Nevin Manimala

Int J Clin Pract. 2021 Feb 26:e14115. doi: 10.1111/ijcp.14115. Online ahead of print.

ABSTRACT

AIMS: To evaluate the effect of pre-RIRS ESWL on the efficiency and safety of RIRS in the treatment of proximal ureter stones.

METHODS: The patients in the study population were divided into 2 groups. Group-1 was composed of patients who had undergone ESWL for proximal ureter stones before RIRS, and Group-2 was composed of patients who directly underwent RIRS without any prior ESWL. The clinical and demographic properties of the patients were analysed in the RIRSearch database. The operative outcomes, peroperative complications, postoperative complications, hospitalization time and the stone-free rates were compared between the groups.

RESULTS: There were 56 patients in Group-1 and 95 patients in Group-2. The demographic and clinical properties were similar between the groups. The stone-free rates, peroperative complications and postoperative complications were also similar between the groups; however, the fluoroscopy time was significantly higher in Group-1 (p=.043). The cut-off duration of 10 weeks between ESWL and RIRS had reasonable/favourable discriminating ability, with a 51% sensitivity and 88% specificity rate for stone-free status.

CONCLUSION: Performing ESWL on the proximal ureter stones before RIRS did not change the efficacy and safety of RIRS. The time between the patient’s last ESWL session and RIRS had a predictive value for stone-free status, but did not have any effect on complications.

PMID:33636023 | DOI:10.1111/ijcp.14115

Stapp Car Crash J. 2020 Nov;64:1-30.

ABSTRACT

The CORA rating metric is frequently used in the field of injury biomechanics to compare the similarity of response time histories. However, subjectivity exists within the CORA metric in the form of user-customizable parameters that give the metric the flexibility to be used for a variety of applications. How these parameters are customized is not always reported in the literature, and it is unknown how these customizations affect the CORA scores. Therefore, the purpose of this study was to evaluate how variations in the CORA parameters affect the resulting similarity scores. A literature review was conducted to determine how the CORA parameters are commonly customized within the literature. Then, CORA scores for two datasets were calculated using the most common parameter customizations and the default parameters. Differences between the CORA scores using customized and default parameters were statistically significant for all customizations. Furthermore, most customizations produced score increases relative to the default settings. The use of standard deviation corridors and exclusion of the corridor component were found to produce the largest score differences. The observed differences demonstrated the need for researchers to exercise transparency when using customized parameters in CORA analyses.

PMID:33636001

J Wildl Dis. 2021 Jan 6;57(1):242-245. doi: 10.7589/JWD-D-20-00095.

ABSTRACT

We determined venous blood gas, acid-base, and biochemical parameters for thirteen free-ranging Indian flying foxes (Pteropus giganteus) in Myanmar, using a handheld i-STAT analyzer with CG8+ and CHEM8 cartridges. For field-based projects, portable blood analyzers enable identification and management of electrolyte and acid-base imbalances and collection of physiologic data, but present logistical challenges.

PMID:33635999 | DOI:10.7589/JWD-D-20-00095

J Wildl Dis. 2021 Jan 6;57(1):60-70. doi: 10.7589/JWD-D-20-00011.

ABSTRACT

The warthog (Phacochoerus africanus) can be used as a model for investigating disease transmission at the human, wildlife, and livestock interface. An omnivore and scavenger, a warthog moves freely between natural ecotypes, farmland, and human communities and is susceptible to diseases of zoonotic, agricultural, and conservation concern. A retrospective study using 100 individual serum samples collected from May 1999 to August 2016 was performed to determine antibody prevalence to seven pathogens in warthogs from five locations in northeastern South Africa. Higher prevalence of antibodies to African swine fever virus and Mycobacterium bovis were detected in warthogs from the Greater Kruger National Park ecosystem in comparison to lower prevalence of antibodies to M. bovis and no antibodies to African swine fever virus in warthogs from uMhkuze Game Reserve. Low prevalence of antibodies to foot-and-mouth disease virus, Rift Valley fever virus, and influenza A virus was detected in all locations, and no antibodies against Brucella and Leptospira spp. were detected. No statistically significant difference in antibody prevalence was found between sexes for any disease. At the univariate analysis, M. bovis seropositivity was significantly different among age categories, with 49% (35/71) of adults found positive versus 29% (4/14) of juveniles and 9% (1/11) of sub-adults (Fisher’s exact test, P=0.020), and between the sampling locations (Fisher’s exact test, P=0.001). The multivariate model results indicated that juvenile warthogs had lower odds of testing positive to M. bovis antibodies than adults (juveniles’ odds ratio [OR]=0.17, 95% confidence interval [CI]: 0.02-1.0), although this result was not statistically significant at the 5% level (P=0.052). For warthogs sampled at Satara Buffalo Camp, the odds (OR=0.22, 95% CI: 0.035-0.96) of being M. bovis antibody positive were significantly lower (P=0.043) than for warthogs sampled at Skukuza. Of particular interest in this study was the detection of warthogs seropositive for influenza A virus.

PMID:33635986 | DOI:10.7589/JWD-D-20-00011

J Wildl Dis. 2021 Jan 6;57(1):104-115. doi: 10.7589/JWD-D-19-00001.

ABSTRACT

Canine distemper virus (CDV) has a broad mammalian host range. In Ontario, Canada, CDV is frequently encountered in wild carnivores and is the most common infectious cause of death for raccoons (Procyon lotor). The isolation of wild-type CDV strains genetically distinct from vaccine strains in North America has renewed interest in the epidemiological patterns of this virus. However, wildlife surveillance is challenging and often utilizes a combination of surveillance methods with aggregation of data from multiple sources. Our objective was to compare raccoon CDV data generated through two separate surveillance components operated by the Ontario-Nunavut node of the Canadian Wildlife Health Cooperative. The raw data generated by each component in addition to the results of multilevel logistic regression and spatial scan statistics, were compared between the datasets. A total of 498 raccoons obtained via passive surveillance between 2007 and 2017 and 887 raccoons obtained via enhanced-passive surveillance between 2014 and 2017, were tested for CDV. The number and geographic distribution of reports, proportion of yearly reports classified as CDV-positive, and characteristics of CDV-positive raccoons differed between passive and enhanced-passive surveillance components. Geographical data demonstrated that CDV infection was present throughout southern Ontario. The geographic area of both surveillance components combined was more representative than either passive or enhanced-passive surveillance in isolation; but was restricted compared to the overall distribution of raccoons in Ontario. Regression analyses produced statistically significant associations between the presence of CDV and host and environmental variables that were at times discordant between the two datasets. Studying the properties of these datasets will inform future passive wildlife surveillance strategies and highlights the impact that a surveillance strategy can have on the results of epidemiological analyses.

PMID:33635985 | DOI:10.7589/JWD-D-19-00001

J Wildl Dis. 2021 Jan 6;57(1):184-188. doi: 10.7589/JWD-D-20-00002.

ABSTRACT

Hunting activities are a potential risk factor for human infection with Leptospira spp. and, although wild boar seroprevalence has been studied, there are no concurrent serosurveys of wild boars (Sus scrofa), hunting dogs (Canis lupus familiaris), and hunters. The aim of our study was to assess the seroprevalence of Leptospira spp. antibodies in free-ranging wild boars, hunting dogs, and hunters, and risk factors associated with exposure in southern and central-western Brazil. Leptospira spp. antibodies were serologically detected using the microscopic agglutination test, with a total 30 serovars. Overall, 12.2% (9/74) of wild boars and 10.6% (16/170) of hunting dogs were seropositive for at least one serovar and all hunters 0.0% (0/49) were seronegative for Leptospira spp. Seropositivity was statistically higher in 42.1% (8/19) wild boars from natural areas when compared to 2.4% (1/41) from anthropized areas (P<0.001), with prevalence ratio of 17.14 (95% confidence interval: 2.29-128.36). Despite the limited sample size, our findings showed that hunters may be less exposed to Leptospira spp. than are wild boars, particularly in natural areas where Leptospira spp. may be maintained by wild reservoirs. In addition to acting as sentinels, hunting dogs may play a role in disease transmission of sylvatic leptospiral serovars.

PMID:33635982 | DOI:10.7589/JWD-D-20-00002

J Wildl Dis. 2021 Jan 6;57(1):194-198. doi: 10.7589/JWD-D-20-00007.

ABSTRACT

Chronic wasting disease (CWD) of white-tailed deer (Odocoileus virginianus) is a fatal neurologic disease that is spreading across North America. A common surveillance protocol for CWD currently involves screening with an enzyme-linked immunosorbent assay (ELISA) followed by confirmatory testing with immunohistochemistry (IHC). Medial retropharyngeal lymph nodes (MRPLN) are the tissue of choice to diagnose CWD in free-ranging white-tailed deer. We examined left and right MRPLN from 101 ELISA-positive deer harvested from 2015 to 2019 to determine the prevalence of cases in which prion protein was not detected by IHC as well as differences in IHC labeling between contralateral lymph nodes. Prion protein was not detected using IHC in either MRPLN in 5.9% (6/101) of cases. There was a significant but weak positive relationship between the number of IHC-positive follicles and ELISA optical density values (R2=0.08, P=0.039). Mean optical density values in IHC-positive MRPLN were higher than in IHC-negative MRPLN; however, this was not statistically significant (P=0.260). Failure to confirm ELISA diagnoses with IHC may have been because the methods tested different areas of MRPLN, or that there were differences in test sensitivity or antibody affinity. An additional 5.9% (6/101) of cases had one IHC-positive MRPLN, whereas the contralateral MRPLN was IHC negative. Therefore, testing a single MRPLN for CWD may lead to false-negative results, regardless of methodology, which highlights the importance of collecting and testing both MRPLN.

PMID:33635974 | DOI:10.7589/JWD-D-20-00007

Arch Pathol Lab Med. 2021 Feb 26. doi: 10.5858/arpa.2020-0441-OA. Online ahead of print.

ABSTRACT

CONTEXT.—: In laboratory testing for monoclonal gammopathies, paraproteins are identified via serum immunofixation or serum immunosubtraction and immunoturbidimetric quantitation of serum immunoglobulins is often used.

OBJECTIVE.—: To evaluate methodic differences between serum immunofixation and serum immunosubtraction as well as in the quantitation of serum immunoglobulins on different clinical chemical platforms.

DESIGN.—: Three hundred twenty-two unique routine patient samples were blinded and used for comparison between serum immunofixation on Sebia’s HYDRASIS 2 and serum immunosubtraction on Sebia’s CAPILLARYS 2 as well as between quantitation results of immunoglobulin A, G, and M on Abbott’s ARCHITECT c16000PLUS and Roche’s Cobas c 502 module. Microsoft Excel 2019 with the add-on Abacus 2.0 and MedCalc were used for statistical analysis and graphic depiction via bubble diagram, Passing-Bablok regressions, and Bland-Altman plots.

RESULTS.—: The median age of patients was 75 years and samples with paraproteinemia were nearly evenly split between sexes. Paraprotein identification differed remarkably between immunofixation and immunosubtraction. Quantitation of serum immunoglobulins showed higher values on Abbott’s ARCHITECT c16000PLUS when compared with Roche’s Cobas c 502 module.

CONCLUSIONS.—: Identification of paraproteins via serum immunosubtraction is inferior to serum immunofixation, which can have implications on the diagnosis and monitoring of patients with monoclonal gammopathy. If immunoturbidimetric quantitation of immunoglobulins is used for follow-up, the same clinical-chemical platform should be used consistently.

PMID:33635966 | DOI:10.5858/arpa.2020-0441-OA

J Am Osteopath Assoc. 2021 Mar 1;121(3):247-253. doi: 10.1515/jom-2020-0280.

ABSTRACT

CONTEXT: Research has been scarce on health professionals’ knowledge about guidelines regulating service dogs in a clinical setting. Gaining insight into health professionals’ understanding of Americans with Disabilities Act (ADA) regulations concerning service dogs is critical for navigating compliance and reducing risk. Misinformation about service dogs could influence decisions affecting policy and care, leading to poor treatment and suboptimal health outcomes for patients with service animals.

OBJECTIVES: To assess health professionals’ knowledge about ADA regulations and beliefs about workplace protocols and training related to service dogs.

METHODS: The study used snowball sampling to distribute surveys to health professionals from around the United States. Initial outreach occurred using mailing lists, investigators’ personal networks, and social media. The survey contained 24 items. True and false questions were used to test ADA knowledge and then coded as correct or incorrect. Most closed-end questions were measured on a 5-point Likert scale using frequencies and descriptive statistics. A one-way analysis of variance (ANOVA) was conducted to test whether variables, such as encounters to service dogs, affected knowledge of ADA requirements.

RESULTS: The survey was completed by 441 health professionals from around the country. Most (234; 53.1%) worked in a hospital and came from a range of professional backgrounds (nurses, 155 [35.2%]; physicians, 71 [16.1%]). While nearly three-quarters (318 [73.1%]) of participants said their workplace had a policy on service animals, 113 (34.9%) of those said they were unfamiliar with the policy and 236 (54.5%) said they had not received adequate training on the topic. Most participants did not know basic ADA policy requirements related to service dogs. Only those who were extremely familiar with policy (F=4.613; p=0.001) and those who strongly agreed that they knew the differences between service dogs and other classes of animals (F=5.906; p=0.000) scored higher on the knowledge test than those who disagreed.

CONCLUSIONS: Our results suggest that increased familiarity and training leads to higher knowledge about service dogs and ADA policy. Health professionals need additional education on ADA service dog regulations and hospital policy in order to minimize risk and ensure patients with service dogs receive optimal care.

PMID:33635961 | DOI:10.1515/jom-2020-0280

J Am Osteopath Assoc. 2021 Mar 1;121(3):281-286. doi: 10.1515/jom-2020-0202.

ABSTRACT

CONTEXT: There has been a steady increase in the number of osteopathic (DO) medical students in the United States without a corresponding increase in DO representation in competitive specialties.

OBJECTIVES: To investigate the trends and impact of the Accreditation Council for Graduate Medical Education (ACGME) single accreditation system on DO match rates into dermatology and other competitive specialty programs.

METHODS: Information was collected through public databases (Electronic Residency Application Service [ERAS]; National Resident Matching Program [NRMP]; Association of American Medical Colleges [AAMC]; National Match Service, Inc. [NMS]; and the ACGME) to evaluate the match statistics of competitive specialties, including dermatology, otolaryngology, orthopedic surgery, neurosurgery, and plastic surgery. Residency program and medical school websites and residency communications were used to confirm whether the match placements were to programs that had traditionally been ACGME-accredited or former American Osteopathic Association (AOA) programs.

RESULTS: From 2012 to 2016 (pre-unification), osteopathic graduates comprised only 0.5% of the matches the specific specialties studied here and only 0.9% of ACGME dermatology positions. Post-unification (2017-2019), DOs comprised 2.0% of the matches into these specialties and 4.4% of the total ACGME dermatology positions. This apparent increase is misleading, as it is solely due to the transition of formerly AOA programs to ACGME status. The true post-unification DO match rate to traditionally ACGME programs is actually 0.6% for all competitive specialties and 0.4% for dermatology. Post-unification, 27.6% of formerly AOA positions in these competitive specialties were filled by allopathic (MD) applicants.

CONCLUSIONS: DO match rates into dermatology and other competitive specialties were poor prior to GME unification and continue to remain low. This situation, when coupled with the closing of many AOA programs and MDs matching into former AOA positions, threatens the future of osteopathic physicians in competitive specialties. Osteopathic recognition is one way to potentially help preserve osteopathic representation and philosophy in the single accreditation system era. Programs should not be hesitant to consider osteopathic applicants for competitive specialties.

PMID:33635959 | DOI:10.1515/jom-2020-0202