Nevin Manimala

Australas J Ultrasound Med. 2023 Mar 5;26(2):91-99. doi: 10.1002/ajum.12335. eCollection 2023 May.

ABSTRACT

OBJECTIVES: Undergraduate ultrasound education is becoming increasingly important, but its expansion is limited by time, space and the availability of trained faculty. In order to validate an alternative and more accessible teaching model, our aim was to assess whether combining teleguidance and peer-assisted learning to teach ultrasound is as effective as traditional in-person methods.

METHODS: Peer instructors taught 47 second-year medical students ocular ultrasound via either teleguidance or traditional in-person methods. Proficiency was assessed using a multiple-choice knowledge test and objective structured clinical examination (OSCE). Confidence, overall experience, and experience with a peer instructor were measured using a 5-point Likert scale. Two one-sided t-tests were used to measure equivalency between the two groups. The null hypothesis that the two groups were not different was rejected when P < 0.05.

RESULTS: The teleguidance group performed as well as the traditional in-person group in terms of knowledge change, confidence change, OSCE time and OSCE score (p = 0.011, p = 0.006, p = 0.005 and = 0.004, respectively, indicating the two groups are statistically equivalent). The teleguidance group rated the experience highly overall (4.06/5), but less than the traditional group (4.47/5; P = 0.448, indicating statistical difference). Peer instruction was rated 4.35/5 overall.

CONCLUSION: Peer-instructed teleguidance was equivalent to in-person instruction with respect to knowledge change, confidence gain and OSCE performance in basic ocular ultrasound.

PMID:37252618 | PMC:PMC10225007 | DOI:10.1002/ajum.12335

Int J Dent. 2023 Jan 18;2023:4586923. doi: 10.1155/2023/4586923. eCollection 2023.

ABSTRACT

Harmony between facial complexion and gingival health goes hand in hand. Gingival depigmentation is an aesthetic correction of hyperactive melanocytes in gingival tissues that lead to hyperpigmentation. Current study compares depigmentation, pain scores, and itching with scalpel technique and nonsurgical intramucosal Vitamin C injection. 30 individuals in the age range of 18-40 years conscious of dark gums were randomly allocated to test and control group by lottery method. Thorough Phase I therapy was performed one week before the procedure. Area and intensity of depigmentation were evaluated preoperatively and postoperatively; pain score, itching, and repigmentation percentage were the postoperative parameters. After 24 hrs, test group showed significantly lesser VAS score for pain as compared to control group. There was no statistically significant difference in preoperative area of pigmentation between the test and control group (p=0.936). Postoperatively also, there was no statistically significant difference in area of pigmentation between the test and control group (p=0.932). For comparing area of pigmentation, an independent t-test was applied and Mann-Whitney test was used for differentiating the intensity of pigmentation, repigmentation, and VAS score between the groups. The study concluded that Vitamin C mesotherapy and scalpel technique showed comparable results in reduction of areas and intensity of gingival hyperpigmentation.

PMID:37252615 | PMC:PMC10212675 | DOI:10.1155/2023/4586923

Cureus. 2023 Apr 27;15(4):e38206. doi: 10.7759/cureus.38206. eCollection 2023 Apr.

ABSTRACT

Background Interest in atraumatic tooth extraction has increased because it aims to preserve the dental alveolus. Several tools have been designed for atraumatic extraction, including the recently invented physics forceps. This study aims to assess the physics forceps and compare the clinical outcomes to the conventional forceps. Methodology A prospective, randomized, split-mouth, single-blind study was conducted among 20 healthy patients needing bilateral extraction. Participants were randomly assigned to perform physics forceps extraction on one quadrant and conventional forceps extraction on the opposite quadrant. Clinical outcomes were recorded and compared, including time taken for extraction, root fracture, buccal cortical plate fracture, postoperative pain, patient satisfaction, and post-extraction socket healing. Results The mean extraction time of physics forceps was shorter than conventional forceps but without statistical significance. Root and buccal cortical plate fractures were lower in the physics forceps group. Statistical difference in postoperative pain was found on the third postoperative day as pain scored higher in the physics group (p = 0.038). Higher patient satisfaction was found in the physics forceps group (85%). Post-extraction socket healing was equal in 75% of the cases. Conclusions Physics forceps is a novel and efficient atraumatic dental extractor. It reduces intraoperative time, is associated with higher patient satisfaction, and has comparable clinical outcomes to conventional forceps.

PMID:37252611 | PMC:PMC10225155 | DOI:10.7759/cureus.38206

Cureus. 2023 Apr 26;15(4):e38160. doi: 10.7759/cureus.38160. eCollection 2023 Apr.

ABSTRACT

Introduction Age estimation has been an area of special interest in the medicolegal context because of its necessity in various criminal and civil cases like assaults, murders, rapes, inheritance, insurance claims, etc. While legal documents are useful in daily activities that require age identity, they cannot be relied on for criminal and civil proceedings because of being falsifiable and inaccessible to some people. Scientific methods of age determination like physical, dental, and radiological examinations are used for reliable age estimation due to their universal and non-falsifiable nature. The skeletal examination is of great importance here because the human skeleton provides many sites for age estimation in different age groups. The xiphisternal joint between the xiphoid process and the body of the sternum provides one such opportunity in participants of 35-50 years of age. The ossification in this joint proceeds gradually in approximately the third to fifth decade of life; this natural variation in the morphology of the joint can be leveraged for age estimation. Previous studies showed that the mean age of fusion varied with the ethnicity of individuals and environmental factors. Thus, it is critical to have statistical information for the concerned population to avoid errors. Also, the relation of gender with the mean age of complete fusion remained ambiguous with the previous studies. The xiphisternal joint can be studied by radiological techniques like computed tomography (CT) and plain radiographs. Radiological methods have the benefit that they can be used on both living and dead participants and are non-invasive. The present study aims at gathering data relevant for use in India (Maharashtra) and to find out the reference age group in which there is complete ossification of the xiphisternal joint in males and females. Methods and materials This was a cross-sectional observational study in a tertiary care setup over a period of one year. High-resolution computed tomography (HRCT) was used for assessing joint fusion due to its high spatial resolution. The participants were included in the study if they were referred for HRCT chest by a physician for some pathology, did not have any trauma or lesion of the sternum and consented to the use of their information for the purpose of this study. Results The study included a total of 384 participants, out of whom 195 (50.8%) were males and 189 (49.2%) were females. The mean age of participants was 42.87 years. The mean age of complete xiphisternal joint fusion was observed to be 46.31 years (95% CI: 45.61 to 47.00) in males and 45.57 years (95% CI: 44.73 to 46.42) in females. Similarly, the mean age of participants with an unfused xiphisternal joint was observed to be 38.42 years (95% CI: 37.47 to 39.39) in males and 37.85 years (95% CI: 37.14 to 38.57) in females. There was no statistically significant difference in the age above which males and females show complete ossification of the xiphisternal joint. Conclusion The xiphisternal joint fusion can be used to determine the chronological age of an individual. It can be estimated as lesser than or equal to 45 years if the xiphisternal joint is unossified and greater than or equal to 37 years if the joint is ossified, with a 95% level of confidence.

PMID:37252603 | PMC:PMC10218762 | DOI:10.7759/cureus.38160

Cureus. 2023 Apr 28;15(4):e38256. doi: 10.7759/cureus.38256. eCollection 2023 Apr.

ABSTRACT

Introduction Coccidian protozoa and microsporidian fungi are opportunistic pathogens increasingly implicated in infections in immunosuppressed individuals. These parasites typically infect the intestinal epithelium, resulting in secretory diarrhea and malabsorption. The disease burden and timeline are both greater and longer among immunosuppressed patients. Therapeutic options for immunocompromised individuals are limited. As a result, we wanted to better characterize the disease course and treatment efficacy of these parasitic gastrointestinal infections. Methods We performed a single-center, retrospective MedMined (BD Healthsight Analytics, Birmingham, AL, USA) chart review of patients between January 2012 and June 2022 diagnosed with coccidian or microsporidian infections. Relevant data were collected from Cerner’s PowerChart (Oracle Cerner, Austin, TX, USA). Descriptive analysis was performed with IBM SPSS Statistics (IBM Corp., Armonk, NY, USA), and Microsoft Excel (Microsoft, Redmond, WA, USA) was used to generate graphs and tables. Results In these 10 years, there were 17 patients with Cryptosporidium infections, four with Cyclospora infections, and no positive cultures for Cystoisospora belli or microsporidian infections. In both infections, the majority of patients experienced diarrhea, fatigue, and nausea, with vomiting, abdominal pain, appetite loss, weight loss, and fever occurring to a lesser degree. Nitazoxanide was the most common treatment for Cryptosporidium, while trimethoprim-sulfamethoxazole or ciprofloxacin were the treatments of choice for Cyclospora. Of the Cryptosporidium infections, three received combination therapy with azithromycin, immunoreconstitution, or IV immunoglobulins. Among the four Cyclospora-infected patients, one received combination therapy of ciprofloxacin and trimethoprim-sulfamethoxazole. Treatment lasted around two weeks, and 88% of Cryptosporidium patients and 75% of Cyclospora patients had a resolution of symptoms. Conclusion The most detected coccidian infection was Cryptosporidium, followed by Cyclospora, with the lack of Cystoisospora or microsporidian infections likely due to diagnostic limitations and prevalence. Cryptosporidium and Cyclospora likely caused their associated symptoms in most cases, with other possible etiologies, including graft-versus-host disease, medications, and feeding tubes. The small number of patients receiving combination therapy prohibited a comparison with monotherapy. In our patient population, though, there was a clinical response to treatment despite immunosuppression. While promising, additional randomized control experiments are required to fully understand the efficacy of parasitic treatments.

PMID:37252590 | PMC:PMC10225162 | DOI:10.7759/cureus.38256

Cureus. 2023 Apr 24;15(4):e38080. doi: 10.7759/cureus.38080. eCollection 2023 Apr.

ABSTRACT

Introduction Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality, which may be further aggravated by episodes of acute exacerbation of COPD (AECOPD). Electrolyte imbalances during these episodes may add to the duration of hospitalization and disease outcome. Aims and objectives This study aims to compare the serum electrolyte levels of patients with AECOPD and stable COPD and correlate them with the severity of exacerbation and disease outcome. Materials and methods The study was conducted as a case-control study between January 2021 and December 2022. Patients with AECOPD and stable COPD were included as “cases” and “controls,” respectively. The various serum electrolyte levels were defined as per recent guidelines. Statistical analysis was performed using SPSS 20.0 (IBM Corp., Armonk, NY). Results A total of 75 patients were included with 41 in the study group and 34 in the control group. The majority of people were between the ages of 61 and 70. The most frequent electrolyte abnormality found was hyponatremia. The mean serum sodium and calcium levels were lower in patients with AECOPD while the mean serum potassium levels were higher. A total of five deaths were recorded in patients with two or more electrolyte imbalances. The latter also had a requirement for home oxygen or non-invasive ventilation at the time of discharge. Conclusion Patients of AECOPD with multiple electrolyte imbalances need scrutinized treatment as they are more prone to develop complications, have poorer outcomes, and prolonged hospital stays.

PMID:37252565 | PMC:PMC10208846 | DOI:10.7759/cureus.38080

Cureus. 2023 Apr 27;15(4):e38215. doi: 10.7759/cureus.38215. eCollection 2023 Apr.

ABSTRACT

Drug-eluting stents have transformed the treatment of coronary artery disease (CAD), and there are two types: polymer-free and polymer-coated stents. Polymer-free stents have a coating that is quickly absorbed by the body, whereas polymer-coated stents have a coating that remains on the stent surface. This meta-analysis and systematic review aimed to compare the clinical outcomes of these two stent types in patients with coronary artery disease. The literature and abstracts from significant databases were reviewed to compare polymer-free drug-eluting stents (PF-DES) and polymer-coated drug-eluting stents (PC-DES) for the treatment of coronary artery disease (CAD). The primary efficacy endpoints of the study were all-cause mortality and deaths from cardiovascular and non-cardiovascular causes. Among the secondary outcomes were incidences of myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), stent thrombosis, stroke, and major adverse cardiovascular events (MACEs). In terms of the primary outcomes, the combined analysis revealed a marginally lower risk of all-cause mortality (relative risk, RR (95% CI) = 0.92 (0.85, 1.00), p = 0.05, I² = 0%) with the use of PF-DES versus PC-DES. Nonetheless, there was no significant difference in cardiovascular mortality (RR (95% CI) = 0.97 (0.87, 1.08)) or non-cardiovascular mortality (RR (95% CI) = 0.87 (0.69, 1.10), p = 0.25, I² = 9%) between the groups. Furthermore, univariate meta-regression revealed that male gender and prior myocardial infarction were independently associated with an increased risk of all-cause mortality and cardiovascular disease. According to the current meta-analysis, no statistically significant differences existed in PF-DES and PC-DES outcomes. More extensive research is needed to investigate these findings further and establish their validity.

PMID:37252538 | PMC:PMC10224769 | DOI:10.7759/cureus.38215

J Pers. 2023 May 30. doi: 10.1111/jopy.12851. Online ahead of print.

ABSTRACT

OBJECTIVE: The present study examined the hierarchical structure of self-reported fearlessness and compared this structure to external criterion measures.

BACKGROUND: Fearlessness is often discussed in relation to clinical and personality research. However, there is a paucity of research focusing on its empirical structure, in particular with self-report measures.

METHOD: Using a preregistered analytical approach, we employed Goldberg’s 2006 “bass-ackward” factor analysis on self-reported trait fear and fearlessness items to uncover the hierarchical structure of the construct. The final sample consisted of 619 participants and 562 informants.

RESULTS: By assessing fit statistics and interpretability of the factors, we found a six-factor model fit the data best. The six-factor solution emerged as comprehensive and included components labeled Assertiveness, Low Anxiety, Sociability, Recklessness, Openness to Action, and Adventurousness. Criterion variables measuring boldness, fear, anxiety, psychopathy, basic personality traits, and impulsivity, were correlated with the factor scores at each factor level of the model. Conclusions The findings from this study elucidate how trait fearlessness unfolds at varying levels and how these factors relate to and diverge from various outcomes.

PMID:37249023 | DOI:10.1111/jopy.12851

J Magn Reson Imaging. 2023 May 30. doi: 10.1002/jmri.28824. Online ahead of print.

ABSTRACT

BACKGROUND: The promoter variant rs17111237 in the CEP128 closely relates to radiotherapy (RT)-related brain necrosis in nasopharyngeal carcinoma (NPC) patients.

PURPOSE: To explore RT-related dynamic alterations in brain morphology and their potential genetic mechanism, and to explore the modulatory effects of CEP128 genetic variants on RT-related brain morphological alterations in NPC patients.

STUDY TYPE: Prospective, longitudinal.

POPULATION: One hundred one patients with histopathologic ally-proven NPC (age 41.64 ± 9.63, 46 male), analyzed at baseline (pre-RT), 3-months post-RT and 6 months post-RT, and 19 sex-, age- and education-matched healthy controls.

FIELD STRENGTH/SEQUENCE: 3D gradient echo brain volume (3D-BRAVO) and diffusion-weighted single-shot spin-echo echo-planar sequences at 3.0 T.

ASSESSMENT: rs17111237 in CEP128 was detected by Sanger sequencing. Structural and diffusion images were processed with FreeSurfer and FSL. Morphometric similarity network (MSN) was constructed with nine cortical indices derived from structural and diffusion images.

STATISTICAL TESTS: One-way ANOVA, chi-square test. Pearson’s correlation analysis was conducted to measure the relationship between CEP128 gene-expression level in human brain and MSN alterations. Repeated analysis of variance performed to assess group differences in MSN and the modulatory effects of the CEP128 gene within patients. Significance level: P < 0.05, false-discovery rate correction.

RESULTS: RT-related significant widespread MSN alterations were observed in the cortices of NPC patients. Notably, regional MSN alterations had a weak but significant negative correlation with the cortical pattern of CEP128 gene expression (r = -0.152). Furthermore, rs17111237 in the CEP128 had significant modulatory effects on the observed MSN alterations in NPC patients, with the modulatory effects being most obvious at 3 months post-RT.

CONCLUSIONS: MSN has potential to serve as a sensitive biomarker to detect RT-related brain injury. Inter-brain regional and inter-patient variability of RT-related brain injuries may be attributed to the cortical expression of the CEP128 gene and the modulatory effects of the promoter variant rs17111237 in CEP128.

EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 2.

PMID:37249021 | DOI:10.1002/jmri.28824

Fundam Clin Pharmacol. 2023 May 30. doi: 10.1111/fcp.12925. Online ahead of print.

ABSTRACT

The aim of this work was to elucidate the role of GalR2 receptor activation in protecting the rat heart in vivo from I/R damage by a pharmacological peptide agonist WTLNSAGYLLGPβAH-OH (G1) and full-length rat galanin GWTLNSAGYLLGPHAIDNHRSFSDKHGLT-NH2 (G2) using M871, a selective inhibitor of GalR2. The peptides were prepared by the automatic solid phase synthesis using the Fmoc-strategy and purified by HPLC. 40-minute LAD coronary artery occlusion followed by a 60-minute reperfusion was performed. The criteria for damage/protection of the heart were the infarct size (IS) and plasma activity of CK-MB at the end of reperfusion. Intravenous injection of G1 or G2 at an optimal dose of 1 mg/kg at the 5th minute of reperfusion significantly reduced the IS (by 35 and 32%, respectively) and activity of CK-MB at the end of reperfusion (by 43 and 38%, respectively) compared with the control. Administration of M871 (8 mg/kg) 5 min before the onset of reperfusion abolished the effects of G1 on IS and CK-MB activity, returning them to control values. Co-administration of M871 (8 mg/kg) with G2 attenuated protective effect of G2 on both IS and plasma СK-MB activity. However, differences in these parameters between the M871+G2 and G2 groups did not reach statistical significance (P=0.139 and P=0.121, respectively). Thus, GalR2 is the principal receptor subtype that transduces the protective effects of galanin and ligand G1 in myocardial I/R injury. This suggests that GalR2-specific peptide agonists could be used as drug candidates for treating ischemic heart disease.

PMID:37249014 | DOI:10.1111/fcp.12925