Category: Nevin Manimala

J Perinat Med. 2021 Jul 5. doi: 10.1515/jpm-2021-0243. Online ahead of print.

ABSTRACT

Non-invasive prenatal testing (NIPT) is often erroneously received as a diagnostic procedure due to its high discriminatory power in the field of fetal trisomy 21 diagnosis (wording: “NIPT replaces amniocentesis”). Already a look at the methodology of NIPT (statistical gene dose comparison of a primarily maternofetal DNA mixture information at selected sites of the genome) easily reveals that NIPT cannot match the gold standard offered by cytogenetic and molecular genetic analysis procedures from the matrix of the entire human genome (origin: vital fetal cells), neither in diagnostic breadth nor in diagnostic depth. In fact, NIPT in fetal medicine in its current stage of development is a selective genetic search procedure, which can be applied in primary (without indication) or secondary (indication-related) screening. Thus, NIPT competes with established search procedures for this field. Here, the combined nuchal translucency (NT) test according to Nicolaides has become the worldwide standard since 2000. The strength of this procedure is its broad predictive power: NT addresses not only the area of genetics, but also the statistically 10 times more frequent structural fetal defects. Thus, NIPT and NT have large overlaps with each other in the field of classical cytogenetics, with slightly different weighting in the fine consideration. However, NIPT without a systematic accompanying ultrasound examination would mean a step back to the prenatal care level of the 1980s. In this respect, additional fine ultrasound should always be required in the professional application of NIPT. NIPT can thus complement NT in wide areas, but not completely replace it.

PMID:34225389 | DOI:10.1515/jpm-2021-0243

Arch Craniofac Surg. 2021 Jun;22(3):148-153. doi: 10.7181/acfs.2021.00241. Epub 2021 Jun 25.

ABSTRACT

BACKGROUND: The zygomaticomaxillary complex (ZMC) has a protruded, convex shape and plays a vital role in determining the contour by affecting the width of the middle face. This study aimed to evaluate the efficiency of ZMC fracture reduction and explore detailed directions for outcome improvement.

METHODS: We conducted a retrospective study of patients diagnosed with unilateral ZMC fracture who underwent ZMC reduction surgery at a single hospital between January 2015 and May 2020. The primary outcome variable was facial asymmetry using the difference in the bilateral malar eminence (ME) position measured by computed tomography scan. The 3-dimensional distance (IA, asymmetry index) and the distance in each dimension, Dx (anteroposterior distance), Dy (mediolateral distance), and Dz (superoinferior distance) were compared.

RESULTS: A total of 101 patients with ZMC fractures and 54 non-fracture patients were enrolled in the study. The mean age of the study sample was 43.49 years (control sample, 43.35 years), and the male-to-female ratio was 66.3:33.7 (control sample, 64.8:35.2). There were 53 and 48 patients with right and left ZMC fractures, respectively. The IA was not statistically different between the two groups. In terms of position in each dimension, only Dx was significantly different between the two groups.

CONCLUSION: The results show that overall facial asymmetry was recovered after ZMC reduction, but in certain dimension significant difference in ME position has still remained. For further improvement, treatment should be performed to relieve malar depression in the anteroposterior dimension.

PMID:34225406 | DOI:10.7181/acfs.2021.00241

J Educ Eval Health Prof. 2021;18:15. doi: 10.3352/jeehp.2021.18.15. Epub 2021 Jul 5.

ABSTRACT

PURPOSE: Diagnostic classification models (DCMs) were developed to identify the mastery or non-mastery of the attributes required for solving test items, but their application has been limited to very low-level attributes, and the accuracy and consistency of high-level attributes using DCMs have rarely been reported compared with classical test theory (CTT) and item response theory models. This paper compared the accuracy of high-level attribute mastery between deterministic inputs, noisy “and” gate (DINA) and Rasch models, along with sub-scores based on CTT.

METHODS: First, a simulation study explored the effects of attribute length (number of items per attribute) and the correlations among attributes with respect to the accuracy of mastery. Second, a real-data study examined model and item fit and investigated the consistency of mastery for each attribute among the 3 models using the 2017 Korean Medical Licensing Examination with 360 items.

RESULTS: Accuracy of mastery increased with a higher number of items measuring each attribute across all conditions. The DINA model was more accurate than the CTT and Rasch models for attributes with high correlations (>0.5) and few items. In the real-data analysis, the DINA and Rasch models generally showed better item fits and appropriate model fit. The consistency of mastery between the Rasch and DINA models ranged from 0.541 to 0.633 and the correlations of person attribute scores between the Rasch and DINA models ranged from 0.579 to 0.786.

CONCLUSION: Although all 3 models provide a mastery decision for each examinee, the individual mastery profile using the DINA model provides more accurate decisions for attributes with high correlations than the CTT and Rasch models. The DINA model can also be directly applied to tests with complex structures, unlike the CTT and Rasch models, and it provides different diagnostic information from the CTT and Rasch models.

PMID:34225413 | DOI:10.3352/jeehp.2021.18.15

Ultraschall Med. 2021 Jul 5. doi: 10.1055/a-1530-5240. Online ahead of print.

ABSTRACT

OBJECTIVES: Prenatal prediction of postnatal univentricular versus biventricular circulation in patients with borderline left ventricle (bLV) remains challenging. This study investigated prenatal fetal echocardiographic parameters and postnatal outcome of patients with a prenatally diagnosed bLV.

METHODS: We report a retrospective study of bLV patients at four prenatal centers with a follow-up of one year. BLV was defined as z-scores of the left ventricle (LV) between -2 and -4. Single-ventricle palliation (SVP), biventricular repair (BVR), and no surgical or catheter-based intervention served as the dependent outcome. Prenatal ultrasound parameters were used as independent variables. Cut-off values from receiver operating characteristic curves (ROC) were determined for significant discrimination between outcomes.

RESULTS: A total of 54 patients were diagnosed with bLV from 2010 to 2018. All were live births. Out of the entire cohort, 8 (15 %) received SVP, 34 (63 %) BVR, and 12 (22 %) no intervention. There was no significant difference with regard to genetic or extracardiac anomalies. There were significantly more patients with endocardial fibroelastosis (EFE) in the SVP group compared to the BVR group (80 % vs. 10 %), (p < 0.001). Apex-forming LV (100 % vs. 70 %) and lack of retrograde arch flow (20 % vs. 80 %) were associated with no intervention (p < 0.001). With respect to BVR vs. SVP, the LV sphericity index provided the highest specificity (91.7 %) using a cutoff value of ≤ 0.5.

CONCLUSION: The majority of bLV patients maintained biventricular circulation. EFE, retrograde arch flow, and LV sphericity can be helpful parameters for counseling parents and further prospective studies can be developed.

PMID:34225376 | DOI:10.1055/a-1530-5240

J Child Psychol Psychiatry. 2021 Jul 5. doi: 10.1111/jcpp.13484. Online ahead of print.

ABSTRACT

BACKGROUND: Eating disorders exhibit high comorbidity with other psychiatric disorders, most notably mood, substance use, and anxiety disorders. However, most studies examining psychiatric comorbidity are conducted in adolescents and adults. Therefore, the comorbidity among children living with eating disorders is unknown. The aim of this study was to characterize co-occurring psychiatric disorders with eating disorders in a US sample of children aged 9-10 years old utilizing the Adolescent Brain Cognitive Development study.

METHODS: The analytic sample included 11,718 children aged 9-10 years. Anorexia nervosa, bulimia nervosa, binge eating disorder, and other specified feeding and eating disorder subtype diagnoses were examined. Statistical analyses were conducted using complex sampling. Odds ratios and 95% confidence intervals were calculated comparing the likelihood of being diagnosed for a psychiatric disorder when having an eating disorder, as compared to children without an eating disorder, children diagnosed with major depressive disorder, and children diagnosed with posttraumatic stress disorder using binary logistic regression.

RESULTS: Co-occurring psychiatric disorders were substantially higher in children with eating disorders as compared to children without eating disorders, but not as compared to children diagnosed with major depressive disorder or posttraumatic stress disorder. The most common comorbidities for the eating disorder group were anxiety disorders (71.4%), attention deficit/hyperactivity disorder (47.9%), disruptive/impulse control disorders (45.0%), mood disorders (29.6%), and obsessive-compulsive disorder (28.8%), largely in line with previous research.

CONCLUSIONS: This study extends prior research finding high rates of comorbidity in eating disorders, specifically with anxiety, mood, and disruptive/impulse control disorders. Clinicians assessing for psychiatric disorders should be aware that eating disorders can occur in children 9 and 10 years old and are associated with severe comorbidity. Referrals for specialty mental health care should be considered.

PMID:34225382 | DOI:10.1111/jcpp.13484

J Am Assoc Nurse Pract. 2021 Jul 2. doi: 10.1097/JXX.0000000000000625. Online ahead of print.

ABSTRACT

BACKGROUND: Lung cancer patients and survivors are vulnerable to disturbed sleep and impaired quality of life (QOL) across the continuum of illness. Few studies have sought to identify predictors of QOL using well-validated measures of both sleep quality and QOL in this population.

PURPOSE: The purpose of this study was to examine factors associated with lung cancer that are predictive of QOL in adult lung cancer patients and survivors in the outpatient setting.

METHOD: Cross-sectional data collected exclusively in the outpatient setting from three lung cancer clinics in the Northeastern United States were pooled and analyzed. The pooled sample (N = 103) data included cancer type and stage, body mass index, Pittsburgh Sleep Quality Index, and Functional Assessment of Cancer Treatment-Lung information.

RESULTS: Significant correlations between sleep quality, lung cancer symptom severity, and QOL were observed. Sleep quality and lung cancer symptoms were found to be statistically significant predictors of QOL. No significant differences in QOL were found based on cancer type or recruitment source. Demographic factors and cancer stage were also not predictive of overall QOL.

CONCLUSIONS: Lung cancer symptoms and sleep quality were important determinants of QOL in this pooled sample of lung cancer patients and survivors.

IMPLICATIONS FOR PRACTICE: Patients and survivors of lung cancer require routine screening for sleep disturbance, lung cancer symptoms, and QOL needs. Nurse practitioners can help improve QOL in this population by screening for and treating sleep disturbance and lung cancer symptoms.

PMID:34225324 | DOI:10.1097/JXX.0000000000000625

J Trauma Acute Care Surg. 2021 Jul 2. doi: 10.1097/TA.0000000000003322. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this systematic review was to investigate the safety and effectiveness of conservative management versus prophylactic intercostal catheter (ICC) insertion for the management of occult pneumothoraces in mechanically ventilated patients.

METHODS: PubMed, Embase, CINAHL, Web of Science, Cochrane Central and other trial registries were searched. Eligible studies were critically appraised using standardised instruments. Meta-analysis was performed with mixed-methods logistic regression where appropriate and sensitivity analyses were performed with alternative statistical methods (StataTM 15 or RevMan 5.3) or summarised in narrative. Randomised controlled trials (RCTs) and cohort studies were analysed separately.

RESULTS: Twelve studies with a total of 354 participants were included; three RCTs (178 participants) and nine cohort studies (176 participants). The majority of the included studies, particularly the cohort studies, were well conducted. Two of the RCTs were rated as low quality. Statistically significant differences were observed in the RCT analysis: ICC insertion (any reason) (OR 2.86, 95% CI 1.26-6.43, 2 RCTs) in favour of prophylactic ICC; ICC complications (OR 0.12, 95% CI 0.02-0.62, 2 RCTs) in favour of conservative management. Non statistically significant differences were observed for progression of pneumothorax, ICC insertion (progression to simple pneumothorax) and ICC insertion (non-pneumothorax reasons). Results of analyses showed high imprecision (wide confidence limits). Conservative management showed a low rate of tension pneumothorax (2.8%). Complications were higher in the ICC group (19.5% vs 5.8%).

CONCLUSIONS: Available evidence suggests that conservative management is safe for the management of occult pneumothoraces in mechanically ventilated patients, especially when undergoing short-term (<4 days) ventilation. We recommend that patients undergoing mechanical ventilation for a procedure alone and patients suspected to be ventilated less than four days can be conservatively managed.

LEVELS OF EVIDENCE: level 3.

STUDY TYPE: systematic review and meta-analysis.

PMID:34225346 | DOI:10.1097/TA.0000000000003322

J Trauma Acute Care Surg. 2021 Jul 2. doi: 10.1097/TA.0000000000003334. Online ahead of print.

ABSTRACT

BACKGROUND: This pilot assessed transfusion requirements during resuscitation with whole blood followed by standard component therapy versus component therapy alone, during a change in practice at a large urban level I trauma center.

METHODS: This was a single-center prospective cohort pilot study. Male trauma patients received up to 4 units of cold-stored low anti-A, anti-B group O whole blood (LTOWB) as initial resuscitation followed by CT as needed (LTOWB + CT). A control group consisting of females, and males who presented when LTOWB was unavailable, received component therapy only (CT group). Exclusion criteria included antiplatelet or anticoagulant medication and death within 24 hours. The primary outcome was total transfusion volume at 24 hours. Secondary outcomes were mortality, morbidity, and ICU- and hospital-free days.

RESULTS: Thirty-eight patients received LTOWB, with a median of 2.0 [IQR 1.0, 3.0] units of LTOWB transfused. Thirty-two patients received CT only. At 24 hours after presentation, the LTOWB +CT group had received a median of 2138 mL [IQR 1275-3325] of all blood products. The median for the CT group was 4225 mL [IQR 1900-5425], p = 0.06 in unadjusted analysis. When adjusted for Injury Severity Score, sex, and positive Focused Assessment with Sonography for Trauma (FAST), LTOWB +CT group patients received 3307 mL of blood products and CT group patients received 3260 mL in the first 24 hours (p = 0.95). The adjusted median ratio of plasma to red cells transfused was higher in the LTOWB + CT group (0.85 vs 0.63 at 24 hours after admission, p = 0.043. Adjusted mortality was 4.4% in the LTOWB + CT group, and 11.7% in the CT group (p = 0.19), with similar complications, ICU-, and hospital-free days in both groups.

CONCLUSIONS: Beginning resuscitation with LTOWB results in equivalent outcomes compared to resuscitation with CT only.

LEVEL OF EVIDENCE: Therapeutic, Level III (Prospective study with 1 negative criterion, limited control of confounding factors).

PMID:34225348 | DOI:10.1097/TA.0000000000003334

Phys Med Biol. 2021 Jul 5. doi: 10.1088/1361-6560/ac1157. Online ahead of print.

ABSTRACT

Healthcare professionals have been increasingly viewing medical images and videos in their routine clinical practice, and this in a wide variety of environments. Both the perception and interpretation of medical visual information, across all branches of practice or medical specialties (e.g., diagnostic, therapeutic, or surgical medicine), career stages, and practice settings (e.g., emergency care), appear to be critical for patient care. However, medical images and videos are not self-explanatory and, therefore, need to be interpreted by humans, i.e., medical experts. In addition, various types of degradations and artifacts may appear during image acquisition or processing, and consequently affect medical imaging data. Such distortions tend to impact viewers’ quality of experience, as well as their clinical practice. It is accordingly essential to better understand how medical experts perceive the quality of visual content. Thankfully, progress has been made in the recent literature towards such understanding. In this article, we present an up-to-date state of the art of relatively recent (i.e., not older than ten years old) existing studies on the subjective quality assessment of medical images and videos, as well as research works using task-based approaches. Furthermore, we discuss the merits and drawbacks of the methodologies used, and we provide recommendations about experimental designs and statistical processes to evaluate the perception of medical images and videos for future studies, which could then be used to optimise the visual experience of image readers in real clinical practice. Finally, we tackle the issue of the lack of available annotated medical image and video quality databases, which appear to be indispensable for the development of new dedicated objective metrics.

PMID:34225264 | DOI:10.1088/1361-6560/ac1157

Nephron. 2021 Jul 5:1-7. doi: 10.1159/000516984. Online ahead of print.

ABSTRACT

Membranous nephropathy (MN) is an immune-mediated glomerular disease that can lead to nephrotic syndrome and progressive kidney function loss. The cyclic steroid-cyclophosphamide regimen (the modified Ponticelli protocol) and the monoclonal anti-CD20 antibody rituximab have been advocated as effective therapies to improve renal outcomes, but a direct comparison of these treatments had never been carried out in a prospective study. Subject of Review: Scolari et al. [J Am Soc Nephrol. 2021;32:972-82] recently reported the results of a pilot randomized controlled trial (RI-CYCLO) designed to provide direct estimates of the effect of rituximab (1 g × 2) compared to the cyclic steroid-cyclophosphamide regimen in 74 patients with MN. The proportion of patients with complete remission at 12 months was higher in the cyclic regimen arm than that of rituximab (32 and 16%, respectively), but the difference was not statistically significant in intention-to-treat analyses. Interestingly, differences in the cumulative incidence of complete and partial remissions between treatment arms progressively reduced over the follow-up and became virtually nonexistent from 24 months (>80% in both groups). The frequency of serious and nonserious adverse events was similar between the 2 treatment arms. Infusion reactions and drug discontinuation were more common with rituximab, while infections and leukopenia were more frequently observed with the cyclic regimen. The risk of cancer was similar in the 2 allocation groups, but the limited follow-up length did not allow to draw definitive conclusions. Independent of treatment allocation, 18% of patients experienced at least 1 relapse after achieving complete or partial remission. Second Opinion: Notwithstanding the intrinsic limitations of a pilot study, the RI-CYCLO trial represents an important milestone in the treatment of MN. Findings from this study support the hypothesis that the cyclic regimen and rituximab may have comparable efficacy in inducing disease remission over the long term. Considering its potentially better-albeit not yet formally proven-long-term safety profile, rituximab could be considered as a first-line therapy for most patients with MN. Several questions remain to be addressed, including rituximab ideal dose and its efficacy in patients with a significant reduction in glomerular filtration rate. In light of RI-CYCLO results, a large-scale trial to assess rituximab noninferiority to the cyclic regimen would require the enrollment of thousands of patients, and it would be probably unfeasible within a reasonable time frame. In our opinion, resources should be allocated to provide an answer to the pressing matter of treatment nonresponse and intolerance, which may be addressed in the near future with novel therapeutic strategies.

PMID:34225270 | DOI:10.1159/000516984