Nevin Manimala

Eur J Obstet Gynecol Reprod Biol. 2021 Feb 24;259:146-152. doi: 10.1016/j.ejogrb.2021.02.023. Online ahead of print.

ABSTRACT

OBJECTIVE: During the past three decades, applying IVF for infertility treatment PCOS women has increased significantly, and the landscape of treatment strategies has changed dramatically. However, early review of IVF on PCOS have insufficiently accounted for efficacy and safety of the technic. With abundant studies in recent years, there is a need to reconcile these new data.

MATERIAL AND METHODS: To compare reproductive and obstetric outcomes of IVF between women with and without PCOS, a meta-analysis of 95 studies involving more than 21289 PCOS patients and 43036 controls was performed.

RESULTS: Despite longer stimulation duration (WMD = 0.34 day, 95 % CI: 0.09, 0.59) and lower dose of Gn required (WMD = -361.3 IU, 95 % CI: -442.3, -280.4), more oocytes (WMD = 3.67, 95 % CI: 3.14-4.21) and matured oocytes (WMD = 2.16, 95 % CI: 1.52-2.80) per cycle were obtained from PCOS women. There were no statistically significant differences for cleavage, high-grade embryo and implantation rate. Although similar pregnancy and live birth rates per cycle were achieved in PCOS and non-PCOS women after IVF, women with PCOS still suffered from significantly increased risks of miscarriage (OR = 1.44, 95 % CI: 1.20-1.72), biochemical pregnancy loss (OR = 1.89, 95 % CI: 1.48-2.41), and OHSS (OR = 3.58, 95 % CI: 2.86-4.48), in addition to lower fertilization rate (OR = 0.79, 95 % CI: 0.71-0.88). Adverse obstetric outcomes including ectopics pregnancy and multiple pregnancies are comparable between two groups. The overall cycle cancellation rate was significantly higher among PCOS women with OR of 2.55 (95 % CI: 1.67-3.89), and concern over OHSS or hyper-response constitute the main cause. Similar results were also observed after stratified analysis.

CONCLUSIONS: Our results support the effectiveness of IVF for infertility treatment among PCOS patients. However, options to minimize adverse outcomes regarding to lower fertilization, miscarriage, biochemical pregnancy loss and OHSS are required. Further studies elucidating detailed mechanism underlying these adverse outcomes could be of great importance to improve the experience of IVF treatment.

PMID:33676123 | DOI:10.1016/j.ejogrb.2021.02.023

Mar Pollut Bull. 2021 Mar 3;166:112040. doi: 10.1016/j.marpolbul.2021.112040. Online ahead of print.

ABSTRACT

Levrier Bay is an important fishing area which is under growing anthropogenic pressures seriously threatening this treasure. Among these pressures Polycyclic Aromatic Hydrocarbon are of great environmental concern. Therefore, 16 EPA-PAHs were analyzed using GC-MS in Perna perna species and sediment. Comparison with Dakar (Senegal) and Moroccan coasts shows that PAHs levels are strikingly lower than that of heavily polluted Dakar coast (2474 μg/kg); nevertheless, comparable to Moroccan Casablanca and Tangier coasts (245 and 351 μg/kg, respectively). Ratio analysis indicates the predominance of pyrogenic sources and partial contribution of automotive traffic for the half of 4 sites. Furthermore, statistical analys shows that there are no significative differences, except for Benzo(b)Fluorentene in P. perna tissue and 4 PAHs (Fluorene; Fluorenthene; Pyrene; diBenzo(ah)Anthracene and dBahANT) in sediment for sites samples. Furthermore, bioconcentration indicates that P. perna is an excellent PAHs bioindicator. This points the necessity for immediate introduction of a sound Pollutants monitoring system.

PMID:33676109 | DOI:10.1016/j.marpolbul.2021.112040

Am J Emerg Med. 2021 Feb 24;45:80-85. doi: 10.1016/j.ajem.2021.02.046. Online ahead of print.

ABSTRACT

BACKGROUND: Children with traumatic head injury are often transferred from community Emergency Departments (ED) to a Pediatric Emergency Department (PED). The primary objective of this study was to describe the outcomes of minor head injury (MHI) transfers to a PED. The secondary objective was to report Computed Tomography (CT) utilization rates for MHI.

METHODS: We conducted a retrospective study of children aged ≤18 years transferred to our PED for MHI from 2013 to 2018. Patients with Glasgow Coma Scale (GCS) < 14, coagulopathies, history of brain mass/shunt and suspected non-accidental trauma were excluded. Data collected included demographics, interventions performed, and disposition. MHI risk stratification and clinically important traumatic brain injury (ciTBI) were defined per the Pediatric Emergency Care Applied Research Network (PECARN) head injury guidelines. Descriptive statistics were reported using general measures of frequency and central tendency.

RESULTS: A total of 1078 children with MHI were analyzed based on eligibility criteria. The majority of patients were male (62%) and ≥ 2 years of age (69.3%). Subspecialist consultation (57.2%) and neuroimaging (27.4%) were the most commonly performed interventions in the PED. Only 14 children (1.3%) required neurosurgical intervention. One-third of the transferred patients required no additional work-up. Two-thirds of the patients (66.6%) were directly discharged from the PED. Though the total number of MHI transfers per year declined steadily during the study period (from 271/year to 119/year), CT head utilization remained relatively similar across the study years (60.3% to 70.8%). A higher proportion of children received CT in the ED when compared to the PED for low-risk (28.9% vs 15.8%) and intermediate-risk groups (42.8% vs 29.4%).

CONCLUSIONS: The majority of pediatric MHI transfers are discharged home following a subspecialty consultation and/or neuroimaging. Despite guidelines and a low incidence of ciTBI, CT utilization remains high in the intermediate and low risk MHI groups, especially in the community settings. Targeted interventions are needed to reduce the potentially avoidable transfers and low-value performance of CT in children with MHI.

PMID:33676080 | DOI:10.1016/j.ajem.2021.02.046

Ophthalmol Glaucoma. 2021 Mar 3:S2589-4196(21)00043-0. doi: 10.1016/j.ogla.2021.02.003. Online ahead of print.

ABSTRACT

PURPOSE: To compare the characteristics of the peripapillary choroid (PPC) between the two eyes of patients with unilateral treatment-naïve normal tension glaucoma (NTG).

DESIGN: Observational case series.

PARTICIPANTS: Sixty-nine patients (138 eyes) with treatment-naive unilateral NTG.

METHODS: The characteristics of PPC vasculature were evaluated by measuring PPC thickness and assessing the presence of parapapillary deep-layer microvasculature dropout (MvD). PPC thickness was measured by enhanced depth imaging optical coherence tomography (OCT). MvD was assessed using OCT angiography. The area and maximum radial width of β-zone parapapillary atrophy (PPA) were measured on infra-red images using the built-in caliper tool of the Spectralis OCT.

MAIN OUTCOME MEASURES: Between-eye differences in PPC thickness, MvD frequency, and the area and maximum width of β-zone PPA.

RESULTS: Eyes with NTG had higher intraocular pressure (IOP), longer axial length, thinner PPC, larger area and maximum radial width of the β-zone PPA, and more frequent MvD (P < 0.01 each) than contralateral healthy eyes. Multivariate conditional logistic regression analysis revealed that higher IOP, thinner PPC, larger maximum radial width of β-zone PPA, and the presence of MvD were independently associated with the risk of NTG (P < 0.03 each). MvD location and retinal nerve fiber layer defect were topographically correlated in eyes with NTG.

CONCLUSIONS: PPC vasculature characteristics are significantly more compromised in eyes with NTG than in contralateral healthy eyes of patients with unilateral NTG.

PMID:33676067 | DOI:10.1016/j.ogla.2021.02.003

Appl Ergon. 2021 Mar 3;94:103385. doi: 10.1016/j.apergo.2021.103385. Online ahead of print.

ABSTRACT

OBJECTIVES: This systematic review and meta-analysis determined the effects of using an exoskeleton during occupational tasks on physical stress and strain compared to not using an exoskeleton.

METHODS: Systematic electronic database searches were performed and the review was prepared according to the PRISMA guidelines. Treatment effects on the predefined outcomes were calculated using standardized mean differences for continuous outcomes in several meta-analyses using Review Manager 5.3. Registration: PROSPERO (CRD42020168701).

RESULTS: 63 articles were included in qualitative syntheses and 52 in quantitative, but most of them did not extensively evaluate musculoskeletal stress and strain and the risk of bias was rated high for all included studies. Statistically significant effects of using back, upper-limb, or lower-limb exoskeletons have been observed in the supported body areas (e.g. reduced muscle activity, joint moments and perceived strain). Studies which did not exclusively focus on the supported body area also showed statistically significant effects in the non-supported areas (e.g. changed muscle activity and perceived strain) and in physiological outcomes (e.g. reduced energy expenditure).

CONCLUSIONS: Using an exoskeleton during occupational tasks seems to reduce user’s acute physical stress and strain in the exoskeleton’s target area. However, impact on workers’ health is still unknown, primarily because of missing long-term evaluations under real working conditions. Furthermore, this systematic review highlights a lack of studies (1) following high quality methodological criteria, (2) evaluating various inter-related stress and strain parameters instead of only focusing on one specific, and (3) evaluating non-target body areas instead of only the directly supported body area.

PMID:33676059 | DOI:10.1016/j.apergo.2021.103385

J Hum Evol. 2021 Mar 3;153:102950. doi: 10.1016/j.jhevol.2021.102950. Online ahead of print.

ABSTRACT

Archaeological remains have highlighted the fact that the interglacial Marine Isotope Stage (MIS) 11 was a threshold from the perspective of hominin evolution in Europe. After the MIS 12 glaciation, considered one of the major climate-driven crises experienced by hominins, the archaeological records show an increasing number of occupations, evidence of new subsistence behaviors, and significant technical innovations. Here, we used statistical and geographic techniques to analyze the amphibian- and reptile-based paleoclimate and habitat reconstructions generated from a large data set of the Iberian Peninsula to (1) investigate if temperature, precipitation, and/or forest cover may have impacted the hominin occupation of the territory during the Early and Middle Pleistocene, (2) propose an ‘Iberian’ ecological model before and after the MIS 12/11 transition, and (3) evaluate, based on this model, the potential hominin occupation at a European scale. The results indicate the existence of climatic constraints on human settlement related to rainfall and environmental humidity. The Early Pleistocene and the first half of the Middle Pleistocene are dominated by the occupation of relatively humid wooded areas, whereas during the second part of the Middle Pleistocene, a broadening of the earlier ecological niche is clearly observed toward the occupation of more open arid areas. Based on the estimated occupational niche for hominins, a maximum potential distribution for early hominins is proposed in Europe before and after 426 ka. Results also indicate that parts of the Iberian Peninsula may not have been suitable for early hominin occupation. Our ecological model is consistent with the pattern of hominin occupation observed in northern and central Europe, where the earliest evidence reflects only pioneering populations merely extending their ranges in response to the expansion of their preferred habitats, as compared with a more sustained occupation by 400 ka.

PMID:33676058 | DOI:10.1016/j.jhevol.2021.102950

Spine J. 2021 Mar 3:S1529-9430(21)00108-X. doi: 10.1016/j.spinee.2021.03.001. Online ahead of print.

ABSTRACT

BACKGROUND CONTEXT: Recent media coverage of overlapping surgery has led to several studies investigating public perception of concurrent and overlapping surgery, both of which involve a single attending surgeon working on two separate cases in two separate operating rooms. In concurrent surgery, the critical periods of the surgeries overlap, while in overlapping surgery they do not. The literature revealed a general lack of knowledge about these practices and strong disapproval of their use by the public.

PURPOSE: To determine the comfort level of spine surgery patients and their family members toward concurrent and overlapping surgery.

STUDY DESIGN/SETTING: This cross-sectional survey study was performed at an urban, adult academic spine surgery clinic.

PATIENT SAMPLE: Patients and their companions who were waiting to be seen at their initial clinic visit or follow-up visit were approached to participate in the study.

OUTCOME MEASURES: The survey queried respondents’ baseline knowledge of and comfort level with concurrent and overlapping surgery, in addition to comfort level with different levels of surgical trainees on a 5-point Likert scale.

METHODS: A five-section, 36-item questionnaire was administered by a research assistant to respondents over a three-month period spanning June 2019 – August 2019. A research assistant described the terms overlapping surgery and concurrent surgery to participants of the survey using diagrams and a pre-formulated script after self-reported knowledge questions. Statistical analysis was performed using the chi-square test for categorical variables, and Kendall’s tau-c rank correlation coefficient with ordinal independent variables for correlations.

RESULTS: Knowledge about concurrent and overlapping surgery was low in our study population (8.22% and 6.16%, respectively). Over half of respondents reported that they felt comfortable with overlapping surgery (58.22%). Most respondents reported that they would like their surgeon to disclose the participation of surgical trainees (residents and fellows) in their surgery (98%). In addition, the 4^th and 5^th years of surgical training were associated with a significant increase in patient comfort with surgical trainee participation. There was no difference in response distribution between patients versus non-patients.

CONCLUSIONS: Knowledge about concurrent and overlapping surgery remains poor in our study population. Lack of general knowledge about overlapping surgery can be a serious impediment to obtaining informed consent, and further study is required to determine the best methods to raising patient awareness.

PMID:33676019 | DOI:10.1016/j.spinee.2021.03.001

Infect Genet Evol. 2021 Mar 3:104801. doi: 10.1016/j.meegid.2021.104801. Online ahead of print.

ABSTRACT

Severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) has first emerged from China in December 2019 and causes coronavirus induced disease 19 (COVID19). Since then researchers worldwide have been struggling to detect the possible pathogenesis of this disease. COVID19 showed a wide range of clinical behavior from asymptomatic to severe acute respiratory disease syndrome. However, the etiology of susceptibility to severe lung injury is not yet fully understood. Angiotensin-converting enzyme1 (ACE1) convert angiotensin I into Angiotensin II that was further metabolized by ACE 2 (ACE2). The binding ACE2 receptor to SARS-CoV-2 facilitate its enter into the host cell. The interaction and imbalance between ACE1 and ACE2 play a crucial role in the pathogenesis of lung injury. Thus, the aim of this study was to investigate the association of ACE1 I/D polymorphism with severity of Covid-19. The study included RT-PCR confirmed 269 cases of Covid-19. All cases were genotyped for ACE1 I/D polymorphism using polymerase chain reaction and followed by statistical analysis (SPSS, version 15.0). We found that ACE1 DD genotype, frequency of D allele, older age (≥46 years), unmarried status, and presence of diabetes and hypertension were significantly higher in severe COVID19 patient. ACE1 ID genotype was significantly independently associated with high socio-economic COVID19 patients (OR: 2.48, 95% CI: 1.331-4.609). These data suggest that the ACE1 genotype may impact the incidence and clinical outcome of COVID-19 and serve as a predictive marker for COVID-19 risk and severity.

PMID:33676010 | DOI:10.1016/j.meegid.2021.104801

Fish Shellfish Immunol. 2021 Mar 3:S1050-4648(21)00058-9. doi: 10.1016/j.fsi.2021.02.017. Online ahead of print.

ABSTRACT

Columnaris, a highly contagious bacterial disease caused by Flavobacterium columnare, is recognized as one of the most important infectious diseases in farmed tilapia, especially during the fry and fingerling stages of production. The disease is associated with characteristic lesions in the mucosa of affected fish, particularly their skin and gills. Vaccines delivered via the mucosa are therefore of great interest to scientists developing vaccines for this disease. In the present study, we characterized field isolates of F. columnare obtained from clinical columnaris outbreaks in red tilapia to select an isolate to use as a candidate for our vaccine study. This included characterizing its colony morphology, genotype and virulence status. The isolate was incorporated into a mucoadhesive polymer chitosan-complexed nanovaccine (CS-NE), the efficacy of which was determined by experimentally infecting red tilapia that had been vaccinated with the nanoparticles by immersion. The experimental infection was performed 30-days post-vaccination (dpv), which resulted in 89 % of the unvaccinated control fish dying, while the relative percentage survival (RPS) of the CS-NE vaccinated group was 78 %. Histology of the mucosal associated lymphoid tissue (MALT) showed a significantly higher presence of leucocytes and a greater antigen uptake by the mucosal epithelium in CS-NE vaccinated fish compared to control fish and whole cell vaccinated fish, respectively, and there was statistically significant up-regulation of IgT, IgM, TNF α, IL1-β and MHC-1 genes in the gill of the CS-NE vaccinated group. Overall, the results of our study confirmed that the CS-NE particles achieved better adsorption onto the mucosal surfaces of the fish, elicited great vaccine efficacy and modulated the MALT immune response better than the conventional whole cell-killed vaccine, demonstrating the feasibility of the mucoadhesive nano-immersion vaccine as an effective delivery system for the induction of a mucosal immune response against columnaris disease in tilapia.

PMID:33675991 | DOI:10.1016/j.fsi.2021.02.017

J Shoulder Elbow Surg. 2021 Mar 3:S1058-2746(21)00148-8. doi: 10.1016/j.jse.2021.02.007. Online ahead of print.

ABSTRACT

BACKGROUND: Amid rising healthcare costs and recent advances in surgical and anesthetic protocols, outpatient joint arthroplasty has risen steadily in recent years. While the safety of outpatient total knee arthroplasty (TKA) and total hip arthroplasty (THA) has been well-established, outpatient shoulder arthroplasty is still in its infancy. The purpose of this study is to synthesize the current literature and to provide further data regarding the outcomes and safety of outpatient shoulder arthroplasty.

METHODS: A systematic review was conducted following the standard PRISMA guidelines. Included were papers that evaluated the outcomes of patients undergoing outpatient total shoulder arthroplasty (TSA) or reverse total shoulder arthroplasty (RTSA). Meta-analysis was conducted using Mantel-Haenszel statistics to generate odds ratios and their corresponding 95% confidence intervals comparing outpatient and inpatient shoulder arthroplasty.

RESULTS: Twelve studies were included with a total of 194,513 patients, of which, 7,162 were outpatients. Of the studies, eight were level III studies and four were level IV. The average age of the outpatients was 66.6 years and the average age of the inpatients was 70.1 years. The overall odds ratio of complications was significantly lower in outpatients (OR=0.40 [0.35-0.45]) than inpatients. There was no significant difference in 90-day readmission (OR=0.88 [0.75-1.03]), revision (OR=0.96 [0.65-1.41]), and infection rates (OR=0.93 [0.64-1.35]) when comparing outpatients to inpatients.

CONCLUSION: Outpatient total shoulder arthroplasty, in an appropriately selected patient population, is safe and results in comparable patient outcomes when compared to inpatient shoulder arthroplasty. Due to the expected increase in patients requiring total shoulder arthroplasty, surgeons, hospital administrators, and insurance carriers should strongly consider the merits of a cost and care efficient approach to total shoulder replacement.

PMID:33675972 | DOI:10.1016/j.jse.2021.02.007