Tag: nevin manimala

Mov Disord. 2023 Jun 26. doi: 10.1002/mds.29516. Online ahead of print.

ABSTRACT

BACKGROUND: Deep brain stimulation (DBS) has been increasingly used in the management of dyskinetic cerebral palsy (DCP). Data on long-term effects and the safety profile are rare.

OBJECTIVES: We assessed the efficacy and safety of pallidal DBS in pediatric patients with DCP.

METHODS: The STIM-CP trial was a prospective, single-arm, multicenter study in which patients from the parental trial agreed to be followed-up for up to 36 months. Assessments included motor and non-motor domains.

RESULTS: Of the 16 patients included initially, 14 (mean inclusion age 14 years) were assessed. There was a significant change in the (blinded) ratings of the total Dyskinesia Impairment Scale at 36 months. Twelve serious adverse events (possibly) related to treatment were documented.

CONCLUSION: DBS significantly improved dyskinesia, but other outcome parameters did not change significantly. Investigations of larger homogeneous cohorts are needed to further ascertain the impact of DBS and guide treatment decisions in DCP. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

PMID:37358761 | DOI:10.1002/mds.29516

Hepatol Int. 2023 Jun 26. doi: 10.1007/s12072-023-10564-3. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Liver fibrosis predicts adverse clinical outcomes, such as liver-related death (LRD) and hepatocellular carcinoma (HCC) in patients with non-alcoholic fatty liver disease (NAFLD). We aimed to investigate the accuracy of semi-automated quantification of collagen proportionate area (CPA) as an objective new method for predicting clinical outcomes.

METHOD: Liver biopsies from patients with NAFLD underwent computerized image morphometry of Sirius Red staining with CPA quantification performed by ImageScope. Clinical outcomes, including total mortality, LRD, and combined liver outcomes (liver decompensation, HCC, or LRD), were determined by medical records and population-based data-linkage. The accuracy of CPA for predicting outcomes was compared with non-invasive fibrosis tests (Hepascore, FIB-4, APRI).

RESULTS: A total of 295 patients (mean age 50 years) were followed for a median (range) of 9 (0.2-25) years totalling 3253 person-years. Patients with CPA ≥ 10% had significantly higher risks for total death [hazard ratio (HR): 5.0 (1.9-13.2)], LRD [19.0 (2.0-182.0)], and combined liver outcomes [15.6 (3.1-78.6)]. CPA and pathologist fibrosis staging (FS) showed similar accuracy (AUROC) for the prediction of total death (0.68 vs. 0.70), LRD (0.72 vs. 0.77) and combined liver outcomes (0.75 vs. 0.78). Non-invasive serum markers Hepascore, APRI, and FIB-4 reached higher AUROC; however, they were not statistically significant compared to that of CPA except for Hepascore in predicting total mortality (0.86 vs. 0.68, p = 0.009).

CONCLUSION: Liver fibrosis quantified by CPA analysis was significantly associated with clinical outcomes including total mortality, LRD, and HCC. CPA achieved similar accuracy in predicting outcomes compared to pathologist fibrosis staging and non-invasive serum markers.

PMID:37358741 | DOI:10.1007/s12072-023-10564-3

Breast Cancer. 2023 Jun 26. doi: 10.1007/s12282-023-01474-1. Online ahead of print.

ABSTRACT

INTRODUCTION: The oncoplastic conservative surgery was developed as a natural evolution of traditional surgery, attempting to improve the therapeutic and aesthetic outcomes where tumor resection could be followed by not-adequate results. Our primary aim is to evaluate how patient satisfaction and quality-of-life after conservative oncoplastic surgery, using BREAST-Q (BCT Module), change pre- and post-operatively. The secondary aim is to compare patient-reported outcome after oncoplastic or traditional conservative surgery.

PATIENTS AND METHODS: We enrolled 647 patients who underwent traditional conservative surgery or oncoplastic surgery from January 2020 to December 2022. Only 232 women (35.9%) completed the BREAST-Q questionnaire on a web-based platform, at the preoperative phase and 3 months after treatment.

RESULTS: The average score of “Psychosocial well-being” and “Satisfaction with Breasts” 3 months after surgery showed a statistically significant improvement, while the average score for “Physical well-being: Chest” at 3 months showed a worsening compared to the baseline. “Sexual well-being” did not show statistically significant change. A significant difference between the post-operative outcome of oncoplastic surgery and traditional surgery was observed only for Physical well-being (better for traditional surgery).

CONCLUSIONS: The study showed significant improvement in patient-reported outcomes 3 months after the surgery, except for physical discomfort that increases especially after oncoplastic surgery. Furthermore, our data, as well as many others, point to the appropriateness of using OCS where there is an effective indication, while the perspective of patients cannot find significant superiority over TCS in any of the areas analyzed.

PMID:37358721 | DOI:10.1007/s12282-023-01474-1

Drugs. 2023 Jun 26. doi: 10.1007/s40265-023-01914-4. Online ahead of print.

ABSTRACT

BACKGROUND: Budesonide is accepted as first-choice therapy for microscopic colitis (MC); however, symptoms often recur and some patients may be dependent, intolerant, or even fail budesonide. We performed a systematic review and meta-analysis to determine the effectiveness of non-budesonide therapies (thiopurines, bismuth subsalicylate [BSS], bile acid sequestrants [BAS], loperamide and biologics) for MC suggested by international guidelines.

METHODS: We searched the CENTRAL, MEDLINE, and EMBASE databases from their inception to 18 April 2023 for the above-mentioned therapeutics in MC. We pooled the response and remission rates by medication using a random-effects model.

RESULTS: Twenty-five studies comprising 1475 patients were included in the meta-analysis. Treatment with BSS showed the highest response rate of 75% (95% confidence interval [CI] 0.65-0.83; I² = 70.12%), with 50% achieving remission of symptoms (95% CI 0.35-0.65; I² = 71.06%). Treatment with tumor necrosis factor (TNF) inhibitors (infliximab and adalimumab) demonstrated a response rate of 73% (95% CI 0.63-0.83; I² = 0.00%), with a remission rate of 44% (95% CI 0.32-0.56; I² = 0.00%). The response rate for those treated with vedolizumab was similar; 73% responded to treatment (95% CI 0.57-0.87; I² = 35.93%), with a remission rate of 56% (95% CI 0.36-0.75; I² = 46.30%). Loperamide was associated with response and remission rates of 62% (95% CI 0.43-0.80; I² = 92.99%) and 14% (95% CI 0.07-0.25), respectively, whereas BAS use was associated with response and remission rates of 60% (95% CI 0.51-0.68; I² = 61.65%) and 29% (95% CI 0.12-0.55), respectively. Finally, the outcomes for thiopurine use were 49% (95% CI 0.27-0.71; I² = 81.45%) and 38% (95% CI 0.23-0.54; I² = 50.05%), respectively DISCUSSION: The present systematic review and meta-analysis provides rates of effectiveness of non-budesonide therapies for MC based on available data in the field. Studies in the meta-analysis showed a large amount of heterogeneity due to the variability in assessing the clinical effects of intervention between the studies caused by differences in the definitions of response or remission rates between the studies included. This may likely result in overestimating the benefit of a treatment. Furthermore, the number of participants and drug dosages varied, and only a few studies applied disease-specific activity indices. Only one randomized controlled trial (RCT) was identified. All other 24 included studies were either case series or (retrospective) cohort studies, which complicated efforts to perform further sensitivity analyses to adjust for potential confounders and risk of bias. In addition, the overall evidence on the effect of these treatment options was judged as low, mostly due to comparability bias and the observational nature of the available studies, which limited statistically robust comparisons of rates of effectiveness of the different non-budesonide agents ranked against each other. However, our observational findings may inform clinicians regarding the most rational selection of non-budesonide therapies to patients with MC.

CLINICAL TRIALS REGISTRATION: PROSPERO protocol #CRD42020218649.

PMID:37358712 | DOI:10.1007/s40265-023-01914-4

Neurosurg Rev. 2023 Jun 26;46(1):150. doi: 10.1007/s10143-023-02050-z.

ABSTRACT

To analyze the perioperative course and clinical outcome of patients with large (lPA) and giant (gPA) pituitary adenoma who underwent endoscopic endonasal transsphenoidal surgery (EETS) using either two-dimensional (2D-E) or three-dimensional (3D-E) endoscopic systems. Single-center retrospective study of consecutive patients with lPA and gPA who underwent EETS between November 2008 and January 2023. LPA were defined as ≥ 3 cm and < 4 cm in diameter in at least one dimension and a volume of ≥ 10ccm; gPA were defined as larger than 4 cm in diameter and with a greater volume than 10ccm. Patient data (age, sex, endocrinological and ophthalmological status) and tumor data (histology, tumor volume, size, shape, cavernous sinus invasion according to the Knosp classification) were analyzed. 62 patients underwent EETS. 43 patients were treated for lPA (69.4%) and 19 patients for gPA (30.6%). 46 patients (74.2%) underwent surgical resection using 3D-E and 16 patients 2D endoscopy (25.8%). Statistical results are referred to the comparison between 3D-E and 2D-E. Patients’ age ranged from 23-88 years (median 57), 16 patients were female (25.8%), 46 male (74.2%). Complete tumor resection was possible in 43.5% (27/62), partial resection in 56.5% (35/62). Resection rates did not differ between 3D-E (27 patients [43.5%]) and 2D-E (7 patients [43.8%], (p = 0.985). Visual acuity improved in 30 of 46 patients with preoperative deficit (65.2%). In the 3D-E group 21 of 32 patients (65.7%) improved, compared to 9 of 14 patients in the 2D-E group (64.3%). Improvement of visual field was achieved in 31 of 50 patients (62.0%; 22 of 37 patients in the 3D-E group [59.4%] and 9 of 13 patients in the 2D-E group [69.2%]). CSF leak was the most frequent complication and occurred in 9 patients (14.5%, [8 patients 17.4% 3D-E]) without statistical significance. Other surgical complications like postoperative bleeding, infection (meningitis) and deterioration of visual acuity and field were detected without statistical difference. New pituitary anterior lobe dysfunction was observed in 30 of 62 patients (48.4%, 8 patients [50.0%] in the 2D-E group and 22 patients [47.8%] in the 3D-E group). A transient deficit of posterior lobe was detected in 22.6% (14/62). No patient died within 30 days of surgery. Although 3D-E may improve surgical dexterity, in this series of lPA and gPA it was not associated with higher resection rates compared to 2D-E. However, 3D-E visualization during resection of large and giant PA is safe and feasible and patient’s clinical outcome is not different compared to 2D-E.

PMID:37358696 | DOI:10.1007/s10143-023-02050-z

Neurol Sci. 2023 Jun 26. doi: 10.1007/s10072-023-06909-3. Online ahead of print.

ABSTRACT

BACKGROUND: Pregnancy has been observed to reduce the frequency of relapses in Multiple Sclerosis (MS) patients, but the relapse risk tends to increase during the early post-partum period. Increased pre- and post-partum disease activity may predict a poor long-term prognosis. This study aimed to evaluate the correlation between magnetic resonance imaging (MRI) activity during the year before pregnancy and long-term clinically meaningful worsening in Expanded Disability Status Scale (EDSS).

METHODS: This observational, retrospective, case-control study included 141 pregnancies in 99 females with MS. Statistical analyses were used to evaluate the correlation between MRI activity during the year pre-pregnancy and post-partum clinical worsening during a 5-year follow-up. Clustered logistic regression was used to investigate the predictors of 5-year clinically meaningful worsening in EDSS (lt-EDSS).

RESULTS: We found a significant correlation between an active MRI pre-pregnancy and lt-EDSS (p = 0.0006). EDSS pre-pregnancy and lt-EDSS were also significantly correlated (p = 0.043). Using a multivariate model, we predicted which females would not experience long-term clinical deterioration by a stable MRI pre-pregnancy (92.7% specificity; p = 0.004).

CONCLUSIONS: An active MRI pre-conception is a strong predictor of lt-EDSS and a higher annual relapse rate during the follow-up period, regardless of whether the female had clinical evidence of disease activity prior to conception and delivery. Optimizing disease control and achieving imaging stability prior to conception may reduce the risk of long-term clinical deterioration.

PMID:37358691 | DOI:10.1007/s10072-023-06909-3

Clin Oral Investig. 2023 Jun 26. doi: 10.1007/s00784-023-05117-9. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the skeletal and dentoalveolar dimensions of subjects with the unilateral maxillary-impacted canine and compare it with the non-impacted side using cone beam computed tomography (CBCT).

METHODS: A split-mouth study that included 26 CBCTs (52 sides) with unilateral impacted canine was designed. The parameters analyzed were alveolar height; bucco palatal width at 2 mm, 6 mm, and 10 mm from alveolar crest; premolar width; lateral angulation of incisors; root length of lateral incisors; and crown-root angulation of lateral incisors. Obtained data were statistically analyzed by unpaired independent t-test.

RESULTS: The bucco palatal width at 2 mm and the premolar width from mid-palatal raphe were 1.22 mm and 1.71 mm less on the impacted side, respectively; the central and lateral incisor angulations were less by 3.69 degrees and 3.40 degrees, respectively, on the impacted side; the lateral incisor root length was 2.8 mm shorter on the impacted side; the crown-root angulation for lateral incisor was 2.4 degrees more on the impacted side.

CONCLUSION: The following conclusions can be drawn: (1) The premolar width is less on the impacted side. (2) The incisors are more distally angulated on the impacted side. (3) The crown-root angulation of the lateral incisor is mesially directed on the impacted side.

CLINICAL RELEVANCE: Asymmetric arch expansions should be undertaken in severe transverse asymmetries. In the beginning stages of treatment, the arch alignment, excluding incisors, must be undertaken to safeguard the roots of incisors.

PMID:37358689 | DOI:10.1007/s00784-023-05117-9

Clin Oral Investig. 2023 Jun 26. doi: 10.1007/s00784-023-05120-0. Online ahead of print.

ABSTRACT

OBJECTIVE: This study evaluated the dimensional and positional osseous temporomandibular joint features in normodivergent facial patterns with and without temporomandibular disorders.

METHODS: A total of 165 adult patients were divided into two groups: group 1 (n = 79 patients; 158 joints): temporomandibular disorders patients and group 2 (n = 86 patients; 172 joints): non-temporomandibular disorders patients. Three-dimensional positional and dimensional temporomandibular joint characteristics, including glenoid fossa, mandibular condyles, and joint spaces, were assessed by cone beam computed tomography.

RESULTS: The glenoid fossa positions in the three orthogonal planes and height showed statistical significance between the two studied groups. The temporomandibular disorders patients showed higher horizontal and vertical condyle inclinations while anteroposterior inclination was less, and the condyle was positioned more superior, anterior, and lateral in the glenoid fossa. The condyle width and length showed no significance between the two groups, while condyle height was smaller in temporomandibular disorders patients. Anterior and medial joint spaces increased while the superior and posterior joint spaces reduced in temporomandibular disorders patients.

CONCLUSION: There were significant differences between the patients with and without temporomandibular joint disorders in terms of mandibular fossa positions and height as well as condylar positions and inclinations in horizontal and vertical planes together with reduced condylar height and reduced posterior and superior joint spaces in the temporomandibular disorders patients.

CLINICAL RELEVANCE: The temporomandibular disorder is a multifactorial disorder in which one of these factors is the dimensional and positional characteristics of the temporomandibular joints; including or excluding this factor requires a comprehensive three-dimensional investigation of patients with TMD compared to the normal group under the condition that the facial pattern is average as a confounding factor.

PMID:37358688 | DOI:10.1007/s00784-023-05120-0

Lasers Med Sci. 2023 Jun 26;38(1):148. doi: 10.1007/s10103-023-03816-z.

ABSTRACT

In this study, it was aimed to evaluate the smear and debris removal efficiency of laser and ultrasonic irrigation activation methods in traditional and conservative endodontic access cavity preparations. 60 freshly extracted human mandibular molar teeth were randomly divided into 2 groups according to the access cavity preparation (n = 30): Traditional endodontic access cavities (TEC) and Conservative endodontic access cavity (CEC). After the access cavity preparation, the mesiobuccal root canals were prepared to 35/0.4 with the VDW Rotate file system. Teeth with completed root canal preparation were randomly divided into 3 subgroups according to the final irrigation activation protocol (n = 30): Conventional needle irrigation, passive ultrasonic activation and laser activation. The crowns of the teeth were removed and the mesiobuccal roots were divided longitudinally into two halves, mesial and distal. Samples were scanned with scanning electron microscopy. Photomicrographs in the coronal, middle, and apical thirds of each specimen were taken at a magnification of 200 for debris and 1000 for evaluation of the smear layer. Data were analysed using the three-way Robust Anova test and Bonferroni test.The effect of access cavity design on remaining smear (p = 0.057) and debris (p = 0.5) was not statistically significant. The effect of the interaction of access cavity and irrigation activation on the remaining smear and debris was not statistically significant (p = 0.556, p = 0.333). Significantly fewer smears were detected in the laser activation group than in the ultrasonic activation and control groups. Conservative access cavities did not differ from conventional access cavities in terms of debris and smear.

PMID:37358660 | DOI:10.1007/s10103-023-03816-z

Graefes Arch Clin Exp Ophthalmol. 2023 Jun 26. doi: 10.1007/s00417-023-06151-9. Online ahead of print.

ABSTRACT

BACKGROUND: Omnigen is a vacuum-dehydrated amniotic membrane transplant. It can be delivered to the eye pre-mounted on a special bandage contact lens (Omnilenz) that enables its application without the need for sutures or glue; the aim of this study is to evaluate the short-term clinical outcomes of Omnilenz-Omnigen complex in eyes with acute chemical injury (CEI).

METHODS: A prospective interventional study included patients with different grades of acute CEI attending the casualty between July 2021 and November 2022. All patients received first aid measures followed by the application of Omnilenz-Omnigen within the first 2 days. Patients were followed up for at least 1 month. Primary outcomes include epithelial defect and limbal ischemia. Secondary outcomes include best-corrected visual acuity (BCVA) and tolerability.

RESULTS: The study included 23 eyes of 21 patients with acute CEI mostly due to alcohol (34.8%). After the 1^st application, the size of the epithelial defect showed a statistically significant reduction (p = 0.016) with improvement in BCVA (p < 0.001). Restoration of the limbal vascularity was obtained in 56.5% of the eyes. Repeated application of Omnilenz was required in 5 eyes (21.7%). The size of the epithelial defect was reduced after the second application (p = 0.504) with improved BCVA (p = 0.185). After 1^st month, complete epithelial healing was achieved in all the eyes. Mild limbal ischemia persists in 3 (13%) of the eyes. Final BCVA showed statistically significant improvement (p < 0.001). None of the patients develops any serious complications.

CONCLUSION: Omnilenz proved to be easy to apply and well tolerated by patients, with promising clinical outcomes.

PMID:37358651 | DOI:10.1007/s00417-023-06151-9