Conservative Modalities Research Articles

Recurrent peripheral odontogenic keratocyst: Review of the literature and presentation of a novel case initially masquerading as an atypical infected lateral periodontal cyst

AimTo review published cases and case series of the peripheral odontogenic keratocyst (POKC) of the gingiva, report an unusual presentation, and discuss lesional recurrence. Materials and methodsA search of the English language literature for gingival OKCs was conducted. The inclusion of new case yielded a database containing 29 affected patients. Clinical, surgical, radiographic, and histopathologic findings have been summarized. ResultsWith available patient demographics, 62.5% were female and 37.5% were male, with an overall mean age at diagnosis of 53.8 years. There was near-equal lesional affinity for the jaws, of which 44.0% occurred in the posterior region, 32.0% anteriorly, and 24.0% overlapped these areas. Twenty-five percent of lesions had a normal color, 30.0% appeared yellow, 20.0% were white, and 10.0% were blue. The majority of lesions were < 1 cm and nearly 42% manifested exudation or fluctuance. Lesional pain was infrequent. Pressure resorption was recorded in 45.8% of cases. Most lesions were managed with conservative surgical modalities. Follow-up information was available in 16 primary cases, of which 5 recurred, signifying a 31.3% recurrence rate, including the featured case, which recurred twice. ConclusionTo reduce recurrence of a gingival OKC, supraperiosteal dissection is advocated. Further, it is advised to follow POKCs for 5–7 years postoperatively, remaining vigilant for subtle clinical manifestations of recurrence. Timely discovery and excision of a POKC of the gingiva may decrease the incidence of a mucogingival defect.

Decision-Making and Management of Tarsal Coalition in the Young Adult Patient: A Critical Analysis Review.

» Tarsal coalitions most commonly affect the calcaneonavicular and talocalcaneal joints in up to 13% of the general population. They alter the mechanics of the subtalar joint, limiting inversion and eversion, and place excessive stress on neighboring joints causing pain, recurrent ankle sprains, and/or progressive pes planus during the adolescent growth spurt.» While many coalitions are identified on radiographs, advanced imaging with computed tomography or magnetic resonance imaging is sometimes required. These advanced imaging modalities also serve an essential role for surgical planning to quantify coalition involvement, identify fibrous or cartilaginous coalitions, and aid in determining the degree of deformity within the foot.» Surgical treatment is reserved for feet with persistent activity-related pain not relieved by prolonged attempts at nonoperative management, which include nonsteroidal anti-inflammatory drugs, shoe orthotics, and periods of non-weight-bearing in a cast. These conservative modalities may be successful in up to 85% of cases.» For adolescent patients, recent surgical options attempt to avoid arthrodesis and focus on coalition resection and interposition grafting with or without deformity correction. The ultimate decision is based on the location of the pain, the size and histology of the coalition, the health of the posterior subtalar facet, the degree of flatfoot deformity, and the presence of degenerative changes in the subtalar and/or adjacent joints.» While many studies focus on subtalar motion and gait kinematics, the critical outcomes remain pain relief and future need for arthrodesis, which may be related not only to resection of the coalition but assessment of deformity, including after the resection has been performed.

ID: 216922 Lumbar Medial Branch Nerve Stimulation With SPRINT Demonstrating No Pacemaker Interference: A Case Report

A 93-year-old male with significant cardiac history including CAD, aortic valve stenosis s/p TAVR, symptomatic bradycardia, paroxysmal atrial fibrillation, second degree AV block on anticoagulation with an implanted Biotronik cardiac pacemaker was evaluated for chronic low back pain. Patient previously completed conservative modalities and multiple interventional procedures including epidural steroid injections and lumbar medial branch blocks with minimal relief. He was not a surgical candidate. The risks and potential benefits of SPRINT peripheral nerve stimulation (PNS) were discussed given his age, cardiac history, and ongoing anticoagulation. Currently, SPRINT is contraindicated in patients with active cardiac implanted devices including pacemakers and defibrillators.

The conservative management for improving Visual Analog Scale (VAS) pain scoring in greater trochanteric pain syndrome: a Bayesian analysis

BackgroundGreater trochanteric pain syndrome (GTPS) possesses a harmful influence on quality of life. Numerous conservative management modalities with varying success have been proposed for patients with GTPS. However, it is not clear which treatment is more effective for reducing pain. The purpose of this Bayesian analysis was to assess the current evidence for the effectiveness of conservative treatments on improving Visual Analog Scale (VAS) pain scoring of GTPS and to determine the most effective treatment protocol.MethodsA comprehensive study search was performed from inception until July 18, 2022, via the electronic databases PubMed, the Cochrane Library, and Web of Science for potential research. The risk of bias assessment for the included studies was independently performed based on the Cochrane Collaboration Risk of Bias Tool. Bayesian analysis was conducted by using ADDIS software (v1.16.5). The DerSimonian-Laird random effects model was used to perform the traditional pairwise meta-analysis.ResultsEight full-text articles with a total of 596 patients with GTPS were included in the analysis. In comparing ultrasound-guided platelet-rich plasma application (PRP-U) to ultrasound-guided corticosteroid injection (CSI-U), patients who received PRP therapy experienced reduced pain as the VAS decreased significantly (MD, -5.21; 95% CI, -6.24 to -3.64). VAS score in group of extracorporeal shockwave treatment (ESWT) was significant improved than that in exercise (EX) group (MD, -3.17; 95% CI, -4.13 to -2.15). There were no statistically significantly different VAS scores between the CSI-U group and the CSI under landmark (CSI-B) group. The treatment efficacy rankings of the different treatments on improving VAS scores showed that the most likely efficacious treatment was PRP-U (99%) followed by ESWT (81%), CIS-U (58%), usual care (48%), CIS-B (54%), and EX (84%).ConclusionBayesian analysis revealed that PRP injection and ESWT are relatively safe and effective in the treatment of GTPS. More multicenter high-quality randomized clinical trials with large sample sizes are still needed in the future to provide further evidence.

Primary Repair of Peroneus Longus Myofascial Herniation With Symptomatic Superficial Peroneal Nerve Compression

Symptomatic myofascial herniations of the extremities occur infrequently; however, they can contribute to significant pain, weakness, and neuropathy with activity. Muscle herniation typically occurs through either a traumatic or congenital focal defect in the deep overlying fascia. Patients may present with an intermittently palpable subcutaneous mass and may have neuropathic symptoms, depending on the degree of nerve involvement. Patients are initially treated with conservative modalities, whereas surgery is reserved for patients who demonstrate persistent functional limitations and neurologic symptoms. Here, we demonstrate a technique for primary repair of a symptomatic lower-leg fascial defect.

Effect of Food Matrix, Cooking and Preservation Modalities on the Outgrowth of Bacillus cereus Spores in Some Starchy Foods

Aim: Starchy products are very important in the fight against food insecurity in developing countries, where they are widely consumed. This study is aimed to assess the impact of cooking and storage methods on the spoilage of some cooked starchy products by spore-forming bacteria&#x0D; Place and Duration: Department of Microbiology of the University of Yaoundé I betweenJune 2020 and September 2022&#x0D; Methodology: In order to better understand the alteration of these foods by spore-forming bacteria, a survey was carried out among some households and restaurant owners in the city of Yaoundé to determine the cooking and preservation methods for cassava, maize and rice couscous. Then, cooking parameters and conservation modalities from the survey were simulated in the laboratory in order to assess the deactivation kinetics of Bacillus cereus.&#x0D; Results: It emerged from this experiment that cooking time varies according to the foodstuffs, the most important being maize. The packaging is mainly done in non-food plastic bags, and the thermos is used more often than the fridge and the pot. Cassava flour was more contaminated in aerobic spore (1.105 spores/g) than maize and rice (5.103 and 9.103 spores/g) after cooking of different starchy food enriched with Bacillus cereus spores, their inactivation was more important in rice followed by cassava and maize couscous as indicated by the Weibull scaleparameters which were respectively 1.1; 0.52 and 0.08. It was also noted that increase in cooking time also reduced the time for spores to initiate outgrowth and this time was affected by the type of flour. These two parameters also affected the time of spore outgrowth to 5logufc/g.&#x0D; Conclusion: Storage in the fridge is still the best way to store food, but the thermos flask is more often used. The use of electric thermostats set at temperatures around 60°C would increase the optimal shelf life and significantly reduce the risk of spoilage and foodborne illness.

The outcome of ponseti method for the treatment of clubfoot; a systematic review

Clubfoot is one of the most common congenital orthopedic disorders that is characterized by four structural deformities. The treatment of clubfoot could be conservative or surgical; however, conservative modalities should be the initial option for the management of clubfoot. Ponseti method is a conservative modality. Thus, this review was conducted to assess the outcomes of the ponseti method in the treatment of clubfoot by reviewing the previous studies conducted on this subject. Google Scholar and PubMed databases were explored for scientific articles using different keywords, including &amp;quot;clubfoot, treatment, management, outcomes and ponseti method.&amp;quot; Original articles focused on the treatment of clubfoot by the ponseti method that were in English and available full-text articles were eligible for the analysis. After refining the findings, only nine articles were found eligible as per the inclusion criteria. The nine studies included a total number of 884 children. It was found that children were suffering from idiopathic clubfoot, neglected clubfoot, idiopathic and flexible clubfoot, complex clubfoot, or undefined clubfoot. Ponseti method is found effective and safe for the management of clubfoot, even for neglected clubfoot in older children with few complications and decreased rate of relapse.

Prevalence, Management and Outcomes of Enterocutaneous Fistulas in Buea Regional Hospital and Laquintinie Hospital of Douala. A Five Years Retrospective Study

Background: An Enterocutaneous fistula (ECF) is an abnormal connection between the intestinal tracts or stomach and the skin. They are a major catastrophe to the patient and surgeons and still have a high incidence of morbidity and mortality which varies between 6% - 33%; their management remains a big challenge. These patients frequently face complications, and a well-organized multidisciplinary approach must be implemented in their management to improve outcomes. Objectives: Our study aims to assess the prevalence, management and outcomes of enterocutaneous fistulas in Buea regional hospital and Laquintinie hospital of Douala over the past 5 years. Methods: This was a hospital-based retrospective study in Buea regional hospital and Laquintinie hospital of Douala. Records of patients who had enterocutaneous fistulas within the period of 1st January 2017 to 31st December 2020 in the surgical departments. Data included demographics, pre-operative diagnosis, comorbidities, type of fistula, management modality and means, the indication of operative treatment, length of stay in the hospital and outcomes. Data was analysed using SPSSv26. Results: The study constituted 1343 medical records of which 83 medical records of patients with enterocutaneous fistulas, giving a prevalence of 6.2%, female predominance at 59% (n = 49), 42.2% (n = 35) were referred cases from the periphery for better management. A vast majority (96.4%) occurred as post-operative complications with appendectomy the most common indication (18.8%). High output fistulas were predominant (43.4%). 59% (n = 47) were managed medically, 6% (n = 5) received both conservative and surgical modalities while 35% (n = 5) were managed surgically. 64.1% (n = 50) were placed on enteral nutrition while 35.9% (n = 28) were placed on parenteral nutrition. Peritonitis/infection 50% (n = 18) was the commonest indication of surgical treatment, followed by failure of medical treatment 25% (n = 9) then high output fistulas 16.7% (n = 6). Resection with end-to-end anastomosis was the preferred repaired work at 61% (n = 22). The mortality rate was 38.5% (n = 32), 29% (n = 24) healed after conservative treatment, 21.7% (n = 18) healed after surgery, 7.2% (n = 6) persisted after surgery while 3.6% (n = 3) persisted after conservative treatment. Anaemia, sepsis, electrolyte imbalance, dehydration and malnutrition were the commonest complications. Conclusion: The prevalence of enterocutaneous fistulas was high, with a female predominance and a mean age of 38 years. Most cases were seen as a referral from the periphery for better management. The greatest majority of fistulas occurred as a postoperative complications. Conservative management with enteral feedings was preferred, they had better outcomes and gave more chances of healing. The commonest indication of surgical treatment was an infection. Resection with end-to-end anastomosis was the preferred repaired work. The mortality rate was high, and anaemia, sepsis and electrolyte imbalance were the commonest complications.

Efficacy of Occlusal Splints and Low-Level Laser Therapy on the Mandibular Range of Motion in Subjects with Temporomandibular Joint Disc Displacement with Reduction.

The study was carried out to evaluate the efficacy of four conservative therapeutic modalities on the mandibular range of motion (MRM) in subjects with anterior disc displacement with reduction (ADDwR) of the temporomandibular joint (TMJ). One hundred patients (64 women and 36 men) were selected, and randomly distributed into four groups. Group I: Subjects receiving behavioral therapy (BT). Group II: Subjects receiving low-level laser therapy (LLLT). Group III: Subjects receiving maxillary anterior repositioning splint (MARS). Group IV: Subjects receiving stabilization splint (SS). The MRM was evaluated for each patient before treatment and after 6 months. Paired t test and one-way analysis of variance (ANOVA) tests were used for statistical analysis followed by a post hoc Tukey test (P ≤ 0.05). All groups showed significant improvement in MRM after 6 months of treatment (P ≤ 0.05) except for BT. There was a significant improvement for SS and MARS on the different movements of MRM, more than for LLLT and BT (P ≤ 0.05). The MARS and the SS are effective in increasing the MRM for patients with ADDwR.

Paediatric Appendicitis: Has SARS-COV-2 Influenced the Clinical Profile and Management during the Pandemic Period?

Introduction: The Coronavirus Disease-2019 (COVID-19) had profound repercussions on routine medical practices all over the globe. There are fewer studies on the impact of the pandemic on childhood surgical conditions like Acute Appendicitis (AA), which is the most common paediatric surgical emergency. Aim: To analyse whether COVID-19 has influenced the clinical profile and management of paediatric appendicitis during the pandemic period. Materials and Methods: A retrospective study was carried out in the Department of Paediatric Surgery, SAT Hospital, Government Medical College, Thiruvananthapuram, Kerala, India, comparing AA cases during the pandemic period (group A=from February 2020 to January 2022) with AA cases during the prepandemic period (group B=from February 2018 to January 2020). Analysis of data regarding patient demographics (age, sex), duration of symptoms and hospital stay, type of appendicitis, total and differential leucocyte count, ultrasonographic findings, treatment modality and complications was done. Subgroup analysis of children in group A was done by comparing AA cases with active/recent COVID-19 infection (Subgroup A1) with the rest of AA in the group (Subgroup A2). Pearson’s Chi-square test was used for the analysis of categorical variables and independent t-test was used for numerical data. p-value&lt;0.05 was considered significant. Results: There were 826 AA cases, with 375 children in group A and 451 in group B. A significant reduction in the number of AA cases was noted during the first year of the pandemic (n=167 vs n=242, p-value=0.009) and a significantly higher number of cases were managed conservatively during the pandemic period (n=48 vs n=10, p-value &lt;0.0001). Children with active/ recent COVID-19 infection presented late (p-value=0.03), had a significantly higher incidence of complicated appendicitis (p-value=0.02), decreased total leucocyte count (p-value=0.01), decreased polymorph count (p-value=0.02) and higher incidence of the conservative modality of treatment (p-value&lt;0.005). Conclusion: Overall, there were no significant differences in the clinical profile of AA during the pandemic period. But, children with AA who had active/recent COVID-19 infection had a longer duration of symptoms and a higher incidence of complicated appendicitis. The pandemic influenced the management protocols with an increase in the number of AA cases being managed conservatively when compared to the prepandemic period.

Management of Acute Anal Fissure at a Tertiary Care Hospital in West Bengal, India- A Longitudinal Study

Introduction: Anal fissure is a tear in the lining of the anus and is a common problem throughout the world. It is one of the most common painful and benign conditions of the anal region, which leads to morbidity and decrease in quality of life. Aim: To prospectively observe the outcomes of management of acute anal fissure, both surgically and conservative modalities of treatment. Materials and Methods: This longitudinal study constituted patients clinically presenting with features of acute anal fissure such as pain, bleeding, constipation attending Out Patient Department (OPD) in College of Medicine and JNM Hospital, West Bengal, India, from January 2020 to June 2021. Patients were grouped according to modalities of treatment given (surgical/conservative), after that regular follow-up was done at regular intervals to find out outcome of treatment, with respect to relief of pain, bleeding, healing rate, fissure relapse and incontinence. Chi-square test was used to compare the proportions and independent t-test was used to compare means. The p-value of &lt;0.05 was considered to be statistically significant. All the analysis was done in IBM Statistical Package for the Social Sciences (SPSS) version 22.0. Results: In the current study, 9 (8.8%) patients had anterior anal fissure and 93 (91.2%) patients had posterior anal fissure. Fifty one patients (50.0%) underwent medical management {(nifedipine 2% gel locally, diltiazem (2%) locally)} and 51 patients (50.0%) were treated with surgical management (lateral internal sphincterectomy). Significant difference was noted at 15th, and 30th and 45th days post-treatment when surgically managed patients were compared with medically managed patients p-value &lt;0.05*. Four patients in the medically managed group, had bleeding during the entire period. Association of Bleeding at 15th day, 30th day, 45th day and 6th month with mode of management was statistically significant (p&lt;0.05*) healing was achieved for 90 patients (88.2%) at the end of 6th month follow-up. In medical management, 9 (17.6%) patients had fissure relapse. In surgical management, 3 (5.9%) patients had fissure relapse p&gt;0.05. Conclusion: In the present study, though patients in both surgical and medical groups had pain relief, those who underwent surgery had better result. Majority of the patients in the study achieved remission, at the end of sixth month follow-up, irrespective of the type of management. Relapse of the disease was slightly more in medically managed group, compared to those, who underwent surgical management.

Conservative Algorithm for the Treatment of Locally Aggressive Tumors: A Retrospective Study.

Aggressive benign odontogenic neoplasms are a group of lesions that have the potential to grow to an enormous size resulting in bony deformities, locally aggressive behavior and have high recurrence rate. Ameloblastomas, keratocystic odontogenic tumors, etc., are included under this group of lesions. Treatment of these lesions is challenging owing to their particular characteristics including high recurrence rate, locally aggressive behavior, etc. A retrospective study was conducted in 40 patients who had undergone enucleation and open packing as treatment for benign aggressive neoplasms in the department of oral and maxillofacial surgery. In the study, all the cases were followed up for a minimum of 5years clinically and radiographically. Satisfactory bone healing was noted with no evidence of recurrence in all cases. Enucleation followed by open packing with iodoform is an excellent conservative modality with proven minimal rate of recurrences in 5-year period.

Chronic low back pain comorbidity count and its impact on exacerbating opioid and non-opioid prescribing behavior.

The objective of the study was to determine the characteristics of chronic low back pain (CLBP) comorbidity and its impact on opioid and non-opioid treatments among Chicagoland patients with CLBP. A retrospective cross-sectional study comparing differences in comorbidity and treatment patterns among Chicagoland patients with CLBP against a matched control arm without chronic low back pain (NCLBP). Academic hospital system outpatient services. Using the International Classification of Diseases, 10th Revision codes (ICD 10) 9589 patients were identified with CLBP with a median age of 57 years old and 62.32% female distribution. The NCLBP group comprised 9589 age-, sex-, race-, and region-matched patients. An increased prevalence across all 17 studied comorbidities was found in CLBP patients as compared to NCLBP patients. CLBP patients carried an average of 3.5 comorbidities compared with 2.4 comorbidities in NCLBP patients. Rheumatoid arthritis (RA), joint arthritis, and obesity had the strongest relationship with CLBP. Additionally, we found that the most prescribed treatment for CLBP were opioids, which ranked above NSAIDs and physical therapy. 56% of CLBP patients were prescribed opioids as compared to 36% of NCLBP patients (Odds Ratio=2.28, 95% CI: 2.16-2.42). Tramadol was the agent with the strongest relationship to CLBP. CLBP patients were more likely to use two or more opioids concomitantly. The number of total treatments was positively associated with the number of comorbidities in both CLBP and NCLBP patients (Cochran-Armitage trend test p < 0.0001). Chronic low back pain patients showed a higher number of comorbidities than their NCLBP counterparts. Comorbidity count trended positively with higher treatment burden with opioids being the most prescribed treatment, often with poly-opioid use, over conservative modalities such as NSAIDs and physical therapy.

A correlation of demographic characteristics, preoperative conservative therapy and timing with postoperative outcome in herniated disc-associated cauda equina syndrome: Do they really matter?

Aim To examine a correlation of demographic characteristics of patients, preoperative modality of conservative therapy and timing on the postoperative outcome of patients six months after the operation. Methods A retrospective, non-randomized, clinical study involved 48 patients of different age and gender with a verified diagnosis of cauda equina syndrome (CES). The inclusion criteria were patients with CES caused by discus hernia. Observed research variables were age, gender, affected vertebral level, conservative modalities of perioperative therapy (nonsteroidal anti-inflammatory drugs - NSAIDs and physiotherapy), duration of symptoms, and outcome parameters (motor and sensory function, sphincter function of the urinary bladder and bowel). Results A statistically significant negative correlation was found between age and postoperative outcome (p<0.05). The affected vertebral level was positively correlated with the motor and sensory outcome (p<0.05). A positive correlation between the use of NSAIDs and the outcome was found (R=0.570; p<0.001), as well as a negative correlation with perioperative physiotherapy (R=-0.201; p= 0.001). Postponement of surgery was negatively correlated with outcome variables (p<0.001). Conclusion The results of the study bring new conclusions that were not previously observed. Possible new characteristics associated with the outcome of cauda equina syndrome were determined.

Effectiveness of conservative therapeutic modalities for temporomandibular disorders-related pain: a systematic review

Purpose The aim of this systematic review was to evaluate the effectiveness of conservative different therapeutic modalities for temporomandibular disorders (TMD) pain. Materials and methods An electronic systematic search was conducted in the MEDLINE (PubMed) database to identify the randomized clinical trials (RCTs) published between 2001 and 2021. The following, simple or multiple conjunctions, search keywords were selected: TMD pain, TMD management or conservative treatment or treatment strategies and TMD pain, therapeutic modalities or interventions and TMD. Studies included must have patients older than 18 years, with painful TMD, which diagnosis was performed by Research Diagnostic Criteria for TMD or Diagnostic Criteria for TMD. Outcome variables were pain relief and post treatment pain intensity reduction. Data were analysed with non-parametric tests and the level of significance was set at p<.05. Results Out of 1599 articles obtained, 28 RCTs fulfilled all selection criteria and were included. The results of this study show that there was a significant decrease in short-term post-treatment TMD pain with the use of occlusal splint alone or in combination with other therapeutic modalities when compared with the control group. Statistically significant differences were also detected between laser and photobiomodulation group and the control, in short-term treatment TMD-related pain. Conclusions The primary findings of the present systematic review showed that the occlusal splint alone or combined with other therapeutic intervention presented positive effect on short-term TMD pain reduction. Secondary outcome suggests that laser and photobiomodulation therapy had, also, a significant role in short term pain relief.

Non-CPAP therapy for obstructive sleep apnoea.

To outline recommendations concerning the proper management of obstructive sleep apnoea (OSA) patients that cannot be treated adequately with continuous positive airway pressure (CPAP) due to intolerance, poor adherence or compliance, or CPAP refusal.To provide information about the selection of appropriate patients for alternative non-CPAP treatment options.To better understand the different aspects of OSA treatment with noninvasive approaches, such as oral appliances, positional therapy, drug treatment and myofunctional therapy, including indications, contraindications, and expected short- and long-term results.To discuss the different surgical options for the treatment of OSA and to provide information on the important issue of proper patient selection for surgery, as most OSA surgical outcomes are associated with the pre-operative assessment of the level(s) of upper airway collapse.

P58. Patterns of comorbidities and medical treatment in patients with chronic low back pain in Chicagoland

P58. Patterns of comorbidities and medical treatment in patients with chronic low back pain in Chicagoland

Use of Virtual Reality-Based Therapy in Patients with Urinary Incontinence: A Systematic Review with Meta-Analysis.

It is estimated that over 400 million people worldwide experience some form of urinary incontinence (UI). Pelvic floor muscle training (PFMT) is commonly used in cases of urine loss. Game therapy (GT) has been suggested as a new conservative modality for UI treatments. GT represents a form of virtual reality (VR) that allows users to interact with elements of a simulated scenario. The purpose of this review was to assess the potential of using VR-based PFMT in the treatment of UI with a particular focus on the impact of this form of therapy on the patients’ muscle function, symptoms of UI and quality of life (QoL). The following electronic databases were searched: PubMed, Embase, Cochrane Library, Scopus and Web of Science. Systematic review methods were based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Electronic medical databases were searched from inception to 28 January 2021. From a total of 38 articles, 26 were analyzed after removing duplicates, then 22 records were excluded according to inclusion criteria and 4 were assessed as full texts. Finally, 2 randomized controlled trials (RCT) with 79 patients were included. For the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), the meta-analysis showed a significant difference in favor of the control condition (MD = 2.22; 95% CI 0.42, 4.01; I2 = 0%). Despite the popularity of the use of VR in rehabilitation, we found a scarcity of literature evaluating the application of VR in the field of UI therapy. Only one study matched all of the criteria established. The effects of VR training improved PFM function and QoL; however, these changes were comparable to those of traditional PFMT. It is not possible to reach final conclusions from one study; thus, further development of VR interventions in the field of UI treatments are needed.

Relationship of isotopic variations with spring density in the structurally controlled springs and related geosystem services in Alaknanda Valley, Garhwal Himalaya, India

As a traditional water source, springs are vital for Himalayan communities and it is essential to consciously focus on springs conservation. We report oxygen isotopes (δ18O) of spring water before, within, and after the tectonically active zones of the Alaknanda Valley, Uttarakhand. Higher variation of δ18O in the spring waters is found in highly tectonically disturbed zone i.e., Zone-2 with δ18O range − 4.9‰ to − 9.0‰ compared to tectonically less disturbed zones: Zone-1 and Zone-3 with δ18O value range − 7.9‰ to − 9.9‰ and − 7.4 to − 10.2‰ respectively. We hypothesize that the highly active thrust zones (Zone-2) with increased permeability compared to other Zones, manifested as greater spring density, results in higher water recharge in Zone-2. Very high to high spring density stretches are dominant in Zone-2 compared to Zone-1 and Zone-3. Stretches in Zone-2 with high spring density formed due to its highly tectonically active nature leads to the higher isotopic variation in Zone-2. The study also identifies the geosystem services provided by thrust zones as water resources to the local people and need of conservation modalities to manage the spring water resources in the thrust zones.

Open Versus Laparoscopic Surgical Management of Rectus Diastasis: Systematic Review and Pooled Analysis of Complications and Recurrence Rates.

Rectus diastasis (RD) is defined as widening of the linea alba and laxity of the abdominal muscles. It can be treated via a wide array of both conservative and surgical modalities. Due to the quickly evolving nature of this field coupled with the multiple novel surgical modalities described recently, there is a need for an updated review of surgical techniques and a quantitative analysis of complications and recurrence rates. A systematic review of PUBMED and EMBASE databases was preformed to retrieve all clinical studies describing surgical management of RD. Pooled analyses were preformed to assess recurrence and complication rates after both open and laparoscopic RD repairs (after controlling for herniorrhaphy). A total of 56 papers were included in this review. In patients who underwent both an RD and a herniorrhaphy, there was no significant difference in recurrence rates between open (0.86%) and laparoscopic repairs (1.6%) (p > 0.05). Similarly, in patients who underwent RD repair without a herniorrhaphy, there was no significant difference in recurrence rates between open (0.89%) and laparoscopic repairs (0%) (p > 0.05). The most common complications reported were seroma, skin dehiscence, hematoma/post-operative bleeding, and infection. After controlling for a herniorrhaphy, there were no significant difference in total complication rates between open and laparoscopic RD repair. The total complication rates in patients who underwent an open RD repair with a herniorrhaphy were 13.3% compared to 14.5% in patients who underwent laparoscopic repairs (p > 0.05). Similarly, the total complication rates in patients who underwent RD repair without a herniorrhaphy were 11.8% in patients who underwent open repairs compared to 16.2% in their counterparts who underwent laparoscopic repairs (p > 0.05). Both open and laparoscopic approaches are safe and effective in repairing RD in patients with and without concurrent herniorrhaphy. Future research should report patient reported outcomes to better differentiate between different surgical approaches.