Category: Nevin Manimala

Neurology. 2022 Sep 6;99(10):e999-e1008. doi: 10.1212/WNL.0000000000200807. Epub 2022 Jun 8.

ABSTRACT

BACKGROUND AND OBJECTIVES: About 30% of patients with glioma need an add-on antiseizure medication (ASM) due to uncontrolled seizures on ASM monotherapy. This study aimed to determine whether levetiracetam combined with valproic acid (LEV + VPA), a commonly prescribed duotherapy, is more effective than other duotherapy combinations including either LEV or VPA in patients with glioma.

METHODS: In this multicenter retrospective observational cohort study, treatment failure (i.e., replacement by, addition of, or withdrawal of an ASM) for any reason was the primary outcome. Secondary outcomes included (1) treatment failure due to uncontrolled seizures and (2) treatment failure due to adverse effects. Time to treatment failure was estimated from the moment of ASM duotherapy initiation. Multivariable cause-specific Cox proportional hazard models were estimated to study the association between risk factors and treatment failure. The maximum duration of follow-up was 36 months.

RESULTS: A total of 1,435 patients were treated with first-line monotherapy LEV or VPA, of which 355 patients received ASM duotherapy after they had treatment failure due to uncontrolled seizures on monotherapy. LEV + VPA was prescribed in 66% (236/355) and other ASM duotherapy combinations including LEV or VPA in 34% (119/355) of patients. Patients using other duotherapy vs LEV + VPA had a higher risk of treatment failure for any reason (cause-specific adjusted hazard ratio [aHR] 1.50 [95% CI 1.07-2.12], p = 0.020), due to uncontrolled seizures (cause-specific aHR 1.73 [95% CI 1.10-2.73], p = 0.018), but not due to adverse effects (cause-specific aHR 0.88 [95% CI 0.47-1.67], p = 0.703).

DISCUSSION: This observational cohort study suggests that LEV + VPA has better efficacy than other ASM combinations. Similar toxicities were experienced in the 2 groups.

CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that for patients with glioma with uncontrolled seizures on ASM monotherapy, LEV + VPA has better efficacy than other ASM combinations.

PMID:36219797 | DOI:10.1212/WNL.0000000000200807

Int J Epidemiol. 2022 Oct 11:dyac185. doi: 10.1093/ije/dyac185. Online ahead of print.

ABSTRACT

BACKGROUND: Health care professionals seek information about effectiveness of treatments in patients who would be offered them in routine clinical practice. Electronic medical records (EMRs) and randomized controlled trials (RCTs) can both provide data on treatment effects; however, each data source has limitations when considered in isolation.

METHODS: A novel modelling methodology which incorporates RCT estimates in the analysis of EMR data via informative prior distributions is proposed. A Bayesian mixed modelling approach is used to model outcome trajectories among patients in the EMR dataset receiving the treatment of interest. This model incorporates an estimate of treatment effect based on a meta-analysis of RCTs as an informative prior distribution. This provides a combined estimate of treatment effect based on both data sources.

RESULTS: The superior performance of the novel combined estimator is demonstrated via a simulation study. The new approach is applied to estimate the effectiveness at 12 months after treatment initiation of acetylcholinesterase inhibitors in the management of the cognitive symptoms of dementia in terms of Mini-Mental State Examination scores. This demonstrated that estimates based on either trials data only (1.10, SE = 0.316) or cohort data only (1.56, SE = 0.240) overestimated this compared with the estimate using data from both sources (0.86, SE = 0.327).

CONCLUSIONS: It is possible to combine data from EMRs and RCTs in order to provide better estimates of treatment effectiveness.

PMID:36219788 | DOI:10.1093/ije/dyac185

Photobiomodul Photomed Laser Surg. 2022 Oct 10. doi: 10.1089/photob.2022.0054. Online ahead of print.

ABSTRACT

Objective: The present study aimed to evaluate the effectiveness of the application of photobiomodulation therapy (PBMT) in the prevention of recurrent herpes labialis (RHL) through a randomized controlled clinical trial. Background data: RHL is a lifelong infection that effects patients’ quality of life. In the literature PBMT has shown positive results preventing RHL, decreasing recurrences and severity of lesions. Despite the good results reported, there are still few controlled clinical studies published on the subject. Methods: For this study, 158 volunteers were recruited and were randomly divided into three study groups: Laser 1-1 J/point (L1J): n = 61, Laser 2-2 J/point (L2J): n = 50, and placebo-0 J/point: n = 47. The treatment consisted of a protocol of 15 sessions throughout 6 months and 2 years of follow-up posttreatment. Results: The results showed that L1J presented the most satisfactory results concerning the reduction of the number of lesions per year and less severity of recurrences in the long-term evaluation when compared with L2J. Both Laser Groups (L1J and L2J) were statistically more efficient than placebo in all aspects analyzed. All patients who received laser treatment (L1J and L2J) and presented recurrences had significant improvement in frequency and/or severity of lesions. No patient had side effects from treatment. Conclusions: PBMT can be effective in the reduction of the frequency of recurrences of RHL and in the severity of postirradiation lesions that may appear.

PMID:36219750 | DOI:10.1089/photob.2022.0054

J Comput Assist Tomogr. 2022 Oct 12. doi: 10.1097/RCT.0000000000001385. Online ahead of print.

ABSTRACT

OBJECTIVES: Contrast-enhanced breast imaging has gained increasing importance in the diagnosis and management of breast cancer. The aim of this study was to assess breast cancer enhancement after contrast administration on prone multidetector computed tomography (MDCT).

MATERIALS AND METHODS: This retrospective, unicentric, institutional review board-approved study included patients with newly diagnosed breast cancer who were submitted to contrast-enhanced MDCT in prone position, with image acquisition before and after nonionic iodinated contrast administration.

RESULTS: Sixty breast cancer patients aged between 31 and 74 years (mean, 49 years) were included. Most patients (n = 50, 83.3%) had no special type invasive breast carcinoma and luminal subtype (n = 45, 75%). All index breast tumors were identified on prone MDCT. Forty-three cases (70.5%) presented as mass, 13 (21.3%) as nonmass enhancement and 4 (6.6%) as both mass and nonmass enhancement. Mean tumor density was 37.8 HU and 87.9 HU on precontrast and postcontrast images, respectively. Mean contrast enhancement was 50.2 HU (range, 20-109 HU). There were no statistically significant differences in tumor enhancement according to histological type, molecular subtype, nuclear grade, tumor size, or imaging presentation.

CONCLUSIONS: Our results show that breast cancer usually can be identified and have significant contrast enhancement on prone MDCT images. This method could be used as an alternative when other contrast-enhanced breast imaging methods are not available.

PMID:36219728 | DOI:10.1097/RCT.0000000000001385

Psychol Sci. 2022 Oct 11:9567976221114055. doi: 10.1177/09567976221114055. Online ahead of print.

ABSTRACT

Our environments are saturated with learnable information. What determines which of this information is prioritized for limited attentional resources? Although previous studies suggest that learners prefer medium-complexity information, here we argue that what counts as medium should change as someone learns an input’s structure. Specifically, we examined the hypothesis that attention is directed toward more complicated structures as learners gain more experience with the environment. College students watched four simultaneous streams of information that varied in complexity. RTs to intermittent search trials (Experiment 1, N = 75) and eye tracking (Experiment 2, N = 45) indexed where participants attended during the experiment. Using two participant- and trial-specific measures of complexity, we demonstrated that participants attended to increasingly complex streams over time. Individual differences in structure learning also predicted attention allocation, with better learners attending to complex structures earlier in learning, suggesting that the ability to prioritize different information over time is related to learning success.

PMID:36219721 | DOI:10.1177/09567976221114055

Clin Infect Dis. 2022 Oct 11:ciac815. doi: 10.1093/cid/ciac815. Online ahead of print.

ABSTRACT

BACKGROUND: Malaria in pregnancy has been associated with worse cognitive outcomes in children, but its association with behavioral outcomes and the effectiveness of malaria chemoprevention on child neurodevelopment are not well characterized.

METHODS: To determine if more effective malaria chemoprevention in mothers and their children results in better neurodevelopment, 305 pregnant women were randomly assigned to 3 doses of sulfadoxine-pyrimethamine, 3 doses of dihydroartemisinin-piperaquine (DP) or monthly DP during pregnancy, and their 293 children were assigned to DP every 3 months or monthly DP from 2 to 24 months of age. Cognition, language and motor function were assessed at 12, 24 and 36 months of age, and attention, memory, behavior and executive function at 24 and 36 months of age.

RESULTS: Children of mothers with vs. without malaria in pregnancy had worse scores on cognitive, behavioral and executive function outcomes at 24 months. Clinical malaria in children within the first 12 months was similarly associated with poorer scores in behavior and executive function at 24 months, language at 24 and 36 months, and motor function scores at 36 months. However, more effective malaria chemoprevention in the mothers and children was not associated with better outcomes.

CONCLUSIONS: Malaria in pregnancy was associated with worse cognitive, behavioral and executive function scores in affected children, but more effective malaria chemoprevention measures did not result in better outcomes. Malaria chemoprevention prior to and early in gestation and with even higher efficacy in mothers and children may be required to prevent neurodevelopmental impairment in children.

PMID:36219705 | DOI:10.1093/cid/ciac815

Am J Hum Biol. 2022 Oct 11:e23817. doi: 10.1002/ajhb.23817. Online ahead of print.

ABSTRACT

OBJECTIVE: To address the relationship between socioeconomic factors and age of menarche among Polish women born and reared in periods that varied considerably in environmental stresses: the Great Depression of the 1930s, the interval of World War II, and the interval of communist rule following World War II through the 1950s.

METHODS: The data set included information on age at menarche and socioeconomic status (SES) of 718 women born during the Great Depression (n = 182), WWII (n = 189), and post-WWII through the 1950s (n = 347). A structured semi-parametric statistical model (generalized additive model [GAM] class) was used for analysis. An ANOVA-like linear model was used to test for marginal effects of SES-related factors and their interactions together with nonparametric seasonal effect.

RESULTS: The influence of period of birth, month of birth, region of early childhood, and father’s education, and the interaction between period of birth and father’s education on age at menarche were statistically significant. During the economic crisis and the interval of WWII, differences in ages at menarche between the extreme categories of father’s education were marked. The differences in ages at menarche between women from the lowest and highest social groups were markedly reduced among women born during the post-war interval. In addition, women born in February-March attained menarche earlier than women born in September-October.

CONCLUSIONS: Unpredictable conditions associated with the economic crisis and war conditions had a stronger impact on age at menarche among women from families of lower SES compared to women from better economic circumstances. Individuals born and reared in low SES conditions likely suffered more severe deterioration across the spectrum of the standard of living and quality of life compared to those with a higher SES.

PMID:36219696 | DOI:10.1002/ajhb.23817

J Pediatr Hematol Oncol. 2022 Oct 3. doi: 10.1097/MPH.0000000000002562. Online ahead of print.

ABSTRACT

We investigated social and logistic factors eg, distance from the medical center, language barriers, other children to care for, number of caregivers, etc.) for families to delay seeking immediate emergency care for neutropenic fever in a retrospective cohort study of all pediatric hematology-oncology patients who presented for fever in the setting of neutropenia to our emergency department or clinic from 2015 to 2020. Patients with a history of at least 2 prior admissions for neutropenic fever waited more often for a second fever before presenting versus those without such history (odds ratio 5.00, 95% CI 1.26 to 19.84, P=0.04). No other significant associations were found.

PMID:36219679 | DOI:10.1097/MPH.0000000000002562

Cutis. 2022 Aug;110(2):76-79. doi: 10.12788/cutis.0587.

ABSTRACT

Dermatology is one of the least diverse medical specialties. Although there have been studies addressing barriers faced by underrepresented in medicine (UIM) applicants to dermatology, there is little information about how UIM applicants approach and fare in the dermatology residency match process. This study aimed to assess differences between UIM and non-UIM applicants in the dermatology match process. A survey was administered to 2020-2021 dermatology applicants (N=232) to evaluate applicant characteristics, approaches, and outcomes in the match process. Survey responses were analyzed to determine if differences between variables were statistically significant. An additional survey was administered to dermatology residency program directors to evaluate their approach to the 2020-2021 application process. Our findings are important in identifying interventions to improve equity in the dermatology application process and to improve diversity in the dermatology workforce.

PMID:36219632 | DOI:10.12788/cutis.0587

Biometrics. 2022 Oct 11. doi: 10.1111/biom.13759. Online ahead of print.

ABSTRACT

Investigating and monitoring misdiagnosis-related harm is crucial for improving health care. However, this effort has traditionally focused on the chart review process, which is labor intensive, potentially unstable, and does not scale well. To monitor medical institutes’ diagnostic performance and identify areas for improvement in a timely fashion, researchers proposed to leverage the relationship between symptoms and diseases based on electronic health records or claim data. Specifically, the elevated disease risk following a false-negative diagnosis can be used to signal potential harm. However, off-the-shelf statistical methods do not fully accommodate the data structure of a well-hypothesized risk pattern and thus fail to address the unique challenges adequately. To fill these gaps, we proposed a mixture regression model and its associated goodness-of-fit testing. We further proposed harm measures and profiling analysis procedures to quantify, evaluate, and compare misdiagnosis-related harm across institutes with potentially different patient population compositions. We studied the performance of the proposed methods through simulation studies. We then illustrated the methods through data analyses on stroke occurrence data from the Taiwan Longitudinal Health Insurance Database. From the analyses, we quantitatively evaluated risk factors for being harmed due to misdiagnosis, which unveiled some insights for health care quality research. We also compared general and special care hospitals in Taiwan and observed better diagnostic performance in special care hospitals using various new evaluation measures.

PMID:36219626 | DOI:10.1111/biom.13759