Nevin Manimala

Respir Med. 2021 Dec 2;191:106705. doi: 10.1016/j.rmed.2021.106705. Online ahead of print.

ABSTRACT

Diffusing capacity for carbon monoxide (DLCO) was measured in a phase I single ascending dose study after inhalation of AZD8154 or placebo in healthy participants at baseline (DLCO_Baseline) and follow-up (DLCO_Follow-up) 6 days after dosing. Initially, DLCO_Follow-up timepoint was 2 h earlier than the DLCO_Baseline timepoint and clinically significant decreases in DLCO_Follow-up (absolute change up to 19% from baseline and DLCO_%predicted values less than 70) were observed then. The observed reduction in DLCO_Follow-up was confirmed as a false positive finding after alignment of DLCO timings. As a consequence, when DLCO is used in clinical studies, measurements should be strictly standardized in relation to time of the day.

PMID:34879298 | DOI:10.1016/j.rmed.2021.106705

J Gynecol Obstet Hum Reprod. 2021 Dec 5:102281. doi: 10.1016/j.jogoh.2021.102281. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the thymic-thoracic ratio (TT ratio) on fetal ultrasound and its association with conotruncal heart defects.

METHODS: A case control study was carried out to retrospectively assess the TT ratio on fetal echocardiograms performed between 19 and 39 weeks of gestation, showing congenital heart defects, from January to December 2018. The control group was comprised of fetuses with no echocardiogram evidence of congenital cardiac malformations. Cases of multiple pregnancies and patients where the TT ratio could not be established have been excluded.

RESULTS: A total of 338 pregnancies have been analysed. Fifty-two pregnancies were diagnosed with fetal heart defects (15%), 17 of which showed conotruncal heart defects (32.7%). The TT ratio in normal fetuses (286 pregnancies) increased with gestational age, and had an average of 0.43 ± 0.06. Compared to the control group (normal fetuses), fetuses with conotruncal heart defects had significantly lower mean TT ratio (0.33 ± 0.07). Those that were diagnosed with nonconotruncal heart defects did not show any statistically significant difference in the TT ratios compared with the control group (0.40 ± 0.09 vs. 0.43 ± 0.06, respectively).

CONCLUSION: The TT ratio was significantly lower in fetuses with conotruncal heart defects compared with both the control group (normal fetuses) and the fetuses with nonconotruncal heart defects.

PMID:34879297 | DOI:10.1016/j.jogoh.2021.102281

Photodiagnosis Photodyn Ther. 2021 Dec 5:102674. doi: 10.1016/j.pdpdt.2021.102674. Online ahead of print.

ABSTRACT

PURPOSE: To compare the differences in retinal vascular structure and choroidal thickness between the active disease and post-recovery periods in COVID-19 patients and healthy controls.

MATERIAL AND METHODS: This prospective, cross-sectional study included 30 eyes from 30 patients with severe COVID-19 and 30 eyes of 30 sex-matched healthy controls. Central macular thickness (CMT), subfoveal choroidal thickness (CT) and retinal vascular changes of patients were measured after positive polymerase chain reaction (PCR) (where the patient had COVID-19-related symptoms) and then three months after two negative PCRs. Laboratory parameters, including C-reactive protein and D-dimer levels, were also recorded.

RESULTS: The mean age of the patients was 47.90 ± 9.06 years in patients group, 49.07 ± 8.41 years in control goups (p=0.467). In terms of choroidal thicknesses subfoveal, nasal and temporal region were significantly higher in the active disease period than control group (p=0.019, p=0.036, p=0.003, respectively). When the after recovery period was compared with the control group in terms of choroidal thickness, although the choroidal thickness was higher in all regions, this difference was not found statistically significant. There was no statistically significant difference in CMT between groups (p=0.506).The mean venous and arterial wall thicknesses were significantly higher in the active period than after recovery (p=0.023, p=0.013, respectively) but there were no differences between after recovery and control groups in the pairwise comparison (p=0.851, p=0.715, respectively).

CONCLUSION: In patients with severe COVID-19, there are changes in thickness of the choroid and retinal vessel walls. While vascular wall thickness increases due to inflammation, the absence of lumen changes may be associated with hemodynamic variables.

PMID:34879296 | DOI:10.1016/j.pdpdt.2021.102674

J Affect Disord. 2021 Dec 5:S0165-0327(21)01326-4. doi: 10.1016/j.jad.2021.12.009. Online ahead of print.

ABSTRACT

OBJECTIVE: The present study aims to investigate the association between PM_2.5 exposure and major depressive disorder, and to examine whether vitamin D and physical activity could attenuate the impact of PM_2.5 on major depressive disorder.

METHODS: 39168 elderly adults (age≥60 years) who had valid estimates on exposure of PM_2.5 in 2010 and data on major depressive disorder were extracted from the UK Biobank. Major depressive disorder was assessed by lifetime experience of mild, moderate, and severe major depression with validated instruments. Logistic regression models were used to estimate the association between PM_2.5 exposure and major depressive disorder.

RESULTS: A total of 9079 participants had major depressive disorder, with a prevalence of 23.2%. The odds ratio (OR) of major depressive disorder was 1.096 (1.023, 1.175) for participants in the highest quartile compared with the lowest quartile of PM_2.5. The correlation of PM_2.5 with major depressive disorder generally increased with the decreasing levels of vitamin D. For instance, in participants with the highest quartile of PM_2.5, the corresponding ORs were 1.141 (0.951, 1.369), 1.232 (1.027, 1.478), 1.286 (1.072, 1.543), and 1.390 (1.159, 1.667) for those who had adequate, desirable, insufficient, and deficient levels of vitamin D, respectively. Additionally, significant modification effects of physical activity on the relationship between PM_2.5 and major depressive disorder were also observed.

CONCLUSIONS: Our study suggests that high levels of vitamin D and physical activity may attenuate the relationship between PM_2.5 and major depressive disorder among elderly adults.

PMID:34879260 | DOI:10.1016/j.jad.2021.12.009

J Dent. 2021 Dec 5:103918. doi: 10.1016/j.jdent.2021.103918. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the effect of a glutaraldehyde-based desensitizer on the postoperative sensitivity (POS) in posterior resin composite restorations up to 12 months using a universal adhesive (Tetric N-Bond Universal) with selective enamel etching (SE) or an etch-and-rinse (ER) strategy.

METHODS: Class I and class II resin composite restorations (n=220) at least 3 mm deep were inserted in 55 subjects. The universal adhesive was applied using the SE (self-etch strategy on dentin with selective enamel etching) or the ER strategy, with or without prior application of a glutaraldehyde-based desensitizer (Gluma Desensitizer – GL) to form groups XXGL and ERGL. A bulk-fill resin composite (Tetric N-Ceram Bulk Fill) was used for all restorations. Spontaneous POS was assessed 7 days after the restorative procedure using the Visual Analog Scale (VAS) and the Numeric Rating Scale (NRS). After 7, 14, and 30 days of completing each restoration, the subjects were reassessed to evaluate POS caused by stimulation with an air blast, horizontal and vertical percussion. In addition, marginal discoloration, marginal adaptation, fracture, and recurrence of caries were evaluated using the FDI (World Dental Federation) criteria after 7 days and at 12 months.

RESULTS: No significant spontaneous or stimuli-induced POS was observed when restorations with or without GL were compared (p>0.05). A higher risk of spontaneous POS was observed within 7 days (40.0%; 95% CI 28.1 to 53.1), without statistically significant differences among groups. None of the participants reported POS at 12 months, however five restorations were considered clinically unsatisfactory (p > 0.05).

CONCLUSIONS: The previous application of GL did not significantly reduce spontaneous or stimuli-induced POS in posterior resin composite restorations at any time, regardless of the adhesive strategy used.

CLINICAL SIGNIFICANCE: The use of a glutaraldehyde-based desensitizing agent did not generate lower incidence of postoperative sensitivity in resin composite posterior restorations.

PMID:34879245 | DOI:10.1016/j.jdent.2021.103918

Int J Infect Dis. 2021 Dec 5:S1201-9712(21)01204-2. doi: 10.1016/j.ijid.2021.12.310. Online ahead of print.

NO ABSTRACT

PMID:34879227 | DOI:10.1016/j.ijid.2021.12.310

Semin Thorac Cardiovasc Surg. 2021 Dec 5:S1043-0679(21)00494-9. doi: 10.1053/j.semtcvs.2021.12.003. Online ahead of print.

ABSTRACT

Anticoagulation could not be currently stopped even after successful thoracoscopic ablation of atrial fibrillation for at least two months. The aim of this study is to compare the safety and efficacy outcomes between a new oral anticoagulant and warfarin after thoracoscopic ablation. This trial was a single-center, prospective, randomized controlled study comparing edoxaban and warfarin in patients undergoing thoracoscopic ablation of atrial fibrillation. This study enrolled 60 patients randomly assigned into two groups. The primary endpoint was efficacy outcomes, including stroke and systemic thromboembolic events. The secondary endpoint was safety outcomes including major bleeding and pericarditis. The patients were evaluated at discharge, two weeks, three months, and six months postoperatively. No stroke and thromboembolic events were noted in both treatment groups during the follow-up period. During the 6 months follow-up period, 4 (13%) of 30 patients in the edoxaban group experienced minor bleeding events, whereas none were noted in the warfarin group. Five anticoagulation-related events (bleeding, and prolongation of international normalized ratio), including pericarditis, were noted in both the edoxaban and warfarin groups. No statistically significant difference existed between the two groups. In conclusion, this study showed the comparable results of edoxaban to warfarin during the window period of post-thoracoscopic ablation of atrial fibrillation. Moreover, anticoagulation-related events were rather affected by patient factors and not by the anticoagulant type.

PMID:34879226 | DOI:10.1053/j.semtcvs.2021.12.003

Hosp Pract (1995). 2021 Dec 8. doi: 10.1080/21548331.2021.2016334. Online ahead of print.

ABSTRACT

OBJECTIVES: Our project aimed to increase knowledge of non-invasive diagnostic modalities (including bone radiotracer scintigraphy), raise suspicion of transthyretin cardiac amyloidosis (ATTR-CA) and improve cardiology team member’s awareness and knowledge of shared decision-making (SDM) as well as the quality of SDM communication between cardiology team members and patients.

METHODS: An online educational module and survey was developed and cardiology team members in Colorado, USA were invited to participate. This online educational module included various important topics related to ATTR-CA (e.g., the cause of ATTR-CA, endomyocardial biopsy, and non-invasive methods to diagnose ATTR-CA) and SDM (e.g., benefits of SDM, the role of SDM in the diagnosis of ATTR-CA, implementation SDM in your cardiology practice and the 3-talk model).

RESULTS: There were 34 survey respondents, over one-third of whom were cardiologists. Most respondents agreed on the importance of diagnosing ATTR-CA at the early stage, and about three-quarters of the survey takers agreed that bone scintigraphy can reliably diagnose ATTR-CA without the need for endomyocardial biopsy. Concern for increased time commitment was the leading barrier to the implementation of SDM in respondents’ clinical practice. The majority of respondents identified the correct answer regarding ATTR-CA and SDM after reading the online educational module. This improvement in scores after exposure to the online educational module was statistically significant.

CONCLUSION: Baseline knowledge and awareness of various issues related to ATTR-CA was relatively low among cardiology team members. Participants’ knowledge was enhanced through our effective online educational program. Prospective educational projects focused on various methods of detecting ATTR-CA as well as other amyloid conditions in diverse clinical settings will remain important.

PMID:34879213 | DOI:10.1080/21548331.2021.2016334

N Engl J Med. 2021 Dec 8. doi: 10.1056/NEJMc2103227. Online ahead of print.

NO ABSTRACT

PMID:34879193 | DOI:10.1056/NEJMc2103227

N Engl J Med. 2021 Dec 8. doi: 10.1056/NEJMoa2115926. Online ahead of print.

ABSTRACT

BACKGROUND: After promising initial results from the administration of a third (booster) dose of the BNT162b2 messenger RNA vaccine (Pfizer-BioNTech) to persons 60 years of age or older, the booster campaign in Israel was gradually expanded to persons in younger age groups who had received a second dose at least 5 months earlier.

METHODS: We extracted data for the period from July 30 to October 10, 2021, from the Israel Ministry of Health database regarding 4,696,865 persons 16 years of age or older who had received two doses of BNT162b2 at least 5 months earlier. In the primary analysis, we compared the rates of confirmed coronavirus disease 2019 (Covid-19), severe illness, and death among those who had received a booster dose at least 12 days earlier (booster group) with the rates among those who had not received a booster (nonbooster group). In a secondary analysis, we compared the rates in the booster group with the rates among those who had received a booster 3 to 7 days earlier (early postbooster group). We used Poisson regression models to estimate rate ratios after adjusting for possible confounding factors.

RESULTS: The rate of confirmed infection was lower in the booster group than in the nonbooster group by a factor of approximately 10 (range across five age groups, 9.0 to 17.2) and was lower in the booster group than in the early postbooster group by a factor of 4.9 to 10.8. The adjusted rate difference ranged from 57.0 to 89.5 infections per 100,000 person-days in the primary analysis and from 34.4 to 38.3 in the secondary analysis. The rates of severe illness in the primary and secondary analyses were lower in the booster group by a factor of 17.9 (95% confidence interval [CI], 15.1 to 21.2) and 6.5 (95% CI, 5.1 to 8.2), respectively, among those 60 years of age or older and by a factor of 21.7 (95% CI, 10.6 to 44.2) and 3.7 (95% CI, 1.3 to 10.2) among those 40 to 59 years of age. The adjusted rate difference in the primary and secondary analyses was 5.4 and 1.9 cases of severe illness per 100,000 person-days among those 60 years of age or older and 0.6 and 0.1 among those 40 to 59 years of age. Among those 60 years of age or older, mortality was lower by a factor of 14.7 (95% CI, 10.0 to 21.4) in the primary analysis and 4.9 (95% CI, 3.1 to 7.9) in the secondary analysis. The adjusted rate difference in the primary and secondary analyses was 2.1 and 0.8 deaths per 100,000 person-days.

CONCLUSIONS: Across the age groups studied, rates of confirmed Covid-19 and severe illness were substantially lower among participants who received a booster dose of the BNT162b2 vaccine than among those who did not.

PMID:34879188 | DOI:10.1056/NEJMoa2115926