Tag: nevin manimala

Ann Thorac Surg. 2023 Jun 2:S0003-4975(23)00575-1. doi: 10.1016/j.athoracsur.2023.04.049. Online ahead of print.

ABSTRACT

BACKGROUND: Postoperative acute kidney injury (AKI) in cardiac surgery patients is multifactorial and associated with low oxygen delivery (DO₂) during cardiopulmonary bypass.

METHODS: Cardiac surgical patients undergoing full cardiopulmonary bypass between 5/1/2016-12/31/2021 were included, while those on preoperative dialysis, underdoing circulatory arrest procedures, or lacking minute-to-minute physiological data were excluded. A 5-minute running average of oxygen delivery (DO₂i, ml/min/m²) was calculated ([pump flow]x[hemoglobin]x1.36[hemoglobin saturation]+0.003[arterial oxygen tension]/body surface area). AKI was defined using established Kidney Disease: Improving Global Outcomes criteria. The threshold of nadir DO₂i on the effect of AKI was estimated using risk-adjusted constrained broken-stick models.

RESULTS: Postoperative AKI occurred among 1,155 (29.4%) patients, with 276 (7.0%) having Stage 2-3 AKI. The median nadir DO₂i was lower for those with (versus without) AKI (197.9 ml/min/m² [166.3-233.2] versus 217.2 [184.5-252.2], p < .001) and Stage 2-3 AKI relative to Stage 1 or none (186.9 ml/min/m² [160.1-220.5] versus 213.8 [180.4-249.4]). In risk-adjusted analyses, the estimated threshold (CI 95%) for nadir DO₂i was 231.2 ml/min/m² (173.6-288.8) for any AKI and 103.3 (68.4-138.3) for Stage 2-3 AKI.

CONCLUSIONS: Decreasing nadir DO₂i was associated with an increased risk of AKI. The identified nadir DO₂i thresholds suggest management and treatment of nadir DO₂i during cardiopulmonary bypass may decrease a patient’s postoperative AKI risk.

PMID:37271444 | DOI:10.1016/j.athoracsur.2023.04.049

Am J Obstet Gynecol. 2023 Jun 2:S0002-9378(23)00369-1. doi: 10.1016/j.ajog.2023.05.031. Online ahead of print.

ABSTRACT

BACKGROUND: In 2020, the American College of Obstetricians and Gynecologists recommended non-invasive prenatal testing be offered to all patients. However, current society guidelines in the United States do not universally recommend a detailed first-trimester ultrasound.

OBJECTIVE: This study aimed to determine the additional findings identified through first-trimester ultrasound that would have otherwise been missed if non-invasive prenatal testing was used alone as a first trimester screening method.

STUDY DESIGN: This was a retrospective cohort study involving 2,158 pregnant patients, 2,216 fetuses that were seen at a single medical center between January 1, 2020 and December 31, 2022. All those included underwent both non-invasive prenatal testing and detailed first-trimester ultrasound between 11.0 – 13.6 weeks gestation. Non-invasive prenatal testing results were categorized as low-risk or high-risk and first-trimester ultrasound results were categorized as normal or abnormal. Abnormal first-trimester ultrasounds were further classified as first trimester screening markers (increased nuchal translucency, absent nasal bone, tricuspid regurgitation, ductus venosus reverse a-wave) or structural defects (cranium, neck, heart, thorax, abdominal wall, stomach, kidneys, bladder, spine, extremities). Descriptive statistics were used to report our findings.

RESULTS: Sixty-five (65/2216, 3%) fetuses had a high-risk non-invasive prenatal testing result, while 2,151 (2151/2216, 97%) fetuses had a low-risk non-invasive prenatal testing result. Of those with a low-risk non-invasive prenatal testing result, 2,035 (2035/2151, 94.6%) had a normal first-trimester ultrasound while 116 (116/2151, 5.4%) had at least 1 abnormal finding on first-trimester ultrasound. The most common screening marker detected within the low-risk non-invasive prenatal testing group was absent nasal bone (52/2151, 2.4%), followed by reversed a-wave of the ductus venosus (30/2151, 1.4%). The most common structural defect in this group was cardiac in nature (15/2151, 0.7%). Overall, 181 fetuses were identified as having “abnormal screening” through either a high-risk non-invasive prenatal testing result (n = 65) or through a low-risk non-invasive prenatal testing result but abnormal first-trimester ultrasound (n = 116). In summary, the incorporation of first-trimester ultrasound screening identified 116 additional fetuses (116/2151, 5.4%) that required further follow-up and surveillance than non-invasive prenatal testing alone would have identified.

CONCLUSION: Detailed first-trimester ultrasound identified more fetuses with a potential abnormality than non-invasive prenatal testing alone. Therefore, first-trimester ultrasound remains a valuable screening method that should be used in combination with non-invasive prenatal testing.

PMID:37271433 | DOI:10.1016/j.ajog.2023.05.031

Sci Total Environ. 2023 Jun 2:164598. doi: 10.1016/j.scitotenv.2023.164598. Online ahead of print.

ABSTRACT

Over the past decade, the Chinese government has implemented the “Clean Air Action” measures to enhance the atmospheric environmental quality, primarily focusing on curbing PM_2.5 and O₃ concentrations. The efficacy of these strategies and the underlying causes (human factors or natural variability) of any observed increases or decreases in PM_2.5 and O₃ concentrations are of great importance. Examining the hourly PM_2.5 and O₃ concentration time series from six representative regions in China between 2015 and 2021 revealed an overall downward trend in PM_2.5 concentrations. However, the O₃ concentration time series indicated upward trends in some regions, except for the Northeast area (NE) and Sichuan Basin (SCB). In the context of conventional significance tests, the assumption is typically that the time series’ samples are independent and therefore memoryless. However, in situations where the time series exhibits strong autocorrelation and limited sample size, this assumption can lead to an overestimation of the statistical significance of the linear trend. To account for this, we utilized a long-term memory model that can reproduce the long-term persistence of pollutant records to improve the accuracy of significance tests. By comparing the P-values of real and surrogate data generated by the long-term memory model, we found that only PM_2.5 concentrations in the Pearl River Delta (PRD) were slightly insignificant. For the remaining five regions, the P-values of PM_2.5 concentrations were smaller than the significant level of 0.05, suggesting that the observed downward trends in PM_2.5 concentrations are not due to natural variability, thereby confirming the effectiveness of the government’s policies aimed at curbing atmospheric particulate matter in recent years. Our results show that O₃ pollution is significantly increasing only in the Beijing-Tianjin-Hebei (BTH) region, beyond natural variability. In contrast, the trends of O₃ pollution in many regions of China are markedly impacted by natural and climate variability.

PMID:37271384 | DOI:10.1016/j.scitotenv.2023.164598

Sci Total Environ. 2023 Jun 2:164628. doi: 10.1016/j.scitotenv.2023.164628. Online ahead of print.

ABSTRACT

OBJECTIVE: To identify the current spatial distribution of iodine concentration in drinking water (dWIC) at the township-level across China and its influencing factors through visualization and spatial statistical analysis by the geographic information system.

METHODS: The dWIC for each township was used to describe the distribution by ArcGIS 10.7. The spatial aggregation characteristics were analyzed by spatial auto-correlation analysis. The inverse distance weight method was used to predict the dWIC at nonsampling sites. The correlation between the dWIC and the distance from each township to the Yellow River as well as the depth of tube wells were analyzed by ordinary least squares and geographically weighted regression, respectively.

RESULTS: A total of 37,541 townships were included in this study. dWIC ranged from 0 to 1113.7 μg/L, and the median was 3.3 μg/L. There were 35,606 townships < 40 μg/L (94.85 % of surveyed townships), 40 μg/L ≤ 1015 townships ≤100 μg/L (2.70 % of surveyed townships), and 920 townships > 100 μg/L (2.45 % of surveyed townships). The results were statistically significant of global autocorrelation analysis (Moran’s I = 0.43, Z = 922.15, P < 0.01). local Moran’s I showed that 3128 townships (8.33 % of surveyed townships) belong to H-H cluster areas. The dWIC were partially negatively correlated with the distance from each township to the Yellow River, as well as positively correlated with the depth of tube wells in partial areas.

CONCLUSIONS: The dWIC varied widely across mainland China (from 0 μg/L to 1113.7 μg/L). 94.85 % of surveyed townships were below 40 μg/L and 2.45 % of surveyed townships were exceeding 100 μg/L. Moreover, the distance from each township to the Yellow River may be one of the geneses of iodine-excess areas. Finally, this study has provided a visible reference of dWIC for the precise control strategy and focused monitoring in China.

PMID:37271383 | DOI:10.1016/j.scitotenv.2023.164628

Spine J. 2023 Jun 2:S1529-9430(23)00230-9. doi: 10.1016/j.spinee.2023.05.015. Online ahead of print.

ABSTRACT

BACKGROUND CONTEXT: Computed tomography-based vertebral attenuation values (CT-based HU) have been shown to correlate with T-scores on DEXA scan; and have been acknowledged as an independent factor for predicting fragility fractures. Most patients undergoing lumbar surgeries require CT as part of their pre-operative evaluation.

PURPOSE: The current study was thus planned to evaluate the role of lumbar CT as an opportunistic investigation in determining BMD pre-operatively in patients undergoing lumbar fusion.

STUDY DESIGN: Prospective cohort study PATIENT SAMPLE: : Patients older than 45 years, who underwent one- to two-level lumbar (L3-S1 levels) fusions OUTCOME MEASURES: : Comparison of the quantitative assessment of osteoporosis using Hounsfield Units on CT (L1-L5) and mean lumbar T-scores on DEXA (Dual Energy Xray Absorptiometry) HYPOTHESIS: : HU on CT is comparable to T-score on DEXA as a suitable modality for the assessment of osteoporosis in patients undergoing 1-2 level lumbar fusion METHODS: : A prospective cohort study was conducted between January and December 2021. Patients older than 45 years, who underwent one- to two-level lumbar (L3-S1 levels) fusions and had complete clinico-radiological records, were prospectively enrolled. A comparison was drawn between the HU [measured by placing an oval region of interest (ROI) over axial, sagittal and coronal images of lumbar vertebrae] on CT and T-scores on DEXA, and analyzed statistically. The HU values correlating best with normal (group A), osteopenia (B) and osteoporosis (C) categories (classified based on T-scores of lumbar spines) were determined statistically.

RESULTS: Overall, 87 patients [mean age of 60.56±11.63 years; 63 (72.4%) female patients] were prospectively studied. There was a statistically significant difference in the mean age (p=0.01) and sex distribution (predominantly female patients; p=0.03) of patients belonging to groups B (osteopenic) and C (osteoporotic patients), as compared with group A. The greatest correlation between T-score (on DEXA) and HU (on CT) for differentiating osteopenia (group B) from group A was observed at levels L1 (p<0.001), L2 (p<0.001) and L3 (p<0.001). Based on receiver-operating characteristic (ROC) curve analysis, the cut-off values for HU for identifying osteopenia were 159 (at L1; sensitivity 81.6 and specificity 80) and 162 (at L2; sensitivity 80 and specificity 71.1). In addition, there was statistically significant correlation between T-score (on DEXA) and HU at all the lumbar levels for distinguishing osteoporosis (group C), although the difference was most evident at the upper lumbar (L1 and L2) levels (p<0.001). Based on ROC analysis, cut-off HU values for defining osteoporosis were 127 (at L1; sensitivity 71.3 and specificity 70) and 117 (at L2; sensitivity 65.5 and specificity 90).

CONCLUSION: Based on our study, the measurement of HU on CT at upper lumbar levels can be considered as “surrogate marker” for BMD in the diagnosis of osteopenia (cut-off: 159 at L1, 162 at L2) and osteoporosis (cut-off: 127 at L1, 117 at L2) in patients undergoing lumbar fusion surgeries. The HU measurements on CT at the lower lumbar levels (L4 and L5) are less reliable in this pre-operative scenario.

PMID:37271374 | DOI:10.1016/j.spinee.2023.05.015

J Am Pharm Assoc (2003). 2023 Jun 2:S1544-3191(23)00167-X. doi: 10.1016/j.japh.2023.05.022. Online ahead of print.

ABSTRACT

BACKGROUND: Pharmacists with specialized knowledge and skills are able to seek board certification from the Board of Pharmacy Specialties (BPS). In 2018, BPS conducted research to evaluate the relationship between eligibility pathways (i.e., completion of a PGY2 specialty residency, completion of a PGY1 residency plus 2 years of practice experience, or 4 years of practice experience) and certification examination pass rate. The study found statistically significant differences in pass rate based on eligibility criteria across all six specialties studied. There was a trend for higher pass rates in cohorts of examinees eligible for board certification based on completion of postgraduate residency training.

OBJECTIVES: To compare examination pass rates among different eligibility cohorts for board certification in recognized pharmacy practice specialties and compare contemporary findings to previously published findings.

METHODS: This cross-sectional study was conducted on data retrieved from BPS certification applications and examination administration records for examinees in the United States and Canada for nine certification programs. A chi-square analysis was utilized to identify if there were differences in pass rate among eligibility pathway cohorts.

RESULTS: Results: 14,894 examinees met inclusion criteria. 6312 (42.4%) of the 14,894 examinees analyzed were eligible via practice experience, 5768 (38.7%) were eligible via PGY1 completion, and 2814 (18.9%) were eligible via PGY2 completion. A statistically significant difference was found for the relationship between pass rate and eligibility pathway for eight of nine BPS certification examinations analyzed (significant: BCACP, BCCCP, BCCP, BCIDP, BCOP, BCPP, BCPPS, BCPS; not significant: BCTXP). Post-hoc analyses showed that in most cases, the PGY2 eligibility cohort outperformed the PGY1 eligibility cohort, which in turn outperformed the practice experience pathway cohort.

CONCLUSION: Analysis of contemporary BPS certification examination administration data yields statistically significant differences among the pass rates by eligibility pathway, replicating previous findings and expanding the scope of the analysis.

PMID:37271347 | DOI:10.1016/j.japh.2023.05.022

J Subst Use Addict Treat. 2023 Jun 2:209082. doi: 10.1016/j.josat.2023.209082. Online ahead of print.

ABSTRACT

BACKGROUND: Given the lack of access to evidenced-based OUD treatment and the corresponding overdose crisis, researchers must evaluate and report health care inequities involving the treatment of OUD. Additionally, clinicians should be aware of these inequities in the treatment of patients.

METHODS: We carried out a scoping review of the literature regarding health inequities in treatment for OUD in July 2022. The study team retrieved articles published between 2016 and 2021 from MEDLINE and Ovid Embase. After authors received training, screening and data extraction were performed in masked, duplicate fashion. The team screened a total of 3673 titles and abstracts, followed by 172 articles for full-text review. The inequities that we examined were race/ethnicity, sex or gender, income, under-resourced/rural, occupational status, education level, and LGBTQ+. We used Stata 17.0 (StataCorp, LLC, College Station, TX) to summarize data and statistics of the studies within our sample.

RESULTS: A total of 44 studies evaluating inequities in OUD treatment met inclusion criteria. The most common inequity that studies examined was race/ethnicity (34/44 [77.27 %] studies), followed by under-resourced/rural (19/44 [43.18 %] studies), and sex or gender (18/44 [40.91 %] studies). LGBTQ+ (0/44 [0.0 %] studies) was not reported in the included studies. Our results indicate that many historically marginalized populations experience inequities related to access and outcomes in OUD treatment. The included studies in our scoping review occasionally demonstrated inconsistent findings.

CONCLUSIONS: Gaps exist within the literature on health inequities in treatment for OUD. The most examined inequities were race/ethnicity, under-resourced/rural and sex or gender, while studies did not examine LGBTQ+ status. Future research should aim to advance and supplement literature investigating health inequities in OUD treatment to ensure inclusive, patient-centered care.

PMID:37271346 | DOI:10.1016/j.josat.2023.209082

J Hosp Infect. 2023 Jun 2:S0195-6701(23)00161-5. doi: 10.1016/j.jhin.2023.05.008. Online ahead of print.

ABSTRACT

BACKGROUND: Studies have shown that nutritional products are discarded via handwashing sinks by healthcare workers, and this practice may promote bacterial growth, including of pathogens such as Carbapenemase-producing Enterobacterales (CPE). Outbreaks and acquisition of CPE in nosocomial settings are associated with negative outcomes for patients and hospitals.

OBJECTIVES: To investigate potential growth-promoting effect of nutritional support drinks (NSDs) and enteral tube-feed products (ETFPs) on CPE.

METHODS: Six different CPE strains were grown in 5 different diluted NSD, 5 different diluted ETFP, Mueller Hinton Broth (MHB) and M9 minimal salts media to simulate discarding of a small volume of nutritional product in a u-bend, already containing liquid. CPE were enumerated at 0h, 6h and 24h, and compared using two-way ANOVA and Dunett test, with confidence levels at 95%. Spearman’s r (rho) was used to measure strength of correlation between concentrations components in nutritional products and CPE growth.

RESULTS: All NSDs and ETFPs promoted CPE growth that exceeded both M9 (negative growth control) and MHB (positive growth control). In several cases, growth in NSDs/ETFPs reached statistical significance compared to growth in MHB.

CONCLUSION: Nutritional products support CPE growth under in-vitro conditions. The propensity of CPE to survive in drain pipework suggests that inappropriate product disposal, may further nourish established CPE in these environmental reservoirs. The growth observed in diluted NSDs and ETFPs signals that modifiable practices should be optimized to mitigate potential CPE transmission risk from these reservoirs.

PMID:37271316 | DOI:10.1016/j.jhin.2023.05.008

Rev Port Cardiol. 2023 Jun 2:S0870-2551(23)00280-9. doi: 10.1016/j.repc.2022.11.008. Online ahead of print.

ABSTRACT

INTRODUCTION AND OBJECTIVES: This study reports the results of an online survey carried out by the Portuguese Society of Cardiology about its medical members’ work characteristics before and during the COVID-19 pandemic, their job satisfaction, work motivation, and burnout.

METHODS: A sample of 157 participants answered a questionnaire with demographic, professional, and health-related information, followed by questionnaires on job satisfaction and motivation designed and validated for this study and a Portuguese version of the Maslach Burnout Inventory. Data were analyzed through descriptive statistics, ANOVA, and MANOVA, considering gender, professional level, and sector of activity, respectively. Multiple regression was used to assess the impact of job satisfaction and motivation on burnout.

RESULTS: The only variable that distinguished participants was sector of activity. Cardiologists working in the private sector worked fewer weekly hours during COVID-19, while those in the public sector worked more. The latter expressed more desire to reduce their working hours than those who worked in private medicine and in both sectors. There were no differences between sectors in work motivation, while job satisfaction was higher in the private sector. Moreover, job satisfaction negatively predicted burnout.

CONCLUSIONS: Our findings point to a deterioration in working conditions during the COVID-19 pandemic, with its consequences being felt especially in the public sector, which may have contributed to the lower levels of satisfaction among cardiologists who worked exclusively in this sector, but also for those working in both public and private sectors.

PMID:37271307 | DOI:10.1016/j.repc.2022.11.008

Respir Med. 2023 Jun 2:107307. doi: 10.1016/j.rmed.2023.107307. Online ahead of print.

ABSTRACT

BACKGROUND: Asthma and inflammatory bowel disease (IBD) are common inflammatory diseases. The aim of this study was to investigate the associations of IBD with asthma and respiratory symptoms.

METHODS: This study is based on 13,499 participants from seven northern European countries that filled in a postal questionnaire on asthma, respiratory symptoms, IBD including ulcerative colitis and Crohn’s disease and various lifestyle variables.

RESULTS: There were 195 participants with IBD. The prevalence of asthma (14.5 vs 8.1%, p = 0.001), different respiratory symptoms (range 11.9-36.8% vs range 6.0-18.6%, p < 0.005), non-infectious rhinitis (52.1 vs. 41.6%, p = 0.004) and chronic rhinosinusitis (11.6 vs 6.0%, p = 0.001) were higher in subjects with IBD than in those without IBD. In multivariable regression analysis, the association between IBD and asthma was statistically significant (OR 1.95 (95% CI 1.28-2.96)) after adjusting for confounders such as sex, BMI, smoking history, educational level and physical activity. There was a significant association between asthma and ulcerative colitis (adjusted OR 2.02 (95% CI 1.27-2.19)), and asthma but not Crohn’s disease (adjusted OR 1.66 (95% CI 0.69-3.95)). A significant gender interaction was found with a significant association between IBD and asthma in women but not in men ((OR 2.72 (95% CI 1.67-4.46) vs OR 0.87 (95% CI 0.35-2.19), p = 0.038).

CONCLUSIONS: Patients with IBD, particularly those with ulcerative colitis and female, have a higher prevalence of asthma and respiratory symptoms. Our findings indicate that it is important to consider respiratory symptoms and disorders when examining patients with manifest or suspected IBD.

PMID:37271300 | DOI:10.1016/j.rmed.2023.107307