Nevin Manimala

Am J Perinatol. 2021 Oct 19. doi: 10.1055/s-0041-1736593. Online ahead of print.

ABSTRACT

OBJECTIVE: Hypoxic-ischemic encephalopathy (HIE) is the second cause of neonatal deaths and one of the main conditions responsible for long-term neurological disability. Contrary to past belief, children with mild HIE can also experience long-term neurological sequelae. The aim of this systematic review is to determine the predictive value of long-term neurological outcome of (electroencephalogram) EEG/amplitude-integrated electroencephalogram (aEEG) in children who complained mild HIE.

STUDY DESIGN: From a first search on PubMed, Google Scholar, and clinicalTrials.gov databases, only five articles were considered suitable for this study review. A statistical meta-analysis with the evaluation of odds ratio was performed on three of these studies.

RESULTS: No correlation was found between the characteristics of the electrical activity of the brain obtained through EEG/aEEG in infants with mild HIE and subsequent neurological involvement.

CONCLUSION: EEG/aEEG monitoring in infants with mild HIE cannot be considered a useful tool in predicting their neurodevelopmental outcome, and its use for this purpose is reported as barely reliable.

KEY POINTS: · Hypoxic-Ischemic Encephalopathy is responsible for long-term neurological outcome, even in newborns with mild HIE.. · No correlation was found between EEG/aEEG trace in infants with mild HIE and neurological sequelae.. · Neurophysiological monitoring, in mild HIE, cannot predic neurodevelopmental outcome..

PMID:34666398 | DOI:10.1055/s-0041-1736593

Am J Perinatol. 2021 Oct 19. doi: 10.1055/a-1673-0183. Online ahead of print.

ABSTRACT

BACKGROUND: Spontaneous intestinal perforation (SIP) occurs commonly in extremely low gestational age newborns (ELGANs; < 30 weeks GA). Early, concurrent neonatal use of indomethacin (Neo_IN) and hydrocortisone (Neo_HC), is a known risk for SIP. Mothers in premature labor often receive indomethacin (Mat_IN) for tocolysis and steroids (Mat_S) for fetal maturation. Coincidentally, ELGANs may receive Neo_IN or Neo_HC within the first week of life. There is limited data on the effect of combined exposures to maternal and neonatal medications. We hypothesized that proximity exposure to these medications may increase the risk of SIP.

DESIGN: We reviewed the medical records of ELGANS from June 2014 to December 2019 at a single Level III NICU. We compared antenatal and postnatal indomethacin and steroid use between neonates with and without SIP. Chi-Square, Student’s t-test, Fisher’s Exact test, and Mann-Whitney U tests were used for analysis.

RESULTS: Among 417 ELGANs, SIP was diagnosed in 23; predominantly neonates <26 weeks GA (n = 21/126, 16.7%). Risk factors analysis focused on this GA cohort in which SIP was most prevalent. Mat_IN administration within two days of delivery increased SIP risk (OR 3.00, 95%Cl 1.25-7.94, p=0.036). Neo_HC was not independently associated with SIP (p=0.38). A higher proportion of SIP group had close temporal exposure of Mat_IN and Neo_HC compared to the non-SIP group, though not statistically significant (14% v. 7%, p=0.24).

CONCLUSIONS: Peripartum Mat_IN was associated with increased risk for SIP in this small study sample. Larger studies are needed to further delineate SIP risk from the interaction of peripartum maternal medication with early postnatal therapies and disease pathophysiology.

PMID:34666387 | DOI:10.1055/a-1673-0183

Am J Perinatol. 2021 Oct 19. doi: 10.1055/a-1673-0708. Online ahead of print.

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is associated with fewer deliveries and premature births; however, the impact of this pandemic on the well-baby nursery (WBN) is unknown.

OBJECTIVE: To evaluate the impact of the COVID-19 pandemic on infants admitted to the WBN by comparing pandemic and pre-pandemic cohorts.

STUDY DESIGN: We performed a retrospective study of infants admitted to a WBN during the pandemic period (March 18, 2020-to-March 17, 2021) and compared them to those during the pre-pandemic period (March 18, 2019-to-March 17, 2020). Maternal (age, parity, gestation, method of delivery, and COVID-19 status) and neonatal (sex, weight, Apgar score, feeding pattern, urine toxicology, and neonatal intensive care unit [NICU] admission) data were collected and compared between the two periods. The results were statistically analyzed, and significance was set at P < 0.05.

RESULTS: There were 824 and 859 WBN admissions during the pandemic and pre-pandemic periods, respectively; a 4% decrease in WBN admissions during the pandemic period. During the pandemic period, the number of deliveries among nulliparous women increased (from 40.3% to 45.1%; p=0.01), and deliveries among multiparous women decreased (from 59.2% to 53.1%; p=0.01). The number of infants exposed to marijuana in-utero increased (24/149 screened vs. 12/146 screened; p=0.038), and transfers from WBN to NICU decreased (from 9% to 6%; p=0.044) during the pandemic period.

CONCLUSIONS: Compared to the pre-pandemic period, the number of WBN admissions, multiparous deliveries, and NICU admissions decreased, while the number of nulliparous deliveries and infants exposed to marijuana in-utero increased during the pandemic period.

PMID:34666385 | DOI:10.1055/a-1673-0708

Am J Perinatol. 2021 Oct 19. doi: 10.1055/a-1673-0527. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine the rate of perinatal mortality among nulliparous women compared to primiparous women at term and further characterize the risk of stillbirth by each week of gestation.

STUDY DESIGN: A retrospective cohort study of all term, singleton, non-anomalous births comparing perinatal mortality (stillbirth and neonatal demise [NND]) between primiparous (parity=1, with no history of abortion) and nulliparous (parity = 0) women who delivered in California between 2007 and 2011. Chi squared tests and multivariable logistic regression analyses were performed to determine the frequencies and strength of association of perinatal mortality and parity, adjusting for maternal age, race, body mass index (BMI), pre-gestational diabetes, chronic hypertension, fetal sex, smoking status, and socioeconomic status. The risk of stillbirth at each gestational age at term was calculated using a pregnancies-at-risk life table method. A p-value less than 0.05 was used to indicate statistical significance.

RESULTS: Of 1,317,761 total deliveries, 765,995 (58.1%) were to nulliparous women and 551,766 (41.9%) were to primiparous women with one prior birth. Nulliparous women had increased odds of stillbirth (adjusted odds ratio [aOR] 3.30, 95% confidence interval (CI) 2.93-3.72) and NND (aOR 1.54, 95% CI 1.19-1.98) compared to primiparous women. The risk of stillbirth in nulliparous women was greater at every gestational age between 37 0/7 and 41 0/7 weeks compared to primiparous women. Nulliparous women also had increased odds of small for gestational age (SGA) infants at <10% birth weight (aOR 1.76, 95% CI 1.72-1.79), <5% birth weight (aOR 1.91, 95% CI 1.86-1.98), and <3% birth weight (aOR 2.02, 95% CI 1.93-2.11).

CONCLUSION: Perinatal mortality is significantly greater in nulliparous women compared to primiparous women with term deliveries. These findings suggest that low-risk nulliparous women may require increased surveillance. There may be a role in improving maternal health by maximizing physiologic adaptation in nulliparous women.

PMID:34666381 | DOI:10.1055/a-1673-0527

J Natl Compr Canc Netw. 2021 Oct 19:1-8. doi: 10.6004/jnccn.2021.7034. Online ahead of print.

ABSTRACT

BACKGROUND: Given a link between sarcomas and hereditary cancer predisposition syndromes, including Li-Fraumeni syndrome, the consideration for genetic counseling is recommended for all adolescent and young adult (AYA) patients diagnosed with sarcoma. The aim of this study was to evaluate factors influencing genetic consultations in AYA patients with sarcoma at the University of Wisconsin (UW).

METHODS: A retrospective chart review was performed on AYA patients diagnosed with sarcoma between the ages of 15 and 39 years who were seen at least once between 2015 to 2019 at UW. Our chart review identified discussions regarding genetics, referrals to genetics, genetic consultations, and results of genetic testing. Variables hypothesized to affect patient referrals for genetic consultation were identified a priori. Descriptive statistical methods and a univariate analysis were used to identify patient characteristics associated with genetic counseling referral.

RESULTS: We identified 87 AYA patients with sarcoma. Only 19 (22%) of these patients had documentation of a discussion about genetics, 15 (17%) of whom were subsequently referred for genetic consultation. Of these 15 patients, 9 (60%) were seen in consultation. All 9 patients seen by genetics underwent genetic testing, with 4 (44%) of these patients having identified heritable cancer predisposition syndromes. Likelihood for genetics referral was linked most strongly to documented genetics discussion with an oncology provider (P<.001).

CONCLUSIONS: Despite the recommendation for consideration for genetic counseling in AYA patients with sarcoma, <25% of such patients in our study had a documented discussion about genetics. Supporting this need, all referred patients met criteria for genetic testing, and 44% of tested patients were found to have a heritable cancer predisposition syndrome. These data support the initial conversation by a provider as critical to genetic referral and suggest the need for more specific national recommendations for the genetic evaluation of all AYA patients with sarcoma.

PMID:34666309 | DOI:10.6004/jnccn.2021.7034

JMIR Ment Health. 2021 Oct 14. doi: 10.2196/32948. Online ahead of print.

ABSTRACT

BACKGROUND: The COVID-19 pandemic and its mitigation measures such as shelter-in-place orders, social isolation, restrictions on freedoms, unemployment, financial insecurity and disrupted routines, have led to declines in mental health worldwide and concomitant escalating demands for mental health services. Under the circumstances, e-mental health programs and services have rapidly become the “new normal”.

OBJECTIVE: To assess key characteristics and evidence gaps in the e-mental health literature published in relation to the COVID-19 pandemic via a scoping review and bibliometric analysis.

METHODS: A search of four academic databases (MEDLINE, EMBASE, PsycINFO, CINAHL) published from 31st December 2019 to 31st March 2021 using keywords for e-mental health and COVID-19. Article information was extracted relevant to the review objective including journal, type of article, keywords, focus and corresponding author. Information was synthesised by coding these attributes, then summarised through descriptive statistics and narrative techniques. Article influence was examined from Altmetric and CiteScore data, and a network analysis was conducted on article keywords.

RESULTS: A total of 356 publications were included in the review. Articles on e-mental health quickly thrived early in the pandemic, with most articles being non-empirical, chiefly commentaries or opinions (n = 225, 63.2%). Empirical publications emerged later and became more frequent as the pandemic progressed. The United States contributed the most articles (n = 160, 44.9%), though a notable number came from middle-income countries (n = 59, 16.6). Articles were spread across 165 journals, and were of above-average-influence (almost half of the articles were in the top 25% of outputs scores by Altmetric and the average CiteScore across articles was 4.22). The network analysis of author-supplied keywords identified key topic areas, including specific: mental disorders; e-health modalities; issues and challenges; and populations of interest. These were further explored via full-text analysis. Applications of e-mental health during the pandemic overcame, or were influenced by system, service, technology, provider and patient factors.

CONCLUSIONS: COVID-19 has accelerated applications of e-mental health. Further research is needed to support the implementation of e-mental health across system and service infrastructure alongside evidence of the relative effectiveness of e-mental health in comparison to traditional modes of care.

PMID:34666306 | DOI:10.2196/32948

Lung Cancer. 2021 Oct 11;162:36-41. doi: 10.1016/j.lungcan.2021.10.002. Online ahead of print.

ABSTRACT

BACKGROUND: Tumor size and metastatic extent may influence tumor response to immunotherapy in non-small cell lung cancer (NSCLC). The aim of this study was to examine the relationship between both baseline sum of longest diameters (bSLD) and number of metastatic organs (NMO) and the tumor response to pembrolizumab. Secondly, we aimed to analyze the association of baseline SLD and NMO with progression-free survival (PFS) and overall survival (OS).

METHODS: This retrospective study included patients with high PD-L1 expressing tumors (≥50%) and a good performance score (ECOG ≤ 2) that received first-line pembrolizumab monotherapy. Tumor response was calculated as the ‘SLD-change score’ and ‘early treatment discontinuation’ within 3 months on therapy (ETD). The relationship of both bSLD (based on RECIST v1.1) and NMO with tumor response and survival outcome (PFS, OS) was evaluated.

RESULTS: No significant differences in SLD-change score could be found using bSLD (OR = 1.010, 95%CI = 0.999-1.021), or using NMO at baseline (OR = 1.608, 95%CI = 0.943-2.743). A bSLD cut-off value of 90 mm was found to be most distinctive for ETD. This cut-off value showed a significant difference for PFS (HR = 2.28, 95%CI = 1.12-4.64, p = 0.023) and OS (HR = 2.99, 95%CI = 1.41-6.34, p = 0.004). NMO also showed a difference for PFS and OS, however, not statistically significant.

CONCLUSIONS: Tumor size and metastatic extent could not discriminate for tumor response, however, a bSLD of 90 mm could differentiate for PFS and OS.

PMID:34666276 | DOI:10.1016/j.lungcan.2021.10.002

Accid Anal Prev. 2021 Oct 16;163:106446. doi: 10.1016/j.aap.2021.106446. Online ahead of print.

ABSTRACT

Safety evaluation of signalized intersections is often conducted by developing statistical and data-driven methods based on data aggregated at certain temporal and spatial levels (e.g., yearly, hourly, or per signal cycle; intersection or approach leg). However, such aggregations are subject to a major simplification that masks the underlying spatio-temporal safety risk patterns within the data aggregation levels. Consequently, high-resolution analysis such as safety risk within signal cycles and at traffic movement level cannot be performed. This study contributes to the literature by proposing a new functional data analysis (FDA) approach for a novel characterization of safety risk patterns of signalized intersections. Functional data smoothing methods that can mitigate overfitting and account for the nonnegative characteristics of safety risk are proposed to model the time series of safety risk within signal cycles at the traffic movement level. Functional analysis of variance method (FANOVA) that can compare the group level differences of functional curves is used to test differences of safety risk functions among different traffic movements. A typical signalized intersection with representative signal types and channelizations is selected as the study location and approximately 1-hour traffic video data recorded by an unmanned aerial vehicle are used to extract traffic conflicts. New movement-level safety risk patterns are characterized based on the safety risk functions that can reveal the temporal distribution of risk within signal cycles. Most of the tested traffic movements have significantly distinct functional risk patterns according to the FANOVA results while risk patterns for most of the traffic movements cannot be differentiated based on the data aggregated at the cycle and approach levels. The proposed functional approach has the potential to be used for facilitating proactive safety management, calibrating microsimulation models for safety evaluation, and optimizing signal timing while considering traffic safety at more disaggregated levels.

PMID:34666264 | DOI:10.1016/j.aap.2021.106446

Clin Nutr. 2021 Oct 8;40(11):5648-5654. doi: 10.1016/j.clnu.2021.09.042. Online ahead of print.

ABSTRACT

AIMS: Data about the influence of short-term lifestyle intervention in children with obesity on long-term follow-up body weight, adipokines and cardiometabolic risk parameters is scarce.

METHODS: In a subgroup of the LOGIC-trial (Long-term Effects of Lifestyle Intervention in Obesity and Genetic Influence in Children), we assessed anthropometry (BMI, BMI-SDS (Standard Deviation Score), adipokines (omentin-1, chemerin, leptin, adiponectin) and cardiometabolic risk parameters, (e.g. hsCRP) in children with overweight/obesity after 4 weeks of lifestyle intervention (n = 156, 14.0 ± 1.8 yrs) and after one year follow-up (n = 50). Data were compared to normal weight children (JuvenTUM school cohort; n = 152, 13.3 ± 0.7 yrs).

RESULTS: Short-term lifestyle intervention was associated with a significant reduction in BMI and BMI-SDS (p < 0.001), with significant reductions in hsCRP, leptin, and chemerin levels, and an increase in adiponectin and omentin-1 levels (p < 0.001 for all). After one year follow-up a significant reduction in BMI and BMI-SDS was observed in children from the LOGIC-trial (p < 0.001). Improvements in adiponectin (p = 0.025) and chemerin levels (p = 0.027) were seen in children with clear weight loss success (BMI-SDS reduction ≥ 0.2), whereas children with no or only mild weight loss success showed an increase in leptin levels (p < 0.001). An increase in omentin-1 levels was observed after 1 year independent of weight change (p < 0.001).

CONCLUSION: Effects of short-term weight reduction on mean BMI and BMI-SDS persist over one year. Improvements in omentin-1 levels were independent of short-term or long-term weight loss.

TRIAL REGISTRATION: ClinicalTrials.gov: LOGIC-trial: NCT01067157, JuvenTUM-trial: NCT00988754.

PMID:34666255 | DOI:10.1016/j.clnu.2021.09.042

J Biomech. 2021 Oct 11;129:110806. doi: 10.1016/j.jbiomech.2021.110806. Online ahead of print.

ABSTRACT

Subacromial shoulder pain (SSP) accounts for 44-65% of all cases of shoulder pain. Kinematic alterations in the upper limbs have been observed in individuals with SSP, although there is no consensus on such alterations in the literature. Therefore, the present study aimed to compare the three-dimensional kinematics of the scapula, trunk, and arm during shoulder flexion-extension and abduction-adduction movements in individuals with SSP and a control group using statistical parametric mapping (SPM). We evaluated 117 participants [61 with SSP and 56 in the control group (CG)]. The three-dimensional kinematic analysis was performed starting from arm extension/adduction (0%), moving to flexion/abduction, and ending returning to extension/adduction, respectively (100%) in both groups. SSP group flexed more their trunk (0-100%, p < 0.001) and rotated scapula internally (0-20%, p < 0.001 and 75-100%, p < 0.001); rotated upwards (17-32%, p < 0.005 and 58-87%, p < 0.003) and posteriorly tilted (28-79%,p < 0.001 and 81-95%,p < 0.006) less than CG group during arm abduction-adduction. Through arm flexion-extension, the SSP group flexed (38-82% p < 0.009) less their trunk, rotated upwards (5-10% p = 0.021) less their scapula, and posteriorly tilted scapula (0-100% p < 0.001) more than CG. Combining conventional variables used to describe motion in individuals with SSP, such as minimum and maximum values, range of motion, and results provided by SPM can furnish a detailed description of the compensations and limitations of the patient, enabling a better understanding of the function of the scapular girdle as well as improvements in the evaluation process and clinical decision making.

PMID:34666249 | DOI:10.1016/j.jbiomech.2021.110806