Category: Statistics

Toxicol Lett. 2023 Aug 8:S0378-4274(23)00238-2. doi: 10.1016/j.toxlet.2023.08.001. Online ahead of print.

ABSTRACT

Arsenic is among the most critical environmental toxicants associated with many human disorders. However, its effect on type 2 diabetes mellitus (T2DM) is contradictory. This systematic review and dose-response meta-analysis aim to update information on the association between arsenic exposure and the risk of T2DM. The sample type (drinking water, urine, blood, and nails) conducted the subgroup analysis. Evaluation of the high vs. low arsenic concentrations showed a significant association between drinking water arsenic (OR: 1.58, 95% CI: 1.20-2.08) and urinary arsenic (OR: 1.37, 95% CI: 1.24-1.51) with the risk of T2DM. The linear dose-response meta-analysis showed that each 1μg/L increase in levels of drinking water arsenic (OR: 1.01, 95% CI: 1.00-1.01) and urinary arsenic (OR: 1.01, 95% CI: 1.00-1.02) was associated with a 1% increased risk of T2DM. The non-linear dose-response analysis indicated that arsenic in urine was associated with the risk of T2DM (_{Pnon-linearity}<0.001). However, this effect was not statistically significant for arsenic in drinking water (_{Pnon-linearity}=0.941). Our findings suggest that blood arsenic was not significantly linked to the increased risk of T2DM in high vs. low (OR: 1.21, 95% CI: 0.85-1.71), linear (OR: 1.04, 95% CI: 0.99-1.09), and non-linear (P_{non-linearity}=0.365) analysis. Also, nail arsenic was not associated with the risk of T2DM in this meta-analysis (OR: 1.33, 95% CI: 0.69-2.59). This updated dose-response meta-analysis indicated that arsenic exposure was significantly correlated with the risk of T2DM.

PMID:37562716 | DOI:10.1016/j.toxlet.2023.08.001

Clin Microbiol Infect. 2023 Aug 8:S1198-743X(23)00365-8. doi: 10.1016/j.cmi.2023.08.003. Online ahead of print.

ABSTRACT

OBJECTIVES: We aimed to explore the impact of social distancing on the incidence and microbiology of peritonsillar abscess (PTA).

METHODS: We performed a cross-sectional analysis of all PTA patients and their microbiological findings in the two years preceding versus the two years following the COVID-19 lockdown in Denmark (March 11, 2020), who were admitted to the Ear-Nose-Throat Department, Aarhus University Hospital. Age-stratified population data for the catchment area were obtained from Statistics Denmark.

RESULTS: The annual incidence rate was significantly higher in the two-years period before (21.8 cases/100,000 inhabitants) compared to after (14.9 cases/100,000) the lockdown (p<0.001). The number of cases with growth of S. pyogenes was significantly higher in the period before (n=67) compared to after (n=28) the lockdown (p<0.001), while the number of cases positive for F. necrophorum (n=60 vs n=64) and streptococcus anginosus group (SAG) (n=37 vs n=43) were stabile (p=0.79 and p=0.58, respectively). The relative prevalence of S. pyogenes was significantly higher in the period before (67/246 cultures, 27%) compared to after (28/179, 16%) the lockdown (p=0.007). On the contrary, the relative prevalence of F. necrophorum and SAG were significantly lower before (60/246, 24% and 37/246, 15%) compared to after (64/179, 36% and 43/179, 24%) the lockdown (p=0.013 and p=0.023).

CONCLUSIONS: Social distancing had a significant impact on the incidence and microbiology of PTA. Our findings suggest that S. pyogenes-positive PTA is highly related to direct social interaction, and represents a contagious pathogen. By contrast, PTA development caused by F. necrophorum and SAG are unrelated to direct social interaction and may be derived from flora imbalance.

PMID:37562694 | DOI:10.1016/j.cmi.2023.08.003

World Neurosurg. 2023 Aug 8:S1878-8750(23)01109-9. doi: 10.1016/j.wneu.2023.08.007. Online ahead of print.

ABSTRACT

BACKGROUND: The decision for treatment for unruptured intracranial aneurysms (UIAs) is often difficult. Innovation in endovascular devices have improved the benefit-to-risk profile for especially elderly patients, however the treatment guidelines from the past decade often recommend conservative management. It is unknown how these changes have affected the overall age of the patients selected for treatment. Herein, we aimed to study potential changes in the average age of the patients that are being treated over time.

METHODS: A systematic search of the literature was performed to identify all studies describing the age of the UIAs that were treated by any modality. Scatter diagrams with trend lines were used to plot the age of the patients treated over time and assess the presence of a potential significant trend via statistical correlation tests.

RESULTS: A total of 280 studies including 83,437 UIAs treated between 1987-2021 met all eligibility criteria and were entered in the analysis. Mean age of the patients was 55.5 years and 70.7% were females. There was a significant increasing trend in the age of the treated patients over time (Spearman’s r: 0.250; p < 0.001), with a 1-year increase in the average age of the treated patients every 5 years since 1987.

CONCLUSIONS: The present study indicates that based on the treated UIA patient data published in the literature, older UIAs are being treated over time. This trend is likely driven by safer treatments while suggesting that reevaluation of certain UIA treatment decision scores may be of great interest.

PMID:37562685 | DOI:10.1016/j.wneu.2023.08.007

World Neurosurg. 2023 Aug 8:S1878-8750(23)01107-5. doi: 10.1016/j.wneu.2023.08.005. Online ahead of print.

ABSTRACT

OBJECTIVE: Disc degeneration following trauma has been the focus of several investigations, while vertebral endplate changes have received comparatively less attention. The main aim of the study is to radiologically evaluate the prevalence of degree of degeneration of the adjacent discs and endplates following AO type A thoracolumbar fractures.

METHODS: We retrospectively reviewed 25 patients with AO type A injury (50 discs, and 150 endplates). The type of disc lesion adjacent to the fractured vertebra was classified based on Pfirrmann’s and Oner’s classifications, immediately after trauma and at 1-year follow-up. The endplate defects were assessed using the endplate scoring system (TEPS – grade 1 to 6) in T1 weighted images. The kyphosis angle and the vertebral body height were also measured.

RESULTS: The study population consisted of 18 males (72%) and 7 females (28%) with a mean age of 38.9 ±11.3 years. Overall, 28% of fractures were type A1, 4% were type A2, 24 % were type A3 and 44% were type A4. On statistical analysis, there was a significant change in the degree of degeneration in the cranial adjacent disc based on both Oner (p=0.004) and Pfirrmann (p=0.001) classification at the end of 1-year. The morphological changes at the cranial adjacent discs at 1-year follow-up showed a strong positive correlation with superior endplate degeneration.

CONCLUSION: The present study indicates that endplate fractures of vertebrae in patients with thoracolumbar burst fractures may cause disc degeneration, especially at the cranial endplate.

PMID:37562684 | DOI:10.1016/j.wneu.2023.08.005

World Neurosurg. 2023 Aug 8:S1878-8750(23)01112-9. doi: 10.1016/j.wneu.2023.08.008. Online ahead of print.

ABSTRACT

OBJECTIVE: Analysis to investigate the correlation between bone cement distribution and adjacent vertebral fractures(AVF) after percutaneous vertebroplasty(PVP).

METHODS: We retrospectively analyzed patients who underwent single-segment PVP for osteoporotic compression fractures in our hospital from January 2016 to January 2021, and divided the patients into two groups, A and B, based on the criterion of whether there were AVF of the operated vertebrae within 1 year after surgery, and compared the general data of the two groups; we assessed the ability of three simple X-ray-based evaluation methods to predict the occurrence of AVF within 1 year after surgery, and derived a simple and accurate evaluation method.

RESULTS: A total of 570 patients were included in this study, including 511 patients in group A and 59 patients in group B. There were no statistical differences in the general data such as age, gender and fracture site between the two groups. The posterior-anterior (PA), lateral (LAT) and PA & LAT methods showed receiver operating characteristic curve (ROC) predicted postoperative AVF of 0.611,0.691 and 0.714, respectively. The difference between the area under curve(AUC) of PA method and LAT method was statistically significant(P=0.0307), the difference between the AUC of PA method and PA & LAT method was statistically significant (P<0.001), the difference between the AUC of LAT method and PA & LAT method was not statistically significant (P= 0.3308).There was no statistical difference between the two groups of patients with PA method point of 1 and statistically different between patients with points of 2 and 3 , statistically different in patients with LAT method points of 1, 2 and 3 in the two groups, and a positive correlation between cement distribution scores and AVF by linear regression analysis of the three evaluation methods.

CONCLUSIONS: The three evaluation methods reliably predict AVF after PVP, with LAT, PA & LAT method being more predictive than the PA method, but the LAT method being simpler, with bone cement being widely distributed after crossing the midline in the PA method and contact with the upper and lower endplates in the LAT method being a risk factor for AVF.

PMID:37562680 | DOI:10.1016/j.wneu.2023.08.008

J Thorac Cardiovasc Surg. 2023 Aug 8:S0022-5223(23)00660-8. doi: 10.1016/j.jtcvs.2023.08.006. Online ahead of print.

NO ABSTRACT

PMID:37562676 | DOI:10.1016/j.jtcvs.2023.08.006

Resuscitation. 2023 Aug 8:109933. doi: 10.1016/j.resuscitation.2023.109933. Online ahead of print.

ABSTRACT

BACKGROUND: The efficacy of empiric calcium for patients with undifferentiated cardiac arrest has come under increased scrutiny, including a randomized controlled trial that was stopped early due to a trend towards harm with calcium administration. However, small sample sizes and non-significant findings have hindered precise effect estimates. In this analysis we evaluate the association of calcium administration with survival in a large retrospective cohort of patients with cardiac arrest treated in the emergency department (ED).

METHODS: We conducted a retrospective review of medical records from two academic hospitals (one quaternary care center, one county trauma center) in San Francisco between 2011-2019. Inclusion criteria were patients aged greater than or equal to 18 years old who received treatment for cardiac arrest during their ED course. Our primary exposure was the administration of calcium while in the ED and the main outcome was survival to hospital admission. The association between calcium and survival to admission was estimated using a multivariable log-binomial regression, and also with two propensity score models.

RESULTS: We examined 781 patients with cardiac arrest treated in San Francisco EDs between 2011-2019 and found that calcium administration was associated with decreased survival to hospital admission (RR 0.74; 95% CI 0.66 – 0.82). These findings remained significant after adjustment for patient age, sex, whether the cardiac arrest was witnessed, and including an interaction term for shockable cardiac rhythms (RR 0.60; 95% CI 0.50 – 0.72) and non-shockable cardiac rhythms (RR 0.87; 95% CI 0.76 – 0.99). Risk ratios for the association between calcium and survival to hospital admission were also similar between two propensity score-based models: nearest neighbor propensity matching model (RR 0.79; 95% CI 0.68 – 0.89) and inverse propensity weighted regression adjustment model (RR 0.75; 95% CI 0.67 – 0.84).

CONCLUSIONS: Calcium administration as part of ED-directed treatment for cardiac arrest was associated with lower survival to hospital admission. Given the lack of statistically significant outcomes from smaller, more methodologically robust evaluations on this topic, we believe these findings have an important role to serve in confirming previous results and allowing for more precise effect estimates. Our data adds to the growing body evidence against the empiric use of calcium in cardiac arrest.

PMID:37562663 | DOI:10.1016/j.resuscitation.2023.109933

Braz J Anesthesiol. 2023 Aug 8:S0104-0014(23)00082-9. doi: 10.1016/j.bjane.2023.08.001. Online ahead of print.

ABSTRACT

BACKGROUND: There are few studies related to Coronavirus Disease 2019 (COVID-19) on the prevalence and nature of pain symptoms after hospital discharge, especially in individuals who develop moderate to severe disease forms. Therefore, this study aimed to evaluate the presence of chronic pain in patients discharged after hospitalization for COVID-19, and the relationship between the presence of chronic pain and intensive care stay, demographics, and risk factors for the worst Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) outcome.

METHODS: A cross-sectional observational study was carried out on patients with COVID-19 who recovered after hospitalization. Patients were recruited at the least 3-months after discharge and their hospital’s health files were prospected. The variables evaluated were demographics, the severity of SARS-CoV-2 infection (considering the need for intensive care), and the presence of chronic pain. The results were shown in a descriptive manner, and multivariate analysis expressed as Odds Ratios (ORs) and respective Confidence Intervals (CIs) for the outcomes studied. Statistical significance was set at p < 0.05.

RESULTS: Of 242 individuals included, 77 (31.8%) reported chronic pain related to COVID-19, with no correlation with the severity of infection. Female sex and obesity were associated with a higher risk for chronic pain with ORs of 2.69 (Confidence Interval [95% CI 1.4 to 5.0]) and 3.02 (95% CI 1.5 to 5.9). The limbs were the most affected areas of the body.

CONCLUSION: Chronic pain is common among COVID-19 survivors treated in hospital environments. Female sex and obesity are risk factors for its occurrence.

PMID:37562649 | DOI:10.1016/j.bjane.2023.08.001

Sci Total Environ. 2023 Aug 8:166178. doi: 10.1016/j.scitotenv.2023.166178. Online ahead of print.

ABSTRACT

Traditional air quality analysis and prediction methods depend on the statistical and numerical analyses of historical air quality data with more information related to a specific region; therefore, the results are unsatisfactory. In particular, fine particulate matter (PM_2.5, PM₁₀) in the atmosphere is a major concern for human health. The modelling (analysis and prediction) of particulate matter concentrations remains unsatisfactory owing to the rapid increase in urbanization and industrialization. In the present study, we reconstructed a prediction model for both PM_2.5 and PM₁₀ with varying meteorological conditions (windspeed, temperature, precipitation, specific humidity, and air pressure) in a specific region. In this study, a prediction model was developed for the two observation stations in the study region. The analysis of particulate matter shows that seasonal variation is a primary factor that highly influences air pollutant concentrations in urban regions. Based on historical data, the maximum number of days (92 days in 2019) during the winter season exceeded the maximum permissible level of particulate matter (PM_2.5 = 15 μg/m³) concentration in air. The prediction results showed better performance of the Gaussian process regression model, with comparatively larger R² values and smaller errors than the other models. Based on the analysis and prediction, these novel methods may enhance the accuracy of particulate matter prediction and influence policy- and decision-makers among pollution control authorities to protect air quality.

PMID:37562623 | DOI:10.1016/j.scitotenv.2023.166178

Am J Emerg Med. 2023 Jul 24;73:1-6. doi: 10.1016/j.ajem.2023.07.042. Online ahead of print.

ABSTRACT

BACKGROUND: Andexanet alfa (AA) is approved for reversal of factor Xa inhibitor (FXaI) bleeds; however, there are limited reports of its use for gastrointestinal bleeding (GIB) in real-world populations. The objective of this study was to report real-world utilization and evaluation of the effectiveness of AA for FXaI-associated GIB.

METHODS: This retrospective cohort study including consecutive patients receiving AA for FXaI-associated GIB (7/2018-2/2021). Demographics, blood product administration, hemostatic efficacy, rebleeding, thrombosis, and mortality rates were collected. Hemostatic efficacy (HE), based on corrected hemoglobin at 12 h compared to baseline, was categorized as excellent (<10% decrease), good (≤ 20% decrease), or poor (>20% decrease, > 2 units of additional coagulation intervention or death prior to repeat hemoglobin). Comparative transfusion requirements between efficacy groups was assessed by Wilcoxon-Rank test.

RESULTS: Twenty-two patients were included (64% male, median (IQR) age 76 years (67, 80). Most patients (59%, n = 13) were on apixaban, and the primary anticoagulation indication was atrial fibrillation (64%, n = 14). Median initial hemoglobin was 7.5 g/dL (IQR 6.4, 8.8) and 50% (n = 11) were upper GIB. Hemostatic efficacy was excellent in 46% (n = 10), good in 23% (n = 5), and poor in 32% (n = 7). There was no statistically significant difference in red blood cells (RBCs) received between those with excellent/good hemostasis (median 2, IQR 1 to 2) and those with poor hemostasis (median 4, IQR 1.5 to 4.5). Two patients (9%) had arterial thrombotic events within 30 days of reversal.

CONCLUSION: In this multicenter, single arm, real-world observational analysis of patients with factor Xa inhibitor associated GIB most patients achieved good hemostasis following administration of AA. There was a 9% 30-day thrombotic event rate. The lack of a control group limits the strength of the conclusions that can be drawn from this study.

PMID:37562071 | DOI:10.1016/j.ajem.2023.07.042