Tag: nevin manimala

J Pak Med Assoc. 2021 Aug;71(8):1980-1983. doi: 10.47391/JPMA.02-250.

ABSTRACT

OBJECTIVE: To compare efficacy of intravenous paracetamol and fentanyl for intra-operative and post-operative analgesia in patients undergoing rigid hysteroscopy.

METHOD: The prospective randomised control trial was conducted at Aga Khan University Hospital, Karachi, from October 2016 to June 2017, and comprised patients aged 18-65 years with American Society of Anesthesiologists grade I or II undergoing hysteroscopy who were randomised into paracetamol group P and fentanyl group F. Anaesthesia induction technique was standardised and analgesia in group P was paracetamol 15mg/Kg administered 15-30 minutes pre-surgery, and in group F, it was fentanyl 2mcg/kg administered at induction of anaesthesia. Intra-operative pain was assessed by changes in heart rate, systolic, diastolic and mean arterial blood pressure, and post-operative pain was assessed using the visual analogue scale. Data was analysed using SPSS 19.

RESULTS: Of the 60 patients, there were 30(50%) in each of the two groups. Baseline parameters were similar in the groups except for age differences (p<0.011). In group P, mean systolic blood pressure at 10,15, 20, 25 and 30 minutes, mean diastolic blood pressure at 20, 25 minutes, and mean arterial blood pressure at 20 minutes were statistically significant (p<0.05) compared to group F. The mean heart rate was not significant between the groups (p>0.05). Post-operative pain scores were similar at 0, 15 and 30 minutes (p>0.05). Rescue analgesia was needed in 3(10%) patients in each group on arrival in the recovery room.

CONCLUSIONS: Intravenous paracetamol offered analgesic efficacy similar to fentanyl for rigid hysteroscopy in ambulatory surgery.

PMID:34418014 | DOI:10.47391/JPMA.02-250

Int Ophthalmol. 2021 Aug 21. doi: 10.1007/s10792-021-02020-8. Online ahead of print.

ABSTRACT

PURPOSE: In the event that any ocular parameter involved in the calculation of intraocular lens power could not be properly measured in one eye, it is important to know whether clinically relevant differences between both eyes can be expected. The aim of this work is to evaluate the symmetry of interocular biometric parameters.

METHODS: This was a prospective, cross-sectional study involving 4090 subjects. Patients underwent consecutive swept-source optical biometry performed with an IOLMaster 700 (Carl Zeiss Meditec AG, Jena, Germany). The biometric parameters that were evaluated were: axial length (AL), mean anterior curvature (Rm), anterior chamber depth (ACD), crystalline lens thickness (LT), central corneal thickness (CCT) and white-to-white (WTW). The Chang-Waring chord distance (CWC-D) and the Chang-Waring chord angle (CWC-A) were also evaluated.

RESULTS: There is an excellent correlation between both eyes for almost all the biometric parameters under study, with the exception of the CWC. Agreement for AL was better for eyes shorter than 24 mm. The linearity of the OD-vs-OS relationship can be correctly assumed for all parameters (Cusum test: p > 0.05 in all cases).

CONCLUSION: There are no clinically significant interocular differences for the biometric parameters under study, although for all of them, except the LT, statistically significant differences did arise. In the case of AL, moderate differences can be expected in eyes larger than 24 mm.

PMID:34417946 | DOI:10.1007/s10792-021-02020-8

Brain Imaging Behav. 2021 Aug 21. doi: 10.1007/s11682-021-00511-x. Online ahead of print.

ABSTRACT

Spinocerebellar ataxias type 3 (SCA3) patients are clinically characterized by progressive cerebellar ataxia combined with degeneration of the cerebellum. Previous neuroimaging studies have indicated ataxia severity associated with cerebellar atrophy using univariate methods. However, whether cerebellar atrophy patterns can be used to quantitatively predict ataxia severity in SCA3 patients at the individual level remains largely unexplored. In this study, a group of 66 SCA3 patients and 58 healthy controls were included. Disease duration and ataxia assessment, including the Scale for the Assessment and Rating of Ataxia (SARA) and the International Cooperative Ataxia Rating Scale (ICARS), were collected for SCA3 patients. The high-resolution T1-weighted MRI was obtained, and cerebellar grey matter (GM) was extracted using a spatially unbiased infratentorial template toolbox for all participants. We investigated the association between the pattern of cerebellar grey matter (GM) loss and ataxia assessment in SCA3 by using a multivariate machine learning technique. We found that the application of RVR allowed quantitative prediction of both SARA scores (leave-one-subject-out cross-validation: correlation = 0.56, p-value = 0.001; mean squared error (MSE) = 20.51, p-value = 0.001; ten-fold cross-validation: correlation = 0.52, p-value = 0.001; MSE = 21.00, p-value = 0.001) and ICARS score (leave-one-subject-out cross-validation: correlation = 0.59, p-value = 0.001; MSE = 139.69, p-value = 0.001; ten-fold cross-validation: correlation = 0.57, p-value = 0.001; MSE = 145.371, p-value = 0.001) with statistically significant accuracy. These results provide proof-of-concept that ataxia severity in SCA3 patients can be predicted by the alteration pattern of cerebellar GM using multi-voxel pattern analysis.

PMID:34417969 | DOI:10.1007/s11682-021-00511-x

Environ Sci Pollut Res Int. 2021 Aug 21. doi: 10.1007/s11356-021-15797-z. Online ahead of print.

ABSTRACT

Along with climate change, unstable weather patterns are becoming more frequent. However, the temporal trend associated with the effect of temperature variation on schizophrenia (SCZ) is not clear. Daily time-series data on SCZ and meteorological factors for 15-year between January 1, 2005 and December 31, 2019 were collected. And we used the Poisson regression model combined with the time-varying distribution lag nonlinear model (DLNM) to explore the temporal trend of the association between three temperature variation indicators (diurnal temperature range, DTR; temperature variability, TV; temperature change between neighboring days, TCN) and SCZ hospitalizations, respectively. Meanwhile, we also explore the temporal trend of the interaction between temperature and temperature variation. Stratified analyses were performed in different gender, age, and season. Across the whole population, we found a decreasing trend in the risk of SCZ hospitalizations associated with high DTR (from 1.721 to 1.029), TCN (from 1.642 to 1.066), and TV (TV0-1, from 1.034 to 0.994; TV0-2, from 1.041 to 0.994, TV0-3, from 1.044 to 0.992, TV0-4, from 1.049 to 0.992, TV0-5, from 1.055 to 0.993, TV0-6, from 1.059 to 0.991, TV0-7, from 1.059 to 0.990), but an increasing trend in low DTR (from 0.589 to 0.752). Subgroup analysis results further revealed different susceptible groups. Besides, the interactive effect suggests that temperature variation may cause greater harm under low-temperature conditions. There was a synergy between TCN and temperature on the addition and multiplication scales, which were 1.068 (1.007, 1.133) and 0.067 (0.009, 0.122), respectively. Our findings highlight public health interventions to mitigate temperature variation effects needed to focus not only on high temperature variations but also moderately low temperature variations. Future hospitalizations for SCZ associated with temperature variation may be more severely affected by temperature variability from low temperature environments. The temporal trend is associated with the effect of temperature variation on schizophrenia (SCZ).

PMID:34417696 | DOI:10.1007/s11356-021-15797-z

Matern Child Health J. 2021 Aug 20. doi: 10.1007/s10995-021-03205-4. Online ahead of print.

ABSTRACT

INTRODUCTION: Community Healthy Start program evaluations are often limited by a lack of robust data and rigorous study designs. This study describes an enhanced methodological approach using local program data linked with existing population-level datasets for external comparison to evaluate the Enterprise Community Healthy Start (ECHS) program in two rural Georgia counties and presents results from the evaluation.

METHODS: ECHS program data were linked to birth records and the Pregnancy Risk Assessment Monitoring System (PRAMS) for 869 women who delivered a live birth in Burke and McDuffie counties from 2010 to 2011. Multivariate logistic regressions with and without propensity score methods modeled the association between ECHS participation and maternal health indicators and pregnancy outcomes.

RESULTS: 107 ECHS participants and 726 non-participants responded to PRAMS and met eligibility criteria. Compared with non-participants, ECHS participants were younger, completed fewer years of education, and were more likely to be non-Hispanic Black, unmarried, insured with Medicaid, participating in WIC, and having an unintended pregnancy. Models with and without propensity score weighting derived similar results: there was a positive association between ECHS participation and receiving adequate or adequate plus prenatal care (p < 0.05); no statistically significant associations were observed between ECHS participation and any other health behaviors, health care access and utilization measures or pregnancy outcomes.

DISCUSSION: Rigorous evaluation of a local Healthy Start program using linked PRAMS and birth records with a population-based external comparison group and propensity score methods is an enhanced and feasible approach that can be applied in other local and state jurisdictions.

PMID:34417685 | DOI:10.1007/s10995-021-03205-4

J Assist Reprod Genet. 2021 Aug 20. doi: 10.1007/s10815-021-02296-w. Online ahead of print.

ABSTRACT

PURPOSE: This study sought to report on the route and gestational age at delivery of gestational carrier (GC) pregnancies with respect to the GCs’ prior obstetric history.

METHODS: A retrospective analysis of all GC pregnancies from one of the largest surrogacy agencies in California between 2008 and 2018 was performed. Available demographic data and obstetric history, including a history of prior cesarean section (CS) and preterm birth (PTB), were collected for each GC and correlated to outcomes of the index GC pregnancy. Primary outcomes for the index GC pregnancies included delivery route and gestational age at delivery.

RESULTS: Eight-hundred-thirty-six GCs were included in our analysis. 319 (38.2%) delivered via CS, and 517 (61.8%) delivered vaginally. 60 (18.8%) of the CS deliveries were due to multifetal gestation. Primary CS rate in singleton GC pregnancies was 38.5%. In women without a history of CS, neither age, BMI, interpregnancy interval, prior parity, nor year of delivery impacted the primary singleton CS rate (all, P > 0.05). Of GCs with a history of a prior CS (n = 350, 41.9%), 218 (62.3%) had a vaginal delivery after CS (VBAC) and 132 (37.7%) had a repeat CS. Women who had successful VBACs were significantly younger than those who had repeat CS (mean 33.7 vs. 35.2 years, P = .003). BMI was lower in patients who had a VBAC compared to those that had a repeat CS (mean BMI 24.6 vs. 25.5, P = 0.074), although this did not reach statistical significance. In GCs with a history of CS, interpregnancy interval, year of delivery, prior parity, and multiple gestation in the index GC pregnancy did not impact mode of delivery. VBAC rates did not change over the study period (P = 0.757). Overall PTB rate was 15.1%. Most PTB in GC pregnancies were in those with a history of PTB, and PTB was more likely in singletons rather than multifetal gestations (76.7% in singletons vs. 30% in multiples) in patients with history of PTB (P < 0.001). Those with no history of PTB and who carried multiples had a low rate of PTB; in fact, in this group, only 1 out of 35 patients had a PTB with multiples.

CONCLUSIONS: Both primary CS and PTB rates in singleton GC pregnancies are higher than national averages. CS rates are independent of age, BMI, and interpregnancy interval. In GCs with a history of a CS, VBAC rates well exceed national averages and are higher in younger GCs with a lower BMI. PTB rates are impacted primarily by the GCs obstetric history. In those GCs without a history of PTB, rates of PTB are low, even in those with a multifetal gestation.

PMID:34417659 | DOI:10.1007/s10815-021-02296-w

Lifetime Data Anal. 2021 Aug 20. doi: 10.1007/s10985-021-09531-7. Online ahead of print.

ABSTRACT

The case-cohort design has been widely used to reduce the cost of covariate measurements in large cohort studies. In many such studies, the number of covariates is very large, and the goal of the research is to identify active covariates which have great influence on response. Since the introduction of sure independence screening, screening procedures have achieved great success in terms of effectively reducing the dimensionality and identifying active covariates. However, commonly used screening methods are based on marginal correlation or its variants, they may fail to identify hidden active variables which are jointly important but are weakly correlated with the response. Moreover, these screening methods are mainly proposed for data under the simple random sampling and can not be directly applied to case-cohort data. In this paper, we consider the ultrahigh-dimensional survival data under the case-cohort design, and propose a conditional screening method by incorporating some important prior known information of active variables. This method can effectively detect hidden active variables. Furthermore, it possesses the sure screening property under some mild regularity conditions and does not require any complicated numerical optimization. We evaluate the finite sample performance of the proposed method via extensive simulation studies and further illustrate the new approach through a real data set from patients with breast cancer.

PMID:34417679 | DOI:10.1007/s10985-021-09531-7

Knee Surg Sports Traumatol Arthrosc. 2021 Aug 21. doi: 10.1007/s00167-021-06708-3. Online ahead of print.

ABSTRACT

PURPOSE: The optimal technique for arthroscopic rotator cuff repair is still controversial. The aim of this study was to compare modified arthroscopic double-pulley suture-bridge (DPSB) technique with medial knot tying to those without tying, considering clinical and radiological outcomes.

METHODS: This study included 292 patients with large full-thickness rotator cuff tears treated with modified DPSB technique. The patients were divided into 158 cases with medial knot tying (knot-tying group) and 134 without tying (knotless group). At follow-up, clinical outcome was assessed by the Constant score, American Shoulder and Elbow Surgeons (ASES) score, and Shoulder Rating Scale of the University of California at Los Angeles (UCLA) score. The assessment of tendon healing was performed with magnetic resonance imaging (MRI) at a minimum of 12 months postoperatively.

RESULTS: The Constant score, ASES score and UCLA score in the knot-tying and knotless groups all improved significantly from before surgery to 12 months postoperatively (P < 0.05, respectively). No significant differences were observed between groups for each phase evaluated (n.s.). Tendon healing was categorised according to Sugaya’s classification. The retearing rate was 27/158 (17.0%) in the knot-tying group and 20/134 (14.9%) in the knotless group, with no statistically significant difference between groups (n.s.). Additionally, the retear was classified using the Cho’s classification. When comparing the retear rates of different types independently, no statistically significant differences were found between groups (n.s.).

CONCLUSIONS: The knotless modified DPSB technique showed comparable short-term functional outcomes to those of the knot tying method in large full-thickness rotator cuff tears. Additionally, no significant differences in repair integrity were observed between the two methods. Both techniques can be considered effective treatments for patients with large-sized full-thickness rotator cuff tears.

LEVEL OF EVIDENCE: III.

PMID:34417658 | DOI:10.1007/s00167-021-06708-3

Neuroradiology. 2021 Aug 20. doi: 10.1007/s00234-021-02782-z. Online ahead of print.

ABSTRACT

PURPOSE: Gait improvement following high-volume lumbar puncture (HVLP) and continuous lumbar drain (cLD) is widely used to predict shunt response in patients with suspected normal pressure hydrocephalus (NPH). Here, we investigate differences in MRI volumetric and traditional measures between HVLP/cLD responders and non-responders to identify imaging features that may help predict HVLP/cLD response.

METHODS: Eighty-two patients with suspected NPH were studied retrospectively. Gait testing was performed before and immediately/24 h/72 h after HVLP/cLD. A positive response was defined as improvement in gait post-procedure. Thirty-six responders (26 men; mean age 79.3 ± 6.3) and 46 non-responders (25 men; mean age 77.2 ± 6.1) underwent pre-procedure brain MRI including a 3D T1-weighted sequence. Subcortical regional volumes were segmented using FreeSurfer. After normalizing for total intracranial volume, two-way type III ANCOVA test and chi-square test were used to characterize statistical group differences. Evans’ index, callosal angle (CA), and disproportionately enlarged subarachnoid space hydrocephalus were assessed. Multivariable logistic regression models were tested using Akaike information criterion to determine which combination of metrics most accurately predicts HVLP/cLD response.

RESULTS: Responders and non-responders demonstrated no differences in total ventricular and white/gray matter volumes. CA (men only) and third and fourth ventricular volumes were smaller; and hippocampal volume was larger in responders (p < 0.05). Temporal horns volume correlated with degree of improvement in gait velocity in responders (p = 0.0006). The regression model was 76.8% accurate for HVLP/cLD response.

CONCLUSION: CA and third and fourth ventricular volumes and hippocampal volume may serve as potentially useful imaging features that may help predict spinal tap response and hence potentially shunt response.

PMID:34417636 | DOI:10.1007/s00234-021-02782-z

Eur Child Adolesc Psychiatry. 2021 Aug 20. doi: 10.1007/s00787-021-01863-x. Online ahead of print.

ABSTRACT

The present study investigated how intervention might alter the relationship between perpetrating violence and later drug use. A cluster-randomized controlled trial design involving 72 schools (38 intervention, 34 control) and 6390 students attending grades 7 and 8 was employed in Brazil. Drug use and violence were assessed at three points. A random-intercept cross-lagged panel model examined the reciprocal association between drug use and school violence domains across the three data collection waves. For both groups, we found that the cross-lagged effect of perpetration on further drug use in adolescents was stronger than the reverse, but the interrelationship was not statistically significant between #Tamojunto and control schools. The carry-over effects of drug use and violence were also not significantly different between groups. There is a lack of evidence showing that #Tamojunto can modify the dynamics between drug use and school violence across the 21-month period. The direction of the causal effect (i.e., the more perpetration behavior, the more subsequent drug use behavior) is present, but weak in both groups. The trial registration protocol at the national Brazilian Register of Clinical Trials (REBEC) is #RBR-4mnv5g.

PMID:34417649 | DOI:10.1007/s00787-021-01863-x