Nevin Manimala

PLoS One. 2022 Jan 20;17(1):e0261162. doi: 10.1371/journal.pone.0261162. eCollection 2022.

ABSTRACT

BACKGROUND: In resource-limited settings, underlying causes of death (UCOD) often are not ascertained systematically, leading to unreliable mortality statistics. We reviewed medical charts to establish UCOD for decedents at two high volume mortuaries in Kisumu County, Kenya, and compared ascertained UCOD to those notified to the civil registry.

METHODS: Medical experts trained in COD certification examined medical charts and ascertained causes of death for 456 decedents admitted to the mortuaries from April 16 through July 12, 2019. Decedents with unknown HIV status or who had tested HIV-negative >90 days before the date of death were tested for HIV. We calculated annualized all-cause and cause-specific mortality rates grouped according to global burden of disease (GBD) categories and separately for deaths due to HIV/AIDS and expressed estimated deaths per 100,000 population. We compared notified to ascertained UCOD using Cohen’s Kappa (κ) and assessed for the independence of proportions using Pearson’s chi-squared test.

FINDINGS: The four leading UCOD were HIV/AIDS (102/442 [23.1%]), hypertensive disease (41/442 [9.3%]), other cardiovascular diseases (23/442 [5.2%]), and cancer (20/442 [4.5%]). The all-cause mortality rate was 1,086/100,000 population. The highest cause-specific mortality was in GBD category II (noncommunicable diseases; 516/100,000), followed by GBD I (communicable, perinatal, maternal, and nutritional; 513/100,000), and III (injuries; 56/100,000). The HIV/AIDS mortality rate was 251/100,000 population. The proportion of deaths due to GBD II causes was higher among females (51.9%) than male decedents (42.1%; p = 0.039). Conversely, more men/boys (8.6%) than women/girls (2.1%) died of GBD III causes (p = 0.002). Most of the records with available recorded and ascertained UCOD (n = 236), 167 (70.8%) had incorrectly recorded UCOD, and agreement between notified and ascertained UCOD was poor (29.2%; κ = 0.26).

CONCLUSIONS: Mortality from infectious diseases, especially HIV/AIDS, is high in Kisumu County, but there is a shift toward higher mortality from noncommunicable diseases, possibly reflecting an epidemiologic transition and improving HIV outcomes. The epidemiologic transition suggests the need for increased focus on controlling noncommunicable conditions despite the high communicable disease burden. The weak agreement between notified and ascertained UCOD could lead to substantial inaccuracies in mortality statistics, which wholly depend on death notifications.

PMID:35051186 | DOI:10.1371/journal.pone.0261162

PLoS One. 2022 Jan 20;17(1):e0260579. doi: 10.1371/journal.pone.0260579. eCollection 2022.

ABSTRACT

With the advancement in machine learning, researchers continue to devise and implement effective intelligent methods for fraud detection in the financial sector. Indeed, credit card fraud leads to billions of dollars in losses for merchants every year. In this paper, a multi-classifier framework is designed to address the challenges of credit card fraud detections. An ensemble model with multiple machine learning classification algorithms is designed, in which the Behavior-Knowledge Space (BKS) is leveraged to combine the predictions from multiple classifiers. To ascertain the effectiveness of the developed ensemble model, publicly available data sets as well as real financial records are employed for performance evaluations. Through statistical tests, the results positively indicate the effectiveness of the developed model as compared with the commonly used majority voting method for combination of predictions from multiple classifiers in tackling noisy data classification as well as credit card fraud detection problems.

PMID:35051184 | DOI:10.1371/journal.pone.0260579

PLoS Negl Trop Dis. 2022 Jan 20;16(1):e0010087. doi: 10.1371/journal.pntd.0010087. eCollection 2022 Jan.

ABSTRACT

INTRODUCTION: Globally, traditional medicine is widely used to treat a variety of injuries and illnesses, including dog bites, and exposures that are risky for rabies. However, efficacy of most traditional remedies used for rabies prevention or treatment has not been demonstrated in controlled trials or proven in community-based surveys.

METHODS: Six databases were searched including the terms rabies, traditional treatment, traditional remedy, traditional therapy, traditional medicine, and medicinal treatment to review traditional remedies used in the prevention and treatment of rabies. In addition, published literature of rabies transmission dynamics was used to estimate statistical likelihood of dog bite victims developing rabies to provide clarity as to why traditional healers have a high apparent success rate when preventing death from rabies in victims bitten by suspected rabid dogs.

RESULTS: Literature review yielded 50 articles, including three controlled experiments, that described use of traditional remedies for rabies prevention and treatment. Traditional remedies for rabies ranged from plant- or animal-based products to spiritual rituals; however, only a few controlled mice trials were conducted, and none of these trials demonstrated efficacy in preventing or treating rabies. Risk of dying from rabies after a bite from a dog with unknown rabies status is low, 1.90% (0.05%-29.60%). Therefore, traditional healers had a 98.10% (70.40%-99.95%) apparent success rate in preventing death from suspected rabid dog bites despite inefficaciousness of herbal remedies.

CONCLUSION: There was no universal plant species or route of administration that was consistently used for rabies prevention or treatment across countries. No traditional remedy was efficacious in the prevention or treatment of rabies in randomized controlled experiments. Understanding the cultural context under which traditional remedies are used may facilitate collaboration of traditional healers with the modern medical system to ensure timely and appropriate use of proven therapies for prevention and clinical management of rabies.

PMID:35051178 | DOI:10.1371/journal.pntd.0010087

Pain Physician. 2022 Jan;25(1):E121-E126.

ABSTRACT

BACKGROUND: Since its adoption as a treatment for neuropathic pain in the 1960s, radiofrequency ablation (RFA) has continued to gain popularity for the management of various pain etiologies. Although RFA is considered to be a safe procedure, post-neurotomy neuritis (PNN), a neuropathic-type pain, is one of the most common side effects. Due to the increasing recognition of PNN, some providers have attempted to mitigate the risk of PNN by injecting local corticosteroids at the site of RFA following the procedure. Recent studies have generally concluded that corticosteroids do not protect against the development of PNN, however, they have been limited by their retrospective study designs and the low incidence of PNN.

OBJECTIVES: We aimed to add to the growing literature regarding the role of post-RFA corticosteroid administration in preventing the development of PNN.

STUDY DESIGN: We conducted a prospective study evaluating the incidence of PNN as well as the efficacy of post-RFA corticosteroid administration in preventing the development of PNN.

SETTING: All RFAs were performed by the same board-certified, pain medicine fellowship-trained, attending physician at the University of Wisconsin who performed the initial patient evaluation at the pain medicine clinic.

METHODS: Thirty-nine patients (47 RFAs) were included in the study. All patients were between the ages of 30 and 81; 23 (59.0%) patients were women comprising 28 (59.6%) of the RFAs performed. RFA was performed for a variety of conditions, including facet joint pain, osteoarthritic knee pain, and occipital nerve pain. The 19 patients (25 RFAs) completed prior to February 2020 received post-RFA corticosteroids; the remaining 21 patients (22 RFAs) completed after this date did not receive corticosteroids. The Numeric Rating Scale (NRS-11) and Douleur Neuropathique 4 Questions (DN4) questionnaire scores were collected before and after completion of an RFA. After their procedure, patients were either called or seen in clinic for re-evaluation of their symptoms, at which time NRS-11 and DN4 scores were collected again.

RESULTS: There were no statistically significant differences between groups when comparing post-RFA DN4 scores. Additionally, the incidence of PNN in our study population was 0% for both treatment groups. The NRS-11 scores were similar between groups prior to completing an RFA. When comparing the post-RFA pain scores, the average NRS-11 scores in the steroid group decreased from 5.8 to 3.4, while the average NRS-11 scores in the nonsteroid group decreased from 5.4 to 3.8. However, the average NRS-11 reductions were similar between groups.

LIMITATIONS: The primary limitation of this study is small sample size, which likely limited our ability to diagnose PNN. Additionally, we utilized the 7-item DN4 and required a DN4 score of ? 4 to diagnose PNN, and therefore, it is likely that our protocol significantly reduced our sensitivity for diagnosing PNN.

CONCLUSIONS: Overall, our study is in agreement with prior studies that RFA is effective for the treatment of facet and osteoarthritic knee pain and that the incidence of PNN is likely small.

PMID:35051159

Pain Physician. 2022 Jan;25(1):E73-E86.

ABSTRACT

BACKGROUND: Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and percutaneous endoscopic TLIF (PE-TILF) have been widely used in spine surgery. The use of a robot-guided technique provided several advantages; however, few studies have investigated the clinical outcomes of robot-assisted PE-TLIF (PE RA-TLIF).

OBJECTIVE: The aim of this prospective cohort study was to compare the clinical outcomes of PE RA-TLIF with MIS-TLIF for the treatment of lumbar 4-5 (L4-5) spondylolisthesis.

STUDY DESIGN: Prospective cohort study.

SETTING: Qilu Hospital of Shandong University.

METHODS: Fifty-eight cases diagnosed with L4-5 spinal stenosis with instability and Meyerding grade I spondylolisthesis (degenerative spondylolisthesis or isthmic spondylolisthesis) were included in this study. Twenty-six patients (group A) were treated with PE RA-TLIF, and the others (group B) underwent MIS-TLIF. The surgical procedures for PE RA-TLIF included the percutaneous implantation of pedicle screws (PS) under robot guidance, percutaneous fully endoscopic transforaminal decompression, and interbody fusion. The Japanese Orthopedic Association (JOA) score, the visual analog scale (VAS) for low back pain (LBP), the VAS for leg pain/numbness, and the Oswestry disability index (ODI) were used as follow-up clinical outcomes, and the lumbar interbody fusion rate was evaluated by CT. All statistical analyses were performed with SPSS 22.0, and the results were presented as mean ± standard deviation (SD).

RESULTS: There were 4 cases of spinal stenosis with instability, 17 cases of degenerative spondylolisthesis, and 5 cases of isthmic spondylolisthesis in group A. For group B, there were 6 cases of spinal stenosis with instability, 19 cases of degenerative spondylolisthesis, and 7 cases of isthmic spondylolisthesis. The preoperative scores for the JOA, ODI, VAS for LBP, and VAS for leg pain were not statistically comparable between the 2 groups (P > 0.05). The incision length for decompression and interbody fusion, estimated blood loss (EBL), and 1-day and 3-day incision pain were significantly higher in group B than in group A (P < 0.05). The mean operative time was longer in group A than in group B (P < 0.05). The operation time of the first 10 cases (251 ± 24 min) was much longer than that of the last 16 cases (200 ± 17 min) in group A. The misplacement rate of percutaneous pedicle screw placement was higher in group B (P < 0.05). No infections of incisions and interbody or nerve root or dural injuries were found in either group A or B. No differences were found between the 2 groups in the JOA scores, ODI, leg pain VAS score, or lumbar interbody fusion rate at the 2-year follow-up. The VAS for back pain was better in group A than in group B (P < 0.05).

LIMITATIONS: The PE RA -TLIF procedure is technically challenging and has a steep learning curve, and the study was not strictly randomized.

CONCLUSION: PE RA-TLIF is a safe and effective procedure that can significantly improve the accuracy of pedicle screw placement, reduce surgical trauma, and facilitate rapid postoperative recovery. However, this technique has a steep and long learning curve and requires long-term follow-ups.

PMID:35051154

Pain Physician. 2022 Jan;25(1):87-93.

ABSTRACT

BACKGROUND: It is well established that the experience of chronic pain significantly differs among ethnic-racial groups. There is mixed evidence to suggest that societal influences may contribute to pain prevalence among cultural groups and their treatment response. One possible explanation for differences in pain experience are the differences in socioeconomic status among patients with chronic pain.

OBJECTIVE: To determine whether there is any difference in pain scores or treatment responses among patients with different socioeconomic status.

STUDY DESIGN: Retrospective analysis.

SETTING: Outpatient pain clinic.

METHODS: After approval from the Advocate Healthcare Institutional Review Board, we included 1,149 patients treated for different chronic pain conditions who were followed for at least 12 months. Patients were stratified into quartiles determined by median income according to ZIP code.

RESULTS: Of the sampled patients, 207 patients lived in ZIP codes with median incomes > $51,294; 515 in ZIP codes with median incomes between $40,083 and $51,294; 332 in ZIP codes with median incomes between $30,625 and $40,083; and 95 in ZIP codes with median incomes < $30,625. Groups differed in age (P = 0.047), race (P < 0.001), body mass index (BMI) (P = 0.019), utilization of opioid medications (P = 0.011), morphine milligram equivalents (MME) on first visit (P = 0.036), and utilization of membrane stabilizers such as gabapentin (P = 0.019). There were no significant differences among groups in terms of gender (P = 0.531), type of pain experienced (P = 0.679), or time since pain onset (P = 0.174). Groups were treated similarly, with no statistically significant differences in the proportions of patients who had taken various nonopioid medications throughout their treatment course other than membrane stabilizers, the number of patients who received interventional pain management procedures, or MME at last visit. Average pretreatment numeric rating scale pain scores were not significantly different among quartiles (P = 0.079), posttreatment pain scores (P = 0.767), and subjective percent improvement (P = 0.434).

LIMITATIONS: This is a single center study and may have limitations in extrapolating to the general population.

CONCLUSION: The results of our study show that there are no differences in pain perception or treatment responses in patients from different socioeconomic statuses despite differences among groups in age, BMI, race, utilization of opioid medications, and MME at first visit. Patients at this pain practice appear to have been treated with similar modalities regardless of socioeconomic status.

PMID:35051148

Pain Physician. 2022 Jan;25(1):77-85.

ABSTRACT

BACKGROUND: Post-traumatic stress disorder (PTSD) is a prevalent and debilitating condition in the United States. Success rates for evidence-based therapies are inconsistent, and many suffer in silence due to the stigmata associated with seeking traditional mental health care. This has led clinicians to explore new therapeutic options, with cervical sympathetic blockade (CSB), performed at the stellate and/or superior cervical ganglion levels, recently emerging as a promising treatment option. Rapid therapeutic onset, improved compliance, and high clinical efficacy rates have made this an attractive approach for both providers and patients. However, to date, CSB as a treatment of PTSD has primarily been used in male patients with military-related trauma.

OBJECTIVE: To evaluate the efficacy of CSB as a treatment option for PTSD in both genders and multiple etiologies of psychological trauma.

STUDY DESIGN: Retrospective cohort study.

SETTING: An established anesthesia pain clinic in Chicago, IL, USA.

METHODS: Following retroactive IRB approval, 484 consecutive cases of patients diagnosed with PTSD and treated with CSB, performed by a single provider (December 2016 – February 2020) were analyzed. The primary outcome measurement was the PTSD Checklist Score version DSM IV (PCL-4). Patient demographic and clinical information collected included age, gender, type of trauma leading to PTSD, history of suicidal attempts, and psychiatric medication use.

RESULTS: After exclusion of cases due to missing data points, 327 patients were included in the final statistical analysis, having completed both PCL-4 pre and post CSB, between 7- and 30-days post-intervention. The patient population included military men (n = 97), civilian men (n = 85), military women (n = 13) and civilian women (n = 132). We identified 21 types of self-reported trauma leading to PTSD. Average decrease in PCL score for men and women was 28.59 and 29.2, respectively. Statistical analysis of the male population with a military background showed a significantly greater change in corresponding PCL scores than civilians (PCL-M change = -31.83 vs PCL-C change = -24.89). Likewise, women who had a military background had a significantly greater reduction in PCL score than civilians (39.15 vs 28.23). Statistically significant improvements in PTSD symptoms were noted independent of the causative trauma type, gender, age greater than 20, previous suicide attempts, or use of prescription medications for PTSD. Among the 21 types of reported trauma, 19 types reached statistical significance.

LIMITATIONS: Limitations include the limited scope of observation giving exclusive focus on pre- and post-PCL data, the limited duration of observation, the self-reported nature of the patient-provided data, and the provision of treatment by a single physician.

CONCLUSION: CSB seems to be an effective treatment for PTSD symptoms irrespective of gender, trauma type, PTSD-related drug use, suicide attempt, or age.

PMID:35051147

Oral Health Prev Dent. 2022 Jan 20;20(1):41-50. doi: 10.3290/j.ohpd.b2585655.

ABSTRACT

PURPOSE: To investigate inflammatory responses in peri-implant crevicular fluid (PICF) in comparison to periodontal tissue.

MATERIALS AND METHODS: Nineteen participants with healthy implants restored with titanium or gold-casting abutment were included. PICF and gingival crevicular fluid (GCF) were collected for inflammatory cytokine detection by ELISA. Cytokine levels in PICF or GCF of the same individual were compared using the paired t-test, and those from titanium or gold-casting (UCLA) abutment were compared using the independent t-test. Human gingival fibroblast responses to PICF and GCF were then evaluated with one-way ANOVA.

RESULTS: The results demonstrated that IL-6, IL-8, TNFα, and IFNγ expressed in PICF are similar to GCF in the same individual. However, IL-1β (p = 0.032) and IL-1α (p = 0.030) was statistically significantly higher in PICF than in GCF. IL-8 level was statistically significantly higher with gold-casting than with titanium abutments (p = 0.003). PICF statistically significantly stimulated higher expression of RANKL, IL-1β, IL-6, and IL-8 mRNA in human gingival fibroblasts (HGF), while focal adhesion kinase (FAK) suppressed mRNA.

CONCLUSION: The inflammatory cytokines, including IL-1α and IL-1β, are higher in healthy peri-implant tissues. Abutment materials may also influence the level of inflammatory cytokines in PICF. Inflammatory mediators in crevicular fluid may affect HGF inflammatory responses and peri-implant tissue integration.

PMID:35049254 | DOI:10.3290/j.ohpd.b2585655

Oral Health Prev Dent. 2022 Jan 20;20(1):61-68. doi: 10.3290/j.ohpd.b2580291.

ABSTRACT

PURPOSE: A number of disinfectants and sanitisers are used in dentistry, and there are numerous commercial solutions available. Nonetheless, because each cleaning solution has its own set of indications and limits, there is no one-size-fits-all approach for processing all types of dental equipment. Functional water, such as electrolysed hypochlorite microbubbled water, efficiently eliminates and sterilises biofilms. The objective of the study was to evaluate whether ozonated water could be used to sterilise and disinfect dental-unit water pipelines (DUWP) that had been contaminated with micro-organisms, including Gram-positive and Gram-negative bacilli and cocci.

MATERIALS AND METHODS: Three different groups were formed: group A – ozonated water (Cantoosh); group B – 1% povidine iodine; and group C: conventional distilled water. Group A was the test group, group B the control group, and group C was the positive control group. The water sterilising system was replaced with the appropriate sterilising agent as per the allocated group classification, with 2 min of purging, so that the complete DUWP was filled with the water sterilising system. Samples were collected and analysed, along with a 2-min purge after 24 h, 7 days and 21 days, at the 3 outlet (OL) points: the 3-way syringe at the dental tray(OL1), the cup filler (OL2), and the 3-way syringe of the assistant zone (OL3). Repeated measures ANOVA was used to test for statistical significance between colony-forming units of control and experimental groups (p < 0.05).

RESULTS: The cup filler yielded higher counts than did the 3-way syringe at the dental tray (OL1) (6.40 and 8.05 on the log scale, respectively). A statistically significant difference in the CFUs was also observed between samples taken after 24 h vs 21 days between groups A, B and C.

CONCLUSION: The findings showed that exposing DUWP tube systems to ozonated water for an extended length of time drastically lowered the number of microorganisms adhering to their surfaces.

PMID:35049253 | DOI:10.3290/j.ohpd.b2580291

Oral Health Prev Dent. 2022 Jan 20;20(1):51-60. doi: 10.3290/j.ohpd.b2573053.

ABSTRACT

PURPOSE: To determine acid-formation potential of saliva and evaluate whether this method corresponds with microbiome composition of individuals with and without caries.

MATERIALS AND METHODS: A clinical, controlled pilot study was performed with two groups: individuals without caries (n = 25; DMFT = 0) and individuals with at least one active carious lesion (n = 25; DMFT>0). A detailed intraoral examination was performed, and the gingival bleeding index (GBI) and plaque index (PI) were recorded. The acid-formation potential was measured (ΔpH) after 1 h. Streptococcus mutans (SM) and lactobacilli (LB) were also quantified. Intergroup comparisons were made using the Mann-Whitney U-test. The diagnostic value was evaluated using the receiver operating characteristics (ROC) method and area under the curve (AUC) values were calculated. The saliva microbiome was analysed by 16S rDNA next-generation sequencing.

RESULTS: A statistically significant difference was found in ΔpH, with the ‘caries’ group showing a higher mean value after 1 h (‘healthy’ = 1.1,’caries’ = 1.4; p = 0.035). The AUC values were moderate to good (ΔpH = 0.67; SM = 0.83; LB = 0.83;1 = ideal). Streptococcus mutans and Lactobacilli were more frequently detected in the ‘caries’ group (p < 0.001), as were statistically significantly higher GBI (p = 0.006) and PI (p = 0.001). The saliva microbiome had a higher α-diversity and greater richness in individuals with active caries. The incidence of the genera Alloprevotella, Prevotella, Campylobacter and Veillonella was statistically significantly higher in the ‘healthy’ group. The incidence of the genera Fretibacterium, Lactobacillus, and Leptotrichia, as well as the phyla Spirochaetes and Synergistetes, was statistically significantly higher in the ‘caries’ group.

CONCLUSION: Further studies must be carried out to determine the extent to which both tests are suitable for predicting future caries development.

PMID:35049252 | DOI:10.3290/j.ohpd.b2573053