Males Mean Age Research Articles

Provision of bystander CPR for out-of-hospital cardiac arrest in the Middle East: a retrospective gender-based analysis

BackgroundPrevious studies conducted in North America, Europe, and East Asia (Liu et al., EClinicalMedicine 44:101293, 2022; Matsui et al., JAMA Netw Open 2:e195111, 2019; Awad et al., J Am Coll Emerg Physicians Open 4:e12957, 2023; Yoon et al., Prehosp Emerg Care :1–7, 2022) reported gender disparities in the provision of bystander CPR for patients with out-of-hospital cardiac arrest (OHCA). However, it remains unknown whether similar disparities exist in the Middle Eastern and Gulf regions. The primary objective of this study is to evaluate gender differences in the provision of bystander CPR for patients with OHCA in Qatar.MethodsRetrospective analysis of data obtained from Hamad Medical Corporation OHCA registry in the State of Qatar (2016–2022). We included adults with non-traumatic and EMS-attended OHCA. We used multilevel logistic regression to examine the association between gender and provision of bystander CPR.ResultsIn total, 4283 patients were included. Of those, 3414 (79.7%) were males, 1639 (38.3%) arrested in public locations, and 1463 (34.2%) received bystander CPR. Unadjusted comparisons showed that females were significantly older than males (mean age: 62.2 vs. 52.7). Females had a lower proportion of OHCA occurring in public locations (15.1% vs. 44.2%) and a lower proportion of shockable rhythm (11.9 vs. 27.5%). Regarding the outcome variable (provision of bystander CPR), the unadjusted analysis showed that the proportion of females who received bystander CPR was lower than that of males (29.2% vs. 35.4%, p < 0.001). However, after adjustment, we found no significant difference in provision of bystander CPR by gender (adjusted OR female vs. male 0.99, 95% CI 0.84–1.20, p = 0.97). In the subgroup who arrested in public locations, the analysis revealed females had greater odds of receiving bystander CPR (adjusted OR female vs. male 1.47, 95% CI 1.10–1.82, p = 0.04).ConclusionsOverall, bystander CPR was less common in female gender; after adjustment for other covariates, including arrest location, we found no significant gender differences in provision of bystander CPR. We also observed that females were found to have a lower incidence of cardiac arrest in public locations. Nevertheless, if females were to experience cardiac arrest in a public location, they would be more likely to receive CPR. Further research is required to explain the observed differences in provision of bystander CPR.

Radiation Dose in Coronary Angiogram: A Comparison of Radial and Femoral Approach

Background: Many clinical trials have demonstrated the benefit of trans-radial access (TRA) over trans-femoral access (TFA) in reducing mortality and bleeding events, but there is some concern about radiation exposure with radial access. Objective: To assess the difference in radiation exposure between radial and femoral approach as measured by dose-area product (DAP) and fluoroscopy time. Methods: This cross-sectional study was performed in patients aged 15 years and above who underwent invasive percutaneous coronary angiography at Ramathibodi Hospital between December 2019 and December 2020. Exclusion criteria included previous coronary artery bypass graft, unstable hemodynamic status during procedure, and changing the access site or using access sites other than femoral or radial arteries. Demographic data of patients was collected through medical records. DAP and fluoroscopy time of patients with radial and femoral approach were evaluated. Results: Of 427 patients (49.4% male wtih mean age of 65.7 years), 245 (57.4%) patients underwent TFA. There was no significant difference in the median DAP between the radial and femoral approach (radial 1838 mGy.cm2 vs femoral 1690.7 mGy.cm2, P = .31). However, the fluoroscopy time was significantly higher in radial approach group (radial 4.6 min vs femoral 3.3 min, P &lt; .001). Conclusions: The radiation exposure was not significantly different between trans-radial and trans-femoral coronary angiography.

Clinical Value of Endoscopic Esophageal Screening in Head and Neck Squamous Cell Carcinoma Patients.

To investigate the clinical benefit of routine esophageal screening in newly diagnosed head and neck squamous cell carcinoma (HNSCC) patients. Retrospective cohort study. Tertiary medical center. This retrospective study selected newly diagnosed HNSCC patients from the Chang Gung Research Database between January 2007 and December 2019. Patients who underwent endoscopic esophageal examinations within 2 months of the initial diagnosis of HNSCC were included in the screening group. The clinical outcomes of the screening and nonscreening groups were analyzed. In total, 13,627 HNSCC patients were included, comprising 1032 females and 12,640 males (mean age 55.0 years), and the esophageal screening group included 7033 (51.4%) patients. The prevalence rate of esophageal tumors was 4.5%. Hypopharyngeal cancer patients were the most likely to have (13.4%) second primary esophageal tumors. The American Joint Committee on Cancer stage of the esophageal tumor was lower in the esophageal screening group than in the nonesophageal screening group. The oral, oropharyngeal, and hypopharyngeal cancer patients in the esophageal screening group had better survival outcomes than their counterparts in the nonesophageal screening group. Endoscopic esophageal screening of newly diagnosed HNSCC patients can detect esophageal tumors at an early stage and improve overall survival. Esophageal screening could be a routine survey in HNSCC patients, particularly those with lifestyle risk factors and in countries with a high prevalence of esophageal cancer.

Fine particulate matter and sleep-disordered breathing severity in a large Italian cohort.

Air pollution and obstructive sleep apnea (OSA) are both linked with cardiovascular co-morbidities and share similar pathophysiological mechanisms. A causal association between the two has been postulated. However, the results of the studies on this topic are conflicting mainly because of the lack of adjustment for important confounders such as seasonality and temperature. We aimed to evaluate if such an association exists in a highly polluted area like Lombardy region (Italy) when accounting for all confounders. Data of adult patients seen at the Sleep Disorder Centre in Milan from 2010 to 2020 were analysed and the main polygraphic data were retrieved. Air pollutant concentrations of the following pollutants NO2, O3, PM2.5, and PM10 were collected through monitoring stations. A total of 3493 patients were included: males (2358, 67.5%) mean age 60.1 (SD = 14.3) years, BMI 29.2 (6.2) kg/m2, mean AHI 16.5 (18.1) events/h. After adjusting for all confounders, in the multivariable analysis, the only associations that remained significant were long-term exposure to O3 with indexes of OSA severity (AHI and ODI) but only in spring. Furthermore, a positive association was seen between long-term exposure to PM10 and ODI but in springtime only. The findings of the current study does not support an association between fine particulate matter and OSA severity.

Examination of the Effect of Somatotype Profiles on Athletic Performance Indicators in Children Aged 48-72 Months.

Physical fitness and anthropometric variables are crucial in achieving success in the field of sports. These variables serve as the foundation and platform for children to showcase their athletic abilities. The aim of this study is to examine the impact of somatotype profiles of children aged 48-72 months on athletic performance in order to contribute to talent selection. A total of 124 students (62 females, 62 males), aged between 48 and 72 months (mean age of females: 5.75±1.00, mean age of males: 5.68±1.15), participated in the study. Somatotype analysis was performed using the Heath-Carter method. Performance measurements of students included a 20-meter sprint test, flexibility, leg strength, push-up tests, crunches, vertical jump, standing long jump, hand strength, back strength, and hamstring length determination tests. In this study, there was a significant difference in favor of mesomorphic endomorph in crunches (F=3.914, p=0.013) and push-up (F=4.864, p=0.004) exercises for female children compared to all somatotypes. In male children, although the central group was dominant in athletic performance measurements, there was no statistically significant difference (p>0.05). Somatotype is a suitable method for enhancing athletic performance and directing individuals to the appropriate sports discipline. Somatotype profiles are not fully developed in children aged 48-72 months. In the later years, children with suitable somatotypes are expected to demonstrate improved athletic performance.

Anatomical and visual outcomes after vitreoretinal surgery in paediatric retinal detachment

Paediatric vitreoretinal surgery (PVRS) has unique set of challenges compared to surgery in adult eyes. An understanding of ocular growth and development is an important consideration in PVRS. Changes in ciliary body dimensions with age may affect how sclerotomies are placed, so as to avoid iatrogenic damage to the peripheral retina.To study the visual and anatomical outcomes after vitreoretinal surgery in paediatric age group after retinal detachment. In this prospective interventional study, 20 consecutive patients aged 18 years or younger undergoing vitreoretinal surgery for retinal detachment were included. A detailed ocular and systemic history was recorded from all patients. Pre and postoperative data were collected. All the evaluated eyes were followed up to 3 months. Outcome of surgery was measured in terms of improvement in visual acuity and retinal status.Twenty eyes of 20 patients were evaluated with male predominance (75%) and mean age of the patient was 16.4±2.01. Most common etiology was found to be trauma (65%) followed by myopia (30%). Pars plana vitrectomy (PPV) was done in 50% patients, lensectomy with vitrectomy was done in 15%, scleral buckle (SB) surgery was done in 25% cases, where as PPV-SB was done in 10% cases. Improvement in visual acuity was noted in 85% cases. Primary anatomical success was achieved in 80% cases. PPV was the major surgical procedure in our study due to complexity of RD. Postoperative visual rehabilitation was also done to fight amblyopia as far as possible.

269 Profiling frail patients assessed by the rapid access frailty team in the emergency Department of a Level 3 hospital

Abstract Background The Rapid Access Frailty Team (RAFT) in the Emergency Department (ED) currently consists of 2 physiotherapists. The aim of the team is to review frail patients presenting to the ED during core working hours. Key roles of the team include facilitating a safe discharge and providing early intervention to assist patient flow and a safer, more positive patient experience. Methods For the purpose of this study, frail patients were defined as those with a score of 4 or greater on the Clinical Frailty Scale (CFS). Data was manually recorded after each episode of care using data entry points including demographic details, interventions, outcome etc. Data was analysed from a 5 month period between January–May 2023. Results The RAFT Team reviewed an average of 100 patients per month. (Age range 44-98 yrs). 51% were over 75 years old. Gender distribution was not significantly different. 57% were female versus 43% male. The main presenting complaint of frail patients assessed by RAFT was falls. 69% of those reviewed were discharged. Approximately 36% of this group lived alone. 61% were female (Mean age 81y). 39% were males (Mean age 77y). CFS scores of those living alone ranged from 4–7. 37.5% of those reviewed had formal care in place at home. 10% of carers showed evidence of carer stress. 88% of patients had a falls assessment and equipment was provided to 65%. Physiotherapy (65%), Occupational Therapy (28%) and PHN were the most common community referrals required. 30% were referred to our Rapid Access Frailty Hub. Conclusion The number of frail patients presenting to our ED is growing. Increasing numbers of frail under 75yo patients are requiring RAFT input. Many frail patients continue to live at home alone. The RAFT team play a vital role in improving quality of care for this patient group and facilitate rapid, safe discharge home where possible.

The Relationship between Nocturnal Dipping Status, Morning Blood Pressure Surge, and Hospital Admissions in Patients with Systolic Heart Failure.

Hypertension is a known risk factor for developing heart failure. However, there is limited data to investigate the association between morning blood pressure surge (MBPS), dipping status, echocardiographic parameters, and hospital admissions in patients with systolic heart failure. To evaluate the relationship between morning blood pressure surge, non-dipper blood pressure pattern, echocardiographic parameters, and hospital admissions in patients with systolic heart failure. We retrospectively analyzed data from 206 consecutive patients with hypertension and a left ventricular ejection fraction below 40%. We divided the patients into two groups according to 24-hour ambulatory blood pressure monitoring (ABPM) results: dippers (n=110) and non-dippers (n=96). Morning blood pressure surge was calculated. Echocardiographic findings and hospital admissions during follow-up were noted. Statistical significance was defined as p < 0.05. The study group comprised 206 patients with a male predominance and mean age of 63.5 ± 16.1 years. The non-dipper group had significantly more hospital admissions compared to dippers. There was a positive correlation between MBPS and left atrial volume index (r=0.331, p=0.001), the ratio between early mitral inflow velocity and flow propagation velocity (r= 0.326, p=0.001), and the ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/Em) (r= 0.314, p=0.001). Non-dipper BP, MBPS, and E/Em pattern were found to be independently associated with increased hospital admissions. MBPS is associated with diastolic dysfunction and may be a sensitive predictor of hospital admission in patients with systolic heart failure.

Causes of Medical Admissions and Outcomes in a Tertiary Health Centre in Northeast Nigeria

Abstract Introduction: Knowledge of prevalent medical conditions in a community is necessary for effective and efficient health-care planning. In low- and middle-income countries, community studies are very costly; hence, hospital-based studies are often employed to give rough estimates of prevalent medical conditions. This study aims to evaluate the pattern of medical admission and outcome in a tertiary health centre in Northeast Nigeria as well as the contribution of noncommunicable diseases (NCDs) to the outcome. Materials and Methods: This is a four-year retrospective study of all admissions into the Medical wards of Abubakar Tafawa Balewa University Teaching Hospital. The case files of all patients admitted during the study period were retrieved and the following were extracted; demographic data, admitting diagnosis, comorbid conditions, length of hospital stay, and outcome. Results: During the period under review 1995 patients were admitted, with mean age of males and females of 52.28 ± 19.7 years and 49.3 ± 18.7 years, respectively. Infectious/parasitic diseases constituted 28.2% followed by diseases of the circulatory and digestive systems with 27.3% and 12.9%, respectively. NCDs constitute the highest number of patients admitted (n = 1405, 71%). Two hundred and ninety-five patients died during the period (14.7%) the highest in 2021 with 93 deaths. NCDs were responsible for 64% of the mortality, whereas death among the CD was 36%. Conclusion: NCDs were responsible for the majority of admissions and mortality during the study period.

The collateral map: prediction of lesion growth and penumbra after acute anterior circulation ischemic stroke

ObjectivesThis study evaluated the collateral map’s ability to predict lesion growth and penumbra after acute anterior circulation ischemic strokes.MethodsThis was a retrospective analysis of selected data from a prospectively collected database. The lesion growth ratio was the ratio of the follow-up lesion volume to the baseline lesion volume on diffusion-weighted imaging (DWI). The time-to-maximum (Tmax)/DWI ratio was the ratio of the baseline Tmax > 6 s volume to the baseline lesion volume. The collateral ratio was the ratio of the hypoperfused lesion volume of the phase_FU (phase with the hypoperfused lesions most approximate to the follow-up DWI lesion) to the hypoperfused lesion volume of the phase_baseline of the collateral map. Multiple logistic regression analyses were conducted to identify independent predictors of lesion growth. The concordance correlation coefficients of Tmax/DWI ratio and collateral ratio for lesion growth ratio were analyzed.ResultsFifty-two patients, including twenty-six males (mean age, 74 years), were included. Intermediate (OR, 1234.5; p < 0.001) and poor collateral perfusion grades (OR, 664.7; p = 0.006) were independently associated with lesion growth. Phase_FUs were immediately preceded phases of the phase_baselines in intermediate or poor collateral perfusion grades. The concordance correlation coefficients of the Tmax/DWI ratio and collateral ratio for the lesion growth ratio were 0.28 (95% CI, 0.17–0.38) and 0.88 (95% CI, 0.82–0.92), respectively.ConclusionPrecise prediction of lesion growth and penumbra can be possible using collateral maps, allowing for personalized application of recanalization treatments. Further studies are needed to generalize the findings of this study.Clinical relevance statementPrecise prediction of lesion growth and penumbra can be possible using collateral maps, allowing for personalized application of recanalization treatments.Key Points• Cell viability in cerebral ischemia due to proximal arterial steno-occlusion mainly depends on the collateral circulation.• The collateral map shows salvageable brain extent, which can survive by recanalization treatments after acute anterior circulation ischemic stroke.• Precise estimation of salvageable brain makes it possible to make patient-specific treatment decision.

INDEX guidelines for extra-pulmonary tuberculosis: knowledge and practice among clinicians in Bengaluru, Karnataka

Background: Extra-pulmonary tuberculosis (EPTB) remains a major problem in developing countries, which acquire diagnostic and management challenges. The study was conducted to characterize the diagnosed EPTB cases, and to understand the perspectives of clinicians on diagnosis and challenges in its management. Methods: A total of 150 EPTB patients' medical records were reviewed at two tertiary hospitals in Bengaluru, Karnataka for the period January 2017 to December 2017. The questionnaire-based interview was conducted among clinicians (n=42) during the study period. Results: The mean age and weight of EPTB patients (females (77, 51%) and males (73, 49%) were 32.5 (±17.5) years and 44.5 (±16.3) kilograms, respectively. Pleural TB (44, 29%), cervical lymph node TB (LNTB) (32, 21%) and abdominal TB (17, 11%) were the most common sites of EPTB involvement, followed by bones and joints TB (11, 7%), spine TB (10, 7%), hilar/mediastinal TB (9, 6%), tuberculoma (8, 5%), TB meningitis (6, 4%), abdominal LNTB (6, 4%), urinary TB (4, 3%) and others (3, 2%). We found GeneXpert was the basis of EPTB diagnosis in 43.3% of cases followed by acid-fast bacilli (AFB) smear microscopy (20.7%) and culture (12.5%). Of 150 EPTB suspected cases, 73% (110) were started anti-TB treatment (ATT), including 8% (12) having received ATT previously. According to LIKERT scale options, 90% of clinicians agreed GeneXpert as a promising diagnostic tool for diagnosis as compared to other microbiological (79%) and histopathological tests (55%). Conclusions: The quality of EPTB diagnosis and management practices at these institutions is satisfactory according to the principles laid down in INDEX TB guidelines or the national guidelines.

Obesogenic diet and metabolic syndrome among adolescents in India: data-driven cluster analysis

BackgroundMetabolic syndrome is on the rise in India and is primarily linked to obesogenic dietary habits. The synergy of both is a prominent risk factor for cardiovascular diseases (CVDs). Hence, the present study aims to unveil clusters at high risk of metabolic syndrome and ascertain cluster characteristics based on dietary patterns among adolescents aged 10–19 years.Data and methodsThe study utilizes secondary data, i.e., Comprehensive National Nutrition Survey conducted in 2016-18. The study sample includes children and adolescents aged 10–19 years. An unsupervised learning algorithm was used to ascertain possible clusters in the data based on individuals’ dietary patterns. The k-means were used to cluster the data according to their dietary patterns. To determine the number of clusters elbow method was used, and appropriate validation indices were also obtained for the final k. Further, to ascertain the distribution of the obesogenic dietary patterns and metabolic conditions in each cluster was analysed. Bivariate descriptive analysis was used to draw further inferences.ResultsThe k-means clusters identified five optimum clusters based on 12,318 adolescents (6333 males (mean age:14.2 ± 2.8) and 5985 females (mean age:14.3 ± 2.8)) 17 dietary patterns. Clusters were named based on how prudent these were in terms of consuming a healthy diet. Cluster phenotypic characteristics were defined as follows: a cluster of obesogenic diets (24%) constituted the highest proportion of the total sample and was significantly suffering from obesity (p < 0.001), and greater proportions of lipid anomalies (p = 0.51) and hypertension (p = 0.44) but not statistically significant. In contrast, 21% of the sample comprised a plant-based diet cluster and suffered from all deficiencies but folate (p = 0.625), zinc (p = 0.132), and greater proportion from obesity (p = 0.19; not significant), and diabetes (p < 0.001). A cluster of “convenient” (20%) mainly suffered from lipid anomalies (p = 0.00), diabetes (p = 0.03), and a greater proportion from hypertension (p = 0.56) with deficiencies of all the essential vitamins and minerals but significantly from vitamin A (p < 0.001), folate (p < 0.001), and iron (p = 0.017). Lastly, the cluster of those who follow a “Western diet” (17%) was found to have lipid anomalies (p = 0.003), diabetes (p = 0.016), greater proportion of vitamin B12 (p = 0.136), D (p = 0.002), folate (p < 0.001), and iron deficiencies (p = 0.013).Conclusions and relevanceAdolescents in India show a strong association between obesogenic diet and metabolic syndrome. Therefore, the burden of metabolic syndrome at early ages can be prevented by controlling obesogenic dietary practices and addressing micronutrient deficiencies. This may be done by targeted health promotional campaigns in schools and college-going populations in India.

Mild cognitive impairment in type 2 diabetes is associated with fibrinogen-to-albumin ratios.

Cognitive impairment is the main manifestation of diabetes central neuropathy. Currently, there is no effective dementia treatment; early diagnosis and treatment are particularly crucial. Inflammation index fibrinogen-to-albumin ratio (FAR) has been shown to predict complications of type 2 diabetes (diabetic kidney disease and diabetes-related arteriosclerosis), but its relationship with mild cognitive impairment (MCI) in type 2 diabetes (T2D) is undetermined. In this study, we examined the association between the FAR and mild cognitive impairment in type 2 diabetes. This is a retrospective and cross-sectional study. From January 2022 to December 2022, we have retrieved 328 inpatient medical records for T2D patients hospitalized at the First Hospital of Harbin Medical University from the hospital's electronic system. Subjects' cognitive function was assessed and grouped by the MoCA scales. Subjects' demographic and various laboratory indicators were collected. Using Spearman's bivariate correlation analysis, the FAR and other clinical variables were analyzed for association strength. A multiple linear regression analysis was conducted to determine the independent relationship between FAR and MoCA scores. Multivariate logistic regression was used to analyze the independent relationship between FAR and MCI. The capacity of the FAR to detect MCI was carried using receiver operating characteristic (ROC) analysis. The included participants' (n = 328; 61.9% male) mean age was 52.62 ± 10.92 years. MoCA scores and MCI prevalence significantly differed (p < 0.05) between the four subgroups of FAR quartiles. The FAR and the MoCA score were significantly negatively correlated in the entire population (p < 0.05). Based on the multiple linear regression analysis, lnFAR and lnMoCA are significantly correlated (β = -0.449, t = -8.21, p < 0.05, R2 = 0.469). In multivariate logistic regression analysis, FAR and MCI were independently correlated after adjusting for covariates (OR 95% CI 34.70 [13.90-86.66]). Finally, the analysis of receptor working characteristics shows that the optimal FAR cut-off value was 0.08 (sensitivity: 95.81%, specificity: 84.47%) for detecting MCI in type 2 diabetes. In type 2 diabetes, the FAR was positive associations with MCI and negative associations with MoCA score. The high FAR was associated with an increased risk of MCI. FAR maybe a appropriate indicator of MCI risk for type 2 diabetes.

The association of problematic usage of the internet with burnout, depression, insomnia, and quality of life among Hungarian high school students.

The extensive availability of the internet has led to the recognition of problematic usage of the internet (PUI) or so called internet addiction (IA), probably mostly involving adolescents. Here we present a study focusing on the incidence and consequences (including burnout, which is relatively rarely studied) of internet addiction among high school students using a questionnaire-based non-random sampling cross-sectional survey. Included questionnaires were the Problematic Internet Use Questionnaire, the Maslach Burnout Inventory General Survey for Students MBI-GS (S), the 9-item short version of Beck Depression Inventory (BDI-SF), the Athens Insomnia Questionnaire and the EQ-5D (quality of life) questionnaire. Data were evaluated the exertion of Student's t-test, chi square test and Pearson's rank-order correlation. Logistic regression analysis was used to determine the significance of the different parameters as independently associated with PUI. Overall 3,000 paper-based questionnaires were successfully delivered and 2,540 responses received (response rate of 84.6%). 1,309 males (mean age 17.6 ± 1.43 years) (51.5%) and 1,231 females (mean age 17.5 ± 1.4 years) (48.5%) took part in our study. Problematic usage of the internet was detected in 486 (19.1%) students (232 males, mean age 17.6 ± 1.35 years and 254 females, mean age 17.34 ± 1.37 years). In a logistic regression analysis sleep disturbance (OR: 1.84, 95% CI: 1.83-2.03), depression (OR: 1.97, 95% CI: 1.77-2.02) and burnout (OR: 1.8, 95% CI: 1.16-1.94) were significantly associated with PUI. Nearly one fifth of our study population suffered from PUI, which was strongly associated with school burnout, insomnia and depression, which underlines the importance of this phenomenon.

Ultrasonographic evaluation of changes in the thickness, width, elasticity index and echogenic pattern of the masseter muscle after mandibular set-back surgery

IntroductionThe masseter muscle is one of the structures that undergoes significant changes following jaw movements in orthognathic surgery. This study aims to investigate the effects of mandibular setback surgery, performed in patients with skeletal class III deformity, on the thickness, width, elasticity index, and echogenic pattern of the masseter muscle. Material and methodsThis prospective case-control study enrolled patients with class III deformity who underwent mandibular setback surgery, while the control group consisted of class I patients. The predictor variable was the time measured at two different points: preoperative (T1) and postoperative 6 months (T2). The primary outcome variable focused on changes in the internal echogenic pattern of the masseter muscle. Secondary, tertiary, and quaternary outcome variables included changes in the thickness, width, and elasticity index of the masseter muscle, respectively. Gender, age, type of operation, and amount of movement were considered as covariates. Ultrasonography was employed to evaluate the outcome variables. ResultsThe study group comprised 31 patients, including 17 females (mean age 22.24 ± 3.52 years) and 14 males (mean age 23.14 ± 2.65 years). The control group consisted of 16 females (mean age 23.34 ± 1.22 years) and 15 males (mean age 23.12 ± 1.76 years). Masseter muscle thickness increased significantly after mandibular setback surgery (p = 0.015). However, there was no statistically significant difference in masseter muscle width before and after surgery (p = 0.627), nor in the elasticity index (p = 0.588). Furthermore, a statistically significant transformation from Type I to Type II was observed in the internal echogenic pattern of the muscle (p = 0.039). Additionally, there was no statistically significant correlation between the amount of mandibular movement performed and the changes in the masseter muscle. ConclusionsMandibular setback surgery leads to changes in both the physical and structural properties of the masseter muscle.

Comparison of the skeletal, dentoalveolar, and periodontal changes after Ni–Ti leaf spring expander and rapid maxillary expansion: a three-dimensional CBCT based evaluation

BackgroundThe aim of the present study was twofold:(1) three-dimensionally evaluate the quantitative skeletal and dentoalveolar changes after Ni–Ti leaf spring expander (leaf expander) and rapid maxillary expansion (RME) in mixed dentition patients;(2) analyze the modifications of the buccal alveolar bone plate of the maxillary first permanent molars.MethodsPatients who underwent CBCT scans before and after maxillary expansion were randomly selected from the records archived at the Department of Biomedical Surgical and Dental Sciences, University of Milan, Italy.Inclusion criteria were the following: no systemic disease or syndromes; maxillary transverse deficiencies (difference between the upper intermolar width and the lower intermolar width of at least 3 mm and/or clinical need based on radiographic evaluation), early mixed dentition with ages between 7 to 10 years old; cervical vertebra maturation stage (CVMS) 1 or 2; no pathologic periodontal status; skeletal class I or II; maxillary expander cemented on the upper second deciduous molars. Exclusion criteria were the following: patients with pubertal or post-pubertal stage of development (CVMS 3–6); late deciduous or late mixed dentition, impossibility to use the second primary molar as anchorage; skeletal class III malocclusion; craniofacial syndromes; patients unable to be followed during the treatment period. Twenty-three patients treated with Leaf Expander, 11 males (mean age 7.8 ± 0.6 years) and 12 females (mean age 8.1 ± 0.8 years), met the inclusion criteria and constituted the case group. Twenty-four (control group) treated with conventional RME, 12 males (mean age 8.4 ± 0.9 years) and 12 females (mean age 8.1 ± 0.7 years). The paired-sample T test was used for intra-group comparison to evaluate the difference between before (T1) and after (T2) maxillary expansion. Independent sample t-test was computed to perform between groups comparison of the skeletal, dentoalveolar, and periodontal changes.ResultsThe Leaf Expander and RME group showed a significant increase between T1 and T2 for most of the skeletal and dentoalveolar variables. Concerning the skeletal variables only the RME demonstrated a significant increase at the level of the posterior nasal (PNW) and apical base width (PABW) and maxillary mid-alveolar width (MMW). Despite this, when compare with the Leaf Expander, the RME group exhibited a statistically larger width increase for only two skeletal parameters: PNW (p = 0.03) and MMW (p = 0.02). No significant changes at the periodontal level were found in either group.ConclusionsAccording to the current research, the authors confirm the effectiveness of the Leaf Expander and RME to produce similar skeletal and dentoalveolar effects in mixed dentition subjects. Moreover, the devices anchored to deciduous teeth did not reduce the thickness and height of the buccal bone at the level of the maxillary permanent first molars in either of the two groups.

Predictive Performance for Hospital Mortality of SAPS 3, SOFA, ISS, and New ISS in Critically Ill Trauma Patients: A Validation Cohort Study.

Background: It is not known whether anatomical scores perform better than general critical care scores for trauma patients admitted to the intensive care unit (ICU). We compare the predictive performance for hospital mortality of general critical care scores (SAPS 3 and SOFA) with anatomical injury-based scores (Injury Severity Score [ISS] and New ISS [NISS]). Methods: Retrospective cohort study of patients admitted to a specialized trauma ICU from a tertiary hospital in São Paulo, Brazil between May, 2012 and January, 2016. We retrieved data from the ICU database for critical care scores and calculated ISS and NISS from chart data and whole body computed tomography results. We compared the predictive performance for hospital mortality of each model through discrimination, calibration, and decision-curve analysis. Results: The sample comprised 1053 victims of trauma admitted to the ICU, with 84.2% male patients and mean age of 40 (±18) years. Main injury mechanism was blunt trauma (90.7%). Traumatic brain injury was present in 67.8% of patients; 43.3% with severe TBI. At the time of ICU admission, 846 patients (80.3%) were on mechanical ventilation and 644 (64.3%) on vasoactive drugs. Hospital mortality was 23.8% (251). Median SAPS 3 was 41; median maximum SOFA within 24 h of admission, 7; ISS, 29; and NISS, 41. AUROCs (95% CI) were: SAPS 3 = 0.786 (0.756-0.817), SOFA = 0.807 (0.778-0.837), ISS = 0.616 (0.577-0.656), and NISS = 0.689 (0.649-0.729). In pairwise comparisons, SAPS 3 and SOFA did not differ, while both outperformed the anatomical scores (p < .001). Maximum SOFA within 24 h of admission presented the best calibration and net benefit in decision-curve analysis. Conclusions: Trauma-specific anatomical scores have fair performance in critically ill trauma patients and are outperformed by SAPS 3 and SOFA. Illness severity is best characterized by organ dysfunction and physiological variables than anatomical injuries.

Sex differences concerning the effects of ankle muscle fatigue on static postural control and spinal proprioceptive input at the ankle.

The main aim of this study was to determine sex differences in postural control changes with ankle muscle fatigue during a standing forward leaning (FL) task under different vision conditions. The secondary aim was to examine sex differences in the effect of fatigue on soleus (SOL) H-reflex amplitude, a measure of motoneuron excitability with activation of Ia afferents. Fifteen healthy young adult males (mean age: 28.0 years) and 16 healthy young adult females (mean age: 26.1 years) were asked to perform four consecutive FL tasks [30 s; two with eyes open (EO) and two with eyes closed (EC)] before, and immediately following a fatiguing exercise consisting of alternating ankle plantarflexion (6 s) and dorsiflexion (2 s) maximal isometric contractions, and at 5 and 10 min of recovery. Center of pressure (COP) sway variables (mean position, standard deviation, ellipse area, average velocity, and frequency), an ankle co-contraction index, and a ratio of SOL H-reflex to the maximum amplitude of the compound muscle action potential (M-max) were obtained during the FL tasks. A rating of perceived fatigue (RPF) was also documented at the different time points. Time to task failure (reduction of 50% in maximal voluntary isometric contraction torque of ankle plantar flexors) and the increase in RPF value were not significantly different between males and females. Both sex groups showed similar and significant increases (p < 0.05) in mean COP sway velocity with no significant changes in co-contraction indices. No significant effects of fatigue and related interactions were found for SOL H/M-max ratio. The absence of a significant sex difference in postural control change (sway and co-contraction) with fatigue could be explained by similar perceived (RPF) and performance fatigability (exercise duration) between males and females in the present study. Fatigue did not lead to significant changes in SOL spinal motoneuron excitability with activation of Ia afferents.

Poster 258: Clinical and social predictors of surgical treatment for ACL injuries

Objectives: Anterior cruciate ligament (ACL) injuries are one of the most common knee injuries sustained during sports, and over 250,000 ACL reconstructions are performed per year. While surgery is often indicated for younger patients, surgical indications in the adult patient are determined based on patient preference, level of functional disability and their desire to return to cutting and pivoting sports. The purpose of this study was to report on the clinical and social predictors of patients undergoing surgical vs nonsurgical treatment for ACL injury, and to compare differences between males and females. Methods: Patient who were evaluated for ACL injury at our institution were identified and those who subsequently underwent surgery were compared to those who did not. Clinical factors collected included sex, age, BMI, Charlson Comorbidity Index (CCI) and smoking status, while social factors collected included race, English-speaking, educational level, insurance type, and marital status. Functional disability was determined by preoperative PROMs scores based on KOOS-PS and PROMIS PF. Descriptive statistics were used to report on the surgical and nonsurgical cohorts with subgroup analysis by sex. Odds ratios were calculated to determine predictors of surgery, with a subgroup analysis of patients over 30 years of age. Multivariate analysis was performed to determine the relationships between clinical and social factors and KOOS-PS and PROMIS PF scores. Results: 3656 patients were included in this study. 1734 females (mean age 34.7y) and 1922 males (mean age 32.8y) were identified with a diagnosis of ACL tear, of whom 53.8% of females and 53.4% of males went on to surgery (p=0.84). KOOS PS and PROMIS PS did not show a relationship with future surgical intervention, although they were lower in females, those with increased BMI, and lower educational levels. In all patients, CCI (OR 0.867, p&lt;0.001) and current smoking status (OR 0.70, p=0.06) were associated with lower rates of surgical treatment, as were Medicare status (OR 0.54, p=0.04) and having subsidized insurance (OR 0.47, p&lt;0.001). In patients over the age of 30, females were more likely than males to undergo surgical treatment (OR 1.36, p=0.04), while CCI (OR 0.89, p=0.07), current smoking status (OR 0.43, p=0.06) and subsidized insurance (OR 0.60, p=0.06) negatively affected rates of surgery in this group. Conclusions: In our cohort, comorbidity index, smoking status and insurance status were found to negatively influence surgical treatment of ACL injury. In patients aged &gt;30y, females were more likely to undergo surgical treatment than males. Additionally, our study identified lower PROMs scores associated with ACL injury in females, those with increased BMI, and lower educational levels. Further studies are needed to understand the social and clinical factors that can influence variability in functional disability and decisions to proceed with surgical treatment in patients with ACL injuries.

Student-led Seminars as an Enforcement-learning Method for Human Anatomy – Dentistry Students’ Perspectives

Background: The “student led seminar (SLS)” is one in which students prepare and present selected topics through multi-source research with the assistance and guidance of the faculty. Teamwork is increasingly emphasized in health care, and team training is now considered to be essential in medical education. Small group learning promotes active learning and develops communication and teamwork skills. It also improves problem-solving skills, attitudes, and the development of interpersonal skills. Aim of the Study: The aim of this study was to evaluate the efficacy of SLSs as a teaching-learning method for Bachelor of Dental Surgery undergraduates through students’ perception. Methodology: This was a prospective, observational study conducted for 5 months among 1st year dentistry students. The students were divided in small groups and the topics for the seminar were allocated for presentation according to the roster. Each group was given 20 min for presentation, 10 min for question time and discussion. A hard copy of the slides presented was also collected. Feedback was taken on pretested questionnaire containing 11 Likert-based items on a five-point scale. Descriptive statistics were applied for each item question. Cronbach’s alpha test was applied to check the internal validity of the questionnaire. Satisfaction rate and index were calculated. Fischer’s exact test was applied to find the odds ratio of satisfaction rate between male verses female students and hosteller verses day scholar students for each item question separately. Student’s t-test was applied to determine the difference in the performance of students in the first and second internal assessments at P = 0.05 significance level. Results: Among the participants, 32 were female (mean age 19 ± 1.46) and 18 were male (mean age 20 ± 1.82) students. Ninety-five percent of students agreed that the seminars improved their self-confidence and enhanced their presentation skills, helped them acquire a deeper understanding of the topic, an opportunity to use resources (time, electronic gadgets, and media) responsibly, even outside the bounds of the lecture theatre. Overall, mean score on Likert scale was 3.9 ± 0.307. The satisfaction rate and index were the highest for question 3. The second term examination result showed statistically significant improvement over that of the 1st term. Conclusions: The student seminar is a potentially important resource of the teaching-learning method that has yet to be fully implemented and therefore needs to be incorporated into the medical curriculum on a regular basis.