Nevin Manimala

PLoS One. 2022 Jul 12;17(7):e0269942. doi: 10.1371/journal.pone.0269942. eCollection 2022.

ABSTRACT

BACKGROUND: People with pre-existing chronic diseases are more likely to acquire COVID-19 infections, which can be fatal, and die from COVID-19 illness. COVID-19 vaccination will benefit those at a higher risk of developing complications and dying from the disease. This study aimed to determine chronic patients’ willingness to receive a COVID-19 vaccine and the factors that influence their willingness.

METHOD: An institutional-based cross-sectional study was conducted among 423 adult chronic patients in the University of Gondar specialized hospital outpatient departments. The participants were chosen using systematic random sampling methods with an interval of 5. Face-to-face interviews were used to collect data from eligible respondents. Epi-data version 4.6 and SPSS version 25 were used for the data entry data analysis. Bivariable and multivariable binary logistic regression analyses were used to evaluate the relationship between the dependent and independent factors. An odds ratio with 95 percent confidence intervals and a P-value was used to determine the association’s strength and statistical significance.

RESULT: Out of 401 respondents, 219 (54.6%) with [95% CI (49.7-59.5%)] of study participants were willing to receive the COVID-19 vaccination. Being a healthcare worker (AOR = 2.94, 95% CI: 1.24-6.96), Lost family members or friends due to COVID-19 (AOR = 2.47, 95% CI: 1.21-5.00), good knowledge about COVID-19 vaccine (AOR = 2.44, 95% CI: 1.37-4.33), favorable attitude towards COVID-19 vaccine (AOR = .8.56 95% CI: 4.76-15.38), perceived suitability of the COVID-19 infection (AOR = 2.94, 95% CI: 1.62-5.33) and perceived benefit of the COVID-19 vaccine (AOR = 1.89, 95% CI: 1.08-3.31), were found to be a significant association with the willingness to receive the COVID-19 vaccine among chronic patients.

CONCLUSION: This study confirms that around 55% of adult chronic patients were willing to receive the COVID-19 vaccine. Providing health education for chronic patients to emphasize the knowledge and attitude of the COVID-19 vaccine and raise patients’ perceived risk of COVID-19 and the benefit of the COVID-19 vaccine could be recommended to improve their willingness to COVID-19 vaccination.

PMID:35819959 | DOI:10.1371/journal.pone.0269942

PLoS Med. 2022 Jul 12;19(7):e1004040. doi: 10.1371/journal.pmed.1004040. eCollection 2022 Jul.

ABSTRACT

BACKGROUND: Apgar scores measure newborn health and are strongly associated with infant outcomes, but their performance has largely been determined in primarily white populations. Given the majority of the global population is not white, we aim to assess whether the association between low Apgar score and mortality in infants varies across racial groups.

METHODS AND FINDINGS: Population-based cohort study using 2016 to 2017 United States National Vital Statistics System data. The study included singleton infants born between 37+0 and 44+6 weeks to mothers over 15 years, without congenital abnormalities. We looked at 3 different mortality outcomes: (1) early neonatal mortality; (2) overall neonatal mortality; and (3) infant mortality. We used logistic regression to assess the association between Apgar score (categorized as low, intermediate, and normal) and each mortality outcome, and adjusted for gestational age, sex, maternal BMI, education, age, previous number of live births, and smoking status, and stratified these models by maternal race group (as self-reported on birth certificates). The cohort consisted of 6,809,653 infants (52.8% non-Hispanic white, 23.7% Hispanic, 13.8% non-Hispanic black, 6.6% non-Hispanic Asian, and 3.1% non-Hispanic other). A total of 6,728,829 (98.8%) infants had normal scores, 63,467 (0.9%) had intermediate scores, and 17,357 (0.3%) had low Apgar scores. Compared to infants with normal scores, low-scoring infants had increased odds of infant mortality. There was strong evidence that this association varied by race (p < 0.001) with adjusted odds ratios (AORs) of 54.4 (95% confidence interval [CI] 49.9 to 59.4) in non-Hispanic white, 70.02 (95% CI 60.8 to 80.7) in Hispanic, 23.3 (95% CI 20.3 to 26.8) in non-Hispanic black, 100.4 (95% CI 74.5 to 135.4) in non-Hispanic Asian, and 26.8 (95% CI 19.8 to 36.3) in non-Hispanic other infants. The main limitation was missing data for some variables, due to using routinely collected data.

CONCLUSIONS: The association between Apgar scores and mortality varies across racial groups. Low Apgar scores are associated with mortality across racial groups captured by United States (US) records, but are worse at discriminating infants at risk of mortality for black and non-Hispanic non-Asian infants than for white infants. Apgar scores are useful clinical indicators and epidemiological tools; caution is required regarding racial differences in their applicability.

PMID:35819949 | DOI:10.1371/journal.pmed.1004040

PLoS One. 2022 Jul 12;17(7):e0271219. doi: 10.1371/journal.pone.0271219. eCollection 2022.

ABSTRACT

To examine the association of fetal fraction with a wide spectrum of pregnancy-related complications among Chinese population, we carried out a single-institution retrospective cohort study of women with negative Noninvasive prenatal testing (NIPT) results and singleton pregnancies between May 2018 and May 2020. Indicators of pregnancy-related complications were examined individually, including preterm birth, low birth weight, hypertensive disorders of pregnancy, gestational diabetes, oligohydramnios and intrahepatic cholestasis. We evaluated disease odds ratios (ORs) and 95% confidence intervals (CIs), after controlling for potential confounders including body mass index (BMI), maternal age and gestational week at NIPT. A total of 3534 women were included in our analyses. Women with fetal fraction<15.15% had increased risk of gestational hypertension (OR 4.41, CI [1.65, 12.45]) and oligohydramnios (OR 2.26, CI [1.33, 3.80]) compared to women with fetal fraction≥15.15%. No significant associations with fetal fraction were found for preterm birth, low birth weight, gestational diabetes, and intrahepatic cholestasis. In Summary, fetal fraction is inversely associated with the risk of gestational hypertension and oligohydramnios.

PMID:35819933 | DOI:10.1371/journal.pone.0271219

PLoS One. 2022 Jul 12;17(7):e0271166. doi: 10.1371/journal.pone.0271166. eCollection 2022.

ABSTRACT

PURPOSE: To evaluate the effect of intravitreal aflibercept monotherapy on arterial and venous oxygen saturation, retinal vessel diameter and flicker response in patients with newly diagnosed specific subtypes of exudative maculopathy.

METHODS: This prospective study included forty-four eyes of 44 patients with treatment-naïve polypoidal choroidal vasculopathy (PCV, n = 12), hemorrhagic choroidal neovascularization (hCNV, n = 12), pigment epithelium detachment (PED, n = 9) and type 3 MNV (RAP, n = 11). All patients received three initial aflibercept 2mg/0.05ml injections (Eylea®) in monthly intervals (loading phase) and were subsequently treated until month 12. Measurements of arterial and venous oxygen saturation, vessel diameters and flicker response were performed using the Dynamic Vessel Analyzer (DVA; IMEDOS, Jena, Germany). Statistical analysis was performed on the total population at baseline, after loading dose and at the last follow-up visit.

RESULTS: The arterial oxygen saturation was 94.01±2.14% and showed no change after loading dose (93.94±2.88%, p = 0.4; estimated difference [confidence interval] -0.38 [-1.24; 0.48]) and at the last visit (95.48±1.90%; p = 0.1; -1.29 [-0.34; 2.91]). The venous oxygenation during treatment was 78.49±6.93% at baseline, 80.94±7.71% after 3-monthly injections (p = 0.7; -0.43 [-2.72; 1.86]) and 80.56±7.33% at month 12 (p = 0.5; 1.07 [-2.10; 4.24). The arterial and venous vessel diameters were 94±22μm and 131±19μm at baseline, and remained unchanged following aflibercept loading dose and at the last follow-up visit (p-value: p = 0.5; 2.30 [-5.00; 9.59] p = 0.8; 0.59 [-3.17; 4.34]). During stimulation with flicker light, arterial diameter changed by +1.24±4.93% at baseline and remained stable at month 3 (+2.70±5.95%; p = 0.5; 1.43 [-2.54; 5.41]) while the change in venous diameter during flicker stimulation was +4.52±4.45% at baseline and +4.13±3.65% after loading dose (p = 0.4, 5.18 [1.73; 8.63]).

CONCLUSION: During intravitreal aflibercept treatment oxygen saturation, vessel diameter and flicker response did not change in the total population of patients with specific subtypes of exudative maculopathy.

PMID:35819932 | DOI:10.1371/journal.pone.0271166

J Comput Assist Tomogr. 2022 Jun 28. doi: 10.1097/RCT.0000000000001339. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to test the usefulness of computer-aided detection (CAD) for the detection of brain metastasis (BM) on contrast-enhanced computed tomography.

METHODS: The test data set included whole-brain axial contrast-enhanced computed tomography images of 25 cases with 62 BMs and 5 cases without BM. Six radiologists from 3 institutions with 2 to 4 years of experience independently reviewed the cases, both in conditions with and without CAD assistance. Sensitivity, positive predictive value, number of false positives, and reading time were compared between the conditions using paired t tests. Subanalysis was also performed for groups of lesions divided according to size. A P value <0.05 was considered statistically significant.

RESULTS: With CAD, sensitivity significantly increased from 80.4% to 83.9% (P = 0.04), whereas positive predictive value significantly decreased from 88.7% to 84.8% (P = 0.03). Reading time with and without CAD was 112 and 107 seconds, respectively (P = 0.38), and the number of false positives was 10.5 with CAD and 7.0 without CAD (P = 0.053). Sensitivity significantly improved for 6- to 12-mm lesions, from 71.2% without CAD to 80.3% with CAD (P = 0.02). The sensitivity of the CAD (95.2%) was significantly higher than that of any reader (with CAD: P = 0.01; without CAD: P = 0.005).

CONCLUSIONS: Computer-aided detection significantly improved BM detection sensitivity without prolonging reading time while marginally increased the false positives.

PMID:35819922 | DOI:10.1097/RCT.0000000000001339

J Comput Assist Tomogr. 2022 Jun 28. doi: 10.1097/RCT.0000000000001346. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to quantify the adenoidal-nasopharyngeal ratio (ANR) in a cohort of healthy adults on cone beam computed tomography (CT) using the Fujioka method, which is a reproducible measure of adenoid size and nasopharyngeal patency.

METHODS: Electronic health records and maxillofacial cone beam CT in 202 consecutive patients aged 16 years and older were retrospectively reviewed. Patients with a history of adenoidectomy, sinonasal disease, lymphoproliferative disorders, and cleft palate were excluded from the study. The midsagittal reconstructed cone beam CT image was used to determine the ANR. Statistical analysis was conducted using 1-way analysis of variance.

RESULTS: Of the 202 subjects, 131 were female and 71 were male. The mean ± SD subject age was 45.43 ± 20.79 years (range, 16-91 years). The mean ± SD ANR in all subjects was 0.22 ± 0.13 (range, 0.03-0.75) and in each decade of adult life was as follows: younger than 21 years, 0.39 ± 0.12; 21 to 30 years, 0.29 ± 0.11; 31 to 40 years, 0.21 ± 0.09; 41 to 50 years, 0.20 ± 0.07; 51 to 60 years, 0.16 ± 0.10; 61 to 70 years, 0.13 ± 0.05; 71 to 80 years, 0.12 ± 0.05; 81 to 90 years, 0.11 ± 0.04; and 91 years or older, 0.10 ± 0. The differences in mean ANR among the age subgroups were statistically significant (P < 0.001).

CONCLUSIONS: The mean ANR gradually decreased from 0.39 in the second decade of life to 0.16 in the sixth decade of life and plateaued at approximately 0.10 thereafter.

PMID:35819911 | DOI:10.1097/RCT.0000000000001346

Br J Radiol. 2022 Jul 12:20220009. doi: 10.1259/bjr.20220009. Online ahead of print.

ABSTRACT

OBJECTIVES: To investigate the diagnostic value of tumor homogeneity on contrast-enhanced (CE) computed tomography (CT) to differentiate multiple myeloma (MM) from osteolytic bone metastases (Mets).

METHODS: This retrospective study included patients who were diagnosed with MM or Mets and had multiple (≥2) osteolytic bone tumors on pre-treatment CE-CT. Intra tumoral homogeneity was assessed by coefficient of variation (CV, ratio of standard deviation to mean) of the density of a single lesion (CV-lesion). Inter tumoral homogeneity was assessed as the CV of the densities of multiple lesions in one patient (CV-patient). A classification model was built from CT parameters using classification and regression tree (CART) analysis. Diagnostic performance of the model was evaluated using C-statistics.

RESULTS: A total of 272 lesions (81 MM and 191 Mets) of 105 patients were analyzed. The mean CV-lesion and CV-patient of MM were significantly lower than those of Mets: 0.17 vs 0.26 for CV-lesion (p = 0.005) and 0.16 vs 0.23 for CV-patient (p = 0.013). Thickened struts were more common in MM than in Mets (49.1% vs 12.8%, p ≤ 0.001). In CART analysis, CV-lesion was the first partitioning predictor, followed by thickened struts and by CV-patient. The CART model could distinguish MM from Mets in both the model development cohort (C-statistic: 0.843) and the temporal validation cohort (0.721, 0.686, and 0.686 for three reviewers, respectively).

CONCLUSIONS: MM showed intra tumoral and inter tumoral homogeneity compared with Mets on CE-CT. The combination of CV-lesion and CV-patient can be helpful to radiologists in differentiation of MM from Mets.

ADVANCES IN KNOWLEDGE: Our study showed that MM had intra tumoral and inter tumoral homogeneity compared with Mets on contrast-enhanced CT.

PMID:35819897 | DOI:10.1259/bjr.20220009

J Cosmet Dermatol. 2022 Jul 12. doi: 10.1111/jocd.15237. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of the study was to compare Retinal Pigment Epithelium (RPE) thickness in patients with Psoriasis and Vitiligo.

MATERIALS AND METHODS: The right eyes of 67 Psoriasis and 65 Vitiligo patients and 71 healthy individuals were included in the study. The RPE thicknesses were analyzed with the Spectral Domain Optical Coherence Tomography after routine ophthalmological examinations (SD-OCT).

RESULTS: No statistically significant differences were detected when Psoriasis and Vitiligo patients were compared in terms of RPE levels (p= 0.033). When compared with the control group, no significant differences were found with Psoriasis patients, but a significant difference was detected with Vitiligo patients (p=0.515, p=0.001, respectively).

CONCLUSION: Although no changes were detected in RPE in Psoriasis, the decreased RPE thickness in Vitiligo may be an indicator of the effect of melanin loss on the posterior segment of the eye in Vitiligo. For this reason, measurement of RPE thickness with OCT can help in detecting the damage in Vitiligo patients.

PMID:35819889 | DOI:10.1111/jocd.15237

Anesthesiology. 2022 Jul 12. doi: 10.1097/ALN.0000000000004282. Online ahead of print.

ABSTRACT

For the task of estimating a target benchmark dose such as the ED50 (the dose that would be effective for half the population), an adaptive dose-finding design is more effective than the standard approach of treating equal numbers of patients at a set of equally spaced doses. Up-and-down is the most popular family of dose-finding designs and is in common use in anesthesiology. Despite its widespread use, many aspects of up-and-down are not well known, implementation is often misguided, and standard, up-to-date reference material about the design is very limited. This article provides an overview of up-and-down properties, recent methodologic developments, and practical recommendations, illustrated with the help of simulated examples. Additional reference material is offered in the Supplemental Digital Content.

PMID:35819863 | DOI:10.1097/ALN.0000000000004282

J Plast Surg Hand Surg. 2022 Jul 12:1-6. doi: 10.1080/2000656X.2022.2097250. Online ahead of print.

ABSTRACT

The stromal vascular fraction (SVF) is isolated from adipose tissue and has tremendous regenerative potential for proliferation and differentiation. This study aimed to investigate the factors affecting the cell yield and viability of the SVF to improve the outcomes of its clinical applications and enhance its clinical usage. We performed a retrospective analysis with 121 patients who underwent liposuction to harvest adipose-derived SVF. We recorded patient demographic and clinical characteristics, including age, sex, body mass index (BMI), blood type, medical comorbidities, and smoking and alcohol consumption. As for operative variables, we noted the amount of lipoaspirate and the donor areas, including the lower and entire abdomen. The viability and the cell count of SVF were documented. Sex was a statistically significant factor for viability rate (p < 0.015) and cell count (p < 0.009). Men had higher viability, while women had higher cell counts. We found a statistically significant difference in the presence of hypertension (p = 0.024) and alcohol consumption (p = 0.024). There was a statistically significant relationship between cell count and age (p < 0.001), BMI (p = 0.006), and amount of lipoaspirate (p < 0.001). Sex had significant associations with cell count and viability, while age, BMI, and lipoaspirate amount were significantly associated with cell count. Hypertension and alcohol consumption significantly affected cell count, which is the first such report of this association. Surgeons could apply this knowledge to patient selection for optimal treatment outcomes. Additionally, understanding these factors can help manage patient expectations.

PMID:35819816 | DOI:10.1080/2000656X.2022.2097250