory tests.

AIM: distribution asessment of the HOMA-IR and TyG indexes in the sample. Also, to determine the predictive capacity of HOMA-IR, using TyG cutoff point as IR-positive diagnostic test.

MATERIALS AND METHODS: a cross-sectional analytical study with 1686 participants aged 18 to 21 years from the state of San Luis Potosí, Mexico. Anthropometric assessment involves variables of weight and height. Fasting glucose, insulin and triglyceride concentrations were quantified. In addition, a questionnaire was carried out to know the hereditary family history and the presence of noncommunicable diseases (NCDs). Student’s t-test was used to assess the differences in mean statistics between males and females. A receiver operating characteristic (ROC) curve was applied to examine the potential of HOMA-IR to identify IR.

RESULTS: 56 % of the study adolescents were females and 44 % were males; mean BMI was 22.62 ± 3.21 kg/m2. In the total sample mean serum glucose, insulin, and triglyceride concentrations were 89.48 ± 9.84 mg/dL, 6.26 ± 5.04 µU/mL, and 95.64 ± 55.78 mg/dL, respectively. A prevalence of 28.2 % of IR was determined, evaluated with the cut-off points for the TyG index. Subsequently, Receiver Operator Curves (ROC) were performed to evaluate the predictive capacity of HOMA-IR. The most outstanding cut-off value was 1.08 for the HOMA-IR index, reaching a sensitivity of 66 % and a specificity of 53 %. The prevalence of HOMA-IR greater than or equal to 1.18 was 47 % in the total population, 19.3 % in males and 28.5 % in females Conclusions: HOMA-IR and TyG can be useful diagnostic parameters for the assessment of IR in late adolescence. To provide a health guide for IR, we propose that a HOMA-IR target value ≤ 1.08 should be considered.

PMID:36373659 | DOI:10.20960/nh.04120

Workplace Health Saf. 2022 Nov 14:21650799221123261. doi: 10.1177/21650799221123261. Online ahead of print.

ABSTRACT

BACKGROUND: Burnout is a significant concern among health care professionals, particularly those working in the emergency department (ED). Given the negative personal and professional consequences that burnout can have on all health care professionals, multidisciplinary solutions are needed to address burnout. Our objective was to evaluate the feasibility and potential impact of resilience training delivered through a smartphone application on burnout among health care professionals working at a tertiary-care pediatric ED.

METHODS: We conducted a single-center pilot randomized controlled study enrolling multidisciplinary health care professionals working in our ED. Participants assigned to the intervention group received self-driven access to a smartphone application that provided a structured resilience curriculum for a period of 3 months. The participants completed psychometric assessments both prior to and following the invention period. Changes in psychometric measures of the intervention group were then compared with a waitlist-control group.

RESULTS: Following the intervention period, a total of 20 participants were included in the final analysis. The change in participant scores on psychometric measures prior to and following the intervention period was calculated. A statistically significant mean decrease in burnout measure (emotional exhaustion subscale of Maslach-Burnout Inventory mean score -5.88, p < .001) and increase in mindfulness measure (Mindful Attention Awareness Scale mean score 0.51, p < .001) was observed among the intervention group participants.

CONCLUSIONS/APPLICATION TO PRACTICE: Our study suggests that a resilience training program delivered using a smartphone application can be an effective intervention in reducing burnout and increasing mindfulness skills. Our study also demonstrated the potential feasibility of a randomized controlled study of burnout within a multidisciplinary group of health care professionals.

PMID:36373628 | DOI:10.1177/21650799221123261

J Interpers Violence. 2022 Nov 13:8862605221134086. doi: 10.1177/08862605221134086. Online ahead of print.

ABSTRACT

Empirical findings on the relationship between women’s employment and intimate partner violence (IPV) in low- and middle-income countries (LMICs) are mixed. These varied findings may arise because research thus far has given insufficient attention to how individual attributes and community context shape the pathways between women’s employment and IPV. Using publicly available Demographic and Health Survey (DHS) data from 20 LMIC settings (n = 168,995), we investigate (1) how women’s employment is associated with past-year IPV and (2) if associations differ by household- or community-level structural drivers of IPV: women’s attitudes toward IPV, women’s participation in household decision-making, and relative wealth. We fit mixed-effects logistic regression models exploring the total, individual, community, and contextual effects of women’s employment on past-year IPV; effect measure modification by structural drivers; and cross-level interactions between community-level structural drivers and individual employment. Our analyses reveal positive associations between total (odds ratio [OR] = 1.31; 95% CI [1.27, 1.35]), individual (OR = 1.23; 95% CI [1.19, 1.27]), community (OR = 1.06; 95% CI [1.06, 1.07]), and contextual effects (OR = 1.04; 95% CI [1.03, 1.05]) of women’s employment for IPV. Only individual wealth demonstrated statistically significant effect measure modification for the relationship between individual employment and past-year IPV (ratio of OR = 0.95; 95% CI [0.92, 0.99]). These findings suggest interventions that focus only on increasing women’s employment may be associated with harmful increases in the occurrence of IPV, even when these interventions enable a large proportion of women in a community to be employed. Structural interventions that change norms of women’s autonomy or attitudes toward IPV at the household or community levels may be insufficient to ameliorate these negative effects, whereas interventions that increase household wealth partly may buffer these effects.

PMID:36373609 | DOI:10.1177/08862605221134086

Chronic Illn. 2022 Nov 13:17423953221138921. doi: 10.1177/17423953221138921. Online ahead of print.

ABSTRACT

OBJECTIVE: To study the prevalence and impact of comorbidities among a cohort of patients with systemic lupus erythematosus (SLE).

METHODS: This study is retrospective, multicenter including 902 Egyptian patients with SLE. Medical records were reviewed for demographic data, clinical characteristics, routine laboratory findings, immunological profile, and medications. Moreover, SLE Disease Activity Index (SLEDAI), and the Systemic Lupus International Collaborating Clinics/American College Rheumatology Damage Index scores were calculated.

RESULTS: Comorbidities were found in 75.5% of the studied group with hypertension and dyslipidemia as the most frequent comorbidities (43.1% and 40.1%, respectively), followed by sicca features, avascular necrosis, diabetes, osteoporosis and renal failure (11.5%,9%, 9%,8.9%, and 7.1%, respectively). Multivariate regression model showed statistically significant relation between the presence of comorbid condition and each of age (P = 0.006), disease duration (P = 0.041), SLEDAI at onset (P < 0.001), cyclophosphamide intake (P = 0.001), and cumulative pulse intravenous methylprednisone (P < 0.001). Also, when adjusted to age and sex, those with multiple comorbid conditions had 18.5 increased odds of mortality compared to those without comorbidities (odds ratio (OR), 95% confidence interval (CI) = 18.5 (6.65-51.69)].

CONCLUSION: Patients with SLE suffer from several comorbidities, with an increasing risk with age, longer disease duration, higher SLEDAI at onset, cyclophosphamide intake and cumulative pulse intravenous methylprednisone. Risk of mortality is exponentiated with multiple comorbidities.

PMID:36373605 | DOI:10.1177/17423953221138921

Cleft Palate Craniofac J. 2022 Nov 13:10556656221139674. doi: 10.1177/10556656221139674. Online ahead of print.

ABSTRACT

The primary goal of palatoplasty is the restoration of normal speech, that can be aimed by, among many procedures, lengthening the palate through the pushback technique; one of its complications is abnormal maxillary growth. The main factor affecting facial growth in CLP patients is believed by many to be the palatoplasty-due to the large scar retraction resulting from some surgical techniques. The non-crosslinked two-layer bioabsorbable collagen matrix Mucograft^™ (Geistlich Pharma AG, Wolhusen, Switzerland) is a potential tool to aid in wound closure in a second-intention healing situation.

The objective of this work was to test the use of an acellular dermal matrix (Mucograft^®) in an experimental model of Veau-Wardill-Kilner palatoplasty, as a tool to reduce scar retraction of the denuded palatine mucosa.

Twenty-four 3-week-old male Wistar rats were used. The animals were randomly divided into two groups. In the control group, an excision was made with bone exposure in the palate, simulating the defect left in the Veau-Wardill-Kilner palatoplasty. In the intervention group, the same procedure was performed, and the area of denuded palatine bone was treated with a bioabsorbable collagen matrix (Mucograft^®). For data collection, 9 weeks after surgery (12 weeks of life), the animals were euthanized by excessive anesthetic dosage. Maxillary growth, macroscopic appearance of the scar, pain, and bleeding were evaluated.

There were significant statistical differences between the groups for palate length growth (7.6 mm + -0.38 mm vs 5.5 mm + -0.36 mm, P = .009) and for palate width growth (1.47 mm + -0.8 mm vs -0.09 mm + -0.55 mm, P = .001), favoring dermal matrix group compared to controls. Whereas for pain and bleeding, there were no differences between the groups.

The use of dermal matrix in rats with an area of bone denudation on the palate increases maxillary length and width growth patterns. Besides, it does not increase pain, bleeding, or post-operative complications.

PMID:36373603 | DOI:10.1177/10556656221139674

Am J Rhinol Allergy. 2022 Nov 13:19458924221139019. doi: 10.1177/19458924221139019. Online ahead of print.

ABSTRACT

BACKGROUND: Caudal pneumatization of the pterygoid process may impact endonasal exposure of the lateral recess of sphenoid sinus (LRSS).

OBJECTIVES: This study aims to explore the implications of a pneumatized pterygoid process for an endonasal transpterygoid approach to the LRSS and to define strategies regarding the preservation or sacrifice of the vidian nerve.

METHODS: Dissection of the LRSS (11 sides) was performed on 6 cadaveric specimens, preselected for the radiographic presence of an LRSS. In addition, the dimensions of the LRSS were measured on the deidentified CT images of 120 patients (240 sides). The sphenoid sinus was subdivided into 3 categories: Type 1 (no identifiable LRSS), Type 2 (lateral pneumatization of the greater wing above the vidian canal), and Type 3 (pneumatization of both the greater wing and the pterygoid process).

RESULTS: On the cadaveric specimens, a Type 2 pneumatization often allowed access to the LRSS above the level of the vidian canal; thus, sparing the vidian neurovascular bundle. In Type 3 pneumatization, a frontal corridor through the pterygoid base could be created to reach the LRSS with preservation of the vidian nerve. Extreme Type 3 pneumatization, however, required the transposition or sacrifice of the vidian nerve to facilitate a full direct access to the superolateral LRSS. Measurements on CT images revealed that the extent of caudal pneumatization of the pterygoid process had no statistically significant correlation with the superolateral extension of the lateral recess in patients with Type 3 LRSS (P > .05).

CONCLUSION: Pneumatization of the LRSS toward a caudal or superolateral direction may develop independent from each other. Caudal pneumatization of the pterygoid process seems to variably impact the endonasal exposure of the LRSS.

PMID:36373591 | DOI:10.1177/19458924221139019

Am J Rhinol Allergy. 2022 Nov 13:19458924221137982. doi: 10.1177/19458924221137982. Online ahead of print.

ABSTRACT

BACKGROUND: Nasal adhesions (NAs) are a known complication of nasal airway surgery. Even minor NAs can lead to significant postoperative nasal airway obstruction (NAO). Division of such NAs often provides much greater relief than anticipated.

OBJECTIVE: We examine the impact of NAs at various anatomical sites on nasal airflow and mucosal cooling using computational fluid dynamics (CFD) and multiple test subjects.

METHODS: CT scans of healthy adult subjects were used to construct three-dimensional nasal airway computational models. A single virtual 2.5 mm diameter NA was placed at one of five sites commonly seen following NAO surgery within each nasal cavity bilaterally, resulting in 10 NA models and 1 NA-free control for each subject. CFD analysis was performed on each NA model and compared with the subject’s NA-free control model.

RESULTS: 4 subjects were recruited to create 44 computational models. The NAs caused the airflow streamlines to separate, leading to a statistically significant increase in mucosal temperature immediately downstream to the NAs (wake region). Changes in the mucosal temperature in the wake region of the NAs were most prominent in anteriorly located NAs with a mean increase of 1.62 °C for the anterior inferior turbinate NAs (P < .001) and 0.63 °C for the internal valve NAs (P < .001).

CONCLUSION: NAs result in marked disruption to airflow patterns and reduced mucosal cooling on critical surfaces, particularly in the wake region. Reduced wake region mucosal cooling may be a contributing factor to the exaggerated perception of nasal obstruction experienced by patients with NAs.

PMID:36373577 | DOI:10.1177/19458924221137982