Nevin Manimala

ANZ J Surg. 2022 May 30. doi: 10.1111/ans.17793. Online ahead of print.

ABSTRACT

BACKGROUND: This study investigated whether there was a change in acute appendicitis, appendicectomy admissions or disease severity during the 2020 lockdown period in NSW.

METHODS: A retrospective before-and-after study was undertaken of patients admitted to two Sydney hospitals (St. Vincent’s and Liverpool Hospitals) who had appendicectomy for presumed acute appendicitis and patients who had confirmed appendicitis but did not undergo surgery. Study periods were the 2020 lockdown period (15 March-15 May 2020), the corresponding period in the previous year, and the 1-month after these periods. Patients were classified as having no, mild or severe appendicitis using operation and histopathological reports.

RESULTS: (Thirty-six percent) fewer patients were admitted with acute appendicitis during the lockdown period compared with the previous year with a substantial reduction in normal/mild appendicitis presentations (OR 0.56, 95% CI 0.34-0.93, P = 0.03). There were 46% fewer patients with mild appendicitis during lockdown (56) compared with the previous year (103); numbers of patients with severe appendicitis were very similar (46 vs. 51). There was no increase in number of admissions with severe appendicitis, or in the time from onset of symptoms to admission, in the month following lockdown.

CONCLUSION: Compared with the previous year, there were markedly fewer admissions with appendicitis during lockdown, with no evidence of a shift to more cases of severe appendicitis nor delayed presentation in the post-lockdown period. It is plausible that some patients with mild appendicitis may have recovered without hospitalization, supporting the importance of implementing trials on non-surgical management of appendicitis.

PMID:35635054 | DOI:10.1111/ans.17793

Int J Eat Disord. 2022 May 30. doi: 10.1002/eat.23749. Online ahead of print.

ABSTRACT

OBJECTIVE: Current evidence indicates treatment for adults with anorexia nervosa (AN) requires improvement given recovery rates are low to moderate, and relapse rates are high. Metacognitive therapy (MCT) is an effective treatment for anxiety and depressive disorders. This study evaluates if MCT can be successfully modified to treat AN in a naturalistic clinical setting.

METHOD: Twenty-four patients with AN participated in an open trial of modified metacognitive therapy (MCT-AN). Twelve of the 24 patients (50%) completed treatment. MCT was modified to include components specific to eating disorders. The MCT-AN was delivered by clinical psychologists who had undertaken training in MCT in a specialist outpatient service. Group and single participant data analyses were undertaken on those who completed treatment.

RESULTS: As well as statistically significant differences from pre- to posttreatment in the group data there were also clinically significant improvements at the individual patient level for eating disorder and depressive symptoms, as well as weight. The mean number of therapy sessions was 18.

DISCUSSION: These findings indicate that MCT-AN may be a promising intervention in the treatment of AN, warranting further investigation.

PUBLIC SIGNIFICANCE: Treatment for anorexia nervosa in adults requires improvement. Research indicates that Metacognitive therapy (MCT) is an effective treatment for anxiety and depression and may be applicable to the eating disorders. This small open trial suggests that MCT can be modified successfully to treat patients with anorexia nervosa (AN). The results are preliminary and require further research to provide more evidence on the effectiveness of this treatment for AN.

PMID:35635052 | DOI:10.1002/eat.23749

Perfusion. 2022 May 30:2676591221105405. doi: 10.1177/02676591221105405. Online ahead of print.

ABSTRACT

AIM: Although the number of global studies on ECMO, which is an important support system in the treatment of COVID-19 related respiratory failure, has increased in recent months, there is still no bibliometric study on the use of ECMO in COVID-19 in the literature. The aim of this study is to analyze the scientific articles on the use of ECMO in COVID-19 by statistical and bibliometric methods.

METHOD: Articles published between 2019-2022 about the use of ECMO in COVID-19 were obtained from the Web of Science (WoS) database and analyzed using statistical and bibliometric methods. Spearman correlation coefficient was used for correlation studies. Network visualization maps were used to identify effe analysis and trending topics.

RESULTS: A total of 1197 publications were found. 758 (63.3%) of these publications were articles. The top 3 contributing countries to the literature were USA (257, 33.9%), Germany (102, 13.4%) and Japan (87, 11.5%). The top 3 most active institutions were League of European Research Universities (90), Harvard University (50), and Udice French Research Universities (39). The top 3 journals with the highest count of publications were ASAIO Journal (n = 36), Frontiers in Medicine (22), and Perfusion-UK (n = 20). According to the average count of citations per article, the most influential journals were JAMA (1319), Intensive Care Medicine (327), and Lancet (95.7), respectively. We have shared a summary of 758 articles in this comprehensive bibliometric study on the use of ECMO in COVID-19.

CONCLUSION: It can be said that the use of ECMO in COVID-19 has been the trending topic recently and most of the studies are from countries in the ELSO Awards of Excellence list which indicates that the follow-up of ECMO in certain centers and teams can also be influencing the publications. This article can be a useful resource for clinicians, scientists, and students concerning global output for ECMO use in COVID-19.

PMID:35635047 | DOI:10.1177/02676591221105405

Palliat Med. 2022 May 30:2692163221099584. doi: 10.1177/02692163221099584. Online ahead of print.

ABSTRACT

BACKGROUND: The efficacy of virtual reality for people living with a terminal illness is unclear.

AIM: To determine the feasibility and effectiveness of virtual reality use within a palliative care setting.

DESIGN: Systematic review and meta-analysis. PROSPERO (CRD42021240395).

DATA SOURCES: Medline, Embase, AMED, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials and Web of Science were searched from inception to March 2021. Search terms included ‘virtual reality’ and ‘palliative care’. Eligibility: (1) adult (>18 years old) with a terminal illness (2) at least one virtual reality session and (3) feasibility data and/or at least one patient outcome reported. The ROB-2 and ROBINS tools assessed risk of bias. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool assessed the quality of the evidence. Standardised mean differences (Hedges’s g) were calculated from the pre- and post-data. A DerSimonian-Laird random effects model meta-analysis was conducted.

RESULTS: Eight studies were included, of which five were in the meta-analysis. All studies had at least some concern for risk of bias. Virtual reality statistically significantly improved pain (p = 0.0363), tiredness (p = 0.0030), drowsiness (p = 0.0051), shortness of breath (p = 0.0284), depression (p = 0.0091) and psychological well-being (p = 0.0201). The quality of the evidence was graded as very low due to small sample sizes, non-randomisation methods and a lack of a comparator arm.

CONCLUSIONS: Virtual reality in palliative care is feasible and acceptable. However, limited sample sizes and very low-quality studies mean that the efficacy of virtual reality needs further research.

PMID:35635018 | DOI:10.1177/02692163221099584

Health Technol Assess. 2022 May;26(26):1-156. doi: 10.3310/OLUE3796.

ABSTRACT

BACKGROUND: Colonoscopy surveillance is recommended for some patients post polypectomy. The 2002 UK surveillance guidelines classify post-polypectomy patients into low, intermediate and high risk, and recommend different strategies for each classification. Limited evidence supports these guidelines.

OBJECTIVES: To examine, for each risk group, long-term colorectal cancer incidence by baseline characteristics and the number of surveillance visits; the effects of interval length on detection rates of advanced adenomas and colorectal cancer at first surveillance; and the cost-effectiveness of surveillance compared with no surveillance.

DESIGN: A retrospective cohort study and economic evaluation.

SETTING: Seventeen NHS hospitals.

PARTICIPANTS: Patients with a colonoscopy and at least one adenoma at baseline.

MAIN OUTCOME MEASURES: Long-term colorectal cancer incidence after baseline and detection rates of advanced adenomas and colorectal cancer at first surveillance.

DATA SOURCES: Hospital databases, NHS Digital, the Office for National Statistics, National Services Scotland and Public Health England.

METHODS: Cox regression was used to compare colorectal cancer incidence in the presence and absence of surveillance and to identify colorectal cancer risk factors. Risk factors were used to stratify risk groups into higher- and lower-risk subgroups. We examined detection rates of advanced adenomas and colorectal cancer at first surveillance by interval length. Cost-effectiveness of surveillance compared with no surveillance was evaluated in terms of incremental costs per colorectal cancer prevented and per quality-adjusted life-year gained.

RESULTS: Our study included 28,972 patients, of whom 14,401 (50%), 11,852 (41%) and 2719 (9%) were classed as low, intermediate and high risk, respectively. The median follow-up time was 9.3 years. Colorectal cancer incidence was 140, 221 and 366 per 100,000 person-years among low-, intermediate- and high-risk patients, respectively. Attendance at one surveillance visit was associated with reduced colorectal cancer incidence among low-, intermediate- and high-risk patients [hazard ratios were 0.56 (95% confidence interval 0.39 to 0.80), 0.59 (95% confidence interval 0.43 to 0.81) and 0.49 (95% confidence interval 0.29 to 0.82), respectively]. Compared with the general population, colorectal cancer incidence without surveillance was similar among low-risk patients and higher among high-risk patients [standardised incidence ratios were 0.86 (95% confidence interval 0.73 to 1.02) and 1.91 (95% confidence interval 1.39 to 2.56), respectively]. For intermediate-risk patients, standardised incidence ratios differed for the lower- (0.70, 95% confidence interval 0.48 to 0.99) and higher-risk (1.46, 95% confidence interval 1.19 to 1.78) subgroups. In each risk group, incremental costs per colorectal cancer prevented and per quality-adjusted life-year gained with surveillance were lower for the higher-risk subgroup than for the lower-risk subgroup. Incremental costs per quality-adjusted life-year gained were lowest for the higher-risk subgroup of high-risk patients at £7821.

LIMITATIONS: The observational design means that we cannot assume that surveillance caused the reductions in cancer incidence. The fact that some cancer staging data were missing places uncertainty on our cost-effectiveness estimates.

CONCLUSIONS: Surveillance was associated with reduced colorectal cancer incidence in all risk groups. However, in low-risk patients and the lower-risk subgroup of intermediate-risk patients, colorectal cancer incidence was no higher than in the general population without surveillance, indicating that surveillance might not be necessary. Surveillance was most cost-effective for the higher-risk subgroup of high-risk patients.

FUTURE WORK: Studies should examine the clinical effectiveness and cost-effectiveness of post-polypectomy surveillance without prior classification of patients into risk groups.

TRIAL REGISTRATION: This trial is registered as ISRCTN15213649.

FUNDING: This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 26. See the NIHR Journals Library website for further project information.

PMID:35635015 | DOI:10.3310/OLUE3796

Ann Med. 2022 Dec;54(1):1570-1577. doi: 10.1080/07853890.2022.2082518.

ABSTRACT

OBJECTIVES: Faecal calprotectin is an important biomarker used in the evaluation of inflammatory bowel disease. The aim of this study was to establish the value of faecal calprotectin concentration as a predictor of remission in ulcerative colitis and its correlation with laboratory, endoscopic and clinical findings.

METHODS: The single centre study included 126 adult patients with established diagnosis of ulcerative colitis consecutively visiting our Day clinic from March 2017 to March 2019. We measured serum biomarkers- CRP, haemoglobin, leukocytes and platelets. Faecal calprotectin was determined from stool, and endoscopy was performed with calculation of MAYO endoscopic subscore system (MES 0-1: remission, and MES 2-3: active disease). Clinical assessment was done by using Mayo score for ulcerative colitis (clinical Mayo score <2:remission, >5: active disease).The statistical analysis was performed using an univariate and multivariate model of disease remission prediction using logistic regression.

RESULTS: According to univariate analysis the increase of faecal calprotectin concentration by 10 ug/g is associated with an 8% decrease in probability of disease remission (OR 0.9921, p < .05). In the multivariate analysis, faecal calprotectin remained a significant predictor of disease remission (OR 0.9948, 95% CI 0.9914-0.9982, p = .0028), however, with a significant contribution of C-reactive protein (OR 0.8340, 95% CI 0.7085-0.9818, p = .0292). According to our model the cut off value for faecal calprotectin was 154 ug/g.

CONCLUSION: Our results have shown that faecal calprotectin is an independent predictor of remission in UC patients. The results of our study represent real-life data from a single university centre dealing with FC as a prognostic marker in patients with UC. KEY MESSAGESFaecal calprotectin is an independent predictor of remission in UC patients.Recent studies have suggested that calprotectin correlates well with endoscopic activity of inflammation but correlation of faecal calprotectin in a phase of remission hasn’t been evaluated yet.We have found that other inflammatory biomarkers do not correlate well with either endoscopic or clinical activity in ulcerative colitis.

PMID:35635011 | DOI:10.1080/07853890.2022.2082518

J Cosmet Dermatol. 2022 May 30. doi: 10.1111/jocd.15133. Online ahead of print.

ABSTRACT

OBJECTIVE: Detect the expression of Interleukin-6(IL-6) in the serum of patients with systemic sclerosis (SSc) and assess its association with clinical and laboratory features of the disease.

METHODS: The clinical data from 50 patients with SSc in the affiliated hospital of Xuzhou Medical University, China were retrospectively analyzed. The level of IL-6 in peripheral blood of systemic sclerosis patients was compared between the different clinical phenotypes groups. Spearman correlation test was used to analyze the correlation of the IL-6 with C-reactive protein(CRP), erythrocyte sedimentation rate (ESR), creatinine, and cystatin C.

RESULTS: IL-6 increased in the disease course ≥ 5 years, systemic sclerosis- Interstitial lung disease(SSc-ILD), pulmonary arterial hypertension(PAH), gastrointestinal involvement, and cardiac involvement group compared with the group with disease course < 5 years, no SSc-ILD, PAH, gastrointestinal involvement, and no cardiac involvement group. The differences were statistically significant (P<0.05). Correlation analysis showed that IL-6 in the group with disease course ≥ 5 years had a positive correlation with ESR (Rs=0.438, P=0.022) and CRP (Rs=0.825, P<0.001), whereas it was negatively correlated with creatinine (Rs=-0.481, P=0.011). Nevertheless, when it came to disease course < 5 years, the figures had no statistically significant difference.

CONCLUSION: Serum IL-6 in patients with systemic sclerosis is related to different clinical phenotypes. IL-6 helps to diagnose various phases of diseases, monitor severities of diseases, and predict the prognosis of patients.

PMID:35634998 | DOI:10.1111/jocd.15133

Perfusion. 2022 May 29:2676591221105610. doi: 10.1177/02676591221105610. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate a restrictive transfusion policy of red blood cells (RBC) and platelets in pediatric patients submitted to extracorporeal membrane oxygenation (ECMO).

METHODS: Retrospective descriptive study of pediatric patients supported with ECMO, from January 2010 to December 2019. Hemoglobin, platelet, lactate and mixed venous oxygen saturation (SvO2) values of each patient while on ECMO, were collected. Transfusion efficiency and tissue oxygenation were statistically evaluated comparing pre-transfusion hemoglobin, lactate and SvO2 with post-transfusion values. Ranges of hemoglobin and platelets were established, and the number of transfusions registered. The bleeding complications and outcome were documented.

RESULTS: Of a total of 1016 hemoglobin values, the mean value before transfusion was 8.6 g/dl. Hemoglobin and SvO2 increased significantly post-transfusion. Red blood cell transfusion varied with hemoglobin values: when hemoglobin value was less than 7 g/dl, 89% (41/46) were transfused but just 23% (181/794) when greater or equal to 7 g/dl. In the presence of active bleeding, the frequency of RBC transfusion increased from 32% to 62%, with hemoglobin between 7 g/dl and 8 g/dl.The mean value for platelet transfusion was 32 x 10⁹/L. Thirty-eight (43%) platelet values between 20 x 10⁹/L and 30×10⁹/L, and 31 (40%) between 30 x 10⁹/L and 40 x 10⁹/L led to platelet transfusion; between 40 x 10⁹/L and 50 x 10⁹/L, only 7 (9%) prompted platelet transfusion.Comparing the 2010-2015 to 2016-2019 periods there was a decrease in RBC and platelet transfusion threshold with similar survival (p = .528). Survival to discharge was 68%.

CONCLUSIONS: Using a restrictive RBC and platelet transfusion policy was safe and allowed a good outcome in this case series. The presence of active bleeding was an important decision factor when hemoglobin was above 7 g/dl and platelets were above 30 x 10⁹/L.

PMID:35634987 | DOI:10.1177/02676591221105610

West Afr J Med. 2022 May 27;39(5):521-528.

ABSTRACT

BACKGROUND: Depression is a significant contributor to the global burden of disease. Several studies have shown that depression in resident doctors is more common than that in the general population. However, data on the prevalence of depression among resident doctors in Nigeria is limited.

OBJECTIVES: The aim of this study is to determine the prevalence of depression as well as factors associated with depression among resident doctors.

METHODS: A cross-sectional study design was employed with semi-structured questionnaires on socio-demographic and other factors associated with depression in resident doctors. The proportionate sample size in hospitals across the six geopolitical zones with multi-stage sampling and systematic random sampling technique was used to recruit resident doctors. The Beck’s Depression Inventory was employed. The data was analyzed using Epi info version 3.5.3 (2011) and Stata 14. A p-value of less than 0.05 was statistically significant.

RESULTS: The prevalence of depression was 18.9% among the resident doctors. Negative binomial regression used showed that depression in resident doctors was significantly associated with age (IRR=1.07, 95%CI:1.01-1.13, p=0.017), female gender ((IRR=1.75, 95%CI: 1.00-3.05, p=0.049) and being a resident in the surgical specialties (IRR=2.31, 95%CI: 1.35-3.94, p=0.002), respectively.

CONCLUSION: The prevalence of depression among resident doctors showed that older age, female gender, and surgical specialties were determinants of depression.

PMID:35633637

West Afr J Med. 2022 May 27;39(5):508-515.

ABSTRACT

BACKGROUND: Medicinal plants have been used for years in daily life all over the world. Herbal medicines (HM) may be beneficial but are not completely harmless especially with unregulated use.

AIM: To assess the knowledge, preference and use of HM in a rural setting, western Nigeria.

METHODOLOGY: This was a cross-sectional study among 417 residents of Epe Local Government Area, Lagos State Nigeria conducted in mid 2016. Respondents were selected using a multi-stage sampling technique. Data were collected using a structured pretested interviewer-administered questionnaire and analyzed using Epi- info version 7.1.5.2. Descriptive and inferential statistics were done. P-value of <0.05 was considered statistically significant.

RESULTS: Nearly half (48.7%) of the respondents were between the ages of 18-33 years, over three fourths (78.4%) were married and majority (89.2%) were Yoruba. About half 207(49.6%) of respondents had good knowledge of HM. Over two thirds (67.6%) would use HM as first line treatment and 69.3% perceive it more effective than conventional medicine. Almost all (95.7%) respondents have used HM, majority (87.4%) in the last six months prior to study. Factors significantly associated with knowledge of HM are age (p=0.001) and sex of respondents (p=0.014). Significant factors influencing HM use include level of education (Fisher’s exact p=0.017), religion (Fisher’s exact p=0.001), and ethnicity (Fisher’s exact p<0.001).

CONCLUSION: Participants were fairly knowledgeable about herbal medicine but most were oblivious of its potential side effects. Majority were HM users mainly because of its perceived effectiveness. There is need for health education in rural areas on the side effects and safe use of herbal medicines.

PMID:35633631