Nevin Manimala

Vasc Med. 2022 Jun 22:1358863X221105113. doi: 10.1177/1358863X221105113. Online ahead of print.

ABSTRACT

BACKGROUND: Point-of-care duplex ultrasound has emerged as a promising test for the diagnosis of peripheral artery disease (PAD). However, the interpretation of morphologically diverse Doppler arterial spectral waveforms is challenging and associated with wide inter-observer variation. The aim of this study is to evaluate the utility of machine learning techniques for the diagnosis of PAD from Doppler arterial spectral waveforms sampled at the level of the ankle in patients with diabetes.

METHODS: In two centres, 590 Doppler arterial spectral waveform images (PAD 369, no-PAD 221) from 305 patients were prospectively collected. Doppler arterial spectral waveform signals were reconstructed. Blinded full lower-limb reference duplex ultrasound results were used to label waveform according to PAD status (i.e., PAD, no-PAD). Statistical metrics and multiscale wavelet variance were extracted as discriminatory features. A long short-term memory (LSTM) network was used for the classification of raw signals, and logistic regression (LR) and support vector machines (SVM) were used for classification of extracted features. Signals and feature vectors were randomly divided into training (80%) and testing (20%) sets.

RESULTS: The highest overall accuracy was achieved using a logistic regression model with a combination of statistical and multiscale wavelet variance features, with 88% accuracy, 92% sensitivity, and 82% specificity. The area under the receiver operating characteristics curve (AUC) was 0.93.

CONCLUSION: We have constructed a machine learning algorithm with high discriminatory ability for the diagnosis of PAD using Doppler arterial spectral waveforms sampled at the ankle vessels.

PMID:35734808 | DOI:10.1177/1358863X221105113

Ann Ital Chir. 2021 Nov 23;10:S0003469X21034643. Online ahead of print.

ABSTRACT

INTRODUCTION: Most patients with male breast cancer (MBC) express the androgen receptor (AR). AR expression in these tumors may have both prognostic and predictive values because its presence indicates the potential benefits of an anti-androgen therapeutic approach. The present study aimed to investigate the relationship between AR expression and clinicopathological parameters in MBC.

MATERIAL AND METHODS: The data of 35 patients who received a histological diagnosis of MBC at the pathology department of our hospital between January 2007 and December 2017 were retrospectively reviewed. The patients’ demographic data, follow-up records and pathology reports were recorded. AR expression status and its relationship with clinicopathological parameters were evaluated. The chi-square test was used to compare independent groups. Univariate survival analyses were performed using the Kaplan-Meier survival procedure. A p value of ≤0.05 was considered statistically significant.

RESULTS: There was no significant relationship between AR expression and AJCC stage (p=0.585), pathologic stage (p=0.696), histologic grade (p=0.685), lymph-node status (p=0.685), survival rate (p=1.000), age(p=1.000), lymphovascular invasion (p=0.700), perineural invasion(p=1.000), skin invasion (p=1.000), nipple involvement(p=1.000), DCIS presence(p=1.000), ER positivity(p=1.000), PR positivity (p=0.218), Her2 expression (p=0.523), Ki67 index (p=0.685), Luminal A group (p=0.700), Luminal B group (p=0.691), triple negative group (p=1.000).

CONCLUSION: Further investigation of the relation between AR expression and clinicopathological parameters of patients with MBC might yield important information and lead to the development of additional treatment options.

KEY WORDS: Androgen receptor, AR expression, breast cancer, Male Breast cancer, Prognosis, Receptor status.

PMID:35734806

J Gastroenterol Hepatol. 2022 Jun 22. doi: 10.1111/jgh.15920. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Symptoms of small intestinal bacterial overgrowth (SIBO) and celiac disease (CeD) often overlap, and studies suggest a link between SIBO and CeD. We thus conducted a systematic review and meta-analysis to compare SIBO prevalence in CeD-patients and controls and assessed effects of antimicrobial therapy on gastrointestinal symptoms in SIBO positive CeD-patients.

METHODS: Electronic databases were searched until February-2022 for studies reporting SIBO prevalence in CeD. Prevalence rates, Odds Ratio (OR) and 95% confidence intervals (CI) of SIBO in CeD and controls were calculated.

RESULTS: We included 14 studies, with 742 CeD-patients and 178 controls. The pooled prevalence of SIBO in CeD was 18.3%(95%CI:11.4-28.1), with substantial heterogeneity. Including case-control studies with healthy controls, SIBO prevalence in CeD-patients was significantly increased (OR5.1, 95%CI:2.1-12.4, p=0.0001), with minimal heterogeneity. Utilizing breath tests, SIBO prevalence in CeD-patients was 20.8%(95%CI:11.9-33.7), almost two-fold higher compared to culture-based methods at 12.6%(95%CI:5.1-28.0), with substantial heterogeneity in both analyses. SIBO prevalence in CeD-patients nonresponsive to a gluten free diet (GFD) was not statistically higher as compared to those responsive to GFD (OR1.5, 95%CI:0.4-5.0, p=0.511). Antibiotic therapy of SIBO positive CeD-patients resulted in improvement in gastrointestinal symptoms in 95.6%(95%CI:78.0-99.9) and normalization of breath tests.

CONCLUSIONS: This study suggests a link between SIBO and CeD. While SIBO could explain nonresponse to a GFD in CeD, SIBO prevalence is not statistically higher in CeD-patients non-responsive to GFD. The overall quality of the evidence is low, mainly due to substantial ‘clinical heterogeneity’ and the limited sensitivity/specificity of the available diagnostic tests.

PMID:35734803 | DOI:10.1111/jgh.15920

Arch Public Health. 2022 Jun 23;80(1):157. doi: 10.1186/s13690-022-00912-4.

ABSTRACT

BACKGROUND: The practice of Pharmacists has changed worldwide over the past years. Today, health promotion is better known as an important part of modern pharmacy practice. Involving Community Pharmacists in health promotion is thus considered a valuable option in addressing public health issues. However, the literature on this practice remains unsubstantiated in African countries. In Rwanda, Community Pharmacists are believed to be solely involved in dispensing and very little has been studied about their role in health promotion. Thus, this study aimed to evaluate attitudes, perceptions, and barriers of Community Pharmacists in Rwanda towards their involvement in health promotion.

METHODS: A cross-sectional study was conducted among 236 licensed Community Pharmacists in Rwanda from 23rd January to 23rd June, 2021. A list of all respondents was obtained from Rwanda Food and Drugs Authority. All participants were randomly enrolled. Each community pharmacy was represented by one Pharmacist. We collected data from community pharmacy settings using a self-administered questionnaire made of close and open-ended questions. Statistical analyses were performed using Statistical Packages for Social Sciences (SPSS) version 25.

RESULTS: Of the 236 respondents, (n = 149, 63.1%) were male and (n = 87,37%) were female. The average age was 38.1 years (SD = 4.3). More than half confirmed that professional curriculum is adequate for offering health promotion services (n = 152, 64.4%).Majority responded that health promotion is part of their responsibility, and they are willing to provide health promotion services (n = 233,98.7%).The statement that “Pharmacists should not be involved in public health activities “was opposed by many (n=174,73.7%).The most sought-after service provided was education to drug misuse (n=211, 89.4%).Three major barriers to provision of health promotion were: lack of coordination with other healthcare professionals(n=106,69%),structure of healthcare system (n=157,67%),and lack of equipment (n=144,61%).Most Pharmacists disagreed with the statement that “patients are not interested in getting health promotion services”(n = 134,57%).

CONCLUSION: Though Community Pharmacists faced several challenges that hindered their participation in health promotion, they had positive attitudes towards promoting public health messages. There are several barriers like lack of structure to provide health promotion services that need to be addressed to boost more active participation of Pharmacists in health promotion.

PMID:35733223 | DOI:10.1186/s13690-022-00912-4

BMC Health Serv Res. 2022 Jun 22;22(1):808. doi: 10.1186/s12913-022-08168-y.

ABSTRACT

BACKGROUND: Investigations of implementation factors (e.g., collegial support and sense of coherence) are recommended to better understand and address inadequate implementation outcomes. Little is known about the relationship between implementation factors and outcomes, especially in later phases of an implementation effort. The aims of this study were to assess the association between implementation success (measured by programme fidelity) and care providers’ perceptions of implementation factors during an implementation process and to investigate whether these perceptions are affected by systematic implementation support.

METHODS: Using a cluster-randomized design, mental health clinics were drawn to receive implementation support for one (intervention) and not for another (control) of four evidence-based practices. Programme fidelity and care providers’ perceptions (Implementation Process Assessment Tool questionnaire) were scored for both intervention and control groups at baseline, 6-, 12- and 18-months. Associations and group differences were tested by means of descriptive statistics (mean, standard deviation and confidence interval) and linear mixed effect analysis.

RESULTS: Including 33 mental health centres or wards, we found care providers’ perceptions of a set of implementation factors to be associated with fidelity but not at baseline. After 18 months of implementation effort, fidelity and care providers’ perceptions were strongly correlated (B (95% CI) = .7 (.2, 1.1), p = .004). Care providers perceived implementation factors more positively when implementation support was provided than when it was not (t (140) = 2.22, p = .028).

CONCLUSIONS: Implementation support can facilitate positive perceptions among care providers, which is associated with higher programme fidelity. To improve implementation success, we should pay more attention to how care providers constantly perceive implementation factors during all phases of the implementation effort. Further research is needed to investigate the validity of our findings in other settings and to improve our understanding of ongoing decision-making among care providers, i.e., the mechanisms of sustaining the high fidelity of recommended practices.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03271242 (registration date: 05.09.2017).

PMID:35733211 | DOI:10.1186/s12913-022-08168-y

Arch Public Health. 2022 Jun 23;80(1):158. doi: 10.1186/s13690-022-00913-3.

ABSTRACT

BACKGROUND: The incidence of any medical condition (e.g., sight, hearing, and speech problems, blackouts, chronic pain etc.) or disability (e.g., limited use of arms or fingers, legs, and feet, or other physical long-term health condition limiting everyday activities etc.) have been increasing among Australian children in recent decades.

OBJECTIVES: This study assessed whether infant or child health characteristics might be predictors of subsequent medical conditions or disabilities in children in the first 15 years of life.

METHODS: Using time to event data of 5107 children, obtained from the Birth cohort of the Longitudinal Study of Australian Children, the study estimated the incidence of any medical condition or disability using the survival analysis technique. This study followed up the children from birth to 14 or 15 years of age (2004-2018) and assessed the association of infant and child health characteristics (birthweight, gestational age, use of intensive care unit or ventilator during their neonatal age and obesity) with hazard of any medical condition or disability using the random effect parametric survival regression model. The infant characteristics were measured in the Wave 1 while the children were aged 0/1 year and obesity characteristics were measured longitudinally over all the waves up to 14/15 years of age.

RESULTS: The hazard rate of any medical condition or disability for all participants was 26.13 per 1000 person-years among children in Australia. This hazard incidence rate was higher among low birthweight (39.07) children compared to the children of normal birthweight (24.89) children. The hazard rate also higher among obese (34.37) children compared to the normal weight children (24.82) and among those who had received after-birth ventilation or intensive care unit emergency services (36.87) compared to those who have not received these services (24.20). The parametric panel regression model also suggests that children with low birthweight were 1.43 times (Hazard Ratio: 1.43, 95% Confidence Interval: 1.05-1.94) more likely to have any medical condition or disability than children with normal birthweight. The time to event analyses also revealed that being recipient of after-birth emergencies (HR: 1.47, 95% CI: 1.23-1.75), being male children (HR: 1.30, 95% CI: 1.14-1.48) or being obese (HR: 1.38, 95% CI: 1.07-1.79) significantly increased the likelihood of the incidence of a medical condition or disability among children. The regression model was adjusted for socio-demographic characteristics of children and mothers..

CONCLUSIONS: The study findings suggest that infants with low birth weight, hospital emergency service use and children with obesity would benefit from additional health care monitoring to minimize the risk of any medical condition or disability.

PMID:35733191 | DOI:10.1186/s13690-022-00913-3

Clin Epigenetics. 2022 Jun 22;14(1):78. doi: 10.1186/s13148-022-01296-6.

ABSTRACT

Adverse birth outcomes, such as early gestational age and low birth weight, can have lasting effects on morbidity and mortality, with impacts that persist into adulthood. Identifying the maternal factors that contribute to adverse birth outcomes in the next generation is thus a priority. Epigenetic clocks, which have emerged as powerful tools for quantifying biological aging and various dimensions of physiological dysregulation, hold promise for clarifying relationships between maternal biology and infant health, including the maternal factors or states that predict birth outcomes. Nevertheless, studies exploring the relationship between maternal epigenetic age and birth outcomes remain few. Here, we attempt to replicate a series of analyses previously reported in a US-based sample, using a larger similarly aged sample (n = 296) of participants of a long-running study in the Philippines. New pregnancies were identified prospectively, dried blood spot samples were collected during the third trimester, and information was obtained on gestational age at delivery and offspring weight after birth. Genome-wide DNA methylation was assessed with the Infinium EPIC array. Using a suite of 15 epigenetic clocks, we only found one significant relationship: advanced age on the epigenetic clock trained on leptin predicted a significantly earlier gestational age at delivery (β = – 0.15, p = 0.009). Of the other 29 relationships tested predicting gestational age and offspring birth weight, none were statistically significant. In this sample of Filipino women, epigenetic clocks capturing multiple dimensions of biology and health do not predict birth outcomes in offspring.

PMID:35733189 | DOI:10.1186/s13148-022-01296-6

BMC Med Educ. 2022 Jun 23;22(1):487. doi: 10.1186/s12909-022-03538-w.

ABSTRACT

BACKGROUND: Previous studies have primarily implemented problem-based learning (PBL) or flipped classroom (FC) teaching models in different majors; however, research on the combined PBL-FC teaching method in clinical medicine is scarce. Therefore, we investigated the combined PBL-FC teaching method in teaching ocular trauma on students’ competencies.

METHOD: About 75 ophthalmology postgraduates were randomly divided into PBL-FC and traditional teaching groups. Students completed pre-and post-class theoretical examinations, skills evaluation, learning ability scales, and feedback questionnaires.

RESULTS: Both groups showed significantly higher theoretical scores and improved learning ability. Feedback questionnaire scores of the PBL-FC group’s postgraduates without clinical experience were significantly higher than the traditional group’s for some items; there was no difference between groups in postgraduates with clinical experience. PBL-FC group’s pre-class preparation time was significantly longer than the traditional group’s, but the post-class review time was significantly shorter. PBL-FC group’s post-class theoretical performance was significantly higher than the traditional group’s. There was no statistical difference between the groups regarding skill operation. Among postgraduates without clinical experience, the PBL-FC group’s skill operation performance was significantly higher than the traditional group’s; for postgraduates with clinical experience, the traditional group’s skill operation performance was significantly higher than the PBL-FC group’s.

CONCLUSIONS: PBL-FC teaching is better for students without clinical experience or knowledge of ophthalmic diseases. Meanwhile, traditional teaching is a good choice for students with clinical experience who need more relevant knowledge.

PMID:35733187 | DOI:10.1186/s12909-022-03538-w

BMC Med Educ. 2022 Jun 23;22(1):486. doi: 10.1186/s12909-022-03548-8.

ABSTRACT

BACKGROUND: Identify the objectives and the instructional design of undergraduate endodontics in dental schools in Saudi Arabia.

METHODS: The online questionnaire was developed from an original survey conducted in the United Kingdom. The questionnaire was modified for purpose of the study and the region of interest. Then it was directed and emailed to the undergraduate endodontic program directors in twenty-six dental schools in Saudi Arabia. The results were analyzed using descriptive statistics and the Chi-square and Fisher’s exact tests.

RESULTS: The response rate was 96.15%. The number of credit hours for preclinical endodontic courses was up to four credit hours (84%). Students were clinically trained to do vital pulp therapies (92%), root canal treatment (100%), and root canal retreatment (68%). The majority of dental schools define the minimum clinical requirements (92%). Practical and clinical competency exams were used to evaluate students’ performance (92% and 84% respectively). The students were trained to treat cases of minimal (52%) to moderate complexity (48%). Endodontic treatment consent and difficulty assessment form were used by 32% and 60% of dental schools respectively. There was no significant difference in the instructional design between public and private dental schools (P > 0.05).

CONCLUSION: The endodontic undergraduate objectives were to graduate competent clinicians who acquired basic science of endodontics and who know their limitations as it is necessary for a safe general dental practice. The use of endodontic treatment consent and case difficulty assessment should be wisely considered in clinical training.

PMID:35733185 | DOI:10.1186/s12909-022-03548-8

BMC Public Health. 2022 Jun 23;22(1):1243. doi: 10.1186/s12889-022-13660-5.

ABSTRACT

BACKGROUND: The simultaneity of undernourishment among child and overweight/obesity among mothers in lower-and-middle-income-countries (LMICs) introduces a new nutrition dilemma, known as double burden of malnutrition (DBM). Amidst of such paradox, the hike of caesarean section (CS) delivery is also triggering child undernutrition and maternal obesity. A gap of knowledge regarding the effect of mode of delivery on DBM still persists. The study aims to explore the association between DBM at household level and mode of delivery over time in LMICs.

METHOD: The study used data from recent four consecutive waves of Bangladesh Demographic and Health Survey (BDHS) ranging from BDHS 2007 to BDHS 2017. It considered the mother-child pairs from data where mothers were non-pregnant women aged 15-49 years having children born in last 3 years preceding the survey. Bivariate analysis and Logistic Regression were performed to explore the unadjusted and adjusted effect of covariates on DBM. An interaction term of mode of delivery and survey year was considered in regression model.

RESULTS: The study evinces a sharp increase of DBM rate in Bangladesh from 2007 to 2017 (2.4% vs. 6.4%). The prevalence of DBM in household level among the children delivered by CS is more than two times of those born by normal delivery (8.2% vs. 3.5%). The multivariate analysis also indicates that the children born by CS delivery are more likely to be affected by DBM at household level significantly than those born by normal delivery in each waves. Moreover, the odds ratio (OR) of DBM at household is increased by 43% for one unit change in time for normal delivery whereas CS delivery births have 12% higher odds of DBM at household level with one unit change in time.

CONCLUSION: The study discloses a drastic increase of rate of DBM among mother-child pairs over the time. It stipulates inflated risk of DBM at household with time for both mode of delivery but the children with CS delivery are at more risk to the vulnerability of DBM at household level. The study recommends a provision of special care to the mothers with CS delivery to reduce DBM at household.

PMID:35733171 | DOI:10.1186/s12889-022-13660-5