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Nevin Manimala Statistics

Infection in Hospitalized Patients With Systemic Lupus Erythematosus: Proposal of an Algorithm for Diagnosis

J Clin Rheumatol. 2022 Apr 1;28(3):113-119. doi: 10.1097/RHU.0000000000001811.

ABSTRACT

BACKGROUND: Identification of infection in patients with systemic lupus erythematosus (SLE) is a major challenge in clinical practice.

OBJECTIVE: This medical records review study evaluated clinical markers, including the performance of C-reactive protein (CRP), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) in the diagnosis of infection in SLE patients.

METHODS: One hundred four SLE patients hospitalized between 2014 and 2018 were allocated into 3 groups, namely, infection, infection and disease activity, and isolated disease activity. Groups were compared in relation to clinical and laboratory variables. Accuracy measures were calculated for CRP, NLR, and PLR.

RESULTS: C-reactive protein, NLR, and PLR differed between the groups with higher values observed in the infected group, intermediate values in the mixed group, and lower values in the group with isolated activity-CRP (56 vs 26 vs 15 mg/dL, p = 0.002), NLR (7.9 vs 4.0 vs 3.1, p = 0.005), and PLR (270 vs 227 vs 134, p = 0.025). Fever, tachypnea, and PLR were independently associated with infection. The cutoff points of the CRP of 20 mg/L, NLR of 3.5, and PLR of 151.4 presented values of sensitivity and specificity for the prediction of infection equal to 67% and 67%, 65% and 58%, and 71% and 53%, respectively. The developed algorithm showed a sensitivity of 86.6% and specificity of 81% for the diagnosis of infection.

CONCLUSIONS: The combined use of clinical and laboratory markers presented superior accuracy than their isolated use, suggesting a great potential for the application of the algorithm in clinical practice.

PMID:35325899 | DOI:10.1097/RHU.0000000000001811

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Nevin Manimala Statistics

Gastrointestinal Health of People Working From Home Due to the COVID-19 Pandemic: Online, Cross-sectional Survey

Altern Ther Health Med. 2022 Mar 24:AT7140. Online ahead of print.

ABSTRACT

CONTEXT: The onset of the COVID-19 pandemic has resulted in an increasingly sedentary lifestyle among people working from home (WFH), including 71% of Information and Technology (IT) workers. The lifestyle lacks physical activity and also affects people emotionally, which can lead to serious ailments.

OBJECTIVE: The study aimed to identify and understand the burden from gastrointestinal complaints on individuals in the IT sector, who have been working from home due to the COVID-19 pandemic and lockdown.

DESIGN: The researcher designed an online, cross-sectional survey, which was prepared on Google Forms.

SETTING: The study was conducted in Dr. D. Y. Patil Homoeopathic Medical College and Research Centre, Pune, India.

PARTICIPANTS: Participants were 101 WFH workers in the IT sector in the Maharashtra state of India.

OUTCOME MEASURE: The survey comprised a set of 28 questions on gastrointestinal health. The responses were analyzed to understand the types of gastric troubles that respondents had experience. Descriptive statistics were used to analyze the data.

RESULTS: The study included 101 responses for analysis. Most respondents were from 26 to 30 years of age (47.5%). Gender was not identified as an affecting variable. The author did not find any correlation between the variables. Of the 101 respondents, 49 (48.5%) of respondents had experienced gastric troubles since working from home in lockdown.

CONCLUSIONS: The complaints of the current study’s respondents suggest an incidence of diseases after lockdown, such as acid peptic disease, first degree hemorrhoids, fissure in ano, gastritis, and irritable bowel syndrome. Together with physical ailments, many people have had a varied mental symptomatology that can be likely to give rise to psychosomatic diseases.

PMID:35325873

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A multitask deep representation for Gleason score classification to support grade annotations

Biomed Phys Eng Express. 2022 Mar 24. doi: 10.1088/2057-1976/ac60c4. Online ahead of print.

ABSTRACT

The Gleason grade system is the main standard to quantify the aggressiveness and progression of prostate cancer. Currently, exists a high disagreement among experts in the diagnosis and stratification of this disease. Deep learning models have emerged as an alternative to classify and support experts automatically. However, these models are limited to learn a rigid stratification rule that can be biased during training to a specific observer. Therefore, this work introduces an embedding representation that integrates an auxiliary task learning to deal with the high inter and intra appearance of the Gleason system. The proposed strategy implements as a main task a triplet loss scheme that builds a feature embedding space with respect to batches of positive and negative histological training patches. As an auxiliary task is added a cross-entropy that helps with inter-class variability of samples while adding robust representations to the main task. The proposed approach shows promising results achieving an average accuracy of 66% and 64%, for two experts without statistical difference. Additionally, reach and average accuracy of 73% in patches where both pathologists are agree, showing the robustness patterns learning from the approach.

PMID:35325887 | DOI:10.1088/2057-1976/ac60c4

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Evaluation of neonatal hearing screening results of newborns with premature retinopathy

Int J Pediatr Otorhinolaryngol. 2022 Mar 17;156:111112. doi: 10.1016/j.ijporl.2022.111112. Online ahead of print.

ABSTRACT

OBJECTIVES: To reveal the risk situations of ROP patients in terms of hearing loss by examining the newborn hearing screening test results.

METHODS: Hearing screening test results of ROP patients and newborns with similar congenital risk factors(control group) treated in our hospital were retrospectively screened. Both groups were compared in terms of newborn hearing screening test results.

RESULTS: In the first screening test, the rate of ”refer” result in the ROP group was significantly higher than the control group (p < 0.05). There was no significant difference between the two groups in terms of second hearing screening test results (p > 0.05). In the second screening test, 100% of stage 3 ROP patients failed from the right ear and 80% in the left ear, and this difference was statistically significant compared to the other two groups (p < 0.05).

CONCLUSION: Newborn hearing screenings of patients with advanced stage ROP patients should be followed up more sensitively, since stage 3 ROP patients had more failure results from the screening test in our study.

PMID:35325847 | DOI:10.1016/j.ijporl.2022.111112

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Presurgical evaluation of drug-resistant paediatric focal epilepsy with PISCOM compared to SISCOM and FDG-PET

Seizure. 2022 Mar 15;97:43-49. doi: 10.1016/j.seizure.2022.03.010. Online ahead of print.

ABSTRACT

PURPOSE: Children with drug-resistant focal epilepsy have a compromised quality of life. Epilepsy surgery can control or significantly reduce the seizures. We assessed and compared the usefulness of PISCOM, a new nuclear imaging processing technique, with SISCOM and 18F-FDG PET (FDG-PET) in pre-surgical evaluation of paediatric drug-resistant focal epilepsy.

METHODS: Twenty-two children with pharmcorefractory epilepsy, mainly extratemporal, who had undergone pre-surgical assessment including SISCOM and FDG-PET and with postsurgical favorable outcome (Engel class I or II) for at least two years, were included in this proof-of-concept study. All abnormalities observed in SISCOM, FDG-PET and PISCOM were compared with each other and with the known epileptogenic zone (EZ) based on surgical treatment, histopathologic and surgical outcome results. Global interobserver agreement, Cohen’s Kappa coeficient and PABAK statistic were calculated for each technique.

RESULTS: PISCOM concordance with the known EZ was significantly higher than SISCOM (p<0.05), and no statistically differences were found with FDG-PET. PISCOM showed successful identification in 19 of 22 cases (86%), successful concordant with FDG-PET in 17 (77%), and SISCOM in 11 (50%). If we consider PISCOM and FDG-PET results together, both techniques successfully localized the known EZ in all cases. The measures of agreement between two experts in nuclear medicine were higher in PISCOM than in SISCOM and FDG-PET.

CONCLUSION: PISCOM could provide complementary presurgical information in drug-resistant paediatric focal epilepsy, particularly in cases in which FDG-PET is doubtful or negative, replacing SISCOM and sparing the use of interictal SPECT.

PMID:35325841 | DOI:10.1016/j.seizure.2022.03.010

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Therapeutic efficacy and safety of Yinzhihuang granules with phototherapy in neonatal pathologic jaundice: An updated systematic review and meta-analysis

Phytomedicine. 2022 Mar 16;100:154051. doi: 10.1016/j.phymed.2022.154051. Online ahead of print.

ABSTRACT

BACKGROUND: Yinzhihuang granule, consisting of extracts of Artemisia capillaris Thunb., Gardenia jasminoides Ellis, Lonicera japonica Thunb., and Scutellaria baicalensis Georgi is a well-known traditional Chinese patent medicine for patients with liver injury in China. However, the effects and safety of its use for pathologic jaundice in newborns require further systematic evaluation.

PURPOSE: To systematically evaluate the efficacy and safety of Yinzhihuang granules for the treatment of neonatal pathologic jaundice and to provide clinical evidence.

METHODS: Chinese databases (China Network Knowledge Infrastructure, Wan Fang Database, and VIP Database) and English databases (PubMed, EmBase, and the Cochrane Library) were thoroughly investigated through screening randomized controlled trials on Yinzhihuang granules for neonatal pathologic jaundice from the establishment of all databases to November 18, 2021. A meta-analysis was performed for selected data using STATA software. TSA software was used for trial sequential analyses of the total effective rate and adverse reactions.

RESULTS: A total of 19 trials and 2,221 newborns with pathologic jaundice were included in this study. Outcome measures of clinical efficacy in the experimental group were higher than in controls, including total bilirubin (WMD = -30.34, 95% CI = -35.44 to -25.23, p < 0.001), direct bilirubin (WMD = -15.03, 95% CI = -23.54 to -6.52, p < 0.001), indirect bilirubin (WMD = -11.22, 95% CI = -17.50 to -4.95, p < 0.001), recovery time (WMD = -2.96, 95% CI = -3.92 to -2.00, p < 0.001), hospitalization time (WMD = -3.83, 95% CI = -4.89 to -2.76, p < 0.001), and liver function indices. There were statistically significant differences between the two groups. Likewise, the incidence of adverse reactions, including diarrhea, erythra, and fever decreased remarkably in the trial group (RR = 0.44, 95% CI = 0.33 to 0.59, p < 0.001). Publication bias did not exist. We verified the efficacy and safety of Yinzhihuang granules with phototherapy for pathologic jaundice in newborns according using TSA analysis.

CONCLUSION: Yinzhihuang granules with phototherapy for neonatal pathologic jaundice are more effective than phototherapy alone. The incidence of ADRs does not increase with the application of Yinzhihuang granules. Due to the heterogeneity across the included studies, additional multicenter clinical trials with follow-ups are needed to confirm our findings.

PMID:35325827 | DOI:10.1016/j.phymed.2022.154051

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Epigenetic landscape in the kick-and-kill therapeutic vaccine BCN02 clinical trial is associated with antiretroviral treatment interruption (ATI) outcome

EBioMedicine. 2022 Mar 21;78:103956. doi: 10.1016/j.ebiom.2022.103956. Online ahead of print.

ABSTRACT

BACKGROUND: The BCN02-trial combined therapeutic vaccination with a viral latency reversing agent (romidepsin, RMD) in HIV-1-infected individuals and included a monitored antiretroviral pause (MAP) as an efficacy read-out identifying individuals with an early or late (< or > 4weeks) viral-rebound. Integrated -omics analyses were applied prior treatment interruption to identify markers of virus control during MAP.

METHODS: PBMC, whole-genome DNA methylation and transcriptomics were assessed in 14 BCN02 participants, including 8 Early and 4 Late viral-rebound individuals. Chromatin state, histone marks and integration analysis (histone-3 acetylation (H3Ac), viral load, proviral levels and HIV-specific T cells responses) were included. REDUC-trial samples (n = 5) were included as a control group for RMD administration alone.

FINDINGS: DNA methylation imprints after receiving the complete intervention discriminated Early versus Late viral-rebound individuals before MAP. Also, differential chromatin accessibility and histone marks at DNA methylation level were detected. Importantly, the differential DNA methylation positions (DMPs) between Early and Late rebounders before MAP were strongly associated with viral load, proviral levels as well as the HIV-specific T-cell responses. Most of these DMPs were already present prior to the intervention and accentuated after RMD infusion.

INTERPRETATION: This study identifies host DNA methylation profiles and epigenetic cascades that are predictive of subsequent virus control in a kick-and-kill HIV cure strategy.

FUNDING: European Union Horizon 2020 Framework Programme for Research and Innovation under Grant Agreement N°681137-EAVI2020 and N°847943-MISTRAL, the Ministerio de Ciencia e Innovación (SAF2017_89726_R), and the National Institutes of Health-National Institute of Allergy and Infectious Diseases Program Grant P01-AI131568.

PMID:35325780 | DOI:10.1016/j.ebiom.2022.103956

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Proximity and density of unconventional natural gas wells and mental illness and substance use among pregnant individuals: An exploratory study in Canada

Int J Hyg Environ Health. 2022 Mar 21;242:113962. doi: 10.1016/j.ijheh.2022.113962. Online ahead of print.

ABSTRACT

BACKGROUND: Hydraulic fracturing (fracking) is a method used to extract unconventional natural gas (UNG). Living near UNG operations has been associated with various health outcomes, but few have explored the association between UNG and mental health and substance use. Our objective was to evaluate the association between metrics of residential UNG well density/proximity and mental illness and substance use among pregnant individuals in Northeastern British Columbia, Canada.

METHODS: Individuals who gave birth at the Fort St John hospital between December 30, 2006 and December 29, 2016 (n = 6278) were included in the study. Exposure was determined using inverse distance weighting (IDW) to calculate the density and proximity of UNG wells to the postal code centroid ofindividual’s residential address at delivery. Four exposure metrics, categorized by quartiles, were calculated based on 50, 10, 5 and 2.5 km buffer zones around each postal code centroid. Logistic regression was used to separately evaluate associations between IDW quartiles of each metric and diagnosis of depression and anxiety prior to or during pregnancy, and self-reported substance use during pregnancy, controlling for relevant and available confounders.

RESULTS: The second and third quartile (Q) of the 10 km IDW were associated with greater odds of depression (Q2: adjusted (aOR) 1.30, 95% (confidence interval) CI 1.03-1.64; Q3: aOR 1.35, 95% CI 1.07-1.70) compared to the first quartile, but not the fourth. Using the 5 km IDW, we observed a suggestive positive association with depression in the second and third quartile (aOR Q2: 1.21, 95% CI 0.96-1.53; aOR Q3: 1.24, 95% CI 0.98-1.57) compared to the first quartile. No statistically significant association was observed using the 2.5 km IDW exposure metric.

CONCLUSION: We observed some evidence of greater odds of mental illness prior to or during pregnancy, and substance use during pregnancy in pregnant individuals living in postal codes with increased UNG well density/proximity, although associations were not observed in smaller buffer zones. This study adds to the growing literature on the adverse health outcomes surrounding living in proximity to UNG operations.

PMID:35325816 | DOI:10.1016/j.ijheh.2022.113962

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Inter-reader agreement of the Prostate Imaging Quality (PI-QUAL) score: A bicentric study

Eur J Radiol. 2022 Mar 18;150:110267. doi: 10.1016/j.ejrad.2022.110267. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the inter-reader agreement of the Prostate imaging quality (PI-QUAL) for multiparametric magnetic resonance imaging (mpMRI).

METHODS: We included 66 men who underwent 1.5 T mpMRI in June 2020-July 2020 in center 1, with no exclusion criteria. mpMRI included multiplanar T2-weighted imaging (T2WI), Diffusion-weighted imaging (DWI), and dynamic contrast-enhanced imaging (DCE). Two readers from center 2 (experience <1000 to >1500 examinations), blinded to clinical history but not to acquisition parameters, independently assessed PI-QUAL qualitative/anatomical items of each mpMRI sequence, final PI-QUAL score (1-5), and the Prostate imaging reporting and data system version 2.1 (PI-RADSv2.1) category of the index lesion. Cohen’s kappa statistics (k) or prevalence-adjusted-bias-adjusted kappa (PABAK) were used to calculate the inter-reader agreement in assessing the PI-QUAL (1-to-5 scale and 1-2 versus 3 versus 4-5), the diagnostic quality of each mpMRI sequence, qualitative/anatomical items, and PI-RADSv2.1 category.

RESULTS: The inter-reader agreement for PI-QUAL category was moderate upon 1-5 scale (k = 0.55; 95%CI 0.39-0.71) or 1-3 scale (k = 0.51; 95%CI 0.29-0.72), with 90.9% examinations categorized PI-QUAL ≥ 3 by readers. The agreement in assessing a sequence as diagnostic was higher for T2WI (k = 0.76) than DCE (PABAK = 0.61) and DWI (k = 0.46), ranging moderate-to-substantial for most of the items. Readers provided comparable PI-RADSv2.1 categorization (k = 0.88 [excellent agreement]; 95%CI 0.81-0.96), with most PI-RADSv2.1 ≥ 3 assignments found in PI-QUAL ≥ 3 examinations (43/46 by reader 1, and 47/47 by reader 2).

CONCLUSIONS: The reproducibility of PI-QUAL was moderate. Higher PI-QUAL scores were associated with excellent inter-reader agreement for PI-RADSv2.1 categorization.

PMID:35325773 | DOI:10.1016/j.ejrad.2022.110267

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Effect of simulated changes in pelvic tilt on hip joint forces

J Biomech. 2022 Mar 12;135:111048. doi: 10.1016/j.jbiomech.2022.111048. Online ahead of print.

ABSTRACT

Musculoskeletal modeling is commonly used to simulate and compare various movements between individuals. For conditions such as femoroacetabular impingement syndrome (FAIS), individuals tend to walk with more anterior pelvic tilt than those without FAIS. However, it is unknown whether accounting for pelvic tilt in musculoskeletal modeling would lead to a change in muscle forces and in turn, joint forces. Gait data of six individuals were collected and processed using Vicon and Visual3D. Each participant’s pelvic tilt was adjusted by ± 10° at all time points during gait. Three analyses were performed per individual: no adjustment in tilt, one posterior (positive) tilt, and one anterior (negative) tilt. The resulting data were imported into OpenSim to determine muscle forces and the resulting femur-on-acetabulum (hip joint) forces in the pelvic and femoral reference frames. Data for each participant were normalized for gait cycle and body weight in MATLAB, and statistical parametric mapping was used to determine if the differences in joint and muscle forces were significant across different pelvic orientations. Shifting from posterior to anterior pelvic tilt reduced resultant forces. In the pelvic reference frame, anteriorly-directed joint forces decreased, while medially-directed forces increased. In the femoral reference frame, anteriorly- and medially-directed joint forces increased, while superiorly-directed forces decreased. Anterior gluteus medius and iliacus muscle forces decreased, while quadratus femoris, piriformis, and gemellus muscle forces increased. Given these results, future studies using musculoskeletal modeling should account for pelvic tilt in musculoskeletal models to obtain more realistic comparisons between healthy and pathological conditions.

PMID:35325751 | DOI:10.1016/j.jbiomech.2022.111048