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JNMA; Journal of the Nepal Medical... Dec 2022Dynamic Hip Screw fixation has shown to be equally effective compared to cephalomedullary nailing. The effectiveness of dynamic hip screw fixation for pertrochanteric...
INTRODUCTION
Dynamic Hip Screw fixation has shown to be equally effective compared to cephalomedullary nailing. The effectiveness of dynamic hip screw fixation for pertrochanteric fractures without using traction table is not well investigated. This study aimed to find out the mean tip apex distance in patients undergoing dynamic hip screw fixation for pertrochanteric fractures without using traction table.
METHODS
A descriptive cross-sectional study was conducted among patients undergoing dynamic hip screw fixation for pertrochanteric fractures without using traction table between 1 September 2021 and 30 June 2022, after getting approval from institutional review committee (Reference number: IRC-2021-08-23-02). All patients undergoing dynamic hip screw fixation for pertrochanteric fractures without using traction table were included in the study. Patients with pre-existing ipsilateral or contralateral hip deformity, contra-lateral hip prosthesis, bilateral hip fractures, and history of prior ipsilateral hip surgeries were excluded. Point estimate and 95% confidence interval were calculated.
RESULTS
Among 45 patients, the mean tip apex distance was 20.45±6.13 mm (18.66-22.24 mm, 95% Confidence Interval). Among 45 patients, 24 (53.33%) were males and 21 (46.66%) were females. The average age of the participants was 67.75±21.33 years.
CONCLUSIONS
The mean tip apex distance in patients undergoing dynamic hip Screw fixation for pertrochanteric fractures without using traction table was similar to that reported in other international studies.
KEYWORDS
fracture fixation; hip fractures; operating tables.
Topics: Male; Female; Humans; Middle Aged; Aged; Aged, 80 and over; Cross-Sectional Studies; Traction; Bone Screws; Femoral Fractures; Hip Fractures; Bone Nails; Retrospective Studies
PubMed: 36705110
DOI: 10.31729/jnma.7766 -
BMC Anesthesiology Jan 2023The present study aimed to evaluate whether the operating table height affected the success rate and incidences of complications of combined spinal-epidural anesthesia... (Randomized Controlled Trial)
Randomized Controlled Trial
The height of the operating table affects the performance of residents in combined spinal and epidural anesthesia training by affecting the vision of the puncture needle: a randomized controlled trial.
BACKGROUND
The present study aimed to evaluate whether the operating table height affected the success rate and incidences of complications of combined spinal-epidural anesthesia administered by residents during training.
METHODS
One-hundred-and-eighty patients were randomly allocated according to landmarks on the resident's body: umbilicus (group U), lowest rib margin (R), and xiphoid process (X). The success rates of combined spinal-epidural anesthesia, and the incidences of paresthesia and vessel trauma were recorded.
RESULTS
There were no differences between the three groups in the success rates of combined spinal-epidural anesthesia, and the incidences of paresthesia and vessel trauma. However, paresthesia during epidural catheter advancement was more common on the left side (66.7%) than the right side (33.3%) (P = 0.03). In group R, the success rate of epidural anesthesia was higher during the residents' third time (100%) than their first time (50%; P = 0.01). Most residents (83%) preferred the table height at which the needle insertion point was at the level of their lowest rib margin.
CONCLUSIONS
Neither the success nor the complication of combined spinal-epidural anesthesia in lateral decubitus position during residents' training affected by the operating table height. However, paresthesia was more likely to occur on the left side when a stiff catheter was inserted into the epidural space. It may be better to keep the table height at residents' lowest rib margin. It was not just preferred by most of residents but also better for their training of performing epidural anesthesia.
TRIAL REGISTRATION
The trial was registered prior to patient enrollment at Chinese Clinical Trial Registry (NCT: ChiCTR1800016078, Principal investigator: Juan Gu, Date of registration: 9 May 2018). Registry URL http://www.chictr.org.cn.
Topics: Humans; Paresthesia; Operating Tables; Spinal Puncture; Anesthesia, Epidural; Anesthesia, Spinal; Epidural Space
PubMed: 36650434
DOI: 10.1186/s12871-023-01985-6 -
The Lancet. Microbe Feb 2023The elimination of onchocerciasis requires increasing ivermectin treatment coverage in communities hypoendemic for onchocerciasis. In areas where loiasis is co-endemic,...
BACKGROUND
The elimination of onchocerciasis requires increasing ivermectin treatment coverage in communities hypoendemic for onchocerciasis. In areas where loiasis is co-endemic, this approach is complicated by the risk of serious adverse events following treatment with ivermectin in individuals with a high Loa loa microfilarial density (MFD). We aimed to evaluate the extent to which the pre-treatment MFD can be inferred from post-treatment MFDs.
METHODS
For this retrospective analysis, we used data from seven clinical or community trials (six were used for the main analysis and one for the secondary analysis) conducted in Cameroon, in which MFDs were measured both before and after (within 14 days) receiving a single dose of ivermectin (150-200 μg/kg bodyweight). The primary objective was to establish the receiver operating characteristic curves and the corresponding area under the curve statistics of MFD measured after treatment to classify pre-treatment MFD (MFD) according to common risk thresholds of serious adverse events. We assessed the performance of post-treatment MFD to accurately classify MFD according to commonly used thresholds using bootstrap procedures.
FINDINGS
281 individuals with MFD measurements available before and 3-10 days after ivermectin treatment were enrolled. Our results show that an MFD of more than 3500 L loa microfilariae per mL of blood (mf per mL) 3 or 4 days after treatment indicates a 68·6% chance (positive predictive value) of an MFD of more than 20 000 mf per mL. An MFD of more than 3500 mf per mL at day 5-10 corresponds to a 72·2% chance of having an MFD of more than 20 000 mf per mL. Conversely, an MFD of less than 2500 microfilariae per mL at day 3-4 or day 5-10 corresponds to a probability of 92·3% or 92·8% (negative predictive value) of having MFD of less than 20 000 mf per mL. An MFD less than 1500 mf per mL on days 3-4 after treatment was associated with a 78·3% probability of having an MFD less than 8000 mf per mL; this probability increased to 89·6% on days 5-10 after treatment.
INTERPRETATION
The MFD threshold of 1000 mf per mL within 1 month of treatment, which is commonly used to attribute the occurrence of a serious adverse event to ivermectin, should be revised. In this study, we present tables that can help to assess this attributability as part of mass or individual treatments.
FUNDING
None.
Topics: Animals; Humans; Ivermectin; Onchocerciasis; Loa; Microfilariae; Retrospective Studies
PubMed: 36646105
DOI: 10.1016/S2666-5247(22)00331-7 -
Frontiers in Veterinary Science 2022The urgency of preventing the increase of antimicrobial resistance has been emphasized by international authorities such as the World Health Organization, European...
INTRODUCTION
The urgency of preventing the increase of antimicrobial resistance has been emphasized by international authorities such as the World Health Organization, European Medicines Agency, and World Organization for Animal Health. Monitoring systems capable of reporting antimicrobial consumption data are regarded as a crucial pillar of this fight. The Vet-AMNet system was developed to collect and analyze national antimicrobial consumption data in Portuguese dairy farms to support the veterinary authority in stewardship actions and to assist both veterinarians and farmers in daily decisions related to antimicrobials.
METHODS
To evaluate the robustness of the system and other identified critical success factors, it was used to analyze antimicrobial consumption data available from the Dutch dairy cow sector over the period from 2012 to 2020. The data previously used for publications by the Netherlands Veterinary Medicines Institute (SDa) were imported and pre-processed by the Vet-AMNet system according to the SDa's standard operating procedure and the Dutch metrics to measure antimicrobial consumption were calculated.
RESULTS
By comparing the outputs with the figures generated by the system established in the Netherlands, the Portuguese system was validated. Antimicrobial consumption data from the Dutch dairy sector during the 9-year period will be presented in unpublished graphs and tables, where each molecule's pharmaceutical formulation, pharmacotherapeutic group and line of choice will be related and discussed, illustrating the evolution of sectorial antimicrobial consumption against a background of a strong national antimicrobial policy initiated by public-private cooperation and supported by legislation.
PubMed: 36590809
DOI: 10.3389/fvets.2022.984771 -
The Cochrane Database of Systematic... Dec 2022Echocardiogram is the reference standard for the diagnosis of haemodynamically significant patent ductus arteriosus (hsPDA) in preterm infants. A simple blood assay for... (Review)
Review
BACKGROUND
Echocardiogram is the reference standard for the diagnosis of haemodynamically significant patent ductus arteriosus (hsPDA) in preterm infants. A simple blood assay for brain natriuretic peptide (BNP) or amino-terminal pro-B-type natriuretic peptide (NT-proBNP) may be useful in the diagnosis and management of hsPDA, but a summary of the diagnostic accuracy has not been reviewed recently.
OBJECTIVES
Primary objective: To determine the diagnostic accuracy of the cardiac biomarkers BNP and NT-proBNP for diagnosis of haemodynamically significant patent ductus arteriosus (hsPDA) in preterm neonates. Our secondary objectives were: to compare the accuracy of BNP and NT-proBNP; and to explore possible sources of heterogeneity among studies evaluating BNP and NT-proBNP, including type of commercial assay, chronological age of the infant at testing, gestational age at birth, whether used to initiate medical or surgical treatment, test threshold, and criteria of the reference standard (type of echocardiographic parameter used for diagnosis, clinical symptoms or physical signs if data were available).
SEARCH METHODS
We searched the following databases in September 2021: MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Web of Science. We also searched clinical trial registries and conference abstracts. We checked references of included studies and conducted cited reference searches of included studies. We did not apply any language or date restrictions to the electronic searches or use methodological filters, so as to maximise sensitivity.
SELECTION CRITERIA
We included prospective or retrospective, cohort or cross-sectional studies, which evaluated BNP or NT-proBNP (index tests) in preterm infants (participants) with suspected hsPDA (target condition) in comparison with echocardiogram (reference standard).
DATA COLLECTION AND ANALYSIS
Two authors independently screened title/abstracts and full-texts, resolving any inclusion disagreements through discussion or with a third reviewer. We extracted data from included studies to create 2 × 2 tables. Two independent assessors performed quality assessment using the Quality Assessment of Diagnostic-Accuracy Studies-2 (QUADAS 2) tool. We excluded studies that did not report data in sufficient detail to construct 2 × 2 tables, and where this information was not available from the primary investigators. We used bivariate and hierarchical summary receiver operating characteristic (HSROC) random-effects models for meta-analysis and generated summary receiver operating characteristic space (ROC) curves. Since both BNP and NTproBNP are continuous variables, sensitivity and specificity were reported at multiple thresholds. We dealt with the threshold effect by reporting summary ROC curves without summary points.
MAIN RESULTS
We included 34 studies: 13 evaluated BNP and 21 evaluated NT-proBNP in the diagnosis of hsPDA. Studies varied by methodological quality, type of commercial assay, thresholds, age at testing, gestational age and whether the assay was used to initiate medical or surgical therapy. We noted some variability in the definition of hsPDA among the included studies. For BNP, the summary curve is reported in the ROC space (13 studies, 768 infants, low-certainty evidence). The estimated specificities from the ROC curve at fixed values of sensitivities at median (83%), lower and upper quartiles (79% and 92%) were 93.6% (95% confidence interval (CI) 77.8 to 98.4), 95.5% (95% CI 83.6 to 98.9) and 81.1% (95% CI 50.6 to 94.7), respectively. Subgroup comparisons revealed differences by type of assay and better diagnostic accuracy at lower threshold cut-offs (< 250 pg/ml compared to ≥ 250 pg/ml), testing at gestational age < 30 weeks and chronological age at testing at one to three days. Data were insufficient for subgroup analysis of whether the BNP testing was indicated for medical or surgical management of PDA. For NT-proBNP, the summary ROC curve is reported in the ROC space (21 studies, 1459 infants, low-certainty evidence). The estimated specificities from the ROC curve at fixed values of sensitivities at median (92%), lower and upper quartiles (85% and 94%) were 83.6% (95% CI 73.3 to 90.5), 90.6% (95% CI 83.8 to 94.7) and 79.4% (95% CI 67.5 to 87.8), respectively. Subgroup analyses by threshold (< 6000 pg/ml and ≥ 6000 pg/ml) did not reveal any differences. Subgroup analysis by mean gestational age (< 30 weeks vs 30 weeks and above) showed better accuracy with < 30 weeks, and chronological age at testing (days one to three vs over three) showed testing at days one to three had better diagnostic accuracy. Data were insufficient for subgroup analysis of whether the NTproBNP testing was indicated for medical or surgical management of PDA. We performed meta-regression for BNP and NT-proBNP using the covariates: assay type, threshold, mean gestational age and chronological age; none of the covariates significantly affected summary sensitivity and specificity.
AUTHORS' CONCLUSIONS
Low-certainty evidence suggests that BNP and NT-proBNP have moderate accuracy in diagnosing hsPDA and may work best as a triage test to select infants for echocardiography. The studies evaluating the diagnostic accuracy of BNP and NT-proBNP for hsPDA varied considerably by assay characteristics (assay kit and threshold) and infant characteristics (gestational and chronological age); hence, generalisability between centres is not possible. We recommend that BNP or NT-proBNP assays be locally validated for specific populations and outcomes, to initiate therapy or follow response to therapy.
Topics: Humans; Infant; Infant, Newborn; Cross-Sectional Studies; Infant, Premature; Natriuretic Peptide, Brain; Prospective Studies; Retrospective Studies
PubMed: 36478359
DOI: 10.1002/14651858.CD013129.pub2 -
BMC Anesthesiology Dec 2022Previous studies have reported that the ramped position provides a better laryngoscopic view, reduces tracheal intubation time, and increases the success rate of... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Previous studies have reported that the ramped position provides a better laryngoscopic view, reduces tracheal intubation time, and increases the success rate of endotracheal intubation. However, the patient's head height changes while in the ramped position, which in turn changes the relative positions of the patient and intubator. Thus, making these changes may affect the efficiency of tracheal intubation; however, few studies have addressed this problem. This study analyzed intubation time and conditions during tracheal intubation using videolaryngoscope in the ramped position.
METHODS
This prospective study included 144 patients who were scheduled to receive general anesthesia for surgeries involving orotracheal intubation. The participants were randomly allocated to either the nipple or umbilical group according to the table height. Mask ventilation was assessed using the Warters grading scale. Tracheal intubation was performed using a McGrath MAC laryngoscope. The total intubation time, laryngoscopy time, tube insertion time, and difficulty of intubation (IDS score) were measured.
RESULTS
The umbilical group had a significantly shorter laryngoscopy time (10 ± 3 vs. 16 ± 4 s), tube insertion time (18 ± 4 vs. 24 ± 6 s), and total intubation time (28 ± 5 vs. 40 ± 7 s) compared to the nipple group. No significant difference in the difficulty of mask ventilation was observed between the two groups. The IDS score was higher in the nipple than umbilical group.
CONCLUSION
The lower (umbilical) table level reduced the intubation time and difficulty of videolaryngoscopy compared to the higher (nipple) table level.
TRIAL REGISTRATION
This study was registered at KCT0005987, 11/03/2021, Retrospectively registered.
Topics: Humans; Prospective Studies; Intubation, Intratracheal; Operating Tables
PubMed: 36476332
DOI: 10.1186/s12871-022-01929-6 -
Data in Brief Dec 2022Resonant wireless power transfer (WPT) systems have been evolving and improving their designs over the last few years, looking to efficiently charge electric vehicles,...
Resonant wireless power transfer (WPT) systems have been evolving and improving their designs over the last few years, looking to efficiently charge electric vehicles, cellphones, and biomedical devices. In this article, we present to the scientific community the data obtained from the optimization of a resonant WPT prototype, operating at different vertical misalignments and load conditions, known to have an impact on the behavior of these type of systems. To maximize the power transferred to the load, we developed a proportional-integral frequency control algorithm that employs the phase-shift between the voltage and current waveforms in the transmitting antenna (resonance indicator) as a setpoint. Data on the performance and control optimization process of the prototype during laboratory tests were acquired using a LabVIEW interface, which was designed to capture information such as the evolution of the frequency, the phase-shift, and the load voltage, from multiple devices (a microcontroller, an oscilloscope, a digital multimeter, and a controllable power supply). The data were organized and presented in tables and graphs using MATLAB. The importance of the dataset relies on the opportunity to utilize the information as a basis for the improvement of the associated electronics by using different transmission topologies, higher speed components, new-generation microcontrollers, and to modelling novel intelligent control algorithms, such as adaptative neuro-fuzzy inference systems.
PubMed: 36426083
DOI: 10.1016/j.dib.2022.108675 -
Data in Brief Dec 2022The summary data presented in this paper describes beekeeping practices, use of natural resources and economic attributes associated with honey bee products, native...
A survey dataset to better understand the honey bee industry, use and value of natural resources and challenges for beekeepers in Western Australia: A beekeepers' perspective.
The summary data presented in this paper describes beekeeping practices, use of natural resources and economic attributes associated with honey bee products, native flora and environmental challenges relating to apiary sites. Despite being a well-established industry, information and data about productivity and the behavior of beekeepers, particularly those who migrate across the state of Western Australia, is lacking. We developed an online quantitative survey, the Natural Resources for Beekeepers Questionnaire (Western Australia) 2020-21, the first comprehensive, spatially referenced survey of beekeepers in Western Australia since 1990. It is also the first survey of small-scale amateur beekeepers that estimates their supply to the local honey market. For commercial beekeepers, a focus of the survey was to estimate the value of apiary sites and the productivity of migratory beekeepers. The data gives measures related to the production system and profitability of the Western Australian beekeeping industry, focusing on the 2019-2020 season and historical production. It includes tables describing memberships and certification; years beekeeping; hive types; apiary site availability, productivity, use, exchange and value; logistics; pollination services; honey bee products, sales and distribution; yields by season and site; targeted flora and commercial significance; recovery after bush fire and logging; labour details; operating costs; and asset values. The dataset in this paper is a subset of the survey results as aggregated summary statistics, categorized by type of beekeeper (Backyard, Hobbyist-Amateur and Commercial) and across eight regions (IBRA7 - Interim Biogeographic Regionalization for Australia). The online survey questionnaire is provided with this paper. Access to the survey offers the opportunity for reproducibility of a complex online questionnaire in the future and/or for other regions. This dataset will allow a more comprehensive assessment of the implications of natural resource management decisions in the future and the potential for strategic development of the beekeeping industry.
PubMed: 36425993
DOI: 10.1016/j.dib.2022.108639 -
Frontiers in Medicine 2022Artificial Intelligence (AI) holds considerable promise for diagnostics in the field of gastroenterology. This systematic review and meta-analysis aims to assess the...
BACKGROUND
Artificial Intelligence (AI) holds considerable promise for diagnostics in the field of gastroenterology. This systematic review and meta-analysis aims to assess the diagnostic accuracy of AI models compared with the gold standard of experts and histopathology for the diagnosis of various gastrointestinal (GI) luminal pathologies including polyps, neoplasms, and inflammatory bowel disease.
METHODS
We searched PubMed, CINAHL, Wiley Cochrane Library, and Web of Science electronic databases to identify studies assessing the diagnostic performance of AI models for GI luminal pathologies. We extracted binary diagnostic accuracy data and constructed contingency tables to derive the outcomes of interest: sensitivity and specificity. We performed a meta-analysis and hierarchical summary receiver operating characteristic curves (HSROC). The risk of bias was assessed using Quality Assessment for Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Subgroup analyses were conducted based on the type of GI luminal disease, AI model, reference standard, and type of data used for analysis. This study is registered with PROSPERO (CRD42021288360).
FINDINGS
We included 73 studies, of which 31 were externally validated and provided sufficient information for inclusion in the meta-analysis. The overall sensitivity of AI for detecting GI luminal pathologies was 91.9% (95% CI: 89.0-94.1) and specificity was 91.7% (95% CI: 87.4-94.7). Deep learning models (sensitivity: 89.8%, specificity: 91.9%) and ensemble methods (sensitivity: 95.4%, specificity: 90.9%) were the most commonly used models in the included studies. Majority of studies ( = 56, 76.7%) had a high risk of selection bias while 74% ( = 54) studies were low risk on reference standard and 67% ( = 49) were low risk for flow and timing bias.
INTERPRETATION
The review suggests high sensitivity and specificity of AI models for the detection of GI luminal pathologies. There is a need for large, multi-center trials in both high income countries and low- and middle- income countries to assess the performance of these AI models in real clinical settings and its impact on diagnosis and prognosis.
SYSTEMATIC REVIEW REGISTRATION
[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=288360], identifier [CRD42021288360].
PubMed: 36405592
DOI: 10.3389/fmed.2022.1018937 -
Journal of Orthopaedics and... Nov 2022Synovial fluid markers (synovial leukocyte count and differential) have been shown to be most accurate in diagnosing prosthetic joint infection (PJI). An inverse...
BACKGROUND
Synovial fluid markers (synovial leukocyte count and differential) have been shown to be most accurate in diagnosing prosthetic joint infection (PJI). An inverse correlation for synovial leukocyte count and synovial pH is known assuming that leukocyte metabolism causes synovial fluid acidosis. This study's purpose is to analyze the use of synovial pH as a potential diagnostic marker for PJI.
MATERIALS AND METHODS
92 patients who presented with painful total joint arthroplasty (TJA) of the hip (THA; n = 25) or knee (TKA, n = 67) were prospectively investigated. In our cohort 33% (30/92) had PJI and 67% (62/92) were diagnosed non-infected based on the modified Musculoskeletal Infection Society (MSIS) criteria of 2018. Receiver operating curves and the Youden's index were used to define an ideal cut-off value for synovial pH and the sensitivity and specificity were calculated using cross-tables. Additionally, the sensitivity and specificity were calculated for synovial white blood cell (WBC) count (cut-off > 3000 leukocytes) and percentage of neutrophils (PMN%, cut-off > 80%).
RESULTS
The median synovial pH level was significantly lower in the group with chronic PJI compared to implants with aseptic failure (7.09 vs. 7.27; p < 0.001). The calculated optimal cut-off value was 7.11 (AUC 0.771) with a sensitivity of 53% and specificity of 89%. However, the sensitivity and specificity of synovial WBC count were 90% and 88% and for synovial PMN% 73% and 98%, respectively.
CONCLUSION
Synovial pH may be a useful adjunct parameter in the diagnosis of chronic PJI after hip or knee arthroplasty, but showed low sensitivity in this preliminary cohort. Future studies with larger numbers are needed.
LEVEL OF EVIDENCE
2a, diagnostic study. Trial registration German Clinical Trials Register (Registration number: DRKS00021038).
Topics: Humans; Synovial Fluid; Prosthesis-Related Infections; Arthritis, Infectious; Leukocyte Count; Arthroplasty, Replacement, Knee; Hydrogen-Ion Concentration
PubMed: 36402933
DOI: 10.1186/s10195-022-00672-5