Revolutionizing Genetic Disease Treatment with Gene Therapy – Dr Pradeep Mahajan

When it comes to better healthcare, scientists and researchers together are on an interesting adventure to discover new methods to combat genetic diseases. With these incredible advancements in generation, we’re now coming into a generation wherein we’re uncovering the secrets of the way our genes can deal with numerous genetic illnesses.
This new advancement opens up numerous opportunities for modern healing procedures. Precision remedy and gene healing procedures and converting the way we treat genetic sicknesses. These customized remedies provide exceptional wishes for patients around the world.
Precision Medicine: Personalizing Paths to Healing
Imagine in case your scientific remedy became tailored mainly for you in keeping with your necessities and severity of your genetic ailment, rather than assuming that every patient is similar. That is what precision medication is all approximately.
By checking your specific genetic code, medical doctors cannot only hit upon the foundation reason for your genetic problems but also create cures that are carefully designed especially for you. It’s like making a custom-designed plan of action that ensures you get the nice feasible remedy primarily based on your genetic makeup. This process makes your medical experience tailored, customized, and focused just on you.
Gene Editing: Rewriting the Future of Genetic Health
Using gene modifying techniques like CRISPR-Cas9, doctors can now finally deal with genetic illnesses that had been as soon as not possible to treat! This modern technique objectives the basic causes of genetic mutations on the molecular stage, paving the way for potential remedies for all kinds of situations that have been, as soon as taken into consideration, impossible to remedy.
It is a dazzling improvement within the scientific global, presenting newfound hope to the ones who have been searching for solutions for goodbye.
Regenerative Medicine: Healing with Minimal Invasiveness
Imagine a discipline of drugs that uses the frame’s recuperation powers to deal with your genetic diseases. That’s what regenerative medication is all about. It makes use of unique cells that can restore or replace damaged tissues that have been a result of genetic issues.
Dr. Pradeep Mahajan is a pinnacle researcher in regenerative medicine, and he believes that those methods have the energy to result in awesome changes in the world of healthcare. He has a speciality in developing customized treatment plans that focus on the foundation purpose of genetic illnesses. The principal intention is to repair the normal body capabilities and create a general high-quality of existence for patients.
Gene Therapy: Lighting the Way to Healing
Gene therapy is a captivating subject in scientific technology that is going beyond treating those signs. The remedy intends to cope with more than one underlying reason of genetic disorders, it additionally entails the substitute or enhancement of fallacious genes with healthy ones. This revolutionary approach holds substantial promise in presenting enduring comfort and enhancing the first-rate existence for people suffering from genetic situations.
A Bright Future: Embracing Genetic Health
Looking towards the destiny of healthcare, we can see a vivid horizon ahead, lighted to deal with genetic diseases with the assistance of great advanced technology. From particular medicine to gene editing and remedy, those interesting new approaches are reworking the sphere of medication and giving vibrant wishes to patients around the arena. We also need to realize and support new ideas and paintings together to create a brighter destiny in which we can conquer various genetic issues, bringing remedy and fulfilment to all.

Disclaimer: The views expressed in this article are of the author and not of Medical Dialogues. The Editorial/Content team of Medical Dialogues has not contributed to the writing/editing/packaging of this article.

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Applying For FMGE June 2024: Know the Exam Scheme

New Delhi- The National Board of Examination in Medical Sciences (NBEMS) recently began the application process for FMGE 2024- Foreign Medical Graduate Examination. For candidates appearing for FMGE, NBE also released an information bulletin detailing the scheme of examination.

FMGE for June 2024 will be conducted on 6th July 2024 on the computer-based platform at various testing centres across the country. The registration has already begun and will be valid till 11:55 pm on 20th May 2024. Candidates can submit the application form for FMGE June 2024 online on the official website of NBE.

Also Read: NBE Invites Online Applications For FMGE June 2024, Know how to apply

SCHEME OF FMGE EXAMINATION

1 The examination consists of one paper, comprising of 300 multiple choice questions and is administered using a computer network as per the prescribed scheme. Each question shall have 4 response options/distractors in English language only. Candidates are required to select the correct/best/ most appropriate response/answer out of the 4 response options provided in each question.

2 The paper shall be delivered in two parts to be taken in a single day with each part comprising of 150 questions to be attempted in 150 minutes. There is a scheduled break between the two parts. Allocation of time for the FMGE shall be as follows:

S.NO

ACTIVITIES

PART-I ((9:00 AM – 11:30 AM)

PART-II ((2:00 PM – 04:30 PM)

1

Allow Candidates to enter the examination centre and Commence Registration.

07:00 AM.

12:00 PM.

2

Entry closes at the Examination Center.

08:30 AM.

01:30 PM.

3

Grant access for Candidate Login.

08:45 AM.

01:45 PM.

4

Candidates log in to read instructions.

08:50 AM.

01:50 PM.

5

Exam Start Time.

09:00 AM.

02:00 PM.

6

Exam End Time.

11:30 AM.

04:30 PM.

3 The question paper for each part of FMGE will be divided into multiple time-bound sections. For example, if there are 3-time bound sections* (Section A, B & C) in each part of the question paper, each such section will have 50 questions and 50 minutes of time allotted for the section. Candidates would be restricted from proceeding to the next section till completion of the allotted time of the previous section and candidates would not be allowed to review the questions/ modify the responses of a section after the completion of the allotted time of that section. Questions of the next section will start automatically after the completion of the allotted time of the previous section.

4 Candidates are given an option to mark any question, whether attempted or not, for review which means that the candidate has been given an option to go through these questions in a section again before the allotted time to a section ends. Candidates may note that such questions which are marked for review shall be evaluated as per the marking scheme mentioned above.

5 There will be no negative marking.

6 A candidate shall be declared as having passed only if he/she obtains a minimum of 150 marks out of 300 in the examination. Results (Pass/Fail) for eligible candidates will be displayed on the NBEMS website. There is no provision for re-totaling/re-evaluation/ award of grace marks in FMGE.

7 There are no restrictions on a number of attempts that can be availed by a candidate. However, FMGE being a qualifying examination, once a candidate qualifies the FMGE, he or she shall not be eligible to take the FMGE again. Any examination taken by a candidate in violation of this clause shall be treated as void and as cancelled.

OVERVIEW OF COMPUTER-BASED TEST

Online Application Form Submission.

⬇️

Issuance of Admit Cards.

⬇️

Reporting at Test Centre on Schedule Date and Time.

⬇️

Security Check-in Process.

⬇️

Registration for Test + Face ID Capture.

⬇️

Examination Ends.

IMPORTANT DATES

S.NO

PARTICULARS

DATES

1

Online Submission of Applications.

29th April 2024 to 20th May 2024 (Till 11:55 PM).

2

Edit Window for All Payment Success Applications (Any information/documents can be edited except Name, Nationality, Email, Mobile number and Test City).

24th May 2024 to 28th May 2024.

3

Final Edit Window to rectify Deficient/Incorrect Images (No further opportunity shall be given)-

1 Photograph.

2 Signatures.

3 Thumb Impression.

7th June 2024 to 10th June 2024.

4

Opportunity to rectify deficiencies related to documents uploaded in the application-

1 Primary Medical Qualification Certificate (PMQC).

2 Apostille/Attestation of PMQC by the Indian embassy concerned.

3 Eligibility Certificate or Admission Letter.

4 Proof of Citizenship.

Through Online Deficient Document Submission Portal.

The portal will be closed on 14th June 2024 at 11:55 PM.

5

Final opportunity to rectify deficiencies related to documents uploaded in the application (A list of such candidates will be published on the NBEMS website).

21st June 2024 (11 AM onwards) to 24th June 2024 (Till 11:55 PM).

6

Issue of Admit Card.

1st July 2024.

7

Examination Date.

6th July 2024.

8

Declaration of Result.

By 6th August 2024.

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Bomb threat at Chacha Nehru Hospital turns out to be hoax

New Delhi: The state-run Chacha Nehru Hospital in Shahdara received an email containing a bomb threat on Tuesday morning. Following this, officials confirmed that no suspicious items had been found on the hospital premises.

One of the Chacha Nehru hospital staff alerted the authorities upon receiving the bomb-threat email around 10 am.

Responding swiftly, a comprehensive team including the Bomb Detection Team, Bomb Disposal Squad, personnel from the Delhi Fire Service, and local law enforcement swiftly reached the children’s hospital. A thorough search operation commenced immediately, police officials confirmed.

Also Read:53-year-old dentist under scanner for hoax bomb threat at Noida hospital

As a precautionary measure, patients were evacuated from the hospital, while security personnel conducted thorough checks lasting for one and a half hours. 

According to a PTI report, The premises were evacuated and searches are underway. However, nothing has been recovered so far, they added.

“The hospital was packed with patients, so we had to ask them to vacate. The dog squad reached the hospital and a thorough search was conducted,” an officer said, adding that they were trying to identify the sender, reports TOI.

Also Read:Bomb scare at Arogya Hospital after owner receives threat on WhatsApp

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Manipal Hospitals to acquire 87% stake in Medica Synergie for Rs 1.4K crore

Delhi: Manipal Hospitals, the second-largest hospital chain in India announced the signing of a binding agreement to acquire 87% stake in Kolkata-based hospital chain Medica Synergie. 

Post a few customary processes, the transaction is expected to be consummated shortly. This acquisition is in line with Manipal Hospitals’ strategy of expanding its footprint and presence in Eastern India as the leading hospital chain in the region.

By leveraging the clinical expertise and infrastructure of Medica Synergie, along with the combined operations of its extensive network, Manipal Hospitals will be well-positioned to meet the increasing demand for high quality tertiary and quaternary healthcare services in Eastern India.

Also Read:Manipal Hospital unveils Advanced Robotic Technology for Orthopedics Surgeries

Commenting on the transaction, Dilip Jose, MD & CEO said, “We are delighted to welcome Medica Synergie with its highly talented team of professionals into the Manipal family. With this acquisition Manipal Hospitals builds on its strong presence in Eastern India, enabling us to expand our reach and meet the healthcare needs of this under-served region. We will integrate Medica Synergie into our portfolio and rebrand it.

Together, we are poised to deliver enhanced, exceptional quality healthcare to our patients across Eastern India, including the cities of Kolkata, Siliguri, and Ranchi.”

With the acquisition of Medica, Manipal Hospitals treats 7 million patients annually across 37 hospitals spanning 19 cities in 14 states. The addition of Medica has pushed the current hospital bed count from over 9,500 to over 10,500. With a talented pool of 5,600+ doctors, along with an employee strength exceeding 18,600, Manipal Hospitals is steadfast in its commitment to clinical excellence, patient-centric care, and ethical practices. Notably, in September 2023, Manipal Hospitals acquired an 84% stake in Emami Group’s AMRI Hospitals Ltd.

The advisors for Manipal Health Enterprise Pvt. Ltd. in this transaction were Allegro Capital Advisors, Khaitan and Co. and KPMG.

Also Read:Manipal Hospitals Launches New Autism Clinic

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No Association Between SARS-CoV-2 Vaccines and New-Onset Seizures, finds Comprehensive Review

Iran: A systematic review and meta-analysis of randomized clinical trials have found no association between SARS-CoV-2 vaccines and new-onset seizures. Amid concerns regarding the potential adverse effects of COVID-19 vaccines, particularly concerning neurological health, this comprehensive analysis provides reassurance regarding the safety profile of these vaccines.

“In the pooled analyses of more than 118,000 participants in randomized clinical trials (RCTs), the incidence proportion of new-onset seizures after SARS-CoV-2 vaccination was not statistically different between vaccine recipients and placebo recipients or unvaccinated participants,” the researchers reported in JAMA Neurology.

Seizures are an adverse effect of the SARS-CoV-2 vaccine. However, no study has answered whether there is any association between seizures in the general population and COVID-19 vaccination. Considering this, Ali Rafati, School of Medicine, Iran University of Medical Sciences, Tehran, Iran, and colleagues aimed to evaluate the seizure incidence among SARS-CoV-2 vaccine recipients compared with those who received a placebo.

For this purpose, the researchers systematically searched online databases and the references of the included studies from 2019 to 2023. RCTs reporting seizure incidence with SARS-CoV-2 vaccination were included.

The study is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework, and the Mantel-Haenszel method was used. The risk of bias in the studies was evaluated using the Cochrane assessment tool for RCTs.

The outcome of interest was new-onset seizure incidence proportion compared among (1) SARS-CoV-2 vaccine recipients and (2) placebo recipients. The study included six RCTs.

The study led to the following findings:

  • Results of the pooled analysis comparing the incidence of new-onset seizure between the 63 521 vaccine and 54 919 placebo recipients in the 28-day follow-up after vaccine/placebo injection showed no statistically significant difference between the 2 groups (0.014% in vaccine and 0.002% in placebo recipients; odds ratio [OR], 2.70).
  • In the entire blinded-phase period after injection, with a median of more than 43 days, the researchers identified no significant difference between the vaccine and placebo groups regarding incident new-onset seizure (0.03% in vaccine and 0.012% in placebo recipients; OR, 2.31).

“According to this systematic review and meta-analysis, we found no statistically significant difference in the risk of new-onset seizure incidence between vaccinated individuals and placebo recipients,” the researchers wrote.

In conclusion, the systematic review and meta-analysis offer valuable insights into the safety profile of SARS-CoV-2 vaccines concerning new-onset seizures. With no evidence of an increased risk of seizures associated with vaccination, these findings provide important reassurance to healthcare providers and the general public. Moving forward, continued research and vigilance will be essential in ensuring the safety and effectiveness of COVID-19 vaccines as a cornerstone of global efforts to combat the pandemic.

Reference:

Rafati A, Jameie M, Amanollahi M, et al. Association of New-Onset Seizures With SARS-CoV-2 Vaccines: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. JAMA Neurol. Published online April 29, 2024. doi:10.1001/jamaneurol.2024.0967

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Uttarakhand Health Department notifies guidelines for dengue and chikungunya management

Dehradun: The Uttarakhand health department has taken proactive measures to address the rising cases of dengue and chikungunya patients in the state by issuing comprehensive guidelines to all districts. Twenty key points have been communicated to District Magistrates and Chief Medical Officers (CMOs) to ensure effective prevention and treatment.

Dr R Rajesh Kumar, Secretary of Health, has been conducting regular review meetings to strategize the prevention of dengue and chikungunya. In consultation with health experts, the department has formulated guidelines aimed at the treatment and prevention of these diseases. 

The Health Secretary said that for the past few years, dengue and chikungunya disease have been reflected as a major public health problem in the state. The vector of dengue and chikungunya disease is the Aedes mosquito. The time from July to November is favourable for the infection of the dengue virus. Dengue and chikungunya disease is a mosquito-borne disease that is born in the water accumulated in coolers, flower vases, pots, open water tanks, old tyres, collected junk, etc. Public participation is very important for the prevention of dengue disease, reports news agency ANI.

Also Read:Spike in Dengue cases: Uttarakhand CM instructs officials for effective control

The Health Secretary said that all other departments also have an important role in the proper prevention and control of dengue and chikungunya disease. All the departments should carry out their activities for dengue prevention and control promptly. All the departments should continue to carry out all the activities to prevent the breeding of dengue mosquitoes so that the breeding of dengue mosquitoes can be prevented and the district health department should receive information about it continuously.  

Kumar said that for the prevention and control of dengue and chikungunya disease, ensure to prepare a block-wise micro plan and take action and the said microplan should be sent to the state NVBDCP unit. Swachhata Abhiyan should be run by municipal corporations so that the breeding of dengue mosquitoes can be prevented.

The Health Secretary said that all other departments also have an important role in the proper prevention and control of dengue and chikungunya disease. All the departments should carry out their activities for dengue prevention and control in a timely manner. 

Also Read:Uttarakhand Health Secretary urges for blood donation amid surge in dengue cases

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Evening Exercise May Offer Higher Health Benefits for Obese Adults: Study

A recent research published in the recent issue of Diabetes Care journal found that the timing of exercise plays a crucial role in reducing the risk of death and cardiovascular diseases in adults with obesity by including those with type 2 diabetes (T2D). The study utilized accelerometry data to monitor physical activity, suggests that performing aerobic moderate to vigorous physical activity (MVPA) in the evening could be particularly beneficial.

The study utilized data from the UK biobank and encompassed a large group of a total of 29,836 adults who were classified as obese with a body mass index (BMI) of 30 kg/m2 or higher. The participants were monitored over an average period of nearly eight years. During this time, the study recorded 1,425 deaths, 3,980 cardiovascular disease (CVD) events and 2,162 microvascular disease (MVD) events among the group.

The participants were divided into categories based on the timing of their exercise routines which were at morning, afternoon and evening. The reference group consisted of the individuals who averaged less than one bout of aerobic MVPA per day. The data revealed that engaging in exercise during the evening was associated with the lowest risk of all-cause mortality with a hazard ratio (HR) of 0.39. Morning and afternoon activities also showed beneficial effects but were less pronounced when compared to evening exercises.

The risk of developing cardiovascular and microvascular diseases were significantly lower among the evening exercisers. The findings showed that evening activity was associated with a 36% lower risk of CVD and a 24% reduction in MVD risk. The benefits extended to the individuals with obesity and T2D that suggests a potentially vital strategy for managing both conditions.

The study adjusted for a variety of potential confounders by ensuring that the results robustly support the conclusion that not just the quantity, but the timing of physical activity is critical for health outcomes in obese adults. These findings could be transformative for the management strategies of obesity and type 2 diabetes that emphasizes the importance of regular physical activity and also its timing. Further research may explore the physiological mechanisms that support why evening exercise offers these health benefits.

Reference:

Sabag, A., Ahmadi, M. N., Francois, M. E., Postnova, S., Cistulli, P. A., Fontana, L., & Stamatakis, E. (2024). Timing of Moderate to Vigorous Physical Activity, Mortality, Cardiovascular Disease, and Microvascular Disease in Adults With Obesity. In Diabetes Care (Vol. 47, Issue 5, pp. 890–897). American Diabetes Association. https://doi.org/10.2337/dc23-2448

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Moderate Alcohol Consumption May Reduce Risk of Peripheral Artery Disease, finds study

A recent research published in the European Journal of Preventive Cardiology unveiled a potentially significant relationship between alcohol consumption and the risk of developing peripheral artery disease (PAD), where narrowed arteries reduce blood flow to the limbs. The study combined new cohort data with a meta-analysis of existing research and suggests that light to moderate drinking could be associated with a reduced risk of PAD which is contrasting strongly with risks associated with high levels of alcohol consumption.

The comprehensive study involved data analysis from two large groups that consisted of 70,116 Swedish and 405,406 British adults who were coupled with results from previous studies. According to the findings of this study, a U-shaped association was observed which indicated that both abstention and high alcohol intake might increase the PAD risk with moderate consumption showing potential protective effects.

The key findings suggest that individuals who consume alcohol lightly (≤2 drinks per week) appear to have the reduced risk of developing PAD, with a relative risk reduction at 17% when compared to non-drinkers. This risk becomes significantly pronounced with higher levels of alcohol consumption for the individuals who consume 10 or more drinks per week.

The meta-analysis included additional observational studies that confirmed the U-shaped curve with a significant statistical nonlinearity (P < 0.001)  by indicating that the relationship between alcohol consumption and PAD risk is not straightforward but varies with the amount of alcohol consumed.

The results could redefine the existing guidelines for alcohol consumption in relation to vascular health for the individuals at risk of or managing PAD. While light to moderate alcohol intake could potentially be advised as part of lifestyle modifications for at-risk populations, the clear risks associated with higher levels of drinking are also poorly underlined.

These findings pertain specifically to PAD and may not necessarily apply to other health conditions or the overall health impact of alcohol that can be detrimental in various other respects. Also, the outcomes emphasized the continuity of these links across different types of observational studies which supports the robustness of the results despite potential limitations in this observational research. Overall, the study adds an crucial dimension to our understanding of the complex interactions between lifestyle factors like alcohol intake and specific health outcomes such as PAD.

Source:

Yuan, S., Wu, J., Chen, J., Sun, Y., Burgess, S., Li, X., Åkesson, A., & Larsson, S. C. (2024). Association between alcohol consumption and peripheral artery disease: two de novo prospective cohorts and a systematic review with meta-analysis. In European Journal of Preventive Cardiology. Oxford University Press (OUP). https://doi.org/10.1093/eurjpc/zwae142

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Flank Position Safe and Effective for Kidney Stone Removal Surgery among obese and high risk patients: Study

A recent comprehensive meta-analysis focused on the safety and efficacy of the flank position during percutaneous nephrolithotomy (PCNL) for the removal of kidney stones and suggests that this surgical position may offer distinct advantages for certain high-risk patient groups.

The study systematically reviewed data from multiple databases including PubMed, Embase, SCOPUS, the Cochrane database libraries and the Chinese Biomedical Literature Database. This research included 7 randomized controlled trials which encompassed a total of 587 patients. By employing rigorous inclusion criteria and analytical methods using RevMan 5.4 software, the team led by Changjian Zheng aimed to provide a clear comparative analysis between the flank and the more traditional prone positions used during PCNL.

The key findings from the study revealed a statistically significant lower reduction in hemoglobin levels in the patients who were operated in the flank position when compared to the individuals in the prone position. The mean difference in hemoglobin reduction was −0.15 with a 95% confidence interval from −0.22 to −0.08 that indicates lesser blood loss during the surgery which is a crucial factor for patient safety.

Also, the analysis showed no significant differences in several other critical outcomes such as the stone-free rate, operative time, length of hospital stay and postoperative complications categorized under Clavien grades I, II and III. These results suggest that the flank position does not compromise the effectiveness or the safety of the surgery when compared to the prone position.

The flank position that involves the patient lying on their side was considered particularly advantageous for obese patients or the individuals with reduced cardiopulmonary function, as this can potentially reduce the stress on the heart and lungs during the operation.

Despite these positive results, the study advocate for more extensive trials to further validate their findings. While the results are encouraging, confirming these benefits across a broader demographic and with larger sample sizes is crucial for universal recommendation.

The findings have significant benefits on clinical practice in the treatment of nephrolithiasis, which affects millions worldwide and often requires surgical intervention. The flank position could become a preferred method in PCNL procedures by potentially offering a safer alternative for high-risk patients. This also helps in ensuring better patient outcomes and potentially reduces the risks associated with this common surgery.

Reference:

Zheng, C., Yang, H., Lv, Y., & Yang, L. (2024). Flank versus prone position in percutaneous nephrolithotomy: a meta-analysis of randomized controlled studies. In Urolithiasis (Vol. 52, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1007/s00240-024-01557-4

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Fibrin sealant may reduce hospitalization and operative time among patients undergoing thyroidectomy: Study

Fibrin sealant may reduce length of hospitalization and operative time among patients undergoing thyroidectomy suggests a study published in the BMC Surgery.

Various studies have focused on the application of fibrin sealants (FS) in thyroid surgery. Utilizing a meta-analysis, this systematic review analyzed the findings of recent randomized controlled trials on the safety and efficacy of FS in patients who underwent thyroidectomy. The Cochrane Library, Web of Science, Embase, PubMed, and Medline databases were searched for relevant studies, without any language restrictions. Seven randomized controlled trials were included in the originally identified 69 studies. Overall, 652 patients received FS during thyroid surgery; their outcomes were compared with those of conventionally treated patients. The primary outcomes were total volume of wound drainage, length of hospitalization, and operative time. Significant differences were observed in the total volume of wound drainage (mean deviation (MD): -29.75, 95% confidence interval (CI): -55.39 to -4.11, P = 0.02), length of hospitalization (MD: -0.84, 95% CI: -1.02 to -0.66, P < 0.00001), and surgery duration (MD: -7.60, 95% CI: -14.75 to -0.45, P = 0.04). Secondary outcomes were seroma and hypoparathyroidism development. The risk of hypoparathyroidism did not differ between the FS and conventional groups (I = 0%, relative risk = 1.31, P = 0.38). Analysis of “seroma formation that required invasive treatment” indicated that FS showed some benefit (I2 = 8%, relative risk 0.44, P = 0.15). Heterogeneity among the different trials limited their conclusions. The meta-analysis showed that although FS use did not significantly reduce seroma or hypoparathyroidism incidence in patients after thyroidectomy, it significantly reduced the total drainage volume, length of hospitalization, and duration of surgery.

Reference:

Zheng, X., Wang, F., Su, Y.C. et al. Efficacy and safety of fibrin sealant application in patients undergoing thyroidectomy: a systematic review and meta-analysis. BMC Surg 24, 122 (2024). https://doi.org/10.1186/s12893-024-02414-2

Keywords:

Fibrin sealant, reduce, length, hospitalization, operative time, among, patients, undergoing, thyroidectomy, study, Zheng, X., Wang, F., Su, Y.C, BMC Surgery, Thyroid surgery, Fibrin sealants, Wound drainage, Length of hospitalization, Meta-analysis

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