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Factors that make Bariatric Surgery Technically Challenging: A Survey of 370 Bariatric Surgeons
No full textBackground: There is no published data on the factors bariatric surgeons think make bariatric surgery challenging. This study aimed to identify factors that bariatric surgeons feel and increase the technical complexity of bariatric surgery. Methods: Bariatric surgeons from around the world were invited to participate in a questionnaire-based survey on Survey Monkey®. An Average Weighted Score was calculated for each factor. A score of < 1.0 meant that the factor was perceived to make surgery technically easier. Results: Three hundred seventy bariatric and metabolic surgeons from 59 countries completed the survey. The top 10 factors that our respondents felt were most important for determining the technical difficulty of a procedure were inappropriate trocar placement (AWS 3.44), BMI above 60 (AWS 3.41), open bariatric surgery (AWS 3.26), less experienced bariatric anesthetist (AWS 3.18), liver cirrhosis (AWS 3), large liver (AWS 2.99), less experienced bariatric assistant (AWS 2.97), lower surgeon total bariatric surgery volume (AWS 2.95), lower surgeon specific procedure volume (AWS 2.85) and previous laparotomy (AWS 2.83), respectively. Respondents also felt that the younger patients (AWS 0.78), dedicated operating team (AWS 0.67), BMI less than 35 (AWS 0.54), and French position (AWS 0.45) actually make the surgery easier. Conclusion: This survey is the first attempt to understand the factors which make bariatric surgery more difficult. Knowing the factors made the operation more challenging, led to better scheduling the potentially difficult patients to reduce the complications. © 2021, Société Internationale de Chirurgie
Association Between Perceived Social Support and Mental Health Status Among Older Adults
Get PDFIntroduction: The elderly need social support to reduce their physical and mental disabilities. Perceived social support is one of the effective factors in the lifestyle of older adults. Objective: This study aimed to determine the association between perceived social support and mental health status among older adults. Materials and Methods: This research is a cross-sectional analytical study. The study data were collected using a Perceived Social Support (PSS) scale and general health questionnaire-12 (GHQ-12). A total of 302 eligible older adults were selected through a random sampling method from primary health centers in the north, south, east, west, and center of Tehran. The inclusion criteria were those community-dwelling older adults aged �60 years and with normal cognitive abilities. The collected data were analyzed using t test, ANOVA, the Pearson correlation, and multiple linear regressions. Results: The Mean±SD age of older adults was 70.01±6.29 years. Their Mean±SD scores of the PSS and GHQ-12 were 130.95±16.05 and 7.29±5.55, respectively. The results showed no significant relationship between demographic variables and PSS. There was a significant inverse correlation between the PSS score and the GHQ-12 score (P= 0.01, r= -0.878). The PSS explained 0.66 of the total variances of �positively phrased items� of GHQ-12 (adjusted R2= 0.66) and 0.76 of the total variances of �negatively phrased items� of GHQ-12 (adjusted R2= 0.76). Conclusion: Our findings showed that the PSS and mental health are at a desirable level in this study, and the PSS is not affected by demographic variables. The PSS is a promoting factor for mental health status among older adults. © 2021, Journal of Holistic Nursing and Midwifery. All Rights Reserved
Comparison of PED and FRED flow diverters for posterior circulation aneurysms: A propensity score matched cohort study
No full textAbstractBackground Flow diversion is a common endovascular treatment for cerebral aneurysms, but studies comparing different types of flow diverters are scarce. Objective To perform a propensity score matched cohort study comparing the Pipeline Embolization Device (PED) and Flow Redirection Intraluminal Device (FRED) for posterior circulation aneurysms. Methods Consecutive aneurysms of the posterior circulation treated at 25 neurovascular centers with either PED or FRED were collected. Propensity score matching was used to control for age, duration of follow-up imaging, adjunctive coiling, and aneurysm location, size, and morphology; previously ruptured aneurysms were excluded. The two devices were compared for the following outcomes: procedural complications, aneurysm occlusion, and functional outcome. Results A total of 375 aneurysms of the posterior circulation were treated in 369 patients. The PED was used in 285 (77.2) and FRED in 84 (22.8) procedures. Aneurysms treated with the PED were more commonly fusiform and larger than those treated with FRED. To account for these important differences, propensity score matching was performed resulting in 33 PED and FRED unruptured aneurysm pairs. No differences were found in occlusion status and neurologic thromboembolic or hemorrhagic complications between the two devices. The proportion of patients with favorable functional outcome was higher with FRED (100 vs 87.9, p=0.04). Conclusion Comparative analysis of PED and FRED for the treatment of unruptured posterior circulation aneurysms did not identify significant differences in aneurysm occlusion or neurologic complications. Variations in functional outcomes warrant additional investigations. © 2021 BMJ Publishing Group. All rights reserved
Concept of error and nature of nursing error detectors in military hospitals: A qualitative content analysis
No full textBackground and objectives Nursing errors can cause irreparable consequences. Understanding the concept of error and the nature of nursing error detectors can significantly reduce this type of errors. The present study was conducted to explain the concept of error and the nature of nursing error detectors in military hospitals. Materials and methods The present study was conducted on eight nurses working in different wards of military hospitals using a qualitative approach to content analysis proposed by Graneheim and Lundman. Data were collected through in-depth semistructured interviews. Findings 'The concept of error' and 'the nature of error detectors' in military hospitals were the two main categories extracted from data analysis. The present findings showed that the nature of errors in military hospitals is inevitable, a threat to job position and bipolar. Nurses use different resources to identify errors, including personal, environmental and organisational factors of detection. Discussion and conclusion Given the military nature of the study hospitals, organisational factors of detection played a key role in identifying errors. Moreover, given the perception of military nurses of errors, they were not inclined to personal detectors. The managers of military hospitals are therefore recommended to pursue a justice-oriented and supportive culture to help nurses play a more active role in identifying errors. © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ
Left ventricle assessment by three-dimensional heartmodel software in different types of mitral valve prolapse (Barlow�s disease and fibroelastic deficiency) with severe mitral regurgitation
No full textBACKGROUND: Mitral valve prolapse (MVP) is the most common cause of isolated mitral regurgitation (MR) requiring surgical repair. Therapeutic interventions should be considered before irreversible left ventricular (LV) dysfunction in asymptomatic patients. Measurement of LV volume and function is very important. Because of two-dimensional (2D) echocardiography limitations, three-dimensional (3D) measurement is preferred on the strength of its speed, accuracy, and reproducibility, which are comparable with those of magnetic resonance imaging (MRI). METHODS: This study was conducted between April 2018 and February 2019 on 50 patients with different MVP types and severe MR scheduled for valve surgery at Rajaie Cardiovascular Research Center, Tehran, Iran, with the aid of the HeartModelAnatomical intelligence (A.I.) (EPIQ 7: new 3D software) for measurement of LV volume indices and function. RESULTS: Patients with the Barlow syndrome had a greater drop in LV ejection fraction (LVEF) than those with fibroelastic deficiency (FED) (57.05 ± 6.00 vs. 65.00 ± 4.08; P = 0.001). LV volume was larger in patients with flail mitral valve (MV) than in those with non-flail MV (165 cc vs. 118 cc; P = 0.001). LVEF declined more in patients with the involvement of both leaflets than in those with the involvement of the anterior leaflet alone (56.00 ± 7.10 vs. 57.70 ± 4.30; P = 0.021). CONCLUSION: The LVEF drop was more remarkable in patients with the Barlow syndrome (both flail and non-flail MV) than in those with FED. It is, therefore, advisable that such patients be monitored more meticulously via the 3D HeartModelA.I. method in terms of LVEF and LV size to prevent irreversible effects on LV function and to reduce mortality. © 2021, Isfahan University of Medical Sciences(IUMS). All rights reserved
A case report of complete resolution of nonimmunological hydrops fetalis without known etiology
Get PDFThe prevalence of nonimmunological hydrops fetalis has been reported between 1 in 1500 and 1 in 4000, with an approximate 80 mortality rate. This case-report study explains a case of hydrops fetalis, presented with generalized edema and pleural and pericardial effusion at 30 weeks of gestation with preterm birth at this age due to preterm uterine contractions. No etiology was found for hydrops and all signs resolved thoroughly after birth without treatment. After birth, the newborn was admitted to neonatal intensive care unit and discharged after 47 days in good condition. The infant was completely healthy within three months after delivery. © 2021
International Prospective Registry of Acute Coronary Syndromes in Patients With COVID-19
Get PDFBackground: Published data suggest worse outcomes in acute coronary syndrome (ACS) patients and concurrent coronavirus disease 2019 (COVID-19) infection. Mechanisms remain unclear. Objectives: The purpose of this study was to report the demographics, angiographic findings, and in-hospital outcomes of COVID-19 ACS patients and compare these with pre�COVID-19 cohorts. Methods: From March 1, 2020 to July 31, 2020, data from 55 international centers were entered into a prospective, COVID-ACS Registry. Patients were COVID-19 positive (or had a high index of clinical suspicion) and underwent invasive coronary angiography for suspected ACS. Outcomes were in-hospital major cardiovascular events (all-cause mortality, re�myocardial infarction, heart failure, stroke, unplanned revascularization, or stent thrombosis). Results were compared with national pre�COVID-19 databases (MINAP Myocardial Ischaemia National Audit Project 2019 and BCIS British Cardiovascular Intervention Society 2018 to 2019). Results: In 144 ST-segment elevation myocardial infarction (STEMI) and 121 non�ST-segment elevation acute coronary syndrome (NSTE-ACS) patients, symptom-to-admission times were significantly prolonged (COVID-STEMI vs. BCIS: median 339.0 min vs. 173.0 min; p < 0.001; COVID NSTE-ACS vs. MINAP: 417.0 min vs. 295.0 min; p = 0.012). Mortality in COVID-ACS patients was significantly higher than BCIS/MINAP control subjects in both subgroups (COVID-STEMI: 22.9% vs. 5.7%; p < 0.001; COVID NSTE-ACS: 6.6% vs. 1.2%; p < 0.001), which remained following multivariate propensity analysis adjusting for comorbidities (STEMI subgroup odds ratio: 3.33 95% confidence interval: 2.04 to 5.42). Cardiogenic shock occurred in 20.1% of COVID-STEMI patients versus 8.7% of BCIS patients (p < 0.001). Conclusions: In this multicenter international registry, COVID-19�positive ACS patients presented later and had increased in-hospital mortality compared with a pre�COVID-19 ACS population. Excessive rates of and mortality from cardiogenic shock were major contributors to the worse outcomes in COVID-19 positive STEMI patients. © 2021 American College of Cardiology Foundatio
Evaluating the independent impact of renal function decline on coronary artery calcification in patients undergone cardiac ct scan
Get PDFBackground: Cardiovascular events are the leading global cause of death. Calcification of coronary arteries is a common complication of renal failure and the leading cause of death in this population. However, its multifactorial mechanism is not fully understood. Objectives: The current study aimed to, firstly, investigate the association between renal dysfunction and the calcification of coronary arteries in patients with severe and milder stages of renal failure and, secondly, to determine the role of this variable by eliminating the effect of established confounding factors. Methods: Following a retrospective design, 261 patients with cardiovascular risk factors or atypical symptoms were investigated. Estimated GFR (glomerular filtration rate) was calculated using both Cockcroft-Gault and MDRD equations. An ECG-gated multidetector CT scan was performed to calculate CACS (coronary artery calcification score) using the Agatston method. The presence of significant CAC (coronary artery calcification) was defined as CACS > 100. Univariate and multivariate analyses were performed using binary logistic regression. Results: A total of 134 cases were diagnosed with CAC, and the mean CACS was 83.4 ± 18. According to univariate analysis, older age, male gender, systolic and diastolic blood pressure, and higher TG levels were correlated with the degree of CAC. HbA1C showed a weak correlation with CACS (P-value = 0.04). Renal insufficiency resulted in increased CAC, and lower eGFR (calculated with both Cockgraft-Gault and MDRD equations) was associated with higher calcification (P-value < 0.01). Our analysis shows that serum Ca, P, LDL, and HDL levels do not have a significant influence on calcification changes. After adjusting for confounding factors, male sex, age, triglyceride level, and eGFR were recognized as independent risk factors for CACS � 100, a marker of coronary artery atherosclerosis. However, HbA1C and systolic and diastolic blood pressure were no longer considered as factors that contribute to the risk of CAC. Conclusions: We observed a gradual and independent association between lower eGFR and higher CAC scores. © 2021, Author(s)
Hypothetical protective effects of crocin carotenoid against coronavirus-induced organ damage: The possible role of the nf-κb signaling pathway
No full textEfficacy and safety of covid-19 vaccines: A systematic review and meta-analysis of randomized clinical trials
Get PDFThe current study systematically reviewed, summarized and meta-analyzed the clinical features of the vaccines in clinical trials to provide a better estimate of their efficacy, side effects and immunogenicity. All relevant publications were systematically searched and collected from major databases up to 12 March 2021. A total of 25 RCTs (123 datasets), 58,889 cases that received the COVID-19 vaccine and 46,638 controls who received placebo were included in the meta-analysis. In total, mRNA-based and adenovirus-vectored COVID-19 vaccines had 94.6 (95 CI 0.936�0.954) and 80.2 (95 CI 0.96.4�0.92.7) efficacy in phase II/III RCTs, respectively. Efficacy of the adenovirus-vectored vaccine after the first (97.6; 95 CI 0.939�0.997) and second (98.2; 95 CI 0.980�0.984) doses was the highest against receptor-binding domain (RBD) antigen after 3 weeks of injections. The mRNA-based vaccines had the highest level of side effects reported except for diarrhea and arthralgia. Aluminum-adjuvanted vaccines had the lowest systemic and local side effects between vaccines� adjuvant or without adjuvant, except for injection site redness. The adenovirus-vectored and mRNA-based vaccines for COVID-19 showed the highest efficacy after first and second doses, respectively. The mRNA-based vaccines had higher side effects. Remarkably few experienced extreme adverse effects and all stimulated robust immune responses. © 2021 by the authors. Licensee MDPI, Basel, Switzerland