Category: Nevin Manimala

PLoS One. 2021 Jul 16;16(7):e0254369. doi: 10.1371/journal.pone.0254369. eCollection 2021.

ABSTRACT

BACKGROUND: Dengue has emerged as a major public health problem in Bhutan, with increasing incidence and widening geographic spread over recent years. This study aimed to investigate the knowledge and clinical management of dengue among medical practitioners in Bhutan.

METHODS: We administered a survey questionnaire to all practitioners currently registered under the Bhutan Medical and Health Council. The questionnaire contained items on four domains including transmission, clinical course and presentation, diagnosis and management, and surveillance and prevention of dengue. Participants were able to respond using an online Qualtrics survey, with the invitation and link distributed via email.

RESULTS: A total of 97 respondents were included in the study (response rate: 12.7%), of which 61.86% were Health Assistants/Clinical Officers (HAs/COs) and 38.14% were medical doctors. The afternoon feeding behaviour of Aedes mosquito was correctly identified by only 24.7% of the respondents, and ~66.0% of them failed to identify lethargy as a warning sign for severe dengue. Knowledge on diagnosis using NS1 antigen and the clinical significance of elevated haematocrit for initial fluid replacement was strikingly low at 47.4% and 27.8% respectively. Despite dengue being a nationally notifiable disease, ~60% of respondents were not knowledgeable on the timing and type of cases to be reported. Respondent’s median score was higher for the surveillance and reporting domain, followed by their knowledge on transmission of dengue. Statistically significant factors associated with higher knowledge included respondents being a medical doctor, working in a hospital and experience of having diagnosed dengue.

CONCLUSION: The study revealed major gaps on knowledge and clinical management practices related to dengue in Bhutan. Physicians and health workers working in Basic Health Units need training and regular supervision to improve their knowledge on the care of dengue patients.

PMID:34270594 | DOI:10.1371/journal.pone.0254369

Gac Med Mex. 2021;157(2):167-173. doi: 10.24875/GMM.M21000541.

ABSTRACT

INTRODUCTION: Promoting breast cancer (BC) detection in women by means of mammography is a viable strategy to reduce the number of diagnoses at clinically advanced stages and mortality.

OBJECTIVES: To describe the results reported by mammography studies in women, carried out nationally during 2013-2017, and to analyze the spatiotemporal trend of Breast Imaging Reporting and Data System (BIRADS) categories suggestive of malignancy by State.

METHOD: Longitudinal, analytical design that included information on mammography studies of women according to age group (< 40 and ≥ 40), evaluated in units of the Ministry of Health of Mexico during 2013-2017. The frequency of BIRADS categories and a standardized rate suggestive of malignancy (categories 4 and 5) were estimated in women aged ≥ 40 years, and spatial statistics were used to analyze the trend by State.

RESULTS: A total of 3,659,151 mammograms were analyzed, 98.5 % in women aged ≥ 40 years. The malignancy-suggestive rate decreased from 38.3 (2013) to 31 (2017) per 100,000 women aged ≥ 40 years; however, the risk of detection increased up to 13 times in ten States.

CONCLUSIONS: Although the risk of detection in categories suggestive of malignancy decreased at the national level, some States need to reinforce the application of BC detection programs through mammography and increase the participation of the target population.

PMID:34270528 | DOI:10.24875/GMM.M21000541

Gac Med Mex. 2021;157(2):127-132. doi: 10.24875/GMM.M21000537.

ABSTRACT

BACKGROUND: The literature refers that falls are of multifactorial origin, and some authors have proposed to classify risk factors as intrinsic and extrinsic.

OBJECTIVE: To estimate the risk of falls and their association with some intrinsic and extrinsic factors in older adults who receive medical care at the Mexican Institute of Social Security.

METHODS: Case-control study that included individuals of both genders aged ≥ 60 years. Cases were patients who were admitted to the emergency department of a secondary care hospital diagnosed with injury or fracture secondary to a fall; the controls were patients who attended family medicine units. Descriptive, bivariate and multivariate statistical analysis was carried out. The SPSS program, version 22.0, was used.

RESULTS: Three-hundred and forty-two patients were included (171 cases and 171 controls). Mean age was 76.1 ± 8.8 years, 66 % were women and 97.1 % had self-reported chronic diseases. Differences were observed in body mass index, in the proportion of cases with cognitive impairment, use of walking devices and dependence to perform basic and instrumental activities of daily living. Adjusted multivariate analysis revealed an association between the fall event and cognitive impairment and dependence to perform instrumental activities of daily living.

CONCLUSIONS: Cognitive impairment and dependence to perform instrumental activities of daily living were associated with the risk of falling.

PMID:34270533 | DOI:10.24875/GMM.M21000537

PLoS One. 2021 Jul 16;16(7):e0254443. doi: 10.1371/journal.pone.0254443. eCollection 2021.

ABSTRACT

INTRODUCTION: Regulations of the sale of tobacco products to minors have been effective at reducing adolescent tobacco use overall. However, these efforts may not be uniformly enforced in all areas, creating uneven protection against adolescent smoking. Knowledge regarding factors associated with tobacco retail outlet (TRO) violations could help inform better enforcement strategies.

METHODS: In this study, we used Bayesian index regression models to determine if tobacco sales to minors violations across Virginia (2012-2021) were related to store characteristics and neighborhood deprivation and identify geographic areas at significantly elevated risk for violations after adjusting for these factors.

RESULTS: Results show that there were multiple factors associated with a higher likelihood of tobacco sales violations. Store type was an important factor, as grocery stores and pharmacies had significantly lowered likelihood of violations compared with convenience stores. Being located near another TRO was significantly associated with increased risk of sales to a minor. Neighborhood deprivation was also positively associated with TRO sales violations. Further, there were statistically higher likelihood of sales violations occurring in specific areas (e.g., southwest and southeast) of the state that were not explained by neighborhood deprivation and store attributes.

CONCLUSIONS: Together, results highlight the need to better understand where and why TRO sales violations are occurring in order to improve efforts aimed at monitoring and remediating TRO sales violations.

PMID:34270555 | DOI:10.1371/journal.pone.0254443

J Comput Assist Tomogr. 2021 Jul 13. doi: 10.1097/RCT.0000000000001189. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the feasibility of quantitative intravoxel incoherent motion (IVIM) and diffusion kurtosis imaging (DKI) analyses in the upper abdominal organs by simultaneous multislice diffusion-weighted imaging (SMS-DWI).

SUBJECTS AND METHODS: In this prospective study, a total of 32 participants underwent conventional DWI (C-DWI) and SMS-DWI sequences with acceleration factors of 2 and 3 (SMS2-DWI and SMS3-DWI, respectively) in the upper abdomen with multiple b-values (0, 10, 20, 50, 80, 100, 150, 200, 500, 800, 1000, 1500, and 2000 seconds/mm2) on a 3 T system (MAGNETOM Prisma; Siemens Healthcare, Erlangen, Germany). Image quality and quantitatively measurements of apparent diffusion coefficient (ADC), true diffusion coefficient (D), pseudodiffusion coefficient (D*), perfusion fraction (f), mean kurtosis (MK), and mean apparent diffusivity (MD) for the liver, pancreas, kidney cortex and medulla, spleen, and erector spine muscle were compared between the 3 sequences.

RESULTS: The acquisition times for C-DWI, SMS2-DWI, and SMS3-DWI were 10 minutes 57 seconds, 5 minutes 9 seconds, and 3 minutes 54 seconds. For image quality parameters, C-DWI and SMS2-DWI yielded better results than SMS3-DWI (P < 0.05). SMS2-DWI had equivalent IVIM and DKI parameters compared with that of C-DWI (P > 0.05). No statistically significant differences in the ADC, D, f, and MD values between the 3 sequences (P > 0.05) were observed. The D* and MK values of the liver (P = 0.005 and P = 0.012) and pancreas (P = 0.019) between SMS3-DWI and C-DWI were significantly different.

CONCLUSIONS: SMS2-DWI can substantially reduce the scan time while maintaining equivalent IVIM and DKI parameters in the abdominal organs compared with C-DWI.

PMID:34270482 | DOI:10.1097/RCT.0000000000001189

J Adhes Dent. 2021 Jul 23;23(4):357-365. doi: 10.3290/j.jad.b1645379.

ABSTRACT

PURPOSE: This study evaluated whether active application of self-etching adhesives would influence their microtensile bond strength (µTBS) to dentin cut with burs of different grit sizes.

MATERIALS AND METHODS: Eighty-four human premolars were divided into 12 groups according to 1) two dentin surface preparations with either superfine- or regular-grit diamond burs; 2) three adhesives – Clearfil SE Bond 2 (SE2), Scotchbond Universal (SBU, 3M Oral Care) and G-Premio Bond (GPB, GC); and 3) two application modes of each adhesive (active or passive). Six bonded teeth per group were sectioned into sticks for µTBS testing. Statistical analyses were performed using 3-way ANOVA followed by Duncan’s test (p < 0.05). Additional teeth were prepared to observe the interaction between the dentin smear layer obtained from each bur with adhesives under different application modes using transmission electron microscopy (TEM).

RESULTS: Active application significantly increased the dentin bond strength of SE2, irrespective of the kind of bur used (p < 0.05). The highest bond strength of SBU was observed when bonded to superfine-grit diamond bur-cut dentin with the active application. There was, however, no influence of the tested factors on GPB group (p > 0.05). TEM observation showed that active application promoted dentin smear layer dissolution in all adhesive groups.

CONCLUSIONS: Bond strengths of self-etching adhesives to dentin are influenced by bur-cut smear layers and mainly by application mode of adhesive materials. Active application improves µTBS of self-etching adhesives by enhancing smear layer modification and resin penetration into bur-cut dentin.

PMID:34269546 | DOI:10.3290/j.jad.b1645379

J Adhes Dent. 2021 Jul 23;23(4):319-326. doi: 10.3290/j.jad.b1367933.

ABSTRACT

PURPOSE: To compare the effect of different methods of cleaning residual composite cement from the surface of lithium-disilicate glass-ceramic on its bond strength.

MATERIALS AND METHODS: Blocks of lithium-silicate glass-ceramic (e.max CAD) were coated with composite cement. Blocks in a positive control (CO+) group received no cement; negative controls (CO-) received composite cement. After water storage (24 h), specimens were cleaned as follows (n = 20/group): BUR: grinding with a fine-grit diamond bur (20 s); ALUM: air abrasion with 50-µm alumina (10 s); GLASS: air abrasion with 50-µm glass beads (10 s); FURN: firing in ceramic furnace and cleaning with ethanol; SULF: immersion in sulfonic acid solution (1 h); HYFL: no additional treatment. All specimens were etched with hydrofluoric acid, aside from the CO- group, and treated with silane. A 1.5-mm diameter cement-filled tube was affixed to the specimens and light polymerized. Specimens were stored in 37°C water for 24 h (n = 10) or 90 days (n = 10). Shear bond strength was tested. Two-way ANOVA and post-hoc Tukey tests were performed. Specimens from each group were examined with SEM.

RESULTS: Bond strength significantly differed according to surface cleaning method (p < 0.01) and storage time (p < 0.01), but their interaction was not significant (p = 0.264). Longer storage time decreased the bond strength. BUR, ALUM, GLASS, and FURN did not differ statistically significantly from CO+, but were significantly greater than CO-. SULF and HYFL did not differ statistically significantly from CO- and were significantly lower than CO+.

CONCLUSIONS: Cleaning composite cement with BUR, ALUM, GLASS, and FURN restored bond strengths to that of the positive control. However, only GLASS and FURN did not roughen the surface of the underlying lithium-silicate glass-ceramic.

PMID:34269542 | DOI:10.3290/j.jad.b1367933

J Adhes Dent. 2021 Jul 23;23(4):335-345. doi: 10.3290/j.jad.b1650153.

ABSTRACT

PURPOSE: The pretreatment of glass-ceramic before adhesive cementation can be performed with hydrofluoric acid (HF)/silanization (S) or with an ammonium polyfluoride-containing primer (APF). It can be modified by application of a silane-containing universal adhesive (UA) and/or additional silanization. The aim of this study was to evaluate the bond strength of composite cements to two different glass ceramics after different pretreatments and aging.

MATERIALS AND METHODS: Disks of leucite-reinforced glass-ceramic or lithium-disilicate glass-ceramic were pretreated with HF+S, HF+UA, HF+S+UA, APF, or APF+S, bonded in pairs with composite cement and sectioned into microsticks (n = 96/group). The microtensile bond strength was determined either after 24 h (n = 48) or after aging for 6 months in water (n = 48). Fracture patterns were analyzed at 50X magnification. Statistical evaluation was performed using the Kruskal-Wallis test, pairwise comparisons with Bonferroni’s correction, and the chi-squared test (p < 0.05).

RESULTS: Pretreatment with HF+UA or APF led to significantly lower bond strength compared to HF+S. Additional silanization after application of UA or APF resulted in a significant increase in bond strength. After aging, HF+UA groups showed significantly lower bond strengths, independent of additive silanization. Aging did not affect APF-pretreated leucite-reinforced glass-ceramic; for lithium-disilicate glass-ceramic, the bond strength dropped significantly. Additional silanization improved aging resistance for the respective groups.

CONCLUSION: Bond strength and its long-term stability depend on the ceramic used and on the pretreatment. An ammonium polyfluoride-containing primer seems to be a promising option compared to conventional pretreatment with hydrofluoric acid. Additive silanization improves the long-term stability of the microtensile bond strength.

PMID:34269544 | DOI:10.3290/j.jad.b1650153

Korean J Radiol. 2021 Jul 14. doi: 10.3348/kjr.2020.1462. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the diagnostic yield of diffusion-weighted imaging (DWI) in patients with transient global amnesia (TGA) and identify significant parameters affecting diagnostic yield.

MATERIALS AND METHODS: A systematic literature search of the MEDLINE and EMBASE databases was conducted to identify studies that assessed the diagnostic yield of DWI in patients with TGA. The pooled diagnostic yield of DWI in patients with TGA was calculated using the DerSimonian-Laird random-effects model. Subgroup analyses were also performed of slice thickness, magnetic field strength, and interval between symptom onset and DWI.

RESULTS: Twenty-two original articles (1732 patients) were included. The pooled incidence of right, left, and bilateral hippocampal lesions was 37% (95% confidence interval [CI], 30-44%), 42% (95% CI, 39-46%), and 25% (95% CI, 20-30%) of all lesions, respectively. The pooled diagnostic yield of DWI in patients with TGA was 39% (95% CI, 27-52%). The Higgins I² statistic showed significant heterogeneity (I² = 95%). DWI with a slice thickness ≤ 3 mm showed a higher diagnostic yield than DWI with a slice thickness > 3 mm (pooled diagnostic yield: 63% [95% CI, 53-72%] vs. 26% [95% CI, 16-40%], p < 0.01). DWI performed at an interval between 24 and 96 hours after symptom onset showed a higher diagnostic yield (68% [95% CI, 57-78%], p < 0.01) than DWI performed within 24 hours (16% [95% CI, 7-34%]) or later than 96 hours (15% [95% CI, 8-26%]). There was no difference in the diagnostic yield between DWI performed using 3T vs. 1.5T (pooled diagnostic yield, 31% [95% CI, 25-38%] vs. 24% [95% CI, 14-37%], p = 0.31).

CONCLUSION: The pooled diagnostic yield of DWI in TGA patients was 39%. DWI obtained with a slice thickness ≤ 3 mm or an interval between symptom onset and DWI of > 24 to 96 hours could increase the diagnostic yield.

PMID:34269537 | DOI:10.3348/kjr.2020.1462

J Adhes Dent. 2021 Jul 23;23(4):309-318. doi: 10.3290/j.jad.b1650013.

ABSTRACT

PURPOSE: Thanks to adhesive techniques and strengthened glass ceramics, ultrathin bonded occlusal veneers have been recently introduced. However, since a universally accepted thickness limit for ultrathin ceramics has yet to be established, their resistance to fracture needs to be better investigated. The purpose of this in vitro study was to evaluate the effect of dentin bonding on the flexural properties (ie, fracture load and flexural strength) of a lithium-disilicate (LD) glass ceramic when used in thicknesses equal to or less than the manufacturer’s recommendations for occlusal restorations.

MATERIALS AND METHODS: A total of 96 dentin slices (2.0 mm thick and 15 mm long) were obtained by sectioning bovine teeth along their long axes. LD slices of different thicknesses (1.5 mm/1.3 mm/1.0 mm/0.8 mm/0.6 mm) and 15 mm in length were cut from CAD/CAM LD blocks (IPS e.max CAD-C16). In each of 5 experimental groups, 16 dentin slices were adhesively luted to 16 LD slices (n = 16) of the same thickness, in order to create 16 bi-layered dentin-LD bonded assemblies. In the control group, the 16 remaining dentin slices were conventionally cemented to 1.5-mm-thick LD slices (n = 16) using a resin-modified glass-ionomer cement (FujiCEM 2). All dentin-LD assemblies were cut perpendicularly to their joint interface, in order to obtain 1-mm-wide, 15-mm-long bi-layered prismatic beams, having the following final thicknesses: for the 5 experimental groups, 2 mm (dentin layer) + 1.5 mm/ 1.3 mm/1.0 mm/0.8 mm/0.6 mm (LD layer); for the control group, 2 mm (dentin layer) + 1.5 mm (LD layer). All prismatic beams were subjected to a three-point bending test (14-mm span, load applied on the LD side). Fracture loads (N) and flexural strengths (MPa) were recorded. Data were analyzed using one-way ANOVA on ranks tests (α = 0.05). The correlations between the recorded flexural strengths and the dentin:LD thickness ratio and between the flexural strength and the luting strategy were also investigated. The failure modes were observed and classified.

RESULTS: No statistically significant differences were recorded between the conventionally luted control group (LD thickness 1.5 mm; fracture load 35.26 N; flexural strength 60.44 MPa) and the thinnest adhesively luted experimental group (LD thickness 0.6 mm; fracture load 28.97 N; flexural strength 90.01 MPa) in terms of fracture load and flexural strength. A fracture involving both the dentin and the LD of the bi-layered prismatic beam, but without any debonding between the LD and the dentin substrates of the broken specimen, was the most common failure mode observed on the adhesively luted samples.

CONCLUSION: Compared to conventional cementation, when LD is bonded to dentin, the flexural properties of the whole system are improved, and the two different substrates seem to behave like a single unit. Once adhesively luted, 0.6-mm-thick LD has the same fracture load and flexural strength as that of the conventionally luted 1.5-mm-thick LD.

PMID:34269541 | DOI:10.3290/j.jad.b1650013