Nevin Manimala

Dtsch Arztebl Int. 2022 Aug 22;(Forthcoming):arztebl.m2022.0229. doi: 10.3238/arztebl.m2022.0229. Online ahead of print.

ABSTRACT

BACKGROUND: 40 000 to 60 000 people develop malignant pleural effusion (MPE) in Germany each year. The most common causes are lung cancer and breast cancer. Patients with pleural carcinomatosis have a median survival time of four months.

METHODS: We investigated the current health services situation regarding treatment with indwelling pleural catheters (IPC) versus talc pleurodesis (TP) in Germany based on registry data from the Federal Statistical Office, the Pleural Tumor Registry of the German Society for Thoracic Surgery, and the IPC registry of the ewimed GmbH company. In addition, we conducted a selective literature review on IPC and TP.

RESULTS: The symptoms of dyspnea and thoracic pressure determine the need for therapy in MPE. Both TP and IPC are effective treatment options for MPE. Both therapeutic procedures are considered equally effective with respect to the relief of dyspnea, post-interventional quality of life, and complication rates. TP yields a higher rate of successful pleurodesis than IPC (relative risk: 1.56; 95% confidence interval: [1.26; 1.92]; p < 0.0001), while patients who receive an IPC stay in the hospital for a shorter time than those who undergo TP (a difference of slightly more than two days). The survival of patients with MPE is not affected by which of the two local therapeutic procedures is chosen.

CONCLUSION: The indication for either IPC or TP needs to be determined individually for each patient on the basis of his or her general condition, symptoms, clinical situation (“trapped lung”), and prognosis.

PMID:35734918 | DOI:10.3238/arztebl.m2022.0229

Dtsch Arztebl Int. 2022 Sep 5;(Forthcoming):arztebl.m2022.0235. doi: 10.3238/arztebl.m2022.0235. Online ahead of print.

ABSTRACT

BACKGROUND: Studies from Denmark and the USA have shown that the outcome of treatment of peripheral arterial occlusive disease (PAOD) varies as a function of the size and certification status of the treating hospital. It is not yet known whether this holds for Germany as well.

METHODS: We studied all hospitalizations for PAOD of stage IIb or higher (in Fontaine’s classification) using DRG statistics from the German Federal Statistical Office. The treating hospitals were classified by size and certification status. For each hospitalization, the patient’s PAOD stage, age, sex, and comorbidities were recorded. Independent variables predicting different endpoints of treatment were identified by univariate and multivariate logistic regression.

RESULTS: 29% of the 558 785 hospitalizations included in our analysis were in hospitals with certified vascular centers. In a multivariate analysis, hospitalization in a certified hospital was associated with a lower rate of major amputation (odds ratio [OR] 0.95; 95% confidence interval [0.92; 0.98], p = 0.003) and a higher rate of minor amputation (OR 1.04 [1.01; 1.06], p = 0.004), with no difference in mortality (OR 0.99 [0.96; 1.03], p = 0.791). Patients who were treated in larger hospitals had more extensive comorbidity, stayed longer in the hospital, and had higher amputation rates and a higher mortality.

CONCLUSION: Being treated for PAOD in a certified hospital is associated with fewer major amputations and more minor amputations. This may be due to greater utilization of treatments aimed at preserving limb function.

PMID:35734915 | DOI:10.3238/arztebl.m2022.0235

Thyroid. 2022 Jun 23. doi: 10.1089/thy.2022.0243. Online ahead of print.

ABSTRACT

BACKGROUND: Thyroid dysfunction has been observed among some patients with COVID-19. It is unclear whether SARS-CoV-2 infection (or its severity) leads to the development of thyroid dysfunction, or vice versa. In this study, we examined the bi-directional causal relationship between host genetic liability to three COVID-19 phenotypes (including SARS-CoV-2 infection, hospitalized and severe COVID-19) and three thyroid dysfunction traits [including hyperthyroidism, hypothyroidism, and autoimmune thyroid disease (AITD)] and three continuous traits of thyroid hormones [including thyroid-stimulating hormone (TSH) and free thyroxine (FT4) within reference range, and TSH in full range].

METHODS: Summary statistics from the largest available meta-analyses of human genome-wide association studies were retrieved for the following variables: SARS-CoV-2 infection (n=1,348,701), COVID-19 hospitalization (n=1,557,411), severe COVID-19 (n=1,059,456), hyperthyroidism (n=51,823), hypothyroidism (n=53,423), AITD (n=755,406), TSH within reference range (n=54,288), FT4 within reference range (n=49,269), and TSH in full range (n=119,715). Using a two-sample Mendelian randomization (MR) approach, the inverse-variance weighted (IVW) method was adopted as the main MR analysis. Weighted median, contamination mixture, MR-Egger, and MR-PRESSO methods were applied as sensitivity analyses.

RESULTS: Host genetic susceptibility to SARS-CoV-2 infection was causally associated with hypothyroidism in the main IVW analysis (per doubling in prevalence of SARS-CoV-2 infection, Odds Ratio (OR)=1.335; 95% CI: 1.167-1.526; p=2.4×10-5, surpassing the Bonferroni multiple-testing threshold). Similar causal estimates were observed in the sensitivity analyses (weighted median: OR=1.296; 95% CI: 1.066-1.575; p=9×10-3; contamination mixture: OR=1.356; 95% CI: 1.095-1.818; p=0.013; MR-Egger: OR=1.712; 95% CI: 1.202-2.439; p=2.92×10-3, and MR-PRESSO: OR=1.335; 95% CI: 1.156-1.542; p=5.73×10-4). Host genetic liability to hospitalized or severe COVID-19 was not associated with thyroid dysfunction or thyroid hormone levels. In the reverse direction, there was no evidence to suggest that genetic predisposition to thyroid dysfunction or genetically determined thyroid hormone levels altered the risk of the COVID-19 outcomes.

CONCLUSIONS: This bi-directional MR study supports that host response to SARS-CoV-2 viral infection plays a role in the causal association with increased risk of hypothyroidism. Long-term follow-up studies are needed to confirm the expected increased hypothyroidism risk.

PMID:35734897 | DOI:10.1089/thy.2022.0243

Tuberc Respir Dis (Seoul). 2022 Jun 23. doi: 10.4046/trd.2022.0006. Online ahead of print.

ABSTRACT

BACKGROUND: The most consistent identified mortality determinants for the new coronavirus 2019 infection (COVID-19) are aging, male sex, cardiovascular/respiratory diseases, and cancer. They were determined from heterogeneous cohorts that included patients with different disease severity and previous condition. The main goal of our study was to test if activities of daily living (ADL) dependence measured by Barthel’s index could be a predictor for COVID-19 mortality.

METHODS: Prospective cohort study with a consecutive sample of 340 COVID-19 patients representing patients from all over the Northern region of Portugal from 10/2020 to 03/2021. Mortality risk factors were determined controlling for demographics, activities of daily living (ADL) dependence, admission time, comorbidities, clinical manifestations, and delay-time for diagnosis. Central tendency measures were used to analyze continuous variables and absolute numbers (proportions) for categorical variables. For univariable analysis we used T-Test/Chi-Square/Fisher Exact Test as appropriate (α=0.05). Multivariable analysis was performed using logistic regression. Statistical software: IBM®SPSS®27.

RESULTS: The cohort included 340 patients (55.3% females, mean age 80.6±11.0) with a mortality rate of 19.7%. Aging, ADL dependence, pneumonia and dementia were associated with mortality and dyslipidemia and obesity with survival in univariate analysis. In multivariable analysis dyslipidemia (OR=0.35, 95%CI:0.17-0.71) was independently associated with survival. Age ≥ 86-year-old (pooled OR 2.239, 95% CI: 1.100-4.559), pneumonia (pooled OR 3.00, 95% CI: 1.362-6.606), and ADL dependence (pooled OR 6.296, 95% CI: 1.795-22.088) were significantly related to mortality (ROC AUC=82.1% (p<0.0001)).

CONCLUSION: ADL dependence, aging and pneumonia are the 3 main COVID-19 mortality predictors among an elderly population.

PMID:35734879 | DOI:10.4046/trd.2022.0006

Psychiatr Serv. 2022 Jun 23:appips202100651. doi: 10.1176/appi.ps.202100651. Online ahead of print.

ABSTRACT

OBJECTIVE: A 3-year study explores employment outcomes of certified peer specialists (CPSs). Analyses reported here identified relationships between demographic, clinical, work history, and geographic characteristics and employment status and current employment in peer services jobs versus other jobs.

METHODS: The study recruited adults who recently became a CPS, regardless of current employment status, in four states. Online survey data were collected from March to October 2020 and included demographic information, health status and diagnoses, mental health service use, motivations for becoming certified, employment history, and job characteristics, including job satisfaction. Descriptive statistics and logistic regression models were used to compare groups.

RESULTS: Of 681 respondents, 591 provided data on current employment and were included. Participants who received Social Security Disability Insurance or Supplemental Security Income, veterans, those who used outpatient counseling or therapy, and those who did not disclose their mental health status in the workplace were less likely to report current employment. Lack of disclosure and higher local unemployment rates contributed to a lower likelihood of working in peer services jobs, whereas individuals reporting depressive disorders were more likely to hold such jobs. Compared with those in other jobs, those in peer services jobs reported longer job tenure, and a larger proportion received employee benefits. Job satisfaction was significantly higher among those with peer services jobs.

CONCLUSIONS: Workers with a CPS credential had higher employment rates, compared with adults with psychiatric disabilities, and the quality of peer specialist jobs was equal to or higher than the quality of other jobs held by study participants.

PMID:35734863 | DOI:10.1176/appi.ps.202100651

Isr Med Assoc J. 2022 Jun;24(6):369-374.

ABSTRACT

BACKGROUND: Low back pain has been the leading cause for disability worldwide for several decades, and clinical guidelines for its management clearly emphasize a multifactorial approach. Yet, current guidelines are still not well implemented by clinicians.

OBJECTIVES: To explore the attitudes of family medicine residents regarding low back pain and to determine whether they positively correlate with their treatment approaches. To test if these attitudes can be affected by the Enhanced Transtheoretical Model Intervention (ETMI), a guideline-based workshop.

METHODS: Participants completed an online questionnaire regarding their attitudes toward low back pain and clinical habits, after which they attended an online ETMI educational workshop. One month later all participants were asked to complete the questionnaire a second time. Statistical analysis was conducted to explore the attitudes of the residents and clinical approaches, as well as any associations between them, as well as possible differences pre- and post-intervention.

RESULTS: The participants exhibited highly psychologically oriented attitudes. Correlations between the attitudes and treatment did not show consistent coherency. Results regarding the participants clinical approaches were revealed to have two distinct and opposed inclinations: biomedically and biopsychosocially. Last, results for the re-activation subscale were significantly higher post-intervention.

CONCLUSIONS: Family medicine residents seem to be highly psychologically oriented regarding low back pain; however, they do not necessarily treat their patients accordingly. Their clinical choices seem to follow two different approaches: guideline-consistent and non-guideline-consistent. An ETMI guideline-based workshop may sway their attitudes toward re-activation of patients. Further research is needed to determine whether similar results would arise in larger physician populations.

PMID:35734835

J Small Anim Pract. 2022 Jun 22. doi: 10.1111/jsap.13523. Online ahead of print.

ABSTRACT

OBJECTIVES: To investigate whether a difference exists in incidence of medial meniscal tears between small (≤15 kg) and medium-to-large (>15 kg) dogs with naturally occurring cranial cruciate ligament disease.

MATERIALS AND METHODS: Records were retrospectively reviewed to identify the incidence of medial meniscal tears in dogs undergoing tibial plateau levelling osteotomy. Degree of cruciate insufficiency, method of identification (arthroscopy or arthrotomy), tibial plateau angle, weight and signalment were recorded. A two-proportion z-test with clustering adjustment was used to compare the meniscal tear rate between the two groups. Logistic regression analysis was used to investigate the effects of variables on medial meniscal tears.

RESULTS: Seventy-six stifles in 67 small dogs and 504 stifles in 384 medium-to-large dogs were included. The rate of meniscal injury at index surgery was 38.2% in small dogs and 36.7% in medium-to-large dogs. The subsequent meniscal tear rate was 1.3% in small dogs and 8% in medium-to-large dogs. The difference in meniscal tear rate was not statistically significant at either index surgery or subsequently. Degree of cruciate ligament insufficiency and use of arthroscopy were significantly associated with medial meniscal tears at index surgery. No variables were significantly associated with subsequent medial meniscal tears.

CLINICAL SIGNIFICANCE: No significant difference exists in medial meniscal tear rate between small and medium-to-large dogs either at index surgery or subsequently. The index of suspicion of concurrent medial meniscal tears should be higher in dogs with complete tear of the cranial cruciate ligament but a partial tear does not preclude meniscal pathology.

PMID:35734828 | DOI:10.1111/jsap.13523

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