1st Follow-up Research Articles

On the estimation of the effect of weight change on a health outcome using observational data, by utilising the target trial emulation framework

Background/ObjectivesWhen studying the effect of weight change between two time points on a health outcome using observational data, two main problems arise initially (i) ‘when is time zero?’ and (ii) ‘which confounders should we account for?’ From the baseline date or the 1st follow-up (when the weight change can be measured)? Different methods have been previously used in the literature that carry different sources of bias and hence produce different results.MethodsWe utilised the target trial emulation framework and considered weight change as a hypothetical intervention. First, we used a simplified example from a hypothetical randomised trial where no modelling is required. Then we simulated data from an observational study where modelling is needed. We demonstrate the problems of each of these methods and suggest a strategy.Interventionsweight loss/gain vs maintenance.ResultsThe recommended method defines time-zero at enrolment, but adjustment for confounders (or exclusion of individuals based on levels of confounders) should be performed both at enrolment and the 1st follow-up.ConclusionsThe implementation of our suggested method [adjusting for (or excluding based on) confounders measured both at baseline and the 1st follow-up] can help researchers attenuate bias by avoiding some common pitfalls. Other methods that have been widely used in the past to estimate the effect of weight change on a health outcome are more biased. However, two issues remain (i) the exposure is not well-defined as there are different ways of changing weight (however we tried to reduce this problem by excluding individuals who develop a chronic disease); and (ii) immortal time bias, which may be small if the time to first follow up is short.

Comparison of Peripheral Nerve Conventional and Pulse Radiofrequency Applications in Patients with Primary Trigeminal Neuralgia: A Retrospective Analysis

Aim: This study aims to retrospectively investigate the results of continuous radiofrequency (CRF) and pulsed radiofrequency (PRF) applications to the peripheral branches of the trigeminal nerve in patients with trigeminal neuralgia (TN).
 Material and Methods: Patients who experienced a significant reduction in pain symptoms after local anesthetic application to the peripheral branches of the trigeminal nerve were divided into two groups. The first group received PRF treatment and the second group received CRF treatment. Pain intensity scores of both groups at 1 and 3 months were compared. The results were analyzed retrospectively.
 Results: Among the participants, 10 received PRF treatment and another 10 received CRF treatment. At the 1st month follow-up, both groups demonstrated considerable reductions in pain levels. By the 3rd month, no substantial disparities were noted between the two groups in terms of pain-related disability and pain intensity.
 Conclusion: Both PRF and CRF interventions emerge as effective and secure techniques applicable to the peripheral branches of the trigeminal nerve. They should be contemplated as valuable options in cases where conventional medical treatments fall short in delivering adequate pain control.

Three-year follow-up outcomes of adult patients with Guillain-Barré Syndrome after rehabilitation.

Guillain-Barré syndrome (GBS), the most common cause of acute paralytic neuropathy, covers a number of recognizably different variants. We aimed to evaluate the clinical characteristics of the patients with GBS and the outcome results of the patients after rehabilitation. We enrolled 24 adult patients with GBS and evaluated their demographic characteristics, signs, complications, functional levels, and residual symptoms at admission, discharge, and during the 1st and 3rd-year follow-up visits. Functional Independence Scale (FIM), Functional Ambulation Scale (FAS), Hughes functional grading scale, Six-Minute Walking Test (6MWT), and Fatigue Severity Scale (FSS) were used for patient evaluation. In this study, patients with a mean age of 47.29 ± 16.2 years (40% female) were hospitalized for an average of 28.91 ± 25.6 days. The predominant symptoms experienced by these patients were fatigue (100%), neuropathic pain (70.8%), joint pain (54.2%), and autonomic dysfunction (50%). Significant changes were observed in FIM, Hughes functional grading scale, FAS, 6MWT, and MRC score at admission, discharge, and 1st/3rd-year follow-ups (p=0.000, p=0.000, p=0.000, p=0.001, p=0.000, respectively). Fatigue and Hughes score increased significantly with age (p=0.019, r=0.475; p=0.041, r=0.419, respectively). Negative correlations were found between age and FAS, 6MWT, and MRC score at 1st-year follow-up (p=0.025, r=-0.456; p=0.027, r=-0.450; p=0.008, r=-0.528). FSS was above 4 before admission and in 53.1% at 3rd-year follow-up, correlating negatively with 6MWT and MRC sum score. GBS clinical types showed no significant differences. Rehabilitation improves functional improvement in GBS patients, with long-term benefits observed. However, residual symptoms such as fatigue and neuropathic pain may persist despite functional improvement. These findings highlight the importance of incorporating rehabilitation into the management of GBS and addressing residual symptoms to improve patient outcomes.

The necessity and timing of exercise after lumbar disc herniation surgery.

Physical therapy and rehabilitation may improve low back pain and quality of life after lumbar disc herniation. However, there is no agreement on its optimal start time and rehabilitative methods. This study evaluates the effects of early and late rehabilitation on low back pain and quality of life following unilateral microdiscectomy. A total of 204 patients who underwent surgery for lumbar disc herniation were included and subsequently randomized into five groups: 1. No exercise, 2. The 2nd-week walking group, 3. 1st-month walking group, 4. 2nd-week waist exercise, 5. 1st-month waist exercise. Visual analog scale (VAS) and Oswestry Disability Index (ODI) were assessed at the 1st week, 1st, 3rd, and 6th, and 12th-month follow-up after surgery. 1st-month VAS scores were analyzed, and a significant difference was found between the VAS scores of the 2nd-week walk (3.60±0.78) and 2nd-week waist exercise (3.38±0.67) groups and the other groups (p<0.001). 3rd-month VAS results were analyzed, and the VAS scores of the 1st-month walk group (2.67±0.48) were significantly higher than those of the 2nd-week walk group (1.73±0.45) (p<0.001). A significant difference was observed between the no-exercise group (2.93±0.91) and the other groups according to the 12-month VAS scores, with the VAS scores of the no-exercise group being significantly higher than the other groups (p<0.001). There was a significant difference between the ODI scores of both the 2nd-week walk (38±8.55) and the 2nd-week waist (33.8±6.61) exercise groups and the other groups according to the 1st-month ODI scores (p<0.001). A significant difference was observed between the no-exercise group (35.2±8.25) and the other groups according to the 12-month ODI scores, and the ODI scores of the no-exercise group were significantly higher than the other groups (p<0.001). Regular exercise is highly recommended for long-term pain relief, as well as for achieving a speedy recovery after surgery, which is crucial to maintaining a high quality of life and preventing loss of earning potential. We believe that early implementation of exercises is ideal, but even if initiated later, standard back exercises can still expedite rehabilitation.

A prospective study of clinicopathological profile and outcome of otomycosis in patients presenting to a tertiary care center

Background: Otomycosis is reported all over the world and it accounts for 5 to 20 percent of all cases of infective otitis externa during rainy seasons. The article's main purpose was to study the predisposing factors, most common symptoms, different species of fungi involved, and the treatment outcome of otomycosis. A Chi-square test was used to analyze the association of various factors. Statistical package for the social sciences (SPSS) version 20 was used for statistical analysis. Methods: In this prospective observational study, 100 patients with clinical evidence of otomycosis were evaluated and data regarding age, gender, risk factors, clinical appearance, fungal culture, and treatment modality received were taken. Response to treatment at the 1st follow-up (at 1 week), 2nd follow-up (at 2 weeks), and 3rd follow-up (at 3 weeks) were statistically analyzed. Results: In our study we found the disease to be more common among the 51 to 60 years age group. Males were affected more than females. The most common occupation was housewife. The most common predisposing factor was ear picking and the symptom was otalgia followed by itching. The disease was predominantly unilateral. Aspergillus niger was found to be the most common organism. Clotrimazole was the effective drug for otomycosis and significant responses were seen at the end of the 3rd week of treatment. Conclusions: Aspergillus niger was the most common organism causing otomycosis and responded well with clotrimazole ear drops.

Response assessment of post-treatment head and neck cancers to determine further management using NI-RADS (Neck Imaging Reporting and Data System): a subgroup analysis of a randomized controlled trial.

Interpreting complex post-treatment changes in head and neck cancer (HNC) is challenging with further added perplexity due to variable interobserver interpretation and hence evolved the NI-RADS lexicon. We evaluated the accuracy of NI-RADS in predicting disease status on 1st post-treatment follow-up CECT in a homogenous cohort of those who received only chemoradiation. Retrospective analysis of imaging was done for LASHNC patients who received radical chemoradiation in an open-label, investigator-initiated, phase 3 randomized trial (2012-2018) randomly assigned to either radical radiotherapy with concurrent weekly cisplatin (CRT) or CRT with the same schedule plus weekly nimotuzumab (NCRT). 536 patients were accrued, and 74 patients who did not undergo PET/CECT after 8 weeks post-CRT were excluded. After assessing 462 patients for eligibility to allocate NI-RADS at primary and node sites, 435 cases fell in the Primary disease cohort and 412 cases in the Node disease cohort. We evaluated sensitivity, disease prevalence, the positive and negative predictive value of the NI-RADS lexicon, and accuracy, which were expressed as percentages. We also prepared flow charts to determine concordance with allocated NI-RADS category and established accuracy with which it can identify disease status. Out of 435 primary disease cohort, 92%, 55%, 48%,70% were concordant and had 100%, 72%, 70%, 82% accuracy in NI-RADS1 (n=12), NI-RADS2 (n=261), NIRADS3 (n=105), and NI-RADS 4 (n=60) respectively. Out of 412 nodes disease cohort, 95%, 90%, 48%, 70%were concordant and had 92%, 97%, 90%, 67% accuracy in NI-RADS1 (n=57), NI-RADS2 (n=255), NI-RADS3 (n=105) and NI-RADS4 (n=60) respectively. % concordance of PET/CT and CECT across all primary and node disease cohorts revealed that PET/CT was 91% concordant in primary NI-RADS2 as compared to 55% concordance of CECT whereas concordance of CECT was better with 57% in primary NI-RADS3 cohort as compared to PET/CT concordance of 41%. The accuracy with which the NI-RADS lexicon performed in our study at node sites was better than that at the primary site. There is a great scope of research to understand if CECT performs better over clinical disease status in NI-RADS 3 and 4 categories. Further research should be carried out to understand if PET/CECT can be used for close interval follow-up in stage III/IV NI-RADS 2 cases.

Volume reduction rate of radiofrequency ablation in ≤ 2 cm Bethesda IV thyroid nodules.

This prospective observational study aimed to evaluate the efficacy of radiofrequency ablation (RFA) in treating ≤ 2 cm thyroid nodules with Bethesda IV cytology and C-TIRADS 4A categorization. Additionally, the factors influencing the completed absorption of ablation (CAA) were examined. A total of 62 cases with 62 nodules underwent ultrasound-guided RFA and were included in the study. The volume reduction rate (VRR), CAA, and incomplete absorption of ablation (IAA) were assessed at the 1st, 3rd, 6th, and subsequent 6-month follow-ups. Clinical and ultrasound features were compared between the CAA and IAA groups at the 12th month follow-up. The average VRR at the 1st, 3rd, 6th, 12th month, and last follow-up were -88.6%, 16.0%, 59.7%, 82.0%, and 98.2%, respectively. More than half of the nodules achieved a 90% VRR after 1 year of RFA, with 88.7% demonstrating CAA at the end of the study (follow-up duration of 14 to 63 months). Nodules with grade 3 vascularity and those associated with chronic thyroiditis showed delayed CAA at the 12th month follow-up (p = 0.036 and 0.003, respectively). RFA is an effective technique for treating ≤ 2 cm thyroid nodules with Bethesda IV cytology and C-TIRADS 4A categorization. Nodules with grade 3 blood supply and patients with chronic thyroiditis exhibited an impact on the completed absorption following RFA. Our study has shown that radiofrequency ablation is an effective treatment for ≤ 2 cm thyroid nodules classified as Bethesda IV cytology. However, we identified that high vascularity of the nodule and chronic thyroiditis are adverse factors affecting the completed absorption of the ablation. •Radiofrequency ablation (RFA) is an effective technique for treatment of ≤ 2 cm Bethesda IV category thyroid nodules. •Higher blood supply and chronic thyroiditis influence the completed absorption after RFA.

Elderly Patients' Outcomes After Robot-Assisted Radical Prostatectomy: A Single Center Experience.

Aim: To assess the oncological and functional outcomes of patients aged 70 years or older after robot-assisted radical prostatectomy (RARP) and compare their results with younger men. Materials and Methods: Our study included 496 men who underwent RARP in our clinic between March 2015 and December 2021 with at least 1-year follow-up. Of these patients, 130 were aged 70 or older, and 366 were between 60 and 69. Preoperative characteristics, perioperative parameters, postoperative oncological, and functional results were studied. Results: The entire cohort (496 patients) aged 67 years on median (range 60-84), with a median prostate-specific antigen of 8.4 ng/mL. All the patients had a minimum 1-year of follow-up and the median follow-up was 32 months. According to the perioperative parameters, the two groups were similar except for hospital length of stay. On final pathology, the pathological stage, positive surgical margin rate and lymph node positivity were statistically not different between the two groups. The International Society of Urological Pathology grades were higher on final pathology for both groups, but this increase was greater in the ≥70 age group, and this was statistically significant (P = .013). In both groups, the median International Index for Erectile Function scores decreased after surgery significantly (P < .001), and at the 1st year follow-up, the decrease between the two groups was not different (0.973). Concerning continence outcomes, pad-free continence was significantly better in the 60-69 age group (94.5%) compared to the ≥70 age group (93.1%). Conclusions: The perioperative safety, oncological, and functional results of RARP in elderly men are comparable to younger patients. Clinical trial registiration number: (30/06/2022-13/24).

Early post-treatment MRI predicts long-term hepatocellular carcinoma response to radiation segmentectomy

ObjectivesRadiation segmentectomy using yttrium-90 plays an emerging role in the management of early-stage HCC. However, the value of early post-treatment MRI for response assessment is uncertain. We assessed the value of response criteria obtained early after radiation segmentectomy in predicting long-term response in patients with HCC.Materials and methodsPatients with HCC who underwent contrast-enhanced MRI before, early, and 12 months after radiation segmentectomy were included in this retrospective single-center study. Three independent radiologists reviewed images at baseline and 1st follow-up after radiation segmentectomy and assessed lesion-based response according to mRECIST, LI-RADS treatment response algorithm (TRA), and image subtraction. The endpoint was response at 12 months based on consensus readout of two separate radiologists. Diagnostic accuracy for predicting complete response (CR) at 12 months based on the 1st post-treatment MRI was calculated.ResultsEighty patients (M/F 60/20, mean age 67.7 years) with 80 HCCs were assessed (median size baseline, 1.8 cm [IQR, 1.4–2.9 cm]). At 12 months, 74 patients were classified as CR (92.5%), 5 as partial response (6.3%), and 1 as progressive disease (1.2%). Diagnostic accuracy for predicting CR was fair to good for all readers with excellent positive predictive value (PPV): mRECIST (range between 3 readers, accuracy: 0.763–0.825, PPV: 0.966–1), LI-RADS TRA (accuracy: 0.700–0.825, PPV: 0.983–1), and subtraction (accuracy: 0.775–0.825, PPV: 0.967–1), with no difference in accuracy between criteria (p range 0.053 to > 0.9).ConclusionmRECIST, LI-RADS TRA, and subtraction obtained on early post-treatment MRI show similar performance for predicting long-term response in patients with HCC treated with radiation segmentectomy.Clinical relevance statementResponse assessment extracted from early post-treatment MRI after radiation segmentectomy predicts complete response in patients with HCC with high PPV (≥ 0.96).Key Points• Early post-treatment response assessment on MRI predicts response in patients with HCC treated with radiation segmentectomy with fair to good accuracy and excellent positive predictive value.• There was no difference in diagnostic accuracy between mRECIST, LI-RADS, and subtraction for predicting HCC response to radiation segmentectomy.

Investigation of time-dependent alterations in adipokine levels and endoplasmic reticulum stress markers in obese patients with laparoscopic sleeve gastrectomy

Background and aimsWe aimed to investigate the time-dependent alterations of serum, adipose tissue WISP1, Nrg4, asprosin, SPX adipokines and serum ER stress markers GRP78, XBP1, ATF6, CHOP in obese patients who underwent laparoscopic sleeve gastrectomy (LSG). Materials and methodsMorbidly obese patients (n = 19) and normal-weight individuals (n = 19) were compared. Preoperative (control, obese) and postoperative 1st, 3rd and 6th month (obese) follow-up measurements were obtained. Levels of adipokines, ER stress markers were measured with commercial kits. ResultsBody mass index (BMI), total fat, trunk fat mass, fat percentage of obese patients decreased after LSG. Postoperative serum glucose, insulin, HOMA-IR, triglyceride levels of obese patients decreased, HDL increased. In obese patients, preoperative LDL and total cholesterol, which were not different from control, were higher in the postoperative 6th month measurements. Omentum WISP1, subcutaneous adipose tissue WISP1 and SPX, and serum WISP1, asprosin, CHOP levels were higher, Nrg4 lower in obese patients. Serum Nrg4 was still lower in the postoperative 1st month measurements, while WISP1 was higher in the 3rd and asprosin in the 3rd, 6th months compared to control. 1st and 3rd month ATF6 and 3rd month CHOP concentrations were lower than preoperative values. Serum CHOP measured at the 6th month was significantly higher than control. Negative correlations were observed between serum Nrg4 and fat percentage, TG concentration. CHOP was negatively correlated with fat percentage. ConclusionThe correlations between changes in serum Nrg4, CHOP and fat percentage highlight the roles of Nrg4 and CHOP in the fat loss following LSG.

Mortality following fragility hip fracture in China: a record linkage study.

Hip fractures in older adults often lead to an elevated risk of death. However, few studies investigated mortality risk following hip fracture in mainland China. This retrospective cohort study aimed to evaluate the crude mortality and excess mortality after fragility hip fractures in Lishui residents aged 50years and older. Patients having a fragility hip fracture between October 2013 and August 2019 were identified from the Lishui District Inpatient Data Collection and followed up until August 2020. Death information was ascertained from the linked death registry records. We calculated the follow-up mortality rate and corresponding 95% confidence intervals (CIs) as well as the standard mortality ratios (SMRs) in comparison with the mortality rates of Lishui residents. During the study period, a total of 808 patients (63.4% females) with an average age of 75years were admitted for fragility hip fractures. The 1st, 2nd, and 3rd year follow-up mortality rates were 16.51, 6.06, and 5.03 per 100 person-year, respectively. The SMRs were 8.46 (6.94, 9.97), 5.74 (4.86, 6.63), and 4.63 (3.98, 5.27) for the 1st, 2nd, and 3rd year following fragility hip fracture. Although mortality risk declined over time, patients with fragility hip fracture experienced an approximate ninefold excess mortality, peaking shortly after fracture, in comparison with that of the general population. Continuous efforts in lowering the occurrence of hip fracture have the potential to improve the survival of the elderly population in China.

Endovascular treatment with coil embolization of saccular celiac artery aneurysm: a case report

Objective: Aneurysms of the celiac artery and its visceral branches are more often an incidental finding and can lead to serious complications. Many difficulties arise in matters of their treatment due to the rarity of occurrence. Case presentation: This report describes the rare case of saccular celiac artery aneurysm in patient with severe cardiac comorbidities including history of cardiac surgeries. Celiac artery aneurysm was treated using the endovascular coiling procedure. We had coil dislocation during procedure, and 2nd attempt of coil embolization of aneurysm was successful. The dislocation into femoral artery was treated successfully. Immediate and 1st month follow-up data showed no evidence of recanalization and aneurysm enlargement and computed tomography angiography chowed correct position of coil. Conclusion: Coil embolization is a safe and effective method for the treatment of celiac artery aneurysm in patients with severe comorbid conditions. One should be also prepared for possible technical difficulties that were overcome successfully and thus making minimal invasive approach in such patients effective.

P.130 Efficacy of decompressive craniectomy after subarachnoid hemorrhage: a propensity-matched analysis of a South Australian Cerebrovascular Registry

Background: The efficacy of decompressive craniectomy (DC) for patients with intracranial hypertension secondary to aneurysmal subarachnoid haemorrhage (aSAH) remains unclear. Methods: We identified aSAH patients who underwent DC following microsurgical aneurysm repair from a prospectively maintained cerebrovascular registry and compared their outcomes with a propensity-matched cohort who did not. Results: A total of 45 aSAH patients underwent DC between 01/09/2011 and 20/07/2020 and were compared with 45 propensity-matched controls. There were no differences in patient age (p=0.48), gender (p=0.53) or the proportion requiring endovascular vasospasm treatment (p=1.00). However, patients in the DC subgroup had a higher mean WFNS grade (3.47±1.53) compared with matched controls (2.8±1.25, p=0.03). Patients treated with DC had a higher rate of inpatient mortality (20.00% vs 0.00%, p=0.0025), unfavourable outcome (mRS≥4) at 1st (42.22% vs 11.11%, p=0.0016) and final (31.11% vs 2.94%, p&lt;0.001) follow-up, and NIS-Subarachnoid Hemorrhage Outcome Measure positivity (40.00% vs 13.33%, p=0.0079). They also had a higher median mRS at 1st [3(2–4) vs 1(1–2), p&lt;0.001], and final [2(1–4 vs 1(1 (0–2), p&lt;0.001] follow-up. Conclusions: Patients treated with DC fared worse at every endpoint, which was disproportionate to the difference in presenting WFNS grade. These data do not support the use of DC following microsurgical clipping of a ruptured aneurysm.

Evaluation of cognitive functions in a group of Egyptian recovered COVID-19 patients

BackgroundNumerous investigations have found that cognitive deficits in COVID-19 survivors may be reversible; hence, early detection is essential. These cognitive deficiencies should be targeted with scaled cognitive therapies that can be widely used even in patients’ homes, supporting the best possible cognitive and functional outcomes. In the meanwhile, it has been observed that COVID-19 patients may experience worry, fear, depression, and other mental health problems. Therefore, subjective cognitive difficulties may be due to emotional discomfort. As a result, these data highlight the significance of early diagnosis of anxiety symptoms and depression symptoms in COVID-19 patients in order to prevent subsequent cognitive problems. All patients were selected in accordance with the case definition and used the following tools after 1, 3, and 6 months after being cleared of COVID-19 infection: developed questionnaire for both clinical and demographic data, the Wisconsin Card Sorting Test, the Wechsler Memory Scale-Revised, the Wechsler Adult Intelligence Scale, the Hamilton Anxiety Rating Scale, the Beck Depression Inventory, and Structured Clinical Interview for DSM-IV disorders.ResultsFifty patients were participated in this study from both gender, different levels of education, and the major group was nonsmokers (82%). A total of 88% of participants had confirmed COVID-19, and 12% had contact with them. Wisconsin Card Sorting Test for preservative parameters revealed that the 2nd follow-up showed nonsignificant comparison to the 1st follow-up, while the 3rd showed highly significant comparison to the 1st follow-up. While for non-preservative errors, the 2nd follow-up showed significant comparison to the 1st, while the 3rd showed highly significant comparison to the 1st follow-up. Conceptual level response parameters showed that both the 2nd and the 3rd follow-ups showed nonsignificant comparison to the 1st follow-up. There was no significant correlation between Hamilton Anxiety Scale (HAS) and any parameter of Wisconsin Card Sorting Test or any parameter of Wechsler Memory Scale-Revised.ConclusionsWhile there was negative impact of COVID-19 infection on cognitive functions in Egyptian recovered COVID-19 patients which improves gradually by time, there was nonsignificant correlations between anxiety symptoms, depressive symptoms, and Wisconsin Card Sorting Test as well as Wechsler Memory Scale-Revised parameters in tested individuals through three consecutive follow-ups of COVID-19 in Egypt. Further testing using other scales or larger sample is mandatory to elucidate further potential impact of COVID-19 on cognitive functions of recovered patients.

CHANGES IN MACULAR THICKNESS FOLLOWING UNEVENTFUL CATARACT SURGERY AT A TERTIARY CARE CENTRE: 3 MONTHS FOLLOW UP STUDY.

Background: Cataract is globally a primary cause of preventable blindness and visual impairment with a prevalence of 47.8%. Small-incision cataract surgery (SICS) and phaco-emulsication are the most commonly performed cataract surgeries. However, they are often associated with postoperative risks like cystoid macular edema. In advent of same the current study aimed to identify the macular thickness following uneventful phacoemulsication &amp; small incision cataract surgery method (SICS) comparison with visual acuity. Material &amp; Method: A prospective observational study was undertaken for a period of 1 year from April 2022 to March 2023 on all cataract patients who presented to the OPD at Department of Ophthalmology, IMCHRC, Indore. 100 patients who qualied the inclusion criteria were enrolled with random allocation into 2 surgery group i.e., Group A (N=50); patients who underwent SICS for one eye with bag polymethacrylate IOL implantation and Group B (N=50); patients who underwent phacoemulsication method in one eye with in bag acrylic type of foldable IOL. Postoperative follow up was done on day 7, week 2 and week 4 and upto 3 months. The complete ophthalmological examination and OCT of macula was done at follow-up. Statistical analysis was done with data collected as per the objectives of the study. Results: Subclinical macular oedema noted in two cases at 1st, 2nd and 4th week follow-up, but i was reduced at 3rd month. A statistically signicant (P&lt;0.05) was observed in macular thickness between the preoperative &amp; post operative 1st week, post-operative 2nd week &amp; post-operative 4th week follow-up in Phacoemulsication group. Patients who underwent SICS procedure also showed statistically signicant difference (P&lt;0.05) between the preoperative &amp; postoperative macular thickness on follow-ups without affecting the nal visual acuity. Conclusion: Phacoemulsication procedure showed increased macular thickness without affecting the nal visual outcome postoperatively as compared to SICS. Subclinical macular edema was noted at 1st week which subsequently reduced at 3rd month.

Prognosis of pulmonary arterial hypertension patients with pericardial effusion before and after initiation of parenteral prostacyclin therapy.

Few studies have evaluated the effects of pulmonary arterial hypertension therapies on pericardial effusion. We evaluated hemodynamics, echocardiograms, and outcomes for 119 parenteral prostanoid-treated patients. We discoveredan increased frequency of pericardial effusions posttreatment, and that a moderate-large pericardial effusion at initiation, but not at 1st follow-up, was significantly associated with mortality.

COMPARISON OF ANTEGRADE PERCUTANEOUS VERSUS RETROGRADE URETEROSCOPIC LITHOTRIPSY FOR MANAGEMENT OF UPPER URETERIC CALCULUS.

Background: Technical advancements in urology have profoundly changed the management of upper ureteric calculus, however, its optimal management remains controversial. Methods: To compare antegrade percutaneous nephrolithotripsy (PCNL) and retrograde ureteroscopic lithotripsy (URSL) for management of upper ureteric calculus by measuring stone clearance rates, morbidity and complications. A prospective, observational, single centre, study including patients of either sex presenting with upper ureteric stone [size&gt;8 mm and &gt;800 Hounseld Unit (HU)]. Patients underwent either antegrade PCNL or retrograde ureteroscopic lithotripsy with follow up on outpatient (OPD) basis at 1 week, 1 month and 3 months post-surgery with Visual Assessment Score (VAS) and radiological investigations. Results: Stone clearance rate for antegrade PCNL was 89.1 % and 72.7% for retrograde ureteroscopic lithotripsy which is a statistically signicant difference. Incidence of pain in antegrade PCNL at 1st and 4th week follow-up was 10.9 % and 1.8% respectively compared to 5.5% and 0% for retrograde ureteroscopic lithotripsy. Two patients (1.8%) who underwent PCNL developed segmental artery pseudoaneurysm; one was managed conservatively while other required angioembolization. One patient in the antegrade PCNLgroup and two in retrograde ureteroscopic lithotripsy group had post operative urine culture proven urinary tract infection (UTI) and were treated with antibiotics. Conclusion:As compared to retrograde ureteroscopic lithotripsy, PCNLis a safer and more effective procedure with higher stone-free rates and acceptable complication rates to treat patients with large impacted upper ureteral stones.

Efficacy of 5-aminolevulinic acid-mediated photodynamic therapy in patients with nicotine stomatitis.

This study aimed to treat smoker's palate (SP) using 5-aminolevulinic acid (5-ALA)-mediated photodynamic therapy (PDT). A total of 24 patients with SP were divided into two groups: group-I (test group; n=12); and group-II (control group; n=12). Group-I patients were treated with 5-ALA-mediated PDT, while group-II patients were advised to cease the smoking habit during the entire duration of the study and later. PDT was repeated on days 3, 7, and 14 (i.e., a total of four sittings including day 0 [baseline]). Later, the participants were called for follow-up after week-4 (1st follow-up), week-6 (2nd follow-up), and week-8 (3rd follow-up) after the completion of the treatment. The SPSS version 22.0 was used for data analysis. Group-I patients showed a statistically significant improvement when all three time points were assessed (p<0.0001). Similarly, the same trend was observed in the group-II participants (p<0.001), however, the difference between both groups (i.e., group-I [test group] and group-II [control group]) was larger. The findings of this clinical trial indicated a promising and satisfactory decrease in the clinical features of the smoker's palate without any adverse impacts utilizing 5-aminolevulinic acid-mediated photodynamic therapy. Hence, 5-ALA-mediated PDT appeared to be a promising treatment option together with smoking cessation.

Development and validation of an ama instrument for assessing the disease activity on the basis of constitutional features in Amavata (Rheumatoid Arthritis)

BackgroundRheumatoid Arthritis (RA), having a striking clinical resemblance to amavata in traditional Indian medicine (Ayurveda) presents an opportunity to look at disease from two different healthcare perspectives. This differential information may potentially supplement one system with the knowledge of the other for optimal application. This study is the first of its kind, where Ayurvedic concepts of amavata have been adopted to enhance the knowledge about RA where optimal care is still beyond the common reach. ObjectiveThe study was conducted to develop and validate a novel ama score based upon constitutional features of ama as depicted in ayurvedic literature as a disease activity indicator in RA. Material and methodsThe study was conducted in two parts comprising development and textual validation of the ama assessment instrument (AAI) followed by its clinical testing. AAI comprising ten items, was developed where each item was provided with a range of scores to offer the assessment close to the patient's observations. The score obtained through AAI was clinically and statistically tested on 79 RA/amavata patients randomly selected for validity and reliability. The score obtained through AAI was tested for its correlation with the DAS-28 score and ESR. ResultsAma Assessment Instrument could find a slight correlation with acute phase reactant ESR (r-value between ESR and AMA at baseline is 0.287, and at 1st, 2nd, and 3rd follow-up is 0.276, 0.276 and 0.160 respectively) and DAS-28 (The r value between DAS and AMA at baseline is 0.231, and at 1st, 2nd and 3rd follow up is 0.218, 0.201 and 0.247 respectively). It however emerged as an independent disease status marker since it could mark the changes in the study population on a time scale more precisely as compared to DAS -28 or ESR. When the ama values at different follow-ups were compared, a significant difference was observed consistent with disease activity marker catching constitutional and GI related domain of the patients. When reducing values of ama score were compared to overall improvements as reported by the patients, a similar trend was observed showing that a change in ama score is reflective of a change in disease status and the impact of the disease on the patient. ConclusionThis study provided a quantitative measure for the abstract concept of ama which could be used to mark the disease activity in amavata or RA. The change in ama based scores can be used to assess disease status and the intervention related benefits. The observations prompt for the possible inclusion of AAI in RA composite score to make it more dynamic in terms of disease activity identification in RA.

Therapeutic efficacy of adjunctive photodynamic therapy in the treatment of denture stomatitis

BackgroundThe present report assessed the efficacy of curcumin-mediated photodynamic therapy (CUR-mediated PDT) as an adjunct to antifungal gel treatment by evaluating the salivary interleukin-6 (IL-6) and matrix metalloproteinases-8 (MMP-8) levels together with Candida species counts in denture stomatitis (DS) patients. MethodsIn total, 50 DS subjects were randomly categorized into 2 groups: Group-1: subjects who received the antifungal gel treatment and Group-2: participants who received CUR-mediated PDT. The Sabourad Dextrose Agar and CHROMAgar were utilized for evaluating Candida species counts, while the Enzyme-Linked Immunosorbent Assay was employed to estimate the salivary levels of IL-6 and MMP-8. All clinical evaluations were performed at the baseline, 1 month, and 2 months. ResultsIn total, group-2 subjects showed a significant decrease in Candida albicans (C. albicans) counts on both follow-ups (i.e., 1-month and 2-month) than group-1 participants. C. krusei count also reduced in group-2 subejcts than group-1 participants at the 2nd follow-up as compared to the baseline, nevertheless, a slight increase in C. krusei count was noticed in group-2 subjects at the 2nd follow-up than the 1st follow-up. The salivary IL-6 and MMP-8 levels in both groups reduced significantly at both follow-ups than the baseline. According to the stepwise logistic regression analysis, no statistically significant correlation was observed between Candida species count and other parameters such as age and gender of the patient, duration of DS, and frequency of treatment(s). ConclusionCUR-mediated PDT is an efficaciousness therapeutic modality for alleviating Candida species counts on the surface of denture and the palatal mucosa, as well as improving the salivary IL-6 and MMP-8 levels in DS patients.