Tag: statistics

BMJ Open. 2023 May 4;13(5):e069768. doi: 10.1136/bmjopen-2022-069768.

ABSTRACT

OBJECTIVE: This study aimed to assess the incidence and identify predictors of perioperative mortality among the adult age group at Tibebe Ghion Specialised Hospital.

DESIGN: A single-centre prospective follow-up study.

SETTING: A tertiary hospital in North West Ethiopia.

PARTICIPANTS: We enrolled 2530 participants who underwent surgery in the current study. All adults aged 18 and above were included except those with no telephone.

PRIMARY OUTCOME MEASURES: The primary outcome was time to death measured in days from immediate postoperative time up to the 28th day following surgery.

RESULT: A total of 2530 surgical cases were followed for 67 145 person-days. There were 92 deaths, with an incidence rate of 1.37 (95% CI 1.11 to 1.68) deaths per 1000 person-day observations. Regional anaesthesia was significantly associated with lower postoperative mortality (adjusted hazard ratio (AHR) 0.18, 95% CI 0.05 to 0.62). Patients aged ≥65 years (AHR 3.04, 95% CI 1.65 to 5.75), American Society of Anesthesiologist (ASA) physical status III (AHR 2.41, 95% CI 1.1.13 to 5.16) and IV (AHR 2.74, 95% CI 1.08 to 6.92), emergency surgery (AHR 1.85, 95% CI 1.02 to 3.36) and preoperative oxygen saturation <95% (AHR 3.14, 95% CI 1.85 to 5.33) were significantly associated with a higher risk of postoperative mortality.

CONCLUSION: The postoperative mortality rate at Tibebe Ghion Specialised Hospital was high. Age ≥65, ASA physical status III and IV, emergency surgery, and preoperative oxygen saturation <95% were significant predictors of postoperative mortality. Patients with the identified predictors should be offered targeted treatment.

PMID:37142313 | DOI:10.1136/bmjopen-2022-069768

BMJ Open. 2023 May 4;13(5):e069664. doi: 10.1136/bmjopen-2022-069664.

ABSTRACT

PURPOSE: The Swedish Tattoo and Body Modifications Cohort (TABOO) cohort was established to provide an infrastructure for epidemiological studies researching the role of tattoos and other body modifications as risk factors for adverse health outcomes. It is the first population-based cohort with detailed exposure assessment of decorative, cosmetic, and medical tattoos, piercing, scarification, henna tattoos, cosmetic laser treatments, hair dyeing, and sun habits. The level of detail in the exposure assessment of tattoos allows for investigation of crude dose-response relationships.

PARTICIPANTS: The TABOO cohort includes 13 049 individuals that participated in a questionnaire survey conducted in 2021 (response rate 49%). Outcome data are retrieved from the National Patient Register, the National Prescribed Drug Register and the National Cause of Death Register. Participation in the registers is regulated by Swedish law, which eliminates the risk of loss to follow-up and associated selection bias.

FINDINGS TO DATE: The tattoo prevalence in TABOO is 21%. The cohort is currently used to clarify the incidence of acute and long-lasting health complaints after tattooing based on self-reported data. Using register-based outcome data, we are investigating the role of tattoos as a risk factor for immune-mediated disease, including hypersensitisation, foreign body reactions and autoimmune conditions.

FUTURE PLANS: The register linkage will be renewed every third year to update the outcome data, and we have ethical approval to reapproach the responders with additional questionnaires.

PMID:37142309 | DOI:10.1136/bmjopen-2022-069664

BMJ Open Gastroenterol. 2023 May;10(1):e001037. doi: 10.1136/bmjgast-2022-001037.

ABSTRACT

OBJECTIVE: To estimate the risk of non-Hodgkin’s lymphoma (NHL) and Hodgkin’s lymphoma (HL) in patients with inflammatory bowel disease (IBD).

DESIGN: We undertook a two-country population cohort study with all patients diagnosed with IBD in Norway and Sweden from 1987 and 1993 through 2015 and 2016, respectively, and analysed the risk of NHL and HL. In Sweden, we also analysed prescriptions of thiopurines and anti-tumour necrosis factor (TNF)-α therapy from 2005. We calculated standardised incidence ratios (SIRs) with 95% CIs using the general populations as reference.

RESULTS: Among 131 492 patients with IBD with a medium follow-up of 9.6 years, we identified 369 cases of NHL and 44 cases of HL. The SIR of NHL was 1.3 (95% CI 1.1 to 1.5) in ulcerative colitis and 1.4 (95% CI 1.2 to 1.7) in Crohn’s disease. We found no compelling heterogeneity in analyses stratified by patient characteristics. We found a similar pattern and magnitude of excess risks for HL. At 10 years, cumulative incidence was 0.26% (95% CI 0.23% to 0.30%) and 0.06% (95% CI 0.04% to 0.08%) for NHL and HL, respectively. Higher excess risks were found among patients with NHL with concomitant primary sclerosing cholangitis (SIR 3.4; 95% CI 2.1 to 5.2) and in those prescribed thiopurines alone (SIR 2.8; 95% CI 1.4 to 5.7) or with anti-TNF-α agents (SIR 5.7; 95% CI 2.7 to 11.9).

CONCLUSION: Patients with IBD have a statistically significant increased risk of malignant lymphomas compared with the general population, but the absolute risk remains low.

PMID:37142293 | DOI:10.1136/bmjgast-2022-001037

Biol Rev Camb Philos Soc. 2023 May 4. doi: 10.1111/brv.12966. Online ahead of print.

ABSTRACT

Despite discussions extending back almost 160 years, the means by which Madagascar’s iconic land vertebrates arrived on the island remains the focus of active debate. Three options have been considered: vicariance, range expansion across land bridges, and dispersal over water. The first assumes that a group (clade/lineage) occupied the island when it was connected with the other Gondwana landmasses in the Mesozoic. Causeways to Africa do not exist today, but have been proposed by some researchers for various times in the Cenozoic. Over-water dispersal could be from rafting on floating vegetation (flotsam) or by swimming/drifting. A recent appraisal of the geological data supported the idea of vicariance, but found nothing to justify the notion of past causeways. Here we review the biological evidence for the mechanisms that explain the origins of 28 of Madagascar’s land vertebrate clades [two other lineages (the geckos Geckolepis and Paragehyra) could not be included in the analysis due to phylogenetic uncertainties]. The podocnemid turtles and typhlopoid snakes are conspicuous for they appear to have arisen through a deep-time vicariance event. The two options for the remaining 26 (16 reptile, five land-bound-mammal, and five amphibian), which arrived between the latest Cretaceous and the present, are dispersal across land bridges or over water. As these would produce very different temporal influx patterns, we assembled and analysed published arrival times for each of the groups. For all, a ‘colonisation interval’ was generated that was bracketed by its ‘stem-old’ and ‘crown-young’ tree-node ages; in two instances, the ranges were refined using palaeontological data. The synthesis of these intervals for all clades, which we term a colonisation profile, has a distinctive shape that can be compared, statistically, to various models, including those that assume the arrivals were focused in time. The analysis leads us to reject the various land bridge models (which would show temporal concentrations) and instead supports the idea of dispersal over water (temporally random). Therefore, the biological evidence is now in agreement with the geological evidence, as well as the filtered taxonomic composition of the fauna, in supporting over-water dispersal as the mechanism that explains all but two of Madagascar’s land-vertebrate groups.

PMID:37142264 | DOI:10.1111/brv.12966

Infect Dis Now. 2023 May 2:104716. doi: 10.1016/j.idnow.2023.104716. Online ahead of print.

ABSTRACT

OBJECTIVE: Fever contributes to the inflammatory response; in some infections, antipyretics could prolong the illness. The objective of our study was to evaluate the impact of antipyretic treatments on the evolution of acute upper and lower respiratory tract infections (RTI).

METHOD: A systematic literature review of randomized controlled trials (RCTs) with meta-analysis was conducted. Our primary endpoint was the time to recovery from illness. Our prespecified secondary endpoints were quality of life, duration and number of fever episodes, repeated medical visits, and adverse events.

RESULTS: Out of the 1466 references found, 25 RCTs were included. There were two studies assessing mean fever clearance time, and five studies examining the duration of symptoms associated with the illness studied. No statistically significant differences were found when pooling the results of the different studies. The assessment of adverse events showed a significant difference disadvantaging non-steroidal anti-inflammatory drugs. No meta-analysis could be performed for our other secondary endpoints. The quality of the evidence is limited by the small number of studies included for our primary endpoint and by heterogeneity between the studies.

CONCLUSION: Our results suggest that the use of antipyretics does not prolong or shorten illness duration in acute upper and lower RTI. The symptomatic efficacy of antipyretics must be weighed against their adverse effects, particularly when fever is well-tolerated.

PMID:37142229 | DOI:10.1016/j.idnow.2023.104716

J Neuroradiol. 2023 May 2:S0150-9861(23)00200-6. doi: 10.1016/j.neurad.2023.05.001. Online ahead of print.

ABSTRACT

PURPOSE: To explore the intrinsic alteration of cerebral 18F-FDG metabolism in acute/subacute seropositive autoimmune encephalitis (AE) and to propose a universal classification model based on 18F-FDG metabolic patterns to predict AE.

METHODS: Cerebral 18F-FDG PET images of 42 acute/subacute seropositive AE patients and 45 healthy controls (HCs) were compared using voxelwise and region of interest (ROI)-based schemes. The mean standardized uptake value ratios (SUVRs) of 59 subregions according to a modified Automated Anatomical Labeling (AAL) atlas were compared using a t-test. Subjects were randomly divided into a training set (70%) and a testing set (30%). Logistic regression models were built based on the SUVRs and the models were evaluated by determining their predictive value in the training and testing sets.

RESULTS: The 18F-FDG uptake pattern in the AE group was characterized by increased SUVRs in the brainstem, cerebellum, basal ganglia, and temporal lobe, and decreased SUVRs in the occipital, and frontal regions with voxelwise analysis (false discovery rate [FDR] p<0.05). Utilizing ROI-based analysis, we identified 15 subareas that exhibited statistically significant changes in SUVRs among AE patients compared to HC (FDR p<0.05). Further, a logistic regression model incorporating SUVRs from the calcarine cortex, putamen, supramarginal gyrus, cerebelum_10, and hippocampus successfully enhanced the positive predictive value from 0.76 to 0.86 when compared to visual assessments. This model also demonstrated potent predictive ability, with AUC values of 0.94 and 0.91 observed for the training and testing sets, respectively.

CONCLUSIONS: During the acute/subacute stages of seropositive AE, alterations in SUVRs appear to be concentrated within physiologically significant regions, ultimately defining the general cerebral metabolic pattern. By incorporating these key regions into a new classification model, we have improved the overall diagnostic efficiency of AE.

PMID:37142216 | DOI:10.1016/j.neurad.2023.05.001

Environ Pollut. 2023 May 2:121757. doi: 10.1016/j.envpol.2023.121757. Online ahead of print.

ABSTRACT

Nonylphenol (NP), Octylphenol (OP), and their ethoxylates (NPEO and OPEO) have been the subject of considerable scientific and regulatory attention, primarily due to concerns about their aquatic toxicity and endocrine activity. Environmental monitoring has been conducted and reported for these substances in the United States (U.S.) for several decades. This paper develops an updated statistically based meta-analysis of the occurrence and ecological relevance of these substances in fresh and marine surface waters and sediments in the U.S. between 2010 and 2020. The overall objectives of this study were: (1) to evaluate the impact of analytical detection limits (DLs) and treatment of censored or non-detected (ND) samples on reported results, (2) to summarize and evaluate recent (2010-2020) occurrence and concentrations of these substances in surface waters and sediments, (3) to conduct an ecological screening assessment of the potential risks of these substances to aquatic organisms in surface waters and sediments for this same period, and (4) to examine temporal trends of these substances in surface waters and sediments relative to previous investigations. Given that a large proportion of all NP, NPEO, OP and OPEO samples in recent (2010-2019) U.S. monitoring studies were below their respective method Limit of Detection/Limit of Quantification (LOD/LOQ) detection frequency ranging from 0 to 24%), proxy values were imputed using robust regression of order statistics (ROS). Nationally, NP and OP concentrations in fresh surface waters and sediments have decreased from 2010 to 2019. In contrast, changes in NP and OP concentrations in marine waters and sediments were more variable with some increases noted. A screening environmental risk assessment indicated that less than 1% of all samples exceeded U.S. or Canadian environmental quality guidelines. No exceedances were noted after 2016 which indicates a low potential for risk to aquatic organisms.

PMID:37142212 | DOI:10.1016/j.envpol.2023.121757

Am J Obstet Gynecol MFM. 2023 May 2:100994. doi: 10.1016/j.ajogmf.2023.100994. Online ahead of print.

ABSTRACT

BACKGROUND: The composition of the infant microbiome can have a variety of short- and long-term implications for health. It is unclear if maternal probiotic supplementation in pregnancy can impact infant gut microbiome.

OBJECTIVE: The aim of our study was to investigate if maternal supplementation of a formulation of Bifidobacterium breve 702258 from early pregnancy until three months postpartum could transfer to the infant gut.

STUDY DESIGN: This was a double-blinded placebo controlled randomised-controlled trial of B. breve 702258 (minimum 1 × 10⁹ colony forming units) or placebo taken orally from 16-weeks’ gestation until three-months postpartum in healthy pregnant women. The primary outcome was presence of the supplemented strain in infant stool up to 3 months of life, detected by at a least two of three methods, i.e., strain specific PCR, shotgun metagenomic sequencing, or genome sequencing of cultured B. breve. 120 individual infants’ stool samples were required for 80% power to detect a difference in strain transfer between groups. Rates of detection were compared using Fishers exact test.

RESULTS: 160 pregnant women with average age 33.6 (3.9) years, mean BMI of 24.3 (22.5, 26.5) kg/m² and 43% with nulliparity (n=58) were recruited from September 2016 to July 2019. Neonatal stool samples were obtained from 135 infants (65 in intervention and 70 in control). The presence of the supplemented strain was detected through at least two methods (PCR and culture) in two infants in the intervention group (n=2/65, 3.1%) and none in the control group (n=0, 0%), p = 0.230.

CONCLUSION: Direct strain transfer from mothers to infants of B. breve 772058 occurred, albeit infrequently. This study highlights potential for maternal supplementation to introduce microbial strains into the infant microbiome.

PMID:37142190 | DOI:10.1016/j.ajogmf.2023.100994

Am J Obstet Gynecol MFM. 2023 May 2:101004. doi: 10.1016/j.ajogmf.2023.101004. Online ahead of print.

NO ABSTRACT

PMID:37142189 | DOI:10.1016/j.ajogmf.2023.101004

Am J Ophthalmol. 2023 May 2:S0002-9394(23)00184-8. doi: 10.1016/j.ajo.2023.04.010. Online ahead of print.

ABSTRACT

PURPOSE: To compare long-term visual outcomes in the two arms of the Early Manifest Glaucoma Trial (EMGT) and determine if delayed treatment was associated with a penalty in terms of visual function.

DESIGN: Long-term follow-up of a prospective, randomized controlled clinical trial.

METHODS: EMGT was carried out at two centers in Sweden; 255 subjects with newly detected, untreated glaucoma were randomized to immediate treatment with topical betaxolol and argon laser trabeculoplasty or to no initial treatment as long as no progression was detected. Subjects were followed prospectively with standard automated perimetry, visual acuity measurements and tonometry for up to 21 years. Outcomes included vision impairment (VI), the perimetric Mean Deviation (MD) index and rate of progression, and visual acuity.

RESULTS: At study end percentages of eyes with VI or blindness were slightly higher in the treated group than in the untreated control group, 12.1% versus 11.0%, and 9.4.% versus 6.1% respectively, as were subjects with VI≥1 eye, 19.5% versus 18.7%. The differences were not statistically significant, nor were cumulative incidences of VI in at least one eye. The control group had more field loss than the treatment group, with median MD in the worse eye of -14.73 dB versus -12.85 dB, and rate of progression of -0.74 versus -0.60 dB/year; not statistically significant. Differences in visual acuity were minimal.

CONCLUSIONS: Delaying treatment did not result in serious penalties. VI occurred at similar proportions in both treatment arms with a slight preponderance in the treatment group, while visual field damage was slightly higher in the control group.

PMID:37142174 | DOI:10.1016/j.ajo.2023.04.010