Category: Statistics

J Clin Endocrinol Metab. 2023 Oct 6:dgad581. doi: 10.1210/clinem/dgad581. Online ahead of print.

ABSTRACT

CONTEXT: Chronic hyperglycaemia in patients with diabetes mellitus (DM) causes retinal damage and leakage, resulting in vision loss. Although diabetic retinopathy (DR) and diabetic kidney disease (DKD) are usually correlated, the relationship between diabetic macular oedema (DME) and DKD remains unknown.

OBJECTIVE: To assess whether DME presence can predict renal failure in patients with DM and chronic kidney disease (CKD).

DESIGN: This retrospective cohort study used data from the TriNetX network.

SETTING: One-hundred and twenty healthcare organisations.

PATIENTS: Electronic medical records of approximately 90 million patients were reviewed. The study population was classified into DME and non-DME cohorts.

MAIN OUTCOME MEASURES: Primary and secondary outcomes were new-onset end-stage renal disease (ESRD) and all-cause mortality, respectively. Covariate factors were incorporated to reduce confounding effects.

RESULTS: Before matching, the DME cohort used more medication and had poorer renal function and blood sugar control than the non-DME cohort. Subsequently, the two groups were well-matched in demographics, socioeconomic status, lifestyle, comorbidities, and medication usage. The DME cohort had a significantly higher risk of ESRD, dialysis, and renal transplantation than the non-DME cohort. Subgroup analyses showed consistent results irrespective of follow-up duration, initial estimated glomerular filtration rate, or glycated haemoglobin levels. Additionally, the DME cohort had a lower risk of all-cause mortality than the non-DME cohort.

CONCLUSIONS: Statistically significant 5-year increased risks of ESRD, dialysis, and renal transplantation were observed in patients with concurrent DME. Therefore, close monitoring and follow-up of the renal function in DM patients with DME are necessary and strongly recommended.

PMID:37804118 | DOI:10.1210/clinem/dgad581

Mol Biol Evol. 2023 Oct 6:msad227. doi: 10.1093/molbev/msad227. Online ahead of print.

ABSTRACT

Phylogenetic inferences under the Maximum-Likelihood criterion deploy heuristic tree search strategies to explore the vast search space. Depending on the input dataset, searches from different starting trees might all converge to a single tree topology. Often, though, distinct searches infer multiple topologies with large log-likelihood score differences or yield topologically highly distinct, yet almost equally likely, trees. Recently, Haag et al. introduced an approach to quantify, and implemented machine learning methods to predict, the dataset difficulty with respect to phylogenetic inference. Easy MSAs exhibit a single likelihood peak on their likelihood surface, associated with a single tree topology to which most, if not all, independent searches rapidly converge. As difficulty increases, multiple locally optimal likelihood peaks emerge, yet from highly distinct topologies. To make use of this information, we introduce and implement an adaptive tree search heuristic in RAxML-NG, which modifies the thoroughness of the tree search strategy as a function of the predicted difficulty. Our adaptive strategy is based upon three observations. First, on easy datasets, searches converge rapidly and can hence be terminated at an earlier stage. Second, over-analyzing difficult datasets is hopeless, and thus it suffices to quickly infer only one of the numerous almost equally likely topologies to reduce overall execution time. Third, more extensive searches are justified and required on datasets with intermediate difficulty. While the likelihood surface exhibits multiple locally optimal peaks in this case, a small proportion of them is significantly better. Our experimental results for the adaptive heuristic on 9,515 empirical and 5,000 simulated datasets with varying difficulty exhibit substantial speedups, especially on easy and difficult datasets (53% of total MSAs), where we observe average speedups of more than 10x. Further, approximately 94% of the inferred trees using the adaptive strategy are statistically indistinguishable from the trees inferred under the standard strategy (RAxML-NG).

PMID:37804116 | DOI:10.1093/molbev/msad227

Hum Reprod Update. 2023 Oct 6:dmad027. doi: 10.1093/humupd/dmad027. Online ahead of print.

ABSTRACT

BACKGROUND: Polycystic ovary morphology (PCOM) on ultrasonography is considered as a cardinal feature of polycystic ovarian syndrome (PCOS). Its relevance as a diagnostic criterion for PCOS was reaffirmed in the most recent International Evidence-Based Guideline for the Assessment and Management of PCOS. However, there remains a lack of clarity regarding the best practices and specific ultrasonographic markers to define PCOM.

OBJECTIVE AND RATIONALE: The aim of this systematic review and diagnostic meta-analysis was to assess the diagnostic accuracy of various ultrasonographic features of ovarian morphology in the diagnosis of PCOS.

SEARCH METHODS: Relevant studies published from 1 January 1990 to 12 June 2023 were identified by a systematic search in PubMed, Web of Science, Scopus, CINAHL, and CENTRAL. Studies that generated diagnostic accuracy measures (e.g. proposed thresholds, sensitivity, specificity) for PCOS using the following ultrasonographic markers met criteria for inclusion: follicle number per ovary (FNPO) or per single cross-section (FNPS), ovarian volume (OV), and stromal features. Studies on pregnant or post-menopausal women were excluded. Risk of bias and applicability assessment for diagnostic test accuracy studies were determined using the QUADAS-2 and QUADAS-C tool for a single index test or between multiple index tests, respectively. Diagnostic meta-analysis was conducted using a bivariate model of pooled sensitivity and specificity, and visualized using forest plots and summary receiver-operating characteristic (SROC) curves.

OUTCOMES: From a total of 2197 records initially identified, 31 studies were included. Data from five and two studies were excluded from the meta-analysis due to duplicate study populations or limited data for the index test, leaving 24 studies. Pooled results of 20 adult studies consisted of 3883 control participants and 3859 individuals with PCOS. FNPO was the most accurate diagnostic marker (sensitivity: 84%, CI: 81-87%; specificity: 91%, CI: 86-94%; AUC: 0.905) in adult women. OV and FNPS had similar pooled sensitivities (OV: 81%, CI: 76-86%; FNPS: 81%, CI: 70-89%) but inferior pooled specificities (OV: 81%, CI: 75-86%; FNPS: 83%, CI: 75-88%) and AUCs (OV: 0.856; FNPS: 0.870) compared to FNPO. Pooled results from four adolescent studies consisting of 210 control participants and 268 girls with PCOS suggested that OV may be a robust ultrasonographic marker for PCOS diagnosis albeit the current evidence remains limited. The majority of the studies had high risk of bias for the patient selection (e.g. lack of randomized/consecutive patient selection)and index test (e.g. lack of pre-proposed thresholds for comparison) domains across all ultrasonographic markers. As such, diagnostic meta-analysis was unable to determine the most accurate cutoff for ultrasonographic markers to diagnose PCOS. Subgroup analysis suggested that stratification based on previously proposed diagnostic thresholds, age, BMI, or technology did not account for the heterogeneity in diagnostic accuracy observed across the studies. Studies that diagnosed PCOS using the Rotterdam criteria had improved sensitivity for FNPO. Studies from North America had lower diagnostic accuracy when compared to Asian studies (FNPO: sensitivity) and European studies (OV: specificity, diagnostic odds ratio and positive likelihood ratio). Geographic differencesin diagnostic accuracy may potentially be due to differences in age, BMI, and diagnostic criteria of the PCOS group across regions.

WIDER IMPLICATIONS: This diagnostic meta-analysis supports the use of FNPO as the gold standard in the ultrasonographic diagnosis of PCOS in adult women. OV and FNPS provide alternatives if total antral follicle counts cannot be accurately obtained. Our findingssupport the potential for ultrasonographic evidence of PCOM in adolescents as more data becomes available. Subgroup analysis suggests the need to investigate any relative contributions of geographical differences on PCOS phenotypes. These findings may provide the basis for the development of strategies and best practices toward a standardized definition of PCOM and a more accurateultrasonographic evaluation of PCOS.

PMID:37804097 | DOI:10.1093/humupd/dmad027

Ann N Y Acad Sci. 2023 Oct 7. doi: 10.1111/nyas.15067. Online ahead of print.

ABSTRACT

Objective analytical identification methods are still a minority in the praxis of paleobiological sciences. Subjective interpretation of fossils and their modifications remains a nonreplicable expert endeavor. Identification of African bovids is a crucial element in the reconstruction of paleo-landscapes, ungulate paleoecology, and, eventually, hominin adaptation and ecosystemic reconstruction. Recent analytical efforts drawing on Fourier functional analysis and discrimination methods applied to occlusal surfaces of teeth have provided a highly accurate framework to correctly classify African bovid tribes and taxa. Artificial intelligence tools, like computer vision, have also shown their potential to be objectively more accurate in the identification of taphonomic agency than human experts. For this reason, here we implement some of the most successful computer vision methods, using transfer learning and ensemble analysis, to classify bidimensional images of African bovid teeth and show that 92% of the large testing set of images of African bovid tribes analyzed could be correctly classified. This brings an objective tool to paleoecological interpretation, where bovid identification and paleoecological interpretation can be more confidently carried out.

PMID:37804072 | DOI:10.1111/nyas.15067

J Coll Physicians Surg Pak. 2023 Oct;33(10):1204-1206. doi: 10.29271/jcpsp.2023.10.1204.

ABSTRACT

COVID-19 ARDS (acute respiratory distress syndrome), caused by SARS-CoV-2, involves a decrease in the end expiratory lung volume (EELV), compliance, and hypoxemia. The authors retrospectively analysed the relationship between the EELV, Plateau pressure (Pplat), and compliance of the respiratory system in a group of 21 mechanically ventilated COVID ARDS patients with moderate to severe hypoxia who were subjected to a recruitment manoeuvre. Further, these parameters were studied after dividing them into two groups as Group 1 of clinically non-recruitable and Group 2 of clinically recruitable patients. There was relationship between EELV, compliance, and Pplat among those patients who were clinically recruited versus those who were not in a homogeneous group of COVID ARDS patients. In Group 1, the statistical value of EELV and compliance were r = 0.395, p>0.05, EELV and Pplat were r = 0.021, p>0.05, and compliance and Pplat were r = -0.848, p<0.001. In Group 2, the statistical values of EELV and compliance were (r = 0.605, p<0.001), EELV and Pplat were r = -0.391, p<0.05, compliance and Pplat were r = -0.848, p<0.001. The additional information gained after understanding this relationship can help to optimise ventilator settings. Key Words: COVID, ARDS, End expiratory lung volume, Plateau pressure, Compliance, Recruitment, Ventilation.

PMID:37804032 | DOI:10.29271/jcpsp.2023.10.1204

J Coll Physicians Surg Pak. 2023 Oct;33(10):1194-1197. doi: 10.29271/jcpsp.2023.10.1194.

ABSTRACT

OBJECTIVE: To evaluate the efficacy of mandibular advancement device as a treatment of mild to moderate obstructive sleep apnoea and to evaluate the change in upper airway space volume by using cone beam CT (CBCT).

STUDY DESIGN: In vivo observational study. Place and Duration of the Study: Department of Prosthodontics, Crown and Bridge, Sri Aurobindo College of Dentistry, Indore (M.P), India, from March 2017 to January 2021.

METHODOLOGY: Patients with mild to moderate obstructive sleep apnoea patients using Berlin questionnaire were selected. Pre- and posttreatment-CBCT analysis was done to compare the changes in superior and inferior upper airway space before and after using mandibular advancement device. The pre and postoperative CBCT were also compared using a paired t-test for the quantitative variables. After two months, the patients were asked to complete a self-administered questionnaire to assess their sleep improvement, initial symptoms regression, and effectiveness of the mandibular advancement device.

RESULTS: On comparative evaluation of the pre- and post-CBCT, the mean score before the mandibular advancement device placement was found to be 7.77+2.79 cc, whereas the mean score after the mandibular advancement device placement was found to be 9.75+3.34 cc (p<0.001). Significant volumetric change was seen in upper airway space after receiving treatment for the two months. The patient noticed a substantial improvement in their sleep as well as a reduction in the original symptoms.

CONCLUSION: This study showed statistically significant volumetric change in the upper airway space and reduction in their symptoms after treatment with the mandibular advancement device (MAD).

KEY WORDS: Obstructive sleep apnoea syndrome (OSA), Continuous positive airway pressure (CPAP), Cone beam computed tomography, Mandibular advancement device (MAD), Upper airway volume.

PMID:37804029 | DOI:10.29271/jcpsp.2023.10.1194

J Coll Physicians Surg Pak. 2023 Oct;33(10):1171-1175. doi: 10.29271/jcpsp.2023.10.1171.

ABSTRACT

OBJECTIVE: To evaluate the student’s perspective about educational and training efficacy of workplace based learning (WBL) during surgical clerkship in Orthopaedics amongst 4th and 5th year medical students.

STUDY DESIGN: Cross-sectional study. Place and Duration of the Study: Department of General Surgery, Shifa Tameer-e-Millat University, Islamabad, from September 2020 to December 2021.

METHODOLOGY: The inclusion criteria was fourth and final year MBBS students who had completed their orthopaedic surgery mini-clerkship. The exclusion criteria was medical students who did not attend the orthopaedics clerkship in the study period. The research instrument was a questionnaire based on the principles of experiential based learning. The participants were sent an online questionnaire as well as a consent form through e-mail. The responses were recorded and analysed for descriptive statistics.

RESULTS: From the target group, 140 responses were received, 94 students (67%) expressed that workplace environment was conducive to learning and 98 (70%) agreed that their diagnostic and management skills further developed following exposure to the orthopaedic workplace. A short duration of 2 weeks served as a hindrance with 53 (38%) of students expressing that they were not able to effectively inculcate all concepts within that limited time-frame. Moreover, 52 (37.5%) students described limited patient’s clerking time.

CONCLUSION: Though majority of students were satisfied with teaching and learning strategies, design and implementation of the curriculum at the orthopaedics department; yet, there were significant limitations requiring further evaluation and cooperation by both students and faculty in order to establish ecosystem focusing on experiential learning.

KEY WORDS: Orthopaedics, Workplace based learning (WBL), Student, Clerkship, Learning environment.

PMID:37804025 | DOI:10.29271/jcpsp.2023.10.1171

J Coll Physicians Surg Pak. 2023 Oct;33(10):1153-1158. doi: 10.29271/jcpsp.2023.10.1153.

ABSTRACT

OBJECTIVE: To determine the clinical impact of preventive nursing on children with hypospadias and the intervention effect on postoperative complications.

STUDY DESIGN: Comparative study. Place and Duration of the Study: Department of Urology Surgery, Beijing Children’s Hospital Affiliated to Capital Medical University Baoding Hospital, Hebei, China, from August 2019 to July 2021.

METHODOLOGY: Children with hypospadias who received elective surgery were randomly divided into two groups of forty cases each. The control group received traditional specialised nursing care during the perioperative period, the study group administered preventive care on the control basis. The postoperative rehabilitation, VAS, anxiety and depression score, postoperative complications, and nursing satisfaction were compared between the two groups.

RESULTS: The time of first bowel movement, extubation, and hospitalisation in the study group were significantly shorter than in the control group, with statistically significant value (p<0.001). After intervention, the SAS and SDS in the study group were significantly lower than those in the control group, and the difference was statistically significant (p<0.05). The incidence of complications in the study group was 7.50%, lower than the 25% of control group (p = 0.034). The postoperative VAS scores of the study group were significantly lower than those of control group at 6 and 24 hours (p<0.05). Besides, nursing satisfaction in the study group was 97.50%, higher than the 82.50% of the control group (p = 0.025).

CONCLUSION: Preventive nursing had a reliable nursing effect on children undergoing hypospadias surgery, which can reduce postoperative complications, alleviate postoperative pain, improve postoperative anxiety and depression, enhance nursing experience, and promote postoperative recovery.

KEY WORDS: Preventive care, Hypospadias in male children, Urethroplasty, Complication, Clinical effect.

PMID:37804022 | DOI:10.29271/jcpsp.2023.10.1153

J Coll Physicians Surg Pak. 2023 Oct;33(10):1141-1147. doi: 10.29271/jcpsp.2023.10.1141.

ABSTRACT

OBJECTIVE: To make a comparative evaluation of induction chemotherapy (ICT) or adjuvant chemotherapy (ACT) added to standard concurrent chemoradiotherapy in patients diagnosed with locally advanced nasopharyngeal cancer (LANPC) (Stage 3-4a patients, except T3N0).

STUDY DESIGN: Observational study. Place and Duration of the Study: Department of Medical Oncology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey, from April 2009 to June 2021.

METHODOLOGY: Clinicopathological features of adult patients diagnosed with LANPC were recorded from the hospital’s patient registry database. Patients without the medical records were excluded. An assessment of the effectiveness of induction or ACT added to standard definitive chemoradiotherapy (CRT) was performed, and the application cycles were evaluated.

RESULTS: Seventy-four patients (71.6% male, mean age 50.8±11.7) with LANPC were included in the study. There is no statistical difference in progression-free survival (PFS) between patients who applied ICT (before CRT) and ACT (after CRT) (p = 0.61). Female patients and patients aged ≤50 years had better PFS as independent factors (HR=3.82, 95% CI 1.14-12.74, p = 0.029; HR: 1.06 95% CI 1.02-1.10, p = 0.002, respectively). Also, patients aged 50 years and younger and female patients had a statistically longer overall survival (OS) (p = 0.045, and p = 0.012, respectively). While there was statistically no significant difference in PFS according to the number of cycles for EBER-positive patients received adjuvant Cisplatin-5FU (CF); 3 cycles compared to 2 showed a statistically higher OS (p = 0.06, and p = 0.022, respectively). Conclusion: LANPC patients were found to have a positive survival if they were young and females. There was a positive impact on survival of intensified adjuvant CF in EBER-positive nonkeratinising, undifferentiated LANPC patients.

KEY WORDS: Locally advanced nasopharyngeal cancer, EBER, Induction chemotherapy, Adjuvant chemotherapy.

PMID:37804020 | DOI:10.29271/jcpsp.2023.10.1141

J Coll Physicians Surg Pak. 2023 Oct;33(10):1136-1140. doi: 10.29271/jcpsp.2023.10.1136.

ABSTRACT

OBJECTIVE: To determine the performance of lactate clearance to predict prognosis in patients with upper gastrointestinal bleeding (UGIB).

STUDY DESIGN: Observational study. Place and Duration of the Study: Department of Emergency Medicine, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey, from January 2018 to 2022.

METHODOLOGY: This study was conducted with 141 patients with UGIB. Lactate clearance was calculated based on the lactate levels at the time of admission and 6th hour. The primary outcome was survival. The secondary outcomes were the need for intensive care unit, endoscopic intervention, blood transfusion, and length of hospital stay.

RESULTS: The median age of the patients was 71 years and 65.2% were males. In the non-survivor group; systolic blood pressure, diastolic blood pressure, base deficit, delta lactate, and lactate clearance were significantly lower; however, heart rate, baseline lactate and final lactate were significantly higher. The median lactate clearance of survivors and non-survivors were 23.61 and -0.51, respectively (p = 0.002). A unit decrease in lactate clearance increased mortality 1.011-fold. The performance of lactate clearance in predicting mortality was followed as; sensitivity 76.4, specificity 51.4 (AUC = 0.673, p = 0.002), and the cut-off value was 21.51. Lactate clearance was not statistically significant in determining the need for intensive care (p = 0.110), endoscopic intervention (p = 0.152) and blood transfusion (p = 0.266) in UGIB.

CONCLUSION: Lactate clearance was an independent predictor of in-hospital mortality in UGIB. It is thought that the study will guide clinicians in the differentiation of critically-ill patients and an effective treatment planning.

KEY WORDS: Upper gastrointestinal haemorrhage, Lactate, Lactate clearance, Mortality, endoscopy, Blood transfusion, Intensive care.

PMID:37804019 | DOI:10.29271/jcpsp.2023.10.1136