Natl Med J India. 2024 Mar-Apr;37(2):118-119. doi: 10.25259/NMJI_988_2023.
NO ABSTRACT
PMID:39222535 | DOI:10.25259/NMJI_988_2023
Tag: pubmed
Natl Med J India. 2024 Mar-Apr;37(2):69-73. doi: 10.25259/NMJI_690_21.
ABSTRACT
Background Membranous tonsillitis is one of the most common forms of acute tonsillitis in childhood. Although many different microorganisms may cause this disease, clinicians generally consider bacterial agents as a possible cause and prescribe a penicillin-group of antibiotic. This study aimed to determine the aetiology of membranous tonsillitis and prescribing errors. In addition, we investigated the effectiveness of epidemiological, clinical and laboratory parameters and their role in guiding treatment. Methods We did this retrospective study at the paediatric emergency department of a tertiary referral hospital including 423 outpatient children aged 0 to 18 years diagnosed with membranous tonsillitis. Results Group A beta-haemolytic streptococcus was found in 132 (31.2%) patients, Epstein-Barr virus (EBV) in 103 (24.3%), and other viral aetiologies in 188 (44.4%). The prescription rate of antibiotics in the EBV-positive group was 27%, and Downey cells were seen at a rate of 98% in this group. Only 7% of patients with a positive throat culture were started on appropriate antibiotics. Conclusion EBV and group A beta-haemolytic streptococcus were the most common causes of membranous tonsillitis. Throat culture and peripheral blood smears are the most useful tests for paediatric emergency clinicians; these are fast and can help ensure correct diagnosis and guide treatment in almost all patients.
PMID:39222534 | DOI:10.25259/NMJI_690_21
Natl Med J India. 2024 Mar-Apr;37(2):74-78. doi: 10.25259/NMJI_212_2022.
ABSTRACT
Background The systemic immune-inflammation index (SII) is a novel marker for predicting the prognosis in patients with various diseases and cancers. We aimed to investigate the relationship between SII and disease activity in patients with Behçet disease (BD). Methods Our retrospective study included 513 patients with BD aged ≥18 years. The patients were classified into an active group (n=355) and an inactive group (n=158). Pearson correlation analysis was performed to elucidate correlations between the SII and other markers. Binary logistic regression analysis was used to determine BD-related risk factors. Receiver operating characteristic (ROC) curves were computed to assess cut-offs for the predictive value of the SII and other markers. Results Patients with active BD had a significantly higher SII (p<0.001) than those in the inactive group. ROC analysis revealed that the optimal SII cut-off value to identify BD activity was 526.23, with 70.4% sensitivity and 70.3% specificity. Pearson correlation coefficient (r) demonstrated a significant positive correlation between SII, and the C-reactive protein level (r=0.427, p<0.001), erythrocyte sedimentation rate (r=0.422, p<0.001), platelet- lymphocyte ratio (r=0.711, p<0.001), and neutrophil- lymphocyte ratio (r=0.672, p<0.001). According to binary logistic regression analysis, the SII (odds ratio [OR] 1.003; 95% confidence interval [CI] 1.001-1.004; p=0.002) was an independent risk factor for active BD. Conclusion The SII can be considered a novel predictor of BD activity.
PMID:39222532 | DOI:10.25259/NMJI_212_2022
Natl Med J India. 2024 Mar-Apr;37(2):79-81. doi: 10.25259/NMJI_182_2022.
ABSTRACT
Background We present the experience of telerheumatology consultation services carried out in an eastern state of India. Methods We did this prospective, observational study of patients with rheumatological disorders and followed through telemedicine between December 2015 and May 2019. Results During the study period, we provided teleconsultation to 3583 patients with the help of 11 201 telemedicine visits. Patients resided at a median distance of 248 (13 to 510) km from the telemedicine hub. The cumulative savings of the patients as a result of this service were ₹2.4 crore (24 million). The median travel time saved was 7 hours (30 minutes to 12 hours) per patient per visit and a median of ₹6700 was saved per visit per patient. Conclusion Sustained efforts over a long period can lead to the delivery of essential rheumatology services via telemedicine to an under-priviledged population, reduce the financial burden of the poor, and help women to access healthcare services in remote parts of low- and middle-income countries (LMICs).
PMID:39222531 | DOI:10.25259/NMJI_182_2022
Natl Med J India. 2024 Mar-Apr;37(2):82-85. doi: 10.25259/NMJI_1000_2022.
ABSTRACT
Background High levels of human HIV and tuberculosis (TB) stigma have been reported among healthcare workers (HCWs). Methods We compared HIV and TB stigma scores reported by nursing students and ward staff from hospitals across India. Transmission worry (TW) and intent to discriminate (ID) for HIV and TB were captured using a validated stigma scale. Results A total of 3733 individuals were interviewed. Nursing students and ward staff expressed higher TW while carrying out high- and low-risk tasks on patients with HIV compared to TB. Mean scores were 2.1 and 1.86 among nursing students; 1.82 and 1.79 among ward staff (all p<0.001). Both groups expressed a significantly higher ID against patients with HIV compared to TB (mean percentage: 75.6 and 70.3 among nursing students; and 81.8 and 78.8 among ward staff; all p<0.001). Conclusion TB stigma has implications for providing quality TB care. Training of HCWs regarding transmission dynamics, the importance of standard precautions during patient care, regardless of diagnosis is essential.
PMID:39222528 | DOI:10.25259/NMJI_1000_2022
Ann Intern Med. 2024 Sep 3. doi: 10.7326/M24-0080. Online ahead of print.
ABSTRACT
BACKGROUND: Despite widespread use of fecal immunochemical tests (FITs) for colorectal cancer (CRC) screening, data to guide test selection are limited.
OBJECTIVE: To compare the performance characteristics of 5 commonly used FITs, using colonoscopy as the reference standard.
DESIGN: Cross-sectional study. (ClinicalTrials.gov: NCT03264898).
SETTING: Three U.S. academic medical centers and affiliated endoscopy units.
PARTICIPANTS: Patients aged 50 to 85 years undergoing screening or surveillance colonoscopy.
INTERVENTION: Participants completed 5 different FITs before their colonoscopy, including 4 qualitative tests (Hemoccult ICT, Hemosure iFOB, OC-Light S FIT, QuickVue iFOB) and 1 quantitative test (OC-Auto FIT, which was run at the manufacturer’s threshold for positivity of >100 ng/mL).
MEASUREMENTS: The primary outcome was test performance (sensitivity and specificity) for each of the 5 FITs for advanced colorectal neoplasia (ACN), defined as advanced polyps or CRC. Positivity rates, positive and negative predictive values, and rates of unevaluable tests were compared. Multivariable models were used to identify factors affecting sensitivity.
RESULTS: A total of 3761 participants were enrolled, with a mean age of 62.1 years (SD, 7.8); 63.2% of participants were female, 5.7% were Black, 86.4% were White, and 28.7% were Hispanic. There were 320 participants with ACN (8.5%), including 9 with CRC (0.2%). The test positivity rate varied 4-fold (3.9% to 16.4%) across FITs. Rates of unevaluable FITs ranged from 0.2% to 2.5%. The sensitivity for ACN varied from 10.1% to 36.7%, and specificity varied from 85.5% to 96.6%. Differences in sensitivity between FITs were all statistically significantly different except between Hemosure iFOB and QuickVue iFOB, and specificity differences were all statistically significantly different from one another. In addition to FIT brand, distal location of ACN was also associated with higher FIT sensitivity.
LIMITATION: The study did not assess the programmatic sensitivity of annual FIT.
CONCLUSION: Although considered a single class, FITs have varying test performance for detecting ACN and should not be considered interchangeable.
PRIMARY FUNDING SOURCE: National Institutes of Health.
PMID:39222513 | DOI:10.7326/M24-0080
Ulus Travma Acil Cerrahi Derg. 2024 Sep;30(9):650-656. doi: 10.14744/tjtes.2024.25442.
ABSTRACT
BACKGROUND: Firearm injuries (FI) remain a significant cause of morbidity and mortality globally. Antibiotic use, supported by guideline recommendations for preventing post-injury infections in FI cases, encounters uncertainties regarding the selection of anti-microbial agents and associated outcomes. This study aimed to investigate the relationship between Injury Severity Scores (ISS) for FI cases presented to the emergency department.
METHODS: We empirically revised antimicrobial treatment protocols based on culture results and mortality rates. In the study, 164 firearm injury cases, admitted to the emergency department in 2022 and subsequently hospitalized in clinics and intensive care units (ICU), were evaluated. Cases included in the study were categorized into four groups based on ISS: mild, moderate, severe, and profound injury severity. The study compared the timing of hospital presentation following the injury, hospital length of stay, tissue or blood culture positivity, empirical treatment administered, antimicrobial revision based on culture results, need for ICU admission, mortality status, and ISS among the cases. Data were analyzed using IBM SPSS Statistics 22.0 (SPSS Inc., Chicago, IL). Variables in trauma patients were compared among various groups using Pearson Chi-Square tests. Binary logistic regression tests were performed to identify independent risk factors. A significance level of p<0.05 was considered statistically significant.
RESULTS: The study included 164 patients, all of whom were male. The mean age was calculated as 28.9±4.51 years. The average hospital length of stay was 25.54±21.81 days. Eighty-three patients (50.6%) required intensive care. Tissue cultures were obtained from 79 patients (48%). Bacterial growth was observed in 45 of these 79 patients (57%). The appropriate empirical antibiotic treatment rate, assessed among patients who received empirical treatment followed by culture-based antibiotic sensitivity testing, was 48.9%. It was observed that empirical antibiotic regimens were appropriate in 80% of cases in the mild group and 16.7% in the profound severe group (p=0.005). Our study compared the relationship between hospitalization duration and ISS groups. It was observed that hospitalization duration was significantly shorter in the mild group compared to the other groups (p=0.003, p=0.000, p=0.000). It was also observed that the need for ICU admission was higher in groups with higher ISS, indicating a correlation between higher ISS and increased ICU requirements (p=0.000).
CONCLUSION: In conclusion, for cases of firearm injuries, we believe empirical antimicrobial therapy should be initiated with narrow-spectrum agents such as beta-lactam + beta-lactamase inhibitor or third-generation cephalosporin + nitroimidazole in the mild group, considering the lack of Pseudomonal activity.
PMID:39222499 | DOI:10.14744/tjtes.2024.25442
Ulus Travma Acil Cerrahi Derg. 2024 Sep;30(9):685-693. doi: 10.14744/tjtes.2024.52932.
ABSTRACT
BACKGROUND: This study aimed to evaluate the approaches of pediatric surgeons and pediatric urologists in Türkiye regarding the diagnosis and treatment of testicular torsion (TT) and their adherence to the European Association of Urology (EAU) pediatric urology guideline.
METHODS: A survey consisting of 19 questions, accompanied by an annotation describing the objective of the study, was emailed to pediatric surgeons and pediatric urologists in June and July 2023.
RESULTS: Of the 95 respondents, 62.1% had over 10 years of experience, and 48.4% treated more than five cases of TT annually. Of the participants, 87.4% stated that scrotal Doppler ultrasonography (US) was always used, and 12.6% stated that US was used in cases of doubtful diagnosis. Concerning treatment, 14.7% reported performing manual detorsion, 70.5% never did, and 14.7% did so only if the operating room was unavailable soon. A total of 92.6% of participants opted for emergency surgery. Among participants who perform manual detorsion, 71.4% perform surgery within 24 hours after successful manual detorsion. Regarding fixation of the contralateral testicle, 14.7% never performed it, and 27.4% did so only when they performed an orchiectomy on the torsion testicle.
CONCLUSION: While most participants follow EAU pediatric urology guidelines by performing emergency surgery, the rate of manual detorsion is low. Few participants stated that emergency surgery may not be performed after manual detorsion. While all of the participants performed fixation of the torsion testicle in accordance with the guidelines, the same adherence was not observed in the contralateral testicle.
PMID:39222498 | DOI:10.14744/tjtes.2024.52932
Ulus Travma Acil Cerrahi Derg. 2024 Sep;30(9):626-634. doi: 10.14744/tjtes.2024.77415.
ABSTRACT
BACKGROUND: Ischemia-reperfusion injury (IRI) is a phenomenon that affects transplant survival. The aim of our study was to examine the effects of IRI in isogenic and allogeneic muscle and skin transplantation models exposed to prolonged warm ischemia.
METHODS: Forty-eight Lewis rats and 16 Brown-Norway rats were used to create four groups: Isogenic Inguinal Flap Transplantation (IST), Isogenic Gastrocnemius Muscle Flap Transplantation (IMT), Allogeneic Inguinal Flap Transplantation (AST), and Allogeneic Gastrocnemius Muscle Flap Transplantation (AMT). Malonyldialdehyde (MDA) and superoxide dismutase (SOD) levels were measured on postoperative days 1, 7, 21, 35, 63, 100, and 120 in all groups. Donor-specific chimerism (DSC) in peripheral blood was evaluated in the allogeneic groups on postoperative days 7, 21, 35, 63, 100, and 120. The microRNA-21 and microRNA-205 levels were evaluated on postoperative days 1, 7, and 120 in all groups. At the end of the study, a histopathological examination was performed.
RESULTS: A statistically significant difference was found between the groups in terms of MDA and SOD levels. DSC was detected in the AMT group. A significant increase in microRNA-205 was observed, especially in the AMT group. There was no significant difference in the number of functional muscle units between the muscle transplantation groups.
CONCLUSION: The presence of DSC in the AMT group and the lack of a significant difference in the number of functional muscle units in the IMT and AMT groups are noteworthy findings.
PMID:39222497 | DOI:10.14744/tjtes.2024.77415
Ulus Travma Acil Cerrahi Derg. 2024 Sep;30(9):644-649. doi: 10.14744/tjtes.2024.78241.
ABSTRACT
BACKGROUND: Aortic dissection (AD) is a serious cardiovascular condition associated with high mortality rates. The systemic inflammatory response can influence the prognosis of AD, and in this context, the neutrophil-to-lymphocyte ratio (NLR) emerges as a simple and rapid inflammatory biomarker.
METHODS: This retrospective cohort study included 103 patients diagnosed with AD and treated in the emergency department between 2018 and 2023. Patient demographics, clinical features, and laboratory results were evaluated. Multivariate logistic regression analysis was performed to adjust for potential confounders such as age, mean systolic blood pressure, oxygen saturation, hemoglobin, lactate values, and the presence of coronary artery disease. The ability of NLR to predict mortality was analyzed using receiver operating characteristic (ROC) analysis.
RESULTS: The study population was divided into two groups: non-survivors (68% mortality rate) and survivors (32% survival rate). The non-survivor group had significantly higher NLR values compared to the survivor group (median NLR 7.66 vs. 2.5, p<0.001). Multivariate logistic regression analysis identified NLR as an independent predictor of in-hospital mortality (adjusted odds ratio [OR] 2.33, 95% confidence interval [CI] 1.42-3.82, p<0.001). ROC analysis for NLR demonstrated high discriminative power with an area under the ROC curve (AUROC) of 0.851 (95% CI 0.768-0.914). The determined cut-off point was >5.08 with a sensitivity of 77.14% and specificity of 81.82%.
CONCLUSION: The findings indicate that high NLR is strongly associated with increased mortality risk in patients with AD and can be used in emergency clinical settings to predict mortality.
PMID:39222496 | DOI:10.14744/tjtes.2024.78241