Category: Nevin Manimala

Eur Heart J. 2021 Jul 16:ehab421. doi: 10.1093/eurheartj/ehab421. Online ahead of print.

ABSTRACT

AIMS : Persistence with direct oral anticoagulants (DOACs) has become a concern in non-valvular atrial fibrillation (NVAF) patients, but whether this affects prognosis is rarely studied. We investigated the persistence with oral anticoagulants (OACs) and its association with prognosis among a nationwide cohort of NVAF patients.

METHODS AND RESULTS : DOAC-naive NVAF patients who started to use DOACs for ischaemic stroke prevention between 2013 and 2018 were included using Dutch national statistics. Persistence with OACs was determined based on the presence of a 100-day gap between the last prescription and the end of study period. In 93 048 patients, 75.7% had a baseline CHA2DS2-VASc score of ≥2. The cumulative incidence of persistence with OACs was 88.1% [95% confidence interval (CI) 87.9-88.3%], 82.6% (95% CI 82.3-82.9%), 77.7% (95% CI 77.3-78.1%), and 72.0% (95% CI 71.5-72.5%) at 1, 2, 3, and 4 years after receiving DOACs, respectively. Baseline characteristics associated with better persistence with OACs included female sex, age range 65-74 years, permanent atrial fibrillation, previous exposure to vitamin K antagonists, stroke history (including transient ischaemic attack), and a CHA2DS2-VASc score ≥2. Non-persistence with OACs was associated with an increased risk of the composite outcome of ischaemic stroke and ischaemic stroke-related death [adjusted hazard ratio (aHR) 1.79, 95% CI 1.49-2.15] and ischaemic stroke (aHR 1.58, 95% CI 1.29-1.93) compared with being persistent with OACs.

CONCLUSION : At least a quarter of NVAF patients were non-persistent with OACs within 4 years, which was associated with poor efficacy of ischaemic stroke prevention. The identified baseline characteristics may help identify patients at risk of non-persistence.

PMID:34269375 | DOI:10.1093/eurheartj/ehab421

Biostatistics. 2021 Jul 7:kxab019. doi: 10.1093/biostatistics/kxab019. Online ahead of print.

NO ABSTRACT

PMID:34269393 | DOI:10.1093/biostatistics/kxab019

Biostatistics. 2021 Jul 16:kxaa053. doi: 10.1093/biostatistics/kxaa053. Online ahead of print.

ABSTRACT

Medical research institutions have generated massive amounts of biological data by genetically profiling hundreds of cancer cell lines. In parallel, academic biology labs have conducted genetic screens on small numbers of cancer cell lines under custom experimental conditions. In order to share information between these two approaches to scientific discovery, this article proposes a “frequentist assisted by Bayes” (FAB) procedure for hypothesis testing that allows auxiliary information from massive genomics datasets to increase the power of hypothesis tests in specialized studies. The exchange of information takes place through a novel probability model for multimodal genomics data, which distills auxiliary information pertaining to cancer cell lines and genes across a wide variety of experimental contexts. If the relevance of the auxiliary information to a given study is high, then the resulting FAB tests can be more powerful than the corresponding classical tests. If the relevance is low, then the FAB tests yield as many discoveries as the classical tests. Simulations and practical investigations demonstrate that the FAB testing procedure can increase the number of effects discovered in genomics studies while still maintaining strict control of type I error and false discovery rate.

PMID:34269373 | DOI:10.1093/biostatistics/kxaa053

Rev Esp Salud Publica. 2021 Jul 28;95:e202107101.

ABSTRACT

OBJECTIVE: The success of policies to eradicate COVID-19 depends on the acceptance of vaccines among the population. This paper measures the influence on the intention to get vaccinated of three usual variables in studies on consumer behavior: the perception of the efficiency and risk of the vaccine and the social influence.

METHODS: It was used a survey of 600 residents in Spain that was answered during September 2020 has been used. That survey was conveniently stratified by age and monthly income. The impact of the explanatory variables on the intention to use the vaccine was measured with generalized linear models: logistic regression and truncated negative binomial regression. Contro variables were gender, age and monthly income.

RESULTS: We have observed a positive (negative) influence of the variables efficacy perception and social influence (perception of risk), i.e. a ratio of rate use above (below) 1 that is statistically significant (p<0.01 in the case of the first two variables and p<0.05 in the third). Their importance follows the order described above. Neither gender nor age were significant in the intention to get vaccinated, but the income level was. We identified that at the highest income levels there was a greater propensity to reject the vaccine (p<0.1).

CONCLUSIONS: The results may be useful to guide the information policy that health authorities should carry out in order to induce the population to use the SARS-CoV-2 vaccine.

PMID:34267176

J Craniofac Surg. 2021 Jul 15. doi: 10.1097/SCS.0000000000007965. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the effect of weight loss after bariatric surgery on eustachian tube (ET) function with video endoscopy.

MATERIALS AND METHODS: The present study was conducted as a prospective cohort and was completed with 19 patients. Three-step tympanometry (basal, Toynbee, Valsalva), dynamic slow-motion video endoscopy, and the Eustachian Tube Dysfunction Questionnaire-7 (ETDA-7) were applied to the patients preoperatively before bariatric surgery and in the postoperative 6th month. Dynamic slow-motion video endoscopy was graded between 0 and 3, or classified as patulous, as indicated in the literature.

RESULTS: The mean body mass index of 6 male and 13 female patients decreased from 47.3 ± 4.6 to 31.2 ± 5.4. Grade decline (median 2 ± 1) was experienced in all patients in DSVE, and 1 patient resulted as patulous ET. The ETDA-7 scores decreased in 11 patients, remained stable in 7 patients, and increased in 1 patient with patulous ET. The statistical analysis of the preoperative and postoperative DSVE grading and ETDA-7 scores, excluding the patulous ET patient, was found to be significant (P = 0.001 and P = 0.003, respectively). There was no significant change in any of the tympanometry parameters (P > 0.05).

CONCLUSIONS: Rapid weight loss with bariatric surgery results in an improvement in both the DSVE images and in the complaints of ET dysfunction in the majority of patients, but in some patients it may result in patulous ET. Therefore, preoperative evaluation of the ET with DSVE and questioning the patient’s complaints are important in predicting patients who may develop patulous ET.

PMID:34267142 | DOI:10.1097/SCS.0000000000007965

Pediatr Emerg Care. 2021 Jul 6. doi: 10.1097/PEC.0000000000002494. Online ahead of print.

ABSTRACT

BACKGROUND: Bacterial meningitis in low-risk febrile young infants (FYIs) aged >28 days has become increasingly rare. Routine performance of lumbar puncture (LP) in these infants is associated with adverse consequences and may be unnecessary. We modified our clinical practice guideline (CPG) to reduce the number of FYIs 29 to 56 days old who receive LP.

METHODS: This quality improvement project sought to modify a preexisting CPG to diagnose and manage FYIs 0 to 56 days old that eliminated routine performance of LP in children 29 to 56 days old who were considered low-risk for serious bacterial infection. The change was implemented by making adjustments to the online CPG. A statistical process control chart was used to assess the affect of the initiative on our primary outcome of LP rate in this population of FYIs.

RESULTS: Postimplementation of the CPG initiative, 71% of FYIs 29 to 56 days old did not receive LP, compared with 42% preimplementation. This practice change was also associated with fewer hospitalizations, lower median emergency department (ED) length of stay, and fewer 72-hour ED revisits. Over 3 years of sustained practice, 1/713 (0.1%; 95% confidence interval, 0%-0.8%) low-risk FYI returned within 72 hours and was subsequently treated for probable bacterial meningitis, although cerebrospinal fluid culture was negative for bacterial growth.

CONCLUSIONS: A change in CPG reduced the number of LPs performed in febrile infants 29 to 56 days old. This change resulted in fewer LPs, hospitalizations, ED revisits, and a lower ED length of stay for FYIs 29 to 56 days old.

PMID:34267159 | DOI:10.1097/PEC.0000000000002494

J Physician Assist Educ. 2021 Jul 14. doi: 10.1097/JPA.0000000000000366. Online ahead of print.

ABSTRACT

PURPOSE: Evaluating the effectiveness of supervised clinical practice experiences (SCPEs) is a primary responsibility of the clinical education team. Physician assistant (PA) education is unique because preceptors are not confined to one professional credential. This study evaluated the relationship between students’ perceptions of rotation experiences and the professional credentials of the preceptor of record.

METHODS: This retrospective data analysis evaluated data from 3 cohorts (2016-2018) across 4 PA programs. Preceptors of record were categorized as MDs/DOs or advanced practice providers (APPs).

RESULTS: Analysis of 209 SCPEs found 91 APP preceptors (43%) and 119 MD/DO preceptors (57%). APP preceptors were most prevalent in family medicine/primary care (57%), internal medicine (50%), and emergency medicine (49%). Students’ evaluation scores were higher for APP preceptors compared to MD/DO preceptors, but not statistically significant.

CONCLUSIONS: This study showed that a considerable number of APPs are serving as preceptors and were found to have similar student evaluation scores to those of MD/DO preceptors.

PMID:34267162 | DOI:10.1097/JPA.0000000000000366

J Craniofac Surg. 2021 Jul 15. doi: 10.1097/SCS.0000000000007836. Online ahead of print.

ABSTRACT

INTRODUCTION: An unsightly scar following cleft repair can undo the good work of even an experienced surgeon. A functioning orbicularis oris muscle beneath the lip scar maintains a zone of dynamic tension resulting in a stretched scar. Botulinum toxin type A (BTA) can be used to create a temporary paralysis of the orbicularis muscle during the healing phase. This may lead to better scar formation after a cleft lip repair.

METHOD: The present prospective randomized control trial enrolled 28 infants with unilateral cleft lip undergoing primary lip repair. They were randomized to receive injection of either BTA (botox group) or normal saline (control group) intraoperatively into adjacent orbicularis oris muscle immediately after completion of cleft lip repair. Blinded experts reassessed the scar after 6 months. Objective assessment was undertaken employing Visual Analogue Scale (VAS), Vancouver Scar Scale (VSS), and photographic scar width measurements.

RESULTS: Twenty-two subjects were able to complete a follow-up duration of 6 months. Children in the BTA (Botox Group) had a statistically significantly better VAS score and lesser scar width compared to the control group. However, the difference in the VSS score between both groups was not statistically significant. On comparing patients with cleft lip alone with cleft lip and palate, no statistically significant difference was found in VAS, VSS, and scar width. There were no complications associated with the use of botulinum toxin A.

CONCLUSIONS: Botulinum toxin type A injection is a safe and effective addition to improve scar appearance following cleft lip repair. There was improvement in appearance of the scar in terms of width, but no improvement was seen in the scar pigmentation. The scar outcome is independent of cleft lip classification.

PMID:34267122 | DOI:10.1097/SCS.0000000000007836

J Craniofac Surg. 2021 Jul 15. doi: 10.1097/SCS.0000000000007834. Online ahead of print.

ABSTRACT

It was aimed to examine the orbital region in children with autism spectrum disorder and comparison with the healthy controls in the present study. A total of 195 children and adolescents (101 of them were in the autism group, 94 of them were in healthy group) were evaluated. Anterior view photographs were taken, and endocanthion (en), exocanthion (ex), and pupil were determined bilaterally on the photographs. Outer canthal (ex-ex), intercanthal (ex-en), inner canthal (en-en) and interpupillary distances were measured and intercanthal index [(en-en / ex-ex) × 100] was calculated. There was a statistically significant difference between the groups for males for all parameters, while a statistically significant difference was not observed for females. All orbital region distances were higher in male autistic children. Although minor physical anomalies in children and adolescents with autism have been reported before, anthropometric measurements in individuals with autism may differ between genders. Further studies are needed to investigate the differences between genders in autism spectrum disorder.

PMID:34267125 | DOI:10.1097/SCS.0000000000007834

Eur J Cancer Prev. 2021 Jul 8. doi: 10.1097/CEJ.0000000000000702. Online ahead of print.

ABSTRACT

We estimated cancer mortality statistics for the current year in seven major Latin American countries, with a focus on colorectal cancer. We retrieved official death certification data and population figures from the World Health Organization and the Pan American Health Organization databases. We analysed mortality from all neoplasms combined and for selected cancer sites. We estimated numbers of deaths and age-standardized mortality rates for the year 2021 using a logarithmic Poisson count data joinpoint model. Total cancer mortality is predicted to decline in all countries considered for both sexes, with the exception of Argentinian women. The lowest total mortality rates were predicted in Mexico (65.4/100 000 men and 62.3 in women), the highest ones were in Cuba (133.3/100 000 men and 91.0 in women). Stomach cancer rates have been decreasing since 1970 in all countries; colorectal cancer started to decline over recent calendar periods. Rates for this cancer were unfavourable in the youngest age group. Lung cancer trends declined in males and remained comparatively low in all countries except Cuba. In Cuba, lung cancer rates in women overtook those for breast. Mortality from cancers of the breast, (cervix) uterus, ovary, prostate and bladder, as well as leukemia mostly showed favourable trends. A marked variability in rates across Latin American countries persists, and rates were relatively high for stomach, uterus, prostate and lung cancers, as compared to Europe and North America, suggesting the need to improve preventive strategies. Colorectal cancer mortality was relatively low in Latin America, except in Argentina, and short-term predictions remain moderately favourable.

PMID:34267112 | DOI:10.1097/CEJ.0000000000000702