Category: Nevin Manimala

JCO Oncol Pract. 2023 May 22:OP2200721. doi: 10.1200/OP.22.00721. Online ahead of print.

ABSTRACT

PURPOSE: Acute care events (ACEs), comprising emergency department visits and hospitalizations, are a priority area for reduction in oncology. Prognostic models are a compelling strategy to identify high-risk patients and target preventive services, but have yet to be broadly implemented, partly because of challenges with electronic health record (EHR) integration. To facilitate EHR integration, we adapted and validated the previously published PRediction Of Acute Care use during Cancer Treatment (PROACCT) model to identify patients at highest risk for ACEs after systemic anticancer treatment.

METHODS: A retrospective cohort of adults with a cancer diagnosis starting systemic therapy at a single center between July and November 2021 was divided into development (70%) and validation (30%) sets. Clinical and demographic variables were extracted, limited to those in structured format in the EHR, including cancer diagnosis, age, drug category, and ACE in prior year. Three logistic regression models of increasing complexity were developed to predict risk of ACEs.

RESULTS: Five thousand one hundred fifty-three patients were evaluated (3,603 development and 1,550 validation). Several factors were predictive of ACEs: age (in decades), receipt of cytotoxic chemotherapy or immunotherapy, thoracic, GI or hematologic malignancy, and ACE in the prior year. We defined high-risk as the top 10% of risk scores; this population had 33.6% ACE rate compared with 8.3% for the remaining 90% in the low-risk group. The simplest Adapted PROACCT model had a C-statistic of 0.79, sensitivity of 0.28, and specificity of 0.93.

CONCLUSION: We present three models designed for EHR integration that effectively identify oncology patients at highest risk for ACE after initiation of systemic anticancer treatment. By limiting predictors to structured data fields and including all cancer types, these models offer broad applicability for cancer care organizations and may offer a safety net to identify and target resources to this high risk.

PMID:37216627 | DOI:10.1200/OP.22.00721

AIDS Care. 2023 May 22:1-8. doi: 10.1080/09540121.2023.2215529. Online ahead of print.

ABSTRACT

HIV/AIDS prevalence in sub-Saharan Africa remains an issue of concern and young women are disproportionately affected by the disease. Premarital HIV testing is one of the key strategies used in HIV prevention since heterosexual sex remains the primary mode of HIV transmission in sub-Saharan Africa. This study uses the 2016 Ethiopia Demographic and Health Survey to examine the association between premarital HIV testing and the ability to negotiate sexual relations among married women aged 15 to 49 years (N = 3,672). Women’s ability to negotiate sexual relations was measured using two variables: the ability to refuse sex and the ability to ask for a condom during intercourse. Descriptive statistics, bivariate, and multiple logistic regression analyses were performed. Only 24.1% of the women had premarital HIV testing. Approximately 46.5% and 32.3% of women reported that they could refuse sexual intercourse and ask their partner to use a condom, respectively. In the multivariable model, having a premarital HIV test was positively associated with the ability to refuse sex odds ratio (95% confidence interval) 1.82 (1.38, 2.41; p < 0.001) and the ability to ask for a condom 2.30 (1.55, 3.41; p < 0.001). Premarital HIV testing can improve women’s sexual negotiation ability and possibly prevent future HIV infection.

PMID:37216612 | DOI:10.1080/09540121.2023.2215529

Am J Gastroenterol. 2023 May 22. doi: 10.14309/ajg.0000000000002334. Online ahead of print.

ABSTRACT

BACKGROUND: /Aims-Chronic isolated terminal ileitis(TI) may be seen in Crohn’s disease(CD) and Intestinal tuberculosis(ITB) in addition to other etiologies that may be managed symptomatically. We developed a revised algorithm to distinguish patients with a specific etiology from a non specific etiology.

METHODS: Patients with chronic isolated TI following-up from 2007 to 2022 were retrospectively reviewed. A specific(ITB or CD) diagnosis was made based on standardized criteria and other relevant data was collected. Using this cohort, validation of a previously suggested algorithm was conducted. Further, based on the results of a univariate analysis, a multivariate analysis with bootstrap validation was used to develop a revised algorithm.

RESULTS: We included 153 patients(mean age-36.9+14.6 years, males-70%, median duration-1.5 years, range:0-56 years) with chronic isolated TI of whom 109(71.2%) received a specific diagnosis(CD-69, ITB-40). On multivariate regression and validation statistics with a combination of clinical, laboratory, radiological and colonoscopic findings, an optimism corrected c-statistic of 0.975 and 0.958 was obtained with and without histopathological findings respectively. Revised algorithm, based on these, showed a sensitivity, specificity, positive and negative predictive value, and overall accuracy of 98.2%(95%CI:93.5 – 99.8), 75.0%(95%CI:59.7 – 86.8), 90.7%(95%CI:85.4 – 94.2), 94.3%(95%CI:80.5 – 98.5) and 91.5%(95%CI:85.9 – 95.4), respectively. This was more sensitive and specific than the previous algorithm(accuracy 83.9%, sensitivity 95.5%, and specificity 54.6%).

CONCLUSION: We developed a revised algorithm and a multi-modality approach to stratify patients with chronic isolated TI into specific and non-specific etiologies with an excellent diagnostic accuracy which could potentially avoid missed diagnosis and unnecessary side effects of treatment.

PMID:37216605 | DOI:10.14309/ajg.0000000000002334

Mycologia. 2023 May 22:1-19. doi: 10.1080/00275514.2023.2205331. Online ahead of print.

ABSTRACT

Optimization of xylanase and cellulase production by a newly isolated Aspergillus fumigatus strain grown on Stipa tenacissima (alfa grass) biomass without pretreatment was carried out using a Box-Behnken design. First, the polysaccharides of dried and ground alfa grass were characterized using chemical methods (strong and diluted acid). The effect of substrate particle size on xylanase and carboxymethylcellulase (CMCase) production by the selected and identified strain was then investigated. Thereafter, experiments were statistically planned with a Box-Behnken design to optimize initial pH, cultivation temperature, moisture content, and incubation period using alfa as sole carbon source. The effect of these parameters on the two enzyme production was evaluated using the response surface method. Analysis of variance was also carried out, and production of the enzymes was expressed using a mathematical equation depending on the influencing factors. The effects of individual, interaction, and square terms on production of both enzymes were represented using the nonlinear regression equations with significant R² and P-values. Xylanase and CMCase production levels were enhanced by 25% and 27%, respectively. Thus, this study demonstrated for the first time the potential of alfa as a raw material to produce enzymes without any pretreatment. A set of parameter combinations was found to be effective for the production of xylanase and CMCase by A. fumigatus in an alfa-based solid-state fermentation.

PMID:37216583 | DOI:10.1080/00275514.2023.2205331

Orthopedics. 2023 May 23:1-6. doi: 10.3928/01477447-20230517-05. Online ahead of print.

ABSTRACT

This study investigated predictive factors for return to play among National Football League athletes after operative treatment of ankle fractures and the impacts of these injuries on career longevity and player performance. Athletes who underwent surgery to repair ankle fractures from the 2013 to 2017 seasons were identified from injury reserve lists and press releases. Demographics and season metrics were collected before and after the injury. Statistical analysis assessed for differences in recorded variables between injured and uninjured players. Thirty-one players met study inclusion criteria. Twenty-two (71%) athletes successfully returned to play. Players who did not return showed no significant differences (P>.05) in position, age, body mass index, number of games or seasons played preinjury, or snaps per game the season prior to injury and had a significantly lower (42.6%, P=.013) preinjury season approximate value (SAV) compared with returning players. Returning athletes showed no significant differences (P>.05) in SAV or snaps per game compared with their preinjury season or with uninjured controls. A high preinjury SAV is associated with successful return to play. No difference in game time or performance metrics was detectable between returning players and uninjured controls, or between preinjury and postinjury seasons. [Orthopedics. 202x;4x(x):xx-xx.].

PMID:37216567 | DOI:10.3928/01477447-20230517-05

Proc Natl Acad Sci U S A. 2023 May 30;120(22):e2211432120. doi: 10.1073/pnas.2211432120. Epub 2023 May 22.

ABSTRACT

The rapid melting of Arctic sea ice is the largest and clearest signal of anthropogenic climate change. Current projections indicate that the first ice-free Arctic summer will likely occur by mid-century, owing to increasing carbon dioxide concentrations in the atmosphere. However, other powerful greenhouse gases have also contributed to Arctic sea ice loss, notably ozone-depleting substances (ODSs). In the late 1980s, ODSs became strictly regulated by the Montreal Protocol, and their atmospheric concentrations have been declining since the mid-1990s. Here, analyzing new climate model simulations, we demonstrate that the Montreal Protocol, designed to protect the ozone layer, is delaying the first appearance of an ice-free Arctic summer, by up to 15 y, depending on future emissions. We also show that this important climate mitigation stems entirely from the reduced greenhouse gas warming from the regulated ODSs, with the avoided stratospheric ozone losses playing no role. Finally, we estimate that each Gg of averted ODS emissions results in approximately 7 km² of avoided Arctic sea ice loss.

PMID:37216559 | DOI:10.1073/pnas.2211432120

Proc Natl Acad Sci U S A. 2023 May 30;120(22):e2221887120. doi: 10.1073/pnas.2221887120. Epub 2023 May 22.

ABSTRACT

Estimating the differences in the incubation-period, serial-interval, and generation-interval distributions of SARS-CoV-2 variants is critical to understanding their transmission. However, the impact of epidemic dynamics is often neglected in estimating the timing of infection-for example, when an epidemic is growing exponentially, a cohort of infected individuals who developed symptoms at the same time are more likely to have been infected recently. Here, we reanalyze incubation-period and serial-interval data describing transmissions of the Delta and Omicron variants from the Netherlands at the end of December 2021. Previous analysis of the same dataset reported shorter mean observed incubation period (3.2 d vs. 4.4 d) and serial interval (3.5 d vs. 4.1 d) for the Omicron variant, but the number of infections caused by the Delta variant decreased during this period as the number of Omicron infections increased. When we account for growth-rate differences of two variants during the study period, we estimate similar mean incubation periods (3.8 to 4.5 d) for both variants but a shorter mean generation interval for the Omicron variant (3.0 d; 95% CI: 2.7 to 3.2 d) than for the Delta variant (3.8 d; 95% CI: 3.7 to 4.0 d). The differences in estimated generation intervals may be driven by the “network effect”-higher effective transmissibility of the Omicron variant can cause faster susceptible depletion among contact networks, which in turn prevents late transmission (therefore shortening realized generation intervals). Using up-to-date generation-interval distributions is critical to accurately estimating the reproduction advantage of the Omicron variant.

PMID:37216529 | DOI:10.1073/pnas.2221887120

Proc Natl Acad Sci U S A. 2023 May 30;120(22):e2301145120. doi: 10.1073/pnas.2301145120. Epub 2023 May 22.

ABSTRACT

Airborne respiratory aerosol particle transmission of pathogens such as severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), influenza, or rhinoviruses plays a major role in the spread of infectious diseases. The infection risk is increased during indoor exercise, as aerosol particle emission can increase by more than 100-fold from rest to maximal exercise. Earlier studies have investigated the effect of factors such as age, sex, and body mass index (BMI), but only at rest and without taking ventilation into account. Here, we report that during both rest and exercise, subjects aged 60 to 76 y emit on average more than twice as many aerosol particles per minute than subjects aged 20 to 39 y. In terms of volume, older subjects emit on average five times as much dry volume (i.e., the residue of dried aerosol particles) than younger subjects. There was no statistically significant effect of sex or BMI within the test group. Together, this suggests that aging of the lung and respiratory tract is associated with an increased generation of aerosol particles irrespective of ventilation. Our findings demonstrate that age and exercise increase aerosol particle emission. In contrast, sex or BMI only have minor effects.

PMID:37216504 | DOI:10.1073/pnas.2301145120

Cureus. 2023 Apr 19;15(4):e37856. doi: 10.7759/cureus.37856. eCollection 2023 Apr.

ABSTRACT

Objective Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterized by impaired levels of inattention, disorganization and/or hyperactivity-impulsivity. The aim of this study was to estimate the prevalence of ADHD among primary school children in Jordan and assess the potential risk factors. Method A cross-sectional study was conducted in 2022-2023 on 1563 school children aged six to 12 years. ADHD was assessed using parent and teacher versions of the Conners Rating scale. Risk factors were evaluated through a sociodemographic questionnaire. A p-value set at <.05 was considered statistically significant. Results ADHD prevalence based on parents’ and teachers’ perspectives was 27.7% and 22.5%, respectively. Males, smoking during pregnancy, low birth weight, low parental education and unemployment, and public schools had increased ADHD rates. Conclusion ADHD presents a major problem among primary school children in Jordan. Early detection, prevention, and management of this disease require parents’ and teachers’ awareness and risk factor control.

PMID:37214023 | PMC:PMC10199271 | DOI:10.7759/cureus.37856

Cureus. 2023 Apr 18;15(4):e37765. doi: 10.7759/cureus.37765. eCollection 2023 Apr.

ABSTRACT

Introduction The use of dental implants provides a revolutionary solution to the problem of missing teeth in the oral cavity. The aim of this study was to assess the early implant survival rate in relation to implant diameter and site of placement. Methods The data were collected from 186 patients treated between January 2019 and June 2021. All the implants were evaluated and restored after three months of implant placement. The early implant survival was calculated for different implant diameters with the odds ratio (OR). Results A total of 373 implants were placed. Implants were placed in the following areas: upper posterior area (UPA), n = 123, upper anterior area (UAA), n = 49, lower posterior area (LPA), n = 184, and lower anterior area (LAA), n = 17. Implants of the following diameters were placed: 3.5 mm (n = 129), 4.3 mm (n = 166), and 5 mm (n = 78). The overall early survival rate was 97.32% after three months of placement. The highest early survival rate was at LAA (100%) and the lowest early survival rate was at UAA (95.9%). The implants 5 mm in diameter had the highest early survival rate (98.72%), while the implants 3.5 mm in diameter had the lowest early survival rate (94.57%). The ORs of the early implant survival were 4.7 [95% confidence interval (CI): 0.96-23.05)] and 4.42 (95% CI: 0.53-36.61) for the 4.3 mm and 5 mm implants, respectively, with no statistical significance. Conclusions The implants placed in the oral cavity had acceptable survival rates regardless of implant diameter or site of placement.

PMID:37214022 | PMC:PMC10194036 | DOI:10.7759/cureus.37765