Tag: nevin manimala

Retina. 2022 Oct 10. doi: 10.1097/IAE.0000000000003641. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study was to determine the ophthalmological involvement in patients with hereditary transthyretin (TTR) amyloidosis and its correlation with the mutations described in the literature.

METHODS: Cross-sectional, non-interventional study. 52 eyes of 26 consecutive patients diagnosed of hereditary TTR amyloidosis that visited Puerta de Hierro-Majadahonda University Hospital from September 2019 to March 2022. All patients underwent complete ophthalmologic examination and multimodal imaging. Cardiological, neurological, digestive and renal examinations were also recorded.

RESULTS: 18 eyes out of the total (34.61%) showed amyloid-related ocular involvement, being vitreous amyloid deposits (AD) the most common ocular manifestation (18/52). Statistically significant differences were found for the presence of vitreous AD (p<0.01), crystalline AD (p<0.05), parenchymal AD (p<0.01) and vascular alterations (p<0.01) when comparing affected and unaffected eyes. Moreover, affected eyes showed worse best corrected visual acuity (p<0.01).

CONCLUSION: Ocular manifestations are present in a substantial number of patients with ATTR that could potentially lead to devastating consequences to patients’ BCVA and quality of life. Therefore, it is important to emphasize the importance of multidisciplinary management and ophthalmological assessment, follow-up and surgical treatment when necessary. To the best of our knowledge, this represents the largest series in Spain of amyloidosis’ ophthalmologic involvement.

PMID:36228151 | DOI:10.1097/IAE.0000000000003641

J Clin Endocrinol Metab. 2022 Oct 14:dgac599. doi: 10.1210/clinem/dgac599. Online ahead of print.

ABSTRACT

CONTEXT/OBJECTIVE: To evaluate association of gestational weight gain (GWG) as low, within, or above (excessive) according to Institute of Medicine (IOM) guidelines, with pregnancy outcomes in women with gestational diabetes (GDM) and normal glucose tolerance (NGT).

DESIGN: Prospective cohort study.

SETTING: 7 Belgian hospitals.

PARTICIPANTS: 1843 women receiving universal GDM screening with 75 g oral glucose tolerance test.

MAIN OUTCOME MEASURE: Pregnancy outcomes and postpartum characteristics.

RESULTS: Women with GDM and low GWG (n = 97, 52.4%) had similar rates of small-for-gestational age infants and preterm delivery, were less often overweight or obese postpartum [35.7% (30) vs. 56.5% (26), p < 0.022] and had less often postpartum weight retention (PPWR) [48.8% (41) vs. 87.9% (40), p < 0.001] compared to GWG within range (n = 58, 31.3%). GDM with excessive GWG (n = 30, 16.2%) had more often neonatal hypoglycemia [30.8% (8) vs. 5.9% (3), aOR 7.15, 95% CI (1.52-33.63), p = 0.013] compared to GWG within range. NGT with excessive GWG [28.3% (383)] had more often instrumental delivery [15.9% (61) vs. 11.9% (64), aOR 1.53, 95% CI (1.03-2.27), p = 0.035] and more large-for-gestational age infants [19.3% (74) vs. 10.4% (56), aOR 1.67, 95% CI (1.13-2.47), p = 0.012] compared to GWG within range.

CONCLUSIONS: GWG below IOM guidelines occurred frequently in GDM women, without increased risk for adverse pregnancy outcomes and with better metabolic profile postpartum. Excessive GWG was associated with increased risk for neonatal hypoglycemia and worse metabolic profile postpartum in women with GDM, and with higher rates of LGA and instrumental delivery in NGT women.

PMID:36228141 | DOI:10.1210/clinem/dgac599

J Am Med Inform Assoc. 2022 Oct 13:ocac184. doi: 10.1093/jamia/ocac184. Online ahead of print.

ABSTRACT

OBJECTIVE: Privacy is a concern whenever individual patient health data is exchanged for scientific research. We propose using mixed sum-product networks (MSPNs) as private representations of data and take samples from the network to generate synthetic data that can be shared for subsequent statistical analysis. This anonymization method was evaluated with respect to privacy and information loss.

MATERIALS AND METHODS: Using a simulation study, information loss was quantified by assessing whether synthetic data could reproduce regression parameters obtained from the original data. Predictors variable types were varied between continuous, count, categorical, and mixed discrete-continuous. Additionally, we measured whether the MSPN approach successfully anonymizes the data by removing associations between background and sensitive information for these datasets.

RESULTS: The synthetic data generated with MSPNs yielded regression results highly similar to those generated with original data, differing less than 5% in most simulation scenarios. Standard errors increased compared to the original data. Particularly for smaller datasets (1000 records), this resulted in a discrepancy between the estimated and empirical standard errors. Sensitive values could no longer be inferred from background information for at least 99% of tested individuals.

DISCUSSION: The proposed anonymization approach yields very promising results. Further research is required to evaluate its performance with other types of data and analyses, and to predict how user parameter choices affect a bias-privacy trade-off.

CONCLUSION: Generating synthetic data from MSPNs is a promising, easy-to-use approach for anonymization of sensitive individual health data that yields informative and private data.

PMID:36228120 | DOI:10.1093/jamia/ocac184

JMIR Hum Factors. 2022 Oct 13;9(4):e37693. doi: 10.2196/37693.

ABSTRACT

BACKGROUND: In 2019, COVID-19 spread worldwide, causing a pandemic that has posed unprecedented challenges and pressure for health systems and economies. Food delivery services have become an important medium for consumer food purchases to limit human-to-human contact. Thus, delivery drivers are at high risk of exposure to COVID-19 infection at work. To the best of our knowledge, no studies have analyzed the dimensions of health literacy (HL) regarding COVID-19 prevention in this population.

OBJECTIVE: This study aims to explore the HL status toward COVID-19 prevention and its associated factors among food delivery drivers in southern Thailand.

METHODS: Following a cross-sectional survey from July to August 2021, Thai food delivery drivers in the upper-south and lower-south regions of southern Thailand were recruited to participate during the compulsory COVID-19 lockdown. An online structured questionnaire was administered verbally and recorded by the interviewer. Univariate and multivariate linear regressions were used to explore independently associated factors.

RESULTS: Of 401 drivers, 291 (72.6%) were men. The median age was 31 years (range 19-64 years). The median number of months working as a driver was 12 months, and the median number of working hours was 9 hours per day. The median number of daily food orders was 20, while the median daily income was Thai baht (THB) 600 (US $15.90). Social media (Facebook and Line) was a common source of health information. The most common information required was about the COVID-19 vaccine, medications, and treatment. Most drivers (285/401, 71.1%) had excellent HL levels regarding COVID-19 prevention. Only the practical application of information was statistically correlated with behavior (r=0.38, P<.001). Drivers in the lower south of Thailand were more likely to have excellent HL than other drivers (β=7.03, P<.001). Those who frequently accessed information through YouTube (β=-2.17, P=.01) and relatives (β=-4.19, P<.001) were less likely to have excellent HL levels.

CONCLUSIONS: Understanding HL among food delivery drivers would be useful for planning effective interventions that target this population. Conventional health education through social media alone may not be effective at educating people about COVID-19 prevention. Information literacy skills could determine individuals’ HL and drivers’ behaviors.

PMID:36227652 | DOI:10.2196/37693

Mycoses. 2022 Oct 13. doi: 10.1111/myc.13538. Online ahead of print.

ABSTRACT

Apophysomyces species are an emerging cause of mucormycosis in several regions of the world, primarily affecting immunocompetent individuals. The present study addresses the global epidemiology, clinical presentation, management and outcome of mucormycosis caused by Apophysomyces spp. The study included patients diagnosed with Apophysomyces infection at our hospital between March 2019 and August 2020. In addition, cases published in PubMed and Google Scholar from inception to July 2022 were systematically searched and analysed. Only proven and probable cases that meet the eligibility criteria were included. The Indian cases were compared with those from other countries and the results were analysed by descriptive statistics. In total, six cases of mucormycosis due to Apophysomyces spp. were diagnosed at our hospital, with additional 250 cases identified through literature search. The main underlying diseases were diabetes mellitus (24%), malignancy (3.2%) and chronic kidney disease (2.8%). The major predisposing factor was trauma (55.6%). Necrotizing fasciitis was the most common (63.2%) clinical presentation. Healthcare associated mucormycosis accounted for 10.4% of the cases. Globally, A. elegans was the most common species (48.8%), whereas A. variabilis was predominant (86.2%) in India. Surgery was performed in 83.5% of patients. Among those treated with antifungal agents, 98% received amphotericin B and 8.1% received posaconazole. Inappropriate antifungal usage was observed in 12.7%. The overall mortality was 42.3%. A combined medical and surgical management was associated with higher survival. Our study highlights the knowledge gap among physicians regarding this infection. A timely diagnosis and aggressive management can improve the outcomes in such cases.

PMID:36227645 | DOI:10.1111/myc.13538

JAMA Oncol. 2022 Oct 13. doi: 10.1001/jamaoncol.2022.4327. Online ahead of print.

ABSTRACT

IMPORTANCE: The phosphoinositide 3-kinase (PI3K) pathway is among the most frequently activated pathways in human cancers. As the use of PI3K inhibitors for cancer treatment grows, there is increasing need for understanding the cutaneous effects associated with these therapies.

OBJECTIVE: To systematically review the published literature reporting incidence of cutaneous adverse events with PI3K inhibitors and to provide pooled incidence estimates using meta-analysis.

DATA SOURCES: This systematic review and meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. The literature search concerned entries through September 2021 in the following sources: PubMed, Cochrane registry, ClinicalTrials.gov, and evidence from the NHS UK and Trip medical database. To analyze PI3K inhibitors’ cutaneous adverse events incidence, only randomized clinical trials (RCTs) were considered. The search strategy used the following keywords: (prevalence OR incidence OR epidemiology) and (phosphoinositide 3 kinase inhibitors OR PI3K inhibitors). No language restriction was applied. Analysis was conducted on July 1, 2022.

STUDY SELECTION: Studies included phase 2 and phase 3 RCTs that reported incidence of cutaneous adverse events associated with use of PI3K inhibitors.

DATA EXTRACTION AND MEASURES: Data extracted included sex, medication name and class, sample size, rash incidence, and grade. The bias risk was assessed by the Cochrane tool for risk of bias assessment in RCTs.

MAIN OUTCOMES AND MEASURES: The primary outcome was incidence of PI3K inhibitor cutaneous adverse events (with 95% CIs) among the overall population and among subgroups. Between-study heterogeneity was assessed using the I2 statistic.

RESULTS: The analysis found the incidence of PI3K inhibitor cutaneous events of any grade to be 29.30% in the intervention group, translating to a pooled odds ratio (OR) for incidence of cutaneous adverse events of any grades of 2.55 (95% CI, 1.74-3.75). Incidence of severe grade (grade ≥3) of rash in the intervention group was estimated to be 6.95%, yielding a pooled Peto OR of 4.64 (95% CI, 2.70-7.97). Subgroup analyses revealed that the incidence of severe cutaneous adverse events (grade ≥3) was higher with the use of Pan-class-1 PI3K inhibitors (OR, 6.67; 95% CI, 4.28-10.38) than isoform-selective PI3K inhibitors (OR, 6.37; 95% CI, 3.25-12.48).

CONCLUSIONS AND RELEVANCE: This systematic review and meta-analysis identified an overall incidence of PI3K inhibitor cutaneous adverse events of any grade to be 29.30% with a pooled OR of 2.55; (95% CI, 1.74-3.75). These findings clarify the risk of cutaneous adverse events associated with this important class of anticancer therapies.

PMID:36227613 | DOI:10.1001/jamaoncol.2022.4327

JAMA Oncol. 2022 Oct 13. doi: 10.1001/jamaoncol.2022.4649. Online ahead of print.

ABSTRACT

IMPORTANCE: Breast cancer is the most common invasive subsequent malignant disease in childhood cancer survivors, though limited data exist on changes in breast cancer rates as primary cancer treatments have evolved.

OBJECTIVE: To quantify the association between temporal changes in cancer treatment over 3 decades and subsequent breast cancer risk.

DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of 5-year cancer survivors diagnosed when younger than 21 years between 1970 and 1999, with follow-up through December 5, 2020.

EXPOSURES: Radiation and chemotherapy dose changes over time.

MAIN OUTCOMES AND MEASURES: Breast cancer cumulative incidence rates and age-specific standardized incidence ratios (SIRs) compared across treatment decades (1970-1999). Piecewise exponential models estimated invasive breast cancer and ductal carcinoma in situ (DCIS) risk and associations with treatment exposures, adjusted for age at childhood cancer diagnosis and attained age.

RESULTS: Among 11 550 female survivors (median age, 34.2 years; range 5.6-66.8 years), 489 developed 583 breast cancers: 427 invasive, 156 DCIS. Cumulative incidence was 8.1% (95% CI, 7.3%-9.0%) by age 45 years. An increased breast cancer risk (SIR, 6.6; 95% CI, 6.1-7.2) was observed for survivors compared with the age-sex-calendar-year-matched general population. Changes in therapy by decade included reduced rates of chest (34% in the 1970s, 22% in the 1980s, and 17% in the 1990s) and pelvic radiotherapy (26%, 17%, and 13% respectively) and increased rates of anthracycline chemotherapy exposures (30%, 51%, and 64%, respectively). Adjusting for age and age at diagnosis, the invasive breast cancer rate decreased 18% every 5 years of primary cancer diagnosis era (rate ratio [RR], 0.82; 95% CI, 0.74-0.90). When accounting for chest radiotherapy exposure, the decline attenuated to an 11% decrease every 5 years (RR, 0.89; 95% CI, 0.81-0.99). When additionally adjusted for anthracycline dose and pelvic radiotherapy, the decline every 5 years increased to 14% (RR, 0.86; 95% CI, 0.77-0.96). Although SIRs of DCIS generally increased over time, there were no statistically significant changes in incidence.

CONCLUSIONS AND RELEVANCE: Invasive breast cancer rates in childhood cancer survivors have declined with time, especially in those younger than 40 years. This appears largely associated with the reduced use of chest radiation therapy, but was tempered by concurrent changes in other therapies.

PMID:36227603 | DOI:10.1001/jamaoncol.2022.4649

JAMA Netw Open. 2022 Oct 3;5(10):e2231633. doi: 10.1001/jamanetworkopen.2022.31633.

ABSTRACT

IMPORTANCE: Older Syrian refugees have a high burden of noncommunicable diseases (NCDs) and economic vulnerability.

OBJECTIVES: To develop and internally validate a predictive model to estimate inability to manage NCDs in older Syrian refugees, and to describe barriers to NCD medication adherence.

DESIGN, SETTING, AND PARTICIPANTS: This nested prognostic cross-sectional study was conducted through telephone surveys between September 2020 and January 2021. All households in Lebanon with Syrian refugees aged 50 years or older and who received humanitarian assistance from a nongovernmental organization were invited to participate. Refugees who self-reported having chronic respiratory disease (CRD), diabetes, history of cardiovascular disease (CVD), or hypertension were included in the analysis. Data were analyzed from November 2021 to March 2022.

MAIN OUTCOMES AND MEASURES: The main outcome was self-reported inability to manage any NCD (including CRD, CVD, diabetes, or hypertension). Predictors of inability to manage any NCD were assessed using logistic regression models. The model was internally validated using bootstrapping techniques, which gave an estimate of optimism. The optimism-adjusted discrimination is presented using the C statistic, and calibration of the model is presented using calibration slope (C slope).

RESULTS: Of 3322 older Syrian refugees, 1893 individuals (median [IQR] age, 59 [54-65] years; 1089 [57.5%] women) reported having at least 1 NCD, among whom 351 (10.6% overall; 18.6% of those with ≥1 NCD) had CRD, 781 (23.7% overall; 41.4% of those with ≥1 NCD) had diabetes, 794 (24.1% overall; 42.2% of those with ≥1 NCD) had history of CVD, and 1388 (42.3% overall; 73.6% of those with ≥1 NCD) had hypertension. Among individuals with NCDs, 387 participants (20.4%) were unable to manage at least 1 of their NCDs. Predictors for inability to manage NCDs were age, nonreceipt of cash assistance, household water insecurity, household food insecurity, and having multiple chronic diseases, with an adjusted C statistic of 0.650 (95% CI, 0.620-0.676) and C slope of 0.871 (95% CI, 0.729-1.023). The prevalence of nonadherence to medication was 9.2%, and the main reasons for nonadherence were unaffordability of medication (40.8%; 95% CI, 33.4%-48.5%) and the belief that they no longer required the medication after feeling better (22.4%; 95% CI, 16.4%-29.3%).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, the predictors of inability to manage NCDs among older Syrian refugees in Lebanon were mainly related to financial barriers. Context-appropriate assistance is required to overcome financial barriers and enable equitable access to medication and health care.

PMID:36227600 | DOI:10.1001/jamanetworkopen.2022.31633

JAMA Netw Open. 2022 Oct 3;5(10):e2236621. doi: 10.1001/jamanetworkopen.2022.36621.

ABSTRACT

IMPORTANCE: Patient experience and patient safety are 2 major domains of health care quality; however empirical data on the association of physician vs nonphysician chief executive officers (CEOs) with public and private quality measures are rare but critical to evaluate as hospitals increasingly seek out physician CEOs.

OBJECTIVES: To evaluate whether there is an association of CEO background with hospital quality and to investigate differences in hospital characteristics between hospitals with a physician CEO vs those with a nonphysician CEO.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used 2019 data from 3 sources (ie, the American Hospital Association [AHA] Annual Survey, the Hospital Consumer Assessment of Healthcare Providers and Systems [HCAHPS], and the Leapfrog Hospital Safety Grades) to identify statistical differences in hospital characteristics and outcomes. Data were analyzed from April to December 2021 .

MAIN OUTCOMES AND MEASURES: Multivariable ordinal logistic regression was used to examine the association of physician CEOs with hospital quality assessment outcomes while controlling for other confounding factors. Characteristics from the AHA Annual Survey database were assessed as potential confounders, including hospital control, bed size, region, teaching status, and patient volume.

RESULTS: The AHA database contained 6162 hospitals; 1759 (29%) had HCAHPS ratings, 1824 (30%) had Leapfrog grades, and 383 (6%) had physician CEOs. A positive Spearman correlation coefficient was found between physician CEOs and HCAHPS patient willingness to recommend the hospital (ρ = 0.0756; P = .002), but the association between CEO medical background and Leapfrog safety grades or HCAHPS ratings did not reach a level of significance in the multivariable ordinal logistic regression models.

CONCLUSIONS AND RELEVANCE: In this study, a positive correlation was found between physician CEOs and HCAHPS patient willingness to recommend the hospital, but the multivariable analysis did not find an association between hospital physician CEOs and the examined quality and safety outcomes.

PMID:36227592 | DOI:10.1001/jamanetworkopen.2022.36621

Logoped Phoniatr Vocol. 2022 Oct 13:1-8. doi: 10.1080/14015439.2022.2130422. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to see if the effects of the sub-domains of the Voice Handicap Index-10 (VHI-10) and Voice Related Quality of Life (VRQoL) differ in organic (OD) and functional dysphonia (FD).

METHOD: A total of 162 patients completed the validated Turkish versions of the Voice Handicap Index-10 (VHI-10) and Voice-Related Quality of Life (VRQoL). Physical (pVHI-10), emotional (eVHI-10) and functional (fVHI-10) sub-domains of VHI-10 and physical-functional (PF-VRQoL), socio-emotional (SE-VRQoL) dimensions of VRQoL were assessed. Confirmatory factor analysis (CFA) was used to compare the sub-domains of these questionnaires between diagnostic categories.

RESULTS: The total and sub-domain scores of both VHI-10 and VRQoL were not statistically different between the two etiologic categories of dysphonia (MANOVA, p > .05). The total VHI-10 and total VRQoL scores were significantly and moderately correlated in both the OD and FD groups. During CFA, 4 models were constructed for the OD and FD groups for VHI-10 and VRQoL factors. There was no significant difference between OD and FD groups in terms of path coefficients of sub-domains (z test, p > .05).

CONCLUSION: In terms of VHI-10 and VRQoL, the sub-domains of each questionnaire are equally important in both organic and functional dysphonia. Functional disorders do not depend only on “emotional” factors, and neither do organic problems. Factor analysis should be included when performing a study on patient-reported outcome measures.

PMID:36227585 | DOI:10.1080/14015439.2022.2130422