Nevin Manimala

Arthritis Res Ther. 2024 Dec 28;26(1):230. doi: 10.1186/s13075-024-03464-w.

ABSTRACT

OBJECTIVE: To investigate differences in arterial involvement patterns on ¹⁸F-FDG PET-CT between predominant cranial and isolated extracranial phenotypes of giant cell arteritis (GCA).

METHODS: A retrospective review of ¹⁸F-FDG PET-CT findings was conducted on 140 patients with confirmed GCA. The patients were divided into two groups: the cranial group, which presented craniofacial ischemic symptoms either at diagnosis or during follow-up, and the isolated extracranial group which never exhibited such manifestations.

RESULTS: Of the 140 patients (90 women), 99 (71%) were considered to have a predominantly cranial phenotype, while 41 (29%) had isolated extracranial GCA. Patients with the extracranial phenotype were younger (p = 0.001), had lower TAB positivity (25%), and experienced longer diagnostic delays (p = 0.004). Polymyalgia rheumatica was more common in the extracranial group (p = 0.029), which also showed fewer constitutional symptoms, milder increases in acute phase reactants, and more frequent limb claudication and aortic complications, although these differences were not statistically significant. When comparing arterial involvement on ¹⁸F-FDG PET-CT, we observed statistically significant differences. The extracranial phenotype showed greater involvement across all segments of the thoracic aorta (p = 0.001), as well as in the abdominal aorta (p = 0.005), subclavian (p = 0.021), iliac (p = 0.004), and femoral arteries (p = 0.025). In contrast, the cranial phenotype exhibited a higher frequency of vertebral artery involvement (p < 0.001).

CONCLUSION: Significant differences in arterial involvement patterns on ¹⁸F-FDG PET-CT were observed between phenotypes. These findings may explain atypical symptoms such as inflammatory lower back pain or limb claudication and the increased risk of aortic complications in extracranial GCA.

PMID:39732686 | DOI:10.1186/s13075-024-03464-w

BMC Med Inform Decis Mak. 2024 Dec 28;24(1):410. doi: 10.1186/s12911-024-02835-2.

ABSTRACT

BACKGROUND: High triglyceride (TG) affects and is affected of other hematological factors. The determination of serum fasted triglycerides concentrations, as part of a lipid profile, is crucial key point in hematological factors and significantly affect various systemic diseases. This study was carried out to assess the potential relation between the concentration of TG and hematological factors.

METHOD: Our sample size was 9704 participants beginning in 2007 and ending in 2020 aged between 35 and 65 years, sourced from the MASHAD cohort (northeastern Iran). Machine learning methodologies, specifically logistic regression, decision tree, and random forest algorithms, were utilized for data analysis in the investigation of individuals with normal and high TG levels.

RESULTS: The highest Gini score belongs to RLR (Red cell distribution width/Lymphocyte) (236.10), RPR (Red cell distribution width/Platelets) (215.78), and PHR (Platelets/high-density lipoprotein) (273.66). We also found that factors such as age are statistically associated with the level of TG in women probably due to the drop in menopausal estrogen. RF model showed to have higher accuracy in predicting the TG level in both males and females.

CONCLUSION: Our model assessed the association between serum TG with several hematological factors like RLR, RPR, and PHR. Other hematological factors also have been reported to be related to the TG level. As these results give us new insights into the association of TG on various hematological factors and their possible interactions with each other. future studies are needed to provide sufficient data for the mechanism and the pathophysiology of the findings.

PMID:39732685 | DOI:10.1186/s12911-024-02835-2

BMC Oral Health. 2024 Dec 28;24(1):1565. doi: 10.1186/s12903-024-05357-5.

ABSTRACT

BACKGROUND: Endodontic emergencies, often presented as acute pain or swelling, constitute a substantial challenge in dental practice. While effective management emphasizes prompt intervention, antibiotics are typically indicated only when systemic signs and symptoms are present. There is limited research exists on evaluating the knowledge and clinical approach of dental practitioners in managing endodontic emergencies from our region of the world. Therefore, this study aims to evaluate dentists’ knowledge, attitude, and practices regarding clinical management and the prescription of antibiotics in endodontic emergency cases.

MATERIALS AND METHODS: A web-based questionnaire was distributed to working dentists in secondary and tertiary care hospitals and clinics. Eligible participants included dental practitioners, postgraduate trainees, and consultants. The questionnaire included demographic information and inquiries about endodontic emergency treatment approaches, antibiotic prescribing habits, and awareness of guidelines. Statistical analysis was performed Stata software version 17 (StataCorp, College Station, Texas, USA), employing a χ2 test.

RESULTS: Of the 527 dentists approached, 409 completed the survey (response rate: 77.6%). The majority of respondents were female (68%) and general dental practitioners (60.32%) with up to 5 years of experience (80.93%). Survey findings highlighted varied treatment approaches, favoring root canal treatment in multiple visits for cases of both irreversible pulpitis (73.59%) as well as with necrotic pulps/periapical lesions (79.95%). Similarly, 45.48% and 37.9% of the respondents favored pulpectomy combined with analgesics and antibiotics in managing irreversible pulpitis and acute apical periodontitis respectively. Moreover, antibiotics were frequently prescribed for acute apical abscess, with amoxicillin-clavulanate being the most common choice (83.6%). Most practitioners (69%) recommended a minimum of 5-day antibiotic course.

CONCLUSIONS: This study highlights Pakistani dentists’ preferences in managing endodontic emergencies and prescribing antibiotics. Despite awareness of guidelines and the consequences of overuse, there’s a tendency towards antibiotic overprescription, indicating a need for educational interventions to promote rational antibiotic use and mitigate antibiotic resistance.

PMID:39732678 | DOI:10.1186/s12903-024-05357-5

BMC Geriatr. 2024 Dec 28;24(1):1044. doi: 10.1186/s12877-024-05586-x.

ABSTRACT

BACKGROUND: Fall prevention programmes are essential interventions in societies with aging populations. This study assessed the fall rate and other health outcomes, as well as the cost-effectiveness of a home-based fall prevention programme for community-dwelling older people. In a single home visit, trained physical or occupational therapists performed fall risk assessments, eliminated environmental risk factors, and provided tailored exercises.

METHODS: A prospective, longitudinal observational study was performed with participants of a fall prevention programme who agreed to be followed-up over one year. Baseline data included self-reported falls one month and one year before the intervention. Participants were monitored through bi-monthly telephone calls, assessing their number of falls, fear of falling (using the Falls Efficacy Scale-International (FES-I), quality of life (using the EuroQuol-5 Dimensions-5 Levels, EQ-5D-5L), and physical activity (in minutes per week). Statistical analysis of the data used a Generalized Estimating Equations (GEE) Poisson-Modell for number of falls and a Linear Mixed Model (LMM) for fear of falling, quality of life and physical activity. In addition, health insurance claims data were used to compare the number of medically treated falls in the year before and after the intervention, as well as the related healthcare spending. Cost-effectiveness of the programme versus usual care was estimated as cost per prevented medically treated fall.

RESULTS: Overall, 639 person-years of observation time were analyzed. Participants had a mean age of 81.8 years (+/- 5.2) and 59% were female. On average, the fall rate decreased from 1.35 to 1.02 per person-year, or -23.9% (95%CI from -35.92 to -9.67), fear of falling decreased by -1.27 points (95%CI from -1.50 to -1.05), quality of life improved by -0.88 points (95%CI from -1.09 to -0.68), and physical activity increased by 9.87 min per day (95%CI from 5.65 to 14.09). Analysis of claims data showed a 48.0% reduction (95%CI from 30.5% to 61.0%) in medically treated falls. The average cost per prevented medically treated fall was estimated at approximately 1,353 USD, with a 50% probability of the intervention being cost saving.

CONCLUSIONS: This fall prevention programme with a single home visit was found to be effective and cost effective. Health policies should establish such a model as a reimbursed standard care to assist in combatting the increasing burden of falls on individuals and societies.

PMID:39732675 | DOI:10.1186/s12877-024-05586-x

BMC Med Educ. 2024 Dec 28;24(1):1545. doi: 10.1186/s12909-024-06578-6.

ABSTRACT

BACKGROUND: Effective communication with patients and their families is a fundamental skill for medical students to cultivate during their undergraduate training. However, communicating with pediatric patients presents unique challenges. This study investigated the perceptions, attitudes, and confidence levels of undergraduate medical students regarding communication skills in pediatrics.

METHODS: A cross-sectional, quantitative, descriptive, and analytical survey was conducted by applying a validated questionnaire, the Housestaff Communication Survey (HCS), to medical students from two higher education institutions in Minas Gerais, Brazil. Data analysis was conducted using SPSS and Excel, employing descriptive statistical tests and multiple logistic regression analyses to evaluate communication, importance, and confidence.

RESULTS: A total of 520 (52%) students participated in the study, with 422 (81.15%) aged from 20 to 29 years and 365 (68.27%) women. While only 113 (21.73%) students reported receiving training in communication skills with both adults and children during their undergraduate studies, over half (270) reported no such training. Those lacking training exhibited lower confidence levels compared with those trained exclusively with adults. Although most students recognized the importance of communication skills, their confidence levels were generally below 60%. Multiple logistic regression analysis identified gender, institution, academic period, and training as significantly associated variables with communication scores.

CONCLUSIONS: Training, gender, and academic period emerged as the most significant variables influencing communication skills. Most students expressed lower confidence in interviewing children. To enhance communication with pediatric patients and their families, comprehensive training in pediatric communication skills during undergraduate studies is imperative.

PMID:39732667 | DOI:10.1186/s12909-024-06578-6

BMC Pregnancy Childbirth. 2024 Dec 28;24(1):873. doi: 10.1186/s12884-024-07096-5.

ABSTRACT

BACKGROUND: Maternal hemoglobin (Hb) is related to nutritional status, and it widely fluctuates during pregnancy. However, the relationship between Hb and blood pressure (BP) during pregnancy is unclear. This study aimed to estimate the associations between maternal Hb in various trimesters and its changes with BP during pregnancy.

METHODS: We conducted this study by using data from the Electronic Medical Record System (EMRS) database of Zhoushan Maternal and Child Care Hospital in Zhejiang Province, China. The pregnancy duration was divided into seven periods: before 14th, 14 to 17th, 18 to 22nd, 23 to 27th, 28 to 31st, 32 to 35th, and 36 to delivery; generalized estimating equations (GEE) and multiple linear regressions were used for exploring their associations.

RESULTS: 8168 pregnant women in the first trimester were included in this study. Hb level decreased significantly from the first to late-second trimester and then increased but did not return to the level of the first trimester. After adjustment for the potential confounders, compared with women with Hb 110 ~ 119 g/L, those with Hb < 110 g/L had low systolic BP (SBP) and diastolic BP (DBP) in the second and third trimesters and those with Hb ≥ 120 g/L had high SBP and DBP in various trimesters. Furthermore, the dose-response effect was observed between them; except that those with Hb < 100 g/L had high SBP in T1 (β = 2.85, P = 0.012). Hb concentration changes during pregnancy were also positively associated with BP level. Furthermore, Hb had a higher effect on DBP than SBP. It is worth noting that the Hb concentration in > = 140 g/L groups had significantly higher SBP and DBP than the other groups. A significant nonlinear relationship was found between hemoglobin changes with both SBP and DBP in different gestational weeks (P non-linear < 0.05).

CONCLUSIONS: This study found that maternal Hb was positively associated with BP during pregnancy and maternal Hb > 120 g/L during pregnancy and increased maternal Hb from the first to third trimesters should especially be given more attention.

PMID:39732648 | DOI:10.1186/s12884-024-07096-5

BMC Oral Health. 2024 Dec 28;24(1):1566. doi: 10.1186/s12903-024-05361-9.

ABSTRACT

BACKGROUND: The success of a restoration largely depends on the quality of its fit. This study aimed to investigate the fit quality of monolithic zirconia veneers (MZVs) produced through traditional and digital workflows.

METHODS: A typodont maxillary right central incisor was prepared. The maxillary arch with the prepared tooth was scanned with Trios 3 Pod intra-oral scanner (IOS), which served as a pattern to create thirty 3D resin models through printing. Additionally, thirty conventional impressions of the maxillary with the prepared tooth were taken using polyvinyl siloxane (PVS) impression material. These impressions were cast using dental gypsum products to create thirty stone dies, which were then scanned externally. Sixty MZVs were milled from multi-layered zirconia disks. The marginal and internal gaps of restorations were assessed using the silicone replica technique.

RESULTS: The highest marginal accuracy for both the conventional and digital impression groups was observed in the cervical area, with values of 74.6 μm and 61.9 μm, respectively. The smallest internal gaps for both groups were also recorded in the cervical area, at 109.9 μm for the conventional group and 109.7 μm for the digital group. The digital group exhibited better marginal fit, particularly in the incisal and mesial areas (79.3 μm and 75.7 μm, respectively), compared to the conventional group (88.1 μm and 90.8 μm). No statistically significant differences in internal fit were observed.

CONCLUSION: MZVs fabricated using the digital workflow exhibited superior marginal fit compared to those fabricated using the conventional workflow, though both techniques yielded clinically acceptable results.

PMID:39732646 | DOI:10.1186/s12903-024-05361-9

BMC Complement Med Ther. 2024 Dec 28;24(1):428. doi: 10.1186/s12906-024-04723-8.

ABSTRACT

INTRODUCTION: Sarcopenia is a disease primarily characterized by age-related loss of skeletal muscle mass, muscle strength, and/or decline in physical performance. Sarcopenia has an insidious onset which can cause functional impairment in the body and increase the risk of falls and disability in the elderly. It significantly increases the likelihood of fractures and mortality, severely impairing the quality of life and health of the elderly people. This disease poses a heavy burden on the healthcare system and society in our country, and currently, there are limited clinical intervention strategies for sarcopenia. This study aims to explore the clinical efficacy and safety of electroacupuncture in treating sarcopenia.

METHODS AND ANALYSIS: In this parallel-design, randomized, sham-controlled trial, a total of 168 elderly sarcopenia patients will be randomly assigned in a 1:1 ratio to receive either electroacupuncture (EA) or sham electroacupuncture (sEA) treatment. The acupuncture points used in the study are Hegu (LI4), Shousanli (LI10), Quchi (LI11), Binao (LI14), Futu (ST32), Liangqiu (ST34), Zusanli (ST36), and Jiexi (ST41). The participants will receive EA or sEA treatment three times per week for eight weeks. The primary outcome measure is the change in grip strength (GS) of the patients after the eight-week treatment. The secondary outcome measures include the changes in grip strength at the fourth and twentieth weeks, changes in appendicular skeletal muscle mass index (ASMI), the Short Physical Performance Battery (SPPB) score, the physical activity level (PAL) assessed by the International Physical Activity Questionnaire (IPAQ), assessment of expectations regarding the efficacy of acupuncture, patient subjective evaluation of efficacy, and evaluation of blinding efficacy of acupuncture. All statistical analyses will be conducted according to the intention-to-treat principle and as per the study protocol.

ETHICS AND DISSEMINATION: This study protocol was reviewed and approved by the Institutional Review Board of West China Hospital of Sichuan University (permission number: 2023 – 525). The participants will provide written informed consent to participate in this study.

TRIAL REGISTRATION: Chinese Clinical Trial Registry ( http://www.chictr.org.cn ), Registration number: ChiCTR2300079294. Date of Registration: 2023-12-29.

PMID:39732636 | DOI:10.1186/s12906-024-04723-8

BMC Infect Dis. 2024 Dec 28;24(1):1472. doi: 10.1186/s12879-024-10359-3.

ABSTRACT

BACKGROUND: Pseudomonas aeruginosa is one of the leading causes of nosocomial infections and the most common multidrug-resistant pathogen. This study aimed to determine antimicrobial resistance patterns, biofilm-forming capacity, and associated factors of multidrug resistance in P. aeruginosa isolates at two hospitals in Addis Ababa, Ethiopia.

METHODS: A cross-sectional study was conducted from August 2022 to August 2023 at Tikur Anbessa Specialized Hospital and Yekatit 12 Hospital Medical College. Culture and identification of P. aeruginosa were done using standard microbiological methods. An antimicrobial susceptibility test was done by Kirby-Bauer disk diffusion according to CLSI recommendations. The microtiter plate assay method was used to determine biofilm-forming capacity. SPSS version 25 was used for data analysis. Bivariate and multivariable logistic regression were used to assess factors associated with multidrug resistance in P. aeruginosa. The Spearman correlation coefficient (rs = 0.266)) was performed to evaluate the relationship between biofilm formation and drug resistance.

RESULTS: The overall prevalence of P. aeruginosa was 19.6%. High levels of resistance were observed for ciprofloxacin (51.8%), ceftazidime (50.6%), and cefepime (48.2%). The level of multidrug-resistance was 56.6%. The isolates showed better susceptibility to ceftazidime-avibactam (95.2%) and imipenem (79.5%). Overall, 95.2% of P. aeruginosa were biofilm-producing isolates, and 27.7% and 39.8% of isolates were strong and moderate biofilm producers, respectively. A positive correlation and statistically significant relationship was observed between resistance to multiple drugs and the level of biofilm formation (rs = 0.266; p-value = 0.015). Previous history of exposure to ciprofloxacin (OR, 5.1; CI, 1.12-24.7, p-value, 0.032) was identified as an independent associated factor for multidrug resistance in P. aeruginosa.

CONCLUSION: The present study indicates an association between multidrug resistance in P. aeruginosa and its biofilm formation capabilities. Additionally, over half of the isolates were resistant to multiple drugs, with prior use of ciprofloxacin linked to the development of multidrug-resistance. These findings suggest that antibiotic stewardship programs in hospital settings may be beneficial in addressing resistance.

PMID:39732630 | DOI:10.1186/s12879-024-10359-3

Plant Foods Hum Nutr. 2024 Dec 28;80(1):21. doi: 10.1007/s11130-024-01261-z.

ABSTRACT

Cellulite is an aesthetically distressing skin condition occurring in 80-90% of females and manifesting as dimples and depressions, producing an uneven surface to the skin. Our aim was to evaluate the effect of combined oral consumption of two dietary supplements based on chokeberry and tart cherry juices over a period of 32 days on cellulite reduction. Twenty women aged 21-49 with a cellulite grade of 1-2 according to the Nurnberger-Muller scale were participating in the study. Ultrasonography was applied to analyze the skin structure in addition to biochemical and anthropometric parameters, which were measured before starting the treatment and after 32 days. A reduction in the thickness of the dermis with subcutaneous fat tissue, subcutaneous fat tissue alone, epidermis, and dermis with epidermis (15.02, 14.34, 21.98, and 20.94%, respectively) was noticed, while the length of the fascicles was reduced by 35.93%. Out of 20 subjects, 11 (57.9%) had edema of the dermis at the beginning of the study, which was not recorded at the end of the study. Moreover, a statistically significant increase in the tissue doppler (TD) signals was recorded in all subjects treated with two dietary supplements, indicating a better blood supply. Changes in anthropometric and biochemical parameters were not recorded. Creatinine, urea, ALT, and AST values, as indicators of kidney and liver function, remained at normal reference levels, pointing out the product’s safety. The positive effect of chokeberry and tart cherry juice-based dietary supplements consumption in cellulite condition could be connected with microcirculation improvements.

PMID:39731691 | DOI:10.1007/s11130-024-01261-z