Category: Statistics

HIV Med. 2021 Jul 29. doi: 10.1111/hiv.13145. Online ahead of print.

ABSTRACT

OBJECTIVES: We compared the characteristics and clinical outcomes of hospitalized individuals with COVID-19 with [people with HIV (PWH)] and without (non-PWH) HIV co-infection in Spain during the first wave of the pandemic.

METHODS: This was a retrospective matched cohort study. People with HIV were identified by reviewing clinical records and laboratory registries of 10 922 patients in active-follow-up within the Spanish HIV Research Network (CoRIS) up to 30 June 2020. Each hospitalized PWH was matched with five non-PWH of the same age and sex randomly selected from COVID-19@Spain, a multicentre cohort of 4035 patients hospitalized with confirmed COVID-19. The main outcome was all-cause in-hospital mortality.

RESULTS: Forty-five PWH with PCR-confirmed COVID-19 were identified in CoRIS, 21 of whom were hospitalized. A total of 105 age/sex-matched controls were selected from the COVID-19@Spain cohort. The median age in both groups was 53 (Q1-Q3, 46-56) years, and 90.5% were men. In PWH, 19.1% were injecting drug users, 95.2% were on antiretroviral therapy, 94.4% had HIV-RNA < 50 copies/mL, and the median (Q1-Q3) CD4 count was 595 (349-798) cells/μL. No statistically significant differences were found between PWH and non-PWH in number of comorbidities, presenting signs and symptoms, laboratory parameters, radiology findings and severity scores on admission. Corticosteroids were administered to 33.3% and 27.4% of PWH and non-PWH, respectively (P = 0.580). Deaths during admission were documented in two (9.5%) PWH and 12 (11.4%) non-PWH (P = 0.800).

CONCLUSIONS: Our findings suggest that well-controlled HIV infection does not modify the clinical presentation or worsen clinical outcomes of COVID-19 hospitalization.

PMID:34324783 | DOI:10.1111/hiv.13145

Prim Care Companion CNS Disord. 2021 Jul 29;23(4):20m02876. doi: 10.4088/PCC.20m02876.

ABSTRACT

Background: Many midlife adults (aged 45-64 years) struggle to become physically active in the context of diminished psychological well-being and multiple concurrent stressors, despite the clear association of low physical activity with the development of chronic medical conditions.

Objectives: To assess the feasibility (rates of session completion) and acceptability (participant 0-10 ratings of weekly session ease and utility) of a novel 12-week, phone-delivered, midlife-adapted positive psychology-motivational interviewing (PP-MI) intervention to promote physical activity. Secondary aims were pre-post changes in accelerometer-measured physical activity and self-reported psychological and functional measures.

Methods: A single-arm proof-of-concept trial of the PP-MI intervention was conducted among 11 inactive midlife adults enrolled from the primary care practices of an urban academic medical center. Descriptive statistics were used to assess feasibility and acceptability outcomes, and mixed effects models were used to examine pre-post changes in psychological, functional, and physical activity outcomes from baseline to 12 weeks.

Results: The intervention exceeded a priori thresholds for feasibility and acceptability, with 80.3% session completion across all participants and mean session ratings of 8.3/10 (SD = 2.1). Participants also had medium effect size magnitude improvements in physical activity and psychological outcomes.

Conclusions: This remotely delivered, midlife-specific PP-MI intervention was feasible and well-accepted among inactive midlife adults, supporting next-step testing of this program in a randomized trial.

Trial Registration: ClinicalTrials.gov identifier: NCT04745182.

PMID:34324798 | DOI:10.4088/PCC.20m02876

J Burn Care Res. 2021 Jul 29:irab148. doi: 10.1093/jbcr/irab148. Online ahead of print.

ABSTRACT

INTRODUCTION: Necrotizing fasciitis (NF) is a rare and quickly progressing infection and leads to 100% mortality if untreated. Quick diagnosis and an early and radical surgical treatment are essential for stopping bacterial progression. Unfortunately, the absence of clear clinical signs makes the diagnosis often challenging. Therefore, we searched for easy determinable predictive laboratory markers for NF. This is the first study which includes lactate values in a new score.

MATERIAL AND METHODS: A retrospective analysis of patients with NF (n = 44) and patients with erysipelas (n = 150) was performed. Lactate values, patients` demographics, clinical presentations, site of infection, comorbidities, microbiological and laboratory findings, antibiotic therapies and LRINEC and modified LRINEC Scores were analyzed. Logistic regression analysis was used to derive adjusted weights, and final simple point score was assessed with a ROC curve analysis.

RESULTS: Patients with NF had a mean age of 57 years, patients with erysipelas 65 years. The median hospital length of stay was 8 and 49 days in patients with erysipelas and NF, respectively. While only one patient (0.7 %) in the group of erysipelas died, the mortality rate of patients with NF was 9/44 (20.5 %). The lactate values were statistically significant higher in the NF group 4.1 vs. 2.0 mmol/l (p < 0.001). The new created CologNe-FaDe-Score shows the highest AUC-value with 0.907.

CONCLUSION: With the help of lactate values the CologNe-FaDe-Score consists of easily practicable and highly available parameters, which could sensitize diagnosis.

PMID:34324681 | DOI:10.1093/jbcr/irab148

Int J Clin Pract. 2021 Jul 29:e14665. doi: 10.1111/ijcp.14665. Online ahead of print.

ABSTRACT

PURPOSE: Methylphenidate hydrochloride is used as a first-line treatment for Attention Deficit Hyperactivity Disorder (ADHD). However, there is concern that this treatment may be associated with increased risk of refractive disorder. The aim of this study was to investigate the effect of methylphenidate therapy on myopic shifts in refraction in children diagnosed with ADHD.

METHODS: This study, children with ADHD and meeting inclusion criteria were examined before the initiation of methylphenidate treatment and 3,6 and 12 months after the initiation of treatment. Twenty age-gender matched participants who applied to the outpatient ophthalmology clinic with various complaints were included in the study as a control group. Cycloplegic refraction examination and detailed eye measurements were performed at each visit.

RESULT: Nineteen patients were included in this study and the group consisted of 11 (%57.9) females and 8 (%42.1) males. The mean age of patients was 11.3 ± 2. (range 8-18) years. During 12 months of use of mph, the spherical equivalent changed from -0.36 ± 1.08 to -0.39 ± 1.05, and this difference was not statistically significant. (p = 0.187) Axial length from 22.92 ± 0.66 There was a change to 22.93 ± 0.62, and this difference was not statistically significant. (p = 0.076) In the control group, the spherical equivalent changed from -0.43 ± 0.62 to -0.56 ± 0.84, and this difference was statistically significant. (p = 0.012) There was a change in axial length from 22.97 ± 0.78 to 22.99 ± 0.62, and this difference was statistically significant. (p = 0.015) CONCLUSION: No significant changes spherical equivalent and axial length were detected during 12-month mph use, but the increase spherical equivalent and axial length in the control group in the similar age group may indicate that mph may reduce myopic shifts in refraction progression through dopamine, similar to invivo studies.

PMID:34324770 | DOI:10.1111/ijcp.14665

J Vet Emerg Crit Care (San Antonio). 2021 Jul 29. doi: 10.1111/vec.13093. Online ahead of print.

ABSTRACT

OBJECTIVE: Species-related differences in the prevalence, manifestation, and outcome of neonatal illness may impact management practices of neonatal intensive care. The study aimed to elucidate similarities between disease manifestations and mortality risks of critically ill (CI) neonatal crias and foals admitted to the same referral center.

DESIGN: A comparative, retrospective cohort evaluation of two species (camelid and equine).

SETTING: The study was conducted in a University hospital.

ANIMALS: Two hundred and forty-six CI neonatal crias (January 1999 to May 2016) and 356 neonatal foals (February 2001 to May 2016) under 4-week-old were admitted to a university hospital.

INTERVENTION: All data are presented descriptively and compared between groups using univariate and multivariate analyses.

MEASUREMENTS AND MAIN RESULTS: Female crias (142/246, 57.7%) were significantly overrepresented in comparison to fillies (132/352, 37.5%). Congenital defects and transfer failure of passive immunity were more often observed in neonatal crias, while colic, diarrhea, patent urachus, septic arthritis, and omphalitis were significantly more common in CI foals. Overall survival to discharge (excluding fatal congenital defects) was comparable between crias (174/224; 77.8%) and foals (287/347, 82.1%), while crias (26/48; 54.2%) were more likely than foals (21/60; 35%) to die naturally than undergo euthanasia. Lower respiratory disease and indications for oxygen or IV glucose support increased mortality in the multivariate outcome models of both species. Species-specific adaptations of pediatric diagnostic criteria for sepsis were significantly associated with mortality in the multivariate analysis of patients with complete hematological datasets. However, the diagnosis of systemic inflammatory response syndrome (SIRS) did not retain statistical significance as an independent outcome predictor.

CONCLUSIONS: Lower respiratory disease and oxygen or glucose dysregulation increased mortality irrespective of species. However, despite species-specific differences in disease prevalence, the success of intensive care management was comparable.

PMID:34324773 | DOI:10.1111/vec.13093

Interact Cardiovasc Thorac Surg. 2021 Jul 29:ivab149. doi: 10.1093/icvts/ivab149. Online ahead of print.

ABSTRACT

OBJECTIVES: The purpose of this study was to determine the expression of PD-L1 in oesophageal squamous cell carcinoma (OSCC) and the prognostic factors.

METHODS: PD-L1 expression was investigated by immunohistochemical staining of resected specimens from 50 OSCC patients who were randomly selected from 104 patients with complete follow-up data. The relationships among PD-L1 expression, clinicopathological factors and prognosis were assessed by statistical analysis.

RESULTS: The expression of PD-L1 was positive in 27 (54%, positive cells’ proportion > 25%) and negative in 23 (46%, positive cells proportion ≤25%) of 50 cases, and PD-L1 expression was negative in all pericarcinomatous tissues (P > 0.05). The 5-year survival rate of patients with PD-L1-positive expression was 22.2% (6 of 27), which was less than that of patients with PD-L1-negative expression (47.8%; 11 of 23) (P < 0.05). The results showed significant differences in the depth of tumour invasion, lymph node status, postoperative pathological stage and PD-L1 expression (P < 0.05). Multivariable analysis showed that PD-L1 expression was an independent prognostic factor for survival.

CONCLUSIONS: The depth of tumour invasion, lymph node status, postoperative pathological stage and PD-L1 expression are important factors affecting the prognosis of patients with thoracic OSCC; in particular, high PD-L1 expression was a significant independent poor prognostic factor in thoracic OSCC patients.

PMID:34324661 | DOI:10.1093/icvts/ivab149

Interact Cardiovasc Thorac Surg. 2021 Jul 29:ivab200. doi: 10.1093/icvts/ivab200. Online ahead of print.

ABSTRACT

OBJECTIVES: The ability to accurately estimate the risk of peri-operative mortality after lung resection is important. There are concerns about the performance and validity of existing models developed for this purpose, especially when predicting mortality within 90 days of surgery. The aim of this study was therefore to develop a clinical prediction model for mortality within 90 days of undergoing lung resection.

METHODS: A retrospective database of patients undergoing lung resection in two UK centres between 2012 and 2018 was used to develop a multivariable logistic risk prediction model, with bootstrap sampling used for internal validation. Apparent and adjusted measures of discrimination (area under receiving operator characteristic curve) and calibration (calibration-in-the-large and calibration slope) were assessed as measures of model performance.

RESULTS: Data were available for 6600 lung resections for model development. Predictors included in the final model were age, sex, performance status, percentage predicted diffusion capacity of the lung for carbon monoxide, anaemia, serum creatinine, pre-operative arrhythmia, right-sided resection, number of resected bronchopulmonary segments, open approach and malignant diagnosis. Good model performance was demonstrated, with adjusted area under receiving operator characteristic curve, calibration-in-the-large and calibration slope values (95% confidence intervals) of 0.741 (0.700, 0.782), 0.006 (-0.143, 0.156) and 0.870 (0.679, 1.060), respectively.

CONCLUSIONS: The RESECT-90 model demonstrates good statistical performance for the prediction of 90-day mortality after lung resection. A project to facilitate large-scale external validation of the model to ensure that the model retains accuracy and is transferable to other centres in different geographical locations is currently underway.

PMID:34324664 | DOI:10.1093/icvts/ivab200

Arch Pathol Lab Med. 2021 Jul 29. doi: 10.5858/arpa.2020-0834-OA. Online ahead of print.

ABSTRACT

CONTEXT.—: Multiple articles and surveys in the literature suggest that medical students find a career in pathology undesirable and believe it is disproportionately focused primarily on the autopsy.

OBJECTIVE.—: To measure the effect of applied interventions on medical student attitudes about the field of pathology.

DESIGN.—: This prospective study involving medical students from first through fourth year was conducted as a pilot study in 2 medical schools in the United States. A 2-part anonymous survey regarding interest in pathology as a career and familiarity with the specialty using a 10-point scale was given to first- and second-year medical students before and after they listened to a 10-minute pathology career presentation. The same survey was given to third- and fourth-year medical students before and after a 4-week pathology elective.

RESULTS.—: A total of 121 and 83 students responded to the survey before and after the intervention, respectively. Of the 121 students who responded to the survey before the intervention, 106 (87.6%) had not spent significant time in a pathology laboratory before the intervention. The majority of responses in interest in career, job responsibilities, and features of pathologists before and after the intervention demonstrated a statistically significant difference (P < .001). We compared survey scores of presentation versus 4-week rotation groups before and after the intervention. Students who experienced the presentation did not differ from students who experienced the rotation in the majority of questions related to interest in career, job responsibilities, and features of pathologists.

CONCLUSIONS.—: Our study suggests that pathology exposure strategies can have a beneficial effect on student perceptions of the field and consideration of a career in pathology. Overall, the presentation intervention on the first- and second-year students seemed to have the greatest effect.

PMID:34324631 | DOI:10.5858/arpa.2020-0834-OA

Rheumatology (Oxford). 2021 Jul 29:keab570. doi: 10.1093/rheumatology/keab570. Online ahead of print.

ABSTRACT

OBJECTIVE: To estimate the occurrence and relative risks of first ever incident non-cutaneous cancer overall and by 16 sites in patients with RA treated with biologic and targeted synthetic DMARDs (b/tsDMARDs), by time since treatment start, attained age, and time on active treatment.

METHODS: Observational nationwide and population-based cohort study of patients with RA(n = 69 308), treated with TNF inhibitors (TNFi; adalimumab, certolizumab, etanercept, golimumab, infliximab) or other b/tsDMARDs (abatacept, rituximab, baricitinib, tofacitinib and tocilizumab) compared with RA patients not treated with b/tsDMARDs, and matched general population referents (n = 109 532), 2001-2018. Study based on prospectively collected data from the Swedish Rheumatology Quality Register and from other registers, linked to the national Cancer Register. Incidence rates and hazard ratios estimated via Cox regression adjusted for co-morbidities and other health characteristics.

RESULTS: : Based on 8633 incident cancers among RA patients, the overall relative risk of cancer with TNFi (HR = 1.0) was neither increased nor did it change with time since treatment start, time on active treatment, or attained age, when compared with b/tsDMARD-naïve RA. For other b/tsDMARDs, we noted no consistent signal of increased overall risks (HRs ranged from 1.0-1.2), but statistically significant estimates above 1 for abatacept with 2-5 years of active treatment, for older age groups, and between several of the bDMARDs and urinary tract cancer.

CONCLUSION: : TNFi, as used long-term in clinical practice against RA are not linked to increased risks for cancer overall. For other b/tsDMARDs, and for site-specific risks, our results are generally reassuring but contain signals that call for replication.

PMID:34324640 | DOI:10.1093/rheumatology/keab570

PLoS One. 2021 Jul 29;16(7):e0255422. doi: 10.1371/journal.pone.0255422. eCollection 2021.

ABSTRACT

In this study, a network autoregressive model with GARCH effects, denoted by NAR-GARCH, is proposed to depict the return dynamics of stock market indices. A GARCH filter is employed to marginally remove the GARCH effects of each index, and the NAR model with the Granger causality test and Pearson’s correlation test with sharp price movements is used to capture the joint effects caused by other indices with the most updated market information. The NAR-GARCH model is designed to depict the joint effects of nonsynchronous multiple time series in an easy-to-implement and effective way. The returns of 20 global stock indices from 2006 to 2020 are employed for our empirical investigation. The numerical results reveal that the NAR-GARCH model has satisfactory performance in both fitting and prediction for the 20 stock indices, especially when a market index has strong upward or downward movements.

PMID:34324604 | DOI:10.1371/journal.pone.0255422