Category: Nevin Manimala

Acta Neurochir (Wien). 2023 Dec 4. doi: 10.1007/s00701-023-05867-1. Online ahead of print.

ABSTRACT

BACKGROUND: Tumor consistency is considered to be a critical factor for the surgical removal of meningiomas and its preoperative assessment is intensively studied. A significant drawback in the research of predictive methods is the lack of a clear shared definition of tumor consistency, with most authors resorting to subjective binary classification labeling the samples as “soft” and “hard.” This classification is highly observer-dependent and its discrete nature fails to capture the fine nuances in tumor consistency. To compensate for these shortcomings, we examined the utility of texture analysis to provide an objective observer-independent continuous measure of meningioma consistency.

METHODS: A total of 169 texturometric measurements were conducted using the Brookfield CT3 Texture Analyzer on meningioma samples from five patients immediately after the removal and on the first, second, and seventh postoperative day. The relationship between measured stiffness and time from sample extraction, subjectively assessed consistency grade and histopathological features (amount of collagen and reticulin fibers, presence of psammoma bodies, predominant microscopic morphology) was analyzed.

RESULTS: The stiffness measurements exhibited significantly lower variance within a sample than among samples (p = 0.0225) and significant increase with a higher objectively assessed consistency grade (p = 0.0161, p = 0.0055). A significant negative correlation was found between the measured stiffness and the time from sample extraction (p < 0.01). A significant monotonic relationship was revealed between stiffness values and amount of collagen I and reticulin fibers; there were no statistically significant differences between histological phenotypes in regard to presence of psammoma bodies and predominant microscopic morphology.

CONCLUSIONS: We conclude that the values yielded by texture analysis are highly representative of an intrinsic consistency-related quality of the sample despite the influence of intra-sample heterogeneity and that our proposed method can be used to conduct quantitative studies on the role of meningioma consistency.

PMID:38044374 | DOI:10.1007/s00701-023-05867-1

Environ Monit Assess. 2023 Dec 4;196(1):4. doi: 10.1007/s10661-023-12175-9.

ABSTRACT

This paper is an effort of geo-statistical analysis of rainfall variability and trend detection in the eastern Hindu Kush region located in the north-west of Pakistan. The eastern section of the HK region lies in the western part of Pakistan. Exploring rainfall variability and quantifying its trend and magnitude is one of the key indicators among all climatic parameters. In the study area, Pakistan Meteorology Department (PMD) has established seven meteorological stations: Drosh, Chitral, Dir, Timergara, Saidu Sharif, Malam Jabba, and Kalam. Daily, mean monthly, and mean annual rainfall time series data for all the met stations were geo-statistically analyzed in the GIS environment for detecting monthly and annual variability in rainfall, variability, and trend detection. Mann-Kendall (MK) and Theil-Sen’s slope (TSS) statistical tests were applied to rainfall data. Initially, the MK test was applied for detection of trends and TSS test was used to quantify the change in magnitude. The results indicate that the rainfall variability in intensity and trend pattern detection. The analysis confirms that an extremely significant rainfall trend in the case of mean annual rainfall was predicted at Dir and Malam Jabba meteorological stations. Opposite to this, at Kalam and Chitral stations, a less significant rainfall trend was noted. In a similar context, no prominent rainfall trend has been found at Drosh, Timergara, and Saidu Sharif meteorological stations. Likewise, using TSS, an extremely negative variation in the magnitude of rainfall was verified at Kalam and Malam Jabba. However, a noteworthy positive change in rainfall magnitude has been noted at Dir and Saidu Sharif meteorological stations. The findings of this research have the potential to assist the decision and policy makers and academicians to think truly and conduct more scientific research studies to mitigate climate change.

PMID:38044361 | DOI:10.1007/s10661-023-12175-9

J Dent Educ. 2023 Dec 3. doi: 10.1002/jdd.13426. Online ahead of print.

ABSTRACT

BACKGROUND: Haptic technologies have opened a new avenue in preclinical dental education, with evidence that they can be used to improve student performance. The aim of this systematic review was to (1) determine the effect of haptic simulators on motor skill acquisition during preclinical dental training, (2) explore students’ perception, and (3) explore the ability of haptic systems to distinguish users based on their initial level of manual dexterity.

METHODS: A comprehensive search of articles published up to February 2023 was performed using five databases (i.e., PubMed/Medline, ScienceDirect, Web of Sciences, Scopus, and Cochrane Library) and specialized journals. The Preferred Reporting Items for Systematic Review and Meta-Analysis 2020 guidelines were followed, and the risk of bias was assessed. Only studies on the application of haptic simulators in dentistry preclinical training were included. Qualitative synthesis of data was performed, and the protocol was registered in PROSPERO (ID = CRD42022337177).

RESULTS: Twenty-three clinical studies, including 1303 participants, were included. The authors observed a statistically significant improvement in dental students’ motor skills in various dental specialties, such as restorative dentistry, pediatric, prosthodontics, periodontics, implantology, and dental surgery, after haptic training. Haptic technologies were perceived well by all participants, with encouraging data regarding their ability to differentiate users according to their initial level of manual dexterity.

CONCLUSIONS: Our work suggests that haptic simulators can significantly improve motor skill acquisition in preclinical dental training. This new digital technology, which was well perceived by the participants, also showed encouraging results in discriminating users according to their level of experience.

PMID:38044266 | DOI:10.1002/jdd.13426

Br J Oral Maxillofac Surg. 2023 Oct 26:S0266-4356(23)00523-5. doi: 10.1016/j.bjoms.2023.10.013. Online ahead of print.

ABSTRACT

Postoperative neck infection (PONI) is a known complication of neck dissection. In this study we explored the impact of dental status on the development of PONI, using orthopantomograms to assess edentulism, periodontal health, and caries status. Retrospective analysis was performed for all new oral cancer patients who had neck dissection between January 2008 and January 2020 in a tertiary head and neck centre. PONI risk factors assessed included patient characteristics, dental status, tumour, and surgical factors. Development of PONI was the primary outcome. Edentulous patients had lower risk of PONI (OR 0.06, p = 0.026) compared to those with 21 or more teeth. Periodontitis and dental caries were not statistically significant. Current smokers (OR 2.09, p = 0.044) and free flap reconstruction (OR 5.41, p < 0.001) were also significant predictors for development of PONI. This study highlights the presence of teeth as a potential source of infection post neck dissection and that orthopantomogram assessment may be inadequate to identify at risk patients. Future studies are required on direct clinical assessment of dentition to evaluate the impact of dental optimisation in prevention of PONI.

PMID:38044253 | DOI:10.1016/j.bjoms.2023.10.013

Vaccine. 2023 Dec 2:S0264-410X(23)01419-6. doi: 10.1016/j.vaccine.2023.11.055. Online ahead of print.

ABSTRACT

BACKGROUND: HPV vaccination prevents cancers, including 90% of cervical cancer. Since 2008, a school-based HPV vaccination program has been implemented in Quebec, but vaccine coverage is suboptimal. The COVID-19 pandemic disrupted school-based vaccination programs. This study aimed to assess variation in HPV vaccination coverage in the school-based program between 2015 and 2022 in Quebec and to identify sociodemographic characteristics associated with non-vaccination.

METHODS: HPV vaccine coverage data were extracted from the Quebec Immunization Registry for students in Grade 4 and matched to the 2016 Canadian census sociodemographic data. Descriptive analysis was conducted to explore individual-level vaccine coverage according to sociodemographic data. A Generalized Estimating Equations model assessed the independent association between non-vaccination and students’ sociodemographic characteristics.

RESULTS: HPV vaccine coverage (at least one dose) was 84% in 2018-2019 and 85% in 2019-2020. A decrease was observed during the pandemic. In 2020-2021, the HPV vaccine coverage (at least one dose) was 52% (at the end of the school year) and rose to 84% with intense catch-up activities. In 2021-2022, the coverage was slightly lower than before the pandemic (81%). Factors in the dissemination area were statistically significantly associated with non-vaccination: material (p-value = 0.0001) and social deprivation index (p-value = 0.0048), the proportion of immigration (p-value < 0.0001), and the language spoken at home (English (p-value = 0.0318), other than French or English (p-value = 0.0001).

CONCLUSION: School-based vaccination programs offer equitable access to vaccination, and our analysis showed that some groups have consistently lower vaccine acceptance and uptake. Strategies to improve HPV vaccine coverage should target children living in areas with a higher proportion of immigrants, non-French speakers, and people from underprivileged backgrounds. Although it is too early to assess the full impact of COVID-19 on school-based programs in Quebec, it remains important to ensure that catch-up strategies are implemented for missed doses.

PMID:38044245 | DOI:10.1016/j.vaccine.2023.11.055

Vaccine. 2023 Dec 2:S0264-410X(23)01399-3. doi: 10.1016/j.vaccine.2023.11.053. Online ahead of print.

ABSTRACT

BACKGROUND: To address the lack of an active vaccine safety surveillance system in Japan, the Vaccine Effectiveness, Networking, and Universal Safety (VENUS) study was initiated in 2021 as a pilot system using existing health insurance claims data and vaccination records.

METHODS: This study evaluated the value of the VENUS study by assessing the incidence of immune thrombocytopenic purpura (ITP) and Guillain-Barré syndrome (GBS) following vaccination with the 23-valent pneumococcal polysaccharide vaccine (PPSV23) using a self-controlled case series (SCCS) design.

RESULTS: Incidence rate ratios for ITP during 28-day and 42-day risk periods were 0.89 (95% confidence interval [CI], 0.12-6.4), and 0.58 (95% CI, 0.081-4.2), respectively. Neither was statistically significant. Incidence rate ratios could not be estimated for GBS due to the limited sample size.

CONCLUSION: The VENUS study can provide valuable insights to facilitate the establishment of an advanced vaccine monitoring system in Japan.

PMID:38044244 | DOI:10.1016/j.vaccine.2023.11.053

Surgeon. 2023 Dec 2:S1479-666X(23)00136-1. doi: 10.1016/j.surge.2023.11.003. Online ahead of print.

ABSTRACT

BACKGROUND: Readmissions following colorectal surgery (CRS) have negative clinical, psychological and financial implications. Identifying patients at risk of readmission remains challenging.

AIMS: To determine factors predictive of those likely to require readmission at 40-days following major CRS and to identify novel strategies capable of reducing readmissions.

METHODS: Consecutive patients were studied from a prospectively maintained database. All patients were operated on by a single surgeon in a high-volume centre. Where applicable, photography was recorded by patients and emailed directly to the institutional email of the consultant surgeon. Data was recorded and analysed using descriptive statistics.

RESULTS: 515 patients were included over a 15-year period (2007-2022). The mean age at surgery was 64 years (18-93). The majority of patients were male (56.9%, n=293) and underwent cancer surgery (58.2%, n=299). Overall, 55 patients were readmitted within 40 days of major CRS (10.7%). Patients with pre-treatment diagnoses of heart failure (P=0.012), ischemic heart disease (P=0.002), renal impairment (P<0.001), atrial fibrillation (P=0.006), hypercholesterolemia (P=0.001), asthma (P=0.013) and hypertension (P=0.001) were more likely to require readmission. The majority of patients were readmitted for definitive management of surgical site issues (SSIs) (43.7% n=24). Other reasons included bowel obstruction (9.1%, n=5), pelvic sepsis (7.3%, n=4) and gastrointestinal upset (7.3%, n=4).

CONCLUSION: This series demonstrated that patients with cardiopulmonary comorbidities were more likely to be readmitted following major CRS and most readmissions are SSI related. Readmissions for SSIs can be reduced by patients sending photography to the treating surgeon which could reduce readmissions and A&E attendances.

PMID:38044235 | DOI:10.1016/j.surge.2023.11.003

Schizophr Res. 2023 Dec 2:S0920-9964(23)00423-1. doi: 10.1016/j.schres.2023.11.011. Online ahead of print.

ABSTRACT

BACKGROUND: Previous longitudinal magnetic resonance imaging studies have shown progressive gray matter (GM) reduction during the earliest phases of schizophrenia. It is unknown whether these progressive processes are homogeneous in all groups of patients. One way to obtain more valid findings is to focus on the symptoms. Auditory hallucinations (AHs) are frequent and reliable symptoms of psychosis. The present study aims to analyze whether longitudinal changes in structural abnormalities in cortical regions are related to the presence of AHs and the intensity of psychotic symptoms in a large sample.

METHODS: A Magnetic Resonance (MR) voxel-based morphometry analysis was applied to a group of 128 first episodes psychosis (FEP) patients (63 patients with AHs and 65 patients without AHs) and 78 matched healthy controls at baseline and at a 2-year follow-up.

RESULTS: At baseline, FEP patients exhibited significant GM volume reductions in the temporal, frontal and precentral regions. At follow-up, FEP patients exhibited GM volume changes in the temporal, Rolandic, frontal, precentral and insula regions. At baseline, no significant differences were found between FEP patients with and without AHs. At follow-up, while FEP patients with AHs showed less GM volume in temporal and frontal lobes, non-AH FEP patients showed reductions in the frontal, precentral and fusiform areas. PANSS scores showed statistically significant correlations with GM volume reductions at baseline and follow-up.

CONCLUSIONS: Brain cortical loss in the early phases of psychosis is not associated with potentially transitory AHs; however, brain structural changes may emerge as AHs appear in chronic patients.

PMID:38044223 | DOI:10.1016/j.schres.2023.11.011

Int Dent J. 2023 Dec 2:S0020-6539(23)00964-4. doi: 10.1016/j.identj.2023.10.020. Online ahead of print.

ABSTRACT

BACKGROUND: Dental sleep medicine education (DSME) should be emphasised in postgraduate orthodontic training; however, there appears to be no clear guideline for its implementation into the curriculum.

OBJECTIVE: The aim was to investigate the current status of DSME as well as its feasibility and implementation in postgraduate orthodontic programmes.

METHODS: A structured interview with predetermined response options was chosen as a data collection method to gather relevant information from representatives of all accredited postgraduate orthodontic programmes in Thailand. These interviews were conducted online via the Cisco Webex Meeting platform. A combination of data analysis techniques was employed to achieve a thorough comprehension of the research findings, including descriptive statistics, quantitative content analysis, thematic analysis, and alignment analysis.

RESULTS: All participating programmes reported the inclusion of DSME in their curricula. A didactic approach was adopted by all programmes. However, only 2 out of 7 programmes offered clinical sessions for their students. Several challenges in implementing DSME within orthodontic programmes were identified, including a shortage of expertise and limited patient access. The participants also suggested that knowledge and resource sharing amongst institutions could serve as a potential solution to enhance the feasibility of DSME.

CONCLUSIONS: This research highlighted the significant disparities and inadequacy of DSME within postgraduate orthodontic programmes in Thailand due to various challenges. Consequently, there is a compelling need to place greater emphasis on DSME and establish a national-level standardisation within orthodontic programmes. This effort is essential for enhancing the awareness and competency of orthodontists in the field of DSME.

PMID:38044215 | DOI:10.1016/j.identj.2023.10.020

J Formos Med Assoc. 2023 Dec 2:S0929-6646(23)00439-4. doi: 10.1016/j.jfma.2023.10.021. Online ahead of print.

ABSTRACT

BACKGROUND: Alzheimer’s disease (AD) is complicated by multiple environmental and polygenetic factors. The accuracy of artificial neural networks (ANNs) incorporating the common factors for identifying AD has not been evaluated.

METHODS: A total of 184 probable AD patients and 3773 healthy individuals aged 65 and over were enrolled. AD-related genes (51 SNPs) and 8 environmental factors were selected as features for multilayer ANN modeling. Random Forest (RF) and Support Vector Machine with RBF kernel (SVM) were also employed for comparison. Model results were verified using traditional statistics.

RESULTS: The ANN achieved high accuracy (0.98), sensitivity (0.95), and specificity (0.96) in the intrinsic test for AD classification. Excluding age and genetic data still yielded favorable results (accuracy: 0.97, sensitivity: 0.94, specificity: 0.96). The assigned weights to ANN features highlighted the importance of mental evaluation, years of education, and specific genetic variations (CASS4 rs7274581, PICALM rs3851179, and TOMM40 rs2075650) for AD classification. Receiver operating characteristic analysis revealed AUC values of 0.99 (intrinsic test), 0.60 (TWB-GWA), and 0.72 (CG-WGS), with slightly lower AUC values (0.96, 0.80, 0.52) when excluding age in ANN. The performance of the ANN model in AD classification was comparable to RF, SVM (linear kernel), and SVM (RBF kernel).

CONCLUSIONS: The ANN model demonstrated good sensitivity, specificity, and accuracy in AD classification. The top-weighted SNPs for AD prediction were CASS4 rs7274581, PICALM rs3851179, and TOMM40 rs2075650. The ANN model performed similarly to RF and SVM, indicating its capability to handle the complexity of AD as a disease entity.

PMID:38044212 | DOI:10.1016/j.jfma.2023.10.021