Category: Nevin Manimala

Esophagus. 2023 Mar 18. doi: 10.1007/s10388-023-00995-0. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the performance of oropharyngoesophageal scintigraphy (OPES) in the assessment of dysphagia in patients with systemic sclerosis (SSc), and to compare OPES results with those of barium esophagogram.

METHODS: Adult SSc patients who underwent OPES for the assessment of dysphagia were enrolled. OPES was performed with both liquid and semisolid boluses and provided information regarding oropharyngeal transit time, esophageal transit time (ETT), oropharyngeal retention index (OPRI), esophageal retention index (ERI), and site of bolus retention. Barium esophagogram results were also collected.

RESULTS: Fifty-seven SSc patients (87.7% female, mean age 57.7 years) with dysphagia were enrolled. OPES identified at least one alteration in each patient and findings were generally worse for the semisolid bolus. Esophageal motility was widely impaired with 89.5% of patients with an increased semisolid ERI, and middle-lower esophagus was the most frequent site of bolus retention. However, oropharyngeal impairment was highlighted by widespread increased OPRI, especially in anti-topoisomerase I positivity. Older patients and with longer disease duration presented slower semisolid ETT (p = 0.029 and p = 0.002, respectively). Eleven patients with dysphagia had a negative barium esophagogram: all of them presented some alterations in OPES parameters.

CONCLUSION: OPES revealed a marked SSc esophageal impairment, in terms of both slowed transit time and increased bolus retention, but also shed light on oropharyngeal swallowing alterations. OPES showed high sensitivity, being able to detect swallowing alterations in dysphagic patients with negative barium esophagogram. Therefore, the use of OPES for the assessment of SSc-related dysphagia in clinical practice should be promoted.

PMID:36933137 | DOI:10.1007/s10388-023-00995-0

Environ Sci Pollut Res Int. 2023 Mar 18. doi: 10.1007/s11356-023-26451-1. Online ahead of print.

ABSTRACT

Epidemiological evidence for the relationship between cadmium exposure and mortality in specific chronic kidney disease (CKD) populations remains scarce. We aimed to explore the relationships between cadmium concentrations in urine and blood and all-cause mortality among CKD patients in the USA. This cohort study was composed of 1825 CKD participants from the National Health and Nutrition Examination Survey (NHANES) (1999-2014) who were followed up to December 31, 2015. All-cause mortality was ascertained by matching the National Death Index (NDI) records. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality in relation to urinary and blood cadmium concentrations by Cox regression models. During an average follow-up period of 82 months, 576 CKD participants died. Compared with the lowest quartiles, HRs (95% CIs) for all-cause mortality associated with the fourth weighted quartiles of urinary and blood cadmium concentrations were 1.75 (1.28 to 2.39) and 1.59 (1.17 to 2.15), respectively. Furthermore, the HRs (95% CIs) for all-cause mortality per ln-transformed IQR increment in cadmium concentrations in urine (1.15 μg/g U_Cr) and blood (0.95 μg/L) were 1.40 (1.21 to 1.63) and 1.22 (1.07 to 1.40), respectively. Linear concentration-response relationships between urinary and blood cadmium concentrations and all-cause mortality were also found. Our findings suggested that increased cadmium concentrations in both urine and blood significantly contributed to enhanced mortality risk in CKD patients, thus highlighting that efforts to reduce cadmium exposure may reduce mortality risk in high-risk populations with CKD.

PMID:36933131 | DOI:10.1007/s11356-023-26451-1

Jpn J Ophthalmol. 2023 Mar 18. doi: 10.1007/s10384-023-00982-z. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the intereye correlations between and differences in the rates of visual field (VF) progression in eyes with bilateral open-angle glaucoma.

STUDY DESIGN: Retrospective, longitudinal, observational study.

METHODS: Patients with bilateral open-angle glaucoma with 8 or more reliable 30 – 2 standard automated perimetry tests over a period of more than 2 years were enrolled. The rate of change of the MD (MD slope) was used as the indicator for the rates of VF progression. Descriptive statistics of the absolute intereye difference in the MD slope values were computed. Factors associated with a large intereye difference (> 0.42 dB/year) were explored.

RESULTS: One hundred eighty-eight eyes from 94 patients (56 women) were enrolled. A significant intereye correlation of the rates of visual field progression (P = .002) was found. The mean ± standard deviation and median intereye differences of the MD slope values were 0.29 ± 0.31 and 0.18 dB/year (range: 0-1.41), respectively. The 5th, 10th, 25th, 75th, 90th, and 95th percentiles of intereye differences were 0.01, 0.02, 0.08, 0.42, 0.72, and 0.91 dB/year, respectively. Older age and slower progression were significantly associated with large intereye difference.

CONCLUSION: A significant intereye correlation in the rate of VF progression was found in eyes with bilateral open-angle glaucoma. We showed the distributions and associated factors of intereye differences in VF progression. These data may be used for improving the estimation of rates of VF progression.

PMID:36933119 | DOI:10.1007/s10384-023-00982-z

Dig Dis Sci. 2023 Mar 18. doi: 10.1007/s10620-023-07862-z. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: We conducted a systematic literature review to understand the evidence supporting treatment decisions for cholestatic pruritus associated with primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC).

METHODS: Studies that enrolled ≥ 75% participants with PBC or PSC and reported ≥ 1 endpoint(s) related to efficacy, safety, health-related quality of life (HRQoL) or other patient-reported outcomes were included. Bias was assessed using the Cochrane risk of bias tool for randomised controlled trials (RCTs) and the Quality of Cohort studies tool for non-RCTs.

RESULTS: Thirty-nine publications were identified, covering 42 studies and six treatment classes (including investigational and approved products): anion-exchange resins, antibiotics (rifampicin/derivatives), opiates, selective serotonin reuptake inhibitors, fibrates, ileal bile acid transporter inhibitors and other agents not categorised in these six classes. Across studies, median sample size was small (n = 18), 20 studies were over 20 years old, 25 followed patients for ≤ 6 weeks, only 25 were RCTs. Pruritus was assessed using several different tools, with inconsistencies in their application. Cholestyramine, considered first-line therapy for moderate-severe cholestatic pruritus, was assessed in six studies (two RCTs) including 56 patients with PBC and 2 with PSC, with evidence of efficacy demonstrated in only three studies, among which, two RCTs were assessed as having a high risk of bias. Findings were similar for other drug classes.

CONCLUSIONS: There is a lack of consistent and reproducible evidence available on efficacy, impact on HRQoL, and safety of cholestatic pruritus treatments, leaving physicians to rely on clinical experience rather than evidence-based medicine for treatment selection.

PMID:36933112 | DOI:10.1007/s10620-023-07862-z

Clin Oral Investig. 2023 Mar 18. doi: 10.1007/s00784-023-04941-3. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the thermocycling effect of 3D-printed resins on flexural strength, surface roughness, microbiological adhesion, and porosity.

MATERIALS AND METHODS: 150 bars (8 × 2 × 2 mm) and 100 blocks (8 × 8 × 2 mm) were made and divided into 5 groups, according to two factors: “material” (AR: acrylic resin, CR: composite resin, BIS: bis-acryl resin, CAD: CAD/CAM resin, and PRINT: 3D-printed resin) and “aging” (non-aged and aged – TC). Half of them were subjected to thermocycling (10,000 cycles). The bars were subjected to mini-flexural strength (σ) test (1 mm/min). All the blocks were subjected to roughness analysis (R_a/R_q/R_z). The non-aged blocks were subjected to porosity analysis (micro-CT; n = 5) and fungal adherence (n = 10). Data were statistically analyzed (one-way ANOVA, two-way ANOVA; Tukey’s test, α = 0.05).

RESULTS: For σ, “material” and “aging” factors were statistically significant (p < 0.0001). The BIS (118.23 ± 16.26^A) presented a higher σ and the PRINT group (49.87 ± 7.55^E) had the lowest mean σ. All groups showed a decrease in σ after TC, except for PRINT. The CR_TC showed the lowest Weibull modulus. The AR showed higher roughness than BIS. Porosity revealed that the AR (1.369%) and BIS (6.339%) presented the highest porosity, and the CAD (0.002%) had the lowest porosity. Cell adhesion was significantly different between the CR (6.81) and CAD (6.37).

CONCLUSION: Thermocycling reduced the flexural strength of most provisional materials, except for 3D-printed resin. However, it did not influence the surface roughness. The CR showed higher microbiological adherence than CAD group. The BIS group reached the highest porosity while the CAD group had the lowest values.

CLINICAL RELEVANCE: 3D-printed resins are promising materials for clinical applications because they have good mechanical properties and low fungal adhesion.

PMID:36933047 | DOI:10.1007/s00784-023-04941-3

Inquiry. 2023 Jan-Dec;60:469580231161428. doi: 10.1177/00469580231161428.

ABSTRACT

In this westernized culture, maintaining a healthy lifestyle has become a major health concern internationally. Health literacy is an emerging concept and requires effective measures and reform to improve the health status and health of individuals at both national and international levels, and has become one of the important determinants of individual health and healthcare service. This study aimed to assess health literacy among adults in Saudi Arabia. A cross-sectional study was conducted among a randomly selected population using a structured validated questionnaire over 4 months in 2021. The questionnaires designed for the study included 26 items divided into 5 domains assessed on a five-point Likert scale. Data were analyzed using IBM SPSS Statistics 26 (IBM Inc., Chicago, IL, USA) and IBM SPSS 26 (IBM Inc.). The mean score for reading, access to information, understanding, appraisal, and decision-making was 12.01 ± 4.37, 20.16 ± 7.17, 24.84 ± 8.37, 11.85 ± 4.90, and 36.94 ± 10.41 respectively. The mean scores of reading and understanding domains were found to have significant differences concerning gender (P < .05). Additionally, participants’ age was significantly associated with the mean score of reading and decision-making (P < .006 and P < .049). The findings reported a prevalence of inadequate HL in the population of Saudi Arabia was 54.4%, and the determinants associated with the scores of HL were age, gender, and education.

PMID:36932856 | DOI:10.1177/00469580231161428

Biometrics. 2023 Mar 18. doi: 10.1111/biom.13857. Online ahead of print.

ABSTRACT

Many popular survival models rely on restrictive parametric, or semi-parametric, assumptions that could provide erroneous predictions when the effects of covariates are complex. Modern advances in computational hardware have led to an increasing interest in flexible Bayesian nonparametric methods for time-to-event data such as Bayesian additive regression trees (BART). We propose a novel approach that we call nonparametric failure time (NFT) BART in order to increase the flexibility beyond accelerated failure time (AFT) and proportional hazard models. NFT BART has three key features: 1) a BART prior for the mean function of the event time logarithm; 2) a heteroskedastic BART prior to deduce a covariate-dependent variance function; and 3) a flexible nonparametric error distribution using Dirichlet process mixtures (DPM). Our proposed approach widens the scope of hazard shapes including non-proportional hazards, can be scaled up to large sample sizes, naturally provides estimates of uncertainty via the posterior and can be seamlessly employed for variable selection. We provide convenient, user-friendly, computer software that is freely available as a reference implementation. Simulations demonstrate that NFT BART maintains excellent performance for survival prediction especially when AFT assumptions are violated by heteroskedasticity. We illustrate the proposed approach on a study examining predictors for mortality risk in patients undergoing hematopoietic stem cell transplant (HSCT) for blood-borne cancer, where heteroskedasticity and non-proportional hazards are likely present. This article is protected by copyright. All rights reserved.

PMID:36932826 | DOI:10.1111/biom.13857

J Pak Med Assoc. 2023 Mar;73(3):723-727. doi: 10.47391/JPMA.6200.

ABSTRACT

Epilepsy is the third most common neurological disease in the world associated with a high frequency in the paediatric age group. This study aims to evaluate the prevalence, types and aetiologies of epilepsy within the Pakistani population. A retrospective review of the charts of all patients, below the age of 18 years, presenting with epilepsy to the Department of Neurology at The Children’s Hospital and Institute of Child Health, Lahore, from January 2016 to December 2020, was carried out. Analysis was performed using SPSS Version 26. A p value of <0.05 was considered statistically significant. A total of 1,097 patients were studied, of which 644 (58.8%) were males and 451 (41.2%) females. a vast majority, i.e. 1,021 (96.1%), of the study participants, belonged to the province of Punjab. Afebrile seizures [n=798 (72.7%)] were more commonly reported than febrile seizures [n=299 (27.3%)]. Among seizure types, generalised seizures were the most common type of seizure reported in 520 (49.8%) patients. Refractory seizures were the least common type reported in 3 (0.3%) patients. Aetiology was mostly idiopathic [n=540 (49.2)], followed by congenital [n=228 (20.8%)]. The most frequently reported duration of seizure was between one and three minutes [n=116 (42.3%)]. The most common ictal features seen were a combination of up-rolling of eyes and frothing from the mouth [n=206 (34.9%)]. Results from this study can be used by health care providers to better formulate therapeutic interventions for a timely diagnosis and effective treatment of epilepsy.

PMID:36932799 | DOI:10.47391/JPMA.6200

J Pak Med Assoc. 2023 Mar;73(3):635-637. doi: 10.47391/JPMA.5288.

ABSTRACT

This cross-sectional study aimed to explore the relationship between perceived social support and psychological well-being in patients with epilepsy. The study was conducted, from January to December 2019, after ethical approval from the research ethical committee of FMU (Faisalabad Medical University, Faisalabad). A sample of 90 patients, attending free epilepsy camp in Mujahid Hospital Madina Town Faisalabad and psychiatry OPD of government General hospital G.M. Abad Faisalabad, was collected by using the Multidimensional Scale of Perceived Social Support (Urdu version). Moreover, Psychological well-being was assessed by Ryff Scale. Statistical analysis was done through data Correlation and T-test SPSS version 21. A positive correlation between psychological well-being and perceived social support in epileptic patients was established (p<0.001). This study concludes that on the one hand, strong social support enhances psychological well-being, while, on the other hand, both these factors collaboratively improve the mental health of PWE, thus promoting a better outcome.

PMID:36932769 | DOI:10.47391/JPMA.5288

J Pak Med Assoc. 2023 Mar;73(3):567-571. doi: 10.47391/JPMA.5008.

ABSTRACT

OBJECTIVE: To determine the difference in the marginal accuracy at buccal, lingual, mesial and distal margins of temporary crowns fabricated with bisacryl-based temporary crown material.

METHODS: The in-vitro, experimental, laboratory-based study was conducted at the Aga Khan University, Karachi, from September to December 2019, and comprised two bisacryl-based temporary crown material, Integrity and Protemp 4, which were used to fabricate a sample of 24 temporary crowns. A pre-operative polyvinyl siloxane impression served as a template for temporary crown fabrication. A right mandibular molar tooth on a typodont was prepared to receive a crown. The provisional crown material was syringed onto the template and was allowed to cure. All four surfaces of the crown were observed under a stereomicroscope equipped with digital single-lens reflex camera at 25.6x magnification. An image of each surface was captured and a photographic record was maintained. An image processing software was used for the measurement of marginal discrepancy. Marginal accuracy among the four surfaces was assessed. Data was analysed using SPSS 23.

RESULTS: Mean marginal discrepancy for provisional crowns fabricated with Protemp 4 and Integrity was 410±222μm and 319±176μm, respectively. The marginal discrepancy between the two groups was statistically significant (p=0.027), with buccal margin exhibiting the most discrepancy (p<0.01).

CONCLUSIONS: Integrity showed less microleakage than Protemp 4. Among all the walls, the buccal wall showed the most microleakage. Marginal accuracy was found to be dependent upon the type of provisional crown material and the side of the prepared axial wall.

PMID:36932761 | DOI:10.47391/JPMA.5008