Nevin Manimala

Osteoarthritis Cartilage. 2022 Apr 9:S1063-4584(22)00715-4. doi: 10.1016/j.joca.2022.04.001. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate firstly the efficacy of three different dosages of one home-based, knee-extensor resistance exercise on knee-extensor strength in patients eligible for knee replacement, and secondly, the influence of exercise on symptoms, physical function and decision on surgery.

METHOD: One-hundred and forty patients eligible for knee replacement were randomized to three groups: 2, 4 or 6 home-based knee-extensor resistance exercise-sessions per week (group 2, 4 and 6 respectively) for 12 weeks.

PRIMARY OUTCOME: isometric knee-extensor strength.

SECONDARY OUTCOMES: Oxford Knee Score, Knee injury and Osteoarthritis Outcome Score, average knee pain last week (0-10 numeric rating scale), 6-minute walk test, stair climbing test, exercise adherence and “need for surgery”.

RESULTS: Primary analysis: Intention-to-treat analysis of 140 patients did not find statistically significant differences between the groups from baseline to after 12 weeks of exercise in isometric knee-extensor strength: Group 2 vs. 4 (0.003 Nm/kg (0.2%) [95% CI -0.15 to 0.15], P=0.965) and group 4 vs. 6 (-0.04 Nm/kg (-2.7%) [95% CI -0.15 to 0.12], P=0.628). Secondary analysis: Intention-to-treat analyses showed statistically significant differences between the two and six sessions/week groups in favor of the two sessions/week group for Oxford Knee Score: 4.8 OKS points (15.2%) [1.3 to 8.3], P=0.008) and avg. knee pain last week (NRS 0-10): -1.3 NRS points (-19.5%) [-2.3 to -0.2], P=0.018. After the 12-week exercise intervention, data were available for 117 patients (N=39/group): 38 (32.5%) patients wanted surgery and 79 (67.5%) postponed surgery. This was independent of exercise dosage.

CONCLUSION: In patients eligible for knee-replacement we found no between-group differences in isometric knee extensor strength after 2, 4 and 6 knee-extensor resistance exercise sessions per week. We saw no indication of an exercise dose-response relationship for isometric knee-extensor strength and only clinically irrelevant within group changes. For some secondary outcome (e.g. KOOS subscales) we found clinically relevant within group changes, which could help explain why only one in three patients decided to have surgery after the simple home-based exercise intervention.

TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02931058. Preprint: https://doi.org/10.1101/2021.04.07.21254965.

PMID:35413476 | DOI:10.1016/j.joca.2022.04.001

J Allergy Clin Immunol Pract. 2022 Apr 9:S2213-2198(22)00342-7. doi: 10.1016/j.jaip.2022.03.030. Online ahead of print.

ABSTRACT

BACKGROUND: An optimal strategy for choosing safe alternative low osmolar contrast media (LOCM) has not yet been established in patients with a history of LOCM-induced anaphylaxis.

OBJECTIVES: To validate the practical pathway in patients with anaphylaxis to LOCMs and to compare two different doses of challenge testing with skin test-negative LOCM.

METHODS: A retrospective cohort study was performed in patients with LOCM-induced anaphylaxis. Patients were challenged with intravenous LOCMs showing negativity in the skin test according to two different protocols: low-dose and high-dose (maximum dose 10 and 30 mL, respectively). Challenge-negative LOCMs were selected for use during computed tomography (CT) scans, and patients received intravenous pretreatment with 4 mg chlorpheniramine and 40 mg methylprednisolone.

RESULTS: Of the 110 challenge tests, there were four (3.6%) positive challenges. Among 106 enhanced CT scans performed using challenge-negative LOCMs, breakthrough reactions (BTRs) occurred in eight (7.6%). BTR rates were not statistically different between the two protocols (8.9% and 6.0% in the low-dose and high-dose challenge, respectively). Compared to the low-dose protocol, the number needed to test of the high-dose challenge test decreased 2.5-fold. Moreover, none of the patients in the high-dose challenge group incurred severe reactions during CT scans with challenge-negative LOCM, while 80% of reactions were severe in the low-dose challenge group.

CONCLUSION: We validated a pathway consisting of a battery of skin testing to LOCMs and challenge with skin test-negative LOCM in patients with LOCM-induced anaphylaxis.

PMID:35413472 | DOI:10.1016/j.jaip.2022.03.030

J Stomatol Oral Maxillofac Surg. 2022 Apr 9:S2468-7855(22)00094-5. doi: 10.1016/j.jormas.2022.04.005. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study was to assess bone density and thickness changed following dental implant placement in the maxillary and mandibular jaws. Also, observe the form of bone loss around the implant and the relationship between preoperative bone density and bone thickness with bone loss around dental implants.

METHODS: 65 patients, including 102 dental implants, were assessed in this study. CBCT was utilized to determine the bone condition (bone thickness and density at three levels (sub-crestal bone at 3 mm (CB3), 6 mm (CB6), and 9 mm (CB9)) before implant placement, and 2 to 3 years after placement, also determine the bone loss pattern.

RESULTS: The difference in bone thickness was 0.32 ± 0.50 mm at CB3, 0.18 ± 0.40 mm at CB6, and 0.14 ± 0.07 mm at CB9. The change buccal bone density at CB3, CB6, and CB9 were 344.5 ± 278.9, 260.5 ± 276, and 138.9 ± 313.9 HU, respectively, and the change in lingual bone density was 252.7 ± 247, 179.9 ± 244.1, and 281 ± 4063 HU, respectively. Only the CB3 level showed a significant decrease in bone thickness (p < 0.001), and a change in bone density was observed at the three levels (p < 0.001). The means of vertical and horizontal bone loss were 0.19 ± 0.23 mm and 0.18 ± 0.22 mm, respectively. Splinted or adjacent dental implants have more horizontal bone loss, with statistically significant (p < 0.001). Age, gender, and implant position were not statistically related to the outcome variables. There was a negative correlation between the preoperative status of the bone condition and pattern bone loss, as indicated by Pearson’s correlation coefficient.

CONCLUSION: CBCT detected a significant bone thickness decrease was found only at the crestal third. A significant bone density increase was found at three levels around dental implants. Implant areas with higher bone thickness and density had less bone loss.

PMID:35413461 | DOI:10.1016/j.jormas.2022.04.005

J Stomatol Oral Maxillofac Surg. 2022 Apr 9:S2468-7855(22)00092-1. doi: 10.1016/j.jormas.2022.04.003. Online ahead of print.

ABSTRACT

BACKGROUND: Our aim was to measure and compare prolonged viral shedding (PVS) identified from external splints (ES) and intranasal packings (IP) for isolated nasal fracture (INF) repair in immediately cured asymptomatic vs. mildly symptomatic COVID-19 patients (AS-COVID vs. MS-COVID).

METHODS: We designed a retrospective cohort study and enrolled a sample of post-AS-COVID and post-MS-COVID patients, whose INF were treated at a German level 1 trauma centre. The primary predictor variable was COVID severity presurgery (AS-COVD vs. MS-COVID). The main outcome variable was PVS detected in ES/IP. Other study variables were separated into demographic, clinical, and operative. Descriptive, bi- and multivariate statistics were computed, and statistical significance was set at P ≤ 0.05.

RESULTS: The study sample comprised 15 INF patients (53.3% females; 46.7% post-AS-COVID) with a mean age of 42.2 ± 22.7 years (range, 18-85). 13.3% ES and 53.3% IP were contaminated with SARS-CoV-2. However, only IP-contamination between the two cohorts reached statistical significance (P = 0.01; odds ratio, 0.02; 95% confidence interval, 0 to 0.47; Pearson’s r = 0.73; post hoc power = 87.4%). Multiple linear regression models refuted the associations between PVS and the other parameters (i.e. age, gender, time to treatment, length of hospital stay, lengths of ES/IP placement).

CONCLUSIONS: Despite a relative low sample size, our findings suggest PVS via endonasal materials removed from cured COVID-19 patients, especially those healed from MS-COVID. This PVS may trigger re-infection and surgical site infections and/or transmission to other humans, and thereby, require further investigations.

PMID:35413460 | DOI:10.1016/j.jormas.2022.04.003

J Hosp Infect. 2022 Apr 9:S0195-6701(22)00102-5. doi: 10.1016/j.jhin.2022.03.014. Online ahead of print.

ABSTRACT

BACKGROUND: Patients are at risk of nosocomial COVID-19 infection. The role of accompanying persons/visitors as potential infection donors is not yet well-known, but the risk will be influenced by prevention measures recommended by infection control practitioners.

AIM: The aim of the study is to collect information about COVID-19 infection control strategies for patients and accompanying persons from infection control practitioners in German hospitals.

METHODS: A cross-sectional questionnaire was developed, ethically-approved, pre-tested and formatted as an online tool. We invited infection control practitioners in 987 randomly-selected German hospitals in March and April 2021 to participate. For statistical analysis, the hospitals were categorised as small (0-499 beds) or large (≥500 beds).

FINDINGS: 100 surveys were completed (response rate: 10%). More large (71%) than small hospitals (49%) let patients decide freely whether to wear medical or FFP2 masks. Most hospitals reported spatial separation for COVID-19 patients and non-COVID-19 cases (38%) or additionally for suspected COVID-19 cases (53%). A separation of healthcare teams for these areas existed in 54% of the hospitals. Accompaniment bans were more prevalent in large (52%) than in small hospitals (29%), but large hospitals granted more exemptions.

CONCLUSION: The possibility to separate areas and teams seemed to depend on the hospital’s structural conditions, therefore impairing the implementation of recommendations. Accompaniment regulations differ between hospital sizes and may depend on patient numbers, case type/severity and patient’s requirements. In the dynamic pandemic, it can be difficult to stay up to date with findings and recommendations about infection control.

PMID:35413422 | DOI:10.1016/j.jhin.2022.03.014

J Dent. 2022 Apr 9:104123. doi: 10.1016/j.jdent.2022.104123. Online ahead of print.

ABSTRACT

OBJECTIVES: Face scans are currently used in dentistry to obtain a virtual patient. Find stable and repeatable references for their matching is a fundamental step. Aim of this study is to evaluate matching reliability of multiple face scans using frontal adhesives references. Null hypothesis was that no significant discrepancy could be detected between the references position analyzed both with surface analysis and linear analysis.

MATERIALS AND METHODS: Nine patients were enrolled for this study and nine soft tissue adhesives landmarks (APLI Paper S.A.U, 4 mm Ø) placed, equally distributed, on the forehead and glabella. Patients were digitally scanned with a portable scanner (iPad Pro 3rd Gen. Apple Store, Cupertino, CA, USA) using the software Bellus3D (Inc. Campbell, CA, USA) in maximum intercuspation, with a full smile and with a scan reference device. After the scan procedure, a high-definition polygon file format (.ply) was exported, and linear measurements were collected with MeshLab (MeshLab; MeshLab). In order to further evaluate reference accuracy, a surface analysis was performed using a CAD software (GOM inspect, GOM). 3D deviations were calculated as root mean square. Statistical analysis was performed used two repeated-measures ANOVAs.

RESULTS: Results showed non-significant differences both for linear measurements (p=.22) and surface analysis (p=.58). Frontal references showed to be clinical reliable landmarks to be used during face scans alignment even with different facial expressions.

CONCLUSION: The proposed technique seems to be suitable for the clinical use when superimposition of several face scans is required.

CLINICAL SIGNIFICANCE: This study showed the clinical reliability of face scans matching method using adhesives references that have low costs and are easy to use, allowing for a rapid registration of patient anatomy.

PMID:35413410 | DOI:10.1016/j.jdent.2022.104123

Sci Total Environ. 2022 Apr 9:155152. doi: 10.1016/j.scitotenv.2022.155152. Online ahead of print.

ABSTRACT

Surface urban heat islands (SUHIs) are an important socio-environmental problem associated with large cities, such as the Santiago Metropolitan Area (SMA), in Chile. Here, we analyze daytime and nighttime variations of SUHIs for each season of the year during the period 2000-2020. To evaluate socioeconomic inequities in the distribution of SUHIs, we establish statistical relationships with socioeconomic status, land price, and urban vegetation. We use the MODIS satellite images to obtain the land surface temperatures and the normalized difference vegetation index (NDVI) through the Google Earth Engine platform. The results indicate more intense SUHIs during the nighttime in the eastern sector, coinciding with higher socioeconomic status and larger green areas. This area during the day is cooler than the rest of the city. The areas with lower and middle socioeconomic status suffer more intense SUHIs (daytime and nighttime) and match poor environmental and urban qualities. These results show the high segregation of SMA. Urban planning is subordinated to land prices with a structure maintained over the study period. The lack of social-climate justice is unsustainable, and such inequalities may be exacerbated in the context of climate change. Thus, these results can contribute to the planning of the SMA.

PMID:35413353 | DOI:10.1016/j.scitotenv.2022.155152

J Prosthodont. 2022 Apr 12. doi: 10.1111/jopr.13522. Online ahead of print.

ABSTRACT

PURPOSE: To compare the accuracy of post and cores created with three different fabricating techniques: direct conventional, machine milling, and three dimensional printing.

MATERIALS AND METHODS: Thirteen extracted single root central incisors were selected. Root canal treatment and tooth preparation for crown were performed on all teeth. Post space preparation of 11 mm was created using prefabricated fiber post drill to standardize post space width and length. Root canal impressions were performed on all teeth using polyvinyl siloxane impression material. Each impression was then three dimensionally scanned using an extraoral lab scanner. The scanned impressions were used to design digital files of post and cores with 3shape CAD software. The digitally designed post and cores were used to fabricate 3D printed and milled post and core resin patterns. The same teeth were used to fabricate post and core with conventional technique (direct duplication of root canal with resin pattern). All posts were then scanned before being invested and then cast using base metal educational alloy. The metal post and cores were tried in with sample teeth and manually adjusted until found to be clinically acceptable. The post and cores were scanned in different stages to perform digital volume measurement using Geomagicࣨ Control X࣪ software to determine accuracy. Pairwise comparisons were accomplished using exact version of the sign test (α = 0.05) RESULTS: These three techniques of post and core fabrication showed different results in the various stages of fabrication. The accuracy of 3D printed resin pattern (26.89 ±11.09 mm³ ) was found to be inferior compare to milled resin pattern (28.20 ±11.41 mm³ , p = 0.0002). However, dimensional stability of the 3D printed resin pattern before and after casting (0.56 ±0.95 mm³ ) was found to be superior to milled resin pattern (0.79 ±0.89 mm³ ) and direct resin pattern (2.51 ±1.38 mm³ , p = 0.00002). All three techniques showed significant volume reduction after adjustment (p = 0.0002). In the final stage, the adjusted metal post and core fabricated with three different techniques showed no statistical different in accuracy (p = 0.15).

CONCLUSION: Digitally fabricated post and cores have the same degree of accuracy as the gold standard direct conventional post and core fabrication technique. This article is protected by copyright. All rights reserved.

PMID:35413146 | DOI:10.1111/jopr.13522

Vet Rec. 2022 Apr 12:e1629. doi: 10.1002/vetr.1629. Online ahead of print.

ABSTRACT

BACKGROUND: Veterinary healthcare can be a complex process and may lead to unwanted, potentially harmful patient safety incidents as a consequence, negatively impacting both the practice team and client satisfaction. The aim of this study was to identify how such incidents impact cats and dogs by analysing reports gathered in a large-scale voluntary incident reporting system.

METHODS: Descriptive statistical analysis was used to study a total of 2155 incident reports, submitted by 130 practices on mainland Europe.

RESULTS: Incidents caused harm in more than 40% of reports. Medication-related incidents were the most frequent type of incident recorded (40%). Treatment-related incidents were the most common type of incident causing patient harm (55%). Anaesthesia-related incidents were the most severe type of incident, resulting in patient death in 18% of these reports. Most incidents were reported from hospital wards, and a significantly higher proportion of cats were harmed by incidents compared to dogs.

CONCLUSION: This study demonstrates that patients are regularly harmed by incidents, with medication-related incidents being most common. In depth understanding of incident data can help develop interventions to reduce the risk of incident recurrence.

PMID:35413131 | DOI:10.1002/vetr.1629

Hum Reprod. 2022 Apr 12:deac075. doi: 10.1093/humrep/deac075. Online ahead of print.

ABSTRACT

STUDY QUESTION: Are there genetic variants that interact with smoking to reduce reproductive lifespan in East-Asian women?

SUMMARY ANSWER: Our study corroborates several recently identified genetic loci associated with reproductive lifespan and highlights specific genetic predispositions that may interact with smoking status to adversely affect reproductive lifespan in East-Asian women.

WHAT IS KNOWN ALREADY: Epidemiological data as well as evaluations on genetic predisposition to smoke indicate on the importance of smoking in adverse effects on reproductive lifespan in women. However, there are no previous smoking and gene interaction studies for reproductive traits in East-Asian women.

STUDY DESIGN, SIZE, DURATION: This population-based prospective cohort study comprised 11 643 East-Asian Chinese women with overlapping genome-wide genotyping and reproductive data.

PARTICIPANTS/MATERIALS, SETTING, METHODS: We performed a genome-wide association study for reproductive lifespan in women (n = 11 643) from the Singapore Chinese Health Study (SCHS) and carried out a genome-wide interaction study to identify loci that interacted with smoking status to affect age of natural menopause and reproductive-time.

MAIN RESULTS AND THE ROLE OF CHANCE: Two known loci associated with menopause, rs113430717 (near HMCES, chromosome 3, Pmeta = 5.72 × 10-15) and rs3020136 (near RAD21, chromosome 8, Pmeta = 1.38 × 10-8) were observed beyond genome-wide levels of association with age at menopause in this study. For reproductive lifespan, the genome-wide association observed at rs79784106 (chromosome 3, Pmeta = 5.05 × 10-12) was in linkage disequilibrium with the menopause lead single-nucleotide polymorphism (SNP) (rs113430717). Four additional loci, first reported to be associated with menopause, were also associated with reproductive lifespan in our study (PAdj between 7.42 × 10-5 to 4.51 × 10-3). A significant interaction was observed between smoking and an East-Asian specific SNP, rs140146885, for reduced reproductive lifespan, per copy of the minor C allele (beta = -1.417 years, Pinteraction = 2.31 × 10-10). This interaction was successfully replicated in additional independent samples (beta = -1.389 years, Pinteraction = 6.78 × 10-3). Another known variant associated with menopause, rs11031006 (near FSHB), was also observed to interact with smoking status to reduce age at menopause in our dataset (beta = -0.450 years, Padj = 0.042).

LIMITATIONS, REASONS FOR CAUTION: The modest sample size of the replication datasets used likely affected the statistical power to firmly replicate all identified novel loci observed in our smoking interaction analyses.

WIDER IMPLICATIONS OF THE FINDINGS: Age of natural menopause and reproductive lifespan have clear genetic predispositions with distinct ethnic differences, and they may be adversely truncated by lifestyle factors such as smoking, which can pose a significant impact on the reproductive lifespan and future health outcomes in women.

STUDY FUNDING/COMPETING INTEREST(S): The Singapore Chinese Health Study is funded by the National Medical Research Council, Singapore (NMRC/CIRG/1456/2016), National Institutes of Health (R01 CA144034 and UM1 CA182876) and National Research Foundation, Singapore (Project Number 370062002). W.-P.K. is supported by the National Medical Research Council, Singapore (MOH-CSASI19nov-0001). The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. The authors do not report conflicts of interest.

TRIAL REGISTRATION NUMBER: N/A.

PMID:35413122 | DOI:10.1093/humrep/deac075