Tag: nevin manimala

Ultrasound Obstet Gynecol. 2023 Jun 17. doi: 10.1002/uog.26292. Online ahead of print.

ABSTRACT

OBJECTIVES: The primary objective was to perform a systematic review on predictive factors for Obstetric Anal Sphincter Injury (OASI) occurrence at a first vaginal delivery, where the diagnosis was made by ultrasound (US-OASI). The secondary objective was to report on incidence rates of sonographic AS trauma, including trauma that was not clinically reported on at childbirth, among the studies providing data for our primary endpoint.

METHODS: We conducted a systematic search of MEDLINE, Embase, Web of Science, Cinahl, Cochrane library and Clinicaltrials.gov databases. Both observational cohort studies and interventional trials were eligible for inclusion. Study eligibility was assessed independently by two authors. Random-effect meta-analyses were performed to pool effect estimates from studies reporting on similar predictive factors. Summary Odds Ratios (ORs) or Mean Differences (MDs) were reported with 95% CI. Heterogeneity was assessed using the I² statistic. Methodological quality was assessed using the Quality in Prognosis Studies tool.

RESULTS: 2805 records were screened and 21 met the inclusion criteria (16 prospective cohort, three retrospective cohort and two interventional non-randomized trials). Increasing gestational age at delivery (MD 0.34w [0.04, 0.64]), shorter antepartum perineal body length (MD -0.60cm [-1.09, -0.11]), labor augmentation (OR 1.81 [1.21-2.71]), instrumental delivery (OR 2.13 [1.13-4.01]), in particular forceps extraction (OR 3.56 [1.31-9.67]), shoulder dystocia (OR 12.07 [1.06-137.6]), episiotomy use (OR 1.85 [1.11-3.06]) and shorter episiotomy length (MD -0.40cm [-0.75, -0.05]) were associated with US-OASI. When pooling incidence rates, 26% of women who first delivered vaginally, had sonographic evidence of AS trauma (95%CI 20-32%, 20 studies, I² =88%). In studies reporting on both clinical and ultrasound OASI rates, 20% of women had AS trauma on ultrasound, that was not reported on at childbirth (95%CI 14-28%, 16 studies, I² =90%). No differences were found in maternal age, BMI, weight, subpubic arch angle, induction of labor, epidural analgesia, duration of first/second/active second stage, vacuum extraction, neonatal birthweight or head circumference. Also, antenatal perineal massage and use of an intrapartum pelvic floor muscle dilator did not affect the odds of US-OASI. Most studies (81%) were judged at high risk of bias on at least one domain, and only four studies (19%) had an overall low risk of bias.

CONCLUSION: Given there was ultrasound evidence of structural damage to the AS in 26% of women who first delivered vaginally, clinicians should have a low threshold of suspicion. Our systematic review identified several predictive factors for this. This article is protected by copyright. All rights reserved.

PMID:37329513 | DOI:10.1002/uog.26292

Ultrasound Obstet Gynecol. 2023 Jun 17. doi: 10.1002/uog.26291. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the performance at 35+0 to 36+6 weeks’ gestation of screening for delivery with pre-eclampsia (PE) at various time points, using one of three approaches: placental growth factor (PlGF) concentration, the soluble fms-like tyrosine kinase-1 (sFLT-1) to PlGF concentration ratio, or the competing risks model, which combines maternal risk factors with biomarkers to estimate patient-specific risk.

METHODS: This was a prospective observational study in women attending for a routine hospital visit at 35+0 to 36+6 weeks’ gestation in two maternity hospitals in England (2016-22). The visits included recording of maternal demographic characteristics and medical history, and measurement of serum PlGF, serum sFLT-1, and mean arterial pressure (MAP). The detection rates (DRs) were evaluated for delivery with PE (by 2019 American College of Obstetricians and Gynecologists criteria), within 1 week, within 2 weeks, or at any time after screening, using either: (i) low PlGF (<10^th percentile), (ii) high sFLT-1/PlGF ratio (>90^th percentile), or (iii) the competing risks model, using a combination of maternal factors and multiple of the median (MoM) values of PlGF (‘single’ test), PlGF and sFLT-1 (‘double’ test), or PlGF, sFLT-1 and MAP (‘triple’ test). Risk cut-offs corresponded to a screen-positive rate of 10%. DRs were compared between tests by McNemar’s test, with p<0.05 considered statistically significant.

RESULTS: Of 34,782 pregnancies, 831 (2.4%) developed PE. In screening for delivery with PE at any time from assessment, the DR at 10% screen-positive rate was 47% by low PlGF alone, 54% by the ‘single test’, 55% by high sFLT-1/PlGF, 61% by the ‘double test’, and 68% by the ‘triple test’. In screening for delivery with PE within 2 weeks, the respective values were 67%, 74%, 74%, 80%, and 87%. In screening for delivery with PE within 1 week, the respective values were 77%, 81%, 85%, 88% and 91%. For prediction of PE at any time, the DR difference [95% confidence interval] was significantly higher with the ‘triple test’, compared with PlGF alone (20.1 [16.7-23.0]) or the sFLT-1/PlGF ratio (12.4 [9.7-15.3]). Similar results were seen for prediction of PE within 2 weeks (20.6 [14.9-26.8] and 12.9 [7.7-17.5], respectively) and prediction of PE within 1 week (13.5 [5.4-21.6]) and (5.4 [0.0-10.8]). The double test was superior to the sFLT-1/PlGF ratio and the single test was superior to PlGF alone in the prediction of PE within 2 weeks and at any time from assessment, but not within 1 week of assessment.

CONCLUSION: At 35+0 to 36+6 weeks’ gestation, the performance of screening for PE by the competing risks model ‘triple test’ is superior to that of PlGF alone or the sFLT-1/PlGF ratio for PE within 1 week, within 2 weeks and at any time from screening. This article is protected by copyright. All rights reserved.

PMID:37329494 | DOI:10.1002/uog.26291

Eur J Orthop Surg Traumatol. 2023 Jun 17. doi: 10.1007/s00590-023-03612-z. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the effectiveness of combined Tranexamic acid (TXA) and dexamethasone (DEX) in total hip and knee arthroplasty.

METHODS: PUBMED, EMBASE, MEDLINE and CENTRAL database were systematically searched for randomized studies that utilized TXA and DEX administration of TXA in THA or TKA.

RESULTS: A total of three randomized studies enrolling 288 patients were eligible for qualitative and quantitative analysis. DEX + TXA group demonstrated statistical significantly lesser usage of oxycodone (OR: 0.34, p < 0.0001), metoclopramide (OR: 0.21, p < 0.00001), lesser incidence of postoperative nausea and vomiting (OR: 0.27, p < 0.0001), better postoperative range of motion (MD: 2.30, p < 0.00001) and shorter length of hospital stay (MD: 0.31, p = 0.03). Comparable results were seen in total blood loss, transfusion rate and postoperative complications.

CONCLUSION: In this meta-analysis, the combination of TXA and DEX has positive impacts on the usage of oxycodone and metoclopramide, postoperative range of motion, postoperative nausea and vomiting and reduces the length of hospital stay.

PMID:37329454 | DOI:10.1007/s00590-023-03612-z

Cancer Causes Control. 2023 Jun 17. doi: 10.1007/s10552-023-01727-6. Online ahead of print.

ABSTRACT

PURPOSE: Older age, risks from pre-existing health conditions and socio-economic disadvantage are negatively related to the prospects of an early-stage cancer diagnosis. With older Aboriginal Australians having an elevated prevalence of these underlying factors, this study examines the potential for the mitigating effects of more frequent contact with general practitioners (GPs) in ensuring local-stage at diagnosis.

METHODS: We compared the odds of local vs. more advanced stage at diagnosis of solid tumours according to GP contact, using linked registry and administrative data. Results were compared between Aboriginal (n = 4,084) and non-Aboriginal (n = 249,037) people aged 50 + years in New South Wales with a first diagnosis of cancer in 2003-2016.

RESULTS: Younger age, male sex, having less area-based socio-economic disadvantage, and fewer comorbid conditions in the 12 months before diagnosis (0-2 vs. 3 +), were associated with local-stage in fully-adjusted structural models. The odds of local-stage with more frequent GP contact (14 + contacts per annum) also differed by Aboriginal status, with a higher adjusted odds ratio (aOR) of local-stage for frequent GP contact among Aboriginal people (aOR = 1.29; 95% CI 1.11-1.49) but not among non-Aboriginal people (aOR = 0.97; 95% CI 0.95-0.99).

CONCLUSION: Older Aboriginal Australians diagnosed with cancer experience more comorbid conditions and more socioeconomic disadvantage than other Australians, which are negatively related to diagnosis at a local-cancer stage. More frequent GP contact may act to partly offset this among the Aboriginal population of NSW.

PMID:37329444 | DOI:10.1007/s10552-023-01727-6

Curr Diab Rep. 2023 Jun 17. doi: 10.1007/s11892-023-01517-z. Online ahead of print.

ABSTRACT

PURPOSE OF REVIEW: Depression is prevalent and common among individuals living with diabetes. The aim of this review is to systematically assess and meta-analyze the treatment effect of cognitive-behavioral therapy for depression (and other affective outcomes) among patients with diabetes.

RECENT FINDINGS: Earlier investigations found both psychosocial and pharmacological interventions, including cognitive-behavioral therapy, were promising in managing depression in patients with diabetes, though these findings remain inclusive due to poor study designs and a small number of trials included, which calls for a comprehensive systematic review and meta-analysis. A total of 33 studies (89 effect sizes) reported a moderate and statistically significant treatment effect of cognitive-behavioral therapy for depressive symptoms among individuals with diabetes (d = 0.301, 95% CI 0.115-0.487, p < 0.001). On average, cognitive-behavioral therapy was effective for psychological stress/distress outcomes but not for anxiety or physiological outcomes. The findings of the study confirmed CBT as an effective treatment option for depression among diabetes patients and identified important areas for future research.

PMID:37329442 | DOI:10.1007/s11892-023-01517-z

Qual Life Res. 2023 Jun 17. doi: 10.1007/s11136-023-03452-8. Online ahead of print.

ABSTRACT

PURPOSE: To identify psychoeducational interventions that target parents of children with congenital abnormalities (CA) and evaluate their impact on quality of life (QoL).

METHODS: The search was conducted in six electronic databases, complemented by references of the studies found, studies of evidence synthesis, a manual search of relevant scientific meetings’ abstracts and contact with experts. We included primary studies on parents of children with CA that studied psychoeducational interventions versus standard care. We assessed the risk of bias using Cochrane Collaboration’s tool.

RESULTS: We included six studies focusing on congenital heart defects (CHD). They described four different psychoeducational strategies. In four studies, statistically significant differences were found. For clinical practice, we considered three interventions as more feasible: the Educational program for mothers, with a group format of four sessions weekly; CHIP-Family intervention, which includes a parental group workshop followed by an individual follow-up booster session; and WeChat educational health program with an online format.

CONCLUSIONS: This review is the first that assesses the impact of psychoeducational interventions targeted at parents of children with CA on their QoL. The best approach to intervention is multiple group sessions. Two essential strategies were to give support material, enabling parents to review, and the possibility of an online program application, increasing accessibility. However, because all included studies focus on CHD, generalizations should be made carefully. These findings are crucial to guide future research to promote and improve comprehensive and structured support for families and integrate them into daily practice.

PMID:37329433 | DOI:10.1007/s11136-023-03452-8

Clin Transl Oncol. 2023 Jun 17. doi: 10.1007/s12094-023-03247-w. Online ahead of print.

ABSTRACT

PURPOSE: To estimate the cost-effectiveness of adding a CDK4/6 inhibitor to standard endocrine therapy in the first-line setting for advanced HR+/HER2- breast cancer in postmenopausal and premenopausal women, from the perspective of the Mexican public healthcare system.

METHODS: We used a partitioned survival model to simulate relevant health outcomes in a synthetic cohort of patients with breast cancer derived from the PALOMA-2, MONALEESA-2, MONARCH-3 trials for postmenopausal patients, and from the MONALEESA-7 study for premenopausal patients. Effectiveness was measured in life years gained. Cost-effectiveness is reported through incremental cost-effectiveness ratios (ICER).

RESULTS: In postmenopausal patients, palbociclib led to an increase of 1.51 life years, ribociclib of 1.58 years, and abemaciclib of 1.75 years, compared to letrozole alone. The ICER was 36,648 USD, 32,422 USD, and 26,888 USD, respectively. In premenopausal patients, ribociclib led to an increase of 1.82 life years when added to goserelin and endocrine therapy, with an ICER of 44,579 USD. In the cost minimization analysis, for postmenopausal patients, ribociclib was the treatment with the highest costs due to follow-up requirements.

CONCLUSION: Palbociclib, ribociclib, and abemaciclib demonstrated a significant increase in effectiveness in postmenopausal patients, and ribociclib in premenopausal patients, when added to standard endocrine therapy for patients with advanced HR+/HER2- breast cancer. At the national stablished willingness to pay, only the addition of abemaciclib to standard endocrine therapy in postmenopausal women would be considered cost-effective. However, differences on results between therapies for postmenopausal patients were not statistically significant.

PMID:37329428 | DOI:10.1007/s12094-023-03247-w

Cardiol Ther. 2023 Jun 17. doi: 10.1007/s40119-023-00322-9. Online ahead of print.

ABSTRACT

INTRODUCTION: This retrospective study investigated major adverse limb events (MALE) and mortality outcomes in critical limb-threatening ischemia (CLTI) patients with tissue loss after an endovascular revascularization-first (EVR-1st) strategy.

METHODS: MALE and mortality were assessed in 157 consecutive patients with CLTI and tissue loss from June 2019 to June 2022 at the Eric Williams Medical Sciences Complex, Trinidad and Tobago.

RESULTS: 157 patients underwent the EVR-1st strategy, of whom 20 were pivoted to immediate surgical revascularization (SR). Of the remaining 137 patients, successful EVR was achieved in 112, giving a procedural success of 82% and an all-comer overall success of 71%. The mortality and MALE rates were 2.7% and 8.9% at 2 years, respectively. Males and patients with previous major amputations were at significantly higher risk for MALE (p values of 0.016 and 0.018, respectively). There was a statistically significant difference in successful EVR for both Rutherford-Baker (RB) 5 (minor) and RB 6 (major) classifications: 63 (56%) vs. 5 (20%) and 49 (44%) vs. 20 (80%), both with a p value of 0.01. There were no differences in successful EVR amongst Wound, Ischemia, Foot Infection (WIfI) clinical stages. There were no differences in successful EVR amongst the Trans-Atlantic Inter-Society Consensus (TASC II) classifications.

CONCLUSIONS: This study may prove clinically informative and applicable for an EVR-1st management strategy for high-risk patients with CLTI in a limited-resource, Caribbean setting.

TRIAL REGISTRATION NUMBER: NCT05547022 (retrospectively registered).

PMID:37329412 | DOI:10.1007/s40119-023-00322-9

Int Ophthalmol. 2023 Jun 17. doi: 10.1007/s10792-023-02735-w. Online ahead of print.

ABSTRACT

PURPOSE: Glare visual acuity and contrast sensitivity are important indicators of visual quality. Studies have shown that the glare visual acuity and contrast sensitivity in dry eye patients tend to degenerate, further affecting their quality of life. The objective of this study was to investigate the effect of notch filters on glare VA and contrast sensitivity in patients with dry eye or with dry eye syndrome.

METHOD: 36 subjects in the 20‒65 age group were diagnosed as having dry eye disease or perceived dry eye syndromes themselves who were included after the initial screening with the OSDI questionnaire, and one was subsequently excluded as they had undergone retinal detachment surgery. Finally, 35 subjects (14 male and 21 female) with a mean age of 40.66 ± 15.62 years participated in this study. All subjects wore their habitual prescriptions and four different filter lenses (namely 480, 620, dual 480 & 620 notch filter, and FL-41 tinted lens), and measured the parameters of glare visual acuity and contrast sensitivity using CSV-1000 and sine wave contrast test (SWCT), respectively. Student t-test and Repeated measurement analysis (R-ANOVA) were utilized by using SPSS 26.0 software.

RESULTS: A dual-wavelength 480 & 620 nm optical notch filter had a significant anti-glare effect decreasing glare disabilities or discomfort, and leading to better visual quality, the same effect was also shown on a 480 nm notch filter lens. All participants showed a significant difference among the baseline, three notch filters (480 nm, 620 nm, dual-wavelength 480 & 620 nm), and FL-41 tinted lens were used on SWCT_A (1.5 cpd, F = 3.054, p = 0.019) and SWCT_E (18 cpd, F = 2.840, p = 0.049); but did not show statistical different on SWCT_B (3 cpd, F = 0.333, p = 0.771), SWCT_C (6 cpd, F = 1.779, p = 0.159), and SWCT_D (12 cpd, F = 1.447, p = 0.228). The baseline showed the best visual performance on CS at a low spatial frequency (SWCT_A, 1.5 cpd), any filter might reduce the contrast sensitivity at low spatial frequencies in the clinical trial, whereas 480 nm notch filter showed the best effectiveness on CS at a high spatial frequency (SWCT_E, 18 cpd), the FL-41 lens that also filters out the 480 nm band does not achieve the same effect. Moreover, patients with dry eye or those older than 40 years old preferred optical multilayer notch filters to FL-41 tinted lenses.

CONCLUSION: The 480- & 620-nm dual-wavelength and 480-nm single-wavelength notch filters have the best effect on the glare visual acuity and contrast sensitivity (CS) at high spatial frequencies in dry eye patients. The 620-nm notch filter performs better in CS at low and mid-low spatial frequencies; the FL-41 tinted lens performs poorly for glare VA and CS spatial frequencies examination. Patients with glare disabilities or CS disturbance at high spatial frequencies may choose a 480-nm notch filter lens, and patients who have CS disturbance at low spatial frequencies may consider a 620-nm notch filter for the prescription.

PMID:37329407 | DOI:10.1007/s10792-023-02735-w

Eur Phys J E Soft Matter. 2023 Jun 17;46(6):47. doi: 10.1140/epje/s10189-023-00307-5.

NO ABSTRACT

PMID:37329396 | DOI:10.1140/epje/s10189-023-00307-5