ABSTRACT
Understanding alignment and gap balancing in Total Knee Arthroplasty (TKA) can be challenging for trainee and experienced orthopedic surgeons. Traditional learning methods may not effectively translate to real-life scenarios. The advent of advanced technologies like robotic surgery and navigation systems has revolutionized intraoperative understanding of gap balancing techniques. This trial aims to investigate the effectiveness of robotic TKA planning software in educating trainees about alignment and ligament balancing. We hypothesize that a single session with the software will significantly enhance trainees' understanding of these techniques. This UK-based single-center, two-arm, group parallel randomized controlled trial was conducted during a national robotic arthroplasty symposium. It aims to evaluate the effect of robotic knee arthroplasty software training on understanding TKA alignment and gap balancing principles using Multiple Choice Questions (MCQs). The MCQ test was crafted based on established guidelines from a different institution with expert consensus in the field. Our study revealed that baseline knowledge of gap balancing and alignment principles was generally low among all participants. However, the intervention group, which received comprehensive robotic software training, demonstrated a significant improvement in their MCQ scores compared to the control group, which did not undergo the training. In conclusion, our study demonstrates that robotic arthroplasty software training significantly improves the understanding of TKA alignment and balancing principles among orthopedic trainees. Level of Evidence II.
Subject(s)
Arthroplasty, Replacement, Knee , Robotic Surgical Procedures , Software , Arthroplasty, Replacement, Knee/education , Arthroplasty, Replacement, Knee/methods , Humans , Robotic Surgical Procedures/education , Robotic Surgical Procedures/methods , Male , Female , Knee Joint/surgery , Clinical CompetenceABSTRACT
The development of proficient electrode materials is one of the major tasks faced by modern techniques for energy storage. Integrating different materials with synergistic effects can be a valuable strategy for designing storage devices with high capacity and energy density. The spinel manganese cobaltite (MnCo2O4) is an outstanding candidate for supercapacitors owing to its remarkable pseudocapacitive behavior. However, it suffers from low electric conductivity and limited cyclic stability. To overcome its limitations, activated carbon with superior cyclic stability and polypyrrole with high electric conductivity can be incorporated in MnCo2O4. The synergistic effect of these components offers high capacitance, better conductivity, and superior cyclic performance to the ternary composite. Herein, the MnCo2O4/AC/PPY ternary composite has been synthesized by a facile approach. The optimized ternary composite (MAP-20) exhibited a wonderful capacitance of 945.77 F g-1 at five mV s-1 compared to pristine MnCo2O4 (254.98 F g-1). The real-time applicability of the optimized composite was tested with asymmetric device configuration. The asymmetric device with MAP-20 and MnO2/AC electrodes exhibited a wonderful Ed of 88.12 W h kg-1 (Pd â¼ 1.6 kW kg-1). The asymmetric device also exhibited excellent cyclic performance of 89.68% for 10 000 cycles. Further, the real-time applicability of the device was tested by illuminating a 39 red LED panel. Three asymmetric cells connected in series illuminated the panel for about 45 minutes. All these results suggest that the synergistic integration of various efficient electrode materials leads to enhanced electrochemical performance of supercapacitors.
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Microvascular inflammation (MVI) is a key diagnostic feature of antibody-mediated rejection (AMR), however recipients without donor specific antibodies (DSA) defy etiological classification using C4dptc and conventional DSA assignment. We evaluated MVI≥2 (Banff g+ptc≥2) using Banff 2019 AMR (independent of MVI≥2 but including C4dptc) with unconventional glomerular capillary (C4dglom) and arterial/endothelial (C4dart) immunoperoxidase detection, shared-eplet and subthreshold DSA (MFI 100-499), and capillary ultrastructure from 3398 kidney transplant samples for evidence of AMR. MVI≥2 (n=202 biopsies) from 149 kidneys (12.4% prevalence) correlated with DSA+, C4dptc+, C4dglom+, Banff cg, i, t, ti scores, serum creatinine, proteinuria, and graft failure compared with 202 propensity score matched normal controls. Laboratory reported DSA- MVI≥2 (MFI≥500) occurred in 34.7%, however subthreshold (28.6%), eplet-directed (51.4%), and/or misclassified anti-HLA DSA (12.9%) were identified in 67.1% by forensic reanalysis, with vascular C4d+ staining in 67.1%, and endothelial abnormalities in 57.1%, totalling 87.1%. Etiological analysis attributed 62.9% to AMR (77.8% for DSA- MVI≥2 with glomerulitis) and pure T cellular rejection is 37.1%. C4dptc-DSA- MVI≥2 was unrecognized AMR in 48.0%. Functional outcomes and graft survival were comparable to normal controls. We concluded that DSA- MVI≥2 frequently signified a mild "borderline" phenotype of AMR which was recognizable using novel serological and pathological techniques.
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Pulse beetle (Callasobruchus maculatus) is a common infestation during storage of legumes in India, and presently being managed by chemical fumigation. In the present investigation, a non-chemical method based on dielectric heating by microwaves (900 W, 2450 MHz) was studied for disinfestation of green gram at different grain layer thickness (5, 10, 15 and 20 mm) and exposure durations (0-60 s). The susceptibility (LT95) of different stages was in the order of egg (31.668 s) > grub (40.388 s) > pupa (44.176 s) > adult (49.018 s). The adult was tolerant up to 50 s (R2-0.799, P < 0.01) to microwave exposure duration without green gram, and up to 30 s (R2-0.804, P < 0.01) with green gram. Hundred percent mortality was observed at 10 mm (30 s, R2-0.969, P < 0.01) and 15 mm (30 s, R2-0.972, P < 0.01) grain layer thickness without significantly affecting grain quality. Cooking time and germination did not vary significantly up to 30 s of exposure, thereafter, reduced significantly. However, water uptake did not vary significantly up to 60 s of exposure. The microwave radiations are found effective for disinfestations of green gram without significantly affecting the grain quality.
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Predicting the temporal and spatial patterns of South Asian monsoon rainfall within a season is of critical importance due to its impact on agriculture, water availability, and flooding. The monsoon intraseasonal oscillation (MISO) is a robust northward-propagating mode that determines the active and break phases of the monsoon and much of the regional distribution of rainfall. However, dynamical atmospheric forecast models predict this mode poorly. Data-driven methods for MISO prediction have shown more skill, but only predict the portion of the rainfall corresponding to MISO rather than the full rainfall signal. Here, we combine state-of-the-art ensemble precipitation forecasts from a high-resolution atmospheric model with data-driven forecasts of MISO. The ensemble members of the detailed atmospheric model are projected onto a lower-dimensional subspace corresponding to the MISO dynamics and are then weighted according to their distance from the data-driven MISO forecast in this subspace. We thereby achieve improvements in rainfall forecasts over India, as well as the broader monsoon region, at 10- to 30-d lead times, an interval that is generally considered to be a predictability gap. The temporal correlation of rainfall forecasts is improved by up to 0.28 in this time range. Our results demonstrate the potential of leveraging the predictability of intraseasonal oscillations to improve extended-range forecasts; more generally, they point toward a future of combining dynamical and data-driven forecasts for Earth system prediction.
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BACKGROUND: Faecal incontinence (FI) is common, with a significant impact on quality of life. Percutaneous tibial nerve stimulation (PTNS) is a therapy for FI; however, its role has recently been questioned. Here we report the short-term clinical and manometric outcomes in a large tertiary centre. METHODS: A retrospective review of a prospective PTNS database was performed, extracting patient-reported FI outcome measures including bowel diary, the St Marks's Incontinence Score (SMIS) and Manchester Health Questionnaire (MHQ). Successful treatment was > 50% improvement in symptoms, whilst a partial response was 25-50% improvement. High-resolution anorectal manometry (HRAM) results before and after PTNS were recorded. RESULTS: Data were available from 135 patients [119 (88%) females; median age: 60 years (range: 27-82years)]. Overall, patients reported a reduction in urge FI (2.5-1) and passive FI episodes (2-1.5; p < 0.05) alongside a reduction in SMIS (16.5-14) and MHQ (517.5-460.0; p < 0.001). Some 76 (56%) patients reported success, whilst a further 20 (15%) reported a partial response. There were statistically significant reductions in rectal balloon thresholds and an increase in incremental squeeze pressure; however, these changes were independent of treatment success. CONCLUSION: Patients report PTNS improves FI symptoms in the short term. Despite this improvement, changes in HRAM parameters were independent of this success. HRAM may be unable to measure the clinical effect of PTNS, or there remains the possibility of a placebo effect. Further work is required to define the role of PTNS in the treatment of FI.
Subject(s)
Fecal Incontinence , Female , Humans , Male , Middle Aged , Fecal Incontinence/therapy , Manometry , Prospective Studies , Quality of Life , Tibial Nerve , Adult , Aged , Aged, 80 and overABSTRACT
INTRODUCTION: Medullary thyroid carcinoma (MTC) is a rare thyroid cancer arising from the calcitonin-secreting parafollicular cells. Previous studies suggested a preoperative calcitonin level >200ng/l is an indication for prophylactic lateral neck dissection (LND) to remove micrometastases and improve survival outcomes. METHODS: This retrospective single-centre study assessed the efficacy of preoperative calcitonin levels as a marker for determining need for prophylactic LND in MTC. Data were obtained on demographics, preoperative calcitonin levels, size and laterality of index tumour, type of neck dissection (central neck dissection (CND), LND), nodes removed, levels with involved nodes, number of nodes histologically involved, mortality, adjuvant therapy and locoregional recurrence. RESULTS: A total of 33 patients were identified from St George's University Hospitals NHS Foundation Trust between 1 January 2001 and 19 August 2021; 8 were excluded for data quality issues. Of the 18 classified with a high preoperative calcitonin level (>200ng/l), 10 (56%) had a LND and 8 (44%) had a CND. In the low-calcitonin group, three (43%) patients had a CND only and four (57%) had a LND. There was no difference in absolute or disease-free survival between the low and high groups (p=0.960, p=0.817), or between those who had a CND and LND in the high-calcitonin group (p=0.607, hazard ratio (HR) 0.55; p=0.129, HR 8.78). CONCLUSION: There was no statistically significant difference in outcomes between high and low calcitonin groups. A selective approach to performing LND in MTC patients based on clinical and imaging findings suggesting disease presence in the lateral neck should be explored further.
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PURPOSE: Neurotoxicity concerns have been raised over general anesthesia and sedation medication use in children. Such concerns are largely based on animal studies, historical anesthetic agents, and assessment tools, thus warranting further investigations. Blood biomarkers in detecting neuronal inflammation and apoptosis are novel methods for detecting neuronal damage. Therefore, the aim of this feasibility study was to assess the usefulness of the levels of four plasma biomarkers in dental general anesthesia (DGA) as surrogate markers of neurotoxicity in children. The secondary aim was to compare changes in motor manipulative skills pre- and post-anesthetic exposure. METHODS: This single-center prospective observational study included 22 healthy children aged between 3 and 6 years old who underwent DGA. Subclinical neurotoxicity was measured with a panel of four plasma biomarkers: Caspase-3, neuron-specific enolase (NSE), neurofilament light chain, and S100B at three time points (1; at start, 2; end and 3; on recovery from DGA). The Skillings-Mack test was used to identify the difference in the biomarker levels at three time points. Motor manipulative score assessment, prior and two weeks after DGA was also performed. RESULTS: A total of 22 study participants (mean age = 5 ± 1 years) were included with a median DGA duration of 106 ± 28 min. A reduction in Caspase-3 levels was recorded, with pairwise comparison over three time points, reporting a statistical significance between time point 2 vs. 1 and time point 3 vs. 1. Although fluctuations in NSE levels were recorded, no significant changes were found following pairwise comparison analysis. Among other biomarkers, no significant changes over the three periods were recorded. Furthermore, no significant changes in manipulative motor scores were reported. CONCLUSION: Caspase-3 reduced significantly in the short time frames during day-care DGA; this might be due to the relatively short anesthesia duration associated with dental treatment as compared with more extensive medical-related treatments. Therefore, further studies on Caspase-3 as a potential biomarker in pediatric DGA neurotoxicity are required to further ascertain results of this study.
Subject(s)
Anesthesia, Dental , Anesthesia, General , Biomarkers , Caspase 3 , Feasibility Studies , Neurotoxicity Syndromes , Phosphopyruvate Hydratase , S100 Calcium Binding Protein beta Subunit , Humans , Biomarkers/blood , Prospective Studies , Anesthesia, General/adverse effects , Child , Child, Preschool , Caspase 3/blood , Male , Female , Phosphopyruvate Hydratase/blood , Neurotoxicity Syndromes/blood , Neurotoxicity Syndromes/etiology , Neurotoxicity Syndromes/diagnosis , Anesthesia, Dental/methods , S100 Calcium Binding Protein beta Subunit/blood , Neurofilament Proteins/bloodABSTRACT
Background: Smoking is common in patients of depression and is known to affect response to antidepressants. This study was undertaken to evaluate the effect of smoking on the antidepressant effect of sertraline. Method: Patients with depression were divided into smoker and nonsmoker cohorts and followed up for 8 weeks. Serum sertraline levels were estimated using the high-performance liquid chromatography system. Response to treatment was evaluated with the Hamilton Depression Rating Scale (HAM-D). Results: Serum sertraline levels did not differ between smokers and nonsmokers at 4 and 8 weeks. Nonsmokers responded better to sertraline than smokers after 8 weeks. Adverse drug reaction profile did not vary between the two groups and was not impacted by serum sertraline levels. Nonsmokers showed a greater fall in the HAM-D score than smokers. Conclusion: This study found depression among smokers to be less responsive to sertraline. This was not explained by serum sertraline levels. Treatment of depression in smokers with sertraline might require higher doses and duration, with more frequent reviews.
Subject(s)
Ascorbic Acid , Humans , Ascorbic Acid/administration & dosage , Male , Female , Antioxidants/administration & dosage , AdultABSTRACT
BACKGROUND: Due to the progressive decline in ß-cell function, it is often necessary to utilize multiple agents with complementary mechanisms of action to address various facets and achieve glycemic control. Thus, this study aimed to evaluate the efficacy and safety of a fixed-dose combination (FDC) of metformin/sitagliptin/pioglitazone (MSP) therapy vs. metformin/sitagliptin (MS) in type 2 diabetes mellitus (T2DM). METHODS: In this phase 3, multicenter, double-blind study, patients with T2DM who exhibited inadequate glycemic control with HbA1c of 8.0-11.0% while taking ≥1500 mg/day metformin for at least 6 weeks were randomized to receive either FDC of MSP (1000/100/15 mg) or MS (1000/100 mg) per day for 24 weeks. The primary outcome measure was the change in HbA1c, and secondary outcomes included changes in fasting plasma glucose (FPG), postprandial plasma glucose (PPG), and body weight from baseline to 24 weeks along with safety and tolerability. RESULTS: Among the 236 patients randomized, 207 (87.71%) successfully completed the study. All baseline characteristics were comparable between the FDC of MSP and MS groups. There was a subsequent significant reduction of HbA1c in FDC of MSP (- 1.64) vs. MS (- 1.32); between groups was [- 0.32% (95% CI, - 0.59, - 0.05)], P = 0.0208. Similar reductions were found in FPG [- 13.2 mg/dL (95% CI, - 22.86, - 3.71)], P = 0.0068, and PPG [- 20.83 mg/dL (95% CI, - 34.11, - 7.55)], P = 0.0023. There were no significant changes in body weight. A total of 27 adverse effects (AEs) and one severe AE were reported, none of which were related to the study drug. CONCLUSION: The FDC of MSP demonstrated significant efficacy in managing glycemic indices and could serve as a valuable tool for physicians in the management of Indian patients with T2DM. TRIAL REGISTRATION: Clinical Trials Registry of India, CTRI/2021/10/037461.
ABSTRACT
HLA-DRB1*08:127 differs from HLA-DRB1*08:01:01:01 by a single substitution in exon 4.
Subject(s)
Tissue Donors , Humans , HLA-DRB1 Chains/genetics , Base Sequence , Haplotypes , Alleles , Histocompatibility TestingABSTRACT
INTRODUCTION: Athletic training can result in electrical and structural changes of the right ventricle that may mimic phenotypical features of arrhythmogenic right ventricular cardiomyopathy (ARVC), such as T-wave inversion and right heart dilatation. An erroneous interpretation may have consequences ranging from false reassurance in an athlete vulnerable to cardiac arrhythmias, to unnecessary sports restriction in a healthy individual. The primary aim of this study was to define normal RV dimension reference ranges for academy adolescent footballers of different ethnicities. Secondary aims include analysis of potential overlap between this adolescent group with ARVC criteria and comparison with normal adult ranges. RESULTS: Electrocardiographic (ECG) and echocardiographic data of 1087 academy male footballers aged between 13 and 18 years old (mean age 16.0 ± 0.5 years), attending mandatory cardiac screening were analysed. Ethnicity was categorised as white (n = 826), black (African/Caribbean; n = 166) and mixed-race (one parent white and one parent black; n = 95). Arrhythmogenic right ventricular cardiomyopathy major criteria for T-wave inversion was seen in 3.3% of the cohort. This was more prevalent in black footballers (12%) when compared to mixed race footballers (6.3%) or white footballers (1%), P < 0.05. Up to 59% of the cohort exceeded adult reference ranges for some of the right ventricular parameters, although values were similar to those seen in adult footballers. There were no differences in right ventricular dimensions between ethnicities. In particular, the right ventricular outflow tract diameter would fulfil major criteria for ARVC dimension in 12% of footballers. Overall, 0.2% of the cohort would fulfil diagnosis for 'definite' arrhythmogenic right ventricular cardiomyopathy and 2.2% would fulfil diagnosis for 'borderline' arrhythmogenic right ventricular cardiomyopathy for RV dimensions and ECG changes. This was seen more frequently in black footballers (9.9%) than mixed race footballers (3.9%) or white footballer (0.6%), P < 0.05. Among athletes meeting definite or borderline arrhythmogenic right ventricular cardiomyopathy criteria, no cardiomyopathy was identified after comprehensive clinical assessment, including with cardiac magnetic resonance imaging, exercise testing, ambulatory electrocardiograms and familial evaluation. CONCLUSION: Right heart sizes in excess of accepted adult ranges occurred in as many as one in two adolescent footballers. Structural adaptations in conjunction with anterior T-wave inversion may raise concern for ARVC, highlighting the need for evaluation in expert settings.
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PURPOSE: Genetic variants of AMELX gene can affect the protein content, organization of enamel prisms, microstructure and microhardness of the enamel, thus altering the caries susceptibility. The present study aims to assess the association between polymorphisms rs17878486, rs5934997, and rs5933871 of AMELX gene and Early Childhood Caries (ECC). MATERIALS AND METHODS: This case-control study was conducted on 200 participants, aged 3-6 years, with 100 controls and 100 children with ECC. A questionnaire was used to collect demographic data, birth-weight, type of delivery, oral hygiene practices, feeding history and 24-h diet diary. DNA was isolated from blood and subjected to PCR followed by Sanger sequencing. RESULTS: The CC genotype of rs17878486 showed an OR of 1.93 (0.34-10.81; P = 0.73). In a recessive model, the CC genotype of rs17878486 reported an OR of 2.04 (0.36-11.40; P = 0.68); rs5593871 reported an OR of 1.00 (0.31-3.21). Statistically significant differences (P ≤ 0.05) between genotype and allele frequencies of rs17878486, rs5934997, and rs5933871 were not observed between children with ECC and the controls. CONCLUSION: Polymorphisms of AMELX gene did not show a significant association with ECC in this population. However, documentation of genetic data in a global context of ECC may be essential for the future.
Subject(s)
Dental Caries , Humans , Case-Control Studies , Dental Caries/genetics , Child , Child, Preschool , Female , Male , India , Polymorphism, Single Nucleotide , Genotype , Amelogenin/genetics , Genetic Predisposition to DiseaseABSTRACT
BACKGROUND: Frailty is a clinical, geriatric syndrome linked to disability and mortality; and may be associated with a variety of factors among underrepresented and underserved women living with HIV (WLWH) and without HIV (WLWOH) transitioning through the adult life course. OBJECTIVES: Determine whether a published set of factors associated cross-sectionally with frailty in WLWH and similar WLWOH at average age 39 years in 2005/2006 were associated with frailty in 2018/2019 among women who initiated frailty assessments at age ≥40 years, or whether a new set of factors were associated with frailty. DESIGN: Cross-sectional analyses within a longitudinal cohort study. SETTING: The multi-center Women's Interagency HIV Study (WIHS). PARTICIPANTS: 1285 participants (951 WLWH, 334 WLWOH), median age 53 years (interquartile range 47-58 years). MEASUREMENTS: The Fried Frailty Phenotype (FFP) in association with 23 factors representing HIV serostatus, other infections, sociodemographic factors, health behaviors, and chronic diseases. RESULTS: Frailty prevalence was 11.1% in 2018/2019 (12.6% among WLWOH, 9.6% among WLWH, p=0.121). The published 2005/2006 final multivariable stepwise regression model contained 9 predictors of frailty. When refit to women in 2018/2019, only age ≥50 years and annual income ≤$12,000 were independently positively associated with frailty; other significant 2005/2006 factors, HIV serostatus, CD4+ count <500 cells/mL among WLWH, smoking, drinking, FIB-4 and eGFR, were not. A newly-derived stepwise model considering all 23 predictors measured in 2018/2019, showed independent positive associations between frailty and age ≥50 years, annual income ≤$12,000, obesity (body mass index (BMI) ≥30kg/m2), and history of tuberculosis and cancer. CONCLUSION: Different chronic and infectious disease factors were associated with frailty among WLWH and WLWOH over the adult life course. Understanding factors associated with frailty by adult life stage, allows identification and implementation of novel, temporal interventions to alleviate frailty-associated outcomes and enhance quality of life among WLWH and WLWOH.
Subject(s)
Frailty , HIV Infections , Female , Humans , Adult , Middle Aged , Aged , HIV Infections/epidemiology , Frailty/diagnosis , Frailty/epidemiology , Frailty/complications , Longitudinal Studies , Quality of Life , Cross-Sectional StudiesABSTRACT
The objective of this study was to analyze the diverse morphological attributes of Kotdhar goat native to Shivalik hill region of Himachal Pradesh. A total number of 180 goats, comprising 150 females and 30 males aged between 1 and 3 years, were randomly selected to estimate15 distinct morphological traits and ten body indices. Mean values of 17.66 cm, 11.68 cm, 8.73 cm, 71.94 cm, 69.83 cm, 74.48 cm, 38.10 cm, 73.38 cm, 20.55 cm, 16.48 cm, 14.89 cm, 13.57 cm, 19.20 cm, 7.71 cm and 26.12 kg were estimated for head length, head width, face length, body length, wither height, heart girth, chest depth, rump height, rump length, rump width, haunch width, bicoastal width, shoulder width, cannon bone and body weight respectively. In addition, morphological indices viz. body index, length index, body ratio, thoracic development, pelvic index, longitudinal pelvic index, transverse pelvic index, proportionality index, dactyl thorax index and relative depth of thorax were estimated from morphological traits. Results of morphological indices indicated that Kotdhar goat are medium bodied, longilinear, tall animals and well-suited for meat production. Phenotypic correlation among most of traits was positive and significant. Among all correlations, correlation between head length and head width was found lowest (- 0.270), while the correlation between heart girth and chest depth was observed highest (0.861). Canonical discriminant function analysis showed that there was no considerable level of intermixing for morphological traits in Kotdhar goat. Employing principal component analysis with varimax rotation, three principal components were observed, accounting for 68.47% of the total variation. First principal component (PC1) encapsulated the highest proportion of variance (44.39), revealing the high loadings on head length (0.777), body length (0.747), wither height (0.782), heart girth (0.785), chest depth (0.706), rump height (0.762), haunch width (0.734) and bicoastal width (0.793). Hence, it is possible to utilize these eight variables out of the 15 morphological traits for the characterization of the Kotdhar goat.
Subject(s)
Goats , Male , Female , Animals , Body Weight , Phenotype , Discriminant Analysis , Principal Component AnalysisABSTRACT
Symptomatic women with angina are more likely to have ischemia with no obstructive coronary arteries (INOCA) compared to men. In both men and women, the finding of INOCA is not benign and is associated with adverse cardiovascular events, including myocardial infarction, heart failure and angina hospitalizations. Women with INOCA have more angina and a lower quality of life compared to men, but they are often falsely reassured because of a lack of obstructive coronary artery disease (CAD) and a perception of low risk. Coronary microvascular dysfunction (CMD) is a key pathophysiologic contributor to INOCA, and non-invasive imaging methods are used to detect impaired microvascular flow. Coronary vasospasm is another mechanism of INOCA, and can co-exist with CMD, but usually requires invasive coronary function testing (CFT) with provocation testing for a definitive diagnosis. In addition to traditional heart disease risk factors, inflammatory, hormonal and psychological risk factors that impact microvascular tone are implicated in INOCA. Treatment of risk factors and use of anti-atherosclerotic and anti-anginal medications offer benefit. Increasing awareness and early referral to specialized centers that focus on INOCA management can improve patient-oriented outcomes. However, large, randomized treatment trials to investigate the impact on major adverse cardiovascular events (MACE) are needed. In this focused review, we discuss the prevalence, pathophysiology, presentation, diagnosis and treatment of INOCA.
Subject(s)
Coronary Artery Disease , Myocardial Ischemia , Male , Female , Humans , Coronary Artery Disease/diagnosis , Quality of Life , Myocardial Ischemia/diagnosis , Myocardial Ischemia/etiology , Myocardial Ischemia/drug therapy , Coronary Vessels , IschemiaABSTRACT
BACKGROUND: Symptomatic haemorrhoids (SH) are a common condition; however, conventional outpatient treatment, including rubber band ligation, is contraindicated in patients receiving concurrent anticoagulation. Injection sclerotherapy (IST) has been proposed as a treatment option for these patients. METHODS: A retrospective review of case notes was performed in a colorectal surgery department that sits alongside a tertiary cardiothoracic surgical unit. Patients treated with an IST for SH between 1 April 2014 and 30 November 2021 were identified. Anticoagulation was not stopped in these patients as they were at high risk of developing thromboembolism, except in two patients who required alternative procedures. The primary outcome was symptom resolution, defined as no patient reporting bleeding for at least six months. The secondary outcomes were patient-reported complications, number of IST procedures and number of other procedures performed to achieve symptom resolution. RESULTS: A total of 20 patients with a median age of 64 years (range 35-86, 14 male) who underwent 32 IST treatments were identified. Symptom resolution was achieved in 18 (90%) patients using IST while continuing anticoagulation treatment, with two (10%) patients requiring alternative interventions. Ten patients (50%) required only one IST procedure, and three patients (15%) required two procedures. The remaining five (25%) patients required three or four interventions. The median time between IST treatments was 32 weeks (range 8-133). No complications were reported. CONCLUSION: Our study demonstrates that IST can be considered as a potential treatment option for patients with SH who are at a high risk of thromboembolic disease requiring anticoagulation.
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Objectives: The present study aimed at determining the incidence of sternal foramina in adult dry bones of North Indian descent. We also aimed to determine the number, precise location of the sternal foramina with a standard reference point which might have considerable importance with regard to procedures involving sternal puncture. Methods: This cross sectional descriptive study was conducted on 72 dry adult human sternums. Various measurements in relation to the sternal foramina were taken with a non-stretchable measuring tape and digital vernier calliper and expressed as: [A]-total sternal length, [B]-distance between the jugular notches to the foramen, [C]-distance between the angle of Louis to the foramen and [D]-distance of the foramen from the mid sternal plane. Statistical analysis was performed with Microsoft Excel version 2019. A p-value of <0.05 was considered significant. Results: We found 6.94% (5 out of 72 sternums) incidence of sternal foramina which corroborates well with the existing literature. Mean sternal length was 127.7 ± 09 mm. The mean distance of the foramina from suprasternal notch, sternal angle and from the median plane were 118.12 ± 0.3 mm, 116.7 mm and 2.4 mm respectively. Incidence of sternal foramina was almost similar to previously reported studies. Conclusions: The precise knowledge about the expected location of sternal foramina is imperative to avoid intra-thoracic visceral injury during commonly performed acupuncture needle insertion and while doing bone marrow aspiration for diagnostic evaluation.