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Nevin Manimala Statistics

Identifying Potential Factors Associated with High HIV viral load in KwaZulu-Natal, South Africa using Multiple Correspondence Analysis and Random Forest Analysis

BMC Med Res Methodol. 2022 Jun 17;22(1):174. doi: 10.1186/s12874-022-01625-6.

ABSTRACT

BACKGROUND: Sustainable Human Immunodeficiency Virus (HIV) virological suppression is crucial to achieving the Joint United Nations Programme of HIV/AIDS (UNAIDS) 95-95-95 treatment targets to reduce the risk of onward HIV transmission. Exploratory data analysis is an integral part of statistical analysis which aids variable selection from complex survey data for further confirmatory analysis.

METHODS: In this study, we divulge participants’ epidemiological and biological factors with high HIV RNA viral load (HHVL) from an HIV Incidence Provincial Surveillance System (HIPSS) sequential cross-sectional survey between 2014 and 2015 KwaZulu-Natal, South Africa. Using multiple correspondence analysis (MCA) and random forest analysis (RFA), we analyzed the linkage between socio-demographic, behavioral, psycho-social, and biological factors associated with HHVL, defined as ≥400 copies per m/L.

RESULTS: Out of 3956 in 2014 and 3868 in 2015, 50.1% and 41% of participants, respectively, had HHVL. MCA and RFA revealed that knowledge of HIV status, ART use, ARV dosage, current CD4 cell count, perceived risk of contracting HIV, number of lifetime HIV tests, number of lifetime sex partners, and ever diagnosed with TB were consistent potential factors identified to be associated with high HIV viral load in the 2014 and 2015 surveys. Based on MCA findings, diverse categories of variables identified with HHVL were, did not know HIV status, not on ART, on multiple dosages of ARV, with less likely perceived risk of contracting HIV and having two or more lifetime sexual partners.

CONCLUSION: The high proportion of individuals with HHVL suggests that the UNAIDS 95-95-95 goal of HIV viral suppression is less likely to be achieved. Based on performance and visualization evaluation, MCA was selected as the best and essential exploration tool for identifying and understanding categorical variables’ significant associations and interactions to enhance individual epidemiological understanding of high HIV viral load. When faced with complex survey data and challenges of variables selection in research, exploratory data analysis with robust graphical visualization and reliability that can reveal divers’ structures should be considered.

PMID:35715730 | DOI:10.1186/s12874-022-01625-6

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Nevin Manimala Statistics

Parastomal Hernia Rates and Exercise Following Ostomy Surgery

Dis Colon Rectum. 2022 Jan 31. doi: 10.1097/DCR.0000000000002395. Online ahead of print.

ABSTRACT

BACKGROUND: Parastomal hernias are common complications following ostomy surgery and affect the patient’s quality of life. We hypothesized that the patient’s physical activity (or lack thereof) might be associated with presence of parastomal hernia. If so, this might be an actionable target for prevention.

OBJECTIVE: The objective was to determine rates of and risk factors for parastomal hernias in patients who underwent surgery resulting in a permanent ostomy.

DESIGN: This was a retrospective cohort and survey study. Postal survey included questions about parastomal hernia, symptoms, lifestyle, and validated instruments to measure stoma quality of life and physical activity. Chart abstraction was conducted for clinical comorbidities.

SETTINGS: This study was conducted in single, large academic medical center.

PATIENTS: Patients who underwent operations that included a permanent urostomy, colostomy, and/or ileostomy between 2014 and 2018 were included in the study.

MAIN OUTCOME MEASURES: Parastomal hernia (self-reported) and physical activity, measured in total activity metabolic equivalent-minutes/week, were our main outcome measures. Quality of life was also assessed.

RESULTS: A total of 443 of 724 patients responded to the survey (response rate, 61.2%). 212 patients (47.9%) had urostomies, 160 (36.1%) had colostomies, and 99 (22.3%) had ileostomies. 128 patients (29.7%) had a parastomal hernia, with rates of 27.1% for urostomy, 40.0% for colostomy, and 23.7% for ileostomy. There was a statistically-significant association between less exercise and higher incidence of parastomal hernia (median, 579 metabolic equivalent -minutes/week for those with parastomal hernias v. 1689 for those without; p = 0.001).

LIMITATIONS: The association between physical activity and parastomal hernia may be confounded by obesity, or by the fact that parastomal hernia patients may have less physical activity due to their hernia.

CONCLUSIONS: Parastomal hernia rates remain high in modern surgical practice, and hernias are associated with poorer quality of life. This study shows an association between patients’ physical activity and the presence of a parastomal hernia, with a higher rate among patients who exercise less. See Video Abstract at http://links.lww.com/DCR/B910.

PMID:35714337 | DOI:10.1097/DCR.0000000000002395

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Nevin Manimala Statistics

Dose-Intensified Infliximab Rescue Therapy for Severe Ulcerative Colitis Does not Reduce Short-term Colectomy Rates or Increase Postoperative Complications

Dis Colon Rectum. 2021 Dec 13. doi: 10.1097/DCR.0000000000002176. Online ahead of print.

ABSTRACT

BACKGROUND: Dose-intensified rescue therapy with infliximab for hospitalized patients with ulcerative colitis has become increasingly popular in recent years. However, there is ongoing debate about both the efficacy of these regimens to reduce the rate of colectomy and the associated risks of increased infliximab exposure.

OBJECTIVE: The purpose of this study was to compare the colectomy and postoperative complication rates in hospitalized patients with severe ulcerative colitis receiving standard infliximab induction therapy (3 doses of 5mg/kg at week 0, 2, 6) and dose-intensified regimens including a higher weight-based dosing or more rapid interval.

DESIGN: This was a retrospective cohort study.

SETTINGS: This study was conducted at an academic tertiary care hospital.

PATIENTS: A total of145 adult patients receiving inpatient rescue infliximab therapy for the treatment of ulcerative colitis between 2008 and 2020.

MAIN OUTCOME MEASURES: The primary outcome was colectomy rate within 3 months of rescue therapy. Secondary outcomes include mid-term colectomy rates as well as perioperative complications in patients receiving colectomy within 3 months of rescue infliximab initiation.

RESULTS: The proportion of dose-intensified regimens increased over time. Unadjusted 3-month colectomy rates were 14% in patients who received standard rescue infliximab dosing, 16% in patients given a single dose-escalated dose, and 24% in patients given multiple inpatient dose-escalated doses. These rates were not statistically significantly different. Of the patients requiring colectomy within 3 months of infliximab rescue, those who received multiple inpatient doses of dose-escalated therapy had a higher percentage of colectomy during the initial hospitalization but a lower rate of perioperative complications.

LIMITATIONS: Retrospective data and limited power to account for heterogeneity of disease.

CONCLUSIONS: No significant difference was found in colectomy rates between patients receiving standard or dose-intensified regimens. However, dose-intensified regimens, including multiple inpatient doses given to patients with more severe disease, were not associated with a greater risk of perioperative complications. See Video Abstract at http://links.lww.com/DCR/B864.

PMID:35714346 | DOI:10.1097/DCR.0000000000002176

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Nevin Manimala Statistics

Using surrogate information to improve confirmatory platform trial with sample size re-estimation

J Biopharm Stat. 2022 Jun 17:1-20. doi: 10.1080/10543406.2022.2080693. Online ahead of print.

ABSTRACT

Platform design which allows exploring multiple arms with a common control simultaneously is becoming essential for efficient drug development. However, one of the critical challenges for confirmatory platform trials is immature data for interim decisions, particularly for the treatment arm selection and sample size determination with limited data available. We use a modified conditional power (CP) for both treatment arm selection and sample size determination at interim analysis for the proposed platform trial. The modified CP uses the available data from both primary and surrogate endpoints. We also demonstrated the application in a case study of a lung cancer trial.

PMID:35714331 | DOI:10.1080/10543406.2022.2080693

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Nevin Manimala Statistics

COVID-19 Posttraumatic Stress Disorder in Clinical Nurse Specialists

Clin Nurse Spec. 2022 Jul-Aug 01;36(4):183-189. doi: 10.1097/NUR.0000000000000679.

ABSTRACT

PURPOSE: The purpose of this study was to examine if a relationship exists between the coronavirus 2019 pandemic and posttraumatic stress disorder in clinical nurse specialists.

DESIGN: The study used a nonexperimental, correlational, cross-sectional design to explore the relationship between exposure to the coronavirus 2019 pandemic and posttraumatic stress disorder signs and symptoms.

METHODS: The National Association of Clinical Nurse Specialists distributed the electronic survey from August to October 2020. State affiliates and accrediting bodies distributed the survey from October to December 2020. The survey consisted of the Impact of Events Scale – Revised, which measures signs and symptoms of posttraumatic stress disorder. The target sample size was at least 100.

RESULTS: Statistically significant relationships were identified between the participant demographics, coronavirus 2019 exposure, and signs and symptoms of posttraumatic stress disorder in clinical nurse specialists. Of 129 participants, 30% had Impact of Events Scale – Revised scores that are clinically concerning for posttraumatic stress disorder.

CONCLUSIONS: Clinical nurse specialists can guide policy, practice, and education interventions to combat posttraumatic stress disorder due to the coronavirus 2019 pandemic.

PMID:35714320 | DOI:10.1097/NUR.0000000000000679

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Nevin Manimala Statistics

Assessment of natural and anthropogenic factors on the distribution of chemical elements in soil from the Skopje region, North Macedonia

J Environ Sci Health A Tox Hazard Subst Environ Eng. 2022;57(5):357-375. doi: 10.1080/10934529.2022.2067444.

ABSTRACT

The main objective of this study is to present the distribution of different chemical elements in soil samples from the Skopje region, North Macedonia. To determine the level of presence of chemical elements, soil samples are collected from a total of 60 locations. From each location, from an area of 5 × 5 km2 samples of soil are collected: topsoil (0-5 cm) and subsoil (20-30 cm). The soil samples were analyzed for 69 elements by using two instrumental methods: inductively coupled plasma-atomic emission spectrometry (ICP-AES) for macro-elements and inductively coupled plasma-mass spectrometry (ICP-MS) for trace elements. A factor analysis was applied to analyze the factors affecting the linear combination variables grouped at the same factor. Spatial distribution maps of each factor as well as distribution maps for the analyzed elements were prepared by universal kriging interpolation. It was found that the distribution of most elements follows the lithology of the examined area, except for some elements (Cd, Cu, Fe, Hg, Mn, Pb, and Zn) whose higher contents are found in the area of the city of Skopje as a result of urban and industrial activities (traffic, metal processing, fossil fuel combustion for heating).

PMID:35714291 | DOI:10.1080/10934529.2022.2067444

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Nevin Manimala Statistics

Human papillomavirus (HPV) vaccination intent and its associated factors: a study of ethnically diverse married women aged 27 to 45 in Malaysia, a Southeast Asian country

Hum Vaccin Immunother. 2022 Jun 17:2076525. doi: 10.1080/21645515.2022.2076525. Online ahead of print.

ABSTRACT

INTRODUCTION: This study aimed to investigate HPV vaccination intention among adult married women aged 27 to 45 years and its associated factors, and their spouse/partner’s influence on HPV vaccination decision-making.

METHODS: This is a cross-sectional, questionnaire-based study. Study participants were recruited through simple random sampling of patients attending obstetrics and gynecology outpatient clinics in a university teaching hospital.Participants were selected based on a computer-generated list of a random list of patients attending the clinic.

RESULTS: A total of 794 complete responses were received (response rate 88.2%). The mean age of the respondents was 32.2 years with a standard deviation (SD) of ±3.9 years.The vast majority (85.3%) would communicate with their spouse/partner with regard to HPV vaccination decision-making. Nearly 30% (over half were of the Malay ethnic group) perceived their spouse/partner would not consent to their HPV vaccination. Over half (54.9%) reported joint decision-making, and 9.1% (the majority of whom were Malay) reported that HPV vaccination was dependent on their spouse/partner’s decision. Intention to vaccinate against HPV was high (74.5%). Factors influencing HPV vaccination intention were spouse/partner’s consent to HPV vaccination (odds ratio [OR] = 4.51; 95% confidence interval [CI], 3.08-6.62), being a postgraduate student (OR = 4.55 ; 95% CI, 2.13-9.72 vs. unemployed/housewife), average household income MYR2000-4000 (OR = 2.09 ; 95%CI, 1.16-3.78 vs. below MYR2000), and an HPV-related knowledge score of 9-20 (OR = 1.60 ; 95% CI, 1.10-2.32 vs. score 0-8).

CONCLUSION: Findings highlight the importance of culture-centered interventions to enhance male partner’s awareness and support for the HPV vaccination of married women.

PMID:35714272 | DOI:10.1080/21645515.2022.2076525

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The Evaluation of Correlation Between Serum PTH and Dentoskeletal Changes in Panoramic Imaging of Hemodialysis Patients

Iran J Kidney Dis. 2022 May;16(3):203-208.

ABSTRACT

INTRODUCTION: This study aimed to investigate the relationship between serum levels of PTH and dental and bone changes in the panoramic view of hemodialysis patients.

METHODS: Out of 236 patients with end-stage kidney disease (ESKD) who were hospitalized in two hemodialysis centers, 68 ones were selected and concerning their PTH serum levels, they were assigned to case group (PTH > 300 pg/mL) and control group (150 < PTH < 300 pg/mL). Patients in both groups had undergone dialysis for at least 6 months. After intraoral and extraoral examinations, panoramic radiography was performed for patients who hadn’t taken any panoramic radiograph within 6 months prior to our study. All radiographs were evaluated for DMFT (decayed, missing and filled teeth) index, bone resorption, periodontal ligament (PDL), lamina dura, mandibular cortical thickness, bone granular pattern, pulp and periapical lesion and giant cell (brown) tumor. The results were analyzed by Chi square statistical tests. Significant level (P value) of test was considered less than .05.

RESULTS: Among the eight variables, there was only a significant statistical difference between the case and control groups in the granular bone pattern and inferior mandibular cortex thickness.

CONCLUSION: High levels of PTH in hemodialysis patients with secondary hyperparathyroidism can significantly change the trabecular alveolar bone pattern to a granular bone pattern. It also dramatically decreases the thickness of the inferior mandibular cortex. The findings of this study could influence the dental treatment plans for ESKD patients and help in early diagnosis of osteoporosis in patients on dialysis with secondary hyperparathyroidism. DOI: 10.52547/ijkd.6817.

PMID:35714215

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Nevin Manimala Statistics

Auryon Laser in Treating Symptomatic Infrainguinal Arterial Disease: 1-Year Outcome

J Invasive Cardiol. 2022 Jun 17:JIC20220617-2. Online ahead of print.

ABSTRACT

BACKGROUND: The Auryon 355-nm laser atherectomy system (AngioDynamics, Inc) showed a low rate of target-lesion revascularization (TLR) at 6-month follow-up in the EX-PAD-03 investigational device exemption study and the Auryon single-center experience (SCE) in treating infrainguinal arteries. In this study, we present the 1-year outcomes of the Auryon SCE study on TLR in all comers at a single center.

METHODS: The Auryon SCE was a retrospective study that evaluated the outcomes of all comers treated with the Auryon laser for infrainguinal arterial disease. There was no TLR seen at 6-month follow-up. We present the TLR rate at 1 year in the same cohort of patients. TLR rates were obtained from medical record review of patients enrolled in the study who had completed office visit follow-up at 1 year. Secondary endpoints included unplanned major amputation and total mortality. Kaplan-Meier survival analysis was performed to estimate the freedom from TLR rate following index procedure. Statistical differences were analyzed for ankle-brachial index (ABI) between baseline and 1 year.

RESULTS: A total of 56 patients (65 procedures, 70 lesions) were enrolled. The mean age was 70.9 ± 10 years, with 66.1% males, 48.2% diabetics, and 25% demonstrating limb ischemia. Of the 70 lesions, 31.4% had severe calcification, 38.6% were chronic total occlusions, and 48.6% were de novo disease (in-stent restenosis, 29.6%). Stenting was performed in 24/70 lesions (34.3%), with 11/70 (15.7%) bailout procedures. Embolic filters were used in 26/65 procedures (40%). The majority of treated lesions were femoropopliteal (90.0%); of all procedures, 29.2% had 2 or more prior interventions. Drug-coated balloon usage was 47.1% Lutonix (BD/Bard), 27.1% In.Pact (Boston Scientific), and 1.4% both in all lesions treated. Distal embolization occurred in 1/65 procedures (1.5%). At 1 year, mortality occurred in 3/56 patients (5.4%). Of 65 limbs treated, 2 (3.1%) had major amputation at 1 year. The probability of freedom from TLR was 83.7%.

CONCLUSION: In a realworld cohort of patient with complex disease, the Auryon laser had excellent freedom from TLR at 1 year.

PMID:35714224

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Nevin Manimala Statistics

Profilometric, volumetric, and esthetic analysis of guided bone regeneration with L-shaped collagenated bone substitute and connective tissue graft in the maxillary esthetic zone: A case series with 1-year observational study

Clin Implant Dent Relat Res. 2022 Jun 17. doi: 10.1111/cid.13116. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study was to evaluate 1-year stability and maintenance of peri-implant soft and hard tissues after guided bone regeneration (GBR) with L-shaped collagenated bone substitute and subepithelial connective tissue graft (CTG) in the maxillary anterior region using profilometric, volumetric, and esthetic analyses.

METHODS: Fourteen peri-implant defects were grafted with L-shaped collagenated bone substitute, and 5 months after implant placement with GBR, reentry surgery in combination with CTG was performed in all participants. CBCT scans and STL files were acquired at baseline (after implant surgery, T1), reentry surgery (T2), and 1-year follow-up (T3). The profilometric and volumetric changes of the peri-implant tissues were measured, and the pink esthetic score (PES) was assessed at T3.

RESULTS: One year after GBR and CTG at the buccal aspect of the maxillary esthetic zone, the mean thickness of the hard tissue (HT) decreased (HT0: -0.87 ± 0.67 mm, HT1: -0.74 ± 0.75 mm, HT2: -0.92 ± 0.48 mm, 45-HT: -0.87 ± 0.73 mm) and the corresponding thickness of the soft tissue (ST) increased (ST0: 0.96 ± 1.06 mm, ST1: 0.85 ± 0.95 mm, ST2: 0.38 ± 0.82 mm, 45-ST: 0.12 ± 0.62 mm), and as a result, there was no statistically significant difference in the total tissue thickness between T1 and T3 (p < 0.05). The mean volumetric changes of the peri-implant tissues increased after 1-year of implant surgery (T1-T2: 1.52 ± 0.83 mm, T2-T3: -0.88 ± 1.04 mm, T1-T3: 0.64 ± 0.90 mm), and a statistically significant difference was shown in all compared time periods (p < 0.05). The mean PES score was 8.07 ± 1.54 at T3 (range, 6-10).

CONCLUSION: Within the limitations of this 1-year follow-up study, GBR with an L-shaped collagenated bone substitute and subepithelial CTG in the maxillary esthetic zone was beneficial for stable and maintainable peri-implant hard and soft tissues.

PMID:35714206 | DOI:10.1111/cid.13116