bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of Sexual Dysfunctions and Orientations on Sexuality in Postpartum Women: Cross-Sectional Study [4T]
Authors: Guendler Julianna , Katz Leila , Flamini Maria Eduarda , Lemos Andrea , Amorim Melania
Published: October 2020

INTRODUCTION:

Sexual education by health professionals during the postpartum period is extremely important in maintaining healthy sexual activity. In this context, the study proposed to identify the prevalence of sexual dysfunction in postpartum women and health professionals' orientations on sexual function after childbirth.

METHODS:

A descriptive, cross-sectional study, including 100 women up to one year postpartum, aged 18 years or more and sexually active, excluding pregnant women. Two questionnaires were applied, one for sample characterization and to evaluate orientations on sexuality and the Female Sexual Function Index (FSFI). An exploratory descriptive analysis was performed using SPSS for Windows. The study was approved by Ethics Committee and all women signed a consent form.

RESULTS:

The mean age of the sample was 26 years (SD 6.2), 45% were brown, 62% were married/stable union, 47% had completed high school and 67% were housewives. Almost half of the women (48%) received orientations on when to return sexual intercourse in the postpartum period, however, none of them received any other orientation about postpartum sexuality. The mean number of days for returning intercourse after delivery was 55.6 (SD 24.8). The prevalence of sexual dysfunction was 55%, using a score lower than 26.55 for classification of sexual dysfunction with the FSFI questionnaire.

CONCLUSION:

More than half of women were classified as having sexual dysfunction and none of them received guidance on postpartum sexual function. These findings serve as an alert to the importance of encouraging health professionals to guide the aspects of sexuality to women during prenatal and postpartum periods.
Postpartum Long-Acting Reversible Contraception Is Associated With a Decrease in Recurrent Preterm Birth [3R]
Authors: Toscano Marika A. , Heyrana Katrina , Chen Michael Y. , Whaley Natalie S. , Olson-Chen Courtney
Published: October 2020

INTRODUCTION:

A history of preterm birth is a major risk factor for subsequent preterm birth. The purpose of this study was to compare the rate of recurrent preterm birth in women who received postpartum long-acting reversible contraception (LARC) to those who did not receive postpartum LARC.

METHODS:

This is a retrospective cohort study of women with singleton gestations who delivered prior to 37 weeks between January 2011 and January 2015. The study was approved by the local IRB, and protected health information was de-identified. The rate of recurrent preterm birth was compared between women who received a LARC method within 12 weeks postpartum and those who did not receive LARC. Chi square analysis and multivariate logistic regression were performed controlling for maternal age, BMI, education, employment, race, ethnicity and insurance type. Interpregnancy interval was investigated as a secondary outcome.

RESULTS:

Of 355 subjects with preterm birth, 110 (31%) received postpartum LARC. The rate of recurrent preterm birth was 10.6% in the LARC group vs 23.4% in the non-LARC group (P=.006). After adjusting for potential confounders, subjects with postpartum LARC were 58% less likely to have a recurrent preterm birth as compared to subjects without postpartum LARC (adjusted 95% CI 0.20 - 0.86). The mean interpregnancy interval was 11.2 months longer in the LARC group as compared to the non-LARC group (P=.003).

CONCLUSION:

LARC placement within 12 weeks following a preterm birth is associated with a decreased risk of recurrent preterm birth. Contraceptive counseling in women with preterm birth should address this risk-reducing intervention.
Perceptions of MFM Trainees and Program Directors Regarding D&E Termination Training [9P]
Authors: Zahedi-Spung Leilah D. , Carter Ebony , Macones George Andrew , Stout Molly Jean
Published: October 2020

INTRODUCTION:

A 2012 study of Maternal Fetal Medicine (MFM) providers found that only 31% of respondents performed dilation and evacuation (D&E) pregnancy terminations, predominantly based on whether the provider was trained in D&E procedures. The aim of this study is to better understand perceptions of MFM fellows and Program Directors (PD) regarding D&E termination training in MFM fellowship.

METHODS:

We performed an anonymous survey distributed by email in September 2018 to all current MFM Fellows enrolled in ACGME approved MFM fellowships and a separate survey for all current PDs of those fellowships. Surveys included demographic questions including year of residency completion, year of fellowship, current practice of D&Es, and perceptions on fellow D&E training. Descriptive statistics were used to examine practice patterns and perceptions about D&E training.

RESULTS:

The survey response rate for PDs was 46.4% (39/84) and Fellows 62.5% (90/144). Fellow respondents were 83.3% female. 91.1% completed residency in 2016-2018. 82.2% reported D&E training in residency. PD respondents were 56.4% female. 67.5% completed their residency before 2000 (27.0% prior to 1990 and 40.5% from 1991-2000). 64.1% reported D&E training in residency. The majority of Fellows (73.3%) responded that MFM physicians should perform D&E terminations compared to 55.3% of PDs. Almost half of Fellows (48.9%) desire D&E training in fellowship, however, only 23.1% of PDs believe D&E training should be required.

CONCLUSION:

There is a discrepancy between MFM Fellow desires for D&E training and PD opinions on training in MFM Fellowship. Whether D&E training resides in the skillset of MFM physicians should be addressed.
Current Concepts in the Diagnosis and Management of Lymphedema
Authors: Oropallo Alisha , Donis-Garcia Miriam , Ahn Soyouen , Rao Amit
Published: October 2020

Lymphedema is a condition characterized by localized protein-rich swelling caused by damaged or malfunctioning lymphatics. Patients with lymphedema have an increased risk of infection because of the lymphostatic nature of the disease. Chronic ulceration of the skin can make individuals vulnerable to infection leading to serious, sometimes fatal, complications. Proper diagnosis and treatment modalities can aid in the prevention of these complications and ensure better outcomes for the patient.

GENERAL PURPOSE

To present a comprehensive review of lymphedema, including its pathophysiology, assessment, diagnosis, and treatment.

TARGET AUDIENCE

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES

After participating in this educational activity, the participant will:

1. Summarize the etiology, pathophysiology, and clinical manifestations of lymphedema.

2. Describe the diagnostic and treatment approaches for patients who have lymphedema.
Advances in anesthesia education: increasing access and collaboration in medical education, from E-learning to telesimulation
Authors: Nelsen Brenna R. , Chen Yun-Yun K. , Lasic Morana , Bader Angela M. , Arriaga Alexander F.
Published: October 2020

Purpose of review

The landscape of medical education continues to evolve. Educators and learners must stay informed on current medical literature, in addition to focusing efforts on current educational trends and evidence-based methods. The present review summarizes recent advancements in anesthesiology education, specifically highlighting trends in e-learning and telesimulation, and identifies possible future directions for the field.

Recent findings

Websites and online platforms continue to be a primary source of educational content; top websites are more likely to utilize standardized editorial processes. Podcasts and videocasts are important tools desired by learners for asynchronous education. Social media has been utilized to enhance the reach and visibility of journal articles, and less often as a primary educational venue; its efficacy in comparison with other e-learning platforms has not been adequately evaluated. Telesimulation can effectively disseminate practical techniques and clinical knowledge sharing, extending the capabilities of simulation beyond previous restrictions in geography, space, and available expertise.

E-learning has changed the way anesthesiology learners acquire knowledge, expanding content and curricula available and promoting international collaboration. More work should be done to expand the principles of accessible and collaborative education to psychomotor and cognitive learning via telesimulation.
Cannabis-related Hospitalizations Among Youth in Canada Before and After Cannabis Legalization
Authors: Auger Nathalie , Luu Thuy Mai , Ayoub Aimina , Bilodeau-Bertrand Marianne , Lo Ernest , Low Nancy
Published: October 2020

Objectives:

We investigated trends in cannabis-related hospitalizations among youth before and after legalization of recreational cannabis in Canada on October 17, 2018.

Methods:

We computed rates of cannabis-related hospitalizations and the proportion of substance-related hospitalizations involving cannabis by age and sex in the months before and after legalization in Quebec, Canada.

Results:

In boys aged 10 to 14 years, cannabis-related hospitalization rates increased from 5.2 per 100,000 one year before legalization [95% confidence interval (CI) 2.9–9.3] to 9.5 per 100,000 after legalization (95% CI 6.2–14.6), although the increase was not statistically significant. Cannabis was reported in 39.3% of substance-related hospitalizations in boys aged 10 to 14 years before legalization, compared with 70.0% after legalization, representing a difference of 30.7% (95% CI 2.8–58.6). There was no increase in cannabis-related hospitalizations among girls or boys aged 15 to 19 years.

Conclusions:

This study suggests that cannabis legalization in Canada did not increase the risk of short-term cannabis-related hospitalization among girls and older boys. However, legalization may have contributed to an increase in the risk in boys under 15 years. Further data are needed to clarify trends after legalization for younger adolescents.
A Bridge Too Far: Individuals With Regular and Increasing Very Heavy Alcohol Consumption Cannot be Considered as Maintaining “Recovery” Due to Toxicity and Intoxication-related Risks
Authors: Kelly John F. , Bergman Brandon G.
Published: October 2020

The concept of “recovery” from alcohol use disorders (AUD) has garnered increasing scientific interest in recent years including attempts to explicate and measure its presumed component parts. In general, there is consensus that “recovery” should not be solely about abstinence or quantity-frequency measures of alcohol consumption and should include measures of functioning. Some researchers have taken an even more radical step, however, to suggest that psychosocial functioning should be the sine qua non defining feature of “recovery,” seemingly irrespective of how much one drinks; as such, people can be classified as achieving and maintaining successful “recovery” despite engaging in regular very heavy drinking. This commentary argues against this notion, as it goes beyond existing data and largely ignores the more insidious toxicity-related, as well as acute intoxication-related, health risks, known to occur with heavy alcohol exposure that contradict the salubrious intent of the “recovery” construct. Furthermore, classifying someone as being in successful “recovery” due to high functioning but while engaging in very heavy drinking, ignores the potential collateral damage to close significant others (eg, children, partners), whose well-being can be severely impacted by the enduring unpredictability of heavy use. Finally, it is argued that exclusive championing of “functioning,” while paying little if any attention to AUD remission or alcohol exposure status, creates a conceptual conundrum whereby someone with low functioning but who is in long-term AUD remission or completely abstinent could be classified as not achieving “recovery,” holding such individuals to a higher standard and may be stigmatizing.
Electroencephalographic Alpha and Delta Oscillation Dynamics in Response to Increasing Doses of Propofol
Authors: Gutiérrez Rodrigo , Maldonado Felipe , Egaña Jose I. , Penna Antonello
Published: October 2020

Background:

The electroencephalogram (EEG) may be useful for monitoring anesthetic depth and avoiding overdose. We aimed to characterize EEG-recorded brain oscillations during increasing depth of anesthesia in a real-life surgical scenario. We hypothesized that alpha power and coherency will diminish as propofol dose increases between loss of consciousness (LOC) and an EEG burst suppression (BS) pattern.

Methods:

This nonrandomized dose-response clinical trial with concurrent control included EEG monitoring in 16 patients receiving slowly increasing doses of propofol. We assessed 3 intraoperative EEG segments (LOC, middle-dose, and BS) with spectral analysis.

Results:

Alpha band power diminished with each step increase in propofol dose. Average alpha power and average delta power during the BS step (−1.4±3.8 and 6.2±3.1 dB, respectively) were significantly lower than during the LOC step (2.8±2.6; P=0.004 and 10.1±5.2 dB; P=0.03, respectively). Peak alpha power was significantly higher during the LOC (5.4±2.6 dB) compared with middle-dose (2.6±3.6; P=0.04) and BS (0.7±3.2; P=0.0002) steps. In addition, as propofol dose increased, alpha band coherence between the F7 and F8 electrodes decreased, whereas delta band coherence exhibited a biphasic response (initial increase between LOC and middle-dose steps and decrease between middle-dose and BS steps).

Conclusion:

We report compelling data regarding EEG patterns associated with increases in propofol dose. This information may more accurately define “therapeutic windows” for anesthesia and provide insights into brain dynamics that are sequentially affected by increased anesthetic doses.
Utility of a Computer-assisted Rod Bending System to Avoid Pull-out and Loosening of Percutaneous Pedicle Screws
Authors: Ohba Tetsuro , Ebata Shigeto , Oda Kotaro , Tanaka Nobuki , Haro Hirotaka
Published: October 2020

Study Design:

This was a retrospective observational study of a cohort of consecutive patients.

Objective:

To compare the influence of (1) manual and (2) computer-assisted (CA) rod bending techniques on pedicle screw pull-out resulting in loosening during rod reduction and final tightening.

Summary of Background Data:

Our recent study showed screw pull-out during rod reduction might be a risk factor for loosening of percutaneous pedicle screws (PPSs) postoperatively, resulting in worse postoperative back pain. We retrospectively analyzed data from 53 consecutive patients who underwent minimally invasive lumbar or thoracic spinal stabilization using intraoperative computed tomography image (CT)-guided navigation with conventional manual rod bending or CA rod bending and were followed up for 1 year.

Method:

Screw pull-out length was measured on axial CT images obtained immediately after screw insertion and postoperatively. Loosening of screws and clinical outcome were evaluated radiographically, clinically, and by CT 1 year after surgery. The frequencies of screw pull-out and screw loosening between the 2 rod bending techniques were compared. Lumbar pain-related factors for both groups of patients were determined preoperatively and 1 year after surgery.

Results:

Overall, 360 pedicle screws were placed in the manual group and 124 pedicle screws were placed in the CA group. There was no significant difference in the mean age, sex, bone mineral density, mean stabilized length, or smoking habits of patients between the groups. The diameters, lengths, and trajectory angle (axial and sagittal) of the screws placed were not significantly different between the groups. Screw pull-out rate/length and loosening in the CA group was significantly lower than that in the manual group. Postoperative low back pain improved significantly in the CA group compared with that in the manual group.

Conclusion:

CA bending is useful to avoid PPS pull-out during rod reduction and screw loosening postoperatively. CA bending is useful to avoid PPS pull-out during rod reduction and screw loosening postoperatively. This result might have been a factor leading to reduced postoperative back pain in the CA group, however, that future studies are need to investigate this association.
Impact of Preload on Right Ventricular Hemodynamics in Acute Pulmonary Embolism
Authors: Mortensen Christian S. , Kramer Anders , Schultz Jacob , Lyhne Mads D. , Nielsen-Kudsk Jens Erik , Andersen Asger
Published: October 2020

Objectives:

To compare the hemodynamic effects of increased versus decreased preload in a porcine model of acute intermediate-risk pulmonary embolism.

Design:

Randomized, controlled animal study.

Setting:

Tertiary medical center, animal research laboratory.

Subjects:

Female, Danish slaughter pigs (n = 22, ~ 60 kg).

Interventions:

Acute pulmonary embolism was induced by large emboli made from clotting of autologous blood. Sixteen animals were randomized to either fluid loading (n = 8, isotonic saline, 1 L/hr for 2 hr) or diuretic treatment (n = 8, furosemide, 40 mg every 30 min, total 160 mg) and compared with a vehicle group (n = 6, no treatment).

Measurements and Main Results:

Hemodynamics were evaluated at baseline, after pulmonary embolism and after each dose by biventricular pressure-volume loops, invasive pressures, diuretic output, respiratory variables, and blood analysis. Pulmonary embolism increased mean pulmonary arterial pressure (p < 0.0001), pulmonary vascular resistance (p = 0.008), right ventricular arterial elastance (p = 0.003), and right ventricular end-systolic volume (p = 0.020) while right ventricular stroke volume and right ventricular ejection fraction were decreased (p = 0.047 and p = 0.0003, respectively) compared with baseline. Fluid loading increased right ventricular end-diastolic volume (+31 ± 13 mL; p = 0.004), right ventricular stroke volume (+23 ± 10 mL; p = 0.009), cardiac output (+2,021 ± 956 mL; p = 0.002), and right ventricular ejection fraction (+7.6% ± 1.5%; p = 0.032), whereas pulmonary vascular resistance decreased (–202 ± 65 dynes; p = 0.020) compared with vehicle. Diuretic treatment decreased right ventricular end-diastolic volume (–84 ± 11 mL; p < 0.001), right ventricular stroke volume (–40 ± 6 mL; p = 0.001), cardiac output (–3,327 ± 451 mL; p = 0.005), and mean pulmonary arterial pressure (–7 ± 1 mm Hg; p < 0.001) and increased right ventricular end-systolic elastance (+0.72 ± 0.2 mm Hg/mL; p < 0.001) and systemic vascular resistance (+1,812 ± 767 dynes; p < 0.001) with no effects on mean arterial pressure.

Conclusions:

In a porcine model of acute intermediate-risk pulmonary embolism, fluid loading increased right ventricular preload and right ventricular stroke volume, whereas diuretics decreased right ventricular preload and right ventricular stroke volume without affecting mean arterial pressure.
Prediction Models for Physical, Cognitive, and Mental Health Impairments After Critical Illness: A Systematic Review and Critical Appraisal
Authors: Haines Kimberley J. , Hibbert Elizabeth , McPeake Joanne , Anderson Brian J. , Bienvenu Oscar Joseph , Andrews Adair , Brummel Nathan E. , Ferrante Lauren E. , Hopkins Ramona O. , Hough Catherine L. , Jackson James , Mikkelsen Mark E. , Leggett Nina , Montgomery-Yates Ashley , Needham Dale M. , Sevin Carla M. , Skidmore Becky , Still Mary , van Smeden Maarten , Collins Gary S. , Harhay Michael O.
Published: October 2020

Objectives:

Improved ability to predict impairments after critical illness could guide clinical decision-making, inform trial enrollment, and facilitate comprehensive patient recovery. A systematic review of the literature was conducted to investigate whether physical, cognitive, and mental health impairments could be predicted in adult survivors of critical illness.

Data Sources:

A systematic search of PubMed and the Cochrane Library (Prospective Register of Systematic Reviews ID: CRD42018117255) was undertaken on December 8, 2018, and the final searches updated on January 20, 2019.

Study Selection:

Four independent reviewers assessed titles and abstracts against study eligibility criteria. Studies were eligible if a prediction model was developed, validated, or updated for impairments after critical illness in adult patients. Discrepancies were resolved by consensus or an independent adjudicator.

Data Extraction:

Data on study characteristics, timing of outcome measurement, candidate predictors, and analytic strategies used were extracted. Risk of bias was assessed using the Prediction model Risk Of Bias Assessment Tool.

Data Synthesis:

Of 8,549 screened studies, three studies met inclusion. All three studies focused on the development of a prediction model to predict (1) a mental health composite outcome at 3 months post discharge, (2) return-to-pre-ICU functioning and residence at 6 months post discharge, and (3) physical function 2 months post discharge. Only one model had been externally validated. All studies had a high risk of bias, primarily due to the sample size, and statistical methods used to develop and select the predictors for the prediction published model.

Conclusions:

We only found three studies that developed a prediction model of any post-ICU impairment. There are several opportunities for improvement for future prediction model development, including the use of standardized outcomes and time horizons, and improved study design and statistical methodology.
Long-Term Sustainability and Acceptance of Antimicrobial Stewardship in Intensive Care: A Retrospective Cohort Study*
Authors: Sehgal Prateek , Elligsen Marion , Lo Jennifer , Lam Philip W. , Leis Jerome A. , Fowler Rob , Pinto Ruxandra , Daneman Nick
Published: October 2020

OBJECTIVES:

To evaluate long-term uptake of an antimicrobial stewardship audit-and-feedback program along with potential predictors of stewardship suggestions and acceptance across a diverse ICU population.

DESIGN:

A retrospective cohort study.

SETTING:

An urban, academic medical institution.

PATIENTS:

Patients admitted to an ICU who received an antimicrobial stewardship program suggestion between June 2010 and September 2019.

INTERVENTION:

None.

MEASUREMENTS AND MAIN RESULTS:

The antimicrobial stewardship program provided 7,749 antibiotic assessments over the study period and made a suggestion to alter therapy in 2,826 (36%). Factors associated with a higher likelihood of receiving a suggestion to alter therapy included shorter hospital length of stay prior to antimicrobial stewardship program review (odds ratio 1.15 for ≤ 5 d; 95% CI 1.00–1.32), admission to cardiovascular (1.37; 1.06–1.76) or burn surgery (1.88; 1.50–2.36) versus general medicine, and preceding duration of antibiotic use greater than 5 days (1.33; 1.10–1.60). Assessment of aminoglycosides (2.91; 1.85–4.89), carbapenems (1.93; 1.54–2.41), and vancomycin (2.71; 2.19–3.36) versus ceftriaxone was more likely to result in suggestions to alter therapy. The suggestion acceptance rate was 67% (1,895/2,826), which was stable throughout the study period. Admission to a level 3 ICU was associated with higher likelihood of acceptance of suggestions (1.50; 1.14–1.97). Factors associated with lower acceptance rates were admission to burn surgery (0.64; 0.45–0.91), treatment of pneumonia (0.64; 0.42–0.97 for community-acquired and 0.65; 0.44–0.94 for ventilator-acquired), unknown source of infection (0.66; 0.48–0.92), and suggestion types of “narrow spectrum” (0.65; 0.45–0.94), “change formulation of antibiotic” (0.42; 0.27–0.64), or “change agent of therapy” (0.63; 0.40–0.97) versus “change of dose”.

CONCLUSIONS:

An antimicrobial stewardship program implemented over a decade resulted in sustained suggestion and acceptance rates. These findings support the need for a persistent presence of audit-and-feedback over time with more frequent suggestions to alter potentially nephrotoxic agents, increased efforts toward specialized care units, and further work approaching infectious sources that are typically treated without pathogen confirmation and identification.
A multi-center investigation of breast-conserving surgery based on data from the Chinese Society of Breast Surgery (CSBrS-005)
Authors: Yu Li-Xiang , Shi Peng , Tian Xing-Song , Yu Zhi-Gang
Published: October 2020

Background:

Although breast-conserving surgery is one of the standard treatments for breast cancer, few studies have assessed its recent implementation in China. We aimed to clarify the current real-world status of breast-conserving surgery in China.

Methods:

This cross-sectional survey relied on data collected by the Chinese Society of Breast Surgery (CSBrS) to examine patients who underwent this surgery between January 2018 and December 2018. The survey was conducted using a uniform electronic questionnaire to collect information, including clinical and pathological data on these patients.

Results:

Overall, 4459 breast-conserving surgeries were performed in 34 member units of CSBrS, accounting for 14.6% of all breast cancer surgeries performed in these units during the study period. In patients who underwent breast-conserving surgery with information on tumor size available, more than half (61.2%) of the tumors were smaller than 2 cm in diameter, and only 87 (3.2%) tumors were larger than 4 cm in diameter. Among patients who underwent breast-conserving surgeries, 457 (10.2%) patients received neoadjuvant therapy before the surgery. Among patients with a reported margin width, 34 (2.0%) patients had a margin of ≤2 mm, and 1530 (88.2%) of them had a margin of >5 mm.

Conclusions:

This study demonstrated the rates of breast-conserving surgery in member units of the CSBrS, and introduced the characteristics and surgical margins of patients who underwent this surgery. This information helps describe the real-world status of breast-conserving surgery in China.

Trial registration

chictr.org.cn, ChiCTR1900026841; http://www.chictr.org.cn/showproj.aspx?proj=42783
Health anxiety among adults with congenital heart disease
Authors: Roseman Alexandra , Morton Liza , Kovacs Adrienne H.
Published: October 2020

Purpose of review

Adults with congenital heart disease (CHD) may experience anxiety specifically related to their medical condition. This review introduces the concepts of health anxiety and heart-focused anxiety, summarizes what is currently known about heart-focused anxiety among adults with CHD and offers suggestions to help adult CHD providers address heart-focused anxiety in their patients.

Recent findings

Although minimal research has been conducted specific to this outcome, health anxiety may occur at any point across the lifespan of individuals with CHD. A recent study found that children and adolescents with CHD reported greater health anxiety than community peers. Health anxiety was commonly reported among adults with CHD presenting for psychological assessment. It was linked with older age, trait anxiety, perceived parental overprotection and greater CHD complexity in one study.

Adults with CHD face many potential health-related stressors, including cardiac symptoms, treatments and interventions throughout the lifespan (including surgeries and other invasive procedures), the impact of CHD on daily lives and longer-term health expectations. Providers should be aware that heart-focused anxiety among patients is understandable and perhaps common. Patient-centred education and psychological intervention should be integrated within a comprehensive approach to long-term disease management.
Evaluation of Emotional Adverse Effects of Antidepressants
Authors: Aşçibaşi Kadir , Çökmüş Fikret Poyraz , Dikici Didem Sücüllüoğlu , Özkan Hüseyin Murat , Alçi Deniz , Altunsoy Neslihan , Kuru Erkan , Yüzeren Serra , Aydemir Ömer
Published: October 2020

Purpose/Background

Emotional adverse effects due to antidepressant use may cause difficulties for the clinician in the treatment of depression. In this prospective study, the emotional adverse effects of antidepressants were evaluated in various aspects.

Methods/Procedures

Ninety eight patients diagnosed with major depressive disorder were included in the study. At 2nd, 4th, 8th, 12th, and 16th weeks, patients were assessed with Montgomery-Asberg Depression Rating Scale (MADRS), and the antidepressant dose was increased in patients with less than a 50% reduction at each visit compared with the initial MADRS score. The Oxford Questionnaire on the Emotional Side-effects of Antidepressants (OQESA) was used at the 8th-week and 16th-week visits.

Findings/Results

A significant difference is found in the OQESA score at the 8th-week visit compared with the 16th-week assessment (P < 0.001, t = 5.73). There were significant correlations between MADRS scores and OQESA scores both at the 8th (r = 0.346, P = 0.05) and the 16th (r = 0.490, P < 0.001) weeks. In regression analyses, at eighth-week assessment, MADRS score (B = 1.487, P = 0.002) and selective serotonin reuptake inhibitor use (B = 14.014, P = 0.023) had a significantly predicted OQESA score.

Implications/Conclusions

In this study, it is found that, as the rate of remitted patients is increased, OQESA scores get decreased, and furthermore, the OQESA score of the remitted group is statistically low when compared with that of the nonremitted group at the 8th- and 16th-week visits. Oxford Questionnaire on the Emotional Side-effects of Antidepressants and MADRS scores are significantly correlated in all assessments. These results suggest that the score obtained from OQESA may be related not only to the emotional adverse effects of antidepressants but also to the residual symptoms of depression.
Alternate Light Source Findings of Common Topical Cosmetics and Three Removal Methods
Authors: Anderson Jocelyn C. , Pollitt Erin N. , Schildbach Caroline , MacDonald Ryan , Rose Lauren , Sheridan Daniel J.
Published: October 2020

Introduction

Alternate light sources (ALSs) are a tool used by forensic nurses to aid in the physical examination of patients. Prior research has shown some topical makeup products absorb alternate light similar to the absorption noted in bruises. Therefore, the purposes of this study were (a) to further examine the ALS findings of multiple brands and types of makeup products and (b) to compare the efficacy of three methods of makeup removal.

Methods

Fourteen makeup products were applied to the forearms of 100 healthy adult volunteers with varying skin tones and then assessed under white light, six alternate light wavelengths, and three color filters, producing 19 total wavelength-and-filter combinations. The results were recorded before and after removal procedures by forensic nurse examiners who were blinded to the removal method. A three-arm randomized controlled trial of makeup removal methods (soap and water, isopropyl alcohol swab, makeup removal wipe) was conducted with the participants.

Results

All 14 makeup products produced absorption in at least 10% of the observations. Fluorescence was observed in more than 10% of the observations for only two products. After product removal, four products continued to produce statistically significant absorption findings when viewed under an ALS. One product produced significant fluorescence after removal procedures. There were no statistically significant differences between the removal methods noted in any of these analyses.

Conclusion

Our findings support the importance of using alternate light as one component of a comprehensive forensic examination, including history taking and physical examination.
Mobile Extracorporeal Membrane Oxygenation
Authors: Corno Antonio F. , Faulkner Gail M. , Harvey Chris
Published: October 2020

To review our experience with mobile extracorporeal membrane oxygenation (ECMO). Mobile ECMO team included: ECMO-trained surgeon and intensivist, specialist nurse, and perfusionist. Patients were cannulated for venous-arterial (V-A) or venous-venous (V-V) ECMO, depending on clinical indication. Mobile transfers were carried out utilizing a Levitronics Centrimag centrifugal pump and Hico Variotherm 555 heater cooler. From October 2009 to May 2019, 571 patients, 185 (32%) neonates, 95 (17%) pediatric, and 291 (51%) adults, underwent mobile ECMO transfer. Four hundred fifty-three (79%) transfers were completed by road, 76 (13%) by air, and 42 (8%) by road/air combination. Road was the travel mode of choice for journeys with expected duration up to 3 hours one way. Nevertheless, road transfers up to 6 hours duration were performed safely. Average duration of mobile ECMO transfer was 5.5 hours (2–18 hours). Two patients died before arrival of mobile ECMO team, four patients were cannulated during cardio-pulmonary resuscitation, and one of them died of uncontrollable hemorrhage in the right hemithorax. One patient had cardiac arrest after V-V cannulation and required conversion to V-A. Mobile ECMO is safe and reliable to transfer the sickest of patients. Fully trained team with all equipment and disposables is indispensable for reliable mobile ECMO service.
The association of diabetes mellitus with neointimal formation following deployment of second-generation drug-eluting stents: an optical coherence tomographic study
Authors: Cai Jin-Zan , Lu Wen-Qi , Xu Chen , Gu Jue , You Wei , Xu Tian , Gogas Bill D. , Jia Hai-Bo , Ye Fei
Published: October 2020

Objectives

The purpose of this study was to evaluate the association of diabetes mellitus (DM) with neointimal formation after implantation of second-generation drug-eluting stent (DES) visualized by optical coherence tomography (OCT).

Methods

Patients with single de novo coronary artery disease treated with second-generation DES between June 2014 and June 2017 in our department underwent OCT examination at 1-year follow-up and were enrolled in this retrospective study. The primary end point was in-stent mean neointimal thickness (MNT), and secondary end points included uncovered stent strut, minimal lumen area (MLA), neointimal burden, neointimal hyperplasia (NIH) patterns and stent thrombosis (ST) after 1 year of OCT follow-up.

Results

A total of 68 patents with DM (DM group) and 216 patients without DM (non-DM group) were enrolled. At 1-year follow-up, the DM group compared with the non-DM group, showed: MNT [160 (85–245) μm vs. 120 (60–220) μm, P = 0.038] and neointimal burden [21.4 (8.3–30.1)% vs. 14.0 (5.7–26.1)%, P = 0.023] to be significantly increased. Concurrently, MLA [4.60 (3.53–6.06) mm vs. 5.76 (4.28–7.20) mm2, P = 0. 0.002] was significantly reduced. Interestingly, the degree of uncovered struts (7.3 ± 7.1% vs. 7.7 ± 6.7%, P = 0.704), NIH patterns (P = 0.984), and ST (7.9% vs. 7.4%, P = 0.88) were comparable between the two groups. After propensity score matching, the MNT [160 (90–240) μm vs. 110 (60–220) μm, P = 0.048] and neointimal burden [21.4 (8.3–30.1)% vs. 15.4 (5.6–26.3)%, P = 0.044] remained significantly different in the DM compared to the non-DM group.

Conclusion

DM leads to significant increase in MNT and neointimal burden even with second-generation DES, nevertheless stent strut coverage, ST and NIH characteristics remained comparable among the cohorts at 1-year.
Avoiding the emergence of contrast-induced acute kidney injury in acute coronary syndrome: routine hydration treatment
Authors: Arslan Sukru , Yildiz Ahmet , Dalgic Yalcin , Batit Servet , Kilicarslan Onur , Ser Ozgur Selim , Dalgic Sadiye Nur , Kocas Cuneyt , Abaci Okay
Published: October 2020

Background:

Patients with acute coronary syndrome (ACS) have about a three-fold risk for developing contrast-induced acute kidney injury(CI-AKI). Investigating studies on routine hydration therapy have frequently included patients with stable coronary artery disease and high risk of CI-AKI [estimated glomerular filtration rate (eGFR) < 60 ml/min]. However, data on routine hydration treatment in non-ST segment elevation myocardial infarction (NSTEMI) patients with eGFR ≥60 ml/min are insufficient. We aimed to investigate the association between routine hydration therapy and CI-AKI development in NSTEMI patients at low risk for nephropathy.

Methods and results:

We randomly assigned a total of 401 NSTEMI patients to two groups: the routine hydration group (198 patients) and the nonhydration group (control group) (203 patients). Intravenous hydration with isotonic saline (1 ml/kg/h, 0.9% sodium chloride) was given for 3–12 h before and 24 h after contrast exposure to the hydration group. CI-AKI was defined as the increase in serum creatinine values 0.5 mg/dl or 25% between 48 and 72 h after the invasive procedures. In our study, the incidence of CI-AKI development in the routine hydration group (7.1%) was significantly lower than in the nonhydration group (14.1%) (P: 0.02). This study revealed that older age, amount of contrast media, and routine hydration were independent risk factors for developing CI-AKI (P < 0.01, P: 0.04, P < 0.01, respectively).

Conclusion:

We found that preprocedural and postprocedural intravenous hydration therapy reduces the development of CI-AKI in patients with NSTEMI at low risk for CI-AKI. We suggest administering routine hydration therapy in all ACS patients regardless of eGFR values.
Acute cardiorenal anemia syndrome among ST-elevation myocardial infarction patients treated by primary percutaneous intervention
Authors: Merdler Ilan , Loewenstein Itamar , Zahler David , Levit Dana , Hochstadt Aviram , Banai Shmuel , Gal-Oz Amir , Shacham Yacov
Published: October 2020

Background

Acute kidney injury (AKI) and anemia have been extensively studied in ST-elevation myocardial infarction (STEMI), yet the precise nature of their reciprocal relationship has not been elucidated in STEMI patients.

Methods

We performed a retrospective analysis of 2096 consecutive patients admitted for STEMI between January 2008 and December 2018 and treated with primary coronary intervention. Patients were stratified into four groups according to the presence of baseline anemia and occurrence of AKI: without anemia or AKI, baseline anemia without AKI, AKI without baseline anemia and acute cardiorenal anemia syndrome (CRAS), defined as the occurrence of AKI in patients with baseline anemia. Patients’ medical records were reviewed for in-hospital complications, 30-day and long-term mortality.

Results

The mean age was 61 ± 13 years and 1682 patients (80%) were men. Ten percent of patients had baseline anemia without AKI, 7% had AKI without baseline anemia and 3% were classified as CRAS. We found increments between the four groups for occurrence of new onset atrial fibrillation and heart failure rates, presence of a critical state, and both 30-day and long-term mortality (P < 0.001 for all). Logistic regression models demonstrated that as compared to AKI alone, CRAS was associated with a higher risk for long-term mortality (HR 10.49; 95% CI 6.5–17.1) as compared to anemia (HR 3.32, 95% CI 2.1–5.2) and AKI (HR 7.71, 95% CI 5.1–11.7) alone (P < 0.001 for all).

Conclusions

Among STEMI patients, the interaction between anemia and AKI is associated with worse short and long-term outcomes and reflects the reciprocity of cardiac and renal exacerbations.
Correlation between aortic root dimension and coronary ectasia
Authors: Ghetti Gabriele , Taglieri Nevio , Donati Francesco , Minnucci Matteo , Bruno Antonio Giulio , Palmerini Tullio , Saia Francesco , Marrozzini Cinzia , Galié Nazzareno
Published: October 2020

Background

Aortic aneurysms are associated with coronary artery ectasia (CAE). However, the relation between the extent of CAE and the severity of aortic dilatation is not understood. This study was undertaken to investigate the relationship between angiographic extension of CAE and aortic dimension.

Patients and methods

We retrospectively include 135 patients with angiographic diagnosis of CAE defined as dilatation of coronary segment more than 1.5 times than an adjacent healthy one. Study population was divided in four groups according to the maximum diameter of ascending aorta beyond sinus of Valsalva obtained in the parasternal long-axis view (group 1: <40 mm; group 2: 40–45 mm; group 3: 45–55 mm; group 4: >55 mm or previous surgery because of aortic aneurysm/dissection). The relationship between aortic dimension and the extension of CAE was investigated by means of multivariable linear regression, including variables selected at univariable analysis (P < 0.1). The total estimated ectatic area (EEA total) was used as dependent variable.

Results

Baseline characteristics of study groups were well balanced. Patients in group 4 were more likely to have both higher neutrophil count and neutrophil to lymphocyte ratio. On univariable analysis ascending aorta diameter [Coef. = 0.075; 95% confidence interval (CI) 0.052–0.103, P < 0.01] and c-reactive protein (CRP) values [Coef. = 0.033, 95% CI 0.003–0.174, P = 0.04] showed a linear association with total EEA. After adjustment for CRP values only the ascending aorta diameter was still associated with the extent of CAE (95% CI 0.025–0.063, P < 0.01).

Conclusion

In patients with diagnosis of CAE, a strong linear association between aortic dimension and coronary ectasia extent exists.
Higher Maintenance Adalimumab Trough Levels are Associated With Achievement of Advanced Remission Targets in Patients With Inflammatory Bowel Disease
Authors: Ritter Einat , Hirsch Ayal , Isakov Naomi F. , Ron Yulia , Cohen Nathaniel A. , Maharshak Nitsan
Published: October 2020

Background:

Biomarker normalization and endoscopic remission are superior to clinical remission in achieving improved long-term clinical outcomes in patients with inflammatory bowel diseases.

Goal:

To study whether higher maintenance adalimumab levels are associated with clinical remission, biomarker normalization, and endoscopic remission.

Study:

Data were collected retrospectively from the patients’ medical records. We defined clinical remission as a Harvey Bradshaw Index ≤5 or a partial Mayo score ≤2 for Crohn’s disease (CD) and ulcerative colitis (UC), respectively, biomarker normalization as a C-reactive protein <0.5 mg/dL and/or calprotectin <250 (mg/kg), endoscopic remission as a (simple endoscopic score-CD) ≤3/4 for ileal/extensive CD, respectively, or an endoscopic Mayo score ≤1 for UC, and deep remission as the combination of clinical and endoscopic remission with normal biomarkers.

Results:

Ninety-seven patients were included (82 CD and 15 UC). Patients who achieved clinical remission, biomarker normalization, or endoscopic remission had higher serum trough adalimumab levels compared with patients not in remission [mean (M)±standard error (SE)=8.98±0.78 vs. 5.92±0.96 μg/mL; P=0.016, 9.38±0.85 vs. 5.48±0.87 μg/mL; P=0.002; 9.13±0.88 vs. 6.02±0.77 μg/mL; P=0.019, respectively]. Receiver-operating curve analysis showed that an adalimumab level of ≥8.25 μg/mL was associated with deep remission (sensitivity 84%, specificity 70%, area under the curve 0.775; P<0.001).

Conclusion:

Clinical remission, biomarker normalization, and endoscopic remission are positively associated with adalimumab trough levels. Adalimumab level of ≥8.25 μg/mL is associated with deep remission. This study provides additional data to guide therapeutic drug monitoring with adalimumab.
Infection Control Practices and Outcomes of Endoscopy Units in the Lombardy Region of Italy
Authors: Capurso Gabriele , Archibugi Livia , Vanella Giuseppe , Testoni Sabrina G.G. , Petrone Maria C. , Fanti Lorella , Greco Salvatore , Cavenati Sergio , Gaffuri Nicola , Lella Fausto , Pace Fabio , Cengia Gianpaolo , Spada Cristiano , Lovera Mauro , Missale Guido , Rosato Stenio , Radaelli Franco , Buscarini Elisabetta , Parente Fabrizio , Pilati Stefano , Luigiano Carmelo , Passoni Giovanni R. , Salerno Raffaele , Bargiggia Stefano , Penagini Roberto , Cantù Paolo , Fregoni Fiorenza , Giannetti Aurora , Devani Massimo , Manes Gianpiero , Fiori Giancarla , Fontana Paola , Gambitta Pietro , Masci Enzo , Mutignani Massimiliano , Gatti Mario , Canani Marcella B. , Vailati Cristian , Dinelli Marco Emilio , Marzo Vincenza , Alvisi Costanza , Caramia Vitantonio , Di Sabatino Antonio , Mauro Aurelio , De Grazia Federico , Balzarini Marco , Segato Sergio , Nella Giovanni A. , Giannini Patrizia , Leoni Piera , Testoni Pier A. , Mariani Alberto , Arcidiacono Paolo G.
Published: October 2020

Goals:

The present survey from the Italian Society of Digestive Endoscopy (SIED—Società Italiana di Endoscopia Digestiva) was aimed at reporting infection control practice and outcomes at Digestive Endoscopy Units in a high-incidence area.

Background:

Lombardy was the Italian region with the highest coronavirus disease-2019 (COVID-19) prevalence, at the end of March 2020 accounting for 20% of all worldwide deaths. Joint Gastro-Intestinal societies released recommendations for Endoscopy Units to reduce the risk of the contagion. However, there are few data from high-prevalence areas on adherence to these recommendations and on their efficacy.

Methods:

A survey was designed by the Lombardy section of SIED to analyze (a) changes in activity and organization, (b) adherence to recommendations, (c) rate of health care professionals’ (HCP) infection during the COVID-19 outbreak.

Results:

In total, 35/61 invited centers (57.4%) participated; most modified activities were according to recommendations and had filtering face piece 2/filtering face piece 3 and water-repellent gowns available, but few had negative-pressure rooms or provided telephonic follow-up; 15% of HCPs called in sick and 6% had confirmed COVID-19. There was a trend (P=0.07) toward different confirmed COVID-19 rates among endoscopists (7.9%), nurses (6.6%), intermediate-care technicians (3.4%), and administrative personnel (2.2%). There was no correlation between the rate of sick HCPs and COVID-19 incidence in the provinces and personal protective equipment availability and use, whereas an inverse correlation with hospital volume was found.

Conclusions:

Adherence to recommendations was rather good, though a minority were able to follow all recommendations. Confirmed COVID-19 seemed higher among endoscopists and nurses, suggesting that activities in the endoscopy rooms are at considerable viral spread risk.