Child developmental outcomes associated with postpartum depression and anxiety in low and middle-income countries: a systematic review.

AIMS: This systematic review aims to summarize the findings of empirical studies conducted in low- and middle-income countries (LMICs) examining the relationship between postpartum depression and anxiety, and child developmental outcomes measured at 24 months of child's age. METHODS: The study was performed as per PRISMA guidelines for a systematic review. EBESCO, ProQuest, PubMed, Science Direct, Google Scholar, and BMJ databases were examined, along with a forward and backward examination of the citations published. The New Ottawa scales (NOS) was used to assess the quality of the studies. The findings of the studies were integrated using a narrative synthesis approach. RESULTS: The systematic review revealed that there are 14 studies examining the impact of postpartum depression (n=14) and postpartum anxiety (n=2) across different domains of child development in LMICs. Studies varied regarding the severity and duration of maternal depression, the context and nature of evaluation, and motherinfant characteristics which are important to understand the association between postpartum depression and anxiety and infant development. Maternal depression is negatively associated with language development, socio-emotional and behavioural development while its association with motor and cognitive development is inconsistent. The impact of maternal anxiety on infant development was examined in two studies, and both have identified a negative association. However, the results of the current review need to be interpreted within the scope and limitations of the methodologies adopted by each study details of which are elaborated in the manuscript. CONCLUSION: Postpartum depression and anxiety can have a wide range of effects on child development. Therefore, periodic infant developmental assessments should become part of routine psychiatric evaluation. There is a need for uniform guidelines for conducting studies and reporting data related to postpartum mental health and child development.

Impact of bariatric surgery on circulating irisin levels: a systematic review and meta­analysis.

This systematic review and meta-analysis evaluated changes in circulating irisin levels after bariatric surgery. A systematic search was performed across Embase, Scopus, PubMed, and Web of Science for this study. The meta-analysis was conducted using Comprehensive Meta-Analysis (CMA) V4 software. The overall effect size was depicted through a random-effects meta-analysis and the leave-one-out method. The meta-analysis, which included 13 studies with a total of 407 participants, showed a statistically non-significant reduction in circulating irisin levels following bariatric surgery (SMD: - 0.089, 95% CI - 0.281, 0.102, 95% PI: - 0.790, 0.611, p = 0.360; I2:70.56). Our research found no significant change in irisin levels after bariatric surgery. Moreover, these findings were not associated with the type of surgery or the duration of follow-up.

Implementation of the International Classification of Diseases 11th revision behavioural indicators for disorders of intellectual development with co-occurring autism spectrum disorder.

BACKGROUND: The classification of mental, behavioural and neurodevelopmental disorders in the World Health Organization's International Classification of Diseases 11th revision (ICD-11) includes a comprehensive set of behavioural indicators (BIs) within the neurodevelopmental disorders grouping. BIs can be used to assess the severity of disorders of intellectual development in situations in which standardised measures of intellectual functioning and adaptive behaviours are not available or feasible. This international study examines the implementation characteristics of the BIs and compares them to standardised measures for assessing the severity of intellectual impairment and adaptive behaviours in disorders of intellectual development and autism spectrum disorder (ASD). The clinical utility of the ICD-11 and the fidelity of its application in international clinical settings were also assessed. METHODS: A total of 116 children and adolescents (5-18 years old) with a suspected or established diagnosis of disorders of intellectual development were included across four sites [Italy (n = 18), Sri Lanka (n = 19) and two sites in India (n = 79)]. A principal component analysis was conducted to evaluate the application of the ICD-11 guidance for combining severity levels. RESULTS: Assessment using the BIs showed a higher proportion of individuals classified with mild severity, whereas the standardised measures indicated a higher proportion of severe ratings. Additionally, individuals with co-occurring ASD tended to have more severe impairments compared with those without ASD, as indicated by both BIs and standardised measures. Overall, the BIs were considered clinically useful, although more time and consideration were required when applying the guidelines for individuals with a co-occurring disorder of intellectual development and ASD. The principal component analysis revealed one principal component representing overall disorders of intellectual development severity levels. CONCLUSIONS: The ICD-11 BIs can be implemented as intended in international clinical settings for a broad range of presentations of individuals with neurodevelopmental disorders. Use of the BIs results in similar severity diagnoses to those made using standardised measures. The BIs are expected to improve the reliability of severity assessments in settings where appropriate standardised measures for intellectual and adaptive behaviours are not available or feasible.

Bariatric Surgery Improves Serum CD40L Levels as a Predictor of Cardiovascular Risk: Systematic Review and Meta-analysis.

CD40 and its ligand have been recently implicated in the pathogenesis of cardiovascular disease (CVD). This meta-analysis examined the effect of bariatric surgery in reducing circulating CD40L levels. A systematic review was performed using Embase, Google Scholar, PubMed, Scopus, and Web of Science. The meta-analysis was provided by Comprehensive Meta-Analysis (CMA) V4 software. The overall effect size was detected by a random-effects meta-analysis and the leave-one-out approach. Random-effects meta-analysis of 7 studies including 191 subjects showed a significant reduction in CD40L after bariatric surgery (standardized mean difference (SMD), - 0.531; 95% CI, - 0.981, - 0.082; p = 0.021; I2, 87.00). Circulating levels of CD40L are decreased after bariatric surgery which may represent a mechanism for improvement of metabolic profile.

A Density Functional Theory Analysis of Electrochemical Oxidation of Methane to Alcohol over High-Entropy Oxide (CoCrFeMnNi)3O4 Catalysts.

The direct conversion of methane into alcohol is a promising approach for achieving a low-carbon future, yet it remains a major challenge. In this study, we utilize density functional theory to explore the potential of the (CoCrFeMnNi)3O4 (CCFMNO) high entropy oxide (HEO) for electrochemical oxidation of methane to methanol and ethanol, alongside their competition with CO2 production. Our primary focus in this study is on thermodynamics, enabling a prompt analysis of the catalyst's potential, with the calculation of electrochemical barriers falling beyond our scope. Among all potential active sites within CCFMNO HEO, we identify Co as the most active site for methane activation when using carbonate ions as oxidants. This results in methanol production with a limiting potential of 1.4 VCHE, and ethanol and CO2 productions with a limiting potential of 1.2 VCHE. Additionally, our findings suggest that the occupied p-band center of O* on CCFMNO HEO is a potential descriptor for identifying the most active site within CCFMNO HEO. Overall, our results indicate that CCFMNO HEO holds promise as catalysts for methane oxidation to alcohols, employing carbonate ions as oxidants.

Prevalence and predictors of female sexual dysfunction among sexually active women in the diabetes prevention program outcomes study.

OBJECTIVE: To determine the burden and identify correlates of female sexual dysfunction (FSD) among women with prediabetes (PreD) and type 2 diabetes (T2D) enrolled in the Diabetes Prevention Program (DPP) Outcomes Study (DPPOS). METHODS: The DPPOS visit included the Female Sexual Function Index (FSFI) to determine sexual function. Of 1464 participants, 1320 (90%) completed the (FSFI) and 426 were sexually active. A backward selection multivariable logistic regression model estimated the odds of FSD for sociodemographic, clinical, and diabetes-related covariates. RESULTS: One hundred and eighty-five (43%) had a score of ≤26.55 and met the criteria for FSD. After adjustment for DPP treatment and age, urinary incontinence (UI) (odds ratio [OR] = 1.91, 95% confidence interval [CI] = 1.15-3.17) and hysterectomy (OR = 1.89, 95% CI = 1.01-3.53) were associated with increased odds of FSD. Increased body mass index was protective for FSD (OR = 0.93 per kg/m2, 95% CI = 0.89-0.96). Michigan Neuropathy Screening Instrument-based peripheral neuropathy (mean±SD scores 1.1±1.3 vs. 0.9±1.1, p < 0.0001) and Electrocardiogram (ECG)-based autonomic dysfunction measures (mean ± SD heart rate levels 64.3 ± 6.8 vs. 65.6 ± 10.2, p = 0.008) were associated with FSD. There were no differences in diabetes rates between women who did (66.5%) and did not (66%) have (p = 0.7). CONCLUSIONS: FSD is prevalent in women with PreD and T2D. Our findings suggest that FSD is associated with neuropathic complications commonly observed in PreD and T2D.

Inflammatory myofibroblastic disease of right petrous apex: A rare case with review of literature.

ABSTRACT: Inflammatory myofibroblastic tumor (IMFT) is a rare tumor of unknown etiology. It can involve any part of the body. The IMFT involving the base of skull is rare with only 36 cases reported in the literature. We report a rare case of IMFT of temporal bone with review of literature. A 42 year old male presented with complaints of headache and double vision and MRI brain showed lesion in the right petrous apex region suggestive of a neurogenic mass. He had excision of lesion and histopathology was suggestive of IMFT with IgG4 and ALK positive. He had complete clinical response but a month later he presented with right eyelid ptosis and decreased rotation of eye medially with recurrent lesion on MRI. Patient received radiation by SRT technique and then started on Ceretinib with partial response. The IMFT is rare tumor of unknown etiology and tumors of temporal bone are more aggressive. It is benign but locally invasive tumor. Treatment of IMFT is controversial. Extensive surgery with complete excision has about 80% response rates and with intracranial extension, adjuvant radiation is need. In head and neck IMFT response rates are lower (30 to 40%). Monoclonal antibodies and steroids are used in IMFT at recurrence. In advanced or metastatic ALK positive tumors, Crizotinib is used with a response rate of 50%. Radiotherapy (25 to 30 Gy) induces remission and helps to taper the steroids. Temporal bone IMFT is a rare tumor with multimodality approach and variable response to treatment.

Prevalence and predictors of erectile dysfunction among men in the diabetes prevention program outcomes study.

OBJECTIVE: To determine burden and identify correlates of erectile dysfunction (ED) among men with prediabetes (PreD) and type 2 diabetes (T2D) enrolled in the Diabetes Prevention Program (DPP) Outcomes Study (DPPOS). RESEARCH DESIGN AND METHODS: The 2017 DPPOS visit included administration of the International Index of Erectile Function. Of 648 male participants, 88 % (n = 568) completed the survey. Associations between sociodemographic, behavioral, clinical, and glycemic measures at time of ED assessment, and ED were examined using multivariable logistic regression models in men with PreD and T2D separately. RESULTS: Overall, 218 (38 %) men met ED criteria. Prevalence was similar in men with PreD (41 %) and T2D (37 %) (p = 0.4). In all men, age (p < 0.001) increased odds of ED. Among men with PreD, those assigned to intensive lifestyle intervention (ILS), but not metformin, had decreased odds of ED compared with the placebo group (OR = 0.35, 95 % CI = 0.13, 0.94). Non-Hispanic White race was associated with increased odds of ED compared with other races (OR = 4.3; 95 % CI = 1.92, 9.65). Among men with T2D, ED risk did not differ by DPP treatment assignment; however, individuals with metabolic syndrome defined by National Cholesterol Education Program criteria, had increased odds of ED (OR = 1.85, 95 % CI = 1.14, 3.01), as did individuals with depression (OR = 2.05; 95 % CI = 1.10, 3.79). CONCLUSIONS: ED is prevalent in men with PreD and T2D. Our finding of reduced odds of ED in men randomized to ILS and with PreD suggests a potential opportunity for risk mitigation in the prediabetes interval. In men who have progressed to T2D, metabolic factors appear to be associated with ED.

Experience and Reporting of Postnatal Depression Across Cultures: A Comparison Using Anchoring Vignettes of Mothers in the United Kingdom and India.

Postnatal mental health is often assessed using self-assessment questionnaires in epidemiologic research. Differences in response style, influenced by language, culture, and experience, may mean that the same response may not have the same meaning in different settings. These differences need to be identified and accounted for in cross-cultural comparisons. Here we describe the development and application of anchoring vignettes to investigate the cross-cultural functioning of the Edinburgh Postnatal Depression Scale (EPDS) in urban community samples in India (n = 549) and the United Kingdom (n = 828), alongside a UK calibration sample (n = 226). Participants completed the EPDS and anchoring vignettes when their children were 12-24 months old. In an unadjusted item-response theory model, UK mothers reported higher depressive symptoms than Indian mothers (d = 0.48, 95% confidence interval: 0.358, 0.599). Following adjustment for differences in response style, these positions were reversed (d = -0.25, 95% confidence interval: -0.391, -0.103). Response styles vary between India and the United Kingdom, indicating a need to take these differences into account when making cross-cultural comparisons. Anchoring vignettes offer a valid and feasible method for global data harmonization.

Individual and environmental factors in internalizing disorders in children and adolescents.

BACKGROUND: Literature has emphasized the role of biopsychosocial factors in internalizing disorders; however, the role of developmental competencies of a child have not been explored much in this context. The current study aimed to understand the differences in developmental competencies, temperament, parenting practices and psychosocial adversities between children with and without internalizing disorders. METHOD: The sample consisted of 200 children and adolescents aged seven to 18 years, with equal number of those with and without an internalizing disorder; and one of their parents. Psychopathology, temperament, interpersonal competence, emotion regulation, executive function, self-concept, adaptive behaviour, parenting practices, life events, family environment and abnormal psychosocial situations were measured using standardized tools. FINDINGS: Discriminant analysis revealed that temperamental domains of sociability and rhythmicity, developmental competencies of adaptive behaviour and self-concept, parenting practices involving father's involvement and overall positive parenting differentiated the clinical and control groups better. Among psychosocial adversities, family environment domains of cohesion and organization, and subjective stress from life events and abnormal psychosocial situations were the most important discriminators. CONCLUSION: The current study reveals that specific individual factors involving temperament and developmental competencies and environmental factors involving parenting practices and psychosocial adversities are significantly associated with internalizing disorders. This has implications for the mental health care of children and adolescents with internalizing disorders.

Effects of testosterone enanthate on aggression, risk-taking, competition, mood, and other cognitive domains during 28 days of severe energy deprivation.

RATIONALE: Behavioral effects of testosterone depend on dose, acute versus sustained formulation, duration of administration, personality, genetics, and endogenous levels of testosterone. There are also considerable differences between effects of endogenous and exogenous testosterone. OBJECTIVES: This study was the secondary behavioral arm of a registered clinical trial designed to determine if testosterone protects against loss of lean body mass and lower-body muscle function induced by a severe energy deficit typical of sustained military operations. METHODS: Behavioral effects of repeated doses of testosterone on healthy young men whose testosterone was reduced by severe energy deficit were examined. This was a double-blind, placebo-controlled, between-group study. Effects of four weekly intramuscular injections of testosterone enanthate (200 mg/week, N = 24) or matching placebo (N = 26) were evaluated. Determination of sample size was based on changes in lean body mass. Tasks assessing aggression, risk-taking, competition, social cognition, vigilance, memory, executive function, and mood were repeatedly administered. RESULTS: During a period of artificially induced, low testosterone levels, consistent behavioral effects of administration of exogenous testosterone were not observed. CONCLUSIONS: Exogeneous testosterone enanthate (200 mg/week) during severe energy restriction did not reliably alter the measures of cognition. Study limitations include the relatively small sample size compared to many studies of acute testosterone administration. The findings are specific to healthy males experiencing severe energy deficit and should not be generalized to effects of other doses, formulations, or acute administration of endogenous testosterone or studies conducted with larger samples using tests of cognitive function designed to detect specific effects of testosterone.

Future thinking and anticipatory pleasure in adolescents with major depression: Association with depression symptoms and executive functions.

OBJECTIVE: Impairments in episodic future thinking and anticipatory pleasure were noted to explain the depressive symptoms in adults however similar studies are not there in adolescents. This study examined whether there are impairments in episodic future thinking and anticipatory pleasure in clinically-depressed adolescents as compared to non-depressed adolescents, and their association with depression when controlled for executive functions and anxiety symptoms among the depressed adolescents. METHODS: The study included 29 adolescents with major depression and 29 adolescents from local schools through convenient sampling technique. All the participants were assessed with standardized measures of depression and anxiety, episodic future thinking, anticipatory pleasure and executive functioning. RESULTS: Depressed adolescents significantly differed from the non-depressed adolescents in autobiographical memory specificity, anticipatory pleasure, and specific dimensions of executive functions. The ANCOVAs indicated executive function slightly attenuated group differences on future specificity which were still non-significant (all p's > .05). For memory specificity and for anticipatory pleasure, group differences were still significant at p < .05 level. CONCLUSION: Adolescents with major depressive episode may display similar, but less pronounced, impairments in future thinking than what is previously reported in adults. Though, autobiographical specificity is prominent. The deficits are attributable to depression than executive functioning deficits.

Improvement of Triglyceride-Glucose Index Following Bariatric Surgery: a Systematic Review and Meta-analysis.

BACKGROUND: Bariatric surgery is an effective intervention for the management of severe obesity and its associated comorbidities, including metabolic abnormalities. This meta-analysis aimed to evaluate the impact of bariatric surgery on the triglyceride-glucose (TyG) index, a novel marker of insulin resistance and metabolic syndrome. METHODS: A systematic search was conducted in Embase, PubMed, Web of Science, and Scopus. The meta-analysis was performed using Comprehensive Meta-Analysis (CMA) V4 software. The overall effect size was determined by a random-effects meta-analysis and the leave-one-out approach. RESULTS: A total of 9 trials including 1620 individuals confirmed a significant reduction in TyG following bariatric surgery (weighted mean difference (WMD) - 0.770, 95% CI - 1.006, - 0.534, p < 0.001). In a sub-analysis according to the type of bariatric surgery there was a significant reduction in TyG index for Roux-en-Y gastric bypass (WMD - 0.775, 95% CI - 1.000, - 0.550, p < 0.001), and sleeve gastrectomy (WMD - 0.920, 95% CI - 1.368, - 0.473, p < 0.001). In a sub-analysis according to the follow-up duration there was similarly a significant reduction in TyG index for both < 12 months (WMD - 1.645, 95% CI - 2.123, - 1.167, p < 0.001), and ≥ 12 months follow-up (WMD - 0.954, 95% CI - 1.606, - 0.303, p < 0.001). CONCLUSION: The results of this meta-analysis demonstrated a significant reduction in the TyG index following bariatric surgery, indicating improved insulin sensitivity and metabolic health. These findings highlight the potential of bariatric surgery as a valuable therapeutic option for individuals with obesity and its metabolic consequences.

Coronary Artery Calcium and Cognitive Decline in the Diabetes Prevention Program Outcomes Study.

Background Our aim was to investigate the association of coronary artery calcium (CAC) with cognitive function in adults with impaired glucose tolerance or type 2 diabetes. Methods and Results The Diabetes Prevention Program was a randomized controlled trial comparing an intensive lifestyle intervention, metformin, or placebo for prevention of type 2 diabetes among patients with prediabetes. After 3 years, intensive lifestyle intervention and placebo were stopped, the metformin arm was unmasked, and participants continued in the DPPOS (Diabetes Prevention Program Outcomes Study). Approximately 14 years after randomization (Y14), CAC (Agatston score) was assessed with computed tomography, and cognitive performance was assessed with the Spanish English Verbal Learning Test (SEVLT) and Digit Symbol Substitution Test. SEVLT and Digit Symbol Substitution Test were reassessed 5 years later (Y19) along with the Modified Mini-Mental State Exam. We examined cross-sectional and longitudinal associations between CAC and cognition among 1931 participants using linear and logistic regression. In unadjusted analyses, compared with no calcification, CAC score >300 was associated with decreased performance on all cognitive tests at Y14 in both sexes. Additionally, CAC >300 was associated with a greater 5-year decline in SEVLT Immediate Recall in both sexes and SEVLT Delayed Recall in women. After adjustment for demographic, genetic, metabolic, vascular, and behavioral covariates, CAC score >300 remained associated with greater decline in only SEVLT Delayed Recall in women. Conclusions In women with prediabetes or diabetes, CAC >300, compared with no calcification, was independently associated with greater decline in verbal memory. Registration information clinicaltrials.gov. Identifier: NCT00038727.

Women's awareness of perinatal mental health conditions and the acceptability of being asked about mental health in two regions in India: a qualitative study.

BACKGROUND: Mental health conditions are common during pregnancy and the first year after childbirth. Early detection allows timely support and treatment to be offered, but identifying perinatal mental health conditions may be challenging due to stigma and under-recognition of symptoms. Asking about symptoms of mental health conditions during routine antenatal and postnatal appointments can help to identify women at risk. This study explores women's awareness of perinatal mental health conditions, their views on the acceptability of being asked about mental health and any preference for specific assessment tools in two regions in India. METHODS: Focus group discussions (FGDs) were conducted with pregnant, post-partum and non-perinatal women in Kangra, Himachal Pradesh (northern India) and Bengaluru, Karnataka (southern India). Settings included a hospital antenatal clinic and obstetric ward, Anganwadi Centres and Primary Health Centres. FGDs were facilitated, audio-recorded and transcribed. Narratives were coded for emerging themes and analysed using thematic analysis. RESULTS: Seven FGDs including 36 participants were conducted. Emerging themes were: manifestations of and contributors to mental health conditions; challenges in talking about mental health; and the acceptability of being asked about mental health. Difficult familial relationships, prioritising the needs of others and pressure to have a male infant were cited as key stressors. Being asked about mental health was generally reported to be acceptable, though some women felt uncomfortable with questions about suicidality. No preference for any specific assessment tool was reported. CONCLUSIONS: Women face many stressors during the perinatal period including difficult familial relationships and societal pressure to bear a male infant. Being asked about mental health was generally considered to be acceptable, but questions relating to suicidality may be challenging in a community setting, requiring sensitivity by the interviewer. Future studies should assess the acceptability of mental health assessments in 'real world' antenatal and postnatal clinics and explore ways of overcoming the associated challenges in resource-constrained settings.

Fundamental Limitation in Electrochemical Methane Oxidation to Alcohol: A Review and Theoretical Perspective on Overcoming It.

The direct conversion of gaseous methane to energy-dense liquid derivatives such as methanol and ethanol is of profound importance for the more efficient utilization of natural gas. However, the thermo-catalytic partial oxidation of this simple alkane has been a significant challenge due to the high C-H bond energy. Exploiting electrocatalysis for methane activation via active oxygen species generated on the catalyst surface through electrochemical water oxidation is generally considered as economically viable and environmentally benign compared to energy-intensive thermo-catalysis. Despite recent progress in electrochemical methane oxidation to alcohol, the competing oxygen evolution reaction (OER) still impedes achieving high faradaic efficiency and product selectivity. In this review, an overview of current progress in electrochemical methane oxidation, focusing on mechanistic insights on methane activation, catalyst design principles based on descriptors, and the effect of reaction conditions on catalytic performance are provided. Mechanistic requirements for high methanol selectivity, and limitations of using water as the oxidant are discussed, and present the perspective on how to overcome these limitations by employing carbonate ions as the oxidant.

Predictors, prevalence, and patterns of cyberbullying among school-going children and adolescents.

Background: Cyberbullying is a major health issue across the globe as it affects the mental health and well-being of the victims, especially children and adolescents, since there is a dearth of studies in the Indian setting. This study aimed to understand the predictors, patterns, prevalence, mental health problems, and coping of cyberbullying among adolescents. Methods: The study adopted a cross-sectional explorative design with 484 adolescents studying in 8th to 12th standards recruited through convenient sampling. The Cyberbullying Online Aggression Survey Instrument (COASI), Strength and Difficulties Questionnaire (SDQ), Coping with Cyberbullying Questionnaire (CWCBQ), and Internet usage pattern were administered to collect the data. Multinomial logistic regression was used to find the predictors of the only cyber-victim, only cyber-offending, and both cyber-victim and cyber-offending. Results: The findings showed that 14.5% of teenagers were victims of cyberbullying, 5.8% were offenders, and 13.8% were both victims and offenders. The predictors for "cyber-victimization" were father's education and religion. The predictors of "cyber-offenders" were grade, Internet usage, and father's occupation. Adolescents identified as both cyber-victims and cyber-offenders were predicted by gender, grade, religion, and father's employment. Conclusion: The study indicated a high prevalence of cyber-victimization and cyber-offending among adolescents with many psychosocial risk factors. The findings highlighted the need for a school-based cyberbullying intervention program to address the issues using a whole-school approach.

Association of Intraoperative Opioid Administration With Postoperative Pain and Opioid Use.

Importance: Opioids administered to treat postsurgical pain are a major contributor to the opioid crisis, leading to chronic use in a considerable proportion of patients. Initiatives promoting opioid-free or opioid-sparing modalities of perioperative pain management have led to reduced opioid administration in the operating room, but this reduction could have unforeseen detrimental effects in terms of postoperative pain outcomes, as the relationship between intraoperative opioid usage and later opioid requirements is not well understood. Objective: To characterize the association between intraoperative opioid usage and postoperative pain and opioid requirements. Design, Setting, and Participants: This retrospective cohort study evaluated electronic health record data from a quaternary care academic medical center (Massachusetts General Hospital) for adult patients who underwent noncardiac surgery with general anesthesia from April 2016 to March 2020. Patients who underwent cesarean surgery, received regional anesthesia, received opioids other than fentanyl or hydromorphone, were admitted to the intensive care unit, or who died intraoperatively were excluded. Statistical models were fitted on the propensity weighted data set to characterize the effect of intraoperative opioid exposures on primary and secondary outcomes. Data were analyzed from December 2021 to October 2022. Exposures: Intraoperative fentanyl and intraoperative hydromorphone average effect site concentration estimated using pharmacokinetic/pharmacodynamic models. Main Outcomes and Measures: The primary study outcomes were the maximal pain score during the postanesthesia care unit (PACU) stay and the cumulative opioid dose, quantified in morphine milligram equivalents (MME), administered during the PACU stay. Medium- and long-term outcomes associated with pain and opioid dependence were also evaluated. Results: The study cohort included a total of 61 249 individuals undergoing surgery (mean [SD] age, 55.44 [17.08] years; 32 778 [53.5%] female). Increased intraoperative fentanyl and intraoperative hydromorphone were both associated with reduced maximum pain scores in the PACU. Both exposures were also associated with a reduced probability and reduced total dosage of opioid administration in the PACU. In particular, increased fentanyl administration was associated with lower frequency of uncontrolled pain; a decrease in new chronic pain diagnoses reported at 3 months; fewer opioid prescriptions at 30, 90, and 180 days; and decreased new persistent opioid use, without significant increases in adverse effects. Conclusions and Relevance: Contrary to prevailing trends, reduced opioid administration during surgery may have the unintended outcome of increasing postoperative pain and opioid consumption. Conversely, improvements in long-term outcomes might be achieved by optimizing opioid administration during surgery.

Analysis of Veno-Venous Extracorporeal Membrane Oxygenation for COVID-19 Compared to Non-COVID Etiologies.

OBJECTIVE: This study analyzed the characteristics and outcomes of veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome (ARDS) due to COVID-19 versus non-COVID causes at US academic centers. BACKGROUND DATA: V-V ECMO support has been utilized for COVID-19 patients with ARDS since the beginning of the pandemic. Mortality for ECMO in COVID-19 has been reported to be high but similar to reported mortality for ECMO support for non-COVID causes of respiratory failure. METHODS: Using ICD-10 codes, data of patients who underwent V-V ECMO for COVID-19 ARDS were compared with patients who underwent V-V ECMO for non-COVID causes between April 2020 and December 2022. The primary outcome was in-hospital mortality. Secondary outcome measures included length of stay and direct cost. Multivariate logistic regression modeling was performed to analyze differences in mortality between COVID and non-COVID groups, adjusting for other important risk factors (age, sex, and race/ethnicity). RESULTS: We identified and compared 6382 patients who underwent V-V ECMO for non-COVID causes to 6040 patients who underwent V-V ECMO for COVID-19. There was a significantly higher proportion of patients aged ≥ 65 years who underwent V-V ECMO in the non-COVID group compared with the COVID group (19.8% vs. 3.7%, respectively, P <0.001). Compared with patients who underwent V-V ECMO for non-COVID causes, patients who underwent V-V ECMO for COVID had increased in-hospital mortality (47.6% vs. 34.5%, P <0.001), length of stay (46.5±41.1 days vs. 40.6±46.1, P <0.001), and direct hospitalization cost ($207,022±$208,842 vs. $198,508±205,510, P =0.02). Compared with the non-COVID group, the adjusted odds ratio (OR) for in-hospital mortality in the COVID group was 2.03 (95% CI: 1.87-2.20, P <0.001). In-hospital mortality for V-V ECMO in COVID-19 improved during the study time period (50.3% in 2020, 48.6% in 2021, and 37.3% in 2022). However, there was a precipitous drop in the ECMO case volume for COVID starting in quarter 2 of 2022. CONCLUSIONS: In this nationwide analysis, COVID-19 patients with ARDS requiring V-V ECMO support had increased mortality compared with patients who underwent V-V ECMO for non-COVID etiologies.