Tag: nevin manimala

Emerg Med J. 2021 Sep 20:emermed-2020-210947. doi: 10.1136/emermed-2020-210947. Online ahead of print.

ABSTRACT

BACKGROUND: Following blunt trauma, diagnosis of shoulder dislocation based on physical examination alone is difficult due to possible concurrent proximal humeral fractures. X-rays are therefore used to confirm diagnosis. Results from recent observational studies comparing diagnostic accuracy of point-of-care ultrasound (PoCUS) with X-rays for shoulder dislocation have been encouraging. The aim of this study was to determine whether PoCUS improves diagnostic accuracy when used with physical examination for the diagnosis of shoulder dislocation, proximal humeral fracture and ascertaining successful reduction in the ED.

METHODS: A prospective, single-centre, open, parallel randomised control study over a 6-month period was used to answer the research question and test the null hypothesis. Consecutive eligible adult patients attending the ED of Mater Dei Hospital in Malta were randomised to either the control (C) (physical examination only) or experimental group (E) (physical examination and a two-point PoCUS scan). The study objectives were to measure diagnostic accuracy for both examinations for detecting shoulder dislocation, any associated proximal humeral fractures and confirming reduction. X-rays were used as reference standard for both groups.

RESULTS: 1206 patients were enrolled in this study (C n=600, E n=606). 290 dislocations (C n=132 and E n=158), 332 proximal humeral fractures (C n=154 and E n=178) and 278 reductions (C n=130 and E n=148) were analysed. A statistically significant difference (p<0.001) was found between the two groups for diagnostic accuracy in shoulder dislocation (C=65%, likelihood ratio (LR)+=2.03 and LR-=0.35 and E=100%, LR+=∞ and LR-=0), proximal humeral fractures (C=45.7%, LR+=1.23 and LR-=0.52 and E=98.3%, LR+=103.9 and LR-=0.03) and reduction (C=68.7%, E=100%). The null hypothesis for this study was thus rejected.

CONCLUSIONS: The addition of PoCUS to a physical examination significantly improves diagnostic accuracy for dislocations, proximal humeral fractures and reduction confirmation.

TRIAL REGISTRATION NUMBER: International Standard Randomised Controlled Trials Number Registry (ISRCTN17048126).

PMID:34544780 | DOI:10.1136/emermed-2020-210947

Pulmonology. 2021 Sep 17:S2531-0437(21)00158-6. doi: 10.1016/j.pulmoe.2021.08.002. Online ahead of print.

ABSTRACT

BACKGROUND: Tuberculosis (TB) incidence declined in Portugal in recent decades, but trends differ between regions and population subgroups. We investigated these differences to inform prevention and control programmes.

METHODS: We extracted TB notifications from the Portuguese National TB Surveillance System (SVIG-TB) in 2010-2017, disaggregated by region, age group, country of birth and HIV status. We calculated notification rates using denominators from the Portuguese National Institute of Statistics and the Joint United Nations Programme on HIV/AIDS and performed stratified time series analysis. We estimated interannual decline percentages and 95% confidence intervals (CI) using Poisson and binomial negative regression models.

RESULTS: The overall TB notification rate decreased from 25.7 to 17.5/100,000 population from 2010 to 2017 (5.2%/year) in Portugal. Interannual decline did not differ significantly between regions, but it was smaller amongst non-Portuguese nationals (-1.57% [CI: -4.79%, 1.75%] vs -5.85% [CI: -6.98%, -4.70%] in Portuguese nationals); children under five years of age (+1.77% [CI: -4.61%, 8.58%] vs -5.38% [CI: -6.33%, -4.42%] in other age groups); and HIV-negative people (-6.47% [CI: -9.10%, -3.77%] vs -11.29% [CI; -17.51%, -4.60%] in HIV-positive).

CONCLUSIONS: The decline in TB notification rates in Portugal during the study period has been steady. However, the decline amongst non-Portuguese nationals, children under five years of age and non-infected-HIV patients was lower. No significant differences were observed between regions. Changes in TB epidemiology in specific risk groups and geographical areas should be closely monitored to achieve the objectives of the End TB Strategy. We recommend intensifying screening of TB in the subpopulations identified.

PMID:34544672 | DOI:10.1016/j.pulmoe.2021.08.002

Dig Liver Dis. 2021 Sep 17:S1590-8658(21)00762-3. doi: 10.1016/j.dld.2021.08.022. Online ahead of print.

ABSTRACT

BACKGROUND: Prognostic stratification in ChronicPancreatitis(CP) remains suboptimal and cumbersome. Chronic Pancreatitis Prognostic Score(COPPS) was recently developed to predict one-year hospitalisations in CP.

AIM: External validation of COPPS in a geographically divergent patient population.

METHODS: A single-center prospective cohort study, conducted on out-patients of a tertiary-care hospital. Consecutive adults with CP were assessed for COPPS risk predictors at baseline, similar to the original development cohort, and followed for one-year for: 1)hospitalisations; 2)development of pancreatitis-related complications; and 3)need for endoscopic and/or surgical interventions. Outcomes were compared by Kendall’s tau-b(τ_b) and other statistical tests. Only those who had complete one-year follow-up were included in analysis.

RESULTS: There were 177 patients(mean±SD age: 35.9 ± 11.2 years), 116(65%) males and 117(66%) with Idiopathic CP. Despite being younger, with significantly more females and Idiopathic CP, than the original development cohort, our cohort was similar to the latter regarding COPPS severity at baseline. Eight patients died over one-year; 169 were evaluated for outcomes. Increasingly severe COPPS categories correlated with increasing number of hospitalisations(both overall and pancreatitis-related) and increasing number of days spent in hospital(both overall and pancreatitis-related) irrespective of age at symptoms-onset(≤35 vs >35years), etiology(idiopathic vs alcohol) and smoking-status.

CONCLUSIONS: COPPS is effective in a geographically distinct cohort having a different case-mix of CP patients(ClincialTrials.gov ID:NCT04907266).

PMID:34544675 | DOI:10.1016/j.dld.2021.08.022

Int Orthod. 2021 Sep 17:S1761-7227(21)00114-5. doi: 10.1016/j.ortho.2021.08.007. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of this study is to compare and analyze the similarities between three-dimensional images captured by a smartphone camera with depth sensors and a conventional 3dMD Face system.

MATERIALS AND METHODS: Twenty six individuals (16 female, 10 male) were involved in this study, agreed to take part and as such had no paralysis, tics, etc., which may prevent taking the image. Anthropometric points were marked, and plasters were placed on the forehead, upper nasal dorsum and zygoma to determine matching areas. 3D images were captured with a DOF (Depth of Field) camera of a smartphone (iPhone X, Apple Inc. CA, USA) and a 3D imaging system (3dMD, Atlanta, GA, USA). Linear and angular measurements were carried. Overlapping area amounts of matched images and X, Y and Z coordinates of landmarks were compared. For comparison of the data, student t-test and Mann-Whitney U test were used at P<0.05.

RESULTS: Statistically significant changes were found in distance between inner commissures of right and left eye fissure and nasolabial angle. RMS (Root Mean Square) values were found between 0.58 and 1.

CONCLUSION: Images captured with a DOF camera of a smartphone, can be used to record and evaluate 3D soft tissue changes. However, due to the anatomical features of some regions, the deficiency of clear visualization needs improvements.

PMID:34544662 | DOI:10.1016/j.ortho.2021.08.007

Neurologia (Engl Ed). 2021 Sep 17:S2173-5808(21)00133-4. doi: 10.1016/j.nrleng.2019.08.004. Online ahead of print.

ABSTRACT

BACKGROUND: Hospital on-call neurology shifts are frequently on-site, but some on-call services may be off-site or mixed. Intravenous tissue plasminogen activator (tPA) is one of the main reperfusion treatments for acute ischaemic stroke (AIS). This study assesses door-to-needle times (DNT) when the neurologist is on-site or off-site.

METHODS: We performed a prospective, observational study from 2012 to 2017, including patients with AIS and treated with tPA. Data were collected on sex, age, door-to-scan time, scan-to-needle time, and DNT. The on-duty neurologist was on-site from 08:00 to 20:00, and on call but off-site from 20:00 to 8:00. Three groups were formed: on-site, off-site, and off-site with resident present.

RESULTS: Our sample included 138 patients. The mean age was 69.7 years, and 45.7% of patients were women. Ninety-six patients were admitted during the on-site shift, 25 during the off-site shift, and 17 during the off-site-resident present shift. Patients admitted during the on-site and off-site shifts presented DNTs of 59 and 72 minutes, respectively (P = .003). DNTs were 59, 74, and 68 minutes (P = .001), respectively, for the on-site, off-site, and off-site-resident present shifts; the difference between DNTs for on-site and off-site shifts was statistically significant. No differences were observed between DNTs according to time of day (morning, afternoon, or night), or between weekdays and weekends.

CONCLUSION: DNT is influenced by whether the on-duty neurologist is on- or off-site at the time of code stroke activation. The presence of a neurology resident can reduce DNT.

PMID:34544671 | DOI:10.1016/j.nrleng.2019.08.004

P R Health Sci J. 2021 Jun;40(2):75-80.

ABSTRACT

OBJECTIVE: The objective of this study was to determine the age-related anatomical changes that take place at the cementodentinal junction (CDJ).

METHODS: Eighty-four teeth were extracted; 42 samples came from patients ranging in age from 18 to 30 years, and 42 came from patients aged from 40 to 60 years. Upper and lower and anterior and posterior teeth were included. Longitudinal slices were made, and 1% toluidine blue was used to stain all the samples prior to microscopic examination. Anatomical landmarks (apical foramen [AF], apical vertex, and cementoenamel junction) in the apical third were identified, and a pre-calibrated software package was employed to take digital measurements. Statistical analysis was performed by means of the Wilcoxon rank-sum test.

RESULTS: The data obtained showed that there were anatomical variations in the apical third in the older patients and that these changes were related to the age of the patient. Narrower root canals and smaller CDJ diameters were found in older patients’ samples.

CONCLUSION: The results of this study suggest that instrumentation and obturation should take place 1 mm from the AF in older patients, and not 0.5 mm, as is usually recommended.

PMID:34543565

P R Health Sci J. 2021 Jun;40(2):63-67.

ABSTRACT

OBJECTIVE: This study aims to describe the frequency of biologic therapy failure in psoriasis patients along with associated patient demographics and characteristics.

METHODS: This was a retrospective medical-record review of psoriasis patients evaluated from January 1st, 2013, through May 1st, 2018, and who failed at least once to adhere to their biologic therapy.

RESULTS: Seventy-seven patients with psoriasis who had discontinued biologic therapy at least once were included in this study. Hypertension (58.4%), diabetes (37.7%), dyslipidemia (27.3%), and psoriatic arthritis (23.4%) were the main comorbidities observed. Adalimumab (ADA, 80.5%), ustekinumab (UST, 70.1%), and etanercept (ETA, 14.2%) were the most frequently used biologics in our cohort. The biologic with the longest mean duration of use prior to its discontinuation was UST (17.0 months), followed by ADA (15.9 months) and ETA (13.6 months).

CONCLUSION: The most common reason for discontinuing biologic therapy was that said therapy was not effective, though for ETA and UST, the fact that biologic therapies are not universally covered by insurance company was found to be associated with their discontinuation, as well. There were no statistically significant associations found between biologic therapy discontinuation and age, gender, or comorbidities, which last included obesity, class I. Larger studies are warranted to identify risk factors associated with biologic therapy failure to help guide drug selection, decrease morbidity associated with such nonadherence and improve patient outcomes.

PMID:34543563

Klin Lab Diagn. 2021 Sep 10;66(9):517-524. doi: 10.51620/0869-2084-2021-66-9-517-524.

ABSTRACT

KIM-1 (kidney injury molecule 1), a marker of acute kidney injury, is produced by epithelial cells of renal proximal tubules. Elevated KIM-1 levels in urine and plasma are associated with renal cell carcinoma (RCC). The aim of this study was to compare the significance of non-normalized uKIM-1 values and those normalized to urine creatinine, as urinary biomarkers in RCC. The uKIM-1, urine creatinine and their ratio (uKIM-1/Cre) were studied in 118 RCC patients and 58 apparently healthy subjects. The median of uKIM-1 in the healthy group was 0.71 ng/ml (1st and 3rd quartiles were 0.35 and 1.23, respectively) and in RCC patients it was 2.36 (1.43; 5.93) ng/ml. The medians of uKIM-1/Cre were 0.77 (0.49; 1.18) and 2.42 (1.41; 4.61) ng/mgCre, respectively. Stage I RCC is statistically significantly different from stages II-III and stage IV using uKIM-1/Cre values (p = 0.0056 and p = 0.0012, respectively); using uKIM-1 values significant differences occur only when comparing stages I and IV (p = 0.015). In both healthy individuals and RCC patients, uKIM-1/Cre levels were slightly lower in subgroups younger than 50 years than in subgroups older than 50 years, whereas a similar trend was observed for uKIM-1 only in patients. In healthy men and male patients, uKIM-1 levels were higher than in the corresponding groups of women (the differences were not statistically significant), but the use of uKIM-1/Cre values eliminated the gender differences. A high correlation was found between the concentrations of uKIM-1 and urine creatinine in three healthy subjects followed up for 3 weeks (Spearman’s correlation coefficients were 0.758, 0.825 and 0.933, respectively). The data obtained are clear evidence of the need for normalization uKIM-1 to urine creatinine in RCC patients.

PMID:34543529 | DOI:10.51620/0869-2084-2021-66-9-517-524

Klin Lab Diagn. 2021 Sep 10;66(9):533-538. doi: 10.51620/0869-2084-2021-66-9-533-538.

ABSTRACT

The data of a comparative enzyme-linked immunosorbent assay of the content of the soluble form of the immunity checkpoint VISTA in the blood serum of 30 healthy donors (control group), 79 patients with primary malignant (osteosarcoma – 30, chondrosarcoma – 31, chordoma – 14) and 14 borderline (giant cell tumor) bone neoplasms are presented. In the general group of patients with malignant neoplasms of bones, the median sVISTA content in blood serum is statistically significant lower than in the control (p = 0.040). In patients with bone tumors and healthy donors over 18 years of age, there was a decrease with age in serum sVISTA levels. There were no significant differences in sVISTA concentration between patients with osteosarcoma, chondrosarcoma and healthy donors. Only in patients with chordoma were sVISTA levels statistically significant lower than in controls (p = 0.013). In the groups of patients with chondrosarcoma and osteosarcoma of the bone, there were no significant associations between the serum sVISTA content and the main clinical and morphological characteristics of the disease. In patients with osteosarcoma, no relationship was found between sVISTA levels and overall survival rates, while in patients with bone chondrosarcoma, there was a tendency towards a favorable prognosis with a high content of the marker in the blood serum.

PMID:34543531 | DOI:10.51620/0869-2084-2021-66-9-533-538

Klin Lab Diagn. 2021 Sep 10;66(9):565-570. doi: 10.51620/0869-2084-2021-66-9-565-570.

ABSTRACT

The concentration of bacterial plasmalogen 18a and endotoxin in the blood of elderly people 45-90 years old with the pathology of type 2 diabetes mellitus (DM 2) – the main group and without diabetes mellitus – the comparison group was investigated. The concentration of both plasmalogen 18a and endotoxin in the blood of individuals with DM 2 pathology is statistically significantly higher than in the blood of individuals without DM 2 pathology. To assess the state of microbiocenosis and predict type 2 diabetes mellitus, decisive rules have been determined in the form of threshold values of plasma concentrations 18a and endotoxin in the blood of elderly people with a suspected or established diagnosis of type 2 diabetes. Using ROC analysis, it was found that values above 20.66 μg / ml for plasmalogen 18a, and 0.48 nmol / ml for endotoxin, determine the presence of type 2 diabetes mellitus pathology in the 45-90 age group.

PMID:34543536 | DOI:10.51620/0869-2084-2021-66-9-565-570