Nevin Manimala

Lupus. 2021 May 6:9612033211014248. doi: 10.1177/09612033211014248. Online ahead of print.

ABSTRACT

OBJECTIVE: Anti-beta 2 glycoprotein I IgA is a common isotype of anti-beta 2 glycoprotein I in SLE. Anti-beta 2 glycoprotein I was not included in the American College of Rheumatology (ACR) SLE classification criteria, but was included in the Systemic Lupus International Collaborating Clinics (SLICC) criteria. We aimed to evaluate the prevalence of anti-beta 2-glycoprotein I IgA in SLE versus other rheumatic diseases. In addition, we examined the association between anti-beta 2 glycoprotein I IgA and disease manifestations in SLE.

METHODS: The dataset consisted of 1384 patients, 657 with a consensus physician diagnosis of SLE and 727 controls with other rheumatic diseases. Anti-beta 2 glycoprotein I isotypes were measured by ELISA. Patients with a consensus diagnosis of SLE were compared to controls with respect to presence of anti-beta 2 glycoprotein I. Among patients with SLE, we assessed the association between anti-beta 2 glycoprotein I IgA and clinical manifestations.

RESULTS: The prevalence of anti-beta 2 glycoprotein I IgA was 14% in SLE patients and 7% in rheumatic disease controls (odds ratio, OR 2.3, 95% CI: 1.6, 3.3). It was more common in SLE patients who were younger patients and of African descent (p = 0.019). Eleven percent of SLE patients had anti-beta 2 glycoprotein I IgA alone (no anti-beta 2 glycoprotein I IgG or IgM). There was a significant association between anti-beta 2 glycoprotein I IgA and anti-dsDNA (p = 0.001) and the other antiphospholipid antibodies (p = 0.0004). There was no significant correlation of anti-beta 2 glycoprotein I IgA with any of the other ACR or SLICC clinical criteria for SLE. Those with anti-beta 2 glycoprotein I IgA tended to have a history of thrombosis (12% vs 6%, p = 0.071), but the difference was not statistically significant.

CONCLUSION: We found the anti-beta 2 glycoprotein I IgA isotype to be more common in patients with SLE and in particular, with African descent. It could occur alone without other isotypes.

PMID:33957797 | DOI:10.1177/09612033211014248

Lupus. 2021 May 6:9612033211014591. doi: 10.1177/09612033211014591. Online ahead of print.

ABSTRACT

BACKGROUND: Systemic lupus erythematosus (SLE) or lupus is an autoimmune disorder whose cause and reason for disproportionate impact on minorities remains enigmatic. Furthermore, statistics describing lupus incidence and prevalence are outdated and often based on small samples. To begin to address this disparity this report describes preliminary data to be utilized in the development of a state-wide lupus registry in South Carolina.

METHODS: A prospective survey and retrospective data from the South Carolina Budget and Control Board Office of Research & Statistics were used to capture data pertaining to knowledge of lupus, prevalence, and access to lupus care.

RESULTS: Retrospective ORS data indicated there were 11,690 individuals living with lupus in 2014 with the average direct cost of $69,999.40 in medical care. Prospective surveys (N = 325), in over 16 locations in South Carolina, showed 31% knew someone with lupus, 16% had been diagnosed with lupus, and 50% did not know of a medical facility that treated lupus.

CONCLUSION: A lupus registry and repository will provide ongoing access for researchers on the impact of lupus on communities in South Carolina. Lupus is highly prevalent, but disproportionately represented in terms of patient information and participation in clinical trials, so it is also expected that this preliminary work will provide an ongoing process in which the medical community can better engage lupus patients.

PMID:33957794 | DOI:10.1177/09612033211014591

Psychiatr Serv. 2021 May 7:appips202000292. doi: 10.1176/appi.ps.202000292. Online ahead of print.

ABSTRACT

OBJECTIVE: Child psychiatry access programs (CPAPs) help increase access to mental health services. This study aimed to provide information on the types of pediatric primary care clinicians (PPCCs) who call Maryland’s CPAP.

METHODS: Descriptive statistics and multinomial logistic regressions were conducted with data from 676 PPCCs who called Maryland’s CPAP at least once between October 2012 and June 2019.

RESULTS: On average, PPCCs contacted Maryland’s CPAP 6.8 times. Providers who called seven or more times were more likely to have an allopathic or osteopathic medicine degree and to specialize in pediatrics. Providers calling from rural regions were less likely to call only for referrals.

CONCLUSIONS: Most PPCCs contacted the CPAP for consultation or referrals but not both. PPCCs in rural areas were more likely to call for consultation, suggesting that they may be more likely to manage the care of patients with mental health conditions themselves, because of a lack of resources in their locations.

PMID:33957762 | DOI:10.1176/appi.ps.202000292

Asian Spine J. 2021 May 10. doi: 10.31616/asj.2020.0301. Online ahead of print.

ABSTRACT

STUDY DESIGN: This is a descriptive observational study.

PURPOSE: The objective of this study is to analyze and document the sagittal alignment of the spine and pelvis in normal Indian adult volunteers and compare these parameters with the study population of other races and ethnicities.

OVERVIEW OF LITERATURE: Given the importance of the spinopelvic parameters, there is a need to describe the parameters differentially in relation to the ethnicity of the studied individual. Very few reports have defined the normal physiological value. Ethnic differences are a significant factor not only when describing the anthropometric data but also when applying the findings to a different ethnic group. We have compared these values with other races and ethnicities so that we can know whether the principles of spinal fixation can be applied globally.

METHODS: In total, 100 participants were studied by using their anteroposterior and lateral radiographic images of whole of pelvic and spinal area. Additionally, various spinal and pelvic parameters were also measured. Subsequently, the outcomes were analyzed with respect to age, sex, and body mass index (BMI). The correlation between different parameters and differences in these parameters between Indians and other races/ethnicities along with population groups were also analyzed.

RESULTS: There was a significant increase in thoracic kyphosis (TK) from T1-T12 and T4-T12 with increasing age. Lumbar lordosis (LL), sacral translation (sagittal vertical axis), and pelvic tilt were significantly higher among females. Additionally, sacral slope (SS), pelvic incidence, C7 sagittal offset, and T9 sagittal offset were also higher in females. TK (T4-T12 and T1-T12), LL, SS, and pelvic incidence showed a significant correlation with BMI. As compared to European population, TK, segmental LL, and sacral translation were found to be significantly lesser in Indian population.

CONCLUSIONS: There is a statistically significant difference between Indians and other races/ethnicities and population groups with respect to TK, LL, and sacral translation. The values obtained can be considered as the physiological normal values for Indian population. Importantly, these values can serve as the reference values for future studies.

PMID:33957746 | DOI:10.31616/asj.2020.0301

Asian Spine J. 2021 May 10. doi: 10.31616/asj.2020.0268. Online ahead of print.

ABSTRACT

STUDY DESIGN: Prospective, randomized study of 100 patients with prolapsed intervertebral disc with an average of 12- to 18-month follow-up postoperatively.

PURPOSE: To compare the role of Gelfoam and autologous fat in the prevention of postoperative epidural fibrosis (EF) after lumbar spine surgery.

OVERVIEW OF LITERATURE: EF is a possible sequelae of lumbar disc surgery. Different treatments and surgical strategies have been attempted to prevent postoperative fibrosis without providing consistent long-term results.

METHODS: The study was conducted on 100 adult patients. The patients were randomly allocated into two groups of 50 patients each: group A, autologous fat group, and group B, Gelfoam group. The postoperative follow-up was conducted at intervals of 6 weeks, 3 months, 6 months, and 12 months. Both groups were evaluated clinically (Oswestry Low Back Pain Disability Questionnaire [ODI], Visual Analog Scale [VAS], Straight Leg Raising Test [SLRT]) and radiologically (using Ross grading by contrast magnetic resonance imaging [MRI]) for development of radicular pain and hence EF.

RESULTS: Based on the analysis, improvement in mean values of ODI score, VAS score, and SLRT were found to be statistically significant postoperatively at intervals of 6 weeks, 3 months, 6 months, and 12 months when compared individually in both groups. However, improvement was greater in the autologous fat group than in the Gelfoam group. Based on contrast-enhanced MRI, the number of patients who developed EF was smaller in the autologous fat group than in the Gelfoam group.

CONCLUSIONS: In the present study, on clinical and radiological assessment, we conclude that both groups prevent radicular pain and postoperative EF individually but relatively autologous fat was found to be more effective than Gelfoam in the prevention of EF and hence radicular pain.

PMID:33957745 | DOI:10.31616/asj.2020.0268

Arch Craniofac Surg. 2021 Apr;22(2):93-98. doi: 10.7181/acfs.2021.00122. Epub 2021 Apr 20.

ABSTRACT

BACKGROUND: Pediatric nasal fractures, unlike adult nasal fractures, are treated surgically as early as 7 days after the initial trauma. However, in some cases, a week or more elapses before surgery, and few studies have investigated the consequences of delayed surgery for pediatric nasal fractures. The purpose of this study was to evaluate the postoperative outcomes of pediatric nasal fractures according to the time interval between the initial trauma and surgery.

METHODS: The records of pediatric patients under 12 years old who underwent closed reduction of nasal bone fracture from March 2012 to February 2020 were reviewed. The interval between trauma and surgery was divided into within 7 days (early reduction) and more than 7 days (delayed reduction). Postoperative results were classified into five grades (excellent, good, moderate, poor, and very poor) based on the degree of reduction shown on computed tomography.

RESULTS: Ninety-eight patients were analyzed, of whom 51 underwent early reduction and 47 underwent delayed reduction. Forty-two (82.4%) of the 51 patients in the early reduction group showed excellent results, and nine (17.6%) showed good results. Thirty-nine (83.0%) of the 47 patients in the delayed reduction group showed excellent results and eight (17.0%) showed good results. No statistically significant difference in outcomes was found between the two groups (chi-square test p= 0.937). However, patients without septal injury were significantly more likely to have excellent postoperative outcomes (chi-square test p< 0.01).

CONCLUSION: No statistically significant difference was found in the outcomes of pediatric nasal fractures between the early and delayed reduction groups. Successful surgical results were found even in patients who received delayed reduction (more than 7 days after trauma).

PMID:33957734 | DOI:10.7181/acfs.2021.00122

Arch Craniofac Surg. 2021 Apr;22(2):78-84. doi: 10.7181/acfs.2020.00423. Epub 2021 Apr 20.

ABSTRACT

BACKGROUND: Facial feminization surgery and malarplasty require information concerning facial features in the malar area. Such information varies as a function of sex and race. The objectives of this study aimed to quantitatively evaluate the location of malar prominence across sexes in the Southeast Asian population, and identify sex-specific differences in malar prominence using a combination of two-dimensional (2D) computed tomography (CT) and three-dimensional (3D) CT.

METHODS: The location of malar prominence was evaluated in 101 Thai adults, consisting of 52 men and 49 women. This study used both 2D CT and 3D CT to achieve greater accuracy, in which 2D CT was used to measure malar distance, malar summit width, facial width, and malar summitto-facial width ratio whereas 3D CT was used to evaluate the positional relationship between the zygomatic summit and four reference points of the zygoma.

RESULTS: The malar summit was positioned more laterally in males (p< 0.01) and was more projected in females (p= 0.01). The other 2D-parameters were wider in males. The ratio between the malar summit width and facial width showed similar results for both sexes. The vertical dimension did not show any statistically significant differences; however, a higher summit position was observed in males.

CONCLUSION: The zygomatic summit is positioned more laterally in males and is more projected in females. However, the ratio was similar, which indicates that the male cranium is larger in size. Based on the results in this study, when facial feminization surgery or malarplasty is performed on a Southeast Asian patient, the malar bone should be reduced horizontally and moved forward for better outcomes.

PMID:33957732 | DOI:10.7181/acfs.2020.00423

Turk J Med Sci. 2021 May 7. doi: 10.3906/sag-2101-406. Online ahead of print.

ABSTRACT

BACKGROUND/AIM: The aim of the study was to evaluate the effect of Controlling Nutritional Status (CONUT) score on the prognosis in patients with diffuse large B-cell lymphoma(DLBCL).

MATERIALS AND METHODS: The present study was a retrospective study. The CONUT score was calculated based on serum albumin, total cholesterol and lymphocyte levels. This study included a total of 266 patients, 131(49.2%) were female and 135(50.8%) were male. The median follow-up period was 51 months (range: 1?190).

RESULTS: The median age was 64 years. The cut off CONUT was 1.5. There was a significant difference between patients with high (?2) or low (<2) CONUT scores in terms of overall survival(OS) and progression-free survival(PFS). The 5-year OS and PFS in patients with high CONUT score was 52.1% and 49.7%. The 5-year OS and PFS in patients with low CONUT score was 79.8% and 75.6% (p<0.001). In the multivariate analysis for OS, age ?65 years (HR=1.80, p=0.028), Eastern Cooperative Oncology Group (ECOG) >1 (HR=2.04, p=0.006), stage IIIA?IVB disease (HR=2.75, p=0.001) and the CONUT score (HR=1.15, p = 0.003) were found statistically significant. In the multivariate analysis for PFS, age ?65 years (HR=2.02, p=0.007), stage IIIA?IVB disease (HR=2.42, p=0.002) and the CONUT score (HR=1.19, p=0.001) were found to be significant parameters.

CONCLUSION: High CONUT score reduces OS and PFS in DLBCL. CONUT score is an independent, strong prognostic index in patients with DLBCL.

PMID:33957727 | DOI:10.3906/sag-2101-406

Turk J Med Sci. 2021 May 7. doi: 10.3906/sag-2012-247. Online ahead of print.

ABSTRACT

OBJECTIVE: Hyperparathyroidism is an endocrine disorder characterized by hypercalcemia. Because of calcium?s effects on parathyroid glands, bone, intestine and kidney, it has an important place in homeostasis. The results of studies regarding hyperparathyroidism hemostasis are conflicting. Thromboelastography helps to evaluate all steps of hemostatic system. Our aim in this study was to investigate the possible role of hemostatic mechanisms in the development of thrombosis in hyperparathyroid patients with the modified rotation thromboelastogram (ROTEM).

METHODS: Twenty-two patients with primary hyperparathyroidism (PHPT) and 20 healthy controls were involved. This study was conducted in Eskisehir Osmangazi University Faculty of Medicine, Endocrinology and Hematology clinics for 2 years. The complete blood count, fibrinogen, D-dimer levels, prothrombin time, activated prothrombin time and ROTEM parameters [clot formation time (CFT), clotting time (CT), and maximum clot formation (MCF)] were determined by two activated tests, INTEM and EXTEM analyses. A thromboelastographic evaluation was performed in the preoperative and postoperative (three months after surgery) periods.

RESULTS: In INTEM assay, the CT (p= 0.012) and CFT (p= 0.07) values were increased in preoperative PHPT patients compared with the control group. Although there was a decrease in the postoperative CT and CFT values, no statistical difference was found.

CONCLUSION: The prolongation of the CT and CFT values were consistent with a hypocoagulable state in patients with PHPT. Hyperparathyroidism causes a hypocoagulable state that can be successfully assessed by ROTEM. Hemostatic changes, do not seem to have an effect on increased cardiovascular mortality.

PMID:33957726 | DOI:10.3906/sag-2012-247

Turk J Med Sci. 2021 May 7. doi: 10.3906/sag-2004-110. Online ahead of print.

ABSTRACT

BACKGROUND/AIM: Anterior cruciate ligament (ACL) injuries cause mechanoreceptor loss in the joint; therefore, proprioceptive deficits are observed after injury. In particular, proprioceptive measurements made in the functional position give more accurate results, and this is an area that requires further studies. This study aimed to evaluate proprioception in patients who had undergone ACL reconstruction (ACLR) in functional positions used in daily life (closed kinetic chain position), according to joint angles where ACL injuries occur more frequently, in comparison with healthy controls.

MATERIALS AND METHODS: Thirty-four participants who underwent ACLR using a hamstring tendon graft (aged 29.18 ± 8.16 years; body mass index (BMI), 26.58 ± 4.02 kg/cm2) and 31 healthy participants (aged 27.35 ± 5.74 years; BMI, 24.76 ± 2.98 kg/cm2) were included. Proprioception was assessed with an active angle repetition test, using an inclinometer in the closed kinetic chain position while standing. Participants were asked to perform single-leg squats until the angle at the knee joint was 30°. After the targeted angle was defined, the participants were asked to find the targeted angle. The difference between the targeted angle and the angle reached by the participants was calculated.

RESULTS: A statistically significant difference in the active joint position sense was found among the ACLR extremity, uninvolved extremity, and control extremity (p < 0.05). The proprioceptive sense between the two extremities in the ACLR group was similar, and the proprioceptive sense was worse than that of the control group.

CONCLUSION: To our knowledge, this is the first study to evaluate closed kinetic chain position in patients who underwent ACLR and showed that proprioceptive sense was still poor in patients with ACLR compared with the control group, even if an average of 24 months have elapsed since surgery.

PMID:33957722 | DOI:10.3906/sag-2004-110