Tag: statistics

Am J Obstet Gynecol. 2021 Nov 1:S0002-9378(21)01183-2. doi: 10.1016/j.ajog.2021.10.034. Online ahead of print.

NO ABSTRACT

PMID:34736916 | DOI:10.1016/j.ajog.2021.10.034

Indian Heart J. 2021 Nov 1:S0019-4832(21)00232-7. doi: 10.1016/j.ihj.2021.10.013. Online ahead of print.

ABSTRACT

The microbiological profile, associated risk factors and demographic characteristics of patients with IE has changed in the recent times. In the present study, the antibiotic susceptibility profile of 66 isolates (40 from IDU and 26 from non IDU) recovered over a period of three years from the the patients with definitive diagnosis of IE along with their absolute minimum inhibitory concentrations (MIC-μg/ml) was determined as per CLSI, 2017 guidelines. Staphylococcus aureus was found to be the predominant pathogen associated with IE out of which 90.2% isolates were MRSA, although none of the isolates were found resistant to vancomycin, teicoplanin, daptomycin and linezolid. Pseudomonas aeruginosa isolates were 100% susceptible to carbapenams, however variable resistance was observed against other antimicrobials. All Enterococci were found to be 100% susceptible to linezolid and daptomycin, whereas vancomycin resistant enterococci phenotype was observed in 25% of the Enterococcal isolates. A noticeable difference in the antimicrobial susceptibility profile and their MICs were observed in the present study, as compared to published literature across the globe and within the country. However, no statistically significant difference (λ ² test, p>0.01)in the AST pattern of isolates from IDU vs. Non IDU was observed. After reviewing the local antibiogram it seems that we need to have our own regional guidelines, which may partially replace the currently prevailing AHA/ESC guidelines.

PMID:34736905 | DOI:10.1016/j.ihj.2021.10.013

Am J Obstet Gynecol. 2021 Nov 1:S0002-9378(21)01186-8. doi: 10.1016/j.ajog.2021.10.037. Online ahead of print.

ABSTRACT

OBJECTIVE: Limited evidence exists on the role that cause of CKD plays in determining pregnancy outcomes. The aim of this systematic review and meta-analysis was to examine the association between CKD and adverse pregnancy outcomes, by cause and severity of CKD where reported. Protocol registration (PROSPERO, CRD:42020211925).

DATA SOURCES: PubMed, Embase, and Web of Science were searched until May 24, 2021, supplemented with reference list checking.

STUDY ELIGIBILITY CRITERIA: Studies that compared pregnancy outcomes in women with or without CKD were included. Two reviewers independently screened titles, abstracts, and full-text articles according to a priori defined inclusion criteria.

STUDY APPRAISAL AND SYNTHESIS METHODS: Data extraction and quality appraisal were performed independently by three reviewers. The GRADE approach was used to assess the overall certainty of the evidence. Random-effects meta-analyses were used to calculate pooled estimates using the generic inverse variance method. Primary outcomes included pre-eclampsia, Caesarean section (CS), preterm birth (PTB) [<37 wk. gestation] and small for gestational age (SGA).

RESULTS: Of 4,076 citations, 31 studies were included. Pre-pregnancy CKD was associated significantly with a higher risk of pre-eclampsia [pooled crude odds ratio (OR)= 8.13 (95% confidence interval (CI), 4.41-15), and adjusted OR (aOR)=2.58 (1.33-5.01)], CS [aOR=1.65 (1.21-2.25)], PTB [aOR=1.73 (1.31-2.27)] and SGA [aOR= 1.93 (1.06-3.52)]. The association with stillbirth was not statistically significant [aOR=1.67 (0.96-2.92)]. Subgroup analyses indicated that different causes of CKD might confer different risks and that severity of CKD is associated with risk for adverse pregnancy outcomes, as pregnancies with later stages CKD, compared to earlier stages, had higher odds of pre-eclampsia, PTB and SGA. The GRADE certainty of the evidence was ‘very low’ across all outcomes.

CONCLUSIONS: This meta-analysis quantified associations between pre-pregnancy CKD, overall and according to cause and severity, and adverse pregnancy outcomes. These findings might support clinicians aiming to counsel women with CKD, by allowing them to tailor their advice according to cause and severity of CKD. We identified gaps in the literature and further studies examining the effect of specific kidney diseases, and other clinical characteristics (e.g. proteinuria, hypertension), on adverse pregnancy outcomes are warranted.

PMID:34736915 | DOI:10.1016/j.ajog.2021.10.037

Explore (NY). 2021 Oct 24:S1550-8307(21)00220-2. doi: 10.1016/j.explore.2021.10.004. Online ahead of print.

ABSTRACT

BACKGROUND: hemodialysis patients’ daily use of medications is essential for the disease management. One of the causes of medication non-adherence is that they forget to take medications, and non-adherence to treatment following memory loss is a common problem in patients on hemodialysis.

OBJECTIVE: the current study aimed to compare the effects of Lavender, Rosemary, and Orange essential oils on memory problems (both retrospective and prospective aspects of memory) and medication adherence in hemodialysis patients.

DESIGN: this study was a parallel randomized controlled trial.

SETTING: the two main hemodialysis centers in Kerman, southeastern Iran.

PARTICIPANTS: eighty-six patients under chronic hemodialysis were randomly allocated into four groups (Lavender, Rosemary, Orange, and control) by simple randomization method.

INTERVENTIONS: The samples of the intervention group, in addition to routine care, received Lavender or Rosemary or Orange essential oils three times a week for a month. A gauze containing with five drops of the essential oil was placed at a distance of 10 cm from the patient’s nose one hour after hemodialysis, and the patient was asked to inhale it for 30 min.

MAIN OUTCOME MEASURES: retrospective and prospective memory, and medication adherence were assessed before, immediately and one month after the intervention.

RESULTS: prospective memory problems in Lavender, Rosemary and Orange groups did not change significantly over time (P > 0.05). Prospective memory problems in the control group had a significant increase (P = 0.002). No significant difference was found in prospective memory problems between the four groups (P > 0.05). Retrospective memory problems in the Lavender and Rosemary groups decreased significantly over time (P <0.05). The decreasing retrospective memory problems in the Orange and control groups were not statistically significant over time (P > 0.05). There was no significant difference in retrospective memory problems between the four groups (P > 0.05). No significant difference was observed between the four groups in medication adherence score during the study (P > 0.05).

CONCLUSION: aromatherapy with Lavender or Rosemary can reduce some memory problems in hemodialysis patients. However, the results of this study could not justify the effect of aromatherapy on the rate of medication adherence in patients on hemodialysis, so further studies are required.

TRIAL REGISTRATION: IRCT20190428043410N1.

PMID:34736874 | DOI:10.1016/j.explore.2021.10.004

Clin Biochem. 2021 Nov 1:S0009-9120(21)00282-4. doi: 10.1016/j.clinbiochem.2021.10.011. Online ahead of print.

ABSTRACT

OBJECTIVES: Biotin therapy can affect the results of many immunoassay procedures. The present study investigates biotin’s interference on 25-hydroxy vitamin D(25-OHD), parathyroidhormone(PTH) and thyroid-stimulating hormone(TSH) tests using four different assay systems and biotin neutralization.

DESIGN AND METHODS: Enrolled in the study were 50 children diagnosed with biotinidase deficiency(BTD) undergoing treatment with biotin(5-20 mg/day) who were subjected to a series of analyses involving 25-OHD (Roche Diagnostics assays, Beckman Coulter assays, HPLC, LC/MS-MS), TSH, PTH (Roche Diagnostics assays, Beckman Coulter assays) and biotin (LC/MS-MS), before and after biotin neutralization with Streptavidin-coated magnetic particles(SMP).

RESULTS: The median biotin concentration was found to be 175.2 [94.0-307.1]μg/L. There was no significant difference in the 25-OHD results before and after neutralization with the Beckman Coulter, HPLC and LC-MS/MS assays. In contrast, the median 25-OHD level was seen to decrease from 90.2[35.9-105.3]ng/mL to 29.1[22.6-37.6]ng/mL after neutralization with the Roche assay(p<0.0001). While there was no statistically significant difference in the values recorded before and after neutralization in PTH analysis using Beckman assay, the median PTH levels increased from 7.8[1.6-21.6]pg/mL to 28.2[22.5-41.9]pg/mL after neutralization with the Roche assay(p<0.0001). The cut-off values at which serum biotin interfered in the Roche assay PTH test, with 25-OHD levels determined as 51.4μg/L and 62.9μg/L, respectively. A significant increase was detected in the TSH levels analyzed with a Roche assay after neutralization (from 2.36[1.85-3.00]mIU/L to 2.74[1.93-3.70]mIU/L, p<0.0001).

CONCLUSIONS: The PTH, 25-OHD and TSH results were found to be affected by high biotin concentrations in Roche assays, leading to a risk of misdiagnosis, although SMP neutralization can suppress any such interference efficiently.

PMID:34736903 | DOI:10.1016/j.clinbiochem.2021.10.011

Glob Chang Biol. 2021 Nov 4. doi: 10.1111/gcb.15972. Online ahead of print.

ABSTRACT

Field studies are essential to reliably quantify ecological responses to global change because they are exposed to realistic climate manipulations. Yet such studies are limited in replicates, resulting in less power and, therefore, unreliable effect estimates. Further, while manipulative field experiments are assumed to be more powerful than non-manipulative observations, it has rarely been scrutinized using extensive data. Here, using 3,847 field experiments that were designed to estimate the effect of environmental stressors on ecosystems, we systematically quantified their statistical power and magnitude (Type M) and sign (Type S) errors. Our investigations focused upon the reliability of field experiments to assess the effect of stressors on both ecosystem’s response magnitude and variability. When controlling for publication bias, single experiments were underpowered to detect response magnitude (median power: 18% – 38% depending on effect sizes). Single experiments also had much lower power to detect response variability (6% – 12% depending on effect sizes) than response magnitude. Such underpowered studies could exaggerate estimates of response magnitude by 2 – 3 times (Type M errors) and variability by 4 – 10 times. Type S errors were comparatively rare. These observations indicate that low power, coupled with publication bias, inflates the estimates of anthropogenic impacts. Importantly, we found that meta-analyses largely mitigated the issues of low power and exaggerated effect size estimates. Rather surprisingly, manipulative experiments and non-manipulative observations had very similar results in terms of their power, Type M and S errors. Therefore, the previous assumption about the superiority of manipulative experiments in terms of power is overstated. These results call for highly powered field studies to reliably inform theory building and policymaking, via more collaboration and team science, and large-scale ecosystem facilities. Future studies also require transparent reporting and open science practices to approach reproducible and reliable empirical work and evidence synthesis.

PMID:34736291 | DOI:10.1111/gcb.15972

Surg Technol Int. 2021 Nov 4;39:sti39/1508. Online ahead of print.

ABSTRACT

INTRODUCTION: Anastomotic leakage (AL) following colorectal resection is a devastating complication affecting morbidity, mortality, and quality of life of patients in the long term. Different tissue sealants and biologic glues were tested showing conflicting results regarding their influence on anastomotic healing and leak prevention. Application of autologous platelet-rich fibrin (Vivostat A/S, Alleroed, Denmark), which acts as a source of angiogenic growth factors and cytokines, showed promising results in an in-vivo porcine model. Herein, we present the first human study of stapled colorectal anastomoses supplemented with an autologous-derived platelet-rich fibrin matrix (Obsidian ASG®, Rivolution GmbH, Rosenheim, Germany and Vivostat A/S, Alleroed, Denmark).

MATERIALS AND METHODS: A retrospective analysis of prospectively accumulated data was performed in two colorectal centers (Linz, Vienna) on patients undergoing left-sided colorectal or coloanal stapled anastomosis between October 2018 and December 2019. The Obsidian ASG® Matrix was applied to the rectal stump, and after closure with the circular stapling device, at the circumference of anastomosis in every single case. Anastomoses were supplemented with intra- and extra-anastomotic application (IAA-intra-anastomotic application developed by Rivolution GmbH, Rosenheim, Germany) of Obsidian ASG® Matrix. The primary endpoints were incidence of perioperative complications and anastomotic leak rate.

RESULTS: Two-hundred-sixty-one (138 female) patients underwent left-sided colonic (n=177) or rectal resection (n=84). In 253 (96.9%) cases, a laparoscopic or robotic-assisted approach was used. There were no complications attributable to the intraoperative application of the Obsidian ASG® Matrix. All intraoperative leak tests were negative. Overall, anastomotic leak rate accounted for 2.3% (6/261). AL following colonic and rectal resection was seen in 2.3% (4/177) and 2.4% (2/84), respectively. Complication and leak rate was similar in the two participating centers. Postoperative fever and elevated CRP levels were significantly correlated to AL. There was no significant risk factor for AL on multivariate analysis.

CONCLUSION: Application of an autologous-derived platelet-rich fibrin matrix (Obsidian ASG®) at anastomotic site following colorectal resection is safe and associated with a low rate of anastomotic leakage.

PMID:34736288

Obes Facts. 2021 Nov 4. doi: 10.1159/000520661. Online ahead of print.

ABSTRACT

INTRODUCTION: In young adults, the metabolic syndrome is rare. To better assess the risks for future cardiovascular disease, a cardiometabolic score can be used, ranking the disease risk in each subject. The score is a continuous variable summarising the individual z-scores for waist circumference, blood pressure, blood levels of glucose, triglycerides and HDL-cholesterol. Our main aim was to assess the association between early childhood growth and the cardiometabolic score in young adults.

METHODS: Study participants were recruited among subjects in the longitudinal population-based GrowUp 1990 Gothenburg study. Those with information on weight and length at birth, as well as weight, height, waist circumference, and parental BMI at ten years of age were invited to participate in a health survey at 18-20 years of age. 513 young adults (female 51%) were included. Multivariable linear stepwise regression analysis was applied.

RESULTS: The mean (SD) BMI was 22.2 (3.26) in males and 21.3 (2.69) kg/m² in females; the cardiometabolic score was 0.24 (3.12) and -0.22 (3.18), respectively. A statistically significantly higher score (p<0.001) was seen in individuals with metabolic syndrome, as defined by IDF. After controlling for adult lifestyle features, BMI z-score at ten years of age was significant risk factor in both sexes for an elevated cardiometabolic score in early adulthood, mean(SE) beta 0.47(0.19), p=0.014 in males, 0.82(017) p<0.0001 in females. In males, high maternal BMI and low age at adiposity rebound and in females high birth weight were also associated with a statistically significant risk. Additionally, contraceptive use in females was a risk factor for elevated cardiometabolic score and, in males a high lifestyle related index score showed a protective association with the cardiometabolic score.

CONCLUSION: A high BMI z-score at ten years of age is a risk factor for the cardiometabolic state in young adults, an outcome points to the preventive potential of monitoring BMI in ten-year-old schoolchildren. This finding must however be validated in a new large cohort. Moreover, in young adults in whom metabolic syndrome is rare, a cardiometabolic score seems to be a promising approach and potentially a more powerful tool to detect risks for cardiovascular disease later in life, than using metabolic syndrome categorisation.

PMID:34736266 | DOI:10.1159/000520661

Obstet Gynecol. 2021 Nov 4. doi: 10.1097/AOG.0000000000004599. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate whether per-procedure work relative value units (RVUs) have changed over time and to compare time-based compensation for female-specific procedures compared with male-specific procedures.

METHODS: Using the National Surgical Quality Improvement Program files for 2015-2018, we compared operative time and RVUs for 12 pairs of sex-specific procedures. Procedures were matched to be anatomically and technically similar. Procedure-assigned RVUs in 2015 were compared with 1997. Procedure compensation was determined using median dollars per RVU provided in SullivanCotter’s 2018 Physician Compensation and Productivity Survey. This was compared with specialty-specific McGraw-Hill per-RVU data from 1994. Statistical analysis was performed with chi-square and Kruskal-Wallis tests.

RESULTS: A total of 12,120 patients underwent 6,217 male-specific procedures and 5,903 female-specific procedures. Male-specific procedures had a median (interquartile range) RVU of 25.2 (21.4-25.2), compared with 7.5 (7.5-23.4) for female-specific procedures (P<.001). Male-specific procedures were 79 minutes longer (median [interquartile range] 136 minutes [98-186] vs 57 minutes [25-125], P<.001). Female-specific procedures were reimbursed at a higher hourly rate (10.6 RVU/hour [7.2-16.2] vs 9.7 RVU/hour [7.4-12.8], P<.001). However, male-specific procedures were better reimbursed ($599/h [$457-790] vs $555/h [$377-843], P<.001). Overall, per-procedure RVUs for male-specific surgeries have increased 13%, whereas, for female-specific surgeries, per-procedure RVUs have increased 26%. Reimbursement per RVU for male-specific procedures has decreased 8% ($67.30 to $61.65), whereas for female-specific procedures it has increased 14% ($44.50 to $52.02).

CONCLUSION: Increases in RVUs and specialty-specific compensation have resulted in more equitable reimbursement for female-specific procedures. However, even with these changes, there is a lower relative value of work, driven by specialty-specific compensation rates, for procedures performed for women-only compared with equivalent men-only procedures.

PMID:34736273 | DOI:10.1097/AOG.0000000000004599

Dement Geriatr Cogn Disord. 2021 Nov 4:1-9. doi: 10.1159/000519766. Online ahead of print.

ABSTRACT

BACKGROUND: Subjective cognitive decline (SCD) is a self-perceived cognitive worsening without objective cognitive impairment. Due to its heterogeneity and potential risk of Alzheimer’s disease (AD), baseline biomarkers to predict progression are clinically important. In the present study, cognitive trajectories during a 24-month period were compared between amyloid-positive SCD (A+SCD) and amyloid-negative SCD (A-SCD) subjects, and biomarkers associated with memory decline were investigated.

METHODS: Data from a prospective cohort study in Korea between 2016 and 2019 were analyzed. SCD subjects ≥50 years of age were eligible. All participants underwent neuropsychological tests, brain magnetic resonance imaging, and florbetaben positron emission tomography scans. Amyloid burden and regional volumes were measured. Cognitive changes corrected for age were compared between A+SCD and A-SCD groups. Biomarkers associated with memory decline were assessed.

RESULTS: Forty-seven SCD subjects (69.9 ± 6.7 years, mini-mental state examination (MMSE) score 27.5) were enrolled, and 31 completed at least 1 annual follow-up (mean follow-up: 24.7 months). Baseline characteristics except age, hippocampal atrophy, and white matter hyperintensities were similar between A+SCDs (n = 12, 25.6%) and A-SCDs (n = 35). A+SCD subjects showed greater decline in the verbal memory function compared with the A-SCD subjects after adjustment for age. MMSE scores decreased more in the A+SCD (1.1 in the A+SCD; 0.55 in the A-SCD), although it was not statistically significant. Amyloid burden and baseline memory score were associated with memory decline.

CONCLUSIONS: Within SCD, A+SCD subjects showed faster memory decline compared with the A-SCD subjects and amyloid burden might be associated with future memory decline in SCD.

PMID:34736258 | DOI:10.1159/000519766