Tag: statistics

Obes Surg. 2022 Jan 23. doi: 10.1007/s11695-021-05854-4. Online ahead of print.

ABSTRACT

PURPOSE: The aim of our study was to assess long-term opioid use following bariatric surgery in patients on preoperative narcotics.

METHODS: We evaluated patients utilizing preoperative opioids (OP) who underwent primary laparoscopic Roux-en-Y gastric bypass (LRYGB) from 2013 to 2020. Patients were propensity-matched to those without preoperative opioid use (NOP) by demographics and comorbidities. Our objectives were to compare opioid use at 1 and 3 years after surgery and evaluate perioperative outcomes.

RESULTS: A total of 806 patients, matched 1:1 were evaluated, with 82.7% being females. Mean age was 46.5 years in the OP and 45.6 years in the NOP (p = 0.0018), preoperative BMI was 45.8 in the OP and 46.1 in the NOP (p = 0.695). All patients were followed up for 1 year. In the OP, 156 (38.7%) patients were taking opioids 1 year after surgery as opposed to 27 (6.7%) in the NOP (p < 0.0001). Three years after surgery, 74 (37.5%) patients in the OP and 27 (14.4%) in the NOP were taking outpatient opioids (p < 0.0001). There was no statistically significant difference between OP and NOP groups in terms of readmissions (9.4% vs. 5.7% p = 0.06), reinterventions (3.7 vs. 1.7% p = 0.13), reoperations (3.5% vs. 1.5% p = 0.11), or emergency room visits (8.9% vs. 7.2% p = 0.44). There were no mortalities.

CONCLUSION: Most patients requiring preoperative opioids can be weaned off after bariatric surgery. Enhanced recovery pathways are key to obtaining these results. Preoperative opioid use is not associated with increased complications compared to opioid-naïve patients.

PMID:35066783 | DOI:10.1007/s11695-021-05854-4

Environ Sci Pollut Res Int. 2022 Jan 23. doi: 10.1007/s11356-022-18552-0. Online ahead of print.

ABSTRACT

Groundwater pollution of the watershed is mainly influenced by the multifaceted interactions of natural and anthropogenic processes. In this study, classic chemical and multivariate statistical methods were utilized to assess the groundwater quality and ascertain the potential contamination sources affecting the groundwater quality of Galma sub-watershed in a tropical savanna. For this purpose, the data set of 18 groundwater quality variables covering 57 different sampling boreholes (BH) was used. The groundwater samples essentially contained the cations in the following order of dominance: Ca²⁺ > Na⁺ > Mg²⁺ > K⁺. However, the anions had HCO₃^– > Cl^– > SO₄^-2 > NO₃^– respectively. The hydrochemical facies classified the groundwater types of the sub-watershed into mixed Ca-Mg-Cl type of water, which means no cations and anions exceeds 50%. The second dominant water type was Ca-Cl. The Mg-HCO₃ water type was found in BH 9, and Na-Cl water type in BH 29 of the studied area. The weathering of the basement rocks was responsible for the concentrations of these ions in the groundwater chemistry of the sub-watershed. Hierarchical cluster analysis (HCA) grouped the groundwater samples (boreholes) into five clusters that are statistically significant regarding the similarities of groundwater quality characteristics. The principal component analysis (PCA) extracted two major principal components explained around 65% of the variance and suggested the natural and anthropogenic processes especially the agricultural pollutants including synthetic fertilizers, and leaching of agricultural waste as the main factors affecting the groundwater quality. The integrated method proved to be efficient and robust for groundwater quality evaluation, as it guaranteed the precise assessment of groundwater chemistry in the sub-watershed of the tropical savanna. The findings of this investigation could be useful to the policy makers for developing effective groundwater management plans for the groundwater resources and protection of the sub-watershed.

PMID:35066782 | DOI:10.1007/s11356-022-18552-0

Am J Emerg Med. 2021 Dec 17;53:201-207. doi: 10.1016/j.ajem.2021.12.032. Online ahead of print.

ABSTRACT

STUDY OBJECTIVE: To evaluate the association between potential emergency department (ED)-based modifiable risk factors and subsequent development of delirium among hospitalized older adults free of delirium at the time of ED stay.

METHODS: Observational cohort study of patients aged ≥75 years who screened negative for delirium in the ED, were subsequently admitted to the hospital, and had delirium screening performed within 48 h of admission. Potential ED-based risk factors for delirium included ED length of stay (LOS), administration of opioids, benzodiazepines, antipsychotics, or anticholinergics, and the placement of urinary catheter while in the ED. Odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CIs) were calculated.

RESULTS: Among 472 patients without delirium in the ED (mean age 84 years, 54.2% females), 33 (7.0%) patients developed delirium within 48 h of hospitalization. The ED LOS of those who developed delirium was similar to those who did not develop delirium (312.1 vs 325.6 min, MD -13.5 min, CI -56.1 to 29.0). Patients who received opioids in the ED were as likely to develop delirium as those who did not receive opioids (7.2% vs 6.9%: OR 1.04, CI 0.44 to 2.48). Patients who received benzodiazepines had a higher risk of incident delirium, the difference was clinically but not statistically significant (37.3% vs 6.5%, OR 5.35, CI 0.87 to 23.81). Intermittent urinary catheterization (OR 2.05, CI 1.00 to 4.22) and Foley placement (OR 3.69, CI 1.55 to 8.80) were associated with a higher risk of subsequent delirium. After adjusting for presence of dementia, only Foley placement in the ED remained significantly associated with development of in-hospital delirium (adjusted OR 3.16, CI 1.22 to 7.53).

CONCLUSION: ED LOS and ED opioid use were not associated with higher risk of incident delirium in this cohort. Urinary catheterization in the ED was associated with an increased risk of subsequent delirium. These findings can be used to design ED-based initiatives and increase delirium prevention efforts.

PMID:35065526 | DOI:10.1016/j.ajem.2021.12.032

Clin Neurol Neurosurg. 2022 Jan 15;213:107133. doi: 10.1016/j.clineuro.2022.107133. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to reveal the clinical significance of the platelet reactivity unit (PRU) and the efficacy of adjunctive cilostazol and its association with thromboembolic and microembolic events after coil embolization for unruptured intracranial aneurysms (UIAs).

METHODS: We retrospectively analyzed the data of 427 patients with UIAs who underwent endovascular treatment between July 2011 and June 2014. When clopidogrel resistance was confirmed via PRU assay after dual antiplatelet medication (aspirin plus clopidogrel) administration for 5 days, triple antiplatelet therapy with cilostazol was administered (Group I, 274 patients). The other group was placed on standard dual antiplatelet therapy (Group II, 153 patients). All patients underwent magnetic resonance diffusion-weighted imaging within 2 days after endovascular coiling.

RESULTS: No significant associations with the occurrence of thromboembolic and microembolic events were found between the groups. The occurrence of thromboembolic and microembolic events showed no statistical difference between groups I and II (p = 0.725 for thromboembolic events and p = 0.109 for microembolic events). Also, the PRU value and the occurrence of microembolic events, using a PRU cutoff value of 240, showed no statistical difference (p = 0.114 in group I and 0.064 in group II). There was significant increase in microembolic events after the use of a stent-assisted endovascular procedure. As the PRU value increased, there was a trend toward an increase in the mean number of microembolic lesions without statistical significance.

CONCLUSION: Even though there is a presumed anti-thromboembolic effect for clopidogrel resistance in other literature, the clinical efficacy of adjustment of additional cilostazol for endovascular coiling of unruptured aneurysms may be limited due to the unspecified cutoff value of the PRU assay for evaluating the resistance.

PMID:35065532 | DOI:10.1016/j.clineuro.2022.107133

Ecotoxicol Environ Saf. 2022 Jan 19;231:113214. doi: 10.1016/j.ecoenv.2022.113214. Online ahead of print.

ABSTRACT

Bioremediation of contaminated soil has received increasing attention, and the effects of antibiotic residues on the soil ecological environment are a current research hotspot. Earthworms are the first choice of soil organisms to indicate the degree of soil pollution, and their detoxification mechanism after antibiotic stress must be further explored. Taking Eisenia fetida as the research object, an antibiotic (tetracycline) stress test was carried out in sterile artificial soil. The stress concentrations were set at 0, 0.3, 3, 30, 300 and 600 mg/kg. The ECO method was used to cultivate microbes in earthworms and soil. The carbon source utilization intensity algorithm developed by our team was used for data statistics, and a factor analysis model was constructed to explore the succession process of microbes of earthworms in vivo and in vitro under tetracycline stress. The results showed that there were four processes in the evolution of microbes under short-term tetracycline stress: at 1-3 days, the microbes in worms played a leading role; at 4-5 days, the microbes in the worms and the soil microbes jointly resisted TET stress; after 6-8 days of stress, the microbes in worms still played the main role, but their role was weakened; and after 9-10 days, soil microbes played a leading role, and tolerant microbes appeared. Under long-term stress, the microbes of earthworms in vivo and in vitro were obvious different, and there may be no regulatory relationship. And the factor analysis model is suitable for the analyse of the changes in microbial communities in vivo and in vitro under TET stress. The research results provide a reference method and model basis for the bioremediation of antibiotic-contaminated soil and the study of earthworm detoxification mechanisms, and help agricultural development.

PMID:35065502 | DOI:10.1016/j.ecoenv.2022.113214

Am J Emerg Med. 2022 Jan 14;53:196-200. doi: 10.1016/j.ajem.2022.01.012. Online ahead of print.

ABSTRACT

BACKGROUND: Exacerbations of acute asthma are frequent presentations to the Emergency Department (ED) and contribute to ED overcrowding and healthcare cost. The purpose of this study was to evaluate whether ED clinicians are implementing secondary asthma prevention measures prior to discharging patients after an acute asthma exacerbation and also to determine whether ED clinicians are able to correctly demonstrate how to use an asthma metered dose inhaler (MDI) device.

METHODS: Consenting doctors employed at four EDs situated in the Gauteng province of South Africa were asked to complete a questionnaire and thereafter demonstrate the technique of using an MDI device. Collected data was presented using descriptive statistics.

RESULTS: Eighty-six doctors were included in the study. Of these, 18 (20.9%) routinely checked that inhaler technique was correct, 50 (58.1%) routinely enquired regarding adherence to their asthma treatment, 8 (9.3%) routinely informed patients of the side effects of asthma medication, 16 (18.6%) routinely provided patients with a written asthma action plan, 7 (8.1%) routinely evaluated for the presence of concurrent allergic rhinitis and 53 (61.6%) routinely counselled patients regarding smoking cessation. With regards to correctly demonstrating how to use an MDI device, only 23 (26.74%) physician participants performed all eight steps correctly.

CONCLUSION: This study indicates that secondary asthma prevention measures are not adequately addressed by clinicians prior to discharging patients from the ED after an acute asthma attack. It is recommended that ED clinicians are educated with regards to the importance of these measures.

PMID:35065525 | DOI:10.1016/j.ajem.2022.01.012

Sex Med. 2022 Jan 19;10(2):100484. doi: 10.1016/j.esxm.2021.100484. Online ahead of print.

ABSTRACT

BACKGROUND: A platinum-containing anti-cancer agent, oxaliplatin (L-OHP), is known to induce peripheral neuropathy, including erectile dysfunction (ED) as a side effect, while Gosha-jinki-gan (GJG) is a traditional Japanese herbal medicine mainly used for peripheral neuropathy.

AIM: To investigate the effect of GJG on L-OHP-induced ED in rats.

METHODS: Twelve-week-old male Wister/ST rats were categorized into the following groups: Sham, Sham+GJG, L-OHP, and L-OHP+GJG (each n = 10). The L-OHP and L-OHP+GJG groups were injected intravenously with L-OHP (4 mg/kg) for 2 consecutive days in the first week. Statistical significance was determined using Bonferroni’s multiple comparison test.

OUTCOMES: At the end of the study period, erectile function was evaluated by measuring intracavernosal pressure (ICP) and mean arterial pressure (MAP) after cavernous nerve stimulation. Western blot analysis was used to assess the neuronal nitric oxide synthase (nNOS) and endothelial nitric oxide synthase (eNOS) levels, and quantitative polymerase chain reaction was used to assess the expression of phosphodiesterase-5 (PDE-5) and nicotinamide adenine dinucleotide phosphate (NADPH) oxidase-1.

RESULTS: The ICP/MAP ratio of L-OHP rats (0.34 ± 0.06) was significantly lower than that of Sham rats (0.67 ± 0.03, P < .01), however, the ICP/MAP ratio of L-OHP+GJG rats (0.55 ± 0.01) was significantly higher than that of L-OHP rats (P < .01). There were no significant differences in the nNOS and eNOS protein expression between both groups (P > .05). GJG administration significantly decreased PDE-5 and NADPH oxidase-1 messenger RNA expressions in the L-OHP+GJG group.

CLINICAL TRANSLATION: This animal model study suggests that GJG might be effective for erectile function in cancer survivors.

STRENGTHS & LIMITATIONS: Our study identified that GJG had no notable side effects in the treated group. Further investigation of the cavernous nerve would also help elucidate the mechanism of GJG effect, which is a limitation of this study.

CONCLUSION: We found that GJG administration improved L-OHP-induced ED by improving transcriptional PDE-5 expression. Kataoka T, Kawaki Y, Kito Y, et al. Gosha-Jinki-Gan Improved Erectile Dysfunction Caused by Anti-Cancer Agent Oxaliplatin by Decreasing Transcriptional Expression of Phosphodiesterase-5 in Rats. Sex Med 2022;10:100484.

PMID:35065470 | DOI:10.1016/j.esxm.2021.100484

Early Hum Dev. 2021 Dec 29;165:105534. doi: 10.1016/j.earlhumdev.2021.105534. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the utility of echocardiographic measures of ventricular-vascular interactions in predicting death or ECMO in congenital diaphragmatic hernia (CDH).

DESIGN: In this single center retrospective study, early (<48 hour age) Doppler ECHOs of neonates (≥34 weeks gestation) with CDH (n = 58) were reviewed. ECHO measures of the relationship of right ventricular (RV) contractility and pulmonary hypertension (PH) were selected: Ratios of 1. pulmonary artery acceleration time to pulmonary ejection time (PAAT/PET) 2. tricuspid annular plane systolic excursion, a measure of regional RV function, to PAAT (TAPSE/PAAT) 3. patent ductus arteriosus (PDA) flow velocity time integral (VTI) from right to left (PDA/RLVTI) 4. PDA flow duration from right to left (PDA/RL) and 5. TAPSE to RV systolic pressure (TAPSE/RVSP). Statistical analyses included t-test and chi-square test and receiver operating characteristic curves were generated.

RESULTS: Our cohort (n = 58) comprised 34 (59%) males and predominantly (81%) left sided CDH. Of these, 34 (58.6%) infants died or received ECMO and 24 (41.4%) survived without ECMO. RVSP and PDA/RL VTI were higher, and RV TAPSE, PAAT/PET, TAPSE/PAAT and TAPSE/RVSP ratios were all significantly lower in the death/ECMO group. PDA/RLVTI ratio had the highest area under the curve (0.76); values ≥ 0.6 had high specificity [88% (95% C.I. 62-98%)] and positive predictive value [88% (95% C.I. 65-96%)] for adverse outcomes.

CONCLUSION(S): Novel early ECHO parameters which combine RV function and PH severity were found to be feasible and prognostic in CDH. A detailed non-invasive assessment of ventricular-vascular interactions is important for risk-stratification in this population.

PMID:35065414 | DOI:10.1016/j.earlhumdev.2021.105534

Int Emerg Nurs. 2022 Jan 19;61:101129. doi: 10.1016/j.ienj.2021.101129. Online ahead of print.

ABSTRACT

INTRODUCTION: Stroke care is time sensitive. Providers in the emergency department (ED) depend on advanced notification from emergency medical services (EMS) transporting patients with stroke signs and symptoms. Barriers to EMS-ED information transfer can delay patient arrival preparation that may impact decisions, diagnosis, and time-sensitive transfer to next site of care. Information gaps or loss of information in the chain of care has been noted to contribute to possible safety threats for patients with stroke symptoms.

METHODS: The aim of this project was to explore the feasibility of improving EMS-ED handover of patients with suspected stroke using a two-tiered checklist ranked in order of importance and a “time-out” upon EMS arrival to help standardize report, bridge the information gap, and promote earlier stroke management decisions. Paramedics from two local EMS agencies participated. Transmission and recorded report were measured before and after implementation followed by a satisfaction survey. Analysis also included a comparison group (control) of non-participating Fire Departments.

RESULTS: One hundred and sixty-eight potential stroke patients were transported to the ED during the 16-month intervention time frame. The pre and post intervention analysis of reported stroke symptoms showed statistically significant improvement in multiple checklist reporting areas. Noteworthy changes included improvement in reporting last time normal, current antiplatelet/anticoagulant, neurological deficits, baseline mental and functional status, medical history, code status, recent surgical history and family enroute. A post-survey demonstrated overall positive EMS-ED response to the new handover process.

CONCLUSION: The feasibility of an EMS-ED standardized handover using a hierarchical (ranked in order of importance), two-tiered checklist and time-out process can effectively bridge the gap of communication between EMS and emergency providers to help promote timely hyperacute stroke care.

PMID:35065390 | DOI:10.1016/j.ienj.2021.101129

Ticks Tick Borne Dis. 2022 Jan 15;13(2):101903. doi: 10.1016/j.ttbdis.2022.101903. Online ahead of print.

ABSTRACT

Due to the scarcity of information regarding the control of Rhipicephalus microplus on bovines with different tick burdens, tick counts and the efficacy of a commercial spray formulation (aspersion bath with organophosphate + pyrethroid) were evaluated for animals with a low and high tick burdens for 35 days in a stall test. Thirty-two crossbreed Bos taurus indicus x Bos t. taurus experimentally infested with R. microplus larvae were divided into four groups: T01 high infestation control, T02 high infestation treated, T03 low infestation control, and T04 low infestation treated. The bovines were kept individually in pens and R. microplus females were collected daily. All data were statistically analyzed with a significance level of 5% (P ≤ 0.05). For linear regressions, variables with P≤0.05 and the highest coefficients of determination (R² ≥ 0.70) were considered the best descriptors. The reliability level was 95%. Tick counts differed (P<0.0001) between T01 and T02 (high infestation control vs. treated), except at day 2 (P >0.05) post-treatment, and efficacy ranged from 85.2 to 50.6%. The number of collected engorged females was lower (P<0.0001) for T04 than for T03 (low infestation treated vs. control) animals from day 3 to 29, and efficacy ranged from 95.2 to 69.8%. In addition, tick burden and efficacy were negatively correlated for both the group of animals with a high tick burden (r = -0.5256; p = 0.0012; R² = 0.2762) and the group of animals with a low tick burden (r = -0.9817; p < 0.0001; R² = 0.9638). In conclusion, a high tick burden on bovines decreases the efficacy of the tested spray acaricide.

PMID:35065397 | DOI:10.1016/j.ttbdis.2022.101903