Category: Nevin Manimala

Int J Pharm Pract. 2021 Dec 30:riab076. doi: 10.1093/ijpp/riab076. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess antibiotic dispensing knowledge and practice among dispensing staff who may or may not have a formal pharmacy qualification working in pharmacies near teaching hospitals in Kathmandu Valley, Nepal.

METHODS: A face-to-face cross-sectional study was conducted among 220 dispensing staff. The data were analysed using SPSS 20 to measure descriptive statistics and logistic regressions.

KEY FINDINGS: Among 220 participants, half of them (50.0%) had inadequate knowledge and slightly less than half of the participants (46.4%) had poor antibiotics dispensing practices.

CONCLUSIONS: The government authority should develop and implement a plan for continuous professional education programmes and frequent monitoring of pharmacies to address inadequate antibiotic dispensing knowledge and poor practice.

PMID:34969084 | DOI:10.1093/ijpp/riab076

Biostatistics. 2021 Dec 30:kxab045. doi: 10.1093/biostatistics/kxab045. Online ahead of print.

ABSTRACT

One-stage meta-analysis of individual participant data (IPD) poses several statistical and computational challenges. For time-to-event outcomes, the approach requires the estimation of complicated nonlinear mixed-effects models that are flexible enough to realistically capture the most important characteristics of the IPD. We present a model class that incorporates general normally distributed random effects into linear transformation models. We discuss extensions to model between-study heterogeneity in baseline risks and covariate effects and also relax the assumption of proportional hazards. Within the proposed framework, data with arbitrary random censoring patterns can be handled. The accompanying $textsf{R}$ package tramME utilizes the Laplace approximation and automatic differentiation to perform efficient maximum likelihood estimation and inference in mixed-effects transformation models. We compare several variants of our model to predict the survival of patients with chronic obstructive pulmonary disease using a large data set of prognostic studies. Finally, a simulation study is presented that verifies the correctness of the implementation and highlights its efficiency compared to an alternative approach.

PMID:34969073 | DOI:10.1093/biostatistics/kxab045

J Public Health (Oxf). 2021 Dec 31:fdab405. doi: 10.1093/pubmed/fdab405. Online ahead of print.

ABSTRACT

BACKGROUND: Shiga toxin-producing Escherichia coli (STEC) are enteric pathogens that cause hemolytic-uremic syndrome (HUS). Ruminants, especially cattle, are their main reservoir. This study describes the seroepidemiology of STEC in rural and urban populations in Argentina, a country with a high HUS incidence.

METHODS: A cross-sectional study was performed in patients without gastrointestinal symptoms. IgG antibodies against Stx2 were detected by western blotting.

RESULTS: Anti-Stx2 antibodies were detected in 14.56% of serum samples, more frequently in rural (19.38%) than urban residents (12%). Seropositivity was associated with lower socioeconomic status (SES). Among the other variables considered, thawing homemade hamburgers before cooking them, and the lack of knowledge about HUS were also associated with seropositivity. A multivariate logistic regression analysis performed with the variables that were statistically significant showed that only the SES index remained significant. As SES was measured based on several variables, we further analyzed each one of them and found that the lack of a high education level was statistically associated with seropositivity.

CONCLUSIONS: The present findings have implications for STEC prevention efforts, highlighting the importance of considering SES and risks factors linked to different SES levels when targeting consumer-level public health interventions.

PMID:34969078 | DOI:10.1093/pubmed/fdab405

Biostatistics. 2021 Dec 30:kxab049. doi: 10.1093/biostatistics/kxab049. Online ahead of print.

ABSTRACT

The causal effects of Apolipoprotein E $epsilon4$ allele (APOE) on late-onset Alzheimer’s disease (AD) and death are complicated to define because AD may occur under one intervention but not under the other, and because AD occurrence may affect age of death. In this article, this dual outcome scenario is studied using the semi-competing risks framework for time-to-event data. Two event times are of interest: a nonterminal event time (age at AD diagnosis), and a terminal event time (age at death). AD diagnosis time is observed only if it precedes death, which may occur before or after AD. We propose new estimands for capturing the causal effect of APOE on AD and death. Our proposal is based on a stratification of the population with respect to the order of the two events. We present a novel assumption utilizing the time-to-event nature of the data, which is more flexible than the often-invoked monotonicity assumption. We derive results on partial identifiability, suggest a sensitivity analysis approach, and give conditions under which full identification is possible. Finally, we present and implement nonparametric and semiparametric estimation methods under right-censored semi-competing risks data for studying the complex effect of APOE on AD and death.

PMID:34969069 | DOI:10.1093/biostatistics/kxab049

Biostatistics. 2021 Dec 30:kxab048. doi: 10.1093/biostatistics/kxab048. Online ahead of print.

ABSTRACT

High-throughput sequencing is widely used to study microbial communities. However, choice of laboratory protocol is known to affect the resulting microbiome data, which has an unquantified impact on many comparisons between communities of scientific interest. We propose a novel approach to evaluating replicability in high-dimensional data and apply it to assess the cross-laboratory replicability of signals in microbiome data using the Microbiome Quality Control Project data set. We learn distinctions between samples as measured by a single laboratory and evaluate whether the same distinctions hold in data produced by other laboratories. While most sequencing laboratories can consistently distinguish between samples (median correct classification 87% on genus-level proportion data), these distinctions frequently fail to hold in data from other laboratories (median correct classification 55% across laboratory on genus-level proportion data). As identical samples processed by different laboratories generate substantively different quantitative results, we conclude that 16S sequencing does not reliably resolve differences in human microbiome samples. However, because we observe greater replicability under certain data transformations, our results inform the analysis of microbiome data.

PMID:34969071 | DOI:10.1093/biostatistics/kxab048

PLoS One. 2021 Dec 30;16(12):e0261006. doi: 10.1371/journal.pone.0261006. eCollection 2021.

ABSTRACT

BACKGROUND: Adherence to antiretroviral therapy (ART) remains problematic. Regular monitoring of its barriers is clinically recommended, however, patient-provider communication around adherence is often inadequate. Our team thus decided to develop a new electronically administered patient-reported outcome measure (PROM) of barriers to ART adherence (the I-Score) to systematically capture this data for physician consideration in routine HIV care. To prepare for a controlled definitive trial to test the I-Score intervention, a pilot study was designed. Its primary objectives are to evaluate patient and physician perceptions of the I-Score intervention and its implementation strategy.

METHODS: This one-arm, 6-month study will adopt a mixed method type 3 implementation-effectiveness hybrid design and be conducted at the Chronic Viral Illness Service of the McGill University Health Centre (Montreal, Canada). Four HIV physicians and 32 of their HIV patients with known or suspected adherence problems will participate. The intervention will involve having patients complete the I-Score through a smartphone application (Opal), before meeting with their physician. Both patients and physicians will have access to the I-Score results, for consideration during the clinic visits at Times 1, 2 (3 months), and 3 (6 months). The implementation strategy will focus on stakeholder involvement, education, and training; promoting the intervention’s adaptability; and hiring an Application Manager to facilitate implementation. Implementation, patient, and service outcomes will be collected (Times 1-2-3). The primary outcome is the intervention’s acceptability to patients and physicians. Qualitative data obtained, in part, through physician focus groups (Times 2-3) and patient interviews (Times 2-3) will help evaluate the implementation strategy and inform any methodological adaptations.

DISCUSSION: This study will help plan a definitive trial to test the efficacy of the I-Score intervention. It will generate needed data on electronic PROM interventions in routine HIV care that will help improve understanding of conditions for their successful implementation.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04702412; https://clinicaltrials.gov/.

PMID:34969046 | DOI:10.1371/journal.pone.0261006

J Korean Assoc Oral Maxillofac Surg. 2021 Dec 31;47(6):445-453. doi: 10.5125/jkaoms.2021.47.6.445.

ABSTRACT

OBJECTIVES: Periodontitis is the most common chronic disease that causes tooth loss and is related to systemic diseases such as cardiovascular disease and diabetes. An objective indicator of the current activity of periodontitis is necessary. Soluble forms of the receptor for advanced glycation end products (sRAGE) are markers that reflect the status of inflammatory diseases. In this study, the relationship between sRAGE and periodontitis was analyzed to determine whether it can be used to diagnose the current state of periodontitis. Patients and.

METHODS: Eighty-four patients without any systemic diseases were diagnosed with periodontitis using three classifications of periodontitis. Demographics and oral examination data such as plaque index (PI), bleeding on probing (BOP) index, and probing pocket depth (PPD) were analyzed according to each classification. In addition, correlation and partial correlation between sRAGE and the values indicating periodontitis were analyzed.

RESULTS: In each classification, the level of sRAGE tended to decrease if periodontitis was present or severe, but this change was not statistically significant. sRAGE and periodontitis-related variables exhibited a weak correlation, among which the BOP index showed a relatively strong negative correlation (ρ=-0.20). Based on this, on analyzing the correlation between the BOP index and sRAGE in the group with more severe periodontitis (PPD≥5 mm group, severe group of AAP/CDC [American Academy of Periodontology/Centers for Disease Control and Prevention], periodontitis group of López), the correlation further increased (ρ=-0.23, -0.40, -0.50). Partial correlation analysis of the sRAGE and BOP index showed a stronger negative correlation (ρ=-0.36, -0.55, -0.45).

CONCLUSION: sRAGE demonstrated a tendency to decrease upon increased severity of periodontitis according to the classifications used. Above all, the correlation with the BOP index, which reflects the current state of periodontitis, was higher in the group with severe periodontitis. This indicates that the current status of periodontitis can be diagnosed through sRAGE.

PMID:34969018 | DOI:10.5125/jkaoms.2021.47.6.445

Acta Cytol. 2021 Dec 30:1-6. doi: 10.1159/000521052. Online ahead of print.

ABSTRACT

INTRODUCTION: The aim of this study is to discover a fast and efficient method for the diagnosis of serous effusion cytology specimens by comparing the cytomorphological features of SurePath (SP) smears and smears prepared by cytospin. After the macroscopic features of the incoming material were recorded, it was divided into 2 for conventional technique (CT) and liquid-based technique. Cytospin was used for CT and SurePath for liquid-based technique in this study.

MATERIALS AND METHODS: 243 serous effusions (33 thoracentesis and 92 paracentesis fluids, 118 peritoneal lavage fluids) were investigated. After shaking the effusion gently, it was centrifuged for 5 min at 1,250 rpm for cytospin smear. SP smear was prepared according to the “BD PrepStain slide processor”. Two smears were prepared with these 2 methods and then stained with Papanicolaou. The smears were examined under a light microscope in terms of fixation, background, cellularity, nucleus, and structural features. All statistical analysis of the data was performed using the SPSS 17.0 software. For each microscopic feature, the χ2 test was used to assess the significance of the relationship between cytospin and SP, and level of agreement in between the methods was assessed using the kappa statistic.

RESULTS: A statistically significant difference was observed between the 2 methods in background (p < 0.001), cellularity (p < 0.001), nucleus features (p < 0.001), and structural features (p < 0.05). There was no significant difference in fixation. Low level of agreement was observed with the kappa statistic in fixation, background, and cellularity. Moderate level of agreement was observed in the nucleus and structural feature groups with the kappa statistic.

DISCUSSION/CONCLUSION: Although there are advantages of liquid-based technique such as standardized fixation and cleaner background, since the cellular and background components required for morphological analysis and diagnosis are better preserved in cytospin, it is considered to be better to use liquid-based technique not alone but together with CT.

PMID:34969029 | DOI:10.1159/000521052

Gait Posture. 2021 Dec 22;92:413-420. doi: 10.1016/j.gaitpost.2021.12.016. Online ahead of print.

ABSTRACT

BACKGROUND: Coordination variability has been linked to overuse running injuries and has been studied both on a treadmill and over-ground. It is not clear, however, if the coordination variability data from over-ground locomotion can be compared with treadmill locomotion data.

RESEARCH QUESTION: Therefore, the purpose of this study was to compare coordination variability of selected lower extremity couplings at different locomotor speeds during over-ground and treadmill walking and running.

METHODS: Nineteen (10 female, 9 male) healthy, recreational collegiate runners participated in this study. Each participant performed in two different conditions: over-ground and on a treadmill at three walking speeds (1.2, 1.6, and 2.0 m•s^-1) and three running speeds (2.8, 3.2, and 3.6 m•s^-1). A modified vector coding technique was used to calculate coordination variability for five selected coupled segment and joint angles. Each of the segmental couples was analyzed separately using a two-way repeated measures ANOVA (Condition Χ Speed) implemented with one-dimensional statistical parametric mapping.

RESULTS: While no interaction effects were observed for condition X speed, we saw increased coordination variability in the sagittal couples during overground compared with treadmill locomotion, which predominantly occurred during the stance phase. There were mixed results for changes in coordination variability as a function of gait speed. However, for the sagital plane couplings, coordination variability decreased with speed, particularly during the stance phase.

SIGNIFICANCE: These results suggest that the controlled belt speed of the treadmill affects the intrinsic dynamics of human movement and this should be considered when making comparisons between treadmill and over-ground studies and in future study designs.

PMID:34968998 | DOI:10.1016/j.gaitpost.2021.12.016

J Korean Assoc Oral Maxillofac Surg. 2021 Dec 31;47(6):438-444. doi: 10.5125/jkaoms.2021.47.6.438.

ABSTRACT

OBJECTIVES: Loss of the interdental papilla is multi-factorial and creates a multitude of problems. Autogenous connective tissue/biomaterial-based regeneration has been attempted for decades to reconstitute the black space created due to the loss of papilla. The aim of this present study was to regenerate papillary recession defects using an amnion-chorion membrane (ACM) allograft and to evaluate the clinical outcome up to six months postoperatively.

MATERIALS AND METHODS: Twenty patients with 25 Nordland and Tarnow’s Class I/II interdental papillary recession defects were treated with ACM and coronal advancement of the gingivo-papillary unit via a semilunar incision on the labial aspect followed by a sulcular incision in the area of interest. A photographic image analysis was carried out using the GNU Image Manipulation software program from the baseline to three and six months postoperatively. The black triangle height (BTH) and the black triangle width (BTW) were calculated using the pixel size and were then converted into millimeters. The mean and standard deviation values were determined at baseline and then again at three and six months postoperatively. The probability values (P <0.05 and P≤0.01) were considered statistically significant and highly significant, respectively. An analysis of variance and post hoc Bonferroni test were carried out to compare the mean values.

RESULTS: Our evaluation of the BTH and BTW showed a statistically and highly significant difference from the baseline until both three and six months postoperatively (P=0.01). A post hoc Bonferroni test disclosed a statistically significant variance from the baseline until three and six months postoperatively (P <0.05) and a non-significant difference from three to six months after the procedure (P≥0.05).

CONCLUSION: An ACM allograft in conjunction with a coronally advanced flap could be a suitable minimally invasive alternative for papillary regeneration.

PMID:34969017 | DOI:10.5125/jkaoms.2021.47.6.438