Nevin Manimala

Cochrane Database Syst Rev. 2023 Mar 13;3:CD005431. doi: 10.1002/14651858.CD005431.pub5.

ABSTRACT

BACKGROUND: Traumatic hyphema is the entry of blood into the anterior chamber, the space between the cornea and iris, following significant injury to the eye. Hyphema may be associated with significant complications that uncommonly cause permanent vision loss. Complications include elevated intraocular pressure, corneal blood staining, anterior and posterior synechiae, and optic nerve atrophy. People with sickle cell trait or disease may be particularly susceptible to increases in intraocular pressure and optic atrophy. Rebleeding is associated with an increase in the rate and severity of complications.

OBJECTIVES: To assess the effectiveness of various medical interventions in the management of traumatic hyphema.

SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2022, Issue 3); MEDLINE Ovid; Embase.com; PubMed (1948 to March 2022); the ISRCTN registry; ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). The last date of the search was 22 March 2022.

SELECTION CRITERIA: Two review authors independently assessed the titles and abstracts of all reports identified by the electronic and manual searches. We included randomized and quasi-randomized trials that compared various medical (non-surgical) interventions versus other medical interventions or control groups for the treatment of traumatic hyphema following closed-globe trauma. We applied no restrictions on age, gender, severity of the closed-globe trauma, or level of visual acuity at time of enrollment.

DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane and assessed the certainty of evidence using GRADE.

MAIN RESULTS: We included 23 randomized and seven quasi-randomized studies with a total of 2969 participants. Interventions included antifibrinolytic agents (systemic and topical aminocaproic acid, tranexamic acid, and aminomethylbenzoic acid), corticosteroids (systemic and topical), cycloplegics, miotics, aspirin, conjugated estrogens, traditional Chinese medicine, monocular versus bilateral patching, elevation of the head, and bed rest. We found no evidence of an effect on visual acuity for any intervention, whether measured within two weeks (short term) or for longer periods. In a meta-analysis of two trials, we found no evidence of an effect of aminocaproic acid on long-term visual acuity (RR 1.03, 95% confidence interval (CI) 0.82 to 1.29) or final visual acuity measured up to three years after the hyphema (RR 1.05, 95% CI 0.93 to 1.18). Oral tranexamic acid appeared to provide little to no benefit on visual acuity in four trials (RR 1.12, 95% CI 1.00 to 1.25). The remaining trials evaluated the effects of various interventions on short-term visual acuity; none of these interventions was measured in more than one trial. No intervention showed a statistically significant effect (RRs ranged from 0.75 to 1.10). Similarly, visual acuity measured for longer periods in four trials evaluating different interventions was also not statistically significant (RRs ranged from 0.82 to 1.02). The evidence supporting these findings was of low or very low certainty. Systemic aminocaproic acid reduced the rate of recurrent hemorrhage (RR 0.28, 95% CI 0.13 to 0.60), as assessed in six trials with 330 participants. A sensitivity analysis omitting two studies not using an intention-to-treat analysis reduced the strength of the evidence (RR 0.43, 95% CI 0.17 to 1.08). We obtained similar results for topical aminocaproic acid (RR 0.48, 95% CI 0.20 to 1.10) in two trials with 131 participants. We assessed the certainty of the evidence as low. Systemic tranexamic acid had a significant effect in reducing the rate of secondary hemorrhage (RR 0.33, 95% CI 0.21 to 0.53) in seven trials with 754 participants, as did aminomethylbenzoic acid (RR 0.10, 95% CI 0.02 to 0.41), as reported in one study. Evidence to support an associated reduction in risk of complications from secondary hemorrhage (i.e. corneal blood staining, peripheral anterior synechiae, elevated intraocular pressure, and development of optic atrophy) by antifibrinolytics was limited by the small number of these events. Use of aminocaproic acid was associated with increased nausea, vomiting, and other adverse events compared with placebo. We found no evidence of an effect on the number of adverse events with the use of systemic versus topical aminocaproic acid or with standard versus lower drug dose. The number of days for the primary hyphema to resolve appeared to be longer with the use of systemic aminocaproic acid compared with no use, but this outcome was not altered by any other intervention. The available evidence on usage of systemic or topical corticosteroids, cycloplegics, or aspirin in traumatic hyphema was limited due to the small numbers of participants and events in the trials. We found no evidence of an effect between a single versus binocular patch on the risk of secondary hemorrhage or time to rebleed. We also found no evidence of an effect on the risk of secondary hemorrhage between ambulation and complete bed rest.

AUTHORS’ CONCLUSIONS: We found no evidence of an effect on visual acuity of any of the interventions evaluated in this review. Although the evidence was limited, people with traumatic hyphema who receive aminocaproic acid or tranexamic acid are less likely to experience secondary hemorrhage. However, hyphema took longer to clear in people treated with systemic aminocaproic acid. There is no good evidence to support the use of antifibrinolytic agents in the management of traumatic hyphema, other than possibly to reduce the rate of secondary hemorrhage. The potentially long-term deleterious effects of secondary hemorrhage are unknown. Similarly, there is no evidence to support the use of corticosteroids, cycloplegics, or non-drug interventions (such as patching, bed rest, or head elevation) in the management of traumatic hyphema. As these multiple interventions are rarely used in isolation, further research to assess the additive effect of these interventions might be of value.

PMID:36912744 | DOI:10.1002/14651858.CD005431.pub5

Plast Reconstr Surg. 2023 Mar 14. doi: 10.1097/PRS.0000000000010389. Online ahead of print.

ABSTRACT

BACKGROUND: Nerve injuries can result in detrimental functional outcomes. Currently, autologous nerve graft offers the best outcome for segmental peripheral nerve injury. Allografts are alternatives, but do not have comparable results. This study evaluated if plasma-derived exosome can improve nerve regeneration and functional recovery when combined with decellularized nerve allografts.

METHODS: The effect of exosomes on Schwann cell proliferation and migration were evaluated. A rat model of sciatic nerve repair was used to evaluate the effect on nerve regeneration and functional recovery. A fibrin sealant was used as the scaffold for exosome. 84 Lewis rats were divided into Autograft, Allograft, and Allograft with exosome groups. Gene expression of nerve regeneration factors were analyzed on postoperative day 7. At 12 and 16 weeks, rats were subjected to maximum isometric tetanic force (ITF) and compound muscle action potential (CMAP). Nerve specimens were then analyzed via histology and immunohistochemistry.

RESULTS: Exosomes were readily taken up by Schwann cells (SCs) that resulted in improved SCs viability and migration. Treated allograft group had comparable functional recovery (CMAP, ITF) as the autograft group. Similar results were observed in gene expression analysis of nerve regenerating factors. Histological analysis showed no statistically significant differences between treated allograft and autograft groups in terms of axonal density, fascicular area, and myelin sheath thickness.

CONCLUSION: Plasma-derived exosome treatment of decellularized nerve allograft may provide comparable clinical outcomes to that of an autograft. This can be a promising strategy in the future as an alternative for segmental peripheral nerve repair.

PMID:36912739 | DOI:10.1097/PRS.0000000000010389

Australas J Dermatol. 2023 Mar 13. doi: 10.1111/ajd.14021. Online ahead of print.

NO ABSTRACT

PMID:36912730 | DOI:10.1111/ajd.14021

Eur J Cardiothorac Surg. 2023 Mar 13:ezad095. doi: 10.1093/ejcts/ezad095. Online ahead of print.

ABSTRACT

INTRODUCTION: Early right heart failure (RHF) was seen in 22% of left ventricular assist device (LVAD) recipients in the European registry for patients with mechanical circulatory support (EUROMACS). However, the optimal treatment of post-LVAD RHF is not well known. Levosimendan has proven to be effective in cardiogenic shock patients, and in end-stage heart failure patients. We sought to evaluate the efficacy of levosimendan on post-LVAD RHF and 30-day and 1-year mortality.

METHODS: The EUROMACS Registry was used to identify adults with mainstream continuous-flow LVAD implantation treated with preoperative levosimendan compared to a propensity-matched control cohort.

RESULTS: In total, 3661 patients received mainstream LVAD, of which 399(11%) were treated with pre-LVAD levosimendan. Levosimendan patients had a higher EUROMACS RHF score [4 (2- 5.5) vs 2 (2- 4); p < 0.001], received more right ventricular assist device (RVAD) [32(8%) vs 178(5.5%); p = 0.038] and stayed longer in the ICU post-LVAD implantation [19 (8- 35) vs 11(5- 25); p < 0.001]. Yet, there was no significant difference in the rate of RHF, 30-day, or 1-year mortality. Also, in the matched cohort (357 levosimendan patients to an average of 622 controls across 20 imputations), we found no evidence for a difference in postoperative severe RHF, RVAD implantation rate, length of ICU stay, or 30-days and 1-year mortality.

CONCLUSION: In this analysis of the EUROMACS Registry, we found no evidence for an association between levosimendan and early RHF or mortality, albeit, levosimendan patients had much higher risk profile. For a definitive conclusion, a multicenter, randomised study is warranted.

PMID:36912728 | DOI:10.1093/ejcts/ezad095

Orthod Craniofac Res. 2023 Mar 13. doi: 10.1111/ocr.12652. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess the skeletal and dental maxillary transverse compensation (yaw) on the CBCT 3-dimensional reconstructed image of the skull in two groups of patients, both clinically affected by a class III malocclusion with deviation of the lower midline.

MATERIALS AND METHODS: An observational retrospective study was designed to analyse differences in two groups of patients, the first one was composed by patients affected by horizontal Condylar Hyperplasia, the second one by patients affected by dento-skeletal asymmetric class III malocclusion. Each group was composed by 15 patients. Transverse analysis was performed by measuring 5 landmarks (three bilateral and 2 uneven) with respect to a Mid-Sagittal Plane; sagittal analysis was performed by measuring the sagittal distance on the Midsagittal Plane between bilateral points. Means were compared through inferential analysis.

RESULTS: In the Condylar Hyperplasia group, all differences between the two sides were not statistically significant, nor for canines’ difference (p=0.0817), nor for molars (p=0.1105) nor for jugular points (0.05871). In the class III group, the differences between the two sides were statistically significant for molars (p=0.0019) and jugular points (p=0.0031) but not for canines (p=0.1158). Comparing the two groups, significant differences were found only for incisors’ midline deviation (p=0.0343) and canine (p=0.0177).

CONCLUSION: The study of the yaw on CBCT should be integrated into 3-dimensional cephalometry and could help in differentiate the various malocclusion patterns.

PMID:36912723 | DOI:10.1111/ocr.12652

Orthod Craniofac Res. 2023 Mar 13. doi: 10.1111/ocr.12651. Online ahead of print.

ABSTRACT

INTRODUCTION: The dentition is one of the most accurate features for age estimation in children. However, there is some evidence that timing of dental development varies across populations. Recent research suggests that dental development may also be susceptible to influence by environmental factors, such as obesity. Given that there are also population differences in average body mass, it is possible that this may be a confounding variable that was not accounted for in prior work. We aim to compare the relative association between body mass index (BMI) and ancestry with timing of dental development.

METHODS: A retrospective cross-sectional chart review was undertaken using panoramic radiographs of 6 to 12-year-olds (n=281). Age, ancestry, sex, height, and weight were obtained. Dental development was assessed using the Demirjian method, and chronological age was subtracted from estimated dental age to determine relative timing of dental development (ΔAge). BMI was calculated based upon recorded height/weight within 6 months of time of radiograph.

RESULTS: We found no difference in timing of dental development (accelerated/delayed) across ancestry groups (African-American, Euro-American, Hispanic, Asian; p=0.15). Overweight/obese subjects had statistically significantly advanced (precocious) dental development (p<0.001). Compared to normal weight subjects, children who were overweight’s age was overestimated by 5.76 months (0.48 years) and children with obesity by 5.97 months (0.49 years) on average.

CONCLUSIONS: BMI appears to have a greater impact on relative timing of dental development than ancestry in this population. Our results support other findings that obesity results in accelerated growth and development.

PMID:36912715 | DOI:10.1111/ocr.12651

Angle Orthod. 2023 Mar 13. doi: 10.2319/072322-512.1. Online ahead of print.

ABSTRACT

OBJECTIVES: To compare skeletal and dentoalveolar changes of miniscrew-assisted rapid palatal expansion (MARPE) according to the length of the miniscrews.

MATERIALS AND METHODS: This two-arm parallel-randomized controlled trial included 32 adult patients aged 19-35 years who received orthodontic treatment with MARPE. Patients were allocated to two groups, group long (L) and short (S), through block randomization according to the length of the miniscrews installed in MARPE. Cone-beam computed tomography was performed before expansion and after removal of the MARPE; superimposition of the images was conducted. The primary outcome included the amount of bone expansion and the change in the inclination of the anchorage teeth. The secondary outcome included the success rate of midpalatal suture opening and stability of the miniscrews. Blinding was performed during outcome assessment.

RESULTS: The final sample comprised 31 patients. There was no significant difference in patient characteristics between group L (n = 16) and group S (n = 15). The change in the width of the processus zygomaticus (P = .010) and ectocanine (P = .001) was significantly higher in group L. A significantly higher success rate of the posterior miniscrews was seen in group L (P = .024). There was no statistically significant difference in the success rate of suture separation or change in tooth inclination. Notable complications were not reported.

CONCLUSIONS: MARPE with longer miniscrews can increase the amount of expansion of the maxillary basal bone and canine alveolar bone. Although it also aided in miniscrew stability, it did not guarantee successful midpalatal suture separation.

PMID:36912712 | DOI:10.2319/072322-512.1

J Natl Cancer Inst. 2023 Mar 13:djad044. doi: 10.1093/jnci/djad044. Online ahead of print.

ABSTRACT

BACKGROUND: We examined adverse birth outcomes among adolescent and young adult women diagnosed with cancer (AYA women, ages 15-39 years) during pregnancy.

METHODS: We linked data from the Texas Cancer Registry, vital records, and Texas Birth Defects Registry to identify all singleton births to AYA women diagnosed during pregnancy from January 1999 to December 2016. We compared prevalence of adverse live birth outcomes between AYA women and women without cancer (matched 1:4 on age, race and ethnicity, and year). Among AYA women, we used log-binomial regression to identify factors associated with these outcomes. Statistical tests were 2-sided.

RESULTS: AYA women had 1,271 singleton live births and 20 stillbirths. AYA women (n=1,291) were 33.3% Hispanic and 9.8% non-Hispanic Black and most commonly had breast (22.5%), thyroid (19.8%), and gynecologic (13.3%) cancers. Among live births, AYA women had a higher prevalence of low birth weight offspring (30.1% vs. 9.0%), very preterm (5.7% vs. 1.2%) and preterm birth (25.1% vs. 7.2%), cesarean delivery (44.3% vs. 35.2%), and low Apgar score (2.7% vs. 1.5%), compared to women without cancer (n=5,084) (all p<0.05). Prevalence of any birth defect by age 12 months did not statistically differ (5.2% vs. 4.7%, p=0.48), but live births to AYA women more often had heart and circulatory system defects (2.2% vs. 1.3%, p=0.01). In adjusted models, cancer type and chemotherapy were associated with adverse live birth outcomes.

CONCLUSIONS: AYA women diagnosed during pregnancy have higher prevalence of adverse birth outcomes and face difficult decisions in balancing treatment risks and benefits.

PMID:36912709 | DOI:10.1093/jnci/djad044

J Cosmet Dermatol. 2023 Mar 13. doi: 10.1111/jocd.15716. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with androgenetic alopecia experience a significant decrease in self-esteem and quality of life. There are several methods by which these factors may be improved.

AIMS: Determining whether patients feel better about themselves with a better quality of life after undergoing hair transplant procedure.

PATIENTS/METHODS: 35 people were chosen from Jordan Skin and Hair Clinic in Tehran, Iran. Following hair transplant, follow-up subjects had their quality of life and level of self-esteem assessed using the Rosenberg Self-Esteem Scale (RSES) and Dermatology Life Quality Index (DLQI), respectively. The means of quantitative results were compared using paired T-test. The chi-square test was done to compare preoperative and postoperative characteristics qualitatively. Differences were regarded significant if p < 0.05. Analysis of covariance was applied to evaluate the effect of marital status and educational level on outcome variables (ANCOVA).

RESULTS: Our findings showed a statistically significant difference (p < 0.001) between pre- and post-operative hair transplantation for quality of life, and mean score increased to 2.17. There was a statistically significant difference between the two groups, with an average self-esteem score on RSES rising to 5.35 (p < 0.001). A statistically significant link between educational achievement and quality of life was found (p < 0.001).

CONCLUSION: This study found postoperative psychological aspects of AGA patients significantly improve than preoperative. Our results show that there is a statistically significant difference between the self-esteem and quality of life of AGA patients before and after hair restoration surgery.

PMID:36912697 | DOI:10.1111/jocd.15716

J Orthop Res. 2023 Mar 13. doi: 10.1002/jor.25547. Online ahead of print.

ABSTRACT

The assessment of three-dimensional (3D) bony defects is important to inform the surgical planning of hip reconstruction. Mirroring of the contralateral side has been previously used to measure the hip centre of rotation (CoR). However, the contralateral side may not be useful when diseased or replaced. Statistical Shape Models (SSMs) can aid reconstruction of patient anatomy. Previous studies have been limited to computational models only or small patient cohorts. We used SSM as a tool to help derive landmarks that are often absent in hip joints of patients with large acetabular defects. Our aim was to compare the reconstructed pelvis with patients who have previously undergone hip revision. This retrospective cohort study involved 38 patients with Paprosky type IIIB defects. An SSM was built on 50 healthy pelvises and used to virtually reconstruct the native pelvic morphology for all cases. The outcome measures were the difference in CoR for 1) SSM vs diseased hip, 2) SSM vs plan and 3) SSM vs contralateral healthy hip. The median differences in CoR were 31.17 mm (IQ: 43.80 – 19.87 mm), 8.53 mm (IQ: 12.76 – 5.74 mm) and 7.84 mm (IQ: 10.13 – 5.13 mm), respectively. No statistical difference (p > 0.05) was found between the SSM vs plan and the SSM vs contralateral CoRs. Our findings show that the SSM model can be used to reconstruct the absent bony landmarks of patients with significant lysis regardless of the defect severity, hence aiding the surgical planning of hip reconstruction and implant design. This article is protected by copyright. All rights reserved.

PMID:36912127 | DOI:10.1002/jor.25547