What did we learn about tocilizumab use against COVID-19? A single-center observational study from an intensive care unit in Serbia

Background

Selection of effective and safe therapy for management of patients with coronavirus disease is challenging. Tocilizumab (TZB) has emerged as a potential treatment option for COVID-19. Several aspects regarding Tocilizumab treatment remain uncertain, such as the optimal timing for its administration and the safety profile, including the potential risk of infections. The aim of the study is to present the clinical characteristics of patients with COVID-19 following the application of Tocilizumab.

Methods

This is a retrospective analysis of 121 patients with severe forms of COVID-19 previously treated with Tocilizumab was conducted. All patients were admitted to intensive care units (ICUs).

Results

Of 121 patients, the majority were men 72 (59.5%) with a median age at presentation of 65 ± 13 years. Only 9 (7.43%) patients were without comorbidities, while the other 112 (92.55%) had two or more comorbidities. Almost all of the 120 patients (99.2%) needed oxygen therapy, such as nasal cannulas in 110 (90.9%) patients, high flow nasal catheter (HFNC) in 4 (3.3%) patients, and continuous positive airway pressure (CPAP) in 5 (4.1%) patients while 1 patient was intubated at the time of hospital admission. The average time from Tocilizumab application to admission to the ICU was 3 days. During clinical deterioration, almost half 57 (47.1%) of the patients were intubated, and 52 (82.5%) of these intubated patients (p < 0.001) had lethal outcomes. The most significant predictors for a lethal outcome according to multivariate analysis were diabetes mellitus (p < 0.001) followed by a subsequent elevation in C-reactive protein levels (CRP; p < 0.002) and ferritin (p < 0.013) after Tocilizumab application. Bloodstream infections were found in 20 (16.5%) patients, most frequently with Gram-negative pathogens like Acinetobacter spp. as in 12 (18.6%) patients, Klebsiella spp. in 6 (8%) patients, and Pseudomonas spp. in 2 (3.2%) patients. Urine culture isolates were found in 9 (7.43%) patients, with Candida spp. being most frequently isolated in 7 (5.8%) patients, followed by Klebsiella spp. and Pseudomonas spp. in 1 patient each (0.8%). Significantly lower survival was seen in patients with proven infection.

Conclusion

The benefit of tocilizumab was not found in our study. The high mortality rate among intubated patients after Tocilizumab use suggests appropriate patient selection and monitoring and emphasizes the risk of superinfections. Diabetes mellitus, increased levels of CRP, and ferritin were identified as the most significant predictors of poor outcomes in contrast to increased levels of IL-6.

Multilevel calibration procedure for the oral health national multicenter survey in primary teeth

BACKGROUND

Early childhood caries (ECC) requires systematically collected and standardized data.

AIM

To describe a novel multilevel calibration procedure in primary dentition.

DESIGN

Calibration method involved two calibration levels: the first (L1 ) involved an interexaminer agreement between three main investigators, the group leaders (GLs) in the following level; the second level (L2 ) involved three groups of 11 paediatric dentists and interexaminer agreement assessment according to the GLs in each group. The study sample consisted of 650 primary teeth surfaces in eight children (mean age 6.56 ± 2.22 years). Surface-by-surface percent agreement, tooth-by-tooth percent agreement, Cohen's kappa, and Fleiss kappa statistics were used to calculate interexaminer reliability. Statistical analysis was performed with SPSS 27.0.

RESULTS

Surface-by-surface percent agreement regarding ICDASepi-merged revealed almost perfect agreement (>90.00%) on both L1 and L2 . Kappa values and ranges showed good agreement at both L1 (overall κ = .95) and L2 (overall κ = .98) and almost perfect consistency was detected between GLs at L1 (>91.30%) and substantial agreement at L2 (>85.00%). All examiners at L2 showed almost perfect positive agreement (sensitivity = 96.77%-100%) when detecting the presence of dental plaque.

CONCLUSION

The calibration procedure appeared feasible prior to organizing multicenter epidemiological oral health survey in large population groups of preschool children, with higher number of examiners.

Future directions in psychiatric neurosurgery: Proceedings of the 2022 American Society for Stereotactic and Functional Neurosurgery meeting on surgical neuromodulation for psychiatric disorders

OBJECTIVE

Despite advances in the treatment of psychiatric diseases, currently available therapies do not provide sufficient and durable relief for as many as 30-40% of patients. Neuromodulation, including deep brain stimulation (DBS), has emerged as a potential therapy for persistent disabling disease, however it has not yet gained widespread adoption. In 2016, the American Society for Stereotactic and Functional Neurosurgery (ASSFN) convened a meeting with leaders in the field to discuss a roadmap for the path forward. A follow-up meeting in 2022 aimed to review the current state of the field and to identify critical barriers and milestones for progress.

DESIGN

The ASSFN convened a meeting on June 3, 2022 in Atlanta, Georgia and included leaders from the fields of neurology, neurosurgery, and psychiatry along with colleagues from industry, government, ethics, and law. The goal was to review the current state of the field, assess for advances or setbacks in the interim six years, and suggest a future path forward. The participants focused on five areas of interest: interdisciplinary engagement, regulatory pathways and trial design, disease biomarkers, ethics of psychiatric surgery, and resource allocation/prioritization. The proceedings are summarized here.

CONCLUSION

The field of surgical psychiatry has made significant progress since our last expert meeting. Although weakness and threats to the development of novel surgical therapies exist, the identified strengths and opportunities promise to move the field through methodically rigorous and biologically-based approaches. The experts agree that ethics, law, patient engagement, and multidisciplinary teams will be critical to any potential growth in this area.

Oral Health in 12- and 15-Year-Old Children in Serbia: A National Pathfinder Study

The aim of the paper is to present the oral health profile of 12- and 15-year-old schoolchildren in Serbia. Basic Methods for Oral Health Surveys of the WHO were implemented to record: Decayed, Missing, and Filled Teeth/Surfaces Index (DMFT/DMFS), gingival bleeding, enamel fluorosis and other structural anomalies, dental erosion, dental trauma, and oral mucosal lesions. In addition, Silness and Löe plaque index and orthodontic status were assessed. A total of 36% of 12-year-olds and 22% of 15-year-olds in Serbia were caries-free. The mean DMFT was 2.32 ± 2.69 for 12-year-olds and 4.09 ± 3.81 for 15-year-olds. DMFT was made up largely by the decayed component. Gingival bleeding was present in 26% of examined 12-year-old and 18% of 15-year-old children. Dental plaque was observed in 63% of both 12- and 15-year-olds. Fluorosis, structural anomalies, dental erosion, dental trauma, and oral mucosal lesion were rarely detected. Low prevalence of malocclusions was found. Oral disease is still a common public health problem among schoolchildren in Serbia. A significant increase in the prevalence of caries disease between 12- and 15-year-old groups implies that preventive care for adolescents requires special attention. Corrective actions and reforms to the current school-based oral health prevention program are needed to further improve oral health in Serbian children.

Towards a Leadless Wirelessly Controlled Intravenous Cardiac Pacemaker

OBJECTIVE

Traditional lead-based cardiac pacemakers suffer from lead-related complications including lead fracture, lead dislodgement, and venous obstruction. Modern leadless pacemakers mitigate the complications, but since they are implanted inside the heart with a small battery, their limited battery lifetime necessities device replacement within the patient's lifetime. This paper presents a leadless and batteryless, wirelessly powered intravenous cardiac pacemaker that can potentially mitigate both problems.

METHODS

Wireless power is transferred at 13.56 MHz in bursts between the pacemaker modules to achieve sufficient power over the required distance for wireless pacing. The pacemaker stimulation module is designed to fit within the anatomical constraints of a cardiac vein, consume low power, apply greater than 5V stimulation and comply with FCC SAR regulations. The module is primarily implemented in CMOS technology to achieve extreme system miniaturization.

RESULTS

Ex-vivo pacing capability was demonstrated with a system that can apply 5V stimulation, consume 1mW power, and operate up to 2.5cm TX and RX separation. An in-vivo experiment verified the pacemaker functionality by increasing the heartbeat of Yorkshire pig from 64bpm to 100bpm.

CONCLUSION

This work establishes that intravascular cardiac pacing can be achieved that can mitigate lead and battery-related complications.

SIGNIFICANCE

This study has a potential to advance leadless and wirelessly powered pacemaker technology.

Panlobular emphysema is associated with COPD disease severity: A study of emphysema subtype by computed tomography

BACKGROUND

Computed tomography has the potential to inform COPD prognosis. We sought to determine associations of emphysema phenotype with clinical parameters including lung function, inflammatory markers, and quality of life.

METHODS

Participants of this single-center observational cohort (n = 83) were 40-80 years old, had ≥10 pack-year smoking, and a diagnosis of COPD confirmed by spirometry. All participants had available historic chest CT scans which were systematically reviewed by a single expert radiologist and scored for emphysema subtype, extent, and distribution. Associations between radiographic findings and clinical parameters were determined.

RESULTS

Median age of participants was 72 years, median smoking 40 pack-years, and median FEV₁ 59% predicted. 84% of the participants had radiographic emphysema. Of those, 26% had panlobular emphysema (PLE), 68% centrilobular emphysema (CLE), and 6% paraseptal emphysema (PSE). As compared to the participants with no radiographic emphysema, the presence of PLE-dominant emphysema was associated with a lower BMI (P = 0.012) and greater extent of emphysema (P = 0.014). After adjusting for age, sex, and pack-years smoking history, PLE was associated with greater airflow obstruction by FEV₁% (48% vs 71%, P = 0.005), greater symptom burden by CAT score (18 vs 9, P = 0.015), worse quality of life by SGRQ score (43 vs 22, P = 0.025), and more systemic inflammation by erythrocyte sedimentation rate (P = 0.001). CLE- or PSE-dominant emphysema were not similarly associated with clinical features or symptom burden.

CONCLUSIONS

The presence of PLE-dominant emphysema was associated with greater extent of emphysema, greater airflow obstruction, increased respiratory symptoms, worse quality of life, and systemic inflammation. Further investigation is indicated to explore the pathogenesis of the PLE phenotype and the prognostic and treatment implications of PLE.

Pediatric Dentists' Service Provisions in South-East Europe during the First Wave of COVID-19 Epidemic: Lessons Learned about Preventive Measures and Personal Protective Equipment Use

Introduction: Having in mind the importance of providing continuous pediatric dental services during the COVID-19 pandemic and the fact that children have similar viral loads to adults, the potential to spread the virus to others, and with variable clinical presentation of COVID-19 infection, this study aimed to analyze the impact of COVID-19 outbreak on pediatric dentistry service provision, risks, and preventive measures before and during dental treatment. Method: Structured and closed epidemiological cross-sectional survey involved seven Southeastern European countries. The questionnaire was developed using the modified Delphi method, pretested, and tested in North Italy during April 2020. The sample consisted of licensed dental professionals reached via national dental chambers and social media using the best strategies according to the national setting. Results: A total of 3227 dentists participated in the survey, and we included 643 specialists in this study—among them, 164 were pediatric dentists. Most pediatric dentists worked in the public sector (61.0%) and provided emergency (64.6%) and routine dental treatment (18.3%) during the outbreak. One-third of pediatric dentists were COVID-19 tested, statistically significantly more than other specialties, and 3.0% tested COVID-19 positive. In addition, significantly more pediatric dentists (13.4%) reported the presence of at least one symptom related to COVID-19 compared to other specialists (6.1%). None of the pediatric dentists reported PPE shortage. However, 26.2% of all specialists stated that they lacked clear step by step professional guidance in a national language. Similarly, in both groups, around 10% of specialists attended education on coronavirus. Conclusions: Considering that most pediatric dentists provided dental treatment during lockdown in their countries in public health centers and that they will continue to work during pandemic, our results suggest that pediatric dentists might be at higher risk of COVID-19 infection. Further research should focus on finding better ways to promote and adapt preventive, protective measures and PPE in the pediatric dental setting to be behaviorally acceptable. Moreover, additional efforts should be invested in dental education regarding COVID-19 in the mother tongue.

Estimating the Effects of Dental Caries and Its Restorative Treatment on Periodontal Inflammatory and Oxidative Status: A Short Controlled Longitudinal Study

Dental caries and periodontitis are among the most common health conditions that are currently recognized as growing socio-economic problems relating to their increasing prevalence, negative socio-economic impact, and harmful effects on systemic health. So far, the exact effects of caries and standard restorative materials on periodontal inflammatory and oxidative status are not established. The present study aimed to investigate the effect of caries and its restoration using standard temporary and permanent filling materials on a panel of 16 inflammatory and oxidative markers in gingival crevicular fluid (GCF) of periodontally healthy individuals, 7 (D7) and 30 (D30) days post-restoration, while the intact teeth represented the control. One hundred ninety systemically and periodontally healthy patients with occlusal caries underwent standard cavity preparation and restorations with one of six standard temporary or permanent restorative material according to indication and randomization scheme. Interleukin (IL)-2, IFN- γ, IL-12, IL-17A, IL-13, IL-9, IL-10, IL-6, IL-5, IL-4, IL-22, TNF-α, IL1- β, thiobarbituric acid reactive substances, superoxide dismutase, and reduced form of glutathione were measured in GCF samples by flowcytometry and spectrophotometry in aid of commercial diagnostic assays. Caries affected teeth exhibited significantly increased IL-1 β, IL-17, IL-22, and TBARS and decreased IL-9 concentrations compared to healthy controls. Treatment generally resulted in an increased antioxidant capacity with exception of zinc-polycarboxylate cement showing distinctive inflammatory pattern. Comparison of inflammatory and oxidative profiles in temporary and permanent restorations showed material-specific patterning which was particularly expressed in temporary materials plausibly related to greater caries extension. Caries affected teeth exhibited a balanced inflammatory pattern in GCF, with a general tendency of homeostatic re-establishment following treatment. Restorative materials did not provide specific pathological effects, although some material groups did exhibit significantly elevated levels of inflammatory and oxidative markers compared to healthy controls, while the material-specific patterning was observed as well.

Long-term cost-effectiveness of glass hybrid versus composite in permanent molars

OBJECTIVES

We assessed the long-term cost-effectiveness of glass hybrid (GH) versus composite (CO) for restoring permanent molars using a health economic modelling approach.

METHODS

A multi-national (Croatia, Serbia, Italy, Turkey) split-mouth randomized trial comparing GH and CO in occlusal-proximal two-surfaced cavities in permanent molars (n=180/360 patients/molars) provided data on restoration failure and allocation probabilities (i.e. failure requiring re-restoration, repair or endodontic therapy). Using Markov modelling, we followed molars over the lifetime of an initially 12-years-old individual. Our health outcome was the time a tooth was retained. A mixed-payers' perspective within German healthcare was used to determine costs (in Euro 2018) using fee item catalogues. Monte-Carlo-microsimulations, univariate and probabilistic sensitivity analyses were conducted. Incremental cost-effectiveness ratios (ICER)s and cost-effectiveness-acceptability were quantified.

RESULTS

In the base-case scenario, CO was more effective (tooth retention for a mean (SD) 54.4 (1.7) years) but also more costly (694 (54) Euro) than GH (53.9 (1.7) years; 614 (56 Euro). The ICER was 158 Euro/year, i.e. payers needed to be willing to invest 158 Euro per additional year of tooth retention when using CO. In a sensitivity analysis, this finding was confirmed or GH found more effective and less costly.

CONCLUSION

CO was more costly and limitedly more effective than GH, and while there is uncertainty around our findings, GH is likely a cost-effectiveness option for restoring permanent molars.

CLINICAL SIGNIFICANCE

When considering the long-term (life-time) cost-effectiveness, GH showed cost savings but CO was limitedly more effective. Overall, cost-effectiveness differences seems limited or in favour of GH.

In Vivo Intravascular Pacing Using a Wireless Microscale Stimulator

Millions of patients worldwide are implanted with permanent pacemakers for the treatment of cardiac arrhythmias and conduction disorders. The increased use of these devices has established a growing clinical need to mitigate associated complications. Pacemaker leads, in particular, present the primary risks in most implants. While wireless power transfer holds great promise in eliminating implantable device leads, anatomical constraints limit efficient wireless transmission over the necessary operational range. We thereby developed a transmitter-centered control system for wireless power transfer with sufficient power for continuous cardiac pacing. Device safety was validated using a computational model of the system within an MRI-based anatomical model. The pacer was then fabricated to meet the acute constraints of the anterior cardiac vein (ACV) to enable intravascular deployment while maintaining power efficiency. Our computational model revealed the wireless system to operate at > 50 times below the tissue energy absorption safety criteria. We further demonstrated the capacity for ex vivo pacing of pig hearts at 60 beats per minute (BPM) and in vivo pacing at 120 BPM following pacer deployment in the ACV. This work thus established the capacity for wireless intravascular pacing with the potential to eliminate complications associated with current lead-based deep tissue implants.

A Multi-Dimensional Analysis of a Novel Approach for Wireless Stimulation

The elimination of integrated batteries in biomedical implants holds great promise for improving health outcomes in patients with implantable devices. However, despite extensive research in wireless power transfer, achieving efficient power transfer and effective operational range have remained a hindering challenge within anatomical constraints.

OBJECTIVE

We hereby demonstrate an intravascular wireless and batteryless microscale stimulator, designed for (1) low power dissipation via intermittent transmission and (2) reduced fixation mechanical burden via deployment to the anterior cardiac vein (ACV, ∼3.8 mm in diameter).

METHODS

We introduced a unique coil design circumferentially confined to a 3 mm diameter hollow-cylinder that was driven by a novel transmitter-based control architecture with improved power efficiency.

RESULTS

We examined wireless capacity using heterogenous bovine tissue, demonstrating >5 V stimulation threshold with up to 20 mm transmitter-receiver displacement and 20° of misalignment. Feasibility for human use was validated using Finite Element Method (FEM) simulation of the cardiac cycle, guided by pacer phantom-integrated Magnetic Resonance Images (MRI).

CONCLUSION

This system design thus enabled sufficient wireless power transfer in the face of extensive stimulator miniaturization.

SIGNIFICANCE

Our successful feasibility studies demonstrated the capacity for minimally invasive deployment and low-risk fixation.

Surgical Challenges of Heart Mate 3 Pump Implantation in Aneurysmally Changed Heart Ventricles

We presented surgical treatment of three patients indicated for implantation of a permanent mechanical circulatory support device and with the associated left ventricular aneurysms. In order to evade the left ventricular rupture, adverse thromboembolic events and provide safe implantation of the inflow cannula, LVAD HM3 implantation together with the reconstruction of the left ventricular aneurysmal wall was performed in two patients. Regarding the third patient, LVAD implantation upon the reconstruction of the left ventricular wall was abandoned because there was no safe location for placement of the inflow cannula.

Wireless Pacing Using an Asynchronous Three-Tiered Inductive Power Transfer System

Despite numerous advancements in pacemaker technology for the treatment of cardiac arrhythmias and conduction disorders, lead-related complications associated with these devices continue to compromise patient safety and survival. In this work, we present a system architecture that has the capacity to deliver power to a wireless, batteryless intravascular pacer. This was made possible through a three-tiered, dual-sub-system, four-coil design, which operates on two different frequencies through intermittent remote-controlled inductive power transfer. System efficiency was enhanced using coil design optimization, and validated using numerical simulations and experimental analysis. Our pacemaker design was concepted to achieve inductive power transfer over a 55 mm range to a microscale pacer with a 3 mm diameter. Thus, the proposed system design enabled long-range wireless power transfer to a small implanted pacer with the capacity for intravascular deployment to the anterior cardiac vein. This proposed stent-like fixation mechanism can bypass the multitude of complications associated with pacemaker wires while wireless power can eliminate the need for repeated procedures for battery replacement.

How Much Country Economy Influences ECC Profile in Serbian Children-A Macro-Level Factor Analysis

Introduction: Serbia has universal health coverage (UHC) for pediatric dental care and similar country distribution for dentists and physicians per 1,000 inhabitants. However, a high prevalence of early childhood caries (ECC) with wide variation across the country was observed in previous studies. This paper aimed to analyze the association between economic and healthcare country macro-level factors with ECC prevalence and treatment. Method: The outcome variables were ECC prevalence and frequency of untreated ECC in 36- to 71-month-olds. Cross-sectional pathfinder survey on a nationally representative sample of children was conducted in order to obtain data. Independent variables included the following: gross domestic product (GDP), social and health care budget beneficiaries' expenditures, local self-government budget, unemployment rate, population density and density of physicians and dentists. Guided by the WHO's Basic Methods for Oral Health Surveys stratified cluster sample, 17 sites were randomly chosen to obtain adequate distribution of data regarding urban, peri-urban and rural areas in each analyzed statistical territorial unit. The variables were analyzed using the independent t-test or Mann-Whitney U test. A probability value of <0.05 was considered significant. Results: The final sample included 864 children aged 36 to 71 months. Observed prevalence of ECC was 41.1%. Although no statistically significant difference was found, children with ECC compared to healthy children were living in parts of the country with averages of ≈122€ lower GDP per capita, ≈4€ lower social and health care expenditures per capita, 9 inhabitants per km2 lower population density, almost 7€ per capita lower local self-government budget and a 0.6% higher unemployment rate. Furthermore, although without a statistically significant difference, untreated ECC was associated with ≈302€ lower GDP per capita, ≈12€ lower social and health care expenditures per capita, 34 inhabitants per km2 lower population density, almost 20€ per capita lower local self-government budget and a 1.7% higher unemployment rate. Conclusions: This study, performed in a nationally representative sample of preschool children, revealed the association of economic macro-level factors with ECC prevalence and its (non-) treatment. Further research on a larger sample is necessary to confirm the results. These findings suggest that most of the public-health efforts regarding prevention and early treatment of ECC should be directed at regions with lower economic performance.

Transesophageal Echocardiography-Guided Thrombectomy of Level IV Renal Cell Carcinoma without Cardiopulmonary Bypass

Advanced renal cell carcinoma accompanied by tumor thrombus in the venous system is present in up to 10% of cases. Extension of tumor thrombus above the diaphragm or into the right atrium represents level IV disease. Level IV tumors are typically treated with sterno-laparotomy approach with or without deep hypothermic circulatory arrest and veno-venous bypass. In this case report, the surgical technique for the resection of advanced RCC were described, with the concomitant use of transesophageal echocardiography for thrombus extraction without the veno-venous or cardiopulmonary bypass.

A 0.338 cm3, Artifact-Free, 64-Contact Neuromodulation Platform for Simultaneous Stimulation and Sensing

Neuromodulation (NM) is the alteration of nervous tissue function through targeted delivery of a stimulus, such as electrical stimulation, into the affected neurological sites in the body. We present a bidirectional NM interface that features 100 mV_pp linear input range and ability to sense data concurrent with stimulation (without blanking). The system includes a flexible 8-driver-to-64-contact custom waveform stimulator able to deliver up to 5.1 mA per driver and a 64-contact sensing unit with online blind artifact rejection unit. This artifact rejection unit removes stimulation artifacts from recorded data and allows extraction of neural biomarkers. The NM interface also features an efficient, integrated power management unit that can support various power delivery options. The proposed 64-contact interface satisfies design requirements of human-grade brain implants at unprecedented level of electronic miniaturization compared to state-of-the-art.

Successful establishment of a left ventricular assist device program in an emerging country: one year experience

Background

The primary goal of this study was to evaluate the outcomes of patients with end-stage heart failure (HF) who underwent continuous flow left ventricular assist device (CF-LVAD) in a developing country and to compare to those reported by more developed countries. The secondary goal was on determining factors that may be connected to improved survival.

Methods

We prospectively analyzed 47 consecutive patients who underwent CF-LVAD at our institution. After one year the survival and adverse event profiles of patients were evaluated. At 3, 6 and 12 months, the cardiac, renal and liver function outcomes were assessed.

Results

The 30-day, 6-month and 1-year survival rates were 89%, 85% and 80%, respectively. A significant improvement in dimensions and ejection fraction of left ventricle, BNP, functional capacity, blood urea nitrogen (BUN) and total bilirubin (P<0.05 for all) were noticed 3 months post-CF-LVAD implantation, and patients were stable throughout the entire first year follow up. In the group of patients with baseline renal dysfunction (RD) there were significant improvements of renal function (P=0.004), with no changes on follow up. 57% of patients exhibited some kind of adverse event, commonly in the form of bleeding. In multivariate Cox regression analysis renal failure was found to be as an independent risk factor for the overall survival (HR =13.1, P<0.001).

Conclusions

In conclusion, our data extends previous findings from centers of developed countries, that CF-LVAD is an adequate treatment option for patients suffering from end-stage HF, and encourages expansion of CF-LVAD implantation in developing countries with nascent HT program.

Oral Health Literacy, Preventive Behavior Measures, and Chronic Medical Conditions

The purpose of this study was to examine the association between oral health literacy, preventive orientation and behaviors, and chronic medical conditions-specifically, hypertension and diabetes. A cross-sectional study was conducted with dental school patients attending the dental clinics in Los Angeles, California, and Baltimore, Maryland. Their health literacy levels were measured using the short Test of Functional Health Literacy in Adults (Short-TOFHLA) and the Rapid Estimate of Adult Literacy in Medicine and Dentistry (REALM-D). The medical history and existing medical conditions-specifically, hypertension and diabetes status-were extracted from patient health history and electronic records. Ten items were asked about preventive behaviors (e.g., brushing teeth in evening, smoking, exercise, drinking soda) and 3 preventive health services (dental checkup, flu shot, medical checkup). Six locus of control items were asked (e.g., good health is a matter of good fortune, what happens to my health is God's will). Out of 793 subjects, 221 had a documented history of hypertension, 88 with diabetes. There was an association between Short-TOFHLA scores and both diabetes and hypertension, but after controlling for sociodemographic and preventive variables, the association was no longer significant. In multivariate analysis, women, people with at least some college, Asians or non-Hispanic Whites, younger people, those who spoke English as a child, those who sought health information from the Internet or health care professionals, and those who smoked reported lower utilization of preventive health services, and those who had less locus of control reported higher Short-TOFHLA scores. There were no significant differences in mean REALM-D scores between patients who had hypertension or diabetes versus not having the condition. Multivariate models showed that people with higher REALM-D scores had at least some college, were other race/ethnicity or non-Hispanic White, spoke English as a child, and sought health information via the Internet. Knowledge Transfer Statement: The results of this study show that dental school patients exhibit a range of health literacy abilities and preventive behaviors, and health literacy measures positively correlated with some preventive behaviors but not others. Dental schools receive a significant number of patients with chronic diseases, and students should be educated to use effective patient communication skills to reinforce positive health behaviors among these patients.

Biocompatibility Investigation of New Endodontic Materials Based on Nanosynthesized Calcium Silicates Combined with Different Radiopacifiers

INTRODUCTION

The aim of this article was to analyze biocompatibility and bioactivity of new endodontic materials on the basis of nanosynthesized calcium silicates (ALBO-MPCA₁ and ALBO-MPCA₂) combined with different radiopacifiers in comparison with MTA⁺.

METHODS

Morphology of the samples was studied by scanning electron microscopy, and the pH and ion release analysis were also assessed. Biocompatibility of materials' eluates (24-hour, 7-day, and 21-day) was conducted by using MTT test. Twelve New Zealand white rabbits were used for intraosseous implantation. Four calvarial defects per animal were created and filled with freshly prepared investigated materials.

RESULTS

Samples mostly consisted of agglomerates built up from nanoparticles, preferably spherical and rod-like. There was no significant difference among pH values of materials' eluates after 24 hours (P > .05). The amount of calcium and aluminum ion release decreased, whereas the amount of magnesium and bismuth (ALBO-MPCA₁, MTA⁺) and barium (ALBO-MPCA₂) increased during 21-day period. The metabolic activity of cells increased after the extraction time, except in case of undiluted elutes of ALBO-MPCA₂ and ALBO-MPCA₁ (21-day). Histologic analysis of the samples revealed newly formed bone tissue with moderate inflammation for all investigated materials, which subsided during 90-day period to mild. Both MTA⁺ and ALBO-MPCA₁ were in direct contact with the newly formed bone tissue. After 90 days, statistically significant difference in hard tissue formation was observed in comparison of MTA⁺ and ALBO-MPCA₁ with control group (P < .05).

CONCLUSIONS

Experimental materials ALBO-MPCA₁ and ALBO-MPCA₂ possess both biocompatibility and bioactivity. Because ALBO-MPCA₁ provokes favorable biological response, it is especially good candidate for further clinical investigations.

The relationship between causative microorganisms and cardiac lesions caused by infective endocarditis: New perspectives from the contemporary cohort of patients

BACKGROUND

The etiology of infective endocarditis (IE) is changing. More aggressive forms with multiple IE cardiac lesions have become more frequent. This study sought to explore the relationship between contemporary causative microorganisms and IE cardiac lesions and to analyze the impact of multiple lesions on treatment choice.

METHODS

In 246 patients hospitalized for IE between 2008 and 2015, cardiac lesions caused by IE were analyzed by echocardiography, classified according to the 2015 European Society of Cardiology guidelines and correlated with microbiological data. We defined a new parameter, the Echo IE Sum, to summarize all IE cardiac lesions in a single patient, enabling comprehensive comparisons between different etiologies and treatment strategies.

RESULTS

Staphylococcus aureus was associated with the development of large vegetation (OR 2.442; 95% CI 1.220-4.889; p=0.012), non-HACEK bacteria with large vegetation (OR 13.662; 95% CI 2.801-66.639; p=0.001), perivalvular abscess or perivalvular pseudoaneurysm (OR 5.283; 95% CI 1.069-26.096; p=0.041), and coagulase-negative staphylococci (CoNS) with leaflet abscess or aneurysm (OR 3.451; 95% CI 1.285-9.266, p=0.014), and perivalvular abscess or perivalvular pseudoaneurysm (OR 4.290; 95% CI 1.583-11.627; p=0.004). The Echo IE Sum significantly differed between different etiologies (p<0.001), with the highest value in non-HACEK and the lowest in streptococcal endocarditis. Patients operated for IE had a significantly higher Echo IE Sum vs those who were medically treated (p<0.001).

CONCLUSION

None of the IE cardiac lesions is microorganism-specific. However, more severe lesions were caused by S. aureus, CoNS, and non-HACEK bacteria. The highest propensity to develop multiple lesions was shown by the non-HACEK group. Higher Echo IE Sum in patients sent to surgery emphasized the importance of multiple IE cardiac lesions on treatment choice and potential usage of Echo IE Sum in patient management.

Kinking of the Outflow Graft, Consequent Ventricular Tachycardia, and the Need for Reoperation in a Patient with Left Ventricular Assist Device

Background: Left ventricular assist devices (LVAD) have become a lifesaving solution for patients awaiting heart transplantation as well as an option to support the failing hearts of non-transplant candidates as a lifelong, or destination therapy (DT). Improvements in LVAD design have enabled greater durability and broader patient applicability, but not without complications. Ventricular arrhythmias in LVAD patients were considered benign in the early days of LVADs, but today are increasingly recognized for their harmful impact on morbidity and quality of life.Case presentation: We describe a 53-year-old male who underwent HeartWare left ventricular assist device (HVAD) implantation. During the postoperative period, the patient experienced ventricular tachycardia (VT) during a coughing episode, later found on CT to be due to significant angulation of the outflow graft. Following reoperation to shorten the outflow graft, the patient returned to hemodynamic stability, without VT or other arrhythmias.Conclusions: Innovative strategies in VT prevention and improved clinical outcomes in LVAD patients may be the result of better understanding of characteristics that predispose these patients to VT. This case report showed that an excessively long outflow graft with considerable kinking created significant VT, but reoperation to correct the length of the graft mitigated further VT complications.

A Miniaturized 0.78-mW/cm2 Autonomous Thermoelectric Energy-Harvesting Platform for Biomedical Sensors

In order to use thermoelectric energy harvesters (TEHs) as a truly autonomous energy source for size-limited sensing applications, it is essential to improve the power conversion efficiency and energy density. This study presents a thin-film, array-based TEH with a surface area of 0.83 cm². The TEH autonomously supplies a power management IC fabricated in a 65-nm CMOS technology. The IC utilizes a single-inductor topology with integrated analog maximum power point tracking (MPPT), resulting in a 68% peak end-to-end efficiency (92% converter efficiency) and less than 20-ms MPPT. In an in-vivo test, a 645-μW regulated output power (effective 3.5 K of temperature gradient) was harvested from a rat implanted with our TEH, demonstrating true energy independence in a real environment while showing a 7.9 × improvement in regulated power density compared to the state-of-the-art. The system showed autonomous operation down to 65-mV TEH input.

Apigenin-7-O-glucoside versus apigenin: Insight into the modes of anticandidal and cytotoxic actions

Bioactive potential of apigenin derivative apigenin-7-O-glucoside related to its antifungal activity on Candida spp. and cytotoxic effect on colon cancer cells was studied and compared with bioactive potential of apigenin. Antifungal activity was tested on 14 different isolates of Candida spp. using membrane permeability assay, measuring inhibition of reactive oxidative species and inhibition of CYP51 C. albicans enzyme. Cytotoxic potential of apigenin-7-O-glucoside was tested on colon cancer HCT116 cells by measuring cell viability, apoptosis rate and apoptosis- and colon cancer-related gene expression. Obtained results indicated considerable antifungal activity of apigenin-7-O-glucoside towards all Candida isolates. Breakdown of C. albicans plasma membrane was achieved upon treatment with apigenin-7-O-glucoside for shorter period of time then with apigenin. Reduction of intra- and extracellular reactive oxidative species was achieved with minimum inhibitory concentrations of both compounds, suggesting that reactive oxidative species inhibition could be a mechanism of antifungal action. None of the compounds exhibited binding affinity to C. albicans CYP51 protein. Besides, apigenin-7-O-glucoside was more effective compared to apigenin in reduction of cell's viability and induction of cell death of HCT116 cells. Treatment with both compounds resulted in chromatin condensation, apoptotic bodies formation and apoptotic genes expression in HCT116 cells, but the apigenin-7-O-glucoside required a lower concentration to achieve the same effect. Compounds apigenin-7-O-glucoside and apigenin displayed prominent antifungal potential and cytotoxic effect on HCT116 cells. However, our results showed that apigenin-7-O-glucoside has more potent activity compared to apigenin in all assays that we used.

Kidney injury secondary to endovascular treatment of renal artery stenosis

In this paper, we present a case of kidney injury as a complication of renal artery angioplasty in a 54-year-old female patient that suffered from resistant renovascular hypertension. This case emphasises the unpredictable nature of endovascular procedures, the need for careful post-procedure evaluation and the role of 'old fashioned' surgical techniques in resolving complications of endovascular procedures.

3D Beam Tracing Based on Visibility Lookup for Interactive Acoustic Modeling

We present a method for accelerating the computation of specular reflections in complex 3D enclosures, based on acoustic beam tracing. Our method constructs the beam tree on the fly through an iterative lookup process of a precomputed data structure that collects the information on the exact mutual visibility among all reflectors in the environment (region-to-region visibility). This information is encoded in the form of visibility regions that are conveniently represented in the space of acoustic rays using the Plücker coordinates. During the beam tracing phase, the visibility of the environment from the source position (the beam tree) is evaluated by traversing the precomputed visibility data structure and testing the presence of beams inside the visibility regions. The Plücker parameterization simplifies this procedure and reduces its computational burden, as it turns out to be an iterative intersection of linear subspaces. Similarly, during the path determination phase, acoustic paths are found by testing their presence within the nodes of the beam tree data structure. The simulations show that, with an average computation time per beam in the order of a dozen of microseconds, the proposed method can compute a large number of beams at rates suitable for interactive applications with moving sources and receivers.

Sensitivity of clinical isolates of Candida to essential oils from Burseraceae family

The aim of this study was to investigate the chemical composition and antifungal activity of four commercial essential oils from the Burseraceae family - two Boswellia carterii Flueck oils, Canarium luzonicum (Blume) A. Gray oil, and Commiphora myrrha (Nees) Engl oil, against most common Candida spp. recovered from the human oral cavity. The essential oil samples were analyzed by GC-FID and GC/MS. The analysis showed that major essential oils' components were α-pinene (23.04 % and 31.84 %), limonene (45.62 %) and curzerene (34.65 %), respectively. Minimum inhibitory (MIC) and minimum fungicidal (MFC) concentrations were determined using a microdilution standardized technique. All tested Candida spp. clinical isolates and ATCC strains showed susceptibility to tested essential oils in a dose dependent manner. The strongest antifungal activity was shown by essential oil of B. carterii, sample 2; the average MIC values ranged from 1.25 to 1.34 mg/ml, and MFC values ranged from 2.50 to 3.75 mg/ml, depending on the fungus. This study supports the possible use of essential oils from the Bursecaceae family in reduction and elimination of Candida spp. populations in patients with oral cavity fungal infections.

Morphologic predictors of in hospital mortality in acute type III aortic dissection

INTRODUCTION

In-hospital mortality of acute aortic type III dissection ranged about 12%. Complicated dissections represent about 18% of all cases, and require open surgery or TEVAR. More morphological predictors of in hospital mortality are needed to differentiate patients who should be selected for immediate, surgical or endovascular intervention.

METHODS

From January 2009 to December 2014, 74 patients with acute aortic type III dissection were enrolled at Clinic of Vascular and Endovascular Surgery in Belgrade Serbia and retrospectively analyzed. Every MSCT was observed in regard to morphologic characteristics of dissection.

RESULTS

By analyzing morphologic parameters in patients between survival and non-survival group only localization of intimal tear showed statistical significance (p=0,020). The size of the intimal tear didn't reach statistical significance with the tendency of doing so in a larger sample of patients (p=0,063) with the cut-off value of 9.55mm. The shape of the true lumen was on the border of statistical significance (p=0,053).

CONCLUSION

Inner curvature intimal tear localization, huge intimal tear as well as elliptic shape of the true lumen together should raise awareness to a subgroup at risk for in hospital mortality. More liberal endovascular treatment in this subgroup of patients is advocated.

After-Hours Versus Office-Hours Dental Injuries in Children: Does Timing Influence Outcome?

AIM

The aim of this study was to analyze the outcomes and factors associated with after-hours dental trauma.

METHODS

Study sample consisted of 1762 permanent teeth injuries in children, gender and age matched with office-hours injuries. Epidemiological and clinical data were collected from 4 university dental trauma centers.

RESULTS

During median follow-up time of 4.3 years, complications have occurred in 14.5% of injured teeth. Age, type, and degree of tissue injury and after-hours time of injury were significantly associated with complications. Unfavorable outcomes were 34% more likely in the after-hours group compared with office-hours. Urgent treatment was significantly delayed in after-hours group with a delay of more than 3 hours in 90.5% versus 38.9% in the office-hours group. Multivariate regression model showed that after-hours time of injury was significant predictor of complications.

CONCLUSION

Delayed urgent treatment was one of the main factors associated with unfavorable outcome of after-hours injuries.

Association between being overweight and oral health in Serbian schoolchildren

BACKGROUND

Childhood obesity, dental caries, and periodontal disease are major public health problems due to their adverse impact on the growth and development of children.

AIM

To examine the association between nutritional status, oral health, and lifestyle habits among schoolchildren in Serbia.

DESIGN

This cross-sectional study assessed 422 children and adolescents aged 6-18 years with the following dental indexes analyzed: DMF/dmf (decayed, missed, and filled teeth), plaque index (PI), and gingival index (GI). Depending on their nutritional status, the subjects were categorized, as being 'normal weight,' 'at risk of overweight,' and 'overweight.' Logistic regression was applied to study the association between the dental indexes and independent variables: gender, age, toothbrushing, nutritional status, and lifestyle factors.

RESULTS

Being overweight positively correlated with GI, but negatively correlated with the DMF/dmf index among the participants. Multivariate analysis showed a strong association between the weight category and toothbrushing with GI and PI. Overweight children (6-11 years) were less likely to have caries, whereas in older children/adolescents (12-18 years), caries was associated with the intake of sugar-sweetened juices.

CONCLUSIONS

Being overweight was found to be significantly associated with a higher probability of developing gingivitis and negatively associated with caries prevalence in Serbian children and adolescents.

In vitro avarol does affect the growth of Candida sp

This work extends in vitro screening of antimicrobial activity of avarol, the marine natural product firstly isolated from the Mediterranean sponge Dysidea avara. Its anticandidial activity was evaluated by microdilution method against eight Candida strains, two ATCC and six clinical ones. At a different extent this compound was proven to be active against all the strains tested (MIC 0.8-6.0 μg/mL and MFC 1.6-12.0 μg/mL, respectively). According to the best of our knowledge, this is the first report on avarol activity towards any yeast strain which may be of relevance for Alzheimer's disease. Indeed, avarol derivatives showing moderate AChE activity should be screened for anticandidial activity both in vitro and in vivo.

Synthesis, electronic properties, antioxidant and antibacterial activity of some new benzimidazoles

Two groups of benzimidazole derivatives were synthesized using as precursors 5(6)-substituted 2-mercapto-benzimidazol-thiols and their antioxidant activity was investigated using TBA-MDA test. In the group of 1,3-disubstituted-benzimidazol-2-imines the highest lipid peroxidation inhibition effect 74.04% (IC₅₀=141.89 μg/mL) revealed ethyl [3-(2-ethoxy-2-oxoethyl)-2-imino-5-benzoyl-2,3-dihydro-1H-benzimdazol-1-yl]acetate 12 while in the group of 2-substituted-1,3-thiazolo[3,2-a]benzimidazolones the highest inhibition effect showed 2-(4-fluorobenzylidene)-7-(phenylcarbonyl)[1,3]thiazolo[3,2-a]benzimidazol-3(2H)-one 17 90.76% (IC₅₀=53.70 μg/mL). In order to estimate the capability of the studied benzimidazoles to act as radical scavengers the structure of the most active derivative within the both subseries was optimized at B3LYP/6-311++G(∗∗) level and the respective bond dissociation enthalpies were calculated. The appropriate models for the HAT and SET-mechanism of the antioxidant activity were proposed. The antibacterial activity of the compounds was evaluated against two Gram-positive bacteria (Bacillus subtilis ATCC 6633 and Staphylococcus aureus ATCC 6538) and three Gram-negative bacteria (Escherichia coli ATCC 8739, Pseudomonas aeruginosa ATCC 9027 and Salmonella abony NCTC 6017). 1,3-Diphenylpropyl-5-methyl-1,3-dihydro-2H-benzimidazol-2-imine 14 exhibited significant activity against B. subtilis, S. aureus, S. abony and E. coli (with MIC values of 0.125, 0.016, 0.50 and 0.50mg/mL, respectively). The group of thiazolobenzimidazolones did not reveal antibacterial activity against the tested strains.

Glucocorticoid receptor mediates the expansion of splenic late erythroid progenitors during chronic psychological stress

Stress evokes an integrated neuroendocrine response perturbing the homeostasis of different physiological systems. In contrast to well established physiologica linteractions between neuroendocrine and immune systems during chronic stress, there has been relatively little information on the effects of psychological stress on erythroid cells. Since stress-induced erythropoiesis occurs predominantly in the spleen, in the current study, we investigated the influence of chronic psychological stress on splenic erythroid progenitors and examined a role of glucocorticoid receptor (GR) in observed effect using a mouse model of restraint. The adult male mice were subjected to 2 hours daily restraint stress for 7 or 14 consecutive days and the role of GR in erythropoietic response to stress was assessed by pretreatment of mice with GR antagonist mifepristone 60 min prior to restraint. The results showed that chronic restraint stress induced an increase in spleen weight as well as in the cellularity of red pulp, as compared to controls. Furthermore, 7 and 14 days of restraint stress resulted in markedly increased number of both splenic early (BFU-E) and late (CFU-E) erythroid progenitors. Blockade of GR with mifepristone did not affect the number of BFU-E in stressed mice, but it completely abolished the effect of repeated psychological stress on CFU-E cells. Additionally, plasma corticosterone concentration was enhanced whereas the GR expression was significantly decreased within splenic red pulp after one and two weeks of stress exposure. Obtained findings suggest for the first time an indispensable role for GR in the expansion of CFU-E progenitors in the spleen under conditions of chronic psychological stress.

Effects of novel hydroxyapatite-based 3D biomaterials on proliferation and osteoblastic differentiation of mesenchymal stem cells

The aim of this study was to examine the differential capacity of isolated dental pulp stem cells (SHED) cultured onto four different scaffold materials. The differential potential of isolated SHED was examined on the following scaffolds: porous hydroxyapatite (pHAP) alone or combined with three polymers [polylactic-co-glycolic acid (PLGA), alginate, and ethylene vinylacetate / ethylene vinylversatate (EVA/EVV)]. SHED were isolated by "outgrowth" method and characterized by the flow cytometry. Viability of cells grown with scaffolds was assessed by MTT and LDH assays. No significant cytotoxic effect of any of the tested materials was shown. Staining with alizarin red and estimated alkaline phosphatase activity to identify differentiation, demonstrated osteoblastic phenotype of SHED and newly deposited and mineralized extra cellular matrix (ECM) in presence of all tested scaffolds. The developed ECM seen at scanning electronic micrographs additionally confirmed the osteogenic differentiation and biocompatibility between cells and materials. In summary, all studied biomaterials are suitable carriers for proliferation and osteoblastic differentiation of dental pulp mesenchymal stem cells in vitro.

Substantial bone loss in the mandibular central incisors area as a complication of tongue piercing: a case report

BACKGROUND

Along with the increasing popularity of oral piercings, the number of reported complications and side effects increases, too.

CASE REPORT

The aim of this report is to present a case of substantial bone loss in the area of the mandibular central incisors caused by lingual piercing and persistent bad habits. Dentist should be aware of potential complications associated with oral piercings and warn patients about them.

Lipid peroxidation, detoxification capacity, and genome damage in mice after transplacental exposure to pharmaceutical drugs

Data on genome damage, lipid peroxidation, and levels of glutathione peroxidase (GPX) in newborns after transplacental exposure to xenobiotics are rare and insufficient for risk assessment. The aim of the current study was to analyze, in an animal model, transplacental genotoxicity, lipid peroxidation, and detoxification disturbances caused by the following drugs commonly prescribed to pregnant women: paracetamol, fluconazole, 5-nitrofurantoin, and sodium valproate. Genome damage in dams and their newborn pups transplacentally exposed to these drugs was investigated using the in vivo micronucleus (MN) assay. The drugs were administered to dams intraperitoneally in three consecutive daily doses between days 12 and 14 of pregnancy. The results were correlated, with detoxification capacity of the newborn pups measured by the levels of GPX in blood and lipid peroxidation in liver measured by malondialdehyde (HPLC-MDA) levels. Sodium valproate and 5-nitrofurantoin significantly increased MN frequency in pregnant dams. A significant increase in the MN frequency of newborn pups was detected for all drugs tested. This paper also provides reference levels of MDA in newborn pups, according to which all drugs tested significantly lowered MDA levels of newborn pups, while blood GPX activity dropped significantly only after exposure to paracetamol. The GPX reduction reflected systemic oxidative stress, which is known to occur with paracetamol treatment. The reduction of MDA in the liver is suggested to be an unspecific metabolic reaction to the drugs that express cytotoxic, in particular hepatotoxic, effects associated with oxidative stress and lipid peroxidation.

The effect of gender and gender match on mortality in pediatric heart transplantation

The effect of organ-recipient gender match on pediatric heart transplant mortality is unknown. We analyzed the effects of gender and donor-recipient gender matching. Based on Organ Procurement and Transplant Network data, we performed a historical cohort study in a population of 3630 heart transplant recipients less than 18 years old. We compared unadjusted and adjusted mortality by recipient gender, donor gender and between gender-matched and gender-mismatched recipients. Female recipients had decreased survival compared to male recipients (unadjusted hazard ratio [HR] 1.16, confidence interval [CI] 1.02-1.31; p = 0.020). Organ-recipient gender mismatch did not affect mortality for either male or female recipients, though gender-mismatched females had the worst survival compared to gender-matched males, who had the best survival (unadjusted HR 1.26, CI 1.07-1.49; p = 0.005). After adjustment for other risk factors affecting transplant mortality, female recipients had decreased survival compared to male recipients (HR 1.27, CI 1.12-1.44; p = 0.020) and gender matching had no effect. In conclusion, gender mismatch alone did not increase long-term mortality for pediatric heart transplant recipients. However, there may be additive effects of gender and gender matching affecting survival. There are insufficient data at this time to support that recipient and donor gender should affect heart allocation in children.

Risk factors for intraoperative hypotension during thyroid surgery

BACKGROUND

Hypotension is a common adverse effect of IV anaesthetics, especially during the induction of anaesthesia. The aim of our study was to determine the incidence and risk factors for intraoperative hypotension (IOH) in thyroid surgery, as well as to determine whether and to what extent IOH affects the occurrence of postoperative hypotension.

MATERIAL AND METHODS

The study included 1252 euthyroid patients, ASA 2 and ASA 3 status (American Society of Anesthesiologists physical status classification), who had thyroid surgery between 2007 and 2011. IOH was defined as a decrease in systolic blood pressure of >20% of baseline values. We studied the influence of demographic characteristics (sex, age, body mass index-BMI), comorbidity, type and duration of surgery, and anaesthesia on the occurrence of IOH. Univariate and multivariate logistic regression were used to determine predictors of occurrence of IOH.

RESULTS

IOH was registered in 6.5% of patients. The most common operation was thyroidectomy. Patients with IOH were younger, had lower BMI, and significantly less often had hypertension as a coexisting disease. The multivariate regression model identified BMI and the absence of hypertension as a coexisting disease, and as independent predictors of occurrence of IOH. Significantly more patients with IOH had postoperative hypotension (9.9% vs. 2.4%, p=0.000).

CONCLUSIONS

IOH is common, even during operations of short duration and with minimal bleeding. It is necessary to pay special attention to these patients, given that many of these patients remained hypotensive during the postoperative period.

The incidence of intraoperative hypertension and risk factors for its development during thyroid surgery

We studied the influence of demographic characteristics, comorbidity, and type and duration of surgery and anesthesia on the occurrence of intraoperative hypertension (IOHTA). Logistic regression analyses were used in order to determine the predictors of occurrence of IOHTA. More than 60% of our patients had IOHTA. Multivariate analysis showed that independent predictors for IOHTA were older age, BMI 25 kg/m(2), and hypertension as a coexisting disease. Hypertension is common during thyroid surgery, and a significant number of patients remained hypertensive during the postoperative period.