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Introduction: Several studies identified a link between gastroesophageal reflux disease (GERD) and obstructive sleep apnea (OSA). GERD is a condition in which acid reflux from the stomach to the esophagus causes troublesome symptoms. On the other hand, OSA is defined as a sleep-related breathing disorder in which airflow significantly decreases or ceases due to upper airway obstruction, leading to arousal from sleep. OSA was found to be associated with GERD. In this study, we aim to study the characteristics and concurrent risk factors associated with GERD and OSA in a large population-based study.Methods: Patients with the diagnosis of GERD were extracted from the National Inpatient Database (NIS) for the years 2016 to 2019. Patients' age, gender, race, and hospital information, including region and bed size, were extracted and considered as baseline characteristics. The comorbidities included are hypertension (HTN), atrial fibrillation (AFib), congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), pulmonary hypertension (PHTN), obesity, and smoking. Patients younger than 18 years old were excluded from this study.Results: Out of 22,677,620 patients with the diagnosis of GERD, 12.21% had a concurrent diagnosis of OSA (compared to 4.79% in patients without GERD, p-value <0.001). The mean age of patients with GERD and OSA was 64.47 years vs 65.42 years in patients without OSA (p-value <0.001). The GERD and OSA group had almost identical gender distribution compared to the GERD only group, as it was predominantly female patients. The white and black races were slightly more prevalent in the GERD and OSA group compared to the GERD only group. Regarding comorbidities, the prevalence of obesity was more clear in the GERD and OSA group. It was noted that the group of patients who carry a diagnosis of GERD and OSA have more prevalence of diabetes (DM), hypertension (HTN), obesity, atrial fibrillation (Afib), congestive heart failure (CHF), and pulmonary hypertension (PHTN). Patients with GERD and OSA were 21% less likely to be older than 65 years rather than younger (95% CI: 0.79-0.8, p-value <0.001), 35% less likely to be females (95% CI: 0.65-0.65, p-value <0.001), and 22% less likely to be non-white (95% CI: 0.77-0.8, p-value <0.001). Obesity was found to be the strongest association with this population, followed by PHTN, CHF, DM, HTN, Afib, and lastly smoking.Conclusion: Patients with GERD and OSA were found more likely to be female, white, living in the southern part of the United States, obese, diabetes mellitus type 2, and being active smokers.

Introduction: Children with special needs have physical limitations and the ability to maintain their oral hygiene, so it needs to be chosen the proper tooth brushing methods for maintaining oral hygiene and prevent periodontal disease.Purpose: This study aimed to know differences of the effectiveness of horizontal tooth brushing methods and foneson the dental plaque index in children with visual impairment.Methods: This research was a quasy experimental laboratory with pre-test and post-test design. The study was conducted on 26 blind children aged 6-13 years in MILB YKTM Budi Asih, SLB-A DriaAdi, and SLB Negeri Semarang that were divided into two groups of horizontal and fonestooth brushing method. Dental plaque was measured using PHP plaque index, examined the dental crown facial or lingual parts by dividing each tooth crown into 5 subdivisions, plaque index inspected before and after 1 week of brushing method application, then analyzed by paired t-test and independent t test at a significance level ofp <0.05. Results: The mean of plaque index before and after brushing the teeth with horizontal method was 2.56 and 0.956 down to 1.61, whereas in the fonesmethod was 3.03 and 1.68down to 1.35. Plaque index before and after brushing teeth both on horizontal and fones method was statistically significant(p <0.05). But the effectiveness of both methods were not different or similar (p = 0.179).Conclusion: There was no difference of effectiveness between horizontal and fones tooth brushing methods on the dental plaque index in children with visual impairment.

Human life can not be separated from the natural world around it. Nature is the main source of humans to connect the chain of life. Suber food basically comes from nature which is then processed in such a way by humans. That way, it is very necessary to have actions that are caring and conserving nature so that it is maintained. In Hinduism, there is the term Panca Yadnya which contains the worship or sacrifice which is done sincerely and sincerely from the heart. One of the elements of the five Yadnya is done to the Butha to preserve nature and harmony of human life during the world called the Bhuta Yadnya. In another sense, Bhuta Yadnya is an offering made with the welfare of plants. Of course this is also related to natural conditions which are an important component in supporting the survival of human life. The relationship between nature and humans is inseparable because the two are interrelated, therefore, it is necessary to have a reciprocal relationship in maintaining a balance between the two. In this paper, it explains about the role of the Panca Yadnya ceremony or the five types of sacrifices performed in Hindu beliefs, especially regarding the Bhuta Yad whose role is to preserve nature. In undergoing the life cycle of the world, humans play an important role in preserving the surrounding natural preservation.

Numerous previous studies investigated the impact of medical training settings on outcomes of hospitalized patients. However, the impact of teaching hospital status on outcomes of percutaneous paracentesis, to the best of our knowledge, has never been studied before. MethodsHospitalized patients who underwent percutaneous paracentesis were identified from the National Inpatient Sample database from 2016 to 2019 across the United States (US) teaching and non-teaching hospitals. Outcomes studied were differences in risk of mortality, postprocedural outcomes, and healthcare resource utilization. Multivariate logistic analysis was performed using STATA software (StataCorp LLC, College Station, Texas, US) and results were adjusted for patient and hospital characteristics and comorbidities. ResultsInpatient mortality rates were significantly higher in patients undergoing paracentesis at US teaching hospitals (adjusted odds ratio (aOR) 1.29, 95%CI 1.23-1.35, p<0.001) compared to non-teaching hospitals. Similarly, higher risk of procedural complications including hemoperitoneum (aOR 1.90, 95%CI 1.65-2.20, p<0.001), hollow viscus perforation (aOR 1.97, 95%CI 1.54-2.51, p<0.001), and vessel injury/laceration (aOR 15.3, 95%CI 2.12-110.2, p=0.007) were noticed in the study group when compared to controls. Furthermore, hospital teaching status was associated with prolonged mean length of stay (9.33 days vs 7.42 days, adjusted mean difference (aMD) 1.81, 95%CI 1. 68-1.94, p<0.001