Tag: nevin manimala

Eur J Obstet Gynecol Reprod Biol. 2021 Dec 2;268:82-86. doi: 10.1016/j.ejogrb.2021.11.435. Online ahead of print.

ABSTRACT

OBJECTIVES: To establish the frequency of torsion with multiple twists of the adnexa in girls 19 years old and younger surgically diagnosed with torsion.

STUDY DESIGN: A retrospective chart review using an institutional tool to review charts of female patients 19 years old or younger who presented with acute abdominal pain leading to a surgical diagnosis of adnexal torsion.

RESULTS: Of 141 pediatric patients with torsion, 61 (43%) had documentation of multiple twists, with 2 to 12 rotations present. 33% reported acute pain (<24 hrs) whereas most (67%) had pain > 24 h up to 4 weeks without abatement (23%) or experienced discrete episodes with pain resolution between episodes (44%). Even when vascular flow was demonstrated, multiple twists were frequently found (14/36 = 39%). When multiple twists were documented, more patients had an extirpative procedure due to a nonviable appearing ovary than when a single or unstated number of twists twist was found, although the results were not statistically significant (53.5% vs 42.9%, p = 0.098).

CONCLUSIONS: Forty-three percent of girls presenting with symptoms of torsion had multiple twists in the adnexa. Many had provided a history of previous similar episodes of pain and presentation to emergency departments, suggesting possible previous undiagnosed episodes of torsion. Earlier diagnosis may provide a better opportunity for ovarian conservation prior to a recurrent torsion. Further study may reveal whether multiple twists are more likely to result in a nonviable ovary and need for oophorectomy.

PMID:34883338 | DOI:10.1016/j.ejogrb.2021.11.435

Public Health. 2021 Dec 6;202:43-48. doi: 10.1016/j.puhe.2021.10.009. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess the utility and measurement properties for the well-being scale Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS) in a Swedish general population survey.

STUDY DESIGN: A cross-sectional survey study.

METHODS: Data were retrieved from the 2018 public health survey in Stockholm County, containing a random sample of 22 856 persons stratified to be representative for the municipalities and districts within the region. The data were analyzed according to Rasch Measurement Theory.

RESULTS: Person attribute values are positively skewed (mean 2.32, SD 1.85), with wide gaps in the item threshold attribute values. Overall item fit statistics were acceptable, and person measurement separation reliability was 0.83, indicating three statistically distinct ranges in the estimated well-being values.

CONCLUSION: While the SWEMWBS items indicated acceptable fit to the Rasch measurement model, targeting of items to sample is skewed toward lower levels of well-being, and there is a ceiling effect. Thus, we suggest a careful reconsideration of SWEMWBS as a tool for use in general public health surveys, especially for assessing change over time and group differences, as there are large measurement uncertainties for the majority of cases when the population as a whole is sampled. We encourage revisions applying a coherent and comprehensive ordinal construct theory for well-being to fill the gaps in the upper end of the SWEMWBS scales’ item thresholds. The addition of more challenging items would improve targeting for population-based surveys, increase reliability, and provide more actionable information that could be useful in improving individuals’ well-being.

PMID:34883409 | DOI:10.1016/j.puhe.2021.10.009

Soc Sci Med. 2021 Dec 1;292:114620. doi: 10.1016/j.socscimed.2021.114620. Online ahead of print.

ABSTRACT

OBJECTIVE: The symptoms and prognosis of Alzheimer’s disease (AD) dementia contribute to the public’s negative reactions toward individuals with AD dementia and their families. But what if, using AD biomarker tests, diagnosis was made before the onset of dementia, and a disease-modifying treatment was available? This study tests the hypotheses that a “preclinical” diagnosis of AD and treatment that improves prognosis will mitigate stigmatizing reactions.

METHODS: A sample of U.S. adults were randomized to receive one vignette created by a 3 × 2 × 2 vignette-based experiment that described a person with varied clinical symptom severity (Clinical Dementia Rating stages 0 (no dementia), 1 (mild), or 2 (moderate)), AD biomarker test results (positive vs negative), and disease-modifying treatment (available vs not available). Between-group comparisons were conducted of scores on the Modified Family Stigma in Alzheimer’s Disease Scale (FS-ADS).

RESULTS: The sample of 1,817 adults had a mean age two years younger than that of U.S. adults but was otherwise similar to the general adult population. The response rate was 63% and the completion rate was 96%. In comparisons of randomized groups, mild and moderate symptoms of dementia evoked stronger reactions on all FS-ADS domains compared to no dementia (all p < 0.001). A positive biomarker test result evoked stronger reactions on all but one FS-ADS domain (negative aesthetic attributions) compared to a negative biomarker result (all p < 0.001). Disease-modifying treatment had no measurable influence on stigma (all p > 0.05).

CONCLUSIONS: The stigmas of dementia spill over into preclinical AD, and availability of treatment does not alter that stigma. Translation of the preclinical AD construct from research into practice will require interventions that mitigate AD stigma to preserve the dignity and identity of individuals living with AD.

PMID:34883313 | DOI:10.1016/j.socscimed.2021.114620

Int J Hyg Environ Health. 2021 Dec 6;240:113895. doi: 10.1016/j.ijheh.2021.113895. Online ahead of print.

ABSTRACT

BACKGROUND/AIM: Glyphosate, a broad-spectrum herbicide, and its main metabolite aminomethylphosphonic acid (AMPA) are persistent in the environment. Studies showed associations between glyphosate or AMPA exposure and several adverse cellular processes, including metabolic alterations and oxidative stress.

OBJECTIVE: To determine the association between glyphosate and AMPA exposure and biomarkers of biological aging.

METHODS: We examined glyphosate and AMPA exposure, mtDNA content and leukocyte telomere length in 181 adults, included in the third cycle of the Flemish Environment and Health Study (FLEHSIII). DNA was isolated from leukocytes and the relative mtDNA content and telomere length were determined using qPCR. Urinary glyphosate and AMPA concentrations were measured by Gas Chromatography-Tandem Mass Spectrometry (GC-MS-MS). We used multiple linear regression models to associate mtDNA content and leukocyte telomere length with glyphosate or AMPA exposure while adjusting for confounding variables.

RESULTS: A doubling in urinary AMPA concentration was associated with 5.19% (95% CI: 0.49 to 10.11; p = 0.03) longer leukocyte telomere length, while no association was observed with urinary glyphosate concentration. No association between mtDNA content and urinary glyphosate nor AMPA levels was observed.

CONCLUSIONS: This study showed that AMPA exposure may be associated with telomere biology in adults.

PMID:34883335 | DOI:10.1016/j.ijheh.2021.113895

J Vasc Surg Venous Lymphat Disord. 2021 Dec 6:S2213-333X(21)00594-1. doi: 10.1016/j.jvsv.2021.11.006. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the effect of the learning curve on percutaneous thrombectomy (PT) outcomes for the treatment of lower extremity deep vein thrombosis (DVT).

METHODS: The study was conducted between October 2019 and September 2020, with patients who had undergone PT due to lower extremity DVT (common iliac, external iliac, common femoral, femoral and popliteal veins). For thrombectomy, aspiration and mechanical thrombectomy procedures were performed until the thrombus was completely dissolved by Dovi (aspiration system) and MANTIS (mechanical thrombectomy system) (INVAMED, Ankara, Turkey). A total of 80 patients were divided equally into 4 groups, with the first 20 cases in Group 1, the second group being the subsequent 20 cases and the final 20 cases in Group 4. Groups were compared for demographic characteristics, intraoperative outcomes, complication rate, and success of procedures.

RESULTS: All demographic parameters were similar between groups. The mean operation time was 139.3 min for group 1, 134.8 min for group 2, 111.3 min for group 3 and 106.7 min for group 4, and statistical analysis revealed that operation time was significantly shorter for group 3 and group 4 in comparison with group 1 and group 2. In addition, fluoroscopy time was significantly decreased in group 3 and group 4 (p= 0.001). Complication rate was similar between the groups (p= 0. 899). However, success was significantly increased after 20 cases, and the other three groups had significantly higher success rate in comparison with group 1 (70% for group 1, 90% for group 2, 95% for group 3 and 100% for group 4, p= 0.024).

CONCLUSION: Success in performance of percutaneous thrombectomy for treatment of acute lower extremity deep vein thrombosis reaches satisfactory levels after 20 cases. Additionally, operation time and fluoroscopy time are significantly decreased after 40 cases and then start plateau.

PMID:34883270 | DOI:10.1016/j.jvsv.2021.11.006

Forensic Sci Int. 2021 Dec 2;330:111135. doi: 10.1016/j.forsciint.2021.111135. Online ahead of print.

ABSTRACT

When estimating the age of an individual it is critical that 1) age ranges are as narrow as possible while still capturing the true age of the individual with an acceptable frequency, and 2) this frequency is known. When multiple traits are used to produce a single age estimate, the simplest practice is to assume that the traits are conditionally independent from one another given age. Unfortunately, if the traits are correlated once the effect of age is accounted for, the resulting age intervals will be too narrow. The frequency at which the age interval captures the true age of the individual will be decreased below the expected value to some unknown degree. It is therefore critical that age estimation methods that include multiple traits incorporate the possible correlations between them. Moorrees et al. (1963) [1] scores of the permanent mandibular dentition from 2607 individuals between 2 and 23 years were used to produce and cross-validate a cumulative probit model for age estimation with an optimal number of stages for each tooth. Two correction methods for covariance of development between teeth were tested: the variance-covariance matrix for a multivariate normal, and the Boldsen et al. (2002) [2] ad-hoc method. Both correction methods successfully decreased age interval error rates from 21% to 23% in the uncorrected model to the expected value of 5%. These results demonstrate both the efficacy of these correction methods and the need to move away from assuming conditional independence in multi-trait age estimation.

PMID:34883298 | DOI:10.1016/j.forsciint.2021.111135

J Arthroplasty. 2021 Dec 6:S0883-5403(21)00904-9. doi: 10.1016/j.arth.2021.11.039. Online ahead of print.

ABSTRACT

BACKGROUND: There is a paucity of data on blood loss and the risk of allogeneic blood transfusion after simultaneous bilateral total hip arthroplasty (SBTHA) with contemporary blood management including neuraxial anesthesia, routine tranexamic acid (TXA) use, and a restrictive transfusion protocol. As such, we sought to determine the in-hospital outcomes of SBTHA, specifically analyzing blood loss and the rate and risk factors for transfusion.

METHODS: We identified 191 patients that underwent SBTHA at a single institution from 2016-2019. No drains were utilized and no patients donated blood preoperatively. Mean age was 59 years with 96 females (50.3%). The surgical approach was posterior in 138 (72.3%) and direct anterior in 53 (27.7%) patients. We analyzed blood loss, the rate of allogeneic blood transfusions, and in-hospital thromboembolic complications. We analyzed risk factors for transfusion with a logistic regression analysis.

RESULTS: Twenty-two patients (11.5%) underwent allogeneic blood transfusion. All transfused patients were female. Univariate analysis revealed female sex as a transfusion risk factor since it had statistically significant higher proportion in the transfusion group than the non-transfusion group (100% vs. 43.5%, respectively, p<0.001). We did not identify any other singular significant risk factors for transfusion in a multivariable regression analysis. However, females with a preoperative Hgb <12 had an elevated risk of transfusion at 37.5% (15/40 patients).

CONCLUSION: With contemporary perioperative blood management protocols, there is a relatively low (11.5%) risk of a blood transfusion after SBTHA. Females with a lower preoperative Hgb (<12 g/dL) had the highest risk of transfusion at 37.5%.

PMID:34883254 | DOI:10.1016/j.arth.2021.11.039

Microb Pathog. 2021 Dec 6:105340. doi: 10.1016/j.micpath.2021.105340. Online ahead of print.

ABSTRACT

BACKGROUND: Growing evidence implicates the potential effect of microbiota on the pathogenesis and course of epilepsy. However, the effects of valproate (VPA), a broad spectrum anti-epileptic drugs, on gut microbiota have not been investigated in humans. This study aimed to analyze fecal microbiota in patients with epilepsy treated with valproate.

METHODS: A total of 10 participants, who were newly diagnosed of cryptogenic epilepsy with treatment naïve and received 1000 mg daily doses of VPA, were recruited in our prospective study. Microbiota compositions were evaluated at baseline and after three months of VPA treatment using 16S rDNA sequencing.

RESULTS: VPA treatment was associated with clinical improvements in all patients, but not changes in gut microbiota richness and complexity (Shannon: p = 0.82). Microbiome composition structure differences also revealed no statistical difference in dissimilarity (Adonis: p = 0.90). No statistical difference taxa were found between two groups. However, the ratio of phyla Firmicutes to Bacteriodetes (ANOVA: p = 0.037) markedly raised after three months of VPA-treatment. A correlation matrix based on the spearman correlation distance confirmed associations between specific fecal taxa and VPA-related clinical metabolic parameters, including drug concentration in the blood, total cholesterol, triglyceride, lactate dehydrogenase, alanine aminotransferase, aspartate aminotransferase and weight gain. (p < 0.05) CONCLUSIONS: Among those patients treated with VPA, characterization of the gut microbiota altered, and gut microbiota associated with weight gain and clinical biochemical indexes, suggesting that microbiome composition data might involve in the mechanisms of VPA induced metabolic disorder.

PMID:34883229 | DOI:10.1016/j.micpath.2021.105340

Resuscitation. 2021 Dec 6:S0300-9572(21)00505-0. doi: 10.1016/j.resuscitation.2021.11.039. Online ahead of print.

ABSTRACT

AIM: Mathematical optimization of automated external defibrillator (AED) placement has demonstrated potential to improve survival of out-of-hospital cardiac arrest (OHCA). Existing models mostly aim to improve accessibility based on coverage radius and do not account for detailed impact of delayed defibrillation on survival. We aimed to predict OHCA survival based on time to defibrillation and developed an AED placement model to directly maximize the expected survival rate.

METHODS: We stratified OHCAs occurring in Singapore (2010 to 2017) based on time to defibrillation and developed a regression model to predict the Utstein survival rate. We then developed a novel AED placement model, the maximum expected survival rate (MESR) model. We compared the performance of MESR with a maximum coverage model developed for Canada that was shown to be generalizable to other settings (Denmark). The survival gain of MESR was assessed through 10-fold cross-validation for placement of 20 to 1000 new AEDs in Singapore. Statistical analysis was performed using χ² and McNemar’s tests.

RESULTS: During the study period, 15,345 OHCAs occurred. The power-law approximation with R² of 91.33% performed best among investigated models. It predicted a survival of 54.9% with defibrillation within the first two minutes after collapse that was reduced by more than 60% without defibrillation within the first 4 minutes. MESR outperformed the maximum coverage model with P-value <0.05 (<0.0001 in 22 of 30 experiments).

CONCLUSION: We developed a novel AED placement model based on the impact of time to defibrillation on OHCA outcomes. Mathematical optimization can improve OHCA survival.

PMID:34883217 | DOI:10.1016/j.resuscitation.2021.11.039

J Ethnopharmacol. 2021 Dec 6:114892. doi: 10.1016/j.jep.2021.114892. Online ahead of print.

ABSTRACT

ETHNOPHARMACOLOGICAL RELEVANCE: In China, Traditional Chinese medicine (TCM) is often used as the main therapy for cancer-related fatigue (CRF). However, there is limited evidence to prove its therapeutic effect and mechanism.

AIM OF THE STUDY: We aimed to provide a basis for the therapeutic effect of TCM for CRF.

MATERIALS AND METHODS: We performed a meta-analysis to investigate the efficacy of TCM treatment for CRF. Through frequency statistics and association rule mining, we screened the core Chinese medicine components, Astragalus mongholicus Bunge., root (Radix astragali, Huangqi) and Atractylodes macrocephala Koidz., rhizome (Rhizoma atractylodis macrocephalae, Baizhu). We then used animal experiments to verify the effectiveness of these two TCMs and changes in related indicators in mice. Relevant molecular mechanisms were explored through network pharmacological analysis.

RESULTS: Twenty-four randomised control trials (RCTs) involving 1865 patients were included in the meta-analysis. TCM produced more positive effects on CRF than standard therapy alone. Radix astragali and Rhizoma atractylodis macrocephalae, as the core drug pair for the treatment of CRF, enhanced the physical fitness of mice; reduced abdominal circumference, level of inflammatory factors, and tumour weight; and increased body weight and blood sugar. Network pharmacology analysis showed that the mechanism of action of Radix astragali and Rhizoma atractylodis macrocephalae on CRF mainly involved compounds, such as quercetin, kaempferol and luteolin, acting through multiple targets, such as Protein kinase B α (AKT1), Tumour necrosis factor (TNF), and Interleukin-6 (IL-6). These molecules regulate cytokines, cancer signalling, and metabolic pathways and confer an anti-CRF effect.

CONCLUSIONS: TCM may be a promising therapy to relieve CRF in cancer patients. Our research may provide a reference for the clinical application of TCM for treating CRF.

PMID:34883219 | DOI:10.1016/j.jep.2021.114892