Tag: nevin manimala

Blood Adv. 2022 Jan 20:bloodadvances.2021006454. doi: 10.1182/bloodadvances.2021006454. Online ahead of print.

ABSTRACT

Patients’ international normalized ratios (INRs) often fall slightly out of range. In these cases, the American College of Chest Physician (ACCP) guidelines suggest maintaining the current warfarin dose and retesting the INR within the following two weeks (watchful waiting). We sought to determine whether watchful waiting or dose changes for slightly out of range INRs is more effective in obtaining in-range INRs at follow-up. INRs and management strategies of warfarin-treated patients within the Michigan Anticoagulation Quality Improvement Initiative (MAQI²) registry were analyzed. Management strategies included watchful waiting or dose changes. INRs slightly out of range (target range 2.0-3.0) and their associated management were identified. Multilevel mixed-effects logistic regression was used to estimate the probability of the next INR being in range adjusted for clustering due to multiple out of range INRs per patient. A total of 45,351 slightly out of range INRs (ranging 1.50-1.99 and 3.01-3.49) from 8,288 patients were identified. The next INR was slightly less likely to be in range with watchful waiting than with a dose change (Predicted Probabilities 58.9% vs. 60.0%, P-value = 0.024). Although a significant statistical difference was detected in the probabilities of the next INR being back in range when managed by a dose change compared to watchful waiting following a slightly out of range INR, the magnitude of the difference was small and unlikely to represent clinical importance. Our study supports the current guideline recommendations for watchful waiting in cases of slightly out of range INRs values.

PMID:35052000 | DOI:10.1182/bloodadvances.2021006454

Ann Work Expo Health. 2021 Nov 23:wxab101. doi: 10.1093/annweh/wxab101. Online ahead of print.

ABSTRACT

α-Diketones such as diacetyl (2,3-butanedione) and 2,3-pentanedione are generated during the roasting and fermentation of foods and are also used as flavoring compounds. Exposure to these compounds has been associated with obliterative bronchiolitis in workers. We report indoor air concentrations of diacetyl and 2,3-pentanedione, as well as acetoin (3-hydroxy-2-butanone), in several small coffee roasteries and breweries using standard integrated air sampling sorbent tubes followed by gas chromatography tandem mass spectrometry as well as the first use of on-site continuous real-time proton-transfer reaction time-of-flight mass spectrometry (PTR-ToF-MS). Diacetyl and 2,3-pentanedione were detected in most of the sorbent samples at concentrations between 0.02 and 8 ppbv, and in general were higher in coffee roasteries compared with breweries. Three integrated air samples, all from the barista area at one facility, exceeded the NIOSH recommended exposure limit (REL) of 5 ppbv for diacetyl. 2,3-Pentanedione concentrations in these three samples were greater than 50% of its REL, but did not exceed it. Acetoin, a precursor to diacetyl, was also detected at concentrations between 0.03 and 5 ppbv in most sorbent tube samples, with concentrations generally higher in breweries. PTR-ToF-MS measurements exhibited similar trends and provided continuous real-time volatile organic compound data that showed episodic excursions with peak concentrations of diacetyl and 2,3-pentanedione between 15 and 20 ppbv. Examination of the time series data identified specific activities associated with peak diketone emissions, including transfer of freshly roasted coffee beans to the cooling tray, or the opening of a brew kettle. Additional indoor air quality parameters including CO2, NO2, and PM2.5 were also assessed on-site. Airway inflammation was assessed in 19 workers before and after each work shift using online measurements of fractional exhaled nitric oxide (FENO). The pre-shift mean FENO was 3.7 (95% confidence interval: -3.6, 11.0) ppbv higher and the post-shift FENO was 7.1 (-1.9, 16.1) ppbv higher for workers at coffee roasteries compared with breweries. The cross-shift change in FENO was 3.4 (-2.8, 9.6) ppbv higher for workers at coffee roasteries compared with breweries. However, none of these differences were statistically significant, and the cross-shift change in FENO was not statistically different from zero for either group of workers. The findings from this pilot study demonstrate that α-diketones and related compounds are present in the indoor air of both breweries and coffee roasteries and may exceed health protective guidelines in coffee roasteries. Additional studies are required to fully characterize worker exposures in these settings and to identify specific work activities and processes associated with high exposures. Engineering controls, including targeted exhaust ventilation and the use of low-cost sensors, are recommended as an approach to protect workers from exposure to hazardous levels of α-diketones.

PMID:35051991 | DOI:10.1093/annweh/wxab101

Ann Work Expo Health. 2021 Nov 23:wxab104. doi: 10.1093/annweh/wxab104. Online ahead of print.

ABSTRACT

OBJECTIVES: The COLCHIC database contains workplace exposure results of chemical samples collected by the French prevention network since 1987. We aimed to investigate potential associations between exposure levels and ancillary variables in COLCHIC across a broad range of chemical agents in order to provide insight into how to best interpret and exploit the information in this national database.

METHODS: We selected personal and area measurements in COLCHIC and collected outside respiratory personal protective equipment (PPE), restricted to chemical agents that had at least 1000 samples available. We used Tobit models to estimate associations between exposure concentrations and sample year, sampling duration, PPE, workforce size, collective protective equipment, origin of request, and reason for request for each chemical agent for the period 1987-2019. Models for period 2002-2019 also included type of process (open/closed) and exposure frequency. We used separate models for each combination of agent, period, and personal or area samples. We then applied Bayesian meta-analytical methods to assess average effects and effect heterogeneity of exposure factors across agents.

RESULTS: COLCHIC contained 720 282 exposure results (62% personal and 38% area samples) to 77 agents, including 346 766 results for the more recent period 2002-2019 (67% personal and 33% area samples). Sample year and duration, PPE, and process type had the strongest and most consistent associations with exposure levels across agents. Personal and area exposure levels decreased yearly (6% for the entire period and 9% since 2002), and 30-min samples were approximately twice as high as 240-min samples. Workers wearing PPE were exposed to levels 1.7 times higher on average than those without PPE for both area and personal samples. Personal exposure levels associated with enclosed or semi-enclosed processes were approximately 20-30% lower compared with open processes. The associations for the other exposure variables were weaker and more inconsistent between agents. Between-agent heterogeneity of estimated effects, based on 80% prediction intervals, was lowest for sampling duration, time trends, and the presence of PPE.

CONCLUSIONS: Sampling duration, time trends, and the presence of PPE are important factors to take into account when analyzing COLCHIC and had similar associations with exposure levels across agents. Other variables generally showed weaker associations or variable effects. These results will be used to adjust exposure estimates for the French working population from measurements stored in COLCHIC.

PMID:35051995 | DOI:10.1093/annweh/wxab104

Neurologist. 2022 Jan 20. doi: 10.1097/NRL.0000000000000418. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this study is to reveal the relationship between end-tidal CO2 (EtCO2) values with infarct volume and early prognosis in patients diagnosed with acute ischemic stroke in the emergency department.

MATERIALS AND METHODS: This prospective cross-sectional study was conducted in a tertiary hospital. The demographics, characteristics, EtCO2, volume of the stroke area on diffusion-weighted magnetic resonance imaging and the modified Rankin Scale (mRS) of the patients were recorded. The values calculated at admission and at discharge were labeled as “mRS-1” and “mRS-2”, respectively, and the mRS-2 measurement was used as a prognostic indicator. The “good” and the “poor” functional outcomes were defined as mRS ≤2 and mRS >2, respectively. Correlations between levels of EtCO2 and infarct volume, mRS were calculated.

RESULTS: In total, 44 patients were included in the study. The median age of the patients was 69 years (interquartile range; 16; min-max: 35 to 88 y) and 68.2% of them were male. In the univariate logistic regression models of the mRS-2 [0 to 2 (0) and 3 to 6 (1)], all variables were not statistically significant to predict mRS-2 group. There were statistically significant differences in EtCO2 values between mRS-1 (P=0.03) and mRS-2 (P=0.04). A negative moderate correlation was found between EtCO2 and mRS-2 (r=-0.410; P=0.006). The correlation between EtCO2 and infarct volume was not statistically significant (r=-0.256; P=0.093).

CONCLUSIONS: This study highlights the importance of capnography follow-up of patients with acute ischemic stroke. In patients with acute ischemic stroke, the EtCO2 value measured at the time of admission is lower in the group with high mRS at both admission and discharge.

PMID:35051967 | DOI:10.1097/NRL.0000000000000418

J Nurs Care Qual. 2022 Jan 19. doi: 10.1097/NCQ.0000000000000616. Online ahead of print.

ABSTRACT

BACKGROUND: Pain management with opioids and underutilization of prophylaxis for constipation can prolong a patient’s hospital length of stay and impede pain management efforts.

PROBLEM: In pediatric postoperative cardiac patients, opioid therapy is a common approach to pain management but often places them at greater risk for constipation due to anatomy and age.

METHODS: A retrospective review of 50 patients’ medical records for baseline data was conducted, and a survey evaluated providers’ current knowledge and practice.

INTERVENTIONS: The intervention was an electronic order set that provided decision support. Additionally, prophylactic measures were supported by a validated assessment tool that created a common language to report constipation risk.

RESULTS: Although not statistically significant, postintervention data demonstrated a 21.5% decrease in postoperative constipation and a 57% increase in ordered bowel regimens.

CONCLUSION: More focus is needed toward prophylactic bowel regimens to reduce the risk in this already high-risk population.

PMID:35051979 | DOI:10.1097/NCQ.0000000000000616

J Occup Environ Med. 2022 Jan 19. doi: 10.1097/JOM.0000000000002488. Online ahead of print.

ABSTRACT

OBJECTIVE: We examined the prevalence of mental health disorders and suicidal behaviours (ideation, planning and attempts) among a sample of provincial correctional workers in Manitoba.

METHODS: Self-reported mental health data from a survey on correctional worker mental health and well-being were analyzed for 491 correctional workers.

RESULTS: Over half (57%) of respondents screened positive for mental health disorder, most commonly Major Depressive Disorder, and over one-third of respondents (37%) screened positive for more than one disorder. Positive mental health screens for all mental health disorders were associated with statistically significantly increased odds of lifetime suicidal ideation, and positive screens for most disorders were associated with past year suicidal ideation.

CONCLUSIONS: Relative to other public safety personnel and the general public, correctional workers appear have a higher prevalence of mental health disorders and suicidal behaviours. The association between positive screens for mental health disorders and suicidal behaviours highlights the vulnerability of correctional workers in regards to mental well-being.

PMID:35051959 | DOI:10.1097/JOM.0000000000002488

J Pediatr Orthop. 2022 Jan 20. doi: 10.1097/BPO.0000000000002053. Online ahead of print.

ABSTRACT

BACKGROUND: Growth modulation using tension band plates (TBPs) is increasingly important for lower limb deformity correction in patients with skeletal dysplasia (SKD). Development of rebound deformity is a concern after TBP removal. Data regarding this complication are rare; therefore, we evaluated the prevalence and risk factors for rebound deformity in children with SKD undergoing correction of genu valgum using TBP.

METHODS: All patients with SKD with genu valgum treated by TBP at the distal femur or/and proximal tibia at a single center were reviewed. Inclusion criteria were: (1) minimum 2-year follow-up after TBP removal or having revision surgery for rebound deformity and (2) implant removal age for girls 14 years and below and boys 16 years and below. Exclusion criteria were any femoral/tibial osteotomies during TBP treatment or follow-up. A change of ≥3 degrees of mechanical lateral distal femoral and/or medial proximal tibial angle was accepted as rebound deformity and analyzed statistically.

RESULTS: Thirty-three patients (59 limbs; 52 femur and 29 tibia physes) met our criteria. Mean follow-up after implant removal was 43.7 months. Rebound deformities were seen in 43 limbs (39 femurs and 13 tibias). Boys had more rebound than girls; however, this was not influenced by body mass index. Femurs had more rebound than tibias. Patients in the rebound group were younger than the nonrebound group. Time from application to removal of TBP was shorter in the rebound versus nonrebound group. Overcorrected limbs had more rebound deformity than not overcorrected. The difference in growth velocity of lower limbs in the rebound versus nonrebound group was statistically significant. Patients with epiphyseal dysplasia had more rebound than metaphyseal dysplasia, but this was not statistically significant.

CONCLUSION: Risk factors for developing a rebound deformity after correction of genu valgum using TBP in SKD included male sex, TBP surgery at a young age, short duration of TBP implantation, overcorrected extremity (mechanical axis deviation ≤1), and high percent growth velocity after TBP removal.

LEVEL OF EVIDENCE: Level IV-retrospective study.

PMID:35051956 | DOI:10.1097/BPO.0000000000002053

Urol Int. 2022 Jan 20:1-7. doi: 10.1159/000521394. Online ahead of print.

ABSTRACT

BACKGROUND: Inflammation is one of the major risk factors for SN complications because the dense and fibrotic tissue leads to significant challenges to dissection.

OBJECTIVES: We aimed to evaluate the predictive factors preoperatively, especially inflammation markers and radiologic findings, which can pose challenges to surgery in simple nephrectomy.

METHODS: We retrospectively evaluated the data of 156 patients who underwent simple open nephrectomy. There were 87 patients in group 1 (peroperative nonadherent perinephric fat) and 69 patients in group 2 (peroperative adherent perinephric fat). The preoperative computed tomography findings (renal volume, perinephric stranding, posterior perinephric fat thickness, lateral perinephric fat thickness, Hounsfield unit [HU] of perinephric fat, HU of subcutaneous fat, HU of renal parenchyma, HU of renal pelvis), side of the kidney affected, prior surgery at the same kidney, complication rates, and operative time were analyzed. Preoperative inflammation markers, neutrophil-lymphocyte ratio, systemic immune-inflammation index, monocyte-HDL ratio, and platelet-lymphocyte ratio levels were recorded.

RESULTS: Preoperative NLR and SII were statistically higher, and HDL was statistically lower in group 2; there was no difference in PLR and monocyte-HDL ratio between the 2 groups. According to the preoperative imaging, the perinephric stranding, HU of perinephric fat, and HU of renal parenchyma were higher in group 2, 54 (78.3), -36.93 (-91.46, -21.69), and 38.60 (32.11, 41.94), respectively. DM, history of nonsterile urine culture, HU of perinephric fat >61.78, and SII >689.36 were the factors that could be identified as independent significant predictors of presence of adherent perinephric fat.

CONCLUSION: The radiological findings and inflammation markers can be used as the predictive factor for peroperative adherent perinephric tissue and surgical difficulties.

PMID:35051943 | DOI:10.1159/000521394

Urol Int. 2022 Jan 20:1-8. doi: 10.1159/000520531. Online ahead of print.

ABSTRACT

INTRODUCTION: This study aimed to investigate the possible effect of gastrodin in renal ischemia-reperfusion injury (IRI) and the mechanisms.

METHODS: Forty-eight male Sprague Dawley rats were randomly divided into 3 groups: sham-operated group, saline-treated IRI group, and gastrodin-treated IRI group. Gastrodin or 0.9% saline (300 mg/kg/day) was intragastrically administrated for 8 days before operation. We analyzed renal function and histological change. The malondialdehyde level, antioxidant enzymes’ activities, and markers of inflammation and apoptosis were measured. Statistical analysis was performed using 1-way analysis of variance (ANOVA) or Kruskal-Wallis ANOVA on ranks.

RESULTS: Gastrodin pretreatment improved IRI-induced renal dysfunction and histologic injury. Mechanistically, gastrodin reversed the elevation of malondialdehyde level and the reduction of antioxidant enzymes’ activities. Gastrodin also reduced the elevated myeloperoxidase activity, TNF-α and IL-1β levels, and the activation of p38 MAPK. Moreover, gastrodin-treated rats exhibited a dramatic reduction in renal tubular apoptosis, along with a decrease in caspase-3 activation and an increase in the Bcl-2/Bax ratio.

CONCLUSION: Gastrodin pretreatment may alleviate renal IRI via the amelioration of oxidative injury, inflammatory response, and renal tubular apoptosis.

PMID:35051947 | DOI:10.1159/000520531

Phys Med Biol. 2022 Jan 20. doi: 10.1088/1361-6560/ac4d85. Online ahead of print.

ABSTRACT

OBJECTIVE: This work investigates the use of deep convolutional neural networks (CNN) to automatically perform measurements of fetal body parts, including head circumference, biparietal diameter, abdominal circumference and femur length, and to estimate gestational age and fetal weight using fetal ultrasound videos.

APPROACH: We developed a novel multi-task CNN-based spatio-temporal fetal US feature extraction and standard plane detection algorithm (called FUVAI) and evaluated the method on 50 freehand fetal US video scans. We compared FUVAI fetal biometric measurements with measurements made by five experienced sonographers at two time points separated by at least two weeks. Intra- and inter-observer variabilities were estimated.

MAIN RESULTS: We found that automated fetal biometric measurements obtained by FUVAI were comparable to the measurements performed by experienced sonographers The observed differences in measurement values were within the range of inter- and intra-observer variability. Moreover, analysis has shown that these differences were not statistically significant when comparing any individual medical expert to our model.

SIGNIFICANCE: We argue that FUVAI has the potential to assist sonographers who perform fetal biometric measurements in clinical settings by providing them with suggestions regarding the best measuring frames, along with automated measurements. Moreover, FUVAI is able perform these tasks in just a few seconds, which is a huge difference compared to the average of six minutes taken by sonographers. This is significant, given the shortage of medical experts capable of interpreting fetal ultrasound images in numerous countries.

PMID:35051921 | DOI:10.1088/1361-6560/ac4d85