Tag: nevin manimala

Cancer Epidemiol. 2021 Aug 18;74:102006. doi: 10.1016/j.canep.2021.102006. Online ahead of print.

ABSTRACT

INTRODUCTION: Childhood brain tumours (CBTs) are the second most common type of cancer in individuals aged 0-24 years globally and cause significant morbidity and mortality. CBT aetiology remains poorly understood, however previous studies found higher CBT incidence in high-income countries (HIC) compared to low-middle income countries (LMIC), suggesting a positive relationship between incidence and wealth.

MATERIALS & METHODS: Aggregated data from Cancer Incidence in Five Continents (CI5) were used to explore CBT epidemiology. Incidence rate ratios (IRR) compared CBT rates between twenty-five geographically and economically diverse countries. The relationship between incidence and economic development was explored using linear regression models and Spearman’s rank correlation tests. Trends in CBT incidence between 1978 and 2012 were investigated using average annual percentage changes (AAPC).

RESULTS: CBT incidence was highest in North America and lowest in Africa. CBT incidence rates increased significantly with increasing GDP per capita (p = 0.006). Gini index was significantly negatively associated with CBT incidence. Incidence decreased with increasing income inequality within countries, indicated by higher Gini indices (p = 0.040). Increasing and decreasing CBT incidence trends were observed within individual countries, although only Italy (p = 0.02) and New Zealand (p < 0.005) experienced statistically significant changes over time.

CONCLUSIONS: The excess disease found in HIC may be explained by environmental risk factor exposure increasing CBT risk in wealthy populations. However, systematic limitations of substandard cancer detection and reporting in LMIC may mean incidence disparities result from misinformation bias rather than genuine differences in risk factor exposure. Further research is required to comprehensively describe CBT epidemiology and explain study findings.

PMID:34418666 | DOI:10.1016/j.canep.2021.102006

Am J Obstet Gynecol MFM. 2021 Aug 18:100466. doi: 10.1016/j.ajogmf.2021.100466. Online ahead of print.

ABSTRACT

BACKGROUND: Maternal biologic factors can affect fetal fraction in cell-free DNA-based prenatal screening assays, thereby limiting effectiveness. Higher rates of indeterminate results from low fetal fraction have been described in cases of autoimmune disease in pregnancy. Existing studies are confounded by the concomitant maternal use of anticoagulants, which may independently influence test characteristics.

OBJECTIVE(S): To evaluate differences in fetal fraction, indeterminate results, and total cell-free DNA concentration for women with autoimmune disease compared to controls using our in-house developed non-invasive prenatal screening platform in the absence of maternal anticoagulation use.

STUDY DESIGN: A retrospective, single institution cohort study of a previously validated cell-free DNA-based non-invasive prenatal screening assay using a low-pass whole genome sequencing platform between 2017 and 2019. A diagnosis of autoimmune disease included systemic lupus erythematosus, rheumatoid arthritis, multiple sclerosis, inflammatory bowel disease, and others. Immunomodulator therapies included biologics, corticosteroids, hydroxychloroquine, azathioprine, and intravenous immunoglobulin. Women on anticoagulation were excluded. We evaluated the association between autoimmune disease and fetal fraction, indeterminate results, and total cell-free DNA concentration using univariate and multivariate analyses, stratifying for immunomodulator therapy and adjusting for body mass index, fetal sex, and gestational age at sample collection.

RESULTS: 1,445 patients met inclusion criteria. Forty-three women had a confirmed autoimmune disease, with 25 not on immunomodulator therapy and 18 on immunomodulator therapy. The mean fetal fraction for women with autoimmune disease was significantly lower compared to controls (9.7% vs. 11.9%, p=0.004). The rate of indeterminate results was significantly higher for women with autoimmune disease compared to controls (16.3% vs. 3.5%; p<0.001). The total cell-free DNA concentration was not statistically different between groups (94.8 pg/uL for autoimmune disease vs. 83.9 pg/uL for controls, p=0.06). In logistic regression, women with autoimmune disease had a significantly higher odds of an indeterminate result compared to controls, (aOR 5.3, 95%CI 2.0, 14.2). Linear regression showed a significant negative association between autoimmune disease and fetal fraction (aβ -2.1, 95%CI -3.4, -0.6). Stratifying by treatment status, mean fetal fraction was 9.8%, 9.6%, and 11.9% for women with autoimmune disease not on immunomodulator therapy, autoimmune disease on immunomodulator therapy, and controls, respectively (p=0.02). The rate of indeterminate results increased in a stepwise fashion from 3.5% to 11.1% to 20.0% for controls, autoimmune disease on immunomodulator therapy, and autoimmune disease not on immunomodulator therapy, respectively (p<0.001). Logistic regression demonstrated higher odds of an indeterminate result for women with autoimmune disease not on immunomodulator therapy compared to controls, (aOR 7.3, 95%CI 2.3, 22.5). Autoimmune disease not on immunomodulator therapy was negatively associated with fetal fraction compared to controls (aβ -2.2, 95%CI -4.2, -0.3).

CONCLUSION(S): Women with autoimmune disease have lower fetal fraction and higher rates of indeterminate results compared to women without autoimmune disease. There was no difference in total cell-free DNA concentration. Treatment of maternal autoimmune disease with immunomodulator therapy may decrease the indeterminate result rate.

PMID:34418590 | DOI:10.1016/j.ajogmf.2021.100466

Epilepsy Behav. 2021 Aug 18;123:108259. doi: 10.1016/j.yebeh.2021.108259. Online ahead of print.

ABSTRACT

OBJECTIVE: Depression and anxiety disorders are common among patients with epilepsy (PWE). These comorbidities have been shown to influence prognosis and may have a greater impact on quality of life than seizure control. Despite guideline recommendations and expert consensus to regularly screen for and treat both conditions, there is evidence that they are underdiagnosed and undertreated. Our goal was to test a novel screening method to determine if it would increase the rate of detecting and treating depression and anxiety disorders among PWE.

METHOD: The Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and the Brief Epilepsy Anxiety Survey Instrument (brEASI) were selected as validated screening instruments for depression and anxiety disorders, respectively. They were sent via an electronic medical record-linked patient portal to all patients of four epileptologists 48 h prior to their clinic appointment. We evaluated whether this increased the rate of detecting and treating depression and anxiety disorders relative to a historical control group.

RESULTS: A total of 563 patients were included of whom 351 were sent the screening instruments. 62.7% of patients completed the screening instruments of whom 47.7% screened positive for either depression only (16.4%), anxiety disorders only (5.5%) or both (25.9%); a statistically significant increase relative to the control group. There was also a significantly increased proportion of patients for whom treatment was initiated for depression (p < 0.01), anxiety disorders (p < 0.01), or both (p < 0.01).

CONCLUSIONS: We identified an easily applicable and efficient means of enhancing detection and treatment rates for depression and anxiety disorders among PWE in a busy clinic setting.

PMID:34418639 | DOI:10.1016/j.yebeh.2021.108259

Pharmacol Res. 2021 Aug 18:105836. doi: 10.1016/j.phrs.2021.105836. Online ahead of print.

ABSTRACT

Despite Sodium-glucose co-transporter-2 (SGLT2) inhibitors have been associated with a reduced risk of heart failure in patients with type 2 diabetes mellitus (T2DM), the effect observed for other cardiovascular (CV) and cerebrovascular outcomes differed among clinical trials. Different observational studies have investigated the effects of SGLT2 inhibitors on these outcomes and mortality. The present meta-analysis aimed to assess the effects of SGLT2 inhibitors on the risk of CV (major adverse CV event – MACE, non-fatal myocardial infarction, or hospitalization for heart failure) and cerebrovascular (stroke) outcomes. A systematic review was conducted in Pubmed from January 1, 2012 to November 31, 2020. Only retrospective cohort studies including as control group users of dipeptidyl peptidase-4 (DPP-4) inhibitors or non-SGLT2 inhibitors were retained and analysed separately. A random effect meta-analysis approach was used. This study followed the PRISMA statement. Of the 158 references identified, 20 articles were selected for meta-analysis, of which 13 considered the comparison with DPP-4 inhibitors and 7 the comparison with non-SGLT2 inhibitors. The pooled intention-to-treat analysis showed a reduced risk of stroke with SGLT2 inhibitors compared to DPP-4 inhibitors (Hazard ratio HR, 0.89; 95%CI, 0.82-0.96; I² = 25%; p = 0.25) and non-SGLT2 inhibitors (HR, 0.83; 95%CI, 0.77-0.91; I2 = 11%; p = 0.34). Finally, SGLT2 inhibitors were also associated with a reduced risk of CV outcomes and mortality in all comparisons. Our data support contemporary society recommendations to prioritize the use of SGLT2 inhibitors in patients with T2DM and at high risk for CV complications.

PMID:34418562 | DOI:10.1016/j.phrs.2021.105836

Nurse Educ Today. 2021 Aug 8;106:105081. doi: 10.1016/j.nedt.2021.105081. Online ahead of print.

ABSTRACT

BACKGROUND: Traditional teaching approaches are generally teacher-directed, and students are taught in a manner that is conducive to sitting and listening. Using three-dimensional (3D) holograms has many benefits in a higher education environment. However, relevant studies on this topic are very limited.

OBJECTIVES: To confirm the efficacy of 3D holograms for educational purposes to support the academic and practical performance of nursing students.

DESIGN: A randomly allocated pretest and posttest quasi-experimental design.

SETTINGS: Mackay Medical College in Taiwan.

PARTICIPANTS: Ninety third-year nursing students at a medical school in Taiwan.

METHODS: The data were collected between January and May 2020. The participants were randomly allocated to an intervention group and a control group. The learning method used in the intervention group was a combination of a 3D hologram learning module and classroom lectures. The control group was exposed to classroom lectures without 3D holograms. The tool included hardware (Windows Mixed Reality Helmet and VR Remote Control) and software (Health Assessment® and Patient First Patient Condition VR System®). The Health Assessment and Practice Knowledge Assessment tool and the Health Assessment and Practice Techniques Performance tool were used to evaluate the effects of the study intervention on the knowledge and techniques of the students.

RESULTS: A total of 79 participants (40 in the intervention group and 39 in the control group) were included in the final statistical analysis. The response rate was 88%. Statistically significant differences in knowledge and practical learning in the health assessment and practice course were observed between the intervention group and the control group (p < .05). The η² effect level was 0.134.

CONCLUSIONS: After attending classroom lectures, the students who also attended the 3D hologram-based laboratory courses had significantly higher knowledge and practical learning scores. This approach may be used as a complementary learning tool in higher education.

PMID:34418588 | DOI:10.1016/j.nedt.2021.105081

Adv Clin Exp Med. 2021 Aug 19. doi: 10.17219/acem/137558. Online ahead of print.

ABSTRACT

BACKGROUND: Frailty syndrome and cardiovascular diseases are closely related because of the shared physiological pathway of chronic, low-intensity inflammation. Frailty syndrome may be an adverse factor in the prognosis of patients with cardiovascular disease (CVD).

OBJECTIVES: To assess the influence of frailty syndrome on patient prognosis after coronary artery bypass grafting (CABG).

MATERIAL AND METHODS: The study was conducted at the Clinic of Cardiac Surgery in Katowice and involved 180 patients (56 women, 31.11%) over 60 years of age who qualified for CABG surgery. The Tilburg Frailty Indicator (TFI) was used to assess frailty syndrome and the The World Health Organization Quality of Life Brief Version (WHOQOL-BREF) questionnaire was used to assess quality of life. Statistical analysis was performed using R software.

RESULTS: Frailty syndrome was diagnosed in 42 patients (23.3%), including 24 men and 18 women. More than 1/3 of patients had complications during or after surgery, including 34.6% of patients without frailty syndrome and 28.6% of patients with frailty features. All of the complications occurred in 57 (31.6%) patients. Early complications accounted for 89.5% of all events – 93.3% of which occurred in patients without frailty syndrome and 75.00% in patients with frailty features (p = 0.289).

CONCLUSIONS: More than 1/3 of patients experienced complications during or after the CABG procedure. Early postoperative complications accounted for almost all of the adverse events in patients with frailty. However, frailty syndrome was a poor predictor of rehospitalization.

PMID:34418334 | DOI:10.17219/acem/137558

Pharmacoepidemiol Drug Saf. 2021 Aug 21. doi: 10.1002/pds.5347. Online ahead of print.

ABSTRACT

PURPOSE: A laboratory-based acute kidney injury (AKI) electronic-alert (e-alert) system, with e-alerts sent to the UK Renal Registry (UKRR) and collated in a master patient index (MPI), has recently been implemented in England. The aim of this study was to determine the degree of correspondence between the UKRR-MPI and AKI International Classification Disease-10 (ICD-10) N17 coding in Hospital Episode Statistics (HES) and whether hospital N17 coding correlated with 30-day mortality and emergency re-admission after AKI.

METHODS: AKI e-alerts in people aged ≥18 years, collated in the UKRR-MPI during 2017, were linked to HES data to identify a hospitalised AKI population. Multivariable logistic regression was used to analyse associations between absence/presence of N17 codes and clinicodemographic features. Correlation of the percentage coded with N17 and 30-day mortality and emergency re-admission after AKI were calculated at hospital level.

RESULTS: In 2017, there were 301,540 adult episodes of hospitalised AKI in England. AKI severity was positively associated with coding in HES, with a high degree of inter-hospital variability – AKI stage 1 mean of 48.2% [SD 14.0], vs AKI stage 3 mean of 83.3% [SD 7.3]. N17 coding in HES depended on demographic features, especially age (18-29 years vs ≥85 years OR 0.22, 95% CI 0.21-0.23), as well as sex and ethnicity. There was no evidence of association between the proportion of episodes coded for AKI with short-term AKI outcomes.

CONCLUSION: Coding of AKI in HES is influenced by many factors that result in an underestimation of AKI. Using e-alerts to triangulate the true incidence of AKI could provide a better understanding of the factors that affect hospital coding, potentially leading to improved coding, patient care and pharmacoepidemiologic research.

PMID:34418198 | DOI:10.1002/pds.5347

Head Neck. 2021 Aug 21. doi: 10.1002/hed.26844. Online ahead of print.

ABSTRACT

BACKGROUND: This study aims to develop and validate a new classification system that better predicts combined risk of neurological and neurovascular complications following CBT surgery, crucial for treatment decision-making.

METHODS: Multinational retrospective cohort study with 199 consecutive cases. A cohort of 132 CBT cases was used to develop the new classification. To undertake external validation, assessment was made between the actual complication rate and predicted risk by the model on an independent cohort (n = 67).

RESULTS: Univariate analyses showed statistically significant associations between developing a complication and the following factors: craniocaudal dimension, volume, Shamblin classification, and Mehanna types. In the multivariate prognostic model, only Mehanna type remained as a significant risk predictor. The risk of developing complications increases with increasing Mehanna type.

CONCLUSIONS: We have developed and then validated a new classification and risk stratification system for CBTs, which demonstrated better prognostic power for the risk of developing neurovascular complications after surgery.

PMID:34418219 | DOI:10.1002/hed.26844

Nurs Crit Care. 2021 Aug 21. doi: 10.1111/nicc.12706. Online ahead of print.

ABSTRACT

BACKGROUND: Prototype analyses of well-being have identified central characteristics and prototypicality for New Zealand teachers, lawyers, adolescents, and work well-being of nurses. What has not yet been explored is the broad construct of well-being in intensive care nurses.

AIMS AND OBJECTIVES: To identify intensive care nurses’ conceptions of general well-being and investigate whether their general well-being is prototypically organized.

DESIGN: Prototype analysis.

METHODS: Three linked studies conceptualize well-being in this prototype analysis. In study 1, nurses reported features of well-being. Study 2 investigated the organization of these features. Study 3 sought confirmation of prototypical organization.

RESULTS: Sixty-five New Zealand nurses participated. For study 1 (n = 23), the most frequently reported elements of well-being included physical health (n = 26), work-life balance (n = 20), and personal relationships (n = 18). For study 2 (n = 25), the highest rated elements included mental and emotional health, [general] health, work-life balance, and love. Work-life balance, physical health, and personal relationships were in the top five most frequently reported and were rated in the top 12 most central. Overall, ratings of centrality and the number of times reported were positively correlated (r = 0.33, P < .005). For study 3 (n = 17), confirmatory analyses did not reach statistical significance (P = .15).

CONCLUSIONS: Physical health, work-life balance, and personal relationships are key characteristics of well-being for intensive care nurses. Mental, emotional, and general health and work-life balance were considered most important for well-being.

RELEVANCE TO CLINICAL PRACTICE: Physical health, work-life balance, and personal relationships are key characteristics of well-being for intensive care nurses. These characteristics of the broad construct of well-being are helpful in both defining and identifying conceptual models of well-being that may be used to inform the development and measurement of well-being programmes.

PMID:34418247 | DOI:10.1111/nicc.12706

Mol Ecol. 2021 Aug 21. doi: 10.1111/mec.16133. Online ahead of print.

ABSTRACT

Recent outbreaks of emerging and re-emerging viruses have shown that timely detection of novel arboviruses with epidemic potential is essential to mitigate human health risks. There are rising concerns that an emergent JEV genotype V (GV) is circulating in Asia, against which current vaccines may not be efficacious. To ascertain if JEV GV and other arboviruses are circulating in East Asia, we conducted next-generation sequencing on 260 pools of Culex tritaeniorhynchus and Culex bitaeniorhynchus mosquitoes (6,540 specimens) collected at Camp Humphreys, Republic of Korea (ROK) in 2018. Interrogation of our data revealed a highly abundant and diverse virosphere that contained sequences from 122 distinct virus species. Our statistical and hierarchical analysis uncovered correlates of potential health, virological, and ecological relevance. Furthermore, we obtained evidence that JEV GV was circulating in Pyeongtaek and, retrospectively, in Seoul in 2016 and place these findings within the context of human and fowl reservoir activity. Sequence-based analysis of JEV GV showed a divergent genotype that is the most distant from the GIII-derived live attenuated SA14-14-2 vaccine strain and indicated likely regions responsible for reduced antibody affinity. These results emphasize recent concerns of shifting JEV genotype in East Asia and highlight the critical need for a vaccine proven efficacious against this re-emergent virus. Together, our one-health approach to Culex viral metagenomics uncovered novel insights into virus ecology and human health.

PMID:34418188 | DOI:10.1111/mec.16133