Dr Ishanka Rajapaksha Mudiyanselage

Background: Human ABO blood group type and the antigenic secretor status are hypothesized to associate with oral diseases including oral cancer. Secretor status is the ability of individuals to secrete blood group antigens into body fluids. This study aimed to evaluate the secretor status of ABO antigens of saliva in patients with oral cancers or oral potentially malignant disorders (OPMDs) relative to healthy adults. Methods: A systematic and comprehensive online search from inception to April 28, 2022, was carried out in MEDLINE, Embase, PsycInfo, and Emcare. The language was limited to English. Yielded records were screened by two independent reviewers at the title and abstract phase and at full-text screening. Studies investigating adults (= 18¿years) with oral cancers or oral potentially malignant disorders compared to adults free of oral cancer were included in this study. Data were extracted according to the planned objectives. Methodological quality was assessed, and the findings were analyzed narratively. Meta-analyses were conducted to pool the odds of the non-secretor status of oral cancers and OPMDs compared to healthy adults. Results: The search included a total of 34 studies from three databases. Nine duplicates were removed. During the title and abstract screening, 11 irrelevant studies were excluded. Twelve studies were screened during the full-text screening, and eight articles were eligible to be included in the final analysis. A pooled odds ratio (OR) of 3.80 (95%CI, 1.53¿9.44) was estimated when pooled 1254 oral cancers and oral potentially malignant disorders patients compared to 666 healthy adults. Discussion and conclusion: The odds of being a non-secretor appear to be approximately 3.8 times higher in patients with oral cancers and oral potentially malignant disorders compared to healthy adults. The lack of ABO blood group antigens in body fluids of non-secretors is more exposed to exogenous antigens than secretors. The host-parasite interactions of secretors and non-secretors underlying oral cancer and other diseases may be evidence to support or refuse them. Clinicians may use the secretor status as a detection test during their regular oral check-ups for high-risk populations for oral cancers. Non-secretors can be given more attention considering them as high-risk groups, and in terms of prognosis, differences between these two groups may be expected.

Purpose: Patient-Reported Outcome Measures (PROMs) aim to facilitate patient-centred care by objectively measuring consumer views of their health and well-being in addition to monitoring patient outcomes. This review sought to identify PROMs suitable for adults receiving inpatient rehabilitation to guide clinical practice and consumer engagement in healthcare. Material and methods: The scoping review methodology was guided by PRISMA-ScR and JBI guidelines. Seven electronic databases (Medline, Embase, CINAHL, PsycInfo, Cochrane CENTRAL, Cochrane Reviews, Scopus) and grey literature were searched from January 2000 to October 2022. Two reviewers independently screened the articles. Data were extracted and summarised thematically to derive clinical implications. Results: Of 9096 records retrieved, 51 articles were included for analysis. Fifty-nine key PROMs were identified in the rehabilitation literature. The Euro-QOL 5D was reported for more than one-third of the studies. There were numerous condition-specific PROMs pertaining to health conditions such as arthritis, stroke and cardiac failure or symptoms such as pain, depression, fatigue and weakness. Most rehabilitation trials reported using PROMs before therapy and after discharge to monitor within-admission changes. Conclusions: PROMs are frequently used in rehabilitation research and have the potential to yield helpful data for the evaluation of clinical services.

The impact of COVID-19 virus infection during pregnancy is still unclear. This systematic review and meta-analysis aimed to quantitatively pool the evidence on impact of COVID-19 infection on perinatal outcomes. Databases of Medline, Embase, and Cochrane library were searched using the keywords related to COVID-19 and perinatal outcomes from December 2019 to 30 June 2021. Observational studies comparing the perinatal outcomes of COVID-19 infection in pregnancy with a non-infected comparator were included. The screening process and quality assessment of the included studies were performed independently by two reviewers. Meta-analyses were used to pool the comparative dichotomous data on perinatal outcomes. The database search yielded 4049 results, 1254 of which were duplicates. We included a total of 21 observational studies that assessed the adverse perinatal outcomes with COVID-19 infection. The odds of maternal death (pooled OR: 7.05 [2.41-20.65]), preeclampsia (pooled OR: 1.39 [1.29-1.50]), cesarean delivery (pooled OR: 1.67 [1.29-2.15]), fetal distress (pooled OR: 1.66 [1.35-2.05]), preterm birth (pooled OR: 1.86 [1.34-2.58]), low birth weight (pooled OR: 1.69 [1.35-2.11]), stillbirth (pooled OR: 1.46 [1.16-1.85]), 5th minute Apgar score of less than 7 (pooled OR: 1.44 [1.11-1.86]) and admissions to neonatal intensive care unit (pooled OR: 2.12 [1.36-3.32]) were higher among COVID-19 infected pregnant women compared to non-infected pregnant women.

Background: Although the potential of big data analytics for health care is well recognized, evidence is lacking on its effects on public health. Objective: The aim of this study was to assess the impact of the use of big data analytics on people's health based on the health indicators and core priorities in the World Health Organization (WHO) General Programme of Work 2019/2023 and the European Programme of Work (EPW), approved and adopted by its Member States, in addition to SARS-CoV-2-related studies. Furthermore, we sought to identify the most relevant challenges and opportunities of these tools with respect to people's health. Methods: Six databases (MEDLINE, Embase, Cochrane Database of Systematic Reviews via Cochrane Library, Web of Science, Scopus, and Epistemonikos) were searched from the inception date to September 21, 2020. Systematic reviews assessing the effects of big data analytics on health indicators were included. Two authors independently performed screening, selection, data extraction, and quality assessment using the AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews 2) checklist. Results: The literature search initially yielded 185 records, 35 of which met the inclusion criteria, involving more than 5,000,000 patients. Most of the included studies used patient data collected from electronic health records, hospital information systems, private patient databases, and imaging datasets, and involved the use of big data analytics for noncommunicable diseases. "Probability of dying from any of cardiovascular, cancer, diabetes or chronic renal disease" and "suicide mortality rate" were the most commonly assessed health indicators and core priorities within the WHO General Programme of Work 2019/2023 and the EPW 2020/2025. Big data analytics have shown moderate to high accuracy for the diagnosis and prediction of complications of diabetes mellitus as well as for the diagnosis and classification of mental disorders; prediction of suicide attempts and behaviors; and the diagnosis, treatment, and prediction of important clinical outcomes of several chronic diseases. Confidence in the results was rated as "critically low" for 25 reviews, as "low" for 7 reviews, and as "moderate" for 3 reviews. The most frequently identified challenges were establishment of a well-designed and structured data source, and a secure, transparent, and standardized database for patient data. Conclusions: Although the overall quality of included studies was limited, big data analytics has shown moderate to high accuracy for the diagnosis of certain diseases, improvement in managing chronic diseases, and support for prompt and real-time analyses of large sets of varied input data to diagnose and predict disease outcomes.

Background: Navigating the rapidly growing body of scientific literature on the SARS-CoV-2 pandemic is challenging, and ongoing critical appraisal of this output is essential. We aimed to summarize and critically appraise systematic reviews of coronavirus disease (COVID-19) in humans that were available at the beginning of the pandemic. Methods: Nine databases (Medline, EMBASE, Cochrane Library, CINAHL, Web of Sciences, PDQ-Evidence, WHO's Global Research, LILACS, and Epistemonikos) were searched from December 1, 2019, to March 24, 2020. Systematic reviews analyzing primary studies of COVID-19 were included. Two authors independently undertook screening, selection, extraction (data on clinical symptoms, prevalence, pharmacological and non-pharmacological interventions, diagnostic test assessment, laboratory, and radiological findings), and quality assessment (AMSTAR 2). A meta-analysis was performed of the prevalence of clinical outcomes. Results: Eighteen systematic reviews were included; one was empty (did not identify any relevant study). Using AMSTAR 2, confidence in the results of all 18 reviews was rated as "critically low". Identified symptoms of COVID-19 were (range values of point estimates): fever (82¿95%), cough with or without sputum (58¿72%), dyspnea (26¿59%), myalgia or muscle fatigue (29¿51%), sore throat (10¿13%), headache (8¿12%) and gastrointestinal complaints (5¿9%). Severe symptoms were more common in men. Elevated C-reactive protein and lactate dehydrogenase, and slightly elevated aspartate and alanine aminotransferase, were commonly described. Thrombocytopenia and elevated levels of procalcitonin and cardiac troponin I were associated with severe disease. A frequent finding on chest imaging was uni- or bilateral multilobar ground-glass opacity. A single review investigated the impact of medication (chloroquine) but found no verifiable clinical data. All-cause mortality ranged from 0.3 to 13.9%. Conclusions: In this overview of systematic reviews, we analyzed evidence from the first 18 systematic reviews that were published after the emergence of COVID-19. However, confidence in the results of all reviews was "critically low". Thus, systematic reviews that were published early on in the pandemic were of questionable usefulness. Even during public health emergencies, studies and systematic reviews should adhere to established methodological standards.

Background: Clinically, a discrepancy of fibular position in relation to the tibia has been proposed as a factor in the persistence of chronic ankle instability (CAI). Previous studies have produced conflicting findings, perhaps due to varying radiological methods and measurement of participants in non-weight-bearing positions. Objectives: To compare normalized-fibular position in weight-bearing in individuals with CAI with healthy controls. Design: A weight-bearing lateral X-ray was taken of the affected ankle of 33 adults with CAI and 33 matched controls. The distance between the anterior edges of the distal fibula and tibia was recorded, and then normalized as a proportion of maximal tibial width. Normalized-fibular position was compared between groups using independent t-tests. Intra-class correlation coefficients (ICC2,1) were calculated to determine reliability of measurements. A receiver-operating characteristic (ROC) curve was used to determine sensitivity, specificity, and a cutoff score to differentiate individuals with CAI from controls using normalized-fibular position. Results: Normalized fibular position was significantly different (CAI, 29.7 (6.6)%; healthy, 26.7 (4.8)%) between the groups. Measurement of intra-rater (0.99, 95%CI¿=¿0.98 to 1.00) and inter-rater (0.98, 95%CI¿=¿0.96 to 0.99) reliability were both excellent. The threshold normalized-fibular position was 27%, with a score more than 27% indicating a greater chance of being in the CAI group. Sensitivity was 69.7% and specificity was 54.5% for this threshold. Conclusion: A slightly anteriorly positioned fibula in relation to the tibia was observed in people with CAI. Specificity/sensitivity scores for normalized-fibular position indicate that it has little ability to predict CAI alone.

Background: Whilst people of all ages are affected in some way by COVID-19 virus, older people are at a high mortality risk. This study aimed to systematically review the numerous factors associated with mortality among COVID-19 infected older people. Method: PubMed and Science Direct were searched from inception to the April 15, 2021. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement and Joanna Briggs Institute critical appraisal tool to assess the methodological quality of the included studies. Results: Of the 4957 studies identified, 20 were included in the qualitative analysis, while 10 were included in the quantitative analysis. Male sex (OR = 2.22, 95% CI = 1.23¿3.99), age (over 75 years old) (OR = 3.36, 95% CI = 2.30¿4.90), Dementia (OR = 3.69, 95% CI = 1.99¿6.83) and Dyspnoea (OR = 3.16, 95% CI = 2.61¿3.82), were found to be significantly associated with mortality. There is no significant association between Diabetes, or Hypertension. Conclusion: Older age, male gender, dyspnoea and dementia were associated with a greater risk of death of older people from COVID-19 infection. These findings may help health care professionals to identify high-risk groups, facilitate appropriate remedial measures, and control mortality among older people.

Objective. This study aims to describe the clinical features in terms of pain perception, ankle range of motion, and foot volume in participants with recurrent ankle sprains compared with first-time sprains. Methods. Individuals with grade I and II ankle sprains were referred to physiotherapy care for further rehabilitation by their general practitioner. Primary outcome measures were range of movement, pain, and foot volume. Recurrences were described according to engagement in sport. Results. A total of 115 participants were recruited (age = 22.2 ± 6.9 years; female, 84). Neither pain level (P =.822), nor range of motion (dorsiflexion P =.452; plantar flexion P =.436; inversion P =.383; eversion P =.657), nor foot volume (P =.654) were significantly different between the groups: individuals with first-time sprain or with recurrences. Conclusion. Pain and high existence of other lower-limb injuries were reported disregarding the presence of a recurrence. Clinically, it is difficult to differentiate recurrent sprain from a first-time ankle sprain by means of foot volume, range of movement, or pain intensity.

Objectives A standard lateral radiograph is the first step in the diagnostic workup in patients with posterior ankle pain. Because of overprojection by other structures at suboptimal radiographic projection angle, often an os trigonum is not discovered or erroneously be mistaken for a hypertrophic posterior talar process. The aim of this study was to identify the projection angles at which a radiograph is optimal for detecting bony impediments in patients suffering from posterior ankle impingement. Methods Using ankle CT scans of patients with posterior ankle impingement, digitally reconstructed radiographs (DRRs) simulating 13 different radiographic projection angles were generated. The ankle CT scans served as a reference for the detection of an os trigonum and hypertrophic posterior talar process. Members of the Ankleplatform Study Group were invited to assess the DRRs, for presence or absence of an os trigonum or hypertrophic posterior talar process. Diagnostic accuracy and interobserver reliability were estimated for each projection angle. In addition, the diagnostic accuracy of the standard lateral view in combination with the rotated views was calculated. Results High sensitivity for detecting an os trigonum was found for +15° (90.3%), +20° (81.7%) and +25° (89.7%) degrees of exorotation. Specificity in this range of projection angles was between 89.6% and 97.8%. Regarding the presence of a hypertrophic posterior talar process, increased sensitivity was found for +15° (65.7%), +20° (61.0%), +25° (60.7%), +30° (56.3%) and +35° (54.5%). Specificity ranged from 78.0% to 94.7%. The combination of the standard lateral view in combination with exorotated views showed higher sensitivity. For detecting an os trigonum, a negative predictive value of 94.6% (+15°), 94.1% (+20°) and 96.1% (+25°) was found. Conclusion This study underlines the additional diagnostic value of exorotated views instead of, or in addition to the standard lateral view in detecting an osseous impediment. We recommend to use the 25° exorotated view in combination with the routine standard lateral ankle view in the workup of patients with posterior ankle pain. Level of evidence Level III.

Objective: To assess the clinical benefits of joint mobilization for ankle sprains. Data Sources: MEDLINE, MEDLINE In-Process, Embase, AMED, PsycINFO, CINAHL, Cochrane Library, PEDro, Scopus, SPORTDiscus, and Dissertations and Theses were searched from inception to June 2017. Study Selection: Studies investigating humans with grade I or II lateral or medial sprains of the ankle in any pathologic state from acute to chronic, who had been treated with joint mobilization were considered for inclusion. Any conservative intervention was considered as a comparator. Commonly reported clinical outcomes were considered such as ankle range of movement, pain, and function. After screening of 1530 abstracts, 56 studies were selected for full-text screening, and 23 were eligible for inclusion. Eleven studies on chronic sprains reported sufficient data for meta-analysis. Data Extraction: Data were extracted using the participants, interventions, comparison, outcomes, and study design approach. Clinically relevant outcomes (dorsiflexion range, proprioception, balance, function, pain threshold, pain intensity) were assessed at immediate, short-term, and long-term follow-up points. Data Synthesis: Methodological quality was assessed independently by 2 reviewers, and most studies were found to be of moderate quality, with no studies rated as poor. Meta-analysis revealed significant immediate benefits of joint mobilization compared with comparators on improving posteromedial dynamic balance (P=.0004), but not for improving dorsiflexion range (P=.16), static balance (P=.96), or pain intensity (P=.45). Joint mobilization was beneficial in the short-term for improving weight-bearing dorsiflexion range (P=.003) compared with a control. Conclusions: Joint mobilization appears to be beneficial for improving dynamic balance immediately after application, and dorsiflexion range in the short-term. Long-term benefits have not been adequately investigated.

Objectives: Sedentary behaviour research is a relatively new field, much of which has emerged since the widespread acceptance of clinical trial registration. The aim of this study was to investigate the trial registration and related issues in studies investigating the effect of frequent activity interruptions to prolonged sitting-time. Methods: Secondary analysis of a scoping review including systematic searches of databases and trial registries. We included experimental studies investigating the effects of frequent activity interruptions to prolonged sitting-time. Results: We identified 32 trials published in 45 papers. Only 16 (50%) trials were registered, with all 16 trials being completed and published. Of the unregistered trials, we identified three (19%) for which similarities in the sample size and participant demographics across papers was suggestive of duplicate publication. Identification of potential duplicate publications was difficult for the remaining 13 (81%). Results from 53 (76%) of the 70 registered outcomes were published, but 11 (69%) registered trials reported results from additional outcomes not prospectively registered. A total of 46 different outcomes (out of 53 reported outcome measures, similar measures were collated) were reported across all trials, 31 (67%) of which were collected in =2 trials. Conclusions: We found direct evidence of trial registration issues in experimental trials of breaking up sitting-time. The lack of prospective registration of all trials, and the large number of outcomes measured per trial are key considerations for future research in this field. These issues are unlikely to be confined to the field of sedentary behaviour research.