Tag: nevin manimala

Odontology. 2025 Sep 24. doi: 10.1007/s10266-025-01193-3. Online ahead of print.

ABSTRACT

This systematic review and network meta-analysis compared the efficacy of platelet concentrates with traditional bioactive capping materials on vital pulp treatment (VPT) healing outcomes in permanent human teeth. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist and a registered protocol (CRD42024614771), a search was conducted across PubMed, Web of Science, Scopus, ClinicalTrials.gov, and the Cochrane Library for studies published until March 31, 2025. Controlled clinical trials evaluating VPT success rates using platelet concentrates versus bioceramics in permanent teeth, with at least 6 months’ follow-up, were included. Data from the selected studies were analyzed using the MetaInsight tool to assess multiple comparisons, and the risk of bias was evaluated using the Cochrane RoB2 and ROBINS-I tools. Evidence quality was graded using the Grading of Recommendations Assessment, Development and Evaluation approach (GRADE). The search identified 1097 studies, with ten meeting the inclusion criteria, encompassing 437 patients and three treatment modalities. At 6 months, success rates for mature teeth showed no statistically significant differences: LPC (RR = 1.00; 95% CI: 0.96-1.04) and PRF (RR = 1.04; 95% CI: 0.96-1.12). For immature teeth, PRF demonstrated no significant effect (RR = 0.99; 95% CI: 0.92-1.06). At 12 months, outcomes remained non-significant for mature teeth with LPC (RR = 1.02; 95% CI: 0.90-1.15) and PRF (RR = 1.10; 95% CI: 0.94-1.28), and for immature teeth treated with PRF (RR = 1.00; 95% CI: 0.94-1.06). These findings suggest that while platelet concentrates may offer comparable outcomes, bioceramics should be considered the preferred option based on probabilistic analysis.PROSPERO registration number: CRD42024614771.

PMID:40991160 | DOI:10.1007/s10266-025-01193-3

Ophthalmol Ther. 2025 Sep 24. doi: 10.1007/s40123-025-01244-6. Online ahead of print.

ABSTRACT

INTRODUCTION: Vernal keratoconjunctivitis (VKC) is a chronic, recurrent ocular surface disease of childhood that often requires long-term anti-inflammatory therapy beyond topical corticosteroids. This study aimed to identify the clinical predictors of suboptimal treatment response with 0.1% cyclosporine A cationic emulsion (CsA CE) in a real-world pediatric cohort.

METHODS: This was a retrospective, single-center study including patients aged 4-18 years with moderate or severe VKC, evaluated at a multidisciplinary ophthalmology clinic between January 2021 and December 2024. All patients received 0.1% CsA CE (administered four times daily). Demographic, clinical, and anamnestic data were collected. Disease severity was assessed using the Bonini grading scale, which provides a semiquantitative evaluation of ocular signs and symptoms. Statistical analysis was performed using univariate and multivariate Cox regression. For significant parameters, ROC curves were generated and optimal cut-off values were identified using the Youden’s Index.

RESULTS: A total of 101 patients were included (mean age 8.86 ± 3.31 years; 27 females). Over a mean follow-up period of 1.44 ± 1.13 years, 18 patients (17.8%) required escalation to 1% CsA galenic eye drops, of whom seven were further switched to 0.1% tacrolimus galenic eye drops. On multivariate analysis, the baseline composite clinical score was the strongest predictor of suboptimal treatment response. Notably, the clinical signs score alone demonstrated superior discriminative ability (AUC 0.732) compared to the total score (AUC 0.714). Optimal cut-off values were identified as 7 for clinical signs and 15 for the overall score.

CONCLUSIONS: Baseline disease severity, particularly the score for clinical signs, is a reliable predictor of response to 0.1% CsA CE. In patients exceeding the identified thresholds, early therapeutic escalation may be warranted to improve disease control and prevent structural complications.

PMID:40991157 | DOI:10.1007/s40123-025-01244-6

J Neurogenet. 2025 Sep 24:1-10. doi: 10.1080/01677063.2025.2561589. Online ahead of print.

ABSTRACT

Previous studies have reported associations between risk of Alzheimer’s disease (AD) or dementia and rare coding variants in a number of genes. A two-stage strategy was used in which a previously released whole exome sequenced sample was used to prioritise 100 genes showing the strongest evidence for association with AD. These genes were then analysed in a newly released whole genome sequenced sample to identify those which showed statistically significant evidence for rare coding variant association. Association analysis of loss of function (LOF) and nonsynonymous variants was carried out in 18,998 protein-coding genes using 11,188 controls and 5,808 cases, with nonsynonymous variants being annotated using 45 different pathogenicity predictors. The 100 genes showing strongest evidence for association were then analysed in a new sample of 27,749 controls and 13,234 cases using only the pathogenicity predictor which had performed best in the first sample. Four genes were statistically significant after correction for multiple testing: ABCA7, PSEN1, SORL1 and TREM2. The association of different categories of variant with AD was characterised and the pattern was seen to vary between genes. This study quantifies the contribution of different types of variant within each gene to AD risk. In general, these variants are probably too rare to be clinically useful for assessing individual risk of AD. Further research into the mechanisms whereby the products of these genes affect AD pathogenesis may aid development of novel therapeutic strategies.

PMID:40990081 | DOI:10.1080/01677063.2025.2561589

Mil Med. 2025 Sep 24:usaf433. doi: 10.1093/milmed/usaf433. Online ahead of print.

ABSTRACT

INTRODUCTION: During interwar transition periods, military medical volume, particularly surgical volume, declines dramatically. The Knowledge, Skills, and Abilities (KSA) metric was developed to assess “readiness” and the ability of the Military Treatment Facilities (MTFs) to prepare active duty (AD) surgeons for deployment. The KSA metric, or threshold for readiness, has not been validated externally. We seek to provide that validation by comparing KSA statistics of the military neurosurgery community to those of civilian neurosurgeons at level 1 civilian trauma centers.

MATERIALS AND METHODS: The Carepoint Health Data base compiles KSA totals for each surgeon over a 12-month period for their current stationed MTF. Forty-six AD attending neurosurgeons were included for the 2022 calendar year. To determine reliability of the Carepoint database, we secondarily analyzed the 2023-2024 academic year case logs of every AD neurosurgeon at 2 individual MTFs (N = 11). Civilian neurosurgeon KSA data was compiled by evaluating the case logs of neurosurgeons from 4 level 1 trauma centers (N = 29). We additionally utilized the database to analyze local Purchased Care Markets for each of the neurosurgery supported MTFs during that year to explain the historically low case volumes at the MTFs.

RESULTS: In 2022, the average KSA per AD neurosurgeon per month was 393, extrapolated to 4,725 annually. Two of the 46 surgeons reached the KSA threshold. For the 2023-2024 academic year, the average AD military annual KSA was 3,192 (N = 9) and the average civilian KSA was 11,272 (N = 29) (P < .0001). Twenty-four of the 29 civilian surgeons met KSA goal 8,000; none of the AD surgeons met goal. Total neurosurgical KSA in Purchased Care was 3,01,535 compared to 1,39,005 for all MTFs. Operative cases were 7,324 deferred to the civilian sector compared to 2,286 performed at MTFs.

CONCLUSIONS: The KSA Metric is a reasonable and attainable readiness standard based on civilian level 1 trauma center statistics but does have its limitations. The current MTF neurosurgery case volume does not support wartime readiness as described by the KSA Metric.

PMID:40990067 | DOI:10.1093/milmed/usaf433

Mil Med. 2025 Sep 24:usaf459. doi: 10.1093/milmed/usaf459. Online ahead of print.

ABSTRACT

INTRODUCTION: Use of the upper limbs is often necessary for military and firefighter personnel who carry backpacks. Backpack straps can compress the brachial plexus nerves of the upper limb. It is known that carrying a backpack can lead to rucksack palsy, but it is unknown if effects of upper limb nerve compression from carrying a heavy backpack can be demonstrated after a single session of backpack use. Our study aimed to investigate the short-term effects of backpack carriage on upper limb nerve conduction.

MATERIALS AND METHODS: Thirty-six participants including 18 female (mean ± SD: age 24.3 ± 7.6 years; height 168.8 ± 9.4 cm; mass 73.1 ± 16.6 kg; BMI 25.4 ± 4.5 kg/m2) and 18 male (24.1 ± 5.8 years; 178.2 ± 9.4 cm; 80.2 ± 11.7 kg; BMI 25.0 ± 4.3 kg/m2) were recruited as a convenience sample and assessed by nerve conduction study (NCS) of the median nerve on the dominant upper limb. Skeletal muscle mass (SMM) and body mass index (BMI) were evaluated using bioelectric impedance. Nerve conduction study measurements were taken before (PRE), after 20 minutes of walking and while still wearing a military-style large frame backpack with hip belt loaded to 30% bodyweight (POST), and immediately after removing the backpack (DOFF). We analyzed comparisons statistically using mixed factor analysis of variance (ANOVA) with significance level of P < .05.

RESULTS: Motor nerve action potential amplitude significantly decreased when stimulation was at the axilla from PRE to POST (P = .025) and PRE to DOFF (P = .012). Motor nerve action potential latency was significantly increased PRE to POST and PRE to DOFF with stimulation at the elbow (P = .029 and P = .030, respectively). Latency was significantly longer for males as compared to females (P ≤ .008). Sensory nerve action potential amplitude decreased significantly between PRE and POST (P = .007). Significant correlation was determined between amount of SMM and percent difference PRE to POST in motor nerve action potential amplitude (r = 0.438, P < .01). Participants with lower SMM demonstrated greater difference in motor nerve action potential after backpack carriage with POST measurements lower than PRE measurements. Body mass index was significantly correlated with sensory baseline-to-peak amplitude percent difference PRE to POST (r = 0.428, P < .01) indicating that those with lower BMI had a larger negative impact on sensory nerve response after backpack carriage.

CONCLUSION: The results of this study reveal that walking for 20 minutes while carrying a 30% bodyweight backpack resulted in an increase in upper limb motor nerve latency and decrease in sensory and motor nerve action potential amplitude. The NCS findings indicate that SMM may have a protective effect and was therefore beneficial to maintaining upper limb nerve conduction after backpack carriage while lower BMI was a risk factor for reduced sensory nerve conduction. The demonstrated deficits in nerve conduction after backpack carriage could have implications for use of hands, especially the thumb, index, and middle finger, as they are innervated by the median nerve.

PMID:40990056 | DOI:10.1093/milmed/usaf459

Intern Med J. 2025 Sep 24. doi: 10.1111/imj.70204. Online ahead of print.

ABSTRACT

Aspirin resistance (AR) is linked to increased morbidity and mortality after cardiovascular and neurovascular procedures but has not been investigated after total hip arthroplasty (THA) and total knee arthroplasty (TKA). To investigate the incidence of AR in high-risk patients after elective THA/TKA, we conducted a prospective cohort study of elective THA/TKA in patients with thromboembolic risk factors: obesity (body mass index [BMI] ≥30 kg/m²), diabetes and/or advanced age (≥65 years) who were administered aspirin for venous thromboembolism prophylaxis. AR was confirmed using a platelet function analyser. Forty patients were included with a mean±standard deviation age of 66.1±10.4 years and BMI of 32.2±6.0 kg/m² and eight (20.0%) had diabetes. Overall, 52.5% of patients were aspirin resistant, with no statistically significant relationships between patient variables and AR (P > 0.05). AR after THA/TKA was an observed phenomenon; however, larger trials are required to determine the clinical consequences of AR and to guide prophylaxis strategies in this population.

PMID:40990050 | DOI:10.1111/imj.70204

Europace. 2025 Sep 1;27(9):euaf200. doi: 10.1093/europace/euaf200.

ABSTRACT

AIMS: Atrial fibrillation (AF) is associated with an increased risk of sudden cardiac death. Therefore, the effect of an implantable cardioverter-defibrillator (ICD) may be greater in patients with AF. We examined the long-term effects of primary prevention ICD implantation vs. usual clinical care according to AF status in DANISH.

METHODS AND RESULTS: Outcomes were analysed according to AF status at baseline (history and/or on enrollment ECG). The primary outcome was all-cause death, and secondary outcomes were cardiovascular and sudden cardiovascular death. Of the 1116 patients with non-ischaemic heart failure with reduced ejection fraction randomized in DANISH, 418 (37.5%) had AF at baseline, of whom 24.2% had paroxysmal AF, 17.0% persistent AF, and 58.9% permanent AF. AF status did not significantly modify the effect of ICD implantation on all-cause death, although there was a suggestion of a greater effect in patients with [hazard ratio (HR) 0.78 (95% CI, 0.59-1.03)] vs. without AF [HR 0.98 (0.75-1.27)] (Pinteraction = 0.15). AF status significantly modified the effect of ICD implantation on cardiovascular death, such that ICD implantation was associated with a lower rate of this outcome in patients with AF [HR 0.67 (0.48-0.94)], but not in those without AF [HR 1.04 (0.76-1.41)] (Pinteraction = 0.04). Although AF status did not significantly modify the effect of ICD implantation on sudden cardiovascular death, there was a suggestion of a greater effect in patients with [HR 0.45 (0.24-0.82)] vs. without AF [HR 0.76 (0.41-1.38)] (Pinteraction = 0.20).

CONCLUSION: In the DANISH trial, the presence of AF was associated with a greater effect of ICD implantation on cardiovascular death, and although similar trends were observed for all-cause and sudden cardiovascular death, the treatment-by-subgroup interaction was not statistically significant for these outcomes.

REGISTRATION: URL: https://www.clinicaltrials.gov; unique identifier: NCT00542945.

PMID:40990042 | DOI:10.1093/europace/euaf200

Dement Neuropsychol. 2025 Sep 19;19:e20250284. doi: 10.1590/1980-5764-DN-2025-0284. eCollection 2025.

ABSTRACT

Dementia significantly impairs cognitive function and severely affects daily living activities. To support independent mobility in older adults and individuals with dementia, home modification strategies, such as safety adaptations, have been identified as critical interventions.

OBJECTIVE: To explore caregivers’ perspectives on the potentials of digital interventions in enhancing independent mobility for PwD in mild to moderate stages of the condition. The aim is to determine if digital intervention could help PwD to effectively use existing home safety interventions and to safely move around their environment.

METHODS: A cross-sectional survey was used to gather insights from 121 professional caregivers and family members providing care for PwD. Participants aged 18 years and above were eligible for inclusion. Responses were analysed using R software, employing descriptive statistics, contingency tables, and graphical charts. χ² tests (p<0.05) assessed the relationships between categorical variables, with Cramér’s V measuring association strength (weak relationship if ≤0.30). Cronbach’s alpha demonstrated reliability for mobility factors (0.87, 95%CI 0.810-0.908).

RESULTS: The study revealed that PwD made limited use of existing home safety interventions, with statistically significant findings (p<0.05) across the four mobility factors evaluated. This indicates that the effectiveness of these interventions could be undermined particularly for individuals living alone.

CONCLUSION: The study found that digital interventions can support PwD in using existing home safety interventions and navigating their environments more independently. It could help the target population know when and how to these interventions thereby increasing the overall goal of their implementations.

PMID:40990005 | PMC:PMC12452096 | DOI:10.1590/1980-5764-DN-2025-0284

Clin Kidney J. 2025 Aug 26;18(9):sfaf268. doi: 10.1093/ckj/sfaf268. eCollection 2025 Sep.

ABSTRACT

BACKGROUND: The ANCA Renal Risk Score was updated in 2023 to the ANCA Kidney Risk Score (AKRiS) to improve clinicopathological prognostication in patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and kidney involvement. Our study aimed to assess whether incorporating recently identified predictors of kidney survival in AAV could further refine the prognostic accuracy of AKRiS in our multicentric cohort.

METHODS: We retrospectively reviewed all incident AAV with kidney biopsy from 2005 to 2020. Cox regression analysis examined factors [AKRiS, dialysis within 4 weeks, urine protein-creatinine ratio (UPCR) and hematuria at baseline, C3 deposits, renal arteritis on biopsy, estimated glomerular filtration rate (eGFR), UPCR and hematuria after induction] associated with kidney failure. These factors in combination with AKRiS were analyzed using the area under the receiver operating characteristic curve (AUROC) for prediction of kidney failure.

RESULTS: The cohort included 115 patients (age 64 years, 55% male, 57% myeloperoxidase-ANCA, baseline creatinine 3.6 mg/dL, eGFR 16 mL/min/1.73 m²), with 34 (30%) dialysed within 4 weeks. During a median 6.4-year follow-up, 39 (34%) patients progressed to kidney failure, and 13 (11%) died. Cox analysis identified AKRiS, dialysis within 4 weeks, C3 deposits, renal arteritis on biopsy, lower eGFR after induction and higher UPCR after induction as unadjusted risk factors for kidney failure. After adjusting for AKRiS, dialysis within 4 weeks [hazard ratio (HR) 6.20 (95% confidence interval 2.76 to 13.95), P ≤ .001], eGFR after induction [HR 0.94 (0.89 to 0.99), P = .03] and UPCR after induction [HR 1.62 (1.02 to 2.58), P = .04] remained significantly associated with kidney outcome. The AUROC for kidney failure prediction was 0.77 for AKRiS, increasing to 0.82, 0.80 and 0.79 when adding dialysis within 4 weeks, eGFR and UPCR after induction, respectively.

CONCLUSION: Dialysis within 4 weeks, eGFR after induction and UPCR after induction are able to predict long-term kidney outcome in AAV patients. Adjusting AKRiS for these variables modestly enhances its predictive power. We propose using them as placeholder endpoints for kidney failure in future studies.

PMID:40989994 | PMC:PMC12451443 | DOI:10.1093/ckj/sfaf268

Int J Clin Pediatr Dent. 2025 Aug;18(8):1031-1038. doi: 10.5005/jp-journals-10005-3171. Epub 2025 Sep 4.

ABSTRACT

AIMS AND BACKGROUND: An optimal pulp capping material should promote the formation of reparative dentin, preserve pulpal vitality, and create an effective barrier against bacterial infiltration. Due to issues like disintegration and tunnel defects, mineral trioxide aggregate (MTA) has become a preferred recent alternative to calcium hydroxide (Ca(OH)₂) for indirect pulp capping in primary teeth. In the literature, there have been conflicting opinions regarding the selection of materials for indirect pulp capping. Hence, the aim of this systematic review was to evaluate and compare the effectiveness of MTA and Ca(OH)₂ as indirect pulp capping agents in deep carious lesions of primary molars.

METHODS: This review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The databases searched included MEDLINE (via PubMed), Google Scholar, and Cochrane. Randomized clinical trials published until January 31, 2024, without year restrictions, were included. The systematic review assessed the effectiveness of MTA and Ca(OH)₂ as indirect pulp capping agents in primary molars.

RESULTS: The search resulted in 412 published studies. Four hundred and five articles that did not meet the inclusion criteria, were duplicates, or were not in English were excluded. A total of seven studies were included in the systematic review to assess clinical and radiographic effectiveness, and five studies were selected for meta-analysis (radiographic effectiveness). MTA showed greater reparative dentin formation as compared to the Ca(OH)₂ group with a standardized mean difference of 0.45; however, the difference between the two groups was not statistically significant.

CONCLUSION: Both MTA and Ca(OH)₂ can be effectively utilized as indirect pulp capping agents in deep carious lesions of primary molars.

CLINICAL SIGNIFICANCE: This systematic review and meta-analysis highlights the effectiveness of MTA and calcium hydroxide [Ca(OH)₂] as indirect pulp capping agents in primary molars with deep carious lesions, providing valuable evidence-based guidance for pediatric dentists in selecting the most suitable pulp capping agent.

HOW TO CITE THIS ARTICLE: CK A, Ninawe NS, Sawant S, et al. Clinical and Radiographic Evaluation of Indirect Pulp Capping with Mineral Trioxide Aggregate and Calcium Hydroxide in Primary Molars: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent 2025;18(8):1031-1038.

PMID:40989989 | PMC:PMC12451570 | DOI:10.5005/jp-journals-10005-3171