Comparative Study Of Outcomes Research Articles

A Comparative Study of 1-Year Postprocedural Outcomes in Transcatheter Mitral Valve Repair in Advanced Primary Mitral Regurgitation: PASCAL vs. MitraClip.

Both the MitraClip and PASCAL systems offer transcatheter edge-to-edge repair (TEER) solutions for mitral regurgitation. Evidence indicates a lower technical success rate for TEER in complex degenerative mitral regurgitation (DMR) cases. We conducted a retrospective analysis of patients who underwent transcatheter edge-to-edge therapy for primary mitral regurgitation with advanced anatomy, defined as mitral regurgitation effective regurgitant orifice area (MR-EROA) ≥0.40 cm2 or large flail gap (≥5 mm) or width (≥7 mm) or Barlow's disease, that completed follow-up after 1 year. Our criteria were met by 27 patients treated with PASCAL and 18 with MitraClip. All patients exhibited a significant, equivalent short-term reduction in MR-EROA, mitral regurgitation vena contracta diameter (MR-VCD), regurgitant volume, and clinical status. At 1 year follow-up, reductions in MR-VCD, regurgitant volume, and MR-EROA remained significant for both groups without significant differences between groups. MR-Grade ≤ 1+ was achieved in 18 (66.7%) and 10 (55.6%) patients, respectively. At follow-up, no difference in hospitalization for cardiac decompensation was observed. Overall death was similar in both groups. Our study suggests that both the PASCAL and MitraClip systems significantly reduce mitral regurgitation even in advanced degenerative diseases. Within our limited data, we found no evidence of inferior performance of the PASCAL system.

A comparative study of surgical outcomes for secondary spontaneous pneumothorax and the postoperative survival prognostic factor: interstitial vs. non-interstitial pneumonia.

To investigate the surgical outcomes and postoperative survival prognostic factors of intractable secondary spontaneous pneumothorax. A total of 95 patients who underwent thoracoscopic surgery for intractable secondary spontaneous pneumothorax between April 2010 and March 2020 were included in this study. These patients were classified into interstitial pneumonia and non-interstitial pneumonia groups, and a comparative study was performed on surgical outcomes and postoperative survival prognostic factors. There was no difference in the 1-year overall survival rate between the two groups. However, the 3-year overall survival rate was significantly lower in the interstitial pneumonia group than in the non-interstitial pneumonia group. The differences in short-term surgical outcomes (persistent air leakage, postoperative complications, etc.) were not significant between the two groups. Univariate analysis revealed that the drainage period, the development of postoperative complications, and recurrence were significant independent postoperative survival prognostic factors for all cases. Postoperative complications were the only associated postoperative survival prognostic factor for interstitial pneumonia pneumothorax in the multivariate analysis. The development of postoperative complications can cause poor postoperative survival prognosis of intractable secondary spontaneous pneumothorax due to interstitial pneumonia.

A Comparative Study of Visual Outcome and IOP Changes in Postoperative PCO Cases Among Diabetics and Non Diabetics Following Nd: YAG Laser Capsulotomy

Background: Posterior capsular opacification is the most common long term complication of modern IOL surgery.ND: YAGlaserre mains the corner stone of its treatment. In this study, an attempt is made to study the visualoutcome and change in the intraocular pressure following Nd: YAG laser capsulotomy and compare the resultsbetween diabetic patients and non-diabetic patients.Method: This was a prospective study of 100 patients (50 diabetics and 50 nondiabetics), conducted in KhajaBanda Nawaz Teaching and General Hospital, Kalaburgai. All patients in the age group 45-75 years, attendingthe regular OPD who presented with visually significant posterior capsular opacification and were treated withNd:YAG laser capsulotomy. Patients were included in the study taking into consideration inclusion and exclusioncriterias. Patients were followed up on first day, first week and the four weeks and the improvement in the BCVAand the changein IOP (Intra Ocular pressure) were recorded.Results: All the patients treated for PCO with Nd:YAG laser capsulotomy showed an improvement in visualacuity. The visual outcome at four weeks (41%had > 6/12) was found to be better than that at first week (34 % hadthe same) and first day (16% had the same). The final visualoutcome at 4 weeks was found to be better in nondiabetics(52% had>6/12) compared to diabetics (30% had>6/12). All the patients showed an increase in IOP atthe first day and first week of follow up and return to near normal of baseline values at four weeks of follow up,the pattern of change in IOP being similar in both the study groups.Conclusion: Nd:YAG laser capsule to May effectively improves the visualacuity inpatients with visually significantPCO. The comparatively poor outcome in the diabetic group can be attributed to the associated retinopathychanges. Nd:YAGl aser capsulotomy is associated with a transient rise in the intraocular pressure in all patientswhich can very rarely remain persistently high.

Comparison of Outcomes Regarding Weight Loss in Laparoscopic Sleeve Gastrectomy vs Laparoscopic Mini Gastric Bypass in Morbidly Obese Patients- A Cohort Study

Introduction: Obesity is defined as abnormal or excessive fat accumulation that may impair health. Body Mass Index (BMI) is a simple index of weight for height (kg/m2 ) that is commonly used to classify overweight and obesity in adults. Mini Gastric Bypass (MGB) leads to improved quality of life, reduction in episodes of Gastroesophageal Reflux Disease (GERD), high patient acceptance, early safety, and efficacy. Laparoscopic Sleeve Gastrectomy (LSG) is a restrictive, irreversible procedure in which stomach capacity is markedly reduced by creating a lesser curvature tube. MGB is mildly restrictive but importantly, a malabsorptive operation. Many observational studies have concluded that better weight loss and diabetes remission are the advantages of MGB. However, comparative studies of outcomes and complications between Laparoscopic Sleeve Gastrectomy (LSG) and MGB are still scarce. Aim: To compare the effectiveness and outcomes regarding weight loss after LSG and MGB in morbidly obese patients. Materials and Methods: This prospective cohort study was carried out in the Department of Surgery of SPS Hospital, Ludhiana, Punjab, India from 1st June 2018 to 31st May 2019. Adults between 20-70 years of age and with BMI >37.5 without co-morbidities, and BMI >32.5 with co-morbidities Type II Diabetes Mellitus (T2DM) were included. The authors included 59 patients; 34 patients underwent MGB (22 were female and 12 were male) and 25 patients underwent LSG (18 were female and 7 were male). A comparison of continuous variables between the study groups was done using the Student’s t-test. For comparing categorical data, a Chi-square (χ2 ) test was performed. Results: The overall % Excess Weight Loss (EWL) after MGB ranged from 27.74 to 62.32% with a mean of 44.88±17.44%. The overall % EWL after LSG ranged from 26.62 to 45.8% with a mean of 36.21±9.59%. (p<0.05) in % EWL at nine months in both procedures as MGB resulted in more % EWL than LSG. Perioperative results regarding the mean operative time for MGB was 3.24 hours and for LSG, 2.43 hours (p<0.05). A total of 50% (5/10) of patients who underwent MGB had remission, and 25% (1/4) of patients who underwent LSG had remission of T2DM after nine months (p>0.05). None of the patients required readmission post LSG, while 3% (1/34) required readmission post MGB. None of the patients had postoperative leakage in both groups. Conclusion: The better outcome was associated with MGB in terms of the percentage of Excess Weight Loss (EWL).

Impact of Sesamoid Coverage on Clinical Foot Function Following Fourth-Generation Percutaneous Hallux Valgus Surgery.

The impact of pronation and sesamoid coverage on clinical outcomes following percutaneous hallux valgus surgery are not currently known. The aim of this study was to investigate if sesamoid coverage was associated with worse clinical outcomes at 12-month follow-up following percutaneous hallux valgus surgery. Retrospective comparative observational study of clinical and radiographic outcomes based on a previously published prospective dataset. Patients were stratified into 3 cohorts based on the degree of sesamoid coverage (normal, mild, or moderate) on 12-month weightbearing radiographs following fourth-generation percutaneous hallux valgus surgery. Primary outcome was a validated patient-reported outcome measure (PROM), the Manchester-Oxford Foot Questionnaire (MOXFQ). Secondary outcomes included Euroqol-5D, VAS Pain, and radiographic deformity correction. Forty-seven feet underwent primary fourth-generation HV surgery and were stratified into 3 cohorts. There were 19, 16, and 12 feet in the normal, mild, and moderate cohorts respectively. There was no significant difference in either pre- or postoperative foot function (all MOXFQ domains, P > .05) or health-related quality of life (EQ-5D Index or VAS, P > .05). The MOXFQ Index preoperatively was as follows: normal cohort, 56.1 ± 26.9; mild cohort, 54.1 ± 17.9; and severe cohort, 49.6 ± 23.8; and postoperatively was as follows: normal cohort, 15.6 ± 21.5; mild cohort, 11.4 ± 15.5; and severe cohort, 11.4 ± 13.6 (P = .737-.908). There was significantly worse hallux valgus angle (HVA) and intermetatarsal angle (IMA) between the cohorts (P < .01). Although HVA and IMA were corrected to normal parameters following surgery in all cohorts, there was a significantly worse postoperative HVA in the moderate sesamoid coverage (5.3 ± 3.9 vs 7.9 ± 5.3 vs 11.4 ± 3.7, P < .01); however, IMA was not significantly different (3.4 ± 2.2 vs 4.1 ± 2.7 vs 5.2 ± 2.9, P = .168). This study found that cases where the sesamoids were not reduced had a poorer correction and had worse preoperative deformity. Clinical outcomes and foot function following fourth-generation percutaneous hallux valgus surgery were not affected by sesamoid coverage at the 12-month follow-up. The long-term implications in the difference in radiographic deformity between the 3 cohorts are not known, and further work should explore the relationship of first ray pronation and sesamoid position, particularly with regard to recurrence. Level III, retrospective comparative study of prospectively collected data.

Laparoscopic vs open transcapsular adenomectomy (Millin): a comparative study of perioperative outcomes and complications

Laparoscopic vs open transcapsular adenomectomy (Millin): a comparative study of perioperative outcomes and complications

Comparative study of pregnancy outcome in elderly and young mothers in a tertiary care hospital

Comparative study of pregnancy outcome in elderly and young mothers in a tertiary care hospital

Innovations in Sacral Fracture Management: A Comparative Study of Open vs Closed Reduction Outcomes

Innovations in Sacral Fracture Management: A Comparative Study of Open vs Closed Reduction Outcomes

Early Discharge versus 6-hour Observation in Mild Traumatic Brain Injury with Normal Brain CT Scan; a Comparative Pilot study of Outcomes.

Early discharge from the emergency department (ED) or a 6-hour observation in the ED are two methods for management of patients with mild traumatic brain injury (mTBI) with normal brain computed tomography (CT) scan. This study aimed to compare the outcomes of the two management options. This study is a single-center, open-label, pilot randomized case control study conducted in the ED of Ramathibodi Hospital from June 2022 to September 2023. Eligible participants included all individuals with mTBI who had negative findings on Brain CT scans. They were randomly assigned to either the early ED discharge or 6-hour ED observation group and compared regarding the outcomes (rate of 48-hour ED revisits; occurrence of post-concussion syndrome (PCS) 1 day, 1 month, and 3 months after the initial injury; and 3-month mortality). 122 patients with the mean age of 74.62 ± 14.96 (range: 25-99) years were consecutively enrolled (57.37% female). No significant differences were observed between the early discharge and observation groups regarding the severity of TBI (p=0.853), age (p=0.334), gender (p=0.588), triage level (p=0.456), Glasgow Coma Scale (GCS) score (p=0.806), comorbidities (p=0.768), medication usage (p=0.548), mechanism of injury (p=0.920), indication for brain CT scan (p=0.593), time from TBI onset to ED arrival (p=0.886), and time from ED triage to brain CT scan (p=0.333). Within 48 hours after randomization, the incidence of revisits was similar between the two groups (1.57% vs. 3.23%; p = 1.000). There were no statistically significant differences in the incidence of PCS between the early discharge and observation groups at 1 day (33.90% vs. 35.48%, p = 0.503), at 1 month (12.07% vs. 13.11%, p = 0.542), and at 3 months (1.92% vs. 5.56%, p = 0.323) after randomization. After a three-month follow-up period, four patients in the early discharge group, had expired (none of the deaths were associated with TBI). It seems that, in mTBI patients with normal initial brain CT scan and the absence of other injuries or neurological abnormalities, early discharge from the ED without requiring observation could be considered safe.

Comparative study of outcomes of different approaches in redo mitral valve surgery

Background Redo mitral valve replacement surgery is a challenging procedure as the access of the mitral valve mandates good exposure yet mitral visualization may not be sufficient as previous cardiac operations may complicate mitral valve exposure, as adhesions and loss of mobility in the surrounding tissues may be present. In such cases, the conventional left atrial incision may not offer satisfactory visualization in the surgical site of the valve. Therefore, several alternative approaches have been proposed, such as superior trans-septal approach, for satisfactory visualization of the mitral valve intra-operatively. Patients and methods Between January 2017 and November 2021, 100 patients were enrolled and with 50 patients randomly assigned in each group. Group one on patients undergoing redo surgery via a superior trans-septal approach and group two undergoing redo surgery via left atrial approach. Results Transeptal approach provides same results like left atrial approach in redo mitral valve surgery. Conclusion We conclude that the transseptal approach when compared to left atrial in redo patients provides comparable results in the intraoperative as well as postoperative outcomes

A comparative study of outcome of teaching related to suicide risk assessment using mobile app versus conventional teaching for undergraduate medical students

Background: In India, the leading cause of mortality for those aged 15–39 in 2016 was reported to be suicide. Despite these alarming statistics, efforts to prevent suicide are nevertheless thwarted by a number of obstacles to getting help. Timely identification is essential to ensuring that people at risk of suicide receive the right care and assistance. The World Health Organization’s mental health action plan advocates employing self-help treatments through electronic and mobile technologies in addition to other steps to promote accessibility to and availability of evidence-based mental health services with encouraging results. With encouraging results, technology has been utilized to give self-help and guided psychological therapies, and it may be employed as a low-intensity and low-cost tactic to reach a bigger population in need of care. Aims and Objectives: The objectives of this study were to study the comparison of mobile application versus conventional teaching techniques for implementation of suicide risk assessment among medical students. Materials and Methods: Study comprises MBBS students. Sample size was calculated to be 138, with 67 in Group A (conventional teaching) and 67 in Group B (mobile teaching). Week 1 and 2 – students were randomly allocated into Group A and B. Both the groups were taught about suicide risk assessment. Results: We found that 87.61% found the mobile application easier to comprehend than the conventional teaching methods. Conclusion: Mobile application learning for implementation of suicide risk assessment in MBBS students is non-inferior to conventional teaching methods.

Comparative Study of Clinical and Radiological Outcomes of Conventional Total Knee Replacement (TKR) and Robotic-Assisted TKR in Patients with Bilateral Varus Deformity Knee OA within the Eastern Population

Background: Osteoarthritis (OA) of the knee, including bilateral varus deformity, presents unique challenges for treatment. This comparative study evaluates clinical and radiological outcomes of conventional total knee replacement (TKR) and robotic-assisted TKR in patients with bilateral varus deformity knee OA within the Eastern population. Methods: A prospective study was conducted on 84 bilateral varus deformity knee OA patients treated with two different surgical approaches: Group A (Conventional TKR) and Group B (Robotic-assisted TKR). Clinical outcomes, including pain relief, functional improvement, and patient satisfaction, were assessed using Visual Analog Scale (VAS), Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and quality of life measures. Radiological outcomes, including alignment and component positioning, were evaluated. Statistical analyses compared outcomes between groups. Results: Both groups demonstrated significant improvements in clinical and radiological outcomes. Robotic-assisted TKR showed advantages with reduced pain (p &lt; 0.001), superior knee function (p &lt; 0.001), better pain relief and function (p &lt; 0.001), higher patient satisfaction (p &lt; 0.001), and improved quality of life (p &lt; 0.001) compared to conventional TKR. Radiologically, robotic-assisted TKR exhibited superior alignment (p &lt; 0.001) and component positioning (p &lt; 0.001). Implant survivorship remained excellent in both groups, with no revisions reported. Conclusion: Robotic-assisted TKR offers significant benefits in pain relief, functional improvement, and radiological outcomes for patients with bilateral varus deformity knee OA within the Eastern population. While both approaches are effective, the advantages of robotic assistance should be considered in surgical decision-making. Further research is needed to assess cost-effectiveness and long-term outcomes.

Comparative study of radiological outcomes of intertrochanteric fractures managed with intra medullary nailing with or without intraoperative temporary K-wire’s stabilization

Background: Inter-trochanteric fractures are one of the most common hip fractures, occurring in both young adults and the elderly, as a result of high-energy trauma or low-energy trauma. These fractures are three to four times more common in elderly women with osteoporosis. The primary concern with Intertrochanteric fractures is the 20% to 30% mortality risk in the first year after the fracture. Methods: Various methods of fracture fixation have been used in treating this fracture with intramedullary nailing has been the most favoured. In this modality maintenance of reduction during and after fixation remains a concern. The temporary stabilization of fracture with K-wires for minimally invasive fixation of Intertrochanteric fracture with an intramedullary nail is advocated and aids in keeping the fracture reduction in place while proximal reaming and nail introduction. Results: In this study a total of 80 patients with intertrochanteric fractures were included, of which 45 patients operated with temporary K-wire, 43 patients reduction was maintained and loss of reduction was noted in 2 patients (4.4%) and 35 patients operated without K-wire, 29 patients reduction maintained and lost in 6 patients (17.1%). Conclusions: There was no statistically significant, difference in the 2 groups with respect to intra/post-operative loss of reduction. Having a larger study group the results may have a statistically significant outcome.

Comparative Study of Postoperative Outcome between Laparoscopic Mesh Repair &amp; Open Mesh Repair of Inguinal Hernia Patient in Tertiary Care Hospital in Bangladesh

Background: Inguinal hernia repair is a commonly performed surgical procedure, and the choice between laparoscopic and open approaches remains a subject of ongoing discussion. This prospective cohort study aimed to compare postoperative outcomes between laparoscopic mesh repair and open mesh repair in inguinal hernia patients in a tertiary care hospital in Bangladesh. Objective: This study aimed to assess and compare the surgical outcomes and patient recovery following laparoscopic and open mesh repair for inguinal hernias. Methods: A prospective study was conducted by Z.H. Sikder Women's Medical College Hospital and Central Hospital Ltd Dhanmondi Dhaka in Bangladesh, spanning from 2022 to 2023. It enrolled 112 individuals, each grappling with inguinal hernias; they were divided into two groups: one undergoing the intricate ballet of laparoscopic mesh repair (n=56) and the other navigating the venerable path of open mesh repair (n=56). With precision, we charted their demographics and chronicled intraoperative nuances. We scrutinized postoperative outcomes to illuminate the interplay between modern innovation and time-tested tradition in hernia care. Results: In our comparative study involving 112 patients (99.5% male, median age 30.8 ± 10.6 years), evaluating postoperative outcomes between laparoscopic and open mesh repair for inguinal hernias in a Bangladesh tertiary care hospital, significant differences were observed. The laparoscopic group demonstrated notably shorter operative durations (p&lt;0.05), a lower incidence of wound infections (p&lt;0.05), and reduced postoperative pain with lower analgesic requirements and shorter hospital stays (p&lt;0.05). Additionally, the laparoscopic group exhibited a faster return to normal activities and Work (p&lt;0.05). However, the mean operative time was significantly longer in the laparoscopic group (20.2 minutes, p&lt;0.001), while the time to return to duty was significantly shorter (2.3 days, p=0.008). Conclusions: Laparoscopic ....

Comparative study of wound outcomes and surgical strategies: Internal fixation versus external stabilization in rib fracture patients with traumatic chest wounds.

The clinical management of traumatic chest incisions accompanied by rib fractures presents the formidable challenge. The study was carried out to compare the outcomes of auscultatory triangle internal fixation (ATIF) and external fixation (EF) in such injuries. From June 2019 to June 2022, 105 patients with multiple rib fractures participated in the cohort study in which they were divided into two groups: 53 patients underwent ATIF and 52 patients underwent EF. The incidence of surgical site infection, wound healing time, incidence of wound dehiscence, number of dressing changes, pain as measured by the visual analogue scale (VAS), duration of hospitalization, period of return to work, pulmonary complications and functionality of the upper limbs as assessed by the Disability of Arm, Shoulder, and Hand (DASH) questionnaire were among the parameters evaluated. In comparison with EF, ATIF demonstrated the decreased incidence of wound dehiscence (1.9% vs. 9.6%) (p < 0.05), surgical site infection (3.8 vs. 11.5) and wound healing time (12.3 ± 2.1 vs. 18.5 ± 3.7 days) (p < 0.05). Furthermore, during their ATIF treatment, patients required fewer changes of dressing (3.5 ± 0.8 vs. 5.7 ± 1.2) and demonstrated enhanced pain management, reduced hospital stays and expedited return to work (p < 0.05). ATIF group demonstrated enhancements in both upper limb functionality and post-operative pulmonary function (p < 0.05). The utilization of ATIF as opposed to EF for the treatment of traumatic chest wounds accompanied by rib fractures yields superior outcomes in terms of wound healing, infection reduction and restoration of pulmonary and upper limb functionality.

The impact of palliative primary tumor resection on overall survival in minimally symptomatic (asymptomatic) colorectal cancer and synchronous unresectable metastases vs chemotherapy only: a comparative study of outcomes

Aim: to evaluate the impact of primary tumor resection (PTR) on treatment outcomes in patients with asymptomatic or minimally symptomatic colorectal cancer (CRC) and synchronous unresectable metastases.Patients and Methods: treatment outcomes of patients with minimally symptomatic CRC and synchronous unresectable metastases were retrospectively assessed (2016–2022). Patients with PTR followed by chemotherapy were compared to patients receiving chemotherapy only. Survival was determined by the Kaplan-Meier method and differences were evaluated using the log-rank test and Cox proportional-hazards regression model. To reduce potential selection bias between two groups a propensity score matching (PSM) was performed.Results: no significant differences in 30-day mortality rate (р = 1,00) and the rate of surgical intervention due to complications of first treatment (р = 1,00) between the two groups. Before matching the median survivals were 27,8 and 24 months in the PTR and chemotherapy groups, respectively (р = 0,2). After PSM the overall survival rate at 3 years was 42,1% for the PTR group and 34% for the chemotherapy group (р = 0,47). The median survivals were 27,9 and 24,4 months, respectively. Three-year overall survival rate for patients with stage IVB was significantly higher in the PTR group than in the chemotherapy group (37,8% versus 4,8%; р = 0,02). The median survivals were 36,1 and 17,2 months, respectively. In multivariate analysis radical resection (R0) if unresectable metastases converted into resectable after initial treatment was the only significant prognostic factor for survival (p &lt; 0,001).Conclusions: PTR in patients with asymptomatic or minimally symptomatic CRC and synchronous unresectable metastases is associated with acceptable postoperative morbidity and mortality rates and may improve overall survival for patients with stage IVB comparing to chemotherapy as a treatment of first line. However, randomized controlled trials are needed.

Comparative study of outcome of the Teaching methods for Early Clinical Exposure in 1st Professional MBBS students: Ward side patient demonstration method Vs Video &amp; Dummy patient demonstration method

Background: Early Clinical Exposure (ECE) is a newer concept of teaching learning methodology which provides clinical perspective and relevance to learning of basic sciences. ECE also orients towards actual clinical scenarios and helps the medical students to correlate their theoretical knowledge with real life situations right from the first year of medical college. Aims and Objectives: This study aimed to compare the outcome of teaching methods for Early Clinical Exposure in 1st Professional MBBS students and to assess the effect and efficiency in their performance. Materials and Methods: This prospective comparative study was carried with a sample population of 50 students of MBBS 1st prof. 2021 batch who were selected by random allocation method and divided into two groups of 25 students each, one acting as Bedside ECE group and other as Virtual ECE group. Pre training evaluation was performed at the beginning of study and Post training evaluation was performed after three months. The student’s feedback was taken regarding advantages, disadvantages and suggestions for further improvement. Results: A statistically significant difference was observed between the Bedside ECE and Virtual ECE group at post training in theory (t=15.682, p&lt;0.001), practical (t=12.671, p&lt;0.001) and total (t=17.460, p&lt;0.001) marks of the students after 3 months training. The mean scores of participants were significantly improved more in the Bedside ECE group (39.92±3.23) as compared to Virtual ECE group (23.04±3.60). Analysis of students’ feedback revealed that Bedside ECE was found to be more interesting method of teaching as compared to virtual methods and helped to develop empathy towards the patients as well as motivated them to read more about the topic and helped in retention. Conclusion: Direct contact with patient has been seen to play a crucial role in development of clinical reasoning, communication skills and professional attitudes. The concept of Bedside Early Clinical Exposure goes longway in helping young minds in grasping clinical and theoretical concepts better by involving all domains of learning. KEY WORDS: Competency Based Medical Education, Early Clinical Exposure, Empathy, Reflection, Bedside ECE, Virtual ECE

A Prospective Comparative Study of the Functional Outcomes of Patellar Resurfacing Versus Non-resurfacing in Patients Undergoing Total Knee Arthroplasty.

Background and objective Total knee arthroplasty (TKA) is a highly successful surgical procedure. However, there is a lack of consensus about whether to resurface the patella or not. This study was aimed at evaluating the outcome of patellar resurfacing in terms of a decrease in the incidence of anterior knee pain after TKA and assessing whether patellar resurfacing is beneficial in improving functional outcomes. Materials and methods This prospective comparative study included 100 patients undergoing TKA who were randomly allotted to the patellar resurfacing or non-resurfacing group. Functional evaluation was done based on the Knee Society Score, and the pain was evaluated by the visual analogue scale (VAS) preoperatively and after one year. Results There was a significant improvement in the Knee Society scores as well as the pain scores in both groups postoperatively. The patellar resurfacing group showed statistically significant improvement as compared to the non-resurfacing group in the Knee Society clinical and functional scores as well as the VAS at the end of one year. Conclusion Patellar resurfacing during TKA provides better clinical and functional outcomes as well as more relief from anterior knee pain as compared to non-resurfacing of the patella.

Comparative Study of Post-Surgical Outcomes in Pain, Disability, and Health-Related Quality of Life for Adult Spinal Deformity in Patients Aged above and below 75 Years.

(1) Background: Adult spinal deformity (ASD) surgery is known to improve clinical and radiological parameters; however, it may also cause more complications in elderly patients. The purpose of this study was to compare the outcomes of ASD surgery, specifically regarding pain, disability, and health-related quality of life (HRQOL) in patients aged 75 years and over and patients aged under 75 years; (2) Methods: A total of 151 patients who underwent ASD surgery between August 2014 and September 2020 were included. Patients were divided into two groups based on whether they are 75 years and over or under. Radiological parameters measured included sagittal vertical axis (SVA), pelvic tilt (PT), and pelvic incidence (PI)- lumbar lordosis (LL). Data were collected 3, 6, and 12 months after surgery; (3) Results: At 12 months postoperatively, visual analog scale (VAS) for low back pain (p = 0.342), Oswestry disability index (ODI) (p = 0.087), and EuroQol 5-Dimensions (EQ-5D) (p = 0.125) did not differ between patients under 75 years and those 75 and above 75 group. PT (p = 0.675), PI-LL (p = 0.948), and SVA (p = 0.108) did not differ significantly 12 months after surgery in the two groups. In the entire patient group, compared to preoperative data, significant improvements were demonstrated for clinical and radiological parameters 12 months after surgery (all p < 0.001). The rate of medical complications did not correlate with age, but the rates of proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) did (p = 0.638, p < 0.001, and p = 0.001, respectively); (4) Conclusions: In terms of clinical and radiological improvements, ASD surgery should be considered for patients regardless of whether they are younger than or older than 75 years. The clinical and radiological improvements and the risk of complications and revision surgeries must be considered in ASD patients who are 75 years or older.

Effects of tissue heterogeneity and comparisons of collapsed cone and Monte Carlo fast neutron patient dosimetry using the University of Washington clinical neutron therapy system (CNTS)

Fast neutron therapy is a high linear energy transfer (LET) radiation treatment modality offering advantages over low LET radiations. Multileaf collimator technology reduces normal-tissue dose (toxicity) and makes neutron therapy more comparable to MV x-ray treatments. Published clinical-trial and other experiences with fast neutron therapy are reported. Early comparative studies failed to consider differences in target-dose spatial conformality between x-ray and neutron treatments, which is especially important for organs-at-risk close to tumor targets. Treatments planning systems (TPS) for high-energy neutrons lag behind TPS tools for MV x-rays, creating challenges for comparative studies of clinical outcomes. A previously published Monte Carlo model of the University of Washington (UW) Clinical Neutron Therapy System (CNTS) is refined and integrated with the RayStation TPS as an external dose planning/verification tool. The collapsed cone (CC) dose calculations in the TPS are based on measured dose profiles and output factors in water, with the absolute dose determined using a tissue-equivalent ionization chamber. For comparison, independent (external) Monte Carlo simulation computes dose on a voxel-by-voxel basis using an atlas that maps Hounsfield Unit (HU) numbers to elemental composition and density. Although the CC algorithm in the TPS accurately computes neutron dose to water compared to Monte Carlo calculations, calculated dose to water differs from bone or tissue depending largely on hydrogen content. Therefore, the elemental composition of tissue and bone, rather than the material or electron density, affects fast neutron dose. While the CC algorithm suffices for reproducible patient dosimetry in fast neutron therapy, adopting methods that consider tissue heterogeneity would enhance patient-specific neutron dose accuracy relative to national standards for other types of ionizing radiation. Corrections for tissue composition have a significant impact on absolute dose and the relative biological effectiveness (RBE) of neutron treatments compared to other radiation types (MV x-rays, protons, and carbon ions).