Category: Nevin Manimala

J Fish Biol. 2021 Mar 27. doi: 10.1111/jfb.14739. Online ahead of print.

ABSTRACT

Meristic variation among stocks of greater lizardfish Saurida tumbil through the western coasts of the Arabian Gulf and Sea of Oman was examined using meristic characters. Statistical analysis of meristic traits proposed that there is constrained migration of populations of greater lizardfish along the western coast of the Arabian Gulf and Sea of Oman. Overlapping of the two samples from the northern part of the Arabian Gulf (Iraq-Kuwait waters), three samples from the middle region of the Arabian Gulf (Bahrain-Qatar-Saudi Arabia) and two samples from the southern part of the Arabian Gulf/Sea of Oman (United Arab Emirates-Sultanate of Oman) suggested that there are three self-recruiting population in the studied area. Inspection of the role of each meristic trait variable to Canonical discriminant analysis showed that changes among samples appeared to be linked with the pattern of distribution of water temperature and configuration of current in both the Arabian Gulf and Sea of Oman areas. This article is protected by copyright. All rights reserved.

PMID:33772771 | DOI:10.1111/jfb.14739

J Dent Educ. 2021 Mar 27. doi: 10.1002/jdd.12599. Online ahead of print.

ABSTRACT

PURPOSE/OBJECTIVES: In light of a movement to eliminate the historical separation of dentistry and medicine to produce more collaborative and knowledgeable clinicians and to improve care, integrated education models are vital. This study aimed to demonstrate the effectiveness of an integrated medical and dental student curriculum at the University of Connecticut. It was hypothesized that a medical and dental student doctoring course within an already combined biomedical curriculum would result in statistically significantly increases in dental student clinical skills performance.

METHODS: Analysis of variance (ANOVA) was utilized for an overall test of scores from 2016 to 2019. When ANOVA indicated significant differences, post hoc pairwise comparisons using Tukey’s adjustment classified pairs that differed significantly. Lastly, a contrast was constructed to test the difference before and after the course’s introduction. A two-sided α of 0.05 was used.

RESULTS: Dental students were assessed on three cases for history taking and master interview rating scale (MIRS) criteria. The mean averages in history taking and MIRS criteria after the implementation of this course increased by 7.81 (SE = 1.83, p < 0.0001) and 11.95 (SE = 1.34, p < 0.0001) for a toothache case, 11.37 (SE = 1.98, p < 0.0001) and 9.84 (SE = 1.35, p < 0.0001) for a loose bridge case, and 12.47 (SE = 1.75, p < 0.0001) and 10.07 (SE = 1.28, p < 0.0001) for a sensitive tooth case.

CONCLUSION: An integrated doctoring course within a combined curriculum at the University of Connecticut Schools of Medicine and Dental Medicine resulted in a statistically significant increase in dental student clinical skills assessment scores, demonstrating this model’s utility.

PMID:33772785 | DOI:10.1002/jdd.12599

Med Phys. 2021 Mar 26. doi: 10.1002/mp.14865. Online ahead of print.

ABSTRACT

PURPOSE: Contouring variation is one of the largest systematic uncertainties in radiotherapy, yet its effect on clinical outcome has never been analysed quantitatively. We propose a novel, robust methodology to locally quantify target contour variation in a large patient cohort and find where this variation correlates with treatment outcome. We demonstrate its use on biochemical recurrence for prostate cancer patients.

METHOD: We propose to compare each patient’s target contours to a consistent and unbiased reference. This reference was created by auto-contouring each patient’s target using an externally trained deep learning algorithm. Local contour deviation measured from the reference to the manual contour were projected to a common frame of reference, creating contour deviation maps for each patient. By stacking the contour deviation maps, time to event was modelled pixel-wise using a multivariate Cox proportional hazards model (CPHM). Hazard ratio (HR) maps for each covariate were created, and regions of significance found using cluster-based permutation testing on the z-statistics. This methodology was applied to Clinical Target Volume (CTV) contours, containing only the prostate gland, from 232 intermediate- and high-risk prostate cancer patients. The reference contours were created using ADMIRE® v3.4 (Elekta AB, Sweden). Local contour deviations were computed in a spherical coordinate frame, where differences between reference and clinical contours were projected in a 2D map corresponding to sampling across the coronal and transverse angles every 3°. Time to biochemical recurrence was modelled using the pixel-wise CPHM analysis accounting for contour deviation, patient age, Gleason score and treated CTV volume.

RESULTS: We successfully applied the proposed methodology to a large patient cohort containing data from 232 patients. In this patient cohort, our analysis highlighted regions where the contour variation was related to biochemical recurrence, producing expected and unexpected results: 1) the interface between prostate-bladder and prostate-seminal vesicle interfaces where increase of the manual contour relative to the reference was related to a reduction of risk of biochemical recurrence by 4-8% per mm and 2) the prostate’s right, anterior and posterior regions where an increase of the manual contour relative to the reference contours was related to an increase of risk of biochemical recurrence by 8-24% per mm.

CONCLUSION: We proposed and successfully applied a novel methodology to explore the correlation between contour variation and treatment outcome. We analysed the effect of contour deviation of the prostate CTV on biochemical recurrence for a cohort of more than 200 prostate cancer patients while taking basic clinical variables into account. Applying this methodology to a larger dataset including additional clinically important covariates and externally validating it can more robustly identify regions where contour variation directly relates to treatment outcome. For example, in the prostate case we use to demonstrate our novel methodology, external validation will help confirm or reject the counter-intuitive results (larger contours resulting in higher risk). Ultimately, the results of this methodology could inform contouring protocols based on actual patient outcomes.

PMID:33772803 | DOI:10.1002/mp.14865

Clin Pharmacol Ther. 2021 Mar 26. doi: 10.1002/cpt.2240. Online ahead of print.

ABSTRACT

Torsade de Pointes (TdP), a rare but lethal ventricular arrhythmia, is a toxic side effect of many drugs. To assess TdP risk, safety regulatory guidelines require quantification of hERG channel block in vitro and QT interval prolongation in vivo for all new therapeutic compounds. Unfortunately, these have proven to be poor predictors of torsadogenic risk, and are likely to have prevented safe compounds from reaching clinical phases. While this has stimulated numerous efforts to define new paradigms for cardiac safety, none of the recently developed strategies accounts for patient conditions. In particular, despite being a well-established independent risk factor for TdP, female sex is vastly underrepresented in both basic research and clinical studies, and thus current TdP metrics are likely biased toward the male sex. Here, we apply statistical learning to synthetic data, generated by simulating drug effects on cardiac myocyte models capturing male and female electrophysiology, to develop new sex-specific classification frameworks for TdP risk. We show that (1) TdP classifiers require different features in females vs. males; (2) male-based classifiers perform more poorly when applied to female data; (3) female-based classifier performance is largely unaffected by acute effects of hormones (i.e., during various phases of the menstrual cycle). Notably, when predicting TdP risk of intermediate drugs on female simulated data, male-biased predictive models consistently underestimate TdP risk in women. Therefore, we conclude that pipelines for preclinical cardiotoxicity risk assessment should consider sex as a key variable to avoid potentially life-threatening consequences for the female population.

PMID:33772748 | DOI:10.1002/cpt.2240

J Am Geriatr Soc. 2021 Mar 26. doi: 10.1111/jgs.17137. Online ahead of print.

ABSTRACT

BACKGROUND/OBJECTIVES: Evidence on the effectiveness of inpatient hospital geriatric consultation is scant, and it is unknown whether adherence to specific recommendations will improve care and patient outcomes. This study was conducted to provide insights from a quality improvement project that may help guide further improvements in the effectiveness of these consultations made as a component of a care transitions program (CTP).

DESIGN: Secondary analysis of the implementation of a multicomponent CTP for high-risk hospitalized patients aged 75 and older.

SETTING: A 400-bed community teaching hospital.

PARTICIPANTS: Two hundred and two patients admitted to non-ICU beds who met high-risk criteria.

INTERVENTION: Inpatient comprehensive geriatric consultation including care transition recommendations, telephone and in-person follow-up weekly for 4 weeks after discharge, and collaboration with post-acute organizations and primary care and specialist physicians to implement recommendations.

MEASUREMENTS: Primary outcomes for this analysis was 30-day hospital readmissions and adherence to transition of care recommendations.

RESULTS: The 142 patients with at least one post-discharge visit received 936 care transition recommendations. Overall, 663 (71%) of the 936 care transition recommendations were adhered to (71%). The adherence rate was lower in the 22 patients who were readmitted to the hospital within 30 days (63%) compared to 72% adherence in the 120 patients who were not readmitted. This was not a statistically significant difference, and there were no significant differences in the number and percent adherence in any recommendation category between the two groups.

CONCLUSION: We found adherence to just over two-thirds of care transition recommendations, similar to a small number of other studies. We did not find a relationship between the number of recommendations and adherence to them with 30-day readmissions to the hospital. Future studies of CTPs should consider several strategies may enhance geriatric consultation care transitions recommendations and adherence to them, and improve patient outcomes.

PMID:33772760 | DOI:10.1111/jgs.17137

Eur J Immunol. 2021 Mar 27. doi: 10.1002/eji.202049101. Online ahead of print.

ABSTRACT

Humoral immunity to the Severe Adult Respiratory Syndrome (SARS) Coronavirus (CoV)-2 is not fully understood yet but is a crucial factor of immune protection. The possibility of antibody cross-reactivity between SARS-CoV-2 and other human coronaviruses (HCoVs) would have important implications for immune protection but also for the development of specific diagnostic ELISA tests. Using peptide microarrays, n = 24 patient samples and n = 12 control samples were screened for antibodies against the entire SARS-CoV-2 proteome as well as the Spike (S), Nucleocapsid (N), VME1 (V), R1ab, and Protein 3a (AP3A) of the HCoV strains SARS, MERS, OC43 and 229E. While widespread cross-reactivity was revealed across several immunodominant regions of S and N, IgG binding to several SARS-CoV-2-derived peptides provided statistically significant discrimination between COVID-19 patients and controls. Selected target peptides may serve as capture antigens for future, highly COVID-19-specific diagnostic antibody tests. This article is protected by copyright. All rights reserved.

PMID:33772767 | DOI:10.1002/eji.202049101

Drug Metab Pers Ther. 2021 Mar 26. doi: 10.1515/dmpt-2020-0187. Online ahead of print.

ABSTRACT

OBJECTIVES: Osteoporosis often occurs in individuals of different age groups, frequently during menopause and after ovariectomy. It increases the risk of pathological fractures almost twice. The aim of our research was to assess bone metabolism, nanocomposite structure of the tibia under conditions of ovariectomy and zoledronic acid treatment.

METHODS: X-ray diffraction has been performed for nanostructure analysis of mineral crystallites and crystal lattice of hydroxyapatite in the tibia samples of ovariectomized rats with additional application of bisphosphonate zoledronic acid (0.025 mg/kg). Markers of remodeling – osteocalcin, alkaline phosphatase, tartrate resistant acid phosphatase 5b – were determined. Quantitative amount of calcium in the bones was detected by atomic absorption method.

RESULTS: Zoledronic acid prevented loss of mineral mass after ovariectomy. Rats after ovariectomy, treated with zoledronic acid, showed statistically higher (р<0.05) values of crystalline phase and calcium content compared with the SHAM-surgery and ovariectomy groups (р<0.05). Zoledronic acid inhibited bone remodeling, which is proved by tartrate resistant acid phosphatase 5b reduction and inhibition of osteoclasts during the experiment.

CONCLUSIONS: These results enable to suggest that zoledronic acid can improve mineral mass of the bone during menopause in individuals of different age groups.

PMID:33770826 | DOI:10.1515/dmpt-2020-0187

Psychiatriki. 2021 Mar 26. doi: 10.22365/jpsych.2021.014. Online ahead of print.

ABSTRACT

Problem gambling emerges as a serious and ever growing problem of modern societies, largely affecting adolescents as well. The etiology of gambling disorder is complex and multifaceted as it is governed by multiple and interrelated factors. In this context and in light of the pervasive financial crisis in Greece, we conducted a study in order to explore adolescents’ gambling involvement in Athens region and also to identify the socio-economic characteristics of adolescents who have engaged into gambling activities. Students were recruited from a sample of schools in Athens area. For the assessment of gambling involvement in adolescents, the Diagnostic and Statistical Manual of Mental Disorders-IV Multiple Response Adapted for Juveniles Questionnaire (DSM-IV-MR-J) was administered. Additional self-constructed questions enquired about students’ socio-demographic and economic characteristics. Our results indicate that adolescents that had problem with gambling or had at least one pathological item on DSM were more likely to be boys and to have been born in a country other than Greece. Additionally, the proportion of those having at least one pathological item on DSM was greater in those with low school grades. Τhe lack of food in the household due to inability of providing food during the last month was significantly associated with both having problem with gambling and having at least one pathological item on DSM. Furthermore, having been worried that there would not be enough food during the last month and having been fed with a restrained variety of food due to lack of recourses were associated with at least one pathological item on DSM. These findings are congruent with the literature suggesting that youth living under poverty often resort to gambling. In conclusion, our results point out the adverse effects of the financial crisis on the development of problem gambling in adolescents within the Greek society. Problem gambling may have developed in response to the ubiquitous insecurity characterizing the Greek society during this rough time period. Interventions should prioritize endowing adolescents with the necessary coping skills for dealing with daily obstacles or life adversities productively and without losing their self-control.

PMID:33770751 | DOI:10.22365/jpsych.2021.014

J Neurosurg. 2021 Mar 26:1-10. doi: 10.3171/2020.9.JNS201828. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of this study was to investigate whether neurosurgical intervention for traumatic brain injury (TBI) is associated with reduced risks of death and clinical deterioration in a low-income country with a relatively high neurosurgical capacity. The authors further aimed to assess whether the association between surgical intervention and acute poor outcomes differs according to TBI severity and various patient factors.

METHODS: Using TBI registry data collected from a national referral hospital in Uganda between July 2016 and April 2020, the authors performed Cox regression analyses of poor outcomes in admitted patients who did and did not undergo surgery for TBI, with surgery as a time-varying treatment variable. Patients were further stratified by TBI severity using the admission Glasgow Coma Scale (GCS) score: mild TBI (mTBI; GCS scores 13-15), moderate TBI (moTBI; GCS scores 9-12), and severe TBI (sTBI; GCS scores 3-8). Poor outcomes constituted Glasgow Outcome Scale scores 2-3, deterioration in TBI severity between admission and discharge (e.g., mTBI to sTBI), and death. Several clinical and demographic variables were included as covariates. Patients were observed for outcomes from admission through hospital day 10.

RESULTS: Of 1544 patients included in the cohort, 369 (24%) had undergone surgery. Rates of poor outcomes were 4% (n = 13) for surgical patients and 12% (n = 144) among nonsurgical patients (n = 1175). Surgery was associated with a 59% reduction in the hazard for a poor outcome (HR 0.41, 95% CI 0.23-0.72). Age, pupillary nonreactivity, fall injury, and TBI severity at admission were significant covariates. In models stratifying by TBI severity at admission, patients with mTBI had an 80% reduction in the hazard for a poor outcome with surgery (HR 0.20, 95% CI 0.04-0.90), whereas those with sTBI had a 65% reduction (HR 0.35, 95% CI 0.14-0.89). Patients with moTBI had a statistically nonsignificant 56% reduction in hazard (HR 0.44, 95% CI 0.17-1.17).

CONCLUSIONS: In this setting, the association between surgery and rates of poor outcomes varied with TBI severity and was influenced by several factors. Patients presenting with mTBI had the greatest reduction in the hazard for a poor outcome, followed by those presenting with sTBI. However, patients with moTBI had a nonsignificant reduction in the hazard, indicating greater variability in outcomes and underscoring the need for closer monitoring of this population. These results highlight the importance of accurate, timely clinical evaluation throughout a patient’s admission and can inform decisions about whether and when to perform surgery for TBI when resources are limited.

PMID:33770754 | DOI:10.3171/2020.9.JNS201828

Female Pelvic Med Reconstr Surg. 2021 Apr 1;27(4):225-229. doi: 10.1097/SPV.0000000000001001.

ABSTRACT

OBJECTIVE: This study aimed to determine if routine assessment of patients after onabotulinumtoxinA injections for overactive bladder is necessary to detect clinically significant voiding dysfunction.

METHODS: This retrospective cross-sectional cohort study analyzed patients who underwent intravesical injection of onabotulinumtoxinA for overactive bladder during a 4-year period. Patients were included for analysis if they returned for an office follow-up visit within 1 month of administration. Baseline demographic data; procedural details; postvoid residual volumes; abnormal postprocedure voiding symptoms, including urinary frequency, pain, or inability to void; urinary tract infections; and initiation of intermittent self-catheterization were recorded. Descriptive statistics, point-biserial and Pearson correlation analyses were performed.

RESULTS: Two hundred thirty-seven injections were included in our analysis. Fifteen encounters, from 13 patients, required the initiation of intermittent self-catheterization (6.3%). The median postvoid residual in those treated with intermittent self-catheterization was 300 mL (min, max: 200, 750 mL); all had received 100 units of onabotulinumtoxinA. The most common symptom among those requiring intermittent self-catheterization was urgency (n = 13; 87%), whereas 93% (n = 14) had at least 1 bothersome symptom. Correlation analyses showed a weak positive correlation with elevated postvoid residual volume and a history of prolapse repair (r = 0.269, P = 0.004), and prior pelvic surgery (r = 0.205, P = 0.029).

CONCLUSIONS: Clinically relevant urinary retention that required intermittent self-catheterization after onabotulinumtoxinA injection for overactive bladder occurred in 6.3% of participants in this sample. The vast majority of patients who required intermittent self-catheterization described symptoms that they were able to self-identify.

PMID:33770805 | DOI:10.1097/SPV.0000000000001001