Tag: nevin manimala

Rehabilitation (Stuttg). 2023 Sep 14. doi: 10.1055/a-2133-2552. Online ahead of print.

ABSTRACT

PURPOSE: Cardiovascular diseases represent a large proportion of the disease burden of the adult population in Germany. Their importance in rehabilitation has increased continuously in recent years. Several studies have investigated return to work of cardiac patients after rehabilitation, which is relevant from the perspective of pension insurance. However, there is a lack of representative findings for the German region on employment trajectories and their influencing factors.

METHODS: The rehabilitation statistics database of the German Pension Insurance (GPI) was used for this study. Subjects were patients with cardiovascular diseases undergoing rehabilitation in 2017. Analyses were performed for the total group and differentiated by relevant diagnosis groups. Occupational participation was operationalized via a monthly state variable up to 24 months after rehabilitation and the rate of all persons who were employed at the 12- and 24- month follow-up and in the 3 months before, respectively. Multiple logistic regression models were calculated to analyze the influencing factors.

RESULTS: The total sample comprised 59,667 patients. The average age in all groups was between 53 and 56 years. Men were disproportionately represented; 70% of the services were provided as follow-up rehabilitations and 88% in the inpatient setting. Stable employment rates were 66% after one year and 63% after two years in the overall group (disease groups: 49% to 71%). The strongest influencing factors were the amount of pay and the number of sickness absence days before rehabilitation, active employment before rehabilitation, and age.

CONCLUSION: For the first time, representative data on occupational participation following rehabilitation on behalf of the GPI are available for the disease groups considered. The analyses underline the need to focus on occupational perspectives already in medical rehabilitation or directly thereafter.

PMID:37709287 | DOI:10.1055/a-2133-2552

Midwifery. 2023 Sep 2;126:103811. doi: 10.1016/j.midw.2023.103811. Online ahead of print.

ABSTRACT

BACKGROUND: Wellbeing in pregnancy can have long term effects for women, infants, and families. Research has shown that music can promote maternal health, infant development, and parent-infant bonding. This study aimed to explore women’s and their partners’ experiences of using music during pregnancy while also considering their perspectives on the potential role of music in maternity care.

METHODS: A cross-sectional online survey was conducted from June to October 2020 in Ireland. 265 respondents including 254 women and 11 partners who were pregnant or had given birth in the past 12 months participated. Descriptive statistics and content analysis were used to analyse the results.

RESULTS: Findings indicated that, during pregnancy, 75% of respondents sang to their unborn baby, 47% created playlists for childbirth, 46% intentionally used music to support their wellbeing, over one-third were not aware of supporting evidence on music for perinatal wellbeing, 88% thought there was not enough guidance, and 70% supported the idea of establishing music therapy in maternity care. Qualitative analysis revealed three themes: ‘Positive impacts of music’, ‘Facilitators and barriers to the use of music during pregnancy’, and ‘Future visions on implementing music in maternity care’.

CONCLUSION: This study is the first to explore the experience and perspectives of women and partners in Ireland on using music during pregnancy. The findings highlight the need for more music-based resources and education on this topic and suggests an openness amongst women and partners towards the implementation of music therapy in maternity care to promote perinatal health and wellbeing.

PMID:37708586 | DOI:10.1016/j.midw.2023.103811

Comput Methods Programs Biomed. 2023 Sep 6;242:107790. doi: 10.1016/j.cmpb.2023.107790. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Phase contrast magnetic resonance imaging (4D flow MRI) is an imaging technique able to provide blood velocity in vivo and morphological information. This capability has been used to study mainly the hemodynamics of large vessels, such as the thoracic aorta. However, the segmentation of 4D flow MRI data is a complex and time-consuming task. In recent years, neural networks have shown great accuracy in segmentation tasks if large datasets are provided. Unfortunately, in the context of 4D flow MRI, the availability of these data is limited due to its recent adoption in clinical settings. In this study, we propose a pipeline for generating synthetic thoracic aorta phase contrast magnetic resonance angiography (PC_MRA) to expand the limited dataset of patient-specific PC_MRA images, ultimately improving the accuracy of the neural network segmentation even with a small real dataset.

METHODS: The pipeline involves several steps. First, a statistical shape model is used to synthesize new artificial geometries to improve data numerosity and variability. Secondly, computational fluid dynamics simulations are employed to simulate the velocity fields and, finally, after a downsampling and a signal-to-noise and velocity limit adjustment in both frequency and spatial domains, volumes are obtained using the PC_MRA formula. These synthesized volumes are used in combination with real-world data to train a 3D U-Net neural network. Different settings of real and synthetic data are tested.

RESULTS: Incorporating synthetic data into the training set significantly improved the segmentation performance compared to using only real data. The experiments with synthetic data achieved a DICE score (DS) value of 0.83 and a better target reconstruction with respect to the case with only real data (DS = 0.65).

CONCLUSION: The proposed pipeline demonstrated the ability to increase the dataset in terms of numerosity and variability and to improve the segmentation accuracy for the thoracic aorta using PC_MRA.

PMID:37708583 | DOI:10.1016/j.cmpb.2023.107790

Altern Ther Health Med. 2023 Sep 15:AT8618. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the clinical efficacy of an enhanced minimally invasive NICE joint technique combined with dual adjustable loop steel plate internal fixation for treating acute acromioclavicular joint dislocation.

METHODS: A retrospective analysis was conducted on 63 surgical patients treated with acute acromioclavicular joint dislocation from May 2017 to March 2022. Among them, 33 cases were treated with the clavicle hook plate, and 30 cases were treated with the minimally invasive loop plate. We compared hospitalization duration, incision length, surgical duration, intraoperative bleeding, visual analogue pain scale scores, shoulder joint Constant scores at 6 months before and after surgery, and the incidence of complications between the two groups.

RESULTS: The comparison between the two groups, including hospitalization duration, incision length, surgical duration, intraoperative bleeding volume, and shoulder joint Constant score at 6 months post-surgery, revealed statistically significant differences where the loop plate group had better results. One case (1/33) experienced postoperative complications in the hook plate group, including screw loosening and plate failure. Additionally, there were 8 cases (8/33) of subacromial osteolysis, 10 cases (10/33) of acromial impact, and 5 cases (5/33) of residual shoulder pain. Conversely, only 1 case (1/30) in the loop plate group had residual shoulder pain.

CONCLUSIONS: The surgical technique involving the reconstruction of the coracoclavicular ligament using an enhanced minimally invasive NICE junction combined with double adjustable loop steel plate placement in the clavicular small bone canal is characterized by simplicity, safety, minimal invasiveness, excellent functional recovery, fewer complications, and superior clinical efficacy compared to clavicular hook steel plates.

PMID:37708565

Altern Ther Health Med. 2023 Sep 15:AT9338. Online ahead of print.

ABSTRACT

CONTEXT: After the age of 35, women’s fertility and physical function gradually decline, and this can significantly increase the risks of postpartum hemorrhage (PPH) after delivery. Sufficient exploration of prenatal indicators of PPH for older pregnant women are still lacking.

OBJECTIVE: The study intended to examine the factors influencing postpartum hemorrhage (PPH) in natural delivery for pregnant women ≥35 years of age and to establish a reliable risk-prediction model.

DESIGN: The research team performed a retrospective study.

SETTING: The study took place at Suzhou Ninth People’s Hospital in Suzhou, Jiangsu Province, China.

PARTICIPANTS: Participants were 351 pregnant women who had undergone a prenatal examination and vaginal delivery at the hospital between January 2019 and October 2022.

GROUPS: The research team divided participants into two groups: (1) a PPH group, with 52 participants who experienced PPH, and (2) a non-PPH group, with 299 participants who had no PPH.

OUTCOME MEASURES: The research team: (1) conducted single-factor analysis of the two groups’ demographic and clinical characteristics; (2) performed multivariate logistic regression analysis to find the factors influencing PPH; (3) built a risk-prediction model based on the results; and (4) analyzed the model’s identification ability, proofreading ability, and clinical applicability using a goodness-of-fit test, a receiver operating characteristic (ROC) curve, a calibration curve, and a decision curve. The team used the SPSS 22.0 and R software for statistical analysis.

RESULTS: The incidence of PPH was 14.81%, for the 52 out of 351 participants. The PPH group’s age (P < .001), rate of pregnancy-induced hypertension (P = .008), length of the third stage of labor (P = .001), and newborn’s birth weight (P < .001) were significantly greater and its FIB before delivery was significantly lower than those of the non-PPH group. The high expression of fibrinogen (FIB) before delivery indicates it may be a protective factor against PPH. The multivariate analysis indicated that a greater age (P = .013), pregnancy-induced hypertension (P = .002), a low FIB level (P < .001), a long third stage of labor (P = .012), and a low birth weight for the newborn (P = .006) were all significantly related to PPH. The research team validated the risk-prediction model, which indicated that the model had good recognition ability (AUC = 0.873). The optimal critical value was 34%, and the sensitivity and specificity were 0.869 and 0.826, respectively. In the comparison of the PPH value that the model predicted and the participants’ actual PPH incidence (U = -0.006, Brier = 0.089), the deviation of the model wasn’t statistically significant (χ2 = 5.964, P = .651). The analysis of the decision curve found that the net benefits for pregnant women ≥35 years of age were higher than those of the other two extreme curves, showing that the model was clinically effective.

CONCLUSIONS: The PPH risk-prediction model for vaginal delivery for pregnant women ≥35 years of age showed that a greater age, pregnancy-induced hypertension, a lower prelabor FIB, a longer third stage of labor, and a higher birth weight for the newborn were significantly related to the incidence of PPH and that its use could be clinically helpful.

PMID:37708560

Altern Ther Health Med. 2023 Sep 15:AT9128. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to investigate the clinical efficacy and safety of combining percutaneous nephrolithotomy (PCNL) with extracorporeal shock wave lithotripsy (ESWL) for the treatment of patients with complicated upper urinary calculi.

METHODS: We employed a randomized controlled experimental design to examine data from patients diagnosed with complex upper urinary tract renal calculi at our hospital from April 2019 to March 2020. A total of 98 eligible patients were included in the study. To ensure the integrity of the research, we computerized and randomized the patient data according to the study’s protocol. Subsequently, we divided the patients into two groups: a control group (n = 49) that received ESWL as the treatment modality and an experimental group (n = 49) that underwent a combined treatment approach involving both PCNL and ESWL. Following the completion of the treatments, we analyzed stone clearance rates and other outcome indicators. Additionally, we carefully documented any post-treatment adverse events to evaluate patient safety comprehensively.

RESULTS: The experimental group exhibited a higher stone clearance rate compared to the control group. Comparison of visual Analog Scale/Score (VAS) pain scores, operation time, and hospitalization time revealed statistically significant differences (P < .05), with the experimental group showing slightly worse performance than the control group. After treatment, both groups experienced varying degrees of complications, with the experimental group demonstrating fewer complications, a statistically significant result (P < .05).

CONCLUSIONS: Extracorporeal shock wave lithotripsy significantly improved stone clearance rates in patients with complex upper urinary tract renal calculi. Simultaneously, it positively impacted surgical outcomes and reduced the incidence of post-treatment adverse events. This intervention offers clinical benefits.

PMID:37708548

Altern Ther Health Med. 2023 Sep 15:AT9091. Online ahead of print.

ABSTRACT

OBJECTIVE: Assessing the safety and efficacy of enteral nutrition in critically ill patients receiving prone position ventilation is essential to optimize treatment strategies for critically ill patients. Systematically evaluate the effectiveness and safety of prone position enteral nutrition in critically ill ventilated patients, providing a reference for clinical decision-making.

METHODS: We conducted a comprehensive search for relevant studies on the safety and efficacy of enteral nutrition in prone ventilation patients. Our search encompassed randomized controlled trials, quasi-experimental studies, and cohort studies, utilizing databases including PubMed, Embase, and Scopus. The search duration spanned from May 2000 to May 2023. Inclusion and exclusion criteria were applied to select eligible literature, followed by data extraction and quality assessment. We employed specific keywords and filters in our search strategy to ensure a robust selection of studies. Subsequently, statistical analysis was performed utilizing RevMan 5.2 software to synthesize and interpret the findings effectively.

RESULT: Five articles were ultimately included, with a total of 372 patients undergoing prone ventilation. The meta-analysis results showed that patients receiving enteral nutrition during prone and supine ventilation had higher levels of gastric residue incidence [RR = -0.01, 95% CI: (-0.08, 0.06), P = .77]. There was no significant difference in the incidence of vomiting/reflux between the prone position group and the control group [RR = 0.60, 95%CI: (0.15-2.45), P = .48]. Prone position ventilation had no significant effect on the incidence of ventilator-associated pneumonia (VAP) [RR = 1.00, 95%CI: (0.14-6.90), P = 1.00]. There was no significant difference in the rate of enteral nutrition interruption between the prone position group and the control group [RR = 0.65, 95%CI: (0.28-1.52), P = .32].

CONCLUSION: Enteral nutrition in critically ill patients receiving prone position ventilation was not associated with high levels of gastric residual, vomiting or reflux, ventilator-associated pneumonia, or increased incidence of enteral nutrition interruption.

PMID:37708547

Altern Ther Health Med. 2023 Sep 15:AT9084. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to explain the associations between different types of uveitis and human leukocyte antigen (HLA)-B27, HLA-DR4, and HLA-DRw53.

METHODS: A retrospective analysis of 390 uveitis cases was conducted among inpatients and outpatients diagnosed at Weifang Eye Hospital from 2013 to 2016. All 390 patients underwent HLA-B27 examination, and an additional 40 patients underwent examination for HLA-DR4 and HLA-DRw53. Gender, age, corrected visual acuity (CVA), and recurrence frequency were statistically analyzed based on the onset site and etiology classification.

RESULTS: Among the 390 enrolled patients, 206 were male, and 183 were female, with ages ranging from 6 to 87 years (mean: 44.2). The disease onset was classified into anterior uveitis (AU), panuveitis (panU), posterior uveitis (PU), and intermediate uveitis in 180, 112, 88, and 10 cases, respectively. HLA-B27 was positive in 94 cases (53 males and 41 females), yielding a positive rate of 24.1%. In AU patients, 80 (44.4%) tested positive for HLA-B27, while 8 (7.1%) panU patients and 6 PU patients (6.8%) were HLA-B27 positive; none of the intermediate uveitis (IU) patients exhibited HLA-B27 positivity. HLA-B27, HLA-DR4, and HLA-DRw53 examinations were performed on 40 patients with binocular uveitis, resulting in 2 HLA-B27 positive cases, 15 HLA-DR4 positive cases, and 20 HLA-DRw53 positive cases, with positive rates of 5%, 37.5%, and 50%, respectively. Among 25 Vogt Koyanagi-Harada (VKH) cases, 1 tested positive for HLA-B27, 22 were positive for HLA-DR4, and 24 were positive for HLA-DRw53, with positive rates of 4%, 88%, and 96%, respectively. No positive HLA-B27, HLA-DR4, or HLA-DRw53 cases were found among the 10 cases of Behcet’s disease (BD).

CONCLUSIONS: Human leukocyte antigens (HLAs) play a significant role in the mechanism of uveitis. HLA-B27 exhibits high diagnostic value in acute AU, while HLA-DR4 and HLA-DRw53 are crucial for diagnosing binocular uveitis, particularly Vogt Koyanagi-Harada (VKH) syndrome. Further investigation is warranted to explore the relationship between HLA-DR4, HLA-DRw53, and uveitis.

PMID:37708541

Altern Ther Health Med. 2023 Sep 15:AT9043. Online ahead of print.

ABSTRACT

OBJECTIVE: To analyze the use of antimicrobial drugs in patients during the COVID-19 pandemic.

METHODS: We searched for literature about antimicrobial treatment in COVID-19 patients through the Cochrane Library, Embase, PubMed, the Chinese biomedical literature database, CNKI, the Chinese journal full-text database, Wanfang, and Vipu. The quality evaluation of the literature was performed by Jadad’s quality score.

RESULTS: A total of three articles reported on ivermectin treatment in patients with COVID-19, and the Meta-analysis showed no clinical and statistical heterogeneity among the studies (I2 = 15%, P = .31), a fixed effect model was used to incorporate effect sizes. The clinical effect of the observed group was not different from the control group (P = .16). None of the three ivermectin articles with clinical effect as the effect indicator showed a significant difference (P > .05), suggesting no publication bias. A total of four publications reported the treatment with azithromycin in patients with COVID-19, and the Meta-analysis showed no clinical and statistical heterogeneity between the studies (I2 = 0%, P = .88), using a fixed-effect model to incorporate the effect sizes. The clinical effect of the observed group was not different from the control group (P = .57). None of the four azithromycin articles with a clinical effect as the effect index was statistically significant (P > .05), suggesting no publication bias.

CONCLUSION: During the COVID-19 pandemic, the patient’s use of antibiotics does not significantly improve clinical efficacy, so antibiotic use is recommended only for patients with complicated bacterial infections.

PMID:37708540

Altern Ther Health Med. 2023 Sep 15:AT8421. Online ahead of print.

ABSTRACT

OBJECTIVE: This study investigated the effectiveness of a technique for eliminating cloudiness and managing liver function in treating liver fibrosis/cirrhosis associated with the Hepatitis B virus (HBV).

METHODS: From January 2022 to January 2023, the researchers’ hospital treated 200 patients with HBV-related liver fibrosis/cirrhosis. These patients constituted two groups for the study: the control group, consisting of 100 cases who received routine treatment, and a study group, consisting of 56 cases who received treatment with a combination of turbidity removal and liver regulation, in addition to the standard treatment given to the control group. The researchers then compared factors such as liver function, level of liver fibrosis, liver stiffness measurement (LSM), and renal function between the two groups. Additionally, the researchers assessed the effectiveness of those treatments and any adverse reactions that may have occurred.

RESULTS: The study group demonstrated significantly higher clinical effectiveness than the control group after undergoing treatment, with statistical significance (P < .05). Post-treatment, both groups experienced lower GGT, ALT, and AST levels than their pre-treatment levels. Additionally, the study group had higher AIB levels than their pre-treatment levels. There was a statistically significant difference between the study and control groups regarding these biomarkers (P < .05), as the study group exhibited lower GGT, ALT, AST, TBIL levels and higher AIB levels. Furthermore, both groups displayed decreased HA, IV-C, PC III, and LN levels post-treatment compared to their pre-treatment values. The study group had significantly lower HA, IV-C, PC III, and LN concentrations than the control group (P < .05). Regarding LSM measurements after treatment for both groups, while there was a decrease in LSM values from their respective pre-treatment readings for each group, no significant difference was observed between them (P < .05). Moreover, the incidence of adverse reactions experienced by individuals in the study group following treatment was significantly lower than that of individuals in the control group (P < .05).

CONCLUSION: Treatment based on removing turbidity and regulating the liver can effectively relieve the clinical symptoms of patients with HBV-related liver fibrosis/cirrhosis, promote the liver function to return to normal, relieve the degree of liver fibrosis, and reduce the LSM value. The curative effect is significant and worthy of clinical application.

PMID:37708539