Tag: pubmed

MEDICC Rev. 2021 Jul-Oct;23(3-4):29-36. doi: 10.37757/MR2021.V23.N3.6. Epub 2021 Aug 22.

ABSTRACT

INTRODUCTION: Unlike most high-income countries where subtype B viruses predominate, the Cuban HIV-1 epidemic is characterized by a great diversity of subtypes and circulating recombinant forms. Some studies have shown that HIV variants exhibiting a preference for the CXCR4 co-receptor (X4-tropic) could have impacts on disease pathogenesis, with clinical implications for antiviral treatment plans. Determination of HIV co-receptor tropism is crucial for clinicians in deciding whether maraviroc is an appropriate antiviral.

OBJECTIVE: Characterize V3 sequence variability and its relation to viral tropism across different subtypes circulating in Cuba and explore how this may affect treatment success with maraviroc.

METHODS: We designed a cross-sectional study that included 72 plasma samples obtained at the Pedro Kourí Tropical Medicine Institute in Havana, Cuba. We sequenced the C2V3 env region and assessed subtype based both on env and pol sequences; tropism was predicted by Geno2pheno analysis. Additionally, 35 V3-loop Cuban sequences, obtained from a previous study, were incorporated into the analysis. Statistical associations among virological, clinical and epidemiological variables were assessed by a chi-square test.

RESULTS: Tropism prediction for 72 variants revealed that CRF19_cpx was associated with dual-tropic R5X4 viruses (p = 0.034). Moreover, when 35 sequences from a former study were added, the association was significant not only for R5X4 (p = 0.019) but also for X4-tropic variants (p = 0.044). Alignment of 107 V3-loop sequences showed wide diversity among the different HIV-1 subtypes circulating in Cuba.

CONCLUSIONS: In accordance with G2P, CRF19_cpx is a genetic variant with a high proportion of X4 and R5X4-tropic viruses. The results from the present study suggest that the Cuban recombinant could be a more pathogenic variant and that maraviroc may not be suitable for patients infected with CRF19_cpx.

PMID:34516534 | DOI:10.37757/MR2021.V23.N3.6

MEDICC Rev. 2021 Jul-Oct;23(3-4):46-53. doi: 10.37757/MR2021.V23.N3.9. Epub 2021 Aug 22.

ABSTRACT

INTRODUCTION: Improved recovery protocols were implemented in surgical specialties over the last decade, which decreased anesthetic and surgical stress and the incidence of perioperative complications. However, these recovery protocols were introduced more slowly for cardiac surgeries. The most frequent complications in cardiac surgery are related to patient clinical status and the characteristics of the surgical procedures involved, which are becoming more varied and complex every day. The first version of the enhanced recovery program for cardiac surgery was published in 2019, but its recommendations were based on only a few studies, and scant research has evaluated its implementation. Randomized and controlled clinical trials for these protocols are scarce, so research that summarizes the results of studies with other methodological designs are useful in demonstrating their benefits in cardiovascular surgery services in Cuba and in other limited-resource settings.

OBJECTIVE: Estimate the effectiveness of improved recovery protocols in the perioperative evolution of patients undergoing cardiac surgery.

METHODS: We performed a systematic review and meta-analysis according to the guidelines of manual 5.1.0 for reviews of the Cochrane library. We included observational and quasi-experimental studies published from January 2015 through May 2020 that compared enhanced recovery protocols with conventional treatments in patients older than 18 years, and used a quality score to evaluate them. We used the following sources: the Cochrane Library, PubMed, LILACS, SciELO, EBSCO, Google Scholar, Web of Science, Clinical Key, ResearchGate and HINARI. The following keywords were used for the database searches in English: ERAS, protocols and cardiac surgery, enhanced recovery after cardiac surgery, ERACS, clinical pathway recovery and cardiac surgery, perioperative care and cardiac surgery. We used the following search terms for databases in Spanish: protocolos de recuperación precoz and cirugía cardiaca, protocolos de recuperación mejorada and cirugía cardiaca, cuidados perioperatorios and cirugía cardiaca, programas de recuperación precoz and cirugía cardiovascular. Methodological quality of included investigations was evaluated using the surgical research methodology scale. Meta-analyses were performed for perioperative complications, intensive care unit and hospital stays, and hospital readmission within 30 days of surgery. We calculated effect sizes of the interventions and the corresponding 95% confidence intervals. We used mean differences and confidence intervals for continuous variables, and for qualitative variables we calculated relative risk (RR). Random effects analysis was used. Heterogeneity of the studies was assessed using the Q statistic and the I2 statistic.

RESULTS: We selected 15 studies (a total of 5059 patients: study group, n = 1706; control group, n = 3353). The average quality score for the 15 articles included was 18.9 (out of a maximum of 36 according to the scale) and 66.6% had a score =18. With improved recovery protocols in cardiac surgery, the incidence of perioperative complications decreased (RR = 0.73; 95% CI 0.52-0.98) as did hospital readmission within 30 days after surgery (RR = 0.51; 95% CI 95% CI: 0.31-0.86). Differences in extubation time, hospital stay and length of stay in intensive care units were less marked, but always favored the group in which the enhanced protocols were implemented.

CONCLUSIONS: Improved recovery protocols in cardiac surgery increase quality of care evidenced by reductions in perioperative complications and decreased incidence of hospital readmission in the month following surgery.

PMID:34516536 | DOI:10.37757/MR2021.V23.N3.9

Medicine (Baltimore). 2021 Sep 10;100(36):e27227. doi: 10.1097/MD.0000000000027227.

ABSTRACT

Endoscopic papillary large balloon dilation (EPLBD) can be used to treat challenging common bile duct stones. No previous studies have reported intractable cases treated either by EPLBD or mechanical lithotripter use. We aimed to evaluate and compare the long-term effects of EPLBD with mechanical lithotripter use.This retrospective cohort study reviewed data from 153 patients admitted to the Eastern Chiba Medical Center from April 2014 to March 2020, presenting with common bile duct calculi that could not be removed using a basket or balloon catheter. Patients were divided into groups depending on whether the treatment was performed using a mechanical lithotripter or EPLBD. The primary outcome was the recurrence rate of common bile duct calculi, and the secondary outcome was the rate of postoperative adverse events. The Wilcoxon test was used to compare the 2 groups. Statistical significance was set at P < .05.The median age of patients included in the lithotripter and EPLBD groups were 73 years and 83 years, respectively (P = .006), while the sex ratio (male:female) in the groups was 18:13 and 55:67, respectively. The EPLBD group showed a statistically larger median bile duct diameter (13 mm [range: 8-24 mm] vs 11 mm [range: 5-16 mm]; P < .001), larger maximal calculus diameter (median, 13.5 mm [range: 8-25 mm] vs 11 mm [range: 7-16 mm]; P < .001), and shorter median cumulative treatment time after reaching the duodenal papilla (35.5 minutes [range: 10-176 minutes] vs 47 minutes [range: 22-321 minutes]; P = .026) in comparison to the lithotripter group. There was no significant difference in the rate of adverse events between the EPLBD and the mechanical lithotripter groups. The recurrence rate was significantly lower (P = .014) in the EPLBD group.EPLBD increases therapeutic efficacy and reduces treatment duration for patients in whom calculus removal is difficult, without increasing the frequency of adverse events. No serious adverse events were observed. Additionally, EPLBD appears to reduce the risk of long-term recurrence. Future studies are needed to evaluate long-term outcomes in younger patients.

PMID:34516527 | DOI:10.1097/MD.0000000000027227

Medicine (Baltimore). 2021 Sep 10;100(36):e27176. doi: 10.1097/MD.0000000000027176.

ABSTRACT

BACKGROUND: Deep sedation relieves a patient’s anxiety and stress during the procedure by inducing patient unconsciousness. However, it remains unclear whether deep sedation actually improves patient satisfaction with the procedure. Therefore, we performed a systematic review and meta-analysis to compare the satisfaction of patients undergoing deep sedation with that of those undergoing light/moderate sedation during non-surgical procedures.

METHODS: A comprehensive literature search was performed using electronic databases (search until September 2020). The primary outcome was whether patient satisfaction was higher after deep sedation or light/moderate sedation. The secondary outcome was the relative safety of deep sedation compared with light/moderate sedation in terms of oxygen saturation, systolic blood pressure, and heart rate. The tertiary outcomes were the relative procedure and recovery times for deep versus light/moderate sedation.Data from each of the trials were combined, and calculations were made using DerSimonian and Laird random effects models. The pooled effect estimates for patient satisfaction were evaluated using relative risk (RR) with the 95% confidence interval (CI). The pooled effect estimates for continuous data are expressed as weighted mean difference with the 95% CI. We assessed heterogeneity with the Cochrane Q statistic and the I2 statistic. The risk of bias assessment and Grading of Recommendations Assessment, Development and Evaluation approach were used as the quality assessment method.

RESULTS: After removing unrelated studies and applying the exclusion criterion, 5 articles satisfied the inclusion criteria. Patient satisfaction was significantly higher in those who received deep sedation compared with light/moderate sedation (relative risk = 1.12; 95% CI, 1.04-1.20; P = .003; Cochrane Q = 25.0; I2 = 76%).There was no significant difference in oxygen saturation, systolic blood pressure, heart rate, and procedure times according to whether the procedures were performed under deep or light/moderate sedation. However, the recovery time was significantly prolonged in patients under deep sedation.

CONCLUSIONS: Our meta-analysis suggests that deep sedation resulted in improved patient satisfaction compared with light/moderate sedation. Deep sedation is recommended for patients undergoing procedures because it improves patient satisfaction. However, respiration and circulation should be carefully monitored both intra-operatively and postoperatively.

PMID:34516514 | DOI:10.1097/MD.0000000000027176

Medicine (Baltimore). 2021 Sep 10;100(36):e27180. doi: 10.1097/MD.0000000000027180.

ABSTRACT

Electronic nicotine delivery systems (ENDS) are growing in use and many of the health implications with these devices remain unknown. This study aims to assess, using a survey representative of the USA general population, if an association exists between a history of ENDS use and a history of stroke.This cross-sectional study was a secondary data analysis using the 2016 behavioral risk factor surveillance system survey. The main exposure variable of the study was a self-reported history of ENDS use. The main outcome was a self-reported history of stroke. Covariates included sex, race, traditional cigarette use, smokeless tobacco use, chronic kidney disease, diabetes, myocardial infarction, and coronary artery disease. Unadjusted and adjusted logistic regression analyses were done. Adjusted odds ratios (AOR) and their corresponding 95% confidence intervals (CI) were calculated.Of the 486,303 total behavioral risk factor surveillance system survey participants, 465,594 met the inclusion criteria for this study of ENDS use and stroke. This study shows that current ENDS use was positively associated with a history of stroke. AOR of some daily ENDS use with stroke was 1.28 (95% CI: 1.02-1.61) and AOR of current daily ENDS use with stroke was 1.62 (95% CI: 1.18-2.31). The majority (55.9%) of current daily ENDS users reported former traditional cigarette smoking. Female sex, non-white ethnicity, elderly age, chronic kidney disease, coronary artery disease, diabetes, and traditional cigarette use characteristics were all also associated with increased odds of reporting a stroke.This study found a statistically significant and positive association between ENDS use and a history of stroke. Further research is warranted to investigate the reproducibility and temporality of this association. Nevertheless, this study contributes to the growing body of knowledge about the potential cardiovascular concerns related to ENDS use and the need for large cohort studies.

PMID:34516517 | DOI:10.1097/MD.0000000000027180

Medicine (Baltimore). 2021 Sep 10;100(36):e27173. doi: 10.1097/MD.0000000000027173.

ABSTRACT

To investigate the usefulness of 123I-BMIPP/201TlCl scintigraphy for evaluating the presence of myocarditis in patients with polymyositis (PM) or dermatomyositis (DM).We performed a retrospective study of 26 patients diagnosed with new-onset active PM/DM who underwent 123I-BMIPP/201TlCl scintigraphy between 01 April 2010 and 20 March 2015. We determined the 123I-BMIPP/201TlCl ratio and grouped the patients according to presence or absence of a mismatch. We evaluated the relationship between mismatch and the laboratory and echocardiographic findings.Mismatch was found in 13 (50%) patients. There was no statistically significant difference in age, cardiac troponin T, myoglobin, myosin light chain, aldolase levels, E wave/A wave ratio, right ventricular systolic pressure between the mismatch and non-mismatch groups. Left ventricular end-diastolic and end-systolic dimensions were significantly greater in the mismatch group (45.0 vs 42.5 mm, P = < .01 and 29.5 mm vs 25.0 mm, P < .01). Left ventricular ejection fraction was significantly lower in the mismatch group (63.5% vs 71.5%, P = .04). Significant inverse correlation (r = -0.44, P = .03) was observed between left ventricular ejection fraction and mismatch ratio.The use of 123I-BMIPP/ 201TlCl scintigraphy may be considered for evaluating myocarditis in patients with PM/DM.

PMID:34516513 | DOI:10.1097/MD.0000000000027173

Scand J Public Health. 2021 Sep 13:14034948211041814. doi: 10.1177/14034948211041814. Online ahead of print.

ABSTRACT

AIMS: Diabetes requires complex self-management. Due to this complexity, social disparities exist in the self-management of type 1 diabetes. Various pathways to describe associations between socio-economic factors and health outcomes have been suggested. We sought to elucidate the potential of health literacy and social support to reduce social disparities in diabetes self-management.

METHODS: Questionnaire responses were linked to data from electronic medical records, yielding a study population of 1186 people with type 1 diabetes. Mediation analyses using adjusted linear regressions were used to establish pathways between self-reported educational attainment, social support, functional health literacy and clinically obtained measures of glycaemic control.

RESULTS: We found evidence of an association between education and glycated haemoglobin, partially mediated by functional health literacy and social support. However, the direct association between social support and glycaemic control was not statistically significant.

CONCLUSIONS: Whilst both functional health literacy and social support play a role in glycaemic control, our findings did not explain the main impact of social disparities on glycaemic control. Interventions to reduce disparities in glycaemic control related to educational attainment should focus beyond functional health literacy and social support.

PMID:34515582 | DOI:10.1177/14034948211041814

Curr Med Res Opin. 2021 Sep 13:1. doi: 10.1080/03007995.2021.1980776. Online ahead of print.

ABSTRACT

OBJECTIVES: Inhalative anesthesia is of common use, but is generally known to potentiate postoperative nausea and vomiting (PONV). With an internal change of anesthesia regimen from total intravenous anesthesia (TIVA) to isoflurane (in terms of myocardial protection) in cardiac anesthesia a higher incidence of PONV was to be expected. Therefore, we evaluated the incidence of PONV after the simultaneous implementation of PONV prophylaxis.

METHODS: The incidence of PONV, prospectively assessed in 197 cardiac surgery patients (68y ± 10.4, 66.5% male) having isoflurane plus dual PONV prophylaxis with dexamethasone and droperidol, was compared with previous data of 190 controls (67y ± 9.6, 71% male) having TIVA without and with single or dual PONV prophylaxis (n = 64 dexamethasone and droperidol, n= 25 dexamethasone, n = 101 only TIVA), and the Apfel-scoring (0-4 depending on PONV-risk). DRKS00014275. Statistics: Chi²-test, p < 0.05 (Bonferroni).

RESULTS: The incidence of PONV under isoflurane with antiemetic prophylaxis was 20.8% (95% confidence interval (CI) 15.4; 27.4) compared to 30.5% (95%CI 24; 37.6) under TIVA (p = 0.029; dexamethasone and droperidol 23.4% (95%CI 13.8; 35.7); dexamethasone 32% (95%CI 14.9; 53.5); only TIVA 34.7% (95%CI 25.5; 44.8)), but was not lower in high-risk patients than predicted according to Apfel-scoring 4 (71.4 vs. 78%).

CONCLUSION: In cardiac anesthesia, the use of isoflurane is not at the expense of PONV when using a risk-independent two-drug-prophylaxis. It is even beneficial resulting surprisingly in a lower incidence of PONV than under TIVA unless with and without prophylaxis. Patients with the highest risk for PONV and receiving isoflurane should receive a third antiemetic prophylactic drug.

PMID:34515599 | DOI:10.1080/03007995.2021.1980776

Interv Neuroradiol. 2021 Sep 13:15910199211038207. doi: 10.1177/15910199211038207. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aims at exploring the 3-month outcome predicting ability of delayed neurological improvement and the cause of delayed neurological improvement.

MATERIALS AND METHODS: Early neurological improvement and delayed neurological improvement were calculated to represent the neurological improvements. Good functional outcome was defined as a 90-day modified Rankin Scale score 0-2. We used multivariant logistic regression to explore the influential factors of good functional outcome as well as delayed neurological improvement. We applied net reclassification improvement and integrated discrimination improvement to assess the quantitative improvement of the predictive model.

RESULTS: Early neurological improvement was observed in 50 (23%) patients and delayed neurological improvement exhibited in 67 (30%) patients. Early neurological improvement and delayed neurological improvement were both independent predictive factors to good functional outcome. In the basic model (adjusted for age, admission glucose level, baseline National Institute of Health Stroke Scale, and complications and number of retrieval attempts), early neurological improvement and delayed neurological improvement statistically improved the predictive ability (early neurological improvement: net reclassification improvement = 0.34, 95% confidence interval, 95% confidential interval (0.06, 0.69); integrated discrimination improvement = 0.05, p < 0.001; delayed neurological improvement: net reclassification improvement = 0.79, 95% confidential interval (0.47, 1.12); integrated discrimination improvement = 0.14, p < 0.001) delayed neurological improvement could predict clinical outcomes more accurately than early neurological improvement (early neurological improvement vs. delayed neurological improvement: integrated discrimination improvement = 0.09, p < 0.001). Moreover, delayed neurological improvement was affected by hypertension (odds ratio = 0.40, 95% CI (0.18, 0.88), p = 0.02), early neurological improvement (odds ratio = 20.10, 95% confidential interval (8.24, 19.02), p < 0.001), number of retrieval attempts (odds ratio = 0.39, 95% confidential interval (0.24, 0.66), p < 0.001), and complication (odds ratio = 0.25, 95% confidential interval (0.12, 0.54), p < 0.001).

CONCLUSIONS: Delayed neurological improvement could predict clinical outcomes more accurately than early neurological improvement. Hypertension, early neurological improvement, numbers of retrieval attempts, and complications were all predicting factors to delayed neurological improvement.

PMID:34515554 | DOI:10.1177/15910199211038207

Int J Low Extrem Wounds. 2021 Sep 13:15347346211043602. doi: 10.1177/15347346211043602. Online ahead of print.

ABSTRACT

Ingrown toenails are a common reason for referral to orthopedics and podiatry clinics. Recurrence and infection are common complications in ingrown toenail surgery. This study investigates the effect of an electrocautery matrixectomy on the recurrence and clinical outcomes in the Winograd technique applied in ingrown toenail surgery and whether prophylactic antibiotic use is necessary for these surgeries. One hundred forty-three patients who underwent surgery for ingrown toenails were analyzed retrospectively. Eighty-two patients underwent the Winograd procedure with electrocautery matrixectomy, whereas 61 patients underwent the Winograd procedure. While 78 patients were given prophylactic antibiotics, 65 patients were not. Patient satisfaction was evaluated with a surgical satisfaction questionnaire (SSQ). A visual analog score was used to evaluate the pain. Recurrence was observed in 3 toenails in the Winograd and electrocautery groups, while recurrence was observed in 9 toenails in the Winograd group (P = .018). In both groups, there was no statistically significant difference between the infection rates between patients who took antibiotics and those who did not (P > .05). There was no statistically significant difference between the groups in terms of SSQ scores (P > .05). It was observed that the surgery performed had a positive effect on pain, and this effect was statistically highly significant in both groups (P < .05). The outcomes of the present study suggest that the addition of an electrocautery matrixectomy to the Winograd technique in the surgical treatment of symptomatic Ingrown toenails may decrease recurrence rates. Additionally, this study showed that oral antibiotics, when used in addition to Ingrown toenail surgery, do not reduce postoperative morbidity.

PMID:34515568 | DOI:10.1177/15347346211043602