Nevin Manimala

Ophthalmic Epidemiol. 2022 Jul 17:1-7. doi: 10.1080/09286586.2022.2094965. Online ahead of print.

ABSTRACT

PURPOSE: The objective of this study is to explore and compare trends in urban and rural cases of endogenous endophthalmitis (EE) in the United States.

METHODS: This study utilizes data from the 2002-2014 National Inpatient Sample (NIS) Database. Disease diagnoses and procedures were identified using codes from the International Classification of Diseases, Ninth Revision (ICD-9). Cases of EE were defined as cases of endophthalmitis in the setting of bacteremia or candidemia without a recent history of ocular trauma. The NIS Database defines urban and rural hospitals based on the hospital county’s population statistics. Statistical analysis was performed using IBM SPSS 23.

RESULTS: We identified 8255 cases of EE. Of these cases, 523 (6.3%) occurred in rural areas; 7733 (93.7%) occurred in urban areas. Of the cases of EE, 7692 (93.2%) were bacterial EE, 412 (5.0%) were candida EE, and 151 (1.8%) were mixed EE. Candida EE was observed in 1.7% of rural cases and 5.2% of urban cases (p < .001). Pars plana vitrectomies were performed more often in urban hospitals than in rural hospitals (11.5% vs. 2.9%; p < .001).

CONCLUSION: Endogenous endophthalmitis remains a rare but devastating ocular infection. In this study, we have demonstrated that there are important differences in cases of EE that present to urban and rural hospitals. Future investigations into these differences in patient demographics, source/systemic infections, and hospital courses may allow clinicians and hospitals to develop a more targeted approach to treating EE based on the type of community from which the patient presents.

PMID:35848205 | DOI:10.1080/09286586.2022.2094965

J Popul Ther Clin Pharmacol. 2022 Jun 16;29(2):e61-e70. doi: 10.47750/jptcp.2022.932. eCollection 2022.

ABSTRACT

Toxoplasmosis is one of the most globally prevalent zoonotic infection caused by an obligate, intracellular parasite called Toxoplasma gondii. Toxoplasmosis actively triggers an acute immune response and inflammatory reactions, which causes serious pathological changes in various tissues in the human body, and more evidently localizes in different nervous tissues of various body organs. The YKL-40 is a glycoprotein secreted by numerous cell types in different patterns associated with various pathological processes such as inflammatory reactions, tissue remodeling, and fibrosis, and is a disease-specific biomarker of neuroinflammation. Therefore, this study aimed to determine whether the YKL-40 is markedly increased in toxoplasmosis or not and whether its level is different between the acute and chronic phases of the infection to determine if it can be used as a clinically useful biomarker in the diagnosis, and determination of disease severity and follow-up of toxoplasmosis. Accordingly, a total of 80 serum samples were collected from previously diagnosed female patients of different ages with toxoplasmosis. In addition, serum samples of 10 healthy females were used as the control. Patients were first divided into two groups (30 patients with acute infection, and 50 patients with chronic infection) depending on the results of detection of specific anti-Toxoplasma IgM and IgG by enzyme-linked immunosorbent assay (ELISA). The level of YKL-40 was then measured in the patients’ serum by ELISA. The statistical analysis of data clearly disclosed very highly significant differences (P < 0.001) between the level of YKL-40 in the acute infection group and healthy controls, chronic infection group and healthy controls, and between the groups with acute and chronic infections. These findings led to conclude that YKL-40 classify as a unique and sophisticated biomarker in the diagnosis of toxoplasmosis where it can vitally be used to detect the stage of the disease, whether acute or chronic, besides its ability to detect the infection.

PMID:35848198 | DOI:10.47750/jptcp.2022.932

J Popul Ther Clin Pharmacol. 2022 Jun 16;29(2):e27-e32. doi: 10.47750/jptcp.2022.927. eCollection 2022.

ABSTRACT

BACKGROUND: Acute otitis externa (AOE) is a common disease encountered in otolaryngology practice, it is mainly bacterial in origin. AOE can cause severe otalgia and can interrupt the daily activities; however, bed rest is required in about 20% of the patients.

AIM: To evaluate the usefulness of adding an oral antibiotic with the topical antibiotic steroid in the treatment of uncomplicated AOE which is limited to the ear canal in immunocompetent patients.

PATIENTS AND METHODS: A prospective comparative clinical study was conducted in the department of otolaryngology at Al-Jerrahat Teaching Hospital and Private Clinic, Baghdad, Iraq, during the period from April 2020 to October 2021. A total of 68 immunocompetent patients (39 females and 29 males), diagnosed as cases of uncomplicated AOE which is limited to the ear canal, were included in this study. The patients were categorized into two groups. Patients in group A were treated with topical tobramycin 0.3%-dexamethasone 0.1% drops, while patients in group B received the same treatment as group A patients plus oral Ciprofloxacin tablets 500 mg twice daily. The patients were followed up on day-to-day basis until complete resolution of pain and edema. The severity of pain was assessed by visual analogue scale (VAS) scores, while edema was graded by dividing the ear canal by imaginary horizontal and vertical lines into four quarters. The post-treatment pain VAS scores and edema grades of both groups were compared. Statistical analysis using t-test was done to calculate P-value in order to find if there is a significant difference regarding the resolution of pain and edema between group A and group B.

RESULTS: During the whole follow-up period there was no significant difference between group A and group B patients regarding the resolution of pain and edema (P-value was more than 0.05).

CONCLUSIONS: There is no significant benefit of adding an oral antibiotic with the topical antibiotic steroid in the treatment of uncomplicated AOE limited to the ear canal in immunocompetent patients.

PMID:35848194 | DOI:10.47750/jptcp.2022.927

J Popul Ther Clin Pharmacol. 2022 Jun 16;29(2):e20-e26. doi: 10.47750/jptcp.2022.926. eCollection 2022.

ABSTRACT

OBJECTIVE: Stress urinary incontinence (SUI) causes a significant physical and psychological burden on women. The laparoscopic vaginal suspension (LC), used in the treatment of women with SUI, is known for its advantages such as smaller incisions, short hospital stays, and better aesthetic results. This article throws light upon the advantages and disadvantages of LC and open Burch vaginal (OC) incontinence along with its associated complications.

PATIENTS AND METHODS: Between December 1, 2017 and February 10, 2019, 26 women with SUI with physical, social, and psychological consequences from two hospitals were enrolled in this study. The sample was divided into two equal groups of 13 women each. Data were collected and statistically analyzed. P ≤ 0.05 is statistically significant.

RESULTS: The study showed that the operational time was significantly shorter in the OC method compared to the LC approach (59.2 ± 5.3 min and 91 ± 4.5 min, respectively). Mean blood loss was higher in the OC approach than in the LC approach (152.2 ± 30.3 and 143.3 ± 38.6, respectively). The LC approach has minimal pain and a shorter hospital stay compared to the OC approach. Patients with the LC approach required less analgesia (8.9 ± 1.3 mg vs 2.5 ± 1.8 mg) and less hospital stay (110.3 ± 11.4 h vs 70.2 ± 8.9 h) after surgery. Resumption of normal activity was faster in the LC approach [25.1 ± (12.6) days, 18.9 ± (12.5) days] than in the OC approach. There was no significant difference between the OC and LC approaches in terms of complications.

CONCLUSIONS: Although LC is a superior and less invasive approach than the OC approach in terms of hospital stay, blood loss, pain, and recovery time, the operation time is longer.

PMID:35848193 | DOI:10.47750/jptcp.2022.926

J Popul Ther Clin Pharmacol. 2022 May 14;29(2):e1-e10. doi: 10.47750/jptcp.2022.893. eCollection 2022.

ABSTRACT

AIM: Evidence-based intervention is an effective method for improving autism spectrum disorder (ASD) in children on socialization, behavior, and communication and may have an impact on brain activity. The aim of this study is to find the effectiveness of picture exchange communication system (PECS) and parent-implemented intervention (PII) among ASD children.

MATERIALS AND METHODS: Sixty ASD children who fulfilled the inclusion criteria were selected and assigned into control (n=30) and experimental (n=30) groups. The experimental group received evidence-based intervention with PECS and PII for 6 months, whereas the control group received routine care. The children were assessed for social relationship and reciprocity (SRR) and speech language communication (SLC) before and after the intervention. For the experimental group, a 3-month post-intervention was also assessed. Parametric and nonparametric statistical methods were used.

RESULTS: The data showed that male nuclear family and birth order above 1 was more among ASD. Two-way RM ANOVA showed a significant difference among the groups and tests (P < 0.001) and interaction of groups with tests (P < 0.001). Experimental post-test-2, that is, after 6 months, showed significant improvement in SRR and SLC compared with the control group.

CONCLUSION: The present study shows that the PECS and PII as a nursing strategy can improve ASD children socialization and communication.

PMID:35848191 | DOI:10.47750/jptcp.2022.893

BJPsych Open. 2022 Jul 18;8(4):e136. doi: 10.1192/bjo.2022.540.

ABSTRACT

BACKGROUND: Mental illness has a significant impact not only on patients, but also on their carers’ capacity to work.

AIMS: To estimate the costs associated with lost labour force participation due to the provision of informal care for people with mental illness in Australia, such as income loss for carers and lost tax revenue and increased welfare payments for government, from 2015 to 2030.

METHOD: The output data of a microsimulation model Care&WorkMOD were analysed to project the financial costs of informal care for people with mental illness, from 2015 to 2030. Care&WorkMOD is a population-representative microsimulation model of the Australian population aged between 15 and 64 years, built using the Australian Bureau of Statistics Surveys of Disability, Ageing and Carers data and the data from other population-representative microsimulation models.

RESULTS: The total annual national loss of income for all carers due to caring for someone with mental illness was projected to rise from AU$451 million (£219.6 million) in 2015 to AU$645 million (£314 million) in 2030 in real terms. For the government, the total annual lost tax revenue was projected to rise from AU$121 million (£58.9 million) in 2015 to AU$170 million (£82.8 million) in 2030 and welfare payments to increase from AU$170 million (£82.8 million) to AU$220 million (£107 million) in 2030.

CONCLUSIONS: The costs associated with lost labour force participation due to the provision of informal care for people with mental illness are projected to increase for both carers and government, with a widening income gap between informal carers and employed non-carers, putting carers at risk of increased inequality.

PMID:35848155 | DOI:10.1192/bjo.2022.540

Orthop Surg. 2022 Jul 18. doi: 10.1111/os.13323. Online ahead of print.

ABSTRACT

OBJECTIVE: Robot-assisted surgery has been promoted worldwide in recent years. The development of a domestic orthopaedic robot and its clinical application are therefore of great significance. This study aimed to compare the early clinical and radiographic outcomes of domestic robot-assisted total knee arthroplasty (RA-TKA) with conventional manual total knee arthroplasty (CM-TKA).

METHODS: A total of 77 patients who underwent primary single-sided TKA from June to December 2020 were prospectively enrolled; resulting in the inclusion of 72 patients. The patients were randomly divided into the RA-TKA group (37 cases, with TKA being assisted by the Yuanhua Orthopaedic Robotic System) and the CM-TKA group (35 cases, with TKA being performed using conventional tools). Knee function was evaluated by the knee range of motion (ROM), the American Knee Society Score (KSS), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Postoperative radiographic results were evaluated by full-length weight-bearing X-rays of the lower limb and anteroposterior and lateral X-rays of the knee were obtained preoperatively and at 90 days postoperative. The operative duration, blood loss, postoperative knee function, radiographic outcomes, and incidence of complications were compared by Student’s t-test, Mann-Whitney U test, or chi-square test. Serum levels of inflammatory markers before the operation and 1, 3, and 30 days after the operation were recorded and compared between the two groups.

RESULTS: The operation was significantly longer in the RA-TKA group than in the CM-TKA group (154.3 vs 115.2 min, p < 0.001). There was no significant difference in blood loss (933 vs 863 ml, p = 0.519) between the two groups. The knee ROM, KSS, and WOMAC were significantly improved in both groups 90 days after the operation compared with before the operation (p < 0.05), but there were no significant differences between the two groups (p > 0.05). The incidence of postoperative deep vein thrombosis was not statistically different between the two groups. In the radiographic findings at 90 days postoperatively we found the frequency of lateral tibial component (LTC) angle outliers was significantly lower in the RA-TKA group (3.0% vs 29.4%, p = 0.003). The neutrophil-to-lymphocyte ratio (NLR) was significantly lower in the RA-TKA group than in the CM-TKA group on day 1 after surgery (9.9 vs 12.7, p = 0.024).

CONCLUSIONS: RA-TKA requires more time than CM-TKA, which may be related to the learning curve and intraoperative registration. The short-term postoperative knee functional outcomes had no differences between the two groups, and RA-TKA improved the accuracy of tibial component alignment. Further follow-up studies are required to investigate the long-term outcomes.

PMID:35848154 | DOI:10.1111/os.13323

Orthop Surg. 2022 Jul 18. doi: 10.1111/os.13285. Online ahead of print.

ABSTRACT

OBJECTIVE: To explore the clinical effect of a new type of bidirectional pressurized porous tantalum screw (PTS) internal fixation in treating femoral neck fractures (FNFs).

METHODS: In this study, geometric models of FNF were first established via reverse engineering method, followed by stimulation of the strength of PTSs in fixation of FNFs. A randomized control trial study was then conducted of 41 patients with FNF from October 2015 to December 2018. These patients included 12 males and 29 females with an average age of 59.9. The 41 patients were randomly divided into two groups: cannulated compression screws (CCSs) group (n = 21) and PTSs group (n = 20). Treatment outcomes in patients were evaluated using multiple imaging techniques, including X-ray and digital subtraction angiography scanning as well as functional recovery Harris hip score. Without other postoperative complications, the primary outcome was defined as fracture healing after FNF internal fixation. Secondary outcomes are the incidence of the avascular necrosis of femoral head (ANFH), fracture nonunion, and reoperation rate.

RESULTS: Following PTS internal fixation of FNF, finite element results revealed a firmly fixed fracture with a slight displacement of less than 0.5 mm. At follow-up, we found a statistically significant difference in Harris scores in the two groups at 1 month and 3 months post-surgery. In the PTSs group, there was no case of ANFH and fracture nonunion, and the average healing time was 94.45 ± 6.47 days. In the CCSs group, there were four cases of ANFH, the necrosis rate was 19.05% (4/21). There was one case of fracture nonunion in the CCSs group, the nonunion fracture rate was 4.76% (1/21), and the average healing time was 122.54 ± 11.37 days. Five patients underwent total hip arthroplasty, and the reoperation rate was 23.81% (5/21). There were significant differences in the postoperative complications, fracture healing time, and reoperation rate between the two groups (p < 0.05).

CONCLUSIONS: PTSs fixation of FNF at the center, does not only avoid the destruction of blood supply in the femoral head and reduction in the incidence of postoperative complications of FNFs, but also induces early bone ingrowth and promotes fracture healing. These findings provide a potential surgical internal fixation system for treating FNFs.

PMID:35848152 | DOI:10.1111/os.13285

Public Health Rep. 2022 Jul 16:333549221110300. doi: 10.1177/00333549221110300. Online ahead of print.

ABSTRACT

OBJECTIVES: The impact and risk of SARS-CoV-2 transmission from asymptomatic and presymptomatic hosts remains an open question. This study measured the secondary attack rates (SARs) and relative risk (RR) of SARS-CoV-2 transmission from asymptomatic and presymptomatic index cases as compared with symptomatic index cases.

METHODS: We used COVID-19 test results, daily health check reports, and contact tracing data to measure SARs and corresponding RRs among close contacts of index cases in a cohort of 12 960 young adults at the University of Notre Dame in Indiana for 103 days, from August 10 to November 20, 2020. Further analysis included Fisher exact tests to determine the association between symptoms and COVID-19 infection and z tests to determine statistical differences between SARs.

RESULTS: Asymptomatic rates of transmission of SARS-CoV-2 were higher (SAR = 0.19; 95% CI, 0.14-0.24) than was estimated in prior studies, producing an RR of 0.75 (95% CI, 0.54-1.07) when compared with symptomatic transmission. In addition, the transmission rate associated with presymptomatic cases (SAR = 0.25; 95% CI, 0.21-0.30) was approximately the same as that for symptomatic cases (SAR = 0.25; 95% CI, 0.19-0.31). Furthermore, different symptoms were associated with different transmission rates.

CONCLUSIONS: Asymptomatic and presymptomatic hosts of SARS-CoV-2 are a risk for community spread of COVID-19, especially with new variants emerging. Moreover, typical symptom checks may easily miss people who are asymptomatic or presymptomatic but still infectious. Our study results may be used as a guide to analyze the spread of SARS-CoV-2 variants and help inform appropriate public health measures as they relate to asymptomatic and presymptomatic cases.

PMID:35848117 | DOI:10.1177/00333549221110300

Am Surg. 2022 Jul 18:31348221091937. doi: 10.1177/00031348221091937. Online ahead of print.

ABSTRACT

The purpose of this study was to identify the population of pediatric patients who arrive without signs of life and describe outcomes using a national database.Patients eighteen and younger with no signs of life were pulled from the National Trauma Database (NTDB) from the years 2007-2016. A total of N = 7503 patients were separated into two cohorts for comparison. Subset analysis was also conducted for patients undergoing a thoracotomy. Statistical analysis was performed on the collected data. Over the 9-year period most patients died in the ED or hospital (95.7%), very few patients were discharged home (1.3%), and ED thoracotomies were performed rarely (9%) with most patients dying (97%).Arrival to the trauma bay without signs of life is associated with a dismal prognosis. Clinical judgment must be carefully applied to choose the small number of patients who would benefit from an aggressive approach.

PMID:35848107 | DOI:10.1177/00031348221091937