Tag: pubmed

J Pak Med Assoc. 2021 Aug;71(Suppl 5)(8):S13-S16.

ABSTRACT

OBJECTIVE: To assess the functional and radiological outcomes in a unique class of fractures i.e. atypical femur fractures and to assess the effects of osteoblastic agents in healing.

METHODS: It is a retrospective observational study conducted at Aga Khan University Hospital, Karachi, Pakistan. All patients with atypical femur fractures who were surgically managed with intramedullary nailing from January, 2013 to June, 2017 and with a follow-up till December 2019, were included in the study. Radiological outcomes were expressed as mean healing time and functional outcomes were recorded as mean Short Musculoskeletal Functional Assessment (SMFA) score.

RESULTS: A total of twenty-four patients were included in this study. Mean age of patients was 65.8 ± 8 years. Mean healing time was 10 ±3.2 months post operatively. Two patients underwent redo procedures. No other complications like paresthesia or weakness was observed in any patients. All the patients reported a good score on SMFA ranging from 19% to 31%.

CONCLUSION: Intra-medullary nailing shows a promising result in treatment of atypical femur fractures. Use of post-operative osteoblastic supplements showed statistically significant results with early healing time (p=0.008 [95% CI]).

PMID:34634008

Anesth Analg. 2021 Oct 11. doi: 10.1213/ANE.0000000000005752. Online ahead of print.

ABSTRACT

BACKGROUND: Depressive symptoms occur in over 40% of neurosurgical patients during the perioperative period. However, no measure has been suggested to have a rapid effect on depressive surgical patients during increasingly shorter stays in the hospital. This study aimed to determine whether ketamine could improve depressive symptoms rapidly and safely during the hospital stay.

METHODS: This was a randomized, placebo-controlled, and double-blinded trial. Patients with moderate-to-severe depressive symptoms undergoing elective supratentorial brain tumor resection were randomized to intravenously receive either (1) 0.5 mg·kg-1 ketamine for 40 minutes or (2) an identical volume of normal saline. The primary outcome was treatment response on postoperative day 3, defined as a ≥50% reduction from the baseline depressive score. The secondary outcomes included the rate of remission and safety outcomes. The Montgomery-Åsberg Depression Rating Scale was applied by trained psychiatrists to evaluate depressive symptoms.

RESULTS: A total of 84 neurosurgical patients were enrolled in the trial. The response rate was increased by the administration of ketamine (41.5% [17/41] vs 16.3% [7/43]; relative risk [RR]: 2.51, 95% confidence interval [CI], 1.18-5.50) relative to the administration of placebo at 3 days. Furthermore, the remission rate at discharge (29.3% [12/41] vs 7.0% [3/43]; RR: 4.20, 95% CI, 1.28-13.80) was also improved by ketamine. No psychotic symptoms or adverse events were reported to be substantially higher in the ketamine group.

CONCLUSIONS: The trial indicates that the intraoperative administration of ketamine could alleviate moderate-to-severe depressive symptoms in neurosurgical patients without worsening safety.

PMID:34633992 | DOI:10.1213/ANE.0000000000005752

Med J Aust. 2021 Oct 11. doi: 10.5694/mja2.51291. Online ahead of print.

ABSTRACT

OBJECTIVE: To estimate the numbers of COVID-19-related hospitalisations in Australia after re-opening the international border.

DESIGN: Population-level deterministic compartmental epidemic modelling of eight scenarios applying various assumptions regarding SARS-CoV-2 transmissibility (baseline R₀ = 3.5 or 7.0), vaccine rollout speed (slow or fast), and scale of border re-opening (mean of 2500 or 13 000 overseas arrivals per day).

SETTING: Simulation population size, age structure, and age-based contact rates based on recent estimates for the Australian population. We assumed that 80% vaccination coverage of people aged 16 years or more was reached in mid-October 2021 (fast rollout) or early January 2022 (slow rollout).

MAIN OUTCOME MEASURES: Numbers of people admitted to hospital with COVID-19, December 2021 – December 2022.

RESULTS: In scenarios assuming a highly transmissible SARS-CoV-2 variant (R₀ = 7.0), opening the international border on either scale was followed by surges in both infections and hospitalisations that would require public health measures beyond mask wearing and social distancing to avoid overwhelming the health system. Reducing the number of hospitalisations to manageable levels required several cycles of additional social and mobility restrictions.

CONCLUSIONS: If highly transmissible SARS-CoV-2 variants are circulating locally or overseas, large and disruptive COVID-19 outbreaks will still be possible in Australia after 80% of people aged 16 years or more have been vaccinated. Continuing public health measures to restrict the spread of disease are likely to be necessary throughout 2022.

PMID:34633100 | DOI:10.5694/mja2.51291

Pediatr Transplant. 2021 Oct 11:e14156. doi: 10.1111/petr.14156. Online ahead of print.

ABSTRACT

BACKGROUND: Adult SOT recipients with COVID-19 have higher mortality rates when compared to general population. There is paucity of data on outcomes in pediatric SOT recipients.

METHODS: This is a cross-sectional study investigating the prevalence of COVID-19 infection and outcomes in pediatric SOT (heart, liver, and kidney) recipients. We extracted demographic and clinical characteristics and COVID-19 testing (PCR or [Ab] test) results from medical records. Clinical characteristics were compared between patients who were positive for COVID-19 (PCR or Ab) and those who did not, using Mann-Whitney, Student’s t test, or chi-square test. p value <.05 was statistically significant.

RESULTS: A total of 108 SOT recipients with a median age of 13.1 (8.4, 17.8) years and median 4.2 (2.7, 7.9) years from transplant were checked for COVID-19 via a PCR or Ab test. A positive PCR was confirmed in 10 patients (9.3%), while 12 patients (11.1%) were positive for COVID-19 Ab. The patients who tested positive in our cohort were 9/50 (18%) heart, 6/68 (8.8%) kidney, and 7/50 (14%) liver transplant recipients. There were no differences in the clinical characteristics between patients with and without COVID-19 infection. All patients were either asymptomatic (50%) or had self-limiting symptoms. No changes were made to the immunosuppressive regimen. Only one patient was hospitalized and none had an oxygen requirement.

CONCLUSIONS: In our cohort of pediatric SOT recipients, COVID-19 infection was asymptomatic or mild. This data may aid clinicians in counseling patients and families in this increased-risk population.

PMID:34633125 | DOI:10.1111/petr.14156

Prostate. 2021 Oct 11. doi: 10.1002/pros.24251. Online ahead of print.

ABSTRACT

BACKGROUND: Interleukin-6 (IL-6) is a pleiotropic cytokine that confers androgen-independence and aggressiveness in prostate cancer (PCa); however, the molecular mechanisms regulating IL-6 expression remain unclear. The expression of ARID5A, an AT-rich interaction domain (ARID) DNA-binding motif-containing transcription factor is positively correlated with IL-6 expression in human PCa. We, therefore, hypothesized that ARID5A could regulate IL-6 expression in PCa.

METHODS: The relationship between ARID5A and IL-6 in PCa patients was analyzed using statistical analyses of multiple clinical microarray data sets. To investigate whether ARID5A regulates IL-6 expression, CRISPR-driven ARID5A knockout clones were established in DU145 and PC-3 cells.

RESULTS: Analysis of three microarray data sets showed a positive correlation between ARID5A and IL-6 expression. The expression of IL-6 in ARID5A knockout clones was significantly reduced compared with control clones in both PCa cell lines. Knockout of ARID5A did not result in any loss of IL-6 mRNA stability. Instead, we observed a significant decrease in the occupancy of both active RNA Polymerase II and the active histone mark, H3K4me3 at the IL-6 transcriptional start site in ARID5A knockout PCa cells, suggesting a role for transcriptional regulation.

CONCLUSIONS: Our study demonstrated that loss of ARID5A downregulates the expression of IL-6 at the transcriptional level.

PMID:34633095 | DOI:10.1002/pros.24251

J Med Virol. 2021 Oct 11. doi: 10.1002/jmv.27384. Online ahead of print.

ABSTRACT

OBJECTIVE: Disparities in outcomes exist in outcomes of COVID19. Little is known about other ethnic minorities in US.

METHODS: We included all COVID-19 positive adult patients (≥18 years) hospitalized between March 1, 2020 and February 5^th 2021. We compared in hospital mortality, use of intensive care unit services and inflammatory markers between non-Hispanic whites with non-White/Black Hispanic. Multivariable Cox proportional Hazard models were used to adjust for differences between the two groups.

RESULTS: There were 4059 hospital admissions with COVID-19 in the study period. Of the 3288 White, 789(24%) required ICU admission in comparison to 187 (24.3%) of the 770 Hispanics. Unadjusted mortality was higher in Whites than Hispanics (17.1% versus 10.7%; p<0.001). After adjusting for confounding variables, in-hospital mortality was not statistically different for Whites in comparison to Hispanics (HR 0.96, 95%CI 0.76-1.21, p=0.73). The adjusted rates of ICU transfers were significantly higher in Hispanics (HR 1.34, 95%CI 1.11-1.61, p=0.002). Hispanics had significantly higher CRP, LDH and fibrinogen when compared to Whites.

CONCLUSION: Hispanics as compared to Whites with COVID-19 require higher rates of ICU admission but have a similar mortality. This article is protected by copyright. All rights reserved.

PMID:34633096 | DOI:10.1002/jmv.27384

Occup Med (Lond). 2021 Oct 11:kqab145. doi: 10.1093/occmed/kqab145. Online ahead of print.

ABSTRACT

BACKGROUND: There is an urgent need to address high levels of work-related violence (WRV) in Britain to improve the workplace experience of both employers and employees.

AIMS: This study specifically explores prevalence rates of work-related violence assaults (WRVAs) for staff at high risk that have supervisor responsibilities and work full-time.

METHODS: Five years of data were used for analysis from the Crime Survey of England and Wales (CSEW). Data were filtered for victims of crime from a working population in Britain.

RESULTS: Forty-four per cent of respondents who are supervisors and have full-time jobs report that they had been victims of WRVAs. This figure is higher than other previous studies of WRV.

CONCLUSIONS: The current study provides further alternative evidence to support high prevalence rates of WRV by selecting for analysis specific work characteristics data that are strongly associated with WRV (supervisor responsibilities and full-time work). It is therefore recommended that future work explores different means of intervention for organizations to implement within the workplace to reduce WRV and protect workers from harm.

PMID:34633045 | DOI:10.1093/occmed/kqab145

Epilepsia. 2021 Oct 11. doi: 10.1111/epi.17095. Online ahead of print.

NO ABSTRACT

PMID:34633079 | DOI:10.1111/epi.17095

Eur J Cardiothorac Surg. 2021 Oct 11:ezab416. doi: 10.1093/ejcts/ezab416. Online ahead of print.

ABSTRACT

OBJECTIVES: Acute thoracic aortic dissection and rupture (TADR) has an incidence of 5-7 per 100 000-person years. Today, most children with congenital heart disease (CHD) survive to become adults with congenital heart disease (ACHD). This study evaluates TADR in patients with ACHD in a large, hospitalized patient population over 11 years to evaluate the incidence, risk factors and outcomes associated with TADR.

METHODS: This was a retrospective review of the Texas Inpatient Discharge Data Set from 1 January 2009 to 31 December 2019. All non-trauma discharges of patients ≥18 years were included. ACHD discharges were identified by International Classification of Diseases, 9th edition (ICD-9)/10 diagnosis codes. TADR were identified using 2 definitions: TADR1 is an ICD-9/10 code for TADR, and TADR2 is TADR1 with an ICD-9/10 procedure code for aortic intervention. Descriptive, univariate and logistic regression statistics were used.

RESULTS: A total of 22 154 664 eligible discharges were identified, of which 12 584 (0.06%) were TADR1 and a subgroup of 5699 (0.03%) were TADR2. CHD was more prevalent in TADR1 (0.2% vs 0.05%; P < 0.001) and TADR2 (0.3% vs 0.04%; P < 0.001). Adjusting for known TADR risk factors, CHD had an odds ratio of 1.69 (95% confidence interval: 1.09-2.63; P = 0.020) for TADR1 and an odds ratio of 1.69 (95% confidence interval: 0.99-2.88; P = 0.056) for TADR2. No in-hospital deaths were found in patients with CHD with TADR.

CONCLUSIONS: ACHD discharges had a higher frequency of TADR versus the general population (0.9-1.2 vs 0.3-0.6 per 1000 discharges). There is an indication that CHD confers an increased adjusted odds of TADR. As the ACHD population continues to grow in number as well as age, it will be important to continue to assess the risk of TADR from CHD and how traditional risk factors impact this risk.

PMID:34633038 | DOI:10.1093/ejcts/ezab416

Br J Nutr. 2021 Oct 11:1-20. doi: 10.1017/S0007114521004116. Online ahead of print.

ABSTRACT

To investigate the association between the Metabolic Score for Visceral Fat (METS-VF) and risk of type 2 diabetes mellitus (T2DM) and compare the predictive value of the METS-VF for T2DM incidence with other obesity indices in Chinese people. A total of 12,237 non-T2DM participants aged over 18 from the Rural Chinese Cohort Study of 2007-2008 were included at baseline and followed up during 2013-2014. The cox proportional hazards regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between baseline METS-VF and T2DM risk. Restricted cubic splines were used to model the association between METS-VF and T2DM risk. Area under the receiver operating characteristic curve (AUC) analysis was used to evaluate the ability of METS-VF to predict T2DM incidence. During a median follow-up of 6.01 (5.09-6.06) years, 837 cases developed T2DM. After adjusting for potential confounding factors, the adjusted HR (95% CI) for the highest versus lowest METS-VF quartile was 5.97 (4.28-8.32), with a per 1-standard deviation increase in METS-VF positively associated with T2DM risk. Positive associations were also found in the sensitivity and subgroup analyses, respectively. A significant nonlinear dose-response association was observed between METS-VF and T2DM risk for all participants (Pnonlinearity = 0.0347). Finally, the AUC value of METS-VF for predicting T2DM was largest among six indices. The METS-VF may be a reliable and applicable predictor of T2DM incidence in Chinese people regardless of sex, age, or body mass index.

PMID:34632975 | DOI:10.1017/S0007114521004116