Tag: nevin manimala

Am J Disaster Med. 2022 Fall;14(4):271-295. doi: 10.5055/ajdm.2021.0411.

ABSTRACT

OBJECTIVE: The objective of this study was to assess the training and readiness levels of Collegiate Emergency Medical Service (EMS) providers to respond to mass casualty incidents (MCIs).

METHODS: An anonymous cross-sectional survey of Collegiate EMS providers was performed.

PARTICIPANTS: Participants were US-based EMS providers affiliated with the National Collegiate Emergency Medical Services Foundation.

OUTCOME MEASURES: The main outcome measures were levels of EMS experience and MCI training, subjective readiness levels for responding to various MCI scenarios, and analyzing the effect of the COVID-19 pandemic on MCI response capabilities.

RESULTS: Respondents had a median age of 21 years (interquartile range IQR 20, 22), with 86 percent (n = 96/112) being trained to the Emergency Medical Technician-Basic level. Providers reported participating in an average of 1.6 MCI trainings over the last four years (IQR, 1.0, 2.2). Subjective MCI response readiness levels were highest with active assailant attacks followed by large event evacuations, natural disasters, hazardous material (HAZMAT) incidents, targeted automobile ramming attacks, explosions, and finally bioweapons release. Disparate to this, only 18 percent of participants reported training in the fundamentals of tactical and disaster medicine. With respect to the effect of the COVID-19 pandemic on MCI readiness, 27 percent of respondents reported being less prepared, and there was a statistically significant decrease in subjective readiness to respond to HAZMAT incidents.

CONCLUSION: Given low rates of MCI training but high rates of self-assessed MCI preparedness, respondents may overestimate their readiness to adequately respond to the complexity of a real-world MCI. More objective assessment measures are needed to evaluate provider preparedness.

PMID:35325463 | DOI:10.5055/ajdm.2021.0411

Updates Surg. 2022 Mar 24. doi: 10.1007/s13304-022-01267-9. Online ahead of print.

ABSTRACT

The liver-gut axis has been identified as crucial mediator of liver regeneration. Thus, the use of a T-tube in liver transplantation (LT), which interrupts the enterohepatic bile circulation, may potentially have a detrimental effect on the early allograft functional recovery. We retrospectively analyzed a cohort of 261 patients transplanted with a whole liver graft, with a duct-to-duct biliary anastomosis, who did not develop any surgical complication within postoperative day 14. Early allograft dysfunction (EAD) was defined according to the criteria of Olthoff et al. (EAD-O), and graded according to the Model for Early Allograft Function (MEAF) score. EAD-O developed in 24.7% of recipients and the median MEAF score was 4.0 [interquartile range 2.9-5.5]. Both MEAF and EAD predicted 90-day post-LT mortality. A T-tube was used in 49.4% of cases (n = 129). After a propensity score matching for donor age, cold and warm ischemia time, donor risk index, balance of risk score, Child-Pugh class C, and MELD score, the T-tube group showed a significantly higher prevalence of EAD-O and value of MEAF than the no-T-tube group (EAD-O: 29 [34.1%] vs 16 [19.0%], p = 0.027; MEAF 4.5 [3.5-5.7] vs 3.7 [2.9-5.0], p = 0.014). In conclusion, T-tube use in LT may be a risk factor for EAD and higher MEAF, irrespective of graft quality and severity of pre-LT liver disease.

PMID:35325442 | DOI:10.1007/s13304-022-01267-9

J Robot Surg. 2022 Mar 24. doi: 10.1007/s11701-022-01400-1. Online ahead of print.

ABSTRACT

Robotic colorectal surgery allows for better ergonomics, superior retraction, and fine movements in the narrow anatomy of the pelvis. Recent years have seen the uptake of robotic surgery in all pelvic surgeries specifically in low rectal malignancies. However, the learning curve of robotic surgery in this cohort is unclear as established training pathways are not formalized. This study looks at the experience and learning curve of a single laparoscopic trained surgeon in performing safe and effective resections, mainly for low rectal and anal malignancies using the da Vinci robotic system by evaluating metrics related to surgical process and patient outcome. A serial retrospective review of the robotic colorectal surgery database, in the University Hospital Coventry and Warwickshire (UHCW), was undertaken. All 48 consecutive cases, performed by a recently qualified colorectal surgeon, were included in our study. The surgical process was evaluated using both console and total operative time recorded in each case along with the adequacy of resections performed; in addition, patient-related outcomes including intraoperative and postoperative complications were analyzed to assess differences in the learning curve. Forty eight sequential recto-sigmoid resections were included in the study performed by a single surgeon. The cases were divided into four cohorts in chronological order with comparable demographics, tumour stage, location, and complexity of the operation (mean age 65, male 79%, and female 29%). The results showed that the mean console time dropped from 3 to 2.5 h, while total operative time dropped from 6 h to 5.5 h as the surgeon became more experienced; however, this was not found to be statistically significant. In addition, no significant difference in pathological staging was seen over the study period. No major intra-op and post-op complications were observed and no 30-day mortality was recorded. Moreover, after 30 cases, the learning curve developed the plateau phase, suggesting the gain of maximum proficiency of skills required for robotic colorectal resections. The learning curve in robotic rectal surgery is short and flattens early; complication rates are low during the learning curve and continue to decrease with time. This shows that with proper training and proctoring, new colorectal surgeons can be trained in a short time to perform elective colorectal pelvic resections.

PMID:35325433 | DOI:10.1007/s11701-022-01400-1

Phys Eng Sci Med. 2022 Mar 24. doi: 10.1007/s13246-022-01118-2. Online ahead of print.

ABSTRACT

Several studies have demonstrated statistical and texture analysis abilities to differentiate cancerous from healthy tissue in magnetic resonance imaging. This study developed a method based on texture analysis and machine learning to differentiate prostate findings. Forty-eight male patients with PI-RADS classification and subsequent radical prostatectomy histopathological analysis were used as gold standard. Experienced radiologists delimited the regions of interest in magnetic resonance images. Six different groups of images were used to perform multiple analyses (seven analyses variations). Those analyses were outlined by specialists in urology as those of most significant importance for the classification. Forty texture features were extracted from each image and processed with Random Forest, Support Vector Machine, K-Nearest Neighbors, and Naive Bayes. Those seven analyses variation results were described in terms of area under the ROC curve (AUC), accuracy, F-score, precision and sensitivity. The highest AUC (93.7%) and accuracy (88.8%) were obtained when differentiating the group with both MRI and histopathology positive findings against the group with both negative MRI and histopathology. When differentiating the group with both MRI and histopathology positive findings versus the peripheral image zone group the AUC value was 86.6%. When differentiating the group with negative MRI/positive histopathology versus the group with both negative MRI and histopathology the AUC value was 80.7%. The evaluation of statistical and texture analysis promoted very suggestive indications for future work in prostate cancer suspicious regions. The method is fast for both region of interest selection and classification with machine learning and the result brings original contributions in the classification of different groups of patients. This tool is low-cost, and can be used to assist diagnostic decisions.

PMID:35325377 | DOI:10.1007/s13246-022-01118-2

Cerebellum. 2022 Mar 24. doi: 10.1007/s12311-022-01397-1. Online ahead of print.

ABSTRACT

This study aims to measure the effects of two different exercise programs on neck pain, proprioception, balance, coordination, posture, and quality of life in patients with Chiari malformation (CM) type 1. Sixteen patients were randomized to two different exercise programs: a tailored exercise protocol for CM (TEP-CM) and cervical spinal stabilization exercises (CSSE). Both exercise programs were implemented by a physiotherapist 3 days a week for 6 weeks. The primary outcome was Neck Disability Index. Secondary outcomes were visual analogue scale for pain, joint position sense error measurement, Berg Balance Scale, Time Up and Go Test, International Coordination Ataxia Rating Scale, PostureScreen Mobile, and Short Form-36. Assessments were done immediately before and after the intervention programs. Both groups showed significant improvement in Neck Disability Index, and some secondary outcome measures (P < 0.05). However, there were no statistical differences in post-intervention changes between the groups (P > 0.05). This is the first study to examine the effects of different exercise programs on symptoms in patients with CM type 1. Our preliminary findings indicate that exercise programs can improve pain, balance, proprioception, posture, coordination, and quality of life in CM type 1. Therefore, exercise should be considered safe, beneficial, and low-cost treatment option for CM type 1 patients without surgical indications.

PMID:35325392 | DOI:10.1007/s12311-022-01397-1

Ir J Med Sci. 2022 Mar 24. doi: 10.1007/s11845-022-02956-5. Online ahead of print.

ABSTRACT

BACKGROUND: Asthma is a prevalent chronic obstructive disease of the airways.

AIMS: The aim of our study was to investigate the relationship between asthma and IL-17F gene 74488 T > C, IL-17A gene -197G > A, and IL17A gene -737C > T polymorphisms in Turkish population.

METHODS: In our study, peripheral blood samples collected from a total of 127 subjects, with 65 in the patient group and 62 in the control group, were analyzed for IL-17F gene 74488 T > C, IL-17A gene -197G > A, and IL17A gene -737C > T polymorphisms using next-generation sequencing.

RESULTS: There was no statistically significant relationship between IL-17A gene -197G > A and IL-17A gene -737C > T polymorphisms and the risk of developing asthma. It was found that the risk of developing asthma was 2.9-fold higher in individuals with a C allele in the IL-17F gene 7488 T > C polymorphic site than the individuals with a T allele. It was shown that ATT and GCT haplotype carriers had a greater disease risk compared with the GTT haplotype carriers.

CONCLUSIONS: In conclusion, IL-17F gene 7488 T > C polymorphism was found to be associated with asthma in the Turkish population. The IL-17 gene should be further investigated as a potential candidate gene in predicting asthma susceptibility and in the treatment of asthma.

PMID:35325374 | DOI:10.1007/s11845-022-02956-5

Target Oncol. 2022 Mar 24. doi: 10.1007/s11523-022-00874-1. Online ahead of print.

ABSTRACT

BACKGROUND: Neoadjuvant chemotherapy is the cornerstone treatment for locally advanced breast cancer. Balancing toxicity and efficacy are a common concern of patients treated with chemotherapy.

OBJECTIVE: The objective of this study was to determine the impact of dose intensity on pathologic complete response (pCR) at the time of surgery in patients with human epidermal growth factor receptor 2-positive (HER2+) breast cancer.

PATIENTS AND METHODS: A retrospective, single-center review was conducted on patients with HER2+ breast cancer who received neoadjuvant docetaxel, carboplatin, trastuzumab and pertuzumab (TCHP) followed by definitive surgery.

RESULTS: A total of 159 patients were included in the analysis; pCR was obtained in 66 patients (42%). There was no statistically significant difference between the mean dose intensity of each of the individual agents in TCHP and pCR rates. The mean overall dose intensity of docetaxel, carboplatin, trastuzumab and pertuzumab was 90.5%, 90.9%, 97.5%, and 93.9%, respectively. Although higher chemotherapy dose intensity (> 85%) was associated with higher pCR rates, no statistically significant difference was found compared with chemotherapy dose intensity < 85%. The TCHP regimen was difficult to tolerate; 104 patients (65%) required a dose reduction or dose delay during treatment due to toxicity.

CONCLUSION: The TCHP regimen, which combines chemotherapy and HER2-directed therapy is effective at obtaining pCR in patients with locally advanced HER2+ breast cancer. These results suggest that the dose intensity of the individual agents did not have a significant impact on pCR rates. Given these findings, providers may be more comfortable allowing dose reductions for greater patient tolerability without sacrificing efficacy.

PMID:35325355 | DOI:10.1007/s11523-022-00874-1

J Biol Phys. 2022 Mar 24. doi: 10.1007/s10867-022-09604-0. Online ahead of print.

ABSTRACT

Changes in the osmolality of the extracellular medium (ECM) affect cell volume and cellular processes such as cell migration and proliferation. Not only may high concentrations of zinc (Zn) lead to cell death by apoptosis, but Zn is also a physiological suppressor of apoptosis. The aim of our study was to examine whether Zn and regulation of extracellular osmolality had an effect on the lung cancer cell line (A549) and how to be changed in ECM according to elements and osmolality depending on incubation time and Zn application. Our study consisted of four groups: cell-free medium, ECM of cancer cell after 24 h incubation (24hECM), ECM of cancer cell after 48 h incubation (48hECM), and ECM of cancer cell after 48 h incubation with ZnCl₂ (48hECM + Zn). ECM osmolality was measured by using osmometer, and the levels of chromium (Cr), iron (Fe), and magnesium (Mg) elements were analyzed using ICP-OES device for all groups. According to the result of the analysis, a statistically significant difference was found when osmolality and element values of ECM of 24hECM and 48hECM groups were compared with the values of the 48hECM + Zn group. It was observed that there was a decrease in the levels of Cr, Fe, and Mg with Zn application and incubation period in ECM. The regulation of ECM osmolality is a promising method due to biophysical effects on cancer cells. In our study, we speculated that the understanding of the effects of Zn and osmolality with the relationship between ECM and cancer cell might lead to the discovery of biophysical approaches as a novel therapeutic strategy.

PMID:35325363 | DOI:10.1007/s10867-022-09604-0

Neurol Sci. 2022 Mar 24. doi: 10.1007/s10072-022-06024-9. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the association between stroke and the risk for mortality among coronavirus disease 2019 (COVID-19) patients.

METHODS: We performed systematic searches through electronic databases including PubMed, Embase, Scopus, and Web of Science to identify potential articles reporting adjusted effect estimates on the association of stroke with COVID-19-related mortality. To estimate pooled effects, the random-effects model was applied. Subgroup analyses and meta-regression were performed to explore the possible sources of heterogeneity. The stability of the results was assessed by sensitivity analysis. Publication bias was evaluated by Begg’s test and Egger’s test.

RESULTS: This meta-analysis included 47 studies involving 7,267,055 patients. The stroke was associated with higher COVID-19 mortality (pooled effect = 1.30, 95% confidence interval (CI): 1.16-1.44; I² = 89%, P < 0.01; random-effects model). Subgroup analyses yielded consistent results among area, age, proportion of males, setting, cases, effect type, and proportion of severe COVID-19 cases. Statistical heterogeneity might result from the different effect type according to the meta-regression (P = 0.0105). Sensitivity analysis suggested that our results were stable and robust. Both Begg’s test and Egger’s test indicated that potential publication bias did not exist.

CONCLUSION: Stroke was independently associated with a significantly increased risk for mortality in COVID-19 patients.

PMID:35325320 | DOI:10.1007/s10072-022-06024-9

Graefes Arch Clin Exp Ophthalmol. 2022 Mar 24. doi: 10.1007/s00417-022-05624-7. Online ahead of print.

ABSTRACT

PURPOSE: Diabetic retinopathy (DR) is a microvascular inflammatory and neurodegenerative disease. The purpose of this study was to analyze the relationship between DR severity and the levels of potential biomarkers in the serum and/or vitreous.

METHODS: A prospective, consecutive, controlled, observational study was performed between June 2018 and January 2020. Blood and vitreous samples were collected on the day of vitrectomy in patients without diabetes and in patients with diabetes with epiretinal membrane, macular edema, and indication for vitrectomy.

RESULTS: Transthyretin (TTR) was the only blood biomarker with levels statistically higher in patients with diabetes (p = 0.037). However, no correlation with DR severity was observed. Erythropoietin (EPO) was the only blood biomarker whose levels were associated with DR severity (p = 0.036). In vitreous samples, levels of EPO (p = 0.011), interleukin (IL)-6 (p < 0.001), IL-8 (p < 0.001), IL-17 (p = 0.022), monokine induced by interferon-γ (MIG) (p < 0.001), and interferon gamma-induced protein 10 (IP-10) (p = 0.005) were significantly higher in patients with diabetes. Additionally, in vitreous, IL-6, IL-8, MIG, and IPL-10 levels were also higher in more severe DR cases (p < 0.05).

CONCLUSIONS: Among the studied biomarkers, vitreous IL-6, IL-8, MIG, and IP-10 were the ones whose levels had the strongest coherent relationship with DR severity prediction and, thus, have the best potential post-vitrectomy prognostic value.

PMID:35325286 | DOI:10.1007/s00417-022-05624-7