Nevin Manimala

J Neurol Surg A Cent Eur Neurosurg. 2021 Nov 16. doi: 10.1055/a-1698-6384. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective study.

OBJECTIVES: The interlaminar window is the most important anatomical corridor for posterior approach of lumbar procedures. Three-dimensional (3D) reconstruction of the L5-S1 interlaminar window may benefit the accurate measurement and assessment of surgical considerations. The aim of this study was to measure surgical relevant parameters of the L5-S1 interlaminar window based on 3D reconstruction of lumbar CTs.

METHODS: 50 thin-layer CT data were retrospectively collected, segmented, and reconstructed. Surgical relevant parameters included the width, left height, right height, interpedicular distance, area, and operable area of the L5-S1 interlaminar window. Morphological measurements were performed independently by two experienced experts. Patients with radiologic abnormalities at L5-S1 level were regarded as group A (n=28), while those without L5-S1 disc herniation were regarded as group B (n=22).

RESULTS: The average left height, right height, width, and area of the L5-S1 interlaminar window were 9.14±2.45mm, 9.55±2.56mm, 23.55±4.91mm, and 144.57±57.05mm2. The average interpedicular distance (IPD) at superior, middle, and inferior pedicle level were 29.29±3.39mm, 27.96±3.38mm and 37.46±4.23mm, with significant differences among these three parameters (P<0.05). The average operable areas of the L5-S1 interlaminar window were: left-axilla 24.52±15.91mm2, left-shoulder 27.14±15.48mm2, right-axilla 29.95±17.17mm2, and right-shoulder 31.12±16.40mm2 (P>0.05). There were no significant differences between group A and B in these parameters (P>0.05), except the inferior IPD (36.69±3.73mm vs 39.23±3.01mm, P=0.017<0.05).

CONCLUSION: The morphological measurement of the L5-S1 interlaminar window based on 3D reconstruction provided accurate and reliable reference data for epidural puncture approach and posterior approach of lumbar surgery. Moreover, it could also assist the placement of endoscopic working channel in percutaneous endoscopic interlaminar discectomy (PEID) and might be useful for further studies of anatomical and surgical consideration of unilateral biportal endoscopic spinal surgery (UBE) procedures. Key words: Interlaminar window; percutaneous endoscopic interlaminar discectomy (PEID); unilateral biportal endoscopy spinal surgery (UBE); 3D reconstruction.

PMID:34784623 | DOI:10.1055/a-1698-6384

Am J Perinatol. 2021 Nov 16. doi: 10.1055/s-0041-1739493. Online ahead of print.

ABSTRACT

BACKGROUND: Prior cesarean delivery is a well-known risk factor for placenta accreta spectrum disorders. While primary cesarean section is unavoidable in some patients, in others it may not be clearly indicated.

OBJECTIVE: The aim of the study is to determine the proportion of patients with placenta accreta spectrum who had a potentially preventable primary cesarean section and to identify factors associated with preventable placenta accreta spectrum.

STUDY DESIGN: This was a single-center retrospective cohort study of women with pathology-confirmed placenta accreta spectrum from 2007 to 2019. Primary cesarean sections were categorized as potentially preventable or unpreventable based on practice consistent with the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine “Safe Prevention of the Primary Cesarean Delivery” recommendations. Fisher’s exact test and Mann-Whitney U-test were used for comparison with p <0.05 considered statistically significant.

RESULTS: Seventy-two patients had pathology-confirmed placenta accreta spectrum over the course of the study period, 15 (20.8%) of whom required a cesarean hysterectomy at the time of primary cesarean section. Fifty-seven patients had placenta accreta spectrum in a pregnancy following their primary cesarean section. Of these, 29 (50.9%) were considered potentially preventable. Most were performed without clear medical indication (37.9%) or for fetal malpresentation without attempted external cephalic version (37.9%). The remainder were due to arrest of labor not meeting criteria (17.2%) and abnormal or indeterminate fetal heart patterns with documented recovery (6.9%). Of the 11 patients without clear medical indication for primary cesarean section, eight (72.7%) were patient-choice cesarean sections and three (27.3%) were for suspected fetal macrosomia with estimated fetal weights not meeting criteria for cesarean delivery. There was no difference in the incidence of potentially preventable primary cesarean sections before and after the ACOG-SMFM “Safe Prevention of the Primary Cesarean Delivery” publication (48.8 vs. 57.1%, p = 0.59). Privately insured patients were more likely to have a potentially preventable primary cesarean section than those with Medicaid (62.5 vs. 23.5%, p = 0.008) and were more likely to have a primary cesarean section without clear medical indication (81.8 vs. 18.2%, p = 0.004).

CONCLUSION: Many patients with placenta accreta spectrum had a potentially preventable primary cesarean section. Most were performed without clear medical indication or for malpresentation without attempted external cephalic version, suggesting that at least a subset of placenta accreta spectrum cases may be preventable. This was particularly true for privately insured patients. These findings call for continued investigation of potentially preventable primary cesarean sections with initiatives to address concerns at the patient, provider, and hospital level.

KEY POINTS: · Many patients with placenta accreta spectrum have potentially preventable primary cesarean sections.. · Privately insured patients are more likely to have potentially preventable primary cesarean sections.. · Our findings suggest that at least a subset of placenta accreta spectrum cases may be preventable..

PMID:34784619 | DOI:10.1055/s-0041-1739493

Am J Perinatol. 2021 Nov 16. doi: 10.1055/s-0041-1739356. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of our study is to determine if human immunodeficiency virus (HIV)-positive pregnant patients have a higher rate of group B streptococcus (GBS) rectovaginal colonization compared with HIV-negative pregnant patients.

METHODS: Our study is a multi-site retrospective study performed at Ochsner Louisiana State University-Health Shreveport and Monroe campuses including patients who delivered between December 2011and June 2019. Rates of GBS rectovaginal colonization between HIV-positive pregnant patients were compared with a control group of HIV-negative patients. The control group was age and race matched in a 2:1 fashion. The primary outcome was to investigate rates of GBS rectovaginal colonization. Secondary outcomes included GBS culture antibiotic sensitivities, presence of GBS urinary tract infection, GBS positivity based on HIV viral load, and GBS positivity based on new vs established diagnosis of HIV. Continuous data were analyzed using an unpaired t-test, and categorical data were analyzed using a Chi-squared test. The probability level of <0.05 was set as statistically significant.

RESULTS: A total of 225 patients were included in the final analysis, 75 HIV-positive and 150 HIV-negative controls. Demographic differences were noted. HIV-positive patients were more likely to deliver preterm and were more likely to deliver via cesarean section. Our primary outcome showed no significant differences in incidence of GBS colonization between HIV-positive patients and control group (n = 31, 41.3% vs n = 46, 30.6%, p = 0.136). Antibiotic resistance patterns showed no significant difference between the two groups. There were no significant differences in GBS positivity based on HIV viral load.

CONCLUSION: Our study does not show a statistically significant difference in the incidence of GBS colonization between HIV-positive patients and HIV-negative controls.

KEY POINTS: · HIV-positive pregnant patients do not have an increased risk of GBS rectovaginal colonization.. · HIV-positive pregnant patients have similar rates of GBS colonization regardless of viral load.. · GBS antibiotic sensitivities are similar in HIV-positive and HIV-negative pregnant patients..

PMID:34784616 | DOI:10.1055/s-0041-1739356

Am J Perinatol. 2021 Nov 16. doi: 10.1055/s-0041-1740014. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of the study is to compare perinatal outcomes for women with greater social needs, as identified by the Community Health Needs Assessment, to those of women living in other areas of the county.

STUDY DESIGN: This was a retrospective cohort study of pregnant women delivering at a large inner-city county hospital. Perinatal outcomes were analyzed for women living within a target area with substantial health disparities and social needs, and compared with those women living outside the target area. Statistical analysis included student’s t-test, Chi square, and logistic regression.

RESULTS: Between January 2015 and July 2020, 66,936 women delivered at Parkland hospital. Of these, 7,585 (11%) resided within the target area. These women were younger (26.8 ± 6.5 vs. 27.9 ± 6.4 years, p < 0.001), more likely to be black (37 vs. 13%, p < 0.001), and had a higher body mass index or BMI (33.3 ± 7.0 vs. 32.6 ± 6.4 kg/m², p < 0.001). All women were likely to access prenatal care, with 7,320 (96.5%) in the target area and 57,677 (97.2%) outside the area attending at least one visit. Adverse perinatal outcomes were increased for women living within the target area, which persisted after adjustment for age, race, and BMI. This included an increased risk of preeclampsia (adjusted risk ratio [aRR] 1.1, 95% confidence interval or CI [1.03, 1.2]) and abruption (aRR 1.3, 95% CI [1.1, 1.7]), as well as preterm birth before both 34 weeks (aRR 1.3, 95% CI [1.2, 1.5]) and 28 weeks (aRR 1.3, 95% CI [1.02,1.7]). It follows that neonatal ICU admission (aRR 2.1, 95% CI [1.3, 3.4]) and neonatal death (aRR 1.2, 95% CI [1.1, 1.3]) were increased within the target area. Interestingly, rate of postpartum visit attendance was higher in the target area (57 vs. 48%), p < 0.001.

CONCLUSION: Even among vulnerable populations, women in areas with worse health disparities and social needs are at greater risk of adverse perinatal outcomes. Efforts to achieve health equity will need to address social disparities.

KEY POINTS: · At a county hospital, 97% of women accessed prenatal care.. · Greater social needs were associated with adverse perinatal outcomes.. · Differences persisted with adjustment for age, race, and BMI..

PMID:34784613 | DOI:10.1055/s-0041-1740014

Chemotherapy. 2021 Nov 16:1-11. doi: 10.1159/000519615. Online ahead of print.

ABSTRACT

AIM: The optimal number of neoadjuvant chemotherapy (NACT) cycles is unclear in epithelial ovarian cancer. Our study aimed to evaluate the effect of the number of NACT cycles before interval debulking surgery on survival.

METHODS: Data of 221 patients with advanced-stage serous epithelial ovarian cancer (EOC) were retrospectively evaluated. The patients were divided into groups as who received 3 cycles of NACT (group A), 4-5 cycles of NACT (group B), and 6 cycles of NACT (group C).

RESULTS: There were 67 (30%) patients in group A, 70 (32%) in group B, and 84 (38%) in group C. Median overall survival (OS) was 61 (range 43-79) months for group A, 44 (range 36-52) months for group B, and 39 (range 27-50) months for group C. In addition, median disease-free survival (DFS) was 23.1 (range 8.5-32.1) months for group A, 19.2 (range 10.1-28.4) months for group B, and 21.5 (range 16-27) months for group C. Patients receiving >3 NACT cycles had worse OS than patients who received 3 NACT cycles (for group A vs. B, p = 0.018; for group A vs. C, p = 0.049). However, in terms of DFS, patients receiving 3 NACT cycles had no statistically significant difference compared to patients who received >3 NACT cycles.

CONCLUSIONS: Patients with advanced-stage serous EOC who received more than 3 cycles of NACT had poor OS. However, there was no statistical difference in terms of DFS. In addition, >3 cycles of NACT did not increase the probability of achieving complete cytoreduction at the time of surgery.

PMID:34784598 | DOI:10.1159/000519615

Cardiorenal Med. 2021 Nov 16:1-6. doi: 10.1159/000519661. Online ahead of print.

ABSTRACT

BACKGROUND: β-Blockers are the most frequently prescribed cardioprotective drugs in hemodialysis (HD) patients, despite their weak evidence. We sought to evaluate the effects of β-blockers on vascular refilling during HD treatments and examine whether carvedilol, for being noncardioselective and poorly dialyzable, associates more impact than others.

METHODS: The study was performed in a cohort of maintenance HD patients from a tertiary center. All patients had previous β-blocker prescription. We conducted a prospective crossover study and measured vascular refilling volume (Vref) and vascular refilling fraction (Fref) in 2 circumstances: under β-blocker treatment (βb profile) and without β-blocker effect (non-βb profile).

RESULTS: Twenty patients were included, 10 of whom were treated with carvedilol. Predialysis values were comparable between the 2 profiles. Although the βb profile showed lower Vref and higher ABV drop, these differences did not reach statistical significance. Data showed an increase in Fref in the non-βb profile (70.01 ± 6.80% vs. 63.14 ± 11.65%; p = 0.015). The βb profile associated a significantly higher risk of intradialytic hypotension (IDH) (risk ratio 2.40; 95% CI: 1.04-5.55). When analyzing separately the carvedilol group, patients dialyzed under drug effect experienced a significant impairment in Vref, Fref, and refilling rate.

CONCLUSIONS: Administering β-blockers before HD associated a higher risk of IDH and a decrease in Fref. Patients dialyzed under carvedilol effect showed an impaired refilling, probably related to its noncardioselectivity and lower dializability.

PMID:34784588 | DOI:10.1159/000519661

Eur J Cancer. 2021 Nov 13;159:237-246. doi: 10.1016/j.ejca.2021.10.015. Online ahead of print.

ABSTRACT

BACKGROUND: Enzalutamide combined with androgen deprivation therapy (ADT) significantly prolonged metastasis-free survival and overall survival (OS) versus ADT alone in patients with non-metastatic castration-resistant prostate cancer (nmCRPC) with rapidly rising prostate-specific antigen (PSA). The objective of this post hoc analysis of the PROSPER trial is to evaluate OS benefit and safety of enzalutamide in patients across age and regional subgroups.

PATIENTS AND METHODS: Eligible men with nmCRPC, PSA doubling time ≤10 months and PSA ≥2 ng/mL with continued ADT use were randomised 2:1 to enzalutamide 160 mg or placebo. OS and safety were examined by age (<70 vs ≥70 years) and region (North America, Europe, Asia or the rest of the world). The impact of prior and subsequent therapy was also examined.

RESULTS: In total, 1401 men were enrolled (median age, 74 years). Enzalutamide plus ADT reduced the risk of death, independent of age or region. Multivariate analyses identified Eastern Cooperative Oncology Group (ECOG) status (P < 0.0001), log (PSA; P = 0.0002) and subsequent therapy (P < 0.0001) as statistically significant factors impacting OS. Safety was consistent across age and regional subgroups. Any grade treatment-emergent adverse events were similar across age groups, were more common in the placebo group and had regional variation.

CONCLUSIONS: In men with nmCRPC and rapidly rising PSA, the benefit and safety of enzalutamide were consistent across age and regional subgroups. Variables impacting OS included ECOG status, log (PSA) and subsequent therapy. CLINICALTRIALS.

GOV IDENTIFIER: NCT02003924.

PMID:34784577 | DOI:10.1016/j.ejca.2021.10.015

Midwifery. 2021 Oct 28;104:103185. doi: 10.1016/j.midw.2021.103185. Online ahead of print.

ABSTRACT

OBJECTIVE: Adherence to iron and folic acid supplementation represents a significant factor contributing to the prevention and treatment of anaemia in pregnancy. However, limited studies have systematically investigated iron and folic acid supplementation adherence among pregnant mothers using a global perspective. We aimed to systematically identify iron and folic acid supplementation adherence and associated factors among pregnant women.

DESIGN: For this systematic review and meta-analysis, we did a systematic search of Academic Search Complete, CINAHL, MEDLINE, PubMed, and Web of Science from inception to October 20, 2020. We included all cohort, case-control, and cross-sectional studies and used the Joanna Briggs Institute tool to assess study quality. A meta-analysis was performed to synthesise the pooled odds ratio for iron and folic acid supplementation adherence using a random-effects model. Heterogeneity was measured using the I² statistic, and Egger’s test was used to assess publication bias.

MEASUREMENTS AND FINDINGS: Eighteen studies were included in systematic review and meta-analysis, including a total of 5,537 pregnant women. The pooled odds ratio for iron and folic acid supplementation adherence in primipara vs multipara, anaemia vs non-anaemia, knowledgeable vs limited knowledge of anaemia, and knowledgeable vs limited knowledge of iron and folic acid supplementation were 3.91 (95% confidence interval: 1.75-8.75), 1.09 (95% confidence interval: 0.67-1.77), 0.32 (95% confidence interval: 0.15-0.69), and 2.48 (95% confidence interval: 1.13-5.47), respectively.

KEY CONCLUSIONS: This review yielded evidence that having one pregnancy, having anaemia, and having satisfactory knowledge of both anaemia and iron and folic acid supplementation were positively associated with iron and folic acid supplementation adherence.

PMID:34784576 | DOI:10.1016/j.midw.2021.103185

Poult Sci. 2021 Oct 13;101(1):101536. doi: 10.1016/j.psj.2021.101536. Online ahead of print.

ABSTRACT

Florfenicol is a broad-spectrum antibacterial drug used in the treatment of farm animals, including poultry. This drug is poorly soluble in water, therefore, administration in drinking water may lead to high variability of concentrations in treated individuals. The use of injection preparations, however, requires individual administration and may have a negative effect on the quality of the carcass. In addition, the renal portal system in birds may reduce the bioavailability of the drug administered in the caudofemoral region of the body. The aim of this study was to compare the pharmacokinetics of florfenicol in turkeys after a single intravenous, intramuscular, and subcutaneous administration at a dose of 15 mg/kg body weight. Additionally, to evaluate the effect of renal portal system on drug kinetics, the intramuscular administration was divided into pectoral and caudofemoral administration. The study showed that the area under the concentration-time curve (AUC) was similar regardless of the route of administration. The mean values for clearance and volume of distribution were 0.33 L/kg/h and 0.92 L/kg, respectively. The mean residence time (MRT) was 2.87 h for an intravenous bolus, while for the extravascular administrations it was approx. 5.5 h. The elimination half-life was approx. 4 h regardless of the route of administration. The maximum plasma concentration did not differ statistically between intramuscular (approx. 6.8 mg/L) and subcutaneous (8.2 mg/L) administrations, while the time to appear for this concentration was the longest for caudofemoral administration (1.5 h). The bioavailability was 88.64% for subcutaneous administration, 77.95% for pectoral administration and 85.30% for caudofemoral administration. Overall, all 3 routes of extravascular administration allowed for efficient drug absorption. There was no evidence of an influence of the renal portal system on the kinetic parameters of the drug administered to the lower extremities of the body.

PMID:34784513 | DOI:10.1016/j.psj.2021.101536

Oral Oncol. 2021 Nov 13;123:105629. doi: 10.1016/j.oraloncology.2021.105629. Online ahead of print.

ABSTRACT

OBJECTIVES: We aimed to evaluate the clinical value of an entire-circumferential intraoperative frozen section analysis (e-IFSA) for the complete resection of superficial squamous cell carcinoma (SCC) of the tongue.

MATERIALS AND METHODS: A total 276 specimens from 51 patients with pT1-2, N0, mucosal or submucosal invasion SCC were analyzed to evaluate the diagnostic accuracy of the e-IFSA and the added value of the e-IFSA to iodine staining. The e-IFSA results were compared with the final histologic results obtained using permanent sections. All specimens for the e-IFSA were taken over the entire circumference 5 mm outside from the iodine unstained areas. The outline of the main resected specimen after taking these outer mucosal specimens were defined as the surgical margins determined by iodine staining alone.

RESULTS: The e-IFSA results were in excellent agreement with final histological results (Cohen’s kappa value: 0.85) and the e-IFSA showed high sensitivity (100%) and high negative predictive value (100%). The actual complete resection rate with an e-IFSA was 100% (51/51), and no patient required additional resection after surgery. In contrast, 10/51 patients (20%) patients showed residual atypical mucosal epithelium at or beyond the margin determined by iodine staining alone; this difference was statistically significant (P = 0.002). The 5-year local control rate and 5-year overall survival rate after this procedure were both 100%.

CONCLUSION: An e-IFSA has additional value when performed in conjunction with iodine staining. An e-IFSA would be useful for achieving complete resection of superficial SCC of the tongue.

PMID:34784507 | DOI:10.1016/j.oraloncology.2021.105629