Tag: nevin manimala

Adv Emerg Nurs J. 2021 Jan-Mar 01;43(1):39-47. doi: 10.1097/TME.0000000000000330.

ABSTRACT

This study was conducted to evaluate the effect of ShotBlocker on the intramuscular injection pain and satisfaction in emergency adult patients. This research was designed as a randomized controlled, double-blind, experimental study. The study was conducted with 74 patients who applied to the adult emergency department. Patients were randomized to ShotBlocker and control groups. Patient Assessment Form, Visual Analog Scale, and Visual Analog Patient Satisfaction Scale were used. The mean scores of postinjection pain and satisfaction level were analyzed between the groups; it was determined that while postinjection pain mean score of the experimental group was statistically significantly lower than that of the control group (p = 0.0001), satisfaction scores were statistically significantly higher in the experimental group than in the control group (p = 0.004). When the correlation between the intragroup Pain Scores (VAS) and the Satisfaction Scores (VAS) of the groups after injection was examined, a statistically significant and inverse correlation was found (p < 0.05). It was determined that ShotBlocker was effective in reducing intramuscular injection pain and increasing satisfaction levels.

PMID:33952876 | DOI:10.1097/TME.0000000000000330

J Biosci. 2021;46:35.

ABSTRACT

Among all the proteins of Periplasmic C type Cytochrome family obtained from cytochrome C₇ found in Geobacter sulfurreducens, only the Periplasmic C type Cytochrome A (PPCA) protein can recognize the deoxycholate (DXCA), while its other paralogs do not, as observed from the crystal structures. Though some existing works have used graph-theoretic approaches to realize the 3-D structural properties of proteins, its usage in the rationalisation of the physiochemical behavior of proteins has been very limited. To understand the driving force towards the recognition of DXCA exclusively by PPCA among its paralogs, in this work, we propose two graph theoretic models based on the combinatorial properties, namely, base-pair-type and impact, of the nucleotide bases and the amino acid residues, respectively. Combinatorial analysis of the binding sequences using the proposed base-pair type based graph theoretic model reveals the differential behaviour of PPCA among its other paralogs. Further, to investigate the underlying chemical phenomenon, another graph theoretic model has been developed based on impact. Analysis of the results obtained from impact-based model clearly indicates towards the helix formation of PPCA which is essential for the recognition of DXCA, making PPCA a completely different entity from its paralogs.

PMID:33952726

J Nutr Sci Vitaminol (Tokyo). 2021;67(2):111-117. doi: 10.3177/jnsv.67.111.

ABSTRACT

To demonstrate that fortified crystal salt enriched with iron, iodine, vitamin B12, folic acid and zinc can combat multi-micronutrient deficiencies. A randomized controlled study was conducted in 6 villages in Tiruvallur district, in Tamilnadu, South India. All the women and children aged 5-17 y in households in the experimental villages (n=117) were provided the fortified salt for 8 mo. Similar demographic group in the control villages (n=95) used regular non-fortified salts for the same time period. Blood from study subjects were analysed for hemoglobin, serum ferritin, serum transferrin receptor, AGP, CRP, and serum zinc, at the beginning and end of the study. Urine was analyzed for iodine at the same times. The experimental group showed a statistically significant increase in hemoglobin (>1.05 g/dL), serum zinc (>12.23 μg/dL), ferritin (>6.97 μg/L) and body iron stores (>0.73 mg/kg body weight), compared to the control group. A significant decrease in the prevalence of anaemia from 67.5% to 29.1% and zinc deficiency from 32.7% to 12.4% was observed in the experimental group relative to control group, using Binary logistic regression. There was no change in urinary iodine in the experimental group while it decreased significantly in the control. The fortified crystal salt was effective in decreasing multi-micronutrient deficiencies.

PMID:33952731 | DOI:10.3177/jnsv.67.111

Jpn J Infect Dis. 2021 Apr 30. doi: 10.7883/yoken.JJID.2020.843. Online ahead of print.

ABSTRACT

Vibrio vulnificus (V. vulnificus) infection is rare but potentially fatal. This study explored the new atypical manifestations and prognostic factors of V. vulnificus-infected patients throughout hospitalization. we retrospectively reviewed 33 patients diagnosed as having V. vulnificus infection in Guangdong Province, China between 2010 and 2020. Medical records were analyzed. Multiple logistic regression and receiver operating characteristic (ROC) curve analyses were performed. New atypical manifestations were found, including cholangitis, urinary tract infection, and suppurative otitis media. Eleven of thirty-three (33.3%) V. vulnificus-infected patients died eventually. By univariate analysis, patients with cardio-cerebro-vascular diseases, lower platelet counts, higher levels of C-reactive protein and procalcitonin (PCT) had a statistically higher mortality. However, multivariate analysis showed that only PCT (P = 0.036) reached statistical significance. Also, the area under the ROC value estimate for PCT was 0.8816 (95% CI, 0.759-1.000; P = 0.0009). More than half of patients with V. vulnificus infection would die when PCT ＞20 ng/ml, while no patient dies when PCT ≤ 20 ng/ml. This study found new atypical manifestations of V. vulnificus infection. Also, PCT is an effective and independent predictor of mortality of V. vulnificus infection, and is suitable for clinicians to make early risk stratification and best therapeutic strategies.

PMID:33952769 | DOI:10.7883/yoken.JJID.2020.843

Neurology. 2021 May 5:10.1212/WNL.0000000000012108. doi: 10.1212/WNL.0000000000012108. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare how structural MRI, Fluorodeoxyglucose (FDG), and Flortaucipir (FTP) PET signal predict cognitive decline in high-amyloid versus low-amyloid participants with the goal of determining which biomarker combination would result in the highest increase of statistical power for prevention trials.

METHODS: In this prospective cohort study, we analyzed data from clinically-normal adults from the Harvard Aging Brain Study with MRI, FDG, FTP, and PiB-PET acquired within a year, and prospective cognitive evaluations over a mean three-year follow-up. We focused analyses on pre-defined regions-of-interest: inferior temporal, isthmus cingulate, hippocampus, and entorhinal cortex. Cognition was assessed using the Preclinical Alzheimer’s Cognitive Composite (PACC5). We evaluated the association between biomarkers and cognitive decline using linear-mixed-effect models with random intercepts and slopes, adjusting for demographics. We generated power curves simulating prevention trials.

RESULTS: Data from 131 participants [52 females, 73.98±8.29 years old] were analyzed in the study. In separate models, most biomarkers had a closer association with cognitive decline in the high-PiB compared to the low-PiB participants. A backward stepwise regression including all biomarkers demonstrated that only neocortical PiB, entorhinal FTP, and entorhinal FDG were independent predictors of subsequent cognitive decline. Power analyses revealed that using both high-PiB and low entorhinal FDG as inclusion criteria reduced 3-fold the number of participants needed in a hypothetical trial compared to using only high-PiB.

DISCUSSION: In preclinical Alzheimer’s disease, entorhinal hypometabolism is a strong and independent predictor of subsequent cognitive decline, making FDG a potentially useful biomarker to increase power in clinical trials.

CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that in people with preclinical Alzheimer’s disease, entorhinal hypometabolism identified by FDG-PET is predictive of subsequent cognitive decline.

PMID:33952655 | DOI:10.1212/WNL.0000000000012108

Reg Anesth Pain Med. 2021 May 5:rapm-2021-102692. doi: 10.1136/rapm-2021-102692. Online ahead of print.

NO ABSTRACT

PMID:33952685 | DOI:10.1136/rapm-2021-102692

J Sport Rehabil. 2021 May 5:1-5. doi: 10.1123/jsr.2021-0021. Online ahead of print.

ABSTRACT

CONTEXT: Reaction time is commonly assessed postconcussion through a computerized neurocognitive battery. Although this measure is sensitive to postconcussion deficits, it is not clear if computerized reaction time reflects the dynamic reaction time necessary to compete effectively and safely during sporting activities. Functional reaction time assessments may be useful postconcussion, but reliability must be determined before clinical implementation.

OBJECTIVE: To determine the test-retest reliability of a functional reaction time assessment battery and to determine if reaction time improved between sessions.

DESIGN: Cohort.

SETTING: Laboratory.

PARTICIPANTS: Forty-one participants (21 men and 20 women) completed 2 time points. Participants, on average, were 22.5 (2.1) years old, 72.5 (11.9) cm tall, had a mass of 71.0 (13.7) kg, and were mostly right leg and hand dominant (92.7%).

INTERVENTIONS: Participants completed 2 clinical reaction time tests (computerized Stroop and drop stick) and 5 functional reaction time tests (gait, jump landing, single-leg hop, anticipated cut, and unanticipated cut) across 2 sessions. Drop stick and functional reaction time assessments were performed in single (motor task only) and dual task (motor task with cognitive task).

MAIN OUTCOME MEASURES: Reaction time (in seconds) was calculated during all assessments. Test-retest reliability was determined using 2-way mixed-effects intraclass correlation coefficients (3, k). Paired samples t tests compared mean reaction time between sessions.

RESULTS: Test-retest reliability was moderate to excellent for all reaction time outcomes (intraclass correlation coefficients [3, k] range = .766-.925). Several statistically significant between-session mean differences were observed, but effect sizes were negligible to small (d range = 0.05-0.44).

CONCLUSIONS: The functional reaction time assessment battery displayed similar reliability to the standard computerized reaction time assessment battery and may provide important postinjury information, but more research is needed to determine clinical utility.

PMID:33952713 | DOI:10.1123/jsr.2021-0021

Arch Dis Child Fetal Neonatal Ed. 2021 May 5:fetalneonatal-2020-321299. doi: 10.1136/archdischild-2020-321299. Online ahead of print.

ABSTRACT

BACKGROUND: Parenteral nutrition is commonly administered during therapeutic hypothermia. Randomised trials in critically ill children indicate that parenteral nutrition may be harmful.

OBJECTIVE: To examine the association between parenteral nutrition during therapeutic hypothermia and clinically important outcomes.

DESIGN: Retrospective, population-based cohort study using the National Neonatal Research Database; propensity scores were used to create matched groups for comparison.

SETTING: National Health Service neonatal units in England, Scotland and Wales.

PARTICIPANTS: 6030 term and near-term babies, born 1/1/2010 and 31/12/2017, who received therapeutic hypothermia; 2480 babies in the matched analysis.

EXPOSURE: We compared babies that received any parenteral nutrition during therapeutic hypothermia with babies that did not.

MAIN OUTCOME MEASURES: Primary outcome: blood culture confirmed late-onset infection; secondary outcomes: treatment for late onset infection, necrotising enterocolitis, survival, length of stay, measures of breast feeding, hypoglycaemia, central line days, time to full enteral feeds, discharge weight.

RESULTS: 1475/6030 babies (25%) received parenteral nutrition. In comparative matched analyses, the rate of culture positive late onset infection was higher in babies that received parenteral nutrition (0.3% vs 0.9%; difference 0.6; 95% CI 0.1, 1.2; p=0.03), but treatment for presumed infection was not (difference 0.8%, 95% CI -2.1 to 3.6, p=0.61). Survival was higher in babies that received parenteral nutrition (93.1% vs 90.0%; rate difference 3.1, 95% CI 1.5, 4.7; p<0.001).

CONCLUSIONS: Receipt of parenteral nutrition during therapeutic hypothermia is associated with higher late-onset infection but lower mortality. This finding may be explained by residual confounding. Research should address the risks and benefits of parenteral nutrition in this population.

PMID:33952628 | DOI:10.1136/archdischild-2020-321299

BMJ Support Palliat Care. 2021 May 5:bmjspcare-2020-002670. doi: 10.1136/bmjspcare-2020-002670. Online ahead of print.

ABSTRACT

OBJECTIVES: The Prognosis in Palliative care Study II (PiPS2) was a large multicentre observational study validating prognostic tools in patients with advanced cancer. Many palliative care studies fail to reach their recruitment target. To inform future studies, PiPS2 rigorously monitored and identified any potential recruitment barriers.

METHODS: Key recruitment stages (ie, whether patients were eligible for the study, approached by the researchers and whether consent was obtained for enrolment) were monitored via comprehensive screening logs at participating sites (inpatient hospices, hospitals and community palliative care teams). The reasons for patients’ ineligibility, inaccessibility or decision not to consent were documented.

RESULTS: 17 014 patients were screened across 27 participating sites over a 20-month recruitment period. Of those, 4642 (27%) were ineligible for participation in the study primarily due to non-cancer diagnoses. Of 12 372 eligible patients, 9073 (73%) were not approached, the most common reason being a clinical decision not to do so. Other reasons included patients’ death or discharge before they were approached by the researchers. Of the 3299 approached patients, 1458 (44%) declined participation mainly because of feeling too unwell, experiencing severe distress or having other competing priorities. 11% (n=1841/17 014) of patients screened were enrolled in the study, representing 15% (n=1841/12 372) of eligible patients. Different recruitment patterns were observed across inpatient hospice, hospital and community palliative care teams.

CONCLUSIONS: The main barrier to recruitment was ‘accessing’ potentially eligible patients. Monitoring key recruitment stages may help to identify barriers and facilitators to enrolment and allow results to be put into better context.

TRIAL REGISTRATION NUMBER: ISRCTN13688211.

PMID:33952580 | DOI:10.1136/bmjspcare-2020-002670

Heart. 2021 May 5:heartjnl-2020-318676. doi: 10.1136/heartjnl-2020-318676. Online ahead of print.

ABSTRACT

OBJECTIVE: Pulmonary vein isolation (PVI) guided by a standardised CLOSE (contiguous optimised lesions) protocol has been shown to increase clinical success after catheter ablation for paroxysmal atrial fibrillation (PAF). This study analysed healthcare utilisation and quality of life (QOL) outcomes from a large multicentre prospective study, measured association between QOL and atrial fibrillation (AF) burden and identified factors associated with lack of QOL improvement.

METHODS: CLOSE-guided ablation was performed in 329 consecutive patients (age 61.4 years, 60.8% male) with drug-refractory PAF in 17 European centres. QOL was measured at baseline and 12 months post-ablation via Atrial Fibrillation Effect on QualiTy of Life Survey (AFEQT) and EuroQoL EQ-5D-5L questionnaires. All-cause and cardiovascular hospitalisations and cardioversions over 12 months pre-ablation and post-ablation were recorded. Rhythm monitoring included weekly and symptom-driven trans-telephonic monitoring, plus ECG and Holter monitoring at 3, 6 and 12 months. AF burden was defined as the percentage of postblanking tracings with an atrial tachyarrhythmia ≥30 s. Continuous measures across multiple time points were analysed using paired t-tests, and associations between various continuous measures were analysed using independent sample t-tests. Each statistical test used two-sided p values with a significance level of 0.05.

RESULTS: Both QOL instruments showed significant 12-month improvements across all domains: AFEQT score increased 25.1-37.5 points and 33.3%-50.8% fewer patients reporting any problem across EuroQoL EQ-5D-5L domains. Overall, AFEQT improvement was highly associated with AF burden (p=0.009 for <10% vs ≥10% burden, p<0.001 for <20% vs ≥20% burden). Cardiovascular hospitalisations were significantly decreased after ablation (42%, p=0.001). Patients without substantial improvement in AFEQT (55/301, 18.2%) had higher AFEQT and CHA₂DS₂-VASc scores at baseline, and higher AF burden following PVI.

CONCLUSIONS: QOL improved and healthcare utilisation decreased significantly after ablation with a standardised CLOSE protocol. QOL improvement was significantly associated with impairment at baseline and AF burden after ablation.

TRIAL REGISTRATION NUMBER: NCT03062046.

PMID:33952593 | DOI:10.1136/heartjnl-2020-318676