Nevin Manimala

Acta Med Acad. 2023 Aug;52(2):119-133. doi: 10.5644/ama2006-124.412.

ABSTRACT

OBJECTIVE: This cross-sectional study determines the impact of the pandemic lockdowns on physical activity, and evaluates the factors associated with physical activity cessation on students and personnel of eight Greek Higher Education Institutions.

MATERIALS AND METHODS: A total of 6,380 volunteer participants completed a survey reporting their physical activity levels and perceptions during the COVID-19 pandemic. The survey was made available through an online platform.

RESULTS: Both the conduct and intensity of physical activity were significantly reduced from the pre-pandemic era to the second lockdown (P<0.001). Walking was the most frequently selected type of physical activity, in all periods except for the second lockdown. Loss of interest (52.4%) was the main, self-reported factor for cessation of physical activity. Females had a 31% lower probability of ceasing physical activity during lockdowns.

CONCLUSION: The conduct and intensity of physical activity decreased significantly during the pandemic. Female gender, annual checkup attendance, and specific physical activity types during the pre-pandemic era were associated with a reduction in the risk of pausing physical activity during lockdowns. Lockdowns may be implemented in future health crises, hence measures for maintaining the physical activity of the general population, such as online group sessions and support from healthcare professionals, should be prepared.

PMID:37933509 | DOI:10.5644/ama2006-124.412

Acta Med Acad. 2023 Aug;52(2):112-118. doi: 10.5644/ama2006-124.411.

ABSTRACT

OBJECTIVES: The aim of this study was to compare the stress response produced during elective CS for the first and second time. For that goal, cortisol blood levels before, during and after childbirth were measured.

MATERIALS AND METHODS: We performed this prospective observational study during the period of September 2020 to September 2021. Blood samples were taken from all participants at three different stages. A statistical analysis was performed to compare the CS1 (first elective Caesarean) and CS2 (second elective Caesarean) groups.

RESULTS: At every stage, the levels of cortisol were statistically higher in the CS1 group than in the CS2 group. Therefore, CS2 generates a significantly less stressful response than CS1. Between stages, in CS2 cortisol was lowered at a faster rate than in CS1, meaning the stress response initiated was present for a longer time period in the CS1 group.

CONCLUSION: A second elective caesarean section is a safe procedure that does not place an unnecessary burden upon the mother. This is an important fact that practitioners can rely upon while designing the ideal management of a pregnant woman for the stressful environment of birth.

PMID:37933508 | DOI:10.5644/ama2006-124.411

Platelets. 2023 Dec;34(1):2264978. doi: 10.1080/09537104.2023.2264978. Epub 2023 Nov 7.

ABSTRACT

Platelets contribute to COVID-19 clinical manifestations, of which microclotting in the pulmonary vasculature has been a prominent symptom. To investigate the potential diagnostic contributions of overall platelet morphology and their α-granules and mitochondria to the understanding of platelet hyperactivation and micro-clotting, we undertook a 3D ultrastructural approach. Because differences might be small, we used the high-contrast, high-resolution technique of focused ion beam scanning EM (FIB-SEM) and employed deep learning computational methods to evaluate nearly 600 individual platelets and 30 000 included organelles within three healthy controls and three severely ill COVID-19 patients. Statistical analysis reveals that the α-granule/mitochondrion-to-plateletvolume ratio is significantly greater in COVID-19 patient platelets indicating a denser packing of organelles, and a more compact platelet. The COVID-19 patient platelets were significantly smaller -by 35% in volume – with most of the difference in organelle packing density being due to decreased platelet size. There was little to no 3D ultrastructural evidence for differential activation of the platelets from COVID-19 patients. Though limited by sample size, our studies suggest that factors outside of the platelets themselves are likely responsible for COVID-19 complications. Our studies show how deep learning 3D methodology can become the gold standard for 3D ultrastructural studies of platelets.

PMID:37933490 | DOI:10.1080/09537104.2023.2264978

Clin Exp Dent Res. 2023 Nov 7. doi: 10.1002/cre2.800. Online ahead of print.

ABSTRACT

OBJECTIVES: Endocrinal variations within an individual impact the electrolyte composition, pH, and flow-rate (FR) of saliva. The aim of this study was to evaluate the gender-specific differences and the effect of combined estrogen-progestin oral contraceptives (COCs) on FR, pH, and electrolyte concentrations in the parotid saliva (PS) of a group of healthy adults.

MATERIAL AND METHODS: Stimulated PS was collected from 20 healthy adults using a Lashley cup; 11 males, 8 females, and 1 female undertaking combined contraceptive therapy (levonorgestrel/ethinyloestradiol 0.1 mg + 0.02 mg). FR and pH were recorded for each saliva sample. Electrolytes concentrations (Na⁺ , Ca²⁺ , K⁺ , Mg²⁺ ) were measured using inductively coupled plasma optical emission spectrometer (ICP-OES). Statistical analysis was performed, and the significance level was set at p < .05.

RESULTS: PS FR varied from 0.13 to 0.42 mL/min in females not taking any medication and from 0.08 to 0.5 mL/min in males not taking any medication. PS pH of females and males not taking any medication ranged from 6.23 to 7.50 and from 6.15 to 7.55. PS pH and FR of the female taking COCs were 6.5 and 0.1 mL/min. PS pH, FR, and electrolytes concentrations (Ca²⁺ , Na⁺ , K⁺ , Mg²⁺ ) were not statistically significantly different between females and males not taking any medication. PS concentrations of Ca²⁺ and Na⁺ were significantly higher in the females taking COCs than in the females not taking any medication. Whereas, concentrations of K⁺ and Mg²⁺ did not differ significantly between the females taking COCs and the females not taking any medication.

CONCLUSIONS: There are no significant gender-specific differences in PS flow rate, pH, and electrolyte concentrations of Na⁺ , Ca²⁺ , Mg²⁺ , and K⁺ . Combined hormonal oral contraceptive has a significant effect on PS flow rate, pH, Ca²⁺ , and Na⁺ concentrations. Whereas the PS concentration of K⁺ and Mg²⁺ are not influenced by COCs. These results warrant further investigation.

PMID:37933471 | DOI:10.1002/cre2.800

J Endovasc Ther. 2023 Nov 7:15266028231209236. doi: 10.1177/15266028231209236. Online ahead of print.

ABSTRACT

OBJECTIVE: The article aimed to compare the efficiency and safety of atherectomy plus balloon angioplasty (BA) with BA alone for the treatment of infrapopliteal arterial disease.

METHODS: According to the inclusion and exclusion criteria, PubMed, Embase, and Cochrane Library database were searched for studies comparing atherectomy plus angioplasty and angioplasty alone in treating infrapopliteal artery lesions until November 2022. The endpoints included technical success, primary patency, clinically-driven target lesion revascularization (CD-TLR), periprocedural complications, distal embolization, target limb major amputation, and all-cause mortality.

RESULTS: Ten studies met the requirements of our meta-analysis, including 7723 patients in the atherectomy plus BA group and 2299 patients in the BA alone group. The meta-analysis showed that atherectomy plus BA was associated with reduced CD-TLR (odds ratio [OR]: 0.51, 95% confidence interval [CI]: 0.34, 0.78, p=0.002) and target limb major amputation (OR: 0.43, 95% CI: 0.19, 1.01, p=0.05) at 12-month follow-up. No statistically significant difference was found in technical success, primary patency, periprocedural complications, distal embolization, or all-cause mortality. Subgroup analysis found a higher rate of primary patency at 6 and 12 months (6 months: OR: 2.26, 95% CI: 1.11, 4.60, p=0.02; 12 months: OR: 2.38, 95% CI: 1.16, 4.86, p=0.02), and lower rates of CD-TLR (OR: 0.45, 95% CI: 0.25, 0.82, p=0.009) and target limb major amputation (OR: 0.43, 95% CI: 0.19, 1.01, p=0.05) at 12 months in patients treated with atherectomy plus drug-coated balloon (DCB) but not in patients treated with atherectomy plus plain old balloon angioplasty (POBA).

CONCLUSIONS: This meta-analysis suggests that compared with BA alone, atherectomy plus BA may reduce the need for CD-TLR and the incidence of target limb major amputation at 12-month follow-up in the treatment of infrapopliteal artery occlusive lesions, even though there are no significant advantages in technical success, primary patency, periprocedural complications, distal embolization, or all-cause mortality. To go further, atherectomy plus DCB shows significant benefits in primary patency, CD-TLR, and target limb major amputation rate but atherectomy plus POBA does not’. However, due to the limitations of this article, more randomized controlled trials (RCTs) are needed to confirm these conclusions.

CLINICAL IMPACT: According to our research, atherectomy combined with BA has the advantages of higher primary patency rate, lower CD-TLR and target limb significant amputation rate in treating infrapopliteal artery occlusive lesions, which may replace the current mainstream surgical method —BA alone. For the clinician, although the surgery may take longer, it will significantly improve the prognosis and quality of life of patients and hold considerable significance for the management of patients with infrapopliteal arterial disease. Based on the characteristics of infrapopliteal artery disease, this study explored the feasibility of atherectomy combined with BA for infrapopliteal artery disease. Moreover, we found that atherectomy combined with DCB had better clinical efficacy, which should be the innovation of this study.

PMID:37933456 | DOI:10.1177/15266028231209236

Vet Comp Oncol. 2023 Nov 7. doi: 10.1111/vco.12940. Online ahead of print.

ABSTRACT

Quality of life (QOL) in dogs with cancer is a key consideration in the assessment of cancer treatment options. Despite interest in dietary strategies to improve management of oncology patients, there have been very few clinical studies showing the impact of diet on adverse effects of chemotherapy in dogs. This study was a randomised, controlled, double-blinded, multicenter clinical trial to investigate a high-protein, increased-fibre diet supplemented with omega-3 fatty acids, for dogs with cancer undergoing standard-of-care chemotherapy. Client-owned dogs with newly diagnosed grade 2 or higher mast cell tumours (or non-resectable/incompletely resected tumours) or multicentric lymphoma were randomised to receive the test diet (n = 24) or control diet (n = 21) for 8 weeks. Primary outcomes were QOL assessments, faecal scores, and blood concentrations of C-reactive protein and monocyte chemoattractant protein-1. Of 12 QOL parameters, 10 significantly improved from baseline to Week 8 in the test group compared with one in the control group. However, differences between the two groups were only statistically significant for ‘frequency of signs of illness’ (P = .009). There were no significant differences in the incidence of any adverse events, including gastrointestinal adverse events or clinically significant differences in laboratory parameters or faecal scores between the two groups. The absence of an observed negative impact of the test diet, combined with the magnitude of QOL improvements associated with the diet, suggest that a larger trial is warranted.

PMID:37933436 | DOI:10.1111/vco.12940

Nutr Clin Pract. 2023 Nov 6. doi: 10.1002/ncp.11089. Online ahead of print.

ABSTRACT

BACKGROUND: Early recognition of sarcopenia in hemodialysis (HD) patients will be of great importance in preventing adverse outcomes and improving the quality of life in these patients. The main goal of this study was to evaluate the diagnostic accuracy of calf circumference (CC) measurement in detecting sarcopenia among CKD patients undergoing maintenance HD.

METHODS: This cross-sectional study included 52 patients (53 ± 17 years) who were currently in a maintenance HD. Muscle strength was evaluated using handgrip strength, and smooth muscle mass index (SMI) was assessed through bioelectrical impedance analysis, and CC was measured at the widest part of the calf with the foot pressed against a hard surface.

RESULTS: Out of the total patient population, sarcopenia was identified in 32.7% (n = 17). The two groups were comparable in terms of age, weight, and height, but the median body mass index of sarcopenic group was statistically lower than nonsarcopenic group (21.6 kg/m² [18.9-24.6] vs 24.7 kg/m² [21.4-27.3]. The sarcopenic group had a substantially smaller CC than the nonsarcopenic group (30.0 cm [26.5-32.0] vs 31.5 cm [30.3-34.8], P = 0.013; respectively). In the regression analysis, CC was found to be independently associated with post-HD SMI (P < 0.001; odds ratio, 1.938; and 95% CI, 1.020-2.856). CC was positively but weakly correlated with handgrip strength, however strong and significant correlation was found between CC and SMI (r = 0.277, P = 0.047 and r = 0.733, P < 0.001; respectively). A CC of 31 cm or less predicted confirmed sarcopenia in HD patients (area under the curve = 0.709, P = 0.006, specificity = 0.556, sensitivity = 0.765).

CONCLUSIONS: Low muscle mass and potentially low muscle strength in HD patients can be accurately identified through the use of CC measurements. Specifically, a CC measurement below 31 cm has found to be a useful indicator to identify individuals on maintenance HD.

PMID:37933421 | DOI:10.1002/ncp.11089

Clin Oral Implants Res. 2023 Nov 6. doi: 10.1111/clr.14208. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to develop a structured light scanning system with a planar mirror to enhance the digital full-arch implant impression accuracy and compare it with photogrammetry and intraoral scanner methods.

MATERIAL AND METHODS: An edentulous maxillary stone cast with six scan bodies was scanned as the reference using a laboratory scanner. Three scanning modalities were compared (n=10): (1) self-developed structured light scanning with a mirror (SSLS); (2) intraoral scanner (IOS); and (3) photogrammetry system (PG). The scanners were stopped for 1 minute after each scan. Six scan bodies were analyzed within each scan model. Linear deviations between the scan bodies (1-2, 1-3, 1-4, 1-5, and 1-6) and 3D mucosal deviations were established. The overall deviation was calculated as the mean of all linear deviations. “Trueness” represented the discrepancy between the test and reference files, while “precision” denoted the consistency among the test files. Kruskal-Wallis and Mann-Whitney U tests were used for statistical analyses.

RESULTS: Significant overall linear discrepancies were noted among the SSLS, PG, and IOS groups (p<.001). SSLS showed the best overall trueness and precision (6.6, 5.7 μm), followed by PG (58.4, 6.8 μm) and IOS (214.6, 329.1 μm). For the 3D mucosal deviation, the trueness and precision (p<.001) of the SSLS group were significantly better than those of the IOS group.

CONCLUSIONS: The SSLS exhibited higher accuracy in determining the implant positions than the PG and IOS. Additionally, it demonstrated better accuracy in capturing the mucosa than IOS.

PMID:37933413 | DOI:10.1111/clr.14208

Pediatrics. 2023 Nov 7:e2023061305. doi: 10.1542/peds.2023-061305. Online ahead of print.

ABSTRACT

BACKGROUND: Relationships between social drivers of health (SDoH) and pediatric health outcomes are highly complex with substantial inconsistencies in studies examining SDoH and extracorporeal membrane oxygenation (ECMO) outcomes. To add to this literature with emerging novel SDoH measures, and to address calls for institutional accountability, we examined associations between SDoH and pediatric ECMO outcomes.

METHODS: This single-center retrospective cohort study included children (<18 years) supported on ECMO (2012-2021). SDoH included Child Opportunity Index (COI), race, ethnicity, payer, interpreter requirement, urbanicity, and travel-time to hospital. COI is a multidimensional estimation of SDoH incorporating traditional (eg, income) and novel (eg, healthy food access) neighborhood attributes ([range 0-100] higher indicates healthier child development). Outcomes included in-hospital mortality, ECMO run duration, and length of stay (LOS).

RESULTS: 540 children on ECMO (96%) had a calculable COI. In-hospital mortality was 44% with median run duration of 125 hours and ICU LOS 29 days. Overall, 334 (62%) had cardiac disease, 92 (17%) neonatal respiratory failure, 93 (17%) pediatric respiratory failure, and 21 (4%) sepsis. Median COI was 64 (interquartile range 32-81), 323 (60%) had public insurance, 174 (34%) were from underrepresented racial groups, 57 (11%) required interpreters, 270 (54%) had urban residence, and median travel-time was 89 minutes. SDoH including COI were not statistically associated with outcomes in univariate or multivariate analysis.

CONCLUSIONS: We observed no significant difference in pediatric ECMO outcomes according to SDoH. Further research is warranted to better understand drivers of inequitable health outcomes in children, and potential protective mechanisms.

PMID:37933403 | DOI:10.1542/peds.2023-061305

J Clin Exp Dent. 2023 Oct 1;15(10):e842-e849. doi: 10.4317/jced.60340. eCollection 2023 Oct.

ABSTRACT

BACKGROUND: Obesity is a prevalent chronic condition affecting children and adults worldwide, and it seems to influence the timing of tooth eruption. The aim of this study was to assess the as-sociation between weight status at age 12 and the eruption of permanent teeth at ages 12 and 14-15 among schoolchildren from southern Brazil.

MATERIAL AND METHODS: A cross-sectional survey was conducted in Porto Alegre, southern Brazil, and included a representative sample of 1,528 12-year-old schoolchildren. After 2.5 years, 801 individuals were reexamined. Baseline data collection included a questionnaire, the record-ing of anthropometric measures (height and weight), and clinical examination to register the number of erupted permanent teeth. At follow-up, the eruption stage of second perma-nent molars was recorded. Statistical analysis used Poisson regression.

RESULTS: Overweight and obese individuals were 32% and 88% more likely to have com-plete permanent dentition at age 12, respectively (overweight, PR=1.32, 95%CI=1.13-1.55; obese, PR=1.88, 95%CI=1.75-2.02). Obese 12-year-olds were more likely to present erupt-ed #17, #27, #37, and #47 at age 12 and to present completely erupted second molars at age 14-15 than normal weight ones.

CONCLUSIONS: This population-based study found a significant association between over-weight/obesity at age 12 and early tooth eruption at ages 12 and 14-15 among schoolchil-dren from southern Brazil. Key words:Tooth eruption, Obesity, Permanent teeth, Epidemiology.

PMID:37933401 | PMC:PMC10625687 | DOI:10.4317/jced.60340