Category: Statistics

Trop Med Int Health. 2023 May 27. doi: 10.1111/tmi.13901. Online ahead of print.

ABSTRACT

OBJECTIVES: Leprosy still represents a public health concern in Brazil. The country is the only one in America not to reach the global goal of leprosy disease control. Hence, this study aimed to assess the temporal, spatial and space-time patterns of leprosy cases in Brazil of the 20-year time series 2001-2020.

METHODS: An ecological and population-based analysis was carried out, applying temporal and spatial techniques, and using the detection coefficient of sociodemographic and clinical-epidemiological variables of leprosy new cases in the 5570 municipalities of Brazil. Temporal trends were assessed using a segmented linear regression model. For spatial analysis, global and local Moran indexes were applied, and space-time scan statistics was used to identify risk clusters.

RESULTS: The mean detection coefficient was 19.36/100,000 inhabitants, with a higher occurrence among men (21.29/100,000 inhabitants) and in the 60-69 age group (36.31/100,000). A decreasing temporal trend was observed in the country (annual percentage change: -5.20% per year). The North and Midwest regions were the most affected, exhibiting municipalities with a high/high standard, and with the highest annual percentage increase of multibacillary (MB) cases. Leprosy has a heterogeneous distribution throughout Brazil, but with high-risk spatiotemporal clusters, mainly located in the North and Midwest regions.

CONCLUSION: Although Brazil has shown a decreasing temporal trend during the past 20 years, the country is still classified as highly endemic for leprosy, showing an increase in the proportion of new MB cases over the years.

PMID:37243431 | DOI:10.1111/tmi.13901

J Magn Reson Imaging. 2023 May 27. doi: 10.1002/jmri.28826. Online ahead of print.

ABSTRACT

BACKGROUND: Diffusion-weighted imaging (DWI) has been considered for chronic liver disease (CLD) characterization. Grading of liver fibrosis is important for disease management.

PURPOSE: To investigate the relationship between DWI’s parameters and CLD-related features (particularly regarding fibrosis assessment).

STUDY TYPE: Retrospective.

SUBJECTS: Eighty-five patients with CLD (age: 47.9 ± 15.5, 42.4% females).

FIELD STRENGTH/SEQUENCE: 3-T, spin echo-echo planar imaging (SE-EPI) with 12 b-values (0-800 s/mm² ).

ASSESSMENT: Several models statistical models, stretched exponential model, and intravoxel incoherent motion were simulated. The corresponding parameters (D_s , σ, DDC, α, f, D, D*) were estimated on simulation and in vivo data using the nonlinear least squares (NLS), segmented NLS, and Bayesian methods. The fitting accuracy was analyzed on simulated Rician noised DWI. In vivo, the parameters were averaged from five central slices entire liver to compare correlations with histological features (inflammation, fibrosis, and steatosis). Then, the differences between mild (F0-F2) or severe (F3-F6) groups were compared respecting to statistics and classification. A total of 75.3% of patients used to build various classifiers (stratified split strategy and 10-folders cross-validation) and the remaining for testing.

STATISTICAL TESTS: Mean squared error, mean average percentage error, spearman correlation, Mann-Whitney U-test, receiver operating characteristic (ROC) curve, area under ROC curve (AUC), sensitivity, specificity, accuracy, precision. A P-value <0.05 was considered statistically significant.

RESULTS: In simulation, the Bayesian method provided the most accurate parameters. In vivo, the highest negative significant correlation (D_s , steatosis: r = -0.46, D*, fibrosis: r = -0.24) and significant differences (D_s , σ, D*, f) were observed for Bayesian fitted parameters. Fibrosis classification was performed with an AUC of 0.92 (0.91 sensitivity and 0.70 specificity) with the aforementioned diffusion parameters based on the decision tree method.

DATA CONCLUSION: These results indicate that Bayesian fitted parameters may provide a noninvasive evaluation of fibrosis with decision tree.

EVIDENCE LEVEL: 1 TECHNICAL EFFICACY: Stage 1.

PMID:37243428 | DOI:10.1002/jmri.28826

Vet Comp Oncol. 2023 May 27. doi: 10.1111/vco.12914. Online ahead of print.

ABSTRACT

Feline oral squamous cell carcinoma (FOSCC) is an aggressive cancer in domestic cats that has no effective treatment option when advanced. Preventative or early diagnostic measures are thus crucial. FOSCC is also a model for human head and neck SCC (HNSCC); strong risk factors in HNSCC include exposure to alcohol, tobacco, areca nut, and high-risk human papillomavirus. Previous studies have identified flea collar and tobacco smoke exposure, feeding canned tuna, canned cat food and cat foods with chemical additives, living in a rural environment, and having outdoor access as risk factors for FOSCC but there was no overlap in the risk factors between studies. In our study, risks for FOSCC were evaluated in an online epidemiologic survey study in 67 cats with FOSCC and 129 control cats. Clumping clay cat litter and flea collar use were significant risk factors for FOSCC on multiple logistic regression with odds ratios of 1.66 (95% CI 1.20-2.30) and 4.48 (95% CI 1.46-13.75) respectively. Crystalline silica is a carcinogen that may be present in all clay cat litters and tetrachlorvinphos is a carcinogen that is present in the most commonly used flea collars in our study. We recommend further investigation into the association between FOSCC and clay-based litter and/or flea collars containing tetrachlorvinphos.

PMID:37243409 | DOI:10.1111/vco.12914

J Eukaryot Microbiol. 2023 May 26:e12986. doi: 10.1111/jeu.12986. Online ahead of print.

ABSTRACT

Several automated molecular methods have emerged for distinguishing eukaryote species based on DNA sequence data. However, there are knowledge gaps around which of these single-locus methods is more accurate for the identification of microalgal species, such as the highly diverse and ecologically relevant diatoms. We applied genetic divergence, Automatic Barcode Gap Discovery for primary species delimitation (ABGD), Assemble Species by Automatic Partitioning (ASAP), Statistical Parsimony Network Analysis (SPNA), Generalized Mixed Yule Coalescent (GMYC) and Poisson Tree Processes (PTP) using partial cox1, rbcL , 5.8S+ITS2 , ITS1+5.8S+ITS2 markers to delineate species and compare to published polyphasic identification data (morphological features, phylogeny and sexual reproductive isolation) to test the resolution of these methods. ASAP, ABGD, SPNA and PTP models resolved species of Eunotia, Seminavis, Nitzschia, Sellaphora and Pseudo-nitzschia corresponding to previous polyphasic identification, including reproductive isolation studies. In most cases, these models identified diatom species in similar ways, regardless of sequence fragment length. GMYC model presented smallest number of results that agreed with previous published identification. Following the recommendations for proper use of each model presented in the present study, these models can be useful tools to identify cryptic or closely-related species of diatoms, even when the datasets have relatively few sequences.

PMID:37243408 | DOI:10.1111/jeu.12986

Clin Trials. 2023 May 26:17407745231177046. doi: 10.1177/17407745231177046. Online ahead of print.

ABSTRACT

BACKGROUND: Composite time-to-event endpoints are beneficial for assessing related outcomes jointly in clinical trials, but components of the endpoint may have different censoring mechanisms. For example, in the PRagmatic EValuation of evENTs And Benefits of Lipid-lowering in oldEr adults (PREVENTABLE) trial, the composite outcome contains one endpoint that is right censored (all-cause mortality) and two endpoints that are interval censored (dementia and persistent disability). Although Cox regression is an established method for time-to-event outcomes, it is unclear how models perform under differing component-wise censoring schemes for large clinical trial data. The goal of this article is to conduct a simulation study to investigate the performance of Cox models under different scenarios for composite endpoints with component-wise censoring.

METHODS: We simulated data by varying the strength and direction of the association between treatment and outcome for the two component types, the proportion of events arising from the components of the outcome (right censored and interval censored), and the method for including the interval-censored component in the Cox model (upper value and midpoint of the interval). Under these scenarios, we compared the treatment effect estimate bias, confidence interval coverage, and power.

RESULTS: Based on the simulation study, Cox models generally have adequate power to achieve statistical significance for comparing treatments for composite outcomes with component-wise censoring. In our simulation study, we did not observe substantive bias for scenarios under the null hypothesis or when the treatment has a similar relative effect on each component outcome. Performance was similar regardless of if the upper value or midpoint of the interval-censored part of the composite outcome was used.

CONCLUSION: Cox regression is a suitable method for analysis of clinical trial data with composite time-to-event endpoints subject to different component-wise censoring mechanisms.

PMID:37243355 | DOI:10.1177/17407745231177046

Clin Infect Dis. 2023 May 27:ciad308. doi: 10.1093/cid/ciad308. Online ahead of print.

ABSTRACT

BACKGROUND: It is unclear whether the reporting quality of antiretroviral non-inferiority randomised controlled trials (ARV NI-RCTs) has improved since the CONSORT guideline release in 2006. The primary objective of this systematic review was assessing the methodological and reporting quality of ARV NI-RCTs. We also assessed reporting quality by funding source and publication year.

METHODS: We searched Medline, Embase, and Cochrane Central from inception to 14 November 2022. We included NI-RCTs comparing ≥2 antiretroviral regimens used for HIV treatment or prophylaxis. We used the Cochrane Risk of Bias 2.0 (RoB 2.0) tool to assess risk of bias. Screening and data extraction were performed blinded and in duplicate. Descriptive statistics were used to summarise data; statistical tests were two-sided, with significance defined as p<0.05. The systematic review was prospectively registered (PROSPERO CRD42022328586), and not funded.

RESULTS: We included 160 articles reporting 171 trials. 101 of 160 (63.1%) did not justify the non-inferiority margin (NIM) used, and 28 (17.5%) did not provide sufficient information for sample size calculation. Eighty-nine of 160 (55.6%) reported both intention-to-treat (ITT) and per-protocol (PP) analyses, while 118 (73.8%) described missing data handling. Ten of 171 (5.9%) trials reported potentially misleading results. Pharmaceutical industry-funded trials were more likely to be double blinded (28.1% vs. 10.3%, p=0.029), and to describe missing data handling (78.5% vs. 59.0%, p=0.021). Overall risk of bias was low in 96 of 160 studies (60.0%).

CONCLUSION: ARV NI-RCTs should improve NIM justification, reporting of ITT and PP analyses, and missing data handling to increase CONSORT adherence.

PMID:37243351 | DOI:10.1093/cid/ciad308

Subst Use Misuse. 2023 May 26:1-4. doi: 10.1080/10826084.2023.2215323. Online ahead of print.

ABSTRACT

Background: Investigating tobacco use and associated factors is essential to set priorities and health promotion strategies among adolescents. Several studies examined the relationship between this behavior and the psychosocial salutogenic construct Sense of Coherence (SOC), but the evidence is limited to adolescents in high-income countries. This study aimed to analyze the association between tobacco use and SOC among Brazilian adolescent students. Methods: A cross-sectional school-based survey was conducted in 2018. Dependent variables were categorical binary (Yes/No): (1) Smoking experimentation (at least one puff in a lifetime); (2) Current smoking (at least one cigarette smoked in the last 30 days); (3) Daily cigarette smoking; and (4) Experimentation with hookah and/or other tobacco products (at least once in a lifetime). Independent variable SOC was assessed with the SOC-13 item scale. Independent-samples t-Test and Logistic regression were used in the statistical analyses. Potential confounders were identified using a Directed Acyclic Graph. Results: Participants were 3034 adolescents aged 13-19. The mean SOC scores were higher among adolescents who answered no to each of the dependent variables than among those who answered yes (p < .05). In the regression analysis, those with higher SOC scores were less likely to report smoking experimentation, current use, daily use, and experimentation with hookah and/or other tobacco products, than those with lower SOC scores. The associations remained after controlling for sociodemographic and/or social-environmental factors. Conclusion: An inverse relationship between SOC and tobacco use was observed among Brazilian adolescent students.

PMID:37243349 | DOI:10.1080/10826084.2023.2215323

Ann Neurol. 2023 May 26. doi: 10.1002/ana.26710. Online ahead of print.

ABSTRACT

OBJECTIVES: The glymphatic function has not yet been explored in behavioral variant frontotemporal dementia (bvFTD). The spatial correlation between regional glymphatic function and bvFTD remain unknown.

METHOD: A total of 74 patients with bvFTD and 67 age- and sex-matched healthy controls (HCs) were selected from discovery dataset and replication dataset. All participant underwent neuropsychological assessment. Glymphatic measures including choroid plexus (CP) volume, diffusion tensor imaging along the perivascular (DTI-ALPS) index, and coupling between blood-oxygen-level-dependent signals and cerebrospinal fluid signals (BOLD-CSF coupling), were compared between the two groups. Regional glymphatic function was evaluated by dividing DTI-ALPS and BOLD-CSF coupling into anterior, middle, and posterior regions. BvFTD-related metabolic pattern was identified using spatial covariance analysis based on ^l8 F-FDG-PET.

RESULTS: Patients with bvFTD showed higher CP volume (P < 0.001); anterior and middle DTI-ALPS (P < 0.001); and weaker anterior BOLD-CSF coupling (P < 0.05) than HCs after controlling for cortical gray matter volume in both datasets. In bvFTD from the discovery dataset, the anterior DTI-ALPS was negatively associated with the expression of the bvFTD-related metabolic pattern (r = -0.52, P = 0.034) and positively related with regional standardized uptake value ratios of ^l8 F-FDG-PET in bvFTD-related brain regions (r = 0.49-0.62, P range: 0.017-0.047). Anterior and middle glymphatic function were related to global cognition and disease severity.

INTERPRETATION: Our findings reveal abnormal glymphatic function, especially in the anterior and middle regions of brain in bvFTD. Regional glymphatic dysfunction may contribute to the pathogenesis of bvFTD. This article is protected by copyright. All rights reserved.

PMID:37243334 | DOI:10.1002/ana.26710

Viruses. 2023 Apr 25;15(5):1047. doi: 10.3390/v15051047.

ABSTRACT

Missing Funding […].

PMID:37243304 | DOI:10.3390/v15051047

Viruses. 2023 May 19;15(5):1199. doi: 10.3390/v15051199.

ABSTRACT

INTRODUCTION: Remdesivir (REM) and monoclonal antibodies (mAbs) could alleviate severe COVID-19 in at-risk outpatients. However, data on their use in hospitalized patients, particularly in elderly or immunocompromised hosts, are lacking.

METHODS: All consecutive patients hospitalized with COVID-19 at our unit from 1 July 2021 to 15 March 2022 were retrospectively enrolled. The primary outcome was the progression to severe COVID-19 (P/F < 200). Descriptive statistics, a Cox univariate-multivariate model, and an inverse probability treatment-weighted (IPTW) analysis were performed.

RESULTS: Overall, 331 subjects were included; their median (q1-q3) age was 71 (51-80) years, and they were males in 52% of the cases. Of them, 78 (23%) developed severe COVID-19. All-cause in-hospital mortality was 14%; it was higher in those with disease progression (36% vs. 7%, p < 0.001). REM and mAbs resulted in a 7% (95%CI = 3-11%) and 14% (95%CI = 3-25%) reduction in the risk of severe COVID-19, respectively, after adjusting the analysis with the IPTW. In addition, by evaluating only immunocompromised hosts, the combination of REM and mAbs was associated with a significantly lower incidence of severe COVID-19 (aHR = 0.06, 95%CI = 0.02-0.77) when compared with monotherapy.

CONCLUSIONS: REM and mAbs may reduce the risk of COVID-19 progression in hospitalized patients. Importantly, in immunocompromised hosts, the combination of mAbs and REM may be beneficial.

PMID:37243285 | DOI:10.3390/v15051199