Nevin Manimala

Int J Biostat. 2021 Oct 27. doi: 10.1515/ijb-2020-0104. Online ahead of print.

ABSTRACT

This paper considers the problem of semi-parametric proportional hazards model fitting where observed survival times contain event times and also interval, left and right censoring times. Although this is not a new topic, many existing methods suffer from poor computational performance. In this paper, we adopt a more versatile penalized likelihood method to estimate the baseline hazard and the regression coefficients simultaneously. The baseline hazard is approximated using basis functions such as M-splines. A penalty is introduced to regularize the baseline hazard estimate and also to ease dependence of the estimates on the knots of the basis functions. We propose a Newton-MI (multiplicative iterative) algorithm to fit this model. We also present novel asymptotic properties of our estimates, allowing for the possibility that some parameters of the approximate baseline hazard may lie on the parameter space boundary. Comparisons of our method against other similar approaches are made through an intensive simulation study. Results demonstrate that our method is very stable and encounters virtually no numerical issues. A real data application involving melanoma recurrence is presented and an R package ‘survivalMPL’ implementing the method is available on R CRAN.

PMID:34714982 | DOI:10.1515/ijb-2020-0104

J Vet Emerg Crit Care (San Antonio). 2021 Oct 29. doi: 10.1111/vec.13153. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the association of candidate attributes and residency training factors with success on the American College of Veterinary Emergency and Critical Care (ACVECC) board certification examination and to develop multivariable models of first-attempt success.

DESIGN: Prospective survey-based study.

SETTING: Post-assessment ACVECC examination candidates.

ANIMALS: None.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Comprehensive surveys were distributed to ACVECC examination candidates in 2016 to 2018 after completion of their assessments, but prior to publication of examination results. Unique anonymous candidate identification numbers were used to match survey responses to outcome data from the office of the ACVECC Executive Secretary. After curation to retain only the first response from each candidate, there were 97 unique candidate responses available for analysis. Univariate analyses identified multiple factors associated with first-attempt success and multiple differences between academic and private practice residency programs. Multivariable logistic regression modeling suggested that 5 factors were independently associated with first-attempt success on the ACVECC examination, specifically younger age, more weeks of study prior to the examination, training at a facility with more ACVECC Diplomates, training at a facility with more ACVECC residents, and having no requirement to manage both Emergency Room (ER) and Critical Care (CC) cases simultaneously.

CONCLUSIONS: Numerous resident and training center factors are associated with success in the ACVECC board certification examination. Residents and training centers might be able to use these data to enhance training, but caution must be exercised because these data are associative only.

PMID:34714977 | DOI:10.1111/vec.13153

Dermatol Ther. 2021 Oct 29. doi: 10.1111/dth.15182. Online ahead of print.

ABSTRACT

AIM: Androgenetic alopecia (AGA) is a progressive hair loss disease that occurs with the effect of androgens and genetic predisposition. Hair thinning and hair loss affect people’s self-confidence and self-image more than is thought. In these patients, platelet rich plasma (PRP) treatment is used in addition to the limited medical treatments available. However, there is a lack of standardization for the application method of PRP treatment in the literature. The number of studies in which objective data and hair analysis parameters were revealed to demonstrate the effectiveness of PRP treatment is also very limited. In this study, it was aimed to show the efficacy of PRP treatment with trichoscan data in AGA patients and to compare dermapen-mediated microneedling and point by point technique injection application methods.

MATERIALS AND METHODS: The study was conducted with 62 male AGA patients, aged between 18-55 years, who applied to the University Faculty of Medicine, Department of Dermatology, and ranged from Norwood-Hamilton Stage II-V. The patients were randomly divided into two groups and one group was given microneedling with a dermapen, an electrical device that makes automatic needling, and the other group was given manual injection with point by point technique with a 30 gauge needle. Before the first treatment, each patient underwent a trichoscan hair analysis evaluation. A total of four sessions of PRP treatment were performed, as three sessions at two week intervals and the fourth session one month after the last session.

RESUTLS: The mean age of the cases was 33.13±6.36. According to Norwood-Hamilton staging, stage III was detected with the highest rate of 46% (29). Hair pulling test became significantly negative after treatment (p<0.05). Statistically significant differences were found in trichoscan analysis parameters for hair count, hair density, terminal hair count, and terminal hair density in both groups compared to pre-treatment (p<0.05). Between the groups, a statistically significant difference was found between the averages of anagen hair, telogen hair and hair length in the dermapen treated group compared to the group treated with the point by point technique.

CONCLUSION: In our study, the efficacy of PRP treatment for AGA patients was demonstrated by trichoscan parameters. Among the PRP application methods, dermapen-mediated application was found to be superior to the point by point technique in terms of anagen, telogen and average hair length parameters. This article is protected by copyright. All rights reserved.

PMID:34714961 | DOI:10.1111/dth.15182

Med J (Ft Sam Houst Tex). 2021 Oct-Dec;(PB 8-21-10/11/12):22-26.

ABSTRACT

INTRODUCTION: Traumatic Brain Injury (TBI) is a prevalent health issue in the US and even more prevalent amongst members of the armed forces. The purpose of this project was to evaluate the association between history of TBI and rates of dental treatment performed, endodontic therapy, and high caries risk.

METHODS: This was a retrospective medical and dental records study. The first 100 of a chosen dental hygienist’s patients in 2016 who were seen for dental prophylaxis appointments were chosen as subjects. Armed Forces Health Longitudinal Technology Application (AHLTA) and Corporate Dental System (CDS) records were used to gather information on these subjects including rank, age, gender, duty status, tobacco use, history of TBI, total number of dental procedures, total Dental Weighted Value (DWV), number of endodontic procedures, endodontic DWV, high caries risk categorization, total days dental fitness class 1, and total days dental fitness class 3. From these subjects, a “TBI group” and a “Non-TBI group” were formed. T-Test analyses were performed to compare these groups to each other in categories of total number of dental procedures, total DWV, total days dental fitness class 1, and total days class 3. Relative risks ratio analysis was used to compare these groups in terms of high caries risk categorization.

RESULTS: Eight out of 100 subjects had a history of TBI. All TBI events were mild. Six subjects had 1 event, 1 had 2 events, and 1 had 4 events. The TBI group had a statistically higher mean number of dental procedures (P=0.00000025) and mean total DWV (P=0.0000062) compared to the non-TBI group. No subjects from the TBI group had an endodontic procedure. The TBI group had lower mean days in dental fitness class 1 and more mean days in dental fitness class 3, but the results were not statistically significant. The TBI group had lower high caries risk categorization rates than the non-TBI group, but the results were not statistically significant.

CONCLUSIONS: Patients with a history of TBI had a significantly higher number of dental procedures performed and DWV generated compared to patients without a history of TBI.

PMID:34714918

Med J (Ft Sam Houst Tex). 2021 Oct-Dec;(PB 8-21-10/11/12):9-17.

ABSTRACT

BACKGROUND: Purpose: The purpose of this Observational Retrospective Cohort is to compare opioid prescription pattern trends from 1 January 2010 to 31 December 2017 amongst the Dental Health Activity (DENTAC), Obstetrics/Gynecology (OBGYN), Emergency Room (ER), and Family Medicine departments assigned to the Carl R. Darnall Army Medical Center, Fort Hood, TX. In addition, as a secondary outcome, the type of opioids prescribed will be explored during the same time frame.

METHODS: An Observational Retrospective Cohort Longitudinal Archival Medical Chart Review was executed by a report collection from the Pharmacy Data Transaction Service (PDTS). Data analysis was developed with a Repeated Measures Analysis of Variance (ANOVA) in order to compare means across multiple variables based on repeated observations. By utilizing a mix of factors model, variables within each department (Test of Within-Subjects Effects) and between departments (Test of Between-Subjects Effects) were analyzed.

RESULTS: The statistical analysis demonstrated no significant differences within the number of pills dispensed from the DENTAC and OBGYN departments. A moderate decrease in prescription patterns at the Emergency Department and extreme decrease at the Family Medicine Department was reported. No significant differences between the number of patients and number of prescriptions dispensed were found within each department over the 8-year period. The statistical analysis showed significant differences between the Family Medicine and Emergency departments in comparison with the DENTAC and OBGYN departments. From 2010-2016, Family Medicine and Emergency Departments demonstrated a substantial decrease in opioid prescribing. The DENTAC and OBGYN departments showed a constant linear factor from 2010 to 2016 indicating minimal changes in number of pills dispensed and revealing a small decrease of pills dispensed during 2017. The most common types of opioid medication prescribed in the four departments from 1 JAN 2010 to 31 DEC 2017 were Morphine Sulfate and Hydromorphone HCL.

CONCLUSIONS: In this study, the DENTAC AND OBGYN departments did not show a significant decrease in number of opioid pills and number of prescriptions dispensed compared to the Family Medicine and ER departments. Overall, the Family Medicine department showed the most drastic change in opioid prescription patterns from 1 JAN 2010 to 31 DEC 2017 at the Carl R. Darnall Army Medical Center, Fort Hood, TX. The most common types of opioid medication prescribed in the same period of time within the four departments were characterized by morphine and hydromorphone components.

PMID:34714916

Rhinology. 2021 Oct 29. doi: 10.4193/Rhin21.159. Online ahead of print.

ABSTRACT

BACKGROUND: Allergic rhinitis (AR), an IgE mediated inflammatory disease, significantly impacts quality of life of a considerable proportion of the general population. Omalizumab, a humanized monoclonal antibody against IgE, has been evaluated for both seasonal and perennial AR. We aimed to assess the efficacy and safety of omalizumab in randomized controlled trials (RCTs) in inadequately controlled AR.

METHODS: We conducted a systematic literature search of RCTs evaluating the safety and efficacy of omalizumab in AR. We synthesized evidence for clinical improvement of AR symptoms, quality of life, reduction of the use of rescue medication, and adverse events.

RESULTS: The systematic search returned 289 articles, of which 12 RCTs were eligible for data extraction and meta-analysis. Omalizumab reduced the Daily Nasal Symptom Severity Score (DNSSS) by a summary standardized mean difference of -0.41 points with large heterogeneity; omalizumab significantly reduced the DNSSS both in the 3 cedar pollen-induced AR trials by -0.97 points and to a lower extent in the remaining five non-cedar trials by -0.19 points. Omalizumab also improved the Daily Ocular Symptom Severity Score (DOSSS) by a summary standardized mean difference of -0.30 points with large heterogeneity; the Rhino-conjunctivitis Quality of Life Questionnaire by a summary standardized mean difference of -0.45 points with no heterogeneity and the mean daily consumption of rescue antihistamines by a summary standardized mean difference of -0.21 with large heterogeneity. No statistically significant difference in the occurrence of adverse events was observed between omalizumab and placebo.

CONCLUSION: Our findings further support the efficacy and safety of omalizumab in the management of patients with allergic rhinitis inadequately controlled with a conventional treatment.

PMID:34714895 | DOI:10.4193/Rhin21.159

PLoS One. 2021 Oct 29;16(10):e0259218. doi: 10.1371/journal.pone.0259218. eCollection 2021.

ABSTRACT

BACKGROUND: Nigeria has a high burden of hepatitis B virus (HBV) infection, commonly acquired through vertical transmission. However, there is a lack of an efficient surveillance system for monitoring and understanding the epidemiology of HBV among pregnant women. Building on a previous review on the prevalence of HBV in Nigeria (2000-2013), we conducted a systematic review and meta-analysis of HBV prevalence among pregnant women in Nigeria.

METHODS: Four electronic databases PubMed, Embase, Global Health, and Scopus were systematically searched from January 2014 to February 2021. We also searched the African Journal Online and manually scanned the reference lists of the identified studies for potentially eligible articles. Observational studies that reported the prevalence of HBsAg and/or HBeAg among pregnant women in peer-reviewed journals were included in the study. We performed a meta-analysis using a random-effects model. We defined HBV infection as a positive test to HBsAg.

RESULTS: From the 158 studies identified, 20 studies with a total sample size of 26, 548 were included in the meta-analysis. The pooled prevalence of HBV infection among pregnant women across the studies was 6.49% (95% confidence interval [CI] = 4.75-8.46%; I2 = 96.7%, p = 0.001; n = 20). The prevalence of HBV was significantly lower among pregnant women with at least secondary education compared with those with no education or primary education (prevalence ratio = 0.7, 95% CI = 0.58-0.87; n = 10). However, the prevalence of HBV was not significantly different by age, religion, marital status, or tribe. The prevalence of HBV was not significantly different among pregnant women with previous surgery, blood transfusion, multiple lifetime sex partners, tribal marks, tattoos, scarification, or sexually transmitted infections, compared with those without these risk factors. From a total sample size of 128 (n = 7), the pooled prevalence of HBeAg among HBV-infected pregnant women was 14.59% (95% CI = 4.58-27.99%; I2 = 65.5%, p = 0.01). Subgroup analyses of HBV infection by study region and screening method, and meta-regression analysis of the study year, sample size, and quality rating were not statistically significant.

CONCLUSIONS: There is an intermediate endemicity of HBV infection among pregnant women in Nigeria. Interventions, such as routine antenatal HBV screening, antiviral prophylaxis for eligible pregnant women, and infant HBV vaccination should be scaled up for the prevention of perinatal transmission of HBV infection in Nigeria.

PMID:34714888 | DOI:10.1371/journal.pone.0259218

PLoS One. 2021 Oct 29;16(10):e0259411. doi: 10.1371/journal.pone.0259411. eCollection 2021.

ABSTRACT

BACKGROUND: Tunga penetrans, also known as sand flea, causes Tungiasis in humans and animals. Despite its notoriety as an entomological problem, however, the ectoparasite receives little consideration from public health professionals. It is against this background that this article aims to assess the prevalence of and factors associated with Tunga penetrans infestation among 5-14-year-olds in rural Western Ethiopia.

METHODS: From November to December 2020, 487 children aged 5 to 14 were selected from four primary schools in a cross-sectional study using systematic random sampling. Clinical exams, Interviews with parents/guardians and observations of the housing and classroom environments were used to collect data. Descriptive statistics and multivariable regression were used to characterize the data and identify factors associated with Tunga penetrans infestation.

RESULT: Tunga penetrans infestation (Tungiasis) was diagnosed in 138 of the 487 children examined, placing the prevalence at 28.3% (95% CI: 24.2%, 32.2%). Mud plastered walls [AOR: 5.83, % CI (3.44-9.88)], having cats in the house [AOR: 5.91, 95% CI (3.51-10.11)], not having separated sleeping quarters for animals [AOR: 4.60, 95% CI (2.69-7.86)], using self-supplied water [AOR: 6.30, 95% CI (3.33-11.93)], walking>30 minutes to school [AOR: 2.37, 95% CI (1.48-3.80)] were associated with Tungiasis.

CONCLUSION: In one way or another, several of the identified factors were linked to poverty. Improved house wall materials, fumigation of mud-plastered houses, dusting or spraying insecticides on domestic animals (such as cats), improved access to water, community education about keeping animals separated from living spaces, and hygiene promotion are all needed, with a focus on locally available, low-cost technologies that the poorest families can afford.

PMID:34714881 | DOI:10.1371/journal.pone.0259411

PLoS One. 2021 Oct 29;16(10):e0259307. doi: 10.1371/journal.pone.0259307. eCollection 2021.

ABSTRACT

Participation and activity post stroke can be limited due to adverse weather conditions. This study aimed to: Quantify and compare summer and winter participation and activity, and explore how community dwelling people with stroke describe their feelings about their level of participation and activity by season. This embedded mixed-methods observational study took place in a city with weather extremes. Community dwelling individuals at least one year post-stroke, able to walk ≥50 metres +/- a walking aide were included. Evaluations and interviews occurred at participants’ homes in two seasons: Reintegration to Normal living Index (RNL), Activities-specific Balance Confidence (ABC) and descriptive outcomes. Participants wore activity monitors for one week each season. Analysis included descriptive statistics, non-parametric tests and an inductive approach to content analysis. Thirteen individuals participated in quantitative evaluation with eight interviewed. Mean age 61.5 years, 62% female and mean 6.2 years post-stroke. No differences between winter-summer values of RNL, ABC, or activity monitor outcomes. However, participants felt they could do more and were more independent in summer. The winter conditions such as ice, snow, cold and wind restricted participation and limited activities. Nonetheless, many participants were active and participated despite the winter challenges by finding other ways to be active, and relying on social supports and personal motivation. The qualitative findings explained unexpected quantitative results. Participants described many challenges with winter weather, but also ways they had discovered to participate and be active despite these challenges. Changes to future studies into seasonal differences are suggested.

PMID:34714877 | DOI:10.1371/journal.pone.0259307

PLoS One. 2021 Oct 29;16(10):e0259288. doi: 10.1371/journal.pone.0259288. eCollection 2021.

ABSTRACT

BACKGROUND: The objective of this study was to compare the prognostic impact of sarcopenia in patients with head and neck cancer (HNC) treated with surgery or radiation.

METHODS: We systematically searched electronic databases to identify articles reporting the impact of sarcopenia on the prognosis of patients with HNC. Hazard ratios (HRs) and 95% confidence intervals (CIs) for overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS) were extracted and pooled. HR according to treatment modality were estimated using random-effects models. Statistical analyses were carried out using the Comprehensive Meta-Analysis software.

RESULTS: In total, 18 studies enrolling 3,233 patients were included. Sarcopenia was associated with poor OS in both surgery and radiotherapy groups (hazard ratio [HR] 2.50, 95% confidence interval [CI] 1.95-3.21; HR 1.63, 95% CI 1.40-1.90, respectively). The HR was significantly higher in the surgery group than in the radiotherapy group (p = 0.004), with similar results obtained for DFS (HR 2.59, 95% CI 1.56-4.31; HR 1.56, 95% CI 1.24-1.97 for the surgery and radiotherapy groups, respectively) and DSS (HR 2.96, 95% CI 0.73-11.95; HR 2.67, 95% CI 1.51-4.73 for the surgery and RT groups, respectively).

CONCLUSIONS: Sarcopenia was a poor prognostic factor for HNC, regardless of the treatment modality. However, the adverse effects of sarcopenia on survival were more prominent in the surgery group than in the radiotherapy group. Sarcopenia assessment is required for appropriate treatment decision-making.

PMID:34714876 | DOI:10.1371/journal.pone.0259288