Category: Nevin Manimala

Clin Oral Investig. 2023 Feb 28. doi: 10.1007/s00784-023-04873-y. Online ahead of print.

ABSTRACT

OBJECTIVES: Periodontal disease and diabetes have an extensively investigated bidirectional correlation. Non-surgical periodontal treatment (NSPT) was proven to contribute to glycemic control. Moreover, it may benefit from the association of adjunctive therapies. The aim of the present systematic review is to assess the clinical efficacy of NSPT in association with laser (LT) or photodynamic therapy (PDT) in controlled or uncontrolled diabetic patients, and to grade the level of evidence.

MATERIALS AND METHODS: Randomized controlled clinical trials with at least 3-month follow-up were searched in MEDLINE via OVID, EMBASE, and Cochrane Central, screened for inclusion, and grouped based on the performed treatments, follow-up time, type of diabetes, and level of glycemic control.

RESULTS: Eleven RCTs with 504 total subjects were included. The adjunct of PDT showed a statistically significant 6-month difference in PD changes (with low certainty of evidence), but not in CAL changes, while a significant difference in 3-month PD and CAL changes was found with the adjunct of LT (low certainty of evidence). Patients treated with PDT registered a higher decrease in HbA1c levels at 3 months, but no significant difference was noted at 6 months; LT also led to better HbA1c changes at 3 months with a moderate certainty of evidence.

CONCLUSION: Despite the promising short-term HbA1c decrease, the results should be interpreted with caution due to the small effect sizes and the statistical heterogeneity, and further evidence from well-designed RCTs is needed to support the routine use of PDT or LT in adjunct to NSPT.

PMID:36849595 | DOI:10.1007/s00784-023-04873-y

Nat Hum Behav. 2023 Feb 27. doi: 10.1038/s41562-023-01522-y. Online ahead of print.

ABSTRACT

Preterm birth (PTB) is the leading cause of infant mortality worldwide. Changes in PTB rates, ranging from -90% to +30%, were reported in many countries following early COVID-19 pandemic response measures (‘lockdowns’). It is unclear whether this variation reflects real differences in lockdown impacts, or perhaps differences in stillbirth rates and/or study designs. Here we present interrupted time series and meta-analyses using harmonized data from 52 million births in 26 countries, 18 of which had representative population-based data, with overall PTB rates ranging from 6% to 12% and stillbirth ranging from 2.5 to 10.5 per 1,000 births. We show small reductions in PTB in the first (odds ratio 0.96, 95% confidence interval 0.95-0.98, P value <0.0001), second (0.96, 0.92-0.99, 0.03) and third (0.97, 0.94-1.00, 0.09) months of lockdown, but not in the fourth month of lockdown (0.99, 0.96-1.01, 0.34), although there were some between-country differences after the first month. For high-income countries in this study, we did not observe an association between lockdown and stillbirths in the second (1.00, 0.88-1.14, 0.98), third (0.99, 0.88-1.12, 0.89) and fourth (1.01, 0.87-1.18, 0.86) months of lockdown, although we have imprecise estimates due to stillbirths being a relatively rare event. We did, however, find evidence of increased risk of stillbirth in the first month of lockdown in high-income countries (1.14, 1.02-1.29, 0.02) and, in Brazil, we found evidence for an association between lockdown and stillbirth in the second (1.09, 1.03-1.15, 0.002), third (1.10, 1.03-1.17, 0.003) and fourth (1.12, 1.05-1.19, <0.001) months of lockdown. With an estimated 14.8 million PTB annually worldwide, the modest reductions observed during early pandemic lockdowns translate into large numbers of PTB averted globally and warrant further research into causal pathways.

PMID:36849590 | DOI:10.1038/s41562-023-01522-y

Sci Rep. 2023 Feb 27;13(1):3340. doi: 10.1038/s41598-023-28637-6.

ABSTRACT

A systematic review and meta-analysis of microsurgical vasoepididymostomy (MVE) for treating epididymal obstructive azoospermia (EOA) with different intussusception techniques. We conducted a comprehensive literature search using PubMed, Embase, and the Cochrane Central Register of Controlled Trials, retained literature related to obstructive azoospermia or male infertility and vasoepididymostomy, proactively reviewed other relevant literature, supplemented valuable references, and excluded studies that did not use intussusception and where valuable statistical data were difficult to obtain. Event rate and risk ratio (RR) were estimated. Patency rates were investigated. The influence of motile sperms found in the epididymal fluid, anastomotic sides and sites on patency was evaluated. 273 articles were comprised in this analysis, and 25 observational studies were eventually included, with a total patient sample of 1400. The overall mean patency rate was 69.3% (95% confidence interval [CI] 64.6-73.6%; I² = 63.735%). We conducted a meta-analysis of the factors affecting patency after microsurgical IVE, finding that the presence of motile sperms in epididymal fluid (RR = 1.52; 95% CI 1.18-1.97%; P = 0.001), anastomosing bilaterally (RR = 1.32; 95% CI 1.15-1.50%; P < 0.0001) and distally (RR = 1.42; 95% CI 1.09-1.85%; P = 0.009) lead to higher patency rates. IVE is an effective treatment for EOA. The presence of motile sperms found in the epididymal fluid, anastomosing bilaterally and distally are significantly correlated with higher patency rates.

PMID:36849574 | DOI:10.1038/s41598-023-28637-6

Surg Endosc. 2023 Feb 27. doi: 10.1007/s00464-023-09933-8. Online ahead of print.

ABSTRACT

AIMS: There is considerable controversy regarding optimal management of patients with paraesophageal hiatus hernia (pHH). This survey aims at identifying recommended strategies for work-up, surgical therapy, and postoperative follow-up using Delphi methodology.

METHODS: We conducted a 2-round, 33-question, web-based Delphi survey on perioperative management (preoperative work-up, surgical procedure and follow-up) of non-revisional, elective pHH among European surgeons with expertise in upper-GI. Responses were graded on a 5-point Likert scale and analyzed using descriptive statistics. Items from the questionnaire were defined as “recommended” or “discouraged” if positive or negative concordance among participants was > 75%. Items with lower concordance levels were labelled “acceptable” (neither recommended nor discouraged).

RESULTS: Seventy-two surgeons with a median (IQR) experience of 23 (14-30) years from 17 European countries participated (response rate 60%). The annual median (IQR) individual and institutional caseload was 25 (15-36) and 40 (28-60) pHH-surgeries, respectively. After Delphi round 2, “recommended” strategies were defined for preoperative work-up (endoscopy), indication for surgery (typical symptoms and/or chronic anemia), surgical dissection (hernia sac dissection and resection, preservation of the vagal nerves, crural fascia and pleura, resection of retrocardial lipoma) and reconstruction (posterior crurorrhaphy with single stitches, lower esophageal sphincter augmentation (Nissen or Toupet), and postoperative follow-up (contrast radiography). In addition, we identified “discouraged” strategies for preoperative work-up (endosonography), and surgical reconstruction (crurorrhaphy with running sutures, tension-free hiatus repair with mesh only). In contrast, many items from the questionnaire including most details of mesh augmentation (indication, material, shape, placement, and fixation technique) were “acceptable”.

CONCLUSIONS: This multinational European Delphi survey represents the first expert-led process to identify recommended strategies for the management of pHH. Our work may be useful in clinical practice to guide the diagnostic process, increase procedural consistency and standardization, and to foster collaborative research.

PMID:36849562 | DOI:10.1007/s00464-023-09933-8

Eur Arch Otorhinolaryngol. 2023 Feb 27. doi: 10.1007/s00405-023-07899-w. Online ahead of print.

ABSTRACT

PURPOSE: MR imaging was used to visualize the vestibular and cochlear endolymphatic hydrops in patients with Meniere’s disease (MD). The relationship between the degree of hydrops and clinical characteristics, audiovestibular function, anxiety and depression state in MD patients.

METHODS: 70 patients with definitely or probably unilateral Meniere’s disease received bilateral intratympanic gadolinium administration and MR scanning. The degree of bilateral vestibular and cochlea hydrops were analyzed and evaluated by three-dimensional real inversion recovery (3D-real IR) sequence, and the correlation between the grades of endolymphatic hydrops (EH) and disease course, vertigo grading assessment, the duration of vertigo, hearing loss level, caloric test, vestibular myogenic evoked potential (VEMP), electrocochleogram (EcoG), vertigo disability scale (physical, emotional, functional), anxiety and depression scale were studied.

RESULTS: It was found that the vestibule and cochlea EH of the affected and the contralateral ear had different degrees of hydrops and there was no statistical difference between the left and right vestibules. The degree of vestibule EH (V-EH) was significantly positively correlated with the degree of cochlear EH (C-EH). C-EH and hearing loss level were positively correlated with EcoG. There was positive correlation between vestibular EH and hearing loss level, VEMP, caloric test, disease course or vertigo duration. There was a negative relationship between Dizziness Handicap Inventory (Emotion) (DHI(E)) and VEMP. Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) scores were positive correlated with DHI(E) and DHI total scores in MD patients.

CONCLUSION: Endolymph-enhancing MRI was used as an important imaging method for the diagnosis of labyrinthine hydrops in Meniere’s disease. There were certain correlation between EH and the degree of vertigo attack, hearing loss level, vestibular function, and further changes in anxiety and depression emotion.

PMID:36849561 | DOI:10.1007/s00405-023-07899-w

Sci Rep. 2023 Feb 27;13(1):3312. doi: 10.1038/s41598-023-30525-y.

ABSTRACT

Recently, short online videos have been highly recognized by video market users and have developed rapidly. This study aims to explore why users enjoy watching and sharing short online videos by applying the theory of flow experience. Previous research has extensively examined traditional video arts such as TV and movies and text or image based, while research on short online videos has increased only in recent years. To improve the precision and comprehensiveness of the research, social influence is also used as a variable. This study takes the short video representative platform DouYin as a case study and the Chinese user market as the background. Through questionnaires, 406 users’ data about short online video experiences were collected. After statistical analysis, the study finds that flow experience has a significant impact on participative behaviour and sharing behaviour for short online videos. According to further analyses, the flow experience, social norms, perceived critical mass and participative and sharing behaviour constitute three groups of mediating relationships. Finally, the discussion of the research results provides help to broaden the academic scope of the flow experience and video art, improve the short online video platform environment, and upgrade short online video services.

PMID:36849531 | DOI:10.1038/s41598-023-30525-y

Clin Exp Hypertens. 2023 Dec 31;45(1):2175848. doi: 10.1080/10641963.2023.2175848.

ABSTRACT

BACKGROUND: To evaluate the correlation between elevated maternal serum alpha-fetoprotein (AFP) in the second trimester and ischemic placental disease (IPD).

METHODS: A retrospective cohort study was conducted to analyze the data of 22,574 pregnant women who delivered in the Department of Obstetrics at Hangzhou Women’s Hospital from 2018 to 2020, and were screened for maternal serum AFP and free beta-human chorionic gonadotropin (free β-hCG) in the second trimester. The pregnant women were divided into two groups: elevated maternal serum AFP group (n = 334, 1.48%); and normal group (n = 22,240, 98.52%). Mann-Whitney U-test or Chi-square test was used for continuous or categorical data. Modified Poisson regression analysis was used to calculate the relative risk (RR) and 95% confidence interval (CI) of the two groups.

RESULTS: The AFP MoM and free β-hCG MoM in the elevated maternal serum AFP group were higher than the normal group (2.25 vs. 0.98, 1.38 vs. 1.04) and the differences were all statistically significant (all P < .001). Placenta previa, hepatitis B virus carrying status of pregnant women, premature rupture of membranes (PROM), advanced maternal age (≥35 years), increased free β-hCG MoM, female infants, and low birth weight (RR: 2.722, 2.247, 1.769, 1.766, 1.272, 0.624, 2.554 respectively) were the risk factors for adverse maternal pregnancy outcomes in the elevated maternal serum AFP group.

CONCLUSIONS: Maternal serum AFP levels during the second trimester can monitor IPD, such as IUGR, PROM, and placenta previa. Maternal women with high serum AFP levels are more likely to deliver male fetuses and low birth weight infants. Finally, the maternal age (≥35 years) and hepatitis B carriers also increased maternal serum AFP significantly.

PMID:36849437 | DOI:10.1080/10641963.2023.2175848

J Contin Educ Health Prof. 2023 Jan 1;43(1):65-67. doi: 10.1097/CEH.0000000000000456.

ABSTRACT

BACKGROUND: “One-minute preceptor” (OMP) is a well-established educational technique; however, primary literature on OMP lacks a tool to assess behavioral change after delivery of curricula.Primary aim of this pilot study was to design a checklist for direct observation of teachers using OMP on general medicine rounds and obtain inter-rater reliability evidence for the checklist.

METHODS: This study pilots an internally designed 6-item checklist to assess change in directly observed behavior. We describe the process of developing the checklist and training the observers. We calculated a percent agreement and Cohen’s kappa to assess inter-rater reliability.

RESULTS: Raters had a high percent agreement ranging from 0.8 to 0.9 for each step of OMP. Cohen’s kappa ranged from 0.49 to 0.77 for the five OMP steps. The highest kappa obtained was for getting a commitment (κ = 0.77) step, whereas the lowest agreement was for correcting mistakes (κ = 0.49).

CONCLUSION: We showed a percent agreement ≥0.8 and moderate agreement based on Cohen’s kappa with most steps of OMP on our checklist. A reliable OMP checklist is an important step in further improving the assessment and feedback of resident teaching skills on general medicine wards.

PMID:36849431 | DOI:10.1097/CEH.0000000000000456

J Contin Educ Health Prof. 2023 Jan 1;43(1):4-11. doi: 10.1097/CEH.0000000000000485.

ABSTRACT

INTRODUCTION: Patients seeking treatment for complex conditions require coordinated care from interprofessional clinicians. Collaborative engagement in an interprofessional community of practice is crucial to the collective competence of a team and the provision of high-quality, safe health care leading to improved patient outcomes. The objective of this descriptive, cross-sectional study was to describe interprofessional communication, coordination, and collaboration of participants in an integrated practice unit that was structured to include weekly case conferences as part of routine practice.

METHODS: Data were collected from October 2019 to February 2020. Web-based surveys were administered to a convenience sample that included 33 questions and followed the CHERRIES checklist for reporting results. Items focused on team knowledge, impact on patient care, and communication, and conference focus and effectiveness. Descriptive and survey item analysis included frequency, percentage, means and standard deviation, Chi-square, and Pearson correlation analysis. Patient outcome data were collected via a Patient Global Impression of Improvement scale and were analyzed using a paired sample t test.

RESULTS: Survey respondents (n = 161) included clinicians and administrative staff. Results demonstrated that interprofessional case conferences improved the collective competence of the team, including team knowledge and communication. Participants viewed case conferences as a means to enhance care delivery quality, value, safety, and equity. In the study period, there was also a statistically significant improvement between the patient’s first follow-up and last visits.

CONCLUSION: Survey respondents indicated that case conferences were an effective means to deliver high-quality, patient-centered care through interprofessional collaboration and education.

PMID:36849427 | DOI:10.1097/CEH.0000000000000485

J Ayub Med Coll Abbottabad. 2023 Feb-Mar;35(1):133-136. doi: 10.55519/JAMC-01-10932.

ABSTRACT

BACKGROUND: Cryotherapy is a common destructive treatment modality for treating plantar warts that results in blistering and scarring. Mitomycin an antitumor drug with antiviral property is a safe, better and a promising option for treating plantar warts. Objective was to compare efficacy of cryotherapy and mitomycin microneedling in the management of plantar warts. It was a randomized controlled trial conducted at the Skin Department CMH Abbottabad from 1st May to 31st December 2021.

METHODS: The study included 60 patients with plantar warts. Each group with 30 patients. Random tables were used to determine the distribution of patients within each group. Group A received mitomycin microneedling (1u/ml) repeated every 3 weeks. Group B was prescribed liquid nitrogen cryotherapy. The freeze-thaw cycle was 20 secs and repeated every 2 weeks. Both groups were treated for 4 months duration. For analysis of data, SPSS version 21.0 was used. Efficacy was compared by the application of Chi-square test between the two groups. p<0.05 was considered statistically significant.

RESULTS: Mitomycin microneedling completely cured 76.7% of patients, while cryotherapy was effective for only 56.7%. Complete remission was observed after two to three sessions of mitomycin microneedling while average of 4 sessions of cryotherapy were required for complete remission. In general, microneedling with mitomycin had better tolerance, pain being the commonest adverse effect.

CONCLUSIONS: Plantar warts can be effectively treated with mitomycin microneedling. Treatment of plantar warts with this method is more effective, requires fewer sessions, and may take less time to complete.

PMID:36849393 | DOI:10.55519/JAMC-01-10932