Nevin Manimala

Asia Pac J Public Health. 2023 Sep 20:10105395231199570. doi: 10.1177/10105395231199570. Online ahead of print.

ABSTRACT

Tuberculosis (TB) infection causes mortality among PLHIV, so the treatment of TB-HIV coinfection is crucial. The study aims to identify the determinants contributing to TB coinfection among PLHIV in Papua. It is a descriptive-analytic study with a cross-sectional design involving 188 PLHIV at the four hospitals in Papua. CD4⁺ was carried out using CD4⁺ counter and viral load using the qPCR technique. A logistic regression test and R statistic with a significance level of 0.05 were used to analyze the determinants of TB coinfection among PLHIV. PLHIV having CD4⁺ count of fewer than 350 cells/mm³ had a 17.8 higher risk for TB-HIV coinfection, P-value = 0.0. In addition, a viral load of more than 10 000 copies/ml will be 12.1 times more likely to be co-infected with TB-HIV compared to those who have a viral load of fewer than 10 000 copies/ml, P-value = 0.0. CD4⁺ markers and viral load are factors that play a role in TB coinfection among PLHIV in Papua Province.

PMID:37727963 | DOI:10.1177/10105395231199570

Otolaryngol Head Neck Surg. 2023 Sep 20. doi: 10.1002/ohn.529. Online ahead of print.

ABSTRACT

OBJECTIVE: There is a link between laryngopharyngeal reflux (LPR) and the formation of benign vocal fold lesions (BVFLs). However, previous studies have mainly focused on LPR suggested by symptoms and signs, rather than objectively diagnosed LPR via pharyngeal pH monitoring. We, therefore, conducted a Meta-analysis to evaluate the association between pharyngeal pH monitoring diagnosed LPR and the odds of BVFLs.

DATA SOURCES: Relevant observational studies were identified by searching PubMed, Embase, Cochrane Library, and Web of Science.

REVIEW METHODS: We evaluated between-study heterogeneity using the Cochrane Q test and estimated the I² statistic. Random-effects models were used when significant heterogeneity was observed; otherwise, fixed-effects models were used.

RESULTS: Thirteen datasets from 9 studies were included. Among them, 493 were diagnosed with LPR and 344 had BVFLs. LPR was related to a higher odds of BVFLs (odds ratio: 3.26, 95% confidence interval: 1.84-5.76, P < .001) with moderate heterogeneity (P for Cochrane Q test = .006, I² = 57%). Subgroup analyses showed that the association was similar in studies with only pharyngeal pH monitoring (Restech), with double-probe or 3-site pH monitoring, and with 24-hour multichannel intraluminal impedance-pH monitoring (P for subgroup difference = .15). In addition, subgroup analysis showed consistent results in studies from Asia and Europe (P for subgroup analysis = .12), and the association seemed to be consistent for vocal Reinke’s edema, nodules, and polyps (P for subgroup difference = .09).

CONCLUSION: Pharyngeal pH monitoring diagnosed LPR is associated with the formation of BVFLs.

PMID:37727944 | DOI:10.1002/ohn.529

Oral Dis. 2023 Sep 20. doi: 10.1111/odi.14743. Online ahead of print.

ABSTRACT

OBJECTIVE: Proper identification of oral potentially malignant disorders (OPMDs) provides an opportunity for oral cancer prevention. This study aims to assess the competency of dental health professionals in identifying OPMDs and, in turn, reducing the incidence of oral malignancy by early detection.

METHODS: A 26-case online questionnaire of oral mucosal lesions was distributed to cohorts of 363 dental health professionals and dental students in Australia. The participants were asked to provide their provisional diagnosis for each case based on the available information.

RESULTS: The overall accuracy in identifying oral mucosal lesions was 65.9%. There were no significant differences in the overall diagnostic accuracies between dental specialists, general dental practitioners and final-year dental students (p > 0.05). The lowest diagnostic accuracies were associated with normal mucosal variations and OPMDs. The predoctoral dental curriculum showed statistically significant values in terms of improving skills in diagnosing oral mucosal lesions.

CONCLUSIONS: Lack of adequate knowledge in identifying OPMDs was evident among the participants, highlighting a non-promising figure in reducing the incidence of oral cancers in Australia. Comprehensive modifications of the current continuing professional development system are required to ensure adequate knowledge among dental health providers in Australia.

PMID:37727932 | DOI:10.1111/odi.14743

Bio Protoc. 2023 Sep 5;13(17):e4812. doi: 10.21769/BioProtoc.4812. eCollection 2023 Sep 5.

ABSTRACT

The centrosome governs many pan-cellular processes including cell division, migration, and cilium formation. However, very little is known about its cell type-specific protein composition and the sub-organellar domains where these protein interactions take place. Here, we outline a protocol for the spatial interrogation of the centrosome proteome in human cells, such as those differentiated from induced pluripotent stem cells (iPSCs), through co-immunoprecipitation of protein complexes around selected baits that are known to reside at different structural parts of the centrosome, followed by mass spectrometry. The protocol describes expansion and differentiation of human iPSCs to dorsal forebrain neural progenitors and cortical projection neurons, harvesting and lysis of cells for protein isolation, co-immunoprecipitation with antibodies against selected bait proteins, preparation for mass spectrometry, processing the mass spectrometry output files using MaxQuant software, and statistical analysis using Perseus software to identify the enriched proteins by each bait. Given the large number of cells needed for the isolation of centrosome proteins, this protocol can be scaled up or down by modifying the number of bait proteins and can also be carried out in batches. It can potentially be adapted for other cell types, organelles, and species as well.

PMID:37727868 | PMC:PMC10505934 | DOI:10.21769/BioProtoc.4812

Res Pract Thromb Haemost. 2023 Aug 9;7(6):102167. doi: 10.1016/j.rpth.2023.102167. eCollection 2023 Aug.

ABSTRACT

BACKGROUND: Acute kidney injury (AKI) in patients with COVID-19 is partly mediated by thromboinflammation. In noncritically ill patients with COVID-19, therapeutic-dose anticoagulation with heparin increased the probability of survival to hospital discharge with reduced use of cardiovascular or respiratory organ support.

OBJECTIVES: We investigated whether therapeutic-dose heparin reduces the incidence of AKI or death in noncritically ill patients hospitalized for COVID-19.

METHODS: We report a prespecified secondary analysis of the ACTIV4a and ATTACC open-label, multiplatform randomized trial of therapeutic-dose heparin vs usual-care pharmacologic thromboprophylaxis on the incidence of severe AKI (≥2-fold increase in serum creatinine or initiation of kidney replacement therapy (KDIGO stage 2 or 3) or all-cause mortality in noncritically ill patients hospitalized for COVID-19. Bayesian statistical models were adjusted for age, sex, D-dimer, enrollment period, country, site, and platform.

RESULTS: Among 1922 enrolled, 23 were excluded due to pre-existing end stage kidney disease and 205 were missing baseline or follow-up creatinine measurements. Severe AKI or death occurred in 4.4% participants assigned to therapeutic-dose heparin and 5.5% assigned to thromboprophylaxis (adjusted relative risk [aRR]: 0.72; 95% credible interval (CrI): 0.47, 1.10); the posterior probability of superiority for therapeutic-dose heparin (relative risk < 1.0) was 93.6%. Therapeutic-dose heparin was associated with a 97.7% probability of superiority to reduce the composite of stage 3 AKI or death (3.1% vs 4.6%; aRR: 0.64; 95% CrI: 0.40, 0.99) compared to thromboprophylaxis.

CONCLUSION: Therapeutic-dose heparin was associated with a high probability of superiority to reduce the incidence of in-hospital severe AKI or death in patients hospitalized for COVID-19.

PMID:37727846 | PMC:PMC10506136 | DOI:10.1016/j.rpth.2023.102167

Cureus. 2023 Sep 18;15(9):e45473. doi: 10.7759/cureus.45473. eCollection 2023 Sep.

ABSTRACT

Background The escalating overload and saturation of emergency services, primarily caused by non-urgent cases overwhelming the system, have spurred a critical necessity for innovative solutions that can effectively differentiate genuine emergencies from situations that could be managed through alternative means, such as using AI chatbots. This study aims to evaluate and compare the accuracy in differentiating between a medical emergency and a non-emergency of three of the most popular AI chatbots at the moment. Methods In this study, patient questions from the online forum r/AskDocs on Reddit were collected to determine whether their clinical cases were emergencies. A total of 176 questions were reviewed by the authors, with 75 deemed emergencies and 101 non-emergencies. These questions were then posed to AI chatbots, including ChatGPT, Google Bard, and Microsoft Bing AI, with their responses evaluated against each other and the authors’ responses. A criteria-based system categorized the AI chatbot answers as “yes,” “no,” or “cannot determine.” The performance of each AI chatbot was compared in both emergency and non-emergency cases, and statistical analysis was conducted to assess the significance of differences in their performance. Results In general, AI chatbots considered around 12-15% more cases to be an emergency than reviewers, while they considered a very low number of cases as non-emergency compared to reviewers (around 35% fewer cases). Google Bard detected the most true emergency cases (87%) and true non-emergency cases (36%). However, no real difference in performance between the three AI chatbots was found in detecting true emergencies (p-value = 0.35) and non-emergency cases (p-value = 0.16). Conclusions These AI systems require further refinement to identify emergency situations accurately, but they could potentially be an innovative tool for emergency care and improving patient outcomes. The integration of AI chatbots like ChatGPT, Google Bard, and Microsoft Bing Chat offers a promising avenue to mitigate ED strain and enhance emergency management.

PMID:37727841 | PMC:PMC10506659 | DOI:10.7759/cureus.45473

Turk Arch Otorhinolaryngol. 2023 Jun;61(2):83-90. doi: 10.4274/tao.2023.2022-11-9. Epub 2023 Sep 18.

ABSTRACT

OBJECTIVE: In hopes of contributing to the decision about the best surgical option in tonsillectomy, we performed this work to compare the effectiveness of the thermal welding system (TW) and monopolar electrocautery (ME) tonsillectomy in terms of postoperative pain, postoperative bleeding, and operation time in patients undergoing tonsillectomy, to determine which procedure is most expected to enhance the postoperative quality of life.

METHODS: Digital databases, including PubMed, Scopus, Cochrane, Web of Science, and Google Scholar, were systematically screened from inception up to October 2022. The included randomized controlled trials (RCTs) were evaluated for risk of bias via the Cochrane tool (version 2). The outcomes were summarized as risk ratio (RR) or mean difference/standardized mean difference (MD/SMD) with a 95% confidence interval (CI) in a random-effects model.

RESULTS: The three RCTs that met our criteria were included in the study. Overall, 151 patients had been enrolled in these three RCTs, in which 75 and 76 were allocated to the TW and ME groups, respectively. The postoperative pain levels were substantially reduced, favoring the TW arm over the ME arm [n=2 RCTs, SMD=-0.39, 95% CI (-0.67, -0.12), p=0.005]. Also, the analysis revealed a substantial variation between the TW and ME arms in terms of operation time [n=2 RCTs, MD=3.29 minutes, 95% CI (1.42, 5.17), p=0.0006]. However, the analysis revealed no substantial variation between the TW and ME arms in term of postoperative bleeding [n=3 RCTs, RR=0.40, 95% CI (0.06, 2.62), p=0.34].

CONCLUSION: This meta-analysis revealed that postoperative bleeding for tonsillectomy were similar between the ME and TW techniques. However, TW showed lower postoperative pain levels than ME statistically but without achieving significant clinical advantage.

PMID:37727819 | PMC:PMC10506519 | DOI:10.4274/tao.2023.2022-11-9

Turk Arch Otorhinolaryngol. 2023 Jun;61(2):58-65. doi: 10.4274/tao.2023.2023-3-5. Epub 2023 Sep 18.

ABSTRACT

OBJECTIVE: To analyze the demographic characteristics and the pathological results of neck dissection in primary parotid gland (PG) cancer patients, and to investigate the effects of histopathological parameters (perineural invasion, lymphovascular invasion, and extracapsular spread), neck metastasis, stage and lymph node ratio (LNR) on survival.

METHODS: Patients who underwent parotidectomy for malignant PG tumors between 2000 and 2019 years were retrospectively reviewed from the medical records. Thirty patients who were treated with parotidectomy and neck dissection were included in the study. Lymph node ratio was calculated as the ratio of the number of metastatic lymph nodes (LN) to the total number of excised LNs. Tumor stage, regional LN metastasis, LNR, perineural invasion, lymphovascular invasion, and extracapsular spread were reviewed for the effects on survival with the Kaplan-Meier analysis.

RESULTS: The study included 17 (57%) male and 13 (43%) female patients. Their mean age was 67.93±16.90 years (range, 50-85 years). The average number of the excised LN was 26.03±11.79 (range, 3-50). Mean LNR was 0.16±0.26. The Kaplan-Meier analysis showed that neck metastasis (p=0.001) and LNR (p<0.001) were associated with shorter survival times compared to perineural invasion (p=0.818), lymphovascular invasion (p=0.154), extracapsular spread (p=0.410) and stage (p=0.294). In multivariate COX regression analysis, only LNR had a statistically significant difference (p=0.027) compared to the other parameters.

CONCLUSION: The present study suggests that LNR and neck metastasis are associated with shorter survival times in PG cancers. Lymph node ratio can be used as a prognostic marker in these patients.

PMID:37727816 | PMC:PMC10506524 | DOI:10.4274/tao.2023.2023-3-5

Infect Dis Model. 2023 Sep 9;8(4):1079-1087. doi: 10.1016/j.idm.2023.09.002. eCollection 2023 Dec.

ABSTRACT

This work addresses the problem of supervised classification for highly correlated high-dimensional data describing non-independent observations to identify SNPs related to a phenotype. We use a general penalized linear mixed model with a single random effect that performs simultaneous SNP selection and population structure adjustment in high-dimensional prediction models. Specifically, the model simultaneously selects variables and estimates their effects, taking into account correlations between individuals. Single nucleotide polymorphisms (SNPs) are a type of genetic variation and each SNP represents a difference in a single DNA building block, namely a nucleotide. Previous research has shown that SNPs can be used to identify the correct source population of an individual and can act in isolation or simultaneously to impact a phenotype. In this regard, the study of the contribution of genetics in infectious disease phenotypes is of great importance. In this study, we used uncorrelated variables from the construction of blocks of correlated variables done in a previous work to describe the most related observations of the dataset. The model was trained with 90% of the observations and tested with the remaining 10%. The best model obtained with the generalized information criterion (GIC) identified the SNP named rs2493311 located on the first chromosome of the gene called PRDM16 ((PR/SET domain 16)) as the most decisive factor in malaria attacks.

PMID:37727806 | PMC:PMC10505671 | DOI:10.1016/j.idm.2023.09.002

Front Immunol. 2023 Sep 1;14:1215302. doi: 10.3389/fimmu.2023.1215302. eCollection 2023.

ABSTRACT

INTRODUCTION: In the absence of clinical efficacy data, vaccine protective effect can be extrapolated from animals to humans, using an immunological biomarker in humans that correlates with protection in animals, in a statistical approach called immunobridging. Such an immunobridging approach was previously used to infer the likely protective effect of the heterologous two-dose Ad26.ZEBOV, MVA-BN-Filo Ebola vaccine regimen. However, this immunobridging model does not provide information on how the persistence of the vaccine-induced immune response relates to durability of protection in humans.

METHODS AND RESULTS: In both humans and non-human primates, vaccine-induced circulating antibody levels appear to be very stable after an initial phase of contraction and are maintained for at least 3.8 years in humans (and at least 1.3 years in non-human primates). Immunological memory was also maintained over this period, as shown by the kinetics and magnitude of the anamnestic response following re-exposure to the Ebola virus glycoprotein antigen via booster vaccination with Ad26.ZEBOV in humans. In non-human primates, immunological memory was also formed as shown by an anamnestic response after high-dose, intramuscular injection with Ebola virus, but was not sufficient for protection against Ebola virus disease at later timepoints due to a decline in circulating antibodies and the fast kinetics of disease in the non-human primates model. Booster vaccination within three days of subsequent Ebola virus challenge in non-human primates resulted in protection from Ebola virus disease, i.e. before the anamnestic response was fully developed.

DISCUSSION: Humans infected with Ebola virus may benefit from the anamnestic response to prevent disease progression, as the incubation time is longer and progression of Ebola virus disease is slower as compared to non-human primates. Therefore, the persistence of vaccine-induced immune memory could be considered as a potential correlate of long-term protection against Ebola virus disease in humans, without the need for a booster.

PMID:37727795 | PMC:PMC10505757 | DOI:10.3389/fimmu.2023.1215302