Nevin Manimala

Eur J Vasc Endovasc Surg. 2021 Apr 23:S1078-5884(21)00190-8. doi: 10.1016/j.ejvs.2021.02.038. Online ahead of print.

ABSTRACT

OBJECTIVE: The decision to undertake a major lower limb amputation can be complex. This review evaluates the performance of risk prediction tools in estimating mortality, morbidity, and other outcomes following amputation.

METHODS: A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The MEDLINE, Embase, and Cochrane databases were searched to identify studies reporting on risk prediction tools that predict outcomes following amputation. Outcome measures included the accuracy of the risk tool in predicting a range of post-operative complications, including mortality (both short and long term), peri-operative morbidity, need for re-amputation, and ambulation success. A narrative synthesis was performed in accordance with the Guidance on the Conduct of Narrative Synthesis In Systematic Reviews.

RESULTS: The search identified 518 database records. Twelve observational studies, evaluating 13 risk prediction tools in a total cohort of 61 099 amputations, were included. One study performed external validation of an existing risk prediction tool, while all other studies developed novel tools or modified pre-existing generic calculators. Two studies conducted external validation of the novel/modified tools. Nine tools provided risk estimations for mortality, two tools provided predictions for post-operative morbidity, two for likelihood of ambulation, and one for re-amputation to the same or higher level. Most mortality prediction tools demonstrated acceptable discrimination performance with C statistic values ranging from 0.65 to 0.81. Tools estimating the risk of post-operative complications (0.65 – 0.74) and necessity for re-amputation (0.72) also performed acceptably. The Blatchford Allman Russell tool demonstrated outstanding discrimination for predicting functional mobility outcomes post-amputation (0.94). Overall, most studies were at high risk of bias with poor external validity.

CONCLUSION: This review identified several risk prediction tools that demonstrate acceptable to outstanding discrimination for objectively predicting an array of important post-operative outcomes. However, the methodological quality of some studies was poor, external validation studies are generally lacking, and there are no tools predicting other important outcomes, especially quality of life.

PMID:33903018 | DOI:10.1016/j.ejvs.2021.02.038

Int J Obstet Anesth. 2021 Mar 11:102973. doi: 10.1016/j.ijoa.2021.102973. Online ahead of print.

ABSTRACT

The incidence of maternal hemorrhage and blood transfusion has increased over time. Causes of massive hemorrhage, defined as a transfusion greater than 10 units of erythrocytes, include abnormal placental insertion, preeclampsia, and placental abruption. Although ratio-based transfusion has been described for managing massive hemorrhage, a goal-directed approach using laboratory or point-of-care data may lead to better outcomes. Autotransfusion, which involves the collection, washing, and filtration of maternal shed blood, avoids many of the complications associated with allogeneic blood transfusion. In this review, we provide an overview of transfusion practices related to the management of obstetric hemorrhage.

PMID:33903001 | DOI:10.1016/j.ijoa.2021.102973

Am J Orthod Dentofacial Orthop. 2021 Apr 23:S0889-5406(21)00185-2. doi: 10.1016/j.ajodo.2020.03.028. Online ahead of print.

ABSTRACT

INTRODUCTION: The objective of this 2-arm parallel trial was to investigate the recall and comprehension of the information of orthodontic patients undergoing fixed orthodontic treatment using either the verbal explanation supported with the British Orthodontic Society (BOS) leaflet or 3-dimensional (3D) animated content.

METHODS: Patients aged 12-18 years, with no relevant medical history or learning and reading difficulties, who were to undergo orthodontic treatment, were randomized to receive information about fixed orthodontic treatment, using either verbal explanation supported with the BOS leaflet or 3D animated content on the basis of the BOS leaflet. Randomization was performed by block randomization; block size of 4 was used, from which 6 blocks with 6 different sequences (AABB, ABBA, ABAB, BBAA, BAAB, BABA). The blinded author asked patients a series of open-ended questions. The primary outcome measure was the total score of the questions. An independent 2 sample t test was conducted to determine if there was a statistical difference in total questions score between the conventional method (verbal and leaflet) and the 3D animation at the time of consent taking (T0) and again 1 year later (T1). The secondary outcome measure was the time spent by the clinician delivering the information to the patient.

RESULTS: Thirty-two patients were randomized into each group. After 1 year, 1 patient was lost in each group. At the time of consent, the conventional group scored 79.1 ± 18.4 compared with 76.4 ± 12.8 for the 3D animation group with no statistically significant difference (95% confidence interval, -11.0 to 5.3), (P = 0.492). One year later, again, there was no statistically significant difference (P = 0.639) between the conventional group (75.6 ± 12.3) and the 3D animation group (74.4 ± 9.0) (95% confidence interval, -7.0 to 4.4). The average exposure time to the educational intervention in the conventional group was 8.5 minutes more than the 3D animation group.

CONCLUSIONS: The use of 3D animation or verbal and leaflet information is relatively equivalent in transferring knowledge to the orthodontic patient. The use of a 3D animated video reduces the clinician time needed in the clinic to deliver information to the patients and also allows multiple views and better suits the younger generation. Patients undergoing short- or long-term orthodontic treatment do not recall root damage as a risk of orthodontic treatment, which requires special attention from the orthodontist to reinforce this information.

REGISTRATION: This trial was not registered.

PROTOCOL: The protocol was not published before trial commencement.

PMID:33902979 | DOI:10.1016/j.ajodo.2020.03.028

Am J Orthod Dentofacial Orthop. 2021 Apr 23:S0889-5406(21)00187-6. doi: 10.1016/j.ajodo.2020.03.030. Online ahead of print.

ABSTRACT

INTRODUCTION: The relationship between malocclusion, orthodontic treatment, and oral health-related quality of life (OHRQOL) is complicated, with some traits, such as increased overjet, having a potentially greater adverse effect on an adolescent’s OHRQOL. The aim of this study was to evaluate the impact of malocclusion and orthodontic treatment on OHRQOL in adolescents presenting with Class II Division 1 malocclusion and explore the relationship between OHRQOL using a condition-specific and generic instrument and occlusal outcome.

METHODS: Two groups of adolescents were recruited from a United Kingdom university hospital: a pretreatment group of adolescents with Class II Division 1 malocclusion and a treated (posttreatment) group whose Class II Division 1 malocclusion had been corrected. Self-reported OHRQOL was assessed using the malocclusion impact questionnaire (MIQ) and the short form of Child Oral Health Impact Profile questionnaires. Occlusion severity and outcome were assessed using Peer Assessment Rating scores.

RESULTS: A total of 241 participants (106 male; 135 female) were recruited. MIQ scores differed significantly between the pretreatment and posttreatment groups, with scores being 11.35 times lower posttreatment than pretreatment, after adjusting for age and sex (95% confidence interval, -17.28 to -5.42; P <0.001). Females had higher total MIQ scores by 2.6 (95% confidence interval, 0.38 to 4.82), which was statistically significant (P = 0.022). There was a moderate correlation between MIQ and Peer Assessment Rating scores, but this relationship strengthened when omitting the global MIQ questions (Spearman’s correlation coefficient, 0.59).

CONCLUSIONS: Increased overjet was associated with impaired OHRQOL using a condition-specific measure. A deeper understanding of associations between malocclusion, orthodontic treatment, and OHRQOL would benefit from longitudinal evaluation.

PMID:33902978 | DOI:10.1016/j.ajodo.2020.03.030

Eur Urol. 2021 Apr 23:S0302-2838(21)00230-X. doi: 10.1016/j.eururo.2021.03.024. Online ahead of print.

ABSTRACT

Atezolizumab is an anti-PD-L1 immune checkpoint inhibitor recommended for the treatment of locally advanced or metastatic urothelial carcinoma (mUC) after prior platinum-containing chemotherapy, regardless of PD-L1 status, among other treatment settings. We conducted a long-term follow-up to the exploratory analysis of overall survival (OS) and safety for the IMvigor211 intent-to-treat (ITT) population. Patients with mUC and disease progression during or following platinum-based chemotherapy were randomised 1:1 to receive atezolizumab 1200 mg or chemotherapy (vinflunine 320 mg/m², paclitaxel 175 mg/m², or docetaxel 75 mg/m² according to investigator choice) intravenously every 3 wk. Although the primary analysis did not demonstrate statistically significant longer OS for patients receiving atezolizumab versus chemotherapy, updated OS showed long-term durable remission. With a median of 33 mo of follow-up, the 24-mo OS rate was 23% with atezolizumab and 13% with chemotherapy. Safety findings were consistent with the primary analysis, with no new signals detected. Chemotherapy-treated patients experienced more grade 3/4 treatment-related adverse events (AEs; 43% vs 22%) and more AEs leading to treatment discontinuation (18% vs 9%). Atezolizumab-treated patients experienced more AEs of special interest (35% vs 20%), which tended to be grade 1-2. Our findings support the use of atezolizumab in platinum-treated patients with mUC regardless of PD-L1 status. PATIENT SUMMARY: We report follow-up results from a study of an immunotherapy treatment, atezolizumab, in patients with bladder cancer who had already received platinum-containing chemotherapy. This analysis compared the effectiveness of atezolizumab with chemotherapy over 2.5 years after starting treatment. The results show that patients who received atezolizumab lived longer and had manageable side effects compared with patients who received chemotherapy. This trial is registered at ClinicalTrials.gov as NCT02302807.

PMID:33902955 | DOI:10.1016/j.eururo.2021.03.024

J Prosthet Dent. 2021 Apr 23:S0022-3913(21)00145-1. doi: 10.1016/j.prosdent.2021.03.007. Online ahead of print.

ABSTRACT

STATEMENT OF PROBLEM: The accuracy of intraoral scanners is a prerequisite for the fabrication of dental restorations in computer-aided design and computer-aided manufacturing (CAD-CAM) dentistry. While the precision of intraoral scanners has been investigated in vitro, clinical data on the accuracy of intraoral scanning (IOS) are limited.

PURPOSE: The purpose of this clinical study was to determine the accuracy of intraoral scanning with different devices compared with extraoral scanning.

MATERIAL AND METHODS: An experimental appliance was fabricated for 11 participants and then scanned intraorally and extraorally with 3 different intraoral scanners and a reference scanner. Intraoral and extraoral scans were subdivided into complete-arch and short-span scans and compared with the reference scan to assess trueness. Repeated scans in each group were assessed for precision.

RESULTS: Precision and trueness were higher for extraoral scans compared with intraoral scans, except for complete-arch scans with 1 intraoral scanner. The median precision of short-span scans was higher (extraoral: 22 to 29 μm, intraoral: 23 to 43 μm) compared with complete-arch scans (extraoral: 81 to 165 μm, intraoral: 80 to 198 μm). The median trueness of short-span scans (extraoral: 28 to 40 μm, intraoral: 38 to 47 μm) was higher than that of complete-arch scans (extraoral: 118 to 581 μm, intraoral: 147 to 433 μm) for intraoral and extraoral scanning.

CONCLUSIONS: Intraoral conditions negatively influenced the accuracy of the scanning devices, which was also reduced for the complete-arch scans.

PMID:33902891 | DOI:10.1016/j.prosdent.2021.03.007

Clin Radiol. 2021 Apr 23:S0009-9260(21)00198-7. doi: 10.1016/j.crad.2021.02.031. Online ahead of print.

ABSTRACT

AIM: To explore the magnetic resonance imaging (MRI) differences between pancreatic neuroendocrine tumour grade 3 (pNET-G3) and pancreatic neuroendocrine carcinoma grade 3 (pNEC-G3).

MATERIALS AND METHODS: Between 2009 and 2019, 31 patients underwent pNEN-G3 resection with preoperative MRI in two local hospitals in China. The 31 patients were assigned to a pNET-G3 group (n=13) or a pNEC-G3 group (n=18). The MRI findings between the groups were compared.

RESULTS: There was no statistically significant difference between the two groups in lesion size, clinical characteristics, or laboratory indexes. The lesions showed high or slightly higher signal on diffusion-weighted imaging and decreased apparent diffusion coefficient (ADC) values, which differed between the two groups (p=0.013). The difference between the groups regarding positive enhancement integral, arterial phase and portal phase signal enhancement ratio were statistically significant; however, the delayed phase signal enhancement ratio was not significantly different.

CONCLUSIONS: pNET-G3 and pNEC-G3 showed different characteristics on MRI. In particular, the ADC value and dynamic enhanced imaging could have an important role in distinguishing between the two.

PMID:33902887 | DOI:10.1016/j.crad.2021.02.031

Injury. 2021 Apr 9:S0020-1383(21)00337-5. doi: 10.1016/j.injury.2021.04.028. Online ahead of print.

ABSTRACT

INTRODUCTION: Electrical burn injuries are devastating and cause not only loss of life but also severe disabilities in the form of limb loss. Increase in urbanization, industrialization and overcrowding has led to an increase in electric injuries.

MATERIAL AND METHODS: The study was prospective in nature evaluating electric burns and studied the pattern of limb loss for a duration of 18 months from October 2016 to March 2018. Parameters recorded were demographic data, clinical data regarding the electrical injuries, complications, and outcomes.

RESULTS: Male patients made up 85.3% of cases. Mean TBSA was 24.76 ± 19.18%. Mean age was 27.59 ± 13.73 years. Pediatric patients made up 17%. High voltage burns constituted 68.2 %. Electric contact burn was the most common type making up 49.5% of cases. The most common cause was occupational (38.9%). A fasciotomy was required in 22% of cases with an amputation rate of 38% (209 out of 550). There were 190 major amputations and 106 minor amputations. Overall, the right upper limb amputations were twice as common as the left. The ratio of upper limb: lower limb amputation was 4:1. Fifty patients (23.9%) required revision amputation. The age group 11 to 30 years made up 55.5% of amputations. There was no statistical difference in amputation rates between males (31.31%) and females (41.97%). In patients with TBSA less than 25% amputation rate was 47.77% as compared to patients with more than 25% TBSA, 19.47% (p<0.001). Most amputations occurred due to electric contact burns (74.16%). In the high voltage group, 46.1% underwent amputation vs low voltage group -20.6% (p<0.001). Overall mortality rate was 12.7%. Three hundred patients (55%) had low level of awareness regarding consequences of electric injury. Thirty one percent had medium level of awareness and only 14 % had high level of awareness. There was a significant correlation between education level and awareness in adult patients (p<0.001). Seventy percent of persons with occupational injuries used only footwear and no other protective equipment.

CONCLUSION: Increasing public awareness, safety measures at workplaces are measures that will help reducing electrical burns which reduce limb and life loss.

PMID:33902868 | DOI:10.1016/j.injury.2021.04.028

West Afr J Med. 2021 Apr 23;38(4):359-365.

ABSTRACT

BACKGROUND: School Health Instructions (SHI) entail the instructional aspect of school health programme, which provides a classroom opportunity for inculcating healthy habits into the school- age child.

OBJECTIVE: To assess the status of implementation of school health instruction in primary schools in Gwagwalada Area Council of the Federal Capital Territory, Nigeria.

METHODS: A cross-sectional descriptive study of 146 primary schools in the Gwagwalada Area Council of the Nigerian Federal capital was carried out to assess the implementation of SHI with respect to the contents, methods of delivery and teachers preparation for health teaching using an evaluation checklist for SHI.

RESULTS: Of 146 schools, 115(78.8%) schools attained the minimum acceptable score of 27. Of the 40 public and 106 private schools, 27(67.5%) public and 88(83.0%) private schools attained the acceptable minimum score of 27. There was a statistically significant difference between the mean scores attained cumulatively in the various components of the school health instruction by the public and private schools (t=2.721, p= 0.008). Public schools had significantly more teachers with education-related qualifications than private schools (p<0.001). Teachings on HIV/ AIDS, safety education and community health were undertaken by 95.9%, 93.2% and 95.2% schools respectively. Only 5(3.4%) schools followed the recommendation of giving health instruction at least thrice a week.

CONCLUSION: Implementation of SHI was adequate in the study area, with a better performance among the private schools.

PMID:33901393

West Afr J Med. 2021 Apr 23;38(4):347-358.

ABSTRACT

BACKGROUND: COVID-19 was declared a pandemic by the World Health Organization (WHO) on 11th March 2020. Individuals with correct understanding about the risks and severity of the disease are more likely to respond positively and practice recommended preventive measures.

OBJECTIVES: To assess the knowledge, attitudes, and practices towards COVID-19 transmission and preventive measures among residents of Nigeria.

METHODS: The study was cross-sectional and involved 469 participants from 1st July to 31st August 2020. A 36-item questionnaire with Cronbach alpha of 0.753 was adapted and administered through an online survey tool. A snowball sampling approach was employed whereby the questionnaire link was distributed through social media networks including WhatsApp©, Facebook© and Instagram©. Data was analysed using SPSS 23 and a statistical significance level of 0.05 was used. Bivariate and multivariate analysis were employed to determine factors affecting the knowledge, attitude and practices towards COVID-19 transmission and prevention.

RESULTS: The mean age of participants was 39±11.29years. Majority (54%) of the participants heard about COVID-19 through mass and social media. The study found that 71.6% of the participants had good knowledge, just 31.3% had a good attitude while 84.9% of them had good practices towards COVID-19 in Nigeria. The high rates of the knowledge and practices were driven by income, age, education and marital status.

CONCLUSIONS: Majority of the study participants showed correct knowledge and adhered to recommended practices towards COVID- 19. However, there were gaps in the understanding of the underlying realities and beliefs in certain myths about COVID-19. Hence, interventions such as jingles and posters in various languages that would serve to correct the negative perceptions and myths about COVID-19 instituted through mass media and social media are recommended.

PMID:33901392