Nonrandomized Study Research Articles

Health-Related Quality of Life and Experiences of Minor Children With Parental Cancer-A Family-Based Multilevel Analysis of Determinants.

Children in families with parental cancer may experience emotional, social or physical problems. The aims are to analyze child, parent and family-based determinants of children's health-related quality of life (HRQoL) and their experiences of parental cancer. As part of a mixed-methods, multicenter, prospective, interventional non-randomized study "Family-SCOUT," a family-centered intervention in the form of care and case management was developed. Children's HRQoL (KIDSCREEN-10) was assessed at baseline (study inclusion). Descriptive analyses and family cluster-adjusted linear mixed models were performed. Qualitative coding of children's experiences reported in an open-ended text field of the questionnaire was performed. Four hundred and seventy-two families with 472 parents with cancer and 649 children were included in the study of which N=346 were analyzed. The average age of the children was 12.8years. 48% of the children were female. Family cluster-adjusted mixed linear model showed significant associations between children's HRQoL (dependent variable) and children's age (-0.44, p=0.023, 95%-CI=-0.82 to -0.06) and between families (ICCnull model=0.377, Pseudo-R2=0.443). Children experienced changes in the family situation, such as daily routines and communication among all family members, death of a parent, COVID-19-related difficulties, and supportive social relationships. Child, parent and family-based factors appear to be related to children's HRQoL. Research on children's HRQoL and experiences in the context of parental cancer underscores the need for a multidimensional and family-based approach to support these children.

Clinical and anamnestic factors affecting the progression of uterine fibroids

Background. Uterine fibroids (UF) is the most common tumor of the female reproductive system. In UF progression environmental factors are of great importance, which, without changing the genome, affect the activity of processes of hereditary information realization, the so-called epigenetic factors.Objective. To identify the most significant factors enhancing uterine myoma growth and the factors having protective effect.Material and methods of research. The study is a cohort retrospective non-randomized study in which 48 women took part: group 1–28 women with large-sized UF, group 2–20 women with small-sized UF. Retrospective analysis of medical records, questionnaire with the help of a questionnaire including 50 questions about the nature of lifestyle was carried out.Results of the study. The studied groups were comparable in age, marital status, education and living conditions. The average age of the patients in the first group was 48,21±5,24 years, in the second group 46,20±3,75 years. Based on the data obtained, the factors influencing the growth of uterine fibroids were identified and ranked. The main factors accelerating the progression of UF are high obesity (OR7.34 95% CL 1,035–178.2, p<0.05), a history of cesarean section (OR4.85 95% CL 1,006–36.51, p<0.05), the presence of UF in the mother (OR4.12 95% CL 1,022–21.21, p<0.05), eating pork more than 3 times a week (OR4.12 95% CL 1,134–17.51, p<0.05), short courses of using oral contraceptives (OR4.12 95% CL 1,02–21.21, p<0.05), rare consumption of fish and seafood (OR3.88 95% CL 1,06–16.57, p<0.05), low physical activity (OR4.12 95% CL 1,134–17.51, p<0.05), duration of dynamic observation for more than 5 years (OR3.506 95% CL 1,042–12.75, p<0.05). Protective factors that slow down the growth of uterine fibroids can be called taking nonsteroidal anti-inflammatory drugs to relieve dysmenorrhea (OR0.28 95% CL 0.075–0.989, p<0.05), limiting sugar intake (OR0.187 95% CL 0.035–0.814, p<0.05), no pork consumption (OR0 95% CL 0.0–0.5097 p<0.05), consumption of fish and seafood 3 or more times a week (OR0.149 95% CL 0.0189–0.7756, p<0.05), the presence of 3 or more births in the anamnesis through the natural birth canal (OR0 95% CL 0.0–0.563, p<0.05), regular sexual activity (OR0.280 95% CL 0.0745–0.989, p<0.05), alcohol exclusion (OR0.495 95% CL 0.01893–0.7756, p<0.05), underweight (OR0.95% CL 0.0–0.3809, p<0.05).Conclusion. It is necessary to encourage women not to postpone motherhood, to popularize having many children, family values, to modify the lifestyle of women with already detected uterine fibroids by increasing motor activity, limiting the consumption of pork and sugar, increasing the consumption of fish and seafood.

Predictors of New-Onset Atrial Fibrillation in Patients With Chronic Coronary Artery Disease After Coronary Artery Bypass Grafting: a Prospective, Observational, Single-Centre, Non-Randomized Study

To study the factors that influence the occurrence of postoperative atrial fibrillation (POAF) in patients with chronic ischemic heart disease (IHD) after coronary artery bypass grafting (CABG). This single-center prospective observational non-randomized study included 152 patients with chronic IHD. Mean age of patients was 64.4±5.9 years. All patients after CABG were divided into two groups based on the occurrence of atrial fibrillation (AF) in the early postoperative period: group 1, with POAF (n=43; 28.3%) and group 2, without POAF (n=109; 71.7%). The primary study endpoint was new-onset POAF in the early postoperative (hospital) period after CABG. The secondary study endpoint was in-hospital postoperative complications (non-fatal/fatal acute coronary syndrome (ACS), non-fatal/fatal stroke, major bleeding, death). Patients with POAF had significantly more pronounced structural and functional changes in the heart than patients with preserved sinus rhythm after CABG: larger left ventricular (LV) volume, greater LV myocardial mass, lower LV systolic function parameters and impaired diastolic function, and an enlarged left atrial (LA) cavity. Analysis of in-hospital complications did not show any differences between the groups associated with the development of POAF. The following risk factors for POAF were identified: age older than 65 years (p=0.022), body mass index ≥30.5 kg/m2 (p=0.020), epicardial adipose tissue thickness >10.5 mm (p=0.015), indexed LA volume >33 ml/m2 (p<0.001), LV myocardial mass index >115 g/m2 (p=0.042), left main coronary artery disease >50% (p=0.043), duration of cardiopulmonary bypass during CABG >60 min (p=0.019), blood potassium concentration in the early postoperative period after CABG (on the first day) <3.6 mmol/l (p<0.001), and pericardial effusion volume in the early postoperative period >88 ml (p<0.001). Determining the risk of developing POAF is important and necessary for the closest monitoring of a patient with chronic IHD in the postoperative period.

The effect of peer tutoring on pediatric nursing education: a systematic review.

This study aimed to systematically review studies on the effect of peer tutoring on pediatric nursing education for nursing students and identify its contents and characteristics. A comprehensive search was conducted from November to December 2023 across databases including PubMed, Embase, CENTRAL, CINAHL, ProQuest, and others. We included both published and unpublished literature in English or Korean. Three reviewers independently screened and selected eligible studies that involved undergraduate nursing students participating in peer tutoring programs focused on pediatric nursing education. We analyzed quantitative outcomes related to learning effects and learner responses. The quality of the studies was assessed using the revised Cochrane risk-of-bias tool for randomized trials and the risk of bias assessment tool for non-randomized studies. Five studies were reviewed, encompassing randomized controlled trials, a non-randomized controlled trial, a cohort study, and a before-after study. These interventions were conducted in school settings or pediatric clinical environments and featured different forms of peer teaching: horizontal, near-peer, and reciprocal. The tutor-to-tutee ratios ranged from 1:3 to 1:36.5. The educational content covered nursing care for major neonatal diseases, communication skills, medication administration, and resuscitation techniques. Significant improvements in cognitive knowledge and communication skills were observed among nursing students. However, there was noticeable variability in the design and reporting of the studies. Peer tutoring programs can effectively enhance pediatric nursing education by improving nursing students' knowledge and skills. For future meta-analyses, more studies in this field reported according to reporting guidelines are needed.

Prophylactic antibiotics for manual removal of retained placenta in vaginal birth.

Retained placenta is a potentially life-threatening condition because of its association with postpartum haemorrhage. Manual removal of the placenta increases the likelihood of infectious complications of the uterine cavity. So, prophylactic antibiotics are recommended by some experts, and commonly administered to reduce these risks. However, the evidence supporting this decision is limited. This review aims to assess the effectiveness of prophylactic antibiotics for manual removal of retained placenta after vaginal birth. To compare the effectiveness and adverse effects of routine prophylactic antibiotics for the manual removal of placenta after vaginal birth. To identify appropriate prophylactic antibiotic regimens. For this update, we searched CENTRAL, MEDLINE, Embase, CINAHL, and two trials registries, in addition to screening the reference lists of retrieved studies and systematic reviews. The last search was 14 May 2024. All randomised controlled trials and non-randomised studies comparing prophylactic antibiotics to no treatment or to another prophylactic antibiotic to prevent postpartum endometritis after manual removal of placenta after vaginal birth. The critical outcome in our review was postpartum endometritis. Other important outcomes were puerperal morbidity, perineal infection, duration of hospital stay, sepsis, any infection, blood loss, postpartum haemorrhage, secondary postpartum haemorrhage, readmission to hospital, adverse effects of the drugs, women's satisfaction, and neonatal outcomes, such as jaundice, sepsis, neonatal intensive care unit admission, et cetera. The risk of bias was assessed at the outcome level. We used the Risk of Bias in Non-Randomised Studies of Interventions (ROBINS-I) tool to assess the risk of bias in non-randomised studies. We carried out statistical analysis using Review Manager. We used a fixed-effect meta-analysis to synthesise the results, and GRADE to assess the certainty of the evidence. We included four retrospective cohort studies with a total of 974 participants. Studies were conducted in Germany, Bulgaria, Norway, and Israel, between 1983 and 2017. Prophylactic antibiotics versus no antibiotics was the only comparison in our analysis. Postpartum endometritis We do not know whether prophylactic antibiotics have an impact on postpartum endometritis (risk ratio (RR) 0.94, 95% confidence interval (CI) 0.48 to 1.85; 4 studies, 974 participants; very low-certainty evidence). Postpartum haemorrhage The evidence suggests that prophylactic antibiotics may result in little to no difference in postpartum haemorrhage (RR 1.00, 95% CI 0.78 to 1.29; 1 study, 325 participants; low-certainty evidence). Neonatal intensive care unit admission (NICU) The evidence suggests that prophylactic antibiotics may result in little to no difference in NICU admission of the neonate (RR 0.86, 95% CI 0.29 to 2.61; 1 study, 353 participants; low-certainty evidence). There were no data available for other important outcomes, including puerperal morbidity, perineal infection, duration of hospital stay, sepsis, any infection, blood loss, secondary postpartum haemorrhage, readmission to hospital, adverse effects of drugs, women's satisfaction, or neonatal outcomes of jaundice or sepsis. There is very uncertain evidence supporting the use of prophylactic antibiotics for manual removal of placenta for preventing postpartum endometritis. The evidence suggests that prophylactic antibiotics result in little to no difference in postpartum haemorrhage or admission to a neonatal intensive care unit. There were no available data on other important outcomes. Multicentre, randomised controlled trials comparing antibiotic prophylaxis and placebo or no antibiotic, or one antibiotic and another, for manual removal of placenta in vaginal birth are needed to provide more robust evidence. This systematic review received support from the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP). Protocol and previous versions are available at https://10.1002/14651858.CD004904.pub3.

The effect of topical retinoids in treatment of acne vulgaris in Khartoum Teaching Dermatological Hospital

Background: Acne vulgaris is a chronic inflammatory skin disease affecting approximately 80% of young adults and adolescents. Prolonged therapy is often required for satisfactory results. Topical retinoids play a central role in acne treatment, with evidence supporting their efficacy in achieving significant improvements in acne symptoms. This study aimed to assess the effectiveness of topical retinoids in treating acne vulgaris among patients at Khartoum Dermatology and Venereal Teaching Hospital from August 2019 to August 2020. Methods: A non-randomized interventional study was conducted at Khartoum Dermatology Teaching Hospital, covering patients diagnosed with mild to moderate acne vulgaris. Data were entered, cleaned, and analysed using statistical package for the social sciences (SPSS) version 25.0. Results: The study included 100 patients. Of these, 38% were aged 25-35 years, and 70% were female. 92% had experienced acne symptoms for more than six months. Regarding treatment duration, 87% used topical retinoids for more than three months. Clinical improvement was observed in 83% of patients, while 14% showed no improvement, and 3% experienced worsened symptoms. Conclusions: Topical retinoids are effective in treating mild and moderate acne vulgaris.

Intravesical Tranexamic Acid for Patients Requiring Continuous Bladder Irrigation in the ED: A Non-Randomized Feasibility Study

Objectives Tranexamic Acid (TXA) is a well studied clot stabilizer that may have benefit when used intravesically prior to continuous bladder irrigation (CBI). This study determined the feasibility of conducting a randomized controlled trial using TXA intravesically in patients who present to the emergency department (ED). The study goals were to recruit 20 participants within a six-month time frame and have an 80% recruitment rate. Methods Potential participants were identified at triage if they presented with a complaint of hematuria or urinary retention and were over the age of eighteen. Informed consent was obtained if the patient needed CBI and met inclusion/exclusion criteria. If consented, TXA was instilled intravesically at the start of CBI treatment and the patient was followed until their CBI treatment was complete. Results A total of 14 (out of 18) participants were recruited over eight months. The mean age of participants was 74.5 +/- 7.4 years with only one of the 14 participants identifying as female. For resource management, the study was designed to include support from an on-call nurse. The on-call nurse was called seven out of fourteen times and came into hospital one time. Eight participants did not require hospital admission after the TXA intervention. The mean length of hospital stay for participants was 4.6+/-2.7 days. The mean ED length of stay was 8.1+/-4.9 hours. There were no reported adverse events. Conclusion The recruitment rate of 78% indicated that the study was acceptable to participants, but we were unable to meet our goal of recruiting 20 participants over six months. Study protocol was followed, and no adverse events were found.

Physical activity and heart rate in PTSD inpatients: Moderation by custody of a service dog

Posttraumatic stress disorder is associated with autonomic hyperarousal often shown to involve elevated resting heart rate and, simultaneously if somewhat paradoxically, reduced physical activity. Both are risk factors for cardiovascular disease and so may contribute to its elevated prevalence in persons with this diagnosis. Epidemiological studies have observed dog owners to exhibit lower rates of cardiovascular disease. Non-randomized between-group studies have found service dog companionship to be associated with increased physical activity and with lower resting heart rate. A challenge to research in this area is its vulnerability to selection biases in group assignment which could lead to over-estimation of advantages or disadvantages associated with pet or service dog contact and companionship. The current study executed a within-subjects design investigating physical activity and heart rate in a sample of U.S. military Veterans engaged in residential treatment for PTSD and a concurrent service animal training intervention. A mean of 37 days of continuously-recorded day-time physical activity and heart rate were obtained from 45 participants. On days when they had custody of a familiar service-dog-in-training, participants exhibited increased physical activity accompanied by a small reduction in concurrent, activity-adjusted heart rate. Though observed in a specialized context, these short-term findings align with prior observations of lowered risk of cardiovascular disease in association with pet dog ownership. Extended longitudinal designs will be necessary to determine whether such short-term effects truly mediate lowered long-term risk.

Social Disadvantage and Disparities in Chronic Liver Disease: A Systematic Review

Introduction: Social determinants of health (SDOH) may impact chronic liver disease (CLD) outcomes but are not clearly understood. We conducted a systematic review to describe the associations of SDOH with mortality, hospitalizations, and readmissions among patients with CLD. Methods: This review was registered (PROSPERO ID: CRD42022346654) and identified articles through MEDLINE, Embase, Cochrane Library, and Scopus databases. The review included studies that reported SDOH characteristics within the domains of economic stability, health care access, education, social and community context, and the neighborhood built environment. Associated outcomes of interest were mortality, hospitalizations, or readmissions. The Cochrane Risk of Bias in Non-randomized Studies for Exposure (ROBINS-E) was used to assess study quality and risk of bias. Results: A total of 5,205 abstracts were screened, 60 articles underwent full-text review, and 27 articles were included in the final review. Poor economic stability, healthcare access, social support, and household/environmental conditions were associated with higher mortality and hospital readmissions among patients with CLD. Increasing distance (≥25 miles away) from a liver transplantation (LT) center was associated with higher mortality despite increasing access to the LT waitlist. When assessing the overall risk of bias among included studies, most had “Some Concern” (N=13, 48.1%) or “High Risk” (N=11, 40.7%) while a minority had “Very High Risk” (N=3, 11.1%). No studies were categorized as “Low Risk.” Conclusions: Unfavorable SDOH were associated with increased mortality and hospital readmissions among patients with CLD. Rigorous empirical research is needed to identify evidence-based strategies that aim to mitigate disparities among vulnerable populations.

Individual and organizational interventions to reduce burnout in resident physicians: a systematic review and meta-analysis

BackgroundBurnout among resident physicians during training has been prevalent, prompting training centers to introduce interventions at the individual or organizational level. However, empirical evidence is crucial before implementing such programs in practice.MethodsA systematic review and meta-analysis was carried out to evaluate the effectiveness of individual and organizational interventions in reducing burnout among resident physicians. Searching was done across five databases—PubMed, Scopus, ScienceDirect, Embase, and Cochrane Library from 1 December 2023 to 26 August 2024. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used for our reporting of study selection process. Eligibility criteria were randomized or non-randomized designs, with prospective intervention, with a comparator group focused on individual or organizational interventions reducing burnout, in any language and publication date. The Maslach Burnout Inventory scores for emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA) were the three outcome measures. Two investigators independently extracted the data. The risk of bias was evaluated using Cochrane risk-of-bias tool for randomized trials (RoB2) and non-randomized studies of interventions (ROBINS-I). Cohen’s d and heterogeneity was estimated using a random-effects DerSimonian-Laird model and visualized by forest plots. Sensitivity analyses were carried out by leave-one-out meta-analysis.ResultsWe identified 33 eligible studies (n = 2536), comprising 25 (75.8%) individual intervention studies and 8 (24.2%) organizational intervention studies. Cohen’s d for individual intervention versus control were as follows: EE -0.25 (95% CI -0.40 to -0.11, p < 0.01, I2 = 49.3%), and DP -0.17 (95% CI -0.32 to -0.03, p = 0.02, I2 = 50.0%). The organizational intervention showed no significant association with any domain. Sensitivity analyses were robust in all outcomes, with differences in intervention description and design identified as potential contributors to heterogeneity.ConclusionsVarious interventions, including individual coaching, meditation, and organization interventions, have been implemented to improve resident burnout. The effectiveness of intervention demonstrated none to small practical significance in improving burnout. Data inconsistency and high risk of bias across studies limited the validity of the pooled results. Further studies should focus on a combined approach.RegistrationThe study was registered on PROSPERO, under PROSPERO registration number CRD42022349698.

Surgical management of first-time patellar dislocations in paediatric patients may lower rates of redislocation compared to conservative management: A systematic review and meta-analysis.

The purpose of this study is to assess whether early surgical intervention for first-time patellar dislocations in paediatric patients is superior to conservative management. We hypothesized that surgical intervention would lead to lower redislocation rates compared to conservative treatment. Three online databases (PubMed, MEDLINE and EMBASE) were searched from inception to 14 March 2024 to identify studies investigating the management options for acute first-time patellar dislocations in paediatric patients. Data pertaining to patient demographics, patient management, redislocation rates and Kujala scores, evaluating function, were abstracted. Weighted means and meta-analyses were conducted to compare rates of redislocation, as well as Kujala scores. The quality of included studies was assessed using the methodological index for non-randomized studies criteria for non-randomized studies and the ROB2 tool for randomized controlled trials (RCTs). A total of 11 studies and 761 patients were included in this review. The weighted mean post-operative combined rates of redislocation in the surgical group was 25.1%, compared to 46.4% in the conservative group at a mean follow-up of 53.2 months (12-168). The relative risk (RR) of redislocation was 0.82 (95% confidence interval [CI]: 0.65-1.04, I2 = 0%, p = 0.11), favouring surgery compared to conservative management. A subgroup meta-analysis of two recent RCTs with 110 patients demonstrated an RR of redislocation of 0.53 (95% CI: 0.31-0.91, I2 = 0%, p = 0.02), favouring surgery. Kujala scores among three comparative studies showed a mean difference of -2.7 (95% CI: -6.1 to 0.68, I2 = 0%, p = 0.12), favouring conservative treatment. The weighted mean redislocation rate in 131 patients undergoing medial patellofemoral ligament reconstruction (MPFLR) was 3.1%, compared to 39.4% in 203 patients undergoing other surgical procedures, such as lateral release and medial imbrication, Roux-Goldwaith and MPFL repair. Furthermore, the conservative groups experienced a complication rate of 0.9% compared to 2.9% across the surgical groups. Surgical management for first-time patellar dislocations in a paediatric population, particularly MPFLR, may be more beneficial in lowering redislocation rates than conservative management. No significant differences in Kujala scores were found. Level IV.

The Increase in Corneal Stiffness After Accelerated Corneal Cross-Linking in Progressive Keratoconus Using Different Methods of Epithelial Debridement.

The purpose of this study was to investigate corneal stiffening after epithelium-off accelerated corneal cross-linking (CXL; 9 mW/cm²) in progressive keratoconus (KC) with different methods of epithelial debridement. This was a retrospective, interventional, and non-randomized study. In group 1, the epithelium was removed using a hockey knife (N = 45). In group 2 (N = 39) and group 3 (N = 22), the epithelial thickness was measured by optical coherence tomography (OCT) and the epithelium was ablated by excimer laser, but, in group 3, stromal ablation was performed additionally to correct high order aberrations (HOAs). Corneal biomechanics (integrated invers radius [IIR], stress-strain index [SSI]) and corneal tomography (thinnest corneal thickness [TCT]) were assessed with Corvis ST and Pentacam prior to and 1 month after CXL. Corneal tomography did not differ among the groups preoperatively (P > 0.05). TCT decreased significantly in all groups after surgery (all P < 0.05). Nonetheless, corneal biomechanical stiffening was found in all three groups indicated by a decreased IIR and an increased SSI (all P < 0.05). For group 3, the HOA improved significantly (P < 0.001). Among the groups, there were no significant differences in changes of biomechanical parameters, but TCT was significantly reduced after laser ablation. Corneal stiffening after CXL is independent from epithelial removal. In particular, despite the removal of stromal tissue to correct HOA, a stiffening effect was achieved in keratoconic corneas, even it was less pronounced compared to mechanical epithelial removal. The reduction in HOA indicates a possible improvement in visual acuity. Cross-linking stiffens the keratoconus independent of epithelial debridement technique and may compensate minor stromal laser ablation.

Effects of Hyrax Maxillary Expander on Nasal Cavity and Upper Airway in Adolescents: A Systematic Review and Meta-Analysis.

Whether Hyrax maxillary expander is an effective treatment for maxillary transverse deficiency as well as expansion of the upper airway is still controversial. The study's purpose was to evaluate 3D changes in upper airway dimensions of adolescent patients measured primarily by cone-beam computed tomography (CBCT) after rapid maxillary expansion (RME) with the Hyrax maxillary expander. Studies up to 1 April 2024 were searched in the following databases: PubMed/MEDICINE, Web of Science, Cochrane Library, and Embase. Inclusion criteria were clinical trials and cohort studies that assessed the effect of RME in adolescent patients with upper airway stenosis using CBCT-based three-dimensional analysis. The risk of bias in the study outcomes was assessed using the Cochrane Collaboration's risk of bias tool, the GRADE method, and a tool for evaluating non-randomized controlled study (non-RCT) literature from a previous systematic review, depending on the types of articles. The study was reported in accordance with PRISMA guidelines. The study conducted a random effects meta-analysis of mean differences and 95% confidence intervals for changes in upper airway volumes, including the nasal cavity (NC), in the outcomes of 16 included studies, followed by subgroup analyses. A significant increase in nasopharynx volume was observed after rapid maxillary expansion (RME) by Hyrax maxillary expander (MD = 0.69, 95% CI (0.09~1.28), p = 0.02).

Greater Trochanteric Pain Syndrome and the Efficacy of Platelet-Rich Plasma Injections: A Systematic Review.

Greater trochanteric pain syndrome (GTPS) is one of the most prevalent causes of lateral hip pain. The incidence rate is as high as 1.8 patients per 1000 annually, with females predominantly affected. We compared and analysed the effectiveness of platelet-rich plasma (PRP) injections in treating GTPS. Literature search was carried out on PubMed, Embase and Cochrane by two independent reviewers using the terms: 'Greater Trochanteric Pain syndrome' and 'Platelet-rich plasma'. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the Cochrane risk of bias tool andMethodological Index for Non-Randomized Studies (MINORS) tool were used to assess bias. Nine studies were shortlisted and reviewed for patient sample size, diagnostic modalities, the presence of tendinopathy or bursitis, the number of PRP injections administered, and the length of symptom relief achieved. We analysed nine studies between 2013 to 2024 comprising of a total of 508 patients who received treatment with PRP injections for lateral hip pain. There was an improvementand sustained relief in symptoms in eight studies, while one reported no change. Many studies indicated PRP injections to be more effective than corticosteroid injections (CSI) in treating GTPS. PRP appears to be an effective injectable treatment option for GTPS, which does not respond to conservative therapy. However, due to the limitations of the current literature, there is a need for more large-scale, high-quality randomized clinical trials to assess further the effectiveness of PRP for treating GTPS.

One-year outcomes of transcatheter mitral valve replacement in patients with severe mitral regurgitation

Abstract Background Mitral valve regurgitation (MR) is a prevalent valvular heart disease, and a subset of patients face challenges in undergoing surgical treatment. Transcatheter mitral valve replacement (TMVR) has emerged as a viable option for selected patients with severe MR deemed unsuitable for traditional valve surgery. Purpose This study aims to evaluate the feasibility, safety, durability, and clinical outcomes of a novel transapical mitral valve system (MitraFix valve) in treating moderate to severe MR patients. Methods The early feasibility study of the MitraFix TMVR transapical system is a multicenter, prospective, nonrandomized study. All patients underwent evaluation by a multidisciplinary heart team and were deemed suitable for mitral valve intervention. Clinical events were adjudicated by an independent clinical events committee. Results From June 2021 to July 2022, 10 patients (mean age: 71.2 ± 7.4 years, 40% male) were enrolled. The mean Society of Thoracic Surgeons(STS) predicted risk of mortality was 7.5 ± 2.7%. All implants were successful, with a mean operational time of 45.2 ± 25.9 min. One patient was converted to open cardiac surgery after successfully implanting the valve due to persistent apical bleeding. At 1-year follow-up, all-cause mortality was 20%, with a cardiovascular mortality at 10.0%. Among survival patients, 87.5% of surviving patients had MR ≤1+ and 75% patients were in NYHA functional class I or II at 1 year. The overall KCCQ score significantly increased from 55.8 (42.9, 72.9) points at baseline to 77.5 (73.7, 88.6) points at 1-year follow up (P = 0.012). Left ventricular ejection fraction showed no significant change from basline (51.5%) to 1 year (50.0%) (P=0.799). No evidence of mitral stenosis or left ventricular outflow tract (LVOT) obstruction was observed. Conclusions The MitraFix TMVR transapical system demonstrated excellent valve function, low mortality, sustained MR elimination and clinical improvement up to one year in this study. Further studies, encompassing a larger cohort of patients and an extended follow-up duration, are needed to confirm these findings.Change in MR and NYHA functional classChange in Quality-of-Life Assessment

Long-standing response to calcium channel blocker therapy on patients with various types of pulmonary hypertension: a systematic review and meta analysis

Abstract Background It is widely acknowledged that the extended use of calcium channel blocker (CCBs) therapy in patients diagnosed with Idiopathic Pulmonary Arterial Hypertension (IPAH), Heritable Pulmonary Arterial Hypertension (HPAH), or Drug- or Toxin-Associated Pulmonary Arterial Hypertension (DPAH) who exhibit a positive acute vasoreactivity test (VdT+) provides benefits to patients. However, this practice is supported by a limited body of evidence in the scientific literature, mainly derived from expert consensus and/or small-scale studies, retrospective analyses, and registries, as per the European Society of Cardiology (ESC) guidelines. Objectives We performed a meta-analysis to evaluate the long-standing response to CCBs in patients diagnosed with various forms of pulmonary hypertension. Design We conducted searches in PubMed, Embase, and Cochrane to select both randomised and non-randomised studies. The primary outcomes of interest identified were Mean Pulmonary Artery Pressure (mPAP), 6-minute walk distance (6MWD), Cardiac Index (CI), Mean Right Atrial Pressure (mRAP), and Mixed venous oxygen saturation (SvO₂) measured at the beginning and end of the studies. Additionally, we performed subgroup analyses for all outcomes based on age groups: ≤18 years and &amp;gt;18 years. Statistical analysis was carried out using OpenMeta[Analyst] 12.11.14, and heterogeneity was assessed using I² statistics. Results We identified 7 non-randomised studies comprising a total of 131 patients with an average follow-up duration of 2.74 (1.3) years. The following are the mean values observed for individual outcomes: mPAP (33.1 mmHg; 95% CI [31.6, 34.6]; p &amp;lt; 0.001; I²=0%), 6MWD (470.1 m; 95% CI [452.6, 487.7]; I²=0%), Cardiac index (3.8 L/min/m²; 95% CI [3.6, 4.0]; I²=0%), mRAP (4.2 mmHg; 95% CI [3.6, 4.8]; I²=0%) and SvO₂ (73.9%; 95% CI [72.5, 75.3]; I²=0%) in patients with positive acute vasoreactivity test (VdT+) treated long-term with CCBs. Additionally, at study initiation, we found the following means: mPAP (51.2 mmHg; 95% CI [49.3, 53.0]; I²=0%), 6MWD (428.4 m; 95% CI [410.3, 446.6]; I²=0%), Cardiac index (2.8 L/min/m²; 95% CI [2.7, 2.9]; I²=0%), mRAP (6.4 mmHg; 95% CI [5.6, 7.2]; I²=0%), and SvO₂ (68.5%; 95% CI [66.5, 70.5]; I²=0%). Conclusion The findings from this meta-analysis suggest that in VdT+ patients, the means of certain haemodynamic parameters with long-standing use of CCBs are similar or nearly similar to those of patients without any subtype of PAH. These results align with current guidelines and reinforce their level of evidence.

Bevacizumab-induced hypertension in patients with glioblastoma: a systematic review and meta-analysis

Abstract Background Bevacizumab is a monoclonal antibody medication used as standard treatment for different types of cancers, one of them is glioblastoma, which is the most common primary brain tumor. Purpose We aimed to assess bevacizumab and its effects on inducing hypertension in patients with glioblastoma. Methods PubMed, Embase and Cochrane databases were searched until February 13th, 2024 for randomized control trials (RCTs) comparing bevacizumab alone with control or bevacizumab in combination with other chemotherapies in patients with glioblastoma. Data was examined using the Mantel-Haenszel method and we computed risk ratio (RRs) for binary endpoints and 95% confidence intervals (Cls). Heterogeneity was assessed using I² statistics. Meta-regression analysis was conducted to evaluate a possible link between the occurrence of hypertension and mortality or progression-free survival. R software version 4.2.3 was used for statistical analysis. Results 5 RCTs and 1 non-randomized study were included with a total of 1402 patients, of whom 608 (43,36%) were assigned to the bevacizumab and 794(56,64%) composed the control group. Compared with bevacizumab, the control achieved statistically significant lower rates of hypertension occurrence (RR 6,31; CI: 2,13 - 18,65; p=0.000872; I²=54%). Subgroup analysis of bevacizumab alone versus bevacizumab in combination with other chemotherapies tended towards the combination group(RR 2,24; CI: 1,19 - 4,21; p= 0.012497; I² = 68%). Mortality was significantly higher in the bevacizumab group (OR 1,60; CI: 1,02 - 2,52; p=0,040443; I²= 0%). Progression-free survival did not reach a statistically significant difference between groups (OR 1,07; CI: 0,33 - 3,43; p= 0,907923; I²= 45%) and meta-regression analysis showed no significant link between hypertension and mortality or progression-free survival. Conclusion Concerning the treatment of glioblastoma, our results showed that induced hypertension is more likely to happen in patients treated with bevacizumab. Significant statistical difference in the mortality was observed between the use of bevacizumab and control. However, the current data is insufficient to determine a link between hypertension and prognostic value through meta-regression analysis.General Analysis

Treatment of Posttraumatic Zygomatic Coronoid Ankylosis. Systematic Review.

Facial trauma is mostly associated with traffic accidents, fights, and sports accidents. The mandible, midface, and temporomandibular joint are usually the region's most frequently affected. Coronoid process fractures are rare, representing ∼2% of facial fractures in the literature, usually being the result of direct trauma to the zygomatic region. Due to the anatomical relationship of the coronoid process, it may be associated with other facial fractures, such as fractures of the zygomatic bone. Zygomatic-coronoid ankylosis is a rare clinical entity with variable etiology. It is most commonly associated with trauma (13%-100%), local or systemic infection (0%-53%), or systemic diseases, such as ankylosing spondylitis, rheumatoid arthritis, or psoriasis. The aim of this research is to evaluate the different treatments for ankylosis from the coronoid process to the zygoma after trauma, allowing to determine the treatment to obtain the best results. A systematic review was carried out following PRISMA "preferred reports for systematic reviews and meta-analyses" search matrix, based on a PICO question; was used PubMed, Embase, Sciencedirect, Cochrane, Google Scholar, and manual search in high-impact journals between 1946 and 2023 publications in English or Spanish, including randomized and nonrandomized clinical trials, prospective and retrospective cohort studies, case-control studies, series, and case reports. A total of 1993 articles were obtained from the 4 databases. After corroborating duplicate articles, 847 articles were excluded. Another 1112 articles were excluded in the title evaluation, and an additional 1093 after the abstract review; a total of 19 articles eligible for full-text evaluation were established and 1 article was added as a result of the manual search. After the full-text review, it was decided to include 16 articles in the study that met the objectives of the systematic review. After evaluating the different treatments described in the literature, the authors can determine that coronoidectomy through an intraoral approach is the most appropriate treatment for zygomatic coronoid ankylosis, accompanied by postoperative physiotherapy to achieve greater oral opening without recurrences.

Including highly educated migrants in academia to improve their health-protocol for a pilot intervention.

Norway's healthcare system needs a diversified work force to meet societal demands for improved cultural competence. However, many migrants in Norway who were educated as health professions in their home countries are not practicing these professions. This may negatively affect their physical and mental health and hinder their personal social integration. Though good health is often seen as a precondition for work, relevant working activities can also improve health. However, including health professionals with foreign education in academic institutions prior to receiving necessary accreditation is a complex task. This study will pilot an intervention aiming to improve health through meaningful integration of these professionals in academic environments. This paper is a protocol for a non-randomized pilot intervention study targeting migrants who are waiting for their health education accreditation in Norway. To test the benefits of meaningful activity on health and explore possibilities for implementing such activity, we have designed a six-month long intervention consisting of including nurses, doctors, and other highly educated migrants with healthcare backgrounds between 20 and 67 years of age, into health-related working tasks, at two higher education institutions in Bergen, Norway. The intervention will be tailored according to the participant's expertise. This hybrid type 2 pilot protocol paper will present how feasibility, fidelity, dose received (satisfaction), and dose of exposure (participation), will be assessed and whether the intervention is experienced as beneficial for the participants' health as primary outcome utilizing both quantitative and qualitative methods. We present a complex, personalized intervention that has the potential for large scale implementation in the future. By thoroughly presenting our designed intervention and assessment methods, this protocol will add to the study's transparency and facilitate replicability and comparison with future studies. This study will be of benefit to the migrants themselves, policy makers, government agencies and academia at large as it can point to a unique and sustainable way of speeding up the integration of highly educated migrants in their respective fields in a new host country.

REDUCE-HF: a stronger heart go a long way

Abstract Introduction/Purpose Heart failure (HF) is a serious cardiovascular condition with a significant global health concern. The risk of heart failure rehospitalisation is high globally and locally, the 30-day HF readmission was about 32% from a local study (1). The study aims to adopt an intensive treatment strategy similar to Strong-HF trial (2) and evaluate rapid up-titration of guideline directed medical therapy (GDMT) and close follow-up will improve patients' outcomes after acute heart failure (AHF). Objectives The Reduction of Decompensation and Unnecessary Cardiac failure Emergency admissions: ambulatory Heart Failure service model (REDUCE-HF) is a non-randomised prospective study evaluating clinical outcome of patients discharged from AHF. Exclusion criteria included primary valvular disorders, end-stage renal failure and metastatic cancer. After HF discharge, eligible patients were recruited into our REDUCE-HF program irrespective of LVEF. They were subsequently managed in our ambulatory HF centre within two weeks, where intensive up-titration of GDMT and close follow-up would be proceeded. The data of our service model will be compared with our 5-year historical cohort. Primary outcome comprised of all-cause mortality and heart failure hospitalisation. Secondary outcome will be comparison of clinical and functional status at baseline and 3-month on follow up. Results Between October 2022, and December 2023, 245 patients were successfully recruited into our REDUCE-HF service model. Historical cohort of 6867 patients with primary diagnosis of acute heart failure were served as control (usual care pathway), data extracted from 2018 to 2022. Their mean age was 67.8+/-12.2 and 72.2%were male. 60% of them were HFrEF (EF&amp;lt;=40%) and 28% were ischaemic cardiomyopathy. The mean follow up period was 3 months. At 90 days, REDUCE-HF cohort group has shown much lower all-cause mortality than usual care group (2.5% vs 9.3%, HR 0.26, 95% CI 0.18-0.41, p&amp;lt;0.001). There was a much lower incidence of heart failure hospitalisation in REDUCE-HF group as compared to control (8.6% vs 13.1%, HR 0.65; 95% CI 0.55 to 0.74, p&amp;lt;0.01). In secondary outcome, there was significant reduction of NT-ProBNP of 45.2% (from 4229 to 2319pg/m, p&amp;lt;0.001), tremendous increment of 6-minute walk test (from 211 to 250m, p&amp;lt;0.001) and remarkable improvement of KCCQ score from 55.1 to 86.7, p&amp;lt;0.001. The overall LVEF was significantly increased from 39% to 44%, p&amp;lt;0.05. The positive outcome were attributed to good adherence to GDMT: ACEi/ARB/ARNI 91%, Betablocker 90.3%, MRA 72.4% and SGLT2i 95.5%. Conclusion The REDUCE-HF ambulatory service model has been proven effective in reducing mortality, decompensation and preventing unnecessary heart failure hospitalisation in this prospective study. By intervening proactively, this model not only enhances the quality of life but also hold promise in alleviating the burden of in-patient services on heart failure.