Nevin Manimala

Psychiatr Pol. 2020 Dec 31;54(6):1091-1107. doi: 10.12740/PP/OnlineFirst/111932. Epub 2020 Dec 31.

ABSTRACT

OBJECTIVES: The objective of the study was to evaluate the prevalence and severity of anxiety and depression in patients with primary hyperparathyroidism (PHPT), and to determine a relationship between the severity of these disorders and the serum calcium ion and parathyroid hormone level, as well as to evaluate the usefulness of self-rating scales in screening for depressive disorders in PHPT patients.

METHODS: Using the 17-item Hamilton Depression Rating Scale (HAM-D), Beck Depression Inventory-II (BDI-II) and Hospital Anxiety and Depression Scale (HADS), study was performed on a group of 101 patients with PHPT. A control group included 50 patients diagnosed with non-toxic thyroid goiter.

RESULTS: The HAM-D indicated higher prevalence and severity of depressive symptoms in the whole population of patients and in women with PHPT. Such a relationship was not observed in men. The BDI-II indicated higher prevalence and severity of depressive symptoms in the whole population of patients and in women with PHPT. Such a relationship was not observed in men. The HADS did not show significant differences in the prevalence of depressive and anxiety symptoms between the study and control groups in the whole population and after taking into account the gender division.

CONCLUSIONS: A relationship between PHPT and depression was confirmed. Such a relationship was not confirmed for anxiety. A relationship between the severity of depression and the serum calcium ion and parathyroid hormone level was also not confirmed. A statistically significant negative correlation between the severity of anxiety and the serum calcium ion level in the whole population of patients, and an additional positive correlation between the serum parathyroid hormone level and the severity of anxiety in women were confirmed. Self-rating tests are not sufficient for screening for depressive disorders in PHPT patients.

PMID:33740798 | DOI:10.12740/PP/OnlineFirst/111932

J Trauma Acute Care Surg. 2021 Apr 1;90(4):738-743. doi: 10.1097/TA.0000000000003062.

ABSTRACT

INTRODUCTION: As the prevalence of geriatric trauma patients has increased, protocols are being developed to address the unique requirements of this demographic. However, categorical definitions for geriatric patients vary, potentially creating confusion concerning which patients should be cared for according to geriatric-specific standards. The aim of this study was to identify data-driven cut points for mortality based on age to support implementation of age-driven guidelines.

METHODS: Adults aged 18 to 100 years with blunt or penetrating injury were selected from 95 hospitals’ trauma registries. Change point analysis techniques were used to detect inflection points in the proportion of deaths at each age. Based on these calculated points, patients were allocated into age groups, and their characteristics and outcomes were compared. Logistic regression was used to estimate risk-adjusted in-hospital mortality controlling for sex, race, Injury Severity Score, Glasgow Coma Scale, and number of comorbidities.

RESULTS: A total of 255,099 patients were identified (female, 45.7%; mean age, 59.3 years; mean Injury Severity Score, 8.69; blunt injury, 92.6%). Statistically significant increases in mortality rate were noted at ages 55, 77, and 82 years. Compared with the referent group (age, <55 years), adjusted odds ratios (AORs) showed increases in mortality if age 55 to 76 years (AOR, 2.42), age 77 to 81 years (AOR, 4.70), or age 82 years or older (AOR, 6.43). National Trauma Data Standard-defined comorbidities significantly increased once age surpassed 55 years, as the rate more than doubled for each of the older age categories (p < 0.001). As age increased, each group was more likely to be female, have dementia, sustain a ground level fall, and be discharged to a skilled nursing facility (p < 0.001).

CONCLUSION: This large multicenter analysis established a clinically and statistically significant increase in mortality at ages 55, 77, and 82 years. This research strongly suggests that trauma patients older than 55 years be considered for inclusion in geriatric trauma protocols. The other age inflection points identified (77 and 82 years) may also warrant additional specialized care considerations.

LEVEL OF EVIDENCE: Epidemiological study, level III; Care management, level IV.

PMID:33740785 | DOI:10.1097/TA.0000000000003062

J Neurosurg Pediatr. 2021 Mar 19:1-8. doi: 10.3171/2020.9.PEDS20748. Online ahead of print.

ABSTRACT

OBJECTIVE: The role of tunneling an external ventricular drain (EVD) more than the standard 5 cm for controlling device-related infections remains controversial.

METHODS: This is a randomized, double-blind, 3-arm controlled trial done in the Children’s Medical Center in Tehran, Iran. Pediatric patients (< 18 years old) with temporary hydrocephalus requiring an EVD and no evidence of CSF infection or prior EVD insertion were enrolled. Patients were randomly assigned (1:1:1) into the following arms: 5-cm (standard; group A); 10-cm (group B); or 15-cm (group C) EVD tunnel lengths. The investigators, parents, and person performing the analysis were masked. The surgeon was informed of the length of the EVD by the monitoring board just before operation. Patients were followed until the EVD’s fate was established. Infection rate and other complications related to EVDs were assessed.

RESULTS: A total of 105 patients were enrolled in three random groups (group A = 36, group B = 35, and group C = 34). The EVD was removed because there was no further need in most cases (67.6%), followed by conversion to a new EVD or ventriculoperitoneal shunt (15.2%), infection (11.4%), and spontaneous discharge without further CSF diversion requirement (5.7%). No statistical difference was found in infection rate (p = 0.47) or EVD duration (p = 0.81) between the three groups. No group reached the efficacy point sooner than the standard group (group B: hazard ratio 1.21, 95% CI 0.75-1.94, p = 0.429; group C: hazard ratio 1.03, 95% CI 0.64-1.65, p = 0.91).

CONCLUSIONS: EVD tunnel lengths of 5 cm and longer did not show a difference in the infection rate in pediatric patients. Indeed, tunneling lengths of 5 cm and greater seem to be equally effective in preventing EVD infection. Clinical trial registration no.: IRCT20160430027680N2 (IRCT.ir).

PMID:33740757 | DOI:10.3171/2020.9.PEDS20748

Knee. 2021 Mar 16;29:432-440. doi: 10.1016/j.knee.2021.01.002. Online ahead of print.

ABSTRACT

BACKGROUND: Patient user embracement involves behaviours of including and listening to the patient, appreciating their complaints, and identifying their needs, whether individual or collective. The aim of this study was to evaluate the influence of a user embracement protocol (SPIKES protocol) for patients with knee osteoarthritis (OA) immediately before intra-articular injection (IAI) relative to procedure tolerance and its effectiveness in the immediate, short and medium terms.

METHODS: This was a randomized controlled trial. Patients received IAIs with triamcinolone hexacetonide (40 mg) preceded or not by the SPIKES protocol. The outcomes measured were: visual analogue scale for pain at rest, pain on movement and joint swelling; morning stiffness; Western Ontario McMaster Universities Index Functional Questionnaire (WOMAC); pain catastrophizing scale; McGill pain questionnaire; SF-36 questionnaire on quality of life; Trace State Anxiety Inventory (IDATE); and a Timed Up and Go functional test.

RESULTS: One hundred patients were randomized in the user embracement group (n = 50) or the control group (n = 50); 89% were women and 60% white, mean age was 67.1 (±7.3) years, and mean disease time was 6.3 (±6.2) years. No statistically significant differences were found between the groups for any variables at pre-procedure time, nor did the groups differ in their tolerance to the procedure or during the 12 weeks of follow up for any evaluated variables.

CONCLUSIONS: No benefit was identified by applying a user embracement protocol to patients with knee OA prior to IAI with corticosteroid, neither to tolerance at the time of the procedure nor to its effectiveness in the immediate, short, and medium terms.

PMID:33740751 | DOI:10.1016/j.knee.2021.01.002

Respir Med. 2021 Mar 13;180:106368. doi: 10.1016/j.rmed.2021.106368. Online ahead of print.

ABSTRACT

INTRODUCTION: Pulmonary function tests (PFTs) are the main objective measures used to assess asthma in children. However, PFTs provide a global measure of lung function. Hyperpolarised xenon-129 magnetic resonance imaging (129Xe-MRI) can assess lung function spatially. This cross-sectional cohort study aimed to evaluate the use of 129Xe-MRI in detecting ventilation abnormalities in children with well-controlled severe asthma pre- and post-bronchodilator (BD).

METHOD: Six healthy children (aged 11 ± 3) and six with well-controlled severe asthma (14 ± 1) underwent spirometry, multiple breath washout (MBW), and 129Xe-MRI. These tests were repeated post-BD in the asthma cohort. Image analysis was performed in MATLAB. Wilcoxon signed-rank test, repeated measures analysis of variance (ANOVA), and Spearman’s rank correlation coefficient were used for statistical analysis.

RESULTS: A significantly higher number of ventilation defects were found in the asthma cohort pre-BD compared to the healthy participants and post-BD within the asthma cohort (p = 0.02 and 0.01). A greater number of wedge-shaped defects were detected in the asthma cohort pre-BD compared to healthy participants and post-BD within the asthma cohort (p = 0.01 and 0.008, respectively). 129Xe ventilation defect percentage (VDP) and coefficient of variation (CoV) were significantly higher in the asthma cohort pre-BD compared to the healthy cohort (p = 0.006 for both). VDP and CoV were reduced significantly post-BD in the asthma cohort, to a level where there was no longer a significant difference between the two cohorts.

CONCLUSION: 129Xe-MRI is a sensitive marker of ventilation inhomogeneity in paediatric severe asthma and may potentially be used as a biomarker to assess disease progression and therapeutic response.

PMID:33740737 | DOI:10.1016/j.rmed.2021.106368

Nurse Educ Today. 2021 Mar 11;100:104865. doi: 10.1016/j.nedt.2021.104865. Online ahead of print.

ABSTRACT

BACKGROUND: Inter Professional Education and Collaboration (IPEC) is grounded on mutual respect, enhances collaborative practice, and increases satisfaction among health care professionals.

PURPOSE: The study was conducted to assess the level of knowledge and readiness for IPEC among nursing students.

METHODS: The student’s level of knowledge was assessed using a 20 item questionnaire while their readiness for IPEC was measured using the Readiness for Interprofessional Learning Scale (RIPLS) comprising 19 items. A total of 125 nursing students participated in the study and data was analyzed using Statistical Package for the Social Sciences (SPSS) version 25 DISCUSSION: The mean level of knowledge was 44.41 with SD of 4.72. The mean readiness score was 79.09 with the SD of 11.77. There is no significant association between the knowledge and readiness of nursing students regarding IPEC and their demographic variables at 0.05 confidence level.

CONCLUSIONS: Majority of the students had moderately adequate knowledge about IPEC and high level of readiness towards IPEC. This implies that when appropriately implemented, the students will reap the benefits of IPEC, which has the potential to improve their ability to provide holistic nursing care to their patients.

PMID:33740703 | DOI:10.1016/j.nedt.2021.104865

Parkinsonism Relat Disord. 2021 Mar 13;85:52-56. doi: 10.1016/j.parkreldis.2021.03.010. Online ahead of print.

ABSTRACT

INTRODUCTION: Cognitive impairment has now been recognised to be present in patients with several of spinocerebellar ataxias (SCAs). Cognitive impairment in patients with spinocerebellar ataxia type 12 has not been evaluated.

OBJECTIVE: To evaluate the cognitive impairment in patients diagnosed with spinocerebellar ataxia type 12 (SCA12).

METHODS: We conducted a cross sectional study and enrolled 30 (20 male and 10 female) genetically confirmed SCA12 patients and 30 healthy, age, gender and education matched individuals as controls. Cognitive domains were tested using a battery of validated neurocognitive tests.

RESULT: Mean age of patients was 51.6 ± 8.0 years and mean disease duration was 5.3 ± 3.0 years. Mean International Cooperative Ataxia Rating Scale (ICARS) score was 29.8 ± 12.5. SCA 12 patients scored significantly lower than controls in executive function and new learning ability. Other tested cognitive domains were also affected but did not reach statistical significance. Age, age at onset, severity of ataxia, disease duration and CAG repeat length did not correlate with cognitive impairment.

CONCLUSION: Cognitive impairment is a part of the spectrum of SCA12 and is characterized by dysfunction in executive function and new learning ability even early in the course of disease.

PMID:33740701 | DOI:10.1016/j.parkreldis.2021.03.010

J Mech Behav Biomed Mater. 2021 Mar 13;118:104456. doi: 10.1016/j.jmbbm.2021.104456. Online ahead of print.

ABSTRACT

OBJECTIVES: To investigate the impact of hydrothermal aging on Martens parameter (Martens hardness: HM/elastic indentation modulus: E_IT) and biaxial flexural strength (BFS) of recently available CAD/CAM silicate ceramics.

METHODS: 220 specimens (diameter: 12 mm, thickness: 0.95 mm) were fabricated from six CAD/CAM ceramics in two translucency levels (LT/HT): (a) two lithium disilicate (Amber Mill, ABM; IPS e.max CAD, IEM), (b) one lithium metasilicate (Cetra Duo, CEL), (c) one lithium alumina silicate (n!ce, NIC), and (d) two leucite ceramics (Initial LRF Block, LRF; IPS Empress CAD, IPR). HM/E_IT and BFS were measured initially and after hydrothermal aging (134 °C/0.2 MPa/100 h) in an autoclave. The Kolmogorov-Smirnov-test, t-test, one-way ANOVA with post-hoc Scheffé test, Kruskal-Wallis-test, Mann-Whitney-U-test with Bonferroni correction and Weibull statistics were performed (α = 0.05).

RESULTS: CEL and IEM showed the highest and the leucite ceramics the lowest Martens parameter. Within HT, ABM and NIC were in same initial HM value range with CEL and IEM. ABM and NIC showed lower initial E_IT values than CEL and IEM, however higher than IPR. The lowest aged values were analyzed for ABM. After aging, Martens parameter decreased for LRF, ABM, and CEL. IEM showed the initial highest BFS, followed by ABM. NIC and LRF showed the lowest BFS. IEM and ABM presented the highest aged BFS. Hydrothermal aging increased BFS values for LRF (HT), IPR, CEL (HT), and NIC (HT) compared to the initial values. CAD/CAM leucite ceramics showed higher Weibull modul values compared to lithium silicate ceramics.

SIGNIFICANCE: The well-considered selection of ceramics in relation to the areas of indication has the highest influence on the long-term stability of restorations: CAD/CAM lithium disilicate ceramics presented the highest and leucite ceramics the lowest mechanical properties, whereas the reliability was better for leucite than for lithium silicate ceramics.

PMID:33740686 | DOI:10.1016/j.jmbbm.2021.104456

Eur J Radiol. 2021 Mar 11;138:109651. doi: 10.1016/j.ejrad.2021.109651. Online ahead of print.

ABSTRACT

PURPOSE: LI-RADS v2018 diagnostic system is used to diagnose hepatocellular carcinoma (HCC) in at risk patients. However, its applicability to HCC in non-alcoholic steatohepatitis (NASH) has not been specifically studied. The purpose of this study was to assess the applicability of LI-RADS v2018 diagnostic system for HCC in patients with NASH.

MATERIALS AND METHODS: The MRI examinations of 41 patients with HCC and NASH (NASH group) were reviewed and compared to those obtained in 41 patients with HCC and virus-induced chronic liver disease (Virus group). MRI examinations of the two groups were compared for imaging presentation, LI-RADS major criteria and LI-RADS categorization. Qualitative variables were compared using Fisher exact test and quantitative variables using Mann-Whitney U test Interreader agreement was assessed using kappa statistic.

RESULTS: No significant differences in qualitative and quantitative variables were observed between the two groups. Most common findings in the two groups were hyperenhancement during the arterial phase and visibility on T2-weighted images (93 % vs. 98 %, P = 0.616 and 85 % vs. 88 %, P = 1.000 for NASH group and Virus group, respectively). No differences in prevalence between the two groups were found for any major LI-RADS v2018 criterion. Interreader agreement for LI-RADS categorization was strong for the NASH group (kappa = 0.802) and moderate for the virus group (kappa = 0.720). No differences were found between the two groups for LI-RADS categories (P = 0.303).

CONCLUSIONS: The LI-RADS v2018 diagnostic algorithm can be applied in patients with NASH.

PMID:33740627 | DOI:10.1016/j.ejrad.2021.109651

Aten Primaria. 2021 Mar 16;53(4):101994. doi: 10.1016/j.aprim.2021.101994. Online ahead of print.

ABSTRACT

OBJECTIVE: Adapt and validate the NECPAL instrument in Chile.

DESIGN: Prospective, longitudinal, analytical study for validation of the instrument in 5 stages: cultural adaptation, content validation, pilot test, application, and statistical analysis.

PLACE: Four primary care centers of the South East Metropolitan Health Service, in Santiago, Chile.

PARTICIPANTS: Primary health care physicians and nurses for cultural adaptation and application, and palliative care experts for content validation.

MAIN MEASUREMENTS: Cultural adaptation was carried out through cognitive interviews. Content validity was measured using Delphi method and the Lawshe content validity ratio (CVR) was obtained. In the pilot test, we measured stability (test-retest), inter judge harmony and application time in 14 chronic advanced patients (CAP). The test was applied to this same group, calculating the sample according to Nunally’s recommendation.

RESULTS: A sample of 118 CAP was obtained. The CVR was 0.75 and the average testing time was 6.7 min (SD = 4.01). The test-retest obtained a Kappa test concordance index between 0.632 and 1.0; and the interjudge harmony agreement between 0.192 and 0.692. The surprise question (PS) was positive in 20.3% of the sample. The main conditions associated with the disease-specific severity item, were fragility (23.7%), chronic heart disease (21.2%) and chronic lung disease (12.7%). The demand group and specific severity indicators obtained a greater predictive capacity of PS+, with an area under the curve of 0.808 (95% CI: 0.697-0.918).

CONCLUSIONS: NECPAL is feasible to be used in Chile, has adequate psychometric properties and will allow early detection of patients in need of palliative care.

PMID:33740612 | DOI:10.1016/j.aprim.2021.101994