Tag: nevin manimala

Malar J. 2024 Oct 19;23(1):316. doi: 10.1186/s12936-024-05138-z.

ABSTRACT

BACKGROUND: Submicroscopic Plasmodium infections can be a source of persistent malaria transmission. The aim of this study was to assess their frequency, distribution, morbidity and associated factors in a pre-elimination malaria setting in sub-Saharan Africa, Guinea-Bissau, where the Plasmodium falciparum is the predominant Plasmodium species.

METHODS: Dried fingerprick whole blood samples from 601 participants in the 2017 national, household-based, cross-sectional survey to estimate malaria prevalence were subjected to DNA extraction. The DNA was used in nested end-point PCR assays targeting genus- and species-specific regions of the Plasmodium 18S rRNA genes. Statistical analysis of socio-demographic, clinical and molecular data was carried out using the Statistical Package for the Social Sciences, version 29. Factors associated with submicroscopic P. falciparum infections and their magnitude were sought using Chi-square test and multiple logistic regression models, respectively. Statistically significant level was considered at P-value < 0.05.

RESULTS: Nested PCR assays detected submicroscopic P. falciparum infections in 20.3% (95% CI = 16.8-23.8) of individuals microscopically negative for Plasmodium species in the general population and in 21.4% (95% CI = 9.9-36.5) of microscopically negative pregnant women. Submicroscopic Plasmodium malariae infections were also detected as co-infections in 3.0% individuals who were microscopically positive only for P. falciparum. Infections with other Plasmodium species were not detected. Submicroscopic P. falciparum infections were not associated with age, sex, or the presence of fever. A logistic regression model adjusted for ethnicity and health region showed that individuals from the Balanta and Bijagos ethnic groups, most of whom live in the low malaria-transmission areas of Quinara and Bissau, and the Bijagos archipelago, respectively, were less likely to have submicroscopic P. falciparum infections than individuals from the large Fula ethnic group, most of whom live in the high malaria-transmission area of Gabu. Submicroscopic P. falciparum infections were not associated with anaemia in children under 5 years of age.

CONCLUSION: The results obtained highlight the contribution of asymptomatic and submicroscopic P. falciparum infections to malaria transmission in high malaria-transmission areas and the need for molecular-based tools to detect submicroscopic Plasmodium species.

PMID:39427159 | DOI:10.1186/s12936-024-05138-z

BMC Musculoskelet Disord. 2024 Oct 19;25(1):824. doi: 10.1186/s12891-024-07931-y.

ABSTRACT

BACKGROUND: This study aims to evaluate the long-term outcomes of one-stage posterior hemivertebra resection and short segment fusion with pedicle screw fixation in children with thoracolumbar congenital early-onset scoliosis (TLCEOS). It specifically investigates the durability of spinal correction and the incidence of complications over an average follow-up of 8.97 years.

METHODS: A retrospective review was conducted on 32 patients treated at a tertiary scoliosis referral center from April 2003 to December 2019. Inclusion criteria were thoracolumbar hemivertebra (T11-L1), treatment via posterior hemivertebra resection and short segment fusion (≤ 5 segments), age under 10 years at surgery, and a follow-up of at least 5 years. Exclusions included idiopathic, syndromic, or neuromuscular scoliosis. Data on demographics, surgical procedures, and radiographic outcomes were collected, and clinical outcomes were evaluated using the Scoliosis Research Society-22 (SRS-22) questionnaire. Statistical analysis was performed using SPSS and R software.

RESULTS: The study included 32 patients (22 males, 10 females) with a mean age of 5.00 ± 2.42 years at surgery and an average follow-up of 8.97 ± 2.81 years. On average, 3.47 ± 1.11 segments were fused. The main curve corrected from 38.64° ± 14.12° preoperatively to 9.06° ± 7.29° postoperatively, with a final correction rate of 61%. Significant improvements were observed in the SRS-22 domains of Appearance and Satisfaction with Treatment. There were 17 complications, including neurological, pulmonary, and mechanical issues, with some cases requiring revision surgery.

CONCLUSIONS: One-stage posterior hemivertebra resection and short segment fusion with pedicle screw fixation effectively correct TLCEOS long-term, offering significant improvements in patient appearance and satisfaction, with a manageable complication profile.

PMID:39427154 | DOI:10.1186/s12891-024-07931-y

BMC Public Health. 2024 Oct 19;24(1):2886. doi: 10.1186/s12889-024-20390-3.

ABSTRACT

BACKGROUND: Emergency contraceptive pills (ECPs) are significantly underutilized in many parts of the world, especially in South-Asia. Within Pakistan, despite the population surge, the utilization of ECPs remains alarmingly low. The purpose of this study was to investigate the knowledge and practices regarding ECPs amongst married women and men in Karachi, Pakistan and the possible barriers hindering access to and use of these contraceptives.

METHODOLOGY: A multi-centric cross-sectional study was conducted in Karachi, Pakistan. Interviews were conducted with participants using validated questionnaire involving different sections on demographics, knowledge, practices, and barriers to ECP use. Categorical variables were summarized as frequencies and percentages while continuous variables were characterized using mean and standard deviation. A chi-square test of variance was used for association between knowledge scores and different categorical values. A p-value of < 0.05 at 95% CI was statistically significant.

RESULTS: Over half of the respondents (52.5%) were not using any method of contraception. 11.1% of respondents had used ECP at some point in their life. 337 (85.8%) participants had low knowledge, 55 (14%) had moderate while only 1 (0.25%) had high knowledge regarding ECPs. There was no significant association of knowledge scores with gender, age, employment status or parity. However, participants who had received counseling for family planning in the past or had previously used ECPs had significantly higher knowledge regarding ECPs. A majority 58% (221) of the participants expressed concerns about the potential side effects and 128 (33.9%) of them believed that ECPs were in contradiction to their religious and moral values.

CONCLUSION: Our study in Karachi, Pakistan, highlights critical challenges in ECP awareness, utilization, and family planning. Although the results show improved ECP usage than studies previously done in Pakistan, there is a further need to increase the reach of ECPs through a variety of methods. Persistent myths and misconceptions and a severe lack of awareness further hinders their use.

PMID:39427150 | DOI:10.1186/s12889-024-20390-3

BMC Med Res Methodol. 2024 Oct 19;24(1):246. doi: 10.1186/s12874-024-02330-2.

ABSTRACT

BACKGROUND: Missing data in confounding variables present a frequent challenge in generating evidence using real-world data, including electronic health records (EHR). Our objective was to apply a recently published toolkit for characterizing missing data patterns and based on the toolkit results about likely missingness mechanisms, illustrate the decision-making process for analyses in an empirical case example.

METHODS: We utilized the Structural Missing Data Investigations (SMDI) toolkit to characterize missing data patterns in the context of a pharmacoepidemiology study comparing cardiovascular outcomes of initiating sodium-glucose-cotransporter-2 inhibitors (SGLT2i) and dipeptidyl peptidase-4 inhibitors (DPP-4i) among older adults. The study used a linked EHR-Medicare claims dataset from Duke Health patients (2015-2017), focusing on partially observed confounders from EHR data (HbA1c lab and body mass index [BMI] values). Our analysis incorporated SMDI’s descriptive functions and diagnostic tests to explore missingness patterns and determine missingness mitigation approaches. We used findings from these investigations to inform estimation of adjusted hazard ratios comparing the two classes of medications.

RESULTS: High levels of missingness were noted for important confounding variables including HbA1c (63.6%) and BMI (16.5%). Diagnostic tests resulted in output that described: 1) the distributions of patient characteristics, exposure, and outcome between patients with or without an observed value of the partially observed covariate, 2) the ability to predict missingness based on observed covariates, and 3) estimate if the missingness of a partially observed covariate is differential with respect to the outcome. There was evidence that missingness could be sufficiently described using observed data, which allowed multiple imputation by chained equations using random forests to address missing confounder data in estimating treatment effects. Multiple imputation resulted in improved alignment of effect estimates with previous studies.

CONCLUSIONS: We were able to demonstrate the practical application of the SMDI toolkit in a real-world setting. Application of the SMDI toolkit and the resulting insights of potential missingness patterns can inform the choice of appropriate analytic methods and increase transparency of research methods in handling missing data. This type of approach can inform analytic decision making and may increase our ability to generate evidence from real-world data.

PMID:39427148 | DOI:10.1186/s12874-024-02330-2

BMC Public Health. 2024 Oct 19;24(1):2885. doi: 10.1186/s12889-024-20334-x.

ABSTRACT

BACKGROUND: Toxoplasmosis is a chronic protozoan parasitic infection that affects nearly one-third of the global population. During the COVID-19 pandemic, cases were observed in patients with COVID-19 and toxoplasmosis. Therefore, this systematic review and meta-analysis aimed to determine the frequency of Toxoplasma gondii exposure in patients with COVID-19.

METHODS: A literature search was conducted in six databases or search tools (PubMed, Scopus, Embase, Web of Science, ScienceDirect, and Google Scholar) until March 3, 2024. Study selection, quality assessment, and data extraction were performed independently by three investigators. Statistical analysis was performed using R version 4.3, applying a random-effects model. The quality of the included observational studies was assessed using the “JBI-MAStARI”.

RESULTS: A total of 5,936 studies were retrieved, 13 of which were included in the final meta-analysis. The sample included a total of 2,947 patients with COVID-19 from four countries, of whom approximately 43.3% were men and 49.4% were women. Among the patients, 1,323 showed evidence of exposure to T. gondii through IgG detection, while 1,302 COVID-19 patients were explicitly examined for T. gondii by IgM detection, and 36 positive cases were identified. The frequency of exposure to T. gondii, determined by the presence of IgG in patients with COVID-19, reached 49% (95% CI: 34-63%; 2,947 participants; 13 studies; I² = 98%, p < 0.01). In addition, the frequency of exposure to T. gondii, evaluated by IgM presence in patients with COVID-19, was 2% (95% CI: 0-6%; 1,302 participants; 6 studies; I² = 94%, p < 0.01).

CONCLUSION: It was shown that almost half of COVID-19 patients had previous exposure to T. gondii through the presence of IgG, and a small percentage, 2%, showed active infection through IgM detection. Although the results indicate a possible correlation between exposure to T. gondii and the presence of COVID-19, it is essential to note that this study is based on observational research, which precludes establishing a causal relationship. Consequently, further research is required to deepen understanding of the interaction between the two conditions.

TERMS USED: The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI), Prospective International Registry of Systematic Reviews (PROSPERO), and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

PMID:39427144 | DOI:10.1186/s12889-024-20334-x

BMC Oral Health. 2024 Oct 19;24(1):1248. doi: 10.1186/s12903-024-04989-x.

ABSTRACT

BACKGROUND: Periodontal health in men with HIV remains understudied, despite suggestions of associations between HIV infection and gingival pocketing, periodontal attachment loss, and gingival inflammation. As antiretroviral therapy (ART) has improved the quality of life for people living with HIV (PLWH), aging-related risk factors and comorbidities, including periodontitis, have emerged. This study aims to assess alveolar bone height, gingival crevicular fluid (GCF) cytokines, and periodontal disease activity in men with and without HIV.

METHODS: Ninety-three men (50 HIV+, 43 HIV-) aged 35-70 years were recruited from Columbia University Irving Medical Center clinics. Periodontal examination, GCF collection, and intraoral radiographs were collected. Statistical analysis was conducted with t-tests for continuous variables and chi-squared tests for categorical variables.

RESULTS: While no significant differences were observed in bleeding on probing, clinical attachment loss and pocket depths, men with HIV exhibited significantly greater alveolar crestal height on radiographs compared to men without HIV (HIV + 3.41+/-1.35 mm, HIV- 2.64+/-1.01 mm; p = 0.004), reflecting greater alveolar bone loss.

CONCLUSIONS: Men living with HIV demonstrate increased alveolar bone loss compared to those without HIV, possibly mediated by elevated IL6 levels. These results underscore the importance of comprehensive oral health management in PLWH and highlight the need for further research understanding the mechanisms linking HIV infection, cytokine dysregulation, and periodontal health.

PMID:39427141 | DOI:10.1186/s12903-024-04989-x

BMC Oral Health. 2024 Oct 19;24(1):1253. doi: 10.1186/s12903-024-05019-6.

ABSTRACT

BACKGROUND: In the socio-dental approach, the integration of normative oral health-related quality of life (OHRQoL) and behavioral propensity measures should be considered when assessing treatment needs and planning oral services. Therefore, this study aimed to evaluate the relationship between oral health impacts attributed to malocclusion and normative and self-perceived orthodontic treatment needs in adolescent patients and to determine the clinical, sociodemographic, and behavioral factors affecting their OHRQoL.

METHODS: This cross-sectional study was conducted using a convenience sample size of 105 adolescent patients aged 11-14 years who were referred to the Orthodontics Clinic in the Faculty of Dentistry, Istanbul. Data were collected using clinical examinations and a self-reported questionnaire, including the condition-specific Child Oral Impact on Daily Performances (CS-COIDP) attributed to malocclusion and sociodemographic, clinical, and behavioral factors. The index of complexity, outcome, and need (ICON), gingival index, and Decayed, Missing, Filled Teeth index was used to assess oral health status. Descriptive statistics and bivariate and multivariate regression analyses were used for the data analyses.

RESULTS: A total of 70 patients (66.7%) reported at least one impact. Furthermore, 47% of the adolescents had very difficult and difficult complexity grades. The most affected performances were “emotional (52.4%) and smiling (40%)”. No significant differences were found in the total CS-COIDP scores according to caries experience; however, the gingival status was associated with the total OHRQoL. Lower tooth brushing frequency, increased malocclusion complexity, and subjective treatment need were the most important predictors of worse OHRQoL, accounting for 39.3% of the variance in the scores. ( R² = 0.422; p < 0.001) CONCLUSIONS: Oral health professionals should consider oral behaviors, malocclusion complexity, and subjective treatment need when planning orthodontic treatment plans. Integrating ICON, CS-COIDP, and behavioral assessment will help identify adolescents who should be prioritized for treatment.

PMID:39427133 | DOI:10.1186/s12903-024-05019-6

BMC Musculoskelet Disord. 2024 Oct 19;25(1):822. doi: 10.1186/s12891-024-07934-9.

ABSTRACT

The accurate classification of bone tumours is crucial for guiding clinical decisions regarding treatment and follow-up. However, differentiating between various tumour types is challenging due to the rarity of certain entities, high intra-class variability, and limited training data in clinical practice. This study proposes a multimodal deep learning model that integrates clinical metadata and X-ray imaging to improve the classification of primary bone tumours. The dataset comprises 1,785 radiographs from 804 patients collected between 2000 and 2020, including metadata such as age, affected bone site, tumour position, and gender. Ten tumour types were selected, with histopathology or tumour board decisions serving as the reference standard.

METHODS: Our model is based on the NesT image classification model and a multilayer perceptron with a joint fusion architecture. Descriptive statistics included incidence and percentage ratios for discrete parameters, and mean, standard deviation, median, and interquartile range for continuous parameters.

RESULTS: The mean age of the patients was 33.62 ± 18.60 years, with 54.73% being male. Our multimodal deep learning model achieved 69.7% accuracy in classifying primary bone tumours, outperforming the Vision Transformer model by five percentage points. SHAP values indicated that age had the most substantial influence among the considered metadata.

CONCLUSION: The joint fusion approach developed in this study, integrating clinical metadata and imaging data, outperformed state-of-the-art models in classifying primary bone tumours. The use of SHAP values provided insights into the impact of different metadata on the model’s performance, highlighting the significant role of age. This approach has potential implications for improving diagnostic accuracy and understanding the influence of clinical factors in tumour classification.

PMID:39427131 | DOI:10.1186/s12891-024-07934-9

Occup Med (Lond). 2024 Oct 19:kqae091. doi: 10.1093/occmed/kqae091. Online ahead of print.

ABSTRACT

BACKGROUND: Academic researchers experience high levels of stress, isolation and loneliness, which compromise their well-being. There is a particular need to address these issues amongst early career and postgraduate research staff. ‘Spaces for Listening’ is an initiative to increase active listening and provide peer support.

AIMS: To assess the feasibility, acceptability and potential impacts of Spaces for Listening in an academic setting.

METHODS: Early career and postgraduate researchers from a large university in the UK were invited to attend ‘Academic Spaces for Listening’ (ASfL). Five ASfL sessions (including in-person and Chinese language) were held. A mixed-methods study using online survey and in-depth interviews was conducted. Quantitative data were analysed using descriptive statistics, and qualitative data were analysed using principles of thematic analysis. The qualitative and quantitative findings were integrated at the interpretation phase.

RESULTS: A total of 25 participants attended an ASfL session, 22 of them completed the survey and 6 participants participated in semi-structured interviews. Participants were very satisfied with the session content (68%, n = 15), organization (68%, n = 15) and delivery (68%, n = 15). Four themes were identified from qualitative analysis: (i) the ‘Academic Spaces for Listening’ (ASfL) experience; (2) impact of ASfL; (3) potential challenges of ASfL and (4) ASfL in the future. Interpersonal connectedness was an important outcome for participants during the session. Participants showed interest in the future of ASfL.

CONCLUSIONS: Implementing Spaces for Listening in an academic setting is feasible and was well received by participants. The initiative may fill a gap in the social interactions amongst academic researchers.

PMID:39425907 | DOI:10.1093/occmed/kqae091

Global Spine J. 2024 Oct 19:21925682241295666. doi: 10.1177/21925682241295666. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective cohort study.

OBJECTIVES: This study aimed to evaluate the survival period in patients with a single spinal metastasis (SSM), subsequently comparing those with isolated-single spinal metastasis (I-SSM) and single spinal metastasis with other metastasis (O-SSM) after surgery, and to identify prognostic factors affecting their survival.

METHODS: A total of 135 patients were included, with 24 patients in the I-SSM group and 111 in the O-SSM group. Survival analysis was utilized to assess the survival of SSM patients, followed by a comparison of survival rates between the two groups. Univariate and multivariate analyses were conducted to identify significant prognostic factors for survival.

RESULTS: The overall median survival period for patients with single spinal metastasis (SSM) was 10.2 ± 1.8 months. Specifically, the median survival was 15.7 ± 5.7 months in the I-SSM group and 10.2 ± 1.5 months in the O-SSM group. The difference in survival periods between the two groups was not statistically significant (P = 0.345). Significant independent prognostic factors for survival included preoperative Karnofsky Performance Status (KPS) of 50 – 70 (OR 0.51, P = 0.017) and 80 – 100 (OR 0.46, P = 0.012), postoperative ambulatory status (OR 1.19, P = 0.028), and primary malignancy site [Group B (OR 2.67, P = 0.021), Group C (OR 2.90, P = 0.016)].

CONCLUSIONS: Patients with SSM have a median survival of 10.2 months, with no significant difference in postoperative survival between the I-SSM and O-SSM groups. Significant prognostic factors influencing the survival period after surgery include preoperative KPS, postoperative ambulatory status, and the primary malignancy site.

PMID:39425906 | DOI:10.1177/21925682241295666