Tag: nevin manimala

Updates Surg. 2023 Oct 8. doi: 10.1007/s13304-023-01661-x. Online ahead of print.

ABSTRACT

The best nonoperative or operative anal fissure (AF) treatment is not yet established, and several options have been proposed. Aim is to report the surgeons’ practice for the AF treatment. Thirty-four multiple-choice questions were developed. Seven questions were about to participants’ demographics and, 27 questions about their clinical practice. Based on the specialty (general surgeon and colorectal surgeon), obtained data were divided and compared between two groups. Five-hundred surgeons were included (321 general and 179 colorectal surgeons). For both groups, duration of symptoms for at least 6 weeks is the most important factor for AF diagnosis (30.6%). Type of AF (acute vs chronic) is the most important factor which guide the therapeutic plan (44.4%). The first treatment of choice for acute AF is ointment application for both groups (59.6%). For the treatment of chronic AF, this data is confirmed by colorectal surgeons (57%), but not by the general surgeons who prefer the lateral internal sphincterotomy (LIS) (31.8%) (p = 0.0001). Botulin toxin injection is most performed by colorectal surgeons (58.7%) in comparison to general surgeons (20.9%) (p = 0.0001). Anal flap is mostly performed by colorectal surgeons (37.4%) in comparison to general surgeons (28.3%) (p = 0.0001). Fissurectomy alone is statistically significantly most performed by general surgeons in comparison to colorectal surgeons (57.9% and 43.6%, respectively) (p = 0.0020). This analysis provides useful information about the clinical practice for the management of a debated topic such as AF treatment. Shared guidelines and consensus especially focused on operative management are required to standardize the treatment and to improve postoperative results.

PMID:37805973 | DOI:10.1007/s13304-023-01661-x

Biostatistics. 2023 Oct 6:kxad028. doi: 10.1093/biostatistics/kxad028. Online ahead of print.

ABSTRACT

Joint modeling of longitudinal data such as quality of life data and survival data is important for palliative care researchers to draw efficient inferences because it can account for the associations between those two types of data. Modeling quality of life on a retrospective from death time scale is useful for investigators to interpret the analysis results of palliative care studies which have relatively short life expectancies. However, informative censoring remains a complex challenge for modeling quality of life on the retrospective time scale although it has been addressed for joint models on the prospective time scale. To fill this gap, we develop a novel joint modeling approach that can address the challenge by allowing informative censoring events to be dependent on patients’ quality of life and survival through a random effect. There are two sub-models in our approach: a linear mixed effect model for the longitudinal quality of life and a competing-risk model for the death time and dropout time that share the same random effect as the longitudinal model. Our approach can provide unbiased estimates for parameters of interest by appropriately modeling the informative censoring time. Model performance is assessed with a simulation study and compared with existing approaches. A real-world study is presented to illustrate the application of the new approach.

PMID:37805939 | DOI:10.1093/biostatistics/kxad028

J Chem Inf Model. 2023 Oct 8. doi: 10.1021/acs.jcim.3c01153. Online ahead of print.

ABSTRACT

AmberTools is a free and open-source collection of programs used to set up, run, and analyze molecular simulations. The newer features contained within AmberTools23 are briefly described in this Application note.

PMID:37805934 | DOI:10.1021/acs.jcim.3c01153

World J Surg. 2023 Oct 8. doi: 10.1007/s00268-023-07207-x. Online ahead of print.

ABSTRACT

OBJECTIVES: Ultrasound tends to present very high sensitivity but relatively low specificity and positive predictive value (PPV), which would result in unnecessary breast biopsies. The purpose of this study is to analyze the diagnostic performance of computer-aided diagnosis (CAD) (S-Detect) system in differentiating breast lesions and reducing unnecessary biopsies in non-university hospitals in less-developed regions of China.

METHODS: The study was a prospective multicenter study from 8 hospitals. The ultrasound images, and cine, CAD analysis, and BI-RADS were recorded. The accuracy, sensitivity, specificity, PPV, negative predictive value (NPV), and area under the curve (AUC) were analyzed and compared between CAD and radiologists. The Youden Index (YI) was used to determine optimal cut-off for the number of planes to downgrade.

RESULTS: A total of 491 breast lesions were included in the study. Less-experienced radiologists combined CAD was superior to less-experienced radiologists alone in AUC (0.878 vs 0.712, p < 0.001), and specificity (81.3% vs 44.6%, p < 0.001). There was no statistical difference in AUC (0.891 vs 0.878, p = 0.346), and specificity (82.3% vs 81.3%, p = 0.791) between experienced radiologists and less-experienced radiologists combined CAD. With CAD assistance, the biopsy rate of less-experienced radiologists was significantly decreased (100.0% vs 25.6%, p < 0.001), and malignant rate of biopsy was significantly increased (15.0% vs 43.9%, p < 0.001).

CONCLUSIONS: CAD system can be an effective auxiliary tool in differentiating breast lesions and reducing unnecessary biopsies for radiologists from non-university hospitals in less-developed regions of China.

PMID:37805926 | DOI:10.1007/s00268-023-07207-x

Georgian Med News. 2023 Jul-Aug;(340-341):264-269.

ABSTRACT

It is essential to study disorders of the immune system in chronic encephalopathies of various genesis, considering that the mechanisms of brain damage remain unknown in their molecular basis. Among numerous inflammatory mediators, cytokines are particular in regulating immunological interactions. Many factors, including the genetic ones, determine these pro-inflammatory proteins’ activity. The aim of study was to study the prevalence of IL1β C3953T gene polymorphism and TNFα G308A gene polymorphism in patients with chronic traumatic encephalopathy (CTE), microvascular ischemic disease of the brain (or cerebral small vessel disease, (SVD)), chronic alcohol-induced encephalopathy (AIE) and postinfectious encephalopathy (PIE), and to evaluate the impact of a particular genotype presence on the occurrence and/or progression of encephalopathy. The molecular genetic study of polymorphic variants – C3953T of the IL1β gene and G308A of the TNFα gene was applied for 96 patients with encephalopathies of various genesis (CTE n=26, CAIE n=26, SVD n=18, and PIE n=26). The patients were undergoing treatment in the neurological departments of the Communal Non-commercial Enterprise “Ternopil Regional Clinical Psychoneurological Hospital” of Ternopil Regional Council (Ternopil, Ukraine) during 2021-2022. The control group consisted of 12 healthy persons, who were representative in terms of age and sex. Statistical processing of the results was carried out using the STATISTICA 10.0 software package. The frequency distribution analysis of the genotypes of the polymorphic variant C3953T of the IL1β gene and G308A of the TNFα gene in patients with CTE, SVD, CAIE, and PIE compared to individuals of the control group was performed. The statistically significant differences were found only in patients with PIE: 26.92% vs. 83.33% – carriers of the C/ C genotype, 61.54% versus 16.67% – carriers of the C/T genotype and 11.54% versus 0% – carriers of the T/T genotype and 53.85% versus 91.67% – carriers of the G/G genotype, 46 .15% versus 8.33% – carriers of the G/A genotype and 0.0% versus 0.0% – carriers of the A/A genotype, respectively. In addition, in the group of patients with PIE, the distribution of genotype frequencies of the polymorphic variant C3953T of the IL1β gene probably differed from the data of patients with CTE, SVD, and PIE (χ2=28.64; p<0.001), and in the group of patients with CAIE, the distribution of genotype frequencies of the polymorphic variant G308A of the TNFα gene probably differed from the data of patients with SVD and PIE (χ2=24.91; p=0.002). Analyzing the odds ratio and its confidence interval for the genotypes of polymorphic variants C3953T of the IL1β gene and G308A of the TNFα gene in patients with CTE, SVD, CAIE, and PIE, it was established that the presence of the C/T genotype of the IL1β gene increases the risk of encephalopathy in patients with PIE by 8.0 times, and the presence of the G/A genotype of the TNFα gene increases the risk of encephalopathy in patients with PIE by 9.4 times. For the first time in the Ukrainian population, an analysis of the frequency distribution of the genotypes of the polymorphic variant C3953T of the IL1β gene and G308A of the TNFα gene in patients with chronic encephalopathies of various genesis was performed. Statistically, significant differences were found only in patients with PIE compared to healthy individuals. At the same time, the presence of the C/T genotype of the IL1β gene increases the risk of the occurrence and/or progression of PIE by 8.0 times, and the presence of the G/A genotype of the TNFα gene by 9.4 times, which indicates the feasibility of including the corresponding single-nucleotide polymorphisms in the genetic panel of the study patients with PIE.

PMID:37805909

Georgian Med News. 2023 Jul-Aug;(340-341):254-258.

ABSTRACT

The objective of study was to investigate the association between the Gln27Glu polymorphism in the β2-АR gene and body mass index in patients with bronchial asthma with regard to the age of onset. Study included 553 patients with bronchial asthma (BA) and 95 apparently healthy individuals with no individual and family history of asthma symptoms. All of them had previously signed an informed consent form for study participation. The patients were divided into 2 clinical groups depending on the age of BA onset. Group I included 282 patients with late-onset asthma (late-onset asthma phenotype), and Group II included 271 patients with early-onset asthma (early-onset asthma phenotype). There was no significant difference in gender, age, severity, or control level between the groups (р>0.05). BA diagnosis and BA severity were determined according to the GINA recommendations-2016 and its later version. Obesity was diagnosed in accordance with the Order of the Ministry of Health of Ukraine № 574 dated 05.08.2009 and the WHO recommendations (1999), the European Association for the Study of Obesity (EASO, 2016). The Gln27Glu polymorphism in the β2-АR gene (rs1042714) was determined using polymerase chain reaction-restriction fragment length polymorphism analysis. The obtained results were statistically analyzed using SPSS-17 program. No significant difference was established in the distribution of alleles and genotypes for the Gln27Glu polymorphism in the β2-adrenergic receptor gene depending on body mass index (BMI), p=0.1. Obesity relative risk estimation showed a statistically significant correlation related to the dominant (p=0.03) and additive (p=0.04) models of inheritance. The risk of obesity in minor allele carriers (Glu/Glu+Gln/Glu) was 1.75 times higher than that in the major allele homozygotes (р=0.03). No association was observed between the Gln27Glu polymorphism in the β2-AR gene and obesity risk in patients with early-onset bronchial asthma in any model of inheritance. Obesity relative risk estimation in late-onset BA patients showed a statistically significant correlation related to the dominant (p=0.03) and additive (p = 0.001) models of inheritance. The minor allele carriers (Gln/Glu and Glu/Glu genotypes) with late-onset BA had a 1.95 times higher risk of obesity in the dominant model and 1.65 times higher risk of obesity in the additive model vs. the major allele homozygotes. The obtained data indicated that the minor allele carriers of the Gln27Glu polymorphism in the β2-АR gene (both homozygotes and heterozygotes) with late-onset BA had a higher risk of obesity.

PMID:37805907

Georgian Med News. 2023 Jul-Aug;(340-341):212-216.

ABSTRACT

Breast cancer is a heterogeneous disease with a variable clinical course, morphological and clinical features. In clinical observation, we attempted to study the correlation between clinical characteristics of breast cancer patients and plasma miRNA-497 concentration as a possible pathogenic molecular disease factor and a diagnostic indicator. It was established that miRNA-497 levels were significantly higher in the plasma of premenopausal compared to menopausal women, while the opposite is true for healthy women. We did not find a link between miRNA-497 levels and tumor size and clinical stage, though a weak positive correlation between miRNA-497 levels and the N0-N3 stage was noted, with a pronounced increase at the N3 stage, which was reliable in the group of patients after APCT. miRNA-497 levels after the first and second courses of NPCT did not differ statistically significant. There was no correlation between miRNA-497 concentration and the molecular subtype of breast cancer, and the difference between patients with HER2+ type and the triple-negative type was not convincing due to the small patient sample size. Also, no connection was found between the analyzed miRNA-497 levels and follow-up results, and positive initial results require additional research and analysis. In conclusion, analysis of miRNA-497 levels can be useful in the study of the molecular type and stage of breast cancer. Prospects for further research are in analyzing this indicator in a larger sample of breast cancer patients, obtaining remote follow-up results, and comparison with other types of miRNA.

PMID:37805900

Georgian Med News. 2023 Jul-Aug;(340-341):198-204.

ABSTRACT

The purpose of the article is to identify the correlation between the right to health care and the right to housing in medical and enforcement practices in terms of the COVID-19 pandemic. The materials of the research were the legislation of the EU, Georgia, Ukraine, as well as information from World Health Organization, the World Bank, the media, and statistical data related to the COVID-19 pandemic. Dialectical, axiological, statistical, comparative and legal methods were applied during the research. Having studied the experience of Georgia, Ukraine and the EU countries allowed us to conclude that individual self-isolation in the housing is a necessary preventive tool in the fight against the COVID-19 pandemic. The essence of self-isolation in terms of COVID-19 pandemic has been determined; its legal regimes have been singled out. It has been concluded that the self-isolation of a person in a dwelling (individual self-isolation) led to the emergence of a phenomenon in the form of a correlation between the right to health protection and the right to housing. In fact, there is a situation when the maintenance of public health has become possible, in particular, due to the self-isolation of a person in a dwelling.

PMID:37805898

Georgian Med News. 2023 Jul-Aug;(340-341):159-164.

ABSTRACT

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects almost all internal organs, among which circulatory system organs (CSO) lesions are not only among the most common but also at the top of the list of causes of mortality. The tactics of treatment of patients with SLE without and in combination with CSO lesions are fundamentally different, and therefore, improving diagnostic methods will help to enhance the effectiveness of the management of this category of patients. The aim of the study – to determine the diagnostic value of laboratory markers of syntropic lesions of the circulatory system organs in patients with systemic lupus erythematosus. The research included 125 patients with SLE with CSO lesions, among whom the vast majority were young women. Patients were stratified according to syntropy. Syntropic lesions were those whose frequency significantly increased with increasing severity of SLE: retinal angiopathy, capillaritis, Raynaud’s syndrome, livedo reticularis, atherosclerosis, mitral valve insufficiency, mitral valve thickening, pericardial effusion, pulmonary hypertension, myocarditis, endocarditis, symptomatic arterial hypertension, and vein thrombosis. During the study, the diagnostic value of individual laboratory markers and their constellations in terms of sensitivity, specificity, and accuracy in patients with SLE with syntropic lesions of CSO was determined step by step, and the one with the highest diagnostic value for the diagnosis of these lesions was chosen. The difference was considered statistically significant if p<0.050. The association coefficient and the contingent coefficient were used to determine the closeness of the relationship between the marker and the syntropic lesion. The relationship was considered confirmed if the association coefficient was ≥ 0.50 or the contingent coefficient was ≥ 0.30. We studied the diagnostic value of individual laboratory markers and their constellations in terms of sensitivity, specificity, and accuracy in patients with SLE with syntropic CSO lesions. It was found that the best diagnostic value for the diagnosis of retinal angiopathy is the constellation of ↑ LDL + ↑ IA + ↑ anti-ds DNA + ↑ ANA; capillaritis – ↑ β-globulins + ↑ IA + ↑ anti-ds DNA + ↑ antiphospholipid antibodies Ig M + ↑ anti-Sm + ↓ C4; Raynaud’s syndrome – a separate marker ↓ C3; livedo reticularis – ↑ ESR + ↑ small CIC + ↑ anti-ds DNA + ↑ anti-Sm; atherosclerosis – ↓ hemoglobin + ↑ LDL + ↑ ANA + ↓ C4; mitral valve insufficiency – ↑ ESR + ↑ anti-ds DNA + ↑ ANA + ↑ antiphospholipid antibodies Ig M; mitral valve stenosis – ↑ ESR+↑ LDL + ↑ small CK + ↑ ANA; pericardial effusion – erythropenia + ↑ C-RP + ↑ lupus anticoagulant; pulmonary hypertension – hypercholesterolemia + ↑ LDL + ↑ anti-ds DNA + ↑ ANA; myocarditis – an individual marker ↓ C4; endocarditis – ↑ ESR + ↑ total fibrinogen + ↑ γ-globulins + hypercholesterolemia + ↑ anti-Sm; symptomatic arterial hypertension – ↑ LDL + ↑ anti-ds DNA + ↑ ANA + ↑ anti-SSA (Ro); vein thrombosis – erythropenia + ↓ hemoglobin + ↑ LDL + ↑ ANA. For each syntropic lesion in patients with systemic lupus erythematosus, an individual laboratory marker or constellations have been identified that having the best diagnostic value for the diagnosis of these lesions.

PMID:37805891

Georgian Med News. 2023 Jul-Aug;(340-341):131-135.

ABSTRACT

Aim – improving the effectiveness of complex treatment of patients with maxillomandibular anomalies and disorders of the architectonics of the vestibule of the mouth. We conducted clinical, X-ray methods and cytomorphometric, rheographic examination of the oral mucosa of 30 patients 15-17-years old with acquired maxillomandibular anomalies and disorders of the architectonics of the vestibule of the mouth (buccal frenum) and 15 relatively healthy children – norm group. The patients of I group had surgical correction of buccal frenum, where the surgical wound was healing by secondary tension. The patients of II group had proposed surgical correction of buccal frenum, where the surgical wound was healing by primary tension Patients were prescribed chlorhexidine-denta and a preparation based on hyaluronic acid (Gengigel, Italy) in the postoperative period. Statistical processing of the results was performed using a personal computer using the software package Statistica 12.0. Data distribution was assessed using the Kolmogorov-Smirnov test of normality. Mean values and standard errors were calculated for continuous variables. Correlation between parameters was analyzed using Spearman’s correlation coefficient and tested for significance. Significance was set at p<0.05. Clinical studies have shown that all patients have anomalies of buccal frenum fixationin the area of the canines and premolars. The results of cytomorphometric and rheographic studies indicated a deficiency of blood supply in these areas. The results of clinical and laboratory examination showed the advantage of the proposed treatment plan. Long-term results indicate the formation of a normorthophic scar, the absence of recurrences and recessions of the gums in the area of projections of the buccal frenum, the normalization of clinical and laboratory parameters. The obtained data in ІІ group significantly differ from those in І group (p <0.05). Surgical correction of disorders of the architectonics of the vestibule of the mouth is an important and necessary stage of complex treatment of patients with maxillomandibular anomalies and disorders of the architectonics of the vestibule of the mouth. We can achieve the desired therapeutic effect in the treatment of such patients and prevent relapses only by eliminating the etiological factor. The use of preparations based on hyaluronic acid in the postoperative period stimulates reparative processes in the operated area and contributes to the formation of a normotrophic scar. Plastic of buccal frenulum is a prevention of abnormal position of premolars and gum recession in the area of canines and premolars. It is important for preventive dentistry.

PMID:37805886