Category: Statistics

Neurologia (Engl Ed). 2022 Jun 9:S2173-5808(22)00067-0. doi: 10.1016/j.nrleng.2021.10.004. Online ahead of print.

ABSTRACT

BACKGROUND: Recent years have seen considerable changes in the prevention and treatment of acute ischaemic stroke in adult patients. However, the low incidence of paediatric stroke makes the development of specific guidelines more challenging. This study aims to clarify the situation of these children in our region in order to establish a regional protocol to improve the care provided to these patients.

METHODS: We performed a regional incidence study of pediatric stroke (≤ 15 years of age) in Aragon, Spain (1308728 population, 15% aged ≤ 15 years) between 2008 and 2019. Data were obtained from hospital discharge records, including deaths, from the regional health service of Aragón, according to ICD codes for cerebrovascular disease. We analysed demographic, clinical, diagnostic/therapeutic, and prognostic variables.

RESULTS: A total of 21 events were recorded: 8 ischaemic (38.1%) and 13 haemorrhagic strokes (61.9%). The mean age (SD) was 9.3 years (1.0). The sample included 12 boys and nine girls. No statistically significant differences were found between ischaemic and haemorrhagic strokes, except in the chief complaint (language and motor impairment in ischaemic stroke and headache in haemorrhagic stroke). None of the patients with ischaemic stroke received reperfusion therapies. Including the 3 patients who died during hospitalisation, eight patients (42.1%) had modified Rankin Scale scores > 2 at 12 months. Motor deficits were the most common sequela (n=9).

CONCLUSION: Though infrequent, paediatric stroke has an important functional impact. In Spain, Madrid was the first region to adapt the existing code stroke care networks for adult patients. In Aragon, this review has enabled us to work closely with the different stakeholders to offer a care plan for acute paediatric ischaemic stroke. Nevertheless, prospective national registries would be valuable to continue improving the care provided to these patients.

PMID:35691906 | DOI:10.1016/j.nrleng.2021.10.004

Acad Radiol. 2022 Jun 9:S1076-6332(22)00313-0. doi: 10.1016/j.acra.2022.05.011. Online ahead of print.

ABSTRACT

RATIONALE AND OBJECTIVES: To assess the effects of a change from free text reporting to structured reporting on resident reports, the proofreading workload and report turnaround times in the neuroradiology daily routine.

MATERIALS AND METHODS: Our neuroradiology section introduced structured reporting templates in July 2019. Reports dictated by residents during dayshifts from January 2019 to March 2020 were retrospectively assessed using quantitative parameters from report comparison. Through automatic analysis of text-string differences between report states (i.e. draft, preliminary and final report), Jaccard similarities and edit distances of reports following read-out sessions as well as after report sign-off were calculated. Furthermore, turnaround times until preliminary and final report availability to clinicians were investigated. Parameters were visualized as trending line graphs and statistically compared between reporting standards.

RESULTS: Three thousand five hundred thirty-eight reports were included into analysis. Mean Jaccard similarity of resident drafts and staff-reviewed final reports increased from 0.53 ± 0.37 to 0.79 ± 0.22 after the introduction of structured reporting (p < .001). Both mean overall edits on draft reports by residents following read-out sessions (0.30 ± 0.45 vs. 0.09 ± 0.29; p < .001) and by staff radiologists during report sign-off (0.17 ± 0.28 vs. 0.12 ± 0.23, p < .001) decreased. With structured reporting, mean turnaround time until preliminary report availability to clinicians decreased by 20.7 minutes (246.9 ± 207.0 vs. 226.2 ± 224.9; p < .001). Similarly, final reports were available 35.0 minutes faster on average (558.05 ± 15.1 vs. 523.0 ± 497.3; p = .002).

CONCLUSION: Structured reporting is beneficial in the neuroradiology daily routine, as resident drafts require fewer edits in the report review process. This reduction in proofreading workload is likely responsible for lower report turnaround times.

PMID:35691879 | DOI:10.1016/j.acra.2022.05.011

Vaccine. 2022 Jun 9:S0264-410X(22)00476-5. doi: 10.1016/j.vaccine.2022.04.048. Online ahead of print.

ABSTRACT

BACKGROUND: Influenza outbreaks in aged care facilities are a major public health concern. In response to the severe 2017 influenza season in Australia, enhanced influenza vaccines were introduced from 2018 onwards for those over 65 and more emphasis was placed on improving vaccination rates among aged care staff. During the COVID-19 pandemic, these efforts were then further escalated to reduce the additional burden that influenza could pose to facilities.

METHODS: An observational epidemiological study was conducted from 2018 to 2020 in nine Sydney (Australia) aged care facilities of the same provider. De-identified vaccination data and physical layout data were collected from participating facility managers from 2018 to 2020. Active surveillance of influenza-like illness was carried out from 2018 to 2020 influenza seasons. Correlation and Poisson regression analyses were carried out to explore the relationship between physical layout variables to occurrence of influenza cases.

RESULTS: Influenza cases were low in 2018 and 2019, and there were no confirmed influenza cases identified in 2020. Vaccination rates increased among staff by 50.5% and residents by 16.8% over the three-year period of surveillance from 2018 to 2020. For each unit increase in total number of beds, common areas, single rooms, all types of rooms (including double occupancy rooms), the influenza cases increased by 1.02 (95% confidence interval:1.018-1.025), 1.04 (95% confidence interval: 1.019-1.073), 1.03 (95% confidence interval: 1.016-1 0.038) and 1.02 (95% confidence interval:1.005-1.026) times which were found to be statistically significant. For each unit increase in the proportion of shared rooms, influenza cases increased by 1.004 (95% confidence interval:1.0001-1.207) which was found to be statistically significant.

CONCLUSIONS: There is a relationship between influenza case counts and aspects of the physical layout such as facility size, and this should be considered in assessing risk of outbreaks in aged care facilities. Increased vaccination rates in staff and COVID-19 prevention and control measures may have eliminated influenza in the studied facilities in 2020.

PMID:35691870 | DOI:10.1016/j.vaccine.2022.04.048

J Cardiothorac Vasc Anesth. 2022 May 13:S1053-0770(22)00337-8. doi: 10.1053/j.jvca.2022.05.012. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the effect of anticoagulation targets and intensity on bleeding events, thrombotic events, and transfusion requirements in patients with acute respiratory distress syndrome (ARDS) receiving venovenous extracorporeal membrane oxygenation (ECMO) and continuous-infusion heparin.

DESIGN: A retrospective cohort study.

SETTING: At a single-center, large academic medical center.

PARTICIPANTS: One hundred thirty-six critically ill patients.

INTERVENTIONS: The following three therapeutic targets were implemented over time and evaluated: (1) no protocol (September 2013-August 2016): no standardized anticoagulation protocol or transfusion thresholds; (2) <50 seconds (September 2016-January 2018): standardized activated partial thromboplastin time (aPTT) goal of <50 seconds, maximum heparin infusion rate of 1,200 units/h, transfusion threshold of hemoglobin (Hgb) <8 g/dL; and (3) 40-to-50 seconds (February 2018-December 2019): aPTT goal of 40-to-50 sec, no maximum heparin infusion rate, transfusion threshold of Hgb <7 g/dL.

MEASUREMENTS AND MAIN RESULTS: Continuous variables were compared using the Kruskal-Wallis test, and categorical variables were compared using Fisher exact tests. The primary endpoint, an incidence of at least 1 bleeding event, was highest in the no-protocol group though not statistically different among groups (39.3% v 26.7% v 34%, p = 0.5). Thrombotic complications were similar. The median units of packed red blood cells transfused were highest in the no-protocol group (3 v 2 v 0.5, p < 0.001).

CONCLUSION: Anticoagulation protocols standardizing aPTT goals to <50 or 40-to-50 seconds may be a reasonable strategy for patients receiving venovenous ECMO for ARDS. More restrictive hemoglobin transfusion thresholds, in combination with lower aPTT targets, may be associated with a reduction in transfusion requirements.

PMID:35691853 | DOI:10.1053/j.jvca.2022.05.012

Can J Urol. 2022 Jun;29(3):11175-11181.

ABSTRACT

INTRODUCTION: Bladder spasm are common complications following cystoscopic urologic procedures. This study aims to determine the incidence and risk factors for bladder spasm after ambulatory cystoscopic urologic procedures.

MATERIALS AND METHODS: Medical records of adult patients who underwent urologic procedures in our ambulatory center from May 1st, 2018 through December 30th, 2020, were reviewed. Bladder spasm was identified from the administration of antispasmodic therapy (e.g. oxybutynin) during anesthesia recovery. Multivariable analyses were performed to assess the association between bladder spasm and clinical factors.

RESULTS: Included were 2,671 patients, of which 917 (34.3%) developed postoperative bladder spasm, yielding an incidence of 343 (95%CI 325-361) per 1,000 procedures. Risk factors associated with bladder spasm were younger adult age (< 60 years), longer (> 45 minutes) and more complex procedures. Compared to cystoscopy the risk of spasm following transurethral resection of the bladder tumor was OR 4.35 (95%CI 3.22, 5.87) and for transurethral resection of the prostate OR 3.25 (95% CI 2.24, 4.71). Spasm prophylaxis with belladonna and opium suppositories (B&O) was used in 1,158 patients and 384 (33.2%) developed spasms. The use of B&O was not associated with reduction of bladder spasm, OR 0.91 (95%CI 0.75, 1.1, p = 0.318). Postoperative outcomes did not differ between patients who did or did not develop spasms.

CONCLUSION: Bladder spasms are common following ambulatory urologic procedures, more so with more extensive procedures. Prophylaxis with B&O was not significantly associated with a lower rate of bladder spasms.

PMID:35691040

Acta Biochim Pol. 2022 Jun 12. doi: 10.18388/abp.2020_5816. Online ahead of print.

ABSTRACT

BACKGROUND: Primary gastrointestinal diffuse large B-cell lymphoma (PGI-DLBCL) lacks specific clinical manifestations and its malignancy renders prognostication and choice of treatment strategy difficult. The aim of this study was to evaluate microRNA (miR)-21 as potential non-invasive biomarkers for prognosis in PGI-DLBCL patients.

METHODS: Serum miR-21 expression in de novo PGI-DLBCL patients, consecutively enrolled for this study, was detected by quantitative real-time polymerase chain reaction (qRT-PCR). Relative expression was calculated using the comparative Ct method. Statistical significance was determined using the Mann-Whitney rank sum and Fisher’s exact test. Survival analysis was conducted using the Kaplan-Meier method.

RESULTS: Compared with healthy controls, serum miR-21 levels were significantly elevated in the PGI-DLBCL patients (n=156). The high expression level of serum miR-21 at diagnosis was associated with worse progression-free survival (PFS) (30 (9-42) vs 42 (12-52) months in high and low miR-21 groups) and overall survival (OS) (35 (15-52) vs 48 (17-61) months in high and low miR-21 groups) and was an independent risk factor for PFS and OS (hazard ratios 4.345 and 3.311, respectively). Furthermore, Bcl-2, Bcl-6 and Ki-67 were independently and positively associated with miR-21 expression.

CONCLUSIONS: Our results suggest that miR-21 is a potential prognostic marker to predict clinical outcomes in PGI-DLBCL patients and a high miR-21 level is associated with poor outcomes.

PMID:35691029 | DOI:10.18388/abp.2020_5816

JNMA J Nepal Med Assoc. 2022 Jun 1;60(250):521-524. doi: 10.31729/jnma.7217.

ABSTRACT

INTRODUCTION: Neural adaptation to physical training allows a person to better coordinate the activation of all relevant muscles producing maximum force. Nerve conduction velocity measures the speed of impulse along the motor neuron and is strongly associated with muscle contraction time. This study aimed to find out the mean motor nerve conduction velocity of the right ulnar nerve among physically trained adult males in a tertiary care centre.

METHODS: This descriptive cross-sectional study was conducted in the Neurophysiology Laboratory of a tertiary care centre from 3rd November, 2019 to 2nd November, 2020. Thirty young adult males who were engaged in the physical training at a training centre for more than 3 months were studied after receiving ethical approval from the Institutional Review Committee (Reference number: 1578/019). Motor nerve conduction parameters of the right ulnar nerve were measured and data were entered in Microsoft Excel. Statistical analysis was done using the Statistical Packages for the Social Sciences version 25.0. Point estimate at 95% Confidence Interval was calculated along with frequency and percentages for binary data, and mean and standard deviation for continuous data.

RESULTS: Among 30 males studied, the mean motor nerve conduction velocity of the ulnar nerve was found to be 61.02±5.86 m/sec (58.92-63.11 at 95% Confidence Interval). The mean distal latency and amplitude of the muscle action potential were 2.33±0.53 ms and 8.08±1.17 mv respectively.

CONCLUSIONS: Our study found that the mean nerve conduction velocity of the ulnar nerve was similar when compared to studies conducted in similar settings.

KEYWORDS: Nepal; nerve conduction; ulnar nerve.

PMID:35690989 | DOI:10.31729/jnma.7217

J Periodontol. 2022 Jun 12. doi: 10.1002/JPER.21-0555. Online ahead of print.

ABSTRACT

BACKGROUND: This study evaluated the effects of systemic administration of Bifidobacterium animalis subsp. lactis HN019 (B. lactis HN019) on experimental periodontitis (EP) in rats.

METHODS: Thirty-two rats were allocated to groups C (control), C-HN019 (probiotic), EP (EP only) and EP-HN019 (EP+probiotic). From day 0, the animals of C-HN019 and EP-HN019 groups received B. lactis HN019 (1×10⁹ CFU/mL) daily. On the 14th day, the animals of EP and EP-HN019 groups received silk ligature around mandibular molars. Animals were euthanized on the 28th day. Samples of oral biofilm, gingival tissues, blood serum and mandible were obtained for microtomographic, histomorphometric, microbiological and immunological analyses. Data were statistically analyzed (p<0.05).

RESULTS: Group EP-HN019 presented significantly less alveolar bone loss when compared with Group EP in histomorphometric and microtomographic analyses. In gingival tissue and serum, Group EP-HN019 presented lower pro-inflammatory/anti-inflammatory cytokines ratios than Group EP. Group EP-HN019 showed higher expression of beta-defensins and less TRAP-positive cells than Group EP. Group EP presented higher gene expression of Ifng and lower gene expression of Foxp3 when compared with Group EP-HN019 in gingival tissue. In oral biofilm, EP-HN019 group presented a lower percentage of species similar to Fusobacterium periodonticum and a higher percentage of species similar to Actinomyces gereneseriae, A. israelli and Streptococcus gordonii when compared with Group EP. There was a significant increase of B. lactis HN019 after administration of probiotic therapy in oral biofilm of Group EP-HN019.

CONCLUSION: The consumption of B. lactis HN019 promotes a protective effect against alveolar bone loss by modifying local and systemic microbiological and immunoinflammatory parameters. This article is protected by copyright. All rights reserved.

PMID:35690993 | DOI:10.1002/JPER.21-0555

JNMA J Nepal Med Assoc. 2022 Jun 1;60(250):537-540. doi: 10.31729/jnma.7257.

ABSTRACT

INTRODUCTION: Middle ear barotrauma is a tissue injury to the ear secondary to inadequate pressure equalisation between the middle ear and the external environment. Paragliding, though an exciting sport, has its own risks and hazards. Para-pilots experience a variety of ear-related symptoms due to pressure discrepancies between the middle ear and ambient air. Middle ear barotrauma amongst para-pilots is a common yet neglected problem. The aim of this study was to find the prevalence of middle ear barotrauma among licensed para-pilots of a metropolitan city.

METHODS: A descriptive cross-sectional study was conducted amongst para-pilots practising in different paragliding companies in a metropolitan city. The study was conducted from 10th October, 2021 to 22nd October, 2021 after getting ethical approval from the Institutional Review Committee (Reference number: 0410202109/2021). A sample size of 76 participants was taken using convenience sampling technique. Data was collected from participants after performing an otoscope examination. The data were entered into Microsoft Excel version 2016 and analysed using the Statistical Package for the Social Science Version 22.0. Point estimate at a 95% Confidence Interval was calculated along with frequency and proportion for binary data and mean and standard deviation for continuous data.

RESULTS: Out of 76 participants, the prevalence of middle ear barotrauma was 10 (13.2%) (5.58-20.81 at 95% Confidence Interval).

CONCLUSIONS: The prevalence of middle ear barotrauma was similar to other studies done in similar settings.

KEYWORDS: barotrauma; eustachian tube; Nepal; pilots.

PMID:35690988 | DOI:10.31729/jnma.7257

JNMA J Nepal Med Assoc. 2022 Jun 1;60(250):525-528. doi: 10.31729/jnma.7416.

ABSTRACT

INTRODUCTION: Mandibular condyle is a prominent structure in the mandible, which forms the temporomandibular joint. An oval-shaped condyle is considered to be present with a normal temporomandibular joint and any morphological variation of the condyle is assumed to be pathologic in temporomandibular disorders. The aim of the study was to find out the prevalence of oval shaped mandibular condyle among orthopantomogram radiographs of patients visiting the tertiary care centre.

METHODS: A descriptive cross-sectional study was performed among 752 condyles visiting a tertiary care center from November 29, 2021 to April 1, 2022. The ethical approval was taken from the Institutional Review Committee (Reference number: 184 (6-11) 078/079) before conducting the study. Convenience sampling was done. The radiographs were first examined and the observed morphological type of mandibular condyle was noted. Data analysis was done using Statistical Package for the Social Sciences version 22.0. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data.

RESULTS: The prevalence of oval shaped mandibular condyles out of 752 condyles was 416 (55.32%) (51.77-58.87 at 95% Confidence Interval). The oval-shaped condyle on the right side was 205 (54.52%) and on the left side was 211 (56.12%).

CONCLUSIONS: The prevalence of oval shaped condyles among patients in this study was similar to the studies done in similar settings.

KEYWORDS: condyle; mandible; Nepal; X-ray.

PMID:35690981 | DOI:10.31729/jnma.7416