Category: Statistics

Transpl Int. 2021 Nov 19. doi: 10.1111/tri.14156. Online ahead of print.

ABSTRACT

Within pregnancies occurring between 1986-2017 in Dutch kidney transplant recipients (KTR), we retrospectively compared short-term maternal and fetal outcomes between patients on calcineurin inhibitor (CNI) based (CNI+) and CNI free -immunosuppression (CNI-). We identified 129 CNI+ and 125 CNI- pregnancies in 177 KTR. Demographics differed with CNI+ having higher body mass index (p=0.045), shorter transplant-pregnancy interval (p<0.01), later year of transplantation and -pregnancy (p<0.01). Serum creatinin levels were numerically higher in CNI+ in all study phases, but only reached statistical significance in third trimester (127 vs 105 µmol/L; p<0.01), where the percentual changes from preconceptional level also differed (+3.1% versus -2.2% in CNI-; p=0.05). Postpartum both groups showed 11-12% serum creatinin rise from preconceptional level. Incidence of low birth weight (LBW) tended to be higher in CNI+ (52% vs 46%; p=0.07). Both groups showed equal high rates of preterm delivery. Using CNIs during pregnancy lead to a rise in creatinin in the third trimester but does not negatively influence the course of graft function in the first year postpartum or direct fetal outcomes. High rates of preterm delivery and LBW in KTR, irrespective of CNI use, classify all pregnancies as high-risk.

PMID:34797607 | DOI:10.1111/tri.14156

Diagn Cytopathol. 2021 Nov 19. doi: 10.1002/dc.24904. Online ahead of print.

ABSTRACT

BACKGROUND: The Thyroid Imaging Reporting and Data System (TIRADS) was created to assess risk of thyroid nodules through ultrasound. Plenty classifications methods for thyroid nodules have already been created, but none of them have yet achieved global utilization. This study analyzed the performance of the American College of Radiology (ACR) TIRADS, its reproducibility and the impact of its utilization as a screening method in a large Cancer Center cohort.

METHODS: Thyroid nodules which underwent fine-needle aspiration (FNA) in a 1-year period were selected, with their ultrasound images retrospectively classified according to the ACR TI-RADS. Cytological evaluation of the nodules and final histology (whenever available) was used to assess risk of neoplasm (RON) and risk of malignancy (ROM) associated to each ACR-TIRADS category. Further analyses were also carried out according to recommendation or not of FNA by the ACR-TIRADS and nodule size. Inter-observer agreement for the system was also assessed.

RESULTS: A total of 1112 thyroid nodules were included. RON for each category according to final cytological diagnosis was 0% for TR1 and TR2, 2.1% for TR3; 15.6% for TR4 and 68.9% for TR5. No significant difference was observed between the RON of the categories for cases above or below 1.0 cm. Nodules that met the criteria for FNA had 3 times greater chance of a positive outcome. Substantial agreement (kappa 0.77) was seen between two different observers.

CONCLUSIONS: ACR TI-RADS scoring system has demonstrated to be an accurate method to stratify thyroid nodules in a Cancer Center, with a high reproducibility.

PMID:34797612 | DOI:10.1002/dc.24904

Eur J Neurol. 2021 Nov 19. doi: 10.1111/ene.15190. Online ahead of print.

ABSTRACT

BACKGROUND: The causal effect of insulin resistance on small vessel stroke and Alzheimer Disease was controversial in previous studies. We therefore applied Mendelian randomization (MR) analyses to identify causal effect of insulin resistance on small vessel stroke and Alzheimer’s disease (AD).

METHODS: We selected 12 single-nucleotide polymorphisms (SNPs) associated with fasting insulin levels and 5 SNPs associated with gold standard measures of insulin resistance as instrumental variables in MR analyses. Summary statistical data of SNP-small vessel stroke and of SNP-AD associations were derived from the MEGASTROKE and PGC-ALZ of individuals of European ancestry. Two-sample MR estimates were conducted with inverse-variance-weighted, robust inverse-variance-weighted, simple median, weighted median, weighted mode-based estimator, and MR pleiotropy residual sum and outlier methods.

RESULTS: Genetically predicted higher insulin resistance had a higher odds ratio (OR) of small vessel stroke [OR 1.23; 95% confidence intervals (CI) 1.05-1.44; P =0.01 using fasting insulin; OR 1.25; 95% CI 1.07-1.46; P =0.006 using gold standard measure of insulin resistance] and AD (OR 1.13; 95% CI 1.04-1.23; P =0.004 using fasting insulin; OR 1.02; 95% CI 1.00-1.03; P =0.03 using gold standard measures of insulin resistance) using the inverse-variance-weighted method. No evidence of pleiotropy was found using MR-Egger regression.

CONCLUSION: Our findings provide a genetic support for potential causal effect of insulin resistance on small vessel stroke and AD.

PMID:34797599 | DOI:10.1111/ene.15190

Rev Gastroenterol Mex (Engl Ed). 2021 Nov 15:S2255-534X(21)00115-8. doi: 10.1016/j.rgmxen.2021.11.001. Online ahead of print.

ABSTRACT

INTRODUCTION AND AIMS: Percutaneous liver biopsy with histopathologic analysis is a valuable tool for the diagnosis, prognosis, and treatment evaluation of liver diseases. Its ultrasound-guided performance is useful, making the procedure safer and reducing the risk for complications and hospital stay. Our aim was to describe the indications, histopathologic study, and complications associated with the performance of ultrasound-guided percutaneous liver biopsy in pediatric patients.

MATERIAL AND METHODS: The study included 102 ultrasound-guided percutaneous liver biopsies performed on patients <16 years of age, within the time frame of January 2014 and December 2019. The information was obtained from electronic files and histopathologic studies and the data were analyzed through descriptive statistics.

RESULTS: A total of 102 procedures were carried out on 99 patients. Mean patient age was 72 months and 58.8% of the patients were female. Over 65% of the indications for liver biopsy included autoimmune hepatitis (23.5%), elevated liver enzymes (21.5%), and chronic liver disease (20.5%). Four patients presented with immediate complications (3.9%), three of which were major (2.9%), concurring with that reported in the international literature.

CONCLUSIONS: Our study corroborates the importance of ultrasound-guided liver biopsy in the diagnosis and follow-up of pediatric patients. The procedure also had a low complication rate of only 3.9%.

PMID:34794922 | DOI:10.1016/j.rgmxen.2021.11.001

Rev Gastroenterol Mex (Engl Ed). 2021 Nov 16:S2255-534X(21)00118-3. doi: 10.1016/j.rgmxen.2021.11.004. Online ahead of print.

ABSTRACT

INTRODUCTION AND AIMS: Due to its different clinical manifestations, gastroesophageal reflux disease (GERD) requires diverse diagnostic and therapeutic interventions. The aim of the study was to evaluate the degree of agreement among Latin American specialists, with respect to the management of GERD.

MATERIALS AND METHODS: A cross-sectional study was conducted through a survey with 42 statements (22 related to diagnosis and 20 to treatment) applied to 56 specialists from Latin America. There were 4 possible statement responses: in complete agreement, in partial agreement, in partial disagreement, and in complete disagreement. Reproducibility, level of agreement, and concordance were measured through the Kappa statistic.

RESULTS: The response rate was 81% (47/56). General concordance was low, given that there was complete concordance in only 12 statements (28.6%). There was partial concordance in 22 statements (52.4%) and no concordance in 8 (19%). The following themes had the most disagreement: the performance of endoscopy before beginning treatment, the use of proton pump inhibitors (PPIs) in patients with extraesophageal symptoms and with no typical symptoms, and the combined use of PPIs and prokinetics.

CONCLUSIONS: In the present study, we found that there was agreement among the Latin American specialists for the diagnosis and management of GERD in less than one-third of the recommendations considered standard. The low concordance could be related to the fact that the availability of diagnostic tools and medications, as well as the prevalence of GERD phenotypes, are different in each country.

PMID:34794927 | DOI:10.1016/j.rgmxen.2021.11.004

Rev Esp Med Nucl Imagen Mol (Engl Ed). 2021 Nov 15:S2253-8089(21)00153-1. doi: 10.1016/j.remnie.2021.10.005. Online ahead of print.

ABSTRACT

INTRODUCTION AND OBJECTIVES: The human immunodeficiency virus [HIV] is a lentevirus, primarily infects certain cells of the immune system, thereby greatly weakens the body’s own defenses against diseases. This study was aimed to explore the value and significance of ¹⁸F-FDG PET/CT in the assessment of patients with HIV infection and to examine the presence of quantitative alterations in ¹⁸F-FDG uptake among patients with HIV-related infections or malignant diseases in HIV-positive patients.

PATIENTS AND METHODS: Forty patients with HIV infection were scanned on PET/CT system. The data were registered according to immune status, antiretroviral therapy, and definitive diagnosis. All pathologic lesions and disease related areas were described, ¹⁸F-FDG uptake patterns were evaluated. Semiquantitative analysis of ¹⁸F-FDG uptake was performed and SUVmax were calculated.

RESULTS: Twenty-eight patients [70%] were diagnosed with HIV-related infection or malignant diseases. The sensitivity of PET/CT was shown to be 100% and the specificity 92% for concomitant diseases requiring additional treatment to antiretroviral therapy. The SUVmax and CD4 counts were not statistically different between HIV-related reactive lymphadenopathy, HIV-related malignancy, and HIV-related infections.

CONCLUSIONS: The pattern of distribution of nodal/extranodal uptake on ¹⁸F-FDG PET/CT may facilitate distinction between HIV-related generalized lymphadenopathies, HIV-related opportunistic infections, and malignancies. In this context, ¹⁸F-FDG PET/CT should be preferred for routine use in the management of patients infected with HIV.

PMID:34794914 | DOI:10.1016/j.remnie.2021.10.005

Rev Gastroenterol Mex (Engl Ed). 2021 Nov 15:S2255-534X(21)00117-1. doi: 10.1016/j.rgmxen.2021.11.003. Online ahead of print.

ABSTRACT

INTRODUCTION: The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein (CRP) level are simple laboratory test parameters that can provide us with information on the inflammatory status of the organism. CRP has been shown to be a predictor of postoperative complications, whereas NLR and PLR have shown greater usefulness in the prognosis of oncologic pathologies.

AIM: To evaluate the associations of NLR and PLR with postoperative complications following gastric oncologic surgery and compare them with CRP.

MATERIALS AND METHODS: A prospective study was conducted on 66 patients that underwent oncologic gastric surgery, within the time frame of January 2014 and March 2019. The variables analyzed were sociodemographic data, surgical technique, tumor extension, and NLR, PLR, and CRP levels from the first day after surgery, as well as postoperative complications.

RESULTS: Seventeen patients (25.8%) presented with grade III-V complications, utilizing the Clavien-Dindo classification system. Mean NLR value was 11.30 and was associated with the appearance of major complications, with statistical significance (p = 0.009). Mean PLR was266.05 and was not significantly associated with complications (p = 0.149). Fifty-four patients had a mean CRP level of 143.24 and it was not related to the appearance of major complications (p = 0.164).

CONCLUSIONS: The NLR is a simple and inexpensive parameter, which measured on postoperative day one, predicted the appearance of major postoperative complications in our study sample and appears to be a better predictive parameter than CRP for said complications. Further studies to confirm that trend need to be carried out.

PMID:34794921 | DOI:10.1016/j.rgmxen.2021.11.003

Pain Manag Nurs. 2021 Nov 15:S1524-9042(21)00220-4. doi: 10.1016/j.pmn.2021.10.002. Online ahead of print.

ABSTRACT

BACKGROUND: Cancer pain prevalence remains high, and variance in self-efficacy for managing pain may explain why some patients experience greater pain severity.

AIM: This study explored perceptions of self-efficacy in relation to cancer pain severity and treatment related characteristics.

METHOD: A descriptive cross-sectional survey was administered to 50 cancer outpatients. Data analysis involved descriptive and correlational statistical analyses.

RESULTS: Self-efficacy to manage pain was significantly associated with time since diagnosis and ability to deal with frustration, and inversely associated with pain severity level. A large proportion of patients reported low satisfaction self-managing their pain. Most patients reported independently self-managing their cancer pain; however, satisfaction with pain management was low for a large proportion of patients. Time since cancer diagnosis and ability to deal with frustration due to cancer pain were positively associated with cancer pain self-efficacy, whereas pain self-efficacy had a significant inverse correlation with cancer pain severity.

CONCLUSIONS: Enhancing self-efficacy to self-manage under-treated cancer pain is important with implications for improving pain outcomes and quality of life. Further investigation on unmet needs and preferences for cancer pain self-management support is warranted.

PMID:34794885 | DOI:10.1016/j.pmn.2021.10.002

Surgeon. 2021 Nov 15:S1479-666X(21)00158-X. doi: 10.1016/j.surge.2021.09.001. Online ahead of print.

ABSTRACT

BACKGROUND: Total hip arthroplasty (THA) using a minimally invasive (MI) approach is a commonly performed procedure, and several approaches are now being used clinically. The MI anterolateral (MIAL) approach is one of the MI approaches used in clinical practice. Whether the MIAL approach is superior to non-MI approaches remains controversial. To resolve this controversy, we performed a systematic review and a meta-analysis of results of THA procedures that used the MIAL approach. We assessed whether the MIAL approach was superior to the lateral transmuscular (LT) approach in terms of operative time, operative blood loss, radiological parameters, and clinical outcomes.

METHODS: We performed a methodical search for all literature published on PubMed, Web of Science, and the Cochrane Library, and pooled data using the RevMan software. A p value < 0.05 was considered statistically significant. We calculated the mean differences (MD) for continuous data with 95% confidence intervals (CI) for each outcome.

RESULTS: This meta-analysis included 6 studies. Pooled results indicated no statistically significant differences between the groups in terms of operative time (MD = 5.13, 95% CI -2.49 to 12.75, p = 0.19), cup abduction angle (MD = 1.64, 95% CI -1.32 to 4.60, p = 0.28), and cup anteversion angle (MD = 0.75, 95% CI -1.09 to 2.59, p = 0.43). Operative blood loss was significantly greater in those who underwent THA via the MIAL approach than those who underwent THA via the LT approach (MD = 68.01, 95% CI 14.69 to 121.33, p = 0.01). The postoperative Harris hip score (HHS) assessed at the time of final follow-up was significantly higher in those who underwent THA via the MIAL approach than those who underwent THA via the LT approach (MD = 1.41, 95% CI 0.50 to 2.33, p = 0.002).

CONCLUSION: We conclude that the MIAL approach is superior to the LT approach in terms of clinical outcomes.

LEVEL OF EVIDENCE: Level Ⅱ.

PMID:34794904 | DOI:10.1016/j.surge.2021.09.001

J Foot Ankle Surg. 2021 Oct 22:S1067-2516(21)00387-2. doi: 10.1053/j.jfas.2021.09.028. Online ahead of print.

ABSTRACT

Diabetes increases the risk of developing postoperative complications such as superficial and deep infection, wound dehiscence, and revisional surgery. Prolonged non-weightbearing and/or augmented fixation may reduce postoperative complications in complicated diabetic ankle fractures. This study’s purpose was to compare the development of postoperative infection, wound dehiscence, and revisional surgery in complicated diabetic ankle fractures with respect to weightbearing status. We hypothesized that fewer complications would occur in patients with prolonged non-weightbearing. Medical records of 90 surgically treated complicated diabetic ankle fractures were retrospectively reviewed for postoperative radiographs, weightbearing status, and complications. Complicated diabetes was defined as HbA1c ≥ 8% within 1 year of surgery. Twenty-four out of 90 patients had prolonged non-weightbearing status, which was defined as ≥ 8 weeks of non-weightbearing postoperatively. Twelve out of 90 patients had augmented fixation, which was defined as standard open reduction and internal fixation plus ≥ 2 tetra-cortical or > 2 tri-cortical syndesmotic screws with medial plate, external fixation, or other combination. Thirty-three out of 90 patients (36.7%) patients developed complications postoperatively. Patients with prolonged non-weightbearing had less complications (29.2% vs 39.4%, p = .37) and larger HbA1c values compared with early weightbearing patients (10.0 vs 9.3, p = .04). A one-unit increase in creatinine value (mg/dL) revealed a 3.15-fold increase in development of complications (95% confidence interval 1.29-7.65, p = .01). Although not statistically significant, complicated diabetic ankle fractures treated with prolonged non-weightbearing had less complications postoperatively except for ankle Charcot. Creatinine can be utilized as an independent risk factor for postoperative complications in this population.

PMID:34794875 | DOI:10.1053/j.jfas.2021.09.028