Nevin Manimala

Ear Nose Throat J. 2023 Oct 20:1455613231207291. doi: 10.1177/01455613231207291. Online ahead of print.

ABSTRACT

Objectives: Little is known about the prevalence of epistaxis in children. Existing reports focus on hospitalized children or those presenting to an emergency department. To better understand pediatric epistaxis in clinical practice, we sought out a searchable, representative outpatient database and examined the incidence of epistaxis in children of different ages. Methods: A cross-sectional analysis of data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from the years 2007 to 2011 was performed. The NHAMCS is a Centers for Disease Control and Prevention-curated national sample of data from visits to non-federally employed office-based physicians and health centers. We queried the NHAMCS to determine the cumulative incidence of epistaxis in children of different age groups. The International Classification of Diseases Ninth Revision code 784.7 was chosen to identify epistaxis. Comparisons of rates were performed using the chi-squared test. A P-value of <.05 was considered statistically significant. Results: In total, 55,435,691 children [27,816,237 (50.2%) males, 55,435,691 (77.2%) white] were included. The overall cumulative incidence rate of epistaxis was 2.4/1000 children. Children in the 3- to 5-year range had the highest cumulative incidence of epistaxis (5.0/1000), followed by those in the 6 to 8 (3.0/1000), 9 to 11 (2.0/1000), 0 to 2 (1.9/1000), 12 to 14 (1.6/1000), and 15 to 17 (0.5/1000) year ranges (P < .001). Conclusion: Pediatric epistaxis is common in the office setting (2.4 per 1000 children)-and well above emergency department estimates (1.7 per 1000 people). Children between the ages of 3 to 5 years have the highest cumulative incidence. Epistaxis is sufficiently unusual in infants and the late teens that alternative causes for nasal bleeding should be included in the differential diagnosis.

PMID:37864343 | DOI:10.1177/01455613231207291

J Clin Oncol. 2023 Oct 21:101200JCO2302132. doi: 10.1200/JCO.23.02132. Online ahead of print.

ABSTRACT

PURPOSE: Immunotherapy and chemotherapy combinations have shown activity in endometrial cancer, with greater benefit in mismatch repair-deficient (dMMR) than MMR-proficient (pMMR) disease. Adding a PARP inhibitor may improve outcomes, especially in pMMR disease.

METHODS: This phase III, global, double-blind, placebo-controlled trial randomized eligible patients with newly diagnosed advanced or recurrent endometrial cancer 1:1:1 to: carboplatin/paclitaxel plus durvalumab placebo followed by placebo maintenance (control arm); carboplatin/paclitaxel plus durvalumab followed by maintenance durvalumab plus olaparib placebo (durvalumab arm); or carboplatin/paclitaxel plus durvalumab followed by maintenance durvalumab plus olaparib (durvalumab+olaparib arm). Primary end points were progression-free survival (PFS) for durvalumab and durvalumab+olaparib arms versus control.

RESULTS: 718 patients were randomized. In the intent-to-treat population, statistically significant PFS benefit was observed in the durvalumab (HR, 0.71; 95% CI, 0.57 to 0.89; P=.003) and durvalumab+olaparib arms (HR, 0.55; 0.43 to 0.69; P<.0001) versus control. Pre-specfied, exploratory subgroup analyses showed PFS benefit in dMMR (HR [durvalumab v control], 0.42; 0.22 to 0.80; HR [durvalumab+olaparib v control], 0.41; 0.21 to 0.75) and pMMR subgroups (HR [durvalumab v control], 0.77; 0.60 to 0.97; HR [durvalumab+olaparib v control] 0.57; 0.44 to 0.73); and in PD-L1-positive subgroups (HR [durvalumab v control], 0.63; 0.48 to 0.83; HR [durvalumab+olaparib v control], 0.42; 0.31 to 0.57). Interim overall survival results (maturity ∼28%) were supportive of the primary outcomes (durvalumab v control: HR, 0.77; 0.56 to 1.07; P=.120; durvalumab+olaparib v control: HR, 0.59; 0.42 to 0.83; P=.003). The safety profiles of the experimental arms were generally consistent with individual agents.

CONCLUSIONS: Carboplatin/paclitaxel plus durvalumab followed by maintenance durvalumab with or without olaparib demonstrated a statistically significant and clinically meaningful PFS benefit in patients with advanced or recurrent endometrial cancer.

PMID:37864337 | DOI:10.1200/JCO.23.02132

Cytometry A. 2023 Oct 20. doi: 10.1002/cyto.a.24808. Online ahead of print.

ABSTRACT

Microalgae, small photosynthetic unicells, are of great interest to ecology, ecotoxicology and biotechnology and there is a growing need to investigate the ability of cells to photosynthesize under variable conditions. Current strategies involve hand-operated pulse-amplitude-modulated (PAM) chlorophyll fluorimeters, which can provide detailed insights into the photophysiology of entire populations- or individual cells of microalgae but are typically limited in their throughput. To increase the throughput of a commercially available MICROSCOPY-PAM system, we present the PAM Automation Control Manager (‘PACMan’), an open-source Python software package that automates image acquisition, microscopy stage control and the triggering of external hardware components. PACMan comes with a user-friendly graphical user interface and is released together with a stand-alone tool (PAMalysis) for the automated calculation of per-cell maximum quantum efficiencies (= F_v /F_m ). Using these two software packages, we successfully tracked the photophysiology of >1000 individual cells of green algae (Chlamydomonas reinhardtii) and dinoflagellates (genus Symbiodiniaceae) within custom-made microfluidic devices. Compared to the manual operation of MICROSCOPY-PAM systems, this represents a 10-fold increase in throughput. During experiments, PACMan coordinated the movement of the microscope stage and triggered the MICROSCOPY-PAM system to repeatedly capture high-quality image data across multiple positions. Finally, we analyzed single-cell F_v /F_m with the manufacturer-supplied software and PAMalysis, demonstrating a median difference <0.5% between both methods. We foresee that PACMan, and its auxiliary software package will help increase the experimental throughput in a range of microalgae studies currently relying on hand-operated MICROSCOPY-PAM technologies.

PMID:37864330 | DOI:10.1002/cyto.a.24808

Brief Bioinform. 2023 Sep 22;24(6):bbad369. doi: 10.1093/bib/bbad369.

ABSTRACT

Inference of gene regulatory network (GRN) from gene expression profiles has been a central problem in systems biology and bioinformatics in the past decades. The tremendous emergency of single-cell RNA sequencing (scRNA-seq) data brings new opportunities and challenges for GRN inference: the extensive dropouts and complicated noise structure may also degrade the performance of contemporary gene regulatory models. Thus, there is an urgent need to develop more accurate methods for gene regulatory network inference in single-cell data while considering the noise structure at the same time. In this paper, we extend the traditional structural equation modeling (SEM) framework by considering a flexible noise modeling strategy, namely we use the Gaussian mixtures to approximate the complex stochastic nature of a biological system, since the Gaussian mixture framework can be arguably served as a universal approximation for any continuous distributions. The proposed non-Gaussian SEM framework is called NG-SEM, which can be optimized by iteratively performing Expectation-Maximization algorithm and weighted least-squares method. Moreover, the Akaike Information Criteria is adopted to select the number of components of the Gaussian mixture. To probe the accuracy and stability of our proposed method, we design a comprehensive variate of control experiments to systematically investigate the performance of NG-SEM under various conditions, including simulations and real biological data sets. Results on synthetic data demonstrate that this strategy can improve the performance of traditional Gaussian SEM model and results on real biological data sets verify that NG-SEM outperforms other five state-of-the-art methods.

PMID:37864293 | DOI:10.1093/bib/bbad369

Physiol Rep. 2023 Oct;11(20):e15843. doi: 10.14814/phy2.15843.

ABSTRACT

Ambulatory sleep and blood pressure monitoring are gaining popularity as these can be completed in an individual’s home. Little is known regarding the reliability of data and the time it takes to acclimate to the equipment. This study aimed to determine how many nights of wearing the monitoring equipment were required to restore sleep architecture and blood pressure data to baseline. It was hypothesized familiarization would be demonstrated by night 3. Ten male and 10 female subjects completed three nights of sleep and blood pressure recordings. At visit 1, the subjects were familiarized with the equipment and instructed to wear the Sleep Profiler{trade mark, serif} and SunTech Medical Oscar2 ambulatory blood pressure cuff simultaneously for three consecutive nights, then subjects returned the equipment. The percent of time spent in rapid eye-movement (REM) sleep was statistically different on night 3 when compared to night 1. Wake-after-sleep onset and sleep latency were not statistically different between nights 1, 2, and 3. Systolic, diastolic, and pulse pressure were all significantly lower on night 3 compared to night 1. Cortical and autonomic arousals were statistically different on night 3. Ambulatory sleep and blood pressure monitoring need at least 3 nights for familiarization. The percent of time spent in REM sleep was statistically different on night 3 when compared to night 1. Systolic blood pressure, diastolic blood pressure, and pulse pressure were all significantly lower on night 3 compared to night 1. Cortical and autonomic arousals were statistically different on nights 3 and 2, respectively compared to night 1. Based on these findings, ambulatory sleep and blood pressure monitoring takes three nights before the data are reliable and the person is familiarized with the mode of measurement. Therefore, it is recommended to use at least three nights of data collection when using the Sleep Profiler and Oscar2 ambulatory blood pressure cuff in order for results to be valid and reliable.

PMID:37864278 | DOI:10.14814/phy2.15843

J Orthop Surg Res. 2023 Oct 20;18(1):788. doi: 10.1186/s13018-023-04282-7.

ABSTRACT

PURPOSE: The purpose of this study was to characterize the impact of detraining due to the COVID-19 pandemic on incidence of bony injuries and stress fractures in collegiate athletes.

METHODS: A comprehensive collegiate athletic conference injury database was queried for all in-season, sport-related bony injuries (defined as all stress reactions and fractures) that occurred across all sports from January 2016 to June 2021. The bony injury rate per 1000 athlete exposure hours (AEH) was calculated and compared between the immediate post-hiatus season and historic rates from pre-hiatus seasons (2016-2019). Injury characteristics were also compared between the pre- and post-hiatus time periods.

RESULTS: A total of 868 bony injuries across 23 sports were identified. The sports with highest overall baseline bony injury rates in historic seasons were women’s cross country (0.57 injuries per 1000 AEH) and men’s cross country (0.32). Compared to historic pre-hiatus rates, female cross-country runners demonstrated a significantly lower bony injury incidence rate in the post-hiatus season (0.24 vs. 0.57, p = 0.016) while male swimming athletes demonstrated a statistically significant increase in bony injury rate (0.09 vs. 0.01, p = 0.015). The proportion of bony injuries attributed to repetitive trauma increased; while, the proportion of injuries attributed to running decreased between the pre- and post-hiatus seasons.

CONCLUSION: Across all sports, there was no consistent trend toward increased rates of bony injury in the immediate post-hiatus season. However, female cross-country runners demonstrated lower rates of bony injury in the post-hiatus season while male swimmers demonstrated higher rates. Furthermore, bony injuries in the post-hiatus season were more likely to be the result of repetitive trauma and less likely to be from running.

LEVEL OF EVIDENCE: Level III, retrospective, cross sectional study.

PMID:37864273 | DOI:10.1186/s13018-023-04282-7

BMC Sports Sci Med Rehabil. 2023 Oct 20;15(1):136. doi: 10.1186/s13102-023-00748-7.

ABSTRACT

BACKGROUND: Dietary patterns that include high-quality and varied food groups have the potential to modulate oxidative status. This research was conducted to determine dietary diversity score (DDS) and food quality score (FQS) in football players and their matched non-athletes, also their associations with oxidative indicators assessed by the urinary levels of F_2alpha-isoprostane (F_2a-IP) and 8-hydroxy-2′-deoxyguanosine (8-OHdG).

METHODS: Participants consisted of 45 male football players and 45 male non-athletes in two age-and body mass index (BMI)-matched groups from Shiraz City, Iran. Anthropometric measurements were performed, and urine samples were analyzed to determine oxidative biomarkers. Dietary data derived from a reliable food frequency questionnaire with 168 items was completed to determine DDS and FQS. For data analysis, an appropriate generalized estimating equation model was set up.

RESULTS: Our results demonstrated that FQS (β = 5.46; P < 0.001) and DDS (β = 1.30; P < 0.001) scores were significantly higher in the footballers in comparison to the non-athletes. Moreover, FQS was negatively associated with 8-OHdG (β=-0.35; P = 0.008) and F_2a-IP (β=-4.30; P = 0.01) levels in all participants. In addition, DDS was inversely related to 8-OHdG (β=-1.25; P = 0.01) and F_2a-IP (β=-11.67; P = 0.04) levels in all participants.

CONCLUSIONS: Food quality scores and dietary diversity of footballers’ diets were found to be higher in comparison to the non-athletes. Furthermore, a higher FQS and DDS were associated with lower levels of oxidative biomarkers in all participants.

PMID:37864256 | DOI:10.1186/s13102-023-00748-7

Malar J. 2023 Oct 20;22(1):318. doi: 10.1186/s12936-023-04687-z.

ABSTRACT

BACKGROUND: The importation of parasites across borders remains a threat to malaria elimination. The Southern African Development Community Malaria Elimination Eight (E8) established 39 border health facilities on 5 key international borders between high and low-burden countries. These clinics aimed to improve access to prevention, diagnosis, and treatment of malaria for residents in border areas and for mobile and migrant populations who frequently cross borders. Studies were conducted in each of the four high-burden E8 countries (Angola, Mozambique, Zambia, and Zimbabwe) to evaluate malaria services in border areas.

METHODS: Cross-sectional surveys were conducted within 30 km of recently established E8 Border Health Posts. Structured questionnaires were administered to randomly selected respondents to assess malaria-related knowledge and behavior, access to malaria prevention, diagnosis and treatment of malaria, and risk factors for malaria associated with local and cross-border travel.

RESULTS: Results showed that most providers followed appropriate guidelines performing blood tests when individuals presented with fever, and that nearly all those who reported a positive blood test received medication. Lack of access to health care due to distance, cost or mistrust of the provider was rare. A minority of respondents reported not receiving timely diagnosis either because they did not seek help, or because they were not offered a blood test when presenting with fever. There was a high level of correct knowledge of causes, symptoms, and prevention of malaria. A majority, of border residents had access to primary prevention against malaria through either long-lasting insecticidal nets (LLINs) or indoor residual spraying (IRS). Cross border travel was common with travellers reporting sleeping outside without protection against malaria.

CONCLUSIONS: The study demonstrated the importance of border health facilities in providing access to malaria services. Prevention needs to be improved for people who travel and sleep outdoors. Community health workers can play a key role in providing access to information, testing and treating malaria.

PMID:37864245 | DOI:10.1186/s12936-023-04687-z

BMC Nurs. 2023 Oct 20;22(1):398. doi: 10.1186/s12912-023-01552-x.

ABSTRACT

BACKGROUND: Basic Life Support (BLS) plays an important role in increasing the survival rate of hospitalized heart attack patients. There are no previous studies on the effect of BLS training among Palestinian nurses. This study aimed to evaluate the effect of simulation-based BLS training program on nurses’ knowledge Palestinian nurses at governmental hospitals.

METHODS: A quasi-experimental, pre & post-test design was used. 700 nurses were recruited proportionally using a simple random sampling method among 2980 nurses from 13 public hospitals in the Gaza Strip. This study was conducted from June to August 2022. A practical BLS test consisting of 10 multiple-choice questions according to American Heart Association guidelines (2020) was collected and sociodemographic characteristics. SPSS software, version 24 was used for the statistical analysis. Descriptive statistics and weighted mean were used. T-Test and One-way analysis of variance (ANOVA) were applied to determine differences in means among groups.

RESULTS: Most of the participating nurses (55.7%) were male, while (44.3%) were female. The majority of nurses (84.4%) are under 40 years of age. The weighted mean scores in the pre-test ranged from 52.2 to 75.1% and the mean scores was (6.16 ± 1.97). After applying conventional BLS training, the weighted mean scores ranged from 85.6 to 97.3% and the mean scores was (9.19 ± 1.04). The study revealed that the nurses’ knowledge increased after applying simulation-based training program. The mean of knowledge scores was statistically significant between the pre and post-test on the basis of the current work hospital (P-value < 0.001).

CONCLUSION: This study affords significant evidence of the positive effects of the BLS training program in improving nurses’ knowledge; we recommend advanced BLS training for all healthcare providers, doctors, and nurses working in hospitals and healthcare centers. Nursing managers can implement systematic strategies to enhance nurses’ knowledge and practice in BLS to target low-scoring Governorates.

PMID:37864224 | DOI:10.1186/s12912-023-01552-x

BMC Public Health. 2023 Oct 20;23(1):2061. doi: 10.1186/s12889-023-16988-8.

ABSTRACT

BACKGROUND: Intimate partner violence (IPV) remains a global public health concern for both men and women. Spatial mapping and clustering analysis can reveal subtle patterns in IPV occurrences but are yet to be explored in Rwanda, especially at a lower small-area scale. This study seeks to examine the spatial distribution, patterns, and associated factors of IPV among men and women in Rwanda.

METHODS: This was a secondary data analysis of the 2019/2020 Rwanda Demographic and Health Survey (RDHS) individual-level data set for 1947 women aged 15-49 years and 1371 men aged 15-59 years. A spatially structured additive logistic regression model was used to assess risk factors for IPV while adjusting for spatial effects. The district-level spatial model was adjusted for fixed covariate effects and was implemented using a fully Bayesian inference within the generalized additive mixed effects framework.

RESULTS: IPV prevalence amongst women was 45.9% (95% Confidence interval (CI): 43.4-48.5%) while that for men was 18.4% (95% CI: 16.2-20.9%). Using a bivariate choropleth, IPV perpetrated against women was higher in the North-Western districts of Rwanda whereas for men it was shown to be more prevalent in the Southern districts. A few districts presented high IPV for both men and women. The spatial structured additive logistic model revealed higher odds for IPV against women mainly in the North-western districts and the spatial effects were dominated by spatially structured effects contributing 64%. Higher odds of IPV were observed for men in the Southern districts of Rwanda and spatial effects were dominated by district heterogeneity accounting for 62%. There were no statistically significant district clusters for IPV in both men or women. Women with partners who consume alcohol, and with controlling partners were at significantly higher odds of IPV while those in rich households and making financial decisions together with partners were at lower odds of experiencing IPV.

CONCLUSION: Campaigns against IPV should be strengthened, especially in the North-Western and Southern parts of Rwanda. In addition, the promotion of girl-child education and empowerment of women can potentially reduce IPV against women and girls. Furthermore, couples should be trained on making financial decisions together. In conclusion, the implementation of policies and interventions that discourage alcohol consumption and control behaviour, especially among men, should be rolled out.

PMID:37864202 | DOI:10.1186/s12889-023-16988-8