Bowker's Test Research Articles

Questionnaire-based study of COVID-19 vaccination induced headache: evidence of clusters of adverse events

BackgroundThe adverse events (AEs) after a Coronavirus disease 2019 (Covid-19) Pfizer-Biotech mRNA vaccination present a medical and epidemiological issue of increasing interest. Headache is the most frequent neurological adverse effect and generally the third most common adverse event after a Covid-19 vaccination, but only a few studies focus on the link between headache and other AEs after vaccination. This study aims to investigate the correlation between headaches and Covid-19 vaccination, as well as the possible links between headaches and other AEs after Covid-19 vaccination, thereby helping the management of AEs and avoiding further occurrences.MethodsThis study is based on a published questionnaire survey of 1,402 healthcare workers. Our study focused on the 5 questions including 12 AEs and headaches extracted from the questionnaire post the first and second Covid-19 vaccination. The severity of the 12 AEs and headaches could be classified by the participants on a five-step scale: “Not at all”, “Little”, “Average”, “Quite”, and “Very” (abbreviated as “N”, “L”, “A”, “Q”, “V”). We used the Bowker test to study the comparison of headache severity, indicated on a 5-point Likert scale between the first and second vaccinations. We applied an ordinal logistic regression to the 5 categories with headache severity serving as the dependent variable and the ratings of the other 12 AEs serving as the independent variable to further explore to what extent the severity of the 12 AEs is associated with the severity of headaches. Receiver Operating Characteristic (ROC) analysis was conducted to evaluate the predictive value of the ratings of the 12 AEs to headache severity.ResultsWe found that participants rated their headaches as more severe after the second vaccination, and participants who reported experiencing fatigue, flu-like symptoms, pain at the injection site, known tension-type headache, fever, dizziness/balance problems and known migraine are associated with headache symptoms.ConclusionsThere are clusters of headache-associated AEs post Covid-19 vaccination. The association of various AEs with headaches may be due to similar causative mechanisms.

PANDEMIC IMPACT ON TRAFFIC TRENDS AND PATTERNS IN THE CITY OF BELGRADE

The appearance of the COVID-19 virus has caused great changes in all spheres of life. Probably the most visible change is the cities’ lockdown, with the suspension of traffic and transport systems. The capital of the Serbia – Belgrade also went through a complete lockdown, which lasted for almost 2 months (53 days). In that period, nearly all activities were reduced, producing significant losses for the whole economic development, healthcare, food supply chain, transport sector and most importantly public transport system. The behaviour of users in such situations can greatly influence the change in the share of certain modes of transport in the overall modal share. The aim of this article is to examine the influence of the COVID-19 pandemic on the transport mode choice for different trip purposes, as well as the examination of different impact factors, such as gender, age, education level, employment status, income, transport mode used before the pandemic, and average distance travelled, on the change of mode of transport. Data of 1143 users were analysed through a survey, for the area of the city of Belgrade, using the McNemar–Bowker test and binary logistic regression. The results showed that pandemic had a significant impact on the transport mode change for all trip purposes. The key factors influencing the change in the mode of transport are factors related to gender, level of education, income, the type of transport used before the pandemic and the average distance travelled. It is also interesting to note that the results showed a significant number of transfers to individual modes of transport, as well as micromobility vehicles and walking. Therefore, this article provides the necessary help in understanding the transport system user’s behaviour, which can facilitate the choice of adequate measures, modes and activities for decision-makers in these specific situations.

MultiCOVID: a multi modal deep learning approach for COVID-19 diagnosis

The rapid spread of the severe acute respiratory syndrome coronavirus 2 led to a global overextension of healthcare. Both Chest X-rays (CXR) and blood test have been demonstrated to have predictive value on Coronavirus Disease 2019 (COVID-19) diagnosis on different prevalence scenarios. With the objective of improving and accelerating the diagnosis of COVID-19, a multi modal prediction algorithm (MultiCOVID) based on CXR and blood test was developed, to discriminate between COVID-19, Heart Failure and Non-COVID Pneumonia and healthy (Control) patients. This retrospective single-center study includes CXR and blood test obtained between January 2017 and May 2020. Multi modal prediction models were generated using opensource DL algorithms. Performance of the MultiCOVID algorithm was compared with interpretations from five experienced thoracic radiologists on 300 random test images using the McNemar–Bowker test. A total of 8578 samples from 6123 patients (mean age 66 ± 18 years of standard deviation, 3523 men) were evaluated across datasets. For the entire test set, the overall accuracy of MultiCOVID was 84%, with a mean AUC of 0.92 (0.89–0.94). For 300 random test images, overall accuracy of MultiCOVID was significantly higher (69.6%) compared with individual radiologists (range, 43.7–58.7%) and the consensus of all five radiologists (59.3%, P < .001). Overall, we have developed a multimodal deep learning algorithm, MultiCOVID, that discriminates among COVID-19, heart failure, non-COVID pneumonia and healthy patients using both CXR and blood test with a significantly better performance than experienced thoracic radiologists.

The Performance of Flash Replenishment Contrast-Enhanced Ultrasound for the Qualitative Assessment of Kidney Lesions in Patients with Chronic Kidney Disease.

We investigated the accuracy of CEUS for characterizing cystic and solid kidney lesions in patients with chronic kidney disease (CKD). Cystic lesions are assessed using Bosniak criteria for computed tomography (CT) and magnetic resonance imaging (MRI); however, in patients with moderate to severe kidney disease, CT and MRI contrast agents may be contraindicated. Contrast-enhanced ultrasound (CEUS) is a safe alternative for characterizing these lesions, but data on its performance among CKD patients are limited. We performed flash replenishment CEUS in 60 CKD patients (73 lesions). Final analysis included 53 patients (63 lesions). Four readers, blinded to true diagnosis, interpreted each lesion. Reader evaluations were compared to true lesion classifications. Performance metrics were calculated to assess malignant and benign diagnoses. Reader agreement was evaluated using Bowker's symmetry test. Combined reader sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for diagnosing malignant lesions were 71%, 75%, 45%, and 90%, respectively. Sensitivity (81%) and specificity (83%) were highest in CKD IV/V patients when grouped by CKD stage. Combined reader sensitivity, specificity, PPV, and NPV for diagnosing benign lesions were 70%, 86%, 91%, and 61%, respectively. Again, in CKD IV/V patients, sensitivity (81%), specificity (95%), and PPV (98%) were highest. Inter-reader diagnostic agreement varied from 72% to 90%. In CKD patients, CEUS is a potential low-risk option for screening kidney lesions. CEUS may be particularly beneficial for CKD IV/V patients, where kidney preservation techniques are highly relevant.

Predicting FDG-PET Images From Multi-Contrast MRI Using Deep Learning in Patients With Brain Neoplasms.

18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET) is valuable for determining presence of viable tumor, but is limited by geographical restrictions, radiation exposure, and high cost. To generate diagnostic-quality PET equivalent imaging for patients with brain neoplasms by deep learning with multi-contrast MRI. Retrospective. Patients (59 studies from 51 subjects; age 56 ± 13 years; 29 males) who underwent 18 F-FDG PET and MRI for determining recurrent brain tumor. 3T; 3D GRE T1, 3D GRE T1c, 3D FSE T2-FLAIR, and 3D FSE ASL, 18 F-FDG PET imaging. Convolutional neural networks were trained using four MRIs as inputs and acquired FDG PET images as output. The agreement between the acquired and synthesized PET was evaluated by quality metrics and Bland-Altman plots for standardized uptake value ratio. Three physicians scored image quality on a 5-point scale, with score ≥3 as high-quality. They assessed the lesions on a 5-point scale, which was binarized to analyze diagnostic consistency of the synthesized PET compared to the acquired PET. The agreement in ratings between the acquired and synthesized PET were tested with Gwet's AC and exact Bowker test of symmetry. Agreement of the readers was assessed by Gwet's AC. P = 0.05 was used as the cutoff for statistical significance. The synthesized PET visually resembled the acquired PET and showed significant improvement in quality metrics (+21.7% on PSNR, +22.2% on SSIM, -31.8% on RSME) compared with ASL. A total of 49.7% of the synthesized PET were considered as high-quality compared to 73.4% of the acquired PET which was statistically significant, but with distinct variability between readers. For the positive/negative lesion assessment, the synthesized PET had an accuracy of 87% but had a tendency to overcall. The proposed deep learning model has the potential of synthesizing diagnostic quality FDG PET images without the use of radiotracers. 3 TECHNICAL EFFICACY: Stage 2.

Sacral Nerve Stimulation in Children with Medically Refractory Fecal Incontinence or Severe Constipation

IntroductionThe goal of this study was to evaluate outcomes in patients treated with sacral nerve stimulation (SNS) for medically refractory fecal incontinence or severe constipation. MethodsWe performed a retrospective cohort study of all patients treated with SNS after failed medical management at a single center between 9/1/2015 and 6/30/2022. Demographic and clinical data was extracted from the electronic medical record. Rates of involuntary bowel movements were evaluated using a bowel severity score questionnaire and compared pre- and post-SNS using McNemar and McNemar–Bowker tests. Results70 patients underwent SNS placement. The median age was 12.8 years (IQR 8.6–16.0) and 61.4% were male. The most common diagnosis was idiopathic constipation (67.1%), followed by anorectal malformation (15.7%), and others. 43 patients had severity scores recorded both pre- and at least 90 days post-SNS insertion. The rates of daytime and nighttime involuntary bowel movements were significantly different pre-compared to post-SNS placement (p = 0.038 and p = 0.049, respectively). The rate of daytime and nighttime fecal continence increased from 44% to 58.1% and 53.5%–83.7%, respectively. The rate of at least weekly daytime and nighttime fecal incontinence decreased from 48.8% to 18.7% and 34.9%–7.0%, respectively. Minor pain/neurological symptoms occurred in 40% of patients, while 5.7% developed a wound infection. Further surgery for the SNS was required in 40% of patients. ConclusionsSNS placement can be an effective treatment for medically refractory fecal incontinence. Minor complications and the need for further procedures are common, while more serious complications like wound infections are rare. Type of StudyRetrospective Cohort Study. Level of EvidenceLevel 3.

Using a multimodel approach to determine the age and growth of an endangered small shark species in the southern Gulf of Mexico

The bonnethead shark (Sphyrna tiburo), recently upgraded to endangered by the IUCN red list, is frequent in artisanal fisheries’ catches of the southern Gulf of Mexico (GOM). The age and growth parameters were determined from 162 vertebral centra collected from bonnethead sharks (28.2–112.1 cm total length; TL) between 2010 and 2019 in the southern GOM. Two readers determined age estimates using two rounds of independent band pair counts (opaque and translucent). The average percent error (APE) and coefficient of variation (CV) were estimated to assess count precision, and a Bowker test of symmetry was performed to determine potential bias between readers’ counts. The edge and marginal increment analyses were conducted to validate the band pair deposition periodicity, and a multimodel approach was used to select the best growth model. The reading precision was good because APE and CV values were 7.9% and 5.6%, respectively, and the Bowker’s symmetry test indicated no systematic differences between readers. The validation analyses did not provide evidence to determine the band pair deposition periodicity; thus, it was assumed that one band pair is deposited yearly. The oldest male and female were five (95.4 cm TL) and eight (112.1 cm TL) years. The Gompertz growth function provided the best statistical fit and best describes the growth of bonnethead sharks. The parameters were L∞=113 cm, k2=0.49/year, L0=39 cm for females, and L∞=83.6 cm, k2=0.79/year, L0=40.2 cm for males. These are the first age and growth parameters estimated for the bonnethead shark in the southern GOM, which is the second most landed shark and needs a population assessment for proper management.

The Effects of COVID-19 School Closures on Physical Fitness in Adolescents

Purpose: This study examined differences in measures of health-related physical fitness in adolescents before and after extended school closures due to COVID-19. Method: The sample consisted of 298 students (135 males and 163 females) from a laboratory high school. Data were collected through FITNESSGRAM assessments. A repeated-measures multivariate analysis of covariance was calculated to analyze differences in fitness before and after COVID-19 closures, including McNemar–Bowker and McNemar tests. Results: Statistically significant differences were identified for Progressive Aerobic Capacity Endurance Run (−4.2%; 1.8 ml·kg−1·min−1) and curl-up (−12.5%; 7.9 repetitions). In addition, 18.8% fewer students were classified within the Healthy Fitness Zone for Progressive Aerobic Capacity Endurance Run, 4% for curl-up, 10.8% for push-up, and 6.4% for sit and reach. Conclusion: Results of this study demonstrate that there was a significant decline in physical fitness for secondary students during extended school closures and social isolation as a result of COVID-19.

Pegcetacoplan Corrects Hyperbilirubinemia in Both Untreated Patients with Paroxysmal Nocturnal Hemoglobinuria (PNH) and in Patients with PNH Who Previously Received Eculizumab

Background Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired disease characterized by complement-mediated hemolysis and thrombosis. It results from loss of the glycosylphosphatidylinositol-linked complement-inhibitor proteins CD55 and CD59 that inhibit early and late complement proteins, respectively, on red blood cell (RBC) membranes. In untreated patients, formation of the C5b-9 membrane attack complex results in chronic intravascular hemolysis (IVH) and acute hemolytic attacks. Treatment with the C5 inhibitors eculizumab (ECU) and ravulizumab inhibits IVH and unmasks extravascular hemolysis (EVH), which is due to C3b-mediated opsonization of RBCs and their clearance by the reticuloendothelial system. This can result in unconjugated (indirect) hyperbilirubinemia, leading to jaundice and scleral icterus when plasma bilirubin levels reach 2.0-3.0 mg/dL. As in other conditions with EVH (eg, sickle cell disease), bilirubin gallstones have been reported in patients with PNH treated with C5 inhibitors. Pegcetacoplan (PEG), a C3 inhibitor that controls IVH and EVH, is approved in the US for the treatment of adults with PNH. We hypothesized that PEG could control hyperbilirubinemia in PNH patients, reducing jaundice and the risk of gallstone formation. Methods This post hoc analysis evaluated 16- and 26-week data from 2 Phase 3 randomized controlled trials. PEGASUS (NCT03500549) evaluated patients with hemoglobin <10.5 g/dL despite stable ECU treatment for 48 weeks; patients received PEG or ECU for 16 weeks. PRINCE (NCT04085601) evaluated PEG therapy for 26 weeks in patients who were untreated with complement inhibitors. Mean and median total and indirect bilirubin values were calculated at baseline and at the end of the treatment period for patients treated with PEG and ECU in PEGASUS and with PEG in PRINCE. Total bilirubin plasma levels were categorized as normal (<1.1 mg/dL), intermediate (1.1-3.0 mg/dL), and high (>3.0 mg/dL). The main endpoint was the distribution of bilirubin categories at baseline compared with the end of the treatment period and probability of normalization as analyzed by Bowker's test of symmetry. Patients were excluded from the analysis if they did not have both a baseline and end of treatment bilirubin value for analysis. Results In PEGASUS, 74 of 80 patients (PEG, n=36; ECU, n=38) had evaluable bilirubin data; 30 of 35 PEG-treated patients were evaluable from PRINCE. At baseline, 85% (n=63) of patients in PEGASUS had abnormal bilirubin values and 26% (n=20) had high bilirubin values. In PRINCE at baseline, 87% had abnormal bilirubin values, and 23% had high bilirubin values. The hyperbilirubinemia was primarily of the indirect form (TABLE). At 16 weeks, 72% of patients treated with PEG in PEGASUS had normal bilirubin values compared with 16% of patients treated with ECU. In PRINCE, 83% of patients treated with PEG had normal bilirubin at 26 weeks; none had high bilirubin values. The shifts toward normalization in bilirubin categorization (FIGURE) were statistically significant (p<0.0001) for patients on PEG therapy in both PEGASUS and PRINCE. Continued treatment with ECU was not associated with a significant change in bilirubin (p=0.39). In PEGASUS, the normalization rate was 71% (n=22/31; exact 95% CI: 52%, 86%) for PEG and 9% (n=3/32; exact CI: 2%, 25%) for ECU. In PRINCE, the normalization rate was 81% (n=21/26 patients; exact CI: 61%, 93%) after PEG treatment. Conclusions This post hoc analysis found a high prevalence of abnormal bilirubin values at baseline in patients with PNH who were treated with a C5 inhibitor or were untreated. Treatment with PEG significantly improved bilirubin levels, with the majority of patients shifting to normal values. Conversely, bilirubin levels did not improve with continued ECU treatment. These findings suggest that long-term treatment with PEG reduces the signs and symptoms of hyperbilirubinemia, improving jaundice, and decreasing the risk of bilirubin stones and associated complications (eg, biliary sepsis and pancreatitis) in patients with PNH. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

A comparison of different established and novel methods to determine horses' laterality and their relation to rein tension.

The present study aimed to assess an agreement between established and novel methods to determine laterality and to identify the distribution of laterality in warmbloods and Thoroughbreds. Nine different methods to investigate a horses' laterality outside a riding context and during riding were compared across two groups of horses (sample A: 67 warmblood- type horses, sample B: 61 Thoroughbreds). Agreement between any two methods was assessed by calculating Cohen's kappa with McNemar's test or Bowker's Test of Symmetry, and the deviation from equal distributions was assessed with chi2-tests. Continuous variables such as rein tension parameters were analyzed using ANOVA or linear mixed models. Generally, laterality test results obtained outside a riding context did not agree with laterality during riding or among each other (Bonferroni corrected p > 0.0018). However, the rider's assessment of her/his horse's laterality allowed conclusions on rein tension symmetry (p = 0.003), and it also agreed substantially with the lateral displacement of the hindquarters (p = 0.0003), a method that was newly developed in the present study. The majority of warmbloods had their hindquarters displaced to the right (73.1%, X2 = 14.3; p < 0.0001). The pattern of lateral displacement of the hindquarters was similar in the Thoroughbred sample (right: 60.7%, left: 39.3%), but did not deviate significantly from an equal distribution (X2 = 2.8; p > 0.05). Laterality seems to be manifested in different ways, which generally are not related to each other. Attention should be paid to the desired information when selecting methods for the assessment of laterality. Horses' laterality has an impact on the magnitude and symmetry of rein tension. Matching horses and riders according to their laterality might be beneficial for the stability of rein tension and thus improve training.

Efficacy of a light convex appliance and mouldable ring in an early postoperative stoma with effluent leakage

Aim: This study aimed to analyse the impact of using both a light convex appliance and mouldable ring in the early postoperative period on leakage frequency, peristomal skin health and quality of life after discharge. Methods: This prospective non-randomised study was performed in patients with a digestive stoma experiencing effluent leakage during the early postoperative period. Evaluation was performed at baseline (V1) during admission and at 2–3 weeks after discharge (V2). The outcomes measurements were: number of leaks per day; satisfaction (0 to 10 VAS scale); DET score evaluating discolouration (D); erosion/ulceration (E) and tissue overgrowth (T); stoma morphology and NANDA International nursing diagnosis, which measures anxiety, fear and image deterioration as well as insomnia. NANDA International diagnosis were evaluated as a percentage of cases with the diagnosis and categorically according to several dimension scores. Signed rank, McNemar, chi-squared and Bowker's tests were used for comparison. Results: Of 257 patients screened, 244 completed the study. The mean number of leak episodes using the light convex appliance and mouldable ring in the early postoperative period decreased from 3.4±5.2 (V1) to 1.3±2.3 (V2) (p&lt;0.0001). Mean discolouration, erosion and tissue overgrowth (DET) score decreased from 3.3±3.3 (V1) to 1.6±2.3 (V2) (p&lt;0.0001). Mean self-reported satisfaction with the appliance increased from 5.1±2 (V1) to 7.2±1.7 (V2) (p&lt;0.0001). The proportion of patients with a retracted peristomal area changed from 27.9% to 21.7%, while that of patients with protruded stoma increased from 32.9% to 40% (p=0.025). Regarding NANDA International diagnosis, anxiety reduced from 36.5% to 9.5% (p&lt;0.0001), fear from 40.6% to 4.9% (p&lt;0.0001), image deterioration from 19.2% to 10.9% (p=0.002) and insomnia from 39.3% to 2.5% (p&lt;0.0001). All the categorical dimensions evaluated for each NANDA International diagnosis improved (p&lt;0.0001). Conclusion: Patients with an ostomy and effluent leakage in the early postoperative period clearly benefited from the use of both a light convex appliance and mouldable ring. This approach had a positive impact on number of leakages per day, peristomal skin status and patient satisfaction, as well as meeting several NANDA International nursing diagnosis criteria.

Echocardiographic Assessment of Left Ventricular Ejection Fraction Recovery after Primary Percutaneous Coronary Intervention in Patients Under 40 Years of Age

Context: The context of this study was acute coronary syndrome. Aims: The purpose of the study was to evaluate left ventricular ejection fraction (LVEF) recovery in postprimary percutaneous coronary intervention (PPCI) patients under the age of 40 years. Settings and Design: Observational study, Hyderabad Satellite Center of National Institute of Cardiovascular Disease (NICVD), Pakistan. Subjects and Methods: This study was conducted on 104 patients at “NICVD, Hyderabad Satellite Center.” ST segment elevation myocardial infarction (STEMI) patients of both genders, between 18 and 40 years of age, and those who underwent coronary angiography were included in this study. LVEF of post-PPCI patients was assessed at admission, 40 and 90 days post-PPCI. Statistical Analysis Used: The McNemar–Bowker test was conducted to assess the variations in the distribution of LVEF at 40 and 90 days as compared to the baseline. Results: A total of 104 patients were included in this study. The mean age of the patients was 34.84 ± 4.82 years. The most common risk factors were hypertension 38.5% (40) and smoking 18.3% (19). At 6 weeks, 18.3% of patient's EF was 40%–50%. At 90 days, 23.1% EF was at 40%–50%. Maximum improvement in EF was seen in patients who timely underwent PPCI. Conclusion: A significant improvement in LVEF was observed in young STEMI patients after 40 and 90 days of PPCI. Timely intervention by PPCI not only preserves LV function at baseline but is also associated with better improvement in the short term in premature STEMI patients.

Development and validation of equations for conversion from DAS28ESR and DAS28CRP to the SDAI in patients with rheumatoid arthritis.

Disease Activity Score-28 (DAS28) with erythrocyte sedimentation rate (DAS28ESR), DAS28 with C-reactive protein (DAS28CRP), and simplified disease activity index (SDAI) are widely used to assess disease activity as low, moderate, or high or in remission in patients with rheumatoid arthritis (RA). However, these indicators can generate inconsistent results, influencing treatment decisions and limiting comparisons across studies. We aimed to establish equations for conversion from DAS28ESR and DAS28CRP to SDAI. We conducted a retrospectivestudy, including 933 outpatients who were simultaneously assessed using DAS28ESR, DAS28CRP, and SDAI. The patients were divided into a training set (70%) and a validation set (30%). We developed equations to convert DAS28ESR and DAS28CRP values into SDAI values by bisquare-weighted robust regression to obtain SDAI-DAS28ESR and SDAI-DAS28CRP. In addition to using kappa values to assess consistency, differences in disease activity classification between SDAI-DAS28ESR and SDAI-DAS28CRP were examined by the Stuart-Maxwell test and the Bowker test. Two quadratic equations were developed as follows: SDAI-DAS28ESR = 1.168 × (DAS28ESR)^2 - 2.432 × (DAS28ESR) + 2.649 and SDAI-DAS28CRP = 1.2 × (DAS28CRP)^2 - 0.3522 × (DAS28CRP) - 0.6014. After applying the equations, the Stuart-Maxwell test and the Bowker test were no longer significant between SDAI-DAS28ESR and SDAI or between SDAI-DAS28CRP and SDAI. The kappa values increased from 0.57 to 0.73 between SDAI-DAS28ESR and SDAI and 0.76 to 0.86 between SDAI-DAS28CRP and SDAI. SDAI-DAS28ESR and SDAI-DAS28CRP are interchangeable with the SDAI on the group level, which will facilitate comparisons among studies. In addition, the equations improved consistency between indicators. Key Points • There is disagreement in assessing disease activity in patients with rheumatoid arthritis between Disease Activity Score-28 (DAS28) with erythrocyte sedimentation rate (DAS28ESR), DAS28 with C-reactive protein (DAS28CRP), and simplified disease activity index (SDAI). • We developed and validated two quadratic equations to convert DAS28ESR and DAS28CRP into SDAI. We found there was no longer significant difference in disease activity between indicators after applying the equations. • This work may allow comparisons across studies which use different indicators.

The impact of COVID-19 pandemic on lifestyle among the Saudi population.

Background:During COVID-19, major change occurred in the governmental regulations to combat the pandemic. Lifestyle factors are changeable habits and routine behaviors with an impact on physical and mental health. With the pandemic, sudden and radical changes occurred in the lifestyle of people worldwide. The main purpose of the study is to assess the impact of COVID-19 on lifestyle factors including (dietary habits, physical activity, sleeping patterns, smoking, and alcohol use) among the Saudi population.Design and methods:This is a cross-sectional study on a convenient sample of adults residing in Saudi Arabia. An online survey was distributed via social media channels. Descriptive statistics were used to analyze the distribution of demographic variables using Chi-square χ2 tests for categorical variables and t-test for continuous variables. Bowker test, and McNemar’s Test were performed to evaluate the effects of lockdown on lifestyle factors.Results:A total of 1051 participants were included in the study. There was a slight decrease in the overall diet score during the pandemic (14.98%) compared to before the pandemic (15.05%) (p-value = 0.02), indicating poorer dietary intake during the lockdown. Approximately one-fourth of the participants (26.1%) reported following specific eating habits or a restricted diet during the pandemic (p-value = 0.0001). There was increased consumption of most components of dietary intake categories, during the lockdown. An increase in physical activities for three or more times was reported. A higher proportion of respondents reported sleeping nine or more hours a day during the lockdown (10.8%). Similarly, a higher percentage of individuals reported smoking daily during the lockdown (12.2%). As of overall health status, higher percentage of respondents reported poor health status during lockdown (6.1%).Conclusion:This study revealed major changes in lifestyle factors, negative shifts were revealed in dietary habits and smoking patterns. Positive changes were shown in physical activity, drinking water, and sleeping patterns. Our findings suggest that COVID-19 played a major role in changing lifestyle factors among adults in Saudi Arabia. Healthcare providers and public health officials are encouraged to increase awareness of healthy lifestyle factors that strengthen the immune system to combat COVID-19. The Saudi population needs increased awareness programs about healthy lifestyles to be prepared during pandemics.

Changes in Health-Related Behaviours and Mental Health in a UK Public Sample during the First Set of COVID-19 Public Health Restrictions.

Public health restrictions, in response to the COVID-19 pandemic, have had potentially wide-ranging, unintended effects on health-related behaviours such as diet and physical activity and also affected mental health due to reduced social interactions. This study explored how health-related behaviours and mental health were impacted in a sample of the UK public during the first set of COVID-19 public health restrictions. Two online surveys were administered in the UK, one within the first three months of the restrictions (Timepoints 1 (T1—involving pre-pandemic recall) and 2/T2) and another ten weeks later (Timepoint 3/T3). Moderate–vigorous physical activity (MVPA), outdoor time, sitting time, screen time and sexual activity were self-reported. Diet was assessed using the Dietary Instrument for Nutrition Education questionnaire. Mental health was measured using the short-form Warwick–Edinburgh Mental Wellbeing Scale and Becks’ Anxiety and Depression Inventories. Differences between timepoints were explored using the Friedman, Wilcoxon signed-rank, McNemar and McNemar–Bowker tests. Two hundred and ninety-six adults (74% under 65 years old; 65% female) provided data across all timepoints. Between T1 and T2, MVPA, time outdoors and sexual activity decreased while sitting, and screen time increased (p < 0.05). Between T2 and T3, saturated fat intake, MVPA, time outdoors, and mental wellbeing increased while sitting, screen time and anxiety symptoms decreased (p < 0.05). This study found that depending on the level of COVID-19 public health restrictions in place, there appeared to be a varying impact on different health-related behaviours and mental health. As countries emerge from restrictions, it is prudent to direct necessary resources to address these important public health issues.

Impact of COVID-19 on college student diet quality and physical activity.

Background: The COVID-19 pandemic can cause in increase in stress experienced by college students and consequently, potentially adversely affect their health behaviours. Aims: The aim of this study was to investigate how COVID-19 impacted college-attending young adults diet quality and physical activity. Methods: Students attending an Appalachian university in spring 2020 participated in this cross-sectional study. Participants were surveyed on their eating habits, diet quality, and physical activity before and since COVID-19. Frequencies of responses were analyzed and Bowker's test was used to determine differences in responses before and since COVID-19. Alpha was set at 0.05. Results: Almost one third (32.6%) of students reported eating somewhat more since COVID-19 and 67.9% of these students stated it was due to boredom. Students showed a significant increase in frequency of eating and in consumption of almost every food group. The number of students engaging in low physical activity increased from 27.8% to 51.9% and the number of students engaging in high physical activity decreased from 59.5% to 34.0% (p < .0001) and many switched to the use of at-home workouts. Conclusion: Results indicate the effects of campus closure on college student's lifestyles and the risk of developing health problems due to the COVID-19 pandemic, potentially inhibiting their academic progress and well-being.

Laser acupuncture for claudication symptoms in peripheral artery disease- Does it work? A randomized trial.

Background:Peripheral artery disease (PAD) receives little attention despite its clinical consequences. Intermittent claudication is the most disturbing symptom of the disease resulting in marked limitations to functional walking performance. Treadmill walking exercise is the first-line non-pharmacological treatment in PAD; however, older patients may be unable to exercise because of the functional disability of the disease itself or deconditioning.Objective:In an attempt to seek an alternative intervention, this study aimed to assess the effect of laser acupuncture on patient-reported claudication symptoms and walk performance in PAD.Methods:Thirty male patients with PAD were assigned randomly to a control group (, years old, kg/m2) or a study group (, years old, kg/m2). Inclusion criteria were mild-to-moderate PAD, Fontaine stage II, unilateral or bilateral claudications, and older men. Exclusion criteria were asymptomatic PAD, resting pain, severe or critical limb ischemia, ischemic ulcers, and patients contraindicated for laser therapy. Both groups received pharmacological treatment, but only the study group received gallium aluminum arsenide (GaAlAs) laser therapy at nine acupuncture points, namely, Liver 2 (LV2), Stomach 41 (ST41), Urinary bladder 40 (UB40), UB60, UB61, Gall bladder 30 (GB30), GB34, GB38, and GB40 for 2 days/week and five consecutive weeks. A pen-type laser device was used at a wavelength of nm, with a power output of mW, a spot size of 0.08 cm2, and an energy density of 2 J/cm2, for 60 s/point. The Edinburgh Claudication Questionnaire (ECQ) and the 6-min walk distance (6-MWD) were the endpoints of the study. The McNemar–Bowker Test and Generalized Estimating Equations Ordinal Logistic Regression Model were used for the within- and between-group statistical analyses of the categorical data of ECQ, respectively; and a mixed model MANOVA was used for the within- and between-group analyses of the 6-MWD data.Results:There was a significant improvement in patients’ response to ECQ only in the study group compared to the baseline () and the controls () after the intervention. The 6-MWD increased significantly in the study group compared to the baseline ( m versus m, ).Conclusion:The GaAlAs laser acupuncture applied at selected acupoints may be a promising intervention complementary to drug therapy that could help relieve claudication symptoms and improve physical functional performance in older men with PAD (Fontaine stage II). Trials were conducted under the Trial Registration No. PACTR201912698539774.

Clinical predictors and electrodiagnostic characteristics in patients with Guillain-Barré syndrome with respiratory failure: a retrospective, matched case-control study.

BackgroundRespiratory failure is a common complication of Guillain-Barré syndrome (GBS). This study aimed to determine the clinical predictors and electrodiagnostic (EDx) characteristics in patients with Guillain-Barré syndrome (GBS) with respiratory failure.MethodsThe retrospective study included 29 confirmed GBS cases with respiratory failure and age- (±5 years) and sex-matched controls (1:1). The dependent t-test and McNemar–Bowker test were used to analyse the continuous and categorical data, respectively. In addition, a multiple logistic regression analysis was used to analyse the predictive factors for respiratory failure.ResultsAmong both cases and controls, the majority were male (72.4%), and the average age was 50.9 years. The data showed that patients with respiratory failure had higher GBS disability scores, lower motor power (≤3) of the hip flexors and ankle dorsiflexors, and experienced facial and bulbar palsy. In the multivariate analysis, the significant predictive factors were bulbar palsy (AOR 10.4 [95% CI [2.6–41.4]) and motor power of hip flexors ≤ 3 (AOR 31.4 [95% CI [3.1–314.5]). Patients with respiratory failure had lower compound muscle action potential amplitude of the ulnar and tibial nerves. The median, ulnar, and tibial nerve conduction studies were more likely to reflect inexcitability. The GBS subtypes in GBS patients with and without respiratory failure were not significantly different.ConclusionsBulbar palsy and motor power of the hip flexors ≤ 3 were significant predictors for respiratory failure. The GBS subtypes in patients with and without respiratory failure were not significantly different.

Whole-body magnetic resonance imaging vs. clinical evaluation of enthesitis in patients with spondyloarthritis

Whole-body magnetic resonance imaging vs. clinical evaluation of enthesitis in patients with spondyloarthritis

Agreement between local and central reading of endoscopic disease activity in ulcerative colitis: results from the tofacitinib OCTAVE trials

SummaryBackgroundEndoscopy is routine in trials of ulcerative colitis therapies.AimTo investigate agreement between central and local Mayo endoscopic subscore (MES) reads in the OCTAVE programmeMethodsFlexible sigmoidoscopy was performed in tofacitinib induction (OCTAVE Induction 1&2, NCT01465763 and NCT01458951), maintenance (OCTAVE Sustain, NCT01458574) and open‐label, long‐term extension (OCTAVE Open, NCT01470612) studies. Kappa statistics and Bowker's tests evaluated agreement/disagreement between centrally and locally read MES, with potential determinants of differences analysed by logistic regression.ResultsModerate‐to‐substantial agreement was observed between central and local reads at screening (77.1% agreement; kappa 0.62 [95% confidence interval 0.59‐0.66]), OCTAVE Induction 1&2 week (Wk) 8 (63.8%; 0.62 [0.59‐0.66]), OCTAVE Sustain Wk 52 (55.6%; 0.56 [0.50‐0.62]) and for induction non‐responders at OCTAVE Open month 2 (59.9%; 0.54 [0.48‐0.60]). Where disagreements occurred, local reads were systematically lower than central reads at OCTAVE Induction 1&2 Wk 8, OCTAVE Sustain Wk 52 and OCTAVE Open month 2 (Bowker's P < 0.0001); this difference was not observed at screening (P = 0.0852). Using multivariable logistic regression, geographical region, C‐reactive protein (Wk 8), partial Mayo score (Wk 8) and prior tumour necrosis factor antagonist failure were associated with disparity at OCTAVE Induction 1&2 Wk 8 (P < 0.05). In OCTAVE Induction 1&2 and OCTAVE Sustain, significantly higher proportions of patients endoscopic improvement, remission and endoscopic remission with tofacitinib vs placebo, using either central or local reads.ConclusionModerate‐to‐substantial agreement was observed between central and local endoscopic reads. Where disagreements occurred, local reads were systematically lower than central reads at most timepoints, suggesting potential bias.ClinicalTrials.gov identifier: NCT01465763, NCT01458951, NCT01458574, NCT01470612.