Nevin Manimala

Dig Dis Sci. 2021 Jun 6. doi: 10.1007/s10620-021-07076-1. Online ahead of print.

ABSTRACT

BACKGROUND: Health administrative databases are essential to define patient populations, make socioeconomic predictions, and facilitate medical research and healthcare planning. The accuracy of this data is dependent on valid codes/coding algorithms.

AIMS: The aim of this study was to systematically identify and summarize the validity of International Classification of Diseases (ICD) codes for identifying patients with cirrhosis in administrative data.

METHODS: Electronic databases, MEDLINE (via Ovid), EMBASE (via Ovid), the Web of Science, and CINAHL (via EBSCOhost), were searched for validation studies which compared ICD codes related to cirrhosis to a clinical reference standard, and reported statistical measures of performance.

RESULTS: Fourteen studies were included in the review. There was a large variation in the algorithms used to validate ICD codes to diagnose cirrhosis. Despite the variation, the positive predictive value (PPV) was greater than 84% and the specificity was greater than 75% in the majority of the studies. The negative predictive value (NPV) was lower, but still was associated with values greater than 70% in the majority of studies. Sensitivity data varied significantly with values ranging from 0.27 to 99%.

CONCLUSIONS: Evaluated ICD codes for cirrhosis, including codes for chronic liver disease, cirrhosis-specific codes, and cirrhosis-related complications, have demonstrated variable sensitivity and reasonable specificity for the identification of cirrhosis. Additional research is needed to maximize the identification of persons with cirrhosis to avoid underestimating the burden of disease.

PMID:34091800 | DOI:10.1007/s10620-021-07076-1

Int J Clin Oncol. 2021 Jun 6. doi: 10.1007/s10147-021-01941-9. Online ahead of print.

ABSTRACT

AIMS: The European Association of Urology guideline for upper tract urothelial carcinoma (UTUC) relies on two grading system: 1973 World Health Organization (WHO) and 2004/2016 WHO. No consensus has been made which classification should supersede the other and both are recommended in clinical practice. We hypothesized that one may be superior to the other.

METHODS: Newly diagnosed non-metastatic UTUC patients treated with radical nephroureterectomy were abstracted from the Surveillance, Epidemiology, and End Results database (2010-2016). Kaplan-Meier plots and multivariable Cox regression models (CRMs) tested cancer-specific mortality (CSM), according to 1973 WHO (G₁ vs. G₂ vs. G₃) or to 2004/2016 WHO (low-grade vs. high-grade) grading systems. Haegerty’s C-index quantified accuracy.

RESULTS: Of 4271 patients, according to 1973 WHO grading system, 134 (3.1%) were G₁, 436 (10.2%) were G₂ and 3701 (86.7%) were G₃; while according to 2004/2016 WHO grading system, 508 (11.9%) were low grade vs 3763 (88.1%) high grade. In multivariable CRMs, high grade predicted higher CSM (Hazard ratio: 1.70, p < 0.001). Conversely, neither G₂ (p = 0.8) nor G₃ (p = 0.1) were independent predictors of worse survival. The multivariable models without consideration of either grading system were 74% accurate in predicting 5-year CSM. Accuracy increased to 76% after either addition of the 1973 WHO or 2004/2016 WHO grade.

CONCLUSIONS: From a statistical standpoint, either 1973 WHO or 2004/2016 WHO grading system improves the accuracy of CSM prediction to the same extent. In consequence, other considerations such as intra- and interobserver variability may represent additional metrics to consider in deciding which grading system is better.

PMID:34091795 | DOI:10.1007/s10147-021-01941-9

Clin Oral Investig. 2021 Jun 6. doi: 10.1007/s00784-021-04014-3. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of this study was to assess the concentrations of heat shock protein 70 (HSP70) and toll-like receptor 4 (TLR4) during orthodontic tooth movement and to compare their levels with interleukin-1β (IL-1β), a well-known proinflammatory biomarker.

MATERIALS AND METHODS: This study consisted of 20 patients (8 males, 12 females; mean age 14.75 ± 2.34 years) who needed maxillary premolar extraction and segmental canine distalization. Concentrations of HSP70, TLR4, and IL-1β were examined before extraction (T1), at the 1st (T2), 4th (T3), 7th (T4), 14th (T5), and 30th (T6) days of canine retraction by enzyme-linked immunosorbent assay analysis of gingival crevicular fluid samples. Statistical analyses were performed with repeated measure ANOVA and Spearman’s rank correlation coefficient analysis (p < 0.05).

RESULTS: HSP70 increased gradually from T1 to T6 and showed significant differences between T1-T6 and T2-T6 (T1:3.28 ± 0.92 ng/ml; T2:3.72 ± 0.66 ng/ml; T6:9.35 ± 2.45 ng/ml). The lowest TLR4 concentration was at T1, peaked at T3 and remained constant afterwards with significant differences between T1-T3, T1-T4, and T1-T6 (T1:0.71 ± 0.02 pg/ml; T3:1.04 ± 0.11 pg/ml; T4:0.95 ± 0.06 pg/ml; T6:1.00 ± 0.07 pg/ml). IL-1β increased from T1 to T6 with significant differences between T1-T4, T1-T5, and T1-T6 (T1:55.71 ± 5.48 pg/ml; T4:100.11 ± 16.92 pg/ml; T5:103.71 ± 23.19 pg/ml; T6:125.12 ± 22.04 pg/ml). The increase in HSP70 and TLR4 from T2-T3 showed a significant correlation (r = 0.598; p = 0.005).

CONCLUSIONS: The increased levels of HSP70, TLR4, and IL-1β show the contribution of these mediators to the inflammatory response from the early stages of orthodontic tooth movement.

CLINICAL RELEVANCE: The regulation of HSP70, TLR4, and/or IL-1β secretion during orthodontic force application could provide alterations for desired optimal tooth movement.

PMID:34091792 | DOI:10.1007/s00784-021-04014-3

Biochem Genet. 2021 Jun 6. doi: 10.1007/s10528-021-10087-2. Online ahead of print.

ABSTRACT

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease affecting primarily distal respiratory pathways and lung parenchyma. This study aimed to determine possible genetic association of chemokine and chemokine receptor genes polymorphisms with COPD in a Tatar population from Russia. SNPs of CCL20, CCR6, CXCL8, CXCR1, CXCR2, CCL8, CCL23, CCR2, and CX3CL1 genes and their gene-gene interactions were analyzed for association with COPD in cohort of 601 patients and 617 controls. As a result statistically significant associations with COPD in the study group under the biologically plausible assumption of additive genetic model were identified in CCL20 (rs6749704) (P = 0.00001, OR 1.55), CCR6 (rs3093024) (P = 0.0003, OR 0.74), CCL8 (rs3138035) (P = 0.0001, OR 0.67), CX3CL1 (rs170364) (P = 0.023, OR 1.21), CXCL8 (rs4073) (P = 0.007, OR 1.23), CXCR2 (rs2230054) (P = 0.0002, OR 1.32). Following SNPs CCL20 (rs6749704), CX3CL1 (rs170364), CCL8 (rs3138035), CXCL8 (rs4073), CXCR2 (rs2230054) showed statistically significant association with COPD only in smokers. The association of CCR6 (rs3093024) with COPD was confirmed both in smokers and in non-smokers. A relationship between smoking index and CCL20 (rs6749704) (P = 0.04), CCR6 (rs3093024) (P = 0.007), CCL8 (rs3138035) (P = 0.0043), and CX3CL1 (rs170364) (P = 0.04) was revealed. A significant genotype-dependent variation of Forced Vital Capacity was observed for CCL23 (rs854655) (P = 0.04). Forced Expiratory Volume in 1 s / Forced Vital Capacity ratio was affected by CCL23 (rs854655) (P = 0.05) and CXCR2 (rs1126579) (P = 0.02). Using the APSampler algorithm, we obtained nine gene-gene combinations that remained significantly associated with COPD; loci CCR2 (rs1799864) and CCL8 (rs3138035) were involved in the largest number of the combinations. Our results indicate that CCL20 (rs6749704), CCR6 (rs3093024), CCR2 (rs1799864), CCL8 (rs3138035), CXCL8 (rs4073), CXCR1 (rs2234671), CXCR2 (rs2230054), and CX3CL1 (rs170364) polymorphisms are strongly associated with COPD in Tatar population from Russia, alone and in combinations. For the first time combination of the corresponding SNPs were considered and as a result 8 SNP patterns were associated with increased risk of COPD.

PMID:34091786 | DOI:10.1007/s10528-021-10087-2

Diagnosis (Berl). 2021 Jun 4. doi: 10.1515/dx-2021-0007. Online ahead of print.

ABSTRACT

OBJECTIVES: Quality control of ultrasonography markers is necessary to ensure greater efficacy of prenatal aneuploidy screening. The aim of this study was to assess the quality of the crown-rump length (CRL) and nuchal translucence (NT) measurement accuracy by the laboratory according to quality indicators.

METHODS: Retrospective observational study on 4,908 single-foetus pregnant women who underwent prenatal aneuploidy screening in the first trimester of pregnancy. Euploid foetuses with CRL between 45 and 84 mm were included, while those with NT≥3.5 mm were excluded. CRL measurement was considered to be accurate if the median multiples of the median (MoM) for pregnancy-associated plasma protein A (PAPP-A) was between 0.90 and 1.10. Fifteen sonographers participated in the study, six of whom comprised the control group. Systematic error for a sonographer was considered when CRL measurement was greater than ±2 mm with respect to the control group. Quality for NT was assured by means of the WHIRI method and each sonographer cumulative sum control chart (CUSUM).

RESULTS: For CRL accuracy, five sonographers underestimated the measurements, while another four overestimated them, with no statistical differences. For smaller sized foetuses, all sonographers met the established specifications. Regarding NT control, three sonographers did not meet the quality criteria for the median MoM. All sonographers met the specifications for the logarithmic standard deviation of the NT MoM levels. Thirteen sonographers met the CUSUM specifications.

CONCLUSIONS: Evaluation of a quality control of ultrasonography parameters by laboratory professionals is necessary to avoid under- or overestimation tendencies for CRL and NT measurements. CUSUM is a useful tool for the immediate correction of errors in NT measurements.

PMID:34090321 | DOI:10.1515/dx-2021-0007

Wiad Lek. 2021;74(5):1256-1261.

ABSTRACT

OBJECTIVE: The aim: Of this research was to investigate the impact of quarantine restrictions on the health care system in Ukraine, quality of providing and accessibility of health care services for population during quarantine; analyze the influence of economic and social outcomes of epidemy on state of health care.

PATIENTS AND METHODS: Materials and methods: For this paper was made a retrospective analysis of COVID-19 morbidity statistics, economic indicators and governmental decrees aimed at resolving the problem of the spreading of coronavirus and ensuring the proper work of medical institutions at all levels of health care. This work includes analysis of data for the period since the beginning of quarantine on the territory of Ukraine in March 2020 till present time.

CONCLUSION: Conclusions: The complexity of the socio-political and economic situation in Ukraine and the conduct of hostilities in the east of the country have significantly complicated the fight against the spread of coronavirus in the country. Negative changes in the indicators of hospital security were observed both at the secondary level – treatment of patients with COVID-19, and the primary level – primary contact with the patient, primary care, prevention measures. In the long run, this will have significant implications for the individual health of those who have not been able to receive quality care, as well as for public health in general.

PMID:34090301

Wiad Lek. 2021;74(5):1241-1244.

ABSTRACT

OBJECTIVE: The aim: The aim of the research is to determine and systematize administrative and medical measures aimed at curbing cholera in the city of Kharkiv in the time of the Russian Empire, to assess the relevance of the experience in fighting the disease, to determine the impact of epidemics and anti-epidemic measures on Kharkiv residents’ public health.

PATIENTS AND METHODS: Materials and methods: General scientific and specific historical methods were used, and methods of related sciences were applied as well. The main methods of historical research included, in particular, historical analytical, chronological and comparative historical; methods of medical statistics, etc. The historiography of the issue was analyzed, unpublished archival materials, local press were studied.

CONCLUSION: Conclusions: Despite the progress made, mortality remained high in general, proving the public health system had to be reorganized. The death rate shocked the local community so much that the authorities had to apply an information blockade. Anti-epidemic components included explanatory work by priests and police, sanitary measures, measures on strict compliance with observation and quarantine, food supplies to the blocked city and free medicine dispensation, involvement of all available medical institutions, and the establishment of special temporary facilities, actual mobilization of medical personnel. It was impossible to act in the other way, because the treatment methods seemed to be ineffective, like today, under the COVID-19 pandemic. When the medical component is proved ineffective in fighting the epidemic, relatively effective administrative measures, tried and tested over the centuries reasonably seem to be useful, and this experience has not lost its relevance.

PMID:34090298

Wiad Lek. 2021;74(5):1229-1236.

ABSTRACT

OBJECTIVE: The aim:TostudyandanalyzeSumy region population morbidity dynamics taking into account current stage of medical reform. Sumy region here is represented as one of the main agricultural regions of Ukraine. The prevalence of ENT disorders (otolaryngologic diseases) was studied.

PATIENTS AND METHODS: Materials and methods: During the study we used data of statistical report of Public Health Board, Sumy State Administration for the period from 2015 to 2019 years by administrative territories. Obtainedresults wereprocessed, usinggeneral statistics methodsandanalyzed, usingstructural-logicalanalysis.

CONCLUSION: Conclusions: The study found that the morbidity rates of ENT disorders in adult population during the study period increased and had levels of 2113.0 and 122.1 per 100 thousand adult population, respectively, and the prevalence rates and the prevalence rates ofENT disorders among the adult population decreased , respectively to 167.7; 2113,0; 665.1 and 389.9. All indicators have reliable differences in terms of administrative territories of the region. The results of the study should be taken into account in the process of reforming the otolaryngological service in the region.

PMID:34090296

Wiad Lek. 2021;74(5):1222-1228.

ABSTRACT

OBJECTIVE: The aim: Conducting a comprehensive analysis on ensuring the mechanism of state regulation of the development of medical emergency response as an element of the civil protection system of Ukraine in the context of dynamic changes of external and internal factors of its functioning.

PATIENTS AND METHODS: Materials and methods: The data of the state statistical reporting for the period 2010-2019 and the legislative acts of Ukraine on medical emergency response were used as the materials of study. Bibiliosemantic and statistical method and the method of structural-and-logical analysis were applied in the course of study.

CONCLUSION: Conclusions: The sustainable socio-economic development of Ukraine should be accompanied by the formation of a safe environment for the society and each individual, guaranteeing an acceptable level of risk and a modern security system based on the principles of international law. The high degree of the Ukrainian industry concentration is currently in a conflict with the low technological discipline of production, which creates objective preconditions for the growth of man-made and technologically-environmental disasters, catastrophes, and other emergencies. Outbreaks of particularly dangerous and infectious diseases, which are of concern not only because of their prevalence but also because of the potential danger to the health of the nation, its economy and international reputation of the state can pose a significant threat to the socio-political and socioeconomic stability of the state. Ukraine is a potentially vulnerable area for epidemics due to a number of natural, geographical and geopolitical factors. Therefore, the health consequences (real and potential) of any emergency are certainly a threat to the national security of Ukraine both directly and due to the extremely negative impact on the socio-economic, socio-political and psychological conditions of the population. Increasing the level of public administration for medical emergency response will increase the effectiveness of emergency response measures.

PMID:34090295

Wiad Lek. 2021;74(5):1219-1221.

ABSTRACT

OBJECTIVE: The aim: Study and analysis of the epidemiological situation of malignant neoplasms of the respiratory system at the regional level during 2015-2019.

PATIENTS AND METHODS: Materials and methods: The study was based on the analysis of data from the state statistical reporting(forms №7, №35 – healthy) and the database of the National Cancer Registry during 2015 – 2019, which was approved by the conclusion of the bioethics commission of Uzhhorod National University (protocol №2/2 of 15.02.2021).

CONCLUSION: Conclusions: The study found an increase in the level of malignant neoplasms of the respiratory system by 17,28%, as well as the uprise in the proportion of malignant neoplasms of the respiratory system in the structure of all tumours, by 11,98%; detection of malignant neoplasms of the respiratory organs in the late stages; the predominance of the death rate of men from MT over women, as well as mortality rate of the respiratory organs MT up to 1 year from the moment of diagnosis among men is higher over women.

PMID:34090294