Maedica最新文献

Purpose: To compare the effectiveness of two widely practiced home-based convergence exercises - cat card exercise (CCE) and pencil push-up exercise (PPE) - in patients with symptomatic convergence insufficiency.

Methods: This retrospective observational study was conducted from June 2023 to June 2024 in the Department of Ophthalmology of a Tertiary Care Centre in North India. In this study, eighty patients aged 10 to 35 years, all exhibiting the best-corrected visual acuity of 20/20 and a receded near point of convergence (NPC) greater or equal to 7.5 cm were included. Participants were arbitrarily allocated to receive either PPE or CCE, each lasting 15 minutes a day, five days a week, for six weeks. Patients were reassessed after the six-week period. Enhancement in NPC was the main outcome. Data were analysed employing suitable statistical tests, with a significance threshold established at P 0.05.

Results: Both CCE and PPE groups demonstrated a significant improvement in NPC after six weeks of therapy. However, the gap regarding NPC advancement in the two groups remained statistically significant (P > 0.05).

Conclusion: Cat card and pencil push-up exercise are both effective home-based treatment options for symptomatic convergence insufficiency, with comparable outcomes.

Cerebrospinal fluid (CSF) rhinorrhea is a relatively rare medical condition characterized by the drainage of CSF through the nasal cavity. Cerebrospinal fluid leakage can be attributed to a plethora of different causes, mostly traumatic or iatrogenic, but it can also be spontaneous. Due to its rare entity, CSF rhinorrhea is often a diagnostic trap and can be misdiagnosed and mistreated as rhinosinusitis or allergic rhinitis. This can result in severe complications, such as meningitis, which could potentially have life-threatening consequences if not accurately identified and managed. In this case report, a 53-year-old Caucasian woman presented at the emergency department with symptoms of headache, fever, transparent nasal discharge from her left nostril when leaning forward and mild neck stiffness. Based on the patient's clinical presentation and physical examination findings, there was a high suspicion of central nervous system infection and cerebrospinal fluid leakage. A lumbar puncture confirmed the diagnosis of meningitis, while imaging exams, including computed tomography (CT) and magnetic resonance imaging (MRI) scans, revealed a fistula between the posterior wall of sphenoid sinus and the subarachnoid space. Additional findings included an empty sella turcica, suggesting a potential underlying cause for this condition and an incidental meningioma near the area of leakage. The patient received empiric intravenous antibiotic therapy and was discharged after ten days. She was referred to the neurosurgical department for surgical repair of the CSF leak and removal of the meningioma, in line with appropriate treatment guidelines. This study highlights the importance of promptly identifying and thoroughly investigating potential causes of CSF leakage to provide appropriate medical management.

Objectives: Autonomic function assessment, performed using heart rate variability and Ewing's battery, can help unravel autonomic neuropathy in many clinical disorders. This assessment can be affected by obesity. We revisited the relationship between autonomic function parameters and obesity. The body mass index (BMI) based stratification based on standard World Health Organization (WHO) classification and revised South East Asian (SEA) classification was employed.

Materials and methods: Apparently, healthy subjects of either sex were included in the present study. Subjects were classified into normal weight (NOR), overweight (OW) and obese (OB) categories using both guidelines. An autonomic function test was performed, documenting heart rate variability (HRV) and Ewing's battery of tests including postural challenge, deep breathing, cold pressor and isometric exercise. Parameters were compared between the three groups.

Results: We recruited 105 healthy subjects (89 males, 16 females) with a mean age of 29.83 ± 5.44 years. There were 33, 29 and 43 subjects in the NOR, OW and OB categories, respectively, as per the revised SEA classification. Similarly, 63 subjects were NOR, 42 OW, and six OB, as per the WHO criteria. There was no significant difference between HRV parameters and autonomic reactivity parameters between NOR, OW and OB subjects as per the revised SEA and WHO criteria.

Conclusions: The WHO criteria underestimated obesity in our population sample. In addition, there was no significant difference in autonomic parameters between NW, OW and OB subjects as per the SEA criteria. We propose that the effect of obesity on autonomic parameters may require a revisit in light of revised BMI criteria for the SEA population.

Background: Periodontitis causes many clinical presentations, one of which is gingival recession, which leads to root exposure, hypersensitivity and esthetic issues. One of the most accepted surgical procedures of root coverage is the coronally advanced flap (CAF) technique. Newer regenerative modalities such as placental-derived chorion membranes and autologous concentrated growth factor (CGF) membranes have a higher capacity to heal because of the bioactive nature of these membranes. Material and method: A randomized controlled clinical trial study was carried out on 10 patients with bilateral gingival recession in maxillary premolars. They happened to receive CAF with chorion membrane on one side (Group A) and CGF membrane on the other side (Group B). Such clinical parameters as probing depth (PD), clinical attachment level (CAL), recession height (RH), recession width (RW) and width of keratinized tissue (WKT) were measured at baseline and after three months of follow-up. Paired and unpaired t-tests were undertaken through IBM SPSS 23.0. Results: In both groups, all clinical parameters improved statistically significant after the surgery (p < 0.05). Group A root coverage mean was 89 percent and Group B 82 percent. The postoperative values of PD, CAL, RH, RW and WKT did not differ statistically between the two groups (p < 0.05), but Group A had slightly superior results. Conclusions: Human chorion membrane and concentrated growth factor membrane being used with CAF lead to effective root coverage and clinical improvement, which is considered significant in Miller Class I and II gingival recessions. Both membranes are effective, but the chorion membrane might provide slightly better clinical results. Longitudinal research involving bigger samples should be done.

Objective: To estimate the pooled effect of robotic rehabilitation on gait in subjects with multiple sclerosis (MS).

Methods: We conducted a systematic search in PubMed, Scopus, EMBASE, IEEE and Web of Science databases on October 1 st 2022, without any time or language limitation. Also, we investigated the grey literature, including conference abstract and references of references, to identify potentially relevant articles. The primary outcomes were the six-minute walking test (6MWT) and Timed Up and Go (TUG). The risk of bias in the included studies was evaluated using the Cochrane's risk of bias tool for non-randomized studies (ROBINS-I) and the Cochrane risk-of-bias tool for randomized trials (RoB2). Meta-analyses were performed using a fixed-effects model as the heterogeneity between study results (I2) was less than 50%. The standardized mean difference (SMD) was calculated as the effect size for study outcomes.

Results: Our systematic search retrieved 6878 studies and, after deleting duplicate results, 5019 articles remained. Two researchers screened the titles and abstracts, with 4942 studies remaining for further screening. After full-text assessment, 12 studies were included for meta-analysis, most of which were conducted in the USA and Italy and were published between 2007 and 2022. The mean age of participants in the selected studies ranged between 46-55 years and the mean expanded disability status scale (EDSS) between 5 and 6.5. The SMD of 6MWT (AFTER-BEFORE) was 0.22 (95% CI -0.01-0.45) (I 2 =0%, P=0.90). The SMD of TUG (AFTER-BEFORE) was -0.29 (95% CI -0.56, -0.02) (I 2 =0%, P=0.70).

Conclusion: This systematic review and meta-analysis concluded that robotic rehabilitation was effective for gait rehabilitation in patients with MS.

This study investigates the safety implications of using glass bottles versus PVC, DEHP-free plastic bags for autologous blood collection in major autohaemotherapy with oxygen-ozone (O 2 -O 3 -MAHT). Concerns have arisen regarding increased haemolysis when blood is collected in glass containers, particularly due to high shear stress, surface irregularities and turbulence associated with vacuum-based collection. Historical data from transfusion medicine already established that glass induces higher red blood cell (RBC) rupture rates, a finding confirmed through mathematical modelling and simulations in this study. The release of haemoglobin and formation of meta-haemoglobin, both pro-inflammatory mediators, pose potential risks to patient safety. The authors applied ordinary differential equations (ODEs) to model haemolysis, biochemical stability and inflammatory responses, revealing that plastic bags offer superior preservation of RBC integrity and reduce inflammation risks. Comparative data on foam formation, albumin adsorption and oxygenation efficacy further reinforce the advantage of plastic containers. Forecast modelling suggests that treatment failure and safety risks increase significantly with glass use, particularly at higher ozone doses. The study concludes that DEHP-free plastic bags provide a more reliable, safe and biocompatible method for O 2 -O 3 -MAHT and recommends phasing out glass bottles to minimize haemolysis and ensure the therapeutic efficacy of medical ozone procedures.

Erythema induratum of Bazin (EIB) is a rare subcutaneous granulomatous disease that is considered to represent a form of tuberculin hypersensitivity. We present the case of a 74-year-old Bacillus Calmette-Guerin (BCG)-vaccinated female patient, who presented to our dermatology clinic with painful, erythematous purple nodules on the lower extremities. Clinical examination, histopathological analysis, a positive tuberculin skin test (TST) and interferon-gamma release assay (IGRA) supported the diagnosis of EIB. A standard six-month anti-tubercular therapy (ATT) led to improvement of the clinical presentation. However, after discontinuation of ATT, the clinical symptoms and sings relapsed and ATT had to be extended for a total of 10 months to achieve complete remission without relapse for 12 months. Given the lack of established treatment guidelines for the management of EIB, this case underscores the need for prolonged ATT for the effective management of this condition, which is guided by the relevant clinical picture and sometimes goes beyond standardized anti-tubercular treatment protocols.

Objectives: Mast cells (MCs) secrete different angiogenic factors stimulating angiogenesis. The purpose of this study was to assess MC count and microvessel density (MVD) in aggressive and non-aggressive central giant cell granulomas (CGCGs) of the jaws.

Materials and methods: Sixteen aggressive and 14 non-aggressive paraffin-embedded samples of CGCGs were prepared for immunohistochemical analysis using anti-MC tryptase and anti-CD31 antibodies.

Results: Mean values±SEM (standard error of mean) for MC count and MVD in aggressive and non-aggressive CGCGs were: 7.48±0.84, 3.85±0.51, 5.55±0.89, 3.19±0.61, respectively. All CGCG cases demonstrated MCs. Differences for both MC count and MVD were statistically significant between aggressive and non-aggressive CGCGs (p=0.002 and p=0.045, respectively), i.e. , MC count and MVD were significantly higher in aggressive lesions. Moreover, there was a significant positive correlation between MC count and MVD in CGCG (r=0.570, p=0.001).

Conclusion: Mast cell count and MVD might be used as prognostic markers of aggressive behavior of CGCGs at the time of initial biopsy. Our findings might postulate that therapeutic strategies against MC mediators and angiogenesis may benefit in aggressive CGCG as a non-surgical modality of treatment. With further studies, their prognostic significance and therapeutic application can be evaluated in patients suffering from aggressive CGCG.

Background: Left ventricular (LV) remodeling plays a pivotal role in the pathophysiology of heart failure (HF) following acute coronary syndrome (ACS). Left ventricular ejection fraction (LVEF), left ventricular (LV) volumes and, more recently, speckle tracking echocardiography (STE) are used to describe LV performance. Myocardial work (MW) is a new noninvasive imaging method that integrates loading conditions and can be used to detect early myocardial dysfunction before LVEF decreases.

Aim: This study aims to characterize the relationship between MW, high-sensitivity troponin (hs-cTn I) and C-reactive protein (CRP) as an inflammation biomarker. Their use as predictors for LV dysfunction in the acute phase of ACS is of particular interest but is still under debate.

Method: Complete clinical examination and two-dimensional echocardiography (2-DE), with speckle-tracking and myocardial work measurements, were performed in the first 24 hours after admission. Locally available biomarkers were assessed in the same timeframe, with special interest in hs-cTn I and CRP, as a marker for inflammation. A follow-up visit, including the same clinical, biological, and echocardiographic measurements, was performed six to eight weeks after the index event.

Results: We evaluated 56 patients (53 ± 10 years, 45 men) with ACS. Baseline hs-cTn I significantly correlated with baseline global longitudinal strain (GLS) (r=0.43, p=0.001) and baseline MW parameters (GWI: r=-0.44, p=0.001; GCW: r=-0.40, p=0.002). A correlation between hs-cTn I and LVEF was not statistically relevant. C-reactive protein, which was used to assess systemic inflammation, also failed to correlate with LVEF. However, CRP significantly correlated with relevant MW parameters (GWE: r=-0.53, p<0.001 and GWW: r=0.48, p<0.001). C-reactive protein levels above 28 mg/L correlated with a decrease in MW performance assessed by GWE, suggesting a possible tendency to adverse remodeling.

Conclusions: C-reactive protein level in the first 24 hours after ACS and its correlation with MW parameters may be a potential indicator of future LV dysfunction and heart failure.