Evaluating the Diagnostic Performance of Nasal Methicillin-Resistant Staphylococcus aureus Polymerase Chain Reaction in Hospital-Acquired Pneumonia Within the Intensive Care Unit. A Retrospective Study.

Background: The methicillin-resistant Staphylococcus aureus (MRSA) accounts for 20% to 40% of all hospital-acquired pneumonia (HAP) cases with mortality rates up to 55%. Prompt and accurate diagnosis is essential, especially in intensive care unit (ICU) patients. Nasal MRSA polymerase chain reaction (PCR) diagnostic utility evidence is conflicting in the literature for HAP due to a low number of HAP patients included in prior studies or due to the lack of high-yield gold standard cultures defined for comparisons. Methods: This was a retrospective cohort study conducted in a 65-bed medical ICU, and encompassing all adult patients admitted from January 2015 to March 2023 for HAP. Respiratory cultures included were those obtained by bronchoalveolar lavage or endotracheal suction within 7 days of nasal MRSA PCR testing. Results: The study included 412 patients; 56.8% were males and 65% were Whites. The mean age was 60.5 years. Most patients (82.5%) underwent MRSA-PCR before intubation, and the average time between MRSA-PCR and lower respiratory cultures was 2.15 days. The diagnostic performance of nasal MRSA PCR in diagnosing HAP in the ICU yielded a sensitivity (Sen) of 47.83%, specificity (Sp) of 92.29%, positive predictive value (PPV) of 26.83%, and negative predictive value (NPV) of 96.77%. For nonventilator HAP (nv-HAP) cases sensitivity was at 50%, specificity 92.83%, PPV 28.57%, and NPV at 97.00%. In ventilator-acquired pneumonia (VAP-HAP), the corresponding values were 42.86%, 90.91%, 23.08%, and 96.15%, respectively. Conclusion: The nasal MRSA PCR shows a high NPV and low false negative rate, suggesting it is a reliable tool for ruling out MRSA HAP in ICU patients. Care should be taken into account for disease prevalence and clinical context, as these factors may influence test performance. Further validation through prospective large-sample studies utilizing high-yield lower respiratory tract cultures is necessary to confirm our findings.

Optimizing learning comfort: ergonomic influences on children's transition to online education.

The COVID-19 pandemic necessitated the implementation of lockdown measures, resulting in children attending classes from their homes through online platforms. This study aimed to examine the impact of studying at home on children by investigating various aspects related to their study environment. Data were gathered through two questionnaires administered in Jordan: One targeted children aged 8-15 year through interviews, while the other targeted parents with at least one school-aged child through an online survey. The interview-based survey (N = 152) identified significant factors such as the study location, excessive use of computer peripherals, and physical discomforts like back, hand, and ear pain. Similarly, the parent survey (N = 1,152) revealed various significant factors including parents' monthly income, educational level, occupation, living area, sources of COVID-19 information, fear of the virus, TV time, eating and reading habits, smartphone usage, difficulty in concentrating while studying, engagement with social media, internet usage, elbow position, and eye protection.

This study examined the impacts of online learning on children during the COVID-19 pandemic. Based on the findings, the practitioners should focus on factors related to the excessive use of screens, ergonomic setup of study environments, and children's physical discomforts. Furthermore, the parents' socioeconomic status, engagement with media, and educational level played an essential role in shaping children's learning experiences. Strategies to improve the study environment, provide ergonomic guidance, and promote healthy media habits could contribute to the effectiveness and success of online learning during a crisis.

HEART Score Recalibration Using Higher Sensitivity Troponin T.

STUDY OBJECTIVE: We examined the diagnostic performance of a recalibrated History, Electrocardiogram, Age, Risk factors, Troponin (HEART), and Thrombolysis in Myocardial Infarction (TIMI) score in patients with suspected acute cardiac syndrome (ACS). Recalibration of troponin thresholds was performed, including shifting from the 99th percentile to the limit of detection (LOD) or to the limit of quantification (LOQ) We compared the discharge potential and safety of the recalibrated composite scores using a single presentation high-sensitivity cardiac troponin (hs-cTn) T to the conventional scores and with a LOD/LOQ troponin strategy alone. METHODS: We undertook a 2-center prospective cohort study in the United Kingdom (UK) (2018) (Clinicaltrials.gov NCT03619733) to specifically assess recalibrated risk scores (shifting the troponin subset scoring from 99th percentile to LOD [UK]) and combined the results of this with secondary analyses of 2 prospective cohort studies in the UK (2011) and the United States (2018, using LOQ rather than LOD). The primary outcome was major adverse cardiovascular events (MACE), defined as adjudicated type 1 myocardial infarction (MI), urgent coronary revascularization, and all-cause death, at 30 days. We evaluated the original scores using hs-cTn below the 99th percentile and recalibrated scores using hs-cTn

Procedural efficiencies, lesion metrics, and 12-month clinical outcomes for Ablation Index-guided 50 W ablation for atrial fibrillation.

AIMS: The safety of Ablation Index (AI)-guided 50 W ablation for atrial fibrillation (AF) remains uncertain, and mid-term clinical outcomes have not been described. The interplay between AI and its components at 50 W has not been reported. METHODS AND RESULTS: Eighty-eight consecutive AF patients (44% paroxysmal) underwent AI-guided 50 W ablation. Procedural and 12-month clinical outcomes were compared with 93 consecutive controls (65% paroxysmal) who underwent AI-guided ablation using 35-40 W. Posterior wall isolation (PWI) was performed in 44 (50%) and 23 (25%) patients in the 50 and 35-40 W groups, respectively, P < 0.001. The last 10 patients from each group underwent analysis of individual lesions (n = 1230) to explore relationships between different powers and the AI components. Pulmonary vein isolation was successful in all patients. Posterior wall isolation was successful in 41/44 (93.2%) and 22/23 (95.7%) in the 50 and 35-40 W groups, respectively (P = 0.685). Radiofrequency times (20 vs. 26 min, P < 0.001) and total procedure times (130 vs. 156 min, P = 0.002) were significantly lower in the 50 W group. No complication or steam pop was seen in either group. Twelve-month freedom from arrhythmia was similar (80.2% vs. 82.8%, P = 0.918). A higher proportion of lesions in the 50 W group were associated with impedance drop >7 Ω (54.6% vs. 45.5%, P < 0.001). Excessive ablation (AI >600 anteriorly, >500 posteriorly) was more frequent in the 50 W group (9.7% vs. 4.3%, P < 0.001). CONCLUSION: Ablation Index-guided 50 W AF ablation is as safe and effective as lower powers and results in reduced ablation and procedure times. Radiofrequency lesions are more likely to be therapeutic, but there is a higher risk of delivering excessive ablation.

Subcutaneous implantable cardioverter defibrillator: Can it overtake its transvenous counterpart.

Over the past decade, the emergence of the subcutaneous implantable cardioverter defibrillator (S-ICD) has provided cardiologists with an option to provide both primary or secondary prevention treatment of sudden cardiac death (SCD) without the associated risks that come with the use of intracardiac leads. S-ICD may prove to be a useful option in those who are young, have thromboembolic risk, immunodeficiency states, unfavorable anatomy due to adult congenital heart disease (ACHD). This article reviews the existing literature to determine whether S-ICD can prove to be a safe alternative in comparison to Transvenous implantable cardioverter defibrillator (TV-ICD) and in which patient population should S-ICD be considered over TV-ICD.

Atrial Fibrillation in Heart Failure: Focus on Antithrombotic Management.

Heart failure (HF) and atrial fibrillation (AF), increasingly common in the aging population, are closely related and commonly found together. This article explores the relationship between AF and HF and the thromboembolic effect of these diseases. Morbidity and mortality are increased when the 2 conditions are seen together. Stroke risks are significant with AF and all subtypes of HF. This article suggests that all patients with AF and HF should be considered for anticoagulation. Current evidence suggests that non-vitamin K antagonist oral anticoagulants are effective and safe in AF and HF in comparison with warfarin.

The influence of human resource management practices on occupational health and safety in the manufacturing industry.

This study provides an overview of the influence of applying two human resource management (HRM) practices on workers' occupational health and safety (OHS). These practices are selection and recruitment, and development and training. Furthermore, this study highlights the observed activities to define hazards, processes and OHS measures in the manufacturing industries. It also assesses the importance of workers' knowledge and awareness of OHS programs. A structured questionnaire was administered to those working in the manufacturing sector in several countries. The responses were analyzed statistically. The results showed that the demographic variables had a significant impact on workers' knowledge and awareness of OHS programs. In addition, HRM practices played a major role in OHS. Therefore, it is recommended to top management to highly consider OHS practices by integrating them into the workplace, starting from worker selection, all the way to production, operations and management, by establishing a strong HRM system.

Symmetry of gamma distribution data about the mean after processing with EWMA function.

Statistical Process Control (SPC) plays a vital role in maintaining quality and reducing variability in manufacturing processes. Among SPC techniques, the Exponentially Weighted Moving Average (EWMA) stands out for its ability to detect small process shifts quickly, making it a valuable tool in ensuring product consistency and preventing quality issues. EWMA constructs control charts to monitor process mean shifts, tracks product/service quality by identifying variations, and monitors manufacturing process parameters for early detection of deviations and necessary adjustments. EWMA control chart has been proposed as an alternative to the Shewhart control chart. Sequential measurements are processed using the EWMA function before being placed on the control chart. One of the crucial concerns about the EWMA control chart is the asymmetry of the data around the mean. Although processing with the EWMA function reduces data skewness, the problem of asymmetric data may not be solved. The control chart is designed to leave in front of the upper control limit (UCL) α/2 of the data and behind the lower control limit (LCL) another α/2 of the data, and this does not occur in the case of symmetric data. α/2 represents the significance level for each tail in a two-tailed hypothesis test, indicating the probability of incorrectly rejecting the null hypothesis for each side of the distribution. Since many of the distributions in real life can be approximated by the Gamma distribution, the Gamma distribution was adopted in this study. The Monte Carlo simulation methodology was implemented to generate Gamma distributed data, process it with EWMA function and assess the skewness and kurtosis. The purpose of this paper is to evaluate the effect of EWMA parameters on the performance of the EWMA control chart. Moreover, it focuses on skewness and kurtosis reduction after data processing using the EWMA function. The findings help researchers and practitioners to select the best parameters. Further, the research investigates the effect of EWMA parameter on the shape of distribution.

Can Inhaled Nitric Oxide Response Predict Tolerance to Therapies and Survival in Patients With Combined Precapillary and Postcapillary Pulmonary Hypertension?

Inhaled nitric oxide (iNO) relaxes the pulmonary circulation and variably increases the left ventricular preload and pulmonary artery wedge pressure (PAWP)-hemodynamic information that may help guide treatment decisions and assess prognosis in patients with combined precapillary and postcapillary pulmonary hypertension (PH). We included consecutive patients with combined precapillary and postcapillary PH (mean pulmonary artery pressure >20 mm Hg, PAWP >15 mm Hg, and pulmonary vascular resistance [PVR] >2 Woods unit [WU]) who underwent right-sided cardiac catheterization with iNO at the Cleveland Clinic Pulmonary Vascular Disease program between 2017 and 2022. We included 104 patients with baseline PAWP and PVR of 22.2 ± 4.2 mm Hg and 6.1 ± 3.2 WU, respectively. Pulmonary arterial hypertension (PAH) with postcapillary component and PH left heart disease with precapillary component were identified in 27 (26%) and 77 patients (74%), respectively. No side effects were noted during the administration of iNO. During iNO, the PVR decreased 1.1 ± 1.4 WU and the PAWP increased 1.3 ± 3.7 mm Hg. A more pronounced increase in PAWP with iNO was associated with a decrease in PVR (R -0.35, p <0.001) and increase in stroke volume (R 0.20, p = 0.046). Tolerance to PAH-specific medications, overall survival, and heart failure hospitalizations were not significantly associated with the change in PAWP or PVR with iNO. In conclusion, in patients with combined precapillary and postcapillary PH, iNO challenge is safe and caused a significant decrease in PVR, with an increase in PAWP. The changes in PAWP and PVR during iNO administration were not associated with tolerance to PAH-specific medications, heart failure-related hospitalization, or survival.

Atrial Fibrillation in Heart Failure: Focus on Antithrombotic Management.

Heart failure (HF) and atrial fibrillation (AF), increasingly common in the aging population, are closely related and commonly found together. This article explores the relationship between AF and HF and the thromboembolic effect of these diseases. Morbidity and mortality are increased when the 2 conditions are seen together. Stroke risks are significant with AF and all subtypes of HF. This article suggests that all patients with AF and HF should be considered for anticoagulation. Current evidence suggests that non-vitamin K antagonist oral anticoagulants are effective and safe in AF and HF in comparison with warfarin.

Analyzing the invisibility angles formed by vehicle blind spots to increase driver's field of view and traffic safety.

A driver's field of view is an essential requirement for decreasing traffic crashes and increasing safety. This article improves driver safety by analyzing factors that affect the invisibility angles formed by a vehicle's A and B pillars. An experiment was conducted with 117 participants. Two models were developed, each associated with one invisibility angle. In the A-pillar invisibility model, the age, weight, waist circumference, torso angle and distance between eyes and windshield were significant. For the B-pillar model, the age, gender, stature, waist depth, waist breadth, torso angle and distance between steering wheel and abdomen were significant. Some of these factors increase the invisibility angle(s), including age, stature, torso angle, distance between windshield and eyes, and distance between steering wheel and abdomen. Other factors decrease the invisibility angle(s), including weight, waist circumference, waist depth and waist breadth. In addition, gender significantly affects the invisibility angle.

The potential benefits of dinitrophenol combination with chemotherapy in the treatment of ovarian cancer.

BACKGROUND: 2,4-dinitrophenol (DNP), an uncoupling mitochondrial agent, has been identified as a source of oxidative stress and linked to the pathogenesis of ovarian cancer. In this study, we determine the cytotoxic effect of DNP alone or in combination with chemotherapies in ovarian cancer cells. METHODS: We utilized human ovarian cancer cell lines SKOV-3 and MDAH-2774 with their chemoresistant counterparts. Cancer stem cells (CSCs) were isolated from SKOV-3 utilizing magnetic-activated cell sorting technique for CD44+/CD117+ cells. Human normal primary ovarian epithelial (NOEC) and HOSEpiC cell lines were used as a control. Cells were treated with and without chemotherapy (Taxotere 0.3µM or cisplatin 50 µM), with or without increasing doses of DNP (0.125, 0.25, or 0.5 mM) for 24 hours followed by evaluation of cell viability and IC50 utilizing MTT assay. For determination of synergism, Facombination index plots were created using the CompuSyn software. All data were run in triplicates and analyzed by t-test. RESULTS: DNP treatment of ovarian cancer and chemoresistant ovarian cancer cell lines as well as CSCs resulted in decreased cell viability in a dose dependent manner with no effect on normal cells. Combination of DNP with chemotherapy synergistically enhances cytotoxicity of chemotherapeutics in all ovarian cancer cells as compared to chemotherapy alone. CONCLUSIONS: Our data indicates the potential of the addition of DNP to the arsenal of drugs available to treat ovarian cancer, whether alone or in combination with chemotherapies. The synergistic effects of DNP in reducing the required amount of chemotherapy, is critical for the alleviation of harmful side effects.

Effects of Vitamin D Receptor Genotype on Lipid Profiles and Retinopathy Risk in Type 2 Diabetes Patients: A Pilot Study.

Genetic polymorphisms affect lipid profiles and are associated with disease complications. Genetic variants in the vitamin D receptor (VDR) gene are associated with type 2 diabetes mellitus (T2DM). In this study, we investigated the effects of VDR genotypes on the lipid profile and disease complications of T2DM patients in a Jordanian population. Ninety T2DM patients were genotyped for four major functional VDR genetic variants, rs2228570 C > T (FokI), rs7975232 A > C (ApaI), rs731236 T > C (TaqI), and rs1544410 C > T (BsmI), using the polymerase chain reaction−restriction fragment length polymorphism method. Lipid profiles and diabetes complications were analyzed and correlated with VDR genotypes. We found that the VDR rs7975232 and rs1544410 alleles were significantly (p = 0.008−0.04) associated with high-density lipoprotein (HDL) levels and retinopathy among patients. Carriers of the rs7975232 A/A genotype exhibited higher levels (49.68 ± 15.86 mg/dL) of HDL than patients with the A/C (44.73 ± 13.38 mg/dL) and C/C (37.93 ± 9.22 mg/dL) genotypes. Moreover, carriers of the rs1544410 T/T genotype had higher levels of HDL (54.31 ± 16.45 mg/dL) than patients with the C/T (43.57 ± 13.24 mg/dL) and C/C (43.98 ± 13.17 mg/dL) genotypes. T2DM patients who carry the rs7975232 C/C genotype were at higher risk (odds ratio [OR] = 7.88) of developing retinopathy compared with carriers of the rs7975232 C/A and A/A genotypes. In addition, T2DM patients with the rs1544410 C/C genotype had a higher risk (OR = 4.21) of developing retinopathy than patients with the rs1544410 C/T and T/T genotypes. Therefore, we concluded that the VDR rs7975232 and rs1544410 alleles were associated with HDL levels and retinopathy and can be considered as potential genetic biomarkers for the lipid profile and retinopathy complication among T2DM patients in a Jordanian population of Arabic origin. Further studies with larger sample sizes are needed to confirm our findings.

Anesthesia experience in a child affected by congenital cystic adenomatoid malformation and retinopathy of prematurity for eye laser procedure--a case report.

Congenital Cystic Adenomatoid Malformation or bronchopulmonary displasia (congenital lung cysts disease) is a rare condition. Intrauterine death affect severe cases, those infants surviving till birth lead a chronic course of respiratory illness amenable to corrective thoracic surgery or other corrective measures for non pulmonary conditions. This report describes an experience with one girl that needed anesthesia for congenital retinopathy's laser treatment.

The ePortfolio in UK cardiology training: time for a new digital platform?

The UK cardiology specialist training programme utilises the National Health Service (NHS) e-Portfolio to ensure adequate progression is being made during a trainees' career. The NHS e-portfolio has been used for 15 years, but many questions remain regarding its perceived learning value and usefulness for trainees and trainers. This qualitative study in the recent pre-COVID era explored the perceived benefits of the NHS e-Portfolio with cardiology trainees and trainers in two UK training deaneries. Questionnaires were sent to 66 trainees and to 50 trainers. 50% of trainees felt that their development had benefited from use of the ePortfolio. 61% of trainees found it an effective educational tool, and 25% of trainees and 39% of trainers found the ePortfolio useful for highlighting their strengths and weaknesses. 75% of trainees viewed workplace based assessments as a means to passing the ARCP. The results show that the NHS ePortfolio and workplace based assessments were perceived negatively by some trainees and trainers alike, with many feeling that significant improvements need to be made. In light of the progress and acceptance of digital technology and communication in the current COVID-19 era, it is likely to be the time for the development of a new optimal digital training platform for cardiology trainees and trainers. The specialist societies could help develop a more speciality specific learning and development tool.

Risk of Major Bleeding With Potent Antiplatelet Agents After an Acute Coronary Event: A Comparison of Ticagrelor and Clopidogrel in 5116 Consecutive Patients in Clinical Practice.

Background Major bleeding after acute coronary syndrome predicts a poor outcome but is challenging to define. The choice of antiplatelet influences bleeding risk. Methods and Results Major bleeding, subsequent myocardial infarction (MI), and all-cause mortality to 1 year were compared in consecutive patients with acute coronary syndrome treated with clopidogrel (n=2491 between 2011 and 2013) and ticagrelor (n=2625 between 2012 and 2015) in 5 English hospitals. Clinical outcomes were identified from national hospital episode statistics. Bleeding and MI events were independently adjudicated by 2 experienced clinicians, blinded to drug, sequence, and year. Bleeding events were categorized using Bleeding Academic Research Consortium 3 to 5 and PLATO (Platelet Inhibition and Patient Outcomes) criteria and MI by the Third Universal Definition. Multivariable regression analysis was used to adjust outcomes for case mix. The median age was 68 years and 34% were women. 39% underwent percutaneous coronary intervention and 13% coronary artery bypass graft surgery. Clinical outcome data were 100% complete for bleeding and 99.7% for MI. No statistically significant difference was seen in crude or adjusted major bleeding for ticagrelor compared with clopidogrel (Bleeding Academic Research Consortium 3-5, hazard ratio [HR], 1.23; 95% CI, 0.90-1.68; P=0.2, PLATO major adjusted HR, 1.30; 95% CI, 0.98-1.74; P=0.07) except in the non-coronary artery bypass graft cohort (n=4464), where bleeding was more frequent with ticagrelor (Bleeding Academic Research Consortium 3-5, adjusted HR, 1.58; 95% CI, 1.09-2.31; P=0.017; and PLATO major HR, 1.67; 95% CI, 1.18-2.37; P=0.004). There was no difference in crude or adjusted subsequent MI (adjusted HR, 1.20; 95% CI, 0.87-1.64; P=0.27). Crude mortality was higher in the clopidogrel group but not after adjustment, using either Cox proportional hazards or propensity matched population (HR, 0.90; 95% CI, 0.76-1.10; P=0.21) as was the case for stroke (HR, 0.82; 95% CI, 0.52-1.32; P=0.42). Conclusions This observational study indicates that the apparent benefit of ticagrelor demonstrated in a clinical trial population may not be observed in the broader population encountered in clinical practice. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02484924.

Acceptance sampling plans from truncated life test based on Tsallis q-exponential distribution.

In this study, we propose a new single acceptance sampling plan from truncated life test assuming that the quality characteristics follow the Tsallis q-exponential distribution. The proposed plan is given, and then we derived the operation characteristics function and calculate the optimal sample size and producer''s risk for some given parameter values to measure the performance of this plan. Also, a comparative study with other sampling plan is discussed to show the benefit of the proposed plan, and real data analysis is given to illustrate the applicability of the proposed plan in the industry.

Identification of high-risk non-ST elevation myocardial infarction at presentation to emergency department. A prospective observational cohort study in North West England.

OBJECTIVES: Early access to invasive coronary angiography and revascularisation for high-risk non-ST elevation myocardial infarction (NSTEMI) improves outcomes and is supported by current guidelines. We sought to determine the most effective criteria at presentation to emergency department (ED) to identify high-risk NSTEMI. SETTING: Secondary care centre northwest England with national follow-up. PARTICIPANTS: 1642 consecutive patients (median age 59, 52% male) presenting to ED with a primary symptom of chest pain in whom there is suspicion of NSTEMI. PRIMARY AND SECONDARY MEASURES: Multivariate logistic regression analysis for the prediction of all-cause death (primary) and major adverse cardiac event (MACE defined as all-cause death, unplanned coronary revascularisation and adjudicated NSTEMI (third universal definition)) (secondary measure) at 1 year. RESULTS: The incidence of adjudicated NSTEMI was 10.7%, and 1-year mortality was 6.3%. Independent predictors for all-cause death at 1 year were Global Registry of Acute Coronary Events (GRACE) >140, age (per decade increase) and high-sensitive cardiac troponin T (hs-cTnT) >50 ng/L. hs-cTnT >50 ng/L was associated with adjudicated index presentation NSTEMI in the greatest proportion of patients (61.7%). When using MACE at 12 months, as opposed to all-cause death, as an end point History, ECG, Age, Risk factors and Troponin (HEART) score ≥7 was included in the multivariate model and had better prediction of index NSTEMI than GRACE>140. Combining hs-cTnT >50 ng/L and a second independent predictor identified both a high proportion of index NSTEMI and elevated risk of all-cause death at 1 year. CONCLUSIONS: hs-cTnT >50 ng/L or HEART score ≥7 appear effective strategies to identify high-risk NSTEMI at presentation to emergency room with chest pain. Multicentre prospective studies enriched with early presenters, and with competitor high-sensitive and point-of-care troponins, are required to validate and extend these findings. TRIAL REGISTRATION NUMBER: NCT02581540.

The clinical impacts of early using glutamine/arginine enriched high protein density formula at trophic dose in intolerant enteral nutrition cachectic hypoalbuminemic hospitalized patients.

BACKGROUND: We sought to evaluate the clinical impacts of the early administration of trophic doses of a glutamine/arginine enriched enteral nutrition formula (ENF) with a high protein density to cachectic hypoalbuminemic hospitalized patients intolerant to enteral nutrition. METHODS: A retrospective analysis was conducted using the nutritional and non-nutritional data of patients admitted to our institution from April 2017 through August 2019. Patients who died or were discharged before completing ≥1 weeks of hospital admission, or those whose data could not be obtained were excluded. Among other variables, percent changes in serum albumin levels (%∆ALB), C - reactive protein (CRP) and their ratios were expressed as Mean ± SD using the Independent Samples T-test, while categorical variables were expressed as numbers with percentages by using χ2 test. Two tested groups were determined based on the use of ENF: Group I received trophic doses of ENF, while Group II received no enteral nutrition. RESULTS: The overall hospital length of stay (LOS) and overall 28-day hospital mortality were significantly lower in Group I when compared with Group II with Means ± SDs of (11.32 ± 2.19 days vs 23.49 ± 4.33 days) and (13.13% vs. 28.16%), respectively. Also, significantly higher (%∆ALB) for Group I compared with group II (43.48% ± 7.89% vs. 33.45% ± 6.18%), respectively was observed. CONCLUSION: In malnourished hypoalbuminemic patients suffering from feeding intolerance, early trophic administration of glutamine/arginine enriched high protein density ENF was well tolerated and may be associated with increased plasma albumin levels, reduced LOS, and overall 28-day mortality, and hence may be considered in such patients.

Gingival health and relapse tendency: a prospective study of two types of lower fixed retainers.

BACKGROUND: Different types and diameters of wire are used in bonded lingual retainers. Some clinicians bond a small diameter multistrand wire to each tooth, while other clinicians bond a large diameter wire to the lingual surfaces of the lower canines. AIM: To compare the gingival health, plaque accumulation, tooth stability and integrity of multistrand wire and round wire bonded lingual retainers. METHODS: Sixty-two subjects, who had completed treatment and who required fixed retention for the lower anterior segment, were assigned to either the Round wire retainer group or the Multistrand wire retainer group. In the Round wire retainer group, a 0.036 inch round, stainless steel wire was bonded to the lingual surfaces of both lower canines. The Multistrand retainer group had a 0.015 inch multistrand wire bonded to the lingual surfaces of all lower anterior teeth. At least 12 months after debonding, the subjects were recalled and the following variables were recorded: Oral Hygiene Index (OHI), Plaque Index (PI) of the lower anterior teeth, Gingival Index (GI) of the lower anterior teeth, Irregularity Index (IRI) of the lower anterior teeth, and the number of broken retainers. RESULTS: There were no significant differences between the PI (p = 0.165) and GI (p = 0.150) of the two groups. More plaque was found on the distal surfaces of the lower anterior teeth in the group with multistrand wire retainers (p = 0.02). The lower anterior teeth were significantly more irregular in the group with round wire retainers compared to the group with multistrand wire retainers (p = 0.002). Although the multistrand wire retainers fractured more frequently than the round wire retainers the difference was not statistically significant (p = 0.325). CONCLUSION: More plaque accumulated on the distal surfaces of the lower anterior teeth in subjects with multistrand wire retainers than in subjects with round wire retainers. Multistrand wire retainers were better at maintaining incisor alignment than single span, round wire retainers.