Tag: statistics

BMC Res Notes. 2021 Jun 30;14(1):244. doi: 10.1186/s13104-021-05658-w.

ABSTRACT

OBJECTIVE: Glutathione S-transferases have been associated with experimental resistance to some drugs. The present study investigated the factors associated with blood pressure control in patients with essential hypertension, especially the role of GSTT1 and GSTM1 genes polymorphisms. This cross-sectional study in Burkina Faso consisted of 200 patients with essential hypertension and under treatment.

RESULTS: In the present study, 57.5% (115/200) of patients had their hypertension under control. No statistically significant difference was found between controlled and uncontrolled groups for anthropometric and biochemical parameters as well as for GSTT1 or GSTM1 gene polymorphisms (all p > 0.05). Current alcohol consumption (OR = 3.04; CI 1.88-6.13; p < 0.001), Physical inactivity (OR = 3.07; CI 1.71-5.49; p < 0.001), severe hypertension before any treatment (Grade III [OR = 3.79; CI 2.00-7.17; p < 0.001]) and heart damage (OR = 3, 14; CI 1.59-6.02; p < 0.001) were statistically more frequent in uncontrolled essential hypertensive patients than controlled hypertensive patients.

PMID:34193266 | DOI:10.1186/s13104-021-05658-w

Clin Epigenetics. 2021 Jun 30;13(1):135. doi: 10.1186/s13148-021-01115-4.

ABSTRACT

BACKGROUND: Environmental exposures may alter DNA methylation patterns of T helper cells. As T helper cells are instrumental for allergy development, changes in methylation patterns may constitute a mechanism of action for allergy preventive interventions. While epigenetic effects of separate perinatal probiotic or ω-3 fatty acid supplementation have been studied previously, the combined treatment has not been assessed. We aimed to investigate epigenome-wide DNA methylation patterns from a sub-group of children in an on-going randomised double-blind placebo-controlled allergy prevention trial using pre- and postnatal combined Lactobacillus reuteri and ω-3 fatty acid treatment. To this end, > 866000 CpG sites (MethylationEPIC 850K array) in cord blood CD4+ T cells were examined in samples from all four study arms (double-treatment: n = 18, single treatments: probiotics n = 16, ω-3 n = 15, and double placebo: n = 14). Statistical and bioinformatic analyses identified treatment-associated differentially methylated CpGs and genes, which were used to identify putatively treatment-induced network modules. Pathway analyses inferred biological relevance, and comparisons were made to an independent allergy data set.

RESULTS: Comparing the active treatments to the double placebo group, most differentially methylated CpGs and genes were hypermethylated, possibly suggesting induction of transcriptional inhibition. The double-treated group showed the largest number of differentially methylated CpGs, of which many were unique, suggesting synergy between interventions. Clusters within the double-treated network module consisted of immune-related pathways, including T cell receptor signalling, and antigen processing and presentation, with similar pathways revealed for the single-treatment modules. CpGs derived from differential methylation and network module analyses were enriched in an independent allergy data set, particularly in the double-treatment group, proposing treatment-induced DNA methylation changes as relevant for allergy development.

CONCLUSION: Prenatal L. reuteri and/or ω-3 fatty acid treatment results in hypermethylation and affects immune- and allergy-related pathways in neonatal T helper cells, with potentially synergistic effects between the interventions and relevance for allergic disease. Further studies need to address these findings on a transcriptional level, and whether the results associate to allergy development in the children. Understanding the role of DNA methylation in regulating effects of perinatal probiotic and ω-3 interventions may provide essential knowledge in the development of efficacious allergy preventive strategies. Trial registration ClinicalTrials.gov, ClinicalTrials.gov-ID: NCT01542970. Registered 27th of February 2012-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT01542970 .

PMID:34193262 | DOI:10.1186/s13148-021-01115-4

J Osteopath Med. 2021 Jun 22. doi: 10.1515/jom-2021-0035. Online ahead of print.

ABSTRACT

CONTEXT: Primary care physicians need a strong foundation in diabetes management, as they are the first line of care for patients with this complex disease, which is increasing in frequency in the United States. This foundational training begins in medical school, but its applications become more important during residency.

OBJECTIVES: To quantify osteopathic and allopathic family medicine residents’ amount of exposure to diabetes in residency training, investigate referral patterns related to diabetes management, and assess comfort levels with various diabetes treatment modalities.

METHODS: An 18-item cross sectional survey was sent via email using Qualtrics to program directors and chief residents of 16 different training programs located in seven different health systems and four different states; the programs were focused on family medicine, internal medicine, pediatrics, and combined internal medicine/pediatrics programs. The link was also posted on Twitter using specific “handles” to “tag” professional associations and groups related to primary care. Emails and tweets were initiated on October 15, 2018 and responses were collected through April 15, 2019. Data collection was reinitiated via email only from May 1, 2020 through July 31, 2020 due to low initial response rate. The study, which included multiple choice and Likert scale questions with some skip logic, was designed by study investigators. Data was exported from Qualtrics to an Excel spreadsheet and analyzed using descriptive statistics, which are reported as percentages.

RESULTS: A total of 61 residents responded to the survey, with most (52; 85.2%) enrolled in family medicine or internal medicine programs. Residents were mostly located in rural (28; 45.9%) and suburban (25; 41.0%) areas. Respondents reported being extremely comfortable with metformin (45; 73.8%), basal insulin (24; 39.3%), and healthy lifestyle education (32; 52.5%) for the treatment of diabetes. They reported being least comfortable with diabetes technology, with 51 (83.6%) uncomfortable or extremely uncomfortable with insulin pumps and 43 (70.5%) uncomfortable with continuous glucose monitoring systems for diabetes treatment. Referral rates to endocrinologists were low, with 47 (77%) reporting referral of diabetes patients 10-15% of the time. Residents reported interest in workshops and online continuing medical education for further training opportunities, but interest in additional formal training was low (3; 4.9%).

CONCLUSIONS: Residents in this study reported confidence in diabetes management and referral rates among this group were low. However, reported comfort levels with treatment modalities beyond metformin and lifestyle changes were not strong. Referral rates may have been low due to the low number of endocrinologists in rural areas and therapeutic inertia. Diabetes fellowships could increase resource availability for patient referral. Utilization of diabetologists in primary care programs may also add benefit and improve skills among trainees including more familiarity with diabetes technology and use of newer medications used in diabetes management.

PMID:34192834 | DOI:10.1515/jom-2021-0035

Thromb Haemost. 2021 Jun 30. doi: 10.1055/a-1541-3885. Online ahead of print.

ABSTRACT

BACKGROUND: It is uncertain whether stroke risk of asymptomatic ambulatory atrial fibrillation (AA-AF) incidentally-detected in primary care is comparable with other clinical AF presentations in primary care or hospital.

METHODS: The stoke risk of 22,035 patients with incident non-valvular AF from the UK primary care Clinical Practice Research Datalink with linkage to hospitalization and mortality data, was compared to 23,605 controls without AF (age and sex-matched 5:1 to 5,409 AA-AF patients). Incident AF included 5,913 with symptomatic ambulatory AF (SA-AF); 4,989 with Primary and 5,724 with non-Primary Hospital AF discharge diagnosis (PH-AF and Non-PH-AF); and 5,409 with AA-AF. Ischemic stroke adjusted subhazard ratios (aSHR) within 3 years of AA-AF were compared with SA-AF, PH-AF, Non-PH-AF and controls, accounting for mortality as competing risk and adjusted for ischemic stroke risk factors.

RESULTS: There were 1026 ischemic strokes in 49,544 person-years in patients with incident AF (crude incidence rate 2.1 ischemic strokes/100 person-years). Ischemic stroke aSHR over 3 years showed no differences between AA-AF, and SA-AF, PH-AF and nonPH-AF groups (aSHR 0.87-1.01 vs AA-AF). All AF groups showed a significantly higher aSHR compared to controls. (subhazard rate ratio 0.40 [0.34 – 0.47].

CONCLUSION: Ischemic stroke risk in patients with AA-AF incidentally-detected in primary care is far from benign, and not less than incident AF presenting clinically in general practice or hospital. This provides justification for identification of previously undetected AF, e.g. by opportunistic screening, and subsequent stroke prevention with thromboprophylaxis, to reduce the approximately 10% of ischemic strokes related to unrecognized AF.

PMID:34192776 | DOI:10.1055/a-1541-3885

Cochrane Database Syst Rev. 2021 Jun 30;6:CD003748. doi: 10.1002/14651858.CD003748.pub5.

ABSTRACT

BACKGROUND: Peripheral arterial disease (PAD) affects between 4% and 12% of people aged 55 to 70 years, and 20% of people over 70 years. A common complaint is intermittent claudication (exercise-induced lower limb pain relieved by rest). These patients have a three- to six-fold increase in cardiovascular mortality. Cilostazol is a drug licensed for the use of improving claudication distance and, if shown to reduce cardiovascular risk, could offer additional clinical benefits. This is an update of the review first published in 2007.

OBJECTIVES: To determine the effect of cilostazol on initial and absolute claudication distances, mortality and vascular events in patients with stable intermittent claudication.

SEARCH METHODS: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, and AMED databases, and the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registries, on 9 November 2020.

SELECTION CRITERIA: We considered double-blind, randomised controlled trials (RCTs) of cilostazol versus placebo, or versus other drugs used to improve claudication distance in patients with stable intermittent claudication.

DATA COLLECTION AND ANALYSIS: Two authors independently assessed trials for selection and independently extracted data. Disagreements were resolved by discussion. We assessed the risk of bias with the Cochrane risk of bias tool. Certainty of the evidence was evaluated using GRADE. For dichotomous outcomes, we used odds ratios (ORs) with corresponding 95% confidence intervals (CIs) and for continuous outcomes we used mean differences (MDs) and 95% CIs. We pooled data using a fixed-effect model, or a random-effects model when heterogeneity was identified. Primary outcomes were initial claudication distance (ICD) and quality of life (QoL). Secondary outcomes were absolute claudication distance (ACD), revascularisation, amputation, adverse events and cardiovascular events.

MAIN RESULTS: We included 16 double-blind, RCTs (3972 participants) comparing cilostazol with placebo, of which five studies also compared cilostazol with pentoxifylline. Treatment duration ranged from six to 26 weeks. All participants had intermittent claudication secondary to PAD. Cilostazol dose ranged from 100 mg to 300 mg; pentoxifylline dose ranged from 800 mg to 1200 mg. The certainty of the evidence was downgraded by one level for all studies because publication bias was strongly suspected. Other reasons for downgrading were imprecision, inconsistency and selective reporting. Cilostazol versus placebo Participants taking cilostazol had a higher ICD compared with those taking placebo (MD 26.49 metres; 95% CI 18.93 to 34.05; 1722 participants; six studies; low-certainty evidence). We reported QoL measures descriptively due to insufficient statistical detail within the studies to combine the results; there was a possible indication in improvement of QoL in the cilostazol treatment groups (low-certainty evidence). Participants taking cilostazol had a higher ACD compared with those taking placebo (39.57 metres; 95% CI 21.80 to 57.33; 2360 participants; eight studies; very-low certainty evidence). The most commonly reported adverse events were headache, diarrhoea, abnormal stools, dizziness, pain and palpitations. Participants taking cilostazol had an increased odds of experiencing headache compared to participants taking placebo (OR 2.83; 95% CI 2.26 to 3.55; 2584 participants; eight studies; moderate-certainty evidence).Very few studies reported on other outcomes so conclusions on revascularisation, amputation, or cardiovascular events could not be made. Cilostazol versus pentoxifylline There was no difference detected between cilostazol and pentoxifylline for improving walking distance, both in terms of ICD (MD 20.0 metres, 95% CI -2.57 to 42.57; 417 participants; one study; low-certainty evidence); and ACD (MD 13.4 metres, 95% CI -43.50 to 70.36; 866 participants; two studies; very low-certainty evidence). One study reported on QoL; the study authors reported no difference in QoL between the treatment groups (very low-certainty evidence). No study reported on revascularisation, amputation or cardiovascular events. Cilostazol participants had an increased odds of experiencing headache compared with participants taking pentoxifylline at 24 weeks (OR 2.20, 95% CI 1.16 to 4.17; 982 participants; two studies; low-certainty evidence).

AUTHORS’ CONCLUSIONS: Cilostazol has been shown to improve walking distance in people with intermittent claudication. However, participants taking cilostazol had higher odds of experiencing headache. There is insufficient evidence about the effectiveness of cilostazol for serious events such as amputation, revascularisation, and cardiovascular events. Despite the importance of QoL to patients, meta-analysis could not be undertaken because of differences in measures used and reporting. Very limited data indicated no difference between cilostazol and pentoxifylline for improving walking distance and data were too limited for any conclusions on other outcomes.

PMID:34192807 | DOI:10.1002/14651858.CD003748.pub5

J Clin Pediatr Dent. 2021 Jul 1;45(3):165-170. doi: 10.17796/1053-4625-45.3.4.

ABSTRACT

OBJECTIVE: This retrospective study aimed to evaluate the clinical outcomes of the apical plug performed using MTA with or without collagen sponge in immature anterior maxillary teeth with necrotic pulp.

STUDY DESIGN: The study included apical obturation of 20 upper incisor teeth from 18 patients and outcomes of 12-month follow-up. The teeth were divided into 2 groups with 10 cases in each group according to the apexification protocol (Group 1; apical plug with MTA, Group 2; collagen sponge and apical plug with MTA). The artificial apical barrier, approximately 4-mm-thick, was created with MTA in each group. Based on clinical and radiographic criteria, the outcome was assessed using the periapical index (PAI) by 2 calibrated investigators.

RESULTS: In this study, 3 of the 6 teeth (50%) in Group 1 and 5 of the 8 teeth (62.5%) in Group 2 healed at the 12-month follow-up. However, there was no statistically significant difference between the groups at the post-treatment follow-up times.

CONCLUSION: The use of collagen as an apical matrix prior to the MTA plug can be suggested due to favorable clinical outcomes.

PMID:34192757 | DOI:10.17796/1053-4625-45.3.4

J Clin Pediatr Dent. 2021 Jul 1;45(3):158-164. doi: 10.17796/1053-4625-45.3.3.

ABSTRACT

OBJECTIVE: In a tooth with deep dentinal caries; judicious removal of infected dentin and isolating affected dentin from oral fluids with suitable biocompatible material is called indirect pulp therapy (IPT). This randomized clinical trial was done to evaluate and compare the efficacy of Biodentine, Theracal LC and. Dycal as an indirect pulp capping agent in young permanent teeth.

STUDY DESIGN: IPT was performed in 60 young permanent molars with caries approaching pulp in 55 healthy children using Biodentine, Theracal and Dycal. A 2-3mm layer of GIC was placed over the intervening material followed by restoration of cavity with composite. Clinical and radiographic examinations were conducted at 3 weeks, 3 months, 6 months,12 months, 18 months and 24 months. The data was compared using chi-square test at a significance level of 0.05.

RESULTS: By end of 24 months ,54 teeth presented for follow up with overall success rate of 100% in Theracal, 94.44% in Biodentine, and 77.78% in Dycal. Overall success of Theracal was statistically significant in comparison to Biodentine and Dycal at 24 months follow up (p= 0.03) Conclusions: Radiographic and clinical outcomes of Theracal and Biodentine suggest their use as an alternative material for IPT in young permanent molars with higher success.

PMID:34192759 | DOI:10.17796/1053-4625-45.3.3

J Clin Pediatr Dent. 2021 Jul 1;45(3):171-176. doi: 10.17796/1053-4625-45.3.5.

ABSTRACT

The purpose of this study was to determine and compare the shear force (N) required to fracture or dislodge an all-ceramic zirconia-based crown using different luting cement with those of polycarbonate crown and strip crown for the primary anterior teeth in vitro.

STUDY DESIGN: Four groups of esthetic restoration for primary anterior teeth were tested for fracture strength: 1) Fifteen all-ceramic zirconia-based crowns cemented with glass ionomer cement, 2) Fifteen all-ceramic zirconia-based crowns bonded with a self-adhesive resin cement, 3) Fifteen polycarbonate crowns cemented with a polymer reinforced zinc-oxide eugenol and 4) Fifteen resin strip crowns. All restorations were placed and cemented on reproductions of dies in an independent laboratory at Delhi, India. All samples underwent loading until fracture or dislodgement with the Universal Testing Machine. The force in Newton (N) required to produce failure was recorded for each sample and the type of failures was also noted and characterized. One-way analysis of variance (ANOVA) test and the Tukey and Scheffe’s post hoc comparisons were used for statistical analyses.

RESULTS: In this invitro study, results were measured in Newtons (N). Group 1 (410.9±79.5 N) and Group 2 (420.5±57.8 N) had higher fracture strength than Group 3 (330.3±85.6 N) and Group 4 (268.4±28.2 N). These differences were statistically significant at P≤.05 among the sample groups. No significant difference was found between groups 1 and 2 (P = 0.984) nor between groups 3 and 4 (P =0.104). Among type of failures, majority of restoration fractures for zirconia-based crowns and resin strip crowns were due to cohesive failures and polycarbonate crowns had predominantly mixed failures.

CONCLUSIONS: Under the limitations of this in vitro study, it could be concluded that all-ceramic zirconia-based crowns attained the highest fracture strength among all restorative samples tested regardless of the type of luting agent employed (P<.01). Cohesive failures were commonly observed in the zirconia crowns and resin strip crowns, whereas polycarbonate crowns revealed predominately mixed failures.

PMID:34192760 | DOI:10.17796/1053-4625-45.3.5

Acad Med. 2021 Jun 29. doi: 10.1097/ACM.0000000000004223. Online ahead of print.

ABSTRACT

PURPOSE: Medical student mistreatment is pervasive, yet whether all physicians have a shared understanding of the problem is unclear. The authors presented professionally designed trigger videos to physicians from six different specialties to determine if they perceive mistreatment and its severity similarly.

METHOD: From October 2016 to August 2018, resident and attending physicians from 10 U.S. medical schools viewed five trigger videos showing behaviors that could be perceived as mistreatment. They completed a survey exploring their perceptions. The authors compared perceptions of mistreatment across specialties and, for each scenario, evaluated the relationship between specialty and perception of mistreatment.

RESULTS: Six-hundred and fifty resident and attending physicians participated. There were statistically significant differences in perception of mistreatment across specialties for three of the five scenarios: aggressive questioning (range 74.1%-91.2%), negative feedback (range 25.4%-63.7%), and assignment of inappropriate tasks (range 5.5%-25.5%) (P ≤ .001, for all). After adjusting for gender, race, professional role, and prior mistreatment, physicians in surgery viewed three scenarios (aggressive questioning, negative feedback, inappropriate tasks) as less likely to represent mistreatment compared to internal medicine physicians. Physicians from obstetrics and gynecology and from “other” specialties perceived less mistreatment in two scenarios (aggressive questioning, negative feedback) while family physicians perceived more mistreatment in one scenario (negative feedback) compared to internal medicine physicians. The mean severity of perceived mistreatment on a 1 to 7 scale (7 most serious) also varied statistically significantly across the specialties for three scenarios: aggressive questioning (range 4.4-5.4, P < .001), ethnic insensitivity (range 5.1-6.1, P = .001), and sexual harassment (range 5.5-6.3, P = .004).

CONCLUSIONS: Specialty was associated with differences in the perception of mistreatment and in the rating of its severity. Further investigation is needed to understand why these perceptions of mistreatment vary among specialties and how to address these differences.

PMID:34192722 | DOI:10.1097/ACM.0000000000004223

J Clin Pediatr Dent. 2021 Jul 1;45(3):152-157. doi: 10.17796/1053-4625-45.3.2.

ABSTRACT

OBJECTIVES: To compare the effectiveness of visual examination, radiographic examination and fluorescence-aided caries excavation (FACE) in detecting occlusal caries in first permanent molars in 150 children aged 6-14 years with intact occlusal surface with caries lesions without cavitation, or with darkened or deep fissures that had no clear diagnosis.

STUDY DESIGN: Two dentists independently performed a visual oral examination, FACE and bitewing radiography. The inter-rater reliability of each detection method was determined and their specificity and sensitivity.

RESULTS: All caries detection methods showed high inter-rater reliability with absolute agreement between raters above 90%. Most caries lesions were detected by visual (75.8%) and FACE (79.1%), while only 28.8% of lesions were detected by radiography. Detection by visual examination was strongly correlated with detection by FACE (X2=37.9, Phi=0.498, p<0.001). A lower, yet statistically significant, correlation was found between visual examination and X-ray radiography (X2=5.53, Phi=0.190, p<0.001). FACE had higher sensitivity (87%) and specificity (65%) for detecting occlusal caries in comparison with radiography (60% specificity and 55% sensitivity).

CONCLUSION: Although visual examination remains the best method to detect occlusal caries in young permanent molars in children, FACE is an effective and accurate diagnostic tool that may aid in detection and treatment decisions.

PMID:34192750 | DOI:10.17796/1053-4625-45.3.2