Nevin Manimala

Australas J Dermatol. 2021 Oct 10. doi: 10.1111/ajd.13730. Online ahead of print.

ABSTRACT

Hypertrophic scars present collagen deposition and an abnormal extracellular matrix that cause abnormal shape changes and limit normal movement. Although fractional carbon dioxide (CO₂ ) laser therapy has provided promising evidence, the improvement of scarring has not been thoroughly reviewed. A systematic review of prospective randomised trial articles collected from PubMed, MEDLINE, EMBASE, Cochrane and Scopus databases was conducted on 15 March 2020 in accordance with the PRISMA-P statement. Types and duration of fractional carbon dioxide laser used in this study along with the comparative modalities were recorded in this review. Treatment efficacy was assessed as the primary outcome. Adverse events and patient satisfaction were assessed as the secondary outcome. Five prospective randomised studies were included in this study. All studies included showed a consistent result with a conclusion that CO₂ fractional laser treatment demonstrated statistically significant improvement for various scar scoring methods. Combination with other modalities may yield better results in some studies with the risk of more severe adverse events. Temporary side effects such as itching or burning sensation, erythema and oedema were present but appeared to be minimal and well tolerated. Overall patients reported significant improvement in quality of life. Some of the studies are uncontrolled with relatively short-term follow-up. Controlled comparative studies within the same scar with larger sample size and longer follow-up period are required. This evidence suggests that fractional CO₂ laser treatment is effective for improving the clinical appearance of hypertrophic scars with a good safety profile.

PMID:34628639 | DOI:10.1111/ajd.13730

J Am Geriatr Soc. 2021 Oct 10. doi: 10.1111/jgs.17503. Online ahead of print.

ABSTRACT

BACKGROUND: Abdominal pain is the most common chief complaint in US emergency departments (EDs) among patients over 65, who are at high risk of mortality or incident disability after the ED encounter. We sought to characterize the evaluation, management, and disposition of older adults who present to the ED with abdominal pain.

METHODS: We performed a survey-weighted analysis of the National Hospital Ambulatory Medical Care Survey (NHAMCS), comparing older adults with a chief complaint of abdominal pain to those without. Visits from 2013 to 2017 to nationally representative EDs were included. We analyzed 81,509 visits to 1211 US EDs, which projects to 531,780,629 ED visits after survey weighting. We report the diagnostic testing, evaluation, management, additional reasons for visit, and disposition of ED visits.

RESULTS: Among older adults (≥65 years), 7% of ED visits were for abdominal pain. Older patients with abdominal pain had a lower probability of being triaged to the “Emergent” (ESI2) acuity on arrival (7.1% vs. 14.8%) yet were more likely to be admitted directly to the operating room than older adults without abdominal pain (3.6% vs. 0.8%), with no statistically significant differences in discharge home, death, or admission to critical care. Ultrasound or CT imaging was performed in 60% of older adults with abdominal pain. A minority (39%) of older patients with abdominal pain received an electrocardiogram (EKG).

CONCLUSIONS: Abdominal pain in older adults presenting to EDs is a serious condition yet is triaged to “emergent” acuity at half the rate of other conditions. Opportunities for improving diagnosis and management may exist. Further research is needed to examine whether improved recognition of abdominal pain as a syndromic presentation would improve patient outcomes.

PMID:34628638 | DOI:10.1111/jgs.17503

Aging Clin Exp Res. 2021 Oct 10. doi: 10.1007/s40520-021-01994-w. Online ahead of print.

ABSTRACT

BACKGROUND: Over the latest years different studies have investigated the possible relationship between D deficiency and occurrence of orthostatic hypotension (OH), often reaching controversial results. We perform an update meta-analysis providing an update overview on the association between hypovitaminosis D and orthostatic hypotension (OH) in older adults.

METHODS: Data extraction was independently performed by two authors and based upon predefined criteria. The meta-analysis was performed using a random-effects model. Statistical heterogeneity between groups was measured using the Higgins I2 statistic.

RESULTS: Eight investigations enrolling 16.326 patients (mean age 75.5 years) met the inclusion criteria and were considered for the analysis. Patients with vitamin D deficiency were more likely to have OH compared to those without (OR: 1.36, 95% CI 1.14-1.63, p = 0.0001, I2 = 43.6%). A further sub-analysis, based on three studies, estimating the risk of OH in patients with hypovitaminosis D receiving antihypertensive treatment, did not reach the statistical significance (OR: 1.40, 95% CI 0.61-3.18, p = 0.418, I2 = 53.3%). Meta-regression performed using age (p = 0.12), BMI (p = 0.73) and gender (p = 0.62) as moderators did not reveal any statistical significance in influencing OH. Conversely, physical activity, Vitamin D supplementation and use of radioimmunoassay for the measurement of vitamin D serum levels showed a significant inverse relationship towards the risk of OH (Coeff.-0.09, p = 0.002, Coeff. – 0.12, p < 0.001 and Coeff. – 0.08, p = 0.03, respectively) among patients with hypovitaminosis D. A direct correlation between the administration of antihypertensive treatment and the risk of OH in older patients with low vitamin D level was observed (Coeff. 0.05, p < 0.001).

CONCLUSIONS: Hypovitaminosis D is significantly associated with OH in older adults and directly influence by the administration of antihypertensive drugs. Conversely, physical activity, vitamin D supplementation and use of radioimmunoassay as analytic method inversely correlated with the risk of OH in older patients.

PMID:34628636 | DOI:10.1007/s40520-021-01994-w

Adv Exp Med Biol. 2021;1336:243-264. doi: 10.1007/978-3-030-77252-9_12.

ABSTRACT

The present chapter describes basic aspects of the main steps for data processing on mass spectrometry-based metabolomics platforms, focusing on the main objectives and important considerations of each step. Initially, an overview of metabolomics and the pivotal techniques applied in the field are presented. Important features of data acquisition and preprocessing such as data compression, noise filtering, and baseline correction are revised focusing on practical aspects. Peak detection, deconvolution, and alignment as well as missing values are also discussed. Special attention is given to chemical and mathematical normalization approaches and the role of the quality control (QC) samples. Methods for uni- and multivariate statistical analysis and data pretreatment that could impact them are reviewed, emphasizing the most widely used multivariate methods, i.e., principal components analysis (PCA), partial least squares-discriminant analysis (PLS-DA), orthogonal partial least square-discriminant analysis (OPLS-DA), and hierarchical cluster analysis (HCA). Criteria for model validation and softwares used in data processing were also approached. The chapter ends with some concerns about the minimal requirements to report metadata in metabolomics.

PMID:34628635 | DOI:10.1007/978-3-030-77252-9_12

Eur Arch Paediatr Dent. 2021 Oct 9. doi: 10.1007/s40368-021-00672-9. Online ahead of print.

ABSTRACT

PURPOSE: According to new studies, oxidative stress may play an important role in the beginning and progression of oral diseases. The aim of this study was the evaluation of thiobarbituric acid reactive substances (TBARS) as an indicator of lipid peroxidation, total protein, and pH of saliva in children with various degrees of early childhood caries in comparison with caries-free children.

METHODS: This case-control study was carried out on 90 children 3-5 years old in three equal groups, including caries-free children (CF), early childhood caries (ECC), and severe early childhood caries (S-ECC) who were age- and sex matched. Saliva pH was measured using a paper pH meter and TBARS and total protein were measured by spectrophotometer methods and data were statistically analysed.

RESULTS: TBARS and total protein levels in ECC and S-ECC groups were significantly higher than the CF group (p < 0.001), but pH was not significantly different between groups. There were no significant differences between ECC and S-ECC groups in any of the studied indicators.

CONCLUSION: Considering the limitations of the present study, the results showing the higher salivary TBARS levels in the S-ECC and ECC groups compared to caries-free children, lead to the conclusion that oxidative stress could be considered as a risk factor for early childhood caries.

PMID:34628622 | DOI:10.1007/s40368-021-00672-9

Environ Sci Pollut Res Int. 2021 Oct 9. doi: 10.1007/s11356-021-16868-x. Online ahead of print.

ABSTRACT

A rapid process of industrialization, on the one hand, transformed the economies from agrarian to industrial societies to improve the living standards and welfare of people. On the other hand, the urbanized and industrialized economies have posed challenging threats to environmental sustainability. The query at hand is whether the growing environmental emissions are driven by industrialization and urbanization or not. This research aims to empirically examine the combined role of industrialization and urbanization in achieving carbon neutrality in Pakistan by considering foreign direct investment and economic growth as control variables in the model. The core empirical results are the following: firstly, industrialization and economic growth exhibit negative but statistically insignificant impacts on CO₂ emissions, imparting a neutral role in determining the environmental degradation in Pakistan. Secondly, urbanization and foreign direct investment disclose positive and statistically significant (at 1% level of significance) impacts on CO₂ emissions, manifesting an environmental degradation driving impact in the country. Thirdly, given the slope coefficients of urbanization and foreign direct investment (0.058 and 0.035), urbanization proved to be a stronger driver than foreign direct investment. Finally, foreign direct investment is revealed to make the Pakistani economy a “Pollution Haven” for the foreign enterprises in the country. Based on empirical results, none of the variables predicted the support for carbon neutrality in Pakistan.

PMID:34628613 | DOI:10.1007/s11356-021-16868-x

Environ Sci Pollut Res Int. 2021 Oct 9. doi: 10.1007/s11356-021-16536-0. Online ahead of print.

ABSTRACT

An increasing number of studies examined the potential effects of PM₁ (submicronic particulate matter with an aerodynamic diameter ≤ 1 μm) on the risk of respiratory diseases; however, the results have been inconclusive. This study aimed to determine the overall association between PM₁ with total and cause-specific respiratory diseases. A systematic review and meta-analysis was conducted with 68 related articles retrieved, and six articles met the full inclusion criteria for the final analysis. For a 10 μg/m³ increase in PM₁, the pooled odds ratio (OR) was 1.05 (95% CI 0.98-1.12) for total respiratory diseases, 1.25 (95% CI 1.00-1.56) for asthma, and 1.07 (95% CI 1.04-1.10) for pneumonia with the I² value of 87%, 70%, and 0%, respectively. Subgroup analyses showed that long-term exposure to PM₁ was associated with increased risk of asthma (OR 1.47, 95% CI 1.33-1.63) with an I² value of 0%, while short-term exposure to PM₁ was not associated with asthma (OR 1.07, 95% CI 0.89-1.27) with the I² value of 0%. Egger’s test showed that publication bias existed (P = 0.041); however, the funnel plot was symmetrical with the inclusion of the moderator. In conclusion, elevated levels of PM₁ may increase morbidity in total and cause-specific respiratory diseases in the population.

PMID:34628607 | DOI:10.1007/s11356-021-16536-0

Ir J Med Sci. 2021 Oct 9. doi: 10.1007/s11845-021-02795-w. Online ahead of print.

ABSTRACT

BACKGROUND: Burnout is a syndrome resulting from chronic workplace stress that has not been successfully managed. Healthcare professionals are particularly susceptible to this occupational phenomenon. There is limited literature currently published addressing burnout in the context of the Irish frontline workers during the COVID-19 pandemic.

OBJECTIVES: Our study aims to determine the rate and degree of burnout present in the emergency department (ED) staff at St. James hospital Dublin (SJH) and at Cork University Hospital (CUH), in the context of the COVID-19 pandemic.

DESIGN: A cross-sectional study was performed on a convenience sample of medical staff and healthcare staff in the ED at Cork University Hospital and St. James Hospital Dublin, two major University Hospital EDs. Burnout was measured using the Oldenburg burnout inventory (OLBI) a standardised 16-question instrument. Participants also provided demographic data and answered several questions relating to the pandemic.

PARTICIPANTS: Ninety-nine participants across two departments responded (a response rate of 30%). All ED cohorts were represented.

RESULTS: Burnout was identified in almost three quarters of respondents (74%). The mean burnout scores were 2.42 (OLBI cut-off 2.18). There was mean disengagement level of 2.25 and a mean exhaustion level of 2.59. There was no statistically significant variance between staff, by demographics (i.e. occupation, years working in the ED, age, or gender). There was no significant difference in burnout rates or scores between St. James Hospital, Dublin, and Cork University Hospital, though the former tended to have a higher rate of burnout at 81% vs the 67% burnout observed in CUH.

CONCLUSIONS: The COVID-19 pandemic may be contributing to the long-established problem of health care burnout. The trajectory of this disease is still unclear. Consistent, progressive measures to address staff well-being, and support frontline workers, are imperative going forward.

PMID:34628589 | DOI:10.1007/s11845-021-02795-w

Dermatol Ther (Heidelb). 2021 Oct 10. doi: 10.1007/s13555-021-00608-7. Online ahead of print.

NO ABSTRACT

PMID:34628584 | DOI:10.1007/s13555-021-00608-7

Int Ophthalmol. 2021 Oct 10. doi: 10.1007/s10792-021-02080-w. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the clinical outcomes of pseudophakic/aphakic eyes with uncontrolled glaucoma that underwent Ahmed glaucoma valve implantation with the tube placement in the ciliary sulcus.

METHODS: Medical records of the patients who underwent Ahmed glaucoma valve implantation through the ciliary sulcus, between December 2017 and June 2019, were reviewed retrospectively. Patients’ age, gender, glaucoma diagnosis, visual acuity, intraocular pressure levels, and complications were recorded.

RESULTS: Forty-seven eyes of 43 patients with glaucoma were enrolled. The mean age was 54.5 ± 19.9 years (range, 7-88 years) at the time of surgery, and the mean postoperative follow-up period was 7.9 ± 3.4 months (range, 3-16 months). The mean preoperative intraocular pressure level was 35.2 ± 6.8 mmHg (range, 25-55 mmHg), and it was found as 15.6 ± 5.4 mmHg (range, 9-33 mmHg) at the last follow-up visit. Decrease in intraocular pressure level was statistically significant (P < 0.001). At the last follow-up visit, success (postoperative IOP ≥ 6 mmHg and ≤ 21 mmHg with or without antiglaucomatous medications, without further surgery for IOP control, without loss of light perception and without removal of the implant) was achieved in 41 eyes (87.2%). Hyphema was the most common postoperative complication and developed in 11 eyes (23.4%) and resolved spontaneously in all of them within one month.

CONCLUSION: In pseudophakic or aphakic eyes with uncontrolled glaucoma, placement of Ahmed glaucoma valve tube in the ciliary sulcus is a safe and effective procedure. Ciliary sulcus can be considered as a potential space during tube shunt surgery in eyes with high risk of tube-corneal touch or corneal decompensation.

PMID:34628581 | DOI:10.1007/s10792-021-02080-w