Nevin Manimala

J Prosthet Dent. 2021 Mar 18:S0022-3913(21)00057-3. doi: 10.1016/j.prosdent.2021.01.017. Online ahead of print.

ABSTRACT

STATEMENT OF PROBLEM: Whether recommendations for the use of occlusal devices are made uniformly in terms of indications, designs, and wearing time is unclear. Different recommendations may lead to different clinical outcomes.

PURPOSE: The purpose of this survey was to assess the professional practice of dental surgeons in France regarding the use of occlusal devices.

MATERIAL AND METHODS: A 26-question cross-sectional survey was sent to a panel of French dentists via the County Councils of the Dental Order. The questionnaire concerned the amount of occlusion-related treatment, the use of an anterior deprogramming device, stabilization splint, and anterior repositioning appliance, and the patient follow-up as well as the drawbacks of using an occlusal device as a therapeutic solution. The statistical tests used in the study were the chi-square test and the Yate correction for continuity.

RESULTS: A total of 771 responses were received. Invasive options were still reported as being used as a first-line treatment for temporomandibular disorder, although a statistical difference was found between experienced and recently graduated practitioners, with recent graduates preferring noninvasive options as first-line treatment. Also, the results showed that anterior deprogramming devices were not used or that their application, particularly the length of treatment, was unfamiliar to practitioners. The anterior repositioning appliance seems to be used, but only a few practitioners integrate it into their practice. In general, about one-third of dentists appear to have a good knowledge of occlusion-related treatments, in particular, the use of occlusal devices.

CONCLUSIONS: The results indicated that only 20% to 30% of practitioners have good knowledge of contemporary occlusion-related practice. There is a need for the standardization of practice and improved education for practitioners in the use of occlusal devices.

PMID:33745683 | DOI:10.1016/j.prosdent.2021.01.017

Clin Nutr ESPEN. 2021 Apr;42:366-372. doi: 10.1016/j.clnesp.2021.01.006. Epub 2021 Jan 20.

ABSTRACT

BACKGROUND: Few studies have analyzed the relationship between dynapenia and lifestyle, physical-health and mental-health variables in middle-aged and older persons classified according to their waist circumference. The aim of this study was to identify the relationships between dynapenia and behavioral, physical-health and mental-health variables in middle-aged and older persons with and without abdominal obesity using Bayesian networks, a graphical analysis technique that allows simultaneous associations between variables to be identified.

METHODS: A cross-sectional study of 2526 participants without abdominal obesity and 2729 with abdominal obesity (waist circumference > 102 cm in men and >88 cm in women) aged 50 years or older who took part in the Brazilian Longitudinal Study of Aging. Two network structures including behavioral, physical-health and mental-health variables and dynapenia (grip strength < 26 kg for men and <16 kg for women) were learnt with the hill-climbing score-based algorithm for a sample of individuals with and without abdominal obesity. Statistical resampling tests were performed to quantify the strength of the relationships between factors associated with dynapenia.

RESULTS: In middle-aged and older persons without abdominal obesity, dynapenia was strongly associated with and influenced by at-risk alcohol consumption while in middle-aged and older persons with abdominal obesity the condition was strongly associated with and influenced by diabetes and depression. In the latter group, dynapenia was also strongly associated with and influenced the disability.

CONCLUSIONS: The use of Bayesian networks allowed different factors associated with dynapenia in middle-aged and older persons classified according to the presence or absence of abdominal obesity to be identified.

PMID:33745607 | DOI:10.1016/j.clnesp.2021.01.006

Clin Nutr ESPEN. 2021 Apr;42:325-332. doi: 10.1016/j.clnesp.2021.01.012. Epub 2021 Feb 3.

ABSTRACT

OBJECTIVE: Vitamin D deficiency and insulin resistance have great prevalence in society. The latest studies indicate an inverse association between Vitamin D levels, insulin resistance, and Type 2 diabetes. The objective of this study was to investigate the effect of vitamin D status on insulin resistance.

METHODS: In a cross-sectional study, 2160 participants were randomly recruited from a nutrition clinic in Tehran, Iran, 1057 (48.9%) were female and 1103 (51.1%) male. Information was gathered by a questionnaire. Following 12-h fasting, fasting plasma glucose (FPG) and insulin levels, as well as 25-hydroxy vitamin D levels were measured. 2-H glucose and insulin levels measured after consumption of 75 g glucose, HOMA2-IR, and HOMA-β indices were then calculated.

RESULTS: The average serum Vitamin D was 22.3 + 8.9 nmol/L and the prevalence of Vitamin D deficiency was 100%. There was an inverse relationship between Vitamin D levels and age, BMI, waist circumference, and all metabolic parameters (p < 0.001 in all) and a direct association with levels of exercise. Two logistic regression models were used to adjust for confounding variables; firstly, for age, gender, and smoking and secondly, additionally for BMI and energy intake. Both models showed a significant inverse relationship between Vitamin D levels and FPG and insulin levels, 2-h glucose and insulin levels, and HOMA2-IR. The optimum cut point for vitamin D was calculated at about 25 nmol/L for preventing insulin resistance.

CONCLUSION: This study illustrated that there is a statistically significant inverse relationship between Vitamin D levels and insulin resistance.

PMID:33745601 | DOI:10.1016/j.clnesp.2021.01.012

Clin Nutr ESPEN. 2021 Apr;42:313-317. doi: 10.1016/j.clnesp.2021.01.014. Epub 2021 Jan 26.

ABSTRACT

BACKGROUND AND AIMS: Novel Coronavirus (COVID-19) first appeared in China in late 2019 which was rapidly spread worldwide. As the COVID-19 pandemic continues to spread, it is crucial to determine the prognostic factors contributing to the development of severe disease and higher mortality. Herein we aimed to evaluate the correlation between the severity and prognosis of patients with COVID 19 with serum 25(OH)D levels.

METHOD: This descriptive retrospective study was performed from March to April 2020 at a referral center for patients with COVID-19, Tehran, Iran. The data collection was performed by a checklist consisting of the demographic features and laboratory assessments consisted of serum 25(OH)D were evaluated and recorded. And investigate the relationship between serum 25(OH)D and clinical outcomes of patients.

RESULT: 205 patients with a mean age of 59.71 years were enrolled. Our findings did not reveal a significant difference in mean levels of vitamin between improved (34.09) and deceased patients (34.54). However, in patients with severe disease, there was a considerable difference in levels of vitamin D in improved and deceased patients (P.value: 0.021). According to our results, the mortality rate was slightly higher in men (odds ratio:2.2). Furthermore, the mean age (64.20 vs. 58.51) and the presence of at least two comorbidities (odds ratio: 2.40) were significantly higher in deceased patients.

CONCLUSION: In this study, we did not reveal a statistical difference in mean levels of vitamin D and the outcome of patients with COVID-19. We concluded that in patients with severe disease, vitamin D deficiency could affect the course of the disease and mortality, especially in comorbidity and older people.

PMID:33745598 | DOI:10.1016/j.clnesp.2021.01.014

Zhonghua Shao Shang Za Zhi. 2021 Mar 18;37(3):1-7. doi: 10.3760/cma.j.cn501120-20200301-00109. Online ahead of print.

ABSTRACT

Objective: To establish a prediction model for acute respiratory distress syndrome (ARDS) in critical burn patients with the screened independent risk factors, and to validate its predictive value. Methods: Totally 131 critical burn patients (101 males and 30 females, aged 18-84 years) who met the inclusion criteria were admitted to the Department of Burns of the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2018 to December 2019. A retrospective case-control study was conducted. The patients were divided into ARDS group (54 cases) and non-ARDS group (77 cases) according to whether ARDS occurred or not. The statistics of patients in the two groups were recorded including the gender, age, burn index, combination of inhalation injury, smoking history, delayed resuscitation, indwelling nasogastric tube, and complication of sepsis, and the data were statistically analyzed with independent sample t test, χ² test, and Fisher’s exact probability method test. The multivariate logistic regression analysis was performed on the indicators with statistically significant differences between the two groups to screen independent risk factors for developing ARDS in critical burn patients, and the corresponding nomograph prediction model for the risk of ARDS in critical burn patients was established. The risk scores for patients developing ARDS were therefore obtained based on the above-mentioned nomograph, and the corresponding receiver operating characteristic (ROC) curve was drawn to calculate the area under the curve. The internal validation of the above-mentioned ARDS prediction model was performed using the Bootstrap method, and the area under the ROC curve was calculated for modeling group (79 cases) and validation group ( 52 cases), respectively. A calibration curve was drawn to assess the predictive conformity of the above-mentioned ARDS prediction model for the occurrence of ARDS in critical burn patients. Results: The burn index, proportion of combination of inhalation injury, and proportion of complication of sepsis of patients were significantly higher in ARDS group than in non-ARDS group (t=0.36, χ²=33.78, 49.92, P<0.01). The gender, age, smoking history, delayed resuscitation, and indwelling nasogastric tube of patients in ARDS group were close to those in non-ARDS group (P>0.05). The multivariate logistic regression analysis showed that the burn index, inhalation injury, and sepsis were independent risk factors for developing ARDS in critical burn patients (odds ratio=1.05, 15.33, 5.02, 95% confidence interval=1.01-1.10, 2.65-88.42, 1.28-19.71, P<0.05 or P<0.01). The overall area under the ROC curve of the above-mentioned ARDS prediction model was 0.92, and the area under the ROC curve was 0.95 and 0.91 for modeling group and validation group, respectively. When applying the above-mentioned ARDS prediction model for ARDS incidence prediction, there might be some risk of overestimating ARDS incidence when the prediction probability was <35% or >85%, and some risk of underestimating ARDS incidence when the prediction probability was 35%-85%. Conclusions: The burn index, inhalation injury, and sepsis are independent risk factors for ARDS in critical burn patients. The risk prediction model for ARDS based on these three indicators has good predictive ability for ARDS in critical burn patients.

PMID:33745255 | DOI:10.3760/cma.j.cn501120-20200301-00109

J Mother Child. 2021 Jan 29;22(4):323-328. doi: 10.34763/devperiodmed.20182204.323328.

ABSTRACT

AIM: The aim of our study was to evaluate the adherence to the 2014 American Academy of Pediatrics guidelines for bronchiolitis.

MATERIAL AND METHODS: The study measured the utility of diagnostic and therapeutic procedures in children with the first episode of bronchiolitis in their lives hospitalized at the University Children’s Hospital in Krakow, Poland, between September 2014 and March 2015. The results were compared with the achievable benchmarks of care (ABCs) for hospitalized children with bronchiolitis. Hospital performance was measured by five clinical indicators: chest X-ray utilization, viral testing implementation, steroids, antibiotics and bronchodilator prescriptions. Odds ratios (OR) with 95% confidence intervals (95%CI) were calculated for comparisons between hospital performance and ABCs.

RESULTS: There were 214 children in the study group (56% were boys). Chest X-ray was performed in 95% of the children, while ABCs indicate 32.4% (OR=42; 95%CI [30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58]); viral testing in 67.9% children, whereas ABCs indicate 0.6% (OR=350; 95%CI [155-790]). Steroids were prescribed in 62% of the patients (ABCs=6.4%; OR=24; 95 %CI [18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31]), similarly antibiotics in 62% (ABCs=18.5%; OR=20; 95 %CI [1525]), bronchodilators were administered in 86% patients (ABCs=18.9%; OR=27; 95%CI [21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34]). All the analyzed procedures were used dozens of times more often than suggested by ABCs (the difference is highly statistically significant).

CONCLUSIONS: Overuse of ineffective procedures and therapies in bronchiolitis remains common, with overuse of chest X-rays, viral testing, prescriptions of bronchodilators, corticosteroids and antibiotics. We should focus our efforts on strategies aimed at decreasing the procedures that have no benefit for children with bronchiolitis.

PMID:33745240 | DOI:10.34763/devperiodmed.20182204.323328

PM R. 2021 Mar 21. doi: 10.1002/pmrj.12593. Online ahead of print.

NO ABSTRACT

PMID:33745236 | DOI:10.1002/pmrj.12593

Clin Transplant. 2021 Mar 20:e14293. doi: 10.1111/ctr.14293. Online ahead of print.

ABSTRACT

BACKGROUND: The medium to long-term outcomes of living kidney donors with hypertension compared to normotensive donors are not well understood, especially with the recent changes in hypertension guidelines.

METHODS: We studied a cohort of 950 living kidney donors using different definitions of hypertension based on either ≥140/90 or ≥130/80 mmHg thresholds and based on either office or ambulatory blood pressure readings. Microstructural features on kidney biopsy at the time of donation were compared using different definitions of hypertension.

RESULTS: After adjusting for years of follow-up, age, sex, and baseline eGFR, hypertension (by any definition) did not significantly predict an eGFR <45 mL/min/1.73 m² at a median follow-up of 10 years post-donation, though there was a borderline association with ambulatory blood pressure ≥130/80 mm Hg predicting a 40% decline in eGFR (OR = 1.53, 1.00-2.36; p=0.051). Proteinuria was predicted by office blood pressure ≥140/90 mmHg and by non-dipper profile on nocturnal ambulatory blood pressure measurements. At the time of donation, larger glomeruli and arterial hyalinosis on biopsy associated with hypertension defined by either ≥140/90 or ≥130/80 mmHg (by office or ambulatory measurements). Nocturnal non-dipper status was associated with larger glomeruli size but not arteriolar hyalinosis when compared to dippers.

CONCLUSIONS: In programs that accept donors with controlled hypertension, various definitions of hypertension are associated with histological findings in the donated kidney, but none predict a clinically significant decline in kidney function 10 years after donation. These data support allowing healthy individuals with controlled hypertension to donate a kidney. However, donors with office hypertension (≥140/90 mmHg) and non-dippers (regardless of hypertension status) are at greater long-term risk for proteinuria, and particularly for these donors, longer follow-up is warranted.

PMID:33745214 | DOI:10.1111/ctr.14293

Pediatr Diabetes. 2021 Mar 21. doi: 10.1111/pedi.13204. Online ahead of print.

ABSTRACT

BACKGROUND: Diabetes distress and depression have been shown to be prevalent among adolescents with type 1 diabetes and screening for these parameters should be a routine part of diabetes care.

OBJECTIVE: To assess the prevalence of diabetes distress and depression and their association with glycemic control in a sample of adolescents with type 1 diabetes attending a diabetes center in Dubai, United Arab Emirates.

SUBJECTS: All adolescents aged 13-18 years with type 1 diabetes that were seeking treatment at the Dubai Diabetes Center from the period of September 1, 2018 to May 1, 2019. A total of 72 participants completed the study.

METHODOLOGY: Adolescents were asked to fill in questionnaires assessing diabetes distress and depression. Multivariate linear regression analysis was used to assess the relationships between the subsets of socio-demographic and clinical characteristics, and the scores of the questionnaires.

RESULTS: The mean HbA1c of the study sample was 9.61% [82 mmol/mol] with higher levels found in females as compared to males (p<0.05). Females showed significantly greater levels of distress as compared to males. Although adolescents with HbA1c ≥ 7.5% scored higher for diabetes distress and depression, the difference was not statistically significant to those with an HbA1c of <7.5%. Higher levels of diabetes distress were highly correlated with depressive symptoms, with distress and depression both being significant predictors of one another.

CONCLUSIONS: Our results highlight the importance of implementing and sustaining psycho-educational interventions to aid in alleviating diabetes distress and depression in this subgroup of the population. This article is protected by copyright. All rights reserved.

PMID:33745208 | DOI:10.1111/pedi.13204

J Clin Periodontol. 2021 Mar 21. doi: 10.1111/jcpe.13461. Online ahead of print.

ABSTRACT

AIM: to assess the effect of aesthetic crown lengthening (ACL) and lip repositioning (LRS) on perception of smile attractiveness.

MATERIALS AND METHODS: Preoperative and 6-month postoperative smile photographs of ACL- or LRS-treated patients were evaluated by 100 raters (five gender-balanced groups of ten per procedure) of diverse background (dental students, general dentists, periodontists, and laypersons with and without any aesthetic concerns about their own smile). Smile attractiveness was rated by visual analogue scale (VAS). Multivariate mixed-effect models were applied to determine the effect of procedure, rater (age, gender, group) and case (gingival display, GD) on smile attractiveness rating.

RESULTS: Average preoperative and postoperative VAS scores for ACL patients were 3.8±2.0 and 6.2±1.9, respectively. Corresponding LRS patient values were 4.8±2.0 and 6.4±1.9. Treatment, baseline GD and rater age were significant determinants (p<0.001) of smile attractiveness for both procedures. Rater gender was not significant. Rater group was significant (p<0.032) only for ACL. Procedure (p<0.001), baseline VAS (p<0.001), change in GD (p≤0.002) and rater age (p≤0.017) were significant determinants of smile attractiveness change from preoperative to postoperative.

CONCLUSIONS: ACL and LRS are two periodontal plastic surgery procedures that deliver significant smile attractiveness improvements, in the eyes of both laypersons and dental professionals.

PMID:33745186 | DOI:10.1111/jcpe.13461