Category: Nevin Manimala

Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi. 2023 Jun 28;35(3):225-235. doi: 10.16250/j.32.1374.2022290.

ABSTRACT

OBJECTIVE: To create risk predictive models of healthcare-seeking delay among imported malaria patients in Jiangsu Province based on machine learning algorithms, so as to provide insights into early identification of imported malaria cases in Jiangsu Province.

METHODS: Case investigation, first symptoms and time of initial diagnosis of imported malaria patients in Jiangsu Province in 2019 were captured from Infectious Disease Report Information Management System and Parasitic Disease Prevention and Control Information Management System of Chinese Center for Disease Control and Prevention. The risk predictive models of healthcare-seeking delay among imported malaria patients were created with the back propagation (BP) neural network model, logistic regression model, random forest model and Bayesian model using thirteen factors as independent variables, including occupation, species of malaria parasite, main clinical manifestations, presence of complications, severity of disease, age, duration of residing abroad, frequency of malaria parasite infections abroad, incubation period, level of institution at initial diagnosis, country of origin, number of individuals travelling with patients and way to go abroad, and time of healthcare-seeking delay as a dependent variable. Logistic regression model was visualized using a nomogram, and the nomogram was evaluated using calibration curves. In addition, the efficiency of the four models for prediction of risk of healthcare-seeking delay among imported malaria patients was evaluated using the area under curve (AUC) of receiver operating characteristic curve (ROC). The importance of each characteristic was quantified and attributed by using SHAP to examine the positive and negative effects of the value of each characteristic on the predictive efficiency.

RESULTS: A total of 244 imported malaria patients were enrolled, including 100 cases (40.98%) with the duration from onset of first symptoms to time of initial diagnosis that exceeded 24 hours. Logistic regression analysis identified a history of malaria parasite infection [odds ratio (OR) = 3.075, 95% confidential interval (CI): (1.597, 5.923)], long incubation period [OR = 1.010, 95% CI: (1.001, 1.018)] and seeking healthcare in provincial or municipal medical facilities [OR = 12.550, 95% CI: (1.158, 135.963)] as risk factors for delay in seeking healthcare among imported malaria cases. BP neural network modeling showed that duration of residing abroad, incubation period and age posed great impacts on delay in healthcare-seek among imported malaria patients. Random forest modeling showed that the top five factors with the greatest impact on healthcare-seeking delay included main clinical manifestations, the way to go abroad, incubation period, duration of residing abroad and age among imported malaria patients, and Bayesian modeling revealed that the top five factors affecting healthcare-seeking delay among imported malaria patients included level of institutions at initial diagnosis, age, country of origin, history of malaria parasite infection and individuals travelling with imported malaria patients. ROC curve analysis showed higher overall performance of the BP neural network model and the logistic regression model for prediction of the risk of healthcare-seeking delay among imported malaria patients (Z = 2.700 to 4.641, all P values < 0.01), with no statistically significant difference in the AUC among four models (Z = 1.209, P > 0.05). The sensitivity (71.00%) and Youden index (43.92%) of the logistic regression model was higher than those of the BP neural network (63.00% and 36.61%, respectively), and the specificity of the BP neural network model (73.61%) was higher than that of the logistic regression model (72.92%).

CONCLUSIONS: Imported malaria cases with long duration of residing abroad, a history of malaria parasite infection, long incubation period, advanced age and seeking healthcare in provincial or municipal medical institutions have a high likelihood of delay in healthcare-seeking in Jiangsu Province. The models created based on the logistic regression and BP neural network show a high efficiency for prediction of the risk of healthcare-seeking among imported malaria patients in Jiangsu Province, which may provide insights into health management of imported malaria patients.

PMID:37455092 | DOI:10.16250/j.32.1374.2022290

Int Wound J. 2023 Jul 16. doi: 10.1111/iwj.14305. Online ahead of print.

ABSTRACT

The present study investigated the antimicrobial and anti-biofilm effects of indigenous Lactobacillus probiotic strains on Pseudomonas aeruginosa isolated from burn wound infection in laboratory conditions. The effect of 7 probiotic strains isolated from infant faeces on the pathogenicity factors of P. aeruginosa, including protease, elastase, antibiofilm and antipyocyanin was measured. Also, diffusion methods in the well and micro broth dilution were used to evaluate the antimicrobial activity of probiotics. All tests were performed in triplicate. A negative control and a positive control were used for each test. SPSS version 22 software was used for statistical analysis, and a p < 0.05 was considered statistically significant. A total of 30 clinical isolates of P. aeruginosa were isolated. The elastolytic activity of P. aeruginosa isolates decreased after adding Cell free supernatant (CFS) of each Lactobacillus. L1, L4, L5, and L6 strains had a 100% inhibitory effect on pathogen isolates. L3 and L7 strains had the lowest inhibitory effect. The inhibitory effect of CFS extracted from lactobacilli on protease production by P. aeruginosa. L1, L4, L5, and L6 strains had an inhibitory effect on all tested isolates. L2, L3, and L7 strains had a less inhibitory effect. L4 strain had the highest inhibitory effect on pyocyanin production by P. aeruginosa (50%), followed by L5 (43.3%), L1 (40%), and L6 (23.3%) strains. L3 and L7 strains had no inhibitory effect on the pyocyanin production of P. aeruginosa isolates. It was found that the CFS of 4 isolates (L1, L4, L5, and L6) was the most active extract and had a 100% inhibitory effect against biofilm formation of all P. aeruginosa strains. The L3 strain had the least inhibitory effect against the biofilm formation of pathogens. Overall, this study showed that probiotics could be promising alternatives to combat the pathogenicity of P. aeruginosa in burn wounds.

PMID:37455022 | DOI:10.1111/iwj.14305

Chemosphere. 2023 Jul 14:139510. doi: 10.1016/j.chemosphere.2023.139510. Online ahead of print.

ABSTRACT

This study utilizes artificial intelligence and statistical modelling to optimize the operating parameters of a carbon-based electro-Fenton process for purifying model dye (RB19)-contaminated wastewater. Multilevel experimental Box-Behken and uniform deisgns (BBD, UD) with four variables were analysed using polynomial regression analysis (PRA) and artificial neural networks (ANN), while the process optimisation was done using desirability function. For the given testing range but different design matrices and runs, both designs predicted a maximum RB19 removal (RB19-RR) of 90 ± 2.1% at lowest energy consumption (EC) of 0.44 ± 2.5 Wh, when voltage, Na₂SO₄, FeSO₄, and time were maintained as follows: 4-5.3 V, 7-11 mM, 0.4-0.6 mM, and 35-40 min, respectively. All the design-model combinations portrayed the similar senitivity analysis revealing that RB19 degradation and EC are primarily influenced by electrolysis time and voltage. The performance assessment demonstrated that all the design-model combinations also excellently predicted for unseen conditions as the maximum root mean squared error (RMSE) value for RB19-RR was 4.07, while it was 0.072 for EC, however, BBD-ANN performance proved to be slightly better than others. Having ∼57% less experimentation, UD based models managed to accurately predict the results for unseen conditions as the statistical errors were quite insignificant, even in some cases, RMSE found to be less for UD compared to BBD elucidating the potential of uniform design as an alternative of conventional factorial designs. Nevertheless, the prediction accuracy is also dependent on modelling approach, as in some cases ANN failed to predict the response precisely specially when dealing with small data. Furthermore, techno-economic evaluation results spell out the efficacy of carbon felt based enhanced electro-Fenton process as promising environmental remediation technology and highlight its practical implication from view of operational cost.

PMID:37454991 | DOI:10.1016/j.chemosphere.2023.139510

J Vasc Surg. 2023 Jul 14:S0741-5214(23)01613-0. doi: 10.1016/j.jvs.2023.07.004. Online ahead of print.

ABSTRACT

OBJECTIVE: This study characterizes racial differences in presentation, as well as short- and long-term outcomes following endovascular treatment of thoracic aortic aneurysm (TAA) and type B aortic dissection (TBAD).

METHODS: We queried the Gore Global Registry for Endovascular Aortic Treatment (GREAT) for thoracic endovascular aortic repairs (TEVARs) performed between 2010-2016 and followed through 2022. Pathologies represented were descending TAA, complicated TBAD, and uncomplicated TBAD. Using standard statistical tests, we compared overall and pathology-specific demographics, procedural factors, and outcomes among Black and White patients undergoing TEVAR.

RESULTS: We identified 438 TEVAR cases, including 236 descending TAA, 121 complicated TBAD, and 74 uncomplicated TBAD. Overall, Black patients were younger and had higher incidence of renal insufficiency (P=.001), whereas White patients had more chronic obstructive pulmonary disease (P=.003) and cardiac arrhythmias (P=.037). In patients treated for descending TAA, Black patients had increased device/procedure-related complications (34.3% vs 17.4%, P=.014), conversion to open repair (2.9% vs 0%, P=.011) and type II endoleak (5.7% vs 1.0%, P=.040) but no differences in mortality, length of hospital stay, or major adverse cardiovascular events. Whereas outcomes of TEVAR for uncomplicated TBAD were comparable, Black patients more frequently presented with complicated TBAD than White patients (Black: 40.5% vs White: 24.8%, P=.008) and had subsequently greater reintervention rate (28.1% vs 12.4%, P=.012), all-cause mortality (HR 4.28, 95% CI 1.74-10.5, P=.002) and aortic-related mortality (HR 16.7, 95% CI 1.49-186, P=.022).

CONCLUSION: Despite increased device- and procedure-related complications, similar short and long-term outcomes are achieved in Black and White patients undergoing TEVAR for descending TAA and uncomplicated TBAD. However, Black patients are more likely to present with, require reintervention, and suffer mortality from complicated TBAD.

PMID:37454953 | DOI:10.1016/j.jvs.2023.07.004

J Arthroplasty. 2023 Jul 14:S0883-5403(23)00743-X. doi: 10.1016/j.arth.2023.07.006. Online ahead of print.

ABSTRACT

BACKGROUND: Hemiarthroplasty (HA) for hip fractures can be performed with an unipolar or bipolar head.We describe the use of unipolar and bipolar HA after a hip fracture in the Netherlands and determined revision rates and risk factors.

METHODS: All HAs for an acute hip fracture registered in the Dutch Arthroplasty Register (LROI) during 2007 to 2021 were included; 44,127(88%) unipolar and 6,013(12%) bipolar HA. Competing risk survival analyses were performed with revision for any reason as endpoint. Multivariable Cox regression analyses were performed adjusted for patient and surgery related factors.

RESULTS: The 1, 5, and 10 year revision rates were comparable for unipolar and bipolar HA. Cox regression analysis showed a Hazard Ratio of 1.2 (95% confidence interval (CI) 1.0 to 1.4)) after adjustment for confounders for bipolar heads. In cases of a cemented stem the 1-year cumulative incidence of revision was lower (1.5% (CI 1.4 to 1.7%) compared to uncemented stems (2.4% (CI 2.1 to 2.7%); uncemented stems showed higher risks for revision after adjustment compared to cemented stems (HR1.4 (CI 1.2 to 1.5)). The anterior, antero-lateral and straight-lateral approach showed lower risk for revision compared to the postero-lateral approach.

CONCLUSION: The revision rate for bipolar HA and unipolar HA was comparable. However, after adjustment for potential confounders the risk for revision showed an estimated 20% increased revision risk for bipolar heads, although not statistically significant. For both head types, the risk for revision was significantly higher when an uncemented stem was chosen or the postero-lateral approach was used.

PMID:37454950 | DOI:10.1016/j.arth.2023.07.006

Am J Med Sci. 2023 Jul 14:S0002-9629(23)01256-9. doi: 10.1016/j.amjms.2023.07.002. Online ahead of print.

ABSTRACT

BACKGROUND: Sleep disturbances in patients with end-stage renal disease (ESRD) are common and more prevalent than in the general population. This study aims to assess the demographic and clinical risk factors for the diagnosis of sleep disorders in ESRD patients.

METHODS: This study is a retrospective analysis of the United States Renal Data System (USRDS) to evaluate risk factors for the diagnosis of sleep disorders, including hypersomnolence, insomnia, restless leg syndrome (RLS), or obstructive or central sleep apnea (OSA/CSA). All ESRD subjects enrolled in the USRDS between 2004-2015 were eligible for inclusion. The risk factors analyzed were age, race, sex, ethnicity, access type, dialysis modality, and the Charlson Comorbidity Index (CCI). All statistical analysis was performed using SAS 9.4, and statistical significance was assessed using an alpha level of 0.05. Descriptive statistics on all variables overall and by each sleep diagnosis were determined.

RESULTS: Increasing age, black race, other race, and Hispanic ethnicity were associated with decreased risk of each sleep diagnosis while CCI was associated with increased risk. Females were at increased risk of RLS and insomnia while males were at increased risk of OSA/CSA. Catheter and graft access decreased risk of RLS but increased risk of insomnia compared to AVF access. Catheter access increased risk of OSA/CSA compared to graft access. Hemodialysis increased risk of OSA/CSA compared to peritoneal dialysis.

CONCLUSIONS: Some ESRD patients are at an increased risk for diagnosis of sleep disorders based on age, race, sex, comorbid health conditions, and dialysis modality.

PMID:37454928 | DOI:10.1016/j.amjms.2023.07.002

Exp Parasitol. 2023 Jul 14:108587. doi: 10.1016/j.exppara.2023.108587. Online ahead of print.

ABSTRACT

Fasciola hepatica, the liver trematode, infects ruminants and causes economic loss. Because parasites are developing resistance to commercial drugs, the negative effects of parasitism are increasing. In this study, we aimed to evaluate the efficacy of cumin (Cuminum cyminum) essential oil against F. hepatica eggs and adults. The eggs were incubated with eight concentrations of the essential oil (0.031125-4.15 mg/mL), and viable eggs were counted after 14 days and classified as embryonated or non-embryonated. Adult flukes were incubated in Roswell Park Memorial Institute medium to ensure their viability and then incubated in essential oil. They were observed for 24 h after treatment. The adults were assessed with the two lowest effective oil concentrations used in the ovicidal test. Three controls were used for both tests: nitroxynil, a negative control, and Tween®80. After incubation in oil, the adult specimens were processed for histological analysis and stained with hematoxylin-eosin. In addition, the oil was tested for cytotoxicity using Madin-Darby bovine kidney cells to assess any possible effect on them. The oil was effective in ovicidal and adulticidal inhibition of the trematode, with statistically significant results. All concentrations assessed in the ovicidal test were 100% effective. The adult test was effective within 15 h and inactivated all the specimens at the highest concentration evaluated (0.06225 mg/mL). Histological analysis showed that cumin essential oil resulted in marked areas of vacuolization. The spines showed no structural changes but were surrounded by microvesicles. These findings indicated that cumin oil could be a potential compound in the control of fasciolosis.

PMID:37454922 | DOI:10.1016/j.exppara.2023.108587

Ann Vasc Surg. 2023 Jul 14:S0890-5096(23)00521-6. doi: 10.1016/j.avsg.2023.07.092. Online ahead of print.

ABSTRACT

INTRODUCTION: This study aimed to analyze the luminal changes in the iliocaval veins and their effects on the development of signs and symptoms of chronic venous disease manifesting from inferior vena cava filter placement.

METHODS: This was a retrospective observations study; deidentified patients with an Inferior Vena Cava (IVC) filter placed with subsequent luminal changes were included. All patients had a computerized tomography (CT) scan with or without ultrasound and those who underwent an intervention for the obstruction had also venography and intravascular ultrasound (IVUS). The diameter of IVC and iliac veins was measured from the near wall to the far wall. IVC diameters measured less than 12 mm were considered to be retractions. Signs and symptoms of chronic venous disease were obtained from patient charts and were reported according to the highest CEAP class. The data was analyzed using descriptive statistics, presenting diameter changes as a mean with standard deviation and a range of diameters included.

RESULTS: Overall, 76 patients were included in this study, of whom 66 had occlusion of the IVC or the Iliac veins. Luminal changes of the inferior vena cava were observed in all patients. A total of 58 patients presented with chronic post-thrombotic changes in both the inferior vena cava and iliac veins. There were 4 patients that had a luminal reduction with no filling defects or post-thrombotic changes. Average inferior vena cava diameter and iliac vein diameter was measured to be 8.3 ± 1.4 mm and 4.6 ± 1.4 mm, respectively. Patients most frequently presented with extremity swelling, but other signs such as venous ulceration or skin damage were observed.

CONCLUSION: Permanent luminal changes of the inferior vena cava and iliac veins were observed as a result of inferior vena cava filter placement and such patients commonly present with signs and symptoms of chronic venous disease. Together, with other known filter complications, these observations add more reasons for a timely retrieval. When such changes occur, patients’ appropriate symptoms can be successfully treated. The permanent changes made by filter placement in the IVC and iliac veins further support filter retrieval in a timely fashion. The luminal changes induced by filter placement should be recognized early, particularly in symptomatic patients who can be safely treated with endovenous procedures.

PMID:37454894 | DOI:10.1016/j.avsg.2023.07.092

Prev Med. 2023 Jul 14:107622. doi: 10.1016/j.ypmed.2023.107622. Online ahead of print.

ABSTRACT

We explored temporal trends and geographic variations in United States of America (US) mortality rates from smoking and firearms from 1999 to 2019. To do so, we used the publicly available Centers for Disease Control and Prevention (CDC) Wide Ranging Online Data for Epidemiologic Research (WONDER) with Multiple Cause of Death files from 1999 to 2019. Using age-specific rates and ArcGIS Pro Advanced software for Optimized Hot Spot Analyses from Esri, we generated maps of statistically significant spatial clusters with 90-99% confidence intervals with the Getis-Ord Gi* statistic for mortality from smoking-related causes and firearms. These data show temporal trends and geographic variations in mortality from smoking and firearms in the US. Smoking and firearm-related mortality from assault and suicide increased throughout the US and clustered in the Southeast. Firearm-related suicide also clustered in the continental West and Alaska. These descriptive data generate many hypotheses which are testable in analytic epidemiologic studies designed a priori to do so. The trends suggest smoking and firearm-related causes pose particular challenges to the Southeast and firearms also to the West and Alaska. These data may aid clinicians and public health authorities to implement evidence-based smoking avoidance and cessation programs as well as address firearm mortality, with particular attention to the areas of highest risks. As has been the case with cigarettes, individual behavior changes as well as societal changes are likely to be needed to achieve decreases in premature mortality.

PMID:37454875 | DOI:10.1016/j.ypmed.2023.107622

Plant Sci. 2023 Jul 14:111793. doi: 10.1016/j.plantsci.2023.111793. Online ahead of print.

ABSTRACT

Nutrient deficiencies considerably limit agricultural production worldwide. However, while single deficiencies are widely studied, combined deficiencies are poorly addressed. Hence, the aim of this paper was to study single and combined deficiencies of iron (Fe) and phosphorus (P) in barley (Hordeum vulgare) and tomato (Solanum lycopersicum). Plants were grown in hydroponics and root exudation was measured over the growing period. At harvest, root morphology and root and shoot ionome was assessed. Shoot-to-root-ratio decreased in both species and in all nutrient deficiencies, besides in -Fe tomato. Barley root growth was enhanced in plants subjected to double deficiency behaving similarly to -P, while tomato reduced root morphology parameters in all treatments. To cope with the nutrient deficiency barley exuded mostly chelants, while tomato relied on organic acids. Moreover, tomato exhibited a slight exudation increase over time not detected in barley. Overall, in none of the species the double deficiency caused a substantial increase in root exudation. Multivariate statistics emphasized that all the treatments were significantly different from each other in tomato, while in barley only -Fe was statistically different from the other treatments. Our findings highlight that the response of the studied plants in double deficiencies is not additive but plant specific.

PMID:37454818 | DOI:10.1016/j.plantsci.2023.111793