Nevin Manimala

Environ Sci Pollut Res Int. 2021 Mar 25. doi: 10.1007/s11356-021-13330-w. Online ahead of print.

ABSTRACT

Two polypropylene HVAC electret filters: a regular filter and an antimicrobial filter containing zinc pyrithione (ZPT), were compared for filtration performance. The study was conducted over 7 months in realistic conditions with semi-urban outdoor air. Several parameters were monitored over the study period: the average temperature was about 20 °C and relative humidity about 60%, the average inlet concentration of cultivable microorganisms was 50 CFU m^-3, the average inlet concentration of particles was 10 μg m^-3, the filter pressure drop increased moderately by about 30 Pa, and the particle collection efficiency of soda fluorescein (median diameter 0.35 μm) decreased in the first half of the study period by about 30% and then stabilized. The microbial concentration on the filters was quantified every 2 months using an innovative methodology based on media coupons in conjunction with microorganism quantification by CFU counting, with 5 culture media favorable to bacteria and/or fungi growth. The microbial concentrations on the filters were between 100 and 2000 CFU cm^-2. The antimicrobial effect of zinc pyrithione was confirmed by the fungi cultivated with DRBC agar: no effects in the level of filter clogging were revealed in the range studied. The high statistical deviation in the results regarding the inhibiting effect of zinc pyrithione on bacteria prevents any conclusion.

PMID:33765264 | DOI:10.1007/s11356-021-13330-w

Insights Imaging. 2021 Mar 25;12(1):41. doi: 10.1186/s13244-021-00984-w.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has impacted education in myriad ways, primarily leading to an abrupt paradigm shift in teaching and learning practices towards distance learning. The study aims to assess the effectiveness of teaching radiology to undergraduate medical students using synchronous distance learning compared to traditional on-campus learning through exploring students’ perceived satisfaction and concerns. Students’ perceptions were correlated with their attendance, grades, and frequency of technical difficulties.

METHODS: The study was designed as an observational study involving fourth-year medical students (2019/2020) from two institutions. The cohort students were exposed to traditional learning, distance learning, or both. Students completed an online self-administered questionnaire concerning their perceptions of distance learning. Students’ attendance, engagement, technical difficulties, and post-clerkship knowledge assessments were analyzed using descriptive and inferential statistics.

RESULTS: A total of 145 participants completed the clerkship using the following strategies: traditional learning (n = 66), both traditional and distance learning (n = 67), and distance learning alone (n = 12). The most important result indicates that the abrupt transition to distance learning was well perceived. Most students preferred distance learning over traditional learning in the radiology clerkship (p = .05). During the synchronous sessions, student attendance was high, reaching to 100%. Technical difficulties were limited (1.9%), and they did not affect learning.

CONCLUSION: Synchronous distance teaching promotes learning, interaction, and enjoyment in undergraduate radiology education, and it can be as effective as traditional on-campus learning. The technical difficulties encountered, although they were limited, can be overcome by recording the synchronous sessions.

PMID:33765254 | DOI:10.1186/s13244-021-00984-w

Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2021 Mar 25. doi: 10.1007/s00103-021-03299-9. Online ahead of print.

ABSTRACT

BACKGROUND: During the German division, two culturally very similar populations were exposed to very disparate socioeconomic conditions, which converged again after 1989. The impact of healthcare and life circumstances on mortality differences can better be estimated when cultural explanations are widely neglectable.

OBJECTIVES: For the first time, we analyse harmonised cause-of-death data explicitly by age. Hereby, we can show which ages or birth cohorts were particularly affected by German division and reunification in their mortality and to which causes of death this is attributable.

MATERIALS AND METHODS: We harmonised the German cause-of-death statistics by applying an internationally standardised harmonisation process to account for differences and breaks in cause-of-death coding practices. We analysed the data using decomposition methods.

RESULTS: During the 1980s, east-west disparities were increasing as progress in the reduction of cardiovascular mortality was much stronger in West Germany, notably at older ages. After 1989, East Germany was able to catch up to the west in many areas. This is especially true for elderly persons and women, while east-west disparities are still visible today, particularly among male adult cohorts (1950-1970) strongly affected by the East German transition crisis.

CONCLUSIONS: The lower life expectancy of the East German population in the late 1980s was primarily caused by a slower pace of the cardiovascular revolution. The remaining present-day disparities are rather an aftermath of the East German transition crisis than direct aftereffects of the division.

PMID:33765247 | DOI:10.1007/s00103-021-03299-9

Skeletal Radiol. 2021 Mar 25. doi: 10.1007/s00256-021-03763-2. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate factors which affect radiographic diagnosis of Hill-Sachs fractures, and find criteria which improve detection.

MATERIALS AND METHODS: Retrospective search was made for the term “Hill Sachs” within MRI reports in our local PACS system, and cases with post-reduction radiographs were included in the study. Prospective diagnoses and subspecialty MSK training of the interpreting radiologist of record were recorded. Images were then retrospectively reviewed by two observers and statistical analysis was performed.

RESULTS: Our retrospective study included 181 cases, of which 35% had prospective radiographic diagnosis of Hill-Sachs fracture. Retrospective review found that 73% of the radiograph series had at least 1 sign of a Hill-Sachs fracture. The internal rotation view showed a Hill-Sachs lesion in 59% of cases, but did not detect it in 14% of cases, where the lesion was instead visible on axillary, external rotation, and/or scapular Y view. Odds ratio of prospective Hill-Sachs detection on radiographs was 2.68 for musculoskeletal fellowship-trained radiologists versus non-musculoskeletal-trained radiologists.

CONCLUSION: Hill-Sachs fractures are often not recognized on post-reduction radiographs. Diagnosis of Hill-Sachs lesion can be significantly increased if radiologists are aware that the internal rotation view may fail to show the injury, and if all 4 views of a shoulder series are scrutinized.

PMID:33765232 | DOI:10.1007/s00256-021-03763-2

Acta Neurochir (Wien). 2021 Mar 25. doi: 10.1007/s00701-021-04824-0. Online ahead of print.

ABSTRACT

INTRODUCTION: Microvascular decompression (MVD) is the preferred surgical method for hemifacial spasm (HFS). The purpose of this study was to analyze the effectiveness and safety of fully endoscopic MVD for HFS relative to microscopic MVD.

MATERIAL AND METHODS: The retrospective study was conducted on HFS patients who underwent microscopic or fully endoscopic MVD from January 2018 to March 2019. All patients were treated at a single institution and by a single surgeon. Patients were divided into two groups based on the surgical method, and clinical data were then compared between groups.

RESULTS: A total of 116 patients, including 54 cases who received fully endoscopic MVD (E group) and 62 cases who received microscopic MVD (M group), were included in this study. Follow-up efficacy did not differ significantly between groups, with total effective rates of 88.9% in the E group and 90.3% in the M group. When postoperative complications were compared individually, there were no statistically significant differences between the two groups; however, the E group had a higher total incidence of complications than the M group (48.1% vs. 29.0%, P = 0.034).

CONCLUSION: Although both fully endoscopic and microscopic MVD for HFS achieved good efficacy, the former method had a higher total incidence of complications. Based on the results of this study, there is no evidence that a microscope can be replaced by a full endoscope in MVD for HFS.

PMID:33765219 | DOI:10.1007/s00701-021-04824-0

Diabetologia. 2021 Mar 25. doi: 10.1007/s00125-021-05436-0. Online ahead of print.

ABSTRACT

AIMS/HYPOTHESIS: It is unclear whether glucose per se has a causal impact on risk of stroke and whether glucose-lowering drugs reduce this risk. This is important for the choice of treatment for individuals at risk. We tested the hypotheses that high plasma glucose has a causal impact on increased risk of ischaemic stroke, and that glucose-lowering drugs reduce this risk.

METHODS: Using a Mendelian randomisation design, we examined 118,838 individuals from two Copenhagen cohorts, the Copenhagen General Population Study and the Copenhagen City Heart Study, and 440,328 individuals from the MEGASTROKE study. Effects of eight glucose-lowering drugs on risk of stroke were summarised by meta-analyses.

RESULTS: In genetic, causal analyses, a 1 mmol/l higher plasma glucose had a risk ratio of 1.48 (95% CI 1.04, 2.11) for ischaemic stroke in the Copenhagen studies. The corresponding risk ratio from the MEGASTROKE study combined with the Copenhagen studies was 1.74 (1.31, 2.18). In meta-analyses of glucose-lowering drugs, the risk ratio for stroke was 0.85 (0.77, 0.94) for glucagon-like peptide-1 receptor agonists and 0.82 (0.69, 0.98) for thiazolidinediones, while sulfonylureas, dipeptidyl peptidase-4 inhibitors, sodium-glucose cotransporter 2 inhibitors, α-glucosidase inhibitors, meglitinides and metformin individually lacked statistical evidence of an effect on stroke risk.

CONCLUSIONS/INTERPRETATION: Genetically high plasma glucose has a causal impact on increased risk of ischaemic stroke. Treatment with glucose-lowering glucagon-like peptide-1 receptor agonists and thiazolidinediones reduces this risk. These results may guide clinicians in the treatment of individuals at high risk of ischaemic stroke.

PMID:33765180 | DOI:10.1007/s00125-021-05436-0

J Orofac Orthop. 2021 Mar 25. doi: 10.1007/s00056-021-00279-1. Online ahead of print.

ABSTRACT

OBJECTIVES: We sought to determine the amount of three-dimensional (3D) movement of soft tissue landmarks in patients who underwent bimaxillary orthognathic surgery.

MATERIALS AND METHODS: We recruited 28 patients (11 women and 17 men), who had received one-piece Le Fort I osteotomy with maxillary advancement and impaction, and bilateral sagittal split ramus osteotomy for mandibular setback. The 3D images were acquired 1-7 days before surgery and at least 6 months after surgery using stereophotogrammetry. We recorded 50 coordinate measurements and correlated the movements between soft and hard tissues. Paired samples t‑test, independent samples t‑test, and Pearson’s correlation analysis were used for statistical analysis.

RESULTS: Patients’ ages ranged from 17-31 years (mean 20.4 ± 3.0 years). The mean advancement and impaction of the maxilla was 4.7 ± 1.2 and 2.2 ± 1.0 mm, respectively. The mean setback of the mandible was 4.2 ± 1.6 mm. Menton (Me) moved significantly closer to the midsagittal plane, and the bilateral alare (Al) and alar curvature (Ac) moved laterally. In addition, pronasale (Prn), bilateral Al, Ac, subnasale (Sn), subspinale (Ss), labiale superior (Ls), sublabiale (Sl), pogonion (Pog), and Me moved upwards. The bilateral cheek bone (Cbp), Al, Ac, Prn, Sn, Ss, Ls, and stomion (Sto) moved forward. Li, Sl, Pog, and Me moved backward. Interestingly, poor correlation was found between soft tissue landmarks and hard tissue movements.

CONCLUSION: We observed 3D coordinate changes in several soft tissue landmarks in the middle and lower thirds of the face. The results of this study may be useful for estimating postoperative changes in similar patients.

PMID:33765157 | DOI:10.1007/s00056-021-00279-1

J Public Health (Oxf). 2021 Mar 26:fdab080. doi: 10.1093/pubmed/fdab080. Online ahead of print.

ABSTRACT

BACKGROUND: The Robert-Koch-Institute reports that during the summer holiday period a foreign country is stated as the most likely place of infection for an average of 27 and a maximum of 49% of new SARS-CoV-2 infections in Germany.

METHODS: Cross-sectional study on observational data. In Germany, summer school holidays are coordinated between states and spread out over 13 weeks. Employing a dynamic model with district fixed effects, we analyze the association between these holidays and weekly incidence rates across 401 German districts.

RESULTS: We find effects of the holiday period of around 45% of the average district incidence rates in Germany during their respective final week of holidays and the 2 weeks after holidays end. Western states tend to experience stronger effects than Eastern states. We also find statistically significant interaction effects of school holidays with per capita taxable income and the share of foreign residents in a district’s population.

CONCLUSIONS: Our results suggest that changed behavior during the holiday season accelerated the pandemic and made it considerably more difficult for public health authorities to contain the spread of the virus by means of contact tracing. Germany’s public health authorities did not prepare adequately for this acceleration.

PMID:33765149 | DOI:10.1093/pubmed/fdab080

Age Ageing. 2021 Mar 26:afab056. doi: 10.1093/ageing/afab056. Online ahead of print.

ABSTRACT

BACKGROUND: Hypernatraemia arises commonly in acute general medical admissions. Affected patients have a guarded prognosis with high rates of morbidity and mortality. Age-related physiology and physical/cognitive barriers to accessing water predispose older patients to developing hypernatraemia. This study sought to perform a descriptive retrospective review of hypernatraemic patients admitted under acute general medicine teams.

METHODS: A retrospective cross-sectional study of a sample of acute medical in-patients with serum[sodium]>145 mmol/L was conducted. Patients were exclusively older(>69 years) and admitted from Nursing homes (NH)(41%) and non-NH pathways(59%). A comparison of management of NH /non-NH patients including clinical presentation, comorbidities, laboratory values, [sodium] monitoring, intravenous fluid regimes and patient outcomes was performed.

RESULTS: In total, 102 consecutive patients (males, n=69(67.6%)) were included. Dementia and reduced mobility were more common in NH residents and admission serum [Sodium] higher (148 vs 142 mmol/L/p=0.003). Monitoring was inadequate: no routine bloods within the first 12h in >80% of patients in both groups. No patient had calculated free water deficit documented. More NH patients received correct fluid management (60% vs 33%/p%0.015). Incorrect fluid regimes occurred in both groups (38% vs 58%/p=0.070). Length of stay in discharged patients was lower in NH, (8(4-20) vs 20.5(9.8-49.3 days)/p=0.003). Time to death for NH residents was shorter (9(5.5-11.5) vs 16 (10.25-23.5) days/p=0.011).

CONCLUSION: This study highlights suboptimal management of hypernatraemia. Implementation of hypernatraemia guidelines for general medical older inpatients are clearly required with mechanisms to confirm adherence. Health care workers require further education on diagnostic challenges of dehydration in older people and the importance of maintaining adequate hydration.

PMID:33765147 | DOI:10.1093/ageing/afab056

PLoS One. 2021 Mar 25;16(3):e0249251. doi: 10.1371/journal.pone.0249251. eCollection 2021.

ABSTRACT

BACKGROUND: During the early phase of the Covid-19 pandemic, reductions of hospital admissions with a focus on emergencies have been observed for several medical and surgical conditions, while trend data during later stages of the pandemic are scarce. Consequently, this study aims to provide up-to-date hospitalization trends for several conditions including cardiovascular, psychiatry, oncology and surgery cases in both the in- and outpatient setting.

METHODS AND FINDINGS: Using claims data of 86 Helios hospitals in Germany, consecutive cases with an in- or outpatient hospital admission between March 13, 2020 (the begin of the “protection” stage of the German pandemic plan) and December 10, 2020 (end of study period) were analyzed and compared to a corresponding period covering the same weeks in 2019. Cause-specific hospitalizations were defined based on the primary discharge diagnosis according to International Statistical Classification of Diseases and Related Health Problems (ICD-10) or German procedure classification codes for cardiovascular, oncology, psychiatry and surgery cases. Cumulative hospitalization deficit was computed as the difference between the expected and observed cumulative admission number for every week in the study period, expressed as a percentage of the cumulative expected number. The expected admission number was defined as the weekly average during the control period. A total of 1,493,915 hospital admissions (723,364 during the study and 770,551 during the control period) were included. At the end of the study period, total cumulative hospitalization deficit was -10% [95% confidence interval -10; -10] for cardiovascular and -9% [-10; -9] for surgical cases, higher than -4% [-4; -3] in psychiatry and 4% [4; 4] in oncology cases. The utilization of inpatient care and subsequent hospitalization deficit was similar in trend with some variation in magnitude between cardiovascular (-12% [-13; -12]), psychiatry (-18% [-19; -17]), oncology (-7% [-8; -7]) and surgery cases (-11% [-11; -11]). Similarly, cardiovascular and surgical outpatient cases had a deficit of -5% [-6; -5] and -3% [-4; -3], respectively. This was in contrast to psychiatry (2% [1; 2]) and oncology cases (21% [20; 21]) that had a surplus in the outpatient sector. While in-hospital mortality, was higher during the Covid-19 pandemic in cardiovascular (3.9 vs. 3.5%, OR 1.10 [95% CI 1.06-1.15], P<0.01) and in oncology cases (4.5 vs. 4.3%, OR 1.06 [95% CI 1.01-1.11], P<0.01), it was similar in surgical (0.9 vs. 0.8%, OR 1.06 [95% CI 1.00-1.13], P = 0.07) and in psychiatry cases (0.4 vs. 0.5%, OR 1.01 [95% CI 0.78-1.31], P<0.95).

CONCLUSIONS: There have been varying changes in care pathways and in-hospital mortality in different disciplines during the Covid-19 pandemic in Germany. Despite all the inherent and well-known limitations of claims data use, this data may be used for health care surveillance as the pandemic continues worldwide. While this study provides an up-to-date analysis of utilization of hospital care in the largest German hospital network, short- and long-term consequences are unknown and deserve further studies.

PMID:33765096 | DOI:10.1371/journal.pone.0249251