Nevin Manimala

J Med Virol. 2021 Jul 24. doi: 10.1002/jmv.27226. Online ahead of print.

ABSTRACT

As the emergence of new variants of SARS-CoV-2 persists across the world, it is of importance to understand the distributional behavior of incubation period of the variants for both medical research and public health policy-making. We collected the published individual level data of 941 patients of the 2020-2021 winter pandemic wave in Hebei province, north China. We computed some epidemiological characteristics of the wave and estimated the distribution of the incubation period. We further assessed the covariate effects of sex, age and living with a case with respect to incubation period by a model. The infection-fatality rate was only 0.1%. The estimated median incubation period was at least 22 days, significantly extended from the estimates (ranging from 4 to 8.5 days) of the previous wave in mainland China and those ever reported elsewhere around the world. The proportion of asymptomatic patients was 90.6%. No significant covariate effect was found. The distribution of incubation period of the new variants showed a clear extension from their early generations. This article is protected by copyright. All rights reserved.

PMID:34302700 | DOI:10.1002/jmv.27226

Ophthalmol Ther. 2021 Jul 24. doi: 10.1007/s40123-021-00378-7. Online ahead of print.

ABSTRACT

INTRODUCTION: This was a comparison of laser trabeculoplasty (LTP) outcomes in eyes with prior Kahook Dual Blade (KDB) goniotomy versus in goniotomy-naive control eyes.

METHODS: This was a retrospective matched comparative case series. We identified a cohort of patients undergoing LTP between February 2017 and July 2020 at University of Missouri. Patients were grouped by history of KDB goniotomy versus goniotomy-naivety as a control group. Inclusion criteria included age at least 18 years, minimum of 6 months follow-up after LTP, and minimum period of 6 months between KDB goniotomy and LTP. All KDB procedures were combined with uncomplicated phacoemulsification. Patients who had any additional intraocular pressure (IOP)-lowering procedures between KDB goniotomy and LTP were excluded. Patients in the control group received a single LTP procedure. Primary outcome consisted of the comparison of LTP success, defined as IOP reduction of at least 20% or reduction of glaucoma medications from pre-LTP baseline. Secondary outcomes included IOP and medication reduction from pre-LTP baseline.

RESULTS: Twenty-one eyes of 19 patients with history of KDB goniotomy and 42 eyes of 36 control patients without previous angle or laser procedures were included. Baseline characteristics including age, gender, ethnicity, type and severity of glaucoma, baseline IOP, and baseline medications were matched between groups. The LTP success rate was higher in the control group, but was not statistically significant (64% vs 57%, p = 0.58). IOP reduction was only significant in the control eyes (2.50 ± 4.0 mmHg, p = 0.01 vs 2.35 ± 4.7 mmHg, p = 0.08). The number of glaucoma medications was not significantly reduced in either group.

CONCLUSION: LTP may have a limited IOP- and medication-lowering effect in eyes with a history of KDB goniotomy compared to goniotomy-naive eyes.

PMID:34302639 | DOI:10.1007/s40123-021-00378-7

Biol Trace Elem Res. 2021 Jul 24. doi: 10.1007/s12011-021-02768-1. Online ahead of print.

ABSTRACT

β-thalassemia major is a significant health problem in the world that obliges patient to repeated blood transfusions. Frequent transfusions cause toxic iron overload and the association between serum iron levels and β-thalassemia major have been extensively studied in literature. Nonetheless, data on trace elements is still limited. The aim of this work was to study the relationship between some trace element levels in serum and β-thalassemia major. The quantifications of Al, K, Sn, Sb, Ni, Cr, Cd, Ba, Co, As and Se elements were carried out by Inductively Coupled Plasma – Mass Spectrometry system. Mann Whitney U test is performed in order to test the statistical difference between patient and control groups in terms of their element concentrations. Significant differences were observed for the concentrations of Al, K, Sn and Sb elements and for the correlation between concentrations of K-Sb elements. The study indicates higher levels of Al and Sb, and lower levels of K and Sn elements of patients when compared to control group. These findings reveal the altered profile of serum trace element concentrations and so, further studies are required to evaluate the potential of trace elements as biomarkers and/or to administrate their levels in blood to reduce the related complications.

PMID:34302625 | DOI:10.1007/s12011-021-02768-1

Sleep Breath. 2021 Jul 24. doi: 10.1007/s11325-021-02436-7. Online ahead of print.

ABSTRACT

PURPOSE: Local and systemic inflammatory markers and pro-inflammatory cytokines are increased in children with obstructive sleep apnea syndrome (OSAS). Therefore, systemic or topical anti-inflammatory agents are used to treat this syndrome. We evaluated the treatment with systemic corticosteroids in children with severe OSAS and adenotonsillar hypertrophy before surgery.

METHODS: This was an unblinded open label study. Children with severe OSAS (diagnosed through polysomnography, obstructive apnea-hypopnea index [AHI] > 10 eV/h) were recruited. Exclusion criteria included age < 3 years, history of acute or chronic cardiorespiratory or neuromuscular or metabolic disease; major craniofacial abnormalities; and chromosomal syndromes and epilepsy. Computer-generated random numbers were used for simple randomization of subjects. All children were treated with intranasal beclomethasone spray, and 15 children additionally received oral betamethasone and 0.1 mg/kg per day for 7 days. Sleep clinical record (SCR) and pulsoximetry were performed before and after 7 days in all children.

RESULTS: Among 28 children with severe OSAS mean age was 4.5 ± 1.8 years, AHI 20.4 ± 1.8 eV/h). In children treated with intranasal and oral corticosteroids, mean (95.3 ± 1.1 vs 97.0 ± 0.8%, p = 0.0001) and minimum oxygen saturation (78.8 ± 6.3 vs 89.2 ± 4.2, p = 0.001) improved, and the SCR score (12.6 ± 1.2 vs 8.3 ± 1.1, p = 0.0001) was reduced. Children treated only with intranasal beclomethasone spray showed no differences in outcome measures before and after treatments. When we considered the oximetry measures, after corticosteroid treatment, we obtained statistical differences between the 2 groups (p < 0.01).

CONCLUSIONS: These results seem to suggest that a short course of oral betamethasone could be useful to treat children with severe OSAS and adenotonsillar hypertrophy waiting for surgery.

PMID:34302609 | DOI:10.1007/s11325-021-02436-7

Updates Surg. 2021 Jul 24. doi: 10.1007/s13304-021-01135-y. Online ahead of print.

ABSTRACT

Splenic flexure mobilization (SFM) is one of the most difficult steps in laparoscopic colorectal surgery and its role is harshly debated. Some surgeons considered it routinely necessary to obtain a safe anastomosis and to respect oncologic criteria; for others SFM is frequently unnecessary, not ensuring the aspects mentioned above and increasing the risk of morbidity (splenic, bowel and vessels injury, lengthened procedure). We performed a systematic review and a comprehensive meta-analysis, without any language restriction, about the peri-operative and post-operative outcomes (anastomotic leakage, intra-operative complication, conversion rate, operative time, post-operative bleeding, intra-abdominal collection, prolonged ileus, wound infection, anastomotic stricture, overall complications, hospital stay, re-operation, post-operative mortality, R0 margin resection, local recurrence) in patients undergoing elective anterior rectal resection (ARR) with or without SFM, both in laparotomic (LT) and laparoscopic (LS) approach. Fourteen studies were meta-analyzed with a total amount of 42,221 patients. The comprehensive meta-analysis shows that the mobilization or the preservation (SFP) of the splenic flexure does not statistically influence the incidence of colorectal anastomotic leakage, conversion rate, post-operative bleeding, intra-abdominal collection, prolonged ileus, wound infection, anastomotic stricture, overall complications, hospital stay, re-operation, R0 margin resection, and local recurrence results. The operative time is significantly longer in every group of patients undergoing SFM. The incidence of intra-operative complication is statistically increased in overall patients and also in the LS subgroup of patients undergoing SFM, in which also higher incidence of wound infection and re-operation is shown. The meta-analysis shows that SFM may be considered not necessary to ensure better peri-operative and post-operative outcomes in both LT and LS ARR.

PMID:34302604 | DOI:10.1007/s13304-021-01135-y

Curr Obes Rep. 2021 Jul 24. doi: 10.1007/s13679-021-00446-w. Online ahead of print.

ABSTRACT

PURPOSE OF REVIEW: Telehealth delivery of pediatric weight management interventions may address time, travel, and cost barriers to in-person interventions, thus improving accessibility. This narrative review highlights findings from the past 5 years of pediatric lifestyle interventions for weight management that utilize telehealth for treatment delivery. We describe impressions and future directions.

RECENT FINDINGS: We identified and included 20 studies that described unique interventions from the past 5 years. The majority of reviewed studies indicated statistically significant reductions in BMI z-scores, high retention and attendance, and high satisfaction. However, mean decreases in BMI z-scores were marginal (approximately 0.10) in all but two studies. Studies did not often report effect sizes. Pediatric telehealth weight management interventions demonstrate good feasibility and acceptability. Improvement in reporting results and more rigorous research, including use of randomized designs, recruitment of larger samples, and incorporation of extended follow-up is needed to determine clinical impact and magnitude of effects.

PMID:34302603 | DOI:10.1007/s13679-021-00446-w

J Thromb Thrombolysis. 2021 Jul 24. doi: 10.1007/s11239-021-02531-2. Online ahead of print.

ABSTRACT

Previous intracerebral hemorrhage (ICH) is labelled as a contraindication for the use of intravenous tissue plasminogen activator (IV-tPA) in acute ischemic stroke (AIS) based on expert opinion. However, there is a paucity of data available regarding the benefits and risks of IV-tPA in this population. Recent small retrospective cohort studies reporting its off-label use suggest it may be beneficial. This study aims to investigate the safety and efficacy of IV-tPA in AIS patients with previous ICH. We performed a systematic review and meta-analysis of studies reporting on IV-tPA use in AIS patients with and without previous ICH. We searched Embase, PubMed and Cochrane Library from inception to 20 April 2021. Outcomes measured included symptomatic ICH (sICH), 3-month modified Rankin Scale (mRS) score, and 3-month mortality. We included seven retrospective cohort studies comprising 5760 AIS patients who had received IV-tPA, of which 134 had previous ICH. There was no significant difference in the odds of sICH (OR 1.57, 95% CI 0.78-3.15, p = 0.21) and 3-month mRS (mRS 0-1: OR 0.78, 95% CI 0.37-1.65, p = 0.52; mRS 0-2: OR 1.07, 95% CI 0.36-3.15, p = 0.90) between patients with and without previous ICH. There was a trend towards higher 3-month mortality in patients with previous ICH (OR 1.69, 95% CI 0.98-2.91, p = 0.06), although this did not reach statistical significance. The use of IV-tPA in AIS patients with previous ICH was not associated with an increased risk of sICH or disability at 3 months. Further larger studies are needed to establish the safety and efficacy of IV-tPA use in this population.

PMID:34302590 | DOI:10.1007/s11239-021-02531-2

Oral Maxillofac Surg. 2021 Jul 24. doi: 10.1007/s10006-021-00988-2. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the accuracy of three-dimensional (3D) soft tissue prediction in bimaxillary orthognathic surgery.

METHODS: Cone-beam computed tomographs of 88 patients with class II (n = 46) and class III (n = 42) malocclusions, who underwent bimaxillary orthognathic surgery, were included in this retrospective study. 3D soft tissue prediction and postoperative outcome were compared by using ten landmarks of facial soft tissues. Patients’ sex and age were also assessed. Results were analyzed using a mixed model methodology (p < 0.05).

RESULTS: The success criterion adopted was a mean discrepancy of < 2 mm. Most mandibular landmarks indicated a tendency for underprediction with a downward direction in class II patients, with some values > 2 mm. In class III, there was overprediction with a downward direction for the mandibular landmarks, with values < 2 mm. More accurate results were found in female and older patients.

CONCLUSIONS: 3D surgical planning showed clinically acceptable results for predicting soft tissues in patients undergoing bimaxillary orthognathic surgery, with more accurate results for class III patients. Although some differences were found when age and sex were interacted, a consistent association between these variables could not be stated. These results support the clinician, as accuracy can provide a strong guide to the surgeon when planning surgical orthodontic treatment.

PMID:34302576 | DOI:10.1007/s10006-021-00988-2

Emerg Radiol. 2021 Jul 24. doi: 10.1007/s10140-021-01967-6. Online ahead of print.

ABSTRACT

PURPOSE: To measure the diagnostic accuracy and inter-observer agreement with the use of COVID-19 Reporting and Data System (CO-RADS) for detection of COVID-19 on CT chest imaging.

METHODS: This retrospective study included 164 consecutive patients with clinical suspicion of COVID-19 in whom a CT chest examination was performed at a single institution between April 2020 and July 2020. Of them, 101 patients was RT-PCR positive for COVID-19. Six readers with varying radiological experience (two each of chest radiologists, general radiologists, and radiologists in training) independently assigned a CO-RADS assessment category for each CT chest study. The Fleiss’ K was used to quantify inter-observer agreement. The inter-observer agreement was also assessed based on the duration of onset of symptoms to CT scan. ROC curve analysis was used to determine the diagnostic accuracy of CO-RADS. The area under curve was calculated to determine the reader accuracy for detection of COVID-19 lung involvement with RT-PCR as reference standards. The data sets were plotted in ROC space, and Youden’s J statistic was calculated to determine the threshold cut-off CO-RADS category for COVID-19 positivity.

RESULTS: There was overall moderate inter-observer agreement between all readers (Fleiss’ K 0.54 [95% CI 0.54, 0.54]), with substantial agreement among chest radiologists (Fleiss’ K 0.68 [95% CI 0.67, 0.68]), general radiologists (Fleiss’ K 0.61 [95% CI 0.61, 0.61]), and moderate agreement among radiologists-in-training (Fleiss’ K 0.56 [95% CI 0.56, 0.56]). There was overall moderate inter-observer agreement in early disease (stages 1 and 2), with cumulative Fleiss’ K 0.45 [95% CI 0.45, 0.45]). The overall AUC for CO-RADS lexicon scheme to accurately diagnose COVID-19 yielded 0.92 (95% CI 0.91, 0.94) with strong concordance within and between groups, of chests radiologists with AUC of 0.91 (95% CI 0.88, 0.94), general radiologists with AUC 0.96 (95% CI 0.94, 0.98), and radiologists in training with AUC of 0.90 (95% CI 0.87, 0.94). For detecting COVID-19, ROC curve analysis yielded CO-RADS > 3 as the cut-off threshold with sensitivity 90% (95% CI 0.88, 0.93), and specificity of 87% (95% CI 0.83, 0.91).

CONCLUSION: Readers across different levels of experience could accurately identify COVID-19 positive patients using the CO-RADS lexicon with moderate inter-observer agreement and high diagnostic accuracy.

PMID:34302561 | DOI:10.1007/s10140-021-01967-6

Support Care Cancer. 2021 Jul 24. doi: 10.1007/s00520-021-06434-z. Online ahead of print.

ABSTRACT

PURPOSE: To assess the prevalence and severity of clinically significant symptoms (CSSs) for breast cancer, colon cancer, and leukemia patients undergoing chemotherapy.

METHODS: A retrospective review of the Edmonton Symptom Assessment System scores reported by patients from the database of our previous large-scale study, which was collected between May 2018 and January 2019. We described the prevalence of CSSs in proportion and severity in mean ± SD.

RESULTS: Of 546 cancer patients, 209 were breast cancer, 159 were colon cancer, and 178 were leukemia. The majority of participants were females 345 (63.2%), and the mean age of the entire study sample was 49.4 ± 13.93. Diminished feeling of well-being was the most prevalent CSS across the three cancers, with a statistically significant difference (p < 0.001). Fatigue (6.59 ± 2.07), pain (6.55 ± 2.01), and loss of appetite were the most distressing CSSs (6.49 ± 1.99) across the whole sample. Loss of appetite (6.34 ± 2.05) was the most distressing CSS in breast cancer, fatigue (6.97 ± 2.07) in leukemia, and pain (7.00 ± 2.11) in colon cancer. Statistically significant differences were found in the severity between the three cancer in pain (p < 0.001), fatigue (p = 0.010), nausea (p = 0.001), and diminished feeling of well-being (p = 0.033). Cancer type, sleeping hours, dependence on caregiver, female gender, level of education, and employment were significantly associated with higher odds of CSS severity.

CONCLUSION: Breast and colon cancer and leukemia patients undergoing chemotherapy experience multiple distressing CSSs. Our study validates CSSs as a discrete set of distressing symptoms that may serve and guide quality of care assessment and cancer clinical research, particularly among patients undergoing chemotherapy.

PMID:34302547 | DOI:10.1007/s00520-021-06434-z