Category: Nevin Manimala

J Surg Res. 2021 Mar 6;263:207-214. doi: 10.1016/j.jss.2021.01.043. Online ahead of print.

ABSTRACT

BACKGROUND: Childhood papillary thyroid cancer is more aggressive than carcinomas in adults. Current American Thyroid Association pediatric guidelines recommend a total or near-total thyroidectomy for all pediatric patients without gross evidence of lymph node metastases. Our objective is to analyze trends in the surgical management of pediatric papillary thyroid cancer and assess how well the guidelines are implemented.

METHODS: A retrospective cohort study of pediatric patients (ages 19 y and under) who underwent a thyroidectomy was conducted using the Surveillance, Epidemiology, and End Results database 2006-2017. Procedure type was classified as lobectomy or less and subtotal or total thyroidectomy. Descriptive statistics to illustrate patient and tumor characteristics as well as chi-square analysis to evaluate frequency of treatment with total thyroidectomies versus lobectomy or less were performed. Logistic regression analysis controlling for age, sex, size of tumor, rural versus urban institutions, and surgery year was conducted to identify factors predictive of procedure type.

RESULTS: A total of 2271 children underwent surgical management of papillary thyroid cancer between 2006 and 2017. Most patients received a subtotal or total thyroidectomy as surgical management (n = 2,085, 91.8%). One hundred eighty-six patients (8.2%) received a lobectomy or less. The number of lobectomies or less increased with time, with 41 (6.6%) patients between 2006 and 2009, 98 (8.0%) between 2009 and 2015, and 47 (11.1%) between 2016 and 2017 (P = 0.03). Mortality rates were low (n = 15, 0.7%). On logistic regression analysis, later stages, larger sizes, and earlier operative years were predictive of a near-total or total thyroidectomy.

CONCLUSIONS: Despite the American Thyroid Association Guidelines recommending a total thyroidectomy for pediatric well-differentiated thyroid cancer, the results of this study demonstrate that thyroid lobectomies are being performed in increasing frequency for smaller tumors in earlier stages of disease. Further investigation of whether this trend actually affects the outcomes in this patient cohort is needed.

PMID:33690052 | DOI:10.1016/j.jss.2021.01.043

Seizure. 2021 Mar 4;87:56-60. doi: 10.1016/j.seizure.2021.03.003. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to evaluate the incidence and period prevalence of epilepsy in the Republic of North Macedonia, an upper-middle-income country with universal access to healthcare, based on a nationwide healthcare platform (NHP).

METHODS: NHP contains reports from all inpatient and outpatient medical encounters and procedures, and all electronic medical records are linked together with a unique patient number. We performed the analysis of the data maintained at the Macedonian Ministry of Health, concerning the five years of the study (2014 through 2018). Population and demographic data for each year were obtained from the State Statistical Office.

RESULTS: The period prevalence was 6.67 per 1,000 inhabitants. There were 6383 (46.2%) females and 7435 (53.8%) males; the gender difference was significant: 6.17 per 1,000 females and 7.16 per 1,000 males (p = 0.0000). Between 2015 and 2018 the median annual incidence of epilepsy was 68 new epilepsy patients per 100,000, with an upward trend over time. The age-specific incidence was high in childhood and adolescence, was constant (and low) in the adult years, and gradually increased in each successive age group after the age of 50 years. The greatest incidence was found in group 70-79 years of age. The incidence in childhood and adolescence tends to gradually decrease from 2015 to 2018, while it progressively increased in population over 50 years of age, which may explain a rise in overall incidence. We found a statistically significant higher incidence in males than in females, a ratio consistently being 1.2: 1.

CONCLUSION: The data from the study provides accurate findings on the prevalence and incidence of epilepsy in the upper-middle-income Southeastern European country.

PMID:33690108 | DOI:10.1016/j.seizure.2021.03.003

Pract Radiat Oncol. 2021 Mar 6:S1879-8500(21)00059-X. doi: 10.1016/j.prro.2021.02.009. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to investigate the contemporary distribution of medical physics (MP) employment opportunities across the country.

METHODS: An annual record (2018-19) of advertised full-time MP jobs were created using publicly available information from the aapm.org, American Association of Physicists in Medicine – AAPM and indeed.com websites. Listed jobs were categorized based on the position name, work experience, job function, and geographical region. To account for regional population differences, a preponderance of employment opportunities per 10 million was computed. Using CAMPEP residency accreditation data the nationwide locations of the MP training centers and the number of residency positions per annum were identified. A Chi-square goodness of fit test was used for statistical analysis.

RESULTS: A total of 441 unique MP jobs were reported nationwide per annum (2018-19). The highest percentage of MP jobs was reported from the South (33.6%), and the lowest (17.2%) was from the West region. Current analysis revealed 148 (33.6%) jobs were academic and 293 (66.4%) non-academic. The South shows the highest overall academic jobs (31.8%), while the West had the lowest (13.5%). Regionally, the highest percentage of academic jobs (46.9%) were reported from the Northeast, while the West showed the lowest (26.3%). The analysis of academic versus non-academic job comparison by regions shows statistically significant (P=0.0133) differences. The Midwest and the West regions showed the highest (18.2) and lowest (10.24) number of jobs per unit population, measured in 10 million.

CONCLUSION: This is one of the first national quantitative job data analyses of the MP job distributions. This study revealed the current level of demand for qualified candidates demonstrating an imbalance between academic and non-academic positions over the regions. Moreover, the geographical distribution of job listings deviated significantly from expectation given the relative population of each region.

PMID:33689922 | DOI:10.1016/j.prro.2021.02.009

Environ Pollut. 2021 Feb 22;278:116752. doi: 10.1016/j.envpol.2021.116752. Online ahead of print.

ABSTRACT

Stillbirth has a great impact on contemporary and future generations. Increasing evidence show that ambient air pollution exposure is associated with stillbirth. However, previous studies showed inconsistent findings. To clarify the effect of maternal air pollution exposure on stillbirth, we searched for studies examining the associations between air pollutants, including particulate matter (diameter ≤ 2.5 μm [PM_2.5] and ≤10 μm [PM₁₀]) and gaseous pollutants (sulfur dioxide [SO₂], nitrogen dioxide [NO₂], carbon monoxide [CO] and ozone [O₃]), and stillbirth published in PubMed, Web of Science, Embase and Cochrane Library until December 11, 2020. The pooled effect estimates and 95% confidence intervals (CI) were calculated, and the heterogeneity was evaluated using Cochran’s Q test and I² statistic. Publication bias was assessed using funnel plots and Egger’s tests. Of 7546 records, 15 eligible studies were included in this review. Results of long-term exposure showed that maternal third trimester PM_2.5 and CO exposure (per 10 μg/m³ increment) increased the odds of stillbirth, with estimated odds ratios (ORs) of 1.094 (95% CI: 1.008-1.180) and 1.0009 (95% CI: 1.0001-1.0017), respectively. Entire pregnancy exposure to PM_2.5 was also associated with stillbirth (OR: 1.103, 95% CI: 1.074-1.131). A 10 μg/m³ increment in O₃ in the first trimester was associated with stillbirth, and the estimated OR was 1.028 (95% CI: 1.001-1.055). Short-term exposure (on lag day 4) to O₃ was also associated with stillbirth (OR: 1.002, 95% CI: 1.001-1.004). PM₁₀, SO₂ and NO₂ exposure had no significant effects on the incidence of stillbirth. Additional well-designed cohort studies and investigations regarding potential biological mechanisms are warranted to elaborate the suggestive association that may help improve intergenerational inequality.

PMID:33689950 | DOI:10.1016/j.envpol.2021.116752

Drug Alcohol Depend. 2021 Feb 19;221:108594. doi: 10.1016/j.drugalcdep.2021.108594. Online ahead of print.

ABSTRACT

BACKGROUND: Sexual and gender minority (SGM) young persons are experiencing compounding effects of COVID-19 due to unique social inequalities and existent mental health and substance use challenges. Given that 41% of all young persons are enrolled in universities, and the increased vulnerabilities faced by SGM young persons during the pandemic, it is imperative to understand the effects of alcohol use on mental health among SGM university students amid COVID-19. This study aims to examine the associations between changes in alcohol use since the start of COVID-19 and mental distress among SGM university students in the U.S., and to explore sex-stratified differences.

METHODS: A nonprobability cross-sectional sample of 509 SGM university students (M_age = 22.04 years, SD = 3.99) were retrospectively surveyed online between May-August 2020 and asked if their alcohol use had changed since the start of COVID-19. Statistical analyses explored the association between changes in alcohol use since the start of COVID-19 and mental distress.

RESULTS: Average psychological distress (M = 27.79, SD = 7.82) was relatively high as per existing research and established clinical cutoff scores. Roughly 32% had increased alcohol use since the start of COVID-19. Subsequently, greater alcohol use (p < .05) since the start of COVID-19 was associated with higher psychological distress among SGM university students, and among females but not males assigned at birth.

CONCLUSIONS: Higher education, medical, and behavioral health professionals should consider how to adapt their practice to address alcohol use and psychological burdens among SGM university students (especially females) who are facing health inequities during and beyond COVID-19, requiring SGM-affirmative care.

PMID:33689965 | DOI:10.1016/j.drugalcdep.2021.108594

Comput Med Imaging Graph. 2021 Feb 25;89:101888. doi: 10.1016/j.compmedimag.2021.101888. Online ahead of print.

ABSTRACT

Unruptured intracranial aneurysms (UIAs) are prevalent neurovascular anomalies which, in rare circumstances, rupture to cause a catastrophic subarachnoid haemorrhage. Although surgical management can reduce rupture risk, the majority of UIAs exist undiscovered until rupture. Current clinical practice in the detection of UIAs relies heavily on manual radiological review of standard imaging modalities. Recent computer-aided UIA diagnoses can sensitively detect and measure UIAs within cranial angiograms but remain limited to low specificities whose output also requires considerable radiologist interpretation not amenable to broad screening efforts. To address these limitations, we have developed a novel automatic pipeline algorithm which inputs medical images and outputs detected UIAs by characterising single-voxel morphometry of segmented neurovasculature. Once neurovascular anatomy of a specified resolution is segmented, correlations between voxel-specific morphometries are estimated and spatially-clustered outliers are identified as UIA candidates. Our automated solution detects UIAs within magnetic resonance angiograms (MRA) at unmatched 86% specificity and 81% sensitivity using 3 min on a conventional laptop. Our approach does not rely on interpatient comparisons or training datasets which could be difficult to amass and process for rare incidentally discovered UIAs within large MRA files, and in doing so, is versatile to user-defined segmentation quality, to detection sensitivity, and across a range of imaging resolutions and modalities. We propose this method as a unique tool to aid UIA screening, characterisation of abnormal vasculature in at-risk patients, morphometry-based rupture risk prediction, and identification of other vascular abnormalities.

PMID:33690001 | DOI:10.1016/j.compmedimag.2021.101888

Res Vet Sci. 2021 Mar 2;136:209-219. doi: 10.1016/j.rvsc.2021.02.025. Online ahead of print.

ABSTRACT

Stray cat population management is an important worldwide issue. Understanding citizen attitudes towards stray cat control options is vital to the success of controlling stray cat numbers, as public perception affects the acceptance of, support for and collaboration in stray cat management policies. Audience segmentation, as to enable each group to be engaged in the stray cat management policy, is important for the success of the interventions. Therefore a web-based survey was conducted among Flemish citizens in order to examine differences in acceptance towards seven management scenarios: household cat neutering with financial support for the owner, household cat neutering without financial support for the owner, encouraging responsible household cat ownership, trapping stray cats and taking them to a shelter, trapping and neutering stray cats for release into a managed “cat colony” (composed by so called “community cats”), trapping and killing of stray cats, and undertaking no action. A total of 4059 valid responses were collected and the proportions of agreement were compared across the different management scenarios using the two-sample z-test. Interactions among factors that influenced each management scenario were investigated using the CHAID (Chi-squared Automatic Interaction Detection) analysis and visualized on a tree. Our results showed that fostering responsible household cat ownership (89.9%) and conversion of stray cats to “community cats” (76.3%) were most supported by respondents in our sample (which consisted mainly of females, cat-lovers, and families without children). Least supported were the killing of stray cats (7.7%) and undertaking no action (3.3%). The demographic analyses revealed that for the acceptance of management scenarios there were three important factors (attitude towards cats, area of residence, and gender), two weaker factors (education and having children) and two which had almost no impact (age and cat ownership). We propose that future studies should focus on the effect of ‘area of residence’, ‘having children’ and ‘education’. In conclusion, our research confirms that management of and communication on stray cat strategies should not be developed with a one-size-fits-all approach. Efforts should be tailored to each audience segment, thus adapted to the area of residence and human characteristics.

PMID:33689877 | DOI:10.1016/j.rvsc.2021.02.025

Contemp Clin Trials. 2021 Mar 6:106336. doi: 10.1016/j.cct.2021.106336. Online ahead of print.

ABSTRACT

Matched-pair cluster randomization design is becoming increasingly used in clinical and health behavioral studies. Investigators often encounter incomplete observations in the data collected. Statistical inference for matched-pair cluster randomization design with incomplete observations has been extensively studied in literature. However, sample size method for such study design is sparsely available. We propose a closed-form sample size formula for matched-pair cluster randomization design with continuous outcomes, based on the generalized estimating equation approach by treating incomplete observations as missing data in a marginal linear model. The sample size formula is flexible to accommodate different correlation structures, missing patterns, and magnitude of missingness. In the presence of missing data, the proposed method would lead to a more accurate sample size estimation than the crude adjustment method. Simulation studies are conducted to evaluate the finite-sample performance of the proposed sample size method under various design configurations. We use bias-corrected variance estimators to address the issue of inflated type I error when the number of clusters per group is small. A real application example of physical fitness study in Ecuadorian adolescents is presented for illustration.

PMID:33689919 | DOI:10.1016/j.cct.2021.106336

Thorac Cancer. 2021 Mar 10. doi: 10.1111/1759-7714.13778. Online ahead of print.

ABSTRACT

BACKGROUND: Here, we report our initial experience with subxifoid video-assisted thoracoscopic surgery (SVATS) lobectomy for the management of primary lung cancer, and compared the outcomes of SVATS with those of conventional transthoracic VATS (CVATS) lobectomies to validate its feasibility and usefulness.

METHODS: The clinical data of consecutive patients undergoing VATS lobectomy via SVATS or CVATS for lung cancer were retrospectively compared. The endpoints were to evaluate the statistical differences in surgical results, postoperative pain (measured with visual analog scale [VAS] scores at 8 hours, Day 1, Day 2, Day 3, at discharge, one month and three months after surgery) and paresthesia (measured at one- month, and three months after surgery). The two groups were compared before and after matching analysis.

RESULTS: Our study population included 223 patients: 84 in the SVATS and 139 in the CVATS group. The two groups were not comparable for sex (P = 0.001), preoperative comorbidity as cardiopathy (P = 0.007), BMI value (P = 0.003), left-sided procedure (P = 0.04), tumor stage (P = 0.04), and tumor size (P = 0.002). These differences were overcome by propensity score matching (PSM) analysis that yielded two well-matched groups which included 61 patients in each group. Surgical outcomes including blood loss, hospital stay and complications were similar before and after matching analysis, but SVATS compared to CVATS was associated with longer operative time before (159 ± 13 vs. 126 ± 6.3, P < 0.0001), and after matching analysis (161 ± 23 vs. 119 ± 8.3; P < 0.0001) and significant reduction of postoperative pain during the different time-points (P < 0.001), and paresthesia at one (P = 0.001), and three months (P < 0.0001).

CONCLUSIONS: SVATS lobectomy is a feasible and safe strategy with surgical outcomes similar to CVATS lobectomy but with less postoperative pain and paresthesia.

KEY POINTS: SIGNIFICANT FINDINGS OF THE STUDY: Subxifoid thoracoscopic lobectomy is a feasible and safe procedure, with potential benefits in terms of postoperative pain and paresthesia compared to conventional thoracoscopic lobectomy Our results showed that surgical outcomes including blood loss, hospital stay, morbidity and mortality are similar but subxifoid thoracoscopy was associated with significant reduction of postoperative pain and paresthesia.

WHAT THIS STUDY ADDS: Subxifoid thoracoscopy is a safe procedure; compared to conventional transthoracic thoracoscopy, it avoids intercostal incisions, and spares nerve trauma, resulting in a reduction of postoperative pain and paresthesia.

PMID:33689213 | DOI:10.1111/1759-7714.13778

Reprod Sci. 2021 Mar 10. doi: 10.1007/s43032-021-00532-3. Online ahead of print.

ABSTRACT

Previous studies have reported that the mitochondrial DNA (mtDNA) contents of cumulus cells (CCs) in ovarian follicular fluid are correlated with embryo quality. Quantification of mtDNA CCs has been suggested as a biomarker of embryo viability. The aim of this study was to determine the relationship between mitochondrial DNA (mtDNA)/genomic DNA (gDNA) ratio in CCs and IVF outcomes such as fertilization rates and embryo quality in infertile women. This is an observational study on 144 cumulus-oocyte complexes obtained from 144 patients undergoing IVF-intracytoplasmic sperm injection (ICSI) at a single fertility center. The CCs in ovarian follicular fluid from patients undergoing IVF-ICSI were collected by ovum pick-up. A relative copy number quantification was used to determine mtDNA/gDNA ratio. Quantitative real-time PCR for various markers (β2M and mtMinArc gene) was used to determine average mtDNA/gDNA ratio of CCs. Investigation of the correlation between mtDNA/gDNA ratio in CCs and IVF outcomes showed no statistically significant correlation between the mtDNA/gDNA ratio in CCs and fertilization rates. However, mtDNA/gDNA ratio and embryo quality showed a statistically significant positive correlation. A significantly higher mtDNA/gDNA ratio was observed in the good quality embryo group compared with the poor quality embryo group (P < 0.05). In addition, the mtDNA/gDNA ratio showed negative correlation with the patient’s age (correlation coefficient= -0.228, P < 0.05). Results of this study demonstrate a negative correlation of mtDNA/gDNA ratio in CCs with patient’s age, and a low copy number of mtDNA in CCs may have adverse effects on embryo quality in IVF cycles. These results suggest that the ratio of mtDNA/gDNA in CCs may serve as a biomarker in predicting IVF outcomes.

PMID:33689162 | DOI:10.1007/s43032-021-00532-3