Tag: nevin manimala

BMC Nephrol. 2022 Sep 8;23(1):308. doi: 10.1186/s12882-022-02931-3.

ABSTRACT

BACKGROUND: Acute kidney injury (AKI) was common in the first two waves of the SARS-COV-2 pandemic in critically ill patients. A high percentage of these patients required renal replacement therapy and died in the hospital.

METHODS: The present study examines the clinical presentation, laboratory parameters and therapeutic interventions in critically ill patients with AKI admitted to the ICU in two centres, one each in India and Pakistan. Patient and outcome details of all critically ill COVID 19 patients admitted to the ICU requiring renal replacement therapy were collected. Data was analysed to detect patient variables associated with mortality.

RESULTS: A total of 1,714 critically ill patients were admitted to the ICUs of the two centres. Of these 393 (22.9%) had severe acute kidney injury (AKIN stage 3) requiring dialysis. Of them, 60.5% were men and the mean (± SD) age was 58.78 (± 14.4) years. At the time of initiation of dialysis, 346 patients (88%) were oligo-anuric. The most frequent dialysis modality in these patients was intermittent hemodialysis (48.1%) followed by slow low efficiency dialysis (44.5%). Two hundred and six (52.4%) patients died. The mortality was higher among the Indian cohort (68.1%) than the Pakistani cohort (43.4%). Older age (age > 50 years), low serum albumin altered sensorium, need for slower forms of renal replacement therapy and ventilatory support were independently associated with mortality.

CONCLUSION: There was a very high mortality in patients with COVID-19 associated AKI undergoing RRT in the ICUs in this cohort from the Indian sub-continent.

PMID:36076183 | DOI:10.1186/s12882-022-02931-3

BMC Cancer. 2022 Sep 8;22(1):964. doi: 10.1186/s12885-022-10056-x.

ABSTRACT

BACKGROUND: First-line treatment of nonsquamous non-small cell lung cancer (NSCLC) has undergone a paradigm shift to platinum combination therapy together with immune checkpoint inhibitors (ICIs). However, phase III studies of combinations of cytotoxic chemotherapy and ICIs have included only patients with maintained organ function, not those with renal impairment.

METHODS: Cytotoxic chemotherapy-naïve advanced nonsquamous NSCLC patients aged 20 years or older with impaired renal function (creatinine clearance of 15 to 45 mL/min) are prospectively registered in this single-arm phase II study and receive combination therapy with carboplatin, nanoparticle albumin-bound (nab-) paclitaxel, and atezolizumab. Individuals with known genetic driver alterations including those affecting EGFR, ALK, ROS1, BRAF, MET, RET, and NTRK are excluded. We plan to enroll 40 patients over 2 years at 32 oncology facilities in Japan. The primary end point is confirmed objective response rate.

DISCUSSION: If the study demonstrates efficacy and safety of carboplatin/nab-paclitaxel/atezolizumab, then this combination regimen may become a treatment option even for nonsquamous NSCLC patients with impaired renal function.

TRIAL REGISTRATION: Registered with Japan Registry for Clinical Trials on 25 February 2021 (jRCTs071200102).

PMID:36076179 | DOI:10.1186/s12885-022-10056-x

Otol Neurotol. 2022 Sep 9. doi: 10.1097/MAO.0000000000003673. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess quality-of-life (QoL) outcomes after modified subtotal petrosectomy with ear canal closure (mSTP) for chronic otitis media.

STUDY DESIGN: Survey study.

SETTING: Tertiary referral center.

PATIENTS: Patients with chronic otitis media.

INTERVENTIONS: mSTP.

MAIN OUTCOME MEASURES: Survey results from enrolled patients on the validated disease-specific Chronic Ear Survey (CES) and Chronic Otitis Media Outcome Test-15 (COMOT-15) regarding their current state of health and, if surgery was performed within 3 years of enrollment, their state of health before mSTP.

RESULTS: A total of 23 patients were studied, including 19 who underwent surgery within 3 years of enrollment. Postoperatively, mean total CES scores were 80 and COMOT-15 scores were 41, with a higher CES and a lower COMOT-15 indicating better QoL. There were statistically significant improvements after mSTP in the CES activity restriction (25% difference; p = 0.008), symptom (17% difference; p = 0.007), and medical resource (13% difference; p = 0.03) domain and total (18% difference; p = 0.006) scores. In addition, there were statistically significant improvements in the COMOT-15 ear symptom (-22% difference; p < 0.001) domain and total (-16% difference; p = 0.01) scores; however, improvements in the hearing function and mental health domains did not achieve statistical significance. Postoperative COMOT-15 total scores were significantly better for patients who underwent aural rehabilitation compared to those who did not (-17% difference; p < 0.001).

CONCLUSION: Modified subtotal petrosectomy with ear canal closure is a useful intervention for patients with recalcitrant chronic otitis media, offering improved QoL in appropriately selected patients. Aural rehabilitation, when feasible, provides the potential for further QoL improvement.

PMID:36075106 | DOI:10.1097/MAO.0000000000003673

Otol Neurotol. 2022 Sep 9. doi: 10.1097/MAO.0000000000003679. Online ahead of print.

ABSTRACT

OBJECTIVES: 1) To assess long-term hearing results after endoskeletal ossicular chain reconstruction (eOCR) using the titanium Kraus K-Helix Crown prosthesis, implanted incus to stapes, with glass-ionomer cement (GIC) in chronic ears and 2) to determine safety of the prosthesis and cement.

STUDY DESIGN: Prospective, nonrandomized, sequential, single center, single surgeon.

SETTING: Private practice, ambulatory surgical center.

PATIENTS: N = 15 males (42%) and 21 females (58%). Mean age was 40.4 years (range, 6-81 years); 38 ears (22 right ears [58%] and 16 left ears [42%]).

INTERVENTIONS: eOCR in chronic ears. Comprehensive preoperative and postoperative hearing measurements were performed for up to 9 years.

MAIN OUTCOME MEASURES: Postoperative hearing results at 1 year showed statistically significant improvement as compared with preoperative hearing. Long-term hearing results remained stable and showed no statistically significant change over 9 years.

RESULTS: Estimated mean pure-tone air conduction average improved by 14.5 dB (95% confidence interval = 10.3-18.7). Estimated mean speech reception thresholds improved by 15.5 dB (10.8-20.2). Word recognition scores improved by -2.2% (-5.3 to 1.0). The estimated mean postoperative air-bone gap was 10.5 dB (7.2-13.8). The estimated mean calculated air-bone gap was 11.3 dB (8.0-14.5). The estimated mean change in high-tone bone conduction (HTBC) average was +3.5 dB (0.9-6.0). Two prostheses extruded (5%). No patients experienced any unanticipated serious adverse effects or events.

CONCLUSION: eOCR using the K-Helix Crown prosthesis, incus to stapes, and GIC can significantly improve hearing at 1 year and maintain stable hearing over 9 years. Both prosthesis and cement are safe.

PMID:36075096 | DOI:10.1097/MAO.0000000000003679

Otol Neurotol. 2022 Sep 8. doi: 10.1097/MAO.0000000000003681. Online ahead of print.

ABSTRACT

OBJECTIVE: To analyze our institutional experience with two active transcutaneous bone-anchored hearing aids.

STUDY DESIGN: Retrospective cohort study.

SETTING: Tertiary academic otology-neurotology practice.

PATIENTS: Patients with conductive or mixed hearing losses meeting criteria to receive active transcutaneous bone-anchored hearing aids.

INTERVENTIONS: Implantation with one of two active transcutaneous bone-anchored hearing aids.

OUTCOME MEASURES: Operative time, dural exposure and decompression, use of lifts, implant position, ease of use, qualitative patient satisfaction, complication rates.

RESULTS: Ten patients received Implant 1 and 11 patients received Implant 2. The most common underlying etiologies of hearing loss were chronic suppurative otitis media in 33.3%, atresia/microtia in 23.8%, and cholesteatoma in 23.8%. Average operative times were 99.3 minutes for Implant 1 and 80.9 minutes for Implant 2 (p = 0.263). Implant 1 required lifts in 60%, dural exposure in 50%, and dural compression in 30%. Overall, placement was difficult in 47.6% of cases. There were no intraoperative complications. There were higher rates of issues with sound quality (27.3% versus 0.0%, p = 0.123) and poor cosmesis (36.4% versus 10.0%, p = 0.360) with Implant 2. Functional gain was not recorded, but all patients derived qualitative benefit from their implant. Three patients had local wound complications that self-resolved or were treated with antibiotics. One patient implanted at an outside institution required explant because of multiple infections.

CONCLUSIONS: There were no statistically significant differences in outcomes comparing Implants 1 and 2; however, Implant 2 had much higher rates of issues with audio quality and poor cosmesis. Placing Implant 1 often required special techniques.

PMID:36075090 | DOI:10.1097/MAO.0000000000003681

Obstet Gynecol. 2022 Sep 8. doi: 10.1097/AOG.0000000000004916. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the association of primary infertility with subsequent bilateral oophorectomy and hysterectomy, using a population-based cohort of women with primary infertility and age-matched women in a referent group.

METHODS: The Rochester Epidemiology Project record-linkage system was used to assemble a population-based cohort of women with primary infertility diagnosed between 1980 and 1999 (index date). Women were age-matched (±1 year) 1:1 to women without a history of infertility or hysterectomy at the index date (referent group). Cox proportional hazards models were fit to compare long-term risks of bilateral oophorectomy and hysterectomy, respectively, between women with infertility and women in the referent group.

RESULTS: Among both groups of 1,001 women, the mean age at the index date was 29.2±4.4 years. Median duration of follow-up was 23.7 years for both groups. Women with primary infertility were 1.7 times (adjusted hazard ratio [aHR] 1.69, 95% CI 1.22-2.33) more likely to undergo bilateral oophorectomy compared with women in the referent group. In a sensitivity analysis that excluded women with a diagnosis of infertility related to endometriosis and their matched referent group participants, this association persisted (aHR 1.50, 95% CI 1.06-2.14). Women with primary infertility did not have a significant increased risk of hysterectomy (aHR 0.98, 95% CI 0.79-1.23). However, risk of hysterectomy was increased in those with primary infertility related to endometriosis (aHR 1.94, 95% CI 1.12-3.34). We observed that women with primary infertility were more likely to undergo hysterectomy with bilateral oophorectomy. Women in the referent group were more likely to undergo hysterectomy with ovarian conservation. Few women in either group had isolated bilateral oophorectomy.

CONCLUSION: Primary infertility, with and without a diagnosis of endometriosis, is associated with an increased risk of bilateral oophorectomy. In women with endometriosis-related infertility, there is an association with future hysterectomy. These findings represent important confounders in the evaluation of long-term health outcomes related to primary infertility.

PMID:36075082 | DOI:10.1097/AOG.0000000000004916

Obstet Gynecol. 2022 Sep 8. doi: 10.1097/AOG.0000000000004931. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the existing evidence on the efficacy of pessaries in improving quality of life when used for the treatment of pelvic organ prolapse (POP).

DATA SOURCES: We searched for the terms “pelvic organ prolapse” and “pessar/y/ies/ium or vaginal support device,” and “safety or safe or outcome or complication or efficacy or effective or effectiveness” in PubMed, EMBASE, and CINAHL on March 16, 2020. A search was also performed on ClinicalTrials.gov, with no studies fitting our strict inclusion and exclusion criteria.

METHODS OF STUDY SELECTION: Studies that reported pretreatment and posttreatment mean scores and SDs after pessary treatment for standardized questionnaires were included. Studies performed in pediatric populations, pregnancy, and use of pessaries not for prolapse were excluded. Three reviewers independently screened studies.

TABULATION, INTEGRATION, AND RESULTS: Data abstraction was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Data were pooled for meta-analysis when reported by at least three studies. The primary study outcome was change in mean pretreatment and posttreatment questionnaire scores, which included those for the PFDI-20 (Pelvic Floor Distress Inventory- Short Form 20), PFIQ-7 (Pelvic Floor Impact Questionnaire – Short Form 7), and subscale POPIQ (Pelvic Organ Prolapse Impact Questionnaire Long Form). A random-effects model was used to combine estimates and capture between-study heterogeneity using the I2-statistic. Eight studies including 627 patients were included for systematic review. The mean (SD) age was 63.0±12.2 years, and the majority of patients had stage III prolapse (48.1%) followed by stage II prolapse (43.2%) when reported. Although variable, the majority of studies conducted 3-month follow-up. A negative change in pretreatment and posttreatment scores was noted, signifying improvement after pessary use: PFDI-20 mean change -46.1 (95% CI -65.4 to -26.8); PFIQ-7 mean change -36.0 (95% CI -46.0 to -26.0); POPIQ-7 (Pelvic Organ Prolapse Impact Questionnaire-7) mean change -16.3 (95% CI -26.8 to -5.7). No significant heterogeneity was found.

CONCLUSION: Based on improvements in standardized questionnaire scores, pessaries are effective treatment options for POP.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42020172618.

PMID:36075076 | DOI:10.1097/AOG.0000000000004931

Nucleosides Nucleotides Nucleic Acids. 2022 Sep 8:1-11. doi: 10.1080/15257770.2022.2118768. Online ahead of print.

ABSTRACT

Considering the role of miR-146a in the control of inflammation, we assessed the importance of two miR-146a polymorphisms (rs2910164 and rs57095329) in the development and severity of ulcerative colitis (UC) in Iran. Genomic DNA of 150 cases with UC and 200 healthy individuals were genotyped using the PCR-RFLP technique. Statistical analyses were performed using Med Calc software. The miR-146a rs2910164 C allele was significantly associated with increased risk of UC. Individuals carrying the CC (rs2910164) were more than fourfold higher risk of UC relative to wild type homozygotes. The combined GC + CC genotypes were also associated with increased UC risk. We also found that the rs2910164 CC genotype was associated with a severe form of the disease However, the distribution of variant allele and genotypes of rs57095329 did not differ between the cases and controls. In conclusion, miR-146a rs2910164 polymorphism may play a role in UC. To confirm our findings, additional well-designed studies in diverse ethnic populations are required.

PMID:36075029 | DOI:10.1080/15257770.2022.2118768

Rheumatology (Oxford). 2022 Sep 8:keac512. doi: 10.1093/rheumatology/keac512. Online ahead of print.

ABSTRACT

OBJECTIVES: Survival and death prognostic factors of systemic sclerosis (SSc) patients varied during the last decades. We aimed to update the 5- and 10-year survival rates and identify prognostic factors in a multicentre cohort of Italian SSc patients diagnosed after 2009.

METHODS: Patients who received a diagnosis of SSc after January 1st, 2009, and were longitudinally followed up in 4 Italian Rheumatologic Centres were retrospectively assessed up to December 31st, 2020. Overall survival of SSc patients was described using the Kaplan-Meier method. Predictors of mortality at 10-year follow-up were assessed by the Cox-regression model. A comparison of our cohort with the Italian general population was performed by determining the standardized mortality ratio (SMR).

RESULTS: A total of 912 patients (91.6% females, 20% dcSSc) were included. Overall survival rates at 5 and 10 years were 94.4%, and 89.4% respectively. The SMR was 0.96 (95% CI 0.81-1.13), like that expected in the Italian general population. Pulmonary arterial hypertension (PAH) and interstitial lung disease (ILD) associated with pulmonary hypertension (PH) significantly reduced survival (p< 0.0001). Main death predictors were male gender (HR = 2.76), diffuse cutaneous involvement (HR = 3.14), older age at diagnosis (HR = 1.08), PAH (HR = 3.21), ILD-associated PH (HR = 4.11), comorbidities (HR = 3.53), and glucocorticoid treatment (HR = 2.02).

CONCLUSIONS: In the last decade, SSc patients have reached similar mortality of that expected in the Italian general population. Male gender, diffuse cutaneous involvement, comorbidities, and PAH with or without ILD represent the main poor prognostic factors.

PMID:36074979 | DOI:10.1093/rheumatology/keac512

Altern Ther Health Med. 2022 Sep 9:AT7483. Online ahead of print.

ABSTRACT

CONTEXT: Severe acute pancreatitis (SAP) is a common critical illness, and stress hyperglycemia is the greatest independent risk factor for poor prognoses in critically ill patients. Enteral nutrition can not only provide an essential energy source for the body and improve a patient’s intestinal micro-ecology but also can play a critical role in blood glucose management, especially for blood glucose variability.

OBJECTIVE: The study intended to investigate the effects of different enteral nutrition preparations, including a slow-release starch, on blood glucose variability, nutritional status, inflammatory indexes, and prognosis for patients with SAP with stress hyperglycemia.

DESIGN: The research team designed a retrospective analysis of SAP patients’ data.

SETTING: The study took place in the Department of Critical Care Medicine at Ruijin Hospital of the Shanghai Jiao Tong University School of Medicine in Shanghai, China.

PARTICIPANTS: Participants were 129 SAP patients with stress hyperglycemia, who had a random blood glucose of ≥11.1 mmol/L and who had been admitted to the department at the hospital between January 2013 and December 2018.

INTERVENTION: After the recovery of intestinal function, Patients were inserted a nasointestinal feeding tube below the ligament of Treitz to deliver enteral nutrition. According to the presence or absence of enteral nutrition preparations containing slow-release starch in the nutritional therapy, the research team divided patients into an intervention group (n = 63) that received a protein-based, enteral nutrition preparation containing slow-release starch and a control group (n = 66) that received a protein- or short-peptide-based, enteral nutrition preparation containing no slow-release starch.

OUTCOME MEASURES: Postintervention for both groups, the research team measured the total amount of insulin used. At baseline and postintervention, the team measured for both groups: (1) the blood glucose variability: the average value of blood glucose (GLU AVE), standard deviation of blood glucose (GLU SD), coefficient of variation of blood glucose (GLU CV), large amplitude of glycemic excursions (GLU LAGE), and nutrition indicators-serum albumin (ALB), serum pre-albumin (PA), serum total protein (TP), and hemoglobin (HB); (2) the inflammatory markers: total amount of white blood cells (WBC), C-reactive protein (CRP), and procalcitonin (PCT); and (3) prognostic indicators: the length of ICU stay, total length of hospital stay, and 60-day and 90-day mortality.

RESULTS: The intervention group used significantly less insulin than the control group did, at 12.23 ± 6.74 and 35.31 ± 12.79 IU/d, respectively (P ≤ .05). Postintervention for 2 weeks, the blood glucose variability in the intervention group showed a decline. Between baseline and postintervention, the following significant decreases in blood glucose variability occurred for the group (P ≤ .05): (1) the GLU AVE from 14.27 ± 2.27 to 10.84 ± 1.97, (2) the GLU SD from 2.76 ± 1.48 to 2.15 ± 0.88, (3) the GLU CV from 20.1 ± 8.93 to 16.2 ± 3.61, and (4) the GLU LAGE from 7.9 ± 4.3 to 6.2 ± 2.5. Between baseline and postintervention, the following significant increases in blood glucose variability occurred for the control group (P ≤ .05): (1) the GLU AVE from 11.2 ± 2.3 to 12.1 ± 1.9, (2) the GLU SD from 1.9 ± 1.09 to 3.2 ± 1.0, (3) the GLU CV from 16.2 ± 6.2 to 19.6 ± 7.8, and (4) the GLU LAGE from 4.6 ± 2.6 to 5.0 ± 2.6. Postintervention, the GLU AVE, GLU SD, and GLU CV in the intervention group were significantly lower than those in the control group (p≤0.05). For nutritional indicators, the levels of ALB, PA, and TP in both groups significantly increased between baseline and postintervention (P ≤ .05), but HB didn’t increase. However, no statistically significant differences existed between the groups (P > .05). For inflammatory markers, the total WBCs, CRP, and PCT in both groups significantly declined between baseline and postintervention (P ≤ .05). However, the decline in CRP in the intervention group was greater, from 154.5 ± 64.8 to 8.4 ± 6.8, than that of the control group, from 155.2 ± 88.4 to 15.6 ± 13.4, but no statistically significant differences existed between the groups (P > .05). The length of ICU stay and total length of hospital stay in the intervention group, from 53.9 ± 5.21 d and 74.7 ± 9.18 d, respectively, were significantly shorter than those in the control group, at 25.9 ± 4.89 and 43.6 ± 7.98 , respectively (P ≤ .05). The 60-day and 90-day mortality in the intervention group were significantly lower than those in the control group, at 0% and 0% compared to 2.8% and 6.9%, respectively (P ≤ .05).

CONCLUSIONS: The application of enteral nutrition preparation containing sustained-release starch in treatment of SAP patients with stress hyperglycemia, may increase nutrition indicators quickly, significantly reduce blood glucose variability, improve inflammatory markers, shorten the length of ICU stay and hospital stay, and decrease the mortality.

PMID:36074968