Nevin Manimala

Rev Esp Quimioter. 2021 Jul 5:barbero05jul2021. doi: 10.37201/req/033.2021. Online ahead of print.

ABSTRACT

OBJECTIVE: Several factors have been associated with the prognosis of prosthetic joint infection (PJI) treated with surgical debridement, antibiotic therapy, and implant retention (DAIR). There is no evidence about the right empirical antibiotic treatment when the causal microorganism is not still identified.

METHODS: We conducted a retrospective observational study in patients with PJI treated with DAIR between 2009 and 2018 in our center. We analyze the risk factors related with their prognosis and the influence of active empirical antibiotic therapy against causative microorganisms in final outcomes.

RESULTS: A total of 80 PJI cases treated with DAIR, from 79 patients (58.7% women, mean age 76.3 years), were included in the study period. Among the cases in which empirical antibiotic therapy were active against the causative microorganisms, the success rate was 46/65 (69.2%) vs 1/15 when not (6.7%, OR 31.5, p = 0.001). Factors related to the success or failure of the DAIR were analyzed with multivariate analysis. We found that active empirical antibiotic treatment remained statistically significant as a good prognostic factor (OR 0.04, p <0.01).

CONCLUSIONS: Empirical antibiotic treatment could be an important factor in the prognosis of PJI treated with DAIR. To identify cases at risk of infection by multidrug resistant microorganisms could be useful to guide empirical antibiotic therapy.

PMID:34223760 | DOI:10.37201/req/033.2021

Vopr Kurortol Fizioter Lech Fiz Kult. 2021;98(3):60-66. doi: 10.17116/kurort20219803160.

ABSTRACT

A scientific review is devoted to the study of the coastal climate in the resort treatment role of patients with chronic diseases and its impact on the health and life quality of the population of the seacoasts. The sources were the Cochrane Library, PubMed MEDLINE, MedlinePlus, PedRO, Google Scholar, British Medical Journal, Elsevier, The Global Wellness Institute, eLIBRARY.ru. The review includes 40 publications including 22 domestic and 18 foreign ones on clinical and surrogate outcomes of climate-therapy at seaside resorts in the structure of spa treatment in patients with chronic diseases. The health problems among the population of the seacoasts are considered. The features of conducting evidence-based studies in assessing the effects of climate procedures are noted. The analysis of the therapeutic and health-improving effect results of the seaside climate and the associated forms of thalassotherapy – terrenkur, swimming, aqua gymnastics, sea bathing, heliotherapy, landscape therapy, and the use of maricultureis carried out. The article presents statistically reliable data on the favorable outcomes of treatment of chronic forms of musculoskeletal, skin, pulmonary and cardiac pathology under the influence of thalassotherapy methods. It was found that the effectiveness of climate-therapy in oncological practice, the treatment of pollinosis, the use of algae and other maricultures has been insufficiently proven: the possibility of percutaneous permeability to seawater and its components. The risk of developing negative meteorological reactions during climate-therapy was noted.

PMID:34223756 | DOI:10.17116/kurort20219803160

Vopr Kurortol Fizioter Lech Fiz Kult. 2021;98(3):18-28. doi: 10.17116/kurort20219803118.

ABSTRACT

There are convincing data on the association of psycho-emotional disorders with the degree of bone mineral density (BMD) loss and the risk of fractures on the basis of osteoporosis (OP) but the nature of the causal relationship has not yet been clearly established. The study of this issue is important to substantiate the need and nature of psychological correction within the framework of comprehensive rehabilitation programs in patients with osteoporotic fractures.

OBJECTIVE: Study of the severity of symptoms of depression and anxiety in patients who have suffered compression fractures of the vertebrae (VF) of osteoporotic genesis who entered the II stage of medical rehabilitation, as well as the contribution to the development of psycho-emotional age disorders, the severity of OP, pain syndrome and the use of orthotics.

MATERIAL AND METHODS: The study sample consisted of 120 women 50 to 80 years old with an established diagnosis of OP based on the results of bone densitometry. The main group included 60 patients with OP complicated by at least one VF. The control group included 60 patients with OP without a history of osteoporotic fractures comparable in age, body mass index and BMD in the spine with the main group. The complex of examination included the collection of complaints, anamnesis of OP, previous fractures, assessment of pain syndrome according to VAS, BMD study and verification of VF by X-ray methods. To assess the level of depression (DL) we used the Tsung depression scale modified by T.I. Balashova, situational (SA) and personal anxiety (PA) – Spielberger-Khanin questionnaire.

RESULTS: In the main group in comparison with the control group the proportion of patients without symptoms of depression was lower (66.7 and 88.3%, respectively; p=0.042), as well as the frequency of detection of high degree of SA was higher (85.0 and 73.4%, respectively; p=0.039). In patients with VF it was higher than in the control, DL – 46.0 [42.0; 54.5] (27-70) and 43.0 [38.0; 47.5] (25-65) points, respectively (p=0.0009), as well as the SA degree – 61.5 [54.0; 71.0] (20-75) and 52.5 [43.5; 64.0] (20-68) points, respectively (p=0.0006). Statistically significant direct correlation dependences of DL on age (r=0.317; p=0.00042), the duration of the postmenopausal period (r=0.325; p=0.0003), the number of VFs (g= -0.245; p=0.00013) were established. Moreover, the intensity of pain syndrome (g= -0.234; p=0.00034), as well as feedbacks of this indicator with BMD in the spine (r= -0.342; p=0.00017) and the duration of the use of thoracolumbar orthoses (r = -0.504; p = 0.00016). There were direct dependence of the SA degree on age (r=0.281; p=0.0019) and the intensity of pain syndrome (g=0.258; p=0.0044). Negative correlation of SA with body weight (r= -0.183; p=0.045), BMD in the spine (r= -0.207; p=0.026), duration of orthosis application (r= -0.327; p=0.0095) and the amount of VF in the lumbar spine (g= -0.214; p=0.044) were detected. There was a significant correlation between the degree of PA and BMD in the lumbar vertebrae (r= -0.18; p=0.046) and the intensity of pain syndrome (g=0.137; p=0.039).

CONCLUSION: The results obtained indicate the need for psychological correction in the framework of the complex rehabilitation of women who underwent VF based on OP due to increased DL and SA especially in older age groups.

PMID:34223751 | DOI:10.17116/kurort20219803118

Can J Surg. 2021 Jul 5;64(4):E364-E370. doi: 10.1503/cjs.005420.

ABSTRACT

BACKGROUND: In 2017, a provincial guideline was created to fast track and standardize care for pediatric appendicitis in Alberta. We conducted a study to determine the impact of implementation of the guideline at our institution on length of stay (LOS), antibiotic stewardship efforts and costs.

METHODS: We performed a retrospective review of the charts of all patients younger than 18 years of age who underwent appendectomy at our institution in 2 periods: before guideline implementation (Dec. 1, 2016, to May 31, 2017) and after implementation (Dec. 1, 2017, to May 31, 2018). We compared LOS, duration of antibiotic therapy, 30-day postdischarge complication rates and variable cost between the 2 cohorts.

RESULTS: Of the 276 total appendectomy procedures performed, 185 were for simple appendicitis (81 before guideline implementation and 104 after implementation), and 91 were for complicated appendicitis (44 and 47, respectively). The median LOS was shorter in the postimplementation cohort for both simple and complicated appendicitis (15.5 h [interquartile range (IQR) 12-19 h] v. 17.0 h [IQR 13-22 h], p = 0.03; and 3.0 d [IQR 2-4 d] v. 3.0 d [IQR 3-5 d], p = 0.05, respectively). Patients with complicated appendicitis had fewer antibiotic days after guideline implementation; the difference was statistically significant for patients without diffuse peritoneal contamination or abscess formation (p = 0.02). There were no differences between the cohorts with respect to 30-day rates of complications, including emergency department visits, readmission and surgical site infections. After guideline implementation, the average variable cost per patient was reduced by $230, equating to a total average annual cost savings of $75 842 for our institution.

CONCLUSION: The implementation of a provincial guideline aimed at standardizing care in pediatric appendicitis at our institution was associated with shortened LOS, improved antibiotic stewardship efforts and reduced cost of care. Other institutions may replicate our model of a standardized pathway in the management of pediatric appendicitis in an effort to improve the quality of patient care and reduce health care costs.

PMID:34223740 | DOI:10.1503/cjs.005420

Arch Razi Inst. 2021 Jul;76(2):283-291. doi: 10.22092/ari.2019.124040.1268. Epub 2021 Jul 1.

ABSTRACT

It is necessary to understand the frequency of virulence factor-encoding genes in the assessment of the carriage proportion. Moreover, it is required in the characterization of major unique antigens that are useful in the development of effective immunological-based preventive measures. The current study aimed to evaluate the frequency of three encoding-virulence genes associated with Enterotoxigenic (ET) and Shigatoxigenic Escherichia coli (E. coli/EC) pathotypes (k99, stx1, and stx2) in North of Sistan and Baluchistan Province, Iran. The frequency of k99, stx1, and stx2 was determined via polymerase chain reaction among E. coli isolates collected from the feces of the clinically healthy suckling (n=50) and diarrheic calves (n=50). The k99 gene was absent in all isolates, and the frequencies of the E. coli containing stx1 and stx2 or both stx1 and stx2 were estimated at 8%, 14%, and 4%, respectively, in the clinically healthy suckling calves (P&amp;gt;0.05), compared to 24%, 16%, and 6% in diarrheic animals (p &amp;lt;0.05). Among the three studied genes, there was a statistically significant difference between clinically healthy suckling and diarrheic calves in terms of the frequency of E. coli isolatescontaining stx1. On the other hand, the results of this study indicated that k99 was not a major fimbrial antigen-encoding gene in the ETECpopulation in the region. It is assumed that in any health measure intended to control the pathogen, other genes involved with encoding fimbriae should also be considered. The noticeable high frequency of E. coli isolates bearing stx1 and/or stx2 virulence elementsboth in clinically healthy and diarrheic suckling calves in this study isa concern for public health. Accordingly, it is recommended that further epidemiological studies be conducted on the role of the stx1 gene in the diarrhea of suckling calves in Sistan and Baluchistan Province, Iran.

PMID:34223727 | DOI:10.22092/ari.2019.124040.1268

Arch Razi Inst. 2021 Jul;76(2):253-259. doi: 10.22092/ari.2019.126417.1343. Epub 2021 Jul 1.

ABSTRACT

The keratinolytic activities of dermatophyte species are accompanied by the secretion of enzymes, such as serine proteases, which are coded by the Subtilisin (SUB) genes. This study aimed to determine the presence of the SUB genes in the clinical and nonclinical samples of Trichophyton verrucosum and Microsporum gypseum. Isolation was carried out by direct and laboratory examination. Following that, for the determination of the presence of the SUB gene, polymerase chain reaction with specific primers was conducted. The frequencies of the SUB gene were observed in almost 66% of the isolates. Statistical analysis showed a significant relationship between the presence of the SUB gene and the samples collected from human, animals, and soil (p ˂0.005). The current investigation has been the first study of the presence/absence of the SUB gene in the clinical and nonclinical isolates of T. verrucosum and M. gypseum in Iran which may be a new step to perform further studies.

PMID:34223724 | DOI:10.22092/ari.2019.126417.1343

Arch Razi Inst. 2021 Jul;76(2):223-229. doi: 10.22092/ari.2020.128417.1413. Epub 2021 Jul 1.

ABSTRACT

Fascioliasis is an emerging and important food and water-borne disease in human communities which has become one of the most important health challenges in countries, like Iran. It causes weight loss, a decrease in feed conversion ratio as well as milk and meat production, and also reduces fertility in animals the prevalence of fasciolosis is increasing in some regions of the world due to various factors. Different methods have been used for the detection of Fasciola hepatica in animals. This study is the first to detect F. hepatica in Lori sheep using polymerase chain reaction (PCR) and conventional diagnostic methods in Western Iran. During three months, 195 fecal samples were collected from sheep in Lorestan province, Iran, using the stratified random sampling method. The conventional diagnostic methods, including wet mount microscopic examination and concentration assays, as well as the PCR technique targeting the intergenic spacer gene of F. hepatica, were used for the detection of the parasite in sheep. In total, 4 (2.1%) out of 195 examined stool samples were positive for F. hepatica based on the conventional assays. The PCR test was positive for F. hepatica in7 (3.6%) samples of 195 studied specimens. Statistical analyses of the data revealed that there is a significant difference between the results of diagnostic methods for F. hepatica detection (P=0.0421). Finally, the results showed that PCR has more diagnostic sensitivity, compared to conventional diagnostic methods, including the concentration techniques and microscopic examination. Hence, it can be advised to use PCR for the detection of F. hepatica in sheep.

PMID:34223721 | DOI:10.22092/ari.2020.128417.1413

Eur J Prosthodont Restor Dent. 2021 Jun 17. doi: 10.1922/EJPRD_2285Muehlemann11. Online ahead of print.

ABSTRACT

This study analyzed the fit accuracy of the removable partial denture (RPD) metal frameworks produced using digital and conventional manufacturing technologies. Mandibular RPD metal frameworks (N=15, n=3 per group) were fabricated on a representative clinical case. RPDs were fabricated using one of the following manufacturing procedures: a) conventional lost-wax casting technique (C-LW), b) conventional casting of milled sacrificial patterns (C-M), c) conventional casting of printed sacrificial patterns (C-P), d) selective laser melting (SLM), e) direct metal laser sintering (DMLS) technologies. The fit accuracy of RPD frameworks was analyzed by fabricating replicas with silicone registration material and measuring with a digital microscope. A total of 11 sites and 29 areas in the RPD metal frameworks were considered for the accuracy measurements (μm). Data were statistically analyzed using Wilcoxon signed rank and Friedman test (α=0.05). Before finishing and polishing, C-M method presented overall significantly better (P⟨.001) fit accuracy (118 μm) than those of other methods (195-265 μm). After finishing and polishing, C-M method showed overall significantly better (P⟨.033) fit accuracy (205.7 μm) than C-LW and SLM methods (285.7 μm; 249 μm) and comparable fit accuracy to that of C-P and DMLS methods. Accuracy at the minor and major connector areas of RPDs were affected from the manufacturing technologies. Clinical Implications: When accuracy of RPDs are considered, digital technologies tested presented similar results to those of conventional manufacturing method except for minor and major connector areas which necessitates further improvement.

PMID:34223713 | DOI:10.1922/EJPRD_2285Muehlemann11

Birth Defects Res. 2021 Jul 5. doi: 10.1002/bdr2.1939. Online ahead of print.

ABSTRACT

BACKGROUND: Bortezomib, a selective inhibitor of 26S proteasome, is commonly used as a chemotherapeutic agent against different types of human cancer cells. While cancer during pregnancy is a rare condition, the trends in becoming pregnant at an advanced age increase the risk of cancer associated with pregnancy. Cancers need to be treated carefully without harming the fetus during pregnancy for the patients who desire to continue their pregnancy. The aim of this study is to demonstrate the potential side effects of bortezomib as this drug has so far not been investigated during preimplantation embryo development.

MATERIALS AND METHODS: Two cell stage embryos were flushed from mated female CD1 mice and were cultured. Two-cell, eight-cell, and morula stage embryos were exposed to different concentrations of bortezomib in vitro. Morphologic alterations of the embryos were evaluated and the data were statistically analyzed.

RESULTS: Our study showed that bortezomib exposure caused a statistically significant decrease in embryo survival and developmental competence and potential rate. We detected those early stages of embryos are more susceptible to bortezomib exposure than later stages.

CONCLUSION: We indicated that bortezomib adversely affects preimplantation embryo development in a dose, time, and developmental stage dependent manner. Moreover, bortezomib treatment inhibits preimplantation embryo development and induces cytoplasmic fragmentation and cell-cycle arrest on embryos.

PMID:34223698 | DOI:10.1002/bdr2.1939

J Cardiovasc Electrophysiol. 2021 Jul 5. doi: 10.1111/jce.15135. Online ahead of print.

ABSTRACT

BACKGROUND: Local impedance (LI) drop measured with micro-fidelity electrodes embedded in the tip of an ablation catheter accurately reflects tissue heating during radiofrequency (RF) ablation. Previous studies found 15-30Ω LI drops created successful lesions, while >40Ω drops were associated with steam pops. The objective of this study was to evaluate the safety and efficacy of LI-guided ablation using standard (30W) and high-power (50W) in a pre-clinical model.

METHODS: RF lesions were created in explanted swine hearts (n=6) to assess the feasibility of LI-guided ablation by targeting 10, 20, or 30Ω (n=20/group) drops. Subsequently LI-guided ablation was evaluated in a chronic animal model (n=8 Canines, 25-29kg, 30/50W). During the index procedure point-by-point intercaval line ablation and left inferior pulmonary vein (PV) isolation were performed. RF duration was at the operators’ discretion, but discontinued early if a 15-30Ω drop was achieved. Operators attempted to avoid LI drops >40Ω⊡ At 1-month, durable conduction block was evaluated with electroanatomic mapping followed by necropsy and histopathology.

RESULTS: In explanted tissue, terminating ablation at 10, 20, or 30Ω LI drops created statistically larger lesions (p<0.05; 1.8 [1.6-2.4]mm, 3.3 [3.0-3.7]mm; 4.9 [4.3-5.5]mm). LI-guided high-power ablation in vivo significantly reduced RF duration per application compared to standard-power (p<0.05; Intercaval: 8.9±5.2 versus 18.1±11.0sec, PV: 9.6±5.4 versus 23.2±10.3sec). LI drops of 15-40Ω were more readily achievable for high-power (90.1%, 318/353) than standard-power (71.7%, 243/339). All intercaval lines and PV isolations were durable (16/16) at 1-month. Necropsy revealed no major collateral injury to the pericardium, phrenic nerve, esophagus, or lungs. There was no pericardial effusion, stroke, tamponade, or PV stenosis. Vagal nerve injury was found in two 30W animals after using 19.7±13.9 and 19.5±11.8 sec RF applications.

CONCLUSION: LI-guided ablation was found to be safe and efficacious in a chronic animal model. High-power ablation more readily achieved >15Ω drops, reduced RF duration compared to standard-power, and had no major RF collateral injury.

CONDENSED ABSTRACT: This study evaluated the safety and efficacy of Local Impedance (LI)-guided High-power ablation in a pre-clinical model. Radiofrequency(RF) lesions were created in explanted swine hearts (n=6) to assess the feasibility of LI-guided ablation. Subsequently LI-guided lesions were created at the pulmonary veins and intercaval line in a chronic animal model. The durability of conduction block was evaluated after 1-month. We found that terminating ablation at 10, 20, or 30Ω LI drops created statistically larger lesions (p<0.05) and was safe. LI-guided high-power ablation in vivo significantly reduced RF duration (p<0.05), also all lesions were durable at 1-month. This article is protected by copyright. All rights reserved.

PMID:34223691 | DOI:10.1111/jce.15135