Tag: pubmed

Arch Environ Contam Toxicol. 2022 Dec 25. doi: 10.1007/s00244-022-00973-0. Online ahead of print.

ABSTRACT

The epiphytic lichen Pseudevernia furfuracea was exposed to a simulation of drift deposition rate of the fungicide Fosetyl-Al in an indoor controlled environment by testing two exposure factors: pesticide concentrations (based on the application rates of 4 kg ha^-1 and 1.6 kg ha^-1) and drop sizes (anti-drift nozzle: 386-484 μm; non-anti-drift nozzle: 159-231 μm) for a total of four treatments. Drift for higher application rate was simulated once and that for the lower one twice to reproduce agricultural practices. Following fungicide spraying, we measured the concentration of Fosetyl and phosphonic acid in lichen thalli, and the response of ecophysiological status parameters. No trace of Fosetyl was quantifiable 4 days after each treatment, being detected only phosphonic acid whose concentrations stayed substantially unchanged for the whole duration of the experiment (40 days) and resulting affected by application rate and not by drop size. Both pesticide concentrations caused a remarkable harmful effect that, however, was statistically significant vs control group only starting from the 20th day of stay in the climatic chamber. The drift associated with the higher rate resulted, on average, to be 83% more effective, with the most affected parameters being membrane integrity, lipid peroxidation and photosynthetic pigments. Because the selected lower rate can be considered a quite low value when compared with the rank of used rates for crop protection, the Fosetyl-Al formulate is classifiable as hazardous for its effect on non-target organisms.

PMID:36566463 | DOI:10.1007/s00244-022-00973-0

J Ayub Med Coll Abbottabad. 2022 Oct-Dec;34(4):838-842. doi: 10.55519/JAMC-04-10969.

ABSTRACT

BACKGROUND: It is a common observation that the aortic size of Pakistani population is relatively less as compared to western population. Till now there is no study which has measured the dimensions of abdominal aorta in local population.The standard diameter of an artery across the body is critical for clinicians to recognize when an artery has become aneurysmal. This study aims to present the results of a local population’s normal diameter of an infrarenal aorta and how it varies by age, gender, weight, height, body mass index (BMI) and body surface area (BSA).

METHODS: This cross-sectional observational study was conducted in Vascular Surgery Department, at Combined Military Hospital (CMH), Peshawar, from July 2020 to November 2021.Participants in the study included all patients who underwent a contrast-enhanced computed tomography (CT) scan of the abdomen for any reason other than cardiovascular disease.The infrarenal abdominal aorta’s mean internal diameter (anteroposterior and transverse diameter) was assessed. SPSS v 23 was used to analyze the data and present it as frequency and percentages. The Pearson correlation coefficient assessed the correlation between aortic diameters, weight, height, BMI, and BSA.

RESULTS: Recruitment of a total of 250 patients was done in this study. Males were 194 (77.6%), while the rest were female patients. The patients’ mean age was 39.6±12.8 years. The mean anteroposterior (AP) diameter of the infrarenal aorta was 16.13±2.32 mm. The mean transverse diameter (TD) was 15.96±2.34 mm. The infrarenal diameter of the aorta was smaller in women when compared to men, and the calibre of the aorta increased with the increasing age of the patients. There was a statistically significant positive relationship between their age and the average diameter of the infrarenal aorta (p<0.001) among both men and women.

CONCLUSIONS: Clinicians and vascular surgeons will benefit from the findings in diagnosing and treating abdominal aortic aneurysms. Hence, thoughtful consideration should be made before formulating intervention protocols.

PMID:36566410 | DOI:10.55519/JAMC-04-10969

J Ayub Med Coll Abbottabad. 2022 Oct-Dec;34(4):802-806. doi: 10.55519/JAMC-04-10265.

ABSTRACT

BACKGROUND: Many drugs are effective are used as second line treatment for cutaneous leishmaniasis. Dapsone therapy is tolerated well and cost effective. The aim of present study is to determine the efficacy of oral dapsone in comparison with intramuscular meglumine antimoniate in patients with cutaneous leishmaniasis and thus find out an effective second line treatment agent.

METHODS: This randomized controlled trial was carried out at dermatology department, of tertiary care centre Rawalpindi, Pakistan from November 2017 to June 2018. Hundred biopsy proven patients of cutaneous leishmaniasis completed the study with 50 patients in two group. Group A received intramuscular meglumine antimoniate (15 mg/kg/day). Group B received oral dapsone2.5 mg /kg/body weight /day (200 mg per day). Efficacy of therapeutic response was noted at the end of treatment. Data was analyzed with statistical analysis program (IBM-SPSS V22). Chi-square test was applied to compare efficacy, p value of ≤0.05 was significant. Stratification of data with respect to age, gender, duration of disease, number of lesions and weight was done to see their effect on treatment efficacy. Post stratification chi-square test for both groups was applied (p≤0.05 considered significant).

RESULTS: A total of 100 participants took part in the study. Duration of treatment (p-value <0.001) and the efficacy of the drugs (p-value=0.020) were significant. Meglumine antimoniate therapy group displayed a comparatively fast-paced recovery in (21- 40 days) whereas Dapsone group showed better recovery in (41-60 days) in their lesions.

CONCLUSIONS: Dapsone is an effective treatment for cutaneous Leishmaniasis.

PMID:36566403 | DOI:10.55519/JAMC-04-10265

J Ayub Med Coll Abbottabad. 2022 Oct-Dec;34(4):777-781. doi: 10.55519/JAMC-04-10565.

ABSTRACT

BACKGROUND: Studies are available on the use of inflammatory biomarkers for profiling and patient prognosis, but literature for tocilizumab monitoring parameters is scarce. Thus, we aim to evaluate different inflammatory markers that can relate to the effectiveness of tocilizumab in hospitalized patients suffering from severe covid.

METHODS: We analyzed a retrospective cohort of 227 patients who were admitted due to SAR-Co2 in one of the largest hospitals in Pakistan, Lady Reading Hospital. Using in-hospital mortality as the primary parameter for the effectiveness of tocilizumab. Wilcoxon rank-sum test, chi-square test and ROC curve analysis were performed to evaluate inflammatory biomarkers. The p- values less than 0.05 were considered statistically significant.

RESULTS: A total of 1639 tests were identified from 227 patients admitted to the hospital. CRP (28%), LDH (27.3%) were the most commonly prescribed and 40% of the total test were prescribed pre-dose. D-dimer, ferritin and CRP were found to have a clinically significant impact of the dose.

CONCLUSIONS: D-dimer, ferritin and LDH do not seem to relate proportionally with tocilizumab effectiveness. CRP can be utilized for monitoring tocilizumab effectiveness.

PMID:36566398 | DOI:10.55519/JAMC-04-10565

Acta Gastroenterol Belg. 2022 Oct-Dec;85(4):573-579. doi: 10.51821/85.4.10811.

ABSTRACT

BACKGROUND AND STUDY AIM: Over the last 20 years, cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has progressively become a therapeutic option for peritoneal carcinomatosis thanks to its favourable oncologic results. The aim of this study is to analyse the overall survival and recurrence-free survival, after complete CRS and closed abdomen technique HIPEC for peritoneal carcinomatosis from colorectal cancer.

PATIENTS AND METHODS: This retrospective study collected the data from all patients who underwent a CRS with HIPEC for colorectal cancer at “Cliniques universitaires Saint Luc” from October 2007 to December 2020. Ninety-nine patients were included.

RESULTS: The median follow-up was 34 months. Post-operative mortality and Clavien-Dindo grade III/IV morbidity rates were 2.0% and 28.3%. The overall 2-year and 5-year survival rates were 80.1% and 54.4%. Using the multivariate analysis, age at surgery, liver metastases and PCI score >13 showed a statistically significant negative impact on overall survival. The 2-year and 5-year recurrence-free survival rates were 33.9% and 22%. Using the multivariate analysis, it was found that liver metastases, the extent of carcinomatosis with PCI>7 have a statistically significant negative impact on recurrence-free survival.

CONCLUSIONS: Despite a high recurrence rate, CRS followed by HIPEC to treat peritoneal carcinomatosis from colorectal origin offer encouraging oncologic results with a satisfying survival rate. When PCI>13, CRS and HIPEC does not seem to offer any survival benefit and to efficiently limit recurrence, our data are in favor of a maximum PCI of 7.

PMID:36566366 | DOI:10.51821/85.4.10811

Nutr Clin Pract. 2022 Dec 25. doi: 10.1002/ncp.10945. Online ahead of print.

ABSTRACT

BACKGROUND: Critically ill patients have intense muscle tissue mobilization, and attenuating protein catabolism may contribute to improved outcomes.

OBJECTIVE: To evaluate short-term muscle loss in critically ill patients.

METHODS: In this prospective observational study, we evaluated the thickness of the rectus femoris muscle by ultrasonography in young and older adults of both sexes admitted to a cardiological intensive care unit within 48 h of admission (baseline) and after 7 days. The results were compared and correlated with anthropometric, clinical, and biochemical parameters. The significance level for all statistical analyses was 0.05.

RESULTS: The final sample comprised 88 patients with a mean age of 66.2 ± 11.8 years. There was an average 13.5% reduction in rectus femoris muscle thickness over the study period (P < 0.001), regardless of the thigh circumference maintenance (P = 0.229). This reduction occurred even with improved clinical parameters (C-reactive protein, Simplified Acute Physiology Score) and was greater in patients receiving mechanical ventilation and sedation and in those who died. Regarding nutrition status, malnourished and eutrophic individuals showed greater muscle loss than overweight individuals. There was also an inverse correlation of muscle loss (percentage) with body mass index, arm circumference, and calf circumference (P < 0.05), demonstrating that the lower these anthropometric measurements, the higher the muscle loss obtained by ultrasound.

CONCLUSION: Ultrasonography assessment detected muscle mass loss in the short-term more sensitively than the anthropometric method. However, it demands caution and further studies demonstrating this analysis.

PMID:36566358 | DOI:10.1002/ncp.10945

Sci Rep. 2022 Dec 24;12(1):22286. doi: 10.1038/s41598-022-26482-7.

ABSTRACT

Recent progress in encoder-decoder neural network architecture design has led to significant performance improvements in a wide range of medical image segmentation tasks. However, state-of-the-art networks for a given task may be too computationally demanding to run on affordable hardware, and thus users often resort to practical workarounds by modifying various macro-level design aspects. Two common examples are downsampling of the input images and reducing the network depth or size to meet computer memory constraints. In this paper, we investigate the effects of these changes on segmentation performance and show that image complexity can be used as a guideline in choosing what is best for a given dataset. We consider four statistical measures to quantify image complexity and evaluate their suitability on ten different public datasets. For the purpose of our illustrative experiments, we use DeepLabV3+ (deep large-size), M2U-Net (deep lightweight), U-Net (shallow large-size), and U-Net Lite (shallow lightweight). Our results suggest that median frequency is the best complexity measure when deciding on an acceptable input downsampling factor and using a deep versus shallow, large-size versus lightweight network. For high-complexity datasets, a lightweight network running on the original images may yield better segmentation results than a large-size network running on downsampled images, whereas the opposite may be the case for low-complexity images.

PMID:36566313 | DOI:10.1038/s41598-022-26482-7

Ther Innov Regul Sci. 2022 Dec 24. doi: 10.1007/s43441-022-00485-y. Online ahead of print.

ABSTRACT

Bayesian strategies for planning and analyzing clinical trials have become a viable choice, especially in rare diseases where drug development faces many challenges and stakeholders are interested in innovations that may help overcome them. Disease natural history and clinical outcomes occurrence and variability are often poorly understood. Standard trial designs are not optimized to obtain adequate safety and efficacy data from small numbers of patients. Bayesian methods are well-suited for adaptive trials, with an accelerated learning curve. Using Bayesian statistics can be advantageous in that design choices and their consequences are considered carefully, continuously monitored, and updated where necessary, which ultimately provides a natural and principled way of seamlessly combining prior clinical information with data, within a solid decision theoretical framework. In this article, we introduce the Bayesian option in the rare disease context to support clinical decision-makers in selecting the best choice for their drug development project. Many researchers in drug development show reluctance to using Bayesian statistics, and the top-two reported barriers are insufficient knowledge of Bayesian approaches and a lack of clarity or guidance from regulators. Here we introduce concepts of borrowing, extrapolation, adaptation, and modeling and illustrate them with examples that have been discussed or developed with regulatory bodies to show how Bayesian strategies can be applied to drug development in rare diseases.

PMID:36566312 | DOI:10.1007/s43441-022-00485-y

J Thromb Thrombolysis. 2022 Dec 24. doi: 10.1007/s11239-022-02757-8. Online ahead of print.

ABSTRACT

The ADA (Age-D-dimer-Albumin) score was developed to identify hospitalized patients at an increased risk for thrombosis in the coronavirus infectious disease-19 (COVID-19) setting. The study aimed to validate the ADA score for predicting thrombosis in a non-COVID-19 medically ill population from the APEX trial. The APEX trial was a multinational, randomized trial that evaluated the efficacy and safety of betrixaban vs. enoxaparin among acutely ill hospitalized patients at risk for venous thromboembolism. The study endpoints included the composite of arterial or venous thrombosis and its components. Metrics of model calibration and discrimination were computed for assessing the performance of the ADA score as compared to the IMPROVE score, a well-validated VTE risk assessment model. Among 7,119 medical inpatients, 209 (2.9%) had a thrombosis event up to 77 days of follow-up. The ADA score demonstrated good calibration for both arterial and venous thrombosis, whereas the IMPROVE score had adequate calibration for venous thrombosis (p > 0.05 from the Hosmer-Lemeshow test). For discriminating arterial and venous thrombosis, there was no significant difference between the ADA vs. IMPROVE score (c statistic = 0.620 [95% CI: 0.582 to 0.657] vs. 0.590 [95% CI: 0.556 to 0.624]; ∆ c statistic = 0.030 [95% CI: -0.022 to 0.081]; p = 0.255). Similarly, for discriminating arterial thrombosis, there was no significant difference between the ADA vs. IMPROVE score (c statistic = 0.582 [95% CI: 0.534 to 0.629] vs. 0.609 [95% CI: 0.564 to 0.653]; ∆ c statistic = -0.027 [95% CI: -0.091 to 0.036]; p = 0.397). For discriminating venous thrombosis, the ADA score was modestly superior to the IMPROVE score (c statistic = 0.664 [95% CI: 0.607 to 0.722] vs. 0.573 [95% CI: 0.521 to 0.624]; ∆ c statistic = 0.091 [95% CI: 0.011 to 0.172]; p = 0.026). The ADA score had a higher sensitivity (0.579 [95% CI: 0.512 to 0.646]; vs. 0.440 [95% CI: 0.373 to 0.507]) but lower specificity (0.625 [95% CI: 0.614 to 0.637] vs. 0.747 [95% CI: 0.737 to 0.758]) than the IMPROVE score for predicting thrombosis. Among acutely ill hospitalized medical patients enrolled in the APEX trial, the ADA score demonstrated good calibration but suboptimal discrimination for predicting thrombosis. The findings support the use of either the ADA or IMPROVE score for thrombosis risk assessment. The applicability of the ADA score to non-COVID-19 populations warrants further research.Clinical Trial Registration: http://www.clinicaltrials.gov . Unique identifier: NCT01583218.

PMID:36566304 | DOI:10.1007/s11239-022-02757-8

Sci Rep. 2022 Dec 24;12(1):22289. doi: 10.1038/s41598-022-25135-z.

ABSTRACT

There were few data regarding the association of volume status with sarcopenia using muscle mass, strength, and physical performance in non-dialysis chronic kidney disease (ND-CKD) patients. We aimed to evaluate the association between volume status and sarcopenia in ND-CKD patients. Our retrospective study analyzed data from a previous study which included ND-CKD patients who had stable renal function. Our study used its baseline data alone. The edema index and muscle mass were measured using a multi-frequency bioimpedance analysis machine. The edema index was calculated using extracellular water/total body water ratio. The skeletal muscle index (SMI, kg/m²) was calculated using appendicular muscle mass per height squared. Handgrip strength (HGS, kg) was measured during the standing position in all patients. Dynamic gait speed (GS, m/s) was evaluated using 6-m walking speed. Patients with both low muscle mass (SMI < 7.0 kg/m² for men and < 5.7 kg/m² for women using bioimpedance analysis) and low HGS (< 28 kg for men and < 18 kg for women) or low GS (< 1.0 m/s) were classified as having sarcopenia. The patients (n = 147) were divided into tertiles based on the edema index level. The mean edema index in the low, middle, and high tertiles was 0.377 ± 0.006, 0.390 ± 0.003, and 0.402 ± 0.006, respectively. The edema index was significantly correlated with SMI, HGS, and GS (r = – 0.343 for SMI, – 0.492 for HGS, and – 0.331 for GS; P < 0.001 for three indicators). The SMI, HGS, and GS values were 8.1 ± 1.0 kg/m², 33.0 ± 9.4 kg, and 1.2 ± 0.2 m/s in the low tertile,7.8 ± 1.2 kg/m², 30.0 ± 7.5 kg, and 1.0 ± 0.3 m/s in the middle tertile, and 7.2 ± 1.4 kg/m², 23.7 ± 7.4 kg, and 1.0 ± 0.3 m/s in the high tertile, respectively. Univariate analyses revealed that SMI was lower in patients in the high tertile than in those in the low tertile. HGS was lowest in high tertile, and GS was greatest in the low tertile. The high tertile for predicting sarcopenia had an odds ratio of 6.03 (95% CI, 1.78-20.37; P = 0.004) compared to low or middle tertiles. The results of multivariate analyses were similar to those of the univariate analyses. The subgroup analyses showed that statistical significance was greater in < 65 years and men than ≥ 65 years and women. The present study showed that the edema index is inversely associated with sarcopenia, muscle mass index, strength, and physical performance in ND-CKD patients. However, considering the limitations of our study such as its small sample size, this association was not strong. Further studies that include volume-independent measurements, data on physical activity and diet, and a larger number of patients are warranted to overcome these limitations.

PMID:36566275 | DOI:10.1038/s41598-022-25135-z