Tag: nevin manimala

Am J Emerg Med. 2021 Jun 9;49:226-232. doi: 10.1016/j.ajem.2021.05.071. Online ahead of print.

ABSTRACT

BACKGROUND: Point-of-care ultrasound (POCUS) is useful in the evaluation of early pregnancy by confirming intrauterine pregnancy and recognizing hemorrhage from ectopic pregnancy. We sought to determine whether transabdominal POCUS by itself or in conjunction with consultative radiology ultrasound (RADUS), reduces Emergency Department (ED) treatment time for patients with ectopic pregnancy requiring operative care, when compared to RADUS alone. A secondary objective was to determine whether the incorporation of POCUS reduces time to operative care for patients with ruptured ectopic pregnancy specifically, when compared to RADUS alone.

METHODS: We performed a retrospective review of patients admitted for operative management of ectopic pregnancy. We excluded patients with known ectopic pregnancy and/or imaging prior to arriving to the treatment area, found not to have an ectopic pregnancy, or did not undergo operative care. Descriptive statistics, classical and nonparametric statistical analysis, and linear regression were performed.

RESULTS: There were 220 patients admitted with ectopic pregnancy, 111 met exclusion criteria, yielding 109 for analysis. Of 109, 36 received POCUS (23/36 also had RADUS), while 73 received RADUS only. Among the POCUS group 31/36 (86%) were classified as ruptured versus 47/73 (64%) in the RADUS group. The average ED treatment time in the POCUS group for all admitted ectopic pregnancies was 157.9 min (standard deviation [SD] 101.3) versus 206.3 min (SD 76.6) in the RADUS group (p = 0.0141). The median time to operating room (OR) for ruptured ectopic pregnancies was 203.0 min (interquartile range [IQR] 159.0) in the POCUS group versus 293.0 min (IQR 139.0) in the RADUS group (p = 0.0002). Regression analysis of the primary outcome was limited by multiple interactions and sample size. When controlling for race, positive shock index and ED visit time, POCUS was found to be associated with a significantly shorter time to OR among ruptured ectopic pregnancies compared to RADUS (p = 0.0052).

CONCLUSION: Compared to RADUS alone, incorporation of POCUS was associated with significantly faster ED treatment time for all ectopic pregnancies and significantly faster time to OR for ruptured ectopic pregnancies, even when combined with RADUS. When controlling for clinical differences, time to OR was still faster for patients who underwent POCUS. The integration of POCUS should be considered to expedite care for patients with ectopic pregnancy requiring operative care.

PMID:34146921 | DOI:10.1016/j.ajem.2021.05.071

Eur J Radiol. 2021 Jun 10;141:109823. doi: 10.1016/j.ejrad.2021.109823. Online ahead of print.

ABSTRACT

PURPOSE: No comparative study on evaluating performance of radiological criteria has been investigated in metastatic colorectal cancer (mCRC) patients treated with the combination of Regorafenib and anti-programmed cell death 1(PD-1) antibody. We aimed to compare the performance of different radiological criteria in evaluating response in mCRC patients treated with the combination of Regorafenib plus anti-PD-1 antibody.

METHOD: We retrospectively recruited patients treated with Regorafenib and anti-PD-1 antibody in a single institution. Baseline and the first tumor evaluation of contrast-enhanced computed tomography (CE-CT) were assessed by three evaluation criteria: RECIST 1.1, Choi, modified Choi (mChoi). Overall survival (OS) was defined as endpoint event.

RESULTS: Twenty-three mCRC patients [age: 58.8 ± 10.6 years, 18 (78.3 %) males] were assessed. The median overall survival was 11.8 months. According to RECIST 1.1, 8 (34.8 %) patients were stable disease (SD) and 15 (65.2 %) were progressive disease (PD). According to Choi and mChoi, 5 (21.7 %) and 1(4.3 %) patient was responders, respectively. All non-PD patients showed significantly better overall survival than PD patients by all criteria. According to Choi, those identified as responders showed better overall survival than non-responders though significant statistics were not reached (P=0.262).

CONCLUSIONS: RECIST 1.1, Choi and mChoi criteria could identify survival benefit from Regorafenib plus anti-PD-1 antibody in mCRC patients. However, the value of responders detected by Choi remains to be validated in further studies.

PMID:34146911 | DOI:10.1016/j.ejrad.2021.109823

Eur J Radiol. 2021 Jun 3;141:109807. doi: 10.1016/j.ejrad.2021.109807. Online ahead of print.

ABSTRACT

PURPOSE: We evaluated respiratory triggered unidirectional single-shot echo-planar imaging (u-SSEPI) as a time-saving measure in diffusion imaging of the upper abdomen. Specifically, we compared the ADC values obtained from unidirectional DWI (u-SSEPI) and routine DWI (4t-SSEPI) and also the diagnostic accuracies of unidirectional and routine DWI sequences in the identification of focal liver lesions in the setting of chronic liver disease (CLD).

MATERIALS AND METHODS: This prospective, IRB approved study, included 48 patients of CLD who underwent-DCE-MRI on a 1.5 T scanner for hepatocellular carcinoma (HCC) workup. In addition to 4t-SSEPI, u-SSEPI was acquired with the diffusion sensitising gradient being applied in only one direction; keeping all other parameters same as 4t-SSEPI. Two blinded radiologists evaluated the DWI studies for image quality and detection of liver lesions. A composite gold standard was established using DCE-MRI, follow-up imaging and patient clinical details. The apparent diffusion coefficients (ADCs) of the liver, spleen and the lesions were compared between the two sequences. ROC analysis evaluated the diagnostic accuracy of ADC from both the sequences in identifying HCC.

RESULTS: Eighty-eight lesions were identified using the composite gold standard. u-SSEPI resulted in 3 times faster image acquisition. No statistically significant differences were demonstrated between the unidirectional and routine DWI sequences for image quality parameters and lesion detection rates. Lesion wise comparison of the ADC values from both the sequences was not statistically different (p = 0.8) with a coefficient of variation = 12-14 %. The Bland- Altman plots and the Passing-Bablock regression analysis demonstrated a systematic and proportional bias between the ADC values obtained. The AUC of the ROC curve, however, was 0.63-observer1; 0.62-oobserver2 for routine DWI and 0.65; 0.62 for unidirectional DWI when ADC was used to identify HCC (the AUCs were not statistically different (p = 0.6-0.8)).

CONCLUSION: No significant differences were demonstrated in the diagnostic accuracies of unidirectional and routine DWI in the diagnosis of HCC. Unidirectional diffusion may be further evaluated in other organs where diffusion is isotropic, especially in respiratory triggered sequences where the imaging time dividend is significant.

PMID:34146912 | DOI:10.1016/j.ejrad.2021.109807

Chemosphere. 2021 Jun 13;283:131169. doi: 10.1016/j.chemosphere.2021.131169. Online ahead of print.

ABSTRACT

BACKGROUND: More and more studies began to explore the hazardous health effects of PM_2.5, but few reported its impacts on stillbirth. The sparse results were inconsistent and remained to be integrated. Therefore, we aimed to reveal the association between maternal exposure to PM_2.5 and stillbirth.

METHODS: In this meta-analysis, we searched PubMed, Web of Science, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases for related articles written in English and published before October 18, 2020. Study selection was conducted according to the predetermined criteria and data attraction was done with predesigned form. A new instrument was applied to conduct the risk of bias assessment. And random-effect models were used to pool the estimates.

RESULTS: A total of 3655 records were identified from the databases, but only 7 studies were ultimately included in this study. Positive association was found between the maternal exposure to PM_2.5 (per 10 μg/m³ increased) in the entire pregnancy (OR: 1.15, 95% CI: 1.07-1.25) and third trimester (OR: 1.09, 95% CI: 1.01-1.18) and stillbirth, but the association between the maternal exposure to PM_2.5 (per 10 μg/m³ increased) in the first trimester (OR: 1.01, 95% CI: 0.90-1.13) and second trimester (OR: 1.06, 95% CI: 0.98-1.14) and stillbirth was not statistically significant. Besides, there was no publication bias.

CONCLUSIONS: Maternal exposure to PM_2.5 in the entire pregnancy and third trimester was associated with elevated risk of stillbirth. However, due to the high heterogeneity, further pathophysiological researches and high quality population studies were still warranted.

PMID:34146867 | DOI:10.1016/j.chemosphere.2021.131169

J Affect Disord. 2021 Jun 8;292:464-470. doi: 10.1016/j.jad.2021.05.125. Online ahead of print.

ABSTRACT

INTRODUCTION: There is growing concern about the effect of lockdown and social distancing on mental health. Subjective feelings related to social relationships such as detachment have shown a strong effect on mental health, whereas objective factors might have a moderating role in that association.

OBJECTIVE: To investigate whether social support and living situation have a moderating effect on the association between detachment and affective disorder symptoms during the COVID-19 lockdown.

METHODS: 3,305 Spanish adults were interviewed by phone at the end of the COVID-19 lockdown (May-June 2020). Detachment during confinement was assessed with a single-item frequency question. Anxiety symptoms were measured through GAD-7, depressive symptoms through PHQ-9, and social support through the Oslo Social Support Scale (OSSS). Associations with anxiety and depressive symptoms were tested through Tobit regression models. Interactions of detachment with living situation and social support were tested as independent variables.

RESULTS: People living alone showed significantly lower levels of anxiety whereas people living with another (but not as a couple) showed higher levels of depression. Detachment was strongly associated with both affective disorders. Social support had a statistically significant moderating effect on that association. Those with a low level of social support and a high level of detachment reported means of depression and anxiety above major depression (10.5 CI 95% 9.6, 11.4 at OSSS=10) and generalized anxiety disorders (10.1 CI 95% 9.2, 11.0 at OSSS=9) cut offs CONCLUSION: Interventions centered on improving social support could alleviate feelings of detachment and prevent affective disorders during lockdowns.

PMID:34146897 | DOI:10.1016/j.jad.2021.05.125

Nurse Educ Today. 2021 Jun 2;104:104990. doi: 10.1016/j.nedt.2021.104990. Online ahead of print.

ABSTRACT

BACKGROUND: Simulation is an important learning-teaching tool for integrating theory and practice in nursing education.

OBJECTIVE: The aim of this study was to develop and to conduct the validity and reliability of a self-evaluation scale for simulation laboratory practices (SES-SLP) with undergraduate nurses.

METHODS: The study sample consisted of 220 undergraduate nursing students. Data were collected using a Descriptive Characteristic Form (DCF) and the 23-item Self-Evaluation Scale for Simulation Laboratory Practices (SES-SLP).

RESULTS: Cronbach’s alpha value of the scale was 0.94. The scale comprised of two subscales: the developing factor (19 items) and the challenging factor (4 items). All items showed a statistically significant correlation (p < 0.05).

CONCLUSIONS: The SES-SLP is a valid and reliable scale that can be used to evaluate students’ learning experience for simulation laboratory practices.

PMID:34146847 | DOI:10.1016/j.nedt.2021.104990

Mar Pollut Bull. 2021 Jun 16;170:112610. doi: 10.1016/j.marpolbul.2021.112610. Online ahead of print.

ABSTRACT

Telomeres protect the coding sequence of chromosome ends and Telomere Length (TL) has been proposed as a biomarker of cellular aging, cumulative stress exposure and life-span in humans. With the aim to propose new biomarkers, a q-PCR protocol was adapted for the measurement of TL in the European flounder Platichthys flesus. The protocol was then applied in 2-year-old flounders from the Seine Estuary. The absolute TL in the flounder is 54 ± 13 kbp per genome (mean ± standard error). Considering relative or absolute TL, no correlation was observed with DNA damage and any of the measured contaminant concentrations (trace elements, metabolites of polycyclic aromatic hydrocarbons, polychlorobiphenyls, organochlorinated pesticides, polybrominated diphenyl ethers, perfluoroalkyl substances). Because sampling was limited, further investigations are required to state a possible impact of chemical pollution on flatfish telomeres. This is motivated by correlations observed with organochlorinated compounds when decreasing statistical significance (p ≤ 0.10).

PMID:34146858 | DOI:10.1016/j.marpolbul.2021.112610

Mar Pollut Bull. 2021 Jun 16;170:112630. doi: 10.1016/j.marpolbul.2021.112630. Online ahead of print.

ABSTRACT

This study investigated the accumulation of debris at four sites, namely, Gebeng, Batu Hitam, Cherok Paloh, and Air Leleh, along the Pahang coastline, Peninsular Malaysia from March 2019 to February 2020. Plastic was the dominant debris (86.1%) and followed by cloth/fabric-based debris (6.0%), processed lumber debris (3.3%), rubber (2.7%), glass (1.5%), and metal (0.4%). The land-based debris (82.0%) was the major source of the deposition of marine waste. A statistically significant relationship was found between the seasonal variation and marine debris density in tidal and seasonal current along the Pahang coastline. In general, the Northeast Monsoon season had a higher amount of debris than the Southwest Monsoon season.

PMID:34146861 | DOI:10.1016/j.marpolbul.2021.112630

Environ Int. 2021 Jun 16;155:106691. doi: 10.1016/j.envint.2021.106691. Online ahead of print.

ABSTRACT

Over the course of the continual phase-outs of toxic halogenated flame retardants (HFRs), there has been an increasing demand for organophosphate esters (OPEs) in global FR markets. OPE-FRs have largely been identified as OP triesters, which have a basic chemical structure of O = P(OR)₃. In addition to OP triesters, OPEs can refer to another class of related substances, namely, OP diesters that have a typical chemical structure of O = P(OR)₂(OH)). OP diesters are known as biotic or abiotic degradation products of OP triesters. In recent years, environmental scientists have proven that OP diesters widely exist in a variety of environmental matrices and biotic samples around the world, implying the potential risks from OP diester exposure to biota and humans in the environment. Here, we have reviewed the scientific literature for studies involving OP diesters and up to the end of 2020. The aim of the present review is to assess the present understanding of the physicochemical properties, sources (industrial production and degradation), environmental occurrence of OP diesters, and adverse effects to exposed organisms. Based on the literature in the Web of Science core collection, we found that at least 23 OP diesters have been reported as contaminants in various environments or as degradation products of OP triesters. The physicochemical properties of OP diesters vary depending on their specific chemical structures. OP diesters containing halogen atoms and aryl groups seem to be more persistent (with greater estimated half-life (t_1/2) values) in environmental matrices. There were multiple sources of OP diesters, including industrial production and biotic or abiotic degradation from OP triesters. Specifically, we found that ten OP diesters are produced somewhere in the world, and the total annual output was estimated to be 17,050 metric tons (this number is underestimated due to the limitation of the available information). In addition, the wide application of OP triesters worldwide makes the degradation of OP triesters another critical source of OP diesters to the environment and to organisms. Current monitoring studies have demonstrated that some OP diesters were detectable in the human body (via both blood and urine samples), indoor dust, wastewater, or sewage sludge worldwide. The highest concentrations of diphenyl phosphate (DPHP) in human urine have been reported as high as 727 ng/mL (children (aged 0-5 years) urine samples from Australia). In addition, adverse effects following direct or indirect exposure to 11 OP diesters in organisms (including animals, bacteria, and algae) have been reported, and the recorded adverse outcomes following exposure to OP diesters included developmental toxicity, alteration of gene expression, and disturbance of nuclear receptor activity. Biomonitoring studies regarding human samples have frequently reported statistically significant associations between the concentrations of OP diesters and markers of human health (mainly related to reproductive toxicity). Finally, on the basis of current knowledge on OP diesters, we propose prospects for related research directions in future studies.

PMID:34146766 | DOI:10.1016/j.envint.2021.106691

Pregnancy Hypertens. 2021 Jun 11;25:156-160. doi: 10.1016/j.preghy.2021.06.001. Online ahead of print.

ABSTRACT

INTRODUCTION: Pre-eclampsia (PE) accounts for 14.8% of maternal deaths in South Africa. Tenascin C (TN-C) is an anti-inflammatory cytokine expressed in the extracellular matrix and may be dysregulated in the hyperinflammatory PE microenvironment.

MATERIAL AND METHODS: This study examined serum TN-C in normotensive pregnant (n = 36) and pre-eclamptic (n = 36) HIV positive and negative women using an immunoassay.

RESULTS: TN-C was significantly upregulated in PE vs normotensive pregnant women (p = 0.0075) and HIV-positive vs negative pregnant women (p = 0.0009). TN-C levels across all groups was statistically different (p < 0.0001).

CONCLUSION: This study demonstrates an elevation of TN-C in HIV-associated PE. The potential benefit of TN-C as a biomarker to detect PE development requires investigation.

PMID:34146831 | DOI:10.1016/j.preghy.2021.06.001