Category: Nevin Manimala

MSMR. 2022 Dec 31;29(12):2-10.

ABSTRACT

The crew of USS Kidd experienced a COVID-19 outbreak identified in April 2020. This is the earliest documented COVID-19 study with RT-PCR, serology, and pre-exposure test data on the entirety of the exposed population (n=333). Case definitions included 121 confirmed (36.3% of crewmembers) and 18 probable (5.4% of crewmembers) based on laboratory diagnostic test results. At the time of testing positive, 62 (44.6%) cases reported no symptoms. Hispanic ethnicity (AOR: 2.71, CI: 1.40-5.25) and non-smoker status (AOR: 2.28, CI: 1.26-4.12) were identified as statistically significant risk factors. This study highlights the value of rapid, onboard diagnostic testing to quickly identify an outbreak and enumerate cases, as well as the serological testing to flag potential cases missed with standard viral case identification methodologies.

PMID:36821705

Surg Laparosc Endosc Percutan Tech. 2023 Feb 24. doi: 10.1097/SLE.0000000000001157. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study is to compare short-term and midterm outcomes between patients with acute pancreatitis (AP) treated with minimally invasive surgery (MIS) and patients treated with open necrosectomy (ON).

MATERIALS AND METHODS: We compared data of all patients who had undergone MIS for AP with a similar group of patients with ON patients between January 2012 and June 2021 using a case-matched methodology based on AP severity and patient characteristics. Inhospital and midterm follow-up variables, including quality-of-life assessment, were evaluated.

RESULTS: Starting from a whole series of 79 patients with moderate to critical AP admitted to our referral center, the final study sample consisted of 24 patients (12 MIS and 12 ON). Postoperative (18.7±10.9 vs. 30.3±21.7 d; P=0.05) and overall hospitalization (56.3±17.4 vs. 76.9±39.4 d; P=0.05) were lower in the MIS group. Moreover, the Short-Form 36 scores in the ON group were statistically significantly lower in role limitations because of emotional problems (P=0.002) and health changes (P=0.03) at 3 and 6 months and because of emotional problems (P=0.05), emotional well-being (P=0.02), and general health (P=0.007) at 1 year.

CONCLUSIONS: MIS for the surgical management of moderate to critical AP seems to be a good option, as it could provide more chances for a better midterm quality of life compared with ON. Further studies are needed to confirm our findings.

PMID:36821700 | DOI:10.1097/SLE.0000000000001157

Surg Laparosc Endosc Percutan Tech. 2023 Feb 20. doi: 10.1097/SLE.0000000000001153. Online ahead of print.

ABSTRACT

BACKGROUND: Thermal ablation is an accepted treatment modality for small and central liver tumors. In extensive colorectal liver metastatic disease (CRLM), hepatectomy can be combined with ablation, resulting in a parenchymal-sparing strategy. This may increase salvageability rates in case of recurrence.

METHODS: All patients with advanced CRLM that underwent combined ablation and resection between April 2012 and April 2021, were retrospectively analyzed from a prospectively maintained database. Primary endpoints include postoperative 30-day morbidity and ablation-site recurrence (ASR). The surgical approaches were compared. Ablated lesions were screened for ASR on postoperative follow-up imaging.

RESULTS: Of 54 patients that underwent combined ablation and resection, 32 (59.3%) were performed through a minimally invasive approach. Eleven (20.4%) were minor resections, 32 (59.3%) were technically major and 11 (20.4%) were anatomically major resections. Twelve complications occurred (22.2%), among which 2 (3.8%) major complications (Clavien-Dindo ≥IIIa). Ninety-day mortality rate was 1.9%. Out of 82 ablated lesions, 6 ASRs (11.1%) occurred. Median blood loss was significantly lower in the minimally invasive group, compared with open [90 mL (32.5 to 200) vs. 200 mL (100 to 400), P=0.005]. Pringle maneuver was significantly performed less in the minimally invasive group [8 (25.0%) vs. 16 (72.7%), P=0.001], but took more time [36.1 min (±15.6) vs. 21.6 (±9.9); P=0.011]. Short-term (1 y) overall and disease-free survival were respectively 81.4% and 50.0%.

CONCLUSION: Combining microwave ablation and liver resection is a feasible and safe parenchymal-sparing technique, through both minimally invasive and open approach for treating extended CRLM disease. It has a low ablation-related complication rate and acceptable ablation-site recurrence rate.

PMID:36821654 | DOI:10.1097/SLE.0000000000001153

Surg Laparosc Endosc Percutan Tech. 2023 Feb 20. doi: 10.1097/SLE.0000000000001151. Online ahead of print.

ABSTRACT

BACKGROUND: Laparoscopic distal pancreatectomy (L-DP) is the standard procedure for treating left-sided pancreatic tumors. Stapler closure of the pancreas is the preferred method for L-DP; however, postoperative pancreatic fistula (POPF) remains a challenging problem. The present study aimed to compare the surgical outcomes of staple closure using a reinforcing stapler (RS) and transection using an ultrasonic dissector followed by hand-sewn (HS) closure in a fish-mouth manner in pure L-DP and to determine independent perioperative risk factors for clinically relevant postoperative pancreatic fistula (CR-POPF).

PATIENTS AND METHODS: Among the 85 patients who underwent pure L-DP between February 2011 and August 2021, 80 of whom the pancreatic stump was closed with RS (n = 59) or HS (n = 21) were retrospectively investigated. Associations between potential risk factors and POPF were assessed using univariate analysis. The factors, of which the P value was determined to be <0.1 by univariate analysis, were entered into a multivariate regression analysis to ascertain independent predictive factors.

RESULTS: The surgery time and estimated blood loss were not significantly different between the two groups. Overall, 13 patients (16.3%) developed CR-POPF (B = 12 and C = 1). The rate of CR-POPF was lower in RS than in HS; however, the difference was not statistically significant (RS vs HS: 11.9% vs 28.9%, P = 0.092). Consistent with the results for CR-POPF, the rate of Clavien-Dindo IIIa or more postoperative complications and the length of hospital stay were also not significantly different between the two groups (RS vs HS: 10.2, 12% vs 14.3%, 14 d). In the univariate analysis of risk factors for CR-POPF, the pancreatic thickness at the transection site, procedure for stump closure, and estimated blood loss were associated with a significantly higher rate of CR-POPF. The multivariate analysis revealed that the pancreatic thickness at the transection site (cutoff: 12 mm) was the only independent risk factor for CR-POPF (odds ratio: 6.5l, 95% CI: 1.4-30.4, P = 0.018). The rate of CR-POPF was much lower in RS than in HS for pancreatic thickness <12 mm (RS vs HS: 4.1% vs 28.6%), whereas that was rather higher in RS than in HS for pancreatic thickness ≥12 mm (RS vs HS: 50% vs 28.6%).

CONCLUSIONS: RS closure was superior to HS closure for pancreatic thickness <12 mm and for prevention of CR-POPF after pure L-DP. It is necessary to seek more reliable procedures for pancreatic stump closure in patients with a pancreatic thickness of ≥12 mm.

PMID:36821651 | DOI:10.1097/SLE.0000000000001151

PLoS Genet. 2023 Feb 23;19(2):e1010596. doi: 10.1371/journal.pgen.1010596. eCollection 2023 Feb.

ABSTRACT

Genetic studies of disease progression can be used to identify factors that may influence survival or prognosis, which may differ from factors that influence on disease susceptibility. Studies of disease progression feed directly into therapeutics for disease, whereas studies of incidence inform prevention strategies. However, studies of disease progression are known to be affected by collider (also known as “index event”) bias since the disease progression phenotype can only be observed for individuals who have the disease. This applies equally to observational and genetic studies, including genome-wide association studies and Mendelian randomisation (MR) analyses. In this paper, our aim is to review several statistical methods that can be used to detect and adjust for index event bias in studies of disease progression, and how they apply to genetic and MR studies using both individual- and summary-level data. Methods to detect the presence of index event bias include the use of negative controls, a comparison of associations between risk factors for incidence in individuals with and without the disease, and an inspection of Miami plots. Methods to adjust for the bias include inverse probability weighting (with individual-level data), or Slope-Hunter and Dudbridge et al.’s index event bias adjustment (when only summary-level data are available). We also outline two approaches for sensitivity analysis. We then illustrate how three methods to minimise bias can be used in practice with two applied examples. Our first example investigates the effects of blood lipid traits on mortality from coronary heart disease, while our second example investigates genetic associations with breast cancer mortality.

PMID:36821633 | DOI:10.1371/journal.pgen.1010596

PLoS One. 2023 Feb 23;18(2):e0282138. doi: 10.1371/journal.pone.0282138. eCollection 2023.

ABSTRACT

AIMS: This study aimed to determine the impact of correlates on tobacco control/smoke-free status of homes and workplace among Indian people. To assess the magnitude of the problem, the relationship between smoke-free status and secondhand smoke (SHS) exposure was also explored.

METHODS: Data was extracted from the Global Adult Tobacco Survey Data (GATS)-2017. It was a household survey that included people aged 15 years or older and covered all 30 states and 2 Union Territories (UTs) of India. A logistic regression model was used to determine the correlates of smoke-free status of homes and workplaces. Additionally, the Pearson correlation was used to explore the relationship between smoke-free status and the proportion of participants exposed to SHS both at homes and in the workplaces.

RESULTS: The overall prevalence of smoke-free status in the home and workplace was 62.8% and 51.7%, respectively. Results of multivariate analysis (Logistic regression) illustrated that indicators like tobacco smoking status, place of residence, region, education, occupation, wealth quintile, and knowledge status about children’s illness were significantly associated with the respondent’s intention to live in a completely smoke-free environment both at home and in the workplace in India. This study revealed that SHS exposure was significantly negatively associated with a smoke-free status.

CONCLUSION: This study will help the policymakers to promote efficient policies for improving smoke-free status and to ensure a better environment both at home and in the workplace in India.

PMID:36821629 | DOI:10.1371/journal.pone.0282138

PLoS One. 2023 Feb 23;18(2):e0282115. doi: 10.1371/journal.pone.0282115. eCollection 2023.

ABSTRACT

PURPOSE: The purposes of this study were to investigate 1) the location of low back pain (LBP) and 2) the relationships between the location of LBP and the LBP intensity or the quality of life (QoL) in a population-based study.

METHODS: The location of LBP was categorized into four areas using palpation: midline of the lumbar region, paravertebral muscles, upper buttock, and sacroiliac joint. The extent of LBP in the situations/positions was assessed. The relationships between the location of LBP and the extent of LBP on the QoL were statistically analyzed.

RESULTS: 174 participants (average age: 72.3 years-old) were analyzed in this study. 93 participants (53.4% of the total) who had experienced LBP in the past three months were included in the LBP-positive group. Numerical rating scale (NRS) scores of the LBP-positive group were highest in the standing position. 51.6% of the LBP-positive group had LBP at the midline of the lumbar region, 40.9% at the paravertebral muscles, 28.0% at the upper buttock, and 15.1% at the sacroiliac joint. In the standing position, NRS scores of LBP at the upper buttock were significantly higher than those at the midline of the lumbar region and the paravertebral muscles (P<0.05). The Oswestry Disability Index scores of participants who had pain at the upper buttock were significantly higher than those at the midline of the lumbar region or paravertebral muscles (P<0.05).

CONCLUSION: Our study was the first report to investigate the location of LBP using palpation in a population-based study. LBP localization was significantly associated with LBP intensity and LBP-related QoL.

PMID:36821626 | DOI:10.1371/journal.pone.0282115

J Fish Dis. 2023 Feb 23. doi: 10.1111/jfd.13773. Online ahead of print.

ABSTRACT

The intestinal nematode Pseudocapillaria tomentosa in zebrafish (Danio rerio) causes profound intestinal lesions, emaciation and death and is a promoter of a common intestinal cancer in zebrafish. This nematode has been detected in zebrafish from about 15% of the laboratories. Adult worms are readily detected about 3 weeks after exposure by either histology or wet mount preparations of the intestine, and larval worms are inconsistently observed in fish before this time. A quantitative PCR (qPCR) test was recently developed to detect the worm in fish and water, and here we determined that the test on zebrafish intestines was effective for earlier detection. Four lines of zebrafish (AB, TU, 5D and Casper) were experimentally infected and evaluated by wet mounts and qPCR at 8, 15-, 22-, 31- and 44-day post-exposure (dpe). At the first two time points, only 8% of the wet mounts from exposed fish were identified as infected, while the same intestines screened by qPCR showed 78% positivity, with low and consistent cycle threshold (Ct) values at these times. Wet mounts at later time points showed a high prevalence of infection, but this was still surpassed by qPCR.

PMID:36821594 | DOI:10.1111/jfd.13773

Proc Natl Acad Sci U S A. 2023 Feb 28;120(9):e2218375120. doi: 10.1073/pnas.2218375120. Epub 2023 Feb 23.

ABSTRACT

The recent increase in openly available ancient human DNA samples allows for large-scale meta-analysis applications. Trans-generational past human mobility is one of the key aspects that ancient genomics can contribute to since changes in genetic ancestry-unlike cultural changes seen in the archaeological record-necessarily reflect movements of people. Here, we present an algorithm for spatiotemporal mapping of genetic profiles, which allow for direct estimates of past human mobility from large ancient genomic datasets. The key idea of the method is to derive a spatial probability surface of genetic similarity for each individual in its respective past. This is achieved by first creating an interpolated ancestry field through space and time based on multivariate statistics and Gaussian process regression and then using this field to map the ancient individuals into space according to their genetic profile. We apply this algorithm to a dataset of 3138 aDNA samples with genome-wide data from Western Eurasia in the last 10,000 y. Finally, we condense this sample-wise record with a simple summary statistic into a diachronic measure of mobility for subregions in Western, Central, and Southern Europe. For regions and periods with sufficient data coverage, our similarity surfaces and mobility estimates show general concordance with previous results and provide a meta-perspective of genetic changes and human mobility.

PMID:36821583 | DOI:10.1073/pnas.2218375120

PLoS One. 2023 Feb 23;18(2):e0282082. doi: 10.1371/journal.pone.0282082. eCollection 2023.

ABSTRACT

OBJECTIVE: This study aimed to enable the automatic detection of the hippocampus and diagnose mesial temporal lobe epilepsy (MTLE) with the hippocampus as the epileptogenic area using artificial intelligence (AI). We compared the diagnostic accuracies of AI and neurosurgical physicians for MTLE with the hippocampus as the epileptogenic area.

METHOD: In this study, we used an AI program to diagnose MTLE. The image sets were processed using a code written in Python 3.7.4. and analyzed using Open Computer Vision 4.5.1. The deep learning model, which was a fine-tuned VGG16 model, consisted of several layers. The diagnostic accuracies of AI and board-certified neurosurgeons were compared.

RESULTS: AI detected the hippocampi automatically and diagnosed MTLE with the hippocampus as the epileptogenic area on both T2-weighted imaging (T2WI) and fluid-attenuated inversion recovery (FLAIR) images. The diagnostic accuracies of AI based on T2WI and FLAIR data were 99% and 89%, respectively, and those of neurosurgeons based on T2WI and FLAIR data were 94% and 95%, respectively. The diagnostic accuracy of AI was statistically higher than that of board-certified neurosurgeons based on T2WI data (p = 0.00129).

CONCLUSION: The deep learning-based AI program is highly accurate and can diagnose MTLE better than some board-certified neurosurgeons. AI can maintain a certain level of output accuracy and can be a reliable assistant to doctors.

PMID:36821567 | DOI:10.1371/journal.pone.0282082