Nevin Manimala

Stat Methods Med Res. 2021 Jul 7:9622802211008945. doi: 10.1177/09622802211008945. Online ahead of print.

ABSTRACT

Mammographic screening and prophylactic surgery such as risk-reducing salpingo oophorectomy can potentially reduce breast cancer risks among mutation carriers of BRCA families. The evaluation of these interventions is usually complicated by the fact that their effects on breast cancer may change over time and by the presence of competing risks. We introduce a correlated competing risks model to model breast and ovarian cancer risks within BRCA1 families that accounts for time-varying covariates. Different parametric forms for the effects of time-varying covariates are proposed for more flexibility and a correlated gamma frailty model is specified to account for the correlated competing events.We also introduce a new ascertainment correction approach that accounts for the selection of families through probands affected with either breast or ovarian cancer, or unaffected. Our simulation studies demonstrate the good performances of our proposed approach in terms of bias and precision of the estimators of model parameters and cause-specific penetrances over different levels of familial correlations. We applied our new approach to 498 BRCA1 mutation carrier families recruited through the Breast Cancer Family Registry. Our results demonstrate the importance of the functional form of the time-varying covariate effect when assessing the role of risk-reducing salpingo oophorectomy on breast cancer. In particular, under the best fitting time-varying covariate model, the overall effect of risk-reducing salpingo oophorectomy on breast cancer risk was statistically significant in women with BRCA1 mutation.

PMID:34232831 | DOI:10.1177/09622802211008945

Prehosp Emerg Care. 2021 Jul 7:1-9. doi: 10.1080/10903127.2021.1951407. Online ahead of print.

ABSTRACT

Background: Research networks need access to EMS data to conduct pilot studies and determine feasibility of prospective studies. Combining data across EMS agencies is complicated and costly. Leveraging the National EMS Information System (NEMSIS) to extract select agencies’ data may be an efficient and cost-effective method of providing network-level data.Objective: Describe the process of creating a Pediatric Emergency Care Applied Research Network (PECARN) specific NEMSIS data set and determine if these data were nationally representative.Methods: We established data use agreements (DUAs) with EMS agencies participating in PECARN to allow for agency identification through NEMSIS. Using 2019 NEMSIS version 3.4.0 data for EMS events with patients 18 years old and younger, we compared PECARN NEMSIS data to national NEMSIS data. Analyzed variables were selected for their ability to characterize events. No statistical analyses were utilized due to the large sample, instead, differences of ±5% were deemed clinically meaningful.Results: DUAs were established for 19 EMS agencies, creating a PECARN data set with 305,188 EMS activations of which 17,478 (5.7%) were pediatric. Of the pediatric activations, 17,140 (98.1%) were initiated through 9-1-1 and 9,487 (55.4%) resulted in transport by the documenting agency. The national data included 36,288,405 EMS activations of which 2,152,849 (5.9%) were pediatric. Of the pediatric activations 1,704,141 (79.2%) were initiated through 9-1-1 and 1,055,504 (61.9%) were transported by the documenting agency. Age and gender distributions were similar between the two groups, but the PECARN-specific data under-represents Black and Latinx patients. Comparison of EMS provider primary impressions revealed that three of the five most common were similar with injury being the most prevalent for both data sets along with mental/behavioral health and seizure.Conclusion: We demonstrated that NEMSIS can be leveraged to create network specific data sets. The PECARN’s EMS data were similar to the national data, though racial/ethnic minorities and some primary impressions may be under-represented. Additionally, more EMS activations in PECARN study areas originated through 9-1-1 and were treated and transported by the documenting agency. This is likely related to the type of participating agencies, their ALS response level, and the diversity of the communities they serve.

PMID:34232828 | DOI:10.1080/10903127.2021.1951407

Ocul Immunol Inflamm. 2021 Jul 7:1-6. doi: 10.1080/09273948.2021.1934036. Online ahead of print.

ABSTRACT

Purpose: To compare an analog visual scale in grading anterior chamber cells (ACC) to a modified Standardization of Uveitis Nomenclature (SUN) ACC scale.Method: A graphical representation of anterior chamber cells as a reference and a test set was created and shown to two groups of experienced uveitis experts. Group 1 was given the analog scale in written format, while group two was given the reference images for comparison. Each test subject was asked to provide the best approximation for each grade.Results: Eleven graders participated in phase 1. Correct grading occurred in 87.4% of cases. Discrepancies were seen at all grades. Only 3 of 11 graders were able to achieve a perfect score. Seven graders participated in phase 2. Agreement was 95.2% with 4/7 graders achieving a perfect score. Discrepancies were seen at higher grades only.Conclusions: ACC grading is improved by a visual grading scale, and interobserver variability is reduced.

PMID:34232824 | DOI:10.1080/09273948.2021.1934036

J Ocul Pharmacol Ther. 2021 Jul 7. doi: 10.1089/jop.2021.0033. Online ahead of print.

ABSTRACT

Purpose: To determine the effect of discontinuing chronic topical immune modulating (IM) treatment on Schirmer tear test (STT) values in dogs with dry eye disease (DED). Methods: Serial measurements of STTs from 14 dogs (16 eyes) previously diagnosed with DED were obtained before and after discontinuation of topical IM agents. Dogs with moderate to severe DED that had been well controlled with a topical IM treatment were included. After initial assessment topical IM treatment was discontinued, but topical lubricant was continued, and STT values were obtained sequentially. A mixed-effects regression model was used to evaluate the effects of age, gender, breed, clinical score, frequency of treatment, baseline STT value, and drug type on final STT values after IM withdrawal. P < 0.05 was considered statistically significant. Results: During the follow-up period after the IM treatment had been discontinued (136 ± 29 days), 50% of the eyes (n = 8) exhibited STT values that never decreased to <10 mm/min. In the other 50% (n = 8), STT values decreased from 15.9 ± 4.7 mm/min to 6.1 ± 0.9 mm/min. In this group, the time it took to decrease the STT to <10 mm/min was 21.1 ± 9.5 days. Severe clinical signs of DED and low baseline STT pre-IM treatment significantly affected STT post-IM treatment withdrawal (P < 0.05). Conclusions: The duration that a residual effect of topical IM treatment persists needs to be taken into consideration when studies are designed utilizing dogs with previous IM treatment for DED.

PMID:34232790 | DOI:10.1089/jop.2021.0033

J Drugs Dermatol. 2021 Jul 1;20(7):744. doi: 10.36849/JDD.735.

ABSTRACT

BACKGROUND: Few studies have examined topical psoriasis therapies in patients with skin of color. Fixed-combination halobetasol propionate (0.01%) and tazarotene (0.045%) lotion (HP/TAZ) was investigated in two phase 3, multicenter, double-blind, vehicle-controlled trials (NCT02462070; NCT02462122). This post hoc analysis evaluated HP/TAZ in subgroups of non-White and White participants, including Hispanic/Latino participants, from these trials.

METHODS: Adult participants were randomized (2:1) to receive HP/TAZ or vehicle lotion once daily for 8 weeks. Data were pooled and analyzed in non-mutually exclusive subgroups of self-identified non-White or White and Hispanic/Latino participants. Efficacy assessments included treatment success (&ge;2-grade improvement from baseline in investigator&rsquo;s global assessment [IGA] and score of clear/almost clear), reduction from baseline in affected body surface area (BSA), and reduction in mean IGA &times; BSA. Safety was evaluated via treatment-emergent adverse events (TEAEs).

RESULTS: Of 418 participants, 60 and 358 self-identified as non-White and White, respectively; 115 of 418 participants self-identified as Hispanic/Latino. At week 8, a higher percentage of HP/TAZ-treated participants achieved treatment success vs vehicle (non-White, 34.4% vs 19.0%; White, 41.8% vs 8.7%; Hispanic/Latino, 39.3% vs 9.3%); rates for White and Hispanic/Latino participants were statistically significant. Compared with vehicle, HP/TAZ-treated participants in each subgroup experienced numerically greater reductions in affected BSA and IGA &times; BSA at week 8. The most common TEAEs were contact dermatitis, pruritus, nasopharyngitis, and application-site pain; discontinuations due to TEAEs were few.

CONCLUSIONS: HP/TAZ reduced disease severity in non-White, White, and Hispanic/Latino participants with psoriasis, with good tolerability and safety over 8 weeks of treatment. J Drugs Dermatol. 2021;20(7):735-744. doi:10.36849/JDD.6158.

PMID:34232005 | DOI:10.36849/JDD.735

J Drugs Dermatol. 2021 Jul 1;20(7):767-770. doi: 10.36849/JDD.5732.

ABSTRACT

BACKGROUND: Dermatology is among the least racially/ethnically diverse medical specialties in the US Dermatology Interest Groups (DIGs). DIGs may play a critical role in addressing these disparities by facilitating early exposure and mentorship, both associated with higher rates of medical students pursuing specific fields.

OBJECTIVE: This study sought to characterize the activities, goals, and challenges of DIGs in medical schools nationwide.

METHODS: A 15-question survey was distributed electronically to 92 DIG leaders enrolled in four-year accredited allopathic/osteopathic medical schools nationwide. Data collected included DIG leaders&rsquo; demographic information, medical training stage, DIG size/age, number/type of DIG activities hosted, presence of faculty/resident mentors, and goals/challenges.

RESULTS: There were 48 total and 46 complete responses (52% response rate). Most DIG leaders were female (81%), white (63%), and from allopathic medical schools of roughly equal geographic distribution. Over three-quarters of DIGs had affiliated dermatology departments and residencies. Most had faculty advisors; few had resident mentors. Presence of an affiliated dermatology department was associated with statistically significant increase in mentoring opportunities (P=0.034), significantly increased odds of having dedicated faculty mentors (OR=6.10, 95%CI 1.11&ndash;33.56), and non-significantly increased odds of having dedicated resident mentors (OR=2.96, 95%CI 0.33&ndash;26.79). DIG leaders self-identified early dermatology exposure, aiding in the match, relationship-building, and community engagement as main objectives and mismatches in opportunities, time, funding, and interest as main challenges.

CONCLUSIONS: DIGs provide valuable opportunities to medical students exploring the field and may play a role in reducing future dermatology workforce disparities. Dermatology departments, residencies, and medical schools should support their aims and reduce structural barriers to success. J Drugs Dermatol. 2021;20(7):767-770. doi:10.36849/JDD.5732.

PMID:34231994 | DOI:10.36849/JDD.5732

Rev Med Inst Mex Seguro Soc. 2021 Jun 14;59(2):127-132.

ABSTRACT

BACKGROUND: Infections increase morbidity and mortality in patients with autoimmune disorders; however, this association has not been established in rheumatic diseases and SARS-CoV-2 infection.

OBJECTIVE: To describe the clinical characteristics and mortality of patients with rheumatic diseases and severe COVID-19.

MATERIAL AND METHODS: Observational and descriptive case series in patients with rheumatic diseases and severe SARS-CoV-2 infection, confirmed by PCR or pulmonary tomography, hospitalized in Mexico City from March to August 2020.

RESULTS: 15 patients with a mean age of 57 years (SD ± 11) were included, 66.6% were women, and 80% had a positive PCR test. The time from onset of symptoms to hospitalization, on average, was 7.2 days (SD ± 2.1). 46.6% died. Patients who died had a lower mean platelet level compared to survivors. The inflammatory reactants were higher in the deceased. There were no statistically significant differences in mortality for the variables related to rheumatic disease.

CONCLUSIONS: The differences in mortality of patients with severe COVID-19 in this series of cases seem to be related to the infection and not to the rheumatic disease.

PMID:34231984

Rev Med Inst Mex Seguro Soc. 2021 Jun 14;59(2):119-126.

ABSTRACT

BACKGROUND: Chronic degenerative diseases have become a challenge for the Mexican health system. Faced with this problem, health institutions have focused on the therapeutic potential of organ and tissue donation and transplantation.

OBJECTIVE: To analyze the experience of the donation program and to identify areas of opportunity at the Hospital de Cardiología No. 34 (Hospital of Cardiology Number 34), in Monterrey, Nuevo León, Mexico.

MATERIAL AND METHODS: Observational, cross-sectional, and retrospective study. The study population was made up by deaths and successful interviews. Only groupings with values of p < 0.05 were considered statistically significant.

RESULTS: A global of 1947 deaths were registered and a total of 210 interviews were carried out; 83 (39.5%) family members accepted to donate and 127 (60.5%) refused to donate. Only 3 associations between variables had significant statistical value. The year was an important determinant in the increase in effective donations (p = 0.010), and so was the month of the year (p = 0.037), obtaining more positive interviews in the second half of the year; finally, the shift also contributed to the family response (p = 0.012), with the morning shift being the best shift to conduct a successful family interview.

CONCLUSIONS: It is imperative to conduct studies that analyze and describe the experience of donation programs to promote and encourage the value of donation.

PMID:34231983

Rev Med Inst Mex Seguro Soc. 2021 Jun 14;59(2):110-118.

ABSTRACT

BACKGROUND: Occupational accidents represent an important problem that affects workers, families, society, industry, social security institutions and the nation as a whole, which affects directly the global economy.

OBJECTIVE: To assess the direct costs of occupational accidents at the Baja California Local Office of the Instituto Mexicano del Seguro Social (IMSS -Mexican Institute for Social Security-) in 2017.

MATERIAL AND METHODS: Cross-sectional descriptive study; the information was obtained from IMSS 2017 Statistical Memory and Baja California Local Office database. We analyzed 26,657 cases of work-related accidents and diseases. Years of potential productive life lost were calculated with the years of potential productive life lost indicator and the accumulated years of potential productive life lost indicator.

RESULTS: 97,901 certificates of temporary incapacity for work were issued in Baja California with a total amount of 150,284,001 Mexican pesos. 1593 permanent disabilities were granted with an average monthly amount of 3830 pesos and a total of 8982 accumulated years of potential productive life lost. 38 death certificates by work-related risks were issued and accounted for a total of 1048 years of potential productive life lost and 182 491 pesos for funeral expenses.

CONCLUSIONS: Direct costs of occupational accidents and diseases in the Baja California Local Office of IMSS have an impact on economic growth. Concerted efforts are needed to achieve a progressive reduction of work-related fatalities, accidents and diseases.

PMID:34231982

Pediatr Pulmonol. 2021 Jul 7. doi: 10.1002/ppul.25503. Online ahead of print.

ABSTRACT

OBJECTIVE: To provide a systematic review of the existing pediatric decannulation protocols, including the role of polysomnography, and their clinical outcomes.

METHODS: Five online databases were searched from database inception to May 29, 2020. Study inclusion was limited to publications that evaluated tracheostomy decannulation in children 18 years of age and younger. Data extracted included patient demographics and primary indication for tracheostomy. Methods used to assess readiness for decannulation were noted including the use of bronchoscopy, tracheostomy tube modifications, and gas exchange measurements. After decannulation, details regarding mode of ventilation, location, and length of observation period, and clinical outcomes were also collected. Descriptive statistical analyses were performed.

RESULTS: A total of 24 studies including 1395 children were reviewed. Tracheostomy indications included upper airway obstruction at a well-defined anatomic site (35%), upper airway obstruction not at a well-defined site (12%) and need for long-term ventilation and pulmonary care (53%). Bronchoscopy was routinely used in 23 of 24 (96%) protocols. Tracheostomy tube modifications in the protocols included capping (n = 20, 83%), downsizing (n = 14, 58%), and fenestrations (n = 2, 8%). Measurements of gas exchange included polysomnography (n = 13/18, 72%), oximetry (n = 10/18, 56%), blood gases (n = 3,17%), and capnography (n = 3, 17%). After decannulation, children in 92% of protocols were transitioned to room air. Observation period of 48 h or less was used in 76% of children.

CONCLUSIONS: There exists large variability in pediatric decannulation protocols. Polysomnography plays an integral role in assessing most children for tracheostomy removal. Evidence-based guidelines to standardize pediatric tracheostomy care remain an urgent priority.

PMID:34231976 | DOI:10.1002/ppul.25503