Cross-sectional Clinical Study Research Articles

Level of patient comfort and measurement reproducibility of three different probes: A cross-sectional study.

To determine the comfort level and reproducibility assessment of the probing pocket depth obtained with three different probes. A cross-sectional clinical study was conducted in accordance with the STROBE standards. Three different types of periodontal probes were selected: (1) University of North Carolina (UNC) probe, (2) World health organization (WHO) probe and (3) UNC12 COLORVUE probe. Three experienced and calibrated periodontists performed periodontal clinical assessments (probing depth) and pain assessment with the visual analogue scale (VAS). The clinical evaluations were carried out in 13 volunteers who attended the dental clinic of the Universidad Científica del Sur (Lima, Peru). A total of 2106 periodontal clinical measurements were obtained (702 measurements per examiner). Each examiner evaluated 234 sites for each type of probe. When patient comfort values during the periodontal evaluation performed with the 3 types of probes were compared, the patients evaluated with the UNC12 COLORVUE probe perceived less pain with a mean value of 0.61, followed by the WHO probe and the UNC probe. When evaluating the clinical measurements, the UNC probe was observed to obtain the greatest mean depth on probing 1.4+0.5mm, while with the UNC12 Colorvue probe, the values obtained were 1.1+0.3mm, and with the WHO probe, 1.2+0.4mm. Based on the periodontal probe used, experience of the examiner and the patient, we can conclude that the UNC12 Colorvue probe was the instrument that promoted the greatest comfort or the slightest response to pain, followed by the WHO probe. However, the use of the WHO probe resulted in obtaining the lowest reproducibility among depths on probing. The UNC probe produced the highest response to pain in the patients.

Association of Monocytes to High-Density Lipoprotein Cholesterol Ratio With Metabolic Syndrome and Its Components

Abstract Background To investigate the association of monocytes to high-density lipoprotein cholesterol ratio (MHR) with metabolic syndrome (MS) and its components. Methods A cross-sectional clinical study was conducted from February 2018 to January 2019 in the First Affiliated Hospital of Fujian Medical University. A total of 890 inpatients or outpatients aged 30–79 years old were enrolled, and their clinical data were collected. MS and its components were defined according to the National Cholesterol Education Program Adult Treatment Panel III (NECP-ATPIII) diagnostic criteria. Spearman correlation and logistic regression analyses were used to analyze the association of MHR with MS and its components. A receiver operating characteristic analysis was used to evaluate the diagnostic efficacy of MHR for MS. Results The monocyte counts and MHR were significantly higher in subjects with MS than those without MS (P < 0.001). The percentage of subjects carrying 3 or more MS components increased with the increment of MHR tertiles (13.7%, 32.7%, and 44.6%, P < 0.001). MHR was correlated with multiple metabolic components, including body mass index, waist circumstance, visceral fat content, total cholesterol, triglyceride, fasting plasma glucose, glycosylated hemoglobin, and systolic blood pressure (all P < 0.001). Logistic regression analyses showed that MHR was independently associated with MS after adjusting for age, gender, multiple metabolic components, and the use of antihypertensive and antihyperglycemic medications. Compared with the lowest tertile of MHR, the risk of MS increased by 2.386 and 3.233 times in moderate (P = 0.010) and highest (P = 0.001) tertiles, respectively. Receiver operating characteristic curve analyses indicated that the best cutoff value of MHR was 6.59 × 105/mg for the diagnosis of MS, with a sensitivity of 75.2% and a specificity of 52.7%. Conclusions Elevated MHR is associated with an increased risk of MS and the accumulation of its components.

Radiographic peri-implant bone loss after a function time up to 15 years

Objective The aim was to assess the degree of radiographic peri-implant bone loss over a follow-up period up to 15 years. In addition, another aim was to identify risk indicators for peri-implant bone loss and for moderate–severe peri-implantitis at patient- and implant level. Materials and methods This is a cross-sectional clinical and radiological study of 147 patients with a total of 425 implants in combination with data collected retrospectively for baseline variables. To calculate the peri-implant bone loss (primary outcome variable), the radiographic bone level measurements from baseline were compared to the radiographic bone level measurements at the final radiographic measurement. Multilevel analyses were adopted with peri-implant bone loss and peri-implantitis as outcome variables. Results The mean follow-up time was 12.5 years (range 10–15) and the mean age of the patients was 63 years (range 29–83). The mean peri-implant bone loss was 0.94 mm (S.D. 1.3). The prevalence of moderate–severe peri-implantitis at patient level was 17% and 8.9% at implant level. The peri-implant bone loss was significantly more pronounced in healthy implants if moderate–severe peri-implantitis was present in at least one implant within the same patient. The presence of moderate–severe peri-implantitis was significantly associated with general periodontitis Stages III or IV at follow-up and smoking. Conclusion The presence of moderate–severe peri-implantitis at patient level was found to be a risk indicator of peri-implant bone loss in healthy implants, while smoking and general periodontitis Stages III and IV were risk indicators of moderate–severe peri-implantitis.

Verbal working memory and processing speed: Correlations with the severity of attention deficit and emotional dysregulation in adult ADHD.

ObjectivesThe Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐5), emphasizes symptoms severity with regard to the diagnosis of attention deficit hyperactivity disorder (ADHD). Many clinicians use neuropsychological test results as objective measures of cognitive functions as part of the diagnostic work‐up. The aim of this study was to investigate whether the psychometric test results regarding verbal working memory and processing speed are useful as indicators of the severity of attention deficits and emotional dysregulation in adults with ADHD.MethodsThis observational cross‐sectional clinical study included 418 adults diagnosed with ADHD according to the DSM‐5. Attention deficit severity was defined based on the inattentive subscale of the Adult ADHD Self‐Report Scale. Emotional dysregulation was assessed with the Deficient Emotional Self‐Regulation scale. Verbal working memory was measured with the Working Memory Index (WMI), and processing speed was measured with the Processing Speed Index (PSI) from the Wechsler Adult Intelligence Scale, third edition.ResultsThe full‐scale intelligence quotients of the participants were in the normal range, with expected reductions in verbal working memory and processing speed. Only processing speed was associated with attention deficits (β = −.056, p = .003). The association between the psychometric test result for verbal working memory and processing speed and that between the severity of attention deficits and emotional dysregulation were weak (R2 < .1) and mostly non‐significant.ConclusionThe psychometric index scores for verbal working memory (WMI) and processing speed (PSI) seem to have limited utility as indicators of the severity of attention deficits and emotional dysregulation in adult ADHD patients.

Inflammatory Biomarkers Levels in T2DM Emirati Patients with Diabetic Neuropathy.

IntroductionPrevious studies have suggested the involvement of chronic low‐grade inflammation in the pathogenesis of diabetic neuropathy (DNP). However, none of these studies have examined the levels of monocyte chemoattractant protein-1 (MCP-1) in type 2 diabetes mellitus (T2DM) patients with confirmed diagnosis of neuropathy. Therefore, the present study aims to investigate the levels of MCP-1 along with IL-6, IL-8 and TGF-β in patients with T2DM and confirmed neuropathy and identify correlations, if any, between MCP-1 and other parameters.MethodsA single center cross-sectional clinical study was conducted at University Hospital Sharjah (UHS) and University of Sharjah. One hundred and two patients with T2DM were recruited from diabetes clinics at UHS and were stratified into different groups based on diagnosis of DNP and other parameters. Several analyses were conducted to evaluate and compare the levels of MCP-1, IL-6, IL-8, and TGF-β across these groups of patients and identify correlations, if any, between MCP-1 and other variables.ResultsA significant increase was found in the levels of MCP-1 in T2DM patients with DNP compared to the patients without DNP (p=0.002, p-adj=0.007). Further analysis has shown that levels of IL-8 (p=0.008) and TGF-β (p=0.06) were increased and decreased, respectively, in patients with DNP compared to patients without DNP. Moreover, strong correlations were found between MCP-1, IL-8 and TGF-β levels.ConclusionThe key finding of the present study is the significant elevation in levels of MCP-1 in T2DM patients with DNP compared to the patients without DNP and IL-8 and TGF-β were strong predictors of MCP-1 increased levels.

Psychotic experiences in patients with obsessive compulsive disorder. A cross sectional clinical study

Background: Obsessive-compulsive disorder (OCD) is associated with heterogeneous and diverse symptoms. A diagnosis is challenging when patients experience psychotic symptoms. This study aimed to evaluate the pattern of psychotic symptoms in patients with OCD. Methods: Using semi-structured clinical interviews, 185 patients meeting the DSM-IV diagnostic criteria for OCD were selected. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Scale for the Assessment of Positive/Negative Symptoms (SAPS/SANS) were used to measure the OCD severity and insight levels and the pattern of psychotic symptoms, respectively. Characteristics of patients with and without psychotic experiences were compared. Results: A total of 38 patients (20.5%) displayed psychotic symptoms. Delusions were observed in 63.2% of these patients, while in 13.2% of them, delusions were accompanied with negative symptoms. Men, those aged between 18 and 34 years, less educated, and singles displayed significantly higher rates of psychotic symptoms. The mean Y-BOCS score (26.42±5.07) was significantly higher in patients with psychotic symptoms than in those without (24.97±6.38). Conclusion: The results showed that in OCD patients, psychotic symptoms are more common in young (&lt;30 years), single, less educated, and those with severe OCD. Keywords: obsessive-compulsive disorder; psychosis; insight.

To evaluate the dimensions of each lobe and total volume of thyroid gland by ultrasonography among pregnant and non pregnant women in local population, Karachi.

To evaluate the dimensions of each lobe and total volume of thyroid gland&#x0D; by ultrasonography among pregnant and non pregnant women in&#x0D; local population, Karachi.&#x0D; &#x0D; &#x0D; Abstract:&#x0D; Background: Pregnancy has an anatomical and physiological influence on the thyroid gland and it’s function. It is good to know the normal changes that occur during pregnancy. The size and volume of this gland is increased through the pregnancy and becomes visible due to iodine deficiency (ID) that can lead to goiter or may develop hypothyroidism. Objective of the study were to evaluate dimensions of both lobes and calculation of thyroid volume by using ultrasonography (USG) and to compare these parameters between pregnant and non pregnant in Karachi, Pakistan.&#x0D; Methodology: It was a clinical cross sectional study that was conducted at Gynae OPD and Radiology Department, Ojha campus, Dow university of health sciences (DUHS), Karachi from October 2016 to December 2018 through consecutive sampling. The study volunteers of reproductive age (14-45 years) were included and divided into two groups (pregnant and non-pregnant women). The dimensions of each lobe and calculation of thyroid volume were taken into the account through their standard protocol after following inclusion and exclusion criteria.&#x0D; Results: The comparisons were made on thyroid gland dimensions, ultrasound outcomes of right and left lobe length, width, depth and volume of thyroid gland. In pregnant women, right lobe length was 2.91±1.05, width was 1.54±0.41 and depth was 2.31±1.41 whereas in non pregnant women mean right lobe length was 2.50±0.97, width was 1.34±0.51 and depth was 1.68±0.98. The mean difference was considered statistically significant in pregnant women with p-value (&lt; 0.01). In pregnant women thyroid volume was 7.02±3.21 whereas in non pregnant, it was 5.58±2.41 which was significantly increased in pregnant women with p-value (&lt; 0.01).&#x0D; Conclusion: Therefore our study concludes that, in our population at least half of the apparently healthy pregnant females do have some degree of iodine deficiency. The volume of the gland is increased during pregnancy, suggesting iodine deficiency.&#x0D; &#x0D; Key Words: Pregnant women, non pregnant women, dimensions of thyroid gland and&#x0D; volume of thyroid gland.

Deficient serum vitamin D level is not a risk for periodontitis-A cross-sectional clinical study

Aim Periodontal diseases are characterized by the presence of bleeding, inflammation, sensitivity, discomfort, mobility and tooth loss. Plenty of studies supported the assumption that vitamin D deficiency might be a risk factor for periodontal diseases. Our hypothesis aimed to investigate if there is a true association between serum vitamin D level and the presence of periodontal disease. Materials and methods Using a cross-sectional study design, a total of 200 participants, 100 periodontitis and 100 non-periodontitis patients, were recruited during the routine examination and enrolled to 2 comparative groups. Results Serum vitamin D levels of periodontitis patients (11.607±7.58 ng/ml) compared to non-periodontitis patients (11.756±5.608 ng/ml) presented non statistically significant differences (p-value = 0.878). Most of the population (97%) in both groups represented significantly lower serum vitamin D levels. Serum vitamin D levels showed inverse correlation with gender (r= - 0.39) as well as age (r= - 0.09), linear correlation with systemic conditions (r= 0.04) and no correlation with periodontal conditions (r= 0.00). Conclusion The serum vitamin D deficiency is not a risk factor for periodontitis and their relationship is spurious.

Analysis of Salivary Metabolites by Nuclear Magnetic Resonance Before and After Oral Mucosa Cleaning of Infants in the Pre-dental Period

The aim of the present study was to verify if a protocol for cleaning the oral cavity of infants in the pre-dental period can reduce extrinsic salivary metabolites observed through Nuclear Magnetic Resonance (NMR). A cross-sectional clinical study with a convenience sample was conducted, and infants were recruited at the UFRJ Pediatric Dentistry Clinic. Participants who had used antibiotics and/or antifungals up to 3 months before and whose legal guardians did not consent or sign the Informed Consent Form were excluded. An anamnesis was performed with the guardians and the participants' intraoral clinical examination. Initial collection of unstimulated total saliva was performed using an automatic pipette with sterile plastic tips in the buccal floor region, at least 1 h after the last feeding. Subsequently, the infants' oral mucosa was cleaned with gauze moistened with filtered water, and after 5 min, a new collection was performed, using the same methodology. The obtained samples were immediately transferred on ice to the laboratory, centrifuged (10,000 g), and stored at −80°C. The NMR analyses were performed using a 500-MHz spectrometer Bruker, Germany); evaluations were done via the 1H and 1H-1H TOCSY spectra for metabolite signaling. Eleven pre-dental infants were evaluated, with a mean age of 3.8 months, including six girls (55%). Of these, nine participants (82%) were exclusively breastfed. The higher presence of components such as lactose, glucose, sugars, acetate, alanine, and lactate were observed in the samples before oral mucosa cleaning. Regarding the type of diet, more lactose was observed in the saliva of patients who were exclusively breastfed than those that received mixed feeding. We conclude that the oral mucosa cleaning of infants in the pre-dental period tends to reduce the concentration of extrinsic components from the diet, such as lactose, in the salivary metabolomic profile analyzed by NMR.

English

BACKGROUND Accurate clinical diagnosis and timely surgical intervention are the two important events that help the surgeon in the management of acute appendicitis. Two diagnostic score systems that help in avoiding the removal of normal appendix are reviewed in this study. The purpose of this study was to evaluate the sensitivity and specificity of Alvarado score (AS) and Appendicitis inflammatory response scores (AIRS) in the diagnosis of acute appendicitis (AA) and correlate their efficacy in the management of acute appendicitis as per the diagnostic scores used. METHODS This was a cross-sectional clinical study. 73 patients who attended the emergency ward for clinical features of acute appendicitis were included in the study. Clinical examination included the diagnostic tools 1. The Alvarado score, 2. Appendicitis Inflammatory Response score. Based on their score a provisional diagnosis was made among the patients. All the data was classified and analysed. RESULTS The positive predictive value was 63/73 (86.30 %) with Alvarado diagnostic tool and 66/73 (90.41 %) with AIS diagnostic tool. The false positive values using Alvarado system was 06.84 % and 04.10 % with AIS system. The true negative rate of diagnosis of acute appendicitis in this study was 09.58 %. CONCLUSIONS Both Alvarado and AIS diagnostic tools were simple and accurate in the early diagnosis of acute appendicitis in the adult population. Both the tools are highly sensitive and specific in nature. KEYWORDS Appendix, Acute Appendicitis, Perforation, USG, Laparotomy and Alvarado Score

Poor Accuracy of Clinical Diagnosis in Pes Anserine Tendinitis Bursitis Syndrome.

To investigate the characteristics of the patients who are clinically diagnosed with pes anserine tendinitis bursitis syndrome (PATBS), and to determine the sensitivity and specificity of clinical diagnose based on magnetic resonance imaging (MRI). Included in this cross-sectional clinical study were 156 patients who were evaluated based on the clinical presence or absence of PATBS. All patients underwent Q-angle measurement, knee osteoarthritis (OA) grading according to the Kellgren-Lawrence classification, and medial joint space measurement, and their cartilage thickness, and any periarticular and intraarticular knee pathologies were recorded from an assessment of knee MRIs. Of the total, 64 cases (41%) were diagnosed clinically with PATBS and 92 (59%) were not. There was no difference in the Q angles of the two groups (p > 0.05), while the medial joint spaces were significantly lower in the PATBS patients (p < 0.05). There were no significant differences between the two groups in an MRI assessment of meniscus and ligament lesions, chondromalacia patella, cyst, bursitis, effusion and synovial pathologies (p > 0.05). The sensitivity and specificity of the PATBS clinical diagnoses relative to the MRI findings were determined as 41.2% and 59.5%, respectively. The medial joint space was found to be significantly lower in patients with PATBS, while there was no difference in any other knee pathologies between the two groups. The sensitivity and specificity of a PATBS clinical diagnosis were found to be low, and so it was concluded that clinical PATBS diagnoses may be inaccurate, particularly in the presence of such invasive therapies as injection, and that diagnoses based on imaging methods would be more accurate.

A comparison of three questionnaires to predict the risk of obstructive sleep apnea and hypopnea syndrome in adults

Objective: To determine the differences in the prognosis of the risk of presenting Obstructive Sleep Apnea/Hypopnea Syndrome (SOAHS) by comparing the results of the Berlin questionnaire (CB), STOP-Bang (SB) and the Epworth Sleepiness Scale (ESE) in patients admitted to the Dos de Mayo National Hospital during the 2019-2020 period. Materials and methods: A quantitative, observational, descriptive, prospective and cross-sectional clinical study of diagnostic tests. A sample of 304 patients older than 18 years was included. The results are presented with frequencies, measures of central tendency and dispersion. An association of variables was made using the Chi2 test. The sensitivity and specificity of CB and ESE with respect to SB were measured. A significant p value of less than 0.05 was used. Results: An average age of 52.89 ± 15.97 years was obtained, predominating adults under 50 years of age (40.5%). 60.5% of the participants were male. The average BMI was 30.74 ± 6.02 kg/m2, with overweight predominating (43.4%). 42.8% had hypertension. According to the SB, CB and ESE; 77.0%, 62.5% and 60.5% had a high risk of presenting SOAHS respectively. The questionnaires found an association between age, sex, nutritional diagnosis and arterial hypertension and a high risk of presenting SOAHS (p &lt;0.05). There is a weak correlation between SB and CB (Kappa: 0.39) and SB and ESE (Kappa: 0.33). Conclusions: Questionnaires are useful tools with the potential to predict SOAHS risk. They present a significant but weak correlation between their risk prognosis for this syndrome. However, they should be considered as rapid and reliable screening tests. Key words: Diagnosis, Sleep Apnea Syndromes, Surveys and Questionnaires, Polysomnography&nbsp;(Source: MeSH NLM). &nbsp;

Clinical Prevalence of Enhanced Vestibulo-Ocular Reflex Responses on Video Head Impulse Test.

To measure and analyze the clinical and epidemiological characteristics of patients and healthy controls with enhanced eye velocity responses as well as evaluate their relationship with endolymphatic hydrops related diseases. Cross-sectional clinical study. Tertiary hospital. Three hundred sixty three participants allocated to patients (310) and healthy control (53) groups were collected on first time visit to neurotology unit. Diagnostic. Video head impulse test records, clinical diagnose, and variables and demographic data were used to get cross tables, a general linear model, diagnostic epidemiological parameters, and machine learning variable importance evaluation methods. All the statistical tests revealed a significant association between enhanced vestibulo-ocular reflex (VOR) and diagnostic categories (p < 0.001). Chi-squared residual and machine learning analyses showed Menière's disease as the main associated diagnostic category, whereas the lowest residuals and gain values were found in the control group. Enhanced VOR as a diagnostic sign of Menière's disease had a sensitivity of 42.59% and a specificity of 86.32%, with an odds ratio of 4.68 (p < 0.001). There is a significantly higher prevalence of enhanced VOR responses in patients with Menière's disease, central origin vertigo, otosclerosis, and vestibular migraine than in those with other neurotologic diseases and controls. Our study found that enhanced VOR are not pathognomonic of hydrops-related diseases and the diagnosis should not solely be based on these and instead take into context other clinical and examination findings.

Knowledge of Diabetes in Geriatric Patients attending Hospitals in Dhaka City, Bangladesh

Diabetes mellitus is a persistent disease in Bangladesh, which reportedly has a strong proportion of 7.1 million diabetics over 60 years old. Limited knowledge is a significant variable which affects and mainly preventsthe development and progression of diabetes. In order to determine the awareness of Type 2 diabetes among Geriatric patients in selected Dhaka hospitals, this cross-sectional clinical study was performed between May and August 2018. The research was carried out among 450 diabetic type 2 patients &gt;60 years of age from three urban and suburban Dhaka hospitals. Data is obtained by standardized questionnaires faceto-face interviews. The average age was 64.86 ± 4.65 years for the respondents. 56 percent of the research participants were guys. With 34.2% of respondents who did not attend school and just 13.8% of graduates, education was low. Much of the respondents (63.56 percent) referred to diabetes. The awareness level of respondents with signs (80.7%), risk factors (84.4%), avoidance (84%), and management (71.6%) was low. Just 8.7 percent heard the risks of diabetes. The overall awareness score for the participants was recorded as fair (18.9%), decent (30.7%) and bad (50.4%). The awareness score was closely linked to schooling and diabetes period (p&lt;0.01). The research indicated a lack of information among respondents. Geriatric diabetes patients with more diabetes treatment needs. It may also be argued that repeated enhancement and inspiration in combination with diabetes health education will contribute to a positive awareness improvement.

English

BACKGROUND Aim of the surgeon repairing the ventral hernia is to alleviate the symptoms and prevent complications with minimal recurrence rates. Recent times have seen the popularity of laparoscopic approach but there is reasonable controversy to its optimal approach when compared to conventional method. The present study analyses and correlates the postoperative outcomes of patients who underwent laparoscopic and conventional methods of ventral hernia repair during the last three years. METHODS This is a cross-sectional clinical study in which 87 patients diagnosed with ventral hernia from the Department of General Surgery of Government Medical College and Hospital, Nizamabad from September 2017 to August 2020 were included. 42 patients underwent laparoscopic repair and 45 underwent conventional hernia repair. Patients aged between 35 and 74 years belonging to American Society of Anaesthesiologist (ASA) grade I and II were included. Clinical history, surgical profile and anaesthesia fitness were obtained using standard operating procedures. All patients were followed up to 06 months. Data variables such as age, gender, BMI (Body Mass Index) size of defect, postoperative hospital stay and other complications were collected and analysed. RESULTS Out of 87 patients, laparoscopic group had 27 (59.52 %) females and 15 (35.71 %) males with a female to male ratio of 1.8:1. Whereas conventional hernia repair group had 29 (64.44 %) females and 16 (35.55 %) males with a female to male ratio of 2:1. 38 out of 87 (43.67 %) patients were in the age group of 45 to 54 years. Incisional hernia - infra umbilical type was found in 34 out of 87 (39.08 %) patients while incisional hernia - supra umbilical type was found in 23 out of 87 (26.43 %) patients. Correlating the adverse events between laparoscopic method and conventional methods of ventral hernia repair showed a statistical significance. Pearson correlation coefficient was with R factor of 0.983 and the P value was 0.00001 (P significant at &lt; 0.05) CONCLUSIONS Laparoscopic ventral hernia repair (LVHR) using bio-material mesh for the repair resulted in low postoperative pain, wound infection, graft rejection and higher long-term recurrence free patient satisfaction when compared to conventional hernia repair. KEYWORDS Ventral Hernia, Anterior Abdominal Wall, Laparoscopy, Repair and Recurrences

Orthostatic hypotension is associated with impaired cardiac structure and function after spinal cord injury

Heart disease is a primary cause of death after spinal cord injury (SCI). A 20 mmHg or more reduction in systolic blood pressure (BP) when assuming the upright posture is termed orthostatic hypotension (OH). Epidemiological data in the general population established a causal relationship between OH and heart disease. Orthostatic hypotension and heart disease are widespread after SCI however, it is unknown if the severity of OH after SCI is associated with cardiac structure or function and markers of cardiac health. We aimed to understand this relationship combining an interventional rodent study and a cross-sectional clinical study, using gold standard invasive techniques and cardiac-optimized magnetic resonance imaging, respectively. We hypothesized that after SCI, OH severity would be associated with reduced cardiac structure and function as well as poorer markers of cardiac health. Twenty-one wistar rats underwent a complete transection at the T3 spinal segment. One week later, half of these animals were exposed to five one-minute intervals of simulated OH daily for eight weeks using a custom lower body negative pressure chamber (n=10; Fig. 1A). Nine weeks post-SCI, invasive pressure-volume catheterization and inferior vena cava occlusion were performed on both groups. Daily exposure to OH impaired left ventricle (LV) structure and function in rats with SCI as evidenced by reduced stroke volume (SV), cardiac output (Q), and end-systolic elastance (Ees), along with increased ventricular-vascular coupling (VVC) and arterial elastance (Ea; Fig. 1B). Guided by these interventional preclinical results, we next cross-sectionally tested this association in a group of eight individuals with motor-complete chronic SCI using 3-Tesla cardiac-optimized magnetic resonance imaging (Fig. 1C), 24-hour ambulatory blood pressure monitoring (Fig. 1D), and orthostatic tilt-table testing at 60 degrees following clinical guidelines (Fig. 1E). More severe OH was associated with impaired cardiac structure and poorer markers of cardiac health, indicated by increased LV mass, increased left atrial volume, and increased troponin T (Fig. 1F). Our translational research, using both interventional preclinical and cross-sectional clinical assessments, indicates that OH after SCI is associated with impaired cardiac structure and function as well as poorer markers of cardiac health. The next step is to test if mitigating OH after SCI prevents this decline.

Translaminar Pressure Difference and Ocular Perfusion Pressure in Glaucomatous Eyes with Different Optic Disc Sizes.

Purpose Intracranial pressure (ICP) and ocular perfusion pressure (OPP) are both involved with the pathogenesis of glaucoma. The orbital ICP determines a retrolaminar counter pressure that is antagonistic to the intraocular pressure (IOP). The purpose of this study is to evaluate whether the translaminar pressure difference (TLPD) and the OPP varies in glaucoma patients with different optic disc sizes.Methods In this university hospital-based, observational, cross-sectional clinical study, all patients underwent an ophthalmic evaluation. Blood pressure, height, weight, and the results of retinal nerve fiber layer examination with optical coherence tomography examination were recorded. TLPD and OPP were calculated for each patient using proxy algorithms to attain indirect surrogate parameter values. Patients' eyes were stratified into three quantiles according to optic disc sizes and the differences compared. Data from both eyes were used after using the appropriate correction for inter-eye dependency.ResultsThe sample consisted of 140 eyes of 73 patients with primary open-angle glaucoma and suspects. Patients with large disc size presented with higher TLPD as compared to those with average and small-sized discs (2.4 4.5, 2.8 3.8, and 3.7 4.7 mmHg for first, second, and third tertile, respectively (P 0.000). OPP did not vary according to the optic disc size.ConclusionGlaucoma patients with larger optic discs have higher TLPD. The pathological significance of this finding warrants further investigation.

Surgical Outcome and Quality of Life After Total Laryngectomy in Advanced Laryngeal Cancer- A Study in Combined Military Hospital, Dhaka

Introduction: Total laryngectomy is the gold standard treatment for advanced laryngeal cancer. Sacrifice of voice is one of the most important shortcomings of the procedure. Possibility of achieving good quality voice is greater with prosthesis compared to other method. Post laryngectomy voice rehabilitation with prosthesis yield excellent outcome in most of the cases. Swallowing, pulmonary and olfactory rehabilitation should be managed by multidisciplinary team for better quality of life (QoL).&#x0D; Objectives: The purpose of this study was to observe the outcomes of voice, swallowing pulmonary and olfactory rehabilitation and QoL following total laryngectomy.&#x0D; Methods: This cross sectional retrospective clinical study was conducted at the Head &amp; Neck Oncology Unit, Combined Military Hospital (CMH), Dhaka. Total 57 candidates were selected. Diagnosis was done by thorough clinical examination, Fibre Optic Laryngoscopy. Contrast Enhanced Computed Tomography (CECT) scan of neck was done except few cases where MRI of neck was done for subtle cartilage erosion was suspected. Examination under anaesthesia, direct larangoscopy and biopsy was done for every cases. Candidates were post chemo-radiated/ radiated biopsy proven recurrent cases, clinically nonfunctional larynx with aspiration and radiologically evident of cartilage erosion. In all cases artificial voice prosthesis was used. All the laryngectomees underwent voice, swallowing, pulmonary and olfactory rehabilitation in laryngectomy club of head &amp; neck oncology unit, CMH Dhaka for a period of 3 months as per standard protocol.&#x0D; Results: Among the 57 patients 42 of them are using voice prosthesis without any complications till to date. Voice rehabilitation started after wound healing &amp; developed meaningful voice in around 6 weeks. Satisfactory speech &amp; voice outcomes were observed near about 3 months. Voice quality was assessed by multivariate statistical analysis. Excellent voice was observed for 38 patients, good voice for 12 patients, fair voice for 05 patients and poor voice for 02 patients. Troubleshooting like mycotic infection developed in 6 patients which was managed by anti-fungal medication with regular appropriate cleaning, Pharyngocutaneous fistula developed in 5 patients, 3 healed later by pressure dressing and anticholinergic &amp; 1 required exploration and flap reconstruction, 01 developed recurrent stomal stenosis which managed surgically by Y-V advancement. Prosthesis expelled out in 3 cases. 02 cases developed dysphagia due to tonicity of pharyngoesophageal (PE) segment &amp; managed by botox injection. Significantly better voice &amp; swallowing were reported by patients undergone laryngectomy alone in comparison with patients receiving adjuvant radiotherapy &amp; patient undergoing salvage laryngectomy.&#x0D; Conclusion: Awareness should be developed as sacrifice of voice box is no more a permanent comorbidity of total laryngectomy. Excellent voice can be developed by insertion of voice prosthesis as well as swallowing pulmonary and olfactory rehabilitation following laryngectomy for better of QoL.&#x0D; Bangladesh J Otorhinolaryngol; April 2021; 27(1): 5-11

Mapping the periapex anatomical pattern of teeth involved in sodium hypochlorite accidents: a cross-sectional quasi-experimental study.

To determine the anatomical reasons for sodium hypochlorite (NaOCl) accidents by testing whether this mishap is likely to occur in cases where the anatomical apex of the teeth fenestrates the overlying buccal cortical alveolar bone, allowing NaOCl to gain direct access to buccal soft tissues. Following a cross-sectional, nonrandomized design, 13 patients who suffered unintentional NaOCl accidents whilst undergoing root canal treatment were included. After remission of symptoms, the root canals were fully irrigated with an innocuous radiopaque solution (saline diluted Claritrast 300) and subsequently CBCT scanned to create a 3D-map of the periapex and tracking of the irrigant pathway throughout the periapical tissues. An extra group of five control patients, who underwent root canal treatment with no NaOCl accident, was also CBCT-scanned after irrigation with the tracking radiopaque solution. The anatomical relationship of the cortical bone and the root apex, as well as the distribution of irrigation solution in the periapical tissue, was associated with patients undergoing a NaOCl accident or not, using a Fisher's exact test. The frequency of teeth with apical cortical fenestration was significantly higher in the NaOCl accident-positive group, compared to the negative (P<0.001). All 13 accident-positive patients had an anatomical apex in direct contact with the buccal soft tissue via fenestration of the overlying cortical bone and direct contact of the foramen with the soft tissues. The radiopaque solution was distributed in the soft tissue in these cases. In contrast, accident-negative patients had no fenestration of the buccal cortical bone and the anatomical root apex was within the cancellous bone or within a bone-confined periapical lesion. The radiopaque solution was also found in the cancellous bone or the periapical lesion, but patients had no manifestations of a NaOCl accident. This quasi-experimental cross-sectional clinical study suggests that, in addition to the presence of the extruded NaOCl solution, a patent foramen that fenestrates the cortical bone merging into the mucosal tissue might constitute a risk for the clinical manifestation of a NaOCl accident. Preoperative 3D scans aid in anticipating when an accident is likely to occur.

Hospital workforce mental reaction to the pandemic in a low COVID-19 burden setting: a cross-sectional clinical study.

Τhe COVID-19 pandemic has mental health implications for both healthcare workforces and general population, particularly in regions heavily hit by the crisis. Τhe study aimed (i) to investigate anxiety- and depression severity differences between staff of a COVID-19 treatment unit (N = 84) and a hospital without such a unit (N = 55) in comparison to participants of a convenience general population online survey (N = 240) and (ii) to explore relations between such symptoms and hospital staff reaction to COVID-19 in a low COVID-19 burden setting. Anxiety was studied with the Generalized Anxiety Disorder 7-Item in hospital workforces and with the Hospital Anxiety Depression Scale (HADS) in online survey participants. Depression symptoms were assessed with the Patient Health Questionnaire-9 in hospital employees and the HADS in the online survey sample. Symptoms were classified as absent/minimal, borderline abnormal or indicating clinical caseness. Staff reaction to COVID-19 was tapped with a 9-item-questionnaire and the 22-item Impact of Event Scale-revised (IES-R). Proper tests for differences and stepwise ordered logistic regression models were employed. Anxiety- and depression severity was higher in hospital workforces than in online survey participants (P < 0.05). Anxiety was more severe in frontline- compared to backstage employees (P < 0.001) was inversely correlated with age (P = 0.011) and positively with avoidance (P = 0.028). Both anxiety and depression symptoms related to intrusion symptoms (P < 0.001). Regarding the relatively long data collection period, an inverse association between crisis duration and depression symptoms was detected (P = 0.025). These observations point to the urgent need for distress-mitigating interventions for hospital workforces even in low COVID-19 burden settings.