Irish journal of medical science
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Review Meta Analysis
Primary closure versus vertical rectus abdominis myocutaneous (VRAM) flap closure of perineal wound following abdominoperineal resection-a systematic review and meta-analysis.
Perianal wound healing and/or complications are common following abdominoperineal resection (APR). Although primary closure is commonly undertaken, myocutaneous flap closure such as vertical rectus abdominis myocutaneous flap (VRAM) is thought to improve wound healing process and outcome. A comprehensive meta-analysis was performed to compare outcomes of primary closure versus VRAM flap closure of perineal wound following APR. ⋯ We highlight the advantage of VRAM flap closure over primary closure for perineal wounds following APR. However, tailoring operative strategy based on patient and disease factors remains important in optimising outcomes.
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Review Meta Analysis
Analyzing the impact of sleep duration on atrial fibrillation risk: a comprehensive systematic review and meta-analysis.
Recent studies have suggested an association between sleep duration and cardiovascular diseases; however, the link to AF is inconclusive. This study aimed to explore the relationship between sleep duration and AF by conducting a systematic review and meta-analysis of primary studies to provide evidence of the link between insufficient sleep and AF. ⋯ Insufficient sleep duration was associated with an increased risk of AF, whereas a longer sleep duration did not show a significant correlation. Standardized methods for sleep assessment and AF diagnosis as well as adjustments for confounding factors are suggested for future studies to improve the clarity and understanding of these associations.
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Review Comparative Study
A comparison of available guidelines for the detection of cauda equina syndrome and assessing the need for further clinical guidance in Ireland.
The cauda equina syndrome (CES) is a rare but critical disorder, which can result in devastating motor weakness and sensory deficit, alongside often irreversible bladder, bowel and sexual dysfunction. In addition to the clinical burden of disease, this syndrome results in a disproportionately high medicolegal strain due to missed or delayed diagnoses. Despite being an emergency diagnosis, often necessitating urgent surgical decompression to treat, we believe there is a lack of clarity for clinicians in the current literature, with no published Irish guideline concerning screening or detection. ⋯ No Irish guidelines or advice were available on CES screening/treatment at the time of review. This review demonstrated the lack of consensus and guidance for clinicians in Ireland on how to effectively screen for CES, judge who requires further imaging and investigations and how to rule out the condition. A national consensus on thorough screening and prompt investigation for CES is necessary, and the formulation of new CES guidelines would be a welcome addition to what is available to clinicians currently.
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Randomized Controlled Trial Comparative Study
Comparison of sequential and mixture injections of opioids and hyperbaric bupivacaine for subarachnoid block for lower segment caesarean section: a randomised controlled study.
Opioids are commonly added to local anaesthetic for subarachnoid block for caesarean section due to their synergistic effects. The physiochemical characteristics of opioids suggest premixing with hyperbaric bupivacaine may limit their distribution within the CSF. We studied the effect of a separate injection with a combination of bupivacaine, morphine and fentanyl on block characteristics, haemodynamic changes, postoperative pain and patient satisfaction. ⋯ NCT04403724.