Nevin Manimala

Am J Surg. 2022 Aug 29:S0002-9610(22)00540-2. doi: 10.1016/j.amjsurg.2022.08.017. Online ahead of print.

ABSTRACT

BACKGROUND: While it is assumed adolescents receive comparable trauma care at pediatric trauma centers (PTC), adult trauma centers (ATC), and combined facilities (MTC), this remains understudied.

METHODS: We conducted a retrospective cohort study through the NTDB evaluating patients 14-18 years of age who presented to an ACS-verified level 1 or 2 trauma facility between 1/1/2016 and 12/31/2019. Multiple logistic regression analyses were performed to compare mortality risk among trauma facility verification types.

RESULTS: 91,881 adolescents presented after trauma over the four-years. Hypotension, severe TBI, firearm mechanism, and ISS >15 were associated with increased mortality. Compared to PTCs, the odds of trauma-related mortality were statistically higher at MTCs (OR 1.82, p = 0.004) and ATCs (OR 1.89-2.05, p = 0.001-0.002).

CONCLUSIONS: Injured adolescents receiving care at ATCs and MTCs have higher mortality risk than those cared for at PTCs. Further evaluation of factors associated with this observed difference is warranted and may help identify opportunities to improve outcomes in injured adolescents.

PMID:36058750 | DOI:10.1016/j.amjsurg.2022.08.017

Gynecol Oncol. 2022 Sep 1:S0090-8258(22)00542-X. doi: 10.1016/j.ygyno.2022.08.004. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of the present study was to define and validate an anastomotic leak prognostic score based on previously described and reported anastomotic leak risk factors (OVA-LEAK: https://n9.cl/ova-leakscore) and to establish if the use of OVA-LEAK score is better than clinical criteria (surgeon’s choice) selecting anastomosis to be protected with a diverting ileostomy.

MATERIAL & METHODS: This is a retrospective, multicentre cohort study that included patients who underwent cytoreductive surgery for primary advanced or relapsed ovarian cancer with colorectal resection and anastomosis between January 2011 and June 2021. Data from patients already included in the previous predictive model were not considered in the present analysis. To validate the performance of our logistic regression model, we used the OVA-LEAK formula (Annex I: https://n9.cl/ova-leakscore) for estimating leakage probabilities in a new independent cohort. Then, receiver operating characteristic (ROC) analysis was performed and area under the curve (AUC) was used to measure the performance of the model. Additionally, the Brier score was also estimated. 95% confidence intervals (CI) for each of the estimated performance measures were also calculated.

RESULTS: 848 out of 1159 recruited patients were finally included in the multivariable logistic regression model validation. The AUC of the new cohort was 0.63 for predicting anastomotic leak. Considering a cut-off point of 22.1% to be ‘positive’ (to get a leak) this would provide a sensitivity of 0.45, specificity of 0.80, positive predictive value of 0.09 and negative predictive value of 0.97 for anastomotic leak. If we consider this cut-off point to select patients at risk of leak for bowel diversion, up to 22.5% of the sampled patients would undergo a diverting ileostomy and 47% (18/40) of the anastomotic leaks would be ‘protected’ with the stoma. Nevertheless, if we consider only the ‘clinical criteria’ for performing or not a diverting ileostomy, only 12.5% (5/40) of the leaks would be ‘protected’ with a stoma, with a rate of diverting ileostomy of up to 24.3%.

CONCLUSIONS: Compared with subjective clinical criteria, the use of a predictive model for anastomotic leak improves the selection of patients who would benefit from a diverting ileostomy without increasing the rate of stoma use.

PMID:36058743 | DOI:10.1016/j.ygyno.2022.08.004

J Am Dent Assoc. 2022 Sep 1:S0002-8177(22)00433-0. doi: 10.1016/j.adaj.2022.07.007. Online ahead of print.

ABSTRACT

BACKGROUND: Obtaining thorough documentation of a patient’s medical history is important for dental care professionals, as oral health is connected intricately to systemic health. The purpose of this study was to assess the accuracy of parent-reported health history for pediatric patients in a dental setting.

METHODS: A retrospective chart review was conducted on 863 patients 17 years and younger. Parent-reported health history was compared with subsequent physician-to-dentist consultations. The most common diagnoses were grouped on the basis of International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, categories.

RESULTS: The sensitivity of parent report of health conditions was highest for reporting mental and behavioral disorders (75.1%; 95% CI, 69.6% to 80.0%), followed by nervous system diseases (63.0%; 95% CI, 47.5% to 76.8%), respiratory conditions (47.9%; 95% CI, 37.6% to 58.4%), congenital conditions (46.3%; 95% CI, 30.7% to 62.6%), and cardiovascular conditions (25.0%; 95% CI, 11.4% to 43.4%) and was lowest for hematologic conditions (12.2%; 95% CI, 4.1% to 26.2%). Parents of children 6 years and older and those with private insurance had higher sensitivity for reporting mental and behavioral conditions than those with children younger than 6 years or having Medicaid (P < .0001). The specificity of parent-reported health conditions ranged from 96.0% for mental and behavioral disorders to 99.8% for hematologic conditions.

CONCLUSIONS: Sensitivity varied widely, showing that parents may be unreliable in their report of children’s health histories and that dentists cannot rely solely on parents when obtaining health history.

PRACTICAL IMPLICATIONS: In advocating for patient safety, especially for those with special needs and complex medical conditions, this study supports the use of medical evaluation before dental treatment and for the integration of dental and electronic health records.

PMID:36058728 | DOI:10.1016/j.adaj.2022.07.007

West Afr J Med. 2022 Aug 31;39(8):836-843.

ABSTRACT

BACKGROUND: Alcoholic beverages come in various shades and flavours, often intensely advertised to the youthful population on various media channels within the state. Excessive intake is known to have deleterious effects on several dimensions of health. This study therefore assessed the prevalence and pattern of alcoholic beverage consumption among undergraduates in Remo division of Ogun State, Nigeria.

METHODS: A cross-sectional study was carried out among 420 students attending three tertiary institutions in Remo area, Ogun State, selected via multi-stage sampling. Data were collected using a validated self-administered, semi-structured questionnaire and analyzed with SPSS 20.0. Relevant descriptive and inferential statistics were calculated (p<0.05).

RESULTS: The mean age of respondents was 20.12±3.2 years, with 219 (54.3%) being female. Only 14 (3.5%) respondents believed alcoholic beverage consumption was good. One hundred and forty-two (35.2%) participants consumed alcoholic beverages. Of these, 58 (40.8%) engaged in binge drinking; 28 (19.7%) drank daily; 101 (70.9%) consumed wines and related drinks. One hundred and twenty (84.5%) of these respondents had difficulty controlling their intake; 25 (17.6%) got drunk; 16 (11.3%) got into fights; 35 (24.6%) skipped meals after drinking; 39 (27.5%) experienced some difficulty with memory; 52 (36.6%) had parents who consumed alcoholic beverages regularly. Alcohol consumption was significantly associated with: age; parents’ occupation; living arrangement and religion.

CONCLUSION: Alcoholic beverage consumption was slightly high, with majority of these respondents drinking at a moderate level. Targeted behaviour change communication and counseling services will be most beneficial to address this emerging public health concern.

PMID:36058005

J Card Surg. 2022 Sep 4. doi: 10.1111/jocs.16880. Online ahead of print.

ABSTRACT

OBJECTIVE: We investigated possible gender differences for hepatic fibrosis in extracardiac-Fontan patients.

METHODS: We identified extracardiac Fontan, performed between 2000 and 2016, who underwent cardiac catheterizations with transvenous hepatic biopsies between April 2012 and June 2022. We divided the patients by gender for analysis.

RESULTS: We identified 116 patients who underwent 145 transvenous biopsies, with 29 patients undergoing 2 biopsies at an average interval of 5 ± 1 years. We divided the 145 biopsies into two groups: 1) 98/145 (68%) males and 2) 47/145 (32%) females. For the 47 female liver biopsy specimens, the median total fibrosis score was 3 (0-8), and for the 98 male liver biopsy specimens, the median total fibrosis score was 2 (0-6), p = .007. The average age at surgery for females was 3 ± 1 years and for males 3 ± 1 years, p = .99. Average Fontan duration at biopsy for females was 11 ± 5 years and for males, 10 ± 4 years, p = .23. No other demographic, anatomic, echocardiographic, laboratory, or hemodynamic findings demonstrated statistically significant gender differences.

CONCLUSIONS: Females had statistically significantly higher median total fibrosis scores than males for the similar average age at extracardiac Fontan and average Fontan duration.

PMID:36057990 | DOI:10.1111/jocs.16880

Age Ageing. 2022 Sep 2;51(9):afac190. doi: 10.1093/ageing/afac190.

ABSTRACT

Approximately two-thirds of hospital admissions are older adults and almost half of these are likely to have some form of dementia. People with dementia are not only at an increased risk of adverse outcomes once admitted, but the unfamiliar environment and routinised practices of the wards and acute care can be particularly challenging for them, heightening their confusion, agitation and distress further impacting the ability to optimise their care. It is well established that a person-centred care approach helps alleviate some of the unfamiliar stress but how to embed this in the acute-care setting remains a challenge. In this article, we highlight the challenges that have been recognised in this area and put forward a set of evidence-based ‘pointers for service change’ to help organisations in the delivery of person-centred care. The DEMENTIA CARE pointers cover areas of: dementia awareness and understanding, education and training, modelling of person-centred care by clinical leaders, adapting the environment, teamwork (not being alone), taking the time to ‘get to know’, information sharing, access to necessary resources, communication, involving family (ask family), raising the profile of dementia care, and engaging volunteers. The pointers extend previous guidance, by recognising the importance of ward cultures that prioritise dementia care and institutional support that actively seeks to raise the profile of dementia care. The pointers provide a range of simple to more complex actions or areas for hospitals to help implement person-centred care approaches; however, embedding them within the organisational cultures of hospitals is the next challenge.

PMID:36057987 | DOI:10.1093/ageing/afac190

Dent Traumatol. 2022 Sep 4. doi: 10.1111/edt.12786. Online ahead of print.

ABSTRACT

BACKGROUND/AIM: Treatment delays in the management of mandible fractures are often unavoidable and, as a result, the timing of treatment of mandibular fractures has remained a contentious issue in clinical practice as the optimal treatment delay for minimizing complications remains unknown. The aim of this study was to determine the rate and types of complications between two cohorts of patients designated as early and late treatment groups and estimate an optimal time threshold for treatment delay after closed reduction and maxillomandibular fixation.

MATERIAL AND METHODS: Demographic and clinical data were collected retrospectively about patients who were treated for isolated, unilateral, favorable, and compound mandibular body fractures between 1999 and 2019 to answer the question of whether treatment delay is an independent variable impacting post-operative mandible body fracture complications. Descriptive and bivariate statistics were computed.

RESULTS: One hundred and seventy subjects were evaluated (n = 87 in the control/early group and n = 83 in the study/late group). The mean time lapses from injury to treatment were: early (5.8 ± 0.4 days) and late (10.3 ± 0.7 days). The overall complication rate was 14.1%. However, the complication rates of the early and late groups were 13.8% and 14.5%, respectively, with no significant difference (p = 0.89).

CONCLUSIONS: There was no difference between early and late treatment groups. Treatment delay was not an independent variable impacting post-operative mandible body fracture complications if treatment is done between 3 and 12 days after the injury.

PMID:36057967 | DOI:10.1111/edt.12786

Andrology. 2022 Sep 4. doi: 10.1111/andr.13289. Online ahead of print.

ABSTRACT

BACKGROUND: The cellular and molecular mechanisms of the events that help spermatozoa acquire their fertilizing capability during capacitation and acrosome reaction are not completely understood.

OBJECTIVE: This study was performed with a postulation that identification of sperm proteins and their changes during in vitro capacitation and acrosome reaction will unravel unknown molecular aspects of fertilization that impact male fertility.

MATERIALS AND METHODS: Spermatozoa collected from sequential conditions, i.e. separation of ejaculated spermatozoa by Percoll gradient centrifugation, in vitro capacitation, and acrosome reaction were processed for tandem mass spectrometric analysis, followed by protein identification, label-free quantitation, and statistical analysis.

RESULTS AND DISCUSSION: Collectively, a total of 1088 sperm proteins were identified. In comparison to ejaculated spermatozoa, 44 and 141 proteins were differentially expressed in capacitated and acrosome reacted spermatozoa, respectively. A large number of proteins were found downregulated, including clusterin, pyruvate dehydrogenase E1 component, semenogelin-1 and 2, heat shock protein 90, beta-microseminoprotein and keratin. It was expected as sperm-membrane-associated proteins are removed during capacitation. There were significant proteomic alterations in asthenozoospermia (AZS) compared to normozoospermia (NZS); however, variation was more noticeable among proteins of acrosome reacted spermatozoa and those released during the acrosome reaction. The processes enriched among downregulated proteins in AZS included acrosome assembly, binding of sperm to zona pellucida, nucleosome assembly, flagellated sperm motility, protein folding, oxidative phosphorylation, TCA cycle, chromatin silencing, gluconeogenesis, glycolytic process, and glycolysis.

CONCLUSION: The dynamic information generated about proteomic alterations in spermatozoa during capacitation and acrosome reaction and their variability in AZS will contribute not only towards enhancing our understanding of processes that prepare spermatozoa to acquire fertilization capability but also help in deciphering novel factors of male infertility. This article is protected by copyright. All rights reserved.

PMID:36057948 | DOI:10.1111/andr.13289

Qual Life Res. 2022 Sep 4. doi: 10.1007/s11136-022-03210-2. Online ahead of print.

ABSTRACT

PURPOSE: We investigated how quality of life (QoL) changed between 2018 and 2020, and how its related factors, i.e., communication with friends and family, loneliness, and sleeping difficulties changed amid the early-phase COVID-19 pandemic among Finnish older people.

METHODS: This study utilizes data from a repeated cross-sectional, population-based FinSote survey in 2018 and 2020. Participants were community-dwelling people aged 75 years or older (N = 9781 in 2018 and N = 9919 in 2020). QoL was assessed with the EUROHIS-QoL-8 scale. Changes in QoL-related factors were self-evaluated in 2020. Statistical methods included t test, Cohen’s D, and chi-square test. To identify potential risk groups, all analyses were stratified by socio-demographic features including sex, age, economic deprivation, living alone, and difficulties in Instrumental Activities of Daily Living (IADL).

RESULTS: QoL improved slightly from 2018 to 2020 (means 3.68 and 3.81, respectively). Only those reporting economic deprivation demonstrated a slight decrease in QoL (3.24 vs. 3.14). Of respondents, 63% reported having less communication with friends and family, 42% having felt lonelier, and 20% having more sleeping difficulties amid the pandemic. Negative changes were more often reported by women, the oldest old, those living alone, reporting economic deprivation, or manifesting IADL difficulties.

CONCLUSION: Finnish older people’s QoL was not affected as much as expected amid the pandemic, although some population groups were, however, more susceptible to the negative effects of the pandemic on QoL-related factors. Results imply that various socio-demographic features may shape the effects of a global pandemic and its control measures on wellbeing.

PMID:36057938 | DOI:10.1007/s11136-022-03210-2

Radiol Med. 2022 Sep 4. doi: 10.1007/s11547-022-01543-z. Online ahead of print.

ABSTRACT

PURPOSE: Bone Strain Index (BSI) is a recently developed dual-energy X-ray absorptiometry (DXA) software, applying a finite element analysis on lumbar spine and femoral DXA scans. BSI is a parameter of bone deformation, providing information on bone resistance to applied loads. BSI values indicate the average bone strain in the explored site, where a higher strain (higher BSI values) suggests a higher fracture risk. This study reports the distributional characteristics of lumbar BSI (L-BSI) in women with normal bone mass, osteopenia or osteoporosis and their relationships with BMD, weight, height and BMI.

MATERIAL AND METHODS: Two-hundred-fifty-nine consecutive unfractured women who performed DXA were divided into three groups based on BMD T-score: normal bone mass (n = 43, 16.6%), osteopenia (n = 82, 31.7%) and osteoporosis (n = 134, 51.7%). The distribution of L-BSI was evaluated with conventional statistical methods, histograms and by calculating parametric and nonparametric 95% confidence intervals, together with the 90%, 95% and 99% bilateral tolerance limits with a 95% confidence.

RESULTS: Ninety percent bilateral tolerance limits with 95% confidence for L-BSI distribution are 1.0-2.40, 0.95-2.63 and 0.84-3.15 in the group of patients with normal bone mass, 1.34-2.78, 1.24-2.95 and 1.05-3.32 in the osteopenic group and 1.68-3.79, 1.58-4.15 and 1.40-4.96 in the osteoporotic group.

CONCLUSION: In women without vertebral fractures at baseline, L-BSI values from 1.68 (osteoporotic group) and 2.40 (upper of the normal bone mass group) can be tentatively chosen as a lower and upper threshold to stratify postmenopausal women according to their bone resistance to loads.

PMID:36057931 | DOI:10.1007/s11547-022-01543-z