Category: Nevin Manimala

Eur J Dermatol. 2022 Jan 1;32(1):94-98. doi: 10.1684/ejd.2022.4233.

ABSTRACT

Background Skin is one of the organs associated with Serratia marcescens infection. The associated morbidity can be significant, however, information is lacking. Objectives To identify characteristics of cases with cutaneous infection of Serratia marcescens. Materials & Methods Cutaneous Serratia marcescens infection was retrospectively analysed between 2005 and 2020. Results A total of 59 patients were identified. Epidemiological data showed an increasing trend of Serratia marcescens isolates. Predisposing conditions were identified as preexisting dermatosis (44.1%), antecedent procedures (35.6%) and trauma (8.5%). The majority of manifestations included cellulitis/erysipelas (50.8%), followed by ulcers (25.4%) and abscesses (11.9%). Most of the isolates were resistant to amoxicillin/clavulanate, ampicillin and firstgeneration cephalosporin. Statistical analysis showed that resistance to second-generation cephalosporin has increased (p < 0.001). Conclusion Serratia marcescens infection appears to have increased in recent years. Clinicians should recognize the clinical significance of this and provide adequate management for better clinical outcome.

PMID:35653082 | DOI:10.1684/ejd.2022.4233

Spine Deform. 2022 Jun 2. doi: 10.1007/s43390-022-00523-7. Online ahead of print.

ABSTRACT

PURPOSE: Limb-lengthening surgery to treat short stature has undergone great development in recent years with the use of intramedullary telescopic nails (TIMNs). A limited number of studies have explored the impact of lower limb lengthening on the spine, though their conclusions are not consistent. The aim of this research is to analyze changes in spinopelvic sagittal alignment and balance after lower limb lengthening in achondroplastic patients.

METHODS: Prospective study of patients with achondroplasia treated with bilateral femoral lengthening using an TIMN. Different sagittal spinal and pelvic plane parameters were measured on pre- and 2 year postoperative lateral spine radiographs: cervical lordosis, thoracic kyphosis, TL junction, lumbar lordosis (LL), pelvic incidence, pelvic tilt (PT), sacral slope (SS), and sagittal vertebral axis (SVA). Similarly, information regarding the elongation procedure was recorded.

RESULTS: A total of 10 patients were included (60% male), with a median age of 13.39 (2.32) years at first surgery and a median height of 120.3 (5.75) cm. A 10 cm elongation was performed in all patients through femoral subtrochanteric osteotomy. Statistically significant changes were found in LL -15.2 (7.4-17.9)º (p = 0.028), PT 11.7 (10.3-13.4)º (p = 0.018), SS – 11.6 (- 13.4 to – 10.4)º (p = 0.018) and |SVA| – 34.3 (- 39.10 to – 1.7) mm (p = 0.043).

CONCLUSION: Bilateral lower limb lengthening in patients with achondroplasia not only increases their size, but also improves sagittal spinopelvic alignment and balance. This may be due to retroversion of the pelvis and subsequent decrease in SS and LL as a result of the increased tightness of the gluteus maximus and hamstring muscles after femoral lengthening through subtrochanteric osteotomy.

LEVEL OF EVIDENCE: II, prospective comparative cohort study, before and after intervention.

PMID:35653063 | DOI:10.1007/s43390-022-00523-7

Drug Saf. 2022 Jun 2. doi: 10.1007/s40264-022-01187-y. Online ahead of print.

ABSTRACT

INTRODUCTION: Vaccine-induced thrombotic thrombocytopenia (VITT) has been identified as a rare but serious adverse event associated with coronavirus disease 2019 (COVID-19) vaccines.

OBJECTIVES: In this study, we explored the pre-pandemic co-occurrence of thrombosis with thrombocytopenia (TWT) using 17 observational health data sources across the world. We applied multiple TWT definitions, estimated the background rate of TWT, characterized TWT patients, and explored the makeup of thrombosis types among TWT patients.

METHODS: We conducted an international network retrospective cohort study using electronic health records and insurance claims data, estimating background rates of TWT amongst persons observed from 2017 to 2019. Following the principles of existing VITT clinical definitions, TWT was defined as patients with a diagnosis of embolic or thrombotic arterial or venous events and a diagnosis or measurement of thrombocytopenia within 7 days. Six TWT phenotypes were considered, which varied in the approach taken in defining thrombosis and thrombocytopenia in real world data.

RESULTS: Overall TWT incidence rates ranged from 1.62 to 150.65 per 100,000 person-years. Substantial heterogeneity exists across data sources and by age, sex, and alternative TWT phenotypes. TWT patients were likely to be men of older age with various comorbidities. Among the thrombosis types, arterial thrombotic events were the most common.

CONCLUSION: Our findings suggest that identifying VITT in observational data presents a substantial challenge, as implementing VITT case definitions based on the co-occurrence of TWT results in large and heterogeneous incidence rate and in a cohort of patints with baseline characteristics that are inconsistent with the VITT cases reported to date.

PMID:35653017 | DOI:10.1007/s40264-022-01187-y

Behav Res Methods. 2022 Jun 2. doi: 10.3758/s13428-022-01838-z. Online ahead of print.

ABSTRACT

Structural equation modeling (SEM) has been deemed as a proper method when variables contain measurement errors. In contrast, path analysis with composite scores is preferred for prediction and diagnosis of individuals. While path analysis with composite scores has been criticized for yielding biased parameter estimates, recent literature pointed out that the population values of parameters in a latent-variable model depend on artificially assigned scales. Consequently, bias in parameter estimates is not a well-grounded concept for models involving latent constructs. This article compares path analysis with composite scores against SEM with respect to effect size and statistical power in testing the significance of the path coefficients, via the z- or t-statistics. The data come from many sources with various models that are substantively determined. Results show that SEM is not as powerful as path analysis even with equally weighted composites. However, path analysis with Bartlett-factor scores and the partial least-squares approach to SEM perform the best with respect to effect size and power.

PMID:35653013 | DOI:10.3758/s13428-022-01838-z

Radiol Med. 2022 Jun 2. doi: 10.1007/s11547-022-01501-9. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study is to evaluate the Radiomics and Machine Learning Analysis based on MRI in the assessment of Liver Mucinous Colorectal Metastases.Query METHODS: The cohort of patients included a training set (121 cases) and an external validation set (30 cases) with colorectal liver metastases with pathological proof and MRI study enrolled in this approved study retrospectively. About 851 radiomics features were extracted as median values by means of the PyRadiomics tool on volume on interest segmented manually by two expert radiologists. Univariate analysis, linear regression modelling and pattern recognition methods were used as statistical and classification procedures.

RESULTS: The best results at univariate analysis were reached by the wavelet_LLH_glcm_JointEntropy extracted by T2W SPACE sequence with accuracy of 92%. Linear regression model increased the performance obtained respect to the univariate analysis. The best results were obtained by a linear regression model of 15 significant features extracted by the T2W SPACE sequence with accuracy of 94%, a sensitivity of 92% and a specificity of 95%. The best classifier among the tested pattern recognition approaches was k-nearest neighbours (KNN); however, KNN achieved lower precision than the best linear regression model.

CONCLUSIONS: Radiomics metrics allow the mucinous subtype lesion characterization, in order to obtain a more personalized approach. We demonstrated that the best performance was obtained by T2-W extracted textural metrics.

PMID:35653011 | DOI:10.1007/s11547-022-01501-9

Eur J Epidemiol. 2022 Jun 2. doi: 10.1007/s10654-022-00880-7. Online ahead of print.

ABSTRACT

The German National Cohort (NAKO) is an ongoing, prospective multicenter cohort study, which started recruitment in 2014 and includes more than 205,000 women and men aged 19-74 years. The study data will be available to the global research community for analyses. Although the ultimate decision about the analytic methods will be made by the respective investigator, in this paper we provide the basis for a harmonized approach to the statistical analyses in the NAKO. We discuss specific aspects of the study (e.g., data collection, weighting to account for the sampling design), but also give general recommendations which may apply to other large cohort studies as well.

PMID:35653006 | DOI:10.1007/s10654-022-00880-7

Lifetime Data Anal. 2022 Jun 2. doi: 10.1007/s10985-022-09555-7. Online ahead of print.

ABSTRACT

This proposal is motivated by an analysis of the English Longitudinal Study of Ageing (ELSA), which aims to investigate the role of loneliness in explaining the negative impact of hearing loss on dementia. The methodological challenges that complicate this mediation analysis include the use of a time-to-event endpoint subject to competing risks, as well as the presence of feedback relationships between the mediator and confounders that are both repeatedly measured over time. To account for these challenges, we introduce path-specific effect proportional (cause-specific) hazard models. These extend marginal structural proportional (cause-specific) hazard models to enable effect decomposition on either the cause-specific hazard ratio scale or the cumulative incidence function scale. We show that under certain ignorability assumptions, the path-specific direct and indirect effects indexing this model are identifiable from the observed data. We next propose an inverse probability weighting approach to estimate these effects. On the ELSA data, this approach reveals little evidence that the total effect of hearing loss on dementia is mediated through the feeling of loneliness, with a non-statistically significant indirect effect equal to 1.01 (hazard ratio (HR) scale; 95% confidence interval (CI) 0.99 to 1.05).

PMID:35652999 | DOI:10.1007/s10985-022-09555-7

J Med Ultrason (2001). 2022 Jun 2. doi: 10.1007/s10396-022-01226-2. Online ahead of print.

ABSTRACT

PURPOSE: The objective of our study was to compare and consider reference values of fetal atrioventricular (AV) intervals as measured by four different pulsed Doppler wave techniques (left ventricular inflow/outflow [LV in/out], pulmonary vein/pulmonary artery [PV/PA], innominate vein/ascending aorta [InnV/AA], and supra vena cava/ascending aorta [SVC/AA]) in pregnant women with anti-SSA/Ro antibodies.

METHODS: Between March 2014 and September 2020, 52 pregnant women with anti-SSA antibodies were enrolled. No bradyarrhythmia was observed in the group. A pulsed Doppler examination of the fetal heart was performed to obtain measurements of the mechanical Doppler AV interval. Doppler measurements were performed using four methods: LV in/out, PV/PA, InnV/AA, and SVC/AA. A statistical analysis was performed to examine the mean, standard deviation, significant difference, and correlation of the four methods. The detection rate of each method was also calculated.

RESULTS: There was no significant difference in the AV intervals between any of the four methods. There was also a positive correlation in the AV intervals of each of the four methods. The fetal heart rate and AV interval showed no correlation. The gestational age and AV interval also showed no correlation. The detection rate was highest for LV in/out (62.6%, 95% confidence interval: 56.5-68.4).

CONCLUSION: All four pulsed Doppler methods are useful for measuring AV intervals. The most practical method is LV in/out.

PMID:35653003 | DOI:10.1007/s10396-022-01226-2

Eur Child Adolesc Psychiatry. 2022 Jun 2. doi: 10.1007/s00787-022-02010-w. Online ahead of print.

ABSTRACT

Emerging research suggests that the prevalence of child and adolescent mental health problems has increased considerably during the COVID-19 crisis. However, there have been few longitudinal studies on children’s mental health issues according to their social determinants in this context, especially in Europe. Our aim was to investigate the association between family socioeconomic status (SES) and children’ mental health during the period of school closure due to COVID-19. Longitudinal data came from 4575 children aged 8-9 years old in 2020 and participating in the ELFE population-based birth cohort that focuses on children’s health, development and socialization. Parents completed the Strengths and Difficulties Questionnaire (SDQ) when children were (a) 5 years of age and (b) 9 years of age, which corresponded to the period of school closure due to the COVID-19 pandemic in France. We retrieved data from the ELFE cohort collected on children from birth to age 5 years (birth, 1 year, 2 years, 3,5 years and 5 years). Socioeconomic status (SES) was measured based on information obtained when the child was 5 years old. Data were analyzed using multinomial logistic regression models. Children’s elevated levels of symptoms of Attention-deficit/Hyperactivity disorder (ADHD) during the period of school closure were significantly associated with prior low family SES (aOR 1.26, 95% CI 1.08-1.48). Children’s elevated symptoms of hyperactivity/inattention and of emotional symptoms were associated with decline in income during the COVID crisis (respectively, aOR 1.38, 95% CI 1.16-1.63 and aOR 1.23, 95% CI 1.01-1.51). Moreover, when testing interactions, a low prior SES was significantly associated with a higher risk of emotional symptoms aOR 1.54 (1.07-2.21), only for children whose families experienced a decline in income, while gender, parental separation and prior mental health difficulties were not associated. This study underlines the impact of the financial crisis related to the COVID-19 epidemic on children’s mental health. Both pre-existing family SES before lockdown and more proximal financial difficulties during the COVID crisis were negatively associated with children’s psychological difficulties during the period of school closure. The pandemic appears to exacerbate mental health problems in deprived children whose families suffer from financial difficulties.

PMID:35652982 | DOI:10.1007/s00787-022-02010-w

Eur Spine J. 2022 Jun 2. doi: 10.1007/s00586-022-07247-2. Online ahead of print.

ABSTRACT

OBJECTIVE: Posterior and transforaminal lumbar interbody fusion (PLIF, TLIF) are among the most popular surgical options for lumbar interbody fusion. If non-union occurs with consequent pain and reduced quality of life, revision surgery should correct any previous technical errors, avoiding further complications. The aim of this study was to analyze technical advantages, radiological and clinical outcomes of anterior approaches (ALIF) in case of failed PLIF or TLIF.

METHODS: Retrospective analysis of consecutive patients with persistent low back pain after failed PLIF/TLIF where salvage ALIF through an anterior retroperitoneal miniopen video-assisted technique was performed. Surgical, clinical and radiological data were analysed. Uni and multivariate statistical analysis were applied.

RESULTS: Thirty-six patients (average age: 47.1 years) were included. Mean follow-up was 34.4 months. In 30 patients (83.3%) a posterior surgical step was necessary. Non-union (86.1%), cage migration (5.5%), infection (8.3%) were the causes of revision surgery. In 22 patients (61.1%) the involved level was L5-S1, in 12 patients (33.4%) L4-L5, in 1 patient (2.7%) L3-L4. One patient (2.7%) had two levels (L4-L5 and L5-S1) involved. No major intraoperative complications were recorded. Significant correlation between clinical and radiological outcomes (L4-S1 and L5-S1 lordosis improvement) were observed (postoperative VAS and L5-S1, p = 0.038).

CONCLUSIONS: Salvage ALIF is a safe option that can significantly ameliorate residual pain achieving primary interbody stability with an ideal segmental lordosis according to pelvic parameters. The advantages of a naive anterior approach fulfils the main objectives of a revision surgery in order to significantly increase the chances of definitive fusion.

PMID:35652952 | DOI:10.1007/s00586-022-07247-2