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Τρίτη 24 Ιανουαρίου 2023

Low prevalence of influenza viruses and predominance of A(H3N2) virus with respect to SARS‐CoV‐2 during the 2021–2022 season in Bulgaria

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Abstract

Social distancing, mask-wearing, and travel restrictions during the COVID-19 pandemic have significantly impacted the spread of influenza viruses. The objectives of this study were to analyze the pattern of influenza virus circulation with respect to that of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Bulgaria during the 2021–2022 season and to perform a phylogenetic/molecular analysis of the hemagglutinin (HA) and neuraminidase (NA) sequences of representative influenza strains. Influenza infection was confirmed using real-time reverse transcription polymerase chain reaction in 93 (4.2%) of the 2193 patients with acute respiratory illness tested wherein all detected viruses were subtyped as A(H3N2). SARS-CoV-2 was identified in 377 (24.3%) of the 1552 patients tested. Significant differences in the incidence of influenza viruses and SARS-CoV-2 were found between individual age groups, outpatients/inpatients, and in the seasonal distribution of cases. Two cases of coinfections were identified. In hospitalized patients, the C t values of influenza viruses at admission were lower in adults aged ≥65 years (indicating higher viral load) than in children aged 0–14 years (p < 0.05). In SARS-CoV-2-positive inpatients, this association was not statistically significant. HA genes of all A(H3N2) viruses analyzed belonged to subclade 3C.2a1b.2a. The sequenced viruses carried 11 substitutions in HA and 5 in NA, in comparison to the vaccine virus A/Cambodia/e0826360/2020, including several substitutions in the HA antigenic sites B and C. This study revealed extensive changes in the typical epidemiology of influenza infection, including a dramatic reduction in the number of cases, diminished genetic diversity of circulating viruses, changes in age, and seasonal distribution of cases.
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What ultimately matters in root canal treatment success and tooth preservation: a 25‐year cohort study

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Abstract

Aim

There are currently no prospective studies evaluating the long-term outcomes of non-surgical root canal treatments beyond 5 years, both in terms of treatment success and tooth preservation, and identifying factors predictive of treatment outcome. The aim of the present work was therefore to fill this gap by assessing these outcomes over time and identifying predictive variables based on a systematic data collection over a 25-year period.

Methodology

Data concerning the treatments (N=2500) were systematically collected since 1990. Information was recorded among clinical, technical, radiographic, patient-related characteristics, i.e. approximately 150 variables for each treatment. The data were analysed regarding both treatment success and tooth preservation by multivariable Cox proportional hazards model and survival curves were generated. Statistical significance level was set at 0.0125.

Results

56.4% of the treatments could be followed over time (0−25y, mean=6.5y, median=5y). Survival probability decreased almost linearly for treatment success, with about 85% after 5 years and 60% after 20 years, and for tooth preservation, with about 90% at 5 years and 50% at 20 years. The variables significantly associated with treatment failure were: pre-operative pain (Hazard Ratio – HR=1.56 (95%CI 1.23−1.97), persistent pain (HR=2.63 (95%CI 1.44−4.80), good operator rating of treatment prognosis (HR=0.46 (95%CI 0.36−0.58), size of periapical bone radiolucency (HR=1.88 (95%CI 1.67−2.11), and tooth type (p=0.0006). For tooth extraction, they were: combined endodontic-periodontal lesion (HR=3.37 (95%CI 1.88−6.05), pre-existing complication before treatment (HR=1.67 (95%CI 1.26−2.21), good operator rating of treatment prognosis (HR=0.45 (95%CI 0.33−0.60), clinical failure of root canal treatment (HR=2.78 (95%CI 1.98−3.89) and tooth type (p=0.0012).

Conclusion

Root canal treatment success and tooth preservation on the arch are not static outcomes, but evolve with time. Among a substantial set of potential predictors, only a small proportion was significantly predictive of treatment success and tooth preservation, most of them being disease and patient characteristics, and not technical aspects, except pre-existing complications. These observations challenge the importance frequently given to byzantine considerations related to the numerous technical details of endodontic procedures, as opposed to general concepts of good clinical practice.
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Preoperative Prediction of Sinonasal Inverted Papilloma‐associated Squamous Cell Carcinoma (IP‐SCC)

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Preoperative Prediction of Sinonasal Inverted Papilloma-associated Squamous Cell Carcinoma (IP-SCC)

The relatively low diagnostic sensitivity of in-office punch biopsy to detect inverted papilloma associated squamous cell carcinoma (IP-SCC) indicates the need to identify other clinical and radiological features associated with IP-SCC. IP patients with chronic systemic diseases, a history of tobacco smoking, facial pain, or epistaxis, and those with bony destruction, remodeling, or invasion of adjacent structures on preoperative radiologic imaging may be at higher risk of IP-SCC, suggesting the need for more aggressive surgical strategies.


Introduction

Sinonasal inverted papillomas (IP) can undergo transformation into IP-squamous cell carcinomas (IP-SCC). More aggressive treatment plan should be established when IP-SCC is suspected. Nevertheless, inaccuracy of the preoperative punch biopsy results to detect IP-SCC from IP raises the need for an additional strategy. The present study aimed to investigate significant clinicoradiological remarks associated with IP-SCC than IP.

Material and Methods

Postoperative surgical specimens obtained from patients with confirmed IP or IP-SCC at a single tertiary medical center from 1997 to 2018 were retrospectively evaluated. Patients' demographic and clinical characteristics, preoperative in-office punch biopsy results, and preoperative computed tomography (CT) or magnetic resonance images were reviewed. Univariate and multivariate analyses were performed to assess the odds ratio (OR) associated with IP-SCC. The area under the curve (AUC) in the receiver Operating Characteristic (ROC) curve was calculated in the prediction model to discriminate IP-SCC from IP.

Results

The study included 44 IP-SCC and 301 patients with IP. The diagnostic sensitivity of in-office punch biopsy to detect IP-SCC was 70.7%. Multivariate analysis showed that factors significantly associated with IP-SCC included tobacco smoking >10PY (adjusted-OR [aOR]: 4.1), epistaxis (aOR: 3.4), facial pain (aOR: 4.2), bony destruction (aOR: 37.6), bony remodeling (aOR: 36.3), and invasion of adjacent structures (aOR: 31.6) (all p < 0.05). Combining all significantly related clinicoradiological features, the ability to discriminate IP-SCC from IP reached an AUC of 0.974.

Conclusion

IP patients with a history of tobacco smoking, facial pain, epistaxis, and bony destruction, remodeling, or invasion of an adjacent structure on preoperative images may be at higher risk for IP-SCC.

Level of Evidence

3 Laryngoscope, 2023
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Strategies to build and maintain competence in pain management: insights from a SIAARTI survey on educational needs among Italian anesthesiologists

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Abstract

Purpose

Fulfilling educational needs in pain management should be a lifelong process, even involving physicians board certified in pain medicine such as the anesthesiologists/pain therapists. The aim of the study was to investigate Italian anesthesiologists' self-perceived competency, confidence, and interest to attend educational programs in relation to their seniority in pain management.

Methods

SIAARTI members were sent an online questionnaire addressing the following items: education, skills (both soft and hard skills), technical expertise and engaged to participate between December 2020 and January 2021. Participants rated their competence based on the following range (no knowledge, knowledge, competence) while their agreement to attend educational courses was assessed with a 5-point Likert-type scale.

Results

Less than one in four participants declare to be dedicated to pain medicine activity with greater proportion among older (over 61 years) compared to younger ones (31-40 years). Regarding cancer and chronic non-cancer pain a positive gradient of self-perceived competence has been observed in relation to seniority. In contrast, no gradient of self-perceived competence was reported about musculoskeletal and low back pain. Participants self-perceived competent in both opioid use and prevention of opioid-related adverse event while feeling less competent when managing drugs with abuse potential. The lowest competence has been observed in pediatric pain along with the lowest interest to attend educational courses. Participants were much and very much interested to education regarding cancer, non-cancer, musculoskeletal and low back pain, invasive analgesic procedures but less regarding items for which they declared less competence, such as use of pain scales, pain management in children and use of drugs with abuse potential.

Conclusion

This work provides first evidence of a summative assessment of competency and related educational needs' profile of anesthesiologists/pain therapists thus paving the way for developing a nationwide educational program to improve chronic pain care in Italy.
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Extended External Rhinoplasty Approach For Nasal Dermoids With Intracranial Extension

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Extended External Rhinoplasty Approach For Nasal Dermoids With Intracranial Extension

We present an extended external rhinoplasty approach with bilateral marginal and alar base incisions for removal of a nasal dermoid cyst with intracranial extension in a 3-year-old patient. This approach provides adequate exposure, enables nasal bone osteotomies, and allows access to the skull base while achieving a cosmetically acceptable scar. Laryngoscope, 2023
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Myer‐Cotton Grade of Subglottic Stenosis Depends on Style of Endotracheal Tube Used

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Myer-Cotton Grade of Subglottic Stenosis Depends on Style of Endotracheal Tube Used

The Myer-Cotton grade of subglottic stenosis depends on the style of endotracheal tube used. Using updated values from currently available endotracheal tubes aims to keep this grading system valid with respect to surgical approach and outcomes following surgery.


Objectives

Determine percentage of subglottic stenosis using current endotracheal tube (ETT) cross-sectional areas as actual, compared with previously published ETT cross-sectional areas as expected, and determine if style of ETT could result in a change in percentage of stenosis or Myer-Cotton grade.

Study Type

Cross-sectional study.

Design

Prospective analysis.

Methods

Eight styles of uncuffed pediatric ETT from four manufacturers ranging from 2.0 to 6.0 inner diameter (ID) were evaluated. ID and outer diameter (OD) measurements were obtained from each company's specification sheets. Cross-sectional area was calculated for each ETT using the formula (Area = πr 2 ). The cross-sectional areas of each current ETT (actual) were compared with those of previously published ETTs (expected) based on age, and the degree of stenosis was calculated using the formula [1- (Area actual/Area expected)] × 100%. Ranges of percentage for each style of ETT were calculated.

Results

There was an increase in range of OD and area with increasing size of ETT ID, with the largest range in OD being 0.8 mm, and the largest range in area being 10.55 mm2. The median interquartile range (IQR), range of percentage stenoses was 11 (5%), ranging from 0% to 21%. Seven of 28 (25%) ranges were found to span two Myer-Cotton grades.

Conclusions

The Myer-Cotton grade of subglottic stenosis depends on the style of ETT used. Using updated values from currently available ETTs aims to keep this grading system valid with respect to surgical approach and outcomes following surgery.

Level of Evidence

NA Laryngoscope, 2023
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Gender Gap in Parental Leave Intentions

alexandrossfakianakis shared this article with you from Inoreader

Despite global commitments and efforts, a gender-based division of paid and unpaid work persists. To identify how psychological factors, national policies, and the broader sociocultural context contribute to this inequality, we assessed parental-leave intentions in young adults (18–30 years old) planning to have children (N = 13,942; 8,880 identified as women; 5,062 identified as men) across 37 countries that varied in parental-leave policies and societal gender equality. In all countries, women intended to take longer leave than men. National parental-leave policies and women's political representation partially explained cross-national variations in the gender gap. Gender gaps in leave intentions were paradoxically larger in countries with more gender-egalitarian parental-leave policies (i.e., longer leave available to both fathers and mothers). Interestingly, this cross-national variation in the gender gap was driven by cross-national variations in women's (rather than men's) leave intentions. Financially generous leave and gender-egalitarian policies (linked to men's higher uptake in prior research) were not associated with leave intentions in men. Rather, men's leave intentions were related to their individual gender attitudes. Leave intentions were inversely related to career ambitions. The potential for existing policies to foster gender equality in paid and unpaid work is discussed.
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Peri‐implantitis: A bibliometric network analysis of top 100 most‐cited research articles

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Abstract

Background

Over the past decades, there has been an increase in research publications focusing on peri-implantitis. When facing limited healthcare resources, bibliometric analyses can guide researchers and funding parties toward areas where reallocation or more focus on research activity is warranted. The main objective of this study was to identify the trends of the top 100 cited articles on peri-implantitis research as the first study of its kind.

Methods

A Web of Science search, using the keywords "peri-implantitis or periimplantitis" was built to create a database of the most-cited articles. Articles were ranked by citation count and screened by two independent reviewers. The bibliometric characteristics of the studies were gathered and analyzed using several bibliometric software. Author collaborations, author clusters, and keyword co-occurrence network analyses were also performed. The correlation between the citation count and the age of each article was tested.

Results

The top 100 cited papers were published from 1994 to 2018 and the total citation counts ranged from 119 to 972 with 244.5 citations/paper on average. There was no correlation between the age of the articles and the citation count (p-value = 0.67). 21% of the studies consisted of prospective clinical studies. 35% of the papers focused on treatment and prevention of peri-implantitis while 65% concerned epidemiology. The top three most prolific countries were Sweden (n = 31), Germany (n = 15), and Switzerland (n = 13). We found 12 authors who had greater than five publications on the list. Also, the most published journal was Clinical Oral Implants Research.

Conclusion

This study provides insight into the characteristics and quality of the most highly cited peri-implantitis literature. This revealed a deficiency in terms of the number of studies on treatment strategies as well as a higher level of evidence studies among the most- impactful papers on peri-implantitis at the moment.
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Prevalence of medication administration errors in hospitalized adults

alexandrossfakianakis shared this article with you from Inoreader

Abstract

Background

Previous estimates to meta-analyze administration error rates were limited by the high statistical heterogeneity, restricting their use.

Objectives

To investigate sources of heterogeneity in pooled administration error rates in hospitalized adults.

Methods

We systematically searched scientific databases up to November 2017 for studies presenting error rates/relevant numerical data in hospitalized adults. We conducted separate meta-analyses for the numerators: One Medication Error (OME) (each dose can be correct or incorrect) and Total Number of Errors (TNE) (more than one error per dose could be counted), using the generic inverse variance with a 95%-confidence interval. Heterogeneity was assessed using the I2 and Cochran's Q test.

Results

We meta-analyzed 33 studies. The global pooled analyses based on the OME and TNE numerators showed very high heterogeneity (I2=100%;p<0.00001). For each meta-analysis, subgroup analyses based on study characteristics (countries, wards, population, routes of administration, error detection methods, and medications) yielded results with consistently elevated heterogeneity. Beyond these characteristics, we stratified the studies according to the mean error prevalence level as the threshold. Based on the OME numerator, we identified two subgroups of low (0.15[0.13-0.17];I2=0%;p=0.43) and high (0.26[0.24-0.27];I2=38%;p=0.17) pooled prevalence rates, with controlled heterogeneity. Similarly, for the TNE numerator, we identified two subgroups of low (0.10[0.09-0.10];I2=0%;p=0.76) and high (0.28[0.27-0.29];I2=0%; p=0.89) pooled prevalence rates, with controlled heterogeneity. These subgroups differed regarding the denominators used : Total opportunities for errors versus others (doses, observations, administrations).

Conclusion

Calculation methods, specifically the denominator, seem a primary factor in explaining heterogeneity in error rates. Standardizing numerators, denominators, and definitions is necessary.
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The potential of biophysiology for understanding motivation, engagement and learning experiences

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Abstract

Background and Aims

Integrative models applied to human learning and performance emphasize the joint operation of biological, psychological, social, and educational processes to fully understand human functioning. Educational psychology researchers have typically emphasized psycho-educational and psycho-social factors in motivation, engagement and learning, but do not often consider the biophysiological factors.

Results

This Editorial and Special Issue advances current understanding on the role of biophysiological factors and processes in students' and teachers' motivation, engagement, and learning experiences, by showcasing recent educational research that included biophysiological measures and methods.

Conclusions

As we discuss, conducting integrative biophysiological and psycho-educational research has potential to derive vital substantive, methodological, and applied insights that provide a rigorous basis for more effective educational theory, research, and practice.
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