Tag: pubmed

BMJ Open. 2021 May 11;11(5):e045074. doi: 10.1136/bmjopen-2020-045074.

ABSTRACT

OBJECTIVE: To examine the effects of prescription sleep medications on patient-reported sleep disturbances.

DESIGN: Retrospective cohort.

SETTING: Longitudinal cohort of community-dwelling women in the USA.

PARTICIPANTS: Racially and ethnically diverse middle-aged women who reported a sleep disturbance.

INTERVENTIONS: New users of prescription sleep medications propensity score matched to women not starting sleep medications.

MAIN OUTCOMES AND MEASURES: Self-reported sleep disturbance during the previous 2 weeks-difficulty initiating sleep, waking frequently and early morning awakening-using a 5-point Likert scale, ranging from no difficulty on any night (rating 1) to difficulty on 5 or more nights a week (rating 5). Sleep disturbances were compared at 1 year (primary outcome) and 2 years of follow-up.

RESULTS: 238 women who started sleep medications were matched with 447 non-users. Participants had a mean age of 49.5 years and approximately half were white. At baseline, sleep disturbance ratings were similar: medication users had a mean score for difficulty initiating sleep of 2.7 (95% CI 2.5 to 2.9), waking frequently 3.8 (95% CI 3.6 to 3.9) and early morning awakening 2.8 (95% CI 2.6 to 3.0); non-users ratings were 2.6 (95% CI 2.5 to 2.7), 3.7 (95% CI 3.6 to 3.9) and 2.7 (95% CI 2.6 to 2.8), respectively. After 1 year, ratings for medication users were 2.6 (95% CI 2.4 to 2.8) for initiating sleep, 3.6 (95% CI 3.4 to 3.8) for waking frequently and 2.8 (95% CI 2.6 to 3.0) for early morning awakening; for non-users, the mean ratings were 2.3 (95% CI 2.2 to 2.5), 3.5 (95% CI 3.3 to 3.6) and 2.5 (95% CI 2.3 to 2.6), respectively. None of the 1 year changes were statistically significant nor were they different between medication users and non-users. Two-year follow-up results were consistent, without statistically significant reductions in sleep disturbance in medication users compared with non-users.

CONCLUSIONS: These analyses suggest that women who initiated sleep medications rated their sleep disturbances similar after 1 and 2 years. The effectiveness of long-term sleep medication use should be re-examined.

PMID:33975865 | DOI:10.1136/bmjopen-2020-045074

Arch Dis Child. 2021 May 11:archdischild-2021-322106. doi: 10.1136/archdischild-2021-322106. Online ahead of print.

NO ABSTRACT

PMID:33975824 | DOI:10.1136/archdischild-2021-322106

BMJ. 2021 May 11;373:n1038. doi: 10.1136/bmj.n1038.

ABSTRACT

OBJECTIVE: To investigate the use of repurposed and adjuvant drugs in patients admitted to hospital with covid-19 across three continents.

DESIGN: Multinational network cohort study.

SETTING: Hospital electronic health records from the United States, Spain, and China, and nationwide claims data from South Korea.

PARTICIPANTS: 303 264 patients admitted to hospital with covid-19 from January 2020 to December 2020.

MAIN OUTCOME MEASURES: Prescriptions or dispensations of any drug on or 30 days after the date of hospital admission for covid-19.

RESULTS: Of the 303 264 patients included, 290 131 were from the US, 7599 from South Korea, 5230 from Spain, and 304 from China. 3455 drugs were identified. Common repurposed drugs were hydroxychloroquine (used in from <5 (<2%) patients in China to 2165 (85.1%) in Spain), azithromycin (from 15 (4.9%) in China to 1473 (57.9%) in Spain), combined lopinavir and ritonavir (from 156 (<2%) in the VA-OMOP US to 2,652 (34.9%) in South Korea and 1285 (50.5%) in Spain), and umifenovir (0% in the US, South Korea, and Spain and 238 (78.3%) in China). Use of adjunctive drugs varied greatly, with the five most used treatments being enoxaparin, fluoroquinolones, ceftriaxone, vitamin D, and corticosteroids. Hydroxychloroquine use increased rapidly from March to April 2020 but declined steeply in May to June and remained low for the rest of the year. The use of dexamethasone and corticosteroids increased steadily during 2020.

CONCLUSIONS: Multiple drugs were used in the first few months of the covid-19 pandemic, with substantial geographical and temporal variation. Hydroxychloroquine, azithromycin, lopinavir-ritonavir, and umifenovir (in China only) were the most prescribed repurposed drugs. Antithrombotics, antibiotics, H2 receptor antagonists, and corticosteroids were often used as adjunctive treatments. Research is needed on the comparative risk and benefit of these treatments in the management of covid-19.

PMID:33975825 | DOI:10.1136/bmj.n1038

Radiography (Lond). 2021 Apr 30:S1078-8174(21)00049-3. doi: 10.1016/j.radi.2021.04.010. Online ahead of print.

ABSTRACT

INTRODUCTION: A more structured role of radiographers is advisable to speed up the management of patients with suspected COVID-19. The purpose of our study was to evaluate the diagnostic performance of radiographers in the detection of COVID-19 pneumonia on chest CT using CO-RADS descriptors.

METHODS: CT images of patients who underwent RT-PCR and chest CT due to COVID-19 suspicion between March and July 2020 were analysed retrospectively. Six readers, including two radiologists, two highly experienced radiographers and two less experienced radiographers, independently scored each CT using the CO-RADS lexicon. ROC curves were used to investigate diagnostic accuracy, and Fleiss’κ statistics to evaluate inter-rater agreement.

RESULTS: 714 patients (419 men; 295 women; mean age: 64 years ±19SD) were evaluated. CO-RADS> 3 was identified as optimal diagnostic threshold. Highly experienced radiographers achieved an average sensitivity of 58.7% (95%CI: 52.5-64.7), an average specificity of 81.8% (95%CI: 77.9-85.2), and a mean AUC of 0.72 (95%CI: 0.68-0.75). Among less experienced radiographers, an average sensitivity of 56.3% (95%CI: 50.1-62.2) and an average specificity of 81.5% (95%CI: 77.6-84.9) were observed, with a mean AUC of 0.71 (95%CI: 0.68-0.74). Consultant radiologists achieved an average sensitivity of 60.0% (95%CI: 53.7-65.8), an average specificity of 81.7% (95%CI: 77.8-85.1), and a mean AUC of 0.73 (95%CI: 0.70-0.77).

CONCLUSION: Radiographers can adequately recognise the classic appearances of COVID-19 on CT, as described by the CO-RADS assessment scheme, in a way comparable to expert radiologists.

IMPLICATIONS FOR PRACTICE: Radiographers, as the first healthcare professionals to evaluate CT images in patients with suspected SARS-CoV-2 infection, could diagnose COVID-19 pneumonia by means of a categorical reporting scheme at CT in a reliable way, hence playing a primary role in the early management of these patients.

PMID:33975783 | DOI:10.1016/j.radi.2021.04.010

HPB (Oxford). 2021 Apr 27:S1365-182X(21)00109-X. doi: 10.1016/j.hpb.2021.04.009. Online ahead of print.

ABSTRACT

BACKGROUND: Gallstone related pathology (GRP) accounts for a significant proportion of general surgery admissions. The aim of this study is to investigate if seasonal variation for GRP admissions exist in England allowing improved resource allocation and planning.

METHODS: This multicentre retrospective cohort study included only emergency adult (≥18 years old) admissions to acute secondary care with ICD-10 codes associated with gallstones between 01/01/2010 to 31/12/2019 in England using Hospital Episode Statistics data. Seasons were defined according to United Kingdom Met Office.

RESULTS: A total of 396 879 GRP related admissions were recorded during the specified period, accounting for 1.44% of all emergency admissions. Our study suggests a significant seasonal peak in Summer (n = 102 620) based cumulative admissions per season and a linear regression model (p < 0.001), followed by Autumn (n = 102 267), then Spring (n = 97 807) and finally Winter (n = 94 185). Spectral analysis confirmed there is seasonality in the emergency GRP admissions every 12 months. A forecasting model was shown to be reliable; all observed admissions for 2019 were within the 95% prediction intervals for each month for the proportion of emergency GRP admissions.

CONCLUSION: Resource allocation towards the Summer months to target seasonal peaks in GRP should be considered.

PMID:33975800 | DOI:10.1016/j.hpb.2021.04.009

Transfus Apher Sci. 2021 May 8:103155. doi: 10.1016/j.transci.2021.103155. Online ahead of print.

ABSTRACT

Allogeneic peripheral blood-derived (PBS) serum eye drops have been largely used in the treatment of dry eye disease (DED). Recently, cord blood has emerged as an effective alternative serum source (cord blood serum, CBS), containing a higher amount of growth factors than PBS, it holds the promise of a better capability to stimulate corneal healing. However, the lack of a standardized method for preparation, dispensation, storage and a poor biochemical characterization still hamper the establishment of a clinical consensus. Here the metabolomes of the two different serum eye drop preparations were compared using proton nuclear magnetic resonance spectroscopy. We found that both PBS and CBS contained several organic compounds, the majority of them already detected in human tears and may be thereby considered lacrimal substitutes. Metabolites having in the multivariate statistical analysis Partial least squares discriminant analysis (PLS-DA) a VIP scores > 1.0 were considered to be significantly different. All the metabolites identified were found to have a p < 0.05 in the univariate analysis. CBS, in particular, showed the highest amount of choline, myo-inositol, glutamine, creatine and β-hydroxybutyrate. These evidences constitute relevant advances towards serum eye drops characterization and confirm that cord blood is a valid alternative source of serum eye drops.

PMID:33975808 | DOI:10.1016/j.transci.2021.103155

Am J Orthod Dentofacial Orthop. 2021 May 8:S0889-5406(21)00247-X. doi: 10.1016/j.ajodo.2020.04.025. Online ahead of print.

ABSTRACT

INTRODUCTION: The purpose of this research was to assess the diagnostic accuracy of sella turcica bridging on lateral cephalograms when compared with true sella turcica bridging determined via cone-beam computed tomography (CBCT).

METHODS: A cross-sectional study was conducted using CBCT images from which lateral cephalograms were generated. The study included 185 subjects (118 females and 67 males; age range, 10-30 years; mean age, 16.63 ± 4.20 years). Sella turcica landmarks and related measurements were calculated for both diagnostic modalities and analyzed by 1 examiner. Subjects were classified into 1 of 3 outcome groups: no bridging, partial bridging, and complete bridging. Diagnostic accuracy was evaluated using sensitivity, specificity, positive and negative predictive values, and receiver operator characteristic curves.

RESULTS: Ten patients were diagnosed as complete bridging on CBCT, whereas 31 patients were diagnosed as complete bridging on lateral cephalogram. Although the lateral cephalogram detected all subjects with complete bridging, it incorrectly classified 12% of subjects. The percent agreement between both diagnostic methods was 55.68%, with a kappa statistic of 0.22 on the right sella turcica and 0.20 on the left sella turcica, indicating fair but statistically significant agreement. The overall accuracy of lateral cephalograms as a diagnostic modality in discriminating between no bridging and partial bridging was good as determined with the area under the curve values of 0.86 and 0.85 for right and left sides, respectively.

CONCLUSIONS: Although lateral cephalograms overestimate patients with complete bridging compared to CBCTs, they are a suitable screening modality for accurately suggesting complete sella turcica bridging and differentiating between patients with no bridging and partial bridging.

PMID:33975746 | DOI:10.1016/j.ajodo.2020.04.025

Am J Orthod Dentofacial Orthop. 2021 May 8:S0889-5406(21)00246-8. doi: 10.1016/j.ajodo.2020.04.024. Online ahead of print.

ABSTRACT

INTRODUCTION: The goal of this research was to experimentally evaluate the surface morphology and adhesion capacity of Streptococcus mutans (U159) on brackets with thin films of titanium nitride (TN) and of titanium nitride doped with calcium phosphate (TNCP).

METHODS: Twenty-four metallic brackets were equally allocated to 3 groups (n = 8), according to the type of covering (no covering, TNCP, and TN). The coatings were deposited by cathodic cage (TNCP and TN groups) and were evaluated by scanning electron microscopy and energy dispersive x-ray spectrometry. The biofilm formation of S. mutans on the surface of brackets was determined by crystal violet assay and subsequent optical density quantification.

RESULTS: There was homogeneity on the surface morphology of the tie wing area in all groups, whereas the TNCP group has presented particles in the slot. After 24 hours, a biofilm of S. mutans was formed in all the observed groups. The optical density obtained in all 3 groups was similar (no covering, 0.347 ± 0.042; TNCP, 0.238 ± 0.055; TN, 0.226 ± 0.057), with no statistically relevant difference (P = 0.06).

CONCLUSIONS: The thin film of TNCP has altered the surface of the bracket’s slot, whereas the coatings of TN and TNCP have not altered the superficial morphology of the tie wings. The presence of coatings have not influenced the formation of the S. mutans biofilm on the surface of metallic brackets.

PMID:33975749 | DOI:10.1016/j.ajodo.2020.04.024

Dtsch Arztebl Int. 2021 Sep 17;118(Forthcoming):arztebl.m2021.0224. doi: 10.3238/arztebl.m2021.0224.

ABSTRACT

BACKGROUND: The accurate diagnosis of a disease is a prerequisite for its appropriate treatment. How well a medical test is able to correctly identify or rule out a target disease can be assessed by diagnostic accuracy studies.

METHODS: The main statistical parameters that are derived from diagnostic accuracy studies, and their proper interpretation, will be presented here in the light of publications retrieved by a selective literature search, supplemented by the authors’ own experience. Aspects of study planning and the analysis of complex studies on diagnostic tests will also be discussed.

RESULTS: In the usual case, the findings of a diagnostic accuracy study are presented in a 2 × 2 contingency table containing the number of true-positive, true-negative, false-positive, and true-positive test results. This information allows the calculation of various statistical parameters, of which the most important are the two pairs sensitivity/specificity and positive/negative predictive value. All of these parameters are quotients, with the number of true positive (resp. true negative) test results in the numerator; the denominator is, in the first pair, the total number of ill (resp. healthy) patients, and in the second pair, the total number of patients with a positive (resp. negative) test. The predictive values are the parameters of greatest interest to physicians and patients, but their main disadvantage is that they can easily be misinterpreted. We will also present the receiver operating characteristic (ROC) curve and the area under the curve (AUC) as additional important measures for the assessment of diagnostic tests. Further topics are discussed in the supplementary materials.

CONCLUSION: The statistical parameters used to assess diagnostic tests are primarily based on 2 × 2 contingency tables. These parameters must be interpreted with care in order to draw correct conclusions for use in medical practice.

PMID:33975672 | DOI:10.3238/arztebl.m2021.0224

Fertil Steril. 2021 May 8:S0015-0282(21)00237-5. doi: 10.1016/j.fertnstert.2021.03.032. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare neonatal and maternal outcomes among twin pregnancies conceived as a result of different types of fertility treatments with those of spontaneously conceived twin pregnancies.

DESIGN: Retrospective Cohort.

SETTING: Population-based analysis.

PATIENT(S): Population-based analysis of twin pregnancies in the United States based on their mode of conception using the natality data from the National Center for Health Statistics from the Centers for Disease Control and Prevention (from January 2015 through December 2017).

INTERVENTION(S): None.

MAIN OUTCOME MEASURE(S): Adverse neonatal and maternal outcomes.

RESULT(S): The overall prevalence of early adverse maternal outcomes and medical complications and obstetric complications including the risk of unplanned hysterectomy, intensive care unit admission, maternal blood transfusion, and perineal laceration were significantly higher in the fertility treatment group (including both ovulation induction/intrauterine insemination and assisted reproductive technology groups) compared with those of the spontaneous conception group, even after adjusting for several potential confounders. The risk of adverse composite neonatal outcomes was slightly lower in the spontaneous conception live twin birth group even after adjustment for several potential confounders.

CONCLUSION(S): The rate of maternal and neonatal morbidity in twins conceived via different fertility treatments was slightly increased compared with those of twins conceived spontaneously. Because the absolute risks of maternal and neonatal morbidity were low, overall reassurance regarding these outcomes can be provided to the patients undergoing all types of fertility treatments.

PMID:33975727 | DOI:10.1016/j.fertnstert.2021.03.032