Tag: nevin manimala

Clin Res Hepatol Gastroenterol. 2021 Apr 19;45(3):101594. doi: 10.1016/j.clinre.2020.101594. Online ahead of print.

ABSTRACT

BACKGROUND: Appropriate nutritional support is critical for patients undergoing liver transplantation (LT). Early enteral nutrition (EEN) has been considered effective in critically ill patients. However, the clinical effect of EEN on liver-transplanted patients is unclear.

AIM: To evaluate the clinical effect of early enteral nutrition in patients receiving a liver transplant.

METHODS: A systematic search was performed on the Cochrane Library, PubMed, CINAHL, EMBASE, Web of Science, WanFang database, Chinese Biomedical Literature Database and China National Knowledge Infrastructure to collect relevant studies up to January, 2020. The results of these studies were pooled to calculate relative risk and mean differences with 95% confidence intervals for dichotomous data and continuous data. All statistical analysis was carried out by Review Manager 5.3.

RESULTS: 9 RCTs and 10 cohort studies with 1300 patients were included in this meta-analysis. Compared with TPN, EEN reduced postoperative infection rates, ICU hours, length of hospitalization, and the duration of bowel ventilation as well as strengthening the nutritional status and liver function of LT patients. There is no difference in mortality rates, blood glucose levels or gastrointestinal complications. Compared to TPN, the combined EN + PN method more effectively prevented infection.

CONCLUSION: For patients undergoing liver transplantation, early enteral nutrition with or without combination may considered as a better nutritional therapy than total parenteral nutrition.

PMID:33887541 | DOI:10.1016/j.clinre.2020.101594

Pathol Res Pract. 2021 Apr 15;221:153447. doi: 10.1016/j.prp.2021.153447. Online ahead of print.

ABSTRACT

BACKGROUND: anaplastic lymphoma kinase (ALK) overexpression and gene alterations have been detected in several malignancies, with prognostic and therapeutic implications. However, few studies investigated the correlation between ALK altered expression and prognosis in patients with glioblastoma (GBM).

METHODS: We performed an evaluation of ALK overexpression and structural/quantitative chromosome alterations through immune-histochemical assay (IHC with D5F3 antibody) and fluorescent in situ hybridization (FISH) in patients with isocitrate dehydrogenase (IDH) wild type (wt) GBM. Assuming an ALK overexpression in 20 % of patients we planned a sample of 44 patients to achieve a probability of 90 % to include from 10 % to 30 % of patients with ALK alterations.

RESULTS: We evaluated 44 patients with IDH wt GBM, treated in our institution and dead due to GBM progression in 2017. ALK overexpression obtained by a composed score (the product of IHC intensity staining and rate of positive cells) was observed in 19 (43 %) patients. FISH analysis showed that 11 patients (25 %) had gene deletion, 2 patients (4.5 %) had monosomy and one patient (2.3 %) presented polysomy. Only one patient (2.3 %) demonstrated ALK rearrangement. There was no statistical difference in median OS between patients with ALK-positive (mOS = 18.9 months) and ALK-negative IHC (mOS = 18.0 months).

CONCLUSION: We identified some rare previously unreported alterations of ALK gene in patients with IDH wt GBM. In these patients, the ALK overexpression does not influences survival.

PMID:33887544 | DOI:10.1016/j.prp.2021.153447

Pain Pract. 2021 Apr 22. doi: 10.1111/papr.13021. Online ahead of print.

ABSTRACT

PURPOSE: Various adjuvants for prolongation of intraoperative and postoperative analgesia have been clinically studied, but the safety and efficiency of nalbuphine as an adjuvant to local anesthetics in spinal anesthesia remains unconfirmed. Therefore, we conducted a meta-analysis about the effect of nalbuphine as an adjuvant to local anesthetics in spinal anesthesia in regard to time of onset of sensory blockade and motor blockade,duration of motor blockade, two-segment sensory regression time, the duration of analgesia, and incidence of side effects to provide a reliable basis for clinical application.

METHODS: Databases including PubMed, Cochrane, EMBASE, Web of Science, CNKI, CBM, WanFang database and Viper database were searched for eligible studies. Data was extracted according to the proposed inclusion and exclusion criteria, RevMan 5.3 and Stata16 were selected to perform meta-analysis.

RESULTS: Eighteen published studies including 1633 patients met the inclusion criteria. The results showed that adding nalbuphine to local anesthetics for spinal anesthesia can prolong two-segment sensory regression time [MD=24.31; 95% CI 19.61~29.00, P < 0.001] and the duration of analgesia [(MD =118.11;95%CI 71.34 ~ 164.89, P < 0.001]without significantly increasing the incidence of adverse reactions in comparison to normal saline group. What’s more, the analgesic effect of nalbuphine group was not statistically different from that of control group when compared with the potent opioid group, but the occurrence of hypotension(RR = 0.35, 95% CI: 0.18-0.68, P<0.01), the occurrence of shivering(RR = 0.19, 95% CI: 0.08-0.43, P<0.01)and the occurrence of pruritus (RR = 0.23, 95% CI: 0.10-0.53, P<0.01) was lower than the potent opioid group.

CONCLUSIONS: Nalbuphine as additives to local anesthetics can significantly prolong the two segments of sensory block and the average duration of analgesia without increasing the incidence of adverse reactions when compared with normal saline group. And the analgesic efficacy of nalbuphine served as an adjunct to local anaesthetics was clinically not different from that of the potent opioids, but the occurrence of hypotension, shivering and pruritus was lower than the potent opioids.

PMID:33887111 | DOI:10.1111/papr.13021

Fam Med. 2021 Apr;53(4):295-299. doi: 10.22454/FamMed.2021.399314.

ABSTRACT

BACKGROUND AND OBJECTIVES: Substance use disorders (SUD) remain a public health crisis and training has been insufficient to provide the skills necessary to combat this crisis. We aimed to create and study an interactive, destigmatizing, skills-based workshop for medical students to evaluate if this changes students’ self-reported knowledge, skills, and attitudes toward patients with SUD.

METHODS: We surveyed students on a required family medicine outpatient rotation at a Pacific Northwest medical school during clerkship orientation on their views regarding SUDs utilizing the validated Drug and Drug Problems Perceptions Questionnaire containing a 7-point Likert scale. After attending a substance use disorder workshop, they repeated the survey. We calculated differences between the paired pre- to postsurveys.

RESULTS: We collected the pre- and postdata for 118 students who attended the workshop and showed statistically significant positive differences on all items.

CONCLUSIONS: The positive change in the medical students’ reported attitudes suggests both necessity and feasibility in teaching SUD skills in a destigmatizing way in medical training. Positive changes also suggest a role of exposing students to family medicine and/or primary care as a strategy to learn competent care for patients with substance use disorders.

PMID:33887053 | DOI:10.22454/FamMed.2021.399314

Int J Clin Pract. 2021 Apr 22:e14256. doi: 10.1111/ijcp.14256. Online ahead of print.

ABSTRACT

AIM: This study aimed to investigate hemogram parameters and CRP that can be used in clinical practice to predict mortality in hospitalized patients with a diagnosis of COVID-19.

METHODS: This cohort study was conducted at University Hospital, which is a designated hospital for COVID-19 patients. Adult patients who were admitted to our hospital emergency department with suspected COVID-19 and who were hospitalized in our institution with a COVID-19 diagnosis were analysed.

RESULTS: There were 148 patients hospitalized with COVID-19. All-cause mortality of follow-up was 12.8%. There were statistically significant results between the 2 groups (survivors and non-survivors), which were classified based on hospital mortality rates, in terms of the lymphocyte to C-reactive protein ratio (LCRP), Systemic immune inflammation index (SII), , neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), CRP concentration and comorbid disease. In a Receiver operating characteristic (ROC)”. curve analysis, LCRP, NLR, PLR, and SII area under the curve (AUC) for in-hospital mortality were 0.817, 0.816, 0.733 and, 0,742 respectively. Based on an LCRP value of 1 for in-hospital mortality, the sensitivity, and specificity rates were 100%, 86.8% respectively. Based on the average SII of 2699 for in-hospital mortality, the sensitivity, specificity, and accuracy rates were 68,4%, 77,5%, and 76,3%, respectively A total of 19 patients died during hospitalization. All of these patients had an LCRP level ≤ 1; 14 had an NLR level ≤ 10.8; 13 had a SII ≥ 2699 (Fisher’s exact test, p = 0.000). Independent predictors of in-hospital mortality rates were LCRP < 1, PLR, SII ≥ 2699, white blood cell count, CRP, age, comorbidities, and ICU stay.

CONCLUSIONS: We concluded that inflammatory parameters, such as LRCP, SII and NLR, were associated with disease severity and could be used as potentially important risk factors for COVID-19 progression.

PMID:33887100 | DOI:10.1111/ijcp.14256

Rev Saude Publica. 2021 Apr 14;55:10. doi: 10.11606/s1518-8787.2021055002685. eCollection 2021.

ABSTRACT

OBJECTIVE: To analyze the effect of matrix support on health for older adults in primary care according to the dimensions of frailty measured with the Clinical-Functional Vulnerability Index-20 (IVCF-20).

METHODS: This is a randomized controlled community trial, developed in the Northern Minas Gerais state, Brazil, in 2018. Initially, the stratification of clinical and functional vulnerability of older adults supported by six Family Health Strategy teams occurred with the IVCF-20. Subsequently, three teams were drawn to receive matrix support for six months, and the others for control. In this intervention, face-to-face educational activities were developed for health teams. Descriptive statistics were performed, followed by bivariate analysis by Pearson’s chi-square test, to compare the variables of the IVCF-20 between the two moments (before and after the intervention), with a 5% significance level. Relative risks and respective 95% confidence intervals (95%CI) were estimated.

RESULTS: The groups were similar before intervention, and the effect of matrix actions was positive for most dimensions measured by IVCF-20 (instrumental daily living activity, cognition, mood, mobility, communication, and multiple comorbidities). At the end of the research, the percentage of frailty in the group assisted by professionals participating in matrix support was lower than that of the control group.

CONCLUSIONS: Matrix support actions, such as pedagogical attribution and horizontal care for health teams, have the potential to contribute to the articulation of models of care for older adults.

REBEC: registro BR-7b9xff.

PMID:33886949 | DOI:10.11606/s1518-8787.2021055002685

J Burn Care Res. 2021 Apr 22:irab070. doi: 10.1093/jbcr/irab070. Online ahead of print.

ABSTRACT

Electrical burn injuries can cause devastating and debilitating morbidities and impairments for patients. This cross-sectional descriptive study was performed on electrical burn patients hospitalized from 2014 to 2019 to evaluate electrical burn injuries’ epidemiology and characteristics. A total number of 726 patients with the mean age of 31.17 years were evaluated for electrical burn injuries. Mean total burn surface area (TBSA) was 16.61 ± 12.56. Most victims were male (696 cases, 95.7%); and most patients did not have a constant job (n = 458, 63%). Most affected burn sites were hands (28.6%) and upper limbs (27.8%). A total number of 89 (12.2%) patients suffered amputations with the hand fingers (64 cases) as the most common site. Low voltage injuries were more common (n = 649 , 89%). Most incidents happened at the workplace (n =459 , 63%). Comparison of patients with high voltage and low voltage injuries showed significant correlations and statistical difference between these 2 groups regarding TBSA, mean hospital stays, escharectomy, fasciotomy, amputations, debridement, fracture and mortality rate (P = 0.001). Our observation revealed that electrical burn injuries are still significant causes of morbidity and mortality among trauma patients. In contrast to previous studies, low voltage injuries were more common than high voltage ones. We propose improvements in the manufacturing of electrical appliances; paying attention to safety measures will reduce thenumber of incidents. Moreover, training and education play important roles in reducing the number of incidents and mortality rates.

PMID:33886962 | DOI:10.1093/jbcr/irab070

Fam Med. 2021 Apr;53(4):256-266. doi: 10.22454/FamMed.2021.406778.

ABSTRACT

BACKGROUND AND OBJECTIVES: The feasibility of funding an additional year of residency training is unknown, as are perspectives of residents regarding related financial considerations. We examined these issues in the Family Medicine Length of Training Pilot.

METHODS: Between 2013 and 2019, we collected data on matched 3-year and 4-year programs using annual surveys, focus groups, and in-person and telephone interviews. We analyzed survey quantitative data using descriptive statistics, independent samples t test, Fisher’s Exact Test and χ2. Qualitative analyses involved identifying emergent themes, defining them and presenting exemplars.

RESULTS: Postgraduate year (PGY)-4 residents in 4-year programs were more likely to moonlight to supplement their resident salaries compared to PGY-3 residents in three-year programs (41.6% vs 23.0%; P=.002), though their student debt load was similar. We found no differences in enrollment in loan repayment programs or pretax income. Programs’ descriptions of financing a fourth year as reported by the program director were limited and budget numbers could not be obtained. However, programs that required a fourth year typically reported extensive planning to determine how to fund the additional year. Programs with an optional fourth year were budget neutral because few residents chose to undertake an additional year of training. Resources needed for a required fourth year included resident salaries for the fourth year, one additional faculty, and one staff member to assist with more complex scheduling. Residents’ concerns about financial issues varied widely.

CONCLUSIONS: Adding a fourth year of training was financially feasible but details are local and programs could not be compared directly. For programs that had a required rather than optional fourth year much more financial planning was needed.

PMID:33887047 | DOI:10.22454/FamMed.2021.406778

J Appl Oral Sci. 2021 Apr 19;29:e20200799. doi: 10.1590/1678-7757-2020-0799. eCollection 2021.

ABSTRACT

OBJECTIVES: This study aimed to investigate patterns and risk factors related to the feasibility of achieving technical quality and periapical healing in root canal non-surgical retreatment, using regression and data mining methods.

METHODOLOGY: This retrospective observational study included 321 consecutive patients presenting for root canal retreatment. Patients were treated by graduate students, following standard protocols. Data on medical history, diagnosis, treatment, and follow-up visits variables were collected from physical records and periapical radiographs and transferred to an electronic chart database. Basic statistics were tabulated, and univariate and multivariate analytical methods were used to identify risk factors for technical quality and periapical healing. Decision trees were generated to predict technical quality and periapical healing patterns using the J48 algorithm in the Weka software.

RESULTS: Technical outcome was satisfactory in 65.20%, and we observed periapical healing in 80.50% of the cases. Several factors were related to technical quality, including severity of root curvature and altered root canal morphology (p<0.05). Follow-up periods had a mean of 4.05 years. Periapical lesion area, tooth type, and apical resorption proved to be significantly associated with retreatment failure (p<0.05). Data mining analysis suggested that apical root resorption might prevent satisfactory technical outcomes even in teeth with straight root canals. Also, large periapical lesions and poor root filling quality in primary endodontic treatment might be related to healing failure.

CONCLUSION: Frequent patterns and factors affecting technical outcomes of endodontic retreatment included root canal morphological features and its alterations resulting from primary endodontic treatment. Healing outcomes were mainly associated with the extent of apical periodontitis pathological damages in dental and periapical tissues. To determine treatment predictability, we suggest patterns including clinical and radiographic features of apical periodontitis and technical quality of primary endodontic treatment.

PMID:33886941 | DOI:10.1590/1678-7757-2020-0799

J Appl Oral Sci. 2021 Apr 14;29:e20200978. doi: 10.1590/1678-7757-2020-0978. eCollection 2021.

ABSTRACT

Mucopolysaccharidosis (MPS) is a group of rare and inherited metabolic disorders caused by the accumulation of macromolecule glycosaminoglycans inside lysosomes. Affected individuals may have dental and craniofacial tissue alterations, facilitating the development of several oral diseases.

OBJECTIVES: To assess, with panoramic radiographic images, the frequency of dental and maxillomandibular incidental findings among MPS individuals and compare them with non-MPS individuals.

METHODOLOGY: A cross-sectional study evaluating a sample of 14 MPS individuals and 28 non-MPS individuals aged from 5 to 26 years was carried out. They were matched for sex and age on a 2:1 proportion. Panoramic radiographs were assessed for the presence/absence of the following dental and maxillomandibular alterations: dental anomalies of number (hypodontia/dental agenesis, supernumerary teeth); anomalies of form (microdontia, macrodontia, conoid teeth, taurodontism, and root dilaceration); anomalies of position (impacted tooth, inverted tooth, tooth migration, partially bony teeth, complete bony teeth); periapical alterations (furcation lesion, circumscribed bone rarefaction); other alterations (radiolucent bone lesions, radiopaque bone lesions, radiopacity in the maxillary sinus, condylar hypoplasia). Differences between groups were tested by the Fisher’s exact test and chi-square test (p<0.05).

RESULTS: For intrarater agreement, Kappa values were 0.76 to 0.85. The presence of supernumerary teeth (p=0.003); conoid teeth (p=0.009); taurodontism (p<0.001); impacted teeth (p<0.001); partial bony teeth (p=0.040); complete bony teeth (p=0.013); and root dilaceration (p=0.047) were statistically more frequent in MPS individuals compared to non-MPS individuals. Bone rarefaction/furcation lesions (p=0.032), condylar hypoplasia (p<0.001), radiolucent bone lesions (p=0.001), and dentigerous cysts (p=0.002) were also more frequent in MPS individuals.

CONCLUSION: The presence of specific oral manifestations is more common in MPS individuals than non-MPS individuals.

PMID:33886944 | DOI:10.1590/1678-7757-2020-0978