Nevin Manimala

BMJ Open. 2021 Sep 29;11(9):e053885. doi: 10.1136/bmjopen-2021-053885.

ABSTRACT

OBJECTIVES: Our aim was to measure ambulance sickness absence rates over time, comparing ambulance services and investigate the predictability of rates for future forecasting.

SETTING: All English ambulance services, UK.

DESIGN: We used a time series design analysing published monthly National Health Service staff sickness rates by gender, age, job role and region, comparing the 10 regional ambulance services in England between 2009 and 2018. Autoregressive Integrated Moving Average (ARIMA) and Seasonal ARIMA (SARIMA) models were developed using Stata V.14.2 and trends displayed graphically.

PARTICIPANTS: Individual participant data were not available. The total number of full-time equivalent (FTE) days lost due to sickness absence (including non-working days) and total number of days available for work for each staff group and level were available. In line with The Data Protection Act, if the organisation had less than 330 FTE days available during the study period it was censored for analysis.

RESULTS: A total of 1117 months of sickness absence rate data for all English ambulance services were included in the analysis. We found considerable variation in annual sickness absence rates between ambulance services and over the 10-year duration of the study in England. Across all the ambulance services the median days available were 1 336 888 with IQR of 548 796 and 73 346 median days lost due to sickness absence, with IQR of 30 551 days. Among clinical staff sickness absence varied seasonally with peaks in winter and falls over summer. The winter increases in sickness absence were largely predictable using seasonally adjusted (SARIMA) time series models.

CONCLUSION: Sickness rates for clinical staff were found to vary considerably over time and by ambulance trust. Statistical models had sufficient predictive capability to help forecast sickness absence, enabling services to plan human resources more effectively at times of increased demand.

PMID:34588266 | DOI:10.1136/bmjopen-2021-053885

Zhonghua Er Ke Za Zhi. 2021 Oct 2;59(10):847-852. doi: 10.3760/cma.j.cn112140-20210323-00246.

ABSTRACT

Objective: To investigate the application of glucocorticoids in children with neurological diseases by pediatricians, and to provide baseline data for further standardization of glucocorticoids application. Methods: This was a cross-sectional survey, an electronic questionnaire survey was conducted online from July 8, 2019 to July 28, 2019 through the Subspecialty Group of Clinical Pharmacology, the Subspecialty Group of Neurology, and Expert Committee on Rational Use of Medicines for Children in the Society of Pediatrics, Chinese Medical Association. This survey was conducted for the application of glucocorticoids in 8 neurological diseases in children, and compared with the current guidelines or consensus to judge whether the application was standard. A total of 1 850 pediatricians from 1 073 hospitals were surveyed. Surveyed diseases included bacterial meningitis, anti-N-methyl-D-aspartate receptor encephalitis, neuromyelitis optica spectrum disease (NMOSD), multiple sclerosis, Guillain-Barre syndrome, myasthenia gravis, juvenile dermatomyositis, and Duchenne muscular dystrophy. In order to explore the associated factors of standardized glucocorticoid application, the level of hospital, whether there was an independent department of pediatric neurology, and working experience of the doctor were used as independent variables. The χ² test and multivariate Logistic analysis was used for statistical analysis. Results: A total of 1 834 (99.1%) valid questionnaires were collected from 1 073 hospitals in 31 provinces, autonomous regions and municipalities. The coincidence rate with recommendation of the current guideline or consensus on glucocorticoids was 5.8% (51/879) in juvenile dermatomyositis, 13.7% (153/1 115) in myasthenia gravis, 18.2% (142/781) in bacterial meningitis, 18.5% (310/1 680) in anti-N-methyl-D-aspartate receptor encephalitis, 23.0% (248/1 079) in Duchenne muscular dystrophy, 33.4% (322/964) in NMOSD and multiple sclerosis, and 43.5% (477/1 096) in Guillain-Barre syndrome. The most common one was the irregular course of treatment, and the coincidence rate was 36.8% (12.5%-62.2%). The multivariate Logistic regression analysis indicated that the use of glucocorticoids was more standardized in bacterial meningitis (OR=1.83, 95%CI 1.39-2.43, P<0.01), Guillain-Barre syndrome (OR=1.97, 95%CI 1.50-2.59, P<0.01), Duchenne muscular dystrophy (OR=1.85, 95%CI 1.38-2.48, P<0.01), juvenile dermatomyositis (OR=2.08, 95%CI 1.03-4.19, P=0.040) and N-methyl-D-aspartate receptor encephalitis (OR=0.302, 95%CI 0.20-0.46, P<0.01) and by pediatricians with pediatric neurology specialty in the hospital. Conclusions: The coincidence rate with recommendation of the current guideline or consensus on glucocorticoids is less than half in children with neurological diseases, and the use of glucocorticoids is more standardized in a variety of diseases by pediatricians with pediatric neurology specialty in the hospital, which indicates that the study of guidelines or consensus and the special training of pediatric neurologists should be further strengthened.

PMID:34587681 | DOI:10.3760/cma.j.cn112140-20210323-00246

J Cosmet Dermatol. 2021 Sep 29. doi: 10.1111/jocd.14488. Online ahead of print.

ABSTRACT

PURPOSE: Androgenetic alopecia (AGA) is the most common cause of hair loss in males. Physical examination and history are the most important examinations in diagnosis of the disease. As yet, there is no diagnostic method to be able to determine which individuals will develop AGA. Shear-wave elastography (SWE) is a novel diagnostic tool, which can evaluate tissue stiffness. Superb microvascular imaging (SMI) can determine low flow in microvessels. The aim of the current study was to determine whether or not AGA would develop in individuals with normal hair and a family history of AGA using B-mode US, SMI, and SWE.

METHODS: The study included 26 patients clinically diagnosed with AGA and a control group of 26 volunteers.

RESULTS: Thickness with the distance from the epidermis to the calvarium (ECD) on the hairline and cranial subcutaneous tissue thickness (CSTD) were determined to be statistically significantly thinner in the AGA group than in the control group (p < 0.0001). For the differentiation of the AGA patients, the cutoff value was determined to be 5.5 mm for ECD and 4.05 mm for CSTD. The cranial epidermis-dermis (CED) stiffness values both as meter/second (m/s) and kilopascals (kPa) were statistically significantly lower in the AGA patients than in the control group (p < 0.0001). The cutoff values were 6.075 as m/s and 104.4 as kPa.

CONCLUSIONS: The results of this study demonstrated that differentiation could be made of individuals before the development of AGA from normal healthy individuals with CSTD measurement on B-mode US and CED stiffness measurement on SWE.

PMID:34587657 | DOI:10.1111/jocd.14488

J Occup Health. 2021 Jan;63(1):e12281. doi: 10.1002/1348-9585.12281.

ABSTRACT

OBJECTIVE: Due to the COVID-19 pandemic, telecommuting has become a new way of working that has not only changed individuals’ work, but also their health and lifestyle. We examined the relationship between telecommuting frequency and unhealthy dietary habits among Japanese workers.

METHODS: A total of 33,302 workers completed an Internet survey about telecommuting and dietary habits. Data from 13,468 office workers who telecommuted were analyzed. Telecommuting frequency during the COVID-19 pandemic was extracted from a questionnaire. The odds ratios (ORs) of four types of dietary habits, namely, skipping breakfast, solitary eating, lower meal frequency, and meal substitution associated with telecommuting frequency were estimated using multilevel logistic regression nested in the prefecture of residence to control for differences in residential area.

RESULTS: The multivariate OR of skipping breakfast was 1.15 (95% CI: 1.03-1.29, p = .013) for participants who telecommuted in excess of four days per week compared to those who rarely telecommuted. Similarly, the OR of solitary eating, lower meal frequency and meal substitution were 1.44 (95% CI: 1.28-1.63, p < .001), 2.39 (95% CI: 1.66-3.44, p < .001), and 1.26 (95% CI: 1.04-1.51, p = .015) for those who telecommuted in excess of four days per week compared to those who rarely telecommuted. There was a statistically significant increase in the dose-response trend in ORs of solitary eating (p for trend <.001), lower meal frequency (p for trend <.001), and meal substitution (p for trend = .001) with increasing telecommuting frequency.

CONCLUSION: Telecommuters may develop unhealthy dietary habits, indicating the need for strategies to help telecommuters manage their nutrition and diet.

PMID:34587654 | DOI:10.1002/1348-9585.12281

Thromb Haemost. 2021 Sep 29. doi: 10.1055/s-0041-1735531. Online ahead of print.

ABSTRACT

Platelet-targeted FVIII gene therapy can efficiently recover bleeding phenotype for hemophilia A (HA), yet characteristics of thrombus formation with this ectopic expression of factor VIII (FVIII) in platelets remain unclear. Here, we generated 2bF8^trans mice restrictively expressing human B-domain-deleted FVIII (hBDD FVIII) in platelets on a hemophilic (FVIII^null) mice background. The results showed no statistical difference in clot strength and stability between wild-type (WT) and 2bF8^trans mice, but with a prolonged reaction time (R-time), by thromboelastography. Fluid dynamics analysis showed that at the shear rates of 500 to 1,500 s^-1, where physiological hemostasis often develops, the thrombi formed in 2bF8^trans mice were more stable than those in FVIII^null mice, while at high pathological shear rates (2,500 s^-1), mimicking atherosclerosis, thrombus size and fibrin deposition in 2bF8^trans mice were less than those in WT mice. Thrombus morphology analysis showed that there was a locally concentrated deposition of fibrin in thrombus at the injured site and fibrin co-localized with activated platelets in 2bF8^trans mice. Moreover, a higher ratio of fibrin to platelets was found in thrombus from 2bF8^trans mice following laser-induced injury in cremaster arterioles, which might be the underlying mechanism of thrombus stability in 2bF8^trans mice at physiological arterial circumstance. These observations suggest that specific morphological features of the thrombi might contribute to the efficacy and safety of platelet-targeted FVIII gene therapy for HA.

PMID:34587639 | DOI:10.1055/s-0041-1735531

Eur J Dent. 2021 Sep 29. doi: 10.1055/s-0041-1732802. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to investigate the impact of mechanical complications on outcome measures for implant dentistry.

MATERIALS AND METHODS: This case-control study included 282 patients with mechanical complications occurring in fixed prosthetic rehabilitation supported by immediate function implants with external connection (cases) and 282 individuals without mechanical complications (control). Pairing was performed for sex, age (range = 3 years), and follow-up months (range = 11 months). The primary outcome measure was implant survival, while the secondary outcome measures were marginal bone loss and biological complication parameters (peri-implant pathology, soft tissue inflammation, fistula formation, and abscess formation).

STATISTICAL ANALYSIS: Cumulative implant survival was estimated by using life tables. Descriptive statistics with 95% confidence intervals (CI) and inferential statistics (Chi-square test) were performed to evaluate differences between cases and controls. The significance level was set at 5%.

RESULTS: The average follow-up duration was 8.5 years. Mechanical complications included prosthetic fracture (n = 159), abutment loosening (n = 89), prosthetic screw loosening (n = 20), milled abutment (n = 12), milled prosthetic screw (n = 1), and decemented crown (n = 1). Implant failure occurred in one patient from the control group, with survival rates of 100 and 99.6% for cases and controls, respectively (p = 0.317). The average marginal bone loss was 1.72 (95% confidence interval [CI]: 1.60-1.84) for cases and 1.55 (95% CI: 1.45-1.65) for controls (p = 0.068). Biological complications were observed in 90 patients, with significant differences between cases (n = 54) and controls (n = 36; p = 0.038).

CONCLUSION: Mechanical complications did not significantly influence survival or marginal bone loss; nevertheless, there is a need for studies with longer follow-up duration. Mechanical complications also significantly influence the incidence of biological complications.

PMID:34587636 | DOI:10.1055/s-0041-1732802

Am J Perinatol. 2021 Sep 29. doi: 10.1055/s-0041-1735554. Online ahead of print.

ABSTRACT

OBJECTIVE: Shallow placental implantation (SPI) features placental maldistribution of extravillous trophoblasts and includes excessive amount of extravillous trophoblasts, chorionic microcysts in the membranes and chorionic disc, and decidual clusters of multinucleate trophoblasts. The histological lesions were previously and individually reported in association with various clinical and placental abnormalities. This retrospective statistical analysis of a large placental database from high-risk pregnancy statistically compares placentas with and without a composite group of features of SPI.

STUDY DESIGN: Twenty-four independent abnormal clinical and 44 other than SPI placental phenotypes were compared between 4,930 placentas without (group 1) and 1,283 placentas with one or more histological features of SPI (composite SPI group; group 2). Placentas were received for pathology examination at a discretion of obstetricians. Placental lesion terminology was consistent with the Amsterdam criteria, with addition of other lesions described more recently.

RESULTS: Cases of group 2 featured statistically and significantly (p < 0.001after Bonferroni’s correction) more common than group 1 on the following measures: gestational hypertension, preeclampsia, oligohydramnios, polyhydramnios, abnormal Dopplers, induction of labor, cesarean section, perinatal mortality, fetal growth restriction, stay in neonatal intensive care unit (NICU), congenital malformation, deep meconium penetration, intravillous hemorrhage, villous infarction, membrane laminar necrosis, fetal blood erythroblastosis, decidual arteriopathy (hypertrophic and atherosis), chronic hypoxic injury (uterine and postuterine), intervillous thrombus, segmental and global fetal vascular malperfusion, various umbilical cord abnormalities, and basal plate myometrial fibers.

CONCLUSION: SPI placentas were statistically and significantly associated with 48% abnormal independent clinical and 51% independent abnormal placental phenotypes such as acute and chronic hypoxic lesions, fetal vascular malperfusion, umbilical cord abnormalities, and basal plate myometrial fibers among others. Therefore, SPI should be regarded as a category of placental lesions related to maternal vascular malperfusion and the “Great Obstetrical Syndromes.”

KEY POINTS: · SPI reflects abnormal distribution of extravillous trophoblasts.. · SPI features abnormal clinical and placental phenotypes.. · SPI portends increased risk of complicated perinatal outcome..

PMID:34587634 | DOI:10.1055/s-0041-1735554

Klin Monbl Augenheilkd. 2021 Sep 29. doi: 10.1055/a-1579-0805. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of the study was to assess retinal microcirculation in patients with coronavirus disease 2019 (COVID-19) through the use of optical coherence tomography angiography (OCT-A) and compare the results with those obtained in healthy controls.

METHODS: The study enrolled 39 patients who had fully recovered from COVID-19 and 40 healthy controls. OCT-A image acquisitions were obtained using AngioVue software (version 2017.1.0.151) and the RTVue XR Avanti imaging system (Optovue Inc., Fremont, CA, USA). Nonflow area in the superficial capillary plexus (SCP), foveal avascular zone (FAZ) area in the whole retinal vasculature, FAZ perimeter, acircularity index of FAZ, and foveal density were automatically obtained with the FAZ assessment tool. Vessel density (VD) at the SCP and deep capillary plexus were also measured.

RESULTS: Compared to the control group, the nonflow area and the FAZ area in the whole retina was greater in the COVID-19 group; however no statistically significant difference was observed (p > 0.05 respectively). As for vessel densities, all superficial parafoveal VD parameters were considerably higher in the COVID-19 group compared to the control group (p < 0.05 respectively). Despite the fact that the vessel densities in the remaining zones were lower in the COVID-19 group, those differences were not statistically significant (p > 0.05 respectively).

CONCLUSION: VD at the parafoveal area of the SCP was significantly higher among patients in the late post-recovery period of COVID-19 disease compared to healthy controls. These findings show the impact of COVID-19 on the retinal microvasculature and its possible role as a risk factor for the development of ocular diseases.

PMID:34587629 | DOI:10.1055/a-1579-0805

Interact Cardiovasc Thorac Surg. 2021 Sep 29:ivab259. doi: 10.1093/icvts/ivab259. Online ahead of print.

ABSTRACT

OBJECTIVES: This study investigated the efficacy and complications of albendazole use after surgery in patients with pulmonary hydatid cysts.

METHODS: One hundred fifty-three consecutive patients who met the study criteria out of 215 patients who received prophylaxis with albendazole after surgery for isolated pulmonary hydatid cysts in our clinic between January 2011 and December 2020 were analysed retrospectively.

RESULTS: Eighty-six out of 153 (56.2%) of cases were male and 67 (43.8%) were female. The average age was 24.6 ± 17.4 (between 3 and 71 years), 76 of them (49.7%) were 18 years old and younger, while 77 (50.3%) were adults. All cases were approached transthoracically and a total of 170 operations were performed on the 153 cases. Fever, weakness and dizziness were reported in only one patient who was given albendazole treatment. A partial increase in liver enzymes was observed in 16 cases (10.5%) after albendazole treatment. Mild leukopoenia and neutropenia were observed in only one of the cases. In 1 case, a second operation was performed 30 months later due to recurrence. Albendazole treatment was not required to be discontinued in any of the cases. Mortality was not observed in any of the cases. Factors such as mean age, cyst size and hospitalization period did not have a statistically significant effect on any changes in liver enzymes tests following albendazole therapy (P > 0.05).

CONCLUSIONS: Albendazole treatment can safely be used for postoperative prophylaxis in patients with pulmonary hydatid cysts in a controlled manner without causing serious complications.

SUBJ COLLECTION: 152.

PMID:34587626 | DOI:10.1093/icvts/ivab259

Phys Med Biol. 2021 Sep 29. doi: 10.1088/1361-6560/ac2b80. Online ahead of print.

ABSTRACT

Modern radiotherapy stands to benefit from the ability to efficiently adapt plans during treatment in response to setup and geometric variations such as those caused by internal organ deformation or tumor shrinkage. A promising strategy is to develop a framework, which given an initial state defined by patient-attributes, can predict future states based on patterns from a well-defined patient population. Here, we investigate the feasibility of predicting patient anatomical changes, defined as a joint state of volume and daily setup changes, across a fractionated treatment schedule using two approaches. The first is based on a new framework employing quantum mechanics in combination with deep recurrent neural networks, denoted QRNN. The second approach is developed based on a classical framework, which models patient changes as a Markov process, denoted MRNN. We evaluated the performance of these two approaches on a dataset of 125 head and neck cancer patients, which was supplemented by synthetic data generated using a generative adversarial network. Model performance was evaluated using area under the receiver operating characteristic curve (AUC) scores. The MRNN framework had slightly better performance, with MRNN(QRNN) validation AUC scores of 0.742 ± 0.021 (0.675 ± 0.036), 0.709 ± 0.026 (0.656 ± 0.021), 0.724 ± 0.036 (0.652 ± 0.044), and 0.698 ± 0.016 (0.605 ± 0.035) for system state vector sizes of 4, 6, 8, and 10, respectively. Of these, the results from the two higher order states had statistically significant differences (p<0.05). A similar trend was observed when the models were applied to an external testing dataset of 20 patients, yielding MRNN(QRNN) AUC scores of 0.707 (0.623), 0.687 (0.608), 0.723 (0.669), and 0.697 (0.609) for states vectors sizes of 4, 6, 8, and 10, respectively. These results suggest that both models have potential value in predicting patient changes during the course of adaptive radiotherapy.

PMID:34587597 | DOI:10.1088/1361-6560/ac2b80