Tag: nevin manimala

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2021 Jun;33(6):671-675. doi: 10.3760/cma.j.cn121430-20210408-00520.

ABSTRACT

OBJECTIVE: To investigate clinicians’ compliance with the 2018 Surviving Sepsis Campaign (SSC) update “1-hour sepsis Bundle therapy” (1-hour Bundle) when treating patients with Sepsis 3 in the intensive care unit (ICU), and to analyze its impact on patient outcomes.

METHODS: A multicenter, prospective observational cohort study was conducted. A total of 153 ICU patients in Ziyang First People’s Hospital, Ziyang People’s Hospital and Yanjiang District People’s Hospital who were diagnosed of sepsis by the definition and diagnostic criteria of Sepsis 3 from January 2019 to December 2020 were selected. Among them, 95 patients who had completed 1-hour Bundle were divided into the Bundle compliance group. 58 patients who did not complete the Bundle within 1 hours were classified as the Bundle non-compliance group. The distribution of pathogenic bacteria and infected sites, 1-hour Bundle compliance and 28-day survival in the 3 hospitals were analyzed. Univariate analysis was used to analyze the risk factors affecting the prognostic between the two groups of sepsis patients. Cox regression model was used to draw a 28-day survival curve to evaluate the survival of the patients in the two groups.

RESULTS: Among 153 sepsis patients in 3 hospitals, the detection rate of pathogenic bacteria was 61.44% (94/153), and Gram-negative bacteria accounted for 79.79% (75/94). The top 3 infection sites were respiratory system, gastrointestinal tract and urinary system, accounted for 32.0%, 28.1% and 18.3%, respectively. In the 3 hospitals, 62.09% (95/153) of patients fully implemented the 1-hour Bundle. The poorly implemented indicators in the 1-hour Bundle were 1-hour blood microbial culture [77.78% (119/153)] and 1-hour antimicrobial application [79.74% (122/153)]. There was no significant difference in the baseline indicators between Bundle compliance and non-compliance groups. Univariate analysis showed that the main prognostic indicators: 28-day survival rate in the Bundle compliance group was significantly higher than that in the Bundle non-compliance group [80.00% (76/95) vs. 62.06% (36/58), χ² = 6.447, P = 0.014]. Secondary evaluation indicators: mean arterial pressure (MAP) at 6 hours and 24 hours in the Bundle compliance group were significantly higher than those in the Bundle non-compliance group [mmHg (1 mmHg = 0.133 kPa): 78.22±11.25 vs. 69.86±14.04, 79.78±11.45 vs. 75.35±12.90]. However, the median length of in hospital stay in the Bundle compliance group was significantly longer than that in the Bundle non-compliance group [days: 13 (17) vs. 6 (11)], with statistically significant differences (all P < 0.05). Bivariate Logistic regression analysis showed that 6 hours and 24 hours MAP were risk factors affecting the prognosis of patients with sepsis [odds ratio (OR), 95% confidence interval (95%CI): 1.064 (0.994-1.102), 1.032 (1.003-1.063), both P < 0.05].

CONCLUSIONS: The 1-hour Bundle compliance rate of ICU patients with sepsis in 3 hospitals of Ziyang City was 62.09%, and the compliance is still to be improved, especially for the 2 aspects of empirical antimicrobial use and microbial culture retention before antimicrobial use. The 28-day survival rate in the Bundle compliance group was significantly higher than that in the Bundle non-compliance group, suggesting that the 1-hour Bundle regimen can improve the prognosis of patients with sepsis.

PMID:34296684 | DOI:10.3760/cma.j.cn121430-20210408-00520

Clin Rehabil. 2021 Jul 23:2692155211034154. doi: 10.1177/02692155211034154. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate whether adding neural mobilization to a standard postoperative physical therapy program could improve the outcomes of patients after lumbar laminectomy.

DESIGN: A single blinded randomized controlled trial.

SETTING: Outpatient setting.

PARTICIPANTS: Sixty participants of both sexes who had undergone lumbar laminectomy.

INTERVENTIONS: Participants were allocated randomly to two groups; study and control groups. All patients received a standard postoperative physical therapy program. Those in the study group received additional neural mobilization in the form of straight leg raising and dorsiflexion with two-ended slider. Treatment was administered three times/week for six successive weeks.

OUTCOME MEASURES: Visual analog scale (VAS), Oswestry disability index (ODI), and H-reflex latency were measured pre and post-treatment.

RESULTS: The mean age of participants was 44.23 ± 4.64 and 45.3 ± 5.3 in study and control groups respectively (P > 0.05). There were statistically significant differences in VAS, ODI, and H-reflex latency in favor of the study group (P < 0.05). The mean ± SD for VAS, ODI, and H-reflex latency pre vs post treatment was 6.13 ± 1.22 vs 1.40 ± 0.77, 64.46 ± 4.05 vs 16.86 ± 2.55, and 32.07 ± 2.76 vs 27.46 ±1.79 in study group and 5.86 ± 1.07 vs 2.46 ± 0.73, 63.93 ± 3.91 vs 23.40 ± 2.93, and 31.76 ± 2.69 vs 29.4 ± 1.94 in control group, respectively.

CONCLUSIONS: Neural mobilization combined with traditional physical therapy program achieved better improvement in pain, functional disability and H-reflex in patients who underwent decompressive laminectomy than traditional physical therapy program only.

PMID:34296639 | DOI:10.1177/02692155211034154

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2021 Jun;33(6):641-647. doi: 10.3760/cma.j.cn121430-20210402-00504.

ABSTRACT

OBJECTIVE: To evaluate the effects and safety of stress ulcer prophylaxis (SUP) versus no prophylaxis in adult septic patients at risk of gastrointestinal bleeding (GIB).

METHODS: A retrospective cohort study was conducted, the data was extracted from Electronic Intensive Care Unit-Collaborative Research Database (eICU-CRD). All patients who received proton pump inhibitor (PPI) or H₂ receptor antagonist (H₂RA) or combined/sequential use for SUP within the first 48 hours of intensive care unit (ICU) admission were enrolled in the SUP group, those who did not received any SUP were enrolled in the non-SUP group. The differences of in-hospital mortality, length of ICU stay (LOS), the incidence of GIB and secondary infection complications between the two groups were compared. Propensity score matching (PSM) was conducted to balance the distributions of study variables between the two groups. Further subgroup analysis was performed according to whether SUP was used for more than 3 days. Multivariate Logistic regression analysis was conducted to analyze the factors influencing the outcome of GIB and secondary pneumonia.

RESULTS: A total of 11 413 patients were included in the final analysis, with 9 799 patients in SUP group and 1 614 in non-SUP group. A 1:1 PSM created 1 600 patients in each cohort. (1) Baseline characteristics: compared with SUP group, patients in non-SUP group were older [years old: 69.0 (56.0, 80.0) vs. 67.0 (56.0, 78.0)], acute physiology and chronic health evaluation IV (APACHE IV) score and sequential organ failure assessment (SOFA) score were significantly lower [APACHE IV score: 65 (50, 73) vs. 72 (58, 87), SOFA score: 5 (4, 7) vs. 7 (5, 9)], higher rates of underlying diseases such as hypertension and diabetes [hypertension: 15.6% (252/1 614) vs. 12.2% (1 196/9 779), diabetes: 4.5% (72/1 614) vs. 3.3% (325/9 779), both P < 0.05], indicating that patients in the SUP group were more severe. (2) Comparison of clinical outcome: before PSM, SUP group had significantly higher in-hospital mortality [17.2% (1 688/9 799) vs. 10.9% (176/1 614)], longer LOS [days: 4.4 (2.9, 7.7) vs. 3.1 (2.5, 4.3)], and higher incidence of secondary pneumonia than non-SUP group [11.3% (1 112/9 799) vs. 6.8% (110/1 614)], with significant differences (all P < 0.05). There was no significant difference in the incidence of GIB and Clostridium difficile infection (CDI) between the two groups. After PSM, no significant differences were observed between the two groups with regard to in-hospital mortality, incidence of GIB and CDI. However, the SUP group had longer LOS [days: 3.9 (2.8, 6.6) vs. 3.1 (2.5, 4.3)], and higher incidence of secondary pneumonia [10.9% (174/1 600) vs. 6.8% (108/1 600)] compared with non-SUP group, the differences were statistically significant (all P < 0.05). Subgroup analysis showed that compared with SUP < 3 days group, patients in SUP ≥ 3 days group had higher disease severity score [APACHE IV score: 66 (51, 79) vs. 62 (48, 72), SOFA score: 6 (4, 8) vs. 5 (4, 7), both P < 0.05], in addition, patients in SUP ≥ 3 days group had higher in-hospital mortality, incidence of GIB and secondary pneumonia (16.4% vs. 10.7%, 6.1% vs. 1.8%, 19.0% vs. 8.6%, respectively), and longer ICU LOS [days: 6.6 (4.1, 11.8) vs. 3.5 (2.6, 5.3), all P < 0.05]. (3) Multivariate Logistic regression analysis showed that SUP ≥ 3 days group was associated with more GIB than that of non-SUP group [odds ratio (OR) = 1.84, 95% confidence interval (95%CI) was 1.07-3.08, P = 0.030], and the incidence of GIB was less in SUP < 3 days group than that of non-SUP group (OR = 0.57, 95%CI was 0.34-0.94, P = 0.020). When compared with non-SUP group, the risk of secondary pneumonia was increased both in SUP ≥ 3 days group and SUP < 3 days group (OR values were 2.95 and 1.34, 95%CI were 2.10-4.13 and 1.01-1.77, P values were < 0.001 and 0.040, respectively).

CONCLUSIONS: Among critically ill adult patients with sepsis at risk for GIB, SUP showed no effect on reducing in-hospital mortality, the rate of GIB and CDI, but was associated with increased risk of secondary pneumonia and prolonged LOS.

PMID:34296679 | DOI:10.3760/cma.j.cn121430-20210402-00504

Br J Clin Pharmacol. 2021 Jul 22. doi: 10.1111/bcp.14999. Online ahead of print.

ABSTRACT

INTRODUCTION: Whereas intravenous administration of TLR4 ligand lipopolysaccharide (LPS) to human volunteers is frequently used in clinical pharmacology studies, systemic use of LPS has practical limitations. We aimed to characterize the intradermal LPS response in healthy volunteers, and as such qualify the method as local inflammation model for clinical pharmacology studies.

METHODS: 18 healthy male volunteers received two or four intradermal 10 ng LPS injections and one saline injection on the forearms. The LPS response was evaluated by non-invasive (perfusion, skin temperature, and erythema) and invasive assessments (cellular and cytokine responses) in skin biopsy and blister exudate.

RESULTS: LPS elicited a visible response and returned to baseline at 48 hours. Erythema, perfusion and temperature were statistically significant (p<0.0001) over a 24 hour time course compared to saline. The protein response was dominated by an acute IL-6, IL-8 and TNF response followed by IL-1β, IL-10 and IFN-γ. The cellular response consisted of an acute neutrophil influx followed by different monocyte subsets and dendritic cells.

DISCUSSION: Intradermal LPS administration in humans causes an acute, localized and transient inflammatory reaction that is well-tolerated by healthy volunteers. This may be a valuable inflammation model for evaluating the pharmacological activity of anti-inflammatory investigational compounds proof of pharmacology studies.

PMID:34293819 | DOI:10.1111/bcp.14999

Ophthalmic Plast Reconstr Surg. 2021 Jul 21. doi: 10.1097/IOP.0000000000002017. Online ahead of print.

ABSTRACT

PURPOSE: To assess the long-term quality of life outcomes of minimally invasive conjunctivodacryocystorhinostomy with StopLoss Jones tubes.

METHODS: A retrospective interventional case series was performed on all patients diagnosed with proximal bicanalicular obstruction who underwent a minimally invasive conjunctivodacryocystorhinostomy with StopLoss Jones tubes over a period of 5 years from October 2014 to September 2019. The procedure was performed as per standard published protocols of minimally invasive conjunctivodacryocystorhinostomy and StopLoss Jones tubes. Patients were followed for a minimum of 1 year after surgery. The tools employed to study were the “Jones tube satisfaction questionnaire” and the “Nasolacrimal duct obstruction-symptom score.” These tools were employed at every step from the preoperative stage to each of the follow ups. Statistical analysis was performed using the R 4.0.4 (R Project, R Foundation).

RESULTS: A total number of 44 eyes of 42 patients were studied. Of these, 73.81% (31/42) were females. The mean age of patients was 61.81 years. Approximately 87% and 64% of the patients completed 2 and 3 years of follow up, respectively. For up to 2 months postoperative period, the outcomes were excellent, with the majority (76.74%, 33/43) reporting “moderately satisfied” outcomes on Jones tube satisfaction questionnaire. The dissatisfaction began at the 3-month follow up (4.55%, 3/44) and peaked at 6-month follow up (25%, 11/44), owing to tube-related complications. The mean ± standard deviation nasolacrimal duct obstruction-symptom score scores dipped from 19.98 ± 2.88 at baseline to 5.58 ± 2.99 at the 2-month follow up. Similar to Jones tube satisfaction questionnaire, the scores began worsening at 3-month follow up (9.8 ± 5.86) with the poorest scores at 6 months (12.34 ± 5.96), and these changes were significant as compared with the baseline (p < 0.001). The Jones tube satisfaction questionnaire and the nasolacrimal duct obstruction-symptom score scores showed significant improvements at 1-year follow up, owing to appropriate management of complications. The good outcomes were maintained for up to 3 years of postoperative period.

CONCLUSIONS: The long-term quality of life outcome following minimally invasive conjunctivodacryocystorhinostomy with StopLoss Jones tubes was good. The quality of life significantly suffers between 3 and 6 months following the surgery and improves equally well following appropriate management of complications.

PMID:34293792 | DOI:10.1097/IOP.0000000000002017

J Physician Assist Educ. 2021 Jul 21. doi: 10.1097/JPA.0000000000000369. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to assess how physician assistant (PA) student depression risk, suicidal ideation, and mental health help-seeking behaviors change during didactic training and the relationship between depression risk and demographic factors.

METHODS: Data were obtained through an anonymous online survey sent to didactic students in 7 PA programs during orientation and again at midpoint of the didactic year. Descriptive statistics, independent samples t-testing, and one-way ANOVA analyses were used to assess trends in patient health questionnaire (PHQ-9) scores over the 6-month time period. The PHQ-9 is the module of the PHQ that measures severity of depression risk.

RESULTS: The orientation survey response rate was 82.7% (287/347) and the midpoint survey response rate was 62% (217/350). Analysis revealed that mean PHQ-9 scores increased significantly from 2.49 to 6.42 (p < 0.001) from orientation to midpoint of the didactic year, with 18.9% of students having scores of 10 or greater at midpoint compared to 4.5% at orientation. Thoughts of self-harm and/or suicidal ideation in the past 2 weeks also increased from 3.5% to 7.4% during the same time frame. Additionally, students’ likelihood of seeking mental health help decreased between orientation and midpoint despite the concurrent increases in depression risk and suicidal ideation.

CONCLUSION: Rising PHQ-9 scores indicated an increased risk of major depression among didactic-year PA students. Further research on early screening methods and factors that encourage help-seeking behaviors may serve to inform programs about how to create learning environments that mitigate depression risk and promote wellbeing during professional training.

PMID:34293797 | DOI:10.1097/JPA.0000000000000369

Dement Geriatr Cogn Disord. 2021 Jul 22:1-5. doi: 10.1159/000517580. Online ahead of print.

ABSTRACT

INTRODUCTION: Mild cognitive impairment (MCI) represents a target for early detection and intervention in dementia, yet there is a shortage of validated screening tools in Arabic to diagnose MCI. The mini-Addenbrooke’s Cognitive Examination (m-ACE) is a brief cognitive battery that is scored out of 30 and can be administered in under 5 min providing a quick screening tool for assessment of cognition.

OBJECTIVE: We aimed to validate the m-ACE in Arabic speakers in Egypt with MCI to provide cut-off scores.

METHODS: We included 24 patients with MCI and 52 controls and administered the Arabic version of the m-ACE.

RESULTS: There was a statistically significant difference (p < 0.0001) on the total m-ACE score between MCI patients (mean 18.54, SD 3.05) and controls (mean 24.54, SD 2.68). There was also a statistically significant difference between MCI patients and controls on the total score and the fluency, visuospatial, and memory recall sub-scores of the m-ACE (p < 0.05). Performance on the m-ACE significantly correlated with both the Mini-Mental State Examination (MMSE) and the Addenbrooke’s Cognitive Examination-III (ACE-III). Using a receiver operator characteristic curve, the optimal cut-off score for MCI on the m-ACE total score was 21 out of 30 (87.5% sensitivity, 84.6% specificity, and 85.5% accuracy).

CONCLUSIONS: We validated the Arabic m-ACE in Egyptian patients with MCI and provided objective validation of it as a screening tool for MCI, with good sensitivity, specificity, and accuracy that is comparable to other translated versions of the m-ACE in MCI.

PMID:34293741 | DOI:10.1159/000517580

Ophthalmic Plast Reconstr Surg. 2021 Jul 21. doi: 10.1097/IOP.0000000000002027. Online ahead of print.

ABSTRACT

PURPOSE: To describe the efficacy of tocilizumab in the treatment of a cohort of patients with active thyroid-associated orbitopathy.

METHODS: Patients were identified with active thyroid-associated orbitopathy who were intolerant of or had progression of disease despite systemic corticosteroids and subsequently were treated with tocilizumab between January 2015 and December 2020. Clinical Activity Score, Thyroid-Associated Ophthalmopathy Scale score, and thyroid-stimulating immunoglobulin levels were assessed prior to initiation of tocilizumab, following the first dose, and after the completion of treatment.

RESULTS: Eleven patients were candidates for and underwent treatment with tocilizumab, 9 of which met criteria for analysis. Average age was 55.6 years. Average time between onset of active thyroid-associated orbitopathy and completion of tocilizumab was 6.5 months. Average number of infusions was 4.2. There was a statistically significant reduction in Clinical Activity Score, Thyroid-Associated Ophthalmopathy Scale score, and thyroid-stimulating immunoglobulin levels when comparing pre-treatment values (mean Clinical Activity Score 6.78 ± 1.09, mean Thyroid-Associated Ophthalmopathy Scale score 10.2 ± 1.92, mean thyroid-stimulating immunoglobulin level 440.6 [%]) to values immediately following completion of treatment (mean Clinical Activity Score 0.44 ± 0.53, mean difference 6.3 points, p < 0.001 [95% CI, 5.5-7.2]; mean Thyroid-Associated Ophthalmopathy Scale score 1.2 ± 1.09, mean difference 9.0 points, p < 0.001 [95% CI, 7.2-10.8]; mean thyroid-stimulating immunoglobulin level 200.7 [%], mean difference 239.9 [%], p = 0.001 [95% CI, 124.3-355.4]). One patient had elevation of cholesterol following therapy induction. Patients were followed for an average of 23.6 months after treatment. No patients had recurrence of active disease after completion of tocilizumab.

CONCLUSIONS: This study supports the use of tocilizumab as a therapy for the inflammatory phase of thyroid-associated orbitopathy.

PMID:34293786 | DOI:10.1097/IOP.0000000000002027

Nutrition. 2021 Jun 7;91-92:111386. doi: 10.1016/j.nut.2021.111386. Online ahead of print.

ABSTRACT

OBJECTIVES: The purpose of this study was to investigate the correlation between dietary patterns and the risk of sarcopenic obesity (SO) in community-dwelling elderly people.

METHODS: SO was defined as the coexistence of sarcopenia and obesity. Participants with low skeletal muscle index, low muscle strength, or low physical performance were diagnosed with sarcopenia, whereas obesity was defined as waist circumference ≥85 cm in men and ≥80 cm in women. Dietary patterns were determined by principal component analysis. Multinomial logistic regression analysis was used to evaluate the relationship between dietary patterns and SO.

RESULTS: Among 3795 Chinese participants, 112 (3.0%) were diagnosed with SO. After adjustment for confounding variables, lacto-ovo-vegetarian dietary pattern was negatively associated with risk of SO. The odds ratio for SO was 0.79 (95% confidence interval, 0.65-0.97; P = 0.027) for the lacto-ovo-vegetarian dietary pattern, whereas meat-fish and junk food dietary patterns were not associated with the risk of SO.

CONCLUSIONS: We suggest that older people should have a balanced daily diet such as a lacto-ovo-vegetarian dietary pattern to prevent the occurrence and progression of SO.

PMID:34293713 | DOI:10.1016/j.nut.2021.111386

Arch Gerontol Geriatr. 2021 Jul 15;97:104485. doi: 10.1016/j.archger.2021.104485. Online ahead of print.

ABSTRACT

PURPOSE: To compare the effects of exergames versus conventional physical training on the cognitive skills of older adults.

MATERIALS AND METHODS: Scientific studies published in PubMed, Web of Science, and Cochrane Library databases were searched. Individual studies were assessed using the Cochrane Risk-of-bias tool for randomized trials (RoB 2). The quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE Pro). The cognitive outcomes were Trail Making Test (TMT)-A, TMT-B, Stroop Word-Color test, Mini Mental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA).

RESULTS: We identified 256 studies, in which 13 studies were included in the systematic review and 11 in the meta-analysis. The majority of the exergame interventions were based on the Xbox 360’s Kinect, followed by the Impact Dance Platform, Nintendo Wii, and the Bike Labyrinth. We observed heterogeneity in the conventional exercise group and in the duration of training, which ranged from 12 to 52 sessions. There was no statistically significant difference between groups in TMT-A (p=0.083), TMT-B (p=0.122), and Stroop (p=0.191). There were differences in favor of exergames in MMSE (raw mean difference=-1.58, 95% CI: -2.87 to -0.28, p<0.001) and MoCA (raw mean difference=-1.22, 95% CI: -2.24 to -0.20, p=0.019).

CONCLUSIONS: Despite statistical differences in MMSE and MoCA, these results should be interpreted with caution due to methodological heterogeneity. Some studies reported possible neurophysiological benefits induced by exergames, which should be explored in future investigations.

PMID:34293715 | DOI:10.1016/j.archger.2021.104485