Useful Tool For Monitoring Patients Research Articles

LUNA EMG as a Marker of Adherence to Prehabilitation Programs and Its Effect on Postoperative Outcomes among Patients Undergoing Cytoreductive Surgery for Ovarian Cancer and Suspected Ovarian Tumors.

Prehabilitation is a novel strategy in preoperative management. The aim of this study was to investigate the effect of prehabilitation programs on peri- and postoperative outcomes and to verify if LUNA EMG has the capacity to monitor compliance with prehabilitation programs. A total of seventy patients with suspected ovarian cancer were recruited between April 2021 and September 2022 and were divided into a prehabilitation group (36 patients) or a control group (34 patients). A LUNA EMG device was utilized to monitor muscle strength and tension. Within the prehabilitation group, we observed a significant increase in the 6-Minute Walk Test distance by 17 m (median, IQR: 0-42.5, p < 0.001) and a significant increase in muscle strength measured with LUNA EMG. In comparison to the control group, the prehabilitation group showed fewer complications according to the Clavien-Dindo classification (47.2% vs. 20.6%, p = 0.02) and shorter postoperative hospital stays (median 5.0 days [IQR: 4.0-6.2] vs. 7.0 days [IQR: 6.0-10.0], p < 0.001). Prehabilitation has a positive effect on physical capacity and muscle strength and is associated with a reduction in the number of complications after surgery. LUNA EMG can be a useful tool for monitoring patients' adherence to prehabilitation programs.

Retinal pigment epithelium melanin imaging using polarization-sensitive optical coherence tomography for patients with retinitis pigmentosa

This study aimed to evaluate the distribution of retinal pigment epithelium (RPE) melanin in patients with retinitis pigmentosa (RP) using entropy measurements by custom-made polarization-sensitive optical coherence tomography (PS-OCT) images, and compare entropy with the intensity of short-wavelength (SW) and near-infrared (NIR) autofluorescence (AF). We retrospectively reviewed the retinal images, including PS-OCT, SW-AF, and NIR-AF of patients with RP who had a hyperautofluorescent ring on AF. A total of 12 eyes of 12 patients (8 women and 4 men; mean age: 37.9 years) were included. There was a strong positive correlation between entropy value and NIR-AF intensity (r = 0.626, p < 0.001), and there was a very weak negative correlation between entropy value and SW-AF (r = − 0.197, p = 0.001). The mean values of the entropy in the foveal, temporal (2 mm from the fovea), and nasal (2 mm from the fovea) sections were 0.41 (± 0.09), 0.29 (± 0.08), and 0.26 (± 0.08), respectively. The entropy was significantly higher in the foveal section than in the temporal and nasal sections (p = 0.002 and p = 0.003, respectively). There was no significant difference between the entropies values for the temporal and nasal sections (p = 0.157). Age, logMAR best-corrected visual acuity, ellipsoid zone width, and central retinal thickness were not correlated with foveal entropy. We presented RPE melanin imaging in patients with RP using PS-OCT for the first time. PS-OCT can be a useful tool for monitoring patients with RP.

Lung ultrasound findings in pediatric patients with COVID-19.

During the pandemic caused by the novel coronavirus (COVID-19), lung ultrasound has been used to diagnose and monitor respiratory condition. The aim of the study was to describe lung ultrasound findings in children with a COVID-19 infection. Patients younger than 18 years old and positive for COVID-19, admitted to pediatric tertiary referral hospital were included. They were divided into two groups depending on the presence of respiratory symptoms. Lung ultrasound results were categorized into four degrees according to Soldati et al. score (J Ultrasound Med 39:1–7, 2020) and it was also described the presence and type of consolidation. Sixteen patients were recruited. The median age was 11 years old (IQR 2.8–12). Four children (25%) required admission to the intensive care unit. Six patients (37.5%) presented with respiratory symptoms. Most of them showed S.score of 2 and subpleural consolidations were observed in four cases (66.6%). Ten patients (62.5%) presented with non-respiratory symptoms, lung ultrasound showed S.score from 0 to 2. Three (30%) were diagnosed of multisystem inflammatory syndrome and lung ultrasounds showed S.score of 2 with bilateral pleural effusion.Conclusions: Children with COVID-19 and respiratory symptoms mostly showed a S.score of 2 and 3 with subpleural consolidations, upon the lung ultrasound assessment.What is Known:• Lung ultrasound is a useful tool for monitoring patients with respiratory symptoms in both adults and children. Lung ultrasounds are altered in adult patients with COVID-19.What is New:• Lung ultrasound might improve COVID-19 assessment, it could be a useful tool to diagnose and monitor patients throughout the COVID-19 pandemic. Even COVID-19 patients with non-respiratory symptoms have lung alterations that are visible on lung ultrasound.Electronic supplementary materialThe online version of this article (10.1007/s00431-020-03839-6) contains supplementary material, which is available to authorized users.

Validación de un método inmunológico para la determinación de vancomicina en líquido cefalorraquídeo

Vancomycin (VAN) is an antibiotic used to treat serious infections. Its use is related to adverse effects such as acute facial hyperemia, nephrotoxicity and ototoxicity. By having a very narrow therapeutic range, its monitoring is necessary to maximize efficiency and minimize toxic effects. It is estimated that its concentration in CSF is approximately 10% of the plasma level in patients who receive intravenous treatment and who have meninges inflammation. Plasma concentrations of VAN are not a reliable indicator of those present in CSF. The aim of this study was to validate an immunological method based on the kinetic interaction of microparticles in solution (KIMS) for the determination of VAN in CSF. Materials and Methods: KIMS was validated for the evaluation of VAN in CSF. For this, the parameters of linearity, precision, accuracy, limit of detection, limit of quantification, interference, selectivity and specificity were determined. Results: The method was linear in a range between 0 and 15 µg/mL, the CV% obtained oscillated between 0.7 and 2.5% on the linear range. The LOD and LOQ were 0.4 µg/mL and 1.4 µg/mL respectively. The equation of the line obtained based on the correlation of methods between KIMS and HPLC-UV was y = 0.9151x + 1.1695, R² = 0.9453. Conclusion: The KIMS method demonstrated to have an adequate sensitivity and specificity to determine VAN in CSF and being a useful tool for monitoring patients who present complicated infections at CNS level. KIMS was validated for the evaluation of VAN in CSF. For this, the parameters of linearity, precision, accuracy, limit of detection, limit of quantification, interference, selectivity and specificity were determined. The method was linear in a range between 0 and 15 µg/mL, the CV% obtained oscillated between 0.7 and 2.5% on the linear range. The LOD and LOQ were 0.4 µg/mL and 1.4 µg/mL respectively. The equation of the line obtained based on the correlation of methods between KIMS and HPLC-UV was y = 0.9151x + 1.1695, R² = 0.9453. The KIMS method demonstrated to have an adequate sensitivity and specificity to determine VAN in CSF and being a useful tool for monitoring patients who present complicated infections at CNS level.

Analysis of Correlation between an Accelerometer-Based Algorithm for Detecting Parkinsonian Gait and UPDRS Subscales.

Our group earlier developed a small monitoring device, which uses accelerometer measurements to accurately detect motor fluctuations in patients with Parkinson's (On and Off state) based on an algorithm that characterizes gait through the frequency content of strides. To further validate the algorithm, we studied the correlation of its outputs with the motor section of the Unified Parkinson's Disease Rating Scale part-III (UPDRS-III). Seventy-five patients suffering from Parkinson's disease were asked to walk both in the Off and the On state while wearing the inertial sensor on the waist. Additionally, all patients were administered the motor section of the UPDRS in both motor phases. Tests were conducted at the patient's home. Convergence between the algorithm and the scale was evaluated by using the Spearman's correlation coefficient. Correlation with the UPDRS-III was moderate (rho -0.56; p < 0.001). Correlation between the algorithm outputs and the gait item in the UPDRS-III was good (rho -0.73; p < 0.001). The factorial analysis of the UPDRS-III has repeatedly shown that several of its items can be clustered under the so-called Factor 1: "axial function, balance, and gait." The correlation between the algorithm outputs and this factor of the UPDRS-III was -0.67 (p < 0.01). The correlation achieved by the algorithm with the UPDRS-III scale suggests that this algorithm might be a useful tool for monitoring patients with Parkinson's disease and motor fluctuations.

Common Mistakes in the Dual-Energy X-ray Absorptiometry (DXA) in Turkey. A Retrospective Descriptive Multicenter Study.

Osteoporosis is a widespread metabolic bone disease representing a global public health problem currently affecting more than two hundred million people worldwide. The World Health Organization states that dual-energy X-ray absorptiometry (DXA) is the best densitometric technique for assessing bone mineral density (BMD). DXA provides an accurate diagnosis of osteoporosis, a good estimation of fracture risk, and is a useful tool for monitoring patients undergoing treatment. Common mistakes in BMD testing can be divided into four principal categories: 1) indication errors, 2) lack of quality control and calibration, 3) analysis and interpretation errors, and 4) inappropriate acquisition techniques. The aim of this retrospective multicenter descriptive study is to identify the common errors in the application of the DXA technique in Turkey. All DXA scans performed during the observation period were included in the study if the measurements of both, the lumbar spine and proximal femur were recorded. Forearm measurement, total body measurements, and measurements performed on children were excluded. Each examination was surveyed by 30 consultants from 20 different centers each informed and trained in the principles of and the standards for DXA scanning before the study. A total of 3,212 DXA scan results from 20 different centers in 15 different Turkish cities were collected. The percentage of the discovered erroneous measurements varied from 10.5% to 65.5% in the lumbar spine and from 21.3% to 74.2% in the proximal femur. The overall error rate was found to be 31.8% (n = 1021) for the lumbar spine and 49.0% (n = 1576) for the proximal femur. In Turkey, DXA measurements of BMD have been in use for over 20 years, and examination processes continue to improve. There is no educational standard for operator training, and a lack of knowledge can lead to significant errors in the acquisition, analysis, and interpretation.

Evaluation of Florida Physicians' Knowledge and Attitudes Toward Accessing the State Prescription Drug Monitoring Program as a Prescribing Tool

The purpose of this study is to assess Florida physicians' attitudes and knowledge toward accessing the state's prescription drug monitoring program (PDMP). Five thousand medical doctors and osteopathic physicians licensed in Florida were randomly selected for a voluntary and anonymous 15-question self-administered survey approved by the Institutional Review Board. Surveys were distributed through U.S. postal service mail. Likert-scale questions were used to assess prior knowledge (1 = none to 5 = excellent) and attitudes toward accessing the PDMP (1 = strongly disagree to 5 = strongly agree). The study yielded a response rate of 7.8%, 71.5% of whom agreed or strongly agreed that the PDMP is a useful tool. Among participants that have access and answered the PDMP usefulness question, 94.8% agree or strongly agree that it is a useful tool. There were 63 out of 64 physicians (98.4%) who conducted 25 or more searches who agreed or strongly agreed that the PDMP is a useful tool for monitoring patients' controlled substance histories. There were 72.5% of participants with access that answered the "doctor shopping" question who agreed that "doctor shopping" will decrease. Among the 64 most frequent PDMP users, 69.4% agreed or strongly agreed that they have prescribed fewer controlled substances after accessing the PDMP. The study revealed that a majority of participants believe that the PDMP is a useful tool for monitoring patients' controlled substance histories. More continuing education programs should be provided to Florida physicians to enhance their knowledge regarding PDMPs.

Effect of combinational non protease inhibitor ART treatment on CD4+ T lymphocyte count in AIDS patients: a study from East India

CD4+ T lymphocyte count measures the progression of HIV infection and hence considered as a useful tool for monitoring patients on antiretroviral (ART) treatment. Scattered data is available regarding the response to ART in terms of CD4+ counts. Therefore, present study was undertaken to analyze the effect of ART treatment on CD4+ cells in HIV serology positive patients in Manipur, an eastern state of India. 210 serology positive patients were counseled and enrolled after obtaining their consent. Patients were given ART treatment in following combinations as two nucleoside reverse transcriptase inhibitors, and a non-nucleoside reverse transcriptase inhibitor. The combinations used were Zidovudine + Lamivudine with Efavirenz or Nevirapine, and Stavudine + Lamivudine with Efavirenz or Nevirapine, depending on patient tolerance. Blood specimens were collected from each subject and were subjected to CD4+ cell count by fluorescent activated cell sorter (FACS). ART therapy results in increase of CD4+ count in 168 cases (80%) showed a mean increase in their cell count while 42 cases (20%) showed a net decrease in their cell count after a period of 6 months of treatment. The results of the present study showed that treatment with non-nucleoside reverse transcriptase inhibitor, Efavirenz or Nevirapine does not affect the cell count and need to be study in detail to find out the factors playing role in it.

Transesophageal Echocardiography in Anesthesiology: Characterization of Use Profile in a Tertiary Hospital

Since its introduction in the 80s, transesophageal echocardiography (TEE) not only gained popularity but also experienced great advances in technology and currently it is an extremely valuable tool in the intraoperative period. In Brazil, there are no published data on the profile of its use in the intraoperative period by anesthesiologists. The objective of this study was to describe the use of intraoperative TEE in an Anesthesiology Service in a tertiary private hospital. Retrospective study from completed medical charts in all cases where the patient was monitored with TEE. Monitoring was applied in patients classified as I-II according to the American Society of Echocardiography and presenting no contraindication to the examination. At the end of procedure, after examination, a note on the chart classified monitoring according to its usefulness in the intraoperative period into three groups: group 1, no interference of TEE in anesthetic or surgical approach; group 2, TEE prompted change in anesthetic approach regarding the administration of volume, introduction and/or modification of vasoactive drugs (here, TEE generated change of anesthetic approach in conjunction with other monitors, but it was the deciding factor); group 3, TEE led to a change in approach or review of surgical procedure performed. From January 2009 to January 2011, 164 intraoperative TEE were performed in our service, with 41 pediatric and 123 adult patients. In all patients, the test was successful and there were no problems regarding the introduction of transesophageal tube. In pediatric sample, group I had 10 patients (24.4%), group II had 27 patients (65.8%), and group III had 4 patients (9.8%). Among adults, group I had 38 patients (30.9%), group II had 81 patients (65.9%), and group III had 4 patients (3.2%). Despite this small sample size compared to the literature, and the limitations of this study, there was agreement with other reports related to changes in anesthetic-surgical approach based on intraoperative TEE. Our data also strongly suggest that transesophageal echocardiography is an extremely useful tool for monitoring patients at high cardiovascular risk, even when undergoing noncardiac surgery. Larger studies conducted in our country are needed, as there are no other studies in literature defining the use profile of TEE or even clearly setting out how it has been used in our field.

Polymorphisms of the SLCO1B1 gene predict methotrexate‐related toxicity in childhood acute lymphoblastic leukemia

Methotrexate (MTX) is an important component of the therapy for childhood acute lymphoblastic leukemia. Treatment with high-dose MTX often causes toxicity, recommending a dose reduction and/or cessation of treatment. Polymorphisms in genes involved in the MTX metabolism have been associated with toxicity with controversial results. The discrepancies could be due to differences in treatment protocols among studies, small, or non-homogeneous populations or the use of different toxicity criteria. The aim of the present study was to analyze the possible correlation of polymorphisms of genes involved in the MTX metabolism with the toxicity during therapy with the well-established LAL/SHOP protocol. We analyzed 10 polymorphisms in seven genes (MTHFR, TS, SHMT1, RFC1, ABCB1, ABCG2, and SLCO1B1) from the MTX metabolism in 115 Spanish pediatric B-ALL patients, using MTX plasma concentration as an objective and quantifiable marker of toxicity. We confirmed the suitability of MTX plasma levels as a toxicity marker. We found a statistically significant association between MTX plasma concentration and the SLCO1B1 rs11045879 CC genotype (P = 0.030). The rs4149081 AA genotype, in the same gene, could also be an indicator for high-MTX plasma concentrations. We did not find any significant association in the other genetic polymorphisms analyzed. Identification of the rs4149081 and rs11045879 SLCO1B1 polymorphisms in children with ALL could be a useful tool for monitoring patients at risk of low-MTX clearance in order to avoid MTX-related toxicity.

The use of telehealth for diabetes management: a qualitative study of telehealth provider perceptions

BackgroundMonitoring and Messaging Devices (MMDs) are telehealth systems used by patients in their homes, and are designed to promote patient self-management, patient education, and clinical monitoring and follow-up activities. Although these systems have been widely promoted by health care systems, including the Veterans Health Administration, very little information is available on factors that facilitate use of the MMD system, or on barriers to use.MethodsWe conducted in-depth qualitative interviews with clinicians using MMD-based telehealth programs at two Veterans Affairs Medical Centers in the Midwestern United States.ResultsFindings suggest that MMD program enrollment is limited by both clinical and non-clinical factors, and that patients have varying levels of program participation and system use. Telehealth providers see MMDs as a useful tool for monitoring patients who are interested in working on management of their disease, but are concerned with technical challenges and the time commitment required to use MMDs.ConclusionTelehealth includes a rapidly evolving and potentially promising range of technologies for meeting the growing number of patients and clinicians who face the challenges of diabetes care, and future research should explore the most effective means of ensuring successful program implementation.

Clinical classification of tetanus patients

The authors propose a clinical classification to monitor the evolution of tetanus patients, ranging from grade I to IV according to severity. It was applied on admission and repeated on alternate days up to the 10th day to patients aged > or = 12 years admitted to the State University Hospital, Recife, Brazil. Patients were also classified upon admission according to three prognostic indicators to determine if the proposed classification is in agreement with the traditionally used indicators. Upon admission, the distribution of the 64 patients among the different levels of the proposed classification was similar for the groups of better and worse prognosis according to the three indicators (P > 0.05), most of the patients belonging to grades I and II of the proposed classification. In the later reclassifications, severe forms of tetanus (grades III and IV) were more frequent in the categories of worse prognosis and these differences were statistically significant. There was a reduction in the proportion of mild forms (grades I and II) of tetanus with time for the categories of worse prognostic indicators (chi-square for trend: P = 0.00006, 0.03, and 0.00000) whereas no such trend was observed for the categories of better prognosis (grades I and II). This serially used classification reflected the prognosis of the traditional indicators and permitted the comparison of the dynamics of the disease in different groups. Thus, it becomes a useful tool for monitoring patients by determining clinical category changes with time, and for assessing responses to different therapeutic measures.

Home Monitoring: what can we expect in the future?

The Home Monitoring of implanted cardiac rhythm management devices developed by Biotronik (Berlin, Germany) is a new useful tool for monitoring patients. Home Monitoring provides access to technical and clinical data, allowing almost continuous patient surveillance. The implanted defibrillators and pacemakers transmit encrypted messages, which are automatically analyzed in the Home Monitoring Service Center and sent to the physician. The expected benefit of this kind of data transmission is an improvement in patient follow-up and early detection of changes in the rhythmologic state of the patient. However, these new tools raise several questions, which will require an answer in the nearest future. These questions focus on safety and economic aspects, and on the liability of the physician and the manufacturer. Technological improvement is also expected.

Evaluation of early motor and sensory evoked potentials in cervical spinal cord injury

To determine the efficacy of motor evoked potentials (MEP) and sensory evoked potentials (SEP) in the assessment of severe cervical injury, 17 subjects with severe cervical injury were studied. During the 1st week post-injury and post-surgical treatment, all subjects were submitted to electromyogram (EMG) recordings, dermatomal somatosensory evoked potentials (D.SEP), posterior tibial nerve somatosensory evoked potentials (PTN.SEP), MEP and bilateral cervical electrical stimulations with recording of the diaphragm. For the D.SEP, the latencies of the N9 and N20 responses and the conduction time (N9-N20) were measured in the upper limbs; the latencies of the P40 and P60 responses were measured in the lower limbs. MEP were recorded from distal upper and lower limb muscles following transcranial electrical stimulation of the cortex. (Magnetic stimulation was not indicated because of implanted metallic material in the cervical skull of many patients.) A SEP and MEP grading system was used to improve the assessment of different root neurological levels. In patients with incomplete lesions PTN.SEP, D.SEP and MEP responses could be recorded in territories that were clinically deficient. Patients with complete lesions and absent SEP and MEP responses had a poor outcome. A good correlation was found between the severity of the spinal cord injury and SEP grading. For MEP, the presence or absence of intercostal responses (C4) to cervical and cortical stimulation was the best prognostic indicator. The combined electrophysiological exploration of MEP and SEP proved to be a useful tool for monitoring patients with severe spinal cord injury.

The neu-oncogene product in serum and tissue of patients with breast carcinoma

A soluble 105 kD neu-related protein is detectable in conditioned medium from breast cancer cells expressing the neu-oncogene product and in serum of nude mice bearing tumors that overexpress neu-oncogene. In 100 patients with primary (n = 33) relapse-free (n = 6) and metastatic (n = 61) breast carcinoma the serum levels of the soluble neu-related protein were investigated by ELISA techniques. Median age was 57 years, range 26-89 years. The neu-protein serum levels were below 40 HNU/ml (human neu-antigen unit) in 72 patients and 40 or more HNU/ml in 28 patients. In 30 patients with primary breast carcinoma, tested before mastectomy, all serum-neu-protein samples were negative. However, 26 of 61 metastasized patients (43%) were serum-neu-protein-positivity. In disseminated disease (n = 61), serum-neu-protein-positivity was more likely to be seen in patients with visceral metastases (18/33 = 54%), than in patients with nonvisceral metastases (8/28 = 28%). Furthermore, monitoring of the serum-neu-protein levels reflected clinical course. For 53 patients original paraffin-embedded tumor material was available for studying immunohistochemical neu-protein expression. In 39/53 (73%) patients immunohistochemical and ELISA data showed corresponding results. In 27/30 (90%) patients, from whom sera and tissue could be obtained at the same time at primary mastectomy, results of immunohistochemistry in primary tumor and serum ELISA were negative and mutually confirmatory. However, the other three patients were positive for immunohistochemical neu-protein expression in primary tumor but negative for serum-neu-protein expression. Our results suggest that patients with advanced breast cancer and an elevated serum-neu-protein level may have a poor clinical outcome. This test might be a useful tool for monitoring patients with advanced breast carcinoma, but not those with early disease. Further prospective studies are warranted to elucidate the question of whether this test can contribute to determining prognosis and treatment strategies.