Category: Nevin Manimala

Skeletal Radiol. 2022 Jul 30. doi: 10.1007/s00256-022-04108-3. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the validity and reliability of the calf injury classification system proposed by the Olympic Park group which focuses on connective tissue structure integrity on MRI.

MATERIALS AND METHODS: A retrospective study analysing calf muscle group injuries in an English Premiership professional rugby union club using the MRI classification proposed by the Olympic Park group. Classification on MRI examinations of 28 calf injuries sustained over a 6-year period was performed by three independent musculoskeletal radiologists to determine the inter-observer variability and correlation of the grade of injury with return-to-full-training (RTFT) time.

RESULTS: RTFT time ranged from 5 to 110 days (mean = 40.1, SD = 26.4) following calf muscle injury. The Olympic Park classification injury grade demonstrated moderate to strong correlation with RTFT time (Spearman’s rank correlation coefficient, 0.661-0.715, p < 0.01). RTFT time was statistically different between different injury grades (one-way ANOVA, p < 0.01). Inter-observer agreement of the overall grade between radiologist pairs was fair to moderate (weighted kappa 0.406-0.583).

CONCLUSION: The Olympic Park classification system demonstrates moderate to strong correlation with time to RTFT following calf injury. Inter-observer reliability is fair to moderate.

PMID:35907017 | DOI:10.1007/s00256-022-04108-3

Eur Arch Otorhinolaryngol. 2022 Jul 30. doi: 10.1007/s00405-022-07571-9. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the efficacy and safety of programmed cell death-1/programmed cell death-ligand 1 (PD-1/PD-L1) inhibitor plus chemotherapy vs standard of care (SoC) treatment in the first-line treatment for recurrent or metastatic head and neck squamous cell carcinoma (R/M-SCCHN).

METHODS: Randomized controlled trials (RCTs) that investigated PD-1/PD-L1 inhibitor plus chemotherapy vs SoC as first-line treatment for R/M-SCCHN were searched from electronic databases (PubMed, Embase and Cochrane Library). The primary outcomes were overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and adverse events (AEs).

RESULTS: In total, three phase 3 RCTs (KEYNOTE-048, CAPTAIN-1st, and JUPITER-02; n = 1120) with three PD-1 inhibitors (pembrolizumab, camrelizumab and toripalimab) were included in the analysis. Compared with SoC, PD-1 inhibitor plus chemotherapy significantly prolonged PFS (hazard ratio [HR] 0.66, 95% CI 0.40-0.93, p < 0.001) and OS (HR 0.73, 95% CI 0.60-0.86, p < 0.001) of patients. There was no statistical differences in ORR (odds ratio [OR] 1.26; 95% CI 0.97-1.64, p = 0.086), grade 3 or higher AEs (OR 0.77, 95% CI 0.50-1.17, p = 0.221), and treatment-related deaths (OR 1.34, 95% CI 0.60-2.98, p = 0.470) between the two groups.

CONCLUSION: PD-1 inhibitor plus chemotherapy showed more survival benefit than SoC in the first-line treatment for R/M-SCCHN, with a similar safety profile.

PMID:35907001 | DOI:10.1007/s00405-022-07571-9

J Clin Endocrinol Metab. 2022 Jul 30:dgac458. doi: 10.1210/clinem/dgac458. Online ahead of print.

ABSTRACT

CONTEXT: Our previous study showed that paternal subclinical hypothyroidism (SCH) had a detrimental effect on the clinical outcomes of assisted reproductive technologies. However, it remains to be determined whether paternal SCH affects sperm DNA integrity.

OBJECTIVE: To investigate the association between SCH and sperm DNA fragmentation in men seeking infertility care.

METHODS: This cross-sectional study included 4,983 men with euthyroidism and 418 men with SCH seeking infertility treatment in a tertiary care academic medical center between January 2017 and December 2021. The outcome measures were the absolute DNA fragmentation index (DFI) and the risk of abnormal DFI (defined as a DFI of ≥25% or ≥30%).

RESULTS: The mean (standard deviation) age of men with euthyroidism and men with SCH was 34.20 (5.97) and 35.35 (6.48) years, respectively (p < 0.001). The difference in DFI was not statistically significant [adjusted mean: 19.7% vs. 18.9% in the SCH and euthyroidism groups, respectively, p = 0.07] after confounder adjustment. A DFI of ≥25% was significantly more frequent in men with SCH (20.57%) than in men with euthyroidism (14.49%) after confounder adjustment [odds ratio (OR) (95% CI): 1.43 (1.09-1.88)]. A DFI of ≥30% was also significantly more common in men with SCH (11.72%) than in men with euthyroidism (6.74%) [OR (95%CI): 1.84 (1.34-2.52)]. In addition, thyroid-stimulating hormone (TSH) concentration was significantly associated with an increased risk of having a DFI of ≥25% (p < 0.001) or ≥30% (p = 0.011).

CONCLUSIONS: SCH was significantly associated with an increased risk of an abnormal DFI.

PMID:35906991 | DOI:10.1210/clinem/dgac458

Eur J Clin Invest. 2022 Jul 29:e13849. doi: 10.1111/eci.13849. Online ahead of print.

ABSTRACT

BACKGROUND: Ischemic Stroke (IS) is associated with various modifiable risk factors but the association of these risk factors based on TOAST classification, which characterizes IS into five subtypes, large artery atherosclerosis (LAA), small vessel occlusion (SVO), cardioembolic disease (CE), other determined etiology (ODE), and undetermined etiology (UDE), is unknown. We aimed to summarize the published evidence for the association of modifiable risk factors with IS subtypes based on TOAST classification, specifically focussing on the Asian versus Caucasian population.

METHOD: A comprehensive search for all the published articles was performed in electronic databases including PubMed, EMBASE, Cochrane Library, and Google Scholar from 01^st January 1950 to 10^th April 2022 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Odds ratio (OR) with 95% Confidence interval (CIs) along with random effect models were used to calculate summary estimates.

RESULTS: In our meta-analysis, 32 studies with a total of 23404 IS (14364 in Asian vs. 9040 in Caucasian population), 7121 LAA (5219 in Asian vs. 1902 in Caucasian), 5532 SVO (3604 in Asian vs. 1928 in Caucasian), 3498 CE (1634 in Asian vs. 1864 in Caucasian), 1131 ODE (546 in Asian vs. 585 in Caucasian) and 4519 UDE (2076 in Asian vs. 2443 in Caucasian) were included. Our findings suggest a significant association between LAA and hypertension (OR=1.07, 95% CI=1.02-1.12), smoking (OR=1.11, 95% CI=1.04-1.17), dyslipidemia (OR=1.13, 95% CI=1.06-1.21), diabetes mellitus (OR=1.18, 95% CI=1.11-1.25) and atrial fibrillation (OR=0.55, 95% CI=0.40-0.75). Significantly strong association of hypertension, smoking, dyslipidemia, diabetes mellitus, and atrial fibrilation was observed with SVO and CE stroke subtypes. Subgroup analysis based on ethnicity revealed a significant association for dyslipidemia, diabetes mellitus, and atrial fibrilation in LAA for both Asians and Caucasians. Hypertension was significantly associated with SVO and ODE subtypes in both Asians and Caucasians; however, only Asian population showed significant association of hypertension in LAA and CE subtypes. The other risk factors did not show any statistical difference between the ethnic groups for the different stroke subtypes. The majority of the risk factors depicted positive association with LAA and SVO, negative with CE and neutral with ODE and UDE.

CONCLUSION: Our findings suggest strong association of smoking, dyslipidemia, and diabetes mellitus with LAA and SVO subtypes in the Caucasian population. However, only diabetes mellitus showed significant association with both LAA and SVO subtypes in Asian population as well. Thus, a majority of the traditional modifiable risk factors had a positive association in LAA and SVO, while a negative protective association was observed in CE subtype, among both the Asian and Caucasian subgroups.

PMID:35906805 | DOI:10.1111/eci.13849

J Sch Health. 2022 Jul 29. doi: 10.1111/josh.13225. Online ahead of print.

ABSTRACT

BACKGROUND: Schools are essential public health partners for safeguarding students’ health. Child Death Review (CDR) is one public health activity where collaboration with schools is integral for developing strategies to prevent child death but the degree of collaboration is unknown. This study assessed school participation in CDR and the prevalence of school problems in reviewed child death cases, comparing non-suicide and suicide-related deaths.

METHODS: Using the National Fatality Review-Case Reporting System, we created a dataset of school-aged children (5 to 20 years) whose death was reviewed from 2005 to 2017 and used frequencies, proportions, and chi-squared statistics on selected measures.

RESULTS: Educational representatives infrequently participated in CDRs (24.9%). School records were rarely accessed for reviewed deaths (5.2%). Less than half (41.2%) of reviewed deaths had any school information and of these, 35.5% of children were indicated as having problems in school. Compared with non-suicide deaths, a larger proportion of suicide deaths had school representatives attend CDRs (28.4% vs 24.1%, P < .0001), and access to educational records (4.2% vs 9.2%, P < .0001).

IMPLICATIONS: Efforts are needed to address potential barriers to systems integration, including state policies and federal educational privacy laws.

CONCLUSIONS: School participation in CDRs is lacking for both suicide and non-suicide deaths.

PMID:35906765 | DOI:10.1111/josh.13225

Community Dent Oral Epidemiol. 2022 Jul 29. doi: 10.1111/cdoe.12779. Online ahead of print.

ABSTRACT

OBJECTIVES: To estimate socioeconomic inequalities in the maternal perception of children’s oral health from a birth cohort study in Brazil.

METHODS: The data from this study were collected through perinatal interviews and at the 48-month follow-up from the 2015 Pelotas Birth Cohort Study. The main outcome was the maternal perception of children’s oral health, dichotomized into positive (good/very good) and negative (fair/bad/very bad). The secondary outcome was untreated dental caries (absence and presence, according to the ICDAS index – International Caries Detection and Assessment System). For the statistical analysis, the absolute inequality index (Slope Index of Inequality – SII) and the relative concentration index (Concentration Index – CIX) were used. Analyses were stratified by maternal educational level, family income and wealth index.

RESULTS: The prevalence of outcomes was 19.4% (95% CI 18.2; 20.7) for the negative maternal perception of children’s oral health and 15.6% (95% CI 14.4; 16.8) for untreated dental caries. Socioeconomics inequalities were observed in negative maternal perception of children’s oral health in both absolute and relative terms. A SII of -16.6 (95% CI -20.8; -12.5) was observed for family income, with higher prevalence in poor families. A higher prevalence of the negative maternal perception of children’s oral health was observed in mothers without any educational level or a few years of study (CIX -21.1 [95% CI -24.5; -17.7]).

CONCLUSIONS: This study demonstrates socioeconomics disparities in the maternal perception of children’s oral health and in the prevalence of untreated caries in children. A higher concentration of negative maternal perception of children’s oral health was identified among the most socioeconomically vulnerable individuals. The findings reinforce the presence of socioeconomic inequalities in subjective measures about children’s oral health.

PMID:35906753 | DOI:10.1111/cdoe.12779

Pediatr Blood Cancer. 2022 Jul 29:e29898. doi: 10.1002/pbc.29898. Online ahead of print.

ABSTRACT

BACKGROUND: Systemic anticoagulation after pediatric liver transplantation (pLT) is believed to reduce the incidence of vascular thrombosis, but it may also cause an increase in hemorrhagic complications.

PROCEDURE: A 5-year retrospective review of pLT done at our institution was performed (2014-2018). The occurrence of early hemorrhagic and thrombotic complications was compared when using low-dose or high-dose anticoagulation after transplant (p < .05 considered significant).

RESULTS: Sixty-nine patients received 73 transplants during the study period. Median age at transplant was 2.3 years (40 days to 18.5 years). Low-dose anticoagulation was utilized in 71% cases. Additionally, six patients were converted from low-dose to high-dose anticoagulation because of a thrombotic event or concerns for suboptimal vascular inflow. Postoperative anticoagulation was discontinued in 18 occurrences due to bleeding (low dose 19%, high dose 47% vs. low dose to high dose 17%, p = .085). Surgical take back for bleeding occurred in 17 occasions (low dose 13.5%, high dose 53% vs. low dose to high dose 33%, p = .005). The overall incidence of hepatic artery thrombosis (HAT) and portal vein thrombosis were each 5.5%, respectively. While patient survival was not statistically different between groups, graft survival was significantly lower in the high-dose group (low dose 93%, high dose 73% vs. low dose to high dose 100%, p = .046). However, graft losses from HAT were similar between groups (low dose 2%, high dose 7% vs. low dose to high dose 0%, p = .56).

CONCLUSION: The use of a standardized risk-adjusted anticoagulation protocol after pLT is associated with a low occurrence of thrombotic and hemorrhagic complications. High-dose anticoagulation leads to more bleeding, but those risks outweigh the risks of possible graft loss.

PMID:35906750 | DOI:10.1002/pbc.29898

Br J Psychol. 2022 Jul 29. doi: 10.1111/bjop.12585. Online ahead of print.

ABSTRACT

Bayesian methods are becoming increasingly used in applied psychological research. Previous researchers have thoroughly written about much of the details already, including the philosophy underlying Bayesian methods, computational issues associated with Bayesian model estimation, Bayesian model development and summary, and the role of Bayesian methods in the so-called replication crisis. In this paper, we seek to provide case studies comparing the use of frequentist methods to the use of Bayesian methods in applied psychological research. These case studies are intended to ‘illustrate by example’ the ways that Bayesian modelling differs from frequentist modelling and the differing conclusions that one may arrive at using the two methods. The intended audience is applied psychological researchers who have been trained in the traditional frequentist framework, who are familiar with mixed-effects models and who are curious about how statistical results might look in a Bayesian context. Along with our case studies, we provide general opinions and guidance on the use of Bayesian methods in applied psychological research.

PMID:35906743 | DOI:10.1111/bjop.12585

Br J Math Stat Psychol. 2022 Jul 29. doi: 10.1111/bmsp.12283. Online ahead of print.

ABSTRACT

Heller (2021) generalized quasi-ordinal knowledge spaces to polytomous items. Inspired by this paper, we propose CD-polytomous knowledge space and its polytomous surmise system. A Galois connection is established between the collection K$$ mathfrak{K} $$ of all polytomous knowledge structures and the collection F1$$ {mathfrak{F}}_1 $$ of particular polytomous attribute functions. The closed elements of the Galois connection are CD-polytomous knowledge spaces in K$$ mathfrak{K} $$ and polytomous surmise functions in F1$$ {mathfrak{F}}_1 $$ , respectively. With the help of these, this paper provides a characterization of the polytomous knowledge structure corresponding to the polytomous surmise function that is weakly factorial. Based on the finite sets of items and response values, these results generalize the previous approaches for polytomous knowledge spaces.

PMID:35906736 | DOI:10.1111/bmsp.12283

Aust N Z J Obstet Gynaecol. 2022 Jul 29. doi: 10.1111/ajo.13602. Online ahead of print.

ABSTRACT

BACKGROUND: In 2020, abortion was removed from the Crimes Act. Abortions under 20 weeks gestation no longer require an indication and criteria for abortion above 20 weeks gestation has broadened. Prior to law reform, all abortions were provided on licensed premises and the responsible health practitioner was a doctor. Subsequently, any health practitioner with abortion in their scope of practice can provide abortion care.

AIMS: To describe the characteristics of health practitioners who expressed an interest in participating in second trimester abortion care, and to identify and describe the barriers to providing an optimal second trimester abortion service.

MATERIALS AND METHODS: This was an exponential non-discriminating snowball email survey using tick boxes and open comments. Quantitative data were analysed using descriptive statistics and free-text components were analysed using a general inductive approach.

RESULTS: The 113 respondents included: 38 hospital-based obstetrics and gynaecology doctors, 22 primary care doctors, 13 midwives and 14 nurses/nurse practitioners. Thirty-three (29.2%) and 62 (54.9%) respondents reported interest in providing second trimester surgical and medical abortion care respectively. The most commonly identified barrier to both surgical and medical second trimester abortion provision was lack of trained staff, followed by an unsupportive work environment. Thematic analysis aligned with these findings and commonly featured difficulty in accessing feticide.

CONCLUSIONS: We need to actively recruit and train all health practitioners interested in providing second trimester abortion care to strengthen the workforce. This requires an organisation to oversee an inclusive national framework for abortion training, including feticide, and provide professional supervision.

PMID:35906725 | DOI:10.1111/ajo.13602