Tag: pubmed

Burns. 2022 Jun 22:S0305-4179(22)00160-7. doi: 10.1016/j.burns.2022.06.010. Online ahead of print.

ABSTRACT

BACKGROUND: Intermittent Fasting (IF) has proved to have various positive effects on life span, diseases, and healing of tissues in rodents. We evaluated the protective effect of fasting in maintaining the ischemic zones in burn wounds.

METHODS: In this study, 20 rats were divided into two groups where the IF rats were deprived of food for three months. Burn wounds were created by burn comb model on the back of all rats. On days 3 and 21 after injury, five rats in each group were euthanized whereby samples were collected for histopathological, immunohistochemical (Bcl2, P53 and VEGF), and biochemical (MDA, TAC, HP) evaluations.

RESULTS: Histopathological analysis revealed epithelial layer and zone of ischemia remained viable in the intermittent fasting group on day 3. On the 21st day, epithelialization, angiogenesis, inflammation, fibrocyte-fibroblast, and collagen density were different in the ischemic and necrotic zones between the control and intermittent fasting groups (p<0.05). We found no statistical differences in Bcl2, P53, VEGF, MDA, TAC, and HP on day 3 between the intermittent fasting and control groups.

CONCLUSIONS: Intermittent fasting before burn wounds reduces tissue damage caused by ischemia and enhanced the viability of cells in zone of stasis. It also accelerated wound healing by increasing epithelialization and collagen production in the skin and regulating inflammatory responses. This intervention appears to be related to better collagen arrangement and angiogenesis.

PMID:35787965 | DOI:10.1016/j.burns.2022.06.010

Burns. 2022 Jun 10:S0305-4179(22)00144-9. doi: 10.1016/j.burns.2022.06.003. Online ahead of print.

ABSTRACT

Low- and middle-income countries (LMICs) remain drastically underrepresented in health research, with African countries producing less than 1% of the global output. This work investigates authorship patterns of publications on burns in LMICs. Original research studies addressing burn injuries in LMICs and published between 1st January 2015 and 31st December 2020 were included in the review. Descriptive statistics were performed for country affiliations of authors, World Bank Country Income Groups, WHO group, study-focus and country studied. Of the 458 results, 426 studies met the inclusion criteria. Nearly a quarter of papers on burns in LMICs had both first and senior authors from high-income countries (HICs, n = 95, 24.4%), more than half of the papers had both first and senior authors from upper middle- income countries (upper MICs, n = 222, 57.2%), while less than 1% (n = 3) had first and senior authors exclusively from lower-income countries (LICs). Eleven percent (n = 41/388) of all papers were written without either first nor senior author being from the country studied, and 17 of them (41%) had both first and senior authors from the USA. Twenty-five (6%) of the papers had the first author and not the senior author from the country of focus, while six (2%) had the senior and not the first author from the country of interest. To overcome global health challenges such as burns, locally led research is imperative. The maximum benefit of HIC-LMIC collaborations is achieved when LMICs play an active role in leading the research. When LMICs direct the research being conducted in their country, the harm of inherently inequitable relationships is minimized.

PMID:35787966 | DOI:10.1016/j.burns.2022.06.003

World Neurosurg. 2022 Jul 1:S1878-8750(22)00914-7. doi: 10.1016/j.wneu.2022.06.129. Online ahead of print.

ABSTRACT

OBJECTIVE: Angiographic treatment of asymptomatic cerebral vasospasm in aneurysmal subarachnoid hemorrhage remains controversial. We sought to investigate its relationship with the development of delayed cerebral ischemia.

METHODS: Consecutive patients admitted between July 2017 and June 2019, with a diagnosis of aneurysmal subarachnoid hemorrhage, were retrospectively analyzed. The rate of development of delayed cerebral ischemia was compared between a group of patients who underwent cerebral angiography for asymptomatic cerebral vasospasm and those who did not. The Mann-Whitney U test or chi-square test was used to compare the two groups.

RESULTS: 37 of the 94 patients with aneurysmal subarachnoid hemorrhage were screened for cerebral vasospasm, of whom 16 (43%) had moderate-severe vasospasm. When patients who underwent therapeutic cerebral angiography were compared with those who did not, and after adjusting for sex, age, and grade of subarachnoid hemorrhage, treatment was not found to be significantly associated with delayed cerebral ischemia (HR=0.82, 95% CI: 0.19-3.52, p=0.79). We found that the median length of stay in the intensive care unit and hospital increased significantly with the severity of cerebral vasospasm (p<0.001).

CONCLUSIONS: Cerebral angiography has a low rate of detecting moderate-severe cerebral vasospasm in asymptomatic patients. Moreover, there was no statistically significant difference in the rate of delayed cerebral ischemia between asymptomatic patients treated versus those not treated for cerebral vasospasm.There was significant association between the severity of CVS and the ICU and hospital length of stay. More studies are needed to evaluate the utility of treating asymptomatic cerebral vasospasm in high-grade aneurysmal subarachnoid hemorrhage.

PMID:35787959 | DOI:10.1016/j.wneu.2022.06.129

Dent Mater. 2022 Jul 1:S0109-5641(22)00193-2. doi: 10.1016/j.dental.2022.06.033. Online ahead of print.

ABSTRACT

OBJECTIVE: Evaluate the effect of different restorative filling techniques on the residual shrinkage stress (ShrS), cuspal strain (CS), depth of cure (DC), and enamel crack formation (Ec) in molars with MOD restorations.

METHODS: Post-gel shrinkage, elastic modulus, compressive and diametral tensile strength of the Filtek One Bulk Fill composite were calculated. Sixty molars with MOD preparations were restored using four filling techniques: Bulk; Horizontal; Oblique; Natural enamel and dentin substitution (NEDS) technique. CS was measured using a strain gauge (n = 10). The DC (n = 5) was measured using Knoop hardness. Shrinkage stress/strain was analyzed using 3D finite element analysis. The Ec analysis was carried out by transillumination. Two-way ANOVA with repeated measures and Tukey’s HSD test (α = 0.05) was performed for the CS data. Two-Way ANOVA and Tukey’s HSD test was performed for the DC data (α = 0.05).

RESULTS: CS was higher at the lingual cusp for the horizontal and NEDS technique. No statistical difference was found between the buccal and lingual CS values for the Bulk (p = 0.367) or Oblique techniques (p = 0.192). CS values were lower for the Bulk. More enamel cracks were found for the Bulk. DC was lower at 4 mm regardless the filling technique. The Horizontal showed the highest ShrS values. The Bulk generated the lower ShrS values.

SIGNIFICANCE: A Bulk technique caused the lowest shrinkage stress/strain. An Oblique technique yielded the best balance between stress, strain and crack formation. NEDS technique is a good alternative to decrease the number of increments while maintaining the stress levels nearby the Oblique technique.

PMID:35787894 | DOI:10.1016/j.dental.2022.06.033

Mayo Clin Proc. 2022 Jul;97(7):1339-1344. doi: 10.1016/j.mayocp.2022.02.026.

ABSTRACT

The use and misuse of prescription stimulants has escalated during the past decade, with concerns of being “the next epidemic.” The diagnosis of attention-deficit/hyperactivity disorder and the use of prescription stimulants have rapidly increased in children and adults in the past decade. Amphetamine use more than doubled from 2006 to 2016. In 2018, among illicit substance users in the past year (53.2 million), more than 5 million 12 years or older had misused prescription stimulants. The most commonly reported motivations for misuse were to help with alertness and concentration, in approximately 60% of respondents. Most persons who misused prescription stimulants received the medication from a friend or relative, who got it through a health care provider. It is important to reexamine the pattern of prescription stimulant use after the loosening of Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria for attention-deficit/hyperactivity disorder diagnosis. Caveats to the this report could be the understudied specific populations (such as medical students), the exclusion of the military and institutionalized populations from the study, and the variations among individual states in stimulant prescribing patterns.

PMID:35787861 | DOI:10.1016/j.mayocp.2022.02.026

Prev Med. 2022 Jul 1:107127. doi: 10.1016/j.ypmed.2022.107127. Online ahead of print.

ABSTRACT

It is well known that the statistical analyses in health-science and medical journals are frequently misleading or even wrong. Despite many decades of reform efforts by hundreds of scientists and statisticians, attempts to fix the problem by avoiding obvious error and encouraging good practice have not altered this basic situation. Statistical teaching and reporting remain mired in damaging yet editorially enforced jargon of “significance”, “confidence”, and imbalanced focus on null (no-effect or “nil”) hypotheses, leading to flawed attempts to simplify descriptions of results in ordinary terms. A positive development amidst all this has been the introduction of interval estimates alongside or in place of significance tests and P-values, but intervals have been beset by similar misinterpretations. Attempts to remedy this situation by calling for replacement of traditional statistics with competitors (such as pure-likelihood or Bayesian methods) have had little impact. Thus, rather than ban or replace P-values or confidence intervals, we propose to replace traditional jargon with more accurate and modest ordinary-language labels that describe these statistics as measures of compatibility between data and hypotheses or models, which have long been in use in the statistical modeling literature. Such descriptions emphasize the full range of possibilities compatible with observations. Additionally, a simple transform of the P-value called the surprisal or S-value provides a sense of how much or how little information the data supply against those possibilities. We illustrate these reforms using some examples from a highly charged topic: trials of ivermectin treatment for Covid-19.

PMID:35787846 | DOI:10.1016/j.ypmed.2022.107127

Arch Phys Med Rehabil. 2022 Jul 1:S0003-9993(22)00485-3. doi: 10.1016/j.apmr.2022.06.003. Online ahead of print.

ABSTRACT

OBJECTIVE: This systematic review and meta-analysis aimed to review and quantify the changes in gait parameters after therapeutic intervention in adults with neurological disorders.

DATA SOURCES: A keyword search was performed in four databases: PubMed, CINAHL, Scopus, and Web of Science (01/2000-12/2021). We performed the search algorithm including all possible combinations of keywords. Full-text articles were examined further using forward/backward search methods.

STUDY SELECTION: Studies were thoroughly screened using the following inclusion criteria: Study design: Randomized Controlled Trial (RCT); adults ≥ 55 years old with a neurological disorder; therapeutic intervention; spatiotemporal gait characteristics; and Language: English.

DATA EXTRACTION: A standardized data extraction form was used to collect the following methodological outcome variables from each of the included studies: author, year, population, age, sample size, and spatiotemporal gait parameters such as cadence, step length, step width, or double limb support. A meta-analysis was performed among trials presenting with similar characteristics, including study population and outcome measure. If heterogeneity was > 50%, a random plot analysis was used, otherwise, a fixed plot analysis was done.

DATA SYNTHESIS: We included 25 out of 34 studies in our meta-analysis that examined gait in adults with neurological disorders. All analyses used effect sizes and standard error and a p < 0.05 threshold was considered statistically significant. Overall, we found that sensory (SS) and electrical stimulation (ES) had the most significant effect on step length (SS: z=5.44*, ES: z=2.42*) and gait speed (SS: z=6.19*, ES: z=7.38*) in adults with Parkinson’s disease (PD). Although balance or physical activity interventions were not found to be effective in modifying step length in adults with PD, they showed a significant effect on gait speed. Further, physical activity had the most significant effect on cadence in adults with PD (z=2.84*) relative to sensory stimulation effect on cadence (z=2.59*). For stroke, conventional physical therapy had the most significant effect on step length (z=3.12*) and cadence (z=3.57*).

CONCLUSION: Sensory stimulation such as auditory and somatosensory stimulation while walking had the most significant effect on step length in adults with PD. We also found that conventional PT did improve spatial gait parameters relative to other physical activity interventions in adults with PD and stroke.

PMID:35787837 | DOI:10.1016/j.apmr.2022.06.003

Minerva Anestesiol. 2022 Jul 5. doi: 10.23736/S0375-9393.22.16631-9. Online ahead of print.

ABSTRACT

INTRODUCTION: Remimazolam is a novel and ultra-short-acting benzodiazepine currently approved for procedural sedation and induction of general anaesthesia, with a possible indication for ICU sedation. This study aimed to evaluate the efficacy and safety of remimazolam and traditional sedatives for patients undergoing procedural sedation.

EVIDENCE ACQUISITION: We systematically searched Cochrane Library, Embase, PubMed, Web of Science and ClinicalTrials.gov for randomized controlled trials of procedural sedation performed with remimazolam versus traditional sedatives. Data from the eligible studies were combined to calculate pooled risk ratio or standardized mean difference.

EVIDENCE SYNTHESIS: Eleven studies of 2356 patients met the inclusion criteria. The results showed that remimazolam was associated with a higher procedure success rate (RR: 1.28, 95% CI: 1.07 to 1.52, P = 0.006; I2 = 99%), a shorter duration of recovery after procedure (SMD: -0.56, 95% CI: -0.98, -0.14, P = 0.009; I2 = 89%), and an earlier patient discharge after procedure (SMD: -0.37, 95% CI: -0.49, -0.25, P 0.00001; I2 = 0%) in comparison with traditional sedatives. There were no statistically significant differences in onset time, procedure time, and cognitive recovery between remimazolam and traditional sedatives groups. Remimazolam significantly decreased the rate of bradycardia (RR: 0.65, 95% CI: 0.43, 0.97, P = 0.04; I2 = 0%), hypotension (RR: 0.57, 95% CI: 0.40, 0.80, P = 0.001; I2 = 80%), and respiratory depression/hypoxia (RR: 0.46, 95% CI: 0.25, 0.83, P = 0.01; I2 = 61%) compared to traditional sedatives.

CONCLUSIONS: Remimazolam is a safe and effective sedative for procedural sedation on account of a higher success procedure rate, a faster recovery, a shorter discharge time, and a superior safety profile in comparison with traditional sedatives. Larger sample-sized and well-designed clinical trials are needed to verify our finding.

PMID:35785930 | DOI:10.23736/S0375-9393.22.16631-9

Minerva Anestesiol. 2022 Jul 5. doi: 10.23736/S0375-9393.22.16460-6. Online ahead of print.

ABSTRACT

BACKGROUND: The Covid-19 pandemic has provided an unprecedented scenario to deepen knowledge of surge capacity (SC), assessment of which remains a challenge. This study reports a large-scale experience of a multi-hospital network, with the aim of evaluating the characteristics of different hospitals involved in the response and of measuring a real-time SC based on two complementary modalities (actual, base) referring to the intensive care units (ICU).

METHODS: Data analysis referred to two consecutive pandemic waves (March-December 2020). Regarding SC, two different levels of analysis are considered: single hospital category (referring to a six-level categorization based on the number of hospital beds) and multi-hospital wide (referring to the response of the entire hospital network).

RESULTS: During the period of 114 days, the analysis revealed a key role of the biggest hospitals (>Category-4) in terms of involvement in the pandemic response. In terms of SC, Category-4 hospitals showed the highest mean surge capacity values, irrespective of the calculation method and level of analysis. At the multi-hospital level, the analysis revealed an overall ICU-SC (base) of 84.4% and an ICU-SC (actual) of 106.5%.

CONCLUSIONS: The results provide benchmarks to better understand ICU hospital response capacity, highlighting the need for a more flexible approach to surge capacity definition.

PMID:35785929 | DOI:10.23736/S0375-9393.22.16460-6

Minerva Obstet Gynecol. 2022 Jul 4. doi: 10.23736/S2724-606X.22.05106-5. Online ahead of print.

ABSTRACT

AIM: The aim of the study is to demonstrate the efficacy of sequential combined treatment with Transobturator Tape (TOT) followed by Posterior Tibial Nerve Stimulation (PTNS) in patients with Mixed Urinary Incontinence (MUI); quality of life and patients’ satisfaction was also assessed.

METHODS: Retrospective analysis on women affected by MUI with prevalent Stress Urinary Incontinence (SUI) component. Women, divided in 2 groups, underwent different treatments, TOT vs TOT+PTNS. Population was assessed by medical history, previous pelvic surgery, clinical exam, urodynamic exams, pelvic ultrasound examination, and questionnaires (The International Consultation on Incontinence Questionnaire Short Form, Overactive Bladder Questionnaire, Health Related Quality of Life) comparing them before and after 12 weeks after treatment.

RESULTS: 112 women were enrolled in the study. The mean age was 57.96±7.34 in the first group(N=60) and 58.29±6.14 in the second group(N=52). Peak flow (ml/s) statistically improved after treatment, 22.23±4.29 (TOT) vs 24.81±5.8 (TOT+PTNS). First voiding desire(ml) improved significantly between the two groups 108.72±19.24 vs 142.43±19.98. Maximum cystometric capacity (ml) in the TOT group at 12-weeks was 328.76±82.44 vs TOT+PTNS group of 396.26±91.21. Detrusor pressure at peak flow(cmH2O) showed a greater improvement in TOT+PTNS than TOT alone 14.45±6.10 vs 11.89±54.49. At 12-week, urinary diary and quality of life improved in terms of urgent urination events, mean number of voids, urge symptoms and nocturia events. The Patient Impression of Global Improvement (PGI-I) after 3 months was better in combined group.

CONCLUSIONS: Combined and sequential TOT+PTNS is more effective compared to TOT alone in MUI patients with prevalent SUI component.

PMID:35785925 | DOI:10.23736/S2724-606X.22.05106-5