Nevin Manimala

Sci Total Environ. 2023 Sep 1:166780. doi: 10.1016/j.scitotenv.2023.166780. Online ahead of print.

ABSTRACT

BACKGROUND: Growing studies have focused on the effects of ambient air pollution on thyroid hormones (THs), but the results were controversial. Therefore, a systematic review and meta-analysis was conducted by pooling current evidence on this association.

METHODS: Four databases were searched for studies examining the associations of particulate matter [diameter ≤10 μm (PM₁₀) or ≤2.5 μm (PM_2.5)] and gaseous [sulfur dioxide (SO₂), nitrogen dioxide (NO₂), ozone (O₃), carbon monoxide (CO)] pollutants with THs levels. Random effects models were used to pool the changes in THs levels with increasing air pollutant concentrations. Subgroup analyses were constructed by region, design, sample size, pollutant concentrations, evaluated methods, and potential risk exposure windows.

RESULTS: A total of 14 studies covering 357,226 participants were included in this meta-analysis. The pooled results showed significant associations of exposure to PM_2.5, PM₁₀, NO₂, SO₂, and CO with decreases in free thyroxine (FT4) with percent changes (PC) ranging from -0.593 % to -3.925 %. PM_2.5, NO₂, and CO were negatively associated with levels of FT4/FT3 (PC: from -0.604 % to -2.975 %). In addition, results showed significant associations of PM_2.5 with hypothyroxinemia and high thyroid-stimulating hormone (TSH). Subgroup analyses indicated that PM_2.5 and NO₂ were significantly associated with FT4 in studies of Chinese, and similar significant findings were found in studies of PM_2.5 and FT4/FT3 in areas with higher concentrations of air pollutants and larger samples. PM_2.5 exposure in the first trimester was found to be associated with lower FT4 levels in pregnant women.

CONCLUSION: Our findings suggest that exposure to air pollution is associated with changes in THs levels. Enhanced management of highly polluted areas, identification of harmful components and sources of PM, and protection from harmful exposures in early pregnancy may be of great public health importance for the population’s thyroid function.

PMID:37660827 | DOI:10.1016/j.scitotenv.2023.166780

Gynecol Oncol. 2023 Sep 1;177:117-124. doi: 10.1016/j.ygyno.2023.08.013. Online ahead of print.

ABSTRACT

OBJECTIVE: In 2014, the World Health Organization introduced a new histologic classification by dividing primary mucinous ovarian carcinoma (PMOC) into two: expansile (ES) or infiltrative subtypes (IS). This study investigated the clinical implications of these histological subtypes on survival outcomes.

METHODS: Data from 131 patients with PMOC who underwent primary surgery between 2003 and 2021 were analyzed. The patients baseline characteristics, surgical and pathological information were collected. Survival outcomes were calculated, while factors affecting them were also investigated.

RESULTS: During 55.9 months of median follow-up, 27 (20.6%) patients experienced recurrence and 20 (15.3%) died. Among 131 patients, 113 patients were classified into 87 (77%) ES and 26 (23%) IS after a slide review. Advanced stage, lymph node involvement, and residual tumors after surgery were more common in the IS, showing poorer prognosis. In multivariate analyses, advanced stage and residual tumors after surgery were associated with worse survival, while the IS showed no statistical significance. In subgroup analysis for stage I disease, survival did not vary between subtypes. Nevertheless, patients in the IS group who underwent fertility-sparing surgeries demonstrated a 5-year progression-free survival (PFS) rate of 83.3%, significantly lower than patients without fertility preservation, irrespective of histologic subtypes (5-year PFS rate: 97.9%; P = 0.002 for the ES, 5-year PFS rate: 100%; P = 0.001 for the IS).

CONCLUSIONS: The IS of PMOC had poorer survival outcomes and a higher proportion of advanced-stage tumors. Although its independent prognostic significance remains uncertain, adjuvant chemotherapy should be considered for patients with fertility preservation in the IS group.

PMID:37660413 | DOI:10.1016/j.ygyno.2023.08.013

Br J Radiol. 2023 Sep 3:20220598. doi: 10.1259/bjr.20220598. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of this study is to present the clinical and imaging findings of 16 patients with intraventricular pilocytic astrocytomas.

METHODS: Sixteen patients with histopathological diagnosis of intraventricular pilocytic astrocytoma between February 2016 and January 2022 were evaluated retrospectively. Imaging and clinical findings of the patients, as well as ADC measurements were analyzed.

RESULTS: Of 16 patients, 8 (%50) were male and 8 (%50) were female. The mean age of the patients was 20,8 years (2-44 years range). The most common symptoms in the patients were headache and ataxia. The mean long-axis size of lesions was found to be 48.19 ± 21.59 (range, 15-92 mm). Nine out of 16 lesions (56.2%) were located in the fourth ventricle. The majority of the lesions were iso-hypointense in T1W and hyperintense in T2W images. The mean ADC value of PAs was 1.57 × 10^-3±0.2 mm²/s, while the mean thalamic ADC and white matter ADC values were found to be 0.78 × 10-3±0.04 mm² and s 0.76 × 10-3±0.06 mm² / s, respectively. There was a statistically significant difference between the ADC values obtained from the solid components of the lesions and the thalami/white matter (p < 0.001).

CONCLUSIONS: PAs often originate from midline structures, however, they can also be located intraventricularly. Although intraventricular pilocytic astrocytomas are frequently seen in pediatric population, it should be kept in mind that they can also be seen in adults, albeit rarely.

ADVANCES IN KNOWLEDGE: PA should be considered in the differential diagnosis of intraventricular neoplasms in case of high ADC values.

PMID:37660368 | DOI:10.1259/bjr.20220598

Int J Dent Hyg. 2023 Sep 3. doi: 10.1111/idh.12727. Online ahead of print.

ABSTRACT

OBJECTIVES: Learning styles have been studied in dental and generational research, but research has been limited with Millennial and Generation Z dental hygiene students. The purpose of this quantitative comparative study was to determine if and to what extent there was a difference between Generation Z and Millennial dental hygiene students’ preferred learning styles.

METHODS: First- and second-year dental hygiene students attending three programs located in Southern California were invited to participate in the study. Additional participants were recruited through dental hygiene social media sites. The 44 item Felder-Soloman Index of Learning Styles (ILS) was administered via an online survey platform. Millennial and Generation Z participants were compared on the four dimensions of the ILS: active/reflective, sensing/intuitive, visual/verbal, and sequential/global. The data were analysed using descriptive statistics and the independent samples t-test.

RESULTS: A total of 150 dental hygiene students agreed to participate; Millennials (n = 61), Generation Z (n = 89). There was no significant difference between Millennial and Generation Z students in the active/reflective, sensing/intuitive, or sequential/global dimensions (p > 0.05); both cohorts preferred the active, sensing, and sequential learning styles. There was a statistically significant difference in the visual/verbal dimension with Millennials indicating a significantly greater preference for the visual learning style than Generation Z (p = 0.04).

CONCLUSION: There may be differences between the learning styles of Millennial and Generation Z dental hygiene students. The finding that Generation Z students differ significantly from Millennials on the visual-verbal dimension may indicate a shift toward the verbal dimension learning style that needs further study.

PMID:37660363 | DOI:10.1111/idh.12727

Diabet Med. 2023 Sep 3:e15219. doi: 10.1111/dme.15219. Online ahead of print.

ABSTRACT

AIM: To better understand the prevalence of self-reported psychosocial burdens and the unmet needs identified by people with diabetes in relation to routine diabetes visits.

METHODS: An English language, online survey was distributed via social media, key stakeholder networks, charity and advocacy groups to adults with type 1 diabetes or type 2 diabetes. Survey items were designed by members of the FDA RESCUE Collaborative Community Governing Committee prior to pilot testing with potential participants. Descriptive statistical analyses were conducted; as well as thematic analyses on free text responses using NVivo v14.

RESULTS: 478 participants completed the survey. 373 (78%) had type 1 diabetes, 346 (73%) identified as a woman and 433 (91%) were white. Most participants had experienced self-reported (rather than diagnosed) anxiety and depression (n=323 and n=313 respectively), as well as fear of low blood sugars (n=294), low mood (n=290) and diabetes-related distress (n=257). 68% reported diabetes had negatively affected self-esteem and 62% to feelings of loneliness but 93% reported friends/family/work colleagues were supportive when needed. 272 (57%) reported their diabetes team had never raised the topic of mental health. The overwhelming majority stated the best thing their diabetes team could do to help was to simply ask about mental well-being; listen with empathy and without judgement; and practice skills to understand psychosocial issues in diabetes.

CONCLUSION: Integrating psychosocial discussions and support within routine healthcare visits is crucial to improve outcomes for people with diabetes. Such a biopsychosocial model of healthcare has long been advocated by regulatory bodies.

PMID:37660355 | DOI:10.1111/dme.15219

Orv Hetil. 2023 Sep 3;164(35):1367-1372. doi: 10.1556/650.2023.32854. Print 2023 Sep 3.

ABSTRACT

INTRODUCTION: The COVID-19 pandemic influenced not only the elective, but the acute surgeries also, all around the world. Some authors found more delayed cases and more orchiectomies performed in childhood because of testicular torsions during the pandemic.

OBJECTIVE: To examine the impact of the COVID-19 pandemic on the treatment of childhood testicular torsion and the frequency of semicastration due to torsion at the first author’s institute.

METHODS: A retrospective observational cohort study was performed in a representative Hungarian centre. Boys under 18 years of age operated with testicular torsion were divided into two groups: before COVID-19 (BC; 01/07/2017-31/12/2019) and during COVID-19 (DC; 01/01/2020-30/06/2022) pandemic.

PARAMETERS: elapsed time between the first symptom and arrival at the hospital (<24 h or >24 h), elapsed time to start the surgical procedure since the arrival to the hospital and the rate of semicastration were analysed. For statistical analysis, Mann-Whitney U and chi2 tests were used.

RESULTS: During the study period, altogether, 100 patients (45 BC and 55 DC) were operated on testicular torsion. Statistically significant difference was found between the two timeframes: in the elapsed time from the first symptom and arrival at the hospital (p = 0.048). During the pandemic surgeries started earlier (1.5; 2.5 h) than before the pandemic (1.5; 3.25 h, p = 0.01). No difference was found in the frequency of semicastration between the groups (p = 0.594).

DISCUSSION: Contrary to the literature, during the COVID-19 pandemic, patients with testicular torsion arrived earlier at the hospital, and surgeries were started earlier, than before the pandemic at the investigated institute.

CONCLUSION: The reason behind this accelerated care pathway might be the absence of less severe cases during the COVID-19 period. When people are more prone to stay home, if it does not seem necessary to seek help for any kind of non-urgent medical problem. Orv Hetil. 2023; 164(35): 1367-1372.

PMID:37660346 | DOI:10.1556/650.2023.32854

Biostatistics. 2023 Aug 31:kxad022. doi: 10.1093/biostatistics/kxad022. Online ahead of print.

ABSTRACT

Despite growing interest in estimating individualized treatment rules, little attention has been given the binary outcome setting. Estimation is challenging with nonlinear link functions, especially when variable selection is needed. We use a new computational approach to solve a recently proposed doubly robust regularized estimating equation to accomplish this difficult task in a case study of depression treatment. We demonstrate an application of this new approach in combination with a weighted and penalized estimating equation to this challenging binary outcome setting. We demonstrate the double robustness of the method and its effectiveness for variable selection. The work is motivated by and applied to an analysis of treatment for unipolar depression using a population of patients treated at Kaiser Permanente Washington.

PMID:37660312 | DOI:10.1093/biostatistics/kxad022

Biostatistics. 2023 Aug 31:kxad021. doi: 10.1093/biostatistics/kxad021. Online ahead of print.

ABSTRACT

Along with the increasing availability of health data has come the rise of data-driven models to inform decision making and policy. These models have the potential to benefit both patients and health care providers but can also exacerbate health inequities. Existing “algorithmic fairness” methods for measuring and correcting model bias fall short of what is needed for health policy in two key ways. First, methods typically focus on a single grouping along which discrimination may occur rather than considering multiple, intersecting groups. Second, in clinical applications, risk prediction is typically used to guide treatment, creating distinct statistical issues that invalidate most existing techniques. We present novel unfairness metrics that address both challenges. We also develop a complete framework of estimation and inference tools for our metrics, including the unfairness value (“u-value”), used to determine the relative extremity of unfairness, and standard errors and confidence intervals employing an alternative to the standard bootstrap. We demonstrate application of our framework to a COVID-19 risk prediction model deployed in a major Midwestern health system.

PMID:37660301 | DOI:10.1093/biostatistics/kxad021

STAR Protoc. 2023 Sep 2;4(3):102541. doi: 10.1016/j.xpro.2023.102541. Online ahead of print.

ABSTRACT

Here, we describe the use of TriNet to predict peptides with anticancer and antimicrobial properties by a tri-fusion neural network. We detail the use of TriNet for both the offline Python script version and the online service, thereby demonstrating its convenience for users. In addition, we provide a detailed explanation of the training process of TriNet to enhance the understanding of researchers seeking to leverage deep learning techniques for peptide classification. For complete details on the use and execution of this protocol, please refer to Zhou et al.¹.

PMID:37660298 | DOI:10.1016/j.xpro.2023.102541

Eur Heart J Qual Care Clin Outcomes. 2023 Sep 2:qcad050. doi: 10.1093/ehjqcco/qcad050. Online ahead of print.

ABSTRACT

AIMS: To conduct a contemporary cost-effectiveness analysis examining the use of implantable cardioverter defibrillators (ICD) for primary prevention in patients with hypertrophic cardiomyopathy (HCM).

METHODS: A discrete-time Markov model was used to determine the cost-effectiveness of different ICD decision-making rules for implantation. Several scenarios were investigated including the reference scenario of implantation rates according to observed real world practice. A 12-year time horizon with an annual cycle length was used. Transition probabilities used in the model were obtained using Bayesian analysis. The study has been reported according to the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.

RESULTS: Using a 5-year SCD risk threshold of 6% was cheaper than current practice and has marginally better total quality adjusted life years (QALYs). This is the most cost-effective of the options considered, with an incremental cost effectiveness ratio of £834 per QALY. Sensitivity analyses highlighted that this decision is largely driven by what health related quality of life (HRQL) is attributed to ICD patients and time horizon.

CONCLUSION: We present a timely new perspective on HCM ICD cost-effectiveness, using methods reflecting real-world practice. While we have shown that a 6% 5-year SCD risk cut-off provides the best cohort stratification to aid ICD decision-making, this will also be influenced by the particular values of costs and HRQL for subgroups or at a local level. The process of explicitly demonstrating the main factors which drive conclusions from such an analysis will help to inform shared decision-making in this complex area for all stakeholders concerned.

PMID:37660245 | DOI:10.1093/ehjqcco/qcad050