World journal of methodology最新文献

Background: Nutritional psychiatry is a rapidly expanding field of research, with mounting evidence suggesting that nutritional factors may play a role in the development of psychiatric disorders.

Aim: To examine the level of evidence for nutritional psychiatry.

Methods: A scoping review was conducted to assess the current state of nutritional psychiatry, including a search for randomized controlled trials (RCTs).

Results: The review identified a total of seven papers, with many concentrating on the relationship between depression and the gut microbiome. A salient issue that emerged from this review was the paucity of sample size in many studies. The inherent complexity of nutritional studies, characterized by a multitude of potential factors and exposures that often act as confounders, poses significant challenges to the development of effective RCT designs. The analysis revealed that probiotics, though demonstrating efficacy, exhibited a modest effect size.

Conclusion: Conducting RCTs with effective markers is imperative from these studies. The implementation of Mendelian randomization and the investigation of mechanisms in basic research are essential complementary approaches.

Pancreatic neoplasms present a significant therapeutic challenge due to their complex anatomy and poor prognosis. In recent years, endoscopic ultrasound guided radiofrequency ablation (EUS-RFA) has emerged as a promising minimally invasive therapeutic option, aiming to provide targeted treatment with improved patients' outcomes. This review aims to shed light on current evidence about the efficacy, safety, and clinical outcomes of EUS-RFA in the management of pancreatic neoplasms. We conducted a comprehensive search of literature, reviewing studies that document the application of EUS-RFA in pancreatic masses. The key metrics for efficacy included tumor size reduction, pain relief, and overall survival, while safety outcomes focused on procedural complications and post-operative recovery. EUS-RFA has demonstrated potential in effectively managing both benign and malignant pancreatic neoplasms, with several studies reporting significant reductions in tumor size and symptomatic relief. The technique is associated with a favorable safety profile, characterized by a low incidence of major complications. EUS-RFA represents a valuable addition to the therapeutic arsenal for pancreatic neoplasms, offering a viable alternative to surgical interventions, especially in patients with contraindications for surgery. Further studies are needed to establish standardized protocols and long-term outcomes, enhancing its applicability and success in clinical practice.

Background: The prevalence of depressive symptoms in patients undergoing total knee arthroplasty (TKA) ranges from 22% to 26%. The impact of depression on functional status post-TKA remains controversial.

Aim: To be the first study in Latin American population to evaluate the association between depression and functional status one year after TKA, hypothesizing that elderly patients with depression will demonstrate lower rates of functional improvement.

Methods: We conducted an observational, descriptive and analytic, retrospective cohort study involving patients over 65 years old who were indicated for TKA. Assessments were made via the Program for Determination and Management of Risks for Practices and Procedures of the Division of Geriatric Medicine at the Italian Hospital of Buenos Aires, between June 2015 and July 2019. Depression screening was conducted using Yesavage's abbreviated score and Patient Health Questionnaire-9, while functional ability was evaluated using the Knee Society Score (KSS).

Results: Of the 100 patients analyzed, 22 (22%) screened positive for depression. The mean age was 80 years ± 6.3 years, with an average of 77.6 years ± 6 years in the depressed group and 80.6 years ± 6.3 years in the non-depressed group (P = 0.05). Depressed patients showed significantly greater cognitive impairment [clock-face drawing test median: 5 (3-6) vs 6 (5-7), P = 0.06] and more risk factors for confusional syndrome (mean: 8 ± 2 vs 6.5 ± 2.2, P = 0.006). Frailty was also more prevalent in depressed patients [Edmonton: 15 (68%) vs 33 (42%), P = 0.05; Fried: 17 (77%) vs 42 (54%), P = 0.05]. Postoperative Functional KSS were similar between groups (depressed: 65 ± 22.1 vs non-depressed: 66.3 ± 20.3, P = 0.8). Linear regression analysis revealed no association between depression and changes in KSS. Spearman's rank correlation coefficients were -0.0304 (P = 0.8) for Functional KSS variation and -0.1 (P = 0.3) for KSS variation.

Conclusion: Depression in patients with osteoarthritis should not hinder surgical planning. Identifying and treating depression preoperatively may enhance outcomes such as pain relief and reduce risks of acute confusional syndrome, cognitive impairment, and frailty.

Background: Glaucoma is the leading cause of irreversible blindness worldwide, with 60.5 million affected individuals, of whom 11 million are from India. Due to its asymptomatic nature, the disease largely remains underdiagnosed or diagnosed in advanced stages, where little can be done to salvage functional vision. The literature suggests that a lack of knowledge is one of the reasons for its grave consequences. Assessment of awareness is the first step in planning management. Several studies have been conducted in the Indian community, but data from healthcare providers, who play a significant role in educating the masses directly or indirectly, are limited.

Aim: To identify awareness, knowledge, and attitudes about glaucoma among healthcare workers in a tertiary center in India.

Methods: This cross-sectional study was conducted at a tertiary care institute in Eastern India. Data were collected from 423 participants by systematic stratified sampling after Institutional Ethics Committee approval via a pretested, self-designed, semistructured, validated questionnaire. Statistical analyses were performed using the Statistical Package for Social Sciences Software v22.0. Continuous variables are expressed as the means ± SD for parametric values and medians with interquartile ranges for nonparametric values. The associations between the variables were studied via multivariate linear and logistic regression. P < 0.05 was considered statistically significant.

Results: Most respondents were 20-30 years old (n = 345, 81.6%). The knowledge regarding glaucoma was good, and almost 56.3% of the participants gained knowledge from their medical training. The majority were aware that it has a familial predisposition and is secondary to high intraocular pressure, leading to irreversible peripheral vision loss. Only 42% knew about the life-long requirements of treatment. The resident group scored highest on knowledge- and attitude-based questions, whereas the faculty group scored highest on practice-based questions. Although 62% of the nursing staff had good attitude scores, their knowledge and practice scores were lower. The occupation group response difference was statistically significant (P < 0.05) for all the knowledge-based questions.

Conclusion: Although the majority of healthcare providers are aware of glaucoma, there is a dearth of knowledge about treatment modalities. Education via seminars and media can improve their knowledge, attitudes, and practices.

Cataract surgery is still the most common surgery performed worldwide. It has evolved tremendously in terms of incision, from 12 mm to 1.8 mm, in terms of capsulotomy from envelope type to automated capsulorhexis, and from rigid intraocular lens to foldable intraocular lenses. Manual small incision cataract surgery (MSICS) remains a valuable technique, particularly in rural and underserved areas, due to its cost-effectiveness and simplicity. Its low logistics and favorable outcomes are particularly useful for managing the cataract backlog in developing countries. This review highlights the history and evolution of MSICS, and the reasons for the advent and popularity of this technique, especially in developing countries. It reviews the various recent modifications of the technique, for example, from a superior incision approach to temporal incision to customized MSICS, 2 mm MSICS, and astigmatism-correcting MSICS. It provides an overview of its applicability in complicated scenarios (viz., small pupil, compromised cornea, pseudoexfoliation, subluxated cataract, etc.). It briefly reviews the clinical trials on MSICS and its comparison with phacoemulsification. Finally, the review emphasizes why every ophthalmic surgeon must know MSICS, its relevance in postgraduate teaching, and the role of MSICS simulators for the same. Overall, the review presents a comprehensive picture of the present status of this technique in the surgical armamentarium of ophthalmology.

Inflammatory bowel disease (IBD) is a chronic condition consisting of two main types: Crohn's disease and ulcerative colitis. Conventional treatments for these diseases include aminosalicylates, corticosteroids, immunomodulators, and biologics. However, these treatments have several drawbacks, including high costs for patients and numerous side effects. Recently, advanced treatments have been developed, such as small-molecule therapies, targeted biologics, innovative drug delivery systems, and microbiome-based interventions. Emerging therapies like anti-interleukin-23 monoclonal antibody inhibitors, sphingosine-1-phosphate receptor modulators, and Janus kinase inhibitors are more specialized in reducing immune activity. They enhance bioavailability, reduce side effects, and specifically target the gastrointestinal tract without affecting other systems. Innovative drug delivery systems for IBD, such as nanoparticles, hydrogels, and microgrippers, improve bioavailability and prolong drug release. The combination of conventional and advanced therapies may benefit from the synergistic effects of both. Furthermore, fecal microbiota transplantation and probiotics can help restore the balance of gastrointestinal microbiota, reducing disease flare-ups. Advances in artificial intelligence, endoscopic techniques, and stem cell therapies have shown great potential in treating IBD, although several significant challenges remain. Treating this disease requires multidisciplinary integration and the application of technology and telemedicine.

Crohn's disease (CD) is an idiopathic, chronic, and recurrent inflammatory condition of the gastrointestinal tract. Recent studies suggest a potential role of gut microbiota in CD, particularly dysbiosis-an imbalance in gut bacteria. While dysbiosis is consistently observed in CD, it remains uncertain whether it is a cause or a consequence of the disease. Given its association with CD, the therapeutic potential of fecal microbiota transplantation (FMT) has been explored. This review examines the role of gut microbiota in CD, evaluates the therapeutic potential of probiotics and FMT, and highlights current research findings and limitations. Key studies on the relationship between gut dysbiosis, probiotics, and FMT in CD were analyzed, with a focus on randomized trials, meta-analyses, and clinical observations. Dysbiosis is a consistent feature of CD, but its causative role remains unclear. Probiotics, prebiotics, and synbiotics have shown no efficacy in inducing or maintaining remission in CD. FMT shows potential as a therapeutic option for CD, but its efficacy remains inconsistent and inconclusive. The variability in outcomes, including diminished effects over time despite repeated FMT, underscores the need for larger, well-controlled trials. Only one randomized controlled trial (RCT) has compared FMT with sham transplantation, but the sample size was very small. Other studies are limited by factors such as small sample sizes, lack of control groups, short follow-up periods, and inconsistent methodologies, making it challenging to draw definitive conclusions. While gut dysbiosis likely plays a role in CD pathogenesis, its causative role remains uncertain. Current evidence does not support FMT as a reliable treatment for inducing or maintaining remission in CD, though it appears generally safe. Larger, standardized, RCTs are necessary to clarify the therapeutic role of FMT in CD management.

Background: Chest physiotherapy and incentive spirometry, essential for pulmonary care, can exacerbate acute post-thoracotomy pain. Pain relief is, therefore, essential to facilitate early mobilization. This study evaluated the analgesic efficacy of unilateral continuous erector spinae block (ESB) compared to thoracic epidural analgesia (TEA) in terms of quality of pain relief and perioperative hemodynamic changes.

Aim: To compare the analgesic efficacy of continuous ultrasound-guided unilateral ESB and thoracic epidural in patients undergoing antero-lateral thoracotomy.

Methods: This prospective, observational study was conducted at a tertiary care hospital of central India. Sixty-eight adult patients of either gender, posted for elective thoracic surgeries requiring one lung ventilation, were allocated to either TEA (n = 34) or ESB (n = 34) group, based on the attending anesthesiologist's expertise. Continuous data were analyzed by independent t-tests, and categorical data by χ ² tests.

Results: The proportion of patients requiring rescue opioids within 24 hours post-extubation was similar between the two group. Resting numerical rating scale scores (0 hour, 6 hours, and 72 hours post-extubation) were significantly higher in the ESB group compared to the TEA group [1.70 ± 1.03 vs 1.05 ± 0.77 (P = 0.004); 1.64 ± 0.98 vs 1.2 ± 0.88 (P = 0.05); 3.2 ± 1.07 vs 2.61 ± 0.92 (P = 0.013)]. Dynamic numerical rating scale scores and post-extubation mean arterial pressures were also higher in the ESB group. Additionally, block performance time was significantly longer in the ESB group (16.58 ± 3.66 vs 13.84 ± 2.88, P = 0.001).

Conclusion: The two techniques provided similar opioid-sparing effects following antero-lateral thoracotomy, though TEA exhibited a superior analgesic efficacy at the expense of increased hemodynamic instability requiring vasopressor support.

Micronutrients are fundamental to support and maintain normal physiological function. Deficiencies of these nutrients are a growing public health concern with potentially devastating consequences. An adequate diet of whole foods is the primary source of micronutrients; supplementation is sometimes necessary. Both deficiency and excess of these nutrients have adverse effects. Common deficiencies include iron, folate, iodine, zinc, and vitamin A, which can present clinically as a syndrome. Micronutrient deficiencies (MNDs) are common contributors to intellectual impairments, poor growth, perinatal complications, and increased risk for morbidity and mortality. Excess of a select few of these nutrients can result in conditions such as idiopathic intracranial hypertension and diarrhea. Interventions, including supplementation, fortification, and biofortification, can help combat MNDs. This article reviews some common micronutrient imbalances, their clinical manifestations, and treatment interventions.

Skeletal dysplasia includes numerous genetic disorders marked by abnormal bone and cartilage growth, causing various spinal issues. The 2023 nosology identifies 771 distinct dysplasias involving 552 genes, with achondroplasia being the most common and significantly affecting the spine. Other disorders include type II collagenopathies, sulphation defects, Filamin B disorders, and osteogenesis imperfecta, presenting with short stature, limb deformities, joint contractures, and spinal abnormalities. Spinal pathology often impacts physeal growth areas, leading to conditions like foramen magnum stenosis, atlantoaxial instability, spinal stenosis, kyphosis, and scoliosis. Non-orthopaedic symptoms can include hearing and vision loss, neurological issues like hydrocephalus, and cardiac abnormalities. The incidence is around 1 in 4000 to 5000 births, with achondroplasia at about 1 in 30000 live births. Advances in genetics and imaging enable prenatal diagnosis, though milder cases may go undetected. Effective management requires a multidisciplinary approach involving various specialists. This review emphasises early diagnosis, continuous monitoring, and comprehensive management of spinal pathology in skeletal dysplasia. In the current article, the authors present a thorough review on spinal conditions associated with skeletal dysplasia, their pathophysiology and management options.