Nevin Manimala

S Afr Med J. 2024 Oct 3;114(10):e2035.

ABSTRACT

BACKGROUND: Adverse events are common, and impact patients and healthcare systems negatively. Large international systems investigate adverse events at length, but South African data are lacking.

OBJECTIVES: To classify all adverse events that have occurred in our department over the last decade.

METHODS: Ten years of data from a prospectively collated electronic medical record system were analysed for adverse events. All admitted patients were included. Duplicate entries and those that did not describe adverse events were excluded.

RESULTS: The study period was from December 2012 to January 2023. There were 52 835 distinct admissions covering 321 385 inpatient days. After categorisation, a total of 14 537 adverse events were captured, giving an adverse event rate of 22%. Adverse events were categorised into four groups. Of the total, 8 027 events were clinical care related, 3 106 were pathology related, 2 662 were system related and 442 miscellaneous. A total of 300 were excluded. Clinical care-related adverse events comprised 57.3% of the total number. Of those, adverse events related to indwelling devices (32.4%), iatrogenic injuries (12.5%) and intravenous therapy administration (12.5%) contributed most. Pathology-related adverse events contributed 21.4% of the total, of which wound sepsis (29.5%), anastomotic leak (15.1%) and nosocomial pneumonia (14.4%) were the most common. There was a general downward trend in reported adverse events from 2016 to 2022.

CONCLUSION: Adverse events are common, and their aetiology is multifactorial. A sustained and multi-faceted approach is needed to address the challenge they pose.

PMID:39508226

Adv Clin Exp Med. 2024 Nov 7. doi: 10.17219/acem/193367. Online ahead of print.

ABSTRACT

BACKGROUND: Out-of-hospital cardiac arrests (OHCA) are a major global health concern, occurring frequently worldwide. Obesity may impact outcomes in OHCA patients.

OBJECTIVES: This study aimed to assess the impact of obesity on the return of spontaneous circulation (ROSC) in OHCA patients, considering sex differences.

MATERIAL AND METHODS: A retrospective cohort study was conducted, analyzing medical records of patients assisted by the Emergency Medical System (EMS) in Poland from January 2021 to June 2022. The study included 33,636 patients with OHCA. Obesity status was determined using ICD-10 codes (E66) and descriptive diagnoses recorded by EMS teams.

RESULTS: Univariate analysis indicated that obesity decreased the odds of ROSC by 25.47% (odds ratio (OR) = 0.75, 95% confidence interval (95% CI): 0.61-0.92) in women and by 19.76% (OR = 0.80, 95% CI: 0.66-0.97) in men. However, multivariate analysis, adjusting for confounding variables, did not confirm a statistically significant impact of obesity on ROSC outcomes. The likelihood of ROSC was significantly higher in individuals with an initial ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT) rhythm compared to Asystole/pulseless electrical activity (PEA), being 4.204 times higher in women (95% CI: 3.525-5.014) and 3.655 times in men (95% CI: 3.320-4.023). Out-of-hospital cardiac arrest in a public place increased the odds of ROSC more than twofold for both sexes (women: OR = 2.20, 95% CI: 2.00-2.43; men: OR = 2.13, 95% CI: 1.98-2.29). Among women without obesity, hypertension decreased the odds of ROSC by 11.11% (OR = 0.89, 95% CI: 0.81-0.99).

CONCLUSIONS: Our study demonstrated that obesity was not an independent predictor of ROSC in OHCA patients. Different predictors of ROSC were identified for men and women. Initial VF/pVT rhythm, location of OHCA and age were the significant factors influencing ROSC.

PMID:39508211 | DOI:10.17219/acem/193367

Biom J. 2024 Dec;66(8):e202300203. doi: 10.1002/bimj.202300203.

ABSTRACT

In practical survival analysis, the situation of no event for a patient can arise even after a long period of waiting time, which means a portion of the population may never experience the event of interest. Under this circumstance, one remedy is to adopt a mixture cure Cox model to analyze the survival data. However, if there clearly exhibits an acceleration (or deceleration) factor among their survival times, then an accelerated failure time (AFT) model will be preferred, leading to a mixture cure AFT model. In this paper, we consider a penalized likelihood method to estimate the mixture cure semiparametric AFT models, where the unknown baseline hazard is approximated using Gaussian basis functions. We allow partly interval-censored survival data which can include event times and left-, right-, and interval-censoring times. The penalty function helps to achieve a smooth estimate of the baseline hazard function. We will also provide asymptotic properties to the estimates so that inferences can be made on regression parameters and hazard-related quantities. Simulation studies are conducted to evaluate the model performance, which includes a comparative study with an existing method from the smcure R package. The results show that our proposed penalized likelihood method has acceptable performance in general and produces less bias when faced with the identifiability issue compared to smcure. To illustrate the application of our method, a real case study involving melanoma recurrence is conducted and reported. Our model is implemented in our R package aftQnp which is available from https://github.com/Isabellee4555/aftQnP.

PMID:39508209 | DOI:10.1002/bimj.202300203

J Interpers Violence. 2024 Nov 7:8862605241293802. doi: 10.1177/08862605241293802. Online ahead of print.

ABSTRACT

This study assessed physical intimate partner violence (IPV) experiences and examined their association with unmet healthcare needs among married women in South Korea. We analyzed data from a nationally representative longitudinal survey of 6,533 women at baseline. Participants were asked yes/no questions about their experiences of physical IPV victimization and perpetration over the past year. The responses were classified into four categories of IPV experience: “none,” “victimization only,” “perpetration only,” and “both victimization and perpetration.” At baseline, 0.9% reported being victimized only, and 25.9% reported both victimization and perpetration. The prevalence of unmet healthcare needs over the past year at baseline was 0.8%. Compared to women without any IPV experience, women in the IPV “victimization only” category had greater unmet healthcare needs (OR: 5.49, 95% CI [2.30, 13.12]) after adjusting for sociodemographic variables. Experiencing IPV perpetration only and both IPV victimization and perpetration were not statistically significantly associated with unmet healthcare needs. These results imply that physical IPV victims face difficulties accessing healthcare services which could exacerbate health inequalities over time. Moreover, this study suggests that it is necessary to distinguish IPV victims from those who experience IPV victimization only and those who experience both IPV victimization and perpetration.

PMID:39508207 | DOI:10.1177/08862605241293802

J Diabetes Investig. 2024 Nov 7. doi: 10.1111/jdi.14344. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to assess the correlation between hip circumference (HC) and the risk of cardiovascular disease (CVD) and type 2 diabetes mellitus using Mendelian randomization (MR) to overcome observational study limitations.

DESIGN: MR analysis utilized genetic variation from the MR Base in a two-sample analysis. Three methods were employed: MR-Egger regression, weighted median estimator, and inverse variance weighting (IVW).

SETTING: Data was acquired from MR Base, a platform summarizing genome-wide association study (GWAS) data for MR research.

MAIN OUTCOME MEASURES: Publicly available summary statistics datasets from GWAS meta-analyses were used, with HC and HC adjusted for body mass index (BMI) as exposures. Data for CVD and type 2 diabetes mellitus were obtained as outcomes.

RESULTS: Results indicated a positive causal relationship between HC and CVD (IVW: P = 1.84e-07, OR: 1.37, 95% CI: 1.22-1.54) as well as type 2 diabetes mellitus (IVW: P = 0.04, OR: 1.62, 95% CI: 1.02-2.56), independent of BMI. However, HC after BMI adjustment showed no significant causal relationship with CVD (IVW: P = 0.05, OR: 1.09, 95% CI: 1.00-1.19) and exhibited a negative association with type 2 diabetes mellitus (IVW: P = 0.00, OR: 0.76, 95% CI: 0.66-0.88), suggesting a protective effect against type 2 diabetes mellitus.

CONCLUSIONS: After adjusting for BMI, adipose tissue concentrated in the hip region showed a protective effect against type 2 diabetes mellitus but not against CVD. These findings offer insights into diabetes prevention and treatment strategies, and may inform plastic surgery procedures. Further research is needed to validate these findings and explore underlying mechanisms.

PMID:39508205 | DOI:10.1111/jdi.14344

J Neurosurg. 2024 Jan 16;141(1):1-9. doi: 10.3171/2023.9.JNS231615. Print 2024 Jul 1.

ABSTRACT

OBJECTIVE: It is unknown whether efforts to expand access to neurosurgery worldwide have translated to an increase in the global neurosurgery workforce, particularly in low- and middle-income countries. The main objective of this study was to quantify the number and distribution of consultant neurosurgeons worldwide, while also identifying temporal and geographic trends in the neurosurgery workforce in different income levels and WHO regions, and analyzing what factors might contribute to the growth of a national workforce.

METHODS: This study was a subanalysis of an electronic cross-sectional survey administered to participants identified through neurosurgery societies, personal contacts, and online searches of all 193 countries and 26 territories, independent states, and disputed regions as defined by the World Bank (WB) and United Nations between October 2022 and March 2023. Population-weighted statistics for the consultant neurosurgery workforce and resource availability were estimated, and linear regression analysis was conducted to identify correlations with growth in the workforce.

RESULTS: Data were obtained for 192 countries (99.5%) and 25 additional territories, states, and disputed regions (96.2%). One hundred seventy-seven respondents participated in the survey. There were an estimated 72,967 neurosurgeons worldwide, representing a global pooled density of 0.93 neurosurgeons per 100,000 people and a median country density of 0.44 neurosurgeons per 100,000 people. The authors found an increasing density of consultant neurosurgeons, from low-income countries (0.12 per 100,000 people), to lower-middle-income countries (LoMICs; 0.37), to upper-middle-income countries (UpMICs; 1.13), and to high-income countries (2.44). The WHO African and Southeast Asia regions had the lowest pooled neurosurgeon density, while the Western Pacific region (WPR) had the highest density. There were 29 countries, 14 territories, and 1 independent state with no neurosurgeons. Neurosurgeons in countries with higher income-level designations had more frequent access to resources and equipment. The annual growth rates in workforce density were highest in LoMICs (26.0%) and UpMICs (21.3%), and the most rapid annual growth was in the Southeast Asia region (33.0%). Regression analysis revealed that an increasing population quartile, the Eastern Mediterranean region (relative to the WPR), the presence of a national neurosurgery society, increasing global development aid, and national gross domestic product were associated with relative growth in national neurosurgeon density.

CONCLUSIONS: The authors estimate a global consultant neurosurgeon workforce of nearly 73,000 neurosurgeons, with stark disparities in the density and growth of the workforce in different WB income-level groups and WHO regions. The presence of a neurosurgery society was correlated with the growth of the workforce, and this study identified several regional targets for further intervention to expand access to neurosurgery.

PMID:39508199 | DOI:10.3171/2023.9.JNS231615

Laryngoscope. 2024 Nov 7. doi: 10.1002/lary.31889. Online ahead of print.

ABSTRACT

OBJECTIVES: We aim to use the Area Deprivation Index (ADI) to investigate the correlations between neighborhood socioeconomic disadvantage (NSD), SARS-CoV-2 vaccination rates, infection severity, and subsequent audiovestibular symptoms.

METHODS: In this retrospective cohort study, surveys were administered to participants ≥18 years of age who received a SARS-CoV-2 vaccination and/or tested positive for SARS-CoV-2 infection between January 2020 and September 2022. ADI scores were calculated for each patient to quantify NSD. Statistical analyses were performed to compare demographic and clinical characteristics between ADI quintiles.

RESULTS: Of 2415 participants, the majority were female (62.8%) and White (87%), with a mean age of 60.8 years. Individuals in ADI Quintile 5 were less likely to receive second booster doses than those in Quintile 1 (58% vs. 71%, p < 0.0001). Among those infected with SARS-CoV-2, those in ADI Quintile 5 were 2.5 times more likely to be hospitalized (relative risk = 2.46, 95% confidence interval [1.03, 5.88]) than those in Quintile 1. Symptoms more likely to be experienced by participants in ADI Quintile 5 than those in Quintile 1 immediately following SARS-CoV-2 infection included headaches (28% vs. 21%, p = 0.02), aural fullness (14% vs. 6%, p < 0.0001), change of hearing (8% vs. 4%, p = 0.01), dizziness (15% vs. 8%, p < 0.01), and otalgia (8% vs. 4%, p < 0.01).

CONCLUSIONS: Individuals experiencing greater NSD were found to have lower SARS-CoV-2 vaccine booster rates, higher rates of postinfection hospitalization, and increased rates of certain otologic and neurotologic symptoms following infection.

LEVEL OF EVIDENCE: III Laryngoscope, 2024.

PMID:39508181 | DOI:10.1002/lary.31889

NMR Biomed. 2024 Nov 7:e5287. doi: 10.1002/nbm.5287. Online ahead of print.

ABSTRACT

Articular cartilage (AC) is a specialized connective tissue that covers the ends of long bones and facilitates the load-bearing of joints. It consists of chondrocytes distributed throughout an extracellular matrix and organized into three zones: superficial, middle, and deep. Nuclear magnetic resonance (NMR) techniques can be used to characterize this layered structure. In this study, devoted to a better understanding of the NMR response of this complex tissue, 20 specimens excised from femoral and tibial cartilage of bovine samples were analyzed by the low-field single-sided NMR-MOUSE-PM10. A multiparametric depth-wise analysis was performed to characterize the laminar structure of AC and investigate the origin of the NMR dependence on depth. The depth dependence of the single parameters T₁, T₂, and D has been described in literature, but their simultaneous measurement has not been fully exploited yet, as well as the extent of their variability. A novel parameter, α, evaluated by applying a double-quantum-like sequence, has been measured. The significant decrease in T₁, T₂, and D from the middle to the deep zone is consistent with depth-dependent composition and structure changes of the complex matrix of fibers confining and interacting with water. The α parameter appears to be a robust marker of the layered structure with a well-reproducible monotonic trend across the zones. The discrimination of cartilage zones was reinforced by a multivariate principal component analysis statistical analysis. The large number of samples allowed for the identification of the smallest number of parameters or their combination able to classify samples. The first two components clustered the data according to the different zones, highlighting the sensitivity of the NMR parameters to the structural and compositional variations of AC. Using two parameters, the best result was obtained by considering T₁ and α. Single-sided NMR devices, portable and low-cost, provide information on NMR parameters related to tissue composition and structure.

PMID:39508171 | DOI:10.1002/nbm.5287

Biol Res Nurs. 2024 Nov 7:10998004241295360. doi: 10.1177/10998004241295360. Online ahead of print.

ABSTRACT

Background: This study aims to investigate the association between serum calcium levels and acute coronary syndrome (ACS) risk, examining whether this relationship differs by sex, given the known differences in calcium metabolism and hormonal influences between males and females. Methods: Utilizing the Korean Genome Epidemiology Study (KoGES) prospective cohort data, our primary exposure variables were serum calcium level and sex. The incidence of ACS served as the main outcome of interest. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox regression analysis. An interaction analysis was conducted to assess the interaction effect of calcium level and sex on ACS incidence. Results: After adjusting for confounding variables, high calcium intake did not significantly increase ACS incidence, with a hazard ratio (HR) of 1.07 (95% CI: 0.90-1.26). There was also no significant difference in ACS risk between females and males (HR: 0.81, 95% CI: 0.61-1.04). However, interaction effect analysis revealed that higher calcium levels were associated with an increased risk of ACS only in females (HR: 1.24, 95% CI: 1.07-1.58), whereas the association in males was not statistically significant (HR: 0.90, 95% CI: 0.71-1.15). Conclusion: Our study results indicate that elevated serum calcium levels alone did not independently increase the risk of ACS; however, high serum calcium levels were associated with an increased risk of ACS in females but not in males, underscoring the importance of sex-specific factors in assessing and managing ACS risk and highlighting the necessity for personalized medical approaches to improve cardiovascular health outcomes for women.

PMID:39508165 | DOI:10.1177/10998004241295360

J Am Heart Assoc. 2024 Nov 7:e036898. doi: 10.1161/JAHA.124.036898. Online ahead of print.

ABSTRACT

BACKGROUND: Seven million lesbian, gay, and bisexual (LGB) adults will be aged >50 years by 2030; assessing and addressing their risk for cardiovascular disease is critical.

METHODS AND RESULTS: We analyzed a nationwide cohort using the Veterans Health Administration data. Sexual orientation (SO) was classified via a validated natural language processing algorithm. Prevalent atherosclerotic cardiovascular disease (ASCVD) (history of acute myocardial infarction, ischemic stroke, or revascularization) was identified via International Classification of Diseases, Ninth and Tenth Revision (ICD-9 and ICD-10) codes. The index date was the date of the first primary care appointment on or after October 1, 2009. We ascertained covariates and prevalent ASCVD in the year following the index date; the baseline date was 1 year after the index date. We calculated sample statistics by sex and SO and used logistic regression analyses to assess associations between SO and prevalent ASCVD. Of 1 102 193 veterans with natural language processing-defined SO data, 170 861 were classified as LGB. Prevalent ASCVD was present among 25 031 (4105 LGB). Adjusting for age, sex, race, and Hispanic ethnicity, LGB veterans had 1.24 [1.19-1.28] greater odds of prevalent ASCVD versus non-LGB identified veterans. This association remained significant upon additional adjustment for the ASCVD risk factors substance use, anxiety, and depression (odds ratio [OR],1.17 [95% CI, 1.13-1.21]). Among a subset with self-reported SO, findings were consistent (OR, 1.53 [95% CI, 1.20-1.95]).

CONCLUSIONS: This is one of the first studies to examine cardiovascular risk factors and disease of the veteran population stratified by natural language processing-defined SO. Future research must explore psychological, behavioral, and physiological mechanisms that result in poorer cardiovascular health among LGB veterans.

PMID:39508159 | DOI:10.1161/JAHA.124.036898