Tag: nevin manimala

J Ultrasound Med. 2022 Jun 24. doi: 10.1002/jum.16044. Online ahead of print.

ABSTRACT

OBJECTIVE: Quantitative contrast-enhanced US (CEUS) provides objective evaluation of bowel wall perfusion and has been reported as a useful method for evaluating Crohn’s disease (CD) activity in children. We tested its’ diagnostic accuracy in comparison to endoscopy and evaluated its’ usefulness in comparison to Pediatric Crohn’s Disease Activity Index (PCDAI) and fecal Calprotectin (FC).

MATERIALS AND METHODS: Children with CD and thickened bowel wall on abdominal US were prospectively enrolled. Disease activity was evaluated with quantitative CEUS, PCDAI and FC and compared to a simple endoscopic score for Crohn’s disease (SES-CD). Spearman’s correlation and Cohen’s kappa statistic between the SES-CD and other disease activity measures were performed and diagnostic accuracies calculated.

RESULTS: 36 children 3.5-18 years old (mean age 14 years) were included. The quantitative CEUS had 78.57% sensitivity (95%CI 0.59-0.92), 100% specificity (95%CI 0.63-1.0) and 83.33% diagnostic accuracy (95% CI 0.67-0.94). The concordance remission agreement with endoscopy was substantial for quantitative CEUS and PCDAI (quantitative CEUS: κ = 0.62; 95% CI 0.363-0.877; PCDAI: κ = 0.615; 95% CI 0.311-0.920), but only fair for FC (κ = 0.389; 95% CI 0.006-0.783). Correlation between all measures and endoscopy was moderate and statistically significant (quantitative CEUS: r_s = 0.535, PCDAI: r_s = 0.543, FC: r_s = 0.497).

CONCLUSIONS: Quantitative CEUS has a potential of becoming a complementary method for evaluation of CD activity in children due to its’ high specificity in comparison to endoscopy. Lower sensitivity makes it deficient as a single measure and further management should be guided by PCDAI and FC results as well.

PMID:35748308 | DOI:10.1002/jum.16044

Euro Surveill. 2022 Jun;27(25). doi: 10.2807/1560-7917.ES.2022.27.25.2100933.

ABSTRACT

BackgroundInterventions to mitigate the COVID-19 pandemic may impact other respiratory diseases.AimsWe aimed to study the course of pertussis in France over an 8-year period including the beginning of the COVID-19 pandemic and its association with COVID-19 mitigation strategies, using multiple nationwide data sources and regression models.MethodsWe analysed the number of French pertussis cases between 2013 and 2020, using PCR test results from nationwide outpatient laboratories (Source 1) and a network of the paediatric wards from 41 hospitals (Source 2). We also used reports of a national primary care paediatric network (Source 3). We conducted a quasi-experimental interrupted time series analysis, relying on negative binomial regression models. The models accounted for seasonality, long-term cycles and secular trend, and included a binary variable for the first national lockdown (start 16 March 2020).ResultsWe identified 19,039 pertussis cases from these data sources. Pertussis cases decreased significantly following the implementation of mitigation measures, with adjusted incidence rate ratios of 0.10 (95% CI: 0.04-0.26) and 0.22 (95% CI: 0.07-0.66) for Source 1 and Source 2, respectively. The association was confirmed in Source 3 with a median of, respectively, one (IQR: 0-2) and 0 cases (IQR: 0-0) per month before and after lockdown (p = 0.0048).ConclusionsThe strong reduction in outpatient and hospitalised pertussis cases suggests an impact of COVID-19 mitigation measures on pertussis epidemiology. Pertussis vaccination recommendations should be followed carefully, and disease monitoring should be continued to detect any resurgence after relaxation of mitigation measures.

PMID:35748301 | DOI:10.2807/1560-7917.ES.2022.27.25.2100933

Front Biosci (Landmark Ed). 2022 Jun 6;27(6):179. doi: 10.31083/j.fbl2706179.

ABSTRACT

INTRODUCTION: Spinal muscular atrophy (SMA) is a progressive neurological disease with autosomal recessive transmission that affects motor neurons, causing their loss and resulting in muscle waste and motor deficiency. Nusinersen, the first SMN2 pre-mRNA targeted therapy approved by the Food and Drug Administration and the European Medicines Agency, has demonstrated high efficacy in improving motor function, as well as respiratory and nutritional statuses.

MATERIALS AND METHODS: We observed 55 patients (children/adolescents) diagnosed with spinal muscular atrophy (SMA), who received nusinersen therapy. To investigate the benefits of physical therapy on rehabilitation outcomes, we compared the motor evolution of patients who received nusinersen and performed daily physical therapy (study group) to those of the control group, who received only nusinersen therapy.

RESULTS: Motor skill improvements were statistically significantly (p < 0.001) higher in the study group, being almost four times better (12.66%), effect size, in comparison to the control group (3.18%).

CONCLUSIONS: Physical therapy has provided superior results for those who receive it on a regular basis. These results include the correction of posture, reduction in stiffness, expansion of the range of motion and strengthening of muscles, thus allowing patients to do more movements and boosting their ability to perform everyday tasks.

PMID:35748255 | DOI:10.31083/j.fbl2706179

Stroke. 2022 Jun 24:101161STROKEAHA122038576. doi: 10.1161/STROKEAHA.122.038576. Online ahead of print.

ABSTRACT

BACKGROUND: In patients with acute stroke who undergo endovascular thrombectomy, the relative prognostic power of computed tomography perfusion (CTP) parameters compared with multiphase CT angiogram (mCTA) is unknown. We aimed to compare the predictive accuracy of mCTA and CTP parameters on clinical outcomes.

METHODS: We included patients with acute ischemic stroke who had anterior circulation large vessel occlusion within 24 hours of onset in Melbourne Brain Centre at the Royal Melbourne Hospital. All patients underwent CTP for endovascular thrombectomy, and the mCTA collateral score was determined using CTP-reconstructed mCTA images. The primary outcome was 90-day functional outcomes defined by modified Rankin Scale. Multivariable logistic regression models analyzed associations between mCTA and CTP parameters and 90-day functional outcomes. The ability to discriminate 90 days-functional outcomes was compared between mCTA collateral score and CTP parameters using receiver operating curve analysis and C statistics.

RESULTS: One hundred and twenty patients were included. The median age was 69 years (interquartile range, 60-79), the median baseline National Institutes of Health Stroke Scale score was 14 (interquartile range, 9-19). The baseline ischemic core volume, defined by CTP-based relative cerebral blood flow <30%, was associated with excellent functional outcome (modified Rankin Scale score 0-1; odds ratio, 0.942 [-0.897 to -0.989]; P=0.015) and poor functional outcome (modified Rankin Scale score 5-6; odds ratio, 1.032 [1.007-1.056]; P=0.010) at 90 days in the analysis of multivariable regression. There was no significant association between the mCTA score and excellent functional outcome (P=0.58) or poor functional outcome (P=0.155). The relative cerebral blood flow <30%-based regression model best fit the data for the 90-day poor functional outcome (C statistic, 0.834).

CONCLUSIONS: The CTP-based ischemic core volume may provide better discrimination for 90-day functional outcomes for patients with acute stroke undergoing endovascular thrombectomy than the mCTA collateral score.

PMID:35748291 | DOI:10.1161/STROKEAHA.122.038576

Circulation. 2022 Jun 24:101161CIRCULATIONAHA122060042. doi: 10.1161/CIRCULATIONAHA.122.060042. Online ahead of print.

ABSTRACT

BACKGROUND: Socioeconomic deprivation is associated with higher cardiovascular morbidity and mortality. Whether deprivation status should be incorporated in more cardiovascular risk estimation scores remains unclear. This study evaluates how socioeconomic deprivation status affects the performance of 3 primary prevention cardiovascular risk scores.

METHODS: The Generation Scotland Scottish Family Health Study was used to evaluate the performance of 3 cardiovascular risk scores with (ASSIGN [Assessing Cardiovascular Risk Using SIGN]) and without (SCORE2 [Systematic Coronary Risk Evaluation 2 Algorithm], pooled cohort equations) socioeconomic deprivation as a covariate in the risk prediction model. Deprivation was defined by Scottish Index of Multiple Deprivation score. The predicted 10-year risk was evaluated against the observed event rate for the cardiovascular outcome of each risk score. The comparison was made across 3 groups defined by the deprivation index score consisting of group 1 defined as most deprived, group 3 defined as least deprived, and group 2, which consisted of individuals in the middle deprivation categories.

RESULTS: The study population consisted of 15 506 individuals (60.0% female, median age of 51). Across the population, 1808 (12%) individuals were assigned to group 1 (most deprived), 8119 (52%) to group 2, and 4708 (30%) to group 3 (least deprived), and 871 individuals (6%) had a missing deprivation score. Risk scores based on models that did not include deprivation status significantly under predicted risk in the most deprived (6.43% observed versus 4.63% predicted for SCORE2 [P=0.001] and 6.69% observed versus 4.66% predicted for pooled cohort equations [P<0.001]). Both risk scores also significantly overpredicted the risk in the least deprived group (3.97% observed versus 4.72% predicted for SCORE2 [P=0.007] and 4.22% observed versus 4.85% predicted for pooled cohort equations [P=0.028]). In contrast, no significant difference was demonstrated in the observed versus predicted risk when using the ASSIGN risk score, which included socioeconomic deprivation status in the risk model.

CONCLUSIONS: Socioeconomic status is a largely unrecognized risk factor in primary prevention of cardiovascular disease. Risk scores that exclude socioeconomic deprivation as a covariate under- and overestimate the risk in the most and least deprived individuals, respectively. This study highlights the importance of incorporating socioeconomic deprivation status in risk estimation systems to ultimately reduce inequalities in health care provision for cardiovascular disease.

PMID:35748241 | DOI:10.1161/CIRCULATIONAHA.122.060042

Diagn Interv Radiol. 2022 May;28(3):200-207. doi: 10.5152/dir.2022.20872.

ABSTRACT

PURPOSE We aimed to investigate whether the texture analysis and functional magnetic resonance imaging (fMRI) could differentiate rectal cancer pathological stages T1-2 (pT1-2) and T3a (pT3a). METHODS Eighty-two rectal adenocarcinoma patients at stage pT1-2 and pT3a received T2 and fMRI examination before surgery. The latter included apparent diffusion coefficient (ADC) sequence, dynamic contrast enhancement (DCE) MRI, and intravoxel incoherent motion (IVIM) diffusion weighted imaging. Patients were grouped into early stage (pT1-2) and advanced stage (pT3a). The MRI accuracy in diagnosing rectal cancer before surgery was calculated. The differences in clinicopathological variables, quantitative parameters including ADC values, IVIM parameters (perfusion fraction [f], true diffusion coefficient [D], and pseudo- diffusion coefficient [D*]), DCE MRI parameters (transfer constant [Ktrans], reflux constant [Kep], and extravascular extracellular fractional volume [Ve]), and texture features were compared between the groups. Receiver operating characteristic (ROC) curves of texture features and fMRI parameters were generated to distinguish pT1-2 and pT3a tumors. The multivariate analysis was used to develop a predictive model and to find independent risk factors. Hosmer-Lemeshow test was used to see the fitness of the model. DeLong test was applied to compare the ROC curves of different features. Correlation of texture features and fMRI parameters with stage were calculated using r (Spearman’s rank correlation coefficient). RESULTS The preoperative accuracy in differentiating pT1-2 from pT3a rectal cancer using MRI was 74.39%. Kep, Ve, and ADC showed significant differences between the groups. Kep and ADC showed negative correlation with stage. Ve correlated positively with stage. Twenty-five texture features from T2 images showed significant differences between groups, and S(0,2)SumOfSqs and WavEnLH_s_2 among these showed better performance, showing negative correlation with stage. The area under the curve (AUC) values of S(0,2)SumOfSqs, WavEnLH_s_2, ADC, Kep, and Ve were 0.721, 0.699, 0.690, 0.666, and 0.653, respectively. The multivariate analysis showed that S(0,2) SumOfSqs, WavEnLH_s_2, and ADC are risk factors for advanced tumors, and the logistic model built by Kep, Ve, S(0,2)SumOfSqs, WavEnLH_s_2, and ADC has the AUC, sensitivity, and specificity of 0.833, 88.5%, and 73.3%, respectively. ROC curve of the model showed statistical significance between S(0,2)SumOfSqs, ADC, Kep, and Ve. The P value of the Hosmer-Lemeshow test was 0.65. CONCLUSION S(0,2)SumOfSqs, WavEnLH_s_2, and ADC are risk factors for advanced rectal cancer, and the model built by Kep, Ve, S(0,2)SumOfSqs, WavEnLH_s_2, and ADC has better performance than using a single method. The application of above combinations could be beneficial to patients’ accurate and individualized treatments.

PMID:35748201 | DOI:10.5152/dir.2022.20872

Pediatrics. 2022 Jun 24:e2021055641. doi: 10.1542/peds.2021-055641. Online ahead of print.

ABSTRACT

BACKGROUND: Several prediction models have been reported to identify patients with radiographic pneumonia, but none have been validated or broadly implemented into practice. We evaluated 5 prediction models for radiographic pneumonia in children.

METHODS: We evaluated 5 previously published prediction models for radiographic pneumonia (Neuman, Oostenbrink, Lynch, Mahabee-Gittens, and Lipsett) using data from a single-center prospective study of patients 3 months to 18 years with signs of lower respiratory tract infection. Our outcome was radiographic pneumonia. We compared each model’s area under the receiver operating characteristic curve (AUROC) and evaluated their diagnostic accuracy at statistically-derived cutpoints.

RESULTS: Radiographic pneumonia was identified in 253 (22.2%) of 1142 patients. When using model coefficients derived from the study dataset, AUROC ranged from 0.58 (95% confidence interval, 0.52-0.64) to 0.79 (95% confidence interval, 0.75-0.82). When using coefficients derived from original study models, 2 studies demonstrated an AUROC >0.70 (Neuman and Lipsett); this increased to 3 after deriving regression coefficients from the study cohort (Neuman, Lipsett, and Oostenbrink). Two models required historical and clinical data (Neuman and Lipsett), and the third additionally required C-reactive protein (Oostenbrink). At a statistically derived cutpoint of predicted risk from each model, sensitivity ranged from 51.2% to 70.4%, specificity 49.9% to 87.5%, positive predictive value 16.1% to 54.4%, and negative predictive value 83.9% to 90.7%.

CONCLUSIONS: Prediction models for radiographic pneumonia had varying performance. The 3 models with higher performance may facilitate clinical management by predicting the risk of radiographic pneumonia among children with lower respiratory tract infection.

PMID:35748157 | DOI:10.1542/peds.2021-055641

Tijdschr Psychiatr. 2022;64(6):353-358.

ABSTRACT

Parenting with Love and Limits (PLL) is a family intervention aimed at reducing behavioral problems in adolescents up to the age of 18 by, among other things, improving communication between family members and the parenting skills of the parents.<br> AIM: This prospective study examined whether parental communication and parenting skills and youth externalizing problem behavior were positively changed after PLL. <br> METHOD: The study group consisted of 48 adolescents who had completed the PLL-intervention with their primary caregivers. Data from two measurements completed by the primary caregivers (44 mothers and 4 fathers) were used: prior to PLL (T0) and after PLL (T1).<br> RESULTS: Results of the paired t-test indicated strong positive changes in communication, parenting and aggressive behavior after nearly eight months of PLL. A statistically significant (reliable change) decrease in aggressive behavior was found in one third of the adolescents, but not in deviant behavior.<br> CONCLUSION: PLL improved functioning in some of the families, but further research is needed into the effective elements and for whom the intervention is effective under what circumstances.<br>.

PMID:35748146

ESC Heart Fail. 2022 Jun 24. doi: 10.1002/ehf2.13979. Online ahead of print.

ABSTRACT

AIMS: Exercise right heart catheterization (RHC) is considered the gold-standard test to diagnose heart failure with preserved ejection fraction (HFpEF). However, exercise RHC is an insufficiently standardized technique, and current haemodynamic thresholds to define HFpEF are not universally accepted. We sought to describe the exercise haemodynamics profile of HFpEF cohorts reported in literature, as compared with control subjects.

METHODS AND RESULTS: We performed a systematic literature review until December 2020. Studies reporting pulmonary artery wedge pressure (PAWP) at rest and peak exercise were extracted. Summary estimates of all haemodynamic variables were evaluated, stratified according to body position (supine/upright exercise). The PAWP/cardiac output (CO) slope during exercise was extrapolated. Twenty-seven studies were identified, providing data for 2180 HFpEF patients and 682 controls. At peak exercise, patients with HFpEF achieved higher PAWP (30 [29-31] vs. 16 [15-17] mmHg, P < 0.001) and mean right atrial pressure (P < 0.001) than controls. These differences persisted after adjustment for age, sex, body mass index, and body position. However, peak PAWP values were highly heterogeneous among the cohorts (I² = 93%), with a relative overlap with controls. PAWP/CO slope was steeper in HFpEF than in controls (3.75 [3.20-4.28] vs. 0.95 [0.30-1.59] mmHg/L/min, P value < 0.0001), even after adjustment for covariates (P = 0.007).

CONCLUSIONS: Despite methodological heterogeneity, as well as heterogeneity of pooled haemodynamic estimates, the exercise haemodynamic profile of HFpEF patients is consistent across studies and characterized by a steep PAWP rise during exercise. More standardization of exercise haemodynamics may be advisable for a wider application in clinical practice.

PMID:35748109 | DOI:10.1002/ehf2.13979

Yonsei Med J. 2022 Jul;63(7):665-674. doi: 10.3349/ymj.2022.63.7.665.

ABSTRACT

PURPOSE: This study was undertaken to identify factors that affect segmental lordosis (SL) after minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) by comparing patients whose postoperative SL increased with those whose decreased.

MATERIALS AND METHODS: Fifty-five patients underwent MIS-TLIF at our institute from January 2018 to September 2019. Demographic, pre- and postoperative radiologic, and cage-related factors were included. Statistical analyses were designed to compare patients whose SL increased with decreased after surgery.

RESULTS: After surgery, SL increased in 34 patients (group I) and decreased in 21 patients (group D). The index level, disc lordosis, SL, lumbar lordosis, proximal lordosis (PL), and Y-axis position of the cage (Yc) differed significantly between groups I and D. The cage in group I was more anterior than that in group D (Yc: 55.84% vs. 51.24%). Multivariate analysis showed that SL decreased more significantly after MIS-TLIF when the index level was L3/4 rather than L4/5 [odds ratio (OR): 0.46, p=0.019], as preoperative SL (OR: 0.82, p=0.037) or PL (OR: 0.68, p=0.028) increased, and as the cage became more posterior (OR: 1.10, p=0.032).

CONCLUSION: Changes in SL after MIS-TLIF appear to be associated with preoperative SL and PL, index level, and Yc. An index level at L4/5 instead of L3/4, smaller preoperative SL or PL, and an anterior position of the cage are likely to result in increased SL after MIS-TLIF.

PMID:35748078 | DOI:10.3349/ymj.2022.63.7.665