Tag: statistics

Med J Armed Forces India. 2023 May-Jun;79(3):280-285. doi: 10.1016/j.mjafi.2021.05.017. Epub 2021 Aug 13.

ABSTRACT

BACKGROUND: Obstetrics as a speciality has a very long association with the transfusion services and poses its own set of immunohematological (IHL) challenges. A study was carried out to evaluate the spectrum of IHL issues in obstetrics in our setup and to suggest a way forward.

METHODS: This study was carried out in a transfusion services setup catering to antenatal care (ANC) clientele in two tertiary-level health care setups. Samples were collected from all ANC patients requiring transfusion and patients reporting for Indirect Coombs Test (ICT). Data included ICT positive cases with implicated alloantibodies, those requiring specialised procedures and the foetal outcome. The results were described using descriptive statistics by frequencies and percentages.

RESULTS: A total of 4683 eligible samples were included in the study, out of 21,893 antenatal patients visiting our setup during study period. One hundred thirty-six ANC patient samples were found to be ICT positive. The most common single alloantibody was anti-D (n = 77, 57.5%). Double antibody positivity was found in 28 patients. Multiple alloantibodies were found in 1 patient. Up to 48% of these allo-anti D cases necessitated specialised procedures.

CONCLUSION: The IHL issues of obstetrics faced in our setup are no less than that in Indian population. We have much higher frequency of double alloantibody in our ANC population. The authors propose that all multiparous ANC patients, especially with a history of transfusion, irrespective of Rh D status should be screened for irregular alloantibodies to circumvent these issues and the last-minute rush for provision of compatible units.

PMID:37193527 | PMC:PMC10182281 | DOI:10.1016/j.mjafi.2021.05.017

Med J Armed Forces India. 2023 May-Jun;79(3):292-299. doi: 10.1016/j.mjafi.2021.06.027. Epub 2021 Sep 7.

ABSTRACT

BACKGROUND: Coma is one of the frequently encountered clinical conditions in any intensive care unit (ICU), which is responsible for considerable morbidity and mortality. Therefore, this study was designed to look at the clinical and EEG profile of Nonconvulsive Status Epilepticus (NCSE) in comatose ICU patients using portable electroencephalography (EEG).

METHODS: In all 102 patients of unresponsive coma (GCS ≤ 8), who remained in poor sensorium despite 48 h of optimum treatment in ICU, were included in the study. All patients underwent 1 h of electroencephalography (EEG) monitoring with a portable EEG machine. All EEGs were screened according to Salzburg Consensus Criteria (SCC) for Nonconvulsive Status Epilepticus (NCSE). Patients with evidence of NCSE were administered parenteral Antiepileptic Drugs (AED). A repeat EEG was done after 24 h of baseline to ascertain the effect of AED. The primary outcome was the recognition of patients with NCSE on the basis of established EEG criteria. The secondary outcome measure was the Glasgow outcome scale (GOS) at the time of discharge.

RESULTS: Out of 102 cases enrolled, 12 (11.8%) cases were detected to have NCSE on portable EEG. The mean age of patients with NCSE was 52.2 years. In terms of gender distribution, 2/12 (17%) were female, and 10/12 (83%) were male (M: F = 5:1). Median GCS was 6 (range 3-8). Looking at CNS infections, 4/12 (33.3%) had evidence of some form of CNS infection in the NCSE group, compared to 16/90 (18%) in the group without NCSE. This difference was statistically significant (P-value < 0.05). The EEG recordings of patients with NCSE showed dynamicity with fluctuating rhythms and ictal-EEG patterns associated with spatiotemporal evolution. All twelve cases showed reversal of EEG changes with AED administration. In 5 out of 12, transient improvement in GCS (>2 points) after administration of AED’ was noted with good clinical outcomes (GOS 5). In five of these 12 cases, death was the final outcome (GOS 1).

CONCLUSIONS: NSCE should be considered in the differential diagnosis of all unresponsive comatose ICU patients. In resource-limited settings, where continuous EEG monitoring may not be feasible, bedside portable EEG testing can be used to diagnose patients with NCSE. Treating NCSE reverses epileptiform EEG changes and improves clinical outcomes in a subset of comatose ICU patients.

PMID:37193513 | PMC:PMC10182287 | DOI:10.1016/j.mjafi.2021.06.027

J Am Stat Assoc. 2023;118(541):257-271. doi: 10.1080/01621459.2021.1924178. Epub 2021 Jun 22.

ABSTRACT

Graphical modeling of multivariate functional data is becoming increasingly important in a wide variety of applications. The changes of graph structure can often be attributed to external variables, such as the diagnosis status or time, the latter of which gives rise to the problem of dynamic graphical modeling. Most existing methods focus on estimating the graph by aggregating samples, but largely ignore the subject-level heterogeneity due to the external variables. In this article, we introduce a conditional graphical model for multivariate random functions, where we treat the external variables as conditioning set, and allow the graph structure to vary with the external variables. Our method is built on two new linear operators, the conditional precision operator and the conditional partial correlation operator, which extend the precision matrix and the partial correlation matrix to both the conditional and functional settings. We show that their nonzero elements can be used to characterize the conditional graphs, and develop the corresponding estimators. We establish the uniform convergence of the proposed estimators and the consistency of the estimated graph, while allowing the graph size to grow with the sample size, and accommodating both completely and partially observed data. We demonstrate the efficacy of the method through both simulations and a study of brain functional connectivity network.

PMID:37193511 | PMC:PMC10181795 | DOI:10.1080/01621459.2021.1924178

J Am Stat Assoc. 2023;118(541):29-42. doi: 10.1080/01621459.2022.2105703. Epub 2022 Sep 20.

ABSTRACT

Cancer is a heterogeneous disease, and rapid progress in sequencing and -omics technologies has enabled researchers to characterize tumors comprehensively. This has stimulated an intensive interest in studying how risk factors are associated with various tumor heterogeneous features. The Cancer Prevention Study-II (CPS-II) cohort is one of the largest prospective studies, particularly valuable for elucidating associations between cancer and risk factors. In this paper, we investigate the association of smoking with novel colorectal tumor markers obtained from targeted sequencing. However, due to cost and logistic difficulties, only a limited number of tumors can be assayed, which limits our capability for studying these associations. Meanwhile, there are extensive studies for assessing the association of smoking with overall cancer risk and established colorectal tumor markers. Importantly, such summary information is readily available from the literature. By linking this summary information to parameters of interest with proper constraints, we develop a generalized integration approach for polytomous logistic regression model with outcome characterized by tumor features. The proposed approach gains the efficiency through maximizing the joint likelihood of individual-level tumor data and external summary information under the constraints that narrow the parameter searching space. We apply the proposed method to the CPS-II data and identify the association of smoking with colorectal cancer risk differing by the mutational status of APC and RNF43 genes, neither of which is identified by the conventional analysis of CPS-II individual data only. These results help better understand the role of smoking in the etiology of colorectal cancer.

PMID:37193510 | PMC:PMC10168026 | DOI:10.1080/01621459.2022.2105703

J Parasit Dis. 2023 Jun;47(2):319-328. doi: 10.1007/s12639-023-01573-y. Epub 2023 Mar 18.

ABSTRACT

Cerebral toxoplasmosis is an opportunistic infection, occurring mostly in immunosuppressed patients due to the reactivation of latent Toxoplasma cysts. The cerebral comorbidity in diabetic patients tends to intensify the burden of pathogenic infection within the brain. The aim of this work was to study the effect of cerebral toxoplasmosis in experimentally infected hyperglycemic mice, on histopathology and glial fibrillary acidic protein (GFAP) expression, compared to normoglycemic mice at different time intervals. Vasculopathy was exclusively observed in diabetic groups, with features of increased severity during Toxoplasma infection. Gliosis was observed in diabetic groups, while hyperactive astroglial activity was detected in normoglycemic groups, especially at 6 weeks of infection. GFAP expression showed significant up-regulation in normoglycemic mice at 6 weeks of infection (40.03 ± 1.41) afterwards, it decreased to 22.22 ± 3.14 at 12 weeks which was statistically insignificant to the normal level, possibly indicating the successful Toxoplasma stage transformation (to bradyzoite), thereby limiting the infection within the brain. In hyperglycemic infected groups, GFAP was significantly down-regulated, in both acute and chronic phases of infection, most likely indicating failure of stage transformation and infection limitation. This may expose those vulnerable groups to the risk of dissemination, resulting in life-threatening diffuse encephalitis. The current study emphasized the importance of rapid diagnosis of Toxoplasma infection in diabetic subjects, and highlighted the value of using GFAP as a neurological indicator of disease progression in those comorbid cases.

PMID:37193484 | PMC:PMC10182235 | DOI:10.1007/s12639-023-01573-y

Cureus. 2023 Apr 12;15(4):e37512. doi: 10.7759/cureus.37512. eCollection 2023 Apr.

ABSTRACT

Background In this study, we aimed to evaluate the knowledge and awareness about cervical cancer, human papillomavirus (HPV) and its vaccine among women living in the western region of Saudi Arabia. Methodology Using a cross-sectional online survey, this study assesses the knowledge and awareness level of HPV and the risk factors of cervical cancer among women living in the western region of Saudi Arabia. The design of the questionnaire is based on several earlier studies in different populations. Results The total completed responses include a sample of 624 that was subjected to statistical analysis; the analysis showed that only 34.6% were aware of HPV. Participants who belonged to the 21-30 and 31-40-year-old groups had comparatively more awareness than other age groups (p<0.001). Most (83.8%) believed that it would cause cervical cancer. Less than half (45.8%) knew that there is a vaccine against HPV infection. When we assessed the willingness to receive the vaccine, it was found that 75.8% were willing to take it. Conclusions The study found that women in the western region of Saudi Arabia have limited knowledge of cervical cancer and HPV and its vaccine. There is a need to educate and promote awareness of HPV and its complications for women in the western region of Saudi Arabia.

PMID:37193479 | PMC:PMC10182381 | DOI:10.7759/cureus.37512

Cureus. 2023 Apr 14;15(4):e37561. doi: 10.7759/cureus.37561. eCollection 2023 Apr.

ABSTRACT

Background Ischemic mitral regurgitation (IMR) or functional MR intensity with or without repair increases the risk of coronary artery bypass grafting (CABG), and if the contaminant is undertaken, it doubles the risk of the surgery. This study aimed to characterize patients with concomitant CABG and mitral valve repair (MVR) and assess the surgical and long-term outcomes. Methods We conducted a cohort study from 2014 to 2020 on 364 patients who underwent CABG. A total of 364 patients were enrolled and divided into two groups. Group I (n= 349) included patients with isolated CABG, and Group II included patients who underwent CABG with concomitant mitral valve repair (MVR) (n= 15). Results Regarding preoperative presentation, most patients were male: 289 (79.40%), hypertensive 306 (84.07%), diabetic 281 (77.20%), dyslipidemic 246 (67.58%), presenting with NYHA classes III-IV: 200 (54.95%), and upon angiography, found to have the three-vessel disease: 265 (73%). Regarding their age mean± SD and Log EuroSCORE median (Q1-Q3), they had a mean age of 60.94± 10.60 years and a median score of 1.87 (1.13-3.19). The most prevalent postoperative complications were low cardiac output 75 (20.66%), acute kidney injury (AKI) 63 (17.45%), respiratory complications 55 (15.32%), and atrial fibrillation (AF) 55 (15.15%). Regarding long-term outcomes, most patients reported class I NYHA 271 (83.13%) and an echocardiographic decrease in MR severity. Patients with a CABG + MVR were significantly younger (53.93± 15.02 vs. 61.24± 10.29 years; P= 0.009), had a lower ejection fraction (33.6 [25-50] vs. 50 [43-55] %; p= 0.032), and had a higher prevalence of LV dilation (32 [9.17%]). EuroSCORE was significantly higher in patients with mitral repair (3.59 [1.54-8.63] vs. 1.78 (1.13-3.11); P= 0.022). The mortality percentage was higher with MVR but did not attain statistical significance. Intraoperative CPB and ischemic durations were longer in the CABG + MVR group. Furthermore, neurological complications were higher in patients with mitral repair (4 (28.57%) vs. 30 (8.65%), P= 0.012). The study’s follow-up duration median was 24 (9-36) months. The composite endpoint occurred more frequently in older patients (HR: 1.05 [95% CI: 1.02-1.09]; 0.001), patients with low ejection fraction (HR: 0.96 [95% CI: 0.93-0.99]; P= 0.006) and in patients with preoperative myocardial infarction (MI) (HR: 2.3 [95%: 1.14- 4.68]; P= 0.021). Conclusion Most IMR patients benefited from CABG and CABG + MVR, as evident by NYHA class and echocardiographic follow-up. CABG + MVR had a higher Log EuroSCORE risk with increased intraoperative cardiopulmonary bypass (CPB) and ischemic durations, which may have played a role in increasing the incidence of postoperative neurological complications. On follow-up, no differences were reported between the two groups. However, age, ejection fraction, and a history of preoperative MI were identified as factors affecting the composite endpoint.

PMID:37193475 | PMC:PMC10183146 | DOI:10.7759/cureus.37561

Cureus. 2023 Apr 13;15(4):e37549. doi: 10.7759/cureus.37549. eCollection 2023 Apr.

ABSTRACT

Introduction Dexamethasone is shown to prolong the duration of nerve blocks when administered perineurally as well as intravenously. The effect of intravenous dexamethasone on the duration of hyperbaric bupivacaine spinal anesthesia is lesser known. We conducted a randomized control trial to determine the effect of intravenous dexamethasone on the duration of spinal anesthesia in parturients undergoing lower-segment cesarean section (LSCS). Methods Eighty parturients planned for LSCS under spinal anesthesia were randomly allocated to two groups. Patients in group A were administered dexamethasone intravenously, and group B received normal saline intravenously before spinal anesthesia. The primary objective was to determine the effect of intravenous dexamethasone on the duration of sensory and motor block after spinal anesthesia. The secondary objective was to determine the duration of analgesia and complications in both groups. Result The total duration of the sensory and motor blocks in group A was 118.38 ± 19.88 minutes and 95.63 ± 19.91 minutes, respectively. The entire sensory and motor blockade duration in group B was 116.88 ± 13.48 minutes and 97.63 ± 15.15 minutes, respectively. The difference between the groups was found to be statistically insignificant. Conclusion Intravenous 8 mg dexamethasone in patients planned for LSCS under hyperbaric spinal anesthesia does not prolong the sensory or motor block duration compared to placebo.

PMID:37193474 | PMC:PMC10183083 | DOI:10.7759/cureus.37549

Cureus. 2023 Apr 14;15(4):e37562. doi: 10.7759/cureus.37562. eCollection 2023 Apr.

ABSTRACT

INTRODUCTION: In-flight medical emergencies occur in an estimated one out of 604 flights. Responding in this environment poses a unique set of challenges unfamiliar to most emergency medicine (EM) providers, including physical space and resource limitations. We developed a novel high-fidelity in-situ training curriculum focused on frequent or high-risk in-flight medical scenarios while replicating this austere environment.

METHODS: Our residency program coordinated with our local airport’s chief of security and an airline-specific station manager to arrange the use of a grounded Boeing 737 commercial airliner during late evening/early morning hours. Eight stations reviewing in-flight medical emergency topics were reviewed, five of which were simulation scenarios. We created medical and first-aid kits that reflect equipment used by commercial airlines. Residents’ self-assessed competency and medical knowledge were assessed both initially and post-curriculum using a standardized questionnaire.

RESULTS: Forty residents attended the educational event as learners. Self-assessed competency and medical knowledge increased after curriculum participation. All tested aspects of self-assessed competency had a statistically significant increase from a mean of 15.04 to 29.20 out of a maximum score of forty. The mean medical knowledge score increased from 4.65 to 6.93 out of 10 maximum points.

CONCLUSION: A five-hour in-situ curriculum for reviewing in-flight medical emergencies increased self-assessed competency and medical knowledge for EM and EM-internal medicine residents. The curriculum was overwhelmingly well-received by learners.

PMID:37193470 | PMC:PMC10183150 | DOI:10.7759/cureus.37562

Cureus. 2023 Apr 14;15(4):e37571. doi: 10.7759/cureus.37571. eCollection 2023 Apr.

ABSTRACT

BACKGROUND AND AIM: Children who are exposed to tobacco smoke (ETS) are at risk for a variety of health issues. There are enough legislative provisions in Indian law to safeguard children from ETS in outdoor settings, but no such specific rules exist to shield them from exposure indoors. This study aimed to examine the trend in under-five children’s exposure to indoor tobacco smoke over the course of a decade (from 2005 to 2016) in India.

MATERIALS AND METHODS: Data from the National Family and Health Survey (NFHS) for the years 2005-2006 (NFHS-3) and 2015-2016 (NFHS-4) on under-five children have been taken into consideration in cross-sectional analyses of the Demographic and Health Survey on India. Based on different sociodemographic factors, the propensity of indoor ETS among Indian children has been estimated and compared using both bivariate and multivariate logistic regression models.

RESULTS: The prevalence of indoor ETS among Indian children under the age of five has greatly risen over the past decade, rising from 4.12% to 52.70%. According to the findings, there has been a noticeable increase in every group of kids, regardless of their age, place of residence, geographic location, socioeconomic status, and literacy level of their mothers.

CONCLUSION: In India, the incidence of indoor ETS among children under five has risen by 13 times in the last 10 years, endangering the country. As a result, the Indian government must prepare to take legislative action to safeguard children by passing laws that forbid smoking inside.

PMID:37193454 | PMC:PMC10183212 | DOI:10.7759/cureus.37571