Category: Statistics

Radiat Prot Dosimetry. 2022 Dec 24:ncac262. doi: 10.1093/rpd/ncac262. Online ahead of print.

ABSTRACT

This study presents a new idea for estimating the number of measurements required for determining the uncertainty in obtaining the desired water absorbed dose using the variation obtained from multicenter absorbed dose measurement data. The number of dose measurements depends on the performance of each linear accelerator (LINAC) tested and the dosimetry equipment and procedure used. However, optimising the number of data collected for the absorbed dose to water has been inadequately reported. Using the absorbed dose measurement data collected 10 times as a reference value, we will compare the changes in the variation of the measurement results caused by the difference in the number of repeated measurements of the absorbed dose. The number of measurements is determined statistically such that this variation would be smaller than the change in absorbed dose. Thus, we can determine the optimum number of measurements suitable for the variability of each LINAC.

PMID:36566494 | DOI:10.1093/rpd/ncac262

J Cosmet Dermatol. 2022 Dec 25. doi: 10.1111/jocd.15566. Online ahead of print.

ABSTRACT

BACKGROUND: Various topical agents have been used to treat melasma; however, a large-scale evaluation among the currently available treatment is lacking.

OBJECTIVES: The aim of this study was to evaluate the efficacy and safety of topical agents for melasma.

METHODS: The MEDLINE, Embase, Web of Science, Cochrane, and Alt-Healthwatch databases were searched in November 2021. Original studies that reported pre- and post-treatment Melasma Area Severity Index (MASI)/modified Melasma Area Severity Index (mMASI) scores and/or adverse effects (AEs) were eligible for inclusion. The main outcome was the efficacy analyzed by the changes in the pre- and post-treatment with standardized mean difference (SMD) of MASI/mMASI scores; the AEs were calculated with incidence proportion by the reported percentage of skin irritations.

RESULTS: A total of 45 studies (2359 patients) and 55 studies (4539 patients) met the inclusion criteria for efficacy and AEs, respectively. Hydroquinone (HQ) monotherapy (SMD -1.3, 95% CI [-1.6 to -1.0]), HQ-containing combination therapy (-1.4, [-1.7 to -1.1]), cysteamine (-1.6, [-2.0 to -1.2]), tranexamic acid (-1.5, [-2.0 to -1.1]), azelaic acid (-1.3, [-1.7 to -1.0]), and kojic acid (-0.9, [-1.3 to -0.5]) demonstrated comparable efficacy, while zinc sulfate did not exhibit statistically significant improvement (-1.2, [-2.7 to 0.4]). HQ-containing combination therapy (50.9%) and cysteamine (42.2%) demonstrated the highest incidence of irritation, while azelaic acid (18.7%), kojic acid (5.3%), and tranexamic acid (0.8%) revealed a lower risk.

CONCLUSIONS: In this meta-analysis, non-HQ agents except zinc sulfate may be considered as an alternative to HQ-containing agents. However, treatment should be guided by patient’s tolerance, availability, and physicians’ experience.

PMID:36566490 | DOI:10.1111/jocd.15566

J Diabetes Investig. 2022 Dec 25. doi: 10.1111/jdi.13966. Online ahead of print.

ABSTRACT

AIMS/INTRODUCTION: Although several noninvasive predictive markers for fatty liver and metabolic markers have been used for fatty liver prediction, whether such markers can also predict metabolic-associated fatty liver disease (MAFLD) remains unclear. We aimed to examine the ability of existing fatty liver or metabolic markers to predict MAFLD.

MATERIALS AND METHODS: Participants in a high-volume center in Tokyo were classified into groups with and without MAFLD, based on the presence of metabolic abnormalities and fatty liver diagnosed through abdominal ultrasonography, between 2008 and 2018. The diagnostic abilities of three fatty liver markers: fatty liver index (FLI), hepatic steatosis index (HSI), and lipid accumulation product (LAP), and three common metabolic markers: waist-to-height ratio (WHR), body mass index (BMI), and waist circumference (WC), for predicting MAFLD, were evaluated. Analyses stratified by MAFLD subtypes were performed.

RESULTS: Of 92,374 individuals, 19,392 (36.1%) had MAFLD. The diagnostic performances for MAFLD prediction, measured as c-statistics, for FLI, HSI, LAP, WHR, BMI, and WC were 0.906, 0.892, 0.878, 0.844, 0.877, and 0.878, respectively. Optimal cutoff values for diagnosing MAFLD for FLI, HSI, LAP, WHR, BMI, and WC were 20.3, 32.7, 20.0, 0.49, 22.9, and 82.1, respectively. Analyses stratified by MAFLD subtypes, based on BMI and metabolic/glycemic abnormalities, suggested that FLI and HSI had acceptable (c-statistics >0.700) diagnostic abilities throughout all the analyses.

CONCLUSIONS: All six markers were excellent predictors of MAFLD in diagnosing among the general population, with FLI and HSI particularly useful among all sub-populations.

PMID:36566480 | DOI:10.1111/jdi.13966

J Rural Health. 2022 Dec 25. doi: 10.1111/jrh.12735. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study is to describe the characteristics of Rural Residency Planning and Development (RRPD) Programs, compare the characteristics of counties with and without RRPD programs, and identify rural places where future RRPD programs could be developed.

METHODS: The study sample comprised 67 rural sites training residents in 40 counties in 24 US states. Descriptive statistics were used to describe RRPD programs and logistic regression to predict the probability of a county being an RRPD site as a function of population, primary care physicians (PCP) per 10,000 population, and the social vulnerability index (SVI) compared to a control sample of nonmetro counties without RRPD sites.

FINDINGS: Most RRPD grantees (78%) were family medicine programs affiliated with medical schools (97%). RRPD counties were more populous (P<.01), had a higher population density (P<.05), and a higher percent of the non-White or Hispanic population (P = .05) compared to non-RRPD counties. Both higher population (P<.001) and PCP ratio (P = .046) were strong predictors, while SVI (P = .07) was a weak predictor of being an RRPD county.

CONCLUSIONS: RRPD sites appear to represent a “sweet spot” of rural counties that have the population and physician supply to support a training program but also are relatively more socially vulnerable with high-need populations. Additional counties fitting this “sweet spot” could be targeted for funding to address health disparities and health workforce maldistribution.

PMID:36566476 | DOI:10.1111/jrh.12735

J Thromb Thrombolysis. 2022 Dec 25. doi: 10.1007/s11239-022-02752-z. Online ahead of print.

ABSTRACT

The purpose of this study was to evaluate and compare clinical outcomes in patients who experienced intracranial hemorrhage (ICH) while taking apixaban or rivaroxaban and were reversed with four-factor prothrombin complex concentrates (4F-PCC) or andexanet alfa (AA). This retrospective cohort included adult patients that received 4F-PCC or AA for the initial management of an apixaban- or rivaroxaban-associated ICH. A primary outcome of excellent or good hemostatic efficacy at 12 h post-reversal was assessed. Secondary outcomes evaluated were change in hematoma volume size at 12 h, functional status at discharge, need for surgical intervention or additional hemostatic agents post-reversal, new thrombotic event within 28 days, 28-day all-cause mortality, discharge disposition, and hospital and intensive care unit lengths of stay. A total of 70 patients were included (4F-PCC, n = 47; AA, n = 23). For the primary outcome analysis, 21 patients were included in the 4F-PCC group and 12 in the AA group. The rate of effective hemostasis was similar between the 4F-PCC and AA groups (66.7% vs 75%, p = 0.62). There were no statistically significant differences between the groups for secondary outcomes, including 28-day mortality (40.4% vs 39.1%, p = 0.92) and thrombotic complications within 28 days of reversal (17.0% vs 21.7%, p = 0.63). In patients who experienced an ICH while taking apixaban or rivaroxaban, 4F-PCC and AA were found to have similar rates of excellent or good hemostatic efficacy.

PMID:36566473 | DOI:10.1007/s11239-022-02752-z

J Robot Surg. 2022 Dec 25. doi: 10.1007/s11701-022-01514-6. Online ahead of print.

ABSTRACT

The robotic platform can overcome technical difficulties associated with laparoscopic colon surgery. Transitioning from laparoscopic right colectomy with extracorporeal anastomosis (ECA) to robotic right colectomy with intracorporeal anastomosis (ICA) is associated with a learning phase. This study aimed at determining the length of this learning phase and its associated morbidity. We retrospectively analyzed all laparoscopic right colectomies with ECA (n = 38) and robotic right colectomies with ICA (n = 67) for (pre)malignant lesions performed by a single surgeon between January 2014 and December 2020. CUSUM-plot analysis of total procedure time was used for learning curve determination of robotic colectomies. Non-parametric tests were used for statistical analysis. Compared to laparoscopy, the learning phase robotic right colectomies (n = 35) had longer procedure times (p < 0.001) but no differences in anastomotic leakage rate, length of stay or 30-day morbidity. Conversion rate was reduced from 16 to 3 percent in the robotic group. This study provides evidence that robotic right colectomy with ICA can be safely implemented without increasing morbidity.

PMID:36566471 | DOI:10.1007/s11701-022-01514-6

Arch Environ Contam Toxicol. 2022 Dec 25. doi: 10.1007/s00244-022-00973-0. Online ahead of print.

ABSTRACT

The epiphytic lichen Pseudevernia furfuracea was exposed to a simulation of drift deposition rate of the fungicide Fosetyl-Al in an indoor controlled environment by testing two exposure factors: pesticide concentrations (based on the application rates of 4 kg ha^-1 and 1.6 kg ha^-1) and drop sizes (anti-drift nozzle: 386-484 μm; non-anti-drift nozzle: 159-231 μm) for a total of four treatments. Drift for higher application rate was simulated once and that for the lower one twice to reproduce agricultural practices. Following fungicide spraying, we measured the concentration of Fosetyl and phosphonic acid in lichen thalli, and the response of ecophysiological status parameters. No trace of Fosetyl was quantifiable 4 days after each treatment, being detected only phosphonic acid whose concentrations stayed substantially unchanged for the whole duration of the experiment (40 days) and resulting affected by application rate and not by drop size. Both pesticide concentrations caused a remarkable harmful effect that, however, was statistically significant vs control group only starting from the 20th day of stay in the climatic chamber. The drift associated with the higher rate resulted, on average, to be 83% more effective, with the most affected parameters being membrane integrity, lipid peroxidation and photosynthetic pigments. Because the selected lower rate can be considered a quite low value when compared with the rank of used rates for crop protection, the Fosetyl-Al formulate is classifiable as hazardous for its effect on non-target organisms.

PMID:36566463 | DOI:10.1007/s00244-022-00973-0

J Ayub Med Coll Abbottabad. 2022 Oct-Dec;34(4):838-842. doi: 10.55519/JAMC-04-10969.

ABSTRACT

BACKGROUND: It is a common observation that the aortic size of Pakistani population is relatively less as compared to western population. Till now there is no study which has measured the dimensions of abdominal aorta in local population.The standard diameter of an artery across the body is critical for clinicians to recognize when an artery has become aneurysmal. This study aims to present the results of a local population’s normal diameter of an infrarenal aorta and how it varies by age, gender, weight, height, body mass index (BMI) and body surface area (BSA).

METHODS: This cross-sectional observational study was conducted in Vascular Surgery Department, at Combined Military Hospital (CMH), Peshawar, from July 2020 to November 2021.Participants in the study included all patients who underwent a contrast-enhanced computed tomography (CT) scan of the abdomen for any reason other than cardiovascular disease.The infrarenal abdominal aorta’s mean internal diameter (anteroposterior and transverse diameter) was assessed. SPSS v 23 was used to analyze the data and present it as frequency and percentages. The Pearson correlation coefficient assessed the correlation between aortic diameters, weight, height, BMI, and BSA.

RESULTS: Recruitment of a total of 250 patients was done in this study. Males were 194 (77.6%), while the rest were female patients. The patients’ mean age was 39.6±12.8 years. The mean anteroposterior (AP) diameter of the infrarenal aorta was 16.13±2.32 mm. The mean transverse diameter (TD) was 15.96±2.34 mm. The infrarenal diameter of the aorta was smaller in women when compared to men, and the calibre of the aorta increased with the increasing age of the patients. There was a statistically significant positive relationship between their age and the average diameter of the infrarenal aorta (p<0.001) among both men and women.

CONCLUSIONS: Clinicians and vascular surgeons will benefit from the findings in diagnosing and treating abdominal aortic aneurysms. Hence, thoughtful consideration should be made before formulating intervention protocols.

PMID:36566410 | DOI:10.55519/JAMC-04-10969

J Ayub Med Coll Abbottabad. 2022 Oct-Dec;34(4):802-806. doi: 10.55519/JAMC-04-10265.

ABSTRACT

BACKGROUND: Many drugs are effective are used as second line treatment for cutaneous leishmaniasis. Dapsone therapy is tolerated well and cost effective. The aim of present study is to determine the efficacy of oral dapsone in comparison with intramuscular meglumine antimoniate in patients with cutaneous leishmaniasis and thus find out an effective second line treatment agent.

METHODS: This randomized controlled trial was carried out at dermatology department, of tertiary care centre Rawalpindi, Pakistan from November 2017 to June 2018. Hundred biopsy proven patients of cutaneous leishmaniasis completed the study with 50 patients in two group. Group A received intramuscular meglumine antimoniate (15 mg/kg/day). Group B received oral dapsone2.5 mg /kg/body weight /day (200 mg per day). Efficacy of therapeutic response was noted at the end of treatment. Data was analyzed with statistical analysis program (IBM-SPSS V22). Chi-square test was applied to compare efficacy, p value of ≤0.05 was significant. Stratification of data with respect to age, gender, duration of disease, number of lesions and weight was done to see their effect on treatment efficacy. Post stratification chi-square test for both groups was applied (p≤0.05 considered significant).

RESULTS: A total of 100 participants took part in the study. Duration of treatment (p-value <0.001) and the efficacy of the drugs (p-value=0.020) were significant. Meglumine antimoniate therapy group displayed a comparatively fast-paced recovery in (21- 40 days) whereas Dapsone group showed better recovery in (41-60 days) in their lesions.

CONCLUSIONS: Dapsone is an effective treatment for cutaneous Leishmaniasis.

PMID:36566403 | DOI:10.55519/JAMC-04-10265

J Ayub Med Coll Abbottabad. 2022 Oct-Dec;34(4):777-781. doi: 10.55519/JAMC-04-10565.

ABSTRACT

BACKGROUND: Studies are available on the use of inflammatory biomarkers for profiling and patient prognosis, but literature for tocilizumab monitoring parameters is scarce. Thus, we aim to evaluate different inflammatory markers that can relate to the effectiveness of tocilizumab in hospitalized patients suffering from severe covid.

METHODS: We analyzed a retrospective cohort of 227 patients who were admitted due to SAR-Co2 in one of the largest hospitals in Pakistan, Lady Reading Hospital. Using in-hospital mortality as the primary parameter for the effectiveness of tocilizumab. Wilcoxon rank-sum test, chi-square test and ROC curve analysis were performed to evaluate inflammatory biomarkers. The p- values less than 0.05 were considered statistically significant.

RESULTS: A total of 1639 tests were identified from 227 patients admitted to the hospital. CRP (28%), LDH (27.3%) were the most commonly prescribed and 40% of the total test were prescribed pre-dose. D-dimer, ferritin and CRP were found to have a clinically significant impact of the dose.

CONCLUSIONS: D-dimer, ferritin and LDH do not seem to relate proportionally with tocilizumab effectiveness. CRP can be utilized for monitoring tocilizumab effectiveness.

PMID:36566398 | DOI:10.55519/JAMC-04-10565