Category: Nevin Manimala

BMJ Open. 2024 Nov 2;14(11):e081908. doi: 10.1136/bmjopen-2023-081908.

ABSTRACT

OBJECTIVE: To analyse the rational prescription of medicines by village clinics following China’s implementation of the New Healthcare System Reform (NHCSR).

DESIGN: Retrospective study.

SETTING: Village clinics in a province in eastern China.

PRIMARY AND SECONDARY OUTCOME MEASURES: Our evaluation was based on the core drug use indicators reported in the study ‘How to Investigate Drug Use in Health Facilities: Selected Drug Use Indicators‘.

RESULTS: The level of rational use of medicines (RUMs) in village clinics improved in 2018 compared with 2009; the average number of drugs per prescription decreased from 3.66 to 2.77, the percentage of prescriptions including antibiotics decreased from 65.40% to 46.00%, and the percentage of prescriptions including injections decreased from 55.75% to 37.48% (all p<0.01), whereas the percentage of drugs prescribed from the list of essential medicines increased from 66.50% to 80.34%, and the percentage of drugs prescribed by generic names increased from 61.29% to 70.65% (all p<0.01).

CONCLUSION: The level of RUMs improved after the implementation of the NHCSR, however, it was found that there was still a gap between the level of RUMs in 2018 and the international reference value. Financial investments, electronic prescription systems, improved supervision and regular training are essential actions that must be implemented.

PMID:39488421 | DOI:10.1136/bmjopen-2023-081908

BMJ Open. 2024 Nov 2;14(11):e081533. doi: 10.1136/bmjopen-2023-081533.

ABSTRACT

BACKGROUND AND OBJECTIVES: Receiving care at patient-centred medical homes (PCMH) is associated with reduced emergency department (ED) visits among children. Adverse social determinants of health (SDoH), such as lower socioeconomic status and household poverty, are associated with increased ED visits in children. The objective of this study is to use machine learning techniques to understand the relative importance of each PCMH component among different populations with adverse SDoH on the outcome of ED visits.

METHODS DESIGN, SETTING AND PARTICIPANTS: This study used the 2018-2019 pooled data from the National Survey of Children’s Health (NSCH), an annual survey of parents and caregivers of US children from birth to 17 years. PCMH components were operationalised by classifying parent/caregiver responses into five domains: care coordination (CC), having a personal doctor or nurse, having a usual source of care, family-centred care and ease of getting referrals. SDoH included five categories: (1) social and community context, (2) economic stability, (3) education access and quality, (4) healthcare access and quality and (5) neighbourhood and built environment.

PRIMARY OUTCOME MEASURE: We used a split-improvement variable importance measure based on random forests to determine the importance of PCMH domains on ED visits overall and stratified by SDoH.

RESULTS: Overall, between 3% and 28% experienced one or more gaps in PCMH domains. Models show that problems with referrals (rank, 2; Gini, 83.5) and gaps in CC (rank, 3; Gini, 81.0) were the two most important domains of PCMH associated with ED visits in children. This result was consistent among black and Hispanic children and among children with lower socioeconomic status.

CONCLUSIONS: Our study findings underscore the importance of poor CC and referrals on ED visits for all children and those from disadvantaged populations. Initiatives for expanding the reach of PCMH should consider prioritising these two domains, especially in areas with significant minority populations.

PMID:39488420 | DOI:10.1136/bmjopen-2023-081533

BMJ Open. 2024 Nov 2;14(11):e083016. doi: 10.1136/bmjopen-2023-083016.

ABSTRACT

OBJECTIVE: To investigate the relationship between sleep duration and myopia among primary school students in minority regions of Southwest China.

METHODS: The school-based, cross-sectional study was conducted from October 2020 to January 2021. All participants underwent a comprehensive ocular examination and completed a questionnaire on demographic characteristics, ophthalmological history and major environmental factors for myopia. Spherical equivalent (SE) and ocular biometric parameters were measured after cycloplegia, with myopia being defined as SE ≤-0.5 D (Diopter). Multivariate regression models were used to examine the association of sleep duration with myopia, SE and axial length (AL).

RESULTS: A total of 857 students from grades 2 to 4 were included in the analysis, of which 63.6% were myopic and 62.0% belonged to ethnic minorities. Boys had a slightly higher prevalence of myopia compared with girls (66.7% vs 60.6%, p=0.06). Myopic students had longer AL, deeper anterior chamber depth and thinner central corneal thickness compared with non-myopic students (all p<0.05). There was no significant association between sleep duration and myopia in both boys and girls (p=0.319 and 0.186, respectively). Moreover, girls with a sleep duration of 8-9 hour/day had higher SE and shorter AL compared with those with less than 8 hour/day of sleep (β=0.41 and -0.32, respectively, all p<0.05).

CONCLUSION: This cross-sectional study did not find a significant association between sleep duration and myopia. However, it suggests that 8-9 hours of sleep per day may have a protective effect on SE progression and AL elongation in girls. Future studies with objectively measured sleep duration are needed to validate the findings.

PMID:39488419 | DOI:10.1136/bmjopen-2023-083016

BMJ Open. 2024 Nov 2;14(11):e085073. doi: 10.1136/bmjopen-2024-085073.

ABSTRACT

OBJECTIVE: To explore the barriers and facilitators of antenatal care (ANC) utilisation in Somaliland.

DESIGN: An exploratory qualitative study design.

SETTING: Various settings were considered for study including maternal and child health clinics, hospitals and community.

METHODS: 74 study participants including 33 pregnant women, 22 healthcare providers, 10 community elders and ten religious leaders were purposively selected. Data was collected via focus group discussion and in-depth interviews in the local Somali language. The data was audio recorded, transcribed verbatim, translated into English and imported into NVivo V.12 software. Thematic framework analysis was used to assess barriers and facilitators of ANC utilisation.

RESULTS: Six main themes were identified as barriers of ANC utilisation. These include lack of awareness, long distance and lack of transportation access, economic barriers, lack of social support, beliefs and thoughts and health facility-related factors such as caregivers approach, waiting time and inadequate skill of providers. Proper dissemination of ANC information, adequate spousal support and cheap pricing of services were found to be facilitators of ANC uptake.

CONCLUSION: A strategy that focuses on raising awareness about ANC, making it accessible by reducing the cost-of-service charge, encouraging partner involvement, improving the quality of services and making it customer-friendly will help to overcome the barriers of antenatal utilisation.

PMID:39488416 | DOI:10.1136/bmjopen-2024-085073

Methods Enzymol. 2024;707:101-152. doi: 10.1016/bs.mie.2024.07.059. Epub 2024 Aug 23.

ABSTRACT

The multiple functions of mitochondria are governed by their proteome comprising 1000-1500 proteins depending on the organism. However, only few proteins are synthesized inside mitochondria, whereas most are “born” outside mitochondria. To reach their destined location, these mitochondrial proteins follow specific import routes established by a mitochondrial translocase network. A detailed understanding of the role and interplay of the different translocases is imperative to understand mitochondrial biology and how mitochondria are integrated into the cellular network. Mass spectrometry (MS) proved to be effective to study the translocase network regarding composition, functions, interplay, and cellular responses evoked by dysfunction. In this chapter, we provide protocols tailored to MS-enabled functional analysis of mutants and interactomes of mitochondrial translocation proteins. In the first part, we exemplify the MS-based proteomics analysis of translocation mutants for delineating the human mitochondrial importome following depletion of the central translocation protein TOMM40. The protocol comprises metabolic stable isotope labeling, TOMM40 knockdown, preparation of mitochondrial fractions, and sample preparation for liquid chromatography (LC)-MS. For deep MS analysis, prefractionation of peptide mixtures by high pH reversed-phase LC is described. In the second part, we outline an affinity purification MS approach to reveal the association of an orphaned protein with the translocase TIM23. The protocol covers FLAG-tag affinity purification of protein complexes from mitochondrial fractions and downstream sample preparation for interactome analysis. In the last unifying part, we describe methods for LC-MS, data processing, statistical analysis and visualization of quantitative MS data, and provide a Python code for effective, customizable analysis.

PMID:39488372 | DOI:10.1016/bs.mie.2024.07.059

J Neurointerv Surg. 2024 Nov 2:jnis-2024-022206. doi: 10.1136/jnis-2024-022206. Online ahead of print.

ABSTRACT

BACKGROUND: Mechanical thrombectomy (MT) is an effective treatment for acute ischemic stroke from large vessel occlusion (LVO). While embolization to a new territory (ENT) after MT is well-documented, data on embolization in the same distal territory (EDT) are limited. Achieving modified Treatment In Cerebral Infarction (mTICI) 3 reperfusion presents significant clinical benefits over mTICI 2b/2c, necessitating strategies to reduce both ENT and EDT. Previous studies suggest higher rates of EDTs with contact aspiration compared with stentrievers. However, comprehensive comparison studies in clinical practice are scarce. This study compares the rates of overall clot emboli (OCE) between these MT strategies.

METHODS: A retrospective, multicenter observational study was conducted at four university hospitals in France from January 2015 to November 2019. Adult patients (≥18 years) with acute ischemic stroke due to LVO, treated with either contact aspiration (ADAPT, A Direct Aspiration First Pass Technique) or stentrievers, specifically using the Embotrap device to maintain sample homogeneity, were included. Digital subtraction angiography was used for imaging, with two independent, blinded reviewers assessing OCE post-first MT pass. Propensity score full matching and independent sample testing were employed to evaluate OCE after the first MT pass.

RESULTS: A significant difference in OCE rates was observed between contact aspiration and stentriever techniques, with the stentriever technique resulting in fewer embolic events compared with ADAPT, based on a propensity score analysis that accounts for key confounding factors.

CONCLUSION: A statistically significant reduction in embolic events was observed with the stentriever technique compared with contact aspiration. These results suggest that the stentriever method may offer a safer profile in terms of embolic risk for LVO interventions, and should be considered over contact aspiration when embolic risk is a primary concern, while also considering individual patient factors.

PMID:39488338 | DOI:10.1136/jnis-2024-022206

J Oral Maxillofac Surg. 2024 Oct 16:S0278-2391(24)00866-8. doi: 10.1016/j.joms.2024.10.004. Online ahead of print.

ABSTRACT

BACKGROUND: Cone-beam computed tomography (CBCT) provides additional 3-dimensional information on the relationship between the mandibular third molar (M3M) and the inferior alveolar nerve (IAN). As such, CBCT is being increasingly utilized in preoperative M3M assessment.

PURPOSE: The purpose of the study was to compare the radiographic findings on panoramic and CBCT and their association with postoperative IAN paresthesia.

STUDY DESIGN, SETTING, SAMPLE: We conducted a retrospective cohort study in a sample of patients referred to the Department of Oral and Maxillofacial Surgery at the Royal Dental Hospital of Melbourne, for management of impacted M3Ms. Patients were included in this study if they had 1 or more high-risk findings on orthopantomogram (OPG), had both OPG and CBCT imaging taken and if at least 1 M3M had been extracted. Subjects were excluded from this study if their M3Ms were not extracted or if a CBCT was not indicated.

INDEPENDENT VARIABLE: The independent variable was radiographic features identified on OPG (Rood and Shehab’s radiographic signs, root morphology, impaction type, Pell and Gregory classification) and CBCT (number and location of roots, severity of IAN compression and the presence of ankylosis).

MAIN OUTCOME VARIABLE: The outcome variable was postoperative neurosensory function defined as any reported paresthesia at 2-week postprocedural review.

COVARIATES: The covariates were patient demographic information (age, sex).

ANALYSES: Variables were initially assessed with univariate logistic regression analysis to determine factors related to developing postoperative paresthesia. Multivariate logistic regression analysis was then used to assess the association between positive univariate study variables and postoperative paresthesia, while adjusting for potential confounders. Covariates were assessed using an omnibus likelihood ratio test and included if they were statistically significant at the P < .05 level.

RESULTS: The study sample consisted of 257 subjects who underwent surgical removal of n = 386 M3Ms. The mean age was 25.9 (SD = 7.05). The panoramic features of narrowing of canal, diversion of canal and dark/bifid roots were identified as statistically significant associations of postoperative paresthesia. No CBCT features were significantly associated of postoperative paresthesia.

CONCLUSION AND RELEVANCE: Certain panoramic features, along with patient age, are significant predictors of IAN paresthesia. CBCT findings were not significant predictors upon multivariate analysis, thus additional CBCT imaging did not significantly improve ability to predict paresthesia.

PMID:39488334 | DOI:10.1016/j.joms.2024.10.004

Sci Total Environ. 2024 Oct 31:177294. doi: 10.1016/j.scitotenv.2024.177294. Online ahead of print.

ABSTRACT

Karst water resources, traditionally used worldwide for drinking purposes, are highly vulnerable to contamination. Scientific-technical efforts must therefore be done to ensure sufficient water quality for human consumption. Early-Warning-Systems emerge as an effective spring scale protection strategy for real-time identification of contamination episodes at drinking water capture points. With this ambition, the proposed stepwise procedure for the implementation of site-specific Early-Warning-Systems (EWS), focuses on three critical features: identification of groundwater contamination proxy parameters, warning dissemination and system validation. It was tested at three karst springs affected by temporary faecal contamination and intended for supplying drinking water to populations in Spain (Ubrique) and France (Montpellier). The applied statistical techniques, coupled to the analysis of individual flood events at karst springs, allowed to identify the optimal combination of groundwater and contamination proxy parameters at each study site according to the main contaminants and recharge mechanisms. The decision tree-like workflow, used to evaluate groundwater quality at hourly time step and set up the EWS, was then constructed considering a specific combination of hydroclimatic, hydrodynamic and physical variables together with national regulations for drinking water. Hence, warning thresholds were adapted to the behaviour of each karst system, and used to trigger the alarm when specific parameters and proxies exceeded the defined limits. The performance of the EWS was assessed by implementing 4 specific Key Performance Indicators (KPIs) dedicated to appreciate the effectiveness of the workflows in identifying contamination events and verifying estimated warning thresholds. The performed analysis demonstrated an overall successful functioning of the EWS for the three case studies, with mean anticipation times ranging between 12 and 45 h and <3 % of failure rate.

PMID:39488278 | DOI:10.1016/j.scitotenv.2024.177294

J Stomatol Oral Maxillofac Surg. 2024 Oct 31:102124. doi: 10.1016/j.jormas.2024.102124. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of this study was to investigate the diagnostic performance of a neural network Artificial Intelligence model for the radiographic confirmation of Temporomandibular Joint Osteoarthritis in reference to an experienced radiologist.

MATERIALS AND METHODS: The diagnostic performance of an AI model in identifying radiographic features in patients with TMJ-OA was evaluated in a diagnostic accuracy cohort study. Adult patients elected for radiographic examination by the Diagnostic Criteria for Temporomandibular Disorders decision tree were included. Cone-beam computed Tomography images were evaluated by object detection YOLO deep learning model. The diagnostic performance was verified against examiner radiographic evaluation.

RESULTS: The differences between the AI model and examiner were non-significant statistically, except in the subcortical cyst (P=0.049*). AI model showed substantial to near-perfect levels of agreement when compared to those of the examiner data. Regarding each radiographic phenotype, the AI model reported favorable sensitivity, specificity, accuracy, and highly statistically significant Receiver Operating Characteristic (ROC) analysis (p < 0.001). Area Under Curve ranged from 0.872, for surface erosion, to 0.911 for subcortical cyst.

CONCLUSION: AI object detection model could open the horizon for a valid, automated, and convenient modality for TMJ-OA radiographic confirmation and radiomic features identification with a significant diagnostic power.

PMID:39488247 | DOI:10.1016/j.jormas.2024.102124

Biomed Rep. 2024 Oct 15;22(1):3. doi: 10.3892/br.2024.1880. eCollection 2025 Jan.

ABSTRACT

Antineutrophil cytoplasmic antibody-associated vasculitis (AAV) is a rare autoimmune disease with an unclear pathogenesis. The present study investigated the associations between autophagy-related protein 16-like 1 (ATG16L1) rs2241880(T300A) and rs4663421 and AAV. A total of 177 patients with AAV and 216 healthy controls were included. Propensity score matching was used to match the two groups of subjects in terms of sex, age and ethnicity. Analyses of the relationships between these genetic polymorphisms and AAV susceptibility, including comparisons of allele and genotype frequency distribution, linkage disequilibrium analysis and analysis of single nucleotide polymorphism (SNP) interactions between two loci were performed. The association between the loci and laboratory test results and renal pathology were also analysed. A total of 154 pairs of patients with AAV and healthy controls was successfully matched. Neither polymorphism was associated with AAV susceptibility. However, SNP interaction in the model constructed with the two loci was statistically significant (P=0.018), and the combination of the AA genotype of rs2241880(T300A) and GG genotype of rs4663421 was associated the highest disease risk. The differences in the Birmingham Vasculitis Activity Score (BVAS), C-reactive protein (CRP) levels and 24-h urine protein level between patients with the rs2241880(T300A) AA + AG genotypes and the GG genotype were statistically significant (P<0.05). Furthermore, significant differences in the severity of glomerulosclerosis and global sclerosis were detected between individuals with the AA + AG genotype and those with the GG genotype at the rs2241880(T300A) locus (P<0.05). Similarly, there were statistically significant differences in degree of segmental sclerosis between individuals with CC + CG genotypes and those with GG genotypes at the rs2243421 locus (P<0.05). In summary, the single gene polymorphisms of these loci were not associated with genetic susceptibility to AAV. However, SNP interactions may serve a role in the risk of AAV. The rs2241880(T300A) polymorphism may be associated with BVAS, CRP levels and 24-h urine protein level in AAV. These SNPs may be associated with glomerulosclerosis and segmental sclerosis.

PMID:39483332 | PMC:PMC11522951 | DOI:10.3892/br.2024.1880