Category: Nevin Manimala

Clin Exp Dent Res. 2021 Sep 29. doi: 10.1002/cre2.470. Online ahead of print.

ABSTRACT

INTRODUCTION: In recent years, a number of clinical trials have been published comparing transcutaneous electrical nerve stimulation (TENS) and traditional speech therapy treatment of voice and swallowing functions, but results have been conflicting.

OBJECTIVE: Assess the methodological quality of studies and determine whether TENS is an efficient therapeutic strategy for speech therapy treatment of healthy adults or those with dysphonia and/or dysphagia.

METHODS: The databases used were Medical Literature Analysis and Retrieval System Online (MedLine), Biblioteca Virtual em Saúde (BVS), Cochrane Library and Web of Science (ISI Web of Knowledge). The study was conducted between May 2018 and January 2019, in line with Cochrane Handbook guidelines, and included studies on the use of TENS in healthy adults or those with compromised voice and/or swallowing function.

RESULTS: After the search and extraction of studies, the following were identified: TENS + VOICE: 7 articles; TENS + SWALLOWING: 5 articles. The studies exhibited medium quality and are heterogeneous, making it difficult to determine their effectiveness and the parameters to be used in future research. There were no statistically significant differences between the use of TENS alone or associated with another therapeutic technique for voice. For swallowing function, one study proved better results in cases of associated techniques – TENS + traditional therapy.

DISCUSSION: Speech therapy should increase the number of studies published and improve their methodological quality, reassessing methodological criteria. Current clinical practice is not grounded in evidence-based science. CLINICAL MESSAGE: the studies analyzed exhibited medium methodological quality; there are variations in the time, number and periodicity of the therapeutic sessions for TENS; there were no statistically significant differences between the use of TENS alone or associated with another therapeutic technique in voice; there were statistically significant differences between the use of TENS associated with traditional therapeutic in swallowing function.

PMID:34587375 | DOI:10.1002/cre2.470

J Long Term Eff Med Implants. 2021;31(4):5-10. doi: 10.1615/JLongTermEffMedImplants.2021036259.

ABSTRACT

The implant-abutment connection is one of the most important factors for prosthesis stability. Moreover, restorations fabricated using CAD/CAM systems are more durable, marginally adaptive, aesthetically pleasing, and faster in fabrication as compared to the conventional restorations. The objective of this study was to retrospectively evaluate the outcome of framework fit in CAD/CAM milled single implant crown restorations using radiographs. Case records of 268 patients who have undergone implant placement and restoration at the Department of Prosthodontics and Implantology in a dental school in Chennai were obtained and analyzed. Intra Oral Periapical Radiographs that were taken post cementation of the crowns were examined for horizontal and vertical misfit. To minimize the sampling bias, the study was double blinded by an analyzer and a reviewer. The study reported that 47.94% (n = 128) had vertical misfit and in 52.06% (n = 139) there was no misfit. Horizontal misfit was found in 25.4% (n = 68) of the cases and was absent in 74.5% (n = 199) of implants that were restored. There was a statistical significance between misfit and the quadrant in which the implant was placed. It was observed that horizontal misfit was high in quadrant 3 with 38.7% (n = 77), followed by quadrant 4 with 31.7% (n = 63), quadrant 2 with 16.6% (n = 33) and quadrant 1 with 13.1% (n = 26). Vertical misfit was high in quadrant 3 with 38.1% (n = 53) followed by quadrant 4 and 2 with 36% (n = 50) and 15.8% (n = 22) respectively, and quadrant 1 with 10.1% (n = 14). It can be concluded that the marginal fit of CAD/CAM milled frameworks for single implant crowns showed higher vertical misfit than horizontal misfit. Horizontal misfit and vertical misfit was evident in quadrant 3.

PMID:34587409 | DOI:10.1615/JLongTermEffMedImplants.2021036259

Nutr Clin Pract. 2021 Sep 29. doi: 10.1002/ncp.10783. Online ahead of print.

ABSTRACT

BACKGROUND: Malnutrition is a problem that greatly affects patients with hematological malignancy (HM) throughout the course of illness. Intensity of the malignancy treatment, inadequate energy intake, complex procedures such as hematopoietic stem cell transplantation, and treatment side effects are contributing factors for malnutrition in HM patients. The aim of this study was to compare the accuracy of the modified Nutrition Risk in Critically Ill (mNUTRIC) score and Nutrition Risk Screening 2002 (NRS-2002) in predicting hospital and long-term mortality of HM patients in the intensive care unit (ICU) and to identify effects of malnutrition on ICU mortality.

METHODS: This prospective observational cohort study was conducted in a university teaching hospital tertiary ICU service. During the study period, 112 HM patients who were >18 years old were admitted to the ICU. We excluded the patients who were discharged or died within 24 h from the statistical analysis. The patients were followed for 3 years after discharge for long-term mortality.

RESULTS: Twenty-nine patients died within 24 h of admission and were excluded from the study; therefore, statistical analysis was done for 81 patients. Logistic regression analysis demonstrated that high malnutrition risk, according to the NRS-2002 score, was associated with greater odds of ICU mortality (P = 0.002, odds ratio = 19.16).

CONCLUSION: In this study, we showed that NRS-2002 is superior to mNUTRIC score in predicting ICU mortality in patients with HMs. mNUTRIC score and NRS-2002 were not superior to each other in predicting long-term mortality.

PMID:34587327 | DOI:10.1002/ncp.10783

Clin Oral Implants Res. 2021 Sep 29. doi: 10.1111/clr.13864. Online ahead of print.

ABSTRACT

OBJECTIVES: This in-vitro study examined the effect of different implant drilling template designs on heat generation during osteotomy and on cooling fluid distribution.

MATERIAL AND METHODS: Five different template designs were investigated in a standardized setup against a control group and a negative control group: Occlusal-splint-design (OSD), OSD-covering, OSD-lateral opening, Bar design, and Orientation template. Pilot and one consecutive drill were run at 800 rpm with external irrigation and 2-kg load. Thermocouples recorded temperature changes at depths of 3 mm, 6 mm, and 9 mm in a bovine rib model. In the second experimental setup, the drill channel of one rib sample was perforated, and the irrigation volume passing through the drill channel was collected separately over time.

RESULTS: Following mean temperature rises occurred [in °C]: control, 4.9; negative control, 12; OSD, 5.6; OSD-covering, 4.7; OSD-lateral opening, 3.8; Bar design, 5.1; and Orientation template, 4.9. The highest temperature increases were found at a drilling depth of 6 mm (p<0.006). The 2.2-mm drill resulted in a significantly higher temperature rise than the 2.8-mm drill (p<0.001). The mean volume (ml/min) of irrigation through the drill channel was: Control group-flow, 28.5; OSD, 4.1; OSD-covering, 2; OSD-lateral opening; 5.8; bar design, 4; and Orientation template, 24.1.

CONCLUSION: Within the limitations, it was shown that fully-guided drilling templates reduce the amount of cooling liquid at the point of osteotomy. The template design had an influence on the effective volume of the cooling liquid. However, this did not seem to increase the intraosseous temperature significantly.

PMID:34587303 | DOI:10.1111/clr.13864

Clin Oral Implants Res. 2021 Sep 29. doi: 10.1111/clr.13858. Online ahead of print.

ABSTRACT

AIM: The aim of this retrospective clinical study was to compare the accuracy of static Computer-Assisted Implant Surgery (sCAIS) in posterior single edentulous patients using different surgical guide designs.

MATERIALS & METHODS: Thirty-seven partially edentulous patients with a total of 54 implants were included in the study. Seventeen implants were included in Group 1 – Unbounded Tooth-Mucosa Supported; 18 implants in Group 2 – Unbounded Tooth Supported; and 19 implants in Group 3 (Control) – Bounded Tooth Supported. All partially edentulous patients were treated with fully guided implant surgery using the corresponding surgical guide. Discrepancies between the pre-planned and post-operative implant position were evaluated.

RESULTS: The mean angular deviation ± standard deviation (SD) was 2.91 ± 1.56°, 3.33 ± 1.72° and 2.25 ± 1.13° for Groups 1, 2 and 3, respectively. The mean ± SD 3D offset at base was 0.66 ± 0.29 mm, 0.77 ± 0.24 mm and 0.49 ± 0.22 mm; and 3D offset at tip was 0.84 ± 0.45 mm, 1.07 ± 0.38 mm and 0.75 ± 0.25 mm for Groups 1, 2 and 3, respectively. No statistically significant differences between groups were found for angular deviation. There were statistically significant differences between Groups 2 and 3 for 3D offset at base (p = 0.002) and 3D offset at tip (p = 0.010).

CONCLUSIONS: Different surgical guide designs for posterior single edentulous areas appear to be associated with the accuracy level of sCAIS. In unbounded sites, having additional posterior attached soft tissue support is preferable.

PMID:34587320 | DOI:10.1111/clr.13858

Med Phys. 2021 Sep 29. doi: 10.1002/mp.15255. Online ahead of print.

ABSTRACT

PURPOSE: Radiomics, the objective study of non-visual features in clinical imaging, has been useful in informing decisions in clinical oncology. However, radiomics currently lacks the ability to characterize the overall topological structure of the data. This niche can be filled by persistent homology, a form of topological data analysis that analyzes high-level structure. We hypothesized that persistent homology features quantified using cubical complexes could be extracted from lung tumor scans and related to survival.

METHODS: We obtained segmented computed tomography (CT) lung scans (n = 565) from the NSCLC-Radiomics and NSCLC-Radiogenomics datasets in The Cancer Imaging Archive. These scans are three dimensional images whose pixel intensity corresponds to a number of Hounsfield units (HU). Cubical complexes are a topological image analysis method that effectively analyze the number of topological features in an image as the image is thresholded at different intensities. We calculated a novel output called a feature curve by plotting the number of 0 dimensional topological features counted from the cubical complex filtration against each Hounsfield value. This curve’s first moment of distribution was utilized as a summary statistic to show association with survival in a Cox proportional hazards model. We hypothesized that persistent homology features quantified using cubical complexes could be extracted from lung tumor scans and related to survival Results: After controlling for tumor image size, age, and stage, the first moment of the 0D topological feature curve was associated with poorer survival (HR = 1.118; 95% CI = 1.026-1.218; p = 0.01). The patients in our study with the lowest first moment scores had significantly better survival (1238 days; 95% CI = 936-1599) compared to the patients with the highest first moment scores (429 days; 95% CI = 326-601; p = .0015).

CONCLUSIONS: We have shown that persistent homology can generate useful clinical correlates from tumor CT scans. Our 0-dimensional topological feature curve statistic predicts survival in lung cancer patients. This novel statistic may be used in tandem with standard radiomics variables to better inform clinical oncology decisions.

PMID:34587294 | DOI:10.1002/mp.15255

Biom J. 2021 Sep 29. doi: 10.1002/bimj.202000336. Online ahead of print.

ABSTRACT

In statistical research, variable selection and feature extraction are a typical issue. Variable selection in linear models has been fully developed, while it has received relatively little attention for longitudinal data. Since a longitudinal study involves within-subject correlations, the likelihood function of discrete longitudinal responses generally cannot be expressed in analytically closed form, and standard variable selection methods cannot be directly applied. As an alternative, the penalized generalized estimating equation (PGEE) is helpful but very likely results in incorrect variable selection if the working correlation matrix is misspecified. In many circumstances, the within-subject correlations are of interest and need to be modeled together with the mean. For longitudinal binary data, it becomes more challenging because the within-subject correlation coefficients have the so-called Fréchet-Hoeffding upper bound. In this paper, we proposed smoothly clipped absolute deviation (SCAD)-based and least absolute shrinkage and selection operator (LASSO)-based penalized joint generalized estimating equation (PJGEE) methods to simultaneously model the mean and correlations for longitudinal binary data, together with variable selection in the mean model. The estimated correlation coefficients satisfy the upper bound constraints. Simulation studies under different scenarios are made to assess the performance of the proposed method. Compared to existing PGEE methods that specify a working correlation matrix for longitudinal binary data, the proposed PJGEE method works much better in terms of variable selection consistency and parameter estimation accuracy. A real data set on Clinical Global Impression is analyzed for illustration.

PMID:34587284 | DOI:10.1002/bimj.202000336

Pharmacotherapy. 2021 Sep 29. doi: 10.1002/phar.2628. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare associations between individual antidepressants and newborn outcomes.

DESIGN: Retrospective cohort study.

SETTING: Deliveries in a large, US medical system.

POPULATION: Women who received at least one antidepressant prescription 3 months prior to conception through delivery.

METHODS: Eligible women had maternal characteristics and newborn outcomes extracted from medical record data. Exposure was defined by the timing of the prescription during pregnancy.

MAIN OUTCOME MEASURES: Newborn outcomes (any adaptation syndrome, neonatal intensive care unit (NICU) admission) were analyzed for each antidepressant and compared using standard statistics and multivariable regression compared to exposure to bupropion. Odds of outcomes based on timing of exposure were also explored.

RESULTS: A total of 3,694 women were analyzed. Rates of any adaptation syndrome (p<0.001), NICU admission (p<0.001), and transient tachypnea of newborn (TTN) (p=0.006) were significantly different between drugs. Infants exposed to duloxetine had the highest rates of NICU admissions (39.6%) and adaptation syndromes (15.1%). Venlafaxine-exposed infants had the highest rates of TTN (18.2%). Controlling for maternal age, race, insurance, and gestational age at delivery, early pregnancy antidepressant exposure was associated with adaptation syndrome and NICU admission for both duloxetine (adjusted odds ratio (aOR) 2.31 [95% Confidence Interval (CI) 1.11-4.80] and aOR 2.47 [95% CI 1.40-4.34], respectively) and escitalopram (aOR 1.72 [95% CI 1.09-2.70] and aOR 1.64 [95% CI 1.21-2.22], respectively). Exposure in the third trimester was associated with any adaptation syndrome for citalopram, duloxetine, escitalopram, fluoxetine, sertraline, and venlafaxine and NICU admission for bupropion, citalopram, duloxetine, escitalopram, and fluoxetine.

CONCLUSION: Duloxetine and escitalopram appear to have the strongest associations with any adaptation syndrome and NICU admission whereas bupropion and sertraline tended to have among the lowest risks of these outcomes. These results can help providers and patients discuss choice of individual antidepressant drugs during pregnancy.

PMID:34587291 | DOI:10.1002/phar.2628

J Nutr. 2021 Sep 29:nxab314. doi: 10.1093/jn/nxab314. Online ahead of print.

ABSTRACT

BACKGROUND: High meat consumption might play a role in promoting low-grade systemic inflammation, but evidence is limited.

OBJECTIVES: We examined cross-sectional associations of habitual meat consumption with serum C-reactive protein (CRP) and total white blood cell count (WBCC) in British adults.

METHODS: We included 403,886 men and women (aged 38-73 y) participating in the UK Biobank who provided information on meat intake (via touchscreen questionnaire) and a nonfasting blood sample at recruitment (2006-2010). For a subset of participants (∼5%), an additional blood sample was collected (median 4.4 y later). We used multivariable linear regression models to estimate associations of meat intake (total meat, unprocessed red meat, processed meat, and poultry) with logCRP and logWBCC.

RESULTS: The difference in the serum CRP (mg/L) for each 50-g/d higher intake for total meat was 11.6% (95% CI: 11.1, 12.0%), for processed meat was 38.3% (95% CI: 36.0, 40.7%), for unprocessed red meat was 14.4% (95% CI: 13.6, 15.1%), and for poultry was 12.8% (95% CI: 12.0, 13.5%). The difference in the WBCC (×10-9L) for each 50 g/d higher intake of total meat was 1.5% (95% CI: 1.4, 1.6%), for processed meat was 6.5% (95% CI: 6.1, 6.9%), for unprocessed red meat was 1.6% (95% CI: 1.4, 1.7%), and for poultry was 1.6% (95% CI: 1.4, 1.7%). All associations were attenuated after adjustment for adiposity; by 67% with BMI (in kg/m2) and by 58% with waist circumference for total meat and CRP, and by 53% and 47%, respectively, for WBCC, although associations remained statistically significant. Findings of sensitivity analyses in 15,420 participants were similar prospectively, except there were no associations between unprocessed red meat and WBCC.

CONCLUSIONS: Higher meat consumption, particularly of processed meat, was positively associated with inflammatory markers in these British adults; however, the magnitudes of associations are small and predominantly due to higher adiposity.

PMID:34587250 | DOI:10.1093/jn/nxab314

Fam Med. 2021 Sep;53(8):712-716. doi: 10.22454/FamMed.2021.175818.

ABSTRACT

BACKGROUND AND OBJECTIVES: In the United States, 89% of counties have no clinics providing abortion care. Though training residents increases intention to provide abortion care, rates of postresidency abortion provision are low. This study, conducted at one family medicine residency program in the Southwest United States, examines graduates’ postresidency practice of abortion care in the context of their intent to provide during residency training.

METHODS: We collected cross-sectional data from a survey of graduates of University of New Mexico Family Medicine Residency from 2005 to 2017. We performed a mixed-methods analysis using descriptive statistics and conceptual content analysis, including a new methodology of performing content analysis of four subgroups based on intention to provide abortion care at different time points.

RESULTS: The response rate was 46%, with 54 responses to 115 surveys. Only 35% residents who intended to provide abortion care had done so after graduation from residency. Barrier analysis revealed that the three most frequent barriers were structural, with 52% of respondents saying that their workplace would not allow abortion care. The two most frequent themes affecting intention were “competence” and feeling that abortion care was “medically necessary.” However, the two most common themes affecting actual practice were “workplace support” and local “patient access.”

CONCLUSIONS: This study provides information about the themes associated with changing intentions and practice of abortion care, which may help elucidate new strategies for training residents to anticipate and address challenges to postresidency provision. The study also provides some insight into residents with no intention to provide abortion care in residency who develop an intention to provide abortion care after graduation, which is a group of people for whom there is little information.

PMID:34587268 | DOI:10.22454/FamMed.2021.175818