Category: Statistics

J Clin Apher. 2021 Sep 6. doi: 10.1002/jca.21936. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Therapeutic plasma exchange (TPE) is a blood purification treatment capable of removing large molecular weight substances from plasma. It is commonly used for the removal of circulating pathogenic immunoglobulins presumed to be the cause of many autoimmune diseases. TPE can be performed with a membrane-based system (mTPE) or a centrifugal-based system (cTPE). When plasma separation is performed with a membrane, filter clotting can lead to longer treatment time, higher cost and can negatively impact patient satisfaction. In this study, we examine the operational characteristics that might influence filter life.

DESIGN, SETTING, PARTICIPANTS, & MEASURES: We report on 24 patients, with a total of 135 mTPE treatments in a single tertiary care academic center using the NxStage machine. The study focuses on treatment specific parameters that may lead to procedure failure. The main parameters of interest were transmembrane pressure (TMP) and the filtration fraction as displayed on the machine (FFd) compared to the calculated filtration fraction (FFc). Primary outcome was to measure whether TMP, FFc, and FFd influenced filter survival. Secondary outcomes included factors that might have indirectly resulted in filter failure, including hematocrit (Hct), platelet count, heparin use, and intra-treatment calcium administration.

RESULTS: In this study, we demonstrated that machine displayed filtration fractions (FFd) were lower than FFc and this difference was significantly larger in TPE sessions that experienced a clotting event (7.58 vs 6.22, P = .031). TPE sessions that clotted had a higher mean TMP (57.48 mmHg vs 44.43 mmHg, P = .001) and clotting events tended to have a lower mean blood flow rate (175.83 mL/min vs 189.55 mL/min, P = .002). In TPE sessions that received prefilter calcium administration, a higher mean dose of calcium gluconate was found in the sessions that experienced clotting (3.27 g vs 2.70 g, P = .013). Patients who experienced at least one clotting event were noted to be heavier than those patients without any clotting events (91.52 kg vs 72.15 kg, P = .040). Prefilter heparin administration was not associated with a lower incidence of filter clotting. We did not find a statistically significant difference in clotting events based upon type of intravenous access, pretreatment hematocrit, or pretreatment platelet counts.

CONCLUSION: Among patients undergoing mTPE, machine FFd on the NxStage system are consistently lower than FFc. Treatments where there was a greater difference between displayed and FFc had a greater likelihood of filter clotting. Treatments with higher TMP were associated with failed treatments. Prefilter calcium administration during treatment was associated with increased filter clotting. Lower blood flow rates and higher patient weight were also associated with increased filter clotting. Prefilter heparin administration did not reduce the incidence of filter clotting.

PMID:34486748 | DOI:10.1002/jca.21936

Transpl Int. 2021 Sep 6. doi: 10.1111/tri.14034. Online ahead of print.

ABSTRACT

Opinion surveys on health issues are considered health promotion tools. However, no studies have confirmed this in deceased organ donation for transplantation. This study aimed to analyse the impact of completing an opinion questionnaire about deceased organ donation on the attitude towards organ donation among the adolescent population. This longitudinal study with repeated measurements of attitude towards deceased organ donation was conducted with an adolescent population. The measurement instrument was a validated questionnaire of the attitude towards organ donation (PCID-DTO-Ríos). The study process involved the application of the questionnaire at an initial time, one month later, and six months later. A total of 1,374 adolescents participated in this study. The favourable attitude towards donation was 43.1%, which fell to 41.4% at one month (p=0.145), and to 39.7% at six months (p=0.019). Changes in the attitude were observed in all groups, both one and six months after the questionnaire was completed. There was no objective relationship between the adolescent’s socio-family environment and the effect of completing the questionnaire on their attitude towards deceased organ donation. In conclusion, the opinion questionnaire was not useful for promoting organ donation and did not have a positive effect on adolescents’ attitudes towards organ donation in the medium or long term.

PMID:34486763 | DOI:10.1111/tri.14034

Int J Cancer. 2021 Sep 6. doi: 10.1002/ijc.33798. Online ahead of print.

ABSTRACT

A biomarker that is useful for the detection of human papillomavirus (HPV)-related oropharyngeal cancer (OPC) and cancer of unknown primary (CUP) is indispensable. We evaluated the diagnostic performance of HPV DNA and mRNA in oral gargle samples and circulating tumor HPV16 DNA (ctHPV16DNA) in blood samples. Oral HPV DNA and mRNA were analyzed using commercially available HPV assays of the GENOSEARCH HPV31 and Aptima, respectively. ctHPV16DNA was analyzed using in-house droplet digital PCR. Seventy-four patients with OPC and eight patients with CUP were included. The sensitivity and specificity of oral HPV DNA, oral HPV mRNA, and ctHPV16DNA were 82% (95% confidence interval [CI], 66-92) and 100% (95% CI, 88-100), 85% (95% CI, 69-94) and 94% (95% CI, 73-100), and 93% (95% CI, 81-99) and 97% (95% CI, 84-100), respectively, for HPV16-related OPC, while those were 20% (95% CI, 1-72) and 100% (95% CI, 3-100), 0% (95% CI, 0-52) and 100% (95% CI, 3-100), and 100% (95% CI, 54-100) and 100% (95% CI, 16-100), respectively, for HPV16-related CUP. The sensitivity of ctHPV16DNA for HPV16-related OPC was higher than that of oral biomarkers, though the difference was not statistically significant. ctHPV16DNA remarkably correlated with the anatomic extent of disease, total metabolic tumor volume, and HPV16 copy number per tumor genome in patients with HPV16-related OPC/CUP, whereas oral biomarkers did not. In conclusion, ctHPV16DNA is a potentially promising biomarker for HPV16-related OPC, while further studies are required for HPV16-related CUP. This article is protected by copyright. All rights reserved.

PMID:34486724 | DOI:10.1002/ijc.33798

Acta Psychiatr Scand. 2021 Sep 6. doi: 10.1111/acps.13367. Online ahead of print.

ABSTRACT

OBJECTIVE: Major depressive disorder (MDD) and anxiety disorders are both common and especially challenging during pregnancy. Considering possible risks of intrauterine drug exposure of the child, the role of psychopharmacological treatment is ambiguous and various negative obstetric outcomes were inconsistently associated with medication. Consequently, a critical examination of peri- and postnatal phenomena associated with intrauterine exposure to antidepressants based on serotonin-reuptake inhibition (SRI) and subsumed under the term “poor neonatal adaptation syndrome” (PNAS) is urgently called for.

METHODS: A comprehensive literature search was conducted, revealing a total number of 33 relevant studies and 69 individual outcomes among 3025 screened studies. Seventeen outcomes allowed meta-analytic evaluation (random effects model). Measures for heterogeneity (I² ) and contour-enhanced funnel plots were generated.

RESULTS: Single studies showed increased risks for deficits in neurological functioning and autonomous adaptation in SRI exposed infants. Meta-analytical evaluation showed increased symptom occurrence or severity in exposed neonates for low APGAR scores, birth weight, size for gestational age, preterm delivery, neuromuscular and autonomous regulation, and higher rates of admission to specialized care. Mostly, increased risk after SRI exposure was supported by comparison to unexposed infants born to mothers diagnosed with depression.

CONCLUSION: Whereas statistically significant evidence for various effects of intrauterine exposure to SRI was found, the clinical relevance remains unresolved due to inherently low data quality in this research domain and insufficiently defined samples and outcomes. More systematic research under ethical considerations is required to improve multiprofessional counselling in the many women dealing with MDD during pregnancy and the peripartum.

PMID:34486740 | DOI:10.1111/acps.13367

Eur Rev Med Pharmacol Sci. 2021 Aug;25(16):5153-5162. doi: 10.26355/eurrev_202108_26529.

ABSTRACT

OBJECTIVE: We aim to evaluate the prognostic value of monocyte-to-high density lipoprotein cholesterol ratio (MHR) in patients undergoing transcatheter aortic valve replacement (TAVR).

PATIENTS AND METHODS: This was a retrospective observational study and all patients who underwent TAVR for symptomatic and/or severe aortic stenosis between January 2014 and October 2019 were evaluated. Demographic characteristics, clinical features and laboratory data were retrieved from hospital electronic database and patient charts. We evaluated independent predictors of all-cause mortality with logistic regression test. p-value <0.05 was accepted as statistically significant.

RESULTS: A total of 145 patients (mean age 78.1±7.2 years, 49.7% female) who underwent TAVR were included in the study. The median MHR was 13.73 (interquartile range (IQR) 10.0-25.9). In correlation analysis, MHR positively correlated with only serum CRP level (R: 0.383, p=<0.001). The mortality rates during the observation period were 76.1% and 4.1% in patients who had MHT over and below the median MHR value, respectively (p<0.001). Based on the results of multivariate binary logistic regression analysis, MHR and presence of cerebrovascular accident emerged as independent predictors of all-cause mortality (OR: 1.514, 95% CI:1.231-1.862).

CONCLUSIONS: This is the first study of the independent predictive ability of MHR in TAVR patients. The strong independent predictive power of MHR possibly stems from the underlying coronary artery disease. Further studies particularly examining the predictive role of MHR on cardiovascular adverse events and cardiovascular death in TAVR patients are needed.

PMID:34486690 | DOI:10.26355/eurrev_202108_26529

Eur Rev Med Pharmacol Sci. 2021 Aug;25(16):5208-5214. doi: 10.26355/eurrev_202108_26534.

ABSTRACT

OBJECTIVE: Bronchial asthma and obesity are correlated diseases that are highly prevalent among children. The effect of increased body mass index (BMI), aggravating asthma, is currently controversial in this group. The aim of this study is to determine the association between Body Mass Index and severity of asthma among obese children with asthma and normal-weight children with asthma in Riyadh, Saudi Arabia.

PATIENTS AND METHODS: Data from a cross-sectional analysis of 64 participants from Riyadh, Saudi Arabia, were analyzed. Symptoms were assessed through children’s and caregivers’ responses to a pretested questionnaire. Grouping of children into obese (18) and non-obese (46) was based on their body mass index (BMI) percentile. Association between obesity and final asthma score was estimated by chi-square test using SPSS software and p-value set at 0.005.

RESULTS: The mean age was 10.13 ± 2.54 years (ranged 5 to 14), and the majority, 46 (71.88%), were boys. Most of the participants, 46 (71.88%), were normal to underweight and 18 (28.13%) were overweight or obese. Most of the children, 35 (54.69%), complained of cough because of asthma sometimes. Out of 64 participants, 21 (32.81%) had uncontrolled asthma, and 43 (67.19%) had controlled asthma calculated using a questionnaire. Out of 46 non-obese children with asthma, 7 (15.22%) had uncontrolled asthma, and out of 18 obese children with asthma, 14 (77.78%) had uncontrolled asthma, and the difference in the proportion of Asthma severity was significant statistically across the groups (p-value <0.001).

CONCLUSIONS: Poor control of asthma symptoms was significantly higher in both obese and normal-weight children with asthma.

PMID:34486695 | DOI:10.26355/eurrev_202108_26534

Eur Rev Med Pharmacol Sci. 2021 Aug;25(16):5090-5103. doi: 10.26355/eurrev_202108_26520.

ABSTRACT

OBJECTIVE: The aim of the study was to compare the risk of chemotherapy induced alopecia among patients with scalp cooling therapy, compared to those that did not receive scalp cooling.

MATERIALS AND METHODS: A systematic search was conducted in the PubMed, Scopus, Cochrane Database of Systematic Reviews and Google scholar databases. Studies, preferably randomized controlled trials, that compared scalp cooling with no scalp cooling (control) for risk of alopecia or hair loss in patients undergoing chemotherapy were considered for inclusion. The strength of association was presented in the form of pooled adjusted relative risk (RR) for categorical outcomes and weighted mean difference (WMD) for continuous outcomes. Statistical analysis was done using STATA version 16.0.

RESULTS: A total of 14 articles were identified, of which 9 were included in the meta-analysis and for the remaining 5 articles, the findings were synthesized descriptively. Compared to control group patients, those that received scalp cooling had 41% lower risk of alopecia [RR 0.59, 95% CI: 0.53, 0.66]. The overall quality of pooled evidence for the risk of alopecia was judged “moderate”. There were no differences in the anxiety score [WMD 0.57, 95% CI: -0.55, 1.69], depression score [WMD 0.31, 95% CI: -1.19, 1.80], score reflecting emotional functioning [WMD 0.06, 95% CI: -1.37, 1.49] and social functioning [WMD -8.37, 95% CI: -25.7, 8.93] among the two groups of patients. The pooled evidence suggests that around 66% (95% CI: 37-95%) of the subjects reported some discomfort with use of scalp cooling system. The commonly reported complaints included headache, scalp and neck pain, discomfort due to chill, nausea/vomiting and dizziness.

CONCLUSIONS: Findings suggest that the use of scalp cooling, compared to no scalp cooling, reduces the risk of significant hair loss. The acceptability of this cooling system might be limited by a high incidence of reported complaints.

PMID:34486683 | DOI:10.26355/eurrev_202108_26520

Eur Rev Med Pharmacol Sci. 2021 Aug;25(16):5137-5144. doi: 10.26355/eurrev_202108_26526.

ABSTRACT

OBJECTIVE: To evaluate the correlation between culprit vessel/tirofiban and reperfusion bradyarrhythmia in patients with ST-segment elevation myocardial infarction (STEMI) after emergency percutaneous coronary intervention (PCI).

PATIENTS AND METHODS: A total of 123 STEMI patients undergoing emergency PCI in our hospital from September 2018 to September 2019 were selected and divided into the reperfusion arrhythmias (RA) group (50 cases) and non-RA group (NRA, 73 cases) according to whether RA occurring during PCI. The baseline data such as age and underlying disease were statistically analyzed. Then, the differences were compared between the two groups. According to whether reperfusion bradyarrhythmia (RB) occurring during PCI, 123 STEMI patients were divided into the RB group (63 cases) and non-RB group (60 cases). The relation between culprit vessel/tirofiban and RB was analyzed. ROC curves analysis and multivariate logistic regression were conducted for the risk factors of RA and RB.

RESULTS: Among 123 patients with STEMI after PCI treatment, 73 patients had RA (59.35%), including RB 63 cases and tachyarrhythmia 10 cases. Results of single factor analysis showed that there was statistical significance in 3 factors including the patient age, infarction area and vascular blood flow TIMI classification between RA group and NRA group (p<0.05). ROC curve analysis indicated that the continuous variable patent ages had predictive value in the prevalence of RA, which resulting in an AUC 0.624 and a cut-off pointed age 57 (sensitivity 72.60, specificity 52.00). Multivariate regression analysis showed that the patient age (>57 years old), infarction area in inferior wall and grade 0 lesion vascular blood flow TIMI classification in RA group was significantly higher than that in NRA group (p<0.05). Tirofiban was not associated with RB in STEMI patients treated with emergency PCI, while culprit vessel was statistically significant between RB group and NRB group (p<0.05). Multivariate regression analysis indicated that culprit vessel of the right coronary artery and grade 0 lesions vascular blood flowed TIMI classification was independent risk factors to occurring RB in the STEMI patients with emergency PCI.

CONCLUSIONS: Tirofiban was not associated with RB in STEMI patients treated with emergency PCI. However, it may increase the risk of RB development when the culprit vessel is the right coronary artery. Therefore, timely corresponding treatments and reduction of reperfusion damage are of great significance for those patients.

PMID:34486688 | DOI:10.26355/eurrev_202108_26526

Aesthet Surg J. 2021 Sep 6:sjab333. doi: 10.1093/asj/sjab333. Online ahead of print.

ABSTRACT

BACKGROUND: Recent evidence suggests tranexamic acid (TXA) may improve outcomes in aesthetic surgery patients.

OBJECTIVES: This systematic review aimed to investigate the impact of TXA use in aesthetic plastic surgery on bleeding and aesthetic outcomes.

METHODS: A systematic literature search was conducted to identify studies evaluating TXA use in aesthetic plastic surgery. The primary outcome of interest was perioperative bleeding, reported as total blood loss (TBL), ecchymosis, and hematoma formation. Meta-analyses analyzing TBL, and postoperative hematoma were performed.

RESULTS: Of 287 identified articles, 14 studies evaluating TXA use in rhinoplasty (6), rhytidectomy (3), liposuction (3), reduction mammaplasty (1), and blepharoplasty (1) were included for analysis. Of 820 total patients, 446 (54.4%) received TXA. Meta-analysis demonstrated TXA is associated with 26.3mL average blood loss reduction (95% CI: -40.0mL to -12.7mL, p < 0.001) and suggested a trend toward decreased odds of postoperative hematoma with TXA use (OR: 0.280, 95% CI: 0.076 – 1.029, p = 0.055). Heterogeneity among reporting of other outcomes precluded meta-analysis; however, 5 of 7 studies found significantly decreased postoperative ecchymosis levels within 7 days of surgery, three studies found statistically significant reductions in postoperative drain output, and one study reported significantly improved surgical site quality for patients who received TXA (p = 0.001).

CONCLUSIONS: TXA is associated with decreased blood loss and a trend toward decreased hematoma formation in aesthetic plastic surgery. Its use has the potential to increase patient satisfaction with postoperative recovery and decrease costs associated with complications, including hematoma evacuation.

PMID:34486647 | DOI:10.1093/asj/sjab333

Ann Med Surg (Lond). 2021 Aug 24;69:102765. doi: 10.1016/j.amsu.2021.102765. eCollection 2021 Sep.

ABSTRACT

INTRODUCTION: Emergence agitation is a common problem that can occur after administration of general anesthesia and during recovery time especially in pediatric patients, which can result in life-threatening events if not managed adequately and timely. Usage of modern inhalational anesthetic agents like sevoflurane, isoflurane, and also halothane is a common cause for emergence agitation. Currently, the use of propofol is gaining acceptance largely on decreasing emergence agitation in addition to prevention of postoperative nausea and vomiting. The objective of this study was to assess the effectiveness of prophylaxis administration of propofol on incidence & severity of emergence agitation on pediatric patients undergo ENT & ophthalmic surgery under general anesthesia.

METHODS AND MATERIAL: An institutional-based prospective cohort study was conducted on 90 patients. Patients who take 1 mg/kg of propofol were grouped into exposed while if propofol were not given grouped to non-exposed. Data were collected through intraoperative observation & by using WATCH & PAED score the patients were observed at 5, 15 & 30 min in the recovery room. Incidence of emergence agitation was analyzed by chi-square test & Mann Whitney U test was applied for the severity of emergence agitation. A P-value less than 0.05 was declared as statistically significant.

RESULT: From a total of 90 study participants 64% of the non-exposed group & 31% of the exposed group were developed emergence agitation which was statistically significant with p = 0.002. The severity of agitation was also higher in the non-exposed group than the exposed group at 5, 15 & 30 min with p = 0.009, 0.013, and 0.011 respectively.

CONCLUSION: Administering 1 mg/kg propofol before the end of surgery in pediatrics ENT & ophthalmic procedure under general anesthesia is effective in reducing incidence & severity of emergence agitation. Based on our findings we recommend using 1 mg/kg propofol at the end of surgery to reduce the occurrence of emergency agitation.

PMID:34484732 | PMC:PMC8403542 | DOI:10.1016/j.amsu.2021.102765