Nevin Manimala

PLoS Comput Biol. 2022 Feb 16;18(2):e1009874. doi: 10.1371/journal.pcbi.1009874. Online ahead of print.

ABSTRACT

Tick paralysis resulting from bites from Ixodes holocyclus and I. cornuatus is one of the leading causes of emergency veterinary admissions for companion animals in Australia, often resulting in death if left untreated. Availability of timely information on periods of increased risk can help modulate behaviors that reduce exposures to ticks and improve awareness of owners for the need of lifesaving preventative ectoparasite treatment. Improved awareness of clinicians and pet owners about temporal changes in tick paralysis risk can be assisted by ecological forecasting frameworks that integrate environmental information into statistical time series models. Using an 11-year time series of tick paralysis cases from veterinary clinics in one of Australia’s hotspots for the paralysis tick Ixodes holocyclus, we asked whether an ensemble model could accurately forecast clinical caseloads over near-term horizons. We fit a series of statistical time series (ARIMA, GARCH) and generative models (Prophet, Generalised Additive Model) using environmental variables as predictors, and then combined forecasts into a weighted ensemble to minimise prediction interval error. Our results indicate that variables related to temperature anomalies, levels of vegetation moisture and the Southern Oscillation Index can be useful for predicting tick paralysis admissions. Our model forecasted tick paralysis cases with exceptional accuracy while preserving epidemiological interpretability, outperforming a field-leading benchmark Exponential Smoothing model by reducing both point and prediction interval errors. Using online particle filtering to assimilate new observations and adjust forecast distributions when new data became available, our model adapted to changing temporal conditions and provided further reduced forecast errors. We expect our model pipeline to act as a platform for developing early warning systems that can notify clinicians and pet owners about heightened risks of environmentally driven veterinary conditions.

PMID:35171905 | DOI:10.1371/journal.pcbi.1009874

Am J Dermatopathol. 2022 Mar 1;44(3):174-178. doi: 10.1097/DAD.0000000000002063.

ABSTRACT

Pityriasis lichenoides et varioliformis acuta (PLEVA) and lymphomatoid papulosis (LyP) can often demonstrate clinical and histopathologic overlap. A recent study demonstrated significant plasmacytoid dendritic cell (pDC) recruitment in lesions of PLEVA, whereas another study reported minimal pDC recruitment in lesions of LyP. To confirm the possible diagnostic value of pDCs in differentiating PLEVA and LyP, we compared the presence and distribution of pDCs and myxovirus protein A (MxA) expression (an indirect assessment of pDC activity). In total, 19 cases of PLEVA (16 patients) and 14 cases of LyP (11 patients) were examined using immunohistochemical stains for anti-blood-derived dendritic cell antigen-2 and MxA. Individual semiquantitative scoring systems were used to assess the immunohistochemical results, and a Mann-Whitney test with a subsequent 2-tailed P test was performed for statistical analysis. No statistically significant difference in the number of pDCs in both groups was found. However, most PLEVA cases (84%) demonstrated intense and diffuse MxA expression, whereas LyP cases (71%) demonstrated weak patchy staining (P < 0.007). Our study suggests that although additional studies may be needed to determine whether pDCs are more relevant to the pathogenesis of PLEVA or LyP, pDC activity through MxA staining may play a role in differentiating PLEVA from LyP and may serve as a platform for additional studies.

PMID:35171884 | DOI:10.1097/DAD.0000000000002063

J Am Acad Orthop Surg. 2022 Feb 15. doi: 10.5435/JAAOS-D-21-00703. Online ahead of print.

ABSTRACT

INTRODUCTION: Although studies have shown the implications of substance use on total joint arthroplasty, studies investigating the association of patients exclusively who have cannabis use disorder (CUD) after primary total knee arthroplasty (TKA) are sparse. As such, this study analyzed a private payor database to assess the relationship of CUD after primary TKA.

METHODS: Data from the Mariner data set were used to identify patients who have CUD undergoing primary TKA. Patients with CUD were ratio matched 1:5 to a comparison population by age, sex, and comorbidities, yielding 55,553 patients in the study (n = 9,260) and case-matched (n = 46,293) population. Variables compared included in-hospital length of stay, complications, and costs. A P value of less than 0.003 was considered statistically significant.

RESULTS: Patients with CUD were found to have longer in-hospital length of stay (3.61 versus 2.07 days, P < 0.0001), in addition to higher frequency and odds ratio (OR) of medical (28.08 versus 12.5; OR, 1.50, P < 0.0001) and prostheses-related complications (9.63 versus 5.16%; OR, 1.56, P < 0.0001). Patients with CUD also incurred significantly higher episode of care costs ($29,025.34 versus $24,258.17, P < 0.0001).

CONCLUSION: With the continued legalization of cannabis use across the United States, studies investigating the association of cannabis on outcomes after primary TKA are limited. The current study helps to expand the current literature on outcomes of substance abuse after total joint arthroplasty and can serve to help educate patients of potential complications after their TKA.

PMID:35171881 | DOI:10.5435/JAAOS-D-21-00703

J Neurosurg. 2022 Jan 14:1-8. doi: 10.3171/2021.10.JNS211006. Online ahead of print.

ABSTRACT

OBJECTIVE: There is a growing body of evidence demonstrating the benefits of diversity across many domains. However, neurosurgery consistently lags most of medicine in many aspects of diversity. Any inability to make progress in this arena is likely due to the multifactorial and complex nature of the issue, which makes it difficult to meaningfully measure and track diversity within the workforce. The goal of this pilot study was to assess the utilization of a multidimensional statistical model to quantify and assess diversity within neurosurgery. The authors sought to 1) assess the diversity of neurosurgery residents using Simpson’s Diversity Index and Sullivan’s Composite Diversity Index (CDI) and 2) determine if a medical school’s intrinsic academic opportunities and resources, indicated by US News & World Report’s (USNWR’s) best research medical schools ranking, are related to the number of neurosurgery residents produced per medical school.

METHODS: A cross-sectional study of all neurosurgery residents (projected graduation years 2020-2026) and 1st-year medical students (matriculating years 2016-2019) was undertaken. Biographical diversity data (gender and matriculation data) were collected from institutional websites between December 2019 and June 2020. The CDI expresses the diversity of a given population by representing the effective proportion of categories present across all diversity attributes and was calculated for neurosurgery residents and medical students. Statistical results are reported as the median and interquartile range.

RESULTS: Neurosurgery residency program CDI (0.21, IQR 0.16-0.25) was significantly less (p < 0.001) than medical school CDI (0.42, 0.37-0.48). There was no significant difference in CDI between top-40 and non-top 40 Doximity ranked research output neurosurgery residency programs (p = 0.35) or between top-40 and non-top 40 USNWR ranked research medical schools (p = 0.11). Over a 7-year period, top-40 ranked research medical schools produced significantly more (p < 0.001) neurosurgery residents (11.9, IQR 7.1-18.9) than the non-top 40 ranked research medical schools (5.6, IQR 2.6-8.5).

CONCLUSIONS: The authors demonstrated the feasibility of using a multidimensional statistical model as a measure to understand the complex issues of diversity. Their preliminary data suggested that neurosurgery’s challenge in achieving the desired diversity relates to uneven attraction and/or recruitment across an increasingly diverse medical student body. In recent years, neurosurgery has made great progress in the arena of diversity and has shown a strong desire to do more. Utilization of these diversity measures will help the neurosurgery field to monitor progress along this valuable journey.

PMID:35171830 | DOI:10.3171/2021.10.JNS211006

Int Braz J Urol. 2022 Mar-Apr;48(2):294-302. doi: 10.1590/S1677-5538.IBJU.2021.0472.

ABSTRACT

OBJECTIVE: To compare enhancement patterns of typical adrenal adenomas, lipid-poor adenomas, and non-adenomas on magnetic resonance imaging (MRI).

MATERIALS AND METHODS: Evaluation of adrenal nodules larger than 1.0 cm, with at least 2-year follow-up, evaluated on MRI in January 2007 and December 2016. Two different protocols were included – upper abdomen MRI (delayed phase after 3 minutes) and abdomen and pelvis MRI (delayed phase after 7 minutes) – and nodules were divided in typical adenomas (characterized on out-of-phase MRI sequence), lipid-poor adenomas (based on follow-up imaging stability) and non-adenomas (based on pathological finding or follow-up imaging). T2-weighted and enhancement features were analyzed (absolute and relative washout and enhancement curve pattern), similarly to classic computed tomography equations.

RESULTS: Final cohort was composed of 123 nodules in 116 patients (mean diameter of 1.8 cm and mean follow up time of 4 years and 3 months). Of them, 98 (79%) nodules had features of typical adenomas by quantitative chemical shift imaging, and demonstrated type 3 curve pattern in 77%, mean absolute and relative washout of 29% and 16%, respectively. Size, oncologic history and T2-weighted features showed statistically significant differences among groups. Also, a threshold greater than 11.75% for absolute washout on MRI achieved sensitivity of 71.4% and specificity of 70.0%, in differentiating typical adenomas from non-adenomas.

CONCLUSION: Calculating absolute washout of adrenal nodules on MRI may help identifying proportion of non-adenomas.

PMID:35170891 | DOI:10.1590/S1677-5538.IBJU.2021.0472

Int Braz J Urol. 2022 Mar-Apr;48(2):275-281. doi: 10.1590/S1677-5538.IBJU.2021.0236.

ABSTRACT

OBJECTIVES: The purpose of our study was to assess the association between the winter season and desmopressin treatment failure in South Chinese children with monosymptomatic nocturnal enuresis (MNE).

MATERIALS AND METHODS: A retrospective study was conducted to analyze the clinical data of children with monosymptomatic nocturnal enuresis who have visited our urology clinic from January to December 2019. All patients received desmopressin treatment. Final treatment outcomes were categorized as successful (complete response) or failed (absent and partial response). The relationship between winter season and treatment response to desmopressin was evaluated. Additionally, associated risk factors were investigated with both univariate and multivariate regression analysis.

RESULTS: In total, 393 patients diagnosed with MNE were included in the present study. There were no statistically significant differences in pretreatment variables at first visit between patients who visited the clinic in winter and those who did so in other seasons. However, the treatment failure rate of MNE in the winter season was higher than that of other seasons (77.50% vs. 52.74%). Multivariate logistic regression analysis demonstrated that the severity of symptoms and an initial clinic visit in the winter season were significantly related to desmopressin treatment failure in MNE patients.

CONCLUSION: Winter season and severity of symptoms are two risk factors associated with desmopressin treatment failure in MNE patients.

PMID:35170888 | DOI:10.1590/S1677-5538.IBJU.2021.0236

Przegl Epidemiol. 2021;75(3):430-436. doi: 10.32394/pe.75.40.

ABSTRACT

BACKGROUND AND AIM: One of the symptoms of burning is chronic and severe pain that affects the quality of life of patients. The aim of this article was to compare of the effect of prayer and ginger on the severity of pain and anxiety in inpatients with burn.

METHODS: This study is a clinical trial study on 120 patients referred to the Burn Ward of Kashani Hospital affiliated to Shahrekord University of Medical Sciences in the southwest of Iran. Patients were randomly divided into three groups: control, prayer and ginger. The visual analogue scale (VAS) was used to determine the severity of pain and the standard measure Spielberger Anxiety Inventory was used to assess anxiety. In this study, group 1 received placebo (starch) capsules (250 mg) daily, group 2 – ginger capsules (250 mg) plus 20 ml water after each meal on a daily basis and group 3 was asked to recite the prayer for 10 minutes three times in the morning, evening and night every day. Data analysis was done by descriptive and inferential statistics (ANOVA and Tukey’s test) in the SPSS.

RESULTS: After the intervention, the pain levels in the prayer and ginger groups at days 3 and 6 of hospitalization, were lower than the control group. On day 6 mean anxiety level was significantly lower in the prayer group than in the ginger group (P < 0.05).

CONCLUSION: According to the results of this study, it is recommended that using ginger or prayer be applied to reduce the pain and anxiety of burn patients, because they not only cause no side effects but also are low cost, leading to reduction in drug consumption and the resulting side effects.

PMID:35170885 | DOI:10.32394/pe.75.40

J Pediatr Endocrinol Metab. 2022 Feb 17. doi: 10.1515/jpem-2021-0635. Online ahead of print.

ABSTRACT

OBJECTIVES: Proper diagnosis and follow-up of children with testicular disorders depend on the presence of adequate references for testicular volume. The objective of this study was to determine the testicular volume by ultrasound in Turkish boys aged between 0 and 8 years.

METHODS: A total of 320 boys with bilaterally descended testes underwent scrotal ultrasound examinations. The testicular volume (mL) was calculated by the empirical formula of Lambert (V=L × T × AP × 0.71) and the formula for an ellipsoid (V=L × T × AP × π/6). The testicular volume was compared with children’s age, and Z-score data for weight, height, and BMI. The age-specific 3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentiles of the testicular volume were produced and compared with the international references.

RESULTS: The median (IQR) volume of the right and left testis were 0.75 (0.57-0.99) and 0.72 (0.56-0.98) mL (formula of Lambert), respectively; and 0.56 (0.42-0.73) and 0.53 (0.41-0.72) mL, (formula for an ellipsoid), respectively. The age-specific median of the average volume of the right and left testis estimated by the Lambert equation in the first five years was measured between 0.63 and 0.71 mL, followed by an increase to about 1.31 mL at the age of 8. This increase was highly statistically significant (p<0.0001). No significant association was found between the Z-scores for weight, height, and BMI of boys and the testicular volumes.

CONCLUSIONS: This study provides the first national ultrasound-based estimates for testicular volume in Turkish boys aged 0-8 years.

PMID:35170878 | DOI:10.1515/jpem-2021-0635

Pediatr Pulmonol. 2022 Feb 16. doi: 10.1002/ppul.25863. Online ahead of print.

ABSTRACT

OBJECTIVES: To study the utility, safety and effects of flexible fiberoptic bronchoscopy (FFB) on oxygenation status, ventilation parameters and hemodynamics in mechanically ventilated children.

DESIGN: Retrospective study PATIENTS: Children age > 1month to 18 years suffering with critical medical and surgical diseases.

RESULTS: First bronchoscopy data of 131 patients was analysed. Indication, FFB findings, microbiological yield from bronchoalveolar lavage and medical and surgical interventions based on FFB results were recorded. Hemodynamic and ventilation parameters before, during and 3 hours after FFB were also captured. Majority of bronchoscopies were done for diagnostic purpose with positivity rate of 90.8%. Retained mucopurulent secretion in airways was the commonest finding in 60 patients. A cause for weaning or extubation failure could be identified in 83.3%. Post FFB radiological resolution of atelectasis was seen in 34/59 (57.6%; P value 0.001) chest radiographs. 47 medical and 25 surgical interventions were done depending on FFB and BAL findings. There was significant drop in oxygenation parameters and rise in heart rate during FFB (P value <0.0001). The peak inspiratory pressure, positive end-expiratory pressure and mean airway pressure increased significantly during bronchoscopy (P value <0.0001) while patients were on pressure regulated volume controlled ventilation. All these changes reversed to pre FFB levels. There were minor procedure related complications.

CONCLUSION: FFB was an important diagnostic and therapeutic tool for mechanically ventilated children and the results helped in planning the interventions. It was a safe procedure with transient reversible cardiopulmonary alterations. This article is protected by copyright. All rights reserved.

PMID:35170875 | DOI:10.1002/ppul.25863

Ann Clin Transl Neurol. 2022 Feb 16. doi: 10.1002/acn3.51525. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate whether herpes zoster (HZ) was associated with subsequent increased risk of dementia diagnosis.

METHODS: We conducted a historical cohort study using primary care electronic health records from the Clinical Practice Research Datalink in the United Kingdom. Individuals with incident HZ aged ≥40 years from 2000 to 2017 were matched with up to four individuals without HZ by age, sex, primary care practise and calendar time. The primary outcome was a new diagnosis of all-cause dementia. We used the Cox proportional hazards regression adjusting for demographic, lifestyle and clinical confounders to assess any association between HZ and dementia. We investigated interactions with sex, frailty index and antiviral treatment and conducted various sensitivity analyses.

RESULTS: The cohort comprised 177,144 individuals with HZ and 706,901 matched unexposed individuals (median age 65 years (IQR 55.1-75.0), 40% male) followed for a median duration of 4.6 years (IQR 2.0-8.1). In total, 26,585 (3%) patients had an incident dementia diagnosis recorded and 113,056 patients died (12.8%). HZ was associated with a small reduction in dementia diagnosis (adjusted HR 0.92 (95% CI 0.89-0.95)), occurring predominantly in frail individuals and females. For patients who were fit (578,115, 65%), no association was seen (adjusted HR 0.97, 95% CI 0.92-1.02). There was no association between HZ and a composite outcome of dementia or death (adjusted HR 1.00, 95% CI 0.99-1.02). Dementia risk did not vary by prescription of antiviral agents. Sensitivity analyses showed consistent results.

INTERPRETATION: HZ was not associated with increased dementia diagnosis in a UK primary care-based cohort.

PMID:35170873 | DOI:10.1002/acn3.51525