Category: Statistics

J Ayub Med Coll Abbottabad. 2021 Apr-Jun;33(2):217-221.

ABSTRACT

BACKGROUND: Urolithiasis is a prevailing ailment affecting all age groups across global population. In modern innovative industry endoscopic instruments alterations and miniaturization has simplified the interventional strategy for undertaking these procedures for renal stones. However, there has been paucity of studies regarding outcomes of Percutaneous Nephrolithotomy (PCNL) in elder age group. We aimed to report success rates and complications in elder age group.

METHODS: This was a retrospective review of the charts for subjects that underwent unilateral PCNL from 2012 till 2018 November at a tertiary care hospital at capital of Pakistan. Patients of age ≥60 years were chosen for this study. PCNL procedures were done in prone position. We implemented the Guy stone scoring (stone complexity) to forecast the net results of PCNL. Information regarding variables were recorded in specified proforma and then processed in SPSS version 16 for the statistical computations.

RESULTS: On the whole 79 patients were incorporated for this study. Most common presenting complaint in clinic was flank pain followed by haematuria and fever respectively. Mean age in this analysis was calculated as 63.36±5.19 years. Mean size for calculi was 449±163mm2. One patient underwent transfusion after surgery while only 2.5% of these patients had sepsis (post PCNL procedure). Stone free rate was significantly affected by Guys stone score (GSS).

CONCLUSIONS: PCNL can be undertaken safely and effectually for achieving treatment goals even in elder subjects. Stone free rates are higher in lower Guys stone score as compared to the higher scores.

PMID:34137532

J Ayub Med Coll Abbottabad. 2021 Apr-Jun;33(2):202-206.

ABSTRACT

BACKGROUND: To compare the effect of ProTaper Next and One Shape rotary files on canal transportation and centering abilities in resin block with simulated curved canal.

METHODS: An in-vitro experimental study was carried out in Dental clinics. Sixty resin blocks (30 per group) having simulated curved canals prepared with ProTaper Next and One Shape and then filled with red and blue Indian ink, respectively. Photographs of resin blocks obtained using standardized manner were then transferred to the Adobe Photoshop 7.0. Centering abilities and amount of transportation were then calculated at coronal, middle and apical portion of canal for both the groups. Independent sample t-test was used to compare the transportation and centering ability of both file systems. Level of significance was kept at p-value ≤0.01.

RESULTS: One Shape file resulted in more canal transportation at all the levels (apical, middle and coronal part) as compared to ProTaper Next file, however, difference was not statistically significant (p-value >0.01). Statistically significant difference was noted at the apical third between these two rotary files with One Shape file showing more centered preparation as opposed to ProTaper Next file (p-value <0.01).

CONCLUSIONS: One Shape file system had more centered canal preparations specifically at the apical region as compared to ProTaper Next. One Shape also lead to more canal transportation in comparison to ProTaper Next, however the difference was not statistically significant.

PMID:34137529

J Cachexia Sarcopenia Muscle. 2021 Jun 17. doi: 10.1002/jcsm.12731. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with Marfan syndrome are at risk for aortic enlargement and are routinely monitored by computed tomography (CT) imaging. The purpose of this study is to analyse body composition using artificial intelligence (AI)-based tissue segmentation in patients with Marfan syndrome in order to identify possible predictors of progressive aortic enlargement.

METHODS: In this study, the body composition of 25 patients aged ≤50 years with Marfan syndrome and no prior aortic repair was analysed at the third lumbar vertebra (L3) level from a retrospective dataset using an AI-based software tool (Visage Imaging). All patients underwent electrocardiography-triggered CT of the aorta twice within 2 years for suspected progression of aortic disease, suspected dissection, and/or pre-operative evaluation. Progression of aortic enlargement was defined as an increase in diameter at the aortic sinus or the ascending aorta of at least 2 mm. Patients meeting this definition were assigned to the ‘progressive aortic enlargement’ group (proAE group) and patients with stable diameters to the ‘stable aortic enlargement’ group (staAE group). Statistical analysis was performed using the Mann-Whitney U test. Two possible body composition predictors of aortic enlargement-skeletal muscle density (SMD) and psoas muscle index (PMI)-were analysed further using multivariant logistic regression analysis. Aortic enlargement was defined as the dependent variant, whereas PMI, SMD, age, sex, body mass index (BMI), beta blocker medication, and time interval between CT scans were defined as independent variants.

RESULTS: There were 13 patients in the proAE group and 12 patients in the staAE group. AI-based automated analysis of body composition at L3 revealed a significantly increased SMD measured in Hounsfield units (HUs) in patients with aortic enlargement (proAE group: 50.0 ± 8.6 HU vs. staAE group: 39.0 ± 15.0 HU; P = 0.03). PMI also trended towards higher values in the proAE group (proAE group: 6.8 ± 2.3 vs. staAE group: 5.6 ± 1.3; P = 0.19). Multivariate logistic regression revealed significant prediction of aortic enlargement for SMD (P = 0.05) and PMI (P = 0.04).

CONCLUSIONS: Artificial intelligence-based analysis of body composition at L3 in Marfan patients is feasible and easily available from CT angiography. Analysis of body composition at L3 revealed significantly higher SMD in patients with progressive aortic enlargement. PMI and SMD significantly predicted aortic enlargement in these patients. Using body composition as a predictor of progressive aortic enlargement may contribute information for risk stratification regarding follow-up intervals and the need for aortic repair.

PMID:34137512 | DOI:10.1002/jcsm.12731

J Ayub Med Coll Abbottabad. 2021 Apr-Jun;33(2):183-187.

ABSTRACT

BACKGROUND: Anti-VEGF agents have been proven to be effective in treating macular oedema secondary to a multitude of pathological conditions. However, in large clinical trial settings, the results may be overstated. This study aimed to evaluate the short-term efficacy of intraocular Bevacizumab in consecutive patients with macular oedema being treated in a ‘real-world’ setting in Pakistan.

METHODS: A prospective study was conducted at Amanat Eye Hospital, Rawalpindi from August 2018 to November 2019. Thirty-five eyes of 29 patients with macular oedema were treated with monthly intravitreal Bevacizumab injections for three consecutive months. Best-corrected visual acuity (BCVA), and OCT parameters including central retinal thickness (CRT) and macular volume were assessed prior to the injections and then 4 weeks post the final injection and compared.

RESULTS: BCVA improved from 1.00±0.44 at baseline to 0.83±0.48 four weeks after the third intravitreal injection. CRT decreased significantly from 492.77±192.31 at baseline to 362.91±126.11 (p<0.05), and macular volume decreased significantly from 11.61±2.39 at baseline to 9.87±1.68 (p<0.05) four weeks after the third intravitreal injection. No systemic or ocular complications were observed during the course of the study.

CONCLUSIONS: Treatment with intravitreal Bevacizumab injections was found safe and resulted in clinically and statistically significant improvement in SD-OCT parameters and visual acuity in patients with macular oedema secondary to various retinal pathologies. However, the improvement in a real-world setting was sub-optimal in comparison to larger clinical trials for specific diseases in the developed world.

PMID:34137525

J Ayub Med Coll Abbottabad. 2021 Apr-Jun;33(2):192-197.

ABSTRACT

BACKGROUND: Inferior Alveolar Nerve Block (IANB) with Buccal Infiltration (BI) anaesthesia is required to completely anesthetize the mandibular molars with symptomatic irreversible pulpitis. 4% Articaine and 2% Lidocaine provide local anaesthesia during the nonsurgical endodontic treatment of mandibular molars with symptomatic irreversible pulpitis. Objective of the study was to compare the effect of Articaine and Lidocaine in the combination of Inferior alveolar nerve block with buccal infiltration anaesthesia during the nonsurgical endodontic treatment of mandibular molars with symptomatic Irreversible Pulpitis.

METHODS: One hundred and sixty participants with Symptomatic Irreversible Pulpitis of permanent mandibular molars were divided randomly in two groups. Group A was given Articaine 4% IANB along with BI whereas group B was given Lidocaine 2%. Pain was assessed after 15 minutes of administration of local anaesthesia. Anaesthetic success of the agents is defined as, absence of pain or mild pain first during the access cavity preparation then instrumentation of the canals of tooth. Chi-square test was applied to analyse data for statistical significance.

RESULTS: Anaesthetic success of Articaine was 96.2% during access cavity preparation compared to Lidocaine (86.2%). Success during instrumentation of canals was also found to be high in Articaine (90.2%) compared to Lidocaine (76.2%). This difference of anaesthetic efficacy between Articaine and Lidocaine was found statistically significant. (p=0.02).

CONCLUSIONS: Articaine is found to be better than Lidocaine regarding anaesthetic efficacy and hence, it can be a safer alternative to Lidocaine.

PMID:34137527

ESC Heart Fail. 2021 Jun 17. doi: 10.1002/ehf2.13463. Online ahead of print.

ABSTRACT

AIMS: The prospective, multicentre Peripartum Cardiomyopathy in Nigeria (PEACE) registry originally demonstrated a high prevalence of peripartum cardiomyopathy (PPCM) among patients originating from Kano, North-West Nigeria. In a post hoc analysis, we sought to determine if this phenomenon was characterized by a differential case profile and outcome among PPCM cases originating elsewhere.

METHODS AND RESULTS: Overall, 199 (81.6%) of a total 244 PPCM patients were recruited from three sites in Kano, compared with 45 patients (18.4%) from 11 widely dispersed centres across Nigeria. Presence and extent of ventricular myocardial remodelling during follow-up, relative to baseline status, were assessed by echocardiography. During median 17 months follow-up, Kano patients demonstrated significantly better myocardial reverse remodelling than patients from other sites. Overall, 50.6% of patients from Kano versus 28.6% from other regions were asymptomatic (P = 0.029) at study completion, with an accompanying difference in all-cause mortality (17.6% vs. 22.2% respectively, P = 0.523) not reaching statistical significance. Alternatively, 135/191 (84.9%) of Kano patients had selenium deficiency (<70 μg/L), and 46/135 (34.1%) of them received oral selenium supplementation. Critically, those that received selenium supplementation demonstrated better survival (6.5% vs. 21.2%; P = 0.025), but the supplement did not have significant impact on myocardial remodelling.

CONCLUSIONS: This study has shown important non-racial regional disparities in the clinical features and outcomes of PPCM patients in Nigeria, that might partly be explained by selenium supplementation.

PMID:34137499 | DOI:10.1002/ehf2.13463

J Diabetes Investig. 2021 Jun 15. doi: 10.1111/jdi.13615. Online ahead of print.

ABSTRACT

AIMS/INTRODUCTION: Few people have reported whether there are sex differences in blood lipids and lipid ratios in type 2 diabetic foot (T2DF) patients in China. This paper attempts to identify the contribution to sex-specific differences in blood lipids and lipid ratios in these patients.

MATERIALS AND METHODS: In this case-control study, we explore that 306 patients with T2DF as study group and 306 patients with type 2 diabetes mellitus (T2DM) as control group. Patients were diagnosed according to the Standards of Medical Care in Diabetes-2014 (ADA). Blood lipid and lipid ratios were determined according to the National Cholesterol Education Program Adult Treatment Panel III criteria.

RESULTS: We studied male patients with T2DF who were 68.00 (18.00) years old and females who were 73.50 (19.00) years old; 61.76% of the patients were male. Males had higher BMIs and HbA1c levels than females. Compared to T2DM patients, T2DF patients had significant differences in TC/HDL-C, LDL-C/HDL-C and apoB/apoA-I ratios. HDL-C, TG, apoA-I and apoB/apoA-I ratio were cardiovascular disease (CVD) risk in males, while TC, LDL-C, apoB, and the LDL/HDL-C and TC/HDL-C ratios were better predictors in females. The apoB/apoA-I ratio OR values were 2.18 (95%CI:1.17-4.41) and 2.14 (95%CI:1.14-4.00) in male patients with T2DF before and after adjusting for age respectively (P<0.05).

CONCLUSIONS: T2DF patients present sex-specific differences in their blood lipid and lipid ratios, especially in the apoB/apoA-I ratio, which could be a better indicator for CVD risk.

PMID:34137504 | DOI:10.1111/jdi.13615

J Magn Reson Imaging. 2021 Jun 16. doi: 10.1002/jmri.27789. Online ahead of print.

ABSTRACT

BACKGROUND: Magnetic resonance imaging (MRI) is the most accurate imaging technique for left ventricular ejection fraction (LVEF) quantification, but as yet the prognostic value of LVEF assessment at any time after ST-segment elevation myocardial infarction (STEMI) for subsequent major adverse cardiac event (MACE) prediction is uncertain.

PURPOSE: To explore the prognostic impact of MRI-derived LVEF at any time post-STEMI to predict subsequent MACE (cardiovascular death or re-admission for acute heart failure).

STUDY TYPE: Prospective.

POPULATION: One thousand thirteen STEMI patients were included in a multicenter registry.

FIELD STRENGTH/SEQUENCE: 1.5-T. Balanced steady-state free precession (cine imaging) and segmented inversion recovery steady-state free precession (late gadolinium enhancement) sequences.

ASSESSMENT: Post-infarction MRI-derived LVEF (reduced [r]: <40%; mid-range [mr]: 40%-49%; preserved [p]: ≥50%) was sequentially quantified at 1 week and after >3 months of follow-up.

STATISTICAL TESTS: Multi-state Markov model to determine the prognostic value of each LVEF state (r-, mr- or p-) at any time point assessed to predict subsequent MACE. A P-value <0.05 was considered to be statistically significant.

RESULTS: During a 6.2-year median follow-up, 105 MACE (10%) were registered. Transitions toward improved LVEF predominated and only r-LVEF (at any time assessed) was significantly related to a higher incidence of subsequent MACE. The observed transitions from r-LVEF, mr-LVEF, and p-LVEF states to MACE were: 15.3%, 6%, and 6.7%, respectively. Regarding the adjusted transition intensity ratios, patients in r-LVEF state were 4.52-fold more likely than those in mr-LVEF state and 5.01-fold more likely than those in p-LVEF state to move to MACE state. Nevertheless, no significant differences were found in transitions from mr-LVEF and p-LVEF states to MACE state (P-value = 0.6).

DATA CONCLUSION: LVEF is an important MRI index for simple and dynamic post-STEMI risk stratification. Detection of r-LVEF by MRI at any time during follow-up identifies a subset of patients at high risk of subsequent events.

LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY STAGE: 2.

PMID:34137478 | DOI:10.1002/jmri.27789

Health Soc Care Community. 2021 Jun 17. doi: 10.1111/hsc.13477. Online ahead of print.

ABSTRACT

Considering the small number of studies aimed at evaluating outcomes related to dizziness and falls in the older adults who live in long-term care facilities, especially in north-eastern Brazil, and considering the negative impact of these events on the quality of life of these individuals, this study purpose was to evaluate dizziness as a predictor of risk of falls in institutionalised older adults. This cross-sectional analysis of data on falls and dizziness of 187 institutionalised older adults carried out between the years 2014 and 2016. The data collection instruments used were a socioeconomic and demographic questionnaire and questionnaires for assessing variables related to falls. The different diagnostic methods were compared using the Spearman correlation, and the Dizziness variable was evaluated by means of logistic regression. Inferential statistical analysis showed a significant association between dizziness and number of morbidities (p = .03) and dizziness and a history of falls (p = .04). Spearman’s correlation analysis revealed statistically significant results only for FES-I (Falls Efficacy Scale-International) (p < .01). Dizziness was a predictor of risk of falls and that it was associated with a greater number of morbidities and previous history of falls. Implementing rehabilitation practices to reduce dizziness symptoms can significantly reduce the risk of falls for institutionalised older adults.

PMID:34137491 | DOI:10.1111/hsc.13477

Chemistry. 2021 Jun 17. doi: 10.1002/chem.202101515. Online ahead of print.

ABSTRACT

We investigated the photoionization and fragmentation of isolated metal protoporphyrin IX cations (MPPIX with M = Fe, Co, Zn) by means of VUV action spectroscopy in the energy range of 8.5-35 eV. Experiments were carried out in the gas phase by interfacing an electrospray ionization tandem mass spectrometer with a synchrotron beamline. The mass spectra and partial ion yields show that photoexcitation of the precursor ions predominantly leads to • CH 2 COOH radical side-chain losses of the macrocycle with additional methyl radical ( • CH 3 ) side-chain losses. Ionization, in contrast, leads to the formation of the intact ionized precursor and various doubly charged fragments which are mostly due to side-chain cleavages. Although statistical fragmentation dominates, we found evidence for non-statistical processes such as new fragments involving e.g. single and double H 2 O losses, indicating that different relaxation mechanisms are at play upon photoionization compared to photoexcitation. The measured ionization energies were 9.6 ± 0.2 eV, 9.4 ± 0.2 eV and 9.6 ± 0.2 eV for FePPIX + , CoPPIX + and ZnPPIX + , respectively.

PMID:34137472 | DOI:10.1002/chem.202101515