Category: Statistics

J Phys Chem A. 2023 Oct 31. doi: 10.1021/acs.jpca.3c05078. Online ahead of print.

ABSTRACT

In this study, mixed carbonyl and nitrous oxide complexes with Rh⁺ were studied by mass-selective infrared photodissociation spectroscopy in a molecular beam. The infrared spectra, recorded in the region of the CO and N₂O N═N stretches, were assigned and interpreted with the aid of simulated spectra of low-energy structural isomers. Clear evidence of an inner coordination shell of four ligands is observed. The observed vibrational structure can be understood on the basis of local mode vibrations in the two ligands. However, there is also evidence of multiple low-lying isomers and cooperative binding effects between the two ligands. In particular, σ donation from directly coordinated nitrous oxide ligands drives more classical carbonyl bonding than has been observed in pure carbonyl complexes. The observed fragmentation branching ratios following resonant infrared absorption are explained by simple statistical and energetic arguments, providing a contrast with those of equivalent Au⁺ complexes.

PMID:37906705 | DOI:10.1021/acs.jpca.3c05078

Epidemiol Health. 2023 Oct 24:e2023095. doi: 10.4178/epih.e2023095. Online ahead of print.

ABSTRACT

OBJECTIVES: Inhalation exposure to humidifier disinfectants has resulted to various types of health damages in Korea. To determine the epidemiological correlation necessary for presuming the legal causation, we aimed to develop a method to synthesize the entire evidence.

METHODS: Epidemiological and toxicological studies are systematically reviewed. Target health problems are selected by criteria such as frequent complaints of claimants. Relevant epidemiologic studies are reviewed and the risk of bias and confidence level of the total evidence are evaluated. Toxicological literature reviews are conducted on a line of evidence comprising hazard information, animal studies, and mechanistic studies. The confidence levels for evidence-based toxicological effects and source-to-outcome pathways are synthesized to classify the toxicological evidence levels for the causality between humidifier disinfectant exposure and health effects. Finally, the levels of epidemiological and toxicological evidence are synthesized.

RESULTS: Under the Special Act revised in 2020, if the history of exposure and the disease occurred/worsened after exposure were approved, and the epidemiological correlation between the exposure and disease was verified, the legal causation is presumed unless the company proves the evidence against it. The epidemiological correlation can be verified through epidemiological investigations, health monitoring, cohort investigations and toxicological studies. It is not simply as statistical correlation as understood in judicial precedents, but a general causation established by the evidence as a whole, i.e., through weight-of-the-evidence approach.

CONCLUSION: The weight-of-the-evidence approach differs from the conclusive single study approach and this systematic evidence integration can be used in presumption of causation.

PMID:37905312 | DOI:10.4178/epih.e2023095

Cureus. 2023 Sep 29;15(9):e46178. doi: 10.7759/cureus.46178. eCollection 2023 Sep.

ABSTRACT

Introduction It has been discovered that low levels of thiamine reserves in the body are related to diabetes mellitus (DM) because thiamine directly influences carbohydrate metabolism. Therefore, the purpose of this study was to assess several metabolic variables and blood thiamine levels in patients with type 1 and type 2 DM and compare them with those in a control group of healthy individuals. Methods This case-control study was conducted at multiple diabetic outpatient centers in Karachi. A total of 90 participants, who were divided into three groups, each containing 30 individuals, were chosen using a convenient non-probability sampling technique. Group A served as the control group and consisted of healthy, non-diabetic individuals. Groups B and C contained subjects with type 1 and type 2 DM, respectively. Descriptive analysis was reported as mean standard deviation, whereas gender and comorbidities were expressed as frequencies and percentages. The chi-square test and Pearson’s correlation coefficient were used to determine the associations of the variables with type 1 DM, type 2 DM, and controls. Results The study results revealed statistically significant differences between controls, type 1 and type 2 DM, in the means of blood glucose levels and all lipid profiles, such as glycated hemoglobin (HbA1c), fasting blood sugar (FBS), random blood sugar (RBS), serum thiamine, triglycerides (p < 0.001), high-density lipoprotein (HDL) (p = 0.014), and total cholesterol (p = 0.013). Furthermore, it was shown that among the control group, type 1 and type 2 DM, HbA1c, and FBS were insignificantly correlated with thiamine levels, whereas the HbA1c and FBS of the combined diabetic groups were significantly correlated with the thiamine level (r = 0.465, p < 0.001) and (r = 0.360, p = 0.005), respectively, where ‘r’ is the Pearson correlation coefficient. Additionally, HbA1c and FBS in the combined three groups were significantly correlated with the thiamine level (r = -0.626, p < 0.001) and (r = -0.561, p < 0.001), respectively. Conclusion This study concluded that patients with type 1 and type 2 DM had significantly higher levels of FBS, RBS, HbA1c, triglycerides, and total cholesterol than controls. Furthermore, both type 1 and type 2 DM patients’ serum thiamine and HDL levels were observed to be considerably lower than those of controls. Additionally, among both types of DM and controls, there was a strong correlation between FBS and HbA1c. Therefore, we recommend that serum thiamine levels be routinely monitored in diabetic patients, and thiamine supplementation should be considered to avoid complications, especially vascular complications of DM.

PMID:37905298 | PMC:PMC10613325 | DOI:10.7759/cureus.46178

Cureus. 2023 Sep 29;15(9):e46189. doi: 10.7759/cureus.46189. eCollection 2023 Sep.

ABSTRACT

BACKGROUND: Craniotomy is associated with significant postoperative discomfort. Standardized pain management and enhanced recovery after surgery (ERAS) protocol could improve patient-reported outcomes and lower medical expenses.

AIM: The aim of this study is to prospectively assess the effectiveness of an ERAS protocol for neurosurgery in the treatment of postoperative pain following elective craniotomies.

METHODS AND MATERIALS: A total of 128 patients were assigned to the ERAS group and received care in accordance with the neurosurgical ERAS regulations, while 130 other participants were assigned to the control group and received traditional postoperative assistance. The participants’ postoperative pain ratings using the numerical rating scale (NRS) were this study’s main outcome of interest. The verbal NRS uses the numbers 0 to 10, with 0 indicating no sensation of pain and 10 indicating the most severe pain. On postoperative day (POD) 1, the patients’ postoperative pain level at the surgical site was evaluated using the NRS. This was repeated every day until the patient either reported feeling no sensation of pain or was discharged home.

RESULTS: The mean value of pain on the day of surgery was 4.43 ± 0.43 and 4.72 ± 0.68 for patients in the ERAS and control groups, respectively. The pain values were higher in the control group compared to the ERAS group. However, the difference was not statistically significant (p = 0.478). The mean value of pain on POD1 was 3.13 ± 0.21 and 4.45 ± 0.95 for patients in the ERAS and control groups, respectively. These pain values were higher in the control group compared to the ERAS group, and the difference was statistically significant (p = 0.011). The mean value of pain on POD2 was 2.86 ± 0.3 and 4.33 ± 0.37 for patients in the ERAS and control groups, respectively. The values of pain were higher in the control group compared to the ERAS group, and the difference was statistically significant (p = 0.003). The mean value of pain on POD3 was 2.33 ± 0.52 and 4.04 ± 0.15 for patients in the ERAS and control groups, respectively. The pain values were higher in the control group compared to the ERAS group. The difference was meaningful statistically (p < 0.001). The mean value of pain on POD4 was 2.26 ± 0.9 and 2.84 ± 0.13 for the ERAS and control groups, respectively. However, the difference was not statistically significant (p = 0.274). The ERAS group had a significantly higher proportion of participants rating their pain between 1 and 3 (68.9%) and a lower proportion rating their pain between 4 and 7 (28.2%), compared to the control group (p < 0.001). Differences in the highest pain ratings (8-10) between the groups were not statistically significant. The duration of hospital stay, beginning from surgery to discharge, was lesser among study participants in the ERAS group, and this finding was statistically significant (p < 0.001).

CONCLUSION: The findings of this study imply that the ERAS protocol may aid pain management following elective craniotomies. Additionally, the ERAS protocol decreased the overall expense of medical care and the cumulative/postoperative length of hospital stay.

PMID:37905293 | PMC:PMC10613341 | DOI:10.7759/cureus.46189

Cureus. 2023 Sep 29;15(9):e46196. doi: 10.7759/cureus.46196. eCollection 2023 Sep.

ABSTRACT

Aim Injectable platelet-rich fibrin (i-PRF) and leukocyte and platelet-rich fibrin (l-PRF) are both blood-derived products used in regenerative medicine and dentistry. They contain platelets, growth factors, and leukocytes, which can have antimicrobial properties to some extent, but their primary purpose is tissue regeneration and wound healing. i-PRF and l-PRF may have some indirect antimicrobial properties due to their composition and ability to enhance tissue healing and immune responses, and they are primarily used in dentistry for their regenerative and wound healing capabilities rather than as standalone antimicrobial agents. This study aims to compare the anti-microbial activity of i-PRF and l-PRF against oral microbes. Methodology This study included 30 patients who were selected using G*Power software version 3.1 (Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany) calculation with the population size. The plaque samples were collected from the subjects using area-specific Gracey curettes used for scaling and root planing to remove plaque and calculus from the teeth and root surfaces. The collected plaque samples were transferred to a tube containing 5 ml of saline (sterile saltwater). The purpose of using saline is to preserve the microbial content of the plaque sample without altering the microbial composition. To obtain a uniform solution, the samples in the saline-containing tube were vortexed for 5 minutes. After vertexing, a small amount of the suspension (0.1 ml) was taken for further analysis. The 0.1 ml suspension was used to plate blood agar using the streak method. A loop or needle is used to streak the sample back and forth across the surface of the agar, leading to the dilution and separation of the bacteria. Results Results state that i-PRF has a maximum zone of inhibition (2.19±0.47 mm) when compared with metronidazole (0.14±0.09 mm). It can be stated that platelet concentrates demonstrate better antimicrobial activity due to their higher oxygen metabolites which help in the aggregation and internalization of microorganisms, which enhances the clearance of pathogens from the bloodstream. Paired t-test has been used for the comparison between the two groups, and the p-value is >0.05 stating that the difference is statistically significant. Conclusion The present study states that i-PRF demonstrated better antimicrobial efficacy as compared to l-PRF. Hence, i-PRF helps in reducing microbial load at the periodontally infected sites when compared with l-PRF.

PMID:37905284 | PMC:PMC10613344 | DOI:10.7759/cureus.46196

Cureus. 2023 Sep 29;15(9):e46191. doi: 10.7759/cureus.46191. eCollection 2023 Sep.

ABSTRACT

Background Plaque and dental caries are the primary agents causing gingival and periodontal diseases, eventually progressing into tooth loss. If oral hygiene practice is poor, plaque easily accumulates on the tooth surface, especially in interproximal areas. To maintain a good oral environment, it is mandatory to remove or at least reduce the percentage of plaque formation from the oral cavity. To achieve this, interdental aids should be used along with toothbrushes, as cleansing the teeth only with a toothbrush is not effective. Various interdental aids, like interdental brushes, floss, toothpicks, etc., are now available on the market. The objective of the current survey was to rate knowledge as well as make a comparison between the cleaning effectiveness of interdental brushes and interdental floss to determine which was better at reducing plaque accumulation and, subsequently, dental caries. The survey was accessed by measuring individual plaque and gingival index before and after using interdental cleaning aids. Methodology The objective of the survey was to evaluate and analyze the efficiency of interdental brushes and interdental floss in maintaining oral hygiene among orthodontic patients residing in the Vidarbha region. After receiving approval from the Ethical Committee DMIHER(DU)/IEC/2023/721, a study was conducted over a 30-day period, focusing on a group of 100 individuals aged between 15 and 30 years, and their assessments were analyzed. The patient was briefed about the study and asked to make use of an interdental brush and interdental floss. The gingival index and plaque index were calculated on the same patients before and after the use of the interdental brush and interdental floss to determine which was better at reducing plaque accumulation on the surface of teeth. Descriptive analysis, unpaired for intergroup comparison, and paired T-tests for intragroup comparison were used. The software used was SPSS 24.0 (IBM Corp., Armonk, NY) and GraphPad Prism 7.0 (GraphPad Software, Inc., La Jolla, CA). Result Everyone’s tooth surfaces naturally develop a thin layer of plaque biofilm, but the presence of heavy plaque deposits on teeth indicates poor dental hygiene, which can lead to various oral health issues. Failure to improve dental hygiene status can result in problems such as halitosis, gingival issues, periodontal disease, and eventually tooth loss. Dentists play a crucial role in raising awareness about these concerns among their patients and providing education on effective oral care practices, including the use of interdental aids in conjunction with toothbrushes. When comparing the effectiveness of interdental brushes and dental floss in removing plaque, interdental brushes have been found to be more efficient. They not only excel in plaque removal but also contribute to a reduction in gingival problems. The statistical analysis supports this, with a significant p-value of less than 0.01 for both the plaque index and gingival index when using interdental brushes, indicating their superior performance in maintaining oral health. Conclusion The study will help every individual improve their oral hygiene status with the help of an interdental aid and a toothbrush. This will reduce the chances of having gingival and periodontal diseases and eventually reduce the risk of tooth loss.

PMID:37905279 | PMC:PMC10613348 | DOI:10.7759/cureus.46191

Cureus. 2023 Sep 28;15(9):e46169. doi: 10.7759/cureus.46169. eCollection 2023 Sep.

ABSTRACT

Background Sepsis is associated with increased Ca⁺⁺ levels in many cell types that can cause cytotoxicity and cell death through multiple mechanisms. In patients with sepsis, limiting beta-adrenergic stimulation may also be beneficial. The intense adrenergic stimulation of sepsis results in cardiac and extra-cardiac effects. In the intensive care unit (ICU), the question of whether to continue calcium channel blockers (CCBs) and beta-blockers in patients with sepsis who were using these medications before ICU admission is of significant concern. Methodology In this prospective observational study, we have included 114 patients who met the inclusion criteria of being diagnosed as having sepsis, aged 18 to 65 years, and expected to stay in the ICU for more than 72 hours. These patients were divided into three groups: group 1 consisted of patients taking CCBs before admission, group 2 included those taking beta-blockers before admission, and group 3 served as the control group, comprising patients who had not taken either of these medications before admission. Disease severity in the ICU was assessed and documented by the Sequential Organ Failure Assessment (SOFA) score. Clinical outcomes among three groups were compared regarding the need for vasopressor support, serum procalcitonin (PCT), serum lactate, serum quantitative C-reactive protein (qCRP), SOFA score, and 28 days mortality. Parametric data were expressed as mean ± standard deviation. The Kruskal-Wallis test was used to analyze parametric data between the two groups and among three groups. Results Mortality was found lower in group 1 (21.05%) and group 2 (26.31%) than in group 3 (47.36%), and this association was found to be statistically significant (P = 0.033). We also found a significant difference in mortality between groups 1 and 3 (P = 0.015) and no significant difference between groups 2 and 3 (P = 0.057). Mortality was found to be significantly associated with high SOFA scores on days 1, 3, and 7. Conclusions From the aforementioned results, we concluded that the mortality rate in patients with sepsis was improved when they were pretreated with beta-blockers or CCBs before admission to the ICU and that medication should be continued if not contraindicated in the ICU course.

PMID:37905278 | PMC:PMC10613320 | DOI:10.7759/cureus.46169

Cureus. 2023 Sep 29;15(9):e46206. doi: 10.7759/cureus.46206. eCollection 2023 Sep.

ABSTRACT

Background Follicular-patterned lesions are a major gray zone in thyroid cytopathology. The recently introduced 2022 World Health Organization (WHO) classification emphasizes the importance of genetic alterations in thyroid neoplasms with the introduction of certain newer terminologies that are expected to cause remarkable changes in cytopathologic and histopathologic reporting. Although molecular assays such as the Afirma gene expression classifier and the ThyroSeq are already in use, there has been an ongoing search for further reliable molecular markers. The growth differentiation factor-15 (GDF-15) is one among them. This study aimed to determine the diagnostic utility of GDF-15 mRNA expression in frozen tissue and fine-needle aspiration (FNA) samples from follicular-patterned thyroid lesions and neoplasms. Methodology The real-time quantitative polymerase chain reaction was performed on 75 frozen tissue and FNA samples each from 19 cases of follicular thyroid hyperplasia (FTH), 10 nodular goiters (NGs), 17 follicular thyroid adenomas (FTAs), eight follicular thyroid carcinomas (FTCs), 12 follicular variant of papillary thyroid carcinomas (FVPTCs), and nine classic papillary thyroid carcinomas (CPTCs) that were diagnosed according to the 2017 WHO classification of thyroid neoplasms. The GDF-15 mRNA expression in all these cases was assessed and compared with the control thyroid tissue samples. One-way analysis of variance and the Kruskal-Wallis test were performed using GraphPad Prism 8 software to determine the significance of differences in the GDF-15 mRNA levels among various thyroid lesions. Results A higher GDF-15 mRNA expression was noted in the malignant thyroid neoplasms including FTC, FVPTC, and CPTC in comparison to FTA, with a fold change between the malignant and benign groups being more than 244.18 times. A difference in the fold change was noted between FTH and FTA with an increase in GDF-15 mRNA level in the latter, which was statistically not significant. Conclusions The fact that GDF-15 mRNA was studied both on fine-needle aspiration cytologic and the frozen tissue material and that the majority of the lesions studied were follicular-patterned establishes the GDF-15 as a potential marker not only for diagnosing malignant thyroid neoplasms of the follicular epithelium but also in distinguishing benign and malignant follicular-patterned neoplasms of the thyroid.

PMID:37905271 | PMC:PMC10613452 | DOI:10.7759/cureus.46206

Cureus. 2023 Sep 29;15(9):e46217. doi: 10.7759/cureus.46217. eCollection 2023 Sep.

ABSTRACT

BACKGROUND: Patients with unilateral peripheral vestibular deficit (UPVD) experience vertigo, dizziness, disability, negative influences on their quality of life, anxiety, and depression. In vestibular rehabilitation, virtual reality (VR) has proven to be effective. This investigation sought to evaluate the efficacy of the Balance Rehabilitation Unit (BRU^TM) (Medicaa^TM Montevideo, Uruguay, Balance Suite, version BRU 415) in patients with UPVD.

METHODS: A prospective, randomized, controlled study involved 38 patients from the Otoneurologic Service at the National Institute of Rehabilitation “Luis Guillermo Ibarra Ibarra” in Mexico. A physician specialist diagnosed the patients with UPVD and assigned them randomly to one of two groups. Group 1 (n = 19) received traditional vestibular rehabilitation, whereas Group 2 (n = 19) received BRU^TM-supported vestibular rehabilitation. Both groups were monitored by medical professionals. Patients were evaluated with the Dizziness Handicap Inventory, static and dynamic balance assessments, the dynamic gait index, and the sensory organization test. The statistical analysis was conducted using the Student’s t-test, with p 0.05 considered statistically significant.

RESULTS: The difference in mean age between the conventional therapy and BRU^TM groups was not statistically significant. Both conventional vestibular rehabilitation and the BRU^TM led to statistically significant improvements in all assessed parameters, with no statistically significant differences between the two groups.

CONCLUSION: Balance, mobility, and quality of life were enhanced similarly in UPVD patients by BRU^TM-supported vestibular rehabilitation and conventional vestibular rehabilitation. In addition, BRU^TM facilitated patient motivation, exercise feedback, and confidence enhancement.

PMID:37905268 | PMC:PMC10613477 | DOI:10.7759/cureus.46217

J Med Internet Res. 2023 Oct 30;25:e46890. doi: 10.2196/46890.

ABSTRACT

BACKGROUND: Despite great efforts in HIV prevention worldwide, HIV testing uptake among men who have sex with men (MSM) remains suboptimal. The effectiveness of digital, crowdsourced, multilevel interventions in improving HIV testing is still unclear.

OBJECTIVE: The aim of this study was to evaluate the effect of a digital, crowdsourced, multilevel intervention in improving HIV testing uptake among MSM in China.

METHODS: We conducted a 2-arm cluster randomized controlled trial among MSM in 11 cities in Shandong province, China, from August 2019 to April 2020. Participants were men who were HIV seronegative or had unknown serum status, had anal sex with a man in the past 12 months, and had not been tested for HIV in the past 3 months. Participants were recruited through a gay dating app and community-based organizations from preselected cities; these cities were matched into 5 blocks (2 clusters per block) and further randomly assigned (1:1) to receive a digital, crowdsourced, multilevel intervention (intervention arm) or routine intervention (control arm). The digital multilevel intervention was developed through crowdsourced open calls tailored for MSM, consisting of digital intervention images and videos, the strategy of providing HIV self-testing services through digital tools, and peer-moderated discussion within WeChat groups. The primary outcome was self-reported HIV testing uptake in the previous 3 months. An intention-to-treat approach was used to examine the cluster-level effect of the intervention in the 12-month study period using generalized linear mixed models and the individual-level effect using linear mixed models.

RESULTS: A total of 935 MSM were enrolled (404 intervention participants and 531 controls); 751 participants (80.3%) completed at least one follow-up survey. Most participants were younger than 30 years (n=601, 64.3%), single (n=681, 72.8%), had a college degree or higher (n=629, 67.3%), and had an HIV testing history (n=785, 84%). Overall, the proportion of testing for HIV in the past 3 months at the 3-, 6-, 9-, and 12-month follow-ups was higher in the intervention arm (139/279, 49.8%; 148/266, 55.6%; 189/263, 71.9%; and 171/266, 64.3%, respectively) than the control arm (183/418, 43.8%; 178/408, 43.6%; 206/403, 51.1%; and 182/397, 48.4%, respectively), with statistically significant differences at the 6-, 9-, and 12-month follow-ups. At the cluster level, the proportion of participants who had tested for HIV increased 11.62% (95% CI 0.74%-22.5%; P=.04) with the intervention. At the individual level, participants in the intervention arm had 69% higher odds for testing for HIV in the past 3 months compared with control participants, but the result was not statistically significant (risk ratio 1.69, 95% CI 0.87-3.27; P=.11).

CONCLUSIONS: The intervention effectively improved HIV testing uptake among Chinese MSM. Our findings highlight that digital, crowdsourced, multilevel interventions should be made more widely available for HIV prevention and other public health issues.

TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR1900024350; http://www.chictr.org.cn/showproj.aspx?proj=36718.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s13063-020-04860-8.

PMID:37902831 | DOI:10.2196/46890