Tag: statistics

Vestn Otorinolaringol. 2022;87(3):92-98. doi: 10.17116/otorino20228703192.

ABSTRACT

The relevance of the issues of diagnosis and treatment of isolated sphenoiditis (IS) is increasing, due to the widespread introduction into clinical practice of radiation diagnostic methods that allow the diagnosis, including latent forms of IS. Among the chronic forms of IS, polypous-cystic and fungal lesions of the sphenoid sinus (SS) predominate.

OBJECTIVE: To study the age, gender and radiological features of SS in patients with IS.

MATERIAL AND METHODS: A retrospective observational single-center non-randomized study was conducted – an analysis of the case histories of 56 patients aged 18 to 68 years who were on inpatient treatment at the Semashko Nizhny Novgorod Regional Clinical Hospital (Department of Ear, Throat and Nose Diseases of the Privolzhsky Research Medical University) in the period 2018-2020, by age, gender composition, clinical and radiological manifestations in various forms of IS.

RESULTS: The duration of the disease was 59±19 days. Latent forms were detected in 40% of patients. Statistically, the polypous-cystic form of IS was diagnosed more often than the fungal one (z=4.2; p=0.001). The median age of patients with polypous-cystic and fungal IS was 46.5 [35.0; 59.0] years. Evaluation of computed tomograms on the Lund-Mackay scale showed higher values in patients with polypous-cystic IS than in patients with fungal SS lesion (p=0.07). Obstruction of the anastomosis was detected in 38 out of 50 (69.5%) patients with polypous-cystic IS and in 13 out of 50 (92.9%) patients with fungal IS.

CONCLUSIONS: Against the background of a significant prevalence of rhinosinusitis, the absolute values of isolated sphenoiditis, even with a relative value of 5% of the total, are very significant. Determining the phenotype of isolated sphenoiditis and their features is very important for building a consistent treatment strategy. Age, gender, clinical and radiological manifestations should form the basis of phenotyping and further construction of a therapeutic and diagnostic algorithm.

PMID:35818952 | DOI:10.17116/otorino20228703192

Vestn Otorinolaringol. 2022;87(3):4-6. doi: 10.17116/otorino2022870314.

ABSTRACT

OBJECTIVE: To assess the impact of septoplasty on quality of life by measuring changes in nasal breathing and voice function using subjective assessment questionnaires.

MATERIAL AND METHODS: The study included 98 patients who underwent septoplasty for the nasal septum deviation. The effect of the operation on nasal breathing was assessed subjectively using the Nasal Obstruction Septoplasty Effectiveness (NOSE) questionnaire, and the effect on voice function was assessed using the Voice Handicap Index-30 (VHI-30) questionnaire.

RESULTS: There was a statistically significant difference between the preoperative and postoperative (after 1 and 3 months) NOSE data (in both cases, p<0.001) and and between the indicators 1 and 3 months after surgery (p<0.001). There was a statistically significant difference (p<0.001 in both cases) between the preoperative VHI-30 and 1 and 3 months postoperatively. There was also a statistically significant difference (p<0.001) between 1 and 3 months after surgery for this test.

CONCLUSION: In this study, the effect of septoplasty on respiratory and voice function was demonstrated using subjective tests. In the postoperative period, patients subjectively positively assessed changes in both nasal breathing and voice.

PMID:35818938 | DOI:10.17116/otorino2022870314

Arch Esp Urol. 2022 May 28;75(4):368-374. doi: 10.37554/en-j.arch.esp.urol-20210619-3504-24.

ABSTRACT

INTRODUCTION: The most common type of renal cancers is the clear cell renal cell carcinoma (CCRCC) and 98% of CCRCCs have a loss of sequence in the short arm of chromosome 3 by deletion or translocation. Programmed cell death; another possible mechanism of tumorigenesis, comprises two separate components: apoptosis and autophagy. This study aims to show the rela-tion between the prognostic parameters and survival, and Beclin-1, as the representative marker of autophagy, and Bcl-2 as the representative marker of apoptosis in CCRCC patients. In this study, we aimed to determine if Beclin-1 and Bcl-2 expression levels can provide any prognostic information about CCRCC patients.

METHODS: We examined a total of 84 patients who underwent partial or radical nephrectomy and were diagnosed as having CCRCC between January 2008 and December 2015. Immunohistochemical staining was performed, the evaluation was for Beclin-1 and Bcl-2 semi-quantitative, and based on the percentage of positively stained cells (proportion) and staining intensity.

RESULTS: There was only a statistical significance between Beclin-1 expression and age (r:-0.274; p=0.012; p <0.05). There was a marginal significance between ISUP grade and Beclin-1 (p=0.051). The relation of Bcl-2 expression with the ISUP grade, recurrence, metastasis, and mortality revealed statistical significance (p=0.001, p=0.019, p=0.009, p=0.013, respectively). The ISUP grade and the Bcl-2 expression revealed statistical significance on multivariate analysis ( HR 7.453, 95% CI: 1.935-28.713, p=0.004). The 5-year and 10-year tumor recurrences rates were lower in Bcl-2 positive group, and Bcl-2 positive group experi-enced longer disease free and overall survival.

CONCLUSION: There was only marginal correlation between Beclin-1 expression and ISUP grade. No other histopathologic prog-nostic parameters histologic parameters revealed any signigificance. The higher expression of Bcl-2 is correlated with nuclear lower ISUP grade, lower pT stage, and longer disease free and overall survival.

PMID:35818918 | DOI:10.37554/en-j.arch.esp.urol-20210619-3504-24

Arch Esp Urol. 2022 May 28;75(4):361-367. doi: 10.37554/en-j.arch.esp.urol-20210525-3501-21.

ABSTRACT

OBJECTIVES: Retrograde intrarenal surgery (RIRS) is commonly performed under general anesthesia (GA) because renal mobility during breathing may affect lithotripsy. However, spinal anesthesia (SA) is adopted in clinical practice due to clinical conditions that contraindicate GA. We aimed to compare results of RIRS for stones performed under GA compared to SA regarding stone-free rate (SFR) status and postoperative complications in a consecutive single-center series.

METHODS: We retrospectively reviewed all patients who underwent RIRS for stones between 2017 and 2020.

INCLUSION CRITERIA: age ≥ 18 years, renal stone burden deemed suitable for RIRS with a stone diameter ≤ 20 mm.

EXCLUSION CRITERIA: stones >20 mm, urinary tract infection, bilateral surgery, second-look procedures, unmodifiable bleeding diathesis, <5mm asymptomatic lower calyx stones. SFR was defined as no residual fragment >3 mm at 6-12 weeks follow-up. The choice of anesthesia was a shared decision between anesthesiologists and patient preference.

RESULTS: 230 patients were included in the analysis. Mean age was 57.50±13.73 years. 33% of stones were located in the pelvis. 28.7% of patients had multiple stones. Mean cumulative stone diameter was 16.60±6.54 mm. 63% of patients underwent RIRS under SA. There were no significant differences between the two groups in terms of preoperative characteristics, except for comor-bidity, significantly higher in the GA group. Mean time of operating room occupation was longer in the GA group (81.58±35.37 minutes) than in the SA group (72.85±25.91 minutes,p=0.033). Length of stay was shorter in the SA group (mean 2.2±1.66 days vs 3.46±5.88 in GA,p=0.019). Logistic regression showed that multiple stones in the collecting system were associated with residual fragments (HR 0.386, 95%CI 0.151-0.991,p=0.04). There were no statistically significant differences in overall and high-grade complications, and in SFR between SA (75.9%) and GA groups (70.6%,p=0.317).

CONCLUSION: SA does not affect SFR and postoperative complications in patients who underwent RIRS in daily practice.

PMID:35818917 | DOI:10.37554/en-j.arch.esp.urol-20210525-3501-21

Arch Esp Urol. 2022 May 28;75(4):339-345. doi: 10.56434/j.arch.esp.urol.20227504.48.

ABSTRACT

OBJECTIVES: We aimed to evaluate the prevalence and predictive factors of postoperative infections after a standardized low-pressure RIRS technique. The secondary outcome was comparing surgeons’ experience in terms of infective complication and stone-free rate.

METHODS: A single-center retrospective analysis was conducted on all patients who underwent RIRS for kidney stones between January 2018 and February 2019.

INCLUSION CRITERIA: adults, stone ≤ 20 mm (unless percutaneous nephrolithotomy contraindica-tions). Concomitant ureteral lithotripsy was allowed.

EXCLUSION CRITERIA: bilateral surgery, active urinary tract infections (UTI), pregnancy, fever at surgery. Low-pressure RIRS and ureteroscopy was achieved with gravity irrigation, a 5 Ch open-ended urethral catheter (ureteral lithotripsy), intravenous furosemide (20 mg), and ureteral access sheath above the ureteral-pelvic junction (RIRS).

RESULTS: 236 patients were included in the analysis. Mean age was 55.89±13.96 years. Mean stone diameter was 14.28±5.81mm. 43 (18.2%) patients underwent concomitant ureteral lithotripsy. Mean operative time was 61.10 ± 31.36 minutes. Infective complications occurred in 13 (5.5%) patients. Sepsis occurred in 10 (4.2%) patients and septic shock occurred in 1 (0.4%). One patient (0.4%) required stent substitution. Multivariate logistic regression analysis showed that history of UTI predicted for higher risk of postoperative infections (OR 8.434, CI 95% 2.36-29.46). Outcomes comparison of surgical expertise did not statistically differ in terms of stone-free rate and infective complications.

CONCLUSION: Our standardized RIRS technique achieved a low postoperative infective complication rate. History of UTI was the strongest predictor of postoperative infections.

PMID:35818914 | DOI:10.56434/j.arch.esp.urol.20227504.48

Arch Esp Urol. 2022 May 28;75(4):318-324. doi: 10.56434/j.arch.esp.urol.20227504.45.

ABSTRACT

OBJECTIVE: To analyse the clinical evolution, the therapeutic strategies and the characteristics of the patients presenting enuresis attended at our outpatient clinic.

MATERIAL AND METHODS: Retrospective study of patients <14 years old(yo) diagnosed of enuresis attended at our outpatient clinic (2011-2019) and completed their follow-up (remission or aged 15). Urotherapy was offered to all patients as initial management. The therapeutic strategies were classified as: first line (desmopressin or clock alarm), second line (desmo-pressin+alarm) and third line(anticholinergics). The remission rate during follow-up, the number of consultations needed until remission and the treatments used were calculated. Statistical tests used:Kaplan-Meier, actuarial survival. Multivariate analysis:Cox regression.Statistical significance:p<0.05.

RESULTS: Data were collected from 125 patients (mean age: 8.6±2.45yo). Family history of enuresis was present in 38.9%. The mean follow-up was 2.37±1.55yo and the average number of consultations was 7.54±5.06. The remission rate (RE) was 84%(n=105), with a median remission interval:2.66 years (2.34-2.991[95%CI]). The average number of treatments required for remission was 2.74±1.27. RE with urotherapy alone was 20%(n=25); RE with first line:19.3%(n=17) and second line:16.7(n=11). In the remaining patients, a RE of 78.18%(n=43) was achieved by adding an anticholinergic. Patients aged > 8.7 years at the beginning of the follow-up required less time to achieve remission (p=.025). These patients had a higher RE (hazard ratio 1.15 (1.05-1.25))(p=.004). No other variables were significant.

CONCLUSION: Staged therapeutic strategies are necessary to achieve remission. Only 25% remitted with urotherapy as single treatment. RE are higher when patients are >8.7 yo once they initiate their follow up.

PMID:35818911 | DOI:10.56434/j.arch.esp.urol.20227504.45

Clin Linguist Phon. 2022 Jul 12:1-16. doi: 10.1080/02699206.2022.2092423. Online ahead of print.

ABSTRACT

Alzheimer’s disease (AD) can manifest itself with prominent language dysfunction. Incompleteness in discourse refers to the lack of indispensable sentence-constructing elements that hinder communication fluency and accuracy. The current study investigates how the pattern of incompleteness is associated with the descriptive discourse produced by elders without AD and those with different stages of AD. The Chinese discourse samples were collected from the picture description of 40 elders with mild probable AD (Mini-Mental State Examination (MMSE) 21-26, Montreal Cognitive Assessment Scale-Basic (MoCA-B) 15-19), 40 elders with moderate probable AD (MMSE 11-20, MoCA-B 10-14), and 40 controls (MMSE 26-29, MoCA-B 24-29). The total production of incomplete sentences and six incompleteness features were examined. The Mild AD, Moderate AD, and Control groups differed in the total output of the incomplete sentence. Group differences also emerged in four incompleteness features: missing subject, missing predicate, missing object, and missing functional word. The Moderate AD group differed from the Mild AD group with respect to most significant features, while Mild AD and Control groups were very similar. The results suggested that AD impairs the sentence construction ability of Chinese elders, especially at the later stage. These statistically significant differences between the groups might provide some references when diagnosing the risk and possibility of cognitive impairment of Chinese elders, facilitating the design of clinical evaluation or screening for probable AD.

PMID:35818887 | DOI:10.1080/02699206.2022.2092423

J Int AIDS Soc. 2022 Jul;25 Suppl 1:e25931. doi: 10.1002/jia2.25931.

ABSTRACT

INTRODUCTION: To investigate the association between individual and community-level measures of HIV stigma and HIV incidence within the 21 communities participating in the HPTN (071) PopART trial in Zambia and South Africa.

METHODS: Secondary analysis of data from a population-based cohort followed-up over 36 months between 2013 and 2018. The outcome was rate of incident HIV infection among individuals who were HIV negative at cohort entry. Individual-level exposures, measured in a random sample of all participants, were: (1) perception of stigma in the community, (2) perception of stigma in health settings and (3) fear and judgement towards people living with HIV. Individual-level analyses were conducted with adjusted, individual-level Poisson regression. Community-level HIV stigma exposures drew on data reported by people living with HIV, health workers and community members. We used linear regression to explore the association between HIV stigma and community-level HIV incidence.

RESULTS: Among 8172 individuals who were HIV negative and answered individual-level stigma questions at enrolment to the cohort, there was no evidence of a statistically significant association between any domain of HIV stigma and risk of incident HIV infection. Among the full cohort of 26,110 individuals among whom HIV incidence was measured, there was no evidence that community-level HIV incidence was associated with any domain of HIV stigma.

CONCLUSIONS: HIV stigma is often cited as a barrier to the effectiveness of HIV prevention programming. However, in the setting for the HPTN 071 “PopART trial,” measured stigma alone was not associated with the risk of HIV infection.

PMID:35818869 | DOI:10.1002/jia2.25931

Aging Ment Health. 2022 Jul 12:1-9. doi: 10.1080/13607863.2022.2098923. Online ahead of print.

ABSTRACT

OBJECTIVES: I sought to identify racial disparities in visitation and health between Non-White and White older adults incarcerated in prison and to examine the contribution of visitation to health among this vulnerable population.

METHODS: Descriptive and bivariate statistics were calculated to describe the cross-sectional sample and relationships between visitation and health. Independent t-tests, Chi-square tests, and effect sizes were used to identify racial disparities in measures of and relationships between visitation and health. Hierarchical multiple linear regression was used to examine the contribution of visitation to physical functioning, chronic disease, and mental health.

RESULTS: Older adults rated their physical functioning higher than their mental health. Over 70% of older adults received zero visits during their current incarceration (∼13 years) and White older adults received 10 times the number of visits than Non-White older adults. Increased visitation related to decreased physical functioning among Non-White older adults, a relationship distinct from that of White older adults (z=-3.14, p<.001) and visitation contributed to variation in older adults’ mental health.

CONCLUSION: Future scholars are encouraged to examine factors associated with visitation and the quality of such visits for older adults. Further, visitation policies warrant amendment to increase visits and to enhance social support for older adults.

PMID:35818818 | DOI:10.1080/13607863.2022.2098923

Hosp Pediatr. 2022 Jul 12:e2021006459. doi: 10.1542/hpeds.2021-006459. Online ahead of print.

ABSTRACT

BACKGROUND: Clinician documentation is highly variable, and awareness of documentation requirements remains low despite post-training experience. At our hospital, critical care (CC) documentation was inconsistent. Our aim was to increase appropriate CC attestations from 51% to 90% for status asthmaticus, anaphylaxis, and diabetic ketoacidosis in the pediatric emergency department by December 2021.

METHODS: A physician team developed a key driver diagram. Retrospective baseline data using International Classification of Diseases, Ninth and Tenth Revision codes were obtained from January 2018 to September 2020, after which data were followed prospectively in consecutive groups of 20 encounters. Statistical process control charts were used to analyze data. Nelson rules were used to detect special cause variation. Primary outcome was the inclusion of appropriate CC attestations. Interventions included education, CC attestation templates, and provider feedback. We also tracked charges for the 3 diagnoses studied. Process measures included template use. Balancing measure was refusal of payment by insurers.

RESULTS: P-charts were used to analyze primary outcome and process measures. X-bar charts were used to analyze charges. Baseline data represented 706 encounters with 51% including CC documentation. Following clinician education and release of the CC template, special cause variation was detected, and centerline shifted to 88.1% (Fig 2). Average charges per encounter increased from $4527 to $5385. There was no reported refusal of payment.

CONCLUSIONS: We successfully achieved improvements in CC documentation in the 3 diagnoses of interest through education and process changes in documentation, leading over $1 million in new charges over the past 15 months.

PMID:35818843 | DOI:10.1542/hpeds.2021-006459