Risk Factors for Cerebral Vasospasm After Subarachnoid Hemorrhage: A Systematic Review of Observational Studies.

Cerebral vasospasm (CV) following subarachnoid hemorrhage (SAH) remains one of the leading causes of high mortality and poor outcomes. Understanding the risk factors associated with CV is pivotal to improving patients' outcomes. We conducted an extensive search for analytical observational studies that analyzed the correlation between various variables and the likelihood of CV development among adult patients with SAH (age ≥ 18 years). Five scholar databases were used, namely, PubMed, EBSCO, Web of Science, Science Direct, and Google Scholar. Relevant studies published between January 1st, 2016, and August 9th, 2023, were included. The Newcastle-Ottawa Scale was adopted to assess the risk of bias among included observational studies. A total of 33 studies met the inclusion criteria. Of the 24,958 patients with SAH who were identified, 6,761 patients had a subsequent CV (27.1%). Several statistically significant risk factors were reported across the literature. Younger age, female sex, smoking, alcohol intake, modified Fisher grade 3-4, higher Hunt and Hess grading, and the presence of multiple comorbidities (diabetes, hypertension, congestive heart failure, and history of stroke) were among the well-established risk factors for CV. Additionally, leukocytosis was consistently reported to be a significant predictor in multiple studies, providing compelling evidence for its association with CV. Even though single studies reported an association between CV and certain variables, further research is necessary to investigate the implications of these findings. These include arterial tortuosity, hypokalemia, potassium to glucose gradient, hypoalbuminemia, anemia, von Willebrand factor and vascular endothelial growth factor, use of desflurane, and hemodynamic stability. Overall, this systemic review provides a comprehensive summary of the current data that evaluates the potential risk factors for the development of CV after SAH. However, because of data heterogeneity, certain factors require further validation in their correlation with CV development. Larger-scale observational and clinical trials are mandatory to extensively investigate the significant predictors of CV to lay the scientific foundation for improving outcomes in susceptible patients with SAH.

Left ventricular strain in neonates using 2-dimensional speckle tracking: Normal range and relation with bi-plan ejection fraction.

OBJECTIVES: Echocardiographic assessment of Left ventricular systolic function is traditionally being performed by estimation of fractional shortening (FS) and ejection fraction (EF). Speckle tracking echocardiography (STE) is a promising tool for assessment of myocardial function. The aim of this study is to evaluate the global longitudinal strain (GLS) using 2D-STE in healthy neonates to establish normal reference ranges. METHOD: It is a retrospective study through an analysis of transthoracic echocardiogram of normal healthy neonates. We enrolled all neonates in our institution from January 1st, 2021 to February 28th, 2021. 2-D STE was used to assess left ventricular GLS from the apical views. RESULTS: 185 neonates were enrolled. Mean value for left ventricle GLS (%) was -19.9 ± 1.2, GLS-derived EF (%) was 60.0 ± 2.7; while the left ventricle EF by biplane Simpson's method (%) was 61.0 ± 3. There is a good positive correlation between the Left Ventricle EF by biplane Simpson's method and EF by 2-D STE, which was statistically significant (r = .294, n = 102, p = .003). Apical 4-chamber longitudinal strain and strain-derived EF is significantly correlated with GLS and bi-plan EF respectively. CONCLUSION: 2-STE is feasible technique for analyzing newborn myocardial systolic function. The normal range of GLS in neonates is not much different than reported for the pediatric. There is a good positive correlation between the Left Ventricle EF by 2-D STE and EF by biplane method.

Mid-Term Outcome of Left Ventricle Reverse Remodeling After Atrial Septal Defect Closure: A Comparison Between Surgical and Device Groups.

Right ventricular (RV) volume overload occurs in patients with significant atrial septal defect (ASD II) shunts, which can impair left ventricle (LV) filling, thus decreasing LV indices. However, after ASD II closure, the left ventricle regains near normal dimensions. The purpose of this study was to compare the long-term outcomes of LV reverse remodeling between device and surgical closure. We retrospectively reviewed the echocardiographic data of 222 patients with isolated ASD II who underwent surgical (95 patients) or device closure (127 patients) between January 2012 and December 2017. The ASD II was significantly larger in the surgical closure group (p < 0.001.) leading to a higher degree of paradoxical interventricular septal (IVS) movement. In contrast, the LV volume was larger in the device closure group (p < 0.001). After a median follow-up period of 19.5 months, the maximum LV systolic and diastolic volumes were reached at 1 year in the device closure group and 2 years in the surgical closure group. IVS motion normalized in 91% of the device closure group compared to 57% of the surgical closure group (p = < 0.001). There was significant improvement in left ventricular indices and IVS motion after ASD II closure in both groups but more favorable in patients after device closure.

ADAMTS19-associated heart valve defects: Novel genetic variants consolidating a recognizable cardiac phenotype.

Recently, ADAMTS19 was identified as a novel causative gene for autosomal recessive heart valve disease (HVD), affecting mainly the aortic and pulmonary valves. Exome sequencing and data repository (CentoMD) analyses were performed to identify patients with ADAMTS19 variants (two families). A third family was recognized based on cardiac phenotypic similarities and SNP array homozygosity. Three novel loss of function (LoF) variants were identified in six patients from three families. Clinically, all patients presented anomalies of the aortic/pulmonary valves, which included thickening of valve leaflets, stenosis and insufficiency. Three patients had (recurrent) subaortic membrane, suggesting that ADAMTS19 is the first gene identified related to discrete subaortic stenosis. One case presented a bi-commissural pulmonary valve. All patients displayed some degree of atrioventricular valve insufficiency. Other cardiac anomalies included atrial/ventricular septal defects, persistent ductus arteriosus, and mild dilated ascending aorta. Our findings confirm that biallelic LoF variants in ADAMTS19 are causative of a specific and recognizable cardiac phenotype. We recommend considering ADAMTS19 genetic testing in all patients with multiple semilunar valve abnormalities, particularly in the presence of subaortic membrane. ADAMTS19 screening in patients with semilunar valve abnormalities is needed to estimate the frequency of the HVD related phenotype, which might be not so rare.

Patient Satisfaction Following Orthodontic Treatment: A Systematic Review.

Patient-reported outcome measures (PROMs) have become increasingly important in orthodontic treatment as they reflect patients' perceptions of treatment outcomes. Understanding patient satisfaction with orthodontic treatment is crucial for improving healthcare delivery and patient-centered care. This systematic review aimed to critically appraise the evidence regarding patient satisfaction after orthodontic treatment, exploring the effects of different treatment types, patient demographics, and other factors on satisfaction levels. Eight electronic bibliographic databases were searched without publication time or language restrictions, including PubMed®, Scopus®, the Cochrane Central Register of Controlled Trials, Web of Science™, Embase®, Google™ Scholar, Trip, and OpenGrey. A manual search was conducted on the references in the included papers. Eligibility criteria were established based on the Population, Intervention, Comparison, Outcomes, and Study (PICOS) framework. Studies were included if they reported patient satisfaction levels following orthodontic treatment using standardized questionnaires. Two reviewers independently collected and analyzed the data. The risk of bias was assessed using Cochrane's risk of bias tool (RoB2) for randomized clinical trials, and the methodologic quality for cohort and cross-sectional studies was assessed using the modified version of the Newcastle-Ottawa scale. Fourteen studies employed various questionnaires and timings to gauge post-orthodontic treatment satisfaction. Patient satisfaction levels were generally high, with most studies reporting satisfaction rates above 91%. Fixed orthodontic appliances were associated with higher satisfaction levels compared to removable appliances. While age and gender did not significantly influence satisfaction, the quality of care and doctor-patient relationships were crucial factors in patient satisfaction. This systematic review proves that patient satisfaction with orthodontic treatment is generally high, with fixed appliances and positive doctor-patient relationships contributing to higher satisfaction levels. However, the quality of the evidence was moderate to low, highlighting the need for further high-quality clinical studies in this area.

Establishment of Neural Series Transmission Keys (NSTKs) and Security in the Field of COVID-19 Telepediatric Oral Health.

In this exceptional COVID-19 crisis, telemedicine had arisen as a substitute technique for medicines. Even more unequivocally, pediatric children were at high risk to outside homes. The spread of COVID-19 has suddenly ascended. Because of lockdown conventions and isolation protocols, kids were confined to live inside their homes. Non-emergency youngsters ought to be managed remotely through the telepediatric health. An establishment of Neural Series Transmission Keys (NSTKs) has been created and security had been planned on the intraoral data. Oral cavity is a kind of dental disease occurring in children. It is for the most cases caused due to drawn out bacterial invasions. Bacterial attacks are more because of sticky chocolates, desserts, sugar, and so forth. Homeopathy medicines are the best prescribed to fix such dental diseases in this current unprecedented COVID-19. Since, it needs no dental medical procedure for the non-invasive kids, which is the reason that the homeopathy medicines are most appropriate in this COVID-19 lockdown stages. The doctor can gather symptoms of the kids from their parents through online interfaces. Some of the normal homeopathy drugs are: Kreasotum, Mercurius, Mezereum, etc. Moreover, in this pandemic situation online telepediatric homeopathy medicines were better alternatives to investigate from home disengages. Additionally it bears no voyaging consumptions and costs. Secure online transmission of clinical pediatric information has been the most challenging issue in COVID-19 telepediatric oral wellbeing. Data mystery factor is protected with tendency in this proposed cryptographic technique. Neural Series Transmission Keys (NSTKs) were established based on neural network based hamming codes. It has been diffused inside the intraoral pediatric data. The proposed key was so particularly amazing that it gives assorted blend after each bit of evolving. Beginning seeds were kept at the dentists and the patients, in order to go against external attacks inside the public channel, especially during this hyper digitized COVID-19 times. Standard graphs were drawn with accuracy using the proposed cryptographic method. The absolute cryptographic time in this strategy was 2.88 ms which was significantly important. By applying Chi Square test, we have noted χ 2 = 17.012, under 5% level of significance.

What Is the Most Effective Frictionless Method for Retracting Anterior Teeth When Using Buccal Fixed-Appliance Therapy? A Systematic Review.

There are various techniques and designs for springs used in orthodontic treatment, including frictionless methods for closing spaces. However, there is limited explicit evidence to support the superiority of one method over another. This review aims to investigate the available evidence and highlight the advantages of these different methods. This review contained six papers, and information such as study design, spring design, applied force systems, variables studied, follow-up period, and records were extracted. All of the studies focused on canine retraction with the Ladanyi spring showing the highest rate of movement (1.8 mm per month) among all springs for upper canine retraction. The Gjessing and T-loop springs outperformed the Reverse Closing Loop and Ricketts spring, respectively, substantially. In terms of tip control, the T-loop spring showed a clear advantage over the modified Marcotte spring with a difference of 1.2° vs. 6.6° per 3 months. Additionally, it was observed that the Reverse Closing Loop caused a significant loss of anchorage during canine retraction with a medial movement of 2.4 mm. When comparing wire types, no significant differences were found between TMA and Nitinol, while stainless steel was found to be less effective in terms of movement rate and tip control. However, the results indicated that there was no clear evidence that one specific technique was definitively preferable to another; therefore, there is an urgent need for more studies with proper study designs to produce more robust conclusions.

Evaluation of the Impact of Orthodontic Treatment on Patients' Self-Esteem: A Systematic Review.

Malocclusion may affect interpersonal relationships, self-esteem (SE), and psychological well-being, weakening patients' psychological and social activities. Several studies investigated the effect of orthodontic treatment on these social and psychological aspects, such as SE. However, the direct relationship between SE and orthodontic treatment has not yet been confirmed. This systematic review aimed to evaluate the existing evidence in the literature concerning the influences of orthodontic treatment on patients' SE systematically and critically. An electronic search in the following databases was done in September 2022: PubMed®, Web of Science™, Scopus®, Embase®, GoogleTM Scholar, Cochrane Library databases, Trip, and OpenGrey. Then, the reference list of each candidate study was checked for any potentially linked papers that the electronic search might not have turned up. Inclusion criteria were set according to the population/intervention/comparison/outcome/study design (PICOS) framework. For the data collection and analysis, two reviewers extracted data separately. The risk of bias 2 (RoB-2) and the risk of bias in non-randomized studies (ROBINS-I) tools were used to assess the risk of bias for randomized controlled trials (RCTs) and non-RCTs, respectively. The grading of recommendations assessment, development and evaluation (GRADE) approach was employed to evaluate the quality of the evidence for each finding. Sixteen studies (five RCTs, seven cohorts, and four cross-sectional) were included in this review. Unfortunately, the results could not be pooled into a meta-analysis. Only six studies have reported an increase in SE after orthodontic treatment (P<0.05 in these studies). No agreement between the included studies was observed regarding the influence of fixed orthodontic treatment, gender, or age on SE. The quality of evidence supporting these findings ranged from very low to low. There is low evidence indicating that fixed orthodontic treatment can improve patients' SE. In addition, unclear data are available about the influence of patients' gender and age on SE after orthodontic treatment. Therefore, high-quality RCTs are required to develop stronger evidence about this issue.

Transcatheter Mitral Valve-in-Valve Implantation in Pediatric Patients.

BACKGROUND: Transcatheter implantation of the Edwards Sapien 3 valve (Edwards Lifesciences, Irvine CA) within the bioprosthetic mitral valve (MV) is an established method of treatment in adults. However, it has not been well studied in the pediatric age group. METHODS: Transcatheter mitral valve-in-valve implantation was attempted in 4 symptomatic pediatric patients with a dysfunctional MV bioprosthesis implanted at an earlier stage due to severe MV stenosis or regurgitation. We reviewed our experience with MV implantation in this cohort. RESULTS: The mean age and weight of the patients at the time of the procedure were 11.4 years (range: 10-14 years) and 36 kg (range: 31-44 kg), respectively. The transmitral mean gradient dropped from a mean of 19.75 mm Hg (range: 15-22 mm Hg) to a mean of 1 mm Hg (range: 0-3 mm Hg) after the procedure. The mean fluoroscopy time was 55.25 minutes (range: 40-72 minutes), and the mean hospital length of stay was 4 days (range: 3-7 days). The patients' functional class improved from New York Heart Association class IV to class I during the follow-up period. CONCLUSIONS: Transcatheter mitral valve-in-valve implantation can be performed safely for dysfunctional bioprosthetic MVs in the pediatric age group with favorable early and midterm outcomes. This procedure offers a viable alternative in patients who have high surgical risk or are deemed unfit for conventional surgery. However, we still recommend a long-term study of this approach in a large cohort, multicentre study.

INTRODUCTION: L'implantation de la prothèse valvulaire Edwards Sapien 3 (Edwards Lifesciences, Irvine, CA) par cathéter dans la bioprothèse valvulaire mitrale (VM) est une méthode de traitement établie chez les adultes. Toutefois, cette méthode n'a pas fait l'objet d'études approfondies auprès d'enfants. MÉTHODES: Une tentative d'implantation valvulaire mitrale de type valve-in-valve par cathéter a été réalisée chez quatre enfants symptomatiques qui avaient une bioprothèse VM dysfonctionnelle implantée antérieurement en raison d'une sténose VM ou d'une régurgitation grave. Nous avons passé en revue notre expérience d'implantation VM auprès de cette cohorte. RÉSULTATS: L'âge et le poids moyens des patients au moment de l'intervention étaient respectivement de 11,4 ans (étendue : 10-14 ans) et de 36 kg (étendue : 31-44 kg). La moyenne du gradient moyen transmitral a baissé. Elle est passée de 19,75 mmHg (étendue : 15-22 mmHg) à 1 mmHg (étendue : 0-3 mmHg) après l'intervention. La durée moyenne de la fluoroscopie était de 55,25 minutes (étendue : 40-72 minutes), et la durée moyenne du séjour à l'hôpital était de quatre jours (fourchette : 3-7 jours). La classification fonctionnelle des patients selon la New York Heart Association a montré une baisse. Les patients sont passés de la classe IV à la classe I durant la période de suivi. CONCLUSIONS: L'implantation valvulaire mitrale de type valve-in-valve par cathéter peut être pratiquée de façon sûre chez les enfants porteurs d'une bioprothèse VM dysfonctionnelle dont les issues à court ou à moyen terme sont favorables. Cette intervention est une alternative viable pour ces patients dont le risque lié à l'intervention chirurgicale est élevé ou considérés inaptes à subir une intervention chirurgicale traditionnelle. Toutefois, nous recommandons encore une étude à long terme sur cette approche, voire une vaste étude multicentrique de cohorte.

Determinants of COVID-19 Vaccine Acceptance among Dental Professionals: A Multi-Country Survey.

PURPOSE: This study sought to investigate the acceptance rate and associated factors of COVID-19 vaccines among dentists and dental students in seven countries. MATERIAL AND METHODS: A structured questionnaire prepared and guided by the report of the SAGE Working Group on Vaccine Hesitancy was distributed among groups of dentists and dental students in seven countries across four continents. RESULTS: A total of 1527 subjects (850 dentists and 677 dental students) participated in this survey. Although 72.5% of the respondents reported their intention to accept COVID-19 vaccines (dentists: 74.4%, dental students: 70.2%), there was a significant difference in agreement between dentists/dental students across countries; generally, respondents in upper-middle-, and high-income countries (UM-HICs) showed significantly higher acceptance rates compared to those in low- and lower-middle income countries (L-LMICs). Potential predictors of higher vaccine acceptance included being a dentist, being free of comorbidity, being well-informed about COVID-19 vaccines, having better knowledge about COVID-19 complications, having anxiety about COVID-19 infection, having no concerns about the side effects of the produced vaccines and being a resident of an UM-HIC. CONCLUSION: The results of our survey indicate a relatively good acceptance rate of COVID-19 among the surveyed dentists and dental students. However, dentists and dental students in L-LMICs showed significantly lower vaccine acceptance rates and trust in COVID-19 vaccines compared to their counterparts in UM-HICs. Our results provide important information to policymakers, highlighting the need for implementation of country-specific vaccine promotion strategies, with special focus on L-LMICs.

A Global Survey of COVID-19 Vaccine Acceptance Among Healthcare Workers.

Objectives: Even though several effective vaccines are available to combat the COVID-19 pandemic, wide disparities in vaccine distribution, and vaccine acceptance rates between high- and low-income countries appear to be major threats toward achieving population immunity. Our global descriptive study aims to inform policymakers on factors affecting COVID-19 vaccine acceptance among healthcare workers (HCWs) in 12 countries, based on income index. We also looked for possible predictors of vaccine acceptance among the study sample. Methods: A structured questionnaire prepared after consultation with experts in the field and guided by the "Report of the SAGE working group on vaccine hesitancy" was administered among 2,953 HCWs. Upon obtaining informed consent, apart from demographic information, we collected information on trust in vaccines and health authorities, and agreement to accept a COVID-19 vaccine. Results: Although 69% of the participants agreed to accept a vaccine, there was high heterogeneity in agreement between HCWs in low and lower-middle income countries (L-LMICs) and upper-middle- and high-income countries (UM-HICs), with acceptance rates of 62 and 75%, respectively. Potential predictors of vaccine acceptance included being male, 50 years of age or older, resident of an UM-HIC, updating self about COVID-19 vaccines, greater disease severity perception, greater anxiety of contracting COVID-19 and concern about side effects of vaccines. Conclusions: COVID-19 vaccine acceptance among HCWs in L-LMICs was considerably low as compared to those from UM-HICs. The lowest vaccine acceptance rates were among HCWs from the African continent. This underlines the need for the implementation of country-specific vaccine promotion strategies, with special focus on increasing vaccine supply in L-LMICs.

A Probabilistic Programming Approach to Protein Structure Superposition.

Optimal superposition of protein structures or other biological molecules is crucial for understanding their structure, function, dynamics and evolution. Here, we investigate the use of probabilistic programming to superimpose protein structures guided by a Bayesian model. Our model THESEUS-PP is based on the THESEUS model, a probabilistic model of protein superposition based on rotation, translation and perturbation of an underlying, latent mean structure. The model was implemented in the probabilistic programming language Pyro. Unlike conventional methods that minimize the sum of the squared distances, THESEUS takes into account correlated atom positions and heteroscedasticity (ie. atom positions can feature different variances). THESEUS performs maximum likelihood estimation using iterative expectation-maximization. In contrast, THESEUS-PP allows automated maximum a-posteriori (MAP) estimation using suitable priors over rotation, translation, variances and latent mean structure. The results indicate that probabilistic programming is a powerful new paradigm for the formulation of Bayesian probabilistic models concerning biomolecular structure. Specifically, we envision the use of the THESEUS-PP model as a suitable error model or likelihood in Bayesian protein structure prediction using deep probabilistic programming.

Comparative cephalometric study of Class II division 1 malocclusion between Lithuanian and Jordanian females.

The Class II malocclusions have a strong hereditary component as etiologic factor, both in families and in ethnic and racial groups. The purpose of this study to compare skeletal and dentoalveolar morphology in Class II division I malocclusion of Lithuanian and Jordanian females. The sample consisted of 60 standardized lateral cephalograms (30 Jordanian - 30 Lithuanian). The mean age of the subjects was 14.8+/-1.11 years. Criteria for cephalometric comparison were 5 linear and 10 angular cephalometric variables. Repeating landmark identification tested reproducibility of the measurements. Unpaired t-test was performed to assess the difference of malocclusion between both groups. Results considered to be statistically significant when p