Tag: nevin manimala

J Infect Chemother. 2024 Jun 27:S1341-321X(24)00171-5. doi: 10.1016/j.jiac.2024.06.015. Online ahead of print.

ABSTRACT

BACKGROUND: Human cytomegalovirus (HCMV) infection occurs in immunosuppressed individuals and is known to increase mortality. Patients with coronavirus disease 2019 (COVID-19) are often treated with steroids, require intensive care unit (ICU) treatment, and may therefore be at risk for HCMV infection. However, which factors predispose severely ill patients with COVID-19 to HCMV infection and the prognostic value of such infections remain largely unexplored. This study aimed to examine the incidence and potential risk factors of HCMV infection in patients with severe or critical COVID-19 and evaluate the relationship between HCMV infection and mortality.

METHODS AND FINDINGS: We used administrative claims data from advanced treatment hospitals in Japan to identify and analyze patients with severe or critical COVID-19. We explored potential risk factors for HCMV infection using multivariable regression models and their contribution to mortality in patients with COVID-19. Overall, 33,151 patients who progressed to severe or critical COVID-19 illness were identified. The incidence of HCMV infection was 0.3-1.7% depending on the definition of HCMV infection. Steroids, immunosuppressants, ICU admission, and blood transfusion were strongly associated with HCMV infection. Furthermore, HCMV infection was associated with patient mortality independent of the observed risk factors for death.

CONCLUSIONS: HCMV infection is a notable complication in patients with severe or critical COVID-19 who are admitted to the ICU or receive steroids, immunosuppressants, and blood transfusion and can significantly increase mortality risk.

PMID:38944381 | DOI:10.1016/j.jiac.2024.06.015

Int J Biostat. 2024 Jul 1. doi: 10.1515/ijb-2023-0050. Online ahead of print.

ABSTRACT

Traditional methods for Sample Size Determination (SSD) based on power analysis exploit relevant fixed values or preliminary estimates for the unknown parameters. A hybrid classical-Bayesian approach can be used to formally incorporate information or model uncertainty on unknown quantities by using prior distributions according to the Bayesian approach, while still analysing the data in a frequentist framework. In this paper, we propose a hybrid procedure for SSD in two-arm superiority trials, that takes into account the different role played by the unknown parameters involved in the statistical power. Thus, different prior distributions are used to formalize design expectations and to model information or uncertainty on preliminary estimates involved at the analysis stage. To illustrate the method, we consider binary data and derive the proposed hybrid criteria using three possible parameters of interest, i.e. the difference between proportions of successes, the logarithm of the relative risk and the logarithm of the odds ratio. Numerical examples taken from the literature are presented to show how to implement the proposed procedure.

PMID:38943460 | DOI:10.1515/ijb-2023-0050

J Foot Ankle Res. 2024 Sep;17(3):e12018. doi: 10.1002/jfa2.12018.

ABSTRACT

BACKGROUND: Medical students face the challenge of learning vast amounts of complex information. Existing research suggests improved learning outcomes using multimedia resources but reports on their impact on podiatric education are scarce. To explore the potential of multimedia-based learning tools in enriching medical education, this study examined the impact of Osmosis, a platform featuring interactive videos, flashcards, and self-assessment quizzes on podiatric medical student outcomes.

METHODS: This quasi-experimental study examined the impact of Osmosis, a multimedia learning platform with videos, flashcards, and quizzes, on podiatric medical students’ learning outcomes. Two cohorts (T = Osmosis access, N = 86; C = no access, N = 87) took Pharmacology and Podiatric Medicine courses consecutively. Final exam scores, final course grades, platform usage metrics (median weekly videos watched, flashcards, and quizzes), and student experience surveys were analyzed.

RESULTS: Analyses revealed no statistically significant differences in final exam scores between the groups in Pharmacology and Podiatric Medicine. While the treatment group exhibited a slight upward trend, further research is required for conclusive evidence. Student perceptions of Osmosis were overwhelmingly positive, with 90.2% of students agreeing that it facilitated concept learning and understanding compared to 54.9% for the textbook. Similarly, 80.4% of the treatment group felt that Osmosis enhanced their test performance, exceeding the 54.9% recorded for the textbook. Correlation analysis indicates a plausible connection between platform usage and academic success, as reflected by moderate positive correlations (r = [0.14, 0.28]) with final grades. Logistic regression analysis revealed that students with Osmosis access were 2.88 times more likely to score 90% or higher on the Pharmacology final exam (p < 0.05) and exhibited increased odds of achieving high (90%+) final course grades in Podiatric Medicine (OR = 2.71).

CONCLUSIONS: These findings suggest that Osmosis holds promise as a tool to support podiatric medical student learning. While the lack of statistically significant differences in final exam scores warrants further investigation, the positive student perceptions, high engagement rates, and increased odds of high scores in specific areas indicate the potential for Osmosis to positively impact academic outcomes. Therefore, a multimedia-based resource like Osmosis appears to show promise as a tool to support podiatric medical education. The limitations inherent in the quasi-experimental design necessitate further studies to confirm its effectiveness and long-term impact on podiatric medical education.

PMID:38943458 | DOI:10.1002/jfa2.12018

Otolaryngol Head Neck Surg. 2024 Jun 29. doi: 10.1002/ohn.885. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate patients’ satisfaction with opioid versus opioid-sparing postoperative analgesia in patients undergoing outpatient head and neck surgery.

STUDY DESIGN: Prospective randomized trial.

SETTING: Tertiary care academic hospital.

METHODS: Adult patients undergoing outpatient head and neck surgery were randomly assigned to 1 of 3 analgesic regimens. First- and second-line medications were the following by group (1) Hydrocodone-acetaminophen with ibuprofen, (2) ibuprofen with hydrocodone-acetaminophen, and (3) ibuprofen with acetaminophen. Preoperative counseling was provided to patients regarding expected pain and proper medication use. Postoperative questionnaires were administered to assess satisfaction.

RESULTS: One hundred three patients were enrolled in the study (mean age, 56.5 years; women, 75 [73%]). The mean satisfaction score with the pain regimen assigned was similar between the 3 groups (scale 0-10, [7.7, 8.3, 8.5, P = .46]). A similar percentage of patients in each group reported that surgery was more painful than anticipated (25%, 32%, 26%, P = .978), and a similar percentage of patients reported willingness to utilize the same analgesic regimen following future surgeries (75%, 83%, 76%, P = .682). Additional questions evaluating the side effect profile, maximum and minimum pain scores, and difficulty of recovery were not statistically different between the 3 groups.

CONCLUSION: In the postoperative population for outpatient head and neck surgeries, there was no significant difference in patient satisfaction and pain control between the opioid and nonopioid arms. Providers should discuss opioid-sparing regimens preoperatively with patients and describe them as effective in providing adequate pain control without a significant impact on patient’s perception of care.

PMID:38943454 | DOI:10.1002/ohn.885

Otolaryngol Head Neck Surg. 2024 Jun 29. doi: 10.1002/ohn.876. Online ahead of print.

ABSTRACT

OBJECTIVE: Our study aims to assess if decreasing bottle cap size was associated with more ingestions and injuries nationally. STUDY DESIGN: Retrospective chart review.

SETTING: The National Electronic Injury Surveillance System (NEISS) database.

METHODS: The NEISS was queried for bottle cap ingestions in children 0 to 18 years old between 2002 and 2021. Demographic factors including age, race, and sex of the patient were recorded. The location where the ingestion took place and the disposition of the patient were also analyzed. Data were excluded if the narrative did not specify the ingestion of a cap of a drinking bottle.

RESULTS: A total of 415 bottle cap ingestion injuries were identified, for a national estimate of 11,683 injuries. The mean age at the time of ingestion was 10.3 ± 5.2 years and the majority of the injuries occurred in males (N = 9129, 78.4%). 46.4% (N = 5398) were Caucasian, 17.6% (N = 2046) were Black or African American, and 2.7% (N = 311) were Hispanic. 55.0% (N = 6405) of injuries occurred at an unknown location, 41.4% (N = 4781) occurred at home, and 2.8% (N = 326) occurred at school. 82.3% (N = 9584) of patients were treated in the emergency department and released, 6.9% (N = 808) were treated and admitted, 6.7% (N = 783) were treated and transferred, and 0.9% (N = 110) were held for observation. From 2002 (N = 6) to 2021 (N = 2291), there was a statistically significant increase in bottle cap ingestions (P < .001).

CONCLUSION: Plastic bottle cap ingestions have increased in children over the last 20 years, coincident with the change to smaller bottle caps.

PMID:38943452 | DOI:10.1002/ohn.876

Work. 2024 Jun 25. doi: 10.3233/WOR-230643. Online ahead of print.

ABSTRACT

BACKGROUND: In vehicles there is often limited space for seats. This might mean that reclining the back rest reduces the legroom. The second row in a cargo van has this problem and in this limited space an upright seat and a reclined seat with less legroom was developed and tested.

OBJECTIVE: The research question of this study is: Does a reclined backrest with less leg room result in the same comfort and/or discomfort as an upright backrest with more leg room?

METHODS: Twenty participants are asked to sit 45 minutes in the upright seat with 8 cm more legroom and 45 minutes in the reclined seat. Ten participants started in the upright seat and ten in the reclined. Participants had to complete a comfort and discomfort questionnaire every 15 minutes and a qualitative interview was conducted after experiencing both seats.

RESULTS: For comfort no statistically significant differences were found between both seats. For discomfort statistically significant differences were found where discomfort was lower in the reclined seat. Half of the participants preferred the upright and half the reclined seat. The interviews showed that the reclined position was more related to relaxation.

CONCLUSIONS: This study indicates that a more reclined back rest results in less discomfort, but that does not lead to a clear preference of participants. The reclined position is associated with relaxing, and this study indicates that for the relaxing state the more reclined seat is preferred. For more active situations the upright posture seems better.

PMID:38943420 | DOI:10.3233/WOR-230643

Technol Health Care. 2024 Apr 30. doi: 10.3233/THC-231270. Online ahead of print.

ABSTRACT

BACKGROUND: Chronic kidney disease (CKD) is a major public health problem, so it is particularly important to quantitatively assess and intervene in the degree of early renal damage in CKD.

OBJECTIVE: The objective of the research is to establish reference values for kidney elasticity by using real-time shear wave elastography (RT-SWE) technology to quantify Young’s modulus values in the renal cortex of normal adults. The intention is to provide a foundation for evaluating renal function and structural changes in patients with CKD. Furthermore, this research investigates the role of RT-SWE in the early detection of renal fibrosis in CKD, providing insights into its diagnostic value for detecting pathological changes at an early stage.

METHODS: Between August 2019 and December 2021, we collected a sample of 100 healthy people (55 men with an average age of 43.5 ± 15.2 years and 45 women with an average age of 41.6 ± 19.8 years) for medical evaluations at our hospital’s Department of Ultrasound Medicine. In addition, 97 individuals with CKD1-3 stage were considered. Following the removal of contraindications and relevant confounding variables, we included a final cohort of 80 individuals in the research (45 men and 35 females, with an average age of 39.1 ± 19.2 years). The RENAL mode was selected and a convex array probe S6-1 operating at a frequency of 3.5-5.5 MHz was used in the research, which made use of the French Supersonic AixPlorer ultrasonic diagnostic instrument. Renal RT-SWE elastography was performed after conventional two-dimensional and color Doppler ultrasonography. The study used RT-SWE technology to assess the mean Young’s modulus of the cortex in healthy individuals (Emean), with data analysis and comparisons based on age and gender. Furthermore, the Emean values of CKD stage 1-3 patients were determined, and analyses were performed about 24-hour urine protein quantitative (24hUTP), serum creatinine concentration (SCr), and renal biopsy pathology, specifically the degree of interstitial fibrosis.

RESULTS: Healthy group: a) The average kPa values of the left kidney (4.2 ± 2.3), right kidney (4.3 + 2.5) kPa, both kidneys’ average kPa values (4.3 ± 2.4) kPa, and the average kPa values of the left and right kidneys do not differ statistically (p= 0.986). b) There was no difference in the kPa values of healthy male and female kidneys (4.4 + 2.1 and 4.2 + 2.6, respectively. c) There was no difference in the renal kPa values of healthy adults aged 50 (4.4 ± 2.8) kPa and renal kPa of the 50-year-old population (4.2 + 2.1) kPa (p= 0.041). Case group: a) the group of patients with CKD1-3 stage and the group did not vary in their Emean values (both p< 0.05); b) There is a difference between CKD stages 1, 2, and 3 (p< 0.05), however, there is still no difference in the pyEmean value corrected for patient age between patients in stages 1 and 2 (p> 0.05).

CONCLUSION: The study reveals no significant differences in the Emean value of bilateral kidneys in normal people and no differences in the elasticity value of kidneys and gender. However, age-based differences were statistically significant. pyEmean may be useful for comparing CKD stage 1, 2, and 3 patients, and RT-SWE can assess early renal damage.

PMID:38943409 | DOI:10.3233/THC-231270

J Back Musculoskelet Rehabil. 2024 Jun 17. doi: 10.3233/BMR-240001. Online ahead of print.

ABSTRACT

BACKGROUND: Clinical research on the management and rehabilitation of work-related upper spinal pain in bus drivers is sparse, indicating a gap in knowledge and treatment strategies. This highlights the growing need for innovative approaches to rehabilitation programs in this area.

OBJECTIVE: To examine the effects of kinesio taping (KT) on pain, functionality, and work performance in bus drivers experiencing neck pain.

METHODS: The study involved 44 participants who were randomised into two different groups: the exercise group (n= 22) and the kinesio tape group (n= 22), with participants in both groups undertaking exercise interventions. Evaluations were made before and after 6 weeks of treatment. At the end of the 6-week, the participants’ ROM, pain evaluations and functional scales were evaluated with disability, and work functionality.

RESULTS: Neck pain severity decreased in both groups (p< 0.001 for each value), but there was no difference between the groups (p: 0.071). When disability scores were evaluated, improvement was noted in both groups (p: 0.001 for each value), but no statistically significant difference was found (p: 0.754). When the improvements in ROM values before and after the treatment were examined, the difference between the groups was recorded only in the neck extension ROM value (p: 0.011). Significant improvement was noted in all sub-steps of job performance in both groups (p< 0.05).

CONCLUSION: KT added to ergonomic training and home exercise programmes is effective in controlling work-related musculoskeletal pain in drivers with neck pain. However, the addition of KT to exercise therapy was found to be no more effective than exercise therapy alone in improving pain control, functionality and work performance.

PMID:38943382 | DOI:10.3233/BMR-240001

J Back Musculoskelet Rehabil. 2024 Jun 16. doi: 10.3233/BMR-230287. Online ahead of print.

ABSTRACT

BACKGROUND: There are no data on the additional contribution of dry needling (DN) for trigger points (TPs) accompanying patients with cervical spondylosis (CS).

OBJECTIVE: To analyse the contribution of DN applied to concomitant active TPs in the upper trapezius muscle on the treatment outcomes of physiotherapy in CS.

METHODS: In this prospective randomized controlled study, 70 patients with CS and active TPs in the upper trapezius muscle were included. The first group received physiotherapy for 5 days per week for 3 weeks. The second group received DN with the same program. All participants were evaluated before treatment (day 0) and at the end of treatment (day 21) in terms of pain, functional status, quality of life, anxiety/depression scores, and number of TPs.

RESULTS: 33 patients in the first group and 32 patients in the second group completed the study. While the change over time was found significant in all variables, the change was not different between groups. The group-time interaction effect was not found to be statistically significant in any variable. Percentage changes of all variables were similar between the groups.

CONCLUSION: DN treatment added to the physiotherapy did not contribute to recovery in patients with CS.

PMID:38943380 | DOI:10.3233/BMR-230287

J Back Musculoskelet Rehabil. 2024 Jun 14. doi: 10.3233/BMR-230242. Online ahead of print.

ABSTRACT

BACKGROUND: During the last two decades, there has been a growing interest in spinal sagittal alignment. Most published studies have focused on the role of spinopelvic parameters in patients with adult spinal deformity or in those with previous spinal fusion.

OBJECTIVE: The aim of this study was to explore possible association between disability related to back pain and spinopelvic parameters in the absence of coronal deformity or previous spinal surgery.

METHODS: In the setting of a larger study involving patients with low back pain (LBP), those without previous surgery or spinal deformity in the coronal plane were selected. A total of 52 patients (mean age 59 years, range 21-86, 23 men and 29 women) were found. The visual analogic scale (VAS) and Oswestry Disability Index questionnaire (ODI) were recorded. Surgimap software was used to measure the sagittal vertical axis (SVA), pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), and lumbar lordosis (LL). Statistical analysis was performed with SPSS Statistics software. Pearson or Spearman correlation were the test of choice depending on the specific variables.

RESULTS: A statistically significant association was found between SVA and ODI (r 0.59, p< 0.03). Increased pelvic tilt was also associated with more severe disability related to back pain (r 0.48, p< 0.03). PI-LL mismatch showed moderate association with disability and severity of back pain, although this association did not reach statistical significance (r 0.52, p< 0.08).

CONCLUSION: Our findings suggest that sagittal misalignment may be related with more severe disability and back pain in patients with minor or null deformity in the coronal plane.

PMID:38943379 | DOI:10.3233/BMR-230242