BMJ. 2024 Aug 5;386:q1732. doi: 10.1136/bmj.q1732.
NO ABSTRACT
PMID:39103172 | DOI:10.1136/bmj.q1732
BMJ. 2024 Aug 5;386:e073515. doi: 10.1136/bmj-2022-073515.
NO ABSTRACT
PMID:39103171 | DOI:10.1136/bmj-2022-073515
BMJ. 2024 Jul 30;386:q1694. doi: 10.1136/bmj.q1694.
NO ABSTRACT
PMID:39103166 | DOI:10.1136/bmj.q1694
J Dermatolog Treat. 2024 Dec;35(1):2386973. doi: 10.1080/09546634.2024.2386973. Epub 2024 Aug 5.
ABSTRACT
BACKGROUND: Biological therapies are effective for psoriasis, but patient responses vary, often requiring therapy switching or discontinuation.
OBJECTIVES: To identify physicians’ prescribing patterns of biological therapies at a referral tertiary center in Saudi Arabia and assess the probability of biologic persistence following treatment initiation.
METHODS: We conducted a retrospective study of biologic-naïve adult psoriasis patients who initiated therapy from October 2013 to July 2022 in Dammam. Descriptive statistics and a Kaplan-Meier analysis evaluated treatment persistence at 6, 12, 24, and 36 months.
RESULTS: A total of 151 patients received adalimumab (n = 89), etanercept (n = 17), risankizumab (n = 30), ustekinumab (n = 14), and ixekizumab (n = 1). At 6 months, all therapies demonstrated 100% persistence. At 12 months, persistence was highest for ustekinumab (100%) and lowest for etanercept (88.2%). At 24 months, ustekinumab maintained 100% persistence, followed by risankizumab (96.6%), adalimumab (94.3%), and etanercept (76.4%). At 36 months, risankizumab had the highest persistence (96.6%), followed by adalimumab (83.1%), ustekinumab (78%), and etanercept (70.6%). The most common reasons for discontinuation were lack of effectiveness and intolerability.
CONCLUSION: This study shows changing psoriasis treatment patterns with new therapies. Risankizumab demonstrated high long-term persistence, while etanercept and ustekinumab showed declining persistence, suggesting evolving treatment considerations.
PMID:39103160 | DOI:10.1080/09546634.2024.2386973
J Oral Maxillofac Surg. 2024 Jul 20:S0278-2391(24)00652-9. doi: 10.1016/j.joms.2024.07.011. Online ahead of print.
ABSTRACT
BACKGROUND: Postoperative pain after orthognathic surgery is commonly managed with opioids, which can cause nausea and vomiting.
PURPOSE: The purpose of this study was to determine whether regional nerve blocks during bimaxillary surgery reduced postoperative pain and vomiting compared with patient-controlled analgesia (PCA).
STUDY DESIGN, SETTING, AND SAMPLE: This retrospective cohort study recruited patients who underwent bimaxillary surgery between August 2018 and September 2020 at the Fourth Military Medical University Hospital. Participants whose procedures involved the cheekbone, temporomandibular joint, mandibular angle, or an autogenous iliac bone graft and those who were admitted to the intensive care unit after surgery were excluded.
PREDICTOR VARIABLES: The primary predictor variables were postoperative analgesia management, regional maxillary and inferior alveolar nerve blocks, and PCA.
OUTCOME VARIABLES: The primary outcome variables were moderate-to-severe postoperative pain and postoperative vomiting (POV) during the first 24 hours. Moderate-to-severe pain was defined as pain numerical rating scale ≥4, POV was defined as vomiting of gastrointestinal contents.
COVARIATES: The study covariates included demographic, surgical, and anesthesia characteristics.
ANALYSES: Statistical analyses were conducted using an unpaired t-test, χ2 test, or Fisher’s exact test for the bivariate analysis. A multivariate logistic regression analysis was performed to assess the associations between the primary predictor variables and outcomes. Statistical significance was set at P < .05.
RESULTS: 354 participants were included in the study (262 in the nerve block group, mean age 22.5 ± 4.0 years; 92 in the PCA group, mean age 22.6 ± 4.4 years; P = .81). There was no significant difference in sex between the groups (63.4 and 55.4% females in nerve block and PCA groups, respectively, P = .18). The multivariate regression analyses demonstrated that nerve blocks did not decrease moderate-to-severe postoperative pain (7.6 vs 10.9%, adjusted odds ratio = 0.67, 95% confidence interval: 0.22-2.01, P = .48), although they were associated with decreased POV (38.5 vs 65.2%, adjusted odds ratio = 0.34, 95% confidence interval: 0.18-0.65, P = .001).
CONCLUSION AND RELEVANCE: For bimaxillary surgery, regional nerve blocks as opioid-free postoperative analgesia were not significantly associated with decreased postoperative pain but were associated with a low POV risk.
PMID:39103152 | DOI:10.1016/j.joms.2024.07.011
J Oral Maxillofac Surg. 2024 Jul 20:S0278-2391(24)00651-7. doi: 10.1016/j.joms.2024.07.010. Online ahead of print.
ABSTRACT
BACKGROUND: Retrusive profiles show an appearance of aging with an under-projected vermilion and pronounced nasolabial folds due to deficient bone support.
PURPOSE: A study was made of the association between orthognathic surgery and changes in the nasolabial and vermilion areas in patients with retrusive profiles.
STUDY DESIGN, SETTING, SAMPLE: A retrospective cohort study evaluated patients subjected to bimaxillary surgery according to the Barcelona Line (BL) protocol during 2021 at Teknon Medical Center (Barcelona, Spain). Subjects with craniofacial syndromes, facial esthetic procedures, and dental rehabilitations involving lip changes, were excluded.
PREDICTOR VARIABLE: The predictor variable was the timing of cephalometric measures, reported as T0 (preoperatively), T1 (1 month after surgery), and T2 (after 1 year of follow-up).
MAIN OUTCOME VARIABLE: The outcome variable corresponded to the soft tissue changes of the nasolabial and vermilion area, reported as the nasolabial fold length and angle, nasolabial angle, upper lip concavity, vermilion length, and upper lip sagittal distance from BL.
COVARIATES: The covariates comprised patient demographic data, the surgical-orthodontic protocol, and the magnitude and direction of the skeletal movements.
ANALYSES: Descriptive and inferential analyses were performed based on analysis of variance, the Bonferroni test, Pearson’s linear coefficient, the nonparametric Mann-Whitney U-test, Kruskal-Wallis test, and multiple linear regression models. Statistical significance was considered for P < .05.
RESULTS: The sample comprised 27 subjects with a mean age of 32.5 ± 11.2 years. A mean decrease in nasolabial angle of 5.5 ± 6° was recorded (P < .001), with a shortening of the nasolabial fold length of 4.4 ± 7.6 mm (P = .019). An increase in upper lip concavity angle of 14.4 ± 12° was recorded (P < .001), along with a vermilion lengthening of 1.6 ± 1.3 mm (P < .001) and an increase in upper lip sagittal distance to BL of 5.7 ± 7.3 mm (P = .001), indicating a more projected and everted upper vermilion.
CONCLUSIONS AND RELEVANCE: When adequate dentoskeletal support is provided by specific positional changes of the jaws planned through orthognathic surgery, the length of the nasolabial fold decreases, and the upper vermilion lengthens and becomes slightly everted.
PMID:39103151 | DOI:10.1016/j.joms.2024.07.010
J Am Med Dir Assoc. 2024 Aug 2:105179. doi: 10.1016/j.jamda.2024.105179. Online ahead of print.
ABSTRACT
OBJECTIVES: Telemedicine has become a widely accepted alternative to face-to-face patient encounters. Although there have been several peer-reviewed journal articles on incorporating telemedicine into the medical school curriculum, particularly during the COVID-19 pandemic, assessments of the effectiveness of remote supervision of medical students have not been reported. This prospective cohort study of student subjects using observational survey data evaluated the efficacy of telemedicine as an educational resource by comparing learning outcomes between osteopathic medical students receiving direct (physically present) supervision with a group who received remote (telemedicine) supervision by clinical faculty within a post-acute/long-term care (PA/LTC) setting. Learning outcomes in the domains of patient rapport, attitudes, knowledge, and behavior were measured using standardized survey instruments.
DESIGN: Prospective cohort study of student subjects using observational survey data.
SETTING AND PARTICIPANTS: A total of 167 fourth-year osteopathic medical students at a teaching nursing home (TNH).
METHODS: A total of 167 fourth-year osteopathic medical students (OMS-4s) were randomly assigned face-to-face PA/LTC patient encounters at the TNH. The encounters were follow-up visits to residents of the TNH that were supervised by faculty geriatricians. Half were accompanied by the physician and the other half were supervised by the physician through telemedicine. Evaluation using validated survey instruments measured patient rapport, verbal communication, and physical examination skills as well as attitudes, knowledge, and behaviors of the student/subjects.
RESULTS: A nonparametric statistical analysis of 4 dependent variables measuring patient rapport, attitudes, knowledge and behavior showed no significant difference between the 2 teaching modalities.
CONCLUSIONS AND IMPLICATIONS: The results of this prospective cohort study indicate that telemedicine supervision is comparable (noninferior) to direct supervision of medical student trainees in a PA/LTC setting.
PMID:39103150 | DOI:10.1016/j.jamda.2024.105179
Orthop Traumatol Surg Res. 2024 Aug 3:103966. doi: 10.1016/j.otsr.2024.103966. Online ahead of print.
ABSTRACT
BACKGROUND: Vasospasm (VS) in microsurgery is a source of surgical complications, repeat operations, stress for the patient and the surgical team, as well as increased length of stay. Various risk factors have been identified but knowledge regarding the implicated mechanism remains limited.
HYPOTHESIS: Our objective was to determine if the harvesting conditions for microsurgical toe transfers could increase the risk of VS. Our secondary objective was to determine the correlation between VS occurrence before flap division, and the occurrence of vascular complications after completion of vascular anastomoses.
PATIENTS AND METHODS: Primary endpoints were the existence of locoregional anaesthesia of the lower limb, the Gilbert classification, the nature of the graft taken from the foot, the characteristics of the patients and smoking status. Our secondary endpoints were the presence of secondary VS or microsurgical failure. This series consists of 14 toe transfers over a 30-month period. Primary VS was defined as occurring prior to flap division, while secondary VS occurred after transfer.
RESULTS: In this series, we identified 4 cases of primary VS. The average age of the operated population was 30.6 ± 11.2 years (16-58). The patients who presented with primary VS had a mean age of 35.3 ± 16.2 years (21-58), with no statistical difference with the other group (p = 0.54). There was a statistically significant difference between the absence of locoregional anaesthesia and the occurrence of primary VS in toe transfer (p = 0.0008). Microsurgical failure occurred in 1 case. This failure was linked to the presence of a primary VS. Gilbert’s classification and type of graft were not predictive of VS (p = 0.15 and p = 0.08, respectively). The occurrence of secondary VS was statistically linked to the occurrence of primary VS (p = 0.009).
DISCUSSION: The occurrence of VS remains unpredictable and the effectiveness of available treatments is debated in the literature. Faced with the failure of curative treatments, this study aimed to determine predictive factors for VS. The existence of secondary VS, when prolonged and non-responsive to conventional measures, can lead to anastomotic revision. Performing locoregional anaesthesia on the lower limb makes it possible to effectively combat the occurrence of VS. The absence of primary VS was correlated with an absence of secondary VS and an absence of microsurgical failure. In addition to controlling vasospasm, regional anaesthesia provides effective analgesia at the harvesting site.
LEVEL OF EVIDENCE: IV.
PMID:39103146 | DOI:10.1016/j.otsr.2024.103966
Clin Res Hepatol Gastroenterol. 2024 Aug 3:102442. doi: 10.1016/j.clinre.2024.102442. Online ahead of print.
ABSTRACT
BACKGROUND: Autoimmune hepatitis (AIH) patients can present with advanced fibrosis at diagnosis or may progress to the same if biochemical remission on treatment is not achieved.
METHODS: We conducted a single-center retrospective analysis of 34 pediatrics and 39 adult AIH patients. Three pathologists, blinded to clinical information, reviewed the diagnostic liver biopsy (DLB) slides of AIH patients. We evaluated the impact of clinical, laboratory, and histopathologic parameters on outcomes including biochemical remission (BR).
RESULTS: Incidence of advanced (Ludwig stage 3 or 4) fibrosis on DLB was 45.2%. AIH patients with advanced fibrosis had higher median Ishak score (p<0.001) and higher IgG level (p=0.01) at diagnosis. The incidence of BR at 6-month (31.2% vs. 88.6%, p=0.001) and 1-year (68.8% vs. 88.6%, p=0.04) post-diagnosis was significantly lower in AIH patients with advanced fibrosis. Although not statistically significant, a higher proportion of AIH patients with advanced fibrosis were on high dose of steroids (58% vs. 37.9%, p=0.1) at 1 year post diagnosis. Higher serum IgG level at diagnosis was associated with lower odds of achieving BR at 6-month (p = 0.004) and 1-year (p=0.03) post-diagnosis in multivariate analysis. Pediatric age at diagnosis (p=0.02) was associated with higher steroid dose at 1-year post-diagnosis in univariate analysis.
CONCLUSIONS: Findings of advanced fibrosis on DLB of AIH patients was accompanied by more pronounced necro-inflammatory activity and higher serum IgG level, which translated to lower rates of BR and higher exposure to steroids during the first year after diagnosis.
PMID:39103121 | DOI:10.1016/j.clinre.2024.102442
Mar Environ Res. 2024 Jul 30;200:106663. doi: 10.1016/j.marenvres.2024.106663. Online ahead of print.
ABSTRACT
Marine Animal Forests (MAFs) form three-dimensional seascapes and provide substrate and shelter for a variety of species. We investigated the fine-scale distribution pattern of three habitat-forming species of the coastal Mediterranean MAFs: Eunicella cavolini, E. singularis and Paramuricea clavata, and assessed the influence of terrain, oceanographic, and biological factors on their distribution and the formation of MAFs in the central-northern Tyrrhenian Sea. Species presence and abundance were obtained through seafloor HD imagery and were combined with terrain and oceanographic parameters extracted from remote sensing data using distance-based linear modeling (DistLM) and generalized additive model (GAM). The three studied species occurred in all the study areas, with marked differences in their abundance and distribution across the different sites and habitat type, in relation to seafloor characteristics. Specifically, positive relationships emerged between the density of colonies and terrain parameters indicative of high seafloor complexity, such as slope and roughness, as well as the number species structuring MAFs. A clear niche separation for the three species was observed: E. cavolini and P. clavata were reported on coralligenous reefs, and in areas where the seafloor complexity may enhance hydrodynamics and transport of organic matter, while E. singularis was observed on red algal mats at shallower depths. A better understanding of the ecology of these gorgonians, as well as of the drivers determining MAFs formation, represent the first step toward the conservation of these threatened habitats which are currently poorly protected by management and conservation plans.
PMID:39102776 | DOI:10.1016/j.marenvres.2024.106663