Nevin Manimala

Am Surg. 2021 Dec 29:31348211065127. doi: 10.1177/00031348211065127. Online ahead of print.

ABSTRACT

BACKGROUND: This study reviews our cumulative experience with the management of patients presenting with a retained knife following a penetrating neck injury (PNI).

METHODS: A retrospective cohort study was conducted at a major trauma center in South Africa over a 15-year period from July 2006 to December 2020. All patients who presented with a retained knife in the neck following a stab wound (SW) were included.

RESULTS: Twenty-two cases were included: 20 males (91%), mean age: 29 years. 77% (17/22) were retained knives and 23% (5/22) were retained blades. Eighteen (82%) were in the anterior neck, and the remaining 4 cases were in the posterior neck. Plain radiography was performed in 95% (21/22) of cases, and computed tomography (CT) was performed in 91% (20/22). Ninety-five percent (21/22) had the knife or blade extracted in the operating room (OR). Formal neck exploration (FNE) was undertaken in 45% (10/22) of cases, and the remaining 55% (12/22) underwent simple extraction (SE) only. Formal neck exploration was more commonly performed for anterior neck retained knives than the posterior neck, although not statistically significant [56% (10/18) vs 0% (0/18), P = .096]. There were no significant differences in the need for intensive care admission, length of hospital stay, morbidities, or mortalities between anterior and posterior neck retained knives.

DISCUSSION: Uncontrolled extraction of a retained knife in the neck outside of the operating room may be dangerous. Retained knives in the anterior neck commonly required formal neck exploration but not for posterior neck retained knives.

PMID:34965158 | DOI:10.1177/00031348211065127

Am Surg. 2021 Dec 29:31348211047503. doi: 10.1177/00031348211047503. Online ahead of print.

ABSTRACT

BACKGROUND: Enhanced recovery after surgery (ERAS) programs have become increasingly popular in general surgery, yet no guidelines exist for an abdominal wall reconstruction (AWR)-specific program. We aimed to evaluate predictors of increased length of stay (LOS) in the AWR population to aid in creating an AWR-specific ERAS protocol.

METHODS: A prospective, single institution hernia center database was queried for all patients undergoing open AWR (1999-2019). Standard statistical methods and linear and logistic regression were used to evaluate for predictors of increased LOS. Groups were compared based on LOS below or above the median LOS of 6 days (IQR = 4-8).

RESULTS: Inclusion criteria were met by 2,505 patients. On average, the high LOS group was older, with higher rates of CAD, COPD, diabetes, obesity, and pre-operative narcotic use (all P < .05). Longer LOS patients had more complex hernias with larger defects, higher rates of mesh infection/fistula, and more often required a component separation (all P < .05). Multivariate analysis identified age (β0.04,SE0.02), BMI (β0.06,SE0.03), hernia defect size (β0.003,SE0.001), active mesh infection or mesh fistula (β1.8,SE0.72), operative time (β0.02,SE0.002), and ASA score >4 (β3.6,SE1.7) as independently associated factors for increased LOS (all P < .05). Logistic regression showed that an increased length of stay trended toward an increased risk of hernia recurrence (P = .06).

CONCLUSIONS: Multiple patient and hernia characteristics are shown to significantly affect LOS, which, in turn, increases the odds of AWR failure. Weight loss, peri-operative geriatric optimization, prehabilitation of comorbidities, and operating room efficiency can enhance recovery and shorten LOS following AWR.

PMID:34965157 | DOI:10.1177/00031348211047503

Psychol Rep. 2021 Dec 29:332941211061078. doi: 10.1177/00332941211061078. Online ahead of print.

ABSTRACT

Student-teacher interpersonal relationships contribute significantly to the academic trajectory and achievement of children and adolescents. The Questionnaire on Teacher Interaction (QTI) is one of the most widely applied measures for assessing students’ perceptions about the teachers’ interpersonal behaviour. QTI comprises eight subscales that are assumed to follow a circumplex model. Prior studies on QTI’s psychometric properties are inconclusive and report mixed findings. The purpose of this study was to examine the applicability of QTI in the Greek cultural context, by testing its circumplex structure and levels of reliability. QTI was administered to 1669 secondary education students, from 85 different classrooms. A cross-validation approach and a variety of statistical techniques were employed. Subscales’ internal consistency and their ability to discriminate among classes were satisfactory. Exploratory statistical techniques provided initial support of the circular pattern. Application of a specifically designed package for testing the circumplex structure of an instrument, showed that a model in which the eight QTI subscales are placed on the circumference of a circle with equal distances form the centre was tenable. However, the assumption of equal distances was not confirmed. Deviation from the theoretical position of the subscales was mainly due to students’ difficulty to discriminate teachers’ proximity behaviour, a finding reported in various studies and across different cultural contexts. Suggestions for improving the psychometric properties of the QTI are discussed.

PMID:34965156 | DOI:10.1177/00332941211061078

Clin Child Psychol Psychiatry. 2021 Dec 29:13591045211055822. doi: 10.1177/13591045211055822. Online ahead of print.

ABSTRACT

The current study aims to clarify the longitudinal relations among parent emotion regulation (ER), child ER, and children’s oppositional defiant disorder (ODD) symptoms. In the current study, parents of 275 children (195 boys, 70.1%) with ODD symptoms (M_age = 9.32 years, SD = 1.64) reported their ER using the Difficulties in Emotion Regulation Scale, child ERs using the Emotion Regulation Checklist, and children’s ODD symptoms using the eight symptoms indicated in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) at three time points (T1, T2, and T3) within 2 years. Results indicated the longitudinal relationships between parent ER and children’s ODD symptoms were directly influenced by each other. Children’s ODD symptoms had important effects on both child ER and parent ER. Findings suggested that to reduce children’s ODD symptoms, it is necessary not only to improve child ER but also to improve parent ER.

PMID:34965152 | DOI:10.1177/13591045211055822

Vestn Oftalmol. 2021;137(6):55-60. doi: 10.17116/oftalma202113706155.

ABSTRACT

PURPOSE: To assess the effects of phacoemulsification cataract surgery (PCS) and its pharmacological support on the prevalence of dry eye (DE) type ocular surface changes.

MATERIAL AND METHODS: The study included 550 patients with age-related (369 patients) or complicated (181 patients) cataracts (247 men, 303 women; mean age 71.6±7.3 years) who were assessed using the Ocular Surface Disease Index (OSDI), tear break-up test (TBUT), Shirmer-1 test, lipid interference test, OCT meniscometry, examined for xerosis indicators and «lid vipers» symptom in order to detect DE before PCS, as well as on days 1, 7, 30 after PCS. Meibomian gland dysfunction (MGD) was determined by the Norn compression test, which was performed before PCS. The significance of differences was assessed using Pearson χ² test.

RESULTS: Before PCS the prevalence of DE was 51.1%, asymptomatic subclinical DE – 28.9%. MGD was detected in 79.4% of DE patients and in 50.3% subclinical DE patients. After PCS, an increase in DE prevalence was noted (due to increase in the prevalence of mild DE): on the 1^st day – up to 58% (χ²=5.295; p=0.022; p<0.05), on the 7^th day after surgery – up to 63.1% (χ²=16.165; p=0.001; p<0.01), on the 30^th day – up to 55.6% (χ²=2.283; p=0.131; p>0.05).

CONCLUSION: The study revealed a trend towards an increase in DE prevalence after PCS (due to an increase in the proportion of hypersecretory mild DE), which was statistically significant on days 1 and 7 after the operation and statistically insignificant by the 30^th day after surgery. Apparently, it could be associated with aggravation of “background” asymptomatic ocular surface changes. From our point of view, the high prevalence of DE and subclinical DE in cataract patients before PCS makes it advisable to carry out preoperative preparation aimed at normalizing the condition of ocular surface. At the same time, the high prevalence of MGD in DE and subclinical DE patients determines one of the directions of preoperative treatment – eyelids hygiene.

PMID:34965068 | DOI:10.17116/oftalma202113706155

Acta Gastroenterol Belg. 2021 Oct-Dec;84(4):601-605. doi: 10.51821/84.4.011.

ABSTRACT

BACKGROUND AND AIMS: Gastric bypass surgery effectively treats obesity; however, its association with belching, which occurs in other bariatric surgeries, remains unclear. Hence, we aimed to evaluate belching occurrence after gastric bypass surgery.

METHODS: We enrolled 12 healthy volunteers and 17 patients (12 and 5 underwent Roux-en-Y gastric bypass and mini-gastric bypass surgeries 24 (18-54) months prior, respectively). Gastrointestinal symptoms were assessed. Gastroscopy was performed, followed by the 24-hour pH-impedance analysis.

RESULTS: Age and sex were not statistically different between the two groups (P > 0.05). Patients had a significantly higher mean DeMeester score than the healthy controls (9.11 ± 19.40 vs. 6.04 ± 5.60, P = 0.048), but the pathologic acid reflux (DeMeester score > 14) rate was similar in both groups (11.8% vs. 8.3%). Regarding the impedance, symptom-association probability was positive in 11.8% of patients. The patients also had higher alkaline reflux rates (6% vs. 0%); additionally, 50% of them experienced belching based on the questionnaire, and 25% had esophagitis based on gastroscopy. Furthermore, patients had a significantly higher number of gas reflux (123.24 ± 80 vs. 37.2 ± 21.5, P = 0.001) and supragastric/ gastric belches (182 ± 64/228 ± 66.69 vs. 25.08 ± 15.20/12.17 ± 17.65, P = 0.001). Supragastric belching was more frequent than gastric belching in the controls, whereas gastric belching was more frequent in the patients.

CONCLUSION: Belching increases after gastric bypass surgery in a long-term period. Gastric belching was more frequent than supragastric belching in these patients.

PMID:34965042 | DOI:10.51821/84.4.011

Acta Gastroenterol Belg. 2021 Oct-Dec;84(4):563-569. doi: 10.51821/84.4.006.

ABSTRACT

BACKGROUND AND STUDY AIM: In European Society of Gastrointestinal Endoscopy guidelines, biliary cannulation of naive papillae is defined as difficult in the presence of more than 5 papilla contacts, more than 5min cannulation time or more than one unintended pancreatic duct cannulation or opacification. It is not known whether cholecystectomy is a cause of difficult biliary cannulation. This study aimed to investigate whether cholecystectomy (CCY) is a cause of difficult biliary cannulation in patients who have undergone Endoscopic Retrograde Cholangiopancreatography (ERCP) for choledocholithiasis.

PATIENTS AND METHODS: Adult patients with naive papillae and those who underwent ERCP for common bile duct stones and/or sludge were included in this retrospective study. Patient demographics, clinical presentation (acute cholangitis, biliary pancreatitis or biliary colic), periprocedural data including laboratory and radiological findings and ERCP results were compared between no-CCY and post-CCY groups.

RESULTS: 438 patients were included in the present study and 347 of these patients were in the no-CCY group and 91 patients were in post-CCY group. A statistically significant difference was found in the number of patients with difficult cannulation in the post-CCY group (n=30, 33.0%) patients compared to the no- CCY group (n=67, 19.3%) (p=0.011). According the multivariate analyses results, presence of history of cholecystectomy was found an independent risk factor of difficult cannulation (Odds ratio: 2.014; 95 % Cl 1.205-3.366; p=0.008).

CONCLUSIONS: The results showed that biliary cannulation was significantly more difficult in patients with cholecystectomy who underwent ERCP for common bile duct stones.

PMID:34965037 | DOI:10.51821/84.4.006

Swiss Med Wkly. 2021 Dec 20;151:w30054. doi: 10.4414/smw.2021.w30054. eCollection 2021 Dec 20.

ABSTRACT

AIMS OF THE STUDY: In Switzerland, there has been a boom in the market for cannabidiol (CBD) products in recent years. However, little is known on the prevalence, modes of administration and motives for use of CBD products. The aim of the present study was to fill this gap using recent (2019) data from the Cohort Study on Substance Use Risk Factors (C-SURF).

METHODS: Between April and December 2019, an unselected sample of 5233 Swiss young men from the French- and German-speaking regions (mean age 28.2 years, standard deviation 1.3) completed a self-report questionnaire covering measures of use of CBD products, modes of administration and motives to use of CBD, tetrahydrocannabinol (THC) and cigarettes. Descriptive statistics were used to estimate prevalence of self-reported use, modes of administration and motives to use CBD, whereas logistic regression models were used to test the associations of linguistic region, THC and tobacco use with use of CBD.

RESULTS: Lifetime and 12-month prevalence of self-reported use of CBD were 32.4% and 18.5%, respectively. Among past 12-month CBD users, 79.4% used CBD once a month or less often, whereas 20.6% used it more than once a month. The most often reported modes of administration of CBD were in association with tobacco: flowers mixed with tobacco (67.5%), and CBD cigarettes with tobacco (37.1%), while 18.6% used flowers without tobacco. The three most reported reasons for using CBD were: out of curiosity (74.0%), to feel the effects of THC (38.1%) and for well-being and health (37.5%). In multivariable models, CBD use was associated with use of THC (odds ratio [OR] 9.85, 95% confidence interval [CI] 8.28-11.73), cigarettes (OR 2.74, 95% CI 2.28-3.29) or e-cigarettes (OR 1.5795% CI 1.27-1.95), as well as for the linguistic region (French-speaking vs German-speaking region OR 1.3895% CI 1.15-1.65).

CONCLUSIONS: Self-reported use of CBD is common among young Swiss men: about one third used CBD in their life and about one in five in the previous 12 months. However, the vast majority of CBD users used it infrequently and out of curiosity. CBD use was particularly prevalent among users of THC and cigarette smokers. CBD was most often used in combination with tobacco, thus exposing users to risks associated with smoking tobacco products.

PMID:34964581 | DOI:10.4414/smw.2021.w30054

Monaldi Arch Chest Dis. 2021 Dec 28. doi: 10.4081/monaldi.2021.2024. Online ahead of print.

ABSTRACT

Chronic obstructive pulmonary disease (COPD) is usually associated with a variety of extra-pulmonary manifestations. Metabolic syndrome (MetS) is one such entity that has been scarcely studied in Indian patients. Availability of a good screening marker may help in timely detection of this co morbidity in COPD patients. We conducted a cross sectional study to evaluate the prevalence of MetS among COPD patients and to evaluate the role of Interleukin-6 and insulin resistance (as measured by HOMA-IR) as screening markers for MetS in COPD. A total of 100 stable COPD patients were evaluated for MetS using US National Cholesterol Education Program Adult Treatment Panel III (2005) guidelines. Interleukin-6 and HOMA-IR (for insulin resistance) were measured and compared between COPD patients with and without MetS. ROC analysis was done to find the best cut-off value and sensitivity and specificity of both the molecules in detecting MetS. In the results, the mean age of the study cohort was 59.9+8.7yrs (males=93). Forty five COPD patients (45%) fulfilled the criteria for MetS. Patients with MetS were comparatively younger (57.9+9.5 v/s 61.6+7.8 years; p=0.037) but had longer duration of preceding COPD (9.9+2.8 v/s 6.0+2.2 years; p<0.001) as compared to those without MetS. Both IL-6 and HOMA index were statistically higher (p<0.05) in COPD-MetS patients as compared to the other group. At cutoff value of 36.3 pg/ml for IL-6 and 1.61 for HOMA index, IL-6 and HOMA-IR had sensitivity 91.1% and 82.2% respectively in detecting MetS among COPD patients. To conclude, metabolic syndrome is a common comorbidity seen in COPD patients. Interleukin-6 has a better sensitivity than HOMA-IR in screening MetS among COPD patients.

PMID:34964574 | DOI:10.4081/monaldi.2021.2024

Monaldi Arch Chest Dis. 2021 Dec 28. doi: 10.4081/monaldi.2021.1984. Online ahead of print.

ABSTRACT

Dyspnea is a common symptom in Systemic Sclerosis (SSc) that considerably decreases patients’ quality of life (QoL). Pulmonary Rehabilitation (PR) mitigates dyspnea impact on daily activities. The aim of this study is to evaluate the effect on respiratory disability of home-based PR in SSc patients with dyspnea. In this observational prospective monocentric study, we screened all dyspneic SSc consecutive patients attending the Rheumatological day hospital in the University hospital of Parma from January 2019 and June 2019. The aim of our study was to understand if a PR unsupervised home-based program could improve respiratory disability in this specific population. Dyspnea was evaluated with the self-administered questionnaires modified Medical Research Council (mMRC) and Saint George’s Respiratory Questionnaire (SGRQ).Patients also filled in Short Form 36 (SF36) and the Modified-Health Assessment Questionnaire for SSc (HAQ-MOD). Health Professionals assessed and trained the patients and collected data before PR and at the end of the program. PR consisted in 5 weekly unsupervised sessions for 8 weeks. Wilcoxon test for paired data evaluated the changes after PR. p<0.05 was considered statistically significant. 46 SSc patients were included (43 female). Only 31 (29 female) performed PR as planned (Adherent Group-AG) while the others gave up within the first week (Non-Adherent Group-NAG). All SGRQ domains (Symptoms: from 30 to 18; p=0.0055; Activity: from 47 to 35, p=0.23; Impact from 29 to 25, p=0.044) and SGRQ total score (from 35 to 29; p=0.022) improved in AG. SGRQ scores did not change in NAG as well as SF36 and HAQ-MOD in both groups. The home-based PR program dramatically decreased the effect, frequency and severity of respiratory symptoms. Conversely, it slightly changed the activities causing breathlessness and dyspnea-related social functioning disturbances. PR appears to be a useful tool in treatment strategies aiming to achieve a QoL improvement in SSc patients.

PMID:34964573 | DOI:10.4081/monaldi.2021.1984