Low-level laser therapy versus local steroid injection in patients with idiopathic carpal tunnel syndrome: a single blind randomized comparative trial

The objective of this study was to compare corticosteroid injection with low-level laser therapy for the short-term treatment of mild or moderate idiopathic carpal tunnel syndrome. Single blind randomized clinical trial was conducted from May 2010 to October 2010 in outpatient clinic and research center at a university hospital. Thirty-eight patients (female to male ratio was 5.3 to 1) with a new episode of carpal tunnel syndrome of mild or moderate severity participated in this study. Corticosteroid injection and low level laser therapy were used as the interventions. Primary outcome measure was the severity of the disease. Based on the electrophysiological findings, we proposed three grades: mild, moderate and severe. Visual analogue scores were used to measure subjective severity of pain. We measured median distal motor and sensory latencies. All participants were followed for two months. Analyses showed favorable outcomes in both groups in terms of visual analogue scores and median distal motor and sensory latencies (p<0.001 for all comparisons). Electrophysiologic studies did not imply any significant difference in the severity (Chi-squared test p = 0.28), and change in the grade of the disease between the two groups. Also there was no significant difference between the groups in mean visual analogue scores (Mann-Whitney test p = 0.45), median motor distal latency (Mann- Whitney test p = 0.08), and sensory distal latency (Mann-Whitney test p = 0.70), 8 weeks after the treatments. Both corticosteroid and laser are advantageous in the short-term treatment of carpal tunnel syndrome and provide satisfactory pain relief, electrophysiological improvement, and are well tolerated by patients.Keywords: Carpal tunnel syndrome; Low level laser; Corticosteroid; Median nerve; Electrophysiologic studies; Peripheral compression neuropathy; Randomized clinical trial; Hydrocortison

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty

Population‐based cohort study of outcomes following cholecystectomy for benign gallbladder diseases

Background The aim was to describe the management of benign gallbladder disease and identify characteristics associated with all‐cause 30‐day readmissions and complications in a prospective population‐based cohort. Methods Data were collected on consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing all‐cause 30‐day readmissions and complications were analysed by means of multilevel, multivariable logistic regression modelling using a two‐level hierarchical structure with patients (level 1) nested within hospitals (level 2). Results Data were collected on 8909 patients undergoing cholecystectomy from 167 hospitals. Some 1451 cholecystectomies (16·3 per cent) were performed as an emergency, 4165 (46·8 per cent) as elective operations, and 3293 patients (37·0 per cent) had had at least one previous emergency admission, but had surgery on a delayed basis. The readmission and complication rates at 30 days were 7·1 per cent (633 of 8909) and 10·8 per cent (962 of 8909) respectively. Both readmissions and complications were independently associated with increasing ASA fitness grade, duration of surgery, and increasing numbers of emergency admissions with gallbladder disease before cholecystectomy. No identifiable hospital characteristics were linked to readmissions and complications. Conclusion Readmissions and complications following cholecystectomy are common and associated with patient and disease characteristics

Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

Background: The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. Methods: We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. Findings: Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1–4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0–8·4) while the total sum of global YLDs increased from 562 million (421–723) to 853 million (642–1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6–9·2) for males and 6·5% (5·4–7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782–3252] per 100 000 in males vs s1400 [1279–1524] per 100 000 in females), transport injuries (3322 [3082–3583] vs 2336 [2154–2535]), and self-harm and interpersonal violence (3265 [2943–3630] vs 5643 [5057–6302]). Interpretation: Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury

Effect of pH and Lidocaine on the Compressive Strength of Calcium Enriched Mixture Cement

Statement of Problem: The pH of the human abscess has been measured as low as 5.0. This low pH could potentially inhibit setting reactions, affect adhesion, or increase the solubility of root end filling materials hence affect the compressive strength. Moreover, root end filling materials might expose or even mix with lidocaine HCL during periapical surgery. Objectives: The aim of this in vitro study was to evaluate the effect of acidic pH and lidocaine on the compressive strength of calcium-enriched mixture (CEM). Materials and Methods: CEM was mixed according to the manufacturer’s instructions or with lidocaine (L), and condensed into 6 × 4 mm split moulds. The samples were exposed to phosphate buffered saline (PBS) at pH 5 or 7.4 for 7 or 28 days. Cylindrical blocks of CEM (total number = 120 and 15 for each group) were subjected to compressive strength test using a universal testing machine. Data were analysed using three-factor analysis of variance (ANOVA). Results: Regardless of pH and time, significant differences were not found between lidocaine groups and the groups that were mixed according to the manufacturer’s instruction (p = 0.083). For both mixing agents, regardless of time, there were no significant differences between the two pH levels (p = 0.157). Regardless of the material and pH, there was a significant increase in the compressive strength from days 7 to 28 (p < 0.001). Conclusions: Mixtures with lidocaine and exposure to an acidic environment had no adverse effects on the compressive strength of CEM Cement

Evaluation of a Native Preparation of HCV Core Protein (2-122) For Potential Applications in Immunization, Diagnosis and Mab Production

Infection with hepatitis C virus (HCV) is a worldwide problem. Among HCV proteins, core antigen (Ag), besides its importance for diagnostic application is a prime candidate for component of a vaccine. Herein, we report results of studies on production of the hydrophilic domain of core Ag (2-122) in native conformation by an arabinose induction system in E.coli and the primary characterization of this recombinant protein for applications in diagnosis, immunization and mAb production. Recombinant core (r-Core) was able to detect anti-core antibodies in HCV positive serum samples in a dilution rate of 1/3200. It was also capable to elicit a potent anti-HCV humoral immune response in BALB/c mice. Finally, we established two stable clones of hybridoma which shown to produce specific and sensitive mAbs against the core protein. HCV core was able to elicit a broad range of antibody specificities depending on the immunogen conformation. Therefore, it may be possible to get new mAbs with higher affinities towards native conformation of core Ag