Tag: nevin manimala

J World Fed Orthod. 2021 Jun 7:S2212-4438(21)00020-5. doi: 10.1016/j.ejwf.2021.05.001. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the rate of tooth movement and the periodontal tissue status over a period of 90 days with and without micro-osteoperforation (MOP).

METHOD: Thirty-three adults of the 19 to 25 age group undergoing labial fixed orthodontic treatment with bilateral maxillary first premolar extraction, requiring individual canine retraction as a part of the treatment plan, were recruited for this split-mouth randomized clinical trial. While performing micro-implant-assisted canine retraction in the maxillary arch, the experimental side received three MOPs each on the mesial and distal aspects of the canine root. The amount of tooth movement was measured clinically at every 15 days interval for 90 days; the periodontal status was assessed clinically (probing depth, relative attachment level) and tomographically (canine root length, alveolar bone level) at the 1st day and 90th day of retraction. The data were subjected to appropriate statistical analyses.

RESULTS: A statistically significant difference in tooth movement on the MOP side was observed in the first 45 days, amounting to 1.5 times more than that of the control side. However, during 45 to 90 days, the difference in the rate of tooth movement between the sides was not statistically significant. Changes in periodontal variables were also insignificant between the sides except for the distal alveolar bone level.

CONCLUSION: An increase in the rate of tooth movement can be achieved without any periodontal adverse effects in the first 45 days of the MOP procedure. The effectiveness of the MOP procedure on the rate of tooth movement gradually declined thereafter.

TRIAL REGISTRATION: CTRI/2019/07/020403.

PMID:34112627 | DOI:10.1016/j.ejwf.2021.05.001

BMJ Open. 2021 Jun 10;11(6):e043444. doi: 10.1136/bmjopen-2020-043444.

ABSTRACT

INTRODUCTION: English is the lingua franca of science. How well doctors understand English is therefore crucial for their understanding of scientific articles. However, only 5% of the world’s population have English as their first language.

METHODS: Objectives: To compare doctors’ comprehension of a scientific article when read in their first language (Norwegian) versus their second language (English). Our hypothesis was that doctors reading the article in Norwegian would comprehend the content better than those reading it in English.

DESIGN: Parallel group randomised controlled trial. We randomised doctors to read the same clinical review article in either Norwegian or English, before completing a questionnaire about the content of the article.

SETTING: Conference in primary care medicine in Norway, 2018.

PARTICIPANTS: 130 native Norwegian-speaking doctors, 71 women and 59 men. One participant withdrew before responding to the questionnaire and was excluded from the analyses.

INTERVENTIONS: Participants were randomly assigned to read a review article in either Norwegian (n=64) or English (n=66). Reading time was limited to 7 min followed by 7 min to answer a questionnaire.

MAIN OUTCOME MEASURES: Total score on questions related to the article content (potential range -9 to 20).

RESULTS: Doctors who read the article in Norwegian had a mean total score of 10.40 (SD 3.96) compared with 9.08 (SD 3.47) among doctors who read the article in English, giving a mean difference of 1.32 (95% CI 0.03 to 2.62; p=0.046). Age was independently associated with total score, with decreased comprehension with increasing age.

CONCLUSION: The difference in comprehension between the group who read in Norwegian and the group who read in English was statistically significant but modest, suggesting that the language gap in academia is possible to overcome.

PMID:34112640 | DOI:10.1136/bmjopen-2020-043444

J Formos Med Assoc. 2021 Jun 7:S0929-6646(21)00242-4. doi: 10.1016/j.jfma.2021.05.027. Online ahead of print.

ABSTRACT

BACKGROUND/PURPOSE: To investigate the clinical characteristics of intraocular lymphoma and to evaluate two protocols of intravitreal methotrexate injection.

METHODS: A retrospective chart review was conducted of newly-diagnosed intraocular lymphoma patients between January 2013 and January 2018 at National Taiwan University Hospital. Patients were divided into two groups. In Group A, intravitreal methotrexate was administered weekly for the initial 8 weeks, every 2 weeks for the following 12 weeks, and then monthly for 7 months. In Group B, intravitreal methotrexate was administered twice a week for the initial 2 weeks, weekly for the subsequent 2 weeks, once every 2 weeks for the next 1 month, and monthly for the last 10 months.

RESULTS: A total of 12 patients were analyzed in the study; seven of these patients were allocated to Group A. Differences in the overall survival and progression-free survival between the two groups did not yield statistical significance. The median visual acuity was improved from LogMAR 0.46 to LogMAR 0.30 with borderline significance in Group A (p = 0.053). Two of seven patients in Group A and five of five patients in Group B developed punctate keratitis during intravitreal methotrexate injection treatment.

CONCLUSION: Intravitreal methotrexate is an effective and repeatable treatment for intraocular lymphoma. A new protocol with reduced frequency of intravitreal injections as shown in this study could potentially produce similar results without a worse prognosis, along with a decrease in the incidence of keratitis.

PMID:34112589 | DOI:10.1016/j.jfma.2021.05.027

Semergen. 2021 Jun 7:S1138-3593(21)00124-6. doi: 10.1016/j.semerg.2021.03.008. Online ahead of print.

ABSTRACT

BACKGROUND: Inhibitors of proprotein convertase subtilisin/kexin type9 (PCSK9 inhibitors) are a treatment option for those patients with familial hypercholesterolemia or in secondary prevention who do not reach the LDL-C target with other therapeutic measures. The aim of this study is to assess the effectiveness and safety of these drugs.

METHODS: Retrospective, multicentric, descriptive study. We collected data from all patients that have started PCSK9 inhibitors treatment in three hospitals in Asturias since the beginning of its use in 2016. We analysed changes in lipid profile with PCSK9 inhibitors and its side effects.

RESULTS: We registered 98 patients, 75 of them affected by familial hypercholesterolemia (FH) and 23 unaffected. Two months after the beginning of PCSK9 inhibitors treatment, a 61% reduction rate in LDL-C in patients with FH and 52% in those without this condition was observed. This statistically significant reduction remained stable during follow-up. A significant decrease in total cholesterol was observed, without significant changes in HDL-C and triglycerides. 96% of patients had no complications.

CONCLUSIONS: PCSK9 inhibitors are safe drugs that rapidly achieve significant reductions in LDL-C after the beginning of treatment, which are maintained over time. Hence, the use of PCSK9 inhibitors is an alternative for the control of LDL-C in those patients in which the LDL-C target is not reached with other therapeutic measures.

PMID:34112592 | DOI:10.1016/j.semerg.2021.03.008

J Voice. 2021 Jun 7:S0892-1997(21)00155-7. doi: 10.1016/j.jvoice.2021.04.018. Online ahead of print.

ABSTRACT

INTRODUCTION: Sulcus vocalis (SV) subtypes are difficult to diagnose. Non-invasive techniques are sometimes not feasible in the diagnosis. The study aims to demonstrate the effectiveness and applicability of objective and subjective voice analysis combined with videolaryngostroboscopic examination (VLS) in the diagnosis of SV types.

MATERIAL AND METHODS: This is a retrospective study that includes patients who presented to Phoniatric outpatient clinic with complaints related to voice and diagnosed with SV on VLS examination between 2017-2020. The SV type was determined based on VLS findings and the patients were categorized into respective groups. Between- and within-group assessment of objective and subjective voice analysis of SV types was conducted.

RESULTS: 47 patients were included in the study; Type I, Type II, Type III SV patients were 16, 17, and 14 in number, respectively. Fundamental frequency (F0) and Shimmer (%) values were significantly high in Type II and III SV cases, whereas the Maximum Phonation Time (MPT) was significantly low. GRBAS, Voice Handicap Index -10 (VHI-10), Reflux Symptom Index (RSI) scores were statistically significantly high in pathological SV and Voice Related Quality of Life (V-RQOL) scores were low. A moderate correlation between VHI-10 and V-RQOL and between RSI and V-RQOL was detected.

CONCLUSIONS: Objective and subjective voice analysis in Type II and III SV show a significant difference compared to Type I SV. The use of objective and subjective voice analysis combined with VLS examination can be helpful in the diagnosis of SV types.

PMID:34112548 | DOI:10.1016/j.jvoice.2021.04.018

J Cardiothorac Vasc Anesth. 2021 May 12:S1053-0770(21)00372-4. doi: 10.1053/j.jvca.2021.05.002. Online ahead of print.

ABSTRACT

OBJECTIVES: The objective of this study was to identify novel serum biomarkers specific to postoperative delirium after major cardiac surgery to provide insight into the pathologic processes involved in delirium and its sequelae.

DESIGN: Nested, case-control study.

SETTING: Cardiac surgical intensive care unit in a single-site hospital setting.

PARTICIPANTS: The study comprised 24 older adults (aged >60 years) undergoing major cardiac surgery with cardiopulmonary bypass.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: The primary outcome was a positive screen for delirium from postoperative days one through three based on criteria included in the long form of the Confusion Assessment Method. A multiplexed proteomic approach was applied using proximity extension assays to identify and quantify proteins found in serum collected on the day of surgery and postoperative day one in delirious and nondelirious patient cohorts. An increase in serum fibroblast growth factor (FGF)-21 levels was identified in the delirious cohort from a presurgery baseline of (mean ± standard deviation) 5.0 ± 1.1 log2 abundance (95% confidence interval [CI], 4.3-5.7) to 6.7 ± 1.6 log2 abundance (95% CI, 5.7-7.7; p = 0.01) postsurgery. A similar increase was identified in FGF-23 from a presurgery baseline of 1.7 ± 1.3 log2 abundance (95% CI, 0.8-2.5) to 3.4 ± 2.2 log2 abundance (95% CI, 2.0-4.8; p = 0.06) postsurgery. An increase in interleukin-6 serum levels also was identified in the delirious cohort from a presurgery baseline of 3.8 ± 1.1 log2 abundance (95% CI, 3.1-4.5) to 8.7 ± 1.9 log2 abundance (95% CI, 7.5-9.9; p < 0.0001) postsurgery. However, the increase in interleukin-6 serum levels of the nondelirious cohort also met the study’s threshold for statistical significance (p < 0.0001). Finally, an increase in monocyte chemotactic protein-3 serum levels was identified in the delirious cohort from a presurgery baseline of 4.1 ± 0.9 log2 abundance (95% CI, 3.6-4.7) to 6.1 ± 2.0 log2 abundance (95% CI, 4.8-7; p = 0.009) postsurgery.

CONCLUSIONS: FGF-21, FGF-23, interleukin-6, and monocyte chemotactic protein-3 serum levels were increased postoperatively in patients who developed delirium after major cardiac surgery. This study identified two members of the FGF family as potential putative systemic biomarkers for postoperative delirium after cardiac surgery, suggesting a possible role for metabolic recovery in the pathophysiologic mechanisms underlying neurocognitive dysfunction.

PMID:34112563 | DOI:10.1053/j.jvca.2021.05.002

Eur J Vasc Endovasc Surg. 2021 Jun 7:S1078-5884(21)00161-1. doi: 10.1016/j.ejvs.2021.02.012. Online ahead of print.

ABSTRACT

OBJECTIVE: The efficacy and cost effectiveness of atherectomy for femoropopliteal (FP) arterial diseases have not been determined yet. A systematic review and meta-analysis were performed to compare the efficacy and safety between atherectomy combined with balloon angioplasty (BA) and BA alone for patients with de novo FP steno-occlusive lesions.

METHODS: The Cochrane Library, Medline, and Embase were used to search for studies evaluating outcomes of atherectomy combined with BA compared with BA alone in FP arterial diseases from inception to July 2020. The methodological quality of the included studies was evaluated with the Cochrane Risk of Bias Tool. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was used to assess the level of evidence for each outcome. The fixed effects model was chosen to combine the data when I² < 50%; otherwise, the random effects model was used. Subgroup and sensitivity analyses were performed to further analyse the results.

RESULTS: Four RCTs were included. The meta-analysis showed that atherectomy combined with BA was associated with improved technical success rate (risk ratio [RR] 0.22, 95% confidence interval [CI] 0.13-0.38, p < .001; I² = 0; high quality), reduced bailout stenting (RR 0.15, 95% CI 0.07-0.32, p < .001; I² = 16%; high quality), and flow limiting dissection (RR 0.24, 95% CI 0.13-0.47, p < .001; I² = 0; high quality). No statistically significant difference was found in target lesion revascularisation (TLR), primary patency, mortality, major adverse event (MAE), or ankle brachial index (ABI) after one year follow up.

CONCLUSION: Compared with BA alone, atherectomy combined with BA may not improve primary patency, TLR, mortality rate, or ABI, but may reduce the need for bailout stenting and the incidence of flow limiting dissection and increase the technical success rate in FP arterial diseases. More studies are warranted to further confirm the conclusion.

PMID:34112574 | DOI:10.1016/j.ejvs.2021.02.012

J Allergy Clin Immunol Pract. 2021 Jun;9(6):2551-2552. doi: 10.1016/j.jaip.2021.03.026.

NO ABSTRACT

PMID:34112495 | DOI:10.1016/j.jaip.2021.03.026

J Natl Med Assoc. 2021 Jun 7:S0027-9684(21)00078-X. doi: 10.1016/j.jnma.2021.05.007. Online ahead of print.

ABSTRACT

Racial tensions continue to ignite social unrest in the United States. Structural racism is increasingly recognized as a public health issue. It is therefore necessary to continue addressing the interaction of race and medicine, including anesthesiology. While many may overlook the impact that racial discrimination has had on the development of anesthesiology, understanding pain through a racialized lens has always been entwined with this medical specialty since its origins. Considering the first public demonstration of ether anesthesia in 1846 occurred 15 years before the American Civil War (1861-1865), it is naïve to pretend that anesthesia has been insulated from racial prejudice. We increasingly recognize the effects of variables, such as housing and education, which are important as social determinants of health. Across ethnic and racial lines, statistically significant differences persist in pain assessment and analgesia delivery. To understand these irregularities without relying on unsupported theories, we must challenge our current understanding of race in medicine. By reviewing the history of anesthesia through a racialized lens, we may better explore our biases and develop strategies towards racially equitable care. This article focuses on anesthesia’s roots on the plantation in the American South, the medical perpetuation of racial disparities, and the challenges we face in healthcare today.

PMID:34112524 | DOI:10.1016/j.jnma.2021.05.007

Rev Esp Cir Ortop Traumatol. 2021 Jul-Aug;65(4):285-293. doi: 10.1016/j.recote.2021.04.010.

ABSTRACT

BACKGROUND AND AIM: Total knee arthroplasty (TKA) is a frequent intervention that can associate significant blood loss. There are several methods to avoid transfusions. One of the most relevant is tranexamic acid (TXA). Our purpose is to analyse the efficacy in terms of blood savings, transfusion needs, functional results, and cost-effectiveness of intra-articular (IA) administration in TKA.

MATERIALS AND METHODS: We conducted a retrospective analysis of historical cohorts (75 patients each) between January 2015 and December 2016. We included 150 patients (59,3% women) with a mean age of 73,58 years. The intervention consisted of administering 2 g of IA TXA with a contact time of 30 min. Demographic data, preoperative haematological status, surgery data, estimated total blood loss (ETBL), need for transfusion, functional results, and cost analysis were collected. The level of statistical significance was p ≤ 0,05.

RESULTS: The incidence of transfusion was 17,33% in the control group and 5,33% in the TXA group (p = 0,039), with a relative risk reduction of 78,3%. The TXA cohort showed a reduction in ETBL (p < 0,0005), units transfused (p = 0,019) and length of stay (p = 0,004). All early functional parameters also improved, including a 10° improvement in both flexion and extension (p < 0,0005). The use of IA TXA resulted in savings of 337,78 € per patient.

CONCLUSIONS: In our experience, the administration of IA TXA in TKA is a cost-effective and efficient measure in terms of blood savings and immediate postoperative functional improvement.

PMID:34112449 | DOI:10.1016/j.recote.2021.04.010