Category: Nevin Manimala

Mol Genet Genomic Med. 2023 Feb 2:e2142. doi: 10.1002/mgg3.2142. Online ahead of print.

ABSTRACT

INTRODUCTION: Sickle cell disease is a genetic disorder with its highest prevalence in Nigeria. The condition causes red blood cells to turn rigid, and consequently, results to several complications including organ damage. This study aimed at assessing views of health practitioners in Nigeria on policies and practices in the area of access to healthcare services for sickle cell disease.

METHODS: A cross-sectional study was undertaken amongst healthcare professionals in Nigeria. Data were collected using a self-administered questionnaire, and analyses were undertaken using Statistical Package for Social Sciences software.

RESULTS: A significant proportion of the participants (42.8%) disagreed that relevant legislative framework exists to facilitate optimal access to high-quality healthcare services for persons with sickle cell disorder in Nigeria. Two-thirds of the study cohort were of the opinion that public health surveillance towards sickle cell disease was suboptimal (61.2%). Also, more than three-quarters of the respondents (78.7%) indicated that the cost of managing sickle cell disease was not affordable to majority of affected Nigerians.

CONCLUSION: This study provides critical insights into access to healthcare services for sickle cell disease. As such, challenges preventing access to healthcare services for sickle cell patients which have been identified in this study can underpin the development of contextual policies to address them.

PMID:36727575 | DOI:10.1002/mgg3.2142

Health Econ. 2023 Feb 2. doi: 10.1002/hec.4653. Online ahead of print.

ABSTRACT

Do movies reduce stigma, increasing healthcare product choices offered by firms? We provide causal evidence on this question in the context of Indian pharmaceutical markets. For unpacking these effects, we use an exogenous shock to the market due to the release of a Bollywood blockbuster movie – My Name is Khan (MNIK) where the protagonist, superstar Shahrukh Khan, suffers from Asperger’s Syndrome (AS). Using a difference-in-differences design, we find a positive and statistically significant effect of MNIK (between 14% and 22% increase in variety sold and prescribed) on product differentiation and choices in the market for antipsychotic medicines used to clinically treat AS. Results are consistent using alternative controls, a placebo treatment-based test and with a variety of other robustness checks. Our findings document likely for the first-time, supply side responses to edutainment and suggests potential associated welfare effects in healthcare markets characterized by sticky demand. Implications for global health and public policy given worldwide concerns around a mental wellness epidemic with Covid-19 are discussed.

PMID:36727570 | DOI:10.1002/hec.4653

Cancer Med. 2023 Feb 2. doi: 10.1002/cam4.5669. Online ahead of print.

ABSTRACT

BACKGROUND: The programmed cell death protein 1 (PD-1) inhibitor, as one of the immune checkpoint inhibitors (ICIs), is the standard treatment for advanced lung cancer. However, immune-related adverse events (irAEs) remain poorly understood toxicities. It is unclear whether frailty plays a role in the occurrence of irAEs. Thus, we assess whether irAEs occur more often in frail patients than in non-frail patients according to the Frailty Index (FI).

METHODS: A retrospective study was conducted. Medical records from lung cancer patients treated with PD-1 inhibitors (Sintilimab, Camrelizumab, Tislelizumab, and Pembrolizumab) at Peking University First Hospital (May 2018-June 2022). Patients were categorized into non-frail and frail groups according to a cut-point of 0.25 by FI. The FI calculation included 28 baseline variables, all of which were health deficits measured by questionnaires and body measurements.

RESULTS: The statistical analysis included 114 advanced lung cancer patients. The median age was 66 years, and the male/female ratio was 4.7:1 (94/20). Approximately 39 (34%) were classified as frail. PD-1 inhibitor-related adverse events occurred in 17.5% of patients, and 6.1% experienced irAEs of grade ≥3. There was no significant difference in the occurrence of irAEs (14.7% vs. 23.1%, p = 0.26), grade ≥ 3 irAEs (5.3% vs. 7.7%, p = 0.93), and treatment discontinuation due to irAEs (12.0% vs. 17.9%, p = 0.39) between non-frail and frail patients. However, frail patients are more likely to have more than one type of irAEs and are more possibly to have checkpoint inhibitor pneumonitis (CIP) than non-frail patients when they use PD-1 inhibitors (p < 0.05). Frail patients had a longer hospital stay (6 vs. 3 days, p = 0.01).

CONCLUSIONS: Frailty is not associated with severe irAEs, but is related to CIP. Meanwhile, it predicts more than one type of irAEs and a longer hospital stay. Frailty screening has added value to the decision-making process for frail patients eligible for PD-1 inhibitors.

PMID:36727563 | DOI:10.1002/cam4.5669

Epilepsia. 2023 Feb 2. doi: 10.1111/epi.17525. Online ahead of print.

ABSTRACT

OBJECTIVE: Understanding fluctuations in seizure severity within individuals is important for determining treatment outcomes and responses to therapy, as well as assessing novel treatments for epilepsy. Current methods for grading seizure severity rely on qualitative interpretations from patients and clinicians. Quantitative measures of seizure severity would complement existing approaches, for electroencephalographic (EEG) monitoring, outcome monitoring, and seizure prediction. Therefore, we developed a library of quantitative EEG markers that assess the spread and intensity of abnormal electrical activity during and after seizures.

METHODS: We analysed intracranial EEG (iEEG) recordings of 1009 seizures from 63 patients. For each seizure we computed 16 markers of seizure severity that capture the signal magnitude, spread, duration, and post-ictal suppression of seizures.

RESULTS: Quantitative EEG markers of seizure severity distinguished focal vs. subclinical seizures across patients. In individual patients 53% had a moderate to large difference (ranksum r>0.3, p<0.05) between focal and subclinical seizures in three or more markers. Circadian and longer-term changes in severity were found for the majority of patients.

SIGNIFICANCE: We demonstrate the feasibility of using quantitative iEEG markers to measure seizure severity. Our quantitative markers distinguish between seizure types and are therefore sensitive to established qualitative differences in seizure severity. Our results also suggest that seizure severity is modulated over different timescales. We envisage that our proposed seizure severity library will be expanded and updated in collaboration with the epilepsy research community to include more measures and modalities. © 2023 International League Against Epilepsy.

PMID:36727552 | DOI:10.1111/epi.17525

Disabil Rehabil. 2023 Feb 2:1-9. doi: 10.1080/09638288.2023.2175045. Online ahead of print.

ABSTRACT

Purpose: The purpose of this study was to adapt Modified Falls Efficacy Scale (MFES) into Arabic and determine the reliability and validity of the instrument.Materials and methods: The study was conducted in two phases: (i) translation and adaptation by the systematic approach of the ‘forward-back’ translation method and (ii) psychometric testing of the Arabic version of the Modified Falls Efficacy Scale among 207 community-dwelling older adults (≥ 60 years).Results: The Arabic version of the Modified Falls Efficacy Scale demonstrated excellent internal consistency (Cronbach’s alpha = 0.98) and test-retest reliability scores (ICC = 0.96, 95% CI; 0.95-0.97). And also showed strong correlations with both the Falls Efficacy International (r = -0.82) and the activities-specific Balance Confidence Scale (r = 0.87). Sampling adequacy for factor analysis was proven by a Kaiser-Meyer-Olkin value of 0.962. Goodness-of-fit (GFI) statistics for the model were in the acceptable range (Chi-Square/Degree of Freedom (CMIN/DF) = 2.59, Goodness-of-fit index (GFI) = 0.9, Comparative Fit Index (CFI) = 0.97, Root Mean Square Error of Approximation (RMSEA) = 0.79).Conclusion: The Arabic version of the Modified Falls Efficacy Scale has demonstrated excellent psychometric qualities to measure the level of fear of falling.IMPLICATIONS FOR REHABILITATIONModified falls efficacy scale (MFES) is a commonly used scale for assessment of fear of fall in elderlyThe translated and adapted Arabic version of (A-MFES) will enhance the assessment of fear of fall in Arabic older adults, though it is a patient response scaleThis scale can assess the fear of falling in indoor and outdoor activities which makes this scale comprehensive in nature.

PMID:36727527 | DOI:10.1080/09638288.2023.2175045

Arterioscler Thromb Vasc Biol. 2023 Feb 2. doi: 10.1161/ATVBAHA.122.318819. Online ahead of print.

ABSTRACT

BACKGROUND: Brain arterial dilation and elongation characterize dolichoectasia, an arteriopathy associated with risk of stroke and death. We aim to determine whether brain arterial elongation increases the risk of stroke and death independent of brain arterial diameters.

METHODS: We analyzed 1210 stroke-free participants (mean age 71±9 years, 41% men, 65% Hispanic) with available time-of-flight magnetic resonance angiogram from the Northern Manhattan Study, a population-based cohort study across a multiethnic urban community. We obtained baseline middle cerebral artery M1-segment (MCA-M1) and basilar artery (BA) mean lengths and diameters using a semi-automated software. Cox proportional hazards models adjusted for brain arterial diameters and potential confounders yielded adjusted hazards ratios with 95% CIs for the primary outcomes of incident stroke and all-cause mortality, as well as secondary outcomes including noncardioembolic stroke, vascular death, and any vascular event.

RESULTS: Neither MCA-M1 nor BA lengths correlated with incident stroke or all-cause mortality. Both MCA-M1 and BA larger diameters correlated with all-cause mortality (MCA-M1 aHR, 1.52 [95% CI, 1.03-2.23], BA aHR, 1.28 [95% CI, 1.02-1.61]), as well as larger MCA-M1 diameters with vascular death (aHR, 1.84 [95% CI, 1.02-3.31]). Larger MCA-M1 and BA diameters did not correlate with incident stroke. However, larger BA diameters were associated with posterior circulation noncardioembolic stroke (aHR, 2.93 [95% CI, 1.07-8.04]). There were no statistical interactions between brain arterial lengths and diameters in relation to study outcomes.

CONCLUSIONS: In a multiethnic cohort of stroke-free adults, brain arterial elongation did not correlate with risk of stroke or death, nor influenced the significant association between brain arterial dilation and vascular risk.

PMID:36727517 | DOI:10.1161/ATVBAHA.122.318819

Circ Cardiovasc Qual Outcomes. 2023 Feb 2:e009277. doi: 10.1161/CIRCOUTCOMES.122.009277. Online ahead of print.

ABSTRACT

BACKGROUND: Hospitals are increasingly likely to implement clinical informatics tools to improve quality of care, necessitating rigorous approaches to evaluate effectiveness. We leveraged a multi-institutional data repository and applied causal inference methods to assess implementation of a commercial data visualization software in our pediatric cardiac intensive care unit.

METHODS: Natural experiment in the University of Michigan (UM) Cardiac Intensive Care Unit pre and postimplementation of data visualization software analyzed within the Pediatric Cardiac Critical Care Consortium clinical registry; we identified N=21 control hospitals that contributed contemporaneous registry data during the study period. We used the platform during multiple daily rounds to visualize clinical data trends. We evaluated outcomes-case-mix adjusted postoperative mortality, cardiac arrest and unplanned readmission rates, and postoperative length of stay-most likely impacted by this change. There were no quality improvement initiatives focused specifically on these outcomes nor any organizational changes at UM in either era. We performed a difference-in-differences analysis to compare changes in UM outcomes to those at control hospitals across the pre versus postimplementation eras.

RESULTS: We compared 1436 pre versus 779 postimplementation admissions at UM to 19 854 (pre) versus 14 160 (post) at controls. Admission characteristics were similar between eras. Postimplementation at UM we observed relative reductions in cardiac arrests among medical admissions, unplanned readmissions, and postoperative length of stay by -14%, -41%, and -18%, respectively. The difference-in-differences estimate for each outcome was statistically significant (P<0.05), suggesting the difference in outcomes at UM pre versus postimplementation is statistically significantly different from control hospitals during the same time.

CONCLUSIONS: Clinical registries provide opportunities to thoroughly evaluate implementation of new informatics tools at single institutions. Borrowing strength from multi-institutional data and drawing ideas from causal inference, our analysis solidified greater belief in the effectiveness of this software across our institution.

PMID:36727516 | DOI:10.1161/CIRCOUTCOMES.122.009277

Soft Matter. 2023 Feb 2. doi: 10.1039/d2sm01299e. Online ahead of print.

ABSTRACT

We probe the complex rheological behaviour of liquid foams flowing through a conical constriction. With fast X-ray tomographic microscopy we measure in situ the displacement and deformation of up to fifty thousand bubbles at any single time instance while varying systematically the foam liquid fraction, the bubble size and the flow direction – convergent vs. divergent. The large statistics and high spatio-temporal resolution allows to observe and quantify the deviations from a purely viscous flow. We indeed reveal an asymmetry between the convergent and divergent flows associated to the emergence of elastic stresses in the latter case, and enhanced as the liquid fraction is reduced. Such effect is related to the reorientation of the deformed bubbles flowing out of the constriction, from a prolate to an oblate shape in average, while they pass through the hopper waist.

PMID:36727511 | DOI:10.1039/d2sm01299e

J Magn Reson Imaging. 2023 Feb 2. doi: 10.1002/jmri.28630. Online ahead of print.

ABSTRACT

BACKGROUND: Genetic testing for molecular markers of gliomas sometimes is unavailable because of time-consuming and expensive, even limited tumor specimens or nonsurgery cases.

PURPOSE: To train a three-class radiomic model classifying three molecular subtypes including isocitrate dehydrogenase (IDH) mutations and 1p/19q-noncodeleted (IDHmut-noncodel), IDH wild-type (IDHwt), IDH-mutant and 1p/19q-codeleted (IDHmut-codel) of adult gliomas and investigate whether radiomic features from diffusion-weighted imaging (DWI) could bring additive value.

STUDY TYPE: Retrospective.

POPULATION: A total of 755 patients including 111 IDHmut-noncodel, 571 IDHwt, and 73 IDHmut-codel cases were divided into training (n = 480) and internal validation set (n = 275); 139 patients including 21 IDHmut-noncodel, 104 IDHwt, and 14 IDHmut-codel cases were utilized as external validation set.

FIELD STRENGTH/SEQUENCE: A 1.5 T or 3.0 T/multiparametric MRI, including T1-weighted (T1), T1-weighted gadolinium contrast-enhanced (T1c), T2-weighted (T2), fluid attenuated inversion recovery (FLAIR), and DWI.

ASSESSMENT: The performance of multiparametric radiomic model (random-forest model) using 22 selected features from T1, T2, FLAIR, T1c images and apparent diffusion coefficient (ADC) maps, and conventional radiomic model using 20 selected features from T1, T2, FLAIR, and T1c images was assessed in internal and external validation sets by comparing probability values and actual incidence.

STATISTICAL TESTS: Mann-Whitney U test, Chi-Squared test, Wilcoxon test, receiver operating curve (ROC), and area under the curve (AUC); DeLong analysis. P < 0.05 was statistically significant.

RESULTS: The multiparametric radiomic model achieved AUC values for IDHmut-noncodel, IDHwt, and IDHmut-codel of 0.8181, 0.8524, and 0.8502 in internal validation set and 0.7571, 0.7779, and 0.7491 in external validation set, respectively. Multiparametric radiomic model showed significantly better diagnostic performance after DeLong analysis, especially in classifying IDHwt and IDHmut-noncodel subtypes.

DATA CONCLUSION: Radiomic features from DWI could bring additive value and improve the performance of conventional MRI-based radiomic model for classifying the molecular subtypes especially IDHmut-noncodel and IDHwt of adult gliomas.

TECHNICAL EFFICACY: Stage 2.

PMID:36727433 | DOI:10.1002/jmri.28630

Indian J Ophthalmol. 2023 Feb;71(2):625-630. doi: 10.4103/ijo.IJO_1505_22.

ABSTRACT

PURPOSE: This study aimed to investigate the effect of virtual reality (VR) technology in children after surgery for concomitant strabismus.

METHODS: A total of 200 children with concomitant exotropia or concomitant esotropia were randomly divided into a training group and a control group according to the single even number random method (100 cases in each group). Patients in the training group received VR intervention training within 1 week after surgery. Patients in the control group did not receive any training.

RESULTS: Six months after the surgery, the orthophoria (the far or near strabismus degree was ≤8Δ) rate was significantly higher in the training group than in the control group (P = 0.001), while the eye position regression rate (compared to the strabismus degree within 1 week after the surgery, the amount of regression >10Δ) was significantly lower in the training group than in the control group (P = 0.001). Six months after the surgery, the number of children with simultaneous vision and remote stereovision was significantly higher in the training group than in the control group (P = 0.017 and 0.002, respectively). The differences in the number of patients with peripheral stereopsis, macular stereopsis, and stereopsis in macular fovea centralis at 1, 3, and 6 months after the surgery between the training and the control groups were not statistically significant (P = 0.916, 0.274, and 0.302, respectively).

CONCLUSION: The intervention of VR technology after strabismus correction effectively improved children’s visual function and maintained their eye position.

PMID:36727374 | DOI:10.4103/ijo.IJO_1505_22