Nevin Manimala

J Child Psychol Psychiatry. 2021 Jul 5. doi: 10.1111/jcpp.13484. Online ahead of print.

ABSTRACT

BACKGROUND: Eating disorders exhibit high comorbidity with other psychiatric disorders, most notably mood, substance use, and anxiety disorders. However, most studies examining psychiatric comorbidity are conducted in adolescents and adults. Therefore, the comorbidity among children living with eating disorders is unknown. The aim of this study was to characterize co-occurring psychiatric disorders with eating disorders in a US sample of children aged 9-10 years old utilizing the Adolescent Brain Cognitive Development study.

METHODS: The analytic sample included 11,718 children aged 9-10 years. Anorexia nervosa, bulimia nervosa, binge eating disorder, and other specified feeding and eating disorder subtype diagnoses were examined. Statistical analyses were conducted using complex sampling. Odds ratios and 95% confidence intervals were calculated comparing the likelihood of being diagnosed for a psychiatric disorder when having an eating disorder, as compared to children without an eating disorder, children diagnosed with major depressive disorder, and children diagnosed with posttraumatic stress disorder using binary logistic regression.

RESULTS: Co-occurring psychiatric disorders were substantially higher in children with eating disorders as compared to children without eating disorders, but not as compared to children diagnosed with major depressive disorder or posttraumatic stress disorder. The most common comorbidities for the eating disorder group were anxiety disorders (71.4%), attention deficit/hyperactivity disorder (47.9%), disruptive/impulse control disorders (45.0%), mood disorders (29.6%), and obsessive-compulsive disorder (28.8%), largely in line with previous research.

CONCLUSIONS: This study extends prior research finding high rates of comorbidity in eating disorders, specifically with anxiety, mood, and disruptive/impulse control disorders. Clinicians assessing for psychiatric disorders should be aware that eating disorders can occur in children 9 and 10 years old and are associated with severe comorbidity. Referrals for specialty mental health care should be considered.

PMID:34225382 | DOI:10.1111/jcpp.13484

Ultraschall Med. 2021 Jul 5. doi: 10.1055/a-1530-5240. Online ahead of print.

ABSTRACT

OBJECTIVES: Prenatal prediction of postnatal univentricular versus biventricular circulation in patients with borderline left ventricle (bLV) remains challenging. This study investigated prenatal fetal echocardiographic parameters and postnatal outcome of patients with a prenatally diagnosed bLV.

METHODS: We report a retrospective study of bLV patients at four prenatal centers with a follow-up of one year. BLV was defined as z-scores of the left ventricle (LV) between -2 and -4. Single-ventricle palliation (SVP), biventricular repair (BVR), and no surgical or catheter-based intervention served as the dependent outcome. Prenatal ultrasound parameters were used as independent variables. Cut-off values from receiver operating characteristic curves (ROC) were determined for significant discrimination between outcomes.

RESULTS: A total of 54 patients were diagnosed with bLV from 2010 to 2018. All were live births. Out of the entire cohort, 8 (15 %) received SVP, 34 (63 %) BVR, and 12 (22 %) no intervention. There was no significant difference with regard to genetic or extracardiac anomalies. There were significantly more patients with endocardial fibroelastosis (EFE) in the SVP group compared to the BVR group (80 % vs. 10 %), (p < 0.001). Apex-forming LV (100 % vs. 70 %) and lack of retrograde arch flow (20 % vs. 80 %) were associated with no intervention (p < 0.001). With respect to BVR vs. SVP, the LV sphericity index provided the highest specificity (91.7 %) using a cutoff value of ≤ 0.5.

CONCLUSION: The majority of bLV patients maintained biventricular circulation. EFE, retrograde arch flow, and LV sphericity can be helpful parameters for counseling parents and further prospective studies can be developed.

PMID:34225376 | DOI:10.1055/a-1530-5240

J Trauma Acute Care Surg. 2021 Jul 2. doi: 10.1097/TA.0000000000003334. Online ahead of print.

ABSTRACT

BACKGROUND: This pilot assessed transfusion requirements during resuscitation with whole blood followed by standard component therapy versus component therapy alone, during a change in practice at a large urban level I trauma center.

METHODS: This was a single-center prospective cohort pilot study. Male trauma patients received up to 4 units of cold-stored low anti-A, anti-B group O whole blood (LTOWB) as initial resuscitation followed by CT as needed (LTOWB + CT). A control group consisting of females, and males who presented when LTOWB was unavailable, received component therapy only (CT group). Exclusion criteria included antiplatelet or anticoagulant medication and death within 24 hours. The primary outcome was total transfusion volume at 24 hours. Secondary outcomes were mortality, morbidity, and ICU- and hospital-free days.

RESULTS: Thirty-eight patients received LTOWB, with a median of 2.0 [IQR 1.0, 3.0] units of LTOWB transfused. Thirty-two patients received CT only. At 24 hours after presentation, the LTOWB +CT group had received a median of 2138 mL [IQR 1275-3325] of all blood products. The median for the CT group was 4225 mL [IQR 1900-5425], p = 0.06 in unadjusted analysis. When adjusted for Injury Severity Score, sex, and positive Focused Assessment with Sonography for Trauma (FAST), LTOWB +CT group patients received 3307 mL of blood products and CT group patients received 3260 mL in the first 24 hours (p = 0.95). The adjusted median ratio of plasma to red cells transfused was higher in the LTOWB + CT group (0.85 vs 0.63 at 24 hours after admission, p = 0.043. Adjusted mortality was 4.4% in the LTOWB + CT group, and 11.7% in the CT group (p = 0.19), with similar complications, ICU-, and hospital-free days in both groups.

CONCLUSIONS: Beginning resuscitation with LTOWB results in equivalent outcomes compared to resuscitation with CT only.

LEVEL OF EVIDENCE: Therapeutic, Level III (Prospective study with 1 negative criterion, limited control of confounding factors).

PMID:34225348 | DOI:10.1097/TA.0000000000003334

J Trauma Acute Care Surg. 2021 Jul 2. doi: 10.1097/TA.0000000000003322. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this systematic review was to investigate the safety and effectiveness of conservative management versus prophylactic intercostal catheter (ICC) insertion for the management of occult pneumothoraces in mechanically ventilated patients.

METHODS: PubMed, Embase, CINAHL, Web of Science, Cochrane Central and other trial registries were searched. Eligible studies were critically appraised using standardised instruments. Meta-analysis was performed with mixed-methods logistic regression where appropriate and sensitivity analyses were performed with alternative statistical methods (StataTM 15 or RevMan 5.3) or summarised in narrative. Randomised controlled trials (RCTs) and cohort studies were analysed separately.

RESULTS: Twelve studies with a total of 354 participants were included; three RCTs (178 participants) and nine cohort studies (176 participants). The majority of the included studies, particularly the cohort studies, were well conducted. Two of the RCTs were rated as low quality. Statistically significant differences were observed in the RCT analysis: ICC insertion (any reason) (OR 2.86, 95% CI 1.26-6.43, 2 RCTs) in favour of prophylactic ICC; ICC complications (OR 0.12, 95% CI 0.02-0.62, 2 RCTs) in favour of conservative management. Non statistically significant differences were observed for progression of pneumothorax, ICC insertion (progression to simple pneumothorax) and ICC insertion (non-pneumothorax reasons). Results of analyses showed high imprecision (wide confidence limits). Conservative management showed a low rate of tension pneumothorax (2.8%). Complications were higher in the ICC group (19.5% vs 5.8%).

CONCLUSIONS: Available evidence suggests that conservative management is safe for the management of occult pneumothoraces in mechanically ventilated patients, especially when undergoing short-term (<4 days) ventilation. We recommend that patients undergoing mechanical ventilation for a procedure alone and patients suspected to be ventilated less than four days can be conservatively managed.

LEVELS OF EVIDENCE: level 3.

STUDY TYPE: systematic review and meta-analysis.

PMID:34225346 | DOI:10.1097/TA.0000000000003322

J Am Assoc Nurse Pract. 2021 Jul 2. doi: 10.1097/JXX.0000000000000625. Online ahead of print.

ABSTRACT

BACKGROUND: Lung cancer patients and survivors are vulnerable to disturbed sleep and impaired quality of life (QOL) across the continuum of illness. Few studies have sought to identify predictors of QOL using well-validated measures of both sleep quality and QOL in this population.

PURPOSE: The purpose of this study was to examine factors associated with lung cancer that are predictive of QOL in adult lung cancer patients and survivors in the outpatient setting.

METHOD: Cross-sectional data collected exclusively in the outpatient setting from three lung cancer clinics in the Northeastern United States were pooled and analyzed. The pooled sample (N = 103) data included cancer type and stage, body mass index, Pittsburgh Sleep Quality Index, and Functional Assessment of Cancer Treatment-Lung information.

RESULTS: Significant correlations between sleep quality, lung cancer symptom severity, and QOL were observed. Sleep quality and lung cancer symptoms were found to be statistically significant predictors of QOL. No significant differences in QOL were found based on cancer type or recruitment source. Demographic factors and cancer stage were also not predictive of overall QOL.

CONCLUSIONS: Lung cancer symptoms and sleep quality were important determinants of QOL in this pooled sample of lung cancer patients and survivors.

IMPLICATIONS FOR PRACTICE: Patients and survivors of lung cancer require routine screening for sleep disturbance, lung cancer symptoms, and QOL needs. Nurse practitioners can help improve QOL in this population by screening for and treating sleep disturbance and lung cancer symptoms.

PMID:34225324 | DOI:10.1097/JXX.0000000000000625

Ann Plast Surg. 2021 Jul 2. doi: 10.1097/SAP.0000000000002941. Online ahead of print.

ABSTRACT

INTRODUCTION: Pressure sores are agonizing complications of chronically bedridden patients. The management of these lesions particularly with respect to grades III and IV lesions are chiefly surgical and involves a multidisciplinary approach. Although there are a variety of local flap options, like fasciocutaneous flaps, musculocutaneous flaps, perforator flaps, and combinations of these to choose from, there is a paucity of literature regarding which flap is better among these in terms of complication and recurrence rates.

METHODS: The databases searched were as follows: Cochrane Central Register of Controlled trials (January 2000 to July 2020), MEDLINE (January 2000 to July 2020), and EMBASE (January 2000 to August of 2020). Key words used were “pressure ulcer,” “flaps,” “surgery,” “pressure sore” with limits, “human,” and “English.” Primary outcomes were “overall complication rates” and “recurrence rates.” Overall complication was further categorized as flap necrosis, flap dehiscence, infection, and others.

RESULTS: Thirty-nine articles were included in the final analysis. There was a statistically significant difference among the various types of flaps for overall complication, flap dehiscence, infection, flap necrosis, and recurrence rates.

CONCLUSIONS: Our study indicates that musculocutaneous flaps have lower recurrence rates, and combined flaps have lower complication rates. However, various other factors, like donor site morbidity, initial defect size, operating time, intraoperative blood loss, salvage options in case of recurrence, should also be considered while choosing a flap to reconstruct a defect.

PMID:34225313 | DOI:10.1097/SAP.0000000000002941

Nephron. 2021 Jul 5:1-7. doi: 10.1159/000516984. Online ahead of print.

ABSTRACT

Membranous nephropathy (MN) is an immune-mediated glomerular disease that can lead to nephrotic syndrome and progressive kidney function loss. The cyclic steroid-cyclophosphamide regimen (the modified Ponticelli protocol) and the monoclonal anti-CD20 antibody rituximab have been advocated as effective therapies to improve renal outcomes, but a direct comparison of these treatments had never been carried out in a prospective study. Subject of Review: Scolari et al. [J Am Soc Nephrol. 2021;32:972-82] recently reported the results of a pilot randomized controlled trial (RI-CYCLO) designed to provide direct estimates of the effect of rituximab (1 g × 2) compared to the cyclic steroid-cyclophosphamide regimen in 74 patients with MN. The proportion of patients with complete remission at 12 months was higher in the cyclic regimen arm than that of rituximab (32 and 16%, respectively), but the difference was not statistically significant in intention-to-treat analyses. Interestingly, differences in the cumulative incidence of complete and partial remissions between treatment arms progressively reduced over the follow-up and became virtually nonexistent from 24 months (>80% in both groups). The frequency of serious and nonserious adverse events was similar between the 2 treatment arms. Infusion reactions and drug discontinuation were more common with rituximab, while infections and leukopenia were more frequently observed with the cyclic regimen. The risk of cancer was similar in the 2 allocation groups, but the limited follow-up length did not allow to draw definitive conclusions. Independent of treatment allocation, 18% of patients experienced at least 1 relapse after achieving complete or partial remission. Second Opinion: Notwithstanding the intrinsic limitations of a pilot study, the RI-CYCLO trial represents an important milestone in the treatment of MN. Findings from this study support the hypothesis that the cyclic regimen and rituximab may have comparable efficacy in inducing disease remission over the long term. Considering its potentially better-albeit not yet formally proven-long-term safety profile, rituximab could be considered as a first-line therapy for most patients with MN. Several questions remain to be addressed, including rituximab ideal dose and its efficacy in patients with a significant reduction in glomerular filtration rate. In light of RI-CYCLO results, a large-scale trial to assess rituximab noninferiority to the cyclic regimen would require the enrollment of thousands of patients, and it would be probably unfeasible within a reasonable time frame. In our opinion, resources should be allocated to provide an answer to the pressing matter of treatment nonresponse and intolerance, which may be addressed in the near future with novel therapeutic strategies.

PMID:34225270 | DOI:10.1159/000516984

Phys Med Biol. 2021 Jul 5. doi: 10.1088/1361-6560/ac1157. Online ahead of print.

ABSTRACT

Healthcare professionals have been increasingly viewing medical images and videos in their routine clinical practice, and this in a wide variety of environments. Both the perception and interpretation of medical visual information, across all branches of practice or medical specialties (e.g., diagnostic, therapeutic, or surgical medicine), career stages, and practice settings (e.g., emergency care), appear to be critical for patient care. However, medical images and videos are not self-explanatory and, therefore, need to be interpreted by humans, i.e., medical experts. In addition, various types of degradations and artifacts may appear during image acquisition or processing, and consequently affect medical imaging data. Such distortions tend to impact viewers’ quality of experience, as well as their clinical practice. It is accordingly essential to better understand how medical experts perceive the quality of visual content. Thankfully, progress has been made in the recent literature towards such understanding. In this article, we present an up-to-date state of the art of relatively recent (i.e., not older than ten years old) existing studies on the subjective quality assessment of medical images and videos, as well as research works using task-based approaches. Furthermore, we discuss the merits and drawbacks of the methodologies used, and we provide recommendations about experimental designs and statistical processes to evaluate the perception of medical images and videos for future studies, which could then be used to optimise the visual experience of image readers in real clinical practice. Finally, we tackle the issue of the lack of available annotated medical image and video quality databases, which appear to be indispensable for the development of new dedicated objective metrics.

PMID:34225264 | DOI:10.1088/1361-6560/ac1157

Eur J Radiol. 2021 Jun 24;141:109827. doi: 10.1016/j.ejrad.2021.109827. Online ahead of print.

ABSTRACT

PURPOSE: In this case-control study, we evaluated different quantitative parameters derived from routine multi-detector computed tomography (MDCT) scans with respect to their ability to predict incident osteoporotic vertebral fractures of the thoracolumbar spine.

METHODS: 16 patients who received baseline and follow-up contrast-enhanced MDCT and were diagnosed with an incident osteoporotic vertebral fracture at follow-up, and 16 age-, sex-, and follow-up-time-matched controls were included in the study. Vertebrae were labelled and segmented using a fully automated pipeline. Volumetric bone mineral density (vBMD), finite element analysis (FEA)-based failure load (FL) and failure displacement (FD), as well as 24 texture features were extracted from L1 – L3 and averaged. Odds ratios (OR) with 95% confidence intervals (CI), expressed per standard deviation decrease, receiver operating characteristic (ROC) area under the curve (AUC), as well as logistic regression models, including all analyzed parameters as independent variables, were used to assess the prediction of incident vertebral fractures.

RESULTS: The texture feature Correlation (AUC = 0.754, p = 0.014; OR = 2.76, CI = 1.16-6.58) and vBMD (AUC = 0.750, p = 0.016; OR = 2.67, CI = 1.12-6.37) classified incident vertebral fractures best, while the best FEA-based parameter FL showed an AUC = 0.719 (p = 0.035). Correlation was the only significant predictor of incident fractures in the logistic regression analysis of all parameters (p = 0.022).

CONCLUSION: MDCT-derived FEA parameters and texture features, averaged from L1 – L3, showed only a moderate, but no statistically significant improvement of incident vertebral fracture prediction beyond BMD, supporting the hypothesis that vertebral-specific parameters may be superior for fracture risk assessment.

PMID:34225250 | DOI:10.1016/j.ejrad.2021.109827

Chemosphere. 2021 Jul 1;284:131400. doi: 10.1016/j.chemosphere.2021.131400. Online ahead of print.

ABSTRACT

We investigated particle size distribution and heavy metal concentrations in surface sediments of streams and lakes in the Seomjin River Basin by comparison with Sediment Quality Guidelines (SQGs). Origins were identified using statistical and geochemical approaches. Sand was prevalent in mean particle size of surface sediments (except lakes). Mean concentrations of Pb, Zn, Cd, and Hg were similar for the Seomjin and Boseong rivers, while those of Cu, As, Cr, and Ni were approximately 1.5-2.0 times higher in the Boseong. SQGs revealed no serious pollution in the basin’s site concentrations, although As and Ni levels in the Boseong had some potential for benthos toxicity. Correlation and principal component/factor analysis showed that concentrations of Cu, As, Cr, and Ni were dominant from geological origins rather than anthropogenic. The reducible fraction bound to Fe and Mn-oxides was prevalent in Pb, while the water- and acid-soluble fractions were easily exchangeable or bound to high Cd carbonates. The fraction bound to the highest lattice in residual prevailed in Zn, Cu, Cr, and Ni, accounting for 64%, 65%, 87%, and 86%, respectively. Similarly, results indicated geological origins. Risk assessment to benthos based on labile fractions (F1 + F2 + F3) were Cd (72%) < Pb (66%) < Zn (36%) ≈ Cu (35%) < Ni (14%) ≈ Cr (13%). While Cd and Pb showed the highest risk, their concentrations were relatively lower. However, Cr and Ni showed the highest concentrations but low risk levels, suggesting their pollution is unlikely to have adverse effects on benthos.

PMID:34225114 | DOI:10.1016/j.chemosphere.2021.131400