28,273 research outputs found

    Efficacy of Intralesion Injection of Combined 5-Flourouracil and Triamcinolone versus Triamcinalone alone in Keloids and Hypertrophic Scars: A Comparative Analysis

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    Objective: The treatment of keloids and hypertrophic scars is challenging and controversial. The therapeutic agents found in the literature include silicone sheets, compression garments, corticosteroid injections, 5-fluorouracil (5-FU), bleomycin and interferon, topical imiquimod, cryotherapy, radiation, and laser or light-based therapies. Triamcinolone acetonide (TCA), a corticosteroid, considered first line treatment for the prevention and treatment of keloids and hypertrophic scars. To compare the efficacy of triamcinolone acetonide alone and triamcinolone acetonide plus 5-florouracil for treating keloids and hypertrophic scars in burn patients. Methodology: In this study, the patients were divided into two groups A and B on the basis of treatment regimen, i.e. Group A (TCA alone) and Group B (5FU+TCA). The efficacy of both treatments was compared for improvement in Vancouver scar scale (VSS) and pruritus scale. Results: The mean VSS score pretreatment was calculated as 10.74±2.36 in Group A and 10.27±3.14 in Group B.  Post-treatment, it was reduced to 5.58±1.04 in Group-A and 3.41±2.11 in Group-B. The comparison of efficacy shows an improvement of 65.80% in Group A and 75.07% in Group B; the p value was 0.047, showing a significant difference. Conclusion: Combination therapy of intra-lesion injection of triamcinolone acetonide and 5-florouracil has significantly higher efficacy as compared to triamcinolone acetonide alone for the treatment of keloids and hypertrophic scars, but necessary precautions have to be taken

    Comparison of induction agents for rapid sequence intubation in refractory status epilepticus: A single-center retrospective analysis

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    Endotracheal intubation, frequently required during management of refractory status epilepticus (RSE), can be facilitated by anesthetic medications; however, their effectiveness for RSE control is unknown. We performed a single-center retrospective review of patients admitted to a neurocritical care unit (NCCU) who underwent in-hospital intubation during RSE management. Patients intubated with propofol, ketamine, or benzodiazepines, termed anti-seizure induction (ASI), were compared to patients who received etomidate induction (EI). The primary endpoint was clinical or electrographic seizures within 12 h post-intubation. We estimated the association of ASI on post-intubation seizure using logistic regression. A sub-group of patients undergoing electroencephalography during intubation was identified to evaluate the immediate effect of ASI on RSE. We screened 697 patients admitted to the NCCU for RSE and identified 148 intubated in-hospital (n = 90 ASI, n = 58 EI). There was no difference in post-intubation seizure (26 % (n = 23) ASI, 29 % (n = 17) EI) in the cohort, however, there was increased RSE resolution with ASI in 24 patients with electrographic RSE during intubation (ASI: 61 % (n = 11/18) vs EI: 0 % (n = 0/6), p =.016). While anti-seizure induction did not appear to affect post-intubation seizure occurrence overall, a sub-group of patients undergoing electroencephalography during intubation had a higher incidence of seizure cessation, suggesting potential benefit in an enriched population

    Quality rating for the included randomised controlled trials & non-randomised controlled trials.

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    Overall quality rating was rated as poor (0–4 as “yes”), fair (5–10 as “yes”), as good (11–14 as “yes”). A “fatal flaw” defined as “no” for questions 7, 8, or 14 resulted in the study being downgraded a category (regardless of overall score).</p

    PRISMA-ScR checklist.

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    A method of overcoming barriers associated with implementing lifestyle interventions in CKD may be through the use of eHealth technologies. The aim of this review was to provide an up-to-date overview of the literature on this topic. Four bibliographical databases, two trial registers, and one database for conference proceedings were searched from inception to August 2023. Studies were eligible if they reported a lifestyle intervention using eHealth technologies. A narrative synthesis of the findings from the included studies structured around the type of eHealth intervention was presented. Where a sufficient number of studies overlapped in terms of the type of intervention and outcome measure these were brought together in a direction of effect plot. There were 54 included articles, of which 23 were randomised controlled trials (RCTs). The main component of the intervention for the included studies was mobile applications (n = 23), with the majority being in the dialysis population (n = 22). The majority of eHealth interventions were reported to be feasible and acceptable to participants. However, there was limited evidence that they were efficacious in improving clinical outcomes with the exception of blood pressure, intradialytic weight gain, potassium, and sodium. Although eHealth interventions appear acceptable and feasible to participants, there is insufficient evidence to make recommendations for specific interventions to be implemented into clinical care. Properly powered RCTs which not only demonstrate efficacy, but also address barriers to implementation are needed to enhance widespread adoption.</div

    Assessing the effectiveness of national park’s policies and laws in promoting biodiversity conservation and ecological development in Pakistan

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    Ecological history is crucial in ecosystem restoration, serving as a tool to identify and characterize suitable restoration targets. Pakistan has implemented laws and policies to enhance forest sustainability and preserve biodiversity, as it is becoming a global strategy for future water planning and management. This study seeks to analyze the impact of national park policies and laws on various factors, including biodiversity conservation, ecological processes preservation, water resource protection, consumptive and non-consumptive benefits, research and education, and the promotion of recreation and tourism. To assess the effectiveness of established policies in 19 National Parks in Pakistan, a mixed-mode research design was utilized, combining both quantitative and qualitative approaches. Data was collected from 300 participants through a close-ended questionnaire employing a Likert scale. Analysis of the collected data was conducted using the software Smart Partial Least Squares method. The findings demonstrate that the existing policies and laws have contributed to the preservation of forest sustainability in Pakistan. The policies related to recreation and tourism; consumptive benefits; and research are more effective respectively compared to other sets of regulations. The laws and policies related to preservation of ecological processes are least effective. The study suggests that laws related to national parks need to be revised to preserve biodiversity and ecological processes. The preservation of water resources should be a major concern, and the consumptive benefits of these parks should be rechecked. Awareness campaigns are to be part of the expansionary policy framework, and while tourism opportunities should be created, a check on natural resource misuse should be implemented. The non-consumptive benefits of these parks should also be assessed. Due to its potential limitations, such as limited stakeholder analysis, difficulty in creating legitimacy in national parks due to bureaucratic structures, lack of community sensitization, and long-term trends in sustainable conservation strategies, there are certain future research directions that can address challenges in studying the impact of policies on national park habitats. There is a pressing demand for a more dynamic approach to ecological policymaking. Continuous evaluation and adaptation of policies will be essential in creating an environment conducive to sustainable development

    Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries

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    Unfavorable social determinants of health and mortality risk by cardiovascular disease status: findings from a National Study of United States Adults

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    Background: The association between cumulative burden of unfavorable social determinants of health (SDoH) and all-cause mortality has not been assessed by atherosclerotic cardiovascular disease (ASCVD) status on a population level in the United States. Methods: We assessed the association between cumulative social disadvantage and all-cause mortality by ASCVD status in the National Health Interview Survey, linked to the National Death Index. Results: In models adjusted for established clinical risk factors, individuals experiencing the highest level of social disadvantage (SDoH-Q4) had over 1.5 (aHR = 1.55; 95%CI = 1.22, 1.96) and 2-fold (aHR = 2.21; 95% CI = 1.91, 2.56) fold increased risk of mortality relative to those with the most favorable social profile (SDoH-Q1), respectively for adults with and without ASCVD; those experiencing co-occurring ASCVD and high social disadvantage had up to four-fold higher risk of mortality (aHR = 3.81; 95%CI = 3.36, 4.32). Conclusions: These findings emphasize the importance of a healthcare model that prioritizes efforts to identify and address key social and environmental barriers to health and wellbeing, particularly in individuals experiencing the double jeopardy of clinical and social risk
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