Category: Nevin Manimala

BMJ. 2021 Apr 28;373:n808. doi: 10.1136/bmj.n808.

ABSTRACT

OBJECTIVE: To assess the overall effect of delayed antibiotic prescribing on average symptom severity for patients with respiratory tract infections in the community, and to identify any factors modifying this effect.

DESIGN: Systematic review and individual patient data meta-analysis.

DATA SOURCES: Cochrane Central Register of Controlled Trials, Ovid Medline, Ovid Embase, EBSCO CINAHL Plus, and Web of Science.

ELIGIBILITY CRITERIA FOR STUDY SELECTION: Randomised controlled trials and observational cohort studies in a community setting that allowed comparison between delayed versus no antibiotic prescribing, and delayed versus immediate antibiotic prescribing.

MAIN OUTCOME MEASURES: The primary outcome was the average symptom severity two to four days after the initial consultation measured on a seven item scale (ranging from normal to as bad as could be). Secondary outcomes were duration of illness after the initial consultation, complications resulting in admission to hospital or death, reconsultation with the same or worsening illness, and patient satisfaction rated on a Likert scale.

RESULTS: Data were obtained from nine randomised controlled trials and four observational studies, totalling 55 682 patients. No difference was found in follow-up symptom severity (seven point scale) for delayed versus immediate antibiotics (adjusted mean difference -0.003, 95% confidence interval -0.12 to 0.11) or delayed versus no antibiotics (0.02, -0.11 to 0.15). Symptom duration was slightly longer in those given delayed versus immediate antibiotics (11.4 v 10.9 days), but was similar for delayed versus no antibiotics. Complications resulting in hospital admission or death were lower with delayed versus no antibiotics (odds ratio 0.62, 95% confidence interval 0.30 to 1.27) and delayed versus immediate antibiotics (0.78, 0.53 to 1.13). A significant reduction in reconsultation rates (odds ratio 0.72, 95% confidence interval 0.60 to 0.87) and an increase in patient satisfaction (adjusted mean difference 0.09, 0.06 to 0.11) were observed in delayed versus no antibiotics. The effect of delayed versus immediate antibiotics and delayed versus no antibiotics was not modified by previous duration of illness, fever, comorbidity, or severity of symptoms. Children younger than 5 years had a slightly higher follow-up symptom severity with delayed antibiotics than with immediate antibiotics (adjusted mean difference 0.10, 95% confidence interval 0.03 to 0.18), but no increased severity was found in the older age group.

CONCLUSIONS: Delayed antibiotic prescribing is a safe and effective strategy for most patients, including those in higher risk subgroups. Delayed prescribing was associated with similar symptom duration as no antibiotic prescribing and is unlikely to lead to poorer symptom control than immediate antibiotic prescribing. Delayed prescribing could reduce reconsultation rates and is unlikely to be associated with an increase in symptoms or illness duration, except in young children.

STUDY REGISTRATION: PROSPERO CRD42018079400.

PMID:33910882 | DOI:10.1136/bmj.n808

In Vivo. 2021 May-Jun;35(3):1611-1615. doi: 10.21873/invivo.12418.

ABSTRACT

BACKGROUND/AIM: Oncogene up-regulation combined with suppressor gene down-regulation is a crucial genetic combination that promotes cell neoplastic phenotype and progressively malignant transformation in solid malignancies, including laryngeal squamous cell carcinoma (LSCC). Among oncogenes, the Kirsten ras oncogene homolog (K-Ras) is involved in LSCC onset and progression.

PATIENTS AND METHODS: Sixty (n=60) primary LSCC tissue sections were analyzed by immunohistochemistry (IHC). Digital image analysis (DIA) was also implemented for measuring K-Ras protein expression levels.

RESULTS: High K-Ras protein expression levels were observed in 20/60 (33.3%) LSCC tissue sections, whereas the rest of the cases (n=40; 66.7%) demonstrated low expression. Overall K-Ras expression was borderline significantly associated to the grade of the examined malignancies (p=0.048), whereas no other strong statistical correlations were identified. A progressive K-Ras overexpression was observed in all grades of the examined cases.

CONCLUSION: K-Ras over expression is correlated to a progressive dedifferentiation in LSCC.

PMID:33910843 | DOI:10.21873/invivo.12418

Mol Inform. 2021 Apr 28. doi: 10.1002/minf.202100011. Online ahead of print.

ABSTRACT

Deep learning has shown great potential for generating molecules with desired properties. But the cost and time required to obtain relevant property data have limited study to only a few classes of materials for which extensive data have already been collected. We develop a deep learning method that combines a generative model with a property prediction model to fuse small data of one class of molecules with larger data in another class. Common low-level physicochemical properties are jointly embedded into a latent space that can be used to design molecules in the smaller class. The chemical space around the molecules in the training set is explored through local gradient ascent optimization. Based on nine molecules from the original training set, nine new molecules are found to have improved properties while remaining structurally similar to the training molecules thereby easing requirements for entirely new synthesis routes. Validation is performed using an equilibrium thermochemistry code to verify the molecules and target properties. A specific example targeting the Chapman-Jouguet velocity and small data for nitrogen-rich molecules is shown. Despite the relative lack of nitrogen-rich molecule data, the results demonstrate that fusing and joint embedding with plentiful low nitrogen molecular data can produce higher generative performance than using the scarce data alone.

PMID:33909951 | DOI:10.1002/minf.202100011

Z Naturforsch C J Biosci. 2021 Jan 19;76(5-6):193-203. doi: 10.1515/znc-2020-0070. Print 2021 May 26.

ABSTRACT

In this study, the chemical composition, antimicrobial, antioxidant, and anticancer effects of Thymus convolutus Klokov oil and its main compound camphor were investigated. The oil was isolated from T. convolutus using hydrodistillation method, analyzed by gas chromatography/mass spectrometry (GC-MS), and 66 compounds were identified. The main component was determined as camphor at 16.6%. The antioxidant properties were identified with the DPPH (2,2′-diphenyl-1-picrylhydrazyl) radical-scavenging method and, 33.39 ± 0.25% DPPH was scavenging in 1000 μg/mL of essential oil. The strong antimicrobial activity was observed against Escherichia coli, Enterobacter aerogenes, Proteus vulgaris, and Pseudomonas aeruginosa with MIC values of 125 μg/mL. Aspergillus flavus was more sensitive (28%) against T. convolutus essential oil than other fungi. The cytotoxic effect of oil was analyzed by MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide) method. Camphor was effective on human hepatoma cells (Hep3B) at concentrations of 1 mg/mL, 500, 250, and 125 μg/mL, while essential oil of T. convolutus was found to be effective at concentrations of 250 and 125 μg/mL. A reduction in cell proliferation was observed in colon carcinoma cells (HT-29) treated with 500 μg/mL camphor for 48 h. No statistically significant effect was found in Umbilical Vein Endothelial Cells (HUVEC) treated with essential oil and camphor.

PMID:33909957 | DOI:10.1515/znc-2020-0070

J Prosthodont. 2021 Apr 28. doi: 10.1111/jopr.13372. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate effect of air-particle abrasion protocol and primer on surface topography and bond strength of resin cement to high-translucent zirconia ceramics.

MATERIALS AND METHODS: Two hundred disk-shaped high-translucent zirconia specimens of 5Y-PSZ were prepared. The specimens were assigned to 5 groups in terms of particle type and air-particle abrasion pressure: (1) control (2) alumina with 0.2 MPa-air pressure [AB-0.2] (3) alumina with 0.4 MPa-air pressure [AB-0.4] (4) glass beads with 0.2 MPa-air pressure [GB-0.2] and (5) glass beads with 0.4 MPa-air pressure [GB-0.4]. Two different primers 1% MDP (Experimental) and MDP-silane primer (Clearfil Ceramic Primer Plus) was also tested. Stainless steel rods were bonded to the 5Y-PSZ specimens with PANAVIA V5. For each group, the tensile bond strength (TBS) was measured after 24h water storage (n = 10) and after 5,000 thermal-cycling (n = 10) at crosshead speed of 2 mm/min. The data were statistically analyzed using Weibull analysis. Surface roughness (Sa) was measured using a 3D-Laser Scanning Confocal Microscope (n = 5) and analyzed by t-test with Bonferroni correction. Surface topography using scanning electron microscopy (SEM) and surface elemental analysis using energy dispersion spectroscopy (EDX), and cross-section SEM at the interface with composite cement were also investigated.

RESULTS: In MDP-silane groups, the highest TBS was observed in AB-0.4 after 24h and GB-0.4 after thermal-cycling (p<0.05). In MDP groups, AB groups resulted in the significantly higher TBS than GB groups (p <0.05). AB-0.4 group showed the highest Sa value compared to all groups (p<0.005), meanwhile GB groups did not show different Sa compared to control (p>0.005).

CONCLUSION: Air-abrasion with different particle and blasting pressure can improve bonding to zirconia with proper primer selection. Particularly, glass beads abrasion followed by MDP-silane primer and alumina abrasion followed by MDP primer alone provided stable bond strength of resin cement to high-translucent zirconia after aging. High-translucent zirconia abraded with glass beads achieves a desirable bonding performance without creating surface microcracks which may hinder zirconia’s mechanical properties. This article is protected by copyright. All rights reserved.

PMID:33909938 | DOI:10.1111/jopr.13372

Mol Nutr Food Res. 2021 Apr 28:e2000991. doi: 10.1002/mnfr.202000991. Online ahead of print.

ABSTRACT

AIMS: The Optimal Fibre Trial investigated metabolic effects of insoluble cereal fibre in subjects with high-risk prediabetes. As the study shows dose-dependent moderate glycemic and anti-inflammatory benefits, especially in subjects with an obesity-related phenotype, the putative mechanism of action of this particular food component warrants clarification. A sub-group of the OptiFiT cohort received detailed body imaging throughout the study, permitting the analysis of effects on body fat distribution by fibre supplementation.

METHODS: 180 Caucasian participants with impaired glucose tolerance (IGT) received a blinded, randomized supplementation with insoluble cereal fibre or placebo for two years. Once a year, all subjects underwent fasting blood sampling, oGTT and full anthropometric measurements. A subgroup of 47 subjects additionally provided data from magnetic resonance imaging and spectroscopy for quantification of adipose tissue distribution and liver fat content. We compare these outcomes between fibre and placebo group and assess mechanistic connections to improvements in glucose metabolism and inflammation.

RESULTS: MR-assessed visceral and non-visceral body fat volume, fasting glucose, HbA1c, fasting insulin, insulin resistance and uric acid decreased in the fibre group, only. However, after adjustment for weight loss, there are no significant differences in changes of MR-derived measurements of body fat distribution between the intervention groups. There is a statistical trend for fibre-driven liver fat reduction in subjects with confirmed non-alcoholic fatty liver disease (NAFLD; n = 19). The entire MR subgroup shows the same pattern in metabolic improvements as the entire cohort.

CONCLUSIONS: Data and evidence on beneficial effects of insoluble cereal fibre on visceral and hepatic fat storage is limited, but warrants further research. Targetted trials assessing the usefulness of fibre in visceral obesity and NAFLD are required. This article is protected by copyright. All rights reserved.

PMID:33909947 | DOI:10.1002/mnfr.202000991

Interact Cardiovasc Thorac Surg. 2021 Apr 28:ivab030. doi: 10.1093/icvts/ivab030. Online ahead of print.

ABSTRACT

OBJECTIVES: Technology has the potential to assist healthcare professionals in improving patient-doctor communication during the surgical journey. Our aims were to assess the acceptability of a quality of life (QoL) application (App) in a cohort of cancer patients undergoing lung resections and to depict the early perioperative trajectory of QoL.

METHODS: This multicentre (Italy, UK, Spain, Canada and Switzerland) prospective longitudinal study with repeated measures used 12 lung surgery-related validated questions from the European Organisation for Research and Treatment of Cancer Item Bank. Patients filled out the questionnaire preoperatively and 1, 7, 14, 21 and 28 days after surgery using an App preinstalled in a tablet. A one-way repeated measures analysis of variance was run to determine if there were differences in QoL over time.

RESULTS: A total of 103 patients consented to participate in the study (83 who had lobectomies, 17 who had segmentectomies and 3 who had pneumonectomies). Eighty-three operations were performed by video-assisted thoracoscopic surgery (VATS). Compliance rates were 88%, 90%, 88%, 82%, 71% and 56% at each time point, respectively. The results showed that the operation elicited statistically significant worsening in the following symptoms: shortness of breath (SOB) rest (P = 0.018), SOB walk (P < 0.001), SOB stairs (P = 0.015), worry (P = 0.003), wound sensitivity (P < 0.001), use of arm and shoulder (P < 0.001), pain in the chest (P < 0.001), decrease in physical capability (P < 0.001) and scar interference on daily activity (P < 0.001) during the first postoperative month. SOB worsened immediately after the operation and remained low at the different time points. Worry improved following surgery. Surgical access and forced expiratory volume in 1 s (FEV1) are the factors that most strongly affected the evolution of the symptoms in the perioperative period.

CONCLUSIONS: We observed good early compliance of patients operated on for lung cancer with the European Society of Thoracic Surgeons QoL App. We determined the evolution of surgery-related QoL in the immediate postoperative period. Monitoring these symptoms remotely may reduce hospital appointments and help to establish early patient-support programmes.

PMID:33909903 | DOI:10.1093/icvts/ivab030

J Periodontol. 2021 Apr 28. doi: 10.1002/JPER.20-0871. Online ahead of print.

ABSTRACT

BACKGROUND: It is well known that following root surface debridement (RSD) residual deposits remain. Periodontal endoscopy has provided a method of directly visualizing root surfaces during periodontal debridement in an intact pocket without the need for surgical incision. The aim of this study was to determine if periodontal debridement utilizing endoscopic visualization was more effective in improving clinical and radiographic parameters as compared to root surface debridement (RSD).

METHODS: Thirty-eight subjects were randomised into RSD with perioscope (n = 19) or RSD only (n = 19) groups. A full mouth evaluation included probing pocket depths (PPD), clinical attachment levels (CAL), bleeding upon probing (BOP) and plaque scores (PI) recorded at baseline, three and twelve months and compared between groups. Radiographs were taken at sites with deepest pockets at baseline and 12-months and the change in radiographic bone levels (RBL) compared. An independent samples T-test was used to assess statistical significance.

RESULTS: Both groups had significant improvements in clinical outcomes. The test (T) group had a significantly lower percentage of PPDs 7-9 mm at three (0.72±1.2%) and twelve months (0.5±1.0%) as compared to the control (C) group (2.25±2.9%; 1.84±2.3%). At twelve months, the test group recorded a significantly lower mean PPD (T: 2.70+0.2 mm; C: 2.98±0.4 mm), BOP% (T: 4.3±3.2%; C: 11.95±7.1%), PI% (T: 25.61±3.9%; C: 30.11±6.3%) and less change in gingival recession (T: -0.13±0.2 mm; C: -0.50±0.6 mm) (p<0.05). More radiographic bone gain was observed in the test group (0.69±0.3 mm) as compared to the control group (0.49±0.2 mm). This was also observed around multi-rooted teeth (T: 0.83±0.45 mm; C: 0.46±0.36 mm).

CONCLUSION: The adjunctive use of the perioscope provided a slight benefit to the outcomes of non-surgical therapy particularly at deeper probing depths. This article is protected by copyright. All rights reserved.

PMID:33909914 | DOI:10.1002/JPER.20-0871

Rev Saude Publica. 2021 Apr 23;55:12. doi: 10.11606/s1518-8787.2021055003417. eCollection 2021.

ABSTRACT

OBJECTIVES: To estimate the prevalence and factors associated with hesitancy in getting the vaccine against SARS-CoV-2 in Maranhão, Brazil.

METHODS: This is a cross-sectional population-based study conducted from October 19 to 30, 2020. The estimates were calculated based on clustering, stratification, and non-response. A three-stage sampling was adopted, considering stratum, census tracts, and domicile. After systematic analysis, thirty sectors were selected in each stratum, totaling 150 sectors. Each sector contained a fixed number of 34 households, thus totaling 5,100 households. One individual within each household (resident for at least six months and aged one year or more) was selected by a simple random sampling. We questioned participants about their vaccination intention. Univariate association between independent variables and the outcome were verified using descriptive analysis (weighted frequencies) and Pearson’s chi-square test (p < 0.05). Robust multivariate analysis was performed using a three-level hierarchical model.

RESULTS: We found 17.5% (95%CI 16.1-19.1%) of the 4,630 individuals interviewed to report hesitancy to be vaccinated against covid-19. After final model adjustment, vaccination hesitancy was statistically higher among residents of the cities of Imperatriz (24.0%; RP = 1.48; IC95% 1.09-2.02) and municipalities of the Grande Ilha de São Luís (20.7%; RP = 1.34; 95%CI 1.02-1.76), female individuals (19.8%; RP = 1.44; 95%CI 1.20-1.75), older adults (22.8%; RP = 1.79; IC95% 1.30-2.46), evangelicals (24.1%; RP = 1.49; 95%CI 1.24-1.79), and those without reported symptoms (18.6%; RP = 1.24; 95%CI 1.02-1.51). We found no statistical differences for other socioeconomic and demographic characteristics, as well as variables related to the labor market, behaviors, and health conditions of the interviewees.

CONCLUSION: The prevalence of vaccine hesitancy in Maranhão and its association with individual, contextual, and clinical factors enable us to identify the groups and contexts of greatest resistance, requiring special attention from public strategies to ensure wide vaccination.

PMID:33909868 | DOI:10.11606/s1518-8787.2021055003417

Angle Orthod. 2021 May 1;91(3):307-312. doi: 10.2319/080220-676.1.

ABSTRACT

OBJECTIVES: To develop a prediction model that combined information derived from chronological age, sex, and the cervical vertebral maturation (CVM) method to predict the pubertal spurt in mandibular growth.

MATERIALS AND METHODS: A total of 50 subjects (29 females, 21 males) were selected from the American Association of Orthodontists Foundation Craniofacial Growth Legacy Collection, the University of Michigan Growth Study, and the Denver Child Growth study. A total of 456 lateral cephalograms were analyzed, and a multilevel logistic model was applied. The outcome variable was the presence or absence of the mandibular pubertal growth peak. The predictive variables were chronological age up to the third order, sex, presence or absence of CS 3 interactions between age and sex, age and CS 3, sex and CS 3.

RESULTS: The mean age ± standard deviation (SD) at the first cephalogram was 8.2 ± 0.5 years, whereas the mean age at the last cephalogram was 16.5 ± 1.1 years. The mean interval ± SD between two consecutive cephalograms was 1.0 ± 0.1 years. The mean age ± SD at the lateral cephalogram obtained immediately before the mandibular pubertal growth peak was 12.1 ± 1.1 years for females and 13.2 ± 0.8 years for males. The greatest increase in mandibular length occurred after CS 3 in 78% of the subjects. The presence of CS 3, age, second-order age, sex, and the interaction between age and sex were all statistically significant predictors of the mandibular pubertal growth spurt.

CONCLUSIONS: CS 3, chronological age, and sex can be used jointly to predict the pubertal peak in mandibular growth.

PMID:33909876 | DOI:10.2319/080220-676.1