Category: Nevin Manimala

Disabil Health J. 2021 May 15:101115. doi: 10.1016/j.dhjo.2021.101115. Online ahead of print.

ABSTRACT

BACKGROUND: Between 2008 and 2014, annual estimates of disability prevalence among U.S. adults varied somewhat across federal surveys that use a standardized measure of disability, but trends over-time were relatively stable and consistent. In 2014, however, estimates of disability from the Survey of Income and Program Participation (SIPP) increased markedly relative to previous years and were much higher than disability estimates from other federal surveys.

OBJECTIVE: To examine why disability prevalence among adults aged 40 and older substantially increased in the first wave of the 2014 SIPP Panel.

METHODS: We consider three factors that may have contributed to the rise in disability: data processing, context effects linked to question order, and sampling. To do so, we compare estimates with and without survey weights and imputed data, analyze supplemental disability-related data collected among SIPP participants, and employ decomposition analysis to assess what proportion of the increase in disability can be attributed to changes in sample composition.

RESULTS: We find evidence that differences in sample composition contributed to the observed rise in disability prevalence in SIPP between 2011 and 2014. There is less evidence that weighting and imputation or context effects played a role.

CONCLUSIONS: Previous studies emphasize differences in operationalization and conceptualization of disability as the major factor driving discrepancies in disability estimates. This study suggests that other factors related to survey design and administration may influence disability measurement. Such aspects of surveys, like question order and sampling, may be difficult to standardize, leading to meaningful cross-survey differences in disability estimates.

PMID:34154971 | DOI:10.1016/j.dhjo.2021.101115

Eur Urol Oncol. 2021 Jun 18:S2588-9311(21)00116-4. doi: 10.1016/j.euo.2021.06.001. Online ahead of print.

ABSTRACT

BACKGROUND: Discordant findings between multiparametric magnetic resonance imaging (mpMRI) and transrectal image-guided biopsies of the prostate (TRUS-P) may result in inadequate risk stratification of localized prostate cancer.

OBJECTIVE: To assess transperineal image-guided biopsies of the index target (TPER-IT) in terms of disease reclassification and treatment recommendations.

DESIGN, SETTING, AND PARTICIPANTS: Cases referred for suspicion or treatment of localized prostate cancer were reviewed in a multidisciplinary setting, and discordance was characterized into three scenarios: type I-negative biopsies or International Society of Urological Pathology (ISUP) grade 1 cancer in Prostate Imaging Reporting and Data System (PI-RADS) ≥4 index target (IT); type II-negative biopsies or ISUP grade 1 cancer in anterior IT; and type III-<3 mm stretch of cancer in PI-RADS ≥3 IT. Discordant findings were characterized in 132/558 (23.7%) patients after TRUS-P. Of these patients, 102 received reassessment TPER-IT.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary objective was to report changes in treatment recommendations after TPER-IT. Therefore, cores obtained by primary TRUS-P and TPER-IT were analyzed in terms of cancer detection, ISUP grade, and Cambridge Prognostic Group classification using descriptive statistics.

RESULTS AND LIMITATIONS: TPER-IT biopsies that consisted of fewer cores than the initial TRUS-P (seven vs 14, p < 0.0001) resulted in more cancer tissue materials for analysis (56 vs 42.5 mm, p = 0.0003). As a result, 40% of patients initially considered for follow-up (12/30) and 49% for active surveillance (30/61) were reassigned after TPER-IT to surgery or intensity-modulated radiotherapy.

CONCLUSIONS: Nonconcordance between pathology and imaging was observed in a significant proportion of patients receiving TRUS-P. TPER-IT better informed the presence and grade of cancer, resulting in a significant impact on treatment recommendations. A multidisciplinary review of mpMRI and TRUS-P findings and reassessment TPER-IT in type I-II discordances is recommended.

PATIENT SUMMARY: In this report, patients with suspicious imaging of the prostate, but no or well-differentiated cancer on transrectal image-guided -biopsies, were offered transperineal image-guided biopsies for reassessment. We found that a large share of these had a more aggressive cancer than initially suspected. We conclude that discordant results warrant reassessment transperineal image-guided biopsies as these may impact disease risk classification and treatment recommendations.

PMID:34154979 | DOI:10.1016/j.euo.2021.06.001

Transpl Infect Dis. 2021 Jun 21:e13673. doi: 10.1111/tid.13673. Online ahead of print.

ABSTRACT

BACKGROUND: Infections post-liver transplantation are major drivers for morbidity and mortality. However, the impact of infections within 180 days post-liver transplantation on long-term survival is not clear.

METHODS: We present a retrospective cohort of 317 liver transplant patients for whom all infectious episodes were prospectively collected during a mean follow-up of 4.4 years.

RESULTS: 143/317 (45%) of patients suffered from any infectious episode during the first six months following liver transplantation. Patients with surgical site infections had a reduced survival compared to those with no infection (HR 0.33, 95% CI 0.172-0.636, p=0.001), whereas infections from other sources, including pneumonia, UTI, and line-related infections were not associated with increased mortality. Furthermore, even though the presence of any infection within 30 days or six months post-transplantation did not affect survival, more than a single infectious episode per patient was significantly associated with increased mortality (HR 1.70, CI 1.12- 2.60, p=0.013). In a multivariate analysis, the number of infectious episodes remained statistically significant (HR 1.58, 95% CI 1.03-2.43, p=0.035) upon adjustment for other major variables associated with comorbidities and infection risk.

CONCLUSIONS: Surgical site infections and the number of infectious episodes within 180 days post-liver transplantation are major determinants of long-term survival among these patients.

PMID:34153169 | DOI:10.1111/tid.13673

Transpl Infect Dis. 2021 Jun 21:e13672. doi: 10.1111/tid.13672. Online ahead of print.

ABSTRACT

BACKGROUND: BK virus is associated with development of nephropathy (BKVN) that can lead to graft failure after renal transplantation. There is limited data on rates of recurrence and outcomes of repeat renal transplantation after prior graft loss due to BKVN.

METHODS: After IRB approval, data on all patients who underwent a repeat renal transplantation after prior graft failure due to BKVN was identified. Data on management of patients prior to retransplantation, induction and maintenance immunosuppression, and key clinical and virologic outcomes was collected. Descriptive statistics were used for analysis.

RESULTS: Thirteen patients were identified over a 13-year period, and follow-up of these patients occurred for a median of 4.7 years. Most patients had previous renal transplants removed prior to (7/13, 53.8%) or at time of retransplantation (3/13, 23.1%). Close virologic monitoring of serum and urine, coupled with early immunosuppression minimization, was associated with few patients developing BK viruria above 1×10⁷ c/mL (4/13, 30.8%), BK viremia above 10,000 c/mL (2/13, 15.4%) and biopsy proven BKVN (1/12, 8.3%); most (8/13, 61.5%) developed BK viruria at any level. Renal function at 1 year post-retransplantation was generally excellent and only 1 patient developed graft failure due to recurrent focal segmental glomerulosclerosis. In our review of the literature, two large observational studies of the UNOS database as well as our analysis of case reports showed excellent graft survival and very low rates of recurrent BKVN leading to graft loss.

CONCLUSIONS: Retransplantation after prior graft failure due to BKVN generally has low rates of recurrence when coupled with close monitoring and early immunosuppression minimization. Removal of failed renal transplant may allow easier monitoring for recurrence.

PMID:34153164 | DOI:10.1111/tid.13672

New Phytol. 2021 Jun 21. doi: 10.1111/nph.17571. Online ahead of print.

ABSTRACT

Minimum water potential (Ψ_min ) is a key variable to characterize dehydration tolerance and hydraulic safety margins (HSM) in plants. Ψ_min is usually estimated as the absolute minimum tissue Ψ experienced by a species, but this is problematic because sample extremes are affected by sample size and by the underlying probability distribution. We compare alternative approaches to estimate Ψ_min and assess the corresponding uncertainties and biases; propose statistically robust estimation methods based on extreme value theory (EVT); and assess the implications of our results for the characterization of hydraulic risk. Our results show that current estimates of Ψ_min and HSM are biased, as they are strongly affected by sample size. Because sampling effort is generally higher for species living in dry environments, the differences in current Ψ_min estimates between these species and those living under milder conditions are partly artifactual. When this bias is corrected using EVT methods, resulting HSM tend to increase substantially with resistance to embolism across species. Although data availability and representativeness remain the main challenges for proper determination of Ψ_min , a closer look at Ψ distributions and the use of statistically robust methods to estimate Ψ_min opens new ground for characterizing plant hydraulic risks.

PMID:34153132 | DOI:10.1111/nph.17571

PLoS One. 2021 Jun 21;16(6):e0253317. doi: 10.1371/journal.pone.0253317. eCollection 2021.

ABSTRACT

BACKGROUND: Individuals with metabolic syndrome are five times more susceptible to chronic diseases. Assessment of its magnitude, components, and risk factors is essentials to deploy visible interventions needed to avoid further complications. The study aimed to assess magnitude, components, and predictors of metabolic syndrome in Tigray region northern Ethiopia, 2016.

METHODS: Data were reviewed from Tigray region NCDs STEPs survey data base between May to June 2016. A total of 1476 adults aged 18-64 years were enrolled for the study. Multi-variable regression analysis was performed to estimate the net effect of size to risk factors associated with metabolic syndrome. Statistical significance was declared at p-value of ≤0.05 at 95% confidence interval (CI) for an adjusted odds ratio (AOR).

RESULTS: The study revealed that unadjusted and adjusted prevalence rate of Metabolic Syndrome (MetS) were (CPR = 33.79%; 95%CI: 31.29%-36.36%) and (APR = 34.2%; 95% CI: 30.31%-38.06%) respectively. The most prevalent MetS component was low HDL concentration (CPR = 70.91%; 95%CI: 68.47%-73.27%) and (APR = 70.61; 95%CI; 67.17-74.05). While; high fasting blood glucose (CPR = 20.01% (95%CI: 18.03-22.12) and (APR = 21.72; 95%CI; 18.41-25.03) was the least ones. Eating vegetables four days a week, (AOR = 3.69, 95%CI; 1.33-10.22), a salt sauce added in the food some times (AOR = 5.06, 95%CI; 2.07-12.34), overweight (AOR = 24.28, 95%CI; 10.08-58.47] and obesity (AOR = 38.81; 12.20-111.04) had strong association with MetS.

CONCLUSION: The magnitude of metabolic syndrome was found to be close to the national estimate. Community awareness on life style modification based on identified MetS components and risk factors is needed to avoid further complications.

PMID:34153079 | DOI:10.1371/journal.pone.0253317

PLoS Pathog. 2021 Jun 21;17(6):e1009669. doi: 10.1371/journal.ppat.1009669. Online ahead of print.

ABSTRACT

Linkage effects in a multi-locus population strongly influence its evolution. The models based on the traveling wave approach enable us to predict the average speed of evolution and the statistics of phylogeny. However, predicting statistically the evolution of specific sites and pairs of sites in the multi-locus context remains a mathematical challenge. In particular, the effects of epistasis, the interaction of gene regions contributing to phenotype, is difficult to predict theoretically and detect experimentally in sequence data. A large number of false-positive interactions arises from stochastic linkage effects and indirect interactions, which mask true epistatic interactions. Here we develop a proof-of-principle method to filter out false-positive interactions. We start by demonstrating that the averaging of haplotype frequencies over multiple independent populations is necessary but not sufficient for epistatic detection, because it still leaves high numbers of false-positive interactions. To compensate for the residual stochastic noise, we develop a three-way haplotype method isolating true interactions. The fidelity of the method is confirmed analytically and on simulated genetic sequences evolved with a known epistatic network. The method is then applied to a large sequence database of neurominidase protein of influenza A H1N1 obtained from various geographic locations to infer the epistatic network responsible for the difference between the pre-pandemic virus and the pandemic strain of 2009. These results present a simple and reliable technique to measure epistatic interactions of any sign from sequence data.

PMID:34153082 | DOI:10.1371/journal.ppat.1009669

Diabet Med. 2021 Jun 21:e14627. doi: 10.1111/dme.14627. Online ahead of print.

ABSTRACT

BACKGROUND: Previous studies have identified several echocardiographic markers of cardiac dysfunction in patients with diabetes mellitus, including E/e’. However, previous studies have been limited by short follow-up duration or low statistical power, and none have assessed whether echocardiographic predictors of adverse cardiovascular outcome differ between individuals with DM and individuals without DM.

METHODS: A total of 1,997 individuals from the general population without heart disease had an echocardiogram performed in 2001-3. Diabetes was defined as HbA1c ≥6.5% (≥48mmol/mol), non-fasted blood glucose ≥ 11.1mmol/L or the use of glucose lowering medication. The end-point was a composite of heart failure (HF), ischemic heart disease (IHD) and cardiovascular death (CVD).

RESULTS: At baseline, a total of 292 participants (15%) had diabetes. Median follow-up time was 12.4 years (interquartile-range: 9.8-12.8 years) and follow-up was 100%. During follow-up, 101 patients (35%) with diabetes and 281 patients without diabetes (16%) reached the composite end-point. The prognostic value of E/e’ was significantly modified by diabetes (p for interaction: 0.003). In patients with diabetes, only E/e’ remained an independent predictor of outcome in a final multivariable model adjusted for clinical and echocardiographic parameters (HR 1.08, 95% CI 1.00-1.17 p=0.0041, per 1 increase). In patients without diabetes, left ventricular mass index (LVMI), left ventricular ejection fraction (LVEF) and a’ remained independent predictors of outcome when adjusted for clinical and echocardiographic parameters. In individuals with diabetes, only E/e’ added incremental prognostic value to risk factors from the SCORE risk chart and the ACC/AHA Pooled Cohort Equation.

CONCLUSION: In individuals with diabetes from the general population, E/e’ is a stronger predictor of cardiovascular mortality and morbidity than in individuals without diabetes and contributes with incremental prognostic value in addition to established cardiovascular risk factors.

PMID:34153131 | DOI:10.1111/dme.14627

PLoS Negl Trop Dis. 2021 Jun 21;15(6):e0009544. doi: 10.1371/journal.pntd.0009544. Online ahead of print.

ABSTRACT

BACKGROUND: There is growing recognition of the contribution of the social determinants of health to the burden of many infectious diseases. However, the relationship between socioeconomic status and the incidence and outcome of melioidosis is incompletely defined.

METHODS: All residents of Far North Queensland, tropical Australia with culture-proven melioidosis between January 1998 and December 2020 were eligible for the study. Their demographics, comorbidities and socioeconomic status were correlated with their clinical course. Socioeconomic status was determined using the Socio-Economic Indexes for Areas (SEIFA) Index of Relative Socio-economic Disadvantage score, a measure of socioeconomic disadvantage developed by the Australian Bureau of Statistics. Socioeconomic disadvantage was defined as residence in a region with a SEIFA score in the lowest decile in Australia.

RESULTS: 321 eligible individuals were diagnosed with melioidosis during the study period, 174 (54.2%) identified as Indigenous Australians; 223/321 (69.5%) were bacteraemic, 85/321 (26.5%) required Intensive Care Unit (ICU) admission and 37/321 (11.5%) died. 156/321 (48.6%) were socioeconomically disadvantaged, compared with 56603/269002 (21.0%) of the local general population (p<0.001). Socioeconomically disadvantaged patients were younger, more likely to be female, Indigenous, diabetic or have renal disease. They were also more likely to die prior to hospital discharge (26/156 (16.7%) versus 11/165 (6.7%), p = 0.002) and to die at a younger age (median (IQR) age: 50 (38-68) versus 65 (59-81) years, p = 0.02). In multivariate analysis that included age, Indigenous status, the presence of bacteraemia, ICU admission and the year of hospitalisation, only socioeconomic disadvantage (odds ratio (OR) (95% confidence interval (CI)): 2.49 (1.16-5.35), p = 0.02) and ICU admission (OR (95% CI): 4.79 (2.33-9.86), p<0.001) were independently associated with death.

CONCLUSION: Melioidosis is disease of socioeconomic disadvantage. A more holistic approach to the delivery of healthcare which addresses the social determinants of health is necessary to reduce the burden of this life-threatening disease.

PMID:34153059 | DOI:10.1371/journal.pntd.0009544

PLoS One. 2021 Jun 21;16(6):e0250329. doi: 10.1371/journal.pone.0250329. eCollection 2021.

ABSTRACT

This study aimed to assess the biophysical parameters of the skin in Polish Konik horses (Polish primitive horses). According to the authors, this is the first assessment performed on such a wide scale in this group of animals. The evaluation carried out is innovative both with regards to the breed of the animals and the wide scope of the physicochemical skin assessment. The study group comprised mares, stallions and geldings, and the evaluations concerned transepidermal water loss, corneometry, pH, skin temperature assessment and mexametry. These parameters were assessed in five skin regions: the lips, the right ear, the prosternum, the right side of the neck and the chest. The measurements were taken after spreading the hair apart, with the use of a Multiprobe Adapter System (MPA®) and dedicated probes (Courage + Khazaka electronic GmbH, Cologne, Germany). The measurements revealed statistically significant differences in the values of transepidermal water loss in the lips in mares compared with stallions (P = 0.023) and also in stallions compared with geldings (P = 0.009). Corneometry showed significantly higher results in the neck region in mares compared with stallions (P = 0.037) and the prosternum areas in mares and geldings compared with stallions (P = 0.037 and P = 0.018). Skin pH measurement on the right side of the neck rendered significantly higher values in stallions than in mares (P = 0.037). In geldings, the skin temperature was significantly higher than in stallions (P = 0.049). Once the appropriate physicochemical values for specific animal species and breeds are determined, non-invasive methods of skin examination in many diseases and also methods of evaluation of the efficacy and/or adverse effects of applied medications can be established.

PMID:34153061 | DOI:10.1371/journal.pone.0250329