Nevin Manimala

Clin Implant Dent Relat Res. 2021 Oct 5. doi: 10.1111/cid.13045. Online ahead of print.

ABSTRACT

BACKGROUND: Sandwich osteotomy technique (Inlay bone grafting) is considered as a highly reliable procedure for vertical bone augmentation in the maxillary anterior esthetic zone. The aim of this study was to compare vertical bone gain and palatal tipping using computer-guided inlay technique versus the conventional technique.

MATERIAL AND METHODS: This was a randomized clinical trial including 12 patients who were randomly divided into two groups: sandwich osteotomy with simultaneous implant placement at the anterior maxillary esthetic zone (six patients) using patient-specific guides (PSGs) in the study group versus conventional technique (six patients). In the control group, free-hand sandwich osteotomy was done, while in the study group all the procedures were performed with two sequential PSGs with cutting slits, guiding holes, and implant sleeves. Radiographic assessment included measurements of linear changes in the vertical dimensions of the labial plate of bone and palatal tipping on cross-sectional cuts of cone-beam computed tomography using special software.

RESULTS: All the procedures were uneventful except one case of the study group showed a cracked bony segment that did not affect the final outcome. Radiographic results showed comparable bone gain in both groups with no statistical significance difference (study group 4.4 mm, control group 3.9 mm). To the contrary, the computer-guided approach significantly reduced the palatal tipping to 0.4 mm compared to 2.1 mm in the conventional group, and there was a statistically significant difference between the two groups (p-value <0.001).

CONCLUSION: Sandwich osteotomy using PSGs appears to be efficient and showed promising results regarding improving the palatal tipping compared to the free-hand technique.

PMID:34609058 | DOI:10.1111/cid.13045

Dermatol Ther. 2021 Oct 5. doi: 10.1111/dth.15151. Online ahead of print.

ABSTRACT

BACKGROUND: Psoriasis is a chronic autoimmune skin disorder that can vary in severity and extent of disease. While localized disease can be managed with topical medications, widespread disease often requires systemic therapy including biologics. This medication class targets different components of the immune system and thus modulates disease activity. The biologic secukinumab is a human monoclonal antibody against interleukin-17A used for the treatment of psoriasis and psoriatic arthritis; cases of inflammatory bowel disease (IBD) have been observed in clinical trials to be associated with this medication.

OBJECTIVE: This review aims to provide evidence for the relationships between secukinumab treatment and the development of inflammatory bowel disease.

METHODS: We have examined review articles and original research papers, published between 2010 and 2020, using the following keywords: psoriasis, psoriatic arthritis, secukinumab, inflammatory bowel disease, Crohn’s disease, ulcerative colitis, interleukin-17, IL-17, IL-17 inhibitor.

RESULTS: Case reports have noted an association between secukinumab use and IBD and have called for IBD pre-screening in patients who will be prescribed this medication. Clinical trials concluded that secukinumab was associated with IBD, while retrospective studies have had mixed results, with most studies showing no statistical significance between secukinumab and IBD but having seen patients with history of IBD or family histories experience new-onset IBD or flare-ups.

CONCLUSION: Given the utilization of secukinumab as a therapy for psoriasis and psoriatic arthritis, appropriate screening and risk stratification could help limit morbidity and mortality that can be associated with secukinumab-induced IBD. This article is protected by copyright. All rights reserved.

PMID:34609037 | DOI:10.1111/dth.15151

Milbank Q. 2021 Oct 5. doi: 10.1111/1468-0009.12532. Online ahead of print.

ABSTRACT

Policy Points Policies that increase county income levels, particularly for middle-income households, may reduce low birth weight rates and shrink disparities between Black and White infants. Given the role of aggregate maternal characteristics in predicting low birth weight rates, policies that increase human capital investments (e.g., funding for higher education, job training) could lead to higher income levels while improving population birth outcomes. The association between county income levels and racial disparities in low birth weight is independent of disparities in maternal risks, and thus a broad set of policies aimed at increasing income levels (e.g., income supplements, labor protections) may be warranted.

CONTEXT: Low birth weight (LBW; <2,500 grams) and infant mortality rates vary among place and racial group in the United States, with economic resources being a likely fundamental contributor to these disparities. The goals of this study were to examine time-varying county median income as a predictor of LBW rates and Black-White LBW disparities and to test county prevalence and racial disparities in maternal sociodemographic and health risk factors as mediators.

METHODS: Using national birth records for 1992-2014 from the National Center for Health Statistics, a total of approximately 27.4 million singleton births to non-Hispanic Black and White mothers were included. Data were aggregated in three-year county-period observations for 868 US counties meeting eligibility requirements (n = 3,723 observations). Sociodemographic factors included rates of low maternal education, nonmarital childbearing, teenage pregnancy, and advanced-age pregnancy; and health factors included rates of smoking during pregnancy and inadequate prenatal care. Among other covariates, linear models included county and period fixed effects and unemployment, poverty, and income inequality.

FINDINGS: An increase of $10,000 in county median income was associated with 0.34 fewer LBW cases per 100 live births and smaller Black-White LBW disparities of 0.58 per 100 births. Time-varying county rates of maternal sociodemographic and health risks mediated the association between median income and LBW, accounting for 65% and 25% of this estimate, respectively, but racial disparities in risk factors did not mediate the income association with Black-White LBW disparities. Similarly, county median income was associated with very low birth weight rates and related Black-White disparities.

CONCLUSIONS: Efforts to increase income levels-for example, through investing in human capital, enacting labor union protections, or attracting well-paying employment-have broad potential to influence population reproductive health. Higher income levels may reduce LBW rates and lead to more equitable outcomes between Black and White mothers.

PMID:34609027 | DOI:10.1111/1468-0009.12532

Clin Anat. 2021 Oct 5. doi: 10.1002/ca.23797. Online ahead of print.

ABSTRACT

During the COVID-19 pandemic, many educational institutions followed the blended learning system. Using the participants’ opinions, we evaluated the Blackboard Collaborate Platform for online team-based learning sessions for undergraduate students from different medical programs in the KSA. The participants were students on the MBBS Program (157 year two and 149 year three), together with 53 students in year one of the Nursing Program, 25 in year two of the Doctor of Pharmacy Program, and 11 in year two of the Medical Laboratory Sciences Program in Fakeeh College for Medical Sciences, KSA. To assess students’ recall, engagement, and satisfaction with the sessions, an online TBL plan was designed and reviewed by the Medical Education Department. The students completed an online survey at the end of each session. All responses in this study showed a statistically significant positive difference from the neutral mid-point response (P < 0.05), reflecting high satisfaction. In the MBBS Program, the survey was completed by 40 students in year two and 76 in year three. The mean responses were 4.1 ± 0.3 and 3.9 ± 0.2 respectively (mean ± SD). In the BSN Program, 19 students completed the survey. The mean response was 4.6 ± 0.2. In the Pharm D Program, 10 students completed the survey. The mean response was 4.9 ± 0.12. In the MLS Program, eight students completed the survey. The mean response was 4.8 ± 0.12. It was concluded that online TBL using Blackboard Collaborate is a successful anatomy learning tool among FCMS students on different programs. This article is protected by copyright. All rights reserved.

PMID:34609024 | DOI:10.1002/ca.23797

Neurourol Urodyn. 2021 Oct 5. doi: 10.1002/nau.24810. Online ahead of print.

ABSTRACT

AIMS: In August 2019, the European Association of Urology (EAU) and European Society for Paediatric Urology (ESPU) published updated guidelines on the management of neurogenic bladder in children and adolescents. Our study aimed to establish whether members of the ESPU are adhering to these guidelines.

METHODS: We designed a survey comprising 26 questions using SurveyMonkey®. Respondents were asked about management of neurogenic bladder at birth in newborns with spina bifida (SB), urological investigations, as well as short and long-term follow-up in their institutions.

RESULTS: There were 103 respondents to the survey (754 recipients, giving a response rate of 14%) spanning 36 countries. 100% of respondents carry out a renal/bladder ultrasound at birth. Only 53% routinely commence clean intermittent catheterization soon after birth as recommended by the guidelines. Only 56% recommend anticholinergic medications after abnormal videourodynamics (VUDs). The guidelines recommend the use of continued antibiotic prophylaxis if there is evidence of vesicoureteral reflux and hostile bladder/non-conclusive results on VUDs which is followed by only 30% of providers. 63% of respondents carry out baseline VUDs at the recommended time. Seeing larger volumes of SB patients, having a formal SB protocol, having formal SB multidisciplinary clinics and working in a tertiary referral center did not make respondents more likely to adhere to guidelines.

CONCLUSIONS: Our survey demonstrated that large variations from the EAU/ESPU guidelines exist in practice. The study confirms that further work is required across institutions and countries to implement these evidence-based recommendations for standardized practice.

PMID:34609014 | DOI:10.1002/nau.24810

J Clin Ultrasound. 2021 Oct 5. doi: 10.1002/jcu.23075. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the effect of the Q-Box size on liver stiffness (LS) measurement by two-dimensional shear wave elastography (2D SWE).

METHODS: Ninety-eight patients with chronic liver disease were enrolled. Each patient was continuously measured five times. The Q-Box diameter was adjusted to 10, 20, and 30 mm each time. The liver stiffness values (LSVs) at different diameters were compared in the following groups: LSVs ≤6.2 kPa, 6.2 kPa < LSVs ≤11 kPa, LSVs >11 kPa. The reliability and repeatability of LS measurement at different diameters were evaluated.

RESULTS: The differences in LSVs at different Q-Box diameters were statistically significant only when LSV ≤6.2 kPa (p = 0.004). There were no statistically significant differences in standard deviation (SD), SD/median, coefficient of variation (CV), and interquartile range (IQR)/median at different Q-Box diameters (p > 0.05). There were statistical differences in minimum LSVs and percentage of minimum LSVs ≤0.2 kPa as well as in stability index (SI) and percentage of SI <90% at different Q-Box diameters (p < 0.05). The intraclass correlation coefficients (ICCs) were up to 0.98 at Q-Box diameters of 10, 20, and 30 mm.

CONCLUSIONS: Our study showed that Q-Box size may lead to significant differences in LSVs, especially when LSVs ≤6.2 kPa. The Q-Box size had a large effect on the reliability of a single LS measurement but did not affect the repeatability of multiple measurements.

PMID:34609006 | DOI:10.1002/jcu.23075

Health Serv Res. 2021 Oct 4. doi: 10.1111/1475-6773.13886. Online ahead of print.

ABSTRACT

OBJECTIVE: To develop a screening tool to identify emergency department (ED) patients at risk of entering a homeless shelter, which could inform targeting of interventions to prevent future homelessness episodes.

DATA SOURCES: Linked data from: 1) ED patient baseline questionnaires; and, 2) citywide administrative homeless shelter database.

STUDY DESIGN: Stakeholder-informed predictive modeling utilizing ED patient questionnaires linked with prospective shelter administrative data. The outcome was shelter entry documented in administrative data within 6 months following the baseline ED visit. Exposures were responses to questions on homelessness risk factors from baseline questionnaires.

DATA COLLECTION/EXTRACTION METHODS: Research assistants completed questionnaires with randomly sampled ED patients who were medically stable, not in police/prison custody, and spoke English or Spanish. Questionnaires were linked to administrative data using deterministic and probabilistic matching.

PRINCIPAL FINDINGS: Of 1,993 ED patients who were not homeless at baseline, 5.6% entered a shelter in the next 6 months. A screening tool consisting of two measures of past shelter use and one of past criminal justice involvement had 83.0% sensitivity and 20.4% positive predictive value for future shelter entry.

CONCLUSIONS: Our study demonstrates the potential of using cross-sector data to improve hospital initiatives to address patients’ social needs.

PMID:34608999 | DOI:10.1111/1475-6773.13886

Biometrics. 2021 Oct 5. doi: 10.1111/biom.13575. Online ahead of print.

ABSTRACT

We propose inference procedures for general factorial designs with time-to-event endpoints. Similar to additive Aalen models, null hypotheses are formulated in terms of cumulative hazards. Deviations are measured in terms of quadratic forms in Nelson-Aalen-type integrals. Different from existing approaches, this allows to work without restrictive model assumptions as proportional hazards. In particular, crossing survival or hazard curves can be detected without a significant loss of power. For a distribution-free application of the method, a permutation strategy is suggested. The resulting procedures’ asymptotic validity is proven and small sample performances are analyzed in extensive simulations. The analysis of a data set on asthma illustrates the applicability.

PMID:34608996 | DOI:10.1111/biom.13575

Evolution. 2021 Oct 5. doi: 10.1111/evo.14365. Online ahead of print.

ABSTRACT

The altricial-precocial spectrum describes patterns of variation in avian developmental mode that greatly influence avian life histories. Appraising a given species’ position on this spectrum is therefore fundamental to understanding patterns of avian life history evolution. However, evaluating avian developmental mode remains a relatively subjective task reliant on untested assumptions, including the notion that developmental strategies are distributed along a single dimension of statistical variation. Here, we present a quantitative multivariate framework that objectively discriminates among meaningfully different modes of avian development. We gathered information on seven hatchling and post-hatching traits for up to 4,000 extant bird species, and find that most traits related to developmental mode show high phylogenetic signal and little intraclade variation, allowing unknown values to be reliably interpolated. Principal component analyses (PCAs) of these traits illustrate that most variation in hatchling state can be quantified along one dimension of trait space. However, our PCAs also reveal an important second dimension explaining variation in post-hatching behavior, enabling factors related to hatchling state and post-hatching behavior to be disentangled. In order to facilitate future macroevolutionary studies of variation in avian developmental strategies, as well as explorations of covariation between developmental mode and other aspects of avian biology, we present PC scores for 9,993 extant avian species. This article is protected by copyright. All rights reserved.

PMID:34608994 | DOI:10.1111/evo.14365

Folia Morphol (Warsz). 2021 Oct 5. doi: 10.5603/FM.a2021.0080. Online ahead of print.

ABSTRACT

BACKGROUND: Piriform aperture is anterior opening of the nasal cavity formed by bones of the viscerocranium and knowledge about differences between genders is important for forensic scientists, anthropologists, orthopedists, neurosurgeons and vascular surgeons. The aim of this study was to examine gender differences of piriform aperture on 3D models of human skulls originating from Bosnian population using the geometric morphometric method.

MATERIALS AND METHODS: The study was conducted on 211 3D models of human skulls of known gender. 3D models were obtained by laser scanning. We analyzed the gender differences of piriform aperture using geometric morphometrics method. On 3D models we marked four landmarks on piriform aperture in the Landmark editor program, after which we analyzed its gender differences in MorphoJ program.

RESULTS: The first PCA axis described 40.398% of total variability of piriform aperture. The greatest gender variability was present in the position of the landmark rhinion. Discriminant functional analysis of the shape and size of the piriform aperture allowed the gender determination with 64.03% accuracy for male and 70.83% accuracy for female gender. The size of the piriform aperture showed a statistically significant difference between genders. Discriminant functional analysis of the shape of the piriform aperture without affecting size enabled gender determination with 59.71% accuracy for male and 62.5% accuracy for female.

CONCLUSIONS: Analysis showed statistically significant differences in the shape and size of piriform aperture between genders. The accuracy for gender determination based on piriform aperture was higher in females.

PMID:34608986 | DOI:10.5603/FM.a2021.0080