Prospective Clinical Analysis Research Articles

BT09 Multicentre prospective clinical performance analysis of an artificial intelligence as a medical device deployed within urgent suspected skin cancer pathways

BT09 Multicentre prospective clinical performance analysis of an artificial intelligence as a medical device deployed within urgent suspected skin cancer pathways

Postoperative Benefits of Soft Tissue Wrist Arthroscopy: Retro- and Prospective Analyses of Outcome Measures.

Background: Elective soft-tissue-only wrist arthroscopy is a standard procedure in hand surgery for the diagnosis and treatment of wrist pain. A number of pathologies can be treated arthroscopically, with the aim of pain reduction and improved wrist mobility. A postinterventional evaluation of the treatment using objective and patient-reported outcome measures (PROMs) allows for an evidence-based statement about the benefits of soft-tissue-only wrist arthroscopy. Methods: A dual-center study combining retro- and prospective clinical analyses of patient outcomes after soft-tissue-only wrist arthroscopies was performed. The data were collected at two hospitals with departments specializing in hand surgery. The outcome was measured by assessing the range of motion of the wrist and its manual strength, as well as PROMs, including Disabilities of the Arm, Shoulder and Hand (DASH) scores. Results: A total of 154 soft interventions met the study criteria and could be included. Seven months after the elective soft-tissue-only wrist arthroscopies, mobility improved significantly for active extension and flexion, as well as the ulnar and radial abduction of the wrist. The grip strength also improved significantly, by an average of 6 kg, during this period. The DASH score improved significantly, from 35 points to 14 points. Additionally, wrist pain at rest was reduced significantly. Conclusions: After elective soft-tissue-only wrist arthroscopy, patients showed an overall functional improvement in their wrist, with a significant reduction in pain and improvement of mobility and grip strength. This study emphasizes the importance of wrist arthroscopy as a successful treatment option for soft tissue pathologies of the wrist.

Heterozygous Pyrin (MEFV) E148Q allele carriers indicate a reduced glaucoma risk for Turkish population: a prospective clinical analysis

ABSTRACT Purpose The MEFV gene encodes pyrin, a protein linked to increased severity of symptoms in Familial Mediterranean Fever (FMF). We consider that inflammation due to MEFV variants would increase eye inflammation and damage aqueous humor regulation. The present study is the first analysis investigating a MEFV (E148Q) variant as a marker protecting from glaucoma. Methods In this prospective clinical analyze, we performed detailed gene sequencing focusing on 22 specific regions of the pyrin (MEFV) gene. The study involved two distinct groups: individuals diagnosed with glaucoma (n = 200) and control subjects without glaucoma (n = 100). Both groups were carefully selected to exclude individuals with symptoms or a previous diagnosis of Familial Mediterranean Fever (FMF). The diagnosis of glaucoma for each participant was rigorously established through comprehensive direct ophthalmic examinations. Results A significant odds ratio for protection against glaucoma was found in carriers of the subclinical E148Q allele (OR:2.22; 95%CI: 1.098–4.485). No significant differences were found for other variants. One mutant E148Q-allele could decrease the probability of glaucoma development by approximately 68,9%. We observed no differences in the genotype frequency between glaucoma and healthy for the other MEFV gene variants. Conclusion The pyrin variant of the MEFV gene resulting in a subclinical phenotype appears to reduce the incidence of glaucoma, and heterozygous pyrin (MEFV) E148Q allele carriers confer protection against glaucoma. It is important to consider the limitations arising from the relatively small number of studies conducted on this topic.

Self-Shielding Gyroscopic Radiosurgery: A Prospective Experience and Analysis of the First 100 Patients.

Background Stereotactic radiosurgery is a well-established treatment option for the management of various benign and malignant brain tumors. It can be delivered with several treatment platforms, usually requiring shielded radiation vaults to meet regulatory safety requirements. Recent technical advances have led to the first self-shielding platform enabling the delivery of gyroscopic radiosurgery (GRS). Given the limited number of GRS treatment platforms, the novelty of its characteristics, and the lack of available data, we report our prospective experience with the first 100 patients treated with GRS. Materials and methods Patients undergoing GRS for the treatment of intracranial tumors were enrolled in this prospective study. Patient and treatment characteristics, including patient satisfaction, were collected and analyzed. Results A total of 100 patients with 155 tumors were treated. The most commonly treated tumors comprised brain metastases (BM) (49%), vestibular schwannomas (31%), and meningiomas (14%). The median prescription dose for malignant and benign tumors was 20 and 13 Gy, respectively. The median prescription isodose line was 56%. Gross tumor volumes were small, with a median of 0.37 cc for BM and 0.92 cc for the other entities. The median total treatment time was 40 minutes. Dosimetric performance indices showed median values of 1.20 (conformity index), 1.24 (new conformity index), 1.74 (homogeneity index), and 3.13 (gradient index). Volumetric assessment of the treated tumors showed an overall decrease in size at the first available follow-up. Most patients were satisfied with the treatment experience. Conclusion Our first prospective experience of the use of GRS is favorable. Analyses of the dosimetric performance, treatment times, volumetric assessment, and patient satisfaction demonstrate its suitability for stereotactic treatments of intracranial tumors. Further prospective clinical and dosimetric analyses for GRS are pending.

A prospective clinical and biomechanical analysis of feet following first metatarsophalangeal joint arthrodesis for end stage hallux rigidus

BackgroundHallux Rigidus is the result of degeneration of the 1st metatarsophalangeal joint (1st MTPJ). In end-stage hallux rigidus, treatment is mainly surgical with arthrodesis being a favourable option. Although the biomechanical effects of arthrodesis have been examined, a detailed comparison of pre- and post-operative biomechanics has yet to be conducted. Research QuestionDoes 1st MTPJ arthrodesis positively affect foot kinematics and plantar pressure distribution? MethodsTwelve 1st MTPJ arthrodesis were performed in patients with a mean age of 53.5 ± 5.4 years and follow up time of 6.9 ± 1.0 months. Pre- and post-operative data were collected at a CMAS (Clinical Movement Analysis Society) accredited gait laboratory using a BTS motion capture system and pedobarographic pressure plates. Patient outcome measures were also assessed using the MOXFQ. Statistical analysis was conducted using a two-way repeated measures ANOVA. ResultsSignificant changes in stride length, cycle duration, cadence and velocity were identified following 1st MTPJ arthrodesis. A significant reduction in forefoot-hallux dorsiflexion at toe-off was identified for the operated foot from the pre-operative (20.23 ± 5.98°) to post-operative (7.56 ± 2.96°) assessment. Post-operative sagittal and transverse plane changes in the operated foot were also identified. Peak pressure and PTI results indicated significant lateralisation of load for the operated foot, but importantly this was not influenced following arthrodesis. Finally, there was a significant improvement in MOXFQ score. SignificanceFollowing 1st MTPJ fusion there is an improvement in overall gait mechanics which accompanied by the improved MOXFQ score indicates a reduction in pain and improved confidence during gait. The lack of post-operative dorsiflexion at forefoot-hallux caused load to remain lateralised and compensatory mechanisms to occur at the more proximal joints within the foot. These results provide valuable information for clinicians and will enable more accurate counselling to be provided to patients with end-stage hallux rigidus.

Evaluation of Risk Factors for the Occurrence of Limb Fractures in Children Due to Unintentional Injury in Podgorica, Montenegro, Mediterranean.

Background and Objectives: Limb injuries in childhood are very common, with most of them being unintentional and often accompanied by soft tissue injuries. The aim of our study was to determine the risk factors that contribute to the occurrence of limb fractures as the most common type of accidental injury to children in our conditions. Materials and Methods: This study was designed as a prospective clinical analysis of predictive factors with a "nested" case-control study. It included all patients under the age of 18 who were diagnosed with unintentional limb injury and limb fracture due to accidental injury, at the Clinical Center of Montenegro, Podgorica, in the period of 7 January 2020-30 June 2021. Results: The gender of the child and the occurrence of the fracture are not related, and a statistically significant relationship was found between the occurrence of the fracture and the place of residence, the child's age, body mass index (BMI), the affected limb, the method of injury, and the mental state of the parents of the injured child, as well as their economic status. It was proved that the older the child was, the lower the chance of injury, while multivariate analysis proved that BMI could be a predictor of accidental fracture. The most common method of accidental limb fractures in children was a fall from a height. Conclusions: The analysis of factors that influence the occurrence of children's injuries is of great importance for public health. Such and similar research can enable a better understanding of the factors that influence accidental injuries, and therefore influence the prevention of these injuries by organizing various educational materials at the primary healthcare level or at the school level, for both children and parents.

Функціональний стан фетоплацентарного комплексу у вагітних із HCV-інфекцією

Purpose - to study the functional state of the fetoplacental complex (FPC) during pregnancy in women with hepatitis C virus (HCV infection). Materials and methods. A prospective clinical and statistical analysis of the functional state of the FP during pregnancy in 40 women (main group, MG) with HCV infection was conducted on the basis of the Kyiv City Center of Reproductive and Perinatal Medicine for the period 2020-2021. The control group (CG) consisted of 50 healthy pregnant women. Statistical processing of research results was carried out using standard programs Microsoft Excel 5.0 and Statistica 8.0. Results. The hormonal status of FPK in MG of pregnant women, starting from the 18th week, was characterised by a significant decrease in the secretion of progesterone (PG) (159.314.6 nmol/l in MG versus 205.44.8 nmol/l in CG; p<0.05) and human chorionic gonadotropin (39.24.6 mIU/mL versus 52.85.3 mIU/mL, respectively). Estradiol (E2) levels in MG of pregnant women from the 18th week of pregnancy were significantly lower (26.32.7 nmol/l) than in CG of pregnant women (33.71.4 nmol/l, p<0.05). A synchronous decrease in the level of PG and E2 was observed in the case of threatened abortion against the background of bloody discharge, which indicated clinical manifestations of placental dysfunction (PD). In MG of pregnant women, the level of placental lactogen (PL) at week 18 was almost the same (80.913.2 nmol/l) compared to CG of pregnant women (79.57.1 nmol/l; p>0.05). From the 29th week, the level of E2 in MG of pregnant women is significantly different from CG (25.61.3 nmol/l in MG versus 51.20.7 nmol/l in CG; p<0.05). The most pronounced difference was the level of estriol (E3) and cortisol (Cr) in blood serum relative to CG in MG of pregnant women, which was manifested by a decrease in the level of E3 (up to 86.4±5.2 nmol/l in MG versus 98.42.6 nmol/l in CG; p<0.05) against the background of a simultaneous increase in Cr content (up to 751.118.6 nmol/l in MG versus 625.618.4 nmol/l in CG; p<0.05). Endocrinological disorders also changed before delivery (39-40 weeks): the E2 level decreased (to 45.41.9 nmol/l in MG versus 65.30.6 nmol/l in CG; p<0.05), E3 (up to 28.32.0 nmol/l versus 57.81.8 nmol/l, respectively; p<0.01), PG (up to 499.4±11.6 nmol/l versus 604,216.3 nmol/l, respectively; p<0.05) and PL (up to 201.4±12.4 nmol/l versus 63.418.8 nmol/l, respectively; p<0.05) and the Cr content increased (up to 812.4±16.7 nmol/l versus 651.614.6 nmol/l, respectively; p<0.01). Conclusions. The functional state of the FPC in pregnant women with HCV infection, on the eve of delivery, is characterized by a high level of premature maturation of the placenta, changes in the volume of amniotic fluid, due to which significant hemodynamic and endocrinological subcompensated disorders appear, but in some cases they are decompensated, which causes disorders from the functional state of the fetus and the high frequency of development of fetal growth retardation syndrome in this group of women. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the paper. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

ROLE OF TETRACYCLINE IN CORNEAL NEOVASCULARIZATION

Purpose: To nd the efcacy of topical tetracycline in corneal neovascularization. Material and Methods: In this prospective observational clinical analysis, patients more than fteen year's age of either sex were enrolled. Anterior segment slit lamp examination was performed. Fluorescein 1% dye and rose bengal were used to stain cornea at the bed and margins simultaneously. The area of corneal vascularization was measured in mm using 0.5% uorescein dye. The percentage of neovascularized corneal areas to the entire cornea was calculated. Result: Out of twenty eight patients, twenty one completed follow up period of four months. Among 21 patients, males were 10 (47.6%) and females 11 (52.38%) with unilateral and bilateral corneal neo-vascularization. 15 (71.42%) responded well and showed reduction in corneal new vessels from 7 mm pre-treatment to 2 mm (overall) post treatment at the end of fourth month. Six patient showed poor or no response due to extended brosis. Conclusion: Topical tetracycline has remained quite instrumental in reducing supercial epithelial and sub-epithelial corneal new vessels.

Assessment of the Effectiveness of Knee Joints Treatment With the Use of 90 Y : Prospective Ultrasound and Clinical Analysis.

The purpose of this prospective study was to assess the effectiveness of knee joints treatment by radiosynoviorthesis with the use of 90 Y based on ultrasound and clinical analysis. Ninety-seven patients were qualified for treatment from October 2016 to June 2017, and observation period lasted until December 2017. Bioethics Committee of the Medical University of Silesia approved this study. The effectiveness of knee joints treatment with the use of 90 Y was based on 927 ultrasound measurements of fluid and 927 synovial thickness in 3 sites of the suprapatellar recess, 309 assessments of patient's disability documented in Lequesne questionnaire, 309 assessments of pain on visual analog scale, as well as 103 overall self-assessment. Statistical methods were used to process the results. A reduction in fluid was found in 62.14% of the knees; synovial thickness reduction was observed in 97.09% of all knees. The greatest benefit from the therapy was experienced by patients complaining of morning stiffness lasting more than 15 minutes (in 85.71% of joints). There was reduction in pain at rest in 94.52% of knee joints and in 80.39% of joints with pain while walking. At the second follow-up visit after treatment, the percentage of improvement in self-assessment was 74.76%. Statistically significant decreases in the amount of fluid and thickness of the synovial membrane as well as the level of disability and the intensity of pain after radiosynoviorthesis 90 Y treatment were demonstrated.

Стан здоров’я новонароджених від матерів із HCV-інфекцією

Purpose - to study the health status of newborns from mothers with viral hepatitis С (HCV infection). Materials and methods. A prospective clinical and statistical analysis of the health status of 40 newborns born to mothers with HCV infection (the main group - MG) and 50 newborns born to healthy women (the control group - CG) was performed. The statistical processing of the study results was carried out using standard software Microsoft Excel 5.0 and Statistica 8.0. Results. In children of MG compared to children of CG had a lower Apgar score at birth (p<0.001). An Apgar score ˂7 points in 15.0% (6/40) of newborns of MG (F=4.61; p=0.032) was diagnosed, which was significantly higher than in newborns of CG - 4.0% (2/50), (р<0.001). The frequency of conjugated jaundice in newborns of CG was 4.0% (2/50), while in children of MG it was 17.5% (7/40) (χ2=7.97; p=0.005). Correlation analysis revealed that the Apgar score has medium strength positive correlations with body length (τ=0.266; p<0.001), and the development of conjugated jaundice in newborns has medium negative correlations with these physical parameters at birth as body weight (τ=-0.302; p<0.001) and body length (τ=-0.306; p<0.001), as well as with Apgar score (τ=-0.302; p<0.001) and gestational age at birth (τ=-0.249; p<0.001). Conclusions. The condition of newborns from women with HCV infection is characterized by lower parameters of physical development and a decrease in Apgar score, increased frequency of development of conjugation jaundice. Physical and clinical parameters of newborns from mothers with HCV infection were related to pathological conditions during pregnancy and delivery. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the author.

Single-centre prospective clinical and procedural analysis identifying causes of delay to haematopoietic stem cell transplant in MPS I (Hurler syndrome) patients

Single-centre prospective clinical and procedural analysis identifying causes of delay to haematopoietic stem cell transplant in MPS I (Hurler syndrome) patients

The blinq™ Vision Screener in Detection of Amblyopia and Strabismus

The blinq (Rebion Inc) is a new screening device designed to directly detect amblyopia and strabismus rather than amblyopia risk factors. We performed an independent assessment of the effectiveness of the blinq in detecting amblyopia and strabismus. Prospective clinical validity analysis of a screening device based on sensitivity and specificity. Children presenting for examination in the pediatric ophthalmology clinic underwent screening with the blinq before examination by a pediatric ophthalmologist blinded to the screening results. Results of the blinq and examination findings of strabismus or amblyopia were compared. In our cohort of 267 children with an average age of 6.3 years, the sensitivity of the blinq to detect amblyopia or any constant strabismus was 87.5% (78.2%-93.8%) and specificity was 51.3% (43.9%-58.7%). Using the previously described "appropriate referral gold standard" criteria, including children with intermittent strabismus and high refractive error, the sensitivity increased to 91.3% and the specificity to 63.2%. We found a high number of children (44 [16%]) upon whom the blinq timed out and were included as automatic referrals. Our results support use of the blinq as a screening device to detect amblyopia and strabismus in children.

Клінічний перебіг вагітності, пологів та стан плаценти в жінок із HCV-інфекцією

Purpose - to conduct a prospective clinical and statistical analysis of the course of pregnancy, childbirth and placental condition in women with hepatitis C virus (HCV-infection). Materials and methods. A prospective clinical and laboratory study of the course of pregnancy, childbirth and placental condition in 40 pregnant women with HCV infection (the main group - MG) was conducted on the basis of the Kyiv City Centre for Reproductive and Perinatal Medicine for the period 2020-2022. 50 healthy pregnant women formed the control group (CG). Statistical processing of the study results was performed using standard software Microsoft Excel 5.0 and Statistica 8.0. Results. The course of pregnancy in women of MG in the trimester I was 2 times more often complicated by early toxicosis compared with women of CG - 3 (7.5%) vs. 2 (4.0%) cases, respectively; p>0.05. The threat of pregnancy termination was 4.3 times more frequent in pregnant women of MG compared with women of CG - 7 (17.5%) vs. 2 (4.0%) cases, respectively; p<0.001. Gestational anemia occurred in 1/3 of pregnant women of MG, which was significantly higher than in pregnant women of CG - 12 (30.0%) vs. 6 (12.0%) cases, respectively; p<0.001. Pregnancy edema (mainly in the trimester III) was detected in pregnant women of MG 4.3 times more often than in pregnant women of CG - 13 (32.5%) vs. 4 (8.0%) cases, respectively; p<0.001. Conclusions. Pregnant women with HCV infection are characterized by a significant increase in the following complications, in particular, during pregnancy: threat of abortion, threat of preterm birth, gestational anemia, placental dysfunction, fetal growth retardation syndrome, preeclampsia; during labor: premature and prenatal amniotic fluid discharge, preterm birth, weakness of labor activity. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patients was obtained for conducting the studies. No conflict of interests was declared by the author.

Translational perspective on bone-derived cytokines in inter-organ communications

Translational perspective on bone-derived cytokines in inter-organ communications

Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a prospective clinical trial and comparative analysis

BackgroundOpen cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with high morbidity, which limits the degree to which patients may benefit from this therapy. This study aimed to determine the feasibility of laparoscopic CRS/HIPEC.MethodsThis was a single institution prospective clinical trial and comparative study using historical controls. Patients with histologically confirmed peritoneal surface malignancy (PSM) of appendiceal, colorectal, ovarian, or primary peritoneal origin, peritoneal carcinomatosis index (PCI) le 10 were eligible.ResultsClinical trial: 18 patients (median age 57 years, 39% female) with appendiceal (15) or colorectal (3) primary PSM underwent laparoscopic CRS/HIPEC. Median and range outcomes were: operative time 219 min (134–378), EBL 10 mL (0–100), time to return to bowel function 3 days (1–7), duration IV narcotic use 3 days (1–8), length of stay 6 days (3–11). All patients had a complete cytoreduction (CC-score 0). Three (17%) experienced minor morbidity, with no major morbidity or mortality. Median DFS and OS were not reached with median follow-up of 48 months. Comparative analysis: Laparoscopic approach associated with reduced time to return of bowel function (3 versus 4 days, p = 0.001), length of stay (8 versus 5 days, p < 0.001), and morbidity (16% versus 42%, p = 0.008). Independent predictors of DFS included prior chemotherapy (HR 5.07, 95% CI 1.85, 13.89; p = 0.002), and CC-score > 0 (HR 3.31, 95% CI 1.19, 9.41; p = 0.025), but not surgical approach. CC-score > 0 was the only independent predictor of OS (HR 10.12, 95% CI 2.16, 47.30, p = 0.003).Conclusions and relevanceLaparoscopic CRS/HIPEC should be considered for patients with PSM with low-volume disease, including those with adenocarcinoma histology.Trial registrationClinicaltrials.gov; NCT02463877.

Subaxial cervical spine ligamentous instability anterior versus posterior fixation: prospective nonrandomized study

BackgroundThe goals of cervical internal fixation are to provide immediate stability to control an unstable segment and to improve bony union. Early cervical fixation methods preferred a posterior approach and consisted of simple wire and cancellous bone graft. Later, anterior, and posterior fixation became recent additions to surgeon’s armamentarium.ObjectivesComparing between anterior and posterior fixation in cervical subaxial ligamentous subluxation regarding the applicability, safety, and clinical efficacy in achieving stability and enhancing bony union. Also cost-related variables are studied.MethodsThis prospective clinical and radiographic analysis was performed on 40 patients with cervical subaxial ligamentous subluxation. Half of these patients were treated with anterior cervical fixation and interlocking screws with inter-body cage fusion. The other half was treated by posterior fixation with lateral mass fixation and inter-facet bone fusion.ResultsThere were 27 male and 13 female patients with mean age 37.4 years. The level of cervical dislocation was C4–5 in four, C5–6 in 14, C6–7 in 20 and more than one level in two patients. Closed reduction was achieved in 33 patients while open reduction through the posterior approach was done in four cases and through anterior approach in other three cases. Statistically significant difference between the two groups was found for estimated blood loss and operating room time with better results in the anterior group. There were no perioperative deaths in both groups. Regarding surgery-related complications, there was injury to a cervical root during posterior fixation in two cases. There was no statistical difference between the two groups regarding the length of the hospital stay. The mean hospital stay was 7 days. Positioning of the plate and screws in all cases was satisfactory. All patients were followed up for at least 6 months. Mean follow-up period was 13 months. Vertebral body alignment (radiological stability) was achieved in all cases with anterior fixation while one case with posterior fixation showed delayed subluxation. Solid bony cage fusion was found in 85% with anterior fixation and solid bony fusion in 70% with lateral mass fixation.ConclusionsAlthough some of the literature have indicated that posterior fixation in ligamentous cervical subaxial injury is more solid than anterior fixation, yet most of these studies were done on cadaver subjects so eliminating any bony fusion, long-term stability, and hardware failure. This study proved that anterior cervical fixation is not only safer and simple procedure than posterior fixation, but also it restores the cervical stability better than the posterior fixation.

Cutaneous Manifestations In the Patients With Covid 19: A Prospective Clinical Analysis

Introduction: The COVID-19 pandemic has become a major health care issue worldwide. The surge in cases was seen in the second wave, with more people getting hospital admissions. An accurate and rapid identification of cutaneous manifestations is vital to early diagnosis and better prognosis. The aim of the study was to determine cutaneous manifestations in patients with COVID-19. Materials and Methods: This prospective observational cross-sectional hospital-based study was conducted from June 2021 to September 2021. Patients admitted to the hospital were examined by the dermatologists. All inpatients diagnosed with COVID-19 with RT PCR were included. Types, patterns and how the skin lesions changed its course during illness were recorded. Ethical clearance was taken from IRC. Statistical analysis was done with SPSS Version 20.0. Results: A total of 452 COVID-19 RT-PCR-positive patients were enrolled out of which 97(21.5%) had skin lesions. Out of 131 comorbid patients, 40(30.5%) had skin lesions. Urticarial wheals and erythema nodosum were seen in 21(4.6%) each and were the most common manifestation, followed by exanthema in 17(3.8%). Conclusion: Study showed maximum patients with COVID-19 had urticaria and erythema nodosum. It is important to know the types of skin lesions for early diagnosis. In order to prevent the spread patient can be sent for investigations on time. More elaborate studies with multicenter involvement are recommended.

Pterygium management and comparison of different surgical approaches with supportive treatment in Rural Maharashtra

BACKGROUND: Numerous surgical procedures and changes have been ineffective in preventing the recurrence of pterygium. A prospective clinical observational analysis of 205 individuals with primary pterygium was conducted where patients were treated with various surgical procedures. The patients were observed for two to five years in order to examine the frequency of recurrences and consequences. RESULT: Patients were divided into four groups and treated using a variety of surgical methods. Straightforward excision of pterygium was the treatement of choice in group 1. Excision with conjunctival rotation pedicle graft was used on patients in Group 2. Excision and conjunctival autograft were used to treat Group 3 patients. Patients in Group 4 received excision and a 0.02 percent solution of mitomycin c drops as a postoperative treatment. Age varied from 22 to 58, with a median of 34. All four groups had an equal number of men and women. Hemorrhage, astigmatism, symblepheron, foreign body feeling, and a corneo-scleral ulcer were among complications that were reported. There were 12 percent complications in group 1, 16 percent complications in group 2, 6 percent complications in group 3, and 8 percent complications in group 4. Criteria for recurrence was defined as the regrowth of fibrovascular tissue or the appearance of an aesthetic flaw. It's 30 percent for group 1; 14 percent for group 2, 9 per cent for group 3, and 8 per cent for group 4. CONCLUSION: The least rate of recurrence was noted in patients of Group 4 who had pterygium excision with postoperative mitomycin c instillation, and complications were least common in patients in Group 3 who had pterygium resection with conjunctival autograft..

Laboratory risk indicator for necrotizing fasciitis: an objective scoring system as a tool for early diagnosis of necrotizing fasciitis

Background: Necrotizing soft tissue infections are often fatal, characterized by extensive necrosis of the subcutaneous tissues and fascia. The mortality of 30-40% reflects the inadequacy of early recognition of necrotizing soft tissue infections. This study emphasizes on the search for a tool that reliably and rapidly identifies patients with NF. An objective of current study was to validate the LRINEC score as a tool for early distinguishing of necrotizing fasciitis from other soft tissue infections.Methods: Prospective clinical study analysis of outcome of sixty of patients with soft tissue infections were evaluated based on LRINEC. Based on their LRINEC score, the patients were categorized as low, intermediate and high risk for the onset of necrotizing fasciitis.Results: A total of 60 patients with soft tissue infections were prospectively evaluated and categorized on the basis of LRINEC score 45 patients in low risk category, 7 in Intermediate risk and 8 patients in high risk group. In terms of outcome, all cases (including positive tissue diagnosis cases) in low risk and intermediate risk groups and 2 cases in high risk group were improved with surgical debridement/fasciotomy. The cutoff of LRINEC ≥6 has better sensitivity and specificity in identifying the risk of the patient.Conclusions: LRINEC scoring system has a better positive predictive value in identifying the onset and risk strategizing of necrotizing fasciitis.

Novel Clinical Biomarkers for Drug-Induced Liver Injury.

Drug-induced liver injury (DILI) remains a critical clinical issue and has been a treatment challenge today as it was in the past. However, the traditional biomarkers or indicators are insufficient to predict the risks and outcome of patients with DILI due to its poor specificity and sensitivity. Recently, the development of high-throughput technologies, especially omics and multiomics has sparked growing interests in identification of novel clinical DILI biomarkers, many of which also provide a mechanistic insight. Accordingly, in this minireview, we summarize recent advances in novel clinical biomarkers for DILI prediction, diagnosis, and prognosis and highlight the limitations or challenges involved in biomarker discovery or its clinical translation. Although huge work has been done, most reported biomarkers lack comprehensive information and more specific DILI biomarkers are still needed to complement the traditional biomarkers such as alanine aminotransferase (ALT) or aspartate transaminase (AST) in clinical decision-making. SIGNIFICANCE STATEMENT: This current review outlines an overview of novel clinical biomarkers for drug-induced liver injury (DILI) identified in clinical retrospective or prospective clinical analysis. Many of these biomarkers provide a mechanistic insight and are promising to complement the traditional DILI biomarkers. This work also highlights the limitations or challenges involved in biomarker discovery or its clinical translation.