Poincaré plots to analyze photoplethysmography signal between non-smokers and smokers

<span>An analysis of blood circulation was used to identify variations of heart rate and to create an early warning system of autonomic dysfunction. The Poincaré plot analyzed blood circulation using photoplethysmography (PPG) signals between non-smokers and smokers in three different indices: SD1, SD2, and SD1 SD2 ratio (SSR). There were twenty subjects separated into non-smoker and smoker groups with sample sizes of 10, respectively. An independent sample t-test to compare the continuous variables. Whereas, the comparison between two groups employed Fisher’s exact test for categorical variables. The result showed that SD1 was found to be considerably lower in the group of smokers (0.03±0.01) than that of the non-smokers (0.06±0.03). Similarly, SSR was recorded at 0.0012±0.0005 and 0.0023±0.0012 for smoking and non-smoking subjects, respectively. As a comparison, SD2 for non-smokers (25.7±0.5) was lower than smokers (27.3±0.4). In conclusion, we revealed that the parameters of Poincaré plots (SD1, SD2, and SSR) exert good performances to significantly differentiate the PPG signals of the group of non-smokers from those of smokers. We also supposed that the method promises to be a suitable method to distinguish the cardiovascular disease group. Therefore, this method can be applied as a part of early detection system of cardiovascular diseases.</span>

Dental extraction, intensity-modulated radiotherapy of head and neck cancer, and osteoradionecrosis

Objective To seek evidence for osteoradionecrosis (ORN) after dental extractions before or after intensity-modulated radiotherapy (IMRT) for head and neck cancer (HNC). Methods Medline/PubMed, Embase, and Cochrane Library were searched from 2000 until 2020. Articles on HNC patients treated with IMRT and dental extractions were analyzed by two independent reviewers. The risk ratios (RR) and odds ratios (OR) for ORN related to extractions were calculated using Fisher’s exact test. A one-sample proportion test was used to assess the proportion of pre- versus post-IMRT extractions. Forest plots were used for the pooled RR and OR using a random-effects model. Results Seven of 630 publications with 875 patients were eligible. A total of 437 (49.9%) patients were treated with extractions before and 92 (10.5%) after IMRT. 28 (3.2%) suffered from ORN after IMRT. ORN was associated with extractions in 15 (53.6%) patients, eight related to extractions prior to and seven cases related to extractions after IMRT. The risk and odds for ORN favored pre-IMRT extractions (RR = 0.18, 95% CI: 0.04–0.74, p = 0.031, I2 = 0%, OR = 0.16, 95% CI: 0.03–0.99, p = 0.049, I2 = 0%). However, the prediction interval of the expected range of 95% of true effects included 1 for RR and OR. Conclusion Tooth extraction before IMRT is more common than after IMRT, but dental extractions before compared to extractions after IMRT have not been proven to reduce the incidence of ORN. Extractions of teeth before IMRT have to be balanced with any potential delay in initiating cancer therapy.

SARS-CoV-2 Gastrointestinal Shedding in Hospitalized Children

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a respiratory virus that can cause gastrointestinal (GI) symptoms, with studies demonstrating detection of stool viral RNA weeks after respiratory tract clearance. It is unknown if children who test negative for SARS-CoV-2 on a nasopharyngeal (NP) swab may be shedding the virus in their stool. OBJECTIVE: To measure the prevalence of SARS-CoV-2 stool shedding in children with positive and negative SARS-CoV-2 NP polymerase chain reactions (PCR) tests, and to determine clinical factors associated with GI shedding. METHODS: In this cross-sectional study, we enrolled hospitalized patients 0 to 21 years old with a positive or a negative SARS-CoV-2 NP PCR test who had respiratory and/or GI symptoms. Participants were surveyed, and stool samples were sent for viral PCR testing. Fisher’s exact test was used to evaluate bivariate associations of stool PCR test positivity with categorical variables. RESULTS: Sixty-seven patients were consented; 34 patients did not provide stool samples so 33 patients were included: 17 NP-positive and 16 NP-negative for SARS-CoV-2. Eight of the 17 NP-positive patients had a positive stool PCR test for SARS-CoV-2, while none of the 16 SARS-CoV-2 NP-negative patients had a positive result (P &lt; .01). For the 17 SARS-CoV-2 NP-positive patients, GI symptoms were associated with a positive stool PCR test (P = .05) for SARS-CoV-2, but this association was not found for all 33 patients (P = .11). No associations were found with patients in an immunocompromised state or those with a comorbid condition, fever and/or chills, respiratory symptoms, headache and/or myalgias, or anosmia and/or ageusia. CONCLUSIONS: SARS-CoV-2 GI shedding is common and associated with GI symptoms in NP-positive children, with 47% having positive stool PCRs for SARS-CoV-2. GI shedding was not demonstrated in SARS-CoV-2 NP-negative children.

Pandemia da covid-19 e os impactos nas atividades acadêmicas no brasil

A pandemia COVID-19 intensificou a diversidade de tecnologias de aprendizagem na educação superior, de maneira impositiva, desmistificou usos remotos, à fronteira da totalidade do ensino à distância a todos cursos superiores, em atendimento aos protocolos sanitários. Todavia, os eixos de aprendizagem (Ensino-Pesquisa-Extensão), tiveram que se adequar ao emprego das tecnologias educacionais. Sob essa abordagem, emergem questões, buscando examinar impactos que os docentes vivenciaram na pandemia para assegurar continuidade de tais eixos. Os dados contaram com 560, respostas válidas, de docentes da educação superior, distribuídos em todas regiões do Brasil. O estudo de abordagem quantitativa contou com o método da estatística não paramétrica, teste qui-quadrado, teste exato de Fischer e U de Mann Whitney. Resultados demonstraram que a adaptação e adoção de novas estratégias aos eixos de aprendizagem foram superadas pelos docentes sem identificações de impactos notórios que gerassem barreiras ou impeditivos. Entretanto, as relações familiares e sociais, assim como a saúde mental e física dos docentes, despertaram como impactos percebidos. Estudos foram sugeridos empregando expectativas diversas, sob contextos que analisem a exclusão digital e a saúde mental como interseccionalidade e enfoque de discussão em período pandêmico e pós-pandemia em países em desenvolvimento. The pandemic COVID-19 intensified the diversity of learning technologies in higher education, in an imposing way, demystified remote uses, to the border of the totality of distance learning to all higher education courses, in attendance to sanitary protocols. However, the learning axes (Teaching-Research-Extension) had to adapt to the use of educational technologies. Under this approach, questions emerge, seeking to examine the impacts that the teachers experienced in the pandemic to ensure the continuity of these axes. The data counted on 560 valid answers from teachers of higher education, distributed in all regions of Brazil. The quantitative approach study relied on the non-parametric statistical method, chi-square test, Fischer's exact test, and Mann Whitney's U test. Results showed that the adaptation and adoption of new strategies to the learning axes were overcome by the teachers without the identification of notorious impacts that would generate barriers or impediments. However, family and social relationships, as well as the mental and physical health of the faculty members aroused as perceived impacts. Studies were suggested employing diverse expectations under contexts that analyze digital exclusion and mental health as intersectionality and focus of discussion in pandemic and post-pandemic period in developing countries.

Prevalence of Findings in Routine Abdominal Ultrasound in Patients with Systemic Autoimmune Rheumatic Diseases and Their Impact on Therapeutic Decision Making

Patients with systemic autoimmune rheumatic diseases (SARD) often receive abdominal ultrasound examinations to screen for organ involvement; yet, the spectrum of findings and their clinical relevance are poorly understood. We conducted a retrospective chart review of inpatients from a rheumatological referral centre with an abdominal ultrasound between 1 January2006 and 31 December 2015, examining 1092 SARD patients with a total of 1695 inpatient stays. The mean age was 55.1 years (range: 17–90 years, SD: 15.8), and the mean disease duration was 6.4 years (range: 0.0–52.8 years, SD: 9.1). A total of 87.5% of the patients were female. The most frequent ultrasound findings were hepatic steatosis (in 26.8% of all patients), splenomegaly (15.2% of all patients), pancreatic lipomatosis (14.3% of all patients) and aortic sclerosis (13.9% of all patients). Based on glucocorticoid and disease-modifying antirheumatic drug use, we identified cases where immuno-modulatory medication was escalated; there was an association between therapy escalation and the findings of hepatomegaly and pleural effusion (as tested via Fisher’s exact test). In patients with several examinations during the defined time span (n = 318), we found ultrasound findings to change, especially findings of hepatomegaly, pleural effusion and splenomegaly. When justifying decisions regarding the further treatment of a patient in the discharge letter, abdominal ultrasound results were rarely discussed. Abdominal ultrasound rarely yielded disease-specific or treatment-changing results.

Celiac Disease in Autism Spectrum Disorder: Data from an Italian Child Cohort

Background: In recent decades some studies described the frequent co-occurrence of celiac disease autoimmunity and/or overt celiac disease in patients with autism. Therefore, it was suggested that celiac disease could play a possible role in the etiopathogenesis of autism spectrum disorder. However, several other studies have not confirmed this association. The aim of the present study was to elucidate the potential association between autism spectrum disorder and celiac disease.Methods: We prospectively collected data from an Italian cohort of 223 children at the time of their clinical diagnosis of autism spectrum disorder in the 2019-2020 period. A serological celiac disease screening was performed and data were available for 196 patients; male (M):female (F) ratio = 4.4:1; median age = 3.6 years; age range = 1.6–12.8 years. Full-blown celiac disease was established according to the diagnostic algorithm of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) 2012 or 2019 guidelines. Fisher’s exact test was used to compare the celiac disease seroprevalence and prevalence in our autism spectrum disorder cohort and in the Italian healthy pediatric population studied by Gatti et al. to highlight the possible differences between the two groups.Results: A not statistically significant difference between the celiac disease seroprevalence in our autism spectrum disorder cohort (4.08%) and Gatti’s Italian healthy group (2.22%) was found, p = 0.0810; OR = 1.871. A similar result emerged for overt celiac disease prevalences (2.24% versus 1.58%, respectively), p = 0.2862; OR = 1.431.Conclusions: Our data validates a weakness of association between autism spectrum disorder and celiac disease. Regular screening for celiac disease in young patients with autism spectrum disorder is not strongly recommended to a greater extent than in the general population.

Evaluating Dental Faculty’s Perspective regarding Emergency Introduction of Online Teaching and Learning: Early Experience during COVID-19 Lockdown in United States

Objectives. The March 2020 lockdown mandated institution closures and forced educators to provide remote instruction. We intended to gain an in-depth and holistic understanding of dental faculty’s experience and perceptions during this mandatory shift. Insights were gathered in 6 key areas: prior remote instruction experience; magnitude of transition and frequency of instruction methods used; training received; preferred teaching methods based on how they promote student learning, interaction, engagement, and performance; social impact; and future of teaching. Methods. An anonymous QualtricsXM survey was distributed to all dental faculties at University of Detroit Mercy in May 2020. Data was collected over a three-week period and analyzed using Statistical Package for the Social Sciences (SPSS) Statistics 26 (IBM; Armonk, New York, USA). Pearson chi-squared test and Fisher’s exact test were used to evaluate categorical data. Results. Out of the 30 participants who transitioned to online remote instruction, 16 (53.3%) reported an age between 30 and 49 years and 14 (46.7%) reported ≥50 years of age. Our analysis revealed that faculty in 30–49-year age range had no prior online synchronous teaching experience. The transition was described as interesting, useful, time-consuming, and challenging. In-person live teaching received highest number of first place rankings (50%), and online asynchronous method received highest number of last place rankings (42.86%). Faculties in >50 year age range expressed maximum satisfaction with online small-group discussions, and those in 30–49 years age group were more satisfied with one-on-one online discussion. Conclusion. Our study finds that the faculty tends to gravitate to online methods that are similar to or mimic their past in-person teaching environment. Forced remote instruction gave new content delivery experiences to faculties of all ranges of age and experience in teaching. This exposure is likely to result in a more widespread adoption of a variety of instructional methods in future. Our study strongly suggests that traditional in-person instruction is the preferred method for delivery of content and is likely better for student learning. Majority of the faculties believed that the future of dental education would be a mix of both in-class and online instruction. In summer and fall 2021, our institution adopted hybrid, flexible models for didactic instruction to allow students the opportunity to digest content in their preferred method. Careful planning and systematic, continued training will be required to enhance technological skills and to incorporate newer models into didactic and clinical instruction. For the success of blended learning, courses will need redesigning of assessment methods, commitment, and support from administrators.

Handheld echocardiographic screening for rheumatic heart disease in rural South Kordofan, Sudan by junior medicals: Supporting task shifting for control of a serious disease

Background Rheumatic heart disease (RHD) is a major and preventable cause of cardiac mortality in Sudan, particularly in Kordofan. It can be detected early with a handheld echocardiography machine. Methods A cross-sectional study was conducted in South Kordofan State, Sudan (as part of a medical convoy organized by Khartoum Medical Students Association). A team of shortly trained medical students and newly graduated doctors conducted a handheld echocardiographic screening using a simplified protocol. All suspected cases were recorded and reviewed later by a senior pediatric cardiologist. Demographic and clinical features of screened subjects were studied. Data analysis was performed using the Statistical Package for Services and Solutions (SPSS 25). Descriptive statistics were presented as “number (%)” or “mean ± SD”. RHD prevalence was expressed as cases per 1000, and Chi-Square test/Fisher’s Exact test was used to compare RHD findings between different groups. Results The disease frequency was found to be 50 per 1000. Out of 452 screened subjects (age 10-25 years), 23 were found to have RHD with a male to female ratio of 1:1.5. Echocardiographic quality was acceptable in 93% of studies. The disease was mild in 70% and moderate or involving 2 valves in 30% of patients. Patients were contacted, advised to start penicillin prophylaxis and referred to cardiologists. Risk factors for the disease included father's occupation and village of residence. Conclusion Shortly trained junior medicals can assist in RHD echocardiographic surveillance in remote areas. South Kordofan state is highly endemic for RHD and a control program needs to be implemented. Handheld echocardiography is of value for early detection and management.

Analysis of Exotic Parasitic Infection in a Large Group of Imported Dogs Following an Animal Welfare Investigation

Background: Increased dog relocation can cause dissemination of parasite and vector populations and this is being recognised in countries across Northern Europe, including the UK. Data regarding the prevalence of exotic infections entering the UK would be beneficial to vets to help assess pets entering the UK from abroad, and to help calculate risk of establishment of novel pathogens. One such group of dogs were seized as part of an RSPCA-led animal welfare investigation and blood tested for exotic pathogens. Methods: As part of the RSPCA investigation, 151 dogs were removed from the site. Blood tests were performed for Babesia. canis, Ehrlichia canis, Hepatozoon canis and Leishmania infantum by PCR, Br.canis by antibody serology and D.immitis by blood antigen. In addition to pathogen screening, a serology titre for Rabies was measured for each dog. A clinical examination was performed by a veterinary surgeon and clinical signs recorded. Clinical signs data were analysed by the Fisher-Freeman-Halton Exact TestResults: Overall, 24% of the dogs tested positive for an infection. Two dogs were positive for Br.canis antibodies and had no clinical signs indicative of infection. Leishmania infantum was identified in 10.5% of dogs with all but two cases being diagnosed in dogs whose microchip originated in Romania. Hepatozoon canis was identified in 9.6% of dogs, all of which had a Romanian microchip. Dirofilaria immitis was identified in 4.1% of dogs, B.canis in 2.3% of dogs and E.canis was only present in 1.5% of dogs tested. Only four dogs were found to have co-infections. No significant association was found between the pathogens detected and presenting clinical signs. Conclusions: This study demonstrates a range of exotic pathogens entering the UK including Br.canis and demonstrates the importance of screening imported dogs. The emphasis for early recognition of exotic pathogens in imported dogs has relied on screening based on relevant clinical signs and the country of origin. While these factors are useful, this study demonstrated no significant association between presenting clinical signs and the pathogens carried.

Obesity and Metabolic Dysregulation in Children Provide Protective Influenza Vaccine Responses

The most effective intervention for influenza prevention is vaccination. However, there are conflicting data on influenza vaccine antibody responses in obese children. Cardio-metabolic parameters such as waist circumference, cholesterol, insulin sensitivity, and blood pressure are used to subdivide individuals with overweight or obese BMI into ‘healthy’ (MHOO) or ‘unhealthy’ (MUOO) metabolic phenotypes. The ever-evolving metabolic phenotypes in children may be elucidated by using vaccine stimulation to characterize cytokine responses. We conducted a prospective cohort study evaluating influenza vaccine responses in children. Participants were identified as either normal-weight children (NWC) or overweight/obese using BMI. Children with obesity were then characterized using metabolic health metrics. These metrics consisted of changes in serum cytokine and chemokine concentrations measured via multiplex assay at baseline and repeated at one month following vaccination. Changes in NWC, MHOO and MUOO were compared using Chi-square/Fisher’s exact test for antibody responses and Kruskal–Wallis test for cytokines. Differences in influenza antibody responses in normal, MHOO and MUOO children were statistically indistinguishable. IL-13 was decreased in MUOO children compared to NWC and MHOO children (p = 0.04). IL-10 approached a statistically significant decrease in MUOO compared to MHOO and NWC (p = 0.07). Influenza vaccination does not provoke different responses in NCW, MHOO, or MUOO children, suggesting that obesity, whether metabolically healthy or unhealthy, does not alter the efficacy of vaccination. IL-13 levels in MUO children were significantly different from levels in normal and MHOO children, indicating that the metabolically unhealthy phenotypes may be associated with an altered inflammatory response. A larger sample size with greater numbers of metabolically unhealthy children may lend more insight into the relationship of chronic inflammation secondary to obesity with vaccine immunity.