Tag: nevin manimala

Altern Ther Health Med. 2023 Jun 9:AT8249. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of this retrospective cohort study was to evaluate clinical outcomes in high-risk patients with symptomatic intracranial atherosclerotic stenosis (sICAS) resulting from plaque enhancement who underwent balloon dilation or stent implantation. Plaque features were identified based on high-resolution magnetic resonance vessel wall imaging (HRMR-VWI).

METHODS: A total of 37 patients with sICAS (degree of stenosis ≥70%) were enrolled between January 2018 and March 2022 at a single center. All patients underwent HRMR-VWI and received standard drug treatment after hospital admission. The patients were divided into 2 groups based on whether they underwent interventional treatment (n = 18) or non-interventional treatment (n = 19). The grade of enhancement and enhancement rate (ER) of culprit plaque were evaluated using 3D-HRMR-VWI. The risk of symptom recurrence was compared between the 2 groups during follow-up.

RESULTS: There was no statistical difference between the intervention and non-intervention groups in the rate and type of enhancement. Median clinical follow-up time was 17.8 (10.0 to 26.0) months and median follow-up time was 3.6 (3.1 to 6.2) months. In the intervention group, 2 patients had stent restenosis, but no stroke or transient ischemia attacks (TIAs) occurred. In contrast, 1 patient in the non-intervention group had an ischemic stroke and 4 patients had TIAs. The incidence of the primary outcome was lower in the intervention group than in the non-intervention group (0 vs 26.3%; P = .046).

CONCLUSIONS: High-resolution magnetic resonance intracranial vessel wall imaging (HR MR-IVWI) can be used to identify vulnerable plaque features. It is safe and effective in high-risk patients with sICAS with responsible plaque enhancement to undergo intravascular intervention combined with standard drug therapy. Further studies are needed to analyze the link between plaque enhancement and symptom recurrence in the medication group at baseline.

PMID:37295005

Acta Orthop Belg. 2023 Mar;89(1):162-166. doi: 10.52628/89.1.11240.

ABSTRACT

Patient-reported outcome measures (PROMs) are essential clinical instruments used for assessing patient function and assisting in clinical decision making. The Western Ontario Rotator Cuff (WORC) index is the PROM for shoulder pathology with the most psychometric properties but is very time consuming. The Single Assessment Numeric Evaluation (SANE) method is a PROM that takes less time to answer and to analyze. The aim of the study is to evaluate the intra- class correlation between these two outcome scores in establishing shoulder function in patients with non-traumatic rotator cuff pathologies. Fifty five subjects of both genders and different ages presenting with non-traumatic shoulder pain for more than 12 weeks had a physical examination and ultrasound as well as MRI arthrogram scan findings that were consistent of a non-traumatic rotator cuff (RC) based pathology. On the same moment a WORC index and a SANE score questionnaire were filled in by the subject. The intra class correlation of both PROMs was statistically analyzed. The WORC index score and the SANE score show a moderate correlation with an Intra Class Coefficient (ICC) of r = 0.60 (95% CI:0.40-0.75). This study demonstrates a moderate correlation between the WORC index score and the SANE score in rating the disability of patients with atraumatic RC disease. The SANE score is applicable in research and clinical practice and is for the patient and the researcher an almost no time consuming PROM.

PMID:37295002 | DOI:10.52628/89.1.11240

Acta Orthop Belg. 2023 Mar;89(1):135-140. doi: 10.52628/89.1.9726.

ABSTRACT

Tibial plateau fractures are usually associated with soft tissue injury. This study aimed to use the extent of joint depression and lateral widening in computed tomography (CT) to predict the soft tissue injury accompanying fractures.The study included 23 patients with type Arbeitsgemeinschaft für Osteosynthesefragen-classified 41B fractures. Demographics, mechanism of injury, age, gender, and injury sites were assessed. Post-traumatic radiography, magnetic resonance imaging (MRI), and CT were obtained. MRI evaluated the meniscal, cruciate, and collateral ligament injuries, and CT measured the extent of joint depression and lateral widening in millimeters using digital imaging software. The relationship between joint depression, lateral widening, and soft tissue injuries was statistically analyzed. Of the 23 patients, 17 (74%) were males and 6 (26%) were females. Lateral meniscus injuries increased and the risk of bucket handle lateral meniscus tears increased as the CT joint depression exceeded 12 mm (p < 0.05). Joint depression of <5.9 mm was associated with medial meniscus injury (p < 0.05). The mean distribution examination of all soft tissue injuries and joint depression revealed no statistically significant difference between the groups (p > 0.05). Increased joint depression in lateral tibial plateau fractures increases the risk of lateral meniscus bucket handle tear, and decreased joint depression increases the risk of medial meniscus injury. Accordingly implementing the treatment plan and patient management will improve the clinical outcomes.

PMID:37294997 | DOI:10.52628/89.1.9726

Acta Orthop Belg. 2023 Mar;89(1):117-121. doi: 10.52628/89.1.10753.

ABSTRACT

Tibial eminentia fractures are avulsion fractures of the anterior cruciate ligament caused with additional injuries like meniscus tears or ligamentous injuries. Arthroscopic assisted internal fixation has become a preferred technique with the development of arthroscopic techniques. We aimed to present our results for arthroscopic assisted double tibial tunnel fixation in patients with displaced eminentia fracture. Twenty patients who were operated on for eminentia fracture between January 2010 and May 2014 were included in this study. All fractures were type II according to Meyers’s classification. Eminentia was reduced with two nonabsorbable sutures through the ACL. Two tibial tunnels were created over the medial proximal tibia with a 2.4 mm cannulated drill. The two suture ends taken out of the 2 tibial tunnels were connected on the bone bridge between the tunnels. Patients were evaluated with Lysholm score, Tegner score, IKDC score and examined for clinical and radiological evidence of bony union. Quadriceps exercises were started on the third day. The patients were followed up with a locked knee brace in extension for 3 weeks after surgery and later patients were encouraged to mobilize as pain allowed. The preoperative Lysholm score was 75 ±3.3 and the postoperative Lysholm score was 94.5 ±3. Tegner score was 3.52±1.02 preoperatively and 6.84±1.099 postoperatively. International Knee Documentation Committee(IKDC) score was abnormal in all of the 20 patients preoperatively but normal postoperatively. The postoperative scores of the patients were statistically significant when compared with preoperative activity scores(p<0,0001). Tibial eminentia fractures may lead to pain, knee instability, malunion, laxity, or extension deficit. The technique we have described together with early rehabilitation may give good clinical results.

PMID:37294994 | DOI:10.52628/89.1.10753

Acta Orthop Belg. 2023 Mar;89(1):37-43. doi: 10.52628/89.1.9913.

ABSTRACT

The UK National Joint Registry(NJR) has not reported total knee replacement (TKR) survivorship based on design phi- losophy alone, unlike its international counterparts. We report outcomes of implant survivorship based on design phi- losophy using data from NJR’s 2020 annual report. All TKR implants with an identifiable design philosophy from NJR data were included. Cumulative revision data for cruciate-retaining(CR), posterior stabilised(PS), mobile-bearing(MB) design philosophies was derived from merged NJR data. Cumulative revision data for individual brands of implants with the medial pivot (MP) philosophy were used to calculate overall survivorship for this design philosophy. The all-cause revision was used as the endpoint and calculated to 15 years follow-up with Kaplan-Meier curves. 1,144,384 TKRs were included. CR is the most popular design philosophy (67.4%), followed by PS(23.1%), MB (6.9%) and least commonly MP (2.6%). MP and CR implants showed the best survivorship (95.7% and 95.6% respectively) at 15 years which is statistically significant at, and beyond, 10 years. Observed survivorship was lower at all time points with the PS and MB implants (94.5% for both designs at 15 years). While all design philosophies considered in this study survive well, CR and MP designs offer statistically superior survivorship at and beyond 10 years. MP design performs better than CR beyond 13 years yet, remain the least popular design philosophy used. Publishing data based on knee arthroplasty design phi- losophy would help surgeons when making decisions on implant choice.

PMID:37294983 | DOI:10.52628/89.1.9913

Acta Orthop Belg. 2023 Mar;89(1):15-19. doi: 10.52628/89.1.8636.

ABSTRACT

There are concerns that selective sonographic screening for developmental dysplasia of the hip (DDH) may be suboptimal. Our aim was to test this hypothesis by identifying trends in presentation and surgical treatment in patients with DDH. This is a retrospective review of children born between 1997-2018 who were treated surgically for DDH at our sub- regional paediatric orthopaedic unit. Demographic data, risk factors, age of diagnosis and surgical treatments were analysed. Late diagnosis was defined as greater than 4 months. 103 children (14 male, 89 female) underwent surgery. 93 hips were operated for dislocation and 21 for dysplasia. 13 patients presented with bilateral hip dislocations. The median age at diagnosis was 10 months (95% CI: 4-15). 62/103 (60.2%) were diagnosed late (after 4 months) and the median age for diagnosis in this group was 18.5 months (95% CI: 16-20.5). Significantly more patients were referred late (p=0.0077). The presence of risk factors (breech presentation or family history) was associated with early diagnosis. Over the duration of our study the operation rate per 1000 live births gradually increased, and on Poisson regression analysis there was a statistically significant increasing trend towards late diagnosis in recent years (p=0.0237), which necessitated more aggressive surgical management. In the UK, the current selective sonographic screening programme for DDH has shown a deterioration over the years of this study and this questions its current effectiveness. It appears that the majority of irreducible hip dislocations are diagnosed late, with an increased need for surgical management.

PMID:37294980 | DOI:10.52628/89.1.8636

Eur J Neurol. 2023 Jun 9. doi: 10.1111/ene.15911. Online ahead of print.

NO ABSTRACT

PMID:37294977 | DOI:10.1111/ene.15911

Health Phys. 2023 Jun 8. doi: 10.1097/HP.0000000000001709. Online ahead of print.

ABSTRACT

DNA double-strand breaks (DSBs) induced by ionizing radiation (IR) are considered to be the most critical lesion that when unrepaired or misrepaired leads to genomic instability or cell death depending on the radiation exposure dose. The potential health risks associated with exposures of low-dose radiation are of concern since they are being increasingly used in diverse medical and non-medical applications. Here, we have used a novel human tissue-like 3-dimensional bioprint to evaluate low-dose radiation-induced DNA damage response. For the generation of 3-dimensional tissue-like constructs, human hTERT immortalized foreskin fibroblast BJ1 cells were extrusion printed and further enzymatically gelled in a gellan microgel-based support bath. Low-dose radiation-induced DSBs and repair were analyzed in the tissue-like bioprints by indirect immunofluorescence using a well-known DSB surrogate marker, 53BP1, at different post-irradiation times (0.5 h, 6 h, and 24 h) after treatment with various doses of γ rays (50 mGy, 100 mGy, and 200 mGy). The 53BP1 foci showed a dose dependent induction in the tissue bioprints after 30 min of radiation exposure and subsequently declined at 6 h and 24 h in a dose-dependent manner. The residual 53BP1 foci number observed at 24 h post-irradiation time for the γ-ray doses of 50 mGy, 100 mGy, and 200 mGy was not statistically different from mock treated bioprints illustrative of an efficient DNA repair response at these low-dose exposures. Similar results were obtained for yet another DSB surrogate marker, γ-H2AX (phosphorylated form of histone H2A variant) in the human tissue-like constructs. Although we have primarily used foreskin fibroblasts, our bioprinting approach-mimicking a human tissue-like microenvironment-can be extended to different organ-specific cell types for evaluating the radio-response at low-dose and dose-rates of IR.

PMID:37294952 | DOI:10.1097/HP.0000000000001709

Health Secur. 2023 Jun 9. doi: 10.1089/hs.2023.0051. Online ahead of print.

ABSTRACT

The National Disaster Medical System (NDMS) Pilot Program was authorized by Congress to improve the interoperability, capabilities, and capacity of the NDMS. To develop a roadmap for planning and research, the mixed-methods Military-Civilian NDMS Interoperability Study (MCNIS) was conducted in 2020-2021. The initial qualitative phase of the study identified critical themes for improvement: (1) coordination, collaboration, and communication; (2) funding and incentives to increase private sector preparedness; (3) staffing capacity and competencies; (4) clinical and support surge capacity; (5) training, education, and exercises between federal and private sector partners; and (6) metrics, benchmarks, and modeling to track NDMS performance. These qualitative findings were subsequently refined, validated, and prioritized through a quantitative survey. Expert respondents ranked 64 statements based on weaknesses and opportunities identified during the qualitative phase. Data were collected using Likert scales, and multivariate proportions and confidence intervals were estimated to compare and prioritize each statement’s level of support. Pairwise tests were conducted for each item-to-item pair to determine statistically significant differences. The survey results corroborated the earlier qualitative findings, with all weaknesses and opportunities ranked as important by a majority of respondents. Survey results also pointed to specific priorities for interventions within the 6 previously identified themes. As with the qualitative study, the survey found that the most common weaknesses and opportunities were related to coordination, collaboration, and communication, especially regarding information technology and planning at the federal and regional levels. These priority interventions are now being developed, implemented, and validated at 5 pilot partner sites.

PMID:37294940 | DOI:10.1089/hs.2023.0051

J Burn Care Res. 2023 Jun 9:irad088. doi: 10.1093/jbcr/irad088. Online ahead of print.

ABSTRACT

Burns represent a large portion of injuries attending emergency departments each year, with children accounting for the biggest proportion. Appropriate first aid has been shown to help improve the outcome of burns and decrease the need for surgical intervention. Several studies outside of Indonesia demonstrate inadequate parental knowledge of burns first aid, but few evaluated interventions to improve knowledge. A period of data gathering from June to September 2022 was include the parents who have offspring aged between 18 and 12. This questionnaire was developed to achieve the objectives of this study and was based on others of a similar nature. A total of 102 participants were included in this study. 102 parents (79.4% female (n=81), 20.6% male (n=21)) were questioned. Baseline knowledge was found to be poor overall; it was found that nearly 91% of parents did not know the first-aid procedures for treating pediatric burns. However, educational initiatives were effective in advancing this knowledge. When a child got burned, nearly 68% of parents knew to use cold running water, and about 70% knew to get help from a doctor. Cold running water being applied is an extremely positive sign, which can have the most beneficial effect on the healing of the injury. No other variables analysed were shown to be statistically significant predictors of pre- or post-test scores (all p > 0.05). This study concluded that educational knowledge was effective to improve the parents’ ability in performing first aid for burn care.

PMID:37294898 | DOI:10.1093/jbcr/irad088