Tag: nevin manimala

Spec Care Dentist. 2022 Mar 24. doi: 10.1111/scd.12715. Online ahead of print.

ABSTRACT

AIM: To describe oral cavity changes in patients who underwent a hematopoietic stem cell transplantation (HSCT).

METHODS AND RESULTS: A group of 32 patients was studied after a mean period of 48.8 months (±11.22) from HSCT; oral, dental, and periodontal status were collected and compared with those of healthy matched controls. Unstimulated whole salivary flow (UWS) and salivary pH were also measured. A validated questionnaire (EORTC QLQH&N-35) was used for reported quality of life. Fifty-nine percent of patients were affected by chronic graft-versus-host disease (cGVHD). Dental health and periodontal status were statistically worse than in controls (P = .003 and P = .008, respectively). Regarding the HSCT group, UWS was statistically lower, and EORTC QLQH&N-35 significantly higher than those reported in controls (P = .000 for both). There was no statistical correlation between hypo-salivation and conditioning, presence of cGVHD, type of medication used before and after transplantation, and time of follow-up. A reduction in salivary pH has been noted only for patients with erosive oral lesions.

CONCLUSION: The oral cavity of HSCT patients appeared to undergo substantial modifications and the quality of life was deeply compromised.

PMID:35325475 | DOI:10.1111/scd.12715

CA Cancer J Clin. 2022 Mar 24. doi: 10.3322/caac.21723. Online ahead of print.

ABSTRACT

Twenty years after the September 11th, 2001 terrorist attacks, the association between exposures present at the World Trade Center (WTC) site and the risk of several specific types of cancer has been reported among rescue and recovery workers. The authors’ objective was to conduct an updated review of these data. Most studies have found elevated rates of both prostate and thyroid cancers compared with rates in the general population, and some have reported statistically significant differences for the rates of all cancers as well. Studies including a larger combined cohort of WTC-exposed rescue and recovery workers from 3 main cohorts have since replicated findings for these cancers, with additional years of follow-up. Among this combined cohort, although a lower-than-expected standardized incidence ratio for all cancers was observed, WTC exposure was also related to an increased risk of cutaneous melanoma and tonsil cancer. Importantly, another study found that WTC-exposed rescue and recovery workers who are enrolled in the federally funded medical monitoring and treatment program experienced improved survival post-cancer diagnosis compared with New York state patients with cancer. On the basis of these combined cohort studies, the full effect of WTC exposure on cancer risk is becoming clearer. Consequently, the authors believe that surveillance of those with WTC exposure should be continued, and in-depth analysis of epidemiologic, molecular, and clinical aspects of specific cancers in these workers should be pursued.

PMID:35325473 | DOI:10.3322/caac.21723

Int J Dermatol. 2022 Mar 24. doi: 10.1111/ijd.16167. Online ahead of print.

ABSTRACT

BACKGROUND: Severe nail lichen planus (NLP) does not respond well to treatment and is often poorly considered and described in detail.

OBJECTIVE: We sought to describe the characteristics of severe NLP.

METHODS: A retrospective data analysis was performed, including the photographic records of the most compromised nails of patients with NLP over 18 years old, who consulted between 2009 and 2019 at the Instituto de Dermatologia Professor Rubem David Azulay in Rio de Janeiro, Brazil. Descriptive and statistical analysis using Fisher’s exact test was performed to verify the hypothesis of independence between characteristics (P < 0.05).

RESULTS: A total of 102 patients were included. Anonychia was associated with severe thinning of the nail plate, retraction of the nail bed or nail plate, residual nail plate, loss of proximal nail fold limits, and onychoatrophy. Dorsal pterygium was associated with loss of proximal nail fold limits, onychoatrophy, and distal splitting greater than 50%.

CONCLUSION: We provide descriptions of the most severe signs in order to facilitate the clinical diagnosis when a biopsy is not feasible and suggest an update of current NLP classifications.

PMID:35325468 | DOI:10.1111/ijd.16167

Am J Disaster Med. 2022 Fall;14(4):255-261. doi: 10.5055/ajdm.2021.0409.

ABSTRACT

OBJECTIVE: To study the pattern of ophthalmic emergencies after Hurricane Harvey (HH).

DESIGN: A retrospective chart review.

SETTING: University of Texas Medical Branch (UTMB) in Galveston, Texas.

PARTICIPANTS: Patients who presented to UTMB emergency room (ER) during the month before (47 patients) and the month after (39 patients) HH landfall and were seen by the ophthalmology service.

MAIN OUTCOME MEASURES: Ocular injuries before and after hurricane landfall were classified by duration of symptoms (acute, subacute, and chronic), type of injury (hurricane related, traumatic, and infectious), region of injury (corneal/anterior segment, glaucoma, vitreoretinal, orbital-oculoplastic, and neuro-ophthalmologic), and level of involvement of injury (limited to eye, a manifestation of systemic disease, and associated with other bodily injuries).

RESULTS: Patient demographics were similar before and after the storm. Three direct hurricane-related injuries from rescue and cleanup activities were identified. Only patients with acute/subacute ophthalmic injuries presented after HH. A trend for more traumatic injuries (from 28 to 41 percent of patients), corneal/anterior segment injuries (from 38 to 46 percent of patients), and vitreoretinal injuries (from 17 to 23 percent of patients) was observed after HH. A greater proportion of patients presented with localized injuries limited to the eye (from 49 to 56 percent of patients). Fewer patients had ocular manifestations of systemic disease (from 38 to 31 percent of patients) after HH. None of the changing trends reached statistical significance.

CONCLUSIONS: The low incidence of hurricane-related injuries was likely due to victims’ evacuation to surrounding nonimpacted areas and limited access to ER facilities within the affected area. ERs and eye care professionals should be prepared for future environmental disasters.

PMID:35325461 | DOI:10.5055/ajdm.2021.0409

Am J Disaster Med. 2022 Fall;14(4):271-295. doi: 10.5055/ajdm.2021.0411.

ABSTRACT

OBJECTIVE: The objective of this study was to assess the training and readiness levels of Collegiate Emergency Medical Service (EMS) providers to respond to mass casualty incidents (MCIs).

METHODS: An anonymous cross-sectional survey of Collegiate EMS providers was performed.

PARTICIPANTS: Participants were US-based EMS providers affiliated with the National Collegiate Emergency Medical Services Foundation.

OUTCOME MEASURES: The main outcome measures were levels of EMS experience and MCI training, subjective readiness levels for responding to various MCI scenarios, and analyzing the effect of the COVID-19 pandemic on MCI response capabilities.

RESULTS: Respondents had a median age of 21 years (interquartile range IQR 20, 22), with 86 percent (n = 96/112) being trained to the Emergency Medical Technician-Basic level. Providers reported participating in an average of 1.6 MCI trainings over the last four years (IQR, 1.0, 2.2). Subjective MCI response readiness levels were highest with active assailant attacks followed by large event evacuations, natural disasters, hazardous material (HAZMAT) incidents, targeted automobile ramming attacks, explosions, and finally bioweapons release. Disparate to this, only 18 percent of participants reported training in the fundamentals of tactical and disaster medicine. With respect to the effect of the COVID-19 pandemic on MCI readiness, 27 percent of respondents reported being less prepared, and there was a statistically significant decrease in subjective readiness to respond to HAZMAT incidents.

CONCLUSION: Given low rates of MCI training but high rates of self-assessed MCI preparedness, respondents may overestimate their readiness to adequately respond to the complexity of a real-world MCI. More objective assessment measures are needed to evaluate provider preparedness.

PMID:35325463 | DOI:10.5055/ajdm.2021.0411

Updates Surg. 2022 Mar 24. doi: 10.1007/s13304-022-01267-9. Online ahead of print.

ABSTRACT

The liver-gut axis has been identified as crucial mediator of liver regeneration. Thus, the use of a T-tube in liver transplantation (LT), which interrupts the enterohepatic bile circulation, may potentially have a detrimental effect on the early allograft functional recovery. We retrospectively analyzed a cohort of 261 patients transplanted with a whole liver graft, with a duct-to-duct biliary anastomosis, who did not develop any surgical complication within postoperative day 14. Early allograft dysfunction (EAD) was defined according to the criteria of Olthoff et al. (EAD-O), and graded according to the Model for Early Allograft Function (MEAF) score. EAD-O developed in 24.7% of recipients and the median MEAF score was 4.0 [interquartile range 2.9-5.5]. Both MEAF and EAD predicted 90-day post-LT mortality. A T-tube was used in 49.4% of cases (n = 129). After a propensity score matching for donor age, cold and warm ischemia time, donor risk index, balance of risk score, Child-Pugh class C, and MELD score, the T-tube group showed a significantly higher prevalence of EAD-O and value of MEAF than the no-T-tube group (EAD-O: 29 [34.1%] vs 16 [19.0%], p = 0.027; MEAF 4.5 [3.5-5.7] vs 3.7 [2.9-5.0], p = 0.014). In conclusion, T-tube use in LT may be a risk factor for EAD and higher MEAF, irrespective of graft quality and severity of pre-LT liver disease.

PMID:35325442 | DOI:10.1007/s13304-022-01267-9

J Robot Surg. 2022 Mar 24. doi: 10.1007/s11701-022-01400-1. Online ahead of print.

ABSTRACT

Robotic colorectal surgery allows for better ergonomics, superior retraction, and fine movements in the narrow anatomy of the pelvis. Recent years have seen the uptake of robotic surgery in all pelvic surgeries specifically in low rectal malignancies. However, the learning curve of robotic surgery in this cohort is unclear as established training pathways are not formalized. This study looks at the experience and learning curve of a single laparoscopic trained surgeon in performing safe and effective resections, mainly for low rectal and anal malignancies using the da Vinci robotic system by evaluating metrics related to surgical process and patient outcome. A serial retrospective review of the robotic colorectal surgery database, in the University Hospital Coventry and Warwickshire (UHCW), was undertaken. All 48 consecutive cases, performed by a recently qualified colorectal surgeon, were included in our study. The surgical process was evaluated using both console and total operative time recorded in each case along with the adequacy of resections performed; in addition, patient-related outcomes including intraoperative and postoperative complications were analyzed to assess differences in the learning curve. Forty eight sequential recto-sigmoid resections were included in the study performed by a single surgeon. The cases were divided into four cohorts in chronological order with comparable demographics, tumour stage, location, and complexity of the operation (mean age 65, male 79%, and female 29%). The results showed that the mean console time dropped from 3 to 2.5 h, while total operative time dropped from 6 h to 5.5 h as the surgeon became more experienced; however, this was not found to be statistically significant. In addition, no significant difference in pathological staging was seen over the study period. No major intra-op and post-op complications were observed and no 30-day mortality was recorded. Moreover, after 30 cases, the learning curve developed the plateau phase, suggesting the gain of maximum proficiency of skills required for robotic colorectal resections. The learning curve in robotic rectal surgery is short and flattens early; complication rates are low during the learning curve and continue to decrease with time. This shows that with proper training and proctoring, new colorectal surgeons can be trained in a short time to perform elective colorectal pelvic resections.

PMID:35325433 | DOI:10.1007/s11701-022-01400-1

Phys Eng Sci Med. 2022 Mar 24. doi: 10.1007/s13246-022-01118-2. Online ahead of print.

ABSTRACT

Several studies have demonstrated statistical and texture analysis abilities to differentiate cancerous from healthy tissue in magnetic resonance imaging. This study developed a method based on texture analysis and machine learning to differentiate prostate findings. Forty-eight male patients with PI-RADS classification and subsequent radical prostatectomy histopathological analysis were used as gold standard. Experienced radiologists delimited the regions of interest in magnetic resonance images. Six different groups of images were used to perform multiple analyses (seven analyses variations). Those analyses were outlined by specialists in urology as those of most significant importance for the classification. Forty texture features were extracted from each image and processed with Random Forest, Support Vector Machine, K-Nearest Neighbors, and Naive Bayes. Those seven analyses variation results were described in terms of area under the ROC curve (AUC), accuracy, F-score, precision and sensitivity. The highest AUC (93.7%) and accuracy (88.8%) were obtained when differentiating the group with both MRI and histopathology positive findings against the group with both negative MRI and histopathology. When differentiating the group with both MRI and histopathology positive findings versus the peripheral image zone group the AUC value was 86.6%. When differentiating the group with negative MRI/positive histopathology versus the group with both negative MRI and histopathology the AUC value was 80.7%. The evaluation of statistical and texture analysis promoted very suggestive indications for future work in prostate cancer suspicious regions. The method is fast for both region of interest selection and classification with machine learning and the result brings original contributions in the classification of different groups of patients. This tool is low-cost, and can be used to assist diagnostic decisions.

PMID:35325377 | DOI:10.1007/s13246-022-01118-2

Cerebellum. 2022 Mar 24. doi: 10.1007/s12311-022-01397-1. Online ahead of print.

ABSTRACT

This study aims to measure the effects of two different exercise programs on neck pain, proprioception, balance, coordination, posture, and quality of life in patients with Chiari malformation (CM) type 1. Sixteen patients were randomized to two different exercise programs: a tailored exercise protocol for CM (TEP-CM) and cervical spinal stabilization exercises (CSSE). Both exercise programs were implemented by a physiotherapist 3 days a week for 6 weeks. The primary outcome was Neck Disability Index. Secondary outcomes were visual analogue scale for pain, joint position sense error measurement, Berg Balance Scale, Time Up and Go Test, International Coordination Ataxia Rating Scale, PostureScreen Mobile, and Short Form-36. Assessments were done immediately before and after the intervention programs. Both groups showed significant improvement in Neck Disability Index, and some secondary outcome measures (P < 0.05). However, there were no statistical differences in post-intervention changes between the groups (P > 0.05). This is the first study to examine the effects of different exercise programs on symptoms in patients with CM type 1. Our preliminary findings indicate that exercise programs can improve pain, balance, proprioception, posture, coordination, and quality of life in CM type 1. Therefore, exercise should be considered safe, beneficial, and low-cost treatment option for CM type 1 patients without surgical indications.

PMID:35325392 | DOI:10.1007/s12311-022-01397-1

Ir J Med Sci. 2022 Mar 24. doi: 10.1007/s11845-022-02956-5. Online ahead of print.

ABSTRACT

BACKGROUND: Asthma is a prevalent chronic obstructive disease of the airways.

AIMS: The aim of our study was to investigate the relationship between asthma and IL-17F gene 74488 T > C, IL-17A gene -197G > A, and IL17A gene -737C > T polymorphisms in Turkish population.

METHODS: In our study, peripheral blood samples collected from a total of 127 subjects, with 65 in the patient group and 62 in the control group, were analyzed for IL-17F gene 74488 T > C, IL-17A gene -197G > A, and IL17A gene -737C > T polymorphisms using next-generation sequencing.

RESULTS: There was no statistically significant relationship between IL-17A gene -197G > A and IL-17A gene -737C > T polymorphisms and the risk of developing asthma. It was found that the risk of developing asthma was 2.9-fold higher in individuals with a C allele in the IL-17F gene 7488 T > C polymorphic site than the individuals with a T allele. It was shown that ATT and GCT haplotype carriers had a greater disease risk compared with the GTT haplotype carriers.

CONCLUSIONS: In conclusion, IL-17F gene 7488 T > C polymorphism was found to be associated with asthma in the Turkish population. The IL-17 gene should be further investigated as a potential candidate gene in predicting asthma susceptibility and in the treatment of asthma.

PMID:35325374 | DOI:10.1007/s11845-022-02956-5