Category: Nevin Manimala

Int J Gynaecol Obstet. 2022 Jan 7. doi: 10.1002/ijgo.14089. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the functional outcomes of nerve-sparing surgery for deep infiltrating endometriosis (DIE) with or without postero-lateral parametrectomy.

METHODS: A multicenter, observational, retrospective, cohort study was performed including all symptomatic women who underwent nerve-sparing laparoscopic excision of DIE and preoperative and postoperative assessment of functional outcomes through validated questionnaires between April 2019 and March 2020. Women with postero-lateral parametrial DIE (P-group) and women with no parametrial involvement (NP-group) were compared in term of preoperative and postoperative: functional outcomes related to pelvic organs assessed through validated questionnaires (KESS and GIQLI for bowel function, BFLUTS for urinary function, and FSFI for sexual function); pain symptoms at 3-month follow-up assessed through a 11-points Visual Analogue Scales (VAS) for dyschezia, dysmenorrhea, dyspareunia and chronic pelvic pain; surgical outcomes; rate of urinary voiding dysfunction at 3-month follow-up.

RESULTS: One-hundred patients were included: 69 in the P-group and 31 in the NP-group. Preoperative and postoperative values of questionnaires, pain symptoms and postoperative complications rates were comparable between the two groups, except for postoperative dyspareunia and sexual dysfunction, which were statistically higher in the P-group. Only patients in the P-group experienced urinary voiding dysfunction, but no statistical significance was reached (p=.173).

CONCLUSION: Postero-lateral parametrectomy for DIE appears associated to a higher risk of post-operative dyspareunia and sexual dysfunction.

PMID:34995374 | DOI:10.1002/ijgo.14089

Int J Gynaecol Obstet. 2022 Jan 7. doi: 10.1002/ijgo.14091. Online ahead of print.

ABSTRACT

OBJECTIVE: To apply a new classification based on 7 clinically relevant subgroups to accurately describe episiotomy practices and evaluate the association between episiotomy and obstetrical anal sphincter injuries (OASIS) rates according to the classification’s subgroups.

METHODS: Observational retrospective cohort study based on a population comprising 39487 women from 01/01/2004 to 31/12/2020 in a level III university maternity unit. The primary outcome was the overall episiotomy rate in the institution, its trend over the time as well as in each subgroup of obstetric population classification. Secondary outcome was the rate of OASIS third and fourth degree, its association with episiotomy practice.

RESULTS: The episiotomy rate decreased significantly from 43,2% to 20% in the total population. The overall OASIS rate was 0,34%, it remained significantly the same during the study period, although the association between OASIS and episiotomy was significant only in group 2 (Nulliparous with instrumental delivery) with a decrease of OASIS rate if using episiotomy (OR 0.5; 95% CI[0,3-0,8]).

CONCLUSION: The episiotomy rate can be decreased without exposing women to an increased risk of OASIS. It encourages restrictive practice of episiotomy, but episiotomy should be considered in case of nulliparous women with instrumental delivery.

PMID:34995361 | DOI:10.1002/ijgo.14091

Int J Gynaecol Obstet. 2022 Jan 7. doi: 10.1002/ijgo.14087. Online ahead of print.

ABSTRACT

BACKGROUND: During pregnancy, urinary infections are an important cause of maternofetal morbimortality and may lead to several complications.

OBJECTIVES: Verify whether the use of antibiotic therapy in a single dose when compared to multiple doses in lower tract urinary infections during pregnancy is effective to obtain microbiological cure.

SEARCH STRATEGY: Online databases were searched. Keywords used were “single-drug dose”, “antibiotic”, “fosfomycin”, “amoxicillin”, “trimethoprim”, “pregnancy” and “urinary tract infection”.

SELECTION CRITERIA: Studies were included if: were randomized controlled trials, population was pregnant woman, microbiological cure was attained and one of the treatment groups received single-dose antibiotic therapy.

DATA COLLECTION AND ANALYSIS: Preselected studies have been independently read by pairs, and data were extracted according to a predetermined sheet. The Cochrane tool was used for the risk of bias.

MAIN RESULTS: 1063 women from 9 studies were included. The primary outcome was the microbiological cure attested by urine culture. When compared to the multiple-day use of antibiotics, the single-dose treatment has shown statistically similar results in reaching culture cure (OR 1.02, 95% IC 0.73-1.44).

CONCLUSION: The current study has shown that the use of single dose treatment for lower tract urinary infections during pregnancy can be recommended, specially using fosfomycin.

PMID:34995367 | DOI:10.1002/ijgo.14087

Blood. 2022 Jan 7:blood.2021014804. doi: 10.1182/blood.2021014804. Online ahead of print.

ABSTRACT

In acute myeloid leukemia (AML), measurable residual disease (MRD) before or after allogeneic hematopoietic cell transplantation (HCT) is an established, independent indicator of poor outcome. To address how peri-HCT MRD dynamics could refine risk assessment across different conditioning intensities, we analyzed 810 adults transplanted in remission after myeloablative conditioning (MAC; n=515) or non-MAC (n=295) who underwent multiparameter flow cytometry-based MRD testing before and 20-40 days after allografting. Patients without pre- and post-HCT MRD (MRDneg/MRDneg) had the lowest risks of relapse and highest relapse-free survival (RFS) and overall survival (OS). Relative to those patients, outcomes for MRDpos/MRDpos and MRDneg/MRDpos patients were poor regardless of conditioning intensity. Outcomes for MRDpos/MRDneg patients were intermediate. Among 161 patients with MRD before HCT, MRD was cleared more commonly with a MAC (85/104 [81.7%]) than non-MAC (33/57 [57.9%]) regimen (P=0.002). Although non-MAC regimens were less likely to clear MRD, if they did the impact on outcome was greater. Thus, there was a significant interaction between conditioning intensity and “MRD conversion” for relapse (P=0.020), RFS (P=0.002), and OS (P=0.001). Similar findings were obtained in the subset of 590 patients receiving HLA-matched allografts. C-statistic values were higher (indicating higher predictive accuracy) for peri-HCT MRD dynamics compared to the isolated use of pre-HCT MRD status and post-HCT MRD status for prediction of relapse, RFS, and OS. Across conditioning intensities, peri-HCT MRD dynamics improve risk assessment over isolated pre- or post-HCT MRD assessments.

PMID:34995355 | DOI:10.1182/blood.2021014804

Rheumatology (Oxford). 2022 Jan 6:keab937. doi: 10.1093/rheumatology/keab937. Online ahead of print.

ABSTRACT

OBJECTIVE: To better understand rheumatology patient and clinician pandemic-related experiences, medical relationships and behaviours in order to help identify the persisting impacts of the Covid-19 pandemic, and inform efforts to ameliorate the negative impacts and build-upon the positive ones.

METHODS: Rheumatology patients and clinicians completed surveys (Patients N = 1,543, Clinicians N = 111) and interviews (Patients N = 41, Clinicians N = 32) between April 2021 and August 2021. A cohort (N = 139) of systemic autoimmune rheumatic disease patients was also followed-up from March 2020 to April 2021. Analyses used sequential mixed methods. Pre-specified outcome measures included the Warwick-Edinburgh Mental wellbeing score (WEMWBS), satisfaction with care, and healthcare-behaviours.

RESULTS: We identified multiple ongoing pandemic-induced/increased barriers to receiving care. The percentage of patients agreeing they were medically supported reduced from 74.4% pre-pandemic to 39.7% during-pandemic. Ratings for medical support, medical-security and trust were significantly (p< 0.001) positively correlated with patient WEMWBS and healthcare-behaviours, and decreased during the pandemic. Healthcare-seeking was reduced, potentially long-term, including from patients feeling ‘abandoned’ by clinicians, and a ‘burden’ from Government messaging to protect the NHS. Blame and distrust were frequent, particularly between primary and secondary care, and towards the UK Government, whom <10% of clinicians felt had supported clinicians during the pandemic. Clinicians’ efforts were reported to be impeded by inefficient administration systems, and chronic understaffing, suggestive of the pandemic having exposed and exacerbated existing healthcare-system weaknesses.

CONCLUSION: Without concerted action-such as rebuilding trust, improved administrative systems, and more support for clinicians-barriers to care and negative impacts of the pandemic on trust, medical relationships, medical-security and patient help-seeking may persist longer-term.

TRIAL REGISTRATION: This study is part of a pre-registered longitudinal multi-stage trial, the LISTEN study (ISRCTN-14966097), with later Covid-related additions registered in March 2021, including a pre-registered statistical analysis plan.

PMID:34995345 | DOI:10.1093/rheumatology/keab937

PLoS One. 2022 Jan 7;17(1):e0262340. doi: 10.1371/journal.pone.0262340. eCollection 2022.

ABSTRACT

BACKGROUND: Readmission to hospital is frequent among older patients and reported as a post-discharge adverse outcome. The effect of treatment in a geriatric ward for acutely admitted older patients on mortality and function is well established, but less is known about the possible influence of such treatment on the risk of readmission, particularly in the oldest and most vulnerable patients. Our aim was to assess the risk for early readmission for multimorbid patients > 75 years treated in a geriatric ward compared to medical wards and to identify risk factors for 30-day readmissions.

METHODS: Prospective cohort study of patients acutely admitted to a medical department at a Norwegian regional hospital. Eligible patients were community-dwelling, multimorbid, receiving home care services, and aged 75+. Patients were consecutively included in the period from 1 April to 31 October 2012. Clinical data were retrieved from the referral letter and medical records.

RESULTS: We included 227 patients with a mean (SD) age of 86.0 (5.7) years, 134 (59%) were female and 59 (26%) were readmitted within 30 days after discharge. We found no statistically significant difference in readmission rate between patients treated in a geriatric ward versus other medical wards. In adjusted Cox proportional hazards regression analyses, lower age (hazard ratio (95% confidence interval) 0.95 (0.91-0.99) per year), female gender (2.17 (1.15-4.00)) and higher MMSE score (1.03 (1.00-1.06) per point) were significant risk factors for readmission.

CONCLUSIONS: Lower age, female gender and higher cognitive function were the main risk factors for 30-day readmission to hospital among old patients with multimorbidity. We found no impact of geriatric care on the readmission rate.

PMID:34995327 | DOI:10.1371/journal.pone.0262340

PLoS One. 2022 Jan 7;17(1):e0262247. doi: 10.1371/journal.pone.0262247. eCollection 2022.

ABSTRACT

Currently, a significant amount of research is focused on detecting Marine Debris and assessing its spectral behaviour via remote sensing, ultimately aiming at new operational monitoring solutions. Here, we introduce a Marine Debris Archive (MARIDA), as a benchmark dataset for developing and evaluating Machine Learning (ML) algorithms capable of detecting Marine Debris. MARIDA is the first dataset based on the multispectral Sentinel-2 (S2) satellite data, which distinguishes Marine Debris from various marine features that co-exist, including Sargassum macroalgae, Ships, Natural Organic Material, Waves, Wakes, Foam, dissimilar water types (i.e., Clear, Turbid Water, Sediment-Laden Water, Shallow Water), and Clouds. We provide annotations (georeferenced polygons/ pixels) from verified plastic debris events in several geographical regions globally, during different seasons, years and sea state conditions. A detailed spectral and statistical analysis of the MARIDA dataset is presented along with well-established ML baselines for weakly supervised semantic segmentation and multi-label classification tasks. MARIDA is an open-access dataset which enables the research community to explore the spectral behaviour of certain floating materials, sea state features and water types, to develop and evaluate Marine Debris detection solutions based on artificial intelligence and deep learning architectures, as well as satellite pre-processing pipelines.

PMID:34995337 | DOI:10.1371/journal.pone.0262247

PLoS One. 2022 Jan 7;17(1):e0261895. doi: 10.1371/journal.pone.0261895. eCollection 2022.

ABSTRACT

INTRODUCTION: There is substantial body of evidence that portrays gap in the existing maternal and child health continuum of care; one is less attention given to adolescent girls and young women until they get pregnant. Besides, antenatal care is too late to reduce the harmful effects that a woman’s may have on the fetus during the critical period of organogenesis. Fortunately, preconception care can fill these gaps, enhance well-being of women and couples and improve subsequent pregnancy and child health outcomes. Therefore, the main aim of the current study was to assess preconception care utilization and associated factors among pregnant women attending antenatal care clinics of public health facilities in Hosanna town.

METHODS: A facility based cross-sectional study design was carried out from July 30, 2020 to August 30, 2020. Data were collected through face-to-face interview among 400 eligible pregnant women through systematic sampling technique. Epi-data version 3.1 and SPSS version 24 was used for data entry and analysis respectively. Both bivariable and multivariable logistic regression analysis was conducted to identify association between dependent and independent variables. Crude and adjusted odds ratio with respective 95% confidence intervals was computed and statistical significance was declared at p-value <0.05.

RESULT: This study revealed that 76 (19%, 95% Cl (15.3, 23.2) study participants had utilized preconception care. History of family planning use before the current pregnancy (AOR = 2.45; 95% Cl (1.270, 4.741), previous history of adverse birth outcomes (AOR = 3.15; 95% Cl (1.650, 6.005), poor knowledge on preconception care (AOR = 0.18; 95% Cl (0.084, 0.379) and receiving counseling on preconception care previously (AOR = 2.82; 95% Cl (1.221, 6.493) were significantly associated with preconception care utilization.

CONCLUSIONS: The present study revealed that nearly one-fifth of pregnant women have utilized preconception care services. History of family planning use before the current pregnancy, previous history of adverse birth outcomes, poor knowledge on preconception care and receiving counseling on preconception care previously were significantly associated with preconception care utilization. Integrating preconception care services with other maternal neonatal child health, improving women’s/couples knowledge & strengthening counseling services is pivotal.

PMID:34995291 | DOI:10.1371/journal.pone.0261895

PLoS One. 2022 Jan 7;17(1):e0260436. doi: 10.1371/journal.pone.0260436. eCollection 2022.

ABSTRACT

Many pathologies can occur in the periportal space and manifest as fluid accumulation, visible in Computed tomography (CT) images as a circumferential region of low attenuation around the intrahepatic portal vessels, called periportal halo (PPH). This finding is associated with different types of hepatic and extra-hepatic disease in humans and remains a non-specific sign of unknown significance in veterinary literature. The aim of this study was to investigate the prevalence of PPH in a population of patients undergoing CT examination and to assess the presence of lesions related to hepatic and extra-hepatic disease in presence of PPH. CT studies including the cranial abdomen of dogs and cats performed over a 5-year period were retrospectively reviewed. The prevalence of PPH was 15% in dogs and 1% in cats. 143 animals were included and the halo was classified as mild, moderate and severe, respectively in 51%, 34% and 15% of animals. The halo distribution was generalized in 79 cases, localized along the second generation of portal branches in 63, and along the first generation only in one. Hepatic disease was present in 58/143 and extra-hepatic disease in 110/143 of the cases. Main cause of hepatic (36%) and extra-hepatic disease (68%) was neoplasia. Associations between halo grades and neoplasia revealed to be not statistically significant (p = 0.057). In 7% of animals the CT examination was otherwise unremarkable. PPH is a non-specific finding, occurring in presence of a variety of diseases in the examined patient population.

PMID:34995282 | DOI:10.1371/journal.pone.0260436

PLoS One. 2022 Jan 7;17(1):e0260836. doi: 10.1371/journal.pone.0260836. eCollection 2022.

ABSTRACT

In the era of open data, Poisson and other count regression models are increasingly important. Still, conventional Poisson regression has remaining issues in terms of identifiability and computational efficiency. Especially, due to an identification problem, Poisson regression can be unstable for small samples with many zeros. Provided this, we develop a closed-form inference for an over-dispersed Poisson regression including Poisson additive mixed models. The approach is derived via mode-based log-Gaussian approximation. The resulting method is fast, practical, and free from the identification problem. Monte Carlo experiments demonstrate that the estimation error of the proposed method is a considerably smaller estimation error than the closed-form alternatives and as small as the usual Poisson regressions. For counts with many zeros, our approximation has better estimation accuracy than conventional Poisson regression. We obtained similar results in the case of Poisson additive mixed modeling considering spatial or group effects. The developed method was applied for analyzing COVID-19 data in Japan. This result suggests that influences of pedestrian density, age, and other factors on the number of cases change over periods.

PMID:34995283 | DOI:10.1371/journal.pone.0260836