Nevin Manimala

Int J Clin Pract. 2021 Jul 31:e14692. doi: 10.1111/ijcp.14692. Online ahead of print.

ABSTRACT

OBJECT: We aimed to evaluate the elevation of amylase and lipase enzymes in coronavirus disease 2019 (COVID-19) patients and their relationship with the severity of COVID-19.

METHOD: In this study, 1378 patients with COVID-19 infection were included. Relation of elevated amylase and lipase levels and comorbidities with the severity of COVID-19 was analyzed. The effects of hemodynamic parameters and organ failure on pancreatic enzymes and their relations with prognosis were statistically analyzed.

RESULTS: The 1378 patients comprised 700 (51.8%) men and 678 (%49.2) women. Of all patients, 687 (49.9%) had mild and 691 (50.1%) patients had severe COVID-19 infection. Amylase elevation at different levels occurred in 316 (%23) out of 1378 patients. In these patients, the amylase levels increased 1-3 times in 261 and 3 times in 55 patients. Pancreatitis was detected in only 6 (%1.89) of these patients according to the Atlanta criteria. According to univariate and multivariate analyses, elevated amylase levels were significantly associated with the severity of COVID-19 (Odds Ratio [OR]: 4.37; p<0.001). Moreover, diabetes mellitus (DM) (OR: 1.82; p=0.001), kidney failure (OR: 5.18; p<0.001), liver damage (OR: 6.63; p<0.001), hypotension (OR: 6.86; p<0.001), and sepsis (OR: 6.20; p=0.008) were found to be associated with mortality from COVID-19.

CONCLUSION: Elevated pancreatic enzyme levels in COVID-19 infections are related to the severity of COVID-19 infection and hemodynamic instability. In a similar way to other organs, the pancreas can be affected by severe COVID-19 infection.

PMID:34331821 | DOI:10.1111/ijcp.14692

J Eur Acad Dermatol Venereol. 2021 Jul 31. doi: 10.1111/jdv.17574. Online ahead of print.

ABSTRACT

BACKGROUND: Mohs micrographic surgery is the gold standard treatment for high-risk non-melanoma skin cancers. The success of Mohs relies on accurate histopathologic evaluation. Due to law restrictions in some European countries Mohs surgeons are not permitted to report on histopathology, therefore a pathologist evaluates the frozen sections.

OBJECTIVE: To retrospectively assess the concordance between the certified Mohs surgeon and the pathologist in evaluating the Mohs slides that were intraoperatively evaluated by the pathologist.

MATERIALS AND METHODS: Frozen section slides of a total of 237 Mohs cases between 2013-2020 were examined by the blinded Mohs surgeon and the tumors were marked on copy maps. The copy maps and the original maps were compared and the non-concordant cases were reevaluated together by the Mohs surgeon and the dermatopathologist. The concordance rate was calculated and the inter-rater agreement was statistically analyzed using Cohen’s Kappa coefficient.

RESULTS: We report high concordance rate (97.9%) and inter-rater agreement (0.96) of Mohs surgeon and dermatopathologist in evaluating Mohs slides.

CONCLUSION: As a newly settled center, our results are in alignment with experienced centers where the Mohs surgeon evaluates the slides herself and performs the surgery.

PMID:34331818 | DOI:10.1111/jdv.17574

Int J Methods Psychiatr Res. 2021 Jul 31:e1888. doi: 10.1002/mpr.1888. Online ahead of print.

ABSTRACT

OBJECTIVES: A clear definition of what we understand of high-dose misuse or of a ‘markedly increased dose’ (as stated by the DSM-5) is important and past definitions may be inadequate. The aim of this review is to describe the different definitions used and to test these definitions for their accuracy.

METHODS: A narrative PubMed literature review was conducted based on articles published between 1 January 1990 and 31 December 2020 describing benzodiazepines (in MeSH Terms or MeSH Major Topic) and high-dose (or high-dosage). Specific definitions were applied to a population sample to show how definitions affect high-dose benzodiazepine prevalence.

RESULTS: Multiples of an equivalent-diazepam dose or of the World Health Organization ‘defined daily dosage’ were used more frequently than the overstep of the recommended maximum therapeutic dosage as a cut-off point.

CONCLUSION: High-dose use is rare but the prevalence in the general population varies among studies, mainly due to different definitions, making both clinical and epidemiological comparisons between studies difficult. Defining a high-dose user as a person who takes at least a higher dose than the maximum usual therapeutic dose over a defined period of time therefore appears to be clinically more consistent.

PMID:34331787 | DOI:10.1002/mpr.1888

Int J Cancer. 2021 Jul 31. doi: 10.1002/ijc.33753. Online ahead of print.

ABSTRACT

Small bowel cancer (SBC) is the malignancy with the highest standardized incidence ratio in Lynch syndrome (LS) patients. Of all SBCs, about 50% are duodenal cancers (DC), therefore being accessible by esophago-gastro-duodenoscopy (EGD) for surveillance. We asked whether early detection of DC is possible for LS patients undergoing surveillance by EGD and if surveillance should be limited to specific subgroups. Data for LS patients with DC were retrieved from the registry of the German Consortium for Familial Intestinal Cancer. Patients undergoing active surveillance by EGDs (surveillance-group) were compared to those who did not (non-surveillance-group) regarding tumor stage at diagnosis. UICC stages I-IIA were defined as early stage disease and IIB-IV as advanced stage disease. Statistical analysis was performed using Fisher’s exact test. Among 2015 patients with pathogenic variants in any mismatch-repair-gene, 47 patients with 49 DCs were identified. In 10% of cases, patients were under 35 years at diagnosis; family and personal tumor history did not correlate with DC diagnosis. Pathogenic germline variants in MSH6, PMS2 or EPCAM were present in 10% of patients. Statistical analysis could be performed on 13 DC patients in the surveillance-group and 14 in the non-surveillance-group. Early detection was possible for 71% of patients in the surveillance-group and 29% of patients in the non-surveillance-group (P = 0.021). Early detection of DC by EGD in LS patients is feasible regardless of family history, mutational status and should start no later than 25 years of age.

PMID:34331771 | DOI:10.1002/ijc.33753

Altern Ther Health Med. 2021 Jul 31:AT6593. Online ahead of print.

ABSTRACT

CONTEXT: Low back pain (LBP) is a painful pathology causing pain and disability despite treatment with the best evidence-based therapies. Osteopathic manual therapy (OMT) and Kaltenborn-Evjenth orthopedic manual therapy (KEOMT) are alternative treatments for LBP.

OBJECTIVE: The study intended to evaluate the efficacy of OMT compared to that of KEOMT for patients with chronic LBP.

DESIGN: The research team designed a randomized study.

SETTING: The study was held at the Medita Health Center in Warsaw, Poland.

PARTICIPANTS: The study included 68 participants of both genders, aged 30 to 60, with chronic LBP.

INTERVENTION: Participants were randomly assigned to one of two parallel groups, each with 34 members. The OMT group received, as a direct technique, a high-velocity/low-amplitude (HVLA) impulse, and as indirect techniques, strain counterstrain (SCS), myofascial release (MFR), and visceral mobilization therapy (VMT). The KEOMT group received lumbar segmental traction and lumbar segmental mobilization-flexion and gliding therapy grade 3. The participants in both groups received 10 treatments, two per week for five weeks.

OUTCOME MEASURES: The primary outcome was pain severity, using a numeric pain rating scale (NPRS). The secondary outcome was measurement of functional disability, using the Oswestry Disability Index (ODI).

RESULTS: The OMT and KEOMT both decreased pain and disability; however, the changes on the NPRS and ODI postintervention were statistically greater for the OMT group compared to the KEOMT group (P < .05).

CONCLUSIONS: OMT was better at reducing pain and improving quality of life. It reduced functional disability more than KEOMT in patients with chronic LBP.

PMID:34331755

J Med Imaging Radiat Oncol. 2021 Jul 31. doi: 10.1111/1754-9485.13287. Online ahead of print.

ABSTRACT

INTRODUCTION: There is significant potential to analyse and model routinely collected data for radiotherapy patients to provide evidence to support clinical decisions, particularly where clinical trials evidence is limited or non-existent. However, in practice there are administrative, ethical, technical, logistical and legislative barriers to having coordinated data analysis platforms across radiation oncology centres.

METHODS: A distributed learning network of computer systems is presented, with software tools to extract and report on oncology data and to enable statistical model development. A distributed or federated learning approach keeps data in the local centre, but models are developed from the entire cohort.

RESULTS: The feasibility of this approach is demonstrated across six Australian oncology centres, using routinely collected lung cancer data from oncology information systems. The infrastructure was used to validate and develop machine learning for model-based clinical decision support and for one centre to assess patient eligibility criteria for two major lung cancer radiotherapy clinical trials (RTOG-9410, RTOG-0617). External validation of a 2-year overall survival model for non-small cell lung cancer (NSCLC) gave an AUC of 0.65 and C-index of 0.62 across the network. For one centre, 65% of Stage III NSCLC patients did not meet eligibility criteria for either of the two practice-changing clinical trials, and these patients had poorer survival than eligible patients (10.6 m vs. 15.8 m, P = 0.024).

CONCLUSION: Population-based studies on routine data are possible using a distributed learning approach. This has the potential for decision support models for patients for whom supporting clinical trial evidence is not applicable.

PMID:34331748 | DOI:10.1111/1754-9485.13287

Am J Transplant. 2021 Jul 31. doi: 10.1111/ajt.16779. Online ahead of print.

ABSTRACT

Bariatric surgery has been shown to be safe in the dialysis population. Whether bariatric surgery before kidney transplantation influences post-transplant outcomes has not been examined nationally. We included severely obese (BMI>35) dialysis patients between 18-70 years who received a kidney transplant according to the US Renal Data System. We determined the association between history of bariatric surgery and risk of 30-day readmission, graft failure, or death after transplantation using multivariable logistic, Cox, and Fine-Gray models. We included 12,573 patients, of whom 503 (4%) received bariatric surgery before transplantation. Median age at transplant was 53 years; 42% were women. History of bariatric surgery was not statistically significantly associated with graft failure (HR 1.02;95% CI 0.77-1.35) or death (HR 1.10;95% CI 0.84-1.45). However, sleeve gastrectomy (vs. no bariatric surgery) was associated with lower risk of graft failure (HR 0.39;95% CI 0.16-0.95). Overall, history of bariatric surgery prior to kidney transplantation was not associated with allograft or patient survival, but findings varied by surgery type. Sleeve gastrectomy was associated with better graft survival and should be considered in severely obese transplant candidates receiving dialysis.

PMID:34331744 | DOI:10.1111/ajt.16779

Transbound Emerg Dis. 2021 Jul 31. doi: 10.1111/tbed.14254. Online ahead of print.

ABSTRACT

Vaccination of badgers with Mycobacterium bovis Bacille Calmette Guérin (BCG) has been shown to protect badgers against tuberculosis in experimental trials. During the three-year County Kilkenny BCG vaccine field study, badgers were treated orally with placebo (100% in Zone A), BCG (100% in Zone C) or randomly assigned 50%: 50% treatment with BCG or placebo (Zone B). At the end of the study 275 badgers were removed from the trial area and subjected to detailed post-mortem examination followed by histology and culture for M. bovis. Among these badgers, 83 (30.2%) were captured for the first time across the three zones, representing a non-treated proportion of the population. Analysis of the data based on the infection status of treated animals showed a prevalence of 52% (95% CI: 40%-63%) infection in Zone A (placebo), 39% (95% CI: 17%-64%) in Zone B (placebo) and 44% (95% CI: 20%-70%) in Zone B (BCG vaccinated) and 24% (95% CI: 14%-36%) in Zone C (BCG vaccinated). There were no statistically significant differences in the proportion of animals with infection involving the lung and thoracic lymph nodes, extra-thoracic infection, or in the distribution and severity scores of histological lesions. Among the 83 non-treated badgers removed at the end of the study, the infection prevalence of animals in Zone A (prevalence = 46%, 95% CI: 32%-61%) and Zone B (prevalence = 44%, 95% CI: 23%-67%) was similar to the treated animals in these zones. However, in Zone C, no evidence of infection was found in any of the untreated badgers (prevalence = 0%, 95% CI: 0%-14%). This is consistent with an indirect protective effect in the non-vaccinated badgers leading to a high level of population immunity. The results suggest that BCG vaccination of badgers could be a highly effective means of reducing the incidence of tuberculosis in badger populations. This article is protected by copyright. All rights reserved.

PMID:34331741 | DOI:10.1111/tbed.14254

Catheter Cardiovasc Interv. 2021 Jul 31. doi: 10.1002/ccd.29885. Online ahead of print.

ABSTRACT

OBJECTIVES: We aimed to identify risk factors for major transcatheter aortic valve intervention (TAVI) access site complications based on detailed analysis of the preprocedural computed tomography angiogram (CTA).

BACKGROUND: Transfemoral TAVI has become the treatment of choice for severe aortic stenosis in elderly patients, especially with increased perioperative risk. Frailty, however, favors complications at the vascular access site due to the large bore vascular sheath devices necessary for valve deployment.

METHODS: In this monocentric study, we retrospectively analyzed the preprocedural CTA of 417 consecutive patients that received transfemoral TAVI between 2015 and 2019 to quantify vessel diameter, calcification volume and calcified plaque location in detail within 10 cm proximal to the femoral bifurcation.

RESULTS: The mean age of the study cohort was 81.4 ± 6.5 years with a STS of 8 ± 5.2 representing a population at increased periprocedural risk. 54.4% of patients were female. Major vascular access site complications occurred in 8.2% of patients. Major vascular complications correlated statistically with a sheath-to-vessel diameter (SFAR) when measured 1 cm proximal to the femoral bifurcation using a line-derived diameter and ventral calcification within the first 5 cm proximal to the bifurcation. In contrast, overall calcification volume had no influence.

CONCLUSIONS: Transfemoral TAVI harbors a considerable risk for vascular access site complications especially if vessel diameter is too small to comfortably host the sheath diameter at the area of the femoral bifurcation. For preprocedural TAVI planning and risk assessment, location of calcification, especially if located ventrally, seems to be more relevant than consideration of overall calcification alone.

PMID:34331732 | DOI:10.1002/ccd.29885

Int J Clin Pract. 2021 Jul 31:e14687. doi: 10.1111/ijcp.14687. Online ahead of print.

ABSTRACT

AIM: In the literature, there are no data examining the association with lichen planus with acanthosis nigricans and acrochordon, which are skin findings of metabolic syndrome (MS).

MATERIALS: 108 lichen planus (LP) cases, age and sex-matched 109 controls, 217 cases in total were prospectively included in the study.

RESULTS: Metabolic Syndrome was found in 55 (50.9%) of 108 cases with lichen planus and 36.7% in the control group. The frequency of MS in the lichen planus group was found to be significantly higher than in the control group (p=0.03). The incidence of Acanthosis nigricans (AN) was statistically higher in the LP group (p=0.009). In addition, while 38 of 47 AN patients in the LP group had MS, while 17 of 61 patients without AN had MS, the presence of MS was found significantly higher in LP cases with AN (p˂0.001). The incidence of acrochordon was statistically higher in the LP group (p=0.03). In addition, while 43 of 62 patients with acrochordon in the LP group had MS, 12 of 46 patients without acrochordon had MS, and the presence of MS was found significantly higher in patients with LP with acrochordon (p˂0.001).

CONCLUSION: In our study, it was found that skin findings such as AN and acrochordon increased in patients with lichen planus. This increase was also observed in lichen planus patients with metabolic syndrome. Therefore, the association of acanthosis nigricans and acrochordon may be a predictive of metabolic syndrome in patients with lichen planus admitted to the dermatology outpatient clinic.

PMID:34331725 | DOI:10.1111/ijcp.14687