Syndesmotic screws, unscrew them, or leave them? A systematic review and meta-analysis of randomized controlled trials.

Background: Syndesmotic injuries are frequently stabilized using syndesmotic screws. Traditionally, these screws were routinely removed during the postoperative period, however recent literature has brought into question the necessity of routine removal, citing no change in functional outcomes and the inherent risks of a second surgery. Our study aimed to compare outcomes of patients undergoing routine syndesmotic screw removal versus those undergoing an on-demand approach to removal. Methods: A systematic search of studies comparing routine syndesmotic screw removal to on-demand screw removal following an acute ankle fracture, or an isolated syndesmotic injury was conducted across seven databases. Only Prospective randomized controlled trials were eligible for inclusion. Data reported on by at least 2 studies was pooled for analysis. Results: Three studies were identified that met inclusion and exclusion criteria. No significant difference in Olerud-Molander Ankle Score (MD -2.36, 95% CI -6.50 to 1.78, p = 0.26), American Orthopedic Foot and Ankle Hindfoot Score (MD -0.45, 95% CI -1.59 to .69, p = 0.44), or dorsiflexion (MD 2.20, 95% CI -0.50 to 4.89, p = 0.11) was found between the routine removal group and on-demand removal group at 1-year postoperatively. Routine removal was associated with a significantly higher rate of complications than on-demand removal (RR 3.02, 95% CI 1.64 to 5.54, p = 0.0004). None of the included studies found significant differences in pain scores or range of motion by 1-year postoperatively. Conclusion: Given the increased risk of complications with routine syndesmotic screw removal and the comparable outcomes when screws are retained, an as-needed approach to syndesmotic screw removal should be considered.

Review of bimekizumab in the treatment of psoriasis.

Bimekizumab, a selective interleukin (IL) 17 inhibitor, is an emerging systemic treatment for moderate-to-severe psoriasis. Although IL-19, IL-22, and IL-36 are implicated in the pathogenesis of psoriasis, IL-17 drives the activation of these interleukins and the formation of psoriatic plaques. This review assesses the efficacy, safety, and implications of bimekizumab in the treatment of moderate-to-severe psoriasis. A review of literature was conducted using the PubMed repository in March 2022. Articles in English discussing the use of bimekizumab in the treatment of psoriasis were included. One phase II and four phase III trials were included. During clinical trials, bimekizumab was more efficacious, when compared to placebo, ustekinumab, adalimumab, and secukinumab in the treatment of moderate to severe psoriasis. Bimekizumab is a promising, efficacious, and relatively tolerable emerging systemic treatment for moderate-to-severe plaque psoriasis.

Baseline Assessment of Evidence-Based Intrapartum Care Practices in Medical Schools in 3 States in India: A Mixed-Methods Study.

INTRODUCTION: Implementation research with pre- and post-comparison was planned to improve the quality of evidence-based intrapartum care services in Indian medical schools. We present the baseline study results to assess the status of adherence to intrapartum evidence-based practices (IP-EBP) in study schools in 3 states in India and the perception of the faculty. METHODS: A concurrent mixed-methods approach was used to conduct the baseline assessment in 9 medical schools in Rajasthan, Gujarat, and Union Territory from October 2018 to June 2019. IP-EBP among pregnant women in uncomplicated first (n=135), second (n=120), and third stage (n=120) of labor were observed using a predesigned, pretested checklist quantitatively. We conducted in-depth interviews with 33 obstetrics and gynecology faculty to understand their perceptions of intrapartum practices. Quantitative data were analyzed using SPSS (version 22). COM-B (Capability, Opportunity, and Motivation Behavior) model was used to understand the behaviors, and thematic analysis was done for the qualitative data. FINDINGS: Unindicated augmentation of labor was done in 64.4%, fundal pressure applied in 50.8%, episiotomy done in 58.3%, and delivery in lithotomy position was performed in 86.7% of women in labor. CONCLUSIONS: Intrapartum practices that are not recommended were routinely practiced in the study medical schools due to a lack of staff awareness of evidence-based practices and incorrect beliefs about their impact.

Bitter and sweet taste perception: relationships to self-reported oral hygiene habits and oral health status in a survey of Australian adults.

BACKGROUND: Oral health, an essential part of general health and well-being, is influenced by multiple factors, including oral hygiene habits and dietary factors. Dietary preferences are influenced by variation in taste perceptions and threshold tasting. Polymorphisms in specific genes for sweet and bitter taste receptors and bitter taste perception have been associated with dental caries. However, taste is complex with multiple receptors, each with multiple potential polymorphisms contributing to taste perception as well as social, cultural, and environmental influences. Additionally, these association studies have been conducted in restricted cohorts (e.g., children only). Furthermore, outcomes have been limited to dental caries and studies between taste perception and oral hygiene habits have not been completed. METHODS: A cross-sectional online survey was conducted to investigate the relationships between bitter and sweet taste perception (liking and intensity of index food items), self-reported oral hygiene habits and oral health (n = 518). RESULTS: Higher mean intensity scores for bitter (16-21%) and sweet (< 5%-60%) were seen with higher frequencies of oral hygiene habits (brushing, use of mouthwash, chewing gum and tongue cleaning). Lower mean bitter liking scores (18-21%) were seen with higher frequencies of oral hygiene habits (brushing, mouthwash use, floss use and chewing gum). Sweet liking scores varied by reported frequency of mouthwash use and flossing only, with mixed patterns of variance. Mean bitter and sweet intensity perception scores varied with the number of dental caries ((13-20% higher in those with 3 or more caries, compared to none). CONCLUSIONS: While there were numerous relationships identified between liking and perception of sweet and bitter and oral health outcomes, the magnitude and direction of associations varied by outcome. The direction of the associations cannot be inferred due to the cross-sectional nature of the study. The demonstrated relationships justify further future investigations, which could help better understand if taste liking and perception is impacted by oral hygiene and health, or vice versa. This could be important in understanding the causation and progression of oral health diseases or the development of novel therapeutics for oral health.

Salt Taste Genotype, Dietary Habits and Biomarkers of Health: No Associations in an Elderly Cohort.

A small amount of emerging research has observed variations between individual sensitivity, preference and intake of salt in the presence of single nucleotide polymorphisms (SNP) on the genes encoding salt taste receptors. Sodium intake is a significant risk factor for common diseases in elderly populations such as hypertension and cardiovascular disease; however, this does not fully explain the risk. Research into the influence of salt taste genetics on diet quality is yet to be undertaken and current research on indicators of health is limited and mixed in the direction of associations. Therefore, a secondary analysis of data from a well-characterised elderly cohort (the cross-sectional Retirement Health and Lifestyle Study, n = 536) was conducted to explore relationships between the salt taste-related SNP TRPV1-rs8065080 (assessed by Taqman genotyping assay), dietary habits and biomarkers of health. Data were analysed with standard least squares regression modelling and Tukey's HSD post hoc tests. No association was found between the TRPV1-rs8065080 genotype, sodium intake or multiple diet quality indices (assessed by food frequency questionnaire). Sodium-related markers of health including blood pressure and markers of kidney function (urinary creatinine and albumin/creatinine ratio) and general health markers, such as Body Mass Index (BMI), were also not related to TRPV1-rs8065080 genotype. To date, this study is the most comprehensive investigation conducted to determine if the TRPV1-rs8065080 genotype relates to sodium intake and health markers influenced by sodium intake. Although no significant relationships were found, these findings are an important contribution to the limited body of knowledge surround this SNP. In addition to further research across other ages and cultures, the TRPV1-rs8065080 genotype may interact with other ion channels, and so further studies are required to determine if polymorphic variations influence sodium intake, diet and health.

Competency assessment of the medical interns and nurses and documenting prevailing practices to provide family planning services in teaching hospitals in three states of India.

OBJECTIVES: The objectives of the study were to assess the knowledge and skills of medical interns and nurses regarding family planning (FP) services, and document the prevailing FP practices in the teaching hospitals in India. STUDY DESIGN: A cross-sectional study was conducted in three states (Delhi, Rajasthan, and Maharashtra) of India, among randomly selected 163 participants, including medical interns (n = 81) and in-service nurses (n = 82), during 2017. The semi-structured, pre-tested interview schedule, was used to assess the knowledge and status of training received; and objective structured clinical examination (OSCE) based checklist was used to evaluate the skills. RESULTS: About 60% of the interns and 48% of the nurses knew more than five contraceptives that could be offered to the clients. About 22% (11.1% interns and 33.3% nurses) respondents believed that contraceptives should not be given to a married woman coming alone, and 31.9% (17.3% interns and 46.3% nurses) respondents reported that it was illegal to provide contraceptives to unmarried people. Nearly 43.3% interns and 69.5% nurses refused to demonstrate intrauterine contraceptive device (IUCD) insertion in the dummy uterus as per OSCE, and among those who did, 12.3% interns and 18.3% nurses had failed. About 63% interns and 63.4% of nurses had observed IUCD insertion, and 12.3% interns and 17.1% had performed IUCD insertion, during their training. CONCLUSIONS: Knowledge and skills of interns and nurses regarding FP services were inadequate. The medical training during graduation or internship, and during the job, was found to be inadequate to provide quality FP services as per guidelines of nursing/medical council of India and Government of India on FP.