Clinical and Epidemiological Changes in French Soldiers After Deployment: Impact of Doxycycline Malaria Prophylaxis on Body Weight

ABSTRACT Background Antibiotics are growth promotors used in animal farming. Doxycycline (DOXY) is a tetracycline antibiotic taken daily and continued 1 month after return to protect against malaria during travel and deployment in endemic areas. We evaluated DOXY impact on body weight in military international travelers. Materiel and Methods A prospective cohort analysis was conducted in 2016-2018, recruiting 170 French soldiers before a 4-month assignment overseas. Many clinical data including anthropometric measures by an investigator were collected before and after deployment. Weight gain was defined by an increase of 2% from baseline. The study protocol was supported by the French Armed Forces Health Services and approved by the French ethics committee (IRB no. 2015–A01961–48, ref promoter 2015RC0). Written, informed consent was obtained with signature from each volunteer before inclusion. Results After deployment, 84 soldiers were followed up. Overall, 38/84 (45%) were deployed to Mali with DOXY malaria prophylaxis, and others were deployed to Iraq or Lebanon without malaria prophylaxis according to international recommendations. Body weight increased in 24/84 (30%), of whom 14/24 (58%) were exposed to DOXY. In bivariate analysis, DOXY had a positive but not significant effect on weight gain (P-value = .4). In the final logistic regression model (Fig. 3), weight gain after deployment positively correlated with an increase in waist circumference (odds ratio [OR] 1.23 with 95% CI [1.06-1.47]) suggesting fat gain; with sedentary work (OR 5.34; 95% CI [1.07-31.90]); and with probiotic intake (OR 5.27; 95% CI [1.51-20.40]). Weight impact of probiotics was more important when associated with DOXY intake (OR 6.86; 95% CI [1.52-38.1]; P-value = .016). Conclusions Doxycycline (DOXY) malaria prophylaxis during several months did not cause significant weight gain in soldiers. Further studies are required in older and less sportive traveling populations, and to investigate a cumulative effect over time and recurrent DOXY exposure. Doxycycline (DOXY) may enhance other growth-promoting factors including fatty food, sedentariness, and strain-specific probiotics contained in fermented dairy products which are also used as growth promotors.

Glycemic control in type 2 diabetic patients during the COVID-19 virus pandemic

Background: The Coronavirus disease 2019 (COVID-19) disease is a pandemic disease spread worldwide and results in lifestyle changes in areas affected by COVID-19. The ongoing social distancing and lockdowns may negatively impact access to medical care and management of type 2 diabetes mellitus (T2DM). Accordingly, we examined the impact of the COVID-19 virus pandemic in Thailand on the glycemic control of patients with T2DM. Method: This study focused on T2DM outpatients at Rajavithi Hospital. Three hundred and fifty participants were included. Baseline characteristics, data on exercise, outdoor activities, and access to foods and blood chemistries, including hemoglobin A1C (A1C) and fasting plasma glucose (FPG), were reviewed, and collected from electronic medical records before and after the COVID-19 pandemic. Results: There was a significant increase in mean A1C (g/L) ± SD (74.8 ± 13.7 vs. 76.0 ± 15.3, p-value <0.016), the mean duration of outdoor activities (hours/day) ± SD during the COVID-19 virus pandemic was significantly decreased. (5.35 ± 4.48 vs. 4.03 ± 4.37, p-value <0.001) Conclusion: The present study showed that mean A1C was significantly increased during the COVID-19 virus pandemic. Nevertheless, a statistical difference was not observed in FPG. The impact of quarantine, social distancing, and community containment during the epidemic on lifestyles may be the essential factor in increasing A1C.

Does Neutrophil to Lymphocyte Ratio Have a Role in Identifying Cytokeratin 19-Expressing Hepatocellular Carcinoma?

Background: Cytokeratin 19-positive (CK19(+)) hepatocellular carcinomas (HCC) are generally associated with poor prognosis after hepatectomy. It is typically detected from postoperative immunochemistry. We have analyzed several clinically available biomarkers, in particular, neutrophil to lymphocyte ratio (NLR) and aim to develop a panel of biomarkers in identifying CK19 expression in (HCC) preoperatively. Methods: We retrospectively reviewed 36 HCC patients who underwent liver resections during January 2017 to March 2018 in Chang Gung Memorial Hospital. Patients were grouped based on the status of CK19 expression and their baseline characteristics, perioperative and oncologic outcomes were compared. Novel biomarkers including NLR, alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA) and uric acid were analyzed and correlated with CK19 expression. Results: NLR is highly associated with CK19 expression. NLR alone gave an AUROC of 0.728 (p-value = 0.043), higher than AFP, CEA or tumor size alone. NLR when combined with AFP, CEA and uric acid, gave an AUROC as high as 0.933 (p-value = 0.004). Conclusion: The current study demonstrated the predictive capability of NLR in combination with AFP, CEA and uric acid for CK19 expression in HCC patients preoperatively. Further prospective, large-scale studies are warranted to validate our findings.

Estimation of Sexual Dimorphism of the Mandible in Coastal Karnataka and Kerala Populations using Cone Beam Computed Tomography

Objective The mandible has been used for sex determination and forensic identification due to its unique anatomy and morphology. Every part of the mandible is unique, including the shape and size of the temperomandibular joint, the ramus, the body and the symphysis region, and the inferior alveolar canal. In addition, the position and placement of the teeth within their sockets are unique for every individual. Sample Population A study was conducted on 20 males and females to estimate sexual dimorphism using anthropometric measurements obtained by cone beam computed tomography images of the mandible of Karnataka and Kerala populations. Materials and Methods The mean, standard deviation, and standard error along with the confidence interval of different measurements were documented. Various measurements between the sexes were compared using Student's t-test. Association between categorical variables was analyzed using the Chi-square test. A p-value < 0.05 was considered to be statistically significant. Data were analyzed using statistical SPSS software. Results The p-value of mRBr L, GA L, and GA R among females was significantly higher in the Karnataka population when compared with that in the Kerala population. The Karnataka State population showed significantly higher values of RL R, BiGBr, and BiCBr among males, and the p-value of the Kerala population for GGL L and GGL R was significant and higher among the males. Conclusion The data derived from the above study suggest that the mandibular anthropometric measurements used may be applied for forensic sex estimation.

The Feasibility and Efficiency of Remote Spirometry System on the Pulmonary Function for Multiple Ribs Fracture Patients

Background: Multiple rib fractures is a common chest trauma with a significant and sustained impact on pulmonary function and quality of life. Continuous monitoring of the pulmonary function parameter was necessary to adjust the therapeutic goals in these patients. We developed an internet-based remote system for lung function monitoring with a remote spirometry and smart device application to follow up these patients consecutively. Method: From Jan 2021 to April 2021, we conducted a prospective study that applied an intelligent spirometry system for patients with multiple rib fractures. With informed consent, we collected clinical data from them and introduced the remote spirometry system. We followed up with these patients for 12 weeks after trauma and compared the recovery of pulmonary function parameters and clinical outcomes. Result: A total of 21 patients were enrolled in our study. We divided them into two groups by the compliance to this remote spirometry system. The improvement of forced vital capacitywas better in the good compliance group than the poor compliance group (110% versus 21%, p value 0.049). Moreover, the complication rate was also lower in the good compliance group than the poor compliance group (10% versus 66.7% p value 0.017). Conclusion: Remote spirometry system is a novel system that can help in lung rehabilitation in patients with multiple rib fractures. Patients that cooperate well with this system presented superior lung function improvement and inferior complication rate.

Treatment with Non-invasive respiratory support in severe COVID-19: Clinical effectiveness observational study

Introduction: The study aimed to analyse the clinical response and short-term outcomes with the use of high-flow oxygen therapy (HFOT), non-invasive mechanical ventilation (NIMV) with bilevel positive airway pressure, or continuous positive airway pressure (CPAP) in severe COVID-19 patients. Methods: We conducted an observational, prospective, single-center study, approved by Ethics Committee of “Instituto de Investigación Sanitaria Fundación Jiménez Díaz” (EO102-20-HRJC). We included a total of 130 patients ≥18 years-old, with proved SARS-CoV-2 infection and secondary Acute Respiratory Failure (ARF) that required treatment with Non-invasive Respiratory Support (NIRS). We collected data about population demographic characteristics, clinical factors, and evolution during the incoming. A baseline of patients treated with HFO, CPAP and NIMV were compared with one-way ANOVA test, while categorical variables were expressed as numbers and percentages and were compared using the chi-square test or Fisher’s exact test when appropriate. Results: The cohort was distributed as follows: CPAP 54.6% (n = 71), NIMV 30% (n = 39), HFO 15.4% (n = 20). There were no differences between NIRS subgroups regarding age, comorbidity, or functional status. At the beginning of NIRS treatment, PaO2/FiO2 value was 149.3 ± 69.7. After 24 hours, PaO2/FiO2 was significantly higher in the CPAP group (CPAP vs NIMV, p-value = 0.0042; CPAP vs HFO, p-value = 0.000169). The overall ICU admission evaded rate was 69.1% and TF rate was 43.8%, without differences between the three therapies (p-value = 0.281). The mortality rate was 37.2%, without significant differences between subgroups. Conclusions: Our data suggest that CPAP versus treatment with NIMV or HFO improves PaO2/FiO2 rate in severe ARF patients, significantly reducing ICU admission. No differences were observed in mortality or therapeutic failure.

Use of the p-values as a size-dependent function to address practical differences when analyzing large datasets

Biomedical research has come to rely on p-values as a deterministic measure for data-driven decision-making. In the largely extended null hypothesis significance testing for identifying statistically significant differences among groups of observations, a single p-value is computed from sample data. Then, it is routinely compared with a threshold, commonly set to 0.05, to assess the evidence against the hypothesis of having non-significant differences among groups, or the null hypothesis. Because the estimated p-value tends to decrease when the sample size is increased, applying this methodology to datasets with large sample sizes results in the rejection of the null hypothesis, making it not meaningful in this specific situation. We propose a new approach to detect differences based on the dependence of the p-value on the sample size. We introduce new descriptive parameters that overcome the effect of the size in the p-value interpretation in the framework of datasets with large sample sizes, reducing the uncertainty in the decision about the existence of biological differences between the compared experiments. The methodology enables the graphical and quantitative characterization of the differences between the compared experiments guiding the researchers in the decision process. An in-depth study of the methodology is carried out on simulated and experimental data. Code availability at https://github.com/BIIG-UC3M/pMoSS.

Intravenous Fluid Bag as a Substitute for Gel Standoff Pad in Musculoskeletal Point-of-care Ultrasound

ABSTRACT Introduction Point-of-care ultrasound (POCUS) is a tool undergoing expanding use in military medicine, including routine inpatient, outpatient, and operational environments. Specific musculoskeletal POCUS examinations require additional equipment in the form of a standoff assist device to maximize image acquisition. These devices may not be readily available to POCUS users in more austere or resource-constrained environments. We devised a study to determine if intravenous fluid bags of various volumes could be substituted for standard standoff devices in musculoskeletal POCUS. Materials and Methods Sequential images of a soft tissue foreign body model, an interphalangeal joint, and a chest wall were taken using a gel standoff pad or water bath and compared to images acquired using three different sizes of intravenous fluid bags after removing excess air from the bags. Images were de-identified and scored for quality using a visual analog scale. We used a two-factor analysis of variance without replication to analyze the differences in image quality between standoff devices, with a P-value less than.05 considered statistically significant. Results We performed 13 POCUS studies and had a group of eight POCUS-trained physicians and physician assistants score these studies, resulting in 104 total quality scores. There was no significant difference in image quality between standoff devices for chest (P-value.280) and hand (P-value 0.947) images. We found a significant difference in image quality between standoff devices for the soft tissue foreign body model (P-value 0.039), favoring larger intravenous fluid bag standoff over standard devices. Conclusions In the absence of a standard commercial gel standoff device or water bath, intravenous fluid bags of 50, 100, and 250 mL can facilitate quality image acquisition for musculoskeletal POCUS.

HUBUNGAN ANTARA PENGETAHUAN DAN SIKAP PENDERITA HIPERTENSI TERHADAP KEAKTIFAN PESERTA BPJS DI UPT PUSKESMAS MERDEKA KOTA BOGOR TAHUN 2018

<p>Menurut WHO, tekanan darah yang normal bagi orang dewasa adalah 120/80 mmHg. Akan tetapi, jika tekanan darah sistolik yaitu antara 130-139 dan tekanan darah distolik antara 80-89, dan itu juga masih bisa disebut dengan tekanan darah yang normal. Program Pengelolaan Penyakit Kronis (prolanis) adalah suatu sistem pelayanan kesehatan dan pendekatan proaktif yang dilaksanakan secara terintegrasi yang melibatkan peserta, fasilitas kesehatan dan BPJS Kesehatan dalam rangka pemeliharaan kesehatan bagi peserta BPJS Kesehatan yang menderita penyakit kronis untuk mencapai kualitas hidup yang optimal dengan biaya pelayanan kesehatan yang efektif dan efisien.Penelitian ini menggunakan metode penelitian kuantitatif dan pengambilan data dilakukan dengan desain <em>Cross Sectional </em>dengan menggunakan kuesioner. Jumlah sampel dalam penelitian ini adalah 49 responden. Cara analisa data menggunakan perangkat lunak aplikasi statistik.Hasil penelitian menunjukan bahwa sebagian besar responden memiliki pengetahuan tidak baik mengenai program pengelolaan penyakit kronis (Prolanis) (61.2%), sikap yang positif mengenai program pengelolaan penyakit kronis (Prolanis) (59.2%), keluarga yang memberikan dukungan dalam keaktifan penderita sebagian besar mendukung (63.3%). Berdasarkan tingkat keaktifan penderita hipertensi sebagian besar (51.0%) termasuk kedalam kategori aktif dalam kegiatan Prolanis. Hasil analisis menunjukan bahwa Terdapat hubungan antara pengetahuan dengan keaktifan penderita hipertensi dalam kegiatan prolanis (<em>p- </em><em>value </em>= 0.035). Tidak terdapat hubungan antara umur <em>(p-value </em>= 1000), Jenis kelamin (<em>p-value </em>= 0.716), Pendidikan (<em>p-value </em>= 1000), Sikap (<em>p-value </em>= 0.863), dan Dukungan keluarga (<em>p-value </em>= 0.053) dengan keaktifan penderita hipertensi dalam kegiatan prolanis. Peneliti memberikan saran kepada Puskesmas Merdeka Kota Bogor untuk meningkatkan keaktifan masyarakat perlu direncanakan dan member tugas kepada sebagian petugas kesehatan di puskesmas untuk melakukan kunjungan home visit kerumah pasien, sehingga 4 aktivitas prolanis bisa berjalan maksimal.</p>

Accuracy of Implant Level Intraoral Scanning and Photogrammetry Impression Techniques in a Complete Arch with Angled and Parallel Implants: An In Vitro Study

(1) Background: Stereophotogrammetry has recently been investigated showing high accuracy in complete implant supported cases but has scarcely been investigated in cases of tilted implants. The aim of this in vitro study was to compare the accuracy of digital impression techniques (intraoral scanning and photogrammetry) at the level of intraoral scan bodies in terms of angular deviations and 3D discrepancies. (2) Methods: A stone master cast representing an edentulous maxilla using four implant analogs was fabricated. The two anterior implants were parallel to each other, and the two posterior implants were at an angulation of 17 degrees. Digital intraoral scanning (DIOS) impressions were taken after connecting implant level scan bodies to the master cast and STL files were exported (n = 15). Digital photogrammetry (DPG) impressions were captured using a PiC Camera after tightening implant level PiC optical markers and STL files were exported (n = 15). Superimposition was carried out by a software for determining the accuracy of both. (3) Results: Significant angular discrepancies (ΔA) and 3D deviations of scan bodies were found among the groups in trueness with lower deviations for the DPG (p value < 0.001). However, trueness within ISBs varied between angular and 3D deviations and outcomes were not specific to determine the effect of implant angulation. In precision, no significant differences were detected within ISBs and among both groups in terms of angular deviation. However, DPG had less deviations than DIOS group in terms of 3D deviations (p value < 0.001). (4) Conclusion: Digital photogrammetry technique conveyed the utmost accuracy in both trueness and precision for the intraoral scan bodies among both impression methods assessed. In addition, implant angulation did not influence the precision of the impression techniques but affected their trueness without explicit conclusions.