Tag: nevin manimala

Neurosurg Rev. 2023 Apr 24;46(1):95. doi: 10.1007/s10143-023-02005-4.

ABSTRACT

The objective of the study is to improve the results of patients undergoing lumbar spine surgery who are at high risk for anesthesia and/or surgical complications. Two independent groups were compared: the study group (SG, n = 40) (standardized neuroanesthetic protocol with multimodal analgesia) and the control group (CG, n = 40) (intravenous anesthesia based on propofol and fentanyl). The data were collected using prospective observation of early and long-term results of lumbar fusion. After 24 months, the level of functional state and quality of life were studied. Patients in the SG did not have statistically significant changes in intraoperative hemodynamics; the best indicators of cognitive functions were noted. The effectiveness of the SG compared with the CG was confirmed by a statistically significantly lower amount of perioperative opioid drugs required (p = 0.01) and a minimal level of incisional pain (p < 0.05). An intergroup comparison of the adverse effects of anesthesia revealed a significantly lower number in the SG (n = 4) compared to the CG (n = 16) (p = 0.004). The number of postoperative surgical complications was comparable (p = 0.72). Intergroup comparison showed improved ODI, SF-36, and the Macnab scale at 24 months after surgery in the SG compared to the CG (p < 0.05). Long-term clinical results correlated with the level of incisional pain in the first three postoperative days. Our standardized neuroanesthetic protocol ensured effective treatment of postoperative incisional pain, significantly decreased the perioperative use of opioids, reduced adverse anesthesia events, and improved long-term clinical results in patients with high risk factors for anesthetic complications who undergoing open lumbar spine surgery.

PMID:37093302 | DOI:10.1007/s10143-023-02005-4

Surg Endosc. 2023 Apr 24. doi: 10.1007/s00464-023-10048-3. Online ahead of print.

ABSTRACT

BACKGROUND: Nonagenarian patients are an age group in progressive growth. In this age group, indications for surgical procedures, including cholecystectomy, will be increasingly frequent, as biliary pathology and its complications are frequent in this population group. The main objective of this study was to analyze the safety and outcomes of laparoscopic cholecystectomy in patients older than 90 years.

METHODS: A retrospective observational cohort study was designed. This study involved 600 patients that were classified in 4 age groups for analysis (under 50 years, 50-69 years, 70-89 years, and over 90 years). Demographic, clinical, paraclinics, surgical, and outcome variables were compared according to age group. A multivariate analysis, which included variables considered clinically relevant, was performed to identify factors associated with mortality and complications classified with the Clavien-Dindo scale.

RESULTS: The patients evaluated had a median age of 65.0 (IQR 34.0) years and there was a female predominance (61.8%). A higher complication rate, conversion rate, subtotal cholecystectomy rate, and prolonged hospital stay were found in nonagenarians. The overall mortality rate was 1.6%. Mortality in the age group over 90 years was 6.8%. Regression models showed that age over 90 years (RR 4.6 CI95% 1.07-20.13), presence of cholecystitis (RR 8.2 CI95% 1.29-51.81), and time from admission to cholecystectomy (RR 1.2 CI95% 1.10-1.40) were the variables that presented statistically significant differences as risk factors for mortality.

CONCLUSION: Cholecystectomy in nonagenarian patients has a higher rate of complications, conversion rate, subtotal cholecystectomy rate, and mortality. Therefore, an adequate perioperative assessment is necessary to optimize comorbidities and improve outcomes. Also, it is important to know the greatest risk for informed consent and choose the surgical equipment and schedule of the procedure.

PMID:37093280 | DOI:10.1007/s00464-023-10048-3

J Enzyme Inhib Med Chem. 2023 Dec;38(1):2202357. doi: 10.1080/14756366.2023.2202357.

ABSTRACT

In this article, emulsomes (EMLs) were fabricated to encapsulate the N-(5-nitrothiazol-2-yl)-carboxamido derivatives (3a–3g) in an attempt to improve their biological availability and antiviral activity. Next, both cytotoxicity and anti-SARS-CoV-2 activities of the examined compounds loaded EMLs (F3a–g) were assessed in Vero E6 cells via MTT assay to calculate the CC₅₀ and inhibitory concentration 50 (IC₅₀) values. The most potent 3e-loaded EMLs (F3e) elicited a selectivity index of 18 with an IC₅₀ value of 0.73 μg/mL. Moreover, F3e was selected for further elucidation of a possible mode of action where the results showed that it exhibited a combination of virucidal (>90%), viral adsorption (>80%), and viral replication (>60%) inhibition. Besides, molecular docking and MD simulations towards the SARS-CoV-2 Mpro were performed. Finally, a structure-activity relationship (SAR) study focussed on studying the influence of altering the size, type, and flexibility of the α-substituent to the carboxamide in addition to compound contraction on SARS-CoV-2 activity.HighlightsEmulsomes (EMLs) were fabricated to encapsulate the N-(5-nitrothiazol-2-yl)-carboxamido derivatives (3a–3g).The most potent 3e-loaded EMLs (F3e) showed an IC₅₀ value of 0.73 μg/mL against SARS-CoV-2.F3e exhibited a combination of virucidal (>90%), viral adsorption (>80%), and viral replication (>60%) inhibition.Molecular docking, molecular dynamics (MD) simulations, and MM-GBSA calculations were performed.Structure-activity relationship (SAR) study was discussed to study the influence of altering the size, type, and flexibility of the α-substituent to the carboxamide on the anti-SARS-CoV-2 activity.

PMID:37092260 | DOI:10.1080/14756366.2023.2202357

Expert Syst Appl. 2023 Sep 1;225:120103. doi: 10.1016/j.eswa.2023.120103. Epub 2023 Apr 17.

ABSTRACT

The sanitary emergency caused by COVID-19 has compromised countries and generated a worldwide health and economic crisis. To provide support to the countries’ responses, numerous lines of research have been developed. The spotlight was put on effectively and rapidly diagnosing and predicting the evolution of the pandemic, one of the most challenging problems of the past months. This work contributes to the existing literature by developing a two-step methodology to analyze the transmission rate, designing models applied to territories with similar pandemic behavior characteristics. Virus transmission is considered as bacterial growth curves to understand the spread of the virus and to make predictions about its future evolution. Hence, an analytical clustering procedure is first applied to create groups of locations where the virus transmission rate behaved similarly in the different outbreaks. A curve decomposition process based on an iterative polynomial process is then applied, obtaining meaningful forecasting features. Information of the territories belonging to the same cluster is merged to build models capable of simultaneously predicting the 14-day incidence in several locations using Evolutionary Artificial Neural Networks. The methodology is applied to Andalusia (Spain), although it is applicable to any region across the world. Individual models trained for a specific territory are carried out for comparison purposes. The results demonstrate that this methodology achieves statistically similar, or even better, performance for most of the locations. In addition to being extremely competitive, the main advantage of the proposal lies in its complexity cost reduction. The total number of parameters to be estimated is reduced up to 93.51% for the short term and 93.31% for the mid-term forecasting, respectively. Moreover, the number of required models is reduced by 73.53% and 58.82% for the short- and mid-term forecasting horizons.

PMID:37090447 | PMC:PMC10108563 | DOI:10.1016/j.eswa.2023.120103

Spat Stat. 2023 Jun;55:100729. doi: 10.1016/j.spasta.2023.100729. Epub 2023 Mar 14.

ABSTRACT

The basic homogeneous SEIR (susceptible-exposed-infected-removed) model is a commonly used compartmental model for analysing infectious diseases such as influenza and COVID-19. However, in the homogeneous SEIR model, it is assumed that the population of study is homogeneous and, one cannot incorporate individual-level information (e.g., location of infected people, distance between susceptible and infected individuals, vaccination status) which may be important in predicting new disease cases. Recently, a geographically-dependent individual-level model (GD-ILM) within an SEIR framework was developed for when both regional and individual-level spatial data are available. In this paper, we propose to use an SEIR GD-ILM for each health region of Manitoba (central Canadian province) population to analyse the COVID-19 data. As different health regions of the population under study may act differently, we assume that each health region has its own corresponding parameters determined by a homogeneous SEIR model (such as contact rate, latent period, infectious period). A Monte Carlo Expectation Conditional Maximization (MCECM) algorithm is used for inference. Using estimated parameters we predict the infection rate at each health region of Manitoba over time to identify highly risk local geographical areas. Performance of the proposed approach is also evaluated through simulation studies.

PMID:37089455 | PMC:PMC10103593 | DOI:10.1016/j.spasta.2023.100729

J Cataract Refract Surg. 2023 May 1;49(5):499-503. doi: 10.1097/j.jcrs.0000000000001138.

ABSTRACT

PURPOSE: To assess whether there are added risks when performing intraocular lens (IOL) exchange in the setting of an open posterior capsule (OPC) when compared with a closed posterior capsule (CPC) IOL exchange.

SETTING: Private practice, Los Angeles, California.

DESIGN: Nonrandomized and unmasked retrospective chart review.

METHODS: Eyes undergoing IOL exchange solely to relieve optical symptoms, with open or intact posterior capsules, were included. Eyes undergoing IOL exchange due to IOL malposition or dislocation were excluded. Eyes with preexisting, uncontrolled glaucoma and inflammation and eyes with a visual potential worse than 20/40 (Snellen) were also excluded. The main outcome measures were the postoperative complications compared between the OPC and CPC groups.

RESULTS: 90 eyes of 75 patients undergoing IOL exchange were included in this study; 38/90 eyes had an OPC, and 52/90 eyes had a CPC. 3/38 in the OPC group and 2/52 in the CPC group experienced worsening intraocular pressure control. 1/38 in the OPC group experienced chronic inflammation. 2/38 in the OPC group and 2/52 in the CPC group experienced cystoid macular edema. 1/52 in the CPC group experienced a retinal tear. Statistically or clinically significant differences in postoperative complications between the OPC and CPC groups were not found.

CONCLUSIONS: In the hands of an experienced surgeon, IOL exchange with an OPC appear red to be just as safe as IOL exchange with a CPC; when deemed necessary, experienced surgeons may perform an IOL exchange safely in the presence of an OPC.

PMID:37088935 | DOI:10.1097/j.jcrs.0000000000001138

Orthop Surg. 2023 Apr 24. doi: 10.1111/os.13727. Online ahead of print.

ABSTRACT

OBJECTIVE: Free flaps are widely used for the repair of soft tissue defects in the lower limbs, but there is still a specific rate of necrosis. Few clinical retrospective studies have analyzed the nontechnical risk factors for lower limb free flap necrosis. This study aimed to analyze the nontechnical causes of flap necrosis in lower limb soft tissue reconstruction in order to identify risk factors and improve the survival rate of free flaps.

METHODS: Clinical data from 244 cases of soft tissue defects of the leg or foot that were repaired with a free flap from January 2011 to June 2020 were retrospectively analyzed. The flap results were divided into complete survival and necrosis groups. The patients’ general information, smoking history, soft tissue defect site, Gustilo-Anderson classification, shock after injury, type and size of the flap, and time from injury to flap coverage were recorded. A logistic regression model was used to analyze the correlations between flap necrosis and possible risk factors.

RESULTS: Of the 244 flaps, 32 suffered from partial or total necrosis, and 212 completely survived. Univariate analysis showed that age, smoking history, soft tissue defect site, and time from injury to flap coverage were significantly correlated with flap necrosis (p ≤ 0.2). Multivariate logistic regression analysis showed that moderate-to-severe smoking history (p < 0.001, odds ratio [OR] = 10.259, 95% confidence interval [CI] = 2.886-36.468), proximal leg defect (p = 0.006, OR = 7.095, 95% CI = 1.731-29.089), and time from injury to flap coverage >7 days (p = 0.003, OR = 12.351, 95% CI = 2.343-65.099) were statistically significant risk factors for flap necrosis (p < 0.05), and age was excluded (p = 0.666; p = 0.924).

CONCLUSION: The risk of flap necrosis was significantly increased when the soft tissue defect was located in the proximal leg, the time from injury to flap coverage was >7 days, and the patient had a moderate-to-severe smoking history. These three risk factors have an increased influence on flap necrosis and have guiding significance in predicting flap prognosis.

PMID:37092532 | DOI:10.1111/os.13727

Orthop Surg. 2023 Apr 24. doi: 10.1111/os.13700. Online ahead of print.

ABSTRACT

OBJECTIVE: Bone cement releases a large amount of heat as it polymerizes. Skin burns caused by discarded bone cement are not well understood during arthroplasty. It is important to study the correlates and mechanisms of scalding and to accurately evaluate the severity of burns to guide treatment decisions.

METHODS: Standardized burns were created in eight anesthetized rabbits using different thicknesses of bone cement. Bone cement was uniformly stirred to make thicknesses of 1 mm, 4 mm, 8 mm, 12 mm, 16 mm, and 20 mm and a 20 × 40 mm cuboid. Bone cement samples were then placed on the back of a rabbit, and the temperature changes were recorded with an industrial digital thermometer. One hour later, the appearance of scalded skin was observed, and the rabbits were euthanized. The scalded parts were cut to make pathological sections and stained with HE, and the differences in the depth of the scalded skin caused by different thicknesses of bone cement were observed under a light microscope.

RESULTS: Damage caused by 1 mm-, 4 mm-, 8 mm-, 12 mm-, 16 mm-, and 20 mm-thick bone cement samples mainly involved the epidermis, the papillary dermis, the reticular dermis layer, and the full thickness of the skin and the subcutaneous tissue. The maximum temperature of 1 mm, 4 mm, 8 mm, and 12 mm bone cementation had a statistically significant difference (p < 0.001), while there was no significant difference between 12 mm, 16 mm, and 20 mm samples (p = 0.856). The time to severe scalding with bone cement at temperatures above 70°C was significantly different between different thicknesses (p < 0.001).

CONCLUSION: The heat released by different thicknesses of bone cement leads to different maximum temperatures and the duration of severe burns, resulting in different degrees of skin burns. Attention should be paid to discarded bone cement to prevent this potential complication in knee arthroplasty.

PMID:37092381 | DOI:10.1111/os.13700

Scand J Psychol. 2023 Apr 24. doi: 10.1111/sjop.12917. Online ahead of print.

ABSTRACT

To create healthy workplaces, organizations need tools for assessing factors contributing to employee well-being. Psychosocial safety climate (PSC) refers to shared perceptions regarding the extent to which psychological health and safety are prioritized in organizations; it is operationalized in the PSC scale. We evaluated the factor structure of the Finnish version of the PSC-4 scale, its invariance across time and concurrent and predictive relationships with perceived stress, job exhaustion, and work engagement. Moreover, the mean-level changes in PSC and well-being during enforced remote work were studied. Participants were 442 higher education employees who completed a well-being survey four times between April 2020 and February 2021. The longitudinal factor structure of the PSC-4 and well-being indicators were investigated using confirmatory factor analysis and structural equation modeling. The statistical analyses supported the one-factor structure of the PSC-4 and its measurement invariance across time. PSC was negatively associated with concurrent stress and job exhaustion and positively associated with concurrent work engagement at each measurement. Moreover, PSC predicted subsequent stress between each time point. Cross-lagged effects were also evident for job exhaustion at T2-T3 and T3-T4 and for work engagement at T1-T2. The mean level of PSC decreased during enforced remote work. To conclude, the Finnish PSC-4 is a valid tool for evaluating perceived psychosocial safety climate in organizations. PSC predicted well-being over time and showed subsequent relationships with job exhaustion and work engagement, which is a new contribution to PSC theory and literature. Organizations need to design interventions to improve it, especially during stressful times.

PMID:37092361 | DOI:10.1111/sjop.12917

Eval Health Prof. 2023 Apr 24:1632787231172277. doi: 10.1177/01632787231172277. Online ahead of print.

ABSTRACT

The impact of multi-point nursing strategies drawing on a problem-solving clinical framework to examine adverse events associated with thyroid nodule resection was investigated. Patients (n = 98) who underwent thyroid nodule resection were divided into observation and control groups. Patients in the control group received conventional care, and patients in the observation group received a multi-point care strategy under a clinical problem-solving framework. The length of stay (p < .001), hospitalization cost (p < .001), nursing satisfaction scores (p < .001) of the observation group were longer or higher and statistically significant. The incidence of complications in the observation group (8.16%) was lower than that in the control group (22.45%). The incidence of adverse events in the observation group (2.04%) was lower than that in the control group (14.29%), and statistically significant (p < .05). The multi-point nursing strategy using a clinical problem-solving framework provided evidence that it shortened the length of stay, reduce hospitalization costs, improve psychological status, increase nursing satisfaction, and reduce complications and adverse events in patients undergoing thyroid nodule resection.

PMID:37092358 | DOI:10.1177/01632787231172277