Category: Nevin Manimala

Turk Kardiyol Dern Ars. 2023 Jun;51(4):241-249. doi: 10.5543/tkda.2023.62296.

ABSTRACT

OBJECTIVE: This study sought to assess the prevalence and identify factors associated with depression among patients with cardiovascular diseases and followed-up in a public teaching hospital.

METHODS: A cross-sectional study was conducted with a systematic random sample of 302 out-patients with cardiovascular diseases and followed-up in the cardiology outpatient department at Tripoli University Hospital. Stable adults (>18 years of age) were eligible to be included in this study. Face-to-face interviews were conducted to complete a questionnaire comprising questions on demographic, medical, and lifestyle issues besides the Patient Health Questionnaire-9 tool. Statistical Package for the Social Sciences, Version 22, was used to analyze the data.

RESULTS: Age ranged between 29 and 84 years with a mean age of 60.6 ± 10.4 years; 60.6% were females and 75.8% were married. The highest prevalent morbidity was hypertension (76.2%) followed by diabetes mellitus (48%), ischemic heart disease (39%), and different types of arrhythmias (22.8%). About 59.3% of screened patients had different degrees of depression from mild to severe. The participants with a positive history of psychological problems, those complicated with cardiomyopathy, those who were females, patients with a history of cerebrovascular accident, and patients who were living alone were more likely to be depressed.

CONCLUSION: Prevalence of depression is found to be higher among patients with cardiovascular diseases and a family history of psychological illnesses, and cardiomyopathy had the highest contribution as independent predictor for depression. Screening of all patients with cardiovas-cular diseases is essential to identify and treat the patients at greater risk of depression.

PMID:37272156 | DOI:10.5543/tkda.2023.62296

J Contemp Dent Pract. 2023 Feb 1;24(2):107-112. doi: 10.5005/jp-journals-10024-3431.

ABSTRACT

AIM: The aim of the present study was to evaluate labiopalatal angulation of maxillary anterior teeth using Custom-made jig, Profile projector, and ImageJ computer software methods.

MATERIALS AND METHODS: The subjects for this study were selected in the age-group of 20-30 years having permanent dentition, including 2nd molars and bilateral Angle’s class 1 molar and canine relationship. Recording the labiopalatal angulation in proximal view was carried out by using one manual method and two digital methods namely using Custom-made jig, Profile projector, and ImageJ computer software, respectively. Alginate impressions were made for the subjects, and the spatial relationship of the maxilla to the cranium was recorded using a facebow. The casts were mounted in a semi-adjustable articulator, and the articulated mounted casts with the mounting ring were transferred to the Custom-made jig, and angulations were measured in proximal view. Digital methods of measurement were recorded by using Profile projector and ImageJ computer software methods. Data were tabulated and statistically analyzed.

RESULTS: In males, the mean labiopalatal angulation of maxillary right and left maxillary canines of Custom-made jig was 91.94 ± 1.47 and 91.70 ± 1.68, in Profile projector method 87.41 ± 3.75 and 87.58 ± 3.79, and in ImageJ computer software 84.23 ± 5.72 and 83.29 ± 6.74, respectively. In females, Custom-made jig was 91.82 ± 1.55 and 92.17 ± 1.84, in Profile projector method 86.70 ± 5.58 and 86.94 ± 5.57, and in ImageJ computer software 82.76 ± 6.34 and 83.05 ± 6.12, respectively. There was a very high statistically significant difference found between different methods.

CONCLUSION: In conclusion, the values obtained in the digital methods (i.e., both the Profile projector and ImageJ computer software) were more accurate than the manual method. However, the ImageJ computer software was most reliable in comparison with the values obtained in Profile projector.

CLINICAL SIGNIFICANCE: The labiopalatal angulation of anterior teeth will act as a guideline in re-establishing the correct angulations and the anatomic contours of the maxillary arch to achieve the desired esthetics that provide adequate lip support and to restore the required functions.

PMID:37272142 | DOI:10.5005/jp-journals-10024-3431

J Contemp Dent Pract. 2023 Feb 1;24(2):103-106. doi: 10.5005/jp-journals-10024-3462.

ABSTRACT

AIM: The aim of this study was to assess, in vitro, the human pulp dissolution capacity of 500 ppm and 200 ppm of hypochlorous acid in comparison with 5.2% sodium hypochlorite (NaOCl).

MATERIALS AND METHODS: Forty pulp tissue samples were standardized to a weight of 9 mg and divided into four groups according to the irrigating solution used: 5.25% NaOCl, 500 ppm hypochlorous acid, 200 ppm hypochlorous acid, and distilled water. Eppendorf tubes carrying 2 mL of the irrigants were taken and the pulp tissue samples were placed in the tubes for the specified time interval: Subgroup A: 30 minutes and subgroup B: 60 minutes. After the designated time interval, the solution from each sample tube was filtered using Whatman filter paper and left for drying overnight. The residual weight was calculated by filtration method. The mean dissolution time for each experimental group at the different time intervals was statistically analyzed.

RESULTS: Mean tissue dissolution increases with an increase in the time period. Approximately 5.25% NaOCl was most effective at both time intervals followed by 500-ppm hypochlorous acid at 60 minutes. Least amount of tissue dissolution was shown by 200-ppm of hypochlorous acid at 30 minutes. Distilled water did not show the ability to dissolve human pulp tissue.

CONCLUSION: Within the limitations of the study, 5.25% NaOCl dissolved the pulp tissue most efficiently at both time intervals and both concentrations. Human pulp tissue dissolution by hypochlorous acid was found to gradually increase with time and with an increase in its concentration.

CLINICAL SIGNIFICANCE: With the basic information that hypochlorous acid does have the capacity to dissolve human pulp tissue, further research can be undertaken to assess methods to increase its efficiency. Sooner than later, hypochlorous acid may be able to completely replace the toxic NaOCl in clinical practice, as the irrigant of choice during root canal therapy.

PMID:37272141 | DOI:10.5005/jp-journals-10024-3462

Dent Mater J. 2023 Jun 3. doi: 10.4012/dmj.2022-230. Online ahead of print.

ABSTRACT

The purpose of the present study is to evaluate the fracture resistance and the fit of CAD-CAM produced inlay-retained fixed partial dentures. Eighteen experimental groups were generated according to different CAD-CAM ceramic materials (zirconia, lithium disilicate, and zirconia-reinforced lithium silicate), different connector dimensions (12, 14, and 16 mm²), and application of thermomechanical-aging (1,200,000 cycles of cyclic loading with simultaneous thermal cycling). Gap values of thermomechanically-aged groups were measured by using periapical radiographs. Then, the specimens were tested for fracture resistance and failure types were examined. The results were statistically analyzed (α=0.05). Higher gap values were observed after aging. Zirconia showed the highest fracture resistance values among the most of the experimental groups. In non-aged groups, the most frequent failure type was decementation in zirconia group. In the aged groups, the most frequent failure type was molar connector fracture. Thermomechanical-aging increased the gap values and decreased the fracture resistance values.

PMID:37271542 | DOI:10.4012/dmj.2022-230

J Pediatr. 2023 Jun 2:113535. doi: 10.1016/j.jpeds.2023.113535. Online ahead of print.

ABSTRACT

OBJECTIVE: To identify prenatal and postnatal risk factors associated with surfactant redosing.

STUDY DESIGN: Retrospective, single-regional center study including all infants born from 24+0 to 31+6 weeks of gestation in the Marche Region, Italy, and admitted to a single level III regional NICU from January 1, 2004, to February 28, 2021. Clinical factors associated with surfactant redosing were identified through logistic regression analysis.

RESULTS: Of 1615 consecutive admissions, 662 infants were treated with exogenous surfactant: 462 (70%) received a single dose and 200 (30%) received more than one dose (25.5% two doses and 4.5% three doses). Risk of redosing was higher for infants born to mothers with hypertension in pregnancy (OR 3.95, p<0.001), for small for gestational age infants (OR 3.93, p<0.001) and when the first surfactant dose was 100mg/kg instead of 200mg/kg (OR 4.56/4.61, p<0.001). Infants with greater gestational age, delayed first surfactant administration, and milder respiratory distress syndrome had reduced risk of redosing. Infants who required multiple surfactant doses had a higher rate of bronchopulmonary dysplasia and mortality, as well as longer duration of respiratory support than patients that received one dose.

CONCLUSION: Hypertension in pregnancy and small-for-gestational age status were found to be statistically and clinically significant predictors of surfactant redosing. Understanding the pathophysiology of these conditions requires further investigation.

PMID:37271494 | DOI:10.1016/j.jpeds.2023.113535

Ann Hepatol. 2023 Jun 2:101120. doi: 10.1016/j.aohep.2023.101120. Online ahead of print.

ABSTRACT

INTRODUCTION AND OBJECTIVES: Various studies have identified single-nucleotide polymorphisms (SNPs) associated with nonalcoholic fatty liver disease (NAFLD) and related traits, including ones located in or near the LYPLAL1, GCKR, PPP1R3B, TM6SF2, MBOAT7, and PNPLA3 genes. However, these SNPs were identified primarily in populations of European ancestry. This study examined the associations of these previously identified SNPs with hepatic steatosis in a sample of Mexican-origin adults living in Southern Arizona.

MATERIALS AND METHODS: A total of 307 Mexican-origin adults between the ages of 18 and 64 with a body mass index (BMI) of 25 kg/m2 or higher were genotyped at the following SNPs: rs12137855 (LYPLAL1), rs1260326 (GCKR), rs4240624 (PPP1R3B), rs58542926 (TM6SF2), rs641738 (MBOAT7), and rs738409 (PNPLA3). Hepatic steatosis was assessed by transient elastography (FibroScan®) with controlled attenuation parameter. Regression models examined the association between each of the six SNPs and hepatic steatosis. BMI was examined as a potential modifier of the genetic associations.

RESULTS: Participants were, on average, 45 years old and mostly female (63%) with an overall mean hepatic steatosis of 288.1 dB/m. Models showed no associations between LYPLAL1, GCKR, PPP1R3B, TM6SF2, or MBOAT7 and hepatic steatosis. Only PNPLA3 was statistically significantly associated with hepatic steatosis in both unadjusted and adjusted models (p<0.01). There was no effect modification observed with BMI.

CONCLUSIONS: SNPs associated with NAFLD in populations of European descent did not strongly contribute to hepatic steatosis in individuals of Mexican-origin, except for rs738409 (PNPLA3). Further efforts are necessary to explore additional SNPs that may be associated with NAFLD in this high-risk population.

PMID:37271481 | DOI:10.1016/j.aohep.2023.101120

J Vasc Surg Venous Lymphat Disord. 2023 Jun 2:S2213-333X(23)00228-7. doi: 10.1016/j.jvsv.2023.05.016. Online ahead of print.

ABSTRACT

OBJECTIVE: We aimed to evaluate the impact of a multidisciplinary pulmonary embolism response team on the management and outcomes of patients with acute pulmonary embolism.

METHODS: We retrospectively reviewed all patients presenting to our institution with a diagnosis of PE from July 2020 to April 2022. The primary outcome measures were in-hospital mortality, major bleeding events defined by the International Society on Thrombosis and Haemostasis (ISTH), and utilization of catheter-directed interventions (CDI). Secondary outcome measures included 30-day and 12-month mortality, hospital and intensive care unit (ICU) length of stay (LOS), vasopressor requirement, and cardiac arrest. Continuous variables were assessed with the Mann-Whitney U test and categorical variables were assessed with the chi-square or Fisher’s exact test when appropriate.

RESULTS: Two hundred and seventy-nine patients with acute PE were identified with 79 (28%), 173 (62%), and 27 (10%) stratified as low-risk, intermediate-risk, and high-risk, respectively. There were 133 (47.7%) PERT activations. Saddle and main pulmonary artery embolisms (P<0.001), RV strain (P=0.001), RV dysfunction (P<0.001), co-existing deep vein thrombosis (P<0.001), and dyspnea as a presenting symptom (P=0.008) were significantly associated with PERT activation. Patients evaluated by PERT were more likely to undergo CDI (49% vs. 27%, P<0.001) across risk stratification, and less likely to have an IVC filter placed (1% vs. 5%, P=0.04). PERT consultation had numerical but non-statistically significant trends towards reduced in-hospital (2% vs. 5%, P=0.2) and 30-day mortality (2% vs. 8%, P=0.06), but similar rates of 12-month mortality (7% vs. 8%, P=0.7). PERT activation was also associated with trends towards reduced rates of major bleeding (2% vs. 7%), cardiac arrests (2% vs. 7%), and vasopressor requirement (9% vs. 18%). PERT consultation decreased median ICU days by half; however, we did not observe any difference in total hospital LOS between groups.

CONCLUSIONS: At our institution, PERT was associated with significantly higher utilization of CDIs and improved clinical outcomes including reduced mortality and major bleeding events. PERT was also associated with less ICU days, suggesting a possible economic benefit of implementing PERT teams, although further research is needed to confirm that conclusion.

PMID:37271478 | DOI:10.1016/j.jvsv.2023.05.016

Ann Thorac Surg. 2023 Jun 2:S0003-4975(23)00575-1. doi: 10.1016/j.athoracsur.2023.04.049. Online ahead of print.

ABSTRACT

BACKGROUND: Postoperative acute kidney injury (AKI) in cardiac surgery patients is multifactorial and associated with low oxygen delivery (DO₂) during cardiopulmonary bypass.

METHODS: Cardiac surgical patients undergoing full cardiopulmonary bypass between 5/1/2016-12/31/2021 were included, while those on preoperative dialysis, underdoing circulatory arrest procedures, or lacking minute-to-minute physiological data were excluded. A 5-minute running average of oxygen delivery (DO₂i, ml/min/m²) was calculated ([pump flow]x[hemoglobin]x1.36[hemoglobin saturation]+0.003[arterial oxygen tension]/body surface area). AKI was defined using established Kidney Disease: Improving Global Outcomes criteria. The threshold of nadir DO₂i on the effect of AKI was estimated using risk-adjusted constrained broken-stick models.

RESULTS: Postoperative AKI occurred among 1,155 (29.4%) patients, with 276 (7.0%) having Stage 2-3 AKI. The median nadir DO₂i was lower for those with (versus without) AKI (197.9 ml/min/m² [166.3-233.2] versus 217.2 [184.5-252.2], p < .001) and Stage 2-3 AKI relative to Stage 1 or none (186.9 ml/min/m² [160.1-220.5] versus 213.8 [180.4-249.4]). In risk-adjusted analyses, the estimated threshold (CI 95%) for nadir DO₂i was 231.2 ml/min/m² (173.6-288.8) for any AKI and 103.3 (68.4-138.3) for Stage 2-3 AKI.

CONCLUSIONS: Decreasing nadir DO₂i was associated with an increased risk of AKI. The identified nadir DO₂i thresholds suggest management and treatment of nadir DO₂i during cardiopulmonary bypass may decrease a patient’s postoperative AKI risk.

PMID:37271444 | DOI:10.1016/j.athoracsur.2023.04.049

Am J Obstet Gynecol. 2023 Jun 2:S0002-9378(23)00369-1. doi: 10.1016/j.ajog.2023.05.031. Online ahead of print.

ABSTRACT

BACKGROUND: In 2020, the American College of Obstetricians and Gynecologists recommended non-invasive prenatal testing be offered to all patients. However, current society guidelines in the United States do not universally recommend a detailed first-trimester ultrasound.

OBJECTIVE: This study aimed to determine the additional findings identified through first-trimester ultrasound that would have otherwise been missed if non-invasive prenatal testing was used alone as a first trimester screening method.

STUDY DESIGN: This was a retrospective cohort study involving 2,158 pregnant patients, 2,216 fetuses that were seen at a single medical center between January 1, 2020 and December 31, 2022. All those included underwent both non-invasive prenatal testing and detailed first-trimester ultrasound between 11.0 – 13.6 weeks gestation. Non-invasive prenatal testing results were categorized as low-risk or high-risk and first-trimester ultrasound results were categorized as normal or abnormal. Abnormal first-trimester ultrasounds were further classified as first trimester screening markers (increased nuchal translucency, absent nasal bone, tricuspid regurgitation, ductus venosus reverse a-wave) or structural defects (cranium, neck, heart, thorax, abdominal wall, stomach, kidneys, bladder, spine, extremities). Descriptive statistics were used to report our findings.

RESULTS: Sixty-five (65/2216, 3%) fetuses had a high-risk non-invasive prenatal testing result, while 2,151 (2151/2216, 97%) fetuses had a low-risk non-invasive prenatal testing result. Of those with a low-risk non-invasive prenatal testing result, 2,035 (2035/2151, 94.6%) had a normal first-trimester ultrasound while 116 (116/2151, 5.4%) had at least 1 abnormal finding on first-trimester ultrasound. The most common screening marker detected within the low-risk non-invasive prenatal testing group was absent nasal bone (52/2151, 2.4%), followed by reversed a-wave of the ductus venosus (30/2151, 1.4%). The most common structural defect in this group was cardiac in nature (15/2151, 0.7%). Overall, 181 fetuses were identified as having “abnormal screening” through either a high-risk non-invasive prenatal testing result (n = 65) or through a low-risk non-invasive prenatal testing result but abnormal first-trimester ultrasound (n = 116). In summary, the incorporation of first-trimester ultrasound screening identified 116 additional fetuses (116/2151, 5.4%) that required further follow-up and surveillance than non-invasive prenatal testing alone would have identified.

CONCLUSION: Detailed first-trimester ultrasound identified more fetuses with a potential abnormality than non-invasive prenatal testing alone. Therefore, first-trimester ultrasound remains a valuable screening method that should be used in combination with non-invasive prenatal testing.

PMID:37271433 | DOI:10.1016/j.ajog.2023.05.031

Sci Total Environ. 2023 Jun 2:164598. doi: 10.1016/j.scitotenv.2023.164598. Online ahead of print.

ABSTRACT

Over the past decade, the Chinese government has implemented the “Clean Air Action” measures to enhance the atmospheric environmental quality, primarily focusing on curbing PM_2.5 and O₃ concentrations. The efficacy of these strategies and the underlying causes (human factors or natural variability) of any observed increases or decreases in PM_2.5 and O₃ concentrations are of great importance. Examining the hourly PM_2.5 and O₃ concentration time series from six representative regions in China between 2015 and 2021 revealed an overall downward trend in PM_2.5 concentrations. However, the O₃ concentration time series indicated upward trends in some regions, except for the Northeast area (NE) and Sichuan Basin (SCB). In the context of conventional significance tests, the assumption is typically that the time series’ samples are independent and therefore memoryless. However, in situations where the time series exhibits strong autocorrelation and limited sample size, this assumption can lead to an overestimation of the statistical significance of the linear trend. To account for this, we utilized a long-term memory model that can reproduce the long-term persistence of pollutant records to improve the accuracy of significance tests. By comparing the P-values of real and surrogate data generated by the long-term memory model, we found that only PM_2.5 concentrations in the Pearl River Delta (PRD) were slightly insignificant. For the remaining five regions, the P-values of PM_2.5 concentrations were smaller than the significant level of 0.05, suggesting that the observed downward trends in PM_2.5 concentrations are not due to natural variability, thereby confirming the effectiveness of the government’s policies aimed at curbing atmospheric particulate matter in recent years. Our results show that O₃ pollution is significantly increasing only in the Beijing-Tianjin-Hebei (BTH) region, beyond natural variability. In contrast, the trends of O₃ pollution in many regions of China are markedly impacted by natural and climate variability.

PMID:37271384 | DOI:10.1016/j.scitotenv.2023.164598