Category: Nevin Manimala

J Med Internet Res. 2021 May 1. doi: 10.2196/28876. Online ahead of print.

ABSTRACT

BACKGROUND: Previous studies have suggested associations between trends of web searches and COVID-19 traditional metrics. It remains unclear whether models incorporating trends of digital searches lead to better predictions.

OBJECTIVE: To investigate the relationship between Google Trends searches of symptoms associated with COVID-19 and confirmed COVID-19 cases and deaths. To develop predictive models to forecast the COVID-19 epidemic based on the combination of Google Trends searches of symptoms and conventional COVID-19 metrics.

METHODS: An open-access web application was developed to evaluate Google Trends and traditional COVID-19 metrics via an interactive framework based on principal components analysis (PCA) and time series modeling. The app facilitates the analysis of symptom search behavior associated with COVID-19 disease in 188 countries. In this study, we selected data of eight countries as case studies to represent all continents. PCA was used to perform data dimensionality reduction, and three different time series models (Error Trend Seasonality, Autoregressive integrated moving average, and feed-forward neural network autoregression) were used to predict COVID-19 metrics in the upcoming 14 days. The models were compared in terms of prediction ability using the root-mean-square error (RMSE) of the first principal component (PC1). The predictive abilities of models generated with both Google Trends data and conventional COVID-19 metrics were compared with those fitted with conventional COVID-19 metrics only.

RESULTS: The degree of correlation and the best time-lag varied as a function of the selected country and topic searched; in general, the optimal time lag was within 15 days. Overall, predictions of PC1 based on both searched termed and COVID-19 traditional metrics performed better than those not including Google searches (median [IQR]: 1.56 [0.90-2.49] vs. 1.87 [1.09-2.95], respectively), but the improvement in prediction varied as a function of the selected country and timeframe. The best model varied as a function of country, time range, and period of time selected. Models based on a 7-day moving average led to considerably smaller RMSE values as opposed to those calculated with raw data (median [IQR]: 0.90 [0.50-1.53] vs. 2.27 [1.62-3.74], respectively).

CONCLUSIONS: The inclusion of digital online searches in statistical models may improve the nowcasting and forecasting of the COVID-19 epidemic and could be used as one of the surveillance systems of COVID-19 disease. We provide a free web application operating with nearly real-time data that anyone can use to make predictions of outbreaks, improve estimates of dynamics of ongoing epidemics, and anticipate future or rebound waves.

PMID:34156966 | DOI:10.2196/28876

Surg Laparosc Endosc Percutan Tech. 2021 May 24. doi: 10.1097/SLE.0000000000000959. Online ahead of print.

ABSTRACT

BACKGROUND: To compare the self-assessment of surgical residents and observers (faculty members and nurses) during laparoscopic cholecystectomy (LC).

MATERIALS AND METHODS: A prospective observational study was conducted between February 2020 and July 2020 at a medical school hospital. Seventy-four LC surgeries were performed by surgical residents in the presence of faculty members. A self-assessment of the technical and nontechnical performance of the residents was requested. The self-assessment of residents was compared with observer evaluations using the Kruskal-Wallis test. Gwet AC2 fit coefficient was used to determine the consistency between the observers’ and residents’ assessments. Bland-Altman plots were generated with 95% limits of agreement to describe the agreement between the total scores of the observers.

RESULTS: The self-assessment of residents had a statistically significant higher score when compared with observers (faculty and nurses) (P<0.001). However, no significant difference was observed between the total scores given by the observers (faculty members and nurses) (P>0.05). There was a moderate agreement between the resident versus faculty members [0.503; 95% confidence interval (CI), 0.430-0.576] and resident versus nurse (0.518; 95% CI, 0.432-0.605) when evaluating technical skills. However, there was substantial agreement between faculty members and nurses (0.736; 95% CI, 0.684-0.789). Postoperative pain was significantly correlated with resident self-assessment (P=0.022).

CONCLUSION: The self-assessment scores of surgical residents in LC operations were overestimated compared with observer assessments.

PMID:34156187 | DOI:10.1097/SLE.0000000000000959

Minerva Urol Nephrol. 2021 Jun 22. doi: 10.23736/S2724-6051.21.04469-4. Online ahead of print.

ABSTRACT

BACKGROUND: Robotic partial nephrectomy (RPN) in patients ≥75 years is certainly underused with concerns regarding surgical quality and a negligible impact on renal function. The aim of this study was to identify predictors of progression of chronic kidney disease for purely off-clamp (ocRPN) and on-clamp RPN (onRPN) in elderly patients on a multi-institutional series.

METHODS: A collaborative minimally-invasive renal surgery dataset was queried for “RPN” performed between July 2007 and March 2021 and “age≥75 years”. A total of 205 patients matched the inclusion criteria. Descriptive analyses were used. Frequencies and proportions were reported for categorical variables while medians and interquartile ranges (IQR) were reported for continuous variables. Baseline, perioperative and functional data were compared between groups. New-onset of stages 3b,4,5 CKD in onRPN and ocRPN cohorts was computed by Kaplan-Meier analysis. Univariable and multivariable Cox regression analyses were performed to identify predictors of progression to severe CKD (sCKD [stages ≥3b]). For all statistical analyses, a two-sided p < 0.05 was considered significant.

RESULTS: Mean age of the cohort considered was 78 years (IQR 76-80). At a median follow-up of 29 months (IQR 14.5-44.5), new onset CKD-3b and CKD-4,5 stages was observed in 16.6% and 2.4% of patients, respectively. At Kaplan-Meier analysis, onRPN was associated with a significantly higher risk of developing sCKD (p=0.002). On multivariable analysis, hypertension (HR 2.64; 95% CI 1.14-6.11; p=0.023), on-clamp approach (HR 3.41; 95% CI 1.50-7.74; p=0.003) non-achievement of trifecta (HR 0.36; 95% CI 0.17-0.78; p=0.01) were independent predictors of sCKD.

CONCLUSIONS: RPN in patients≥75 years is a safe surgical option. On-clamp approach, hypertension and non-achievement of trifecta were independent predictors of sCKD in the elderly after RPN.

PMID:34156202 | DOI:10.23736/S2724-6051.21.04469-4

J Sports Med Phys Fitness. 2021 Jun 22. doi: 10.23736/S0022-4707.21.12268-6. Online ahead of print.

ABSTRACT

BACKGROUND: The purpose of this study was to measure and compare jump load and dynamic performance in elite volleyball athletes under varied conditions over an entire season of practices and games. Jump load and dynamic performance were compared among (i) best jump height, (ii) mean jump height, as well as according to (iii) the number of jumps per game or practice session and (iv) the proportion of jumps higher than 50 cm relative to the total number of jumps in a practice or game.

METHODS: Every jump performed by each of 12 players, in all practices and regular games (813 player-sessions in total), was measured by a particle accelerometer in accordance with a validated protocol (Vert®). Data were collected and analysed using STATA; the significance level for definition of confidence intervals was set to 95%, unless otherwise specified. Statistical analysis and comparison of means and proportions between groups was based on standard t-tests.

RESULTS: Among player positions, the Middle Blocker consistently presented the greatest jump loads during the season; by comparison, the smallest jump loads were observed in the Setter.

CONCLUSIONS: Monitoring players’ jump loads and performance using a simple accelerometer provides evidence which can be used to plan individual player activity, roster composition, the season calendar and furthermore increase knowledge to reduce over-training and recurrence of injuries.

PMID:34156178 | DOI:10.23736/S0022-4707.21.12268-6

J Sports Med Phys Fitness. 2021 Jun 22. doi: 10.23736/S0022-4707.21.12349-7. Online ahead of print.

ABSTRACT

BACKGROUND: We tested the hypothesis that Whole Body Vibration (WBV) positively affects the fatigue process ensuing from repeated bouts of maximal efforts, as induced by repeated sprints ability (RSA). Eleven male soccer players performed three sets of six repeated shuttle sprints (40 metres).

METHODS: Eleven male soccer players (age 23,6±4,5 years) were cross-randomized to perform WBW before RSA and during the recovery between sets (WBV-with) or to warm-up and passive recovery between sets (WBV-without). The effects of WBV were quantified by sprint time (ST) and blood lactate concentration (LA), collected up to 15th min after completion of tests.

RESULTS: ST during RSA showed a better maintenance of performance in the WBV-with compared to WBV-without condition in all three sets, reaching a statistical significance between-groups during the 2nd and 3rd set (P< 0.05). No significant differences in ST over the sets were detected in WBVwith, whereas a significant decrease was observed in the WBV-without condition (P<0.001). LA recovered significantly faster from the 9th to 15th minute of recovery in WBV-with as compared to WBV-without (P<0.05).

CONCLUSIONS: These findings would indicate that WBV performed during recovery between RSA sets is capable of delaying the onset of muscle fatigue resulting in a better maintenance of sprint performance.

PMID:34156181 | DOI:10.23736/S0022-4707.21.12349-7

J Magn Reson Imaging. 2021 Jun 21. doi: 10.1002/jmri.27792. Online ahead of print.

ABSTRACT

BACKGROUND: Fetal growth restriction (FGR) is associated with a high fetal brain volume/liver volume (FBV/FLV) ratio. Ultrasound may not always be reliable, which has prompted further investigation of MRI techniques.

PURPOSE: To determine the relationship between FBV/FLV ratio, as measured by MRI, and gestational age (GA) in normal fetuses and those with FGR.

STUDY TYPE: Retrospective.

POPULATION: One hundred and forty seven singleton pregnancies including 105 appropriate-for-gestational age (AGA) fetuses and 42 FGR fetuses.

FIELD STRENGTH/SEQUENCE: Three-dimensional fast imaging employing steady-state acquisition at 1.5 T.

ASSESSMENT: The FBV and FLV were measured by three radiologists. The inter- and intraobserver agreements, the correlation between FBV/FLV ratio, and advancing GA were evaluated; the diagnostic value of FBV/FLV ratio was evaluated and compared with head circumference/abdominal circumference (HC/AC) ratio measured by ultrasound.

STATISTICAL TESTS: Intraclass correlation coefficient (ICC) was used to determine inter- and intraobserver agreements. Regression analysis was used to assess the correlation between FBV/FLV ratio and advancing GA. The diagnostic value of the FBV/FLV ratio was examined by the area under the receiver operating characteristic (ROC) curve.

RESULTS: The inter- and intraobserver agreements were excellent with an interobserver ICC of 0.984 and intra-observer ICCs of 0.989, 0.994, and 0.995. The FBV/FLV ratio in AGA fetuses decreased significantly with advancing GA (Pearson correlation coefficient = -0.844). The FBV/FLV ratio in FGR fetuses was significantly higher than that in AGA fetuses. To identify fetuses at high risk for FGR using the FBV/FLV ratio, the area under the ROC curve was 0.978, with an optimal cut-off value of 4.10. The sensitivity of FBV/FLV ratio in identifying FGR was significantly higher than that of HC/AC ratio (0.929 vs. 0.529).

DATA CONCLUSION: An inverse correlation exists between FBV/FLV ratio and advancing GA in normal fetuses. A high FBV/FLV ratio may be used to ascertain fetuses at high risk for FGR.

LEVEL OF EVIDENCE: 3 Technical Efficacy Stage: 3.

PMID:34156128 | DOI:10.1002/jmri.27792

ESC Heart Fail. 2021 Jun 22. doi: 10.1002/ehf2.13476. Online ahead of print.

ABSTRACT

AIMS: Heart failure (HF) is common in both men and women, yet disease pathophysiology, presentation, and progression differ between sexes. Studies addressing whether biomarkers predict new onset HF sex-specifically are scarce. This study therefore aims to test the sex-specificity of 252 protein biomarkers for new-onset HF.

METHODS AND RESULTS: A matched case-control design in patients selected from cohorts within the HOMAGE consortium was used. Cases (new-onset HF, n = 562) and controls (n = 780) were matched for cohort (PREDICTOR, HEALTH-ABC, & PROSPER), follow-up time (defined as time from entry to incident HF), and age. Incident HF was defined as first hospitalization for HF. Targeted plasma proteins (n = 252) were measured using Proximity Extension Assay technology from O-link. To look for sex differences for new onset HF, we adjusted for cohort, age, and baseline clinical parameters. At baseline, women had a biomarker profile reflecting activated metabolism and immune responses. However, none of the biomarkers had a significant interaction with sex in predicting new onset HF, but four biomarkers had a trend towards sex-specificity (P < 0.013). E-selectin and interleukin 1 receptor antagonist were more female-specific, whereas IL17A and CHIT1 tended to be male sex-specific for incident HF.

CONCLUSIONS: The majority of biomarkers associated with incident HF did not significantly differ between women and men, despite clear differences in biomarkers at baseline.

PMID:34156155 | DOI:10.1002/ehf2.13476

Wiad Lek. 2021;74(4):998-1002.

ABSTRACT

OBJECTIVE: The aim: To analyze and calculate CVR in patients with T2DM and concomitant obesity.

PATIENTS AND METHODS: Materials and methods: The selection of patients was carried out based on the Uzhhorod District Clinical Hospital, in the period from November 2016 to January 2020. All patients were divided into 3 groups: 1 (n=93) with T2DM and concomitant obesity, 2 (n=87) with T2DM, 3 (n=39) with obesity. The treatment period lasted 1 year and included dosed exercise for at least 30 minutes per day and dietary recommendations. Patients in groups 1 and 2 received metformin 850 mg twice daily in combination with dapagliflozin 10 mg once daily. CVR was determined at the time of enrollment and after 1 year of treatment using: American College of Cardiology / American Heart Association Guideline on the Assessment of Cardiovascular Risk (2013) (ASCVD Risk) and Framingham Risk Score (FRS).

RESULTS: Results: The data obtained as a result of the study revealed the highest CVR in patients of group 1, in contrast to group 2 and 3 (p<0.05). After 1 year of complex treatment, CVR indicators were statistically significantly reduced in all experimental groups (p<0.05).

CONCLUSION: Conclusions: Determining CVR parameters and exposure to them within 10 years can remove unwanted cardiovascular complications.

PMID:34156019

Wiad Lek. 2021;74(4):1019-1023.

ABSTRACT

OBJECTIVE: The aim: Was to study the dynamics of the incidence of diphtheria in the Transcarpathian region of Ukraine.

PATIENTS AND METHODS: Materials and methods: A retrospective analysis of the data of the state statistical reporting of the Transcarpathian region on the incidence of diphtheria, the carriage of infection, vaccination coverage and the severity of diphtheria immunity was carried out.

CONCLUSION: Conclusions: Low coverage of the population with vaccination against diphtheria, registration of an outbreak of diphtheria among international students of the region, and other regions of Ukraine in conditions of increased population migration, are alarming prognostic signs of the possible development of another significant epidemic rise of diphtheria morbidity in Transcarpathia.

PMID:34156023

Rev Esp Salud Publica. 2021 Jun 22;95:e202106086.

ABSTRACT

OBJECTIVE: The increasing complexity of clinical trial protocols and the very nature of investigational drugs increase the likelihood of prescribing errors and require comprehensive control and monitoring of treatments. The aim of this study was to measure and analyze the potential risks of prescribing errors in investigational drugs.

METHODS: A prospective, descriptive, and observational study was carried out in a third-level hospital in Madrid, for one month in 2017. Manual prescribing errors (EP) in investigational drugs and potential risks of harm to the patient were analyzed. A descriptive statistical analysis was performed, including the absolute and relative frequency for the variables.

RESULTS: A total of 254 medical orders corresponding to 327 lines of treatment and 274 different drugs were reviewed, of which 83% were categorized as “high-risk”. Results showed 217 (85.4%) EP within the identification of the medical order and 1,045 (319,6%) in the treatment. The risk level of harm to the patient was high for all EP in patient identification and moderate for all EP in the clinical trial identification. The lines of treatment showed an especially high-risk potential for EP in dosage (25%) and frequency (41%).

CONCLUSIONS: The high rate of EP found, along with the high-risk potential these entail, reflects the need for improving the security process when prescribing investigational drugs in our field.

PMID:34156039