Tag: pubmed

Auris Nasus Larynx. 2021 Dec 17:S0385-8146(21)00278-9. doi: 10.1016/j.anl.2021.12.002. Online ahead of print.

ABSTRACT

OBJECTIVES: Orthostatic dizziness/vertigo (ODV) is a common symptom and is believed to occur due to the cerebral hypoperfusion caused by orthostatic hypotension (OH). However, the detailed mechanism underlying ODV onset is poorly understood. The vertebral artery (VA) mainly supplies blood to the central vestibular system; therefore, the orthostatic decrease of VA blood flow could possibly lead to ODV. This study investigated the orthostatic blood pressure and VA hemodynamics in ODV patients to elucidate the hemodynamic mechanism underlying ODV onset. Furthermore, the influence of orthostatic hypotension (OH) on VA hemodynamics was examined because OH is probably the most common cause of ODV.

METHODS: This study included 181 patients with ODV and 73 control patients without ODV. All subjects underwent an active standing test to measure the extracranial Doppler (ECD) sonography spectrum of the VA and blood pressure (BP). VA blood flow velocity and BP were simultaneously measured for each patient in the supine static position and then in the upright standing positions following 3 min of standing. We investigated the orthostatic change in the average of flow velocity in bilateral VAs (VAFV) and BP for ODV patients compared with the control patients.

RESULT: VAFV in ODV patients was significantly reduced when standing up compared with the control patients. In the ODV patients, there was no difference in orthostatic decrease in VAFV between patients those with OH and without OH. However, the VAFV in the standing position was significantly lower in patients with OH than without OH. In cases with OH, the ODV patients exhibited a greater decrease in VAFV compared with the control patients, but this was not statistically significant. In the absence of OH, a significantly greater orthostatic decrease in VAFV was observed in ODV patients compared with the controls.

CONCLUSION: Our findings suggest that the orthostatic decrease of VA blood flow is deeply involved in the hemodynamic mechanism underlying ODV onset and is possibly associated with OH and other etiologies.

PMID:34930632 | DOI:10.1016/j.anl.2021.12.002

Burns. 2021 Nov 25:S0305-4179(21)00332-6. doi: 10.1016/j.burns.2021.11.016. Online ahead of print.

ABSTRACT

BACKGROUND: Suicide attempted by self-inflicted burns are associated with lower survival rates compared to accident related burns.

OBJECTIVE: We investigate the relation between self-inflicted burns (SIB) and survival rates and how this relation is moderated by variables used to predict survival rates in the ABSI score, a widely used measure. Additionally, we compare the predicted survival rates by the ABSI score to the actual rates in our sample for SIB and accident patients.

METHODS: In this prospective multicenter study data from the German Burn Registry are statistically analyzed using two sided t-test and multivariate linear regression models.

RESULTS: 5330 patients (214 with SIB) met our inclusion criteria. We find a 6.8 percentage points lower survival rate for patients with SIB when we control for patient condition with the five ABSI components as covariates. These higher mortality rates can be explained by the higher rate of therapy restrictions for patients with self-inflicted burns. Additionally, different ABSI modifications can improve the predictive power of the score.

CONCLUSION: Patients with SIB have lower survival rates compared to accident patients. Recently proposed modifications of the ABSI score can improve the accuracy of survival rate prediction for SIB.

PMID:34930642 | DOI:10.1016/j.burns.2021.11.016

Am J Cardiol. 2021 Dec 17:S0002-9149(21)01105-X. doi: 10.1016/j.amjcard.2021.11.006. Online ahead of print.

ABSTRACT

The objective is to define the clinical echocardiographic characteristics and cardiovascular outcome in patients with acute heart failure (HF) with versus without diabetes mellitus (DM). Demographic, clinical, laboratory, and echocardiographic data were collected in Olmsted County adults hospitalized for acute HF between 2005 and 2008. Analyses were performed for mortality and acute HF hospitalization outcomes stratified by diabetic status, systolic function, and diastolic function. There were 912 subjects who met inclusion criteria, and mean age was 79 (SD 13.1) years with 53% women. Prevalence of DM was 42% in the study population, and those with DM had worse diastolic function and increased mortality and HF rehospitalization. Among those with DM and acute HF, reduced left ventricular ejection fraction and worse diastolic function conferred increased HF rehospitalization (p = 0.010 and p = 0.022, respectively). In conclusion, DM is common in those hospitalized for acute HF and is associated with worse long-term clinical outcomes. The subgroup of DM with acute HF and left ventricular systolic dysfunction or diastolic dysfunction had worse HF rehospitalization outcomes.

PMID:34930613 | DOI:10.1016/j.amjcard.2021.11.006

J Cyst Fibros. 2021 Dec;20 Suppl 3:3-8. doi: 10.1016/j.jcf.2021.08.028.

ABSTRACT

BACKGROUND: Novel therapies have dramatically changed cystic fibrosis (CF) and innovative care delivery systems are needed to meet future patient needs. Telehealth has been shown to be an efficient and desirable form of care delivery. The COVID-19 pandemic caused a rapid shift to telehealth, and this presented a unique opportunity to study facilitators, barriers, and satisfaction with this mode of care delivery. We aim to report survey methods, demographics and telehealth use among CF care programs, patients, and families during the pandemic.

METHODS: CF programs completed two surveys between July 29 and September 18, 2020, and between April 19 and May 19, 2021. Patients and families completed a similar survey between August 31 and October 30, 2020. The surveys addressed topics assessing the pandemic’s financial impact, telehealth modes and experiences, licensure and reimbursement issues, health screening, and remote monitoring. Quantitative data were analyzed with descriptive statistics and were compared to the CF Foundation Patient Registry.

RESULTS: Most programs (278 at timepoint one and 274 at timepoint two) provided telehealth during the pandemic. The percent of visits containing either telephone or video components changed from 45% to 25% over the time periods. Additionally, 424 patients and families from various ages and backgrounds responded to the survey and 81% reported having a telehealth visit.

CONCLUSIONS: The pandemic accelerated telehealth adoption and these datasets are a valuable source for exploring telehealth barriers and facilitators, the quality-of-care experience, financial and workforce implications, the impact on underrepresented populations, and implications for coverage and reimbursement.

PMID:34930539 | DOI:10.1016/j.jcf.2021.08.028

Fungal Biol. 2022 Jan;126(1):82-90. doi: 10.1016/j.funbio.2021.10.006. Epub 2021 Oct 30.

ABSTRACT

Maize grown in both North and South America are now predominantly genetically modified (GM) cultivars with some resistance to herbicide, pesticide, or both. There is little information on the relative colonisation and aflatoxin B₁ (AFB₁) production with maize meal-based nutritional matrices based on kernels of non-GM maize and isogenic GM-ones by strains of Aspergillus flavus. The objectives were to examine the effect of interacting conditions of temperature (25-35 °C) and water availability (0.99-0.90 water activity, a_w) on (a) mycelial growth, (b) AFB₁ production and (c) develop contour maps of optimum and marginal conditions of these parameters for four strains of A. flavus on three different non-GM and isogenic GM-maize based nutritional media. The growth of the four strains of A. flavus (three aflatoxigenic; one non-aflatoxigenic) was relatively similar in relation to the temperature × a_w conditions examined on both non-GM and GM-based matrices. Optimum growth overall was at 30-35 °C and 0.99 a_w for all four strains. Under water stress (0.90 a_w) growth was optimum at 35 °C. Statistically: non-GM, GM cultivars, temperature and a_w all significantly affected growth rates. For AFB₁ production, all single and interacting factors were statistically significant except for non-GM × GM cultivar. In conclusion, colonisation of GM- and non-GM nutritional sources was similar for the different A. flavus strains examined. The contour maps will be very useful for understanding the ecological niches for both toxigenic and non-toxigenic strains in the context of the competitive exclusion of those producing aflatoxins.

PMID:34930561 | DOI:10.1016/j.funbio.2021.10.006

Eur J Med Res. 2021 Dec 20;26(1):150. doi: 10.1186/s40001-021-00623-6.

ABSTRACT

BACKGROUND: Metatarsal fractures are common skeletal injuries of the lower extremity in adults. The majority involves the proximal fifth metatarsal bone. In the current literature, there still exists controversy regarding treatment recommendations for the different fracture entities.

METHODS: All patients suffering from single fractures to the proximal fifth metatarsal bone between 2003 and 2015 were enrolled in this retrospective analysis. Only patients with a minimum follow-up of 12 months were included. The fractures were classified according to Lawrence and Botte (L&B). Data were collected via patient registry, radiographs and a standardized questionnaire (Foot and Ankle Outcome Score = FOAS). For outcome analysis, the nonparametric Mann-Whitney U test was performed and Spearman’s rank correlation coefficient calculated.

RESULTS: In total, the functional outcomes of 103 patients suffering from fractures to the proximal fifth metatarsal bone were analyzed. L&B type I fractures (n = 13) had a FAOS score of 91 ± 23, L&B type II (n = 67) presented a score of 91 ± 15 and L&B type III (n = 23) a score of 93 ± 11. Surgically treated patients with an L&B type II fracture had no statistically significant better functional outcome in comparison to conservative management (p = 0.89). Operatively treated L&B type III fractures tended to have a better functional score (p = 0.16). The follow-up time was 58 (min: 15; max: 164) months.

CONCLUSIONS: Overall, the functional outcome following fractures to the proximal fifth metatarsal bone is satisfactory. Conservatively treated L&B type II fractures showed an equivalent functional outcome compared to surgical management. Patients with an L&B type III fracture mainly were treated surgically, but difference in FAOS score did not reach level of significance.

PMID:34930495 | DOI:10.1186/s40001-021-00623-6

Eur J Med Res. 2021 Dec 20;26(1):151. doi: 10.1186/s40001-021-00614-7.

ABSTRACT

BACKGROUND: For patients with primary brain injury, septic shock is especially dangerous due to the possibility of secondary cerebral damage. The key factor of sepsis-associated brain injury is inflammatory mediators, pathogen and damage-associated molecular patterns (PAMPs, DAMPs) release. Theoretically, blood purification may be beneficial for patients with primary brain injury due to its possibility for fast removal of inflammatory mediators.

CASE PRESENTATION: We report on six post-neurosurgery septic shock patients treated with combined blood purification (CBP), which included CRRT with high adsorption capacity membrane in combination with CytoSorb adsorber. Clinical improvement in the course of CBP was registered in all patients. Three patients had a stable clinical improvement; the other three patients had only a transient improvement due to underlying neurological and cardiac deficits aggravation. We observed septic shock reversal in four patients. The key observations of the case series are a significant decrease in MOF severity (measured by SOFA score) and in catecholamine need (not statistically significant). By the end of CBP we observed a significant decrease in blood lactate, PCT and IL-6 levels. Two patients demonstrated level of consciousness increase in the setting of CBP therapy measured by GCS and FOUR score.

CONCLUSION: This case series demonstrates that CBP therapy may have a role for septic shock patients with primary brain injury.

PMID:34930484 | DOI:10.1186/s40001-021-00614-7

Anim Microbiome. 2021 Dec 20;3(1):86. doi: 10.1186/s42523-021-00151-y.

ABSTRACT

BACKGROUND: Intestinal health remains a key factor in animal production because it is essential for digestion, absorption and bacterial fermentation. Feed additives have been used to attenuate the weaning stress such as Zinc Oxide (ZnO) and benzoic acid (C₇H₆O₂). The objective of this study was to evaluate the impact of of benzoic acid and probiotics (BA + P) on performance, diarrhea and cecal microbiota of piglets in the nursery phase (23 to 65 days).

RESULTS: One hundred and sixty weaned piglets with an initial weight of 6.335 ± 0.698 kg and 23 days of age were submitted to four treatments: supplementation with 2500 ppm of Zinc oxide (ZnO), supplementation with a commercial blend of benzoic acid and probiotics (Bacillus licheniformis, Bacillus subtilis and Enterococcus faecium NCIMB 10415; Vevogut P®) (BA + P), supplementation with Zinc oxide plus benzoic acid and probiotics (ZnO + BA + P), and controls receiving only the basal diet without any supplementation. At 65 days of age, 32 piglets (n = 8 per treatment) were slaughtered for the evaluation of the cecal microbiota. Supplementation with ZnO and BA + P were associated with better feed conversion (P < 0.05) in the early stage (23 to 49 days) and with an improvement in all performance parameters over the entire experimental period. The occurrence of diarrhea was lower (P < 0.05) in the BA + P group. The 4 most abundant phyla along with unclassified bacteria represented 93% of all sequences. Firmicutes dominated the cecal microbiota of all groups, followed by Bacteroidetes. Richness represented by the observed number of genera and by the Chao index were statistically lower in ZnO and ZnO + BA + P supplemented animals compared to controls. The beta diversity analysis that compares similarities between bacterial communities demonstrated formation of two distinct clusters containing samples with and without supplementation with ZnO, confirming a strong influence of ZnO on the intestinal microbiota.

CONCLUSION: The use of Benzoic acid with probiotics yields similar performance results with lower impact on the gut microbiota compared to ZnO, and it should be considered as a potential alternative in swine production.

PMID:34930490 | DOI:10.1186/s42523-021-00151-y

Pilot Feasibility Stud. 2021 Dec 20;7(1):220. doi: 10.1186/s40814-021-00947-4.

ABSTRACT

BACKGROUND: Excess weight and unhealthy behaviours (e.g. sedentariness, high alcohol) are common amongst women including those attending breast screening. These factors increase the risk of breast cancer and other diseases. We tested the feasibility and acceptability of a weight loss/behaviour change programme framed to reduce breast cancer risk (breast cancer prevention programme, BCPP) compared to one framed to reduce risk of breast cancer, cardiovascular disease (CVD) and diabetes (T2D) (multiple disease prevention programme, MDPP).

METHODS: Women aged 47-73 years with overweight or obesity (n = 1356) in the NHS Breast Screening Programme (NHSBSP) were randomised (1:2) to be invited to join a BCPP or a MDPP. The BCPP included personalised information on breast cancer risk and a web and phone weight loss/behaviour change intervention. The MDPP also included an NHS Health Check (lipids, blood pressure, HbA1c and personalised feedback for risk of CVD [QRISK2] and T2D [QDiabetes and HbA1c]). Primary outcomes were uptake and retention and other feasibility outcomes which include intervention fidelity and prevalence of high CVD and T2D risk. Secondary outcomes included change in weight.

RESULTS: The BCPP and MDPP had comparable rates of uptake: 45/508 (9%) vs. 81/848 (10%) and 12-month retention; 33/45 (73%) vs. 53/81 (65%). Both programmes had a high fidelity of delivery with receipt of mean (95% CI) 90 (88-98% of scheduled calls, 91 (86-95%) of scheduled e-mails and 89 (76-102) website entries per woman over the 12-month period. The MDPP identified 15% of women with a previously unknown 10-year CVD QRISK2 of ≥ 10% and 56% with 10-year Qdiabetes risk of ≥ 10%. Both groups experienced good comparable weight loss: BCPP 26/45 (58%) and MDPP 46/81 (57%) with greater than 5% weight loss at 12 months using baseline observation carried forward imputation.

CONCLUSIONS: Both programmes appeared feasible. The MDPP identified previously unknown CVD and T2D risk factors but does not appear to increase engagement with behaviour change beyond a standard BCPP amongst women attending breast screening. A future definitive effectiveness trial of BCPP is supported by acceptable uptake and retention, and good weight loss.

TRIAL REGISTRATION: ISRCTN91372184 , registered 28 September 2014.

PMID:34930478 | DOI:10.1186/s40814-021-00947-4

J Intensive Care. 2021 Dec 20;9(1):78. doi: 10.1186/s40560-021-00592-2.

ABSTRACT

BACKGROUND: A structure and staffing model similar to that in general intensive care unit (ICUs) is applied to cardiac intensive care unit (CICUs) for patients with acute heart failure. However, there is limited evidence on the structure and staffing model of CICUs. The present study aimed to assess whether critical care for patients with acute heart failure in the ICUs is associated with improved outcomes than care in the high-dependency care units (HDUs), the hospital units in which patient care levels and costs are between the levels found in the ICU and general ward.

METHODS: This nationwide, propensity score-matched, retrospective cohort study was performed using a national administrative inpatient database in Japan. We identified all patients who were hospitalized for acute heart failure and admitted to the ICU or HDU on the day of hospital admission from April 2014 to March 2019. Propensity score-matching analysis was performed to compare the in-hospital mortality between acute heart failure patients treated in the ICU and HDU on the day of hospital admission.

RESULTS: Of 202,866 eligible patients, 78,646 (39%) and 124,220 (61%) were admitted to the ICU and HDU, respectively, on the day of admission. After propensity score matching, there was no statistically significant difference in in-hospital mortality between patients who were admitted to the ICU and HDU on the day of admission (10.7% vs. 11.4%; difference, – 0.6%; 95% confidence interval, – 1.5% to 0.2%). In the subgroup analyses, there was a statistically significant difference in in-hospital mortality between the ICU and HDU groups among patients receiving noninvasive ventilation (9.4% vs. 10.5%; difference, – 1.0%; 95% confidence interval, – 1.9% to – 0.1%) and patients receiving intubation (32.5% vs. 40.6%; difference, – 8.0%; 95% confidence interval, – 14.5% to – 1.5%). There were no statistically significant differences in other subgroup analyses.

CONCLUSIONS: Critical care in ICUs was not associated with lower in-hospital mortality than critical care in HDUs among patients with acute heart failure. However, critical care in ICUs was associated with lower in-hospital mortality than critical care in HDUs among patients receiving noninvasive ventilation and intubation.

PMID:34930470 | DOI:10.1186/s40560-021-00592-2