Tag: pubmed

Ocul Immunol Inflamm. 2021 Jul 7:1-6. doi: 10.1080/09273948.2021.1934036. Online ahead of print.

ABSTRACT

Purpose: To compare an analog visual scale in grading anterior chamber cells (ACC) to a modified Standardization of Uveitis Nomenclature (SUN) ACC scale.Method: A graphical representation of anterior chamber cells as a reference and a test set was created and shown to two groups of experienced uveitis experts. Group 1 was given the analog scale in written format, while group two was given the reference images for comparison. Each test subject was asked to provide the best approximation for each grade.Results: Eleven graders participated in phase 1. Correct grading occurred in 87.4% of cases. Discrepancies were seen at all grades. Only 3 of 11 graders were able to achieve a perfect score. Seven graders participated in phase 2. Agreement was 95.2% with 4/7 graders achieving a perfect score. Discrepancies were seen at higher grades only.Conclusions: ACC grading is improved by a visual grading scale, and interobserver variability is reduced.

PMID:34232824 | DOI:10.1080/09273948.2021.1934036

Prehosp Emerg Care. 2021 Jul 7:1-9. doi: 10.1080/10903127.2021.1951407. Online ahead of print.

ABSTRACT

Background: Research networks need access to EMS data to conduct pilot studies and determine feasibility of prospective studies. Combining data across EMS agencies is complicated and costly. Leveraging the National EMS Information System (NEMSIS) to extract select agencies’ data may be an efficient and cost-effective method of providing network-level data.Objective: Describe the process of creating a Pediatric Emergency Care Applied Research Network (PECARN) specific NEMSIS data set and determine if these data were nationally representative.Methods: We established data use agreements (DUAs) with EMS agencies participating in PECARN to allow for agency identification through NEMSIS. Using 2019 NEMSIS version 3.4.0 data for EMS events with patients 18 years old and younger, we compared PECARN NEMSIS data to national NEMSIS data. Analyzed variables were selected for their ability to characterize events. No statistical analyses were utilized due to the large sample, instead, differences of ±5% were deemed clinically meaningful.Results: DUAs were established for 19 EMS agencies, creating a PECARN data set with 305,188 EMS activations of which 17,478 (5.7%) were pediatric. Of the pediatric activations, 17,140 (98.1%) were initiated through 9-1-1 and 9,487 (55.4%) resulted in transport by the documenting agency. The national data included 36,288,405 EMS activations of which 2,152,849 (5.9%) were pediatric. Of the pediatric activations 1,704,141 (79.2%) were initiated through 9-1-1 and 1,055,504 (61.9%) were transported by the documenting agency. Age and gender distributions were similar between the two groups, but the PECARN-specific data under-represents Black and Latinx patients. Comparison of EMS provider primary impressions revealed that three of the five most common were similar with injury being the most prevalent for both data sets along with mental/behavioral health and seizure.Conclusion: We demonstrated that NEMSIS can be leveraged to create network specific data sets. The PECARN’s EMS data were similar to the national data, though racial/ethnic minorities and some primary impressions may be under-represented. Additionally, more EMS activations in PECARN study areas originated through 9-1-1 and were treated and transported by the documenting agency. This is likely related to the type of participating agencies, their ALS response level, and the diversity of the communities they serve.

PMID:34232828 | DOI:10.1080/10903127.2021.1951407

J Ocul Pharmacol Ther. 2021 Jul 7. doi: 10.1089/jop.2021.0033. Online ahead of print.

ABSTRACT

Purpose: To determine the effect of discontinuing chronic topical immune modulating (IM) treatment on Schirmer tear test (STT) values in dogs with dry eye disease (DED). Methods: Serial measurements of STTs from 14 dogs (16 eyes) previously diagnosed with DED were obtained before and after discontinuation of topical IM agents. Dogs with moderate to severe DED that had been well controlled with a topical IM treatment were included. After initial assessment topical IM treatment was discontinued, but topical lubricant was continued, and STT values were obtained sequentially. A mixed-effects regression model was used to evaluate the effects of age, gender, breed, clinical score, frequency of treatment, baseline STT value, and drug type on final STT values after IM withdrawal. P < 0.05 was considered statistically significant. Results: During the follow-up period after the IM treatment had been discontinued (136 ± 29 days), 50% of the eyes (n = 8) exhibited STT values that never decreased to <10 mm/min. In the other 50% (n = 8), STT values decreased from 15.9 ± 4.7 mm/min to 6.1 ± 0.9 mm/min. In this group, the time it took to decrease the STT to <10 mm/min was 21.1 ± 9.5 days. Severe clinical signs of DED and low baseline STT pre-IM treatment significantly affected STT post-IM treatment withdrawal (P < 0.05). Conclusions: The duration that a residual effect of topical IM treatment persists needs to be taken into consideration when studies are designed utilizing dogs with previous IM treatment for DED.

PMID:34232790 | DOI:10.1089/jop.2021.0033

Rev Med Inst Mex Seguro Soc. 2021 Jun 14;59(2):127-132.

ABSTRACT

BACKGROUND: Infections increase morbidity and mortality in patients with autoimmune disorders; however, this association has not been established in rheumatic diseases and SARS-CoV-2 infection.

OBJECTIVE: To describe the clinical characteristics and mortality of patients with rheumatic diseases and severe COVID-19.

MATERIAL AND METHODS: Observational and descriptive case series in patients with rheumatic diseases and severe SARS-CoV-2 infection, confirmed by PCR or pulmonary tomography, hospitalized in Mexico City from March to August 2020.

RESULTS: 15 patients with a mean age of 57 years (SD ± 11) were included, 66.6% were women, and 80% had a positive PCR test. The time from onset of symptoms to hospitalization, on average, was 7.2 days (SD ± 2.1). 46.6% died. Patients who died had a lower mean platelet level compared to survivors. The inflammatory reactants were higher in the deceased. There were no statistically significant differences in mortality for the variables related to rheumatic disease.

CONCLUSIONS: The differences in mortality of patients with severe COVID-19 in this series of cases seem to be related to the infection and not to the rheumatic disease.

PMID:34231984

J Drugs Dermatol. 2021 Jul 1;20(7):767-770. doi: 10.36849/JDD.5732.

ABSTRACT

BACKGROUND: Dermatology is among the least racially/ethnically diverse medical specialties in the US Dermatology Interest Groups (DIGs). DIGs may play a critical role in addressing these disparities by facilitating early exposure and mentorship, both associated with higher rates of medical students pursuing specific fields.

OBJECTIVE: This study sought to characterize the activities, goals, and challenges of DIGs in medical schools nationwide.

METHODS: A 15-question survey was distributed electronically to 92 DIG leaders enrolled in four-year accredited allopathic/osteopathic medical schools nationwide. Data collected included DIG leaders&rsquo; demographic information, medical training stage, DIG size/age, number/type of DIG activities hosted, presence of faculty/resident mentors, and goals/challenges.

RESULTS: There were 48 total and 46 complete responses (52% response rate). Most DIG leaders were female (81%), white (63%), and from allopathic medical schools of roughly equal geographic distribution. Over three-quarters of DIGs had affiliated dermatology departments and residencies. Most had faculty advisors; few had resident mentors. Presence of an affiliated dermatology department was associated with statistically significant increase in mentoring opportunities (P=0.034), significantly increased odds of having dedicated faculty mentors (OR=6.10, 95%CI 1.11&ndash;33.56), and non-significantly increased odds of having dedicated resident mentors (OR=2.96, 95%CI 0.33&ndash;26.79). DIG leaders self-identified early dermatology exposure, aiding in the match, relationship-building, and community engagement as main objectives and mismatches in opportunities, time, funding, and interest as main challenges.

CONCLUSIONS: DIGs provide valuable opportunities to medical students exploring the field and may play a role in reducing future dermatology workforce disparities. Dermatology departments, residencies, and medical schools should support their aims and reduce structural barriers to success. J Drugs Dermatol. 2021;20(7):767-770. doi:10.36849/JDD.5732.

PMID:34231994 | DOI:10.36849/JDD.5732

J Drugs Dermatol. 2021 Jul 1;20(7):744. doi: 10.36849/JDD.735.

ABSTRACT

BACKGROUND: Few studies have examined topical psoriasis therapies in patients with skin of color. Fixed-combination halobetasol propionate (0.01%) and tazarotene (0.045%) lotion (HP/TAZ) was investigated in two phase 3, multicenter, double-blind, vehicle-controlled trials (NCT02462070; NCT02462122). This post hoc analysis evaluated HP/TAZ in subgroups of non-White and White participants, including Hispanic/Latino participants, from these trials.

METHODS: Adult participants were randomized (2:1) to receive HP/TAZ or vehicle lotion once daily for 8 weeks. Data were pooled and analyzed in non-mutually exclusive subgroups of self-identified non-White or White and Hispanic/Latino participants. Efficacy assessments included treatment success (&ge;2-grade improvement from baseline in investigator&rsquo;s global assessment [IGA] and score of clear/almost clear), reduction from baseline in affected body surface area (BSA), and reduction in mean IGA &times; BSA. Safety was evaluated via treatment-emergent adverse events (TEAEs).

RESULTS: Of 418 participants, 60 and 358 self-identified as non-White and White, respectively; 115 of 418 participants self-identified as Hispanic/Latino. At week 8, a higher percentage of HP/TAZ-treated participants achieved treatment success vs vehicle (non-White, 34.4% vs 19.0%; White, 41.8% vs 8.7%; Hispanic/Latino, 39.3% vs 9.3%); rates for White and Hispanic/Latino participants were statistically significant. Compared with vehicle, HP/TAZ-treated participants in each subgroup experienced numerically greater reductions in affected BSA and IGA &times; BSA at week 8. The most common TEAEs were contact dermatitis, pruritus, nasopharyngitis, and application-site pain; discontinuations due to TEAEs were few.

CONCLUSIONS: HP/TAZ reduced disease severity in non-White, White, and Hispanic/Latino participants with psoriasis, with good tolerability and safety over 8 weeks of treatment. J Drugs Dermatol. 2021;20(7):735-744. doi:10.36849/JDD.6158.

PMID:34232005 | DOI:10.36849/JDD.735

Rev Med Inst Mex Seguro Soc. 2021 Jun 14;59(2):110-118.

ABSTRACT

BACKGROUND: Occupational accidents represent an important problem that affects workers, families, society, industry, social security institutions and the nation as a whole, which affects directly the global economy.

OBJECTIVE: To assess the direct costs of occupational accidents at the Baja California Local Office of the Instituto Mexicano del Seguro Social (IMSS -Mexican Institute for Social Security-) in 2017.

MATERIAL AND METHODS: Cross-sectional descriptive study; the information was obtained from IMSS 2017 Statistical Memory and Baja California Local Office database. We analyzed 26,657 cases of work-related accidents and diseases. Years of potential productive life lost were calculated with the years of potential productive life lost indicator and the accumulated years of potential productive life lost indicator.

RESULTS: 97,901 certificates of temporary incapacity for work were issued in Baja California with a total amount of 150,284,001 Mexican pesos. 1593 permanent disabilities were granted with an average monthly amount of 3830 pesos and a total of 8982 accumulated years of potential productive life lost. 38 death certificates by work-related risks were issued and accounted for a total of 1048 years of potential productive life lost and 182 491 pesos for funeral expenses.

CONCLUSIONS: Direct costs of occupational accidents and diseases in the Baja California Local Office of IMSS have an impact on economic growth. Concerted efforts are needed to achieve a progressive reduction of work-related fatalities, accidents and diseases.

PMID:34231982

Rev Med Inst Mex Seguro Soc. 2021 Jun 14;59(2):119-126.

ABSTRACT

BACKGROUND: Chronic degenerative diseases have become a challenge for the Mexican health system. Faced with this problem, health institutions have focused on the therapeutic potential of organ and tissue donation and transplantation.

OBJECTIVE: To analyze the experience of the donation program and to identify areas of opportunity at the Hospital de Cardiología No. 34 (Hospital of Cardiology Number 34), in Monterrey, Nuevo León, Mexico.

MATERIAL AND METHODS: Observational, cross-sectional, and retrospective study. The study population was made up by deaths and successful interviews. Only groupings with values of p < 0.05 were considered statistically significant.

RESULTS: A global of 1947 deaths were registered and a total of 210 interviews were carried out; 83 (39.5%) family members accepted to donate and 127 (60.5%) refused to donate. Only 3 associations between variables had significant statistical value. The year was an important determinant in the increase in effective donations (p = 0.010), and so was the month of the year (p = 0.037), obtaining more positive interviews in the second half of the year; finally, the shift also contributed to the family response (p = 0.012), with the morning shift being the best shift to conduct a successful family interview.

CONCLUSIONS: It is imperative to conduct studies that analyze and describe the experience of donation programs to promote and encourage the value of donation.

PMID:34231983

J Appl Clin Med Phys. 2021 Jul 7. doi: 10.1002/acm2.13340. Online ahead of print.

ABSTRACT

PURPOSE: To estimate the overall spatial distortion on clinical patient images for a 0.35 T MR-guided radiotherapy system.

METHODS: Ten patients with head-and-neck cancer underwent CT and MR simulations with identical immobilization. The MR images underwent the standard systematic distortion correction post-processing. The images were rigidly registered and landmark-based analysis was performed by an anatomical expert. Distortion was quantified using Euclidean distance between each landmark pair and tagged by tissue interface: bone-tissue, soft tissue, or air-tissue. For baseline comparisons, an anthropomorphic phantom was imaged and analyzed.

RESULTS: The average spatial discrepancy between CT and MR landmarks was 1.15 ± 1.14 mm for the phantom and 1.46 ± 1.78 mm for patients. The error histogram peaked at 0-1 mm. 66% of the discrepancies were <2 mm and 51% <1 mm. In the patient data, statistically significant differences (p-values < 0.0001) were found between the different tissue interfaces with averages of 0.88 ± 1.24 mm, 2.01 ± 2.20 mm, and 1.41 ± 1.56 mm for the air/tissue, bone/tissue, and soft tissue, respectively. The distortion generally correlated with the in-plane radial distance from the image center along the longitudinal axis of the MR.

CONCLUSION: Spatial distortion remains in the MR images after systematic distortion corrections. Although the average errors were relatively small, large distortions observed at bone/tissue interfaces emphasize the need for quantitative methods for assessing and correcting patient-specific spatial distortions.

PMID:34231963 | DOI:10.1002/acm2.13340

Obesity (Silver Spring). 2021 Jul 7. doi: 10.1002/oby.23197. Online ahead of print.

ABSTRACT

OBJECTIVE: Classifying adiposity based on dual-energy x-ray absorptiometry (DXA) muscle and fat mass phenotypes has been proposed. Whether these phenotypes are more accurate in predicting cardiometabolic risk than BMI weight status is unknown.

METHODS: Data were from the National Health and Nutrition Examination Survey (NHANES; 1999-2006 cycles, n = 5,475). Weight status was defined by BMI. Phenotypes of adiposity and muscle were based on high (≥50th percentile) and low (<50th percentile) permutations of sex- and age-specific fat and muscle mass population curves. The area under the curves of receiver operating characteristic curves (ROC-AUCs), which predicted the presence of abnormal lipids, glucose, and blood pressure, were compared. All analyses were stratified by sex and incorporated the complex survey design and weighting of NHANES.

RESULTS: The ROC-AUCs from weight status models used to correctly identify cardiometabolic risk ranged from 0.57 to 0.68, indicating generally weak predictive power. However, the ROC-AUCs from DXA phenotypes were lower (ranging from 0.53-0.68), indicating weaker predictive power than weight status, and were statistically inferior for nearly all of the comparisons.

CONCLUSIONS: Despite DXA’s high cost and detailed output regarding body composition, its phenotype classification was inferior to weight status in predicting cardiometabolic risk. Further studies investigating the utility of the phenotypes are needed.

PMID:34231966 | DOI:10.1002/oby.23197