Tag: nevin manimala

Cureus. 2023 Apr 11;15(4):e37442. doi: 10.7759/cureus.37442. eCollection 2023 Apr.

ABSTRACT

Osteosarcomas are a type of bone cancer that typically affect young adults, often in the bones of the arms and legs. To treat osteosarcoma, doctors typically use a combination of chemotherapy, radiotherapy, and surgery, with External Beam Radiation Therapy (EBRT) being the most commonly used form of radiotherapy. EBRT involves directing high-energy photons, X-rays, gamma rays, protons, and electrons at the tumor to induce cancer cell death. Additionally, healthcare providers use imaging techniques to monitor treatment success. This literature review aims to explore the relationship between osteosarcomas and EBRT, investigate the impact of the delayed diagnosis on survival rates, and examine the effectiveness of innovative uses of EBRT for treating osteosarcomas in unusual locations using comprehensive diagnostic techniques. To achieve these objectives, the review examines case studies and literary analyses and categorizes them based on the delay between symptom onset and diagnosis. The null hypothesis is that the presence or absence of a delay in diagnosis does not significantly impact outcomes for the “Delay” category. A lack of delay results in a more favorable outcome in the “Lack of Delay” category. However, the data and statistical results suggest that additional follow-up care in patients with rare or commonly recurring cancers could benefit outcomes. It is important to note that due to the rarity of osteosarcoma with EBRT, the small sample size in the studies warrants further investigation. Interestingly, many patients presented with head and neck tumors despite the most common location of osteosarcoma being in the long bones.

PMID:37182042 | PMC:PMC10174335 | DOI:10.7759/cureus.37442

Cureus. 2023 Apr 11;15(4):e37426. doi: 10.7759/cureus.37426. eCollection 2023 Apr.

ABSTRACT

Background The orthopedic surgery workforce constitutes a vital role in the healthcare system, with data being scarce. Therefore, through this study, we share an overview of the orthopedic workforce distribution, demographic trends, and changes over the past decade in Saudi Arabia. Methods All practicing orthopedic surgeons in Saudi Arabia from January 1, 2010, to December 31, 2021, were included in the study. Data regarding orthopedic surgeons’ demographics and numbers were obtained from the Saudi Commission for Health Specialties (SCFHS), whereas the data related to the geographical distribution of orthopedic surgeons was obtained from the Ministry of Health Statistical Yearbook of 2020. Results The ratio of orthopedic surgeons per 100,000 people was 5.42 in 2010, which grew subsequently to 12.29 in 2021. The number of Saudi orthopedic surgeons has been noticeably rising through the years, while a slowly growing pattern can be seen among non-Saudi orthopedic surgeons. In addition, the highest ratios of orthopedic surgeons per 100,000 were in Makkah (1.72), Riyadh (1.26), and the Eastern Region (1.06). Conclusion In this study, we demonstrate the progress of the orthopedic workforce in Saudi Arabia over a period of 12 years. The number of orthopedic surgeons per 100,000 people showed a significant rise due to several factors, one of which is road traffic accidents. Also, although the number of female orthopedic surgeons has been rising lately, they are still much fewer than males in this field. In addition, Saudi Arabia has been developing a new healthcare system via the privatization of some of the governmental hospitals, which will lead to changes in the future workforce and its accommodations.

PMID:37182036 | PMC:PMC10173370 | DOI:10.7759/cureus.37426

Cureus. 2023 Apr 11;15(4):e37447. doi: 10.7759/cureus.37447. eCollection 2023 Apr.

ABSTRACT

Background The outcomes after fixation of the supracondylar humerus fracture (SCHF) are not documented in the current literature. In our study, we endeavour to determine the factors that influence the functional outcome and gauge their respective impact. Methodology We retrospectively reviewed the outcomes of patients who presented to our tertiary care centre (Royal London Hospital) with SCHFs between September 2017 and February 2018. We analysed patient records to assess several clinical parameters, including age, Gartland’s classification, comorbidities, time to treatment, and fixation configuration. We conducted a multiple linear regression analysis to determine each of the clinical parameter’s impact on the functional and cosmetic outcome, as reflected in Flynn’s criteria. Results We included 112 patients in our study. Pediatric SCHFs had good functional outcomes based on Flynn’s criteria. There was no significant statistical difference in functional outcomes with respect to sex (p= 0.713), age (p= 0.96), fracture type (p= 0.14), K-wire configuration (p=0.83), and time elapsed since surgery (p= 0.240). Conclusions Our results demonstrate that good functional outcomes can be expected with paediatric SCHFs based on Flynn’s criteria, regardless of age at injury, sex, or pin configuration, provided satisfactory reduction is achieved and maintained. The only variable with statistical significance was Gartland’s grade; Grades III and IV were correlated with poorer outcomes.

PMID:37182015 | PMC:PMC10174634 | DOI:10.7759/cureus.37447

Cureus. 2023 Apr 10;15(4):e37394. doi: 10.7759/cureus.37394. eCollection 2023 Apr.

ABSTRACT

BACKGROUND: As the general population is expanding their choices regarding healthcare, many are opting for complementary and alternative medicine (CAM) in addition to or instead of conventional modes of treatment, for the management of various health conditions.

AIMS: This study investigated the utilization of CAM for the management of various cardiovascular diseases as well as its risk factors among the adult population in Ajman, UAE.

MATERIALS AND METHODS: The study was conducted upon receiving approval from the Institutional Review Board (IRB). This cross-sectional study was conducted by administering an interviewer-administered questionnaire, consisting of three domains aimed at assessing the sociodemographic features and use of CAM and factors associated with the use among the respondents. A total of 414 responses were collected from adults residing in Ajman, UAE, who consented to participate in the study. A chi-square test was performed on Statistical Product and Service Solutions (SPSS) (IBM SPSS Statistics for Windows, Version 27.0, Armonk, NY) to assess the association between the use of CAM and factors. Statistical significance was set to p ≤ 0.05.

RESULTS: Out of 414 participants in the study, 57% of the participants used CAM before, while 43% of the participants never used CAM. Among the CAM users, 23% used it for anxiety and stress, 7.6% utilized it for the management of hypertension, 3.3% used it for high cholesterol, 3.1% for obesity, 1.9% for chronic kidney disease, 0.9% used it for diabetes mellitus, 0.5% used it for stroke, and 0.5% used it for heart failure.

CONCLUSIONS: From the results of the study, it can be concluded that the majority (57%) of the participants have used CAM before. Most of the participants utilized CAM to manage chronic conditions (81.9%).

PMID:37182011 | PMC:PMC10171885 | DOI:10.7759/cureus.37394

Front Immunol. 2023 Apr 27;14:1133656. doi: 10.3389/fimmu.2023.1133656. eCollection 2023.

ABSTRACT

BACKGROUND: Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) has significant morbidity and mortality and is associated with the induction of cytokines/chemokines, which might contribute to the pathogenesis of liver injury. This study aimed to explore the cytokine/chemokine profiles of patients with HBV-ACLF and develop a composite clinical prognostic model.

METHODS: We prospectively collected blood samples and the clinical data of 107 patients with HBV-ACLF admitted to the Beijing Ditan Hospital. The concentrations of 40-plex cytokines/chemokines were measured in 86 survivors and 21 non-survivors using the Luminex assay. Discrimination between the cytokine/chemokine profiles in different prognosis groups was analyzed using the multivariate statistical techniques of principal component analysis (PCA) and partial least squares discriminant analysis (PLS-DA). An immune-clinical prognostic model was obtained using multivariate logistic regression analysis.

RESULTS: The PCA and PLS-DA indicated that cytokine/chemokine profiling could clearly distinguish patients with different prognoses. A total of 14 cytokines, namely, IL-1β, IL-6, IL-8, IL-10, TNF-α, IFN-γ, CXCL1, CXCL2, CXCL9, CXCL13, CX3CL1, GM-SCF, CCL21, and CCL23, were significantly correlated with disease prognosis. Multivariate analysis identified CXCL2, IL-8, total bilirubin, and age as independent risk factors that constituted the immune-clinical prognostic model, which showed the strongest predictive value of 0.938 compared with those of the Chronic Liver Failure Consortium (CLIF-C) ACLF (0.785), Model for End-Stage Liver Disease (MELD) (0.669), and MELD-Na (0.723) scores (p < 0.05 for all).

CONCLUSION: The serum cytokine/chemokine profiles correlated with the 90-day prognosis of patients with HBV-ACLF. The proposed composite immune-clinical prognostic model resulted in more accurate prognostic estimates than those of the CLIF-C ACLF, MELD, and MELD-Na scores.

PMID:37180134 | PMC:PMC10172591 | DOI:10.3389/fimmu.2023.1133656

Front Immunol. 2023 Apr 27;14:1176403. doi: 10.3389/fimmu.2023.1176403. eCollection 2023.

ABSTRACT

INTRODUCTION: The prevalence of obesity in general pediatric population increases without sparing children with T1D. We intended to find factors associated with the possibility of preserving endogenous insulin secretion in individuals with long-standing T1D. At onset, higher BMI is associated with higher C-peptide level, which may indicate to be one of the favorable factors involved in preserving residual β-cell function. The study determines the influence of BMI on C-peptide secretion in children newly diagnosed with T1D in two years observation.

METHODS: We assessed the possible relationship between selected pro- and anti-inflammatory cytokines, body mass at recognition and β-cell function status. 153 pediatric patients with newly diagnosed T1D were divided into quartiles according to BMI-SDS index. We separated a group consisted of patients with BMI-SDS >1. Participants were followed up for two years and examined for changes in body weight, HbA1c, and insulin requirement. C-peptide was assessed at baseline and after two years. We evaluated the patients’ levels of selected inflammatory cytokines at baseline.

RESULTS: Subjects with higher BMI-SDS presented higher serum C-peptide levels and lower insulin requirements at diagnosis than children with lower body weight. The two-year follow-up showed that C-peptide levels of obese patients dropped more rapidly than in children with BMI-SDS within normal limits. The group with BMI-SDS >1 showed the greatest decrease in C-peptide level. Despite statistically insignificant differences in HbA1c at diagnosis between the study groups, in the fourth quartile and BMI-SDS >1 groups, HbA1c as well as insulin requirements increased after two years. The levels of cytokines varied the most between BMI-SDS <1 and BMI-SDS >1 groups and were significantly higher within BMI-SDS >1 group.

DISCUSSION: Higher BMI, associated with enhanced levels of inflammatory cytokines, relates to preservation of C-peptide at T1D recognition in children but is not beneficial in the long term. A decrease in C-peptide levels combined with an increase in insulin requirements and in HbA1c among patients with high BMI occur, which may indicate a negative effect of excessive body weight on the long term preservation of residual β-cell function. The process seems to be mediated by inflammatory cytokines.

PMID:37180128 | PMC:PMC10174309 | DOI:10.3389/fimmu.2023.1176403

Front Vet Sci. 2023 Apr 27;10:1167387. doi: 10.3389/fvets.2023.1167387. eCollection 2023.

ABSTRACT

Artificial insemination (AI) is the first and the most used biotechnologies in reproduction all over the world. Many studies reported the beneficial role of gonadotropin-releasing hormone (GnRH) administrated some hours before the AI or at the artificial insemination time. This study aimed to assess the effect of GnRH analogs given at the time of insemination on the first, second, and third AIs and to assess the economical implications of GnRH administration. We hypothesized that administration of GnRH at the time of insemination would increase ovulation and pregnancy rate. The study was conducted on small farms in northwestern Romania and included animals of the Romanian Brown and Romanian Spotted breeds. Animals in estrous at the first, second, and third inseminations were randomly divided into groups that received GnRH at insemination and groups that did not. A comparison between the groups was performed and the cost of GnRH administration to obtain one gestation was calculated. The GnRh administration increased the pregnancy rate at the first and the second inseminations by 12 and 18%, respectively. For one pregnancy, the cost of GnRH administration was approximately 49 euros for the first insemination group and around 33 euros for the second insemination group. No improvement of the pregnancy rate was observed after the GnRH administration for the cows at the third insemination, so, for this group, no economic statistics were performed.

PMID:37180075 | PMC:PMC10172496 | DOI:10.3389/fvets.2023.1167387

Front Vet Sci. 2023 Apr 25;10:1106619. doi: 10.3389/fvets.2023.1106619. eCollection 2023.

ABSTRACT

The use of co-products as a feed supplement for ruminants makes livestock sustainable and optimizes the use of available areas and animal performance. Furthermore, when cakes are used, the residual fat composition can influence ruminal metabolism and methane (CH₄) production. This study aimed to assess the effects of a diet containing cupuassu (CUP; Theobroma grandiflorum) and tucuma (TUC; Astrocaryum vulgare Mart.) cakes on intake, digestibility, serum metabolites, performance, and CH₄ emissions in confined sheep in the Amazon. Approximately 28 animals, Dorper-Santa Inês, castrated, with an average initial live weight (ILW) of 35 ± 2.3 kg, were distributed in metabolic cages, in a completely randomized design, with four treatments and seven replications: (1) Control (C40), without the addition of Amazonian cake and with 40 g of ether extract (EE)/kg of dietary dry matter (DM); (2) CUP, the inclusion of the CUP cake and 70 g of EE/kg; (3) TUC, the inclusion of the TUC cake and 70 g of EE/kg; and (4) Control (C80), without the addition of Amazonian cake and with 80 g of EE/kg of dietary DM, with roughage to concentrate ratio of 40:60. The use of the TUC cake as a feed supplement reduced the intake of DM, crude protein (CP), and EE compared to the inclusion of the CUP cake (p < 0.05); however, it increased the intake of neutral detergent fiber (NDF) by 32% (p < 0.01). The highest averages of DM (732 g/kg) and CP (743 g/kg) digestibility were presented in C40, while the highest digestibility of NDF was presented in TUC (590 g/kg). Albumin levels stayed above and protein levels were below the reference values, and the C40 diet also obtained below results for cholesterol, triglycerides and High Density Lipoprotein (HDL) (P < 0.05). Sheep fed CUP (91 g) and TUC (45 g) had lower daily weight gains (DWGs) than those fed with diets without the inclusion of cakes (C40 = 119 g; C80 = 148 g), and feed efficiency (FE) was also lower in CUP (84) and TUC (60) diets than in C40 (119) and C80 (137) diets. CH₄ emissions were lower in animals fed TUC (26 L/day) and higher in C40 (35 L/day); however, TUC resulted in higher CH₄ emissions in grams/body live weight (BW) gain/day (353 g/BW/day) vs. 183 g/BW/day (C40), 157 g/BW/day (C80), and 221 g/BW/day (CUP). The supplementation with cakes did not improve intake, digestibility and performance, did not compromise blood metabolites and did not reduce the enteric CH4 emission in confined sheep in the Amazon; however, the use of CUP cake showed similar results to the control treatments and did not increase CH₄ emissions, as occurred with the inclusion of TUC cake.

PMID:37180068 | PMC:PMC10167019 | DOI:10.3389/fvets.2023.1106619

Sovrem Tekhnologii Med. 2022;14(4):50-57. doi: 10.17691/stm2022.14.4.06. Epub 2022 Jul 29.

ABSTRACT

The aim of the study was to examine the effect of cervical segment mobility on spinal sagittal balance parameters after cervical total disc arthroplasty (CTDA) and anterior cervical discectomy and fusion (ACDF) using the first domestic intervertebral disc endoprosthesis.

MATERIALS AND METHODS: The randomized prospective study included 98 patients (48 with CTDA, 50 with ACDF). Implants used: intervertebral disc endoprosthesis or intervertebral fusion cage (Endocarbon; NPP “MedInzh”, Russia).Total cervical mobility and range of motion in the target and adjacent vertebral motion segments were studied by functional radiography before surgery, at an early postoperative period (within 3 days), and 3, 6, and 12 months after the intervention.Values of cervical lordosis (CL, °), cervical sagittal vertical alignment (cSVA, mm), and first thoracic vertebra slope (T1 slope, °) were determined by using spinal radiography. Surgimap V2.2 software (Nemaris, USA) was used for measurements.

RESULTS: When comparing changes of overall cervical mobility at different time intervals, statistically significant differences were obtained in ACDF group (p=0.001). When comparing this parameter between ACDF and CTDA, a statistically significant difference was found only at the early postoperative period (p=0.004).In CTDA group, the range of motion increased at the operated segment (p=0.001) and decreased at the caudal segment (p=0.002). In ACDF group, no motion was observed at the operated segment (p=0.001) and the range of motion increased at adjacent segments (p=0.001). A statistically significant difference between ACDF and CTDA was obtained only at the operated (p=0.001) and caudal segments (p≤0.002).Correlation analysis showed no dependence between range of motion influence and regional/global balance values (p>0.5).The intergroup comparison of cervical lordosis (CL) values revealed a statistically significant difference after 6 (p=0.001) and 12 (p=0.001) months. The best results were obtained at ACDF group towards lordosis increase (p=0.001). The relationship between cervical lordosis and arthroplasty of segments C5-C6, C6-C7 (p=0.003; ρ=0.41) was determined using correlation analysis. The correlation between CL and ACDF (p=0.001; ρ=0.72) was also established.cSVA comparison between groups showed no difference at preoperative period (p=0.215), 6 (p=0.20) and 12 (p=0.425) months after surgery. cSVAs at both groups were equally close to normal values.T1 slope changes before and 12 months after surgery were statistically significant at ACDF (p=0.008) and CTDA (p=0.001) groups. T1 slope values comparison between ACDF and CTDA shows statistically significant difference after 12 months (p=0.003). T1 slopes were equally close to normal values 1 year after surgical treatment.

CONCLUSION: Over a 12-month observation period, the segmental range of motion was found to have no effect on changes of regional and global balance of the cervical spine. No influence was confirmed of range of motion on adjacent level syndrome development – the syndrome was diagnosed in none of the cases.This study demonstrated the effectiveness of arthroplasty using an Endocarbon endoprosthesis in improving cSVA and T1 slope values, but no significant improvement of CL values after treatment compared to ACDF group.

PMID:37179984 | PMC:PMC10171048 | DOI:10.17691/stm2022.14.4.06

Sovrem Tekhnologii Med. 2022;14(4):6-14. doi: 10.17691/stm2022.14.4.01. Epub 2022 Jul 29.

ABSTRACT

The aim of the study is to develop and verify an algorithm for automatic generation of leaflet apparatus models for prosthetic heart valves, to optimize the basic parameters of the models in order to minimize the stress-strain state and maximize the geometric area of the orifice.

MATERIALS AND METHODS: The suggested algorithm consists of three blocks: “Generator”, “Modeling”, “Analysis”. The first block creates a three-dimensional model of the leaflet apparatus using the specified parameters (height, radius, thickness, degree of “sagging”, angle of the free edge deviation). Numerical simulation of the apparatus functioning is further performed using the finite element method. Then, the statistical analysis of the von Mises stresses is done and the opening area of the design in question is calculated.Verification was performed by comparing quantitatively the lumen areas of the leaflet apparatus in the open state, obtained from the literature data for the Trifecta bioprosthesis (19, 21, and 23 mm in diameter), with the results of the described algorithm operation.

RESULTS: The verification of the algorithm has demonstrated the following deviations in the lumen area in the open state: 2.85% for 19 mm, 14.81% for 21 mm, and 23.17% for 23 mm models. This difference is due to the choice of the model material (no data could be found on the physical and mechanical properties of the pericardium used for the fabrication of the Trifecta bioprostheses).The generation of a large number of designs (n=1517) without fixation of certain geometry parameters has shown that thickness of the leaflet apparatus makes the greatest contribution to the degree of opening; its dependence on the thickness and arising peak von Mises stresses has been demonstrated. Of the valvular models obtained, 278 showed the opening degree greater than 80% and maximum peak von Mises stresses below 4 MPa for the proposed model of the pericardium, which is 65% below the ultimate strength of the material.Out of 278 leaflet models, 3 “optimal” designs were selected meeting the diameter criteria of 19, 21, and 23 mm. The loss index for them was 0.24, 0.19, 0.20 with the opening degrees of 88.28, 84.48, 88.12%, and maximum peak von Mises stresses of 3.62, 1.21, 1.87 MPa, respectively.

CONCLUSION: The developed algorithm makes it possible to automatically generate three-dimensional models of the leaflet apparatus, numerically simulate the opening process using the finite element method, statistically analyze the results obtained, and calculate the lumen area. The algorithm was verified based on the data for the Trifecta bioprosthesis of three standard sizes. The presented algorithm can be used both for the research and development of various designs and for obtaining “optimal” models of sash devices.

PMID:37179983 | PMC:PMC10171043 | DOI:10.17691/stm2022.14.4.01