Mean Initial Score Research Articles

4DryField vs. hyalobarrier gel for preventing the recurrence of intrauterine adhesions – a pilot study

Introduction This was a single-center pilot study that sought to describe an innovative use of 4DryField® PH (premix) for preventing the recurrence of intrauterine adhesions (IUAs) after hysteroscopic adhesiolysis in patients with Asherman’s syndrome (AS). Material and methods Twenty-three patients with AS were enrolled and 20 were randomized (1:1 ratio) to intrauterine application of 4DryField® PH (n = 10) or Hyalobarrier® gel (n = 10) in a single-blind manner. We evaluated IUAs (American Fertility Society [AFS] score) during initial hysteroscopy and second-look hysteroscopy one month later. Patients completed a follow-up symptoms questionnaire three and reproductive outcomes questionnaire six months later. Results The demographic and clinical characteristics, as well as severity of IUAs, were comparable in both groups. The mean initial AFS score was 9 and 8.5 in the 4DryField® PH and Hyalobarrier® gel groups, respectively (p = .476). There were no between-group differences in AFS progress (5.9 vs. 5.6, p = .675), need for secondary adhesiolysis (7 vs. 7 patients, p = 1), and the follow-up outcomes. Conclusion 4DryField® PH could be a promising antiadhesive agent for preventing the recurrence of IUAs, showing similar effectiveness and safety to Hyalobarrier® gel. Our findings warrant prospective validation in a larger clinical trial. Clinical trial registry number ISRCTN15630617

Singing Voice Handicap Index-10 Minimal Clinically Important Difference: A Prospective Determination.

The Singing Voice Handicap Index-10 (SVHI-10) is a validated patient-reported outcome measure (PROM) that assesses patients' perception of handicap related to singing voice. A normative value has been established with a score ≥20 being abnormal. However, there is no defined minimal clinically important difference (MCID). This study prospectively determines the MCID of SVHI-10 among a diverse group of singers. 103 adult singers with and without voice complaints completed SVHI-10 twice, 30 days apart. MCID for the SVHI-10 was determined using distribution-based receiver-operating characteristic (ROC) curve analysis. Twenty-two men (1 transgender), 75 women (1 transgender), and 6 nonbinary individuals participated. The most frequently reported singing genres were classical (44.7%), musical theater (17.5%), and pop (10.7%). Mean initial SVHI-10 score was 13.05 (standard deviation 7.397), and mean follow-up SVHI-10 was 13.13 (7.994). There was a significant positive correlation between initial and follow-up SVHI-10 scores (r = 0.879, p < 0.001). SVHI-10 scores were significantly higher among participants who reported voice changes in the past year (p < 0.001) or sought voice treatment (p = 0.001) compared with participants who did not. SVHI-10 scores varied significantly based on singing type. The area under the ROC curve for SVHI-10 was 0.700 (p = 0.003). The SVHI-10 MCID was determined to be 9.5. An SVHI-10 score change ≥10 should be considered clinically meaningful. This definition has been missing from the literature and will improve understanding of patients' responses to treatment, which will help advance clinical care and track research outcomes. 4 Laryngoscope, 2024.

Evaluation of the impact of short term manual small incision cataract surgery (MSICS) training program on trainees with varying prior surgical experience using international council of ophthalmology-ophthalmology surgical competency assessment rubrics (ICO-OSCAR).

To assess the learning curve of MSICS in three different groups of trainees with varying prior MSICS experience. To evaluate the effectiveness of ICO OSCAR for objective assessment of surgical skill transfer. Ninety-five MSICS trainees were divided into three groups as 1st year resident, fellow and external trainee. Each group were evaluated for their surgical skill acquisition during one month MSICS training program using ICO-OSCAR. Each trainee performed an average of 19 surgeries. The progress in the learning curve of the three groups of trainees was analyzed by evaluating the mean scores in sets of five consecutive cases. Complications during the training period were also noted. The study evaluated a total of 1842 cases. The fellows and external trainees, with prior MSICS experience, had an initial mean score of 57.57 ± 16.16 and 56.86 ± 17.82 respectively, whereas the 1st year resident group had a relatively low initial mean score of 45.91(p = 0.009). The difference in mean scores between the 1st year resident group and other groups significantly reduced towards the end of training. The most common complications made by 1st year residents were in sclero-corneal tunnel construction. The external trainee group had statistically significant higher rates of zonular dialysis in the study. ICO-OSCAR is an effective tool for assessing MSICS training program. Structured short term MSICS surgical training program is effective in surgical skill transfer, especially in novice surgeons.

The impact of MELD exception points for hydrothorax on posttransplant mortality: a propensity score-matched analysis.

Hepatic hydrothorax is a challenging complication of end-stage liver disease, and.patients with this complication can receive model for end-stage liver disease (MELD) exception points if they meet specific criteria as defined by United Network for Organ Sharing (UNOS). This research aimed to analyze the effect of receiving MELD exception points for hepatic hydrothorax on posttransplant mortality, using a national transplant database. Patients >18 years in the UNOS database awaiting liver transplant between 2012 and 2023 were identified based on their petition for MELD exception points. Using a 1: 1 propensity score-matched analysis, 302 patients who received MELD exception points for hepatic hydrothorax were compared with 302 patients who did not receive MELD exception points.Demographic, clinical and laboratory values were compared. The primary outcome was posttransplant mortality. Multivariate logistic regression controlled for potential confounders. No significant difference was observed in mean age (58.20 vs 57.62 years), mean initial MELD score (16.93 vs 16.54), or mean Child-Pugh score (9.77 vs 9.74) in patients with hepatic hydrothorax receiving MELD exception points versus their matched cohort who did not recieve exception points. The proportion of males was slightly higher among patients who received MELD exception points (57.6% males vs 53.6% males). A majority of patients in both groups had Child-Pugh grade C (>56%). Patients receiving MELD exception points for hepatic hydrothorax had a statistically significant 44% decrease in the odds of posttransplant death compared to those who did not (OR 0.56; 95% CI 0.37-0.88; P = 0.01). Among the combined cohort, each year increase in age resulted in a 3.9% increase in mortality (OR 1.04; 95% CI 1.01-1.07; P = 0.005), and every one-unit increase in serum creatinine resulted in a 40% increase in mortality (OR 1.40; 95% CI 1.03-1.92; P = 0.03). Receiving MELD exception points for hepatic hydrothorax is associated with a significant reduction in the odds of posttransplant mortality. These findings underscore the importance of MELD exception points for hepatic hydrothorax among patients with decompensated cirrhosis, potentially improving patient prioritization for liver transplantation and influencing clinical decision-making.

Successful treatment of diplopia using prism correction combined with vision therapy/orthoptics improves health-related quality of life.

To track improvement in diplopia symptoms with strabismus-specific health-related quality of life (HRQOL) questionnaire across a treatment consisting of prism correction followed by vision therapy/orthoptics when prism treatment alone has not succeeded. Forty-eight participants with diplopia and a mean age of 62.45 were asked to complete an Adult Strabismus-20 (AS-20) questionnaire and a Diplopia Questionnaire (DQ) before and after prism correction. Inclusion criteria were diplopia reported on the DQ as "sometimes", "often" or "always" at reading or straight-ahead distance. The prism correction was classified as successful if the participant reported "never" or "rarely" on the DQ for reading and straight-ahead distance; and unsuccessful if the perceived diplopia worsened or remained the same. For all participants, mean initial AS-20 scores were compared with mean post-prism correction scores, taking into account AS-20 subscales (reading and general functions, and self-perception and interaction). Participants in the failed prism treatment subgroup subsequently underwent a programme of vision therapy wearing their prism correction, the results of which were again determined by participants' responses on the AS-20 questionnaire, completed before and after the vision therapy. Five of the 48 participants dropped out of the study. Prism correction was classified as successful in 22 of 43 participants (51%), and unsuccessful in 21 (49%). Those participants for whom the prism correction was classified as a success showed a statistically significant improvement (p = 0.01) in both reading and general functions. In the failed treatment subgroup, no significant change in AS-20 score was recorded for any of the domains (p = 0.1). After treatment with vision therapy/orthoptics, however, 13 of the 20 participants in the unsuccessful prism correction subgroup (one of them dropped out the study) achieved binocular vision and statistically significant improvement in reading and general functions (p = 0.01). Although effective prism correction of diplopia is correlated with enhanced HRQOL, prism correction alone is frequently not sufficient to achieve this objective. In these cases, vision therapy/orthoptics treatment as a coadjutant to prism correction is shown to improve HRQOL.

Implementation of robot-assisted lymphaticovenous anastomoses in a microsurgical unit

BackgroundNumerous papers have been published evaluating the clinical benefits of robot-assisted microsurgery. In this study, we describe the incorporation of the MUSA-2 robot (Microsure, Eindhoven, The Netherlands) into a plastic surgery unit outside of its development centre. We aimed to assess robot implementation timeframes, areas of future development, and key learning points for centres considering the establishment of a robot-assisted microsurgery service.MethodsWe identified 12 female patients with upper limb lymphoedema secondary to breast cancer treatment, who consented to have a robotic-assisted lymphaticovenous anastomosis (LVA) from September 2022 to March 2023. All patients had at least one robot-assisted LVA. Post operatively, a surgical evaluation of the robot’s performance and of the surgeon’s intraoperative workload was measured. Each patient completed a postoperative Likert scale, which measured their surgical experience.ResultsThe mean robot time per case was 60.25 min. The mean time taken for the first robot-assisted anastomosis was 32 min. The second robot anastomoses was 30% faster than the first, taking a mean of 22.5 min. The average anastomosis had 4.5 sutures placed robotically. Initial mean scores in the workload survey completed by the surgeon were highest for frustration and effort, both reduced with increasing volume of cases. In 91% of cases, physical intraoperative discomfort was reported by the surgeon but completely resolved following repositioning.ConclusionsThe current technology can be readily incorporated into a microsurgical unit. We developed four key learning points from the implementation of robot-assisted LVA in our microsurgical unit.Level of evidence: Level IV, risk/prognostic study

Diagnostic Efficacy of SOFA Score in Predicting Outcome and Mortality: An ICU Experience from Pakistan

Objective: To determine the cut-off value of Sequential Organ Failure Assessment score at the time of admission in Intensive Care Unit to predict mortality and outcome in critically ill patients.&#x0D; Materials and Methods: This cross-sectional, descriptive study was undertaken at Intensive Care Unit of Rawalpindi Teaching Hospital, Rawalpindi, Pakistan between April and August 2023. SOFA score of all critically ill patients at the time of admission in ICU and their outcome (expired or discharged) was recorded. Receiver Operator Characteristics Curve (ROC) was drawn for SOFA score and mortality. Cut off value for SOFA score was calculated. Outcome of patients above and below the cut off value for SOFA score was studied using Chi-square test.&#x0D; Results: A total of 100 patients (54% females and 46% males) were included in the study with mean patient age of 68.93±11.09 years. Out of 100 patients, 48 (48%) improved and 52 (52%) expired. The Mean initial SOFA score was 5.44±3.99 in patients who improved and 9.91±4.20 in patients who expired. Coordinates of the ROC curve showed that SOFA score cut off value 7.5 had best corresponding sensitivity (0.777) and specificity (0.740). The patients were categorized to Group I (SOFA score ≤7), and Group II (SOFA score ≥8). 34.04% of the Group I and 75.47% of the Group II patients expired (p-value 0.0000001)&#x0D; Conclusions: Mortality was higher in patients who had higher SOFA score at the time of admission in Intensive Care Unit. At admission SOFA scores (≤7 and &gt;8) are best predictor of outcome in critically ill patients.

Changes in visual acuity and quality of life following lens surgery in Alport syndrome

Aims/Purpose: Alport syndrome can have ocular features, including anterior lenticonus, which affects vision and quality of life. We explored visual acuities and vision‐related quality of life, as quantified using the National Eye Institute 25 item Visual Functioning Questionnaire (VFQ‐25), in a cohort of patients before and after lens exchange surgery.Methods: Patients with genetically confirmed Alport syndrome were recruited for an ocular phenotyping study, and completed the NEI‐VFQ25 (a validated visual function questionnaire, yielding a total score out of 100). Patients with lenticonus were offered lens exchange surgery. Best recorded visual acuities before and after surgery were collated, and converted to logMAR for analysis. Changes in quality of life were ascertained by comparing scores obtained before, and some time after, surgery.Results: Five patients (10 eyes) underwent lens exchange surgery for lenticonus. All were male; mean (SD) age at first eye surgery was 43 (8.5) years. For right eyes, mean (SD) pre‐ and post‐operative logMAR visual acuities were 0.31 (0.28) and 0.05 (0.10), respectively. For left eyes, these were 0.23 (0.11) and 0.02 (0.10), respectively. Median pre‐op acuities were 0.30 and 0.18 for right and left eyes, respectively; median post‐operative acuities were 0.03 and 0.00, respectively. Median improvements were 0.2 and 0.18 for right and left eyes, respectively. Taking all eyes together, the improvement seen following surgery was significant (p = 0.001). Four of the five patients completed the VFQ25 before and after surgery. Initial and final mean (SD) scores were 68.5 (13.7) and 94.1 (4.9), respectively, with a significant difference seen (p &lt; 0.05).Conclusions: Objective improvement in best‐recorded visual acuity was seen in this cohort of patients. Anterior lenticonus was shown to have an adverse effect of vision‐specific quality of life, with improvement demonstrated following lens exchange surgery.

Prism adaptation treatment improves spatial neglect after severe traumatic brain injury: A case series.

Spatial neglect (SN) after traumatic brain injury (TBI) is common, hindering rehabilitation progress and functional outcomes. Most research has focused on SN treatment after stroke with few published instances of post-TBI SN treated using prism adaptation treatment (PAT) in inpatient rehabilitation. This case series characterizes the dose, after-effect, and treatment response of PAT in patients with SN after severe TBI. Six patients exhibiting severe (n = 2), moderate (n = 2), or mild (n = 2) SN after severe TBI received 5 to 10 PAT sessions during their inpatient rehabilitation stay. Functional improvement in SN was measured by the Catherine Bergego Scale (CBS). Patients presented with a mean initial CBS score of 16.8 (range: 8.8-24.3). Prism after-effect was present after PAT. Following 5-10 sessions, the mean CBS score improved by 11.6 points to 5.2 (range: 7.8-21.8); the change in initial versus final CBS scores was significant (P = 0.031). This study is the first to demonstrate prism after-effect and functional SN improvement in individual patients with TBI. Patients showed a clinically meaningful improvement in mild, moderate, and severe SN following 5 to 10 PAT sessions. Additional studies are needed to assess tolerability, benefit, and optimal PAT dose for SN after TBI.

Implementation of a visual aid to improve disease comprehension in patients with new breast cancer diagnoses.

358 Background: Studies have shown that patients with new cancer diagnoses are overwhelmed due to the large amount of information presented at their initial oncology visit. Inability to meet these high informational demands has been associated with poorer outcomes. Most patient education is done verbally despite data showing that patients only retain 14% of verbal communication compared to 85% of information with visual aids. The aim of this study was to determine if implementation of a visual educational tool on breast cancer diagnosis and treatment would improve comprehension in patients with new diagnoses. Methods: We designed an educational tool to visually depict breast cancer subtype, stage, and treatment plan. We recruited English-speaking patients with new diagnoses of breast cancer who were seen for an initial oncology visit at the Mount Sinai Dubin Breast Center. Patients were randomized to receive the visual aid (intervention) or continue with standard-of-care (control). For patients randomized to the intervention arm, the oncologist used the visual aid to provide education on their diagnosis and treatment plan during the visit. All patients completed a survey at their initial visit and approximately 1 month after diagnosis. The survey included demographic information, patient preferences, and assessment of their understanding of diagnosis and treatment. The worksheet and surveys were piloted with 5 patients with breast cancer and modified based on their feedback. A knowledge score was calculated based on their survey responses with scores ranging from 2 (low knowledge) to 6 (all questions answered correctly). We utilized paired t-test to compare the means of knowledge scores at initial visit and 1 month follow up. Results: Twenty female patients were enrolled from 2022-2023 with a median age of 61 years. Ten patients were randomized to the intervention arm and 10 to the control arm. The initial mean knowledge score of the control group was 4.9 and the follow up mean score was 5.6 (P = 0.11). The initial mean score of the intervention group was 5.3 whereas the follow up mean score was 5.6 (P = 0.84). There was no significant difference between the intervention group and the control group (P = 0.944). An increase in overall scores was noted from initial to follow up survey in all groups. There was a complete elimination of all low scores (&lt; 3) across both groups in the follow up survey. Conclusions: Education at the initial visit improves understanding of breast cancer diagnosis and treatment. Our study demonstrated a standardized informational tool did not improve understanding when compared to individualized teaching with their oncologist. However, our study was limited to a single breast cancer center with a small sample size and English-speaking patients. Next steps include translation of the educational tool into additional languages, as well as expansion of this study to a larger patient population.

USING COOPERATIVE LEARNING MODEL WITH PEER TUTORS TO IMPROVE UNDERGRADUATE STUDENTS' READING ACHIEVEMENT

This research is aimed to improve students' reading achievement by implementing cooperativelearning with peer tutors in the learning process. The subjects of this research were the students of XI MIPA 1of SMA Negeri 1 Pupuan studying reading in the English subject in academic year 2022/2023. The data of thisresearch were collected using a reading test. The result of this reasearch was analyzed by using descriptiveanlysis. The study found that students achieved improvement in reading achievement after being taught usingcooperative learning with peer tutor method. The improvement was signified by the increase of the students'mean scores from the preliminary study to the end of the second cycle. Students' initial mean score was 69with 30,77% of completion in preliminary study. Students' mean score increased to 74 with the total numberof mastery learning of 61,54% after the first cycle. In the second cycle it had increased into 76,81 with 88,64%of mastery learning. The data analysis implies that the implementation of cooperative learning model with peertutor has been able to increase the reading achievement of the students in XI MIPA 1 of SMA Negeri 1 Pupuan.

Health behaviour change and activation in e-health weight loss intervention for elderly: a randomised clinical trial

ABSTRACT Patient activation is associated with treatment adherence, self-accountability for healthcare and a healthy lifestyle change. Mobile health (m-Health) apps can lead to greater patient treatment adherence and health behaviour change. This study aimed to evaluate the health behaviour change of elderly people through a healthcare programme focused on activation with the support of technology. Three phases were conducted: (1) pre-intervention – design of the intervention protocol and the app, (2) intervention – randomised clinical trial with 41 overweight/obese elderly people. m-Health app-supported group psychotherapy was compared with group psychotherapy only and individual psychotherapy (control) and (3) post-intervention – statistical analysis, intervention’s assistant interviews and app heuristics evaluation. By crossing the results, the study has shown that there was no significant difference in the activation level before and after intervention between groups. However, there was a significant increase from the initial mean score to the final one when considering the three groups together. Group therapy, whether with or without the support of the app, was more effective for behaviour change measured by the achievement of the goals, than individual psychotherapy. The lack of impact on group therapy with app support calls into question which and how much technology support is useful.

Transcranial direct current stimulation as an adjuvant in the improvement of symptoms of depression: A quasi-experimental design study.

Aims To evaluate the efficacy and tolerance of Transcranial Direct Current Stimulation (tDCS) in patients with major depression at the “Fray Bernardino Álvarez” Psychiatric Hospital. Method A pre/post intervention study, Patients attended in the outpatient clinic or continuous hospitalization with a diagnosis of major depression efficacy was measure with the Hamilton Depression Rating Scale (HDRS) and the Beck Depression Inventory (BDI). The tDCS was applied in the region corresponding to the left lateral prefrontal cortex on the anode and the cathode on the right supraorbital region. Descriptive statistics were performed for continuous and discrete variables as appropriate, t-test, chi-square, significance p&lt;0.05 was accepted. Results 39 patients were included, 100% of patients reported symptom improvement, the mean initial versus final scores on the HDRS and BDI scales were 19.5±7.4 versus 9.9±6 and 25.4±8.8 versus 14.4±7.3, respectively with statistically significant differences (p=&lt;0.05) for both scales. Discussion Transcranial direct current stimulation is an effective therapeutic option in the reduction of depressive symptoms as an adjunct to pharmacological treatment. The intervention did not cause adverse reactions requiring additional medication.

Pengaruh Kombinasi Progressive Muscle Relaxation dan Slow Deep Breathing Exercise terhadap Kinesiophobia pada Pasien Rawat Jalan di Surabaya

Objective: Kinesiophobia is an excessive fear of physical activity or movement so that patients tend to avoid moving their painful limbs. Not many longitudinal studies have reported that progressive muscle relaxation (PMR) and slow deep breathing exercise (SDBE) have a direct impact on the level of Kinesiophobia. Therefore, we explored the effect of a combination of progressive muscle relaxation and slow deep breathing exercise on kinesiophobia in outpatients with chronic musculoskeletal pain in Surabaya.Methods: This study had 43 respondents who all completed a randomized controlled trial (RCT) for 5 weeks, 21 respondents were randomized to receive a combination of progressive muscle relaxation and slow deep breathing exercise and received standard physiotherapy interventions, while the control group consisted of 22 respondents only with standard physiotherapy interventions. The Tampa Scale of Kinesiophobia (TSK) is used to assess the level of Kinesiophobia experienced by patients.Results: 1. In the experimental group that was given a combination of progressive muscle relaxation and slow deep breathing exercise and standard physiotherapy, the initial mean score without the scale of kinesiophobia (TSK) was 51.73 points, and after the intervention it was 42.32 points.2. As for the control group which was only given standard physiotherapy intervention, the initial average score without the scale of kinesiophobia (TSK) was 51.71 points, and after the intervention it became 48.33 points.3. The Effect of a Combination of Progressive Muscle Relaxation and Slow Deep Breathing Exercise on Kinesiophobia in Outpatients in Surabaya, with a p-value = (p &lt;0.05).Conclusion: The combined progressive muscle relaxation (PMR) and slow deep breathing exercise (SDBE) combination technique is safe to apply to patients with Kinesiophobia disorder because it has relatively no side effects and is practical in its application. The findings from this study support that combination therapy of progressive muscle relaxation (PMR) and slow deep breathing exercise (SDBE) offers beneficial outcomes for patients experiencing chronic pain, as well as for preventing and treating Kinesiophobia.

Bioenergetic changes and mitochondrial dysfunction in mania versus euthymia in bipolar disorder type I

IntroductionCurrent evidence has hypothesized the involvement of mitochondrial dysfunction during the acute episodes of BD compared to symptomatic remission. So far, no studies have compared mitochondrial and bioenergetic functions both in-vivo (respiratory parameters) and ex-vivo (cellular respiration) in different phases of the disease in the same individuals.ObjectivesThis multidisciplinary pilot study aims at assessing bioenergetic and mitochondrial intra-individual differences between manic and euthymic states.MethodsFour patients with a manic episode admitted to our acute psychiatric ward were recruited. Bioenergetic parameters were measured at admission (T0) and after symptomatic remission (T1).At admission (T0) and before discharge (T1), HAMD and YMRS total scores were obtained. For the assessment of cellular respiration, polymorphonuclear cells were obtained by a Ficoll density gradient centrifugation procedure. To determine oxygen consumption (at T0 and T1), a million of living peripheral blood mononuclear cells (PBMC) were used. High-resolution respirometry was performed at 37°C by polarographic oxygen sensors in a two-chamber Oxygraph-2k system.Specific oxygen uptakes (Routine: basal oxygen consumption; Proton Leak: oxygen consumption not coupled to ATP synthesis; and ETC: maximal capacity of the electron transport chain) rates were obtained using mitochondrial chain inhibitors and uncouplers. Oxygen consumption was normalized for protein concentration. Results are expressed as picomoles of oxygen per millilitre (pmol O2/s*μg prot).Also, a constant work rate exercise test was performed on a cycle ergometer and basal and effort respiratory variables were measured.Statistical analysis was performed with the SPSS v. 25.0 and GraphPad. Results were expressed as means and SD. Nonparametric tests (Mann–Whitney, Pearson) were used to determine differences (significant at p value &lt;0.05).ResultsOne patient was a man and three patients were women, with a mean age of 28 years old. HAMD initial and final mean scores were 11.0 and 7.0, and mean YMRS scores were 21.5 and 7.0 respectively.Results from mitochondrial oxygen consumption revealed that mean basal oxygen consumption tended to be higher in T1 (0.98±0.45) than in T0, and maximal respiratory capacity was significantly increased in T1 (2.26±0.33; p=0.028) compared to T0.Mean lactate levels and pH levels were similar in T0 and T1. Scales scores were not correlated to different pH or lactate changes after the effort task. Higher initial oxygen consumption was significantly correlated to higher maximal capacity (p&lt;0.05) in T0 and T1.Image:ConclusionsOur preliminary results suggest that mania could imply lower oxygen consumption capacity, which should be confirmed in future studies. A bigger study is planned to determine changes in bioenergetic patterns and capacity for aerobic response in manic and depressive episodes.Disclosure of InterestNone Declared

IPP and Changes in IPSS in Benign Prostatic Hyperplasia (BPH) Patients Treated with ?1-Blocker

Benign prostatic hyperplasia (BPH) is a benign enlargement of the prostate gland caused by the proliferation of epithelial cells and stroma, causing Lower Urinary Tract Symptoms (LUTS). One of the ways to treat BPH is through medical therapy with ?1-blockers. The success of medical therapy is influenced by many factors, one of which is Intravesical Prostatic Protrusion (IPP). This study was a comparative prospective study that aimed to find the effect of IPP on response to therapy with ?1-blockers in BPH patients. IPSS was used as a measuring tool. IPP was examined using transabdominal ultrasound. The study was conducted from July 2020 to December 2020. Data were analyzed using the one way ANOVA average comparison test and Pearson correlation test. A sample of 30 patients was divided into 3 groups based on the IPP degree, namely grade I (&lt;5mm), grade II (5-10mm) and grade III (&gt; 10mm). There were no significant differences in the mean initial IPSS scores in each group, namely 19.6, 18.90, and 21.30 (p = 0.216). There was a significant decrease in mean IPSS after 1 month of ?1-blocker therapy. In addition, there was also found a significant correlation between the IPP value and the decrease in the final IPSS with a negative correlation. There is a significant correlation between the IPP degree and the decrease in IPSS in BPH patients after receiving ?1-blocker therapy as the higher the IPP degree, the lower the final IPSS improvement.

Our Experience on Tug Test as Diagnostic Marker in Peripheral Vestibular Diseases

Background: Vestibular dysfunction in elderly screened with Timed Up and Go (TUG) test, is fast, simple way to assess fall risk, lower limb mobility, and function in clinical settings. This study was initiated to assess improvement of patient symptoms and postural control after performing Epley's maneuver using the Timed Up and test. Incorporation of the TUG test in this study provided a comprehensive evaluation of the effects of Epley's maneuver on both symptom relief and functional mobility. It allowed for objective measurements and quantifiable data to assess the effectiveness of the intervention, providing valuable insights for clinical decision-making and patient management. Methods: Prospective observational study was carried out on 100 patients aged 65 years and above suffering with peripheral vertigo were performed with "timed up and go" (TUG) test. We Propose Cutoff point of 13.5 seconds proposed as standard for identifying at risk of falling after particle repositioning maneuver. This decision was based on several factors and considerations specific to our study population and objectives. By setting a cut-off value of 13.7 seconds, we tried to achieve better balance between sensitivity and specificity, ensuring a more accurate identification of the target parameter in our study population. Results: In our study we observed from the results that the mean age of the patients in study was 69.6 years. A study population of 62 (62.0%) males and a number of 38(38.0%) females were considered for the study. Clinical findings of the study revealed that for patients suffering with dizziness it was observed that 29(29.0%) of patients had dizziness of less than 6 months, 24(24.0%) of the patients had dizziness for 6-12 months, 23(23.0%) patients had dizziness for &gt;2 years, and 22(22.0%) of patients had dizziness for 1-2 years. Based on frequency of dizziness attacks it was observed that 53(53.0%) of study population had dizziness every day and 47(47.0%) had dizziness every week. Based on the duration of dizziness in the study population 29(6.0%6) of them had dizziness for few seconds only, 25(25.0%) of them had dizziness lasting for few minutes to hours, and 23(23.0%) of study population had continuous dizziness. In the study population 28(28.0%) had dizziness on lying down, 24(24.0%) had dizziness on turning, and 22(22.0%) had dizziness on lying down and turning. Also 84(84.0%) of these population had body instability, 73(73.0%) had vomiting during dizziness, 71(71.0%) had anxiety related to dizziness, 67(67.0%) had associated symptoms of nausea during attacks, 65(65.0%) of study population had associated tinnitus, 61(61.0%) among the study population had disordered sleep. Also it was observed that 59(59.0%) had headache, 56(56.0%) had sensation of fainting, 39(39.0%) had pallor &amp; hearing loss, 38(38.0%) had sensation of pressure, and 29(29.0%) had sweating as associated clinical symptoms during the attacks of dizziness. Re-assessment after Epley’s maneuver reveals reduction in majority clinical findings. TUG test findings show mean initial assessment score of 15.3 + 3.02, after Epley’s maneuver was 12.3 + 3.34 with mean difference of 3.01 with p-value (&lt;0.001). Discussion and Conclusion: Epley’s maneuver is useful to reduce clinical symptoms with peripheral vestibular disorders as assessed by TUG test in elderly

TO INVESTIGATE THE ASSOCIATION OF DOSE-DEPENDENT VITAMIN D SUPPLEMENT ON CLINICAL OUTCOMES IN VETERANS WITH MULTIPLE SCLEROSIS

Objective: To investigate the association of daily dose-dependent Vitamin-D supplement on clinical outcomes including mortality in veterans with multiple sclerosis (MS) with low serum Vitamin-D (25[OH]D) levels. This Methods: observational, longitudinal study reports on data collected from 1/1/2000 to 12/31/2020 at the MS Regional Program. We reviewed the electronic records of 163 veterans with MS who were followed every four months in our MS clinic. The study sample was divided into three groups based on the daily Vitamin-D supplement doses: low (1000 IU/day), medium (2000 IU/day) and high (4000 IU/day). The clinical outcomes were changes in physical disability (Expanded Disability Severity Scale (EDSS)), function (Total Function Independence Measures (TFIM)), time-to-event EDSS score of 6 (progressive MS) and mortality. Results: There were 32 patients in the low, 46 in the medium, and 85 in the high-dose daily Vitamin-D supplement groups. The mean age of the entire study sample was 51 12 SD years (range 23 - 79 years). The mean duration of MS was 21.7 13 years. The mean initial EDSS and TFIM scores were 3.4 2.8 and 111 17 SD. At entry, mean serum 25[OH]D and calcium levels were 30 16 nmol/l and 9.3 0.4. The risk of MS-related progressive disability (time-to-event EDSS score 6) was lower and there were fewer deaths in the high- (compared to low- and medium-) dose groups. Conclusion: This study suggests that among veterans with MS and low 25[OH]D levels, those who received high-doses daily of supplemental Vitamin-D supplement were associated with a decreased risk of MS-related progressive disability and death than those who received a lower dose. No adverse clinical or biochemical events were noted.

Using the Pelvic Floor Impact Questionnaire to Improve Urinary Incontinence Assessments for Female Veterans

ObjectiveTo evaluate quality of life (QoL) in female veterans by comparing responses of the Pelvic Floor Impact Questionnaire (PFIQ-7) before and after a chosen treatment for urinary incontinence (UI), determine whether a QoL assessment was being completed for each woman seeking care for UI, and review the PFIQ-7 questionnaire scores to ensure the veterans were offered the appropriate levels of treatment. DesignQuality improvement project using the plan–do–study–act cycle for evaluating change. Setting/Local ProblemA Veterans Affairs Medical Center in the midwestern United States. No standardized education or QoL questionnaire was being used for female veterans diagnosed with UI before implementation of the project. ParticipantsTwenty female veterans diagnosed with stress or mixed UI who had completed Kegel exercises or pelvic floor rehabilitation (PFR) and a pre- and posttreatment PFIQ-7. Interventions/MeasurementsThe Veterans Affairs Medical Center incorporated the PFIQ-7 into routine practice for pre- and posttreatment assessment of UI. Data were collected through a retrospective chart review. ResultsThe mean initial PFIQ-7 score for participants (n = 4) who chose PFR was 71.77 (SD = 82.79). The mean final PFIQ-7 score for participants in the PFR group was 43.99 (SD = 63.34). The mean initial PFIQ-7 score for participants who chose Kegel exercises was 71.72 (SD = 34.92), and the final score was 60.71 (SD = 44.98). When comparing pre- and posttreatment scores, a lower score means there was a positive effect from the treatment and reflects an improved QoL. ConclusionThe addition of the QoL assessment tool assisted staff in developing an individualized plan of care for female veterans. Regardless of treatment option chosen, participants who did not show an overall improvement in the pre- and posttreatment QoL scores were referred to a more advanced level of care.

Virtual Reality as Anxiolysis During Laceration Repair in the Pediatric Emergency Department

BackgroundAlthough procedural pain is effectively treated with analgesics, managing anxiety during laceration repair is more challenging. ObjectivesWe examined the feasibility of using immersive virtual reality (VR) as anxiolysis during laceration repair in the pediatric emergency department (ED). MethodsWe conducted a non-blinded, observational, pilot study in an urban pediatric ED that enrolled a convenience sample of children aged 5–13 years undergoing sutured repair of non-facial lacerations. Subjects played an immersive VR game while undergoing laceration repair. Parents assessed their child's anxiety on a 100-mm visual analogue scale at enrollment and during laceration repair. The primary outcome measure was the percentage of children whose anxiety score did not increase by ≥ 20 mm from enrollment to the first stitch. ResultsForty patients completed the study. Mean initial anxiety score was 54 mm (standard deviation 33 mm). Thirty-seven of forty patients (93%; 95% confidence interval [CI] 83–99%) had anxiety scores that did not increase by 20 mm or more from enrollment to the first stitch. Eighty percent (95% CI 64–91%) of patients’ anxiety scores decreased between enrollment and first stitch. The mean change in anxiety score at first stitch was −39 mm (95% CI −51 mm to −27 mm; p < 0.001). Similar downward trends in anxiety scores were noted throughout the procedure. All laceration repairs were successfully completed without sedation or restraints. There were no adverse events noted, and the main barriers identified with VR use involved easily correctable technical difficulties with the equipment. ConclusionImmersive VR is a safe and effective distractive technique to reduce procedural anxiety during laceration repair in the pediatric ED.