Category: Statistics

Indian J Tuberc. 2024 Apr;71(2):163-169. doi: 10.1016/j.ijtb.2023.04.025. Epub 2023 Apr 29.

ABSTRACT

BACKGROUND: The management of choice for granulomatous mastitis (GM) has yet to be determined but few studies have demonstrated that anti-tubercular treatment (ATT) could be an effective alternative therapeutic option. Hence, the objective of the current study is to determine the clinical feature, radiological imaging findings, and histopathological examination results exhibited by GM and tuberculosis (TB)-proven GM as well as to evaluate the ATT clinical outcome in GM patients.

METHODS: The study was performed on 68 GM patients who were referred to the department of pulmonology by the breast clinic (from January 2018 to August 2021). Study populations were categorized into two groups GM and TB-proven GM patients and all were prescribed with standard ATT regimen and were continuously followed up. SPSS version 25 was employed for statistical assessment.

RESULTS: Our study showed that 6 patients from GM and 4 patients from the TB-proven GM group got relapsed. For patients who displayed partial remission, ATT treatment was started after assessing the side effects potential. 14.6% (n = 6) and 7.4% (n = 2) patients who initially demonstrated partial remission were also completely cured. ATT treatment curable rate was determined to be 90% (n = 37) and 81.5% (n = 22) for GM and TB-proven GM patients correspondingly. Therefore, the current study demonstrated nil significant differences between groups.

CONCLUSION: The current study warrants that ATT therapy could be an effective and better treatment of choice for GM patients irrespective of their clinical condition.

PMID:38589120 | DOI:10.1016/j.ijtb.2023.04.025

Indian J Tuberc. 2024 Apr;71(2):153-162. doi: 10.1016/j.ijtb.2023.04.022. Epub 2023 Apr 27.

ABSTRACT

BACKGROUND: Tuberculosis (TB), an infectious disease caused by Mycobacterium tuberculosis is one of the top ten causes of death worldwide. Isoniazid (INH) is an important component of anti-tuberculosis therapy (ATT). Low isoniazid levels can serve as a risk factor for the development of treatment failure, relapse of disease and acquired secondary resistance. Hence, serum level of isoniazid becomes a critical factor in determining the treatment outcome of patients on ATT. This study aimed to evaluate the correlation between serum isoniazid concentration and therapeutic response in patients of pulmonary tuberculosis in Central India.

METHODS: This was a prospective single cohort observational study conducted at a tertiary care hospital. Therapeutic response in newly diagnosed patients of pulmonary TB was determined based the microbiological, clinical and radiological parameters. Serum INH levels were estimated based on a spectrophotometric method using nano-spectrophotometer.

RESULTS: In this study, patients had a significant improvement in treatment outcome as evident by a significant decrease in the TB score I at end of IP (p = 0.001) and a significant decline in the Timika score at end of CP (p = 0.001). Although all patients converted to sputum negative at end of CP, 20% remained positive at end of IP. Lower INH levels were seen in 13.3% of the study population. Higher INH levels were observed in sputum converters, patients with low TB score I and low Timika score, although no statistically significant difference was noted (p > 0.05).

CONCLUSION: In this study, we could not find any statistically significant association between serum INH levels and therapeutic outcome of the patients. Further studies on a larger population could provide better understanding about the prevalence of low serum isoniazid levels among the Indian population and establish its relationship with therapeutic outcome. Also, the usage of a comparatively less expensive spectrophotometric method of analysis makes this feasible in almost every district hospital without the need of high-performance liquid chromatography which is costlier and needs more expertise.

PMID:38589119 | DOI:10.1016/j.ijtb.2023.04.022

AJNR Am J Neuroradiol. 2024 Apr 8:ajnr.A8276. doi: 10.3174/ajnr.A8276. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: To compare the image quality and radiation dose of temporal bone CT scans in pediatric patients acquired with photon counting detectors (PCD) CT and energy integrating detectors (EID) CT.

MATERIALS AND METHODS: The retrospective study included a total of 110 pediatric temporal bone CT scans (PCD-CT, n=52; EIDCT, n=58). Two independent readers evaluated the spatial resolution of 4 anatomical structures (tympanic membrane, incudostapedial joint, stapedial crura, and cochlear modiolus) and overall image quality using a 4-point scale. Inter-reader agreement was assessed. Dose length product (DLP) for each CT was compared, and subgroup analyses were performed based on age (under 3 years, 3-5 years, 6-11 years, and 12 years and above).

RESULTS: PCD-CT demonstrated statistically significantly higher scores than EID-CT for all items (tympanic membrane, 2.9 vs. 2.4; incudostapedial joint, 3.6 vs. 2.6, stapedial crura, 3.2 vs. 2.4; cochlear modiolus, 3.4 vs. 2.8; overall image quality, 3.6 vs. 2.8; p<0.05). Inter-reader agreement ranged from good to excellent (ICCs, 0.6-0.81). PCD-CT exhibited a 43% dose reduction compared to EID-CT, with a particularly substantial reduction of over 70% in the subgroups of children under 6 years.

CONCLUSIONS: PCD temporal bone CT achieves significantly superior imaging quality at a lower radiation dose compared to EID-CT.

ABBREVIATIONS: PCD-CT = photon counting detectors CT; EID-CT = energy integrating detectors CT; DLP = dose length product; AEC = automatic exposure control; ICC = interclass correlation coefficient.

PMID:38589057 | DOI:10.3174/ajnr.A8276

BMJ Open Qual. 2024 Apr 8;13(2):e002453. doi: 10.1136/bmjoq-2023-002453.

ABSTRACT

INTRODUCTION: Effective communication in the operating room (OR) is crucial. Addressing a colleague by their name is respectful, humanising, entrusting and associated with improved clinical outcomes. We aimed to enhance team communication in the perioperative environment by offering personalised surgical caps labelled with name and provider role to all OR team members at a large academic medical centre.

MATERIALS AND METHODS: This was a quasi-experimental, uncontrolled, before-and-after quality improvement study. A survey regarding perceptions of team communication, knowledge of names and roles, communication barriers, and culture was administered before and after cap delivery. Survey results were measured on a 5-point Likert Scale; descriptive statistics and mean scores were compared. All cause National Surgical Quality Improvement Project (NSQIP) morbidity and mortality outcomes for surgical specialties were examined.

RESULTS: 1420 caps were delivered across the institution. Mean survey scores increased for knowing the names and roles of providers around the OR, feeling that people know my name and feeling comfortable communicating without barriers across disciplines. The mean score for team communication around the OR is excellent was unchanged. The highest score both before and after was knowing the name of an interdisciplinary team member is important for patient care. A total of 383 and 212 providers participated in the study before and after cap delivery, respectively. Participants agreed or strongly agreed that labelled surgical caps made it easier to talk to colleagues (64.9%) while improving communication (66.0%), team culture (60.5%) and patient care (56.8%). No significant differences were noted in NSQIP outcomes.

CONCLUSIONS: Personalised labelled surgical caps are a simple, inexpensive tool that demonstrates promise in improving perioperative team communication. Creating highly reliable surgical teams with optimal communication channels requires a multifaceted approach with engaged leadership, empowered front-line providers and an institutional commitment to continuous process improvement.

PMID:38589054 | DOI:10.1136/bmjoq-2023-002453

Plant Sci. 2024 Apr 6:112079. doi: 10.1016/j.plantsci.2024.112079. Online ahead of print.

ABSTRACT

The cotton boll weevil (CBW, Anthonomus grandis) stands as one of the most significant threats to cotton crops (Gossypium hirsutum). Despite substantial efforts, the development of a commercially viable transgenic cotton event for effective open-field control of CBW has remained elusive. This study describes a detailed characterization of the insecticidal toxins Cry23Aa and Cry37Aa against CBW. Our findings reveal that CBW larvae fed exclusively on artificial diets supplemented with Cry37Aa alone displayed no statistical difference compared to the control. Conversely, when exposed solely to Cry23Aa, larval survival decreased by roughly 69%. However, the combined provision of both Cry23Aa and Cry37Aa in the artificial diet led to mortality rates approaching 100% among CBW larvae (LC₅₀ equal to 0.26 PPM). Additionally, we engineered transgenic cotton plants by introducing cry23Aa and cry37Aa genes under the regulation of the flower bud-specific pGhFS4 and pGhFS1 promoters, respectively. After confirming forty-five transgenic cotton events, we selected the top seven events that exhibited elevated expression levels of Cry23Aa and Cry37Aa toxins in flower buds, 70%, for greenhouse bioassays. The mortality rate of CBW larvae feeding on both T₀ and T₁ generation transgenic cotton plants ranged from 75 to 100%. Our computational analyses unveiled that Cry23Aa possesses all the hallmark characteristics of a β-pore-forming toxin (β-PFT), specifically binding to sugar components in glycoproteins. Intriguingly, our studies also discovered a distinctive zinc-binding site within Cry23Aa, which appears to be involved in protein-protein interactions. Ultimately, our discussion centers on the crucial structural attributes of Cry23Aa that likely play a role in the toxin’s mechanism of action. With the observed low LC₅₀ for CBW and the significant accumulation of these toxins in the flower buds of both T₀ and T₁ plants, we anticipate that across successive generations of these transgenic lines, cotton plants engineered to overexpress cry23Aa and cry37Aa hold promise for effectively managing CBW infestations in cotton crops.

PMID:38588981 | DOI:10.1016/j.plantsci.2024.112079

J Endod. 2024 Apr 6:S0099-2399(24)00226-7. doi: 10.1016/j.joen.2024.03.014. Online ahead of print.

ABSTRACT

INTRODUCTION: Pathological conditions such as internal root resorption (IRR) may complicate root canal filling. This study aimed to evaluate and compare the obturation quality by measuring the percentage of obturation volume (POV) in root canals with artificial IRR obturated with different materials and techniques using cone beam computed tomography (CBCT).

METHODS: Forty single canal extracted mandibular premolars were decoronated to standardize their length to 14mm. Following instrumentation, the roots were cut horizontally, and artificial IRR cavities were made at the level of 7mm from the apex. The root halves were joined using cyanoacrylate adhesive. The samples were randomly assigned to four groups (n = 10), and the canals were filled as follows: Single-cone technique (SC), bulk-fill Bio-C Sealer (BF), Bio-C Repair for the coronal and middle third (BCR) +cold lateral condensation technique (CLC) for the apical third and continuous wave compaction technique (CWC). The pre-and post-obturation volumes and the POV were measured in the total canal and for the apical, middle, and coronal thirds separately using CBCT and Mimics Medical software. The results were analyzed statistically using one-way ANOVA and Tukey HSD test, and statistical significance was set at p<0.05.

RESULTS: BF group resulted in significantly lower total, coronal, middle and apical POV values compared to SC, BCR+ CLC, and CWC groups (p < 0.05), respectively. Also, at the apical third, the BCR+ CLC group showed significantly lower POV than the SC and CWC groups (P<0.05), respectively. The intra-group comparison showed that BF and BCR+ CLC groups had a significantly lower POV in the apical third compared to the middle third (p<0.05). Conversely, the CWC group had a significantly higher apical POV than the middle third (p<0.05).

CONCLUSIONS: The maximum POV was obtained using the CWC technique, Bio-C Repair, and SC technique with Bio-C Sealer, making their application in IRR more preferable than the BF Bio-C Sealer.

PMID:38588977 | DOI:10.1016/j.joen.2024.03.014

Am J Pharm Educ. 2024 Apr 6:100698. doi: 10.1016/j.ajpe.2024.100698. Online ahead of print.

ABSTRACT

OBJECTIVE: One of the barriers that might prevent an underrepresented minority (URM) individual from pursuing a professional career in the United States is finances. The high disproportionate burden of student debt among URM students further perpetuates the racial wealth gap. Therefore, this study sought to evaluate the extent to which URM students’ personal finance perceptions, and current and projected student loan indebtedness, affect post-graduation career intentions.

METHODS: A cross-sectional analysis was conducted using data from 4 cohorts of pharmacy students using a survey from November 2, 2022 to February 1, 2023. The financial perception survey included subscales namely personal finance self-efficacy, debt influence and pressure, and risk mitigation and retirement. Descriptive statistics, simple logistic regression, and multivariate logistic regression analyses were conducted.

RESULTS: 93 students completed the survey and had a mean age of 28.1+5.3 years. Seventy-one percent of the respondents were female, and 67.7% had completed a 4-year bachelor’s degree. There was a significant association between age and the intention to pursue postgraduate training as well as a significant association between risk mitigation and retirement perceptions and intention to pursue postgraduate training after adjusting for other factors.

CONCLUSION: Among students from largely minority backgrounds, age and confidence in their ability to make wise investment decisions for retirement are associated with a greater likelihood of pursuing post-graduate training opportunities.

PMID:38588974 | DOI:10.1016/j.ajpe.2024.100698

Ann Vasc Surg. 2024 Apr 6:S0890-5096(24)00173-0. doi: 10.1016/j.avsg.2024.02.007. Online ahead of print.

ABSTRACT

BACKGROUND: We investigated the long-term safety and efficacy of anatomical and extra-anatomical bypass for the treatment of unilateral iliac artery disease.

METHODS: A systematic search on PubMed, Scopus and Web of science for articles published by June 2023 was performed. We implemented a two-stage individual participant data (IPD) meta-analysis and pooled survival probabilities using the multivariate methodology of DerSimonian and Laird. The primary endpoint was primary patency at five and ten years of follow-up.

RESULTS: Ten studies encompassing 1907 patients were included. The five- and ten-year pooled primary patency for anatomical bypass was 83.27% (95% CI:69.99- 99.07) and 77.30% (95% CI:60.32- 99.04), with a mean primary patency time representing the duration individuals remained event-free of 10.08 years (95% CI:8.05-10.97). The five- and ten-year pooled primary patency for extra-anatomical bypass was 77.02% (95% CI:66.79-88.80) and 68.54% (95% CI:53.32-88.09) with a mean primary patency time of 9.25 years, (95% CI:7.21-9.68). Upon two-stage IPD meta-analysis anatomical bypass displayed a decreased risk for loss of primary patency compared to extra-anatomical bypass, hazard ratio (HR) 0.51 (95% CI:0.30-0.85). The five- and ten-year secondary patency for anatomical bypass was 96.83% (95% CI:90.28-100) and 96.13% (95% CI:88.72.3-100). The five- and ten-year secondary patency for extra-anatomical bypass was 91.39% (95% CI:84.32-99.04) and 85.05% (95% CI:74.43-97.18), with non-statistically significant difference between the two groups. The five- and ten-year survival for patients undergoing anatomical bypass was 67.99% (95% CI:53.84-85.85) and 41.09% (95% CI:25.36-66.57). The five- and ten-year survival for extra-anatomical bypass was 70.67% (95% CI:56.76-87.98) and 34.85% (95% CI:19.76-61.44). The mean survival time was 6.92 years (95% CI:5.56-7.89) for the anatomical and 6.78 years (95% CI:5.31-7.63) for the extra-anatomical groups. The pooled overall thirty-day mortality was 2.32% (95% CI:1.12-3.87) with meta-regression analysis displaying a negative association between year of publication and mortality (β =-0.0065, p<0.01). Further analysis displayed a thirty-day mortality of 1.29% (95% CI:0.56-2.26) versus 4.02% (95% CI:1.78-7.03), (p=0.02) for studies published after and before the year 2000. Non-statistically significant differences were identified between the two groups concerning long-term and thirty-day mortality outcomes.

CONCLUSION: While we have demonstrated favorable long-term primary and secondary patency outcomes for both surgical techniques, anatomical bypass exhibited a reduced risk of primary patency loss potentially reflecting its inherent capacity to circumvent the anticipated disease progression in the distal aorta and the contralateral donor artery. The reduction in perioperative mortality observed in our review, coupled with the anachronistic demographic characteristics and inclusion criteria presented in the existing literature, underscores the imperative necessity for contemporary research.

PMID:38588957 | DOI:10.1016/j.avsg.2024.02.007

Am J Med. 2024 Apr 6:S0002-9343(24)00216-X. doi: 10.1016/j.amjmed.2024.04.007. Online ahead of print.

ABSTRACT

PURPOSE: Long COVID and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) patients experience multiple complex symptoms, potentially linked to imbalances in brain neurochemicals. This study aims to measure brain neurochemical levels in long COVID and ME/CFS patients as well as healthy controls to investigate associations with severity measures.

METHODS: Magnetic resonance spectroscopy (MRS) data was acquired with a 3T Prisma MRI scanner. We measured absolute levels of brain neurochemicals in the posterior cingulate cortex in long COVID (n=17), ME/CFS (n=17), and healthy controls (n=10) using Osprey software. The statistical analyses were performed using SPSS version 29. Age and sex were included as nuisance covariates.

RESULTS: Glutamate levels were significantly higher in long COVID (p=0.02) and ME/CFS (p=0.017) than in healthy controls. No significant difference was found between the two patient cohorts. Additionally, N-acetyl-aspartate levels were significantly higher in long COVID patients (p=0.012). Importantly, brain neurochemical levels were associated with self-reported severity measures in long COVID and ME/CFS.

CONCLUSION: Our study identified significantly elevated Glutamate and N-acetyl-aspartate levels in long COVID and ME/CFS patients compared with healthy controls. No significant differences in brain neurochemicals were observed between the two patient cohorts, suggesting a potential overlap in their underlying pathology. These findings suggest that imbalanced neurochemicals contribute to the complex symptoms experienced by long COVID and ME/CFS patients.

PMID:38588934 | DOI:10.1016/j.amjmed.2024.04.007

Radiother Oncol. 2024 Apr 6:110271. doi: 10.1016/j.radonc.2024.110271. Online ahead of print.

ABSTRACT

PURPOSE: Re-irradiation (re-RT) for recurrent intracranial meningiomas is hindered by the limited radiation tolerance of surrounding tissue and the risk of side effects. This study aimed at assessing outcomes, toxicities and prognostic factors in a cohort of patients with recurrent meningiomas re-treated with different RT modalities.

MATERIALS AND METHODS: A multi-institutional database from 8 Italian centers including intracranial recurrent meningioma (RM) patients who underwent re-RT with different modalities (SRS, SRT, PT, EBRT) was collected. Biologically Equivalent Dose in 2 Gy-fractions (EQD2) and Biological Effective Dose (BED) for normal tissue and tumor were estimated for each RT course (α/β = 2 for brain tissue and α/β = 4 for meningioma). Primary outcome was second progression-free survival (s-PFS). Secondary outcomes were overall survival (OS) and treatment-related toxicity. Kaplan-Meier curves and Cox regression models were used for analysis.

RESULTS: Between 2003 and 2021 181 patients (pts) were included. Median age at re-irradiation was 62 (range 20-89) and median Karnofsky Performance Status (KPS) was 90 (range 60-100). 78 pts were identified with WHO grade 1 disease, 65 pts had grade 2 disease and 10 pts had grade 3 disease. 28 pts who had no histologic sampling were grouped with grade 1 patients for further analysis. Seventy-five (41.4 %) patients received SRS, 63 (34.8 %) patients SRT, 31 (17.1 %) PT and 12 (6.7 %) EBRT. With a median follow-up of 4.6 years (interquartile range 1.7-6.8), 3-year s-PFS was 51.6 % and 3-year OS 72.5 %. At univariate analysis, SRT (HR 0.32, 95 % CI 0.19-0.55, p < 0.001), longer interval between the two courses of irradiation (HR 0.37, 95 % CI 0.21-0.67, p = 0.001), and higher tumor BED (HR 0.45 95 % CI 0.27-0.76, p = 0.003) were associated with longer s-PFS; in contrast, Ki67 > 5 % (HR 2.81, 95 % CI 1.48-5.34, p = 0.002) and WHO grade > 2 (HR 3.08, 95 % CI 1.80-5.28, p < 0.001) were negatively correlated with s-PFS. At multivariate analysis, SRT, time to re-RT and tumor BED maintained their statistically significant prognostic impact on s-PFS (HR 0.36, 95 % CI 0.21-0.64, p < 0.001; HR 0.38, 95 % CI 0.20-0.72, p = 0.003 and HR 0.31 95 % CI 0.13-0.76, p = 0.01, respectively). Acute and late adverse events (AEs) were reported in 38 (20.9 %) and 29 (16 %) patients. Larger tumor GTV (≥10 cc) was significantly associated with acute and late toxicity (p < 0.001 and p = 0.009, respectively).

CONCLUSIONS: In patients with recurrent meningiomas, reirradiation is a feasible treatment option associated with acceptable toxicity profile. Prognostic factors in the decision-making process have been identified and should be incorporated in daily practice.

PMID:38588920 | DOI:10.1016/j.radonc.2024.110271