EVALUATION OF CAUSATIVE FACTORS IN AMLODIPINE INDUCED PEDAL EDEMA

Objective: To study the edema causing factors in hypertensive, amlodipine-induced pedal edema patients.Methods: The present was a prospective, observational study. A total of one hundred and twenty-four essential hypertensive patients, of either gender attending the outpatient department of cardiology and medicine, were recruited for this study. Out of the 124 patients, 62 were of the amlodipine-induced pedal edema [AIPE] group and other 62 patients were amlodipine-treated non-edema [ATNE] group. All the patients were receiving a dosage of amlodipine 5 mg/day. All recruited patients completed the study. The present study conducted at Kasturba Hospital, Manipal.Results: The vanillyl mandelic acid (VMA) (mean±SD) 7.08±2.3 mg/24 h and 4.9±1.7 mg/24 h in AIPE and ATNE groups respectively. Blood pressure (BP) and VMA was higher in AIPE group than the ATNE group (p<0.001). Pulse rate (PR), serum proteins, creatinine, sodium, osmolality, did not show any significant difference between the two study groups.Conclusion: In essential hypertensive patients with AIPE group presented with a higher VMA level than the ATNE group. The elevated catecholamine's possibly the causative factor for AIPE

Alcohol Use Effects on Burn Related Reconstruction Patient Outcomes and Complications Following Hospital Admission: Systematic Review and Meta-analysis

Patients suffering from burn-related injuries admitted to the hospital concurrently consuming alcohol are believed to be at an increased risk of poor outcomes and the development of complications following burn reconstruction, however data varies within the literature and remains controversial. This systematic review and meta-analysis compared outcomes and complications from studies during the years 1958 to 2018 between 813 burn patients admitted to the hospital with alcohol use reported by a positive blood alcohol concentration (BAC), intoxication, or the patient on admission to 299543 burn patients admitted who were not consuming alcohol. The PubMed, EMBASE, Cochrane Library, and Web of Science databases were systematically and independently searched. Clinical characteristics, alcohol use, outcomes and complications were recorded. PRISMA and Cochrane guidelines where used throughout the review. Eleven of the 14 studies included in our study, were eligible for meta-analysis, with results from 9 of the possible 21 outcomes and complications queried. In conclusion, this systematic review and meta-analysis found that compared to patients suffering from burn-related injuries who did not consume alcohol, patients consuming alcohol spent more days on a ventilator, had a higher rate of intubation, had a higher rate of inhalation injury, longer intensive care unit length of stay, and increased mortality

Nicotine and Smoking Effects on Burn Related Reconstruction Patient Outcomes and Complications Following Hospital Admission: Systematic Review and Meta-analysis

Patients suffering from burn-related injuries admitted to the hospital concurrently using nicotine and/or smoke are believed to be at an increased risk of poor outcomes and the development of complications following burn reconstruction, however data varies within the literature and remains controversial. This systematic review and meta-analysis compared outcomes and complications from studies during the years 1986 to 2018 between 8568 burn patients admitted to the hospital who use nicotine and/or smoke to 299543 burn patients admitted who do not use nicotine and/or smoke. The PubMed, EMBASE, Cochrane Library, and Web of Science databases were systematically and independently searched. Clinical characteristics, nicotine/smoking use, outcomes and complications were recorded. PRISMA and Cochrane guidelines where used throughout the review. Five of the 9 studies included in our study, were eligible for meta-analysis, with results from 7 of the possible 21 outcomes and complications queried. In conclusion, this systematic review and meta-analysis found that compared to patients suffering from burn-related injuries who do not use nicotine and/or smoke, patients using nicotine/smoking were found to have a higher rate of intubation and more wound/local skin infections

Illicit Substance Use Effects on Burn Related Reconstruction Patient Outcomes and Complications Following Hospital Admission: Systematic Review and Meta-analysis

Patients suffering from burn-related injuries admitted to the hospital concurrent illicit substance use are believed to be at an increased risk of poor outcomes and the development of complications following burn reconstruction, however data varies within the literature and remains controversial. This systematic review and meta-analysis compared outcomes and complications from studies during the years 1986 to 2017 between 15653 burn patients admitted to the hospital with substance use alcohol use reported by a positive toxicology screen (amphetamines, barbiturates, benzodiazepines, cannabinoids, cocaine, methadone, codeine/morphine, PCP, LSD, inhalants, solvents, aerosols, legal highs), or the patient on hospital admission to 299543 burn patients admitted who were not using substances. The PubMed, EMBASE, Cochrane Library, and Web of Science databases were systematically and independently searched. Clinical characteristics, illicit substance use, outcomes and complications were recorded. PRISMA and Cochrane guidelines where used throughout the review. Five of the 10 studies included in our study, were eligible for meta-analysis, with results from 8 of the possible 21 outcomes and complications queried. In conclusion, this systematic review and meta-analysis found that compared to patients suffering from burn-related injuries who did not use illicit substance, patients using illicit substances had a higher %TBSA of burns, longer hospital LOS, had a higher rate of intubation, had a higher rate of inhalation injury, longer ICU LOS, and increased wound/local skin infections

Unveiling the Potential of AI in Plastic Surgery Education: A Comparative Study of Leading AI Platforms’ Performance on In-training Examinations

Background:. Within the last few years, artificial intelligence (AI) chatbots have sparked fascination for their potential as an educational tool. Although it has been documented that one such chatbot, ChatGPT, is capable of performing at a moderate level on plastic surgery examinations and has the capacity to become a beneficial educational tool, the potential of other chatbots remains unexplored. Methods:. To investigate the efficacy of AI chatbots in plastic surgery education, performance on the 2019–2023 Plastic Surgery In-service Training Examination (PSITE) was compared among seven popular AI platforms: ChatGPT-3.5, ChatGPT-4.0, Google Bard, Google PaLM, Microsoft Bing AI, Claude, and My AI by Snapchat. Answers were evaluated for accuracy and incorrect responses were characterized by question category and error type. Results:. ChatGPT-4.0 outperformed the other platforms, reaching accuracy rates up to 79%. On the 2023 PSITE, ChatGPT-4.0 ranked in the 95th percentile of first-year residents; however, relative performance worsened when compared with upper-level residents, with the platform ranking in the 12th percentile of sixth-year residents. The performance among other chatbots was comparable, with their average PSITE score (2019–2023) ranging from 48.6% to 57.0%. Conclusions:. Results of our study indicate that ChatGPT-4.0 has potential as an educational tool in the field of plastic surgery; however, given their poor performance on the PSITE, the use of other chatbots should be cautioned against at this time. To our knowledge, this is the first article comparing the performance of multiple AI chatbots within the realm of plastic surgery education

Early Outcomes of Endoscopic Versus Open Carpal Tunnel Release

Purpose: To compare the short-term outcomes of endoscopic carpal tunnel release (ECTR) and open carpal tunnel release (OCTR), including patient-reported outcomes, pain and satisfaction scores, return to work, and postoperative prescription pain medication use. Methods: We included all patients over 18 years of age undergoing carpal tunnel release at a single hand center between January 2018 and December 2019. The carpal tunnel release method was driven by variations in surgeon practice. Data from patient-reported outcomes measurement information system (PROMIS) questionnaires and brief Michigan hand outcomes questionnaires and data on patient-reported pain levels, satisfaction with care, return to work, and postoperative prescription pain medication use were collected at preoperative visits and the first follow-up visit between postoperative days 7 and 14. Results: We included 678 (586 ECTR and 92 OCTR) patients. The median age was 58 years, and 75% of the patients were women. At early follow up, patients who underwent OCTR reported significantly lower postoperative PROMIS upper-extremity scores than those who underwent ECTR (median, 32 vs 36 points, respectively) but similar postoperative PROMIS pain interference, global physical health, global mental health, and brief Michigan hand outcomes questionnaire scores. The postoperative pain and satisfaction scores were similar between the 2 groups. In multivariable models, patients who underwent OCTR had 62% lower odds of returning to work and 30% greater odds of remaining on a postoperative pain prescription at the first follow-up visit. Conclusions: This study found no evidence suggesting the definitive superiority of 1 surgical technique with regard to clinical outcomes in the early postoperative period. However, OCTR was associated with lower postoperative PROMIS upper-extremity scores of unclear clinical significance, higher odds of remaining on pain medication, and lower odds of returning to work by the first postoperative visit. Endoscopic carpal tunnel release may be preferred in patients who need to return to work within the first 2 weeks after the procedure. Type of study/level of evidence: Therapeutic IV

The role of red blood cell S-nitrosation in nitrite bioactivation and its modulation by leucine and glucose

Previous work has shown that red blood cells (RBCs) reduce nitrite to NO under conditions of low oxygen. Strong support for the ability of red blood cells to promote nitrite bioactivation comes from using platelet activation as a NO-sensitive process. Whereas addition of nitrite to platelet rich plasma in the absence of RBCs has no effect on inhibition of platelet activation, when RBCs are present platelet activation is inhibited by an NO-dependent mechanism that is potentiated under hypoxia. In this paper, we demonstrate that nitrite bioactivation by RBCs is blunted by physiologically-relevant concentrations of nutrients including glucose and the important signaling amino acid leucine. Our mechanistic investigations demonstrate that RBC mediated nitrite bioactivation is largely dependent on nitrosation of RBC surface proteins. These data suggest a new expanded paradigm where RBC mediated nitrite bioactivation not only directs blood flow to areas of low oxygen but also to areas of low nutrients. Our findings could have profound implications for normal physiology as well as pathophysiology in a variety of diseases including diabetes, sickle cell disease, and arteriosclerosis

Need and Viability of Newborn Screening Programme in India: Report from a Pilot Study

India, a country with the second largest population in the world, does not have a national newborn screening programme as part of its health policy. With funding support from the Grand Challenges Canada, a pilot newborn screening programme was implemented for the Udupi district of South India to study the need and viability of a national programme in India. Six disorders were selected for the study based on the availability of funding and recommendation from pediatricians in the district. Here, we report the observed incidence during the study. A cost-effectiveness analysis of implementing newborn screening in India was performed. It is evident from our analysis that the financial loss for the nation due to these preventable diseases is much higher than the overall expenditure for screening, diagnosis, and treatment. This cost-effectiveness analysis justifies the need for a national newborn screening programme in India