Tag: nevin manimala

J Laryngol Otol. 2021 Apr 22:1-5. doi: 10.1017/S0022215121000293. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to compare the necessary scutum defect for transmeatal visualisation of middle-ear landmarks between an endoscopic and microscopic approach.

METHOD: Human cadaveric heads were used. In group 1, middle-ear landmarks were visualised by endoscope (group 1 endoscopic approach) and subsequently by microscope (group 1 microscopic approach following endoscopy). In group 2, landmarks were visualised solely microscopically (group 2 microscopic approach). The amount of resected bone was evaluated via computed tomography scans.

RESULTS: In the group 1 endoscopic approach, a median of 6.84 mm3 bone was resected. No statistically significant difference (Mann-Whitney U test, p = 0.163, U = 49.000) was found between the group 1 microscopic approach following endoscopy (median 17.84 mm3) and the group 2 microscopic approach (median 20.08 mm3), so these were combined. The difference between the group 1 endoscopic approach and the group 1 microscopic approach following endoscopy plus group 2 microscopic approach (median 18.16 mm3) was statistically significant (Mann-Whitney U test, p < 0.001, U = 18.000).

CONCLUSION: This study showed that endoscopic transmeatal visualisation of middle-ear landmarks preserves more of the bony scutum than a microscopic transmeatal approach.

PMID:33883045 | DOI:10.1017/S0022215121000293

Rocz Panstw Zakl Hig. 2021;72(1):77-82. doi: 10.32394/rpzh.2021.0148.

ABSTRACT

BACKGROUND: Poor oral health among children is common finding in the rural regions of India. But if the existent structure of primary health care is used, favourable oral health habits and importance of oral health can be instilled in the children and their parents at a very early stage.

OBJECTIVE: To evaluate the effectiveness of Anganwadi workers (AWWs) in improving the oral hygiene of the preschool children through oral health education.

MATERIAL AND METHODS: 250 children in the age group of 2.5-6 years, were included in the study. The study was conducted in three phases over a period of 8 months which included a follow up of six months. Baseline oral health was determined using a questionnaire assessing the oral hygiene practices and DMFT Index, Plaque Index and Gingival Index. This was re-assessed after 6 months using the same questionnaire and indices. Statistical significance was fixed at p value Ł 0.05. Chi square and paired ‘t’ test were used to assess the difference in the variables after providing oral health education.

RESULTS: Out of 250 children, with mean age of 4.24 years, majority were girls (142, 56.8%). The use of fluoridated toothpaste among the study population significantly increased from 34.4% to 41.5% (p=0.001) with the intervention of oral health education (OHE). Decrease in consumption of sticky sugar, addition of sugar in the night-feeds and cleaning of teeth after night-feeds were also found to change significantly. Gingival index showed significant reduction after OHE (p=0.001).

CONCLUSION: The study revealed that training of Anganwadi workers (AWWs) could be used to improve the oral health of the Anganwadi children. They represent an untapped source for delivering oral care to rural communities that otherwise have limited access.

PMID:33883064 | DOI:10.32394/rpzh.2021.0148

Surg Today. 2021 Apr 21. doi: 10.1007/s00595-021-02286-6. Online ahead of print.

ABSTRACT

PURPOSE: The coronavirus disease (COVID-19) pandemic has caused unprecedented challenges for surgical staffs to minimize exposure to COVID-19 or save medical resources without harmful patient outcomes, in accordance with the statement of each surgical society. No research has empirically validated declines in surgical volume in Japan, based on the usage of surgical triage. We aimed to identify whether the announcement of surgical priorities by each Japanese surgical society may have affected the surgical volume decline during the 1st wave of this pandemic.

METHODS: We extracted 490,719 available cases of patients aged > 15 years who underwent elective major surgeries between July 1, 2018, and June 30, 2020. After the categorization of surgical specialities, we calculated descriptive statistics to compare the year-over-year trend and conducted an interrupted time series analysis to validate the decline of each surgical procedure.

RESULTS: Monthly surgical cases of eight surgical specialities, especially ophthalmology and ear/nose/throat surgeries, decreased from April 2020 and reached a minimum in May 2020. An interrupted time series analysis showed no significant trends in oncological and critical surgeries.

CONCLUSION: Non-critical surgeries showed obvious and statistically significant declines in case volume during the 1st wave of the COVID-19 pandemic according to the statement of each surgical society in Japan.

PMID:33881619 | DOI:10.1007/s00595-021-02286-6

Surg Endosc. 2021 Apr 21. doi: 10.1007/s00464-020-08283-z. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this meta-analysis is to evaluate the safety and efficacy of bariatric surgery (BS) in patients with obesity by robotic bariatric surgery (RBS) compared with laparoscopic bariatric surgery (LBS).

METHODS: The study was performed through searching in Pubmed, Web of Science, Embase database and Cochrane Library until March 31, 2020 comparing RBS with LBS. Data were calculated on the following endpoints: operative time, length of hospital stay, reoperation within 30 days, overall complications, leak, stricture, pulmonary embolisms, estimated blood loss and mortality. Data as relative risks (OR), or weighted mean difference (WMD) were summarized with 95% confidence interval (CI). Risk of publication bias was assessed through standard methods.

RESULTS: Thirty eligible trials including 7,239 robotic and 203,181 laparoscopic surgery cases showed that RBS was referred to attain longer operative time [WMD = 27.61 min; 95%CI (16.27-38.96); P < 0.01] and lower mortality [OR 2.40; 95% CI (1.24-4.64); P = 0.009] than LBS. Length of hospital stay [WMD = – 0.02; 95% CI (- 0.19-0.15); P = 0.819], reoperation within 30 days [OR 1.36; 95% CI (0.65-2.82); P = 0.411], overall complications [OR 0.88; 95% CI (0.68-1.15); P = 0.362], leak [OR 1.04; 95% CI (0.43-2.51); P = 0.933], stricture [OR 1.05; 95% CI (0.52-2.12); P = 0.895], pulmonary embolisms [OR 1.97; 95% CI (0.93-4.17); P = 0.075], estimated blood loss[WMD = – 1.93; 95% CI (- 4.61-0.75); P = 0.158] were almost similar in both RBS group and LBS group. Three was no statistically significant difference between RRYGB and LRYGB in EWL%, no statistical significance between RSG and LSG after 1 year, 2 years and 3 years.

CONCLUSION: RBS presented lower mortality within 90 days and longer operative time in this meta-analysis with similar safety and efficacy for the obesity compared with LBS in other outcomes. Additionally, RBS might be beneficial in the future if it would be evaluated in comprehensive and long-term endpoints.

PMID:33881624 | DOI:10.1007/s00464-020-08283-z

Pediatr Nephrol. 2021 Apr 21. doi: 10.1007/s00467-021-05045-4. Online ahead of print.

ABSTRACT

BACKGROUND: Studies have shown that losartan reduces serum uric acid in adults, unlike angiotensin-converting enzyme inhibitors. A previous study demonstrated that losartan and enalapril had comparable effects on proteinuria in children.

METHODS: We conducted a post hoc analysis of results from a prospective trial in which the proteinuria-reducing effects of losartan and enalapril were compared. We have now evaluated (a) the effects of these medications on SUA in 248 children with proteinuria and (b) the correlation between changes in SUA and eGFR.

RESULTS: SUA levels after 36 months were found to be increased when compared to baseline in both losartan and enalapril groups. The mean change in SUA from baseline was significantly different at 12 months between 23 hypertensive patients randomised to losartan (3.69% decrease [95% CI 11.31%, 3.93%]) and 24 randomised to enalapril (12.57% increase [95% CI 3.72%, 21.41%]), p = 0.007. This significant difference remained after 24, 30 and 36 months but was observed in the entire group of 248 patients only at 12 months. There was a statistically significant negative correlation between changes in SUA and changes in eGFR at each time point over 36 months.

CONCLUSIONS: Losartan may have long-term beneficial effects on SUA and eGFR in children with proteinuria.

PMID:33881639 | DOI:10.1007/s00467-021-05045-4

Int Urogynecol J. 2021 Apr 21. doi: 10.1007/s00192-021-04777-z. Online ahead of print.

ABSTRACT

INTRODUCTION AND HYPOTHESIS: To systematically review evaluation guidelines of uncomplicated urinary incontinence (UI) in community-dwelling adult women to assess guidance available to the full range of providers treating UI.

METHODS: Systematic literature search of eight bibliographic databases. We included UI evaluation guidelines written for medical providers in English after January 1, 2008.

EXCLUSION CRITERIA: guidelines for children, men, institutionalized women, peripartum- and neurologic-related UI. A quantitative scoring system included assessed components and associated recommendation level and clarity.

RESULTS: Twenty-two guidelines met the criteria. All guidelines included: history taking, UI characterization, physical examination (PE) performance, urinalysis, and post-void residual volume assessment. At least 75% included medical and surgical history assessment, other disease process exclusion, medication review, impact on quality of life ascertainment, observing stress UI, mental status assessment, performing a pelvic examination, urine culture, bladder diary, and limiting more invasive diagnostics procedures. Fifty to 75% included other important evaluation components (i.e., assessing obstetric history, bowel symptoms, fluid intake, patient expectations/preferences/values, obesity, physical functioning/mobility, other PE [abdominal, rectal, pelvic muscle, and neurologic], urethral hypermobility, and pad testing. Less than 50% of guidelines included discussing patient treatment goals. Guidelines varied in level of detail and clarity, with several instances of unclear or inconsistent recommendations within the same guideline and evaluation components identified only by inference from treatment recommendations. Non-specialty guidelines reported fewer components with a lesser degree of clarity, but this difference was not statistically significant (p = 0.20).

CONCLUSIONS: UI evaluation guidelines varied in level of comprehensiveness, detail, and clarity. This variability may lead to inconsistent evaluations in the work-up of UI, contributing to missed opportunities for individualized care.

PMID:33881602 | DOI:10.1007/s00192-021-04777-z

Int Urogynecol J. 2021 Apr 21. doi: 10.1007/s00192-021-04799-7. Online ahead of print.

ABSTRACT

INTRODUCTION AND HYPOTHESIS: We aimed to evaluate the safety of same-day discharge (SDD) compared with next-day discharge (NDD) after prolapse surgery on a national level hypothesizing that readmission and complication rates after SDD would not be higher than NDD.

METHODS: We performed a retrospective cohort study using the National Surgical Quality Improvement Program database including 2014-2018. Current Procedural Terminology (CPT) codes were used to identify minimally invasive apical suspensions or obliterative procedures. Exclusion criteria were length of stay > 1 day, unrelated concomitant procedures, serious medical comorbidities, American Society of Anesthesiologists (ASA) Class >2, and complication during index admission. The primary outcome was 30-day readmission, and secondary outcomes included 30-day complications.

RESULTS: 12,583 were included in analysis. SDD rate was 16.7%. The majority of women were white (91%) with a mean age of 59 years and mean body mass index of 28 kg/m². Medical comorbidities were similar between the SDD and NDD groups. Overall incidence of 30-day readmission was 1.7%. SDD had lower odds of 30-day readmission than NDD (aOR 0.63, 95% CI 0.41-0.98). SDD had lower odds of 30-day complications but this failed to reach statistical significance (aOR 0.67, 95% CI 0.44-1.03).

CONCLUSIONS: In this cohort, 30-day readmission and complication rates were not higher after SDD compared to NDD in women undergoing minimally-invasive apical suspension or obliterative procedures. We interpret these findings carefully given study limitations but believe our findings support the safety of SDD after minimally invasive apical suspension or obliterative procedures in a low-risk population.

PMID:33881603 | DOI:10.1007/s00192-021-04799-7

Aesthetic Plast Surg. 2021 Apr 21. doi: 10.1007/s00266-021-02232-4. Online ahead of print.

ABSTRACT

BACKGROUND: Scarring can jeopardize the final result of plastic surgeries. Deep dermal injuries activate dermal fibroblasts that produce excessive amount of collagen and inflammatory cytokines and growth factors, which contributes to increased fibrous tissue and scarring tissue formation.

OBJECTIVES: The aim of this early study, double-blind, prospective, randomised clinical trial was to investigate the use of laser-assisted drug delivery (LADD) for scar improvement to support the establishment of LADD as standard therapy modality and to indicate suitable drugs for dermal administration.

MATERIAL AND METHODS: In total, 132 patients seeking scar treatment were consented and randomised. The control group (64 patients) received laser resurfacing immediately followed by skin surface application of Vitamin C and 68 patients received laser treatment followed by skin surface application of a cosmeceutical containing growth factors (GFs) and Vitamin C. Photographs were obtained before and three months after the procedure and submitted to three-dimensional reconstruction by the software Dermapix^®. Objective measurements provided by the software were statistically analysed and established the differences in the treatment result between the two groups.

RESULTS: There was a significant reduction in scar roughness and volume in both groups (p < 0.01). Mann-Whitney test confirmed that the group treated vitamin C and GFs presented significantly better results than the group treated with vitamin C alone (p < 0.01).

CONCLUSION: LADD has proven efficient as scars were reduced in both study groups. Furthermore, the addition of growth factors provided statistically significant better outcomes and resulted in more inconspicuous scars. No adverse reactions were observed.

CLINICAL TRIAL REGISTRATION: Plataforma Brasil under the number CAAE: 63710716.2.0000.5664.

LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

PMID:33881605 | DOI:10.1007/s00266-021-02232-4

Arch Orthop Trauma Surg. 2021 Apr 21. doi: 10.1007/s00402-021-03908-x. Online ahead of print.

ABSTRACT

PURPOSE: The characteristic two-dimensional bone morphology in patients with a discoid lateral meniscus (DLM) has been described. However, the associated three-dimensional imaging findings have not been characterized. This study was performed to identify differences in the knee bone morphology between juvenile patients with a DLM and those with a normal meniscus using magnetic resonance (MR) imaging.

METHODS: The DLM group comprised 33 consecutive juvenile patients (33 knees) with a complete DLM, and the control group comprised 24 juvenile patients (24 knees) with normal menisci on the basis of MR imaging findings. Each MR image was evaluated to determine the anterior obliquity of the lateral tibial plateau (AOLTP), posterior obliquity of the lateral tibial plateau (POLTP), lowest point of the lateral femoral condyle (LPLFC), posterior lateral condylar angle (PLCA) and posterior medial condylar angle (PMCA). Statistical analyses were performed to determine the differences between the two groups.

RESULTS: The POLTP was significantly larger, the LPLFC was significantly more lateral, and the PLCA was significantly smaller in the DLM group than in the control group (p < 0.001, p < 0.001 and p < 0.001 respectively). However, there was no statistically significant difference in the AOLTP or PMCA between the two groups (p = 0.429 and p = 0.148, respectively).

CONCLUSIONS: Hypoplasia of the lateral femoral condyle and posterior lateral tibial plateau is recognized in juvenile patients with a complete DLM on coronal and axial MRI images.

LEVEL OF EVIDENCE: Diagnostic study, Level III.

PMID:33881591 | DOI:10.1007/s00402-021-03908-x

Arch Orthop Trauma Surg. 2021 Apr 21. doi: 10.1007/s00402-021-03902-3. Online ahead of print.

ABSTRACT

PURPOSE: Functional results after internal fixation of trochanteric femoral fractures may be negatively affected by healing in a non-physiological position. The aim of this study was to evaluate the occurrence and severity of femoral malrotation after nailing of trochanteric fractures.

MATERIALS AND METHODS: The authors conducted a prospective study focused on a CT analysis of malrotation after intramedullary nailing of trochanteric fractures (AO 31A1-3) in 101 patients. We recorded the type of fracture, method of anesthesia, scheduled surgery vs. acute surgery, and the surgeon’s experience as possible risk factors for limb malrotation after trochanteric fracture surgeries.

RESULTS: The average extent of malrotation was 9° of internal rotation ranging from 29° of external to 48°of internal rotation. In 35% of patients, we observed a rotation greater than 15°, and in 15 patients (15%), the rotation was greater than 25°. The risk of significant internal malrotation was significantly higher than external malrotation (37 vs. 4 patients). None of the factors observed proved to be statistically significant. The effect of general anesthesia and the type of intertrochanteric fracture came closest to having a significant effect on rotational error.

CONCLUSION: Improper reduction of a trochanteric fracture is a common problem that can lead to femur malrotation. In our study, a rotational error greater than 15° occurred in 35% of the patients, but none of the monitored factors represented a statistically significant risk for this complication.

PMID:33881592 | DOI:10.1007/s00402-021-03902-3