Venous Thromboembolism Risk Assessment Models in Plastic Surgery: A Systematic Review and Meta-Analysis.

Postoperative venous thromboembolism (VTE) is the most common complication of plastic surgery procedures. Diverse risk assessment models (RAMs) exist to stratify patients by VTE risk, but due to a lack of high-quality evidence and heterogeneity in RAM data, there is no recommendation regarding RAM that can be used for plastic surgery patients. This study compares the reliability and outcomes of Caprini and American Society of Anesthesiologists (ASA) physical status classification RAMs used in plastic surgery to help surgeons stratify the risk of VTE. Methods: MEDLINE and Embase databases were searched between February 2010 and December 2021. All published English articles that report the incidence of VTE stratified by a RAM among patients who underwent plastic surgery were included. The results of the presented meta-analysis were pooled using a random-effects model. Results: The database search revealed 809 articles, out of which eight studies (n = 1,348,606) were eligible. Out of the eight studies, six utilized the Caprini score, and three utilized ASA score. Super-high-risk patients were significantly more likely to present with VTE than their high-risk [odds ratio (OR), 2.92; 95% confidence interval (CI), 1.26-6.78], medium-risk (OR, 5.29; 95% CI, 2.38-11.79), or low-risk counterparts (OR, 10.00; 95% CI, 2.32-43.10) at Caprini score. High-risk patients in ASA score showed significant increase in VTE incidents (OR, 2.72; 95% CI, 1.10-6.72). Conclusions: Both Caprini and ASA RAMs showed compelling evidence of efficacy in our study. However, the Caprini RAM is more predictive of postoperative VTE incidents in high-risk plastic surgery patients than the ASA grading system.

Risk Models to Predict Mortality in Burn Patients: A Systematic Review and Meta-analysis.

The predictive capability of various risk assessment models (RAMs) in evaluating the risk of mortality in burn patients is not well established. It is also unclear which RAM provides the highest discriminative ability and presents the highest clinical utility. We pooled all available studies to establish this validity and compare the predictive capability of the various RAMs. Methods: We reviewed PubMed, MEDLINE, and Embase from their inception up until December 2021 for studies evaluating risk of mortality in burn patients as stratified by RAMs. Data were pooled using random-effect models and presented as area under the receiver operating characteristic (AUROC) curve. Results: Thirty-four studies, comprising of a total of 98,610 patients, were included in our analysis. Most studies were found to have a low risk of bias and a good measure of applicability. Nine RAMs were evaluated. We discovered that the classic Baux; the revised Baux; and the Fatality by Longevity, APACHE II score, Measured Extent of burn, and Sex (FLAMES) scores presented with the highest discriminative power with there being no significant difference between the results presented by them [AUROCs (95% CI), 0.92 (0.90-0.95), 0.92 (0.90-0.93), 0.94 (0.91-0.97), respectively, with P < 0.00001 for all]. Conclusions: Many RAMs exist with no consensus on the optimal model to utilize and assess risk of mortality for burn patients. This study is the first systematic review and meta-analysis to compare the current RAMs' discriminative ability to predict mortality in patients with burn injuries. This meta-analysis demonstrated that RAMs designed for assessing mortality in individuals with burns have acceptable to great discriminative capacity, with the classic Baux, revised Baux, and FLAMES demonstrating superior discriminative performance in predicting death. FLAMES exhibited the highest discriminative ability among the RAMs studied.

First Aid for Burns and Burn-Related Nutrition among 2437 Inhabitants: A Nationwide Survey in Saudi Arabia.

BACKGROUND: Although burn-related injuries are serious and can cause significant morbidity and mortality, this can be alleviated through the appropriate practice of first aid for burns. We aimed to explore the practice of first aid and measure the level of knowledge of burns and burn-related nutrition in Saudi Arabia. Methods: Data were collected using an online questionnaire, distributed among the general Saudi population between Jul and Sep 2020. It included socioeconomic and biographical data, and knowledge and practice of first aid for burns and burn-related nutrition. Data were analyzed using SPSS. Results: Overall, 2437 people were enrolled in this study, of which 59.5% were female. More than half (51.9%) the subjects were between 19 and 25 yr of age. Younger age group (≤25 yr) showed a significantly better practices score (t=4.844; P<0.001). Females exhibited a significantly better knowledge score than males (t=-3.131; P=0.021). Unemployed respondents were significantly more associated with a lower knowledge score (t=4.796; P=0.007) and a lower practices score (t=18.375; P<0.001) while those with a history of exposure to burn injury had a lower knowledge score (t=-4.816; P<0.001) and a lower practices score (t=-3.237; P=0.001). Conclusion: There is a lack of knowledge and practice of burn's first aid and burn-related nutrition. Thus, courses and training in first aid for burns and awareness campaigns are essential in order to improve the knowledge of the general Saudi population.

Effectiveness of Autologous Fat Transfer in the Treatment of Scar-Related Conditions: A Systematic Review and Meta-analysis.

BACKGROUND AND AIM: Autologous fat transfer (AFT) has been introduced as a potential treatment option for scar-tissue and its related symptoms. However, the scientific evidence for its effectiveness remains unclear. This meta-analysis aims to evaluate the available evidence regarding the effectiveness of autologous fat transfer for the treatment of scar-tissue and its related conditions. METHODS: PubMed/Medline database was queried from its inception till the end of November 2021. All the relevant studies assessing the effect of autologous fat transfer in the treatment of scar-related conditions were pooled in using a random-effects model. RESULTS: 9 studies (n=179) were included in the meta-analysis. Pooled analysis demonstrates significant improvement in all subscales of the POSAS patient score with most prominent in color 2.4 points (95% CI 1.78-3.041), stiffness 2.9 points (95% CI 2.33-3.45), irregularity 2.2 points (95% CI 1.093-3.297) and thickness 1.8 points (95% CI 0.804-2.719), respectively. Pain and itch improved relatively lesser, 1.3 points (95% CI 0.958-1.674) and 0.6 points (95% CI 0.169-1.215), respectively. The POSAS observer scale showed a relatively lower improvement with the least in vascularity 0.5 points (95% CI 0.098-0.96), pigmentation 0.8 points (95% CI 0.391-1.276) and surface area 0.8 points (95% CI 0.34-1.25). Thickness improved by 1.4 points (95% CI 0.582-2.3), relief 1.0 points (95% CI 0.461-1.545) and pliability 1.5 points (95% CI 1.039-2.036). CONCLUSION: Our findings demonstrate that autologous fat transfer (AFT) is a promising treatment for scar-related conditions as it provides beneficial results in the scar quality. Future research should focus on the long-term effects of AFT and high-level evidence studies such as, randomized controlled trials (RCTs) and cohort studies are required. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Dry Eye Disease Symptoms and Its Association with Daily Beverage Intake Among Adults in Saudi Arabia.

PURPOSE: To evaluate the association between dry eye disease (DED) symptoms and daily beverage intake among adults in Saudi Arabia. PATIENTS AND METHODS: In this cross-sectional, questionnaire-based study, we distributed an online questionnaire to men and women older than 18 years living in Saudi Arabia. The questionnaire consisted of items related to the sociodemographic characteristics of the participants and two validated indices: the Ocular Surface Disease Index (OSDI) and the brief 15-item Beverage Intake Questionnaire (BEVQ-15). Participants were excluded if they were aged less than 18 years; wore contact lenses; had existing eye disease (excluding refractive errors), history of eye surgery (including corrective eye surgeries), or autoimmune diseases (rheumatoid arthritis, systemic lupus erythematosus, Sjogren's syndrome); or were currently taking specific medications including antidepressants, antihistamines, and diuretics. RESULTS: After applying the study exclusion criteria, a total of 615 participants were included in the statistical analysis. The majority of participants were 18-34 years old (450, 73.2%), and men (381, 62%) exceeded women (234, 38%) by approximately 1.5-fold. OSDI scores showed that 344 participants (55.9%) had DED symptoms, 145 (23.6%) had mild dry eyes; and 106 (17.2%) and 93 (15.1%) had moderate and severe dry eyes, respectively. There was a significant association between sex and DED symptoms (p = 0.012); the frequency of DED symptoms in women exceeded that in men. However, no significant differences were observed with other demographic data such as age and location of residence. Although beverage intake was moderately correlated to OSDI score (R = 0.27), we found no significant association between beverage intake and DED symptoms. CONCLUSION: This is the first study to highlight the association between DED symptoms and daily beverage intake. We found a significant association between DED symptoms and female sex. However, no significant association was found between DED symptoms and other demographic characteristics or beverage intake.

Plastic and aesthetic surgery among medical students: A cross-sectional study.

OBJECTIVES: The wide variety of operations that a plastic surgeon can deal with creates confusion regarding its proper scope. This confusion was observed in primary physicians as well as medical students. Increasing the perception of medical students toward plastic surgery can aid in career decision-making and early referral patterns. The aim of this study is to gauge a holistic overview of how medical students and interns perceive the plastic and aesthetic surgical specialty in King Faisal University and to suggest a recommended plan. METHODS: An online questionnaire was distributed equally to male and female medical students and interns in a local medical institute. The questionnaire constituted three sections; the first included the biographical data. The second is concerned with the different case scenarios and specialties to be chosen. The third is concerned with the previous clinical exposures. The data were analyzed by SPSS version 21. Between comparison, chi-square tests, Mann-Whitney U-test, and Kruskal-Wallis tests were applied. Normality tests were conducted using the Shapiro-Wilk's test. RESULTS: Two hundred ninety-two students and interns have participated and completed the questionnaire. There were 189 males and 103 females. Plastic surgery was most commonly chosen in the following case scenarios; burn of the hand (74%), broken nose (64.7%), and cosmetic nose reshaping (80.8%). However, plastic surgery was infrequently chosen (selected by <30% of students) in many areas of hands and peripheral neuropathies (severed finger extensor tendon (26.4%), fractured scaphoid (12.7%), carpal tunnel syndrome (14.4%), brachial plexus injury (16.1%)). The most common source of information was the social media, and the least one is meeting with doctors and professors. CONCLUSION: Medical students and interns lack a full view of plastic and reconstructive surgery, especially in hand and peripheral neuropathies. Improving the education of medical students and interns is recommended and needed.

Gynecomastia: a study to assess how students perceive this disease.

Background: Gynecomastia is a benign proliferation of the glandular male breast tissue. Gynecomastia etiology might be physiological or non-physiological such as medications, chronic diseases (e.g. hypogonadism), or steroid supplements. Aim: The purpose of this study was to assess the knowledge and understanding of gynecomastia among medical students and which resources were used to gain their understanding regarding the disease. Methods: Data for this qualitative, questionnaire-based cross-sectional study was collected on the basis of our own study objectives and from available questionnaires with similar objectives. The questionnaire was composed of 26 questions divided into many items that were recorded including sociodemographic data, gynecomastia symptoms, and holistic perception of the problem by the students. Exclusion criteria included those who refused to participate in the study and did not complete the questionnaire. Statistical tests were taken significant at p-value ≤0.05. All analyses were performed using SPSS, version 21. Results: A total of 200 medical students participated in this study, among them more males than females (64% vs. 36%). We observed that medical students had significantly more moderate knowledge with teachers as their source of information on gynecomastia (p=0.028) while with books (p=0.005) and internet (p=0.041) as their sources of information they had significantly more a higher level of knowledge. Conclusions: Medical students have overall insufficient knowledge about gynecomastia especially in physical examination and treatment aspects. Therefore, gynecomastia is to be considered more thoroughly in the curriculum.