Nevin Manimala

Rev Med Virol. 2022 Aug 28:e2389. doi: 10.1002/rmv.2389. Online ahead of print.

ABSTRACT

Human astroviruses (HAstVs) have frequently been detected in individuals with acute gastroenteritis (AGE). However, a precise estimate of the overall prevalence of the virus in children with AGE as well as the possible association of the virus with gastrointestinal complications is not available up to now. The present study estimated the overall prevalence of HAstVs in children with gastrointestinal complications as well as the association between the virus and symptoms. We systematically searched four international databases (PubMed, Scopus, Web of Science, and Google scholar) to find studies on the prevalence of HAstVs in people with AGE published between Jan 2000 and Sep 2021. Analysis of the 223 included studies presented a 4.2% (95% CI 3.8%-4.8%) prevalence of the virus in AGE individuals. Based on case-control studies, a significant association between these viruses and AGE was detected (OR: 2.059, 95% CI; 1.438-2.949). HAstV-1 and HAstV-VA-2 is the most and least common genotypes in the AGE patients, respectively (59.0%, 95% CI: 52.1%-65.6% vs. 4.9%, 95% CI: 2.6%-9.1%). Due to the statistically significant association between HAstV and gastrointestinal complications, more attention should be paid to these viruses in people with AGE and more studies should employ case-control design.

PMID:36030520 | DOI:10.1002/rmv.2389

J Gastrointest Cancer. 2022 Aug 28. doi: 10.1007/s12029-022-00858-4. Online ahead of print.

ABSTRACT

PURPOSE: To investigate whether the early perfusion change in hepatocellular carcinoma (HCC) predicts the long-term therapeutic response to atezolizumab plus bevacizumab.

METHODS: We retrospectively selected 19 subjects (median age: 62 years, 4 females, and 15 males) having advanced HCC and treated with atezolizumab alone (n = 3) or in combination with bevacizumab (n = 16). The 4-phased CT or MRI imaging was performed for each subject before and at 9 ± 2 and 21 ± 5 weeks after therapy initiation. The tumor-to-liver signal ratio in the arterial phase was used to estimate the tumor perfusion. The change in tumor perfusion from the baseline to the 1st follow-up exam was correlated with the tumor response evaluated using mRECIST at the 2nd follow-up exam. The difference between favorably responding and non-responding groups was statistically analyzed using one-way ANOVA.

RESULTS: The mean tumor long axis in the baseline image was 59 ± 47 mm. The HCC perfusion changes were -26 ± 18% for complete (or partial) response (CR/PR, n = 8), -24 ± 12% for stable disease (SD, n = 8), and 9 ± 13% for progressive disease (PD, n = 3). The HCC perfusion change of the CR/PR groups was significantly lower than that of the PD group (p = 0.0040). The HCC perfusion changes between the SD and PD groups were also significantly different (p = 0.0135). The sensitivity and specificity of the early perfusion change to predict the long-term progression of the disease were 100 and 94%, respectively.

CONCLUSION: The early change in HCC perfusion may predict the long-term therapeutic response to atezolizumab plus bevacizumab, promoting personalized treatment for HCC patients.

PMID:36030519 | DOI:10.1007/s12029-022-00858-4

Acta Obstet Gynecol Scand. 2022 Aug 28. doi: 10.1111/aogs.14444. Online ahead of print.

ABSTRACT

INTRODUCTION: During the second stage of labor, vacuum-assisted delivery is an alternative to forceps delivery and emergency cesarean section. Extensive research concerning perinatal outcomes has indicated that the risk of complications, although rare, is higher than with a spontaneous vaginal delivery. An important factor related to perinatal outcomes is the traction force applied. Our research group previously developed a digital extraction handle, the Vacuum Intelligent Handle-3 (VIH3), that measures and records traction force. The objective of this study was to compare traction force profiles in children with and without severe perinatal outcomes delivered with the digital handle. A secondary aim was to establish a safe force limit.

MATERIAL AND METHODS: This was an observational case-control study at the delivery ward at Karolinska University Hospital, Sweden. In total, 573 children delivered with the digital handle between 2012 and 2018 were included. Cases were defined as a composite of severe perinatal outcomes, including subgaleal hematoma, intracranial hemorrhage, hypoxic ischemic encephalopathy 1-3, seizures or death. The cases in the cohort were matched 1:3 based on five matching variables. Traction profiles were analyzed using the MATLAB® software and conditional logistic regression.

RESULTS: The incidence of severe perinatal outcomes was 2.3%. The 13 cases were matched with three controls each (n = 39). A statistically significant increased odds for higher total traction forces was seen in the case group (odds ratio [OR] 1.004; 95% confidence interval [CI] 1.001-1.007) and for the peak force (OR 1.022; 95% CI 1.004-1.041). Several procedure-related parameters were significantly increased in the case group. As expected, some neonatal characteristics also differed significantly. An upper force limit of 343 Newton minutes (Nmin) revealed an 86% reduction in severe perinatal outcomes (adjusted OR 0.14; 95% CI 0.04-0.5).

CONCLUSIONS: Children with severe perinatal outcomes had traction force profiles with significantly higher forces. The odds for severe perinatal outcomes increased for every increase in Nmin and Newton used during the extraction procedure. A calculated total force level of 343 Nmin is suggested as an upper safety limit, but this must be tested prospectively to provide validity.

PMID:36030477 | DOI:10.1111/aogs.14444

Clin Oral Investig. 2022 Aug 28. doi: 10.1007/s00784-022-04693-6. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the longevity of metal-ceramic single crowns cemented onto resin composite prosthetic cores using a self-adhesive resin cement in a prospective clinical descriptive study.

METHODS: A total of 152 teeth were endodontically treated and received resin composite prosthetic cores and metal-ceramic crowns cemented with a self-adhesive resin cement. The patients included in the sample were recalled for clinical and radiography evaluation in an up-to-106-month period after the final cementation procedures, with an average of 62 months of follow-up. 91.5% of the sample (142 teeth) were evaluated regarding the treatment survival rate, analyzed considering the loss of crown retention (crown debonding) and tooth loss as the primary outcome. In addition, post debonding, and root fracture occurrences were also recorded as secondary outcomes to evaluate the success rate of the prosthetic treatment. The aesthetic parameters were also evaluated according to the FDI criteria. The Kaplan-Meier method and Cox regression with 95% confidence interval were applied for the statistical analysis.

RESULTS: Regarding the primary outcome, the metal-ceramic crowns cemented with self-adhesive resin cement presented a high survival rate (91.5%), with 8 crown debondings and 3 tooth losses (1 due to caries and 2 due to periodontal disease) occurring after the evaluation period. For secondary outcomes, 9 root fractures and 4 post debondings occurred, generating a success rate of 72%. All crowns had a score 1 on the FDI criteria, indicating that they were clinically excellent or very good regarding the aesthetic parameters.

CONCLUSION: The metal-ceramic crowns luted with a self-adhesive resin cement presented a survival rate of 91.5% after an average of 62 months of follow-up. Furthermore, the restorations remained aesthetically satisfactory over time, without changes that would indicate prosthetic retreatment. A success rate of 72% was obtained considering the secondary outcome, mainly related to intraradicular retainer failures (root fractures or post debonding).

CLINICAL SIGNIFICANCE: The self-adhesive resin cement is clinically indicated for cementation of metal-ceramic crowns onto resin composite prosthetic cores.

PMID:36030454 | DOI:10.1007/s00784-022-04693-6

Bull Hosp Jt Dis (2013). 2022 Sep;80(3):282-285.

ABSTRACT

BACKGROUND: There is currently an alarming upward trend in the use of prescription opioids in the pediatric population. Previous medical use of prescription opioids has shown to correlate to non-medical use of prescription opioids. To combat this, institutions have started to look at prescribing patterns to understand and eventually standardize a pain protocol to reduce unnecessary analgesics after surgery. Opioids continue to be used widely for postoperative pain control in orthopedic patients. Therefore, this study examined the prescription patterns within a large pediatric orthopedic hospital consortium after closed reduction and percutaneous pinning for supracondylar humerus fractures.

METHODS: A retrospective analysis was performed in order to understand the prescribing variability in analgesics for this patient population better. Descriptive statistics and chi-squared analysis were used to evaluate for prescribing patterns.

RESULTS: Narcotic medications were prescribed postoperatively to 49.6% of patients. There was no difference in narcotic prescription with length of stay or severity of fracture. Additionally, there were several documented prescribing errors, most commonly by a junior orthopedic resident.

CONCLUSIONS: There is significant variability in prescribing patterns among physicians after pediatric supracondylar humerus fractures. Understanding the patterns and implementing a more standardized approach to pain control may help to combat prescribing errors.

PMID:36030449

Bull Hosp Jt Dis (2013). 2022 Sep;80(3):270-276.

ABSTRACT

PURPOSE: The purpose of this study was to systematically review and analyze the current evidence in the literature to determine the relative complication rates of the singleincision versus dual-incision approach to distal biceps tendon repair.

METHODS: The literature search was performed based on the PRISMA guidelines. Cohort studies comparing the single-incision or dual-incision approach to biceps tendon repair alone were included. Clinical outcomes were compared, with all statistical analysis performed using Review Manager Version 5.3. A p-value < 0.05 was considered to be statistically significant.

RESULTS: Twelve clinical studies with varying levels of evidence (LOE I: 1, LOE II: 1, LOE III: 10) with 2,429 patients were included. Overall, there was a significantly lower rate of total complications with the dual-incision approach (16.1% vs. 23.1%, p < 0.01) and a lower rate of neurological injuries (9.1% vs. 24.1%, p < 0.01). There was a lower rate of lateral antebrachial cutaneous nerve injuries with the dual-incision approach (5.2% vs. 19.5%, p < 0.01), and superficial radial nerve injuries (2.5% vs. 4.8%, p < 0.01), but there was no significant difference in the rate of posterior interosseous nerve injuries (2.2% vs. 1.2%, p = 0.20). There was a significantly lower rate of heterotopic bone formation with the single-incision approach (1.3% vs. 2.7%, p = 0.01).

CONCLUSION: The dual-incision approach decreases the risk of total, overall postoperative complications and sensory nerve injuries following distal biceps repair. However, it has a higher risk of heterotopic bone formation.

PMID:36030447

Bull Hosp Jt Dis (2013). 2022 Sep;80(3):265-269.

ABSTRACT

PURPOSE: Over 200,000 anterior cruciate ligament (ACL) reconstructions are performed in the US each year. The recovery process following surgery can be slow and difficult with patients suffering persistent strength and endurance deficits. Testosterone is an important anabolic hormone responsible for maintenance and development of muscle mass. While the response of the hypothalamic-pituitary axis (HPA) to surgery has been investigated, no studies exist tracking the HPA response, specifically that involved in testosterone homeostasis, to ACL reconstructions. The purpose of this study was to explore the response of endogenous testosterone production after ACL reconstruction and determine a possible correlation between perioperative testosterone levels in males and postoperative strength and clinical outcomes.

METHODS: This was a single-center, prospective observational study measuring preoperative and postoperative testosterone levels. Plasma testosterone, follicle stimulating hormone (FSH), and lutenizing hormone (LH) were measured before 10:30 am on the day of surgery. These were then checked at the same time of day at 1 week, 6 weeks, and 12 weeks postoperatively. Patients were also evaluated with the visual analog scale for pain (VAS), Tegner, and Lysholm scales preoperatively and at postoperative visits. Statistical analysis was performed using ANOVA and were considered significant at p < 0.05.

RESULTS: Twenty male patients with a mean age of 34.0 ± 9.2 years undergoing ACL reconstruction were enrolled between October 2017 and April 2018. Results showed a decrease in testosterone (3.7 ng/mL vs. 2.9 ng/mL, p = 0.05), free testosterone (8.2 pg/mL vs. 6.8 pg/mL, p = 0.05), and follicle stimulated hormone (1.8 mIU/mL vs. 1.7 mIU/ mL, p = 0.83) between the preoperative plasma draw and 1-week postoperative follow-up visit. Luteinizing hormone (1.1 mIU/mL vs. 1.5 mIU/mL, p = 0.11) increased postoperatively. By week 6, testosterone returned to baseline (3.7 ng/mL vs. 3.9 ng/mL), while free testosterone continued to increase through week 12. Lutenizing hormone peaked at the 1-week postoperative visit and trended downward until week 6 (1.5 mIU/mL vs. 1.4 mIU/mL, p = 0.79). Follicle stimulating hormone continued to increase after the week-1 visit through week 12. Patient reported outcomes exhibited a trend similar to hormone levels, with the lowest patient reported outcome (PRO) scores reported at week 1 and a constant trend upward. Although there were similar trends, there were no significant correlations between change in hormone levels and change in PRO scores.

CONCLUSION: Our study emphasizes the crucial period of hormonal decrease and their return to baseline. This knowledge will contribute to the understanding and timing of hormone therapy supplementation. Short-term testosterone replacement may be beneficial to return patients to work and physical activity at a faster rate.

PMID:36030446

Bull Hosp Jt Dis (2013). 2022 Sep;80(3):260-264.

ABSTRACT

PURPOSE: Chronic use of selective serotonin reuptake inhibitors (SSRIs) for the treatment of depression has been linked to an imbalance in bone metabolism leading to osteoporosis. More recently, the use of SSRIs in murine models has been shown to delay bone healing both in vivo and in vitro by decreasing the osteoblastic differentiation and mineralization. The purpose of this study was to evaluate whether or not chronic use of SSRI’s in nonunion patients increases their time to union after surgical intervention.

METHODS: We retrospectively analyzed 343 patients in a nonunion database to determine which patients were on SSRI medication. Of these patients, 139 could be contacted and of those 102 were not taking SSRIs and 37 were taking SSRIs. Patient’s time to union from nonunion surgical intervention between each cohort at our institution was recorded as the primary outcome. Patient’s medical comorbidities that could affect union rates such as diabetes and smoking status were also noted. Baseline Short Musculoskeletal Function Assessment (SMFA) index for bother and function were recorded from the time of nonunion surgery as well as last follow-up.

RESULTS: Compared to recent census data, we found significantly more patients in the nonunion cohort using SSRIs (26.6%) than patients in the general population using any type of antidepressant (11%). There was no significant difference in the patients’ baseline characteristics other than patients on SSRI treatment had a higher body mass index (BMI) and age (p = 0.048 and p = 0.043, respectively). There was no significant difference noted in the fracture types (p = 0.2063). Patients on SSRIs had a higher SMFA bother index and function index on follow-up (p = 0.0103, p = 0.0147). Patients in the SSRI group had a mean time to union from nonunion surgery of 6.1 months compared to 6.0 in patients without SSRI usage (p = 0.74). These did not reach statistical significance when subcohort analysis for long bone fractures was performed for the femur, tibia, and humerus.

CONCLUSION: To our knowledge, this is the first clinical study to investigate the effects of SSRIs on fracture healing. While in vivo and in vitro murine models have shown that SSRIs can have a deleterious effect on osteoblastic activity, our retrospective analysis did not show a significant difference in time to union between patients with chronic SSRI use and patients who have not been on SSRIs. However, this investigation did show a higher incidence of SSRI use in the nonunion cohort when compared to the general population. In the context of the recent animal model study, this may point to a negative effect of SSRI use on the acute fracture healing process.

PMID:36030445

Bull Hosp Jt Dis (2013). 2022 Sep;80(3):239-245.

ABSTRACT

BACKGROUND: The purpose of this study was to evaluate for changes in the incidence of arthroscopic meniscal procedures, especially meniscal allograft transplantation (MAT) in New York State (NYS) between 2005 to 2014.

METHODS: The New York Statewide Planning and Research Cooperative Systems (SPARCS) database was queried from 2005 through 2014 to identify patients undergoing meniscetomies, meniscal repairs, and MAT. Patients were followed longitudinally to determine the incidence of subsequent ipsilateral knee procedures. The impact of patient demographics and surgeon volume on reoperation was explored.

RESULTS: From 2005 through 2014, there were 524,737 arthroscopic meniscal procedures. Of these, there were 510,406 meniscectomies, 14,214 meniscal repairs, and 117 MATs. The number of MATs increased 15.5% per year, with the largest increase being between 2013 to 2014 (an increase of 86.5%). Average MAT patient age was 29.8 ± 11.1 years; 65.0% of patients were male; 66% were Caucasian; 84% were privately-insured; and 23% of surgeons met the criteria for high-volume (five or more MATs in a year). A total of 25.6% (30/117) patients underwent subsequent surgery; 26 patients underwent knee procedures at mean of 18.9 ± 18.3 months after initial MAT, the most common of which were ipsilateral meniscectomies (19/26). Four patients underwent total knee arthroplasty (TKA) at a mean of 21.0 ± 9.2 months after initial MAT. Patients undergoing TKA after MAT were significantly older (42.0 ± 15.0 years vs, 29.3 ± 10.7 years; p = 0.0242) than patients who did not. Neither demographics nor surgeon volume were statistically significant factors for undergoing subsequent surgery (p > 0.05).

CONCLUSION: Meniscal allograft transplantation, though relatively uncommon, is being performed with greater frequency in NYS. Surgeons should counsel patients regarding the likelihood of requiring subsequent knee surgery after MAT, with repeat arthroscopic partial meniscectomy being the most commonly performed procedure.

PMID:36030442

Arch Gynecol Obstet. 2022 Aug 28. doi: 10.1007/s00404-022-06754-3. Online ahead of print.

ABSTRACT

PURPOSE: Intrahepatic cholestasis of pregnancy (ICP) is associated with adverse fetal and neonatal outcome. Evidence for improvement by obstetric management is sparse. Common international guidelines recommend induction of labor before term, however, they differ in recommendations of monitoring the disease and time point of active management. So far, an official guideline for treatment and management of ICP in Germany does not exist. This study aims to compile common practice and policy in obstetric management of ICP in German maternity units. The objective is to gather obstetricians’ opinion on management of ICP, and to estimate the need for standardization of current practice in Germany on the background of existing evidence.

METHODS: A questionnaire focusing on indications for interventions was developed including fourteen multiple-choice questions comprising the areas of diagnostic criteria, laboratory testing, fetal monitoring, treatment, and delivery timing. The survey was sent to 699 maternity clinics and was distributed to participants of the annual congress hosted by the German society of perinatal medicine (DGPM). Collected data were summarized and evaluated in relation to available evidence and existing guidelines. Descriptive statistics and Fisher’s exact test were used.

RESULTS: 334 completed questionnaires returned corresponding to a response rate of 48.1%. Coinciding with existing international guidelines, 48.8% of the participants acknowledge bile acid concentrations above 10 µmol/L to be indicative of ICP. 85.0% of obstetricians recommend antenatal testing with cardiotocography, exceeding common standards of maternity policy guidelines; 50.3% execute active management in ICP-affected pregnancies as they generally recommend a delivery between 37 + 0 and 38 + 6 weeks of gestation. Although recent studies evinced a risk of stillbirth in ICP-affected pregnancies not until a bile acid concentration of > 100 µmol/L, 22.2% of the respondents recommend delivery before 37 + 0 weeks of gestation due to raised bile acids of 40-99 µmol/L.

CONCLUSIONS: Opinions on the management of ICP in German maternity units differ widely and partly deviate by large from international standards. Reasons for this may be the lack of a national guideline and the low awareness due to the rarity of the disease on the one hand and the very slow dynamics in evidence generation and thus the uncertainty about the actual risks and optimal management on the other. The present data highlight the need for further research and clinical guidelines to standardize and optimize treatment based on the best available evidence.

PMID:36030428 | DOI:10.1007/s00404-022-06754-3