Prospective Comparative Study Research Articles

Axilla Reconstruction Post Burn Contracture: Thoracodorsal Artery Flap Versus Local Flap and Skin Grafts

Background: Burns are a prevalent worldwide morbidity that frequently results in contractures that impede function and appearance, especially in the axilla, which has a major impact on upper limb mobility. Aim: To compare the functional results of local flaps with skin transplants versus Thoracodorsal artery flaps for axilla repair following burn contracture. Methods: A prospective comparative study was conducted. In the Department of Plastic and Reconstructive Surgery, thirty patients were split into two groups for a prospective comparative study. Group B underwent local flaps utilizing skin grafts, whereas Group A underwent thoracodorsal artery flaps. An analysis was conducted on pre- and post-operative shoulder joint abduction, complications, and demographic factors. Result: The two groups' post-operative shoulder abduction did not significantly differ, according to the results; however, younger patients and those with concomitant conditions including diabetes and hypertension were more likely to benefit from thoracodorsal artery flaps because of increased vascularization. The study discovered that middle-aged individuals typically had local flaps, but younger patients frequently had thoracodorsal artery flaps. Though not statistically significant, the gender distribution revealed a trend with more males obtaining local flaps and more females receiving thoracodorsal artery flaps. Thoracic dorsal artery flaps were substantially more common in patients with diabetes and hypertension. Practical Implication: The higher prevalence of thoracodorsal artery flaps in patients with diabetes and hypertension underscores importance of choosing flaps that provide better vascular support for patients with compromised vascular health. Conclusion: The findings highlight the significance of considering patient-specific criteria when choosing a flap, as thoracodorsal artery flaps provide better vascular support and are advantageous for patients with compromised vascular health. These results emphasize the need for customized surgical planning to improve results in post-burn contracture axilla repair. To enhance patient care and further improve surgical protocols, future research should concentrate on long-term results.

A Comparative Analysis of Single Versus Multiple Arterial Grafts in Coronary Arterial Bypass Grafting: Initial Experience in Iraq.

The global recognition of multiple arterial grafting (MAG) and total arterial grafting (TAG) in coronary artery bypass grafting (CABG) is increasing. However, many centers have not yet adopted these procedures. Our study aims to examine the intraoperative, early postoperative, and two-year follow-up outcomes associated with MAG and TAG in candidates for CABG. The goal is to provide valuable insights into the role of these procedures. A prospective comparative study was conducted at Sulaimani Cardiac Hospital to analyze a cohort of 300 patients who underwent CABG surgery between January 2021 and April 2022. Convenience sampling was used to select participants. Prior to surgery, patients underwent comprehensive pre-operative evaluations, with certain CABG types being excluded. The patients were then categorized into three groups based on their surgical approach: single arterial conduit (SA), two arterial conduits (MA), and total arterial revascularization (TA). The standard bypass procedure was performed for all patients, and they were monitored for 30 days, six months, and two years after the surgery. A range of variables, including bypass and cross-clamp times, as well as postoperative complications such as bleeding and stroke, were recorded and analyzed. Statistical Product and Service Solutions (SPSS, version 25; IBM Corp.,Armonk, NY) was used for this analysis, with a predetermined significance threshold of p ≤ 0.05. The study included 300 participants who underwent CABG. The participants had an average age of 61.19 ± 4.67 years (95% CI: 36-81) and an average BMI of 27.40 ± 8.4 kg/m² (95% CI: 18-45). Diabetes was present in 40.3% of the patients, and the majority of the participants were male (77.7%). The number of vessels involved in the bypass varied, with two vessels in 21% of cases, three vessels in 65%, and four vessels in 14%. The left internal thoracic artery (LITA) was primarily used for arterial revascularization, and additional arterial conduits were used in 30.3% of cases. Statistical analysis showed significant differences in the number of grafts among patient groups (P = 0.042). However, there were no significant differences in bypass duration, cross-clamp duration, stroke incidence, or in-hospital mortality rates among the groups (P > 0.05). The rates of myocardial infarction (MI) approached significance (P = 0.05), and the mortality rates were comparable over a two-year period after CABG (4.7%) and at shorter intervals. These findings highlight the importance of age and the number of grafts in determining outcomes in CABG patients. In a developing nation, the lack of a specialized center for MAG does not hinder the implementation of MAG or TAG. The overall occurrence of complications after CABG is similar across all groups, except for MI. Patients who undergo MAG have higher rates of overall survival compared to those who receive SA and TAG.

Comparison of surgical site infection in patients undergoing laparoscopic cholecystectomy with or without prior ERCP.

Objective: To compare the risk of surgical site infections in patients undergoing laparoscopic cholecystectomy with or without prior ERCP. Study Design: Prospective Comparative study. Setting: Surgical Unit-I of Holy Family Hospital, Rawalpindi. Period: December 2021 to May 2022. Methods: Total 140 patients were included. Group A had ERCP before their laparoscopic cholecystectomy. Those, who had laparoscopic cholecystectomy without first undergoing ERCP included in Group B. For this study, we used SPSS to analyze the data we gathered (version 23.0). Two groups were compared for surgical site infection using the Chi-square test. The level of significance was set at P 0.05. Results: Total 140 patients with biliary tract disease (choledocholithiasis, cholangitis and cholelithiasis) were enrolled in this study. In group-A, there were 16(22.9%) males and 54(77.1%) females, while in Group-B, there were 14(20.0%) males and 56(80.0%) females. In patients with prior ERCP group, 28(40.0%) developed surgical site infections, while in patients without ERCP group, 13(18.6%) developed surgical site infections with a p-value of 0.005, which is statistically significant. Conclusion: An increase in the incidence of SSI following laparoscopic cholecystectomy by two- fold is connected with pre-operative (ERCP) so we plan to assess if this technique is linked to a higher risk of wound infection after surgery. we suggest that long term use of antibiotics can reduce the rate of SSI and longer stay of patients in hospital.

Immature Platelet fraction (IPF) in preeclampsia: A prospective comparative study

Immature Platelet fraction (IPF) in preeclampsia: A prospective comparative study

Introduction and Validation of Low-Cost Ocular Biometry in Healthy and Cataractous Eyes Using a Thermally-Tunable Swept-Source Laser

To introduce and validate a novel substantially lower-priced and rapid swept-source investigational optical biometer in healthy and cataractous eyes, employing a thermally tuned laser diode used extensively in cell-phones and data communication as an alternative swept-source. Prospective accuracy, validity, and reliability analysis. Sixty eyes of 59 subjects (twenty-nine eyes of 29 healthy subjects and thirty-one eyes of 30 cataract patients) were enrolled in a prospective comparative study at the Vienna General Hospital between August 2021 and April 2023. Averaged intraocular distances were acquired in 2.5 seconds from datasets consisting of 5000 consecutive A-scans at a single position by a low-cost swept-source optical biometry (SSOB) system. Instrument repeatability was assessed via standard deviations (SDs) and coefficients of variation (COVs) of parameters such as axial length (AL), anterior chamber depth (ACD), lens thickness (LT), and central corneal thickness (CCT). Healthy subjects and cataract patients were subsequently measured on the same day with the SSOB and a referential partial coherence interferometry (PCI) biometer (IOL Master 500, Zeiss, Jena, Germany) to establish AL inter-device correlation (r) for instrument calibration. AL and ACD as shared parameters between both biometers were evaluated for their limits of agreements (LoA) using Bland-Altman analysis. Repeated measurements of AL, ACD, LT, and CCT revealed SDs of 18 µm, 12 µm, 12 µm, and 10 µm, respectively. All parameters except for CCT had a COV < 1%. Except for 1 eye with white cataract, 59 eyes of 59 study participants with various degrees and types of cataract could be measured with both devices. AL inter-device correlation was excellent (r=>0.99). The 95 % LoAs between both biometers were -0.14 to 0.13 mm for AL and -0.28 to 0.25 mm for ACD. Optical biometry using a thermally-tunable VCSEL swept source light source has the potential to provide clinically relevant biometric parameters at an unprecedented 100-fold lower price point than currently employed state of the art optical biometers, paving the way for compact devices in remote care settings.

Comparative Study of Endoscopic Transcanal Tympanoplasty and Tympanoplasty by Conventional Postaural Approach in a Tertiary Care Hospital in Central India.

Background Chronic otitis media (COM) often necessitates tympanoplasty to repair the tympanic membrane. While conventional postaural tympanoplasty (PA) is well-established, endoscopic transcanal tympanoplasty (ET) is gaining traction for its minimally invasive benefits. This study aims to compare these two surgical techniques regarding their anatomical and functional outcomes and assess the role of platelet-rich plasma (PRP) in improving these outcomes. Material and methods This prospective comparative study was conducted at Acharya Vinoba Bhave Rural Hospital, involving 60 patients with COM. Participants were randomly assigned to receive either ET or PA, with each group further subdivided based on PRP use. Preoperative evaluations included auditory function tests and diagnostic endoscopy. Postoperative assessments were performed at seven days, one month, and three months to evaluate graft acceptance and hearing improvement using pure tone audiometry (PTA). Statistical analyses included the chi-square test, t-test, ANOVA, and paired t-test. Results The study included patients with a mean age of 38.1 years, predominantly female (71.67%). ET demonstrated superior anatomical outcomes compared to PA, with higher graft acceptance rates and better hearing improvements. The average hearing gain was 10.4 dB in the ET group versus 8.1 dB in the PA group. PRP uses enhanced graft acceptance and hearing restoration across both surgical approaches, contributing to better overall outcomes. Conclusion ET offers significant advantages over conventional postaural tympanoplasty in terms of anatomical and functional results. PRP further improves surgical outcomes, making ET a preferable option for tympanoplasty in COM patients. These findings support the broader adoption of ET and PRP to enhance patient outcomes in tympanoplasty procedures.

Is there any concern of insulin resistance and metabolic dysfunctions with antiseizure medications? A prospective comparative study of valproate vs. levetiracetam

PurposeTo evaluate the incidence of insulin resistance and its association with change in serum anti-seizure medication (ASM) level and their pharmacokinetic, body composition and metabolic hormones after six months of levetiracetam (LEV) exposure in persons with epilepsy (PWE) in comparison to valproate (VPA). MethodsThis prospective-longitudinal study included clinically diagnosed PWE on VPA or LEV monotherapy (for<3 months). At enrolment, body weight/composition, BMI were measured and blood samples were collected for assessing metabolic dysfunctions by estimation of serum insulin, insulin resistance [in terms of Homeostatic Model Assessment of Insulin Resistance (HOMA-IR)], leptin, adiponectin, lipid profile along with ASMs level. Subjects were followed up for six months and all the above parameters were reassessed. ResultsA total of 150 PWE were screened based on inclusion and exclusion criteria, and 105 number of subjects were enrolled (n=35 in VPA and n=70 in LEV group). Out of them, 92 subjects (n=32 in VPA; n=60 in LEV) completed six months follow-up. After six months, serum insulin level increased significantly in VPA group compared to baseline p<0.001). Insulin resistance (HOMA-IR>2.5) was observed in 14.28% of PWE in VPA group. Significantly higher percentage-change in body-weight (p=0.003), leptin and decreased adiponectin were found in VPA-group compared to baseline ((p=0.003, 0.02, 0.001, <0.001, respectively). These changes were independent of serum level or pharmacokinetic of VPA. On the other hand, no such changes were observed in LEV-group despite increased serum LEV level and altered pharmacokinetic parameters after six months. ConclusionSix months treatment with VPA resulted in insulin resistance and metabolic dysfunctions in PWE. These alterations were not correlated with change in VPA serum level. These changes were not observed in LEV therapy suggesting its better safety profile. This may be considered while prescribing the ASM like VPA and LEV in adult patients with obesity or insulin resistance and diabetes.

A Comparative Study of Peripheral Smear Findings with RBC Indices and Automated Analyzer Generated RBC Histograms in the Diagnosis of Anemia's

Abstract Introduction The red blood cell (RBC) indices generated by cell counters help in the morphological classification of anemia. The importance of microscopic examination of peripheral blood smears (PBSs) stained by Leishman stain cannot be used alone when it comes to interpretation of the underlying cause of anemia. Hence, all three RBC histograms, indices, and microscopic examination of PBSs are very essential for a complete assessment of anemia. Aims and Objectives To diagnose the type of anemia by examination of PBSs, automated cell-generated RBC histograms, and RBC indices and to compare and correlate the findings of RBC indices and automated cell-generated RBC histograms with PBS examination. Materials and Methods This was a prospective comparative study done on 500 cases of anemia for a period of 5 months from August 2023 to December 2023 in a rural tertiary care teaching hospital and all the patients' RBC indices, RBC histogram findings, and PBS findings were noted and analyzed. Results Among 500 samples, normocytic normochromic anemia consists of the majority of the cases 272 (54.4%), followed by microcytic hypochromic anemia cases 183 (36.6%), macrocytic anemia cases 27 (5.4%), normocytic hypochromic anemia were 10 (2%) cases, and dimorphic were 8 cases (1.6%). When compared with RBC histogram, 265 (53.0%) cases showed normal bell-shaped curve, 188 (37.6%) cases showed left shift, 27 (5.4%) cases showed broad based curve, 10 (2%) cases showed right shift, and 10 (2%) cases showed bimodal curve suggesting normocytic normochromic, microcytic hypochromic, normocytic hypochromic anemia, macrocytic, and dimorphic anemia, respectively. Conclusion This study showed a well correlation in the findings of the automated hematology analyzer with the microscopic examination. Histogram alone could be used as a screening method but when combined with RBC indices and PBS findings, they act as useful supplements and by correlating findings of all three, we could diagnose the majority of anemia.

Measurements of the Interventricular Septum and Mitral Leaflet Length in Hypertrophic Cardiomyopathy Patients Who Underwent Surgical Myectomy: A Prospective Comparative Multimodality Imaging Study

Transesophageal echocardiography (TEE) plays an important role for real-time procedural guidance during surgical myectomy (SM) for hypertrophic obstructive cardiomyopathy (HOCM). We aimed to compare a) IVS thickness using two (2D) and three-dimensional (3D) intraoperative TEE and pre-operative cardiac magnetic resonance (CMR) and b) mitral valve (MV) leaflet length using 2D, 3D TEE, automatic quantification of mitral valve (AMVQ) and pre-operative CMR. We prospectively studied 50 HOCM patients (age 59 ±12, 44% men) undergoing SM during 2018-2019. Maximal basal, mid, and distal anteroseptum (AS) and inferoseptum (IS) were measured by multiplanar 3D reconstruction on TEE and by short axis imaging on pre-operative CMR, and classified as mild (≤18mm), moderate (18-25mm) or severe (≥ 25 mm) groups, based on AS and IS thickness on CMR. MV leaflet lengths were evaluated by pre-operative CMR and intra-procedural 2D TEE, zoom 3D TEE and AMVQ (EchoPAC, General Electric, Wi). There was a moderate correlation between AS and IS thickness on 3D TEE and CMR (R2=0.46, p<0.01 and R2=0.41, p<0.01 respectively), with 3D TEE showing an average overestimation of 3.8 and 4.7 mm vs. CMR. 3D TEE over-estimated 14 (56%) patients with mild thickness as moderate, and 5 (22%) patients with moderate thickness as severe. Assuming 3D TEE as the gold standard, the closest correlation for anterior mitral leaflet length was with CMR (average overestimation by CMR of 0.5 mm [root mean square deviation or RMSE% 17]), intermediate correlation with 2D TEE (average deviation of 0.6 mm [RMSE%:21]) and no correlation with AMVQ (average deviation of 0.7mm [RMSE% 24]). In conclusion, 3D TEE overestimates IVS thickness vs. CMR in HOCM patients undergoing SM, with greater discrepancy in those with thinner IVS. There are significant differences in MV lengths measured using different imaging techniques.

A Prospective Comparative Study of Ray Resection versus Amputation through Proximal Phalanx for Nonviable Digits of Upper Limb

Abstract Background Finger amputations aim at preserving function and optimizing cosmesis. The crucial decision here is whether to preserve a stump or to do a ray amputation. The present study aimed to compare the functional outcome and postoperative quality of life after ray amputation or amputation through the proximal phalanx. Methods A prospective study was conducted from January 2019 to June 2020 in patients requiring single-finger amputation through the proximal phalanx or metacarpal. Patients were divided into two groups; Group A: amputation through the proximal phalanx and Group B: ray amputation of the finger. The following functional parameters were assessed: grip strength, hand circumference, palmar volume, and webspace span. The Michigan Hand Outcomes Questionnaire (MHQ) score was employed to score hand function and aesthesis at 6 months in both hands. Results Thirty patients were enrolled. Findings in 26 patients (52 hands) were subjected to further analysis, 12 in Group A and 14 in Group B. Patients in both groups lost grip strength significantly compared with their contralateral normal hands (29.22 ± 14.88 [Group A] and 34.57 ± 19.12 [Group B]); however, it was statistically nonsignificant between the two groups. There was reduced mean palmar circumference in both groups' involved hands, but the decrease in circumference was statistically significant, only for Group B. Group B patients scored better in all the six subscales of the MHQ; however, only the Aesthetics score was significantly superior. The operated hand's webspace span increased significantly with respect to the normal contralateral web by a mean of 4.55 mm. Conclusion The study concluded that both the surgical options for the level of amputation should be discussed with the patients in detail, taking into account their occupational and personal requirements. Our study findings will help to objectively counsel the patients regarding expectations in functional and aesthetic outcomes following either technique.

A comparative study of the effect of port-site local anaesthetic application and standard analgesics on postoperative pain management in laparoscopic cholecystectomy

Background: Laparoscopic cholecystectomy is the gold standard for treating patients with cholelithiasis. It is a minimally invasive technique that reduces surgical trauma with small and more cosmetic incisions, reduces blood loss and is associated with fewer postoperative complications and decreased length of hospital stay. The study was done to evaluate the efficacy of the local anaesthetic infiltrated at the port sites in laparoscopic cholecystectomy, in reducing postoperative pain. Methods: In the period from July to December 2023, fifty patients who underwent laparoscopic cholecystectomy at Sardar Vallabhbhai Patel Institute of Medical Sciences and Research, Ahmedabad were included in this prospective comparative study. Cases were divided into two groups. Patients who received bupivacaine at the port site were put in the local anaesthetic group and patients who received postoperative analgesia with NSAIDs/Opioids were put into the Standard Analgesia Group. Pain was measured by the Visual Analog Scale in all patients at the 1st, 6th, 12th, and 24th hour postoperatively. Results: A Significant reduction in pain intensity was detected in the Bupivacaine Group compared to the patients in Standard Analgesia Group at 1st and 6th hour. On other hand, there was no difference in pain intensity at the 12th and 24th hour. There was delay in the time and total doses of rescue analgesia in the local anaesthetic group. Conclusion: Applying local anaesthetic to the port sites after laparoscopic cholecystectomy significantly reduces postoperative pain intensity in the first 6 hours and delays the need for rescue analgesia, suggesting potential decrease in analgesic drug usage for postoperative pain management.

Etanercept versus Methotrexate in the Treatment of Psoriasis and Associated Metabolic Syndrome: 12 Months Open-Label Comparative Study.

Psoriasis is a chronic inflammatory systemic disease accompanied by systemic damage that leads to the development of multiple comorbidities including metabolic syndrome. Conventional systemic therapies for psoriasis are associated with toxicity and have a greater burden on the patients. The study aimed to assess the effectiveness of etanercept (ETN) monotherapy in comparison to methotrexate (MTX) monotherapy. In this prospective interventional comparative open-label study, 117 patients with psoriasis were randomized to 2 groups; one group of 42 patients; 32(67.2%) males and 10(23.8%) females treated with MTX, and the second group of 75 patients; 54(72%) males and 21(28%) females treated with ETN. Full laboratory investigations, body mass index (BMI), measurement of skin disease severity which was performed using Psoriasis Area Severity Index (PASI), and the reduction of 75% of the skin lesions (PASI 75) were calculated for all participants. In the MTX group, there were no significant differences in BMI, or blood pressure after 12 weeks of the study. There is a reduction in the values of FBS, TSC, LDL, TRIG, ESR, CRP, and PASI, but this reduction was statistically not significant. Ten (23.8%) patients achieved PASI 75. In the ETN group, except for BMI, systolic and diastolic blood pressure, all other metabolic syndrome components, inflammatory markers, and PASI were decreased; the reduction was statistically significant. Sixty (80%) patients achieved PASI 75. Etanercept monotherapy is superior to methotrexate monotherapy in the treatment of moderate to severe plaque-type psoriasis as it achieved greater reductions in PASI score and greater achievement of PASI 75 after 12 weeks. Etanercept monotherapy is superior to methotrexate monotherapy in the improvement of all components of the associated metabolic syndrome except for BMI, which was increased in etanercept-treated patients.

Glucometric parameter changes in patients with type 2 diabetes during ramadan fasting: A prospective comparative real-world study

BackgroundThis study assessed glucometric changes in Type 2 diabetes mellitus (T2DM) patients before, during, and after Ramadan fasting using an intermittently scanned continuous glucose monitoring system (isCGMS). MethodsThis prospective comparative study included T2DM patients aged 30–70 years who were receiving nonintensive insulin in Riyadh, Saudi Arabia. In addition to the baseline characteristics, glycated hemoglobin (HbA1c) and ambulatory glucose profile (AGP)-derived metric data were collected at three specific points: pre-, during-, and post-Ramadan. Self-care activities during Ramadan were evaluated using the Diabetes Self-Management Questionnaire (DSMQ). ResultsOverall, a total of 93 T2DM patients were enrolled in the study. Their mean age ±SD age was 47.9 ± 7.5 years, and 51.6 % of them were males. Compared with pre- and post-Ramadan, there was a significant decrease in HbA1c (p < 0.001 for both periods), average glucose level (p = 0.001 and p = 0.026, respectively), glucose variability (p = 0.043 and p = 0.005, respectively), and % time above the range of 181–250 mg/dL (p < 0.001 for both periods), as well as a significant increase in % time in target (70–180 mg/dL) during Ramadan (p < 0.001 for both periods). However, the % time below 54 mg/dL was slightly greater during Ramadan than both pre- and post-Ramadan (p < 0.001 and p = 0.002, respectively). Furthermore, 32.3 % reported inadequate self-care behaviors during Ramadan. ConclusionsRamadan fasting could improve glucose levels in T2DM patients who were not on intensive insulin, with a relatively low incidence of hypoglycemia.

Prospective validation of a virtual post-operative clinic in vitreoretinal surgery.

To evaluate the clinical efficacy and safety of asynchronous virtual post-operative assessments following vitreoretinal surgery and procedures compared to traditional face-to-face assessments in a high-volume tertiary eye centre. Prospective comparative clinical series study of patients who had undergone vitreoretinal surgery or post-laser retinopexy. Patients received both virtual and face-to-face assessments. The virtual assessment included clinical questions, visual acuity measurement, and virtual retinal imaging using ultra-wide field (UWF) imaging and macular optical coherence tomography (OCT). Face-to-face assessments involved standard clinical examinations. We included 142 patients undergoing a variety of vitreoretinal procedures. We showed comparable results between virtual and face-to-face assessments in both, post-operative and post-laser treatments. UWF imaging with macular OCT demonstrated potential for effective virtual post-operative assessment. The virtual assessment has a sensitivity of 91% and specificity of 100% for detecting retinal detachments with 100% specificity and 100% sensitivity for detecting new retinal tears or insufficient laser treatment. The implementation of asynchronous virtual post-operative assessments following a variety of vitreoretinal procedures is a promising alternative to traditional face-to-face assessments. Virtual assessments using UWF imaging and macular OCT showed high sensitivity and specificity. Virtual post-operative clinics offer the potential to improve patient access and decrease the clinical burden, especially with the continuing evolution of telemedicine technologies and imaging modalities.

Variation of retinal and choroidal microvascularization after an exercise stress test in patients with effort angina.

To describe retinal and choroidal vascular changes following an exercise stress test (ET) in patients with effort angina and to determine whether optical coherence tomography angiography (OCT-A) could play a role in the prediction of ischemic cardiac events. Prospective comparative study including patients with effort angina. All patients underwent OCT-A before and after an ET was performed. Blood flow, intercapillary spaces, and vessel density were analyzed in the superficial capillary plexus (SCP) and the deep capillary plexus (DCP). Vessel density in the choriocapillaris and the parameters of the central avascular zone (CAZ) were also analyzed. Of the 38 eyes included in the study, a decrease in blood flow was found in 39.5% in the large SCP vessels, in 50% in the capillaris of the SCP, and in 81.6% in the DCP. An increase in intercapillary spaces was observed in the SCP in 68.4% of eyes and in the DCP in 55.3% of eyes. A statistically significant decrease in the DCP density was observed after an ET (p = 0.03). There were no significant modifications in the CAZ parameters, the SCP density, nor the choriocapillaris density. Patients with a positive ET had a decreased DCP density in 83.3%. Among patients with an increased DCP density, 92.85% had a negatif ET. This pilot study suggests that DCP density significantly decreases after an ET. The DCP appears to be most affected in patients with effort angina. A larger trial is needed to further investigate these hypotheses.

Nrf2, gp91phox and IL-17 are associated with severity and clinical outcomes of patients with subclinical hypothyroidism: a comparative study

The mechanisms underlying subclinical hypothyroidism (SCH) remain unclear, making timely and accurate differentiation between hypothyroidism and SCH, as well as severity assessment, challenging. This study aimed to investigate the role of NFE2 like bZIP transcription factor 2 (Nrf2), gp91phox, and interleukin-17 (IL-17) in the pathogenesis of SCH. In this prospective comparative study, 105 SCH patients, 105 hypothyroidism patients, and 105 healthy individuals were enrolled from January 2022 to August 2023. SCH patients were categorized into mild-moderate and severe groups based on thyroid-stimulating hormone (TSH) levels. Levels of TSH, free T4 (FT4), free T3 (FT3), thyroglobulin antibodies (TG-Ab), thyroid peroxidase antibodies (TPO-Ab), cholesterol (TC), triglycerides (TG), high-density lipoprotein-cholesterol (HDL-ch), and low-density lipoprotein-cholesterol (LDL-ch) were measured. Nrf2, IL-1β, IL-6, IL-17, and gp91phox levels were tested using ELISA. Nrf2, IL-17 and gp91phox were significantly higher in SCH and hypothyroidism patients compared to the healthy controls, with hypothyroidism patients showing the highest levels. Nrf2 levels were negatively correlated with TSH, TG-Ab and IL-17, but not gp91phox. Nrf2, IL-17 and gp91phox could be used for diagnosis of SCH and severe SCH. Only TG-Ab, IL-17 and gp91phox were independent risk factors for severe SCH. This study demonstrates a negative correlation between serum Nrf2 levels and SCH severity. TG-Ab, IL-17, and gp91phox are independent risk factors, and their associations with SCH pathology suggest their potential roles in the disease mechanism. These findings provide insights into SCH pathogenesis and highlight the need for further research to elucidate their diagnostic or prognostic significance.

A prospective comparative study of preoperative and postoperative clinicopathological correlation of fibroadenoma of breast: A study protocol

Fibroadenoma of the breast most often arises during the late teens and early reproductive years. It is the most prevalent tumor in women &lt; 30 years. After the age of 40 to 45, fibroadenomas are rarely observed as new masses in women. Fibroadenomas are made up of both epithelial and stromal components. Fibroadenoma is the most frequent type of breast tumor. It is crucial to diagnose preoperatively, both clinically and pathologically, by using F.N.A.C. Postoperatively, Fibroadenoma is confirmed histopathology. However, malignant transformation is very rare in Fibroadenoma of the breast. Early identification, accurate analysis, and appropriate management are advantageous. The current study's goal is to examine preoperative and postoperative clinicopathological aspects of Fibroadenoma and to assess any differences between preoperative and postoperative diagnosis in patients admitted to Jawaharlal Nehru Medical College, Sawangi (M), Wardha, Maharashtra, India.

Simple Hip Value: a simple score to evaluate Hip function

BackgroundSeveral self-administered questionnaires are available for assessing hip function in clinical practice (HOOS-12, Oxford-12). These questionnaires can be used to assess and monitor patients with hip pathology. However, they are sometimes difficult to deploy in clinical practice. Recent studies on the shoulder and knee have shown that a single-question assessment provides a relevant evaluation of joint function, and correlates with more complex scores. However, this has not yet been evaluated for the hip. We set out to develop a single-question test that would enable patients to assess their hip function between 0 and 100. Therefore, we did a prospective study aiming to assess: (1) the relevance of the SHV (Simple Hip Value) test by comparing it with the Oxford-12 and HOOS-12 scores, (2) the discriminatory capacity and reproducibility of this test. HypothesisThe hypothesis of this study was that the assessment of hip function by a single-question patient-completed questionnaire (PROM) would be reliable and useful in clinical practice. Patients and methodsWe conducted a prospective study including 74 patients operated on for total hip arthroplasty from February 2020 to April 2021 in a high-volume center and 20 healthy subjects. The SHV questionnaire, as well as HOOS-12 and OXFORD-12 were submitted on average 18 months after surgery, with values scaled to 100 points. A second test containing the 3 questionnaires was resubmitted to 20 patients randomly chosen from hip arthroplasty group to evaluate the reproducibility of the test. To evaluate the discrimination capacity of our test, 20 controls were selected to respond to the three questionnaires. ResultsTest results were median SHV, Oxford-12 and HOOS-12 scores of 90/100 (Interquartile Range [IQR]: 80–95), 88.5 (IQR: 77.1–95.8) and 79.1 (IQR: 65.1–93.2), respectively. The SHV was strongly correlated with the Oxford-12 (Spearman coefficient: 0.63 [IQR: 0.45−0.76]) and the HOOS-12 (Spearman coefficient: 0.66 [IQR: 0.46−0.79]). The SHV differed significantly from the control group (90.0 vs 100.0 in the control group [p < 0.001]) and had excellent reproducibility (Interclass Correlation Coefficient [ICC]: ICC: 0.82 [CI95%, 0.59−0.93]). DiscussionThe SHV test seems to be a reliable, reproducible and discriminating tool for assessing hip function after total hip arthroplasty, thus offering a simplified and practical approach for practitioners. Further testing in different populations would be useful to validate this test. Level of evidenceIII; prospective comparative diagnostic study.

Clinical Presentation and Treatment Outcomes of Necrotizing Fasciitis: A Prospective Comparative Study of Children and Adults in Sokoto

Abstract Background: Necrotizing fasciitis (NF) is a severe soft tissue infection typified by swiftly spreading necrosis of the fascia and subcutaneous fat with successive necrosis of the skin which affects all age groups. Objective: To compare the clinical presentation and treatment outcome of NF between children and adults. Materials and Methods: A prospective descriptive study of all patients presenting with NF to the (Usmanu Danfodiyo Univrersity Teaching Hospital, Sokoto), from September 2018 to August 2019. Participants were stratified into adults and children for comparison during data analysis. Results: A total of 32 patients were analyzed, 24 (75.0%) were adults. The age range was 2 weeks to 75 years with a median age of 35 years. Necrotic skin patches and skin erythema were the most common cutaneous findings. The lower limb was the most commonly affected region in adults (58.3%), whereas the head and neck and abdominal wall were equally commonly involved in children (37.5%). Children had more multiple isolates than adults, 87.5% compared to 62.5%, respectively, and it was significant (P value 0.04). Escherichia coli and Klebsiella species were both significantly commoner in isolates of children than adults (P value 0.01 and 0.04, respectively). The method of wound coverage was significantly different (P value 0.003) as fewer children required skin grafting. The mortality rate was 6.25%, the two deaths occurred in adults. Conclusion: NF is commoner in adults in our region. The predilection sites of the disease in the two groups differ and healing by secondary intention was more possible in children.

Evaluation of peri-implant perfusion in patients who underwent avascular augmentation or microvascular reconstruction using laser Doppler flowmetry and tissue spectrophotometry: a prospective comparative clinical study

ObjectivesThe aim of this study was to evaluate the peri-implant perfusion, such as oxygen saturation, the relative amount of hemoglobin, and blood flow, in implants placed in pristine bone and avascular and microvascular grafts using a non-invasive measurement method.Materials and methodsA total of 58 patients with 241 implants were included. Among them, 106 implants were based in native bone (group I), 75 implants were inserted into avascular bone grafts (group II), and 60 implants were placed in microvascular bone grafts (group III). Gingival perfusion was measured using laser Doppler flowmetry and tissue spectrophotometry (LDF-TS). Implants with signs of gingival inflammation were excluded to analyze healthy implant perfusion in different bony envelopes.ResultsThe mean values for oxygen saturation, relative hemoglobin levels, and blood flow did not differ significantly between the groups (p = 0.404, p = 0.081, and p = 0.291, respectively). There was no significant difference in perfusion between implants that were surrounded by mucosa and implants based within cutaneous transplants (p = 0.456; p = 0.628, and p = 0.091, respectively).ConclusionNo differences in perfusion were found between implants inserted into native bone and implants involving bone or soft tissue augmentation. However, implants based in avascular and microvascular transplants showed higher rates of peri-implant inflammation.Clinical relevancePeri-implant perfusion seems to be comparable for all implants after they heal, irrespective of their bony surroundings. Although perfusion does not differ significantly, other factors may make implants in avascular and microvascular transplants vulnerable to peri-implant inflammation.