Nevin Manimala

Bone Jt Open. 2021 Dec;2(12):1082-1088. doi: 10.1302/2633-1462.212.BJO-2021-0119.R1.

ABSTRACT

AIMS: Single-shot adductor canal block (ACB) after total knee arthroplasty (TKA) for postoperative analgesia is a common modality. Patients can experience breakthrough pain when the effect of ACB wears off. Local anaesthetic infusion through an intra-articular catheter (IAC) can help manage breakthrough pain after TKA. We hypothesized that combined ACB with ropivacaine infusion through IAC is associated with better pain relief compared to ACB used alone.

METHODS: This study was a prospective double-blinded placebo-controlled randomized controlled trial to compare the efficacy of combined ACB+ IAC-ropivacaine infusion (study group, n = 68) versus single-shot ACB+ intra-articular normal saline placebo (control group, n = 66) after primary TKA. The primary outcome was assessment of pain, using the visual analogue scale (VAS) recorded at 6, 12, 24, and 48 hours after surgery. Secondary outcomes included active knee ROM 48 hours after surgery and additional requirement of analgesia for breakthrough pain.

RESULTS: The study group (mean visual analogue scale (VAS) pain score of 5.5 (SD 0.889)) experienced significant reduction in pain 12 hours after surgery compared to the control group (mean VAS 6.62 (SD 1.356); mean difference = 1.12, 95% confidence interval (CI) -1.46 to 0.67; p < 0.001), and pain scores on postoperative day (POD) 1 and POD-2 were lower in the study group compared to the control group (mean difference in VAS pain = 1.04 (-1.39 to -0.68, 95% CI, p < 0.001). Fewer patients in the study group (0 vs 3 in the control group) required additional analgesia for breakthrough pain, but this was not statistically significant. The study group had significantly increased active knee flexion (mean flexion 86.4° (SD 7.22°)), compared to the control group (mean 73.86° (SD 7.88°), mean difference = 12.54, 95% CI 9.97 to 15.1; p < 0.014).

CONCLUSION: Combined ACB+ ropivacaine infusion via IAC is a safe, reproducible analgesic modality after primary TKA, with superior analgesia compared to ACB alone. Further large volume trials are warranted to generate evidence on clinical significance on analgesia after TKA. Cite this article: Bone Jt Open 2021;2(12):1082-1088.

PMID:34931538 | DOI:10.1302/2633-1462.212.BJO-2021-0119.R1

Minerva Endocrinol (Torino). 2021 Dec 21. doi: 10.23736/S2724-6507.21.03686-1. Online ahead of print.

ABSTRACT

BACKGROUND: Since low-intensity shockwave treatment (LISWT) has putative effects on penile hemodynamics remodeling, the aim of this study was to evaluate any improvement of penile vascular flows after LISWT treatment in patients with erectile dysfunction (ED) and poor response to PDE5i.

METHODS: Twenty-one eugonadal patients with different ED severity underwent six weekly LISWT sessions (1500-4000 pulses) after 2 weeks withdrawal from PDE5i assumption. Once daily Tadalafil (2.5 mg daily) was reintroduced 4 weeks apart from LISWT termination and patients were evaluated at 1, 2 and 6 months follow-up (T1, T2, T6) by the International Index of Erectile Function-15 items questionnaire (IIEF-15) erectile function (EF) domain, Erection Hardness Score (EHS) and Global Assessment Questionnaires (GAQ). Basal Penile Color-Doppler Ultrasound parameters in the flaccid state (B-PCDU) were evaluated before, during and after interventional protocol.

RESULTS: Mean EHS score improved in 35% of patients at T1, and in up to 50 % of patients at T2 and T6 follow-up visits (p<0.05). We found 25% improvement of EF scores at T1 session, 43.75% at T2 and 62.5% at T6, respectively (p<0.05). No statistically significant differences in flow parameters, EF-domain and testosterone levels were found when baseline and last observation carried forward (LOCF) parameters were compared. The GAQ questionnaire scored higher satisfaction rates either at the end of the treatment (100%), or at LOCF (92.5%).

CONCLUSIONS: Despite the study limitations with respect to B-PCDU in this setting, our results confirm a trend toward improvement of erectile questionnaire scores after LISWT with higher overall satisfaction rates among patients with ED. We conclude that LISWT may be an effective option in some difficult-to-treat patients with ED by improving the erectile response to PDE5i.

PMID:34931511 | DOI:10.23736/S2724-6507.21.03686-1

J Korean Med Sci. 2021 Dec 20;36(49):e339. doi: 10.3346/jkms.2021.36.e339.

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is affecting people at any age and there is limited information about the effect of the COVID-19 pandemic on quality of life (QoL) in adolescents with asthma. In the present study, it was aimed to assess the attitudes of adolescents with asthma toward the COVID-19 pandemic and determine the effects of the pandemic on their QoL.

METHODS: In total, 125 adolescents with asthma and 98 healthy adolescents participated in the present study. The questionnaire form consisted of three parts. In the first part, all the participants were asked whether they complied with the protective measures against COVID-19. The second part included questions for measuring the participants’ level of concern about COVID-19, while the third part consisted of EUROHIS-QOL 8.

RESULTS: The patient and control groups were similar in terms of the female/male ratio (55/70 and 48/50, respectively) and mean participant age (14.6 ± 2 and 15.1 ± 1.65 years, respectively) (P = 0.459 and P = 0.062, respectively). The prevalence of COVID-19 in the patients (n = 2, 1.6%) was lower than that in the controls (n = 6, 6.1%); however, the difference was not statistically significant (P = 0.142). The total EUROHIS-QOL score was significantly lower in the patients (31.2 ± 6.7) than in the controls (33.7 ± 4.4) (P < 0.001). The total QoL scores of asthmatic adolescents without other allergic disease (31.4 ± 6.7) was also lower than those of the controls (33.7 ± 4.4) (P = 0.009). Treatment disruption was significantly more common in patients who received subcutaneous immunotherapy (n = 20, 48.8%) than in those who did not (n = 8, 9.5%) (P < 0.001). Moreover, the patients had lower EUROHIS-QOL scores in the overall QoL, general health, finance, and home domains.

CONCLUSION: Our results indicate that the mean QoL score of asthmatic adolescents during COVID-19 pandemic is lower than in the healthy population. Disruption in their treatment was most common in patients with asthma who were receiving subcutaneous immunotherapy.

PMID:34931499 | DOI:10.3346/jkms.2021.36.e339

Arthritis Care Res (Hoboken). 2021 Dec 20. doi: 10.1002/acr.24848. Online ahead of print.

ABSTRACT

OBJECTIVE: Women with systemic lupus erythematosus (SLE) may experience adverse perinatal outcomes in the years before an SLE diagnosis. Overall, there is limited research on perinatal outcomes among African American women with SLE.

METHODS: Women with SLE identified from the Georgia Lupus Registry and the Georgians Organized Against Lupus Cohort were linked with birth certificates by the Georgia Department of Public Health. Births were categorized into occurring more than 3 years before SLE diagnosis, 0-3 years before SLE diagnosis, 0-3 years after SLE diagnosis or more than 3 years after SLE diagnosis. Comparison births certificates to African American women in the same geographic area were obtained from the National Center for Health Statistics. We used log-risk models to compare the risk of preterm birth or small-for-gestational age among SLE births in each diagnosis timing category to the general population, adjusting for maternal age and education and parity.

RESULTS: Births to women with SLE were more likely to occur preterm 0-3 years before SLE diagnosis (risk ratio [RR]: 1.71, 95% confidence interval [CI]: 1.24, 2.35), 0-3 years after SLE diagnosis (RR: 2.29, 95% CI: 1.70, 3.09) and 3 or more years after diagnosis (RR: 2.83, 95% CI: 2.36, 3.38), but not 3 or more years before SLE diagnosis compared to the general population (RR: 1.03, 95% CI: 0.77, 1.38). Similar results were observed for small-for-gestational age births.

CONCLUSION: Our analysis, conducted among African American women, demonstrates an increased risk of adverse perinatal outcomes even before a clinical diagnosis of SLE.

PMID:34931482 | DOI:10.1002/acr.24848

Oral Surg Oral Med Oral Pathol Oral Radiol. 2021 Oct 22:S2212-4403(21)00689-1. doi: 10.1016/j.oooo.2021.10.010. Online ahead of print.

ABSTRACT

OBJECTIVES: Some experts have suggested that burning mouth syndrome (BMS) should be included in the family of central sensitivity syndromes, a group of similar medical disorders linked by the central sensitization (CS) mechanism. Our objective is to assess the presence of CS in patients with BMS by performing a clinical examination and administering questionnaires to measure the generalized extent of pain, the presence of associated symptoms, and the number of other concurrent chronic pain conditions.

STUDY DESIGN: We conducted a case-control study in 82 subjects (40 patients with BMS and 42 controls). Patients with BMS were diagnosed using The International Classification of Headache Disorders 3rd edition, beta version (ICHD-IIIβ) criteria. The Widespread Pain Index (WPI) and Symptom Severity (SS) Score questionnaires were used to determine the degree of central sensitivity. The number of other concurrent chronic pain conditions was determined with the Neblett inventory.

RESULTS: Data indicative of CS show a statistically significant association with BMS. Both SS Score and Widespread Pain Index scores higher in patients with BMS. Additionally, patients with BMS reported a significantly higher number of other central sensitivity syndromes.

CONCLUSIONS: Patients with BMS could present a CS component as well as other chronic pain conditions. The use of questionnaires may be useful to determine the degree of central sensitivity in patients with BMS.

PMID:34930705 | DOI:10.1016/j.oooo.2021.10.010

J Plast Reconstr Aesthet Surg. 2021 Nov 28:S1748-6815(21)00609-4. doi: 10.1016/j.bjps.2021.11.062. Online ahead of print.

ABSTRACT

BACKGROUND: Many Oriental eyes feature single eyelid fold and ptotic eyelid. Performing the double eyelid blepharoplasty (DEB) in a minimally invasive manner with simultaneous blepharoptosis correction (BPC) is important to achieve an aesthetic pleasing outcome.

OBJECTIVE: To demonstrate an effective mini-invasive transcutaneous and transconjunctival dual approach technique for simultaneous DEB and BPC. Furthermore, to compare the outcome of BPC in dual approach, transcutaneous procedure and transconjunctival procedure.

METHODS: This is a retrospective study reviewing 159 eyelids that underwent mini-invasive DEB with BPC from November 2018 to May 2019, including the technical description and the surgical outcomes. To investigate the efficacy, the pre- and postoperative margin reflex distance 1 (MRD1) and levator function (LF) corresponding to the different surgical procedures and preoperative severity was analyzed.

RESULTS: Statistically, the dual approach group has significant improvement in MRD1 and LF (47 eyelids, p<0.05) corresponding to patients with ptosis of any severity. Under the same tucking amount, dual approach can achieve 1.6±0.7 mm of MRD1 improvement, which is nearly twice the amount compare with transconjunctival approach alone. No revision nor complication noted in the dual approach group by 6-month follow-up.

CONCLUSION: The dual approach technique is a method with a wide range of applications, effective, and low revision rate that simultaneously correct blepharoptosis and create a double eyelid.

PMID:34930703 | DOI:10.1016/j.bjps.2021.11.062

Prim Care Diabetes. 2021 Dec 17:S1751-9918(21)00225-4. doi: 10.1016/j.pcd.2021.12.009. Online ahead of print.

ABSTRACT

AIMS: To evaluate the short-term effect of lifestyle intervention in people with prediabetes.

METHODS: A stratified multistage sampling method was used in the recruitment of residents of the Jiangsu Province, China in 2017, who had no previous diagnosis of diabetes. Physical examination and laboratory tests were performed, and questionnaires were completed. Those with a prediabetes diagnosis at baseline were included in the cohort and participants were randomized to the intervention group or the control group. The intervention group received a lifestyle intervention strategy, which included exercise, diet and peer educations. The control group received general health education. Participants were followed up in 2018.

RESULTS: A total of 2005 individuals were included in the analysis. At follow-up, there were 516 (36.7%) individuals in the intervention group and 207 (34.5%) individuals in the control group with normal blood glucose levels. The decline in waist circumference and fasting plasma glucose levels was significantly higher in the intervention group than in the control group. This was still observed after adjusting for variables (odds ratio 1.32, P = 0.02). Females or younger individuals who had lower body mass index and plasma glucose levels at baseline were more likely to reverse to normoglycemia at follow-up.

CONCLUSIONS: Compared with a strategy of general health education, a lifestyle intervention strategy could reverse glucose levels to normoglycemia in individuals with prediabetes.

PMID:34930688 | DOI:10.1016/j.pcd.2021.12.009

Prim Care Diabetes. 2021 Dec 17:S1751-9918(21)00223-0. doi: 10.1016/j.pcd.2021.12.007. Online ahead of print.

ABSTRACT

AIM: To compare the contribution of sodium-glucose cotransporter-2 inhibitors (SGLT2is) with that of DPP4i or GLP-1ra toward lower extremity amputation rate.

METHODS: Electronic databases were searched for articles published on the differences between the rates of lower extremity amputation among patients with type 2 diabetes mellitus (T2DM) undergoing SGLT2i treatment and those undergoing other anti-hyperglycemic agent (dipeptidyl peptidase-4 inhibitors [DPP4is], glucagon-like peptide-1 receptor agonist [GLP-1as], or sulfonylurea [SUs]) treatments. Random-effect models were used to generate data if heterogeneity was detected.

RESULTS: Eight studies based on retrospective case-control designs with propensity matching were included. The propensity score-matching method increased credibility. Compared with SGLT2i treatment, DPP4i or GLP-1a treatment tended to result in a higher amputation rate (pooled hazard ratio [HR] = 1.1, 95% confidence interval [CI]: 0.98-1.23), whereas SU treatment resulted in similar amputation rates (pooled HR = 0.92, 95% CI: 0.74-1.13). After excluding the heterogeneous study, the meta-analysis of the remaining studies attained a statistical value (pooled HR = 0.81, 95% CI: 0.65-1.01).

CONCLUSION: The study findings suggest that, with respect to diabetic foot-related limb amputations, SGLT2is are not superior to novel anti-hyperglycemic agents (DPP4is and GLP-1as) or other types of oral hypoglycemic agents (SUs). Therefore, SGLT2is may not have significantly positive effects on the prognosis for T2DM patients with complicated diabetic foot.

PMID:34930687 | DOI:10.1016/j.pcd.2021.12.007

J Am Pharm Assoc (2003). 2021 Dec 2:S1544-3191(21)00495-7. doi: 10.1016/j.japh.2021.11.034. Online ahead of print.

ABSTRACT

BACKGROUND: Expanding reproductive health services in community pharmacies is a promising strategy for reaching underserved communities. Limited information exists on women’s attitudes to receive these services and if interest may differ in urban and rural locations.

OBJECTIVE: We sought to determine whether there were differences by rural location in women’s perspectives and willingness to receive essential preventative and diagnostic reproductive health services in community pharmacies.

METHODS: We conducted a cross-sectional national survey of women in November 2020. The survey consisted of demographic data, women’s experiences receiving essential preventative health services, and questions regarding perspectives on and interest in receiving these services in community pharmacies. Descriptive statistics assessed differences in survey responses between rural and urban communities.

RESULTS: Our sample size consisted of 867 women. We received 544 responses for a response rate of 62.7%. Rural women were as likely as their urban counterparts to delay receiving preventative care owing to concerns about insurance or how they would pay for services (P = 0.45). Rural women were less likely than urban women to have received the human papillomavirus vaccine (P = 0.02) or have had regular cervical cancer screenings (P = 0.04). Overall, both rural and urban women want to receive preventative reproductive health services in community pharmacies.

CONCLUSION: Expanded access to reproductive health services in community pharmacies has the potential to improve access and health screening, particularly in underserved rural areas.

PMID:34930682 | DOI:10.1016/j.japh.2021.11.034

Reprod Biomed Online. 2021 Nov 10:S1472-6483(21)00545-9. doi: 10.1016/j.rbmo.2021.10.023. Online ahead of print.

ABSTRACT

RESEARCH QUESTION: Can (mosaic) aneuploidy be reliably detected in preimplantation embryos after multiple displacement amplification and single nucleotide polymorphism detection, independent of haplotyping and copy number detection, with a new method ‘analysis of parental contribution for aneuploidy detection’ or ‘APCAD’?

DESIGN: This method is based on the maternal contribution, a parameter that reflects the proportion of DNA that is of maternal origin for a given chromosome or chromosome segment. A maternal contribution deviating from 50% for autosomes is strongly indicative of a (mosaic) chromosomal anomaly. The method was optimized using cell mixtures with varying ratios of euploid and aneuploid (47,XY,+21) lymphocytes. Next, the maternal contribution was retrospectively measured for all chromosomes from 349 Karyomapping samples.

RESULTS: Retrospective analysis showed a skewed maternal contribution (<36.4 or >63.6%) in 57 out of 59 autosome meiotic trisomies and all autosome monosomies (n = 57), with values close to theoretical expectation. Thirty-two out of 7436 chromosomes, for which no anomalies had been observed with Karyomapping, showed a similarly skewed maternal contribution.

CONCLUSIONS: APCAD was used to measure the maternal contribution, which is an intuitive parameter independent of copy number detection. This method is useful for detecting copy number neutral anomalies and can confirm diagnosis of (mosaic) aneuploidy detected based on copy number. Mosaic and complete aneuploidy can be distinguished and the parent of origin for (mosaic) chromosome anomalies can be determined. Because of these benefits, the APCAD method has the potential to improve aneuploidy detection carried out by comprehensive preimplantation genetic testing methods.

PMID:34930679 | DOI:10.1016/j.rbmo.2021.10.023