Tag: nevin manimala

J AAPOS. 2023 May 5:S1091-8531(23)00081-2. doi: 10.1016/j.jaapos.2023.02.005. Online ahead of print.

ABSTRACT

PURPOSE: To analyze rates of follow-up eye care for students that failed school vision screenings over a 7-year period in 238 Arkansas school districts.

METHODS: In this cross-sectional study, vision screening, demographic, socioeconomic, academic, and eye care provider data were collected. The main outcomes were referral rates, rates of follow-up eye care for students with failed vision screenings, and estimated associations between the rate of follow-up and school district and county-level characteristics, such as race, poverty, insurance coverage, academic achievement, and the number of eye care providers.

RESULTS: A total of 1,744,805 vision screenings over 7 academic years (2013-2020) were included. The average screening rate was 35.4% across the study years. The screening failure rate ranged from 8.0% to 9.4%. Two-thirds of districts had a follow-up rate between 20% and 50%. 91% had follow-up rates of <60%. School districts with higher concentrations of White students (P < 0.001), higher graduation rates (P = 0.024), higher percentages of students on government-assisted insurance (P = 0.035), and higher standardized scores (P < 0.001) had higher rates of follow-up. There were no statistically significant relationships between the rate of follow-up eye care and the number of school nurses per school district or the number of ophthalmologists or optometrists per county.

CONCLUSIONS: Arkansas children in our study cohort that failed vision screenings had inadequate follow-up eye care. Follow-up rates were associated with several key indicators of socioeconomic status.

PMID:37150435 | DOI:10.1016/j.jaapos.2023.02.005

J Minim Invasive Gynecol. 2023 May 5:S1553-4650(23)00170-X. doi: 10.1016/j.jmig.2023.05.001. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the efficacy and safety of mechanical bowel preparation before benign laparoscopic or vaginal gynecologic surgeries.

DATA SOURCES: Database searches of MEDLINE (PubMed), EMBASE (OVID), Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Sciences as well as citations and reference lists published up to December 2021.

METHODS OF STUDY SELECTION: Randomized clinical trials in any language comparing mechanical bowel preparation with no preparation were included. Two reviewers independently screened 925 records and extracted data from 12 selected articles and assessed the risk of bias with the Rob2 tool. A random-effects model was used for the analysis. Surgeon findings (surgical field view, quality of bowel handling and bowel preparation), operative outcomes (blood loss, operative time, length of stay, surgical site infection) and patient’s pre-operative symptoms and satisfaction were collected.

TABULATION, INTEGRATION AND RESULTS: Thirteen studies (1715 patients) assessing oral and rectal preparations before laparoscopic and vaginal gynecologic surgeries were included. No significant differences were observed with or without mechanical bowel preparation on surgical field view (primary outcome, risk ratio (RR) = 1.01, 95%CI 0.97 to 1.05, p=0.66, I²=0%); bowel handling (RR = 1.01, 95%CI 0.95 to 1.08, p=0.78, I²=67%) or bowel preparation. In addition, there were no statistically significant differences in peri-operative findings. Mechanical bowel preparation was associated with increased pain (mean difference (MD) 11.62[2.80 to 20.44], I²=76, p=0.01); weakness (MD 10.73[0.60 to 20.87], I²=94, p=0.04); hunger (MD 17.52[8.04 to 27.00], I²=83, p=0.0003); insomnia (MD 10.13[0.57 to 19.68], I²=82, p=0.04); and lower satisfaction (RR = 0.68 95%CI 0.53 to 0.87, I²=76%, p=0.002), compared with controls.

CONCLUSIONS: Mechanical bowel preparation has not been associated with improved surgical field view, bowel handling or operative outcome. However, in view of the adverse effects induced, its routine use prior to benign gynecological surgeries should be abandoned. PROSPERO Registration: CRD42022296724.

PMID:37150431 | DOI:10.1016/j.jmig.2023.05.001

Arch Phys Med Rehabil. 2023 May 5:S0003-9993(23)00284-8. doi: 10.1016/j.apmr.2023.04.016. Online ahead of print.

ABSTRACT

OBJECTIVE: This study describes the creation and examination of the internal consistency, content validity, construct-structural validity, and criterion-concurrent validity of the Select Medical Patient Reported Experience Measure (SM-PREM ©).

DESIGN: Observational study design.

SETTING: 1,054 outpatient physical and occupational therapy locations in North America.

PARTICIPANTS: The study included 89,205 patients with various musculoskeletal disorders.

INTERVENTION: Not applicable.

MAIN OUTCOME MEASURES: Content validity was described, and internal consistency, construct-structural validity (factor analysis), and criterion-concurrent validity were analyzed, with concurrent validity compared against patient reported outcomes (PROM), the Net Promoter Scale (NPS), and the Orebro Musculoskeletal Screening Questionnaire-12 (OMSQ-12).

RESULTS: Exploratory and confirmatory factor analysis of the SM-PREM yielded three dimensions, each with a very strong internal consistency (>.850). The SM-PREM yielded statistically significant results in all areas, with values that reflected minimal to fair association with PROMs.

CONCLUSION: The SM-PREM appears to capture a unique construct compared to PROMs. The 11-item tool has three definitive dimensions and exhibits strong internal consistency. The tool may be useful in examining patient experience in patients with musculoskeletal injuries seen by physical and occupational therapists.

PMID:37150428 | DOI:10.1016/j.apmr.2023.04.016

J Ethnopharmacol. 2023 May 5:116609. doi: 10.1016/j.jep.2023.116609. Online ahead of print.

ABSTRACT

ETHNOPHARMACOLOGICAL RELEVANCE: The traditional Chinese medicine formula Danggui-Shaoyao-San (DSS) has been reported to have estrogen-like effects and therapeutic effects on the symptoms of Alzheimer’s disease (AD).

AIM OF THE STUDY: To explore whether the central oxytocin and neuroendocrine system is involved in the modulating effects of DSS on the cognition and neuropsychiatric hebaviors in female AD rats, and to investigate the pharmacokinetics of paeoniflorin and ferulic acid in female AD rats with DSS treatment.

MATERIAL AND METHODS: DSS (1.2, 3.2, 8.6g/kg/day) was orally administered to ovariectomized (OVX) rats, and saline was orally administered to sham operation rats as control group. The Morris water maze test, novel object recognition test, and passive avoidance test were conducted for evaluation of learning and memory abilities, while elevated plus maze test and forced swim test were performed to assess anxiety- and depressive-like behaviors. ELISA kits were used to detect the levels of estrogen (E), estrogen receptor α (ERα), oxytocin (OT), oxytocin receptor (OTR), acetylcholine (Ach), acetylcholin esterase (AchE), and choline acetyl transferase (ChAT) in the cortex. The concentrations of Ach, glutamate (Glu), γ-aminobutyric acid (GABA), 5-hydroxytryptamine (5-HT), norepinephrine (NE) and dopamine (DA) in the hippocampus were assessed by HPLC-MS. The changes of neuronal morphology in the hippocampus were observed by Nissl staining. The pharmacokinetics of paeoniflorin and ferulic acid in OVX rats with DSS treatment were studied by HPLC.

RESULTS: In the Morris water maze test, novel object recognition test, and passive avoidance test, OVX rats showed cognitive impairment. In the elevated plus maze test and forced swim test, the anxiety- and depressive-like behaviors of OVX rats were significant as compared to the control group. Treatment of DSS significantly imporved the cognitive deficits, and ameliorated anxiety- and depressive-like behaviors of OVX rats. The expression of E, ERα, OT, OTR, AchE and ChAT in the cortex of model group were significantly decreased, and DSS significantly reversed these changes. The concentrations of Ach, Glu, GABA, 5-HT and NE in the hippocampus of OVX rats were significantly decreased, whereas DSS significantly increased the levels of Ach, Glu, GABA, 5-HT and NE. There was no significant difference in the concentration of DA in the hippocampus among groups. Degenerating neurons in the hippocampal CA3 region were observed in OVX rats, and the number of neurons was decreased. DSS treatment reduced the degenerating neurons, and incresed the number of neurons. The MRT (0 – ∞), AUC (0 – ∞), Cmax and t1/2z values of paeoniflorin, and the AUC _0-∞ and C_max value of ferulic acid were higher in DSS-treated OVX rats than those in the DSS-treated control rats.

CONCLUSIONS: DSS improves the learning and memory ability, and attenuates anxiety- and depressive-like behaviors of OVX rats. The mechanism may be through increasing estrogen, reducing cholinergic damage, and modulating neurotransmitters. The increase in absorption and elimination time of paeoniflorin and ferulic acid in OVX rats may enhance the efficacy of DSS.

PMID:37150422 | DOI:10.1016/j.jep.2023.116609

Gastrointest Endosc. 2023 May 5:S0016-5107(23)02505-1. doi: 10.1016/j.gie.2023.04.2091. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Endoscopic ultrasound (EUS)-guided interventions currently serve as first-line treatment for symptomatic pancreatic fluid collections (PFCs) but require high-level expertise and multidisciplinary care. Hospital caseload has not been fully examined in relation to clinical outcomes of patients with endoscopically managed PFCs.

METHODS: Using the Diagnosis Procedure Combination database, a Japanese nationwide inpatient database, we identified 4,053 patients receiving EUS-guided treatment of PFCs at 486 hospitals in 2010-2020 and examined an association of hospital volume (average annual number of cases at a hospital) with in-hospital mortality. Associations with bleeding, length of stay, and total costs were examined as secondary analyses. Multivariable logistic regression analysis was conducted with adjustment for potential confounders.

RESULTS: The hospital volume was inversely associated with the risk of in-hospital mortality (P_trend < .001). The adjusted odds ratio for in-hospital mortality comparing the extreme quintiles of hospital volume was 0.17 (95% confidence interval, 0.09-0.33). A restricted cubic spline analysis yielded no statistically significant evidence on the nonlinear relationship (P_nonlinearity = .19). The types of stents (plastic vs. lumen-apposing metal stent) appeared to have no effect modification on the volume-mortality relationship (P_interaction = .58). Higher hospital volume was also associated with lower risk of bleeding, shorter length of stay, and lower medical costs of inpatient care.

CONCLUSIONS: Higher hospital volume was associated with a lower risk of in-hospital mortality of patients receiving EUS-guided treatment of PFCs. A further investigation is warranted to justify the volume-based selective referral of the patients.

PMID:37150410 | DOI:10.1016/j.gie.2023.04.2091

J Control Release. 2023 May 5:S0168-3659(23)00310-3. doi: 10.1016/j.jconrel.2023.05.004. Online ahead of print.

ABSTRACT

The local fluid dynamics experienced by circulating microbubbles vary across different anatomical sites, which can influence ultrasound-mediated therapeutic delivery efficacy. This study aimed to elucidate the effect of fluid flow rate in combination with repeated short-pulse ultrasound on microbubble-mediated endothelial cell permeabilization. Here, a seeded monolayer of human umbilical (HUVEC) or brain endothelial cells (HBEC-5i) was co-perfused with a solution of microbubbles and propidium iodide (PI) at either a flow rate of 5 or 30 ml/min. Using an acoustically coupled inverted microscope, cells were exposed to 1 MHz ultrasound with 20-cycle bursts, 1 ms PRI, and 2 s duration at a peak negative pressure of 305 kPa to assess the role of flow rate on ultrasound-stimulated endothelial cell permeability, as well as Ca²⁺ modulation. In addition, the effect of inter-pulse delays (∆t = 1s) on the resulting endothelial permeability was investigated. Our results demonstrate that under an identical acoustic stimulus, fast-flowing microbubbles resulted in a statistically significant increase in cell membrane permeability, at least by 2.3-fold, for both endothelial cells. Likewise, there was a substantial difference in intracellular Ca²⁺ levels between the two examined flow rates. In addition, multiple short pulses rather than a single pulse ultrasound, with an equal number of bursts, significantly elevated endothelial cell permeabilization, at least by 1.4-fold, in response to ultrasound-stimulated microbubbles. This study provides insights into the design of optimal, application-dependent pulsing schemes to improve the effectiveness of ultrasound-mediated local therapeutic delivery.

PMID:37150403 | DOI:10.1016/j.jconrel.2023.05.004

Resuscitation. 2023 May 5:109821. doi: 10.1016/j.resuscitation.2023.109821. Online ahead of print.

ABSTRACT

BACKGROUND: Early Warning Scores (EWS) monitor inpatient deterioration predominantly using vital signs. We evaluated inpatient outcomes after implementing an Artificial Intelligence (AI) based intervention in our local EWS.

METHODS: A prior study calculated a Deterioration Index (DI) with logistic regression utilising demographics, vital signs, and laboratory results at multiple time points to predict any major adverse event (MAE-all cause mortality, ICU admission, or medical emergency team activation). The current study is a single hospital, pre-post study in Australia comparing the DI plus the existing EWS (Between the Flags-BTF) to only BTF. Data were collected on all eligible inpatients (≥ 16 years, admitted ≥ 24 hours, in general non-palliative wards). Controls were inpatients in the same hospital between January and December 2019. The DI was integrated into the electronic medical record and alerts were sent to senior ward nurse phones (July 2020 -April 2021).

RESULTS: We enrolled 28,639 patients (median age 73 years, IQR:60-83) with 52.3% female. The intervention and control groups did not show any statistically significant differences apart from reduced admissions via the emergency department in the intervention group (40.4% vs 41.6%, P=0.03). Risk for an MAE was lower in intervention than control (RR: 0.81; 95%CI: 0.74-0.89). Length of hospital stay was significantly reduced in the intervention group (3.74 days, IQR 1.84-7.26) compared to the control group (3.86 days, IQR 1.86-7.86, P=0.002) CONCLUSIONS: Implementing the DI in one hospital in Australia was associated with some improved patient outcomes. Future RCTs are needed for further validation.

PMID:37150397 | DOI:10.1016/j.resuscitation.2023.109821

Resuscitation. 2023 May 5:109822. doi: 10.1016/j.resuscitation.2023.109822. Online ahead of print.

ABSTRACT

AIM: The aim of this study was to explore associations between comorbidities and health-related quality of life (HRQoL) among in-hospital cardiac arrest (IHCA) survivors.

METHODS: This registry study is based on data from the Swedish Registry of Cardiopulmonary Resuscitation (SRCR) collected during 2014-2017. HRQoL was assessed using the EQ-5D-5L, the EQ Visual Analogue Scale (EQ VAS) and the Hospital Anxiety and Depression Scale (HADS). In total, 1,278 IHCA survivors were included in the study, 3-6 months after the cardiac arrest (CA). Data were analyzed with descriptive and inferential statistics. The comorbidities analysed in this study were the patients’ status for diabetes, previous myocardial infarction, previous stroke, respiratory insufficiency, and heart failure.

RESULTS: Overall, the IHCA survivors reported high levels of HRQoL, but there was great variation within the population, e.g., EQ VAS median (q1-q3)=70 (50-80). Survivors with one or more comorbidities reported worse HRQoL in 6 out of 8 outcomes (p<0.001). All studied comorbidities were each associated with worse HRQoL, but no comorbidity was associated with every outcome measure. Previous stroke and respiratory insufficiency were significantly associated with every outcome measure except for HADS Anxiety. The linear regression models explained 4-8 % of the total variance in HRQoL (p<0.001).

CONCLUSION: Since IHCA survivors with comorbidities report worse HRQoL compared to those without comorbidities, it is important to pay directed attention to them when developing and providing post-CA care, especially in those with respiratory insufficiency and previous stroke.

PMID:37150395 | DOI:10.1016/j.resuscitation.2023.109822

Resuscitation. 2023 May 5:109818. doi: 10.1016/j.resuscitation.2023.109818. Online ahead of print.

ABSTRACT

Context Deciding on “termination of resuscitation” (TOR) is a dilemma for any physician facing cardiac arrest. Due to the lack of evidence-based criteria and scarcity of the existing guidelines, crucial arbitration to interrupt resuscitation remains at the practitioner’s discretion.

AIM: Evaluate with a quantitative method the existence of a physician internal bias to terminate resuscitation.

METHOD: We extracted data concerning OHCAs managed between January 2013 and September 2021 from the RéAC registry. We conducted a statistical analysis using generalized linear mixed models to model the binary TOR decision. Utstein data were used as fixed effect terms and a random effect term to model physicians personal bias towards TOR.

RESULTS: 5,144 OHCAs involving 173 physicians were included. The cohort’s average age was 69 (SD 18) and was composed of 62% of women. Median no-flow and low-flow times were respectively 6 (IQR [0,12]) and 18 (IQR [10,26]) minutes. Our analysis showed a significant (p<0.001) physician effect on TOR decision. Odds ratio for the “doctor effect” was 2.48 [2.13-2.94] for a doctor one SD above the mean, lower than that of dependency for activities of daily living (41.18 [24.69-65.50]), an age of more than 85 years (38.60 [28.67-51.08]), but higher than that of oncologic, cardiovascular, respiratory disease or no-flow duration between 10 to 20 minutes (1.60 [1.26-2.00]).

CONCLUSIONS: We demonstrate the existence of individual physician biases in their decision about TOR. The impact of this bias is greater than that of a no-flow duration lasting ten to twenty minutes. Our results plead in favor developing tools and guidelines to guide physicians in their decision.

PMID:37150394 | DOI:10.1016/j.resuscitation.2023.109818

Int J Biol Macromol. 2023 May 5:124721. doi: 10.1016/j.ijbiomac.2023.124721. Online ahead of print.

ABSTRACT

This study presented for the first time the PHA-lipid interactions by circular dichroism (CD) spectroscopy, besides a sustainable PHA production strategy using a cost-effective microbial isolate. About 48 bacterial isolates were selected from multifarious Egyptian sites and screened for PHAs production. The Fe(AZU-A6) was the most potent isolate, and identified genetically as Priestia filamentosa AZU-A6, while the intracellular PHA granules were visualized by TEM. Sugarcane molasses (SCM) was used an inexpensive carbon source and the production conditions were optimized through a Factor-By-Factor strategy and a Plackett-Burman statistical model. The highest production (6.84 g L^-1) was achieved at 8.0 % SCM, pH 8.0, 35 °C, 250 rpm, and 0.5 g L^-1 ammonium chloride after 72 h. The complementary physicochemical techniques (e.g., FTIR, NMR, GC-MS, DSC, and TGA) have ascertained the structural identity as poly-3-hydroxybutyrate (P3HB) with a characteristic melting temperature of 174.5 °C. The circular dichroism analysis investigated the existence of interactions between the PHB and the different lipids, particularly 1,2-dimyristoyl-sn-glycero-3-phosphocholine. The ATR technique for the lipid-PHB films suggested that both the hydrophobic and electrostatic forces control the lipid-PHB interactions that might induce changes in the structuration of PHB.

PMID:37150380 | DOI:10.1016/j.ijbiomac.2023.124721