Category: Nevin Manimala

Am J Med Genet A. 2021 Dec 4. doi: 10.1002/ajmg.a.62587. Online ahead of print.

ABSTRACT

Children with Down syndrome (DS) show delayed acquisition of cognitive and functional skills compared to typically developing children. The objective of this study was to accurately describe early development of infants and young children (children hereafter) with DS based on a large recent sample. We carried out repeated measure analysis of the global development quotient (GDQ) and developmental age using data from the Assessment of Systematic Treatment with Folinic Acid and Thyroid Hormone on Psychomotor Development of Down Syndrome Young Children (ACTHYF) study (NCT01576705). Because there was no statistically significant difference in the primary endpoint between active treatment and placebo, data from all treatment groups were pooled for post-hoc analysis. Data of 141 children with DS aged 6-18 months at inclusion were analyzed. Mean GDQ decreased over the study period, especially in the youngest age classes ([6-9] and [9-12] months), indicating that acquisition of skills occurred at a slower pace compared to typically developing children. Strongest deficits were observed for motor and hearing and language skills. Only GDQ at baseline correlated significantly with evolution of GDQ. Future studies should aim at elucidating the mechanisms underlying motor and language development. Early pharmacological interventions together with early childhood therapies might be necessary to improve the developmental trajectory of children with DS.

PMID:34863019 | DOI:10.1002/ajmg.a.62587

Biometrics. 2021 Dec 4. doi: 10.1111/biom.13609. Online ahead of print.

ABSTRACT

Complementary features of randomized controlled trials (RCTs) and observational studies (OSs) can be used jointly to estimate the average treatment effect of a target population. We propose a calibration weighting estimator that enforces the covariate balance between the RCT and OS, therefore improving the trial-based estimator’s generalizability. Exploiting semiparametric efficiency theory, we propose a doubly robust augmented calibration weighting estimator that achieves the efficiency bound derived under the identification assumptions. A nonparametric sieve method is provided as an alternative to the parametric approach, which enables the robust approximation of the nuisance functions and data-adaptive selection of outcome predictors for calibration. We establish asymptotic results and confirm the finite sample performances of the proposed estimators by simulation experiments and an application on the estimation of the treatment effect of adjuvant chemotherapy for early-stage non-small cell lung patients after surgery. This article is protected by copyright. All rights reserved.

PMID:34862966 | DOI:10.1111/biom.13609

J Eur Acad Dermatol Venereol. 2021 Dec 4. doi: 10.1111/jdv.17857. Online ahead of print.

ABSTRACT

BACKGROUND: A large discrepancy between physician-diagnosed and self-reported HS exists. Knowledge regarding incidence and remission rates of self-reported HS is missing, but may help bridge the gap in understanding between these two phenotypes.

OBJECTIVES: To determine the incidence and remission rates of self-reported HS, and to what degree these are affected by sex, smoking and BMI.

METHODS: A prospective cohort of 23,930 Danish blood donors. Information on self-reported HS, symptom-localization, sex, age, BMI and smoking status was collected at baseline and study termination. Self-reported HS fulfilled clinical obligatory diagnostic criteria. Cox proportional hazards regression analyses were conducted for both incidence and remission rates providing a hazard ratio (HR) of risk for each variable in the regression.

RESULTS: incidence rate of self-reported HS was 10.8/1,000 person-years (95% CI: 9.9-11.7), decreasing as a function of numbers of areas affected. Female BMI points above 25 (HR=1.11, 95% CI: 1.09-1.13), male BMI points above 25 (HR=1.07, 95% CI: 1.04-1.11) , active smoking (HR=1.72, 95% CI: 1.15-2.57), male sex (HR=0.55, 95% CI: 0.45-0.67) and years of age above 25 (HR=0.97, 95% CI: 0.96-0.97) were all statistically associated with the development of self-reported HS. Remission rate of self-reported HS was 256.7/1,000 person-years (95% CI: 223.9-292.6), decreasing as a function of numbers of affected areas. Symptoms in ≥3 areas (HR=0.54, 95% CI: 0.34-0.85), active smoking (HR=0.49, 95% CI: 0.32-0.76) and female weight loss (every percentage drop in BMI: HR=1.07, 95%CI: 1.05-1.11) all significantly affected the remission rate.

CONCLUSIONS: Both incidence and remission rates of self-reported HS are high, indicating that many with self-reported HS are unlikely to be diagnosed, as they to a higher degree experience mild transient HS symptoms.

PMID:34862994 | DOI:10.1111/jdv.17857

Ophthalmol Ther. 2021 Dec 4. doi: 10.1007/s40123-021-00413-7. Online ahead of print.

ABSTRACT

INTRODUCTION: To compare the long-term effect after modified CO₂ laser-assisted sclerectomy surgery (MCLASS) and conventional trabeculectomy (TRAB) in medically uncontrolled Chinese primary open-angle glaucoma (POAG) patients. This was a retrospective comparative study.

METHODS: A total of 87 patients were reviewed, including 45 in the MCLASS group and 42 in the TRAB group. Intraocular pressure (IOP), best-corrected visual acuity (BCVA), and use of supplemental medical therapy were retrospectively compared at baseline, and until 36 months postoperatively.

RESULTS: Patients in both groups achieved a significant IOP decrease from baseline (P < 0.001); postoperative IOP in the MCLASS group was significantly lower than that in the TRAB group at 24 and 36 months. The reduced use of medication was statistically significant in both groups, and the number of postoperative medications was significantly more in TRAB group at 24 and 36 months. At 24 and 36 months, the complete success rate was 60% and 53.3% for MCLASS versus 66.7% and 59.5% for TRAB, and the qualified success rate was 91.1% and 88.9% for MCLASS versus 83.3% and 80.9% for TRAB, respectively. BCVA deterioration post TRAB was clinically more serious than that post MCLASS at 24 and 36 months, although the difference was not statically significant at any time point postoperatively. Compared with MCLASS, more complications occurred postoperatively in the TRAB group.

CONCLUSIONS: MCLASS is an effective surgical option for Chinese POAG patients. Compared to TRAB, eyes undergoing MCLASS experience a comparable success rate, a greater IOP reduction, fewer medications, and a lower risk of complications up to 36 months.

PMID:34862960 | DOI:10.1007/s40123-021-00413-7

Int J Gynaecol Obstet. 2021 Dec 4. doi: 10.1002/ijgo.14060. Online ahead of print.

ABSTRACT

OBJECTIVE: To study the association between precipitous labor (less than 3 hours) and the onset of transient tachypnea in singleton fetuses in cephalic presentation with term vaginal deliveries.

METHODS: This cohort study included women delivered from 2013 through 2017 in our French tertiary university hospital maternity unit. Inclusion criteria were vaginal delivery of liveborn singleton fetus in cephalic presentation and at term. We compared women with precipitous labor and those with longer labor. The principal endpoint was the rate of transient tachypnea of the newborn (TTN). We investigated risk factors for TTN besides duration of labor.

RESULTS: Comparison of 2644 women with precipitous labor and 7571 with longer labor showed a lower TTN rate in the precipitous labor group (1.6 vs 2.7%; P=0.003). The association was no longer significant after adjustment for the risk factors identified in the univariate analysis (adjusted OR 0.99, 95% CI 0.64-1.54). Risk factors identified for TTN were non-clear amniotic fluid, shoulder dystocia, umbilical cord encirclement, birth weight less than 2500 g, use of cervical ripening and operative vaginal delivery.

CONCLUSION: Precipitous labor, lasting less than 3 hours, is not associated with a higher risk of transient tachypnea in term newborns after vaginal delivery.

PMID:34862963 | DOI:10.1002/ijgo.14060

Skeletal Radiol. 2021 Dec 4. doi: 10.1007/s00256-021-03951-0. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess prevalence of CT imaging-derived sarcopenia, osteoporosis, and visceral obesity in clinically frail and prefrail patients and determine their association with the diagnosis of frailty.

MATERIALS AND METHODS: This cross-sectional study was constructed using our institution’s pelvic trauma registry and ambulatory database registry. The study included all elderly pelvic trauma patients and ambulatory outpatients between May 2016 and March 2020 who had a comprehensive geriatric assessment and CT abdomen/pelvis within 1 year from the date of the assessment. Patients were dichotomized in prefrail or frail groups. The study excluded patients with history of metastatic disease or malignancy requiring chemotherapy.

RESULTS: The study cohort consisted of 151 elderly female and 65 male patients. Each gender population was subdivided into frail (114 female [75%], 51 male [78%]) and prefrail (37 female [25%], 14 male [22%]) patients. CT-imaging-derived diagnosis of osteoporosis (odds ratio, 2.5; 95% CI: 1.2-5.5) and sarcopenia (odds ratio, 2.6; 95% CI: 1.2-5.6) were associated with frailty in females, but did not reach statistical significance in males. BMI and subcutaneous adipose tissue at L3 level were statistically lower in the frail male group compared to the prefrail group. BMI showed strong correlation with the subcutaneous area at the L3 level in both genders (Spearman’s coefficient of 0.8, p < 0.001). Hypoalbuminemia and visceral obesity were not associated with frailty in either gender.

CONCLUSION: This proof-of-concept study demonstrates the feasibility of using CT-derived body-composition parameters as a screening tool for frailty, which can offer an opportunity for early medical intervention.

PMID:34862921 | DOI:10.1007/s00256-021-03951-0

Ultrasound J. 2021 Dec 4;13(1):47. doi: 10.1186/s13089-021-00247-1.

ABSTRACT

BACKGROUND: Traditional anatomy teaching methods are based on the models and cadaveric dissections, providing fixed views of the anatomical structures. However, in the last few years, the emerging concept of ultrasound-based teaching in anatomy has started to gain ground among medical curricula. This study aims to evaluate the integration of ultrasound as an adjunct tool to traditional anatomy teaching methods and explore students’ perceptions of whether ultrasound-based teaching enhances their interest and knowledge of anatomy. A cross-sectional study was carried out among the students of the 6-year undergraduate entry (MD) and 4-year graduate entry (MBBS) program of the University of Nicosia. A questionnaire was distributed to them after the delivery of several twenty minutes ultrasound sessions by an expert in the field during anatomy practicals. The data were analyzed utilizing SPSS software, and the statistical significance was determined as p value < 0.05.

RESULTS: 107 MD and 42 MBBS students completed the questionnaire. Both groups agreed that their ultrasound-based learning experience was good or excellent (79.4% MD students; 92.9% MBBS students), that it enhanced their knowledge of anatomy (68.2% MD students; 90.5% MBBS students) and boosted their confidence regarding their examination skills practice (69.2% MD students; 85.7% MBBS students). Although most students desired more time allocated to the ultrasound station (72% MD students; 85.7% MBBS students), they believed that ultrasound-based teaching is a necessary adjunct to the traditional teaching methods of anatomy (89.7% MD students; 92.9% MBBS students).

CONCLUSIONS: Overall, MBBS students were more confident about the benefits of ultrasound-based teaching. Most of the students agreed that cross-sectional sessions of traditional teaching and ultrasound-based teaching strengthened their knowledge of anatomy and enhanced their confidence concerning their clinical examination skills. Medical schools should embrace the advantages that ultrasound-based teaching offers in order future doctors to be qualified to utilize ultrasound for procedural and diagnostical purposes.

PMID:34862937 | DOI:10.1186/s13089-021-00247-1

Arch Gynecol Obstet. 2021 Dec 4. doi: 10.1007/s00404-021-06336-9. Online ahead of print.

ABSTRACT

OBJECTIVE: The COVID-19 pandemic restricting clinical practice and exacerbating the lack of medical staff. There is currently a lack of young residents who are deciding on further training in gynecology and obstetrics.

DESIGN: review and prospective, cross-sectional study.

SETTING: the aim of this study was to investigate if structured mentoring programs can counteract this deficiency.

POPULATION: medical students took part from Germany in the clinical phase.

METHODS: An anonymous questionnaire was developed and distributed to students from January to October 2020. Epidemiological data, questions about mentoring experiences, necessity and their expected influence on career planning were collected and statistically evaluated.

MAIN OUTCOME MEASURES: structured mentoring-programs can influence the choice of subject. In particular, men are still underrepresented. Research on the topic of mentoring during in the field of gynaecology and obstetrics is completely lacking.

RESULTS: A representative number of 927 medical students took part in the survey. 22% (170/906) of the students had already participated in a mentoring program with a significantly higher proportion of men (69%; 117/170; p < 0.001). Of these, 94% (453/170) said this was helpful. 6% (55/906) wanted to pursue a career in gynecology and obstetrics. When asked about their appreciation for structured mentoring programs in gynecology and obstetrics, 95% (880/906) would participate and 94% agreed (871/906) that this could have an impact on their choice of specialist and career planning.

CONCLUSIONS: An active provision of mentoring programs and more content can be a way of counteracting the shortage of residents in gynecology and obstetrics.

PMID:34862919 | DOI:10.1007/s00404-021-06336-9

Psychiatr Danub. 2021 Dec;33(Suppl 11):100-115.

ABSTRACT

BACKGROUND: Intra-operative anxiety is a commonly experienced feeling amongst patients undergoing surgery. Moreover, conscious patients are exposed to the multiple environmental factors triggering this emotion. Apprehension and fear are common emotions interlinked with associated intra-operative anxiety. Several concerning complications are associated with this emotion during surgery, many of which include severe cardiac related events, such as heart failure and acute myocardial infarction, extreme postoperative pain, increased requirement of analgesic, sedation and anaesthetic demand, extended hospital stay, and reduced patient satisfaction. In this review, the effect of intra-operative music therapy to alleviate anxiety in adults undergoing surgery will be studied in order to establish whether intra-operative music alleviates anxiety in adults undergoing local anaesthetic surgical interventions.

METHODS: The Population studied was adults aged 18-80 years old undergoing local anaesthetic interventions. The Intervention observed was the exposure of intra-operative music therapy. The Comparison was against patients undergoing surgery without being subject to music therapy. The desired Outcome was the alleviation of intra-operative anxiety. The intention was to develop a systematic review of the available data. In orderto develop the literature search, Key elements of the question were identified and utilized to generate alternative terms. Subsequently, Boolean Operators were used to combine these terms. Search results were narrowed down by means of limiters and selected databases; EBSCO, PubMed and ScienceDirect were used to execute the search. The PRISMA 2009 framework was used as a guideline in excluding irrelevant studies. Assessment of study eligibility was done byapplying inclusion/exclusion criteria. Appraisal of literature was done by using The Critical Appraisal Skills Programme (CASP) tool as a framework.

RESULTS: A total of five studies were identified. These included randomised control trials. Two of these studies demonstrated statistical significance whilst the remaining three failed to do so. The overall result of these studies was inconclusive and inconsistent in attempting to determine whether intra-operative music therapy alleviates anxiety in patients undergoing local anaesthetic interventions.

CONCLUSION: The presentation of a definite conclusion is not possible. However, evidence is promising and pointing towards the likelihood of beneficial outcomes resulting from the intervention of interest. However, further research is required.

IMPLICATIONS AND RECOMMENDATIONS: It is recommended that the patients be offered the choice of selecting their preferred music if they give consent to undergo surgery while being exposed to music therapy. Various cost-effective audio devices could be installed in operating theatres. The general public and healthcare professionals should be educated about the benefits of intra-operative music therapy. Future studies should use larger sample sizes, and attrition rate should be reduced through better communication with patients and thorough taking into account the demographic characteristics of the patients.

PMID:34862901

Psychiatr Danub. 2021 Dec;33(Suppl 11):121-132.

ABSTRACT

BACKGROUND: Violence Against Women and Girls (VAWG) (physical, sexual, and psychological/emotional) is a type of structural discrimination that violates the basic human rights of females on a global scale. Cultural norms that glorify male dominance, power imbalances, and abuse of authority are the most encountered reasons for VAWG. Emotional abuse, which can start in childhood, is widely recognised as the most prevalent form of VAWG. However, although victims of emotional abuse usually suffer terribly, perpetrators often evade accountability. Emotional abuse is underestimated in part because it is normalized by victims who are mostly women and girls. The normalization of VAWG is contributing to the propagation and perpetuation of biased perceptions of sexism. The intergenerational transmission of parenting styles – which is an important contributory factor for child development – often includes gender-stereotyping norms, or patriarchy. Hitherto, limited focus has been directed towards the consequences that emotional abuse related to patriarchal upbringing has on children. Aim – to investigate if emotional abuse related to patriarchal upbringing influences the perception of sexism and gender stereotyping across genders, and the development of unresolved trauma in children.

METHODS: Participants were recruited via social media platforms to complete online questionnaires assessing parental emotional abuse, control, trauma, misogyny, and perceptions of sexism. Parametric analyses were conducted on the 188 participants (158 women and 30 men) recruited. Trauma and perceptions of sexism were statistically analysed using correlation and multiple linear regression.

RESULTS: Our findings show that parental emotional abuse and control in females predicted for unresolved traumatic experiences (16.6%). Misogynistic culture and male gender predicted for hostile sexism (9.9%), whereas emotional abuse predicted for benevolent sexism (40%).

CONCLUSION: Emotional abuse related to patriarchal upbringing contributes to the genesis of gender inequality and unresolved trauma in children. Given that parental styles are transmitted from one generation to the next, to reduce sexism and improve mental health outcomes, the patriarchal parental cycle must be broken.

PMID:34862904