Nevin Manimala

Ann Hepatol. 2021 Nov 17:100556. doi: 10.1016/j.aohep.2021.100556. Online ahead of print.

ABSTRACT

INTRODUCTION AND OBJECTIVES: Cause of mortality in patients with chronic liver diseases (CLDs) may differ based on underlying etiology of liver disease. Our aim was to assess different causes of death in patients with the most common types of CLD using a national database from the United States.

MATERIALS AND METHODS: Death data from 2008 and 2018 from the National Vital Statistics System (NVSS) by the National Center for Health Statistics (NCHS) were used. The rank of cause-of-death for each etiology of CLDs was assessed. Causes of death were classified by the ICD-10 codes. Liver-related deaths included liver cancer, cirrhosis and CLDs.

RESULTS: Among a total of 2,826,531 deaths in 2018, there were 85,807 (3.04%) with underlying CLD (mean age at death 63.0 years, 63.8% male, 70.8% white). Liver-related mortality was the leading cause of death for all types of CLD [45.8% in non-alcoholic fatty liver disease (NAFLD), 53.0% in chronic hepatitis C (CHC), 57.8% in chronic hepatitis B (CHB), 81.8% in alcoholic liver disease (ALD)]. This was followed by death from cardiac causes (NAFLD 10.3%, CHC 9.1%, CHB 4.6%, ALD 4.2%) and extrahepatic cancer (NAFLD 7.0%, CHC 11.9%, CHB 14.9%, ALD 2.1%). Although liver cancer was the leading cause of cancer death, lung, colorectal and pancreatic cancer were also common causes of cancer death.

CONCLUSIONS: Among deceased patients with CLD, underlying liver disease was the leading cause of death. Among solid cancers, liver cancer was the leading cause of cancer-related mortality.

PMID:34800721 | DOI:10.1016/j.aohep.2021.100556

Infect Genet Evol. 2021 Nov 17:105143. doi: 10.1016/j.meegid.2021.105143. Online ahead of print.

ABSTRACT

North Central Nigeria is one region in Nigeria with a significant incidence of malaria caused majorly by Plasmodium falciparum. This study utilizes the msp1 and msp2 genes of P. falciparum to examine its diversity and multiplicity of infection (MOI). Blood samples were collected from 247 children across selected healthcare facilities in Minna, from infants and children aged 6 months to 17 years. Of the total collection, 143 (58%) of the children were infected with P. falciparum with parasite density ≥ 1000 μl, and from which fifty (50) samples was randomly selected and presented for PCR for the characterization of msp1 and msp2 gene using nested-PCR method. Overall, 57 msp1 genotypes, including K1, MAD20 and RO33 were identified, ranging from (250-1000 bp), (100-500 bp) and (400-500 bp), respectively. In addition, 54 different msp2 genotypes of FC27 and 3D7 alleles ranging from (100-900 bp) and (100-800 bp), respectively were selected. A monoclonal infection of 39% and a polyclonal infection of 61% was recorded, however, a particularity about this study is the polyclonal nature of RO33. Determination of gene diversity revealed MAD20 as the predominant allele for msp1 with a mean MOI of 1.35 and FC27 for msp2 with 1.72 MOI. The overall MOI recorded for the study was 1.60. There was, however, no statistical significance difference between MOI and age of the child (P > 0.05). Meanwhile, findings from this study revealed P. falciparum populations were not genetically diverse with Heterozygosity (He) index of 0.0636. However, a significant level gene diversity within the antigenic markers of msp1 and msp2 was observed with He index of 0.714 and 0.830, respectively. This study has demonstrated the potential of gene diversity and MOI of P. falciparum, as important markers for assessing differences in malaria transmission intensity. Continuous malaria genetic surveillance is therefore recommended as a fundamental tool for monitoring changes in gene types and for intervention programs’ effectiveness.

PMID:34800712 | DOI:10.1016/j.meegid.2021.105143

J Acad Nutr Diet. 2021 Nov 17:S2212-2672(21)01470-2. doi: 10.1016/j.jand.2021.11.008. Online ahead of print.

ABSTRACT

BACKGROUND: Evening eating has been associated with higher energy intake and lower nutrient density. However, these qualities may not characterize all late evening (LE) eating patterns.

OBJECTIVE: We sought to characterize U.S. adults’ LE eating patterns on a given day and identify differences, if any, in pattern-specific associations with, and impact on, daily energy intake and total diet quality.

DESIGN: LE eating patterns, energy intakes, and HEI scores were identified using Day-1 dietary recall data from the cross-sectional National Health and Nutrition Examination Survey 2013-2016.

PARTICIPANTS/SETTING: The sample included adults age ≥20 years (n=9,861). “LE reporters” were respondents who consumed foods/beverages between 20:00 h and 23:59 h on the intake day.

MAIN OUTCOME MEASURES: Energy intake and HEI-2015 scores by LE status/pattern and the impact of LE consumption on these measures.

STATISTICAL ANALYSES: Cluster analysis assigned individuals to LE eating patterns based on the LE energy contribution of food/beverage groups. Regression models estimated energy intake and HEI-2015 scores; estimates were compared between LE reporters and non-reporters. Similarly, LE’s contribution to total energy and the difference in total HEI inclusive versus exclusive of LE consumption were estimated and compared among patterns.

RESULTS: Among U.S adults, 64.4% were LE reporters. Eleven LE patterns were identified; the six most prevalent patterns (representing 89% of LE reporters) were further analyzed. Daily energy intake in all prevalent patterns except the fruit pattern exceeded that of non-reporters by ≥268 kcal (unadjusted; p<0.001), varying by pattern. Conversely, total HEI score did not differ from that of non-reporters (51.0) in any pattern except the fruit pattern, where it was higher (57.4, unadjusted; p<0.001). Generally, LE consumption’s impact on energy was high and its impact on HEI scores was low.

CONCLUSIONS: Late evening food/beverage consumption is common among U.S. adults, and LE patterns are not monolithic in their associations with, and impact on, total energy intake and dietary quality.

PMID:34800696 | DOI:10.1016/j.jand.2021.11.008

Travel Med Infect Dis. 2021 Nov 17:102209. doi: 10.1016/j.tmaid.2021.102209. Online ahead of print.

ABSTRACT

BACKGROUND: Aircrew members of airlines are exposed to travel risks. The objectives of our study are to assess the experience of aircrews about these risks and their knowledge about prevention means.

METHODS: We conducted an observational qualitative study in commercial aircrews at the aeromedical center of Percy Military Hospital between November 2018 and June 2019.

RESULTS: 200 aircrews answered the questionnaire, 54% of which were pilots, 91% work on long and/or medium-haul flights, 82.5% of airmen are concerned by their immunization status. Vaccination rate varied according to the vaccine. Two third of airmen usually go to malaria-endemic countries, 12% of respondents use antimalarial treatment in such infected countries, while 93.5% protect themselves against mosquito bites mainly with insect repellent. In case of a fever after a stay in a malaria-endemic country, only 51.5% of respondents immediately think about acute malaria. Aircrews are very motivated by their job but 58% of them feel tired probably linked to quality of sleep and effects of jet-lag, with a statistically significant difference between pilots and cabin crews (43% vs 75% [p < 0.01]).

CONCLUSION: Aircrew members know a lot about travel issues. Malaria remains a major concern for aircrews, but it is necessary to maintain information about this topic throughout their career and to provide them with repellents, what many airlines actually do. Fatigue management is also important for airmen, so as they use different technics to accelerate recovery. Some airlines try to help them with a guide for aircrew fatigue management. This particular population involved in flight safety has few risky behaviors; nevertheless, alcohol misuse and drug use are screened during medical examinations and by airlines.

PMID:34800693 | DOI:10.1016/j.tmaid.2021.102209

Int J Infect Dis. 2021 Nov 17:S1201-9712(21)00871-7. doi: 10.1016/j.ijid.2021.11.023. Online ahead of print.

ABSTRACT

OBJECTIVE: Analyse differences in clinical presentation and outcome between bacteraemic pneumococcal community-acquired pneumonia (B-PCAP), and SARS-CoV-2 pneumonia.

METHODS: Observational multicenter study conducted on patients hospitalized for B-PCAP between 2000-2020 and SARS-CoV-2 pneumonia during 2020. We compared 30-day survival, predictors of mortality and intensive care unit (ICU) admission.

RESULTS: We included 663 B-PCAP and 1561 SARS-CoV-2 pneumonia. B-PCAP patients had higher severity, ICU admission and more complications. SARS-CoV-2 pneumonia patients had higher in-hospital mortality (10.8%vs6.8%, p 0.004). Among ICU patients, need for invasive mechanical ventilation (69.7%vs36.2%, p<0.001) and mortality were higher in SARS-CoV-2 pneumonia. In B-PCAP, our predictive model related mortality to systemic complications (hyponatremia, septic shock, neurological complications), lower respiratory reserve or tachypnoea; whereas chest pain and purulent sputum were protective. In SARS-CoV-2, mortality was related to previous liver and cardiac disease, advanced age, altered mental status, tachypnoea, hypoxemia, bilateral involvement, pleural effusion, septic shock, neutrophilia, and high blood urea nitrogen; in contrast, ≥7 days of symptoms was a protective factor. In-hospital mortality occurred earlier in B-PCAP.

CONCLUSIONS: Although B-PCAP was associated with higher severity and ICU rate, SARS-CoV-2 pneumonia-related mortality was higher and occurred later. New prognostic scales and more effective treatments are needed for SARS-CoV-2 pneumonia.

PMID:34800689 | DOI:10.1016/j.ijid.2021.11.023

Ecol Appl. 2021 Nov 20:e02500. doi: 10.1002/eap.2500. Online ahead of print.

ABSTRACT

Near-term iterative forecasting is a powerful tool for ecological decision support and has the potential to transform our understanding of ecological predictability. However, to this point, there has been no cross-ecosystem analysis of near-term ecological forecasts, making it difficult to synthesize diverse research efforts and prioritize future developments for this emerging field. In this study, we analyzed 178 near-term (≤10-year forecast horizon) ecological forecasting papers to understand the development and current state of near-term ecological forecasting literature and compare forecast accuracy across scales and variables. Our results indicate that near-term ecological forecasting is widespread and growing: forecasts have been produced for sites on all seven continents and the rate of forecast publication is increasing over time. As forecast production has accelerated, a number of best practices have been proposed and application of these best practices is increasing. In particular, data publication, forecast archiving, and workflow automation have all increased significantly over time. However, adoption of proposed best practices remains low overall: for example, despite the fact that uncertainty is often cited as an essential component of an ecological forecast, only 45% of papers included uncertainty in their forecast outputs. As the use of these proposed best practices increases, near-term ecological forecasting has the potential to make significant contributions to our understanding of forecastability across scales and variables. In this study, we found that forecastability (defined here as realized forecast accuracy) decreased in predictable patterns over 1-7 day forecast horizons. Variables that were closely related (i.e., chlorophyll and phytoplankton) displayed very similar trends in forecastability, while more distantly related variables (i.e., pollen and evapotranspiration) exhibited significantly different patterns. Increasing use of proposed best practices in ecological forecasting will allow us to examine the forecastability of additional variables and timescales in the future, providing a robust analysis of the fundamental predictability of ecological variables.

PMID:34800082 | DOI:10.1002/eap.2500

Thorac Cancer. 2021 Nov 20. doi: 10.1111/1759-7714.14247. Online ahead of print.

ABSTRACT

BACKGROUND: Studies on the clinical implication of hospital selection for patients with lung cancer are few. Therefore, this study aimed to analyze 2005-2016 data from the Korean national database to assess annual trends of lung cancer surgery and clinical outcomes according to hospital selection.

METHODS: Data of 212 554 patients with lung cancer who underwent upfront surgery were screened. Trends according to sex, age, residence, and income were examined. Descriptive statistics were performed, and p_trend values were estimated. The association between survival and hospital selection was assessed using the log-rank test. A multivariate Cox regression analysis was also performed.

RESULTS: A total of 49 021 patients were included in this study. Surgery was prevalent among men, patients aged 61-75 years, capital area residents, and high-income patients. However, with the increasing rate of surgery among women, patients aged ≥76 years, city residents, and middle-income patients, the current distribution of lung cancer surgery could change. The rate of lobectomy among these groups increased. All patients, except those in capital areas, preferred a hospital outside their area of residence (HOR); the number of patients with this tendency also increased. However, this trend was not observed among low-income patients and those aged ≥76 years. There were significant differences in survival according to hospital selection.

CONCLUSIONS: The trend of lung cancer surgery is changing. The current medical system is effective in providing lobectomy for patients including women, aged ≥76 years, city residents, and middle-income. Increasing tendency to choose an HOR requires further study.

PMID:34800078 | DOI:10.1111/1759-7714.14247

Pharmacoepidemiol Drug Saf. 2021 Nov 19. doi: 10.1002/pds.5386. Online ahead of print.

ABSTRACT

PURPOSE: Validating outcome measures is a prerequisite for using administrative databases for comparative effectiveness research. Although the Japanese Diagnosis Procedure Combination database is widely used in surgical studies, the outcome measure for postsurgical infection has not been validated. We developed a model to identify postsurgical infections using the routinely-collected Diagnosis Procedure Combination data.

METHODS: We retrospectively identified inpatients who underwent surgery for gastric, colorectal, or liver cancer between April 2016 and March 2018 at four hospitals. Chart reviews were conducted to identify postsurgical infections. We used bootstrap analysis with backwards variable elimination to select independent variables from routinely-collected diagnosis and procedure data. Selected variables were used to create a score predicting the chart review-identified infections, and the performance of the score was tested.

RESULTS: Among the 756 eligible patients, 102 patients (13%) had postoperative infections. Three variables were identified as predictors: diagnosis of infectious disease recorded as a complication arising after admission, addition of an intravenous antibiotic, and bacterial microscopy or culture. The prediction model had a C-statistic of 0.891 and pseudo-R² of 0.380. A cut-off of 1 point of the score showed a sensitivity of 92% and specificity of 71%, and a cut-off of 2 points showed a sensitivity of 77% and specificity of 91%.

CONCLUSIONS: Our model using routinely-collected administrative data accurately identified postoperative infections. Further external validation would lead to the application of the model for research using administrative databases. This article is protected by copyright. All rights reserved.

PMID:34800063 | DOI:10.1002/pds.5386

Int J Cancer. 2021 Nov 20. doi: 10.1002/ijc.33880. Online ahead of print.

ABSTRACT

Adolescents and young adults (AYAs, 15-39 years) are the largest uninsured population in the Unites States, increasing the likelihood of late-stage cancer diagnosis and poor survival. We evaluated the associations between the Affordable Care Act (ACA), insurance coverage, stage at diagnosis, and survival among AYAs with lymphoma. We used data from the California Cancer Registry linked to Medicaid enrollment files on AYAs diagnosed with a primary non-Hodgkin (NHL; n=5,959) or Hodgkin (HL; n=5,378) lymphoma pre-ACA and in the early and full ACA eras. Health insurance was categorized as continuous Medicaid, discontinuous Medicaid, Medicaid enrollment at diagnosis/uninsurance, other public, and private. We used multivariable regression models for statistical analyses. The proportion of AYAs uninsured/Medicaid enrolled at diagnosis decreased from 13.4% pre-ACA to 9.7% with full ACA implementation, while continuous Medicaid increased from 9.3% to 29.6% during this time (p<0.001). After full ACA, AYAs with NHL were less likely to be diagnosed with stage IV disease (aOR=0.84, 95% CI 0.73-0.97). AYAs with lymphoma were more likely to receive care at National Cancer Institute-Designated Cancer Centers (aOR=1.42, 95% CI 1.28-1.57) and had lower likelihood of death (aHR=0.54, 95% CI 0.46-0.63) after full ACA. However, AYAs from the lowest socioeconomic neighborhoods, racial/ethnic minority groups, and those with Medicaid, continued to experience worse survival. In summary, AYAs with lymphomas experienced increased access to healthcare and better clinical outcomes following Medicaid expansion under the ACA. Yet, socioeconomic and racial/ethnic disparities remain, calling for additional efforts to decrease health inequities among underserved AYAs with lymphoma. This article is protected by copyright. All rights reserved.

PMID:34800045 | DOI:10.1002/ijc.33880

Int Endod J. 2021 Nov 20. doi: 10.1111/iej.13667. Online ahead of print.

ABSTRACT

AIM: To examine the efficacy rate of four anaesthetic protocols in mandibular first molars with symptomatic irreversible pulpitis (SIP).

METHODOLOGY: One-hundred-sixty patients with a SIP diagnosis were included in this randomized clinical trial. Patients were randomly allocated into 4 treatment groups (N=40) according to the administered technique: Group 1 (IANB): standard inferior alveolar nerve block (IANB) injection; Group 2 (IANB + IO): standard IANB followed by a supplemental intraosseous infusion (IO) injection; Group 3 (IANB + PDL): standard IANB followed by a supplemental periodontal ligament (PDL) injection; Group 4 (IANB + BI): standard IANB followed by a supplemental buccal infiltration. Patients rated pain intensity using a verbal rating scale (VRS) when root canal treatment procedure was initiated, i.e. during caries removal, access preparation, and pulpectomy. Heart rate changes were recorded before, during and after each injection. The anaesthetic efficacy rates were analyzed using chi-square test, age differences using One Way ANOVA, gender differences using Fischer Exact test whilst heart rate changes were analyzed using Kruskal Wallis test. Statistical significances were set at P < 0.05 level.

RESULTS: All the included patients were analysed. No differences in the efficacy rate were found in relation to the age or gender of the participants amongst the study groups (P >0.05). IANB+IO injections had a significantly higher efficacy rate (92.5%) when compared to other techniques (p<0.05), followed by IANB+PDL injections (72.5%), IANB+BI injections (65.0%), with no significant differences between the IANB+PDL or IANB+BI injections (p>0.05). IANB injection alone had a significantly lower rate (40%) compared to the other techniques (p<0.05). A transient but significant rise in the heart rate was recorded in 60% (24/40) of patients who received the IANB+IO injection compared to other groups (p<0.05).

CONCLUSIONS: IANB injection alone did not reliably permit pain-free treatment for mandibular molars with SIP. The use of an additional IO supplemental injection provided the most effective anaesthesia for patients requiring emergency root canal treatment for SIP in mandibular posterior teeth.

PMID:34800034 | DOI:10.1111/iej.13667