Comparative Efficacy of Interventions for the Management of Oral Submucous Fibrosis: A Systematic Review and Network Meta-Analysis

Introduction: Oral submucous fibrosis (OSMF) is a chronic premalignant condition and is characterized by fibroblastic change of lamina propria and stiffness of oral mucosa. Though there are several treatment options available, the best agent is not yet identified. This study assessed the comparative efficacy and safety of medical interventions in the management of OSMF. Methods: A systematic review was performed to identify randomized controlled trials (RCTs) that compared the efficacy of interventions for OSMF with each other, or placebo. A network meta-analysis was performed, and the interventions were ranked according to their efficacy based on the surface under the cumulative ranking. (PROSPERO Registration no: CRD42021255094). Results: Thirty-two RCTs comprising 2063 patients were eligible for quantitative analysis. In terms of therapeutic efficacy in the improvement of mouth opening Oxitard, a herbal formulation was ranked as the most efficacious agent, [MD, 10.29 (95%CI 6.34–14.25)] followed by combination therapy of Lycopene with corticosteroids and hyaluronidase [MD, 7.07 (95%CI 1.82–12.31)]. For improvement of burning sensation aloe vera was ranked first [MD, 6.14 (95%CI 4.58–7.70)] followed by corticosteroids with antioxidants [MD, 6.13 (95%CI 4.12–8.14)] and corticosteroids in combination with hyaluronidase with antioxidants [MD, 5.95 (95%CI 3.79–8.11)]. In terms of safety, most of the drugs were reported to cause mild adverse effects only. Significant inconsistencies could be identified in the analysis for both the outcomes assessed and were further explored. Conclusions: Our study highlighted the potential efficacy of several agents over placebo in the improvement of mouth opening and burning sensation in OSMF patients. However, the RCTs lacked methodological soundness. Well-designed studies with a larger number of participants with a rigorous randomization process and stringent methodology are recommended to strengthen the results obtained, which may help to construct a clinical guideline for OSMF management

Teaching and learning strategies of evidence based medicine: A meta-synthesis of learners and instructors perspective

Objective: Evidence Based Medicine (EBM) knowledge and skills have been recommended as a core competency of healthcare professionals worldwide. However, EBM teaching and learning approaches is quite heterogeneous. Hence, we aimed to conduct a meta-synthesis to identify various teaching and learning aspects of EBM from the learners and instructors perspective. Methodology: This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines. A comprehensive search strategy was used to retrieve articles from PubMed/Medline and Embase from inception till June 2022. To find additional studies, bibliographic search of included studies, review articles, a random search in Google Scholar, Research Gate and Google were carried out. This review evaluated studies published in English language that explained the teaching and learning aspects of EBM among healthcare professionals and students. Result: A total of 41 out of 8139 studies were included in this study. Both learners and instructors preferred tutorials, lectures, short courses, and workshops on EBM as a teaching method. To continue learning and practicing EBM, instructors suggested curricular changes as well as continuing education programmes. Learners preferred to learn EBM by direct clinical practice along with peers. Blended learning, group activities, assignments, workshops, journal clubs, task based learning, didactic teaching, team based learning, problem based learning, case based learning, blended learning, flipped learning and E-learning were the identified pedagogical approaches for teaching EBM. Conclusion: Different pedagogical approaches are used for teaching EBM among healthcare professionals. Continuous education programs for skill development must be held on a regular basis to improve the instructors and learners competency in EBM. Learners and instructors preferred learning approach should be considered while designing EBM educational studies as it is a life-long self-directed learning process

Responses of birds and mammals to long-established wind farms in India

Wind turbines have been recognised as an alternative and clean-energy source with a low environmental impact. The selection of sites for wind-farm often creates serious conservation concerns on biodiversity. Wind turbines have become a serious threat to migratory birds as they collide with the turbine blades in some regions across the globe, while the impact on terrestrial mammals is relatively less explored. In this context, we assessed the responses of birds and mammals to the wind turbines in central Karnataka, India from January 2016 to May 2018 using carcass searches to quantify animal collisions (i.e., birds and bats), fxed radius point count for bird population parameters, and an occupancy framework for assessing the factor that determines the spatial occurrence of terrestrial mammals. The mean annual animal fatality rate per wind turbine was 0.26/year. Species richness, abundance, and unique species of birds were relatively higher in control sites over wind turbine sites. Species and functional compositions of birds in control sites were diferent from wind turbine sites, explaining the varied patterns of bird assemblages of diferent feeding guilds. Blackbuck, Chinkara, Golden Jackal, and Jungle Cat were less likely to occupy sites with a high number of wind turbines. The study indicates that certain bird and mammal species avoided wind turbine-dominated sites, afecting their distribution pattern. This is of concern to the management of the forested areas with wind turbines. We raised conservation issues and mitigating measures to overcome the negative efects of wind turbines on animals

Proceedings of International Web Conference in Civil Engineering for a Sustainable Planet

This proceeding contains articles of the various research ideas of the academic community and practitioners accepted at the "International Web Conference in Civil Engineering for a Sustainable Planet (ICCESP 2021)". ICCESP 2021 is being Organized by the Habilete Learning Solutions, Kollam in Collaboration with American Society of Civil Engineers (ASCE), TKM College of Engineering, Kollam, and Baselios Mathews II College of Engineering, Kollam, Kerala, India. Conference Title: International Web Conference in Civil Engineering for a Sustainable PlanetConference Acronym: ICCESP 2021Conference Date: 05–06 March 2021Conference Location: Online (Virtual Mode)Conference Organizer: Habilete Learning Solutions, Kollam, Kerala, IndiaCollaborators: American Society of Civil Engineers (ASCE), TKM College of Engineering, Kollam, and Baselios Mathews II College of Engineering, Kollam, Kerala, India