Nevin Manimala

Eur J Anaesthesiol. 2022 Jul 1;39(7):591-601. doi: 10.1097/EJA.0000000000001644. Epub 2021 Dec 7.

ABSTRACT

BACKGROUND: Patients undergoing mastectomy surgery experience severe postoperative pain. Several regional techniques have been developed to reduce pain intensity but it is unclear, which of these techniques is most effective.

OBJECTIVES: To synthesise direct and indirect comparisons for the relative efficacy of different regional and local analgesia techniques in the setting of unilateral mastectomy. Postoperative opioid consumption at 24 h, postoperative pain at extubation, 1, 12 and 24 h, postoperative nausea and vomiting were collected.

DESIGN: Systematic review with network meta-analysis (PROSPERO:CRD42021250651).

DATA SOURCE: PubMed, Scopus, the Cochrane Central Register of Controlled Trials (from inception until 7 July 2021).

ELIGIBILITY CRITERIA: All randomised controlled trials investigating single-injection regional and local analgesia techniques in adult patients undergoing unilateral mastectomy were included in our study without any language or publication date restriction.

RESULTS: Sixty-two included studies randomising 4074 patients and investigating nine techniques entered the analysis. All techniques were associated with less opioid consumption compared with controls The greatest mean difference [95% confidence interval (CI)] was associated with deep serratus anterior plane block: mean difference -16.1 mg (95% CI, -20.7 to -11.6). The greatest reduction in pain score was associated with the interpectoral-pecto-serratus plane block (mean difference -1.3, 95% CI, -1.6 to – 1) at 12 h postoperatively, and with superficial serratus anterior plane block (mean difference -1.4, 95% CI, -2.4 to -0.5) at 24 h. Interpectoral-pectoserratus plane block resulted in the greatest statistically significant reduction in postoperative nausea/vomiting when compared with placebo/no intervention with an OR of 0.23 (95% CI, 0.13 to 0.40).

CONCLUSION: All techniques were associated with superior analgesia and less opioid consumption compared with controls. No single technique was identified as superior to others. In comparison, local anaesthetic infiltration does not offer advantages over multimodal analgesia alone.

TRIAL REGISTRATION: PROSPERO (CRD4202125065).

PMID:35759292 | DOI:10.1097/EJA.0000000000001644

JAMA Intern Med. 2022 Jun 27. doi: 10.1001/jamainternmed.2022.2300. Online ahead of print.

ABSTRACT

IMPORTANCE: Smoking cessation interventions for hospitalized patients must continue after discharge to improve long-term tobacco abstinence. How health systems can best deliver postdischarge tobacco treatment is uncertain.

OBJECTIVE: To determine if health system-based tobacco cessation treatment after hospital discharge produces more long-term tobacco abstinence than referral to a community-based quitline.

DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial was conducted September 2018 to November 2020 in 3 hospitals in Massachusetts, Pennsylvania, and Tennessee. Cigarette smokers admitted to a study hospital who received brief in-hospital tobacco treatment and wanted to quit smoking were recruited for participation and randomized for postdischarge treatment to health system-based Transitional Tobacco Care Management (TTCM) or electronic referral to a community-based quitline (QL). Both multicomponent interventions offered smoking cessation counseling and nicotine replacement therapy (NRT) for up to 3 months. Data were analyzed from February 1, 2021, to April 25, 2022.

INTERVENTIONS: TTCM provided 8 weeks of NRT at discharge and 7 automated calls with a hospital-based counselor call-back option. The QL intervention sent referrals from the hospital electronic health record to the state quitline, which offered 5 counseling calls and an NRT sample.

MAIN OUTCOMES AND MEASURES: The main outcome was biochemically verified past 7-day tobacco abstinence at 6 months. Self-reported point-prevalence and continuous tobacco abstinence and tobacco treatment utilization were assessed 1, 3, and 6 months after discharge.

RESULTS: A total of 1409 participants (mean [SD] age, 51.7 [12.6] years; 784 [55.6%] women; mean [SD] 16.4 [10.6] cigarettes/day) were recruited, including 706 randomized to TTCM and 703 randomized to QL. Participants were comparable at baseline, including 216 Black participants (15.3%), 82 Hispanic participants (5.8%), and 1089 White participants (77.3%). At 1 and 3 months after discharge, more TTCM participants than QL participants used cessation counseling (1 month: 245 participants [34.7%] vs 154 participants [21.9%]; 3 months: 248 participants [35.1%] vs 123 participants [17.5%]; P < .001) and pharmacotherapy (1 month: 455 participants [64.4%] vs 324 participants [46.1%]; 3 months: 367 participants [52.0%] vs 264 participants [37.6%]; P < .001). More TTCM than QL participants reported continuous abstinence for 3 months (RR, 1.30; 95% CI, 1.06-1.58) and point-prevalence abstinence at 1 month (RR, 1.22; 95% CI, 1.08-1.35) and 3 months (RR, 1.23; 95% CI, 1.09-1.37) but not at 6 months (RR, 1.14; 95% CI, 0.99-1.29). The primary outcome, biochemically verified point-prevalence abstinence at 6 months, was not statistically significantly different between groups (19.9% vs 16.9%; RR, 1.18; 95% CI, 0.92-1.50).

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, biochemically verified tobacco abstinence rates were not significantly different between groups at the 6-month follow-up. However, the health system-based model was superior to the community-based quitline model throughout the 3 months of active treatment. A longer duration of postdischarge treatment may sustain the superiority of the health system-based model.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03603496.

PMID:35759282 | DOI:10.1001/jamainternmed.2022.2300

JAMA Neurol. 2022 Jun 27. doi: 10.1001/jamaneurol.2022.1567. Online ahead of print.

ABSTRACT

IMPORTANCE: Posttraumatic headache is the most disabling complication of mild traumatic brain injury. Posttraumatic stress disorder (PTSD) symptoms are often comorbid with posttraumatic headache, and there are no established treatments for this comorbidity.

OBJECTIVE: To compare cognitive behavioral therapies (CBTs) for headache and PTSD with treatment per usual (TPU) for posttraumatic headache attributable to mild traumatic brain injury.

DESIGN, SETTING, AND PARTICIPANTS: This was a single-site, 3-parallel group, randomized clinical trial with outcomes at posttreatment, 3-month follow-up, and 6-month follow-up. Participants were enrolled from May 1, 2015, through May 30, 2019; data collection ended on October 10, 2019. Post-9/11 US combat veterans from multiple trauma centers were included in the study. Veterans had comorbid posttraumatic headache and PTSD symptoms. Data were analyzed from January 20, 2020, to February 2, 2022.

INTERVENTIONS: Patients were randomly assigned to 8 sessions of CBT for headache, 12 sessions of cognitive processing therapy for PTSD, or treatment per usual for headache.

MAIN OUTCOMES AND MEASURES: Co-primary outcomes were headache-related disability on the 6-Item Headache Impact Test (HIT-6) and PTSD symptom severity on the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (PCL-5) assessed from treatment completion to 6 months posttreatment.

RESULTS: A total of 193 post-9/11 combat veterans (mean [SD] age, 39.7 [8.4] years; 167 male veterans [87%]) were included in the study and reported severe baseline headache-related disability (mean [SD] HIT-6 score, 65.8 [5.6] points) and severe PTSD symptoms (mean [SD] PCL-5 score, 48.4 [14.2] points). For the HIT-6, compared with usual care, patients receiving CBT for headache reported -3.4 (95% CI, -5.4 to -1.4; P < .01) points lower, and patients receiving cognitive processing therapy reported -1.4 (95% CI, -3.7 to 0.8; P = .21) points lower across aggregated posttreatment measurements. For the PCL-5, compared with usual care, patients receiving CBT for headache reported -6.5 (95% CI, -12.7 to -0.3; P = .04) points lower, and patients receiving cognitive processing therapy reported -8.9 (95% CI, -15.9 to -1.9; P = .01) points lower across aggregated posttreatment measurements. Adverse events were minimal and similar across treatment groups.

CONCLUSIONS AND RELEVANCE: This randomized clinical trial demonstrated that CBT for headache was efficacious for disability associated with posttraumatic headache in veterans and provided clinically significant improvement in PTSD symptom severity. Cognitive processing therapy was efficacious for PTSD symptoms but not for headache disability.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02419131.

PMID:35759281 | DOI:10.1001/jamaneurol.2022.1567

Math Med Biol. 2022 Jun 27:dqac008. doi: 10.1093/imammb/dqac008. Online ahead of print.

ABSTRACT

Estimating the longevity of an individual’s immune response to the SARS-Cov-2 virus is vital for future planning, particularly of vaccine requirements. Neutralizing antibodies (Nabs) are increasingly being recognized as a correlate of protection and while there are many studies that follow the response of a cohort of people, each study alone is not enough to predict the long-term response. Studies use different assays to measure Nabs, making them hard to combine. We present a modelling method that can combine multiple datasets and can be updated as more detailed data becomes available. Combining data from seven published datasets we predict that the NAb decay has two phases, an initial fast but short-lived decay period followed by a longer term and slower decay period.

PMID:35759280 | DOI:10.1093/imammb/dqac008

JAMA Pediatr. 2022 Jun 27. doi: 10.1001/jamapediatrics.2022.1990. Online ahead of print.

ABSTRACT

IMPORTANCE: Although preterm birth is associated with later deficits in lung function, there is a paucity of information on geographical differences and whether improvements occur over time, especially after surfactant was introduced.

OBJECTIVE: To determine deficits in percentage predicted forced expiratory volume in 1 second (%FEV1) in preterm-born study participants, including those with bronchopulmonary dysplasia (BPD) in infancy, when compared with term-born control groups.

DATA SOURCES: Eight databases searched up to December 2021.

STUDY SELECTION: Studies reporting spirometry for preterm-born participants with or without a term-born control group were identified.

DATA EXTRACTION AND SYNTHESIS: Data were extracted and quality assessed by 1 reviewer and checked by another. Data were pooled using random-effects models and analyzed using Review Manager and the R metafor package.

MAIN OUTCOMES AND MEASURES: Deficits in %FEV1 between preterm-born and term groups. Associations between deficits in %FEV1 and year of birth, age, introduction of surfactant therapy, and geographical region of birth and residence were also assessed.

RESULTS: From 16 856 titles, 685 full articles were screened: 86 with and without term-born control groups were included. Fifty studies with term controls were combined with the 36 studies from our previous systematic review, including 7094 preterm-born and 17 700 term-born participants. Of these studies, 45 included preterm-born children without BPD, 29 reported on BPD28 (supplemental oxygen dependency at 28 days), 26 reported on BPD36 (supplemental oxygen dependency at 36 weeks’ postmenstrual age), and 86 included preterm-born participants. Compared with the term-born group, the group of all preterm-born participants (all preterm) had deficits of %FEV1 of -9.2%; those without BPD had deficits of -5.8%, and those with BPD had deficits of approximately -16% regardless of whether they had BPD28 or BPD36. As year of birth increased, there was a statistically significant narrowing of the difference in mean %FEV1 between the preterm- and term-born groups for the all preterm group and the 3 BPD groups but not for the preterm-born group without BPD. For the all BPD group, when compared with Scandinavia, North America and western Europe had deficits of -5.5% (95% CI, -10.7 to -0.3; P = .04) and -4.1% (95% CI, -8.8 to 0.5; P = .08), respectively.

CONCLUSIONS AND RELEVANCE: Values for the measure %FEV1 were reduced in preterm-born survivors. There were improvements in %FEV1 over recent years, but geographical region had an association with later %FEV1 for the BPD groups.

PMID:35759258 | DOI:10.1001/jamapediatrics.2022.1990

J Biol Dyn. 2022 Dec;16(1):480-498. doi: 10.1080/17513758.2022.2091800.

ABSTRACT

In this paper, we consider a fear effect predator-prey model with mutual interference or group defense. For the model with mutual interference, we show the interior equilibrium is globally stable, and the mutual interference can stabilize the predator-prey system. For the model with group defense, we discuss the singular dynamics around the origin and the occurrence of Hopf bifurcation, and find that there is a separatrix curve near the origin such that the orbits above which tend to the origin and the orbits below which tend to limit cycle or the interior equilibrium.

PMID:35759246 | DOI:10.1080/17513758.2022.2091800

Immun Inflamm Dis. 2022 Jul;10(7):e670. doi: 10.1002/iid3.670.

ABSTRACT

BACKGROUND: Asymptomatic infections may play an important role in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) Delta variant transmissions. However, the immunologic features of asymptomatic postvaccination infections with the Delta variant of SARS-CoV-2 in adults remain to be defined.

METHODS: A retrospective study involving 36 vaccinated adults infected with the SARS-CoV-2 Delta variant was performed. Their demographic and laboratory data were collected and analyzed in The First People’s Hospital of Jingmen from August 4 to 20, 2021.

RESULTS: Of the 36 adults, 6 persons had an asymptomatic infection. The severity of the SARS-CoV-2 infections was highly correlated with the doses of vaccinations (p = 0.019). The symptomatic and asymptomatic infected SARS-CoV-2 adults showed normal levels of leukocytes and lymphocytes. The C-reactive protein (CRP) and interleukin-6 (IL-6) levels were elevated in the symptomatic groups. The period between the last vaccination to the time of infection in the asymptomatic group was longer than that in the mild and moderate groups (73 vs. 61 vs. 50 days; p = 0.047). The percentage of suppressor T-cells in the asymptomatic group was the highest (32.2 ± 4.0% vs. 22.0 ± 7.2% vs. 29.3 ± 8.0%; p = 0.004). The signal-to-cutoff ratio value of total antibody against SARS-CoV-2 in the asymptomatic group was lower than that in the other two groups (383 vs. 703 vs. 1792; p < 0.001) and much lower than that in the moderate group. The multivariate ordinal logistic analysis after adjusting for gender, vaccination date, and vaccination dose indicated that CRP at Days 4-7 and 8-14, IL-6 on Days 4-7, and total antibody were risk factors for coronavirus disease 2019 severity.

CONCLUSIONS: Asymptomatic postvaccination infections with the Delta variant of SARS-CoV-2 in adults tend to infect persons vaccinated twice. The immunophenotype profile for asymptomatic postvaccination infections is less inflammatory and accompanied by relatively lower antibody titers.

PMID:35759224 | DOI:10.1002/iid3.670

Int J Med Educ. 2022 Jun 24;13:171-175. doi: 10.5116/ijme.629d.d88f.

ABSTRACT

R Statistics is a comprehensive and widely-used suite of packages for statistical operations. From 27 R packages indexed with the word “Rasch”, 11 packages capable of Rasch estimation and analysis are identified and critiqued. A commercial Rasch application is included for comparison. Three R data frames are used. A larger and a smaller 0/1 data frame are analyzed with the Dichotomous Rasch Model. A polytomous 0/1/2 data frame is analyzed with the Partial Credit Model. The R packages can all use the same data frame. They are easy to use and mostly fast, though their documentation is generally skimpy. Every package has obvious shortcomings, but the unique features of each package could make them all useful. For general Rasch estimation and fit analysis of dichotomous data, three packages stand out: eRm, TAM and autoRasch. Two packages stand out for polytomous data: TAM and autoRasch.

PMID:35759222 | DOI:10.5116/ijme.629d.d88f

Int J Radiat Biol. 2022 Jun 27:1-24. doi: 10.1080/09553002.2022.2094021. Online ahead of print.

ABSTRACT

PURPOSE: To test the performance of different algorithms that can be used in interlaboratory comparisons based on dicentric chromosome analysis, and to evaluate the impact of considering a priori values different to calculate individual laboratory performance based on the ionizing radiation dose estimation.

METHODS: Mean and standard deviation estimations in inter-laboratory comparisons are tested on simulated data and data from previously published inter-laboratory comparisons using three robust algorithms, algorithm A, Algorithm B and Q/Hampel, all programmed in R-project language and implemented in a Shiny application. The simulated data were generated assuming three different probabilities to contaminate inter-laboratory comparisons samples with atypical dose values. Comparison between different algorithms was also done using published exercises where blood samples were irradiated at 0 and 0.7 Gy that represent a challenge for the assessment of an inter-laboratory comparison.

RESULTS: The best performance was obtained with the Q/Hampel algorithm for the estimation of the dose mean and with the algorithm B for the estimation of the dose standard deviation under the conditions tested in the simulations. The Q/Hampel algorithm showed the best performance when non-irradiated samples were evaluated and there was a high proportion of identical values. The presence identical values causes the Algorithm B to fail. Real examples illustrating the need to consider standard deviation priors, and the need to use algorithms resistant to a high proportion of identical values are presented.

CONCLUSIONS: Q/Hampel algorithm is a serious candidate to estimate the dose mean in the inter-laboratory comparisons, and to estimate both parameters when the proportion of identical values equals or higher than the half of the results. When the proportion of identical values is less than the half of the results, the Algorithm B should be considered as a candidate to estimate the standard deviation in the inter-laboratory comparisons with small number of laboratories. We remark that special attention is needed to establish prior definitions of standard deviation in the assessment of inter-laboratory dicentric assay comparisons.

PMID:35759221 | DOI:10.1080/09553002.2022.2094021

Hum Vaccin Immunother. 2022 Jun 27:2082792. doi: 10.1080/21645515.2022.2082792. Online ahead of print.

ABSTRACT

The rapid manufacturing of vaccines has increased hesitancy toward receiving the COVID-19 vaccines. Clarifying what to expect after vaccination and revealing the possible side effects will lower hesitancy toward receiving the COVID-19 vaccine and increase public awareness. This descriptive cross-sectional survey-based study was conducted in Jordan (August 2021) to collect data on the short-term side effects following the COVID-19 vaccines. An extensive literature review was conducted by the research team to assist in developing the first draft of the survey. The survey was tested for face and content validity and piloted test to improve readability and clarity. The survey was organized into two sections (demographics and perceived COVID-19 vaccines’ side effects). Data were analyzed using the Statistical Package for Social Science (SPSS). A total of 1,044 participants were enrolled in the study. The most received vaccine among the participants was Pfizer-BioNTech (51.1%). The most frequently reported side effects were sore arm at the injection site (84.65%), fatigue (84.48%), discomfort (65.43%), muscles/joint pain (61.38%), drowsiness (58.73%), and headache (58.38%). More side effects were significantly associated with being older (p = 0.046), having an allergy (p = 0.024) or rheumatoid arthritis (p = 0.023), and participants who take NSAIDs regularly (p = 0.029). Short-term side effects of COVID-19 vaccines seem to be mostly local or transient in nature. Older age and certain comorbidities may increase susceptibility to side effects.

PMID:35759219 | DOI:10.1080/21645515.2022.2082792