Effect of Different Irrigating Solutions on Root Canal Dentin Microhardness-A Systematic Review with Meta-Analysis.

The aim of this study was to evaluate the effect of different irrigating solutions as well as their combination and activation modes on root canal dentin microhardness. The protocol was registered in PROSPERO and PRISMA guidelines were followed. The structured question was as follows: "Which type of irrigating solution used in endodontic treatment causes more change in dentin microhardness?" The literature was screened via PubMed, Google Scholar, Scopus, and Science Direct. The last search was carried out in February 2023 with English language restriction. Two reviewers independently performed screening and evaluation of articles. A total of 470 articles were retrieved from all the databases, whereas only 114 articles were selected for full-text analysis. After applying eligibility criteria, 44 studies were evaluated and included in this review. The results showed that with increased contact time with irrigants, dentin microhardness decreases. Increased contact time with sodium hypochlorite (NaOCl) was associated with more reduction in dentin microhardness compared with other irrigants. Other irrigants, with the exception of distilled water, including EDTA, citric acid, herbal irrigants, glycolic acid, phytic acid, etc., in this study significantly decreased dentin microhardness. The maximum reduction in dentin microhardness was seen with 2.5% NaOCl after 15 min of contact time. The use of irrigating solutions alters the chemical composition of dentin, thereby decreasing its microhardness, which affects the clinical performance of endodontically treated teeth.

Effect of exercise based interventions on sleep and circadian rhythm in cancer survivors-a systematic review and meta-analysis.

Background: Disrupted circadian rhythm commonly reported in cancer survivors is closely associated with cancer related fatigue, sleep disturbances and compromised quality of life. As more cancer survivors request non-pharmacological treatment strategies for the management of their chronic sleep-related symptoms, there is a need for meta-analyses of various interventions such as exercise on sleep and circadian rhythm disturbances. Methods: A search for RCT's was conducted in April 2020 and updated in July 2023 using relevant keywords for cancer, sleep, circadian rhythm and exercise interventions on PubMed, Scopus, Web of Science, PEDro and CINAHL. Results: Thirty-six studies were included for qualitative analysis and 26, for meta-analysis. Thirty-five studies analyzed sleep outcomes, while five analyzed circadian rhythm. RCT's studying the effect of aerobic exercise, resistance exercise, combined aerobic and resistance exercise, physical activity, yoga, or tai chi were included. Meta-analysis results showed significant exercise-related improvements on sleep quality assessed by Pittsburgh Sleep Quality index (PSQI) (SMD = -0.50 [-0.87, -0.13], p = 0.008), wake after sleep onset (WASO) (SMD = -0.29 [-0.53, -0.05], p = 0.02) and circadian rhythm, assessed by salivary cortisol levels (MD = -0.09 (95% CI [-0.13 to -0.06]) mg/dL, p < 0.001). Results of the meta-analysis indicated that exercise had no significant effect on sleep efficiency, sleep onset latency, total sleep time and circadian rhythm assessed by accelerometry values. Conclusion: While some sleep and circadian rhythm outcomes (PSQI, WASO and salivary cortisol) exhibited significant improvements, it is still somewhat unclear what exercise prescriptions would optimize different sleep and circadian rhythm outcomes across a variety of groups of cancer survivors. Implication: As exercise does not exacerbate cancer-related circadian rhythm and sleep disturbances, and may actually produce some significant benefits, this meta-analysis provides further evidence for cancer survivors to perform regular exercise.

Initial COVID-19 Severity and Long-COVID Manifestations: An Observational Analysis.

OBJECTIVE: New-onset or persistent symptoms beyond after 4 weeks from COVID-19 are termed "long-COVID." Whether the initial severity of COVID-19 has a bearing on the clinicoradiological manifestations of long COVID is an area of interest. MATERIAL AND METHODS: We did an observational analysis of the long-COVID patients after categorizing them based on their course of COVID-19 illness into mild, moderate, and severe groups. The clinical and radiological profile was compared across these groups. RESULTS: Out of 150 long-COVID patients recruited in the study, about 79% (118), 14% (22), and 7% (10) had a history of mild, moderate, and severe COVID-19, respectively. Fatigue (P = .001), breathlessness (P = .001), tachycardia (P = .002), tachypnea (P < .001), raised blood pressure (P < .001), crepitations (P = .04), hypoxia at rest (P < .001), significant desaturation in 6-minute walk test (P = .27), type 1 respiratory failure (P = .001), and type 2 respiratory failure (P = .001) were found to be significantly higher in the long-COVID patients with a history of severe COVID-19. These patients also had the highest prevalence of abnormal chest X-ray (60%) and honeycombing in computed tomography scan thorax (25%, P = .027). CONCLUSION: The course of long COVID bears a relationship with initial COVID-19 severity. Patients with severe COVID-19 are prone to develop more serious long-COVID manifestations.

Uncontrolled Diabetes Mellitus Predicts Post-COVID-19 Fibrosis.

INTRODUCTION: Post-coronavirus 2019 (COVID-19) complications are now well-recognized and may involve multiple organs. Post-COVID-19 pulmonary fibrosis is one of the serious long-term consequences of COVID-19 infection, and the risk factors for its development largely remain unidentified. AIMS AND OBJECTIVES: The study aimed to evaluate the clinical and radiological profile of post COVID-19 patients with diagnosed diabetes mellitus (DM). MATERIALS AND METHODS: All the patients attending the post-COVID-19 respiratory care center over a period of 1 year who were diagnosed with cases of DM were evaluated for residual clinical symptoms and radiological changes and glycosylated hemoglobin (HbA1c) levels were measured from their blood samples. RESULTS: A total of 50 patients were enrolled in this observational cross-sectional study. Most patients were males in the age group of 45-60 years. Approximately 74% of patients had uncontrolled DM. Patients with uncontrolled DM had a higher probability of having a severe disease with an odds ratio (OR) of 7.30 (0.85, 62.42, and confidence interval (CI) 95%) and were more likely to have fibrotic abnormalities on computed tomography (CT) chest with OR of 3.38 (0.87, 16.86, and CI 95%). CONCLUSION: Uncontrolled diabetes predisposes to the development of post-COVID-19 fibrosis, so physicians should be more vigilant while managing these patients.

Can Immunoexpression of Cancer Stem Cell Markers Prognosticate Tongue Squamous Cell Carcinoma? A Systematic Review and Meta-Analysis.

The objective was to evaluate the association of the immunoexpression of cancer stem cell (CSC) markers with clinicopathological and survival outcomes in tongue squamous cell carcinoma (TSCC) patients. This systematic review and meta-analysis [PROSPERO (CRD42021226791)] included observational studies that compared the association of clinicopathological and survival outcomes with CSC immunoexpression in TSCC patients. Pooled odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals (CI) were used as outcome measures. Six studies identified the association with three surface markers (c-MET, STAT3, CD44) and four transcription markers (NANOG, OCT4, BMI, SOX2). The odds of early-stage presentation were 41% (OR = 0.59, 95% CI 0.42-0.83) and 75% (OR = 0.25; 95% CI 0.14-0.45) lower in CSC and SOX2 immuno-positive cases than immuno-negative cases, respectively. The odds of well-differentiated tumors in transcription marker immuno-positive cases were 45% lower compared to immuno-negative cases (OR = 0.55, 95% CI 0.32-0.96). The odds of positive lymph nodes were 2.01 times higher in CSC immuno-positive cases compared to immuno-negative cases (OR = 2.01, 95% CI 1.11-3.65). Mortality in immuno-positive cases was 121% higher than that in immuno-negative cases (HR = 2.21; 95% CI 1.16-4.21). Advanced tumor staging and grading, lymph node metastasis, and mortality were significantly associated with positive immunoexpression of CSC markers.

Knowledge of Medical Imaging Professionals on Healthcare-Associated Infections: A Systematic Review and Meta-Analysis.

Healthcare-associated infections (HCAIs) are a significant concern for both healthcare professionals and patients. With recent advances in imaging modalities, there is an increase in patients visiting the radiology department for diagnosis and therapeutic examination. The equipment used for the investigator is contaminated, which may result in HCAIs to the patients and healthcare professionals. Medical imaging professionals (MIPs) should have adequate knowledge to overcome the spread of infection in the radiology department. This systematic review aimed to examine the literature on the knowledge and precaution standard of MIPs on HCIAs. This study was performed with a relative keyword using PRISMA guidelines. The articles were retrieved from 2000 to 2022 using Scopus, PubMed, and ProQuest databases. The NICE public health guidance manual was used to assess the quality of the full-length article. The search yielded 262 articles, of which Scopus published 13 articles, PubMed published 179 articles, and ProQuest published 55 articles. In the present review, out of 262 articles, only 5 fulfilled the criteria that reported MIPs' knowledge of Jordan, Egypt, Sri Lanka, France, and Malawi populations. The present review reported that MIPs have moderate knowledge and precautionary standards regarding HCIAs in the radiology department. However, due to the limited studies published in the literature, the current review limits the application of the outcome in the vast MIPs population. This review recommended further studies to be conducted among the MIPs worldwide to know the actual knowledge and precaution standards regarding HCIAs.

Quantification of Indoor Respirable Suspended Particulate Matters (RSPM) and Asthma in Rural Children of Delhi-NCR.

OBJECTIVES: To assess the exposure of indoor respirable suspended particulate matters (PM10, PM2.5, and PM1) and their association with asthma in children in a rural area of Delhi-NCR. METHODS: It was a cross-sectional study. Fifty children with asthma from both biomass fuel users in group A and liquefied petroleum gas (LPG) fuel users in group B households were enrolled along with 50 healthy control subjects. The diagnosis of asthma was done as per the Global Initiative for Asthma (GINA), 2014. The 24-h levels of PM from all three groups of households were measured and compared. The level of PM with confounding factors like smoking and room occupancy was also compared between the groups. RESULTS: The 24-h concentrations of PM10, PM2.5, and PM1 were found significantly higher in the households of group A and group B as opposed to group C (p < 0.001). The number of smokers with a mean pack year and a lack of an exhaust fan was highest in group A and lowest in group C, while diesel and kerosene machines were highest in group B. The PMs were highest in group A even with different confounding factor (p < 0.001). The level of all PM was higher in group B than in group C, despite the presence of both types of fuel in group C households. The level of all PM was highest during the cooking hour. CONCLUSION: The level of 24-h PM was highest in group-A households. However, the level of PM was higher in group-B households than group C despite the presence of biomass fuel users in group C. This may be due to the higher number of smokers, poor room-occupancy and lack of exhaust fans.

Impact of COVID-19 on Mental Health Among Healthcare Workers in India: A Mixed-methods Systematic Review.

Healthcare workers (HCWs) experienced significant mental health challenges during the COVID-19 pandemic. This review aimed to comprehensively assess the impact of the COVID-19 pandemic on the mental health of HCWs in India. We conducted a mixed-methods systematic review, which adopts a results-based convergent approach that incorporates quantitative and qualitative data. A comprehensive literature search was conducted in relevant databases: PubMed-Medline, CINAHL, Web of Science, and ProQuest. All available full-text studies in the English language that assessed the mental health outcomes (anxiety, stress, and depression) of HCWs during the pandemic and published until 28 February 2022 were included. A total of 31 studies were included in this review (27 quantitative studies, three qualitative studies, and one mixed-method study). The pooled prevalence of depression, anxiety, and stress among HCWs in India was 32.96%, 29.49%, and 33.47%, respectively. Integration of quantitative and qualitative findings using social determinants of health framework resulted in various contributing factors and coping strategies. There is a need for a supportive work environment, mental health support, and mental health policies for HCWs in India.

Relationship between physical activity, objective sleep parameters, and circadian rhythm in patients with head and neck cancer receiving chemoradiotherapy: A longitudinal study.

OBJECTIVES: This study was developed to assess the relationship between physical activity, sleep and circadian rhythm using accelerometer and urine melatonin levels in patients with head and neck cancer (HNC). Also, this study evaluated the changes in physical activity, sleep, and circadian rhythm during the seven-week course of chemoradiotherapy. METHODS: This longitudinal study recruited 27 participants diagnosed with HNC who were planning to undergo chemoradiotherapy. Accelerometers worn for 3 days during the 1st, 3rd, and 7th weeks of chemoradiotherapy were used to assess physical activity levels (step count and metabolic equivalents [METs]) and sleep quality (total sleep time [TST], sleep onset latency [SOL], and sleep efficiency [SE]). Urine melatonin analysis was conducted using the morning void urine sample on 1st, 3rd, and 7th weeks. The change in variables during the seven weeks and the correlation between them were analyzed. RESULTS: During the seven weeks, trends of reduction in variables of physical activity, sleep and circadian rhythm were observed with significant decrease in step count, TST and melatonin levels. SE was found to have strong negative correlation with physical activity. TST was found to have moderate correlation with SE and step count. The variables of physical activity also showed moderate correlation among them. CONCLUSION: This study concludes that higher physical activity is associated with poor SE due to increased night-time activity. There was a significant reduction in physical activity and sleep observed during seven weeks with moderate association between them. The significant circadian rhythm deregulation however showed poor association with the other variables.Level of Evidence: 2b.

Systemic corticosteroids for management of 'long-COVID': an evaluation after 3 months of treatment.

Some patients even 4 weeks after Corona Virus Disease 2019 (COVID-19) remain to be symptomatic and are known as "long-COVID". In the present study we performed the follow up evaluation at 3 months of long-COVID patients, after treatment with systemic steroids. During the study duration, out of the 4,542 patients managed in the outpatient department of the particular unit, there were 49 patients of Long-COVID. The patients having abnormal computed tomography (CT) alongwith resting hypoxia or exertional desaturation were treated with systemic steroid (deflazacort) in tapering doses for 8-10 weeks. We retrospectively analysed the clinical and radiological findings of these patients at first presentation and at about 3 months of follow up visit. On follow up, all the 49 long-COVID patients showed improvement. The occurrence of breathlessness decreased from 91.83% to 44.89% (p<0.001) and cough from 77.55% to 8.16% (p<0.001). Twenty-four patients were prescribed systemic steroids. Out of these, nearly 58% patients had MMRC grade 4 breathlessness, which decreased to < 2 MMRC in about 86% of these patients. MMRC grade (median) decreased from 3 to 1 (p<0.001). Majority of patients who were tachypnoeic and hypoxic at rest (n=7) showed improvement (71%), post-treatment with corticosteroids. Occurrence of normal chest X-ray increased from 12% to 71% (p<0.001). All these patients had abnormal CT thorax initially, and post-treatment 25% had normal CT thorax. Hence, we conclude that systemic steroids are helpful in hastening recovery of select subset of long-COVID patients. Simultaneously, we should be cautious of immunosuppressive effects of steroids like tuberculosis reactivation, especially in tuberculosis endemic countries. These findings have therapeutic implications and may serve as guidance for future approach to the management of 'long-COVID' with pulmonary sequalae.

Maximal Respiratory Pressures and Maximum Voluntary Ventilation in Young Arabs: Association with Anthropometrics and Physical Activity.

BACKGROUND: Maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP) and maximum voluntary ventilation (MVV) measurements assist in determining the respiratory muscle strength and endurance. These determinants of respiratory muscles vary significantly by age, gender, height, and ethnic origin. Normative values for maximum respiratory pressures (MRPs) and MVV would aid in evaluating respiratory muscle function in athletes, estimating performance, and assisting in rehabilitation. In addition, the reference values may aid in determining the efficacy of therapeutic interventions in young people with chronic respiratory diseases. The purpose of this study was to see how respiratory muscle strength indices correlated with anthropometric and physical activity characteristics in young Arabs. METHODOLOGY: The study included 80 male volunteers and 85 female volunteers ranging in age from 18 to 30 years. MicroRPM was used to measure MIP and MEP, and pulmonary function test data, including MVV values, were recorded. All subjects completed the Global Physical Activity Questionnaire (GPAQ) and anthropometric measurements. Unpaired t-tests or Mann-Whitney U-tests were used to determine male-female differences. Using the Pearson correlation coefficient and Spearman Rho correlation coefficient tests, MIP and MEP values were correlated with body composition and physical activity. Using stepwise multiple linear regression analysis, the relationships between respiratory function (MVV, MIP, and MEP) and PFT values (FVC, FEV1, and FEV1/FVC), physical activity, and sedentary behavior were investigated. RESULTS: MIP, MEP, and MVV values were significantly lower in females than in males. MIP, MEP, and MVV values had a moderate correlation with forced vital capacity, forced expiratory volume in 1 second, and height, but not with weight, BMI, or GPAQ. Age, gender, and body mass index were found to be significant predictors of maximal respiratory pressures in a young Arab population. CONCLUSION: Maximum respiratory pressures and maximal voluntary ventilation were significantly lower in young Arabs than in other ethnic groups; these values were influenced by gender and height but not by levels of physical activity.

Prevalence of COPD among population above 30 years in India: A systematic review and meta-analysis.

BACKGROUND: By 2030, Sustainable Development Goal 3.4 aims to reduce the premature mortality caused by non-communicable diseases through prevention and treatment. Chronic obstructive pulmonary disease is the second leading cause of mortality and disability-adjusted life years in India. This review was conducted to estimate the prevalence of COPD using systematic review and meta-analysis technique. METHOD: Search was conducted using six databases for studies on COPD among population above 30 years in India between years 2000 to 2020. Cross-sectional and cohort studies reporting prevalence of COPD and associated risk factors were included in the present review. Screening and data extraction was done by two authors independently. Studies were appraised for quality using the modified New Castle Ottawa scale and reporting quality was assessed using STROBE guidelines. RESULT: Our search returned 8973 records, from which 23 records fulfilled the eligibility criteria. Overall, the prevalence of COPD among population aged 30 years and above in India was 7%. Risk factors like active and passive smoking, biomass fuel exposure, environmental tobacco smoke, occupational exposure to dust, indoor and outdoor pollution, and increasing age were reported to have a significant association with COPD among Indian population. CONCLUSION: Our findings suggest the need for a multicentric national-level research study to understand COPD burden and its contributing risk factors. The findings also suggest the need for COPD sensitive health literacy program focused on early screening and primary prevention of risk factors for COPD, which may help early initiation of self-management practices, that are crucial for better quality of life.

Prevalence of musculoskeletal chest pain in the emergency department: a systematic review and meta-analysis.

OBJECTIVES: Our objective was to systematically review and meta-analyse relevant studies to determine the prevalence of musculoskeletal chest pain in the emergency department. METHODS: This review was constructed while confirming to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. PubMed, Cochrane Library, SCOPUS, Science Direct, and OVID were systematically searched from their inception to January 19, 2020, to identify observational studies, where the prevalence of musculoskeletal causes of chest pain was reported in isolation or in combination with other causes or could be calculated from the available data. RESULTS: A meta-analysis of the nine included studies, having a total of 14,743 participants, showed the global pooled prevalence of musculoskeletal chest pain in the emergency department to be 16% (10-22%) [I2=99.24%]. The pooled prevalence for the European continent was 17% (9-25%) [I2=99.51%] and that for the urban areas was 13% (7-19%) [I2=99.00%]. CONCLUSIONS: This review provides a reliable estimate of the prevalence of musculoskeletal chest pain in the emergency department. More studies providing age and gender-specific data for the prevalence of musculoskeletal chest pain in the emergency department should be carried out. A paucity of such data from rural areas also needs to be addressed in future research work. The prevalence values from this study will be useful in the application of Bayesian reasoning utilised in diagnosing patients, where the process of Bayesian arguing begins by knowing pre-test probabilities of different differential diagnosis, in this case that of musculoskeletal chest pain in the emergency department.

Prevalence of low bone mineral density in inflammatory bowel disease and factors associated with it.

BACKGROUND: Patients with inflammatory bowel disease (IBD) have numerous risk factors for low bone mineral density (BMD). We aimed to study the prevalence of low BMD in IBD and the factors associated with it. METHODS: BMD was measured by radial quantitative ultrasound, and clinical and biochemical characteristics were compared in prospectively enrolled patients and healthy age and gender-matched controls. Chi-square test, t test for independent samples, analysis of variance (ANOVA), Mann-Whitney U test and Kruskal-Wallis H tests were used as appropriate for univariate analysis to compare the characteristics between patients with and without abnormal BMD. Binary logistic regression analysis was done to determine the factors associated with low BMD in IBD patients. RESULTS: One hundred and six patients (Crohn's disease [CD] = 35, ulcerative colitis [UC] = 71) and 55 controls were included. Low BMD was equally prevalent in CD, UC and controls (42.9%, 36.6%, 36.4% respectively, p = 0.791). Serum calcium and vitamin D were significantly lower in IBD patients compared to controls (p < 0.001 and p = 0.003, respectively) but not between patients with low and normal BMD. Older age (Odds ratio [OR] = 66.12 [9.299-470.243], p < 0.001), late onset of disease (OR = 4.795 [1.067-21.543], p = 0.041) and absence of steroid usage (OR = 0.272 [0.089-0.832], p = 0.022) were significantly associated with low BMD. CONCLUSIONS: The prevalence of low BMD in patients with IBD was similar to controls and this was associated with increasing age, late onset of disease, and absence of steroid usage. Judicious use of steroids can help preserve bone health in IBD.