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Nevin Manimala Statistics

Leptospirosis modelling using hydrometeorological indices and random forest machine learning

Int J Biometeorol. 2023 Jan 31. doi: 10.1007/s00484-022-02422-y. Online ahead of print.

ABSTRACT

Leptospirosis is a zoonosis that has been linked to hydrometeorological variability. Hydrometeorological averages and extremes have been used before as drivers in the statistical prediction of disease. However, their importance and predictive capacity are still little known. In this study, the use of a random forest classifier was explored to analyze the relative importance of hydrometeorological indices in developing the leptospirosis model and to evaluate the performance of models based on the type of indices used, using case data from three districts in Kelantan, Malaysia, that experience annual monsoonal rainfall and flooding. First, hydrometeorological data including rainfall, streamflow, water level, relative humidity, and temperature were transformed into 164 weekly average and extreme indices in accordance with the Expert Team on Climate Change Detection and Indices (ETCCDI). Then, weekly case occurrences were classified into binary classes “high” and “low” based on an average threshold. Seventeen models based on “average,” “extreme,” and “mixed” indices were trained by optimizing the feature subsets based on the model computed mean decrease Gini (MDG) scores. The variable importance was assessed through cross-correlation analysis and the MDG score. The average and extreme models showed similar prediction accuracy ranges (61.5-76.1% and 72.3-77.0%) while the mixed models showed an improvement (71.7-82.6% prediction accuracy). An extreme model was the most sensitive while an average model was the most specific. The time lag associated with the driving indices agreed with the seasonality of the monsoon. The rainfall variable (extreme) was the most important in classifying the leptospirosis occurrence while streamflow was the least important despite showing higher correlations with leptospirosis.

PMID:36719482 | DOI:10.1007/s00484-022-02422-y

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Nevin Manimala Statistics

Machine learning to predict overall short-term mortality in cutaneous melanoma

Discov Oncol. 2023 Jan 31;14(1):13. doi: 10.1007/s12672-023-00622-5.

ABSTRACT

BACKGROUND: Cutaneous malignant melanoma (CMM) ranks among the ten most frequent malignancies, clinicopathological staging being of key importance to predict prognosis. Artificial intelligence (AI) has been recently applied to develop prognostically reliable staging systems for CMM. This study aims to provide a useful machine learning based tool to predict the overall CMM short-term survival.

METHODS: CMM records as collected at the Veneto Cancer Registry (RTV) and at the Veneto regional health service were considered. A univariate Cox regression validated the strength and direction of each independent variable with overall mortality. A range of machine learning models (Logistic Regression classifier, Support-Vector Machine, Random Forest, Gradient Boosting, and k-Nearest Neighbors) and a Deep Neural Network were then trained to predict the 3-years mortality probability. Five-fold cross-validation and Grid Search were performed to test the best data preprocessing procedures, features selection, and to optimize models hyperparameters. A final evaluation was carried out on a separate test set in terms of balanced accuracy, precision, recall and F1 score. The best model was deployed as online tool.

RESULTS: The univariate analysis confirmed the significant prognostic value of TNM staging. Adjunctive clinicopathological variables not included in the AJCC 8th melanoma staging system, i.e., sex, tumor site, histotype, growth phase, and age, were significantly linked to overall survival. Among the models, the Neural Network and the Random Forest models featured the best prognostic performance, achieving a balanced accuracy of 91% and 88%, respectively. According to the Gini importance score, age, T and M stages, mitotic count, and ulceration appeared to be the variables with the greatest impact on survival prediction.

CONCLUSIONS: Using data from patients with CMM, we developed an AI algorithm with high staging reliability, on top of which a web tool was implemented ( unipd.link/melanomaprediction ). Being essentially based on routinely recorded clinicopathological variables, it can already be implemented with minimal effort and further tested in the current clinical practice, an essential phase for validating the model’s accuracy beyond the original research context.

PMID:36719475 | DOI:10.1007/s12672-023-00622-5

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Nevin Manimala Statistics

Influencing factors of acute kidney injury following retrograde intrarenal surgery

World J Urol. 2023 Jan 31. doi: 10.1007/s00345-023-04301-6. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the influencing factors of acute kidney injury (AKI) following retrograde intrarenal surgery (RIRS).

METHODS: The data of patients who underwent RIRS for kidney stones between January 2018 and June 2022 at two tertiary centers were retrospectively analyzed. Demographic data of patients were obtained. According to kidney disease: Improving Global Outcomes (KDIGO) criteria, those with and without AKI were divided into two groups. Preoperative, intraoperative, and postoperative predictive factors of patients were investigated between the groups. In addition, the influencing factors of AKI were examined by multivariate analysis.

RESULTS: This study included 295 (35.7%) women and 532 (64.3%) men. The mean age was 50.03 ± 15.4 years (range 18-89), and mean stone size was 15.5 ± 6.1 mm (range 6-47). Overall, 672 of patients (81.3%) were stone-free after the initial treatment. According to KDIGO, 110 of patients (13.3%) had AKI during the postoperative period. Univariate analysis showed that stone size (P = .003), previous stone surgery (P = .010), renal malformations (P = .017), high operative time (P = < .001), high preoperative creatinine value (P = .036), intraoperative complications (P = .018), and postoperative urinary tract infection (P = .003) had significant influence on the AKI after RIRS. Multivariate analysis excluded previous stone surgery, high preoperative creatinine value, renal malformations, and intraoperative complications from the logistic regression model, whereas other factors maintained their statistically significant effect on AKI, indicating that they were independent predictors.

CONCLUSIONS: Stone size, operative time, postoperative urinary tract infection, and diabetes mellitus are significant predictors of AKI. During RIRS, urologists should consider the factors that increase the risk of AKI and evaluate the treatment outcomes based on these factors.

PMID:36719465 | DOI:10.1007/s00345-023-04301-6

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Nevin Manimala Statistics

Deciphering pH-dependent microbial taxa and functional gene co-occurrence in the coral Galaxea fascicularis

Microb Ecol. 2023 Jan 31. doi: 10.1007/s00248-023-02183-0. Online ahead of print.

ABSTRACT

How the coral microbiome responds to oceanic pH changes due to anthropogenic climate change, including ocean acidification and deliberate artificial alkalization, remains an open question. Here, we applied a 16S profile and GeoChip approach to microbial taxonomic and gene functional landscapes in the coral Galaxea fascicularis under three pH levels (7.85, 8.15, and 8.45) and tested the influence of pH changes on the cell growth of several coral-associated strains and bacterial populations. Statistical analysis of GeoChip-based data suggested that both ocean acidification and alkalization destabilized functional cores related to aromatic degradation, carbon degradation, carbon fixation, stress response, and antibiotic biosynthesis in the microbiome, which are related to holobiont carbon cycling and health. The taxonomic analysis revealed that bacterial species richness was not significantly different among the three pH treatments, but the community compositions were significantly distinct. Acute seawater alkalization leads to an increase in pathogens as well as a stronger taxonomic shift than acidification, which is worth considering when using artificial ocean alkalization to protect coral ecosystems from ocean acidification. In addition, our co-occurrence network analysis reflected microbial community and functional shifts in response to pH change cues, which will further help to understand the functional ecological role of the microbiome in coral resilience.

PMID:36719456 | DOI:10.1007/s00248-023-02183-0

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Nevin Manimala Statistics

Transdermal scopolamine and urinary retention following urogynecologic surgery: a systematic review and meta-analysis

Int Urogynecol J. 2023 Jan 31. doi: 10.1007/s00192-023-05467-8. Online ahead of print.

ABSTRACT

INTRODUCTION AND HYPOTHESIS: Both urogynecologic surgeries and transdermal scopolamine (TDS) patches are independently associated with postoperative urinary retention (POUR). It is unclear if the risk of POUR increases when these interventions are used in combination. This systematic review and meta-analysis aim to synthesize current evidence to optimize clinical management and outcomes for patients undergoing urogynecologic procedures.

METHODS: This systematic review was conducted in concordance with the PRISMA 2020 guidelines. MEDLINE, ClinicalTrials.gov, and Cochrane Library were searched. Publications were filtered by inclusion and exclusion criteria. Inclusion criteria required: (1) preoperative or perioperative application of TDS, (2) surgery indicated for stress urinary incontinence and/or pelvic organ prolapse, (3) results given for postoperative voiding trials, and (4) were available in English. Exclusion criteria included: (1) oral or parenteral formulations of scopolamine, (2) administration of alternative preoperative antiemetics, and (3) use of combination antiemetic therapy. Quality was assessed using the Joanna Briggs Institute Checklist. Publication bias was evaluated via the ROBINS-I assessment tool, and Egger regression and Begg and Mazumumdar rank correlation tests. A meta-analysis was conducted using Meta-Essentials Excel Workbook.

RESULTS: Four publications were identified which complied with inclusion and exclusion criteria. Included studies comprised 752 patients (237 experimental group, 515 control group). All were retrospective cohort studies conducted via chart review in America. Meta-analysis revealed a risk ratio (RR) of 2.35 with a confidence interval (CI) of 0.61 to 9.07, indicating a positive association between TDS and POUR, but without statistical significance.

CONCLUSIONS: Current evidence suggests that TDS application may be associated with increased risk of POUR following urogynecologic procedures. While research on this topic is greatly limited, this systematic review and meta-analysis highlights that alternative antiemetic therapy may be necessary for patients undergoing such interventions in effort to limit the risk of POUR.

PMID:36719449 | DOI:10.1007/s00192-023-05467-8

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Nevin Manimala Statistics

Efficacy and safety of Politranexamide® liposomal emulsion on facial melasma: A comparative study

J Cosmet Dermatol. 2023 Jan 31. doi: 10.1111/jocd.15648. Online ahead of print.

ABSTRACT

INTRODUCTION: Melasma is a human melanogenesis dysfunction that results in localized, chronic acquired hypermelanosis of the skin difficult to treat.

METHODS: This prospective, randomized, single-blind, study aimed to compare the efficacy and tolerability of a liposomal emulsion based on Politranexamide® (SAMPLE A) with that of a competitor based on acetylglucosamine, ethyl linoleate and phenyl ethyl resorcinol (SAMPLE B) in patients affected by facial melasma on 26 patients. Disease severity was assessed by the Melasma Area Severity Index (MASI) at baseline and after 6 and 12 weeks of therapy. All patients were subjected to photo documentation using DermaView camera and Antera 3D camera.

RESULTS: The mean MASI score at baseline was 10.93 ± 7 in the group A and 9.34 ± 6.29 in the group B, respectively. A significant decrease in MASI score from baseline was noted in both treatment groups as early as 6 weeks of follow-up (p = 0.00096 for SAMPLE A and p = 0.0049 for SAMPLE B) and was confirmed at the end of the treatment (p = 0.0006 for SAMPLE A and p = 0.00039 for SAMPLE B). Intergroup comparison revealed a greater improvement of melasma among patients in group A compared to those in group B that was quite statistically significant at weeks 6 (p = 0.055009) and significant after 12 weeks of follow-up (p = 0.032942). Both treatment groups experienced an improvement in Antera average level of melanin.

CONCLUSION: Our results suggested Politranexamide® to be a useful and safe therapeutic option in treating melasma, more effective than competitor used in this study.

PMID:36718844 | DOI:10.1111/jocd.15648

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Nevin Manimala Statistics

Use of nasal septal bone to straighten septal L-Strut in correction of east Asian short nose: A retrospective study

J Cosmet Dermatol. 2023 Jan 31. doi: 10.1111/jocd.15643. Online ahead of print.

ABSTRACT

BACKGROUND: The perpendicular plate of ethmoid (PPE) was used to correct short noses in rhinoplasty in Asians, but the safe harvest of the plate and the assessment of its clinical application has been perplexing to plastic surgeons.

AIMS: To explore how to safely cut the perpendicular plate of ethmoid bone and evaluate its application effect.

PATIENTS/METHODS: A finite element model was established to guide the clinical operation. A total of 30 patients with short noses were selected. Among them, 15 patients used autologous septal cartilage to lengthen the nasal tip, and 15 patients used the PPE to strengthen the L-shape nasal septum. The differences in the esthetic parameters of the nose, complications, and patients’ satisfaction were compared between the two groups.

RESULTS: Significant differences were noted in the nasal dorsal length (p = 0.001), Goode’s ratio (p = 0.001), and nasofrontal angle (p = 0.003) after rhinoplasty, and no significant differences were noted in any of the esthetic parameters between the two groups. The symptoms of nasal obstruction in the experimental group were significantly lighter than those in the control group (p = 0.04). There was no statistically significant difference in the doctors’ assessment of outcomes between the two groups (p = 0.48).

CONCLUSION: The safest region to harvest the PPE is in the middle and lower third. Rhinoplasty improves the esthetics of the patient’s nose. The PPE used to strengthen the L-shape nasal septum structure has a smaller probability of nasal septal deviation with the time in Asian short noses.

PMID:36718843 | DOI:10.1111/jocd.15643

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Validation of the Cardiff acne disability index and the impact of educational materials in a Romanian cultural adaptation context

J Cosmet Dermatol. 2023 Jan 31. doi: 10.1111/jocd.15609. Online ahead of print.

ABSTRACT

BACKGROUND: Acne has a high impact on patients being a chronic, common, and visible skin condition. Knowledge regarding treatment improves outcomes. The Cardiff Acne Disability Index (CADI) is commonly used in clinical practice for quality-of-life assessment. It has been validated in many languages, however, not in Romanian.

AIMS: To validate the Romanian adaptation of the CADI and educational materials for acne patients.

PATIENTS AND METHOD: A 12-week prospective cross-sectional Web-based study, including 3rd- to 5th-year medical students attending our university was conducted. We obtained permission from the CADI copyright owner and performed the steps of the standardized translation process. The Romanian CADI adaptation was delivered online in a test-retest setup, during which participants were offered acne educational materials and completed a knowledge evaluation questionnaire.

RESULTS: A total of 95 complete answers were analyzed. The Romanian CADI adaptation showed good internal consistency, with Cronbach’s α = 0.807 in the first application and Cronbach’s α = 0.839 in the second. High test-retest reliability was observed, with interclass correlation coefficient ICC = 0.987 and Spearman’s rank correlation coefficient rs = 0.970 for the overall CADI scores between the two administrations. The mean baseline score in the knowledge evaluation questionnaire was 15.52 points (±1.556), with a statistically significant improvement after exposure to the educational material (Z = -7.207, p < 0.001). This material was considered useful or very useful by 78(82.8%) participants.

CONCLUSION: Romanian acne patients can benefit from CADI, a reliable and disease-specific tool for quality-of-life evaluation, together with validated, guideline-aligned educational material in their language.

PMID:36718840 | DOI:10.1111/jocd.15609

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Intralesional injection of platelet-rich plasma versus steroid in the treatment of oral lichen planus

J Cosmet Dermatol. 2023 Jan 31. doi: 10.1111/jocd.15622. Online ahead of print.

ABSTRACT

BACKGROUND: Oral licen planus (OLP) is a chronic inflammatory disease and may have immunological background. Both intralesional injection of PRP and steroids succeeded in treating and decreasing recurrence of the disease.

PATIENTS AND METHODS: Twenty-four participants with clinically diagnosed as OLP were enrolled in this study. We separated the patients in 2 groups, 12 patients in group A were treated by intralesional PRP every two weeks for 2 months or stopped if healing occurred earlier. Group B (12 patients) treated by intralesional Triamcinolone Acetonide (TA) (20 mg) every two weeks for 2 months or may be less if healing occurred earlier. The response of OLP lesions to treatment was evaluated by reduction of lesional areas, REU scores, and NRS scores. The patients with complete response (CR; 80%-100% reduction in the lesion area) were followed for 3 months biweekly.

RESULTS: There was a statistically significant decrease in REU and pain score in both groups after treatment compared to before. There was a statistically increase in frequency of side effects among patients received PRP especially pain compared to those treated by steroid. Also, recurrence of the disease after treatment during follow-up for 3 months was more significant among patients treated by PRP.

CONCLUSION: Intralesional PRP is a good and safe modality for treatment of OLP and intralesional TA. However, there were some side effects and recurrence of disease after follow-up for three months in patients treated by PRP more than those treated by TA.

PMID:36718838 | DOI:10.1111/jocd.15622

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Evaluation of botulinum toxin type A for treating post burn hypertrophic scars and keloid in children: An intra-patient randomized controlled study

J Cosmet Dermatol. 2023 Jan 31. doi: 10.1111/jocd.15634. Online ahead of print.

ABSTRACT

BACKGROUND: Consequently, the management of post burn hypertrophic scars and keloid in children are a great challenge for the physicians, parents, and children themselves.

PURPOSE OF THE STUDY: To assess the efficacy and safety of treating hypertrophic and keloid scars with botulinum toxins injections.

PATIENTS AND METHODS: This is a randomized intra-patient comparative study was conducted on 15 children with post burn hypertrophic and keloid scars. Children were randomized to receive Intralesional injection of botulinum toxins on one part of the hypertrophic scar/keloid where the other part was left as a control. The assessment of clinical improvement was measured by the Vancouver scar scale (VSS) and by skin analysis camera system. Sessions were performed every month for 6 months.

RESULTS: Clinical and statistical dramatic improvement in the vascularity, pliability, and height of the lesions which have been injected with neuronox. Evaluation of the lesions by the Antera camera has proven marked changes in the vascularity and height. There was no correlations between Vancouver score improvement and variables such as the age, sex, skin type, and duration and lesion type.

CONCLUSIONS: The botulinum toxins proved its efficacy and safety in treatment of hypertrophic scars and keloid in children. It improved the associated itching and pain. Moreover it improves the pliability, erythema, and thickness of the scars.

PMID:36718819 | DOI:10.1111/jocd.15634