Category: Statistics

Sex Transm Dis. 2023 Dec 13. doi: 10.1097/OLQ.0000000000001909. Online ahead of print.

ABSTRACT

BACKGROUND: The United States has seen a significant rise in syphilis over the past twenty years with a disparate impact on American Indian communities. We conducted a thorough review of the local epidemiology that guided an innovative response to curb the epidemic.

METHODS: We analyzed syphilis data from a hospital in rural Arizona that serves an American Indian population of over 18,000. Testing data was extracted from 2017-2023 with detailed chart reviews of all reactive results since January 2022. Descriptive and comparative statistics were computed using parametric and non-parametric methods where appropriate.

RESULTS: Among 5,888 tested persons, 555 (9.4%) had reactive results and 277 (4.7%) represented new infections. Among new cases, 151 (54.5%) were female and 55 (19.9%) were reinfections. The annualized incidence rate was 10.0 cases per 1000 persons with peak annualized incidence among women ages 30-34 years of 22.6 infections per 1000 persons. During the observation period and after the implementation of programmatic changes in June 2022, there were statistically significant reductions in median time to treatment (-80%), test positivity (-70%), infections (-60%) and no congenital syphilis cases during the observation period.

CONCLUSIONS: We observed significantly elevated syphilis rates in AI/AN persons compared to the general population. Strategic implementation of new policies and practices led to a measurable and meaningful improvement in several epidemic variables and our experience may serve as a model to other communities.

PMID:38100793 | DOI:10.1097/OLQ.0000000000001909

J Neurosurg Spine. 2023 Dec 15:1-8. doi: 10.3171/2023.10.SPINE23806. Online ahead of print.

ABSTRACT

OBJECTIVE: Since its introduction, electrocautery has served as a valuable surgical tool, enabling precise tissue cutting and effective hemostasis in spine surgery. While there have been numerous efforts to elucidate the possible hazardous effects of surgical smoke in various surgical fields, there has been very little discussion in the context of spine surgery. The objective of this study was to measure and conduct a quantitative analysis of the particulate matter (PM) of different sizes and of formaldehyde (HCHO) generated by smoke during spine surgeries.

METHODS: This study included a consecutive series of patients who underwent 1- or 2-level lumbar spinal fusion surgery between June and November 2021. Particle counts were measured using a particle counter, specifically focusing on six different sizes of PM (0.3, 0.5, 1, 2.5, 5, and 10 µm). Additionally, measurements were taken for HCHO in parts per million (ppm). Monopolar cautery was used in the surgical setting. Systematic measurements were conducted at specific time points during the surgical procedures to assess the levels of PM and HCHO. Furthermore, the efficacy of surgical smoke suction was evaluated by comparing the PM levels with and without adjacent placement of suction.

RESULTS: This study involved 35 patients, with measurements of both PM and HCHO taken in 27 cases. The remaining 8 cases had measurements only for PM. In this study, statistically significant quantitative changes in various PM sizes were observed when electrocautery was used during spine surgery (12.3 ± 1.7 vs 1975.7 ± 422.8, 3.4 ± 0.5 vs 250.1 ± 45.7, and 1.9 ± 0.2 vs 78.1 ± 13.3, respectively, for 2.5-, 5-, and 10-µm PM; p < 0.05). The level of HCHO was also significantly higher (0.085 ± 0.006 vs 0.131 ± 0.014 ppm, p < 0.05) with electrocautery use. Utilization of adjacent suction of surgical smoke during electrocautery demonstrated a statistically significant reduction in PM levels.

CONCLUSIONS: The findings of this study highlight the potential surgical smoke-related hazards that spine surgeons may be exposed to in the operating room. Implementing simple interventions, such as utilizing nearby suction, can effectively minimize the amount of toxic surgical smoke and mitigate these risks.

PMID:38100756 | DOI:10.3171/2023.10.SPINE23806

J Neurosurg Pediatr. 2023 Dec 15:1-12. doi: 10.3171/2023.10.PEDS23174. Online ahead of print.

ABSTRACT

OBJECTIVE: Abdominal CSF pseudocysts are an uncommon but challenging complication of ventriculoperitoneal shunts. Pseudocysts consist of a loculated intraperitoneal compartment that inadequately absorbs CSF and may be infected or sterile at diagnosis. The treatment goal is to clear infection if present, reduce inflammation, and reestablish long-term function in an absorptive (intraperitoneal) space. This aim of this paper was to study the efficacy of primary laparoscopic repositioning of the distal shunt catheter for treatment of sterile abdominal CSF pseudocysts.

METHODS: All patients treated for abdominal CSF pseudocysts at Dallas Children’s Health from 1991 to 2021 were retrospectively reviewed. Patient history and pseudocyst characteristics were analyzed, with a primary outcome of pseudocyst recurrence at 1 year.

RESULTS: Of 92 primary pseudocysts, 5 initial treatment strategies (groups) were used depending on culture status, clinical history, and surgeon preference: 1) shunt explant/external ventricular drain (EVD) placement (23/92), 2) distal tubing externalization (13/92), 3) laparoscopic repositioning (35/92), 4) open repositioning (4/92), and 5) other methods such as pseudocyst drainage or direct revision to another terminus (17/92). Seventy pseudocysts underwent shunt reimplantation in the peritoneal space. The 1-year peritoneal shunt survival for groups 1 and 2 combined was 90%, and 62% for group 3. In group 3, 1-year survival was better for those with normal systemic inflammatory markers (100%) than for those with high markers (47%) (p = 0.042). In a univariate Cox proportional hazards model, the risk of pseudocyst recurrence was increased if the most recent abdominal procedure was a nonshunt abdominal surgery (p = 0.012), and it approached statistical significance with male sex (p = 0.054) and elevated inflammatory markers (p = 0.056. Multivariate Cox analysis suggested increased recurrence risk with male sex (p = 0.05) and elevated inflammatory markers (p = 0.06), although the statistical significance threshold was not reached. The length of hospital stay was shorter for laparoscopic repositioning (6 days) than for explantation/EVD placement (21 days) (p < 0.0001). Ultimately, 62% of patients had a peritoneal terminus at the last follow-up, 33% (n = 30) had an extraperitoneal terminus (19 pleura, 8 right heart, and 3 gallbladder), and 5 patients were shunt free.

CONCLUSIONS: Some sterile pseudocysts with normal systemic inflammatory markers can be effectively treated with laparoscopic repositioning, resulting in a significantly shorter hospitalization and modestly higher recurrence rate than shunt explantation.

PMID:38100755 | DOI:10.3171/2023.10.PEDS23174

Ann Med. 2023;55(2):2252439. doi: 10.1080/07853890.2023.2252439. Epub 2023 Dec 15.

ABSTRACT

OBJECTIVE: The purpose of this study was to determine whether a single session of trans-cranial direct current stimulation (tDCS) of the cerebellum and M1 has any advantages over one another or sham stimulation in terms of balance, gait and lower limb function.

METHODS: A total of 66 patients who had experienced their first ever stroke were recruited into three groups for this double-blinded, parallel, randomized, sham-controlled trial: cerebellar stimulation group (CbSG), M1 stimulation group (MSG) and sham stimulation group (SSG). A single session of anodal tDCS with an intensity of 2 mA for a duration of 20 min was administered in addition to gait and balance training based on virtual reality using an Xbox 360 with Kinect. Balance, gait, cognition and risk of fall were assessed using outcome measures before intervention (T0), immediately after intervention (T1) and an hour after intervention (T2).

RESULTS: Across group analysis of all outcome measures showed statistically non-significant results (p > .05) except for Six Minute Walk Test (p value T0 = .003, p value T1 = .025, p value T2 = .016). The training effect difference showed a significant difference in balance, gait and cognition, as well as cerebral and cerebellar stimulation, in comparison to sham stimulation (p < .05). The risk of falls remained unaffected by any stimulation (p > .05).

CONCLUSIONS: In addition to Xbox Kinect-based rehabilitation training, a single session of anodal tDCS to the M1 or cerebellum may be beneficial for improving lower limb function, balance and gait performance.

PMID:38100750 | DOI:10.1080/07853890.2023.2252439

Pediatr Infect Dis J. 2024 Jan 1;43(1):63-68. doi: 10.1097/INF.0000000000004117. Epub 2023 Sep 14.

ABSTRACT

BACKGROUND: Elizabethkingia meningoseptica is an emerging nosocomial pathogen implicated in neonatal sepsis with high mortality and morbidities. However, there is very limited data regarding the characteristics as well as outcomes following this infection, particularly in developing countries.

METHODS: We conducted a retrospective observational study of all infants with culture-positive Elizabethkingia sepsis as part of an outbreak, to study their clinical and epidemiological characteristics, as well as their antimicrobial susceptibility patterns, using a structured proforma from the neonatal intensive care unit database. Analysis was done using descriptive statistics and predictors of mortality and hydrocephalus were also identified.

RESULTS: Of the 21 neonates enrolled, 9 (42.9%) were male, with a mean gestational age and birth weight of 31.7 ± 3.4 weeks and 1320 ± 364 g, respectively. The median (interquartile range) age of onset of illness was 7 (5-12) days. The overall mortality rate was 23.8%, and among survivors, 50% had neurologic complications requiring intervention. Vancomycin and ciprofloxacin were the most used antibiotics for treatment in our series, with a median duration of 26 (17-38) days. On univariate analysis, shock at presentation was significantly associated with increased mortality (P = 0.04) while, seizures (P = 0.04) and elevated cerebrospinal fluid protein levels (P = 0 .01) at onset of illness predicted progressive hydrocephalus in surviving neonates.

CONCLUSION: E. meningoseptica sepsis is associated with high morbidity and mortality. Early diagnosis and prompt initiation of appropriate antibiotics are critical for improving survival and neurodevelopmental outcomes. Though isolation of the organism by environmental surveillance is always not possible, with proper infection control measures, the infection can be controlled.

PMID:38100733 | DOI:10.1097/INF.0000000000004117

Dis Esophagus. 2023 Dec 14:doad069. doi: 10.1093/dote/doad069. Online ahead of print.

ABSTRACT

Stag Beetle Knife (SB Knife) is increasingly being utilized for Zenker’s Diverticulectomy (ZD). Our study assessed the effectiveness and safety of the SB Knife for the management of ZD. Ovid EBM reviews, Ovid Embase, Ovid Medline, ClinicalTrials.gov, Scopus, and Web of Science were searched to identify studies that utilized SB knife for ZD. Pooled proportions (PP) were calculated using the random-effects model. Heterogeneity was evaluated using I2 statistics. A total of 7 studies with 268 patients were included in the final analysis. Dysphagia and regurgitation were the most common clinical symptoms. The mean size of the ZD was 2.8 ± 0.7 cm and 28 (of 148) patients had undergone previous treatments. The PP of technical success was 98% (95% CI: 92.3-99.5; I20) with a mean procedure duration of 26.2 ± 8.3 minutes. The PP of clinical response at first follow-up and relapse after index procedure was 87.9% (95% CI: 81.6-92.3; I219) and 13.5% (95% CI: 9.6-18.6; I22), respectively. At final follow-up, the PP of clinical remission was 96.2% (95% CI: 91-98.4; I230.6) while the PP of procedure failure was 3.6% (95% CI: 1.6-8.1; I20). No severe adverse events (AEs) were noted while using the SB Knife. However, the PP of intraprocedural and postprocedural AEs was 13.2% (95% CI: 9.6-17.8; I20) and 9.3% (95% CI: 5.7-14.9; I2 < 20.9), respectively. SB Knife is highly safe and effective for Zenker’s Diverticulectomy with a failure rate of only 3.6%.

PMID:38100729 | DOI:10.1093/dote/doad069

Chron Respir Dis. 2023 Jan-Dec;20:14799731231222282. doi: 10.1177/14799731231222282.

ABSTRACT

BACKGROUND: Chronic lung diseases, such as chronic obstructive pulmonary disease or asthma, are associated with an increased risk of dementia. However, few data are available regarding the risk of dementia in individuals with bronchiectasis.

OBJECTIVES: To explore the association between bronchiectasis and the risk of incident dementia using a longitudinal population-based cohort.

METHODS: A total of 4,068,560 adults older than 50 years without previous dementia were enrolled from the Korean National Health Insurance Service database in 2009. They were followed up until the date of the diagnosis of dementia or December 31, 2020. The study exposure was the diagnosis of bronchiectasis, and the primary outcome was incident dementia comprising Alzheimer’s disease and vascular dementia.

RESULTS: During the median follow-up duration of 9.3 years, the incidence of all-cause dementia was 1.6-fold higher in individuals with bronchiectasis than in those without bronchiectasis (15.0 vs. 9.3/1000 person-years, p < .001). In the multivariable Cox regression analysis, the risk of all dementia was significantly higher in individuals with bronchiectasis than in those without bronchiectasis (adjusted hazard ratio [aHR] 1.09, 95% confidence interval [CI] 1.04-1.14). In a subgroup analysis by dementia type, individuals with bronchiectasis had an increased risk of Alzheimer’s disease compared to those without bronchiectasis (aHR 1.07, 95% CI 1.01-1.12); the risk of vascular dementia did not significantly differ between the two groups (aHR 1.05, 95% CI 0.90-1.21).

CONCLUSION: Bronchiectasis was associated with an increased risk of dementia, especially Alzheimer’s disease.

PMID:38100725 | DOI:10.1177/14799731231222282

Mod Rheumatol. 2023 Dec 8:road109. doi: 10.1093/mr/road109. Online ahead of print.

ABSTRACT

OBJECTIVES: : Assess real-world, long-term safety/effectiveness of mepolizumab for eosinophilic granulomatosis with polyangiitis (EGPA) in Japan.

METHODS: : MARS (GSK ID:213684/NCT04551989) is an ongoing 96-week study of patients with EGPA who received 4-weekly mepolizumab 300 mg subcutaneously for ≥96 weeks before study entry (baseline) and continued treatment. This interim analysis included safety from baseline to Week 48 (observation period) and clinical outcomes before mepolizumab and during the observation period.

RESULTS: : Of 118 patients enrolled, 29% (34/118) experienced adverse events (AEs) of which 13% (15/118) experienced serious AEs; none were considered mepolizumab-related. Median oral corticosteroid (OCS) dose decreased from 6.9 (pre-mepolizumab) to 3.0 (baseline) and 2.0 mg/day (Weeks 45-48); the proportion of patients receiving no OCS increased from 8% to 32% and 38%, respectively. Patients experiencing clinical symptoms decreased from 94% (pre-mepolizumab) to 73% (baseline) and 67% (Week 48). During the observation period, 5% of patients experienced EGPA relapse; rates of EGPA-related hospitalisations, EGPA-related emergency room/unscheduled visits and asthma exacerbations were 0.05, 0.09 and 0.08 event/person-year, respectively.

CONCLUSIONS: : Results of mepolizumab treatment for ≥144 weeks (before baseline plus observation) were consistent with the known safety profile and allowed OCS dose reduction while improving disease control versus pre-treatment among patients with EGPA.

PMID:38100679 | DOI:10.1093/mr/road109

J Phys Chem A. 2023 Dec 15. doi: 10.1021/acs.jpca.3c06244. Online ahead of print.

ABSTRACT

In a recent study [J. Chem. Theory Comput. 2021, 17, 1457-1468], some of us examined the accuracy of magnetizabilities calculated with density functionals representing the local density approximation (LDA), generalized gradient approximation (GGA), meta-GGA (mGGA), as well as global hybrid (GH) and range-separated (RS) hybrid functionals by assessment against accurate reference values obtained with coupled-cluster theory with singles, doubles, and perturbative triples [CCSD(T)]. Our study was later extended to local hybrid (LH) functionals by Holzer et al. [J. Chem. Theory Comput. 2021, 17, 2928-2947]; in this work, we examine a larger selection of LH functionals, also including range-separated LH (RSLH) functionals and strong-correlation LH (scLH) functionals. Holzer et al. also studied the importance of the physically correct handling of the magnetic gauge dependence of the kinetic energy density (τ) in mGGA calculations by comparing the Maximoff-Scuseria formulation of τ used in our aforementioned study to the more physical current-density extension derived by Dobson. In this work, we also revisit this comparison with a larger selection of mGGA functionals. We find that the newly tested LH, RSLH, and scLH functionals outperform all of the functionals considered in the previous studies. The various LH functionals afford the seven lowest mean absolute errors while also showing remarkably small standard deviations and mean errors. Most strikingly, the best two functionals are scLHs that also perform remarkably well in cases with significant multiconfigurational character, such as the ozone molecule, which is traditionally excluded from statistical error evaluations due to its large errors with common density functionals.

PMID:38100678 | DOI:10.1021/acs.jpca.3c06244

Int J Pharm Compd. 2023 Nov-Dec;27(6):503-511.

ABSTRACT

Maintaining the microbial quality of the environment is crucial in pharmaceutical institutions, especially community pharmacies, since they have a direct relationship with patients. The sterility of the environmental surfaces of pharmacies can be maintained by proper cleaning and disinfecting. Microbial contamination is the primary reason for product spoilage or deterioration. The present study was carried out to assess the sanitation practices of pharmacies on the maintenance of cleanliness followed by isolation and identification of microorganisms from surface and air samples of selected pharmacies. All the pharmacies followed daily sanitization practices in the pharmacy premises and surrounding environment. However, only 20% of the pharmacies cleaned their equipment daily. In total, 33 bacterial species were identified from the pharmacies. Of these, 31 were Gram-positive (29 coagulase-negative staphylococci) and 2 Streptococcus spp., while 2 were Gram-negative (Pseudomonas aeruginosa and Proteus vulgaris). The colony-forming unit count of air samples after one-hour exposure under uni-directional air flow was less than 20 except from one pharmacy which was 59. Significant statistical associations were not observed between the presence of separate extemporaneous preparation rooms, separate counseling places, type of disinfectant, spillage management, and the growth of organisms in the pharmaceutical products and complaints received for spoiled products. However, some pharmacies under investigation were confirmed to have had poor sterility-control practices since they showed the growth of fastidious organisms both Gram-negative bacilli and Gram-positive cocci of which the latter was in more abundance.

PMID:38100668