Nevin Manimala

PM R. 2022 Aug 28. doi: 10.1002/pmrj.12891. Online ahead of print.

ABSTRACT

OBJECTIVE: Several recent studies show growing popularity of therapeutic climbing (TC) for patients with various conditions. This could be an attempt to fill the gap left by traditional exercises that do not always address physical, mental and social well-being. The review provides an overview of physical, mental and social effects and safety aspects of climbing for different indications.

LITERATURE SURVEY: A literature search was conducted on July 8^th 2020 (update search August 26^th 2021). We searched MEDLINE via Ovid, Embase, and PubMed, bibliographies of included studies and conducted a manual search.

METHODOLOGY: Two independent reviewers evaluated the studies’ quality using appropriate Risk of Bias (RoB) tools, and domains’ level of evidence was graded. Study characteristics and TC’s effectiveness data were extracted and synthesised. Meta-analyses were conducted for the three dimensions (physical/mental/social health), using a random-effects model.

SYNTHESIS: 112 publications were reviewed, and 22 full-text articles were assessed regarding the eligibility criteria, of which 18 trials involving 568 patients were included. TC is safe and positively affects physical (e.g., fitness, motor control, movement velocity, dexterity, strength), mental (e.g., depressiveness, somatisation, psychoticism, emotion regulation, body perception, self-esteem, fatigue), and social health (e.g., social functioning, trust, communication, sense of responsibility) for those with neurological, orthopaedic, psychiatric and paediatric ailments. The meta-analysis showed a statistically significant improvement in the physical dimension favouring the climbing group Improvements that were not statisticaly significant were found for the mental/social dimensions in the climbing group. The heterogeneity of data was moderate/high (social/mental dimension), and for the physical dimension, data were homogenous.

CONCLUSIONS: The studies investigating TC outline its positive effects in various patient groups. TC is a safe and effective treatment for improving physical/mental/social well-being. This review is based on the best available evidence; however, significant gaps remain in providing sufficiently strong evidence. This article is protected by copyright. All rights reserved.

PMID:36031691 | DOI:10.1002/pmrj.12891

Intern Emerg Med. 2022 Aug 29. doi: 10.1007/s11739-022-03068-9. Online ahead of print.

ABSTRACT

The HEFESTOS scale was developed in 14 Spanish primary care centres and validated in 9 primary care centres of other European countries. It showed good performance to predict death/hospitalisation during the first 30 days after an episode of acute heart failure (AHF), with c-statistics of 0.807/0.730 in the derivation/validation cohorts. We evaluated this scale in the emergency department (ED) setting, comparing it to the EHMRG and MEESSI scales in the ED and the EFFECT and GWTG scales in hospitalised patients, to predict 30-day outcomes, including death and hospitalisation. Consecutive AHF patients were enrolled in 34 Spanish EDs in January-February 2016, 2018, and 2019 with variables needed to calculate outcome scores. Thirty-day hospitalisation/death (together and separately) and post-discharge combined adverse event (ED revisit or hospitalisation for AHF or all-cause death) were determined for patients discharged home after ED care. Predictive capacity was assessed by c-statistic with 95% confidence intervals. Of 10,869 patients, 4,044 were included (median age: 83 years, 54% women). The performance of HEFESTOS was modest for 30-day hospitalisation/death, c-statistic=0.656 (0.637-0.675), hospitalisation, 0.650 (0.631-0.669), and death, 0.610 (0.576-0.644). Of 1,034 patients with scores for the 5 scales, HEFESTOS had the numerically highest c-statistic for hospitalisation/death at 30 days, 0.666 (0.627-0.704), vs. MEESSI= 0.650 (0.612-0.687, p=0.51), EFFECT=0.633 (0.595-0.672, p=0.21), GWTG=0.618 (0.578-0.657, p=0.06) and EHMRG=0.617 (0.577-0.704, p=0.07). Similar modest performances were observed for predicting hospitalisation [ranging from HEFESTOS=0.656 (0.618-0.695) to GWTG=0.603 (0.564-0.643)]. Conversely, prediction of 30-day death was good with the MEESSI=0.787 (0.728-845), EFFECT=0.754 (0.691-0.818) and GWTG=0.749 (0.689-0.809) scales, and modest with EHMRG=0.649 (0.581-0.717) and HEFESTOS=0.610 (0.538-0.683). Although the HEFESTOS scale was numerically better for predicting 30-day hospitalisation/death in ED AHF patients, its modest performance precludes routine use. Only 30-day mortality was adequately predicted by some scales, with the MEESSI achieving the best results.

PMID:36031673 | DOI:10.1007/s11739-022-03068-9

Int Orthop. 2022 Aug 29. doi: 10.1007/s00264-022-05553-4. Online ahead of print.

ABSTRACT

PURPOSE: Total knee arthroplasty is one of the significantly evolving procedures with different knee designs available in the market. The continued development of these prosthesis resulted in improvement of the implant survivorship and patient satisfaction. This study is an RCT-based meta-analysis aimed to compare two designs of total knee replacement: the conventional modular and the monoblock trabecular metal tibial trays.

METHODS: This meta-analysis was performed by a literature review according to the PRISMA guidelines. A detailed search of the English literature was done using the PubMed, Medline, CINAHL, Cochrane, Embase, and Google Scholar databases. Only randomized control trials were included in the analysis after ensuring homogeneity. RevMan V.5.0.18.33 (The Cochrane Collaboration, Copenhagen, Denmark) was used to perform the meta-analysis. Extracted outcome measures were Knee Society score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, survivorship, complication rate, and radiostereographic analysis.

RESULTS: Seven randomized control trials with 635 patients were eligible for our analysis after they met our inclusion criteria. Three hundred twelve patients received monoblock tibias, and the other 323 patients received modular tibial trays during their total knee arthroplasty surgeries. There were statistically significant superiority of the modular knees in the functional Knee Society and WOMAC scores at five years (P = 0.003 and 0.05, respectively). The modular design was also more stable on RSA at two years (P < 0.0001).

CONCLUSION: Modular and monoblock tibial trays are comparable knee designs with comparable survivorship and complication rates. However, the modular knees had better mid-term functional outcome and are more stable on radiostereographic analysis.

PMID:36031663 | DOI:10.1007/s00264-022-05553-4

Perioper Med (Lond). 2022 Aug 29;11(1):43. doi: 10.1186/s13741-022-00273-0.

ABSTRACT

BACKGROUND: Significant resources are invested in the UK to collect data for National Clinical Audits (NCAs), but it is unclear whether and how they facilitate local quality improvement (QI). The perioperative setting is a unique context for QI due to its multidisciplinary nature and history of measurement. It is unclear which NCAs evaluate perioperative care, to what extent their data have been used for QI, and which factors influence this usage.

METHODS: NCAs were identified from the directories held by Healthcare Quality Improvement Partnership (HQIP), Scottish Healthcare Audits and the Welsh National Clinical Audit and Outcome Review Advisory Committee. QI reports were identified by the following: systematically searching MEDLINE, CINAHL Plus, Web of Science, Embase, Google Scholar and HMIC up to December 2019, hand-searching grey literature and consulting relevant stakeholders. We charted features describing both the NCAs and the QI reports and summarised quantitative data using descriptive statistics and qualitative themes using framework analysis.

RESULTS: We identified 36 perioperative NCAs in the UK and 209 reports of local QI which used data from 19 (73%) of these NCAs. Six (17%) NCAs contributed 185 (89%) of these reports. Only one NCA had a registry of local QI projects. The QI reports were mostly brief, unstructured, often published by NCAs themselves and likely subject to significant reporting bias. Factors reported to influence local QI included the following: perceived data validity, measurement of clinical processes as well as outcomes, timely feedback, financial incentives, sharing of best practice, local improvement capabilities and time constraints of clinicians.

CONCLUSIONS: There is limited public reporting of UK perioperative NCA data for local QI, despite evidence of improvement of most NCA metrics at the national level. It is therefore unclear how these improvements are being made, and it is likely that opportunities are being missed to share learning between local sites. We make recommendations for how NCAs could better support the conduct, evaluation and reporting of local QI and suggest topics which future research should investigate.

TRIAL REGISTRATION: The review was registered with the International Prospective Register of Systematic Reviews (PROSPERO: CRD42018092993 ).

PMID:36031654 | DOI:10.1186/s13741-022-00273-0

Allergy Asthma Clin Immunol. 2022 Aug 28;18(1):79. doi: 10.1186/s13223-022-00720-z.

ABSTRACT

BACKGROUND: Asthma, allergic rhinitis and eczema have been identified as the most prevalent childhood allergic diseases. However, the prevalence of these allergic diseases can vary in different regions within a country and in the world.

METHODS: The objective of the study was to estimate the prevalence of asthma, allergic rhinitis and eczema in schoolchildren in the Kandy and Anuradhapura districts of Sri Lanka. This was a multicentre cross sectional study carried out among children of age 6-7 years and 13-14 years attending state schools fulfilling the entry criteria of the Global Asthma Network Phase 1 study methodology.

RESULTS: A total of 3673 children of 6-7 years and 4658 children of 13-14 years were recruited. The prevalence of current asthma, allergic rhinitis and eczema were 12% (CI 10.44-13.75), 15.7% (CI 13.94-17.64) and 9.7% (CI 8.30-11.31) among 6-7 years age group and 15.3% (CI 13.66-17.09), 30.5% (CI 28.86-32.74) and 7.3% (CI 6.15-8.65) respectively among the 13-14 age group in Kandy district. The reported prevalence rates of the disease conditions were 9.9% (CI 8.72-11.22), 10.1% (CI 8.90-11.44) and 5.9% (CI 4.98-6.98) among 6-7 years age group and 14.9% (CI 13.67-16.22), 22.5% (CI 21.04-24.03) and 1.8% (CI 1.38-2.34) in the 13-14 years age group in Anuradhapura district. When comparing these prevalence rates, there is relatively a higher prevalence of childhood allergic diseases in Kandy district. This difference is statistically significant in all three allergic disease conditions (P < 0.001).

CONCLUSION: Prevalence of allergic diseases in Anuradhapura is closer to reported data in the previous studies. There is relatively higher prevalence of childhood allergic diseases among children in Kandy district.

PMID:36031628 | DOI:10.1186/s13223-022-00720-z

BMC Med Inform Decis Mak. 2022 Aug 28;22(1):225. doi: 10.1186/s12911-022-01969-5.

ABSTRACT

BACKGROUND AND OBJECTIVE: The automated detection of atrial activations (AAs) recorded from intracardiac electrograms (IEGMs) during atrial fibrillation (AF) is challenging considering their various amplitudes, morphologies and cycle length. Activation time estimation is further complicated by the constant changes in the IEGM active zones in complex and/or fractionated signals. We propose a new method which provides reliable automatic extraction of intracardiac AAs recorded within the pulmonary veins during AF and an accurate estimation of their local activation times.

METHODS: First, two recently developed algorithms were evaluated and optimized on 118 recordings of pulmonary vein IEGM taken from 35 patients undergoing ablation of persistent AF. The adaptive mathematical morphology algorithm (AMM) uses an adaptive structuring element to extract AAs based on their morphological features. The relative-energy algorithm (Rel-En) uses short- and long-term energies to enhance and detect the AAs in the IEGM signals. Second, following the AA extraction, the signal amplitude was weighted using statistics of the AA sequences in order to reduce over- and undersensing of the algorithms. The detection capacity of our algorithms was compared with manually annotated activations and with two previously developed algorithms based on the Teager-Kaiser energy operator and the AF cycle length iteration, respectively. Finally, a method based on the barycenter was developed to reduce artificial variations in the activation annotations of complex IEGM signals.

RESULTS: The best detection was achieved using Rel-En, yielding a false negative rate of 0.76% and a false positive rate of only 0.12% (total error rate 0.88%) against expert annotation. The post-processing further reduced the total error rate of the Rel-En algorithm by 70% (yielding to a final total error rate of 0.28%).

CONCLUSION: The proposed method shows reliable detection and robust temporal annotation of AAs recorded within pulmonary veins in AF. The method has low computational cost and high robustness for automatic detection of AAs, which makes it a suitable approach for online use in a procedural context.

PMID:36031620 | DOI:10.1186/s12911-022-01969-5

J Headache Pain. 2022 Aug 28;23(1):111. doi: 10.1186/s10194-022-01476-y.

ABSTRACT

OBJECTIVE: This study examines changes in utilization and costs trends associated with migraine medications.

BACKGROUND: Migraine attacks are a burden to many patients. There are many pharmacotherapy options available with newer migraine drug classes entering the market in the past decade. Little is known about the use, associated costs, and the impact of the newer agents.

METHODS: This retrospective, cross-sectional study examined 2017-2020 administrative claims from a large national pharmacy benefits manager. Patients aged ≥ 18 years enrolled in commercial, Medicare, Medicaid, or health insurance exchange insurance plans who filled ≥ 2 prescription claims for triptans, ergotamines, isometheptenes, gepants, ditans, and CGRP mABs were included. A two-sample t-test was conducted to estimate whether differences in mean utilization and costs between 2017 and 2020 were statistically significant for migraine drug classes, except for CGRP mABs, which were estimated between 2018 and 2020.

RESULTS: The sample ranged from 161,369 (2017) to 240,330 (2020) patients. 84.5% (n = 203,110; 2020) of patients were women. The number of 30-day adjusted prescription fills for prophylaxis remained stable over the four-year period, except for CGRP mABs, which increased from 0.5% (n = 0.007; 2018) to 5.3% (n = 0.075; 2020). Antiepileptics, antidepressants and beta blockers were the most common prophylaxes, while triptans, non-steroidal anti-inflammatory drugs/non-narcotic analgesics and opioids were the most common treatments utilized. CGRP mABs were the most expensive, while utilization of triptans were the highest. CGRP mABs had the largest increase in utilization (177.5%) and costs (166.3%) PPPM in 2020 ($291.17) compared to 2018 ($109.35), the year they were first available (p < 0.001). Between 2018 and 2020, costs increased overall and for commercial and Medicare enrollees, but remained unchanged for Medicaid and HIX members.

CONCLUSION: Our study demonstrates a shift in migraine medication utilization from 2017-2020, where increased use of CGRP mABs had a significant contribution to increased costs. These increased pharmacy costs must be weighed against the improved tolerability of these agents likely resulting in other healthcare and indirect cost savings.

PMID:36031609 | DOI:10.1186/s10194-022-01476-y

Zhongguo Ying Yong Sheng Li Xue Za Zhi. 2022 Mar;38(2):113-118. doi: 10.12047/j.cjap.6220.2022.023.

ABSTRACT

Objective: To investigate the effects of intrathecal injection of IRF8 SiRNA on the pain threshold and activation of spinal cord microglia in rats with postoperative persistent pain. Methods: One hundred and twenty male Sprague-Dawley rats were randomly divided into sham group (SH, n=12), SMIR group (SM, n=48), SMIR + DEPC group (SD, n=12) and SMIR + irf8 SiRNA group (SS, n=48). In the SM group, the persistent postsurgical pain(PPsP) model was established according to the skin/muscle incision and retraction (SMIR), and the SH group was only incised without retracted. The SD group and SS group received intrathecal catheterization one week before SMIR, the SS group was injected with 20 μl of IRF8 SiRNA solution (dissolved in DEPC-treated water, 150 pmol) intrathecally on the 5^th and 6^th day after SMIR, and the SD group was injected with the same amount of DEPC-treated water. The paw withdrawal threshold (PWT) of each group was measured and recorded before SMIR and on the 1^st, 3^rd, 7^th, 12^th, 22^nd and 33^rd days after SMIR. Western blot was used to detect the expression of Iba-1 in the dorsal horn of spinal cord on the 12^th days after SMIR, and the saphenous nerves in the SH group and SM group were collected to observe their ultrastructural changes under electron microscope. The flow cytometry was used to detect the activation of microglia in spinal cord dorsal horn before SMIR and on the 1^st, 3^rd, 7^th, 12^th, 22^nd and 33^rd days after SMIR in the SM group and SS group. Results: Compared with D0, the PWT of SM group was decreased on the 1^th to 22^nd day after SMIR (P＜0.05 or P＜0.01), and returned to normal level on the 33^rd day after SMIR (P＞ 0.05). Compared with the SH group, the PWT of the SM group was decreased on the 1^th to 22^nd day after SMIR (P＜0.05 or P＜ 0.01). However, compared with the SD group, the PWT of the SS group was increased on the 7^th to 22^nd day after SMIR (P＜0.05 or P＜0.01). Compared with SH group, the PWT of SS group was decreased on the 7^th to 22^nd day after SMIR (P＜0.05 or P＜0.01). The average thickness of saphenous nerve myelin was (377.0 3±69.60) nm in the SH group and (369.50±73.26) nm in the SM group, and there was no significant difference between the two groups (P＞0.05). Compared with the SH group, the expression level of Iba-1 was increased significantly (P＜0.01) in the SM group. Compared with the SD group, the expression of Iba-1 was inhibited (P＜0.05) in the SS group, and compared with the SH group, the expression of Iba-1 was also statistically different (P＜0.05) in the SS group, while the expression of Iba-1 was not statistically significant between the SM group and the SD group (P＞0.05). Compared with D0, the activation ratio of microglia was increased significantly on the 3^rd to 22^nd day after SMIR (P＜0.01) in the SM group , while the activation of microglia reached a peak on 3rd day after SMIR (P＜0.01) in the SS group. After intrathecal administration, the activation rate of microglia in the spinal dorsal horn of the SS group was decreased significantly, and compared with the SM group, it was decreased significantly on the 7^th to 12^th day after SMIR (P＜0.01). Conclusion: The significant and persistent mechanical hyperalgesia in PPsP induced by SMIR was caused non-obvious peripheral nerve injury, which may be mediated by the activation of microglia in the dorsal horn of the spinal cord. IRF8 SiRNA administrated by intrathecal injection could inhibit the activation of microglia and reverse SMIR-induced hyperalgesia.

PMID:36031567 | DOI:10.12047/j.cjap.6220.2022.023

Eur Urol Focus. 2022 Aug 25:S2405-4569(22)00175-4. doi: 10.1016/j.euf.2022.08.006. Online ahead of print.

ABSTRACT

BACKGROUND: Erectile dysfunction (ED) increases with age. Remarkably, the relationship between age and the risk of ED has only been described in crude categories, such as risk for men aged 50-59 yr, without taking comorbidities into account.

OBJECTIVE: To understand how the risk of patient-reported ED varies according to age and comorbidity status.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included a cohort of 17 250 patients with prostate cancer who completed the International Index of Erectile Function erectile function domain (IIEF-EF) questionnaire before any prostate treatment.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We created a logistic regression model to predict the probability of ED using age and comorbidities such as cardiovascular disease, diabetes, and hypertension as predictors. We used age as a nonlinear term to allow a curvilinear relationship between age and ED.

RESULTS AND LIMITATIONS: The prevalence of patient-reported ED among men without any comorbidities increased from 10% to 79% from the age of 40 and 80 yr. The risk of ED increased sharply with comorbidity: the probability of ED for 50- and 75-yr-old individuals was 20% and 68% for healthy men, but 41% and 85% for those with hypertension, obesity, and diabetes. Men with several comorbidities have the same risk of ED as that of healthy men 15-25 yr older. Limitations include a healthier-than-average patient group and lack of information about some comorbidities and the severity of comorbidities.

CONCLUSIONS: Our results allow us to better understand how the risk of ED changes with age and comorbidities. Further research should evaluate the impact of other risk factors not considered in the present study and should take risk factor severity into account.

PATIENT SUMMARY: Our study shows how the probability of erectile dysfunction (ED) changes with increasing age, analyzed alone and when taking into account the presence of other risk factors for this condition (eg, diabetes, high blood pressure, and cardiovascular disease). Our results help in better understanding the probability of ED for men with and without comorbidities.

PMID:36031560 | DOI:10.1016/j.euf.2022.08.006

Vet Anaesth Analg. 2022 Jul 21:S1467-2987(22)00108-8. doi: 10.1016/j.vaa.2022.07.005. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare dexmedetomidine and fentanyl constant rate infusions in anesthetic protocols for septic dogs with pyometra, using microcirculatory, hemodynamic and metabolic variables.

STUDY DESIGN: Randomized clinical study.

ANIMALS: A total of 33 dogs with pyometra with two or more systemic inflammatory response syndrome variables undergoing ovariohysterectomy.

METHODS: Dogs were randomized into two groups: group DG, dexmedetomidine (3 μg kg^-1 hour^-1; 17 dogs) and group FG, fentanyl (5 μg kg^-1 hour^-1; 16 dogs) infused during isoflurane anesthesia and mechanical ventilation. Microcirculation flow index (MFI), total vessel density and De Backer score were assessed using orthogonal polarization spectral imaging at the sublingual site. Heart rate, invasive blood pressure, temperature, arterial blood gas analysis and lactate concentration were obtained at various time points. Variables were recorded at baseline (BL), immediately before (T0), 30 (T30) and 60 (T60) minutes after infusion, and 60 minutes after surgery. Data were analyzed using the Shapiro-Wilk test. To compare variables between groups, the unpaired Student t test was used. Comparison between evaluation time points was performed with two-way anova for repeated measures. Where statistical significance was detected, the Bonferroni post hoc test was used.

RESULTS: MFI was significantly higher in group FG at T30. Mean arterial pressure at T30 was higher in group DG (89 ± 15 mmHg) than in group FG (72 ± 13 mmHg). Lactate concentrations were not significantly different between groups at each time point. Both groups had similar clinical outcomes (mortality, extubation time and occurrence of hypotension and bradyarrhythmias).

CONCLUSIONS AND CLINICAL RELEVANCE: Dexmedetomidine (3 μg kg^-1 hour^-1) without a loading dose can be included in the maintenance of anesthesia in dogs with pyometra and sepsis without compromising microcirculation and hemodynamic values when compared with fentanyl (5 μg kg^-1 hour^-1).

PMID:36031557 | DOI:10.1016/j.vaa.2022.07.005