Nevin Manimala

J Acad Consult Liaison Psychiatry. 2022 Jun 2:S2667-2960(22)00274-9. doi: 10.1016/j.jaclp.2022.05.006. Online ahead of print.

ABSTRACT

BACKGROUND: Delirium prediction can augment and optimize care of older adults. Mayo delirium prediction (MDP) tool is a robust tool, developed from a large retrospective data set. MDP tool predicts delirium risk for hospitalized older adults, within 24 hours of hospital admission, based on risk factor information available from electronic health record. We intend to validate the prediction performance of this tool and optimize the tool for clinical use.

DESIGN: Observational cohort study SETTINGS: Mayo Clinic Hospitals, Rochester, MN PARTICIPANTS: All Hospitalized older adults (age >50 years) from December 2019 to June 2020. Patients with an admitting diagnosis of substance use disorder were excluded.

INTERVENTION: Original MDP tool was modified to adjust for the fall risk variable as a binary variable that will facilitate broader applicability across different fall risk tools. The modified MDP tool was validated in the retrospective derivation and validation data set which yielded similar prediction capability (AUROC = 0.85, 0.83 respectively).

MEASUREMENTS: Diagnosis of delirium was captured by flowsheet diagnosis of delirium documented by nursing staff in medical record. Predictive variable data were collected daily.

RESULTS: 8055 patients were included in the study (median age 71 years). The modified MDP tool delirium prediction compared to delirium occurrence was 4% in the low-risk group, 17.8% in the medium-risk group, and 45.3% in the high-risk group (AUROC of 0.80). Recalibration of the tool was attempted to further optimize the tool that resulted in both simplification and increased performance (AUROC 0.82). The simplified tool was able to predict delirium in hospitalized patients admitted to both medical and surgical services.

CONCLUSIONS: Validation of modified MDP tool revealed good prediction capabilities. Recalibration resulted in simplification with increased performance of the tool in both medical and surgical hospitalized patients.

PMID:35660677 | DOI:10.1016/j.jaclp.2022.05.006

J Acad Consult Liaison Psychiatry. 2022 Jun 2:S2667-2960(22)00273-7. doi: 10.1016/j.jaclp.2022.05.005. Online ahead of print.

ABSTRACT

INTRODUCTION: COVID-19 has been a devastating pandemic with little known of its neuropsychiatric complications. Delirium is one of the most common neuropsychiatric syndromes among hospitalized cancer patients with incidence ranging from 25%-40% and rates of up to 85% in the terminally ill. Data on the incidence, risk factors, duration, and outcomes of delirium in critically ill cancer patients with COVID-19 are lacking.

METHODS: Retrospective single center study evaluating delirium frequency and outcomes in all critically ill cancer patients with COVID-19 admitted between March 1 and July 10, 2020. Delirium was assessed by Confusion Assessment Method – Intensive Care Unit (CAM-ICU), performed twice daily by trained ICU nursing staff. Patients were considered to have a delirium positive day if CAM-ICU was positive at least once per day.

RESULTS: A total of 70 patients were evaluated. Of those 53 (75.7%) were found to be positive for delirium. Patients with delirium were significantly older compared to patients without delirium (median 67.5 vs 60.3, p=0.013). There were no significant differences in demographic characteristics, chronic medical conditions, neuropsychiatric history, cancer type, or application of prone positioning between the two groups. Delirium patients were less likely to receive cancer-directed therapies (58.5% vs 88.2%, p=0.038), but more likely to receive antipsychotics (81.1% vs 41.2%; p=0.004), dexmedetomidine (79.3% vs 11.8%; p<0.001), steroids (84.9% vs 58.8%; p=0.039), and vasopressors (90.6% vs 58.8%; p=0.006). Delirium patients were more likely to be intubated (86.8% vs 41.2%; p<0.001) and all tracheostomies (35.9%) occurred in patients with delirium. ICU length of stay (LOS) (19 vs 8 days; p<0.001) and hospital LOS (37 vs 12 days; p<0.001) were significantly longer in delirium patients but there was no statistically significant difference in hospital mortality (43.4% vs 58.8%; p=0.403) or ICU mortality (34% vs 58.8%; p=0.090) CONCLUSION: Delirium in critically ill cancer patients with COVID-19 was associated with less cancer directed therapies, and increased hospital and ICU LOS. However, the presence of delirium was not associated with an increase in hospital or ICU mortality.

PMID:35660676 | DOI:10.1016/j.jaclp.2022.05.005

World Neurosurg. 2022 Jun 2:S1878-8750(22)00770-7. doi: 10.1016/j.wneu.2022.05.130. Online ahead of print.

ABSTRACT

Ping-pong fractures (PPF) have become less frequent and no definite predictors to determine which fractures will elevate spontaneously and which should undergo surgical treatment have not been clearly defined. Herein, the authors present a revision of the literature, in which 54 papers were included, with a total of 228 children studied. Patients who underwent surgery accounted for 30%; elevation through obstetrical vacuum or other aspiration systems was applied in 30%, spontaneous resolution occurred in 40%; in 4 patients percutaneous microscrew elevation was applied. Overall, in 96.4% of patients the outcome was favorable since we found no significant increase in the incidence of post-traumatic seizures or neurologic sequelae with no significant differences between treated patients and spontaneous elevation. Statistical analysis showed no significant differences among the different treatment methods (P=0.53). Our results suggest that simple compound PPFs without brain compression, hematomas or dural tears could benefit from conservative management. In cases of non-spontaneous resolution after 6 months, operative strategies should be performed, considering that there is no evidence of differences between vacuum elevation and surgical elevation.

PMID:35660672 | DOI:10.1016/j.wneu.2022.05.130

J Glob Antimicrob Resist. 2022 Jun 2:S2213-7165(22)00132-1. doi: 10.1016/j.jgar.2022.05.027. Online ahead of print.

ABSTRACT

BACKGROUND: The Mycobacterium avium complex (MAC), comprising a series of subspecies, has a worldwide distribution, with differences in drug susceptibility among subspecies. This study aimed to assess the composition of MAC and susceptibility differences among subspecies in mainland China.

METHODS: A total of 287 MAC clinical strains were included in the study. Multitarget sequences were applied to accurately identify subspecies, and a microdilution method was used to evaluate minimum inhibitory concentrations (MICs) among subspecies using Sensititre SLOMYCO plates.

RESULTS: M. intracellular (N=169), M. avium (N=52), M. chimaera (N=22), M. marseillense (N=25), M. colombiense (N=14), M. yongonense (N=4), M. vulneris (N=3) and M. timonense (N=2) were isolated from MAC. Clarithromycin, amikacin and rifabutin showed lower MIC₅₀ and MIC₉₀ values than other drugs, and the resistance rates of clarithromycin, amikacin, linezolid and moxifloxacin were 6.3%, 10.5%, 51.9% and 46.3%, respectively. The resistance rates of clarithromycin and moxifloxacin in the initial treatment group were significantly lower than those in the retreatment group (4.09% vs. 12.94%; 30.41% vs. 75.29%; p<0.05). Drug susceptibility differences were observed in clarithromycin and moxifloxacin among the 5 major subspecies (p<0.05); however, those statistically significant differences disappeared when MACs were divided into two groups according to previous anti-TB treatment history.

CONCLUSIONS: This study revealed that MAC, primarily comprising M. intracellulare, was susceptible to clarithromycin, amikacin and rifabutin. Drug susceptibility among subspecies did not exhibit intrinsic differences in our study. Previous anti-TB treatment patients are more resistant to drugs; thus, attention should be given to those patients in the clinic.

PMID:35660663 | DOI:10.1016/j.jgar.2022.05.027

Neurosci Lett. 2022 Jun 2:136705. doi: 10.1016/j.neulet.2022.136705. Online ahead of print.

ABSTRACT

Since 1967, spinal cord stimulation (SCS) has been used to manage chronic intractable pain of the trunk and limbs. Low-intensity, paresthesia-free, 10 kHz SCS has demonstrated statistically- and clinically-superior long-term pain relief compared to conventional SCS. 10 kHz SCS has been proposed to operate via selective activation of inhibitory interneurons in the superficial dorsal horn. In contrast, 40 Hz SCS is presumed to operate largely via dorsal column fiber activation. To determine if these mechanisms may be implemented synergistically, we examined the effect of each type of stimulation both independently and simultaneously on putatively inhibitory and putatively excitatory neurons in the superficial dorsal horn. When 10 kHz SCS was applied relatively caudally to the measured spinal segment, simultaneous with 40 Hz SCS applied relatively rostrally to that spinal segment, inhibitory interneurons demonstrated a median increase of 26 spikes/s compared to their baseline firing rates. Median firing rate increases of inhibitory interneurons were 8.7 and 5.1 spikes/s during 40 Hz SCS applied rostrally and 10 kHz SCS applied caudally, respectively. By comparison, the median firing rate of excitatory interneurons increased by 4.1 spikes/s during simultaneous 40 Hz SCS applied rostrally and 10 kHz SCS applied caudally. Median firing rate increases of excitatory interneurons were 13 and 0.8 spikes/s during 40 Hz SCS applied rostrally and 10 kHz SCS applied caudally, respectively. This suggests that simultaneously applying 10 kHz SCS caudally and 40 Hz SCS rostrally may provide greater pain relief than either type of SCS alone by increasing the firing rates of inhibitory interneurons, albeit with greater excitatory interneuron activation.

PMID:35660650 | DOI:10.1016/j.neulet.2022.136705

Exp Gerontol. 2022 Jun 2:111865. doi: 10.1016/j.exger.2022.111865. Online ahead of print.

ABSTRACT

BACKGROUND: We hypothesized that factors related to malnutrition, namely low muscle mass, appetite loss, and adiposity, are associated with frailty and pre-frailty in community-dwelling older adults.

AIMS: To identify the prevalence of frailty and pre-frailty in a Brazilian convenience sample and test the association between these conditions and malnutrition-related factors.

METHODS: This is a cross-sectional analysis of an ongoing community project. We studied 106 older adults (≥60 years old). Frailty (dependent variable) was screened using the FRAIL-BR scale. The independent variables were appetite loss (AL), screened from the SNAQ questionnaire; sarcopenia risk, investigated by SARC-F; body adiposity, estimated by the body mass index (BMI); visceral adiposity, estimated by waist circumference (WC) and the combination of these two indicators. The associations were investigated using multinomial logistic regression models.

MAIN RESULTS: We found, from our sample, 30.2 % pre-frail and 31.1 % frail participants. The frail and pre-frail were older than the non-frail; the frail ones presented a higher proportion of sarcopenia risk and a higher proportion of AL. From the multiple regression models, frailty conditions showed significant association with the AL (OR = 0.68; p = 0.012 and OR = 0.64; p = 0.009 for pre-frail and frail, respectively) and with sarcopenia risk (OR = 3.24; p = 0.001 and OR = 5.34; p < 0.011 for pre-frail and frail respectively). The adiposity indicated by waist circumference, and age, remained in the final model only as adjusting variables but without statistical significance.

CONCLUSIONS: in our convenience sample of older adults, frailty and pre-frailty showed significant association with appetite loss and sarcopenia risk, but not with adiposity indicators. Future studies are needed to better understand our findings.

PMID:35660640 | DOI:10.1016/j.exger.2022.111865

Khirurgiia (Mosk). 2022;(6):116-126. doi: 10.17116/hirurgia2022061116.

ABSTRACT

OBJECTIVE: To compare the outcomes of thermal and mechanochemical endovenous ablative techniques in patients with varicose veins.

MATERIAL AND METHODS: We searched the PubMed, EMBASE and Cochrane Library databases for studies devoted to mechanochemical and thermal endovenous ablative techniques from inception until July 2021. The primary outcome was anatomical success. Secondary endpoints were intraoperative pain syndrome, complications, modification of disease severity and quality of life.

RESULTS: This meta-analysis enrolled 10 comparative studies and 1.252 participants after truncal ablations. The follow-up period ranged from 4 weeks to 36 months. With regard to overall anatomical success, 245 out of 267 (91.8%) patients after mechanochemical ablation and 249 out of 266 (93.6%) patients after thermal ablation had favorable results after a month (low-quality evidence; odds ratio [OR] 0.79; 95% CI 0.40-1.55). No statistical heterogeneity was identified (χ²=1.48; df=2; p=0.48; I²=0%). Further analysis identified different incidence of total occlusion after 12 months or later (OR 0.36; 95% CI 0.11-1.21; p=0.05; I²=68%). Mechanochemical ablation resulted less intraoperative pain. Mean difference was -1.3 (95% CI -2.53- -0.07; p=0.00001). MOCA was followed by fewer incidence of nerve injury, hematoma, deep vein thrombosis and phlebitis. There were more cases of skin pigmentation compared to thermal ablation (low-quality evidence, p>0.05). Subsequent assessment of disease severity identified significant between-group difference of means (-0.64 (95% CI -1.82-0.53; p=0.004) and -0.16 (95% CI -0.43-0.11; p=0.005) after 6 and 12 months, respectively). Further assessment of quality of life revealed no between-group differences. These data were characterized by moderate methodological quality.

CONCLUSION: Mechanochemical ablation is as effective as standard TA within the first postoperative month. However, this approach is associated with lesser anatomical success after 12 months. In most studies, pain syndrome was less severe in case of mechanochemical ablation. These data suggest that mechanochemical ablation is a safe alternative for varicose veins. However, further large-scale trials are required to define the role of MOCA.

PMID:35658143 | DOI:10.17116/hirurgia2022061116

Khirurgiia (Mosk). 2022;(6):88-101. doi: 10.17116/hirurgia202206188.

ABSTRACT

OBJECTIVE: Comparative assessment of immediate and long-term results of robot-assisted and conventional endoscopic technologies in the Russian Federation.

MATERIAL AND METHODS: Searching for primary trials devoted to robot-assisted (RAE) and traditional video endoscopic (TVE) surgeries in the Russian Federation was carried out in the e-library and CENTRAL Cochrane databases. We used the recommendations of the Center for Expertise and Quality Control of Medical Care (2017, 2019) and the current version of the Cochrane Community Guidelines (2021). These guidelines define the features of meta-analysis of non-randomized comparative studies. Review Manager 5.4 software was used for statistical analysis.

RESULTS: We enrolled 26 Russian-language primary sources (3111 patients) including 1174 (38%) ones in the RAE group and 1937 (62%) patients in the TVE group. There were no randomized controlled trials in the Russian Federation, and all primary studies were non-randomized. We found no significant between-group differences in surgery time, incidence of intraoperative complications, intraoperative blood loss in thoracic surgery, urology and gynecology, conversion rate, postoperative hospital-stay, postoperative morbidity (in abdominal surgery, urology and gynecology), postoperative mortality. We observed slightly lower intraoperative blood loss for RAE in abdominal surgery and lower incidence of postoperative complications in robot-assisted thoracic surgery. These results can be compromised by methodological quality of comparative studies, significant heterogeneity and systematic errors.

CONCLUSION: Currently, we cannot confirm the benefits of robot-assisted technologies, since this approach does not worsen or improve treatment outcomes. Further high-quality studies are needed.

PMID:35658141 | DOI:10.17116/hirurgia202206188

Khirurgiia (Mosk). 2022;(6):27-31. doi: 10.17116/hirurgia202206127.

ABSTRACT

OBJECTIVE: To analyze creatine phosphokinase as a predictor of destructive cholecystitis.

MATERIAL AND METHODS: We analyzed 105 patients with various clinical variants of acute calculous cholecystitis (catarrhal, phlegmonous, gangrenous), and comparable age, gender and comorbidities. The study included patients with gallstone disease and gallbladder inflammation aged 30-7 years who underwent laparoscopic cholecystectomy, open cholecystectomy, cholecystectomy through mini-laparotomy. We excluded patients with gallstone disease complicated by mechanical jaundice aged under 30 years and over 70 years old. Control group consisted of 35 patients with exacerbation of chronic calculous cholecystitis. Creatinine phosphokinase (CPK) was analyzed at admission by standard kinetic colorimetric method in all patients with suspected acute cholecystitis. Statistical analysis of data was carried out using the SPSS Statistics 7.0 software in compliance with the principles of statistical analysis adopted for research in biology and medicine.

RESULTS: CPK level was 257.7±27.9 U/L (p<0.05) in patients with acute calculous cholecystitis that is 3.5 times higher than in the control group. We found an increase of concentration of this enzyme depending on severity of gallbladder wall destruction.

CONCLUSION: Analysis of serum creatine phosphokinase can be included in the algorithm of preoperative examination to study the prospects of this approach for predicting severity of acute cholecystitis.

PMID:35658133 | DOI:10.17116/hirurgia202206127

Med Care. 2022 Jun 6. doi: 10.1097/MLR.0000000000001742. Online ahead of print.

ABSTRACT

BACKGROUND: Persons with multimorbidity (≥2 chronic conditions) face an increased risk of poor health outcomes, especially as they age. Psychosocial factors such as social isolation, chronic stress, housing insecurity, and financial insecurity have been shown to exacerbate these outcomes, but are not routinely assessed during the clinical encounter. Our objective was to extract these concepts from chart notes using natural language processing and predict their impact on health care utilization for patients with multimorbidity.

METHODS: A cohort study to predict the 1-year likelihood of hospitalizations and emergency department visits for patients 65+ with multimorbidity with and without psychosocial factors. Psychosocial factors were extracted from narrative notes; all other covariates were extracted from electronic health record data from a large academic medical center using validated algorithms and concept sets. Logistic regression was performed to predict the likelihood of hospitalization and emergency department visit in the next year.

RESULTS: In all, 76,479 patients were eligible; the majority were White (89%), 54% were female, with mean age 73. Those with psychosocial factors were older, had higher baseline utilization, and more chronic illnesses. The 4 psychosocial factors all independently predicted future utilization (odds ratio=1.27-2.77, C-statistic=0.63). Accounting for demographics, specific conditions, and previous utilization, 3 of 4 of the extracted factors remained predictive (odds ratio=1.13-1.86) for future utilization. Compared with models with no psychosocial factors, they had improved discrimination. Individual predictions were mixed, with social isolation predicting depression and morbidity; stress predicting atherosclerotic cardiovascular disease onset; and housing insecurity predicting substance use disorder morbidity.

DISCUSSION: Psychosocial factors are known to have adverse health impacts, but are rarely measured; using natural language processing, we extracted factors that identified a higher risk segment of older adults with multimorbidity. Combining these extraction techniques with other measures of social determinants may help catalyze population health efforts to address psychosocial factors to mitigate their health impacts.

PMID:35658116 | DOI:10.1097/MLR.0000000000001742