Search results for: cohort prospective studies

Authors: Mei Han, Jinkou Zhao, Yuan Yao, Liangui Feng, Xianbin Ding, Guohui Wu, Chao Zhou, Lin Ouyang, Rongrong Lu, Bo Zhang

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To compare the HIV incidence estimated using BED capture enzyme linked immunosorbent assay (BED-CEIA) and observed in a cohort against the HIV incidence among men who have sex with men (MSM) measured by pooling polymerase chain reaction (pooling-PCR). A total of 617 MSM subjects were included in a respondent driven sampling survey in Chongqing in 2008. Among the 129 that were tested HIV antibody positive, 102 were defined with long-term infection, 27 were assessed for recent HIV infection (RHI) using BED-CEIA. The remaining 488 HIV negative subjects were enrolled to the prospective cohort and followed-up every 6 months to monitor HIV seroconversion. All of the 488 HIV negative specimens were assessed for acute HIV infection (AHI) using pooling-PCR. Among the 488 negative subjects in the open cohort, 214 (43.9%) were followed-up for six months, with 107 person-years of observation and 14 subjects seroconverted. The observed HIV incidence was 12.5 per 100 person-years (95% CI=9.1-15.7). Among the 488 HIV negative specimens, 5 were identified with acute HIV infection using pooling-PCR at an annual rate of 14.02% (95% CI=1.73-26.30). The estimated HIV-1 incidence was 12.02% (95% CI=7.49-16.56) based on BED-CEIA. The HIV incidence estimated with three different approaches was different among subgroups. In the highly HIV prevalent MSM, it costs US$ 1724 to detect one AHI case, while detection of one case of RHI with BED assay costs only US$ 42. Three approaches generated comparable and high HIV incidences, pooling PCR and prospective cohort are more close to the true level of incidence, while BED-CEIA seemed to be the most convenient and economical approach for at-risk population’s HIV incidence evaluation at the beginning of HIV pandemic. HIV-1 incidences were alarmingly high among MSM population in Chongqing, particularly within the subgroup under 25 years of age and those migrants aged between 25 to 34 years.

Keywords: BED-CEIA, HIV, incidence, pooled PCR, prospective cohort

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Authors: Roohallah Fallah-Moshkani, Mohammad Ali Mohsenpour, Reza Ghiasvand, Hossein Khosravi-Boroujeni, Seyed Mehdi Ahmadi, Paula Brauer, Amin Salehi-Abargouei

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Purpose: Several investigations have proposed the protective association between dietary approaches to stop hypertension (DASH) style diet and risk of cancers; however, they have led to inconsistent results. The present study aimed to systematically review the prospective cohort studies conducted in this regard and, if possible, to quantify the overall effect of using meta-analysis. Methods: PubMed, EMBASE, Scopus, and Google Scholar were searched for cohort studies published up to December 2017. Relative risks (RRs) which were reported for fully adjusted models and their confidence intervals were extracted for meta-analysis. Random effects model was incorporated to combine the RRs. Results: Sixteen studies were eligible to be included in the systematic review from which 8 reports were conducted on the effect of DASH on the risk of mortality from all cancer types, four on the risk of colorectal cancer, and three on the risk of colon and rectal cancer. Four studies examined the association with other cancers (breast, hepatic, endometrial, and lung cancer). Meta-analysis showed that high concordance with DASH significantly decreases the risk of all cancer types (RR=0.83, 95% confidence interval (95%CI):0.80-0.85); furthermore participants who highly adhered to the DASH had lower risk of developing colorectal (RR=0.79, 95%CI: 0.75-0.83), colon (RR=0.81, 95%CI: 0.74-0.87) and rectal (RR=0.79, 95%CI: 0.63-0.98) cancer compared to those with the lowest adherence. Conclusions: DASH-style diet should be suggested as a healthy approach to protect from cancer in the community. Prospective studies exploring the effect on other cancer types and from regions other than the United States are highly recommended.

Keywords: cancer, DASH-style diet, dietary patterns, meta-analysis, systematic review

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Authors: Vasoontara Yiengprugsawan, Sam-ang Seubsman

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As Thais live longer, caregivers will become even more important to social and healthcare systems. Commonly reported in many low and middle‐income countries in Asia, formal social welfare services to support caregivers are lacking and informal family support will be required for all levels of care. In 2005, 87,151 open‐university adults were recruited to the Thai Cohort Study, with the majority aged between 25 and 39 years, and residing nationwide. At the 4‐year follow up in 2009 (n=60569) and the 8‐year follow‐up in 2013 (n=42785), prospective cohort participants were asked if they provide care for chronically ill, disabled, or frail family members. Among Thai cohort members reporting between 2009 and 2013, approximately 56% were not caregivers in either year, 24.5% reported providing care in 2009 only, 8.6% in 2013 only, and 10.6% reported providing care at both time points. Caregivers in the cohort reported providing financial support, help with shopping, emotional support, and assist with daily activities. Kessler 6 psychological distress scale, measured in both 2009 and 2013, was used as the primary outcome of a relationship between caregiving status and mental health. Using multivariate logistic regression, our 4‐year longitudinal findings revealed that cohort members who reported providing care at both time points were 1.4 to 1.6 times more likely to report high psychological distress than non‐caregivers, after accounting for potential covariates. With increasing needs for informal care provided by family members, the future health and social welfare system will need to provide adequate support to caregivers (e.g., respite care, clinical support and information for the family, and awareness of mental health among caregivers).

Keywords: family caregivers, psychological distress, prospective cohort, longitudinal study, Thailand

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Authors: Samuel Kwaku Essien, Catherine Trask, Niels Koehncke, Brenna Bath

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Background: Low back disorder (LBD) is the most common musculoskeletal problem among farmers, with higher prevalence than other occupations. Operators of tractors and other farm machinery such as combines or all-terrain vehicles (ATV) can have considerable cumulative exposure to whole body vibration (WBV). Although there appears to be an association between LBD and WBV, lack of prospective studies makes the relationship between LBD and WBV unclear. Purpose: This study investigates the association between WBV and LBD among Saskatchewan farmers using a prospective cohort study Methods: The Saskatchewan Farm Injury Cohort Study Phase I (2007) and II (2013) data were used. Baseline data were collected via postal questionnaire on accumulated yearly tractor, combine, and ATV use as well as several covariates to support a biopsychosocial model of LBD. Follow-up data on musculoskeletal symptoms were collected for the 6-year with sample size of 1149. Questions on ‘low back trouble’ (ache, pain, discomfort) experienced in the last 12 months answered by farmer participants as ‘yes’ or ‘no’. A GEE-modified Poisson approach was performed using SPSS 22 and SAS 9.4. Results: Twelve-month Prevalence of LBD was 59.8%. In multivariate analysis of the 6-year follow-up, LBD was associated with ATV operation and tractor operation, with a dose-response relationship for annual accumulated tractor operation. Although combine operation ≥ 61 hrs/year was related to LBD in bivariate analysis, this difference did not persist after adjustment for confounder. Age was found to be a confounder in relationship between WBV and LBD and no interactions were found. Conclusion: Longer annual tractor operation and older age are important predictors of LBD symptoms in farmers. Future research involving direct measurement can help identify appropriate prevention strategies.

Keywords: agriculture, low back disorder, low back pain, occupational health

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Authors: Sayantika Biswas, Dipanshu Sur, Amitoj Athwal, Ratnabali Chakravorty

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Title: Impact of serum estrogen and progesterone levels in the outcome pregnancy rate in frozen embryo transfer cycles. A prospective cohort study Objective: The aim of the current study was to evaluate the effect of serum estradiol (E2) and progesterone (P4) levels at different time points on pregnancy outcomes in frozen embryo transfer (FET) cycles. Materials & Method: A prospective cohort study was performed in patients undergoing frozen embryo transfer. Patients under age 37 years of age with at least one good blastocyst or three good day 3 embryos were included in the study. For endometrial preparation, 14 days of oral estradiol use (2X2 mg for 5 days. 3X2 mg for 4 days, and 4X2 mg for 5 days) was followed by vaginal progesterone twice a day and 50 mg intramuscular progesterone twice a day. Embryo transfer was scheduled 72-76 hrs or 116-120hrs after the initiation of progesterone. Serum E2 and P4 levels were examined at 4 times a) at the start of the menstrual cycle prior to the hormone supplementation. b) on the day of P4 start. c) on the day of ET. d) on the third day after ET. Result: A total 41 women were included in this study (mean age 31.8; SD 2.8). Clinical pregnancy rate was 65.55%. Serum E2 levels on at the start of the menstrual cycle prior to the hormone supplementation and on the day of P4 start were high in patients who achieved pregnancy compared to who did not (P=0.005 and P=0.019 respectively). P4 levels on on the day of ET were also high in patients with clinical pregnancy. On the day of P4 start, a serum E2 threshold of 186.4 pg/ml had a sensitivity of 82%, and P4 had a sensitivity of 71% for the prediction of clinical pregnancy at the threshold value 16.00 ng/ml. Conclusion: In women undergoing FET with hormone replacement, serum E2 level >186.4 pg/ml on the day of the start of progesterone and serum P4 levels >16.00 ng/ml on embryo transfer day are associated with clinical pregnancy.

Keywords: serum estradiol, serum progesterone, clinical pregnancy, frozen embryo transfer

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Authors: Anandkumar S. Purohit

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Introduction: Amblyopia is a serious condition resulting in monocular impairment of vision. Although traditional treatment improves vision, we attempted the results of perceptual learning in this study. Methods: The prospective cohort study included all patients with amblyopia who were subjected to perceptual learning. The presenting data on vision, stereopsis, and contrast sensitivity were documented in a pretested online format, and the pre‑ and post‑treatment information was compared using descriptive, cross‑tabulation, and comparative methods on SPSS 22. Results: The cohort consisted of 47 patients (23 females and 24 males) with a mean age of 14.11 ± 7.13 years. A significant improvement was detected in visual acuity after the PL sessions, and the median follow‑up period was 17 days. Stereopsis improved significantly in all age groups. Conclusion: PL with hand-eye coordination is an effective method for managing amblyopia. This approach can improve vision in all age groups.

Keywords: amblyopia, perceptual learning, hand-eye coordination, visual acuity, stereopsis, contrast sensitivity, ophthalmology

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Authors: Jiaqian Yin, Ruoling Chen, David Churchill, Huijuan Zou, Peipei Guo, Chunmei Liang, Xiaoqing Peng, Zhikang Zhang, Weiju Zhou, Yunxia Cao

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Purpose: This study aimed to explore the interaction of male and female age on implantation failure from in vitro fertilisation (IVF)/ intracytoplasmic sperm injection (ICSI) treatments in couples following their first cycles using the Anhui Maternal-Child Health Study (AMCHS). Methods: The AMCHS recruited 2042 infertile couples who were physically fit for in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) treatment at the Reproductive Centre of the First Affiliated Hospital of Anhui Medical University between May 2017 to April 2021. This prospective cohort study analysed the data from 1910 cohort couples for the current paper data analysis. The multivariate logistic regression model was used to identify the effect of male and female age on implantation failure after controlling for confounding factors. Male age and female age were examined as continuous and categorical (male age: 20-<25, 25-<30, 30-<35, 35-<40, ≥40; female age: 20-<25, 25-<30, 30-<35, 35-<40, ≥40) predictors. Results: Logistic regression indicated that advanced maternal age was associated with increased implantation failure (P<0.001). There was evidence of an interaction between maternal age (30-<35 and ≥ 35) and paternal age (≥35) on implantation failure. (p<0.05). Only when the male was ≥35 years of increased maternal age was associated with the risk of implantation failure. Conclusion: In conclusion, there was an additive effect on implantation failure with advanced parental age. The impact of advanced maternal age was only seen in the older paternal age group. The delay of childbearing in both men and women will be a serious public issue that may contribute to a higher risk of implantation failure in patients needing assisted reproductive technology (ART).

Keywords: parental age, infertility, cohort study, IVF

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Authors: Mohamed A. Hammad, Dzul Azri Mohamed Noor, Syed Azhar Syed Sulaiman, Ahmed A. Khamis, Abeer Kharshid, Nor Azizah Aziz

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The effect of statins dose intensity (SDI) on glycemic control in patients with existing diabetes is unclear. Also, there are many contradictory findings were reported in the literature; thus, it is limiting the possibility to draw conclusions. This project was designed to compare the effect of SDI on glycated hemoglobin (HbA1c%) control in outpatients with Type 2 diabetes in the endocrine clinic at Hospital Pulau Pinang, Malaysia, between July 2015 and August 2016. A prospective cohort study was conducted, where records of 345 patients with Type 2 diabetes (Moderate-SDI group 289 patients and high-SDI cohort 56 patients) were reviewed to identify demographics and laboratory tests. The target of glycemic control (HbA1c < 7% for patient < 65 years, and < 8% for patient ≥ 65 years) was estimated, and the results were presented as descriptive statistics. From 289 moderate-SDI cohorts with a mean age of 57.3 ± 12.4 years, only 86 (29.8%) cases were shown to have controlled glycemia, while there were 203 (70.2%) cases with uncontrolled glycemia with confidence interval (CI) of 95% (6.2–10.8). On the other hand, the high-SDI group of 56 patients with Type 2 diabetes with a mean age 57.7±12.4 years is distributed among 11 (19.6%) patients with controlled diabetes, and 45 (80.4%) of them had uncontrolled glycemia, CI: 95% (7.1–11.9). The study has demonstrated that the relative risk (RR) of uncontrolled glycemia in patients with Type 2 diabetes that used high-SDI is 1.15, and the excessive relative risk (ERR) is 15%. The absolute risk (AR) is 10.2%, and the number needed to harm (NNH) is 10. Outpatients with Type 2 diabetes who use high-SDI of statin have a higher risk of uncontrolled glycemia than outpatients who had been treated with a moderate-SDI.

Keywords: cohort study, diabetes control, dose intensity, HbA1c, Malaysia, statin, type 2 diabetes mellitus, uncontrolled glycemia

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Authors: Yung-Feng Yen, Yun-Ju Lai

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Background: Metabolic syndrome (MetS) is reversible; however, the effect of changes in MetS status on the risk of incident cancer has not been extensively studied. We aimed to investigate the effects of changes in MetS status on incident cancer risk. Methods: This prospective, longitudinal study used data from Taiwan’s MJ cohort of 157,915 adults recruited from 2002–2016 who had repeated MetS measurements 5.2 (±3.5) years apart and were followed up for the new onset of cancer over 8.2 (±4.5) years. A new diagnosis of incident cancer in study individuals was confirmed by their pathohistological reports. The participants’ MetS status included MetS-free (n=119,331), MetS-developed (n=14,272), MetS-recovered (n=7,914), and MetS-persistent (n=16,398). We used the Fine-Gray sub-distribution method, with death as the competing risk, to determine the association between MetS changes and the risk of incident cancer. Results: During the follow-up period, 7,486 individuals had new development of cancer. Compared with the MetS-free group, MetS-persistent individuals had a significantly higher risk of incident cancer (adjusted hazard ratio [aHR], 1.10; 95% confidence interval [CI], 1.03-1.18). Considering the effect of dynamic changes in MetS status on the risk of specific cancer types, MetS persistence was significantly associated with a higher risk of incident colon and rectum, kidney, pancreas, uterus, and thyroid cancer. The risk of kidney, uterus, and thyroid cancer in MetS-recovered individuals was higher than in those who remained MetS but lower than MetS-persistent individuals. Conclusions: Persistent MetS is associated with a higher risk of incident cancer, and recovery from MetS may reduce the risk. The findings of our study suggest that it is imperative for individuals with pre-existing MetS to seek treatment for this condition to reduce the cancer risk.

Keywords: metabolic syndrome change, cancer, risk factor, cohort study

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Authors: Olor Obi, Ishiekwen Bridget, Ekpeyong Edom

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Even though gout is becoming more common, the role of dietary risk factors in the development and management of this condition remains unclear. Therefore, this review work will aim at clarifying the role of dietary factors in the risk and management of gout. An extensive search of literature published between 1960 and 2018 will be performed on the databases of PubMed, CINAHL, Science Direct, Cochrane, BMJ, Ann Rheum Dis, and BioMed to identify relevant cohort, prospective, population-based, or cross-sectional studies that examined the effect of diet on gout. About 19 studies will be included in this review work. The methodological quality of these studies will be evaluated using the quality assessment tool for observational and cross-sectional studies developed by the National Heart, Lungs, and Blood Institute. This work intends to reveal that a positive association exists between the intake of sugary, sweetened beverages and the risk of gout. It will also reveal the relationship between the increase in coffee consumption and the risk of gout.

Keywords: gout, dietary factors, management of gout, gouty arthritis

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Authors: Ammar Asma, Bouafia Nabiha, Ghammam Rim, Ezzi Olfa, Ben Cheikh Asma, Mahjoub Mohamed, Helali Radhia, Sma Nesrine, Chouchène Imed, Boussarsar Hamadi, Njah Mansour

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Background: Central venous catheter associated infections (CVC-AI) are among the serious hospital-acquired infections. The aims of this study are to determine the incidence of CVC-AI, and their risk factors among patients followed in a Tunisian medical intensive care unit (ICU). Materials / Methods: A prospective cohort study conducted between September 15th, 2015 and November 15th, 2016 in an 8-bed medical ICU including all patients admitted for more than 48h. CVC-AI were defined according to CDC of ATLANTA criteria. The enrollment was based on clinical and laboratory diagnosis of CVC-AI. For all subjects, age, sex, underlying diseases, SAPS II score, ICU length of stay, exposure to CVC (number of CVC placed, site of insertion and duration catheterization) were recorded. Risk factors were analyzed by conditional stepwise logistic regression. The p-value of < 0.05 was considered significant. Results: Among 192 eligible patients, 144 patients (75%) had a central venous catheter. Twenty-eight patients (19.4%) had developed CVC-AI with density rate incidence 20.02/1000 CVC-days. Among these infections, 60.7% (n=17) were systemic CVC-AI (with negative blood culture), and 35.7% (n=10) were bloodstream CVC-AI. The mean SAPS II of patients with CVC-AI was 32.76 14.48; their mean Charlson index was 1.77 1.55, their mean duration of catheterization was 15.46 10.81 days and the mean duration of one central line was 5.8+/-3.72 days. Gram-negative bacteria was determined in 53.5 % of CVC-AI (n= 15) dominated by multi-drug resistant Acinetobacter baumani (n=7). Staphylococci were isolated in 3 CVC-AI. Fourteen (50%) patients with CVC-AI died. Univariate analysis identified men (p=0.034), the referral from another hospital department (p=0.03), tobacco (p=0.006), duration of sedation (p=0.003) and the duration of catheterization (p=0), as possible risk factors of CVC-AI. Multivariate analysis showed that independent factors of CVC-AI were, male sex; OR= 5.73, IC 95% [2; 16.46], p=0.001, Ramsay score; OR= 1.57, IC 95% [1.036; 2.38], p=0.033, and duration of catheterization; OR=1.093, IC 95% [1.035; 1.15], p=0.001. Conclusion: In a monocenter cohort, CVC-AI had a high density and is associated with poor outcome. Identifying the risk factors is necessary to find solutions for this major health problem.

Keywords: central venous catheter associated infection, intensive care unit, prospective cohort studies, risk factors

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Authors: Mark Angelo Maranon, David Endriga

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Objective: The aim of the study is to determine the differences in functional outcome and quality of life of adult patients with Potts disease who have undergone surgical versus non-surgical management. Methods: In this prospective cohort study, 45 patients were followed up for 1 year after undergoing pharmacologic treatment alone versus a combination of anti-Kochs and surgery for Potts disease. Oswestry Disability Index (ODI) and Short Form-36 (SF-36) were obtained on initiation of treatment, after three months, six months and one year. Results: ASIA scores from the onset of treatment and after 1 year significantly improved (p<0.001) for both non-surgical and surgical patients. ODI scores significantly improved after 6 months of treatment for both surgical and non-surgical patients. Both surgical and non-surgical patients showed significant improvement in their SF-36 scores, but scores were noted to be higher in patients who underwent surgery. Conclusions: Significant improvement with regards to functional outcome and quality of life was noted from both surgical and non-surgical patients after 1 year of treatment, with earlier improvements and better final scores in SF 36 and ODI in patients who underwent surgery.

Keywords: tuberculosis, spinal, potts disease, functional outcome

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Authors: Hongxin Zhao, Shibing Yang, Bingming Yi, Yi Ning

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Background: A few studies have found evidence that exposure to endogenous or postmenopausal exogenous estrogens may be associated with a lower prevalence of age-related macular degeneration (AMD), but dispute over this association is ongoing due to inconsistent results reported by different studies. Objectives: To conduct a systematic review and meta-analysis to investigate the association between hormone replacement therapy (HRT) use and AMD. Methods: Relevant studies that assessed the association between HRT and AMD were searched through four databases (PubMed, Web of Science, Cochrane Library, EMBASE) and reference lists of retrieved studies. Study selection, data extraction and quality assessment were conducted by three independent reviewers. The fixed-effect meta-analyses were performed to estimate the association between HRT ever-use and AMD by pooling risk ratio (RR) or odds ratio (OR) across studies. Results: The review identified 2 prospective and 7 cross-sectional studies with 93992 female participants that reported an estimate of the association between HRT ever-use and presence of early AMD or late AMD. Meta-analyses showed that there were no statistically significant associations between HRT ever-use and early AMD (pooled RR for cohort studies was 1.04, 95% CI 0.86 - 1.24; pooled OR for cross-sectional studies was 0.91, 95% CI 0.82 - 1.01). The pooled results from cross-sectional studies also showed no statistically significant association between HRT ever-use and late AMD (OR 1.01; 95% CI 0.89 - 1.15). Conclusions: The pooled effects from observational studies published to date indicate that HRT use is associated with neither early nor late AMD. Exposure to HRT may not protect women from developing AMD.

Keywords: hormone replacement therapy, age-related macular degeneration, meta-analysis, systematic review

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Authors: Jeffrey Tzu-Hao Tsai, Yi-Shan Wong

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This article proposes a cohort-age-period (CAP) model to characterize multi-population mortality processes using cohort, age, and period variables. Distinct from the factor-based Lee-Carter-type decomposition mortality model, this approach is empirically based and includes the age, period, and cohort variables into the equation system. The model not only provides a fruitful intuition for explaining multivariate mortality change rates but also has a better performance in forecasting future patterns. Using the US and the UK mortality data and performing ten-year out-of-sample tests, our approach shows smaller mean square errors in both countries compared to the models in the literature.

Keywords: longevity risk, stochastic mortality model, multivariate mortality rate, risk management

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Authors: Iris W. A. Boot, Anke Wesselius, Maurice P. Zeegers

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Diet may play an essential role in the aetiology of bladder cancer (BC). Vitamin D is involved in various biological functions which have the potential to prevent BC development. Besides, vitamin D also influences the uptake of calcium and phosphorus , thereby possibly indirectly influencing the risk of BC. The aim of the present study was to investigate the relation between vitamin D intake and BC risk. Individual dietary data were pooled from three cohort studies. Food item intake was converted to daily intakes of vitamin D, calcium and phosphorus. Pooled multivariate hazard ratios (HRs), with corresponding 95% confidence intervals (CIs) were obtained using Cox-regression models. Analyses were adjusted for gender, age and smoking status (Model 1), and additionally for the food groups fruit, vegetables and meat (Model 2). Dose–response relationships (Model 1) were examined using a nonparametric test for trend. In total, 2,871 cases and 522,364 non-cases were included in the analyses. The present study showed an overall increased BC risk for high dietary vitamin D intake (HR: 1.14, 95% CI: 1.03-1.26). A similar increase BC risk with high vitamin D intake was observed among women and for the non-muscle invasive BC subtype, (HR: 1.41, 95% CI: 1.15-1.72, HR: 1.13, 95% CI: 1.01-1.27, respectively). High calcium intake decreased the BC risk among women (HR: 0.81, 95% CI: 0.67-0.97). A combined inverse effect on BC risk was observed for low vitamin D intake and high calcium intake (HR: 0.67, 95% CI: 0.48-0.93), while a positive effect was observed for high vitamin D intake in combination with low, moderate and high phosphorus (HR: 1.31, 95% CI: 1.09-1.59, HR: 1.17, 95% CI: 1.01-1.36, HR: 1.16, 95% CI: 1.03-1.31, respectively). Combining all nutrients showed a decreased BC risk for low vitamin D intake, high calcium and moderate phosphor intake (HR: 0.37, 95% CI: 0.18-0.75), and an increased BC risk for moderate intake of all the nutrients (HR: 1.18, 95% CI: 1.02-1.38), for high vitamin D and low calcium and phosphor intake (HR: 1.28, 95% CI: 1.01-1.62), and for moderate vitamin D and calcium and high phosphorus intake (HR: 1.27, 95% CI: 1.01-1.59). No significant dose-response analyses were observed. The findings of this study show an increased BC risk for high dietary vitamin D intake and a decreased risk for high calcium intake. Besides, the study highlights the importance of examining the effect of a nutrient in combination with complementary nutrients for risk assessment. Future research should focus on nutrients in a wider context and in nutritional patterns.

Keywords: bladder cancer, nutritional oncology, pooled cohort analysis, vitamin D

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Authors: Münevver Başman, Ezel Tavşancıl

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Making the right decisions about students depends on teachers’ use of the assessment and evaluation techniques effectively. In order to do that, teachers should have positive attitudes and adequate self-efficacy perception towards assessment and evaluation. The purpose of this study is to investigate relationship between self-efficacy perception and the attitudes of prospective teachers towards assessment and evaluation and what kind of differences these issues have in terms of a variety of demographic variables. The study group consisted of 277 prospective teachers who have been studying in different departments of Marmara University, Faculty of Education. In this study, ‘Personal Information Form’, ‘A Perceptual Scale for Measurement and Evaluation of Prospective Teachers Self-Efficacy in Education’ and ‘Attitudes toward Educational Measurement Inventory’ are applied. As a result, positive correlation was found between self-efficacy perceptions and the attitudes of prospective teachers towards assessment and evaluation. Considering different departments, there is a significant difference between the mean score of attitudes of prospective teachers and between the mean score of self-efficacy perceptions of them. However, considering variables of attending statistics class and the class types at the graduated high school, there is no significant difference between the mean score of attitudes of prospective teachers and between the mean score of self-efficacy perceptions of them.

Keywords: attitude, perception, prospective teacher, self-efficacy

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Authors: Mohamed Eftal Bin Mohamed Ebrahim, Alexander Varey

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Aim: Topical negative pressure has been shown to enhance angiogenesis during wound healing, both for open and closed wounds. Since angiogenesis is a key requirement for successful fat grafting, there may be a role for topical negative pressure as a means of enhancing the take rate during autologous fat grafting to breasts. Here we present a systematic review of the literature on this topic. Methods: Ovid and Embase were utilized, with searches ranging between 1960 – 2019. Terms (“Liposculpting” OR “Fat grafting” OR “Lipofilling” OR “Lipograft” OR “Fat transfer”) AND (“Negative Pressure” OR “Brava” OR “Kiwi”) AND (“Breast”) were merged as keywords. Inclusion criteria were females, autologous fat graft to breast with topical negative pressure prior to the procedure. Studies were excluded if there was no primary endpoint or non-original article. Results: Upon reviewing 219 articles, 2 met inclusion criteria. A total of 565 and 46 breasts in each article were treated respectively using the negative pressure device BRAVA®, with each cohort having different pre-and post-operative pressure settings. Khouri et al. cohort had higher graft survival (79%) compared to Del Vecchio et al. cohort (64%); however, the latter had fewer complications compared to Khouri’s cohort, e.g., fat necrosis, pneumothorax and infection. Conclusion: There is limited evidence regarding the use of topical negative pressure for fat grafting to the breasts. However, in the two studies published, the reported rates of success are high, suggesting there may be a benefit. Consequently, a randomized controlled trial on this area is required.

Keywords: fat grafting, lipograft, negative pressure, breast, breast augmentation, brava

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Authors: Majeda Hammoud

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Background: Anemia during pregnancy increases the risk of delivery by cesarean section, low birth weight, preterm birth, perinatal mortality, stillbirth, and maternal mortality. In this study, we aimed to assess the prevalence of anemia in pregnant women and its associated factors in the Kuwait birth cohort study. Methods: The Kuwait birth cohort (N=1108) was a prospective cohort study in which pregnant women were recruited in the third trimester. Data were collected through personal interviews with mothers who attend antenatal care visits, including data on socio-economic status and lifestyle factors. Blood samples were taken after the recruitment to measure multiple laboratory indicators. Clinical data were extracted from the medical records by a clinician including data on comorbidities. Anemia was defined as having Hemoglobin (Hb) <110 g/L with further classification as mild (100-109 g/L), moderate (70-99 g/L), or severe (<70 g/L). Predictors of anemia were classified as underlying or direct factors, and logistic regression was used to investigate their association with anemia. Results: The mean Hb level in the study group was 115.21 g/L (95%CI: 114.56- 115.87 g/L), with significant differences between age groups (p=0.034). The prevalence of anemia was 28.16% (95%CI: 25.53-30.91%), with no significant difference by age group (p=0.164). Of all 1108 pregnant women, 8.75% had moderate anemia, and 19.40% had mild anemia, but no pregnant women had severe anemia. In multivariable analysis, getting pregnant while using contraception, adjusted odds ratio (AOR) 1.73(95%CI:1.01-2.96); p=0.046 and current use of supplements, AOR 0.50 (95%CI: 0.26-0.95); p=0.035 were significantly associated with anemia (underlying factors). From the direct factors group, only iron and ferritin levels were significantly associated with anemia (P<0.001). Conclusion: Although the severe form of anemia is low among pregnant women in Kuwait, mild and moderate anemia remains a significant health problem despite free access to antenatal care.

Keywords: anemia, pregnancy, hemoglobin, ferritin

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Authors: N. G. Obaje, S. I. Ibrahim, N. Dadi-Mamud, M. K. Musa, I. Yusuf

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An integrated study combining geological prospectivity mapping and geophysical aeromagnetic interpretation was carried out to determine hydrocarbon new business opportunities that may exist in the Bida Basin of Central Nigeria. Geological mapping was used to delineate the geological boundaries between the formations which is a significant initial criterion in evaluating hydrocarbon prospectivity. Processed and interpreted geophysical aeromagnetic data over the basin juxtaposed against the geological map has led to ranking of the prospectivity as less prospective, prospective and more prospective. The prospective and more prospective areas constitute new hydrocarbon business opportunities in the basin. The more prospective areas are at Pattishabakolo near Bida and at Kandi near Gulu. Prospective areas cover Badegi, Lemu, Duba, Kutigi, Auna, Mashegu and Mokwa. Geochemical data show that hydrocarbon source rocks exist within the Enagi and Patti formations in the northern and southern sections respectively. The geophysical aeromagnetic data indicates depths of more than 2,000m (> 2 Km) within the identified prospective areas. New business opportunities as used here refer to open acreages in Nigeria’s sedimentary basins that have not been licensed out by the government (Department of Petroleum Resources) to any operator but with significant potentials for commercial hydrocarbon accumulation.

Keywords: hydrocarbon, aeromagnetic, business opportunity, Bida Basin

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Authors: K. Tesfamariam, S. Gebreyesus, C. Lachat, P. Kolsteren, S. De Saeger, M. De Boevre, A. Argaw

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Aflatoxins are toxic secondary metabolites produced by Aspergillus fungi, which are ubiquitously present in the food supplies of low- and middle-income countries. Studies of maternal aflatoxin exposure and fetal outcomes are mainly focused on size at birth and the effect on intrauterine fetal growth has not been assessed using repeated longitudinal fetal biometry across gestation. Therefore, this study intends to assess the association between chronic aflatoxin exposure during pregnancy and fetal growth trajectories in a rural Ethiopian setting. In a prospective cohort study, we enrolled 492 pregnant women. A phlebotomist collected 5 mL of a venous blood sample from eligible women before 28 completed weeks of gestation and aflatoxin B1-lysine concentration was determined using liquid chromatography-tandem mass spectrometry. The mean (±SD) gestational age was 19.1 (3.71) weeks at enrollment, and 28.5 (3.51) and 34.5 (2.44) weeks of gestation at the second and third rounds of ultrasound measurements, respectively. Estimated fetal weight was expressed in centiles using the INTERGROWTH-21st reference. We fitted a multivariable linear mixed-effects model to estimate the rate of fetal growth between aflatoxin-exposed (i.e., aflatoxin B1-lysine concentration above or equal to the limit of detection) and non-exposed mothers in the study. Mothers had a mean (±SD) age of 26.0 (4.58) years. The median (P25, P75) serum AFB1-lysine concentration was 12.6 (0.93, 96.9) pg/mg albumin, and aflatoxin exposure was observed in 86.6% of maternal blood samples. Eighty-five percent of the women enrolled provided at least two ultrasound measurements for analysis. On average, the aflatoxin-exposed group had a significantly lower change over time in fetal weight-for-gestational age centile than the unexposed group (ß = -1.01 centiles/week, 95% CI: -1.87, -0.15, p = 0.02). Chronic maternal AF exposure is associated with lower fetal weight gain over time. Our findings emphasize the importance of nutrition-sensitive strategies to mitigate dietary aflatoxin exposure as well as adopting food safety measures in low-income settings, particularly during the fetal period of development.

Keywords: aflatoxin, fetal growth, low-income setting, mycotoxins

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Authors: Haoyu Zhao, Qianshu Ma, Min Xie, Yunqi Huang, Yunjia Liu, Huan Song, Hongsheng Gui, Mingli Li, Qiang Wang

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Rationale: Bipolar disorder (BD) and major depressive disorder (MDD), as severe chronic illnesses that restrict patients’ psychosocial functioning and reduce their quality of life, are both categorized into mood disorders. Emerging evidence has suggested that the reliability of self-rated health (SRH) was wellvalidated and that the risk of various health outcomes, including mortality and health care costs, could be predicted by SRH. Compared with other lengthy multi-item patient-reported outcomes (PRO) measures, SRH was proven to have a comparable predictive ability to predict mortality and healthcare utilization. However, to our knowledge, no study has been conducted to assess the association between SRH and hospitalization among people with mental disorders. Therefore, our study aims to determine the association between SRH and subsequent all-cause hospitalizations in patients with BD and MDD. Methods: We conducted a prospective cohort study on people with BD or MDD in the UK from 2006 to 2010 using UK Biobank touchscreen questionnaire data and linked administrative health databases. The association between SRH and 2-year all-cause hospitalizations was assessed using proportional hazard regression after adjustment for sociodemographics, lifestyle behaviors, previous hospitalization use, the Elixhauser comorbidity index, and environmental factors. Results: A total of 29,966 participants were identified, experiencing 10,279 hospitalization events. Among the cohort, the average age was 55.88 (SD 8.01) years, 64.02% were female, and 3,029 (10.11%), 15,972 (53.30%), 8,313 (27.74%), and 2,652 (8.85%) reported excellent, good, fair, and poor SRH, respectively. Among patients reporting poor SRH, 54.19% had a hospitalization event within 2 years compared with 22.65% for those having excellent SRH. In the adjusted analysis, patients with good, fair, and poor SRH had 1.31 (95% CI 1.21-1.42), 1.82 (95% CI 1.68-1.98), and 2.45 (95% CI 2.22, 2.70) higher hazards of hospitalization, respectively, than those with excellent SRH. Conclusion: SRH was independently associated with subsequent all-cause hospitalizations in patients with BD or MDD. This large study facilitates rapid interpretation of SRH values and underscores the need for proactive SRH screening in this population, which might inform resource allocation and enhance high-risk population detection.

Keywords: severe mental illnesses, hospitalization, risk prediction, patient-reported outcomes

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Authors: Mihriban Hacisalihoğlu Karadeniz, Figen Bozkuş, Tuğba Baran, Ümit Akar

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Creating the correct symmetry of conceptual knowledge about students, conceptual information about the symmetry of the instructors is important. However, teachers’, the students should be aware of the existing misconceptions and be able to develop strategies to correct these misconceptions. In this study, the purpose, the prospective teachers’, the students’ explanations for corrections of misconceptions and misconceptions were asked to be introduced. The working group during the 2012-2013 academic year, Kocaeli University Faculty of Education Mathematics Education consists of studying at the twenty-six prospective teachers. The study adopted a qualitative approach. The data prepared by the researchers were obtained with an open-ended test. As a result of analysis of the data, prospective with teaching the concept of symmetry observed in more developed practical solutions. These solutions are focused on the method, students utilization mirrors, paper folding, such as using a square piece of registration of events. Prospective teachers’ who think this way, students observed that overlooked the creation of conceptual knowledge.

Keywords: symmetry concepts, misconceptions, elementary mathematics, prospective teachers-students

Procedia PDF Downloads 351

Authors: Merve Akca

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Retrieval-induced forgetting (RIF) refers to the phenomenon that selective retrieval of some information impairs memory for related, but not previously retrieved information. Despite age differences in retrieval-induced forgetting regarding retrospective memory being documented, this research aimed to highlight age differences in RIF of the prospective memory tasks for the first time. By using retrieval-practice paradigm, this study comparatively examined RIF effects in retrospective memory and event-based prospective memory in young and old adults. In this experimental study, a mixed factorial design with age group (Young, Old) as a between-subject variable, and memory type (Prospective, Retrospective) and item type (Practiced, Non-practiced) as within-subject variables was employed. Retrieval-induced forgetting was observed in the retrospective but not in the prospective memory task. Therefore, the results indicated that selective retrieval of past events led to suppression of other related past events in both age groups but not the suppression of memory for future intentions.

Keywords: prospective memory, retrieval-induced forgetting, retrieval inhibition, retrospective memory

Procedia PDF Downloads 315

Authors: Mohamed Wahba

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Objective: To build a comparative arm for product (X) in specific gene mutated advanced gastrointestinal cancer using real world evidence to fulfill HTA requirements in drug evaluation. Methods: Data for product (X) were collected from phase II clinical trial while real world data for (Y) and (Z) were collected from US database. Real-world (RW) cohorts were matched to clinical trial base line characteristics using weighting by odds method. Outcomes included progression-free survival (PFS) and overall survival (OS) rates. Study location and participants: Internationally (product X, n=80) and from USA (Product Y and Z, n=73) Results: Two comparisons were made: trial cohort 1 (X) versus real-world cohort 1 (Z), trial cohort 2 (X) versus real-world cohort 2 (Y). For first line, the median OS was 9.7 months (95% CI 8.6- 11.5) and the median PFS was 5.2 months (95% CI 4.7- not reached) for real-world cohort 1. For second line, the median OS was 10.6 months (95% CI 4.7- 27.3) for real-world cohort 2 and the median PFS was 5.0 months (95% CI 2.1- 29.3). For OS analysis, results were statistically significant but not for PFS analysis. Conclusion: This study provided the clinical comparative outcomes needed for HTA evaluation.

Keywords: real world evidence, pharmacoeconomics, HTA agencies, oncology

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Authors: Reyhan Tekin Sitrava

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Teachers should have robust and comprehensive content knowledge for effective mathematics teaching. It was explained that content knowledge includes knowing the facts, truths, and concepts; explaining the reasons behind these facts, truths and concepts, and making relationship between the concepts and other disciplines. By virtue of its importance, it will be significant to explore teachers and prospective teachers’ content knowledge related to variety of topics in mathematics. From this point of view, the purpose of this study was to investigate prospective mathematics teachers’ content knowledge. Particularly, it was aimed to reveal the prospective teachers’ knowledge regarding the definition of limit and derivate. To achieve the purpose and to get in-depth understanding, a qualitative case study method was used. The data was collected from 34 prospective mathematics teachers through a questionnaire containing 2 questions. The first question required the prospective teachers to define the limit and the second one required to define the derivative. The data was analyzed using content analysis method. Based on the analysis of the data, although half of the prospective teachers (50%) could write the definition of the limit, nine prospective teachers (26.5%) could not define limit. However, eight prospective teachers’ definition was regarded as partially correct. On the other hand, twenty-seven prospective teachers (79.5%) could define derivative, but seven of them (20.5%) defined it partially. According to the findings, most of the prospective teachers have robust content knowledge on limit and derivative. This result is important because definitions have a virtual role in learning and teaching of mathematics. More specifically, definition is starting point to understand the meaning of a concept. From this point of view, prospective teachers should know the definitions of the concepts to be able to teach them correctly to the students. In addition, they should have knowledge about the relationship between limit and derivative so that they can explain these concepts conceptually. Otherwise, students may memorize the rules of calculating the derivative and the limit. In conclusion, the present study showed that most of the prospective mathematics teachers had enough knowledge about the definition of derivative and limit. However, the rest of them should learn their definition conceptually. The examples of correct, partially correct, and incorrect definition of both concepts will be presented and discussed based on participants’ statements. This study has some implications for instructors. Instructors should be careful about whether students learn the definition of these concepts or not. In order to this, the instructors may give prospective teachers opportunities to discuss the definition of these concepts and the relationship between the concepts.

Keywords: content knowledge, derivative, limit, prospective mathematics teachers

Procedia PDF Downloads 221

Authors: Yasmeen Jamal Alabdallat, Almutazballlah Bassam Qablan, Hamza Al-Salhi, Salameh Alarood, Ibraheem Alkhawaldeh, Obada Abunar, Adam Abdallah

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Obstructive sleep apnea (OSA) is a disorder caused by the repeated collapse of the upper airway during sleep. It is the most common cause of sleep-related breathing disorder, as OSA can cause loud snoring, daytime fatigue, or more severe problems such as high blood pressure, cardiovascular disease, coronary artery disease, insulin-resistant diabetes, and depression. The hypoglossal nerve stimulator (HNS) is an implantable medical device that reduces the occurrence of obstructive sleep apnea by electrically stimulating the hypoglossal nerve in rhythm with the patient's breathing, causing the tongue to move. This stimulation helps keep the patient's airways clear while they sleep. This systematic review and meta-analysis aimed to assess the clinical outcome of hypoglossal nerve stimulation as a treatment of obstructive sleep apnea. A computer literature search of PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials was conducted from inception until August 2022. Studies assessing the following clinical outcomes (Apnea-Hypopnea Index (AHI), Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ), Oxygen Desaturation Indices (ODI), (Oxygen Saturation (SaO2)) were pooled in the meta-analysis using Review Manager Software. We assessed the quality of studies according to the Cochrane risk-of-bias tool for randomized trials (RoB2), Risk of Bias In Non-randomized Studies - of Interventions (ROBINS-I), and a modified version of NOS for the non-comparative cohort studies.13 Studies (Six Clinical Trials and Seven prospective cohort studies) with a total of 817 patients were included in the meta-analysis. The results of AHI were reported in 11 studies examining OSA 696 patients. We found that there was a significant improvement in the AHI after 12 months of HNS (MD = 18.2 with 95% CI, (16.7 to 19.7; I2 = 0%); P < 0.00001). Further, 12 studies reported the results of ESS after 12 months of intervention with a significant improvement in the range of sleepiness among the examined 757 OSA patients (MD = 5.3 with 95% CI, (4.75 to 5.86; I2 = 65%); P < 0.0001). Moreover, nine studies involving 699 participants reported the results of FOSQ after 12 months of HNS with a significant reported improvement (MD = -3.09 with 95% CI, (-3.41 to 2.77; I2 = 0%); P < 0.00001). In addition, ten studies reported the results of ODI with a significant improvement after 12 months of HNS among the 817 examined patients (MD = 14.8 with 95% CI, (13.25 to 16.32; I2 = 0%); P < 000001). The Hypoglossal Nerve Stimulation showed a significant positive impact on obstructive sleep apnea patients after 12 months of therapy in terms of apnea-hypopnea index, oxygen desaturation indices, manifestations of the behavioral morbidity associated with obstructive sleep apnea, and functional status resulting from sleepiness.

Keywords: apnea, meta-analysis, hypoglossal, stimulation

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Authors: Amin Davoudi

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Aim: New approaches have been introduced to improve soft tissue indices of the dental implants. This systematic review aimed to investigate the effect of computer-aided design and computer-assisted manufacture (CAD/CAM) zirconia (Zr) implant abutments on periodontal aspects. Materials and Methods: Five electronic databases were searched thoroughly based on prior defined MeSH and non-MeSH keywords. Clinical studies were collected via hand searches in English language journals up to September 2020. Interproximal papilla stability, papilla recession, pink and white esthetic score (PES, WES), bone and gingival margin levels, color, and contour of soft tissue were reviewed. Results: The initial literature search yielded 412 articles. After the evaluation of abstracts and full texts, six studies were eligible to be screened. The study design of the included studies was a prospective cohort (n=3) and randomized clinical trial (n=3). The outcome was found to be significantly better for Zr than titanium abutments, however, the studies did not show significant differences between stock and CAD/CAM abutments. Conclusion: Papilla fill, WES, PES, and the distance from the contact point to dental crest bone of adjacent tooth and inter-tooth–implant distance were not significantly different between Zr CAD/CAM and Zr stock abutments. However, soft tissue stability and recession index were better in Zr CAD/CAM abutments.

Keywords: zirconia, CADCAM, periodental, implant

Procedia PDF Downloads 100

Authors: G. Shiha, S. Seif, W. Samir, K. Zalata

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Prospective Validation of the FibroTest Score in assessing Liver Fibrosis in Hepatitis C Infection with Genotype 4 FibroTest (FT) is non-invasive score of liver fibrosis that combines the quantitative results of 5 serum biochemical markers (alpha-2-macroglobulin, haptoglobin, apolipoprotein A1, gamma glutamyl transpeptidase (GGT) and bilirubin) and adjusted with the patient's age and sex in a patented algorithm to generate a measure of fibrosis. FT has been validated in patients with chronic hepatitis C (CHC) (Halfon et al., Gastroenterol. Clin Biol.( 2008), 32 6suppl 1, 22-39). The validation of fibro test ( FT) in genotype IV is not well studied. Our aim was to evaluate the performance of FibroTest in an independent prospective cohort of hepatitis C patients with genotype 4. Subject was 122 patients with CHC. All liver biopsies were scored using METAVIR system. Our fibrosis score(FT) were measured, and the performance of the cut-off score were done using ROC curve. Among patients with advanced fibrosis, the FT was identically matched with the liver biopsy in 18.6%, overestimated the stage of fibrosis in 44.2% and underestimated the stage of fibrosis in 37.7% of cases. Also in patients with no/mild fibrosis, identical matching was detected in 39.2% of cases with overestimation in 48.1% and underestimation in 12.7%. So, the overall results of the test were identical matching, overestimation and underestimation in 32%, 46.7% and 21.3% respectively. Using ROC curve it was found that (FT) at the cut-off point of 0.555 could discriminate early from advanced stages of fibrosis with an area under ROC curve (AUC) of 0.72, sensitivity of 65%, specificity of 69%, PPV of 68%, NPV of 66% and accuracy of 67%. As FibroTest Score overestimates the stage of advanced fibrosis, it should not be considered as a reliable surrogate for liver biopsy in hepatitis C infection with genotype 4.

Keywords: fibrotest, chronic Hepatitis C, genotype 4, liver biopsy

Procedia PDF Downloads 413

Authors: Mohamed A. Hammad, Dzul Azri Mohamed Noor, Syed Azhar Syed Sulaiman, Abeer Kharshid, Nor Azizah Aziz, Tarek M. Elsayed

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Medication safety is always an issue. In 2015, the National Pharmaceutical Control Bureau released a statement requesting all statins manufacturers in Malaysia to include the risk of diabetes information in the drug information leaflet in response to United States Food and Drug Administration (U.S. FDA) report. However, the data regarding this warning label in Malaysia is limited, so there is still some uncertainty whether such risk can also be observed in the Malaysian population or not. The study aims to determine the effect of statins on HbA1c% in type 2 diabetic outpatients in endocrine clinics at Hospital Pulau Pinang between June 2015 and May 2016 in Malaysia. In a prospective cohort study, records of 400 type 2 diabetic patients (control group 104 patients not using statin and treatment group 296 patients using statin) were reviewed to identify demographic criteria and lab tests. The prevalence of glycemic control (Glycated hemoglobin, HbA1C ≤ 7% for patient < 65 years, and < 8% for patient ≥ 65 years) was estimated, according to American Diabetes Association guidelines 2015. The results were presented as descriptive statistics. From 296 patients with Type 2 diabetes using statins cohort with a mean age of 57.52 ± 12.2 years, only 81 (27.4%) cases had controlled glycemia, and 215 (72.6%) had uncontrolled glycemia, CI: 95% (6.3–11.1). While the control group 104 diabetic patients had a mean age 46.1 ± 18 years and distributed among 59 (56.7%) patients with controlled diabetes and 45 (43.3%) cases, had uncontrolled glycemia, CI: 95% (5.2–10.3). The relative risk (RR) of uncontrolled glycemia in diabetic patients used statins was 1.68, and the excessive relative risk (ERR) was 68%. The absolute risk (AR) was 29.3%, and the number needed to harm (NNH) was 4. Diabetic patients using statins have more risk of uncontrolled glycemia than the patients with Type 2 diabetes non-using statins.

Keywords: diabetes mellitus, HbA1c, Malaysia, outpatients, statin, type 2, uncontrolled glycemia

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Authors: Sarina Sahmeddini, Fahimeh Safarpour, Forough Pazhuheian

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With the concepts of minimally invasive treatment and preventive dentistry gaining more and more recognition by dentists, there are many published clinical trials comparing the use of the erbium laser with traditional drilling for caries removal. However, the efficacy of the erbium laser is still controversial. The aim of this review study is to compare the effects of tooth preparation by laser irradiation and conventional preparation by bur to identify the best means for cavity preparation and reduction of recurrent caries. Randomized controlled trials, controlled clinical trials, and prospective, and retrospective cohort studies were included in this review. The eligibility criteria included studies in humans’ permanent teeth in which cavities were conducted in their cervical third and proximal surfaces. PubMed, Google scholar, and Scopus about Er:YAG laser and bur prepared cavities were carried out. The studies’ details were organized in four tables according to the groups: (1) Microleakage; (2) Morphological changes; (3) Microhardness; and (4) Bond strength. The initial search resulted in 134 articles, 12 studies published from 2012 up to March 2020 were included in this review. According to the risk of bias evaluation, all studies were classified as high quality. Clinical implications: Er:YAG lasers with the energy levels between 250 to 300 mJ can be proper alternatives to conventional burs, as minimal invasive instruments with no significant differences or better results in microleakage, microhardness, and bond strength compared with conventional burs. In conclusion, Er:YAG laser irradiations accompanied by phosphoric acid etching can reduce the chance of recurrent carries.

Keywords: lasers, drilling, caries, micro leakage

Procedia PDF Downloads 131