Tag: nevin manimala

Ann Epidemiol. 2023 Sep 22:S1047-2797(23)00180-1. doi: 10.1016/j.annepidem.2023.09.006. Online ahead of print.

ABSTRACT

PURPOSE: To assess the distribution and clustering of COVID-19 testing and incidence over space and time, U.S. Department of Veteran’s Affairs (VA) data were used to describe where and when Veterans experienced highest proportions of test positivity.

METHODS: Data for 6,342,455 Veterans who utilized VA services between January 1, 2018 and September 30, 2021 were assessed for COVID-19 testing and test positivity. Testing and positivity proportions by county were mapped and focused-cluster tests identified significant clustering aroung VA facilities. Spatial cluster analysis also identified where and when Veterans experienced highest proportions of test positivity.

RESULTS: Within the Veterans study population and our time window, 21.3% received at least one COVID-19 test, and 20.4% of those tested had at least one positive test. There was statistically significant clustering of testing around VA facilities, revealing regional variation in testing practices. Veterans experienced highest test positivity proportions between November 2020 and January 2021 in a cluster of states in the Midwest, compared to those who received testing outside of the identified cluster (RR: 3.45).

CONCLUSION: Findings reflect broad regional trends in COVID-19 positivity which can inform VA policy and resource allocation. Additional analysis is needed to understand patterns during Delta and Omicron variant periods.

PMID:37742880 | DOI:10.1016/j.annepidem.2023.09.006

Ann Epidemiol. 2023 Sep 22:S1047-2797(23)00181-3. doi: 10.1016/j.annepidem.2023.09.007. Online ahead of print.

ABSTRACT

BACKGROUND: We developed a predictive model to estimate the risk of sub-optimal HIV clinical outcomes among people living with HIV and mental illness or substance use disorders in Texas.

METHODS: The Texas Medical Monitoring Project (MMP) data obtained from June 2015 to May 2020 was used to develop and internally validate the predictive model. Univariate descriptive and bivariate inferential statistics were performed to describe the characteristics of the study population and unadjusted associations with HIV clinical outcomes. Multivariable logistic regression was used to develop the prediction model. Internal validation was performed using the bootstrap method.

RESULTS: A total of 518 respondents aged 18 years and above, representing 27,255 adults living with HIV and mental illness or substance use disorders in Texas were included. Most participants were male (77.04%), less than 50 years of age (56.98%), had mild diagnosed mental illness and substance use disorder (56.59%). The risk predictive model contained 8 predictors, which together yielded an AUC of 0.727. Nonretention in care appeared to be the strongest predictor for having suboptimal HIV clinical outcome (aOR = 3.27; 95% CI = 1.45, 7.42).

CONCLUSION: The predictive model had good discrimination between persons at risk of poor HIV clinical outcomes and those not at risk.

PMID:37742879 | DOI:10.1016/j.annepidem.2023.09.007

J Neurol Sci. 2023 Sep 19;453:120813. doi: 10.1016/j.jns.2023.120813. Online ahead of print.

ABSTRACT

BACKGROUND: Conventional MRI scans have limited usefulness in monitoring Parkinson’s disease as they typically do not show any disease-specific brain abnormalities. This study aimed to identify an imaging biomarker for tracking motor symptom progression by using a multivariate statistical approach that can combine gray matter volume information from multiple brain regions into a single score specific to each PD patient.

METHODS: A cohort of 150 patients underwent MRI at baseline and had their motor symptoms tracked for up to 10 years using MDS-UPDRS-III, with motor symptoms focused on total and subscores, including rigidity, bradykinesia, postural instability, and gait disturbances, resting tremor, and postural-kinetic tremor. Gray matter volume extracted from MRI data was summarized into a patient-specific summary score using Mahalanobis distance, M_GMV. MDS-UPDRS-III’s progression and its association with M_GMV were modeled via linear mixed-effects models over 5- and 10-year follow-up periods.

RESULTS: Over the 5-year follow-up, there was a significant increase (P < 0.05) in MDS-UPDRS-III total and subscores, except for postural-kinetic tremor. Over the 10-year follow-up, all MDS-UPDRS-III scores increased significantly (P < 0.05). A higher baseline M_GMV was associated with a significant increase in MDS-UPDRS-III total, bradykinesia, postural instability and gait disturbances, and resting tremor (P < 0.05) over the 5-year follow-up, but only with total, bradykinesia, and postural instability and gait disturbances during the 10-year follow-up (P < 0.05).

CONCLUSIONS: Higher M_GMV scores were linked to faster motor symptom progression, suggesting it could be a valuable marker for clinicians monitoring Parkinson’s disease over time.

PMID:37742348 | DOI:10.1016/j.jns.2023.120813

Med Phys. 2023 Sep 24. doi: 10.1002/mp.16753. Online ahead of print.

ABSTRACT

BACKGROUND: Accurate delineations of regions of interest (ROIs) on multi-parametric magnetic resonance imaging (mpMRI) are crucial for development of automated, machine learning-based prostate cancer (PCa) detection and segmentation models. However, manual ROI delineations are labor-intensive and susceptible to inter-reader variability. Histopathology images from radical prostatectomy (RP) represent the “gold standard” in terms of the delineation of disease extents, for example, PCa, prostatitis, and benign prostatic hyperplasia (BPH). Co-registering digitized histopathology images onto pre-operative mpMRI enables automated mapping of the ground truth disease extents onto mpMRI, thus enabling the development of machine learning tools for PCa detection and risk stratification. Still, MRI-histopathology co-registration is challenging due to various artifacts and large deformation between in vivo MRI and ex vivo whole-mount histopathology images (WMHs). Furthermore, the artifacts on WMHs, such as tissue loss, may introduce unrealistic deformation during co-registration.

PURPOSE: This study presents a new registration pipeline, MSERgSDM, a multi-scale feature-based registration (MSERg) with a statistical deformation (SDM) constraint, which aims to improve accuracy of MRI-histopathology co-registration.

METHODS: In this study, we collected 85 pairs of MRI and WMHs from 48 patients across three cohorts. Cohort 1 (D₁ ), comprised of a unique set of 3D printed mold data from six patients, facilitated the generation of ground truth deformations between ex vivo WMHs and in vivo MRI. The other two clinically acquired cohorts (D₂ and D₃ ) included 42 patients. Affine and nonrigid registrations were employed to minimize the deformation between ex vivo WMH and ex vivo T2-weighted MRI (T2WI) in D₁ . Subsequently, ground truth deformation between in vivo T2WI and ex vivo WMH was approximated as the deformation between in vivo T2WI and ex vivo T2WI. In D₂ and D₃ , the prostate anatomical annotations, for example, tumor and urethra, were made by a pathologist and a radiologist in collaboration. These annotations included ROI boundary contours and landmark points. Before applying the registration, manual corrections were made for flipping and rotation of WMHs. MSERgSDM comprises two main components: (1) multi-scale representation construction, and (2) SDM construction. For the SDM construction, we collected N = 200 reasonable deformation fields generated using MSERg, verified through visual inspection. Three additional methods, including intensity-based registration, ProsRegNet, and MSERg, were also employed for comparison against MSERgSDM.

RESULTS: Our results suggest that MSERgSDM performed comparably to the ground truth (p > 0.05). Additionally, MSERgSDM (ROI Dice ratio = 0.61, landmark distance = 3.26 mm) exhibited significant improvement over MSERg (ROI Dice ratio = 0.59, landmark distance = 3.69 mm) and ProsRegNet (ROI Dice ratio = 0.56, landmark distance = 4.00 mm) in local alignment.

CONCLUSIONS: This study presents a novel registration method, MSERgSDM, for mapping ex vivo WMH onto in vivo prostate MRI. Our preliminary results demonstrate that MSERgSDM can serve as a valuable tool to map ground truth disease annotations from histopathology images onto MRI, thereby assisting in the development of machine learning models for PCa detection on MRI.

PMID:37742344 | DOI:10.1002/mp.16753

J Sports Sci. 2023 Sep 24:1-18. doi: 10.1080/02640414.2023.2257513. Online ahead of print.

ABSTRACT

Badminton footwork has been characterised with jump-landing, cross step, side side and lunges, which requires movement agility to facilitate on-court performance. A novel badminton shoe design with systematic increase of lateral wedge hardness (Asker C value of 55, 60, 65, and 70) was developed and investigated in this study, aiming to analyse the dose-response effect of incremental wedge hardness on typical badminton footwork. Stance time and joint stiffness were employed to investigate the footwork performance, and the factorial Statistical non-Parametric Mapping and Principal Component Analysis (PCA) were used to quantify the biomechanical responses over the stance. As reported, shorter contact times (decreased by 8.9%-13.5%) and increased joint stiffness (in side step) of foot-ankle complex were found, suggesting improved footwork stability and agility from increased hardness. Time-varying differences were noted during the initial landing and driving-off phase of cross and side steps and drive-off returning of lunges, suggesting facilitated footwork performance. The reconstructed modes of variations from PCA further deciphered the biomechanical response to the wedge dosage, especially during drive-off, to understand the improved footwork agility and stability.

PMID:37742342 | DOI:10.1080/02640414.2023.2257513

Afr J Reprod Health. 2023 Jul;27(7):109-126. doi: 10.29063/ajrh2023/v27i7.11.

ABSTRACT

This review’s main objective is to discuss how demographic and epidemiological transitions relate to the burden of adolescent healthcare in sub-Saharan Africa (SSA). The review explicitly discussed the burden of adolescent healthcare, the current African policies on adolescent healthcare, and gaps in the African policies compared with Europe and North America. We also examined how adolescent healthcare policies evolve and documented the recommended essential part of the policy for enhancing its sustainability. The burden of adolescent health is high in SSA with diseases and reproductive health-related problems prevailing among adolescents. However, variations exist in the burden of adolescent healthcare across countries in the region. While some SSA countries are currently undergoing demographic and epidemiological transition processes concerning adolescent health care, the majority are either at an early stage of the transition or yet to commence the process. Policy-makers should consider effective ways to improve adolescents’ health in SSA through preventive mechanisms and a multi-dimensional approach.

PMID:37742339 | DOI:10.29063/ajrh2023/v27i7.11

Afr J Reprod Health. 2023 Jul;27(7):85-98. doi: 10.29063/ajrh2023/v27i7.9.

ABSTRACT

Plook-Fire-Thatu is a traditional Thai medication designed to assist breastfeeding moms. However, no documented clinical research on its efficacy exists. Therefore, the authors recruited women who had a singleton baby vaginally between June 2019 and July 2020 and randomly allocated them to one of three groups: Plook-Fire-Thatu, Domperidone, or Placebo. The test-weight method was used to compare breastmilk amounts. During the hospital stay, all volunteers and newborns were followed for adverse effects. There were three groups of participants: Plook-Fire-Thatu 78, Domperidone 74, and Placebo 76. On the third postpartum day, the Plook-Fire-Thatu group exhibited a statistically significant increase in breastmilk quantity (F=15.11, p≤0.01). The mean body temperature of postpartum women in the Plook-Fire-Thatu group on the third day was significantly higher than in the placebo group. (F=4.22, p=0.016). Participants and infants in the intervention groups experienced a few adverse effects. In comparison to domperidone, Plook-Fire-Thatu has been discovered to be a natural way to increase postpartum breastmilk supply.

PMID:37742337 | DOI:10.29063/ajrh2023/v27i7.9

Int Urol Nephrol. 2023 Sep 24. doi: 10.1007/s11255-023-03806-8. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the effect of using statins and ascorbic acid for the prevention of post-contrast acute kidney injury (PC-AKI) in patients undergoing urologic diagnostic elective contrast-enhanced computed tomography (CECT).

METHODS: This registered trial (NCT03391830) was for statin naïve patients underwent elective CECT. Patients were randomized allocated to two groups: the first group received atorvastatin 80-mg the day before the study and atorvastatin 40-mg two hours before the CECT and for continue on atorvastatin 40-mg two days after CECT; plus ascorbic acid 500 mg with atorvastatin. The other group received two tablets of placebo once/daily before the procedure and for another 3 days. The primary outcome was to assess the incidence PC-AKI.

RESULTS: The baseline parameters were comparable between both groups. The final median (interquartile range “IQR”) serum creatinine were 0.80 (0.60, 1.00) and 0.80 (0.60, 1.00), respectively, with insignificant p-value (p = 0.8). The median (IQR) final estimated GFR were 95.2 (72.8, 108.1) and 88.6 (71.9, 111.0) mL/min in placebo and statin plus ascorbic acid groups, respectively (p = 0.48). The eGFR difference median (IQR) were – 6.46 (- 11.72, – 4.18) and – 6.57 (- 13.38, – 3.82) ml/min in placebo and statin plus ascorbic acid groups, respectively (p = 0.58). PC-AKI occurred in 11 patients (9.8%) in placebo group and in 3 patients (3%) in statin plus ascorbic acid group (p = 0.04).

CONCLUSIONS: Statin and ascorbic acid did not statistically improve neither serum creatinine nor eGFR values in patient underwent CECT. However, it can decrease the incidence of the clinically insignificant PC-AKI.

PMID:37742328 | DOI:10.1007/s11255-023-03806-8

CJEM. 2023 Sep 24. doi: 10.1007/s43678-023-00597-w. Online ahead of print.

ABSTRACT

BACKGROUND: Older trauma patients have a higher mortality yet are more likely to be under-triaged compared to younger patients. Studies have suggested that current trauma team activation criteria are suboptimal for older patients.

OBJECTIVES: The objective was to describe trauma care delivered, patient outcomes, and to identify variables independently associated with mortality.

METHODS: We performed a health records review from 2014 to 2020 of older (age ≥ 65 years) trauma patients presenting to a level one trauma centre with any of the following: injury severity score (ISS) > 12, and all trauma team activations or admission to the trauma ward. The primary outcome was 30-day all-cause mortality. Secondary outcomes included injury mechanism and trauma care delivered. Multivariable logistic regression was used to identify factors independently associated with 30-day all-cause mortality. Multiple imputation was used to deal with missing data.

RESULTS: We enrolled 1,380 patients (mean age 80 years, mean ISS 18); 26.8% had multimorbidity (≥ 2 chronic conditions) and 65.9% met criteria for polypharmacy (≥ 5 medications). The most common mechanism was fall from standing height (61.1%). Thirty-day all-cause mortality occurred in 239 (17.3%) patients. A Glasgow coma scale (GCS) < 15 (odds ratio [OR] = 5.55; 95% CI 3.73-8.24), ISS > 15 (OR = 3.75, 95% CI 2.35-6.01), age ≥ 85 years (OR = 2.04, 95% CI 1.29-3.22), anticoagulation with a direct oral anticoagulant (DOAC) or warfarin (OR = 1.59, 95% CI 1.08-2.35) and multimorbidity (OR = 1.53, 95% CI 1.06-2.22) were significantly associated with increased risk 30-day mortality (C-statistic = 0.82, 95% CI 0.79-0.85). Dementia (OR = 0.61, 95% CI 0.40-0.95) and time to CT scan > 60 min (OR = 0.50, 95% CI 0.34-0.74) were associated with decreased mortality risk.

CONCLUSION: We identified five factors associated with increased 30-day mortality in older trauma patients: GCS < 15, ISS > 15, age ≥ 85 years, anticoagulation, and multimorbidity. These factors should be considered when developing modified trauma team activation criteria for older adults.

PMID:37742324 | DOI:10.1007/s43678-023-00597-w

Surg Radiol Anat. 2023 Sep 24. doi: 10.1007/s00276-023-03244-2. Online ahead of print.

ABSTRACT

PURPOSE: Peroneus tertius (PT) or Fibularis tertius, a muscle of the anterior compartment of the leg is very distinctive to the Homo sapiens. This is because of the evolutionary acquisition of bipedal gait along with the eversion of the foot, which are unique to humans. It is considered as the fifth tendon of the extensor digitorum longus. Variations in the attachments of PT can cause stress fractures like the Jones fracture. PT has been extensively used in tendoplasty, tendon transfer and resection of the foot. The study aims to transpose the knowledge in variations of the morphology of PT from bench to bedside.

METHODS: Routine dissection of a 64-year-old male cadaver revealed bilateral variations in the insertion of PT. This was documented photographically. The findings prompted a systematic literature review on the morphological variations of PT. An exhaustive search was undertaken through PubMed and Google Scholar databases to identify the published literature related to variations in the morphology of PT. Related anatomical studies of the variations in peroneus tertius were identified and a review of the literature was performed.

RESULTS: Variations in the insertion of PT were observed bilaterally in the cadaver dissected by us. Statistical analysis revealed the absence of PT in 7.03% of lower limbs. 10% of studies showed accessory and duplicated PT each. Out of 20 articles reviewed, 51 lower limbs showed variation in origin, 230 lower limbs showed variations in insertion and 161 lower limbs showed other variations.

CONCLUSION: PT muscle flap and tendon grafts are used in correcting the laxity of the ankle joint and foot drop. Absence of PT plays a crucial role in altering the mechanics of stress fractures of the 5th metatarsal. Thus, knowledge of the morphology of PT is crucial for plastic surgeons and orthopedic surgeons.

PMID:37742309 | DOI:10.1007/s00276-023-03244-2