Tag: nevin manimala

J Laparoendosc Adv Surg Tech A. 2023 Apr 4. doi: 10.1089/lap.2022.0528. Online ahead of print.

ABSTRACT

Purpose: Dissecting and ligating the splenic artery is crucial for bleeding control during laparoscopic splenectomy (LS). However, for patients with portal hypertension from liver cirrhosis, it is difficult for identification and ligation because the splenic vessel is circuitous and dilated. The aim of this study was to describe a simple technique of constructing a tunnel behind the tail of the pancreas for occluding the splenic vessels during LS in patients with portal hypertension. Materials and Methods: The clinical data of 61 patients who underwent LS from April 2016 to January 2017 were retrospectively analyzed. In 27 patients, the tunnel construction (TC) behind the tail of the pancreas approach was performed owning to difficulty in dissecting and ligating the splenic artery (TC group), including 17 patients who received the TC method directly and 10 patients who received the TC method after trying to dissect the splenic artery. The remaining 34 patients underwent traditional ligating of the splenic artery (LA group). The peri- and postoperative outcomes of operative time, blood loss, conversion rate, postoperative oral diet intake, postoperative hospital stay, and postoperative complication rate of the two groups were analyzed. All the operations were completed by the same group of surgeons. Results: All 61 operations were successfully completed. Compared with patients in the LA group, patients in the TC group had less blood loss (120.37 ± 40.74 mL versus 162.65 ± 87.47 mL; t = -2.317, P = .024). There was no statistical difference of operative time, conversion rate, complication rate, postoperative hospital stays, and follow-up between the two groups. Conclusions: The technique of constructing a tunnel behind the tail of the pancreas for occluding the splenic vessels was effective and safe in those patients whose splenic artery was difficult to dissect and ligate.

PMID:37015064 | DOI:10.1089/lap.2022.0528

Dermatitis. 2023 Apr 4. doi: 10.1089/derm.2022.0040. Online ahead of print.

ABSTRACT

Background: Real-life data on severity and treatments in children with atopic dermatitis (AD) are needed to evaluate self-management. Objectives: To determine severity and use of topical treatments in children with AD in the general population. Furthermore, we aim to determine agreement and correlation between objective and subjective AD severity measures. Methods: Data were used from the Rotterdam Eczema Study, an observational prospective cohort study with an embedded pragmatic open-label randomized controlled trial. Descriptive statistics were used for baseline characteristics, medication use, and severity. Strength of agreement and correlation were determined using kappa analysis and Pearson correlation. Results: In total, 367 children (mean age 5.7 years) were recruited. The mean eczema area and severity index (EASI) score was 2.1 (±3.2) and mean patient-oriented eczema measure (POEM) score was 10.3 (±6.1). The majority applied emollients on a daily basis (54.9%) and had not used topical corticosteroids (TCSs) over the past week (51%). Based on severity banding of POEM and EASI, 49.9% and 24.9% of the children were undertreated, respectively. No evidence was found for an agreement between EASI and POEM (kappa 0.028, n = 178, P = 0.451). A moderate correlation between POEM, EASI, infants’ dermatitis quality of life index, and children’s dermatology life quality index was found. POEM showed higher correlation with quality of life (QoL) than EASI. Conclusion: Emollients were used sufficiently in the study population. Based on signs or symptoms, 24.9% and 49.9% of children are undertreated, respectively. POEM scores correlated better with QoL than with EASI scores. We argue that EASI underestimates severity of AD, and treatment based on EASI scores may lead to undertreatment of AD. Treating physicians should be aware of suboptimal use of TCSs.

PMID:37015063 | DOI:10.1089/derm.2022.0040

Anesthesiology. 2023 Apr 4. doi: 10.1097/ALN.0000000000004567. Online ahead of print.

ABSTRACT

BACKGROUND: Balancing between opioid analgesia and respiratory depression continues to challenge clinicians in perioperative, emergency department and other acute care settings. Morphine and hydromorphone are postoperative analgesic standards. Nevertheless, their comparative effects and side effects, timing, and respective variabilities, remain poorly understood. We tested the hypothesis that intravenous morphine and hydromorphone differ in onset, magnitude, duration and variability of analgesic and ventilatory effects.

METHODS: We conducted a randomized crossover study in healthy volunteers. Forty-two subjects received a 2-hour intravenous infusion of hydromorphone (0.05 mg/kg) or morphine (0.2 mg/kg) 1-2 weeks apart. We measured arterial opioid concentrations, analgesia in response to heat pain (maximally tolerated temperature, and verbal analog pain scores at discreet preset temperatures to determine half-maximum temperature effect), dark-adapted pupil diameter and miosis, end-expired CO2, and respiratory rate for 12 h after dosing.

RESULTS: For morphine and hydromorphone, respectively: maximum miosis was less (3.9 [3.4,4.2] vs 4.6 mm [4.0,5.0], P<0.001; median and 25%-75% quantiles) and occurred later (3.1 ± 0.9 vs 2.3 ± 0.7 h after infusion start, P<0.001; mean ± SD); maximum tolerated temperature was less (49 ± 2 vs 50 ± 2°C, P<0.001); verbal pain scores at end-infusion at the most informative stimulus (48.2°C) were 82 ± 4 and 59 ± 3 (P<0.001); maximum end-expired CO2 was 47 [45,50] and 48 mmHg [46,51] (P=0.007), and occurred later (5.5 ± 2.8 vs 3.0 ± 1.5 h after infusion start, P<0.001); respiratory nadir was 9 ± 1 and 11 ± 2 breaths/min (P<0.001) and occurred at similar times. Area under the temperature tolerance-time curve was less for morphine (1.8 [0.0,4.4]) than hydromorphone (5.4°C-h [1.6,12.1] P<0.001). Inter-individual variability in clinical effects did not differ between opioids.

CONCLUSIONS: For morphine compared to hydromorphone, analgesia and analgesia relative to respiratory depression were less, onset of miosis and respiratory depression was later, and duration of respiratory depression was longer. For each opioid, timing of the various clinical effects was not coincident. Results may enable more rational opioid selection, and suggest hydromorphone may have a better clinical profile.

PMID:37014986 | DOI:10.1097/ALN.0000000000004567

Anesth Analg. 2023 Apr 3. doi: 10.1213/ANE.0000000000006422. Online ahead of print.

ABSTRACT

BACKGROUND: Preoperative abnormal cognitive status is a risk factor for postoperative complications yet remains underdiagnosed. During propofol general anesthesia, intraoperative electroencephalography (EEG) variables, such as alpha band power (α-BP), correlate with cognitive status. This relationship under sevoflurane is unclear. We investigated whether EEG biomarkers of poor cognitive status found under propofol could be extended to sevoflurane.

METHODS: In this monocentric prospective observational study, 106 patients with intraoperative EEG monitoring were included (propofol/sevoflurane = 55/51). We administered the Montreal Cognitive Assessment (MoCA) scale to identify abnormal cognition (low MoCA) 1 day before intervention. EEG variables included delta to beta frequency band powers. Results were adjusted to age and drug dosage. We assessed depth of anesthesia (DoA) using the spectral edge frequency (SEF95) and maintained it within (8-13) Hz.

RESULTS: The difference in α-BP between low and normal MoCA patients was significantly larger among propofol patients (propofol: 4.3 ± 4.8 dB versus sevoflurane: 1.5 ± 3.4 dB, P = .022). SEF95 and age were not statistically different between sevoflurane and propofol groups. After adjusting to age and dose, low α-BP was significantly associated with low MoCA under propofol (odds ratio [OR] [confidence interval {CI}] = 0.39 [0.16-0.94], P = .034), but not under sevoflurane, where theta-band power was significantly associated with low MoCA (OR [CI] = 0.31 [0.13-0.73], P = .007).

CONCLUSIONS: We suggest that intraoperative EEG biomarkers of abnormal cognition differ between propofol and sevoflurane under general anesthesia.

PMID:37014984 | DOI:10.1213/ANE.0000000000006422

Anesthesiology. 2023 Apr 4. doi: 10.1097/ALN.0000000000004570. Online ahead of print.

ABSTRACT

BACKGROUND: COVID-19 forced healthcare systems to make unprecedented changes in clinical care processes. We hypothesized that the COVID-19 pandemic adversely impacted timely access to care, perioperative processes, and clinical outcomes for pediatric patients undergoing primary appendectomy.

METHODS: We conducted a retrospective, international, multicenter study using matched cohorts within participating centers of the international PEdiatric Anesthesia COVID-19 Collaborative (PEACOC). Patients < 18 years old were matched using age, ASA-PS status, and sex. The primary outcome was the difference in hospital length of stay of patients undergoing primary appendectomy during a 2-month period early in the COVID-19 pandemic (April-May 2020) compared to pre-pandemic (April-May 2019). Secondary outcomes included time to appendectomy and the incidence of complicated appendicitis.

RESULTS: 3351 cases from 28 institutions were available with 1684 cases in the pre-pandemic cohort matched to 1618 in the pandemic cohort. Hospital length of stay was statistically significantly different between the two groups: 29 hours (IQR: 18, 67) in the pandemic cohort versus 28 hours (IQR: 18, 79) in the pre-pandemic cohort (adjusted coefficient, 1; 95% CI 0.39 to 1.61, P<0.001), but this difference was small. Eight centers demonstrated a statistically significantly longer hospital length of stay in the pandemic period compared to the pre-pandemic period, while 13 were shorter and 7 did not observe a statistically significant difference. During the pandemic period, there was a greater occurrence of complicated appendicitis, pre-pandemic 313 (18.6%) versus pandemic 389 (24.1%), absolute difference of 5.5% (adjusted OR, 1.32; [95% CI 1.1 to 1.59]; P=0.003). Preoperative SARS CoV-2 testing was associated with significantly longer time-to-appendectomy, 720 minutes (IQR: 430, 1112) with testing versus 414 minutes (IQR: 231, 770) without testing, adjusted coefficient, 306 minutes, (95% CI 241 to 371, P <0.001), and longer hospital length of stay, 31 hours (IQR: 20, 83) with testing versus 24 hours (IQR: 14, 68) without testing, adjusted coefficient, 7.0, (95% CI 2.7 to 11.3, P=0.002).

DISCUSSION: For children undergoing appendectomy, the COVID-19 pandemic did not significantly impact hospital length of stay.

PMID:37014980 | DOI:10.1097/ALN.0000000000004570

Arch Pathol Lab Med. 2023 Apr 5. doi: 10.5858/arpa.2022-0338-OA. Online ahead of print.

ABSTRACT

CONTEXT.—: End-stage kidney disease (ESKD) is defined as renal impairment requiring renal replacement therapy to sustain life. With a 1-year mortality of ∼20% to 30%, many die of complications related to this disease.

OBJECTIVE.—: To determine the percentage of autopsy cases of decedents with ESKD in which the contribution of ESKD to death is accurately reflected in the final report.

DESIGN.—: Autopsy case records were retrospectively reviewed at 4 institutions (Yale New Haven Hospital, University of Chicago Medical Center, University of Illinois at Chicago Hospital, University of Iowa Hospital). Clinical, macroscopic, and microscopic autopsy findings were reviewed, with attention to renal disease findings.

RESULTS.—: One hundred sixty decedents with documented ESKD and premortem dialysis were identified who underwent autopsy assessment. ESKD was implicated as a cause of death (CoD) or significant contributing factor in 44 cases (28%), but not in the remaining 116 cases (72%). Cardiovascular disease was the most common CoD in ESKD. There was significant interpathologist variation in the inclusion of ESKD as a CoD across institutions. These rates ranged from 85% correlation (23 of 27 cases), to 13% (4 of 31 and 8 of 62 cases at 2 institutions), and 22.5% (9 of 40 cases) across the 4 participating institutions.

CONCLUSIONS.—: The recognition at autopsy of ESKD as a CoD or contributing CoD at autopsy in patients undergoing dialysis remains low (28%). The detrimental impact of ESKD is not reflected in hospital autopsy reports, which carries implications for collection of vital statistics and allocation of research funding for kidney diseases.

PMID:37014976 | DOI:10.5858/arpa.2022-0338-OA

J Cardiopulm Rehabil Prev. 2023 Apr 5. doi: 10.1097/HCR.0000000000000789. Online ahead of print.

ABSTRACT

PURPOSE: Exercise performance and quality of life (QoL) of left ventricular assist device (LVAD) patients improve after early cardiac rehabilitation (CR). The purpose of this study was to examine the efficacy of multiprofessional long term phase 3 outpatient CR, and whether cardiopulmonary exercise testing (CPX) and 6-min walk testing (6MWT) post-LVAD implantation predict hospital readmission.

METHODS: This retrospective observational cohort study included 29 LVAD patients (58.6 ± 7.7 yr, female: 13.8%, body mass index: 29.4 ± 3.3 kg/m2). Functional performance tests (CPX, 6MWT, sit-to-stand test), QoL, and psychological surveys (Kansas City Cardiomyopathy Questionnaire, hospital anxiety and depression scale, and Control Convictions about Disease and Health [KKG]) were performed at baseline and at the end of CR.

RESULTS: The CR was initiated at a median (IQR) of 159 (130-260) d after LVAD implantation for a duration of 340 (180-363) d with 46.8 ± 23.2 trainings. The 6MWT (408.4 ± 113.3 vs 455.4 ± 115.5 m, P = .003) and sit-to-stand test (16.7 ± 6.9 vs 19.0 ± 5.3 repetitions, P = .033) improved, but relative peak oxygen uptake (V˙o2peak: 9.4 [8.2-14.4] vs 9.3 [7.8-13.4] mL/min/kg, P = .57) did not change. Using receiver operating characteristic curve analysis, baseline V˙o2peak values were associated with readmission 1-yr after CR onset (C-statistic = 0.88) with a cutoff value of V˙o2peak < 9.15 mL/min/kg (100% sensitivity, 78% specificity, P < .001). The Kansas City Cardiomyopathy Questionnaire self-efficacy and knowledge (+6.3 points), QoL (+5.0 points), and social limitation (+7.1 points) demonstrated clinically important changes. In addition, the hospital anxiety and depression scale showed a significant reduction in anxiety (4.6 ± 3.2 vs 2.6 ± 2.4, P = .03).

CONCLUSIONS: Long-term CR is safe and LVAD outpatients showed improvement of QoL, anxiety, and submaximal exercise performance. In addition, V˙o2peak and 6MWT have prognostic value for readmission.

PMID:37014949 | DOI:10.1097/HCR.0000000000000789

J Am Chem Soc. 2023 Apr 4. doi: 10.1021/jacs.3c01726. Online ahead of print.

ABSTRACT

While the oxidative addition of Ni(I) to aryl iodides has been commonly proposed in catalytic methods, an in-depth mechanistic understanding of this fundamental process is still lacking. Herein, we describe a detailed mechanistic study of the oxidative addition process using electroanalytical and statistical modeling techniques. Electroanalytical techniques allowed rapid measurement of the oxidative addition rates for a diverse set of aryl iodide substrates and four classes of catalytically relevant complexes (Ni(^MeBPy), Ni(^MePhen), Ni(Terpy), and Ni(BPP)). With >200 experimental rate measurements, we were able to identify essential electronic and steric factors impacting the rate of oxidative addition through multivariate linear regression models. This has led to a classification of oxidative addition mechanisms, either through a three-center concerted or halogen-atom abstraction pathway based on the ligand type. A global heat map of predicted oxidative addition rates was created and shown applicable to a better understanding of the reaction outcome in a case study of a Ni-catalyzed coupling reaction.

PMID:37014945 | DOI:10.1021/jacs.3c01726

JBRA Assist Reprod. 2023 Apr 4. doi: 10.5935/1518-0557.20220046. Online ahead of print.

ABSTRACT

OBJECTIVE: The use of donor oocytes in assisted reproduction has seen a significant rise worldwide in the last two decades. Postponement of motherhood and premature ovarian insufficiency are the main reasons for the increase in the number of in vitro fertilization cycles with donor oocytes. The present study aims to characterize donor oocyte cycles to analyze factors that may have an effect on live births and clinical pregnancy outcomes.

METHODS: Data were obtained from a single Assisted Reproduction Center in southern Brazil. Recipient demographics (n=148 patients) and cycle characteristics (n=213 cycles; 50 patients did more than one IVF attempt) were analyzed. Statistical analysis was performed using chi-squared and t-test as appropriate.

RESULTS: On average, recipients that reached gestation were significantly younger than the ones that did not. We also observed a significant positive effect of constant dose estrogen therapy on pregnancies.

CONCLUSIONS: Patient age and response to estradiol therapy are important factors in the attainment of the best possible outcomes in cycles with donor oocytes.

PMID:37014939 | DOI:10.5935/1518-0557.20220046

Wound Manag Prev. 2023 Mar;69(1):32-48.

ABSTRACT

BACKGROUND: Pain management is important for patient comfort in the treatment of partial-thickness burn wounds. The topical application of ibuprofen provides analgesic and anti-inflammatory effects.

PURPOSE: To evaluate the efficacy of ibuprofen-containing foam dressing in partial-thickness burns.

METHODS: The study included 50 patients with superficial second-degree burn wounds. Ibuprofen-containing foam dressing was used in 25 patients and paraffin gauze dressing in 25 patients as controls. The visual analogue score (VAS) was evaluated 30 min after dressing. On the 90th day following wound healing, the Vancouver scar scale (VSS) was administered to the patients to evaluate healing and scar formation.

RESULTS: The rate of wound healing significantly increased in the study (ibuprofen-containing foam dressing) group compared to control group (8.84±2.97 vs 11.32±4.39, P = 0.010), and the frequency of dressing change significantly decreased in the study group vs control group (1.36±0.49 vs 5.68±2.07, P = 0.000). The oral analgesic needs and VAS scores of the patients were also found to be statistically significantly lower in the study group (5.04 ± 2.44) than for the control group (8.64 ± 1.29, P = 0.000). In the evaluation of the VSS, the total score was lower in the study group, but no statistically significant difference was observed.

CONCLUSION: The use of ibuprofen-containing foam dressing in patients with superficial second-degree burns eligible for outpatient follow-up provides effective pain management and increases patient comfort. It does not have a negative effect on wound healing. We consider that ibuprofen-containing foam dressing can be safely used in partial-thickness burns.

PMID:37014935