Nevin Manimala

J Prev Med Hyg. 2022 Jan 31;62(4):E904-E908. doi: 10.15167/2421-4248/jpmh2021.62.4.2176. eCollection 2021 Dec.

ABSTRACT

BACKGROUND: The adverse effects of coronavirus infection on pregnant women and their infants are not apparent. The best strategies to deal with this disease is avoiding the infection and preventing its transmission.

PURPOSE: the present study aimed to investigate the relationship between demographic factors and levels of self-care against coronavirus in pregnant women referred to maternity wards of Kerman, southeast Iran.

METHOD: The present descriptive study was conducted on 200 pregnant women who referred to maternity wards in Kerman in 2020 and met the inclusion criteria. The required information was collected using demographic and obstetric questionnaires and a self-care checklist.

FINDINGS: The mean age of the participants was 28.89 ± 7.07. Iranian and Afghan citizens comprised 82 and 18% of the participants, respectively. The highest level of self-care measures against coronavirus in pregnant women was attributed to the use of face masks (74%), and the lowest was warning the personnel to wear masks (28%). There was a statistically significant relationship between the nationality of the participants and warning the personnel to wear facemasks (r = 0.183; p = 0.02), having a sick spouse (r=0.149;P = 0.039), and having a sick child (r = 0.191; p = 0.043), and between the husbands’ job and the patients’ demand for a private room (r = 0.173; p = 0.013). There was an inverse relationship between mothers’ age and warning the personnel about paying attention to their hygiene (r = -0.145; p = 0.04).

CONCLUSIONS: The results indicated that most pregnant women in the present study were active in self-care against coronavirus. Using face masks was more widely followed than other self-care measures; moreover, there was a relationship between personal characteristics and self-care levels.

PMID:35603249 | PMC:PMC9104661 | DOI:10.15167/2421-4248/jpmh2021.62.4.2176

J Prev Med Hyg. 2022 Jan 31;62(4):E909-E917. doi: 10.15167/2421-4248/jpmh2021.62.4.2287. eCollection 2021 Dec.

ABSTRACT

INTRODUCTION: Nutrition plays an integral part in growth and development of a child. Age-appropriate feeding is known to improve the child’s well-being and reduce the risk of specific diseases. The present study aimed to assess the awareness of parents regarding breastfeeding and complementary feeding practices.

METHODOLOGY: This health-based prospective observational study was conducted in a tertiary care hospital enrolling 95 parents with children in the age group 1-2 years. The data was analyzed using SPSS version 26 and Microsoft excel.

RESULTS: In the present study, the prevalence of exclusive breastfeeding was 73.68%. Eighty-six (90.53%) parents initiated complementary feeds at 6 months. However, only 45.26% of children were consuming adequate quantity of complementary foods. The association of child’s calorie consumption with maternal age and occupation was found to be statistically significant.

CONCLUSION: Adequate nutrition during childhood and infancy is a key factor influencing growth and development. In the present study, the overall breastfeeding and complimentary feeding practices were satisfactory. However, the quantity of complementary feeding was inadequate. Counselling the mothers on appropriate breastfeeding and complementary feeding practices during antenatal and postnatal visits may have a positive impact on infant feeding practices.

PMID:35603241 | PMC:PMC9104673 | DOI:10.15167/2421-4248/jpmh2021.62.4.2287

Acta Ophthalmol. 2022 May 22. doi: 10.1111/aos.15189. Online ahead of print.

ABSTRACT

PURPOSE: The aim of the study was to obtain the values of oxygen saturation in retinal vessels and ophthalmic blood flow parameters in a healthy Caucasian population and assess whether the oximetry parameters are affected by the flow rate or the vascular resistance.

METHODS: The spectrophotometric retinal oximetry and colour Doppler imaging (CDI) of retinal vessels were successfully performed with 52 healthy subjects (average age 29.7 ± 5.6 years). The retinal oximeter simultaneously measures the wavelength difference of haemoglobin oxygen saturation in retinal arterioles and venules. The arteriolar and venular saturation in both eyes was measured. The peak systolic (PSV) end diastolic (EDV) velocities, resistive (RI) and pulsatility (PI) indices were obtained for both eyes using CDI in the ophthalmic artery. A paired t-test and two sample t-tests were used for statistical analyses. The correlation was assessed using the Pearson coefficient correlation.

RESULTS: The mean oxygen saturation level was 96.9 ± 3.0% for the retinal arterioles and 65.0 ± 5.1% for the retinal venules. The A-V difference was 31.8 ± 4.6%. The mean of the measured haemodynamic parameters was PSV 46.6 ± 9.4 cm/s, EDV 12.0 ± 3.5 cm/s, PI 1.68 ± 0.38 and RI 0.74 ± 0.05. No significant difference in oxygen saturation and haemodynamic parameters was found between the left and the right eyes or the dominant and non-dominant eye. The oximetry and ultrasound values were sex independent. The Pearson correlation coefficient demonstrated a significant yet weak negative correlation between A-V difference and RI (r = -0.321, p = 0.020).

CONCLUSIONS: A negative correlation between A-V difference and resistance index was observed, suggesting that reduced oxygen consumption may reflect the increased vascular tone of the ophthalmic vessels, which is likely determined by autoregulatory mechanisms.

PMID:35599335 | DOI:10.1111/aos.15189

BMC Oral Health. 2022 May 22;22(1):195. doi: 10.1186/s12903-022-02215-0.

ABSTRACT

BACKGROUND: To compare the solution on the cyclic fatigue resistance of EdgeTaper Platinum (ETP) instruments with that of ProTaper Gold (PTG) in the presence of ethylenediaminetetraacetic acid (EDTA) or sodium hypochlorite (NaOCl) irrigating solutions.

METHODS: Sixty PTG and 60 ETP instruments with the same size (#25) and taper (8%) were tested under 17% EDTA, 5.25% NaOCl, or distilled water (n = 20 each). Cyclic fatigue was tested using artificial canals that were milled in stainless steel blocks using a laser micromachining technique. The canals had a curvature angle of 60 and a curvature radius of 5 mm. The center of maximum curvature was set at 5 mm from the instrument tip. The block of artificial canals was stabilized inside a container that was filled with one of the tested solutions. The temperature was fixed at 37 °C with a tolerance limit of 1 °C. The number of cycles to fracture (NCF) was calculated and the fractured surfaces were examined using a scanning electron microscope. All statistical analyses were performed using SPSS software Version 20 (IBM-SPSS Inc., Chicago, IL) at a confidence level of 95%.

RESULTS: ETP showed higher NCF than PTG in any of the tested solutions (P < 0.05). Within each group, NaOCl drastically decreased the NCF compared to water and EDTA (P < 0.05) and changing the solution from distilled water to EDTA did not affect the fatigue resistance (P > 0.05).

CONCLUSIONS: ETP showed improved cyclic fatigue performance compared to PTG in all tested irrigating solutions. EDTA can be used in combination with NiTi instruments during canal instrumentation without compromising the cyclic fatigue resistance of PTG and ETP instruments. However, NaOCl drastically decreased the NCF.

PMID:35599316 | DOI:10.1186/s12903-022-02215-0

Genome Med. 2022 May 23;14(1):54. doi: 10.1186/s13073-022-01053-7.

ABSTRACT

BACKGROUND: Low-energy diets (LEDs) comprise commercially formulated food products that provide between 800 and 1200 kcal/day (3.3-5 MJ/day) to aid body weight loss. Recent small-scale studies suggest that LEDs are associated with marked changes in the gut microbiota that may modify the effect of the LED on host metabolism and weight loss. We investigated how the gut microbiota changed during 8 weeks of total meal replacement LED and determined their associations with host response in a sub-analysis of 211 overweight adults with pre-diabetes participating in the large multicentre PREVIEW (PREVention of diabetes through lifestyle intervention and population studies In Europe and around the World) clinical trial.

METHODS: Microbial community composition was analysed by Illumina sequencing of the hypervariable V3-V4 regions of the 16S ribosomal RNA (rRNA) gene. Butyrate production capacity was estimated by qPCR targeting the butyryl-CoA:acetate CoA-transferase gene. Bioinformatics and statistical analyses, such as comparison of alpha and beta diversity measures, correlative and differential abundances analysis, were undertaken on the 16S rRNA gene sequences of 211 paired (pre- and post-LED) samples as well as their integration with the clinical, biomedical and dietary datasets for predictive modelling.

RESULTS: The overall composition of the gut microbiota changed markedly and consistently from pre- to post-LED (P = 0.001), along with increased richness and diversity (both P < 0.001). Following the intervention, the relative abundance of several genera previously associated with metabolic improvements (e.g., Akkermansia and Christensenellaceae R-7 group) was significantly increased (P < 0.001), while flagellated Pseudobutyrivibrio, acetogenic Blautia and Bifidobacterium spp. were decreased (all P < 0.001). Butyrate production capacity was reduced (P < 0.001). The changes in microbiota composition and predicted functions were significantly associated with body weight loss (P < 0.05). Baseline gut microbiota features were able to explain ~25% of variation in total body fat change (post-pre-LED).

CONCLUSIONS: The gut microbiota and individual taxa were significantly influenced by the LED intervention and correlated with changes in total body fat and body weight in individuals with overweight and pre-diabetes. Despite inter-individual variation, the baseline gut microbiota was a strong predictor of total body fat change during the energy restriction period.

TRIAL REGISTRATION: The PREVIEW trial was prospectively registered at ClinicalTrials.gov ( NCT01777893 ) on January 29, 2013.

PMID:35599315 | DOI:10.1186/s13073-022-01053-7

Langenbecks Arch Surg. 2022 May 23. doi: 10.1007/s00423-022-02545-1. Online ahead of print.

ABSTRACT

PURPOSE: While liver resection is a well-established treatment for primary HCC, surgical treatment for recurrent HCC (rHCC) remains the topic of an ongoing debate. Thus, we investigated perioperative and long-term outcome in patients undergoing re-resection for rHCC in comparative analysis to patients with primary HCC treated by resection.

METHODS: A monocentric cohort of 212 patients undergoing curative-intent liver resection for HCC between 2010 and 2020 in a large German hepatobiliary center were eligible for analysis. Patients with primary HCC (n = 189) were compared to individuals with rHCC (n = 23) regarding perioperative results by statistical group comparisons and oncological outcome using Kaplan-Meier analysis.

RESULTS: Comparative analysis showed no statistical difference between the resection and re-resection group in terms of age (p = 0.204), gender (p = 0.180), ASA category (p = 0.346) as well as main preoperative tumor characteristics, liver function parameters, operative variables, and postoperative complications (p = 0.851). The perioperative morbidity (Clavien-Dindo ≥ 3a) and mortality were 21.7% (5/23) and 8.7% (2/23) in rHCC, while 25.4% (48/189) and 5.8% (11/189) in primary HCC, respectively (p = 0.851). The median overall survival (OS) and recurrence-free survival (RFS) in the resection group were 40 months and 26 months, while median OS and RFS were 41 months and 29 months in the re-resection group, respectively (p = 0.933; p = 0.607; log rank).

CONCLUSION: Re-resection is technically feasible and safe in patients with rHCC. Further, comparative analysis displayed similar oncological outcome in patients with primary and rHCC treated by liver resection. Re-resection should therefore be considered in European patients diagnosed with rHCC.

PMID:35599252 | DOI:10.1007/s00423-022-02545-1

Med Educ. 2022 May 22. doi: 10.1111/medu.14842. Online ahead of print.

ABSTRACT

INTRODUCTION: Medical students’ longitudinal care of patients supports clinical learning and promotes patient-centeredness. The literature presents little empirically derived guidance for faculty to facilitate students’ longitudinal learning and care. Informed by the conceptual framework of relational learning, this study investigated faculty perspectives about longitudinal teaching, their strategies for facilitating students’ longitudinal learning, and perceived barriers and enablers.

METHODS: Using a convergent mixed-methods approach at a single academic medical center, the authors conducted a survey and two focus groups in 2018-2019 with faculty members teaching in three longitudinal clinical courses. Quantative analyses included descriptive statistics and chi-square tests. Qualitative content analysis described deductive categories and identified inductive themes.

RESULTS: Fourty-three eligible faculty (69%) completed the survey. Ninety-one percent (n=39) reported that teaching in a longitudinal model enhanced their experience as preceptors. Faculty described activities students performed to provide longitudinal care: spending time with patients independently (n=38, 88%), making follow-up phone calls (n=35; 81%), and participating in home- and community-based visits (n=20, 47%), among others. Twelve faculty participated in two focus groups. Deductive analysis characterized strategies for facilitating students’ longitudinal learning and barriers and enablers. Strategies included “encouraging students to follow patients”, “faculty adaptability”, “offering guidance and setting expectations”, and “careful patient selection”. Barriers included scheduling limitations, and enablers included student initiative. Inductive analysis identified two themes: faculty goals for students and faculty benefits from teaching. Goals included meaningful engagement with patients and their illness over time. Benefits from teaching included personal gratification, mentorship, and holistic student assessment.

DISCUSSION: Our survey and focus group findings demonstrated positive faculty attitudes and experiences, characterized faculty goals and approaches, and identified elements of the educational context that hindered or facilitated longitudinal teaching and learning. This study’s faculty perspectives build upon prior investigations of students’ and patients’ perspectives, offer teaching strategies, and may guide faculty development.

PMID:35599241 | DOI:10.1111/medu.14842

Clin Transl Sci. 2022 May 22. doi: 10.1111/cts.13291. Online ahead of print.

ABSTRACT

Aggregated risk of carbamazepine (CBZ)-induced cutaneous adverse drug reactions (cADRs) with different HLA variants are unclear and limited in terms of the power of studies. This study aimed to assess the aggregated risk of CBZ-induced cADRs associated with carrying the following HLA variants: HLA-B*15:02, HLA-B*15:11, HLA-B*15:21, HLA-B*38:02, HLA-B*40:01, HLA-B*46:01, HLA-B*58:01, HLA-A*24:02, and HLA-A*31:01. Literature was searched in different databases following PRISMA guidelines. The outcomes were measured as odds ratio (OR) using RevMan software by a random/fixed effects model, where p < 0.05 was set as statistical significance. In total, 46 case-control studies met the inclusion criteria and were included in this analysis consisting of 1817 cases and 6614 controls. It was found that case-patients who carried the HLA-B*15:02 allele were associated with a significantly increased risk of CBZ-induced Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) compared to controls (OR 26.01; 95% CI 15.88-42.60; p < 0.00001). The aggregated risk of cADRs was slightly higher in Asian compared to Caucasian patients (Asians: OR 14.84; 95% CI 8.95-24.61; p < 0.00001; Caucasians: OR 11.65; 95% CI 1.68-80.70; p = 0.01). Further, HLA-B*15:11, HLA-B*15:21, or HLA-A*31:01 allele was also associated with significantly increased risk of CBZ-induced cADRs (HLA-B*15:11: OR 6.08; 95% CI 2.28-16.23; p = 0.0003; HLA-B*15:21: OR 5.37; 95% CI 2.02-14.28; p = 0.0008; HLA-A*31:01: OR 5.92; 95% CI 4.35-8.05; p < 0.00001). Other HLA variants were not found to have any significant associations with CBZ-induced cADRs. Strong associations between the HLA-B*15:02, HLA-B*15:11, HLA-B*15:21, or HLA-A*31:01 allele with CBZ-induced cADRs have been established in this analysis. Pharmacogenetic testing of particular HLA alleles before initiation of CBZ therapy may be beneficial to patients and may help to eradicate cADRs substantially.

PMID:35599240 | DOI:10.1111/cts.13291

J Plast Reconstr Aesthet Surg. 2022 Apr 21:S1748-6815(22)00191-7. doi: 10.1016/j.bjps.2022.04.012. Online ahead of print.

ABSTRACT

PURPOSE: Triple negative breast cancer (TNBC) patients have a significantly worse prognosis and survival compared to non-TNBC patients. Mastectomy and immediate breast reconstruction (MIBR) is associated with higher rates of complications overall, but whether MIBR significantly increases oncological risk in TNBC patients has not been fully elucidated. Our study aimed to evaluate the oncological safety of MIBR in patients with TNBC compared to non-TNBC.

METHODS: A 6-year prospectively maintained retrospective database at The Ottawa Hospital was reviewed from January 1, 2013 to May 31, 2019. Propensity score-matching was performed using the nearest-neighbour method with a matching ratio of 2:1. Kaplan-Meier and log rank tests were performed to provide statistical comparison of disease-free interval (DFI). DFI was defined as time from MIBR to locoregional recurrence or disease-specific mortality. P-value < 0.05 indicated statistical significance.

RESULTS: Of 277 eligible patients, 153 patients were matched. The cohort consisted of 51(33%) TNBC patients and 102 (67%) non-TNBC patients after 2:1 propensity score-matching. The rates of delays to first radiochemotherapy [17 (33%) vs.14 (14%), p = 0.10], postoperative complications [13 (26%) vs. 34 (33%), p = 0.50], and locoregional recurrence [2 (1.96%) vs. 1 (1.96%), p = 1.0] were statistically similar in TNBC and non-TNBC, respectively. DFI was not significantly different in TNBC compared to non-TNBC patients (log-rank p = 1.0). There was no mortality in this cohort.

CONCLUSIONS: This 6-year retrospective 2:1 propensity score-matched cohort study demonstrated similar oncological safety for MIBR in patients with TNBC and non-TNBC.. Overall, these findings provide additional support for the oncological safety of MIBR in TNBC. . Therefore, MIBR remains a therapeutic option for patients with TNBC.

PMID:35599222 | DOI:10.1016/j.bjps.2022.04.012

J Plast Reconstr Aesthet Surg. 2022 Apr 24:S1748-6815(22)00224-8. doi: 10.1016/j.bjps.2022.04.027. Online ahead of print.

ABSTRACT

OBJECTIVE: Opioid-based analgesia is often used in the management of postoperative pain in arthroplasty cases. This article analyses the safety of single-shot peripheral nerve block (PNB) and potential analgesic benefits in patients undergoing lower limb free flap reconstruction.

METHODS: A retrospective review including all patients undergoing lower limb reconstruction with free flaps between October 2017 and April 2020 was performed. Patients were divided into two groups based on PNB utilization. The use of oral opioids, post-operative pain scores, flap-related outcomes, patient morbidity, and length of hospital stay (LOS) were compared between groups.

RESULTS: Thirty-one patients who underwent lower limb reconstruction with free flaps, were finally included in the study. Preoperative PNB was performed on 14 patients, while 17 patients received general anesthesia (GA) alone. Pain at rest, measured using the visual analog scale (VAS) score, was significantly lower (2.2 ± 1.7 vs. 4.9 ± 1.7) in the PNB group on postoperative day 1 (POD). The mean [median]±SD amounts of opioids consumed in morphine milligram equivalent (MME) were significantly lower in the PNB group on both POD1 (33.5 [22.5] ± 33.9 vs. 61.6 [48.0] ± 39.0), POD2 (29.0 [15.0] ± 29.2 vs. 58.0 [52.5] ± 37.0) and cumulatively over 7 days (164.0 [197.0] ± 132.8 vs. 315.4 [225] ± 203.2). Complication rates and LOS were not statistically different between groups, although trending toward lower take-back procedures and major complications in the PNB group.

CONCLUSION: Preoperative single-shot PNB significantly reduced postoperative opioid use and patient-reported pain severity and was not associated with an increase in complication rates.

PMID:35599221 | DOI:10.1016/j.bjps.2022.04.027