Tag: nevin manimala

Disabil Health J. 2021 Oct 4:101219. doi: 10.1016/j.dhjo.2021.101219. Online ahead of print.

ABSTRACT

BACKGROUND: Recent evidence suggests that many adults with intellectual and developmental disabilities (IDD) do not adequately manage hypertension (HTN) medication. Known risk factors for insufficient prescription filling include age, residential placement, and lack of caregiver support. This is a first report of a randomized intervention trial designed to analyze the relationship of a brief educational intervention with increased knowledge about HTN and improvement in prescription filling for anti-hypertensive medication.

OBJECTIVE/HYPOTHESIS: The objective was to test whether an educational flyer and regular messages about HTN and the importance of refilling medication would improve scores on knowledge surveys. Participants were Medicaid members with HTN and IDD (Member) or caregivers (Helpers) who chose to participate on behalf of a Member.

METHODS: Recruitment letters explained that either the Member or their Helper could participate (not both). Participants were randomly assigned to the Case or Comparison group, and both were comprised of Members and Helpers. Only Case participants received a flyer and monthly HTN education messages for one year, but all participants completed knowledge surveys at baseline, six, and 12 months. Linear regression and log-binomial models were used to compare responses between groups.

RESULTS: Case Helpers had statistically significant improvements on HTN knowledge from baseline through the first year, compared to Comparison Members and Comparison Helpers. Regardless of group assignment, Helpers scored better on surveys than did Members.

CONCLUSIONS: This study suggests that it is beneficial to explicitly include Helpers in health care instruction and in management of chronic disease for adults with IDD.

PMID:34625396 | DOI:10.1016/j.dhjo.2021.101219

BMJ Open. 2021 Oct 8;11(10):e045871. doi: 10.1136/bmjopen-2020-045871.

ABSTRACT

OBJECTIVES: To investigate the association between shingles and dementia, and between Zostavax vaccination and dementia.

DESIGN: Nested case-control study.

SETTINGS: Data were drawn from the UK Biobank cohort study with a total of 228 223 participants with Hospital Episodes Statistics and primary care linkage health records.

PARTICIPANTS: The analyses included 2378 incident dementia cases and 225 845 controls. Inclusion criteria for incident cases were a dementia diagnosis 3 years or more after the first assessment date derived from all sources including International Classification of Diseases (ICD)-10, ICD-9, self-report and primary care linkage records. Subjects with no dementia code from all sources were coded as controls. Both shingles and Zostavax vaccination were investigated for their association with dementia risk.

RESULTS: There was a small but non-significant increase in the risk of dementia in subjects with shingles diagnosed 3 years or more prior to dementia diagnosis (OR: 1.088 with 95% CI: 0.978 to 1.211). In those subjects who had had Zostavax vaccination, the risk of dementia significantly decreased (OR: 0.808 with 95% CI: 0.657 to 0.993).

CONCLUSION: A history of shingles was not associated with an increased risk of dementia. In subjects who were eligible for the immunisation and vaccinated with Zostavax, we saw reduced risk of developing dementia.

PMID:34625411 | DOI:10.1136/bmjopen-2020-045871

Nutr Metab Cardiovasc Dis. 2021 Aug 12:S0939-4753(21)00395-1. doi: 10.1016/j.numecd.2021.08.026. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Triglyceride-Glucose (TyG) index is an accurate biomarker of insulin resistance, which is potentially associated with adverse cardiovascular events. We aimed to assess the dose-response relationship between Triglyceride-Glucose (TyG) Index and Major Adverse Cardiovascular Events (MACE) in patients with Acute Coronary Syndrome (ACS).

METHODS AND RESULTS: A systematic literature search was performed using PubMed, Scopus, and Embase for records published from the inception up until 7 February 2021. Studies that fulfilled all of these criteria were included: 1) prospective or retrospective observational studies reporting patients with ACS and 2) assessing the impact of TyG index on MACE with at least three quantitative classifications. The outcome of interest is MACE across the TyG index intervals. MACE was a composite of all-cause mortality, myocardial infarction, unstable angina pectoris, target vessel revascularization, cerebrovascular accidents, and heart failure. The effect estimates were reported as relative risks (RRs). There are 13,684 subjects from 4 studies included in this meta-analysis. This meta-analysis showed that the highest category of TyG index was associated with twofold MACE (RR 2.09 [1.59, 2.76], p < 0.001; I²: 68.4%, p = 0.02) compared to the lowest category in patients with ACS. Dose-response meta-analysis showed that the relationship between TyG index and MACE was non-linear (p < 0.001), with statistical significance reached around TyG index 8.9 and increased non-linearly. The dose-response curve became significantly steeper after TyG index of 9.1-9.2.

CONCLUSION: TyG index was associated with MACE in patients with ACS in a non-linear fashion.

PROSPERO: CRD42021235765.

PMID:34625361 | DOI:10.1016/j.numecd.2021.08.026

Dig Liver Dis. 2021 Oct 5:S1590-8658(21)00779-9. doi: 10.1016/j.dld.2021.09.010. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare initial clinical/laboratory parameters and outcomes of mortality/rebleeding of endoscopy performed <12 h(early UGIE) versus endoscopy performed after 12-24h(late UGIE) of ED admission in children with acute upper gastrointestinal bleeding(AUGIB) due to portal hypertension.

METHODS: This is a retrospective cohort study. From January 2010 to July 2017, medical records of all children admitted to a tertiary care hospital with AUGIB due to portal hypertension were reviewed until 60 days after ED admission.

RESULTS: A total of 98 ED admissions occurred from 73 patients. Rebleeding was identified in 8/98(8%) episodes, and 9 deaths were observed. UGIE was performed in 92(94%) episodes, and 53(58%) of them occurred within 12 h of ED admission. Episodes with early UGIE and late UGIE were similar in terms of history/complaints/laboratory data at admission, chronic liver disease associated, AUGIB duration, and initial management. No statistically significant associations were found between early UGIE and the outcomes of death/rebleeding and prevalence of endoscopic hemostatic treatment (band ligation or sclerotherapy) compared to late UGIE. In the multivariable logistic regression model, the endoscopic hemostatic treatment showed a negative association with early UGIE(OR=0.33;95%CI=0.1-0.9;p = 0.04).

CONCLUSIONS: This study suggests that in pediatric patients with AUGIB and portal hypertension, UGIE may be performed after 12-24 h without harm to the patient, facilitating better initial clinical stabilization/treatment and optimization of resources.

PMID:34625365 | DOI:10.1016/j.dld.2021.09.010

J Cardiol. 2021 Sep 28:S0914-5087(21)00255-0. doi: 10.1016/j.jjcc.2021.09.013. Online ahead of print.

ABSTRACT

BACKGROUND: Obesity is reported to be a predictor of adverse clinical events in coronavirus disease 2019 (COVID-19) in Western countries. However, there are limited data reported regarding the prognostic impact of obesity in Asian patients. We investigated the relationship between body mass index (BMI) and in-hospital outcomes in 580 Japanese patients with cardiovascular disease and/or risk factors and who were admitted for COVID-19 infection using data from 49 hospitals in Japan.

METHODS: We analyzed data from the Clinical Outcomes of COVID-19 Infection in Hospitalized Patients with Cardiovascular Disease and/or Risk Factors (CLAVIS-COVID) registry. BMI was classified into four groups accordance with the definition of the Japan Society for the Study of Obesity, as follows: underweight, <18.5 kg/m²; normal range, 18.5 to <25 kg/m²; pre-obese, 25 to 30 kg/m²; and obese, ≥30 kg/m².

RESULTS: In-hospital death occurred in 15.0% (n=87) of the patients and intubation was performed for 139 (24.0%) patients. In a multivariate analysis, we found a significant association between higher BMI and in-hospital mortality [underweight: hazard ratio (HR) 0.47, 95% confidence interval (CI) 0.23-0.97; p=0.041; pre-obese: HR 1.46, 95%CI 0.84-2.55; p=0.18; and obese: HR 3.28, 95%CI 1.34-8.02; p=0.009 vs. normal range]. In contrast, the association between BMI and the intubation rate was not statistically significant.

CONCLUSIONS: Obesity was associated with a stepwise increase in the risk of in-hospital mortality in Japanese patients with COVID-19 infection. The threshold BMI for the increased risk of a worse outcome was 30, which was much lower in comparison to Western countries.

PMID:34625315 | DOI:10.1016/j.jjcc.2021.09.013

J Hist Behav Sci. 2021 Oct 8. doi: 10.1002/jhbs.22145. Online ahead of print.

ABSTRACT

Anders N. Kiaer (1838-1919), the director of Norway’s Central Bureau of Statistics between 1877 and 1913, was the foremost promoter, at the turn of the 20th century, of the rebirth of what came to be known as the “representative method” or sample survey. His advocacy of a methodology that had been abandoned at the beginning of the 19th century in favor of complete enumeration (the census) provoked a controversy at the International Statistical Institute (ISI) when he first presented it in 1895. Yet, it was “recommended” in fairly short order, by 1903. This was the result of a convergence of factors that prevented the dispute from degenerating into a full-blown conflict and facilitated continuing the discussion while preventing a potential break-up of the association. To understand how this came about, the paper examines (1) the role of the historical background from which the ISI emerged; (2) the epistemic beliefs that informed the ISI members in their daily professional practice; (3) the social structure of the ISI and its “ethos”; (4) the professional standing Kiaer enjoyed within the international statistical community. This is a case-study in the sociology of how and why some scientific practices initially seen as “dangerous” gain acceptance and become part of science’s lore.

PMID:34624935 | DOI:10.1002/jhbs.22145

Biomed Phys Eng Express. 2021 Oct 8. doi: 10.1088/2057-1976/ac2e16. Online ahead of print.

ABSTRACT

In the medical field, automated and computerised analytic tools are essential for faster disease diagnosis. The main objective of this research work is to classify the leukocytes accurately into four different subtypes based on the pattern of the nucleus. The features are extracted from the segmented nucleus, which play a vital role in the pattern recognition. The technique comprises a novel idea of computing the statistical measures such as peak difference and standard deviation of the radon transformed graph for a single angle of rotation along with other features. Three Gray Level Co-occurrence Matrix (GLCM) based features, two geometric features and four RST moment invariants are also extracted for feature fusion. The fused feature vectors are trained and evaluated using random forest classification algorithm.This method provides an overall accuracy of 97.61% and it is able to determine the lymphocyte, neutrophil and eosinophil with 100% accuracy. The classification without incorporating radon transform features is also performed which provides an accuracy of only 80.95% .

PMID:34624876 | DOI:10.1088/2057-1976/ac2e16

J Radiol Prot. 2021 Oct 8. doi: 10.1088/1361-6498/ac2e0a. Online ahead of print.

ABSTRACT

This study investigated the variability of indoor radon concentrations in 518,100 homes in the UK. The statistical analysis included measurements in 395,720 homes with downstairs living rooms and upstairs bedrooms. The radon concentration in these bedrooms was found to be on average 63% of the living room value. The analysis of 122,380 homes with living rooms and bedrooms situated on the same floor found that there is a small difference in radon concentration of 9% between the two rooms. The results showed that the ratios of the living room to bedroom radon concentrations were approximately lognormally distributed. The geometric mean of the ratio was found to be 1.6 for rooms situated on different storeys and 1.1 for rooms situated on the same floor. It was found that house characteristics and energy efficiency measures affect the distribution of radon within homes. Detached houses and those with suspended floors had higher radon levels in their upstairs bedroom, 66.7 % and 76.9 % of the downstairs living room values, respectively. For homes built between 1993 and 2007, the bedroom to living room ratio increased from 58.8 % to 76.9 % due to the increased airtightness and improved energy performance of the modern buildings. Homes with installed wall and loft insulation had much higher bedroom to living room ratio (76.9 %) than those without energy efficiency measures (52.6%).

PMID:34624870 | DOI:10.1088/1361-6498/ac2e0a

J Neurosurg Pediatr. 2021 Oct 8:1-8. doi: 10.3171/2021.7.PEDS21263. Online ahead of print.

ABSTRACT

OBJECTIVE: Malignant peripheral nerve sheath tumors (MPNSTs) are rare tumors found throughout the body, with their clinical course in children still not completely understood. Correspondingly, this study aimed to determine survival outcomes and specific clinical predictors of survival in this population from a large national database.

METHODS: All patients with MPNSTs aged ≤ 18 years in the US National Cancer Database (NCDB) between 2005 and 2016 were retrospectively reviewed. Data were summarized, and overall survival was modeled using Kaplan-Meier and Cox regression analyses.

RESULTS: A total of 251 pediatric patients with MPNSTs (132 [53%] females and 119 [47%] males) were identified; the mean age at diagnosis was 13.1 years (range 1-18 years). There were 84 (33%) MPNSTs located in the extremities, 127 (51%) were smaller than 1 cm, and 22 (9%) had metastasis at the time of diagnosis. In terms of treatment, surgery was pursued in 187 patients (74%), chemotherapy in 116 patients (46%), and radiation therapy in 129 patients (61%). The 5-year overall survival rate was estimated at 52% (95% CI 45%-59%), with a median survival of 64 months (range 36-136 months). Multivariate regression revealed that older age (HR 1.10, p < 0.01), metastases at the time of diagnosis (HR 2.14, p = 0.01), and undergoing biopsy only (HR 2.98, p < 0.01) significantly and independently predicted a shorter overall survival. Chemotherapy and radiation therapy were not statistically significant.

CONCLUSIONS: In this study, the authors found that older patient age, tumor metastases at the time of diagnosis, and undergoing only biopsy significantly and independently predicted poorer outcomes. Only approximately half of patients survived to 5 years. These results have shown a clear survival benefit in pursuing maximal safe resection in pediatric patients with MPNSTs. As such, judicious workup with meticulous resection by an expert team should be considered the standard of care for these tumors in children.

PMID:34624851 | DOI:10.3171/2021.7.PEDS21263

J Neurosurg. 2021 Oct 8:1-10. doi: 10.3171/2021.4.JNS204013. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this study was to compare complications, seizures, and neuropsychological outcomes after resective epilepsy surgery in patients ≥ 60 years of age who underwent operations to younger and matched controls.

METHODS: Charts of 2243 patients were screened for operated patients in the authors’ center between 2000 and 2015. Patients with available postsurgical follow-up data who were operated on at the age of 60 years or older and matched (by gender, histopathology, and side of surgery) controls who were between 20 and 40 years of age at the time of surgery were included. Outcomes regarding postoperative seizure control were scored according to the Engel classification and group comparisons were performed by using chi-square statistics.

RESULTS: Data of 20 older patients were compared to those of 60 younger controls. Postoperative seizure control was favorable in the majority of the elderly patients (Engel classes I and II: 75% at 12 months, 65% at last follow-up), but the proportion of patients with favorable outcome tended to be larger in the control group (Engel classes I and II: 90% at 12 months, p = 0.092; 87% at last follow-up, p = 0.032, chi-square test). The surgical complication rate was higher in the elderly population (65% vs 27%, p = 0.002), but relevant persistent deficits occurred in 2 patients of each group only. Neuropsychological and behavioral assessments displayed considerable preoperative impairment and additional postoperative worsening, particularly of verbal skills, memory (p < 0.05), and mood in the elderly.

CONCLUSIONS: The overall favorable postsurgical outcome regarding seizure control and the moderate risk of disabling persistent neurological deficits in elderly patients supports the view that advanced age should not be a barrier per se for resective epilepsy surgery and underscores the importance of an adequate presurgical evaluation and of referral of elderly patients to presurgical assessment.

PMID:34624859 | DOI:10.3171/2021.4.JNS204013