Category: Statistics

Transpl Infect Dis. 2022 Jul 3. doi: 10.1111/tid.13898. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate epidemiology, risk-factors and outcomes of high-level cytomegalovirus (CMV) viremia in liver transplant recipients.

METHODS: Adult patients receiving a liver transplant between 1/1/2017-9/30/2020 were evaluated. Viral loads at UW Health Clinical Laboratories were required to allow for numerical comparison. Primary objective was incidence and outcomes of high-level (HL) CMV viremia (viral-load >100,000 IU/mL). Secondary objective was to elucidate risk factors to allow targeted interventions.

RESULTS: 209 patients met inclusion criteria; 175 kept their graft for at least 240 days. Of these 9 patients developed HL CMV, 28 developed low-level (LL CMV, viral-load 250-100,000 IU/mL) and 138 did not develop CMV viremia. When comparing these 3 groups via classic statistical methods time from transplant to viremia was similar (HL 158 ± 77 days, LL 150 ± 76 days). Clinical factors were also similar with the exception of donor seropositivity (HL 87.5%, LL 70.4%, No CMV 49.6%, p = 0.025). HL CMV was significantly associated with graft loss (p < 0.0001) on Kaplan-Meier analysis; graft loss in the LL CMV group did not differ from the No CMV group (p = 0.96) To allow valid assessment of risk factors in the total study population (n = 209) models of time-varying covariates were used and Cox proportional hazards ratios were calculated. In this analysis HL CMV was associated with a significantly increased risk of graft loss (HR 5.6, p = 0.0016). When investigating risk factors associated with HL CMV, donor seropositivity significantly increased risk (HR 8.85, 95% CI 1.13-71.43, p = 0.038). Pre-transplant total bilirubin (HR 1.04, 95% CI 0.998-1.07, p = 0.06) trended towards significance. Recipient seronegativity, liver disease, clinical and allocation MELD, transplant surgery duration, age, sex, induction immunosuppression, and maintenance immunosuppression were not significantly associated with development of HL CMV.

CONCLUSION: HL CMV after liver transplant is uncommon but is associated with a significantly increased risk of graft loss that is not present in those patients who develop LL CMV or do not develop CMV viremia. Given these negative graft effects, CMV stewardship interventions targeting recipients of CMV seropositive allografts are warranted. Future larger scale studies evaluating the potential role of other factors in risk stratification are needed. This article is protected by copyright. All rights reserved.

PMID:35780512 | DOI:10.1111/tid.13898

Nutr Clin Pract. 2022 Jul 3. doi: 10.1002/ncp.10890. Online ahead of print.

ABSTRACT

BACKGROUND: Nutrition support is an essential part of critical care medicine. It is commonly accepted that for the critically ill patient, enteral nutrition (EN) is favored. For the patient who receives neuromuscular blockades, EN may be held, or initiation delayed, because of concerns for EN intolerance. We hypothesized there would be no difference in EN tolerance between groups receiving cisatracurium while receiving EN compared with those not receiving cisatracurium.

METHODS: This was a retrospective study that included 459 patients from a combined medical and surgical intensive care unit. There were 44 patients who received cisatracurium with EN and 415 who received EN alone. Data collected included gastric residual volume (GRV) and emesis occurrences, new-onset abdominal pain, new or worsening abdominal distention, and bowel ischemia.

RESULTS: There were more patients with new or worsening abdominal distention in the group receiving cisatracurium (31.82% vs 14.94%; P < 0.01) as well as occurrences of GRV > 300 ml (P < 0.01). There was no statistically significant difference between the groups regarding emesis, new-onset abdominal pain, or bowel ischemia.

CONCLUSION: Our findings suggest that it is acceptable to provide patients with EN who are receiving cisatracurium.

PMID:35780473 | DOI:10.1002/ncp.10890

Pharmaceut Med. 2022 Jul 3. doi: 10.1007/s40290-022-00435-x. Online ahead of print.

ABSTRACT

In the last decade there has been a significant increase in the literature discussing the use of benefit-risk methods in medical product (including devices) development. Government agencies, medical product industry groups, academia, and collaborative consortia have extensively discussed the advantages of structured benefit-risk assessments. However, the abundance of information has not resulted in a consistent way to utilize these findings in medical product development. Guidelines and papers on methods, even though well structured, have not led to a firm consensus on a clear and consistent approach. This paper summarizes the global landscape of benefit-risk considerations for product- or program-level decisions from available literature and regulatory guidance, providing the perspectives of three stakeholder groups-regulators, collaborative groups and consortia, and patients. The paper identifies key themes, potential impact on benefit-risk assessments, and significant future trends.

PMID:35780471 | DOI:10.1007/s40290-022-00435-x

Am J Epidemiol. 2022 Jul 2:kwac117. doi: 10.1093/aje/kwac117. Online ahead of print.

ABSTRACT

The early identification of clusters of persons with tuberculosis (TB) that will grow to become outbreaks creates an opportunity for intervention in preventing future TB cases. We used surveillance data (2009-2018) from the United States, statistically derived definitions of unexpected growth, and machine learning techniques to predict which clusters of genotype-matched TB cases are most likely to continue accumulating cases above expected growth within a 1-year follow-up period. We developed a model to predict which clusters are likely to grow on a training and testing dataset that was generalizable to a validation dataset. Our model shows that characteristics of clusters were more important than the social, demographic, and clinical characteristics of the patients in those clusters. For instance, the time between cases before unexpected growth was identified as the most important of our predictors. A faster accumulation of cases increased the probability of excess growth being predicted during the follow-up period. We demonstrated that combining the characteristics of clusters and cases with machine learning can add to existing tools to help prioritize which clusters may benefit most from public health interventions. For example, consideration of an entire cluster, not only an individual patient, may assist in interrupting ongoing transmission.

PMID:35780450 | DOI:10.1093/aje/kwac117

Arch Orthop Trauma Surg. 2022 Jul 3. doi: 10.1007/s00402-022-04517-y. Online ahead of print.

ABSTRACT

BACKGROUND: There are various classification systems described in the literature for managing bone defects in revision knee arthroplasty (RTKA). We analysed the reliability and usefulness of these classification systems.

QUESTIONS/PURPOSES: (1) To review and critique the various classification systems proposed for bone loss in RTKA. (2) Among all the proposed classifications which one is the most commonly used by surgeons to report their results. (3) What is the reliability of various bone defect classification systems for RTKA. In this review, we have assessed the studies validating those classifications with a detailed description of the limitations and the proposed modifications.

METHODS: This systematic review was conducted following PRISMA guidelines. Pubmed/Medline, CINAHL, EMBASE, Scopus, Cochrane databases and Web of Science databases were searched using multiple search terms and MeSH terms where possible. Studies meeting inclusion criteria were assessed for statistical parameters of reliability of a classification system.

RESULTS: We found 16 classification systems for bone defects in RTKA. Six studies were found evaluating a classification system with reporting their reliability parameters. Fifty-four studies were found which classified bone loss using AORI classification in their series. AORI classification is most commonly reported for classifying bone defects. Type T2B and F2B are the most common bone defects in RTKA. The average kappa value for AORI classification for femoral bone loss was 0.38 (0.27-0.50) and 0.76 (0.63-1) for tibial bone loss assessment.

CONCLUSION: None of the available classification systems is reliably established in determining the bone loss and treatment plans in RTKA. Among all, AORI classification is the most widely used system in clinical practice. The reliability of AORI Classification is fair for femoral bone loss and substantial for tibial bone loss.

PMID:35780426 | DOI:10.1007/s00402-022-04517-y

Arch Gynecol Obstet. 2022 Jul 3. doi: 10.1007/s00404-022-06515-2. Online ahead of print.

ABSTRACT

PURPOSE: Uterine sarcoma (US) as a histologically heterogeneous group of tumors is rare and associated with poor prognosis. Prognostic factors based on systematic data collection need to be identified to optimize patients’ treatment.

METHODS: This unicenter, retrospective cohort study includes 57 patients treated at the University Hospital Freiburg, Germany between 1999 and 2017. Progression-free survival (PFS) and overall survival (OS) were calculated and visualized in Kaplan-Meier curves. Prognostic factors were identified using log-rank test and Cox regression.

RESULTS: 44 Leiomyosarcoma (LMS), 7 low-grade endometrial stromal sarcoma (LG-ESS), 4 high-grade ESS and 2 undifferentiated US patients were identified. The median age at time of diagnosis was 51.0 years (range 18-83). The median follow-up time was 35 months. PFS for the total cohort was 14.0 (95%-Confidence-Interval (CI) 9.7-18.3) and OS 36.0 months (95%-CI 22.1-49.9). Tumor pathology was prognostically significant for OS with LG-ESS being the most favorable (mean OS 150.3 months). In the multivariate analysis, patients over 52 years showed a four times higher risk for tumor recurrence (hazard ratio (HR) 4.4; 95%-CI 1.5-12.9). Progesterone receptor negativity was associated with a two times higher risk for death (HR 2.8; 95%-CI 1.0-7.5). For LMS patients age ≥ 52 years (p = 0.04), clear surgical margins (p = 0.01), FIGO stage (p = 0.01) and no application of chemotherapy (p = 0.02) were statistically significant factors for OS.

CONCLUSION: Tumor histology, age at time of diagnosis and progesterone receptor status were prognostic factors for US. Unfavorable OS in LMS patients was associated with advanced FIGO stage, suboptimal cytoreduction and application of chemotherapy.

PMID:35780401 | DOI:10.1007/s00404-022-06515-2

Cereb Cortex. 2022 Jul 2:bhac265. doi: 10.1093/cercor/bhac265. Online ahead of print.

ABSTRACT

Primates learn statistical regularities that are embedded in visual sequences, a form of statistical learning. Single-unit recordings in macaques showed that inferior temporal (IT) neurons are sensitive to statistical regularities in visual sequences. Here, we asked whether ventrolateral prefrontal cortex (VLPFC), which is connected to IT, is also sensitive to the transition probabilities in visual sequences and whether the statistical learning signal in IT originates in VLPFC. We recorded simultaneously multiunit activity (MUA) and local field potentials (LFPs) in IT and VLPFC after monkeys were exposed to triplets of images with a fixed presentation order. In both areas, the MUA was stronger to images that violated the learned sequence (deviants) compared to the same images presented in the learned triplets. The high-gamma and beta LFP power showed an enhanced and suppressed response, respectively, to the deviants in both areas. The enhanced response was present also for the image following the deviant, suggesting a sensitivity for temporal adjacent dependencies in IT and VLPFC. The increased response to the deviant occurred later in VLPFC than in IT, suggesting that the deviant response in IT was not inherited from VLPFC. These data support predictive coding theories that propose a feedforward flow of prediction errors.

PMID:35780398 | DOI:10.1093/cercor/bhac265

Mymensingh Med J. 2022 Jul;31(3):826-834.

ABSTRACT

Corona mortis (CMOR) is an anastomotic channel either arterial, venous or both connecting the obturator and external iliac systems excluding aberrant channels in the retropubic space. The goal of this study is to illustrate the type of CMOR via the Anterior Intrapelvic approach (AIP) which has not been studied in tandem. This descriptive observational study was performed in the Department of Anatomy, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India from January 2018 to December 2020. It is a potential culprit for significant haemorrhage in scenarios of pelvic trauma or when sectioned accidentally, augmenting difficult haemostasis behind the superior pubic ramus. Previously reported to be exclusively arterial, the venous variant has now emerged as the more frequent anastomosis. AIP was performed on 31 adult human cadavers of 62 hemipelvises to record variations and statistical analysis of retropubic anastomosis with respect to gender, weight groups and side distribution was done. Corona Mortis was observed in 50(80.6%) hemipelvises. To ramify, venous CMOR and arterial CMOR were exclusively encountered in 25(40.3%) and 10(16.10%) hemipelvises respectively. Males recorded a higher prevalence of CMOR. Despite being a frequent anastomotic variant, it is a rare entity in textbooks. CMOR can potentially alter patient outcome and have serious implications in pelvic surgeries via AIP owing to its easier accessibility. Besides, venous CMOR being more common, a venous bleed is inherently more arduous to manage in the pelvis. A larger calibre, less frequent aberrant channel could also prove to be lethal in its injury. Hence, cadaveric simulation of the technique is paramount to master the technique and to mitigate catastrophic vascular events.

PMID:35780370

Mymensingh Med J. 2022 Jul;31(3):819-825.

ABSTRACT

Corona Virus Disease 2019 (COVID-19) was declared a pandemic in March 2020. This global health crisis caused thousands of pneumonia related death all over the world since December 2019. RT-PCR is the primary test for diagnosis of COVID-19, though its sensitivity and specificity is variable. Several studies revealed that chest HRCT complements RT-PCR in highly suspected cases or in false negative RT-PCR and helps to gauge disease severity. This study was carried out with an aim to find out the severity scores of chest HRCT in hospitalized patients with COVID-19. This cross sectional descriptive type of observational study was carried out at COVID-19 unit of Sylhet Women’s Medical College Hospital, Bangladesh from April 2021 to September 2021. Data were collected from purposively selected 204 patients with COVID-19 by face to face interview, chest HRCT and necessary laboratory investigations. Informed written consent was taken from the participants of the study at the beginning of the interview. Data were analyzed by using SPSS version 21.0. The results of the study showed that mean age of the patients with COVID-19 was 57.9 years with a standard deviation of ±15.8 years. Majority of them (121, 59.3%) were female and the remaining (83, 40.7%) were male. Regarding co-morbidities it was found that each 115 (56.4%) patients were hypertensive and diabetic. Thirty five (16.2%) had ischemic heart disease; 3(1.5%) had congestive cardiac failure and 2(1.0%) had asthma. One (0.5%) patient has atrial fibrillation. In case of 160(78.4%) RT-PCR confirmed patients with COVID-19, chest HRCT was found positive and in 44(21.6%) it was found negative. Among the positive cases mild (7 or less) chest HRCT score was found in 26(12.7%) patients; moderate (8-17) score was found in highest number of patients (128, 62.7%) and severe (18 or more) chest HRCT score was found in 6(2.9%) patients with COVID-19. Chi-square test was carried out to assess the relation of chest HRCT scores with age group, sex, troponin-I, D-Dimer and clinical outcomes within CCU but statistically significant relation was not found (p>0.05). The negative scans were highest (20, 9.8%) in the age group of 41-60 years. Mild, moderate and severe chest HRCT scores was found highest in the age group of 61-80 years (13, 6.4%; 51, 25.0% and 5, 2.5% respectively) (p=0.508). Chest HRCT scans were negative in 18(8.8%) male and 26(12.7%) female. Mild scores were equally distributed between each sex i.e. male 13(6.4%) and female 13(6.4%). Both moderate and severe scores were found more in female (77, 37.7% and 5, 2.5% respectively) than male (51, 25.0% and 1, 0.5% respectively) (p=0.492). Negative chest HRCT scans, mild, moderate and severe scores-all were found more in patients with elevated D-Dimer (p=0.194). Among 204 patients one (0.5%) died in the CCU who had mild score of chest HRCT (p=0.076) but highly elevated Troponin-I (21.70ng/mL). Chest HRCT was found positive among 78.4% of patients with COVID-19 confirmed by RT-PCR. Chest HRCT can help physicians to detect suspected cases and to assess the severity and outcome of the disease. However, further research is recommended to clarify the role of chest HRCT in assessing severity of COVID-19 and prediction of prognosis.

PMID:35780369

Mymensingh Med J. 2022 Jul;31(3):806-811.

ABSTRACT

The Myers-Briggs Type Indicator (MBTI) personality types were established in 1940s. Career planning of doctors were found related to the MBTI personality. There are 16 subtypes of MBTI based on 4 dichotomies. Relationship between MBTI and career choice has been changed gradually in last few decades. Extroverted doctors are supposed to select surgery and introverted are prone to choose medicine according to MBTI study. This was a cross-sectional study on the female interns of Sylhet Women’s Medical College Hospital, Bangladesh from September 2021 to November 2021, to evaluate their MBTI personality type and the career planning of these individual subtypes. Commonest subtypes of participants ISTP (Introverted, Sensing, Thinking, Perceiving) (14.13%) and ESTP (Extraverted, Observant, Thinking and Prospecting) (14.13%). Other common MBTI personality subtypes were ISTJ (Introversion, Sensing, Thinking and Judgment) (9.78%), ISFP (Introverted, Sensing, Feeling, Perceiving) (8.69%), ESFJ (Extraverted, Sensing, Feeling and Judging) (6.52%), ENTP (Extraverted, Intuitive, Thinking and Perceiving) (5.43%), INFJ (Introverted, Intuitive, Feeling and Judging) (5.43%), INTJ (Introverted, Intuitive, Thinking and Judging) (5.43%) and ISFJ (Introverted, Sensing, Feeling and Judging) (5.43%). Introverted (57.7%) participants were more than extroverted (42.3%) participants. Percentage of general surgery and OBG were higher in the extroverted group and the percentage of medicine was more in the introverted group but the differences were not statistically significant (p>0.05). The career planning of ENFJ, ENFP, ESTP and ISTJ subtypes of participants of this study had similarity of those of MBTI database.

PMID:35780367