Category: Nevin Manimala

Clin Oral Investig. 2023 May 25. doi: 10.1007/s00784-023-05068-1. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of the present randomized controlled trial (RCT) was to evaluate the efficacy of different alveolar ridge preservation (ARP) techniques on dimensional alterations after tooth extraction, based on clinical measurements.

BACKGROUND: Alveolar ridge preservation (ARP) is a common procedure in every day clinical practice, when dental implants are involved in treatment planning. In ARP procedures, a bone grafting material is combined with a socket sealing (SS) material in order to compensate the alveolar ridge dimensional alterations after tooth extraction. Xenograft and allograft are the most frequently used bone grafts in ARP, while free gingival graft (FGG), collagen membrane, and collagen sponge (CS) usually applied as SS materials. The evidence comparing xenograft and allograft directly in ARP procedure is scarce. In addition, FGG is usually combined with xenograft as SS material, while the evidence combing allograft with FGG is absent. Moreover, CS could probably be an alternative choice in ARP as SS material, since it has been used in previous studies but more clinical trials are required to evaluate its effectiveness.

MATERIALS AND METHODS: Forty-one patients were randomly assigned in four treatment groups: (A) freeze-dried bone allograft (FDBA) covered with collagen sponge (CS), (B) FDBA covered with free gingival graft (FGG), (C) demineralized bovine bone mineral xenograft (DBBM) covered with FGG, and (D) FGG alone. Clinical measurements were performed immediately after tooth extraction and 4 months later. The related outcomes pertained to both vertical and horizontal assessment of bone loss.

RESULTS: Overall, groups A, B, and C presented significantly less vertical and horizontal bone resorption compared to group D. No statistically significant difference was observed between allograft and xenograft, except for the vertical bone resorption at the buccal central site, where xenograft showed marginally statistically significantly reduced bone loss compared to allograft (group C vs group B: adjusted β coef: 1.07 mm; 95%CI: 0.01, 2.10; p = 0.05). No significant differences were observed in hard tissue dimensions when CS and FGG were applied over FDBA.

CONCLUSIONS: No differences between FDBA and DBBM could practically be confirmed. In addition, CS and FGG were equally effective socket sealing materials when combined with FDBA, regarding bone resorption. More RCTs are needed to compare the histological differences between FDBA and DBBM and the effect of CS and FGG on soft tissue dimensional changes.

CLINICAL RELEVANCE: Xenograft and allograft were equally efficient in ARP 4 months after tooth extraction in horizontal level. Xenograft maintained the mid-buccal site of the socket marginally better than the allograft, in vertical level. FGG and CS were equally efficient as SS materials regarding the hard tissue dimensional alterations.

TRIAL REGISTRATION: Clinical trial registration Number: NCT04934813 (clinicaltrials.gov).

PMID:37227497 | DOI:10.1007/s00784-023-05068-1

Pediatr Radiol. 2023 May 25. doi: 10.1007/s00247-023-05676-9. Online ahead of print.

ABSTRACT

We established a framework for collecting radiation doses for head, chest and abdomen-pelvis computed tomography (CT) in children scanned at multiple imaging sites across Latin America with an aim towards establishing diagnostic reference levels (DRLs) and achievable doses (ADs) in pediatric CT in Latin America. Our study included 12 Latin American sites (in Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Honduras and Panama) contributing data on the four most common pediatric CT examinations (non-contrast head, non-contrast chest, post-contrast chest and post-contrast abdomen-pelvis). Sites contributed data on patients’ age, sex and weight, scan factors (tube current and potential), volume CT dose index (CTDIvol) and dose length product (DLP). Data were verified, leading to the exclusion of two sites with missing or incorrect data entries. We estimated overall and site-specific 50th (AD) and 75th (diagnostic reference level [DRL]) percentile CTDIvol and DLP for each CT protocol. Non-normal data were compared using the Kruskal-Wallis test. Sites contributed data from 3,934 children (1,834 females) for different CT exams (head CT 1,568/3,934, 40%; non-contrast chest CT 945/3,934, 24%; post-contrast chest CT 581/3,934, 15%; abdomen-pelvis CT 840/3,934, 21%). There were significant statistical differences in 50th and 75th percentile CTDIvol and DLP values across the participating sites (P<0.001). The 50th and 75th percentile doses for most CT protocols were substantially higher than the corresponding doses reported from the United States of America. Our study demonstrates substantial disparities and variations in pediatric CT examinations performed in multiple sites in Latin America. We will use the collected data to improve scan protocols and perform a follow-up CT study to establish DRLs and ADs based on clinical indications.

PMID:37227466 | DOI:10.1007/s00247-023-05676-9

Int J Surg. 2023 May 23. doi: 10.1097/JS9.0000000000000342. Online ahead of print.

ABSTRACT

BACKGROUND: Extended arch repair in elderly patients with acute type A aortic dissection (ATAAD) remains challenging for cardiac surgeons. Data on extended arch repair for ATAAD in septuagenarians are scarce.

MATERIALS AND METHODS: Consecutive adult patients with ATAAD undergoing extended arch repair from January 2015 to December 2021 were identified. According to age at presentation, 714 eligible patients were entered into either an elderly group (septuagenarians, n=65) or a control group (patients aged < 70, n=649). Using propensity score matching, 60 pairs of patients were successfully established at a 1:1 ratio. In-hospital outcomes (operative death and major postoperative morbidity) and mid-term outcomes (survival and aortic re-intervention) were compared before and after matching.

RESULTS: Operative death occurred in 64 patients (9.0%), including 7 septuagenarians (10.8%) and 57 (8.8%) from the control group, without significant differences between groups before and after matching (P=0.593 and 0.774, respectively). Major postoperative morbidity was observed in 298 patients (41.7%), including 29 (44.6%) in the elderly group and 269 (41.4%) in the control group (P=0.622). Age-based grouping was not significantly associated with operative mortality or major postoperative morbidity in the crude, multivariable, and propensity score analyses. The 5-year cumulative survival and cumulative aortic reintervention rates in the elderly group were 83.5% and 4.6%, respectively, which were not statistically different from those in the control group before and after matching.

CONCLUSIONS: Extended arch repair may be safely and effectively performed in septuagenarians with ATAAD, with in-hospital and midterm outcomes comparable to those obtained in patients aged < 70 years.

PMID:37226875 | DOI:10.1097/JS9.0000000000000342

Health Promot Pract. 2023 May 25:15248399231173704. doi: 10.1177/15248399231173704. Online ahead of print.

ABSTRACT

Background. Postpartum weight retention is a risk factor for obesity and is particularly important among Hispanic women who have an increased rate of obesity. Given its broad reach, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program provides an ideal setting to implement community-based interventions for low-income postpartum women. Purpose. To examine the feasibility, acceptability, and preliminary efficacy of a multicomponent intervention delivered by staff within the WIC program designed to promote behavior changes in urban, postpartum women with overweight/obesity. Method. This was a 12-week pilot trial randomizing participants to a health behavior change (Intervention) or control (Observation) group. The Intervention included monthly visits with trained WIC staff providing patient-centered behavior change counseling, with multiple touchpoints between visits promoting self-monitoring and offering health behavior change support. Results. Participants (n = 41), who were mainly Hispanic (n = 37, 90%) and Spanish-speaking (n = 33, 81%), were randomized to the Intervention (n = 19) or Observation (n = 22) group. In the Intervention group, 79% (n = 15) of eligible participants were retained for the study duration. All Intervention participants endorsed that they would participate again. Regarding physical activity, participant readiness to change and self-efficacy improved for Intervention participants. About one-quarter of women in the Intervention group (27%, n = 4) had a 5% weight loss compared with one woman (5%) in the Observation group; this difference was not statistically significant (p = .10). Conclusions. This pilot demonstrated the feasibility and acceptability of delivering a low-intensity behavior change intervention within the WIC setting for postpartum women with overweight/obesity. Findings support the role of WIC in addressing postpartum obesity.

PMID:37226873 | DOI:10.1177/15248399231173704

Int J Surg. 2023 May 23. doi: 10.1097/JS9.0000000000000497. Online ahead of print.

ABSTRACT

BACKGROUND: Malnutrition is significantly associated with unfavourable outcomes, but there is little high-level evidence to elucidate the association of malnutrition with losing walking independence (LWI) after hip fracture surgery. This study aimed to assess the association between preoperative nutritional status evaluated by the Controlling Nutritional Status (CONUT) score and walking independence at 180 days postoperatively in Chinese older hip fracture patients.

METHODS: This prospective cohort study included 1958 eligible cases from the SSIOS database. The restricted cubic spline (RCS) was used to assess the dose-effect relationship between the CONUT score and recovery of walking independence. Propensity score matching (PSM) was performed to balance potential preoperative confounders, and multivariate logistic regression analysis was applied to assess the association between malnutrition and LWI with perioperative factors for further adjustment. Furthermore, inverse probability treatment weighting (IPTW) and sensitivity analyses were performed to test robustness of the results and the Fine and Grey hazard model was applied to adjust the competing risk of death. Subgroup analyses were used to determine potential population heterogeneity.

RESULTS: We found a negative relationship between the preoperative CONUT score and recovery of walking independence at 180 days postoperatively, and that moderate-to-severe malnutrition evaluated by the CONUT score was independently associated with a 1.42-fold (95%CI, 1.12-1.80; P=0.004) increased risk of LWI. The results were overall robust. And in the Fine and Grey hazard model, the result was still statistically significant despite the apparent decrease in the risk estimate from 1.42 to 1.21. Furthermore, significant heterogeneities were observed in the subgroups of age, body mass index (BMI), American Society of Anesthesiologists (ASA) score, Charlson’s comorbidity index (CCI) and surgical delay (P for interaction < 0.05).

CONCLUSION: Preoperative malnutrition is a significant risk factor for LWI after hip fracture surgery, and nutrition screening on admission would generate potential health benefits.

PMID:37226868 | DOI:10.1097/JS9.0000000000000497

Eur J Cardiovasc Nurs. 2023 May 25:zvad050. doi: 10.1093/eurjcn/zvad050. Online ahead of print.

ABSTRACT

AIMS: A nutritional status is related to the length of hospitalisation and in-hospital mortality of patients with heart failure (HF). The aim of this study is to assess the prognostic impact of nutritional status and BMI on in-hospital mortality among patients with HF relative to their sex.

METHODS AND RESULTS: We conducted a retrospective study and analysis of 809 medical records of patients admitted to the Institute of Heart Disease of the University Clinical Hospital in Wroclaw (Poland). Women were statistically significantly older than men (74.67±11.15 vs 66.76±17.78; p<0.001). In unadjusted model significant Predictor of the odds of in-hospital mortality for man are underweight (OR=14.81, p=0.001) and the risk of malnutrition (OR=8.979, p<0.001). In case of woman none of the traits analyzed was a significant. In age-adjusted model significant independent predictor of the odds of in-hospital mortality in the case of men was BMI>18,5 (OR=15.423, p=0.001) and risk of malnutrition (OR=5.557, p=0.002). In case of woman none of the nutritional status traits analyzed was a significant. In multivariable-adjusted model in men, significant independent predictors of the odds of in-hospital mortality were BMI>18,5 (OR=15.978, p=0.007) compared to having normal body weight and the risk of malnutrition (OR=4.686, p=0.015). In case of woman none of the nutritional status traits analyzed was a significant.

CONCLUSION: Both underweight and the risk of malnutrition are direct predictors of the odds of in-hospital mortality in men, but not in women. The study did not find a relationship between nutritional status and in-hospital mortality in women.

PMID:37226867 | DOI:10.1093/eurjcn/zvad050

Integr Environ Assess Manag. 2023 May 25. doi: 10.1002/ieam.4794. Online ahead of print.

ABSTRACT

Cyclic C6O4 (cC6O4, CAS number 1190931-27-1) is a new generation polyfluorinated alkyl substance (PFAS) used as polymerisation aid in the synthesis of fluoropolymers, produced in Italy since 2011. A review of the properties of cC6O4, focused on environmental distribution and ecotoxicology, was conducted. EQC model was applied, using default environmental scenarios, to estimate environmental distribution and fate. In a situation of static thermodynamic equilibrium in a closed system (level I) cC6O4 distributes mainly to water (97.6%) and in a minor amount to soil (2.3%). In a more realistic scenario (level III), with dynamic condition in an open system, with advection in air and water and with equal emissions in air and water, the major amount of the compound is transported through water advection. Monitoring data, mainly referred to surface and groundwater, are available for water bodies close to the production sites (maximum measured concentration 52 μg/L) as well as for a wider area in the river Po watershed with concentrations generally lower than 1 μg/L. Few values are also available for concentration in biota. Effect data indicate low toxicity on all tested organisms with NOEC values always higher than the maximum concentrations tested (100 mg/L for acute tests). Bioaccumulation potential is also very low. A comparison with selected widely used PFAS with five to eight C atoms indicate that cC6O4 is substantially less dangerous to aquatic organisms. At the time being, an ecological risk for the aquatic ecosystem may be excluded even in directly exposed ecosystems. However, for a complete assessment of the suitability of cC6O4 as substitute of other PFAS (namely PFOA), more comprehensive chronic experiments are necessary, to produce realistic NOECs, as well as higher tier experiments (e.g., mesocosms) capable to provide ecologically relevant endpoints. Moreover, a more accurate evaluation of the environmental persistence would be necessary.

PMID:37226845 | DOI:10.1002/ieam.4794

Clin Oral Implants Res. 2023 May 25. doi: 10.1111/clr.14099. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to evaluate the effects of the cushioned grind-out technique transcrestal sinus floor elevation for simultaneous implant placement with ≤4 mm of residual bone height (RBH).

MATERIALS AND METHODS: This was a retrospective propensity score matching (PSM) study. Five PSM analyses included the confounding variables of Schneiderian membrane perforation, early and late implant failure, and peri-implant apical and marginal bone resorption. After PSM, we compared the difference in five aspects between the RBH ≤ 4 and >4 mm groups.

RESULTS: A total of 214 patients with 306 implants were included in this study. After PSM, the generalized linear mixed model (GLMM) indicated that RBH ≤ 4 mm had no significantly higher risk of Schneiderian membrane perforation and early and late implant failure (p = .897, p = .140, p = .991, respectively). The implant cumulative 7-year survival rate of the RBH ≤ 4 and >4 mm groups was 95.5% and 93.9%, respectively (log-rank test: p = .900). Within at least 40 cases per group after PSM, two multivariate GLMMs indicated that RBH ≤ 4 mm could not be identified as the promotive factor of bone resorption of either endo-sinus bone gain or crest bone level (RBH × time interaction p = .850, p = .698, respectively).

CONCLUSIONS: Within the limitations, 3 months to 7 years of post-prosthetic restoration review data indicated an acceptable mid-term survival and success rate of applying the cushioned grind-out technique in RBH ≤ 4 mm cases.

PMID:37226843 | DOI:10.1111/clr.14099

Inquiry. 2023 Jan-Dec;60:469580231174326. doi: 10.1177/00469580231174326.

ABSTRACT

Mothers’ delivery care satisfaction is one of the indicators used to monitor the quality of health care provision. However, there is paucity of evidence on level of maternal satisfaction and its determinants, in Ethiopia, particularly in Somali regional state. Determining the maternal delivery care satisfaction level and identifying its determinants is important to understand the gap and strengthen the existing strategies. Therefore, the study aimed to determine the level of maternal satisfaction and the associated factors among post-cesarean section delivery care at selected public hospitals in the Somali regional state of Ethiopia. An institutional-based cross-sectional study was conducted on 285 mothers who gave birth in selected public hospitals in the Somali region from June 15 to August 29, 2021. The study subjects were chosen from the hospital using simple random sampling, and data was collected by interviewing newly delivered mothers. The data was entered into EPI DATA version 3, exported and analyzed using the Statistical Package for the Social Sciences (SPSS) 26 statistical package. A multivariable logistic regression was applied to identify the factors related to maternal satisfaction at a 95% confidence interval. Variables with a P-value of less than .05 in the multivariable regression were considered to be significantly related to maternal satisfaction. The overall maternal satisfaction level with cesarean section delivery care service was 61.5% (95% CI: 56.1-66.3). Current planned pregnancy [AOR = 2.793; 95% CI: (1.42, 5.51)], antenatal care follows up [AOR = 2.008; 95% CI: (1.097, 3.67)], time spent obtaining health professionals [AOR = 4.045; 95% CI: (2.12, 7.71)], and gender of healthcare provider [AOR = 7.993; 95% CI: (4.11, 15.53)] were all associated with maternal satisfaction with cesarean. The overall maternal satisfaction level with cesarean section delivery care service was found to be low as per the national standards. Maternal satisfaction with cesarean section delivery care services was significantly associated with current pregnancy planned, antenatal care follow-up, time spent waiting for health professionals, and gender of healthcare provider. Thus, hospital administrators should focus on the cesarean section delivery service quality improvement area, and the care should be client-centered.

PMID:37226839 | DOI:10.1177/00469580231174326

Psychol Med. 2023 May 25:1-11. doi: 10.1017/S0033291723001186. Online ahead of print.

ABSTRACT

BACKGROUND: Hospital-based biobanks are being increasingly considered as a resource for translating polygenic risk scores (PRS) into clinical practice. However, since these biobanks originate from patient populations, there is a possibility of bias in polygenic risk estimation due to overrepresentation of patients with higher frequency of healthcare interactions.

METHODS: PRS for schizophrenia, bipolar disorder, and depression were calculated using summary statistics from the largest available genomic studies for a sample of 24 153 European ancestry participants in the Mass General Brigham (MGB) Biobank. To correct for selection bias, we fitted logistic regression models with inverse probability (IP) weights, which were estimated using 1839 sociodemographic, clinical, and healthcare utilization features extracted from electronic health records of 1 546 440 non-Hispanic White patients eligible to participate in the Biobank study at their first visit to the MGB-affiliated hospitals.

RESULTS: Case prevalence of bipolar disorder among participants in the top decile of bipolar disorder PRS was 10.0% (95% CI 8.8-11.2%) in the unweighted analysis but only 6.2% (5.0-7.5%) when selection bias was accounted for using IP weights. Similarly, case prevalence of depression among those in the top decile of depression PRS was reduced from 33.5% (31.7-35.4%) to 28.9% (25.8-31.9%) after IP weighting.

CONCLUSIONS: Non-random selection of participants into volunteer biobanks may induce clinically relevant selection bias that could impact implementation of PRS in research and clinical settings. As efforts to integrate PRS in medical practice expand, recognition and mitigation of these biases should be considered and may need to be optimized in a context-specific manner.

PMID:37226828 | DOI:10.1017/S0033291723001186