Rationale: Coronavirus disease 2019 (COVID-19) leads to hospitalization and death, especially in elderly and those with comorbidities. There are evidences showing that sitagliptin and spironolactone can potentially improve the clinical outcomes of COVID-19 cases. Objective: In this observational study on acutely symptomatic outpatient COVID-19 cases, we investigated the effects of spironolactone and sitagliptin on the outcomes of the disease. Methods: This prospective cohort study was conducted at Shiraz University of Medical Sciences Clinics during the fifth wave of the COVID-19 pandemic between July 2021 and September 2021. We followed mild to moderate symptomatic COVID-19 patients, who were treated with either combination (spironolactone 100 mg daily and sitagliptin 100 mg daily) or standard (steroid, antiviral and/or supportive care) therapy up to 30 days. Our primary outcome was hospitalization rate. The secondary outcomes included ER visit, duration of disease, and complications, such as hypoglycemia, low blood pressure or altered mental status. Results: Of the 206 patients referred to clinics, 103 received standard therapy and 103 treated with combination therapy. There were no significant differences in baseline characteristics, except for slightly higher clinical score in control group (6.92 ± 4.01 control, 4.87 ± 2.92 combination; P <0.0001 ). Treatment with combination therapy was associated with lower admission rate (5.8% combination, 22.3% control; P = 0.0011 ), ER visits (7.8% combination, 23.3% control; P = 0.0021 ) and average duration of symptoms (6.67 ± 2.30 days combination, 18.71 ± 6.49 days control; P =<0.0001 ). Conclusion : In this prospective cohort study of acutely ill outpatients with COVID-19, the combination of sitagliptin and spironolactone reduced duration of COVID infection and hospital visits better than standard therapeutic approaches. The effects of combination of sitagliptin and spironolactone in COVID-19 patients should be further verified in a double blind, randomized, placebo-controlled trial. Iranian Registry of Clinical Trials : IRCT registration number: IRCT20201003048904N2, Registration date: December 10, 2020.
Purpose This study investigated vocabulary growth from 18 to 24 months of age in young children with repaired cleft palate (CP), children with otitis media, and typically developing (TD) children. In addition, the contributions of factors such as hearing level, middle ear status, size of consonant inventory, maternal education level, and gender to the development of expressive vocabulary were explored. Method Vocabulary size of 40 children with repaired CP, 29 children with otitis media, and 25 TD children was measured using the parent report on MacArthur-Bates Communicative Development Inventories: Words and Sentences (Fenson et al., 2007) at 18 and 24 months of age. All participants underwent sound field audiometry at 12 months of age and tympanometry at 18 months of age. A multiple linear regression with and without covariates was used to model vocabulary growth from 18 to 24 months of age across the 3 groups. Results Children with CP produced a significantly smaller number of words at 24 months of age and showed significantly slower rate of vocabulary growth from 18 to 24 months of age when compared to TD children (
Purpose: Research has shown an increase in dental hygiene (DH) students' knowledge and attitudes toward teledentistry (TD) after TD training in states with permissive but not restrictive DH scope of practice policies. The purpose of this study was to identify self-reported knowledge and attitudes regarding TD among the DH students at the University of North Carolina (UNC) at Chapel Hill before and after an educational intervention and student recommendations for TD curriculum placement.Methods: A faculty presentation and video demonstration, followed by small group discussions and a large group debriefing session were conducted at the UNC Adams School of Dentistry in March 2019. Participants were invited to complete a survey before and after the educational session. McNemar's matched pair test was used to compare the proportion of the participants' pre- and post-test responses.Results: Survey participants (n=30) included first year and second year DH students. There was significant difference (p<0.001) between pre and post self-reported knowledge of TD as well as a significant difference in participant's response (p= 0.012) about facilitating consultation with health care specialists through TD in NC. There was a significant difference in favorable responses (p=0.0394) that TD could increase reimbursement to dentists to enhance the provision of more services in NC. Students identified didactic courses (43%), simulated cases (47%), and integration into the DH community rotations (66%) as potential ways to incorporate TD into curriculum. Most students (93%) identified DH restricted scope of practice as a barrier to TD implementation in NC.Conclusion: The educational session resulted in increased self-reported knowledge and demonstrated positive attitudes toward the adoption of TD into multiple facets of DH curriculum. A major barrier to its adoption into practice is the DH restricted scope of practice in NC.
Abstract Rationale Coronavirus disease 2019 (COVID-19) leads to hospitalization and death, especially in elderly and those with comorbidities. There are evidences showing that sitagliptin and spironolactone can potentially improve the clinical outcomes of COVID-19 cases. Objective In this observational study on acutely symptomatic outpatient COVID-19 cases, we investigated the effects of spironolactone and sitagliptin on the outcomes of the disease. Methods This prospective cohort study was conducted at Shiraz University of Medical Sciences Clinics during the fifth wave of the COVID-19 pandemic between July 2021 and September 2021. We followed mild to moderate symptomatic COVID-19 patients, who were treated with either combination (spironolactone 100 mg daily and sitagliptin 100 mg daily) or standard (steroid, antiviral and/or supportive care) therapy up to 30 days. Our primary outcome was hospitalization rate. The secondary outcomes included ER visit, duration of disease, and complications, such as hypoglycemia, low blood pressure or altered mental status. Results Of the 206 patients referred to clinics, 103 received standard therapy and 103 treated with combination therapy. There were no significant differences in baseline characteristics, except for slightly higher clinical score in control group (6.92 ± 4.01 control, 4.87 ± 2.92 combination; P <0.0001 ). Treatment with combination therapy was associated with lower admission rate (5.8% combination, 22.3% control; P = 0.0011 ), ER visits (7.8% combination, 23.3% control; P = 0.0021 ) and average duration of symptoms (6.67 ± 2.30 days combination, 18.71 ± 6.49 days control; P =<0.0001 ). Conclusion In this prospective cohort study of acutely ill outpatients with COVID-19, the combination of sitagliptin and spironolactone reduced duration of COVID infection and hospital visits better than standard therapeutic approaches. The effects of combination of sitagliptin and spironolactone in COVID-19 patients should be further verified in a double blind, randomized, placebo-controlled trial. Iranian Registry of Clinical Trials IRCT registration number: IRCT20201003048904N2, Registration date: December 10, 2020.
Objective Buprenorphine is a medication for opioid use disorder that reduces mortality. This study aims to investigate the less well-understood relationship between the dose in the early stages of treatment and the subsequent risk of death. Methods We used Kentucky prescription monitoring data to identify adult Kentucky residents initiating transmucosal buprenorphine medication for opioid use disorder (January 2017 to November 2019). Average daily buprenorphine dose for days covered in the first 30 days of treatment was categorized as ≤8 mg, >8 to ≤16 mg, and >16 mg. Patients were followed for 365 days after the first 30 days of buprenorphine treatment. Endpoints were opioid-involved overdose death and death from other causes. Causes and dates of death were obtained using Kentucky death certificate records. Associations were evaluated using multivariable Fine and Gray models adjusting for patient baseline characteristics. Results In the cohort of 49,857 patients, there were 227 opioid-involved overdose deaths and 459 deaths from other causes. Compared with ≤8 mg, the adjusted subdistribution hazard ratio (aSHR) of opioid-involved overdose death decreased by 55% (aSHR, 0.45; 95% confidence interval [CI], 0.34–0.60) and 64% (aSHR, 0.36; 95% CI, 0.25–0.52) for patients receiving doses of >8 to ≤16 mg and >16 mg, respectively. The incidence of death from other causes was lower in patients receiving >8 to ≤16 mg (aSHR, 0.78; 95% CI, 0.62–0.98) and >16 mg (aSHR, 0.62; 95% CI, 0.47–0.80) versus ≤8 mg dose. Conclusions Higher first 30-day buprenorphine doses were associated with reduced opioid-involved overdose death and death from other causes, supporting benefit of higher dosing in reducing mortality.
Purpose. The first statewide teledentistry (TD) Summit in North Carolina (NC) was convened by the University of North Carolina (UNC) at Chapel Hill in 2018. The purpose of this analysis is to compare Summit participants' understanding of TD, its benefits, challenges, solutions and the role of dental hygienists, pre- and post-Summit.Methods. Summit invitees included leaders in related policy, education, advocacy, legislation, technology and UNC dental hygiene and dental students. Descriptive analyses and exact McNemar's matched pair tests compared proportions of participants' responses to pre- and post-Summit surveys.Results. Response rates were pre-Summit 75.3% (n= 58) and post-Summit 70.1% (n= 47); matched pre-post survey pairs (n=42). Pre-Summit respondents reported their primary role in administration (48.0%), teaching and mentoring (21.0%), patient care (12.0%) or as a student (19.0%). Among respondents, overall self-reported TD knowledge increased from 38.1% to 92.9%, p< 0.001. Their reported extent TD should be developed in NC increased from 78.6% to 95.2%, p = 0.07; the extent hygienists should have a role in TD services increased from 83.3% to 88.1%, p = 0.73. The most frequently mentioned challenge was state practice acts requiring direct supervision of dental hygienists, limiting their TD use in community settings, which increased in the pre- to post-surveys from 33.3% to 59.5% respectively, p = 0.01.Conclusion. Among attendees at the statewide TD Summit, self-reported knowledge was high and attitudes favorable for moving forward with TD in NC. However, state dental practice act barriers restricting dental hygienist participation in TD was the first challenge respondents thought needed to be addressed.
Abstract Inflammatory bowel disease (IBD) is a chronic illness that is comprised of two major disorders: Crohn's disease and ulcerative colitis. Adults with IBD have adopted telehealth and mobile health (mHealth) interventions to improve their self‐management skills and symptom‐monitoring. This systematic review aimed to evaluate the efficacy of telehealth and mHealth interventions and explore the benefits and challenges of these interventions in patients with IBD. This review used a convergent segregated approach to synthesize and integrate research findings, a methodology recommended by the Joanna Briggs Institute for mixed‐methods systematic reviews. Databases searched included PubMed, CINAHL, Embase, Cochrane Controlled Trials Registry, and ClinicalTrials.gov. The search followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses, which yielded sixteen quantitative and two qualitative articles. A narrative synthesis was performed to present the findings of quantitative and qualitative studies. Evidence from quantitative and qualitative studies was then integrated for a combined presentation. The results of quantitative analysis supported the efficacy of telehealth and mHealth interventions to improve patients' quality of life, medication adherence, disease activity, medication monitoring, disease‐related knowledge and cost savings. While some participants in qualitative studies reported certain challenges of telehealth and mHealth interventions, most of the participants conferred the benefits of the interventions, including improved disease‐related knowledge, communication between patients and providers, sense of reassurance, and appointment options. The evidence from quantitative and qualitative synthesis partially supported each other.
