Nevin Manimala

J Neurol Surg A Cent Eur Neurosurg. 2021 Apr 12. doi: 10.1055/s-0040-1721017. Online ahead of print.

ABSTRACT

BACKGROUND: The human brain can respond to and participate in music. Learning to play a musical instrument requires complex multimodal skills involving the simultaneous perception of several sensory modalities. In case of brain damage, the musician and nonmusician brains may have different capacities for reorganization and neural remapping. We aimed to investigate the effect of music on patients who had a brain tumor and/or underwent a neurosurgical procedure, comparing the recovery of those who had a musical background with those who did not.

METHODS: A literature review was performed to search for any evidence on this issue. We divided the cases into two groups: as group I consisted of the nonmusician patients, while group II consisted of musicians with a neurosurgical disease. Studies were rated from 0 (no effect) to 4 (high effect).

RESULTS: We found seven published studies as well as case reports. It was observed that the outcomes and quality of life of the musician group were better than those of the control groups or nonmusician patients in all of the investigated studies, but no statistical difference between musicians and nonmusicians was found.

CONCLUSION: Music-related structural changes in the brain may occur in musicians. However with limited number of cases, it cannot be assorted the improved recovery in musicians after neurosurgical disease or procedures by his or her enhanced plasticity. There are limited number of cases, for that reason, it cannot be assorted the improved recovery in musicians after neurosurgical disease or procedures by his or her enhanced plasticity. Professional musicians, who are making a living through their musical abilities, may also have a strong motivation to undergo stressful and enduring rehabilitation. An early restart of the musical activity in musicians with neurosurgical disease may lead to better outcomes, better quality of life, and better psychological parameters, in a shorter time than in nonmusicians.

PMID:33845506 | DOI:10.1055/s-0040-1721017

J Neurol Surg A Cent Eur Neurosurg. 2021 Apr 12. doi: 10.1055/s-0041-1722968. Online ahead of print.

ABSTRACT

BACKGROUND AND STUDY AIMS: Spinal schwannomas are benign slow-growing tumors, and gross total resection is the gold standard of treatment. The conventional surgical approach is laminectomy, which provides a wide working area. Today minimally invasive surgery (MIS) is popular because it is associated with shorter hospital stay, less operative blood loss, minimized tissue traumas and relative postoperative pain, and, and spine surgery, avoidance of spinal instability.

MATERIAL AND METHODS: From January 2016 to December 2019, we operated on 40 patients with spinal intradural extramedullary tumor (schwannoma) with laminectomy or hemilaminectomy. Baseline medical data, including patients’ sex and age, tumor location, days of postoperative bed rest, operative time, length of hospitalization, and 1-month visual analog scale (VAS) value were collected and analyzed. Data analysis was performed using STATA/IC 13.1 statistical package (StataCorp LP, College Station, Texas, United States).

RESULTS: Hemilaminectomy was associated with faster operative time (p < 0.001), shorter postoperative time spent in bed (p < 0.001), and shorter hospitalization (p < 0.001). At 1-month follow-up, the mean VAS score was 4.6 (1.7) among the laminectomy patients and 2.5 (1.3) among the hemilaminectomy patients (p < 0.001). Postoperative complications occurred in 1 (7.7%) and 7 (25.9%) patients in the hemilaminectomy and laminectomy groups, respectively (p = 0.177).

CONCLUSIONS: Unilateral hemilaminectomy has significant advantages compared with laminectomy in spinal schwannoma surgery including shorter operative time, less time spent in bed, shorter hospitalization, and less postoperative pain.

PMID:33845505 | DOI:10.1055/s-0041-1722968

Value Health Reg Issues. 2021 Apr 9;24:199-213. doi: 10.1016/j.vhri.2020.12.010. Online ahead of print.

ABSTRACT

OBJECTIVES: This article explores the consequences of hospitalization expenditure on noncommunicable diseases (NCD) and its impact on out-of-pocket expenditure (OOPE), catastrophic health expenditure, impoverishment, and hardship financing of households in India.

METHODS: Data on hospitalized cases of NCDs from the 3 rounds of National Sample Surveys (NSS) (2004, 2014, 2018) were used. Bivariate and multivariate analyses were conducted to investigate the socioeconomic differentials of the impact of OOPE on catastrophic health expenditure, impoverishment, and exposure to hardship financing.

RESULTS: Rural households had greater exposure to catastrophic health expenditure but urban households had higher risk of impoverishment due to OOPE. Older patients (aged ≥60 years) had the highest hospitalization rate per 100 000, including increase in average healthcare expenditure from 2004 to 2018. At 10% and 30% thresholds, 50% and 25% of the households, respectively, faced catastrophic health expenditure across all the 3 rounds. Due to OOPE on hospitaliation treatment for NCDs, about 3.8%, 7.4% and 4.8% of households fell below poverty line, and percentage shortfall in income for the population from the poverty line was 3%, 4.9% and 3%, in 2004, 2014 and 2018 respectively. Percentage of households facing hardship financing reduced from 49.2% in 2004 to 24.4% 2014 and 12.7% in 2018.

CONCLUSION: OOPE by households are still very high and hence the higher effects of CHE, impoverishment and exposure to hardship financing due to health expenditure in India. This study proposes that along with increase in budgetary allocations for healthcare, the government should develop suitable policies to expand the effectiveness of government-sponsored health insurance, such as developing a specific NCD service package to be included in the health insurance program.

PMID:33845450 | DOI:10.1016/j.vhri.2020.12.010

Am J Emerg Med. 2021 Apr 3;48:73-78. doi: 10.1016/j.ajem.2021.04.005. Online ahead of print.

ABSTRACT

BACKGROUND: Emergency Department (ED) patients who leave without being seen (LWBS) are associated with adverse safety and medico-legal consequences. While LWBS risk has been previously tied to demographic and acuity related factors, there is limited research examining crowding-related risk in the pediatric setting. The primary objective of this study was to determine the association between LWBS risk and crowding, using the National Emergency Department Overcrowding Score (NEDOCS) and occupancy rate as crowding metrics.

METHODS: We performed a retrospective observational study on electronic health record (EHR) data from the ED of a quaternary care children’s hospital and trauma center during the 14-month study period. NEDOCS and occupancy rate were calculated for 15-min windows and matched to patient arrival time. We leveraged multiple logistic regression analyses to demonstrate the relationship between patientlevel LWBS risk and each crowding metric, controlling for characteristics drawn from the pre-arrival state. We performed a chi-squared test to determine whether a difference existed between the receiver operating characteristic (ROC) curves in the two models. Finally, we executed a dominance analysis using McFadden’s pseudo-R 2 to determine the relative importance of each crowding metric in the models.

RESULTS: A total of 54,890 patient encounters were studied, 1.22% of whom LWBS. The odds ratio for LWBS risk was 1.30 (95% CI 1.27-1.33) per 10-point increase in NEDOCS and 1.23 (95% CI 1.21-1.25). per 10% increase in occupancy rate. Area under the curve (AUC) was 86.9% for the NEDOCS model and 86.7% for the occupancy rate model. There was no statistically significant difference between the AUCs of the two models (p-value 0.27). Dominance analysis revealed that in each model, the most important variable studied was its respective crowding metric; NEDOCS accounted for 55.6% and occupancy rate accounted for 53.9% of predicted variance in LWBS.

CONCLUSION: Not only was ED overcrowding positively and significantly associated with individual LWBS risk, but it was the single most important factor that determined a patient’s likelihood of LWBS in the pediatric ED. Because occupancy rate and NEDOCS are available in real time, each could serve as a monitor for individual LWBS risk in the pediatric ED.

PMID:33845424 | DOI:10.1016/j.ajem.2021.04.005

J Surg Res. 2021 Apr 9;264:316-320. doi: 10.1016/j.jss.2021.03.016. Online ahead of print.

ABSTRACT

BACKGROUND: Current thyroid hormone replacement therapy (THRT) is built on weight-based standard calculation of dose. A novel Poisson regression model, which accounts for seven clinical variables, was recently proposed to improve accuracy of THRT. We aimed to compare the accuracy of estimated THRT dose to reach euthyroid and the difference in predicted dose between the Poisson (scheme A) and the weight-based standard (scheme B) in patients following total thyroidectomy for benign disease.

METHODS: We retrospectively reviewed medical record of patients who underwent total or completion thyroidectomy for benign disease at a single institution between 2011 and 2019. The THRT dose was calculated using both schemes. We compared the difference between calculated THRT and prediction rates for optimal THRT dosing needed to achieve a euthyroid state between dosing schemes. Patients were evaluated for achieving euthyroid state, defined as TSH 0.45-4.5 mIU/L. We also compared dosing error rates (> 25 mcg over- and underdosing) between schemes. Prediction rates were compared by BMI tertiles to account for the effect of BMI extremes in achieving euthyroid state. The difference in predicted dose between schemes was calculated in both the total sample size and patients that met euthyroid. A measure of agreement, Kappa, was used to estimate agreement between dosing schemes.

RESULTS: A total of 406 patients underwent total thyroidectomy for benign disease, with 184 having sufficient follow up data confirming euthyroid state. Of the 184 patients, 85.9% (n = 158) were women, 81% (n = 149) were Hispanic, and 56.5% (n = 104) were obese with a median BMI of 30.8 kg/m2. Scheme A resulted in a higher, but not statistically significant, accuracy rate (A: 60.3%, n = 111 versus B: 53.8%, n = 99; P = 0.21). Overdosing errors were lower with Scheme A (A:17.9% versus B: 32.1%; P = 0.0025) and less extreme > 25 µg (A: 17.9% versus B: 26.1%; P = 0.08). A trend in improved accuracy in patients with a BMI > 35 kg/m2 was noted (A: 46.9% versus B: 34.4%; P = 0.20). Scheme A also resulted in less overdosing errors in obese patients compared to Scheme B (A: 19.2% versus 45.2%; P = 0.0006). The average difference in predicted dose between schemes was an entire dose difference, mean of 16.0 µg and 15.8 µg for the total and euthyroid samples respectively. Furthermore, for the majority of patients the predicted dose did not match between the two dosing schemes for total and euthyroid samples, 76% (n = 311) and 76% (n = 141) respectively. In patients that achieved euthyroid, agreement between dosing schemes was low to moderate (Kappa = 0.360).

CONCLUSIONS: Lower rates of overdosing were found for scheme A, particularly with obese patients. No statistically significant differences in predicted THRT dose was observed between schemes. The difference in predicted dose between schemes was on average 15 ug, correlating with an entire dose. The consideration of clinical variables other than weight (scheme A) when determining optimal THRT dosing may be of importance to prevent overdoses, with particular clinical relevance in patients with higher BMIs.

PMID:33845415 | DOI:10.1016/j.jss.2021.03.016

Clin Neurol Neurosurg. 2021 Mar 25;205:106610. doi: 10.1016/j.clineuro.2021.106610. Online ahead of print.

ABSTRACT

INTRODUCTION: The relationship between degree of surgical overlap and adverse postoperative outcomes remains poorly defined. This study aims to evaluate the impact of increasing duration of overlap on lumbar fusion outcomes.

PATIENTS AND METHODS: 1302 adult patients undergoing overlapping surgery during single-level, posterior-only lumbar fusion at a multi-hospital, university health system were retrospectively assessed. Amount of overlap was calculated as a percentage of total overlap time. Patients were separated into groups with the most (top 10% of patients) and least amounts of overlap (bottom 40% of patients). Using Coarsened Exact Matching, patients with the most and least amounts of overlap were matched on demographics alone, then on both demographics and attending surgeon. Univariate analysis was performed for the whole population and both matched cohorts to compare amount of overlap to risk of adverse postsurgical events. Significance for all analyses was p-value < 0.05.

RESULTS: Duration of overlap was not associated with outcomes in the whole population, demographic-matched, or surgeon-matched analyses. Before exact matching, patients with the most amount of overlap had a significantly higher CCI score (p = 0.031) and shorter length of surgery (p = 0.006). In the demographic matched cohort, patients with increased overlap had a significantly shorter length of surgery (p = 0.001) only. In the surgeon matched cohort, there were no differences in length of surgery or CCI score.

CONCLUSIONS: Duration of surgical overlap does not predict adverse outcomes following lumbar fusion. These results suggest that overlapping surgery is a safe practice within this common neurosurgical indication.

PMID:33845404 | DOI:10.1016/j.clineuro.2021.106610

Biomed Pharmacother. 2021 Apr 9;139:111559. doi: 10.1016/j.biopha.2021.111559. Online ahead of print.

ABSTRACT

BACKGROUND: In a previous drug-drug interaction (DDI) screening study intended to generate hypotheses, clopidogrel + either eszopiclone or zolpidem (vs. clopidogrel alone) were associated with serious bleeding.

OBJECTIVES: To confirm or refute these DDI signals and examine associations with other hypnotics in an independent population of United States Medicaid beneficiaries METHODS: We employed a bi-directional self-controlled case series design in eligible individuals concomitantly exposed to one of 12 hypnotics (precipitants, exposures of interest) plus either clopidogrel (the object drug) or pravastatin (the negative control object drug). The outcome was hospital presentation with serious bleeding. Using conditional Poisson regression, we calculated confounder-adjusted rate ratios (RRs) and 95% confidence intervals for serious bleeding during clopidogrel + precipitant use (vs. clopidogrel alone). To distinguish a DDI from a precipitant’s inherent effect on bleeding, we divided effect measures by the adjusted RR for the corresponding pravastatin + precipitant pair to obtain ratios of RR (RRRs).

RESULTS: Among 23,194 users of clopidogrel and 3824 of pravastatin who experienced serious bleeding during an active prescription for one of these agents, confounder-adjusted RRRs for serious bleeding were 6.63 (0.39-113.01) and 0.77 (0.53-1.11) with eszopiclone and zolpidem, respectively, whereas confounder-adjusted RRRs for other hypnotics ranged from 0.18 (0.04-0.85) for triazolam to 1.79 (0.16-20.44) for zaleplon. Statistical imprecision therefore precluded us from confirming or refuting these prior signals with eszopiclone and zolpidem.

CONCLUSIONS: While we could not confirm or refute previously identified DDI signals, numerically elevated RRRs for serious bleeding with several clopidogrel + hypnotic pairs warrant further examination.

PMID:33845372 | DOI:10.1016/j.biopha.2021.111559

Clin Biomech (Bristol, Avon). 2021 Mar 24;84:105333. doi: 10.1016/j.clinbiomech.2021.105333. Online ahead of print.

ABSTRACT

BACKGROUND: Patellar instability is a considerable problem that leads to pain and anxiety during simple functional tasks. Femoral derotational osteotomy has become a common surgical procedure to improve patella mechanics, stability and loading. However, it remains unclear if static (MRI measured) femoral anteversion is sufficient to capture the dynamic femoral rotation during walking and represents a good indication for the surgical procedure. This research investigates the relationship between static femoral anteversion and internally rotated gait in adolescents with patellofemoral instability.

METHODS: This retrospective study included 30 adolescents with recurrent patella instability (minimum three patella dislocations) aged 12 to 18 years (28 female/2 male; 22 unilateral/8 bilateral). All participants were assessed with 3D gait analysis and the femoral anteversion was examined using a rotational MRI. Multiple kinematic parameter were correlated with the ipsilateral femoral anteversion and tibia torsion using the Pearson coefficient.

FINDINGS: The correlation between parameters of dynamic hip rotation (e.g. maximum and mean internal hip rotation in stance and swing) and MRI measured femoral anteversion (mean 26.5° ± 9°) was weak and did not reach statistical significance. We found 47% (14 out of 30) subjects with increased femoral anteversion but normal hip rotation in stance.

INTERPRETATION: There was no relationship between increased femoral anteversion and dynamic hip rotation. Consequently, femoral anteversion should not be used as the only indication for femoral derotational osteotomy. Three-dimensional gait analysis might be necessary to assess the appropriate surgical intervention in adolescents with patello femoral instability.

PMID:33845347 | DOI:10.1016/j.clinbiomech.2021.105333

Epilepsy Behav. 2021 Apr 9;118:107945. doi: 10.1016/j.yebeh.2021.107945. Online ahead of print.

ABSTRACT

BACKGROUND: The identification of hyperperfusion on ictal single-photon emission computed tomography (SPECT) scan is a technique for the localization of the epileptogenic zone (EZ) in patients with focal epilepsy undergoing presurgical evaluation. The accuracy of this technique has been improved by subtraction from an interictal image and coregistration with magnetic resonance imaging (MRI) (subtraction ictal SPECT coregistered to MRI (SISCOM)), and subsequently by the development of Statistical Ictal SPECT Co-registered to MRI (STATISCOM) which is reported to further improve localization accuracy by statistically accounting for random variation between images. However, the use of ictal SPECT is limited by the necessity for rapid injection of the radiotracer. The purpose of this study was to investigate the effect of tracer injection time on EZ localization rates using both STATISCOM and SISCOM.

METHODS: Consecutive patients with drug-resistant focal epilepsy who had an ictal SPECT scan while admitted to the video-electroencephalography (EEG) monitoring unit at the Royal Melbourne Hospital, Victoria, Australia, and a subsequent interictal scan, between 2009 and 2017 were included. The information collected included age, sex, seizure type, epilepsy diagnosis, and injection time. Statistical Ictal SPECT Co-registered to MRI and SISCOM images were generated and reviewed by two blinded reviewers. The rates of potential localization of the EZ, and the agreement with the EEG, were determined for each scan. Localization rates were compared between ictal scans with different radiotracer injection time windows (<30 s, 30-45 s, 45-60 s, 60-90 s, 90-120 s, >120 s).

RESULTS: Seventy patients (male = 32, 16-67 years) were included in the study. Overall agreement between the primary raters was moderate for STATISCOM (k = 0.44) and SISCOM (k = 0.57). The ability of SPECT to localize the potential EZ was 69% (48/70) for STATISCOM and 59% (41/70) for SISCOM. Injection time was not associated with the rate of localizing the potential EZ for STATISCOM (p = 0.64), whereas for SISCOM there was a trend that shorter injection times were associated with better ability to localize the potential EZ (p = 0.06). Agreement between SPECT and video-EEG data was 54% (38/70) for STATISCOM and 39% (27/70) for SISCOM. Statistical Ictal SPECT Co-registered to MRI did not show any difference of agreement across injection time groups (p = 0.42) whereas SISCOM showed better agreement with video-EEG data in the earlier injection time groups (p = 0.02). No differences in agreement between SPECT and video-EEG data were seen between patients with and without MRI lesions for either STATISCOM or SISCOM. Statistical Ictal SPECT Co-registered to MRI showed significantly better agreement for temporal than extratemporal seizures, with no difference of agreement between early (<45 s) and late (>45 s) injections.

CONCLUSION: Statistical Ictal SPECT Co-registered to MRI showed overall higher agreement rates with EZ localization by video-EEG than SISCOM, which was not affected by the injection times. Statistical Ictal SPECT Co-registered to MRI may provide localizing information for “late” injections where visual reads and SISCOM are inconclusive.

PMID:33845344 | DOI:10.1016/j.yebeh.2021.107945

Plant Physiol Biochem. 2021 Apr 4;163:139-153. doi: 10.1016/j.plaphy.2021.03.059. Online ahead of print.

ABSTRACT

In this study, the effects of three halotolerant rhizobacterial isolates AL, HR, and SB, which are able to grow at a salinity level of 1600 mM NaCl, with multiple plant growth promoting (PGP) traits on some seed and forage quality attributes, and vegetative, reproductive, biochemical and physiological characteristics of wheat plant irrigated with saline water (0, 40, 80, and 160 mM NaCl) were investigated. The ability of halotolerant bacterial isolates to produce PGP traits was affected by salinity levels, depending upon the bacterial isolates. Salinity stress significantly affected the yield, quality, and growth of wheat by modifying the morpho-physiological and biochemical traits of the exposed plants. However, all three bacterial isolates, especially isolate AL, significantly improved the biochemical (an increase in K⁺/Na⁺ ratio by 55%, plant P content by 50%, and plant Ca content by 31%), morphological (an increase in stem dry weight by 52%, root dry weight by 44%, spike dry weight by 34%, and grain dry weight by 43%), and physiological (an increase in leaf proline content by 50% and total phenol in leaf by 42%) attributes of wheat and aided the plant to tolerate salinity stress in contrast to un-inoculated plant. Plants inoculated with bacterial isolates showed significantly improved seed amylose by 36%, leaf crude protein by 30%, leaf metabolic energy by 37%, and leaf water-soluble sugar content by 34%. Among the measured PGP and plant attributes, bacterial auxin and plant K content were of key importance in increasing reproductive performance of wheat. The bacterial isolates AL, HR, and SB were identified as Bacillus safensis, B. pumilus, and Zhihengliuella halotolerans, respectively, based on 16 S rDNA sequence. The study reveals that application of halotolerant plant growth-promoting rhizobacteria isolated from halophytic rangeland plants can be a cost effective and ecological sustainable method to improve wheat productivity, especially the attributes related to seed and forage quality, under salinity stress conditions.

PMID:33845330 | DOI:10.1016/j.plaphy.2021.03.059