Nevin Manimala

Plast Reconstr Surg Glob Open. 2024 Jul 18;12(7):e5995. doi: 10.1097/GOX.0000000000005995. eCollection 2024 Jul.

ABSTRACT

BACKGROUND: Closed incision negative-pressure therapy (ciNPT) has become increasingly used on surgical sites to attempt to minimize postoperative complications. The literature describing the benefits of ciNPT in reducing donor site morbidity after free tissue transfer is limited. This review compares the effectiveness of ciNPT and conventional dressings in reducing donor site complications after free tissue transfer.

METHODS: A systematic review of PubMed and Ovid (MEDLINE) utilizing the search terms ((flap) AND (donor)) AND ((negative pressure) OR (vacuum)) was conducted. Bibliographies of selected articles were also searched. Relevant outcomes were collected and analyzed.

RESULTS: After screening 156 articles, 12 studies were included in the study with a total of 1074 donor sites. The following postoperative complications at the donor site after a free tissue transfer were analyzed: wound dehiscence, infection, seroma, hematoma, and skin necrosis. Use of ciNPT was associated with lower incidence of wound dehiscence compared with conventional dressings (OR: 0.37; 95% CI, 0.23-0.58). The incidence of infection, seroma, hematoma, and skin necrosis were overall lower in the ciNPT group; although, this was not statistically significant.

CONCLUSIONS: Use of ciNPT was associated with a significantly lower incidence of free flap donor site wound dehiscence compared with conventional dressings. The use of ciNPT on free flap donor sites appears to have overall lower rates of other wound complications such as seroma, hematoma, skin necrosis, and infection.

PMID:39027894 | PMC:PMC11257675 | DOI:10.1097/GOX.0000000000005995

Ann Appl Stat. 2023 Mar;17(1):815-837. doi: 10.1214/22-aoas1652. Epub 2023 Jan 24.

ABSTRACT

The growing number of available treatment options has led to urgent needs for reliable answers when choosing the best course of treatment for a patient. As it is often infeasible to compare a large number of treatments in a single randomized controlled trial, multivariate network meta-analyses (NMAs) are used to synthesize evidence from trials of a subset of the treatments, where both efficacy and safety related outcomes are considered simultaneously. However, these large-scale multiple-outcome NMAs have created challenges to existing methods due to the increasing complexity of the unknown correlations between outcomes and treatment comparisons. In this paper, we proposed a new framework for PAtient-centered treatment ranking via Large-scale Multivariate network meta-analysis, termed as PALM, which includes a parsimonious modeling approach, a fast algorithm for parameter estimation and inference, a novel visualization tool for presenting multivariate outcomes, termed as the origami plot, as well as personalized treatment ranking procedures taking into account the individual’s considerations on multiple outcomes. In application to an NMA that compares 14 treatment options for labor induction, we provided a comprehensive illustration of the proposed framework and demonstrated its computational efficiency and practicality, and we obtained new insights and evidence to support patient-centered clinical decision making.

PMID:39027887 | PMC:PMC11257173 | DOI:10.1214/22-aoas1652

Open Med (Wars). 2024 Jul 17;19(1):20230815. doi: 10.1515/med-2023-0815. eCollection 2024.

ABSTRACT

To investigate the renal function and fibrosis indexes of conventional western medicine with Chinese medicine for dredging collaterals in the treatment of renal fibrosis (RF). We searched articles from databases (PubMed, Embase, The Cochrane Library, CNKI, and Wanfang data) and references of included studies. The quality of literature was evaluated and data were extracted in regard to the inclusion and exclusion criteria. RevMan5.3 software was applied for all statistical analyses. Eleven eligible RCTs with a total of 898 patients were included in this meta-analysis. Compared with conventional western medicine alone, conventional western medicine with Chinese medicine for dredging collaterals in the treatment of RF has lower BUN levels and SCr levels (P < 0.05). As for fibrosis indexes, conventional western medicine with Chinese medicine for dredging collaterals has lower HA, laminin (LN), IV-Col, and PC-III levels (P < 0.05). Conventional western medicine with Chinese medicine for dredging collaterals with lower BUN, Scr, HA, LN, PC-III, and IV-Col levels, has an advantage in the treatment of RF. These lower serum levels may not be associated with the presence of RF. Ideally, kidney biopsies should be performed to confirm that these markers reduce RF. This is a major limitation of this study.

PMID:39027883 | PMC:PMC11255556 | DOI:10.1515/med-2023-0815

J Family Med Prim Care. 2024 Jun;13(6):2221-2226. doi: 10.4103/jfmpc.jfmpc_497_23. Epub 2024 Jun 14.

ABSTRACT

BACKGROUND: Severe Cognitive Impairment (CI) is a major cause of disability and dependency among the elderly worldwide, and it has a significant impact not only on individuals but also on families, communities, and societies. Early identification and management of CI are critical in geriatric medicine. Prevalence data is often scarce, and this hinders the ground-level implementation of preventive health programs.

OBJECTIVES: The objective was to find the prevalence of CI and its covariates among the urban geriatric population of Haryana.

MATERIALS AND METHODS: This was a community-based cross-sectional study conducted among 300 geriatric participants residing in an urban area of Rohtak district, Haryana. Hindi Mental State Examination (HMSE) tool was used to assess CI. Data were analyzed using IBM Corp, released 2020, IBM SPSS statistics for windows Ver 20, Armonk, NY.

RESULTS: The prevalence of geriatric CI was found to be 27.3% and was found to be significantly associated with age, female gender, scheduled and backward caste (BC), widowhood, and low educational status and is not engaged in any occupation, low socioeconomic status, teetotalism, economic dependency, physical dependency on others, and chronic morbidity.

CONCLUSION: Age, female gender, scheduled and backward caste, widowhood, low educational status, nil employment status, low socioeconomic status, teetotalism, economic dependency, physical dependency on others, and chronic morbidity were found to be important correlates of CI. Further analytical studies can focus on these aspects for an early targeted preventive approach.

PMID:39027874 | PMC:PMC11254047 | DOI:10.4103/jfmpc.jfmpc_497_23

J Family Med Prim Care. 2024 Jun;13(6):2397-2403. doi: 10.4103/jfmpc.jfmpc_1785_23. Epub 2024 Jun 14.

ABSTRACT

CONTEXT: Dengue is one of the important vector-borne viral diseases affecting humans with diverse manifestations. Toll-like receptors (TLR) are pattern recognition receptors and play an important role in innate immunity against microbes. TLR3 plays a critical role in controlling the innate immune response mediated by flaviviruses such as dengue.

AIM: We attempted to study the susceptibility of single nucleotide polymorphism of the TLR3 gene in dengue encephalitis (DE) patients and determine the association in terms of genotype, allele, and haplotype distribution along with the clinical outcome.

SETTINGS AND DESIGN: It was a case-controlled observational study in a tertiary care hospital.

METHODS AND MATERIAL: We investigated the single nucleotide polymorphism in the TLR3 Leu412Phe gene using real-time polymerase chain reaction in 29 cases of DE and compared them with equal number of age- and sex-matched dengue patients without neurological features.

STATISTICAL ANALYSIS USED: The genotype and allele frequencies were compared using a two-sided Chi-square or Fisher’s exact test.

RESULTS: The findings revealed that the genotypic distribution of TLR3 Leu412Phe polymorphism for the mutant genotype Phe/Phe (TT) demonstrated increased association of DE (31.03% vs 6.8%, P 0.019, odds ratio 6.075, 95% confidence interval 1.181-31.245). However, the number of heterozygous (H) genotype (Leu/Phe-CT) and mutant Phe allele (T) did not show any statistically significant association. TLR3 gene polymorphism did not show any correlation with mortality outcome at 1 month.

CONCLUSION: The presence of mutant TLR3 Leu412Phe polymorphism may confer the propensity to have DE in patients with dengue infection in the Indian population. TLR3 polymorphism did not affect mortality outcome at 1 month.

PMID:39027870 | PMC:PMC11254067 | DOI:10.4103/jfmpc.jfmpc_1785_23

J Family Med Prim Care. 2024 Jun;13(6):2449-2454. doi: 10.4103/jfmpc.jfmpc_1107_23. Epub 2024 Jun 14.

ABSTRACT

CONTEXT: The aim of the study was to identify and monitor the circulating strains of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the samples received at our center and update the existing national and international genomic surveillance data.

INTRODUCTION: SARS-CoV-2 is no exception to the basic nature of the viruses ability to change and evolve. Since its first report in December 2019 from Wuhan, China, multiple variants of the virus have emerged and been reported. Five variants of concern have been recognized and reported by the Centers for Disease Control and Prevention, which are associated with variable degrees of transmissibility and mortality.

MATERIALS AND METHODS: Nasopharyngeal and oropharyngeal swabs received in viral transport medium at the Viral Research Diagnostic Laboratory were processed for reverse transcription-polymerase chain reaction for SARS-CoV-2. Whole genome sequencing (WGS) was performed for selective positive samples using Oxford Nanopore sequencing technology, using MinKNOW software for data acquisition.

STATISTICAL ANALYSIS: The clades were assigned using Nextclade v2.4.1 software. The statistical analysis was calculated using OpenEpi version 3, an open-source calculator, and two by two.

RESULTS: Variants reported over the study period included Alpha, Kappa, Delta, and Omicron. Delta dominated in the year 2021, while Omicron was the dominant variant in 2022. In both the dominant variants, asymptomatics contributed to around 30-40% of positives. Intensive care unit admissions and mortality were higher in the Delta variant, while vaccination history and travel history were higher in the patients with Omicron variant.

CONCLUSION: The trend tracking of these variants has been important in view of public health, enabling early interventions to control the spread of the disease and foresight in preparation for the situation.

PMID:39027869 | PMC:PMC11254030 | DOI:10.4103/jfmpc.jfmpc_1107_23

J Family Med Prim Care. 2024 Jun;13(6):2300-2304. doi: 10.4103/jfmpc.jfmpc_733_23. Epub 2024 Jun 14.

ABSTRACT

CONTEXT: The efficacy of the combination of albendazole and praziquantel has not been thoroughly studied in multiple neurocysticercosis in children.

OBJECTIVE: To compare the efficacy and safety of albendazole and praziquantel combination versus albendazole alone in the treatment of children with multiple neurocysticercosis in terms of proportion of cysts undergoing complete resolution or calcification at 6-month follow-up.

MATERIALS AND METHODS: A total of 52 children, aged 1-14 years, with newly diagnosed two or more active neurocysticercosis were randomized to either group A or B. Group A (n = 26) received albendazole plus praziquantel, and Group B (n = 26) received albendazole alone. At the end of 6 months, a repeat MRI brain was performed to see for the resolution of cysts and was classified as complete resolution, calcified, or persistence of viable and noncalcified cysts.

RESULTS: The proportion of cysts undergoing complete resolution was higher in Group A (23/60 [38.33%]) than in Group B (19/65 [29.23%]), but the difference was not statistically significant. The proportion of cysts undergoing calcification was also comparable in Group A (20/60 [33.33%]) and Group B (20/65 [30.77%]). Both groups had comparable safety profiles.

CONCLUSION: Albendazole and praziquantel combination therapy is as effective as albendazole alone in terms of complete resolution of viable cysts and calcification of cysts.Trial registration: CTRI/2021/12/038492.

PMID:39027868 | PMC:PMC11254057 | DOI:10.4103/jfmpc.jfmpc_733_23

J Family Med Prim Care. 2024 Jun;13(6):2455-2461. doi: 10.4103/jfmpc.jfmpc_1884_23. Epub 2024 Jun 14.

ABSTRACT

INTRODUCTION: During the 2 years and 9 months from March 2020 to December 2022, the SARS-CoV-2 virus raged across the country. Cases occurred in three particular time clusters recognised by World Health Organisation as coronavirus disease 2019 (COVID-19) waves. In this study, we compare the clinical parameters of adult non-obstetric COVID-19 patients admitted to our rural tertiary care hospital during the three distinct waves of the pandemic.

MATERIALS AND METHODS: Retrospective chart analysis of 272, 853 and 97 patients admitted with SARS-CoV-2 infection to the only rural medical tertiary care centre in the Sunderbans of West Bengal in the first, second and third waves, respectively, was done after obtaining ethical and scientific clearance. Clinical [vital parameters, oxygen requirement, mental status, risk factor assessment, duration of hospital stay, modified-emergency warning score (m-EWS), quick Sequential Organ Failure Assessment (qSOFA), confusion, uraemia, respiratory rate, blood pressure, age ≥ 65 years (CURB65)], epidemiological variables (age, gender, and vaccination status), laboratory parameters and in-hospital outcome were recorded and analysed statistically.

RESULTS: Statistically significant (P < 0.05) m-EWS and qSOFA scores were recorded during the second wave of the pandemic. The second wave also recorded the highest mortality (14.89%) compared to the first (12.87%) and third (11.96%) waves, though this was not statistically significant. The highest duration of hospital stay was recorded in the first wave of the pandemic (mean = 9.99 days, P < 0.01). The difference in mortality rates between patients with and without co-morbidity (P < 0.05) was observed during Wave-1, across any pandemic wave, and overall but not in Wave-2 and Wave-3.

CONCLUSION: The second wave of the COVID-19 pandemic was the most severe in comparison with the other two waves, while the outcome was poorer in those with co-morbidities, especially in the first wave.

PMID:39027859 | PMC:PMC11254042 | DOI:10.4103/jfmpc.jfmpc_1884_23

J Family Med Prim Care. 2024 Jun;13(6):2227-2232. doi: 10.4103/jfmpc.jfmpc_1057_23. Epub 2024 Jun 14.

ABSTRACT

CONTEXT: Medical colleges regularly examine mass drug administration (MDA) programs to determine their effectiveness and pinpoint areas for development. These analyses frequently show a discrepancy between the program’s coverage and actual drug use. This study was conducted in the Chamorshi and Armori blocks of the Gadchiroli District in Maharashtra.

AIM: This study aimed to find out the coverage and compliance of MDA in the Chamorshi and Armori blocks of Gadchiroli, Maharashtra.

SETTINGS AND DESIGN: This study was a cross-sectional study.

MATERIALS AND METHODS: Thirty houses from each of the three randomly chosen villages and a ward were surveyed in each implementing unit. Thus, a total of 120 households’ worth of data were gathered and examined. Information was gathered from each individual in the chosen home at the individual level.

STATISTICAL ANALYSIS USED: Data were collected and duly filled out on questionnaire forms, which were then entered in Microsoft (MS) Excel. Statistical Package for the Social Sciences (SPSS) version 16.0 (Chicago) was used as a statistical tool in the analysis.

RESULTS: Consumption rates in rural areas were much higher than in urban areas. A minimum consumption rate was found in the 2- to 5-year-old age range.

CONCLUSIONS: In this study, the percentage of coverage and compliance rates was 89.5% and 99.4% and 90.81% and 99.2% for the Armori and Chamorshi blocks, respectively. In comparison, coverage was better in rural areas than in urban areas. The MDA program must therefore be significantly strengthened in urban areas, particularly by guaranteeing improved compliance through monitored drug consumption.

PMID:39027856 | PMC:PMC11254051 | DOI:10.4103/jfmpc.jfmpc_1057_23

J Family Med Prim Care. 2024 Jun;13(6):2305-2309. doi: 10.4103/jfmpc.jfmpc_1603_23. Epub 2024 Jun 14.

ABSTRACT

BACKGROUND: The canine plays a vital role in dentofacial aesthetics and function. It supports the base of the alar and upper lip, which are crucial for smile aesthetics. When impacted, these functions are lost, leading to low self-esteem and overall poor health-related quality of life. The present study was conducted to find the prevalence of impacted and transmigrated canines in orthodontic patients and also to find the most prevalent type of canine impaction.

MATERIALS AND METHODS: This retrospective study was conducted in a hospital setting at Dental College. A total of 3050 OPGs (Orthopantomagram) of patients who visited dental hospitals for orthodontic treatment constituted the final sample. Demographic details regarding age, gender, and place of residence were collected from the patients. Evaluation of sample radiographs on the standard light box was performed to collect data regarding impacted and transmigrated canines. Statistical analysis was performed using descriptive statistics and Chi-square test.

RESULTS: Prevalence of impacted canine was found to be 2.46%. Impacted canine prevalence of 1.53% and 2.85% was reported in males and females, respectively. Only two female patients had transmigrated mandibular impacted canines. Comparison of arch showed a statistically significant (P value 0.02) higher prevalence in the maxillary arch, which was 1.54%, and in the mandibular arch, it was 0.92%. The present study reported significantly more unilateral impactions (P value 0.00) than bilateral impactions.

CONCLUSION: The overall prevalence for impacted canine was 2.46%. Prevalence was higher in female patients. Early diagnosis of impacted canines is vital for planning orthodontic treatment in such patients.

PMID:39027854 | PMC:PMC11254074 | DOI:10.4103/jfmpc.jfmpc_1603_23