Tag: pubmed

Postgrad Med J. 2021 Sep 3:postgradmedj-2020-139382. doi: 10.1136/postgradmedj-2020-139382. Online ahead of print.

ABSTRACT

BACKGROUND: Postpartum haemorrhage is one of the direct and the leading causes of maternal morbidity and mortality. There are many risk factors of postpartum haemorrhage, which vary in different settings. Therefore, the purpose of this study was to assess postpartum haemorrhage and associated factors among mothers who gave birth in public health facilities.

METHODS: A cross-sectional study was employed from 17 November 2019 to 15 February 2020. The study participants were selected using a systematic sampling technique. The data were entered and cleaned using EpiData V.3.1 then exported to SPSS V.20 for analysis. Factors associated with postpartum haemorrhage were selected for multiple logistic regression at the probability value (p value) of less than 0.2 in the χ² analysis. Statistically significant associated factors were identified at probability value (p value) less than 0.05 and adjusted OR (AOR) with a 95% CI.

RESULTS: The mean age of participants was 31.3 (SD ±5.7) years. This study found that the prevalence of postpartum haemorrhage was 13.6% (67). Age of participants (AOR 12.5, 95% CI 4.0 to 38.6), disrespectful maternity care (AOR 8.4, 95% CI 3.2 to 22.0), labour induction and augmentation (AOR 6.97, 95% CI 2.34 to 20.8), the prolonged second stage of labour (AOR 9.9, 95% CI 2.6 to 37.1) and no antenatal care visit (AOR 10.1, 95% CI 3.4 to 29.7) were statistically significant associated factors of postpartum haemorrhage.

CONCLUSIONS: The prevalence of postpartum haemorrhage is high. The age of the participants, disrespectful maternity care, labour induction and augmentation, the prolonged second stage of labour and no antenatal care visit were independent predictors of postpartum haemorrhage.

PMID:34479977 | DOI:10.1136/postgradmedj-2020-139382

BMJ Open. 2021 Sep 3;11(9):e051904. doi: 10.1136/bmjopen-2021-051904.

ABSTRACT

INTRODUCTION: Person-centred outcome measures improve quality of care and patient outcomes but are used inconsistently in palliative care practice. To address this implementation gap, we developed the ‘RESOLVE Implementation Strategy’. This protocol describes a process evaluation to explore mechanisms through which this strategy does, or does not, support the implementation of outcome measures in routine palliative care practice.

METHODS AND ANALYSIS: Multistrand, mixed-methods process evaluation. Strand one will collect routine outcomes data (palliative Phase of Illness, Integrated Palliative care Outcomes Scale, Australia-modified Karnofsky Performance Status) to map the changes in use of outcome measures over 12 months (July 2021-July 2022). Strand two will collect survey data over the same 12-month period to explore how professionals’ understandings of, skills in using and ability to build organisational practices around, outcome measures change over time. Strand three will collect interview data to understand the mechanisms underpinning/affecting our implementation strategy. Thematic framework analysis and descriptive statistics will be used to analyse qualitative and quantitative data, respectively.

ETHICS AND DISSEMINATION: For strand one, ethical approval has been obtained (Cambridge REC, REF: 20/EE/0188). For strands two and three, ethical approval has been obtained from Hull York Medical School ethics committee (2105). Tailored feedback of study findings will be provided to participating sites. Abstracts and papers will be submitted to national/international conferences and peer-reviewed journals. Lay and policy briefings and newsletters will be shared through patient and public involvement and project networks, plus via the project website.

PMID:34479939 | DOI:10.1136/bmjopen-2021-051904

BMJ Open. 2021 Sep 3;11(9):e051003. doi: 10.1136/bmjopen-2021-051003.

ABSTRACT

INTRODUCTION: Acute traumatic coagulopathy (ATC) in bleeding trauma patients increase in-hospital mortality. Fibrinogen concentrate (FC) and prothrombin complex concentrate (PCC) are two purified concentrates of clotting factors that have been used to treat ATC. However, there is a knowledge gap on their use compared with the standard of care, the transfusion of plasma.

METHODS AND ANALYSIS: The factors in the initial resuscitation of severe trauma 2 trial is a multicentre, randomised, parallel-control, single-blinded, phase IV superiority trial. The study aims to address efficacy and safety of the early use of FC and PCC compared with a plasma-based resuscitation. Adult trauma patients requiring massive haemorrhage protocol activation on hospital arrival will receive FC 4 g and PCC 2000 IU or plasma 4 U, based on random allocation. The primary outcome is a composite of the cumulative number of all units of red cells, plasma and platelets transfused within 24 hours following admission. Secondary outcomes include measures of efficacy and safety of the intervention. Enrolment of 350 patients will provide an initial power >80% to demonstrate superiority for the primary outcome. After enrolment of 120 patients, a preplanned adaptive interim analysis will be conducted to reassess assumptions, check for early superiority demonstration or reassess the sample size for remainder of the study.

ETHICS AND DISSEMINATION: The study has been approved by local and provincial research ethics boards and will be conducted according to the Declaration of Helsinki, Good Clinical Practice guidelines and regulatory requirements. As per the Tri-Council Policy Statement, patient consent will be deferred due to the emergency nature of the interventions. If superiority is established, results will have a major impact on clinical practice by reducing exposure to non-virally inactivated blood products, shortening the time for administration of clotting factors, correct coagulopathy more efficaciously and reduce the reliance on AB plasma.

TRIAL REGISTRATION NUMBER: NCT04534751, pre results.

PMID:34479938 | DOI:10.1136/bmjopen-2021-051003

Trop Med Int Health. 2021 Sep 3. doi: 10.1111/tmi.13676. Online ahead of print.

ABSTRACT

Arterial stiffness is a known indicator for cardiovascular disease. However, the factors that lead to arterial stiffening have primarily been studied in participants from high-income countries. We performed pulse wave velocity (PWV), the gold standard measure of arterial stiffness, on 808 Tanzanian adults (ages 18 to 65) enrolled in a longitudinal cohort studying trends in blood pressure. As expected, PWV was strongly associated with age, blood pressure and sex. We controlled for these factors in our statistical analysis. Lifestyle metrics were compared across multiple PWV quantiles. We found that determinants of PWV varied by sex: in female participants, PWV was associated with common obesity metrics and menopause, while in male participants, PWV was associated with HIV status and duration of anti-retroviral therapy (ART). Further clinical and lifestyle factors such as marriage status and type of occupation were also significantly associated with PWV and moderated by sex. Together our data demonstrate the importance of studying sex-specific causal pathways for arterial stiffness and of including under-represented populations in these studies.

PMID:34478605 | DOI:10.1111/tmi.13676

J Magn Reson Imaging. 2021 Sep 3. doi: 10.1002/jmri.27909. Online ahead of print.

ABSTRACT

BACKGROUND: Autoimmune encephalitis (AE) is a noninfectious emergency with severe clinical attacks. It is difficult for the earlier diagnosis of acute AE due to the lack of antibody detection resources.

PURPOSE: To construct a deep learning (DL) algorithm using multi-sequence magnetic resonance imaging (MRI) for the identification of acute AE.

STUDY TYPE: Retrospective.

POPULATION: One hundred and sixty AE patients (90 women; median age 36), 177 herpes simplex virus encephalitis (HSVE) (89 women; median age 39), and 184 healthy controls (HC) (95 women; median age 39) were included. Fifty-two patients from another site were enrolled for external validation.

FIELD STRENGTH/SEQUENCE: 3.0 T; fast spin-echo (T₁ WI, T₂ WI, fluid attenuated inversion recovery imaging) and spin-echo echo-planar diffusion weighted imaging.

ASSESSMENT: Five DL models based on individual or combined four MRI sequences to classify the datasets as AE, HSVE, or HC. Reader experiment was further carried out by radiologists.

STATISTICAL TESTS: The discriminative performance of different models was assessed using the area under the receiver operating characteristic curve (AUC). The optimal threshold cut-off was identified when sensitivity and specificity were maximized (sensitivity + specificity – 1) in the validation set. Classification performance using confusion matrices was reported to evaluate the diagnostic value of the models and the radiologists’ assessments before being assessed by the paired t-test (P < 0.05 was considered significant).

RESULTS: In the internal test set, the fusion model achieved the significantly greatest diagnostic performance than single-sequence DL models with AUCs of 0.828, 0.884, and 0.899 for AE, HSVE, and HC, respectively. The model demonstrated a consistently high performance in the external validation set with AUCs of 0.831 (AE), 0.882 (HSVE), and 0.892 (HC). The fusion model also demonstrated significantly higher performance than all radiologists in identifying AE (accuracy between the fuse model vs. average radiologist: 83% vs. 72%).

DATA CONCLUSION: The proposed DL algorithm derived from multi-sequence MRI provided desirable identification and classification of acute AE.

LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY: Stage 2.

PMID:34478565 | DOI:10.1002/jmri.27909

Mol Ecol. 2021 Sep 3. doi: 10.1111/mec.16162. Online ahead of print.

ABSTRACT

Evidence that telomere length (TL) and dynamics can be interpreted as proxy for ‘life stress’ experienced by individuals stems largely from correlational studies. We tested for effects of an experimental increase of workload on telomere dynamics by equipping male great tits (Parus major) with a 0.9 gram backpack for a full year. In addition, we analysed associations between natural life-history variation, TL and TL dynamics. Carrying 5% extra weight for a year did not significantly accelerate telomere attrition. This agrees with our earlier finding that this experiment did not affect survival or future reproduction. Apparently, great tit males were able to compensate behaviourally or physiologically for the increase in locomotion costs we imposed. We found no cross-sectional association between reproductive success and TL, but individuals with higher reproductive success (number of recruits) lost fewer telomere base pairs in the subsequent year. We used the TRF method to measure TL, which method yields a TL distribution for each sample, and the association between reproductive success and telomere loss was more pronounced in the higher percentiles of the telomere distribution, in agreement with the higher impact of ageing on longer telomeres within individuals. Individuals with longer telomeres and less telomere shortening were more likely to survive to the next breeding season, but these patterns did not reach statistical significance. Whether successful individuals are characterized by losing fewer or more base pairs from their telomeres varies between species, and we discuss aspects of ecology and social organisation that may explain this variation.

PMID:34478576 | DOI:10.1111/mec.16162

Oper Dent. 2021 Sep 3. doi: 10.2341/20-112-L. Online ahead of print.

ABSTRACT

OBJECTIVES: The exposure reciprocity law (ERL) has been used to calculate the optimal irradiation time of dental composites. This study examined the applicability of ERL for fast polymerization of restorative composites containing various photoinitiating systems using a high-power multi-peak light-emitting diode (LED) lamp.

METHODS: Three commercial composites differing in photoinitiating systems were tested: Filtek Ultimate Universal Restorative (FU) with a camphorquinone-amine (CQ-A) photoinitiating system, Tetric EvoCeram (TEC) with CQ-A and (2,4,6-trimethylbenzoyl)phosphine oxide (TPO), and Estelite Σ Quick (ESQ) with CQ and a radical amplified photopolymerization (RAP) initiator. Specimens 2-mm thick were polymerized using a high-power multipeak LED lamp (Valo) at 3 pairs of radiant exposures (referred to as low, moderate, and high) ranging from 15.8-26.7 J/cm2. They were achieved by different combinations of irradiation time (5-20 seconds) and irradiance (1300-2980 mW/cm2) as determined with a calibrated spectrometer. Knoop microhardness was measured 1, 24, and 168 hours after polymerization on specimen top (irradiated) and bottom surfaces to characterize the degree of polymerization. The results were statistically analyzed using a three-way analysis of variance and Tukey’s post hoc tests, α = 0.05.

RESULTS: Microhardness increased with radiant exposure and except for ESQ, top-surface microhardness was significantly higher than that on bottom surfaces. Combinations of high irradiance and short irradiation time significantly increased the top-surface microhardness of TEC at low and moderate radiant exposures, and the bottom-surface microhardness of FU at a low radiant exposure. In contrast, the microhardness of ESQ on both surfaces at high radiant exposure increased significantly when low irradiance and long irradiation time were used. With all tested composites, bottom-surface microhardness obtained at low radiant exposure was below 80% of the maximum top-surface microhardness, indicating insufficient polymerization.

CONCLUSION: Combinations of irradiance and irradiation time had a significant effect on microhardness, which was affected by photoinitiators and the optical properties of composites as well as spectral characteristics of the polymerization lamp. Therefore, ERL cannot be universally applied for the calculation of optimal composite irradiation time. Despite high irradiance, fast polymerization led to insufficient bottom-surface microhardness, suggesting the necessity to also characterize the degree of polymerization on the bottom surfaces of composite increments when assessing the validity of ERL.

PMID:34478559 | DOI:10.2341/20-112-L

Int J Gynaecol Obstet. 2021 Sep 3. doi: 10.1002/ijgo.13912. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the effect of hemostatic techniques (bipolar energy versus hemostatic sealants versus suture) on the ovarian reserve of patients submitted to laparoscopic cystectomy for the surgical excision of a unilateral endometrioma.

METHODS: A randomized controlled trial conducted in a teaching hospital included 84 patients with a unilateral endometrioma. The patients underwent laparoscopic stripping for excision of the unilateral endometrioma between March 2018 and February 2020. Three different hemostatic techniques – bipolar energy (Group 1), hemostatic sealants (Group 2) and suture (Group 3) – were compared. Anti-Müllerian hormone (AMH) levels were measured prior to and 1 and 6 months after surgery to determine changes in ovarian function.

RESULTS: Following surgery, AMH levels decreased in all the groups; however, this decrease was not statistically significant. Comparison between groups showed no statistically significant differences in AMH levels between the three hemostatic techniques used. Six months after surgery, median AMH levels were: 1.65 (interquartile range [IQR]: 0.62-2.08) ng/ml in Group 1, 1.87 (IQR: 1.27-2.97) in Group 2, and 1.53 (IQR: 1.18-2.44) in Group 3.

CONCLUSION: The present study suggests that there is no difference between the different hemostatic techniques used in laparoscopic cystectomy for the treatment of unilateral endometriomas.

PMID:34478564 | DOI:10.1002/ijgo.13912

J Am Podiatr Med Assoc. 2021 Jul 1;111(4):Article_10. doi: 10.7547/18-147.

ABSTRACT

BACKGROUND: Hallux valgus, one of the most common deformities of the great toe, may cause pain, dysfunction, and impaired gait pattern. In this retrospective study we report the results of a new type of distal metatarsal osteotomy combined with distal soft-tissue release in patients with mild-to-moderate hallux valgus deformity.

METHODS: This new technique was used in the management of 32 feet of 31 patients (eight men and 23 women) with mild-to-moderate hallux valgus. Hallux valgus angle, intermetatarsal angle, and distal metatarsal articular angle were measured on preoperative, early postoperative (6-8 weeks), and late (1 year) postoperative radiographs. American Orthopaedic Foot and Ankle Society hallux metatarsophalangeal score was calculated. Sesamoid position, by considering medial sesamoid position, and metatarsal shortness were also measured.

RESULTS: Statistically significant differences were detected between the preoperative and late postoperative measurements of the hallux valgus angle, distal metatarsal articular angle, intermetatarsal angle, and sesamoid position parameters in patients operated on with this technique. Improvement was 14° for the hallux valgus angle, 4° for the distal metatarsal articular angle, and 4° for the intermetatarsal angle. Sesamoid position was also improved, and the mean American Orthopaedic Foot and Ankle Society score was significantly improved. Metatarsal shortness greater than 2 mm was observed in two patients without resulting in any clinical discomfort.

CONCLUSIONS: This new technique was easy, safe, and promising in patients diagnosed as having mild-to-moderate hallux valgus deformity.

PMID:34478540 | DOI:10.7547/18-147

Oper Dent. 2021 Sep 3. doi: 10.2341/19-296-L. Online ahead of print.

ABSTRACT

The anticaries potential of restorative ionomeric materials should be evaluated under a pH-cycling regime that simulates the caries process of demineralization and remineralization. Ten glass ionomer cement (GIC) materials and five resin-modified glass ionomer cement (RMGIC) materials were evaluated. A resin composite was used as a negative control. Six discs of each material were immersed for 6 and 18 hours each day in demineralizing (De-) and remineralizing (Re-) solutions, respectively. The solutions were changed daily over 12 days, during which the fluoride concentration was determined using an ion-specific electrode. The results were expressed as (1) the daily fluoride concentration in the De- and Re- solutions (μg F/ml), (2) the amount of fluoride released daily in the De- + Re- solution per area of specimens (μg F/cm2/day), and (3) the cumulative release over the 12-day period (μg F/cm2). During the first days, all materials showed a surge in fluoride release, followed by a gradual decline; however, three distinct patterns were observed, specifically: (1) greater fluoride release in the De- solution compared to the Re- solution during the study period; (2) an initial higher release in De- solution; and (3) a similar release in both solutions over the whole period. The materials differed statistically (p<0.05) with respect to daily and cumulative fluoride release. One GIC (Maxxion R) and one RMGIC (Resiglass R) had the highest and lowest ability to release fluoride, respectively. In conclusion, the GICs and RMGICs evaluated exhibited distinct qualitative and quantitative patterns of fluoride release under conditions simulating the caries process, which might reflect their anticaries potential.

PMID:34478544 | DOI:10.2341/19-296-L