Tag: statistics

Niger J Clin Pract. 2023 Feb;26(2):153-161. doi: 10.4103/njcp.njcp_1636_21.

ABSTRACT

BACKGROUND: Ultrasound-guided bilateral erector spinae plane block is also a technique for providing analgesia after a cesarean section.

AIM: We hypothesized that bilateral erector spinae plane block applied from the transverse process of T9 who underwent elective cesarean section could provide effective postoperative analgesia.

PATIENTS AND METHODS: Fifty parturients who were scheduled to undergo elective cesarean section under spinal anesthesia were included in the study. Group SA (n = 25) was categorized as the group in which spinal anesthesia alone (SA) was performed, and Group SA+ESP (n = 25) was categorized as the group in which SA + ESP block was performed. All patients were given a solution containing 7 mg isobaric bupivacaine + 15 μg fentanyl intrathecally through spinal anesthesia. In the SA + ESP group, the bilateral ESPB was performed at level T9 with 20 ml 0.25% bupivacaine + 2 mg dexamethasone immediately after the operation. Total fentanyl consumption in 24 h, the visual analogue scale for pain, and time to the first analgesic request were evaluated postoperatively.

RESULTS: The total fentanyl consumption in 24 h was statistically significantly lower in the SA + ESP group than the SA group (279 ± 242.99 μg vs. 423.08 ± 212.55 μg, respectively, P = 0.003). The first analgesic requirement time was statistically significantly shorter in the SA group than the SA + ESP group (150.20 ± 51.83 min vs. 197.60 ± 84.49 min, respectively, P = 0.022). Postoperative VAS scores at 4^th, 8^th, and 12^th h at rest were statistically significantly lower in group SA + ESP than in group SA (P = 0.004, P = 0.046, P = 0.044, respectively). VAS scores during the postoperative 4^th, 8^th, and 12^th h cough were statistically significantly lower in group SA + ESP than in group SA (P = 0.002, P = 0.008, P = 0.028, respectively).

CONCLUSION: Ultrasound-guided bilateral ESP provided adequate postoperative analgesia and significantly decreased postoperative fentanyl consumption in patients having cesarean section. Also, it has a longer analgesia time than the control group, and it has been shown to delay the first analgesic requirement.

PMID:36876603 | DOI:10.4103/njcp.njcp_1636_21

Niger J Clin Pract. 2023 Feb;26(2):145-152. doi: 10.4103/njcp.njcp_1628_21.

ABSTRACT

BACKROUND: Treatment of geriatric intensive care patients is tiring and difficult for intensive care physicians due to comorbidities, accompanying acute illnesses and vulnerabilities.

AIM: The aim of our study was to determine other factors affecting mortality and morbidity with age in geriatric intensive care patients.

PATIENTS AND METHODS: A total of 937 geriatric intensive care patients were divided into three groups as young-old (65-74 years), middle-old (75-84 years), and oldest-old (85 years and more). Demographic characteristics such as age, gender, and comorbid diseases (oncological malignancy, chronic renal failure, sepsis, chronic anemia, hypertension, diabetes mellitus, chronic obstructive pulmonary disease, pulmonary embolism) were recorded. The number of patients who needed a mechanical ventilator, developed decubit ulcers, underwent percutaneous tracheostomy, and renal replacement therapy were recorded. In addition, the number of central venous catheter insertions for patients, Acute Physiology and Chronic Health Evaluation II scores (APACHE II), hospitalization days, and mortality rates were recorded and compared.

RESULTS: In the comparison between the groups in terms of gender, in the 65-74 years’ age group, male gender was higher, while in the age group of 85 years and more, the female gender was found to be statistically higher. Among comorbid diseases, the rate of oncological malignancy was found to be statistically significantly lower in patients aged 85 years and more. Comparing the APACHE II scores of the patients as per the groups, scores were found to be statistically significantly higher in the oldest-old group. APACHE II Score, central venous catheter application, chronic obstructive pulmonary disease, chronic renal failure, sepsis, oncological malignancy, and renal replacement therapy were shown to be statistically significant as factors affecting death. The factors affecting the survival or hospitalization time of the patients of decubit ulcer, mechanical ventilator, percutaneous tracheostomy, chronic obstructive pulmonary disease, Sepsis, APACHE II Score, and age were shown to be statistically significant.

CONCLUSION: Our study showed that not only age has an effect on mortality and morbidity in geriatric intensive care patients but also comorbidities and intensive care treatments of the patients are also effective in this process.

PMID:36876602 | DOI:10.4103/njcp.njcp_1628_21

Niger J Clin Pract. 2023 Feb;26(2):133-137. doi: 10.4103/njcp.njcp_600_20.

ABSTRACT

BACKGROUND: Diabetes is a common systemic disease in the world. Acute complications of diabetes may cause sudden unexpected deaths. Analysis done in vitreous fluid which is more protected and less contaminated by bacteria comparing to blood will produce more accurate results.

AIM: Thus, we aimed to diagnose diabetes by comparing glucose levels of post mortem blood and vitreous fluid in death cases.

MATERIALS AND METHODS: A total of 17 New Zealand-type rabbits were divided into hyperglycemia (8), hypoglycemia (8), and control group (1). Rabbits were monitored for 5 days after experimental diabetes induction, and samples were taken at the point of death. Later rabbits were left in their environment, and samples were taken again at the post mortem first day. Mean blood glucose levels of hyperglycemia and hypoglycemia group were in diabetic range.

RESULTS: Blood glucose levels of hyperglycemic rabbits were measured as 512 ± 52,1 mg/dl, while vitreous glucose levels were 518,3 ± 76,8 mg/dl at the point of death. After one day, levels were measured as 433,9 ± 59,3 mg/dl and 329,8 ± 86,6 mg/dl. Blood glucose levels of hypoglycemic rabbits were measured as 39 ± 3,8 mg/dl, while vitreous glucose levels were 53,4 ± 13,9 mg/dl at the point of death. After one day, levels were measured as 36 ± 4,2 mg/dl and 1,6 ± 0,6 mg/dl. After analysis, there was a statistically significant difference between day 0 and 1 vitreous levels of hypoglycemia group.

CONCLUSION: It can be clearly seen that vitreous fluid samples should be taken in judicial cases with sudden unexpected deaths like diabetes. This will contribute to identification cause of death.

PMID:36876600 | DOI:10.4103/njcp.njcp_600_20

J Magn Reson Imaging. 2023 Mar 6. doi: 10.1002/jmri.28670. Online ahead of print.

ABSTRACT

BACKGROUND: The volume doubling time (VDT) of breast cancer was most frequently calculated using the two-dimensional (2D) diameter, which is not reliable for irregular tumors. It was rarely investigated using three-dimensional (3D) imaging with tumor volume on serial magnetic resonance imaging (MRI).

PURPOSE: To investigate the VDT of breast cancer using 3D tumor volume assessment on serial breast MRIs.

STUDY TYPE: Retrospective.

SUBJECTS: Sixty women (age at diagnosis: 57 ± 10 years) with breast cancer, assessed by two or more breast MRI examinations. The median interval time was 791 days (range: 70-3654 days).

FIELD STRENGTH/SEQUENCE: 3-T, fast spin-echo T2-weighted imaging (T2WI), single-shot echo-planar diffusion-weighted imaging (DWI), and gradient echo dynamic contrast-enhanced imaging.

ASSESSMENT: Three radiologists independently reviewed the morphological, DWI, and T2WI features of lesions. The whole tumor was segmented to measure the volume on contrast-enhanced images. The exponential growth model was fitted in the 11 patients with at least three MRI examinations. The VDT of breast cancer was calculated using the modified Schwartz equation.

STATISTICAL TESTS: Mann-Whitney U test, Kruskal-Wallis test, Chi-squared test, intraclass correlation coefficients, and Fleiss kappa coefficients. A P-value <0.05 was considered statistically significant. The exponential growth model was evaluated using the adjusted R² and root mean square error (RMSE).

RESULTS: The median tumor diameter was 9.7 mm and 15.2 mm on the initial and final MRI, respectively. The median adjusted R² and RMSE of the 11 exponential models were 0.97 and 15.8, respectively. The median VDT was 540 days (range: 68-2424 days). For invasive ductal carcinoma (N = 33), the median VDT of the non-luminal type was shorter than that of the luminal type (178 days vs. 478 days). On initial MRI, breast cancer manifesting as a focus or mass lesion showed a shorter VDT than that of a non-mass enhancement (NME) lesion (median VDT: 426 days vs. 665 days).

DATA CONCLUSION: A shorter VDT was observed in breast cancer manifesting as focus or mass as compared to an NME lesion.

LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY: Stage 2.

PMID:36876593 | DOI:10.1002/jmri.28670

Paediatr Anaesth. 2023 Mar 6. doi: 10.1111/pan.14658. Online ahead of print.

ABSTRACT

BACKGROUND: Liberal fasting regimens, which support clear fluid intake up to 1 hour before surgery in children scheduled for elective surgery, are taking their place in guidelines. However, because of the lack of publications that investigate the gastric emptying time in preoperative obese children, the practice of 1-hour clear fluid fasting in obese children remained at the level of recommendation with weak evidence.

AIMS: The primary aim was to investigate whether there is a difference in gastric emptying times between obese and non- obese children after preoperative intake of 3 ml/kg clear liquid containing 5% dextrose by using ultrasound.

METHODS: A total of 70 children were included in the study in two groups, 35 obese and 35 non-obese, aged 6-14 years, who were scheduled for elective surgery. The baseline antral cross-sectional area measurements of the children in the groups were made using ultrasound. 3 ml/kg 5% dextrose was consumed. Ultrasound was repeated immediately after fluid intake and every 5 minutes until the antral cross-sectional area was at the baseline level.

RESULTS: The difference in median (IQR [range]) gastric emptying times (minutes) of non-obese [(35 (30.0-45.0 [20-60])] and obese children [(35 (30.0-40.0 [25-60])] were not statistically significant (median of differences 0.0, 95% CI 0.0 to 0.0; P=0,563). The antral cross-sectional area and weight- adjusted gastric volumes returned to the baseline level within 60 minutes after the intake of clear liquid with 3 ml/kg 5% dextrose in all children in both groups.

CONCLUSIONS: Obese and non-obese children have similar gastric emptying times, and these groups can be offered clear fluids containing 3 ml/kg 5% dextrose 1 hour before the surgery.

PMID:36876549 | DOI:10.1111/pan.14658

Folia Med (Plovdiv). 2022 Oct 31;64(5):782-786. doi: 10.3897/folmed.64.e67757.

ABSTRACT

The share of unwanted pregnancies and voluntary abortions among women from Central and Eastern Europe is still quite high, and Bulgaria is no exception to this statistic. This might be accounted for by the low frequency of use of contraceptives or their improper use. Our country is home to a variety of ethnic groups, with Roma being one of the most numerous, ranking third in population behind Bulgarians and Turks. This determines the influence of this ethnic group on the demographic indicators of the country.

PMID:36876529 | DOI:10.3897/folmed.64.e67757

Public Health Nutr. 2023 Mar 6:1-26. doi: 10.1017/S1368980023000411. Online ahead of print.

ABSTRACT

OBJECTIVE: Explore patterns of post-malnutrition growth (PMGr) during and after treatment for severe malnutrition, and describe associations with survival and non-communicable disease (NCD) risk seven years post-treatment.

DESIGN: Six indicators of PMGr were derived based on a variety of timepoints, weight, weight-for-age z-score (WAZ) and height-for-age z-score (HAZ). Three categorisation methods included: no categorisation, quintiles, and latent class analysis (LCA). Associations with mortality risk, and seven NCD indicators were analysed.

SETTING: Secondary data from Blantyre, Malawi between 2006 and 2014.

PARTICIPANTS: A cohort of 1024 children treated for severe malnutrition (weight-for-length z-score <70% median and/or MUAC<110 mm and/or bilateral oedema) at aged 5 to 168 months.

RESULTS: Faster weight gain during treatment (g/day) and after treatment (g/kg/day) were associated with lower risk of death (aOR 0.99, 95%CI 0.99 to 1.00; and aOR 0.91, 95% CI 0.87 to 0.94 respectively). In survivors (mean age 9 years), it was associated with greater hand grip strength (0.02, 95%CI 0.00 to 0.03) and larger HAZ (6.62, 95%CI 1.31 to 11.9), both indicators of better health. However, faster weight gain was also associated with increased waist:hip ratio (0.02, 95%CI 0.01 to 0.03), an indicator of later life NCD risk. The clearest patterns of association were seen when defining PMGr based on weight gain in g/day during treatment and using the LCA method to describe growth patterns. Weight deficit at admission was a major confounder.

CONCLUSIONS: A complex pattern of benefits and risks is associated with faster PMGr. Both initial weight deficit and rate of weight gain have important implications for future health.

PMID:36876519 | DOI:10.1017/S1368980023000411

United European Gastroenterol J. 2023 Mar 6. doi: 10.1002/ueg2.12366. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: The availability of biological agents for inflammatory bowel disease has increased over the past years. In this systematic review and meta-analysis, we aimed to explore time trends in clinical response and clinical remission rates in Crohn’s disease (CD) patients treated with biologics while discussing the need for new strategies.

METHODS: MEDLINE, Cochrane, and ISI Web of Science databases were searched for randomized placebo-controlled trials with biological agents in moderate-to-severe CD patients. Sub-group and meta-regression analyses compared treatment and placebo by calculating the pooled odds ratios of clinical remission and clinical response, across time categories and publication year. We also estimated the proportion of patients achieving clinical remission and clinical response by comparing both groups according to the publication year.

RESULTS: Twenty-five trials were included in the systematic review, which enrolled 8879 patients between 1997 and 2022. The clinical remission and clinical response odds, in induction and maintenance, have been constant over time, as no statistically significant differences were found between time categories (interaction p-values: clinical remission [induction, p = 0.19; maintenance, p = 0.24]; clinical response [induction, p = 0.43; maintenance, p = 0.59]). In meta-regression analyses, publication year did not influence these outcomes (clinical remission [induction, OR 1.01{95% CI 0.97-1.05}, p = 0.72; clinical response [induction, OR 1.01{95% CI 0.97-1.04]; p = 0.63; maintenance, OR 1.03{95% CI 0.98-1.07}; p = 0.21]), with the exception of clinical remission in maintenance studies, which presented a decreased effect (odds ratio 0.97{95% CI 0.94-1.00}, p = 0.03]).

CONCLUSIONS: Our review highlights that the odds of clinical outcomes in CD patients receiving biological treatment relative to placebo have been stable in the last decades.

PMID:36876515 | DOI:10.1002/ueg2.12366

Am Surg. 2023 Mar 6:31348231161082. doi: 10.1177/00031348231161082. Online ahead of print.

ABSTRACT

INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) in acute trauma patients is a poorly characterized event. While ECMO most commonly has been deployed for advanced cardiopulmonary or respiratory failure following initial resuscitation, growing levels of evidence for out of hospital cardiac arrest support early ECMO cannulation as part of resuscitative efforts. We sought to perform a descriptive analysis evaluating traumatically injured patients, who were placed on ECMO, during their initial resuscitation period.

METHODS: We performed a retrospective analysis of the Trauma Quality Improvement Program Database from 2017 to 2019. All traumatically injured patients who received ECMO within the first 24 hours of their hospitalization were assessed. Descriptive statistics were used to define patient characteristics and injury patterns associated with the need for ECMO, while mortality represented the primary outcome evaluated.

RESULTS: A total of 696 trauma patients received ECMO during their hospitalization, of which 221 were placed on ECMO within the first 24 hours. Early ECMO patients were on average 32.5 years old, 86% male, and sustained a penetrating injury 9% of the time. The average ISS was 30.7, and the overall mortality rate was 41.2%. Prehospital cardiac arrest was noted in 18.2% of the patient population resulting in a 46.8% mortality. Of those who underwent resuscitative thoracotomy, a 53.3% mortality rate was present.

CONCLUSION: Early cannulation for ECMO in severely injured patients may provide an opportunity for rescue therapy following severe injury patterns. Further evaluation regarding the safety profile, cannulation strategies, and optimal injury patterns for these techniques should be evaluated.

PMID:36876475 | DOI:10.1177/00031348231161082

J Man Manip Ther. 2023 Mar 6:1-9. doi: 10.1080/10669817.2023.2179285. Online ahead of print.

ABSTRACT

OBJECTIVES: This study includes two separate parts: the objective for part A was to evaluate the practical manual therapy skills of undergraduate physiotherapy students who had learned manual therapy techniques either online or in classroom depending on the phases of the pandemic. The objective for part B was to evaluate in a randomized prospective design the effectiveness of video-based versus traditional teaching of a manual therapy technique.

DESIGN: Cross-sectional cohort study (part A) and randomized controlled trial (part B).

SETTING: University of Luebeck, undergraduate physiotherapy students in years 1-3.

METHOD: In part A, physiotherapy students who had learned manual therapy either online (during the pandemic) or in classroom (prior to and after the lock down periods of the pandemic) were videotaped while performing two manual techniques on the knee joint and on the lumbar spine. Recordings were analyzed independently by two blinded raters according to a 10-item list of criteria. Inter-rater reliability was assessed using Cohen’s kappa for each item. Performance across cohorts was analyzed using analysis of variance. In part B, students were randomized to learn a new technique on the cervical spine either from a lecturer or from the same lecturer on a video recording (independent variable). Practical performance of the technique was analyzed by two raters blinded to group allocation according to a 10-item list of criteria (dependent variable). Results were analyzed statistically by using ANCOVA with year of study as a covariate.

RESULTS: Sixty-three and 56 students participated in part A and part B of the study, respectively. The inter-rater reliability for video analyses for both parts of the study was moderate (k = 0.402 to 0.441). In part A, there was no statistically significant difference across years of study for the practical performance of the technique on the back F(2,59) = 2.271; p = 0.112 or the knee joint F(2,59) = 3.028; p = 0.056. In part B, performance was significantly better when learned from a lecturer and practiced on a peer than when learned from a video and practiced on a rescue dummy (p < 0.001).

CONCLUSION: Practical skill performance can be acquired from videos but immediate skill reproduction is significantly better when the technique is presented by a lecturer in classroom and practiced on peer students.

PMID:36876463 | DOI:10.1080/10669817.2023.2179285