Tag: nevin manimala

BMC Urol. 2023 Apr 28;23(1):70. doi: 10.1186/s12894-023-01242-5.

ABSTRACT

BACKGROUND: About one in 200 to one in 300 male births has hypospadias. The prevalence of this congenital anomaly varies worldwide. The meatus is located distally in approximately 70% of cases. Several surgical techniques were described for distal hypospadias repair; despite this, there is no ideal approach. This study compares urethral advancement &glanuloplasty, and TIP techniques in terms of feasibility, duration of operation, and complications. Patients and.

METHODS: This prospective randomized comparative study was conducted at Al-Azhar University Hospitals from April 2022 to October 2022. Fifty-seven cases with different types of hypospadias were assessed for eligibility. Among them, seven cases were excluded due to the presence of severe chordee (n = 3), proximal variant (n = 2), and recurrent cases of hypospadias (n = 2). Fifty cases were randomly divided into two groups using a 1:1 ratio (computer-generated randomization). Twenty-five cases were subjected to urethral advancement and glanuloplasty, and the rest were subjected to tubularized incised plate (TIP) urethroplasty.

RESULTS: The mean age of all studied cases was 4.2 years. Approximately 52% had coronal or sub-coronal meatus, whereas 48% had glandular meatus. Both groups were matched according to age and meatus location (p > 0.05). No statistically significant difference was observed between the two groups regarding duration of operation, postoperative pain, and postoperative hospital stay. In addition, both groups did not differ significantly in late complications (meatal stenosis, meatal retraction, fistula, and glans dehiscence).

CONCLUSIONS: Both urethral advancement &glanuloplasty, and TIP urethroplasty have comparable short-term outcomes. Urethral advancement and glanuloplasty is preferred in certain conditions, especially in circumcised children or those with a narrow urethral plate.

TRIAL REGISTRATION: The study protocol was approved by the Pan African Clinical Trials Registry (number for the registry is: PACTR202211757905870) on (29/11/2022). All procedures were performed per the Helsinki Declaration.

PMID:37118711 | DOI:10.1186/s12894-023-01242-5

BMC Urol. 2023 Apr 28;23(1):73. doi: 10.1186/s12894-023-01246-1.

ABSTRACT

BACKGROUND: Worldwide, prostate cancer (PC) is the second most diagnosed cancer and the fifth leading cause of cancer death in men. Hormonal therapies, commonly used for PC, are associated with a range of treatment-emergent adverse events (TEAEs). The population from Japan seems to be at higher risk of developing TEAEs of skin rash compared to the overall global population. This study was conducted to get a better insight into the incidence, management, and risk factors for skin rash during active treatment for advanced PC in Japan.

METHODS: A retrospective cohort of PC patients was identified and subsequently categorized, into non-metastatic and metastatic castration-resistant prostate cancer patients (nmCRPC and mCRPC), and metastatic castration-naïve prostate cancer patients (mCNPC). The analysis was based on a dataset from the Medical Data Vision (MDV) database. Descriptive statistics were determined, and a multivariate Cox proportional hazards model was used to the associated risk factors for the onset of rash.

RESULTS: Overall, 1,738 nmCRPC patients, 630 mCRPC patients, and 454 mCNPC patients were included in this analysis. The median age was 78 years old and similar across the three cohorts. The skin rash incidence was 19.97% for nmCRPC cohort, 28.89% for mCRPC cohort, and 28.85% for mCNPC cohort. The median duration of skin rash ranged from 29 to 42 days. Statistically significant risk factors for developing skin rash included a history of allergy or hypersensitivity (all cohorts), increased age (nmCRPC and mCRPC), a body mass index (BMI) of < 18.5 (nmCRPC and mCRPC), and a PSA level higher than the median (nmCRPC). Skin rash was commonly managed with systemic and topical corticosteroids which ranged from 41.76% to 67.03% for all cohorts. Antihistamines were infrequently used.

CONCLUSION: This study provides a better understanding of the real-world incidence, onset, duration, management and risk factors of skin rash in patients on active PC treatment in Japan. It was observed that approximately 20-30% of PC patients experience skin rash. Development of skin rash was associated with previous allergy or hypersensitivity, BMI of < 18.5, increased age and higher PSA levels, and was usually treated with corticosteroids.

PMID:37118710 | DOI:10.1186/s12894-023-01246-1

BMC Psychiatry. 2023 Apr 28;23(1):293. doi: 10.1186/s12888-023-04800-1.

ABSTRACT

OBJECTIVE: Non-suicidal self-injury (NSSI) is common among adolescents and has been linked to mental disorders and suicide in addition to physical injuries. According to the empirical avoidance model, adolescents with NSSI have stronger emotional affect and poorer emotional regulation than those without NSSI, and these constitute core features of borderline personality disorder (BPD). The relationship between borderline personality features, emotional regulation, and NSSI in the population is unclear. This study explored these associations to provide a theoretical basis for the treatment of NSSI in the future.

METHODS: Depressed adolescents (n = 1192) were evaluated using Chinese versions of the Function Assessment of Self-mutilation Scale, Emotional Regulation Questionnaire for Children and Adolescents, and Borderline Personality Features Scale for Children.

RESULTS: The majority of depressed adolescents (71.3%, 850/1192) had demonstrated NSSI in the past year, with cutting or scratching being the most common form (57.4%). Pearson correlation analysis with NSSI as a fixed factor (NSSI = 1, no NSSI = 2) revealed a negative correlation between NSSI and borderline personality features (r = -0.314, P < 0.01) but a positive correlation between NSSI and emotional regulation capacity (r = 0.159, P < 0.01), which was positively correlated with the expression suppression dimension (r = 0.079, p < 0.01); however, there was no significant correlation between the cognitive reappraisal dimension and expression suppression (r = 0.022, p > 0.05). The occurrence of NSSI was also positively correlated with borderline personality features in general (r = 0.314, p < 0.01). These results were statistically significant. Emotional regulation played a mediating role between borderline personality traits and NSSI in adolescents with depression (effect value = 0.151).

CONCLUSION: Borderline personality features and emotional regulation ability were significantly correlated with NSSI in depressed adolescents. Borderline personality symptoms not only directly influenced NSSI risk in adolescents with depression, but also indirectly influenced NSSI risk through emotional regulation.

PMID:37118709 | DOI:10.1186/s12888-023-04800-1

BMC Musculoskelet Disord. 2023 Apr 28;24(1):335. doi: 10.1186/s12891-023-06429-3.

ABSTRACT

BACKGROUND: Lumbar herniated disc (HNP) is mainly treated by conservative management. Epidural steroid injection (ESI) has been an option to treat failed cases prior to surgery. Triamcinolone has been widely used due to its efficacy in bringing about pain reduction for up to three months. However, several reports have shown some severe adverse events. Platelet-rich plasma (PRP) is made from blood through centrifugation. Several studies supported the potential short to long-term effects, and safety of PRP injection in treating HNP. The study objective was to evaluate the efficacy of PRP in treatment of single-level lumbar HNP in comparison to triamcinolone.

METHODS: Thirty patients were treated by transforaminal epidural injections. PRP was obtained from 24 ml venous blood through standardized double-spin protocol. Participants included fifteen patients each being in triamcinolone and PRP groups. The same postoperative protocols and medications were applied. The visual analogue scale of leg (LegVAS), collected at baseline, 2, 6, 12, and 24 weeks, was the primary outcome. The BackVAS, Oswestry Disability Index (ODI), adverse event, and treatment failure were the secondary endpoints.

RESULTS: Platelet ratio of PRP in fifteen patients was 2.86 ± 0.85. Patients treated by PRP injections showed statistically and clinically significant reduction in LegVAS at 6, 12, and 24 weeks, and in ODI at 24 weeks. It demonstrated comparable results on other aspects. No adverse event occurred in either group.

CONCLUSION: Noncommercial epidural double-spin PRP yielded superior results to triamcinolone. Due to its efficacy and safety, the procedure is recommended in treating single level lumbar HNP.

TRIAL REGISTRATION: NCT, NCT05234840. Registered 1 January 2019, https://clinicaltrials.gov/ct2/show/record/NCT05234840 .

PMID:37118707 | DOI:10.1186/s12891-023-06429-3

BMC Public Health. 2023 Apr 28;23(1):789. doi: 10.1186/s12889-023-15666-z.

ABSTRACT

BACKGROUND: Diabetes and arterial hypertension are the two most common types of non-communicable diseases (NCDs) impacting people globally. There is no prior research on the Syrian population’s knowledge and treatment of hypertension and diabetes. It is crucial to investigate how the Syrian public understands and perceives these disorders in order to address the increased incidence and prevalence of hypertension and diabetes. This research intends to assess the level of hypertension and diabetes-related awareness, knowledge, attitude, and practices among Syrian individuals.

METHODS: A cross-sectional survey was conducted online between 1 August and 25 August 2022. The questionnaire for the study was developed based on previous research, and the inclusion criteria for the sample were Syrian residents older than 18 who presently live in Syria. The survey consisted four sections: sociodemographics information, WHO STEPS survey instrument on knowledge of and lifestyle determinants for hypertension and diabetes, respondents’ knowledge of and comprehension of hypertension and diabetes, and respondents’ awareness of these disorders.

RESULTS: Among 976 participants, 65.8% were females. the most common causes for hypertension from the perspective of participants were (90.1%) for stress, (87%) High salt consumption, (82.1%) genetics, (78.2%) old age, (78%) obesity (69%) anxiety, and (38.6%) for drug usage. Primary and middle school educational status participants had greater hypertension knowledge (92.3%) than other educational levels. There was a statistical significant difference between the knowledge toward the hypertension and the drinking alcohol, which the nonalcoholic knowledgeable persons were the most common (819 / 976)(P < 0.05). Participants whose lifestyles did not include alcohol use had a higher hypertension knowledge level (90.3%). Participants who do not consume alcohol have shown better hypertension knowledge (90.3%) than those who do (81.9%). Almost age groups have shown good knowledge of diabetes, especially participants aged above 55 (93.8%). However, most individuals have examined blood pressure (82.3%), whereas fewer than half had screened for blood sugar (64.4%). About 82.2% of individuals check their blood pressure frequently, whereas 6.2% monitor their blood sugar. There were significant associations between hypertension knowledge and gender, education, employment, and economic position (P value < 0.05). Men (mean = 8.39, SD = 2.02, P-value < 0.05) have a higher hypertension knowledge than females, and knowledge of hypertension among participants was shown to be higher among those in good income status than other economic levels (mean = 8.34, SD = 1.98). Age, gender, education, employment, and marital status were all associated with diabetes knowledge. Participants between the ages of 40 and 55 showed better knowledge of diabetes compared to other age groups (mean = 11.32, SD = 2.54); also, men demonstrated greater knowledge of diabetes than females (mean = 10.76, SD = 2.79).

CONCLUSION: We indicated that the Syrian population has a good to moderate understanding of hypertension and diabetes. However, there is still a shortage of standardized, regular screening practices. Since individuals remain involved in unhealthy lifestyle habits, it is vital to provide accurate information about hypertension and diabetes to encourage them to make healthy changes.

PMID:37118706 | DOI:10.1186/s12889-023-15666-z

BMC Cardiovasc Disord. 2023 Apr 28;23(1):217. doi: 10.1186/s12872-023-03235-6.

ABSTRACT

BACKGROUND: There is currently a lack of a precise, concise, and practical clinical prediction model for predicting coronary artery disease (CAD) in patients with essential hypertension (EH). This study aimed to construct a nomogram to predict CAD in patients with EH based on flow-mediated dilation (FMD) of brachial artery and traditional risk factors.

METHODS: Clinical data of 1752 patients with EH were retrospectively collected. High-resolution vascular ultrasound was used to detect FMD in all patients at the Fujian Hypertension Research Institute, China. Patients were divided into two groups, i.e. training group (n = 1204, from August 2000 to December 2013) and validation group (n = 548, from January 2014 to May 2016) according to the time of enrollment. Independent predictors of CAD were analyzed by multivariable logistic regression in the training group, and a nomogram was constructed accordingly. Finally, we evaluated the discrimination, calibration, and clinical applicability of the model using the area under curve (AUC) of receiver operating characteristic analysis, calibration curve combined with Hosmer-Lemeshow test, and decision curve, respectively.

RESULTS: There were 263 (21.8%) cases of EH combined with CAD in the training group. Multivariate logistic regression showed that FMD, age, duration of EH, waist circumference, and diabetes mellitus were independent influencing factors for CAD in EH patients. Smoking which was close to statistical significance (P = 0.062) was also included in the regression model to increase the accuracy. Ultimately, the nomogram for predicting CAD in EH patients was constructed according to above predictors after proper transformation. The AUC values of the training group and the validation group were 0.799 (95%CI 0.770-0.829) and 0.836 (95%CI 0.787-0.886), respectively. Calibration curve and Hosmer-Lemeshow test showed that the model had good calibration (training group: χ² = 0.55, P = 0.759; validation group: χ² = 1.62, P = 0.446). The decision curve also verified the clinical applicability of the nomogram.

CONCLUSION: The nomogram based on FMD and traditional risk factors (age, duration of EH disease, smoking, waist circumference and diabetes mellitus) can predict CAD high-risk group among patients with EH.

PMID:37118701 | DOI:10.1186/s12872-023-03235-6

BMC Pregnancy Childbirth. 2023 Apr 28;23(1):301. doi: 10.1186/s12884-023-05597-3.

ABSTRACT

BACKGROUND: Cervical length (CL) measured by ultrasound in the second trimester is a predictor of spontaneous preterm birth (sPTB). The uterocervical angle (UCA) has recently been suggested as a predictor to identify women at risk of sPTB. The aim of this study was to investigate the UCAs’ distribution in singleton pregnant women at 16^{+ 0} – 23^{+ 6} weeks of gestation with low risk for sPTB.

METHODS: This was a prospective cohort study of 1,051 pregnant women with singleton pregnancies at low risk for preterm delivery. Pregnant women with a viable singleton fetus at 16^{+ 0} – 23^{+ 6} weeks of gestation were enrolled in the study conducted at the Haiphong Hospital of Obstetrics and Gynecology, Vietnam, from 09/2019 to 09/2020. CL and the UCA were assessed using transvaginal ultrasonography (TVS) by a single sonographer. Subjects were followed-up until the end of pregnancy, and maternal and neonatal outcomes were recorded. The UCAs’ range and their relationship with gestational age were evaluated using regression analysis. P < 0.05 was considered statistically significant.

RESULTS: The normal range of the UCA (5^th – 95^th percentiles) was 46.47° (95% CI, 40.27°-51.81°) to 127.06° (95% CI, 123.02° – 130.71°). The UCAs in the preterm birth (< 37 weeks) and full-term groups were 117.86° ± 20.25° and 83.80° ± 24.18°, respectively (p < 0.001). Linear regression analysis showed a significant change in the UCA range from 16^{+ 0} to 23^{+ 6} weeks of gestation (2.51 degrees per week, p < 0.001). The linear function yielded the highest correlation coefficient in the variation rule of the UCA values (r = 0.22). A total of 42/63 (66.7%) patients with preterm birth < 37 weeks had a UCA above the 75^th percentile. The majority of women with preterm birth had a UCA ≥ 95° compared with those with full-term delivery (88.9% vs. 31.3%, p < 0.001).

CONCLUSIONS: The results of this study present background information about the normal range of UCA values in singleton pregnant women at 16^{+ 0} to 23^{+ 6} weeks at low risk for sPTB in this Vietnamese cohort. In this study population at low risk for sPTB, pregnant women with a UCA value ≥ 95^o were also considered at risk for preterm birth.

PMID:37118695 | DOI:10.1186/s12884-023-05597-3

BMC Urol. 2023 Apr 28;23(1):69. doi: 10.1186/s12894-023-01241-6.

ABSTRACT

INTRODUCTION: Multiparametric magnetic resonance imaging (mpMRI) of the prostate gland is now the recommended initial investigation of choice for the detection of Prostate cancer (PCa). It effectively identifies patients who require prostate biopsies due to the risk of clinically significant PCa. It helps patients with clinically insignificant PCa avoid the invasive biopsies and possible accompanying complications. Large clinical trials have investigated the accuracy of mpMRI in detecting PCa. We performed a local review to examine the reliability of omitting tissue sampling in men with a negative (PIRADS 2 (P2) or less) mpMRI in the primary diagnostic setting.

METHODS: This was a retrospective study of patients with clinical suspicion of PCa within a 2-year period. Patients had a mpMRI prior to having trans-perineal prostate gland biopsies. Clinically significant disease was defined as Gleason 7 and above. The descriptive data was analysed using contingency table methods. A p-value less than 0.05 was statistically significant.

RESULTS: Out of 700 patients 90 had an mpMRI score of PIRADS 2. Seventy-seven (85.5%) of these patients had a negative biopsy, 9(10%) showed Gleason 6, 4 patients showed Gleason 7 or above. 78 patients with PIRADS 2 had a PSA density of < 0.15, none of which had a clinically significant biopsy result. The negative predictive value of mpMRI from this study is 95%.

CONCLUSION: Our results are in line with negative predictive values demonstrated in the current literature. This local study, likely applicable to other district general hospitals, shows that mpMRI is a safe and reliable initial investigation to aid decisions on which patients require biopsies.

PMID:37118694 | DOI:10.1186/s12894-023-01241-6

BMC Nephrol. 2023 Apr 28;24(1):117. doi: 10.1186/s12882-023-03157-7.

ABSTRACT

BACKGROUND: Kidney transplantation is the gold-standard treatment for patients with kidney failure. However, one-third of patients awaiting a kidney transplant are highly sensitized to human leukocyte antigens (HLA), resulting in an increased waiting time for a suitable kidney, more acute and chronic rejection, and a shorter graft survival compared to non-highly sensitised patients. Current standard immunosuppression protocols do not adequately suppress memory responses, and so alternative strategies are needed. Autologous polyclonally expanded regulatory T cells (Tregs) have been demonstrated to be safe in transplant settings and could be a potential alternative to modulate memory immune alloresponses.

METHODS: The aim of this trial is to determine whether adoptive transfer of autologous Tregs into HLA sensitised patients can suppress memory T and B cell responses against specific HLA antigens. This is a two-part, multi-centre, prospective clinical trial, comprising an observational phase (Part 1) aiming to identify patients with unregulated cellular memory responses to HLA (Pure HLA Proteins) followed by an interventional phase (Part 2). The first 9 patients identified as being eligible in Part 1 will undergo baseline immune monitoring for 2 months to inform statistical analysis of the primary endpoint. Part 2 is an adaptive, open labelled trial based on Simon’s two-stage design, with 21 patients receiving Good Manufacturing Practice (GMP)-grade polyclonally expanded Tregs to a dose of 5-10 × 106 cells/kg body weight. The primary EP is suppression of in vitro memory responses for 2 months post-infusion. 12 patients will receive treatment in stage 1 of Part 2, and 9 patients will receive treatment in stage 2 of Part 2 if ≥ 50% patients pass the primary EP in stage 1.

DISCUSSION: This is a prospective study aiming to identify patients with unregulated cellular memory responses to Pure HLA Proteins and determine baseline variation in these patterns of response. Part 2 will be an adaptive phase IIa clinical trial with 21 patients receiving a single infusion of GMP-grade polyclonally expanded Tregs in two stages. It remains to be demonstrated that modulating memory alloresponses clinically using Treg therapy is achievable.

TRIAL REGISTRATION: EudraCT Number: 2021-001,664-23. REC Number: 21/SC/0253. Trial registration number ISRCTN14582152.

PMID:37118685 | DOI:10.1186/s12882-023-03157-7

BMC Cardiovasc Disord. 2023 Apr 28;23(1):219. doi: 10.1186/s12872-023-03255-2.

ABSTRACT

BACKGROUND: Primary cardiac tumors are rare, and cardiac myxoma (CM) accounts for the majority of these tumors. Most of the reports in the literature are case reports. This study summarizes our clinical experience in the surgical treatment of CM over the past 12 years.

METHODS: We retrospectively analyzed the clinical data of 23 children with CM(8 boys, 15 girls; median age: 8.92 months, range: 2 years 5 months-12 years 9 months; body weight: 11-45 kg, median body weight: 28.21 kg) admitted to our hospital in the previous 12 years, and we statistically analyzed their clinical manifestations and surgical methods.

RESULTS: 23 cases underwent myxoma excision under cardiopulmonary bypass(CPB). The follow-up period was 0.2 to 12.6 years (mean:7.2 years). Two patients could not be traced, and the follow-up completion rate was 91.30%. One patient (4.35%) died of myocardial infarction early after surgery with low continuous cardiac output. There were no cerebral embolism, acute heart failure, atrioventricular block and other related complications in 19 cases. A patient with cerebral infarction complicated with right hemiplegia recovered well after rehabilitation treatment. There was no recurrence of CM in 19 cases and all patients recovered after surgery. One patient relapsed 5 years after surgery, and no tumor recurrence was observed after the second surgery. Among the 20 long-term survivors, 13 (65.00%) were NYHA Class I patients and 7(35.00%) were NYHA Class II patients.

CONCLUSIONS: Although CM in children is rare, it may cause cerebral infarction and other multi-organ embolism. Once CM is found and removed as soon as possible, it can reduce serious complications. If the complete resection is possible, surgery provides better palliation. Follow-up echocardiographic should be paid attention to after surgery.

PMID:37118677 | DOI:10.1186/s12872-023-03255-2