Nevin Manimala

Burns. 2023 Nov 3:S0305-4179(23)00226-7. doi: 10.1016/j.burns.2023.10.019. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the prognostic value of the Ryan score, Belgian Outcome of Burn Injury (BOBI) score,revised Baux (rBaux) score, and a new model (a Logit(P)-based scoring method created in 2020) for predicting mortality risk in patients with extremely severe burns and to conduct a comparative analysis.

METHODS: A retrospective analysis was conducted on 599 burn patients who met the inclusion criteria and were admitted to the burn unit of the First Affiliated Hospital of Nanchang University from 2017 to 2022. Relevant information was collected, and receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) were plotted for each of the four models in assessing mortality in these burn patients using both age-stratified and unstratified forms. The ROC curve section was further compared with the area under the curve (AUC), optimal cutoff value, as well as its sensitivity and specificity. Additionally, the quality of the AUC was assessed using the Delong test.

RESULT: Among the patients who met the inclusion criteria, 532 were in the survival group and 67 in the death group. Irrespective of age stratification, the novel model exhibited superior performance with an AUC of 0.868 (95% CI: 0.838-0.894) among all four models predicting mortality risk in included patients, and also demonstrated better AUC quality than other models; the calibration curves showed that the accuracy of all four models was good; the DCA curves showed that the clinical utility of the novel model and rBuax score were better. In the comparison of four scoring models across different age groups, the new model demonstrated the largest AUC in both 0-19 years (0.954, 95% CI 0.914-0.979) and 20-59 years groups (0.838, 95% CI 0.793-0.877), while rBuax score exhibited the highest AUC in ≥ 60 years group (0.708, 95% CI of 0.602-0.800). The calibration curves showed that the four models exhibited greater accuracy within the age range of 20-59 years, while the DCA curves indicated that both the novel model and rBuax score scale displayed better prediction in both the 20-59 and ≥ 60 years groups.

CONCLUSIONS: All four models demonstrate accurate and effective prognostication for patients with severe burns. Both the novel model and rBaux score exhibit enhanced prediction utility. In terms of the model itself alone, the new model is not simpler than, for example, the rBaux score, and whether it can be applied clinicallyinvolves further study.

PMID:38008701 | DOI:10.1016/j.burns.2023.10.019

Drugs Real World Outcomes. 2023 Nov 26. doi: 10.1007/s40801-023-00403-0. Online ahead of print.

ABSTRACT

BACKGROUND: Adverse drug events among older adults result in significant mortality, morbidity and cost. This harm may be mitigated with appropriate prescribing and deprescribing. We sought to understand the prescribing outcomes of an interdisciplinary geriatric virtual consultation service.

METHODS: We conducted a retrospective, before-and-after feasibility study to measure prescribing outcomes for a medication optimization virtual interdisciplinary geriatric specialist (MOVING) programme comprised of expertise from geriatric clinical pharmacology, pharmacy and psychiatry for older adults (aged ≥ 65 years) between June and December 2018, Ontario, Canada. The primary outcome was the number of distinct prescriptions and the presence of polypharmacy (defined as ≥ 4 medications) before and after the service. Secondary outcomes included the number of as needed and regularly administered prescriptions, number of potentially inappropriate prescriptions as defined by the Beers and STOPP criteria, and number of prescriptions for psychotropics, long-acting opioids and diabetic medications.

RESULTS: We studied 40 patients with a mean age of 80.6 [standard deviation (SD) 8.8] years who received a MOVING consult. We found no significant change in the mean total number of prescriptions per patient before (12.02, SD 5.83) and after the intervention (11.58, SD 5.28), with a mean difference of -0.45 [95% confidence interval (CI) -0.94 to 0.04; p = 0.07]. We found statistically significant decreases in as needed prescriptions (mean difference – 0.30, 95% CI – 0.45 to – 0.15; p<0.001), and potentially harmful medications as identified by the Beers (mean difference -1.25, 95% CI -2.00 to -0.50; p = 0.002) and STOPP (mean difference -1.65, 95% CI -2.33 to -0.97; p < 0.001) scores. Without including the cost savings from hospital diversion by a MOVING consult, the costs of a MOVING consult were $545.80-$629.80 per person, compared with the costs associated with traditional in-person consults involving similar specialist clinical services ($904.89-$1270.69 per person).

CONCLUSION: A MOVING model of care is associated with decreases in prescriptions for potentially inappropriate medications in older adults. These findings support further evaluation to ascertain health system impacts.

PMID:38007818 | DOI:10.1007/s40801-023-00403-0

Stud Health Technol Inform. 2023 Nov 23;308:669-679. doi: 10.3233/SHTI230899.

ABSTRACT

OBJECTIVE: To analyze the regularity of modern Chinese herbal compound in the treatment of salivation based on data mining technology, and to study the potential mechanism of core Chinese herbal medicine in the treatment of salivation using network pharmacology and molecular docking.

METHODS: CNKI, VIP and Wanfang literature databases were searched.Choose a prescription for salivation.Excel2019 was used to establish a database of formulas for the treatment of salivation.The included TCM compounds were analyzed by frequency statistics and association rules using the ancient and modern medical record cloud platform to obtain the core drug pairs.TCMSP and Uniprot were used to search the components and targets of the core drug pairs, and intersected with the disease targets obtained from Genecards, OMIM, TTD, PharmgKb, and DrugBank platforms.Complex networks were constructed by cytoscape3.9.1; PPI networks were completed by STRING platform; GO and KEEG pathway enrichment analysis was performed by R language; finally molecular docking validation was performed using AutoDockTools software; and the results were visualized by Pymol software.

RESULTS: 122 prescriptions were obtained, 194 herbs were used, the total frequency was 1047, and the top ten drugs used were Atractylodes macrocephala Koidz, Poria cocos, Glycyrrhiza uralensis, Yizhiren, Citrus sinensis, Codonopsis pilosula, Yam, Pinellia ternate, Zingiber officinale, and Coptis chinensis.After association rule analysis, the core drug pair Codonopsis pilosula – Atractylodes macrocephala Koidz was obtained.Twenty-seven effective active components of core drug pairs were screened, corresponding to 62 targets for the treatment of salivation, and four core targets were MAPK1, TP53, MAPK14, and ESR1.GO enrichment analysis yielded 1789 biological process entries, 81 cellular component entries and 111 molecular function entries.KEGG enrichment analysis resulted in 157 pathways, and the first 30 were selected for visualization.Molecular docking of luteolin, 7-Methoxy-2-methyl isoflavone, Stigmasterol, 3β-acetoxyatractylone, Frutinone A, 3betaHydroxymethyllenetanshiquinone, glycitein to the core target showed that the key active components had good binding activity to the core target.

CONCLUSION: The key active components of Codonopsis pilosula and Atractylodes macrocephala Koidz in the treatment of salivation act on MAPK1, TP53, MAPK14 and ESR1 through Calcium, PI3K Akt and IL-17 signaling pathways to regulate the physiological processes of nerve, muscle, endocrine and reproductive systems and the physiological functions of nerve cells, providing a theoretical reference for the later study of integrated traditional Chinese and western medicine in the treatment of salivation.

PMID:38007798 | DOI:10.3233/SHTI230899

Stud Health Technol Inform. 2023 Nov 23;308:662-668. doi: 10.3233/SHTI230898.

ABSTRACT

With the development of the times, spinal problems are not only one of the diseases that older people pay close attention to, but also gradually spread among teenagers. Therefore, it is very important to predict the possibility of wound infection in patients after spinal fusion and internal fixation. The method is to statistically analyze the clinical data of patients with clinical spinal disease, and to propose individualized treatment and recovery plan for each patient’s pathological characteristics and postoperative recovery, so as to realize humanized service and minimize the possibility of wound infection. In this paper, Logistic logistic regression, SMOTE algorithm and confusion matrix are used to model the probability of infection after spinal fusion and internal fixation. In the positive confirmation analysis part, the information data of 449 clinical cases were selected for analysis, and 14 variables such as gender, age, number of internal fusion fixation segments, past medical history, intraoperative blood transfusion and bleeding volume were selected as research indicators to explore the related factors of postoperative infection. The classification method adopts two classifications. The two types of data are ‘postoperative infection’ and ‘postoperative non-infection’. In the statistical description of the data, it is found that age, selection of internal fusion fixation segments, preoperative hospitalization days, cerebrospinal fluid leakage, and preoperative ASA score are all important factors affecting the incidence of postoperative infection.

PMID:38007797 | DOI:10.3233/SHTI230898

Stud Health Technol Inform. 2023 Nov 23;308:583-589. doi: 10.3233/SHTI230888.

ABSTRACT

This study focuses on the analysis of the effects of potential factors on the Death Rate of Covid-19. The factors, in both demographic and economic aspects, have been discussed in the study through the extensive application of statistical inference, such as the Analysis of Variance (ANOVA), Univariate Linear Regression, and Multivariate Linear Regression. In the result section, the significance of the effects of these factors on Covid-19 has been carefully discussed.

PMID:38007787 | DOI:10.3233/SHTI230888

Stud Health Technol Inform. 2023 Nov 23;308:359-364. doi: 10.3233/SHTI230860.

ABSTRACT

In this study, screening, confirmation and validation of mismatch allele-specific (AS) forward (F)-primers are executed to establish a quadruplex amplification analysis (real-time PCR) for discrimination of CYP2D6*10, ADRB1, NPPA and CYP3A5*3 genotypes associated with hypertensive pharmacogenomics. To significantly distinguish heterozygote and homozygote, ΔCq (differences in threshold cycles between the wild-type F-primer amplification assay and the mutant-type F-primer amplification assay) was utilized to determine outcomes. Detection of plasmid by uniplex real-time PCR was used to screen the mismatch AS F-primers. Robustness assessment and agreement analysis were employed to confirm and validate initially selected F-primers, respectively. Robustness assessment confirmed that except of ADRB1 (0.7-0.9), amplification efficiency ranged from 0.9 to 1.1. No statistically significant difference was found between the analysis and NGS. Therefore, the optimized F-primer as polymorphism recognition molecules can benefit the genotyping guiding drug delivery in anti-hypertension treatment.

PMID:38007760 | DOI:10.3233/SHTI230860

Stud Health Technol Inform. 2023 Nov 23;308:253-260. doi: 10.3233/SHTI230847.

ABSTRACT

Gram-negative bacteria had been regarded as several important sources of lethal infection. Rapid identification of pathogenic bacteria is extremely important for the diagnosis and clinical treatment of diseases. In current study, three gram-negative bacteria, including Klebsiella aerogenes, Enterobacter cloacae and Escherichia coli, were used to access the feasibility of characterizing Gram-negative bacteria by surface-enhanced Raman Spectroscopy (SERS). Bacterial samples were from Escherichia coli isolates (n=1000), Klebsiella aerogenes isolates (n=1000) and Enterobacter cloacaeand isolates (n=1000). The differences of three Gram-negative bacteria were characterized by SERS spectra. Furthermore, four multivariate statistical algorithms based on the combination of principal component analysis (or partial least squares) and linear discriminant analysis (or support vector machine) were used to discriminate the spectra of three gram-negative bacteria.

PMID:38007748 | DOI:10.3233/SHTI230847

Stud Health Technol Inform. 2023 Nov 23;308:245-252. doi: 10.3233/SHTI230846.

ABSTRACT

Polysiloxane is widely used in biomedical applications because of its good biocompatibility and excellent micro and nano-scale processability. Using PubMed and Citex’s data analysis platform, this paper examines polysiloxane research and compares its development history from 2002-01 to 2021-12. Research hotspots, keyword analysis, and the number of papers published on polysiloxane in biomedicine are used in this study to analyze and discuss the current status of polysiloxane research in biomedicine. Over the last twenty years, there has been a significant surge in the number of publications related to the use of polysiloxane in biomedicine. This trend highlights the growing intersection and collaboration between the fields of polymeric material science and biomedical disciplines. Therefore, statistics about the number of papers on polysiloxane and the frequency of hot words are valuable resources for biomedical research and development.

PMID:38007747 | DOI:10.3233/SHTI230846

HERD. 2023 Nov 26:19375867231207651. doi: 10.1177/19375867231207651. Online ahead of print.

ABSTRACT

BACKGROUND: The absence of a cure for dementia, combined with the increased longevity of the baby boom generation, is resulting in a dramatic increase in the number of people living with dementia. Aging-related changes coupled with dementia-related behavioral symptoms pose unique challenges for those living with dementia as well as those who provide care. There is evidence that improved sleep can improve health and well-being. Research also supports using auditory interventions as a form of nonpharmacological therapy.

OBJECTIVE: This study evaluated the effects of a customized auditory (sonic) treatment during sleep on the mood, behavior, quality of life, functional ability, and health condition of individuals living with the symptoms of dementia. Workforce outcomes were evaluated as a secondary outcome.

METHODS: A controlled before-after design with a mixed-method approach was used to evaluate the impact of the sonic sleep treatment during baseline, intervention, and discontinuation time frames.

RESULTS: Statistically significant improvements were observed in participants’ cooperation with care (p = .0249) and daytime drowsiness (p = .0104). Other nonstatistically significant improvements included bed mobility, appetite, bathing self-performance, toilet use, incidence of falls, following requests and instructions, and nighttime insomnia. While workforce outcomes remained unchanged, staff were supportive of resuming the sonic sleep treatment after the discontinuation time frame.

CONCLUSIONS: The sonic sleep treatment demonstrated improved outcomes for individuals living with dementia. This supports using an appropriate auditory stimulus as a fundamental component of care for individuals living in memory care settings.

PMID:38007718 | DOI:10.1177/19375867231207651

Orv Hetil. 2023 Nov 26;164(47):1865-1870. doi: 10.1556/650.2023.32862. Print 2023 Nov 26.

ABSTRACT

INTRODUCTION: The diagnosis of acute myocardial infarction is based on ECG abnormalities besides to chest pain and dyspnea. It is caused by myocardial hypoperfusion, in most patients due to severe coronary artery narrowing or occlusion, but it can also occur without visible coronary artery changes. The non-ST-elevation form (NSTEMI) is usually associated with less complaints compared to the ST-elevation form (STEMI), the ECG changes are not so typical, so its recognition is more difficult in the early stage. Possibility of myocardial cell damage reduction is the restoration of perfusion with coronary intervention.

OBJECTIVE: To investigate how much time elapses in acute NSTEMI from the onset of the complaint to the opening of the coronary vasodilator balloon.

METHOD: From 3733 acute coronary interventions performed in NSTEMI between 01. 01. 2016 and 12. 31. 2020, in 1376 patients who underwent percutaneous intervention for the first time, the onset of the complaints, the date of the first medical contact and opening of the balloon, as well as the 30-day or 1-year mortality were known. The median values of the time differences and the mortality data were compared with the similar data of 1718 STEMI patients of this period. The median times were given in hours:minutes, incidence in percent, a two-sample t-test was calculated for the comparison of mortality data.

RESULTS: In NSTEMI, the median time between the first medical contact (5:35 vs. 2:05 h:min) and PTCA balloon opening (18:12 vs. 4:05 h:min) was longer compared to the onset of the complaint as in STEMI. Within 2 hours, 21.3% of NSTEMI patients reached the first medical contact and 1.2% had the PTCA balloon opened, in STEMI this ratios were 48.7% and 11.7%. Within 4 hours, these were in NSTEMI 36.3% and 6.1%, in STEMI 64.1% and 46.8%. The 30-day mortality rate in NSTEMI was lower than in STEMI (5.9% vs. 7.9%, p = 0.03), the 1-year rate was higher (16.1% vs. 12.5%, p = 0.004). In 554 primarily admitted patients who met the study criteria, the median P-B time intervals were shorter (10:55 h:min), the mortality data showed a mild but statistically insignificant difference (5.6% at 30 days, 13.9% at 1 year).

CONCLUSION: Based on the 1-year mortality data, NSTEMI cannot be considered less harmful compared to STEMI. After the onset of hypoperfusion, myocardium necrosis proportional to the elapsed time increases the likelihood of subsequent heart failure. For this reason, it seems advisable for patients to reach the intervention center earlier than at present due to the invasive diagnostic and therapeutic options. Orv Hetil. 2023; 164(47): 1865-1870.

PMID:38007711 | DOI:10.1556/650.2023.32862