Nevin Manimala

Int J Implant Dent. 2023 Sep 12;9(1):28. doi: 10.1186/s40729-023-00489-9.

ABSTRACT

OBJECTIVES: The aim of the ITI Consensus Workshop on zygomatic implants was to provide Consensus Statements and Clinical Recommendations for the use of zygomatic implants.

MATERIALS AND METHODS: Three systematic reviews and one narrative review were written to address focused questions on (1) the indications for the use of zygomatic implants; (2) the survival rates and complications associated with surgery in zygomatic implant placement; (3) long-term survival rates of zygomatic implants and (4) the biomechanical principles involved when zygoma implants are placed under functional loads. Based on the reviews, three working groups then developed Consensus Statements and Clinical Recommendations. These were discussed in a plenary and finalized in Delphi rounds.

RESULTS: A total of 21 Consensus Statements were developed from the systematic reviews. Additionally, the group developed 17 Clinical Recommendations based on the Consensus Statements and the combined expertise of the participants.

CONCLUSIONS: Zygomatic implants are mainly indicated in cases with maxillary bone atrophy or deficiency. Long-term mean zygomatic implant survival was 96.2% [95% CI 93.8; 97.7] over a mean follow-up of 75.4 months (6.3 years) with a follow-up range of 36-141.6 months (3-11.8 years). Immediate loading showed a statistically significant increase in survival over delayed loading. Sinusitis presented with a total prevalence of 14.2% [95% CI 8.8; 22.0] over a mean 65.4 months follow-up, representing the most common complication which may lead to zygomatic implant loss. The international experts suggested clinical recommendations regarding planning, surgery, restoration, outcomes, and the patient’s perspective.

PMID:37698775 | DOI:10.1186/s40729-023-00489-9

Neurosurg Rev. 2023 Sep 12;46(1):240. doi: 10.1007/s10143-023-02151-9.

ABSTRACT

Optic canal unroofing (OCU) has gradually become a routine technique for tuberculum sellae meningiomas (TSMs) resection. This meta-analysis aimed to evaluate the efficacy and safety of OCU. A systematic review and meta-analysis of the published literature on this topic from 2003 to 2023 were conducted in accordance with the PRISMA guidelines. Rigorous statistical analysis with a p-value was performed for related change in visual improvement, gross total resection (GTR), visual deterioration, and olfactory nerve damage. The study included 15 articles with 384 patients in whom OCU was performed by the transcranial approach (TCA) or the endoscopic endonasal approach (EEA). Of these, 341 patients had preoperative visual loss, and 266 patients had postoperative visual recovery. The overall rate of visual improvement was 0.803 (95% CI: 0.733-0.874, p < 0.01). The rate of visual improvement in the EEA and TCA groups was 0.884 (95% CI: 0.803-0.965, p < 0.01) and 0.788 (95% CI: 0.700-0.875, p < 0.01). Further analysis of classification shows that the rate of visual improvement in Type I: < 2 cm was 0.889(95% CI: 0.739-0.969), Type II:2-4 cm was 0.844(95% CI: 0.755-0.910), Type III: > 4 cm was 0.500(95% CI: 0.068-0.932) and the total was 0.853(95% CI: 0.779-0.927 p < 0.01) with low heterogeneity of I² = 20.80%.Twelve studies separately reported GTR with OCU was 293; the rate of GTR was 0.911 (95% CI: 0.848-0.961, p < 0.01). And the rate of GTR in Type I: < 2 cm was 0.933(95% CI: 0.817-0.986), Type II:2-4 cm was 0.880(95% CI: 0.800-0.936), Type III: > 4 cm was 0.600(95% CI: 0.147-0.947). The total was 0.897(95% CI: 0.830-0.965 p < 0.01) with low heterogeneity of I² = 34.57%. The related complications of OCU were visual deterioration and olfactory nerve damage. Visual decline was reported in nine studies, and the rate was 0.077 (95% CI: 0.041-0.113, p < 0.01). Six studies reported olfactory nerve damage, and the overall rate was 0.054 (95% CI: 0.019-0.090, p < 0.01). OCU could significantly recover preoperative impaired vision and make GTR easier to achieve, which was also a safe and effective technique in TSM.

PMID:37698750 | DOI:10.1007/s10143-023-02151-9

Metabolomics. 2023 Sep 12;19(9):82. doi: 10.1007/s11306-023-02046-2.

ABSTRACT

INTRODUCTION: The objective of this study was to explore potential novel biomarkers for moderate to severe lower urinary tract symptoms (LUTS) using a metabolomics-based approach, and statistical methods with significant different features than previous reported.

MATERIALS AND METHODS: The patients and the controls were selected to participate in the study according to inclusion/exclusion criteria (n = 82). We recorded the following variables: International prostatic symptom score (IPSS), prostate volume, comorbidities, PSA, height, weight, triglycerides, glycemia, HDL cholesterol, and blood pressure. The study of 41 plasma metabolites was done using the nuclear magnetic resonance spectroscopy technique. First, the correlations between the metabolites and the IPSS were done using Pearson. Second, significant biomarkers of LUTS from metabolites were further analysed using a multiple linear regression model. Finally, we validated the findings using partial least square regression (PLS).

RESULTS: Small to moderate correlations were found between IPSS and methionine (-0.301), threonine (-0.320), lactic acid (0.294), pyruvic acid (0.207) and 2-aminobutyric-acid (0.229). The multiple linear regression model revealed that only threonine (p = 0.022) was significantly associated with IPSS, whereas methionine (p = 0.103), lactic acid (p = 0.093), pyruvic acid (p = 0.847) and 2-aminobutyric-acid (p = 0.244) lost their significance. However, all metabolites lost their significance in the PLS model.

CONCLUSION: When using the robust PLS-regression method, none of the metabolites in our analysis had a significant association with lower urinary tract symptoms. This highlights the importance of using appropriate statistical methods when exploring new biomarkers in urology.

PMID:37698748 | DOI:10.1007/s11306-023-02046-2

Health Justice. 2023 Sep 12;11(1):38. doi: 10.1186/s40352-023-00240-x.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has disproportionately impacted individuals in carceral facilities – both incarcerated people and staff. Vaccination is an important tool in reducing the risk of COVID-19 infection, hospitalization, and death. While the importance of promoting vaccination is clear, there are considerable barriers to doing so. This study aims to better understand: (1) why individuals chose to receive the COVID-19 vaccine; (2) why individuals were hesitant to vaccinate; (3) what motivators might influence a person’s decision to get vaccinated; and (4) what sources of information about COVID-19 vaccination people trust.

METHODS: We conducted a survey of incarcerated people and facility staff in three, large state prisons in Minnesota to identify barriers and facilitators to COVID-19 vaccination. Facilities were recruited to participate through purposive sampling, and surveys were administered between November and December 2021. Descriptive statistics were calculated using Stata.

RESULTS: Findings demonstrate that, for incarcerated individuals (N = 1,392), the most common reason for getting vaccinated was to return to normal activities in prison (61%, n = 801); the most common reason for being hesitant to get vaccinated was “other” (41%, n = 342), with individuals citing a variety of concerns. For staff (N = 190), the most common reason for getting vaccinated was to protect the health of family and friends (79%, n = 114); the most common reasons for being hesitant were disbelief that vaccination is necessary (55%, n = 23) and distrust of healthcare and public health systems (55%, n = 23). Incarcerated individuals reported that monetary and programmatic incentives would help motivate them to get vaccinated, while staff members said speaking with healthcare professionals and monetary incentives would help motivate them. Lastly, trusted sources of information for incarcerated individuals were healthcare professionals outside of prisons and jails, along with friends and family members. Staff members reported that they trusted healthcare professionals and national health organizations for information about COVID-19 vaccination.

CONCLUSIONS: While considerable barriers to COVID-19 vaccination persist among both incarcerated individuals and staff members, these findings also highlight areas of intervention to increase COVID-19 vaccine confidence and promote health equity among those disproportionately impacted by the COVID-19 pandemic.

PMID:37698742 | DOI:10.1186/s40352-023-00240-x

Intern Emerg Med. 2023 Sep 12. doi: 10.1007/s11739-023-03416-3. Online ahead of print.

ABSTRACT

Real-life outcomes data for elderly patients with infections caused by Klebsiella pneumoniae producing New Delhi metallo-beta-lactamase (NDM-Kp) are lacking. We conducted a retrospective cohort study enrolling 33 consecutive adult patients (mean age 77.4 years; 48.5% males; mean Charlson Comorbidity Index-CCI 5.9) hospitalized for NDM-Kp infections during a 24-month period in an Italian highly endemic area. 78.8% were admitted to Internal Medicine ward. 45.4% of patients had bloodstream infections (BSI), 39.4% urinary tract infections (UTI) without BSI, 9.1% respiratory tract infections and 6.1% intra-abdominal infections. 93.9% had rectal colonization.Adequate definitive antibiotic therapy (mainly represented by aztreonam plus ceftazidime/avibactam) was provided to 36.4% of cases. Mean age and CCI of patients adequately treated were significantly lower than those inadequately treated (71.2 vs 80.9 years, p = 0.041, and 4.6 vs 6.7, p = 0.040, respectively). Patients adequately treated had a mean hospitalization length significantly higher (28 vs 15 days, p = 0.016). The overall 30-day survival rate of patients adequately and inadequately treated was 83.3% and 57.1%, respectively: this difference was not statistically significant. Mean age and CCI of 22 patients who survived at 30 days were lower than those of 11 patients who died (73.7 vs 84.8 years, p = 0.003, and 5.3 vs 7.2, p = 0.049, respectively). Twelve survivors received an inadequate therapy: 8/12 had UTI. Six of nine patients inadequately treated who died within 30 days, died before microbiological diagnosis. Our study provides real-life data on outcomes of elderly and multimorbid patients hospitalized for infections caused by NDM-Kp. Further studies with larger sample size are warranted.

PMID:37698741 | DOI:10.1007/s11739-023-03416-3

Environ Monit Assess. 2023 Sep 12;195(10):1187. doi: 10.1007/s10661-023-11750-4.

ABSTRACT

Ambient PM_2.5 (particles less than 2.5 μm in diameter) is monitored in many countries including Australia. Occasionally PM_2.5 instruments may report negative measurements, although in realty the ambient air can never contain negative amounts of particles. Some negative readings are caused by instrument faults or procedural errors, thus can be simply invalidated from air quality reporting. There are occasions, however, when negative readings occur due to other factors including technological or procedural limitations. Treatment of such negative data requires consideration of factors such as measurement uncertainty, instrument noise and risk for significant bias in air quality reporting. There is very limited documentation on handling negative PM_2.5 data in the literature. This paper demonstrates how a threshold is determined for controlling negative hourly PM_2.5 readings in the New South Wales (NSW) air quality data system. The investigation involved a review of thresholds used in different data systems and an assessment of instrument measurement uncertainties, zero air test data and impacts on key reporting statistics when applying different thresholds to historical datasets. The results show that a threshold of -10.0 μg/m³ appears optimal for controlling negative PM_2.5 data in public reporting. This choice is consistent with the measurement uncertainty estimates and the zero air test data statistics calculated for the NSW Air Quality Monitoring Network, and is expected not to have significant impacts on key compliance reporting statistics such as data availability and annual average pollution levels. The analysis can be useful for air quality monitoring in other Australian jurisdictions or wider context.

PMID:37698727 | DOI:10.1007/s10661-023-11750-4

Environ Monit Assess. 2023 Sep 12;195(10):1191. doi: 10.1007/s10661-023-11704-w.

ABSTRACT

The influence of three main parameters including irradiation time, weight fraction of photocatalysts including multi-walled carbon nanotubes and different amount of TiO₂ (MCT#1 and MCT#2) and pH is investigated for the degradation rate of methyl orange (MO). Analysis of variance (ANOVA) and response surface methodology (RSM) have been applied to study the binary and ternary interactions of the main parameters on the degradation rate. The ANOVA results confirm that all of three studied factors have a considerable efficacy on degradation rate of MO at 5% level of probability. Meanwhile, the results show that the degradation rate is enhanced with increasing the weight fraction in range of 0.1 to 0.3%wt and irradiation time in a period of 5 to 35min.The lowest and highest degradation are observed at pH=7 and pH=3, respectively. The normality of residue distribution can be confirmed using graphical analysis. The RSM results reveal that the degradation rate dependency on irradiation time is higher than the weight fraction of photocatalysts.

PMID:37698686 | DOI:10.1007/s10661-023-11704-w

Eur J Orthop Surg Traumatol. 2023 Sep 12. doi: 10.1007/s00590-023-03714-8. Online ahead of print.

ABSTRACT

BACKGROUND: The Tibialis Posterior tendon (TPT) is the only tendon to encounter the distal tibia and is therefore at greatest risk of injury in fractures of the distal tibia. Although TPT injury has been reported rarely with injuries around the ankle, they often have been missed and present late.

AIM: Our aim was to analyse the rate to TPT entrapment in fractures involving the posterior tibia, i.e. Pilon (PLM) and posterior malleolar fractures (PMF).

METHODS: A retrospective analysis of PMF and Pilon fractures over an 8-year period was undertaken. Patients who had undergone surgical fixation of their PMF or PLM were identified from 2014 to 2022, using our prospectively collected database. Any fracture which had undergone a preoperative CT was included. Analysis of their pre-operative CT imaging was utilised to identify TPT entrapment, where if < 50% of the tendon cross section was present in the fracture site, this was denoted as a minor entrapment and if ≥ 50% of the tendon was present in the fracture site was denoted as major.

RESULTS: A total of 363 patients were identified for further analysis, 220 who had a PMF and 143 with PLM injury. The incidence of TPT entrapment was 22% (n = 79) with 64 minor and 15 major entrapments. If the fracture line entered the TPT sheath, there was a 45% rate (72/172) of entrapment as compared to 3.7% (7/190) in fractures not entering the sheath (p < .001). There was no significant difference in TPT entrapment in PMF as compared to PML (p = 0.353).

CONCLUSION: In our assessment, we found significant prevalence of 22% of TPT entrapment in fractures involving the posterior tibia. PMF and PLF had no statistically significant difference in the rate of TPT entrapment. Additionally, we found that there was a significant risk of TPT entrapment when the CT images display the fracture line entering the tendon sheath. We recommend that surgeons consider taking care assessing pre-operative imaging to seek to identify the TPT and to assess intraoperatively where entrapment does occur.

PMID:37698673 | DOI:10.1007/s00590-023-03714-8

Ann Surg Oncol. 2023 Sep 12. doi: 10.1245/s10434-023-14208-6. Online ahead of print.

ABSTRACT

BACKGROUND: We compared the perioperative efficacy and safety of da Vinci robot-assisted Ivor Lewis esophagectomy and McKeown esophagectomy for middle and lower thoracic esophageal cancer.

METHODS: A retrospective case-control study method was used. A total of 181 patients with esophageal cancer admitted to three medical centers in China from February 2018 to October 2022 were collected and divided into two groups according to surgical method: da Vinci robot-assisted thoracic surgery (RATS) Ivor Lewis esophagectomy (Ivor Lewis group) and RATS McKeown esophagectomy (McKeown group), respectively. Propensity score matching (PSM) analysis was used to reduce selection bias caused by confounding factors. The perioperative indicators of the two groups were compared and analyzed.

RESULTS: There was a statistically significant difference in age and tumor location between the Ivor Lewis group and the McKeown group. After PSM, the above factors were no longer statistically significant. There were 80 patients in each group after PSM. In terms of operative time (P = 0.005), anastomotic leakage (P = 0.029), and pulmonary infection (P = 0.035), the Ivor Lewis group has significant advantages; in terms of the number of lymph nodes dissected around the recurrent laryngeal nerve (P = 0.010), the McKeown group has significant advantages.

CONCLUSION: Both RATS Ivor Lewis esophagectomy and McKeown esophagectomy are safe and effective for treatment of middle and lower thoracic esophageal cancer. Ivor Lewis has advantages in operative time, anastomotic leakage, and pulmonary infection, while McKeown has advantage in lymph node dissection around the recurrent laryngeal nerve.

PMID:37698668 | DOI:10.1245/s10434-023-14208-6

Int Ophthalmol. 2023 Sep 12. doi: 10.1007/s10792-023-02856-2. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to compare posterior subtenon triamcinolone acetonide injection either formulated or alone versus suprachoroidal triamcinolone in the management of diabetic macular edema.

METHODS: This study is a prospective interventional study that included 75 patients, divided into three groups, each group with 25 patients. Group I received a combination of triamcinolone acetonide (TA) (40 mg) and VISCOAT, which is a combination of sodium chondroitin sulfate (20 mg) and sodium hyaluronate (15 mg). The injection was done in the posterior subtenon space using the NAGATA cannula. Group II received TA (40 mg) in the posterior subtenon space. Group III underwent an injection of 4 mg/100µl of TA in the supra choroidal space.

RESULTS: We found a statistically significant difference between the three studied groups regarding BCVA (P = 0.001) and CMT at six months postoperative (P = 0.001) with the highest median BCVA and lowest median CMT observed in the formulated TA group.

CONCLUSION: We concluded that early treatment of DME by formulated TA is better than TA alone, and suprachoroidal TA in the form of increasing the BCVA and decreasing the CMT without any elevation of IOP. Trial registration number NCT05464953. Date of registration 17/7/2022 (retrospectively registered).

PMID:37698662 | DOI:10.1007/s10792-023-02856-2