Category: Nevin Manimala

Clin Endocrinol (Oxf). 2023 Jun 8. doi: 10.1111/cen.14934. Online ahead of print.

ABSTRACT

OBJECTIVE: Increasing referrals to Endocrinology with nonspecific symptoms of suspected adrenal insufficiency (AI) has increased use of the short-synacthen test (SST). Prevailing resource and safety concerns emphasise importance of patient selection criterion to optimise SST use. This study aimed to (1) document the adverse event profile of the SST (2) identify any pretest predictors of SST outcome.

DESIGN, PATIENTS AND MEASUREMENTS: Retrospective data analysis of all patients referred for SST in Oxford from 2017 to 2021. Pretest clinical variables (age, sex, BMI, blood pressure and electrolytes), symptoms (fatigue, dizziness, weight loss) and pretest morning cortisol were included in the statistical model with the aim of identifying any variables that could predict SST outcome in Group 1 primary AI, Group 2 central AI and Group 3 glucocorticoid induced AI. Symptoms and signs during and post SST were also noted with the aim of describing adverse effects to synacthen across a large cohort.

RESULTS: A total 1480 SSTs (Males:38%, age 52 [39-66] years) were performed: 505 (34.1%) in Group 1, 838 (57%) in Group 2, and 137 (9.3%) in Group 3. Adverse-effects were recorded in 1.8% of tests, including one episode of anaphylaxis. Pretest morning-cortisol was the only predictor for an “SST pass” (whole cohort: B = 0.015, p < 0.001, Group 1: B = 0.018, p < .001; Group 2: B = 0.010, p < 0.012; Group 3: B = 0.018, p = <.001). A threshold of ≥343 nmol/l (receiver-operating characteristic [ROC] area under the curve [AUC] = 0.725, 95% confidence interval [CI] 0.675-0.775, p < 0.001) for the whole cohort, ≥300 nmol/L (ROC AUC = 0.763, 95% CI 0.675 to 0.850, p < 0.001) for Group 1, ≥340 nmol/L (ROC AUC = 0.688, 95% CI 0.615 to 0.761, p < 0.001) for Group2, and ≥376 nmol/L [baseline cortisol] (ROC AUC = 0.783, 95% CI 0.708 to 0.859, p < 0.001) for Group 3, predicted an ‘SST pass’ with 100% specificity.

CONCLUSIONS: Adverse effects to synacthen are rare. Pretest morning cortisol is a reliable predictor for SST outcome and is a helpful tool to rationalise use of the SST. Predictive morning-cortisol thresholds vary according to the aetiology of AI.

PMID:37288515 | DOI:10.1111/cen.14934

Am J Epidemiol. 2023 Jun 7:kwad136. doi: 10.1093/aje/kwad136. Online ahead of print.

ABSTRACT

Traffic-calming measures (TCMs) are physical modifications to the road network aimed at making the roads safer. Although studies have reported reductions in road crashes and injuries tied to the presence of TCMs, they have been criticized for their pre-post designs. This study aims to complement our knowledge of TCMs effectiveness by assessing their impact using a longitudinal design. The implementation of eight TCMs, including curb extensions and speed humps, was evaluated at the intersections and census tract levels in Montreal, Canada from 2012 to 2019. The primary outcome was fatal or serious collisions among all road users. Inference was performed using a Bayesian implementation of Conditional Poisson regression in which random effects were used to account for the spatiotemporal variation in collisions. TCMs were generally implemented on local roads, although most collisions occurred on arterial roads. Overall, there was weak evidence that TCMs were associated with study outcomes. However, subgroup analyses of intersections on local roads suggested a reduction in collision rates due to TCMs (median IRR: 0.31; 95% Credible Interval: 0.12 – 0.86). To improve road safety, effective counterparts of TCMs on arterial roads must be identified and implemented.

PMID:37288501 | DOI:10.1093/aje/kwad136

Vet Radiol Ultrasound. 2023 Jun 8. doi: 10.1111/vru.13255. Online ahead of print.

ABSTRACT

Slab fractures of the third carpal bone (C3) are a common cause of lameness in Thoroughbred racehorses. Information on fracture morphology is commonly obtained from radiographs or CT. This retrospective, methods comparison aimed to explore the agreement between radiography and CT for imaging C3 slab fractures and discuss the contribution of the latter to clinical case management. Thoroughbred racehorses with a slab or incomplete slab fracture of C3 identified on radiographs that subsequently underwent CT examination were included. Fracture characteristics (location, plane, classification, displacement, comminution) and fracture length as a percentage of the proximodistal length of the bone, termed the proximodistal fracture percentage (PFP) were recorded independently from both modalities and then compared. Across all fractures (n = 82) radiographs and CT showed slight agreement on the presence of comminution (Cohen’s Kappa (κ) 0.108, P 0.031) and moderate agreement on fracture displacement (K 0.683, P < 0.001). Computed tomography identified comminution in 49 (59.8%) and displacement in nine (11.0%) fractures that were not detected by radiographs. Half of the fractures were only seen on flexed dorsoproximal-dorsodistal oblique (DPr-DDiO) radiographs and therefore were of unknown length without additional CT imaging. Incomplete fractures that could be measured on radiographs (n = 12) had a median (IQR) PFP of 40% (30%-52%) on radiographs and 53% (38%-59%) on CT, a statistically significant difference (P = 0.026). Radiography and CT showed the poorest agreement when determining the presence of comminution. Additionally, radiography often underestimated the incidence of displacement, and fracture length, and resulted in more fractures being classified as incomplete when compared to CT.

PMID:37288478 | DOI:10.1111/vru.13255

Cancer Rep (Hoboken). 2023 Jun 7:e1837. doi: 10.1002/cnr2.1837. Online ahead of print.

ABSTRACT

BACKGROUND: The treatment of glottic cancer remains challenging, especially with regard to morbidity reduction and larynx preservation rates. The National Comprehensive Cancer Network (NCCN) has published guidelines to aid decision-making about this treatment according to the tumor site, clinical stage, and patient medical status.

AIM: The present review was conducted to identify changes in the NCCN guidelines for glottic cancer treatment made between 2011 and 2022 and to describe the published evidence concerning glottic cancer treatment and oncological outcomes in the same time period.

METHODS AND RESULTS: Clinical practice guidelines for head and neck cancer published from 2011 up to 2022 were obtained from the NCCN website (www.NCCN.org). Data on glottic cancer treatment recommendations were extracted, and descriptive analysis was performed. In addition, a review of literature registered in the PubMed database was performed to obtain data on glottic cancer management protocols and treatment outcomes from randomized controlled trials, systematic reviews, and meta-analyses published from 2011 to 2022. In total, 24 NCCN guidelines and updates and 68 relevant studies included in the PubMed database were identified. The main guideline changes made pertained to surgical and systemic therapies, the consideration of adverse features, and new options for the treatment of metastatic disease at initial presentation. Early-stage glottic cancer received the most research attention, with transoral endoscopic laser surgery and radiotherapy assessed and compared as the main treatment modalities. Reported associations between treatment types and survival rates for this stage of glottic cancer appear to be similar, but functional outcomes can be highly compromised.

CONCLUSION: NCCN panel members provide updated recommendations based on currently accepted treatment approaches for glottic cancer, constantly reviewing new surgical and non-surgical techniques. The guidelines support decision-making about glottic cancer treatment that should be individualized and prioritize patients’ quality of life, functionality, and preferences.

PMID:37288471 | DOI:10.1002/cnr2.1837

Stat Commun Infect Dis. 2020 Dec 11;12(Suppl1):20190018. doi: 10.1515/scid-2019-0018. eCollection 2020 Sep 1.

ABSTRACT

OBJECTIVES: Exploratory studies that aim to evaluate novel therapeutic strategies in human cohorts often involve the collection of hundreds of variables measured over time on a small sample of individuals. Stringent error control for testing hypotheses in this setting renders it difficult to identify statistically signification associations. The objective of this study is to demonstrate how leveraging prior information about the biological relationships among variables can increase power for novel discovery.

METHODS: We apply the class level association score statistic for longitudinal data (CLASS-LD) as an analysis strategy that complements single variable tests. An example is presented that aims to evaluate the relationships among 14 T-cell and monocyte activation variables measured with CD4 T-cell count over three time points after antiretroviral therapy (n=62).

RESULTS: CLASS-LD using three classes with emphasis on T-cell activation with either classical vs. intermediate/inflammatory monocyte subsets detected associations in two of three classes, while single variable testing detected only one out of the 14 variables considered.

CONCLUSIONS: Application of a class-level testing strategy provides an alternative to single immune variables by defining hypotheses based on a collection of variables that share a known underlying biological relationship. Broader use of class-level analysis is expected to increase the available information that can be derived from limited sample clinical studies.

PMID:37288470 | PMC:PMC10243175 | DOI:10.1515/scid-2019-0018

Stat Commun Infect Dis. 2020 Nov 12;12(Suppl1):20190017. doi: 10.1515/scid-2019-0017. eCollection 2020 Sep 1.

ABSTRACT

BACKGROUND: Human immunodeficiency virus (HIV) viral failure occurs when antiretroviral therapy fails to suppress and sustain a person’s viral load count below 1,000 copies of viral ribonucleic acid per milliliter. For those newly diagnosed with HIV and living in a setting where healthcare resources are limited, such as a low- and middle-income country, the World Health Organization recommends viral load monitoring six months after initiation of antiretroviral treatment and yearly thereafter. Deviations from this schedule are made in cases where viral failure occurs or at the discretion of the clinician. Failure to detect viral failure in a timely fashion can lead to delayed administration of essential interventions. Clinical prediction models based on information available in the patient medical record are increasingly being developed and deployed for decision support in clinical medicine and public health. This raises the possibility that prediction models can be used to detect potential for viral failure in advance of viral measurements, particularly when those measurements occur infrequently.

OBJECTIVE: Our goal is to use electronic health record data from a large HIV care program in Kenya to characterize and compare the predictive accuracy of several statistical machine learning methods for predicting viral failure at the first and second measurements following initiation of antiretroviral therapy. Predictive accuracy is measured in terms of sensitivity, specificity and area under the receiver-operator characteristic curve.

METHODS: We trained and cross-validated 10 statistical machine learning models and algorithms on data from over 10,000 patients in the Academic Model Providing Access to Healthcare care program in western Kenya. These included parametric, non-parametric, ensemble, and Bayesian methods. The input variables included 50 items from the clinical record, hand picked in consultation with clinician experts. Predictive accuracy measures were calculated using 10-fold cross validation.

RESULTS: Viral load failure rate is about 20% in this patient cohort at both the first and second measurements. Ensemble techniques generally outperformed other methods. For predicting viral failure at the first follow up measure, specificity was over 90% for these methods, but sensitivity was typically in the 50-60% range. Predictive accuracy was greater for the second follow up measure, with sensitivities over 80%. Super Learner, gradient boosting and Bayesian additive regression trees consistently outperformed other methods. For a viral failure rate of 20%, the positive predictive value for the top-performing methods is between 75 and 85%, while the negative predictive value is over 95%.

CONCLUSION: Evidence from this study suggests that machine learning techniques have potential to identify patients at risk for viral failure prior to their scheduled measurements. Ultimately, prognostic virologic assessment can help guide the administration of earlier targeted intervention such as enhanced drug resistance monitoring, rigorous adherence counseling, or appropriate next-line therapy switching. External validation studies should be used to confirm the results found here.

PMID:37288469 | PMC:PMC10243177 | DOI:10.1515/scid-2019-0017

J Sustain Metall. 2023;9(2):564-577. doi: 10.1007/s40831-023-00667-4. Epub 2023 Mar 9.

ABSTRACT

Titanium products play an important and irreplaceable role in national defense and military applications and are considered as strategic resources by many governments. Although China developed a large-scale titanium industrial chain that affects the global market, it is still weak in high-end titanium-based alloys and needs an urgent upgrade. Few policies have been implemented at the national level to explore the development strategies of China’s titanium industry and related industries. One major issue is the lack of reliable statistical data, which is essential for setting the national strategies of China’s titanium industry. Additionally, waste management and scrap recycling in titanium products manufacturers are not yet considered, which would significantly impact the lifetime of titanium scrap and demand for virgin titanium metal resources. To address this gap, this work has developed a titanium products flow chart for China and presented trends in the titanium industry from 2005 to 2020. The results show that only about 65% to 85% of domestic titanium sponge is finally sold as ingots, and only about 60% to 85% of ingots are finally sold as mills, indicating excessive production has been a characteristic of China’s titanium industry. The average recovery ratio of prompt swarf for ingots is about 63%, and that for mills is about 56%, which can be recycled into ingots by remelting, relieving constraints on high-grade titanium sponge and reducing dependence on it to some extent.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40831-023-00667-4.

PMID:37288450 | PMC:PMC9997429 | DOI:10.1007/s40831-023-00667-4

eNeurologicalSci. 2023 May 25;31:100468. doi: 10.1016/j.ensci.2023.100468. eCollection 2023 Jun.

ABSTRACT

BACKGROUND AND PURPOSE: Guillain- Barré syndrome (GBS) is a neuropathic condition that leads to the rapid development of impairments and is characterized by weakness and numbness or tingling sensation in the legs and arms and sometimes loss of movement and feeling in the legs, arms, upper body, and face. Currently, the cure for the disease is yet to be developed. However, treatment options such as intravenous immunoglobulin (IVIG) and plasma exchange (PE) have been used to minimize the symptoms and duration of the disease. Therefore, this systematic review and meta-analysis compared the efficacy of IVIG and PE in treating GBS patients with severe symptoms.

METHODOLOGY: Six electronic databases, including PubMed, Embase, Scopus, ScienceDirect, Medline, and Google scholar, were scoured for articles related and relevant to our research. Additionally, more studies were obtained through the reference lists of the studies retrieved from these electronic databases. Quality assessment and statistical data analysis were conducted using Review Manager software (RevMan 5.4.1).

RESULTS: The search for relevant articles resulted in 3253 articles, of which only 20 were included for review in the current study. A sub-group analysis indicated no significant difference in the curative effect (Hughes score reduces by at least one score 4 weeks after GBS treatment; OR: 1.00; 95% CI: 0.66-1.52; p = 1.00 and Achieving grade 0 or 1 on Hughes scale; OR: 1.03; 95% CI: 0.27-3.94; p = 0.97). Similarly, the statistical showed that the difference in length of hospitalization and duration of mechanical ventilation was insignificant between the IVIG and PE group (Standard Mean Difference (SMD): -0.45; 95% CI: -0.92, 0.02; I² = 91%; p = 0.06 and SMD: -0.54; 95% CI: -1.67, 0.59; I² = 93%; p = 0.35, respectively). Moreover, the meta-analysis did not find any significant difference in the risk of GBS relapse (RR: 0.47; 95% CI: 0.20-1.14; p = 0.10) and risk of complications related to the treatment regimens (RR: 1.03; 95% CI: 0.71-1.48; p = 0.89). However, the statistical analysis of outcomes from 3 studies showed that the risk of discontinuation was significantly lower in the IVIG group than in the PE group (RR: 0.22; 95% CI: 0.06-0.88; p = 0.03).

CONCLUSION: Our study suggests that IVIG and PE have similar curative effects. Similarly, IVIG seems easier to use and thus can be preferred for treating GBS.

PMID:37288440 | PMC:PMC10242495 | DOI:10.1016/j.ensci.2023.100468

JPRAS Open. 2023 Apr 22;37:1-8. doi: 10.1016/j.jpra.2023.04.002. eCollection 2023 Sep.

ABSTRACT

BACKGROUND: Acquired factor XIII deficiency is an underestimated risk in patients with large surface burns, which potentially exposes these patients to prolonged bleeding and delayed wound healing if undetected.

METHODS: A retrospective matched-pair analysis of the burn registry of the Department of Plastic, Aesthetic, Hand, and Reconstructive Surgery of Hannover Medical School was performed from 2018 to 2023.

RESULTS: A total of 18 patients were included. Acquired factor XIII deficiency was not statistically significant correlated with age, sex, or body mass index. Patients who developed acquired factor XIII deficiency had a significantly longer hospital stay (72.8 days) compared with those in the matched group (46.4 days), although burn depths, total body surface area, and Abbreviated Burn Severity Index were not statistically correlated with factor XIII deficiency.

CONCLUSIONS: Little is known about acquired factor XIII deficiency in patients with burns. Factor XIII supplementation may improve hemostasis, wound healing, and general outcome while reducing the patient’s exposure to blood products.

PMID:37288428 | PMC:PMC10242619 | DOI:10.1016/j.jpra.2023.04.002

J Educ Health Promot. 2023 Mar 31;12:90. doi: 10.4103/jehp.jehp_1216_22. eCollection 2023.

ABSTRACT

BACKGROUND: Anger is a natural feeling which is essential for survival, however, which can impair functioning if it is excessive. Adolescents need to be equipped with skills to cope with their anger for the promotion of their health and safety. This study aims to examine the effectiveness of anger management program on anger level, problem solving skills, communication skills, and adjustment among school-going adolescents.

MATERIALS AND METHODS: An experimental, pre-test-post-test control group design with a multistage random sampling was adopted to select 128 school-going adolescents aged between 13 and 16 years. Experimental group received six sessions of anger management program, while control group received one session on anger management skill after the completion of post-assessment for both the groups. Sessions included education on anger, ABC analysis of behavior and relaxation training, modifying anger inducing thoughts, problem solving, and communication skills training. Assessment done after the 2 months of anger management program. Data were analyzed through descriptive and inferential statistics.

RESULTS: Study reveals the improvement in the problem solving skills (81.66 ± 4.81), communication skills (82.40 ± 3.82), adjustment (28.35 ± 3.76), and decreased anger level (56.48 ± 4.97). Within the experimental and between the experimental and control group, post-test mean scores differed significantly (P < 0.05).

CONCLUSION: The results revealed that the anger management program was effective in decreasing anger level and increasing problem solving skills, communication skills, and adjustment among school-going adolescents.

PMID:37288422 | PMC:PMC10243415 | DOI:10.4103/jehp.jehp_1216_22