Tag: nevin manimala

Vet Anaesth Analg. 2022 May 26:S1467-2987(22)00076-9. doi: 10.1016/j.vaa.2022.05.003. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the feasibility of an ultrasound (US)-guided quadratus lumborum (QL)-psoas muscle (Pm) interfascial plane injection using a dorsoventral (DV) approach, and to compare needle visualization and distribution pattern between DV and ventrodorsal (VD) approaches.

STUDY DESIGN: Experimental anatomical study.

ANIMALS: A total of 14 cat cadavers.

METHODS: Bilateral in-plane US-guided injections in the QL-Pm plane were performed at the level of the second lumbar (L2) transverse process. A spinal needle was inserted using either a VD or DV approach. A total volume of 0.4 mL kg^-1 of a solution of ropivacaine 0.18%, tissue dye and iohexol (350 mg mL^-1), in a proportion of 3:1:1, respectively, was injected bilaterally. Spread of injectate was compared and evaluated using US, computed tomography (CT) scanning and anatomical dissection. Presence of dye on the sympathetic trunk was compared between methods using Kappa (κ) coefficient of agreement.

RESULTS: The QL-Pm plane was visualized, and dye was present in the target plane using both approaches. Needle visualization in the VD approach was enhanced compared with the DV approach (p = 0.0005). Mean distribution along the sympathetic trunk was 4.8 and 4.1 segments in the VD and DV approaches, respectively, showing non-statistical differences. The ventral branches of L1, L2 and L3 were successfully stained in 11/14 and 6/14 using the VD and DV approaches, respectively. Substantial agreement (κ = 0.61) of sympathetic trunk staining was observed between CT scan and anatomical dissection. Dye was observed cranial to the diaphragm in 7/8 cases on CT with both approaches. Epidural and abdominal cavity dye distribution was not observed.

CONCLUSIONS AND CLINICAL RELEVANCE: The DV approach to the QL-Pm plane could be an alternative to the VD approach. Both approaches seem capable of reaching the spinal nerves, the sympathetic trunk and both splanchnic and coeliac nerves in feline cadavers.

PMID:35718717 | DOI:10.1016/j.vaa.2022.05.003

Z Evid Fortbild Qual Gesundhwes. 2022 Jun 16:S1865-9217(22)00064-2. doi: 10.1016/j.zefq.2022.04.014. Online ahead of print.

ABSTRACT

BACKGROUND: The randomized controlled trial (RCT) is the gold standard in evidence-based medicine. However, this design may not be appropriate in every setting, so other methods or designs such as the regression discontinuity design (RDD) are required.

METHOD: The aim of this article is to introduce the RDD, summarise methodology in the context of health services research and present a worked example using the statistic software SPSS (Examples for R and Stata in the Appendix A). The mathematical notations of sharp and fuzzy RDD as well as their distinction are presented. Furthermore, examples from the literature and recent studies are highlighted, and both advantages and disadvantages of the design are discussed.

APPLICATION: The RDD consists of four essential steps: 1. Determine feasibility; 2. Note possible treatment manipulation, 3. Check for the treatment effect, and 4. Fit the regression models to measure the treatment effect.

CONCLUSION: The RDD comes as an alternative for studies in health service research where an RCT cannot be conducted, but a threshold-based comparison can be made.

PMID:35718728 | DOI:10.1016/j.zefq.2022.04.014

Vet Anaesth Analg. 2022 May 12:S1467-2987(22)00074-5. doi: 10.1016/j.vaa.2022.05.001. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare two commercial formulations of alfaxalone for immersion anaesthesia in laboratory zebrafish.

STUDY DESIGN: Prospective, blinded, randomized study.

ANIMALS: A total of 20 adult Danio rerio (Tuebingen strain).

METHODS: Zebrafish were divided into two groups of 10 (five female, five male) and placed in individual immersion baths containing 10 mg L^-1 of unpreserved alfaxalone (group 1) or preserved alfaxalone (group 2). Anaesthetists blinded to treatment used a composite score scale (CSS) (range 0-12) to assess fish every 30 seconds until induction of anaesthesia. Anaesthetic induction occurred when equilibrium and response to stimulus were lost. Fish were then placed in a clean water bath and scored every 60 seconds. Recovery from anaesthesia was defined as a CSS of ≤ 1. Time variables recorded were anaesthetic induction time (AIT), anaesthetic recovery time (ART) and total procedure time (TPT). Fish were observed for evidence of roupgross external pathology during the procedure. Following anaesthesia, four fish from each group were randomly chosen and euthanized for gill histopathology analysis immediately after recovery criteria were met. Data are presented as mean ± standard deviation. An independent t test was used to compare the difference in average anaesthetic time variables between groups (α = 0.05).

RESULTS: There were no statistical differences between groups in reported variables. TPT, AIT and ART were 10.2 ± 1.2, 1.9 ± 0.9 and 8.3 ± 1.2 minutes for group 1 and 10.8 ± 2.9, 2.4 ± 1.2 and 8.4 ± 2.7 minutes for group 2. No gross external pathology was evident, and no fish died during the experimental period. Histopathology showed normal gill pathology and no difference between the groups.

CONCLUSIONS AND CLINICAL RELEVANCE: Immersion anaesthesia using 10 mg L^-1 of either formulation of alfaxalone resulted in anaesthesia of similar quality and duration.

PMID:35718716 | DOI:10.1016/j.vaa.2022.05.001

J Am Pharm Assoc (2003). 2022 May 24:S1544-3191(22)00155-8. doi: 10.1016/j.japh.2022.05.017. Online ahead of print.

ABSTRACT

BACKGROUND: The Centers for Medicare and Medicaid (CMS) established the Hospital Readmissions Reduction Program (HRRP) to reduce reimbursement payments to hospitals with excessive patient readmissions. Because of this program, hospitals have developed transitions of care (TOC) programs to improve patient outcomes.

OBJECTIVES: To identify and uniformly summarize the impact of pharmacy-led TOC interventions on 30-day readmission rates since the implementation of CMS HRRP.

METHODS: This study followed an a-priori protocol that was registered to International Prospective Register of Systematic Reviews. A systematic search was conducted using PubMed, EMBASE, International Pharmaceutical Abstracts, and CINAHL from January 1, 2013 through January 14, 2022. Studies were included if they met the following criteria: pharmacy-led intervention, 30-day readmission outcomes, patients at least 18 years old, original research performed in the United States, and English language only articles. Descriptive statistics were used to summarize study characteristics, outcomes, and elements of the study interventions.

RESULTS: A total of 1964 abstracts were screened with 123 studies being included in the review. A total of 110 (89.4%) studies showed a decrease in readmission rates. The largest decrease in readmission rates was 44.5% (range 0.2%-44.5%, median = 7.4%) and the most common pharmacy-led intervention was patient counseling (n = 119, 96.7%) followed by medication reconciliation (n = 111, 90.2%). High-risk patient populations were commonly targeted with 52 studies (42.3%) focusing on CMS HRRP related diagnoses.

CONCLUSION: Most pharmacist-led TOC interventions contributed to lower rates of 30-day readmission. Future studies should investigate the types of interventions that most significantly impact readmission rates.

PMID:35718715 | DOI:10.1016/j.japh.2022.05.017

Transfus Apher Sci. 2022 Jun 7:103482. doi: 10.1016/j.transci.2022.103482. Online ahead of print.

ABSTRACT

BACKGROUND: With the use of granulocyte colony stimulating factor (G-CSF) after allogeneic hematopoietic stem cell transplantation (HSCT), the duration of neutrophil engraftment and hospitalization were shortened. However, there is no consensus on the effect of G-CSF on platelet engraftment time. The primary aim of our study is to determine the effect of G-CSF use on platelet engraftment time after HSCT. Secondary purposes are to determine the number of platelet suspension, number of erythrocyte suspension and incidence of acute graft versus disease after HSCT.

MATERIAL AND METHODS: Patients who had allogeneic stem cell transplantation at our center between 01.01.2011 and 01.01.2022 were retrospectively analyzed. Patients were divided into 2 groups as those who received and did not receive G-CSF after transplantation.

RESULTS: A total of 64 patients were included. While 32 patients were given post-HSCT G-CSF support, the other 32 patients were not given. Neutrophil engraftment time and length of hospital stay were shorter in the group receiving G-CSF (p < 0.05). Platelet engraftment time was shorter in the group that did not receive G-CSF (p < 0.05). The incidence of acute GVHD of the patients in group 1 tended to be higher than the patients in group 2 (40.6 % vs 15.6 %, p = 0.052). Post-HSCT platelet suspension was less in the group that did not receive G-CSF, but this difference was not statistically significant (p = 0.173).

CONCLUSION: While the positive effect of post HSCT G-CSF use on duration of neutrophil engraftment and hospitalization is evident, its effects on platelet engraftment need to be investigated.

PMID:35718683 | DOI:10.1016/j.transci.2022.103482

Hepatobiliary Pancreat Dis Int. 2022 Jun 7:S1499-3872(22)00133-3. doi: 10.1016/j.hbpd.2022.06.001. Online ahead of print.

ABSTRACT

BACKGROUND: Minimally invasive surgery is becoming increasingly popular in the field of pancreatic surgery. However, there are few studies of robotic distal pancreatectomy (RDP) for pancreatic ductal adenocarcinoma (PDAC). This study aimed to investigate the efficacy and feasibility of RDP for PDAC.

METHODS: Patients who underwent RDP or laparoscopic distal pancreatectomy (LDP) for PDAC between January 2015 and September 2020 were reviewed. Propensity score matching analyses were performed.

RESULTS: Of the 335 patients included in the study, 24 underwent RDP and 311 underwent LDP. A total of 21 RDP patients were matched 1:1 with LDP patients. RDP was associated with longer operative time (209.7 vs. 163.2 min; P = 0.003), less open conversion rate (0% vs. 4.8%; P < 0.001), higher costs (15722 vs. 12699 dollars; P = 0.003), and a higher rate of achievement of an R0 resection margin (90.5% vs. 61.9%; P = 0.042). However, postoperative pancreatic fistula grade B or C showed no significant inter-group difference (9.5% vs. 9.5%). The median disease-free survival (34.5 vs. 17.3 months; P = 0.588) and overall survival (37.7 vs. 21.9 months; P = 0.171) were comparable between the groups.

CONCLUSIONS: RDP is associated with longer operative time, a higher cost of surgery, and a higher likelihood of achieving R0 margins than LDP.

PMID:35718650 | DOI:10.1016/j.hbpd.2022.06.001

Clin Infect Dis. 2022 Jun 19:ciac489. doi: 10.1093/cid/ciac489. Online ahead of print.

ABSTRACT

BACKGROUND: COVID-19-associated fungal infections cause severe illness, but comprehensive data on disease burden are lacking. We analyzed US National Vital Statistics System (NVSS) data to characterize disease burden, temporal trends, and demographic characteristics of persons dying from fungal infections during the COVID-19 pandemic.

METHODS: Using NVSS’s January 2018-December 2021 Multiple Cause of Death Database, we examined numbers and age-adjusted rates (per 100,000 population) of fungal deaths by fungal pathogen, COVID-19 association, demographic characteristics, and year.

RESULTS: Numbers and age-adjusted rates of fungal deaths increased from 2019 (n = 4,833, rate 1.2, 95% confidence interval [CI] 1.2-1.3) to 2021 (n = 7,199, rate: 1.8, 95% CI = 1.8-1.8); of 13,121 fungal deaths during 2020-2021, 2,868 (21.9%) were COVID-19-associated. Compared with non-COVID-19-associated fungal deaths (n = 10,253), COVID-19-associated fungal deaths more frequently involved Candida (n = 776 [27.1%] versus n = 2,432 [23.7%]) and Aspergillus (n = 668 [23.3%] versus n = 1,486 [14.5%]) and less frequently involved other specific fungal pathogens. Fungal death rates were generally highest in non-White and non-Asian populations. Death rates from Aspergillus infections were approximately two times higher in the Pacific US census division compared with most other divisions.

CONCLUSIONS: Fungal deaths increased during 2020-2021 compared with previous years, primarily driven by COVID-19-associated fungal deaths, particularly those involving Aspergillus and Candida. Our findings may inform efforts to prevent, identify, and treat severe fungal infections in COVID-19 patients, especially in certain racial/ethnic groups and geographic areas.

PMID:35717660 | DOI:10.1093/cid/ciac489

Med Oral Patol Oral Cir Bucal. 2022 Jun 19:25280. doi: 10.4317/medoral.25280. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of the study was to evaluate the changes in craniofacial dimensions of newly diagnosed and untreated acromegaly patients, patients with non-functional pituitary adenoma and healthy individuals on Cone Beam Computed Tomography (CBCT).

MATERIAL AND METHODS: 50 newly diagnosed acromegaly patients who did not receive any treatment for acromegaly were included in the study (Group A). Twenty patients with nonfunctional pituitary adenoma (Group B) and 30 healthy individuals were included (Group C). Linear, angular and volumetric measurements were performed.

RESULTS: Mandibular length showed significant difference in acromegaly patients, and maxillar length statistically significant difference was found between the A-B and B-C (p> 0,05), no difference was found between the A-C (p<0,05). SNB and ANB angle was statistically different in all groups, while SNA angle was statistically different between group A-C and B-C. In volumetric measurements, a statistically significant difference was found between groups a-c and groups A-B (p< 0,05), no difference was found between groups B-C (p>0,05).

CONCLUSIONS: CBCT measurements showed that mandibular volume and length were increased in the acromegaly group compared to the group B-C. Present study is the first research that compares acromegaly patients in respect to changes in maxillofacial dimensions.

PMID:35717618 | DOI:10.4317/medoral.25280

Med Oral Patol Oral Cir Bucal. 2022 Jun 19:25253. doi: 10.4317/medoral.25253. Online ahead of print.

ABSTRACT

BACKGROUND: This study retrospectively analyzed the risk factors for transchemotherapy oral mucositis (OM).

MATERIAL AND METHODS: Before each chemotherapy cycle, patients were routinely evaluated for the presence/severity of OM based on the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 scale for adverse effects and graded as follows: However, specific conditions such as mucositis are graded on a five-point scale: 0, absence of mucositis, grade 1 (Asymptomatic or mild), 2 (Presence of pain and moderate ulceration, without interference with food intake), 3 (severe pain with interference with food intake) or 4 (Life-threatening with the need for urgent intervention). Information from 2 years of evaluations was collected and patient medical records were reviewed to obtain data on chemotherapy cycle, sex, age, body mass index, body surface area, primary tumor, chemotherapy protocol, and history of head and neck radiotherapy. The X² test and multinomial logistic regression were used for statistical analysis (SPSS 20.0, p<0.05).

RESULTS: Among 19,000 total evaluations of 3,529 patients during 5.32±4.7 chemotherapy cycles (CT) the prevalence of OM was 6.3% (n=1,195). Chemotherapy duration (p<0.001), female sex (p=0.001), adjuvant intention (p=0.008) and the use of carboplatin (p=0.001), cisplatin (p=0.029), docetaxel (p<0.001) and bevacizumab (p=0.026) independently increased the risk of mucositis. In head and neck tumors, 2018 year (p=0.017), chemotherapy duration (p=0.018), BMI>30 (p=0.008), radiotherapy (p=0.037) and use of carboplatin (p=0.046) and cyclophosphamide (p=0.010) increased this prevalence.

CONCLUSIONS: Cycles of chemotherapy, sex, cytotoxicity drugs, bevacizumab and head and neck radiotherapy increase the risk of OM in solid tumors.

PMID:35717621 | DOI:10.4317/medoral.25253

Med Oral Patol Oral Cir Bucal. 2022 Jun 19:25259. doi: 10.4317/medoral.25259. Online ahead of print.

ABSTRACT

BACKGROUND: We aimed to evaluate the prevalence of predisposing factors and oral manifestations in SARS-CoV-2 infection.

MATERIAL AND METHODS: 204 SARS-CoV-2 positive patients were included in the study. Questions regarding the systemic, periodontal health, oral hygiene habits, common symptoms and, oral manifestations of COVID-19 such as oral lesions, and dry mouth were included in the survey. The Visual Analogue Scale (VAS) was used.

RESULTS: 47.5% of individuals had various systemic diseases. Dry mouth (44.2%) and oral lesions (22.4%) were the most common oral manifestations in COVID-19 patients. Also, dry mouth had the highest VAS score. The most common oral lesion locations were buccal mucosa (15.2%) and tongue (10.8%). The majority of participants (142 patients) were affected by taste disorders. Patients who received periodontal treatment before SARS-CoV-2 infection reported fewer oral complaint and manifestations than those who did not receive periodontal therapy (p=0.032). There was no statistically significant difference between males and females on the presence of any oral manifestations, and taste disorders.

CONCLUSIONS: Our results showed that SARS-CoV-2 could cause oral manifestations. However various predisposing factors may be part of the etiology and promote oral findings.

PMID:35717616 | DOI:10.4317/medoral.25259