Tag: nevin manimala

BMC Pregnancy Childbirth. 2022 Nov 24;22(1):874. doi: 10.1186/s12884-022-05225-6.

ABSTRACT

BACKGROUND: While a reduction in the global maternal mortality ratio (MMR) has slowed, newer strategies are needed to achieve an ongoing and sustainable reduction of the MMR. Previous studies have investigated the association between health system-related factors such as wealth inequalities, healthcare access and use on maternal mortality. However, a women’s rights-based approach to address MMR has not been studied, excluding the health system-related factors. This study aimed to analyse the association between gender equality and MMR globally.

METHODS: Using structural equation modelling (SEM), secondary and open access data from the United Nations and other international agencies from 193 countries were analysed using structural equation modelling (SEM). Gender-sensitive variables that represented the theoretical, conceptual framework of the study were selected. The association between latent variable gender equality and the outcome, MMR, was examined in the SEM. A second SEM model (n = 158) was designed to include two variables related to gender-based violence.

FINDINGS: The latent variable, gender equality, was negatively associated with MMR (p < 0‧001, Z = -6‧96, 95% CI: – 6508.98 to – 3141.89 for Model 1 and p < 0‧001, Z = -7‧23, 95% CI: – 6045.356 to – 3467.515 for Model 2).

INTERPRETATION: Gender equality was significantly associated with maternal mortality. Investing in higher education for women, improving their paid employment opportunities, increasing participation in leadership roles and politics, reducing intimate partner violence (IPV) and ending child marriage can significantly reduce maternal mortality.

PMID:36424537 | DOI:10.1186/s12884-022-05225-6

J Med Radiat Sci. 2022 Nov 24. doi: 10.1002/jmrs.634. Online ahead of print.

ABSTRACT

INTRODUCTION: Stereotactic ablative radiotherapy (SABR) can be a curative option for non-small cell lung cancer (NSCLC) and oligometastatic lung disease. Volumetric modulated arc therapy (VMAT) has offered further advancements in terms of radiation dose shaping without compromising treatment times however there is potential for greater low-dose exposure to the lung. This study was to assess whether VMAT lung SABR would result in any increase to the dosimetry parameters compared with three-dimensional conformal radiotherapy (3D-CRT) that could confer increased risk of radiation pneumonitis.

METHODS: A total of 53 and 30 3D-CRT treatment plans of patients treated with 48 Gy in 4 fractions were compared.

RESULTS: No statistically significant difference in planning target volumes between the VMAT 29.9 cc (range 12.4-58.5 cc) and 3D-CRT 31.2 cc (range 12.3-58.3 cc) P = 0.79. The mean of total lung V5, ipsilateral lung V5 and contralateral lung V5 all showed a trend of being smaller in the VMAT treatment group- 14% versus 15.8%, 25.6% versus 30.4% and 1.6% versus 2.2%, respectively, but all were not statistically significant differences. Mean of the mean lung dose MLD, again showed a trend of being lower in the VMAT treatments but was also non-significant, 2.6 Gy versus 3.0 Gy, P = 1.0. Mean V20 was the same in both cohorts, 3.3%.

CONCLUSIONS: The dosimetry for 3D-CRT and VMAT plans were not significantly different including V5, and therefore we conclude that VMAT treatment is unlikely to be associated with an increased risk of radiation pneumonitis.

PMID:36424510 | DOI:10.1002/jmrs.634

Med Klin Intensivmed Notfmed. 2022 Nov 24. doi: 10.1007/s00063-022-00969-7. Online ahead of print.

ABSTRACT

BACKGROUND: Agency work in nursing is used as a form of labor to counter vacant staff positions in hospitals. Both hospital owners and nurses view this critically for different reasons.

AIM: The aim of this study was to assess what personal net income nurses in German intensive care units and intermediate care units consider “fair and sufficient” for their work (addressed in Part 1 of the survey) and what influence-aside from the salary-the working conditions have on the willingness to change to temporary work or back to a permanent position.

METHODS: From September to October 2020, an anonymous online survey was conducted among nurses of intermediate care units, intensive care units, and special care units in German-speaking countries. Descriptive statistics were used for the analysis.

RESULT: Of 1203 participants, 86% (n = 1036) could be evaluated. None of the job satisfaction factors queried received four or five stars (maximum five stars) from those participating in the survey. The most unsatisfied group proved to be regularly employed nurses with an additional part-time job. Key job satisfaction factors differed markedly between the groups, with regular employees favoring consistency and stability. Agency workers prefer gaining experience in a broader range of tasks. Unreliable duty rosters and poor nurse to patient ratios were common points of criticism.

CONCLUSION: For job satisfaction, making nurses feel appreciated and respected is essential. This includes a guaranteed nurse to patient ratio and reliable duty rosters that also include tasks outside direct patient care. In order for nurses to leave agency work, it is necessary to take into account the differences in interests in terms of the focus of activity.

PMID:36424476 | DOI:10.1007/s00063-022-00969-7

J Perinat Med. 2022 Nov 25. doi: 10.1515/jpm-2022-0452. Online ahead of print.

ABSTRACT

OBJECTIVES: To determine the morphological characteristics of the placentas from COVID-19 positive mothers in regard to the trimester of COVID-19 infection onset and low weight molecular heparin (LMWH) treatment.

METHODS: Placentas were collected in the period April 1st till September 1st 2021 after delivery at Department of Obstetrics and Gynecology University Hospital Split, Croatia, and sent for pathological examination. Medical history and pathology reports were used to collect the data. Pregnant women were divided based on the onset of COVID-19 infection and stratified into low molecular weight heparin (LMWH)+ or LMWH-. Depending on the data distribution, the following test were used: chi-squared test. Student’s t-test, Mann-Whitney U test, ANOVA and Kruskal-Wallis test.

RESULTS: In 38% of patients the onset of COVID-19 infection was the 1st trimester of pregnancy, in 27% in the 2nd and 35% of women were infected in the 3rd trimester The fetal vascular malperfusion (FVM) occurrence was statistically significantly higher in the LMWH- group and if the onset of infection was in the 2nd trimester, while the perivillous fibrin deposition was most likely to happen if the COVID-19 infection that occured in the 1st trimester of pregnancy.

CONCLUSIONS: The onset of COVID-19 infection has the influence on trophoblast damage and subsequent morphological appearance of the placenta. LMWH use in COVID positive pregnant women decreases the rate of the FVM in examined placentas.

PMID:36423330 | DOI:10.1515/jpm-2022-0452

Interact J Med Res. 2022 Nov 24. doi: 10.2196/41520. Online ahead of print.

ABSTRACT

BACKGROUND: Older adults have worse outcomes following hospitalisation with COVID-19, but within this group there is substantial variation. Although frailty and comorbidity are key determinants of mortality, it is less clear which specific manifestations of frailty and comorbidity are associated with the worst outcomes.

OBJECTIVE: We aimed to identify the key comorbidities and domains of frailty that were associated with in-hospital mortality in older patients with COVID-19 using models developed using machine learning algorithms.

METHODS: This was a retrospective study that used the Hospital Episode Statistics administrative dataset from 1st March 2020 to 28th February 2021 for hospital patients in England aged 65 years and over. The dataset was split into separate training (70%), test (15%) and validation (15%) datasets during model development. Global frailty was assessed using the Hospital Frailty Risk Score (HFRS) and specific domain of frailty identified using the Dr Foster Global Frailty Scale (GFS). Comorbidity was assessed using the Charlson Comorbidity Index (CCI). Additional features employed in the random forest algorithms included age, sex, deprivation, ethnicity, discharge month and year, geographical region, hospital trust, disease severity, International Statistical Classification of Disease and Related Health Problems 10th edition codes recorded during the admission. Features were selected, pre-processed and inputted into a series of random forest classification algorithms developed to identify factors strongly associated with in-hospital mortality. Two models were developed, the first model included the demographic, hospital-related and disease related items described above and individual GFS domains and CCI items. The second model was as the first but replaced the GFS domains and CCI items with the HFRS as a global measure of frailty. Model performance was assessed using the area under the receiver operating characteristic (AUROC) curve and measures of model accuracy.

RESULTS: In total 215,831 patients were included. The model containing the individual GFS domains and CCI items had an AUROC curve for in-hospital mortality of 90% and a predictive accuracy of 83%. The model containing the HFRS had a similar performance (AUROC curve 90%, predictive accuracy 82%). The most important frailty items in the GFS were dementia/delirium, falls/fractures and pressure ulcers/weight loss. The most-important comorbidity items in the CCI were cancer, heart failure and renal disease.

CONCLUSIONS: The physical manifestation of frailty and comorbidity, particularly a history of cognitive impairment and falls, may be useful in identification of patients who may need additional support during hospitalization with COVID-19.

PMID:36423306 | DOI:10.2196/41520

Brain Behav. 2022 Nov 24:e2825. doi: 10.1002/brb3.2825. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with Parkinson’s disease (PD) present various responsiveness to levodopa, but the cause of such differences in levodopa responsiveness is unclear. Previous studies related the damage of brain white matter (WM) to levodopa responsiveness in PD patients, but no study investigated the relationship between the structural brain network change in PD patients and their levodopa responsiveness.

METHODS: PD patients were recruited and evaluated using the Unified Parkinson’s Disease Rating Scale (UPDRS). Each patient received a diffusion tensor imaging (DTI) scan and an acute levodopa challenge test. The improvement rate of UPDRS-III was calculated. PD patients were grouped into irresponsive group (improvement rate < 30%) and responsive group (improvement rate ≥ 30%). Tract-based spatial statistics (TBSS), deterministic tracing (DT), region of interest (ROI) analysis, and automatic fiber identification (AFQ) analyses were performed. The structural brain network was also constructed and the topological parameters were calculated.

RESULTS: Fifty-four PD patients were included. TBSS identified significant differences in fractional anisotropy (FA) values in the corpus callosum and other regions of the brain. DT and ROI analysis of the corpus callosum found a significant difference in FA between the two groups. Graph theory analysis showed statistical differences in global efficiency, local efficiency, and characteristic path length.

CONCLUSION: PD patients with poor responsiveness to levodopa had WM damage in multiple brain areas, especially the corpus callosum, which might cause disruption of information integration of the structural brain network.

PMID:36423257 | DOI:10.1002/brb3.2825

J Card Surg. 2022 Nov 24. doi: 10.1111/jocs.17166. Online ahead of print.

ABSTRACT

OBJECTIVE: Prior studies have demonstrated robotic excision of cardiac tumors as a safe and effective treatment option. The procedure is performed with five incisions: three robotic arm ports, one atrial retractor port, and one working port. We report our unique initial experience in robotic tumor removal. To our knowledge, this is one of the first reports demonstrating cardiac myxoma and fibroelastoma removal with use of exclusively 8-mm ports.

METHODS: All data for robotic cardiac tumor resection at our institution from June 2019 to December 2021 were retrospectively collected; 18 cases were included, including 13 cardiac myxomas and five fibroelastomas. Baseline demographics, intraoperative characteristics, and surgical outcomes were recorded. Descriptive statistics were calculated; continuous variables were reported as median [interquartile range], and categorical variables were reported as percentages.

RESULTS: Median patient age was 64 [55, 70] years old. The cohort consisted of primarily female (67%) and white (83%) patients. Median body mass index was 26.3 [23.0, 31.5] kg/m² . 11% of patients were current tobacco users and 50% had hypertension. All patients underwent myxoma or fibroelastoma removal with the use of five 8-mm robotic ports. Each patient underwent percutaneous cannulation via the femoral arteries. Aortic occlusion was achieved via an endoaortic balloon (67%) or transthoracic cross-clamp (33%). Cross-clamp time was 30 [26, 41] minutes. Concomitant procedures performed during myxoma removal included patent foramen ovale closure (28%), mitral valve repair (8%), left atrial appendage closure (8%), Cox-maze procedure (6%), and coronary artery bypass grafting (6%). All cardiac tumors were packaged with use of the endo-bag and subsequently removed through the working port. Maximal myxoma and fibroelastoma diameters were 2.5 [1.7, 3.5] and 0.6 [0.4, 0.7] cm, respectively. Procedural cardiopulmonary bypass time was 77 [65, 84] minutes. No intraoperative mortality, reoperation for bleeding, or postoperative cardiac issues were recorded. One in-hospital mortality occurred as the result of a thrombotic event in the context of a hypercoagulable state unrelated to the patient’s operation. No other mortalities were observed at 30 days. Hospital length of stay was 4.5 [3.0, 7.8] days.

CONCLUSIONS: In our study, the robotic platform facilitated safe and effective cardiac tumor excision. Our results highlight the efficacy of 8-mm port sizing and the concurrent use of other minimally invasive techniques, including percutaneous cannulation, in this patient population. In general, patients prefer the least invasive treatment option available. Our findings emphasize the importance of training cardiac surgeons to perform robotic procedures using the least invasive means possible to provide patients with various options for their treatment.

PMID:36423256 | DOI:10.1111/jocs.17166

Acta Radiol. 2022 Nov 24:2841851221139125. doi: 10.1177/02841851221139125. Online ahead of print.

ABSTRACT

BACKGROUND: Satisfactory magnetic resonance imaging (MRI) of those patients with involuntary head motion due to brain diseases is essential in avoiding missed diagnosis and guiding treatment.

PURPOSE: To investigate the clinical feasibility of artificial intelligence-assisted compressed sensing single-shot fluid-attenuated inversion recovery (ACS-SS-FLAIR) in evaluating patients with involuntary head motion due to brain diseases, compared with the conventional T2-FLAIR with parallel imaging (PI-FLAIR).

MATERIAL AND METHODS: A total of 33 uncooperative patients with brain disease were prospectively enrolled. Two readers independently reviewed images acquired with ACS-SS-FLAIR and PI-FLAIR at a 3.0-T MR scanner. In the aspects of qualitative evaluation of image quality, overall image quality and lesion conspicuity of ACS-SS-FLAIR and PI-FLAIR were assessed and then statistically compared by paired Wilcoxon rank-sum test. For quantitative evaluation, the relative contrast of lesion-to-cerebral parenchyma were calculated and compared.

RESULTS: Overall image quality scores of ACS-SS-FLAIR evaluated by two readers were 2.94 ± 0.24 and 2.91 ± 0.29, respectively, both of which were significantly higher than that of PI-FLAIR, respectively (P < 0.001 and <0.001). Lesion conspicuity scores of were 2.74 ± 0.47 and 2.79 ± 0.44, both of which were significantly higher than that of PI-FLAIR, respectively (P < 0.001 and <0.001). In the quantitative evaluation for image quality, the relative contrast of lesion-to-cerebral parenchyma was 0.34 ± 0.09 in the ACS-SS-FLAIR sequence, significantly larger than that in the PI-FLAIR sequence (P = 0.001).

CONCLUSION: The ACS-SS-FLAIR sequence is clinically feasible in the MRI workup of those patients with involuntary head motion due to brain diseases, showing shorter image acquisition time and better image quality compared with conventional PI-FLAIR.

PMID:36423247 | DOI:10.1177/02841851221139125

Viruses. 2022 Nov 21;14(11):2583. doi: 10.3390/v14112583.

ABSTRACT

From 2019 to 2021, a retrospective molecular study was conducted in the Campania region (southern Italy) to determine the prevalence of viral diseases in domestic cats. A total of 328 dead animals were analyzed by Real-Time PCR for the presence of feline panleukopenia virus (FPV), feline leukemia virus (FeLV), feline enteric coronavirus (FCoV), rotavirus (RVA), feline herpesvirus type 1 (FHV-1), and feline calicivirus (FCV). The possible presence of SARS-CoV-2 was also investigated by Real-Time PCR. The cats included in this study were specifically sourced and referred by local veterinarians and local authorities to the Zooprofilactic Experimental Institute of Southern Italy (IZSM) for pathological evaluation. The samples consisted of owners, catteries, and stray cats. Results revealed: 73.5% positive cats for FPV (189/257), 23.6% for FeLV (21/89), 21.5% for FCoV (56/266), 11.4% for RVA (16/140), 9.05% for FeHV-1 (21/232), and 7.04 for FCV (15/213). In contrast, SARS-CoV-2 was never detected. FPV was more prevalent in winter (p = 0.0027). FCoV FHV-1, FCV, and RVA predominated in autumn, whereas FeLV predominated in summer. As expected, viral infections were found more frequently in outdoor and shelter cats than in indoor ones, although no statistical association was found between animal lifestyle and viral presence. The study showed a high prevalence of FPV, FeLV, and FCoV and a moderate prevalence of RVA, FHV-1, and FCV. Moreover, the prevalence of these pathogens varied among the cat populations investigated.

PMID:36423192 | DOI:10.3390/v14112583

Viruses. 2022 Nov 18;14(11):2550. doi: 10.3390/v14112550.

ABSTRACT

Respiratory infections remain a major public health problem, affecting people of all age groups, but there is still a lack of studies analyzing the burden of upper respiratory infections (URIs) in Asian countries. We used the data from the Global Burden of Diseases Study 2019 results to assess the current status and trends of URI burden from 1990 to 2019 in Asian countries. We found that Thailand had the highest age-standardized incidence rate (ASIR) of URI both in 1990 (354,857.14 per 100,000) and in 2019 (344,287.93 per 100,000); and the highest age-standardized mortality rate (ASMR) was in China in 1990 (2.377 per 100,000), and in Uzbekistan in 2019 (0.418 per 100,000). From 1990 to 2019, ASIRs of URI slightly increased in several countries, with the speediest in Pakistan (estimated annual percentage change [EAPC] = 0.404%, 95% CI, 0.322% to 0.486%); and Kuwait and Singapore had uptrends of ASMRs, at a speed of an average 3.332% (95% CI, 2.605% to 4.065%) and 3.160% (95% CI, 1.971% to 4.362%) per year, respectively. The age structure of URI was similar at national, Asian and Global levels. Children under the age of five had the highest incidence rate, and the elderly had the highest mortality rate of URI. Asian countries with a Socio-demographic Index between 0.5 and 0.7 had relatively lower ASIRs but higher ASMRs of URIs. The declined rate of URI ASMR in Asian countries was more pronounced in higher baseline (ASMR in 1990) countries. Our findings suggest that there was a huge burden of URI cases in Asia that affected vulnerable and impoverished people’s livelihoods. Continuous and high-quality surveillance data across Asian countries are needed to improve the estimation of the disease burden attributable to URIs, and the best public health interventions are needed to curb this burden.

PMID:36423159 | DOI:10.3390/v14112550