Nevin Manimala

Am J Perinatol. 2021 Dec 2. doi: 10.1055/s-0041-1740212. Online ahead of print.

ABSTRACT

OBJECTIVE: The primary objective of this study was to evaluate coronavirus 2019 (COVID-19) pandemic-related changes in the antenatal utilization of high-risk obstetric services. Our secondary objective was to characterize change in stillbirth rate during the pandemic.

STUDY DESIGN: This is a retrospective, observational study performed at a single, tertiary care center. Maternal-Fetal Medicine (MFM) visits, ultrasounds, and antenatal tests of fetal well-being during the pandemic epoch (2020), which spans the first 12 weeks of the year to include pandemic onset and implementation of mitigation efforts, were compared with the same epoch of the three preceding years visually and using general linear models to account for week and year effect. An analysis of stillbirth rate comparing the pandemic time period to prepandemic was also performed.

RESULTS: While there were decreased MFM visits and antenatal tests of fetal well-being during the pandemic epoch compared with prepandemic epochs, only the decrease in MFM visits by year was statistically significant (p < 0.001). The stillbirth rate during the pandemic epoch was not significantly different when compared with the prepandemic period and accounting for both week (p = 0.286) and year (p = 0.643) effect.

CONCLUSION: The COVID-19 pandemic resulted in a significant decrease in MFM visits, whereas obstetric ultrasounds and antenatal tests of fetal well-being remained unchanged. While we observed no change in the stillbirth rate compared with the prepandemic epoch, our study design and sample size preclude us from making assumptions of association. Our findings may support future work investigating how changes in prenatal care for high-risk obstetric patients influence perinatal outcomes.

KEY POINTS: · MFM visits significantly decreased during the COVID-19 pandemic epoch.. · The overall stillbirth rate during the COVID-19 pandemic epoch was not significantly changed.. · Larger studies are needed to capitalize on these changes to evaluate rare outcomes such as stillbirth..

PMID:34856612 | DOI:10.1055/s-0041-1740212

Med Sci Sports Exerc. 2021 Nov 29. doi: 10.1249/MSS.0000000000002833. Online ahead of print.

ABSTRACT

INTRODUCTION: Existing predictive equations underestimate the metabolic costs of heavy military load carriage. Metabolic costs are specific to each type of military equipment and backpack loads often impose the most sustained burden on the dismounted warfighter.

PURPOSE: Develop and validate an equation for estimating metabolic rates during heavy backpacking for the US Army Load Carriage Decision Aid (LCDA); an integrated software mission planning tool.

METHODS: Thirty healthy, active military-age adults (3 women, 27 men; age, 25 ± 7 years old; height, 1.74 ± 0.07 m; body mass, 77 ± 15 kg) walked for 6-21 min while carrying backpacks loaded up to 66% body mass at speeds between 0.45 and 1.97 m·s-1. A new predictive model, the LCDA backpacking equation, was developed on metabolic rate data calculated from indirect calorimetry. Model estimation performance was evaluated internally by k-fold cross-validation and externally against seven historical reference datasets. We tested if the 90% confidence interval of the mean paired difference was within equivalence limits equal to 10% of the measured metabolic rate. Estimation accuracy and level of agreement were also evaluated by the bias and concordance correlation coefficient (CCC) respectively.

RESULTS: Estimates from the LCDA backpacking equation were statistically equivalent (p < 0.01) to metabolic rates measured in the current study (Bias, -0.01 ± 0.62; CCC, 0.965) as well as from the seven independent datasets (Bias, -0.08 ± 0.59 W·kg-1; CCC, 0.926).

CONCLUSION: The newly derived LCDA backpacking equation provides close estimates of steady-state metabolic energy expenditure during heavy load carriage. These advances enable further optimization of thermal-work strain monitoring, sports nutrition, and hydration strategies.

PMID:34856578 | DOI:10.1249/MSS.0000000000002833

Obstet Gynecol. 2021 Dec 2. doi: 10.1097/AOG.0000000000004593. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the effects of an environmentally friendly drug deactivation bag on opioid disposal among patients undergoing gynecologic surgery.

METHODS: This prospective cohort study included patients undergoing gynecologic procedures requiring an opioid prescription from March 2020 to December 2020. Patients were managed on a restrictive opioid prescribing algorithm and given an opioid disposal bag. The carbon drug deactivation bag neutralizes the opioid medication and can be discarded safely in the trash. Patients were educated about pain management goals and the disposal bag. Patients were surveyed at their postoperative visit to evaluate satisfaction, number of leftover pills, and disposal methods. Statistical analysis was performed using SPSS Statistics 26.

RESULTS: Two hundred patients were asked to complete the survey, with a response rate of 78%. The most common procedures were exploratory laparotomy (50%) and minimally invasive hysterectomy (41%). Most patients (91%, 95% CI 91-97) filled their opioid prescription and 64 (41%, 95% CI 34-48) had leftover opioid pills. Most patients with leftover opioid pills (73%, 95% CI 67-79) discarded them; 78%, 95% CI 69-80 used the disposal bag. Patients undergoing an exploratory laparotomy most commonly used the disposal bag. All patients who used the disposal bag stated they would use it again.

CONCLUSION: Despite a restrictive opioid prescribing algorithm, 41% of gynecologic surgical patients had leftover opioid pills. This study demonstrated that leftover opioid pills were safely discarded 73% of the time when patients were provided an opioid disposal bag and preoperative education.

PMID:34856576 | DOI:10.1097/AOG.0000000000004593

Obstet Gynecol. 2021 Dec 2. doi: 10.1097/AOG.0000000000004611. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the prevalence of posttraumatic stress disorder (PTSD) symptoms and identify characteristics associated with it 2 months after singleton vaginal delivery at or near term.

METHODS: We conducted an ancillary cohort study of the TRAAP (TRAnexamic Acid for Preventing postpartum hemorrhage after vaginal delivery) randomized controlled trial in 15 French hospitals in 2015-2016. Women who had singleton vaginal delivery after 35 weeks of gestation were enrolled. After randomization, characteristics of labor and delivery were prospectively collected and paid special attention to postpartum blood loss. Posttraumatic stress disorder profile and provisional diagnosis were assessed 2 months after childbirth by two self-administered questionnaires: the IES-R (Impact of Event Scale-Revised) and the TES (Traumatic Event Scale). Associations between potential risk factors and PTSD symptoms were analyzed by multivariable logistic or linear regression modeling, depending on the type of dependent variable.

RESULTS: Questionnaires were returned by 2,740 of 3,891 women for the IES-R and 2,785 of 3,891 women for the TES (70.4% and 71.6% response rate). The prevalence of PTSD symptoms was 4.9% (95% CI 4.1-5.8%; 137/2,785) with the TES, and the prevalence of PTSD provisional diagnosis was 1.6% (95% CI 1.2-2.1%; 44/2,740), with the IES-R and 0.4% (95% CI 0.2-0.8%; 9/2,080) with the TES. Characteristics associated with a higher risk of PTSD in multivariable analysis were vulnerability factors – notably migrant status and history of psychiatric disorder (adjusted odds ratio [aOR] 2.7 95% CI 1.4-5.2) – and obstetric factors – notably induced labor (aOR 1.5 95% CI 1.0-2.2), being labor longer than 6 hours (aOR 1.7 95% CI 1.1-2.5), postpartum hemorrhage of 1,000 mL or more (aOR 2.0 95% CI 1.0-4.2), and bad memories of delivery at day 2 postpartum (aOR 4.5 95% CI 2.4-8.3) as assessed with the IES-R. Results were similar with the TES.

CONCLUSION: Approximately 1 of 20 women with vaginal delivery have PTSD symptoms at 2 months postpartum. History of psychiatric disorder, postpartum hemorrhage, and bad memories of deliveries at day 2 were the main factors associated with a PTSD profile.

PMID:34856568 | DOI:10.1097/AOG.0000000000004611

J Pediatr Gastroenterol Nutr. 2021 Dec 1. doi: 10.1097/MPG.0000000000003362. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of our study was to assess the response to hepatitis B virus (HBV) vaccination and risk of HBV infection in patients with celiac disease (CD).

PATIENTS AND METHODS: We performed a cross-sectional study using the National Health and Nutrition Examination Survey (NHANES) database (2009-2014) to assess the rate of HBV vaccination, immune response, and HBV infection risk in patients with and without CD. We also determined the rate of HBV infection via retrospective analysis of 2 cohorts: 1) patients seen at Mayo Clinic (1998-2021), and 2) a stable longitudinally observed cohort, the Rochester Epidemiology Project (REP; 2010-2020).

RESULTS: Based on the NHANES data, the rate of HBV infection in the US was 0.33% (95% CI, 0.25%-0.41%). Of 93 patients with CD, 46 (49%) were vaccinated for HBV and of the remaining 19,422 without CD, 10,228 (53%) were vaccinated. Twenty-two (48%) vaccinated patients with CD had HBV immunity and 4,405 (43.07%) vaccinated patients without CD had HBV immunity, which was not statistically different. In NHANES data there were no cases of HBV infection in patients with CD. During the study period, 3,568 patients with CD were seen at Mayo Clinic and 3,918 patients with CD were identified using the REP database. Of those patients with CD, only 4 (0.11%) at Mayo Clinic and 9 (0.23%) of the REP patients had HBV infection.

CONCLUSION: The rate of HBV vaccination and immunity were similar in individuals with and without CD. Predictably, no increased risk of HBV infection was detected in CD patients. These results do not support screening and revaccination practice for HBV immunity in patients with CD within the US.

PMID:34856564 | DOI:10.1097/MPG.0000000000003362

Obstet Gynecol. 2021 Dec 2. doi: 10.1097/AOG.0000000000004626. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the prospective risk of stillbirth between women with and without a stillbirth in their first pregnancy.

METHODS: We conducted a cohort study using perinatal data from Finland, Malta, and Scotland. Women who had at least two singleton deliveries were included. The exposed and unexposed cohorts comprised women with a stillbirth and live birth in their first pregnancy, respectively. The risk of stillbirth in any subsequent pregnancy was assessed using a Cox proportional hazards model. Time-to-event analyses were conducted to investigate whether first pregnancy outcome had an effect on time to or the number of pregnancies preceding subsequent stillbirth.

RESULTS: The pooled data set included 1,064,564 women, 6,288 (0.59%) with a stillbirth and 1,058,276 with a live birth in a first pregnancy. Compared with women with a live birth, women with a stillbirth in the first pregnancy were more likely to have a subsequent stillbirth (adjusted hazard ratio [aHR] 2.25, 95% CI 1.86-2.72). For women with more than two pregnancies, the difference in risk of subsequent stillbirth between the two groups increased with the number of subsequent pregnancies. Maternal age younger than 25 years or 40 years and older, smoking, low socioeconomic status, not having a partner, pre-existing diabetes, preeclampsia, placental abruption, or delivery of a growth-restricted neonate in a first pregnancy were independently associated with subsequent stillbirth. Compared with women with a live birth in the first pregnancy, women with a stillbirth were more likely to have another pregnancy within 1 year. The absolute risk of stillbirth in a subsequent pregnancy for women with stillbirth and live birth in a first pregnancy were 2.5% and 0.5%, respectively.

CONCLUSION: Compared with women with a live birth in a first pregnancy, women with a stillbirth have a higher risk of subsequent stillbirth irrespective of the number and sequence of the pregnancies. Despite high relative risk, the absolute risk of recurrence was low.

PMID:34856561 | DOI:10.1097/AOG.0000000000004626

Cerebrovasc Dis. 2021 Dec 2:1-9. doi: 10.1159/000520052. Online ahead of print.

ABSTRACT

INTRODUCTION: Serum potassium abnormality is a risk factor of incident stroke, but whether it is associated with recurrent stroke in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA) remains unknown. This study aimed to investigate the association of serum potassium with the risk of recurrent stroke in patients with AIS or TIA.

METHODS: We included 12,425 patients from the China National Stroke Registry III. Patients were classified into 3 groups according to tertiles of potassium. The outcomes were recurrence of stroke and combined vascular events at 1 year. Cox proportional hazards regression was adopted to explore the associations by calculating hazard ratios (HRs) and their 95% confidence intervals (CIs).

RESULTS: Among 12,425 enrolled patients, the median (interquartile range) of potassium was 3.92 (3.68-4.19) mmol/L. Compared with the highest tertile, after adjusted for confounding factors, the lowest tertile potassium was associated with increased risk of recurrent stroke at 1 year. The adjusted HR with 95% CI was 1.21 (1.04-1.41). There was an independent, linear association between serum potassium and stroke recurrence. Per 1 mmol/L decrease of potassium was associated with 19% higher risk of recurrent stroke (HR, 1.19; 95% CI, 1.04-1.37). Similar trends were found in ischemic stroke and combined vascular events.

CONCLUSIONS: Lower serum potassium level was independently associated with elevated risk of recurrent stroke in patients with AIS or TIA. The finding suggested that monitoring serum potassium may help physicians to identify patients at high risk of recurrent stroke and to stratify risk for optimal management.

PMID:34856549 | DOI:10.1159/000520052

J Clin Anesth. 2021 Nov 29;77:110614. doi: 10.1016/j.jclinane.2021.110614. Online ahead of print.

ABSTRACT

STUDY OBJECTIVE: Oxidative stress plays a pivotal role in the development and aggravation of cardiovascular diseases. The influence of intraoperative inspired oxygen concentrations on oxidative stress is still not entirely known. Therefore, we evaluated in this sub-study if supplemental oxygen affects the oxidation-reduction potential in patients at-risk for cardiovascular complications undergoing moderate- to high-risk major abdominal surgery.

DESIGN: Sub-study of a prospective parallel-arm double-blinded single-center superiority randomized trial.

SETTING: Operating room and postoperative recovery area.

INTERVENTION: Administration of 0.8 FiO₂ versus 0.3 FiO₂ throughout surgery and for the first two postoperative hours.

MEASUREMENTS: The primary outcome was the static oxidation-reduction potential (sORP) and the oxidation-reduction potential capacity (cORP) between both groups. The secondary outcome was the trend of sORP and cORP in the overall study population. We assessed sORP and cORP before induction of anesthesia, 2 h after induction of anesthesia, within 2 h after surgery and on the first and third postoperative day.

MAIN RESULTS: 258 patients were analyzed. 128 patients were randomly assigned to the 80% oxygen group and 130 patients were randomly assigned to the 30% oxygen group. Postoperative sORP values did not differ significantly between the 80% and 30% oxygen group (effect estimate: -1.162 mV,95% CI: -2.584 to 0.260; p = 0.109). On average, we observed a change in sORP of 5.288 mV (95% CI:4.633 to 5.913, p < 0.001) per day. cORP values did not differ significantly between the 80% and 30% oxygen group (effect estimate: -0.015μC, (95%CI: -0.062 to 0.032; p = 0.524). On average, we observed a change in cORP values of -0.170μC (95%CI: -0.194 to -0.147, p < 0.001) per day.

CONCLUSION: In contrast to previous reports, we could not find any evidence of an association between intraoperative supplemental oxygen and perioperative oxidative stress assessed by sORP and cORP.

TRIAL REGISTRATION: clinicaltrials.gov: NCT03366857https://clinicaltrials.gov/ct2/show/NCT03366857?term=vienna&cond=oxygen&draw=2&rank=1.

PMID:34856530 | DOI:10.1016/j.jclinane.2021.110614

Forensic Sci Int. 2021 Nov 12;330:111100. doi: 10.1016/j.forsciint.2021.111100. Online ahead of print.

ABSTRACT

This work evaluated the accuracy of 3D models generated by a DJI Mavic Pro drone with 3DF Zephyr software photogrammetry. The models were compared to models generated by a Trimble X7 laser scanner. The tests were performed in the outdoor area of a vehicle parking inbound to simulate the characteristics of a crime scene. Ground control points (GCPs) were distributed in ten positions within the surroundings. In manual flight, the drone performed nadiral photographs from one side to the other side and with an elliptical 45° center pointed. Three altitudes where tested: 10 m, 20 m and 40 m. The Trimble X7 laser scanner performed six scans and generated one set of point clouds. Drone photogrammetry returned eligible data for distances of 20 m and 40 m with errors of ~0.25 mm. To increase the overlay in the photogrammetry procedure, all photographs from distances of 10-40 m were processed, returning an error of ~0.53 mm. The results of the measured distances, which were manually picked from the GCPs, from the 3D-scanned model and photogrammetric 3D models were then statistically analyzed. The Trimble X7 laser scanner showed an average error of 3 cm, which was approximately equivalent to the results obtained with all images or when using a known scale value for the drone photographs, presenting no significant differences among the evaluated methods.

PMID:34856522 | DOI:10.1016/j.forsciint.2021.111100

J Reprod Immunol. 2021 Nov 23;149:103454. doi: 10.1016/j.jri.2021.103454. Online ahead of print.

ABSTRACT

The over expression of Indoleamine 2, 3-Dioxygenase (IDO1), an immune checkpoint inhibitor, is well known in cervical cancer. However, its association with chemokine signals promoting cellular infiltration in the cervical tumor microenvironment, is unknown. In the current study, we evaluated the expression and enzymatic activity of IDO1. We also profiled the expression of chemokine ligand-receptors- CCR4-CCL22, CXCR3-CXCL10, CXCR4-CXCL12, and CCR7-CCL19 using immunohistochemistry (IHC), and studied their association with IDO1, statistically. After getting an informed consent, punch biopsy samples were obtained from 105 patients diagnosed with cervical cancer. HPV typing by Sanger sequencing, realtime PCR for quantifying IDO1 mRNA expression, HPLC for determining the K/T ratio and IHC for all the above chemokine receptor-ligand pairs along with IDO1 were performed. We found a significant increase in the expression of IDO1 and K/T levels in early and locally advanced stages when compared to Stage IV disease. Among the chemokine ligand -receptor pairs profiled, we found that high CCL19 marker expression was a good prognostic indicator of patients’ disease-free (p = 0.013) and overall survival (p = 0.043). Although we could not identify IDO1 as an independent prognostic factor, we found that high levels of IDO1 expression may further reduce survival outcomes in patients with low CCL19 expression. This could be vital for designing immuno therapeutic interventions targeting IDO1.

PMID:34856521 | DOI:10.1016/j.jri.2021.103454