Category: Statistics

West Afr J Med. 2023 Nov 30;40(11):1223-1231.

ABSTRACT

BACKGROUND: Secondary peritonitis is a common emergency surgical condition with varying aetiologies managed by surgeons all over the world. One important morbidity associated with it is postoperative surgical site infection (SSI). A better prevention strategy can be instituted if this complication in patients can be correctly predicted. The study aimed to identify factors in patients with peritonitis that have a significant bearing on the development of postoperative SSI.

METHOD: A total of fifty patients operated on for peritonitis in a period of one year were studied. Factors including age, gender, comorbidities, presenting symptoms, time of presentation, time of intervention, intraoperative findings, duration of surgery, and postoperative SSI were noted. Chi-square, Fisher’s exact test and Student’s t-test were used to test for association where appropriate and a p-value of < 0.05 was considered statistically significant.

RESULTS: Peritonitis was most commonly due to a ruptured appendix (46%) followed by perforated peptic ulcer disease (42%). The incidence of SSI was 44%. For the patients that developed SSI, the lowest rate was observed in cases of ruptured appendix (39.1%) and the highest in perforated gastric ulcer (64.3%) which was closely followed by perforated duodenal ulcer (57.1%). The association between the time of presentation and the occurrence of SSI was statistically significant (p = 0.028).

CONCLUSION: The SSI rate (44%) from peritonitis in our centre was quite high and the time of presentation played a crucial role. Prevention strategies focusing on predictors of SSI is necessary to reduce the rate of SSI in our setting.

PMID:38099433

Alcohol Clin Exp Res (Hoboken). 2023 Dec 15. doi: 10.1111/acer.15242. Online ahead of print.

ABSTRACT

BACKGROUND: Understanding how treatments for alcohol use disorder (AUD) facilitate behavior change has long been recognized as an important area of research for advancing clinical care. Even after decades of research, however, the specific mechanisms of change for most AUD treatments remain largely unknown because most prior work in the field has solely focused on statistical mediation. Statistical mediation is a necessary but not sufficient condition for establishing evidence for a mechanism of change. Mediators are intermediate variables that statistically account for the relationship between an independent and dependent variable whereas mechanisms provide more detailed explanations of how an intervention leads to a desired outcome. Thus, mediators and mechanisms are not equivalent.

METHODS: To advance mechanisms of behavior change research, this critical review provides an overview of methodological shortfalls of existing AUD treatment mechanisms research and introduces an etiologically informed precision medicine approach that facilitates testing mechanisms of behavior change rather than treatment mediators.

RESULTS: We propose a framework for studying mechanisms in alcohol treatment research that holds promise for facilitating our understanding of behavior change and precision medicine (i.e., for whom a given mechanisms of behavior change operates under what conditions). The framework forwarded in this review has several overarching goals including providing a methodological roadmap for testing AUD recovery mechanisms. We provide two examples of our framework, one pharmacological and one behavioral, to facilitate future efforts to implement this methodological approach to mechanisms research.

CONCLUSIONS: The framework proposed in this critical review facilitates the alignment of AUD treatment mechanisms research with current theories of etiologic mechanisms, precision medicine efforts, and cross-disciplinary approaches to testing mechanisms. Although no framework can resolve all the challenges related to mechanisms research, our goal is to help facilitate a shift towards more rigorous and falsifiable behavior change research.

PMID:38099412 | DOI:10.1111/acer.15242

Indian J Ophthalmol. 2023 Dec 15. doi: 10.4103/IJO.IJO_495_23. Online ahead of print.

ABSTRACT

PURPOSE: To study the epidemiological profile of various pediatric orbital tumors and determine their clinicopathological correlation over 20 years.

METHODS: A retrospective analysis of all pediatric patients with orbital tumors from the medical records between 1995 and 2015 was done. Tumors were categorized based on their cellular origin. Demographic details, clinical and histopathological diagnoses, frequency, and clinicopathological correlation were studied.

RESULTS: A total of 265 pediatric patients with orbital tumors were analyzed, of which 145 (54.7%) patients were males and 120 (45.3%) were females. The mean age was 7 years (median: 6 years; range: 10 days-16 years).The distribution of lesions in each group was as follows: vasculogenic, 76 (28.7%); lipogenic and myxoid, 66 (25%); myogenic, 31 (11.7%); optic nerve and meningeal, 22 (8.3%); lymphoid and lymphoproliferative, 18 (6.8%); secondary orbital tumors, 14 (5.2%); histiocytic, 9 (3.4%); miscellaneous, 9 (3.4%), lacrimal gland, 8 (3%); mesenchymal with neural differentiation, 6 (2%); osseous, 4 (1.5%), and fibrocystic, 2 (0.8%). The most common benign and malignant pediatric orbital tumors were dermoid cysts (65, 24.5%) and rhabdomyosarcoma (31, 11.7%). A statistically significant (P < 0.0001) clinicopathological correlation was observed in 208 (83.2%) out of 250 biopsy-proven cases.

CONCLUSION: Pediatric orbital neoplasms include a broad spectrum of benign and malignant lesions. Vasculogenic tumors constitute the majority of them, followed by lipogenic and myxoid tumors. A thorough knowledge of the incidence, clinical profile, imaging features, and histopathology of specific orbital tumors aids in accurate diagnosis and their successful management.

PMID:38099389 | DOI:10.4103/IJO.IJO_495_23

Indian J Ophthalmol. 2023 Dec 15. doi: 10.4103/IJO.IJO_2878_22. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to investigate the incidence of Ocular Surface Disorders (OSDs), including Dry Eye Disease, Chemosis, and Exposure Keratitis, among patients admitted to the Neurocritical Care Unit (NCC). Additionally, we sought to assess the correlation between these OSDs, the length of hospitalization at NCC, and the Glasgow Coma Score (GCS). The heightened risk of OSD development in the NCC environment, coupled with pre-existing neurological impairments, can lead to conditions like dry eye disease, chemosis, corneal abrasions, and infectious keratitis, ultimately resulting in corneal opacities and perforations that significantly impact visual acuity and overall quality of life.

METHODS: In this observational cross-sectional study, we examined the ocular health of all patients admitted to an NCC unit from February to May 2022. We assessed the presence of Conjunctivitis, chemosis, Keratitis, and Dry Eyes in relation to the duration of stay at NCC, GCS, lagophthalmos, adherence to the prescribed eye care protocol in NCC, and the use of mechanical ventilation. Our study comprised one hundred subjects over a four-month period, with a mean age of 51.92 ± 18.73 years (ranging from 17 to 89), including 70% males and 30% females (gender ratio of 2.33).

RESULTS: Our findings revealed that 26 eyes (13%) exhibited Conjunctival Hyperemia, 23 eyes (11.5%) displayed Chemosis, and severe dry eye was prevalent in 41 (20.5%) eyes. A statistically significant association was observed between GCS (p-value <0.001) and Keratitis (p-value 0.0035) with dry eyes (Chi-Square Test). Notably, the incidence of dry eyes was significantly higher among patients with a prolonged stay of ≥10 days (p-value 0.003).

CONCLUSIONS: Patients admitted to Neurocritical Care Units necessitate meticulous eye care and structured protocols to mitigate the risk of long-term ocular complications such as exposure keratitis. Given their heightened susceptibility to these conditions, proactive measures are imperative to ensure optimal ocular health among NCC patients.

PMID:38099377 | DOI:10.4103/IJO.IJO_2878_22

Indian J Ophthalmol. 2023 Dec 15. doi: 10.4103/IJO.IJO_1037_23. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study was to evaluate the effectiveness and safety of repeated low-level red light (RLRL) therapy in controlling myopia progression in children through a meta-analysis.

METHODS: We searched several databases including PubMed, Embase, The Cochrane Library, Web of Science, CNKI, WANFANG, CBM, and VIP with languages restricted to both Chinese and English. The search was conducted from the establishment of the databases to March 23, 2023. We collected randomized controlled trials and controlled experiments to evaluate changes in axial length (AL) and spherical equivalent (SE) before and after RLRL intervention. Two researchers performed literature screening and data extraction, and RevMan software (Ver 5.3) and StataMP 17.0 were used for meta-analysis.

RESULTS: A total of 141 articles were retrieved, and finally, six randomized controlled trials met the inclusion and exclusion criteria, including 820 eyes (RLRL group: 411 eyes, control group: 409 eyes). The meta-analysis results showed that the RLRL group was significantly better than the control group in controlling AL, and the difference between the two groups was statistically significant (mean difference [MD] = -0.22, 95% confidence interval [CI] [ – 0.28, -0.16]; P < 0.001). The RLRL group was also better than the control group in terms of SE, and the difference between the two groups was statistically significant (MD = 0.46, 95% CI [0.32, 0.6]; P < 0.001). Five studies reported adverse reactions in the RLRL group, and two cases stopped treatment due to the feeling of too bright light, while the others had no significant side effects in the short term.

CONCLUSION: RLRL therapy is a safe and effective method for controlling myopia, which can inhibit the growth of AL and slow down the progression of myopia. However, further research and validation are needed to determine its treatment efficacy and course.

PMID:38099371 | DOI:10.4103/IJO.IJO_1037_23

Indian J Ophthalmol. 2023 Dec 15. doi: 10.4103/IJO.IJO_806_23. Online ahead of print.

ABSTRACT

PURPOSE: Adherence to glaucoma medical therapy is a key factor in achieving target intraocular pressure to prevent glaucoma progression. To determine factors affecting medication adherence in glaucoma patients in an urban population belonging to poor socioeconomic status.

METHODS: A cross-sectional study was conducted on 200 patients attending glaucoma services in a tertiary referral hospital of North India. Adherence to medication was determined subjectively by questionnaire and objectively by counting the number of used bottles at the end of a month or during refill, whichever was earlier. Patient-related parameters in adherence toward glaucoma medication were studied based on demography, knowledge, attitudes, and practices (KAP). The statistical techniques of bivariate and multivariate logistic regression were adopted to test the objective.

RESULTS: The population was statistically homogeneous based on gender and income in both groups. A large proportion of patients had bilateral disease (87%) and were on two or more medications (62.5%). Adherence to glaucoma medical therapy was seen in 68% of patients, with knowledge about glaucoma present in 58% of patients. Deterrents to drug adherence were identified as forgetfulness (71%), unavailability of drugs (19%) or funds to purchase the same (26%), polypharmacy (21%), and side effects (5%). Dependence on an escort by 44% and dependence on hospital supply of medications by 60% emerged as the contextual factors requiring scrutiny while prescribing lifelong glaucoma medications. Disease misconceptions (53%) were prevalent and drug instillation practices were unsatisfactory (57%).

CONCLUSION: The study offers insight into patients’ perspectives regarding the lifetime use of antiglaucoma medications and focuses on key issues linked to drug nonadherence.

PMID:38099369 | DOI:10.4103/IJO.IJO_806_23

Indian J Ophthalmol. 2023 Dec 15. doi: 10.4103/IJO.IJO_1263_23. Online ahead of print.

ABSTRACT

PURPOSE: Corneal biopsy helps in diagnosing deep-seated or recalcitrant lesions of microbial keratitis (MK). We aim to analyze its role in managing these challenging cases.

METHODS: This is a retrospective review of 22 cases of corneal biopsy at our institute from January 2010 to December 2021. Data were retrospectively collected using the electronic medical record (EMR) system. Those cases of indolent, progressive MK or deep-seated lesions where cornea scraping was not possible were considered for corneal biopsy to establish the microbiological diagnosis. The primary aims of our study were to analyze the indications, success rates, and outcomes for biopsy patients in our series. Additional outcomes that were analyzed included the average time from presentation to biopsy, the type of causative organism isolated from the biopsy by either histopathological or microbiological method, and the frequency and outcome of surgical interventions performed. Descriptive statistics using mean (±standard deviation) and median (±range) were used to interpret the demographic data.

RESULTS: Overall, 15 of 22 patients (68%) had a positive corneal biopsy after microbiological or histopathological examinations. The most identified organism was microsporidia (n = 4,30.7%), followed by mycobacteria (n = 2,15.4%), gram-negative bacilli (n = 2,15.4%), acid-fast bacilli (n = 1,7.6%), fungus (n = 2,15.4%), gram-positive cocci (n = 1,7.6%), and mixed bacterial infection (n = 1,7.6%).

CONCLUSION: Corneal biopsy should be considered a diagnostic modality for patients with deep-seated or unresponsive MK. It can improve the treatment for MK, ensuring targeted therapy.

PMID:38099368 | DOI:10.4103/IJO.IJO_1263_23

Indian J Ophthalmol. 2023 Dec 15. doi: 10.4103/IJO.IJO_958_23. Online ahead of print.

ABSTRACT

PURPOSE: To report the seroprevalence of bloodborne viral infection (BBVI) in patients undergoing ophthalmic surgeries and assess the utility and feasibility of preoperative screening for BBVI in India’s current eye care system.

METHODS: This retrospective, hospital-based, descriptive study included data from patients undergoing preoperative screening for Hepatitis B virus (HBV), Hepatitis C virus (HCV), and human immunodeficiency virus (HIV) at a tertiary eye care institute from 2018 to 2022. Rapid diagnostic tests (RDTs) were performed on the blood samples after obtaining informed consent from the patients. Seroreactive patients underwent surgery with additional safety precautions. The demographic data and surgical details of these patients were collected and analyzed. ANOVA was used to carry out statistical analysis between groups. During the study period, the number of healthcare workers (HCWs) sustaining needle stick injury (NSI) and accidental sharp injury (ASI) in the operating theater (OT) and details of these injuries were recorded.

RESULTS: Samples from 28,563 patients were included. The seroprevalence of BBVI was 1.87% (536/28563). Hepatitis B virus (322, 60.1%) was the most commonly detected infection, and HIV (59, 11%) was the least detected infection. The mean age of the seroreactive patients was 60.3 ± 30.8 years. The incidence of NSI was 0.49/1000 surgeries. Nurses (11) and technicians (4) in the OT sustained maximum NSI. None of the HCWs had seroconversion after NSI.

CONCLUSION: The overall seroprevalence of BBVI in the current study is lower than that reported in previously published studies from eye care organizations. Currently, mandatory preoperative screening for BBVI to prevent transmission of these infections to HCWs working in the eye care sector in India appears to be less cost-effective.

PMID:38099360 | DOI:10.4103/IJO.IJO_958_23

Indian J Ophthalmol. 2023 Dec 15. doi: 10.4103/IJO.IJO_618_23. Online ahead of print.

ABSTRACT

PURPOSE: To examine the ocular surface disease in primary open-angle glaucoma (POAG) patients already on treatment versus POAG patients without treatment.

METHODS: A prospective cohort study was conducted on 120 eyes of 60 POAG patients: 60 treatment-naïve eyes (group I) and 60 eyes already on topical anti-glaucoma medications (AGMs) (group II). All patients had filled out the Ocular Surface Disease Index (OSDI) questionnaire and underwent a comprehensive glaucoma workup. Tear break-up time (TBUT) test, Schirmer’s test (type I), corneal sensitivity, anterior segment-optical coherence tomography (AS-OCT), and corneal and conjunctival staining were done at day 1, 1 month, 3 months, 6 months, and 12 months follow-up.

RESULTS: On presentation, TBUT, Schirmer’s test, tear meniscus height (TMH), and tear meniscus depth (TMD) were significantly higher in group I compared to group II. No significant difference was noted in OSDI score, corneal sensitivity, and tear meniscus area (TMA) between the groups on presentation. Both, lissamine green and rose bengal staining, had higher grades in group II compared to group I. Worsening of ocular surface disease was noted in both groups on follow-up. OSDI score, TBUT, Schirmer’s test, TMH, and TMD had better values in group I in comparison to group II on follow-up.

CONCLUSION: The study has identified glaucoma patients on AGMs to be more affected by dry eye disease (DED) compared to treatment-naive glaucoma patients. We found statistically significant differences in values of TBUT, Schirmer tests, lissamine and rose bengal staining, and AS-OCT parameters at baseline and 3, 6, and 12 months follow-up. OSDI scores showed significant differences at 6 and 12 months of follow-up. We recommend consideration of evaluation and management of DED/ocular surface disease in glaucoma patients on topical AGMs, particularly multiple drugs and doses.

PMID:38099355 | DOI:10.4103/IJO.IJO_618_23

Platelets. 2024 Dec;35(1):2290108. doi: 10.1080/09537104.2023.2290108. Epub 2023 Dec 15.

ABSTRACT

Previous research suggests that individuals with 22q11.2 deletion syndrome (DS) have an increased risk of bleeding following cardiac surgery. However, current guidelines for management of patients with 22q11.2DS do not provide specific recommendations for perioperative management. This study sought to identify specific risk factors for bleeding in this patient population. Examine the factors determining bleeding and transfusion requirements in patients with 22q11.2DS undergoing cardiac surgery. This was a single center review of patients who underwent cardiac surgery at the Children’s Hospital of Philadelphia from 2000 to 2016. Data was extracted from the medical record. Frequency of bleeding events, laboratory values, and transfusion requirements were compared. We included 226 patients with 22q11.2DS and 506 controls. Bleeding events were identified in 13 patients with 22q11.2DS (5.8%) and 27 controls (5.3%). Platelet counts were lower among patients with 22q11.2DS than in control patients, but not statistically different comparing bleeding to not bleeding. Patients with 22q11.2DS received more transfusions (regardless of bleeding status). However, multivariate analysis showed only procedure type was associated with increased risk of bleeding (p = .012). The overall risk of bleeding when undergoing cardiac surgery is not different in patients with 22q11.2DS compared to non-deleted patients. Though platelet counts were lower in patients with 22q11.2DS, only procedure type was significantly associated with an increased risk of bleeding.

PMID:38099325 | DOI:10.1080/09537104.2023.2290108