Nevin Manimala

Influenza Other Respir Viruses. 2022 Jan 19. doi: 10.1111/irv.12923. Online ahead of print.

ABSTRACT

BACKGROUND: In the United States, infection with SARS-CoV-2 caused 380,000 reported deaths from March to December 2020.

METHODS: We adapted the Moving Epidemic Method to all-cause mortality data from the United States to assess the severity of the COVID-19 pandemic across age groups and all 50 states. By comparing all-cause mortality during the pandemic with intensity thresholds derived from recent, historical all-cause mortality, we categorized each week from March to December 2020 as either low severity, moderate severity, high severity, or very high severity.

RESULTS: Nationally for all ages combined, all-cause mortality was in the very high severity category for 9 weeks. Among people 18 to 49 years of age, there were 29 weeks of consecutive very high severity mortality. Forty-seven states, the District of Columbia, and New York City each experienced at least 1 week of very high severity mortality for all ages combined.

CONCLUSIONS: These periods of very high severity of mortality during March through December 2020 are likely directly or indirectly attributable to the COVID-19 pandemic. This method for standardized comparison of severity over time across different geographies and demographic groups provides valuable information to understand the impact of the COVID-19 pandemic and to identify specific locations or subgroups for deeper investigations into differences in severity.

PMID:35044097 | DOI:10.1111/irv.12923

J Appl Clin Med Phys. 2022 Jan 19:e13476. doi: 10.1002/acm2.13476. Online ahead of print.

ABSTRACT

PURPOSE: Calculating the adequate target margin for real-time tumor tracking using the Cyberknife system is a challenging issue since different sources of error exist. In this study, the clinical log data of the Cyberknife system were analyzed to adequately quantify the planned target volume (PTV) margins of tumors located in the lung and abdomen regions.

METHODS: In this study, 45 patients treated with the Cyberknife module were examined. In this context, adequate PTV margins were estimated based on the Van Herk formulation and the uncertainty estimation method by considering the impact of errors and uncertainties. To investigate the impact of errors and uncertainties on the estimated PTV margins, a statistical analysis was also performed.

RESULTS: Our study demonstrates five different sources of errors, including segmentation, deformation, correlation, prediction, and targeting errors, which were identified as the main sources of error in the Cyberknife system. Furthermore, the clinical evaluation of the current study reveals that the two different formalisms provided almost identical PTV margin estimates. Additionally, 4-5 mm and 5 mm margins on average could provide adequate PTV margins at lung and abdomen tumors in all three directions, respectively. Overall, it was found that concerning the PTV margins, the impact of correlation and prediction errors is very high, while the impact of robotics error is low.

CONCLUSIONS: The current study can address two limitations in previous researches, namely insufficient sample sites and a smaller number of patients. A comparison of the present results concerning the lung and abdomen areas with other studies reveals that the proposed strategy could provide a better reference in selection the PTV margins. To our knowledge, this study is one of the first attempts to estimate the PTV margins in the lung and abdomen regions for a large cohort of patients treated using the Cyberknife system.

PMID:35044071 | DOI:10.1002/acm2.13476

BJU Int. 2022 Jan 19. doi: 10.1111/bju.15693. Online ahead of print.

ABSTRACT

AIM: To compare between transurethral cystolithotripsy and percutaneous cystolithotripsy in the management of bladder stones in male children regarding efficacy and morbidity.

PATIENTS AND METHODS: One hundred boys younger than 14 years with a single bladder or urethral stone less than 30 mm were randomized into two equal groups. Initial diagnostic urethro-cystoscopy and push back of urethral stones were done for patients in both groups. Patients in group A had transurethral cystolithotripsy, while those in group B had percutaneous cystolithotripsy through a 20-Fr sheath using a 12-Fr nephroscope. The two groups were compared regarding preoperative criteria, intraoperative details and postoperative outcomes.

RESULTS: The patients in this study had a median (range) age of 36 (4-144) months and a median (range) stone size of 10 (5-26) mm. There was no statistically significant difference between the two groups regarding preoperative criteria. The assigned procedure was successful in 48(96%) patients in group A and 49 (98%) patients in group B (p = 1). Complications were encountered in 11(22%) patients in group A and five (10%) patients in group B (p = 0.171). The median (range) operative time was 21.5 (4-90) minutes in group A and 13 (5-70) minutes in group B (p < 0.001). Forty seven (94%) stones needed disintegration in group A versus 22 (44%) in group B (p < 0.001).

CONCLUSION: Both techniques have comparable success and complications rates. However, percutaneous cystolithotripsy has a shorter operative time and less need for stone disintegration.

PMID:35044035 | DOI:10.1111/bju.15693

Water Environ Res. 2021 Dec 29;94(1):e1683. doi: 10.1002/wer.1683. Online ahead of print.

ABSTRACT

The presence of reactive dyes in textile wastewater is a serious environmental concern due to their associated mutagenic and carcinogenic effects. The present study aims to analyze the effect of different anodic materials on the decolorization of a real textile wastewater effluent. For this purpose, four different anodic materials-TiO₂ -coated platine, TiO₂ -coated ruthenium dioxide (RuO₂ ) (viz., RuO₂ ), titanium dioxide (TiO₂ ), and graphite-were connected, respectively, to titanium dioxide (TiO₂ ) used as a cathode electrode. Color and cost optimization studies were performed using the response surface methodology and the Box-Behnken experimental design (BBD). According to ANOVA results, the R² values for Pt/TiO₂ , RuO₂ /TiO₂ , TiO₂ /TiO₂ , and graphite/TiO₂ electrode pairs were found to be 97.4%, 93.8%, 92.44%, and 92.2%, respectively, indicating a good compatibility as it is close to one. The results show that color removal efficiencies at the optimal conditions were 86.3%, 90.8%, 91.5%, and 93.6% for Pt/TiO₂ , graphite/TiO₂ , TiO₂ /TiO₂ , and RuO₂ /TiO₂ , respectively. Furthermore, energy consumption cost at the optimum conditions was also evaluated, and the results were as follows: Pt/TiO₂ (0.95 €/m³ ), graphite/TiO₂ (0.74 €/m³ ), TiO₂ /TiO₂ (0.31 €/m³ ), and RuO₂ /TiO₂ (0.26 €/m³ ). Consequently, this research paper shows that all of the tested anodic materials give satisfactory color removal efficiencies higher than 86%. When energy consumption and color removal are considered together, the use of TiO₂ /TiO₂ and RuO₂ /TiO₂ pairs would be preferred. PRACTITIONER POINTS: Anodic contribution was investigated for decolorization of textile wastewater by electrooxidation process. Graphite, TiO₂ -coated Pt, TiO₂ -coated RuO₂ , and TiO₂ were used as anode materials. Highest color removal with lowest energy consumption was achieved with TiO₂ -coated RuO₂ anode material (93.6%).

PMID:35044018 | DOI:10.1002/wer.1683

NMR Biomed. 2022 Jan 14:e4693. doi: 10.1002/nbm.4693. Online ahead of print.

ABSTRACT

The cell volume fraction (CVF) of the human brain is high (~ 82%) and preserved across healthy aging while the brain declines in volume. These two observations, supported by several independent techniques, suggest that cell volume fraction is an important structural parameter. A new biophysical model is presented that incorporates CVF into the Goldman equation of classical membrane electrophysiology. The Goldman equation contains few structural constraints beyond two compartments separated by a semipermeable membrane supporting ion gradients. As potassium is the most permeable ion in the resting state, the resting membrane potential is determined by the potassium ion gradient. This biophysical model indicates that the sodium-potassium ion pumps use less energy at high CVF to maintain the resting membrane potential, explaining the high value of CVF and its conservation with healthy aging. Cell volume fraction is measured to be statistically significantly higher in the brains of males compared to females, suggesting a structural requirement for higher energy efficiency in the larger male brain to support the greater number of neurons and synapses. As CVF can be measured in humans using quantitative sodium MR imaging and has potential implications for brain health, CVF may be a quantitative parameter that is useful for assessment of brain health, especially in patients with diseases such as dementia and psychiatric disease that do not have anatomical correlates detectable by clinical proton MR imaging.

PMID:35044017 | DOI:10.1002/nbm.4693

J Vet Intern Med. 2022 Jan 19. doi: 10.1111/jvim.16344. Online ahead of print.

ABSTRACT

BACKGROUND: The magnitude of diagnostic abnormalities can influence the perception of clinical outcome. Extreme neutrophilic leukocytosis (ENL) is an uncommon finding caused by markedly increased granulopoiesis. A lack of recent, large-scale studies limits our understanding of the importance, causation, and prognosis associated with ENL in dogs.

HYPOTHESIS/OBJECTIVES: Describe disease categories (DC) identified in dogs with ENL and identify variables associated with survival. We hypothesized that factors including fever, segmented and band neutrophil counts, and DC would be negatively associated with survival.

ANIMALS: Two-hundred sixty-nine dogs with ENL (segmented neutrophils ≥50 × 10³ cells/μL) presented to the veterinary teaching hospitals at Auburn University (n = 164), the University of Missouri (n = 81), and Oklahoma State University (n = 24) between January 1, 2009 and December 31, 2019.

METHODS: Retrospective study. Demographic data and outcome variables including temperature, CBC findings, DC, duration of hospitalization (DOH) and outcome were acquired from the medical record. Statistical analyses included chi-squared and Kruskal-Wallis tests, and Pearson product moment correlations with a P < .05 significance level.

RESULTS: Mortality was 41%. Survival differed with DC (P = .002). Mortality was higher (P < .05) in dogs with neoplasia (56.2%) vs immune-mediated disease (20.5%) or tissue damage/necrosis (19%). Weight (P = .001, r = -0.14) and total neutrophil count (P = .04, r = -0.02) were weakly negatively associated with survival whereas DOH was weakly positively associated with survival (P = .03, r = 0.14).

CONCLUSIONS AND CLINICAL IMPORTANCE: Mortality in dogs with ENL is high but differed according to DC. Only weak correlations between clinical or clinicopathologic variables and mortality were identified. Extreme neutrophilic leukocytosis should be interpreted in conjunction with the underlying disease process, and not broadly used to predict clinical outcome.

PMID:35043992 | DOI:10.1111/jvim.16344

Laryngoscope. 2022 Jan 19. doi: 10.1002/lary.30024. Online ahead of print.

ABSTRACT

OBJECTIVES: Paralysis of the recurrent laryngeal nerves (RLNs), albeit decreased over the years, leaves the surgeon helpless as there is not much that can be done once it occurs. Nimodipine has been suggested as a remedy that could accelerate the recovery of the nerve. Our study aimed to examine the factors that affect the recovery rate (RR) and time to recovery (TTR) of post-thyroidectomy RLN paralysis, with an emphasis on the use of nimodipine.

METHODS: A total of 197 patients who had undergone thyroid and parathyroid surgeries were retrospectively reviewed from October 2016 to August 2019. Patients who had RLN paralysis following surgery were assessed. The medical records were retrospectively analyzed to look for possible factors that may influence RLN recovery.

RESULTS: A total of 289 nerves were at risk. Temporary RLN paralysis rate was 7.9% while 1.7% was permanent. Age (odds ratio [OR] = 4.8) and intra-operative extra-thyroid extension (OR = 9.0) were independent risk factors for RLN paralysis. The rate of recovery was 82.1%. Loss of signal (LOS; P = .066) was a factor trending for an impact on RR but not nimodipine (P > .05). The mean TTR was 32 days. LOS, nimodipine, and steroid use, among others, were factors trending for an impact on the TTR.

CONCLUSION: Although not reaching statistical significance, nimodipine and steroids might influence TTR but not the RR. Larger studies are warranted to address the effect of nimodipine on the outcome of RLN paralysis.

LEVEL OF EVIDENCE: 4 Laryngoscope, 2022.

PMID:35043983 | DOI:10.1002/lary.30024

J Trop Pediatr. 2022 Jan 7;68(1):fmac001. doi: 10.1093/tropej/fmac001.

ABSTRACT

OBJECTIVE: This study aimed to investigate the diagnostic value of presepsin, a new inflammatory marker for paediatric appendicitis, and to determine a reference range of presepsin for children.

METHODS: This single-center prospective study was conducted in our paediatric emergency department between 1 February 2021 and 1 July 2021. Patients aged 0-18 years diagnosed with acute appendicitis, which was pathologically confirmed, and healthy volunteers in the same age group were included in the study. Serum presepsin levels were analysed using an enzyme-linked immunosorbent assay reader. In addition to presepsin, other acute-phase reactants, paediatric appendicitis scores and imaging methods were evaluated.

RESULTS: There were 94 patients in the acute appendicitis group and 102 healthy volunteers in the control group. Median values were compared between the two groups, and no statistically significant differences were found (p = 0.544). In addition, no statistically signivficant differences in presepsin levels were found between the acute and perforated appendicitis groups (p = 0.344). The median (IQ1-IQ3) reference range for presepsin in healthy children was 0.9950 (0.7575-1.610) ng/mL.

CONCLUSION: Presepsin is not a suitable marker for the diagnosis of acute appendicitis. We observed that serum presepsin levels were not elevated in paediatric appendicitis, which is a local infection, in contrast to previous studies.

PMID:35043966 | DOI:10.1093/tropej/fmac001

Mil Med. 2022 Jan 19:usac003. doi: 10.1093/milmed/usac003. Online ahead of print.

ABSTRACT

BACKGROUND: Military general surgeons commonly perform urologic procedures, yet, there are no required urologic procedural minimums during general surgery residency training. Additionally, urologists are not included in the composition of forward operating surgical units. Urologic Care Army/Air Force/Navy Provider Education was created to provide military general surgeons with training to diagnose and treat frequently encountered urologic emergencies when practicing in environments without a urologist present.

STUDY DESIGN: A literature review and needs assessment were conducted to identify diagnoses and procedures to feature in the course. The course included a 1-hour didactic session and then a 2-hour hands-on simulated skills session using small, lightweight, cost-effective simulators. Using a pretest-posttest design, participants completed confidence and knowledge assessments before and after the course. The program was granted educational exemption by the institutional review board.

RESULTS: Twenty-seven learners participated. They demonstrated statistically significant improvement on the knowledge assessment (45.4% [SD 0.15] to 83.6% [SD 0.10], P < .01). On the confidence assessment, there were statistically significant (P ≤ .001) improvements for identifying phimosis, paraphimosis, and testicular torsion, as well as identifying indications for suprapubic catheterization, retrograde urethrogram, and cystogram. There were also statistically significant (P < .001) improvements for performing: suprapubic catheterization, dorsal penile block, dorsal slit, scrotal exploration, orchiopexy, orchiectomy, retrograde urethrogram, and cystogram.

CONCLUSION: We created the first-ever urologic emergencies simulation curriculum for military general surgeons that has demonstrated efficacy in improving the diagnostic confidence, procedural confidence, and topic knowledge for the urologic emergencies commonly encountered by military general surgeons.

PMID:35043957 | DOI:10.1093/milmed/usac003

Pain Med. 2022 Jan 19:pnac007. doi: 10.1093/pm/pnac007. Online ahead of print.

ABSTRACT

OBJECTIVES: Large-scale procedural safety data on pterygopalatine fossa nerve blocks (PPFB) using a suprazygomatic, ultrasound-guided approach are lacking, leading to hesitancy surrounding this technique. The aim of this study was to characterize the safety of PPFB.

METHODS: This retrospective chart review comprised adults who received an ultrasound-guided PPFB from 01/01/2016-08/30/2020 at the University of Florida. Indications included surgical procedures and non-surgical pain. Clinical data describing PPFB were extracted from medical records. Descriptive statistics were calculated for all variables, and quantitative variables were analyzed using the paired t-test to detect differences between pre- and post-procedure.

RESULTS: A total of 833 distinct PPFBs were performed on 411 subjects (59% female, mean age 48.5 years). Minor oozing from the injection site was the only reported side effect in a single subject. While systolic blood pressure, heart rate and oxygen saturation were significantly different pre- and post-procedure (132.3 vs 136.4 mmHg, p < 0.0001; 78.2 vs 80.8, p = 0.0003; and 97.8% vs 96.3%, p < 0.0001 respectively), mean arterial pressure and diastolic blood pressure were not significantly different (96.2 vs 97.1, p = 0.1545; and 78.2 vs 77.4 mmHg, p = 0.1314 respectively). Similar results were found within subgroups, including sex, race, and indication for PPFB.

DISCUSSION: We have not identified clinically significant adverse effects from PPFB using an ultrasound-guided suprazygomatic approach in a large cohort in the hospital setting. PPFBs are a safe and well-tolerated pain management strategy; however, prospective multicenter studies are needed.

PMID:35043949 | DOI:10.1093/pm/pnac007