The association between obesity and migraine in a population of Iranian adults: a case-control study

Aim

To assess the association between obesity and risk of migraine with aura and features of migraine attacks among a population of Iranian adults.

Flixweed vs. Polyethylene Glycol in the Treatment of Childhood Functional Constipation: A Randomized Clinical Trial

Background:

Polyethylene glycol (PEG) is often considered as the first-line treatment for functional constipation in children. Descurainia sophia (L.) Webb et Berth (D. sophia) is a safe recommended medicine in Iranian folk and Traditional Persian Medicine for the treatment of constipation.

Objectives:

To clinically compare D. sophia with PEG 4000 (without electrolyte) in pediatric constipation and to assess its efficacy and side effects.

Patients and Methods:

120 patients aged 2 - 12 years with constipation for at least 3 months were included in an 8 weeks lasting randomized controlled trial within two parallel-groups. Children received either PEG, 0.4 g/kg/day, or D. sophia seeds, 2 grams (for children aged 2 - 4 years) and 3 grams (for those aged > 4 years) per day.

Results:

A total of 109 patients completed the study (56 in D. sophia and 53 in PEG group). At the end of the study, 36 (64.3%) patients in D. sophia group and 29 (54.7%) in PEG group were out of Rome III criteria (P = 0.205). Median weekly stool frequency in 0, 1, 2, 3 weeks of the treatment was found to be 2, 5, 5, 5 in D. sophia and 3, 4, 4, 5 in PEG group (P = 0.139, 0.076, 0.844, 0.294), respectively. The number of patients who suffered flatulence was less (5, 8.9%) in D. sophia group as compared to PEG group (6, 11.3%) at the end of the trial (P = 0.461). D. sophia taste was less tolerated.

Conclusions:

D. sophia is introduced as a cheap and available medication which can be applied as a safe alternative to conventional PEG in the management of pediatric chronic functional constipation.     

The Effect of Age on Outcomes After Destination-Therapy Left Ventricular Assist Device Implantation: An Analysis of the IMACS Registry

BackgroundAs patients with advanced heart failure are living longer, defining the impact of left ventricular assist devices (LVADs) on outcomes in an aging population is of great importance. We describe overall survival, rates of adverse events (AEs), and post-AE survival in patients age ≥ 70 years vs age 50-69 years after destination-therapy (DT) LVAD implantation.MethodsA retrospective analysis was conducted with the use of the International Society for Heart and Lung Transplantation Mechanically Assisted Circulatory Support (IMACS) registry. All adults age ≥ 50 years with a continuous-flow DT LVAD from 2013 to 2017 were included. The primary outcome was all-cause mortality. The secondary outcomes were the incidence of and survival after gastrointestinal (GI) bleeding, infection, stroke, pump thrombosis, pump exchange, and right-side heart failure. Mortality and AEs were assessed with the use of competing risk models.ResultsAt total of 5,572 patients were included: 3,700 aged 50-69 and 1,872 aged ≥ 70. All-cause mortality by 42 months was 55.8% in patients aged ≥ 70 and 44.8% in patients aged 50-69 (P = 0.001). Patients aged ≥ 70 had a 37.8% higher risk of death after DT LVAD implantation (hazard ratio 1.378, 95% CI 1.251-1.517). Patients aged ≥ 70 had higher risk of GI bleeding but lower risk of right-side heart failure. There was no difference between age groups for risk of infection or stroke. Experiencing any AE was associated with an increased risk of death that did not vary with age.ConclusionsPatients aged ≥ 70 years have reduced survival after DT LVAD, in part because of increased GI bleeding, while the incidence of other AEs is similar to that of patients aged 50-69 years. Careful patient selection beyond age alone may allow for optimal outcomes after DT LVAD implantation.     

Left Ventricular Dysfunction and Mortality in Adult Patients with Eisenmenger Syndrome

Objectives. To identify risk factors associated with mortality in adult patients with Eisenmenger syndrome and to assess the effect of left ventricular dysfunction on mortality in these patients. Methods and Results. One hundred twenty‐two adult patients with Eisenmenger syndrome were retrospectively evaluated for signs and symptoms of heart failure, and underwent electrocardiography and laboratory investigations. Available echocardiograms were analyzed and left ventricular function was assessed both qualitatively and quantitatively. There were 47 deaths at 37.8 ± 12.0 years of age. On univariate analysis clinical signs and symptoms of heart failure, right ventricular hypertrophy on electrocardiography, wide QRS (QRS duration >130 milliseconds), and left ventricular dysfunction (left ventricular ejection fraction [LVEF] <50%) on echocardiography were associated with mortality. On multivariate analysis, signs and symptoms of heart failure, right ventricular hypertrophy on electrocardiography, and LVEF <50% remained strong predictors of death. Conclusions. Signs and symptoms of heart failure predict mortality in patients with Eisenmenger syndrome. Furthermore, patients with left ventricular dysfunction (LVEF <50%) have higher mortality. A combination of signs and symptoms of heart failure, right ventricular hypertrophy on electrocardiography, and left ventricular dysfunction on echocardiography provides the most powerful predictor of death in patients with Eisenmenger syndrome.     

The relative locations of the supraorbital,infraorbital, and mental foramina: A cadaveric study

The purpose of this study is to investigate the applicability of the current surgical guideline stating that the main facial foramina that transmit cutaneous nerves to the face (supraorbital notch/foramen, infraorbital foramen, and mental foramen) are equidistant from the midline in European and Hispanic populations. Previous studies suggest this surgical guideline is not applicable for all ethnicities; however, to our knowledge, no data have been published regarding the accuracy of this guideline pertaining to the Hispanic population. An experimental study was performed on 67 cadavers donated to the Human Anatomy Program at UT Health San Antonio. The supraorbital, infraorbital, and mental foramina were dissected and midline structures including the crista galli, internasal suture, anterior nasal spine, and mandibular symphysis were identified. The distance from each foramen to midline was recorded using a digital caliper. For all cadavers/ethnicities studied, the supraorbital, infraorbital, and mental foramina were 25.32 mm, 29.57 mm, and 25.55 mm to the midline, respectively. Thus, the infraorbital foramen is located significantly more lateral compared to the supraorbital (p < 0.0001) and mental foramina (p < 0.0001). After dividing the sample based on ethnicity, this relationship was also true for the European sample and tended to be true for the Hispanic sample. Significant anatomical variations exist in the current surgical guideline stating that the supraorbital foramen, infraorbital foramen, and mental foramen are equidistant from the midline. Clinicians may need to adjust their methodology during surgical procedures of the face in order to optimize patient care.     

Marginal adaptation of zirconia complete-coverage fixed dental restorations made from digital scans or conventional impressions: A systematic review and meta-analysis

Statement of problemIntraoral scanners have been increasingly used in recent years. However, the accuracy of digital scans as it affects marginal adaptation is unclear.PurposeThe purpose of this systematic review and meta-analysis was to compare the marginal adaptation of single-unit zirconia crowns fabricated with digital scans or with conventional impressions.Material and methodsThe electronic databases PubMed (MEDLINE), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science (ISI), Scopus, and EMBASE were searched and complemented by a manual search. Risks of bias were assessed by using a modified methodological index for nonrandomized studies (MINORS). Mean ±standard deviation (SD) values of marginal accuracy of studies were extracted for both methods. Mean marginal difference and 95% confidence interval (CI) were calculated to evaluate the marginal accuracy of each method. Pooled data were statistically analyzed by using a random-effect model.ResultsSeventeen studies were used to perform the meta-analysis. Subgroup analysis was performed based on intraoral scanners. Standardized mean marginal difference and 95% CI of each subgroup were as follows: Lava: -0.85 μm (95% CI: -1.67, -0.03) (P=.043); CEREC: -1.32 μm (95% CI: -2.06, -0.59) (P<.001); iTero: -0.44 μm (95% CI: -1.35, 0.47) (P=.338); TRIOS: -1.26 μm (95% CI: -2.02, -0.51) (P=.001); unknown scanner: -0.21 μm (95% CI: -1.14, 0.72); all studies: -0.89 μm (95% CI: -1.24, -0.54) (P<.001).ConclusionsDigital scanning of prepared teeth for single-unit zirconia restorations resulted in better marginal accuracy than conventional techniques using elastomeric impression materials.     

Postoperative Pain: An Analysis on Evolution of Research in Half-Century

IntroductionExamining the evolution of research parameters helps scientists to discover the well-developed and neglected aspects of knowledge. Pain after root canal treatment is a health problem affecting millions of patients. Research in this field has a meaningful impact on quality of lives. The aim of this study was to analyze the evolution of research on postoperative pain over the past 50 years.MethodsElectronic searches were performed in Scopus and MEDLINE databases to identify studies on pain after nonsurgical root canal treatments/retreatments. The full texts of eligible articles were reviewed to determine the study category and to extract and analyze the methodological variables. A series of statistical analyses were performed to determine the trend of publications based on the variable of interest over time.ResultsFour hundred twenty-four articles were included. There was a positive trend for systematic reviews, studies with sample size <200, studies on single-visit treatment, and clinical trials on instrumentation and adjunct treatments (P < .05). There was a negative trend for the use of numeric rating scales, studies on multiple-visit treatments, clinical trials on medication/medicament, and studies on pain in maxillary incisors (P < .05). No trend was observed based on pulpal diagnosis or for studies with longer observation periods (>8 weeks) (P > .05).ConclusionsA paradigm shift is needed toward clinical studies with larger sample sizes, longer observation periods, and more focus on pulpal diagnoses associated with higher rates of postoperative pain. There is a need to view postoperative pain as an important patient-centered outcome and to develop and disseminate standard reporting guidelines for future studies.