Nevin Manimala

Int Urogynecol J. 2021 Apr 17. doi: 10.1007/s00192-021-04797-9. Online ahead of print.

ABSTRACT

INTRODUCTION AND HYPOTHESIS: The purpose of this article is to understand that the majority of studies investigating the role of risk factors for maternal birth trauma and pelvic floor disorders are designed using causal inferential statistical methods and have not been designed to investigate the more useful goal of clinical prediction.

METHODS: A review of the literature was conducted to describe notable causal and predictive associations between risk factors and maternal birth trauma outcomes. Examples were obtained to illustrate and contrast differences in clinical usefulness between causal and predictive models.

RESULTS: Effects of pregnancy and childbirth on the risk of maternal birth trauma outcomes and subsequent pelvic floor disorders are an area of profound investigation. Numerous observational studies provide evidence that pregnancy and childbirth play a causal role in the increasing prevalence of these outcomes, and clinicians must rely on this observational evidence to guide decisions about preventing maternal birth trauma and pelvic floor disorders. However, there are important differences between the design and evaluation of models for a predictive context including: study design goals, inclusion or exclusion of candidate risk factors, model evaluation and the additional need to assess model error.

CONCLUSION: This article contrasts how causal and predictive modeling approaches are different and argues that indiscriminately modeling risk factors for birth trauma and pelvic floor disorder outcomes is costly to women.

PMID:33864475 | DOI:10.1007/s00192-021-04797-9

Int Urogynecol J. 2021 Apr 17. doi: 10.1007/s00192-021-04710-4. Online ahead of print.

ABSTRACT

INTRODUCTION AND HYPOTHESIS: While pelvic organ prolapse is common in clinical observation, there is a lack of evidence regarding its actual proportion and associated factors in the study area. Understanding the prevalence and risk factors could potentially help with prevention. Thus, this study aimed to determine the prevalence and associated factors related to pelvic organ prolapse in the Amhara region, northwest Ethiopia.

METHODS: An institutional-based cross-sectional study was conducted among 424 women, recruited by the systematic random sampling technique. Data were collected in a face-to-face interview using a structured and pre-tested questionnaire to assess the symptoms of pelvic organ prolapse and the socio-demographic, obstetric, gynecologic, medical and surgical characteristics. The stage of prolapse was determined by pelvic examination using the Simplified Pelvic Organ Prolapse Quantification staging system. Descriptive statistics and logistic regression analyses were employed.

RESULTS: The overall prevalence of pelvic organ prolapse (stage I-IV) was found to be 37.6% when determined by pelvic examination and 9.2% as assessed by prolapse symptoms. Age ≥ 40 years [AOR 2.46 (1.320, 5.314)], age at first delivery ≤ 20 years [AOR 4.719 (2.44, 9.11)], carrying heavy objects for ≥ 5 hours a day [AOR 12.724 (4.89, 33.07)], parity ≥ 4 [AOR 3.739 (1.693, 8.208)], prolonged labor [AOR 3.487 (1.699, 7.159)], constipation [AOR 2.835 (1.273, 6.317)] and anemia [AOR 2.22 (1.049, 4.694)] were significantly associated with pelvic organ prolapse.

CONCLUSION: Prevalence of pelvic organ prolapse is high in the area; thus, developing information and education programs on avoiding risk factors is advisable to reduce the problem.

PMID:33864474 | DOI:10.1007/s00192-021-04710-4

Indian Pediatr. 2021 Apr 17:S097475591600311. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the prognostic value of amplitude-integrated EEG in term neonates with encephalopathy.

METHODS: In this prospective observational study we enrolled 58 term neonates with encephalopathy from March, 2019 to March, 2020. Level of alertness was ascertained as per Volpe’s classification and tone as per Amiel-Tison scale of tone assessment. Abnormal aEEG was defined as background activity other than continuous normal voltage, or immature or absent sleep-wake cycle, or presence of electrical seizure. Primary outcome was abnormal neurological examination at discharge and/or death prior to discharge.

RESULTS: Out of 58 neonates, aEEG was abnormal for 50 (86.2%). There was a statistically significant association between abnormal aEEG findings and primary outcome (P=0.04). The aEEG score cut-off of >2 had satisfactory sensitivity (88.8%) and specificity (79.5%) to predict primary outcome.

CONCLUSIONS: Abnormal aEEG had good sensitivity but low specificity to predict primary outcome in term neonates with encephalopathy.

PMID:33864450

Proteomics Clin Appl. 2021 Apr 17:e2100002. doi: 10.1002/prca.202100002. Online ahead of print.

ABSTRACT

OBJECTIVE: We aim to investigate the changes of plasma proteome among mild, severe AIS patients and healthy controls.

METHODS: In this retrospective study, 84 individuals including 56 confirmed AIS patients (27 follow-up AIS patients and 29 surgical AIS patients) and another 28 healthy teenagers. Plasma samples were obtained and Quadrupole-Orbitrap Mass Spectrometer was performed to identify proteins in AIS patients and control group. T-test and ANOVA were performed to screen for differential proteins. GO and KEGG pathway, Pearson’s correlation analysis and PLS model were applied to identify enriched proteins, investigate correlation between proteins and Cobb angles. ELISA was performed to further verify the quantitative proteomics results.

RESULTS: A total of 349 proteins were identified, among which 55 protein levels changed significantly in AIS group, compared with control group. Post hoc test indicated 36 proteins were significantly different between surgical and control group, 35 proteins between follow-up and control group. Fibronectin, fibrinogen and calmodulin were statistically different among three groups through MS and were positively correlated with the Cobb angle.

CONCLUSIONS: We performed the proteomic study and revealed that fibronectin, fibrinogen and calmodulin might not only be considered as biomarkers for AIS but could be correlated with curve severity. This article is protected by copyright. All rights reserved.

PMID:33864425 | DOI:10.1002/prca.202100002

Arch Sex Behav. 2021 Apr 16. doi: 10.1007/s10508-021-01960-7. Online ahead of print.

ABSTRACT

The purpose of this study was to identify factors associated with HIV and vulnerability contexts for women in Porto Alegre, Brazil. The participants were 1326 women recruited by complex sampling design, divided into two groups: 640 women with HIV (WLH) and 686 women who did not have HIV (WNLH). Gross and weighted statistical analyses were performed. Logistic regression models were used to estimate the odds ratio (OR) for 12 variables. The main results demonstrated that WLH had lower income (p < .001) and poorer education (p = .038), and few used condoms during their first sexual intercourse (p < .001). The occurrence of HIV was higher among the black population (p < .001). Sex in exchange for money (p < .001) and sexually transmitted infections (p < .001) were more frequent among WLH than among WNLH. The age of sexual debut and age difference from the partner at first sexual intercourse (FSI) were not associated with the outcome. The high percentage of non-use of condoms during the FSI shows how vulnerable individuals are right at the beginning of their sexual lives. More effective prevention strategies can be developed by nurses in view of the contexts of vulnerability surrounding women.

PMID:33864176 | DOI:10.1007/s10508-021-01960-7

J Exp Orthop. 2021 Apr 17;8(1):29. doi: 10.1186/s40634-021-00348-9.

ABSTRACT

PURPOSE: To measure the safe range of angles during tunnel drilling and map ideal patella tunnel placement with the use of preoperative computed tomography (CT) scan and compare results after medial patellofemoral ligament (MPFL) reconstruction using a hardware-free patellar fixation technique with two semi-patellar tunnels between a) a free-hand technique, and b) its modification with the use of an anterior cruciate ligament (ACL) tibia aiming device.

METHODS: CT scan was performed on 30 fresh-frozen cadaveric knees a) prior to any intervention and b) after MPFL reconstruction. For MPFL reconstruction, specimens were randomly allocated to 1) Group A, which consisted of knees operated with free-hand, hardware-free patellar fixation technique with two semi-patellar tunnels and 2) Group B, which consisted of knees operated on with a technique modification with the ACL tibia device.

PATELLAR MEASUREMENTS: L1 was the maximal patellar length. L2 was the minimum possible distance of placement for the upper tunnel from the proximal pole of the patella. The maximum bone bridge between tunnels was calculated as half of L1 minus the L2 distance (L1/2-L2). We also measured R1 and R2 angles at the proximal and distal tunnel that represent safe angles at the entry point during tunnel drilling (without breaching the anterior cortex or articular cartilage).

RESULTS: Preoperatively, mean L1 was 3.45 cm (range 3.05-4.52). Mean L2 was 0.62 cm (range 0.49-0.89). The mean maximum possible bone bridge between tunnels (L1/2-L2) was 1.1 cm (range 0.77-1.58). R1 was 6.05⁰ (range 4.78-7.44), R2 was 6.64⁰ (range 4.57-9.03), and their difference reached statistical significance (p = 0.03). Postoperatively, in group A, in 4 out of 15 patellas, multiple attempts were made during tunnel drilling in order to avoid anterior cortex or cartilage breaching. In group B, all tunnels were correctly drilled with the first attempt. Bone bridge between tunnels was significantly shorter postoperatively (0.93 cm, p < 0.01).

CONCLUSION: Small-size patellae correlate with short maximum bone bridge between tunnels, which makes anatomic, double-bundle, hardware-free patella fixation, with two semi-patellar tunnels MPFL reconstruction challenging. Furthermore, R angles create a narrow window to avoid intraoperative breaching, rendering the use of the ACL tibia device an extremely useful instrument.

LEVEL OF EVIDENCE: II.

PMID:33864169 | DOI:10.1186/s40634-021-00348-9

Arch Orthop Trauma Surg. 2021 Apr 16. doi: 10.1007/s00402-021-03901-4. Online ahead of print.

ABSTRACT

INTRODUCTION: Operative treatment of tibial pilon fracture is challenging. There is a lack of consensus and only one clinical study on the optimal location of distal tibial plating for fixation of pilon fractures based on varus or valgus fracture patterns. We hypothesize that complications rates, specifically mechanical complications, are not influenced by the location of the tibial plating in the fixation of pilon fractures with respect to varus or valgus fracture patterns.

MATERIALS AND METHODS: Sixty-nine patients who had single plating for tibial pilon from 2007 to 2017 were recruited. They were divided into two groups, transverse fibular fracture (varus fracture pattern) and comminuted fibular fracture (valgus fracture pattern). Our primary outcome measure was any mechanical complications as a result of the location of plating (medial vs lateral) on varus or valgus fracture patterns.

RESULTS: There were 38 (55.1%) patients with varus fracture pattern and 31 (44.9%) patients with valgus fracture pattern tibial pilon fractures. In the varus fracture pattern group, mechanical complications were not significantly different between the two plating locations (27.3 vs 33.3%, p > 0.05). Notably, there were more fibula fixations performed in patients with medial plating (74.1 vs 45.5%, p = 0.092) when compared those with lateral plating in the varus fracture pattern group. There were also no statistically significant differences found although 10 (40%) out of 25 patients had mechanical complications in the medial plating group compared to 1 (16.7%) out of 6 patients with lateral plating (p = 0.383) in the valgus fracture pattern group.

CONCLUSION: There were no differences in mechanical complications for medial vs lateral plating in tibial pilon fracture based on varus or valgus deforming forces. As much as we should consider the fracture patterns and deforming forces when deciding on plating location, other factors such as careful soft tissue management and fragment-specific fixation should be prioritized.

PMID:33864133 | DOI:10.1007/s00402-021-03901-4

Radiat Environ Biophys. 2021 Apr 16. doi: 10.1007/s00411-021-00906-w. Online ahead of print.

ABSTRACT

The present paper proposes a novel method, based on Bayesian statistics, as a new approach in the field of thermoluminescence dosimetry for the assessment of personal doses in mixed beta-gamma radiation fields. The method can be utilized in situations when the classical way of dose calculation is insufficient or impossible. The proposed method uses a prior function which can be assigned to the unknown parameter and the likelihood function obtained from an experiment, which together can be transformed into the posterior probability distribution of the sought parameter. Finally, the distribution is converted to the value of the dose. The proposed method is supported by analytical and Monte Carlo calculations, which confirmed the results obtained through the Bayesian approach.

PMID:33864119 | DOI:10.1007/s00411-021-00906-w

Urolithiasis. 2021 Apr 16. doi: 10.1007/s00240-021-01245-7. Online ahead of print.

ABSTRACT

This study aimed to evaluate the preoperative and intraoperative factors that may cause systemic inflammatory response syndrome (SIRS) after percutaneous nephrolithotomy (PCNL) and to investigate the effect of the duration between urine culture (UC) and operation on postoperative SIRS. Three hundred and fifty-six patients who had PCNL between January 2015 and June 2019 were retrospectively included in the study. UC was obtained from all patients before the operation and during the puncture at the beginning of the operation. Postoperatively, patients were closely monitored for fever and other signs of SIRS. The post-PCNL SIRS incidence was 7%. In univariable and multivariable analyses, the rate of ipsilateral PCNL history, recurrent urinary tract infection (UTI) history, operation time and the length of hospital stay were significant predictive factors for SIRS. The duration between UC and PCNL was not a statistically significant variable in both univariable and multivariable analysis. Our study concluded that the duration between UC and PCNL is not an influential factor for post-PCNL SIRS. Clarifying this issue may be possible with prospective studies in which the effects of factors such as ipsilateral PCNL history and recurrent urinary tract infection history which has been proven to be risk factors for post-PCNL SIRS are restricted.

PMID:33864111 | DOI:10.1007/s00240-021-01245-7

Eur J Cardiovasc Nurs. 2021 Apr 17:zvab023. doi: 10.1093/eurjcn/zvab023. Online ahead of print.

ABSTRACT

AIMS: Coronary artery bypass graft (CABG) is one of the most performed cardiac surgery globally. CABG is known to have a high rate of short-term readmissions. The 30-day unplanned readmission rate as a quality measure is associated with adverse health outcomes. This study aimed to identify and synthesize the perioperative risk factors for 30-day unplanned readmission after CABG.

METHODS AND RESULTS: We systematically searched seven databases and reviewed studies to identify all eligible English articles published from 1 October 1999 to 30 September 2019. Random-effect models were employed to perform pooled analyses. Odds ratio and 95% confidence interval were used to estimate the risk factors for 30-day unplanned readmission. The 30-day hospital readmission rates after CABG ranged from 9.2% to 18.9% in 14 cohort studies. Among preoperative characteristics, older adults, female, weight loss, high serum creatinine, anticoagulant use or dialysis, and comorbidities were found to be statistically significant. Postoperative complications, prolonged length of hospital stay, and mechanical ventilation were revealed as the postoperative risk factors for 30-day unplanned readmission. However, intraoperative risk factors were not found to be significant in this review.

CONCLUSION: Our findings emphasize the importance of a comprehensive assessment during the perioperative period of CABG. Healthcare professionals can perform a readmission risk stratification and develop strategies to reduce readmission rates after CABG using the risk factors identified in this review. Future studies with prospective cohort samples are needed to identify the personal or psychosocial factors influencing readmission after CABG, including perioperative risk factors.

PMID:33864067 | DOI:10.1093/eurjcn/zvab023