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2. The effect of hard tissue defects on the clinical outcome of endodontic microsurgery: a systematic review and meta-analysis.

Author

Sabeti, Mohammad, Kharat, Piyusha, Azarpazhooh, Amir, and Ihsan, Mohammad Saqib

Subjects
Evidence-based dentistry, Meta-analysis, Prospective cohort, Surgical endodontics, Systematic review, Humans, Microsurgery, Treatment Outcome, Dental Care
Abstract

OBJECTIVES: The purpose of this systematic review was to appraise the existing literature on the effect of hard tissue defects on the clinical outcome of endodontic microsurgery (EMS). METHODS: MEDLINE (PubMed), Embase, Web of Science, Cochrane Library and grey literature were searched from January 2000 to May 2023. Study selection and data extraction were performed in duplicate. Eligible studies were critically appraised for the risk of bias using the Cochrane Risk of bias tool. The quality of evidence was assessed using GRADE. Review Manager (RevMan Computer program Version 5.4, The Cochrane Collaboration, 2020) was utilized and the Mantel Haenszel fixed or random effects model was applied, depending on the heterogeneity of the studies. Meta-analysis was performed to estimate the Risk ratio (RR) and 95% Confidence Interval (CIs) to correlate the effects of these factors on treatment outcomes. RESULTS: Nineteen studies were included. The EMS overall pooled success rate was 84.5%. Five characteristics of hard tissue were identified. The size of the lesion (Small ≤ 5 mm: 78.4% vs. Large > 5 mm: 63.3%, RR = 1.12, 95% CI 1.00-1.26, P ≤ .05), significantly affected the outcomes of EMS. Endodontic lesions exhibited slightly better outcomes than endodontic-periodontal lesions (81.4% vs. 68.2%, RR = 1.14 95% CI 0.98-1.33, P > .05). Cases with the height of the buccal bone > 3 mm also exhibited slightly better outcomes (91.5% vs. 71.4%, RR = 1.20, 95% CI 0.88-1.62, P > .05). Additionally, through and through lesions exhibited better outcomes when grafting was completed during the EMS procedure both in 2D (RR = 1.12 95% CI 0.97-1.29, P > .05) and 3D evaluation ((RR = 1.28 95% CI 0.69-2.37 P > .05). The overall quality of evidence was graded as low to high. CONCLUSION: With a low to high quality of evidence, the size of the lesion is a key prognostic variable that significantly affects the outcome of EMS, as lesions ≤ 5 mm exhibit better outcomes as compared to larger lesions. CLINICAL SIGNIFICANCE: The presence of hard tissue defects can affect the outcome of endodontic microsurgery (EMS). The presented data can aid the clinicians decision-making process by examining certain pre-operative prognostic variables, when considering EMS as a treatment option. Clinical cases with more favorable hard tissue characteristics lead to a better prognosis in EMS.

Published
2023

8. Development of a Core Outcome Set in Endodontics (COS-ENDO): Part 1 – General Methods for Developing COS-ENDO for Studies of Nonsurgical Root Canal Treatment, Retreatment, Surgical Endodontics, Vital Pulp Therapy, Apexification, and Regenerative Endodontics in Permanent Teeth

Author

Azarpazhooh, Amir, Zanjir, Maryam, Cardoso, Elaine, Harman, Nicola L., Khansari, Ava, Jafarzadeh, Hamid, Malkhassian, Gevik, Sabeti, Mike, Aminoshariae, Anita, Kishen, Anil, Sale, Joanna E.M., and Shah, Prakesh S.

Published
2025
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9. Simulation of Heat and Mass Transfer in a Refractance Window Dryer for Aloe vera gel

Author

A. Shahraki, M. Khojastehpour, M. R. Golzarian, and E. Azarpazhooh

Subjects
aloe vera gel, heat transfer, mass transfer, refractance window dryer, simulation, Agriculture (General), S1-972, Engineering (General). Civil engineering (General), TA1-2040
Abstract

IntroductionDrying is one of the oldest methods of food preservation. To increase the efficiency of heat and mass transfer while maintaining product quality, the study of the drying process is crucial scientifically and meticulously. It is possible to conduct experimental tests, trial and error, in the drying process. However, this approach consumes time and cost, with a significant amount of energy resources. By harnessing available software and leveraging technological advancement to develop a general model for drying food under varying initial conditions, the drying process can be significantly optimized.Materials and MethodsThis study was conducted with the aim of simulating heat and mass transfer during Refractance window drying for aloe vera gel. Comsol Multiphysics version 5.6 is a three-dimensional model used to solve heat and mass transfer equations. For this purpose, the differential equations of heat and mass transfer were solved simultaneously and interdependently. The above model considered various initial conditions: water temperature of 60, 70, 80, and 90℃, and aloe vera gel thickness of 5 and 10 mm. The initial humidity and temperature of the aloe vera is uniform. The initial temperature is 4℃ and the initial humidity of the fresh aloe vera sample is 110 gwater/gdry matter. Heat is supplied only by hot water from the bottom surface of the product.Results and DiscussionThe drying time was needed to reduce the moisture content of aloe vera gel from 110 to 0.1 gwater/gdry matter during Refractance window drying. Aloe vera gel with a thickness of 5 mm dried in 120, 100, 70, and 50 minutes at water temperatures of 60, 70, 80, and 90℃, respectively. For a 10 mm thick layer of aloe vera gel, the drying time was 240, 190, 150, and 120 minutes, for water temperatures of 60 to 90℃, respectively. These results demonstrate the importance of both the water temperature and thickness on the drying time. Furthermore, the drying rate of aloe vera gel increased as the water temperature increased from 60 to 90℃, the drying rates were 0.915, 1.099, 1.57, and 2.198 gwater/min for 5 mm thickness and 0.457, 0.578, 0.732, and 0.915 gwater/min for 10 mm thick layer of aloe vera gel, respectively.ConclusionBased on the simulation results, the optimal model is with a water temperature of 90℃ and an aloe vera gel thickness of 5 mm. Overall, the modeling results are consistent with the results of experimental data.

Published
2024
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10. Evaluation of the Quantitative and Qualitative Characteristics of Gluten-free Chicken Nuggets Containing Quinoa Flour and Hydroxypropyl Methyl Cellulose (HPMC)

Author

Ghazal Shekari, Elnaz Milani, and Elham Azarpazhooh

Subjects
celiac, chicken nugget, gluten free, hpmc, quinoa, Food processing and manufacture, TP368-456
Abstract

IntroductionCeliac disease is one of the most common digestive disorder. Chicken nugget is one of the most popular instant and ready-to-eat foods, and wheat flour is one of its main coating ingredients, which contains approximately 60% gluten. Quinoa is a gluten-free grain, as a good source of dietary fiber, has various applications in the meat products processing system as a stabilizer, fat substitute, structural components, etc. The addition of hydrocolloids also helps to improve the rheological properties of gluten-free products. The purpose of this research was to evaluate the effect of quinoa-corn mixed flour in the preparation of nugget batter as a gluten-free combination as an alternative to wheat flour, and also to investigate the effect of adding HPMC hydrocolloid on the final product characteristics. In this research, a rotatable central composite design was used to investigate the effect of two independent variables including different proportions of quinoa-corn flour (0-100, 50-50, 100-0%) and different levels of hydrocolloid (0.5-1-1.5%) on the quality characteristics of nugget. With the increase of quinoa replacement level, moisture content (0.60), batter pick up (138) and redness level 5.5 (a*) increased, and oil content (11), hardness (7.5), brightness level 41(L*), yellowness level 20(b*) decreased. The increase of HPMC also caused an increase in moisture content (0.59), brightness level (L*) of 0.39, batter pick up (137) and decrease in oil content (10) and hardness (7). Optimum conditions for the production of gluten-free nugget were determined by considering the optimal amounts for the production of high quality and healthy products, contained 90% quinoa and HPMC at a level of about 1%. Materials and Methods Corn flour was purchased from the pilot of Ferdowsi University of Mashhad. The de-saponified quinoa was prepared from Kashmir and then ground. In order to make the grains more uniform, both flours were sieved using a 30 mesh. Hydrocolloid hydroxypropyl methylcellulose was also prepared from Kian Shimi Mashhad. Oyla frying oil was used for frying the samples.The chicken nugget formulation was a mixture of 86% minced chicken, 10% onion, 1.5% garlic powder, 1% salt and 1.5% pepper. After complete mixing, these materials were poured into a freezer bag until a homogeneous and uniform mixture was obtained, and they were flatted until they reached the desired thickness (1 cm). Plastics containing chicken paste were stored in the freezer for 2 hours to facilitate cutting. Then molding was done with a circular mold with a diameter of 4 cm (Dehghan Nasiri et al., 2012).The batter formulation consisted of flour, water, baking powder, salt and hydrocolloids. In order to investigate the effect of quinoa and corn flours, and hydrocolloids, these substances were added to nugget water paste in different percentages (quinoa-corn ratio: 0-100, 50-50, 0-100 and hydrocolloids at the level of 1-1 / 5 -0.5%) and then mixed with water by mixer for 1 minute. The molded samples were first coated with flour and then immersed in the batter for 60 seconds and dripped for 30 seconds. Finally, deep frying was performed in the fryer at 170 ° C for 3.5 minutes. The fried samples were taken out of the fryer basket and the excess oil on the surface of the nuggets was removed with absorbent paper. The oil was changed after twice frying. After cooling the samples at room temperature, the tests such as moisture content, oil content, texture (hardness), color, batter pick up, peroxide and overall acceptance were performed.In this study, Design Expert 10.0.7 software and a rotatable central composite design to investigate the effect of two independent variables including different ratios of quinoa-corn flour (0-100, 50-50, 0-100%) and hydrocolloid (0.5-1-1.5%), Was used on the quality characteristics of the nugget. Finally, different models were fitted to the data obtained from the experiments and the best model was selected according to the results of analysis of variance. Results and DiscussionWith increasing quinoa replacement level, moisture content, redness (a*) and pH increased and oil content, batter pick up, texture (hardness), brightness (L*), yellowness (b*) and cooking loss decreased. Increasing the HPMC also increased the moisture content, brightness (L*), cooking loss, batter pick up, and decreased oil content and hardness. Optimum condition for production of gluten-free chicken nuggets, considering the appropriate properties was found to be 90% quinoa flour and 1% HPMC. Conclusion In general, it can be concluded that the addition of quinoa and HPMC leads to the production of high quality products with high moisture and low oil content and high nutritional value.

Published
2024
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12. Tenecteplase versus standard of care for minor ischaemic stroke with proven occlusion (TEMPO-2): a randomised, open label, phase 3 superiority trial

Author

Salluzzi, Marina, Blenkin, Nicole, Dueck, Ashley, Doram, Craig, Zhang, Qiao, Kenney, Carol, Ryckborst, Karla, Bohn, Shelly, Collier, Quentin, Taylor, Frances, Lethebe, B. Cord, Jambula, Anitha, Sage, Kayla, Toussaint, Lana, Save, Supryia, Lee, Jaclyn, Laham, N, Sultan, A.A., Deepak, A., Sitaram, A., Demchuk, Andrew M., Lockey, A., Micielli, A., Wadhwa, A., Arabambi, B., Graham, B., Bogiatzi, Chrysi, Doshi, Darshan, Chakraborty, D., Kim, Diana, Vasquez, D, Singh, D, Tse, Dominic, Harrison, E., Smith, E.E., Teleg, E., Klourfeld, E., Klein, G., Sebastian, I.A., Evans, J, Hegedus, J, Kromm, J, Lin, K, Ignacio, K, Ghavami, Kimia, Ismail, M., Moores, M., Panzini, M.A., Boyko, M., Almekhlafi, M.A., Newcommon, Nancy, Maraj, N., Imoukhuede, O., Volny, O., Stys, Peter, Couillard, Phillipe, Ojha, P., Eswaradass, P., Joundi, Raed, Singh, R., Asuncion, R.M., Muir, R.T., Dey, S., Mansoor, S., Wasyliw, S., Nagendra, S., Hu, Sherry, Althubait, S., Chen, S., Bal, S., Van Gaal, Stephen, Peters, Steven, Ray, Sucharita, Chaturvedi, S., Subramaniam, Suresh, Fu, Vivian, Villaluna, K., Maclean, G., King-Azote, P., Ma, C., Plecash, A., Murphy, C., Gorman, J., Wilson, L., Zhou, L., Benevente, O., Teal, P., Yip, S., Mann, S., Dewar, B., Demetroff, M., Shamloul, R., Beardshaw, R., Roberts, S., Blaquiere, D., Stotts, G., Shamy, M., Bereznyakova, O., Fahed, R., Alesefir, W., Lavoie, Suzy, Hache, A., Collard, K, Mackey, A., Gosselin-Lefebvre, S., Verreault, S., Beauchamp, B., Lambourn, L., Khaw, A., Mai, L., Sposato, L., Bres Bullrich, M., Azarpazhooh, R., Fridman, S., Kapoor, A., Southwell, A., Bardi, E., Fatakdawala, I., Kamra, M, Lopes, K., Popel, N., Norouzi, V., Liu, A., Liddy, A.M., Ghoari, B., Hawkes, C., Enriquez, C.A., Gladstone, D.J., Manosalva Alzate, H.A., Khosravani, H., Hopyan, J.J., Sivakumar, K., Son, M., Boulos, M.I., Hamind, M.A., Swartz, R.H., Murphy, R., Reiter, S., Fitzpatrick, T., Bhandari, V., Good, J., Penn, M., Naylor, M., Frost, S., Cayley, A., Akthar, F., Williams, J., Kalman, L., Crellin, L., Wiegner, R., Singh, R.S., Stewart, T., To, W., Singh, S., Pikula, A., Jaigobin, C., Carpani, F., Silver, F., Janssen, H., Schaafsma, J., del Campo, M., Alskaini, M., Rajendram, P., Fairall, P., Granfield, B., Crawford, D., Jabs, J., White, L., Sivakumar, L., Piquette, L., Nguyen, T., Nomani, A., Wagner, A., Alrohimi, A., Butt, A., D'Souza, A., Gajurel, B., Vekhande, C., Kamble, H., Kalashyan, H., Lloret, M., Benguzzi, M., Arsalan, N., Ishaque, N., Ashayeriahmadabad, R., Samiento, R., Hosseini, S., Kazi, S., Das, S., Sugumar, T., Selchen, D., Kostyrko, P., Muccilli, A., Saposnik, A.G., Vandervelde, C., Ratnayake, K., McMillan, S., Katsanos, A., Shoamanesh, A., Sahlas, D.J., Naidoo, V., Todorov, V., Toma, H., Brar, J., Lee, J., Horton, M., Shand, E., Weatherby, S., Jin, A., Durafourt, B., Jalini, S., Gardner, A., Tyson, C., Junk, E., Foster, K., Bolt, K., Sylvain, N., Maley, S., Urroz, L., Peeling, L., Kelly, M., Whelan, R., Cooley, R., Teitelbaum, J., Boutayeb, A., Moore, A., Cole, E., Waxman, L., Ben-Amor, N., Sanchez, R., Khalil, S., Nehme, A., Legault, C., Tampieri, D., Ehrensperger, E., Vieira, L., Cortes, M., Angle, M., Hannouche, M., Badawy, M., Werner, K., Wieszmuellner, S., Langer, A., Gisold, A., Zach, H., Rommer, P., Macher, S., Blechinger, S., Marik, W., Series, W., Baumgartinger, M., Krebs, S., Koski, J., Eirola, S., Ivanoff, T., Erakanto, A., Kupari, L., Sibolt, G., Panula, J., Tomppo, L., Tiainen, M., Ahlstrom, M., Martinez Majander, N., Suomalainen, O., Raty, S., Levi, C., Kerr, E., Allen, J., Kaauwai, L.P., Belevski, L., Russell, M., Ormond, S., Chew, A., Loiselle, A., Royan, A., Hughes, B., Garcia Esperon, C., Pepper, E., Miteff, F., He, J., Lycett, M., Min, M., Murray, N., Pavey, N., Starling de Barros, R., Gangadharan, S., Dunkerton, S., Waller, S., Canento Sanchez, T., Wellings, T., Edmonds, G., Whittaker, K.A., Ewing, M., Lee, P., Singkang, R., McDonald, A., Dos Santos, A., Shin, C., Jackson, D., Tsoleridis, J., Fisicchia, L., Parsons, N., Shenoy, N., Smith, S., Sharobeam, A., Balabanski, A., Park, A., Williams, C., Pavlin-Premri, D., Rodrigues, E., Alemseged, F., Ng, F., Zhao, H., Beharry, J., Ng, J.L., Williamson, J., Wong, J.Z.W., Li, K., Kwan, M.K., Valente, M., Yassi, N., Yogendrakumar, V., McNamara, B., Buchanan, C., McCarthy, C., Thomas, G., Stephens, K., Chung, M., Chung, M.F., Tang, M., Busch, T., Frost, T., Lee, R., Stuart, N., Pachani, N., Menon, A., Borojevic, B., Linton, C.M., Garcia, G., Callaly, E.P., Dewey, H., Liu, J., Chen, J., Wong, J., Nowak, K., To, K., Lizak, N.S., Bhalala, O., Park, P., Tan, P., Martins, R., Cody, R., Forbes, R., Chen, S.K., Ooi, S., Tu, S., Dang, Y.L., Ling, Z., Cranefield, J., Drew, R., Tan, A., Kurunawai, C., Harvey, J., Mahadevan, J.J., Cagi, L., Palanikumar, L., Chia, L.N., Goh, R., El-Masri, S., Urbi, B., Rapier, C., Berrill, H., McEvoy, H., Dunning, R., Kuriakose, S., Chad, T., Sapaen, V., Sabet, A., Shah, D., Yeow, D., Lilley, K., Ward, K., Mozhy Mahizhnan, M., Tan, M., Lynch, C., Coveney, S., Tobin, K., McCabe, J., Marnane, M., Murphy, S., Large, M., Moynihan, B., Boyle, K., Sanjuan, E., Sanchis, M., Boned, S., Pancorbo, O., Sala, V., Garcia, L., Garcia-Tornel, A., Juega, J., Pagola, J., Santana, K., Requena, M., Muchada, M., Olive, M., Lozano, P.J., Rubiera, M., Deck, M., Rodriguez, N., Gomez, B., Reyes Munoz, F.J., Gomez, A.S., Sanz, A.C., Garcia, E.C., Penacoba, G., Ramos, M.E., de Lera Alfonso, M., Feliu, A, Pardo, L., Ramirez, P., Murillo, A., Lopez Dominguez, D., Rodriguez, J., Terceno Izaga, M., Reina, M., Viturro, S.B., Bojaryn, U., Vera Monge, V.A., Silva Blas, Y., R Siew, R., Agustin, S J, Seet, C., Tianming, T., d'Emden, A., Murray, A., Welch, A., Hatherley, K., Day, N., Smith, W., MacRae, E., Mitchell, E.S., Mahmood, A., Elliot, J., Neilson, S., Biswas, V., Brown, C., Lewis, A., Ashton, A., Werring, D., Perry, R., Muhammad, R., Lee, Y.C., Black, A., Robinson, A., Williams, A., Banaras, A., Cahoy, C., Raingold, G., Marinescu, M., Atang, N., Bason, N., Francia, N., Obarey, S., Feerick, S., Joseph, J., Schulz, U., Irons, R., Benjamin, J., Quinn, L., Jhoots, M., Teal, R., Ford, G., Harston, G., Bains, H., Gbinigie, I., Mathieson, P., Sim, C.H., Hayter, E., Kennedy, K., Binnie, L., Priestley, N., Williams, R., Ghatala, R., Stratton, S., Blight, A., Zhang, L., Davies, A., Duffy, H., Roberts, J., Homer, J., Roberts, K., Dodd, K., Cawley, K., Martin, M., Leason, S., Cotgreave, S., Taylor, T., Nallasivan, A., Haider, S., Chakraborty, T., Webster, T., Gil, A., Martin, B., Joseph, B., Cabrera, C., Jose, D., Man, J., Aquino, J., Sebastian, S., Osterdahl, M., Kwan, M., Matthew, M., Ike, N., Bello, P., Wilding, P., Fuentes, R., Shah, R., Mashate, S., Patel, T., Nwanguma, U., Dave, V., Haber, A., Lee, A., O'Sullivan, A., Drumm, B., Dawson, A.C., Matar, T., Roberts, D., Taylor, E., Rounis, E., El-Masry, A., O'Hare, C., Kalladka, D., Jamil, S., Auger, S., Raha, O., Evans, M., Vonberg, F., Kalam, S., Ali Sheikh, A., Jenkins, I.H., George, J., Kwan, J., Blagojevic, J., Saeed, M., Haji-Coll, M., Tsuda, M., Sayed, M., Winterkron, N., Thanbirajah, N., Vittay, O., Karim, R., Smail, R.C., Gauhar, S., Elmamoun, S., Malani, S., Pralhad Kelavkar, S., Hiden, J., Ferdinand, P., Sanyal, R., Varquez, R., Smith, B., Okechukwu, C., Fox, E., Collins, E., Courtney, K., Tauro, S., Patterson, C., McShane, D., Roberts, G., McIImoyle, J., McGuire, K., Fearon, P., Gordon, P., Isaacs, K., Lucas, K., Smith, L., Dews, L., Bates, M., Lawrence, S., Heeley, S., Patel, V., Chin, Y.M., Sims, D., Littleton, E., Khaira, J., Nadar, K., Kieliszkowska, A., Sari, B., Domingos Belo, C., Smith, E., Manolo, E.Y., Aeron-Thomas, J., Doheny, M., Garcia Pardo, M., Recaman, M., Tibajia, M.C., Aissa, M., Mah, Y., Yu, T., Meenakshisundaram, S., Heller, S., Alsukhni, R., Williams, O., Farag, M., Benger, M., Engineer, A., Bayhonan, S., Conway, S., Bhalla, A., Nouvakis, D., Theochari, E., Boyle, F., Teo, J., King-Robson, J., Law, K.Y., Sztriha, L., McGovern, A., Day, D., Mitchell-Douglas, J., Francis, J., Iqbal, A., Punjabivaryani, P., Anonuevo Reyes, J., Anonuevo Reyes, M., Pauls, M., Buch, A., Hedstrom, A., Hutchinson, C., Kirkland, C., Newham, J., Wilkes, G., Fleming, L., Fleck, N., Franca, A., Chwal, B., Oldoni, C., Mantovani, G., Noll, G., Zanella, L., Soma, M., Secchi, T., Borelli, W., Rimoli, B.P., da Cunha Silva, G.H., Machado Galvao Mondin, L.A., Barbosa Cerantola, R., Imthon, A.K., Esaki, A.S., Camilo, M., Vincenzi, O.C., ds Cruz, R.R., Morillos, M.B., Riccioppa Rodrigues, G.G., Santos Ferreira, K., Pazini, A.M., Pena Pereira, M.A., de Albuquerque, A.L.A., Massote Fontanini, C.E., Matinez Rubio, C.F., dos Santos, D.T., Dias, F.A., Alves, F.F.A., Milani, C., Pegorer Santos, B., Winckler, F., De Souza, J.T., Bonome, L.A.M., Cury Silva, V.A., Teodoro, R.S., Modolo, G.P., Ferreira, N.C., Barbosa dos Santos, D.F., dos Santos Moreira, J.C., Cruz Guedes de Morais, A.B., Vieira, J., Mendes, G., de Queiroz, J.P., Coutts, Shelagh B, Ankolekar, Sandeep, Appireddy, Ramana, Arenillas, Juan F, Assis, Zarina, Bailey, Peter, Barber, Philip A, Bazan, Rodrigo, Buck, Brian H, Butcher, Ken S, Camden, Marie-Christine, Campbell, Bruce C V, Casaubon, Leanne K, Catanese, Luciana, Chatterjee, Kausik, Choi, Philip M C, Clarke, Brian, Dowlatshahi, Dar, Ferrari, Julia, Field, Thalia S, Ganesh, Aravind, Ghia, Darshan, Goyal, Mayank, Greisenegger, Stefan, Halse, Omid, Horn, Mackenzie, Hunter, Gary, Imoukhuede, Oje, Kelly, Peter J, Kennedy, James, Kleinig, Timothy J, Krishnan, Kailash, Lima, Fabricio, Mandzia, Jennifer L, Marko, Martha, Martins, Sheila O, Medvedev, George, Menon, Bijoy K, Mishra, Sachin M, Molina, Carlos, Moussaddy, Aimen, Muir, Keith W, Parsons, Mark W, Penn, Andrew M W, Pille, Arthur, Pontes-Neto, Octávio M, Roffe, Christine, Serena, Joaquin, Simister, Robert, Singh, Nishita, Spratt, Neil, Strbian, Daniel, Tham, Carol H, Wiggam, M Ivan, Williams, David J, Willmot, Mark R, Wu, Teddy, Yu, Amy Y X, Zachariah, George, Zafar, Atif, Zerna, Charlotte, and Hill, Michael D

Published
2024
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16. Safety and Outcomes of Intravenous Thrombolytic Therapy in Ischemic Stroke Patients with COVID-19: CASCADE Initiative

Author

Sasanejad, Payam, Afshar Hezarkhani, Leila, Arsang-Jang, Shahram, Tsivgoulis, Georgios, Ghoreishi, Abdoreza, Barlinn, Kristian, Rahmig, Jan, Farhoudi, Mehdi, Sadeghi Hokmabadi, Elyar, Borhani-Haghighi, Afshin, Sariaslani, Payam, Sharifi-Razavi, Athena, Ghandehari, Kavian, Khosravi, Alireza, Smith, Craig, Nilanont, Yongchai, Akbari, Yama, Nguyen, Thanh N, Bersano, Anna, Yassi, Nawaf, Yoshimoto, Takeshi, Lattanzi, Simona, Gupta, Animesh, Zand, Ramin, Rafie, Shahram, Pourandokht Mousavian, Seyede, Reza Shahsavaripour, Mohammad, Amini, Shahram, Kamenova, Saltanat U, Kondybayeva, Aida, Zhanuzakov, Murat, Macri, Elizabeth M, Nobleza, Christa O'Hana S, Ruland, Sean, Cervantes-Arslanian, Anna M, Desai, Masoom J, Ranta, Annemarei, Moghadam Ahmadi, Amir, Rostamihosseinkhani, Mahtab, Foroughi, Razieh, Hooshmandi, Etrat, Akhoundi, Fahimeh H, Shuaib, Ashfaq, Liebeskind, David S, Siegler, James, Romano, Jose G, Mayer, Stephan A, Bavarsad Shahripour, Reza, Zamani, Babak, Woolsey, Amadene, Fazli, Yasaman, Mojtaba, Khazaei, Isaac, Christian F, Biller, Jose, Di Napoli, Mario, and Azarpazhooh, M Reza

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Neurosciences, Stroke, Brain Disorders, Clinical Research, Good Health and Well Being, Aged, Aged, 80 and over, COVID-19, Disability Evaluation, Europe, Female, Fibrinolytic Agents, Hospital Mortality, Humans, Infusions, Intravenous, Intracranial Hemorrhages, Iran, Ischemic Stroke, Male, Middle Aged, Risk Assessment, Risk Factors, Thrombolytic Therapy, Time Factors, Treatment Outcome, COVID 19, Thrombolytic therapy, Longitudinal study, Safety, Outcomes, Disability, Stroke severity, death, Neurology & Neurosurgery, Clinical sciences
Abstract

BackgroundThere is little information regarding the safety of intravenous tissue plasminogen activator (IV-tPA) in patients with stroke and COVID-19.MethodsThis multicenter study included consecutive stroke patients with and without COVID-19 treated with IV-tPA between February 18, 2019, to December 31, 2020, at 9 centers participating in the CASCADE initiative. Clinical outcomes included modified Rankin Scale (mRS) at hospital discharge, in-hospital mortality, the rate of hemorrhagic transformation. Using Bayesian multiple regression and after adjusting for variables with significant value in univariable analysis, we reported the posterior adjusted odds ratio (OR, with 95% Credible Intervals [CrI]) of the main outcomes.ResultsA total of 545 stroke patients, including 101 patients with COVID-19 were evaluated. Patients with COVID-19 had a more severe stroke at admission. In the study cohort, 85 (15.9%) patients had a hemorrhagic transformation, and 72 (13.1%) died in the hospital. After adjustment for confounding variables, discharge mRS score ≥2 (OR: 0.73, 95% CrI: 0.16, 3.05), in-hospital mortality (OR: 2.06, 95% CrI: 0.76, 5.53), and hemorrhagic transformation (OR: 1.514, 95% CrI: 0.66, 3.31) were similar in COVID-19 and non COVID-19 patients. High-sensitivity C reactive protein level was a predictor of hemorrhagic transformation in all cases (OR:1.01, 95%CI: 1.0026, 1.018), including those with COVID-19 (OR:1.024, 95%CI:1.002, 1.054).ConclusionIV-tPA treatment in patients with acute ischemic stroke and COVID-19 was not associated with an increased risk of disability, mortality, and hemorrhagic transformation compared to those without COVID-19. IV-tPA should continue to be considered as the standard of care in patients with hyper acute stroke and COVID-19.

Published
2021

20. Dental treatment needs in the Canadian population: analysis of a nationwide cross-sectional survey

Author

Ramraj Chantel, Azarpazhooh Amir, Dempster Laura, Ravaghi Vahid, and Quiñonez Carlos

Subjects
Dental care needs, Health policy, Socio-demographic/economic factors, Dentistry, RK1-715
Abstract

Abstract Background Nationally representative clinical data on the oral health needs of Canadians has not been available since the 1970s. The purpose of this study was to determine the normative treatment needs of a nationally representative sample of Canadians and describe how these needs were distributed. Methods A secondary analysis of data collected through the Canadian Health Measures Survey (CHMS) was undertaken. Sampling and bootstrap weights were applied to make the data nationally representative. Descriptive frequencies were used to examine the sample characteristics and to examine the treatment type(s) needed by the population. Bivariate logistic regressions were used to see if any characteristics were predictive of having an unmet dental treatment need, and of having specific treatment needs. Lastly, multivariate logistic regression was used to identify the strongest predictors of having an unmet dental treatment need. Results Most of the population had no treatment needs and of the 34.2% who did, most needed restorative (20.4%) and preventive (13.7%) care. The strongest predictors of need were having poor oral health, reporting a self-perceived need for treatment and visiting the dentist infrequently. Conclusions It is estimated that roughly 12 million Canadians have at least one unmet dental treatment need. Policymakers now have information by which to assess if programs match the dental treatment needs of Canadians and of particular subgroups experiencing excess risk.

Published
2012
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27. Stroke Care Trends During COVID-19 Pandemic in Zanjan Province, Iran. From the CASCADE Initiative: Statistical Analysis Plan and Preliminary Results

Author

Ghoreishi, Abdoreza, Arsang-Jang, Shahram, Sabaa-Ayoun, Ziad, Yassi, Nawaf, Sylaja, PN, Akbari, Yama, Divani, Afshin A, Biller, Jose, Phan, Thanh, Steinwender, Sandy, Silver, Brian, Zand, Ramin, Bin Basri, Hamidon, Iqbal, Omer M, Ranta, Annemarei, Ruland, Sean, Macri, Elizabeth, Ma, Henry, Nguyen, Thanh N, Abootalebi, Shahram, Gupta, Animesh, Alet, Matias, Lattanzi, Simona, Desai, Masoom, Gagliardi, Rubens J, Girotra, Tarun, Inoue, Manabu, Yoshimoto, Takeshi, Isaac, Cristian Flavo, Mayer, Stephan A, Morovatdar, Negar, Nilanont, Yongchai, Nobleza, Christa O'Hana S, Saber, Hamidreza, Kamenova, Saltanat, Kondybayeva, Aida, Krupinski, Jerzy, Siegler, James E, Stranges, Saverio, Torbey, Michel T, Yorio, Diana, Zurrú, María Cristina, Rubinos, Clio Aracelli, Shahripour, Reza Bavarsad, Borhani-Haghighi, Afshin, Di Napoli, Mario, and Azarpazhooh, M Reza

Subjects
Stroke, Brain Disorders, Neurosciences, Patient Safety, Health and social care services research, 8.1 Organisation and delivery of services, Good Health and Well Being, Aged, Aged, 80 and over, Bayes Theorem, Brain Ischemia, COVID-19, Female, Hospital Mortality, Hospitalization, Humans, Interrupted Time Series Analysis, Intracranial Hemorrhages, Iran, Length of Stay, Male, Middle Aged, Outcome and Process Assessment, Health Care, Recovery of Function, Thrombolytic Therapy, Time Factors, Time-to-Treatment, Treatment Outcome, Epidemiology, Outcome, Mortality, Disability, Stroke care, Clinical Sciences, Neurology & Neurosurgery, Clinical sciences
Abstract

BackgroundThe emergence of the COVID-19 pandemic has significantly impacted global healthcare systems and this may affect stroke care and outcomes. This study examines the changes in stroke epidemiology and care during the COVID-19 pandemic in Zanjan Province, Iran.MethodsThis study is part of the CASCADE international initiative. From February 18, 2019, to July 18, 2020, we followed ischemic and hemorrhagic stroke hospitalization rates and outcomes in Valiasr Hospital, Zanjan, Iran. We used a Bayesian hierarchical model and an interrupted time series analysis (ITS) to identify changes in stroke hospitalization rate, baseline stroke severity [measured by the National Institutes of Health Stroke Scale (NIHSS)], disability [measured by the modified Rankin Scale (mRS)], presentation time (last seen normal to hospital presentation), thrombolytic therapy rate, median door-to-needle time, length of hospital stay, and in-hospital mortality. We compared in-hospital mortality between study periods using Cox-regression model.ResultsDuring the study period, 1,026 stroke patients were hospitalized. Stroke hospitalization rates per 100,000 population decreased from 68.09 before the pandemic to 44.50 during the pandemic, with a significant decline in both Bayesian [Beta: -1.034; Standard Error (SE): 0.22, 95% CrI: -1.48, -0.59] and ITS analysis (estimate: -1.03, SE = 0.24, p

Published
2020

28. Call to Action: SARS-CoV-2 and CerebrovAscular DisordErs (CASCADE).

Author

Abootalebi, Shahram, Aertker, Benjamin M, Andalibi, Mohammad Sobhan, Asdaghi, Negar, Aykac, Ozlem, Azarpazhooh, M Reza, Bahit, M Cecilia, Barlinn, Kristian, Basri, Hamidon, Shahripour, Reza Bavarsad, Bersano, Anna, Biller, Jose, Borhani-Haghighi, Afshin, Brown, Robert D, Campbell, Bruce Cv, Cruz-Flores, Salvador, De Silva, Deidre Anne, Di Napoli, Mario, Divani, Afshin A, Edgell, Randall C, Fifi, Johanna T, Ghoreishi, Abdoreza, Hirano, Teruyuki, Hong, Keun-Sik, Hsu, Chung Y, Huang, Josephine F, Inoue, Manabu, Jagolino, Amanda L, Kapral, Moira, Kee, Hoo Fan, Keser, Zafer, Khatri, Rakesh, Koga, Masatoshi, Krupinski, Jerzy, Liebeskind, David S, Liu, Liping, Ma, Henry, Maud, Alberto, McCullough, Louise D, Meyer, Dawn Matherne, Mifsud, Victoria, Morovatdar, Negar, Nilanont, Yongchai, Oxley, Thomas J, Özdemir, Atilla Özcan, Pandian, Jeyaraj, Pantoni, Leonardo, Papamitsakis, Nikolaos IH, Parry-Jones, Adrian, Phan, Thanh, Rodriguez, Gustavo, Romano, Jose G, Sabaa-Ayoun, Ziad, Saber, Hamidreza, Sasannezhad, Payam, Saver, Jeffrey L, Scharf, Eugene, Shuaib, Ashfaq, Silver, Brian, Singhal, Shaloo, Smith, Craig J, Stranges, Saverio, Sylaja, PN, Torbey, Michel, Toyoda, Kazunori, Tsivgoulis, Georgios, Wasay, Mohammad, Yassi, Nawaf, Yoshimoto, Takeshi, Zamani, Babak, and Zand, Ramin

Subjects
Humans, Pneumonia, Viral, Coronavirus Infections, Treatment Outcome, Hospitalization, Registries, Incidence, Hospital Mortality, Risk Factors, Retrospective Studies, Prospective Studies, Comorbidity, Time Factors, Stroke, Healthcare Disparities, Host-Pathogen Interactions, Pandemics, Interrupted Time Series Analysis, Practice Patterns, Physicians', Betacoronavirus, COVID-19, SARS-CoV-2, Health policy, Mortality, National crisis, Pandemic, Pneumonia, Viral, Practice Patterns, Physicians', Physicians, Neurology & Neurosurgery, Clinical Sciences, Neurosciences
Abstract

Background and purposeThe novel severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), now named coronavirus disease 2019 (COVID-19), may change the risk of stroke through an enhanced systemic inflammatory response, hypercoagulable state, and endothelial damage in the cerebrovascular system. Moreover, due to the current pandemic, some countries have prioritized health resources towards COVID-19 management, making it more challenging to appropriately care for other potentially disabling and fatal diseases such as stroke. The aim of this study is to identify and describe changes in stroke epidemiological trends before, during, and after the COVID-19 pandemic.MethodsThis is an international, multicenter, hospital-based study on stroke incidence and outcomes during the COVID-19 pandemic. We will describe patterns in stroke management, stroke hospitalization rate, and stroke severity, subtype (ischemic/hemorrhagic), and outcomes (including in-hospital mortality) in 2020 during COVID-19 pandemic, comparing them with the corresponding data from 2018 and 2019, and subsequently 2021. We will also use an interrupted time series (ITS) analysis to assess the change in stroke hospitalization rates before, during, and after COVID-19, in each participating center.ConclusionThe proposed study will potentially enable us to better understand the changes in stroke care protocols, differential hospitalization rate, and severity of stroke, as it pertains to the COVID-19 pandemic. Ultimately, this will help guide clinical-based policies surrounding COVID-19 and other similar global pandemics to ensure that management of cerebrovascular comorbidity is appropriately prioritized during the global crisis. It will also guide public health guidelines for at-risk populations to reduce risks of complications from such comorbidities.

Published
2020

34. The Hospitalization Rate of Cerebral Venous Sinus Thrombosis before and during COVID-19 Pandemic Era: A Single-Center Retrospective Cohort Study

Author

Vasaghi Gharamaleki, Maryam, Habibagahi, Maryam, Hooshmandi, Etrat, Tabrizi, Reza, Arsang-Jang, Shahram, Barzegar, Zohreh, Fadakar, Nima, Reza Ostovan, Vahid, Rahimi-Jaberi, Abbas, Ashjazadeh, Nahid, Petramfar, Peyman, Poursadeghfard, Maryam, Izadi, Sadegh, Nazeri, Masoumeh, Bazrafshan, Hanieh, Bahrami, Zahra, Karimlu, Sedigheh, Shaghayegh Zafarmand, Seyedeh, Bayat, Mahnaz, Saied Salehi, Mohammad, Owjfard, Maryam, Karimi-Haghighi, Saeideh, Safari, Anahid, Shakibajahromi, Banafsheh, Lim Alvin Chew, Beng, Worral, Bradford B. g, Coutinho, Jonathan M., Garcia-Esperon, Carlos, Spratt, Neil, Levi, Christopher, Azarpazhooh, Mahmoud Reza, and Borhani-Haghighi, Afshin

Published
2022
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37. Xylitol for the prevention of acute otitis media episodes in children aged 2-4 years: protocol for a pragmatic randomised controlled trial.

Author

Persaud, Nav, Laupacis, Andreas, Azarpazhooh, Amir, Birken, Catherine, Hoch, Jeffrey S, Isaranuwatchai, Wanrudee, Maguire, Jonathan L, Mamdani, Muhammad M, Thorpe, Kevin, Allen, Christopher, Mason, Dalah, Kowal, Christine, Bazeghi, Farnaz, Parkin, Patricia, and TARGet Kids! Collaboration

Subjects
TARGet Kids! Collaboration, Humans, Otitis Media, Xylitol, Sweetening Agents, Child, Preschool, Canada, Multicenter Studies as Topic, Pragmatic Clinical Trials as Topic, dental caries, otitis media, sorbitol, upper respiratory tract infection, xylitol, Child, Preschool, Clinical Sciences, Public Health and Health Services, Other Medical and Health Sciences
Abstract

IntroductionXylitol (or 'birch sugar') is a naturally occurring sugar with antibacterial properties that has been used as a natural non-sugar sweetener in chewing gums, confectionery, toothpaste and medicines. In this preventative randomised trial, xylitol will be tested for the prevention of acute otitis media (AOM), a common and costly condition in young children. The primary outcome will be the incidence of AOM. Secondary outcomes will include upper respiratory tract infections (URTIs) and dental caries.Methods and analysisThis study will be a pragmatic, blinded (participant and parents, practitioners and analyst), two-armed superiority, placebo-controlled randomised trial with 1:1 allocation, stratified by clinical site. The trial will be conducted in the 11 primary care group practices participating in the TARGet Kids! research network in Canada. Eligible participants between the ages of 2-4 years will be randomly assigned to the intervention arm of regular xylitol syrup use or the control arm of regular sorbitol use for 6 months. We expect to recruit 236 participants, per treatment arm, to detect a 20% relative risk reduction in AOM episodes. AOM will be identified through chart review. The secondary outcomes of URTIs and dental caries will be identified through monthly phone calls with specified questions.Ethics and disseminationEthics approval from the Research Ethics Boards at the Hospital for Sick Children and St. Michael's Hospital has been obtained for this study and also for the TARGet Kids! research network. Results will be submitted for publication to a peer-reviewed journal and will be discussed with decision makers.Trial registration numberNCT03055091; Pre-results.

Published
2018

38. Case-Fatality and Functional Outcome after Subarachnoid Hemorrhage (SAH) in INternational STRoke oUtComes sTudy (INSTRUCT)

Author

Rehman, Sabah, Phan, Hoang T., Reeves, Mathew J., Thrift, Amanda G., Cadilhac, Dominique A., Sturm, Jonathan, Breslin, Monique, Callisaya, Michele L., Vemmos, Konstantinos, Parmar, Priya, Krishnamurthi, Rita V., Barker-Collo, Suzanne, Feigin, Valery, Chausson, Nicolas, Olindo, Stephane, Cabral, Norberto L., Carolei, Antonio, Marini, Carmine, Degan, Diana, Sacco, Simona, Correia, Manuel, Appelros, Peter, Kõrv, Janika, Vibo, Riina, Minelli, Cesar, Sposato, Luciano, Pandian, Jeyaraj Durai, Kaur, Paramdeep, Azarpazhooh, M. Reza, Morovatdar, Negar, and Gall, Seana

Published
2022
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43. Therapeutic Effect of Curcumin in Women with Polycystic Ovary Syndrome Receiving Metformin: A Randomized Controlled Trial

Author

Sohrevardi, Seyed Mojtaba, Heydari, Behrooz, Azarpazhooh, Mahmoud Reza, Teymourzadeh, Mohammad, Simental-Mendía, Luis E., Atkin, Stephen L., Sahebkar, Amirhossein, Karimi-Zarchi, Mojgan, Crusio, Wim E., Series Editor, Dong, Haidong, Series Editor, Radeke, Heinfried H., Series Editor, Rezaei, Nima, Series Editor, Xiao, Junjie, Series Editor, Steinlein, Ortrud, Series Editor, Barreto, George E., editor, and Sahebkar, Amirhossein, editor

Published
2021
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