Nevin Manimala

Pain Physician. 2022 Sep;25(6):E851-E856.

ABSTRACT

BACKGROUND: Chronic foot pain (CFP) is a widespread condition worldwide; however, few studies that relate CFP and foot health-related quality of life have been reported.

OBJECTIVE: The aim of this study was to describe the impact of foot health and health in general in a sample of adult people with CFP compared with a control group.

STUDY DESIGN: This study was designed as a retrospective case-control study.

SETTING: Podiatric section of a care center.

METHODS: Two hundred adults were included in the study. Patients were divided into CFP patient (n = 100) and control groups (n = 100). All of them regularly attended a private podiatric clinic to take care of their foot health. Self-reported data and medical histories for people with and without CFP were evaluated. All findings were compared with quality of life (QoL) scores based on the Foot Health Status Questionnaire, Spanish version.

RESULTS: Adults with CFP (compared to the control group) showed reductions in QoL linked to overall health and foot health in particular and were statistically significant with respect to several domains: (1) foot pain, (2) foot function, (3) general health, and (4) physical activity. These differ-ences were evaluated with a t-test for independent samples, and statistical significance was consid-ered a P value of P < 0.05.

LIMITATIONS: The study was not a randomized controlled trial. Although primary outcome data were self-reported, the assessor was not blinded.

CONCLUSIONS: CFP patients, regardless of gender, recorded a negative influence on QoL-related foot health that seems to be linked with the presence of this chronic condition.

PMID:36122268

Pain Physician. 2022 Sep;25(6):E831-E840.

ABSTRACT

BACKGROUND: Fibromyalgia (FM) is a chronic disease, with no effective treatments for this disorder. The origin is suspected to be a misprocessing of signals in the central nervous system. One of the experimental treatments is very low intensity transcranial magnetic stimulation (LITMS) used to perform central neuromodulation.

OBJECTIVES: The main objective was to characterize the differences in oscillatory brain processing before and after LITMS in FM and compare the results with healthy controls.

STUDY DESIGN: This is an interventional study with control group, which shows how the treatment with LITMS could modify brain oscillatory activity and be useful for the improvement of symptoms in FM patients.

METHODS: Thirty-three women with FM and 14 healthy controls are studied using magnetoencephalography recording, and mechanical stimuli are applied before and after treatment with transcranial magnetic stimulation. Changes in different brain areas and a specific brain frequency are studied, and the results are analyzed within and between patients, before and after treatment.

RESULTS: In the FM group, an increase in alpha brain oscillatory activity was observed mainly in the dorsolateral prefrontal cortex (DLPFS), and more pronounced in the left hemisphere (P = 0.03). In addition, there was a significant improvement in the FM impact questionnaire in the patients (P < 0.01). When comparing patients with controls, it is observed that the differences in alpha frequency in this brain area disappear between groups.

LIMITATIONS: Age difference between patients and controls. Replicating the long-term results.

CONCLUSIONS: This treatment improves the patients’ symptomatology, and also produces statistical changes in alpha brain activity in the DLPFS. Furthermore, a normalization was observed in this frequency and in this area, similar to that of the controls.

PMID:36122266

Pain Physician. 2022 Sep;25(6):E805-E813.

ABSTRACT

BACKGROUND: Percutaneous kyphoplasty (PKP) is an effective treatment for osteoporotic vertebral compression fractures (OVCF). Comparisons of different approaches have previously focused primarily on x-rays. Three-dimensional (3D) computed tomography (CT) enables better imaging evaluation of bone cement distribution.

OBJECTIVES: To compare the CT imaging parameters and clinical efficacies of unilateral and bilateral PKP.

STUDY DESIGN: This was a prospective, nonrandomized controlled study.

SETTING: Department of Orthopedics from an affiliated hospital.

METHODS: Seventy-two single-level OVCF patients who underwent 3D CT between 2018 and 2020 were evaluated prospectively. All patients underwent PKP and were assigned to 2 groups: unilateral PKP and bilateral PKP. Imaging outcomes were assessed by determining the cement volume, leakage, dispersion index, vertebral height (VH) and the cement volume of the noninjected and injected sides. Clinical outcomes were evaluated using the Visual Analog Scale (VAS). The correlations between the bone cement volume or dispersion index and the VAS, VH improvement rate (VHIR), or bone cement leakage were also evaluated.

RESULTS: The mean follow-up time was 17.1 months. The postoperative VH and VAS in both groups were significantly improved (P < 0.05). However, there were no statistically significant differences in the cement volume, leakage or dispersion index, VH, or VAS between the 2 groups. No statistically significant differences in the cement volume or VH were found between the noninjected and injected sides within the unilateral group. The operative time was significantly shorter in the patients who underwent unilateral PKP. Unilateral PKP in which the bone cement did not cross the midline had a higher VAS compared with bilateral PKP. Both the bone cement volume and dispersion index displayed a positive correlation with the VHIR, but no correlation with the VAS or bone cement leakage.

LIMITATIONS: This study was limited by the nonrandomized design, small sample size, and short follow-up period.

CONCLUSIONS: While unilateral PKP was as effective as bilateral PKP, it had a shorter operation time. However, the bilateral PKP approach might be followed when bone cement is distributed in only one side following the unilateral PKP procedure.

PMID:36122263

Pain Physician. 2022 Sep;25(6):E795-E803.

ABSTRACT

BACKGROUND: Anesthesiologists are always looking for a regional analgesic technique which is easy, safe, has a low complication rate, and provides satisfactory analgesia. A retrolaminar block is a recent modified paravertebral technique for analgesia in thoracoabdominal procedures with a local anesthetic injected at the retrolaminar site. It has the advantage of being safe and easy compared with traditional thoracic epidural analgesia but is still under investigation.

OBJECTIVE: This study aimed to compare ultrasound-guided bilateral retrolaminar block with ultrasound-guided thoracic epidural analgesia for pain relief after laparoscopic cholecystectomy.

STUDY DESIGN: A prospective randomized double-blinded clinical study.

SETTING: Academic University Hospitals.

METHODS: Fifty-two adult patients were randomly allocated into 2 equal groups at the end of the surgery: Group R (n = 26) received a bilateral ultrasound-guided retrolaminar block with 20 mL of 0.25% bupivacaine and 5 µg/mL adrenaline (1:200000) in each side. Group T (n = 26) received ultrasound-guided thoracic epidural analgesia with 20 mL of 0.25% bupivacaine and 5 µg/mL adrenaline (1:200000).

RESULTS: The Numeric Rating Scale scores both at rest and during cough were statistically significantly lower in Group R compared with Group T at 30 minutes and one hour postoperatively. The pain scores were statistically significantly lower for about 4 hours in Group R group compared with 6 hours in Group T. The time for the first call of nalbuphine was highly statistically significantly shorter in Group R group (233.04 ± 5.27 minutes) compared with Group T (353.77 ± 5.16 minutes) (mean difference -120.37, (95% CI, -123.6 to -117.8) P < 0.001. The total amount of nalbuphine consumption in the first 12 hours was statistically significantly decreased in Group T (17.31 ± 5.52 mg) compared with Group R (27.69 ± 5.52 mg) (Mean difference 10.4, 95% CI 7.3-13.5), P < 0.001. The total number of patients who developed nausea and vomiting were statistically significantly greater in Group T (9 patients) compared with Group R group (3 patients), P = 0.04. Moreover, hypotension was statistically significantly more common among patients in Group T group (10 patients) compared with Group R (3 patients), P = 0.025. Both groups were comparable regarding patient satisfaction.

LIMITATIONS: There is limited literature in the field of the present study and sensory dermatome assessment, but this does not affect the results as we used an ultrasound-guided technique.

CONCLUSIONS: A single injection retrolaminar block provides adequate postoperative pain relief for about 4 hours compared with a single shot thoracic epidural that lasts about 6 hours. Patient satisfaction with both techniques was the same; about two-thirds of the patients were satisfied or very satisfied with either block.

PMID:36122260

Pain Physician. 2022 Sep;25(6):427-439.

ABSTRACT

BACKGROUND: COVID-19 quarantine measures have created new challenges in the delivery of medical care, especially in the realm of medical and interventional chronic pain management. This study evaluated the effect of COVID-19 social distancing and quarantine measures on symptoms of pain and anxiety, as well as substance abuse and health care engagement in patients with chronic pain and the role of the clinic’s virtual assessment initiatives in managing these patients.

METHODS: A 24-question cross-sectional survey was conducted with patients with chronic pain seen at the Montefiore Medical Center Comprehensive Pain Clinic from June 2020 through July 2020. The survey was administered to 552 high-utilizer patients via telephone, evaluating domains such as pain, anxiety, substance use, and health care engagement. The questions were quantitively assessed on a Likert scale or a numerical rating scale. We used descriptive statistics to report our results.

RESULTS: Of the 1,023 patients identified as high utilizers of the pain clinic, 552 patients participated in the survey. The median (25th-75th percentile) pain score reported was 7 (5-9) for all responders. Approximately 50% of the patients reported that they were anxious about their pain and somewhat or very concerned that their pain would be uncontrolled during the pandemic. Further, the severity of the pain reported was associated with sleep, appetite, and mood changes. In our cohort, 95% of all patients denied using alcohol, 92% denied using marijuana, and 98% denied using other recreational drugs to manage their pain during the pandemic. In addition, just more than three-fourths (79%) of all patients reported needing to speak with their health care provider during the pandemic.

CONCLUSIONS: The survey conducted among high-utilizers demonstrated that patients who remained engaged with their health care team reported minimal concerns regarding chronic pain and associated symptoms during the COVID-19 quarantine period. In addition, the early implementation of virtual consults in the pain clinic may have contributed to mitigating patient concerns. Finally, the study also identified the importance of outreach and patient education on the availability and utilization of telemedicine services. Consequently, it is reasonable to implement virtual assessments and visits alongside other education outreach methods to engage patients with chronic pain who frequently utilize chronic pain health care resources.

PMID:36122253

Proc Natl Acad Sci U S A. 2022 Sep 27;119(39):e2202779119. doi: 10.1073/pnas.2202779119. Epub 2022 Sep 19.

ABSTRACT

Translocation of proteins is correlated with structural fluctuations that access conformational states higher in free energy than the folded state. We use electric fields at the solid-state nanopore to control the relative free energy and occupancy of different protein conformational states at the single-molecule level. The change in occupancy of different protein conformations as a function of electric field gives rise to shifts in the measured distributions of ionic current blockades and residence times. We probe the statistics of the ionic current blockades and residence times for three mutants of the [Formula: see text]-repressor family in order to determine the number of accessible conformational states of each mutant and evaluate the ruggedness of their free energy landscapes. Translocation becomes faster at higher electric fields when additional flexible conformations are available for threading through the pore. At the same time, folding rates are not correlated with ease of translocation; a slow-folding mutant with a low-lying intermediate state translocates faster than a faster-folding two-state mutant. Such behavior allows us to distinguish among protein mutants by selecting for the degree of current blockade and residence time at the pore. Based on these findings, we present a simple free energy model that explains the complementary relationship between folding equilibrium constants and translocation rates.

PMID:36122213 | DOI:10.1073/pnas.2202779119

Proc Natl Acad Sci U S A. 2022 Sep 27;119(39):e2212959119. doi: 10.1073/pnas.2212959119. Epub 2022 Sep 19.

ABSTRACT

Detecting genetic variants associated with the variance of complex traits, that is, variance quantitative trait loci (vQTLs), can provide crucial insights into the interplay between genes and environments and how they jointly shape human phenotypes in the population. We propose a quantile integral linear model (QUAIL) to estimate genetic effects on trait variability. Through extensive simulations and analyses of real data, we demonstrate that QUAIL provides computationally efficient and statistically powerful vQTL mapping that is robust to non-Gaussian phenotypes and confounding effects on phenotypic variability. Applied to UK Biobank (n = 375,791), QUAIL identified 11 vQTLs for body mass index (BMI) that have not been previously reported. Top vQTL findings showed substantial enrichment for interactions with physical activities and sedentary behavior. Furthermore, variance polygenic scores (vPGSs) based on QUAIL effect estimates showed superior predictive performance on both population-level and within-individual BMI variability compared to existing approaches. Overall, QUAIL is a unified framework to quantify genetic effects on the phenotypic variability at both single-variant and vPGS levels. It addresses critical limitations in existing approaches and may have broad applications in future gene-environment interaction studies.

PMID:36122202 | DOI:10.1073/pnas.2212959119

Arthritis Rheumatol. 2022 Sep 19. doi: 10.1002/art.42368. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess the reliability and diagnostic accuracy of new radiographic definitions for calcium pyrophosphate deposition (CPPD) identification, developed by an international multidisciplinary working group.

METHODS: Patients with knee osteoarthritis scheduled for knee replacement were enrolled. Two radiologists and two rheumatologists assessed twice the images for presence/absence of CPPD on menisci, hyaline cartilage, tendons, joint capsule, synovial membrane, using the new definitions. In case of disagreement, a consensus decision was taken and considered for the assessment of diagnostic performance. Histological examination of specimens under compensated polarized light microscopy was the reference standard. Prevalence-adjusted bias-adjusted kappa (PABAK) was used to assess the reliability. Diagnostic performance statistics were calculated.

RESULTS: Sixty-seven participants were enrolled for the reliability study. The inter-observer reliability was substantial in most of the assessed structures when considering all 4 readers (kappa range 0.59 – 0.90), substantial to almost perfect among radiologists (kappa range 0.70-0.91), and moderate to almost perfect among rheumatologists (kappa range 0.46 – 0.88). The intra-observer reliability was substantial to almost perfect for all the observers (kappa range 0.70 – 1). Fifty-one patients were enrolled for the accuracy study. Radiography demonstrated to be specific for CPPD (92%), but sensitivity remained low in all sites and in the overall diagnosis (54%).

CONCLUSION: The new imaging definitions of CPPD are highly specific against the gold standard of histological diagnosis; when described findings are present these definitions allow for a definite diagnosis of CPPD, rather than other calcium-containing crystal depositions; instead a negative finding does not exclude the diagnosis.

PMID:36122187 | DOI:10.1002/art.42368

Microbiol Spectr. 2022 Sep 20:e0175222. doi: 10.1128/spectrum.01752-22. Online ahead of print.

ABSTRACT

Meteorological phenomena such as warm summer temperatures and increased numbers of sunlight hours have repeatedly been hypothesized to be associated with infectious diseases and an increased prescription of antimicrobial compounds in Danish aquaculture. To address this hypothesis, we prepared statistical models incorporating aquaculture production data from Danish Aquaculture, detailed records on prescription of antimicrobials from the Danish VETSTAT program, and meteorological data from 2001 to 2019 from the Danish Meteorological Institute. Separate series of models were made and refined for land-based and marine production, respectively. For both production forms, the models identify summer sunlight hours as having a significant influence on antimicrobial use. In addition to summer sunlight, spring sunlight and water temperature were integral, although not statistically significant, parameters when modeling antimicrobial use in marine production. Although the extensive availability and accuracy of relevant data are associated with Danish production, we believe the results allow for more general conclusions on the influence of meteorological parameters on outbreaks of bacterial pathogens in international aquaculture. Such insights could have a substantial impact on prophylactic strategies, fish husbandry, and our understanding of how increasing temperatures may affect future antimicrobial usage in the global aquaculture industry. IMPORTANCE Global aquaculture production has been rapidly increasing for decades and is set to play a pivotal role in feeding a growing human population. Along with the growth in aquaculture production, the annual global use of antimicrobials is estimated to increase by one-third between 2017 and 2030. Using detailed antimicrobial prescription records as a proxy for outbreaks, we were able to evaluate the effects of a variety of meteorological parameters through statistical modeling. Our results lend scientific support to informal observations from the industry, but more importantly, this study provides novel, essential information on the importance of abiotic factors that can, in turn, lead to improved prophylactic efforts and thus help to reduce antimicrobial use in global aquaculture.

PMID:36122183 | DOI:10.1128/spectrum.01752-22

IEEE J Biomed Health Inform. 2022 Sep 19;PP. doi: 10.1109/JBHI.2022.3207416. Online ahead of print.

ABSTRACT

Breathing pattern has been shown to be different in chronic obstructive pulmonary disease (COPD) patients compared to healthy controls during rest and walking. In this study we evaluated respiratory parameters and the breathing variability of COPD patients as a function of their severity. Thoracic bioimpedance was acquired on 66 COPD patients during the performance of the six-minute walk test (6MWT), as well as 5 minutes before and after the test while the patients were seated, i.e. resting and recovery phases. The patients were classified by their level of airflow limitation into moderate and severe groups. We characterized the breathing patterns by evaluating common respiratory parameters using only wearable bioimpedance. Specifically, we computed the median and the coefficient of variation of the parameters during the three phases of the protocol, and evaluated the statistical differences between the two COPD severity groups. We observed significant differences between the COPD severity groups only during the sitting phases, whereas the behavior during the 6MWT was similar. Particularly, we observed an inverse relationship between breathing pattern variability and COPD severity, which may indicate that the most severely diseased patients had a more restricted breathing compared to the moderate patients.

PMID:36121947 | DOI:10.1109/JBHI.2022.3207416