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BACKGROUND The relationship between office vs. ambulatory blood pressure (BP) indices are well-studied in patients with essential hypertension and based on these data, it is known that the average 24-h ambulatory BP is typically lower than office BP. However, emerging data show that office SBP underestimates arterial afterload in patients with coarctation of aorta (COA), and a minimal increase in stroke volume during low-intensity exercise results in an exaggerated rise in SBP as compared to those with essential hypertension. We hypothesized that COA patients will have higher ambulatory SBP and a higher prevalence of masked hypertension compared to patients with essential hypertension. METHODS Case-control study of 118 COA patients and 118 patients with essential hypertension matched by age, sex, BMI and office SBP. RESULTS Although both groups had similar office SBP (132 ± 17 mmHg) by design, the COA group had paradoxical increases in 24-h ambulatory SBP (135 ± 14 vs. 126 ± 13; P

Objectives: Tooth fracture is a common complication following MOD restorations. This study sought to assess the effect of bulk fill flowable composite reinforced with short fibers on fracture resistance of maxillary premolar teeth that have extensively restored MOD cavities. Materials and Methods: In this invitro experimental study, 60 human maxillary sound premolar teeth were chosen and stored in chloramine solution. The teeth were then mounted into acrylic blocks 1mm below the CEJ. The teeth were randomly divided into 4 groups of 15 each. Group A, Teeth were intact without any cavity (negative control). Wide MOD cavities were prepared using cylindrical bur with high-speed handpiece for the 3 other groups. Group B, the teeth with MOD cavities without any restoration (positive control); Group C, the teeth were restored with bulkfill flowable composite Tetric N flow bulk fill (Ivoclar Vivadent); and group D, the teeth were restored with short fibers reinforced bulkfill flowable composite ever X Flow(GC). The teeth were then stored in water at 37°C for 24h and their fracture resistance was assessed using (INSTRON). The load at fracture was recorded in N, fracture mode was observed. Data were analyzed using one-way ANOVA and Tukey’s test with 95% CI. Results: The mean fracture strength was 1216 ± 352 N in group A, 330 ± 201 N in group B, 1013 ± 389 N in group C and 1019 ± 164 N in group D. Conclusion: Extensive MOD cavities restored with bulk fill flowable composite having short fiber reinforcement, increased the fracture strength of teeth against compressive forces, with no difference than did the other bulk fill flowable composite.

Objectives Tracheostomy is a very common clinical intervention in critically ill adult patients. The indications for tracheostomy procedures in pediatric patients with complex conditions have increased dramatically in recent years, but there are currently no guidelines on the optimal timing of tracheostomy in pediatric patients undergoing prolonged ventilation. Data sources We performed a systematic search of the existing literature in MEDLINE via PubMed and Embase databases and the Cochrane Library to identify clinical trials, observational studies, and cohort studies that compare early and late tracheostomy in children. The date of the last search was August 27, 2018. Included articles were subjected to manual searching. Study selection Studies in mechanically ventilated children that compared early with late tracheostomy were included. Data extraction Data were extracted into a spreadsheet and copied into Review Manager 5.3 (The Cochrane Collaboration, Copenhagen, Denmark). Data synthesis Data were meta-analyzed using an inverse variance, random effects model. Continuous outcomes were calculated as mean differences with 95% CIs, and dichotomous outcomes were calculated as Mantel-Haenszel risk ratios with 95% CIs. We included eight studies (10 study arms). These studies were all retrospective cohort studies. Early tracheostomy was associated with significant reductions in mortality, days on mechanical ventilation, and length of intensive care and total hospital stay, although the lack of randomized, controlled trials limits the validity of these findings. Although variance was imputed for some studies, these conclusions did not change after removing these studies from the analysis. Conclusions In children on mechanical ventilation, early tracheostomy may improve important medical outcomes. However, our data demonstrate the urgent need for high-quality, randomized controlled trials in the pediatric population.

Background Patients with Ebstein anomaly have impaired aerobic capacity, but the relationship between aerobic capacity and clinical outcomes are unknown. The purpose of this study was to determine the prognostic role of aerobic capacity and the hemodynamic mechanism underlying temporal deterioration in aerobic capacity in this population. Methods Retrospective cohort study of adults with Ebstein anomaly that underwent exercise test (2000–2018). Primary objective was to determine the relationship between aerobic capacity (%-predicted peak oxygen consumption, VO2) and cardiovascular adverse events (death, heart transplant, aborted sudden death, and heart failure hospitalization). Secondary objective was to delineate the relationship between temporal change in hemodynamic indices and subsequent decline in peak VO2. Results We studied 248 patients (peak VO2 22.4 ​± ​7.1 ​ml/kg/min; 64 ​± ​21 %-predicted), and these events occurred during follow-up (death n ​= ​12, transplant n ​= ​1, aborted sudden death n ​= ​7, and heart failure hospitalization n ​= ​11). Peak VO2 was an independent predictor of cardiovascular adverse events (hazard ratio 1.32; 95% confidence interval 1.18–1.59, p ​= ​0.002 per 5%-point decrease). Of 101 patients with ≥2 exercise tests, %-predicted peak VO2 decreased by 2.3%-points/year, and rate of decline correlated with change in right atrial (RA) strain and left heart hemodynamics. Hemodynamic deterioration started with RA dysfunction, followed by left heart hemodynamic impairment, and then decline in peak VO2. Conclusions Peak VO2 is a predictor of cardiovascular adverse events in Ebstein anomaly. Temporal decline in peak VO2 was preceded by RA dysfunction and left heart hemodynamic impairment suggesting that impaired aerobic capacity represents a late stage in disease pathogenesis.

Background: This study aimed to assess the correlation between the internal jugular vein/common carotid artery (IJV/CCA) cross-sectional area (CSA) ratio and the inferior vena cava (IVC) diameter as non-invasive techniques for the assessment of intravascular volume. Methods: The study samples included 35 adult patients of both sexes (age range: 20 - 60 years) according to the criteria of the American Society of Anaesthesiology (ASA) physical status II - III, who were admitted to the surgical intensive care unit (SICU) after major surgeries for the assessment of intravascular volume status. Results: There was a positive correlation between the IJV/CCA CSA ratio and the IVC maximum and minimum diameter before and after fluid infusion (r = 0.923, P < 0.001 and r = 0.390, P = 0.021, respectively) and between the IJV/CCA CSA ratio at inspiration and the IVC minimum diameter before and after fluid infusion (r = 0.605, P < 0.001 and r = 0.496, P < 0.001, respectively). The sensitivity and specificity analysis of the IJV/CCA CSA during inspiration after fluid correction to predict a central venous pressure (CVP) of 8 - 12 cmH2O showed that at a ratio of 2.56, the highest sensitivity was 56.5%, and the specificity was 83.3%; at a ratio of 2.58, the highest sensitivity was 65.2% and the specificity was 75%. During expiration, at a ratio of 2.62, the highest sensitivity was 52.2%, and the specificity was 67%; and at a ratio of 2.65, the sensitivity was 56.5%, and the specificity was 50%. Conclusions: The assessment of the IJV/CCA CSA ratio using bedside ultrasound could be a non-invasive tool for the evaluation of intravascular volume status in spontaneously breathing adult patients after major surgeries.

Objective: This study aims to evaluate the expression pattern of circulating microRNAs (miR)-486-5p, miR-497, miR-509-5p, and miR-605 in the serum of metabolic syndrome (MetS) Egyptian male patients. Methods: In this study, the circulating miR-486-5p, miR-497, miR509-5p, and miR-605 were amplified and quantitatively detected by quantitative real-time polymerase chain reaction in sera of 55 MetS male patients in comparison to 20 male controls. The level of fasting plasma glucose and triacylglycerol (TAG) were measured using calorimetric assay. Blood pressure was measured using mercuric sphygmomanometer. Anthropometric measurements were done to each individual. Furthermore, MetS patients were defined according to the criteria proposed by the American Heart Association and divided into three groups according to MetS index. Results: The study was performed on three groups and a control group defined as follows: group 1: 15 MetS patients who fulfilled all diagnostic criteria of MetS; group 2: 20 MetS patients with normal blood pressure; group 3: 20 MetS patients with normal TAG levels.The levels of miRs are expressed as [median (IQR)]. miR-486-5-p and miR-497 expression were elevated in group 1 [31.9(49), p˂0.0001; 73.1(42.5), p˂0.0001], group 2 [36.4(15.7), p˂0.0001; 68.3(54.8), p˂0.0001], and group (3) [10.8(18.9), p=0.0014; 27.5(39.7), p=0.0012]. MiR-509-5p was elevated in groups 1 and 2 [501(468), p=0.0001], [309(436), p=0.0006], respectively, while normally expressed in group 3 [0.93(0.077), p=0.0001]. miR-605 was elevated in groups 1 and 3 [25.4(20.0), p=0.0018], [54.8(65.8), p˂0.0001], while normally expressed in group 2 [0.84(0.67), p˂0.0001]. Conclusion: miRs (486-5p, 497, 509-5p, and 605) serum levels were higher in MetS patients than in healthy control subjects; therefore, these serum miRs can serve as early biomarkers and can be used to follow-up the prognosis of MetS.

Background Cardiac arrhythmia cannot be overlooked in patients with coronavirus disease 2019 (COVID-19) as it carries a great influence on the outcomes. Hence, this study aimed to build concrete evidence regarding the incidence of cardiac arrhythmia in patients with COVID-19. Methods We performed a systematic search for trusted databases/search engines including PubMed, Scopus, Cochrane library and web of science. After screening, the relevant data were extracted and the incidences from the different included studies were pooled for meta-analysis. Results Nine studies were finally included in our study consisting of 1445 patients. The results of meta-analysis showed that the incidence of arrhythmia in patients with COVID-19 was 19.7% with 95% confidence interval (CI) ranging from 11.7 to 27.6%. There was also a significant heterogeneity (I2□ =□94.67%). Conclusion Cardiac arrhythmias were highly frequent in patients with COVID-19 and observed in 19.7% of them. Appropriate monitoring by electrocardiogram with accurate and early identification of arrhythmias is important for better management and outcomes. Highlights Cardiac arrhythmia cannot be overlooked in patients with coronavirus disease 2019 (COVID-19) as it carries a great influence on the outcomes. This study aimed to build concrete evidence regarding the incidence of cardiac arrhythmia in patients with COVID-19. Cardiac arrhythmias were highly frequent in patients with COVID-19 and observed in 19.7% of them. Appropriate monitoring by electrocardiogram with accurate and early identification of arrhythmias is important for better management and outcomes.

BackgroundThere is an increasing evidence that COVID-19 could be complicated by coagulopathy which may lead to death; especially in severe cases. Hence, this study aimed to build concrete evidence regarding the incidence and mortality of pulmonary embolism (PE) in patients with COVID-19.MethodsWe performed a systematic search for trusted databases/search engines including PubMed, Scopus, Cochrane library and Web of Science. After screening, the relevant data were extracted and the incidences and mortality rates from the different included studies were pooled for meta-analysis.ResultsTwenty studies were finally included in our study consisting of 1896 patients. The results of the meta-analysis for the all included studies showed that the incidence of PE in patients with COVID-19 was 17.6% with the 95% confidence interval (CI) of 12.7 to 22.5%. There was significant heterogeneity (I2□=□91.17%). Additionally, the results of meta-analysis including 8 studies showed that the mortality in patients with both PE and COVID-19 was 43.1% with the 95% confidence interval (CI) of 19 to 67.1%. There was significant heterogeneity (I2□=□86.96%).ConclusionPE was highly frequent in patients with COVID-19. The mortality in patients with both COVID-19 and PE was remarkable representing almost half of the patients. Appropriate prophylaxis and management are vital for better outcomes.

Background Catheter-related thrombosis (CRT) is a serious complication of vascular catheters. Retrograde catheter insertion has been shown to decrease pericatheter hemostasis and thrombosis, but it is technically challenging. The current in silico trial is an analytical approach to evaluating different approaches to designing retrograde flow into a vascular catheter. Methods The novel catheter design aims to provide antistasis retrograde flow (ASRF) of fluid through multiple backward-directed side openings, with a self-closing terminal opening to facilitate standard insertion. Four different models of the catheter were evaluated by computational fluid dynamic studies, with retrograde-angled openings of 15°, 30°, 45°, and 60° to the long axis of the catheter. Results ASRF successfully reduced the areas of fluid stagnation in models with 15° and 30° openings. Models with 45° and 60° did not significantly reduce stagnation. ASRF is reversed by the main bloodstream after a few millimeters. The novel catheter design achieved a slightly higher saline flow rate compared with the standard catheter (89.75, 91.72, 94.13, and 94.26 mL/min for 15°, 30°, 45°, and 60° designs, respectively, versus 86.93 mL/min for the standard catheter). Conclusions The novel ASRF vascular catheter reduces pericatheter fluid stasis and has the potential to reduce CRT. Further in vitro and in vivo trials are warranted to validate these findings and evaluate clinical efficacy.

The caries infiltration technique was introduced with the aim of filling the intercrystalline spaces with a low-viscosity resin, to arrest lesions and treat the esthetic problem of white spot lesions. This study was designed to evaluate the effect and clinical efficacy of resin infiltration technique on masking of enamel white spot lesions compared to an ordinary adhesive system. Methods: A total number of 20 patients having 120 not cavitated anterior teeth with white spot lesions were subjected to this study. After scaling, polishing and oral hygiene measures, the six maxillary anterior teeth were isolated with rubber dam. The teeth were divided into two groups, the first group (central incisor, lateral incisor and canine on right side of patient) was treated with hydrochloric acid (Icon-Etch) then ethanol (Icon-Dry) followed with application of resin (Icon-Infiltrant), while the second group: (central incisor, lateral incisor and canine on left side of the same patient) was treated with phosphoric acid (N-Etch) and adhesive (ExciTE F).Durability of used resins were clinically assessed by six of the FDI World Dental Federation criteria which were selected to be suitable for the current study (Surface luster, Surface Staining, Postoperative hyper-sensitivity, Recurrence of caries, Adjacent mucosa, and Patient’s view), Each property has five grades from excellent to poor. Results: Both of treated groups showed improved surface luster, decreased postoperative hypersensitivity, diminished recurrent caries and increased patient satisfaction. Icon resin infiltration was more durable than Excite F adhesive after one year follow up. Both groups showed no initial surface staining, but with timesurface stainingbeing more with icon infiltrated group. Both materials have no effect on adjacent mucosa at different aging times. Conclusions: Icon resin infiltration is an effective treatment for deminiralized white spot lesions but with frequent repolishing to overcome surface staining for long lasting esthetic outcome. Excite F adhesive can be used only for short time sealing of enamel surface to improve the esthetics of white spot lesions and control of caries progression.

The caries infiltration technique was introduced with the aim of filling the intercrystalline spaces with a low-viscosity resin, to arrest lesions and treat the esthetic problem of white spot lesions. This study was designed to evaluate the color effect and durability of resin infiltration technique on masking of enamel white spot lesions compared to an ordinary adhesive system. Methods: a total number of 20 patients having 120 not cavitated anterior teeth with white spot lesions were subjected to this study. The six maxillary anterior teeth were isolated with rubber dam. The teeth were divided into two groups, the first group (central incisor, lateral incisor and canine on right side of patient) was treated with hydrochloric acid (Icon-Etch) then ethanol (Icon-Dry) followed with application of resin (Icon-Infiltrate), while the second group: (central incisor, lateral incisor and canine on left side of the same patient) was treated with phosphoric acid (N-Etch) and adhesive (ExciTE F).Evaluation of color was done using VITA Easyshade V (VITA Germany) at the following intervals (pre-operative, immediate, one week, three months, six months and twelve months post-operatively). Results: the highest mean value of color change was found immediately post-operatively for icon resin infiltration group presented as positive (ΔL) and negative (ΔC) that means decrease in the whitish discoloration of teeth. Conclusions: Icon resin infiltration is an effective treatment for deminiralized white spot lesions, while Excite F adhesive can be used for short time sealing of enamel surface to improve the esthetics of white spot lesions.

Background Total cavopulmonary connection (TCPC) is associated with a lower risk of incident atrial arrhythmias as compared to atriopulmonary Fontan, but the risk of recurrent atrial arrhythmias is unknown in this population. The purpose of this study was to determine the incidence and risk factors for recurrent atrial arrhythmias and thromboembolic complications in patients with TCPC. Methods This is a retrospective multicenter study conducted by the Alliance for Adult Research in Congenital Cardiology (AARCC), 2000–2018. The inclusion criteria were TCPC patients (age > 15 years) with prior history of atrial arrhythmia. Results A total of 103 patients (age 26 ± 7 years; male 58 [56%]) met inclusion criteria. The mean age at initial arrhythmia diagnosis was 13 ± 5 years, and atrial arrhythmias were classified as atrial flutter/tachycardia in 85 (83%) and atrial fibrillation in 18 (17%). The median duration of follow-up from the first episode of atrial arrhythmia was 14.9 (12.1–17.3) years, and during this period 64 (62%) patients had recurrent atrial arrhythmias (atrial flutter/tachycardia 51 [80%] and atrial fibrillation 13 [20%]) with annual incidence of 4.4%. Older age was a risk factor for arrhythmia recurrence while the use of a class III anti-arrhythmic drug was associated with a lower risk of recurrent arrhythmias. The incidence of thromboembolic complication was 0.6% per year, and the cumulative incidence was 4% and 7% at 5 and 10 years respectively from the time of first atrial arrhythmia diagnosis. There were no identifiable risk factors for thromboembolic complications in this cohort. Conclusions Although TCPC provides superior flow dynamics and lower risk of incident atrial arrhythmias, there is a significant risk of recurrent arrhythmias among TCPC patients with a prior history of atrial arrhythmias. These patients may require more intensive arrhythmia surveillance as compared to other TCPC patients.

Objective. The aim of this study was to evaluate the effect of different disinfectant agents on bond strength of two types of resin composite materials.Methods. A total of 80 sound posterior teeth were used. They were divided into four groups(n=20)according to the dentin surface pretreatment (no treatment, chlorhexidine gluconate 2%, sodium hypochlorite 4%, and EDTA 19%). Each group was divided into two subgroups according to the type of adhesive (prime and bond 2.1 and Adper easy one). Each subgroup was further divided into two subgroups according to the type of resin composite (TPH spectrum and Tetric EvoCeram). Shear bond strength between dentin and resin composite was measured using Universal Testing Machine. Data collected were statistically analyzed byt-test and one-way ANOVA followed by Tukey’spost hoctest.Results. It was found that dentin treated with EDTA recorded the highest shear bond strength values followed by sodium hypochlorite and then chlorhexidine groups while the control group showed the lowest shear bond strength.Conclusions. The surface treatment of dentin before bonding application has a great effect on shear bond strength between resin composite and dentin surface.