Nevin Manimala

Pediatr Neonatol. 2022 Jul 19:S1875-9572(22)00147-4. doi: 10.1016/j.pedneo.2022.06.002. Online ahead of print.

ABSTRACT

AIM: We aimed to compare the General Movement Assessment (GMA) and the Alberta Infant Motor Scale (AIMS) in preterm infants for the prediction of cerebral palsy (CP) and neurodevelopmental delay (NDD). Additionally, we aimed to evaluate the diagnostic compatibility of the General Movement Optimality Score (GMOS), the Motor Optimality Score (MOS), and AIMS for detecting CP and NDD.

METHOD: Seventy-five preterm infants with gestational age (GA) 24-37 weeks were enrolled. Group 1 was composed of infants with 24-28 GA (n = 22); groups 2 and 3 consisted of infants with 29-32 GA weeks (n = 23) and 33-37 GA (n = 30) weeks, respectively. The infants were assessed during the writhing period, the fidgety period, and at 6-12 months of corrected age with GMOS, MOS, and AIMS, respectively.

RESULTS: In the writhing period, a cramped-synchronized pattern was observed in 17 (22%) infants, whereas a poor repertoire pattern was observed in 34 (45%) infants. In the fidgety period of the 63 infants, 29 (46%) presented with fidgety movements absent. The MOS and AIMS scores of the infants in group 1 were significantly lower than the other groups, which were statistically significant (p = 0.004, p˂0.001). High and positive compatibility (Kappa coefficient: 0.709; p = 0.001) was found between AIMS and GMOS scores and between AIMS and MOS scores (Kappa coefficient: 0.804; p < 0.001). In all groups, a statistically significant association was found between total GMOS scores (p = 0.003) and the presence of fidgety movements (p = 0.003). GMOS, MOS, and AIMS were found to be associated with CP and NDD (p < 0.001).

CONCLUSION: GMA is an important tool for the prediction of CP and NDD. The combined use of GMOS, MOS, and AIMS may guide the clinical practice for the valid and reliable diagnosis of CP and NDD.

PMID:35965235 | DOI:10.1016/j.pedneo.2022.06.002

Value Health. 2022 Aug 11:S1098-3015(22)02101-5. doi: 10.1016/j.jval.2022.07.005. Online ahead of print.

ABSTRACT

OBJECTIVES: The National Institute for Health and Care Excellence in England has implemented severity-of-disease modifiers that give greater weight to health benefits accruing to patients who experience a larger shortfall in quality-adjusted life-years (QALYs) under current standard of care than healthy individuals. This requires an estimate of quality-adjusted life expectancy (QALE) of the general population based on age and sex. Previous QALE population norms are based on nearly 30-year-old assessments of health-related quality of life in the general population. This study provides updated QALE estimates for the English population based on age and sex.

METHODS: 5-level version of EQ-5D data for 14 412 participants from the Health Survey for England (waves 2017 and 2018) were pooled, and health-related quality of life population norms were calculated. These norms were combined with official life tables from the Office for National Statistics for 2017 to 2019 using the Sullivan method to derive QALE estimates based on age and sex. Values were discounted using 0%, 1.5%, and 3.5% discount rates.

RESULTS: QALE at birth is 68.24 QALYs for men and 68.21 QALYs for women. These values are significantly lower than previously published QALE population norms based on the older 3-level version of EQ-5D data.

CONCLUSION: This study provides new QALE population norms for England that serve to establish absolute and relative QALY shortfalls for the purpose of health technology assessments.

PMID:35965226 | DOI:10.1016/j.jval.2022.07.005

J Pediatr Urol. 2022 Jul 30:S1477-5131(22)00316-3. doi: 10.1016/j.jpurol.2022.07.012. Online ahead of print.

ABSTRACT

INTRODUCTION: Idiopathic overactive bladder (OAB) is defined as an urgency symptom with or without urge incontinence, which is not due to known neurological abnormalities. Since children present with variable symptoms, pediatric nonneurogenic idiopathic OAB is a condition that is difficult to diagnose and treat. Although there are few reports on bladder function in pediatric patients compared to adult patients, it can be useful for diagnosis. Antimuscarinic therapy is the pharmacological mainstay of OAB management. However, antimuscarinic use is limited by side effects and Insufficient effects. Vibegron, a new drug with a different mechanism of action (β3-adrenoreceptor agonist), was recently introduced for treating OAB in adults but has not been studied in the pediatric population.

OBJECTIVE: This study aimed to determine the efficacy and tolerability of vibegron in children and adolescents with idiopathic OAB.

STUDY DESIGN: We conducted a retrospective study enrolling pediatric patients with OAB whose symptoms did not improve with behavioral therapy or pharmaceutical therapy. Efficacy and tolerability were assessed via a question, and patients underwent video-urodynamic testing before and during treatment with once-daily 50 mg vibegron. Statistical differences were evaluated using Wilcoxon matched-pairs signed-rank tests.

RESULTS: Out of the 17 patients that were recruited, full study with two urodynamic studies were confirmed by 11 patients. OAB symptoms improved in 14 (82.4%) patients, and 3 patients discontinued treatment because of ineffectiveness. No patients discontinued treatment because of intolerance to vibegron. The median (IQR) first desire to void (133 [82-185]-161 [123-227] mL), bladder capacity (158 [136-238]-204 [150-257] mL), and bladder compliance (18.1 [9.1-76.7]-34.0 [30.0-82.3] mL/cm H₂O) improved significantly post treatment compared to before treatment. Detrusor overactivity disappeared in one of the eight patients with this condition. The parameters of voiding function did not change significantly after the administration of vibegron.

DISCUSSION: Treatment with vibegron significantly improved clinical and urodynamic parameters of pediatric OAB with no adverse effects. Little information is available regarding the feasibility of switching drugs when patients discontinue prior pharmacological therapy because of insufficient efficacy or poor tolerability in children. Vibegron may be a promising OAB treatment option with a better balance of efficacy and tolerability.

CONCLUSIONS: Vibegron is an alternative agent for pediatric patients with idiopathic OAB for improving both subjective symptoms and lower urinary tract function. Future prospective randomized studies with larger sample sizes must be conducted to validate the results of the present study.

PMID:35965225 | DOI:10.1016/j.jpurol.2022.07.012

J Pediatr Urol. 2022 Jun 30:S1477-5131(22)00294-7. doi: 10.1016/j.jpurol.2022.06.024. Online ahead of print.

ABSTRACT

BACKGROUND: Proximal hypospadias and severe ventral chordee are often challenging to repair. To preserve penile length in chordee repair, Small Intestinal Submucosa (SIS) corporal grafting is often performed with potential long-term complications including recurrent curvature and erectile dysfunction (ED). There is a paucity of data evaluating sexual function in mid, late and post-pubertal patients.

OBJECTIVE: We aimed to assess long-term outcomes of genital self-perception and erectile function in mid, late and post-pubertal patients who underwent single-layer (1-ply) SIS corporal body grafting for correction of severe chordee.

STUDY DESIGN: Patients with proximal hypospadias who underwent correction of severe chordee using SIS grafting between 2001 and 2015 were retrospectively identified. Patients were evaluated for erectile and sexual function using the modified erection hardness score (mEHS) and the modified sexual health inventory for men (mSHIM). Perceived function and straightness were measured with Hypospadias Objective Scoring Evaluation (HOSE). Penile self-perception was assessed using the Pediatric Penile Perception Score (PPPS). Results were compared to an age-matched healthy control group. Categorical variables were analyzed using Fisher’s exact test, and continuous variables using paired and unpaired t-test and ANOVA.

RESULTS: Nineteen patients with proximal hypospadias who underwent correction of severe chordee using SIS grafting and 18 controls participated in the study with a median age of 17 years for both groups. In the mEHS, 12 (63.2%) hypospadias-patients and 14 (87.5%) controls rated their erections as completely hard and very rigid. In the mSHIM, 1 (5.2%) hypospadias-patient was classified as having moderate ED. A total of 16 hypospadias-patients (84%) and 16 controls (88.9%) reported being very satisfied or satisfied with the straightness of their penis. No significant difference was observed in the mEHS, mSHIM and PPPS between groups (p < 0.05). The straightness of the erection was rated lower by participants, than by the pediatric urologist. In the HOSE, 12 (63.2%) hypospadias-patients and 16 (88.9%) controls obtained an acceptable score.

DISCUSSION: Our findings indicate favorable long-term outcomes in ED and genital self-perception; only 5% of our population reported having a mild-moderate to moderate presentation of ED, and there were no reports of severe ED. The overall PPPS satisfaction rates were statistically similar for the control and hypospadias groups. The small sample population limits the significance of our findings.

CONCLUSION: Corporal body grafting with 1-ply SIS suggests positive long-term outcomes in genital self-perception and erectile function, with mid, late and post-pubertal patients who underwent hypospadias repair having comparable results to age-matched healthy controls.

PMID:35965224 | DOI:10.1016/j.jpurol.2022.06.024

J Craniomaxillofac Surg. 2022 Jun 23:S1010-5182(22)00066-X. doi: 10.1016/j.jcms.2022.05.003. Online ahead of print.

ABSTRACT

The aim of the study was to compare incidences and types of injury incurred between e-scooter crashes and bicycle crashes. This retrospective study included all victims of e-scooter crashes who were treated in the department of oral and maxillofacial surgery during a 12-months interval.A comparison was made with a cohort of patients who underwent bicycle crashes. Study parameters included type of fracture, soft tissue and dental affection, necessity of inpatient or outpatient treatment, the use of helmets, and the time of admission. In total, 400 patients were included. Of these 40 had suffered a crash on an e-scooter and 360 on a bicycle. Descriptive statistics showed a low helmet-wearing rate among cyclists (16.1% of recorded cases), with no helmet wearing recorded among e-scooter users. E-scooter-related crashes showed a higher rate of facial soft-tissue injuries (77.5%, p = 0.049) than among cyclists (61.7%), as well as a higher rate of dental injuries (27.5%, p = 0.017) compared with the bicycle cohort (13.3%). Facial fractures were also more common in the e-scooter cohort (45% vs 25.8%, p = 0.010). Admission was typically at the weekend – in the afternoon for the bicycle cohort and in the evening and at night for the e-scooter cohort. As a consequence of the fact that e-scooter riders seem to have an increased risk of facial injuries, it seems that an awareness campaign might be necessary to encourage helmet usage and to persuade intoxicated persons to use public transportation instead.

PMID:35965223 | DOI:10.1016/j.jcms.2022.05.003

Clin Genitourin Cancer. 2022 Jul 16:S1558-7673(22)00156-2. doi: 10.1016/j.clgc.2022.07.004. Online ahead of print.

ABSTRACT

INTRODUCTION: Percutaneous microwave ablation (MWA) of renal masses (RM) is still considered experimental as opposed to established procedures such as cryoablation (CA). We aimed to compare perioperative, functional and oncological outcomes of patients with RM treated with CA and MWA.

MATERIALS AND METHODS: Data from 116 (69.9%) and 50 (30.1%) patients treated with CA and MWA for RM were analyzed. Patients’ demographics and perioperative data were collected including nephrometry scores, complications, pre- and postprocedural renal function. Tumor persistence and recurrence were recorded. Descriptive statistics compared functional outcomes between groups. Cox regression analyses tested risk factors associated with recurrence.

RESULTS: Groups were similar in terms of RM diameter, nephrometry scores and histology distribution. Median follow-up was 26 (13-46) and 24 (14-36) months for CA and MWA, respectively. The rate of overall (36.2% for CA vs. 24% for MWA, P= .1) and major (Clavien ≥ 3a) complications (1.7% vs. 5.4%, P = .1) were similar among groups. The median decline of renal function after 6 months follow-up did not differ between CA and MWA (P = .8). Tumor persistence [4.3% vs. 12%] and recurrence [9.5% and 7.1%] rates were similar for CA and MWA. Three years recurrence free and overall survival were 91% versus 95% (log-rank P = .77) and 80 versus 88% (log-rank P = .23) in the CA and MWA groups, respectively. At Cox analysis no predictors were found associated with recurrence.

CONCLUSION: Despite being considered still experimental, MWA showed comparable outcomes relative to CA in terms of safety, preservation of renal function and oncological efficacy.

PMID:35965197 | DOI:10.1016/j.clgc.2022.07.004

Allergol Int. 2022 Aug 11:S1323-8930(22)00079-X. doi: 10.1016/j.alit.2022.07.001. Online ahead of print.

ABSTRACT

BACKGROUND: Asthma cases have been increasingly investigated using claims data. However, the validity of defining asthma cases using health insurance claims in Japan is unclear. This study aims to assess the positive and negative predictive values of our proposed discrimination criteria for asthma.

METHODS: We developed discrimination criteria for asthma based on both the International Statistical Classification of Diseases and Related Health Problems (ICD)-10 disease codes for asthma and health insurance claims data for prescriptions and the treatment of asthma. Inclusion criteria were patients aged ≥16 years with at least one health insurance claim from April 2018 to March 2019 in all departments of our hospital. Physician-diagnosed asthma documented in the charts was used as the reference standard. Positive and negative predictive values of the discrimination criteria for physician-diagnosed asthma were estimated and compared with those estimated from discrimination criteria based solely on ICD-10 codes.

RESULTS: The new discrimination criteria had a high positive predictive value (PPV) of 86.0%, which was significantly higher than the PPV for the criteria defined solely by the ICD-10 codes (61.5%) (P < 0.01). The negative predictive values for both criteria were 100%. Allergic rhinitis and chronic cough were frequently misclassified as asthma using the discrimination criteria based solely on ICD-10 codes but were more likely to be appropriately classified using our proposed criteria.

CONCLUSIONS: Our proposed criteria adequately identified asthma subjects using health insurance claims data in Japan with a high PPV. Further studies are needed for external validation of these criteria.

PMID:35965192 | DOI:10.1016/j.alit.2022.07.001

Sleep Health. 2022 Aug 11:S2352-7218(22)00108-5. doi: 10.1016/j.sleh.2022.06.008. Online ahead of print.

ABSTRACT

OBJECTIVES: To examine whether gender moderates the effects of childhood trauma on subjective and objective sleep measures.

DESIGN: Secondary data analysis, exploratory SETTINGS: Sleep research lab PARTICIPANTS: A total of 213 men and 278 women aged 18-30 completed subjective measures. A subsample of 172 participants without any psychiatric, medical, or sleep disorders completed objective polysomnography for 1 night at baseline, before sleep manipulation.

MEASUREMENTS: Subjective measures: Childhood Trauma Questionnaire (CTQ), Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Epworth Sleepiness Scale. Objective measures: Standard polysomnography measures. Multiple regressions determined whether gender moderated CTQ score on any objective or subjective sleep measures. If gender was not a moderator, we examined additive effects of gender and CTQ score. Models were adjusted for race and age.

RESULTS: Gender and CTQ score interactions were non-significant for both subjective (p > .675) and objective (p > .110) sleep. Women demonstrated better subjective sleep quality (Pittsburgh Sleep Quality Index, B = -0.264, p = .041) and more delta sleep than men (B = 3.032, p =.005). Greater CTQ score was associated with increased sleepiness (Epworth Sleepiness Scale, B = 0.029, p = .042), increased insomnia severity (Insomnia Severity Index, B = 0.027, p = .005), and lower REM density (B = -0.132, p = .045).

CONCLUSION: Our finding of greater delta sleep and better subjective overall sleep quality in women suggests that, among people without comorbidities, women may experience better sleep. Childhood trauma is associated with objective and subjective sleep measures, but this association is non-specific to gender. Clear links between childhood trauma and sleep are detectable in a sample of healthy sleepers with no comorbidities.

PMID:35965190 | DOI:10.1016/j.sleh.2022.06.008

Am J Orthod Dentofacial Orthop. 2022 Aug 11:S0889-5406(22)00437-1. doi: 10.1016/j.ajodo.2022.07.007. Online ahead of print.

ABSTRACT

INTRODUCTION: This retrospective study aimed to evaluate whether the treatment of Class II malocclusion with Invisalign aligners with sequential distalization of posterior teeth in adult patients would meet the criteria of American Board of Orthodontics (ABO) standards for the treatment and assess the predictive value of ClinCheck Pro software with the final results comparing the initial time, predictive planning using ClinCheck Pro software, and the final time without any require refinement.

METHODS: The sample consisted of 32 adult patients with Class II malocclusion (n = 32 [7 men and 25 women]; mean age 35.47 ± 9.61 years). All of them used a set of Invisalign aligners; no refinement set was evaluated. The 7 measurements of the ABO Model Grading System, the millimeter measurements for the anteroposterior ratios of maxillary first molars and the overbite were used in the evaluations and were compared in phases initial time, predictive planning using ClinCheck Pro software, and the final time. For the intraexaminer reliability test, the intraclass correlation coefficient was calculated to analyze the reliability of the measures. The Shapiro-Wilk normality test was used to examine whether the variables were normally distributed. The Wilcoxon nonparametric test for paired samples was applied for variables that did not show normal distribution. The parametric Student t test for paired samples was used for variables that presented normal distribution. The significance level adopted for this study was 0.05.

RESULTS: In comparison between final ClinCheck and posttreatment results, the ABO index showed a statistically significant difference between the predictions and results for alignment and rotation, buccolingual inclination, overjet, occlusal contact, occlusal relationship, molar relationship, and overbite. The final score of the ABO scores did not meet the standards for Class II correction, contrary to what the ClinCheck Pro software predicted.

CONCLUSIONS: The null hypothesis that distalization of the posterior teeth occurs in adult patients using Invisalign aligners was rejected. The treatment of Class II malocclusion with Invisalign aligners did not occur as estimated by the virtual planning prepared by ClinCheck according to the standards for evaluating occlusal results established by the ABO at the end of the use of a set of aligners with sequential distalization.

PMID:35965168 | DOI:10.1016/j.ajodo.2022.07.007

Am J Orthod Dentofacial Orthop. 2022 Aug 11:S0889-5406(22)00438-3. doi: 10.1016/j.ajodo.2021.06.024. Online ahead of print.

ABSTRACT

INTRODUCTION: During treatment, some patients may need to change the location of mini-implants (MIs). This study investigated the stability of MIs relocated to another position in the same patient using the periotest and torque device.

METHODS: Twenty-nine MIs were applied randomly to 1 side of the maxillary region, and torque and periotest values were recorded. The patients were followed-up at 4-week intervals, and periotest measurements were performed at each session. After recording the torque and periotest values in the fourth session, the MIs were removed. After applying the appropriate sterilization procedure, the same MIs were relocated to the contralateral side of the patients’ jaw, and distalization was achieved using a similar procedure for the group of as-received MIs.

RESULTS: Negative correlations were obtained between the torque meter and periotest data for both MI groups. We observed no significant effect of the MI group on periotest measurements (P >0.05). The effect of the MI group on torque values and the interaction effect of the MI group and torque values were not statistically significant (P >0.05).

CONCLUSIONS: It is possible to achieve similar stability values with as-received and retrieved MIs when appropriate cleaning and sterilization protocols are performed.

PMID:35965167 | DOI:10.1016/j.ajodo.2021.06.024