Evaluation of neurological testing for hand-arm vibration syndrome

BACKGROUND

The neurological component of hand-arm vibration syndrome (HAVS) uses the Stockholm Workshop Scale sensorineural (SWS SN) stages for classification. Proximal compressive neuropathies are common in HAVS and the symptoms are similar to SN HAVS. The SWS may not be a valid staging tool if a patient has comorbid proximal compression neuropathy.

AIMS

To evaluate the prevalence of proximal compression neuropathy in patients presenting for HAVS assessment and examine the association between compressive neuropathies and SWS SN.

METHODS

A standardized assessment protocol was used to assess 431 patients for HAVS at St. Michael's Hospital, Toronto, Ontario. The prevalence of median and ulnar compressive neuropathies was determined. The association between proximal compression neuropathies and SWS SN stage (0/1 versus 2/3) was evaluated using Chi-square and Fisher's exact tests as well as multivariable logistic regression.

RESULTS

Most patients (79%) reported numbness and 20% had reduced sensory perception (SWS SN Stage 2/3). Almost half (45%) had median neuropathy at the wrist and 7% had ulnar neuropathy. There was no association between the SWS SN stage and median or ulnar neuropathy.

CONCLUSIONS

Two neurological lesions should be investigated in patients presenting for HAVS assessment: compressive neuropathy and digital neuropathy. The prevalence of compressive neuropathies is high in patients being assessed for HAVS and therefore nerve conduction studies (NCS) should be included in HAVS assessment protocols. Comorbid proximal neuropathy does not affect the SWS SN stage; therefore, NCS and SWS SN seem to be measuring different neurological outcomes in HAVS patients.

Emotional intelligence and academic performance among medical students - a correlational study

OBJECTIVE

Emotional intelligence is the ability to monitor one's emotions and feelings and those of others, to distinguish between them, and to use this information to guide one's thoughts and actions. A growing body of evidence suggests that highly emotionally intelligent student groups have better academic performance, better emotional awareness, and relationship management. We set forward to determine if any such positive relation exists among medical students.

MATERIALS AND METHODS

A descriptive cross-sectional study was conducted on undergraduate medical students of Majmaah University. Convenient sampling was done to enroll the consenting students. A self-administered questionnaire on emotional intelligence was adapted from a model by Paul Mohapel. The questions based on a 5-point Likert scale assessed the four domains of emotional intelligence i.e., emotional awareness, emotional intelligence; demographic details and grade-point averages (GPA) were also collected. The data was tabulated and analyzed using SPSS 22.0 (IBM Corp., Armonk, NY, USA).

RESULTS

Hundred and forty medical undergraduates enrolled in the study with a male-to-female ratio of 1:06. The median semester score was 4.47 (range 1.1-5.8) and the median cumulative score was 4.44 (range 2.8-5.0). The emotional management score was highest among those with a CGPA >4.50 (p=0.048). A significantly higher mean emotional awareness score (p<0.001), social-emotional awareness score (p<0.001), and relationship management score (p=0.030), and the mean EQ total was higher among males than for females (p<0.001). A small but significant correlation was observed and also with EQ total score (r= 0.18, p= 0.032).

CONCLUSIONS

Emotional management affects the academic performance of medical students. There should be more sessions to improve the emotional intelligence of the students so that it can aid in their academic performance.

Double-diffusive Hamel-Jeffrey flow of nanofluid in a convergent/divergent permeable medium under zero mass flux

In the recent era, the nanofluid's transportation due to the Jeffrey-Hemal flow phenomenon (i.e., carrying fluid through a converging/diverging channel) has significant applications in numerous engineering and science technologies. Therefore, multi-disciplinary evolution and research motivated us to present current attempt. The aim of this attempt is to present Jeffrey-Hamel mechanism of the nanofluid through non-parallel channel under thermally balance non-Darcy permeable medium impacts. The nanomaterial is represented using the Buongiorno nanofluid model. The investigation also includes zero mass flux impacts as well as variable rheological fluid properties. The influences of temperature jump are also encountered in the current analysis. The governing flow expressions under the Jeffrey-Hemal analysis are made dimensionless utilizing the similarity variables. The dimensionless equations are then solved using the analytical scheme (homotopy method) and the obtained series solutions are convergent. The influences of the involved parameters on concerned profiles are investigated through graphs. Force of drag, Nusselt and Sherwood numbers are elaborated graphically. In this analysis, intensification in Prandtl number enhances the heat transfer rate whereas decrement is seen in heat transfer rate for larger thermal slip parameter. Further, mass diffusivity parameter adversely affects the mass transfer rate. The current analysis incorporates numerous industrial and technological processes including transportation, material synthesis, microfluidics, high-power Xrays, biomedical, solid-state lighting, microelectronics, scientific measurement, medicine, molten polymers extrusion via converging dies, cold drawing operation related to polymer industry etc.

A time and motion study in pediatric ER of the Secondary Hospital in Al Jouf Region, Saudi Arabia

OBJECTIVE

In the hospital setting, long waiting times and the lengthy formal process have increased the inefficiency and mismanagement resulting in the missing chance of saving the patients' life. Our aim was to assess the time wastage of every patient coming from reception to the actual emergency unit, to analyze the factor associated with the time lapse that occurs during every visit, and to see the effect of training on the services provided in the Pediatric emergency room.

SUBJECTS AND METHODS

An intervention study was carried out in the following secondary care hospital in the Al Jouf region, Saudi Arabia: Esawiyah Hospital, Haditha Hospital, King Faisal Hospital, and Gurayat General Hospital among 400 study participants for 12 months. The study was carried out in 2 phases: pre-training, a period of training for hospital staff, and post-training data collection. Templates were generated on an MS Excel sheet and analysis of data was done using SPSS software. Percentages and proportions were calculated for descriptive statistics.

RESULTS

Male and female patients were in the ratio of nearly 1:1. Training has significantly reduced the time to doctor consultation (U = 188, p < 0.001), and the time difference pre- and post-training from triage to consultation in a pediatric emergency is not significant (U = 16,769, p = 0.01). There is a strongly significant association (p < 0.001) between Canadian Triage and Acuity Scale (CTAS) implementation in triage. The practice of giving intravenous (IV) antibiotics in the emergency room has reduced significantly (p < 0.001) post-training.

CONCLUSIONS

Training has a significant impact on the services provided in the pediatric emergency room.

Epilepsia Partialis Continua that Improved in a Pediatric Patient with Sub-dural Empyema

In epilepsia partialis continua (EPC), the EEG tracings may fail to show epileptiform activity because the electrical activity is too subtle or too deep to be picked up by surface electrodes. EPC can occur at any age and may have many etiologies, including genetic, metabolic, structural, infectious, and idiopathic. Typical EEG in EPC is characterized by discharges of cortical origin that commonly consist of sharp waves, spikes or periodic lateralized epileptiform discharge; however, EEG findings at large are variable and often not even identified. Here we present a pediatric case of EPC in the setting of subdural empyema with atypical EEG seizure associated with focal clonic activity who made rapid improvements.

The psychological burden of disease among patients undergoing cervical spine surgery: Are we underestimating our patients' inherent disability?

BACKGROUND

Studies have utilized psychological questionnaires to identify the psychological distress among certain surgical populations.

RESEARCH QUESTION

Is there an additional psychological burden among patients undergoing surgical treatment for their symptomatic degenerative cervical disease?

MATERIALS AND METHODS

Patients>18 years of age with symptomatic, degenerative cervical spine disease were included and prospectively enrolled. Correlations and multivariable logistic regression analysis assessed the relationship between these mental health components (PCS, FABQ) and the severity of disability described by the NDI, EQ-5D, and mJOA score. Patient distress scores were compared to previously published benchmarks for other diagnoses.

RESULTS

47 patients were enrolled (age: 56.0 years,BMI: 29.7kg/m²). Increasing neck disability and decreasing EQ-5D were correlated with greater PCS and FABQ(all P<0.001). Patients with severe psychological distress at baseline were more likely to report severe neck disability, while physician-reported mJOA had weaker associations. Compared to historical controls of lumbar patients, patients in our study had greater levels of psychological distress, as measured by FABQ (40.0 vs. 17.6; P<0.001) and PCS (27.4 vs. 19.3;P<0.001).

DISCUSSION AND CONCLUSION

Degenerative cervical spine patients seeking surgery were found to have a significant level of psychological distress, with a large portion reporting severe fear avoidance beliefs and catastrophizing pain at baseline. Strong correlation was seen between patient-reported functional metrics, but less so with physician-reported signs and symptoms. Additionally, this population demonstrated higher psychological burden in certain respects than previously identified benchmarks of patients with other disorders. Preoperative treatment to help mitigate this distress, impact postoperative outcomes, and should be further investigated.

LEVEL OF EVIDENCE

Level III.

Knowledge, attitude and practices regarding dengue and its vector among medical practitioners in Malakand region, Pakistan

Abstract Dengue fever (DF) is increasingly recognized as one of the world’s major mosquito borne diseases and causes significant morbidity and mortality in tropical and subtropical countries. Dengue fever is endemic in most part of Pakistan and continues to be a public health concern. Knowledge, attitude and practices can play an important role in management of the disease. Current study was aimed to determine the level of knowledge, attitude and practices regarding dengue fever among health practitioners, to study the level of knowledge and attitude with preventive practices for dengue fever. A cross sectional study was carried out in medical practitioners of the four districts of Malakand region during October to November 2019. A pre-structured questionnaire was used to collect data from medical practitioners. Data was analyzed using Graph Pad version 5. Significant value was considered when less than 0.05 (at 95% confidence of interval). The results revealed that most of participants have seen dengue vector (62%), the media being the most quoted source of information. Nearly 81.2% participants were aware from transmission of dengue fever is by mosquito bite. Practices based upon preventive measures were found to be predominantly focused towards prevention of mosquito bites rather than elimination of breeding places. Although the knowledge regarding DF and mosquito control measure was quite high among the medical practitioners but this knowledge was not put into practice. Further studies are required to aware the people about dengue and its vector in order to get prevention and control.

Significance of Orlistat in management of dyslipidemia, systolic blood pressure and body mass index

OBJECTIVE

The current study intends to find out the efficacy of Orlistat in the management of hyperlipidemia, Systolic Blood Pressure (SBP) and Body Mass Index (BMI).

MATERIALS AND METHODS

This retrospective study has evaluated the lipid profiles of the patients, who have been using metformin therapy for Type 2 diabetes. The study has obtained data regarding the parameters like triglyceride, Total cholesterol (TC), LDL cholesterol, HDL cholesterol and LDL/HDL ratio, systolic blood pressure and Body Mass Index (BMI). Random distribution of patients was done into placebo and Orlistat groups. The placebo group received only metformin, and patients in the Orlistat group received Orlistat along with metformin. After 24 weeks, the follow-up study was done, and statistical analysis was conducted.

RESULTS

The study found that the Orlistat group has significant improvement (p<0.05) more improvement in LDL cholesterol, HDL cholesterol, Total cholesterol, LDL/HDL Ratio and Triglycerides, while BMI and systolic blood pressure did not show a significant difference between placebo and Orlistat group.

CONCLUSIONS

This study has concluded that Orlistat can be used for significant improvement in lipid profile. The study also found that Orlistat may not have a significant effect on reducing BMI and blood pressure without adequate lifestyle modification.

P-144 THE ABDOMINAL BINDERS FOLLOWING ABDOMINAL WALL RECONSTRUCTIVE SURGERY: USEFUL OR USELESS? - A META-ANALYSIS

Aim

Despite a recent meta-analysis published in SAGE in 2021 by a group of chinese researchers, which included 10 RCTs, the research committee for this study felt that a substantial volume of recent literature, including 7 RCTs and 3 high value non-RCT newly published articles have not been included in the latest meta-analysis and a new study is required, to understand the clinical usefulness of abdominal binders, following abdominal wall reconstructive surgery. Furthermore, no recent studies looked at the long-term impact of abdominal binders and whether their use prevent hernia recurrence, if applied from the immediate post-op period.

Material & Methods

A thorough review of all medical literature published in english language since year 2000 and to date was carried out, using the following keywords: “hernia”, “hernia repair”, “abdominal wall reconstruction” and “abdominal binder”. 17 randomised control trials and 3 non-RCT studies (systematic reviews and surveys) were included in the study. A total of 5216 patients were included in the 20 studies included. The databases searched were PubMed, Medbase, Jama and Embase.

Results/Conclusions

The use of abdominal binders following abdominal wall surgery suggests a better pain control when compared with non-users group. This contributes to earlier mobilisation and by this preventing secondary post-op complications. There is building evidence that in long term the use of abdominal binders reduces the risk of hernia recurrence and this could be in relation to decreased post-op pain and earlier return to a normal activities in the immediate post-op period.

Comparative analysis between mono approach and multi approaches in managing T2DM: a survey-based study

OBJECTIVE

The aim of the study was to analytically compare the therapeutic effect of the addition of diet modification and regular exercise to oral agents.

MATERIALS AND METHODS

This cross-sectional study surveyed 1248 participants via online and offline modes by employing a questionnaire about an individual's management of diabetes. Group 1 patients follow Single Approach Management for Type 2 Diabetes Mellitus (T2DM), while Group 2 and Group 3 patients follow Multi-Approach Management for T2DM. Based on the answers, the participants were classified into three groups. The diagnostic criteria of Diabetes Mellitus Type-2 in this study were done by determining morning Fasting Blood Sugar (FBS) and glycated Hemoglobin (HbA1c).

RESULTS

The current study found 656 single oral agent users and 592 combination regimens users among all the study participants. The study also found that, among all participants, 511 patients were on mild to moderate diet modification while 325 patients were on moderate to severe diet modification. The study also noted that 232 males and 215 females took Complementary and Alternative Medicines (CAM). Of 447 patients, 12 showed menstrual abnormalities (2.6%), and 18 had mild diarrhoea (4%). The study also found that there is a vital significance of lowering FBS and HbA1c with the management strategies (p=0.000). The study showed a strong association between group 3 and improved FBS and HbA1c (p=0.000).

CONCLUSIONS

This study reveals that diet modification and regular exercise improve FBS and HbA1c levels significantly. Hence, diet modification and exercise can be added as adjuvants and should be incorporated into the management guidelines of T2DM.

Detection of right atrial thrombus in a woman with pulmonary embolism and right heart compromise by bedside echocardiography

A 59-year-old female with a history of stage IV lung adenocarcinoma presented with worsening shortness of breath and cough over several weeks. She was tachycardic, hypotensive, and tachypneic. Portable chest x-ray suggested bilateral pleural effusions and computed tomography angiography (CTA) revealed bilateral pulmonary emboli (PE) with suspected right heart strain. Upon admission to the medical intensive care unit for treatment of PE, bedside echocardiography was performed to direct management. Indicators of cor pulmonale and right heart strain were apparent including right ventricle dilation, reduced tricuspid systolic excursion, and a deformed left ventricle with “D sign”. Most notably, a right atrial thrombus was detected, a finding not initially seen on CTA. Ultimately, prompt detection of the effects on the right ventricle by bedside echocardiography directed the next step in this patient's clinical course without delay.

Epidemiology and impact of frailty in patients with atrial fibrillation in Europe

BACKGROUND

Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent.

OBJECTIVES

We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients.

METHODS

A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined.

RESULTS

Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty.

CONCLUSIONS

In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.

Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study

BACKGROUND

No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge.

METHODS

The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing.

FINDINGS

2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters.

INTERPRETATION

The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials.

FUNDING

UK Research and Innovation and National Institute for Health Research.

Concise convolutional neural network model for fault detection

Fault detection is an urgent need for maintenance to obtain the optimal scheduling of production activities, improve system reliability, and reduce operation and maintenance costs. Many studies published in recent years focus on machine learning models to detect any system anomalies in line with the era of big data and the fourth industrial revolution (Industry 4.0). Say, a working condition of bearing can be monitored and then any fault can be detected using the vibration analysis of bearing acceleration data. Most of the published works are presented based upon the knowledge of signal processing in which the result depends heavily on feature extraction. It becomes a challenge then to apply a machine learning algorithm directly to the raw acceleration data as it has been successfully applied to raw data in other science and engineering domains. In this article, a concise Convolutional Neural Networks-based deep learning model is proposed for bearing fault detection. The proposed model was concise with 98% less number of parameters compared to other well-known models. It produced 21.21% and 7.03% better accuracy and fault detection rate, respectively. The model was also tested in different operating parameter environments and still gave an excellent result. Since the proposed concise architecture of the model needed short training time, it is deemed suitable for application on manufacturing floor where the pace of production moves fast and the change of the production machine configuration likely occurs.

Hypertriton Production in p-Pb Collisions at sqrt[s_{NN}]=5.02 TeV

The study of nuclei and antinuclei production has proven to be a powerful tool to investigate the formation mechanism of loosely bound states in high-energy hadronic collisions. The first measurement of the production of _{Λ}^{3}H in p-Pb collisions at sqrt[s_{NN}]=5.02  TeV is presented in this Letter. Its production yield measured in the rapidity interval -1<y<0 for the 40% highest-multiplicity p-Pb collisions is dN/dy=[6.3±1.8(stat)±1.2(syst)]×10^{-7}. The measurement is compared with the expectations of statistical hadronization and coalescence models, which describe the nucleosynthesis in hadronic collisions. These two models predict very different yields of the hypertriton in charged particle multiplicity environments relevant to small collision systems such as p-Pb, and therefore the measurement of dN/dy is crucial to distinguish between them. The precision of this measurement leads to the exclusion with a significance larger than 6.9σ of some configurations of the statistical hadronization model, thus constraining the theory behind the production of loosely bound states at hadron colliders.

Impact of mapping technology on procedural characteristics during radiofrequency or cryoballoon pulmonary vein isolation for atrial fibrillation

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction: Cryoballoon ablation (CBA) is often associated with shorter procedure times along with tradeoffs such as increased fluoroscopy use compared to radiofrequency (RF) ablation of atrial fibrillation (AF), however the impact of mapping technology on these characteristics is not fully understood.

Purpose

To assess the effect of mapping technology on trends in fluoroscopy use and procedure times in AF pulmonary vein isolation (PVI) procedures with an RF or CBA catheter.

Methods

Acute procedure data from 210 de novo AF cases using a 3D mapping system was prospectively collected from 48 centers in eight countries. Choice of technology was left to physician discretion; a PVI only ablation strategy was utilized in all cases. Procedure data such as total procedure and fluoroscopy times from cases using either an RF or CBA catheter with either a grid-style mapping catheter (HD Grid) or circular mapping catheter (CMC) were compared.

Results

Of the 210 cases, RF ablation was used in 103 (49%), and CBA used in 107 (51%). In RF cases, a relatively even split between CMC and HD Grid use was observed (n=46, 45% vs. n=57, 55%), while a CMC was used in 100% of CBA cases (Figure 1). Across all cases, fluoroscopy and procedure times were significantly shorter when HD Grid was used (7.4±26.7 minutes; 108.2±46.3 minutes) compared to a CMC (20.4±17.6 minutes; 133.7±62.7) (p&lt;0.001; p=0.003). A similar trend was also observed in RF cases using HD Grid (7.4±26.7 minutes; 108.2±46.3 minutes) compared to a CMC (17.9±12.3 minutes; 175.1±50.5) (p=0.01; p&lt;0.001). Fluoroscopy times in RF cases with HD Grid (7.4±26.7 minutes) were significantly shorter compared to CBA cases with a CMC (21.5±19.4 minutes) (p&lt;0.001), while procedure times were similar (108.2±46.3 minutes; 116.0±59.2 minutes, p=0.20).

Conclusion(s)

Use of HD Grid resulted in significantly shorter procedure and fluoroscopy times compared to a CMC across all cases, including those using RF ablation. Fluoroscopy times were also significantly shorter in RF cases using HD Grid compared to CBA cases using a CMC, with similar procedure times. These observations suggest that use of HD Grid may better enable safer and more efficient PVI, specifically when employing RF ablation, in addition to safer and equally efficient RF PVI compared to CBA with a CMC. Further study in in a larger, randomized cohort may be necessary.