Tag: pubmed

Eur J Ophthalmol. 2021 Dec 28:11206721211066196. doi: 10.1177/11206721211066196. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the occurrence of transient central retinal artery occlusion following intravitreal anti-vascular endothelial growth factor injection.

METHODS: Prospective, observational study of 807 patients (807 eyes) who were given intravitreal injections of ranibizumab or aflibercept to treat any cause of retinal vascular diseases between 1 January 2017 and 30 November 2018 at the Federal Fluminense University Hospital in Niteroi, and a private facility in Rio de Janeiro, Brazil. Patients who did not present transient central retinal artery occlusion were excluded.

RESULTS: Among 4069 injections, only 18 patients (0.44%) presented transient central retinal artery occlusion, 14 mild cases (77.7%), and 4 severe cases (22.3%). The clinical factors associated with more severe cases of transient central retinal artery occlusion were the duration of the transient central retinal artery occlusion (p = 0.001), number of prior injections (p = 0.01), and a positive carotid Doppler test (p = 0.01). Twelve cases (66.6%) had positive carotid artery obstruction (atheroma plaque size ≥70%) while 6 cases (33.3%) had negative carotid artery obstruction (atheroma plaque size <70%). The age group >60 years old (p = 0.06), cup/disc ratio >0.6 (p = 0.06), and pseudophakic lens status were also factors with association with transient central retinal artery occlusion, although did not meet criteria for statistical significance. The only patient who experienced a recurrent episode of transient central retinal artery occlusion had diabetic macular edema, positive carotid Doppler test, and cup/optic disc ratio >0.6.

CONCLUSION: Transient central retinal artery occlusion is a rare adverse event that can appear in patients with retinal vascular disease receiving anti-vascular endothelial growth factor therapy. The atheroma plaque size and the number of prior injections can be associated with the severity of the event.

PMID:34962172 | DOI:10.1177/11206721211066196

Int J Soc Psychiatry. 2021 Dec 28:207640211067677. doi: 10.1177/00207640211067677. Online ahead of print.

ABSTRACT

BACKGROUND: Previous studies have demonstrated the positive effects of film screening for raising awareness and improving treatment in various clinical groups. This study not only focused on film screening but also paid special attention to pre-screening group analysis to explore the effectiveness of group movie analysis on mothers with schizophrenic sons.

METHODS: The present study was conducted using a quasi-experimental design with pre-test and post-test and a control group. The research population included all mothers with schizophrenic sons who had enrolled in the Iranian Society Supporting Individuals with Schizophrenia in Tehran in 2021. The participants were 30 mothers with schizophrenic sons who were selected based on the inclusion criteria and were randomly assigned to intervention and control groups. The participants in the intervention group attended 12 film therapy analysis sessions (one session per week). The data were collected using the Connor-Davidson Resilience Scale (CD-RISC). Statistical analyses were performed using the analysis of covariance (ANCOVA).

RESULTS: The results showed a significant difference between the mean scores of resilience for the participants before (M = 28.89) and after the film therapy analysis intervention (M = 52.56, F = 6.15, p = .0001).

CONCLUSION: Film therapy analysis was effective in improving the resilience of mothers with schizophrenic sons. It seems that movie screening with the group analysis afterward contributed to sharing the experiences of caring for the sick child and creating a sense of empathy in mothers. Thus, group movie analysis can be used as a suitable option to reduce the psychological distress of mothers with schizophrenic sons and improve their quality of life.

PMID:34962176 | DOI:10.1177/00207640211067677

J Laparoendosc Adv Surg Tech A. 2021 Dec 28. doi: 10.1089/lap.2021.0520. Online ahead of print.

ABSTRACT

Objectives: To evaluate the impact of body mass index (BMI), preoperative risk classification, previous inguinal herniotomy, and abdominal operations on several steps of robot-assisted radical prostatectomy (RARP) and lymph node (LN) involvement. Methods: A total number of 225 consecutive patients were included in the study who underwent transperitoneal RARP by 1 surgeon. We defined the following parameters as dependent variables: duration of prostatectomy, duration of pelvic lymphadenectomy, incision to suture time, console time, number of dissected LNs and number of positive LNs for metastasis. We assessed the impact of the following covariates using univariate nonparametric and multivariate analysis: BMI, preoperative D’Amico risk classification, history of inguinal herniotomy, and previous abdominal operations. Results: We observed a statistically significant difference among our three BMI groups (<25, ≥25 and <30, and ≥30 kg/m²) regarding pelvic lymphadenectomy and LN metastasis. Moreover, among the three risk groups (low, intermediate, and high) duration of prostatectomy, pelvic lymphadenectomy, and LN metastasis were statistically different. Previous abdominal operations have been also demonstrated to significantly influence the pelvic lymphadenectomy. In addition, our multivariate model proved the impact of our covariates on pelvic lymphadenectomy. Conclusions: Our findings highlight the impact of BMI and preoperative risk on various steps of RARP. We revealed longer duration of pelvic lymphadenectomy and more nodal yield in patients with higher BMI and high-risk disease. Therefore, we suggest that BMI and risk classification according to D’Amico should be taken into account while a RARP is being planned.

PMID:34962160 | DOI:10.1089/lap.2021.0520

Surg Obes Relat Dis. 2021 Nov 13:S1550-7289(21)00544-X. doi: 10.1016/j.soard.2021.11.011. Online ahead of print.

ABSTRACT

BACKGROUND: Major concerns years after the sleeve gastrectomy (SG) include weight regain, development of hiatal hernia (HH) and gastroesophageal reflux disease, with esophagitis and Barrett’s esophagus (BE). Both problems could be related, and the incidence of asymptomatic patients is troubling.

OBJECTIVE: To study the incidence of reflux symptoms, esophagitis, BE, HH, and asymptomatic pathology and their relationship with weight regain in patients 5 years after undergoing SG at different bariatric centers in Spain.

SETTING: Public and private hospitals with bariatric surgery units.

METHODS: Prospective, multicenter, nonrandomized study involving 13 Spanish hospitals with a cumulative experience of 4,500 patients having undergone the SG procedure and patients who had been subjected to the procedure at least 5 years previously along with preoperative gastroscopy. The clinical history, preoperative gastroscopy, and technical details of the SG were recorded. A specific clinical questionnaire was given that recorded the intake volume, perception of satiety, and gastroesophageal reflux (GER) symptoms. Gastroscopy, pH-metry, and manometry studies were carried out, and the data were analyzed statistically. The study has been authorized by the official Spanish ethics committee CEI/CEIm Hospital Universitario Gran Canaria Dr Negrín (code 2019-216-1).

RESULTS: One hundred and five patients who underwent SG and who had with at least 5 years of follow-up were included. All procedures were performed laparoscopically. The mean age of patients was 51.1 years, and 70.5% were women. The mean characteristics of the SG procedure were a 37.2F probe, at 4.6 cm from the pylorus, and a crura closure was performed in 5 cases. There were no major complications (Clavien-Dindo grade >3) or deaths. The average preoperative body mass index was 46.3 kg/m², the minimum reached was 20.6 kg/m², whereas the average after 5 years was of 34.5 kg/m². GER, HH, and esophagitis symptoms went from 17.1%, 28.6%, and 5.7%, respectively, before the SG to 76%, 30.5%, and 31.4%, respectively, 5 years after the procedure. Symptoms persisted over the years in 37.1% of cases and presented de novo in 52.8% of cases. Fifty-three percent of manometries (n = 27, total 51) and 64% of pH-metries (n = 32, total 53; DeMeester average score was 65) were pathologic 5 years after the procedure. Concerning gastroscopies, 5 years after the procedure, HH was found in 33 patients (30.5% of total) and esophagitis in 32 patients (31.4% of total). Eighty patients (76%) had GER symptoms, and 25 patients (24%) were asymptomatic. Only 1 patient (.9%) developed BE.

CONCLUSIONS: Our study has confirmed a high rate of both persistent and de novo esophagitis and hiatal hernia, many of which were asymptomatic, 5 years after SG had been performed. Weight regain and a striking increase in gastric capacity are risk factors indicative of esophagitis, even when patients are asymptomatic. We consider a control gastroscopy and the preventive use of proton pump inhibitors necessary in these cases regardless of symptoms. We recommend that a control gastroscopy should be performed in all cases regardless of symptoms 5 years after SG. Further studies are needed to validate these recommendations.

PMID:34961735 | DOI:10.1016/j.soard.2021.11.011

J Med Imaging Radiat Sci. 2021 Dec 24:S1939-8654(21)00302-7. doi: 10.1016/j.jmir.2021.12.001. Online ahead of print.

ABSTRACT

INTRODUCTION: The idea of radiographer image interpretation has not been fully explored in Fiji despite the great shortage of radiologists in the country. This is a feasibility study of radiographer image interpretation aimed at assessing the accuracy of radiographers in interpreting adult chest X-ray images at the Colonial War Memorial Hospital (CWMH) in Fiji.

METHODS: Forty PA chest X-ray images were interpreted in terms of correctly commenting on the presence/ absence of pathology, the name of the pathology, and the location of the pathology on the data sheets by the CWMH diagnostic radiographers (n = 14). The radiographers were grouped according to their years of work experience (≤ 5 vs > 5) and the Mann Whitney U test on a two-tailed p-value of 0.05 was used to compare this grouping.

RESULTS: The data analysis was conducted using the Statistical Package for Social Sciences (SPSS) v.25 and Microsoft Excel. The diagnostic performance of all radiographers in terms of triaging normal and abnormal in the images shows sensitivity ranging from 71.4 to 100%, with specificity ranging from 47.4 to 100%. The mean sensitivity, specificity, and the overall accuracy of radiographers in triaging normal and abnormal on the images were 89.5%, 72.9%, and 81.6%, respectively. The mean accuracy in naming the pathology was 33.6% and the location sensitivity was 45.7%. There was no statistically significant difference in results between the radiographers’ years of experience.

CONCLUSION: Without any formal qualification, training, and practice, the current results suggest that the cohort of radiographers can perform normal/abnormal triage of CXRs within a test setting. With a significant reduction in the radiographers’ accuracy in terms of naming and locating the abnormality, the study results do not support image interpretation by the radiographers at this stage.

IMPLICATIONS FOR PRACTICE: This feasibility study provides baseline information about the accuracy of image interpretation by diagnostic radiographers at CWMH and provides a platform for further research in image interpretation in Fiji.

PMID:34961703 | DOI:10.1016/j.jmir.2021.12.001

Rev Gastroenterol Mex (Engl Ed). 2021 Dec 24:S2255-534X(21)00140-7. doi: 10.1016/j.rgmxen.2021.12.005. Online ahead of print.

ABSTRACT

INTRODUCTION AND AIMS: There are few studies that compare polyethylene glycol (PEG) 3350 and magnesium hydroxide (MH), as long-term treatment of functional constipation (FC) in children, and they do not include infants as young as 6 months of age. Our aim was to determine the efficacy, safety, and acceptability of PEG vs MH in FC, in the long term, in pediatric patients.

METHODS: An open-label, parallel, controlled clinical trial was conducted on patients from 6 months to 18 years of age, diagnosed with FC, that were randomly assigned to receive PEG 3350 or MH for 12 months. Success was defined as: ≥ 3 bowel movements/week, with no fecal incontinence, fecal impaction, abdominal pain, or the need for another laxative. We compared adverse events and acceptability, measured as rejected doses of the laxative during the study, in each group and subgroup.

RESULTS: Eighty-three patients with FC were included. There were no differences in success between groups (40/41 PEG vs 40/42 MH, p = 0.616). There were no differences in acceptability between groups, but a statistically significant higher number of patients rejected MH in the subgroups > 4 to 12 years and > 12 to 18 years of age (P = .037 and P = .020, respectively). There were no differences regarding adverse events between the two groups and no severe clinical or biochemical adverse events were registered.

CONCLUSIONS: The two laxatives were equally effective and safe for treating FC in children from 0.5 to 18 years of age. Acceptance was better for PEG 3350 than for MH in patients above 4 years of age. MH can be considered first-line treatment for FC in children under 4 years of age.

PMID:34961695 | DOI:10.1016/j.rgmxen.2021.12.005

J Plast Reconstr Aesthet Surg. 2021 Nov 30:S1748-6815(21)00632-X. doi: 10.1016/j.bjps.2021.11.084. Online ahead of print.

ABSTRACT

This study aimed to determine the effectiveness of triamcinolone acetonide in suppressing inflammation after blepharoptosis surgery. The study was designed as prospective, randomized, two medical centers’ clinical trial. Thirty-two patients with involutional blepharoptosis of the same degree in both eyelids underwent bilateral transcutaneous levator advancement. At the end of the surgery, 4 mg/0.1 ml of triamcinolone acetonide was injected into a randomly selected upper eyelid. The fellow eyelid was not injected and was used as control. Facial photographs were taken on day 1, week 1, month 1, and month 3, and the degree of inflammation, the margin reflex distance 1 (MRD-1), and levator function (LF) between the two eyelids of each patient were compared. The primary outcome was the selection of the less inflamed eyelid decided by the majority of three individuals unrelated to the study. MRD-1 and LF were analyzed for secondary outcomes. As a result, the injected eyelid was judged to be the less inflamed eyelid in all cases. The MRD-1 in the postoperative period less than 1 month was significantly larger in the injected eyelids than the control eyelids (P<0.03). The postsurgical MRD-1 at month 3, the postsurgical LF at all postsurgical examination times were not statistically different. Adverse complications by the injection, including ptosis, levator dysfunction, increase of the intraocular pressure, and visual disturbance were not observed. In conclusion, a triamcinolone acetonide injection after ptosis surgery is both safe and effective in reducing the early postsurgical inflammation and helpful in an earlier return to a daily routine for the patients.

PMID:34961699 | DOI:10.1016/j.bjps.2021.11.084

J Card Fail. 2021 Dec 25:S1071-9164(21)00478-4. doi: 10.1016/j.cardfail.2021.10.014. Online ahead of print.

ABSTRACT

BACKGROUND: The Fried Frailty Phenotype predicts adverse outcomes in geriatric populations, but has not been well-studied in advanced heart failure (HF). The Registry Evaluation of Vital Information for Ventricular Assist Devices (VADs) in Ambulatory Life (REVIVAL) study prospectively collected frailty measures in patients with advanced HF to determine relevant assessments and their impact on clinical outcomes.

METHODS AND RESULTS: HF-Fried Frailty was defined by 5 baseline components (1 point each): (1) weakness: hand grip strength less than 25% of body weight; (2) slowness based on time to walk 15 feet; (3) weight loss of more than 10 lbs in the past year; (4) inactivity; and (5) exhaustion, both assessed by the Kansas City Cardiomyopathy Questionnaire. A score of 0 or 1 was deemed nonfrail, 2 prefrail, and 3 or greater was considered frail. The primary composite outcome was durable mechanical circulatory support implantation, cardiac transplant or death at 1 year. Event-free survival for each group was determined by the Kaplan-Meier method and the hazard of prefrailty and frailty were compared with nonfrailty with proportional hazards modeling. Among 345 patients with all 5 frailty domains assessed, frailty was present in 17%, prefrailty in 40%, and 43% were nonfrail, with 67% (n = 232) meeting the criteria based on inactivity and 54% (n = 186) for exhaustion. Frail patients had an increased risk of the primary composite outcome (unadjusted hazard ratio [HR] 2.82, 95% confidence interval [CI] 1.52-5.24; adjusted HR 3.41, 95% CI 1.79-6.52), as did prefrail patients (unadjusted HR 1.97, 95% CI 1.14-3.41; adjusted HR 2.11, 95% CI 1.21-3.66) compared with nonfrail patients, however, the predictive value of HF-Fried Frailty criteria was modest (Harrel’s C-statistic of 0.603, P = .004).

CONCLUSIONS: The HF-Fried Frailty criteria had only modest predictive power in identifying ambulatory patients with advanced HF at high risk for durable mechanical circulatory support, transplant, or death within 1 year, driven primarily by assessments of inactivity and exhaustion. Focus on these patient-reported measures may better inform clinical trajectories in this population.

PMID:34961663 | DOI:10.1016/j.cardfail.2021.10.014

Radiography (Lond). 2021 Dec 24:S1078-8174(21)00192-9. doi: 10.1016/j.radi.2021.12.001. Online ahead of print.

ABSTRACT

INTRODUCTION: The evolution of technology within healthcare is continuing at a rapid rate. Touchless technologies (i.e. those involving gestures and voice commands) are rapidly being integrated into daily life. The aim of this study was to investigate the potential role for such technologies within diagnostic radiography.

METHODS: An online survey was developed, piloted and deployed using SurveyMonkey as part of an online radiology congress. Eligible respondents were radiographers or radiologic technologists, including students. The survey covered ten themes relating to the potential role of touchless technologies within diagnostic radiography. Results were analysed using descriptive and inferential statistics.

RESULTS: 155 people completed the questionnaire. 100 (64.9%) were women and clinical experience ranged from 13.5 (0-40) years. The majority, 54 (35.1%), had a Bachelor’s degree with respondents being from 23 different countries (five continents). 34 (21.9%) respondents did not personally own nor intended to purchase touchless technologies. 89 (84.8%) respondents saw themselves using touchless technologies, if available on current imaging equipment. 25 (16.0%) respondents reported that they currently have access to touchless technologies within their workplace. 88 (81.5%) and 67 (65.0%) respondents reported that they saw voice and gesture controls as being key in improving exam efficiency.

CONCLUSION: Participants clearly perceived a role for touchless technologies within diagnostic radiography. Access to such technologies is not yet widely available within X-ray rooms. Voice activated technologies appear more appealing that gesture-based aids. The primary role for such technologies was defined by participants as focusing on improving examination efficiency.

IMPLICATIONS FOR PRACTICE: Touchless technologies have been identified and as important and potentially useful in diagnostic radiography. Collaboration between healthcare institutions, industry and academia is required to design and successfully implement these technologies into practice.

PMID:34961676 | DOI:10.1016/j.radi.2021.12.001

Dent Mater. 2021 Dec 24:S0109-5641(21)00356-0. doi: 10.1016/j.dental.2021.12.029. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate in vitro the mechanical, biological, and polymerization behavior of a flowable bulk-fill composite with fibers as a dispersed phase.

METHODS: EverX Flow™ (GC Corporation) (EXF), one conventional bulk-fill composite (Filtek™ Bulk Fill Posterior Restorative, 3 M (FBF)), and one flowable bulk composite without fibers (SDR® flow+, Dentsply (SDR)) were tested. Samples were characterized in terms of flexural strength (ISO 4049), fracture toughness (ISO 20795-1), and Vickers hardness. Polymerization stress and volumetric shrinkage were evaluated. The in vitro biological assessment was achieved on cultured primary Human Gingival Fibroblast cells (HGF). The cell metabolic activity was evaluated using Alamar Blue assay at 1, 3, and 5 days of contact to the 3 tested composite extracts (ISO 10993) and cell morphology was evaluated by confocal microscopy. Data were submitted to One-Way analysis of variance (ANOVA) and independent t-test (α = 0.05).

RESULTS: FBF showed statistically higher Vickers hardness and flexural modulus than EXF and SDR. However, EXF showed statistically higher K_IC than FBF and SDR. EXF had the statistically highest shrinkage stress values and FBF the lowest. Archimedes volumetric shrinkage showed significantly lower values for FBF as compared to the other two composites. Slight cytotoxic effect was observed for the three composites at day one. An enhancement of metabolic activity at day 5 was observed in cells treated with EXF extracts.

SIGNIFICANCE: EXF had a significantly higher fracture toughness validating its potential use as a restorative material in stress bearing areas. EXF showed higher shrinkage stress values, and less cytotoxic effect. Fiber reinforced flowable composite is mainly indicated for deep and large cavities, signifying the importance for assessing its shrinkage stress and biological behavior.

PMID:34961643 | DOI:10.1016/j.dental.2021.12.029