Statistical Validation of Cardiovascular Digital Biomarkers Towards Monitoring the Cardiac Risk in COPD: A Lyfas Case Study

Background: Mobile health (mHealth) is gaining popularity due to its pervasiveness. Lyfas is a smartphone-based optical biomarker instrument catering to mHealth. It captures the Pulse Rate Variability (PRV) and its associated digital biomarkers from the index finger capillary circulation using the principle of arterial photoplethysmography. PRV surrogates for the Cardiovascular Autonomic Modulation (CvAM) and provides a snapshot of psychophysiological homeostasis of the body. Objective: The paper investigates the roles of (a) physiological factors, e.g., Age, Duration of illness, Heart Rate (HR), Respiration Rate (RR), SpO2 level, and (b) popular digital biomarkers, such as SDNN, LF/HF, RMSSD, pNN50, SD1/SD2 to evaluate the cardiac risk. The paper hypothesizes that low FEV1, which is another physiological factor, plays a critical role in defining such risk. Method: A total of 50 males and females each, suffering from Chronic Obstructive Pulmonary Disease (COPD) took the Lyfas test after appropriate ethical measures. Data, thus collected by Lyfas had been statistically analyzed using histogram plots and Kolmogorov-Smirnov test for normality check, Pearson's Correlations (PC) to measure the strength of associations, and linear regressions to test the goodness of fit of the model. Results: Positive PCs are noted between (a) RMSSD and SDNN ('very high'-females: 0.86 and males: 0.91), (b) pNN50 and RMSSD (PC: moderate 0.46), (c) pNN50 and SDNN (PC: moderate 0.44), (d) Duration of illness and Age ('high'-females: 0.71 and males: 0.77), and (e) Age and RR ('high'-females: 0.67, males: 0.53). Negative PC is noted between (a) LF/HF and FEV1 ('moderately high'-males 0.42) and (b) LF/HF and SpO2 ('moderately high'-males 0.30). Although the R2 values are not so encouraging (most are < 0.5), yet, the models are statistically significant (p-values 0.0336; CI 95%). Conclusion: The paper concludes that Lyfas may be used to predict the cardiac risk in COPD patients based on the LF/HF values correlated to SpO2 and FEV1 levels.

Effect of oseltamivir phosphate versus placebo on platelet recovery and plasma leakage in adults with dengue and thrombocytopenia; a phase 2, multicenter, double-blind, randomized trial

Background Thrombocytopenia, bleeding and plasma leakage are major complications of dengue. Activation of endogenous sialidases with desialylation of platelets and endothelial cells may underlie these complications. We aimed to assess the effects of the neuraminidase inhibitor oseltamivir on platelet recovery and plasma leakage in dengue. Methods We performed a phase 2, double-blind, multicenter, randomized trial in adult dengue patients with thrombocytopenia (<70,000/μl) and a duration of illness ≤ 6 days. Oseltamivir phosphate 75mg BID or placebo were given for a maximum of five days. Primary outcomes were the time to platelet recovery (≥ 100,000/μl) or discharge from hospital and the course of measures of plasma leakage. Results A total of 70 patients were enrolled; the primary outcome could be assessed in 64 patients (31 oseltamivir; 33 placebo). Time to platelet count ≥100,000/μl (n = 55) or discharge (n = 9) were similar in the oseltamivir and placebo group (3.0 days [95% confidence interval, 2.7 to 3.3] vs. 2.9 days [2.5 to 3.3], P = 0.055). The kinetics of platelet count and parameters of plasma leakage (gall bladder thickness, hematocrit, plasma albumin, syndecan-1) were also similar between the groups. Discussion In this trial, adjunctive therapy with oseltamivir phosphate had no effect on platelet recovery or plasma leakage parameters. Trial registration ISRCTN35227717.

Biomarkers of Length of Stay On An Inpatient Eating Disorder Unit For Treatment of Anorexia Nervosa in Females

Background. Length of stay on an inpatient unit for treatment of anorexia nervosa (AN) is widely variable. Although previous research has used anthropometric and clinical variables and duration of illness to predict length of stay, there has been limited investigation of the predictive ability of biomarkers. Biomarkers, including those collected through a comprehensive metabolic panel (CMP) and appetite hormones, such as ghrelin and leptin, are impacted by disease presence and may play an etiological role in AN. Methods. Using a series of regression models, we retrospectively evaluated the associations of these putative biomarkers at admission with length of inpatient stay in 59 females receiving treatment on an inpatient eating disorder unit for anorexia nervosa. Results. Both lower levels of magnesium and higher active ghrelin levels at inpatient admission predicted length of stay. Conclusions. This research provides further evidence supporting both biological and psychological components of AN, identifying potential biomarkers that could aid in prospective prediction of treatment needs. Ghrelin monitoring throughout inpatient stays may aid clinicians in better predicting physical recovery and renourishment from AN and prepare for stepdown from an inpatient setting. Further research is necessary to replicate and extend these findings across treatment settings.

Non-Motor Symptoms and their associated factors in Parkinson’s Disease

Aim: To find the frequency of Non Motor Symptoms in patients with Parkinson’s Disease (PD) and describe their association with different factors like age, gender and duration of disease. Methodology: A cross sectional observational study was carried out in Rehman Medical Institute, Peshawar for the period of 1year. All patients of idiopathic Parkinson’s disease (PD) were included. 13 Non motor symptoms (NMS) were evaluated and noted in predesigned proforma. Data was entered and analyzed by SPSS 22. Results: Mean Age was 62.10±10.01 years. 58.82%(n=40) were males. 47.05%(n=32) belong to urban residence. Mean duration of illness was 4.52±3.82 years. NMS were found in 100% (n=68) patients. Among NMS, sleep disturbance was the most common symptom found in 77.9% (n=53) followed by constipation that was present in 75%(n=51) of patients. Depression was significantly associated with advance age (P value 0.01) and in those taking treatment of motor symptoms of PD (P value 0.02). Perspiration was significantly more with longer duration of illness (P value 0.006) and advance age (P value 0.04). Orthostatic hypotension was associated with longer duration of disease. (P value 0.04) There was no other significant association found. Conclusion: NMS were seen in all the patients presenting to Neurology OPD in our study. The most common NMS was sleep disturbance followed by constipation and depression. Autonomic disturbance were associated with longer disease duration while depression was associated with old age.

Metabolic Syndrome in a Population of In-Patients with Schizophrenia in the Western Siberia

Background. The relevance of this work is due to the incomplete nature of existing studies on risk factors of metabolic syndrome (MS) in patients with schizophrenia. Aim: to study the MS prevalence in schizophrenia in-patients and their clinical, therapeutic and socio-demographic features. Patients and methods: 517 in-patients diagnosed with schizophrenia according to the ICD-10 criteria were examined. All patients underwent a structured clinical interview (SCID); measurement of waist circumference, blood pressure and assessment of biochemical parameters for verification of MS based on the criteria of the IDF (International Diabetes Fediration). An assessment of the severity of clinical and psychopathological symptoms was performed using the PANSS. Results: the prevalence of MS in in-patients with schizophrenia in the Western Siberia is similar to that reported in the literature. It was found that in-patients with schizophrenia and MS are characterized by a predominance of women and older age, as well as a large proportion of divorced, and a smaller proportion of never married. Women with MS were older, got longer duration of illness, and got later onset of disease than men with MS. The age of disease onset was significantly greater in patients with MS than in patients without MS. Atypical antipsychotics were more often used as the basic antipsychotic treatment in the group of patients with MS but this difference between the groups did not reach statistical significance. Conclusions: the main risk factors in patients with schizophrenia and MS coincide with risk factors of MS in general population. A later onset of the disease can act as an independent risk factor. The relationship and mutual influence of risk factors for the development of MS in patients with schizophrenia needs further study.

The Effect of Self-Efficacy in Self-Management on Diabetes Distress in Young People with Type 2 Diabetes

To understand the relationship among glycemic control, self-efficacy in diabetes management, and diabetes distress in young people with type 2 diabetes, a cross-sectional descriptive study with convenience sampling was designed. A total of 60 young people who had type 2 diabetes (T2D), with 24 (40%) males and 36 (60%) females were included. The mean age was 17.2 and ranged from 10.5 to 24.5 years, and they completed a Perceived Diabetes Self-Management Scale, the Problem Areas in Diabetes Scale and their pharmacologic management and life adjustment. Glycated hemoglobin (HbA1c) was routinely drawn before the outpatient visit. HbA1c and diabetic distress were positively correlated. Self-efficacy was negatively correlated with HbA1c and diabetic distress. In the hierarchical multiple regression analysis, only the duration of illness and self-efficacy remained significant in the final model. The variance for the overall model was 64%, with self-efficacy alone explaining 30% of the variance. In addition, 31.6% of participants had extremely high levels of psychological distress. Conclusions: T2D is an early onset chronic disease, and the young people may have had other health problems, which made the diabetes management a complex process. Nursing staff should regularly assess both the confidence and ability to manage treatment regimen of young people with type 2 diabetes and their psychological distress.

Locus of Control and Dizziness: Mediation Effect of Self-Efficacy

Objectives: An attention to psychological aspects can clarify the understanding and management of patients with unresolved dizziness/vertigo. Thus, we study the locus of control and the mediation effect of self-efficacy for assessing the relationship between locus of control and dizziness/vertigo in a referral-based dizziness clinic.Methods: We analyzed the dizziness-specific locus of control and self-efficacy using the modified questionnaire in 117 consecutive dizzy patients (34 males; age range, 20–74 years). In addition to the visual analogue scale-dizziness for evaluation of subjective dizziness, the following items were further evaluated; Korean Dizziness Handicap Inventory, Korean Beck Depression Inventory II, and Korean Beck Anxiety Inventory. According to the verification procedure proposed by Hayes, the mediation effect of self-efficacy verifies the relationship between the locus of control and dizziness through analysis.Results: Except the scale of emotion such as anxiety and depression, sex, age, duration of illness, and diagnosis all did not significantly affect the dependent variables. Vestibular migraine (39.3%), vestibulopathy (15.4%), and dizziness associated with anxiety and depression (14.5%) were the most common diagnoses. On all scales, Cronbach’s α ranged from 0.72 to 0.94. In the direct effect, the internal locus of control had a tendency of aggravation of dizziness/vertigo, but in the indirect effect, the higher the internal locus of control, the higher the self-efficacy, and the higher the self-efficacy, the lower the dizziness.Conclusions: In our study, we can assume that the locus of control can impart ambivalent effects on dizziness/vertigo. And the modulation of self-efficacy could be another treatment for patients with unresolved dizziness.

Assessment of Food and Waterborne Viral Outbreaks by Using Field Epidemiologic, Modern Laboratory and Statistical Methods—Lessons Learnt from Seven Major Norovirus Outbreaks in Finland

Seven major food- and waterborne norovirus outbreaks in Western Finland during 2014–2018 were re-analysed. The aim was to assess the effectiveness of outbreak investigation tools and evaluate the Kaplan criteria. We summarised epidemiological and microbiological findings from seven outbreaks. To evaluate the Kaplan criteria, a one-stage meta-analysis of data from seven cohort studies was performed. The case was defined as a person attending an implicated function with diarrhoea, vomiting or two other symptoms. Altogether, 22% (386/1794) of persons met the case definition. Overall adjusted, 73% of norovirus patients were vomiting, the mean incubation period was 44 h (4 h to 4 days) and the median duration of illness was 46 h. As vomiting was a more common symptom in children (96%, 143/149) and diarrhoea among the elderly (92%, 24/26), symptom and age presentation should drive hypothesis formulation. The Kaplan criteria were useful in initial outbreak assessments prior to faecal results. Rapid food control inspections enabled evidence-based, public-health-driven risk assessments. This led to probability-based vehicle identification and aided in resolving the outbreak event mechanism rather than implementing potentially ineffective, large-scale public health actions such as the withdrawal of extensive food lots. Asymptomatic food handlers should be ideally withdrawn from high-risk work for five days instead of the current two days. Food and environmental samples often remain negative with norovirus, highlighting the importance of research collaborations. Electronic questionnaire and open-source novel statistical programmes provided time and resource savings. The public health approach proved useful within the environmental health area with shoe leather field epidemiology, combined with statistical analysis and mathematical reasoning.

Rating Opportunity for Long-Acting Injectable Antipsychotic Initiation Index (ROLIN)

Background: Schizophrenia is a severe psychiatric condition with devastating consequences for the individual's functionality and leading to severe disability. Lack of insight and non-adherence to treatment remain the most important factors in the progression of the disease to chronicity. Despite their proven effectiveness in preventing relapses, reducing morbidity and mortality, long-acting injectable antipsychotics (LAIs) are still underused. One of the causes invoked is the lack of guidelines or protocols for initiating LAIs.Objective: The aim of this article is to present Rating Opportunity for Long-Acting Injectable Antipsychotic Initiation Index (ROLIN), a clinician-rated index that rates the important factors of the disorder across seven items: age, duration of illness, relapses, antipsychotic treatment response, family support, antipsychotic existing formulation and adherence.Method: A retrospective study in which all patients with schizophrenia discharged on oral antipsychotics without LAIs treatment lifetime were evaluated with ROLIN for opportunity for LAIs initiation.Results: Of 225 consecutive patients, 126 patients (56%) had a strong indication for initiating LAI (score between 25 and 35). Kolmogorov-Smirnov test was used for checking the normal distribution of values (95% CI for the mean = 9.5781 to 20.4219; 95% CI for the median = 6.5920 to 24.8161; SD = 9.7907; Coefficient of Skewness = 0.0743; Coefficient of Kurtosis = −1.1377).Conclusion: This paper proposed an instrument designed to improve treatment in schizophrenia using a simple conceptual model which integrates important predictors of good or poor outcomes.