Tag: nevin manimala

Dermatol Surg. 2021 Dec 16. doi: 10.1097/DSS.0000000000003348. Online ahead of print.

ABSTRACT

BACKGROUND: Bilobed transposition flaps are prone to pincushioning (trapdooring), whereby contraction of the flap over the wound bed may produce an unsatisfactory functional and aesthetic outcome. There are several proposed methods to prevent this, but there is currently no clear consensus on the ideal technique.

OBJECTIVE: To compare primary lobe pexing sutures versus intraoperative triamcinolone (TAC) injection as methods to prevent pincushioning in bilobed transposition flaps.

MATERIAL AND METHODS: A retrospective chart review of bilobed flap reconstructions identified from the Mohs micrographic surgery database at a single tertiary center in New Zealand.

RESULTS: Three hundred forty-two patients met the inclusion criteria: 37 received pexing sutures, 42 intraoperative TAC, and 263 no additional intervention. The most defect common location was the nasal tip (43.6%), followed by the ala (20.8%). Ninety-three participants (27.2%) developed pincushioning at a median 35 days postoperatively. Participants receiving no intervention had a 30.8% pincushioning rate. The TAC group had a 23.8% pincushioning rate (p = .358), and the pexing group had a 5.5% pincushioning rate (p = .001).

CONCLUSION: Participants receiving primary lobe pexing sutures had a statistically significantly lower rate of pincushioning than those receiving no intervention. Intraoperative TAC injections appeared to have little impact on pincushioning.

PMID:34923529 | DOI:10.1097/DSS.0000000000003348

Dermatol Surg. 2021 Dec 14. doi: 10.1097/DSS.0000000000003353. Online ahead of print.

ABSTRACT

BACKGROUND: Pain assessment plays an important role in dermatologic surgery. The numeric rating scale (NRS), visual analog scale (VAS), verbal rating scale (VRS), and Faces Pain Scale (FPS) are commonly used scales for pain measurement. Conflicting evidence exists regarding the use of each. Prompt pain recognition and treatment during procedures result in higher patient satisfaction.

OBJECTIVE: Determine the most applicable scale for acute pain measurement in dermatologic surgery.

MATERIALS AND METHODS: This systematic review was performed in accordance with PRISMA-Supplemental Digital Content 4, http://links.lww.com/DSS/A976 (PROSPERO; CRD42018091058). PubMed, Cochrane, EMBASE, Scopus, and Web of Science were searched between April 24, 2018, and May 06, 2018. The search query consisted of pain, pain measurement (NRS, VAS, VRS, and FPS), and assessment/comparison. The inclusion criteria included English language literature with primary/secondary outcome objectives directly comparing ≥2 pain scales in acute pain (age: 13+). Study end points included interscale correlations, patient preferences, provider preferences, study author recommendations, and failure rates.

RESULTS: Eight hundred seven studies were retrieved: A total of 42 studies were included. The visual analog scale (n = 42) was most studied, followed by NRS (n = 29), VRS (n = 27), and FPS (n = 11). 93.1% studies showed a high statistical correlation between VAS and NRS. Patients preferred NRS (n = 8/11), followed by FPS (n = 3/11), VRS (n = 2/11), and VAS (n = 1/11). Study authors recommended NRS/VAS (n = 8/19), VRS (n = 6/19), and FPS (n = 1/19). Providers preferred NRS (n = 2/3) and VRS (n = 1/3). The visual analog scale had the highest failure rate (n = 11/12).

CONCLUSION: The numeric rating scale is most applicable for dermatologic surgery because of reported patient and provider preferences, lowest failure rates, and most frequent study author recommendations.

PMID:34923536 | DOI:10.1097/DSS.0000000000003353

Retina. 2021 Dec 15. doi: 10.1097/IAE.0000000000003378. Online ahead of print.

ABSTRACT

PURPOSE: To compare the choroidal characteristics between the eyes of patients with and without hereditary transthyretin amyloidosis (hTTRA).

METHODS: Case-control observational study with choroidal thickness and vasculature evaluation by Optical Coherence Tomography with Enhanced Depth Imaging protocol (OCT-EDI) of the macula.

RESULTS: The study included 332 eyes: 166 eyes of hTTRA patients and 166 eyes of healthy patients. Mean age was similar between groups (p=0.979). For hTTRA patients, on average, in all sectors analysed (in the full 5mm-width image (G) and also in 1mm-width central (C), nasal (N), and temporal (T) sectors), there was a higher stromal area (SA), a lower choroidal thickness (CT) and a lower choroidal vascularity index (CVI), compared to the control group. The linear mixed models revealed no differences according to the systemic treatment groups.

CONCLUSION: hTTRA patients showed statistically significant differences in choroidal characteristics, compared to eyes without pathology. These age-related and statistically significant changes compared to the healthy eyes may help in the future to better monitor the systemic hTTRA disease and complement other systemic evaluations, including on clinical trials to analyse more objective the results of new therapies.

PMID:34923509 | DOI:10.1097/IAE.0000000000003378

J Pediatr Orthop. 2021 Dec 20. doi: 10.1097/BPO.0000000000002032. Online ahead of print.

ABSTRACT

BACKGROUND: Femoral fractures are the most common cause of fracture-related admissions. Unplanned return to the operating room (UpROR) is a major event and imposes a substantial burden on the family and health care system. The purpose of this study was to determine the incidence of complications and early UpROR during the first 6 months following treatment of femoral fractures and their risk factors.

METHODS: In an institutional review board-approved study, a retrospective review of all patients who were treated for a femoral fracture during a 10-year period at a pediatric tertiary care center was performed. Patients less than 18 years old with a diaphyseal fracture and complete records were included, and nondiaphyseal or pathologic fractures, as well as underlying metabolic or genetic disorders, were excluded. All clinic visits in the first 6 months after treatment were reviewed, and all complications and UpRORs were extracted. Patients were grouped based on their age (below 5, 5 to 11, above 11 y old) at initial treatment, and statistical tests were used to infer differences between groups.

RESULTS: Overall, 841 fractures in 832 patients were included, with a mean age of 5.5±4.8 years fracture, of which 72% were male. A total of 106 complications (12.6%) and 45 UpRORs (5.3%) were encountered during the study period. Patients with and without UpROR had similar demographics and injury and treatment characteristics. Loss of reduction was the most common reason for UpROR (58%), followed by implant-related complications. Flexible nails had the highest risk of UpROR among patients who were initially treated surgically (P=0.03).

CONCLUSIONS: Our findings indicate that children under the age of 5 years have a 5% risk of UpROR in the first 6 months after the fracture, mainly for repeat spica casting due to loss of reduction. Patients aged 5 years or older have an ∼6% risk of UpROR, mainly related to complications of flexible nails. The findings of this study are important when consulting families on different treatments of diaphyseal femoral fractures.

LEVEL OF EVIDENCE: Therapeutic level III-retrospective cohort study.

PMID:34923506 | DOI:10.1097/BPO.0000000000002032

West Afr J Med. 2021 Nov 30;Vol. 38(11):1101-1107.

ABSTRACT

BACKGROUND: Fertility is an important component of population change and has attracted the interest of scholars and policy makers. Nigeria’s population growth rate has been driven by high fertility, which has fallen in the last few decades but not as rapidly as the fall of the crude death rate. Men and their kinsmen are the decision-makers on issues relating to reproductive health such as timing of the next birth, number of children and when to stop childbearing while their women cooperate. We determined the reproductive behaviors of men in Doka community in Kaduna State Nigeria.

METHODOLOGY: A cross-sectional descriptive community based study of 320 men was conducted.

RESULTS: The mean age±SD of the male respondents was 40 (±14.2) years. The average age at first marriage among men was 23.32 (±4.62 years), the contraceptive use among men was 10(3.2%). Above a third 118 (37.9%) of men were in polygamous union. There was a statistically significant increase in the mean number of living children as the age of men increased (p=0.001). The mean number of children ever fathered was significantly associated with the educational status of men (p=0.03).

CONCLUSION: we found a very low contraceptive use, high number of desired children as well as living children among the men. Government should enlighten married men on the importance of contraceptive use for birth control as well as the social and economic implications of having too many children.

PMID:34922410

West Afr J Med. 2021 Nov 30;Vol. 38(11):1088-1094.

ABSTRACT

BACKGROUND: Blood transfusion therapy remains a mainstay in the care of many tropical diseases. Blood supply in sub-Saharan Africa (SSA) including Nigeria is still a challenge in terms of perennial blood shortages and transfusion transmissible infections (TTI). This study aimed to describe blood donation patterns and compare the rates of TTIs among types of blood donors seen at LUTH.

STUDY METHOD: A 6-year retrospective review of data on donor types and pattern of TTIs at LUTH transfusion service. TTI rates and odd ratios (OR) of TTI positivity amongst VNRD versus FRD were computed at 95% confidence intervals. Proportion of TTI sero-positivity was also compared between the VNRD and FRD groups.

RESULTS: A total of 53,319 blood donors were observed over the study period, with average of 8886.5 donors per year. VNRDs accounted for 12.3% (6533/53,319), while FRDs accounted for 87.7% (46,789/53,319) of all donors. The proportion of VNRDs ranged from 5.1% to 20.8%. The overall prevalence of TTIs over the 6-year period for all donors was 1.34% for HIV, 5.79% for HBV, 2.23% for HCV and 0.88% for syphilis. Sero-positivity rates for HIV, HBV, HCV, and syphilis was statistically significantly lower among VNRD compared to FRDs.

CONCLUSION: There exists a lot of room for improvement in our blood donation practices to improve blood stock and transfusion safety. A more aggressive strategic effort needs to be directed towards achieving a target of 100% voluntary blood donor base through partnerships, advocacy, more financing and resource allocation, and other proven initiatives.

PMID:34922408

J Clin Endocrinol Metab. 2021 Dec 18:dgab911. doi: 10.1210/clinem/dgab911. Online ahead of print.

ABSTRACT

BACKGROUND: Observational studies have demonstrated associations between plasma proteins and obesity, but evidence of causal relationship remains to be studied.

METHODS: To evaluate the causal relationship between plasma proteins and body composition, we conducted a two-sample Mendelian randomization (MR) analysis based on the genome-wide association study (GWAS) summary statistics of 23 body composition traits and 2,656 plasma proteins. We then performed hierarchical cluster analysis to evaluate the structure and pattern of the identified causal associations, and performed gene ontology enrichment analysis to explore the functional relevance of the identified proteins.

RESULTS: We identified 430 putatively causal effects of 96 plasma proteins on 22 body composition traits (except obesity status) with strong MR evidence (P < 2.53 × 10 -6, at a Bonferroni-corrected threshold). The top 3 causal associations are FST (follistatin) on trunk fat-free mass (Beta = -0.63, SE = 0.04, P = 2.00 × 10 -63), IGFBP1 (insulin-like growth factor-binding protein 1) on trunk fat-free mass (Beta = -0.54, SE = 0.03, P = 1.79 × 10 -57) and RSPO3 (r-spondin-3) on WHR (waist circumference/hip circumference) (Beta = 0.01, SE= 4.47 × 10 -4, P = 5.45 × 10 -60), respectively. Further clustering analysis and pathway analysis demonstrated that the pattern of causal effect to fat mass and fat-free mass may be different.

CONCLUSION: Our findings may provide evidence for causal relationships from plasma proteins to various body composition traits and provide basis for further targeted functional studies.

PMID:34922401 | DOI:10.1210/clinem/dgab911

Eur J Prev Cardiol. 2021 Dec 18:zwab213. doi: 10.1093/eurjpc/zwab213. Online ahead of print.

ABSTRACT

AIMS: To report the prevalence, deaths, and disability-adjusted life years (DALYs) associated with ischemic heart disease (IHD) and its attributable risk factors in 204 countries and territories from 1990 to 2019, by age, sex, and socio-demographic index (SDI).

METHODS AND RESULTS: Ischemic heart disease was defined as acute myocardial infarction (MI) and chronic IHD (angina; asymptomatic IHD following MI). Cause of death ensemble modelling was used to produce fatality estimates. The prevalence of the non-fatal sequalae of IHD was estimated using DisMod MR 2.1. All estimates were presented as counts and age-standardized rates per 100 000 population. In 2019, IHD accounted for 197.2 million (177.7-219.5) prevalent cases, 9.1 million (8.4-9.7) deaths, and 182.0 million (170.2-193.5) DALYs worldwide. There were decreases in the global age-standardized prevalence rates of IHD [-4.6% (-5.7, -3.6)], deaths [-30.8% (-34.8, -27.2)], and DALYs [-28.6% (-33.3, -24.2)] from 1990 to 2019. In 2019, the global prevalence and death rates of IHD were higher among males across all age groups, while the death rate peaked in the oldest group for both sexes. A negative association was found between the age-standardized DALY rates and SDI. Globally, high systolic blood pressure (54.6%), high low-density lipoprotein cholesterol (46.6%), and smoking (23.9%) were the three largest contributors to the DALYs attributable to IHD.

CONCLUSION: Although the global age-standardized prevalence, death, and DALY rates all decreased. Prevention and control programmes should be implemented to reduce population exposure to risk factors, reduce the risk of IHD in high-risk populations, and provide appropriate care for communities.

PMID:34922374 | DOI:10.1093/eurjpc/zwab213

Int J Epidemiol. 2021 Dec 18:dyab213. doi: 10.1093/ije/dyab213. Online ahead of print.

NO ABSTRACT

PMID:34922344 | DOI:10.1093/ije/dyab213

Mod Rheumatol. 2021 Jan 18:1859675. doi: 10.1080/14397595.2020.1859675. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate efficacy and safety of filgotinib in Japanese RA patients who have failed or were intolerant to one or more biologic disease-modifying antirheumatic drugs (bDMARD) from the global FINCH 2 study (NCT02873936).

METHODS: This subgroup analysis was performed using the predefined statistical analyses. The FINCH 2 study is a randomized, double-blind, placebo-controlled, Phase 3 study in adult RA patients with inadequate response to bDMARDs. The randomized patients were treated with once-daily filgotinib 200 mg, filgotinib 100 mg or placebo on a background of csDMARDs for 24 weeks.

RESULTS: Of 449 patients enrolled in the overall population, 40 patients were enrolled from Japan. In the Japanese population, the American College of Rheumatology 20% response rates at week 12 (primary endpoint) were 83.3% and 53.3% for filgotinib, 200 mg and 100 mg, respectively, vs 30.8% for placebo. Filgotinib was well tolerated, similar to the overall population.

CONCLUSIONS: Both doses of once-daily filgotinib 200 mg and filgotinib 100 mg were effective, and generally well-tolerated in Japanese patients with active refractory RA.

PMID:34922366 | DOI:10.1080/14397595.2020.1859675