Category: Nevin Manimala

Probl Endokrinol (Mosk). 2023 Feb 25;69(1):59-67. doi: 10.14341/probl13141.

ABSTRACT

BACKGROUND: Gonadotropin therapy in boys with congenital isolated hypogonadotropic hypogonadism helps to increase testes volume and induce spermatogenesis in comparison with testosterone therapy. However, difficulties with dose titration, partial therapy success, absence of generally accepted regimen protocols don’t allow to use this therapy in order to induce puberty in adolescents with Kallmann syndrome or normosmic hypogonadotropic hypogonadism.

AIM: To assess the effectiveness of combination hormonal replacement therapy via human chorionic gonadotropin and recombinant follicle stimulation hormone in adolescents with congenital isolated normosmic hypogonadotropic hypogonadism and with Kallmann syndromeMATERIALS AND METHODS: This is an open single-center prospective non-controlled study. Boys with hypogonadotropic hypogonadism were receiving hormonal replacement therapy for 12 months. Initial dose of human chorionic gonadotropin was 500 IU per week. Initial dose of recombinant follicle stimulation hormone was 37.5 IU per week. Doses were doubled in 6 months. Antropometric data, Tanner stage, testes volumes, inhibin B and anti-Mullerian hormone (AMH) levels were evaluated in all the patients before the treatment, after 6 and 12 months of the therapy.

RESULTS: 8 boys with hypogonadotropic hypogonadism were included into the study. Median age before therapy initiation was 15.7 years [15.33; 16.41]. In 12 months after the therapy initiation puberty development, testosterone increase from 0.44 [0.34;0.62] to 4.39 [0.88;10.51] nmol/l (p=0.012), AMH decrease from 35.70 [18.00;59.00] to 14.41 [11.60;16.65] ng/ml were noted in all the patients (p=0.017). Testes volumes increase and inhibin B level increase were not statistically significant.

CONCLUSION: Gonadotropin therapy is effective in order to puberty initiation in adolescents with congenital hypogonadotropic hypogonadism. In helps to achieve not only androgenization, but also to Sertoli cells maturation.

PMID:36842078 | DOI:10.14341/probl13141

Gerontologist. 2023 Feb 26:gnad018. doi: 10.1093/geront/gnad018. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Alzheimer’s disease or related dementia are a major cause of death in the United States. While effective interventions have been developed to deliver palliative care to nursing home residents with ADRD, little work has identified effective interventions to reach assisted living (AL) residents with dementia.

RESEARCH DESIGN AND METHODS: 118 AL residents with dementia from 10 different ALs in Florida participated. A pilot study using a cluster-randomized trial was conducted, with six sites randomized to receive a palliative care educational intervention for staff (N =23) to deliver care to residents; four sites were usual care. The feasibility of the intervention was assessed by examining recruitment, retention and treatment fidelity at 6 months. Cohen’s d statistic was used to calculate facility level treatment effect sizes on key outcomes (documentation of advance care planning discussions, hospice admission, and documentation of pain screening).

RESULTS: The intervention proved feasible with high ratings of treatment fidelity. The intervention also demonstrated preliminary evidence for efficacy of the intervention, with effect sizes for the treatment group over .80 for increases in documentation of ACP discussions compared to the control group. Hospice admissions had a smaller effect size (.16) and documentation of pain screenings had no effect.

DISCUSSION AND IMPLICATIONS: The pilot results suggest that the intervention shows promise as a resource for educating and empowering AL staff on implementing person-centered palliative care delivery to persons with dementia in assisted living. a larger, fully powered randomized trial Is needed to test for its efficacy.

PMID:36842068 | DOI:10.1093/geront/gnad018

J Pak Med Assoc. 2023 Jan;73(1):222-224. doi: 10.47391/JPMA.6450.

ABSTRACT

A quasi-experimental study was conducted at the Aga Khan University, Karachi, Pakistan, to evaluate the outcomes of a series of workshops on 25 medical students’ statistical knowledge and acceptance of RStudio. The knowledge in each of the five sessions was assessed using pre- and post- knowledge-based quizzes. In addition, the Student’s Attitude Towards Statistics (SATS-36) and the Technology Acceptance Model were used. Data analysis on RStudio revealed a statistically significant improvement in knowledge in all five sessions (p<0.05). SATS-36 showed statistically significant improvement in Cognitive Competence (p<0.001). RStudio had commendable acceptance with relatively high scores of Attitudes (behavioural intention, median = 6.00 [5.20-7.00]) and Utility (perceived usefulness, median = 5.20 [4.10-6.20]). In conclusion, medical students had improved statistical knowledge and acceptance towards the novel statistical tool. Hence, further studies must evaluate the effectiveness of RStudio when integrated as part of the medical curriculum.

PMID:36842055 | DOI:10.47391/JPMA.6450

J Pak Med Assoc. 2023 Jan;73(1):157-161. doi: 10.47391/JPMA.2075.

ABSTRACT

Bone defect assessment in primary advanced knee arthritis can present a challenge for the surgeon and lead to unfavourable outcomes if not adequately determined during preoperative planning. The aim of this study was to introduce a new, simple and quick way to assess and quantify bone defect using short film radiographs and utilising it to choose the total knee prosthesis. This is a prospective case series of patients who underwent TKA (Total Knee Arthroplasty) using various types of prostheses. Three different angles – Tibiofemoral angle, MPTA (medial proximal tibial angle), and JLCA (joint line convergence angle) – were measured preoperatively to evaluate limb alignment, placement of the tibial, and femoral components of total knee prosthesis. Postoperatively roentgenographic index introduced by Lotke et al was used to assess our preoperative methodology. The American knee society score was used pre- and postoperatively up to one year. A total of eight knees of six patients were analysed (four males, two females). The mean age of the patients was 57.75±5.701 years. All the knees were in varying degrees of varus deformity preoperatively. The accuracy of the preoperatively used radiological angles was analysed by postoperative measurement of tibiofemoral angle (d), tibial anatomical axis (b) and femoral anatomical axis (a), and Roentgenographic index as suggested by Lotke et al. Postoperatively, all the knees were in valgus with tibiofemoral angle (d) 6.50±0.926, tibial component alignment (b) mean was 89±1.195, and femoral component alignment (a) mean was 5.13±0.991 valgus. Mean roentgenographic index was 89.38±3.292. American knee society score improved at one-year follow-up postoperatively and was statistically significant with p<0.001. In this study, a new classification for bone defects in primary arthritic knees by utilising simple plain radiograph short films and as a guide for implant selection is proposed.

PMID:36842029 | DOI:10.47391/JPMA.2075

J Pak Med Assoc. 2023 Jan;73(1):129-130. doi: 10.47391/JPMA.3594.

ABSTRACT

The term temporomandibular disorder is used for pain and dysfunction at the temporomandibular joint. Manual therapy or exercise therapy has proven to be an effective measure for pain relief. The purpose of this study was to compare the effectiveness of manual therapy and exercise therapy in temporomandibular disorders. A quasi-experimental study was conducted from June 30, 2020 to December 30, 2020 in Al-Sheikh teaching hospital, Sialkot, Pakistan. A convenient sample of 24 patients was involved in the study. Lottery method was used to randomise the patients in either the Manual Therapy Group or Exercise Therapy Group. The participants were assessed before and after the intervention through Numeric Pain Rating Scale (NPRS) for pain, Patient-Specific Functional Scale (PSFS) for function, Fonesca Amnestic Index (FAI) for the severity of condition, and Millimetre Mouth Opening (MMO) for ranges. The manual therapy group showed a statistically significant difference in pre- and post-treatment NPRS, PSFS, FAI and MMO (p< 0.0001). Manual physical therapy is more effective to improve pain, ROM, function, and severity in temporomandibular disorders.

PMID:36842021 | DOI:10.47391/JPMA.3594

J Pak Med Assoc. 2023 Jan;73(1):111-116. doi: 10.47391/JPMA.3852.

ABSTRACT

Congenital muscular torticollis is a problem that arises at birth or immediately after birth in which the sternocleidomastoid muscle is shortened on the afflicted side, leading to an ipsilateral rotated of the head and a contralateral rotation of the face and jaw. To determine the effectiveness of physical therapy treatment in infants treated for congenital muscular torticollis, relevant articles published between 2011 and 2020 were located using electronic databases. A total of 9 studies out of 24 potentially relevant articles were reviewed. All studies were randomised controlled trials with 6-8 score on the Physiotherapy Evidence Database scale (Pedro scale) which showed high quality of methodology. The studies typically found significant statistical effects in the management of congenital muscular torticollis. Additionally, most of the studies reported increased adherence to exercise as another essential advantage. Conservative physical therapy management showed positive outcomes, and early physiotherapy referral showed significant reduction in treatment duration.

PMID:36842018 | DOI:10.47391/JPMA.3852

J Pak Med Assoc. 2023 Jan;73(1):74-77. doi: 10.47391/JPMA.6251.

ABSTRACT

OBJECTIVE: To determine the frequency of agenesis of palmaris longus muscle and its association with gender and hand dominance.

METHODS: The cross-sectional descriptive study was conducted at the Bahria University Medical and Dental College, Karachi, from March 2021 to November 2021, and comprised medical students of either gender from 1st, 2nd and 3rd year of studies. Clinical examination of palmaris longus was done by using the classic Schaeffer’s test, and it was confirmed using the Thompson’s test. The agenesis of palmaris longus muscle and its association with gender and hand dominance was also tested. Data was analysed using SPSS 23.

RESULTS: Of the 200 participants, 114(57%) were female and 86(43%) were male. The overall age range was 18-23 years. Of the total, 195(97.5%) subjects were right hand dominant and 5(2.5%) were left hand dominant. Agenesis was found in 67(33.5%) subjects with no significant difference in terms of gender or hand dominance (p>0.05). Statistically significant difference (p=0.01) was found related to bilateral agenesis.

CONCLUSIONS: Bilateral agenesis was found significantly more in females compared to the males, while palmaris longus agenesis and hand dominance had no significant association.

PMID:36842011 | DOI:10.47391/JPMA.6251

J Pak Med Assoc. 2023 Jan;73(1):13-16. doi: 10.47391/JPMA.4773.

ABSTRACT

OBJECTIVES: To assess the diagnostic accuracy of different cut-off values of pleural fluid adenosine deaminase levels as a diagnostic method for tuberculous pleural effusion.

METHODS: The prospective study was conducted from 2014 to 2016 at the Aga Khan University Hospital, Karachi, and comprised pleural fluid samples of adult patients with and without tuberculosis which were tested for adenosine deaminase levels, and divided into tuberculosis group A and non-tuberculosis group B. Sensitivity, specificity, negative predictive value and positive predictive value were calculated using different cut-offs. Data was analysed using IBM SPSS (Statistical Package for Social Sciences) version 21.0 (IBM Corp., Armonk, NY).

RESULTS: Of 155 patients, 46(29.7%) had tuberculosis; 30(65.2%) males and 16(34.8%) females. Those who did not have tuberculosis were 109(70.3%); 69(63.3%) males and 40(36.7%) females. The adenosine deaminase levels were elevated in group A compared to group B (p<0.001). The cut-off of 30U/L showed the highest sensitivity (71.7%) and negative predictive value (87.4%), and a specificity of 82.6%. The cut-off of 50U/L showed the highest specificity (89.9%) with sensitivity 52.2%, and the cut-off of 40U/L showed the highest positive predictive value of 68.9% with sensitivity 67.4% and specificity 87.2%.

CONCLUSIONS: Pleural fluid adenosine deaminase testing for diagnosing tuberculosis pleuritis revealed highest sensitivity and moderate specificity for cut-off value of 30U/L.

PMID:36841999 | DOI:10.47391/JPMA.4773

J Sep Sci. 2023 Feb 26:e2201004. doi: 10.1002/jssc.202201004. Online ahead of print.

ABSTRACT

Epilepsy is a complex neurological disease characterized by spontaneous recurrent seizures that affects around 1% of the global population. Despite the significant progress in the mechanisms of epileptogenesis, there is still about 60% of cases in which the cause is unknown. Thus, revealing the molecular mechanisms of epileptogenesis will greatly improve the development of epilepsy treatment. Since comprehensive characterization of amino acids and water-soluble vitamins is important in understanding the underlying mechanisms of epilepsy or seizures, we developed two liquid chromatography-tandem mass spectrometry methods to quantify 17 water-soluble vitamins and 46 amino acids and applied them to our pentylenetetrazole-induced kindling rat model. All water-soluble vitamins were detected with a linearity of r > 0.992 and limits of quantitation between 0.1 and 5 ng/ml except for nicotinic acid. For amino acids, the linearities obtained were good with correlation coefficients higher than 0.99, and matrix effects were between 85.3 and 110%. To handle the multidimensional data more effectively, multivariate statistical analysis approaches used in non-targeted metabolomics were creatively exploited in the visualization, interpretation, and exploration of the results. This article is protected by copyright. All rights reserved.

PMID:36841992 | DOI:10.1002/jssc.202201004

Isr Med Assoc J. 2023 Feb;25(2):91-95.

ABSTRACT

BACKGROUND: Several approaches are used to access the hip joint; most common are the direct lateral and posterior. Little consensus exists on which to use when treating hip fractures.

OBJECTIVES: To compare short-term complications, postoperative ambulation, and patient-reported outcome measures (PROMS) of direct lateral vs. posterior approaches in hemiarthroplasty for acute hip fractures.

METHODS: We conducted a retrospective clinical trial with 260 patients who underwent bipolar hemiarthroplasty in the direct lateral or posterior approach (166 and 94, respectively) between January 2017 and December 2018. The clinical data included short-term complications: prosthetic dislocation, periprosthetic fractures, and infection. Postoperative ambulation was collected 6 weeks postoperatively; PROMS were collected for 173 patients at 2 years follow-up.

RESULTS: There were six dislocations overall, average time to dislocation was 22 days postoperative (range 4-34). Five dislocations were after the posterior approach (5.3%) and one after direct lateral (0.6%) (P = 0.01). At 6 weeks follow-up, inability to walk was found in 16.9% of the direct lateral group and 6.4% of the posterior approach group (P = 0.02). In the posterior approach group, 76% could walk more than 20 meters; only half of the direct lateral group could (P = 0.0002). At 2 years follow-up, PROMS did not show a statistically significant difference between the groups.

CONCLUSIONS: Posterior approach for hemiarthroplasty following femoral neck fractures allows superior ambulation to the direct lateral approach only for the short-term. However, no long-term clinical advantage was found. This short-term benefit does not justify the increased dislocation rate in the posterior approach.

PMID:36841975