Nevin Manimala

Med Clin (Barc). 2021 Aug 6:S0025-7753(21)00393-6. doi: 10.1016/j.medcli.2021.04.032. Online ahead of print.

ABSTRACT

INTRODUCTION AND OBJECTIVES: Hypertension is one of the main cardiovascular risk factors. An educational intervention, aimed at increasing or reinforcing the patient’s knowledge, can contribute to better control of their blood pressure. Our goal was to evaluate the efficacy of a continuing therapeutic education versus an initial intervention in hypertensive patients.

METHODS: Experimental study of multicenter community intervention, through the application of a therapeutic education program in hypertension.

RESULTS: 980 patients on antihypertensive treatment were included, 490 in each group, with a mean age of 65 years, and 50% women, baseline mean SBP in both groups was136 mmHg. Regarding knowledge about hypertension, although a similar initial improvement was observed in both groups, at the end of the study, in the continuous intervention group (CIG) an average of 23.06 correct answers was observed, while in the Initial intervention group (IIG) the mean was 20.91, being the difference statistically significant (p < 0.001). At the end of the study, the mean SBP was 127.5 mmHg in the CIG and 136.57 mmHg in the IIG group. Likewise, a lower percentage of patients with a BMI ≥25 was observed in the CIG (78.2%) than in the IIG 82.6%, this difference being statistically significant (p < 0.001). This same effect was observed on the abdominal perimeter, observing an increased abdominal perimeter in 46.3% of the CIG compared to 68.8% in the IIG (p < 0.001). CONCLUSIóN: A continuous educational intervention increases the degree of knowledge about hypertension compared to an initial intervention. Likewise, this intervention is associated with an improvement in blood pressure, weight, body mass index and abdominal girth figures.

PMID:34373072 | DOI:10.1016/j.medcli.2021.04.032

J Clin Neurosci. 2021 Sep;91:93-98. doi: 10.1016/j.jocn.2021.06.011. Epub 2021 Jul 3.

ABSTRACT

The purpose of this study was to assess the change of dynamic alignment after the short and intensive rehabilitation (SHAiR) program in patients with dropped head syndrome (DHS). Eighteen patients with DHS patients who complained of their inability to maintain horizontal gaze and underwent the SHAiR program. Patients performed level walking at a self-selected speed. Spatiotemporal, kinematic, and kinetic data were recorded using a three-dimensional motion analysis system. Statistical analysis was performed to compare these data before and after the SHAiR program. Those who underwent the SHAiR program showed a significant increase in the head angle and stride length compared to pre-treatment measurements (p < 0.05). The SHAiR program modifies the malalignment of the head and neck and spatiotemporal parameters in DHS patients during level walking.

PMID:34373067 | DOI:10.1016/j.jocn.2021.06.011

J Clin Neurosci. 2021 Sep;91:391-395. doi: 10.1016/j.jocn.2021.04.006. Epub 2021 Aug 2.

ABSTRACT

BACKGROUND: Large supratentorial intraparenchymal hemorrhages are managed emergently with image-guided catheters that aim to minimize injury to surrounding parenchyma. Robotic assistance may offer advantages for stereotactic guidance and placement of such catheters. We describe our center’s experience with minimally invasive ROSA-assisted intraventricular and intraparenchymal hemorrhage catheter placement and delineate its safety and outcomes.

METHODS: A retrospective analysis was performed including all patients with intraparenchymal hematoma that underwent ROSA-assisted intraparenchymal and intraventricular catheter placement at the University of Pittsburgh Medical Center between 2017 and 2019. All patients received tissue plasminogen activator (tPA) through the intraparenchymal catheter. We performed a manual chart review of these patients. Pertinent clinical and radiological characteristics and patient outcomes were recorded and analyzed. Catheter trajectory was independently quantified and analyzed by two independent reviewers. Error between the planned trajectory and final position was calculated and analyzed.

RESULTS: Four patients (2 males and 2 females, mean age of 64 years) with deep brain large volume intraparenchymal hemorrhages were treated with catheter evacuation with robotic assistance. For 2 of the 4 patients, thin-cut CT imaging allowed for the real trajectory of the catheter to be compared to the targeted trajectory to calculate error. The mean error of catheter placement was 3.48 mm. ROSA-assisted catheter placement achieved up to 95% reduction of intraparenchymal hematoma volume with a statistically significant decrease following catheter drainage (pre- 51.8 ± 19.1 cc vs. post- 13.0 ± 14.4; p < 0.01).

CONCLUSION: Robotic stereotactic assistance offers a safe and sufficiently accurate technique for intraparenchymal hematoma and intraventricular catheter placement.

PMID:34373057 | DOI:10.1016/j.jocn.2021.04.006

Br J Clin Pharmacol. 2021 Aug 9. doi: 10.1111/bcp.15028. Online ahead of print.

ABSTRACT

AIM: This study aimed to evaluate the association between opioid-related deaths and persistent opioid utilisation in the United Kingdom (UK).

METHODS: This nested case-control study used the UK Clinical Practice Research Datalink, linking the Office for National Statistics death registration. Adult opioid users with recorded opioid-related death between 2000 and 2015 were included and matched to four opioid users (controls) based on a disease risk score. Persistent opioid utilisation (opioid prescriptions ≥3 quarters/year and oral morphine equivalent dose ≥4500 mg/year) and psychotropic prescriptions were identified annually during the three patient-years before the date of opioid-related death. Conditional logistic regression was used to assess the association between persistent opioid utilisation and opioid-related death, and the results were reported as adjusted odds ratios (aOR) and 95% confidence intervals (95%CI).

RESULTS: Of the 902,149 opioid users, 230 opioid-related deaths (cases) and 920 controls were identified. Persistent opioid utilisation was significantly associated with an increased risk of opioid-related deaths (aOR: 1.9; 95%CI: 1.2, 2.9) when persistent opioid utilisation was defined by both annual dose and number of quarters. Concurrent prescription of opioids and tricyclic antidepressants (aOR: 2.0; 95%CI: 1.2, 3.5) or higher dose of benzodiazepine (aOR: 6.5; 95%CI: 4.0, 10.4) or gabapentinoids (aOR: 6.2; 95%CI: 2.9, 13.5) were associated with opioid-related death.

CONCLUSION: Persistent opioid prescribing and concurrent prescribing of psychotropics were associated with a higher risk of opioid-related death and should be avoided in clinical practice. An evidence-based indicator to monitor the safety of prescribed opioids during opioid de-prescribing is needed.

PMID:34371521 | DOI:10.1111/bcp.15028

J Cataract Refract Surg. 2021 Aug 4. doi: 10.1097/j.jcrs.0000000000000768. Online ahead of print.

ABSTRACT

PURPOSE: To quantify the damage to the corneal endothelium from the flow of balanced salt solution during phacoemulsification.

SETTING: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.

DESIGN: Experimental Study.

METHODS: Twelve New Zealand white rabbits received bilateral surgery. Six eyes served as controls with no irrigation (incision only). In 18 eyes, the Intrepid Balanced tip of the Centurion (Alcon) Ozil handpiece was inserted into the anterior chamber for continuous irrigation at 50mL/minute with either 250 mL or 500 mL of balanced salt solution (BSS). After euthanasia and enucleation, the corneas were removed, stained with trypan blue/alizarin red, and photographed in a standardized manner (X400 photographs from 5 specific areas, and 1 overview photograph from each corneal button). The ImageJ program was used to evaluate cell damage and loss in the photographs obtained from each cornea.

RESULTS: Analysis of the X400 photographs showed no statistical differences between control, 250 mL, and 500 mL groups in the percentage of intact, damaged, or lost cells (P= 0.896, 0.851, and 0.972 respectively). For the overview photos, the differences in areas of intact and damaged cells among the groups were statistically significant, likely due to the peripheral areas of damage related to touches between the phaco tip and the endothelium during irrigation.

CONCLUSION: The volume of BSS flow alone does not appear to be a major contributing source of endothelial cell damage and loss, providing further insight on mechanisms of corneal endothelium damage during phacoemulsification.

PMID:34371510 | DOI:10.1097/j.jcrs.0000000000000768

J Water Health. 2021 Aug;19(4):671-681. doi: 10.2166/wh.2021.074.

ABSTRACT

Adequate hydration is an essential component of health at every stage of life. Although many factors such as age, gender, physical activity, drug use, and illness affect hydration status, it is vital to maintain water balance, especially in infectious diseases. This study was conducted to estimate the hydration status of young adults living in Turkey during the COVID-19 pandemic. The total water intake (TWI) and total water loss of the individuals were determined using the Water Balance Questionnaire (WBQ), which consists of questions about physical activity status, frequency of food and beverage consumption, water consumption, and water loss with urine and feces. The TWI of men and women was found to be 4,776.1 and 4,777.3 mL/day, respectively (p > 0.05). It was determined that 29% of the total water was obtained from drinking water, 49% from other beverages, and 22% from food. A positive net water balance was found in all body mass index (BMI) groups, men, and women. The net water balance was statistically lower in men (2,230.6 mL) than women (2,783.8 mL) (p < 0.05). As the COVID-19 pandemic continues, studies should be done on hydration status in the more balanced populations in terms of BMI and age groups.

PMID:34371502 | DOI:10.2166/wh.2021.074

J Water Health. 2021 Aug;19(4):575-591. doi: 10.2166/wh.2021.269.

ABSTRACT

Tropical communities in the developing world depend heavily on riverine systems for their socioeconomic development. However, these resources are poorly protected from diffuse pollution, and there is a lack of quantitative information regarding the microbial pollution characteristics of riverine water, despite frequently reported gastrointestinal diseases. The aim of our study was to apply faecal taxation (i.e., faecal pellet counting in representative test areas to estimate the potential availability of diffuse pollution sources) in combination with a detailed microbiological faecal pollution analysis in a riverine environment to elucidate the importance of diffuse pollution. To realize this approach, ambient faecal pellets, a multiparametric data set for standard faecal indicator bacteria (SFIB), including Escherichia coli, Clostridium perfringens spores and enterococci from catchment soil and river water, and a number of riverine water physicochemical variables were analysed during a one-year cycle. We demonstrated that the abundance of ambient faecal pellets, which were consistently counted at reference sites in the catchment, was associated with faecal pollution in the river water. Water SFIB, dissolved oxygen, nutrients, conductivity and total suspended solids were strongly linked with the abundance of ambient faecal pellets in the river catchment, as demonstrated by principal component analysis (PCA). Elevated concentrations of SFIB in the riverine water in the absence of rainfall also suggested the direct input of faecal bacteria into the riverine water by livestock (e.g., during watering) and humans (e.g., during bathing). Statistical analyses further revealed that the microbiological water quality of the investigated riverine water was not influenced by SFIB potentially occurring in the soil. This study demonstrates the importance of diffuse faecal pollution sources as major drivers of the microbiological quality of riverine water in the Ethiopian highlands. In addition, the new successfully applied integrated approach could be very useful for developing predictive models, which would aid in forecasting riverine microbiological quality in tropical developing countries.

PMID:34371495 | DOI:10.2166/wh.2021.269

Aging (Albany NY). 2021 Aug 9;13(undefined). doi: 10.18632/aging.203374. Online ahead of print.

ABSTRACT

To map the magnitudes and temporal trends of blindness and vision loss (BVL) due to common eye diseases along with its attributable risk factors at the national, regional, and global levels. The annual burden of BVL in 204 countries and territories was extracted from the Global Burden of Disease Study 2019. The estimated annual percentage change (EAPC) and causes composition change were calculated to quantify the temporal trends of BVL-related disease burden by sex, region, and eye disease. The global disability-adjusted life years (DALYs) of BVL increased from 12.44 million in 1990 to 22.56 million in 2019, with a slightly decreased rate from 3.03 to 2.78 per 1000 population (EAPC = -0.30). About 29.6% of BVL-related DALYs worldwide were caused by cataract, followed by refraction disorders (29.1%), near vision loss (21.7%), other vision loss (13.7%), glaucoma (3.3%), and age-related macular degeneration (2.5%) in 2019. The age-standardized DALYs rates due to each eye disease type in most regions were decreased, especially in countries with high burden and high-middle socio-demographic index. Moreover, the contribution of smoking and air pollution from solid fuels to BVL burden decreased, however, the age-standardized burden of BVL attributed to high body-mass index and high fasting plasma glucose elevated gradually across almost all regions. The temporal trend of BVL burden due to specific eye diseases varies remarkably by region, sex and age. Understanding the real-time patterns of BVL burden is crucial for formulating more effective and targeted prevention and healthcare strategies to decrease the BVL burden.

PMID:34371482 | DOI:10.18632/aging.203374

Nurse Educ Pract. 2021 Jul 23;55:103164. doi: 10.1016/j.nepr.2021.103164. Online ahead of print.

ABSTRACT

AIM: The number of online graduate nursing programs across the United States has increased to address a critical shortage of nurse educators. Web-based learning appeals to nurses returning to school as a means of gaining an education at their convenience. More schools are offering compressed courses to meet this demand. Although students have a preference toward shorter intensive online courses, it is unclear how that affects the quality of the learning experience such as student engagement. The study explored the effect of course length on the student learning experience in a graduate online nurse educator course.

DESIGN: Using the community of inquiry framework, this study examined the effect of course duration (8-week versus traditional 16-week timeframes) on student engagement, student perceptions of the learning experience and self-reported learning behaviors. Study participants were enrolled in an online graduate nurse educator program located in the northwest United States.

METHODS: Data were collected using a background information form, a course evaluation form and the Community of Inquiry Questionnaire which measured teaching presence, social presence and cognitive presence. Data were analyzed using descriptive and inferential statistics.

RESULTS: High mean scores on the questionnaire showed that a community of inquiry was established regardless of course duration. However, there were differences in terms of the social and teaching presence subscales but not in the cognitive presence subscale suggesting that students in the traditional course were better able to establish the type of rapport with each other that increased comfort and engagement with peer interactions. Independent t-tests revealed statistically significant differences in perceptions of time to complete course activities. Students in the 16-week course were more likely to report that they had adequate time to complete course teachings, think critically about course content, complete course assignments and thoughtfully engage in course discussion and that they performed their best on assignments.

CONCLUSIONS: The findings support the traditional course duration over an intensive 8-week format because it allows for students to build a better rapport and greater student engagement with the course materials and peers. The study reinforces previous work on distance education noting social presence and connectedness as essential to optimal online learning. Using the community of inquiry framework and best-practice pedagogies for online education in the design and development of online courses can contribute to greater collaboration and deeper learning.

PMID:34371480 | DOI:10.1016/j.nepr.2021.103164

J Biomech. 2021 Jul 29;127:110657. doi: 10.1016/j.jbiomech.2021.110657. Online ahead of print.

ABSTRACT

Various methods have been suggested for estimating the variability in biomechanical variables during gait. However, all current measures of variability are performed on discrete measurements extracted from the kinematic or kinetic waveforms, which provide no temporal information on where differences in variability occur. This study used a variance equality test to compare temporal differences in group variance along the entire ground reaction force waveform. The variance equality test used an F-statistic whose critical value was determined using the random field theory function within the one-dimensional statistical parametric mapping package. Twenty healthy younger and twenty older adults were included in the study and completed gait analysis as they walked along a level walkway at a self-selected pace. Variance for each group was calculated and compared at each interval along the waveform to produce the F-value. The F-value was compared against a calculated F-critical value to determine where in the waveform significant differences in ground reaction force variance occurred. Results suggest that younger individuals may exhibit greater ground reaction force variance during heel contact in the vertical and posterior directions, and that older individuals may exhibit greater variability in the mediolateral direction at toe-off. This study was able to identify differences in ground reaction force variance within the gait cycle between younger and older adults. The findings of this study warrant the use of the function as a suitable method to compare variance along the entire waveform between two groups.

PMID:34371475 | DOI:10.1016/j.jbiomech.2021.110657