Tag: pubmed

Adv Respir Med. 2021;89(3):262-267. doi: 10.5603/ARM.a2021.0053.

ABSTRACT

INTRODUCTION: Obstructive sleep apnea (OSA) is highly prevalent. Home sleep apnea testing (HSAT) for OSA is rapidly expanding because of its cost effectiveness in the diagnosis of OSA. Type 3 portable monitors are used for this purpose. In most cases, these devices contain an algorithm for automatic scoring of events. We propose to study the accuracy of the automatic scoring algorithm in our population in order to compare it with the manually edited scoring of Nox-T3®.

MATERIAL AND METHODS: For five months, a prospective study was performed. Patients were randomly distributed to the available HSAT devices. We collected the data of patients who performed HSAT with Nox-T3®. We used normality plots, the Spearman correlation, the Wilcoxon signed-rank test, and Bland-Altman plots.

RESULTS: The sample consisted of 283 participants. The average manual apnea and hypopnea index (AHI) was 23.7 ± 22.1 events/h. All manual scores (AHI, apnea index, hypopnea index, and oxygen desaturation index) had strong correlations with their respective automated scores. When AHI > 15 and AHI > 30 the difference between the values of this index (automatic and manual) was not statistically significant. Also, for AHI values > 15 the mean difference between the two scoring methods was 0.17 events/h. For AHI values > 30, this difference was – 1.23 events/h.

CONCLUSIONS: When AHI is < 15, there may be a need for confirmation of automatic scores, especially in symptomatic patients with a high pretest probability of OSA. But, for patients with AHI > 15, automatic scores obtained from this device seem accurate enough to diagnose OSA in the correct clinical setting.

PMID:34196378 | DOI:10.5603/ARM.a2021.0053

Adv Respir Med. 2021;89(3):277-283. doi: 10.5603/ARM.a2021.0056.

ABSTRACT

BACKGROUND: Intelligent volume-assured pressure support (iVAPS) is a new noninvasive ventilation (NIV) mode that can automatically adjust pressure support to deliver effective ventilation. Our aim was to compare treatment efficacy and level of satisfaction between auto-titrating expiratory positive airway pressure (auto-EPAP) and fixed expiratory positive airway pressure (fixed-EPAP) during iVAPS treatment in stable hypercapnic chronic obstructive pulmonary disease (COPD) patients.

MATERIAL AND METHODS: In this prospective single-blinded, randomized study, 50 patients with chronic stable hypercapnia (COPD) who met the study criteria were randomized into a group I treated with auto-EPAP and a group II who received fixed-EPAP during iVAPS treatment for 5 consecutive days. The patients’ characteristics, arterial blood gases, and lung function test were recorded. Numeric rating scale (NRS), dyspnea and comfort scale were obtained. The study subjects were evaluated and followed up after initiating therapy for 5 consecutive days. Outcome measures were recorded at baseline (T0) and after three (T1) and five (T2) days of each consecutive period All parameters were collected and statistically analyzed.

RESULT: No significant differences were found regarding age, sex, or BMI between the both groups. It was noted that daytime PaCO2 decreased significantly over the follow-up period in the group I patients treated with auto-EPAP as compared with fixed-EPAP. Regarding the patient comfort and dyspnea during iVAPS treatment, dyspnea sensation was significantly lower with auto-EPAP 7.9 ± 1.8 (T0) vs 3.5 ± 1.1 (T2), p = 0.001 and fixed-EPAP 7.7 ± 1.9 (T0) vs 3.4 ± 1.6 (T2), p = 0.001, but no significance was reached between the both groups. However, auto-EPAP demonstrated significant improvement in comfort when compared with fixed-EPAP modality. However, the overall satisfaction of the patients receiving auto-EPAP modality was significantly increased. Mean tidal volume tended to be higher in auto-EPAP 698 ± 213 mL compared with 628 ± 178 mL in fixed-EPAP (p = 0.001). The air leak was significantly lower in auto-adjusting mode (2.5 ± 1.3 vs 3.7 ± 2.2 L/ min) in fixed-EPAP modality.

CONCLUSION: Auto-titrating NIV mode may provide additional benefit in decreasing PaCO2 more efficiently and improve patient comfort and satisfaction.

PMID:34196380 | DOI:10.5603/ARM.a2021.0056

Vasc Endovascular Surg. 2021 Jul 1:15385744211026452. doi: 10.1177/15385744211026452. Online ahead of print.

ABSTRACT

OBJECTIVES: Patients often require multiple access re-interventions to improve fistula patency and the overall usable lifespan of autogenous arteriovenous fistula (aAVF). There is no consensus on the appropriate number of re-interventions after which an access should be abandoned and new access placed. We evaluated whether repeated endovascular interventions for failing/failed aAVF are worthwhile or futile.

METHODS: A retrospective review was performed on aAVFs created between 2009-2014. Fistula function was evaluated until January 2017. Functional fistula patency (FFP) was defined as the total time of functional fistula use for hemodialysis, from time of cannulation to time of measurement or fistula abandonment, including all interventions performed to maintain/reestablish patency. Primary outcomes were FFP duration and number of post-dialysis interventions.

RESULTS: The study included 163 patients. Mean age was 67 (SD = 15.03). The only variable statistically different between functional fistulas and abandoned fistulas was obesity (p = 0.03). At the end of the study period, 145 (89.0%) patients continued to have functional fistulas, and 73 (44.8%) patients died, but had functional fistulas at time of death. Median FFP for the functional group was 3.18 years (range 0.01-7.01 years) and median number of interventions was 1 (range 0-13). In 18 patients (11%), the fistula was abandoned, most commonly due to thrombosis (47.1%), followed by infection (23.5%). No fistula was abandoned because of an unacceptable rate of reintervention. Median FFP in the abandoned group was 0.91 years (range 0.03-5.30 years), and median number of interventions was 0 (range of 0-5).

CONCLUSIONS: Through repeated interventions on aAVFs, none of the patients in our study exhausted all hemodialysis access options prior to transplantation, death or loss to follow-up. These results may indicate repeated and/or more frequent revisions do not negatively affect the FFP nor do they increase the overall risk for abandonment of aAVFs.

PMID:34196244 | DOI:10.1177/15385744211026452

Adv Respir Med. 2021;89(3):241-246. doi: 10.5603/ARM.a2021.0050.

ABSTRACT

INTRODUCTION: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of mediastinal lymph nodes is currently considered to be the most effective minimally invasive diagnostic method in patients with suspected stage I and II sarcoidosis. However, diagnostic effectiveness depends on the experience and skills of the doctor which is dependent on the number of correctly performed procedures. The aim of the study is to compare the diagnostic effectiveness of the EBUS-TBNA test obtained by an expert in this field vs that of his student.

MATERIAL AND METHODS: in patients with a clinical and radiological suspicion of sarcoidosis, EBUS-TBNA procedures were performed by an expert (over 1000 previously performed tests) and by his student who completed basic training (15 procedures performed). In the expert’s opinion, the student was experienced enough to perform the EBUS-TBNA on his own. Previously, more than 100 conventional fibreoptic bronchoscopies had been performed by the student. During that time, he had been working in the department of pulmonary diseases and tuberculosis for two years. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), negative likelihood ratio (LR-), and accuracy of the EBUS-TBNA test in diagnosing sarcoidosis were calculated. Statistical evaluation was made using ROC curves for the expert and for the student.

RESULTS: The study included 215 patients between 22-68 years of age with suspected sarcoidosis who were diagnosed between 2013-2016. 124 EBUS-TBNA tests were performed by the expert, and 91 procedures were performed by the student. The presence of sarcoid granulomas was confirmed by a biopsy in 165 (76.7%) patients. In terms of the diagnosis of sarcoidosis, a higher sensitivity and accuracy of the EBUS test was found in the procedures done by the expert (76.7% and 95.3%, respectively) as compared to the results obtained by the student (66.1% and 93.1%, respectively). However, these differences were not statistically significant (p = 0.11). All tests were assessed in a hospital pathology unit, but not necessarily by one person, which may be a limitation of our research. In this study, only cytological smears were taken into consideration.

CONCLUSIONS: In the diagnosis of sarcoidosis, the student, after appropriate training by an expert, achieved a comparable level of diagnostic effectiveness with EBUS-TBNA after performing 90 tests independently.

PMID:34196375 | DOI:10.5603/ARM.a2021.0050

Arch Iran Med. 2021 May 1;24(5):390-396. doi: 10.34172/aim.2021.56.

ABSTRACT

BACKGROUND: Surgical procedures applied in the treatment of early breast cancer (EBC) to achieve satisfactory oncological results lie in a wide spectrum. There has been a major shift toward less-invasive treatments during the past decades. We compared the outcomes of oncoplastic breast surgery (OBS), non-oncoplastic breast conserving surgery (NBCS) and mastectomy in the treatment of EBC.

METHODS: The records of 412 patients with EBC who underwent OBS, NBCS or mastectomy at our institution between January 2012 and June 2019 were retrospectively analyzed. Postoperative complications, local recurrences (LR) and disease-free survival (DFS) were compared between the groups. EBC patients with unilateral stage-I, IIa and IIb tumors were studied. All patients received adjuvant, targeted and/or endocrine therapy according to the tumor characteristics, followed by radiotherapy (all OBS and NBCS cases, and selected mastectomy patients).

RESULTS: Postoperative complications were similar in all groups except for six fat necrosis and partial nipple-areola necrosis in two diabetic patients treated with OBS. Re-excision rate was lower in OBS (6.5%) than NBCS (8%). There was no statistical difference between the groups regarding recurrence (P=1.000) or DFS (P=0.937).

CONCLUSION: OBS, NBCS and mastectomy are equally acceptable procedures in EBC in terms of both oncological and surgical aspects.

PMID:34196204 | DOI:10.34172/aim.2021.56

Arterioscler Thromb Vasc Biol. 2021 Jul 1:ATVBAHA121316595. doi: 10.1161/ATVBAHA.121.316595. Online ahead of print.

NO ABSTRACT

PMID:34196218 | DOI:10.1161/ATVBAHA.121.316595

J Orthop Surg (Hong Kong). 2021 May-Aug;29(2):23094990211028048. doi: 10.1177/23094990211028048.

ABSTRACT

PURPOSE: This study was designed to investigate (1) the contour of the distal tibial cutting surface, and (2) the bone mineral density (BMD) of the distal tibial cutting surface used during total ankle arthroplasty (TAA).

METHODS: Eight-four distal tibial models were created using foot and ankle computerized tomographic (CT) images taken from normal people. The distal tibial cutting surface for TAA was determined to be 10 mm proximal to the tibial plafond. The bony contour and BMD values were determined from the CT image at that level. A bounding box was made on the contour and the width and length of the contour was measured. Regional BMD was evaluated by Hounsfield units (HU) value measurement, with 7 regions of interest (ROI) on 8 different directions for all the 84 CT images. Two different observers made independent measurements and mean HU values for all the 56 ROIs were calculated.

RESULTS: Great variations were found among the contours of the cutting surface especially in term of the shape of the anterior and posterior tibial tubercle, and the fibular notch. These variations could be grouped into six categories. For the BMD of the cutting surface, the medial border of the cutting surface did not included cortical bone. The HU value of seven ROIs, which included cortical bone, were significantly greater than all the other ROIs. Few statistical differences were found by multiple comparisons among HU value of all the 49 ROIs without cortex.

CONCLUSIONS: Great variability existed in the shape and the BMD of the distal tibial cutting surface.

PMID:34196230 | DOI:10.1177/23094990211028048

Folia Med (Plovdiv). 2021 Jun 30;63(3):377-384. doi: 10.3897/folmed.63.e55136.

ABSTRACT

INTRODUCTION: Parkinson’s disease (PD) is а neurodegenerative disorder characterized mainly by its motor symptoms. The non-motor symptoms including pain are increasingly recognized in the last few decades. Existing evidence suggests that the dopaminergic neurotransmission has an essential role in pain control.

AIM: The aim of the present study was to investigate the antinociceptive effect of dopaminergic drugs pramipexole and tolcapone against chemical and thermal stimuli in naive rats.

MATERIALS AND METHODS: Male Wistar rats divided into 8 groups (n=8): saline; diclofenac 25 mg/kg body weight (bw) (positive control); pramipexole 0.5; 1 and 3 mg/kg bw; tolacapone 5; 15 and 30 mg/kg bw. Paw pressure and plantar tests were performed. Paw withdrawal pressure and latent time were measured. Statistical analysis was done by SPSS 19.

RESULTS: In the paw pressure test, pramipexole, in a dose of 1 and 3 mg/kg bw and tolcapone in a dose of 30 mg/kg bw, increased significantly the latency at 1, 2, and 3 hours compared to saline (p<0.05). In the plantar test, only the highest dose of pramipexole reached significance at 3 hours compared to the control rats (p<0.05). In contrast to pramipexole the three experimental groups with tolcapone markedly increased the latent time at 1 and 3 hours compared to saline (p<0.05).

CONCLUSIONS: Pramipexole and tolcapone reduce mechanical and thermal nociception in naïve rats by enhancing dopaminergic neurotransmission at both spinal and supraspinal levels. In addition, tolcapone stimulates noradrenergic mediation which may contribute to its antinociceptive effect.

PMID:34196153 | DOI:10.3897/folmed.63.e55136

Arch Iran Med. 2021 Apr 1;24(4):333-338. doi: 10.34172/aim.2021.47.

ABSTRACT

BACKGROUND: Decision-making on allocating scarce medical resources is crucial in the context of a strong health system reaction to the coronavirus disease 2019 (COVID-19) pandemic. Therefore, understanding the risk factors related to a high mortality rate can enable the physicians for a better decision-making process.

METHODS: Information was collected regarding clinical, demographic, and epidemiological features of the definite COVID-19 cases. Through Cox regression and statistical analysis, the risk factors related to mortality were determined. The Kaplan-Meier curve was used to estimate survival function and measure the mean length of living time in the patients.

RESULTS: Among about 3000 patients admitted in the Taleghani hospital as outpatients with suspicious signs and symptoms of COVID-19 in 2 months, 214 people were confirmed positive for this virus using the polymerase chain reaction (PCR) technique. Median time to death was 30 days. In this population, 24.29% of the patients died and 24.76% of them were admitted to the ICU (intensive care unit) during hospitalization. The results of Multivariate Cox regression Analysis showed that factors including age (HR, 1.031; 95% CI, 1.001-1.062; P value=0.04), and C-reactive protein (CRP) (HR, 1.007; 95% CI, 1.000-1.015; P value=0.04) could independently predict mortality. Furthermore, the results showed that age above 59 years directly increased mortality rate and decreased survival among our study population.

CONCLUSION: Predictor factors play an important role in decisions on public health policy-making. Our findings suggested that advanced age and CRP were independent mortality rate predictors in the admitted patients.

PMID:34196195 | DOI:10.34172/aim.2021.47

Clin Exp Dent Res. 2021 Jun 30. doi: 10.1002/cre2.466. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of this study is to evaluate dentists’ working conditions and the policies implemented for dentistry during the COVID-19 pandemic. In addition, effects of working in private practice or governmental practice in terms of pandemic are also evaluated in the manuscript.

METHODS: A questionnaire was prepared to elicit dentists’ working conditions during the pandemic and analyze and evaluate the policies implemented for dentistry. The questionnaires were sent to the dentists registered in the Turkish Dental Association (TDA) via e-mail, and collected between September 30, 2020, and October 20, 2020. Descriptive statistical methods, validity and reliability analysis, and regression analysis were applied for data analysis.

RESULTS: Seven hundred thirty-four dentists registered in the Turkish Dental Association took part in the study. 47% of respondents examined five or fewer patients per day during the pandemic. Dentists working in private practice examine more patients per day during the pandemic. 80.8% of the respondents experienced anxiety while examining patients during the pandemic. While the dentist’s anxiety level increased with increasing the number of patients examined per day (β: 0.399), it decreased with increasing the dentist’s age (β: -0.065). Respondents were not satisfied with the pandemic’s management, with the decisions taken regarding dentistry, and with the supports provided to the dentists. 85.8% of the respondents were concerned about their professional future, which is higher among dentists who work in governmental practice (p < 0.05, ANOVA).

CONCLUSIONS: Increasing dentists’ representation in the management of the pandemic and the future policy-making process, taking steps for the future by creating planning processes will eliminate the uncertainties and dissatisfaction and ensure to be ready for new pandemics.

PMID:34196128 | DOI:10.1002/cre2.466