Nevin Manimala

Orthop Surg. 2022 Jul 22. doi: 10.1111/os.13409. Online ahead of print.

ABSTRACT

OBJECTIVES: Although corrective osteotomy with volar or dorsal plate fixation can treat malunion of distal radius fractures, each has its own disadvantages. Little is currently known on whether dorsal fixation combined with volar fixation may further improve recovery. This study aimed to evaluate the clinical value of corrective osteotomy combined with volar and dorsal plate fixation in patients with malunion of intra-articular fractures of the distal radius.

METHODS: Seventeen patients with malunion of intra-articular fractures of the distal radius treated with corrective osteotomy with volar and dorsal plate fixation from 1 January 2016 to 31 November 2018 were retrospectively analyzed. The enrolled patients included seven males and 10 females with an average age of 54.9 years (range: 36-70 years). The radiographic parameters, including the radial length, the radial inclination angle, the ulnar variance, and the volar tilt, as well as clinical outcomes, including wrist and forearm range of motion (ROM), grip strength, the Mayo Modified Wrist Score (MMWS), and the disabilities of the Arm, Shoulder, and Hand (DASH) score, were examined at 3 months and 18 months after operation and compared with the preoperative state. The paired t-test was used for statistical analysis.

RESULTS: After corrective osteotomy combined with volar and dorsal plate fixation, all included patients were followed up for 18 months, and there was no surgical site infection. Patients reported postoperative pain due to the irritation of extensor tendon (two cases) and wrist arthritis (two cases). The radial length increased from 1.34 ± 2.34 mm to 9.25 ± 2.65 mm and 9.03 ± 2.47 mm at 3 months and 18 months postoperatively (t = 8.257, 7.954, all p < 0.05). The radial inclination angle increased from 6.45° ± 0.76° to 19.35° ± 3.43° and 19.03° ± 3.63° at 3 and 18 months (t = 12.517, 12.122, all p < 0.05). The ulnar variance decreased from 5.11 ± 0.23 mm to 1.32 ± 0.31 mm and 1.54 ± 0.62 mm at 3 and 18 months (t = 4.214, 4.895, all p < 0.05). The volar tilt was corrected from 4.47° ± 3.46° to 15.51° ± 2.72° and 14.12° ± 2.41°, respectively (t = 11.247, 10.432, all p < 0.05). Moreover, wrist ROM increased from 42.53° ± 8.99° to 98.70° ± 7.61° and 101.24° ± 7.66° (t = 41.433, 46.627, all p < 0.05), while forearm ROM was increased from 94.82° ± 6.54° to 134.47° ± 5.06° and 137.24° ± 5.52°, respectively (t = 31.507, 32.584, all p < 0.05). Similarly, grip strength, MMWS, and DASH were also remarkably improved. There were no significant differences in the wrist and forearm ROM, grip strength, MMWS, and DASH scores between follow-up at 3 and 18 months (all p > 0.05).

CONCLUSIONS: Corrective osteotomy with volar and dorsal fixation can improve recovery of volar tilt, relieve wrist pain, restore wrist and forearm function, and increase grip strength of patients with malunion of intra-articular fractures of the distal radius.

PMID:35866348 | DOI:10.1111/os.13409

J Cosmet Dermatol. 2022 Jul 22. doi: 10.1111/jocd.15257. Online ahead of print.

ABSTRACT

BACKGROUND: Tear trough deformity, hyperpigmentation and skin laxity of the lower eyelid makes individuals appear fatigued and elderly. Many patients prefer less invasive, cosmetic correction of the aged lower eyelid. PDO barbed threads introduced braided fine threads design, which works as a template for attraction the regenerative factors and for cells’ migration and proliferation. The purpose of this study to estimate the outcomes of simultaneous additional application of braided type PDO threads’ N-scaffold for aged lower eyelids’ rejuvenation in patients, who underwent the midface PDO thread lifting.

MATERIALS AND METHODS: Total thirty patients with mildly loose skin in the facial area, who underwent the thread lifting using PDO threads, were included in this study. Patients were divided into two groups, 15 patients per group. First group underwent the midface thread lifting using PDO threads (“non-SCA” group). The second group underwent midface thread lifting in combination with braided PDO threads for tear trough deformity improvement (“SCA” group). Results were evaluated subjectively, based on the patients’ satisfaction rates, and objectively, by photographs’ evaluation.

RESULTS: According to Barton’s grading system: seven months after the treatment, there was statistical significant difference between the two groups: 1.733±0.74 in the non-SCA group and 0.733±0.83 in the SCA group (p<0.05). Based on patients’ self-assessment: there was significant difference at 7 month after the treatment: 2.86±0.84 in “non-SCA” group and 3.76±0.90 in “SCA” group, p<0.05. Complications such as persistent swelling, hematoma, skin irregularity, and infection were not observed during follow-up assessments.

CONCLUSION: The application of PDO braided type threads (N-scaffold) as a part of the midface thread lifting, for aged lower eyelids rejuvenation appears to be effective and safe within a period. This study suggests that PDO threads insertion may be a useful additional, non-invasive tool for the aged lower eyelids rejuvenation.

PMID:35866335 | DOI:10.1111/jocd.15257

Health Soc Care Community. 2022 Jul 22. doi: 10.1111/hsc.13918. Online ahead of print.

ABSTRACT

Surveys of people who experience homelessness can portray their life and healthcare experiences with a level of statistical precision; however, few have explored how the very same surveys can deliver qualitative insights as well. In responding to surveys, people experiencing homelessness can use the margins to highlight health and social concerns that investigators failed to anticipate that standard question batteries miss. This study describes the unprompted comments of a large national survey of Veterans with homeless experiences. The Primary Care Quality-Homeless Services Tailoring (PCQ-HOST) survey presented 85 close-ended items to solicit social and psychological experiences, health conditions, and patient ratings of primary care. Amongst 5377 Veterans responding to the paper survey, 657 (12%) offered 1933 unprompted comments across nearly all domains queried. Using a team-based content analysis approach, we coded and organised survey comments by survey domain, and identified emergent themes. Respondents used comments for many purposes. They noted when questions called for more nuanced responses than those allowed, especially ‘sometimes’ or ‘not applicable’ on sensitive questions, such as substance use, where recovery status was not queried. On such matters, the options of ‘no’ and ‘yes’ failed to capture important contextual and historical information that mattered to respondents, such as being in recovery. Respondents also elaborated on negative and positive care experiences, often naming specific clinics or clinicians. This study highlights the degree to which members of vulnerable populations, who participate in survey research, want researchers to know the reasons behind their responses and topics (like chronic pain and substance use disorders) that could benefit from open-ended response options. Understanding patient perspectives can help improve care. Quantitative data from surveys can provide statistical precision but may miss key patient perspectives. The content that patients write into survey margins can highlight shortfalls of a survey and point towards future areas of inquiry. Veterans with homeless experience want to provide additional detail about their lives and care experiences in ways that transcend the boundaries of close-ended survey questions. Questions on substance use proved especially likely to draw comments that went beyond the permitted response options, often to declare that the respondent was in recovery. Respondents frequently clarified aspects of their care experiences related to pain, pain care, transportation and experiences of homelessness.

PMID:35866310 | DOI:10.1111/hsc.13918

Rev Esp Salud Publica. 2022 Jul 21;96:e202207055.

ABSTRACT

OBJECTIVE: The COVID-19 pandemic has had a negative effect on the mental health on the population. It is unknown if the different types of patient isolation affect them equally. The objective of the study was to determine if the effect on the psychological discomfort caused by the isolation of the population with COVID-19 in a hotel supervised by health professionals was different compared with those who were isolated at home.

METHODS: Patients diagnosed with COVID-19 during the first pandemic wave in Barcelona, consecutively selected from the Primary Care lists. A telephone survey was carried out to collect information about mental health in patients who were isolated in a hotel compared to those isolated at their homes. Descriptive statistics were performed and the study variables were analyzed using mean and standard deviation, count (percentage), Chi-square test, and Student’s t-test. Logistic regression models were carried out selecting frustration and anger/irritability as response variables.

RESULTS: Of the 89 patients included, 45 (50.6%) were isolated at their homes and 44 (49.4%) at the hotel. Frustration was identified in 48.3% and irritability in 29.2% of the most patients. Most of those who presented frustration were between 45 and 65 years old, while 50% of those who felt irritability were younger. Multivariate models confirmed that patients isolated at home showed a higher risk of frustration (Odds ratio 4,12; 95% Confidence interval 1,60-11,49) and irritability (Odds ratio 3,81; 95% Confidence interval 1,32-12,10), respectively.

CONCLUSIONS: Patients isolated at home show a higher risk of presenting feelings of frustration and irritability than isolated patients in supervised hotels.

PMID:35866292

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2022 Jul 7;57(7):868-873. doi: 10.3760/cma.j.cn115330-20211021-00678.

ABSTRACT

Objective: To evaluate the clinical value of high-definition intelligent endoscopy (iSCAN) combined with stroboscopy in identifying vocal cord leukoplakia. Methods: Seventy-nine patients with vocal cord leukoplakia who underwent CO₂ laser laryngeal microsurgery and diagnosed by histopathology were recruited between October 2020 to August 2021. The morphological features, microvascular morphology and mucosal waves were observed by stroboscope; SPSS 20.0 software was used for statistical analysis. Results: There were 79 patients with a total of 119 lesions (56 on left and 63 on right).Pathological examination showed that 51 sides of the vocal cords were malignant lesions (severe dysplasia, carcinoma in situ and invasive carcinoma), and 68 sides were benign lesions.Under stroboscopy, 69 sides of mucosal wave were normal or slightly decreased, and 50 sides were severely decreased or disappeared.The decrease degree of mucosal wave was positively correlated with malignant lesions (ρ=0.687, P<0.001).Under iSCAN endoscopy, there was a positive correlation between the morphological changes of microvessels at the lesion site (vertical) and the malignant lesion (ρ=0.687, P<0.001).Univariate analysis showed that lesion size, thickness, uneven color, granular elevation, peripheral erythema and asymmetry were positively correlated with malignant lesions (ρ=0.530, 0.401, 0.538, 0.315, 0.497, 0.281, P<0.05).Logistic regression analysis showed that the risk of pathological malignancy with large lesions was 5.437 times higher than those of small lesions, the vertical vascular changes under iSCAN were 8.711 times higher than that of normal vascular morphology, and the severe reduction or disappearance of mucosal waves was 9.12 times higher than that of normal or mild reduction of mucosal waves. Conclusion: ISCAN can be combined with staphyloscopy to comprehensively observe and evaluate the changes of vocal cord morphology, submucosal microvessels and mucosal wave of vocal cord in patients with vocal cord leukoplosis, thus improving the ability to distinguish benign and malignant lesions.

PMID:35866281 | DOI:10.3760/cma.j.cn115330-20211021-00678

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2022 Jul 7;57(7):860-867. doi: 10.3760/cma.j.cn115330-20210701-00412.

ABSTRACT

Objective: To investigate the effects of ursolic acid (UA) on oxidative stress and inflammatory factors in a rat model of AR after PM2.5 exposure. Methods: Sixty healthy female SD rats were randomly divided into five groups: normal control group (NC group), PM2.5 unexposed AR group (AR group), PM2.5 exposed AR group (ARE group), UA intervention AR group (AR+UA group), and UA intervention PM2.5 exposed AR group (ARE+UA group), with 12 rats in each group. AR model was performed by a basal sensitization with intraperitoneal injection of ovalbumin (OVA) and followed by nasal instillation. PM2.5 exposure was carried out by inhalation exposure system at a concentration of 200 μg/m³ for 3 h/d for 30 days. UA intervention group was given UA intragastric administration at 20 mg/(kg·d). AR symptoms including sneezing, nasal scratching and nasal secretion of rats in each group were observed. The activities of superoxide dismutase (SOD) and the level of malondialdehyde (MDA) in nasal mucosa were tested. The pathological changes of nasal mucosa were observed by HE staining. The levels of OVA-sIgE, IL-6 and IL-17 in serum were measured by enzyme-linked immunosorbent assay (ELISA). Protein microarray was used to measure the expression of multiple inflammation cell factors in nasal mucosa. Statistical analysis was performed with SPSS 20.0. Results: After UA intervention, the frequency of nasal sneezing, scratching and nasal secretion in ARE+UA group were lower than those of ARE group (P<0.05). Pathological examination of nasal mucosa showed that ARE+UA group had less inflammatory granulocyte infiltration and less pathological damage to the epithelial layer than ARE group. The activities of SOD in nasal mucosa of ARE+UA group were higher than those of ARE group ((50.10±3.09) U/mg vs (20.13±1.30) U/mg, F value was 597.54, P<0.01). The contents of MDA in nasal mucosa of ARE+UA group were lower than those of ARE group ((57.78±12.36) nmol/g vs (124.12±9.40) nmol/g, F value was 115.51, P<0.01). The expression levels of OVA-sIgE, IL-6 and IL-17 proteins were lower in the ARE+UA group than those in ARE group ((11.61±0.27) ng/ml vs (20.30±0.67) ng/ml, (47.59±15.49) pg/ml vs (98.83±10.98) pg/ml, (623.30±8.75) pg/ml vs (913.32±9.06) pg/ml, F value was 283.42, 80.45, 683.73, respectively, all P<0.01). After UA intervention, protein microarray analysis showed that the expression of IL-4, IL-6, IL-13, chemokine CXCL7, IL-1α, IL-1β, MMP-8 and MCP-1 in ARE+UA group was decreased compared with ARE group while IFN-γ and IL-10 increased (all P<0.01). Conclusion: UA can reduce the aggravated AR symptoms and pathological damage of nasal mucosa, inhibit oxidative stress and release of inflammatory factors after PM2.5 exposure, and thus plays a protective role in the pathological damage of AR induced by PM2.5 exposure.

PMID:35866280 | DOI:10.3760/cma.j.cn115330-20210701-00412

J Obstet Gynaecol. 2022 Jul 22:1-6. doi: 10.1080/01443615.2022.2099256. Online ahead of print.

ABSTRACT

The aim of this study was to investigate the reproductive profiles, metabolic parameters and cardiometabolic risk assessed by surrogate indexes in women with adenomyosis. Ninety-six premenopausal women who were diagnosed with adenomyosis by transvaginal ultrasound and 97 age-body mass index (BMI) matched controls with normal ultrasound during routine examination were included. Women with adenomyosis were more likely to have higher gravidity and had more abortions than women without adenomyosis. Regarding the individual metabolic syndrome components, the adenomyosis group was more likely to have higher prevalence of hypertension, low HDL-C and central obesity. No significant difference was found between the groups in terms of visceral adiposity index, lipid accumulation product and fatty liver index. Only higher blood pressure (BP) remained statistically significant after adjustment for confounding factors in multivariate analysis. Women with adenomyosis had remarkably high risk of hypertension. It may be advisable to monitor their BP closely.Impact StatementWhat is already known on this subject? The only anthropometric characteristic assessed in women in relation to adenomyosis is body mass index (BMI). A case-control study showed that women who are obese are more likely to have adenomyosis. The gravidity, number of spontaneous abortions and previous uterine surgeries such as dilatation and curettage (D&C) and caesarean section were found significantly associated with adenomyosis.What do the results of this study add? A remarkable finding of our study was the increased incidence of higher systolic BP in women with adenomyosis. No difference was observed in adiposity indices between women with and without adenomyosis. Higher prevalence of central obesity and lower HDL-C levels were seen in women with adenomyosis.What are the implications of these findings for clinical practice and/or further research? The study identifies that adenomyosis is associated with an increased risk of hypertension, and women with adenomyosis may be monitored closely for blood pressure changes. Our report also provides novel information about the metabolic risk profiles associated with adenomyosis.

PMID:35866244 | DOI:10.1080/01443615.2022.2099256

J Clin Sleep Med. 2022 Jul 22. doi: 10.5664/jcsm.10202. Online ahead of print.

ABSTRACT

STUDY OBJECTIVES: Pediatric obstructive sleep apnea (OSA) impacts child and familial well-being. Airway management in patients with hypotonic pharyngeal conditions is complex. Some patients may benefit from CPAP or BPAP, others may require further invasive measures for treatment. There is critical need for treatment alternatives for patients with pharyngeal hypotonia.

METHODS: This is a retrospective case series. Collaboratively with patients, families, biomedical engineers, and medical professionals, a long-term nasopharyngeal airway (NPA) was created to bypass upper airway obstruction. Two patients used a safety pin and tape attachment, and two patients used a novel 3D-printed, self-supporting nasal securement (ssNPA). All four patients had polysomnography before and during NPA use. Paired 1-tailed t-tests were conducted to compare apnea-hypopnea index (AHI), hypopnea index (HI), obstructive index (OI), and oxygen nadir.

RESULTS: Compared to baseline polysomnography, repeat polysomnography with the NPA in place demonstrated statistically significant improvement for AHI (75.8±36.6 to 8.9±2.9, p=0.03), HI (45.4±25.8 to 7.7±3.2, p=0.04), and SpO₂ nadir (60.3±13.0% to 79.3±8.7%, p=0.01). The NPA had been used for over one year in three of the four children. Those using the safety pin and tape did report skin irritation due to adhesive required to keep device in place.

CONCLUSIONS: Current management of severe upper airway obstruction and obstructive sleep apnea in hypotonic pharyngeal conditions requires a team-based approach to care. A long-term NPA device may be an alternative or temporizing option to CPAP, upper airway surgery, or tracheostomy in children with pharyngeal hypotonia and severe OSA. Larger studies of this approach are underway to assess efficacy in a range of OSA severity in this population.

PMID:35866230 | DOI:10.5664/jcsm.10202

J Oral Biol Craniofac Res. 2022 Sep-Oct;12(5):542-546. doi: 10.1016/j.jobcr.2022.06.010. Epub 2022 Jul 8.

ABSTRACT

BACKGROUND: Pain control by means of local anesthesia is an intrinsic part of clinical practice in dentistry. It is an irony that the modality used for pain free procedure itself is a source of fear & anxiety to the patient. Several modifications have been made to the injecting devices, local anesthetic solutions and techniques to render their administration comfortably. The objective of this study was thus designed to evaluate and compare anxiety and pain perception during conventional greater palatine injections versus use of a novel barovibrotactile device named Accupal to give painless anesthesia. This device has an additional attachment which works on Vibra-pulse technology thus minimizing pain during injection technique.

MATERIALS AND METHODS: A prospective, split mouth, open label, randomized, crossover clinical study was conducted on 50 patients coming to our institute whereby on one side Accupal was used during administration of local anesthesia. And on other side, traditional local anesthetic injection technique was used with one week of time interval.

RESULTS: A statistically significant difference was found as in the pain perception between the two techniques as per Visual Analogue Scale whereas no difference was seen in the anxiety levels as per the physiological parameters recorded by noninvasive blood pressure machine at various intervals.

CONCLUSION: The use of Accupal has thus proved to show better pain control as compared to traditional injection techniques of local anesthesia.

PMID:35866146 | PMC:PMC9294554 | DOI:10.1016/j.jobcr.2022.06.010

Iran J Public Health. 2022 Feb;51(2):278-291. doi: 10.18502/ijph.v51i2.8681.

ABSTRACT

BACKGROUND: Vitamin D plays an essential role in the regulation of bone metabolism. The current meta-analysis aimed to assess the effectiveness of vitamin D fortification on special bone biomarkers.

METHODS: Five main databases (PubMed/Medline, ISI Web of Knowledge, Science Direct, Scopus, Cochrane Library as well as Science Direct, and Scopus) were considered for this systematic review, until Jan 2020. All randomized controlled trials were included to evaluate the probable relationship between consumption of vitamin D fortification products and bone biomarkers profile in this review.

RESULTS: Among serum bone biomarkers (osteocalcin and telopeptides of type-1 collagen) investigated, only the level of telopeptides of type-1 collagen significantly decreased after fortification of vitamin D in the intervention group. A significant increase in vitamin D was seen in those older than 18 yr old, while the increase in younger children was not statistically significant between intervention and control groups.

CONCLUSION: Vitamin D fortification was not associated with a significant improvement in bone mass density (BMD), while it resulted in decreased PTH levels. Vitamin D fortified foods have some benefits on bone health due to increase in the level of vitamin D and IGF-1; and decreasing PTH and CTx levels.

PMID:35866135 | PMC:PMC9273499 | DOI:10.18502/ijph.v51i2.8681