OBJECTIVE: To find out the accuracy of plain Magnetic Resonance imaging (MRI) in comparison with arthroscopy in diagnosing cruciate ligaments and meniscal injuries. METHODS: This prospective study ...was conducted from June 2019 to June 2020 at Khyber teaching hospital Peshawar, Pakistan. All patients, aging 14-55 years, with history of trauma to knee and suspected meniscal and ligament injuries were included. Patients with positive findings on clinical examination and MRI were sent for arthroscopy. Findings on MRI and arthroscopy were compared for diagnostic accuracy. RESULTS: Out of 100 patients, 87 were males. Fifty-nine patients had anterior cruciate ligament injuries (ACLI), one patient had posterior cruciate ligament injuries (PCLI), 49 patients had medial meniscus injuries (MMI) and 8 had lateral meniscal injuries (LMI) respectively. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MRI was 93.4%, 71.4%, 82.35% & 88.23% respectively for ACLI and 100%, 96%, 20% and 100% respectively for PCLI. Similarly, sensitivity, specificity, PPV and NPV of MRI was 81.6%, 45.3%, 57.97% & 72.72% respectively for MMI and 37.5%, 91.5%, 27.27% and 94.5% respectively for LMI. There was no statistically significant difference for gender (p=0.43) and side of knee (p=0.22) between MRI vs arthroscopy. CONCLUSION: MRI has high sensitivity and NPV for ACLI & PCLI, low sensitivity for LMI, low specificity for MMI and low PPV for PCLI, MMI and LMI. In cases of clinical suspicion of meniscal or ligamental injury, clinicians should not rely on MRI findings alone but should follow it up with diagnostic arthroscopy.
There are important differences between patients requiring sentinel lymph node biopsy (SLNB) and those who do not require axillary surgery at the time of breast reconstruction. We aimed to perform a ...propensity score-matched analysis to evaluate the impact of SLNB at the time of immediate implant-based breast reconstruction (IBBR) with tissue expanders compared with IBBR alone.
Consecutive female patients undergoing total mastectomy and immediate two-stage IBBR between January 2011 and May 2021 were included. A 1:1 nearest-neighbor matching method without replacement was implemented with a caliper width of 0.01. Patients were matched for age, diabetes, hypertension, hyperlipidemia, premastectomy radiotherapy, neoadjuvant chemotherapy, the plane of prosthesis placement, mastectomy specimen weight, number of drains, and radiation of the expander.
We included 320 two-stage immediate IBBRs after propensity score matching, 160 reconstructions per group. Relevant surgical variables were comparable between groups. A higher rate of 30-day seroma formation was reported in immediate reconstructions that had SLNB at the time of mastectomy compared with reconstructions that did not have axillary surgery (16.3% versus 8.1%, p = 0.039). The time to complete outpatient expansions and time for expander-to-implant exchange were comparable between patients who underwent IBBRs with SLNB and those who did not.
SLNB performed at the time of mastectomy and IBBR with tissue expander increased the risk of seroma formation compared with reconstructions that did not have axillary surgery. The rate of infection, hematoma, and unplanned procedures to manage complications did not differ between groups.
Resumen La estadística es uno de los pilares de la ciencia, especialmente para describir y analizar los datos, la que ha progresado exponencialmente en los últimos años. Se le debe entender como un ...apoyo fundamental para la toma de decisiones en las distintas disciplinas. Los análisis exploratorios son descritos como el primer paso en la estadística, buscando organizar, representar y describir los datos, pero muchas veces este proceso se vuelve complejo, siendo importante realizar una revisión exhaustiva de la matriz de datos. Es objetivo de este manuscrito describir una propuesta metodológica para la validación de bases de datos aplicada a las ciencias de la salud. Esta metodología consta de seis etapas: cuatro de ellas obligatorias y sucesivas, y las otras dos opcionales. En la literatura médica, estos procedimientos general-mente son pasados por alto; buscamos, en consecuencia, recalcar la importancia de este proceso como previo a los análisis exploratorios.
The COVID-19 vaccine rollout has had various degrees of success in different countries. Achieving high levels of vaccine coverage is key to responding to and mitigating the impact of the pandemic on ...health and aged care systems and the community. In many countries, vaccine hesitancy, resistance, and refusal are emerging as significant barriers to immunisation uptake and the relaxation of policies that limit everyday life. Vaccine hesitancy/ resistance/ refusal is complex and multi-faceted. Individuals and groups have diverse and often multiple reasons for delaying or refusing vaccination. These reasons include: social determinants of health, convenience, ease of availability and access, health literacy understandability and clarity of information, judgements around risk versus benefit, notions of collective versus individual responsibility, trust or mistrust of authority or healthcare, and personal or group beliefs, customs, or ideologies. Published evidence suggests that targeting and adapting interventions to particular population groups, contexts, and specific reasons for vaccine hesitancy/ resistance may enhance the effectiveness of interventions. While evidence regarding the effectiveness of interventions to address vaccine hesitancy and improve uptake is limited and generally unable to underpin any specific strategy, multi-pronged interventions are promising. In many settings, mandating vaccination, particularly for those working in health or high risk/ transmission industries, has been implemented or debated by Governments, decision-makers, and health authorities. While mandatory vaccination is effective for seasonal influenza uptake amongst healthcare workers, this evidence may not be appropriately transferred to the context of COVID-19. Financial or other incentives for addressing vaccine hesitancy may have limited effectiveness with much evidence for benefit appearing to have been translated across from other public/preventive health issues such as smoking cessation. Multicomponent, dialogue-based (i.e., communication) interventions are effective in addressing vaccine hesitancy/resistance. Multicomponent interventions that encompasses the following might be effective: (i) targeting specific groups such as unvaccinated/under-vaccinated groups or healthcare workers, (ii) increasing vaccine knowledge and awareness, (iii) enhanced access and convenience of vaccination, (iv) mandating vaccination or implementing sanctions against non-vaccination, (v) engaging religious and community leaders, (vi) embedding new vaccine knowledge and evidence in routine health practices and procedures, and (vii) addressing mistrust and improving trust in healthcare providers and institutions via genuine engagement and dialogue. It is universally important that healthcare professionals and representative groups, as often highly trusted sources of health guidance, should be closely involved in policymaker and health authority decisions regarding the establishment and implementation of vaccine recommendations and interventions to address vaccine hesitancy.
BACKGROUND: Muscle injuries are a common manifestation of exercise and non-mechanical factors such as drugs, genetic defects, and systemic diseases. Despite their clinical importance, the cellular ...and molecular mechanisms of muscle injury and repair are poorly understood, which hamper development of effective clinical interventions. OBJECTIVE: This review is an attempt to recognize basic principles of skeletal muscle regeneration process. METHODS: A thorough systematic review of articles on muscle injury and repair processes was conducted using three reliable search engines for biomedical literature as ScienceDirect, Scopus and PubMed. REVIEW: Following injury, rapid activation and differentiation of satellite cells is major cellular repair process. At the molecular levels, activation of dysferlin and MG53 proteins help in building the ‘’repair cap’’ at injury site to initiate repair process. This event is followed by secretion of muscle myokines and subsequent infiltration of macrophages into muscle fibers, which remove cellular debris and activate other repair proteins and satellite cells. This review elaborates cellular and molecular mechanisms regulating these events following muscle injury. Effective therapeutic interventions to counter muscle injury-related atrophy remain elusive. Conclusion: Altogether, this review proposes cellular and molecular targets to accelerate muscle regeneration process following mechanical and non-mechanical injuries. Further investigations are required to elucidate the pathways dictating muscle regeneration process following injury.
OBJECTIVE: to determine the more effective dose of intramuscular (IM) Phenylephrine in preventing hypotension due to spinal anesthesia (SA) administered for cesarean section. METHODS: The study was ...conducted from January1, 2020 to July 31, 2020, at Rehman Medical Institute, Peshawar, Pakistan. Sixty participants of American Society of Anesthesiologists (ASA) physical status 1 and 2, scheduled for elective cesarean section (CS) under SA were enrolled in this prospective double-blind study and randomized into two equal groups, P4-group and P8-group. P4-group received IM Phenylephrine 04 mg and P8-group received IM Phenylephrine 08 mg before SA. The incidence and intensity of hypotension, rescue doses of Phenylephrine and any adverse event, were recorded. Data collected was analyzed using Epi lnfo ™ version 7.2.5. RESULTS: Mean age of patients from P4-Group and P8-Group was 28.10±4.39 years and 28.33±4.95 years respectively. There were no statistically significant differences in the two groups with respect to demographic and clinical characteristics. Hypotension occurred in 33.3% (n=20/60) of participants. The incidence of hypotension in P4-group and P8-group were 46.7% (n=14/30) and 20% (n=6/30) respectively. In P8-group, risk of hypotension was 1.5 times less common compared with P4-group with 95% confidence interval of 1.02–2.19 (p=0.02). There was also no statistically significant difference between the onset of hypotension in the two groups. Those who developed hypotension had consumed a lesser amount of rescue Phenylephrine in P8-group compared with P4-group (p-value <0.01). CONCLUSION: Phenylephrine 08 mg IM preemptively controls SA induced hypotension in a sustained way in the fit participants.
For the most part, heart disease increases with age; on the other hand, although the role of exercise and antioxidants in the health of the elderly has been reported, the simultaneous effect of these ...two interventions is a new research topic. Thus, the aim of this study was to evaluate the effect of eight weeks of high intensity interval training (HIIT) and genistein (G) supplementation on oxidative stress, apoptosis and mitochondrial biogenesis in the heart tissue of elderly rats.
In this experimental study, 40 elderly female Sprague-Dawley rats aged 20 ± 2 months and weighing 250 ± 30 g were randomly divided into five groups of eight animals, including: (1) control (C), (2) sham (Sh), (3) HIIT, (4) HIIT + G and (5) G. Also, to evaluate the effect of time passage on the variables, 8 healthy young rats were included in the healthy young control group. HIIT protocol was performed for eight weeks, three sessions with an intensity of 95–90 % VO2max at high intensity intervals and 45–45 % VO2max at low intensity intervals. Ge was received daily at a dose of 60 mg/kg peritoneally. Data analysis was performed using one-way ANOVA with Tukey's post hoc test (P ≤ 0.05).
In the HIIT and HIIT + G groups, levels of Bax, Bax/Bcl-2 ratio, MDA, PAB, GSSG were lower and levels of PGC-1α, TFAM, GSH, GSH/GSSG ratio and NDUFS7 were higher than the control and sham groups (P ≤ 0.05). In the HIIT + G group, levels of Bcl-2 were significantly higher than the control group (P ≤ 0.05). In the HIIT + G group, levels of Bax, GSSG, Bax/Bcl-2 ratio, and PAB were lower, and levels of GSH/GSSG ratio, Bcl-2, PGC-1α, TFAM and NDUFS7 were higher than the G consumption group (P ≤ 0.05). In the HIIT + G group, levels of PGC-1α and TFAM were significantly higher and levels of MDA and PAB were lower than the HIIT group (P ≤ 0.05).
Both HIIT and G consumption seem to have beneficial effects on reducing oxidative stress; in addition, the interaction of these two variables on the improvement of apoptosis and mitochondrial biogenesis is more favorable than the effect of either one alone. However, more studies are needed on different pathways of apoptosis following G administration.
•Overdose of G can inhibit phenolsulfotransferases and activate apoptotic proteins, but not in the oxidative-antioxidant system•Both HIIT and G consumption can have beneficial effects on reducing oxidative stress.•The interaction of HIIT and G on the improvement of apoptosis and mitochondrial biogenesis is favorable than each one alone.
