Nevin Manimala

Ann Palliat Med. 2022 Jul;11(7):2478-2491. doi: 10.21037/apm-22-656.

ABSTRACT

BACKGROUND: The efficacy and safety between connective tissue graft (CTG) and acellular dermal matrix (ADM) remain inconsistent. Meta-analysis is a valuable approach to resolve inconsistencies across studies and provide a high level of evidence to comprehensively evaluate the effect and safety of ADM versus CTG for root coverage of Miller’s Class I and II gingival recession. Our study was conducted to comprehensively analyze the efficacy and safety of ADM versus CTG for root coverage in patients with gingival recession.

METHODS: Articles on randomized controlled trials (RCTs) that compared the ADM with CTG for adult patients with the gingival recession in terms of percent root coverage (PRC), clinical attachment level (CAL), keratinized tissue (KT), probing depth (PD), recession width (RW), and recession depth (RD) were identified in PubMed, Embase, Cochrane Library, and Web of Science databases until 15 May 2020. Weighted mean difference (WMD) was used as the statistic for measurement data and the effect sizes were expressed as 95% confidence intervals (CIs).

RESULTS: A total of 24 RCTs were eligible for the final analysis. A total of 587 patients with 1,315 gingival recession sites were involved in the study. There were 724 loci in the ADM group and 591 loci in the CTG group. The patients who underwent ADM had a higher gain in CAL (WMD: 0.25, 95% CI: 0.03 to 0.47, P=0.026) but a smaller gain in KT width (WMD: -0.44, 95% CI: -0.63 to -0.25, P<0.001) than those who underwent CTG. No significant differences were found between the patients who underwent ADM and those who received CTG in PRC (WMD: -1.61, 95% CI: -3.49 to 0.28, P=0.094), PD (WMD: 0.07, 95% CI: -0.01 to 0.14, P=0.067), RW (WMD: 0.07, 95% CI: -0.10 to 0.23, P=0.437), and RD (WMD: 0.11, 95% CI: -0.10 to 0.31, P=0.294).

DISCUSSION: The ADM treatment for patients with gingival recession may be superior to CTG in gaining CAL, but CTG has a significant advantage over ADM for gaining KT width. ADM can be considered in the future as a treatment for root coverage in patients with gingival recession.

PMID:35927781 | DOI:10.21037/apm-22-656

Ann Palliat Med. 2022 Jul;11(7):2422-2431. doi: 10.21037/apm-22-676.

ABSTRACT

BACKGROUND: Many patients with cholangiocarcinoma also present with malignant obstructive jaundice (MOJ), which requires biliary drainage and stent placement. Recently, clinicians have tried to implant iodine-125 seeds into the biliary tract. However, we know very little about this treatment. This study aimed to compare biliary stenting alone and stenting combined with iodine-125 seed strand implantation to evaluate the safety and efficacy of this technique.

METHODS: Sixty patients of cholangiocarcinoma with MOJ were enrolled into the study. According to voluntary choices, 30 received biliary stenting combined with iodine-125 seed strand implantation (study group), and 30 received biliary stent implantation alone (control group). Various biochemical indicators and the manifestation of computed tomography (CT) or magnetic resonance imaging (MRI) were compared before and after operation. We evaluated the safety and efficacy of these treatments by observing patients’ symptoms, biochemical indicators and imaging data. Individualized antitumor therapy and regular follow-up were given according to the patients’ condition.

RESULTS: All 60 patients successfully completed operation. There were no statistically significant differences in baseline data between two groups (P>0.05). Before and 4 weeks after operation, the average total bilirubin levels decreased from 268.14±114.97 to 54.00±80.78 µmol/L in study group, and decreased from 228.89±162.04 to 58.80±61.14 µmol/L in control group. The difference between two groups was not statistically significant (P=0.796). Before and 4 weeks after operation, the average Child-Pugh scores decreased from 7.83±0.59 to 6.20±1.03 points in study group, and decreased from 7.93±1.08 to 7.07±1.39 points in control group, with a statistically significant difference between two groups (P=0.008). The median patency time of stents was 41.71±3.46 weeks in study group and 29.00±5.81 weeks in control group, with a statistically significant difference between the two groups (P=0.037). A statistically significant difference in disease control rate (DCR) was observed between the two groups (P=0.045).

CONCLUSIONS: This study demonstrated biliary stenting combined with iodine-125 seed strand implantation may be consider as a safe treatment option for the patients of cholangiocarcinoma with MOJ, and this treatment may improve liver function, reduce the incidence of in-stent restenosis, and improve DCR.

PMID:35927776 | DOI:10.21037/apm-22-676

Ann Palliat Med. 2022 Jul;11(7):2410-2421. doi: 10.21037/apm-22-528.

ABSTRACT

BACKGROUND: The purpose of this study was to investigate the illness uncertainty and its influencing factors in patients after heart stent implantation, and to explore the relationship between uncertainty of disease, self-management behavior of coronary heart disease and quality of life after stenting.

METHODS: A cross-sectional study of 168 patients with cardiac stent implantation on illness uncertainty in a tertiary hospital in Shanghai. The General Information Questionnaire and the Mishel’s Uncertainty in Illness Scale (MUIS) was used to measure the uncertainty of disease in patients after coronary stenting, and the Coronary Self-Management Scale (CSMS) and 36-item Short Form Health Survey Scale (SF-36) were collected, using Pearson’s method for correlation analysis. The indicators with significant statistical differences in univariate analysis were included, and the factors affecting patients’ perception of disease uncertainty were analyzed by stepwise regression fitting multiple linear regression equations.

RESULTS: The study showed that the mean score for disease uncertainty was 79.83±14.05 out of 160 points. By the multiple stepwise linear regression analysis, the results showed that subjective symptom improvement, follow-up with nurses after discharge, care and support from family members after discharge, quality of the quantity of stents, guidance and support from nurses during hospitalization, and educational level had a significant impact on the total uncertainty score, and were the most important factor of patient illness uncertainty. In patients with coronary heart disease, uncertainty was moderately negatively correlated with self-management ability (P<0.05, r=-0.636), and highly negatively correlated with overall quality of life scores (P<0.05, r=-0.857).

CONCLUSIONS: Overall, patients with coronary stents had moderate disease uncertainty, suggesting that uncertainty is common among patients after cardiac stenting. In order to improve the uncertainty of disease in patients after with heart stent implantation (especially for patients with a large number of implanted stents), family members should give sufficient care; doctors and nurses should provide patients with adequate health education, assist patients in establishing healthy behaviors, and strengthen its self-management ability, thereby reducing the patient’s sense of uncertainty, thereby improving the long-term prognosis and the patient’s quality of life.

PMID:35927775 | DOI:10.21037/apm-22-528

Ann Palliat Med. 2022 Jul;11(7):2368-2381. doi: 10.21037/apm-22-437.

ABSTRACT

BACKGROUND: The related factors of diabetic retinopathy (DR) had attracted the attention of many scholars, and a large number of articles had been published, but the research results were not consistent. A meta-analysis was conducted to synthesize recent evidence, aiming at exploring the relationship between DR and multiple risk factors.

METHODS: The China National Knowledge Infrastructure, VIP, Wanfang, PubMed, Embase, Medline, and Cochrane databases were searched. The English and Chinese keywords included diabetes mellitus, DM, diabetic retinopathy, DR, and risk factors. In case-control study, the subjects are DR patients and NDR patients. In the cohort study, the subjects were diabetic patients. Measures in the intervention and control groups were described in detail. The methodological quality of the included literature was assessed using the Newcastle-Ottawa Scale (NOS). Egger’s test is used to identify publication bias. With odds ratio (OR) as the effect index, heterogeneity test was conducted, and fixed effect model or random effect model was selected to calculate the combined OR and 95% CI.

RESULTS: The meta-analysis included 12 literatures and 13 related risk factors, of which 4 (33.33%) were cohort studies and 8 (66.66%) were case-control studies. NOS shows that there are 7 references with 8 points (58.33%), 4 references with 7 points (33.33%) and 1 reference with 6 points (8.33%). The risk factors associated with the occurrence of DR were: course of diabetes (OR =1.03, 95% CI: 1.02-1.03), systolic blood pressure (OR =1.01, 95% CI: 1.01-1.02), body mass index (OR =0.96, 95% CI: 0.94-0.99), HbA1c (OR =1.08, 95% CI: 1.06-1.10), total cholesterol (OR =1.20, 95% CI: 0.98-1.46), high-density lipoprotein cholesterol (OR =1.74, 95% CI: 1.19-2.56), fasting blood glucose (OR =1.19, 95% CI: 1.13-1.26), and hypertension (OR =1.25, 95% CI: 1.07-1.47), and the overall effect test results were statistically significant. Sensitivity analysis results show that the random effect model is used for meta-analysis of all Meta, and the combined OR is 1.10, and the 95% CI is (1.05, 1.15).

DISCUSSION: The occurrence of DR was related to the course of diabetes, SBP, HbA1c, total cholesterol, high-density lipoprotein cholesterol, fasting blood glucose, and hypertension which provided a more intuitive and comprehensive scientific basis for the prevention and treatment of DR.

PMID:35927772 | DOI:10.21037/apm-22-437

Ann Palliat Med. 2022 Jul;11(7):2360-2367. doi: 10.21037/apm-21-2460.

ABSTRACT

BACKGROUND: This study sought to compare the efficacy of the modified transtibial (TT) technique and the transportal (TP) technique in arthroscopic anterior cruciate ligament (ACL) reconstruction.

METHODS: This study retrospectively analyzed the clinical data of 74 patients (74 knees) who underwent ACL reconstruction using a single bundle of autologous hamstring tendon graft from October 2013 to September 2017. Forty-one knees were reconstructed using the TT technique (the TT group), and 33 were reconstructed using the TP technique (the TP group). There was no statistically significant difference between the two groups (P>0.05) in terms of age, sex, follow-up time, time from injury to operation, left and right knees, body mass index, and preoperative International Knee Documentation Committee (IKDC) score, Tegner Activity score (Tegner score), Lysholm score, Lachman test results, and Pivot-Shift test results.

RESULTS: The incisions in both groups were healed by first intention, and no early postoperative complications occurred. All patients attended follow-up appointments. The TT group had a follow-up period of 24-46 months (average follow-up time: 27.3 months). The TT group had a follow-up period of 24-38 months (average follow-up time: 26.3 months). Two years after surgery, the IKDC, Lysholm, and Tegner scores of the two groups were significantly improved compared to those before surgery (P<0.05), and there was no statistically significant difference between the two groups in relation to these scores (P>0.05). There was also no statistically significant difference in the Lachman and Pivot-Shift test results between the two groups (P>0.05).

CONCLUSIONS: Both the TT and TP techniques provide satisfactory efficacy in ACL reconstruction.

PMID:35927771 | DOI:10.21037/apm-21-2460

Reprod Health. 2022 Aug 4;19(1):172. doi: 10.1186/s12978-022-01480-0.

ABSTRACT

BACKGROUND: In developing countries, including Ethiopia the risk of neonatal death can be easily prevented and avoided by implementing essential newborn care with simple, low cost, and a short period time immediately after delivery. However, the problem is still persisting due to lack of adequate maternal and newborn care practice. Hence, this review aimed to estimate the pooled prevalence of women’s knowledge and practice of essential newborn care and its associated factors in Ethiopia using systematic review and meta-analysis.

METHOD: An intensive literature search was performed from PubMed, Google Scholar, EMBASE, HINARI, Scopus, and Web of Sciences from April 1-30, 2021. Data were extracted by using a pre-tested and standardized data extraction format. The data were analyzed by using STATA 14 statistical software. I² tests assessed heterogeneity across the included studies. A random-effect model was used to estimate the pooled prevalence of knowledge and practice of essential newborn care.

RESULTS: From 1275 identified studies, 25 articles were included. The national pooled prevalence of essential newborn care knowledge and practice among women was 55.05% and 41.49% respectively. Secondary education (AOR = 2.75, 95% CI 1.62, 4.66), multiparity (AOR = 2.14, 95% CI 1.41, 3.26), antenatal care (AOR = 2.94; 95% CI 2.03, 4.26), and postnatal follow-up (AOR = 1.64, 95% CI 1.20, 2.23) were significantly associated with knowledge level whereas; primary education (AOR = 7.08, 95% CI 4.79, 10.47), urban residency (AOR = 2.22, 95% CI 1.65, 3.00), attending monthly meetings (AOR = 2.07, 95% CI 1.64, 2.62), antenatal care (AOR = 2.89, 95% CI 1.97, 4.26), advised during delivery (AOR = 2.54, 95% CI 1.80, 3.59), postnatal follow-up (AOR = 7.08, 95% CI 4.79, 10.47) and knowledge (AOR = 2.93; 95% CI 1.81, 4.75) were statistically significant with essential newborn practice.

CONCLUSIONS: The current systematic review and meta-analysis findings reported that the level of knowledge and practice of essential newborn care among Ethiopian women was low. Therefore, improvement of essential newborn through the provision of community-based awareness creation forum, improving antenatal and postnatal care follow up, education on essential newborn care to all pregnant and postnatal women are very important. Trial registration Prospero registration: CRD 42021251521.

PMID:35927762 | DOI:10.1186/s12978-022-01480-0

Genome Biol. 2022 Aug 4;23(1):168. doi: 10.1186/s13059-022-02734-7.

ABSTRACT

Spatial transcriptomic studies are reaching single-cell spatial resolution, with data often collected from multiple tissue sections. Here, we present a computational method, BASS, that enables multi-scale and multi-sample analysis for single-cell resolution spatial transcriptomics. BASS performs cell type clustering at the single-cell scale and spatial domain detection at the tissue regional scale, with the two tasks carried out simultaneously within a Bayesian hierarchical modeling framework. We illustrate the benefits of BASS through comprehensive simulations and applications to three datasets. The substantial power gain brought by BASS allows us to reveal accurate transcriptomic and cellular landscape in both cortex and hypothalamus.

PMID:35927760 | DOI:10.1186/s13059-022-02734-7

BMC Med Educ. 2022 Aug 5;22(1):602. doi: 10.1186/s12909-022-03631-0.

ABSTRACT

BACKGROUND: To outline how the training program and work situation of residents in Obstetrics and Gynecology (OB-GYN) was affected by the pandemic and to illuminate how residents experienced these changes.

METHODS: As part of the COVID-19 in Pregnancy and Early Childhood Staff (COPE Staff) cohort study, between January and May 2021, all participating residents were invited to answer a 28-question online Resident Survey focusing on their specialist education, work situation and experiences during the COVID-19 pandemic. Descriptive statistics were given in percentages for categorical variables and means and standard deviations (SD) for continuous variables. Univariate comparative analyses were performed with the use of the Pearson’s Chi-2-test for dichotomous data. The association between residents’ worry about the quality and length of their specialist training, with extra clinical hours and transfer to other healthcare institutions were assessed by multivariate logistic regression. Free text responses were analyzed by content analysis.

RESULTS: Of the 162 participating OB-GYN residents, 69% expressed concern that the pandemic would have a negative impact on their training. Ninety-five (95%) reported cancellation/postponement of educational activities, 70% performed fewer surgeries and 27% had been transferred to other healthcare institutions where about half reported having gained more general knowledge as a physician. Working extra clinical hours was reported by 69% (7.4 ± 5.3 hours per week) and 14% had considered changing their profession due to the pandemic. Senior residents, compared to junior residents, more often experienced cancelled/postponed clinical rotations (30% vs 15%, P=0.02) and reported performing fewer surgeries (P=0.02). The qualitative analysis highlighted the lack of surgical procedural training as a major concern for residents.

CONCLUSION: The COVID-19 pandemic has strongly impacted the training program and work situation of OB-GYN residents in Sweden. Residents were concerned over the negative impact of the pandemic on their training program and senior residents reported more missed educational opportunities as compared to junior residents. Program directors, head of institutions and clinical supervisors can use the problem areas pinpointed by this study to support residents and compensate for missed educational opportunities. While hands-on-training and operating time cannot be compensated for, the authors hope that the findings of the study can help develop new strategies to minimize the negative impact of the current and future pandemics on resident education and work situation.

PMID:35927725 | DOI:10.1186/s12909-022-03631-0

BMC Womens Health. 2022 Aug 4;22(1):331. doi: 10.1186/s12905-022-01916-6.

ABSTRACT

BACKGROUND: Cervical cancer is a preventable disease. This study aimed to share the results of the national cervical cancer screening program performed in primary health care institutions in Samsun between 2015 and 2019.

METHODS: Women aged 30-65 years who were screened for cervical cancer in screening centers of Samsun between January 01, 2015, and December 31, 2019, were included in this descriptive study. The data were obtained from the automation program of the “National Human Papilloma Virus (HPV) Laboratory Application” used by the Provincial Directorate of Health Cancer Unit through filtering the completion time of the tests, and all results were evaluated without sampling. Thus, data were presented using descriptive statistics.

RESULTS: The mean age of 89,302 women included in the cervical cancer screening program was 45.9 ± 9.0 years. Of the samples obtained from the participants, 1.0% were determined as insufficient material, 94.1% as HPV-negative, and 4.9% as HPV-positive. The most common HPV genotypes were 16, 51, 31, and 52. Of the 4337 HPV-positive women, 74.7% of the pap smear results were negative (including infection, 36.5%), and the most common premalignant lesions were atypical squamous cells of undetermined significance in 7.1% and low-grade squamous intraepithelial lesions in 6.9%. HPV 16/18 was also observed in 31.7% of HPV-positive women. Seven hundred ninety-five women were referred to a specialist physician for further examination and treatment within the scope of the screening algorithm.

CONCLUSION: Detecting HPV-positivity by reaching more women within the national cervical cancer screening program’s scope is vital in fighting against this disease. The effectiveness of cancer screening programs should be increased by ensuring community participation through awareness activities.

PMID:35927723 | DOI:10.1186/s12905-022-01916-6

BMC Pregnancy Childbirth. 2022 Aug 4;22(1):616. doi: 10.1186/s12884-022-04932-4.

ABSTRACT

BACKGROUND & AIM: Pregnancy is associated with numerous physical and psychological changes and affects the sexual function of couples. Since the root of many marital problems lies in the quality of the relationship and sexual function, the present study investigates the effect of virtual cognitive-behavioral sexual counseling on pregnant women’s sexual function and intimacy.

METHODS & MATERIALS: This study is a randomized clinical trial, and 80 pregnant women aged 18 to 35 years and in 16-24 weeks of pregnancy were assigned to two intervention and control groups based on randomized blocks from June 2021 to July 2021. The control group received routine prenatal care, but the intervention group, in addition to routine prenatal care, underwent virtual counseling with a cognitive-behavioral approach during eight sessions of 90 minutes. Data were collected using the Female Sexual Function Index (FSFI) and sexual intimacy questionnaire. SPSS software was used for statistical analysis.

RESULTS: The comparison of mean scores of sexual function and intimacy in the two groups before the intervention was not statistically significant with each other. However, after the intervention, the mean scores of sexual function and intimacy in the intervention group were significantly increased compared to the control group (p < 0.001). The effect size of the intervention was 0.52 for sexual function and 0.272 for sexual intimacy.

CONCLUSION: Virtual cognitive-behavioral counseling can be used as an effective treatment to promote sexual function and intimacy of women during pregnancy.

TRIAL REGISTRATION: IRCT20161230031662N10. Registry date: 21/06/2021.

PMID:35927705 | DOI:10.1186/s12884-022-04932-4