Category: Nevin Manimala

J Appl Oral Sci. 2021 Oct 22;29:e20210192. doi: 10.1590/1678-7757-2021-0192. eCollection 2021.

ABSTRACT

OBJECTIVE: To evaluate non-carious cervical lesions (NCCLs) restored with different adhesion strategies.

METHODOLOGY: This is a prospective, randomized, double-blind, split-mouth study. An adhesive restorative system (Single Bond Universal/Filtek Z350XT – SBU) was evaluated both without and with selective enamel conditioning (E-SBU), resin-modified glass-ionomer cements (Vitremer; RMGIC), and ethylenediaminetetraacetic acid pretreatment (EDTA; E-RMGIC). In total, 200 restorations, placed in 50 patients, were evaluated at baseline and at a 3-year follow-up using the modified United States Public Health Service (USPHS) criteria. Data were analyzed using the two-proportion equality test, multinomial logistic regression, Wilcoxon test, and Kaplan-Meier survival curves.

RESULTS: In total, 42 (84%) patients returned for the 3-year follow-up. SBU showed restoration losses statistically different from RMGIC. Retention was also statistically different in SBU between baseline and the 3-year follow-up. Marginal defects and surface texture were statistically significant for all groups in the period studied, except for the surface texture of SBU and the marginal integrity in E-RMGIC. We observed no statistically significant difference in wear, secondary caries, anatomical form, surface staining, and color over time. Recession degree was the only factor to influence retention rates. Cumulative survival (%) was 89, 98, 98, and 95.3, for SBU, SE-SBU, RMGIC, and E-RMGIC, respectively, without significant differences among them. There was a statistically significant difference between survival curves; however, multiple comparison procedures found no statistical differences.

CONCLUSION: Selective enamel etching affected the retention of non-carious cervical restorations. Adhesion using EDTA and resin-modified glass-ionomer cements delayed marginal defects over time. The degree of gingival recession influenced retention rates. Resin composite restorations showed initial marginal defects, and ionomer restorations, reduced surface luster. EDTA pre-treatment followed by resin-modified glass-ionomer cements may be a promising adhesion strategy for NCCL restorations.

PMID:34705986 | DOI:10.1590/1678-7757-2021-0192

Rev Bras Enferm. 2021 Oct 25;75(2):e20201383. doi: 10.1590/0034-7167-2020-1383. eCollection 2021.

ABSTRACT

OBJECTIVES: to describe clinical characteristics and mortality of people with ischemic cerebrovascular accidents (strokes); to compare disability before the event and 90 days after.

METHODS: longitudinal study with 308 people hospitalized in Salvador-BA. Data collection took place from 03/2019 to 01/2020. Descriptive and inferential statistics were used.

RESULTS: mean age was 64.8 years, and National Institute of Health Stroke Scale score was 10.7. The median length of stay in the hospital was 11 days. Afro-descendants predominated (84%), elementary educational level (68.4%), income up to three minimum wages (89.1%), arrival within 4.5 hours of symptoms (57.9%) and admission to a specialized unit (71.8%). Prevalence of thrombolysis: 26%. The asymptomatic before the event category predominated (85.3%) as did the moderate/severe disability (41.5%) after 90 days. 19.7% of the sample evolved to death. Conclusions: the high mortality and disability generated by the event have implications for health management and care.

PMID:34705991 | DOI:10.1590/0034-7167-2020-1383

Arq Gastroenterol. 2021 Jul-Sep;58(3):337-343. doi: 10.1590/S0004-2803.202100000-57.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has changed digestive endoscopy services around the world.

OBJECTIVE: This study aimed to measure the number of urgent/emergency endoscopic procedures performed in a Brazilian hospital, comparing it to the same period in the previous year, and to identify risk factors in COVID-19 patients undergoing endoscopic procedures for upper gastrointestinal bleeding (UGIB).

METHODS: This was a retrospective, cross-sectional, observational, single-center study. The study evaluated urgent/emergency endoscopic procedures performed on adult patients from March to August in 2019 and 2020. The COVID-19 patients included were diagnosed using RT-PCR, aged over 18 years with complete medical record information. The variables evaluated were age, sex, comorbidities, length of stay, D-dimer, need for intensive care unit (ICU) and mechanical ventilation. Student’s t-test for independent samples or the non-parametric Mann-Whitney test was used to compare quantitative variables. Categorical variables were analyzed using Fisher’s exact test. A P-value <0.05 indicated statistical significance.

RESULTS: A total of 130 urgent/emergency endoscopic procedures were performed in 2020 and 97 in 2019. During the study period, 631 patients were hospitalized due to COVID-19, of whom 16 underwent urgent/emergency endoscopic procedures, 10 (1.6%) due to UGIB. Of the variables analyzed, the need for ICU and/or mechanical ventilation during hospitalization was statistically significant as a risk factor for UGIB.

CONCLUSION: This study showed increased urgent/emergency endoscopic procedures during the pandemic at the study site. Among the patients hospitalized with the novel coronavirus, there is a higher risk for UGIB in those needing ICU and/or mechanical ventilation.

PMID:34705968 | DOI:10.1590/S0004-2803.202100000-57

Arq Gastroenterol. 2021 Jul-Sep;58(3):364-369. doi: 10.1590/S0004-2803.202100000-61.

ABSTRACT

BACKGROUND: Dyspeptic symptoms are among the eight symptoms that most lead to the use of self-medication globally.

OBJECTIVE: The aim of the present study was to evaluate the frequency of use and profile of the population doing self-medication to control dyspeptic symptoms in a capital from South Brazil.

METHODS: Application of a survey consisting of topics regarding individual’s socio-cultural data, self-reported comorbidities, use of self-medication in the 15 days prior to the interview and information on the use of this medication. Statistical analysis was performed on the data collected to determine the prevalence of self-medication for dyspeptic symptoms (SMDS) and to establish correlations with independent factors, such as gender, age, body mass index (BMI), education, family income and self-reported comorbidities.

RESULTS: A total of 719 individuals from the public health system were interviewed. Overall, 67.7% were female, 65.3% had a BMI greater than 25; 28.4% presented with self-reported hypertension, 21.4% with depression and 13.8% with diabetes. The prevalence of self-medication to control digestive symptoms in this population was 28.7% (95%CI: 25.3-32), 91.8% (n=189) due to complaints of dyspeptic origin. Proton pump inhibitors were the most used class of medication (67%), followed by antacids (15%). There was a relationship between SMDS and age >38 years (OR=1.734, 95%CI: 1.177-2.580, P=0.001), BMI >26 (OR=1.660, 95%CI: 1.166-2.362, P<0.001) and self-reported depression (OR=1.471, 95%CI: 0.983-2.201, P=0.04).

CONCLUSION: There was a higher prevalence of the use of self-medication to control dyspeptic symptoms in relation to previous data from the literature. Age >38 years, BMI >26 and self-reported depression were associated with SMDS.

PMID:34705972 | DOI:10.1590/S0004-2803.202100000-61

Arq Gastroenterol. 2021 Jul-Sep;58(3):281-288. doi: 10.1590/S0004-2803.202100000-49.

ABSTRACT

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is an important option for enteral nutrition for both children and adults. It is considered a safe, effective, and advantageous technique in comparison to other complementary feeding routes. It allows continuous feeding, the feeding of patients with swallowing disorders due to neurological causes or others, and the administration of non-palatable diets or medications, all with low rates of complications and mortality.

OBJECTIVE: This study aimed to evaluate the main indications and complications of PEG in pediatric patients. In addition, the impact on the nutritional status of patients undergoing PEG was also compared with weight, body mass index (BMI), and height according to references from the World Health Organization.

METHODS: This observational and retrospective study included 152 children and adolescents who underwent PEG between January/2003 and December/2018. Patients up to 18 years of age at the time of the procedure were included. Complications related to the procedure were classified as minor or major. Patients with PEG indication for nutritional supplementation were evaluated for weight gain, height, and BMI, using the Z score at the day of the procedure and six months, 1 year, and 2 years after the procedure.

RESULTS: Indications for PEG were: swallowing disorder of neurological cause (67.1%), need for nutritional supplementation (25%), swallowing disorder of mechanical origin (6.6%), and indication of gastric decompression (1.3%). Minor complications occurred in 57.8% of patients and major complications in 9.8% of patients. The traction technique corresponded to 92.1% and puncture to 7.9%. The death rate was 1.3%. Thirty-eight patients had an indication for nutritional supplementation. In these patients, there was a gradual increase in both BMI and weight, reaching statistically significant differences (P=0.0340 and P= 0.0105, respectively). These differences were more evident in chronic renal disease patients. Height did not vary significantly (P=0.543).

CONCLUSION: PEG proved to be an advantageous option as an auxiliary feeding method in pediatric patients. Dysphagia of neurological origin was the main indication followed by the need for nutritional supplementation. PEG has low frequency of major complications and mortality. This study also showed the importance of PEG in patients who need nutritional supplementation, as it enabled patients to move from undernutrition to normal weight ranges.

PMID:34705960 | DOI:10.1590/S0004-2803.202100000-49

Arq Gastroenterol. 2021 Jul-Sep;58(3):289-295. doi: 10.1590/S0004-2803.202100000-50.

ABSTRACT

BACKGROUND: A healthy diet is recommended for patients with Crohn’s disease (CD) in remission.

OBJECTIVE: To evaluate the diet quality of patients with CD.

METHODS: Cross-sectional study with patients with CD and clinical remission using the biological agent infliximab. The diet quality was assessed using the Diet Quality Index-Revised (DQI-R). DQI-R was calculated based on 24-hour dietary recalls (24HR), being classified as “inadequate diet” (≤40 points), “diet requiring modifications” (41 to 64 points) and “healthy diet” (≥65 points). Weight, height and waist circumference (WC) of patients were assessed. For comparison between groups, Student’s t-test or Mann-Whitney was used. For correlation between continuous variables, Pearson or Spearman coefficient was used. Values of P<0.05 indicated statistical significance.

RESULTS: A total of 43 patients participated in the study. The final DQI-R score was 49.1 points – “diet requiring modifications”. No patient received the classification of “healthy diet” (maximum score =59.7), 55.8% presented “diet requiring modifications” and 44.2% “inadequate diet”. When comparing the “inadequate diet” and “diet requiring modifications” groups, a lower mean age was observed in the “inadequate diet” group (37.6±14.8 versus 47.4±10.5 y, P=0.02). It was found that 44.2% of the patients were overweight (body mass index [BMI] ≥25 kg/m²) and had increased WC (women: WC ≥80 cm and men: WC ≥94 cm). A positive correlation was found between the final DQI-R score and BMI (P=0.046; r=0.346).

CONCLUSION: Patients with CD in clinical remission using infliximab are not adopting a diet considered healthy, which points to the need for an individualized nutritional approach.

PMID:34705961 | DOI:10.1590/S0004-2803.202100000-50

Arq Gastroenterol. 2021 Jul-Sep;58(3):322-328. doi: 10.1590/S0004-2803.202100000-55.

ABSTRACT

BACKGROUND: Crohn’s disease (CD) is an inflammatory bowel disease characterized by a chronic and recurrent inflammation of the gastrointestinal tract caused by an interaction of genetic and environmental factors.

OBJECTIVE: To compare the quality and acceptance of two different oral contrast volumes for computed tomography enterography in Crohn’s disease patients.

METHODS: A cross-sectional study was conducted in 58 consecutive Crohn’s disease patients who randomly received an oral contrast agent composed of 78.75 g polyethylene glycol diluted in either 1,000 mL or 2,000 mL of water. An examination was performed to evaluate the presence of inflammation or complications in the small bowel. The variables included the quality of intestinal segment filling and luminal distension, and oral contrast agent acceptance and tolerance in the patients. Statistical analysis included descriptive statistics and association tests.

RESULTS: A total of 58 patients were assessed, in which 58.6% were female, 34.5% exhibited clinically-active disease, and 63.8% were receiving biologic therapy. As for comparative analysis between the two different volumes of oral contrast, no statistically significant difference was found regarding bowel loop filling (P=0.58) and adequate luminal distension (P=0.45). Patients who received a larger volume (2,000 mL) exhibited side-effects more frequently (51.7% vs 31.0%; P=0.06) and had greater difficulty ingesting the agent (65.5% vs 37.9%; P=0.07) compared with a volume of 1,000 mL.

CONCLUSION: The quality of computed tomography enterography was not influenced by the contrast volume. However, acceptance and tolerance were better in the 1,000 mL group.

PMID:34705966 | DOI:10.1590/S0004-2803.202100000-55

Arq Gastroenterol. 2021 Jul-Sep;58(3):270-275. doi: 10.1590/S0004-2803.202100000-47.

ABSTRACT

BACKGROUND: Endoscopic retrograde cholangiopancreatography is a widely used therapeutic modality for the pancreaticobiliary tree. However, it is responsible for the highest rates of complications among the endoscopic procedures, especially post-endoscopic retrograde cholangiopancreatography pancreatitis. The preventive methods include mechanical and pharmacological approaches, such as the use of non-steroidal anti-inflammatory drugs.

OBJECTIVE: To compare the efficacy of two different strategies using non-steroidal anti-inflammatory drugs for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis, and to clarify the uncertainty about the route of administration of non-steroidal anti-inflammatory drugs in the prevention of this complication.

METHODS: This was a prospective trial. Two therapeutic groups were compared with a control group that was composed of patients who underwent endoscopic retrograde cholangiopancreatography, performed in the same service and by the same team in the period preceding the study (historical series), without the administration of any type of prophylaxis. The first group received 100 mg rectal diclofenac. The second group received 100 mg intravenous ketoprofen. Both groups were compared, separately and jointly, with the control group.

RESULTS: Post-endoscopic retrograde cholangiopancreatography pancreatitis occurred in 4.39% (12/273) of the participants. In the group without prophylaxis, the incidence was 6.89% (10/145). Among those who received intravenous ketoprofen, the incidence was 2.56% (2/78). No cases of acute post-procedural pancreatitis were observed in the group that received rectal diclofenac (0/52). Although there was no statistical difference between the therapeutic groups when they were separately analyzed, a statistical difference in the prevention of post-procedural pancreatitis was observed when they were analyzed together (P=0.037).

CONCLUSION: This study provides evidence for the efficacy of non-steroidal anti-inflammatory drugs in the prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis.

PMID:34705958 | DOI:10.1590/S0004-2803.202100000-47

Pain Physician. 2021 Nov;24(7):E1075-E1083.

ABSTRACT

BACKGROUND: Computed tomography (CT)-guided radiofrequency thermocoagulation of lumbar sympathetic nerve has been gradually applied to the treatment of many autonomic nerve disorders, such as plantar hyperhidrosis (PH) and diabetic peripheral neuropathy (DPN). The difference in the success rate of operation between the left and right sides is not yet studied.

OBJECTIVE: This study aimed to explore a statistically significant difference between the success rate of left and right CT-guided radiofrequency thermocoagulation of lumbar sympathetic nerve and screen the risk factors affecting the success rate of the right surgery.

STUDY DESIGN: This is a single-center retrospective cohort study.

SETTING: The study was carried out in the Pain Department of the affiliated Hospital of Jiaxing College in Jiaxing, China.

METHODS: A total of 86 patients who received CT-guided radiofrequency thermocoagulation of lumbar sympathetic nerve were included in this study approved by the Ethics Committee of the affiliated Hospital of Jiaxing University. Nonparametric and chi-square tests were used to compare the operation times, CT scan times, and success rate on the left and right sides. Binary multivariate logistic regression analysis was applied to screen the risk factors on the outcome variable.

RESULTS: The bilateral operation time, CT scan times, and success rate differed significantly between the left and right sides (P < 0.05). After univariate analysis, 6 covariates (gender, body mass index, treatment history, operation time, CT scan times, and puncture needle type) were selected. Finally, the multivariate regression model screened out 2 risk factors: the operation time and puncture needle type.

LIMITATIONS: We look forward to increasing the sample size in follow-up studies and exploring relevant conclusions in randomized controlled trials.

CONCLUSION: This study proved that in CT-guided radiofrequency thermocoagulation of the lumbar sympathetic nerve, the difficulty of operation on the right side was significantly high, and the success rate was also lower than that on the contralateral side. Multivariate logistic regression analysis showed that operation time and type of puncture needle were risk factors affecting the success rate of the operation. These findings laid a foundation for the accomplishment of technical improvement and innovation in the future. A preliminary exploration was carried out to reduce the risk and complications and to improve the success rate of the operation.

PMID:34704717