Tag: nevin manimala

Altern Ther Health Med. 2024 Mar 22:AT10322. Online ahead of print.

ABSTRACT

OBJECTIVE: To systematically assess the impact of prone position ventilation on hypoxemia in patients following extracorporeal cardiac surgery and to establish a reference for further clinical investigation into effective post-surgery mechanical ventilation positions.

METHODS: A meta-analysis was conducted through extensive database searches, focusing on randomized controlled trials of cardiopulmonary bypass in hypoxic patients meeting specific inclusion and exclusion criteria. A total of 8 papers involving 442 patients were finally included in this study.

RESULTS: The meta-analysis revealed that the oxygenation index was significantly higher in the prone position ventilation group compared to the supine position ventilation group [MD=51.24, 95% CI (46.14, 56.35), P < .001]. The partial pressure of oxygen in prone patients was also significantly higher than in supine patients [MD=-2.96, 95% CI (1.78, 4.14), P < .001]. Regarding oxygen saturation, blood oxygen saturation in the prone position group surpassed that in the supine position group, showing a statistically significant difference [MD=4.81, 95% CI (3.83, 5.79), P < .001]. Additionally, patients ventilated in the prone position exhibited a shorter duration of mechanical ventilation compared to those in the supine position, with a statistically significant difference [MD=-57.31, 95% CI (-66.57, -48.06), P < .001].

CONCLUSIONS: In the absence of significant hemodynamic changes, prone position ventilation significantly enhances the oxygenation index and reduces the duration of mechanical ventilation in patients undergoing extracorporeal circulation surgery. However, the observed heterogeneity across studies may be attributed to variations in breathing styles, respiratory techniques, and physiological parameters among different patient groups.

PMID:38518160

Altern Ther Health Med. 2024 Mar 22:AT10313. Online ahead of print.

ABSTRACT

OBJECTIVE: Maxillofacial-neck hyperplastic scars have long been a persistent concern among individuals in both Western and Eastern countries. These scars exhibit rapid growth within 3-6 months following wound healing, subsequently receding at a slower pace, leading to skin redness, tension, and potential itching. The lack of comprehensive understanding regarding the formation mechanism and biological attributes of these scars has made them a prominent subject of research both domestically and internationally.

METHODS: Research data from 2010 to 2023 was selected, and relevant literature on the efficacy of botulinum toxin in the treatment of facial and neck hypertrophic scars was searched until August 2023. The literature on the incidence of facial-neck hypertrophic scars included in PubMed, the Cochrane Library, EMbase, and Web of Science was searched. Two researchers independently screened and extracted the data according to strict inclusion and exclusion criteria.Risk bias in Review Manager 5.4, provided by the Cochrane Collaboration, was used for methodological quality assessment and meta-analysis of the included literature. In case of any disagreement, the decision shall be made through consultation with the third party. Scar width, patient satisfaction, and visual analogue scale (VAS) were evaluated. Weighted mean difference (WMD), odds ratio (OR), and 95% confidence interval (95%CI) were used for evaluation. Publication bias was intuitively determined by funnel plot, and sensitivity analysis was conducted by removing literatures one by one for risk assessment.

RESULTS: After reading the title, abstract, and full text, a total of 237 patients were included in 7 articles. Scar width was only studied in 6 literatures, and the heterogeneity test of the included studies (χ2 = 148.95, P < .001, I2 = 98%) showed significant heterogeneity among the studies. Therefore, the random effects model was used to merge the data. Combined effect value WMD =-2.85 [95% CI :(-6.51, 0.81), P < .001], the difference between the two groups was statistically significant. The combined OR of the random-effects model was 8.52 [95%CI: (7.96, 9.08), P < .001], and the difference between the two groups was statistically significant. Among them, the heterogeneity test (χ2 = 2.69, P = .44, I² = 0%) was carried out in two studies, indicating good homogeneity among the studies, so the combined WMD was 0.68 [95%CI: (0.38, 0.99), P < .001] by using the fixed-effect model. The median VAS was described in the other two literatures, and the mean scores in the experimental group were 8.9 and 8.25, respectively, while the mean scores in the control group were 7.2 and 6.28, respectively, indicating that local injection of botulinum A toxin at the early stage of wound healing can significantly improve scar quality. Sensitivity analysis suggested that the meta-analysis results were stable and reliable, and publication bias was not analyzed using funnel plots.

CONCLUSION: Botulinum toxin has a positive effect on preventing hyperplastic scars in the maxillofacial and neck areas, and it can also help fade existing scars.

PMID:38518155

Altern Ther Health Med. 2024 Mar 22:AT10133. Online ahead of print.

ABSTRACT

OBJECTIVE: The study aimed at explore the correlation between the CT-based Peritoneal Carcinomatosis Index (PCI) and pathological parameters of rectal cancer, as well as the correlation with short-term postoperative prognosis.

METHODS: A retrospective analysis was performed on 198 rectal cancer patients treated in our institution from January 2017 to December 2022. Based on preoperative CT-PCI, patients were classified into a normal and low CT-PCI groups. Baseline characteristics and short-term postoperative outcomes were compared between the two groups. Univariate and Multivariable logistic regression analyses were conducted to ascertain the independent risk factors for postoperative complications (Clavien-Dindo classification ≥ Grade II) following neoadjuvant treatment and radical rectal cancer surgery.

RESULTS: There were significant statistical differences between the two groups regarding age, ASA score, and surgical method (P < .05). Variations in overall postoperative complications and complications of Grade II or higher among patients with differing preoperative CT-PCI were statistically significant (P < .05). No significant statistical difference was found in the time to first liquid intake post-surgery between the preoperative low CT-PCI group and the normal CT-PCI group (P > .05); however, differences in the time to first flatus, duration of postoperative hospital stay, and total hospital expenditure were statistically meaningful (P < .05). Multivariate logistic regression revealed that CT-PCI (OR=2.254) was an influential factor for postoperative complications (Clavien-Dindo classification ≥ Grade II) (P < .05). The ROC curve demonstrated an AUC of 0.854 for CT-PCI in predicting postoperative complications (Clavien-Dindo classification ≥ Grade II).

CONCLUSION: Preoperative CT-PCI may be utilized to evaluate the short-term prognosis of patients who undergo radical surgery for rectal cancer after neoadjuvant therapy. This evaluation assists in guiding clinical diagnostic and therapeutic decision-making, allowing for prompt interventions and enhancing short-term patient outcomes.

PMID:38518149

Altern Ther Health Med. 2024 Mar 22:AT9172. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to comprehensively examine and assess the changes and significance of irisin levels in individuals with carotid atherosclerosis (CAS) who are concurrently dealing with obesity.

METHOD: A total of 156 CAS patients admitted between March 2020 and March 2022 were categorized into CAS normal weight (C1), CAS overweight (C2), and CAS obesity (C3) groups based on BMI. Simultaneously, 80 healthy adults from the same period comprised the control group (C0). The study conducted a comparative analysis of biochemical indexes, serum irisin levels, and carotid artery ultrasounds across all groups. Correlation analyses and diagnostic assessments for serum irisin in obesity with carotid atherosclerosis were executed using ROC curves.

RESULTS: Statistically significant differences were observed in cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), serum homocysteine (Hcy), and irisin levels among all groups (P < .05). Obese CAS patients exhibited higher levels of TC, TG, LDL-C, and Hcy, with notably lower levels of HDL-C and irisin compared to other groups (P < .05). Significant variations in carotid artery ultrasound intima-media thickness (IMT) and Crouse scores were also evident among all groups (P < .05). Specifically, IMT and Crouse scores were higher in obese CAS patients compared to other groups (P < .05). Correlation analysis results indicated a significant negative correlation between irisin and TC, TG, LDL-C, Hcy, IMT, and Crouse score (P < .05). Conversely, irisin exhibited a significant positive correlation with HDL-C levels (P < .05). The ROC curve analysis for the diagnostic value of irisin in obesity with CAS revealed an area under the curve of 0.957.

CONCLUSIONS: Serum irisin levels are significantly reduced in CAS patients, particularly those with overweight and obese. Additionally, irisin levels are closely associated with patients’ blood lipids, homocysteine levels, and the severity of atherosclerosis.

PMID:38518138

Hum Vaccin Immunother. 2024 Dec 31;20(1):2322795. doi: 10.1080/21645515.2024.2322795. Epub 2024 Mar 22.

ABSTRACT

Coronavirus disease 2019 (COVID-19) was extraordinarily harmful, with high rates of infection and hospitalization. This study aimed to evaluate the impact of COVID-19 vaccination status and other factors on hospitalization and disease severity, using data from Nagasaki Prefecture, Japan. Confirmed cases of COVID-19 infection with vaccination status were included and the differences in characteristics between different vaccination statuses, hospitalization or not, and patients with varying levels of disease severity were analyzed. Furthermore, logistic regression was used to calculate odds ratio (ORs) and 95% confidence intervals (CI) to evaluate the association of various factors with hospitalization and disease severity. From March 14, 2020 to August 31, 2022, 23,139 patients were unvaccinated 13,668 vaccinated the primary program with one or two doses, and 4,575 completed the booster. Vaccination reduced the risk of hospitalization with an odd ratio of 0.759 (95% CI: 0.654-0.881) and the protective effect of completed booster vaccination was more pronounced (OR: 0.261, 95% CI: 0.207-0.328). Similarly, vaccination significantly reduced the risk of disease severity (vaccinated primary program: OR: 0.191, 95% CI: 0.160-0.228; completed booster vaccination: OR: 0.129, 95% CI: 0.099-0.169). Overall, unvaccinated, male, elderly, immunocompromised, obese, and patients with other severe illness factors were all risk factors for COVID-19-related hospitalization and disease severity. Vaccination was associated with a decreased risk of hospitalization and disease severity, and highlighted the benefits of completing booster.

PMID:38517220 | DOI:10.1080/21645515.2024.2322795

Hand (N Y). 2024 Mar 22:15589447241235343. doi: 10.1177/15589447241235343. Online ahead of print.

ABSTRACT

BACKGROUND: Thumb metacarpophalangeal (MP) fusion is generally successful; however, complications have been reported to occur in 0% to 30% of cases, whereas nonunion rates vary by method but, overall, are reported to occur in 0% to 15% of cases. Many fixation techniques have been described, but there is no consensus on the optimal fusion technique. Our goal was to compare complication and union rates of different thumb MP arthrodesis techniques.

METHODS: We performed a retrospective review of patients who underwent primary thumb MP fusion between 2000 and 2022. Patients who underwent revision fusion, fusion for infection, or amputation were excluded. Fusions of MP joints of other fingers were also excluded. Data collection consisted of demographic data, complications, time to fusion, rate of delayed union and rate of nonunion. Five different fusion constructs were evaluated during our study period: staples, Kirschner wires (K-wires), cerclage, K-wires with cerclage, and intramedullary screw.

RESULTS: Forty-seven patients underwent fusion with staples, 16 with K-wires, 14 with cerclage, 9 with K-wires and cerclage, and 6 with an intramedullary screw. The individual complication and nonunion rates differed significantly among the groups with the intramedullary screw group having a statistically higher rate of nonunion (P = .004). Furthermore, smoking, diabetes, and being overweight were associated with nonunions.

CONCLUSION: Union rates were significantly lower in patients treated with an intramedullary screw and those who are smokers, diabetics, and/or overweight. Caution should be exercised when using intramedullary screw fixation for MP fusion, especially in patients with these comorbidities.

PMID:38516828 | DOI:10.1177/15589447241235343

Laryngoscope. 2024 Mar 22. doi: 10.1002/lary.31398. Online ahead of print.

ABSTRACT

OBJECTIVES: Obstructive sleep apnea (OSA) is usually assessed at discrete and infrequent timepoints. Wearable consumer sleep technologies (CST) may allow for more granular and longitudinal assessments of OSA therapy responses and OSA-related symptoms.

METHODS: In this case series, we enrolled hypoglossal nerve stimulator (HGNS) patients who had an effective treatment response for an 8-week study using a wearable CST. Participants started with “HGNS-on,” were randomized to turn off HGNS therapy during either week 4 or 5 (“HGNS-off”), followed by a return to therapy, “HGNS-resume.” Participants completed validated symptom questionnaires assessing sleepiness, insomnia symptoms, functional status, and overall sleep health (Satisfaction, Alertness, Timing, Efficiency, and Duration, SATED) each week. CST metrics and survey scores were compared between HGNS treatment phases. Associations between CST metrics and survey scores were assessed.

RESULTS: Seven participants with a total of 304 nights of CST data showed no statistically significant changes in total sleep time (TST), wake time after sleep onset, or sleep efficiency (SE) across the study periods. During HGNS-off, survey scores indicated significantly worsened OSA-related symptom scores. Two participants had significantly higher heart rate variability (HRV) during HGNS-off (by 3.3 and 6.3 ms) when compared to HGNS active therapy periods. Amongst CST metrics, SATED scores correlated with TST (r = 0.434, p < 0.0001), HRV (r = -0.486, p < 0.0001), and SE (r = 0.320, = 0.0014). In addition, FOSQ-10 scores correlated with average HR during sleep (r = -0.489, p < 0.001).

CONCLUSION: A 1-week HGNS therapy withdrawal period impacted OSA-related sleep symptoms. Sleep-related metrics measured by a wearable CST correlated with symptom scores indicating potental value in the use of CSTs for longitudinal sleep-tracking in OSA patients.

LEVEL OF EVIDENCE: 4 Laryngoscope, 2024.

PMID:38516821 | DOI:10.1002/lary.31398

Am Surg. 2024 Mar 22:31348241241624. doi: 10.1177/00031348241241624. Online ahead of print.

ABSTRACT

OBJECTIVE: To retrospectively apply the Geriatric Trauma Outcome (GTO) score to the patient population of a rural South Central Appalachian level 1 trauma center and identify the potential utility of the GTO score in guiding goals of care discussions.

METHODS: Trauma registry data was extracted for 5,627 patients aged 65+ from 2017 to 2021. GTO score was calculated for each patient. Descriptive statistics were calculated for age, Injury Severity Score (ISS), GTO score, receipt of red blood cells, discharge status, and code status. A simple logistic regression model was used to determine the relationship between GTO score and discharge status. The probability of mortality was then calculated using GTO score, and the distribution of code status among patients with ≤50, 51-75%, and >75% probability of mortality was examined.

RESULTS: For every 10-point increase in GTO score, odds of mortality increased by 79% (OR = 1.79; P < .001). Patients had an estimated 50% probability of mortality with a GTO score of 156, 75% with 174, and 99% with a score of 234, respectively. Seventeen patients had a GTO score associated with >75% probability of mortality. Of those 17 patients, four retained a full code status.

CONCLUSIONS: Our analysis demonstrates that the GTO score is a validated measure in a rural setting and can be an easily calculated metric to help determine a geriatric patient’s probability of mortality following a trauma. The results of our study also found that GTO score can be used to inform goals of care discussions with patients.

PMID:38516793 | DOI:10.1177/00031348241241624

Circ Genom Precis Med. 2024 Mar 22:e004312. doi: 10.1161/CIRCGEN.123.004312. Online ahead of print.

ABSTRACT

BACKGROUND: Heart failure is heterogeneous syndrome with persistently high mortality. Nuclear magnetic resonance spectroscopy enables high-throughput metabolomics, suitable for precision phenotyping. We aimed to use targeted metabolomics to derive a metabolic risk score (MRS) that improved mortality risk stratification in heart failure.

METHODS: Nuclear magnetic resonance was used to measure 21 metabolites (lipoprotein subspecies, branched-chain amino acids, alanine, GlycA, ketone bodies, glucose, and citrate) in plasma collected from a heart failure community cohort. The MRS was derived using LASSO penalized Cox regression and temporal validation. The association between the MRS and mortality and whether risk stratification was improved over the Meta-Analysis Global Group in Chronic Heart Failure clinical risk score and NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels were assessed.

RESULTS: The study included 1382 patients (median age, 78 years, 52% men, 43% reduced ejection fraction) with a 5-year survival rate of 48% (95% CI, 46%-51%). The MRS included 9 metabolites measured. In the validation data set, a 1 SD increase in the MRS was associated with a large increased rate of death (hazard ratio, 2.2 [95% CI, 1.9-2.5]) that remained after adjustment for Meta-Analysis Global Group in Chronic Heart Failure score and NT-proBNP (hazard ratio, 1.6 [95% CI, 1.3-1.9]). These associations did not differ by ejection fraction. The integrated discrimination and net reclassification indices, and Uno’s C statistic, indicated that the addition of the MRS improved discrimination over Meta-Analysis Global Group in Chronic Heart Failure and NT-proBNP.

CONCLUSIONS: This MRS developed in a heart failure community cohort was associated with a large excess risk of death and improved risk stratification beyond an established risk score and clinical markers.

PMID:38516784 | DOI:10.1161/CIRCGEN.123.004312

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2024 Mar 21. doi: 10.5507/bp.2024.010. Online ahead of print.

ABSTRACT

BACKGROUND AND AIM: In a previous follow-up of glaucoma patients taking carteolol or latanoprost, we found a greater progression of visual field changes with the prostaglandin than the betablocker. In the present study we compared the impact of carteolol and latanoprost on peripapillary vessel density in newly diagnosed primary open-angle glaucoma (POAG) patients.

METHODS: The study consisted of two groups of POAG patients. There were 46 patient eyes treated with carteolol (Carteol LP 2%) in the first group and 52 eyes treated with latanoprost (Xalatan 0.005%) in the second. Intraocular pressure (IOP), vessel density (VD) and visual field were assessed in all patients. VD was measured peripapillary by optical coherence tomography angiography (OCTA) with the Avanti RTVue XR in eight segments: Inferior Temporal – IT (1); Temporal Inferior -TI (2); Temporal Superior – TS (3); Superior Temporal – ST (4); Superior Nasal – SN (5); Nasal Superior – NS (6); Nasal Inferior – NI (7) and Inferior Nasal – IN (8). The measurements were compared before and after three months of treatment. The visual field was examined with a fast threshold glaucoma program using a Medmont M 700 instrument from Medmont International Pty Ltd. and only when a diagnosis of POAG was done. The overall defect (OD) was assessed.

RESULTS: Before treatment, there was no difference between groups in either OD or VD. After treatment, there was a decrease in IOP in both groups. In the carteolol-treated group, the mean decrease was 5.8 mmHg and in the latanoprost-treated eyes, the mean decrease was 7 mmHg. The difference was not statistically significant (P=0.133). After treatment with carteolol, there was a statistically significant increase in VD in segments 4, 5 and 6. After latanoprost treatment, VD was statistically significantly improved only in segment 5. A greater increase in VD values was found in eyes treated with carteolol than in eyes treated with latanoprost.

CONCLUSION: Carteolol had a better effect on vessel density than latanoprost.

PMID:38516775 | DOI:10.5507/bp.2024.010