Category: Statistics

Front Vet Sci. 2024 Nov 1;11:1443847. doi: 10.3389/fvets.2024.1443847. eCollection 2024.

ABSTRACT

BACKGROUND: Myxomatous mitral valve disease (MMVD) is a common, acquired, and progressive canine heart disease. The presence of heart murmur and current cardiac biomarkers are useful in MMVD cases but are not sufficiently discriminatory for staging an individual patient.

OBJECTIVES: This study aimed to conduct a preliminary assessment of canine serum and plasma expression profiles of 15 selected miRNA markers for accurate discrimination between MMVD patients and healthy controls. Additionally, we aim to evaluate the effectiveness of this method in differentiating between pre-clinical (stage B1/B2) and clinical (stage C/D) MMVD patients.

ANIMALS: Client-owned dogs (n = 123) were recruited for the study. Following sample exclusions (n = 26), healthy controls (n = 50) and MMVD cases (n = 47) were analyzed.

METHODS: A multicenter, cross-sectional, prospective investigation was conducted. MicroRNA expression profiles were compared among dogs, and these profiles were used as input for predictive modeling. This approach aimed to distinguish between healthy controls and MMVD patients, as well as to achieve a more fine-grained differentiation between pre-clinical and clinical MMVD patients.

RESULTS: Performance metrics revealed a compelling ability of the method to differentiate healthy controls from dogs with MMVD (sensitivity 0.85; specificity 0.82; and accuracy 0.83). For the discrimination between the pre-clinical (n = 29) and clinical (n = 18) MMVD cases, the results were promising (sensitivity 0.61; specificity 0.79; and accuracy 0.73).

CONCLUSION AND CLINICAL IMPORTANCE: The use of miRNA expression profiles in combination with customized probabilistic predictive modeling shows good scope to devise a reliable diagnostic tool to distinguish healthy controls from MMVD cases (stages B1 to D). Investigation into the ability to discriminate between the pre-clinical and clinical MMVD cases using the same method yielded promising early results, which could be further enhanced with data from an increased study population.

PMID:39553198 | PMC:PMC11565599 | DOI:10.3389/fvets.2024.1443847

Obstet Med. 2024 Sep 17:1753495X241275847. doi: 10.1177/1753495X241275847. Online ahead of print.

ABSTRACT

BACKGROUND: Preeclampsia is an independent risk factor for vascular diseases. The Postpartum Preeclampsia Clinic (PPPC) intervenes in the first year postpartum to address these risks. This study aims to characterize physicians’ understanding and management of the cardiovascular risk associated with preeclampsia and whether this differs in physicians who had a patient attend the PPPC.

METHODS: Family physicians, obstetricians, internists, obstetric internists, and cardiologists in Edmonton were anonymously surveyed. Results were analyzed using SPSS.

RESULTS: Sixty-four surveys were returned, with physicians correctly identifying preeclampsia as a vascular risk factor 73% of the time. Physicians who had a patient attend the PPPC were more likely to counsel patients on their increased cardiovascular risk, although increased knowledge did not reach statistical significance.

CONCLUSION: Vascular risk reduction clinics may benefit the long-term management of patients with a history of preeclampsia by improving counseling by physicians, which may reduce the disproportionate vascular morbidity these patients face.

PMID:39553184 | PMC:PMC11563521 | DOI:10.1177/1753495X241275847

Obstet Med. 2024 May 23:1753495X241255812. doi: 10.1177/1753495X241255812. Online ahead of print.

ABSTRACT

OBJECTIVE: This study evaluates obstacles peripartum patients with additional medical needs face and services that would be helpful in obtaining this care.

STUDY DESIGN: A survey was administered to 226 patients at a clinic specializing in internal medicine care for peripartum patients. Data was analyzed through descriptive statistics and linear regression.

RESULTS: The three most reported barriers that interfered with attending medical appointments included the inability to leave work (41%), being too busy (33%), and lack of childcare (29%). Hispanic and Black patients reported more barriers to care as compared to White patients. The three most reported interventions that would be helpful in attending appointments were more virtual appointment options (38%), increased insurance coverage (31%), and provision of childcare (30%). Interventions were widely rated as helpful regardless of barriers faced and race reported.

CONCLUSIONS: Targeted interventions are needed to enhance access to peripartum care, especially for patients from marginalized racial and ethnic populations.

PMID:39553181 | PMC:PMC11563510 | DOI:10.1177/1753495X241255812

Obstet Med. 2024 Jul 25:1753495X241263135. doi: 10.1177/1753495X241263135. Online ahead of print.

ABSTRACT

BACKGROUND: Transthoracic echocardiography, a validated tool for risk assessment in non-pregnant population with sickle cell disease (SCD), uses tricuspid regurgitant velocity (TRV) over 2.5 m/s is an independent mortality risk factor. Its applicability in obstetrics lacks sufficient evidence.

METHODS: In this multicenter retrospective cohort study across five tertiary centers, we aimed to validate TRV as a determinant of increased maternal and fetal risk. Data was collected on 93 women and included 21 patients with TRV of at least 2.5 m/s. The maternal primary composite outcome included occurrence of vaso-occlusive crisis, acute chest syndrome, gestational hypertension, preeclampsia, and mortality. The fetal primary composite outcome comprised perinatal mortality, premature delivery, reduced birth weight, and fetal distress.

RESULTS: Adverse maternal and fetal events arose in both groups with no statistical difference.

CONCLUSION: This study cannot support TRV of 2.5 m/s or more as an independent predictor of adverse obstetric outcomes among women with SCD.

PMID:39553170 | PMC:PMC11563517 | DOI:10.1177/1753495X241263135

Cureus. 2024 Oct 16;16(10):e71587. doi: 10.7759/cureus.71587. eCollection 2024 Oct.

ABSTRACT

Background Currently, there is no known correlation between relevant parameters of respective non-adjacent spinal segments, which suggests the possibility of a third external factor. To our knowledge, no study has examined the humeral head position in consideration of spinal sagittal alignment.This study aims to establish new parameters related to the humeral head axis and evaluate the relationship between the axis of the humeral head and spinal sagittal alignment in asymptomatic volunteers. Methods Standing posteroanterior and lateral radiographs of the entire spine were obtained from 62 asymptomatic volunteers. We analyzed the relationship of the newly established parameters related to the humeral head axis We analyzed the relationship of the newly established parameters related to the humeral head axis and other established spinal parameters. The new parameters are: shoulder tilt (ST: the angle between a line drawn from the center of the humeral head to the center of the superior endplate of T1 and vertical line through the center of the humeral head), shoulder incidence (SI: the angle between a line perpendicular to the upper endplate of the T1 vertebra and a line joining the center of the upper endplate of the T1 vertebra and the axis of the humeral head), shoulder pelvic angle (SPA: the angle between a line joining the axis of the humeral head and the femoral head and a line joining the axis of the femoral heads and the center of the upper endplate of the S1 vertebra), C2 shoulder angle (C2SA: the angle between a line joining the C2 body center and the axis of the humeral head and a line joining the axis of the humeral head and the center of the upper endplate of the T1 vertebra). Statistical analysis was performed using Pearson’s correlation coefficient. Results Mean ST, SI, SPA, and C2SA were 20.0±20.6°, 43.7±21.6°, 7.7±6.6°, and 17.8±13.5° respectively. The SI was found to be correlated with pelvic tilt (r=0.373), lumbar lordosis (r=0.351), and thoracic kyphosis (r=0.469). Pelvic incidence was correlated with SPA (r=0.724), T1 pelvic angle (r=0.691), and C2 pelvic angle (r=0.667). Correlations were observed between SPA and T1PA (r=0.955) and C2PA (r=0.956), and between TIPA and C2PA (r=0.985). Conclusions This report introduced novel parameters related to humeral head position and confirmed their correlation with sagittal alignment from the cervical spine to the pelvis. Humeral head position may play a role in maintaining spinal sagittal balance.

PMID:39553153 | PMC:PMC11565215 | DOI:10.7759/cureus.71587

Cureus. 2024 Oct 18;16(10):e71756. doi: 10.7759/cureus.71756. eCollection 2024 Oct.

ABSTRACT

Background There is not much data regarding the effect of plasma glucose on thyroid hormones. Currently, there is no consensus regarding the timing of blood sample collection for thyroid hormones. Evaluation of the correlation between plasma glucose and thyroid hormones may enhance pathophysiological understanding of postprandial thyroid stimulating hormone (TSH) decline. Objectives To study the effect of pre-and postprandial plasma glucose levels on thyroid hormones. Methodology A cross-sectional study was done among participants aged 18 years and above after obtaining informed consent. Venous blood samples for fasting and postprandial plasma glucose, fasting, and postprandial thyroid profile ((FT3), (FT4), and TSH) were collected. The association was studied using the t-test and chi-square test between groups, while correlation using Pearson’s correlation coefficient. A p-value of <0.05 was considered statistically significant. Results Among the 197 participants, 126 (64%) were female and 71 (36%) were male. The mean (± S.D.) of age was 43.74 (± 12.62) years. Mean (± S.D.) postprandial TSH (4.31 μU/ml (± 7.79)) and free T3 (285.52 pg/dl (± 32.46)) were less than the fasting values (4.99 μU/ml (± 7.78)) and (295.84 pg/dl (± 32.56)). The mean (± S.D.) of both fasting and postprandial TSH and free T4 were less in the high plasma glucose group compared to the normal plasma glucose group (fasting state p-values 0.005, <0.0001 & postprandial state p-values 0.016, <0.0001). The correlation between fasting plasma glucose and fasting TSH values (Pearson correlation; r=-0.18; p-value 0.232) was observed across all the plasma glucose ranges. Conclusion There is a significant postprandial decline in TSH levels than the fasting TSH, indicating that there is a plasma glucose-mediated reduction in TSH values.

PMID:39553151 | PMC:PMC11569395 | DOI:10.7759/cureus.71756

Cureus. 2024 Oct 16;16(10):e71588. doi: 10.7759/cureus.71588. eCollection 2024 Oct.

ABSTRACT

Amphotericin B deoxycholate (AMPH-B) is a polyene macrolide with antifungal activity. Liposomal AMPH-B (L-AMB) was developed to reduce side effects while maintaining antifungal activity. This study was aimed at evaluating and comparing the adverse event profiles of AMPH-B and L-AMB using a spontaneous reporting system. We analyzed the adverse event reports of AMPH-B and L-AMB from the United States Food and Drug Administration Adverse Event Reporting System (FAERS). Case report counts of adverse events were generated according to the preferred terms of the Medical Dictionary for Regulatory Activities (MedDRA). Standardized MedDRA queries (SMQs) and system organ classes (SOCs) were used to compare the organ-specific adverse event profiles of AMPH-B and L-AMB. The reporting odds ratio and proportional reporting rate were used to detect pharmacovigilance signals. The FAERS database contains 21,173,818 cases from January 2004 to March 2024. Adverse events were reported in 2438 cases receiving AMPH-B treatment and 3344 cases receiving L-AMB treatment, including 848 and 1591 cases receiving intravenous AMPH-B and L-AMB injections, respectively. The most frequently reported drug-related adverse event in the AMPH-B and L-AMB groups was hypokalemia. SOCs with statistically significant differences were “Inv” (laboratory tests), “Resp” (respiratory, thoracic, and mediastinal disorders), “Genrl” (general and systemic disorders and conditions at the site of administration), “Card” (cardiac disorders), and “Blood” (blood and lymphatic system disorders). No statistically significant difference was observed in the SMQ profile of adverse events in “Renal” (renal and urinary disorders) and “Hepat” (hepatobiliary disorders) between the L-AMB and AMPH-B formulations in this study. Based on real-world data from FAERS, adverse event profiles of AMPH-B and L-AMB were compared. No statistically significant difference was observed in the SMQ profile of adverse events in the renal and hepatic SOCs between the L-AMB and AMPH-B formulations. Our results suggest that L-AMB is more tolerated by the kidneys than AMPH-B.

PMID:39553150 | PMC:PMC11565214 | DOI:10.7759/cureus.71588

Cureus. 2024 Oct 16;16(10):e71639. doi: 10.7759/cureus.71639. eCollection 2024 Oct.

ABSTRACT

Non-alcoholic fatty liver disease (NAFLD) has emerged as a major global health concern due to its association with increased mortality. While previous studies have indicated a link between NAFLD and mortality, variations in risk factors such as age, sex, and disease severity warrant a comprehensive meta-analysis to clarify these associations. This meta-analysis aimed to evaluate the overall cardiovascular disease (CVD) mortality risk associated with NAFLD, considering various subgroups defined by age, sex, disease severity, presence of cirrhosis or fibrosis, study quality, and follow-up duration. A systematic search of eight studies was conducted to assess the hazard ratios (HRs) for all-cause and CVD mortality associated with NAFLD. Heterogeneity among studies was evaluated using the I² statistic, and subgroup analyses were performed based on participant age, sex, disease severity, presence of cirrhosis or fibrosis, study quality, and follow-up duration. NAFLD was significantly associated with an increased risk of all-cause mortality (HR = 1.34, 95% CI: 1.17-1.54, I² = 80.0%). Subgroup analyses revealed that individuals aged ≥50 years (HR = 1.50, 95% CI: 1.31-1.73) and males (HR = 1.43, 95% CI: 1.29-1.59) had a higher mortality risk. Patients with nonalcoholic steatohepatitis (NASH) showed a significant association with both overall (HR = 1.37, 95% CI: 1.14-1.65) and CVD mortality (HR = 1.56, 95% CI: 1.25-1.97). The presence of cirrhosis or fibrosis further elevated the risk of mortality (HR = 3.22, 95% CI: 2.40-4.33). However, NAFLD was not significantly associated with CVD mortality in the overall analysis (HR = 1.13, 95% CI: 0.92-1.38). Heterogeneity was high across most subgroups, indicating varying effects based on study characteristics. NAFLD is significantly associated with increased all-cause mortality, particularly in older individuals, males, and those with NASH or cirrhosis/fibrosis. The association with CVD mortality was not significant in the overall analysis but was evident in specific subgroups. These findings underscore the importance of early detection and tailored management of NAFLD to mitigate its impact on mortality. Further research is needed to elucidate the mechanisms linking NAFLD with adverse health outcomes and to develop effective interventions.

PMID:39553144 | PMC:PMC11567170 | DOI:10.7759/cureus.71639

Cureus. 2024 Oct 16;16(10):e71611. doi: 10.7759/cureus.71611. eCollection 2024 Oct.

ABSTRACT

INTRODUCTION: The modified OXIS (O – open contact, X – point contact, I – straight contact, S – curved contact) classification provides a useful framework for assessing interproximal contacts in primary canines and predicting caries risk. The study aimed to assess the incidence of modified OXIS classification of canine interproximal contacts in six-to-nine-year-old children from the Delhi National Capital Region (NCR) population.

METHODS: A cross-sectional study was conducted to assess the interproximal contact areas between primary canine and first molar among six-to-nine-year-old children (n=400) according to the modified OXIS classification using the die stone study model. A single calibrated examiner performed a type III examination to assess a total of 1,536 contact areas from the occlusal aspect. The prevalence of each type was reported in terms of both numbers and percentages using the Chi-square test to find the prevalence, Fisher’s exact test to compare the inter- and intra-arch occurrence of the different contact types, and Kruskal-Wallis test to find its correlation with age.

RESULTS: The Chi-square test showed that the most common contact type was I at 46.55% (715), followed by S1 at 28.06% (431), X at 18.56% (285), O at 6.19% (95), and S2 at 0.65% (10). The p-value of 0.000 indicated a statistically significant difference among the groups. The Kruskal-Wallis test found no statistically significant differences in patient ages. Additionally, Fisher’s exact test demonstrated a statistically significant prevalence of types O, I, and S1 when comparing them across arches.

CONCLUSION: Based on the current study, the most common contact type observed was type I, followed by type S1, according to the modified OXIS criteria. The findings indicate a higher prevalence of closed-type contacts in this population, suggesting that the occurrence of such contacts increases as permanent teeth erupt. This tool may be useful for assessing caries risk in this age group.

PMID:39553136 | PMC:PMC11566099 | DOI:10.7759/cureus.71611

Cureus. 2024 Oct 17;16(10):e71682. doi: 10.7759/cureus.71682. eCollection 2024 Oct.

ABSTRACT

Background Rock climbing is becoming increasingly popular in Singapore resulting in an increasing number of rock-climbing-associated injuries requiring surgery. The main objective of this study is to evaluate the demographics, mechanism, and extent of injuries in patients admitted following rock-climbing-related injuries over a seven-year period. Method All patients admitted to the Department of Orthopedic Surgery between January 2017 and December 2023 with injuries related to rock-climbing accidents were recruited. Data collection was performed retrospectively on the patient profile, day and time of injury, type of rock climbing, mechanism, pattern, and the extent of injury. Results Across 22 patients, 68.4% of injuries occurred in the afternoon, distributed equally across the week. Demographically, majority were young adults (27.3 + 7.8 years), female (77.3%) with a mean BMI of 23.67 + 3.27 kg/m². A total of 90.9% of them fell from height commonly resulting in fractures (95.5%), of which 54.5% sustained two or more fractures and 9.5% sustained open fractures. Comparatively, falling from a higher height resulted in multiple injuries, though not statistically significant. The two patients who sustained open fractures fell from a height of 2 m and 10 m. Lower limb injuries (72.7%) were more common than upper limb (18.2%) and spine (22.7%) injuries. A total of 90.9% of them required surgery, of which 36.8% required a second surgery. A relatively equal number of injuries were sustained from bouldering (45.5%) and sport climbing (54.5%). Females were shown to be more likely injured from bouldering than sport climbing (p = 0.040). A total of 100% of bouldering injuries occurred due to falls from height, while 16.7% of injuries during sport climbing were due to laceration or hand-hold injury. Patients who fell from sport climbing fell from a higher height of 3.35 + 2.6 m compared to bouldering at 2.5 + 0.9 m. Moreover, 33.3% of patients injured from sport climbing sustained multiple regions of injuries, two of which were open fractures, while all injured from bouldering only sustained injuries in a single region, only sustained closed fractures, and none affected the upper extremity. A total of 100% of bouldering injures and 80% of sport-climbing injuries required surgery where around 37% of patients in both groups required repeat surgery. Patients with sport-climbing injuries had a longer length of hospital stay (13.8 + 18.3 days) and duration of hospitalization leave (dHL) (81.3 + 45.5 days) compared to bouldering injuries. Conclusion Rock-climbing-associated injuries are predominantly caused by falls, commonly resulting in fractures requiring admission and surgical intervention, especially in the lower extremities. With increasing popularity and accessibility of the sport in Singapore, there is an expected increase in the number of orthopedic injuries. Injuries vary widely from lacerations to fractures of the extremities and spine to open fractures requiring emergency surgery. Proper safety precautions, equipment, training, and strict regulations for belay certification should be put in place to mitigate the risk of such injuries.

PMID:39553129 | PMC:PMC11568870 | DOI:10.7759/cureus.71682