Nevin Manimala

Acta Obstet Gynecol Scand. 2021 Nov 3. doi: 10.1111/aogs.14277. Online ahead of print.

ABSTRACT

INTRODUCTION: Conflicting reports of increases and decreases in rates of preterm birth (PTB) and stillbirth in the general population during the coronavirus disease 2019 (COVID-19) pandemic have surfaced. The objective of our study was to conduct a living systematic review and meta-analyses of studies reporting pregnancy and neonatal outcomes by comparing the pandemic and pre-pandemic periods.

MATERIAL AND METHODS: We searched PubMed and Embase databases, reference lists of articles published up until August 14, 2021 and included English language studies that compared outcomes between the COVID-19 pandemic time period and the pre-pandemic time periods. Risk of bias was assessed using the Newcastle-Ottawa scale. We conducted random-effects meta-analysis using the inverse variance method.

RESULTS: Forty-five studies with low-to-moderate risk of bias, reporting on 1 843 665 pregnancies during the pandemic period and 23 564 552 pregnancies during the pre-pandemic period, were included. There was significant reduction in unadjusted estimates of PTB (35 studies, unadjusted odds ratio [uaOR] 0.95, 95% CI 0.92-0.98), but not in adjusted estimates (six studies, adjusted OR [aOR] 0.95, 95% CI 0.80-1.13). This reduction was noted in studies from single centers/health areas (25 studies, uaOR 0.90, 95% CI 0.86-0.96) but not in regional/national studies (10 studies, uaOR 0.99, 95% CI 0.95-1.02). There was reduction in spontaneous PTB (six studies, uaOR 0.89, 95% CI 0.81-0.96) and induced PTB (five studies, uaOR 0.89, 95% CI 0.81-0.97). There was no difference in the odds of stillbirth between the pandemic and pre-pandemic time periods (24 studies, uaOR 1.11, 95% CI 0.97-1.26 and four studies, aOR 1.06, 95% CI 0.81-1.38). There was an increase in mean birthweight during the pandemic period compared with the pre-pandemic period (six studies, mean difference 17 g, 95% CI 7-28 g). The odds of maternal mortality were increased (four studies, uaOR 1.15, 95% CI 1.05-1.26); however, only unadjusted estimates were available and the result was mostly influenced by one study from Mexico. There was significant publication bias for the outcome of PTB.

CONCLUSIONS: The COVID-19 pandemic may be associated with a reduction in PTB; however, referral bias cannot be excluded. There was no statistically significant difference in stillbirth between pandemic and pre-pandemic periods.

PMID:34730232 | DOI:10.1111/aogs.14277

Med Phys. 2021 Nov 3. doi: 10.1002/mp.15332. Online ahead of print.

ABSTRACT

BACKGROUND: The prevalence of thyroid diseases has been increasing year by year. In this study, we established and validated a deep learning method (Cascade region-based convolutional neural network, R-CNN) based on ultrasound videos for automatic detection and segmentation of the thyroid gland and its surrounding tissues in order to reduce the workload of radiologists and improve the detection and diagnosis rate of thyroid disease.

METHODS: 71 patients with normal thyroid ultrasound were included. The ultrasound videos of 59 patients were used as the training dataset, the data of 12 patients were used as the validation dataset, and in addition, the data of 9 patents were used as the testing dataset. Ultrasound videos of thyroid examination, including five standard sections (left and right lobe transverse scan, central isthmus transverse scan, left and right lobe longitudinal scan), were collected from all patients. The radiologists labeled the neck tissues, including anterior cervical muscle, cricoid cartilage, trachea, thyroid gland, endothyroid vessels, carotid artery, internal jugular vein, and esophagus. A large dataset was constructed to train and test the deep learning method. The performance was evaluated using the COCO metrics AP, AP50, and AP75. We compared the Cascade R-CNN with a state-of-the-art method CenterMask in the test dataset.

RESULTS: We annotated 166817, 34364 and 29227 regions in training, validation and testing samples. The model could achieve a good detection performance for the thyroid left lobe, right lobe, isthmus, muscles, trachea, carotid artery, and jugular vein; the AP₅₀ of these tissues were 86.5%, 87.5%, 89.1%, 96.1%, 96.6%, 97.7%, and 91.8%, respectively. In addition, the model showed good segmentation performance for the muscles, trachea, and carotid artery; the AP₅₀ of these tissues were 96%, 96.6%, and 97.8%, respectively. For the left lobe, right lobe, isthmus, esophagus, and jugular vein, AP₅₀ was ≥86%. However, the segmentation results for the cricoid cartilage and endothyroid vessels were not high (AP₅₀ of 53.9% and 48.5%, respectively). For fair comparison, the performance of Cascade R-CNN is better than that of CenterMask for detection and segmentation tasks. The difference was statistically significant (P < 0.05).

CONCLUSIONS: The new method could successfully detect and segment the thyroid gland and its surrounding tissues. This article is protected by copyright. All rights reserved.

PMID:34730231 | DOI:10.1002/mp.15332

Eur Rev Med Pharmacol Sci. 2021 Oct;25(20):6349-6355. doi: 10.26355/eurrev_202110_27008.

ABSTRACT

OBJECTIVE: Pupillometry has been used to assess pain intensity and response to analgesic drugs in adults. The aim of this study was to verify the usefulness and effectiveness of the pupillometer to assess pain and depth of sedation in pediatric patients undergoing painful procedures and to optimize pain management by observing pupillary variations induced by opioids.

PATIENTS AND METHODS: This is a prospective, monocentric study conducted in the sedation room of the Pediatric Intensive Care Unit of Fondazione Policlinico A. Gemelli in Rome. A population of 22 pediatric patients who underwent painful procedures was enrolled. Eleven children were sedated by opioid drugs. Heart rate, systolic blood pressure, diastolic blood pressure, bispectral index, maximum pupil size (Size), pupil change (CH), Neurological Pupil Index (NPi) were collected over four times: before starting the procedure; before the painful stimulus (when the patient was sedated); when the painful stimulus was applied; at the end of the procedure. A NeurOptics NPi-200 pupillometer was used for the study.

RESULTS: Statistical significance in the variation of haemodynamic parameters was less significant than the variation obtained by analyzing the pupillary parameters: a significant change in NPi and CH in the transition from wakefulness to sedation and from the application of the painful stimulus to awakening was found in both study populations, patients who have received opioids and patients who have not received opioids. Changes in the mean CH of the pupil diameter correlate with the depth of sedation, and the size values vary in relation to the administration of opioids.

CONCLUSIONS: Our findings highlight the potential role of pupillometry as a non-invasive method to objectively quantitate pain response in children to reach an efficient analgesic approach.

PMID:34730216 | DOI:10.26355/eurrev_202110_27008

Eur Rev Med Pharmacol Sci. 2021 Oct;25(20):6339-6348. doi: 10.26355/eurrev_202110_27006.

ABSTRACT

OBJECTIVE: Acute Cholecystitis (AC) accounts for a significant proportion of patients presenting to the Emergency Department with abdominal pain. We suggest grading the severity of AC with a simple system: TNM, an acronym borrowed by cancer staging where T indicated Temperature, N neutrophils and M Multiple organ failure. This retrospective-prospective observational study evaluates the predictive value of TNM score on mortality of patients with AC.

PATIENTS AND METHODS: TNM was developed in a training cohort of 178 patients with AC who underwent cholecystectomy from February 2005 to December 2012 (retrospectives data). To verify the prognostic value of TNM score, we prospectively recruited 172 patients who were consecutively included and treated from January 2013 to July 2020 as the validation cohort. After defining the categories T, N and M, patients were grouped in stages. The variables analyzed were age, sex, American Society of Anesthesiologists (ASA) score, blood transfusion, temperature, neutrophils count, preoperative organ failure, immune-compromised status, stage.

RESULTS: In the training cohort TNM staging was: none patient at stage 0; 6 patients at stage I; 71 patients at stage II; 71 patients at stage III; 30 patients at stage IV. Death occurred in 51 patients. ASA score, neutrophils count, preoperative organ failure, stage III-IV emerged as statistically significant different prognostic factors. ASA score (III-IV) and stage (III-IV) were significant independent predictors of post-operative mortality in multivariate analysis. Comparable results were observed in the validation cohort.

CONCLUSIONS: TNM classification is very easy to use; it helps to define the mortality risk and it is useful to objectively compare patients with AC.

PMID:34730215 | DOI:10.26355/eurrev_202110_27006

Eur Rev Med Pharmacol Sci. 2021 Oct;25(20):6319-6325. doi: 10.26355/eurrev_202110_27002.

ABSTRACT

OBJECTIVE: To evaluate the effect of near infra-red gallium-aluminium-arsenide (GaAlAs) diode laser (805 nm) irradiation on proliferation and differentiation of rat femoral bone marrow-derived mesenchymal stem cells (BMSCs) cultured in osteogenic medium.

MATERIALS AND METHODS: BMSCs were obtained from femurs of 60 Sprague Dawley rats (200 gm). The control group comprised isolated BMSCs supplemented with an osteogenic differentiation medium. On the other hand, in the experimental group, the BMSCs were irradiated with a near-infrared laser in addition to an osteogenic differentiation medium. The experimental group was irradiated with a soft tissue laser comprising of allium-aluminium-arsenic (Ga-Al-Ar) Diode at a near-infrared wavelength of 805 nm in continuous mode. The different output powers applied were 0.5 W, 1.0 W, 1.5 W and 2.0 W respectively. Various energy levels of 1, 4, 7 and 10 J were used for irradiation. Alkaline phosphatase (ALP) assay and Alizarin staining were performed to confirm osteogenic differentiation. Statistical analysis was done using a one-way ANOVA and a p-value of <0.05 was considered significant.

RESULTS: According to our findings, 1.27 J/cm2 was the optimal energy density value that significantly increased the BMSC proliferation at the output of 1.5 W with the power density of 1.27 W/cm2. On 1.27 J/cm2, there was a significant difference compared to the control group on the first day, and the osteogenic differentiation increased significantly on the 4th day compared to the 1st day.

CONCLUSIONS: According to our findings, 1.27 J/cm2 was the optimal energy density value that significantly increased the BMSC proliferation at the output of 1.5 W with the power density of 1.27 W/cm2.

PMID:34730212 | DOI:10.26355/eurrev_202110_27002

Eur Rev Med Pharmacol Sci. 2021 Oct;25(20):6311-6318. doi: 10.26355/eurrev_202110_27001.

ABSTRACT

OBJECTIVE: This study was done to determine UI prevalence among women in Saudi Arabia and identify the associated risk factors.

PATIENTS AND METHODS: This cross-sectional study was conducted from January 2020 to September 2020 in Saudi women who came to the Urology Department at King Khalid Hospital, Majmaah, Saudi Arabia. In the age group of 20 to 50 years, Saudi women who are not seriously ill or pregnant or in the postnatal period or diagnosed with pelvic organ prolapse were included as participants. A semi-structured questionnaire modified from the International Consultation Incontinence Questionnaire-Short Form was used to collect data on frequency, the severity, consequences, and impact of UI on quality of life. Data were analyzed by SPSS 23 (IBM, Armonk, NY, USA) with the calculation of mean and standard deviation for quantitative variables. Logistic regression analyses were applied to determine the predictors of UI.

RESULTS: A total of 451 participants were included in the final analysis. The mean age of the study population was 42.52 years (SD 11.75). Among risk factors, 45 (10%) had diabetes, 56 (12.4%) had hypertension, 36 (8%) had asthma, 80 (17.7%) had UTI/STDs. Out of 451 participants, 188 (41.7%) had urinary incontinence (UI). Sociodemographic characteristics and risk factors like family income, urinary and genital infections (UTI/STDs), pelvic/uterine prolapse, any other disease, and cough were found to have a statistically significant association with urinary incontinence (p-value <0.05).

CONCLUSIONS: The prevalence of UI was 41.7% among the study population. The various risk factors associated with UI are older age, parity, multiple vaginal deliveries, hypertension, history of asthma, and chronic cough. Poor health-seeking behavior was observed. Creating awareness and the need for early diagnosis with timely intervention is recommended.

PMID:34730211 | DOI:10.26355/eurrev_202110_27001

Eur Rev Med Pharmacol Sci. 2021 Oct;25(20):6300-6310. doi: 10.26355/eurrev_202110_27000.

ABSTRACT

OBJECTIVE: Understanding changes of right ventricular (RV) geometry and function in repaired Tetralogy of Fallot (rToF) patients can improve decision-making for pulmonary valve replacement. Therefore, we aimed to assess the magnitude and clinical correlations of RV changes in rToF patients.

PATIENTS AND METHODS: Clinical and MRI data of rToF patients who underwent repeated cardiac magnetic resonance imaging (MRI) at two centers between December 2003 and September 2020 were analyzed together with anatomical factors, including RV outflow tract obstruction, pulmonary artery branch stenosis, and tricuspid regurgitation. Adverse cardiac events and/or NYHA class worsening were documented and correlated with MRI changes. QRS length was reported at each MRI.

RESULTS: Two-hundred-and-nineteen rToF patients (53% males, aged 20.2 ± 10.1 years) were enrolled. An increase of ventricular dimensions, except LVEDVi, and worsening of right and left ejection fractions were found over an average period of 5 years of follow-up. These changes were statistically significant but within 10% of the initial value. No significant changes were reported on a year-to-year basis, except in a small group of patients (6%) in whom no predictive factors were identified. Despite similar RV dimensions at the first examination, younger patients had a higher RV ejection fraction and a different annual rate of change of ventricular dimensions compared to older ones. Patients with arrhythmias (20%) were more frequently older and had larger RV dimensions but showed no significant correlations with MRI changes/years.

CONCLUSIONS: Changes in RV dimensions and function occur rarely and very slowly in rToF patients. A small percentage of patients experience a significant worsening in a short time interval without any recognized risk factors. Arrhythmias appear to occur in a small percentage of cases in the late follow-up.

PMID:34730210 | DOI:10.26355/eurrev_202110_27000

Indian J Med Ethics. 2021 Aug 10;-(-):1-5. doi: 10.20529/IJME.2021.060. Online ahead of print.

ABSTRACT

Predatory journals charge publication fees from authors and publish without an adequate peer review, and often do not provide editorial and/or publishing services. Our objective was to evaluate e-mail solicitations received by authors in a defined time period to identify attributes of these solicitations as a metric to identify legitimacy of the journal. All e-mails seeking article submission received between January 1 and September 30, 2019, were evaluated. Each e-mail along with its respective webpage was evaluated for the journal’s and publisher’s names, mention of peer review, any assurance of publication, a mention of article processing charges (APC), composite invites [in the e-mail] and mention of peer review, the presence and functionality of archives, presence of manuscript management tab, mention of APC [on the webpage]. Descriptive statistics were used for the analysis. Of the 135 e-mails screened, 100 were finally included in the analysis. We found that 72% of the journals and/ or publishers were included in Beall’s list. According to our criteria, a total of 85% of the solicitations were from journals that we identified as “presumed predatory”. Our study has identified assurance of publication, rapid turnaround time, ambiguous information in the email and webpage, false claims of indexing as some descriptors which may help young authors and researchers assess a journal’s legitimacy.

PMID:34730088 | DOI:10.20529/IJME.2021.060

Radiol Technol. 2021 Nov;93(2):161-176.

ABSTRACT

PURPOSE: To explore self-reported musculoskeletal symptoms in radiographers registered by the American Registry of Radiologic Technologists (ARRT) in the United States. There is a gap in the literature focusing on the unique set of risk factors for radiographers.

METHODS: A subset of ARRT radiographers received an email invitation to complete an online survey that included questions about their experience with musculoskeletal symptoms and their exposure to potential risk factors for those symptoms.

RESULTS: Out of the 635 ARRT credentialed, nonretired radiographers who completed the survey, 81% reported experiencing pain or discomfort while performing patient cases. Through logistic regression statistical modeling, a set of 4 personal factors (including poorer perceptions of health and sleep quality), 1 work demographic factor (working in fluoroscopy), and 3 psychosocial work factors (including perceptions of higher physically demanding workload and work pressure and stress) were identified in differentiating radiographers who experience pain or discomfort when performing patient cases from those who do not.

DISCUSSION: Consistent with prior research, these results indicate multiple work-related factors, including physical and psychosocial work factors, appear to be associated with the prevalence of musculoskeletal symptoms in radiographers. Ideas for addressing these risk factors are discussed, as well as opportunities for radiography managers and academics to collaborate in evaluating the effectiveness of intervention ideas when deployed in practice.

CONCLUSION: Although this study is cross-sectional, these results can be used to inform intervention efforts, such as limiting or rotating work duties in fluoroscopy, reducing other physically demanding aspects of work, addressing understaffing, which increases work pressure in many ways, and promoting employee self-care practices.

PMID:34728578

Mol Cancer Ther. 2021 Nov 2:molcanther.0511.2021. doi: 10.1158/1535-7163.MCT-21-0511. Online ahead of print.

ABSTRACT

The pro-survival MCL1 protein is overexpressed in many cancers, including B-cell non-Hodgkin lymphomas (B-NHL). S63845 is a highly specific inhibitor of MCL1. We analyzed mechanisms of sensitivity/resistance to S63845 in preclinical models of diffuse large B-cell lymphoma (DLBCL) and Burkitt lymphoma (BL). Annexin V-based cytotoxic assays, western blot, protein co-immunoprecipitation, and cell clones with manipulated expression of BCL2 family proteins were used to analyze mechanisms of sensitivity to S63845. Experimental in vivo therapy with S63845 and/or venetoclax was performed using patient-derived xenografts (PDX) of treatment-refractory B-NHL. A subset of DLBCL and majority of BL cell lines were sensitive to S63845. The level of BCL2 protein expression was the major determinant of resistance to S63845: BCL2 serves as a buffer for pro-apoptotic proteins released from MCL1 upon exposure to S63845. While BCL2-negative lymphomas were effectively eliminated by single-agent S63845, its combination with venetoclax was synthetically lethal in BCL2-positive PDX models. Concerning MCL1, both, the level of MCL1 protein expression, and its occupational status represent key factors mediating sensitivity to S63845. In contrast to MCL1-BIM / BAK1 complexes that prime lymphoma cells for S63845-mediated apoptosis, MCL1-NOXA complexes are associated with S63845 resistance. In conclusion, MCL1 represents a critical survival molecule for most BLs and a subset of BCL2-negative DLBCLs. The level of BCL2 and MCL1 expression and occupational status of MCL1 belong to the key modulators of sensitivity/resistance to S63845. Co-treatment with venetoclax can overcome BCL2-mediated resistance to S63845, and enhance efficacy of MCL1 inhibitors in BCL2-positive aggressive B-NHL.

PMID:34728569 | DOI:10.1158/1535-7163.MCT-21-0511