Tag: nevin manimala

Eur Heart J. 2021 Aug 23:ehab579. doi: 10.1093/eurheartj/ehab579. Online ahead of print.

ABSTRACT

AIMS: The aim of this study was to generate a biomarker-driven prognostic tool for patients with chronic HFrEF. Circulating levels of N-terminal pro B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) each have a marked positive relationship with adverse outcomes in heart failure with reduced ejection fraction (HFrEF). A risk model incorporating biomarkers and clinical variables has not been validated in contemporary heart failure (HF) trials.

METHODS AND RESULTS: In EMPEROR-Reduced, 33 candidate variables were pre-selected. Multivariable Cox regression models were developed using stepwise selection for: (i) the primary composite outcome of HF hospitalization or cardiovascular death, (ii) all-cause death, and (iii) cardiovascular mortality. A total of 3730 patients were followed up for a median of 16 months, 823 (22%) patients had a primary outcome and 515 (14%) patients died, of whom 389 (10%) died from a cardiovascular cause. NT-proBNP and hs-cTnT were the dominant predictors of the primary outcome, and in addition, a shorter time since last HF hospitalization, longer time since HF diagnosis, lower systolic blood pressure, New York Heart Association (NYHA) Class III or IV, higher heart rate and peripheral oedema were key predictors (eight variables in total, all P < 0.001). The primary outcome risk score discriminated well (c-statistic = 0.73), with patients in the top 10th of risk having an event rate >9 times higher than those in the bottom 10th. Empagliflozin benefitted patients across risk levels for the primary outcome. NT-proBNP and hs-cTnT were also the dominant predictors of all-cause and cardiovascular mortality, followed by NYHA Class III or IV and ischaemic aetiology (four variables in total, all P < 0.001). The mortality risk model presented good event discrimination for all-cause and cardiovascular mortality (c-statistic = 0.69 for both). These simple models were externally validated in the BIOSTAT-CHF study, achieving similar c-statistics.

CONCLUSIONS: The combination of NT-proBNP and hs-cTnT with a small number of readily available clinical variables provides prognostic assessment for patients with HFrEF. This predictive tool kit can be easily implemented for routine clinical use.

PMID:34423361 | DOI:10.1093/eurheartj/ehab579

Fam Pract. 2021 Aug 23:cmab093. doi: 10.1093/fampra/cmab093. Online ahead of print.

ABSTRACT

BACKGROUND: Studies have shown the existence of health concordance between patients with type 2 diabetes mellitus (T2DM) and their spouses, and also that spouses could influence the effect of self-management, benefiting patients’ health. However, these studies are heterogeneous and the evidence is inconclusive.

OBJECTIVE: To synthesize evidence from published randomized controlled trials: the interventional effects and the quality of study performance, also to identify the research gap and the directions for future studies.

METHODS: We performed the scoping review by following the PRISMA-ScR guidance. We searched and examined the reports from MEDLINE, EMBASE, PsychInfo, CINAHL Plus by the pre-specified criteria. Key characteristics and information of eligible reports were extracted, analysed and synthesized comprehensively, and the results were presented in the form of words and diagrams.

RESULTS: We identified 5 reports from 4 studies out of 3479 records included. Qualified studies indicated a positive effect of couple-based interventions on couples’ distress. Insufficient evidence on physiological health or health behaviours was identified owing to the small number of included studies and inconsistent assessment outcomes. The methodological quality across these studies was generally low due to inadequate reporting of study process and substantial biases.

CONCLUSIONS: Couple-based interventions for patients with T2DM showed small effects on the couple’s distress while the effects of other outcomes were inconclusive. Future studies should strengthen methodologies by using standard measures of core diabetic outcomes, including detailed assessments of implementation process, and taking a dyadic approach to systematically examine the effects.

PMID:34423363 | DOI:10.1093/fampra/cmab093

J Affect Disord Rep. 2021 Dec;6:100202. doi: 10.1016/j.jadr.2021.100202. Epub 2021 Jul 20.

ABSTRACT

BACKGROUND: This study compared a computer and manual version of a tailored Coordinated Anxiety Learning and Management (VA CALM) protocol on provider fidelity to CBT and patient outcomes.

METHODS: This study was a cluster randomized controlled trial. Providers (N = 32) were randomized to deliver VA CALM by computer or manual. Veteran patients (N = 135), treated by study providers, were recruited. The primary outcome was CBT fidelity, measured by rating audiotaped sessions. Secondary outcomes were Veterans’ general (BSI-18 GSI, SF-12) and disorder-specific (GAD-7, PCL-5, PHQ-9) outcomes assessed at baseline, three and six month follow-up.

RESULTS: We found a large (d = 0.88) but not statistically significant difference in mean fidelity rating scores between conditions. Compared with the manual, participants with generalized anxiety disorder receiving VA CALM by computer reported lower GAD-7 scores at three (-5.88; 95% CI=-11.37, -0.39) and six month (-5.25; 95% CI=-10.29, -0.22) follow-ups (d = 0.37 to 0.55). Participants in the computer and manual conditions reported lower PHQ-9 (-3.11; 95% CI=-5.51, -0.71; -4.06; 95% CI=-7.22, -0.90, respectively) and BSI-18 GSI (0.78; 95% CI=0.68,0.90; 0.71; 95% CI=0.58, 0.87, respectively) scores from baseline to six month follow-up. We did not find statistically significant differences over time or between conditions on SF-12 or PCL-5 scores.

LIMITATIONS: This study was underpowered to test the primary outcome. Small samples sizes in the disorder-specific subgroup analysis may limit the generalizability of findings.

CONCLUSIONS: Neither modality proved to be superior on VA CALM fidelity. The computer version of VA CALM, compared to the manual, may provide modest benefit to Veterans with GAD.

PMID:34423330 | PMC:PMC8373037 | DOI:10.1016/j.jadr.2021.100202

Int J Dent Hyg. 2021 Aug 22. doi: 10.1111/idh.12547. Online ahead of print.

ABSTRACT

OBJECTIVE: Periodontitis is a chronic inflammatory disease initiated by dysbiotic microbiota. Conventional mechanical debridement often needs adjunctive measures to control the disease process. The objective of the present study was to find out benefit of ozonized water irrigation along with nonsurgical periodontal therapy for the management of periodontitis.

METHODS: We have conducted a Randomized Controlled, triple blinded, parallel group clinical trial. Test Group (n=25) was treated with ozonized water irrigation whereas control group (n=25) received normal saline irrigation along with mechanical debridement. Full mouth plaque score, bleeding score, probing pocket depth and clinical attachment loss were evaluated at baseline and 4 weeks after treatment. Salivary Interleukin 1 beta was analyzed using enzyme linked immunosorbent assay. Analysis of covariance, t test and chi square test were used for intergroup comparison. Intragroup comparison was done using paired t test.

RESULTS: Adjunctive ozone water irrigation resulted in significant improvement in all clinical parameters except probing pocket depth after adjusting the extraneous effects due to initial confounding factors(p<0.001). But as per subgroup analysis ozone water irrigation resulted in significant reduction of pocket depth in deep pockets (p=0.01) and number of sites with pocket depth ≥4mm with bleeding on probing. Salivary Interleukin 1 Beta also reduced significantly in test group after therapy.

CONCLUSION: Ozone irrigation provide adjunctive benefit along with nonsurgical periodontal therapy in reducing clinical parameters as well as inflammatory mediator in saliva. But long- term benefits need to be assessed with future studies.

PMID:34420261 | DOI:10.1111/idh.12547

Int J Older People Nurs. 2021 Aug 22:e12413. doi: 10.1111/opn.12413. Online ahead of print.

ABSTRACT

OBJECTIVES: For community-dwelling older adults with hospitalisation experience, it is necessary to be strategic when promoting successful ageing. This study aimed to investigate whether components of successful ageing (i.e., diseases and complications, functions and engagement with life) differ according to hospitalisation experience in community-dwelling older adults.

METHODS: A secondary data analysis with the Korean national survey was performed. Using propensity score matching, 1812 older adults with hospitalisation experience were matched to 1812 older adults without hospitalisation experience. Sampling weight of the survey was considered for all statistical analyses.

RESULTS: The hospitalisation experienced group had more chronic illnesses, malnourishment, impairment in physical function, and depressive symptoms, and less activity in terms of working and social activities. There were no differences in cognitive function or religious activities.

CONCLUSIONS: Older adults with hospitalisation experience were less likely to experience successful ageing. To facilitate successful ageing of community-dwelling older adults with hospitalisation experience, nursing interventions for effective transitional care to encourage the use of community resources and participation in social activities are needed.

PMID:34420263 | DOI:10.1111/opn.12413

Skin Res Technol. 2021 Aug 22. doi: 10.1111/srt.13091. Online ahead of print.

ABSTRACT

BACKGROUND: In the still ongoing COVID-19 pandemic, one of the main prevention strategy remain to be the use of protective face masks. Changes in skin characteristics and dermatological problems related to wearing different types of masks have been observed. The aim of this study was to compare the short-term effects of cotton versus medical masks on skin biophysical parameters in general population.

MATERIALS AND METHODS: Twenty-eight human volunteers were enrolled and divided in cotton mask and medical mask wearing groups. We measured four skin biophysical parameters: trans-epidermal water loss (TEWL), stratum corneum hydration (SCH), skin pH, and erythema index (EI) before and 3 h after wearing masks on both uncovered and mask-wearing face area.

RESULTS: TEWL increased after 3 h on exposed skin in cotton mask group and slightly decreased in medical mask group There was an increase in SCH after 3 h of wearing protective face masks in both groups. pH of the covered skin slightly decreased while EI increased after 3 h in both groups; changes were not statistically significant. Parameters did not change significantly on uncovered skin.

CONCLUSION: There were no differences between the influence of cotton versus medical protective masks on the skin of healthy volunteers in our study. Both types of masks could be recommended for short-time protection in individuals with healthy skin during COVID-19 pandemic.

PMID:34420235 | DOI:10.1111/srt.13091

Ecol Lett. 2021 Aug 22. doi: 10.1111/ele.13863. Online ahead of print.

ABSTRACT

Globalisation has facilitated the spread of alien species, and some of them have significant impacts on biodiversity and human societies. It is commonly thought that biological invasions have accelerated continuously over the last centuries, following increasing global trade. However, the world experienced two distinct waves of globalisation (~1820-1914, 1960-present), and it remains unclear whether these two waves have influenced invasion dynamics of many species. To test this, we built a statistical model that accounted for temporal variations in sampling effort. We found that insect and plant invasion rates did not continuously increase over the past centuries but greatly fluctuated following the two globalisation waves. Our findings challenge the idea of a continuous acceleration of alien species introductions and highlight the association between temporal variations in trade openness and biological invasion dynamics. More generally, this emphasises the urgency of better understanding the subtleties of socio-economic drivers to improve predictions of future invasions.

PMID:34420251 | DOI:10.1111/ele.13863

Equine Vet J. 2021 Aug 22. doi: 10.1111/evj.13497. Online ahead of print.

ABSTRACT

BACKGROUND: Osteochondral fragmentation of the proximal phalanx (DPP1 fragment) is a common finding in the racehorse. Whilst radiographic assessment has been reported to lack diagnostic sensitivity, ultrasonographic examination has been documented to be extremely sensitive for identification of bone fragments in the metacarpophalangeal joint.

OBJECTIVES: To determine the sensitivity and specificity of ultrasonography as an imaging modality for diagnosis of DPP1 fragmentation and to compare it with radiography in the Thoroughbred racehorse.

STUDY DESIGN: Retrospective cohort study.

METHODS: Medical records (radiographs and ultrasonographic examinations) of 56 Thoroughbred racehorses in training (average age 26.4 months [SD ± 5.9]) with a history of forelimb fetlock joint effusion and arthroscopically confirmed DPP1 fragmentation were evaluated. Inter-observer agreement was calculated between 3 blinded reviewers for both ultrasonographic and radiographic findings. Median values were used for statistical analyses. Ultrasonographic and radiographic identification of DPP1 fragmentation was considered correct if in agreement with arthroscopic findings. The McNemar test was used to compare correct proportions between radiography and ultrasonography. Analyses were performed to evaluate correct identification of presence of fragment(s), location of fragment(s), and presence and location of fragment(s) within the joints, with values P<0.05 considered significant.

RESULTS: Eighty-one fetlock joints from 56 Thoroughbreds were evaluated. In total, 99 individual DPP1 fragments were confirmed arthroscopically. Ultrasonography was shown to have high levels of sensitivity (94%, 95% CI 89-99%) and specificity (97%, 95% CI 92-100%) for identification of DPP1 fragments, with transverse ultrasonographic images being more sensitive than sagittal ultrasonography (p=0.001). Ultrasonography was also shown in this population to have significantly greater sensitivity than radiography (47%, 95% CI 37-56%) (p<0.001).

CONCLUSIONS: Ultrasonography is an extremely sensitive and specific imaging modality for evaluation of DPP1 fragmentation, with transverse ultrasonographic imaging being the most sensitive technique. Radiographic evaluation was less sensitive than ultrasonography in this study.

PMID:34420230 | DOI:10.1111/evj.13497

Skin Res Technol. 2021 Aug 22. doi: 10.1111/srt.13086. Online ahead of print.

ABSTRACT

BACKGROUND: Deep-learning algorithms (DLAs) have been used in artificial intelligence aided ultrasonography diagnosis of thyroid and breast lesions. However, its use has not been described in the case of dermatologic ultrasound lesions. Our purpose was to train a DLA to discriminate benign form malignant lesions in dermatologic ultrasound images.

MATERIALS AND METHODS: We trained a prebuilt neural network architecture (EfficientNet B4) in a commercial artificial intelligence platform (Peltarion, Stockholm, Sweden) with 235 color Doppler images of both benign and malignant ultrasound images of 235 excised and histologically confirmed skin lesions (84.3% training, 15.7% validation). An additional 35 test images were used for testing the algorithm discrimination for correct benign/malignant diagnosis. One dermatologist with more than 5 years of experience in dermatologic ultrasound blindly evaluated the same 35 test images for malignancy or benignity.

RESULTS: EfficientNet B4 trained dermatologic ultrasound algorithm sensitivity; specificity; predictive positive values, and predicted negative values for validation algorithm were 0.8, 0.86, 0.86, and 0.8, respectively for malignancy diagnosis. When tested with 35 previously unevaluated images sets, the algorithm´s accuracy for correct benign/malignant diagnosis was 77.1%, not statistically significantly different from the dermatologist’s evaluation (74.1%).

CONCLUSION: An adequately trained algorithm, even with a limited number of images, is at least as accurate as a dermatologic-ultrasound experienced dermatologist in the evaluation of benignity/malignancy of ultrasound skin tumor images devoid of clinical data.

PMID:34420233 | DOI:10.1111/srt.13086

Int Endod J. 2021 Aug 22. doi: 10.1111/iej.13615. Online ahead of print.

ABSTRACT

AIM: To analyse the contents and thermal behavior of several brands of contemporary gutta-percha points due to the variable nature of the components of gutta-percha, and the impact they can have on the physical properties of this unique material during canal filling.

METHODOLOGY: Six brands of gutta-percha were investigated: Conform Fit ^TM Gutta-Percha Points for ProTaper Gold^® (PTG) (Dentsply Sirona, Charlotte, NC, USA), ProTaper^® Universal Gutta-Percha Points (PTU) (Dentsply Sirona), Autofit ^TM Feathered Tip Gutta Percha (Kerr, Brea, CA, USA), Mtwo^® Gutta-Percha (VDW, Munich, Germany), Gutta Percha Root Canal Points (GC) (GC Corporation, Tokyo, Japan), Gutta-Percha Points ISO Color-Coded (ISO) (Dentsply Sirona). The organic and inorganic fractions of gutta-percha points were separated by quantitative chemical analysis. Thermal conductivity was detected using a laser flash method. In addition, thermal behavior of gutta-percha in response to temperature variations was analysed using differential scanning calorimetry (DSC). Kruskal-Wallis and Dunn tests were applied for comparisons amongst groups for chemical compositions and temperature obtained from DSC. The associations between compositions and thermal conductivity were determined using simple linear regression. A P value < 0.05 was considered to be statistically significant.

RESULTS: There were significant difference in the inorganic fractions of the gutta-percha points in percentage by weight amongst the groups (P < 0.05). PTG had the lowest thermal conductivity (0.42 W/m・K). A positive correlation was observed between the percentage of inorganic fraction and thermal conductivity (r = 0.95). The initial phase changing temperature and peak temperature measured by DSC were significantly different when the β-form transformed to α-form (P < 0.05), whereas no significant difference was found during the α-form to the amorphous phase transition (P > 0.05).

CONCLUSIONS: hemical compositions and initial phase changing temperature by DSC varied according to the various brands of gutta-percha points. Conform Fit ^TM gutta-percha had the lowest percentage of inorganic fraction and thermal conductivity amongst these six brands of gutta-percha. Thermal conductivity had the strongest positive correlation with the percentage of inorganic components and zinc, while there was a negative correlation to the amount (ratio) of gutta-percha.

PMID:34420210 | DOI:10.1111/iej.13615