Objective: To identify pathophysiological mechanisms of nocturia and the correlation of these mechanisms with nocturia severity. Methodology: After approval by the local ethics committee, all patients with nocturia (≥1 nocturnal void/night) were included and filled the overactive bladder questionnaire (OABq), nocturia quality of life (N-QoL), ICIQ-MLUTS (male), ICIQ-FLUTS (female) and 3-day frequency-volume chart. Patients were divided into three groups according the severity of nocturia: group 1 consisted of patients with mild (1-2 voids/night), group 2 with moderate (3-4 voids/night) and group 3 with severe nocturia (>4 voids/night). Comparative analysis were performed between groups, p<0.05 was deemed as statistically significant. Results: 68.1%, 64.1% and 8.7% of the patients had nocturnal polyuria, reduced bladder capacity and global polyuria; respectively. 42.7% of the patients had mixed nocturia. 6.1% of the patients did not comply with the afore-mentioned subtypes and defined as isolated nocturia. Regarding the severity of nocturia; 155 (41%) patients had mild, 167 (45%) patients had moderate and 57 (15%) patients had severe nocturia. Increased nocturia severity was related with decreased quality of life; higher age, urinary tract symptom scores, nocturnal urine volume, evening fluid consumption and beta-blocker medication rates. Increased nocturia severity was also associated with higher nocturnal polyuria, global polyuria and reduced bladder capacity rates. Conclusions: Nocturia mechanisms may vary between mild and moderate to severe nocturia groups according to the present study. Nocturia grading with identification of subtypes may help for better standardization of the diagnostic and treatment approaches as well as for the design of future clinical trials.
Aim: The cognate receptor expression of AGE (RAGE; receptor for AGE) on malignant tissues in diabetic patients has been suggested as a co-factor in determining the clinical course and prognosis. We aimed to search this relationship between RAGE expression and clinicopathological features of prostate neoplasia. Methods: A total of 197 patients; 64 (diabetic n=24; non-diabetic n=40) with benign prostate hyperplasia, and 133 (diabetic n=71; non-diabetic n=62) with localized (LPCa)/metastatic prostate cancer (MetPCa) were included the study. The expression of RAGE was studied by immunohistochemically on prostate specimens. The RAGE score was assessed in the specimens according to the extent of immunoreactivity and staining intensity. Results: The RAGE scores of BPH patients (diabetic and non-diabetic) were found as negative. Patients with both LPCa and MetPCa showed significantly higher scores, respectively (LPCa and MetPCa vs. BPH; p<0.01). RAGE scores of diabetic patients with LPCa and MetPCa were found to be 4.71±3.14 and 4.97±3.69, respectively. RAGE scores of the non-diabetic patients who had LPCa and MetPCa were 1.52±1.87 and 1.69±1.58, respectively. When compared both groups with LPCa, RAGE scores of the diabetic patients were significantly higher than that of the non-diabetics (p=0.01). Similar results were revealed as for the patients with MetPCa (4.97±3.69 vs. 1.69±1.58 (diabetic vs. non-diabetic), respectively (p<0.01). Conclusion: We found a high rate of RAGE expression in malign prostate neoplasias to the BPH. Furthermore, as expected, higher scores were demonstrated in those with diabetes than non-diabetics. Disease progression and survival parameters were worse in the patients with high RAGE levels. RAGE may be useful in the diagnosis of prostate cancer and in determining its prognosis.
Background: Radiofrequency ablation in patients with atrial fibrillation (AF) is effective but hampered by pulmonary veins reconnection due to insufficient lesions. High power shorter duration ablation (HPSD) seen to increase efficacy and safety. This analysis aimed to evaluate the clinical benefits of HPSD in patients with AF. Methods: The Medline, PubMed, Embase, and the Cochrane Library databases were searched for studies comparing HPSD and Low power longer duration (LPLD) ablation. Results: A total of seven trials with 2023 patients were included in the analysis. Pooled analyses demonstrated that HPSD showed a benefit of first-pass pulmonary vein isolation (PVI) [risk ratio (RR): 1.27; 95% confidence interval (CI): 1.18–1.37, P < 0.001]. HPSD could reduce recurrence of atrial arrhythmias (RR: 0.70; 95% CI: 0.50–0.98, P = 0.04). Additionally, HPSD was more beneficial in terms of procedural time [Weighted Mean Difference, (WMD): −44.62; 95% CI, −63.00 to −26.23, P < 0.001], ablation time (WMD: −21.25; 95% CI: −25.36 to −17.13, P < 0.001), and fluoroscopy time (WMD: −4.13; 95% CI: −7.52 to −0.74, P < 0.001). Moreover, major complications and esophageal thermal injury (ETI) were similar between two groups (RR: 0.75; 95% CI: 0.44–1.30, P = 0.31) and (RR: 0.64; 95% CI: 0.17–2.39, P = 0.51). Conclusion: HPSD was safe and efficient for treating AF with clear advantages of procedural features, it also showed benefits of higher first-pass PVI and reducing recurrence of atrial arrhythmias compared with the LPLA. Moreover, major complications and ETI were similar between two groups.
Introduction: To evaluate the long-term (5 years) effects of perioperative briefing and debriefing on team climate. We explored the barriers and facilitators of the performance of perioperative briefing and debriefing to explain its effects on team climate and to make recommendations for further improvement of surgical safety tools. Methods: A mixed-method evaluation study was carried out among surgical staff at a tertiary care university hospital with 593-bed capacity in the Netherlands. Thirteen surgical teams were included. Team climate inventory and a standardised evaluation questionnaire were used to measure team climate (primary outcome) and experiences with perioperative briefing and debriefing (secondary outcome), respectively. Thirteen surgical team members participated in a semi-structured interview to explore barriers and facilitators of the performance of perioperative briefing and debriefing. Results: The dimension ‘participative safety’ increased significantly 5 years after the implementation of perioperative briefing and debriefing (p = 0.02 (95% confidence interval 1.18–9.25)). Perioperative briefing and debriefing was considered a useful method for improving and sustaining participative safety and cooperation within surgical teams. The positive aspects of briefing were that shared agreements made at the start of the day and that briefing enabled participants to work as a team. Participants were less satisfied regarding debriefing, mostly due to the lack of a sense of urgency and a lack of a safe culture for feedback. Briefing and debriefing had less influence on efficiency. Conclusions: Although perioperative briefing and debriefing improves participative safety, the intervention will become more effective for maintaining team climate when teams are complete, irrelevant questions are substituted by customised ones and when there is a safer culture for feedback.
Objectives: There is no standardized and up-to-date education model for urology residents in our country. We aimed to describe our National E learning education model for urology residents. Methodology: The ERTP working group; consisting of urologists was established by Society of Urological Surgery to create E-learning model and curriculum at April 2018. Learning objectives were set up in order to determine and standardize the contents of the presentations. In accordance with the Bloom Taxonomy, 834 learning objectives were created for a total of 90 lectures (18 lectures for each PGY year). Totally 90 videos were shoot by specialized instructors and webcasts were prepared. Webcasts were posted at uropedia.com.tr, which is the web library of Society of Urological Surgery. Satisfaction of residents and instructors was evaluated with feedbacks. An assessment of knowledge was measured with multiple-choice exam. Results: A total of 43 centers and 250 urology residents were included in ERTP during the academic year 2018/2019. There were 93/38/43/34/25 urology residents at 1st/2nd/3rd/4th and 5th year of residency, respectively. Majority of the residents (99.1%) completed the ERTP. The overall satisfaction rate of residents and instructors were 4,29 and 4,67(min:1 so bad, max:5 so good). An assessment exam was performed to urology residents at the end of the ERTP and the mean score was calculated as 57.99 points (min:20, max:82). Conclusion: Due to the Covid-19 pandemic, most of the educational programs had to move online platforms. We used this reliable and easily accessible e-learning platform for standardization of training in urology on national basis. We aim to share this model with international residency training programs.
Introduction: Access to public healthcare is limited in Brazilian underserved areas, and long waiting lists remain for echocardiography (echo). We aimed to develop a tool to optimize indications and shorten waiting lists for standard echo in primary care. Methods: Patients in waiting list for standard echo were enrolled. For derivation, patients underwent a clinical questionnaire, simplified 7-view echo screening by non-physicians with handheld devices (GE-VSCAN), and standard echo (Vivid-Q) by experts. Two models were adjusted, one including clinical variables and other adding screen-detected major heart disease (HD). For validation, patients were risk-classified according to the clinical score. High-risk patients and a sample of low-risk underwent standard echo. Intermediate-risk patients first had screening echo, with a complete study if HD was suspected. Discrimination and calibration of the 2 models were assessed to predict HD in standard echo. Results: In derivation (N=603), clinical variables associated with HD were female gender, body mass index, Chagas disease, prior cardiac surgery, coronary disease, valve disease, hypertension, and heart failure, and this model was well calibrated with C-statistic=0.781. Performance was improved with the addition of echo screening, with C-statistic=0.871 after cross-validation. For validation (N=1,526), 227 (14.9%) patients were classified as low-risk, 1082 (70.9%) as intermediate-risk, and 217 (14.2%) as high-risk by the clinical model. The final model with 2 categories had high sensitivity (99%) and negative predictive value (97%) for HD in standard echo. Model performance was good with C-statistic=0.720. Conclusion: The addition of screening echo to clinical variables significantly improves the performance of a score to predict major HD.
INTRODUCTION: The anemia leads to a worse prognosis in patients with heart failure(HF). There are few data on the impact of anemia on mortality in patients with acute heart failiure(AHF), and the studies available are mainly retrospective and include hospitalized patients. OBJECTIVE. Evaluate the role of anemia in 30-days and one-year mortality in patients with AHF attended in hospital emergency departments(HEDs). METHODS. Multicenter, observational study of prospective cohorts of patients with AHF. Study variables: anemia(hemoglobin<12g/dL in women and <13g/dL in men), 30-days-mortality and at one year, risk factors, comorbidity, functional impairment, basal functional grade for dyspnea, chronic and acute treatment, clinical and analytical data of the episode and patient destination. Statistical analysis: bivariate analysis and survival analyses using Cox regression. RESULTS. A total of 13,454 patients were included, 7662(56.9%) of whom had anemia. Those with anemia were older, had more comorbidity, a worse functional status and New York Heart Association class, greater renal function impairment and more hyponatremia. The mortality was higher in patients with anemia at 30-days and one-year: 7.5% vs. 10.7%(p<0.001) and 21.2% vs. 31.4%(p<0.001), respectively. The crude and adjusted hazard ratios of anemia for 30-days-mortality were: 1.46(confidence interval[CI]95% 1.30-1.64);p<0.001 and 1.20(CI95% 1.05-1.38);p=0.009, respectively, and 1.57(CI95% 1.47-1.68) and 1.30(CI95% 1.20-1.40) for one-year-mortality. The weight of anemia on mortality was different in each follow-up period. CONCLUSIONS. Anemia is an independent predictor of 30-days-mortality and one year in patients with AHF attended in HEDs. It is important to study the etiology of AHF since adequate treatment would reduce mortality.
Objective: The impact of thyroid hormones within normal range on muscle mass remains unknown. We examined the association between new onset of low muscle mass (LMM) and thyroid hormones among euthyroid men and women with three different definitions of LMM in prospective cohort study. Methods: We performed a cohort study of 198,069 Korean adults (mean age of 39.2 years), free of LMM at baseline, who participated in a repeated screening examination and were followed-up annually or biennially for up to 6.3 years. Thyroid-stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxin (FT4) levels were measured by an electrochemiluminescent immunoassay. Muscle mass was assessed using a bioelectrical impedance analyzer. LMM was defined as the appendicular skeletal muscle mass (ASM) by body weight (ASM/weight, LMM-W), height squared (ASM/height2, LMM-H) and BMI (ASM/BMI, LMM-B) of one standard deviation below the sex-specific mean for young reference group. Results: During a median follow-up of 3.1 years (interquartile range, 2.0-4.1 years), new-onset LMM-W, LMM-H, and LMM-B occurred in 17,856 (incident rate, 27.8 per 1,000 person-years), 8,307 (incident rate, 13.4 per 1,000 person-years), and 13,990 participants (incident rate, 24.5 per 1,000 person-years) in each. In euthyroid men, FT4 was inversely and FT3 positively associated with incident LMM-W in a dose-response manner. TSH and FT4 had inverse dose-response relationship with incident LMM-B. Incident LMM-H of euthyroid men has no apparent associations with any thyroid hormones. Euthyroid women had no dose-response relationship between thyroid hormones and any definition of LMM. Conclusions: Among euthyroid men, FT4 had inverse dose-response association with new onset of LMM defined with weight (LMM-W) and BMI (LMM-B). Height squared LMM (LMM-H) had no apparent relationship with any thyroid hormones. Euthyroid women had no dose-responsive association between thyroid hormones and incident LMM. Key words: appendicular skeletal muscle mass, low muscle mass, thyroid hormones, Cohort study
Aim: To evaluate risk factors associated with nocturia in patients with obstructive sleep apnea syndrome (OSAS). Materials and Methods: Patients diagnosed with OSAS by polysomnography (PSG) and over eighteen years old evaluated retrospectively between January and December 2019. The number of nocturia episodes was assessed in the 3-day bladder diary. We analyzed age, gender, body mass index (BMI), apnea-hypopnea index (AHI) scores and severity, hypertension, diabetes mellitus, smoking, heart diseases in all patients. Results: A total of 124 patients with the mean age of 49.9±11.6 years (range 25–81 years) was included in the study. Ninety-two (75.8%) patients had nocturia. The mean nocturia episode of patients with nocturia was 2.41.3. To determine the factors that affect the risk of nocturia, logistic regression analysis was performed. The results revealed that patient age and BMI were found as the most effective risk factors determining nocturia (p<0.05). The odds of patient age were 1.06 (95% CI 1.01-1.11, p=0.010) times higher for patients with nocturia. Every 1 unit increase in BMI increased the risk of nocturia by 1.12. 48 patients with nocturia underwent continuous positive airway pressure (CPAP) therapy or surgical treatment. The mean nocturia epi¬sodes of these patients were 2.3±1.4 before treatment and were 1.7±2.2 after treatment. There was a significant decrease in terms of nocturia episodes (p=0.032). Although there was a significant increase in the total daily urine volume after treatment, there was a statistically decrease in total night-time urine volume at night (p=0.016 and p=0.024, respectively). Conclusion Age and BMI were risk factors associated with nocturia in patients with OSAS.
BACKGROUND Primary glomerulonephritis (PGN) has a significant part in non-diabetic kidney disease (NDKD) in diabetes mellitus (DM) patients. In our study, we compared the clinical, demographic, and laboratory features of patients with biopsy-proven diabetic nephropathy (DN) and PGN with type 2 DM METHODS In our retrospective study, type 2 DM patients who underwent kidney biopsy between 2011-2019 were included. Demographic, clinical, and laboratory characteristics of DN and PGN patients were compared. RESULTS Seventy patients with a mean age of 55.7 ± 9.4 and 43 (61.4%) males were included. 38 (54.3%) of the patients had DN, and 32 (45.7%) had PGN. In the PGN, membranous GN (20, 62.5%) was most common. In DN patients, diabetes duration was longer; complications such as retinopathy, neuropathy, hypertension, coronary artery disease, heart failure were more frequent. At the time of renal biopsy, blood sugar, HbA1C, blood pressure, serum albumin, and proteinuria values were similar in 2 groups. The pathological damage findings of kidney biopsy in DN patients were more severe. In the first year after kidney biopsy decrease in eGFR was higher in DN patients, whereas eGFR did not change in PGN patients. CONCLUSION In a diabetic patient, fasting blood sugar, hbA1C, serum albumin, and proteinuria did not differ in the differential diagnosis of DN and PGN, whereas complications of DM (retinopathy, neuropathy, hypertension, coronary artery disease) were more characteristic in differentiation. Detection of PGN in a diabetic patient is crucial for the success of the treatment, according to DN.
Abstract Background Differentiating viral from bacterial acute respiratory infections (ARIs) remains challenging, due to the non-specific clinical manifestations. The COVID-19 pandemic is putting extraordinary strain on healthcare resources. To date, molecular testing is available but has a long turnaround time and therefore cannot provide results at the point-of-care (POC) thereby exposing COVID-19/Non-COVID-19 patients to each other while awaiting diagnosis. Methods This observational study prospectively evaluated the utility of a triage strategy including FebriDx, a POC fingerstick blood test that differentiates viral from bacterial ARIs through simultaneous detection of Myxovirus-resistance protein A (MxA) and C-reactive protein (CRP), in rapidly determining viral cases requiring immediate isolation and confirmatory molecular testing, from non-infectious patients or bacterial infections requiring antibiotics. Results 75 consecutive patients were screened, 48 eligible cases were tested with FebriDx, 36 were confirmed viral infection and 35/36 had COVID-19. 31/35 COVID-19 cases tested positive for SARS-CoV-2 via rRT-PCR and (4/35) had a clinical diagnosis of probable COVID-19 based on symptoms, epidemiological history, and chest imaging (PPV 100% (35/35)). 13 cases were FebriDx viral negative and rRT-PCR was also negative. In one case, it was not possible to determine the exact cause of infection, although a viral infection could not be excluded. Including this patient, FebriDx NPV was 92.3% (12/13), exceeding the NPV of rRT-PCR a 68.3% (13/19), and diagnostic sensitivity was conservatively calculated at 97% (35/36) compared to 82.9% (29/35) for initial rRT-PCR. The diagnostic specificity of both FebriDx and rRT-PCR was 100%. Conclusions: FebriDx could be deployed as part of a reliable triage strategy for identifying possible COVID-19 patients with symptomatic ARI in the COVID-19 pandemic. Key words: Pandemic; COVID-19; SARS-CoV-2; pneumonia; viral; point of care; infection
Now, we know that the first report of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) was in December 2019 in Wuhan, China. In January, the existence of a disease caused by a virus with respiratory tropism for humans was announced, and in February it was already named SARS-Cov-2. The World Health Organization (WHO) 1 gave it the name of COVID-19, on February 11. One month later, WHO declared that the disease caused by this virus was already a pandemic (WHO, 2020)1. The virus started in China, then affected other Asian countries such as Japan, South Korea, etc., and later spread to Europe, then America.As this pandemic progresses, the reports of this six-month period show that this SARS-CoV-2 coronavirus not only targets the respiratory system, its effect on the cardiovascular, digestive, and renal apparatus has also been described. In addition, recent reports have described a set of neurological symptoms 2-4. Furthermore, the presence of this virus in the neurons and the capillary endothelium of the frontal cortex was seen in a patient who died of SARS-CoV-24. Moreover, other reports have shown its presence in the brainstem and in the cerebrospinal fluid (CSF) of other patients with SARS-CoV-2 5-6. Recent reports suggested that the cells with the expression of the angiotensin-converting enzyme 2 (ACE-2) may be a target for this coronavirus, since ACE 2 is a suggested cellular receptor for this coronavirus 4,7-8. Interestingly, various reports have demonstrated the presence of ACE-2, in both neurons and glial cells 7,9-11. Consequently, the evidence suggests that central nervous system (CNS) may be a target organ for this virus. It is known that the presence of this virus is responsible for the inflammatory process, which causes damage not only at the pulmonary level, but also at the cardiovascular, renal, and digestive system levels. All of these structures have a great regenerative capacity and thus reduce the damage in the long term. However, an inflammatory process at the CNS level could leave sequelae that, with age, could favor the early appearance of neurodegenerative processes, such as Alzheimer’s disease, Parkinson’s disease, vascular type dementia, multiple sclerosis etc., 12-13. Consequently, preventive measures should be taken to avoid the CNS from suffering future damage.Autopsy of patients with COVID-19 has shown that the brain tissue is hyperemic, edematous, and has degenerated neurons 2,7. However, it is necessary to know the percentage of cases in which there were changes in the nervous tissue caused by SARS-CoV-2, the types of modifications and the CNS regions most affected by COVID\sout-19. Data can help us know the impact on the brain tissue of this viral infection. In addition to supporting the neuroinvasive effect on the CNS and peripheral nervous system (PNS) of this coronavirus, there are the reported cases of meningitis, encephalitis, and Guillain-Barré syndrome associated with SARS-CoV-2 7,14-17.The clinical picture of SARS-CoV-2 is very wide, with symptoms and signs that involve the respiratory, cardiovascular, renal, digestive, and hepatic systems. However, there are also symptoms in which the CNS and PNS could be involved 2,3. Neurological manifestations have been classified as non-specific and specific by various authors2,15,18-20. Among the non-specific ones are headache, fatigue, dyspnea, etc. While the specific ones imply clear CNS or PNS affection data, such as loss of smell and reduction of taste and vision, neural pain, epileptic seizures, acute cerebrovascular disease, and deterioration of the state of consciousness have also been reported3,14,15,17,19,20.The way in which the SARS-CoV-2 can reach neurons and glial cells is through the blood crossing the blood-brain barrier or by retrograde transport through peripheral nerves. There is evidence for both hypotheses. At the beginning of the disease, patients with COVID-19 may have alterations or loss of smell and taste, probably because the virus may damage this pathway, which has been reported to recover, in some cases at the end of the disease and in others up to several weeks after the patient recovered 20. The virus can pass through the olfactory pathway, which enters the brain through the cribiform plate (transcribial route) 5,7,21. This route has been reported for other viruses, including SARS-CoV7,18,22. In addition, various reports have detected various viruses with respiratory tropism, including some coronaviruses, can reach the brain by retrograde transport, due to their neurotropic properties 5,7,21,22.Moreover, there is a percentage of patients who enter the ICU and require ventilatory assistance, since they do not breathe spontaneously7,21,23. Consequently, it is necessary to study whether this effect of COVID-19 is due to direct action on lung tissue or due to its neurotoxicity at the level of the brainstem, by affecting the respiratory center, which responds to changes in blood pH and CO2 levels 24.In summary, more studies are required to obtain additional information on the neurotoxic effects of COVID-19. However, with the aforementioned data, we can suggest that this coronavirus has neurotropic properties with neuroinvasive activity, which should be investigated, looking for therapeutic tools to reduce the damage that could be left at the nervous tissue level.ReferencesWorld Health Organization, Novel Coronavirus (2019-nCoV) Situation Report – 22, 2020Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, Chang J, et al., Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol . 2020;77;1–9.Helms J, Kremer S, Merdji H, Clere-Jehl R, Schenck M, Kummerlen C, Collange O, et al., Neurologic Features in Severe SARS-CoV-2 Infection. N Engl J Med . 2020;382;2268-2270.Paniz-Mondolfi A, Bryce C, Grimes Z, Gordon RE, Reidy J, Lednicky J, Sordillo EM, Fowkes M. Central nervous system involvement by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). 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Guillain-Barré syndrome: The first documented COVID-19-triggered autoimmune neurologic disease: More to come with myositis in the offing. Neurol Neuroimmunol Neuroinflamm . 2020;7; e781.Faucher A, Rey PA, Aguadisch E, Degos B.Isolated post SARS-CoV-2 diplopia. J Neurol. 2020;1–2.Joob B, Wiwanitkit V. COVID-19 and Guillain-Barré syndrome. Rev Neurol (Paris), 2020.Wang L, Shen Y, Li M, Chuang H, Ye Y, Zhao H, Wang H. Clinical manifestations and evidence of neurological involvement in 2019 novel coronavirus SARS-CoV-2: a systematic review and meta-analysis. J Neurol . 2020;1–13.Asadi-Pooya AA, Simani L Central nervous system manifestations of COVID-19: A systematic review. J Neurol Sci . 413,116832..Kanwar D, Baig AM, Wasay M. Neurological manifestations of COVID-19. J Pak Med Assoc. 2020;70(Suppl 3), S101-S103.Kosugi EM, Lavinsky J, Romano FR, Fornazieri MA, Luz-Matsumoto GR, Lessa MM, Piltcher O, Sant’Anna GD. Incomplete and late recovery of sudden olfactory dysfunction in COVID-19. 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Introduction: Dental caries is an infectious disease with predominantly of cariogenic bacteria such as Streptococcus mutans (S. mutans). Xylitol is considered as one of the effective agents that can limit this dental infection. In this randomized, placebo-controlled trial, we aimed to evaluate the potential reflection of short-term xylitol consumption on pro-inflammatory cytokines (TNF-, IL-6 and IL-8) and S. mutans counts by ELISA and qPCR (Quantitative real-time PCR), respectively. Methods: In this study, 154 participants were assigned to two groups, control and xylitol. Dental examination, saliva and swab samples were done at baseline and at 3-week for clinical and microbiological assessment. Results: In xylitol group at the end of 3-week, gingival and plaque index scores were significantly decreased with respect to baseline values (p<0.001 and p<0.05, respectively). The salivary concentration of TNF-, IL-6 and IL-8 were statistically declined at 3-week, more so than those at baseline in xylitol group (p<0.001). S. mutans expression was reduced about 5-fold at 3-week use of xylitol and it was a statistically significant difference compared to baseline (p<0.001). Conclusion: Intriguingly, even short-term consumption of xylitol might play a favorable role in maintaining the oral health status, possibly as a result of decreasing the release of pro-inflammatory cytokines and the counts of S. mutans. Nonetheless, this investigation warrants further endorsement.
Background: Pharmacogenomics (PG) is a modern tool of personalizing treatment protocols to improve the efficacy and safety of drug prescriptions. These benefits are offset by a slow uptake in clinical application due to a host of physician factors, patient factors, and/or health system factors. Our study, thus, aimed to determine the knowledge, attitude, future expectations, and perceived barriers of medical students and physicians in Jordan regarding PG testing. Methods: A descriptive, cross-sectional study was conducted between February-August 2019. Physicians and senior medical students from academic and non-academic institutions in North Jordan (n=424) were surveyed. A structured, self-administered questionnaire was designed and piloted for the purpose of the study. A scoring system for each dimension assessed was calculated and presented using means. Mean scores were compared by sociodemographic and professional variables. Results: The response rate was 70.7%. The mean total PG knowledge score (±SD) was 5.42 (±1.51) out of 10, with a significantly higher mean among respondents aged ≥30 years (5.21 ± 1.62) compared to those <30 years-old (5.54 ± 1.43; p= 0.03). The mean total PG attitude score was 21.18 (±2.58) out of 24, with significant differences by seniority levels evident (p= 0.03). The future expectations of PG among our sample were high, with a mean score of 10.44 (±1.64) out of 12. The top three perceived barriers in applying PG were the high cost, lack of clinical guidelines, and limited knowledge and awareness. Conclusion: Physicians and medical students in Jordan have low overall knowledge, albeit strongly positive attitude and future expectations toward PG, despite the perceived high cost and lack of clinical guidelines. Thus, we strongly recommend adopting a comprehensive educational strategy that aims to integrate PG concepts into medical curricula, and promote the culture of continuous medical education about PG among practitioners.
Background Atopic dermatitis (AD) is the chronic inflammatory disorder that affects both in childhood and adulthood. Mounting evidence indicates that gut dysbiosis contributes to AD via the gut-skin axis. Constipation can result in alteration of the gut microflora. The clinical impact of constipation on AD has not been researched. Therefore, we aim to assess the risk of AD in constipated patients by the population-based cohort study. Methods We collected 87015 constipated people and 87015 people without constipation between 1999 and 2013 from the Taiwanese National Health Insurance Research Database. Propensity score analysis was administrated to match age, gender, comorbidities, and medications at a ratio of 1:1. Multiple Cox regression analysis was utilized to evaluate the adjusted hazard ratio of AD. In addition, sensitivity tests and a stratified analysis were conducted. Results The incidence of AD was 4.7 per 1,000 person-years in the constipation group, which was higher than the rate of 2.2 per 1,000 person-years observed in the non-constipation group. After adjustment for age, gender, comorbidities, corticosteroids, and antihistamine, constipated people had a 2.11-fold greater risk of AD compared to those without constipation (adjusted hazard ratio [aHR]: 2.11 (95% C.I. 1.98-2.24). Moreover, constipated people had a higher likelihood of AD, regardless of gender, comorbidities, as well as the usage of corticosteroids, and antihistamines. Conclusion Constipation is associated with a significantly risk factor of AD. Clinicians should be careful of the possibility of AD in constipated people. Further study is warranted to investigate the possible pathological mechanisms of this relationship.
Background: The relationship between socioeconomic status (SES) and the prognosis of HF with reduced (HFrEF) vs. preserved (HFpEF) ejection fraction remains unsettled. Objective: To analyze the relationship between SES and the prognosis of patients with incident HFrEF and HFpEF. Methods: Prospective study over 15 years (2003-2017) on 9658 patients diagnosed with HF. Main outcomes were mortality and hospitalizations for HF. The independent relationship between SES and the prognosis, stratifying patients for cardiovascular co-morbidity after propensity score-matching was analyzed. Results: After matching 7116 patients, during a median follow-up of 8.11 years, 5616 patients died (78.9%) and 5549 patients were hospitalized (78.0%). High income level was associated with a lower all-cause mortality (RR for HF patients [95% CI]: 0.86 [0.80-0.92], RR for HFrEF: 0.88 [0.82-0.95] and RR for HFpEF: 0.82 [0.75-0.90], P <0.001 in all cases), and cardiovascular mortality (RR for HF: 0.84 [0.76-0.92], RR for HFrEF: 0.87 [0.81-0.93] and RR for HFpEF: 0.88 [0.77-0.88], P <0.001 in all cases), less hospitalizations (RR for HF: 0.70 [0.65-0.78], RR for HFrEF: 0.78 [0.68-0.88] and RR for HFpEF: 0.61 [0.55-0.68], P <0.001 in all cases), and less 30-day readmissions (RR for HF: 0.67 [0.59-0.75], RR for HFrEF: 0.71 [0.63-0.79] and RR for HFpEF: 0.61 [0.55-0.69], P <0.001 in all cases), after adjustment for comorbidities, and other potential confounders. Analyses of recurrent hospitalizations gave larger SES benefits than time-to-first-event analyses. Conclusions: In this propensity-matched study, a high net annual household income is associated with an improved prognosis of patients with incident HFrEF and HFpEF.
Objective: We aimed to investigate the demographic shifts in emergency service admissions, possible measures and room for improvement in emergency services during the Covid-19 pandemic. Methodology: Our study retrospectively analyzed the demographic features and clinical admission types of patients admitted to Batman District State Hospital Emergency Service at two different time periods, one prior to the Covid-19 pandemic and the other during the Covid-19 pandemic. The results were compared between the two periods designated as the pandemic period and the pre-pandemic period. Results: The number of patients admitted to emergency service was 47.681 in the pre-pandemic period and 9455 in the pandemic period (p<0.01). The number of patients admitted for trauma was 1247(2.61%) in the pre-pandemic period and 59(0.62%) in the pandemic period (p<0.01). The number of patients hospitalized to cardiology department or coronary care unit for acute coronary syndrome was 602(1.26%) in the pre-pandemic period and 29(0.3%) in the pandemic period (p<0.01). The number of patients hospitalized to neurological intensive care unit for acute cerebrovascular disease was 542(1.13%) in the pre-pandemic period and 22(0.2%) in the pandemic period (p<0.01). The number of patients hospitalized to pulmonary diseases department or intensive care unit for dyspnea was 622(1.21%) in the pre-pandemic period and 515 (5.4%) in the pandemic period (p <0.01). Conclusion: Measures taken to prevent the spread of Covid-19 infection have caused a significant drop in emergency service admissions. We are of the opinion that this will lead to an increase in deaths occurring at home, and we will soon encounter patients with worse prognosis and overcrowded emergency services. In order to prevent this problem, we believe that the public awareness about emergency conditions requiring emergency service admission should be heightened alongside of the ‘stay home’ calls.
The COVID-19 pandemic has transformed lives across the world. In the UK there has been a public health driven policy of population ‘lockdown’ that had enormous personal and economic impact. We compare UK response/outcomes including excess deaths with European countries with similar levels of income/healthcare resources. We calibrate estimates of the economic costs as different %loss in GDP against possible benefits of avoiding life years lost, for different scenarios where local COVID-19 mortality/comorbidity rates were used to calculate the loss in life expectancy. We apply quality-adjusted life years (QALY) value of £30,000 (maximum under NICE guidelines). The implications for future lockdown easing policy in the UK are also evaluated. The spread of cases across European countries was extremely rapid. There was significant variation both in severity and timing of both implementation and subsequent reductions in social restrictions. There was less variation in the trajectory of mortality rates and excess deaths, which have fallen across all countries during May/June 2020. The average age at death and life expectancy loss for non-COVID-19 was 79.1 and 11.4years respectively while COVID-19 were 80.4 and 10.1years; including for life-shortening comorbidities and quality of life reduced this to 5QALY for each COVID-19 death. The lowest estimate for lockdown costs incurred was 50% higher than highest benefits from avoiding the worst mortality case scenario at full life expectancy tariff and in more realistic estimation they were over 50 times higher. Application to potential future scenarios showed in the best case a QALY value of £220k (7xNICE guideline) and in the worst-case £3.7m (125xNICE guideline) was needed to justify the continuation of the lockdown. The evidence suggests that the costs of continuing severe restrictions in the UK are so great relative to likely benefits in numbers of lives saved so that a substantial easing in restrictions is now warranted.