Nevin Manimala

BMJ Open. 2021 Apr 7;11(4):e041917. doi: 10.1136/bmjopen-2020-041917.

ABSTRACT

OBJECTIVE: The purpose of this study was to assess the trends in outcomes of out-of-hospital cardiac arrest (OHCA) in Beijing over 5 years.

DESIGN: Cross-sectional study.

METHODS: Adult patients with OHCA of all aetiologies who were treated by the Beijing emergency medical service (EMS) between January 2013 and December 2017 were analysed. Data were collected using the Utstein Style. Cases were followed up for 1 year. Descriptive statistics were used to characterise the sample and logistic regression was performed.

RESULTS: Overall, 5016 patients with OHCA underwent attempted resuscitation by the EMS in urban areas of Beijing during the study period. Survival to hospital discharge was 1.2% in 2013 and 1.6% in 2017 (adjusted rate ratio=1.0, p for trend=0.60). Survival to admission and neurological outcome at discharge did not significantly improve from 2013 to 2017. Patient characteristics and the aetiology and location of cardiac arrest were consistent, but there was a decrease in the initial shockable rhythm (from 6.5% to 5.6%) over the 5 years. The rate of bystander cardiopulmonary resuscitation (CPR) increased steadily over the years (from 10.4% to 19.4%).

CONCLUSION: Survival after OHCA in urban areas of Beijing did not improve significantly over 5 years, with long-term survival being unchanged, although the rate of bystander CPR increased steadily, which enhanced the outcomes of patients who underwent bystander CPR.

PMID:33827829 | DOI:10.1136/bmjopen-2020-041917

BMJ Open. 2021 Apr 7;11(4):e041742. doi: 10.1136/bmjopen-2020-041742.

ABSTRACT

INTRODUCTION: This double-blind, randomised controlled trial (RCT) aims to estimate the effect of a physiotherapist-led intervention with targeted strengthening compared with a physiotherapist-led intervention with standardised stretching, on hip-related quality of life (QOL) or perceived improvement at 6 months in people with femoroacetabular impingement (FAI) syndrome. We hypothesise that at 6 months, targeted strengthening physiotherapist-led treatment will be associated with greater improvements in hip-related QOL or greater patient-perceived global improvement when compared with standardised stretching physiotherapist-led treatment.

METHODS AND ANALYSIS: We will recruit 164 participants with FAI syndrome who will be randomised into one of the two intervention groups, both receiving one-on-one treatment with the physiotherapist over 6 months. The targeted strengthening physiotherapist-led treatment group will receive a personalised exercise therapy and education programme. The standardised stretching physiotherapist-led treatment group will receive standardised stretching and personalised education programme. Primary outcomes are change in hip-related QOL using International Hip Outcome Tool-33 and patient-perceived global improvement. Secondary outcomes include cost-effectiveness, muscle strength, range of motion, functional task performance, biomechanics, hip cartilage structure and physical activity levels. Statistical analyses will make comparisons between both treatment groups by intention to treat, with all randomised participants included in analyses, regardless of protocol adherence. Linear mixed models (with baseline value as a covariate and treatment condition as a fixed factor) will be used to evaluate the treatment effect and 95% CI at primary end-point (6 months).

ETHICS AND DISSEMINATION: The study protocol was approved (La Trobe University Human Ethics Committee (HEC17-080)) and prospectively registered with the Australian New Zealand Clinical Trials Registry. The findings of this RCT will be disseminated through peer reviewed scientific journals and conferences. Patients were involved in study development and will receive a short summary following the completion of the RCT.

TRIAL REGISTRATION NUMBER: ACTRN12617001350314.

PMID:33827828 | DOI:10.1136/bmjopen-2020-041742

J Pediatr Urol. 2021 Jan 21:S1477-5131(20)30746-4. doi: 10.1016/j.jpurol.2020.12.024. Online ahead of print.

ABSTRACT

OBJECTIVES: Hypospadias is a congenital birth defect affecting around one in every 300 male infants, characterized by incomplete fusion of the urethralfold.Our objective was to identify drug and chemical exposure in pregnancy associated with increased risk for hypospadias.

METHODS: We conducted a scoping review of studies of drugs and chemicals associated with hypospadias by searching Medline, EMBASE, Cochrane, Google and Google Scholar from inception to October 9, 2020 in any language. We searched for the terms; drugs, medications, chemicals, environmental agents, hypospadias, humans, In these papers we evaluated the existence of statistical evidence for an association between exposure to drugs and chemicals, and the occurrence of hypospadias. In examining the statistical evidence, we noted whether an association was made between a drug or chemical and hypospadias at p < 0.05, or Odds Ratio or Relative risk above 1, where the lower 95% confidence interval is also above 1. We also noted whether the study’s statistical method adjusted for co-variates or confounders.

RESULTS: Significant statistical evidence for association between hypospadias and the following drugs and chemicals has been verified: Progestins, dydrogesterone, clomiphene, ibuprofen, venlafaxine, endocrine disruptors, valproic acid and polybrominated diphenyl esters flame retardants.

CONCLUSIONS: There is increasing accumulation and quality of evidence of drugs and chemicals associated with hypospadias in humans. These may partially explain the rise in the prevalence of male reproductive health disorders in the last fifty years. Advising women of reproductive age about these risks should be an important component of prenatal counseling.

PMID:33827778 | DOI:10.1016/j.jpurol.2020.12.024

Injury. 2021 Mar 26:S0020-1383(21)00267-9. doi: 10.1016/j.injury.2021.03.049. Online ahead of print.

ABSTRACT

INTRODUCTION: Amongst critically ill trauma patients admitted to ICU and still alive and in ICU after 24 hours, it is unclear which trauma scoring system offers the best performance in predicting in-hospital mortality.

METHODS: The Australia and New Zealand Intensive Care Society Adult Patient Database and Victorian State Trauma Registry were linked using a unique patient identification number. Six scoring systems were evaluated: the Australian and New Zealand Risk of Death (ANZROD), Acute Physiology and Chronic Health Evaluation III (APACHE III) score and associated APACHE III Risk of Death (ROD), Trauma and Injury Severity Score (TRISS), Injury Severity Score (ISS), New Injury Severity Score (NISS) and the Revised Trauma Score (RTS). Patients who were admitted to ICU for longer than 24 hours were analysed. Performance of each scoring system was assessed primarily by examining the area under the receiver operating characteristic curve (AUROC) and in addition using standardised mortality ratios, Brier score and Hosmer-Lemeshow C statistics where appropriate. Subgroup assessments were made for patients aged 65 years and older, patients between 18 and 40 years of age, major trauma centre and head injury.

RESULTS: Overall, 5,237 major trauma patients who were still alive and in ICU after 24 hours were studied from 25 ICUs in Victoria, Australia between July 2008 and January 2018. Hospital mortality was 10.7%. ANZROD (AUROC 0.91; 95% CI 0.90-0.92), APACHE III ROD (AUROC 0.88; 95% CI 0.87-0.90), and APACHE III (AUROC 0.88; 95% CI 0.87-0.89) were the best performing tools for predicting hospital mortality. TRISS had acceptable overall performance (AUROC 0.78; 95% CI 0.76-0.80) while ISS (AUROC 0.61; 95% CI 0.59-0.64), NISS (AUROC 0.68; 95% CI 0.65-0.70) and RTS (AUROC 0.69; 95% CI 0.67-0.72) performed poorly. The performance of each scoring system was highest in younger adults and poorest in older adults.

CONCLUSION: In ICU patients admitted with a trauma diagnosis and still alive and in ICU after 24 hours, ANZROD and APACHE III had a superior performance when compared with traditional trauma-specific scoring systems in predicting hospital mortality. This was observed both overall and in each of the subgroup analyses. The anatomical scoring systems all performed poorly in the ICU population of Victoria, Australia.

PMID:33827776 | DOI:10.1016/j.injury.2021.03.049

Fertil Steril. 2021 Apr 4:S0015-0282(21)00147-3. doi: 10.1016/j.fertnstert.2021.02.029. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the association between body mass index (BMI) and embryo aneuploidy and mosaicism in a cohort of patients undergoing in vitro fertilization (IVF) with trophectoderm biopsy for preimplantation genetic testing for aneuploidy (PGT-A) using next-generation sequencing technology.

DESIGN: Retrospective cohort study.

SETTING: Academic center.

PATIENTS: Patients undergoing their first IVF cycle with trophectoderm biopsy and PGT-A at our center between January 1, 2017, and August 31, 2020. Patients classified as underweight on the basis of BMI (BMI <18.5 kg/m²) and patients who underwent fresh embryo transfers were excluded.

INTERVENTION: None.

MAIN OUTCOME MEASURES: Number and proportion of aneuploid, mosaic, and euploid embryos.

RESULTS: The patients were stratified according to the World Health Organization’s BMI classification: normal weight (18.5-24.9 kg/m², n = 1,254), overweight (25-29.9 kg/m², n = 351), and obese (≥30 kg/m², n = 145). Age-adjusted regression models showed no relationship between BMI classification and the number or proportion of aneuploid embryos. There were no statistically significant associations between BMI classifications and the number or proportion of mosaic or euploid embryos. A subgroup analysis of patients classified into age groups of <35, 35-40, and >40 years similarly showed no relationships between BMI and embryo ploidy outcomes.

CONCLUSION: Body mass index was not associated with the number or proportion of aneuploid, mosaic, or euploid embryos in this large cohort of patients undergoing IVF with PGT-A, suggesting that the negative effect of excess weight on reproductive outcomes was independent of the ploidy status of the embryo cohort.

PMID:33827765 | DOI:10.1016/j.fertnstert.2021.02.029

Zygote. 2021 Apr 8:1-7. doi: 10.1017/S096719942100006X. Online ahead of print.

ABSTRACT

This study aimed to describe the viability of domestic feline spermatozoa after epididymal tail vitrification. For this, 10 pairs of testis-epididymis complexes were used. The epididymal tails were vitrified using the solid-surface vitrification (SSV) method, in which two vitrification media containing ethylene glycol (EG) 40% or glycerol (GLY) 40% were tested. Vitrification with the presence of EG resulted in better results for all sperm motility parameters (motility, vigour and CASA) compared with GLY (P < 0.05). There were no statistical differences for sperm viability and acrosome integrity, plasma membrane integrity, or overall health of morphologically normal sperm before or after vitrification among experimental groups. In conclusion, epididymal tail vitrification appears to be a suitable method for long-term storage of cat sperm, especially if the procedure is performed with EG as the cryoprotectant.

PMID:33827737 | DOI:10.1017/S096719942100006X

J Perinat Med. 2021 Apr 7. doi: 10.1515/jpm-2020-0505. Online ahead of print.

ABSTRACT

OBJECTIVES: In Germany, cesarean section (CS) rates more than doubled within the past two decades. For analysis, auditing and inter-hospital comparison, the 10-Group Classification System (TGCS) is recommended. We used the TGCS to analyze CS rates in two German hospitals of different levels of care.

METHODS: From October 2017 to September 2018, data were prospectively collected. Unit A is a level three university hospital, unit B a level one district hospital. The German birth registry was used for comparison with national data. We performed two-sample Z tests and bootstrapping to compare aggregated (unit A + B) with national data and unit A with unit B.

RESULTS: In both datasets (national data and aggregated data unit A + B), Robson group (RG) 5 was the largest contributor to the overall CS rate. Compared to national data, group sizes in RG 1 and 3 were significantly smaller in the units under investigation, RG 8 and 10 significantly larger. Total CS rates between the two units differed (40.7 vs. 28.4%, p<0.001). The CS rate in RG 5 and RG 10 was different (p<0.01 for both). The most relative frequent RG in both units consisted of group 5, followed by group 10 and 2a.

CONCLUSIONS: The analysis allowed us to explain different CS rates with differences in the study population and with differences in the clinical practice. These results serve as a starting point for audits, inter-hospital comparisons and for interventions aiming to reduce CS rates.

PMID:33827151 | DOI:10.1515/jpm-2020-0505

Anesth Prog. 2020 Mar 1;68(1):19-25. doi: 10.2344/anpr-67-03-12.

ABSTRACT

The aim of this study was to analyze the use of dental local anesthetics in Germany compared with international data. The type and distribution of dental local anesthetics and added vasoconstrictors based on a representative sample of German dentists itemized over a period of 7 years (2011 to 2017) were evaluated and statistically analyzed. The results were compared with international dental local anesthetic consumption data published since 2005. With a consistent market share of nearly 98%, articaine was the first-line local dental anesthetic agent in Germany. During the investigation period, German dental local anesthetics with epinephrine 1:200,000 had ∼50% market shares, whereas formulations with epinephrine 1:100,000 had 40% to 45% market shares. Articaine, with market shares between 38% and 81%, was also the preferred anesthetic agent in various other countries, with the notable exceptions of the United Kingdom and the United States, where lidocaine was the preferred local anesthetic agent. Epinephrine was the preferred vasoconstrictor internationally, similar to Germany. The larger market share of higher concentrated epinephrine 1:100,000 was remarkable, considering the increasing number of medically compromised patients. Increased consideration for using agents with reduced dosages of epinephrine (1:200,000) is generally recommended.

PMID:33827123 | DOI:10.2344/anpr-67-03-12

Eur Neurol. 2021 Apr 7:1-6. doi: 10.1159/000514828. Online ahead of print.

ABSTRACT

INTRODUCTION: The primary aim of the present study was to evaluate the long-term efficacy of fingolimod in patients with multiple sclerosis (MS); secondary aims were to describe the safety of fingolimod with the evaluation of treatment satisfaction and impact on the quality of life in real life.

METHODS: We collected clinical, demographical, neuroradiological, and treatment data, including pre- and posttreatment status health-related quality of life from 286 MS patients consecutively treated with fingolimod. Clinical assessment was based on the Expanded Disability Status Scale (EDSS), and quality of life assessment was performed with MS-related quality of life inventory (MSQOLI). The data were recorded at baseline and every 6 months for 2 years.

RESULTS: One hundred and fourteen males and 172 females were enrolled. The annualized relapse rate and EDSS showed a statistically significant reduction during the observation period (p < 0.001). The patients also demonstrated substantial improvements in magnetic resonance imaging (MRI) outcomes (p < 0.001). Health-related quality of life scores improved significantly between baseline and 24-month visit (p < 0.001). No serious adverse events occurred.

CONCLUSION: In our cohort, fingolimod treatment was associated with reduced relapse, MRI activity, and improved EDSS and MSQOLI scores. Additionally, fingolimod has been able to maintain its effectiveness over a considerable long period of treatment.

PMID:33827097 | DOI:10.1159/000514828

Med Princ Pract. 2021 Apr 7. doi: 10.1159/000516342. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this retrospective study was to investigate the effect of photobiomodulation therapy on postoperative pain provoked by thermal stimulation in direct pulp capping.

SUBJECT AND METHODS: A retrospective study was performed using the records of patients who received direct pulp capping using mineral trioxide aggregate. Teeth irradiated with a laser were assigned as the photobiomodulation therapy group and non-irradiated teeth were considered as the control group. Before treatment and 6 hours, 1 day and 7 days after treatment, tooth sensitivity to a cold stimulus was recorded using a visual analog scale.

RESULTS: From a total of 123 documented direct pulp capping procedures, only 72 directly capped permanent teeth met the inclusion criteria. Age, gender, and tooth location were comparable between the groups. A statistically significant difference was found in sensitivity to cold stimulus between groups on day 7 (p=.007), but no difference was found at the preoperative, 6 hour, and day 1 time points (p=.055, p=.132, p=.100, respectively). In the intragroup evaluation, a significantly greater decrease was detected in the photobiomodulation therapy group compared to the control group, although both groups showed a reduction in discomfort throughout the follow-up period (p=.000).

CONCLUSION: Photobiomodulation therapy is an effective method for enhancing patient comfort by reducing thermal sensitivity following direct pulp capping procedures.

PMID:33827095 | DOI:10.1159/000516342