Nevin Manimala

Open Access Emerg Med. 2022 Jan 11;14:15-24. doi: 10.2147/OAEM.S344744. eCollection 2022.

ABSTRACT

PURPOSE: Obstructive uropathy (OU) is a potentially life-threatening urologic emergency that requires urgent decompression. Percutaneous nephrostomy (PCN) is a commonly performed procedure to decompress OU. The objective of this study is to assess disease patterns and treatment outcome at two urologic centers in Ethiopia.

METHODS: A cross-sectional study was conducted on 110 patients who underwent emergency PCN from October 1, 2019 to September 30, 2020. Data were collected by a retrospective chart review. SPSS 25 was used for analysis. Descriptive statistics and logistic regression were utilized to assess disease pattern and significant predictors. A p-value of <0.05 on multivariate logistic regression was considered statistically significant.

RESULTS: Females accounted for 70% of cases and mean age at presentation was 48 ± 12.9 years. Bilateral OU was diagnosed in 60% of patients and 77.3% of obstructions occurred at the level of the ureter. Malignancies were diagnosed in >80% of patients among which cervical cancer was the commonest (37.3%) followed by bladder cancer (17.3%). Acute kidney injury (AKI) accounted for 70% of the presenting indications for PCN. Success rate after emergency PCN was 75.5% and 41.8% of the cases developed post-procedure complications. Factors that predicted successful outcome include male gender [AOR = 5.72 (1.13-28.92), 95% CI; p = 0.035], severe hydronephrosis pre-operatively [AOR = 7.12 (1.32-38.45), 95% CI; p = 0.022], and use of combined imaging (ultrasound and fluoroscope) to guide PCN [AOR = 12.91 (1.13-46.54), 95% CI; p = 0.039]. On the other hand, postoperative complication is a negative predictor [AOR = 0.26 (0.08-0.86), 95% CI; p = 0.027].

CONCLUSION: In this study, overall success of emergency PCN is low. Presence of severe hydronephrosis predicts technical ease and better outcome of PCN. Procedures performed under ultrasound and fluoroscope guidance also improve outcome. Postoperative complication rate is high in this study and mandates strict preventive measures as it predicts unfavorable outcome.

PMID:35046735 | PMC:PMC8761074 | DOI:10.2147/OAEM.S344744

J Exp Pharmacol. 2022 Jan 11;14:7-15. doi: 10.2147/JEP.S328954. eCollection 2022.

ABSTRACT

BACKGROUND: Currently, malaria elimination is intimidated by the emergence of antimalarial drug and insecticide resistance. This scenario urges scientists to develop new antimalarial drugs, where plant-based compounds are the major candidates.

OBJECTIVE: The objective of this experiment was to examine the antimalarial activities of the solvent fractions of the stem bark of P. linearifolia in mice.

METHODS: The dried hydromethanolic extract was treated with n-hexane, chloroform, and ethyl acetate solvents based on increasing order of polarity. For the suppressive test, after three hours post-inoculation of P. berghei, the first group was administered the vehicle 2 mL/100 g. The second group was given chloroquine 25 mg/kg, whereas the remaining nine groups were administered 100, 200, and 400 mg/kg of each of the chloroform, ethyl acetate and aqueous fractions. Furthermore, the aqueous fraction was evaluated using Rane’s model for the curative test. The result was statistically analyzed using a one-way analysis of variance (ANOVA). The results were considered significant at P < 0.05.

RESULTS: In the suppressive test, the solvent fractions suppressed parasitemia level significantly (P < 0.01 for 100 mg/kg, P < 0.001 for 200 and 400 mg/kg of the aqueous and P < 0.01 for 200 mg/kg, P < 0.001 for 400 mg/kg of chloroform fractions) as compared to vehicle-treated mice, whereas in the curative model 400 mg/kg of the aqueous fraction (P < 0.01) showed a significant parasitemia level reduction.

CONCLUSION: The results of this study indicated that the solvent fractions have promising antiplasmodial activity against Plasmodium berghei, which is consistent with the earlier in vivo study of the hydromethanolic extract.

PMID:35046734 | PMC:PMC8761000 | DOI:10.2147/JEP.S328954

J Exp Pharmacol. 2022 Jan 11;14:1-5. doi: 10.2147/JEP.S336304. eCollection 2022.

ABSTRACT

The IRIDIUM and ARGON studies provided positive findings concerning the benefits of the once-daily triple mometasone furoate/indacaterol/glycopyrronium (MF/IND/GLY) fixed-dose combination (FDC) for the treatment of uncontrolled asthma, at the least by a strict statistical point of view. In the IRIDIUM study patients received medium-dose (MD) or high-dose (HD) MF/IND/GLY or MF/IND oncex daily or HD fluticasone/salmeterol (FLU/SAL) twice daily; in the ARGON study patients received MD or HD MF/IND/GLY once daily or HD FLU/SAL twice daily + tiotropium (TIO) once daily. Since a detailed interpretation of clinical results has not yet been performed, we provided the clinical interpretation of efficacy outcomes resulting from the IRIDIUM and ARGON studies according to the currently available minimal clinically important difference (MCID) thresholds. The triple MF/IND/GLY FDC elicited beneficial clinically relevant effects compared to active comparators in asthmatic patients, according to the levels of ICS doses, by generally achieving and overcoming the MCID. The level of clinical benefit was usually greater in patients treated with HD-MF/IND/GLY compared to those treated with MD-MF/IND/GLY. Overall, HD-MF/IND/GLY induced greater clinically relevant benefits even when compared to HD-FLU/SAL + TIO. Considering that a balanced triple MF/IND/GLY FDC with MD ICS resulted as effective as HD-MF/IND in preventing moderate or severe exacerbations, thus triple ICS/LABA/LAMA FDCs with MD ICS should be considered for the treatment not only of uncontrolled asthma but also for those patients suffering from less severe forms of disease with airflow limitation as well as a possible as-needed therapeutic option.

PMID:35046733 | PMC:PMC8762517 | DOI:10.2147/JEP.S336304

Int J Womens Health. 2022 Jan 11;14:9-14. doi: 10.2147/IJWH.S341603. eCollection 2022.

ABSTRACT

PURPOSE: To evaluate the quality of life (QoL) of women with endometrioma and explore the associated factors.

PATIENTS AND METHODS: A cross-sectional study was conducted between August 2020 and March 2021. A total of 99 women diagnosed with ovarian endometrioma with at least one endometriosis-associated symptom completed the Endometriosis Health Profile 30 (EHP-30) questionnaire for their QoL score before treatment for ovarian endometrioma. The questionnaire comprises a central questionnaire (30 items) and a modular questionnaire (23 items divided into 6 sections). Demographics and QoL scores were analyzed using descriptive statistics and multivariable linear regression or median regression.

RESULTS: The mean QoL score was 35.0±15.8 (range, 16.0±21.2 in the social support dimension to 45.1±24.4 in the control and powerlessness dimension). In the modular questionnaire, the highest score was in the infertility domain, while the lowest was in the relationship with the physician domain. The pain score and chronic pelvic pain (CPP) were independent correlation factors for a higher total EHP-30 score: the higher the total EHP-30, the poorer the QoL. CPP was positively correlated with the QoL score in the work domain.

CONCLUSION: The present study revealed that CPP was the factor associated with a worse QoL and work performance in women with endometrioma based on a disease-specific, EHP-30 questionnaire.

PMID:35046731 | PMC:PMC8760997 | DOI:10.2147/IJWH.S341603

Drug Healthc Patient Saf. 2022 Jan 10;14:1-8. doi: 10.2147/DHPS.S332162. eCollection 2022.

ABSTRACT

PURPOSE: Perioperative cardiac arrests (CAs) are a rare but catastrophic perioperative complication. Much about incidence, risk factors, and outcomes of such events are still unknown. This study investigated anesthesia-related CAs at a tertiary teaching hospital.

METHODS: CA incidence within 24 hours of anesthesia administration was prospectively identified from May 1, 2016 to April 31, 2019. Each CA was matched by four other cases without CA receiving anesthesia on the same date and under similar operating conditions. The CA cases were reviewed and assigned to one of three groups: anesthesia-related, anesthesia-contributing, and anesthesia not related.

RESULTS: A total of 58,303 patients underwent 73,557 procedures under anesthesia during the study period. In sum, 27 CAs were reported for incidence of 3.7 per 10,000 anesthesia administrations (95% CI 2.3-5.1). Eleven CA were anesthesia-related for incidence of 1.5 per 10,000 anesthesia administrations. Four CA cases were anesthesia-contributing for incidence of 0.5 per 10,000 anesthesia administrations, while 53% of the anesthesia-related and -contributing CAs were due to respiratory problems. American Society of Anesthesiologists (ASA) physical status score, cardiovascular surgery, emergency surgery, and increased duration of surgery were significantly correlated with CA incidents when compared to the control group. ASA physical status score is an independent risk factor of the occurrence of perioperative CA (OR 7.6, 95% CI 2.6-22.4; P<0.001).

CONCLUSION: Identifying factors associated with increased risk for anesthesia-related CA is of great importance in risk stratification for surgical patients. ASA physical status score was found to be a major factor in predicting perioperative CA, since patients with higher ASA scores had a statistically significant increased risk of CA. Therefore, extra precautions must be taken when dealing with unprepared patients who have uncontrolled medical illnesses, especially those who will be undergoing emergency surgery.

PMID:35046730 | PMC:PMC8759986 | DOI:10.2147/DHPS.S332162

Int J Gen Med. 2022 Jan 13;15:535-543. doi: 10.2147/IJGM.S343403. eCollection 2022.

ABSTRACT

BACKGROUND: Recent study has revealed that enlarged diameters of the ascending aorta and proximal aortic arch enhance the probability of ATBAD. However, little is understood about the relation to ATBAD.

OBJECTIVE: This study explored the differences in proximal aortic segment (PAS) morphology in patients with acute type B aortic dissection (ATBAD), and performed hemodynamic simulations to provide proof of principle.

MATERIALS AND METHODS: The morphological characteristics of PAS in the ATBAD group (n = 163) and corresponding segment in the control group (n = 120) were retrospectively measured. The morphological parameters were analyzed using comprehensive statistical approaches. Ridge regression analysis was also performed to determine the association between independent variable and dependent variable. P < 0.01 was considered significant. Idealized aortic models were established based on variables of statistical significance, and hemodynamic simulations were performed to evaluate blood flow changes caused by morphology.

RESULTS: Diameters at landmarks of PAS were significantly larger in the ATBAD group. The lumen volume (V_PAS) of PAS in the ATBAD group was significantly enlarged than that of the control group (124,659.07 ± 34,089.27 mm³ vs 89,796.65 ± 30,334.40 mm³; P < 0.001). Furthermore, the V_PAS was positively correlated to diameters. As the V_PAS increased, the fluid kinetic energy in PAS enhanced linearly, and time-averaged wall shear stress and oscillatory shear index at the distal area of the left subclavian artery increased significantly.

CONCLUSION: In the ATBAD group, the enlarged V_PAS and increased diameters of PAS are positively correlated. Meanwhile, the enlarged V_PAS leads to more aggressive hemodynamic parameters at the distal area of the left subclavian artery, which may create a contributory condition for ATBAD.

PMID:35046712 | PMC:PMC8763263 | DOI:10.2147/IJGM.S343403

Int J Gen Med. 2022 Jan 11;15:501-511. doi: 10.2147/IJGM.S340066. eCollection 2022.

ABSTRACT

OBJECTIVE: This study aims to evaluate the clinical value of laparoscopic temporary internal iliac artery blockage (TIIAB) compared with uterine artery embolization (UAE) in type III cesarean scar pregnancy (CSP).

METHODS: A total of 76 patients with type III CSP admitted to the Department of Gynecology the First Affiliated Hospital of Zhengzhou University between September 2017 and June 2019 were selected for this retrospective study. Thirty-six of them in the study group received TIIAB, and the rest in control group received UAE. Laparoscopic pregnancy tissue was removed from all patients, and the uterine defects were repaired. The absence of remnants was then confirmed using ultrasonography. Follow-ups were performed in the two groups for six months, and the factors of intraoperative blood loss, operation and menelipsis time, 24-h human chorionic gonadotropin decline rate, postoperative complications, hospitalization days, hospitalization costs, peri-operative hormone levels, and ovarian function indicators were compared between the two groups and within each group.

RESULTS: There were statistically significant differences in the hospitalization cost, menelipsis time, and postoperative complication incidence between the two groups (p < 0.05). There were statistically significant differences between ovarian function at one month and three months after surgery (p < 0.05) as well as among the follicle-stimulating hormone, luteinizing hormone, and estradiol levels at one, three, and six months after surgery in the control group (p < 0.05).

CONCLUSION: Compared with uterine artery embolization, laparoscopic TIIAB has the advantages of a low hospitalization cost, lower postoperative complication rate, and shorter menelipsis time. Moreover, it avoids ovarian function damage. It is a safe method worthy of clinical popularization.

PMID:35046710 | PMC:PMC8760988 | DOI:10.2147/IJGM.S340066

Int J Gen Med. 2022 Jan 4;15:45-52. doi: 10.2147/IJGM.S342087. eCollection 2022.

ABSTRACT

BACKGROUND: Measuring portal vein diameter (PVD) is a feasible method of detecting portal vein hypertension, which is a primary and fatal complication of chronic liver disease (CLD) and is usually diagnosed very late. However, there is a paucity of morphometric information on portal vein diameter in the Ethiopian population. Hence, it is important to determine the portal vein diameter among adults with and without chronic liver disease.

PURPOSE: The study aimed to identify how PVD is affected by age, sex, and anthropometric measurements in patients with and without CLD.

METHODS: A cross-sectional study was conducted among 220 participants (110 CLD patients and 110 controls) who have visited the radiology unit at selected Hospitals. Patients with CLD were selected consecutively as they present while controls were selected by a systematic sampling technique. A structured questionnaire was used to collect the data. Correlation and independent t-test were used to assess the relations. A statistically significant association was declared at P-value <0.05.

RESULTS: Mean portal vein diameter for CLD patients was 17.03±1.97 mm with a range of 12.8-20.8mm and 10.79±1.27mm with a range of 7.70-13.25mm for the control group. Age, weight, and body mass index had a positive correlation with portal vein diameter in both groups. The mean portal vein diameter increased by 21.34% during deep inspiration in the control group.

CONCLUSION: The mean portal vein diameter among patients with CLD was higher than that of the control group. A significant gender-based difference was recorded in the portal vein diameter of the control group only. Ultrasonography is a non-invasive, readily available diagnostic tool for portal vein pathology.

RECOMMENDATION: It is recommended for clinicians to take into consideration age, sex and anthropometric measurements while measuring PVD.

PMID:35046700 | PMC:PMC8760923 | DOI:10.2147/IJGM.S342087

J Inflamm Res. 2022 Jan 8;15:153-162. doi: 10.2147/JIR.S344282. eCollection 2022.

ABSTRACT

BACKGROUND: Complement plays a pivotal role in the immune response to infection. Several studies demonstrated complement activation in sepsis, yet little is known of the relationship of complement terminal pathway activation and the clinical characteristics of sepsis patients. Therefore, we investigated serum C5, soluble C5b-9 (sC5b-9), and soluble CD59 (sCD59) and their relation to organ failure in sepsis patients in the intensive care unit (ICU).

METHODS: In this prospective cohort study, all available patients admitted to the adult ICUs between June 2020 and January 2021 were included. Patients were divided into sepsis and non-sepsis groups according to the Sepsis-3 criteria, serum samples from both groups were investigated for the levels of C5, sC5b-9, and sCD59 using commercial sandwich ELISA kits.

RESULTS: We analyzed 79 serum samples, 36 were from sepsis patients. We found that sepsis patients had significantly lower C5 (83.6± 28.4 vs 104.4± 32.0 µg/mL, p = 0.004) and higher sCD59 (380.7± 170.5 vs 288.9± 92.5 ng/mL, p = 0.016). sC5b-9, although higher in sepsis patients, did not reach statistical significance (1.5± 0.8 µg/mL vs 1.3± 0.7 µg/mL, p = 0.293). Sepsis patients who died during their ICU stay had significantly higher sCD59 compared to those who survived (437.0 ± 176.7 vs 267.8 ± 79.7 ng/mL, p = 0.003, respectively). Additionally, C5 and sCD59 both correlated to SOFA score in the sepsis group (r_s = -0.44, P = 0.007 and = 0.43, P = 0.009, respectively), and a similar correlation was not found in the non-sepsis group.

DISCUSSION: In sepsis patients, levels of C5 and sCD59, but not sC5b-9, correlated to the severity of organ damage measured by SOFA. A similar correlation was not found in non-sepsis patients. This indicated that organ damage associated with sepsis led to a more pronounced terminal pathway activation than in non-sepsis patients, it also indicated the potential of using C5 and sCD59 to reflect sepsis severity.

PMID:35046691 | PMC:PMC8760944 | DOI:10.2147/JIR.S344282

Diabetes Metab Syndr Obes. 2022 Jan 10;15:103-109. doi: 10.2147/DMSO.S341364. eCollection 2022.

ABSTRACT

BACKGROUND: Recurrence of high-risk diabetic feet, after wound, healing is a common challenge among diabetic patients. Continuous use of an offloading device significantly prevents recurrence of high-risk diabetic feet, although patient adherence is imperative to ensuring this therapy’s clinical efficacy. In this study, we explored clinical outcomes of patients with a high-risk diabetic foot who had been prescribed with custom-molded offloading footwear under different adherence conditions.

METHODS: A total of 48 patients (17 females and 31 males) with high-risk diabetic feet, who had been with prescribed offloading footwear in 13 medical centers across 4 cities, were enrolled in the current study. The patients were assigned into either continuous offloading therapy (COT, n = 31) or interrupted offloading therapy (IOT, n = 17) groups, according to their adherence to the therapy. All patients were followed up monthly, and differences in recurrence, amputation, and deaths between the groups were analyzed at 4 months after therapy.

RESULTS: Forty-eight patients met our inclusion criteria and were therefore included in the final analysis. Among them, 31 were stratified into the COT group and adhered to offloading therapy throughout the study period, whereas 17 were grouped as IOT and exhibited interrupted adherence to offloading therapy. We found statistically significant differences in recurrence rates (0 vs 38.46%, p < 0.01), amputation (0 vs 11.76%, p < 0.01), and deaths (0% vs 5.88%, p < 0.01) between the groups during follow-up.

CONCLUSION: Patients’ adherence is imperative to efficacy of custom-molded offloading footwear during treatment of high-risk diabetic foot. Further studies are needed to elucidate the role of improved design of the offloading device and the need for enhanced patient education for improved adherence.

PMID:35046681 | PMC:PMC8759996 | DOI:10.2147/DMSO.S341364