Position In Patients Research Articles

Flank-free modified supine vs. prone position for pediatric nephrolithotripsy: an updated systematic review and meta-analysis

IntroductionPercutaneous nephrolithotomy (PCNL) is widely performed as the preferred treatment for kidney stones larger than 20 mm in pediatric patients, with current research focusing on comparing outcomes between prone and supine positions to determine optimal procedural positioning. Therefore, the aim of this study is to compare the efficacy of prone versus supine positioning in pediatric PCNL, providing clarity on this critical aspect of the procedure to guide clinical decision-making.MethodsWe conducted a systematic review in PubMed, Embase, Scopus, Cochrane, Web of Science and Google Scholar. We included studies that compared PCNL in prone vs supine positions for pediatric patients. Our primary outcome was stone-free rate (SFR). Secondary outcomes included operative time, length of hospital stay and overall complications rate. The statistical analysis was performed using Review Manager 5.4.ResultsWe retrieved 8 articles, with 269 patients in the prone group and 223 patients in the supine group. The mean age of all patients was 7.92 years old. Our findings presented no statistically significant difference in SFR between the two positions (OR 0.67; CI95 0.38, 1.18; p = 0.17; I2 = 0%). Additionally, we noted a significant reduction in operative time in the supine position group (MD 13.75; CI95 4.35, 23.15; p = 0.004; I2 = 84%). At the same time, the length of hospital stay after the procedure was lower in supine group (MD 0.61; CI95 0.34, 0.88; p < 0.0001; I2 = 21%). No difference was observed regarding the total complication rate (OR 1.47; CI95 0.88, 2.47; p = 0.15; I2 = 0%).ConclusionOur meta-analysis suggests that PCNL performed in the prone position is equivalent to supine PCNL in terms of SFR. However, mainly in the RCT studies, we could observe benefits of the supine position in comparison of prone position in terms of lower operative time, as well as a reduced postoperative hospital stay.

Association between condylar surface computed tomography values in the coronal plane and temporomandibular joint disc position in jaw deformity patients: a retrospective study.

This study aimed to examine the relationship between computed tomography (CT) values of the condylar surface in the coronal plane, condylar morphology and the disc positions in the temporomandibular joint (TMJs) in patients with deformities before and after orthognathic surgery. MATERIALS AND METHODS: The maximum CT values (pixel values) on the condylar surface, condylar thickness, condylar width, condylar angle, condylar height, and joint space were measured. TMJ disc position was classified into five types (anterior type, fully covered type, posterior type, anterior disc displacement with [AW] and without reduction [AWO]), using magnetic resonance imaging (MRI), before and 1 year after surgery. Statistical analysis was performed to assess differences between groups and between the pre- and postoperative values. RESULTS: We enrolled 142 TMJs from 71 female patients diagnosed with jaw deformities. Disc position classification did not change after surgery in all TMJ. Significant differences were observed between anterior displacement (AW and AWO) and other types (fully covered type and posterior type) in the lateral CT value and condylar angle before and 1 year after surgery (P < 0.05). CONCLUSIONS: This study demonstrated a strong relationship between condylar surface CT values in the coronal plane and condylar angle with TMJ disc position classification.

Prone position in obese patients with acute respiratory distress syndrome after cardio-thoracic surgery.

Prone positioning (PP) has benefits in patients with acute respiratory distress syndrome (ARDS). The objective of this study was to compare the effects and complications of PP in obese vs non-obese patients with moderate-to-severe ARDS after cardiothoracic surgery. We retrospectively analysed a database established in 2014-2021 in an intensive care unit (ICU). The primary end-point was the change in PaO2/FiO2 induced by PP. Secondary end-points included pressure ulcers, mediastinitis, and ICU mortality. The groups with vs without obesity (body mass index >30 kg/m2) were compared and a mixed linear model was built to identify factors associated with the PaO2/FiO2 change. 81 patients with ARDS (36 with vs 45 without obesity) and 189 PP sessions were included. PP duration was 17.2 ± 4.5 h in obese and 18.0 ± 3.8 in non-obese patients (p = 0.23). Mean number of sessions was 2.6 ± 1.4 in obese and 2.1 ± 1.3 in non-obese patients (p = 0.10). Median PaO2/FiO2 increase after the first PP session was 75.0% [14.5-123.0] and 72% [15.5-130.5] in the groups with vs without obesity (p = 0.67). Stage 3/4 pressure ulcers were more common in the obese group (44.4% vs 22.2%; p = 0.03) and occurred chiefly on the face. No significant differences between the obese and non-obese groups were found for mediastinitis (16.7% vs 8.9%, p = 0.33) or ICU mortality (22% vs 20%, p = 0.81). Improvement of oxygenation was not statistically different between patients with vs without obesity. Pressure ulcers were more common in the obese group, whereas mediastinitis was not. No patient experienced wound dehiscence.

Early physiologic changes after awake prone positioning predict clinical outcomes in patients with acute hypoxemic respiratory failure.

The optimal physiologic parameters to monitor after a session of awake prone positioning in patients with acute respiratory failure are not well understood. This study aimed to identify which early physiologic changes after the first session of awake prone positioning are linked to the need for invasive mechanical ventilation or death in patients with acute respiratory failure. We performed a secondary analysis of a prospective cohort study of adult patients with acute respiratory failure related to coronavirus disease 2019 (COVID-19) treated with awake prone positioning. We assessed the association between relative changes in physiological variables (oxygenation, respiratory rate, pCO2 and respiratory rate-oxygenation [ROX] index) within the first 6h of the first awake prone positioning session with treatment failure, defined as endotracheal intubation and/or death within 7days. 244 patients [70 female (29%), mean age 60 (standard deviation [SD] 13) years] were included. Seventy-one (29%) patients experienced awake prone positioning failure. ROX index was the main physiologic predictor. Patients with treatment failure had lower mean [SD] ROX index at baseline [5 (1.4) versus 6.6 (2.2), p < 0.0001] and within 6h of prone positioning [5.6 (1.7) versus 8.7 (2.8), p < 0.0001]. After adjusting for baseline characteristics and severity, a relative increase of the ROX index compared to baseline was associated with lower odds of failure [odds ratio (OR) 0.37; 95% confidence interval (CI) 0.25-0.54 every 25% increase]. Relative changes in the ROX index within 6h of the first awake prone positioning session along with other known predictive factors are associated with intubation and mortality at day 7.

Bioprosthetic Valve Positions in Patients With Atrial Fibrillation - Insights From the BPV-AF Registry.

Data on the impact of valve position on clinical outcomes in patients with atrial fibrillation (AF) and bioprosthetic valves (BPVs) are limited. The BPV-AF Registry was a multicenter, prospective, observational study involving 894 patients with BPVs and AF. In this post-hoc substudy, patients were classified according to BPV position: aortic (n=588; 65.8%), mitral (n=195; 21.8%), or both (n=111; 12.4%). The primary outcome was a composite of stroke/systemic embolism, major bleeding, heart failure requiring hospitalization, all-cause death, or BPV reoperation. During a mean follow up of 15.3±4.0 months, the primary outcome occurred in 90 (15.3%) patients (12.7/100 patient-years) in the aortic group, 25 (12.8%; 10.2/100 patient-years) in the mitral group, and 16 (14.4%; 11.8/100 patient-years) in the both-valves group (log-rank P=0.621). The unadjusted and adjusted risks were not significant for the mitral and both-valves groups relative to the aortic group (unadjusted hazard ratio [95% confidence interval] 0.80 [0.52-1.25] and 0.92 [0.54-1.57]; adjusted hazard ratio 0.89 [0.51-1.54] and 1.10 [0.58-2.09], respectively). There was no significant difference in the incidence of stroke/systemic embolism or major bleeding among the 3 groups (log-rank P=0.651 and 0.156, respectively). In patients with BPVs and AF, the risk for the composite outcome was comparable regardless of the BPV position.

The Use of Trendelenburg Position in the Management of Retropharyngeal Abscess: A Case Report and Clinical Considerations

Background: Retropharyngeal abscess (RPA) is a serious deep neck space infection that can lead to life-threatening complications such as airway obstruction, mediastinitis, and sepsis. The Trendelenburg position, where the patient's head is lower than their feet, has been traditionally used in the management of RPA to prevent aspiration of pus in case of abscess rupture. However, the optimal positioning for patients with RPA remains a topic of debate. Case presentation: A 51-year-old male patient presented to the emergency room with a 5-day history of progressive dysphagia and neck swelling. He was diagnosed with a ruptured retropharyngeal abscess extending to the mediastinum (descending necrotizing mediastinitis). The patient underwent surgical drainage and was subsequently admitted to the intensive care unit (ICU), where he was intubated and mechanically ventilated in the Trendelenburg position. Five days later, the patient developed pneumonia, suspected to be ventilator-associated pneumonia (VAP). Conclusion: The Trendelenburg position may be considered in the management of RPA to minimize the risk of aspiration. However, it is essential to weigh the potential benefits against the risks, including VAP, and to consider alternative positions such as the lateral Trendelenburg position, which may offer similar benefits with reduced risk. Further research is needed to determine the optimal positioning strategy for patients with RPA.

BEST PRACTICE FOR OPTIMIZATION AND RADIATION SAFETY IN THE CARDIOVASCULAR CATHETERIZATION ROOM (CATHLAB) OF SENTRA MEDIKA CIBINONG HOSPITAL

Scattered radiation generated during fluoroscopy increases the potential for patients and staff to receive radiation doses, so it is necessary to take optimization steps for radiation safety to minimize the risk of exposure to scattered X-ray radiation. This study aims to implement radiation protection in cardiac and vascular catheterization laboratories and summarize best practices for implementing efforts to minimize radiation exposure. The method used was qualitative and quantitative from 2023 to 2024; with this qualitative approach, the supervision activities in TLD badges for radiation workers, the level of diagnostic guidance for patients, and the use of radiation protection equipment were observed. For the quantitative approach, measuring the dose rate was carried out, and optimizing the positioning of the distance between the patient's table and the radiation source was carried out by direct measurement. Based on research data, the observation results obtained that the apron is still by the minimum thickness, which is 0.35-0.5 mm Pb for intervention, the results of exposure tests around the cathlab room are around 0.08-0.12 μSv/hour still below the dose constraint value, Mapping the rate of exposure in the work area during the intervention procedure obtained an optimal safe distance of around 60-70 cm from the X-ray tube. The setup of the effective distance position for intervention patients is at a distance of 80 cm from the X-ray tube to the patient table, which can reduce the absorbed dose to the patient by around 30%, the use of low dose mode (7.5 fps) with pulsed fluoroscopy during the intervention obtained the absorbed dose received by the patient reduced by 70-72% for PCI procedures and 25-29% for the type of CAG procedure. It is hoped that the protocol that uses this best practice can minimize the risk of exposure to scattered radiation and optimize medical exposure. Keywords: cathlab, best practices radiation protection, dose rate, radiation exposure, patient radiation dose.

The position, orientation, and relative size of the fibularis longus tubercle in normal patients: A weightbearing CT assessment.

The fibularis longus attaches to the base of the first metatarsal at the fibularis/peroneus longus tubercle (FLT/PLT). Theoretically, differences in FLT morphology may reflect changes in the function of the fibularis longus. This study defines the normal limits of the FLT position, orientation, and size in patients with morphologically normal foot anatomy. A retrospective analysis of 131 feet without deformity in 72 patients undergoing weightbearing CT (WBCT) at a single center was conducted. The position and morphology of the FLT was assessed with novel measurements including tubercle-floor distance, tubercle-metatarsal angle, and the angle between the floor and a line bisecting the FLT (bisecting angle). Roundness of the FLT was compared to a triangle limiting its shape (triangular ratio), with lower values indicating increasing roundness. We also report relative size of the FLT to the first metatarsal (X/Y ratio), and relative size of the first metatarsal and FLT to the second metatarsal (XY/Z ratio). There were no significant side to side differences for any measurement (p > 0.05). Mean values were: tubercle-floor distance 28.02 ± 2.63 mm, tubercle-metatarsal angle 32.7 ± 6.32 degrees, bisecting angle 65.58 ± 6.27 degrees, triangular ratio 0.69 ± 0.04, X/Y ratio 1.13 ± 0.20, and XY/Z ratio 3.44 ± -0.72. Bisecting angle strongly correlated with tubercle-metatarsal angle (Pearson correlation 0.840, p < 0.001) suggesting FLT rotation occurred independent of foot position. ICC was >0.943 for all measurements. This study reports the morphology of the FLT in individuals with normal feet. This normative data may be used in future studies examining differences between groups of patients with foot pathology, helping us better understand the role of fibularis longus in the development and treatment of foot disorders.

Effects of sodium-glucose cotransporter 2 inhibitors on pulmonary hemodynamics in chronic heart failure patients with a pulmonary artery pressure sensor

Abstract Background Approximately 50% of patients with chronic heart failure (HF), either with preserved or reduced left ventricular ejection fraction (LVEF), have secondary pulmonary hypertension, which results in poorer prognosis. In previous studies, sodium-glucose cotransporter 2 inhibitors (SGLT2i) have shown a reduction in cardiovascular death, HF hospitalization and pulmonary artery pressure (PAP) in patients with HF, regardless of LVEF, but exact mechanisms remain unclear. Purpose The main objective of this study is to analyse effects of SGLT2i on PAP in patients with chronic HF followed by a PAP sensor (CardioMEMS HF system). The secondary objective is to analyse effects in subgroups of LVEF. Methods We included chronic HF patients (regardless of LVEF) with previously implanted a PAP sensor, from July 2019 to February 2023. SGLT2i had been added in fourth position in patients with reduced LVEF, since they were previously on optimal HF treatment as chronic patients. Changes in PAP, renal function and N-terminal pro B-type natriuretic peptide (NTproBNP) were compared between two periods of time: "30 days before" and "30 days after" SGLT2i initiation. Patients were then classified in two groups: group 1 (LVEF ≤40%) and group 2 (LVEF &amp;gt;40%) and repeated same analyses. Results Overall, 61 patients were screened, and 17 finally were included, mean age 71.7 ± 9.6 years, 64.7% were men, mean LVEF was 49.4 ± 17.5%, 23.5% had ischaemic aetiology and 64.7% were in NYHA class III (Table 1). There were more men in group 1 than in group 2 (p=0.043), without other differences in basal characteristics between groups (Table 1). Dapagliflozin (10mg daily) was initiated in 14 patients (82.4%), 5 from group 1 and 9 from group 2 (p=1.000), and empagliflozin (10mg daily) in 3 patients (17.6%), 1 from group 1 and 2 from group 2 (p=1.000). Before SGLT2i, mean diastolic PAP (dPAP) was 17.3 ± 5.6 mmHg and median NTproBNP was 2841.5 (289-10515) pg/mL. SGLT2i significantly reduced dPAP; average dPAP ("30 days after" period) was 1.5 mmHg lower (95% CI, 0.26-2.74; p=0.021) compared to "30 days before" period (Figure 1). SGLT2i also reduced systolic PAP (-2.2 mmHg), mean PAP (-1.7 mmHg), NTproBNP (-183 pg/mL) and creatinine (-0.2 mg/dL), but not statistically significant. SGLT2i reduced PAP, NTproBNP and creatinine too in group 1 (6 patients), but did not achieve statistical significance. Reductions were as well observed in group 2 (11 patients), and SGLT2i significantly reduced dPAP (-2.04 mmHg) (95% CI, 0.31-3.77; p=0.025). Conclusions In patients with chronic HF and a PAP sensor, SGLT2i, added to previous HF treatment, significantly reduced dPAP. PAP reductions were observed regardless LVEF, but results were more robust in patients with LVEF &amp;gt;40%.Figure 1

Defibrillation success with a second generation intercostal extravascular ICD lead and commercially available left pectoral pulse generator

Abstract Background/Introduction An investigational intercostal extravascular ICD lead has been developed for compatibility with commercially available pulse generators (PGs) that are placed in a left pectoral position in appropriate patients. This is substantially different from currently available extravascular ICD systems that require a custom PG placed in a left lateral position. Purpose The purpose of this analysis was to evaluate sensing and defibrillation of a second-generation intercostal, extravascular defibrillation lead (EV-ICD Lead) when used with currently available ICD PGs in a traditional left pectoral location. Methods Patients (n=20) undergoing an ICD implant or replacement underwent acute VF EV-ICD Lead connected to a left pectoral pulse generator. Induced VF was sensed and shocked using a 10 J safety margin, with subsequent higher-energy shocks delivered if required. Testing was also conducted in the left lateral pocket for a paired analysis with patients serving as their own control. Results Automatic sensing of acute, induced VF episodes from the left pectoral PG was successful in 19 of 20 patients (95%) whose pre-induction R-waves were greater than 1.0 mV and unsuccessful in one subject with a pre-induction R-wave of 0.3 mV. VF was successfully terminated with a 10 J safety margin in 17 of 20 (83%) patients, a 5 J safety margin in 2 of 20 (10%) patients and failed to convert one patient (BMI 32.9) from the pectoral pocket (however, conversion was successful from a lateral pocket with a 10 J shock, which provides a 30 J safety margin. With a left lateral ICD, 100% of patients demonstrated successful VF termination with ≥10 J safety margin. Conclusion(s) Sensing and defibrillation using a left pectoral PG location is feasible with a new intercostal, extravascular defibrillation lead.

Posterior Correction and Fusion Using a 4D Anatomical Spinal Reconstruction Technique Improves Postural Stability Under the Eye-Closed Condition in Patients with Adolescent Idiopathic Scoliosis.

Background: Patients with adolescent idiopathic scoliosis (AIS) has been reported to exhibit impaired postural stability. Posterior correction and fusion using four-dimensional (4D) anatomical spinal reconstruction techniques may improve postural stability to correct the spine for optimal anatomical alignment. This prospective study aimed to determine the effect of posterior correction and fusion using a 4D anatomical spinal reconstruction technique on postural stability in the eye-open and eye-closed standing position in patients with thoracic AIS. Methods: Thirty-three patients with AIS, excluding those with Lenke type 5C AIS, participated in the study. The mean and standard deviation of the minimum values of the time-to-boundary (TTB) were determined. All patients were asked to perform the quiet standing position under the eye-open and eye-closed condition on a force plate preoperatively and at 1 week and 2 years postoperatively. The TTB value was calculated from the velocity and distance to the foot boundary of the acquired center-of-pressure data. Results: Under the eye-closed condition, the mean and standard deviation of the minimum TTB were significantly higher at 2 years postoperatively than preoperatively and at 1 week postoperatively. The mean and standard deviation of the minimum TTB values were significantly lower at 1 week postoperatively than preoperatively. Conclusions: The results of this study suggest that surgery using the 4D anatomical spinal reconstruction technique reduces postural stability immediately after surgery; however, it improves postural stability at 2 years compared to the preoperative values.

Use of a Microelectromechanical Systems Sensor for Objective Measurements of Abnormal Head Posture in Congenital Superior Oblique Palsy Patients.

The purpose of this study was to design an objective method for measurement of head positions as achieved with use of a microelectromechanical systems (MEMS) sensor. In addition, to use this system to observe the abnormal head position (AHP) in patients with congenital superior oblique palsy (SOP) before and after their surgery. An MEMS sensor was designed for recording of the pitch, roll, and yaw values of the head position in real time. The MEMS sensor was then fixed on the synoptophore from -30 degrees to +30 degrees positions horizontally and vertically to test the accuracy of these measurements. Then, we tested 13 participants with AHP using the MEMS method and the photographic method and compared their correlations. Finally, the pitch, roll, and yaw values of head positions were measured using this MEMS sensor in 31 patients with congenital SOP as performed before and after their surgery. The MEMS sensor (LPMS-B2; Alubi, Guangzhou, China; 400 hertz [Hz]), as based on the theory of a gyroscope, was designed and connected to a smartphone via Bluetooth. It was able to conveniently record the patient's pitch, roll, and yaw head positions in real time, recordings which were consistent with the scales of the synoptophore (P > 0.05) and good correlations with the photographic method (P < 0.001). The main preoperative AHP in patients with SOP was roll (22/31, 71%). Pre- and postoperative vertical deviations were 16.4 ± 7.3 prism diopters (PD) and 4.1 ± 4.2 PD, respectively (P = 0.001). The AHP in patients with SOP was positively correlated with the angle of extorsion in the dominant eye (P = 0.01), rather than that of the vertical deviation. The MEMS sensor described in this report is a simple, practical, and accurate objective device for use in head position measurements. In patients with SOP, the AHP is related to the angle of extorsion in the dominant eye. The MEMS sensor was designed as a micro-wireless dynamic high-precision device for AHP measurement, which has the potential for use in a clinic.

Does the utilization of fluoroscopy affect the accuracy of prosthesis position in patients undergoing hip replacement surgery via the direct anterior approach compared to the posterolateral approach for an experienced surgeon? A single-center retrospective study

BackgroundThe direct anterior approach (DAA) for total hip arthroplasty (THA) has gained popularity due to perceived advantages in achieving better early outcomes. However, the theoretical benefits such as precise implant positioning and accurate leg length restoration are still inconsistent. In this study, we compared implant position and leg length discrepancy (LLD) of the DAA and posterolateral approach (PLA) conducted by a single surgeon who had mastered both approaches.MethodsThis study retrospectively reviewed the medical records and radiographic images of 244 patients who underwent THA between 2012 and 2021 by a single experienced surgeon using either the DAA (n = 120) or PLA (n = 124). Postoperative pelvic anteroposterior radiographs at 6 months follow-up were used to assess acetabular component inclination and anteversion, as well as LLD. Mann-Whitney U tests and Chi-squared test were performed to compare outcomes between the two approaches.ResultsNo significant differences were observed in patient demographics between the two groups. The DAA group demonstrated significantly lower postoperative LLD (0.00 mm) compared to the PLA group (5.00 mm, p < 0.0001). No significant difference was observed in the Lewinnek zone for cup anteversion and inclination angles between the two groups.ConclusionsFor experienced surgeons in other approaches, our findings suggest transferring to the DAA may not substantially improve cup positioning, but it might slightly enhance limb length measurement. For surgeons already proficient in other approaches and deciding to maintain those approaches, their primary concern for optimal THA outcome should be striving for leg length equivalence.

Prone position applied to COVID-19 patients: Systematic review-meta-analysis.

Position change and interventions to increase lung capacity should be considered in mechanically ventilated patients. The most effective of these is the prone position. This systematic review and meta-analysis aimed to determine the effects of the prone position on respiratory parameters and outcomes and to guide nurses working in the intensive care unit. This systematic review-meta-analysis was conducted in accordance with the Preferred Reporting in Systematic Reviews and Meta-Analyses guideline. ScienceDirect, CINAHL, Academic Search Complete (EBSCOhost), MEDLINE, EMBASE, Web of Science, Cochrane and PubMed databases were searched between January 2022 and January 2023 to access studies related to prone position in COVID-19 patients. Twenty-three studies were included. This meta-analysis shows that a prone position is feasible and can achieve improvements in gas exchange. Prone position increases PaO2/FiO2 in the majority of patients followed with a diagnosis of COVID-19 and severe hypoxemic. The study has shown that the prone position is effective in improving patients' respiratory function and oxygenation. The results presented in this article support the notion that the prone position can be an effective strategy in the clinical management of COVID-19 patients.

Impact of Exclusive Mouth Route and Lateral Position on the Efficacy of Oronasal CPAP to Treat OSA in Patients With OSA Adapted to Oronasal Mask

BackgroundOronasal masks are widely used for treating OSA with CPAP. However, oronasal CPAP is associated with lower effectiveness and lower adherence than nasal CPAP. Research QuestionWhat is the impact of oral route and lateral position in patients well adapted to oronasal CPAP? Can these patients be switched to nasal CPAP? Study Design and MethodsPatients with OSA on oronasal CPAP underwent 2 CPAP polysomnography (PSG) titrations in random order using an oronasal mask with 2 independent sealed compartments connected to two separate pneumotachographs. One study was done with the nasal and oral compartments opened and the other study with only the oral compartment opened. CPAP titration was done in the supine and lateral position. Finally, the patients were offered a nasal mask. A third PSG was performed using nasal CPAP. ResultsTwenty OSA patients (baseline AHI: 52 ± 21 events/h) adapted to oronasal CPAP were studied. Most patients (75%) were oronasal breathers on optimal CPAP. Oral CPAP was less effective to treat OSA than oronasal CPAP, evidenced by a higher residual AHI (2 (1 - 6.0) vs 12.5 (1.8 - 28.3); P = 0.003), despite a significantly higher CPAP level, (10 (9 - 10) vs 11 (10 - 12) cmH20; P = 0.003). The residual AHI was significantly lower in the lateral position for both oronasal and oral CPAP. Finally, patients (75%) agreed to change and preferred to continue on nasal mask, which resulted in lower CPAP and better OSA control. InterpretationThe effectiveness of oronasal CPAP to abolish OSA is significantly decreased when patients are required to breathe exclusively through the mouth. Oronasal CPAP efficacy is significantly better in the lateral position. The transition to nasal mask results in higher CPAP effectiveness to treat OSA.

Pelvic and Lower Limb Kinematics in Individuals With Chronic Low Back Pain During Sit-to-Stand Function: A Cross-Sectional Study

ObjectivesThe aim of this study was to investigate the 3-dimensional movement kinematics of pelvic and lower limb joints in CLBP subjects, compared to healthy individuals, utilizing a functional data analysis (FDA) approach. MethodsIn this study, a 7-camera Qualisys motion capture system was employed to record the kinematics of the pelvic, hip, knee, and ankle joints in 20 patients with low back pain (LBP) and 20 control subjects on both sides during the sit-to-stand motion. An FDA statistical approach was utilized to compare the data collected over time between the 2 groups. The STS task was divided into two distinct phases: the prelift off phase (pre-Lo) and the postlift off phase (post-Lo). ResultsDuring the “pre-Lo phase” of the STS motion, our statistical analysis revealed that the only significant difference between the two groups was a decreased medial rotation (P = .00) in the hip joint position of LBP patients on their dominant side, in comparison to healthy subjects. As for the “post-Lo phase,” the LBP group exhibited a more anterior pelvic tilt position (P = .00) and increased pelvic counterclockwise rotation (P = .03) in the sagittal and transverse planes when compared to the control group. Regarding hip joints, the LBP group demonstrated a more flexed position (indicative of reduced extension) on both the dominant (P = .00) and nondominant (P = .00) sides, coupled with diminished abduction (P = .04) and internal rotation (P = .03) of the hip on the dominant side. In relation to the knee and ankle joints, the results indicated a more adducted knee position (P = .00) and decreased ankle joint flexion (P = .02) on the dominant side in CLBP subjects when compared to the healthy group during the STS motion. ConclusionOur findings indicate that patients with CLBP exhibited distinct kinematic patterns in the pelvic and lower limb joints during the STS motion. These kinematic alterations primarily manifest in the joints of the dominant limb, with most of the differences observed during the second phase (postlift off phase) of the motion. It appears that these changes in pelvic and lower limb joint kinematics should be taken into account when planning future rehabilitation programs for CLBP patients engaged in this task.

Evaluation of changes in Mallampati grading in patients undergoing elective urological procedures in prone and lithotomy positions- A prospective observational study

Intubation often results in airway edema, which can lead to reintubation following planned extubation in the post-anesthesia care unit. In urological procedures like percutaneous nephrolithotomy (PCNL) and ureteroscopic lithotripsy (URSL), the use of irrigation fluids may exacerbate these airway changes. This study aims to assess alterations in Mallampati grading in patients undergoing elective urological procedures, particularly in prone and lithotomy positions.This prospective observational study was conducted at a tertiary care hospital from May 2021 to September 2021. Sixty patients with ASA I and II classifications scheduled for elective PCNL in the prone position and URSL in the lithotomy position, with 30 patients in each group, were enrolled. We assessed the Modified Mallampati Grading (MPG) before the procedure and at postoperative intervals of 4 h, 8 h, 12 h, 24 h, and 48 h, noting any changes and the time required to return to the baseline. We also recorded the number of irrigation fluids used, intravenous (IV) fluids administered, surgery duration, and estimated blood loss to explore potential associations.MPG changed by at least one class in 36.6 % of patients in the prone position and 20 % of patients in the lithotomy position. Furthermore, MPG changed by two classes in 20 % of patients in the prone position and 3.3 % of patients in the lithotomy position. The absorption of irrigation fluids was identified as a potential cause of airway edema, with a significant p-value of 0.0001, leading to worsening of the MPG. Fortunately, in most patients, the changes in MPG returned to baseline values within 24 h.In conclusion, our study confirms that Mallampati grading may experience at least a one-class increase in both prone and lithotomy positions in most patients, and it typically reverts to baseline in about 24 h for most patients. These airway changes should be considered when re-intubating patients in the postoperative period.

Respiratory effects of prone position in COVID-19 acute respiratory distress syndrome differ according to the recruitment-to-inflation ratio: a prospective observational study

BackgroundImprovements in oxygenation and lung mechanics with prone position (PP) in patients with acute respiratory distress syndrome (ARDS) are inconstant. The objectives of the study were (i) to identify baseline variables, including the recruitment-to-inflation ratio (R/I), associated with a positive response to PP in terms of oxygenation (improvement of the ratio of arterial oxygen partial pressure over the inspired oxygen fraction (PaO2/FiO2) ≥ 20 mmHg) and lung mechanics; (ii) to evaluate whether the response to the previous PP session is associated with the response to the next session.MethodsIn this prospective, observational, single-center study in patients who underwent PP for ARDS due to COVID-19, respiratory variables were assessed just before PP and at the end of the session. Respiratory variables included mechanical ventilation settings and respiratory mechanics variables, including R/I, an estimate of the potential for lung recruitment compared to lung overinflation.ResultsIn 50 patients, 201 PP sessions lasting 19 ± 3 h were evaluated. Neuromuscular blockades were used in 116 (58%) sessions. The PaO2/FiO2 ratio increased from 109 ± 31 mmHg to 165 ± 65 mmHg, with an increase ≥ 20 mmHg in 142 (71%) sessions. In a mixed effect logistic regression, only pre-PP PaO2/FiO2 (OR 1.12 (95% CI [1.01–1.24])/every decrease of 10 mmHg, p = 0.034) in a first model and improvement in oxygenation at the previous PP session (OR 3.69 (95% CI [1.27–10.72]), p = 0.017) in a second model were associated with an improvement in oxygenation with PP. The R/I ratio (n = 156 sessions) was 0.53 (0.30–0.76), separating lower- and higher-recruiters. Whereas PaO2/FiO2 improved to the same level in both subgroups, driving pressure and respiratory system compliance improved only in higher-recruiters (from 14 ± 4 to 12 ± 4 cmH2O, p = 0.027, and from 34 ± 11 to 38 ± 13 mL/cmH2O, respectively, p = 0.014).ConclusionsA lower PaO2/FiO2 at baseline and a positive O2-response at the previous PP session are associated with a PP-induced improvement in oxygenation. In higher-recruiters, lung mechanics improved along with oxygenation. Benefits of PP could thus be greater in these patients.

Study of the Diagnostic Accuracy Between the Position of the Articular Disc According to Magnetic Resonance Imaging and Arthroscopy Findings for Temporomandibular Disorders.

The aim of this study was to prospectively evaluate the diagnostic accuracy between the position of the disc in the temporomandibular joint (TMJ) according to findings on magnetic resonance (MRI) imaging and the position of the disc depending on the "roofing" in arthroscopic evaluation in patients who underwent arthroscopy for a temporomandibular disorder (TMD). This relationship was analyzed in 298 patients diagnosed with internal derangements. The concordance between the 2 methods was evaluated using the κ coefficient. A significant agreement was observed between the findings in MRI and roofing in arthroscopy with an excellent concordance between the variables (κ=0.83, P<0.05). This indicates that both diagnostic methods are equally valid in the precise description and evaluation of the disc position for patients with a TMD undergoing arthroscopy.

ABC/VEN-analysis of baseline therapy for chronic heart failure: the position of physicians and patients

Introduction. Pharmacoeconomic studies of chronic heart failure (CHF) treat- ment remain relevant in primary care. Objective – ABC/VEN-, analysis of the three-component therapy of CCN from the perspective of physicians’ prescribing and its use by patients. Material and methods. Two groups of CHF patients were analyzed. The first group consisted of 71 patients selected from 745 outpatient records. The second group consisted of 31 CHF patients, obtained from 1,284 online questionnaires. They studied the use of angiotensin converting enzyme in- hibitors (iACE), angiotensin II receptor antagonists (APA II), beta blockers (BB), aldosterone antagonists (AA) and fixed combinations (FC) contain- ing antihypertensive drugs. ABC, VEN, and frequency analysis and the “cost minimization” method were used. The daily cost of treatment with the drug was estimated, taking into account its price in the “EAPTEK” and the target/maximum dose prescribed in the clinical recommendations (CR). Results. Physicians and patients used 4 groups of three-component therapy (iACE/APA II; BB and AA) as well as FC in the treatment of CHF. Three-com- ponent therapy was prescribed by physicians in single cases; patients took it more often. In physicians and patients, the choice of drugs from different groups of three-component therapy for CHF from the position of VEN analysis corresponded to class A, such was not the case in classes B and C. Physicians prescribed 9 drugs from the group of ACE inhibitors to half of the patients; one third of them took 6 items. Their use did not always take into account dosing frequency and cost, contributing to 2.5 times more spending per patient per day than the use of ramipril. Physicians prescribed 5 items from the ARA II group to every fifth patient; a third of them were taking 2 drugs. Both did not always take into account the CR and the cost of the drugs. The latter resulted in 1.5 times higher costs per patient per day than the use of Lorista®. Doctors and patients used the same BB only in 60.0% of cases. The choice of drugs from this group was rationalised in only half of the cases, resulting in one- third more costs compared to cheap Bisoprolol. Physicians prescribed AA to only one in ten patients; they took them in almost one in two cases. Both preferred Verospirone to Spironolactone, which was 0.2 roubles/day cheaper. Physicians and patients used FC equally rarely. Out of 9 drugs prescribed by doctors, patients took two. Many of them contained drugs not specified in the CR for treatment of CHF. The cost of treatment of one patient with them ex- ceeded the justified use of Valsartan+hydrochlorthiazide more than 1.5 times. Conclusion. Physicians in the outpatient clinic and patients at home rarely use three-component therapy of CHF. From the position of ABC- and VEN-analy- sis, the most optimal was class A in category V, which represents drugs from all groups (iAPP/APA II; BB, AA and FC) used in the treatment of CHF. Howev- er, both do not always focus on CR and drug cost when selecting them. The latter contributes to a greater financial cost compared to the proposed option. The situation can be improved through online interaction between doctors, patients, pharmacies and pharmaceutical companies.