Tag: pubmed

PLoS One. 2021 Apr 30;16(4):e0251084. doi: 10.1371/journal.pone.0251084. eCollection 2021.

ABSTRACT

BACKGROUND: Hepatitis B virus (HBV) kills millions of people globally; it is worse in pregnant women. HBV and Human Immune Virus (HIV) co-infection is associated with increased liver diseases such as cirrhosis and hepatocellular carcinoma. This study aimed at identifying the determinants of HBV infection among HIV-positive pregnant women.

METHODS: A multicentre unmatched case-control study was conducted among 109 cases (HBV/HIV co-infected) and 327 controls (HIV positive) pregnant women in seven hospitals of the Eastern Amhara region. Interview and chart review data collection techniques were employed by trained personnel. A binary logistic regression model was used to identify independent predictors of hepatitis B virus infection. Variables with a p-value of <0.05 and 95% confidence interval for odds ratio not containing 1 considered independent predictors of HBV infection.

RESULTS: The findings of this study revealed that history of STI [AOR, 1.97, 95%CI, 1.09-3.56], hospital admission [AOR, 3.08, 95%CI, 1.69-5.61], traditional delivery care [AOR, 3.31, 95%CI, 1.72-6.37], family history of HBV [AOR, 3.33, 95%CI, 1.72-6.37], presence of opportunistic infections [AOR, 0.23, 95%CI, 0.12-0.58], viral load [AOR, 7.58, 95%CI, 3.18-8.01], CD4 count [AOR, 2.15, 95% CI, 1.01-4.59], anaemia [AOR, 3.07, 95% CI, 1.71-5.51] and unsafe sex [AOR, 1.98, 95%CI, 1.09-3.61] had a statistically significant association with HBV infection.

CONCLUSIONS: Several exposure variables had statistically significant association with HBV infection. High Viral Load appeared to be the largest predictor of HBV infection in HIV patients. Therefore, targeted interventions such as behavioral change intervention for unsafe sex and STI should be in place, and screening tests and treatment at the early stage of conception for both partners is necessary.

PMID:33930097 | DOI:10.1371/journal.pone.0251084

Anesthesiology. 2021 Apr 30. doi: 10.1097/ALN.0000000000003797. Online ahead of print.

ABSTRACT

BACKGROUND: Evoked potential monitoring is believed to prevent neurologic injury in various surgical settings; however, its clinical effect has not been scrutinized. It was hypothesized that an automated nerve monitor can minimize intraoperative nerve injury and thereby improve clinical outcomes in patients undergoing shoulder arthroplasty.

METHODS: A prospective, blinded, parallel group, superiority design, single-center, randomized controlled study was conducted. Study participants were equally randomized into either the automated nerve-monitored or the blinded monitored groups. The primary outcome was intraoperative nerve injury burden as assessed by the cumulative duration of nerve alerts. Secondary outcomes were neurologic deficits and functional scores of the operative arm, and the quality of life index (Euro Quality of life-5 domain-5 level score) at postoperative weeks 2, 6, and 12.

RESULTS: From September 2018 to July 2019, 213 patients were screened, of whom 200 were randomized. There was no statistically significant difference in the duration of nerve alerts between the automated nerve-monitored and control groups (median [25th, 75th interquartile range]: 1 [0, 18] and 5 [0, 26.5]; Hodges-Lehman difference [95% CI]: 0 [0 to 1] min; P = 0.526). There were no statistically significant differences in secondary outcomes between groups. However, in the ancillary analysis, there were reductions in neurologic deficits and improvements in quality of life index occurring in both groups over the course of the study period.

CONCLUSIONS: Protection from nerve injury is a shared responsibility between surgeons and anesthesiologists. Although a progressive improvement of clinical outcomes were observed over the course of the study in both groups as a consequence of the real-time feedback provided by the automated nerve monitor, this trial did not demonstrate that automated nerve monitoring by itself changes important clinical outcomes compared with no monitoring.

PMID:33930115 | DOI:10.1097/ALN.0000000000003797

PLoS One. 2021 Apr 30;16(4):e0250941. doi: 10.1371/journal.pone.0250941. eCollection 2021.

ABSTRACT

BACKGROUND: Central venous access (CVA) is a frequent procedure taught in medical residencies. However, since CVA is a high-risk procedure requiring a detailed teaching and learning process to ensure trainee proficiency, it is necessary to determine objective differences between the expert’s and the novice’s performance to guide novice practitioners during their training process. This study compares experts’ and novices’ biomechanical variables during a simulated CVA performance.

METHODS: Seven experts and seven novices were part of this study. The participants’ motion data during a CVA simulation procedure was collected using the Vicon Motion System. The procedure was divided into four stages for analysis, and each hand’s speed, acceleration, and jerk were obtained. Also, the procedural time was analyzed. Descriptive analysis and multilevel linear models with random intercept and interaction were used to analyze group, hand, and stage differences.

RESULTS: There were statistically significant differences between experts and novices regarding time, speed, acceleration, and jerk during a simulated CVA performance. These differences vary significantly by the procedure stage for right-hand acceleration and left-hand jerk.

CONCLUSIONS: Experts take less time to perform the CVA procedure, which is reflected in higher speed, acceleration, and jerk values. This difference varies according to the procedure’s stage, depending on the hand and variable studied, demonstrating that these variables could play an essential role in differentiating between experts and novices, and could be used when designing training strategies.

PMID:33930076 | DOI:10.1371/journal.pone.0250941

PLoS One. 2021 Apr 30;16(4):e0250860. doi: 10.1371/journal.pone.0250860. eCollection 2021.

ABSTRACT

In this laboratory study, we assessed the resistance to microvacuole (glistening) formation in hydrophobic intraocular lenses (IOLs). Glistenings were induced in five lenses each of five different hydrophobic acrylic IOL models, using an established in vitro laboratory model: 800C (Rayner, Worthing, UK), AcrySof SN60WF (Alcon, Fort Worth, USA), Tecnis ZCB00 (Johnson & Johnson Vision, Santa Ana, USA), Vivinex XY1 (Hoya, Tokyo, Japan) and CT Lucia 611P (Zeiss, Oberkochen, Germany). We evaluated the number of microvacuoles per square millimeter (MV/mm2) in the central part of each IOL. Results were analyzed statistically, and mean glistening numbers were ranked, with the highest in the SN60WF which had 66.0 (±45.5) MVs/mm, followed by the 611P with 30.7 (±8.4) MVs/mm2. The 800C and XY1 showed comparable values of 2.0 (±3.6) and 2.7 (±2.4) MVs/mm2, respectively. ZCB00 had the lowest number with 0.9 (±0.6) MVs/mm2. This study shows that the resistance to glistening formation differs depending on the hydrophobic acrylic copolymer composition of the IOL material. Some IOLs from current clinical use are still prone to develop glistenings whereas others, including the ZCB00, 800C and XY1 show high resistance to microvacuole formation.

PMID:33930084 | DOI:10.1371/journal.pone.0250860

PLoS Pathog. 2021 Apr 30;17(4):e1009560. doi: 10.1371/journal.ppat.1009560. Online ahead of print.

ABSTRACT

Herpes-Simplex Virus 1 (HSV-1) infects most humans when they are young, sometimes with fatal consequences. Gene expression occurs in a temporal order upon lytic HSV-1 infection: immediate early (IE) genes are expressed, then early (E) genes, followed by late (L) genes. During this infection cycle, the HSV-1 genome has the potential for exposure to APOBEC3 (A3) proteins, a family of cytidine deaminases that cause C>U mutations on single-stranded DNA (ssDNA), often resulting in a C>T transition. We developed a computational model for the mutational pressure of A3 on the lytic cycle of HSV-1 to determine which viral kinetic gene class is most vulnerable to A3 mutations. Using in silico stochastic methods, we simulated the infectious cycle under varying intensities of A3 mutational pressure. We found that the IE and E genes are more vulnerable to A3 than L genes. We validated this model by analyzing the A3 evolutionary footprints in 25 HSV-1 isolates. We find that IE and E genes have evolved to underrepresent A3 hotspot motifs more so than L genes, consistent with greater selection pressure on IE and E genes. We extend this model to two-step infections, such as those of polyomavirus, and find that the same pattern holds for over 25 human Polyomavirus (HPyVs) genomes. Genes expressed earlier during infection are more vulnerable to mutations than those expressed later.

PMID:33930088 | DOI:10.1371/journal.ppat.1009560

J Cataract Refract Surg. 2021 Apr 5. doi: 10.1097/j.jcrs.0000000000000668. Online ahead of print.

ABSTRACT

PURPOSE: To analyze the difference in anterior chamber depth (ACD) after uneventful cataract surgery between two hydrophobic acrylic single-piece intraocular lenses (IOLs) with different material properties.

SETTING: Hanusch Hospital, Vienna, Austria DESIGN:: Single-center, bilateral randomized paired-eye controlled study METHODS:: Patients scheduled for bilateral cataract surgery were randomized to receive the Clareon IOL in one eye and the AcrySof IQ IOL (both Alcon Laboratories Inc.) in the contralateral eye. Preoperatively a slit lamp examination, optical biometry (IOLMaster 700, Carl Zeiss Meditec AG), refraction and visual acuity measurements were performed. ACD was assessed 1 hour and 1 week after surgery as well as with additional measurement of uncorrected (UDVA) and corrected distance visual acuity (CDVA) 6 months postoperatively.

RESULTS: Eighty eyes of 40 patients were analyzed in this study. ACD at the 6-month follow-up was 3.94 ± 0.30 mm for the Clareon IOL and 3.91 ± 0.32 mm for the AcrySof IQ IOL (P=.08). Statistically significant differences in the ACD shift between both IOLs were detected between 1 week and 6 months (P=.04) and 1 hour to 6 months (P=.04). There were no significant differences between both IOLs in UDVA (P=.78), in CDVA (P=.59) and in spherical equivalent (SE, P=.39) at the 6-month visit. The mean absolute error between the measured and the aimed SE was not significant (P=.97).

CONCLUSIONS: There was no clinically relevant difference in ACD between the Clareon IOL and the AcrySof IQ IOL in patients after uneventful cataract surgery. Both IOLs yielded good refraction and visual acuity outcomes.

PMID:33929807 | DOI:10.1097/j.jcrs.0000000000000668

J Cataract Refract Surg. 2021 Apr 22. doi: 10.1097/j.jcrs.0000000000000676. Online ahead of print.

ABSTRACT

PURPOSE-: To investigate complications and outcomes of clear corneal incision cataract surgery in patients with thrombocytopenia.

SETTING-: One veterans hospital and two academic medical centers DESIGN-: Multi-center retrospective chart review.

METHODS-: All eyes of thrombocytopenic patients that underwent clear corneal incision cataract surgery with a platelet count ≤100 x 10/µl measured ≤30 days prior to surgery were included. Subject demographics, intraoperative complications, use of pupil expansion devices, use of local anesthetic injections, and change in best corrected visual acuity were recorded.

RESULTS-: Three sites recorded 40,113 clear corneal incision cataract surgeries, of which 0.49% (196 eyes) were performed on 150 thrombocytopenic patients. The mean platelet count in the study subjects was 73.0×10/µl ± 20.5×10/µl. Two cases of intraoperative iris hemorrhage which were readily controlled occurred in conjunction with pupillary expansion. There were no bleeding complications associated with retrobulbar, peribulbar, or sub-Tenon anesthetic injections. There was a statistically significant improvement (p <0.0001) in visual acuity postoperatively.

CONCLUSION-: Clear corneal incision cataract surgery with pupillary expansion devices and local anesthetic injections can be safely performed in patients with thrombocytopenia.

PMID:33929795 | DOI:10.1097/j.jcrs.0000000000000676

J Cataract Refract Surg. 2021 Apr 5. doi: 10.1097/j.jcrs.0000000000000666. Online ahead of print.

ABSTRACT

PURPOSE: Compare realtime intraocular pressure(IOP) response to occlusion break event in two phacoemulsification systems.

SETTING: Iladevi Cataract & IOL Research Centre,India DESIGN:: Randomized,experimental study METHODS:: 10 rabbits(20 eyes) randomized to one of two groups: group I(n=10 eyes), Centurion Vision system with active fluidics, or, group II(n=10 eyes), Centurion with Active Sentry upgrade. Within each group, parameter set 1(IOP 30mmHg, aspiration flow rate(AFR) 20cc/min, vacuum 600mmHg) and parameter set 2(IOP 50mmHg, AFR 25cc/min, vacuum 600mmHg) were tested. Realtime rate of drop and rise of IOP following occlusion break event(mmHg/second) and percentage(%) reduction of IOP from maximum during nuclear fragment removal were compared.

RESULTS: Rate of drop of IOP following occlusion break was not significantly different between groups. Rate of rise of IOP was statistically significantly higher in group II with both parameter sets (199.09 + 69.28 vs 94.33 + 45.66 in parameter set 1,p=0.006; and 256 + 45.05 vs 165.25 + 51.80 in parameter set 2,p=0.005), suggesting faster recovery to baseline IOP following occlusion break. Mean % reduction of IOP from maximum was significantly higher in group I(P=0.003).

CONCLUSION: Rise of IOP to baseline following occlusion break event was faster and mean % reduction of IOP from maximum during nuclear fragment removal was lower when using the Centurion Vision system with the Active Sentry upgrade compared to the traditional handpiece. The ability to sense IOP at the level of the handpiece with the Active Sentry upgrade allows faster mitigation of surge response.

PMID:33929803 | DOI:10.1097/j.jcrs.0000000000000666

J Cataract Refract Surg. 2021 Apr 5. doi: 10.1097/j.jcrs.0000000000000669. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to determine the prevalence of keratoconus (KC) in the students and faculty members (aged ≥18 and ≤30 years) studying/working at the Medical and Health Sciences faculties of Eskişehir Osmangazi University.

SETTING: Eskişehir Osmangazi University DESIGN:: Prevalence study METHODS:: Subjects were randomly selected to undergo KC screening using a proportional stratified sampling method. Out of the 648 invited subjects, 585 (90.3%) responded to the invitation. The demographic data, medical/family history and habits of the subjects were collected using a standardized questionnaire. Subjects were classified as KC, ectasia susceptibility, and normal based on the corneal tomography. The chi-square and Kruskal-Wallis tests were used for the analysis of categorical variables and parametric values, respectively. Risk factors for KC were determined using logistic regression analysis.

RESULTS: The prevalence of KC was 2,393/100,000 (2.4%, 95% CI: 1.3%-4%), whereas that of ectasia susceptibility was 1,538/100,000 (1.5%, 95% CI: 0.7%-2.9%). Although the prevalence was much higher in male (4%, 95% CI: 1.7%-7.7%) than in female (1.6%, 95% CI: 1.1%-4.4%) the difference was not statistically significant (p=0.09). The majority (78.6%, n=11) of KC patients were unaware of their disease. Eye rubbing (OR:3.53, p=0.024) and consanguineous marriage (OR:12.87, p=0.032) were independent risk factors for KC.

CONCLUSION: This is the first population-based KC prevalence study in a randomized sample conducted in Turkey. The prevalence of KC in Turkey was much higher than in European countries but similar to neighboring countries in the Middle East. Eye rubbing and history of consanguineous marriage were significant risk factors.

PMID:33929805 | DOI:10.1097/j.jcrs.0000000000000669

Br J Clin Pharmacol. 2021 Apr 30. doi: 10.1111/bcp.14883. Online ahead of print.

ABSTRACT

AIMS: There are several limitations to the existing method of administering cefoxitin as a prophylactic antibiotic, and the limitations may be overcome by applying the target-concentration controlled infusion (TCI) method. Population pharmacokinetic parameters are required to administer cefoxitin by the TCI method. The aim of this study was to construct a new pharmacokinetic model of cefoxitin for the TCI method in colorectal surgical patients METHODS: In patients undergoing colorectal surgery, 2 g cefoxitin was dissolved in 50 mL saline and administered for 10 min prior to skin incision. Arterial blood samples were obtained at pre-set intervals to measure the total and free plasma concentrations of cefoxitin. Population pharmacokinetic analysis was performed using the NONMEM software (ICON Development Solutions, Dublin, Ireland). Additionally, the stochastic simulation was used to indirectly evaluate the effectiveness of the two administration methods (standard method vs. TCI) RESULTS: In total, 297 plasma concentration measurements from 31 patients were used to characterize the pharmacokinetics of cefoxitin. A three-compartment mammillary model well-described the pharmacokinetics of cefoxitin. Body weight and creatinine clearance were significant covariates for clearance. The stochastic simulation showed that when compared with the standard method, the TCI method has a significantly higher fraction of time that the free concentration of cefoxitin is maintained above the minimum inhibitory concentration (P < 0.001).

CONCLUSIONS: TCI has the potential to become a new infusion method for patient-tailored dosing in surgical patients. To administer cefoxitin via TCI in clinical practice, the newly constructed pharmacokinetic model should undergo proper external validation.

PMID:33929765 | DOI:10.1111/bcp.14883