Differences In Clinical Parameters Research Articles

Does Adding TENS to Pelvic Floor Rehabilitation Effect on Urodynamics and Clinical Results in Children With Spina Bifida?

Children with spina bifida (SB) experience a reduced quality of life due to neurogenic bladder dysfunction and the risk of renal failure later in life. Pelvic floor rehabilitation (PFR) and transcutaneous electrical nerve stimulation (TENS) have gained prominence in recent years due to their positive effects in treating different types of bladder issues in both adults and children. Our study aims to investigate the effects of using these two methods together in children with SB and to delineate their potential value for clinical practice. Children with neurogenic bladder dysfunction due to SB who admitted to our spina bifida center were enrolled. Those patients, between 5 and 15 years of age, with only neurogenic detrusor overactivity (NDO) were randomly divided into two groups using an online computer application. While only the PFR was applied to Group PFR (n = 14), TENS was used in addition to this therapy in Group PFR + T (n = 14). The PFR sessions included abdominal massage, strength exercises, diaphragmatic breathing exercises, and contracting pelvic floor muscles. TENS was used in a standard fashion as previously described in patients with SB. Before and after treatment, patients' clinical data, dysfunctional voiding symptom score (DVSS), lower urinary tract symptoms, and quality of life scores due to urinary incontinence were evaluated. Urodynamic outcomes such as detrusor pressure, bladder capacity, contractility, and residual urine amount were also evaluated. Twenty eight children out of 750 SB patients were enrolled in our center. Children with only NDO due to SB were included in the study (Group PFR, mean age 8.3 ± + 2.7 years, 10 boys, four girls; Group PFR + T, 7.86 ± 2.03 years, eight boys, six girls). Treatment duration was 6 weeks (18 sessions). There was a decrease in voiding and lower urinary tract symptoms in both groups regardless of the use of TENS (p < 0.05). Maximum detrusor pressure significantly decreased only in the TENS group after treatment (from 82.143 ± 58.069 cmH2O to 58.077 ± 39.872 cmH2O) (p < 0.05). The difference in clinical parameters, quality of life scores and other urodynamic parameters were not found to be significant between groups. PFR and TENS may be effective in SB with NDO to reduce voiding symptoms, and protect bladder from increased pressures. PFR seems to be a useful conservative approach in patients with NDO, adjunt to standard treatment. Further studies are needed in delineation of a personalized holistic treatment approach in these patients. Addition of TENS to standard PFR in NDO may be effective in reducing maximum detrusor pressures, however, it does not seem to specifically contribute for improving incontinence and incontinence-related quality of life.

Validity of a Consumer-Based Wearable to Measure Clinical Parameters in Patients With Chronic Obstructive Pulmonary Disease and Healthy Controls: Observational Study.

Consumer-based wearables are becoming more popular and provide opportunities to track individual's clinical parameters remotely. However, literature about their criterion and known-groups validity is scarce. This study aimed to assess the validity of the Fitbit Charge 4, a wrist-worn consumer-based wearable, to measure clinical parameters (ie, daily step count, resting heart rate [RHR], heart rate variability [HRV], respiratory rate [RR], and oxygen saturation) in patients with chronic obstructive pulmonary disease (COPD) and healthy controls in free-living conditions in Belgium by comparing it with medical-grade devices. Participants wore the Fitbit Charge 4 along with three medical-grade devices: (1) Dynaport MoveMonitor for 7 days, retrieving daily step count; (2) Polar H10 for 5 days, retrieving RHR, HRV, and RR; and (3) Nonin WristOX2 3150 for 4 nights, retrieving oxygen saturation. Criterion validity was assessed by investigating the agreement between day-by-day measures of the Fitbit Charge 4 and the corresponding reference devices. Known-groups validity was assessed by comparing patients with COPD and healthy controls. Data of 30 patients with COPD and 25 age- and gender-matched healthy controls resulted in good agreement between the Fitbit Charge 4 and the corresponding reference device for measuring daily step count (intraclass correlation coefficient [ICC2,1]=0.79 and ICC2,1=0.85, respectively), RHR (ICC2,1=0.80 and ICC2,1=0.79, respectively), and RR (ICC2,1=0.84 and ICC2,1=0.77, respectively). The agreement for HRV was moderate (healthy controls: ICC2,1=0.69) to strong (COPD: ICC2,1=0.87). The agreement in measuring oxygen saturation in patients with COPD was poor (ICC2,1=0.32). The Fitbit device overestimated the daily step count and underestimated HRV in both groups. While RHR and RR were overestimated in healthy controls, no difference was observed in patients with COPD. Oxygen saturation was overestimated in patients with COPD. The Fitbit Charge 4 detected significant differences in daily step count, RHR, and RR between patients with COPD and healthy controls, similar to those identified by the reference devices, supporting known-groups validity. Although the Fitbit Charge 4 shows mainly moderate to good agreement, measures of clinical parameters deviated from the reference devices, indicating that monitoring patients remotely and interpreting parameters requires caution. Differences in clinical parameters between patients with COPD and healthy controls that were measured by the reference devices were all detected by the Fitbit Charge 4.

Efficacy of balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary disease and exercise pulmonary hypertension

BackgroundThe efficacy of balloon pulmonary angioplasty (BPA) in patients with chronic thromboembolic disease (CTEPD) without pulmonary hypertension (PH) remains unknown. Exercise PH (Ex-PH) is associated with impaired exercise capacity, even when pulmonary hemodynamics are normal at rest. We hypothesized that patients with Ex-PH could be the candidates for BPA. This study aimed to determine the prevalence and clinical profiles of Ex-PH and the effect of BPA on oxygenation and Ex-PH in patients with CTEPD and mean pulmonary arterial pressure (mPAP) ≤ 20 mmHg. MethodsWe retrospectively reviewed 23 patients (median age 65 years) with CTEPD and mPAP ≤20 mmHg at rest who underwent cardiopulmonary exercise testing with right heart catheterization. Patients were divided into two groups: Ex-PH, defined by an mPAP/cardiac output (CO) slope (mPAP/CO slope) > 3.0, and non-Ex-PH. ResultsOverall, 12 and 11 patients were identified as Ex-PH and non-Ex-PH groups, respectively. There were no significant differences in clinical parameters, including hemodynamics at rest, and blood gas analysis between Ex-PH and non-Ex-PH groups. Among 9 patients with Ex-PH, BPA improved World Health Organization-functional class and PaO2 at rest and was associated with a decrease in the mPAP/CO slope. All 3 patients discontinued LTOT after BPA. There were no significant complications during each BPA session. ConclusionsEx-PH was common among patients with CTEPD without PH. BPA could improve symptoms, oxygenation, and exercising hemodynamics in patients with CTEPD and Ex-PH.

Laparoscopic enucleation of tumors embedded in the pancreatic head: Safety and feasibility

BackgroundSurgical treatment for a benign or low-grade malignant tumor in the pancreatic head remains a challenge at present. As an organ-sparing procedure, enucleation is ideal. However, it is still controversial whether laparoscopic enucleation (LapEN) can be safely performed for a pancreatic head tumor, especially a deeply embedded one. MethodsThe cases who underwent LapEN of a pancreatic tumor from January 2014 to September 2022 in our hospital were collected and analyzed. ResultsA total of 151 cases were collected. The incidence of pancreatic fistula (PF, grade B) was 21.9%. No patient developed PF (grade C) or died. Compared with enucleating a tumor in the distal pancreas (N = 98), enucleating a tumor in the pancreatic head (N = 53) showed a longer operation time and a higher incidence of conversion. The cases with a tumor in the pancreatic head were then divided into the group with a deeply embedded tumor (N = 32) and the group with a superficial tumor (N = 21). The embedded group had a smaller tumor size and a higher proportion of insulinoma. There were no statistical differences in the parameters of operation time, blood loss and incidence of complications between the two groups. The outcomes of enucleating a tumor deeply embedded in the proximal and distal pancreas were further analyzed, which indicated no statistical differences in clinical parameters between the two groups. ConclusionLapEN of a tumor in the pancreatic head is feasible and safe, even for a deeply embedded tumor.

APOBEC family reshapes the immune microenvironment and therapy sensitivity in clear cell renal cell carcinoma

Emerging evidence suggests that the APOBEC family is implicated in multiple cancers and might be utilized as a new target for cancer detection and treatment. However, the dysregulation and clinical implication of the APOBEC family in clear cell renal cell cancer (ccRCC) remain elusive. TCGA multiomics data facilitated a comprehensive exploration of the APOBEC family across cancers, including ccRCC. Remodeling analysis classified ccRCC patients into two distinct subgroups: APOBEC family pattern cancer subtype 1 (APCS1) and subtype 2 (APCS2). The study investigated differences in clinical parameters, tumor immune microenvironment, therapeutic responsiveness, and genomic mutation landscapes between these subtypes. An APOBEC family-related risk model was developed and validated for predicting ccRCC patient prognosis, demonstrating good sensitivity and specificity. Finally, the overview of APOBEC3B function was investigated in multiple cancers and verified in clinical samples. APCS1 and APCS2 demonstrated considerably distinct clinical features and biological processes in ccRCC. APCS1, an aggressive subtype, has advanced clinical stage and a poor prognosis. APCS1 exhibited an oncogenic and metabolically active phenotype. APCS1 also exhibited a greater tumor mutation load and immunocompromised condition, resulting in immunological dysfunction and immune checkpoint treatment resistance. The genomic copy number variation of APCS1, including arm gain and loss, was much more than that of APCS2, which may help explain the tired immune system. Furthermore, the two subtypes have distinct drug sensitivity patterns in clinical specimens and matching cell lines. Finally, we developed a predictive risk model based on subtype biomarkers that performed well for ccRCC patients and validated the clinical impact of APOBEC3B. Aberrant APOBEC family expression patterns might modify the tumor immune microenvironment by increasing the genome mutation frequency, thus inducing an immune-exhausted phenotype. APOBEC family-based molecular subtypes could strengthen the understanding of ccRCC characterization and guide clinical treatment. Targeting APOBEC3B may be regarded as a new therapeutic target for ccRCC.

Genotype–Phenotype Correlations in 83 Korean X-linked Retinoschisis Patients: Impact of Retinoschisin 1 Secretion Profiles on Clinical Phenotypes

To assess the correlation between genotype and phenotype severity in X-linked juvenile retinoschisis (XLRS) by examining clinical and genetic features of a cohort of Korean XLRS patients. Retrospective, observational study. Data from 83 consecutive male patients with molecularly confirmed XLRS were collected retrospectively. Clinical evaluation included best-corrected visual acuity (BCVA), fundus photography, spectral-domain optical coherence tomography (SD-OCT), and full-field electroretinography (ERG). The phenotypic characteristics of a cohort of pediatric Korean XLRS patients, based on mutation types (truncating versus missense) and secretory profile (secretion versus non-secretion), were assessed. One hundred sixty-six eyes of 83 patients were included. The mean age at diagnosis was 6.1 ± 8.8 years (range, 0.5-20.7 years), with a mean follow-up time of 9.2 ± 7.0 years (range, 0.6-24.3 years). The BCVA at first and last examination ranged from light perception to 0.1 logarithm of the minimum angle of resolution (mean ± SD, 0.75 ± 0.59 and 0.82 ± 0.65, respectively). There were no significant differences in the first and last BCVA measurements between the truncating (0.71 ± 0.51 and 0.75 ± 0.44) and missense (0.77 ± 0.59 and 0.84 ± 0.66) variants (P = 0.678 and 0.551, respectively). Additionally, there were no differences in clinical parameters from fundus photography, SD-OCT, and full-field ERG. However, the BCVA at the first and last measurement were better for patients in the secretion group (0.51 ± 0.24 and 0.61 ± 0.30) compared to patients in the non-secretion group (0.65 ± 0.71 and 0.87 ± 0.81). The last BCVA showed a statistically significant difference between the two groups (P = 0.021). In OCT findings, the frequency of ellipsoid zone disruption was higher in patients with non-secretion variants than those with secretion variants (P = 0.030), with no significant differences in other parameters. The secretion profile of RS1 could influence the severity of XLRS phenotypes. Patients with RS1-secreted mutants, particularly with intact octamerization, exhibit more homogeneous phenotypes and better visual acuity than the RS1-non-secreted group. This data provides insights for studying genotype and phenotype correlations in both clinical and research fields.

Evaluation and comparison of autologous particulate dentin with demineralized freeze dried bone allograft in ridge preservation procedures - a prospective clinical study.

To compare effectiveness of Autologous Particulate Dentin (APD) with Demineralized Freeze-Dried Bone Allograft (DFDBA) in ridge preservation, using radiographic and clinical parameters. Thirty subjects with indication of mandibular posterior teeth extraction were randomly assigned to either test or control group. After atraumatic extraction, ridge preservation was performed using APD or DFDBA mixed with i-PRF in test and control groups respectively. Both groups had sockets sealed with A-PRF membrane. Clinical parameters (plaque, gingival and healing indices) and radiographic parameters (vertical ridge height, horizontal ridge width) were assessed at baseline and 6 months using CBCT. Statistical analysis was performed using an independent t-test to compare clinical and radiographic parameters between the groups. Both groups had significant decreases in ridge dimensions over 6 months (p < 0.001). The test group showed less reduction in ridge dimensions than control group at 6 months (p < 0.001). Mean change in vertical height was not significant (1.37 ± 1.32, 1.7311 ± 0.563), but in horizontal ridge width (1.3120 ± 1.13, 1.8093 ± 1.16) was significantly different between test and control groups respectively. There was no statistical difference in clinical parameters between the groups at 6 months (p > 0.001). APD grafts resulted in significant improvements in radiographic parameters, specifically in vertical ridge height and horizontal ridge width, compared to DFDBA group. Autologous particulate dentin is a promising, versatile substitute for regenerative procedures. While more research on its long-term efficacy and application is needed, current evidence suggests it could significantly improve patient care and outcomes.

Surgical technique for preventing lymphatic complications during robot-assisted radical prostatectomy

Introduction. Radical prostatectomy (RP) stands the gold standard method of treatment for localised prostate cancer. Pelvic lymph node dissection (PLND) is a common surgical procedure that can be used for both diagnostic and therapeutic purposes. Lymphocele is the most common complication after robot-assisted radical prostatectomy (RARP) and PLND.Objective. To develop a surgical technique aimed at reducing the incidence of lymphocele in patients who underwent RARP with TL and to evaluate its efficacy and safety.Materials &amp; methods. The study included 49 patients who underwent RARP and PLND. The patients were divided into 2 groups: group 1 — patients with free peritoneal flap fixed to the pubic bone after RARP and PLND (n = 25) and group 2 — control group «without peritoneal flap fixation» (n = 24). The average follow-up period was 3 months.Results. No significant differences in clinical parameters were observed between the groups in perioperative period. In postoperative period lymphocele was diagnosed in 5 (10.2%) patients: group 1 — 1 (4%) patients, group 2 — 4 (16.7%). There were no significant differences in lymphocele volume between the groups. In group 1 lymphocele had no clinical manifestation. Symptomatic lymphocele was diagnosed in 1 patient (4.2%) from the control group.Conclusion. The surgical technique of a free peritoneal flap fixation to the pubic bone combined with PLND after RARP may reduce the incidence of lymphocele if compared to the standard technique.

Association between specific IgE to staphylococcal enterotoxin B and the eosinophilic phenotype of asthma.

Sensitization to staphylococcal superantigens (SAgs) could contribute to asthma severity. However, its relevance with eosinophilic phenotype has not yet been clarified. This study aimed to investigate associations between serum specific IgE levels to SAg and eosinophilic airway inflammation in adult asthmatics. The serum specific IgE levels to 3 SAgs, including staphylococcal enterotoxin A (SEA) and B (SEB), and toxic shock syndrome toxin-1 (TSST-1) were measured by ImmunoCAP in 230 adult asthmatic patients and 50 healthy controls (HCs). Clinical characteristics and laboratory parameters, including serum total/free IgE, and 2 eosinophil-activation markers, eosinophil cationic protein (ECP), and eosinophil-derived neurotoxin (EDN), were analyzed according to blood eosinophil counts (BEC; 150 cells/μL) and serum specific IgE levels to 3 SAgs (0.35 kU/L). Asthmatic patients showed higher serum specific IgE levels to 3 SAgs than HCs (p < 0.05 for all). The serum total/clinfree IgE levels were significantly higher in asthmatics with positive IgE responses to 3 SAgs than those without (p < 0.05 for all). There were no significant differences in clinical parameters including age, asthma severity, comorbidities, or smoking according to IgE responses to 3 SAgs. Patients with positive IgE responses to SEB (not to SEA/TSST-1) had higher serum specific IgE levels to house dust mites and ECP/EDN as well as higher BEC with positive correlations between serum SEB-specific IgE levels and BEC/ECP/EDN (p < 0.05 for all). These findings suggest that serum SEB-specific IgE levels could contribute to eosinophil activation as well as IgE production in adult asthma.

No difference in clinical parameters and drug retention in PsA patients receiving b/tsDMARD monotherapy versus combination with methotrexate: data from the RABBIT-SpA registry

BackgroundThe potential benefit of methotrexate (MTX) in combination with biologic (b) and targeted synthetic (ts) disease modifying anti-rheumatic drugs (DMARDs) in psoriatic arthritis (PsA) is still a matter of debate.ObjectivesTo...

Enhancing Clinical Outcomes and Quality of Life in Acute Myocardial Infarction Patients Through Standard Clinical Pathway Implementation: A Study From a Public Tertiary Care Hospital in Karachi, Pakistan

Objectives: This study aimed to assess and compare the impact of implementing a standard clinical pathway on clinical outcomes and quality of life among Acute Myocardial Infarction (AMI) patients at Dr. Ruth Katherina Martha Pfau Civil Hospital in Karachi, Pakistan. Methodology: A quasi-experimental non-randomized controlled study was conducted from September to December 2018, involving 220 AMI patients. The control group (110) received standard care, while the interventional group (110) was managed using a standardized clinical pathway. Data was collected using the AMI standard clinical pathway tool and the SF-36 questionnaire. Statistical analysis was performed using SPSS version 22, presenting categorical variables as frequencies and percentages, and continuous variables as mean and standard deviation. Mean differences in clinical parameters and quality of life were assessed using paired sample t-tests with a significance level set at p &lt; 0.05. Results: Among the participants, 50% were in the control group and 50% in the interventional group, with a predominance of males. The quality-of-life scores significantly differed between the control and intervention groups (p &lt; 0.001). Furthermore, significant improvements in quality of life were observed in both male and female patients’ post-intervention (p &lt; 0.001). Conclusion: Implementation of a standard clinical pathway led to improved clinical outcomes and quality of life among AMI patients. This highlights the potential benefits of standardized care pathways in enhancing patient outcomes in similar healthcare settings.

Evaluating breast ultrasonography as a complementary diagnostic method in girls with central precocious puberty.

Assessment of breast development by physical examination can be difficult in the early stages and in overweight girls. To investigate ultrasonography (US) for evaluation of early breast development. In a prospective study, 125 girls (age 7.1 ± 1.5years) with breast development before 8years underwent US breast staging, breast volume, and elastography, in addition to clinical/hormonal evaluation for precocious puberty. Accuracy of US for determining breast development and predicting progression to central precocious puberty was investigated. Physical examination revealed glandular breast enlargement in 100 and predominantly lipomastia in 25. Breast US in the former confirmed glandular breast development in 92 (group 1, physical examination and US positive), but not in 8 (group 2, physical examination positive, US negative). Comparison of the two groups demonstrated lower Tanner and US staging, bone age/chronological age, basal luteinizing hormone (LH), breast volume, and uterine volume in group 2. In the 25 lipomastia patients, US demonstrated no breast tissue in 19 (group 3, physical examination and US negative), but US stage ≥ II in 6 (group 4, physical examination negative, US positive) without differences in clinical parameters. After follow-up of 19.8 ± 4.2months, 46/125 subjects were diagnosed with precocious puberty. US stage, total breast volume, and shear-wave speeds were significantly higher in these 46 patients. Multivariate analyses demonstrated breast volume > 3.4cc had odds ratio of 11.0, sensitivity of 62%, and specificity of 89, in predicting progression to precocious puberty, being second only to stimulated LH for all variables. Breast US is a useful predictive tool for diagnosis of precocious puberty in girls. Higher US stages and higher breast volume on US increased the likelihood of eventual diagnosis of precocious puberty.

Efficacy and tolerability of oral semaglutide in Japanese patients with type 2 diabetes mellitus: Analysis report from diabetes specialist clinics.

Glucagon-like peptide 1 receptor agonists (GLP1Ras) have emerged as pivotal agents in diabetes management and organ protection. However, their use is limited due to the necessity for injectable administration. The advent of the first oral GLP1Ra (oral semaglutide) in Japan since 2021 is expected to expand its usage. The aim of this study is to survey the efficacy and tolerability of oral semaglutide in clinical practice. We retrospectively analyzed 120 outpatients diagnosed with type 2 diabetes mellitus who had received oral semaglutide for >6 months. Changes in clinical parameters during oral semaglutide treatment from baseline to 12 months were analyzed. The inverse probability weighting method using the propensity score was used to evaluate the differences in clinical parameters at 6 months after treatment, based on the patients' obesity levels. Body weight (BW), glycated hemoglobin A1c (HbA1c), and alanine aminotransferase (ALT) levels at baseline decreased significantly after treatment compared with those at 12 months (P < 0.001, P < 0.001, and P = 0.03, respectively). The patients were divided into two groups using a cutoff baseline body mass index (BMI) of 30.3 kg/m2. Although no significant difference was observed, changes in body weight and HbA1c indicated a potentially greater decrease in the BMI ≧ 30.3 group than that in the BMI < 30.3 group (P = 0.07 and 0.13, respectively). Among 206 registered patients, 25 (12.1%) discontinued oral-semaglutide treatment owing to adverse effects, including gastrointestinal symptoms. Oral semaglutide treatment demonstrates efficacy and tolerability for managing type 2 diabetes mellitus in Japan. Significant improvements in metabolic factors induced by oral semaglutide are anticipated, particularly in obese patients.

Predictive value of left ventricular global longitudinal peak strain for the prognosis of septic patients

To investigate the predictive value of left ventricular global longitudinal peak strain (GLPS) for the prognosis of septic patients. A prospective cohort study was conducted. Patients diagnosed with sepsis and admitted to the intensive care unit (ICU) of the First Affiliated Hospital, Sun Yat-sen University from December 2018 to November 2019 were enrolled. The patient characteristics, cardiac ultrasound parameters [left ventricular ejection fraction (LVEF), right ventricular ejection fraction (RVEF), four-dimensional ejection fraction (4DEF), GLPS] and cardiac biomarkers [N-terminal pro-brain natriuretic peptide (NT-proBNP), cardiac troponin T (cTnT)] within 24 hours of ICU admission, organ support therapies, severity of illness, and prognostic indicators were documented. The differences in clinical parameters between patients with varying outcomes during ICU hospitalization were assessed. Pearson correlation analysis was employed to explore the correlation between GLPS and other cardiac systolic parameters, as well as the associations between various cardiac systolic parameters and sequential organ failure assessment (SOFA) score. Receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive capacity of cardiac ultrasound parameters and cardiac biomarkers for death during ICU hospitalization in septic patients. A total of 50 septic patients were enrolled, with 40 surviving and 10 dying during ICU hospitalization, resulting in a mortality of 20.0%. All patients in the death group were male. Compared with the survival group, the patients in the death group were older, had a higher prevalence of diabetes mellitus, and received continuous renal replacement therapy (CRRT) more frequently, additionally, they exhibited more severe illness and had longer length of ICU stay. The levels of GLPS and cTnT in the death group were significantly elevated as compared with the survival group [GLPS: -7.1% (-8.5%, -7.0%) vs. -12.1% (-15.5%, -10.4%), cTnT (μg/L): 0.07 (0.05, 0.08) vs. 0.03 (0.02, 0.13), both P < 0.05]. However, no statistically significant difference was found in other cardiac ultrasound parameters or cardiac biomarkers between the two groups. Pearson correlation analysis revealed a negative correlation between GLPS and LVEF (r = -0.377, P = 0.014) and 4DEF (r = -0.697, P = 0.000), while no correlation was found with RVEF (r = -0.451, P = 0.069). GLPS demonstrated a positive correlation with SOFA score (r = 0.306, P = 0.033), while LVEF (r = 0.112, P = 0.481), RVEF (r = -0.134, P = 0.595), and 4DEF (r = -0.251, P = 0.259) showed no significant correlation with SOFA score. ROC curve analysis indicated that the area under the ROC curve (AUC) of GLPS for predicting death during ICU hospitalization in septic patients was higher than other cardiac systolic parameters, including LVEF, RVEF, and 4DEF, as well as cardiac biomarkers NT-proBNP and cTnT (0.737 vs. 0.628, 0.556, 0.659, 0.580 and 0.724). With an optimal cut-off value of -14.9% for GLPS, the sensitivity and negative predictive value reached to 100%. GLPS < -14.9% within 24 hours of ICU admission in septic patients indicated a reduced risk of death risk during ICU hospitalization, while also correlating with the severity of organ dysfunction in this patient population.

Efficacy of Bovine-derived Xenograft and Minimally Invasive Surgical Technique in the Treatment of Human Periodontal Intrabony Defects - A Systematic Review and Meta-analysis

ABSTRACT Aim: The aim of this study was to evaluate the efficacy of minimally invasive surgical technique (MIST) with the use of bovine-derived xenograft (BDX) in the treatment of intrabony defects. Materials and Methods: An electronic search using PUBMED, Google Scholar, Google, Clinical Trials Registry, and Web of Science and manual search using Dr. D. Y. Patil Dental College library resources was conducted. Randomized controlled trials and case cohorts were included in this study. Case reports, reviews, and in vitro studies were excluded from the study. Meta-analysis was conducted to assess differences in clinical parameters (pocket probing depth, clinical attachment level, gingival recession) between MIST and MIST with BDX. Results: Both MIST alone and with xenograft showed statistically significant improvements in all the clinical and radiographic parameters. However, MIST alone showed marginally better improvement as compared to MIST with xenograft. Conclusions: MIST with or without BDX improves clinical, radiographic, and patient-related outcomes for treating intrabony defects. The improvement in the outcomes of MIST alone is found to be comparatively similar when used along with BDX suggesting that the benefits of MIST are not improved by xenograft.

Antifibrotic drug treatment of patients with idiopathic pulmonary fibrosis in Sweden: A registry-based observational study.

Idiopathic pulmonary fibrosis (IPF) is characterized by progressive fibrosis of the lung parenchyma, resulting in respiratory failure. This study analysed differences in patient characteristics and antifibrotic treatment strategies during the first years after IPF diagnosis. Data from patients with IPF was extracted from the Swedish IPF registry. Patients were defined as treated (either as fully- or reduced treated) or non-treated with antifibrotic drugs. Differences in clinical parameters and side effects were defined. Among 532 patients, 371 received treatment with antifibrotic drugs. Treated patients were younger, had worse lung function, higher body mass index (BMI), higher Gender-Age-Physiology stage, and were more often on oxygen treatment. Non-treated patients displayed a stable BMI, whereas patients treated with antifibrotics declined in BMI during follow-up. More than half (56%) of treated patients had reduced antifibrotic treatment. Sixty per cent reported side effects, with diarrhoea, nausea, and skin rash as the most common. Patients prescribed antifibrotic treatment had more advanced disease compared to patients not prescribed antifibrotics. A considerable proportion of the patients had reduced treatment, probably due to more side effects in this group. This indicates that individuals starting treatment at IPF diagnosis are considered to be in greater need of antifibrotic drug treatment by the prescriber, compared to individuals with less severe disease.

Systemic Melatonin Supplementation as an Adjunct to Non-Surgical Periodontal Treatment in Obese Patients with Periodontitis

Background: Obesity is considered an important risk factor for periodontal disease. It has been reported that reactive oxygen species linking both diseases, systemic melatonin supplementation as antioxidant therapy, was addressed as an adjuvant to scaling and root surface debridement (SRP) to enhance the treatment of periodontitis. Objective: To investigate the efficacy of systemic melatonin administration in periodontitis-obese patients as an adjuvant to scaling and root surface debridement (SRP). Methods: A randomized clinical trial was conducted at a dental-specialized center. Eighty subjects were included and allocated into group-I: twenty periodontium-healthy, normal-weight people; group-II: 30 obese patients with stage-III treated only with SRP; and group-III: 30 obese patients with stage-III periodontitis treated with SRP and 5mg melatonin. periodontitis and subjected to estimation, serum levels of Receptor Activator of Nuclear Factor-Kappa B Ligand (RANKL) were estimated in all groups. Probing pocket depth (PPD), bleeding on probing (BOP), and relative attachment level (RAL) were estimated in Groups II and III at baseline and after a one-month visit. Results: RANKL baseline visits were significantly different between the control and studied groups, with no significant difference in clinical parameters except for PPD. The 2nd visit showed a significant difference in BOP score-1 compared to RAL and BOP score 0. In the second visit, only weak negative and positive significant correlations were found between RANKL and BOP. Conclusion: Daily use of 5 mg of melatonin improves periodontal parameters and decreases serum RANKL levels.

The 6-minute walk test and fall risk in patients with heart failure: A cross-sectional study

BackgroundGiven the increased risk of falls in patients with heart failure (HF), there is limited information in the literature about the possible relationship between fall risk and functional capacity. ObjectiveTo investigate the relationship between functional capacity and fall risk in patients with HF and to determine whether there are differences in clinical parameters between patients with and without fall risk. MethodsThe study included 64 patients with HF. The Activity-Specific Balance Confidence Scale (ABC) determined the fall risk. Functional capacity was assessed with the 6-minute walk test (6MWT). The Berg Balance Scale (BBS), the timed up-and-go test (TUG), and the five times sit-to-stand (5-STS) test were used to evaluate functional balance and mobility. Comorbidities and dyspnea perception were assessed with the Charlson Comorbidity Index (CCI) and modified Medical Research Council (mMRC), respectively. ResultsThe 6MWT was associated with fall risk in logistic regression with an odds ratio of 0.979 (0.970–0.989, p < 0.001). Furthermore, the 6MWT had a discriminative value for increased fall risk in patients with HF, with a cutoff value of 248 m. Patients with increased fall risk had lower 6MWT distance, BBS, and gait speed, and higher CCI and mMRC, number of falls, duration of TUG and 5STS compared to patients with no increased fall risk (p < 0.05). ConclusionsThe study results demonstrated that 6MWT may be a clinically useful tool in quickly identifying potential balance problems and increased fall risk by providing insight into fall risk/balance confidence in addition to assessing functional capacity.

Relationship of Serum Vitamin D Levels With Diabetic Foot in Patients With Type 2 Diabetes Mellitus: A Cross-Sectional Study.

Background and aims: Diabetic foot is one of the most severe complications in patients with diabetes mellitus and has been linked to 25-OH-vitamin D status. This study aims to determine the prevalence of 25-OH-vitamin D deficiency and its association with diabetic foot. Methods: Patients with type 2 diabetes mellitus were enrolled in this study. The patients were divided into the diabetic foot group (n = 95) and the non-diabetic foot group (n = 388). Weight, height, and waist circumference were measured. The 25-OH-vitamin D and the other biochemical tests were extracted from the electronic medical records. The difference in clinical parameters between the diabetic foot group and the non-diabetic foot group was analyzed, and the risk factors of the diabetic foot group were analyzed using logistic regression. Results: The prevalence of 25-OH-vitamin D deficiency was 44.6%, accounting for 57.9% of all the diabetic foot group patients and only 41.0% of the non-diabetic foot group patients. The mean serum 25-OH-vitamin D level was significantly different between the diabetic foot group and the non-diabetic foot group (19.8 ± 9.5 vs 24.1 ± 11.8; P = .011). Serum 25-OH-vitamin D and B12 were found to have a significant positive correlation (r = 0.410, P = <.01). The 25-OH-vitamin D level and body mass index were independently associated with diabetic foot (P = .043, OR = 1.21; P = .009, OR = 1.47), respectively. Conclusions: The 25-OH-vitamin D deficiency was higher in the diabetic foot group. More research is needed to understand the role of 25-OH-vitamin D in the development of diabetic foot.

Estimating the salivary levels of IL-35 in smokers with periodontitis: A cross sectional study

BackgroundA refined network and integrated host immune response to bacteria are formed by anti-inflammatory cytokines and the cells that they are associated to IL-35 has been recognized as having strong suppressive activity in chronic inflammatory diseases, together with IL-10 and TGF-β. It is believed that inflammatory diseases like periodontitis trigger the inducible Treg population to express IL-35, expanding regulatory responses by increasing infection. AimThe objective is to estimate and compare the salivary IL-35 levels in Periodontally healthy subjects, smokers and non-smokers with Periodontitis in order to educate on the consequences of periodontal health among the diseased patients. Materials and MethodsTotally 42 subjects were included and they were categorized into Group 1 (n = 14) as Periodontally healthy subjects, Group 2 (n = 14) as systemically healthy non-Smokers with periodontitis and Group 3 (n = 14) as systemically healthy smokers with periodontitis. Each subject was assessed for clinical parameters such as Plaque index, Gingival index, Probing depth, clinical attachment. A polypropylene tube was used to collect unstimulated saliva and centrifuged it at 800 × g for 10 min. Supernatants were collected and stored at −80◦C. A commercially available enzyme-linked immunosorbent assay kit was used to analyse levels of human salivary IL-35. ResultsThe average age of the subjects in Group 1, Group 2 and Group 3 were 50.53, 52.93 and 52.07 years respectively. All three groups showed a statistically significant difference in clinical parameters including Plaque index, Gingival index, Probing depth and clinical attachment. The salivary IL-35 level was found to be elevated in non-smokers who have periodontitis compared to smokers with periodontitis and healthy individuals. Despite this, the salivary IL-35 levels were found to be statistically significant among three groups at P < 0.001. ConclusionThe salivary levels of IL-35 were found to increase in Periodontitis patients with/without smoking, along with increased clinical parameters. IL-35 is considered a influential biomarker for periodontal disease.