Tag: nevin manimala

Ann Med. 2024 Dec;56(1):2391536. doi: 10.1080/07853890.2024.2391536. Epub 2024 Aug 16.

ABSTRACT

BACKGROUND: Submucosal fibrosis is associated with adverse events of endoscopic submucosal dissection (ESD). The present study mainly aimed to establish a predictive model for submucosal fibrosis in patients with early gastric cancer (EGC) undergoing ESD.

METHODS: Eligible patients with EGC, identified at Qilu Hospital of Shandong University from April 2013 to December 2023, were retrospectively included and randomly split into a training set and a validation set in a 7:3 ratio. Logistic regression analyses were used to pinpoint the risk factors for submucosal fibrosis. A nomogram was developed and confirmed using receiver operating characteristic (ROC) curves, calibration plots, Hosmer-Lemeshow (H-L) tests, and decision curve analysis (DCA) curves. Besides, a predictive model for severe submucosal fibrosis was further conducted and tested.

RESULTS: A total of 516 cases in the training group and 220 cases in the validation group were recruited. The nomogram for submucosal fibrosis contained the following items: tumour location (long axis), tumour location (short axis), ulceration, and biopsy pathology. ROC curves showed high efficiency with an area under the ROC of 0.819 in the training group, and 0.812 in the validation group. Calibration curves and H-L tests indicated good consistency. DCA proved the nomogram to be clinically beneficial. Furthermore, the four items were also applicable for a nomogram predicting severe fibrosis, and the model performed well.

CONCLUSION: The predictive models, initially constructed in this study, were validated as convenient and feasible for endoscopists to predict submucosal fibrosis and severe fibrosis in patients with EGC undergoing ESD.

PMID:39149760 | DOI:10.1080/07853890.2024.2391536

Clin Transl Radiat Oncol. 2024 Jul 7;48:100813. doi: 10.1016/j.ctro.2024.100813. eCollection 2024 Sep.

ABSTRACT

PURPOSE/OBJECTIVES: Retrospective analysis suggests that dose escalation to a biologically effective dose of more than 70 Gy may improve overall survival in patients with pancreatic ductal adenocarcinoma (PDAC), but such treatments in practice are limited by proximity of organs at risk (OARs). We hypothesized that CT-guided online adaptive radiotherapy (OART) can account for interfraction movement of OARs and allow for safe delivery of ablative doses.

MATERIALS/METHODS: This is a single institution retrospective analysis of patients with PDAC treated with OART on the Ethos platform (Varian Medical Systems, a Siemens Healthineers Company, Palo Alto). All patients were treated to 40 Gy in 5 fractions. PTV overlapping with a 5 mm planning risk volume expansion on the stomach, duodenum and bowel received 25 Gy. Initial treatment plans were created conventionally. For each fraction, PTV and OAR volumes were recontoured with AI assistance after initial cone beam CT (CBCT). The adapted plan was calculated, underwent QA, and then compared to the scheduled plan. A second CBCT was obtained prior to delivery of the selected plan. Total treatment time (first CBCT to end of radiation delivery) and active physician time (first to second CBCT) were recorded. PTV_4000 V95 %, PTV_2500 V9 5%, and D0.03 cc to stomach, duodenum and bowel were reported for scheduled (S) and adapted (A) plans. CTCAEv5.0 toxicities were recorded. Statistical analysis was performed using a two-sided T test and α of 0.05.

RESULTS: 21 patients with unresectable or locally-recurrent PDAC were analyzed, with a total of 105 fractions. Average total time was 29 min and 16 s (16:36-49:40) and average active physician time was 19:41 min (9:25-39:34). All fractions were treated with adapted plans. 97 % of adapted plans met PTV_4000 V95.0 % >95.0 % coverage goal and 100 % of adapted plans met OAR dose constraints. Median follow up was 6.6 months. Only 1 patient experienced acute grade 3+ toxicity directly attributable to radiation. Only 1 patient experienced late grade 3+ toxicity directly attributable to radiation.

CONCLUSIONS: Daily CT-based OART was associated with significantly reduced dose OARs while achieving superior PTV coverage. Given the relatively quick total treatment time, radiation delivery was generally well tolerated and easily incorporated into the clinic workflow. Our initial clinical experience demonstrates OART allows for safe dose escalation in the treatment of PDAC.

PMID:39149753 | PMC:PMC11324999 | DOI:10.1016/j.ctro.2024.100813

Saudi J Anaesth. 2024 Jul-Sep;18(3):352-359. doi: 10.4103/sja.sja_694_23. Epub 2024 Jun 4.

ABSTRACT

INTRODUCTION: Spine fixation surgery for traumatic vertebral fractures is associated with severe pain and is often difficult to control. Traditionally systemic opioids have been the mainstay of analgesia for these procedures, which can lead to hyperalgesia, nausea, ileus, sedation, cognitive impairment, dependence, etc., limiting usage of opioids. The Erector spinae plane block (ESPB) is a novel ultrasound-guided procedure with easily identifiable sonoanatomy. We hypothesized that a multimodal approach involving ESPB to a conventional analgesic regimen with local infiltration for patients undergoing major traumatic spine surgeries might provide better perioperative analgesia and reduce the need for postoperative opioid requirements.

MATERIAL AND METHODS: A randomized control prospective trial was conducted on 34 ASA grade I -II patients aged 18 to 65 years who were scheduled to undergo elective posterior spine fixation surgery with ASIA B to E after traumatic spine fracture under general anesthesia. Patients were randomized to Group A which included patients who received general anesthesia with ESPB, and Group B, or the control group, included patients who received general anesthesia with systemic analgesics and postoperative local infiltration without ESPB. Intraoperative total fentanyl consumption, VAS score at 0, 3, 6, 12, 18, and 24 hours, time to activate patient-controlled analgesia (PCA) pump, total morphine consumption, and opioid-related side effects were monitored and compared in both groups.

RESULTS: Postoperative PCA morphine consumption was significantly lower in group A patients who received ESPB than those in the control group (17.06 ± 9.59 vs 37.82 ± 9.88 P value = <0.0001). VAS scores at rest and movement at 0, 3, 6, 9, 12, 18, and 24 hours were significantly lower (P value = 0.05) in the ESPB group compared with the control group at all time points.

CONCLUSION: Bilateral ultrasound-guided Erector spinae plane block, when administered in traumatic spine patients undergoing spine fixation surgery, provides better analgesia with statistically decreased VAS scores and less postoperative opioid requirement.

PMID:39149750 | PMC:PMC11323918 | DOI:10.4103/sja.sja_694_23

Saudi J Anaesth. 2024 Jul-Sep;18(3):376-387. doi: 10.4103/sja.sja_104_24. Epub 2024 Jun 4.

ABSTRACT

BACKGROUND AND AIMS: Anesthesiologists’ services extend to many critical areas of any healthcare setup. However, there needs to be more understanding among the public regarding their crucial role. Preanesthesia evaluation (PAE) visits can disseminate information about anesthesiologists and services. We aimed to evaluate patient’s knowledge and the impact of interview-based surveys on increasing knowledge about anesthesiologists and anesthesia services.

METHODOLOGY: It was a single-center, cross-sectional survey involving 550 patients aged 18-65 undergoing elective surgeries. Pre- and postoperative interviewer-assisted questionnaires were administered to assess patients’ baseline knowledge and perception of anesthesia and anesthesiologists. Statistical analysis focused on demographic, educational, and previous anesthesia exposure among subgroups; a P-value <0.05 was considered significant.

RESULTS: Less than half comprehended anesthesia’s role as a specialist in inducing unconsciousness. 55.3% were unaware of general anesthesia, and 69.6% were unaware of regional anesthesia as a technique. Higher education and previous anesthesia exposure correlated with better awareness with regard to the perioperative role of anesthesiologists and their fields of work (P < 0.05). The postoperative survey indicated good satisfaction with anesthesiologists’ services, which might be attributable to the survey-based interaction.

CONCLUSION: A significant need for more understanding regarding anesthesia and anesthesiologists’ roles still prevails. Interview-based effective communication during PAE visits, perioperative period, and shared decision-making (SDM) improves patients’ knowledge, comprehension, and satisfaction.

PMID:39149746 | PMC:PMC11323907 | DOI:10.4103/sja.sja_104_24

Saudi J Anaesth. 2024 Jul-Sep;18(3):360-370. doi: 10.4103/sja.sja_74_24. Epub 2024 Jun 4.

ABSTRACT

BACKGROUND: Randomized controlled trials (RCTs) investigating the efficacy of bispectral index (BIS) to reduce intra-operative awareness (IOA) have reported conflicting results. The purpose of this meta-analysis is to consolidate results from RCTs to assess the efficacy of BIS in reducing IOA when compared to controls. Secondary outcomes included time to extubation, time to spontaneous and/or verbal eye opening, PACU discharge time, and utilization of inhaled anesthetics.

METHODS: RCTs which reported on one of the primary and/or secondary outcomes were included. Literature search utilized keywords “randomized control trial” and “intraoperative awareness.” Meta-analysis was performed using RevMan 5.

RESULTS: Twenty-seven RCTs were included in the study with a total of 35,585 patients, with 18,146 patients in the BIS and 17,439 in the control group. Eighteen of 14,062 patients (0.12%) and 42 of 16,765 (0.25%) reported definite IOA in the BIS and control group, respectively, with no statistically significant difference. BIS was effective in reducing the time to spontaneous eye opening by an average of 1.3 minutes and the time to extubation by an average of 1.97 minutes. There was no difference in PACU discharge times among the groups. There was a significant decrease in consumption of sevoflurane but no difference in desflurane and propofol compared to the control group.

CONCLUSION: While BIS monitoring results in decreased incidence of intra-operative awareness by half, it was not statistically significant. BIS provides modest benefits with regard to reducing the time to extubation, the time to spontaneous eye opening, and consumption of sevoflurane.Level of evidence: I.

PMID:39149744 | PMC:PMC11323923 | DOI:10.4103/sja.sja_74_24

Saudi J Anaesth. 2024 Jul-Sep;18(3):371-375. doi: 10.4103/sja.sja_86_24. Epub 2024 Jun 4.

ABSTRACT

CONTEXT: Splanchnic nerve block (SPN) with local anesthetic and steroid is used to relieve the pain of chronic pancreatitis. However, it does not provide long-lasting relief. We hypothesize that the use of 70% alcohol will give adequate analgesia for more than months.

AIMS: The primary objective was to find out the analgesic efficacy of the use of 70% alcohol with SPN. Secondary objectives included the incidence of side effects, analgesic consumption postintervention, quality of life (QOL) assessed via a self-reported quality of life scale, and repeat block during the 1-year follow-up period.

SETTINGS AND DESIGN: Retrospective analysis of all patients with chronic pancreatitis who received bilateral SPN over the last 4 years.

METHODS AND MATERIALS: SPN was performed using the posterior retrocrural approach with the patient in the prone position as described in the literature using a 23 G × 90 mm spinal needle bilaterally at the level of T12 using C-arm/fluoroscopy guidance. Data were collected from the procedure book of the pain clinic and medical records.

STATISTICAL ANALYSIS USED: Quantitative data for change in pre- to post-block VAS score was collected using the non-parametric Wilcoxon signed ranks test.

RESULTS: The baseline VAS, post-procedure VAS, and VAS at 3 months follow-up was 7.69 ± 1.3,2.44 ± 0.96 and 1.56 ± 1.15. A pairwise comparison of VAS performed between baseline and immediate post-procedure, baseline, and VAS at 3 months was found to be highly significant.

CONCLUSIONS: Fluoroscopy-guided neurolytic SPN with 70% alcohol gives significant pain relief for more than 3 months. It also leads to improvement in 3 months QOL.

PMID:39149730 | PMC:PMC11323924 | DOI:10.4103/sja.sja_86_24

Saudi J Anaesth. 2024 Jul-Sep;18(3):388-394. doi: 10.4103/sja.sja_142_24. Epub 2024 Jun 4.

ABSTRACT

INTRODUCTION: In the backdrop of escalating healthcare costs and an increasing focus on resource optimization, this audit study delves into the realm of anesthesia management, specifically exploring the application of low-flow anesthesia (LFA). The primary objective was to assess adherence to hospital standards and evaluate the economic implications of LFA (<1 L/min).

MATERIALS AND METHODS: This retrospective audit focused on 700 adult patients undergoing elective surgeries with general anesthesia. Data sources included anesthesia records, electronic recording systems, and audits by a dedicated team. Fresh gas flow rates (FGFRs), minimum alveolar concentration (MAC), and volatile anesthetic consumption were analyzed. Cost comparisons between low-flow and high-flow anesthesia were conducted, employing specific cost per milliliter metrics.

RESULTS: The average FGFR during the maintenance phase was found to be 0.45 ± 0.88 L/min. Adherence to hospital standards was notably high, with 94.29% of patients being maintained on low-flow gas rates. The differences in anesthetic consumption between low-flow and high-flow FGFR were statistically significant for both desflurane (12.17 ± 10.84 ml/MAC hour versus 43.12 ± 27.25 ml/MAC hour) and sevoflurane (3.48 ± 7.22 ml/MAC hour versus 5.20 ± 5.20 ml/MAC hour, P < 0.001). The calculated savings per patient with low-flow desflurane and sevoflurane anesthesia compared to high flow were found to be 109.25 AED and 6.74 AED, respectively.

CONCLUSION: This audit advocates for the widespread adoption of LFA as a standard practice. Beyond aligning with hospital standards, the study highlights the multi-faceted benefits of LFA, encompassing economic savings, environmental safety, and enhanced patient care.

PMID:39149724 | PMC:PMC11323908 | DOI:10.4103/sja.sja_142_24

Adv Pharmacol Pharm Sci. 2024 Aug 7;2024:6668480. doi: 10.1155/2024/6668480. eCollection 2024.

ABSTRACT

BACKGROUND: Self-medication practice is the use of medicine without consulting health professionals to treat self-recognized illness by the general population including pregnant women. Inappropriate self-medication practice during pregnancy may pose harmful consequences for the fetus as well as the mother. There is not given much attention on the practice of self-medication among pregnant women in our setting. Therefore, this study aimed to assess the prevalence of self-medication practice and associated factors among pregnant women who attended antenatal care at North Shewa Zone public hospitals.

METHODS: An institution-based cross-sectional study was conducted from June 01, 2022 to July 30, 2022, among 650 pregnant women who attended antenatal care at North Shewa Zone public hospitals. A multistage sampling technique was employed. The questionnaires were pretested. A structured interviewer-administered questionnaire and reviewed medical records were used for data collection. Epi-data version 4.6.2 and SPSS version 20 were utilized for data entry and analysis, respectively. Bivariate and multivariable logistic regression was done to identify associated factors, and P values less than 0.05 were considered statistically significant.

RESULTS: The prevalence of self-medication practice among pregnant women was 65.38%. Housewives (AOR = 0.097 95% CI 0.030, 0.310), farmers (AOR = 0.117, 95% CI 0.028, 0.493), people with health insurance (AOR = 0.507, 95% CI 0.300, 0.858), and people in preconception care (AOR = 0.038, 95% CI 0.011-0.135) were less likely to practice self-medication, while people with primary education (AOR = 3.00, 95% CI 1.217, 7.435), income less than 3,000 birr (AOR = 5.46, 95% CI 1.41, 21.1), participants in the first (AOR = 4.183, 95% CI 2.12, 8.24) and second trimesters (AOR = 2.05, 95% CI 1.18, 3.56), pregnant women who lived in rural areas (AOR = 1.579, 95% CI 1.103-2.260), and people who previously practiced self-medication (AOR = 8.2, 95% CI 5.04, 13.3) were more likely to practice self-medication.

CONCLUSION: From the present finding, it can be concluded that self-medication among pregnant women is high. Previous self-medication practice, gestation period, educational status, monthly income, no preconception care, no health insurance, being a housewife, farmer, and place of residence were significantly associated with self-medication practice. Therefore, preventive measures such as proper counseling during dispensing, awareness creation programs on preconception care, and enrolling in health insurance programs to minimize the practice of self-medication are necessary.

PMID:39149722 | PMC:PMC11325016 | DOI:10.1155/2024/6668480

Annu Rev Sociol. 2024 Aug;50:41-59. doi: 10.1146/annurev-soc-091523-013249. Epub 2024 Apr 17.

ABSTRACT

Experience sampling (ES) – also referred to as ecological momentary assessment (EMA) – is a data collection method that involves asking study participants to report on their thoughts, feelings, behaviors, activities, and environments in (or near) real time. ES/EMA is typically administered using an intensive longitudinal design (repeated assessments within and across days). Although use of ES/EMA is widespread in psychology and health sciences, uptake of the method among sociologists has been limited. We argue that ES/EMA offers key advantages for the investigation of sociologically relevant phenomena, particularly in light of recent disciplinary emphasis on investigating the everyday mechanisms through which social structures and micro (individual and relational) processes are mutually constitutive. We describe extant and potential research applications illustrating advantages of ES/EMA regarding enhanced validity, disentangling short-term dynamics, and the potential for linkage with spatially and temporally referenced data sources. We also consider methodological challenges facing sociological research using ES/EMA.

PMID:39149714 | PMC:PMC11326442 | DOI:10.1146/annurev-soc-091523-013249

Ophthalmol Sci. 2024 May 23;4(6):100557. doi: 10.1016/j.xops.2024.100557. eCollection 2024 Nov-Dec.

ABSTRACT

PURPOSE: Diabetic macular edema (DME), a leading cause of visual impairment, can occur regardless of diabetic retinopathy (DR) stage. Poor metabolic control is hypothesized to contribute to DME development, although large-scale studies have yet to identify such an association. This study aims to determine whether measurable markers of dysmetabolism are associated with DME development in persons with diabetes.

DESIGN: Retrospective cohort study.

PARTICIPANTS: Using data from the Sight Outcomes Research Collaborative (SOURCE) repository, patients with diabetes mellitus and no preexisting DME were identified and followed over time to see what factors associated with DME development.

METHODS: Cox proportional hazard modeling was used to assess the relationship between demographic variables, diabetes type, smoking history, baseline DR status, blood pressure (BP), lipid profile, body mass index (BMI), hemoglobin A1C (HbA1C), and new onset of DME.

MAIN OUTCOME MEASURES: Adjusted hazard ratio (HR) of developing DME with 95% confidence intervals (CIs).

RESULTS: Of 47 509 eligible patients from 10 SOURCE sites (mean age 63 ± 12 years, 58% female sex, 48% White race), 3633 (7.6%) developed DME in the study period. The mean ± standard deviation time to DME was 875 ± 684 days (∼2.4 years) with those with baseline nonproliferative DR (HR 3.67, 95% CI: 3.41-3.95) and proliferative DR (HR 5.19, 95% CI: 4.61-5.85) more likely to develop DME. There was no difference in DME risk between type 1 and type 2 patients; however, Black race was associated with a 40% increase in DME risk (HR 1.40, 95% CI: 1.30-1.51). Every 1 unit increase in HbA1C had a 15% increased risk of DME (HR 1.15, 95% CI: 1.13-1.17), and each 10 mmHg increase in systolic BP was associated with a 6% increased DME risk (HR 1.06, 95% CI: 1.02-1.09). No association was identified between DME development and BMI, triglyceride levels, or high-density lipoprotein levels.

CONCLUSIONS: These findings suggest that in patients with diabetes modifiable risk factors such as elevated HbA1C and BP confer a higher risk of DME development; however, other modifiable systemic markers of dysmetabolism such as obesity and dyslipidemia did not. Further work is needed to identify the underlying contributions of race in DME.

FINANCIAL DISCLOSURES: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

PMID:39149711 | PMC:PMC11324816 | DOI:10.1016/j.xops.2024.100557