Nevin Manimala

Eur J Dent. 2022 Jan 11. doi: 10.1055/s-0041-1736418. Online ahead of print.

ABSTRACT

OBJECTIVES: The use of herbal dentifrices has grown exponentially over the years. They are categorically referred to as ethnomedicines. Various agents have been tried with contradicting findings based on phytopharmacological analysis. Miswak is one agent which has been used over the years. A novel Moringa oleifera-based dentifrice has shown promising results in terms of its cytotoxicity, biocompatibility, and as a potent anti-inflammatory agent. Therefore, the present study aims to compare the efficacy of two commercially available miswak- and moringa-based herbal dentifrices on the reduction of plaque and gingivitis scores.

MATERIALS AND METHODS: This randomized clinical crossover study included 20 subjects with mild to moderate gingivitis. The study was conducted over a total examination period of 20 days with a wash-out period of 2 weeks between the use of both the toothpastes. The plaque index and gingival index of the study subjects were recorded at the designated time intervals throughout the study period.

STATISTICAL ANALYSIS: The data collected were entered on Microsoft Excel, and statistical analysis using SPSS software (SPSS version 28, IBM Corp, Armonk, New York, United States) was done. The statistical test used was the Wilcoxon signed-rank test. Moreover, p ≤0.05 was considered significant.

RESULTS: The results showed that the reduction in mean gingival index scores from baseline to day 3 was more statistically significant in the moringa-based dentifrice. Similarly, the plaque index scores showed statistically significant reduction following the use of the moringa-based dentifrice when compared with the miswak dentifrice. This study reveals that the moringa dentifrice is a safe and effective agent in reducing plaque accumulation and treating gingival inflammation.

CONCLUSION: The current study aims to provide an insight into the possible role of moringa dentifrice as a possible adjunctive oral hygiene aid.

PMID:35016231 | DOI:10.1055/s-0041-1736418

Eur J Dent. 2022 Jan 11. doi: 10.1055/s-0041-1739438. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate and compare the first tooth contact region, occlusion time, time to generate total force, and force distribution between open bite (OB) and non-OB (NOB) patients at the maximum intercuspation position using the T-Scan III system.

MATERIALS AND METHODS: Sixteen patients were divided into the OB and NOB groups (n = 8 for each group). The T-Scan III system was used to evaluate the first tooth contact region, occlusion time, time to generate total force, and force distribution.

STATISTICAL ANALYSIS: The mean patient age, overjet, overbite, occlusion time, and time to generate total force were compared between the groups by independent samples t-test. Relative force distributions between groups and among regions were compared by the Mann-Whitney U- and Kruskal-Wallis H-tests, respectively. A probability value of less than 5% (p < 0.05) was considered significant.

RESULTS: Differences in the first tooth contact region between groups were observed. The molar region was the first tooth contact region in the OB group, while first tooth contact was observed in all regions in the NOB group. Neither the occlusion time nor the time to generate total force was significantly different between the groups (p > 0.05). The highest force distributions were observed in the molar regions in both groups. Significant intragroup differences were found among all regions (p < 0.05), except between the anterior and premolar regions in the NOB group (p = 0.317). Intergroup differences in the force distributions in the anterior (p = 0.000), premolar (p = 0.038), and molar (p = 0.007) regions were significant.

CONCLUSION: Unlike in the NOB group, in which first tooth contact occurred in every region, in the OB group, first tooth contact occurred only in the molar region. Compared with those in the NOB group, the force distributions in the OB group were approximately 1.5 times higher in the molar region but were significantly lower in the anterior and premolar regions.

PMID:35016230 | DOI:10.1055/s-0041-1739438

Eur J Dent. 2022 Jan 11. doi: 10.1055/s-0041-1739442. Online ahead of print.

ABSTRACT

OBJECTIVES: Diabetes mellitus (DM) is a major risk factor for periodontitis. Susceptibility to periodontitis increases approximately three times in people with DM. There is a clear relationship between the degree of hyperglycemia and the severity of periodontitis. This study aimed to analyze the reduction of tumor necrosis factor-α (TNF-α) in diabetics who came for periodontitis examination to prevent exacerbations.

MATERIALS AND METHODS: This was an analytic observational study using a cross-sectional approach at health centers in Surabaya, Indonesia. Measurement of periodontal status used the community periodontal index of treatment needs by measuring bleeding at probing and pocket depth. TNF-α was measured using enzyme-linked immunosorbent assay, and behavior and lifestyle using a questionnaire.

STATISTICAL ANALYSIS: The Kolmogorov-Smirnov test was performed to identify data normality (p < 0.05). A nonparametric test was used to measure the degree of association between different characteristics and the incidence of periodontitis in type 2 DM patients with and without periodontitis. Spearman’s test was done to examine the correlation between TNF-α level and severity of periodontitis in diabetics. The significant level was at p <0.05.

RESULTS: There was a correlation between age, predisposing factors, reinforcing factors, drug consumption, and TNF-α levels in patients with type 2 DM and the incidence of periodontitis.

CONCLUSIONS: Poor glycemic control can induce oxidative stress on the gingiva, thereby aggravating damage to periodontal tissue. An important factor in preventing periodontitis for type 2 DM patients is controlling blood sugar levels through regular consumption of drugs and regular maintenance of oral cavity health. Knowledge is a predisposing factor that affects adherence of people with type 2 DM to consuming drugs regularly, which can be strengthened by family support. These will ultimately play a role in reducing TNF-α levels.

PMID:35016229 | DOI:10.1055/s-0041-1739442

Clin Infect Dis. 2022 Jan 7:ciab1029. doi: 10.1093/cid/ciab1029. Online ahead of print.

ABSTRACT

BACKGROUND: The degree to which the 2019 novel coronavirus disease (COVID-19) pandemic will affect the US human immunodeficiency virus (HIV) epidemic is unclear.

METHODS: We used the Johns Hopkins Epidemiologic and Economic Model to project HIV infections from 2020 to 2025 in 32 US metropolitan statistical areas (MSAs). We sampled a range of effects of the pandemic on sexual transmission (0-50% reduction), viral suppression among people with HIV (0-40% reduction), HIV testing (0-50% reduction), and pre-exposure prophylaxis use (0-30% reduction), and indexed reductions over time to Google Community Mobility Reports.

RESULTS: Simulations projected reported diagnoses would drop in 2020 and rebound in 2021 or 2022, regardless of underlying incidence. If sexual transmission normalized by July 2021 and HIV care normalized by January 2022, we projected 1,161 (1%) more infections from 2020 to 2025 across all 32 cities than if COVID had not occurred. Among “optimistic” simulations in which sexual transmission was sharply reduced and viral suppression was maintained we projected 8% lower incidence (95% credible interval: 14% lower to no change). Among “pessimistic” simulations where sexual transmission was largely unchanged but viral suppression fell, we projected 11% higher incidence (1% to 21% higher). MSA-specific projections are available at jheem.org?covid.

CONCLUSIONS: The effects of COVID-19 on HIV transmission remain uncertain and differ between cities. Reported diagnoses of HIV in 2020-2021 are likely to correlate poorly with underlying incidence. Minimizing disruptions to HIV care is critical to mitigating negative effects of the COVID-19 pandemic on HIV transmission.

PMID:35016216 | DOI:10.1093/cid/ciab1029

Adv Nutr. 2021 Nov 23:nmab140. doi: 10.1093/advances/nmab140. Online ahead of print.

ABSTRACT

Whether older adults need more protein than younger adults is debated. The population reference intake for adults set by the European Food Safety Authority is 0.83 g/kg body weight (BW)/d based primarily on nitrogen balance studies, but the underlying data on health outcomes are outdated. An expert committee of the Health Council of the Netherlands conducted a systematic review (SR) of randomized controlled trials (RCTs) examining the effect of increased protein intake on health outcomes in older adults from the general population with an average habitual protein intake ≥0.8 g/(kg BW · d). Exposures were the following: 1) extra protein compared with no protein and 2) extra protein and physical exercise compared with physical exercise. Outcomes included lean body mass, muscle strength, physical performance, bone health, blood pressure, serum glucose and insulin, serum lipids, kidney function, and cognition. Data of >1300 subjects from 18 RCTs were used. Risk of bias was judged as high (n = 9) or “some concerns” (n = 9). In 7 of 18 RCTs, increased protein intake beneficially affected ≥1 of the tested outcome measures of lean body mass. For muscle strength, this applied to 3 of 8 RCTs in the context of physical exercise and in 1 of 7 RCTs without physical exercise. For the other outcomes, <30% (0-29%) of RCTs showed a statistically significant effect. The committee concluded that increased protein intake has a possible beneficial effect on lean body mass and, when combined with physical exercise, muscle strength; likely no effect on muscle strength when not combined with physical exercise, or on physical performance and bone health; an ambiguous effect on serum lipids; and that too few RCTs were available to allow for conclusions on the other outcomes. This SR provides insufficiently convincing data that increasing protein in older adults with a protein intake ≥0.8 g/(kg BW · d) elicits health benefits.

PMID:35016214 | DOI:10.1093/advances/nmab140

Neural Comput. 2022 Jan 11:1-38. doi: 10.1162/neco_a_01468. Online ahead of print.

ABSTRACT

We propose a novel method for enforcing AI fairness with respect to protected or sensitive factors. This method uses a dual strategy performing training and representation alteration (TARA) for the mitigation of prominent causes of AI bias. It includes the use of representation learning alteration via adversarial independence to suppress the bias-inducing dependence of the data representation from protected factors and training set alteration via intelligent augmentation to address bias-causing data imbalance by using generative models that allow the fine control of sensitive factors related to underrepresented populations via domain adaptation and latent space manipulation. When testing our methods on image analytics, experiments demonstrate that TARA significantly or fully debiases baseline models while outperforming competing debiasing methods that have the same amount of information-for example, with (% overall accuracy, % accuracy gap) = (78.8, 0.5) versus the baseline method’s score of (71.8, 10.5) for Eye-PACS, and (73.7, 11.8) versus (69.1, 21.7) for CelebA. Furthermore, recognizing certain limitations in current metrics used for assessing debiasing performance, we propose novel conjunctive debiasing metrics. Our experiments also demonstrate the ability of these novel metrics in assessing the Pareto efficiency of the proposed methods.

PMID:35016212 | DOI:10.1162/neco_a_01468

Eur Heart J. 2022 Jan 7:ehab892. doi: 10.1093/eurheartj/ehab892. Online ahead of print.

ABSTRACT

AIMS: This report from the European Society of Cardiology (ESC) Atlas Project updates and expands upon the widely cited 2019 report in presenting cardiovascular disease (CVD) statistics for the 57 ESC member countries.

METHODS AND RESULTS: Statistics pertaining to 2019, or the latest available year, are presented. Data sources include the World Health Organization, the Institute for Health Metrics and Evaluation, the World Bank, and novel ESC sponsored data on human and capital infrastructure and cardiovascular healthcare delivery. New material in this report includes sociodemographic and environmental determinants of CVD, rheumatic heart disease, out-of-hospital cardiac arrest, left-sided valvular heart disease, the advocacy potential of these CVD statistics, and progress towards World Health Organization (WHO) 2025 targets for non-communicable diseases. Salient observations in this report: (i) Females born in ESC member countries in 2018 are expected to live 80.8 years and males 74.8 years. Life expectancy is longer in high income (81.6 years) compared with middle-income (74.2 years) countries. (ii) In 2018, high-income countries spent, on average, four times more on healthcare than middle-income countries. (iii) The median PM2.5 concentrations in 2019 were over twice as high in middle-income ESC member countries compared with high-income countries and exceeded the EU air quality standard in 14 countries, all middle-income. (iv) In 2016, more than one in five adults across the ESC member countries were obese with similar prevalence in high and low-income countries. The prevalence of obesity has more than doubled over the past 35 years. (v) The burden of CVD falls hardest on middle-income ESC member countries where estimated incidence rates are ∼30% higher compared with high-income countries. This is reflected in disability-adjusted life years due to CVD which are nearly four times as high in middle-income compared with high-income countries. (vi) The incidence of calcific aortic valve disease has increased seven-fold during the last 30 years, with age-standardized rates four times as high in high-income compared with middle-income countries. (vii) Although the total number of CVD deaths across all countries far exceeds the number of cancer deaths for both sexes, there are 15 ESC member countries in which cancer accounts for more deaths than CVD in males and five-member countries in which cancer accounts for more deaths than CVD in females. (viii) The under-resourced status of middle-income countries is associated with a severe procedural deficit compared with high-income countries in terms of coronary intervention, ablation procedures, device implantation, and cardiac surgical procedures.

CONCLUSION: Risk factors and unhealthy behaviours are potentially reversible, and this provides a huge opportunity to address the health inequalities across ESC member countries that are highlighted in this report. It seems clear, however, that efforts to seize this opportunity are falling short and present evidence suggests that most of the WHO NCD targets for 2025 are unlikely to be met across ESC member countries.

PMID:35016208 | DOI:10.1093/eurheartj/ehab892

Ophthalmologica. 2022 Jan 11. doi: 10.1159/000521834. Online ahead of print.

ABSTRACT

BACKGROUND: To systematically review the literature and to perform meta-analyses on full-field electroretinography (ffERG) between healthy controls and age-related macular degeneration (AMD) to map the extent of retinal dysfunction.

SUMMARY: We systematically searched 11 databases on 3 March 2021. Eligible studies had to measure retinal function using ffERG in eyes with AMD and in healthy controls. We extracted data on a-wave and b-wave function in dark- and light-adapted ffERG, and calculated summary estimates on differences between eyes with AMD and controls using weighted mean differences (WMD). Subgroup analyses were made for early and late AMD. Six studies (n=481 eyes) were eligible for review (301 with any AMD, 180 controls). For dark-adapted data, any AMD was associated with reduced a-wave amplitude (WMD: -17.16 µV; 95% CI: -31.79 to -2.52 µV; P=0.02) and b-wave amplitude (WMD: -28.70 µV; 95% CI: -51.40 to -6.01 µV; P=0.01). For light-adapted data, any AMD was associated with longer a-wave implicit time (WMD: 0.92 ms; 95% CI: 0.12 to 1.72 ms; P=0.02), reduced b-wave amplitude (WMD: -13.26 µV; 95% CI: -18.64 to -7.88 µV; P<0.0001), and longer b-wave implicit time (WMD: 0.69 ms; 95% CI: 0.30 to 1.08 ms; P=0.0006). Subgroup analyses found that these changes were only statistically significant in eyes with late AMD, not early AMD. Key messages: Reduced retinal function on ffERG is present in eyes with AMD, in particular those with late AMD. These findings suggest that AMD is a pan-retinal disease with AMD-associated photoreceptor dysfunction beyond the macula.

PMID:35016191 | DOI:10.1159/000521834

Am J Nephrol. 2022 Jan 11:1-9. doi: 10.1159/000520466. Online ahead of print.

ABSTRACT

INTRODUCTION: Using a large diverse population of incident end-stage kidney disease (ESKD) patients from an integrated health system, we sought to evaluate the concordance of causes of death (CODs) between the underlying COD from the United States Renal Data System (USRDS) registry and CODs obtained from Kaiser Permanente Southern California (KPSC).

METHODS: A retrospective cohort study was performed among incident ESKD patients who had mortality records and CODs reported in both KPSC and USRDS databases between January 1, 2007, and December 31, 2016. Underlying CODs reported by the KPSC were compared to the CODs reported by USRDS. Overall and subcategory-specific COD agreements were assessed using Cohen’s weighted kappa statistic (95% CI). Proportions of positive and negative agreement were also determined.

RESULTS: Among 4,188 ESKD patient deaths, 4,118 patients had CODs recorded in both KPSC and USRDS. The most common KPSC CODs were circulatory system diseases (35.7%), endocrine/nutritional/metabolic diseases (24.2%), genitourinary diseases (12.9%), and neoplasms (9.6%). Most common USRDS CODs were cardiac disease (46.9%), withdrawal from dialysis (12.6%), and infection (10.1%). Of 2,593 records with causes listed NOT as “Other,” 453 (17.4%) had no agreement in CODs between the USRDS and the underlying, secondary, tertiary, or quaternary causes recorded by KPSC. In comparing CODs recorded within KPSC to the USRDS, Cohen’s weighted kappa (95% CI) was 0.20 (0.18-0.22) with overall agreement of 36.4%.

CONCLUSION: Among an incident ESKD population with mortality records, we found that there was only fair or slight agreement between CODs reported between the USRDS registry and KPSC, a large integrated health care system.

PMID:35016183 | DOI:10.1159/000520466

Blood Purif. 2022 Jan 11:1-9. doi: 10.1159/000520891. Online ahead of print.

ABSTRACT

INTRODUCTION: Cytokine storm control is the main target for improving severe COVID-19 by using immunosuppressive treatment. Effective renal replacement therapy (RRT) could give us an advantage removing cytokines in patients with RRT requirements superimposed on COVID-19.

METHODS: This is a prospective observational study in COVID-19 patients who required hemodialysis (HD). Patients were assigned to online hemodiafiltration (OL-HDF) and expanded HD (HDx) according to Brescia group recommendations. We measured several cytokines, β2 microglobulin and albumin levels pre/post-dialysis and on 1st-2nd week. We compared levels among both techniques and control group (HD without COVID-19).

RESULTS: We included 26 patients: 18 with COVID-19 on RRT (5 of them had acute kidney injury [AKI]) and 8 controls. We confirm higher cytokine levels in COVID-19 patients than controls and even higher in patients with AKI than in those with chronic kidney disease. Most cytokines raised during HD session, except IL-10 and TNFα. IL-10 was eliminated by any dialysis technique, while clearance of TNFα was higher in the HDx group. HDx achieved a deeper normalization of cytokines and β2 microglobulin reduction. Mortality was higher in the OL-HDF group than the HDx group.

DISCUSSION: Not all cytokines behave equally along HD session. The following characteristics should be taken into account, such as intrinsic kinetic profile during a HD session. HDx seems to get better performance, probably due to the combination of different factors; however, we did not reach statistical significance due to the small sample size, dropout, and reduction of AKI incidence during the 2nd pandemic wave.

CONCLUSION: HDx appears to provide better clearance for TNFα and β2 microglobulin during HD session and associates lower mortality. We propose the HDx technique for COVID-19 patients with RRT requirements since it seems to be safe and more effective than OL-HDF. Further studies are still needed, but we hope that our preliminary data may help us in future pandemic waves of SARS-CoV-2 or other viruses still to come.

PMID:35016172 | DOI:10.1159/000520891