Statistical Significance P-value Research Articles

Knowledge and Preparedness Regarding Chemical, Biological, Radiological and Nuclear (CBRN) Warfare among Doctors and Medical Students at Combined Military Hospital (CMH) Lahore Medical College

Chemical, biological, radiological and nuclear-related disasters have become increasingly common all around the world. Objectives: To assess the knowledge and preparedness regarding chemical, biological, radiological and nuclear Warfare among Doctors and Medical students at Combined Military Hospital Lahore Medical College. Methods: In this descriptive cross-sectional study, 311 respondents participated from November 2022 to May 2023. Non-probability convenience sampling technique was used. Data were analyzed on SPSS version 26.0. Results: The study revealed a significant knowledge gap regarding chemical, biological, radiological and nuclear warfare. Almost 290 participants had never encountered the term 'chemical, biological, radiological and nuclear' signifying a substantial lack of awareness. Furthermore, a slightly higher knowledge gap was observed among female participants, although this difference did not reach statistical significance (p-value=0.07). Additionally, students in their 3rd, 4th, and final years of medical college demonstrated a more comprehensive understanding of chemical, biological, radiological and nuclear compared to those in their initial years of study (p-value=0.008). Conclusions: It was concluded that there is a significant knowledge gap about chemical, biological, radiological and nuclear Warfare and its management among medical professionals. A very low percentage of professionals were properly trained in chemical, biological, radiological and nuclear emergency management. Respondents stressed the inclusion of chemical, biological, radiological and nuclear emergency management training in the curriculum. These findings suggest that proper provision of knowledge, and training related to these disasters is inevitable for timely management and future risk reduction from such events.

Evaluation of Clozapine-induced Toxicities in Psychic Patients in Mental Health Care Hospitals in the Southern Region of the Saudi Arabia Kingdom

Background: Clozapine is a psychiatric medication that may cause various side effects, some of them may be serious and fatal adverse effects, such as severe neutropenia, agranulocytosis, lymphocytopenia, myocarditis, and orthostatic hypotension, that have been associated to an increased risk of death. Objective: This study aimed to evaluate the serious and potentially fatal adverse effects of clozapine toxicity in psychic patients at mental health care hospitals in the Southern region of the Kingdom of Saudi Arabia. Methods: By using a survey, data were retrospectively collected from 193 adult psychic patient reports who have been administrated clozapine with regular follow-ups, in mental health hospitals in the Southern region of Saudi Arabia between 2019 and 2021. Then, these data are recorded and analyzed Statistically using SPSS software, with suitable tests, and predetermined statistical significance (p-value) of less than 0.001. Results: The occurrence of agranulocytosis, neutropenia, hypotension, and seizures showed a highly significant correlation with higher doses of clozapine administration (i.e. p < 0.001). Similarly, agranulocytosis and neutropenia were significantly associated with the occurrence of both hypotension and seizures (i.e. p < 0.001). Conclusion: The collected data in this study showed an increased incidence of agranulocytosis and neutropenia associated with clozapine-treated psychic patients in the Southern region of the Kingdom of Saudi Arabia which warrants further clinical studies to find this correlation.

Unicompartimental Knee Arthroplasty In Patients With or Without Patellofemoral Arthritis: 2-Year Clinical Outcome

Objectives Evaluate patients submitted to unicompartimental knee arthroplasty (UKA) by two surgeons with partial knee replacement expertise and, analyze the outcomes comparing a group of patients with preoperative isolated medial compartment arthritis to another group of patients with associated patellofemoral arthritis. Methods We conducted a retrospective cohort study to compare the clinical results of all patients submitted to UKA by two senior surgeons, between 2009 and 2020. All patients were submitted to partial knee arthroplasty using fixed-bearing Zimmer Unicondylar Knee System (ZUK). During analysis, they were divided into two groups, without patellofemoral arthritis (Group 1) and with patellofemoral arthritis (Group 2). Data collected from patient’s records included demographic information, range of motion (ROM), patient-reported outcome measures (PROMs) and preoperative radiographs. Only patients with minimum 2-year follow-up were included. Results Preoperative ROM was 122.6º (±6.2º) and 122.2º (±9.2º), in Group 1 and in Group 2, respectively (p-value = 0.9). While postoperative ROM was 114.5º (±2.9º) in Group 1 and 112.5º (±3.6) in Group 2 and, there was no statistical significance (p-value = 0.4). There was also no statistical significance regarding PROMs (Table 3). In Group 1, Oxford Knee Score was 17.1 (±1.8) and 40.2 (±2.1), before and after surgery, respectively. In Group 2, Oxford Knee Score changed from 18.8 (±1.9) to 40.5 (±2.5). The KOOS went from 129.3 (±15.2) preoperatively to 61.4 (±18.3) after surgery, in Group 1, while Group 2 evolved from 137.2 (±14.8) to 57.3 (±11.9). No complications were identified during the period studied. Conclusion UKA is an acceptable treatment option for unicompartimental tibiofemoral arthritis of the knee in patients with associated PFOA. There was an improvement in ROM of the knee, Oxford Knee Score and KOOS, with no differences between patients with or without PFOA.

P53 ABNORMAL ENDOMETRIAL CANCERS – ANALYSIS OF PD-1 CO-EXPRESSION BY CD4 HELPER AND CD8 CYTOTOXIC T-CELL SUBTYPES IN THE TUMOR MICROENVIRONMENT

Abstract Introduction/Objective Endometrial cancer is classified into four molecular subtypes of which the p53 abnormal variant is biologically aggressive. Programmed cell death protein 1 (PD-1) is a cell surface receptor and a vital inhibitor of the immune response. Programmed death ligand 1 (PD-L1) is a trans-membrane co-inhibitory factor of the immune response. PD-1 / PDL-1 interaction inhibits the activation and survival of T cells and decreases cytokine secretion. Some cancer cells express PD-L1, which then bind to PD-1 expressed on tumor specific T cells, and escape destruction by the T cells. The CD4/CD8 T cell immune response in the p53 abnormal variant has not been adequately evaluated with respect to the PD-1/PD-L1 pathway. Understanding this immune microenvironment is important to assess the potential use of anti-PD-1 targeted tumor therapy. Methods/Case Report Twenty cases of p53 abnormal endometrial cancers were obtained. All cases were PDL-1 +ve by immunohistochemistry. Two dual stains were performed - PD-1/CD4 and PD-1/CD8 antibodies. Six high-power fields (40x objective) with the greatest concentration of lymphocytes were counted. The total number of CD4 or CD8-only cells was recorded for each of the two stained slides for each case. The total number of PD- 1/CD4 and PD-1/CD8 positive cells were counted and recorded. The results were tabulated, and a paired t-test statistical analysis was performed to compare the total number of CD4 and CD8 cells and the percentage of PD-1/CD4 cells with the percentage of PD-1/CD8 positive cells. Results (if a Case Study enter NA) A statistically significant increase in the number of CD8 (Mean = 383) compared to CD4 cells (Mean = 317) was seen in the tumor microenvironment (p-value=0.0023). Evaluating PD-1 expression, the converse was true, and the percentage of PD-1/CD4 cells (Mean = 13.035%) was increased compared to the percentage of PD-1/CD8 cells (Mean = 9.205%), achieving statistical significance (p-value=0.0116). Conclusion The statistically significant increase in CD8 cells in the tumor and its stroma suggests that a robust cytotoxic response is being mounted to this high-risk molecular variant. The concurrent increase in CD4/PD-1 positive lymphocytes provides an appropriate microenvironment for the use of anti-PD-1 immunotherapy, since blockade of PD-1 on CD4 helper T cells may augment the tumor ablative cytotoxic properties of the CD8 positive lymphocytes. This includes reinvigoration of exhausted CD8+ T cells. Anti-PD-1 may also prevent the inhibition of PD-1 positive CD8 cells.

Frequency of Dry Socket among Patients Undergoing Dental Extractions Presenting to A Teaching Hospital, Rawalpindi

A dry socket, a painful post-extraction complication, occurs when the blood clot at the extraction site is dislodged or fails to form. Understanding its prevalence is crucial for improving outcomes in dental practices. Objective: To determine the frequency of dry sockets in patients undergoing dental extraction. Methods: A cross-sectional descriptive study was carried out and two customized questionnaires were filled out over three months. One questionnaire was for patients undergoing extractions and the other was filled for patients returning with dry sockets. The study included Pakistani individuals with permanent dentition while excluding non-Pakistani individuals, children with deciduous/mixed dentition, and severely immunocompromised patients. Chi-square and Fischer's exact tests were used to compare the frequency of dry sockets between gender and age groups. p-value of less than or equal to 0.05 was considered statistically significant. Results: Out of the 188 patients, 85 (45.2%) were males and 103 (54.8%) were females. Medically compromised patients comprised 24.5% of the study population. The overall incidence of dry sockets was 9.0%, with a slightly higher occurrence in females (9.7%), though the difference was not statistically significant (p-value=0.802). Smokers demonstrated a higher incidence of dry sockets (23.1%), which was also not statistically significant (p-value=0.099). Medically compromised patients experienced dry sockets at 17.4%, compared to 6.3% in healthy patients, suggesting a trend that did not reach statistical significance (p-value=0.363). Conclusions: It was concluded that identifying high-risk groups and promoting effective prevention and management techniques can reduce the incidence of dry sockets, leading to better outcomes and overall oral health

Survival status and its predictors among adult victims of road traffic accident admitted to public hospitals of Bahir Bar City, Amhara regional state, Northwest, Ethiopia, 2023: multi center retrospective follow-up study

IntroductionRoad traffic accident is the most common cause of death in adults worldwide. Road traffic accident-related deaths increased from time to time in low- and middle-income countries including Ethiopia; however, there is limited evidence about Survival status and its predictors among adult victims of road traffic accidents admitted to Hospitals in Ethiopia specifically in the study area. Thus, this study aimed to assess Survival status and its predictors among adult victims of road traffic accident admitted to Hospitals.MethodsAn institutional-based retrospective follow-up study was conducted from July 01/2019 to June 30/2022. A total of 402 samples were chosen using simple random sampling. Data was collected by a prepared checklist from the victims’ chart and entered into Epi-Data version 4.6 software and then exported to STATA version 14.1 for analysis. Kaplan-Meier failure function and log-rank test were computed. The assumption was checked by Schoenfeld residual test. All variables in bivariable analysis, p-value < 0.25 were entered into multivariable cox-regression model. Adjusted Hazard Ratio with 95% Confidence Interval was reported to declare the strength of association and statistical significance p-value of < 0.05. Model fitness was checked by using Cox-Snell residual. Data was presented by text, table, and graph.ResultThe median survival time was 504 h. From all, 63(15.6%) deaths, 57% of deaths occurred between 24 and 168 h of follow-up with an overall incidence of 15.34deaths per10, 000 victims-hours observation. According to the Kaplan-Meier failure curve together with the log-rank test, the incidence density rate of death among victims who had a complication during admission was71.86per10,000victims-hour observation (95%, CI:53.66–96.25), which is different from those who did not have complication 5.17per10,000person-hour observation (95%, CI:3.26–8.21). The incidence density rate of death among victims who had low level of arterial oxygen saturation (SPO2 < 95%) during admission was 82.87per10, 000 victims-hour observation (95%, CI: 63.15-108.75), which is different from those who had arterial oxygen saturation ≥ 95% 3.16per10, 000victims -hour observation (95%, CI: 1.75–5.71) Develop complication (AHR = 3.1,95% CI:1.44–6.70), systolic blood pressure measurement value ≤ 89 mmHg (AHR = 2.4,95% CI:1.10–5.19), not admitted intensive care unit (AHR = 0.46,95% CI:0.022–0.97), Glasgow Coma Scale score ≤ 8 (AHR = 2.9,95% CI:1.07–7.75), Glasgow Coma Scale score 9–12(AHR = 3.8,95% CI:1.61–8.97) and, level of arterial oxygen saturation ≤ 95% (AHR = 6.5,95% CI:2.38–17.64) were predictors of outcome variable.Conclusion and recommendationsThe median survival time was short. Complication, low systolic blood pressure measurement value, low Glasgow Coma Scale score, not admit to intensive care unit and low level of arterial oxygen saturation were significant predictors of the outcome variable. So that healthcare providers better give special attention and care to those victims admitted to Hospitals. A further prospective study is recommended.

Prevalence of onychomycosis among psoriasis patients: a clinico-mycological and dermoscopic comparative cross sectional study

Onychomycosis, a nail infection caused by dermatophytes, yeast, and molds makes up roughly half of all onychopathies and is the most prevalent nail condition in the world. Clinically, nail psoriasis and onychomycosis can frequently be difficult to distinguish from one another. To assess the prevalence of onychomycosis in patients with psoriasis. Fifty patients with psoriasis associated with nail disease were included in this study. After taking clinical history, nail samples were gathered for dermoscopic inspection, culture, direct microscopy with 20% KOH solution, and nail clipping with PAS stain. Of the 50 patients recruited, 43 were males and 7 were females, with mean age 6–71 years (mean ± SD 44.06 ± 16.2). Eleven patients (22%) tested positive for onychomycosis. Dermatophytes were isolated from 2% of patients, yeast from 14% of patients, and non-dermatophytic mold from 38% of patients. Histopathological results revealed fungal hyphae and spores in 18% of patients. The most prevalent dermoscopic sign in psoriatic patients with onychomycosis was spikes (81.8%) with statistical significance (P-value < 0.001), while nail pitting was the most prevalent dermoscopic feature in nail psoriasis. This study lays the way for an accurate diagnosis of nail lesions by highlighting the significance of cooperation between mycology, histology, and dermoscopy in the diagnosis of onychomycosis in patients with nail psoriasis.

Components and Indicators of Innovators Among Primary School Teachers

The objectives of this study were: 1) to study the components and indicators of innovators in primary school teachers, and 2) to examine the consistency of the components model and indicators of innovators in primary school teachers with empirical data. The participants were 220 primary teachers under the Office of the Basic Education Commission in the Northeastern Region. The researcher determined the sample size based on a 20:1 ratio of the number of parameters and used a multi-stage random sampling. The research instrument was a questionnaire for developing elements and indicators of innovator in primary school teachers. The Item-Objective Congruence (IOC) index ranges from 0.80 to 1.00, the discriminatory power using Pearson Product-Moment Correlation ranges from 0.24 to 0.83, and the reliability of the entire instrument, as measured by Cronbach&amp;rsquo;s alpha coefficient (&amp;alpha;), is 0.97. Data were analyzed using confirmatory factor analysis (CFA). The results revealed the following: 1) the elements and indicators of innovators in primary school teachers were identified through a synthesis of relevant documents and research, consisting of (1) initiative, (2) observation and asking questions, (3) interaction with others, (4) applying, and (5) adapting to the situation, with a total of 11 indicators. 2) The examination of the consistency of the components model and indicators of innovators in primary school teachers with empirical data found that (&amp;chi;2) was equal to 15.073, the degrees of freedom (df) was equal to 22, the chi-square value is the correlation (&amp;chi;2/df) is equal to 0.685. The statistical significance (p-value) was 0.859, and the goodness-of-fit index (GFI) was 0.988. The Relative Harmony Index (CFI) was equal to 1.000. The Harmonic Harmony Index (NFI) was equal to 0.985. The Root Mean Residual Index (RMR) was equal to 0.004. The square root of the mean square of the estimation (RMSEA) was equal to 0.000, indicating that this tool can be used to evaluate the innovators of primary school teachers.

The Status of Canadian Radiology Mentorship Programs, Where We Stand and Where to Improve.

Background: The importance of mentorship in medicine is well-established. Access to mentors is pivotal in enhancing career opportunities and networking, increasing research productivity, and overall wellness and resilience at all career stages. Our study aims to assess the current status of radiology mentorship programs for Canadian medical students and radiology residents. Methods: We distributed an anonymous survey to Canadian radiology program directors in December 2022. The questions pertained to the existing mentorship programs' specific goals, structure, and success. Our null hypothesis was that medical students and residents have similar mentorship opportunities. Results: We have received 12 responses (a response rate of 12/16 = 75%), 9 of which had formal mentorship programs and 3 (25%) did not. Comparing the mentorship program for medical students and residents yielded a P-value = .11 > .05. This result does not reject our null hypothesis, indicating there is no significant difference between these 2 groups. Using qualitative analysis, we categorized the responses into 4 main themes: mentorship programs' goals, structures, evaluation methods, and their results. Conclusion: Although our result did not reach statistical significance (P-value = .11 > .05), the observed trend shows that one third of Canadian medical schools do not offer a radiology mentorship program for medical students, highlighting a potentially significant opportunity for improvement. Qualitative analysis shows that despite various methods for assigning mentees to mentors, developing formalized yet flexible mentorship models that allow students and residents to self-select their mentors might be more beneficial than randomly assigning mentors to them.

Comparison of Various Low Density Lipoprotein Cholesterol Calculators: Is It Time for the Friedewald Equation to Go in India?

Low-density lipoprotein cholesterol (LDL-c) is the main target in the management of dyslipidemia in primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD). Our study aims to compare the conventional and most popular Friedewald equation, and the more recent Sampson equation (literally unknown in India but more accurate), to the directly estimated LDL-c by the homogenous method. No such comparative study has been done in India. A multicenter retrospective analysis of the lipid profiles of patients whose LDL-c was derived directly by the homogenous method was included. Indirect LDL-c was estimated using the Friedewald and Sampson equations. The accuracy, error, and level of correlation between direct LDL-c and the two equations were assessed for concordance and discordance based on LDL-c categories (≤50, 51-70, 71-100, 101-130, ≥131 mg/dL). Upward discordance is when the calculated LDL-c was at least one category higher and downward discordance is when the calculated LDL-c was at least one category lower than the corresponding direct LDL-c (DLDL-c). Subgroup analyses were also done for triglycerides (TGLs) <150, 151-199, ≥200 mg/dL. TGL >400 were assessed separately. A total of 30,810 samples from four centers were studied. The overall mean DLDL-c was 107.86 mg/dL. The mean estimated LDL-c by Friedewald's equation (FLDL-c) and Sampson's equation (SLDL-c) were 101.37 and 104.37 mg/dL, respectively. There was statistical significance (p-value < 0.0005) in the mean difference when DLDL-c was compared with combined SLDL-c and FLDL-c as per the Games-Howell multiple comparison study, in which the mean difference was greater with the Friedewald equation (6.495) than with the Sampson equation (3.491). The overall concordance between FLDL-c vs DLDL-c and SLDL-c vs DLDL-c was nearly similar (74 vs 77%, respectively). The overall discordance upward was 5% with FLDL-c and 7% with SLDL-c (p-value < 0.0005). The overall discordance downward for FLDL-c and SLDL-c was 22 and 15% (p-value < 0.0005). When subgroup analysis was done for LDL-c ≤ 70, the downward discordance was 41% (FLDL-c) and 32% (SLDL-c), giving a false sense of goal LDL-c being achieved more often with FLDL-c. For LDL-c > 70, the corresponding downward discordance was 16 and 11%, respectively. Starting from TGL ≥ 200 mg/dL, there was consistent underestimation of LDL-c by the Friedewald equation. When TGL was > 400, the mean DLDL-c was 109 mg/dL, while for FLDL-c, it was 82 mg/dL and for SLDL-c, it was 98 mg/dL. Sampson's equation improves the accuracy of the indirectly calculated LDL-c compared to Friedewald's equation. The FLDL-c is estimated falsely low at LDL-c ≤ 70 mg/dL, giving a lower sense of LDL-c goal being achieved, and these patients will be undertreated. By switching to Sampson's equation, 9% in the LDL-c ≤ 70 mg/dL and 5% in the LDL-c > 70 mg/dL can be correctly classified. The shift to Sampson's equation requires a simple formula change and can be easily embraced in India-a small change but in the right direction.

Evaluation of Open-Source Ciliary Analysis Software in Primary Ciliary Dyskinesia: A Comparative Assessment.

Primary Ciliary Dyskinesia (PCD) is a rare genetic disorder characterized by alterations in motile cilia function. The diagnosis of PCD is challenging due to the lack of standardized methods in clinical practice. High-speed video microscopy analysis (HSVA) directly evaluates ciliary beat frequency (CBF) in PCD. Recently, open-source ciliary analysis software applications have shown promise in measuring CBF accurately. However, there is limited knowledge about the performance of different software applications, creating a gap in understanding their comparative effectiveness in measuring CBF in PCD. We compared two open-source software applications, CiliarMove (v219) and Cilialyzer (v1.2.1-b3098cb), against the manual count method. We used high-speed videos of nasal ciliary brush samples from PCD RSPH4A-positive (PCD (RSPH4A)) patients and healthy controls. All three methods showed lower median CBF values for patients with PCD (RSPH4A) than in healthy controls. CiliarMove and Cilialyzer identified lower CBF in patients with PCD (RSPH4A), similarly to the manual count. Cilialyzer, CiliarMove, and manual count methods demonstrated statistical significance (p-value < 0.0001) in the difference of median CBF values between patients with PCD (RSPH4A) and healthy controls. Correlation coefficients between the manual count values against both software methods demonstrated positive linear relationships. These findings support the utility of open-source software-based analysis tools. Further studies are needed to validate these findings with other genetic variants and identify the optimal software for accurate CBF measurement in patients with PCD.

The prominence of Oligoclonal Bands for clinical conversion in Radiologically isolated syndrome: 10-year follow-up study in Isfahan, Iran

BackgroundSince data is limited on radiologically isolated syndrome (RIS) subjects in certain regions like the Middle East, we aimed to further explore the replicability and generalizability of previously suggested predictors among a cohort of Iranian RIS subjects and report the long-term clinically definite MS (CDMS) conversion rate in this cohort. MethodsWe conducted a prospective 10-year cohort on our RIS participants, during which we collected the MRI, paraclinical, and demographic data of the subjects, and identified those who converted to CDMS. ResultsOut of 35 participants, 10 (28.5 %) developed CDMS during an average of 5.58 ± 3.08 years (range: 4 months to 10.33 years). OCB positivity was the only definitive predictor for conversion to CDMS in this cohort (P-value = 0.006), but other previously reported risk factors such as spinal cord lesions or age lacked statistical significance (P-values > 0.05). We also reported the median survival time as 114 months, the proportion surviving after 14 months as 96.9 % ± 3.1 %, and the overall conversion rate as 0.05 cases per year. ConclusionOur results highlight OCB as an important predictive factor of clinical conversion in RIS. The prominence of OCB suggests a need for routine CSF analysis in RIS subjects and could guide clinicians in deciding which RIS subjects benefit from DMTs.

Metagenome comparison (MC): A new framework for detecting unique/enriched OMUs (operational metagenomic units) derived from whole-genome sequencing reads

BackgroundCurrent methods for comparing metagenomes, derived from whole-genome sequencing reads, include top-down metrics or parametric models such as metagenome-diversity, and bottom-up, non-parametric, model-free machine learning approaches like Naïve Bayes for k-mer-profiling. However, both types are limited in their ability to effectively and comprehensively identify and catalogue unique or enriched metagenomic genes, a critical task in comparative metagenomics. This challenge is significant and complex due to its NP-hard nature, which means computational time grows exponentially, or even faster, with the problem size, rendering it impractical for even the fastest supercomputers without heuristic approximation algorithms. MethodIn this study, we introduce a new framework, MC (Metagenome-Comparison), designed to exhaustively detect and catalogue unique or enriched metagenomic genes (MGs) and their derivatives, including metagenome functional gene clusters (MFGC), or more generally, the operational metagenomic unit (OMU) that can be considered the counterpart of the OTU (operational taxonomic unit) from amplicon sequencing reads. The MC is essentially a heuristic search algorithm guided by pairs of new metrics (termed MG-specificity or OMU-specificity, MG-specificity diversity or OMU-specificity diversity). It is further constrained by statistical significance (P-value) implemented as a pair of statistical tests. ResultsWe evaluated the MC using large metagenomic datasets related to obesity, diabetes, and IBD, and found that the proportions of unique and enriched metagenomic genes ranged from 0.001% to 0.08 % and 0.08%–0.82 % respectively, and less than 10 % for the MFGC. ConclusionThe MC provides a robust method for comparing metagenomes at various scales, from baseline MGs to various function/pathway clusters of metagenomes, collectively termed OMUs.

Inter-rater reliability among healthcare professionals in assessing postoperative wound photos for the presence or absence of surgical wound dehiscence: A Pretest - Posttest study

BackgroundSurgical wound dehiscence (SWD) has various definitions, which complicates accurate and uniform diagnosis. To address this, the World Union Wound Healing Societies (WUWHS) presented a consensus based definition and classification for SWD (2018). AimThis quasi-experimental pretest-posttest study investigates the inter-rater reliability among healthcare professionals (HCP) and wound care professionals (WCP) when assessing wound photos on the presence or absence of SWD before and after training on the WUWHS-definition. MethodsWound expert teams compiled a set of twenty photos (SWD+: nineteen, SWD−: one), and a video training. Subsequently, 262 healthcare professionals received the pretest link to assess wound photos. After completion, participants received the posttest link, including a (video) training on the WUWHS-definition, and reassessment of fourteen photos (SWD+: thirteen, SWD−: one). Primary outcomes1) pretest-posttest inter-rater-reliability among participants in assessing photos in congruence with the WUWHS-definition 2) the impact of training on assessment scores. Secondary outcome: familiarity with the WUWHS-definition. ResultsOne hundred thirty-one participants (65 HCPs, 66 WCPs) completed both tests. The posttest inter-rater reliability among participants for correctly identifying SWD was increased from 67.6 % to 76.2 %, reaching statistical significance (p-value: 0.001; 95 % Confidence Interval [1.8–2.2]).Sub-analyses per photo showed improved SWD posttest scores in thirteen photos, while statistical significance was reached in seven photos.Thirty-three percent of participants knew the WUWHS-definition. ConclusionThe inter-rater reliability among participants increases after training on the WUWHS-definition. The definition provides diagnostic criteria for accurate SWD diagnosis. Widespread use of the definition may improve uniformity in care for patients with SWD.

Assessment the Role of Non Invasive Biomarkers as an Early Predictors of Mucosal Healing in Ulcerative Colitis Patients Treated with the Biological Therapy

Abstract Background Ulcerative colitis (UC) is characterized by confluent mucosal inflammation and erosions starting from the anal verge and extending to a variable extent, where patients often complain of diarrhea associated with rectal bleeding, abdominal tenderness, and weight loss. Numerous disease biomarkers have been studied in ulcerative colitis (UC) such as Erythrocyte sedimentation rate(ESR) and C- reactive protein(CRP). On the other hand, fecal calprotectin and Lactoferrin are more specific and sensitive but expensive and still not commonly used in clinical practice due to the need for on demand specimen collection. Objective To evaluate the role of the non-invasive biomarkers as an early predictor of mucosal healing in ulcerative colitis patients treated with biological therapy. Methods Twenty adult patients with ulcerative colitis who received biological therapy (after adequate screening) were included in our study. The patients met the indications for treatment with biological therapy according to European Crohn and Colitis Organization guidelines. The patients were presented to our IBD clinic at tropical medicine department, Ain shams university in the period from 1/2018 to 9/2021. Results There is a strong relationship between clinical response and mucosal healing at 6 months of starting biological therapy as 100% of patients who achieved mucosal healing showed clinical response. Median N/L ratio, median PLT/L ratio and CRP/albumin ratio were 1.58, 425 and 1.19 respectively in patients who achieved mucosal healing at 6 months after 3 months of starting biological therapy with statistical significance (p-value = 0.019, 0.019 and 0.008) respectively in comparison to the patients who didn’t achieve mucosal healing. Both median of L/M ratio and PLT/M ratio were decreased in patients achieved mucosal healing at 6 months after 3 months of starting biological therapy (3.43 and 660) respectively in comparison to patients who didn’t achieve mucosal healing but it didn’t reach any statistical significance. Conclusion Non invasive biomarkers at 3 months like N/L ratio, PLT/L ratio, L/M ratio and PLT/M ratio may be used as non invasive predictors of mucosal healing at 6 months after starting treatment with biological treatment.

Risk Predictors of Severity in Egyptian Patients with Covid-19 Infection

Abstract Background In modern human history, infectious diseases have posed a threat to public health several times, coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as a global public health crisis. Objective Identification of demographic, laboratory and radiological predictors of progression of COVID-19 infection in Egyptian patients. A special concern is focused on the poor prognostic factors associated with mortality, this will help to classify and monitor COVID-19 patients to deliver best medical care in order to decrease mortality and morbidity in Egyptian patients. Patients and Methods A single-center, retrospective cohort study. This study was conducted in Almaza Fever Hospital after obtaining approval from the Research Ethical Committee. Results The current study conducted on (325) known positive COVID-19 patients divided into 2 groups: Group I (204) patients and Group II (121) patients. It was found that an increase in age among Group II (mean age was 66.22 ± 12.18) in comparison to Group I (mean age was 47.78 ± 14.73) with a statistically significant difference (p-value &amp;lt;0.001). There was no statistically significant difference (p-value 0.432) between Sex and severe disease patients. Among Group II (121) out of the total study population 103 (85%) of these were found to have co-morbidities (highly significant, p value &amp;lt; 0.001. Moreover, there was a higher prevalence of co-morbidities among non survivors however this didn’t reach the level of statistical significance (p-value 0.174). The current study showed that there was an increase in hematological parameters (TLC, Neutrophils), biochemical parameters (Urea, Creatinine, AST, D-Dimer, Ferritin, CRP, LDH, IL-6) and a decrease in Lymphocytes within Group II in comparison with Group I with statistically Significant difference (p-value &amp;lt; 0.001), also there was a trend toward higher levels of ALT in group II, however this didn’t reach the level of statistical significance (p-value 0.068). Statistically significant difference (p-value &amp;lt; 0.001) was found between disease severity and CT findings as from a total of (121) severe disease patients 105(86.8%) had CORADS (4-5). Conclusion The current study shows old age, elevated biochemical parameters (creatinine, urea, AST, D-dimer, IL-6, CRP, ferritin and LDH), hematological parameters (TLC) and extensive lung affection could be considered predictors of severity and mortality among Covid-19 patients. Also lymphopenia and associated co-morbidities are considered predictors of severity.

The Effect of Neurophysiological Modulation on Muscle Power and Pain Through Manual Therapy Over Electro- Physiotherapy for Athletes with Illio Tibial Band Syndrome (ITBS)

Introduction and Objectives: Iliotibial Band Syndrome (ITBS) is a common overuse injury in athletes, primarily impacting the knee and hip due to repetitive friction of the iliotibial band against the femur, resulting in pain and restricted hip abduction and knee extension. Muscle power and pain associated with ITBS can be measured using Hand-held Dynamometer (HHD) and Visual-Analog-Scale scores (VAS) respectively. This study aimed to compare the efficacy of two treatment groups, Manual-Therapy (MT) and Electro-Physiotherapy (EPT), in determining the most effective approach for managing ITBS. Materials and Methods: A RCT was conducted at the Sports Medicine Clinic of the Teaching Hospital Karapitiya, enrolling twenty athletes in each group as controls and experimental subjects. The control group received EPT, NSAIDS, and paracetamol for one week, while the experimental group received MT, NSAIDS, and paracetamol for the same duration. Muscle power and pain measurements were assessed using HHD &amp; VAS on D1 and D28. P-values for statistical significance were obtained using RM-ANOVA followed by Bonferroni test. Results: Mean ages for EPT and MT groups were 24.4±6.6 and 25.4±6.6years, respectively. Muscle power (N) for EPT group on D1, and D28 were 101.7±26.3 and 112.7±23 respectively. The same parameters for MT group were 98.1±26 and 186.8±25.3. The mean differences for muscle power of two groups on D1 and D28 were -3.600(P=0.666) and 74.050(P&lt;0.001). VAS scores for EPT group on D1, and D28 were 8.2±0.9 and 7±1 respectively. The same parameters for MT group were 7.9±0.8 and1.8±0.8. The mean differences for pain of two groups on D1 and D28 were 0.250(P=0.395) and -5.200(P&lt;0.001). Partial-Eta-Squared for the two groups were 0.355 and 0.758respectively. ManualTherapy group’s higher effectiveness was statistically significant (p&lt;0.001) and a 35.5% variance in muscle power and 75.8% variance in VAS score was attributable to it. Conclusion:Manual-therapy is superior to electro-physiotherapy in improving muscle power and decreasing in VAS scores of athletes with ITBS.

Prevalence and Association of Risk Factors According to Liver Steatosis and Fibrosis Stages among Nonalcoholic Fatty Liver Disease Patients with Type 2 Diabetes Mellitus in India: A Cross-sectional Study.

Type 2 diabetes mellitus (T2DM) and nonalcoholic fatty liver disease (NAFLD) are linked to the global diabetes epidemic, leading to increased disease progression and adverse health outcomes. The renaming of NAFLD to metabolic dysfunction-associated steatotic liver disease (MASLD) at the 2023 European Association for the Study of the Liver Congress highlights the complex relationship between metabolic disorders and liver health. Taking this into consideration, we aimed this study to identify prevalence and risk factors associated with the stages of NAFLD in individuals with T2DM in the Indian population. This observational, cross-sectional study was conducted on 1,521 T2DM patients at Dr Panikar's Speciality Care Centre, Mumbai, between September 1, 2022 and October 31, 2022. Demographic parameters such as age, gender, height, weight, and anthropometric parameters such as body mass index (BMI) and waist circumference were measured. Liver fibrosis and steatosis stages were identified by vibration-controlled transient elastography (VCTE) using FibroScan®. The prevalence of liver steatosis was 75.1% among the 1,521 diabetes cases [S0 (24.9%), S1 (15.1%), S2 (24%), and S3 (36%)], whereas the prevalence of liver fibrosis was 28.0% [F0 (72%), F1 (19%), F2 (5%), F3 (1.5%), and F4 (3.4%)]. The S1 (p = 0.012), S3 (p = 0.001), F1 (p = 0.001), and F2 (p = 0.001) grades showed significant gender-related changes, demonstrating a positive connection. Furthermore, waist circumference was associated with disease severity in both liver steatosis and fibrosis stages (p = 0.001), but BMI was solely associated with the degree of steatosis (p = 0.001). The mean age differences between these categories, however, did not reach statistical significance (p-values of 0.149 and 0.078, respectively, for the steatosis and fibrosis grades). The study reveals a high prevalence of NAFLD (steatosis and fibrosis) in T2DM patients, increasing the risk of advanced fibrosis. In T2DM patients with risk factors including waist circumference and BMI, appropriate screening and intervention are required.

Investigating the Performance of Frequentist and Bayesian Techniques in Genomic Evaluation.

The genomic evaluation process relies on the assumption of linkage disequilibrium between dense single-nucleotide polymorphism (SNP) markers at the genome level and quantitative trait loci (QTL). The present study was conducted with the aim of evaluating four frequentist methods including Ridge Regression, Least Absolute Shrinkage and Selection Operator (LASSO), Elastic Net, and Genomic Best Linear Unbiased Prediction (GBLUP) and five Bayesian methods including Bayes Ridge Regression (BRR), Bayes A, Bayesian LASSO, Bayes C, and Bayes B, in genomic selection using simulation data. The difference between prediction accuracy was assessed in pairs based on statistical significance (p-value) (i.e., t test and Mann-Whitney U test) and practical significance (Cohen's d effect size) For this purpose, the data were simulated based on two scenarios in different marker densities (4000 and 8000, in the whole genome). The simulated data included a genome with four chromosomes, 1 Morgan each, on which 100 randomly distributed QTL and two different densities of evenly distributed SNPs (1000 and 2000), at the heritability level of 0.4, was considered. For the frequentist methods except for GBLUP, the regularization parameter λ was calculated using a five-fold cross-validation approach. For both scenarios, among the frequentist methods, the highest prediction accuracy was observed by Ridge Regression and GBLUP. The lowest and the highest bias were shown by Ridge Regression and GBLUP, respectively. Also, among the Bayesian methods, Bayes B and BRR showed the highest and lowest prediction accuracy, respectively. The lowest bias in both scenarios was registered by Bayesian LASSO and the highest bias in the first and the second scenario were shown by BRR and Bayes B, respectively. Across all the studied methods in both scenarios, the highest and the lowest accuracy were shown by Bayes B and LASSO and Elastic Net, respectively. As expected, the greatest similarity in performance was observed between GBLUP and BRR ( , in the first scenario and , in the second scenario). The results obtained from parametric t and non-parametric Mann-Whitney U tests were similar. In the first and second scenario, out of 36 t test between the performance of the studied methods in each scenario, 14 ( ) and 2 ( ) comparisons were significant, respectively, which indicates that with the increase in the number of predictors, the difference in the performance of different methods decreases. This was proven based on the Cohen's d effect size, so that with the increase in the complexity of the model, the effect size was not seen as very large. The regularization parameters in frequentist methods should be optimized by cross-validation approach before using these methods in genomic evaluation.

Mapping and predicting open defecation in Ethiopia: 2021 PMA-ET study

IntroductionThere has been extensive research conducted on open defecation in Ethiopia, but a notable gap persists in comprehensively understanding the spatial variation and predictors at the household level. This study utilizes data from the 2021 Performance Monitoring for Action Ethiopia (PMA-ET) to address this gap by identifying hotspots and predictors of open defecation. Employing geographically weighted regression analysis, it goes beyond traditional models to account for spatial heterogeneity, offering a nuanced understanding of geographical variations in open defecation prevalence and its determinants. This research pinpoints hotspot areas and significant predictors, aiding policymakers and practitioners in tailoring interventions effectively. It not only fills the knowledge gap in Ethiopia but also informs global sanitation initiatives.MethodsThe study comprised a total weighted sample of 24,747 household participants. ArcGIS version 10.7 and SaT Scan version 9.6 were used to handle mapping, hotspots, ordinary least squares, Bernoulli model analysis, and Spatial regression. Bernoulli-based model was used to analyze the purely spatial cluster detection of open defecation at the household level in Ethiopia. Ordinary Least Square (OLS) analysis and geographically weighted regression analysis were employed to assess the association between an open defecation and explanatory variables.ResultsThe spatial distribution of open defecation at the household level exhibited clustering (global Moran’s I index value of 4.540385, coupled with a p-value of less than 0.001), with significant hotspots identified in Amhara, Afar, Harari, and parts of Dire Dawa. Spatial analysis using Kuldorff’s Scan identified six clusters, with four showing statistical significance (P-value < 0.05) in Amhara, Afar, Harari, Tigray, and southwest Ethiopia. In the geographically weighted regression model, being male [coefficient = 0.87, P-value < 0.05] and having no media exposure (not watching TV or listening to the radio) [coefficient = 0.47, P-value < 0.05] emerged as statistically significant predictors of household-level open defecation in Ethiopia.ConclusionThe study revealed that open defecation at the household level in Ethiopia varies across the regions, with significant hotspots identified in Amhara, Afar, Harari, and parts of Dire Dawa. Geographically weighted regression analysis highlights male participants lacking media exposure as substantial predictors of open defecation. Targeted interventions in Ethiopia should improve media exposure among males in hotspot regions, tailored sanitation programs, and region-specific awareness campaigns. Collaboration with local communities is crucial.