Category: Nevin Manimala

Am J Med Genet A. 2023 May 14. doi: 10.1002/ajmg.a.63243. Online ahead of print.

ABSTRACT

People with Down syndrome (DS) have a unique medical profile which may impact views of health. We aimed to study the use of global health measures for DS in a national cohort. We prospectively surveyed parents of individuals with DS from the DS-Connect® registry with validated Patient Reported Outcomes Measurement Information System (PROMIS)® instruments of global health. Analyses included use of scoring manuals and the PROMIS® scoring service, descriptive statistics, and t-tests. We received completed surveys from 223 parents of individuals with DS; previously published limitations of the instrument in this population were shown again. T-scores differed from the available comparative standardized scores to these measures from PROMIS® reference population on Fatigue (p < 0.001) and Global Health (p < 0.001), but not on Pain Interference (p = 0.41).

PMID:37183579 | DOI:10.1002/ajmg.a.63243

Int J Dent Hyg. 2023 May 14. doi: 10.1111/idh.12680. Online ahead of print.

ABSTRACT

OBJECTIVE: To validate the level of agreement between self-report and clinical examination for oral conditions and evaluate the effect of sociodemographic conditions on the validity of self-report among women aged 60 and older.

METHODS: A cross-sectional study was conducted in a social community center for seniors in Southern Brazil. Sociodemographic data (age, level of education, and income) were measured. Participants were interviewed and clinically examined for the number of teeth (DMF-T index) and the use of dental prostheses. The self-reported number of teeth in each arch and the use of dental prostheses were gathered through interviews. The level of agreement was estimated using the observed agreement, Kappa statistics, sensitivity/specificity (edentulism/prostheses) and Lin’s concordance correlation coefficient, and related tests (number of teeth). The validity of the oral conditions was estimated according to sociodemographic information.

RESULTS: Ninety-nine women participated in the study. High levels of agreement were observed for edentulism (97.8%; 95%CI 92.8;99.7; Kappa 0.947) and the use of dental prostheses (97.0%; 95%CI 91.3;99.4; Kappa 0.922). In both conditions, despite achieving similar concordance correlation coefficients (ranging from weak to moderate), the mean number of upper teeth was lower in clinical examination (7.1 ± 5.2) compared with self-reported (8.6 ± 3.6), while the opposite was observed for lower teeth (clinical examination: 9.1 ± 3.4; self-reported: 6.6 ± 5.3). Larger differences were found among women of low income and educational levels.

CONCLUSIONS: Our findings suggest that the participants’ socio-economic position might influence their self-reported number of teeth.

PMID:37183553 | DOI:10.1111/idh.12680

Liver Int. 2023 May 15. doi: 10.1111/liv.15606. Online ahead of print.

ABSTRACT

BACKGROUND & AIMS: Alcohol-related hepatitis (AH) encompasses a high mortality. AH might be a concomitant event in patients with acute variceal bleeding (AVB). The current study aimed to assess the prevalence of AH in patients with AVB and to compare the clinical outcomes of AH patients to other alcohol-related liver disease (ALD) phenotypes and viral cirrhosis.

METHODS: Multicentre, observational study including 916 patients with AVB falling under the next categories: AH (n = 99), ALD cirrhosis actively drinking (d-ALD) (n = 285), ALD cirrhosis abstinent from alcohol (a-ALD) (n = 227) and viral cirrhosis (n = 305). We used a Cox proportional hazards model to calculate adjusted hazard ratio (HR) of death adjusted by MELD.

RESULTS: The prevalence of AH was 16% considering only ALD patients. AH patients exhibited more complications. Forty-two days transplant-free survival was worse among AH, but statistical differences were only observed between AH and d-ALD groups (84 vs. 93%; p = 0.005), when adjusted by MELD no differences were observed between AH and the other groups. At one-year, survival of AH patients (72.7%) was similar to the other groups; when adjusted by MELD mortality HR was better in AH compared to a-ALD (0.48; 0.29-0.8, p = 0.004). Finally, active drinkers who remained abstinent presented better survival, independently of having AH.

CONCLUSIONS: Contrary to expected, AH patients with AVB present no worse one-year survival than other patients with different alcohol-related phenotypes or viral cirrhosis. Abstinence influences long-term survival and could explain these counterintuitive results.

PMID:37183551 | DOI:10.1111/liv.15606

Liver Int. 2023 May 15. doi: 10.1111/liv.15595. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Risk prediction in alcohol-related liver disease (ArLD) is an unmet need. We aimed to assess PRO-C3 models to predict liver-related events (LRE) in patients with a history of excessive alcohol use without an established diagnosis of chronic liver disease.

METHODS: A prospective cohort study of 462 patients with ArLD, split into a derivation cohort of 221 secondary care patients and a validation cohort of 241 primary care patients. Baseline variables, including fibrogenesis marker PRO-C3, were used to develop a prediction model. Prognostic accuracy was compared to enhanced liver fibrosis (ELF), fibrosis-4-index (FIB-4), transient elastography (TE) and ADAPT.

RESULTS: In the derivation and validation cohorts, 67 (30%) and 19 (8%) experienced an LRE during a median follow-up of 5.2 years (IQR: 3.2-6.8) and 4.0 years (IQR: 2.7-5.6). On top of PRO-C3 and ADAPT score, we generated a model (ALPACA) of independent predictors of LREs (PRO-C3, AST/ALT, platelets). ALPACA had high prognostic accuracy with a C-statistic of 0.85 in the derivation cohort, comparable to ELF (0.83) and TE (0.84) and significantly higher than FIB-4 (0.78), PRO-C3 (0.80) and ADAPT (0.81). In the validation cohort, all tests had comparable C-statistics. Compared to low-risk patients (ALPACA ≤11), high-risk patients (>11) had a subhazard ratio for LREs of 12.6 (95% CI 5.9-26.8, p < .001) and higher cumulative incidence (57% vs. 7%, p < .001; derivation cohort). We observed similar subhazard ratio in the validation cohort.

CONCLUSIONS: PRO-C3-based scores are reliable tools to predict LREs in ArLD patients and are suitable for risk stratification in primary and secondary care.

PMID:37183542 | DOI:10.1111/liv.15595

Cogn Sci. 2023 May;47(5):e13294. doi: 10.1111/cogs.13294.

ABSTRACT

People are known for good predictions in domains they have rich experience with, such as everyday statistics and intuitive physics. But how well can they predict for problems they lack experience with, such as the duration of an ongoing epidemic caused by a new virus? Amid the first wave of COVID-19 in China, we conducted an online diary study, asking each of over 400 participants to predict the remaining duration of the epidemic, once per day for 14 days. Participants’ predictions reflected a reasonable use of publicly available information but were meanwhile biased, subject to the influence of negative affect and future time perspectives. Computational modeling revealed that participants neither relied on prior distributions of epidemic durations as in inferring everyday statistics, nor on mechanistic simulations of epidemic dynamics as in computing intuitive physics. Instead, with minimal experience, participants’ predictions were best explained by similarity-based generalization of the temporal pattern of epidemic statistics. In two control experiments, we further confirmed that such cognitive algorithm is not specific to the epidemic scenario and that minimal and rich experience do lead to different prediction behaviors for the same observations. We conclude that people generalize patterns in recent history to predict the future under minimal experience.

PMID:37183511 | DOI:10.1111/cogs.13294

Neurol Res. 2023 May 14:1-11. doi: 10.1080/01616412.2023.2211457. Online ahead of print.

ABSTRACT

OBJECTIVE: This systematic review with meta-analysis aimed to evaluate the effectiveness of tDCS on lower limb function, balance and quality of life in stroke patients.

METHODS: The search included PubMed, CENTRAL, PEDro, Web of Science, SCOPUS, PsycINFO Ovid, CINAHL EBSCO, EMBASE, ScienceDirect, reference lists of relevant reviews, clinical trials registries and academic google, in June and July 2021. Randomized controlled trials were selected, which present the effect of tDCS on lower limb motor function recovery in stroke patients, comparing any type of active tDCS versus sham; parallel or crossover study design; adult patients; stimulation on the primary motor cortex; articles published in any language; without restriction of publication period.

RESULTS: Nineteen studies were included. The treatment with active tDCS did not improve motor function (Chi² = 32,87, I² = 76%, SMD = 0,36 e 95% CI -0,18-0,90). Subgroup analyzes showed a significant effect favorable to tDCS, in relation to motor function, in the acute and subacute post stroke phases. However, the quality of evidence for this outcome was very low. Regarding balance outcome, a meta-analysis showed a significant difference in favor of active tDCS, but the quality of the evidence was considered very low. As for the quality of life outcome, no statistically significant difference was found in favor of tDCS.

DISCUSSION: There is a lack of evidence in recommending the use of tDCS in isolation in the treatment of patients after stroke, aiming at improving motor function, balance and quality of life. However, it is possible that tDCS can be beneficial when associated with other therapies or interventions.

PMID:37183510 | DOI:10.1080/01616412.2023.2211457

Cogn Sci. 2023 May;47(5):e13284. doi: 10.1111/cogs.13284.

ABSTRACT

There are two main approaches to how statistical patterns are extracted from sequences: The transitional probability approach proposes that statistical learning occurs through the computation of probabilities between items in a sequence. The chunking approach, including models such as PARSER and TRACX, proposes that units are extracted as chunks. Importantly, the chunking approach suggests that the extraction of full units weakens the processing of subunits while the transitional probability approach suggests that both units and subunits should strengthen. Previous findings using sequentially organized, auditory stimuli or spatially organized, visual stimuli support the chunking approach. However, one limitation of prior studies is that most assessed learning with the two-alternative forced-choice task. In contrast, this pre-registered experiment examined the two theoretical approaches in sequentially organized, visual stimuli using an online self-paced task-arguably providing a more sensitive index of learning as it occurs-and a secondary offline familiarity judgment task. During the self-paced task, abstract shapes were covertly organized into eight triplets (ABC) where one in every eight was altered (BCA) from the canonical structure in a way that disrupted the full unit while preserving a subunit (BC). Results from the offline familiarity judgment task revealed that the altered triplets were perceived as highly familiar, suggesting the learned representations were relatively flexible. More importantly, results from the online self-paced task demonstrated that processing for subunits, but not unit-initial stimuli, was impeded in the altered triplet. The pattern of results is in line with the chunking approach to statistical learning and, more specifically, the TRACX model.

PMID:37183483 | DOI:10.1111/cogs.13284

Am Surg. 2023 May 15:31348231175104. doi: 10.1177/00031348231175104. Online ahead of print.

ABSTRACT

The COVID-19 pandemic has had profound effects on the everyday behaviors of all patients. At the same time, the United States population is aging, and an increasing portion of traumatically injured patients are geriatric. Our study aims to examine the effects of the COVID-19 pandemic on the geriatric trauma population. We performed a retrospective review of the trauma database from our single institution level I trauma center examining pandemics impact on geriatric trauma demographics, mechanism of injury, injury severity, hospitalization characteristics, and alcohol use. Data during the pandemic was compared to the prior 3 years and controlled for seasonality. Statistical analysis demonstrated an increase in duration of mechanical ventilation and alcohol use during the pandemic while other factors remained stable. This shows the need for targeted alcohol assessment in the geriatric trauma population during periods of social isolation and additional research into the effects of the COVID-19 on trauma patients.

PMID:37183430 | DOI:10.1177/00031348231175104

Saudi Med J. 2023 May;44(5):486-491. doi: 10.15537/smj.2023.44.5.20220818.

ABSTRACT

OBJECTIVES: To understand the most common type and clinical manifestations of associated vasculitis (AAV) in the Saudi Arabia.

METHODS: This retrospective study was conducted at King Fahad Medical City and the Security Forces Hospital Program, Riyadh, Saudi Arabia, between January 2014 and May 2022. Patients aged ≥18 years were included in the study and diagnosed based on clinical manifestations, serology, or histopathology according to the EMA algorithm. Univariate analysis was carried out to compare different groups; a series of independent samples t-tests was applied for continuous data.

RESULTS: A total of 53 patients were enrolled: eosinophilic granulomatosis with polyangiitis (EGPA), granulomatosis with polyangiitis (GPA), and microscopic polyangiitis (MPA). Overall, proteinase-3 was the most prevalent (52.8%), and myeloperoxidase, myeloperoxidase MPO was the least prevalent antineutrophil cytoplasmic antibody (ANCA)-type (18.9%) among patients; other patients showed negative ANCA test results. The clinical manifestations differed significantly between EGPA and GPA groups in pulmonary, neurological, cardiological, and renal signs and symptoms (p<0.05); there was a higher incidence of the former 3 in the EGPA group. Although upper airway was predominant in all groups, there was no statistical difference between both groups.

CONCLUSION: This study validated international reports on AAV clinical manifestations in the Saudi population. The GPA was associated with more upper airway and pulmonary signs and symptoms. Further investigation is needed to understand the treatments and quality of life of patients with AAV.

PMID:37182925 | DOI:10.15537/smj.2023.44.5.20220818

Saudi Med J. 2023 May;44(5):498-499. doi: 10.15537/smj.2023.44.5.20230070.

ABSTRACT

OBJECTIVES: To investigate the clinical and pathological characteristics of extracranial germ cell tumors (GCTs) in children aged 0-168 months treated at the National Guard Hospital, Jeddah, Saudi Arabia from 1990 to 2020.

METHODS: In this retrospective analysis, the data for all cases of GCTs were collected from 1990 to 2020. Statistical analyses were carried out using JMP software. The data was divided into 4 main categories: demographics, pathological/clinical features, recurrence, treatment and outcome.

RESULTS: The study included 50 patients, with a mean age at diagnosis of 56.52 months. The median follow-up duration was 30 months. Most tumors were in the gonads, and among the extragonadal tumors, the sacro-coccyx was the most frequent site of the disease.The most common histological subtype of GCTs is yolk sac tumor, accounting for 28% of cases. Of the 50 patients, 46% received chemotherapy, and 54% underwent surgery without chemotherapy. Ten (20%) patients experienced recurrence after treatment. At the last follow-up, 96% of the patients were alive, and only 2 of the patients died due to advanced disease.

CONCLUSION: Our findings were comparable to international data, but improvement in surveillance is required for long-term survivors.

PMID:37182921 | DOI:10.15537/smj.2023.44.5.20230070