Nevin Manimala

J Biomed Mater Res B Appl Biomater. 2021 Nov 22. doi: 10.1002/jbm.b.34966. Online ahead of print.

ABSTRACT

This study evaluated the physicochemical and biological properties of novel reparative materials composed of pure tricalcium silicate (Ca₃ SiO₅ ), Ca₃ SiO₅ doped with fluoride ions (Ca₃ SiO₅ -F) and their association with ZrO₂ (Ca₃ SiO₅ + ZrO₂ , Ca₃ SiO₅ -F + ZrO₂ ), in comparison with Biodentine (BIO). Setting time radiopacity, pH, solubility, and dimensional change were evaluated based on ISO 6876 Standard. Volumetric change and flow/filling were assessed by microcomputed tomography (micro-CT). Biological properties were evaluated by the MTT assay 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide), Neutral Red (NR), cell migration, alkaline phosphatase activity (ALP), and Alizarin Red Staining (ARS) assays. Statistical analysis was performed by ANOVA, Tukey, or Bonferroni tests (α = .05). Ca₃ SiO₅ -F + ZrO₂ had higher radiopacity, shorter setting time, and lower solubility and volumetric loss than BIO (p < .05). Ca₃ SiO₅ -F + ZrO₂ had flow and filling capacity similar to BIO (p > .05). All the cements evaluated had an alkaline pH. Ca₃ SiO₅ -F + ZrO₂ demonstrated cell viability similar to negative control (p > .05), increase in ALP activity in 7 days, mineralized nodule production in 21 days and repair capacity according to cell migration. In conclusion, Ca₃ SiO₅ -F + ZrO₂ had adequate setting time, radiopacity, solubility, and dimensional change. This material presented low volumetric change besides flow and filling capacity in micro-CT assessment. In addition, Ca₃ SiO₅ -F + ZrO₂ was biocompatible and bioactive, suggesting its use as reparative material.

PMID:34808030 | DOI:10.1002/jbm.b.34966

Int J Clin Pract. 2021 Nov 22:e15014. doi: 10.1111/ijcp.15014. Online ahead of print.

ABSTRACT

INTRODUCTION: The incidence of chronic subdural hematoma (CSDH) is increasing. This study evaluates the etiologic causes and findings of CSDH and compared unilateral CSDH with bilateral CSDH. This study aims to draw attention to this increasingly prevalent condition.

METHODS: We retrospectively analyzed 195 surgically treated cases of CSDH in our clinic between 2008 and 2018.

RESULTS: The average age of the patients was 65.7±19.6 years. The most common symptom was headache (53.3%). The case background was use of anticoagulant (37.9%), head trauma (34.3%). The hematomas were 28.7% right side, 44.6% left side, and 26.7% bilateral. The mean Glasgow Coma Score (GCS) was13.4±2.9, early postop 13.8±2.5, and late postop was 14.6±1.1. Postoperative complications included acute subdural hematoma (5.1%), cerebral infarction (1.5%), wound infection (0.5%) and others (13.3%). Re-expansion of brain were statistically significantly less frequent and impaired consciousness, anticoagulant use, early and late postop thickness were statistically significantly more frequent in patients with bilateral CSDH.

CONCLUSIONS: CSDH is seen more patients of advanced age, those who use anticoagulants, patients with hypertension and diabetes and in patients with a history of head trauma. Prognosis is worse in bilateral CSDH. We estimate that the incidence of CSDH will go up in the future.

PMID:34808025 | DOI:10.1111/ijcp.15014

Eur J Dent Educ. 2021 Nov 22. doi: 10.1111/eje.12725. Online ahead of print.

ABSTRACT

BACKGROUNDS: Canalis sinuosus (CS) is a neurovascular canal that corresponds to a small branch of the infraorbital canal.

OBJECTIVE: This study aimed at assessing the knowledge and detection performance of CS among dentists and dental students.

METHODS: Four-hundred and five dentists and dental students answered a questionnaire with three parts: 1. Socio-demographic; 2. Clinical cases with cone- beam computed tomography (CBCT) sections showing CS, and 3. Previous knowledge about CS. Chi-square test and Spearman’s correlation test were used to compare results as appropriate. P-values below 0.05 were considered statistically significant.

RESULTS: Most participants did not identify CS in any CBCT. There was association between the number of correct answers and dental specialties. Most individuals had not learned about CS previously. There was association between past knowledge of CS and gender, highest academic degree, working environment, dental specialty, and number of correct answers but not with age or experience in dentistry.

CONCLUSIONS: This study suggests that most dentists are not aware about CS and do not know how to diagnose it. Previous knowledge about CS positively influenced its identification in CBCT.

PMID:34808014 | DOI:10.1111/eje.12725

Eur J Neurol. 2021 Nov 22. doi: 10.1111/ene.15193. Online ahead of print.

ABSTRACT

BACKGROUND: A sensitive and frequent clinical sign of a vestibular tone imbalance is the tilt of the perceived subjective visual vertical (SVV). So far there are no data yet focusing on lesion location at the cortical level as a factor for predicting compensation from tilt of SVV.

METHODS: With modern voxelwise lesion-behavior mapping (VLBM) analysis, the present study determines whether lesion location in 23 right-hemispheric cortical stroke patients with an otolith dysfunction could predict the compensation of a vestibular tone imbalance in the chronic stage.

RESULTS: Our statistical anatomical lesion analysis revealed that lesions of the posterior insular cortex (IC) are involved in vestibular otolith compensation.

CONCLUSION: The IC appears to be a critical anatomical region for predicting a tilt of SVV as a chronic disorder in stroke patients.

PMID:34808013 | DOI:10.1111/ene.15193

PLoS One. 2021 Nov 22;16(11):e0260301. doi: 10.1371/journal.pone.0260301. eCollection 2021.

ABSTRACT

Wasting in children under-five is a form of acute malnutrition, a predictor of under-five child mortality and of increased risk of future episodes of stunting and/or wasting. In India, national estimates of wasting are high compared to international standards with one in five children found to be wasted. National surveys are complex logistical operations and most often not planned or implemented in a manner to control for seasonality. Collection of survey data across differing months across states introduces seasonal bias. Cross-sectional surveys are not designed to collect data on seasonality, thus special methods are needed to analyse the effect of data collection by month. We developed regression models to estimate the mean weight for height (WHZ), prevalence of wasting for every month of the year for an average year and an overall weighted survey estimates controlling for the socio-demographic variation of data collection across states and populations over time. National level analyses show the mean WHZ starts at its highest in January, falls to the lowest in June/August and returns towards peak at year end. The prevalence of wasting is lowest in January and doubles by June/August. After accounting for seasonal patterns in data collection across surveys, the trends are significantly different and indicate a stagnant period followed by a decline in wasting. To avoid biased estimates, direct comparisons of acute malnutrition across surveys should not be made unless seasonality bias is appropriately addressed in planning, implementation or analysis. Eliminating the seasonal variation in wasting would reduce the prevalence by half and provide guidance towards further reduction in acute malnutrition.

PMID:34807959 | DOI:10.1371/journal.pone.0260301

PLoS One. 2021 Nov 22;16(11):e0260399. doi: 10.1371/journal.pone.0260399. eCollection 2021.

ABSTRACT

Efforts to control the spread of the novel Coronavirus (COVID-19) pandemic include drastic measures such as isolation, social distancing, and lockdown. These restrictions are accompanied by serious adverse consequences such as forgoing of healthcare. The study aimed to assess the prevalence and correlates of forgone care for a variety of healthcare services during a two-month COVID-19 lockdown, using Andersen’s Behavioral Model of Healthcare Utilization. A cross-sectional study using computerized phone interviews was conducted with 302 Israeli Jewish participants aged 40 and above. Almost half of the participants (49%) reported a delay in seeking help for at least one needed healthcare service during the COVID-19 lockdown period. Among the predisposing factors, we found that participants aged 60+, being more religious, and reporting higher levels of COVID-19 fear were more likely to report forgone care than younger, less religious and less concerned participants. Among need factors, a statistically significant association was found with a reported diagnosis of diabetes, with participants with the disease having a considerably higher likelihood of forgone care. The findings stress the importance of developing interventions aimed at mitigating the phenomenon of forgoing care while creating nonconventional ways of consuming healthcare services. In the short term, healthcare services need to adapt to the social distancing and isolation measures required to stanch the epidemic. In the long term, policymakers should consider alternative ways of delivering healthcare services to the public regularly and during crisis without losing sight of their budgetary consequences. They must recognize the possibility of having to align medical staff to the changing demand for healthcare services under conditions of health uncertainty.

PMID:34807948 | DOI:10.1371/journal.pone.0260399

PLoS One. 2021 Nov 22;16(11):e0260446. doi: 10.1371/journal.pone.0260446. eCollection 2021.

ABSTRACT

INTRODUCTION: The coronavirus disease (COVID-19) pandemic has caused unprecedented challenges for the medical staff worldwide, especially for those in hospitals where COVID-19-positive patients are hospitalized. The announcement of COVID-19 hospital restrictions by the Japanese government has led to several limitations in hospital care, including an increased use of physical restraints, which could affect the care of elderly dementia patients. However, few studies have empirically validated the impact of physical restraint use during the COVID-19 pandemic. We aimed to evaluate the impact of regulatory changes, consequent to the pandemic, on physical restraint use among elderly dementia patients in acute care hospitals.

METHODS: In this retrospective study, we extracted the data of elderly patients (aged > 64 years) who received dementia care in acute care hospitals between January 6, 2019, and July 4, 2020. We divided patients into two groups depending on whether they were admitted to hospitals that received COVID-19-positive patients. We calculated descriptive statistics to compare the trend in 2-week intervals and conducted an interrupted time-series analysis to validate the changes in the use of physical restraint.

RESULTS: In hospitals that received COVID-19-positive patients, the number of patients who were physically restrained per 1,000 hospital admissions increased after the government’s announcement, with a maximum incidence of 501.4 per 1,000 hospital admissions between the 73rd and 74th week after the announcement. Additionally, a significant increase in the use of physical restraints for elderly dementia patients was noted (p = 0.004) in hospitals that received COVID-19-positive patients. Elderly dementia patients who required personal care experienced a significant increase in the use of physical restraints during the COVID-19 pandemic.

CONCLUSION: Understanding the causes and mechanisms underlying an increased use of physical restraints for dementia patients can help design more effective care protocols for similar future situations.

PMID:34807945 | DOI:10.1371/journal.pone.0260446

PLoS One. 2021 Nov 22;16(11):e0260351. doi: 10.1371/journal.pone.0260351. eCollection 2021.

ABSTRACT

Eye movements measured by high precision eye-tracking technology represent a sensitive, objective, and non-invasive method to probe functional neural pathways. Oculomotor tests (e.g., saccades and smooth pursuit), tests that involve cognitive processing (e.g., antisaccade and predictive saccade), and reaction time tests have increasingly been showing utility in the diagnosis and monitoring of mild traumatic brain injury (mTBI) in research settings. Currently, the adoption of these tests into clinical practice is hampered by a lack of a normative data set. The goal of this study was to construct a normative database to be used as a reference for comparing patients’ results. Oculomotor, cognitive, and reaction time tests were administered to male and female volunteers, aged 18-45, who were free of any neurological, vestibular disorders, or other head injuries. Tests were delivered using either a rotatory chair equipped with video-oculography goggles (VOG) or a portable virtual reality-like VOG goggle device with incorporated infrared eye-tracking technology. Statistical analysis revealed no effects of age on test metrics when participant data were divided into pediatric (i.e.,18-21 years, following FDA criteria) and adult (i.e., 21-45 years) groups. Gender (self-reported) had an effect on auditory reaction time, with males being faster than females. Pooled data were used to construct a normative database using 95% reference intervals (RI) with 90% confidence intervals on the upper and lower limits of the RI. The availability of these RIs readily allows clinicians to identify specific metrics that are deficient, therefore aiding in rapid triage, informing and monitoring treatment and/or rehabilitation protocols, and aiding in the return to duty/activity decision. This database is FDA cleared for use in clinical practice (K192186).

PMID:34807938 | DOI:10.1371/journal.pone.0260351

PLoS One. 2021 Nov 22;16(11):e0259991. doi: 10.1371/journal.pone.0259991. eCollection 2021.

ABSTRACT

BACKGROUND: The problem of multicollinearity in multiple linear regression models arises when the predictor variables are correlated among each other. The variance of the ordinary least squared estimator become unstable in such situation. In order to mitigate the problem of multicollinearity, Liu regression is widely used as a biased method of estimation with shrinkage parameter ‘d’. The optimal value of shrinkage parameter plays a vital role in bias-variance trade-off.

LIMITATION: Several estimators are available in literature for the estimation of shrinkage parameter. But the existing estimators do not perform well in terms of smaller mean squared error when the problem of multicollinearity is high or severe.

METHODOLOGY: In this paper, some new estimators for the shrinkage parameter are proposed. The proposed estimators are the class of estimators that are based on quantile of the regression coefficients. The performance of the new estimators is compared with the existing estimators through Monte Carlo simulation. Mean squared error and mean absolute error is considered as evaluation criteria of the estimators. Tobacco dataset is used as an application to illustrate the benefits of the new estimators and support the simulation results.

FINDINGS: The new estimators outperform the existing estimators in most of the considered scenarios including high and severe cases of multicollinearity. 95% mean prediction interval of all the estimators is also computed for the Tobacco data. The new estimators give the best mean prediction interval among all other estimators.

THE IMPLICATIONS OF THE FINDINGS: We recommend the use of new estimators to practitioners when the problem of high to severe multicollinearity exists among the predictor variables.

PMID:34807916 | DOI:10.1371/journal.pone.0259991

PLoS Genet. 2021 Nov 22;17(11):e1009918. doi: 10.1371/journal.pgen.1009918. Online ahead of print.

ABSTRACT

The majority of genetic variants detected in genome wide association studies (GWAS) exert their effects on phenotypes through gene regulation. Motivated by this observation, we propose a multi-omic integration method that models the cascading effects of genetic variants from epigenome to transcriptome and eventually to the phenome in identifying target genes influenced by risk alleles. This cascading epigenomic analysis for GWAS, which we refer to as CEWAS, comprises two types of models: one for linking cis genetic effects to epigenomic variation and another for linking cis epigenomic variation to gene expression. Applying these models in cascade to GWAS summary statistics generates gene level statistics that reflect genetically-driven epigenomic effects. We show on sixteen brain-related GWAS that CEWAS provides higher gene detection rate than related methods, and finds disease relevant genes and gene sets that point toward less explored biological processes. CEWAS thus presents a novel means for exploring the regulatory landscape of GWAS variants in uncovering disease mechanisms.

PMID:34807913 | DOI:10.1371/journal.pgen.1009918