Nevin Manimala

Adv Med Sci. 2021 Aug 21;66(2):403-410. doi: 10.1016/j.advms.2021.08.001. Online ahead of print.

ABSTRACT

PURPOSE: Although coronavirus disease 2019 (COVID-19) primarily affects the pulmonary system, the involvement of the heart has become a well-known issue. Pulmonary CT plays an additive role in the diagnosis and prognosis of the disease. We aimed to investigate the association of echocardiographic indices with pulmonary CT scores and mortality in COVID-19 patients.

MATERIALS AND METHODS: A total of 123 patients diagnosed with COVID-19 were included in this study. The British Society of Thoracic Imaging (BSTI) score and echocardiographic parameters were calculated, and echocardiographic indices were compared between BSTI score grades.

RESULTS: During in-hospital follow-up, 36 of 123 patients (29.3%) had died. BSTI score, IVS, LVPWd, RV mid-diameter, RV basal diameter, RV longitudinal diameter, sPAP, and RVMPI were higher, and RVFAC, TAPSE, and RVS were lower in the non-survivor group than in the survivor group. There were statistically significant changes between BSTI scores in terms of LVPWd, RV mid diameter, RV basal diameter, RV longitudinal diameter, sPAP, RVFAC, RVMPI, and TAPSE. BSTI score was positively correlated with sPAP and RV basal diameter and negatively correlated with TAPSE and RVFAC. Multivariate logistic regression analysis demonstrated that sPAP (OR ​= ​1.071, p ​= ​0.002) and RV basal diameter (OR ​= ​1.184, p ​= ​0.005) were independent predictors of high BSTI scores (grade 4 and 5). Furthermore, age, sPAP, and a high BSTI score (grade 5) were independent predictors of in-hospital mortality in COVID-19 patients.

CONCLUSION: Echocardiographic indices were correlated with BSTI scores, and patients with higher BSTI scores had more cardiac involvement in COVID-19.

PMID:34454343 | DOI:10.1016/j.advms.2021.08.001

Gen Hosp Psychiatry. 2021 Aug 14;72:131-140. doi: 10.1016/j.genhosppsych.2021.08.004. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine the prevalence of anxiety in general hospital inpatients by conducting a systematic review and meta-analysis of all relevant published studies.

METHOD: We searched Ovid Medline, Ovid Embase and Ovid PsycINFO from inception to December 2020. We included studies of the prevalence of anxiety symptoms of clinically significant severity (using cut-off scores on rating scales) and of the prevalence of anxiety disorders (using diagnostic interviews) in general hospital inpatients. Two independent reviewers assessed articles and extracted data. The review is registered with PROSPERO, number CRD42020189722.

RESULTS: We included 32 studies. Pooled prevalence estimates in random-effects meta-analyses were: anxiety symptoms 28% (95% CI 19% to 38%, 95% prediction interval 5% to 72%), any anxiety disorder 8% (95% CI 5% to 12%, 95% prediction interval 2% to 33%), panic disorder 3% (95% CI 2% to 4%, 95% prediction interval 1% to 8%), generalized anxiety disorder 5% (95% CI 3% to 8%, 95% prediction interval 1% to 23%). There was high heterogeneity in prevalence, little of which was explained in exploratory analyses of a limited number of potential determinants.

CONCLUSION: Anxiety symptoms of clinically significant severity affect more than one in four inpatients and anxiety disorders affect nearly one in ten.

PMID:34454342 | DOI:10.1016/j.genhosppsych.2021.08.004

Eur J Paediatr Neurol. 2021 Aug 24;34:99-104. doi: 10.1016/j.ejpn.2021.08.004. Online ahead of print.

ABSTRACT

AIM: To describe factors affecting eligibility for, and rates of utilization of, hyperacute therapy in children with acute ischemic stroke (AIS) following establishment of our institutional acute stroke treatment pathway in 2005.

METHODS: A retrospective analysis of a prospectively enrolled, single-center cohort was performed including children age 2 – <18 years with acute AIS from 2005 through 2017. Descriptive statistics were used to summarize clinical characteristics, presentation data, and Pediatric NIH Stroke Scale (PedNIHSS) scores that were abstracted from medical records. Assessment for eligibility and administration of hyperacute therapy was determined at the time of presentation according to the institutional stroke pathway.

RESULTS: Of 90 children (median age at presentation 11.3 years, 36% female) with acute AIS, 5 (6%) received hyperacute therapy: 3 received intravenous tissue plasminogen activator (IV-tPA) alone, 1 received endovascular therapy (EVT) alone, and 1 received IV-tPA and EVT. Of 54 children (60%) who presented within 4.5 h of time last seen well, 6 had PedNIHSS scores 6-24, no medical contraindication to IV-tPA, and a partial or complete vessel occlusion. Of 7 children >3 years old who presented after EVT became available at our hospital and within 6 h of time last seen well with a PedNIHSS score 6-24, 3 (43%) had a large vessel occlusion (LVO). Two patients underwent EVT and the other patient was not transferred until >6 h from time last seen well.

CONCLUSIONS: Delay to presentation and diagnosis of childhood acute AIS, mild neurologic deficits at presentation, medical contraindications to IV-tPA, and lack of vessel occlusion on acute neuroimaging contribute to low rates of hyperacute treatment in children with acute AIS.

PMID:34454335 | DOI:10.1016/j.ejpn.2021.08.004

Clin Biomech (Bristol, Avon). 2021 Aug 20;89:105455. doi: 10.1016/j.clinbiomech.2021.105455. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with knee osteoarthritis can adapt their gait to unload the most painful knee joint in order to try to reduce pain and improve physical function. However, these gait adaptations can cause higher loads on the contralateral joints. The aim of the study was to investigate the interlimb differences in knee and hip frontal plane moments during gait in patients with knee osteoarthritis and in healthy controls.

METHODS: Forty patients with knee osteoarthritis and 19 healthy matched controls were measured during comfortable treadmill walking. Frontal plane joint moments were obtained of both hip and knee joints. Differences in interlimb moments within each group were assessed using statistical parametric mapping and discrete gait parameters.

FINDINGS: No interlimb differences were observed in patients with knee osteoarthritis and control subjects at group level. Furthermore, the patients presented similar interlimb variability as the controls. In a small subgroup (n = 12) of patients, the moments in the most painful knee were lower than in the contralateral knee, while the other patients (n = 28) showed higher moments in the most painful knee compared to the contralateral knee. However, no interlimb differences in the hip moments were observed within the subgroups.

INTERPRETATION: Patients with knee osteoarthritis do not have interlimb differences in knee and hip joint moments. Patients and healthy subjects demonstrate a similar interlimb variability in the moments of the lower extremities. In this context, differences in knee pain in patients with knee osteoarthritis did not induce any interlimb differences in the frontal plane knee and hip moments.

PMID:34454328 | DOI:10.1016/j.clinbiomech.2021.105455

Clin Biomech (Bristol, Avon). 2021 Aug 24;89:105457. doi: 10.1016/j.clinbiomech.2021.105457. Online ahead of print.

ABSTRACT

BACKGROUND: This study presented the load profile applied on transfemoral osseointegrated implants by bone-anchored prostheses fitted with state-of-the-art ÖSSUR microprocessor-controlled Rheo Knee XC and energy-storing-and-returning Pro-Flex XC or LP feet during five standardized daily activities.

METHODS: This cross-sectional cohort study included 13 participants fitted with a press-fit transfemoral osseointegrated implant. Loading data were directly measured with the tri-axial transducer of an iPecsLab (RTC Electronics, USA) fitted between the implant and knee unit. The loading profile was characterized by spatio-temporal gaits variables, magnitude of loading boundaries as well as onset and magnitude of loading extrema during walking, ascending and descending ramp and stairs.

FINDINGS: A total of 2127 steps was analysed. The cadence ranged between 36 ± 7 and 47 ± 6 strides/min. The absolute maximum force and moments applied across all activities was 1322 N, 388 N and 133 N as well as 22 Nm, 52 Nm and 88 Nm on and around the long, anteroposterior and mediolateral axes of the implant, respectively.

INTERPRETATION: This study provided new benchmark loading data applied by transfemoral bone-anchored prostheses fitted with selected ÖSSUR state-of-the-art components. Outcomes suggested that such prostheses can generate relevant loads at the interface with the osseointegrated implant to restore ambulation effectively. This study is a worthwhile contribution toward a systematic recording, analysis, and reporting of ecological prosthetic loading profiles as well as closing the evidence gaps between prescription and biomechanical benefits of state-of-the-art components. Hopefully, this will contribute to improve outcomes for growing number of individuals with limb loss opting for bionic solutions.

PMID:34454327 | DOI:10.1016/j.clinbiomech.2021.105457

Clin Neurophysiol. 2021 Jul 24;132(10):2416-2421. doi: 10.1016/j.clinph.2021.07.011. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the prognostic value of needle electromyography (EMG) genioglossus involvement in patients with amyotrophic lateral sclerosis (ALS) at diagnosis.

METHODS: We separately explored the prognostic value of clinical bulbar lower motor neuron (LMN) signs and EMG genioglossus involvement using Cox proportional hazard models adjusted for age, gender, diagnostic delay, presence of bulbar upper motor neuron (UMN) signs, EMG cervical and lumbosacral region involvement, ALSFRS-R score and C9Orf72 gene status. Then, we compared the prognostic value of EMG masseter and genioglossus abnormalities in a subset of patients in whom both muscles were analysed.

RESULTS: 103 ALS patients were included in the study. Neurophysiological genioglossus involvement was associated with a shorter survival (p = 0.002), a shorter time to moderate dysphagia (p = 0.0001) and to severe dysarthria (p = 0.012). Its prognostic value was still evident in patients without clinical bulbar LMN signs. Bulbar clinical LMN signs were only associated with an earlier onset of moderate dysphagia (p = 0.0001). EMG masseter abnormalities did not reach statistical significance with regard to all the clinical milestones.

CONCLUSIONS: Genioglossus EMG at diagnosis could provide important information about ALS progression rate. The masseter muscle seems to be less involved in ALS.

SIGNIFICANCE: EMG genioglossus involvement is a prognostic factor in ALS.

PMID:34454268 | DOI:10.1016/j.clinph.2021.07.011

Chemosphere. 2021 Aug 19;287(Pt 1):131931. doi: 10.1016/j.chemosphere.2021.131931. Online ahead of print.

ABSTRACT

As part of the global monitoring plan on persistent organic pollutants (GMP) under the Stockholm Convention passive air samplers equipped with polyurethane foam disks (PUFs) were applied to monitor dioxin-like POPs. For sampling, toluene-pretreated PUFs were exposed for three months during two years. Chemical analysis was performed in one accredited expert laboratory using internationally accepted methods; for comparison, all results were normalized to one PUF and 3 month exposure. Total TEQs, using WHO₂₀₀₅-TEFs, were lowest in the Pacific Islands countries (PAC) and had similar mean values in Africa (16.8 pg TEQ/PUF), Asia (16.9 pg TEQ/PUF), and Latin American and Caribbean countries (GRULAC, 13.3 pg TEQ/PUF). Using median values, Asia (13.4 pg TEQ/PUF) and GRULAC (13.1 pg TEQ/PUF) had higher amounts than Africa (6.1 pg TEQ/PUF) and PAC (2.1 pg TEQ/PUF). The contribution of PCDD/PCDF to the total TEQ was 2-3-times higher than from the dl-PCB. Mono-ortho PCB did not play a role in any of the samples. The previous 40 samples during 2010/2011 and the present 195 samples from 2017/2018 did not show a statistical difference (p value = 0.3), only for GRULAC, a downward trend was identified. It is recommended combining 4 PUFs to ‘annual’ samples.

PMID:34454223 | DOI:10.1016/j.chemosphere.2021.131931

Clin Neurol Neurosurg. 2021 Aug 19;208:106900. doi: 10.1016/j.clineuro.2021.106900. Online ahead of print.

ABSTRACT

BACKGROUND & PURPOSE: The safety and efficacy of the Woven EndoBridge (WEB) device has been proven in recent multicenter trials. This study investigated whether operator experience influences WEB treatment-related outcomes.

MATERIAL AND METHODS: This was a retrospective analysis of a prospectively collected multicenter database. The data of all patients who underwent WEB treatment for an intracranial aneurysm from March 2014 to June 2020 in two high-volume centers were pooled. Operator experience was indexed by the number of WEB treatments performed previously. The primary endpoint was the overall complication rate. Secondary endpoints were long-term adequate (Raymond-Roy classification of 1-2.) angiographic occlusion, WEB-related complications, number of WEB not deployed, procedure duration, and radiation exposure (air kerma).

RESULTS: Among 237 patients (mean age 59.4 +/- 11.5 years) treated with WEB (median aneurysm diameter, 5.8 mm; interquartile range 4.5-7 mm), WEB-related complications occurred in 28 patients (11.8%) and adequate long-term occlusion was achieved for 154 aneurysms (86%). The median number of WEB treatment performed previously per operator was 20 (IQR, 9-41). The overall complication rate, WEB-related complication rate and aneurysm occlusion rate were not significantly correlated with WEB operator experience. There were also no significant correlations between the WEB operator experience and the number of WEB not deployed, procedure duration or radiation exposure.

CONCLUSION: There was no significant association between the number of WEB treatments previously performed per operator and any technical or clinical results after intracranial aneurysm treatment with WEB. These results imply a relatively short learning curve for this device in high-volume neurovascular centers.

PMID:34454205 | DOI:10.1016/j.clineuro.2021.106900

J Environ Manage. 2021 Aug 25;299:113505. doi: 10.1016/j.jenvman.2021.113505. Online ahead of print.

ABSTRACT

The biorefinery approach must be boosted in the management of agro-residues in the future. The present study aims to investigate the valorization of tomato production residues, namely rotten tomato (unfit for consumption – RT), green tomato (GT), and tomato branches (TB). The assessment involves the recovery of value-added compounds through the extraction process followed by biogas production through anaerobic digestion. A thorough characterization of the three residues (RT, GT, and TB) was carried out, including the identification of volatile compounds by solid-phase microextraction (SPME) and gas chromatography/mass spectrometry (GC/MS). The volatiles analysis revealed the presence of flavor enhancer compounds and molecules with insecticidal properties. A solid-liquid extraction with ethanol allowed the recovery of value-added compounds in the extracts, in particular phenolic compounds, β-carotene, and lycopene, which contributed to the antioxidant activity. RT and TB extracts were found to be richer in total phenolic compounds (~27 mg GAE/g_db dry basis) and exhibited higher antioxidant activity (IC₅₀ = 0.911 and 0.745 mg/mL). The tomato branches extract had the highest concentration of carotenoids with 37.23 and 3.08 mg/kg_db of β-carotene and lycopene, respectively. The biochemical methane potential (BMP) was assessed in sealed reactors operating in anaerobic conditions for all the raw (RT, GT, and TB) and extracted substrates waste (RTe, GTe, and TBe). While the BMP of RT and GT was in the range of 232-285 mL CH₄/g VS, a lower value of 141 mL CH₄/g VS was obtained for TB. The methane production for each pair of raw and extracted substrates (RT/RTe, GT/GTe, and TB/TBe) was considered statistically similar at a 95 % confidence level. Overall, the value-added compounds recovery through ethanolic extraction did not compromise the methane production of the materials.

PMID:34454202 | DOI:10.1016/j.jenvman.2021.113505

J Environ Manage. 2021 Aug 25;299:113586. doi: 10.1016/j.jenvman.2021.113586. Online ahead of print.

ABSTRACT

Anthropogenic activities responsible for modifying climatic regimes and land use and land cover (LULC) have been altering fire behavior even in regions with natural occurrences, such as the Pantanal. This biome was highlighted in 2020 due to the record number of fire foci and burned areas registered. Thus, this study aimed to understand how changes in LULC and climate affect the spatial, temporal and magnitude dynamics of fire foci. The Earth Trends Modeler (ETM) was used to identify trends in spatiotemporal bases of environmental and climatic variables. No trend was identified in the historical series of precipitation data. However, an increasing trend was observed for evapotranspiration, normalized difference vegetation index (NDVI) and temperature. For soil moisture, a decreasing trend was observed. The comparison between the mean of the historical series and the year 2020 showed that the variables precipitation, temperature, soil moisture and evapotranspiration had atypical behavior. Such behavior may have contributed to creating a drier environment with available combustible material, leading to a record number of burned areas, about three million hectares (248%) higher than the historical average. The 2020 fire foci data were used in two types of spatial statistical analyses: Grouping, showing that 76% of the registered fire foci were at high risk of fire and; Hot and Cold Spots, indicating high concentrations of Hot Spots in the northern region of the Pantanal, close to Cerrado and Amazon biomes agricultural frontier. The results of the Land Change Modeler (LCM) tool evidenced a strong transition potential from the natural vegetation to agriculture and pasture in the eastern region of the Pantanal, indicating that this could be, in the future, a region of high concentration of fire foci and possibly high risk of fire. This tool also allowed the prediction of a scenario for 2030 that showed that if measures for environmental protection and combating fires are not adopted, in this year, 20% of the Pantanal areas will be for agricultural and pasture use. Finally, the results suggest that the advance of agriculture in the Pantanal and changes in climatic and environmental variables boosted the increase in fire foci and burned areas in the year 2020.

PMID:34454200 | DOI:10.1016/j.jenvman.2021.113586