Nevin Manimala

Rev Esp Salud Publica. 2021 Apr 30;95:e202104066.

ABSTRACT

OBJECTIVE: Highlighting gender inequalities during the pandemic and its relationship with other axes of social inequality will be decisive for its adequate monitoring. The aim of this study was to assess the differences between men and women in the main measures of infection and mortality by COVID-19, considering its temporal evolution, raising awareness about the weaknesses and contradictions between sources of information.

METHODS: Cross-sectional analysis based on the microdata on COVID cases notified by the National Epidemiological Surveillance Network (RENAVE), the Death Statistics of the National Statistical Institute (INE) and the estimates of excess mortality from the INE and the Daily Mortality Monitoring System (MoMo) microdata. Standardized rates, prevalences and and ratios by sex were calculated for each indicator. The percentage of excess mortality without COVID-19 diagnosis in each sex was calculated. Male/female ratios for symptoms and risk factors of COVID-19 were also calculated.

RESULTS: The rate of infection by COVID-19 was higher in women in the three waves of the pandemic, reaching 65% of infections during April and May 2020. Complications were between 1.5 and 2.5 times higher in men, especially in ICU admissions, which were 2.5 times more frequent than in women. Although mortality rates and excess mortality were also higher in men (around 1.8 times), the percentage of excess mortality without COVID-19 diagnosis was higher in women (44% in men vs. 52% in women the first wave). With regard to the symptoms of COVID-19, fever, cough, and dyspnoea were more frequent in men (20%, 10% and 19% more, respectively) compared to sore throat, vomiting or diarrhea that were more prevalent in women (90%, 40% and 10% more, respectively).

CONCLUSIONS: The analysis disaggregated by sex has made it possible to identify differences between men and women in the diagnosis, presentation and severity of the COVID-19 that can help a better clinical and epidemiological approach to the disease. However, official sources present important gaps when presenting information disaggregated by sex. It is therefore necessary to advance in the inclusion of a gender perspective in the statistics on COVID-19, starting with a necessary but not sufficient condition such as the disaggregation by sex of the data.

PMID:33927179

Ophthalmic Plast Reconstr Surg. 2021 Apr 28. doi: 10.1097/IOP.0000000000001989. Online ahead of print.

ABSTRACT

PURPOSE: Autologous fat transfer is an effective tool for volume restoration to the aging face. Although numerous reports exist regarding injection site complications, there is limited data on donor-site morbidity in the cosmetic surgery literature.

METHODS: This study is a large-scale retrospective review to determine incidence of fat harvest-site complications, identify risk factors, and describe management strategies. Records of all patients who underwent autologous fat harvesting and facial grafting at a single oculofacial plastic surgery practice from 2010 to 2019 were reviewed. Patient demographics and clinical data were collected and assessed. A statistical analysis was performed using a two-tailed T-test with p values of <0.05 considered significant.

RESULTS: Four-hundred sixteen patients were followed for an average of 6.2 months postoperatively. There was an overall 5.5% harvest-site complication rate. There was no correlation of harvest-site complications with gender (p = 0.249) or age (p = 0.881). Harvest location did not significantly correlate with complication rate. The most common complications were contour irregularities, prolonged induration, and prolonged erythema. Low body mass index was associated with higher complication rate (p = 0.003), even when excluding those patients with contour irregularities (p = 0.001). Various treatment modalities were used to manage donor-site morbidity with consistent improvement.

CONCLUSIONS: Autologous fat transfer used for facial volume augmentation has low donor-site morbidity. Minor harvest-site complications occur more commonly in patients with low body mass index, irrespective of age, gender, or fat source.

PMID:33927171 | DOI:10.1097/IOP.0000000000001989

Epidemiology. 2021 Apr 12. doi: 10.1097/EDE.0000000000001363. Online ahead of print.

ABSTRACT

BACKGROUND: Important questions exist regarding the comparative effectiveness of alternative childhood vaccine schedules; however, optimal approaches to studying this complex issue are unclear.

METHODS: We applied methods for studying dynamic treatment regimens to estimate the comparative effectiveness of different rotavirus vaccine (RV) schedules for preventing acute gastroenteritis-related emergency department visits or hospitalization. We studied the effectiveness of six separate protocols: one- and two-dose monovalent rotavirus vaccine (RV1); one-, two-, and three-dose pentavalent rotavirus vaccine (RV5); and no RV vaccine. We used data on all infants to estimate the counterfactual cumulative risk for each protocol. Infants were censored when vaccine receipt deviated from the protocol. Inverse probability of censoring-weighted estimation addressed potentially informative censoring by protocol deviations. A non-parametric group-based bootstrap procedure provided statistical inference.

RESULTS: The method yielded similar 2-year effectiveness estimates for the full-series protocols; weighted risk difference estimates comparing unvaccinated children to those adherent to either full-series (two-dose RV1, three-dose RV5) corresponded to four fewer hospitalizations and 12 fewer emergency department visits over the 2-year period per 1,000 children. We observed dose-response relationships, such that additional doses further reduced risk of acute gastroenteritis. Under a theoretical intervention to fully vaccinate all children, the 2-year risk differences comparing full to observed adherence were 0.04% (95% CI: 0.03%, 0.05%) for hospitalizations and 0.17% (95% CI: 0.14%, 0.19%) for emergency department visits.

CONCLUSIONS: The proposed approach can generate important evidence about the consequences of delaying or skipping vaccine doses, and the impact of interventions to improve vaccine schedule adherence.

PMID:33927157 | DOI:10.1097/EDE.0000000000001363

Gastroenterol Nurs. 2021 Apr 26. doi: 10.1097/SGA.0000000000000542. Online ahead of print.

ABSTRACT

The aim of this research study was to evaluate the effectiveness of lidocaine versus lidocaine with sodium bicarbonate in reducing anxiety and pain, using visual analog scales, in subjects receiving local anesthetic during liver biopsies. The project included 199 subjects presenting for percutaneous liver biopsy using local anesthesia. Subjects were randomized into 2 groups: the control group, which received lidocaine alone, and the experimental group, which received lidocaine buffered with sodium bicarbonate. Immediately after they received the lidocaine injection, both groups were asked to rate their preprocedure anxiety and pain using a 0-10 visual analog scale. Mean postprocedure pain was statistically significantly different between the two arms with the intervention group reporting less pain (1.65 vs. 2.27, p = .037). Change in pain scores between the two groups were also statistically significantly different with the intervention group reporting a mean change in pain score of 0.93 compared to 1.63 in the control group (p = .021). However, no differences were found for reported anxiety. This study has shown that using sodium bicarbonate with lidocaine significantly decreased pain sensation at the injection site when used for deep visceral anesthesia during percutaneous liver biopsy.

PMID:33927155 | DOI:10.1097/SGA.0000000000000542

J Glaucoma. 2021 Apr 28. doi: 10.1097/IJG.0000000000001857. Online ahead of print.

ABSTRACT

PRCIS: The vessel density and perfusion density generated by optical microangiography is significantly affected by the signal strength. Gender, hypertension, diabetes and axial length did not have any statistically significant effect on these measurements.

PURPOSE: To assess the effect of subject-related factors (age, gender, systemic hypertension, diabetes and axial length) and machine related factor (signal strength) on vessel density (VD) and perfusion density (PD) generated by optical microangiography (OMAG) in peripapillary and macular regions.

METHODS: In an observational, cross-sectional study of 200 eyes of 100 healthy individuals (age: 18-80▒y), mean and sectoral VD and PD were calculated on disc and macular scans. Effect of subject-related and machine-related factors on VD and PD parameters were evaluated using multivariate mixed effect models.

RESULTS: Mean (±standard deviation) peripapillary and macular VD of the study population was 18.56±1.11▒mm-1 and 20.59±1.85▒mm-1 respectively. Mean peripapillary and macular PD was 46.43±3.22% and 37.61±3.26% respectively. Sex, hypertension, diabetes and axial length did not have any statistically significant effect on the OMAG measurements (P>0.05 for all associations). However, the signal strength (SS) had significant effect on the OMAG measurements. Mean peripapillary and macular VD on scans with SS of 10 was 1.4▒mm-1 and 3.79▒mm-1 greater respectively than that on scans with SS of 7. Mean peripapillary and macular PD on scans with SS of 10 was 4.43% and 7.85% greater respectively than that on scans with SS of 7.

CONCLUSION: Significant association exists between SS of the scan and the optical coherence tomography angiography (OCT-A) measurements generated by OMAG even when the scans had acceptable SS as recommended by the manufacturer (≥7). This needs to be considered while interpreting OCT-A measurements.

PMID:33927147 | DOI:10.1097/IJG.0000000000001857

J Cardiovasc Med (Hagerstown). 2021 Apr 28. doi: 10.2459/JCM.0000000000001202. Online ahead of print.

ABSTRACT

AIMS: We performed a systematic review to summarize the clinical features, diagnostic methods, treatment, and outcomes of coronavirus disease 2019 (COVID-19) patients with pericarditis.

METHODS: We searched electronic databases from inception to 17 December 2020. Studies that reported clinical data on patients with COVID-19 and pericarditis were included. Descriptive statistics were used for categorical and continuous variables [mean ± standard deviation or median (interquartile range)]. As an exploratory analysis, differences between patients with acute pericarditis and myopericarditis were compared.

RESULTS: A total of 33 studies (32 case reports and 1 case series) involving 34 patients were included. The mean age was 51.6 ± 19.5 years and 62% of patients were men. Sixty-two percentage of patients were diagnosed with myopericarditis. The most frequent electrocardiographic pattern (56%) was diffuse ST-elevation and PR depression. Pericardial effusion and cardiac tamponade were reported in 76 and 35% of cases, respectively. The median values of C-reactive protein [77 mg/dl (12-177)] and white blood cells [12 335 cells/μl (5625-16 500)] were above the normal range. Thirty-eight percent and 53% of patients were treated with nonsteroidal anti-inflammatory drugs (NSAIDs) and colchicine, respectively. These drugs were more frequently used in patients with acute pericarditis compared with myopericarditis. The in-hospital mortality was 6% without a significant difference between both groups.

CONCLUSION: Our review shows that COVID-19 patients with pericarditis had similar clinical features to other viral cardiotropic infections. However, NSAIDs and colchicine were used in half or less of the cases. Overall, the short-term prognosis was good across groups.

PMID:33927144 | DOI:10.2459/JCM.0000000000001202

Am J Gastroenterol. 2021 Apr 29. doi: 10.14309/ajg.0000000000001272. Online ahead of print.

ABSTRACT

INTRODUCTION: In patients with cirrhosis, highly prevalent vitamin D deficiency and low bone mineral density (BMD) increase the burden of disease, and role of vitamin D supplementation is not clear. So, our aim was to determine the effect of vitamin D supplementation on vitamin D level and BMD in patients with cirrhosis.

METHODS: Patients with cirrhosis (18-60 years) of any etiology were enrolled. We measured serum 25(OH)D, parathyroid hormone, thyroid-stimulating hormone, free T4, bone-specific alkaline phosphatase, insulin-like growth factor (IGF)-1, and health-related quality of life at entry and at 1 year; however, serum calcium was measured at 3-month interval. BMD was measured by dual-energy x-ray absorptiometry at lumbar spine and left hip neck at entry and after 1 year. Statistical analysis was performed according to intention-to-treat analysis.

RESULTS: Of 390 screened patients with cirrhosis, 164 participants (82 in each group) were randomized. There was significant increase in 25(OH)D levels in intervention group after 1 year (33.7 [24.3-45.7] ng/mL vs 23.1 [17-28.2] ng/mL; P < 0.001) when compared with placebo. The mean difference in BMD at lumbar spine and left hip neck was not significantly changed after 1 year of intervention with vitamin D between both groups. There was no significant change in both the groups in levels of calcium, thyroid-stimulating hormone, parathyroid hormone, free T4, IGF-1, and bone-specific alkaline phosphatase and quality of life.

DISCUSSION: Supplementation with vitamin D for 1 year improves vitamin D levels but did not result in improvement in BMD at lumbar spine and left hip neck in patients with cirrhosis.

PMID:33927126 | DOI:10.14309/ajg.0000000000001272

Crit Care Med. 2021 Apr 30. doi: 10.1097/CCM.0000000000005065. Online ahead of print.

ABSTRACT

OBJECTIVES: To investigate whether intervention effect estimates for mortality differ between blinded and nonblinded randomized controlled trials conducted in critical care. We used a meta-epidemiological approach, comparing effect estimates between blinded and nonblinded randomized controlled trials for the same research question.

DATA SOURCES: Systematic reviews and meta-analyses of randomized controlled trials evaluating a therapeutic intervention on mortality in critical care, published between January 2009 and March 2019 in high impact factor general medical or critical care journals and by Cochrane.

DATA EXTRACTION: For each randomized controlled trial included in eligible meta-analyses, we evaluated whether the trial was blinded (i.e., double-blinded and/or reporting adequate methods) or not (i.e., open-label, single-blinded, or unclear). We collected risk of bias evaluated by the review authors and extracted trial results.

DATA SYNTHESIS: Within each meta-analysis, we compared intervention effect estimates between blinded and nonblinded randomized controlled trials by using a ratio of odds ratio (< 1 indicates larger estimates in nonblinded than blinded randomized controlled trials). We then combined ratio of odds ratios across meta-analyses to obtain the average relative difference between nonblinded and blinded trials. Among 467 randomized controlled trials included in 36 meta-analyses, 267 (57%) were considered blinded and 200 (43%) nonblinded. Intervention effect estimates were statistically significantly larger in nonblinded than blinded trials (combined ratio of odds ratio, 0.91; 95% CI, 0.84-0.99). We found no heterogeneity across meta-analyses (p = 0.72; I2 = 0%; τ2 = 0). Sensitivity analyses adjusting the main analysis on risk of bias items yielded consistent results.

CONCLUSIONS: Intervention effect estimates of mortality were slightly larger in nonblinded than blinded randomized controlled trials conducted in critical care, but confounding cannot be excluded. Blinding of both patients and personnel is important to consider when possible in critical care trials, even when evaluating mortality.

PMID:33927122 | DOI:10.1097/CCM.0000000000005065

Curr Opin Urol. 2021 Apr 28. doi: 10.1097/MOU.0000000000000884. Online ahead of print.

ABSTRACT

PURPOSE OF REVIEW: Artificial intelligence has become popular in medical applications, specifically as a clinical support tool for computer-aided diagnosis. These tools are typically employed on medical data (i.e., image, molecular data, clinical variables, etc.) and used the statistical and machine-learning methods to measure the model performance. In this review, we summarized and discussed the most recent radiomic pipeline used for clinical analysis.

RECENT FINDINGS: Currently, limited management of cancers benefits from artificial intelligence, mostly related to a computer-aided diagnosis that avoids a biopsy analysis that presents additional risks and costs. Most artificial intelligence tools are based on imaging features, known as radiomic analysis that can be refined into predictive models in noninvasively acquired imaging data. This review explores the progress of artificial intelligence-based radiomic tools for clinical applications with a brief description of necessary technical steps. Explaining new radiomic approaches based on deep-learning techniques will explain how the new radiomic models (deep radiomic analysis) can benefit from deep convolutional neural networks and be applied on limited data sets.

SUMMARY: To consider the radiomic algorithms, further investigations are recommended to involve deep learning in radiomic models with additional validation steps on various cancer types.

PMID:33927099 | DOI:10.1097/MOU.0000000000000884

Dermatol Surg. 2021 Apr 27. doi: 10.1097/DSS.0000000000003062. Online ahead of print.

ABSTRACT

BACKGROUND: The reallocation of health care resources to focus on the acute care needs of COVID-19 patients leads to a delay and deferral of outpatient surgical procedures such as Mohs surgery.

OBJECTIVE: Planning for the resumption of regular outpatient surgical care and preparing for future surges in COVID-19 cases requires identifying surrogate markers of health care demand.

MATERIALS AND METHODS: United States national and state-based Google search data for “Mohs surgery” and other common elective surgical and cosmetic procedures were evaluated. These were compared with national and state-wide COVID-19 case number and death data from the Johns Hopkins University. Pearson correlation coefficients were generated to assess the association between COVID-19 cases and deaths with Google search trends.

RESULTS: Search volume for “Mohs surgery” and other elective surgical and cosmetic procedures significantly decreased as the number of new deaths from COVID-19 increased. Statistically significant inverse correlation was noted between “Mohs surgery” search volume and new COVID-19 deaths on a national and state-based level.

CONCLUSION: Search metric analysis may be used as part of a big data model to help predict health care demand during the reopening phase of the COVID-19 pandemic.

PMID:33927090 | DOI:10.1097/DSS.0000000000003062