Tag: nevin manimala

Cureus. 2023 Sep 8;15(9):e44885. doi: 10.7759/cureus.44885. eCollection 2023 Sep.

ABSTRACT

Introduction Resorption often takes the form of external inflammatory root resorption. Apical periodontitis or an apical cyst is the most typical cause of external inflammatory root resorption. Failure of endodontic treatment can occur if severe apical root resorption occurs.This is due to the difficulty of reaching these sites.Apical root resorption is usually discovered during routine radiographs and is usually in its later stages. If the lesion is advanced, extraction is the only viable solution. An accurate diagnosis of incipient root resorption is essential. This research is designed to analyze the effectiveness of digital intraoral periapical radiographs in assessing apical root resorption (ARR) related to periapical pathologies. Material and methods This cross-sectional radiographic observational research was conducted in a dental college and hospital in central India. Radiovisiography (RVG) images of 190 patients’ teeth with inflammatory periapical pathologies were evaluated to determine the presence or absence of resorption in the apical area of the root. After the radiographic assessment of the apical root resorption, the extraction of the affected teeth was done under all aseptic conditions. The periapical tissue was sent for histological analysis and the extracted tooth sample was examined for the presence or absence of apical root resorption. Results In comparison to apical periodontitis, the proportion of severe root resorption patients was significantly higher in abscess and periapical granuloma. Using Pearson’s Chi-square test, the difference in patient proportions according to the kind of resorption in the three radiological diagnosis groups was statistically significant with a p-value of 0.0058. Conclusion It was concluded that on radiographic examination, digital intraoral periapical radiographs were found to be accurate in determining periapical apical pathologies and apical root resorption.

PMID:37814761 | PMC:PMC10560382 | DOI:10.7759/cureus.44885

Cureus. 2023 Sep 8;15(9):e44900. doi: 10.7759/cureus.44900. eCollection 2023 Sep.

ABSTRACT

Background Packed red blood cell (PRBC) transfusions are routine in neonatal care and the most common blood product administered to sick neonates. However, their impact on leukocyte and platelet profiles in very low birth weight (VLBW) preterm infants remains largely unexplored. This study examines leukocyte profile shifts and platelet dynamics following leukoreduced PRBC transfusions in VLBW preterm infants, offering insights to improve neonatal care and reduce unnecessary interventions. Methods The study utilized a retrospective cohort design within a single center, focusing on VLBW preterm infants who received PRBC transfusions at a level 3 NICU between January 2014 and June 2019. Data collection encompassed white blood cell (WBC) and platelet count measurements taken 24 hours before and up to 72 hours after PRBC transfusion. Neonates lacking complete blood count (CBC) data within the 72-hour post-transfusion window were excluded. A subgroup analysis distinguished the outcome between the initial PRBC transfusion and subsequent ones. The statistical significance of pre- and post-transfusion laboratory data was determined using the Wilcoxon signed ranks test and paired T-test. Results A cohort of 108 VLBW preterm infants who underwent a total of 402 PRBC transfusions was included in the analysis. The subjects exhibited a mean gestational age of 27.2 ± 2.5 weeks and a mean birth weight of 913 ± 264 grams. Analysis of pre- and post-transfusion data revealed no significant differences in total white blood cell count (WBC), absolute neutrophil count (ANC), absolute monocyte count (AMC), absolute eosinophil count, and absolute lymphocyte count. Notably, the platelet count was significantly decreased in the post-transfusion group (p < 0.001). In a subset analysis limited to the first-time transfusions among the 108 infants, a statistically significant increase was observed in total WBC, AMC, and ANC following transfusion. Conclusions The findings of this study highlight that PRBC transfusions can prompt an increase in neutrophils, monocytes, and eosinophils, coupled with a decline in platelet counts, all within a 72-hour window post-transfusion. Notably, these changes were predominantly discernible after the initial transfusion, with subsequent transfusions demonstrating consistency, except for the observed platelet count reduction. Recognizing these patterns could prove instrumental in averting undue investigations for suspected sepsis, particularly following the initial transfusion event. However, further in-depth investigations are necessary to uncover the underlying factors responsible for the shifts in leukocyte and platelet profiles triggered by PRBC transfusions.

PMID:37814753 | PMC:PMC10560488 | DOI:10.7759/cureus.44900

Cureus. 2023 Sep 8;15(9):e44882. doi: 10.7759/cureus.44882. eCollection 2023 Sep.

ABSTRACT

Introduction Alopecia areata (AA) is an autoimmune disorder causing hair loss, including eyebrows, eyelashes, and body hair, primarily due to melanocyte impact. Though the precise AA melanocyte hearing loss mechanisms are not fully clear, it’s speculated that cochlear melanocyte inflammation could disrupt endolymph production, which is necessary for sound signal transmission. Cochlear melanocytes maintain crucial potassium ion levels, which are pivotal for hearing. The potential AA-melanocyte-hearing loss link underscores the need to monitor auditory and cochlear function and consider interventions for AA-related hearing challenges. The study aimed to assess auditory and cochlear function using OAE and audiometry measurements to correlate disease severity and duration with OAE outcomes. Materials and methods In this study, we included 32 patients diagnosed with AA; the control group consisted of 29 healthy volunteers. We collected data on the patient’s age, gender, onset age, family history, and disease duration. Audiological and otological evaluations were conducted, including pure tone audiometry (PTA), speech discrimination test (SD), and otoacoustic emission (DPOAE) measurements at frequencies of 500, 1000, 2000, 4000, 6000, 8000, and 10000 Hz. The patients were divided into two groups based on age: 18-25 and over 25 years old, and all parameters were compared. To examine differences between the right and left ears, gender, and age groups, we initially tested the variables for normal distribution using the Kolmogorov-Smirnov and Shapiro-Wilk tests. An independent sample t-test was conducted to compare the means for normally distributed variables. Results There were statistical differences at the 5% significance level in the mean DPOAE values of the 1 KHz SNR and 6 KHz SNR variables. According to the Mann-Whitney U test results, a significant difference was found in the gender-based DPOAE value at 2 kHz SNR (p=0.041), which was lower in men than women. Although there were no significant differences in the audiological parameters based on age, significant differences were found in the otoacoustic emission values. Variables, including 4 kHz DP1 (p=0.049), 500 Hz SNR (p=0.045), and 1 kHz SNR (p=0.023), differed significantly between age groups, with these values being lower in patients over 25 years old. Conclusion Overall, our study contributes to the growing body of evidence supporting an association between AA and auditory dysfunction, emphasizing the need for comprehensive assessment and management of hearing-related issues in individuals with AA.

PMID:37814747 | PMC:PMC10560379 | DOI:10.7759/cureus.44882

Cureus. 2023 Sep 8;15(9):e44899. doi: 10.7759/cureus.44899. eCollection 2023 Sep.

ABSTRACT

Introduction Chronic hepatitis B (CHB) continues to be a significant global public health problem. Conventional serological markers play a pivotal role in diagnosing and prognosticating CHB, but atypical serological profiles deviating from established norms pose challenges. Methods A cohort of 35 CHB patients who did not receive an antiviral treatment with atypical serological markers was followed for five years (2017-2022). Demographics, serological parameters, and changes were documented. Serological parameters and serum viral loads (hepatitis B virus (HBV)-deoxyribonucleic acid (DNA) levels) were assayed at the central laboratory during their routine follow-ups. Three groups of atypical serological markers are defined: hepatitis B surface antigen (HBsAg) and hepatitis B surface antibody (anti-HBs) positivity; hepatitis B e antigen (HBeAg) and anti-hepatitis B e-antigen (anti-HBe) positivity; and isolated core (anti-hepatitis B core (anti-HBc) immunoglobulin G (IgG)) positivity. Patients with concomitant HBsAg and anti-HBs were also stratified into seroreversion groups. Changes in serological markers and HBV-DNA levels across the study period were documented and evaluated at the end of the study period. Statistical analysis was conducted using the Kruskal-Wallis test and IBM SPSS Statistics software for Windows, Version 23.0 (IBM Corp., Armonk, NY, USA). Results In a cohort of 35 patients with atypical hepatitis B serology, demographic analysis revealed that 51.4% (n=18) were female and 48.6% (n=17) were male, with a mean age of 45.7 years. Educational distribution showed that 45.7% (n=16) completed primary education, 22.8% (n=8) had a high school education, and 31.5% (n=11) held university degrees. Among these patients, 10 displayed the concurrent presence of HBsAg and anti-HBs, with 60% (n=6) being female. Serum HBV-DNA was detectable in all cases. After five years, 60% (n=6) exhibited seroconversion from HBsAg to anti-HBs, particularly notable in females (66.7%). These patients showed lower HBsAg titers and serum HBV-DNA levels (p = 0.048, p = 0.036). A subset of 15 patients demonstrated simultaneous HBeAg and anti-HBe positivity. The HBeAg seropositivity waned over time, with 40% (n=6) and 26.7% (n=4) females and males, respectively, retaining positivity by the fifth year. During this period, serum HBV-DNA levels decreased. The remaining five patients sustained HBeAg and anti-HBe positivity. Among 10 patients solely positive for anti-HBc IgG, three had concurrent HBV-DNA positivity. Strikingly, three patients with negative HBV-DNA developed anti-HBs positivity after five years. Conclusion The complexity of CHB infection demands a comprehensive understanding. Atypical serological profiles suggest distinct disease stages, immune response variations, and viral mutations. This study enhances comprehension of viral replication, immune responses, and disease progression, potentially guiding tailored therapeutic strategies.

PMID:37814733 | PMC:PMC10560487 | DOI:10.7759/cureus.44899

Transl Pediatr. 2023 Sep 18;12(9):1707-1714. doi: 10.21037/tp-23-144. Epub 2023 Sep 4.

ABSTRACT

BACKGROUND: In prior studies, there has been no report of clinical observation of postoperative reconnection of the sternocleidomastoid muscle (SCM) in children with congenital muscular torticollis (CMT). Therefore, the objective of this study is to investigate the factors associated with postoperative reconnection of the SCM in children with CMT, and to provide clinical evidence.

METHODS: A retrospective study was conducted, wherein 83 CMT children without any missing data were followed up from November 2019 to June 2021. The age at the time of surgery, sex, preoperative and postoperative follow-up duration, laterality, neck mass history, preoperative physical therapy history, and severity type were recorded. The severity classification of CMT was based on clinical features and ultrasound images of SCM. The postoperative reconnection of SCM was measured.

RESULTS: Out of 83 patients, ten had postoperative reconnection. The rate of postoperative reconnection of SCM in children with CMT who had undergone unipolar SCM release surgery was 18.994 times higher than in patients who had not undergone such surgery. This difference was statistically significant [odds ratio (OR) =18.994, 95% confidence interval (CI): 1.583 to 227.897, P=0.020].

CONCLUSIONS: The history of SCM release surgery in CMT children can predict the postoperative reconnection of SCM, which will aid in determining the optimal surgical approach for recurrent CMT patients.

PMID:37814721 | PMC:PMC10560359 | DOI:10.21037/tp-23-144

Transl Pediatr. 2023 Sep 18;12(9):1668-1675. doi: 10.21037/tp-23-194. Epub 2023 Sep 11.

ABSTRACT

BACKGROUND: Identification of biological molecules related to post cardiopulmonary bypass (CPB) lung injury could help diagnose, predict and potentially impact patient’s clinical course after cardiac surgery. Proteoglycan 4 (PRG4) initially identified as potential biomarker for patients with prolonged mechanical ventilation following CPB in a prior study. To further validate these findings, we sought to understand the association of lower plasma PRG4 with prolonged mechanical ventilation and worse lung compliance in a larger cohort of pediatric patients post CPB.

METHODS: Retrospective chart review study. Pediatric Cardiac Intensive Care Unit, Tertiary Hospital. Infants <1 year old with tetralogy of Fallot, ventricular septal defect, or atrioventricular septal defect who underwent surgical repair 2012-2020 and had stored plasma samples in our biorepository were screened for inclusion. Patients with mechanical ventilation before surgery were excluded. Patients were divided into quartiles based on postoperative duration of mechanical ventilation (control <25^th percentile, study >75^th percentile). Preoperative and 48-hour postoperative samples for each cohort (20 patients each) were tested for PRG4 level using enzyme-linked immunosorbent assay (ELISA) technique.

RESULTS: Study group had lower lung compliance, higher mean airway pressure and higher oxygen need postoperative when compared to control group. Plasma PRG4 levels before surgery and 48 hours postoperative were lower in study group compared to control group (P=0.0232 preoperative; P=0.0016 postoperative). Plasma PRG4 levels were compared preoperative to PRG4 levels postoperative in both group, there was no statistically significant difference (study group: P=0.0869; control group: P=0.6500).

CONCLUSIONS: Lower levels of plasma PRG4 is associated with longer duration of mechanical ventilation, worse ventilator compliance and higher oxygen requirement after cardiac surgery in our patient population. Further validation of this finding in a larger and more diverse patient population is necessary prior to its application at the bedside.

PMID:37814710 | PMC:PMC10560364 | DOI:10.21037/tp-23-194

Transl Androl Urol. 2023 Sep 30;12(9):1375-1382. doi: 10.21037/tau-23-222. Epub 2023 Sep 11.

ABSTRACT

BACKGROUND: Endoscopic treatment of ureteral strictures provides a minimally invasive approach with a shorter hospital stay and less postoperative pain. There are different therapeutic options, the dilatation balloon and endoureterotomy with holmium yttrium-aluminum-garnet (Ho:YAG) laser are the most used. To assess histological changes after endoureterotomy in the ureteral stricture treatment comparing Ho:YAG laser endoureterotomy versus balloon dilatation endoureterotomy.

METHODS: The subjects used were a total of 48 female pigs. The initial assessment consisted of an endoscopic, nephrosonographic, and contrast fluoroscopic evaluation of the urinary tract. Subsequently, a model of ureteral stricture was performed. Three weeks later, the ureteral stricture was diagnosed and treated. Then animals were randomly assigned to two groups (group A, Balloon dilatation endoureterotomy and group B, Holmium laser retrograde endoureterotomy) in which a double-pigtail ureteral stent was placed for 3 weeks. Follow-up assessments were performed at 3-6 weeks. The final follow-up was completed at 5 months and included the pathological study.

RESULTS: In terms of therapeutic effectiveness, the overall success was 81.2%. The success rate was 91.7% in group B and 70.8%in group A without statistical significance. No evidence of vesicoureteral reflux nor urinary tract anomalies were observed. Histological assessment showed statistical significance in overall score, lamina propria fibrosis and serosal alterations in group A with higher histological changes.

CONCLUSIONS: The overall histopathological score after ureteral stricture treatment in an animal model showed better remodeling of incised ureteral wall healing after Ho:YAG laser endoureterotomy. Laser endoureterotomy tends to have higher success rate compared to balloon dilatation.

PMID:37814702 | PMC:PMC10560343 | DOI:10.21037/tau-23-222

Bioinformation. 2023 Feb 28;19(2):221-225. doi: 10.6026/97320630019221. eCollection 2023.

ABSTRACT

The most frequent instrument used to begin tightening screws is a manually regulated screwdriver. Regarding manually regulated screwdrivers, predicted margins of error vary between fifteen percent to forty eight percent. Mechanical Torque restricting devices can consistently produce the requisite torques. As a result, devices like wrenches are needed to achieve the desirable values of torque. Hence, the present study was designed to evaluate the torque difference between handheld drivers and torque wrench and thereby its effect on the internal threads of implant surface.120 blocks was prepared from an autopolymerizing type of acrylic material each with a dimension of 1 inch. The centre of each block was affixed with analogue of dental impalnts with dimensions of 3.5 mm width and 13 mm length. With 60 specimens each, these models were split into two categories: hand torque specimens category and torque wrench specimens category. A stereomicroscope was used to look at the implant analog’s internal threading architecture at a magnification of 100. At the bottom and top, four threads were spaced apart by a certain amount. Biowizard software was used for the assessment, and the results were recorded. Threads on the internal surface of dental implants were produced once more following torquing the implant’s impression, and the stereomicroscope was used to quantify the separation between the 4 threads. Statistics were used to correlate the readings. All study participants’ hand torque as well as torque wrench measurements were documented and statistical analysis was performed on them. When there was statistical analysis of the measurements then it was observed that mean values of torque in specimens included category of manual torque application was found out to be 33.6 ± 6.510 Ncm. On the other hand the mean values of torque in specimens included in category of torque application by torque wrench were found out to be 33.57 ± 3.472 Ncm. The outcome showed operator heterogeneity for both categories and operator variance when using a manual driver to generate torque. One independent – sample t test was used to contrast the mean data between the two categories, and P< 0.05 was chosen to determine whether the intergroup difference was meaningful. Because the torque values obtained with hand tightening were uneven, it may be concluded that different levels of hand torquing skill caused the torque to fluctuate. The torque wrench device displayed the desired torque data in the range that the manufacturer had advised. However, utilising manual drivers and a mechanical torque instrument did not cause any modifications to thread on the internal surface, and it rarely underwent significant deformation during the preliminary tightening torque readings. Thus, given that manually hand regulated drivers create a range of torques, it may be inferred that the employment of mechanical torque restricting instruments should be required.

PMID:37814682 | PMC:PMC10560308 | DOI:10.6026/97320630019221

Neurology. 2023 Oct 9:10.1212/WNL.0000000000207716. doi: 10.1212/WNL.0000000000207716. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Despite notable advances in genetic understanding of stroke recovery, most studies focus only on candidate genes. To date, only two genome-wide association studies (GWAS) have focused on stroke outcomes but they were limited to the modified Rankin Scale (mRS). The mRS maps poorly to biological processes. Therefore, we performed a GWAS to discover single nucleotide polymorphisms (SNPs) associated with motor recovery post-stroke.

METHODS: We used the Vitamin Intervention for Stroke Prevention (VISP) dataset of 2,100 genotyped participants with non-disabling stroke. We included only participants that had motor impairment at randomization. Participants with a recurrent stroke during the trial were excluded. Genotyped data underwent strict quality control and imputation. The GWAS utilized logistic regression models with generalized estimating equations (GEE) to leverage the repeated NIH Stroke Scale (NIHSS) motor score measurements spanning six time points over 24 months. The primary outcome was a decrease in the motor drift score of ≥1 vs <1 at each time point. Our model estimated the odds ratio of motor improvement for each SNP after adjusting for age, sex, race, days from stroke to visit, initial motor score, VISP treatment arm, and principal components.

RESULTS: A total of 488 (64%) participants with a mean (SD) age of 66 +/- 11 years were included in the GWAS. Although no associations reached genome-wide significance (p<5×10^-8), our analysis detected 115 suggestive associations (p<5×10^-6). Notably, we found multiple SNP clusters near genes with plausible neuronal repair biology mechanisms. The CLDN23 gene had the most convincing association with rs1268196-T as its most significant SNP (odds ratio 0.32; 95% CI 0.21, 0.48; pvalue 6.19×10^-7). CLDN23 affects blood-brain barrier integrity, neurodevelopment, and immune cell transmigration.

CONCLUSION: We identified novel suggestive genetic associations with the first-ever motor-specific post-stroke recovery GWAS. The results seem to describe a distinct stroke recovery phenotype compared to prior genetic stroke outcome studies that use outcome measures, like the mRS. Replication and further mechanistic investigation are warranted. Additionally, this study demonstrated a proof-of-principle approach to optimize statistical efficiency with longitudinal datasets for genetic discovery.

PMID:37813584 | DOI:10.1212/WNL.0000000000207716

Heart. 2023 Oct 9:heartjnl-2023-322871. doi: 10.1136/heartjnl-2023-322871. Online ahead of print.

ABSTRACT

OBJECTIVE: Left atrial appendage closure (LAAC) is recommended to decrease the stroke risk in patients with atrial fibrillation and contraindications to anticoagulation. However, age-stratified data are scarce. The aim of this study was to provide information on the safety and efficacy of LAAC, with emphasis on the oldest patients.

METHODS: A nationwide, prospective, multicentre, observational registry was established by 53 French cardiology centres in 2018-2021. The composite primary endpoint included ischaemic stroke, systemic embolism, and unexplained or cardiovascular death. Separate analyses were done in the groups <80 years and ≥80 years.

RESULTS: Among the 1053 patients included, median age was 79.7 (73.6-84.3) years; 512 patients (48.6%) were aged ≥80 years. Procedure-related serious adverse events were non-significantly more common in octogenarians (7.0% vs 4.4% in patients aged <80 years, respectively; p=0.07). Despite a higher mean CHA₂DS₂-VASc score in octogenarians, the rate of thromboembolic events during the study was similar in both groups (3.0 vs 3.1/100 patient-years; p=0.85). By contrast, all-cause mortality was significantly higher in octogenarians (15.3 vs 10.1/100 patient-years, p<0.015), due to a higher rate of non-cardiovascular deaths (8.2 vs 4.9/100 patient-years, p=0.034). The rate of the primary endpoint was 8.1/100 patient-years overall with no statistically significant difference between age groups (9.4 and 7.0/100 patient-years; p=0.19).

CONCLUSION: Despite a higher mean CHA₂DS₂-VASc score in octogenarians, the rate of thromboembolic events after LAAC in this age group was similar to that in patients aged <80 years.

TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT03434015).

PMID:37813560 | DOI:10.1136/heartjnl-2023-322871