Category: Nevin Manimala

Acta Orthop Belg. 2024 Jun;90(2):229-232. doi: 10.52628/90.2.12459.

ABSTRACT

While many humeral shaft fractures can be successfully treated with nonoperative management, compression plating techniques using at least three or four screws on either side of the fracture are the current gold standard. We hypothesized that a less rigid construct using compression with only two screws on either side of the fracture can provide adequate strength for uneventful fracture union. This is a retrospective review of all the patients who underwent open reduction and compression plate fixation for acute diaphyseal humerus fractures (ADHFs) at an academic Level-1 urban trauma center between 2018 and 2023. Patients treated with compression plating using only two screws and three or four plate-holes on either side of the fracture (Group 1) were matched one-to-one with patients treated using the conventional number of screws (three or more on either side of the fracture – Group 2). The incidence of nonunion/malunion, infection, and implant failure was compared among the two groups. There were eleven matched patients in both groups. The nonunion, infection complications, and hardware failure rates were 0% and 9.1% for the control group (Group 2) and four-screw group (Group 1) respectively. This difference was not statistically significant (p = 1.00). Although convention dictates the use of six or more bicortical screws (at least three bicortical screws on each side of the fracture), four-screw bicortical fixation may be a feasible option for ADHFs treated with large fragment compression plating techniques.

PMID:39440498 | DOI:10.52628/90.2.12459

Acta Orthop Belg. 2024 Jun;90(2):211-216. doi: 10.52628/90.2.12480.

ABSTRACT

This study aims to analyze the improvement and prognosis of anxiety and depression in patients with knee osteoarthritis after total knee arthroplasty. A retrospective questionnaire survey was conducted on 180 patients with knee osteoarthritis who underwent total knee arthroplasty. The questionnaire consisted of a general information questionnaire, the Zung Self-Rating Anxiety Scale (SAS) for anxiety, the Zung Self-Rating Depression Scale (SDS) for depression, the Visual Analog Scale (VAS), the Pittsburgh sleep quality Index (PSQI), and the American Knee Society Scores (AKSS). The same questionnaires were administered preoperatively and at 3, 6 and 12 months postoperatively, and the results were statistically analyzed. The prevalence of anxiety in preoperative knee osteoarthritis patients was 29.2% and the prevalence of depression was 37.5%. At 3, 6, and 12 months after total knee arthroplasty, anxiety and depression, pain levels, sleep disturbances, and functional status of the knee were significantly improved in patients with knee osteoarthritis compared with the preoperative period (all P<0.05). Patients with knee osteoarthritis have significant anxiety and depression before surgery, and total knee arthroplasty can significantly improve their anxiety, depression and prognosis, and should be performed as early as possible in patients with knee osteoarthritis.

PMID:39440495 | DOI:10.52628/90.2.12480

Acta Orthop Belg. 2024 Jun;90(2):205-209. doi: 10.52628/90.2.9079.

ABSTRACT

This retrospective study was designed to assess two fixed bearing total knee design concepts and their clinical outcomes, particularly in Forgotten Joint Score-12 (FJS-12). Patients were assessed clinically using the Knee Society Score (KSS). Participants completed an FJS-12 and a short form of the Knee Injury and Osteoarthritis Outcome Score (KOOS-PS). A total of 216 knees -76 with Genesis II and 150 with Vanguard total knee arthroplasties – were included. Patients in the Vanguard group had significantly better postoperative FJS-12 scores (by 10.1 points, p = 0.019). Differences in KSS subscores also reached the level of statistical significance. KOOS-PS did not differ significantly. Statistically significant differences between the two knee designs on FJS-12, KS and FS assessments were revealed, but overall, these differences may not reach the threshold of clinical significance.

PMID:39440494 | DOI:10.52628/90.2.9079

Acta Orthop Belg. 2024 Jun;90(2):195-203. doi: 10.52628/90.2.9742.

ABSTRACT

Reconstruction of the Medial Patellofemoral Ligament (MPFL) has become the procedure of choice in patients with patellar instability. The type of graft used for reconstruction is controversial. The purpose of this study was to analyze and describe the clinical and radiological results achieved with a MPFL reconstruction performed using an extensor hallucis longus allograft. This work is a retrospective study of 41 patients (45 knees) who underwent MPFL reconstruction using an extensor hallucis longus allograft. The patellar apprehension test, Kujala scale, and EQ-5D European quality of life scale were evaluated preoperatively and postoperatively at 24 months. Complications, recurrence rate, time to return to sports, and satisfaction with the procedure were also assessed. Statistically significant differences were observed between pre- and postoperative variables on the Kujala scale (p < .001) and the EQ-5D (p < .001). The isolated MPFL presented an increase on the Kujala scale of 41.9 ± 13.4, in contrast to the reconstruction with tibial tubercle osteotomy with an increase of 29.4 ± 16.6 (p = 0.031). MPFL reconstruction with an extensor hallucis longus allograft is a suitable alternative in patients with patellofemoral instability because it offers clinically and radiologically satisfactory results. MPFL reconstruction combined with a tibial tubercle osteotomy can offer inferior functional outcomes to the isolated reconstruction.

PMID:39440493 | DOI:10.52628/90.2.9742

BMC Public Health. 2024 Oct 22;24(1):2925. doi: 10.1186/s12889-024-20364-5.

ABSTRACT

INTRODUCTION: The development of a potent immune response and antibodies against SARS-CoV-2 is important for herd immunity. The serological response may be due to a previous infection or vaccination. Healthy blood donors could represent and provide information on the immune status of the general population. Therefore, we estimated the global and regional prevalence of SARS-CoV-2 antibodies among healthy blood donors.

METHODS: We conducted a systematic search of PubMed, Scopus, and ProQuest from December 2019 to January 2023. After critical appraisal and quality assessment, a qualitative synthesis of the identified relevant articles was performed. The random-effects model was used to estimate the pooled prevalence of SARS-CoV-2 antibodies. Funnel plots and Egger’s test were used to assess publication bias. Sensitivity analysis was performed, and heterogeneity was quantified using I² statistics.

RESULTS: A total of 70 peer-reviewed articles were selected that together included 2,454,192 blood donors. The global estimated pooled prevalence of SARS-CoV-2 antibodies among healthy blood donors was 10.3% (95% CI: 4.6 – 18.0%, n = 70). The highest seroprevalence was observed in Asia (17.7%), followed by Africa (16.1%). The seroprevalence in studies conducted before the introduction of the vaccine was 6.1%, whereas those of studies conducted after vaccines were available was 27.6%. High seroprevalence was observed in studies that measured antibodies against the S protein of the virus (15.2%), while lower (12.5%) in those that measured antibodies against the N protein. A high seroprevalence was observed in studies that only measured IgG antibodies (16.3%), and it was 5.9% in studies that measured total antibodies.

CONCLUSION: The prevalence of SARS-CoV-2 antibodies among healthy blood donors varies, potentially indicating geographical disparities in transmission and vaccination rates. To enhance community resilience, addressing these differences through inclusive health policies and adaptable public health measures is crucial.

PMID:39438911 | DOI:10.1186/s12889-024-20364-5

BMC Cancer. 2024 Oct 22;24(1):1302. doi: 10.1186/s12885-024-13023-w.

ABSTRACT

BACKGROUND: Patients with cancer (PwC) who undergo specific treatments reported greater fatigue and reduced functional capacity as predominant outcomes, compromising their QoL during and following the treatment. Prehabilitation intervention, provided after diagnosis and before treatments, is to optimize the physiological reserve and address modifiable risk factors before surgery or chemotherapy to improve post-treatment results. The primary aim of this study is to obtain a common line of efficacy compared with prehabilitation treatment; the secondary endpoint is to assess the methodological quality of the studies eligible in the review.

METHODS: The systematic review was conducted from September to February 2024, in accordance with PRISMA guidelines. Databases consulted were MEDLINE, Scopus, Web of science and CINAHL, RCTs related to Prehabilitation intervention on PwC were included. The methodological quality of the included studies was assessed through the RoB2 Cochrane tool and the PEDro scale. Meta-analysis was performed to estimate relative treatment effects among evaluated outcomes.

RESULTS: Forty-two studies were included in the systematic review, 13 were included in the quantitative analysis. The results of the studies reporting reduced postoperative hospital stay, improved endurance, muscle strength, respiratory function, quality of life, and urinary incontinence. Critical analysis of the articles using the PEDro scale revealed 28 RCTs with a good rating, 9 with a fair rating, and 5 with a poor rating; in contrast, the Cochrane RoB2 tool revealed that all articles were at high risk of bias. Meta-analysis showed statistically significant values for 6MWT (38.53, 95%CI 33.03 – 44.04); HADS-depression (-0.71, 95%CI -0.93 -0.49) and HADS-anxiety (-0.49, 95%CI -0.76 -0.23).

CONCLUSIONS: Prehabilitation represents a specific intervention that aims to improve postoperative outcomes in fragile patients undergoing surgery, increasing their preoperative physiological reserve in anticipation of the stress they will face and facilitating the postoperative recovery of functional capacity. Prehabilitation is a good intervention to use, especially in terms of functional capacity and mental health, the latter being very impactful in terms of reduced levels of anxiety and depression. These data make it possible to justify supportive intervention by physical therapists aimed at improving and restoring health-related QoL especially in the short term.

PMID:39438910 | DOI:10.1186/s12885-024-13023-w

BMC Public Health. 2024 Oct 22;24(1):2930. doi: 10.1186/s12889-024-20291-5.

ABSTRACT

BACKGROUND: Social inequalities in child mental health are an important public health concern. Whilst previous studies have examined inequalities at a single time point, very few have used repeated measures outcome data to describe how these inequalities emerge. Our aims were to describe social inequalities in child internalising and externalising problems across multiple countries and to explore how these inequalities change as children age.

METHODS: We used longitudinal data from eight birth cohorts containing participants from twelve countries (Australia, Belgium, Denmark, France, Germany, Greece, Italy, Netherlands, Poland, Norway, Spain and the United Kingdom). The number of included children in each cohort ranged from N = 584 (Greece) to N = 73,042 (Norway), with a total sample of N = 149,604. Child socio-economic circumstances (SEC) were measured using self-reported maternal education at birth. Child mental health outcomes were internalising and externalising problems measured using either the Strengths and Difficulties Questionnaire or the Child Behavior Checklist. The number of data collection waves in each cohort ranged from two to seven, with the mean child age ranging from two to eighteen years old. We modelled the slope index of inequality (SII) using sex-stratified multi-level models.

RESULTS: For almost all cohorts, at the earliest age of measurement children born into more deprived SECs had higher internalising and externalising scores than children born to less deprived SECs. For example, in Norway at age 2 years, boys born to mothers of lower education had an estimated 0.3 (95% CI 0.3, 0.4) standard deviation higher levels of internalising problems (SII) compared to children born to mothers with high education. The exceptions were for boys in Australia (age 2) and both sexes in Greece (age 6), where we observed minimal social inequalities. In UK, Denmark and Netherlands inequalities decreased as children aged, however for other countries (France, Norway, Australia and Crete) inequalities were heterogeneous depending on child sex and outcome. For all countries except France inequalities remained at the oldest point of measurement.

CONCLUSIONS: Social inequalities in internalising and externalising problems were evident across a range of EU countries, with inequalities emerging early and generally persisting throughout childhood.

PMID:39438908 | DOI:10.1186/s12889-024-20291-5

BMC Health Serv Res. 2024 Oct 22;24(1):1269. doi: 10.1186/s12913-024-11762-x.

ABSTRACT

BACKGROUND: Internally displaced persons (IDPs) in Nigeria face a high burden of mental health disorders, with limited access to evidence-based, culturally relevant interventions. Life skills education (LSE) is a promising approach to promote mental health and psychosocial well-being in humanitarian settings. This study aims to evaluate the effectiveness and implementation of a culturally adapted LSE program delivered through in-person and mobile platforms among IDPs in Northern Nigeria.

METHODS: This cluster-randomized hybrid type 2 effectiveness-implementation trial will be conducted in 20 IDP camps or host communities in Maiduguri, Nigeria. Sites will be randomly assigned to receive a 12-week LSE program delivered either through in-person peer support groups or WhatsApp-facilitated mobile groups. The study will recruit 500 participants aged 13 years and older. Intervention effectiveness outcomes include the primary outcome of change in post-traumatic stress disorder (PTSD) symptoms assessed using the PCL-5 scale, and secondary outcomes of depression, anxiety, well-being, and life skills acquisition. Implementation outcomes will be assessed using the Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM). Both sets of outcomes will be compared between the in-person and mobile delivery groups. Quantitative data will be analyzed using mixed-effects linear regression models, while qualitative data will be examined through reflexive thematic analysis. The study will be guided by the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) framework.

DISCUSSION: The RESETTLE-IDPs study addresses key gaps in the evidence base on mental health interventions for conflict-affected populations. It focuses on underserved IDP populations, evaluates the comparative effectiveness of in-person and mobile-delivered LSE, and incorporates implementation science frameworks to assess contextual factors influencing adoption, fidelity, and sustainability. The study employs a community-based participatory approach to enhance cultural relevance, acceptability, and ownership. Findings will inform the development and scale-up of evidence-based, sustainable mental health interventions for IDPs in Nigeria and other humanitarian contexts.

TRIAL SPONSOR: Dalhousie University, 6299 South St, Halifax, NS B3H 4R2, Canada.

TRIAL REGISTRATION: ClinicalTrials.gov, NCT06412679 Registered 15 May 2024.

PMID:39438885 | DOI:10.1186/s12913-024-11762-x

Cardiovasc Diabetol. 2024 Oct 22;23(1):374. doi: 10.1186/s12933-024-02460-3.

ABSTRACT

BACKGROUND: The Steno Type 1 Risk Engine (ST1RE) was developed to aid clinical decisions in primary prevention for individuals with type 1 diabetes (T1D), as existing cardiovascular (CV) risk models for the general population and type 2 diabetes tend to underestimate CV risk in T1D. However, the applicability of ST1RE in different populations remains uncertain, as prediction models developed for one population may not accurately estimate risk in another. This study aimed to evaluate the performance of the ST1RE in predicting CV events among ethnically mixed T1D individuals and its association with the progression of microangiopathy complications.

METHODS: A retrospective survey of 435 adults with T1D who were free of CV events at baseline was assessed by ST1RE and chronic diabetes complications at 5 and 10 years of follow-up. The estimated CV risk rates were compared with the observed rates at 5 and 10 years using statistical analyses, including Receiver Operating Characteristic (ROC) curve analysis, Hosmer-Lemeshow test, Kaplan-Meier curves analysis and Cox-regression models.

RESULTS: Among 435 patients (aged 25 years; interquartile range [IQR]: 21-32) with a median T1D duration of 13 years (IQR: 9-18), only 5% were categorized into the high ST1RE group. Within a median follow-up of 9.2 years (IQR 6.0-10.7), 5.5% of patients experienced a CV event (1.6%, 14.9%, and 50% from the low, moderate, and high-risk groups, respectively). The hazard ratios (HRs) for CV events were greater in the high-risk group (HR 52.02; 95% CI 18.60-145.51, p < 0.001) and in the moderate-risk group (HR 8.66; 95% CI 2.90-25.80, p < 0.001) compared to the low-risk group. The ST1RE estimated CV events were similar to the observed at 5 years (3.4% vs. 3.5%; χ² = 10.12, p = 0.899) and 10 years (6.8% vs. 9.9%; χ² = 14.80, p = 0.676) of follow-up. The progression of microangiopathies was greater in the high vs. low for retinopathy (p = 0.008), diabetic kidney disease (p < 0.001), peripheral neuropathy (p = 0.021), and autonomic neuropathy (p = 0.008).

CONCLUSIONS: ST1RE performed well in predicting CV events at 5 and 10 years of follow-up. Moreover, higher ST1RE scores were associated with the progression of microangiopathy complications in this genetically heterogeneous T1D population.

PMID:39438880 | DOI:10.1186/s12933-024-02460-3

Head Face Med. 2024 Oct 22;20(1):61. doi: 10.1186/s13005-024-00460-y.

ABSTRACT

BACKGROUND: Regenerative endodontic procedures (REPs) offer the promise of restoring vitality and function to a previously necrotic and infected tooth. However, the nature of regenerated tissues following REPs remains unpredictable and uncontrollable. Decellularized extracellular matrix scaffolds have gained recent attention as scaffolds for regenerative endodontics.

OBJECTIVES: Preparation and characterization of a bovine dental pulp-derived extracellular matrix (P-ECM) hydrogel for regenerative endodontic applications. Biocompatibility and regenerative capacity of the prepared scaffold were evaluated in vivo in a canine animal model.

METHODS: Fifteen freshly extracted bovine molar teeth were used to prepare P-ECM hydrogels following approval of the institutional review board of the faculty of dentistry, Alexandria University. Decellularization and lyophilization of the extracted pulp tissues, DNA quantification and histological examination of decellularized P-ECM were done. P-ECM hydrogel was prepared by digestion of decellularized pulps. Prepared scaffolds were evaluated for protein content and release as well as release of VEGF, bFGF, TGF-β1 and BMP2 using ELISA. Rabbit dental pulp stem cells’ (rDPSCs) viability in response to P-ECM hydrogels was performed. Finally, proof-of-concept of the regenerative capacity of P-ECM scaffolds was assessed in an infected mature canine tooth model following REPs versus blood clot (BC), injectable platelet-rich fibrin (i-PRF) or hyaluronic acid (HA). Statistical analysis was done using independent t test, the Friedman test and chi-square tests (p value ≤ 0.05).

RESULTS: DNA was found to be below the cut-off point (50 ng/mg tissue). Histological evaluation revealed absence of nuclei, retention of glycosaminoglycans (GAGs) and collagen content, respectively. P-ECM hydrogel had a total protein content of (493.12 µg/µl) and protein release was detected up to 14 days. P-ECM hydrogel also retained VEGF, bFGF, TGF-β1 and BMP2. P-ECM hydrogel maintained the viability of rDPSCs as compared to cells cultured under control conditions. P-ECM hydrogel triggered more organized tissues compared to BC, i-PRF and HA when used in REPs for necrotic mature teeth in dogs. Periapical inflammation was significantly less in HA and P-ECM groups compared to blood-derived scaffolds.

CONCLUSION: Bovine dental pulp-derived extracellular matrix (P-ECM) hydrogel scaffold retained its bioactive properties and demonstrated a promising potential in regenerative endodontic procedures compared to conventional blood-derived scaffolds.

PMID:39438876 | DOI:10.1186/s13005-024-00460-y