Tag: pubmed

J Burn Care Res. 2024 Jul 3:irae126. doi: 10.1093/jbcr/irae126. Online ahead of print.

ABSTRACT

Burn injury contributes to significant morbidity and mortality in the United States. Despite an increased focus on racial and ethnic disparities in healthcare, there remains a critical knowledge gap in our understanding of the effect of these disparities on complications experienced by burn patients. The American Burn Association’s National Burn Repository data were reviewed from 2010-2018. Information regarding demographics, burn mechanism and severity, complications, and clinical outcomes were recorded. Data analysis was performed using 1:1 propensity-score-matching and logistic regression modeling. A separate analysis of Hispanic and non-Hispanic patients was performed using Chi squared tests. Among 215,071 patients, racial distribution was 65.16% white, 19.13% black, 2.18% Asian, 0.74% American Indian/Alaskan Native, and 12.78% other. Flame injuries were the most common cause (35.2%), followed by scald burns (23.3%). All comparisons were made in reference to the white population. Black patients were more likely to die (OR: 1.28; 95%CI: 1.17-1.40), experience all (OR: 1.08; 95%CI: 1.03-1.14), cardiovascular (OR: 1.24; 95%CI: 1.08-1.43), or infectious (OR: 1.64; 95%CI: 1.40-1.91) complications, and less likely to experience airway complications (OR: 0.83; 95%CI: 0.74-0.94). American Indian/Alaskan Native patients were more likely to experience any complication (OR: 1.33; 95%CI: 1.05-1.70). All minority groups had increased length of hospital stay. Black, Asian, and other patients had longer length of ICU stay. Black patients had longer ventilator duration. Among 82,775 patients, 24,075 patients were identified as Hispanic and 58,700 as non-Hispanic. Statistically significant differences were noted between groups in age, TBSA, proportion of 2nd degree burn, and proportion of 3rd degree burn (p<0.01). These findings highlight the need for further work to determine the etiology of these disparities to improve burn care for all patients.

PMID:38957983 | DOI:10.1093/jbcr/irae126

Ann Surg. 2024 Jul 3. doi: 10.1097/SLA.0000000000006373. Online ahead of print.

ABSTRACT

OBJECTIVES: A recent study of 21 institutions noted significant differences between number of cases reported during general surgery residency by trainees who are Underrepresented in Medicine (URiM) versus trainees who are not Underrepresented in Medicine (non-URiM). This study also identified differences between female residents and male residents. We partnered with the Accreditation Council for Graduate Medical Education to examine case logs reported from all accredited general surgery programs in the United States. This is the first time this data has been examined nationally.

METHODS: We examined total case logs submitted by graduating residents between 2017 and 2022. Group differences in mean reported case logs were examined using paired t- tests for female versus male and URiM versus non- URiM overall case numbers.

RESULTS: A total of 6,458 residents submitted case logs from 319 accredited programs. Eight-hundred and fifty-four (13%) were URiM and 5,604 (87%) were non-URiM. Over the 5-year study period, URM residents submitted 1096.95 (SD +/- 160.57) major cases versus 1115.96 (+/- 160.53) for non-URiM residents (difference =19 cases, P=0.001). Case logs were submitted by 3,833 (60.1%) male residents and 2,625 (39.9%) female residents over the five-year study period. Male residents reported 1128.56 (SD +/- 168.32) cases versus 1091.38 (+/- 145.98) cases reported by females (difference=37.18, P<0.001). When looking at Surgeon Chief and Teaching Assistant cases, there was no significant difference noted between cases submitted by URiM versus non- URiM residents. However, male residents reported significantly more in both categories than their female peers (P<0.001).

CONCLUSIONS: Overall, URiM residents submitted fewer cases in the five- year study period than their non-URiM peers. The gap in submitted cases between male and female residents was more pronounced, with male residents submitting significantly more cases than their female counterparts. This finding was consistent and statistically significant throughout the entire study period, in most case categories, and without narrowing of difference over time. A difference of 30-40 cases can amount to 1-3 months of surgical training and is a concerning national trend deserving the attention of every training program and our governing institutions.

PMID:38957982 | DOI:10.1097/SLA.0000000000006373

Surg Infect (Larchmt). 2024 Jul 3. doi: 10.1089/sur.2024.054. Online ahead of print.

ABSTRACT

Background: The prophylactic use of antibiotics in parotid region surgery continues to be a subject of debate. The aim of this study is to elucidate the impact of antibiotic prophylaxis on surgical site infections (SSIs) in parotid region surgery. Patients and Methods: Patients who received antibiotic prophylaxis during the peri-operative period were designated as group 1, whereas those who did not were categorized into group 2. Group 1 cases were further subdivided into three subgroups based on different antibiotic usage patterns. Patient individual information was collected. Clinical data such as surgical duration, post-operative hospital stay, incision infection status, and antibiotic usage were recorded. All data were compared and analyzed among different groups. Results: A total of 357 patients were included in the study, with no statistically significant differences in baseline characteristics. Pre-operative American Society of Anesthesiologists scores did not significantly differ between groups (p = 0.151), but there was a significant distinction in National Nosocomial Infection Surveillance (NNIS) index values (p = 0.044). Furthermore, surgical duration (p = 0.001) and pathology types (p = 0.016) differed significantly. The post-operative hospital stay in group 1 was longer than that in group 2 (p < 0.01). The post-operative SSI rate in group 1 was lower than that in group 2 without statistical significance (2.55% vs. 5.59%, p = 0.141). The logistic regression analysis showed that malignant tumors, longer surgical durations, and higher NNIS index scores correlated positively with post-operative SSI rates. Meanwhile, compared with non-use, all three different antibiotic use modes correlated negatively with SSI occurrence. Conclusions: Antibiotic prophylaxis in parotid gland surgery shows no significant reduction in SSI occurrence. If there is a compelling reason to administer prophylactic antibiotics, pre-operative single dose may be a relatively feasible measure for preventing SSIs.

PMID:38957972 | DOI:10.1089/sur.2024.054

Am J Epidemiol. 2024 Jul 2:kwae169. doi: 10.1093/aje/kwae169. Online ahead of print.

ABSTRACT

In longitudinal studies, the devices used to measure exposures can change from visit to visit. Calibration studies, wherein a subset of participants is measured using both devices at follow-up, may be used to assess between-device differences (i.e., errors). Then, statistical methods are needed to adjust for between-device differences and the missing measurement data that often appear in calibration studies. Regression calibration and multiple imputation are two possible methods. We compared both methods in linear regression with a simulation study, considering various real-world scenarios for a longitudinal study of pulse wave velocity. Regression calibration and multiple imputation were both essentially unbiased, but correctly estimating the standard errors posed challenges. Multiple imputation with predicted mean matching produced close agreement with the empirical standard error. Fully stochastic multiple imputation underestimated the standard error by up to 50%, and regression calibration with bootstrapped standard errors performed slightly better than fully stochastic multiple imputation. Regression calibration was slightly more efficient than either multiple imputation method. The results suggest use of multiple imputation with predictive mean matching over fully stochastic imputation or regression calibration in longitudinal studies where a new device at follow-up might be error-prone compared to the device used at baseline.

PMID:38957970 | DOI:10.1093/aje/kwae169

AIDS Patient Care STDS. 2024 Jul 3. doi: 10.1089/apc.2024.0100. Online ahead of print.

ABSTRACT

To understand the global dual HIV infection (DI) profiles comprehensively, the databases Cochrane Library, Embase, PubMed, and Web of Science were the data sources up to March 31, 2024 (PROSPERO: CRD42023388328). Stata and R-language software were used to analyze the extracted data. Publication bias was assessed using Egger’s test. Sensitivity analysis was conducted to evaluate the stability of the combined effect values. Data from 17 eligible studies across four continents (Africa, Asia, Europe, and North America) with 1,475 subjects were used. The combined dual infection rate (DIR) was 10.47% (95% CI: 7.11%-14.38%) without a time trend (p = 0.105). The DIRs of target population groups differed significantly, with FSWs having the highest DIR (15.14%), followed by general population (12.08%), MSM (11.84%), and DUs (9.76%). The subtype profiles of 122 patients with dual infection were extracted, and the results showed that intrasubtype infections were predominant in coinfection (16/22, 72.73%) and superinfection (68/100, 68.00%) groups, with the subtype pattern B and B accounts for the largest proportion. The global dual infection rate may be underestimated, even though the data fluctuated around 10% and showed no time trend. The occurrence of DI indicated that individuals still do not acquire sufficient resistance to HIV even after primary infection, which could potentially compromise the patient’s treatment effect and lead to the emergence of new subtypes, posing a significant challenge to HIV prevention, control, and treatment, suggesting that behavioral counseling and health education for all HIV-infected individuals are still crucial during the antiviral therapy.

PMID:38957963 | DOI:10.1089/apc.2024.0100

Eur J Paediatr Dent. 2024 Jun 1:1. doi: 10.23804/ejpd.2024.2098. Online ahead of print.

ABSTRACT

AIM: During adolescence, there is a significant surge in height and total body mass of males. Consequently, they simultaneously experience enhancements in their circulatory and respiratory systems, which adapt to these physiological transformations. The purpose of present study was to investigate the developmental changes in male pharyngeal airway from adolescence to adulthood.

METHODS: Lateral cephalograms of 192 males were obtained and divided into 5 groups: early adolescence (age 10-13 years), middle adolescence (age 14-17 years), late adolescence (age 18-21 years), early adulthood (age 22-30 years), and middle adulthood (ages 31-50 years). The dimensions of pharyngeal airway spaces and the related anatomical structures were investigated. The one-way analysis of variance and Pearson correlation analysis were employed for statistical analysis.

CONCLUSION: During middle adolescence, the pharyngeal airway seems to be nearly completed in males. A significant negative correlation was found between the ANB angle and SPS, TPS, and EPS values.

PMID:38957934 | DOI:10.23804/ejpd.2024.2098

Aesthet Surg J. 2024 Jul 3:sjae144. doi: 10.1093/asj/sjae144. Online ahead of print.

ABSTRACT

BACKROUND: An important factor which underlines the clinical significance of vaginal laxity presence is the association of the latter with the female sexual function. Male sexuality can also be affected by vaginal laxity.

OBJECTIVES: We aimed to investigate the effect of vaginoplasty on a cohort of women, who underwent the respective procedure under the indication of vaginal laxity/impaired sexual function. At the same time, it is very important to evaluate the sexual satisfaction of partners after vaginal tightening.

METHODS: Fifty women who underwent vaginoplasty and their male partners (n=50) were included in the study. State-Trait Anxiety Inventory (STAI) and Female Sexual Function Index (FSFI) were performed to female patients three months before and after the treatment. Also, male partners were asked for their sexual functions by International Index of Erectile Function-5 (IIEF-5) three months before and after the treatment. A 5-question questionnaire inquiring about pleasure status was administered to the male partners using a four-point Likert scale.

RESULTS: Post-treatment STAI THE STATE and STAI THE TRAIT scores of the female patients were statistically significantly lower than their pre-treatment scores (52.5 vs 32, p<0.001; 56 vs 44, p<0.001, respectively). The post-treatment FSFI score of the female patients was significantly higher than their pre-treatment score (19.2 vs 29.7, p<0.001).

CONCLUSIONS: Our results demonstrated significant improvement in the sexual function of males and females and additionally, a significant decrease in the indices of the temporary anxiety levels and the inherent predisposition for anxiety disorders after vaginoplasty.

PMID:38957918 | DOI:10.1093/asj/sjae144

J Indian Soc Pedod Prev Dent. 2024 Apr 1;42(2):156-164. doi: 10.4103/jisppd.jisppd_39_24. Epub 2024 Jun 28.

ABSTRACT

BACKGROUND: Many practitioners have questioned whether the construction method of pediatric zirconia crowns impacts the periodontal health and clinical performance of severely decayed primary molars. The objective of this study was to compare the periodontal health and clinical performance of primary molars restored with custom-made zirconia crowns (CZCs) and prefabricated zirconia crowns.

METHODS: Twenty primary molars indicated for crown restorations were selected from ten patients (5-9 years old) randomly. Each patient received two pediatric zirconia crowns constructed by two different methods: one custom-made and one prefabricated. The primary molars were divided into two groups: Group 1: primary molars received CZCs and Group 2: primary molars received prefabricated zirconia crowns (PZCs).

RESULTS: After a 12-month follow-up, there was no statistically significant difference between the periodontal health of primary molars restored with custom-made and prefabricated zirconia crowns. The clinical performance of primary molars restored with CZCs was statistically significantly higher than those restored with PZCs in terms of retention and fracture resistance (P ≤ 0.05).

CONCLUSIONS: The construction method of pediatric zirconia crowns does not significantly affect the periodontal health of primary molars; however, clinical performance is significantly affected in terms of retention and fracture resistance.

CLINICAL SIGNIFICANCE: A CZC is an excellent alternative option, especially for primary molars whose permanent successors still have a long time to erupt. The PZC is a quick and easy restoration, but the technique is sensitive.

PMID:38957914 | DOI:10.4103/jisppd.jisppd_39_24

J Indian Soc Pedod Prev Dent. 2024 Apr 1;42(2):149-155. doi: 10.4103/jisppd.jisppd_116_24. Epub 2024 Jun 28.

ABSTRACT

INTRODUCTION: Dental caries results from an ecologic shift within the dental biofilm from a balanced population of microorganisms to an acidogenic, aciduric, and cariogenic microbiological population developed and maintained by frequent consumption of fermentable dietary carbohydrates. Total caries removal (TCR) of deep lesion may result in pulpal exposure requiring more invasive treatment. Hence, current pediatric dentistry has shifted to minimally invasive treatment that avoids more complex, time-consuming procedure, and the child’s discomfort.

AIM: The aim of this study is to evaluate and compare clinical performance and radiographic changes after complete and incomplete caries removal procedures.

MATERIALS AND METHODS: The study was conducted on 60 primary molars in children aged 6-9 years. Selected 60 primary molars were randomly divided into two groups. Group 1 (PCR): infected dentin was removed, while the affected dentin was maintained on the pulpal wall. Group 2 (TCR): both infected and affected dentin were removed through low-speed carbide bur and hand excavator. Teeth were evaluated at 4 and 6 months clinically and radiographically.

RESULTS: The proportion was compared using Fisher’s exact test. The Statistical Package for the Social Sciences version 21 was used for analysis. The level of significance was kept at 5%.

CONCLUSION: The clinical and radiographic success rates of ICR and CCR in primary teeth with deep carious lesions were high and did not differ significantly, indicating that the retention of carious dentin does not interfere with pulp vitality. Thus, ICR is a reliable minimally invasive approach that might replace the CCR in primary teeth when correctly indicated.

PMID:38957913 | DOI:10.4103/jisppd.jisppd_116_24

J Indian Soc Pedod Prev Dent. 2024 Apr 1;42(2):141-148. doi: 10.4103/jisppd.jisppd_104_24. Epub 2024 Jun 28.

ABSTRACT

BACKGROUND: Pharmacological methods, specifically sedatives, have gained popularity in managing the behavior of children during dental appointments.

AIM: The aim of this study was to compare 1 m/kg intranasal dexmedetomidine, 0.3 mg/kg intranasal midazolam, and nitrous oxide in evaluating the level of sedation, behavior of the child, onset of sedation, physiologic signs, and adverse effects.

MATERIALS AND METHODS: In this cross-over trial, 15 children aged 6-8 years were randomized to receive intranasal atomized dexmedetomidine, intranasal atomized midazolam, and inhalation nitrous oxide at three separate visits. After administering the sedative agent, a single pulpectomy was performed during each appointment, and the outcomes were recorded. The washout period between each visit was 1 week.

RESULTS: All three sedative agents were equally effective in controlling overall behavior. Dexmedetomidine showed lower sedation level scores (agitated; score 9) than the other groups. There was a statistically significant difference in the onset of sedation, with dexmedetomidine having the longest onset of 36.2 ± 9.47 min. Coughing and sneezing were predominantly observed after administration of intranasal midazolam. Oxygen saturation levels were statistically lower in the intranasal midazolam group during local anesthesia administration and post-treatment.

CONCLUSION: 0.3 mg/kg intranasal midazolam is as effective as nitrous oxide sedation for controlling behavior and providing adequate sedation in pediatric dental patients. However, 1 m/kg dexmedetomidine did not provide the same level of sedation and had a significantly longer onset. 0.3 mg/kg intranasal midazolam is an effective alternative to nitrous oxide sedation in anxious children.

PMID:38957912 | DOI:10.4103/jisppd.jisppd_104_24