Nevin Manimala

Rev Assoc Med Bras (1992). 2021 Aug;67(8):1102-1108. doi: 10.1590/1806-9282.20210257.

ABSTRACT

OBJECTIVE: The aim of this study was to build a prediction model to discriminate precociously hantavirus infection from leptospirosis, identifying the conditions and risk factors associated with these diseases.

METHODS: A logistic regression model in which the response variable was the presence of hantavirus or leptospirosis was adjusted.

RESULTS: As a result, the method selected the following variables that influenced the prediction formula: sociodemographic variables, clinical manifestations, and exposure to environmental risks. All variables considered in the model presented statistical significance with a p<0.05 value. The accuracy of the model to differentiate hantavirus from leptospirosis was 88.7%.

CONCLUSIONS: Concluding that the development of statistical tools with high potential to predict the disease, and thus differentiate them precociously, can reduce hospital costs, speed up the patient’s care, reduce morbidity and mortality, and assist health professionals and public managers in decision-making.

PMID:34669853 | DOI:10.1590/1806-9282.20210257

J Bras Pneumol. 2021 Oct 15;47(5):e20210236. doi: 10.36416/1806-3756/e20210236. eCollection 2021.

ABSTRACT

OBJECTIVE: Chloroquine or hydroxychloroquine has demonstrated no effect on the treatment of hospitalized COVID-19 patients. This study aimed to answer questions related to the use of hydroxychloroquine for pre-exposure or post-exposure prophylaxis of SARS-CoV-2 infection and in the treatment of patients with mild COVID-19 in terms of hospitalization, adverse events, and mortality.

METHODS: This was a systematic review and meta-analysis of phase 3 randomized clinical trials, selected from various databases, which compared patients who received hydroxychloroquine for SARS-CoV-2 prophylaxis or treatment of mild COVID-19 cases with controls.

RESULTS: A total number of 1,376 studies were retrieved. Of those, 9 met the eligibility criteria and were included in the study. No statistically significant differences were found between the hydroxychloroquine and control groups in terms of pre- or post-exposure prophylaxis of SARS-CoV-2 infection. The use of hydroxychloroquine increased the risk of adverse events by 12% (95% CI, 6-18%; p < 0.001), and the number needed to harm was 9. In addition, no significant differences were found between the hydroxychloroquine and control groups regarding hospitalization (risk difference [RD] = -0.02; 95% CI, -0.04 to 0.00; p = 0.14) or mortality (RD = 0.00; 95% CI, -0.01 to 0.02; p = 0.98) in the treatment of mild COVID-19.

CONCLUSIONS: The use of hydroxychloroquine for prophylaxis of SARS-CoV-2 infection or treatment of patients with mild COVID-19 is not recommended.

PMID:34669839 | DOI:10.36416/1806-3756/e20210236

Dental Press J Orthod. 2021 Oct 15;26(5):e2119364. doi: 10.1590/2177-6709.26.5.e2119364.oar. eCollection 2021.

ABSTRACT

INTRODUCTION: The probability of improvement in the upper airway space (UAS) with orthognathic surgery should be considered during the surgical-orthodontic treatment decision, providing not only an esthetic, but also a functional benefit for the patient.

OBJECTIVE: The purpose of this study was to evaluate the 3D changes in the upper airway space after maxillomandibular advancement surgery (MMA).

METHODS: A retrospective analysis of 56 patients, 21 male and 35 female, with a mean age of 35.8 ± 10.7 years, who underwent MMA was performed. Pre- and postoperative cone-beam computed tomography scans (CBCT) were obtained for each patient, and the changes in the UAS were compared using Dolphin Imaging 11.7 software. Two parameters of the pharyngeal airway space (PAS) were measured: airway volume (AV) and minimum axial area (MAA). Paired t-test was used to compare the data between T0 and T1, at 5% significance level.

RESULTS: There was a statistically significant increase in the UAS. Bimaxillary advancement surgery increased the AV and the MAA, on average, by 73.6 ± 74.75% and 113.5 ± 123.87%, respectively.

CONCLUSION: MMA surgery tends to cause significant increase in the UAS; however, this increase is largely variable.

PMID:34669826 | DOI:10.1590/2177-6709.26.5.e2119364.oar

Arq Neuropsiquiatr. 2021 Sep;79(9):789-794. doi: 10.1590/0004-282X-ANP-2020-0425.

ABSTRACT

BACKGROUND: Migraines are headaches caused by changes in the trigeminovascular metabolic pathway. Migraine headache attacks are associated with neurovascular inflammation, but their pathophysiological mechanisms have not been fully explained.

OBJECTIVE: To investigate the relationship between serum vaspin, visfatin, chemerin and interleukin-18 (IL-18) levels and the frequency of attacks in migraine headache.

METHODS: Three groups were established: migraine with aura (n = 50), migraine without aura (n = 50) and control group (n = 50). The migraine diagnosis was made in accordance with the International Classification of Headache Disorders-III beta diagnostic criteria. The analyses on serum vaspin, visfatin, chemerin and IL-18 levels were performed using the enzyme-linked immunosorbent assay method.

RESULTS: The serum vaspin, visfatin, chemerin and IL-18 levels were found to be significantly higher in the migraine patients than in the control group (p < 0.01). No statistically significant differences in serum vaspin, visfatin, chemerin and IL-18 levels were found among the migraine patients during attacks or in the interictal period (p>0.05). The serum visfatin and chemerin levels of the migraine patients were positively correlated with their serum IL-18 levels (p < 0.01), while their serum chemerin and visfatin levels were positively correlated with their serum vaspin levels (p < 0.05).

CONCLUSIONS: This study showed that these biomarkers may be related to migraine pathogenesis. Nonetheless, we believe that more comprehensive studies are needed in order to further understand the role of vaspin, visfatin, chemerin and IL-18 levels in the pathophysiology of migraine headaches.

PMID:34669816 | DOI:10.1590/0004-282X-ANP-2020-0425

Cad Saude Publica. 2021 Oct 15;37(9):e00178520. doi: 10.1590/0102-311X00178520. eCollection 2021.

ABSTRACT

The objective was to demonstrate the rate of detection of mental disorders in primary healthcare units as a marker of access and indicator of care in mental health. A comparative case study was performed in the electronic patient files of adults seen in two neighboring primary care units in the city of Rio de Janeiro, Brazil, in 2015-2016 and 2016-2017. Diagnoses of mental disorders were extracted, using the International Classification of Diseases, dividing them into three groups: common mental disorders (CMD: F32; F33 F40-45, except F42, and R45), severe mental disorders (SMD: F20-F29; F31-F39), and alcohol and drug use (AD: F10-F19 and Z72). The results were compared to the community prevalence of mental disorders reported in the literature. Statistical analysis was applied with the chi-square test, in addition to a qualitative analysis of each unit´s scenario. Unit A (2015-2016) showed a low detection rate for all disorders [SMD = 45 (0.8%); CMD = 148 (2.64%) and AD = 0]; unit B detected about 50% of the expected cases [SMD = 23 (0.98%); CMD = 140 (5.97%) and AD = 130 (5.54%)]. In 2016-2017 there was an increase in the overall detection of mental disorders at unit A [SMD = 89 (1.6%); CMD = 298 (5.24%) and AD = 7 (0.12%)], in unit B the detection rate remained similar [SMD = 25 (1.0%); CMD = 176 (7.14%) and AD = 121 (4.9%)]. Changes in the units were detected. Distinction in the detection rate was used as an indicator for analysis of mental health care, allowing the study of factors potentially associated with this variation, influencing access to care. Monitoring this indicator helps improve mental health care.

PMID:34669772 | DOI:10.1590/0102-311X00178520

PLoS One. 2021 Oct 20;16(10):e0258807. doi: 10.1371/journal.pone.0258807. eCollection 2021.

ABSTRACT

The outbreak of the COVID-19 pandemic has dramatically shaped higher education and seen the distinct rise of e-learning as a compulsory element of the modern educational landscape. Accordingly, this study highlights the factors which have influenced how students perceive their academic performance during this emergency changeover to e-learning. The empirical analysis is performed on a sample of 10,092 higher education students from 10 countries across 4 continents during the pandemic’s first wave through an online survey. A structural equation model revealed the quality of e-learning was mainly derived from service quality, the teacher’s active role in the process of online education, and the overall system quality, while the students’ digital competencies and online interactions with their colleagues and teachers were considered to be slightly less important factors. The impact of e-learning quality on the students’ performance was strongly mediated by their satisfaction with e-learning. In general, the model gave quite consistent results across countries, gender, study fields, and levels of study. The findings provide a basis for policy recommendations to support decision-makers incorporate e-learning issues in the current and any new similar circumstances.

PMID:34669757 | DOI:10.1371/journal.pone.0258807

PLoS One. 2021 Oct 20;16(10):e0258815. doi: 10.1371/journal.pone.0258815. eCollection 2021.

ABSTRACT

Rigorous healthcare design research is critical to inform design decisions that improve human experience. Current limitations in the field include a lack of consistent and valid measures that provide feedback about the role of the built environment in producing desirable outcomes. Research findings about nurses’ efficiency, quality of care, and satisfaction related to inpatient unit designs have been mixed, and there was previously no validated instrument available to quantitatively measure nurses’ ability to work efficiently and effectively in their environment. The objective of this study was to develop, refine, and validate a survey instrument to measure affordance of the care environment to nurse practice, based on various aspects of their work in inpatient units. The HDR Clinical Activities Related to the Environment (CARE) Scale Inpatient Version was developed using item design, refinement, and reliability and validity testing. Psychometric methods from classical test theory and item response theory, along with statistical analyses involving correlations and factor analysis, and thematic summaries of qualitative data were conducted. The four-phase process included (1) an initial pilot study, (2) a content validation survey, (3) cognitive interviews, and (4) a final pilot study. Results from the first three phases of analysis were combined to inform survey scale revisions before the second pilot survey, such as a reduction in the number and rewording of response options, and refinement of scale items. The updated 9-item scale showed excellent internal consistency and improved response distribution and discrimination. The factor analysis revealed a unidimensional measure of nurse practice, as well as potential subscales related to integration, efficiency, and patient care. Within the healthcare design industry, this scale is much needed to generate quantitative and standardized data and will facilitate greater understanding about the aspects of an inpatient healthcare facility that best support nurses’ ability to provide quality patient care.

PMID:34669741 | DOI:10.1371/journal.pone.0258815

PLoS One. 2021 Oct 20;16(10):e0258720. doi: 10.1371/journal.pone.0258720. eCollection 2021.

ABSTRACT

The assessment of the strength and muscle mass of the hand-finger segment are reliable indicators of health and predictors of cardiometabolic risk in the adult population. However, there are no valid and reliable tests to assess the muscle power of this segment in healthy adolescents. The objective of this study was to determine the validity and inter-day reliability of a grip power test (GripW test) in healthy adolescents. Twenty-one adolescents (15.61 ± 2.20 years old) were part of the study. All participants were instructed to perform a grip with incremental load sets from 1-10 kg as fast as possible. The validity of the GripW test was determined with the load-power curve and linear regression equation. Inter-day reliability considered the coefficient of variation (CV), intra-class correlation coefficient (ICC), and standard error of the mean (SEM). The significance level for all statistical analyses was p < 0.05. The parabola in the load-power curve for both hands showed normality for the GripW test. In addition, the analysis showed a CV = 4.63% and ICC = 1.00 for the right hand, while the left hand showed a CV = 3.23% and ICC = 1.00. The GripW test proved to be valid and reliable for assessing gripping muscle power functionally and unilaterally in healthy adolescents.

PMID:34669739 | DOI:10.1371/journal.pone.0258720

PLoS Genet. 2021 Oct 20;17(10):e1009853. doi: 10.1371/journal.pgen.1009853. Online ahead of print.

ABSTRACT

Genome-wide association studies (GWAS) have identified thousands of genetic variants that are associated with complex traits. However, a stringent significance threshold is required to identify robust genetic associations. Leveraging relevant auxiliary covariates has the potential to boost statistical power to exceed the significance threshold. Particularly, abundant pleiotropy and the non-random distribution of SNPs across various functional categories suggests that leveraging GWAS test statistics from related traits and/or functional genomic data may boost GWAS discovery. While type 1 error rate control has become standard in GWAS, control of the false discovery rate can be a more powerful approach. The conditional false discovery rate (cFDR) extends the standard FDR framework by conditioning on auxiliary data to call significant associations, but current implementations are restricted to auxiliary data satisfying specific parametric distributions, typically GWAS p-values for related traits. We relax these distributional assumptions, enabling an extension of the cFDR framework that supports auxiliary covariates from arbitrary continuous distributions (“Flexible cFDR”). Our method can be applied iteratively, thereby supporting multi-dimensional covariate data. Through simulations we show that Flexible cFDR increases sensitivity whilst controlling FDR after one or several iterations. We further demonstrate its practical potential through application to an asthma GWAS, leveraging various functional genomic data to find additional genetic associations for asthma, which we validate in the larger, independent, UK Biobank data resource.

PMID:34669738 | DOI:10.1371/journal.pgen.1009853

CJEM. 2021 Oct 20. doi: 10.1007/s43678-021-00204-w. Online ahead of print.

ABSTRACT

OBJECTIVES: Frequent emergency department (ED) use is a growing problem that is associated with poor patient outcomes and increased health care costs. Our objective was to analyze the association between mood disorders and the incidence of frequent ED use.

METHODS: We used the Canadian Community Health Survey conducted by Statistics Canada, 2015-2016. Mood disorder was defined as depression, bipolar disorder, mania, or dysthymia. Frequent ED use was defined as 4 or more visits in the year preceding the interview. Multivariable log-binomial regression models were used to determine the associations between mood disorders and frequent ED use.

RESULTS: Among the 99,009 participants, 8.4% had mood disorders, 80.3% were younger than 65, and 2.2% were frequent ED users. Mood disorders were significantly associated with the 1-year cumulative incidence of frequent ED use (RR = 2.5, 95% CI 2.2-2.7), after adjusting for several potential confounders.

CONCLUSIONS: This national survey showed that people with a mood disorder had a three-fold risk of frequent ED use, compared to people without mood disorder. These results can inform the development of policies and targeted interventions aimed at identifying and supporting ED patients with mood disorder.

PMID:34669174 | DOI:10.1007/s43678-021-00204-w