Nevin Manimala

Wounds. 2021 Jul;33(7):185-191.

ABSTRACT

INTRODUCTION: When closure is not feasible, Mohs micrographic surgical wounds typically are left to heal by secondary intention and require weeks to close. Amniotic tissue-derived allograft (ATDA) has proven successful in promoting wound closure in diabetic and refractory wounds, and it may be beneficial for patients who have undergone Mohs micrographic surgery.

OBJECTIVE: The authors conducted a preliminary study to assess the efficacy of ATDA in speeding wound closure time and improving cosmetic outcomes in the specified patient population.

MATERIALS AND METHODS: Patients received an injection of amniotic fluid, an overlay of amniotic membrane, or standard of care. Photographs of wounds taken at the time of treatment and at each subsequent visit were analyzed.

RESULTS: The cosmetic outcome and time to wound closure appeared to be improved in patients treated with ATDA when compared with expected outcomes. Owing to small sample size, differences in initial defect size, and variety of body locations, the wound closure rate between treatment groups was not found to be significantly different with most comparisons. Statistical significance was seen, however, when normalized closure rates between membrane and control intervention were compared after outlier analysis (P = .0288).

CONCLUSIONS: Data indicate that ATDA treatment may be beneficial and suggest that further investigation of the efficacy of ATDA to promote wound healing and improve cosmetic outcomes of post-Mohs surgical wounds is warranted. Future studies should be designed to match initial defect size and location between control and treatment groups.

PMID:34237012

J Med Internet Res. 2021 Jun 13. doi: 10.2196/29240. Online ahead of print.

ABSTRACT

BACKGROUND: Telemedicine has been deployed by healthcare systems in response to the COVID-19 pandemic to enable healthcare workers to provide remote care for both outpatients and inpatients. Although it is reasonable to suspect telemedicine visits limit unnecessary personal contact and thus decrease the risk of infection transmission, the impact of the use of such technology on clinician workflows in the emergency department is unknown.

OBJECTIVE: To use real-time locating systems (RTLS) to evaluate the impact of a new telemedicine platform, which permitted clinicians located outside patient rooms to interact with patients who were under isolation precautions in the emergency department, on in-person interaction between healthcare workers and patients.

METHODS: A pre-post analysis was conducted using a badge-based RTLS platform to collect movement data including entrances and duration of stay within patient rooms of the emergency department for nursing and physician staff. Movement data was captured between March 2nd, 2020, the date of the first patient screened for COVID-19 in the emergency department, and April 20th, 2020. A new telemedicine platform was deployed on March 29th, 2020. Number of entrances and duration of in-person interactions per patient encounter, adjusted for patient length of stay, were obtained for pre- and post-implementation phases and compared with t-tests to determine statistical significance.

RESULTS: There were 15,741 RTLS events linked to 2,662 encounters for patients screened for COVID-19. There was no significant change in number of in-person interactions between the pre- and post-implementation phases for both nurses (5.7 vs 7.0 entrances per patient, p=0.07) and physicians (1.3 vs 1.5 entrances per patient, p=0.12). Total duration of in-person interaction did not change (56.4 vs 55.2 minutes per patient, p=0.74) despite significant increases in telemedicine videoconference frequency (0.6 vs 1.3 videoconferences per patient, p<0.01 for change in daily average) and duration (4.3 vs 12.3 minutes per patient, p<0.01 for change in daily average).

CONCLUSIONS: Telemedicine was rapidly adopted with the intent of minimizing pathogen exposure to healthcare workers during the COVID-19 pandemic, yet RTLS movement data did not reveal significant changes for in-person interactions between staff and patients under investigation for COVID-19 infection. Additional research is needed to better understand how telemedicine technology may be better incorporated into emergency departments to improve workflows for frontline healthcare clinicians.

PMID:34236993 | DOI:10.2196/29240

Cranio. 2021 Jul 8:1-8. doi: 10.1080/08869634.2021.1950336. Online ahead of print.

ABSTRACT

OBJECTIVE: The associations between the presence of differing severity/form of temporomandibular disorder (TMD) symptoms and oral health-related quality of life (OHRQoL) were explored.

METHODS: The severity and form of TMDs in young adults were categorized based on the Fonseca Anamnestic Index (FAI) and Diagnostic Criteria for TMDs (DC/TMD), and OHRQoL was assessed with the Oral Health Impact Profile-14 (OHIP-14). Data were analyzed using non-parametric statistics (α = 0.05).

RESULTS: The study cohort consisted of 501 young adults (mean age 19.7 ± 1.3 years; 75.2% women). Participants with severe/moderate TMDs had significantly higher OHIP severity scores than those with mild/no TMDs. Moreover, participants with combined/pain-related symptoms exhibited significantly higher severity scores compared to those without symptoms. The physical pain and psychological discomfort domains were typically more impaired regardless of severity/form of TMD symptoms.

CONCLUSION: More severe and painful symptoms were related to greater impairments in OHRQoL, especially in the physical and psychological domains.

PMID:34236942 | DOI:10.1080/08869634.2021.1950336

Phys Sportsmed. 2021 Jul 8. doi: 10.1080/00913847.2021.1953357. Online ahead of print.

ABSTRACT

BACKGROUND: Orthostatic intolerance (OI) following pediatric concussion is not well understood. Assessing the prevalence of concussion-related OI and how it compares to non-concussion-related OI will improve care for patients suffering with these symptoms.

OBJECTIVE: We set out to describe concussion related OI in adolescence, with particular emphasis on time to recovery and differences from non-concussion related OI (including male vs. female prevalence).

METHODS: Retrospective chart reviews were completed on post-concussion patients endorsing symptoms of OI. The patients’ sex, sport history, previous concussions, time since injury, and recovery time were analyzed and compared between males and females as well as against general OI statistics.

RESULTS: 39 pediatric patients, representing 8.7% of all new patients referred to a specialized concussion clinic over a 13-month interval, were included in the chart review. Mean age of onset was 15.0±2.5 years and 18 (46%) were males. The median times from evaluation to symptoms resolution was 120 days. Of 18 patients who completed head up tilt table testing, 17 (94%) had orthostatic tachycardic response (>40 bpm heart rate increment).

CONCLUSION: Post-concussive OI differs from other orthostatic intolerance etiologies, lacking a strong female predominance and exhibiting a shorter time course to recovery compared to other etiologies of OI (but longer recovery time compared to concussion patients in general). Clinical orthostatic vital signs may not be sensitive for diagnosing orthostatic intolerance in athletes, likely due to higher vagal tone and more efficient skeletal muscle pump.

PMID:34236936 | DOI:10.1080/00913847.2021.1953357

J Refract Surg. 2021 Jul;37(7):472-476. doi: 10.3928/1081597X-20210401-01. Epub 2021 Jul 1.

ABSTRACT

PURPOSE: To evaluate the refractive outcomes of the new Carlevale foldable sutureless scleral fixation intraocular lens (SSF-IOL) (Soleko in eyes without capsular support.

METHODS: This retrospective, single-center, noncomparative interventional case series included 25 consecutive eyes of 25 consecutive patients with either aphakia or lens/IOL dislocation due to capsular or zonular defects. The Hoffer Q, Holladay 1, and SRK/T formulas, which do not need measurements of the anterior chamber depth to predict the IOL position, were used to calculate the IOL power. Constant optimization was performed to zero out the mean prediction error (PE). The main outcome measures were mean PE ± standard deviation, median absolute error (MedAE), mean absolute error (MAE), and percentage of eyes with a PE within ±0.50 and ±1.00 diopters (D).

RESULTS: Mean axial length was 24.09 ± 2.09 mm (range: 21.85 to 32.17 mm). No statistically significant differences were found among the three formulas for any parameter. The PE was zero due to constant optimization and its standard deviation ranged between 0.89 and 0.95 D. The MedAE ranged between 0.30 and 0.34 D, whereas the MAE ranged between 0.62 and 0.67 D. The percentage of eyes with a PE within ±0.50 D was between 56% and 64% and the percentage of eyes with a PE within ±1.00 D was between 69% and 72%.

CONCLUSIONS: Reasonably good refractive outcomes can be obtained when implanting SSF-IOLs in eyes with no capsular support, although the accuracy is lower than what is reported for normal in-the-bag IOL implantation. [J Refract Surg. 2021;37(7):472-476.].

PMID:34236911 | DOI:10.3928/1081597X-20210401-01

J Refract Surg. 2021 Jul;37(7):466-471. doi: 10.3928/1081597X-20210406-01. Epub 2021 Jul 1.

ABSTRACT

PURPOSE: To assess the incidence and risk factors of Descemet membrane detachment due to laser application in femtosecond laser-assisted cataract surgery (FLACS).

METHODS: In this retrospective case series, all patients who underwent FLACS with the LenSx system (Alcon Laboratories, Inc) were eligible to participate. The medical records were reviewed to collect data regarding potential risk factors related to Descemet membrane detachment, including patients’ demographics, laser parameters, and ocular measurements. The eyes were separated into two groups based on the clinical diagnosis of Descemet membrane detachment as the femto-second laser was performing the corneal incisions.

RESULTS: Five hundred ten eyes (304 patients) were included. Descemet membrane detachment occurred in 20 (3.9%) eyes of 16 (5.3%) patients. Four (1.3%) patients had a detachment in both eyes. In 16 (3.1%) eyes, the Descemet membrane detachment occurred in the secondary incision site. The eyes that had a detachment had a statistically lower mean endothelial cell density (2,193.40 ± 313.37 versus 2,385.08 ± 357.80 cells/ mm²; P = .019), and a statistically higher prevalence of corneal guttata (25.0% versus 8.8%; P = .015). None of the other analyzed variables statistically differed between the groups (P > .05). The risk of having Descemet membrane detachment was statistically higher among eyes with guttata (odds ratio = 3.47; P = .015) and in those with an endothelial cell density of less than 2,000 cells/mm² (odds ratio = 3.26; P = .014).

CONCLUSIONS: The incidence of Descemet membrane detachment due to laser application in FLACS was 3.9%, with the associated risk factors being endothelial cell density of less than 2,000 cells/mm² and corneal guttata. [J Refract Surg. 2021;37(7):466-471.].

PMID:34236908 | DOI:10.3928/1081597X-20210406-01

Sci Prog. 2021 Jul-Sep;104(3):368504211028371. doi: 10.1177/00368504211028371.

ABSTRACT

Bayesian Nonparametric (BNP) modelling can be used to obtain more detailed information in test equating studies and to increase the accuracy of equating by accounting for covariates. In this study, two covariates are included in the equating under the Bayes nonparametric model, one is continuous, and the other is discrete. Scores equated with this model were obtained for a single group design for a small group in the study. The equated scores obtained with the model were compared with the mean and linear equating methods in the Classical Test Theory. Considering the equated scores obtained from three different methods, it was found that the equated scores obtained with the BNP model produced a distribution closer to the target test. Even the classical methods will give a good result with the smallest error when using a small sample, making equating studies valuable. The inclusion of the covariates in the model in the classical test equating process is based on some assumptions and cannot be achieved especially using small groups. The BNP model will be more beneficial than using frequentist methods, regardless of this limitation. Information about booklets and variables can be obtained from the distributors and equated scores that obtained with the BNP model. In this case, it makes it possible to compare sub-categories. This can be expressed as indicating the presence of differential item functioning (DIF). Therefore, the BNP model can be used actively in test equating studies, and it provides an opportunity to examine the characteristics of the individual participants at the same time. Thus, it allows test equating even in a small sample and offers the opportunity to reach a value closer to the scores in the target test.

PMID:34236901 | DOI:10.1177/00368504211028371

Am J Sports Med. 2021 Jul 8:3635465211024249. doi: 10.1177/03635465211024249. Online ahead of print.

ABSTRACT

BACKGROUND: Recently developed multivariate sex-specific statistical models can predict anterior cruciate ligament (ACL) injury risk using various knee anatomic factors. However, screening tools able to identify individuals at an increased injury risk are unlikely to be developed based on these models, given that sophisticated and time-consuming methods were used to measure those factors on research-grade resolution magnetic resonance images (MRIs).

PURPOSE: To determine whether simpler methods, amenable to using clinical-grade resolution MRIs, can identify the same knee anatomic factors previously found to contribute to ACL injury risk using sophisticated methods and research-grade resolution images.

STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2.

METHODS: High-resolution 3-dimensional MRIs previously acquired from 87 patients with primary, noncontact, grade III ACL injury and 87 uninjured matched control participants for a series of published studies were downgraded to clinical-grade resolution images. The 4 knee anatomic factors found to contribute to ACL injury risk in women and in men in these published studies-femoral intercondylar notch width at the anterior outlet of the ACL (NW_O), posterior-inferior directed slope of the middle region articular cartilage surface of the tibial plateau’s lateral compartment (L_atT_ibMCS), ACL volume, and tibial plateau’s lateral compartment posterior meniscus to subchondral bone wedge angle (L_atT_ibMBA)-were measured using clinical-grade resolution MRI-based methods. Stepwise multivariate conditional logistic regressions were used to identify the combinations of factors most highly associated with an ACL injury risk in women and men separately.

RESULTS: The multivariate model that best predicted ACL injury risk in the female participants included the L_atT_ibMCS and the NW_O. For the male participants, this model included the ACL volume and the L_atT_ibMBA. These results corroborate the previously published results that reported models with the same knee anatomic factors to best predict injury risk in this group of young women and men.

CONCLUSION: Simpler methods using MRIs downgraded to a clinical-grade resolution can identify the same knee anatomic factors previously found to significantly contribute to ACL injury risk using sophisticated methods and research-grade resolution MRIs.

PMID:34236896 | DOI:10.1177/03635465211024249

J Proteome Res. 2021 Jul 8. doi: 10.1021/acs.jproteome.1c00483. Online ahead of print.

ABSTRACT

The standard proteomics database search strategy involves searching spectra against a peptide database and estimating the false discovery rate (FDR) of the resulting set of peptide-spectrum matches. One assumption of this protocol is that all the peptides in the database are relevant to the hypothesis being investigated. However, in settings where researchers are interested in a subset of peptides, alternative search and FDR control strategies are needed. Recently, two methods were proposed to address this problem: subset-search and all-sub. We show that both methods fail to control the FDR. For subset-search, this failure is due to the presence of “neighbor” peptides, which are defined as irrelevant peptides with a similar precursor mass and fragmentation spectrum as a relevant peptide. Not considering neighbors compromises the FDR estimate because a spectrum generated by an irrelevant peptide can incorrectly match well to a relevant peptide. Therefore, we have developed a new method, “subset-neighbor search” (SNS), that accounts for neighbor peptides. We show evidence that SNS controls the FDR when neighbors are present and that SNS outperforms group-FDR, the only other method that appears to control the FDR relative to a subset of relevant peptides.

PMID:34236864 | DOI:10.1021/acs.jproteome.1c00483

Braz J Cardiovasc Surg. 2021 Jul 7. doi: 10.21470/1678-9741-2020-0618. Online ahead of print.

ABSTRACT

INTRODUCTION: Coronary artery ectasia (CAE) is one of the uncommon cardiovascular disorders and its prognosis is still debated.

OBJECTIVE: We aimed to review long-term follow-up data in patients with CAE and to evaluate the prognosis of CAE patients with coronary slow flow phenomenon (CSFP).

METHODS: This study had a prospective design and 143 patients with CAE were included. The angiographic and demographic characteristics were reviewed in detail. The patients were categorized, based on concomitant coronary artery stenosis detected by angiography, as CCAE group (n=87, ≥30% luminal stenosis) and ICAE group (n=56, <30% luminal stenosis) and also categorized by the coronary flow as CSFP group (n=51) and normal flow coronary ectasia – NCEA group (n=92). All patients were re-evaluated at 6-month intervals. Followup data, cardiovascular (CV) mortality, hospitalization and major adverse cardiac events (MACE) were collected. The level of statistical significance was set at 5%.

RESULTS: Patients were followed up for an average of 56.9±7.4 months. During the follow-up, statistically significant differences were found in hospitalization, CV mortality and MACE between the CCAE and ICAE groups (P=0.038, P=0.003, P=0.001, respectively). The CSFP and NCEA groups were also compared. There was a statistical difference with respect to hospitalization between the CFSP and NCEA groups (P=0.001), but no difference was observed in terms of MACE and CV mortality (P=0.793 and P=0.279).

CONCLUSION: CSFP accompanying CAE may be a predictor of hospitalization. Significant atherosclerotic plaques coexisting with CAE may be predictive for MACE.

PMID:34236824 | DOI:10.21470/1678-9741-2020-0618