Nevin Manimala

PLoS One. 2021 Mar 30;16(3):e0249085. doi: 10.1371/journal.pone.0249085. eCollection 2021.

ABSTRACT

BACKGROUND: Ethiopia launched free access for antiretroviral therapy in 2005. The number of patients on second line antiretroviral treatment has increased with each passing year. The objectives of this study were to describe the clinical, immunological and virologic outcomes of children and adolescents receiving second line anti-retroviral therapy in two referral hospitals, Yekatit 12 and Zewditu Memorial Hospitals, in Addis Ababa, Ethiopia.

METHODS: This was a hospital based retrospective cohort study conducted among children and adolescents aged 18 years and less and receiving a second line antiretroviral drugs. Data was collected using structured questionnaires. Means and percentages were used for nominal variables. Statistical analysis was made using statistical software-SPSS 23.0. Kaplan Meier analysis, long rank test and multivariate Cox proportion model were used to identify factors affecting survival.

RESULTS: A total of 75 children and adolescents were studied with a mean age of 13.28 years (SD: 4) with a mean treatment period on second line regimens of 35.2 months (SD: 21.8 months). Forty-eight participants were experiencing successful measures (in all three parameters) for their second line anti-retroviral treatment. Ten had virologic treatment failure while seven had died. Both treatment failure and death rates were higher within the first two years of treatment. Poor treatment adherence (Adjusted hazard ratio: 5.1 (95% CI: 1.1-23.2; p-value = 0.02)) and advanced World Health Organization clinical stage at start of the second line antiretrovirals (Adjusted hazard ratio: 7.51 (95% CI: 1.35-18.02; p-value = 0.002)) correlated significantly with survival of children and adolescents receiving treatment.

CONCLUSIONS: The study describes clinical, immunological and virologic outcomes of second line antiretroviral treatment in a pediatric cohort under care in two hospitals in Addis Ababa, Ethiopia. Poor adherence and pre-treatment advanced clinical stages were predictors of survival.

PMID:33784335 | DOI:10.1371/journal.pone.0249085

PLoS One. 2021 Mar 30;16(3):e0248676. doi: 10.1371/journal.pone.0248676. eCollection 2021.

ABSTRACT

INTRODUCTION: Governmental measures aiming at social protection, with components of disease control, have potential positive impacts in the nutritional and health outcomes of the beneficiaries. The concomitant presence of these measures with environmental sanitation interventions may increase their positive effect. The context of simultaneous improvement of social protection and environmental sanitation is found in Brazil since 2007 and an assessment of the combined effects of both programs has not been performed so far.

OBJECTIVE: To evaluate whether interaction effects between improvement of access to water, sanitation and solid waste collection with the Bolsa Família Program [PBF] were related to better responses in the reduction of morbidity due to diarrhea and malnutrition in children less than five years of age, acknowledging the positive results of these improved conditions and the PBF separately in coping with these diseases.

METHODS: Descriptive and inferential analyses were performed through Generalized Linear Models of the Negative Binomial type of fixed effects, with and without addition of zeros. Interaction models were inserted in order to evaluate the outcomes when the two public policies of interest in the current study were present simultaneously in the municipalities.

RESULTS: Interaction with negative effect when a concomitantly high municipal coverage of the Bolsa Família Program and adequate access to sanitation and solid waste collection were present. In contrast, regardless of municipal coverage by the PBF, the simultaneous presence of water and sanitation (0.028% / 0.019%); water and solid waste collection (0.033% / 0.014%); sanitation and solid waste collection (0.018% / 0.021%), all resulted in a positive effect, with a decrease in the average morbidity rates for both diseases.

CONCLUSION: Investments aimed at universalizing water, sanitation and solid waste collection services should be priorities, aiming at reducing the incidence of morbidity due to malnutrition and diarrhea and preventing deaths from these poverty-related diseases.

PMID:33784331 | DOI:10.1371/journal.pone.0248676

PLoS One. 2021 Mar 30;16(3):e0246965. doi: 10.1371/journal.pone.0246965. eCollection 2021.

ABSTRACT

BACKGROUND: While motorcycles are essential for moving people and goods, they are also, a significant contributor to Road Traffic Accidents (RTAs), making it a public health issue of concern globally. The Hohoe Municipal Hospital records increasing RTAs due to commercial motorcycles. Determining motorcycle riders’ compliance with road safety regulations is critical in helping to curb this menace.

METHOD: A cross-sectional study was employed involving a multistage sample of 238 motorcycle riders. Data were collected using a pretested structured questionnaire and entered into Epi Data version 3.2 software and exported to STATA software version 12 for analysis. Descriptive and inferential analyses were done while statistical significance was determined at 95% reliability interval and p-value of 0.05.

FINDINGS: The level of compliance with road safety regulations among respondents was 59.2%. The mean age of respondents was 29.9 ± 7.9 years, and all respondents were males. Respondents who did not own their motorbikes were 0.39 times less likely to comply with road safety regulations compared to their counterparts who owned one, while those without alternate occupations were 0.51times less likely to comply with road safety regulations compared to those with an additional occupation. Those aged between 30-39 years and 40-49 years were 2.37 and 4.1 times more likely to comply with road safety regulations, respectively, compared to those aged ≤29 years, and those who did not smoke were 3.15 times more likely to comply with road safety regulations than those who smoked.

CONCLUSION: Compliance to safety regulations are fairly low and although motorcycle usage on a commercial basis is yet to be legalised in Ghana, routine education targeting riders who smoke, do not have alternate occupations, do not own motorbikes and younger riders will improve their compliance. Also, riders should be encouraged to obtain their license from the appropriate authorities.

PMID:33784328 | DOI:10.1371/journal.pone.0246965

PLoS One. 2021 Mar 30;16(3):e0248437. doi: 10.1371/journal.pone.0248437. eCollection 2021.

ABSTRACT

Gun violence and mass shootings are high-profile epidemiological issues facing the United States with questions regarding their contagiousness gaining prevalence in news media. Through the use of nonparametric Hawkes processes, we examine the evidence for the existence of contagiousness within a catalog of mass shootings and highlight the broader benefits of using such nonparametric point process models in modeling the occurrence of such events.

PMID:33784326 | DOI:10.1371/journal.pone.0248437

PLoS One. 2021 Mar 30;16(3):e0249082. doi: 10.1371/journal.pone.0249082. eCollection 2021.

ABSTRACT

Wildlife-related accidents, especially deer-vehicle accidents, pose a serious problem for road safety and animal protection in many countries. Knowledge of spatial and temporal patterns of deer-vehicle accidents is inevitable for accident analysis and mitigation efforts with temporal deer-vehicle accident data being much more difficult to obtain in sufficient data quality. We described the temporal patterns of roe deer (Capreolus capreolus) roadkills occurring in the period 2002-2006 in southeastern Austria. Using a comprehensive dataset, consisting of 11.771 data points, we examined the influence of different time units (i.e. season, month, day of week, day of year), illumination categories (coarse and fine temporal resolution) and lunar phases on deer-vehicle accidents by performing linear and generalized additive models. Thereby, we identified peak accident periods within the analyzed time units. Highest frequencies of deer-vehicle accidents occurred in November, May and October, on Fridays, and during nights. Relationships between lunar phases and roe deer-vehicle accidents were analysed, providing evidence for high frequencies of deer-vehicle accidents during full moon phases. We suggest that deer-vehicle accidents are dependent both on human activity in traffic and wildlife activity, which is in turn affected by phenology, intra- and interspecific competition, climatic and astronomical events. Our results highlight, that short-term mitigation measures (e.g. traffic controls and speed limits) can be highly effective to reduce deer-vehicle accidents, but should be flexibly adapted to specific temporal periods.

PMID:33784325 | DOI:10.1371/journal.pone.0249082

PLoS One. 2021 Mar 30;16(3):e0249027. doi: 10.1371/journal.pone.0249027. eCollection 2021.

ABSTRACT

The estimation of the entropy of a random system or process is of interest in many scientific applications. The aim of this article is the analysis of the entropy of the famous Kumaraswamy distribution, an aspect which has not been the subject of particular attention previously as surprising as it may seem. With this in mind, six different entropy measures are considered and expressed analytically via the beta function. A numerical study is performed to discuss the behavior of these measures. Subsequently, we investigate their estimation through a semi-parametric approach combining the obtained expressions and the maximum likelihood estimation approach. Maximum likelihood estimates for the considered entropy measures are thus derived. The convergence properties of these estimates are proved through a simulated data, showing their numerical efficiency. Concrete applications to two real data sets are provided.

PMID:33784310 | DOI:10.1371/journal.pone.0249027

Cir Cir. 2021;89(2):212-217. doi: 10.24875/CIRU.20000094.

ABSTRACT

ANTECEDENTES: Los pacientes geriátricos presentan dificultad progresiva para expresar el dolor. Es muy importante establecer un parámetro preciso para manejar el dolor posoperatorio.

OBJETIVO: Determinar la validez de la escala facial del dolor (EFD) en pacientes geriátricos posquirúrgicos.

MÉTODO: Estudio comparativo, observacional, prolectivo, en un hospital de segundo nivel de atención. Fase 1: se presentaron las caras de la escala desordenadas a personas ≥ 60 años, con Glasgow íntegro, previa firma de consentimiento, para ordenarlas ascendentemente. Fase 2: se incluyeron pacientes ≥ 60 años, de cualquier sexo, sometidos a cualquier procedimiento quirúrgico, con Glasgow íntegro, previa firma de consentimiento informado. Se eliminaron los que no cooperaron o no completaron ambas escalas. A cada paciente se aplicó, antes de recibir analgesia, la escala visual numérica (EVN), y 5 minutos después la EFD, y nuevamente 30 minutos tras la analgesia. Se utilizó estadística descriptiva, tamaño del efecto, t pareada y Spearman.

RESULTADOS: Fase 1: todas las caras fueron ubicadas correctamente (75-100%). Fase 2: participaron 142 pacientes, 76 (53.5%) hombres y 66 (46.5%) mujeres. Promedios preanalgesia: EFD 3.4, EVN 7.9; posanalgesia: EFD 1.8, EVN 4.8. Tamaño del efecto (EFD): 2.389; t pareada 17.231 (p < 0.002); Spearman 0.654 (p = 0.016) preanalgesia, 0.798 (p = 0.004) posanalgesia.

CONCLUSIÓN: La EFD es válida para evaluar la intensidad del dolor posoperatorio en pacientes geriátricos.

BACKGROUND: Geriatric patients present progressive difficult to assess pain. Getting a precise parameter to approach postsurgical pain is a very important issue.

OBJECTIVE: To explore Faces Pain Scale (EFD) validity in geriatric post-surgical patients.

METHOD: Comparative, observational, prolective study in patients from a second level attention unit. Phase 1: faces were disorderly presented to ≥ 60 years old persons, Glasgow scale scored 15, signed authorization, to place them in ascending order. Phase 2: ≥ 60 years old patients, any sex, who received any surgical procedure, Glasgow scale scored 15, signed authorization were recruited. Those who did not cooperate/complete scales application were eliminated. Numeral Visual Scale (EVN) and 5 minutes after EFD were applied to each patient, before analgesia, and again 30 minutes after analgesia. Descriptive statistical data, effect-size, Student paired-t and Spearman tests were used.

RESULTS: Phase 1: every face was correctly placed (75-100%). Phase 2: 142 patients participated, 76 (53.5%) male, 66 (46.5%) female. Pre-analgesia media scores: EFDA 3.4, EVN 7.9; post-analgesia media scores: EFD 1.8, EVN 4.8. EFD effect-size test scored 2.389, paired-t scored 17.231 (p < 0.002); Spearman scores: 0.654 (p = 0.016) pre-analgesia, 0.798 (p = 0.004) post-analgesia.

CONCLUSION: EFD is a valid scale to evaluate postoperative pain intensity in geriatric patients.

PMID:33784276 | DOI:10.24875/CIRU.20000094

Cir Cir. 2021;89(2):170-182. doi: 10.24875/CIRU.20000022.

ABSTRACT

INTRODUCTION: Liver cancer (LC) is a public health problem in the world, since is the second leading cause of death and Mexico is no exception, in 2013 the LC ranked fourth of mortality among malignancies.

MATERIAL AND METHODS: The records of mortality associated to LC for the period 2000-2013 were obtained from National Institute of Statistics and Geography. National mortality rates were calculated by state and by socioeconomic region. The strength of association of the states of residency and educational level with mortality from LC was determined.

RESULTS: In 2000-2013, the crude death rate per 100,000 people increased from 4.2 to 4.9. Individuals with no schooling or incomplete elementary school the relative risk (RR) of dying from LC was the highest (RR 8.61, 95% CI 8.35-8.89), while in individuals with senior in high school or equivalent the RR decreased (RR 0.74, 95% CI 0.71-0.77). Chihuahua had the highest risk of dying [RR 30.3, 95% CI 19.6-46.8 (2000) and RR 22.3, 95% CI 15.1-33 (2013)]. Region 2 had the highest mortality rate.

CONCLUSIONS: In Mexico in the study period, the crude death rate increased from LC. Individuals with no schooling or with incomplete elementary school the RR of dying from LC was the highest. Chihuahua had the highest mortality rate and the highest risk of dying. Region 2 had the highest mortality rate.

ANTECEDENTES: El cáncer de hígado es un problema de salud pública en el mundo, ya que es la segunda causa de muerte, y México no es la excepción; en 2013, dicho cáncer ocupó el cuarto lugar en mortalidad entre las neoplasias malignas.

MÉTODO: Se obtuvieron los registros de mortalidad asociada al cáncer de hígado correspondientes al periodo 2000-2013 del Instituto Nacional de Estadística y Geografía. Se calcularon las tasas de mortalidad nacional, por Estados y por región socioeconómica. Se determinó la fuerza de la asociación de los Estados donde residían los individuos y el nivel de estudios con la mortalidad por cáncer de hígado.

RESULTADOS: En 2000-2013, la tasa cruda de mortalidad por 100,000 individuos se incrementó de 4.2 a 4.9. En individuos sin escolaridad o con primaria incompleta, el riesgo relativo (RR) de morir por cáncer de hígado fue el mayor (RR: 8.61; intervalo de confianza del 95% [IC95%]: 8.35-8.89), mientras que en aquellos con preparatoria disminuyó (RR: 0.74; IC95%: 0.71-0.77). El Estado que tuvo el mayor riesgo de morir fue Chihuahua (RR: 30.3, IC95%: 19.6-46.8 en 2000 y RR: 22.3, IC95%: 15.1-33 en 2013). La región socioeconómica con la mayor tasa de mortalidad fue la región 2.

CONCLUSIONES: En México, en el periodo de estudio, la tasa cruda de mortalidad por cáncer de hígado se incrementó. En individuos sin escolaridad o con primaria incompleta, el RR de morir por cáncer de hígado fue el mayor. El Estado que tuvo la mayor tasa de mortalidad y el mayor riesgo de morir fue Chihuahua. La región socioeconómica con la mayor tasa de mortalidad fue la región 2.

PMID:33784273 | DOI:10.24875/CIRU.20000022

J Chin Med Assoc. 2021 Apr 1;84(4):418-422. doi: 10.1097/JCMA.0000000000000498.

ABSTRACT

BACKGROUND: Bladder instillation of hyaluronic acid (HA) is an acceptable treatment for bladder pain syndrome/interstitial cystitis (BPS/IC). The treatment is limited by a high proportion of non-responders (~30%-40%). Here, we aimed to evaluate predisposing factors associated with treatment outcomes.

METHODS: This is a prospective multicenter study. We enrolled a total of 137 (out of 140) women with refractory IC. They all underwent a standard protocol of 6-month intravesical HA therapy (initial 4 weeks, once weekly, followed by once monthly). To assess the outcomes, we used the pain Visual Analog Scale (Pain-VAS), Interstitial Cystitis Symptom and Problem Index (ICSI & ICPI), and a scaled Global Response Assessment (GRA).

RESULTS: The age of patients was 47.6 ± 27.5 (range 24-77) years. We found statistically significant improvement (p < 0.001) in the Pain-VAS and the ICSI & ICPI scores both after the initial 4-weekly instillations and at the end of 6-month treatment. Those who reported moderate/marked improvement on GRA at the 2 follow-up visits were considered responders: 39.4% (n = 54) at the first follow-up, and 59.9% (n = 82) at the second follow-up. No remarkable side effect was noted. After statistical analyses, treatment outcomes on GRA were positively associated with baseline functional bladder capacity and with Pain-VAS scores. The initial treatment responses optimally (p < 0.001) predicted final treatment outcomes (McNemar).

CONCLUSION: Intravesical HA therapy is safe and effective for most (~60%) of our patients with refractory IC. Functional bladder capacity and Pain-VAS scores before treatment, and the early treatment responses are helpful predictors of treatment outcomes.

PMID:33784267 | DOI:10.1097/JCMA.0000000000000498

Platelets. 2021 Mar 30:1-7. doi: 10.1080/09537104.2021.1902967. Online ahead of print.

ABSTRACT

Our objective was to analyze if there was a significant relationship between platelet parameters (PLT, MPV, PDW, P-LCR, PCT) among dengue, its serological subgroups and controls. Serologically proven adult patients with dengue {(n = 238) (NS1 positive = 218, IgM positive = 14, NS1 & IgM positive = 6)} and age- and gender-matched controls (n = 254) were included. The MPV, PDW and P-LCR were significantly higher, and PLT and PCT were significantly lower in cases compared with controls. Cases as well as controls showed a positive correlation between PLT and PCT, both parameters individually showed negative correlation with MPV, PDW, P-LCR. MPV, PDW and P-LCR showed positive correlation with each other. The results were similar in the serological subgroups. Comparison of our results with other studies points toward an overall hyperdestructive etiology for thrombocytopenia in dengue. There were two subgroups of cases based on the severity of thrombocytopenia. The mean/median value of all the platelet parameters was lesser in the ≤20k group than the >20k group, except for PDW, which was high although not statistically significant. Suppression of megakaryopoiesis with concomitant immune destruction of platelets in severe dengue could explain low MPV and P-LCR with a high PDW in view of the presence of microthrombocytes as a result of immune destruction. Although an overall hyperdestructive mechanism contributes to thrombocytopenia in dengue, regular monitoring of the platelet indices could reflect the status of megakaryopoiesis and thrombokinetic axis, thus aiding easy determination of pathophysiology and treatment.

PMID:33784226 | DOI:10.1080/09537104.2021.1902967