Tag: nevin manimala

BMC Med Genomics. 2022 Aug 15;15(1):179. doi: 10.1186/s12920-022-01333-6.

ABSTRACT

Determining the associated relationship of genotype and phenomenon would benefit the understanding of disease and renew disease intervention means. 14,518 patients who underwent haemoglobin electrophoresis from June 2020 to December 2020 were enrolled in our study, and additional data including sex, age and routine blood examination results were collected. We focused on individuals with normal red blood cell indices and no common thalassemia pathogenic mutation and selected three groups for the following study: the control group (2.5% ≤ HbA₂ ≤ 3.5%), the HbA₂ under 2.5 group (HbA₂ < 2.5%) and the HbA₂ under 2.4 group (HbA₂ < 2.4%). Four regions of β-globin regulation were sequenced. Statistical analysis was conducted to compare the collected information of the three groups and the genotype distributions in the control group and sequenced group. The HbA₂ under 2.5 group was characterized by a majority of females and lower red blood cell counts and haemoglobin compared with the control group. There were genotypes associated with the grouping as the T of rs12574989 and TTTAGC of the haplotype were significantly increased in the HbA₂ under 2.4 group and CTTAGC was significantly decreased in the HbA₂ under 2.4 group. This study demonstrated that the genotypes of the population associated with HbA₂ were reduced in southern China.

PMID:35971149 | DOI:10.1186/s12920-022-01333-6

Ital J Pediatr. 2022 Aug 15;48(1):146. doi: 10.1186/s13052-022-01342-2.

ABSTRACT

BACKGROUND: The practice of therapeutic hypothermia (TH) is widely used for neonatal hypoxic-ischemic encephalopathy (HIE) despite its corresponding feeding strategies are still controversial. This randomized controlled trial (RCT) demonstrated to evaluate the effect of early vs. delayed enteral nutrition on the incidence of feeding intolerance (FI) and other association during TH.

METHODS: This single center, parallel-group, and no-blinded RCT was processed in a level III, and academic neonatal intensive care unit. Infants who were diagnosed with HIE and undertaken TH from September 2020 to August 2021 were enrolled. Participants were randomized to receive enteral nutrition either during TH/rewarming (early enteral nutrition, EEN) or after TH (delayed enteral nutrition, DEN) according to a recommend enteral feeding protocol. All data were analyzed using SPSS 26.0 software with a p-value< 0.05 was considered statistically significant.

RESULTS: Ninety-two infants were enrolled after randomization, but 12 (13.04%) cases including 3 (3.26%) deaths were excluded from eventually analyzed, who did not initiate or discontinue the intervention. 80 cases (42 and 38 in the EEN and DEN group, respectively) who completed the interventions were eventually analyzed. Besides initial time of enteral feeds, two groups had processed the same feeding method. Total 23 (25.0%) cases developed FI, and no difference of morbidity was found between two groups (23.4% vs 26.7%, p = 0.595; Log Rank, p = 0.803). There was no case died or developed late-onset bloodstream and no difference of the incidence of hypoglycemia or weight gain was found (p > 0.05). The percentage of infants who had not reaching the goal of full enteral feeding volume between the two groups was similar (21.43% vs 23.68%, p = 0.809). The average time of parenteral nutrition, reaching full enteral feeds and hospital stay were shorter in the EEN group compared with the DEN group with significant differences (8.81 ± 1.67 vs 10.61 ± 2.06 days, p < 0.001; 9.91 ± 1.88 vs 12.24 ± 2.50 days, p < 0.001; 12.55 ± 4.57 vs 16.47 ± 5.27 days, p = 0.001 respectively).

CONCLUSIONS: Compared with delayed enteral nutrition, introduction of early enteral nutrition according to a recommend feeding strategy for neonatal HIE undergoing TH may be feasible and safe.FI is frequent in this high-risk group of infants which should not be ignored during feeding process.

TRIAL REGISTRATION: The Chinese Clinical Trial Registry,ChiCTR2000038193, 2020-9-13, https://www.chictr.org.cn .

PMID:35971138 | DOI:10.1186/s13052-022-01342-2

J Eat Disord. 2022 Aug 15;10(1):120. doi: 10.1186/s40337-022-00645-3.

ABSTRACT

BACKGROUND: Anorexia nervosa (AN) is often diagnosed in adolescence, and most evidence-based treatments for AN in young people involve the family. Family therapies for AN are intensive, outpatient treatments that utilise the parents as the primary resource in the young person’s recovery. Research regarding family treatment for AN is often conducted in specialist settings-with relatively little data reporting the translation of this specialised treatment into real-world, non-specialist settings. This systematic review and meta-analysis aims to determine the efficacy of family treatments for adolescents with AN in specialist settings versus non-specialist settings.

METHODS: This systematic review and meta-analysis will be conducted according to the preferred reporting items for systematic reviews and meta-analyses guidelines. Retrospective cohort studies, pilot studies, case series, randomised controlled trials and qualitative investigations that present original data and investigated the efficacy of family treatments for adolescents with AN in either a specialist or non-specialist setting will be included in the review. Data will be extracted by two reviewers and study quality will be assessed. The primary outcome, change in weight, will be used to determine via meta-analysis and, depending on study heterogeneity, subgroup analysis or meta-regression whether there is a statistically significant subgroup difference between specialist and non-specialist treatment settings. The review will also consider changes in eating disorder symptomology and related constructs.

DISCUSSION: Results from this review will help determine if there is a difference in the efficacy of family treatments for adolescent AN in specialist versus non-specialist treatment settings, primarily in relation to weight recovery. This, in turn, will inform the translation of evidence-based interventions that are generally studied and implemented within specialist centres into the non-specialist health care system.

PMID:35971136 | DOI:10.1186/s40337-022-00645-3

BMC Chem. 2022 Aug 15;16(1):60. doi: 10.1186/s13065-022-00854-6.

ABSTRACT

Several quantitative analytical methods were used to estimate aspirin and omeprazole in recently FDA-approved tablets. The first derivative of the ratio spectra was used to resolve the recorded overlapping spectra between aspirin and omeprazole. The first derivative of the ratio spectra of the studied drug mixtures was divided by a spectrum of a standard solution of omeprazole for the estimation of aspirin. Also, the first derivative of the ratio spectra of the studied drug mixtures was divided by a spectrum of the standard solution of aspirin for the estimation of omeprazole. For the simultaneous quantitative analysis of aspirin and omeprazole, the TLC densitometry technique was applied using TLC aluminum silica gel plates, toluene-acetonitrile-methanol (7:2:0.5, by volume) as the mobile phase, and UV detection at 272 nm. The advantages and disadvantages of the proposed techniques were discussed in the context of the results and the sensitivity limits of the methods. The proposed techniques were validated and successfully applied to the analysis of drugs in pure and pharmaceutical forms. A statistical comparison of the data obtained by the described methods with other data obtained by a previously published HPLC method was performed. The results agreed well with respect to the recommended statistical tests. Furthermore, the greenness of the described methods was assessed using different tools, the analytical eco-scale, the green analytical procedure index and the AGREE evaluation method. The proposed methods showed more adherence to the greenness characters in comparison to the previously reported HPLC method.

PMID:35971129 | DOI:10.1186/s13065-022-00854-6

BMC Med Educ. 2022 Aug 15;22(1):620. doi: 10.1186/s12909-022-03679-y.

ABSTRACT

BACKGROUND: Nationwide restrictions and recommendations from the Association of American Medical Colleges mandated program directors to conduct all graduate medical education interviews virtually in the Spring of 2020 in response to the COVID-19 pandemic. This study was conducted to assess the impact of virtual interviews on a candidates’ ability to effectively create a rank list.

OBJECTIVE: The primary objective of this study was to evaluate Obstetrics and Gynecology (ObGyn) subspecialty fellowship applicants’ perspectives regarding the effectiveness of virtual interviews for creating a rank list. Secondary outcomes included perceived advantages and disadvantages of the process and costs of the process.

METHODS: This was a cross-sectional IRB-exempt study, using an electronic survey administered to a convenience sample of applicants to ObGyn subspecialty fellowship programs. The survey was administered via RedCap between the rank list submission deadline and the Match. Descriptive statistics were used.

RESULTS: Response rate was 158/330 (48%). Overall, 129/158 (82%) percent of respondents felt confident in making their rank list based on the virtual interviews, and 146/158 (92%) were “very satisfied” or “somewhat satisfied” with the process. Of those who expressed an interview style preference, 65/149(44%) of respondents preferred virtual interviews; 49/149(33%) had no preference or were not sure. Nearly all 146/148(99%) applicants cited cost-savings as a distinct advantage of virtual interviews.

CONCLUSION: Applicants to ObGyn subspecialty fellowships felt comfortable to create a rank list based on the virtual interview. This study indicates that the virtual format is effective, less stressful and less costly for ObGyn subspecialty interviews and should be considered beyond the pandemic to remove barriers and burdens for applicants.

PMID:35971126 | DOI:10.1186/s12909-022-03679-y

BMC Med Educ. 2022 Aug 15;22(1):619. doi: 10.1186/s12909-022-03642-x.

ABSTRACT

BACKGROUND: Calling within the medical context receives growing academic attention and empirical research has started to demonstrate its beneficial effects. The purpose of this study is to investigate what motivates students to enter medical school and what role calling may play (i), to evaluate if calling influences the way in which they experience their studies (ii), and to compare medical students’ experience of calling with those of physicians.

METHODS: A questionnaire survey was distributed among medical students (N = 1048; response rate above 60%) of the University of Lausanne in Switzerland. It was supplemented by a group discussion between bachelor medical students (N = 8) and senior physicians (N = 4), focusing on different facets of calling. An existing data set of a survey among physicians, addressing calling with the same questionnaire, was used to compare students’ and physicians’ attitudes towards calling. Survey data were analyzed with the habitual statistical procedures for categorical and continuous variables. The group discussion was analyzed with thematic analysis.

RESULTS: The survey showed that experiencing calling is a motivational factor for study choice and influences positively choice consistency. Students experiencing calling differed from those who did not: they attributed different definitions to calling, indicated more often prosocial motivational factors for entering medical school and perceived the learning context as less burdensome. The analysis of the group discussion revealed that the concept of calling has a fluid definition. It was conceived as having the characteristics of a double-edged sword and as originating from within or outside or from a dialectic interplay between the inner and outer world. Finally, calling is experienced less often by physicians than by medical students, with a decreasing prevalence as the immersion in the clinical years of the study of medicine progresses.

CONCLUSIONS: Calling plays an important role in study choice and consistency of medical students. Given its relevance for medical students and its ramifications with the learning context, calling should become a topic of the reflexive parts of the medical curriculum. We critically discuss the role played by calling for medical students and provide some perspectives on how calling could be integrated in the reflection and teaching on physicianhood.

PMID:35971124 | DOI:10.1186/s12909-022-03642-x

BMC Public Health. 2022 Aug 15;22(1):1550. doi: 10.1186/s12889-022-13939-7.

ABSTRACT

BACKGROUND: A single anthropometric index such as stunting, wasting, or underweight does not show the holistic picture of under-five children’s undernutrition status. To alleviate this problem, we adopted a multifaceted single index known as the composite index for anthropometric failure (CIAF). Using this undernutrition index, we investigated the disparities of Ethiopian under-five children’s undernutrition status in space and time.

METHODS: Data for analysis were extracted from the Ethiopian Demographic and Health Surveys (EDHSs). The space-time dynamics models were formulated to explore the effects of different covariates on undernutrition among children under five in 72 administrative zones in Ethiopia.

RESULTS: The general nested spatial-temporal dynamic model with spatial and temporal lags autoregressive components was found to be the most adequate (AIC = -409.33, R² = 96.01) model. According to the model results, the increase in the percentage of breastfeeding mothers in the zone decreases the CIAF rates of children in the zone. Similarly, the increase in the percentages of parental education, and mothers’ nutritional status in the zones decreases the CIAF rate in the zone. On the hand, increased percentages of households with unimproved water access, unimproved sanitation facilities, deprivation of women’s autonomy, unemployment of women, and lower wealth index contributed to the increased CIAF rate in the zone.

CONCLUSION: The CIAF risk factors are spatially and temporally correlated across 72 administrative zones in Ethiopia. There exist geographical differences in CIAF among the zones, which are influenced by spatial neighborhoods of the zone and temporal lags within the zone. Hence these findings emphasize the need to take the spatial neighborhood and historical/temporal contexts into account when planning CIAF prevention.

PMID:35971115 | DOI:10.1186/s12889-022-13939-7

BMC Cancer. 2022 Aug 15;22(1):891. doi: 10.1186/s12885-022-09968-5.

ABSTRACT

BACKGROUND: Alveolar soft part sarcoma (ASPS) is a rare histological subtype of soft-tissue sarcoma, which remains refractory to conventional cytotoxic chemotherapy. We aimed to characterize ASPS and investigate whether the oncological outcome has improved over the past decade.

METHODS: One hundred and twenty patients with newly diagnosed ASPS from 2006 to 2017, identified from the Bone and Soft-Tissue Tumor Registry in Japan, were analyzed retrospectively.

RESULTS: The study cohort comprised 34 (28%) patients with localized ASPS and 86 (72%) with metastatic disease at presentation. The 5-year disease-specific survival (DSS) was 68% for all patients and 86% and 62% for localized and metastatic disease, respectively (p = 0.019). Metastasis at presentation was the only adverse prognostic factor for DSS (hazard ratio [HR]: 7.65; p = 0.048). Patients who were > 25 years (80%; p = 0.023), had deep-seated tumors (75%; p = 0.002), and tumors > 5 cm (5-10 cm, 81%; > 10 cm, 81%; p < 0.001) were more likely to have metastases at presentation. In patients with localized ASPS, adjuvant chemotherapy or radiotherapy did not affect survival, and 13 patients (45%) developed distant metastases in the lung (n = 12, 92%) and brain (n = 2, 15%). In patients with metastatic ASPS (lung, n = 85 [99%]; bone, n = 12 [14%]; and brain n = 9 [11%]), surgery for the primary or metastatic site did not affect survival. Prolonged survival was seen in patients who received pazopanib treatment (p = 0.045), but not in those who received doxorubicin-based cytotoxic chemotherapy. Overall, improved DSS for metastatic ASPS has been observed since 2012 (5-year DSS, from 58 to 65%) when pazopanib was approved for advanced diseases, although without a statistically significant difference (p = 0.117).

CONCLUSION: The national study confirmed a unique feature of ASPS with frequent metastasis to the lung and brain but an indolent clinical course. An overall trend toward prolonged survival after the introduction of targeted therapy encourages continuous efforts to develop novel therapeutic options for this therapeutically resistant soft-tissue sarcoma.

PMID:35971085 | DOI:10.1186/s12885-022-09968-5

BMC Prim Care. 2022 Aug 16;23(1):208. doi: 10.1186/s12875-022-01811-x.

ABSTRACT

BACKGROUND: Obesity is a chronic disease with increasing prevalence. We aimed to explore primary care physicians’ knowledge and attitudes about obesity and how knowledge and attitudes are associated with confidence and adherence to obesity guidelines and barriers to obesity treatment.

METHODS: A questionnaire survey was sent by e-mail to 1642 primary care physicians in four regions in Sweden. The survey focused on the physicians’ knowledge, attitudes towards obesity, confidence in obesity management, adherence to obesity guidelines and barriers to optimal care. We created different statistical indices for knowledge, attitudes and adherence. To analyse the correlation between these indices, we used linear regression analyses.

RESULTS: Replies from 235 primary care physicians yielded a response rate of 14.3%. Most physicians answered correctly that obesity is a disease (91%), that obesity regulation sits in the hypothalamus (70%) and that obesity is due to disorders of appetite regulation (69%). However, 44% of the physicians thought that the most effective weight reduction method for severe obesity was lifestyle changes; 47% believed that obesity is due to lack of self-control, 14% mentioned lack of motivation and 22% stated laziness. Although 97% believed that physicians can help individuals with obesity and 56% suggested that obesity treatment should be prioritised, 87% of the physicians expressed that losing weight is the patients’ responsibility. There was a positive association between higher knowledge and better adherence to obesity guidelines (B = 0.07, CI 0.02-0.12, p-value = 0.005) and feeling confident to suggest medication (p < 0.001) or bariatric surgery (p = 0.002). While 99% of the physicians felt confident to discuss lifestyle changes, 67% and 81% were confident to suggest medication or bariatric surgery, respectively. Respondents perceived that the greatest barrier in obesity management was lack of time (69%) and resources (49%).

CONCLUSION: There was a positive association between Swedish primary care physicians’ knowledge and adherence to obesity guidelines and being more confident to suggest obesity treatment. Yet, many physicians had an ambivalent attitude towards obesity management.

PMID:35971075 | DOI:10.1186/s12875-022-01811-x

BMC Med Res Methodol. 2022 Aug 15;22(1):228. doi: 10.1186/s12874-022-01683-w.

ABSTRACT

BACKGROUND: Platform trials can evaluate the efficacy of several experimental treatments compared to a control. The number of experimental treatments is not fixed, as arms may be added or removed as the trial progresses. Platform trials are more efficient than independent parallel group trials because of using shared control groups. However, for a treatment entering the trial at a later time point, the control group is divided into concurrent controls, consisting of patients randomised to control when that treatment arm is in the platform, and non-concurrent controls, patients randomised before. Using non-concurrent controls in addition to concurrent controls can improve the trial’s efficiency by increasing power and reducing the required sample size, but can introduce bias due to time trends.

METHODS: We focus on a platform trial with two treatment arms and a common control arm. Assuming that the second treatment arm is added at a later time, we assess the robustness of recently proposed model-based approaches to adjust for time trends when utilizing non-concurrent controls. In particular, we consider approaches where time trends are modeled either as linear in time or as a step function, with steps at time points where treatments enter or leave the platform trial. For trials with continuous or binary outcomes, we investigate the type 1 error rate and power of testing the efficacy of the newly added arm, as well as the bias and root mean squared error of treatment effect estimates under a range of scenarios. In addition to scenarios where time trends are equal across arms, we investigate settings with different time trends or time trends that are not additive in the scale of the model.

RESULTS: A step function model, fitted on data from all treatment arms, gives increased power while controlling the type 1 error, as long as the time trends are equal for the different arms and additive on the model scale. This holds even if the shape of the time trend deviates from a step function when patients are allocated to arms by block randomisation. However, if time trends differ between arms or are not additive to treatment effects in the scale of the model, the type 1 error rate may be inflated.

CONCLUSIONS: The efficiency gained by using step function models to incorporate non-concurrent controls can outweigh potential risks of biases, especially in settings with small sample sizes. Such biases may arise if the model assumptions of equality and additivity of time trends are not satisfied. However, the specifics of the trial, scientific plausibility of different time trends, and robustness of results should be carefully considered.

PMID:35971069 | DOI:10.1186/s12874-022-01683-w