Category: Nevin Manimala

J Ayub Med Coll Abbottabad. 2021 Apr-Jun;33(2):192-197.

ABSTRACT

BACKGROUND: Inferior Alveolar Nerve Block (IANB) with Buccal Infiltration (BI) anaesthesia is required to completely anesthetize the mandibular molars with symptomatic irreversible pulpitis. 4% Articaine and 2% Lidocaine provide local anaesthesia during the nonsurgical endodontic treatment of mandibular molars with symptomatic irreversible pulpitis. Objective of the study was to compare the effect of Articaine and Lidocaine in the combination of Inferior alveolar nerve block with buccal infiltration anaesthesia during the nonsurgical endodontic treatment of mandibular molars with symptomatic Irreversible Pulpitis.

METHODS: One hundred and sixty participants with Symptomatic Irreversible Pulpitis of permanent mandibular molars were divided randomly in two groups. Group A was given Articaine 4% IANB along with BI whereas group B was given Lidocaine 2%. Pain was assessed after 15 minutes of administration of local anaesthesia. Anaesthetic success of the agents is defined as, absence of pain or mild pain first during the access cavity preparation then instrumentation of the canals of tooth. Chi-square test was applied to analyse data for statistical significance.

RESULTS: Anaesthetic success of Articaine was 96.2% during access cavity preparation compared to Lidocaine (86.2%). Success during instrumentation of canals was also found to be high in Articaine (90.2%) compared to Lidocaine (76.2%). This difference of anaesthetic efficacy between Articaine and Lidocaine was found statistically significant. (p=0.02).

CONCLUSIONS: Articaine is found to be better than Lidocaine regarding anaesthetic efficacy and hence, it can be a safer alternative to Lidocaine.

PMID:34137527

ESC Heart Fail. 2021 Jun 17. doi: 10.1002/ehf2.13463. Online ahead of print.

ABSTRACT

AIMS: The prospective, multicentre Peripartum Cardiomyopathy in Nigeria (PEACE) registry originally demonstrated a high prevalence of peripartum cardiomyopathy (PPCM) among patients originating from Kano, North-West Nigeria. In a post hoc analysis, we sought to determine if this phenomenon was characterized by a differential case profile and outcome among PPCM cases originating elsewhere.

METHODS AND RESULTS: Overall, 199 (81.6%) of a total 244 PPCM patients were recruited from three sites in Kano, compared with 45 patients (18.4%) from 11 widely dispersed centres across Nigeria. Presence and extent of ventricular myocardial remodelling during follow-up, relative to baseline status, were assessed by echocardiography. During median 17 months follow-up, Kano patients demonstrated significantly better myocardial reverse remodelling than patients from other sites. Overall, 50.6% of patients from Kano versus 28.6% from other regions were asymptomatic (P = 0.029) at study completion, with an accompanying difference in all-cause mortality (17.6% vs. 22.2% respectively, P = 0.523) not reaching statistical significance. Alternatively, 135/191 (84.9%) of Kano patients had selenium deficiency (<70 μg/L), and 46/135 (34.1%) of them received oral selenium supplementation. Critically, those that received selenium supplementation demonstrated better survival (6.5% vs. 21.2%; P = 0.025), but the supplement did not have significant impact on myocardial remodelling.

CONCLUSIONS: This study has shown important non-racial regional disparities in the clinical features and outcomes of PPCM patients in Nigeria, that might partly be explained by selenium supplementation.

PMID:34137499 | DOI:10.1002/ehf2.13463

J Diabetes Investig. 2021 Jun 15. doi: 10.1111/jdi.13615. Online ahead of print.

ABSTRACT

AIMS/INTRODUCTION: Few people have reported whether there are sex differences in blood lipids and lipid ratios in type 2 diabetic foot (T2DF) patients in China. This paper attempts to identify the contribution to sex-specific differences in blood lipids and lipid ratios in these patients.

MATERIALS AND METHODS: In this case-control study, we explore that 306 patients with T2DF as study group and 306 patients with type 2 diabetes mellitus (T2DM) as control group. Patients were diagnosed according to the Standards of Medical Care in Diabetes-2014 (ADA). Blood lipid and lipid ratios were determined according to the National Cholesterol Education Program Adult Treatment Panel III criteria.

RESULTS: We studied male patients with T2DF who were 68.00 (18.00) years old and females who were 73.50 (19.00) years old; 61.76% of the patients were male. Males had higher BMIs and HbA1c levels than females. Compared to T2DM patients, T2DF patients had significant differences in TC/HDL-C, LDL-C/HDL-C and apoB/apoA-I ratios. HDL-C, TG, apoA-I and apoB/apoA-I ratio were cardiovascular disease (CVD) risk in males, while TC, LDL-C, apoB, and the LDL/HDL-C and TC/HDL-C ratios were better predictors in females. The apoB/apoA-I ratio OR values were 2.18 (95%CI:1.17-4.41) and 2.14 (95%CI:1.14-4.00) in male patients with T2DF before and after adjusting for age respectively (P<0.05).

CONCLUSIONS: T2DF patients present sex-specific differences in their blood lipid and lipid ratios, especially in the apoB/apoA-I ratio, which could be a better indicator for CVD risk.

PMID:34137504 | DOI:10.1111/jdi.13615

J Magn Reson Imaging. 2021 Jun 16. doi: 10.1002/jmri.27789. Online ahead of print.

ABSTRACT

BACKGROUND: Magnetic resonance imaging (MRI) is the most accurate imaging technique for left ventricular ejection fraction (LVEF) quantification, but as yet the prognostic value of LVEF assessment at any time after ST-segment elevation myocardial infarction (STEMI) for subsequent major adverse cardiac event (MACE) prediction is uncertain.

PURPOSE: To explore the prognostic impact of MRI-derived LVEF at any time post-STEMI to predict subsequent MACE (cardiovascular death or re-admission for acute heart failure).

STUDY TYPE: Prospective.

POPULATION: One thousand thirteen STEMI patients were included in a multicenter registry.

FIELD STRENGTH/SEQUENCE: 1.5-T. Balanced steady-state free precession (cine imaging) and segmented inversion recovery steady-state free precession (late gadolinium enhancement) sequences.

ASSESSMENT: Post-infarction MRI-derived LVEF (reduced [r]: <40%; mid-range [mr]: 40%-49%; preserved [p]: ≥50%) was sequentially quantified at 1 week and after >3 months of follow-up.

STATISTICAL TESTS: Multi-state Markov model to determine the prognostic value of each LVEF state (r-, mr- or p-) at any time point assessed to predict subsequent MACE. A P-value <0.05 was considered to be statistically significant.

RESULTS: During a 6.2-year median follow-up, 105 MACE (10%) were registered. Transitions toward improved LVEF predominated and only r-LVEF (at any time assessed) was significantly related to a higher incidence of subsequent MACE. The observed transitions from r-LVEF, mr-LVEF, and p-LVEF states to MACE were: 15.3%, 6%, and 6.7%, respectively. Regarding the adjusted transition intensity ratios, patients in r-LVEF state were 4.52-fold more likely than those in mr-LVEF state and 5.01-fold more likely than those in p-LVEF state to move to MACE state. Nevertheless, no significant differences were found in transitions from mr-LVEF and p-LVEF states to MACE state (P-value = 0.6).

DATA CONCLUSION: LVEF is an important MRI index for simple and dynamic post-STEMI risk stratification. Detection of r-LVEF by MRI at any time during follow-up identifies a subset of patients at high risk of subsequent events.

LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY STAGE: 2.

PMID:34137478 | DOI:10.1002/jmri.27789

Health Soc Care Community. 2021 Jun 17. doi: 10.1111/hsc.13477. Online ahead of print.

ABSTRACT

Considering the small number of studies aimed at evaluating outcomes related to dizziness and falls in the older adults who live in long-term care facilities, especially in north-eastern Brazil, and considering the negative impact of these events on the quality of life of these individuals, this study purpose was to evaluate dizziness as a predictor of risk of falls in institutionalised older adults. This cross-sectional analysis of data on falls and dizziness of 187 institutionalised older adults carried out between the years 2014 and 2016. The data collection instruments used were a socioeconomic and demographic questionnaire and questionnaires for assessing variables related to falls. The different diagnostic methods were compared using the Spearman correlation, and the Dizziness variable was evaluated by means of logistic regression. Inferential statistical analysis showed a significant association between dizziness and number of morbidities (p = .03) and dizziness and a history of falls (p = .04). Spearman’s correlation analysis revealed statistically significant results only for FES-I (Falls Efficacy Scale-International) (p < .01). Dizziness was a predictor of risk of falls and that it was associated with a greater number of morbidities and previous history of falls. Implementing rehabilitation practices to reduce dizziness symptoms can significantly reduce the risk of falls for institutionalised older adults.

PMID:34137491 | DOI:10.1111/hsc.13477

Chemistry. 2021 Jun 17. doi: 10.1002/chem.202101515. Online ahead of print.

ABSTRACT

We investigated the photoionization and fragmentation of isolated metal protoporphyrin IX cations (MPPIX with M = Fe, Co, Zn) by means of VUV action spectroscopy in the energy range of 8.5-35 eV. Experiments were carried out in the gas phase by interfacing an electrospray ionization tandem mass spectrometer with a synchrotron beamline. The mass spectra and partial ion yields show that photoexcitation of the precursor ions predominantly leads to • CH 2 COOH radical side-chain losses of the macrocycle with additional methyl radical ( • CH 3 ) side-chain losses. Ionization, in contrast, leads to the formation of the intact ionized precursor and various doubly charged fragments which are mostly due to side-chain cleavages. Although statistical fragmentation dominates, we found evidence for non-statistical processes such as new fragments involving e.g. single and double H 2 O losses, indicating that different relaxation mechanisms are at play upon photoionization compared to photoexcitation. The measured ionization energies were 9.6 ± 0.2 eV, 9.4 ± 0.2 eV and 9.6 ± 0.2 eV for FePPIX + , CoPPIX + and ZnPPIX + , respectively.

PMID:34137472 | DOI:10.1002/chem.202101515

Retina. 2021 Jul 1;41(7):1379-1388. doi: 10.1097/IAE.0000000000003059.

ABSTRACT

PURPOSE: To investigate the vascular remodeling of optical coherence tomography angiography in full-thickness macular hole surgery.

METHODS: This retrospective, observational case series included 33 eyes of 33 patients with a full-thickness macular hole who underwent epiretinal membrane removal. Data were collected on best-corrected visual acuity, structural B-scan optical coherence tomography, and optical coherence tomography angiography preoperatively and at 1, 3, and 6 months postoperatively. Optical coherence tomography angiography was used to assess the retinal vascular density (VD) of the superficial vascular plexus and deep vascular plexus (DVP). Vascular density was assessed using the Early Treatment Diabetic Retinopathy Study grid for the whole, inner, and outer grids.

RESULTS: A statistically significant correlation was found between the VD (whole, inner, and outer grids) of the superficial vascular plexus alone from baseline to 1-month postoperatively (P < 0.001). Similarly, VD was correlated from baseline to 1, 3, and 6 months postoperatively to the whole (P < 0.0005, F = 23.22), inner (P < 0.0005, F = 28.23), and outer Early Treatment Diabetic Retinopathy Study grids of DVP (P = 0.033, F = 3.49). The best-corrected visual acuity and VD were significantly correlated with the superficial vascular plexus and DVP at baseline and 6 months (P < 0.05, all correlations). The most significant correlation was observed at 6 months between best-corrected visual acuity and DVP in the whole, inner, and outer Early Treatment Diabetic Retinopathy Study grids (P < 0.001).

CONCLUSION: Superficial vascular plexus and DVP are affected by full-thickness macular holes, with the most significant effects being on the DVP. Full-thickness macular hole surgery leads to an improvement in the best-corrected visual acuity in many eyes and the restoration of the VD, especially of the DVP.

PMID:34137384 | DOI:10.1097/IAE.0000000000003059

Genet Mol Biol. 2021 Jun 11;44(2):e20200448. doi: 10.1590/1678-4685-GMB-2020-0448. eCollection 2021.

ABSTRACT

The inclusion of a genetic risk score (GRS) can modify the risk prediction of coronary artery disease (CAD), providing an advantage over the use of traditional models. The predictive value of the genetic information on the recurrence of major adverse cardiovascular events (MACE) remains controversial. A total of 33 genetic variants previously associated with CAD were genotyped in 1587 CAD patients from the GENEMACOR study. Of these, 18 variants presented an hazard ratio >1, so they were selected to construct a weighted GRS (wGRS). MACE discrimination and reclassification were evaluated by C-Statistic, Net Reclassification Index and Integrated Discrimination Improvement methodologies. After the addition of wGRS to traditional predictors, the C-index increased from 0.566 to 0.572 (p=0.0003). Subsequently, adding wGRS to traditional plus clinical risk factors, this model slightly improved from 0.620 to 0.622 but with statistical significance (p=0.004). NRI showed that 17.9% of the cohort was better reclassified when the primary model was associated with wGRS. The Kaplan-Meier estimator showed that, at 15-year follow-up, the group with a higher number of risk alleles had a significantly higher MACE occurrence (p=0.011). In CAD patients, wGRS improved MACE risk prediction, discrimination and reclassification over the conventional factors, providing better cost-effective therapeutic strategies.

PMID:34137427 | DOI:10.1590/1678-4685-GMB-2020-0448

Acta Anaesthesiol Scand. 2021 Jun 17. doi: 10.1111/aas.13940. Online ahead of print.

ABSTRACT

BACKGROUND: Acute acidosis can increase the plasma potassium concentration. However, data on the effects of acute respiratory acidosis on plasma potassium concentration is conflicting. This study aimed to determine whether acute respiratory acidosis induces an immediate increase in plasma potassium concentration.

METHODS: This observational study was conducted on participants undergoing apnoea testing prior to final radiological examination, registered in an internal quality registry at Oslo University Hospital between 25, April 2013 and 1, May 2020. A total of 124 donors were assessed for inclusion. Sixteen donors with blood glucose concentrations exceeding 10 mmol l^-1 were excluded; finally, data from 108 donors were included in the study. The apnoea test, which is a standard neurological test performed in potential organ donors prior to radiological confirmation of ceased brain circulation, induces respiratory acidosis. The arterial plasma potassium concentration, pH, and PaCO₂ before and after the apnoea test were compared. Statistical analysis was conducted using the paired t-test.

RESULTS: The pre- and post-apnoea mean plasma potassium concentrations were 3.79 (95% confidence intervals [CI] 3.70-3.87) and 3.79 mmol l^-1 (95% CI 3.70-3.88), respectively. The mean difference was -0.002 mmol l^-1 (95% CI -0.04 to 0.04); the difference was not significant. The pre- and post-apnoea mean pH were 7.39 and 7.21, respectively and the mean difference was 0.175 (p<0.01). The pre- and post-apnoea mean PaCO₂ were 5.66 and 9.48 kPa, respectively and the mean difference was -3.83 (p<0.01).

CONCLUSIONS: Acute respiratory acidosis does not lead to rapid changes in plasma potassium concentration during apnoea testing in potential organ donors.

PMID:34137462 | DOI:10.1111/aas.13940

Gynecol Endocrinol. 2021 Jun 17:1-8. doi: 10.1080/09513590.2021.1940127. Online ahead of print.

ABSTRACT

INTRODUCTION: Both obesity and diabetes play a significant role in reproductive disorders in women and insulin resistance (IR) is a confirmed trait d’union. We evaluated the relationship between IR and an established ovarian reserve biomarker such as anti-mullerian hormone (AMH) together with other potential modulators of ovarian physiology (adiponectin and kisspeptin) in young reproductive-aged group women with obesity and type 1 diabetes (T1D).

PATIENTS AND METHODS: We recruited 32 female youths: 14 of them presented with T1D (14.6 ± 2.6 years) and 18 with obesity (15.1 ± 2.6 years). The control group included 20 age-matched normal weight females. Each patient underwent physical examination and hormonal assessment. AMH, kisspeptin and adiponectin levels were also measured. IR was calculated as the homeostasis model assessment for insulin resistance (HOMA-IR) and the glucose disposal rate (eGDR) in patients with obesity and with T1D, respectively.

RESULTS: adiponectin and kisspeptin levels were significantly different into groups (p ≤ .001), whereas AMH levels were not. Adiponectin values were higher in controls compared to patients with obesity (p < .001) and T1D (p = .02). Kisspeptin levels were lower in controls compared to patients with obesity (p = .001), without reaching statistical significance when compared to T1D (p = .06). IR was associated with lower adiponectin and higher kisspeptin levels (p < .001 and p = .02, respectively), but not with AMH.

CONCLUSIONS: IR displays a relationship with adiponectin and kisspeptin in young reproductive-aged women with obesity and T1D. Interventions to correct IR in adolescents could be part of an early approach to prevent reproductive disorders and to promote factors associated with longevity in adult women.

PMID:34137355 | DOI:10.1080/09513590.2021.1940127