Category: Nevin Manimala

Scand J Trauma Resusc Emerg Med. 2023 Feb 5;31(1):6. doi: 10.1186/s13049-023-01070-4.

ABSTRACT

BACKGROUND: Diagnostic uncertainty in patients with dyspnea is associated with worse outcomes. We hypothesized that prehospital point-of-care ultrasound (POCUS) can improve diagnostic accuracy.

METHODS: Prospective observational study of adult patients suffering dyspnea. Prehospital critical care physicians registered a suspected diagnosis based on clinical examination alone, performed POCUS of the heart and lungs, and finally registered suspected diagnoses based on their clinical examination supplemented with POCUS. Pre- and post-POCUS diagnoses were compared to endpoint committee adjudicated diagnoses. The primary outcome was improved sensitivity for diagnosing acute heart failure. Secondary outcomes included other diagnostic accuracy measures in relation to acute heart failure and other causes of dyspnea.

RESULTS: In total, 214 patients were included. The diagnosis of acute heart failure was suspected in 64/214 (30%) of patients before POCUS and 64/214 (30%) patients after POCUS, but POCUS led to reclassification in 53/214 (25%) patients. The endpoint committee adjudicated the diagnosis of acute heart failure in 87/214 (41%) patients. The sensitivity for the diagnosis of acute heart failure was 58% (95% CI 46%-69%) before POCUS compared to 65% (95% CI 53%-75%) after POCUS (p = 0.12). ROC AUC for the diagnosis acute heart failure was 0.72 (95% CI 0.66-0.78) before POCUS compared to 0.79 (0.73-0.84) after POCUS (p < 0.001). ROC AUC for the diagnosis acute exacerbation (AE) of chronic obstructive pulmonary disease (COPD) or asthma was 0.87 (0.82-0.91) before POCUS and 0.93 (0.88-0.97) after POCUS (p < 0.001). A POCUS finding of any of severely reduced left ventricular function, bilateral B-lines or bilateral pleural effusion demonstrated the highest sensitivity for acute heart failure at 88% (95% CI 79%-94%), whereas the combination of all of these three findings yielded the highest specificity at 99% (95% CI 95%-100%).

CONCLUSION: Supplementary prehospital POCUS leads to an improvement of diagnostic accuracy of both heart failure and AE-COPD/-asthma overall described by ROC AUC, but the increase in sensitivity for the diagnoses of acute heart failure did not reach statistical significance. Tailored use of POCUS findings optimizes diagnostic accuracy for rule-out and rule-in of acute heart failure.

TRIAL REGISTRATION: Registered in Clinical Trials, 05.04.2019 (identifier: NCT03905460) https://clinicaltrials.gov/ct2/show/study/NCT03905460?term=NCT03905460&cond=Dyspnea&cntry=DK&draw=2&rank=1 .

PMID:36740691 | DOI:10.1186/s13049-023-01070-4

BMC Med Res Methodol. 2023 Feb 6;23(1):35. doi: 10.1186/s12874-023-01857-0.

ABSTRACT

BACKGROUND: Composite endpoints for estimating treatment efficacy are routinely used in several therapeutic areas and have become complex in the number and types of component outcomes included. It is assumed that its components are of similar asperity and chronology between both treatment arms as well as uniform in magnitude of the treatment effect. However, these assumptions are rarely satisfied. Understanding this heterogeneity is important in developing a meaningful assessment of the treatment effect.

METHODS: We developed the Weighted Composite Endpoint (WCE) method which uses weights derived from stakeholder values for each event type in the composite endpoint. The derivation for the product limit estimator and the variance of the estimate are presented. The method was then tested using data simulated from parameters based on a large cardiovascular trial. Variances from the estimated and traditional approach are compared through increasing sample size.

RESULTS: The WCE method used all of the events through follow-up and generated a multiple recurrent event survival. The treatment effect was measured as the difference in mean survivals between two treatment arms and corresponding 95% confidence interval, providing a less conservative estimate of survival and variance, giving a higher survival with a narrower confidence interval compared to the traditional time-to-first-event analysis.

CONCLUSIONS: The WCE method embraces the clinical texture of events types by incorporating stakeholder values as well as all events during follow-up. While the effective number of events is lower in the WCE analysis, the reduction in variance enhances the ability to detect a treatment effect in clinical trials.

PMID:36740676 | DOI:10.1186/s12874-023-01857-0

BMC Oral Health. 2023 Feb 5;23(1):74. doi: 10.1186/s12903-023-02776-8.

ABSTRACT

BACKGROUND: Tooth loss is a known marker of oral and systemic health, but large-scale population-based and cross-sectional multi-year comparative studies on tooth loss have yet to be much studied in China. This study explores the changing trends in tooth loss status and the associated factors influencing the prevalence of tooth loss over the past two decades in Guangdong, Southern China.

METHODS: Data from three cross-sectional, representative oral epidemiological surveys in Guangdong Province were analyzed, including 400 in 1995, 720 in 2005, and 288 in 2015, for a total of 1408 participants. Sample selection is based on the National Census of China published by the National Bureau of Statistics. In this study, each year, the number of missing teeth (MT) and the prevalence of tooth loss (MT > 0) were calculated. Basic demographic information, socioeconomic status, caries and periodontal status, personal lifestyle factors, and dental health care behaviors were analyzed by multivariate logistic regression to estimate their associations with tooth loss. Statistical significance was evaluated with 2-sided tests with a significance level of P < 0.05.

RESULTS: This study found that the mean number of missing teeth and the prevalence of tooth loss among adults aged 35-44 years in Guangdong Province did not change significantly in the first decade (1995-2005) but decreased significantly in the second decade (2005-2015) (0.94 and 40.8% in 1995, 0.99 and 42.9% in 2005, and 0.63 and 33.3% in 2015, respectively). The mean number of MT by tooth position was highest for the first and second molars, and both were larger in the mandible than in the maxilla. In 1995, populations with low educational attainment and the presence of caries or periodontal pocket (periodontal probing depth ≥ 4 mm) were associated with a higher chance of MT > 0. In 2005, those with low educational attainment, the presence of caries, and 40-44 years old were associated with a higher chance of MT > 0. Moreover, in 2015, females, rural residents, and those with caries or periodontal pocket were associated with a higher chance of MT > 0.

CONCLUSIONS: Although tooth retention has improved recently (2005-2015) and the preventive effect of education level on tooth loss has increased over time, efforts to prevent tooth loss in adults need to be strengthened. Particular attention should be given to preventive interventions for women, rural residents, and those suffering from caries or periodontal pocket.

PMID:36740667 | DOI:10.1186/s12903-023-02776-8

Environ Monit Assess. 2023 Feb 6;195(3):364. doi: 10.1007/s10661-023-10970-y.

ABSTRACT

Polycyclic aromatic hydrocarbons (PAHs) are mistakenly consumed by people through their diet, including food and water. The occurrence, source, and health hazards of 16 PAHs in 36 tilapia (Sarotherodon melanotheron) and silver catfish (Chrysichthys nigrodigitatus) samples from Okulu River, Nigeria were investigated in this study. The total PAH concentration ranged from 11.70-24.20 to 13.40-19.60 µg/kg, being statistically different between the two species. The values were higher than the European Commission limits of 12 µg/kg and within the World Health Organization limit of 20 µg/kg. The 16 PAHs were detected in both fish species. The diagnostic ratio revealed that petroleum, fossil fuel, and incomplete combustion of biomass wastes were the sources of PAHs in the fishes. Pearson’s correlation showed that the PAHs can come from diverse sources. The non-carcinogenic risk quotients (HQs) and hazard index (HI) in both fish species were 1, an indication of no adverse health effects. Among the 9 PAHs that were used to calculate the HI, BaP and BgP accounted for 31% and 62%, respectively, for Chrysichthys nigrodigitatus, and 25% and 69%, respectively, for Sarotherodon melanotheron. The carcinogenic hazard of the 7 PAHs assessed was within the acceptable range of 10^-6-10^-4. But the sum of the carcinogenic hazard was on the order of 10^-3 in both species of fish, an indication of carcinogenic health effects. 79% and 75% of the total carcinogenic risk for Chrysichthys nigrodigitatus and Sarotherodon melanotheron, respectively, are from DaA and InP. The consumption of PAHs by residents of the study area and other population groups through fish foods from the studied river underlines the importance of checking PAHs in aquatic foods for health concerns on a frequent basis.

PMID:36740655 | DOI:10.1007/s10661-023-10970-y

Braz J Microbiol. 2023 Feb 6. doi: 10.1007/s42770-023-00907-5. Online ahead of print.

ABSTRACT

The growth of the lactic acid bacteria (LAB), Streptococcus thermophilus and Lactobacillus bulgaricus, widely used for yogurt production, results in acid production and the reduction of the milk [Formula: see text]. Industrial processes can show temperature ([Formula: see text]) changes due to the large scale of the equipment. As [Formula: see text] and [Formula: see text] affect the LAB growth, this study aimed to model the dependence of S. thermophilus and L. bulgaricus as a function of temperature and pH and to estimate and internally validate their growth parameters and confidence intervals with different modeling approaches. Twenty-four datasets regarding the growth kinetics of S. thermophilus and L. bulgaricus were used for estimating the kinetic parameters for each pure culture. The classical Baranyi and Roberts (sigmoidal) primary and Rosso and coworkers (cardinal parameter) secondary models successfully described the experimental data. The one-step modeling approach showed better statistical results than the two-step approach. The values of eight growth parameters ([Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text], and [Formula: see text]) for each culture estimated from the fitting with the one-step approach and the Monte-Carlo-based approach were similar. Low averaged root-mean-squared errors ([Formula: see text]) (0.125 and 0.090 log CFU/mL) and percent discrepancy factor [Formula: see text] ([Formula: see text] and [Formula: see text]) values for S. thermophilus and L. bulgaricus were obtained in the internal model validation, reinforcing the predictive ability of the model.

PMID:36740644 | DOI:10.1007/s42770-023-00907-5

J Epidemiol Glob Health. 2023 Feb 6. doi: 10.1007/s44197-023-00085-5. Online ahead of print.

ABSTRACT

AIM: Because of the COVID-19 pandemic, many support programs for tuberculosis (TB) patients have been discontinued and TB mass screening activities decreased worldwide, resulting in a decrease in new case detection and an increase in TB deaths (WHO, WHO global lists of high burden countries for TB, multidrug/rifampicin-resistant TB (MDR/RR-TB) and TB/HIV, 2021-2025, 2021). The study aimed to assess changes in epidemiological indicators of tuberculosis in the Russian Federation and to simulate these indicators in the post-COVID-19 period.

MATERIALS AND METHODS: The main epidemiological indicators of tuberculosis were analyzed with the use of government statistical data for the period from 2009 to 2021. Further mathematical modeling of epidemiological indicators for the coming years was carried out, taking into account the TB screening by chest X-ray. Statistical analysis was carried out using the software environment R (v.3.5.1) for statistical computing and the commercial software Statistical Package for the Social Sciences (SPSS Statistics for Windows, version 24.0, IBM Corp., 2016). Time series forecasting was performed using the programming language for statistical calculations R, version 4.1.2 and the bsts package, version 0.9.8.

STUDY RESULTS: The study has found that the mean regression coefficient of a single predictor differs in the model for TB incidence and mortality (0.0098 and 0.0002, respectively). Forecast of overall incidence, the incidence of children and the forecast for mortality using the basic scenario (screening 75-78%) for the period from 2022 to 2026 was characterized by a mean decrease rate of 23.1%, 15.6% and 6.0% per year, respectively. A conservative scenario (screening 47-63%) of overall incidence indicates that the incidence of children and the forecast for mortality will continue to decrease with a mean decrease rate of 23.2%, 15.6% and 6.0% per year, respectively. Comparable data were obtained from the forecast of overall incidence, the incidence of children and the forecast for mortality using the optimistic scenario (screening 82-89%) with a mean decrease rate of 22.9%, 15.4% and 6.0% per year, respectively.

CONCLUSIONS: It has been proven that the significance of screening with chest X-ray as a predictor of mortality is minimal. However, TB screening at least 60% of the population (chest X-ray in adults and immunological tests in children) have provided relationship between the TB screening rate and TB mortality rate (TB mortality rate increases with an increase in the population coverage and, conversely, decreases with a decrease in the population coverage).

PMID:36740623 | DOI:10.1007/s44197-023-00085-5

J Mass Spectrom. 2023 Feb;58(2):e4903. doi: 10.1002/jms.4903.

ABSTRACT

Dendrobium officinale is a traditional Chinese herb with beneficial properties. Modern pharmacological studies show that bibenzyl is one of the antitumor active ingredients, but there is no effective quality control method for identifying ingredients. In this study, the composition of bibenzyls in Dendrobium officinale was studied by high-performance liquid chromatography coupled with electrospray ionization multistage mass spectrometry (HPLC-ESI-MSⁿ ). A total of nine isolated bibenzyls and their glycosides, 22 bis (bibenzyls), and two phenylpropanol bibenzyl derivatives were identified. The results of HPLC characteristic chromatogram analysis and statistical analysis showed that the relative content of bibenzyls in wild imitation cultivation of samples had been significantly higher than that in greenhouse cultivation. In addition, the relative content of bibenzyls increased with the growth of the original plant. This study provided a scientific reference for controlling the quality of bibenzyls in Dendrobium officinale, developing the cultivation technology and improving the quality of Dendrobium officinale. HIGHLIGHTS: HPLC-ESI-MS/MS method for the analysis of bibenzyls and bis (bibenzyls) in Dendrobium officinale. Easy-to-use method facilitating rapid measurement of large sample quantities. The method requires only small volumes of samples for the analysis. Applicable for the establishment of Chinese medicine studies and the quality control standard of Chinese herbs.

PMID:36740613 | DOI:10.1002/jms.4903

Plant Foods Hum Nutr. 2023 Feb 6. doi: 10.1007/s11130-023-01047-9. Online ahead of print.

ABSTRACT

The germinated seeds of many plants are a natural source of substances that can be used to supplement food and increase its functionality. The seeds’ metabolism may be modified during germination to produce specific health-promoting compounds. Fagopyrum esculentum Moench is a rich source of nutrients. Buckwheat seeds modified during germination may be helpful as an additive to new functional food products with anti-atherogenic properties. However, their effect and safety should be assessed in in vivo studies. The aim of the study was to evaluate the effect that adding modified buckwheat sprouts (Fagopyrum esculentum Moench) to an atherogenic (high-fat) diet has on the morphology and digestibility parameters of rats. Buckwheat seeds were modified by adding the probiotic strain of the yeast Saccharomyces cerevisiae var. boulardii. The study was carried out on 32 Wistar rats, and digestibility and blood counts were assessed during the experiment. There was no evidence of an adverse effect on the animals’ weight gain and nutritional efficiency. However, the influence of diets with freeze-dried buckwheat sprouts on digestibility and morphological parameters was noticed. Fat digestibility registered a statistically significant decrease in the groups fed a high-fat diet with the addition of sprouts. The study shows a new direction in the use of buckwheat sprouts.

PMID:36740612 | DOI:10.1007/s11130-023-01047-9

Breast Cancer Res Treat. 2023 Feb 6. doi: 10.1007/s10549-023-06861-y. Online ahead of print.

ABSTRACT

PURPOSE: To identify demographic and imaging features of MRI-detected enhancing lesions without clinical, ultrasound, and mammographic correlation associated with false-positive outcomes, impacting patient care.

MATERIALS AND METHODS: A retrospective multi-institutional study of imaging studies and patient’s chart review of consecutive women with MRI-detected enhancing lesions without clinical, mammogram, or ultrasound correlation between January and December 2018, who underwent MRI-guided biopsy. According to the BI-RADS lexicon, lesions’ frequency and imaging features were recorded. The demographic and imaging characteristics variables were correlated with histopathology as the gold standard and an uneventful follow-up of at least one year. Univariate logistic regression analysis was used to explore the correlation between the baseline variables such as age, genetic mutation, family history of breast cancer, personal history of breast cancer, MRI indication, background parenchymal enhancement, and MRI characteristic of the lesion with the false-positive results in main data and subgroup analysis.

RESULTS: Two hundred nineteen women (median age 49 years; range 26-85 years) with 219 MRI-detected enhancing lesions that underwent MRI-guided vacuum-assisted biopsy during the study period fulfilled the study criteria and formed the study cohort. Out of 219, 180 lesions (82.2%) yielded benign pathology results, including 137 benign outcomes (76%) and 43 high-risk lesions (24%). Most demographic and imaging characteristics variables did not help to differentiate malignant from benign lesions. The variables that showed statistically significant association with true-positive results in univariate analyses were age (OR 1.05; 95% CI 1.02-1.08; p = 0.0015), irregular mass-lesion shape when compared with oval/round mass lesion (OR 11.2; 95% CI 1.6-78.4; p = 0.015), and clumped and clustered ring of enhancement when compared with homogeneous (OR 3.22, 95% CI 1.40-7.40; p = 0.0058). For participants with mass breast lesion, the hyperintense signal on the T2-weighted sequence (compared to the normal fibroglandular signal) was significantly related to the false-positive result (OR 0.13; 95% CI 0.02-0.76; p = 0.024).

CONCLUSION: Young patients, oval/round mass-lesion shape, and homogeneous pattern of non-mass enhancement showed the strongest association with false-positive results of enhancing lesions depicted by MRI. For participants with mass breast lesion, T2-bright mass lesion showed significant association with false-positive result. It may impact the patient’s management with a suggestion of follow-up rather than interventional procedure when these demographic and imaging parameters are present, consequently decreasing the patient’s anxiety and health care costs.

PMID:36740611 | DOI:10.1007/s10549-023-06861-y

Eur Spine J. 2023 Feb 6. doi: 10.1007/s00586-023-07562-2. Online ahead of print.

ABSTRACT

PURPOSE: Postoperative complication prediction helps surgeons to inform and manage patient expectations. Deep learning, a model that finds patterns in large samples of data, outperform traditional statistical methods in making predictions. This study aimed to create a deep learning-based model (DLM) to predict postoperative complications in patients with cervical ossification of the posterior longitudinal ligament (OPLL).

METHODS: This prospective multicenter study was conducted by the 28 institutions, and 478 patients were included in the analysis. Deep learning was used to create two predictive models of the overall postoperative complications and neurological complications, one of the major complications. These models were constructed by learning the patient’s preoperative background, clinical symptoms, surgical procedures, and imaging findings. These logistic regression models were also created, and these accuracies were compared with those of the DLM.

RESULTS: Overall complications were observed in 127 cases (26.6%). The accuracy of the DLM was 74.6 ± 3.7% for predicting the overall occurrence of complications, which was comparable to that of the logistic regression (74.1%). Neurological complications were observed in 48 cases (10.0%), and the accuracy of the DLM was 91.7 ± 3.5%, which was higher than that of the logistic regression (90.1%).

CONCLUSION: A new algorithm using deep learning was able to predict complications after cervical OPLL surgery. This model was well calibrated, with prediction accuracy comparable to that of regression models. The accuracy remained high even for predicting only neurological complications, for which the case number is limited compared to conventional statistical methods.

PMID:36740608 | DOI:10.1007/s00586-023-07562-2