Tag: nevin manimala

J Am Acad Orthop Surg. 2022 Apr 25. doi: 10.5435/JAAOS-D-21-01169. Online ahead of print.

ABSTRACT

INTRODUCTION: Fragility fractures are an enduring source of morbidity in the elderly with unfortunate frequency and rising costs. Although the predominant cause of fractures is generally understood to be falls, the exact stratification of the causes of fractures presenting to the emergency department has not yet been described in the literature. We sought out to stratify the primary products associated with fractures in the elderly, further describing the anatomic location of the fracture and setting of injury.

METHODS: We queried the National Electronic Injury Surveillance System database for all fractures in patients older than 65 years from January 1, 2000, to December 31, 2019. We analyzed demographic data, patient disposition, anatomic fracture location, and injury setting for the top 20 causes of fractures. Trends, proportions and distributions were analyzed using descriptive statistics.

RESULTS: A total of 901,418 visits to the Emergency Department were reviewed. Of these, 216,657 (24%) were found to have fractures. The top 20 causes for fractures accounted for a total of 173,557 (19%) fractures. The average age in our population was 80.1 years (SD 8.7). Women constituted most of the patients (127,753 [74%]). Flooring (58,347 [33.6%]) was the most common product associated with the cause of fractures, with stairs/steps (29,804 [17.2%]) and bed/bed frames (19,004 [10.9%]) being the second and third most common, respectively. Lower extremity fractures (97,195 [56%]) were more common than upper extremity fractures (63,899 [37%]). The lower trunk (pelvis, femoral neck, and lower spine) was the most common anatomic location of fractures reported (64,132 [37.0%]). Most fractures occurred either at home (113,158 [65.2%]) or at a public setting (31,162 [18.0%]).

CONCLUSIONS: Most products associated with fractures among mature adults were related to flooring, stairs, or bedding. This study offers a detailed understanding on the common products associated with fractures in mature adults and aids in discussing preventive measures for lowering fracture risk with patients, communities, and healthcare systems.

PMID:35472060 | DOI:10.5435/JAAOS-D-21-01169

Psychosom Med. 2022 Apr 27. doi: 10.1097/PSY.0000000000001087. Online ahead of print.

ABSTRACT

OBJECTIVE: Recent research identified that workplace factors play a role in the development of diabetes mellitus (DM). This study examines the longitudinal association of work-related overqualification with the incidence of DM over a 14-year follow-up period.

METHODS: We used data from the 2003 Canadian Community Health Survey linked to the Ontario Health Insurance Plan and the Canadian Institute for Health Information Discharge Abstract databases. Cox-proportional hazards regression models were performed to evaluate the relationship between overqualification and the incidence of DM.

RESULTS: Over the study period, there were 91,835 person-years of follow-up (median follow-up 13.7 years). The final sample included 7,026 respondents (mean age at baseline = 47.1; SD = 8.2; 47% female). An elevated risk of DM was associated with substantial overqualification (HR = 1.58, 95% CI: 1.01 – 2.49) after adjustment for socio-demographic, health and work variables. Additional adjustment for body mass index (BMI) and health behaviours attenuated this risk (HR = 1.30, 95% CI: 0.81 – 2.08). Underqualification was not associated with the incidence of DM in adjusted regression models. We did not observe any statistical difference in the effects of overqualification on DM risk across sex or education groups.

CONCLUSIONS: This study adds to the growing body of research literature uncovering the relationships between work exposures and DM risk. The results from the study suggest that higher BMI, and to a lesser extent health behaviours, may be mediating factors in the association between overqualification and incident DM. Further research on the association of overqualification with DM is warranted.

PMID:35472044 | DOI:10.1097/PSY.0000000000001087

Am J Hematol. 2022 Apr 26. doi: 10.1002/ajh.26581. Online ahead of print.

ABSTRACT

Iron overload is a severe general complication of hereditary anemias. Treatment with iron chelators is hampered by important side-effects, high costs and the lack of availability in many countries with high prevalence of hereditary anemias. In this phase III randomized placebo-controlled trial we assigned adults with non-transfusion-dependent hereditary anemias with mild-to-moderate iron overload to receive esomeprazole (at a dose of 40mg twice daily) or placebo for 12 months in a cross-over design. The primary end point was change of liver iron content measured by MRI. A total of thirty participants were enrolled in the trial. Treatment with esomeprazole resulted in a statistically significant reduction in liver iron content that was 0.55 mg Fe/g dw larger than after treatment with placebo (95%CI [0.05 to 1.06]; p=0.03). Median baseline liver iron content at start of esomeprazole was 4.99 versus 4.49 mg Fe/g dw at start of placebo. Mean delta liver iron content after esomeprazole treatment was -0.57 (SD 1.20) versus -0.11 mg Fe/g dw (SD 0.75) after placebo treatment. Esomeprazole was well tolerated, reported adverse events were mild and none of the patients withdrew from the study due to side effects. In summary, esomeprazole resulted in a significant reduction in liver iron content when compared to placebo in a heterogeneous group of patients with non-transfusion-dependent hereditary anemias. From an international perspective this result can have major implications given the fact that proton pump inhibitors may frequently be the only realistic therapy for many patients without access to or not tolerating iron chelators. This article is protected by copyright. All rights reserved.

PMID:35472008 | DOI:10.1002/ajh.26581

J Am Acad Orthop Surg Glob Res Rev. 2022 Apr 1;6(4). doi: 10.5435/JAAOSGlobal-D-21-00016.

ABSTRACT

Whether to undergo bilateral total knee arthroplasty (BTKA) depends on patient and surgeon preferences. We used the National Inpatient Sample to compare temporal trends in BTKA utilization and in-hospital complication rates among TKA patients ≥50 with Medicare/Medicaid versus private insurance from 2007 to 2016. We used multivariable logistic regression to assess the association between insurance type and trends in utilization and complication rates adjusting for individual-, hospital-, and community-level covariates, using unilateral TKA (UTKA) for reference. Discharge weights were used for nationwide estimates. About 132,400 (49.5%) Medicare/Medicaid patients and 135,046 (50.5%) privately insured patients underwent BTKA. Among UTKA patients, 62.7% had Medicare/Medicaid, and 37.3% had private insurance. Over the study period, BTKA utilization rate decreased from 7.18% to 5.63% among privately insured patients and from 4.59% to 3.13% among Medicaid/Medicare patients (P trend difference <0.0001). In multivariable analysis, Medicare/Medicaid patients were less likely to receive BTKA than privately insured patients. Although Medicare/Medicaid patients were more likely to develop in-hospital complications after UTKA (adjusted odds ratio, 1.06; 95% confidence interval, 1.002 to 1.12; P = 0.04), this relationship was not statistically significant for BTKAs. In this nationwide sample of TKA patients, BTKA utilization rate was higher in privately insured patients compared with Medicare/Medicaid patients. Furthermore, privately insured patients had lower in-hospital complication rates than Medicare/Medicaid patients.

PMID:35472007 | DOI:10.5435/JAAOSGlobal-D-21-00016

Inflamm Bowel Dis. 2022 Apr 26:izac088. doi: 10.1093/ibd/izac088. Online ahead of print.

ABSTRACT

BACKGROUND: There is lack of knowledge concerning postpartum infections in women with inflammatory bowel disease (IBD). Our aim is to determine the 30-day postpartum infectious complications in women with and without IBD who have a caesarian section, normal vaginal delivery, or assisted vaginal delivery.

METHODS: We used Danish national registries to establish a study population of liveborn, singleton births from January 1, 1997, through December 31, 2015. We examined 30-day postpartum maternal infectious complications in women with and without IBD, according to the mode of delivery. Statistical models were adjusted for multiple confounders.

RESULTS: In all, 3255 women with and 207 608 without IBD had a caesarian section. Within 30 days postpartum, 4.5% of women with and 3.7% without IBD had an infectious complication. Increased infectious complications included overall infections (adjusted OR [aOR], 1.83; 95% confidence interval [CI], 1.35-2.47), infections of the gastrointestinal tract (aOR, 4.36, 95% CI 2.34-8.10), and infections of the skin and subcutaneous tissue (aOR, 4.45; 95% CI, 2.30-8.50). Other puerperal infections, urological and gynecological, and other infections were increased, although not significantly. For vaginal deliveries, 1.6% of 5771 women with IBD and 1.3% of 793 110 women without IBD had an infectious complication, and the aOR of infections of the gastrointestinal tract was 3.17 (95% CI, 1.47-6.85). There were too few outcomes to calculate the risk of infections after assisted vaginal delivery.

CONCLUSIONS: The risk of a 30-day postpartum infectious complication is increased in women with IBD. Physicians should carefully monitor their patients postpartum to prevent these adverse outcomes.

PMID:35472003 | DOI:10.1093/ibd/izac088

J Am Coll Health. 2022 Apr 26:1-4. doi: 10.1080/07448481.2022.2066976. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this study was to identify out-of-hospital cardiac arrest characteristics for patients treated by collegiate-based emergency medical services (CBEMS) organizations.

PARTICIPANTS: CBEMS organizations provided data via the National Collegiate EMS Foundation Cardiac Arrest Data Registry.

METHODS: CBEMS organization details, patient demographics, cardiac arrest characteristics and treatments, and prehospital outcomes for cases spanning October 2007 to May 2020 were analyzed with descriptive statistics.

RESULTS: There were 65 OHCA entries. The majority were for male patients (82%) and a notable number of cases occurred in patients 45 years of age or younger (41%). Cases were frequently witnessed (71%) with high rates of bystander cardiopulmonary resuscitation (57%) and defibrillation (29%) prior to EMS arrival. Almost half of the patients (48%) had achieved return of spontaneous circulation until care was transferred to a provider of equal/higher level.

CONCLUSIONS: CBEMS organizations may be well situated to respond rapidly to on-campus OHCAs.

PMID:35472006 | DOI:10.1080/07448481.2022.2066976

PLoS Negl Trop Dis. 2022 Apr 26;16(4):e0010324. doi: 10.1371/journal.pntd.0010324. eCollection 2022 Apr.

ABSTRACT

BACKGROUND: The combination of Wolbachia-based incompatible insect technique (IIT) and radiation-based sterile insect technique (SIT) can be used for population suppression of Aedes aegypti. Our main objective was to evaluate whether open-field mass-releases of wAlbB-infected Ae. aegypti males, as part of an Integrated Vector Management (IVM) plan led by the Mexican Ministry of Health, could suppress natural populations of Ae. aegypti in urbanized settings in south Mexico.

METHODOLOGY/PRINCIPAL FINDINGS: We implemented a controlled before-and-after quasi-experimental study in two suburban localities of Yucatan (Mexico): San Pedro Chimay (SPC), which received IIT-SIT, and San Antonio Tahdzibichén used as control. Release of wAlbB Ae. aegypti males at SPC extended for 6 months (July-December 2019), covering the period of higher Ae. aegypti abundance. Entomological indicators included egg hatching rates and outdoor/indoor adult females collected at the release and control sites. Approximately 1,270,000 lab-produced wAlbB-infected Ae. aegypti males were released in the 50-ha treatment area (2,000 wAlbB Ae. aegypti males per hectare twice a week in two different release days, totaling 200,000 male mosquitoes per week). The efficacy of IIT-SIT in suppressing indoor female Ae. aegypti density (quantified from a generalized linear mixed model showing a statistically significant reduction in treatment versus control areas) was 90.9% a month after initiation of the suppression phase, 47.7% two months after (when number of released males was reduced in 50% to match local abundance), 61.4% four months after (when initial number of released males was re-established), 88.4% five months after and 89.4% at six months after the initiation of the suppression phase. A proportional, but lower, reduction in outdoor female Ae. aegypti was also quantified (range, 50.0-75.2% suppression).

CONCLUSIONS/SIGNIFICANCE: Our study, the first open-field pilot implementation of Wolbachia IIT-SIT in Mexico and Latin-America, confirms that inundative male releases can significantly reduce natural populations of Ae. aegypti. More importantly, we present successful pilot results of the integration of Wolbachia IIT-SIT within a IVM plan implemented by Ministry of Health personnel.

PMID:35471983 | DOI:10.1371/journal.pntd.0010324

J Chem Theory Comput. 2022 Apr 26. doi: 10.1021/acs.jctc.1c00548. Online ahead of print.

ABSTRACT

Despite the variety of available computational approaches, state-of-the-art methods for calculating excitation energies, such as time-dependent density functional theory (TDDFT), are computationally demanding and thus limited to moderate system sizes. Here, we introduce a new variation of constrained DFT (CDFT), wherein the constraint corresponds to a particular transition (T), or a combination of transitions, between occupied and virtual orbitals, rather than a region of the simulation space as in traditional CDFT. We compare T-CDFT with TDDFT and ΔSCF results for the low-lying excited states (S₁ and T₁) of a set of gas-phase acene molecules and OLED emitters and with reference results from the literature. At the PBE level of theory, T-CDFT outperforms ΔSCF for both classes of molecules, while also proving to be more robust. For the local excitations seen in the acenes, T-CDFT and TDDFT perform equally well. For the charge transfer (CT)-like excitations seen in the OLED molecules, T-CDFT also performs well, in contrast to the severe energy underestimation seen with TDDFT. In other words, T-CDFT is equally applicable to both local excitations and CT states, providing more reliable excitation energies at a much lower computational cost than TDDFT cost. T-CDFT is designed for large systems and has been implemented in the linear-scaling BigDFT code. It is therefore ideally suited for exploring the effects of explicit environments on excitation energies, paving the way for future simulations of excited states in complex realistic morphologies, such as those which occur in OLED materials.

PMID:35471972 | DOI:10.1021/acs.jctc.1c00548

J Am Acad Orthop Surg Glob Res Rev. 2022 Apr 1;6(4). doi: 10.5435/JAAOSGlobal-D-20-00084.

ABSTRACT

INTRODUCTION: Variability in follow-up has previously been identified in orthopaedic trauma. Variability in follow-up for pediatric femur fractures has not previously been documented. The aim of this study was to document the variability in clinical and radiographic follow-up for pediatric femur fractures based on the fixation method and the treating surgeon.

METHODS: This retrospective case series identified isolated femoral fractures in patients younger than 18 years, treated by eight surgeons at a single center from 2010 to 2015. The total number and frequency of clinical visits, radiographic visits and discrete radiograph views, demographic data, fracture classification, treatment method, and presence of complications were extracted. Variability in follow-up was assessed through descriptive statistics and linear and Poisson regression models.

RESULTS: One hundred sixty-four femoral fractures in 160 patients were included. Fractures were stratified by the treating surgeon. The mean length of follow-up ranged from 6.5 to 13.6 months. Complications increased follow-up time by mean 1.7 months (1.3 to 2.4). Patients who were treated with rigid locking nails were followed for the shortest amount of time, averaging 9.9 months, while traction followed by rigid locking nails averaged 24.4 (0.5 to 9.3) months of follow-up.

DISCUSSION: Variation in the length of follow-up was identified and was associated with the fixation method and the treating surgeon. Few patients were followed long enough to definitively identify complications and sequelae known to occur after femur fractures such as femoral overgrowth or growth arrest. The results of this study indicate a need for additional study and consensus on an appropriate follow-up for pediatric femur fractures.

PMID:35471962 | DOI:10.5435/JAAOSGlobal-D-20-00084

J Am Coll Health. 2022 Apr 26:1-5. doi: 10.1080/07448481.2022.2068016. Online ahead of print.

ABSTRACT

OBJECTIVES: The relative high rates of homelessness and housing insecurity among college students has become a public health concern within the U.S. This study explores the relationship between housing instability in relation to academic and mental health outcomes.

PARTICIPANTS: College students attending a larger public university (N = 1,416 students; M age = 22.54; 47.2% Pell Eligible; 54.6% racially/ethnically minoritized students) were surveyed employing cluster-sampling in the Fall Semester of 2019.

METHODS: Participants completed validated measures of housing instability, mental health outcomes, and demographics. Additional measures were matched with survey responses through the Office of Institutional Research (i.e., GPA, Pell Grant eligibility).

RESULTS: Students who experienced housing insecurity and homelessness were more likely to have a lower GPA as well as poorer mental health outcomes.

CONCLUSION: Findings highlight implications surrounding the need for housing programs and additional financial support in an effort to bolster students’ academic performance and mental well-being.

PMID:35471954 | DOI:10.1080/07448481.2022.2068016