Tag: nevin manimala

Work. 2021 Nov 25. doi: 10.3233/WOR-205029. Online ahead of print.

ABSTRACT

BACKGROUND: Work-related stress (WRS) presents a risk for sick leave. However, effective methods to identify people at risk for sick leave due to WRS at an early stage are lacking in primary health care.

OBJECTIVE: To evaluate whether a systematic early identification of WRS can prevent sick leave over 24 months after the intervention.

METHODS: Study participants (n = 132 intervention; n = 139 control) were employed, non-sick-listed persons seeking care at primary health care centres. The intervention included early identification of WRS by a validated instrument, general practitioner (GP) awareness supported by a brief training session, patients’ self-reflection by instrument completion, GP giving the patient feedback at consultation and GP identifying preventive measures. The control group received treatment as usual. Outcome data were retrieved from the Swedish Social Insurance Agency.

RESULTS: The intervention group had less registered median sick leave days (n = 56) than the control group (n = 65) but the difference was not statistically significant.

CONCLUSIONS: The brief intervention was not proven effective in preventing sick leave in the following 24 months compared to treatment as usual. Further research on how to identify, advice and treat those at high risk for sick leave in primary health care is needed.

PMID:34842202 | DOI:10.3233/WOR-205029

J Surg Educ. 2021 Nov 25:S1931-7204(21)00318-4. doi: 10.1016/j.jsurg.2021.11.002. Online ahead of print.

ABSTRACT

OBJECTIVE: Integrated plastic surgery (PS) is one of the most competitive residency programs, but current literature lacks data specific to matched applicants from medical schools without home integrated PS residency programs (NHP). Therefore, there is a need to examine this specific demographic of applicants to identify key factors that led to a successful match.

DESIGN: An anonymous survey was sent to PS residents who graduated from US allopathic medical schools with NHP. Survey questions focused on applicants’ objective statistics (USMLE scores, research experiences, etc.), as well as various other factors, including access to resources and letters of recommendation.

SETTING: All US-based integrated plastic surgery residency programs.

PARTICIPANTS: PGY-1 through PGY-6 integrated PS residents who graduated from US allopathic medical schools with NHP.

RESULTS: The survey was distributed to 178 NHP residents from May to June of 2021, achieving a 55.1% response rate. Thirty-seven percent attended an institution with an independent, but not integrated, residency program. Average USMLE Step 1 and 2 scores were 248 ± 10.1 and 256 ± 9.7, respectively. Respondents reported having 9.8 ± 9.5 abstracts, presentations, and publications listed on their residency applications. NHP applicants had an average of 1.5 letters of recommendation written by away rotation faculty. Forty-five percent reported accessing resources at institutions with home integrated residency programs (HP), 55.6% of whom “strongly agreed” or “agreed” that this significantly helped in matching.

CONCLUSION: The USMLE Step scores and research experiences of NHP residents are similar to those which are reported among all matched applicants nationally. NHP respondents optimized their success by utilizing plastic surgery-related resources at their own institutions, while often seeking resources at other institutions.

PMID:34840121 | DOI:10.1016/j.jsurg.2021.11.002

J Plast Reconstr Aesthet Surg. 2021 Oct 22:S1748-6815(21)00481-2. doi: 10.1016/j.bjps.2021.09.044. Online ahead of print.

ABSTRACT

Insensate flaps are used in several reconstructions. A search of the literature showed that most studies are limited to particular flaps in specific body areas. There is a lack of uniform scientific data on the pattern of sensory recovery in various body parts for different kinds of flaps. We conducted a prospective observational study for over one year to study the pattern of sensory return in 74 flaps and studied the disparity in the return of sensation of touch, pain, warmth and cold. After that, we analyzed the relationship between sensory return in flaps and the region of the body (head and neck/upper limb/lower limb), type of flap (cutaneous/fasciocutaneous/musculocutaneous), age of patient and type of wound bed (surgically created defect/raw area such as post trauma, post debridement). Touch sensations were assessed by Semmes-Weinstein (SW) monofilament of 5.01 number, pain was assessed using a sterile 26 G needle, cold sensation was assessed using water at 4 °C and warm sensation was assessed using water at 44 °C. The sensations were evaluated at one-fourth and one-half of distance from the periphery to the center, at eight equidistant points along the circumference and at the center of the flap. Sensations were observed to return in the periphery of the flap earlier and in the center later. Touch sensation was recovered the earliest (three months onwards), followed by sensations of pain, warmth and cold (around the sixth month). Flaps performed in the head and neck showed the best recovery of sensation. Best recovery of sensation was observed in cutaneous flaps. Flaps performed on surgically created defects showed better recovery of sensation compared with flaps performed to cover raw areas; however, the differences were statistically nonsignificant. Children showed better recovery of sensations; however, this was not statistically significant. Sensory nerve coaptation is recommended in flaps folded on themselves and in fasciocutaneous flaps of the lower limb.

PMID:34840119 | DOI:10.1016/j.bjps.2021.09.044

Arab J Gastroenterol. 2021 Nov 25:S1687-1979(21)00060-5. doi: 10.1016/j.ajg.2021.05.021. Online ahead of print.

ABSTRACT

BACKGROUND AND STUDY AIMS: Progressive familial intrahepatic cholestasis (PFIC) is an autosomal recessively inherited disease that causes intrahepatic-hepatocellular cholestasis. PFIC constitutes approximately 10-15% of cholestatic liver diseases in children. The aim of this study is to draw attention to this group of diseases, which pose a higher risk, in societies where consanguineous marriage is more common, and to share our experiences since the studies in the literature, regarding this group of diseases are case series with small number of patients.

PATIENTS AND METHODS: This cross-sectional study was conducted on 34 patients who were admitted with jaundice and diagnosed by genetic analysis, between January 2015 and July 2020.

RESULTS: We found 17.6% of patients with PFIC type 1, 55.9% patients had PFIC type 2, 14.7% patients had PFIC type 3, 8.8% patients had PFIC type 4 and 2.9% patients had PFIC type 5. Partial internal biliary diversion was performed in 5 (14.7%) patients, who had severe itching during follow-up, did not respond to medical treatment, and did not have significant fibrosis in liver biopsy yet. The degree of itching before PIBD was rated as +4 (cutaneous erosion, bleeding and scarring), in 5 patients and the rates were 0 (absent) in two patients, and +1 (mild itching) in 3 patients, 6 months after PIBD, these differences were statistically significant(p = 0.027). The mean weight z score was-1.43 (-3.72-+0.73), before PIBD, while it was 0.39(-1.86 -+2.45), six months after PIBD; the diference was statistically significant(p = 0.043). Liver transplantation was performed in 12 (35.3%) patients with significant fibrosis in liver biopsy and developing signs of portal hypertension.

CONCLUSION: The PFIC disease group is a heterogeneous disease group that is difficult to diagnose and treat. It should be considered in patients with cholestasis and/or pruritus and those with a history of consanguineous marriage between parents and death of a sibling with similar clinical symptoms.

PMID:34840097 | DOI:10.1016/j.ajg.2021.05.021

Eur Urol Oncol. 2021 Nov 25:S2588-9311(21)00190-5. doi: 10.1016/j.euo.2021.10.007. Online ahead of print.

ABSTRACT

BACKGROUND: There is an ongoing need to develop prognostic biomarkers to improve the management of clear cell renal cell carcinoma (ccRCC).

OBJECTIVE: To leverage enriched pathways in ccRCC to improve risk-stratification.

DESIGN, SETTING, AND PARTICIPANTS: We retrospectively identified two complementary discovery cohorts of patients with ccRCC who underwent (1) radical nephrectomy (RNx) with inferior vena cava tumor thrombectomy (patients = 5, samples = 24) and (2) RNx for localized disease and developed recurrence versus no recurrence (n = 36). Patients with localized ccRCC (M0) in The Cancer Genome Atlas (TCGA, n = 386) were used for validation.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: A differential expression gene (DEG) analysis was performed on targeted RNA next-generation sequencing data from both discovery cohorts. Using TCGA for validation, Kaplan-Meier survival analysis and multivariable Cox proportional hazard testing were utilized to investigate the prognostic impact of DEGs, cell cycle proliferation (CCP), and a novel epithelial-mesenchymal transition (EMT) score on progression-free (PFS) and disease-specific (DSS) survival.

RESULTS AND LIMITATIONS: In the discovery cohorts, we observed overexpression of WT1 and CCP genes in the tumor thrombus versus the primary tumor, as well as in patients with recurrence versus those without recurrence. A hallmark pathway analysis demonstrated enrichment of the EMT- and CCP-related pathways in patients with high WT1 expression in the TCGA (validation) ccRCC cohort. CCP and EMT scores were derived in the validation cohort, which was stratified into four risk groups using Youden Index cut points: CCP^low/EMT^low, CCP^low/EMT^high, CCP^high/EMT^low, and CCP^high/EMT^high. The CCP^high/EMT^high risk group was associated with the worst PFS and DSS (both p < 0.001). In a multivariable analysis, CCP^high/EMT^high was independently associated with poor PFS and DSS (hazard ratio = 4.6 and 10.3, respectively; p < 0.001).

CONCLUSIONS: We demonstrate the synergistic prognostic impact of EMT in tumors with a high CCP score. Our novel EMT score has the potential to improve risk stratification and provide potential novel therapeutic targets.

PATIENT SUMMARY: Genes involved in epithelial-mesenchymal transition provides important prognostic information for patients with clear cell renal cell carcinoma.

PMID:34840106 | DOI:10.1016/j.euo.2021.10.007

Cont Lens Anterior Eye. 2021 Nov 25:101544. doi: 10.1016/j.clae.2021.101544. Online ahead of print.

ABSTRACT

PURPOSE: Contact lens discomfort (CLD) is a major concern that can lead to the decreased or abandoned use of contact lenses. Contact lens users with dry eye disease are more likely to present with CLD. This study was conducted to evaluate the efficacy of a bioprotective preservative free, hypotonic, 0.15% hyaluronic acid (HA)-3% Trehalose artificial tear in managing dry eye symptoms in contact lens wearers.

METHODS: A prospective, single-arm, observational pilot study to evaluate the effectiveness of treatment with HA-Trehalose artificial tears in contact lens wearers (N = 33) aged 18-45 years with symptoms of ocular discomfort. Participants used a preservative-free, hypotonic HA-Trehalose artificial tear (1 drop/4 times per day) for 84 days. Participants were assessed using Visual Analogue Scale (VAS) for dry eye symptoms (pain, photophobia, dry eye sensation, blurry vision, foreign body sensation, itching, tingling/burning, and sticky eye feeling), Ocular Surface Disease Index (OSDI), Contact Lens Dry Eye questionnaire (CLDEQ-8), Berkley Dry Eye Flow-Chart (DEFC) on Day 0 and Day 84 and tear break-up time (TBUT), ocular surface staining with fluorescein and lissamine green, tear meniscus evaluation, and visual acuity on Day 0, 35, and 84.

RESULTS: All VAS symptoms (except tingling/burning and sticky eye feeling), OSDI, CLEDQ-8, and DEFC showed statistically significant (p < 0.05) improvement from baseline (Day 0) to Day 84. Similarly, corneal (fluorescein) and conjunctival (lissamine green) quality improved during the study (p < 0.05 at Day 84 versus baseline). Tear break-up time (TBUT), conjunctival (lissamine green) staining, and tear meniscus decreased but the changes were not statistically significant. Visual acuity did not change during the study. There were no ocular or systemic adverse events.

CONCLUSIONS: This study showed that the instillation of a preservative-free, hypotonic, HA-Trehalose artificial tear in contact lenses wearers with dry eye syndrome significantly improved symptoms and reduced associated signs such as corneal and conjunctival staining.

PMID:34840071 | DOI:10.1016/j.clae.2021.101544

Surgeon. 2021 Nov 25:S1479-666X(21)00160-8. doi: 10.1016/j.surge.2021.09.003. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with advanced illnesses are often admitted with acute surgical emergencies. There is currently no evidence characterising such admissions. We aimed to evaluate emergency patients, managed non-operatively, who died during the same admission.

METHODS: This single-centre retrospective, observational study collected data points for a 12 month period including age, prior documented do not resuscitate order (DNAR), existing cancer, Charlson Comorbidity Index, frailty, surgical diagnosis, interval from admission to death and care given. Patients who underwent surgical intervention were excluded. Non-parametric tests were used for statistical analysis.

RESULTS: A total of 72 patients were included in this study, of which 68.1% died within 6 days of admission (median 4.0 days). Patients with visceral perforation, obstruction, bowel ischaemia or known malignancy were more likely to die within 6 days than those with pancreatitis, sepsis or new malignancy (median 2 vs 7 days, p < 0.001). Patients with frailty (2 vs 4 days, p = 0.017) and existing DNAR (3 vs 4 days, p = 0.048) died more rapidly than those without. Age and comorbidity index did not impact time to death.

CONCLUSION: Frailty, surgical diagnosis and existing DNAR were predictors of shorter admission to death interval, while age and comorbidity index were not. This has implications on inpatient palliative care service planning.

PMID:34840066 | DOI:10.1016/j.surge.2021.09.003

Eur J Cancer. 2021 Nov 25:S0959-8049(21)01177-1. doi: 10.1016/j.ejca.2021.10.019. Online ahead of print.

NO ABSTRACT

PMID:34840027 | DOI:10.1016/j.ejca.2021.10.019

J Infect Chemother. 2021 Nov 17:S1341-321X(21)00319-6. doi: 10.1016/j.jiac.2021.11.008. Online ahead of print.

ABSTRACT

OBJECTIVE: We aimed to perform a meta-analysis to summarize the overall evidence from randomized controlled trials related to higher-intensity anticoagulation in hospitalized patients with COVID-19.

METHODS: A systematic literature search was performed in electronic databases to identify randomized controlled trials comparing the clinical outcomes between intermediate/ therapeutic anticoagulation and prophylactic anticoagulation. Meta-analyses with random-effects models were used to estimate the pooled odds ratio (OR) for outcomes of interest at a 95% confidence interval (CI).

RESULTS: Eight randomized controlled trials were included, with a total of 5405 hospitalized patients with COVID-19. The meta-analysis revealed no statistically significant difference in the odds of mortality (pooled OR = 0.92; 95% CI 0.71-1.19) but a statistically significant reduction in the odds of development of thrombotic events (pooled OR = 0.55; 95% CI 0.42-0.72), and significantly increased odds of development of major bleeding (pooled OR = 1.81; 95% CI 1.20-2.72) with the use of intermediate/therapeutic anticoagulation, relative to prophylactic anticoagulation. Subgroup analysis in patients with a severe course of COVID-19 observed a statistically significant reduction in the odds of development of thrombotic events (pooled OR = 0.66; 95% CI 0.45-0.98) but no significant difference in the odds of development of major bleeding events (pooled OR = 1.37; 95% CI 0.74-2.56), with the use of intermediate/therapeutic anticoagulation, relative to prophylactic anticoagulation.

CONCLUSION: There could be net clinical benefits with higher-intensity dosing of anticoagulation relative to prophylactic-dosing of anticoagulation among hospitalized patients with severe COVID-19.

PMID:34840039 | DOI:10.1016/j.jiac.2021.11.008

Arch Pediatr. 2021 Nov 26:S0929-693X(21)00229-3. doi: 10.1016/j.arcped.2021.11.001. Online ahead of print.

ABSTRACT

OBJECTIVES: This study was conducted to examine the effect of healthy lifestyle beliefs on their attitudes toward physical activity, nutrition, exercise, and weight-related self-efficacy lifestyles in Turkish adolescents.

METHODS: This study used a methodological and descriptive design. The study was conducted with 445 adolescents aged 13-18 years. The data were collected using a Descriptive Information Form, the Healthy Lifestyle Beliefs Scale for Adolescents, the Nutrition Exercise Attitudes Scale, and the Attitudes Toward Physical Activity Scale. Mean and percentage values, t-test, ANOVA test, and linear regression analysis were used in the analysis of the research data.

RESULTS: A statistically significant difference was found between adolescents’ obesity status, paternal educational level, maternal educational level, income status, and the mean scores obtained for healthy lifestyle beliefs, nutrition and exercise attitudes, physical activity attitudes, and weight-related self-efficacy, as well as between sex and mean scores for attitudes toward nutrition, exercise, and physical activity. In the model created with regression analysis, it was found that the adolescents’ healthy lifestyle beliefs and sociodemographic variables explained 96.3% of their attitudes toward nutrition and exercise, 93.6% of physical activity attitudes, and 96.5% of weight-related self-efficacy levels, with statistical significance.

CONCLUSION: According to the results of the study, healthy lifestyle beliefs are an important predictor of adolescents’ attitudes toward nutrition, exercise, and physical activity as well as their weight-related self-efficacy. We recommend that school nurses consider healthy lifestyle beliefs when creating intervention programs for adolescents .

PMID:34840020 | DOI:10.1016/j.arcped.2021.11.001