Nevin Manimala

Transpl Infect Dis. 2022 Aug 9:e13920. doi: 10.1111/tid.13920. Online ahead of print.

ABSTRACT

BACKGROUND: Carbapenem-resistant Enterobacterales (CRE) colonisation at liver transplantation (LT) increases the risk of CRE infection after LT, which impacts on recipients’ survival. Colonization status usually becomes evident only near LT. Thus, predictive models can be useful to guide antibiotic prophylaxis in endemic centres.

AIMS: This study aimed to identify risk factors for CRE colonisation at LT in order to build a predictive model.

METHODS: Retrospective multicentre study including consecutive adult patients who underwent LT, from 2010 to 2019, at two large teaching hospitals. We excluded patients who had CRE infections within 90 days before LT. CRE screening was performed in all patients on the day of LT. Exposure variables were considered within 90 days before LT and included cirrhosis complications, underlying disease, time on the waiting list, MELD and CLIF-SOFA scores, antibiotic use, intensive care unit and hospital stay, and infections. A machine learning model was trained to detect the probability of a patient being colonized with CRE at LT.

RESULTS: A total of 1544 patients were analyzed, 116 (7.5%) patients were colonized by CRE at LT. The median time from CRE isolation to LT was 5 days. Use of antibiotics, hepato-renal syndrome, worst CLIF sofa score, and use of beta-lactam/beta-lactamase inhibitor increased the probability of a patient having pre-LT CRE. The proposed algorithm had a sensitivity of 66% and a specificity of 83% with a negative predictive value of 97%.

CONCLUSIONS: We created a model able to predict CRE colonization at LT based on easy-to-obtain features that could guide antibiotic prophylaxis.

PMID:35942941 | DOI:10.1111/tid.13920

Biometrics. 2022 Aug 9. doi: 10.1111/biom.13732. Online ahead of print.

ABSTRACT

Mendelian randomization (MR) utilizes genetic variants as instrumental variables (IVs) to estimate the causal effect of an exposure variable on an outcome of interest even in the presence of unmeasured confounders. However, the popular inverse-variance weighted (IVW) estimator could be biased in the presence of weak IVs, a common challenge in MR studies. In this article, we develop a novel penalized inverse-variance weighted (pIVW) estimator, which adjusts the original IVW estimator to account for the weak IV issue by using a penalization approach to prevent the denominator of the pIVW estimator from being close to zero. Moreover, we adjust the variance estimation of the pIVW estimator to account for the presence of balanced horizontal pleiotropy. We show that the recently proposed debiased IVW (dIVW) estimator is a special case of our proposed pIVW estimator. We further prove that the pIVW estimator has smaller bias and variance than the dIVW estimator under some regularity conditions. We also conduct extensive simulation studies to demonstrate the performance of the proposed pIVW estimator. Furthermore, we apply the pIVW estimator to estimate the causal effects of five obesity-related exposures on three coronavirus disease 2019 (COVID-19) outcomes. Notably, we find that hypertensive disease is associated with an increased risk of hospitalized COVID-19; and peripheral vascular disease and higher body mass index are associated with increased risks of COVID-19 infection, hospitalized COVID-19 and critically ill COVID-19. This article is protected by copyright. All rights reserved.

PMID:35942938 | DOI:10.1111/biom.13732

Pflege. 2022 Aug 9. doi: 10.1024/1012-5302/a000904. Online ahead of print.

ABSTRACT

Nursing interventions by school nurses in Germany: A cross-sectional study Abstract. Background: The internationally established professional profile of school nursing has not yet been implemented across the board in Germany. In model projects and some international schools the feasibility of the concept and the daily work of school nurses in Germany can already be observed. Urgent and currently often unsolved issues in the school setting are the inclusion of chronically ill students and health promotion in the living environment. Aim: The aim of this paper is to describe the interventions of school nurses in everyday school life. Method: Using a standardized online questionnaire, school nurses in Germany were surveyed regarding the activities they performed and their frequency. The data on the activities were collected based on the Nursing Intervention Classification (NIC). Data were analyzed using descriptive statistics. Results: Respondents (n = 25) focused on acute care and health education/promotion. Nursing interventions that have a family or population-based approach are performed only “every 2-3 months” or less by the average respondent. Conclusions: The daily intensive implementation of diverse nursing interventions indicates an urgent need for nursing expertise in schools.

PMID:35942890 | DOI:10.1024/1012-5302/a000904

Stroke. 2022 Aug 9:101161STROKEAHA122038673. doi: 10.1161/STROKEAHA.122.038673. Online ahead of print.

ABSTRACT

BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) can cause short-term cerebrovascular complications, such as brain infarction and hemorrhage. We hypothesized that PRES is also associated with an increased long-term risk of stroke.

METHODS: We performed a retrospective cohort study in the United States using statewide all-payer claims data from 2016 to 2018 on all admissions to nonfederal hospitals in 11 states. Adults with PRES were compared with adults with renal colic (negative control) and transient ischemic attack (TIA; positive control). Any stroke and the secondary outcomes of ischemic and hemorrhagic stroke were ascertained using International Classification of Diseases, Tenth Revision, Clinical Modification codes. We excluded prevalent stroke. We used time-to-event statistics to calculate incidence rates and Cox proportional hazards analyses to evaluate the association between PRES and stroke, adjusting for demographics and stroke risk factors. In a sensitivity analysis, outcomes within 2 weeks of index admission were excluded.

RESULTS: We identified 1606 patients with PRES, 1192 with renal colic, and 38 216 with TIA. Patients with PRES had a mean age of 56±17 years; 72% were women. Over a median follow-up of 0.9 years, the stroke incidence per 100 person-years was 6.1 (95% CI, 5.0-7.4) after PRES, 1.0 (95% CI, 0.62-1.8) after renal colic, and 9.7 (95% CI, 9.4-10.0) after TIA. After statistical adjustment for patient characteristics and risk factors, patients with PRES had an elevated risk of stroke compared with renal colic (hazard ratio [HR], 2.3 [95% CI, 1.7-3.0]), but lower risk than patients with TIA (HR, 0.67 [95% CI, 0.54-0.82]). In secondary analyses, compared with TIA, PRES was associated with hemorrhagic stroke (HR, 2.0 [95% CI, 1.4-2.9]). PRES was associated with ischemic stroke when compared with renal colic (HR, 1.9 [95% CI, 1.4-2.7]) but not when compared with TIA (HR, 0.49 [95% CI, 0.38-0.63]). Results were similar with 2-week washout.

CONCLUSIONS: Patients with PRES had an elevated risk of incident stroke.

PMID:35942880 | DOI:10.1161/STROKEAHA.122.038673

Int J Pharm Pract. 2022 Aug 9:riac063. doi: 10.1093/ijpp/riac063. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to explore the eye drop instillation technique of patients with glaucoma and whether a pharmacist-led counselling session can improve their technique. Patients’ perceptions of pharmacists’ role in providing the counselling were also explored.

METHODS: This cross-sectional study was conducted between December 2020 and March 2021 at Sarawak General Hospital, Malaysia. Convenience sampling was used to recruit patients with glaucoma who self-administered their eye drops. Participants’ background information were obtained using an investigator-administered questionnaire before their eye drop instillation technique was assessed. Those with imperfect techniques were counselled by a pharmacist before being reassessed. Differences in eye drop instillation competency were determined using paired T-test.

KEY FINDINGS: A total of 138 participants were recruited. Participants were on a median of two eye drops (IQR 2-4) for a median of five years (IQR 2-8). Prior to being counselled, they demonstrated a mean total of 8.4/13 steps (SD 2.33) correctly. A statistically significant improvement in eye drop instillation technique was observed post-pharmacists’ counselling, with a mean increase of 4.3 steps demonstrated correctly (95% CI, 4.0 to 4.7, P < 0.001). The majority of participants agreed that pharmacists are knowledgeable in providing counselling on eye drop administration techniques.

CONCLUSIONS: Patients with glaucoma treated at Sarawak General Hospital had imperfect eye drop instillation techniques, despite most having used their eye drops for several years. Interventions by pharmacists to improve eye drop instillation are crucial to optimise the medical treatment of patients with glaucoma.

PMID:35942810 | DOI:10.1093/ijpp/riac063

Bone Joint Res. 2022 Aug;11(8):585-593. doi: 10.1302/2046-3758.118.BJR-2021-0523.R2.

ABSTRACT

AIMS: A number of anti-retroviral therapies (ART) have been implicated in potentially contributing to HIV-associated bone disease. The aim of this study was to evaluate the effect of combination ART on the fracture healing process.

METHODS: A total of 16 adult male Wistar rats were randomly divided into two groups (n = eight each): Group 1 was given a combination of Tenfovir 30 mg, Lamivudine 30 mg, and Efavirenz 60 mg per day orally, whereas Group 2 was used as a control. After one week of medication preload, all rats underwent a standardized surgical procedure of mid-shaft tibial osteotomy fixed by intramedullary nail with no gap at the fracture site. Progress in fracture healing was monitored regularly for eight weeks. Further evaluations were carried out after euthanasia by micro-CT, mechanically and histologically. Two blinded orthopaedic surgeons used the Radiological Union Scoring system for the Tibia (RUST) to determine fracture healing.

RESULTS: The fracture healing process was different between the two groups at week 4 after surgery; only two out of eight rats showed full healing in Group 1 (ART-treated), while seven out of eight rats had bone union in Group 2 (control) (p = 0.040). However, at week eight postoperatively, there was no statistical difference in bone healing; seven out of eight progressed to full union in both groups.

CONCLUSION: This study demonstrated that combination ART resulted in delayed fracture healing at week 4 after surgery in rats, but did not result in the development of nonunion.Cite this article: Bone Joint Res 2022;11(8):585-593.

PMID:35942801 | DOI:10.1302/2046-3758.118.BJR-2021-0523.R2

Math Biosci Eng. 2022 Jul 4;19(9):9658-9696. doi: 10.3934/mbe.2022449.

ABSTRACT

In this paper, we propose a new mathematical model to study the epidemic and economic consequences of COVID-19, with a focus on the interaction between the disease transmission, the pandemic management, and the economic growth. We consider both the symptomatic and asymptomatic infections and incorporate the effectiveness of disease control into the respective transmission rates. Meanwhile, the progression of the pandemic and the evolution of the susceptible, infectious and recovered population groups directly impact the mitigation and economic development levels. We fit this model to the reported COVID-19 cases and unemployment rates in the US state of Tennessee, as a demonstration of a real-world application of the modeling framework.

PMID:35942777 | DOI:10.3934/mbe.2022449

Math Biosci Eng. 2022 Jul 1;19(9):9590-9611. doi: 10.3934/mbe.2022446.

ABSTRACT

We propose stage-structured single-species population models with psychological effects and partial tolerance in polluted environments in this paper. First, the conditions of extinction and the time for extinction are investigated respectively. Especially, the time for extinction takes longer as the value of the psychological effects increases. Then the weak persistence in the mean around the pollution-free equilibrium and the stochastic permanence have been derived under some moderate conditions. Further, the existence of a periodic solution for the periodic single-species population has been determined. The corresponding numerical simulations verify the efficiency of the main theoretical results.

PMID:35942774 | DOI:10.3934/mbe.2022446

Math Biosci Eng. 2022 Jun 29;19(9):9505-9519. doi: 10.3934/mbe.2022442.

ABSTRACT

This paper proposes an anti-rotation template matching method based on a portion of the whole pixels. To solve the problem that the speed of the original template matching method based on NCC (Normalized cross correlation) is too slow for the rotated image, a template matching method based on Sub-NCC is proposed, which improves the anti-jamming ability of the algorithm. At the same time, in order to improve the matching speed, the rotation invariant edge points are selected from the rotation invariant pixels, and the selected points are used for rough matching to quickly screen out the unmatched areas. The theoretical analysis and experimental results show that the accuracy of this method is more than 95%. For the search map at any angle with the resolution at the level of 300,000 pixel, after selecting the appropriate pyramid series and threshold, the matching time can be controlled to within 0.1 s.

PMID:35942770 | DOI:10.3934/mbe.2022442

Math Biosci Eng. 2022 Jun 22;19(9):9125-9146. doi: 10.3934/mbe.2022424.

ABSTRACT

Influenza is a respiratory infection caused influenza virus. To evaluate the effect of environment noise on the transmission of influenza, our study focuses on a stochastic influenza virus model with disease resistance. We first prove the existence and uniqueness of the global solution to the model. Then we obtain the existence of a stationary distribution to the positive solutions by stochastic Lyapunov function method. Moreover, certain sufficient conditions are provided for the extinction of the influenza virus flu. Finally, several numerical simulations are revealed to illustrate our theoretical results. Conclusively, according to the results of numerical models, increasing disease resistance is favorable to disease control. Furthermore, a simple example demonstrates that white noise is favorable to the disease’s extinction.

PMID:35942752 | DOI:10.3934/mbe.2022424