A real-world exploration into clinical outcomes of direct oral anticoagulant therapy in people with chronic kidney disease: a large hospital-based study

Background There is limited evidence to support definite clinical outcomes of direct oral anticoagulant (DOAC) therapy in chronic kidney disease (CKD). By identifying the important variables associated with clinical outcomes following DOAC administration in patients in different stages of CKD, this study aims to assess this evidence gap. Methods An anonymised dataset comprising 97,413 patients receiving DOAC therapy in a tertiary health setting was systematically extracted from the multidimensional electronic health records and prepared for analysis. Machine learning classifiers were applied to the prepared dataset to select the important features which informed covariate selection in multivariate logistic regression analysis. Results For both CKD and non-CKD DOAC users, features such as length of stay, treatment days, and age were ranked highest for relevance to adverse outcomes like death and stroke. Patients with Stage 3a CKD had significantly higher odds of ischaemic stroke (OR 2.45, 95% Cl: 2.10–2.86; p = 0.001) and lower odds of all-cause mortality (OR 0.87, 95% Cl: 0.79–0.95; p = 0.001) on apixaban therapy. In patients with CKD (Stage 5) receiving apixaban, the odds of death were significantly lowered (OR 0.28, 95% Cl: 0.14–0.58; p = 0.001), while the effect on ischaemic stroke was insignificant. Conclusions A positive effect of DOAC therapy was observed in advanced CKD. Key factors influencing clinical outcomes following DOAC administration in patients in different stages of CKD were identified. These are crucial for designing more advanced studies to explore safer and more effective DOAC therapy for the population

Association of radiological type of dural tail sign in contrast MRI with histopathological grading of intracranial meningiomas

Background: In neurosurgical practice meningiomas are one of the commonest intracranial tumors to seek surgical intervention which is classified into 3 histological grades and 15 subtypes according to the 2016 WHO classification of tumors of the CNS. The aim of this study was to evaluate the association between radiological type of dural tail sign in contrast MRI with histopathological grading of intracranial meningiomas. Methods: This was a cross sectional interventional study carried out in the Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Dhaka Medical College Hospital and National Institute of Neuroscience Hospital including 35 patients of intracranial meningiomas who fulfilled the selection criteria were enrolled in this study. Results: This study included 35 cases of intracranial meningiomas. There were 22 individuals (62.9%) in the 28-47 age group. The mean±standard deviation (SD) age of the participants was 45.97±9.56 years. There were 9 male participants (25.7%) and 26 female participants (74.3%) with ratio 1:3. We see that parasagittal location (50%) and sphenoid wing (33.3%) were more prevalent in grade II. We found significant distribution of the types of DTS among the histological grades of meningioma. The nodular cases (6,100%) were all grade II type. Mixed type was the most prevalent type among grade I. Conclusions: There is association of radiological type of dural tail sign in contrast MRI with histopathological grading of intracranial meningiomas and may be used as a good tools for forecasting tumor type and prognosis

Thalassemias in South Asia:clinical lessons learnt from Bangladesh

Abstract Thalassemias are emerging as a global public health concern. Due to remarkable success in the reduction of childhood mortality by controlling infectious diseases in developing countries, thalassemias are likely to be a major public health concern in the coming decades in South Asia. Despite the fact that Bangladesh lies in the world’s thalassemia belt, the information on different aspects (epidemiology, clinical course, mortality, complications and treatment outcomes) of thalassemias is lacking. In this comprehensive review, the aim is to to depict the epidemiological aspects of thalassemias, mutation profile and current treatment and management practices in the country by sharing the experience of dealing with 1178 cases over 2009–2014 time periods in a specialized thalassemia treatment centre. We have also discussed the preventative strategies of thalassemias from the context of Bangladesh which could be effective for other developing countries

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Investigating Explorative Character of Ozone Layer Depletion Between Pakistan and China: A Comparative Regional Study

In this communication we have assessed explorative nature of ozone layer dynamics using data of ozone depth from 1984-to 2010 at the stratospheric region of China and Pakistan. This study comprises the parametric evaluation that characterizes the physical behaviour of stratospheres of both the regions. For this purpose we have adopted exploratory data analysis (EDA). The results indicated an obvious distinction in the fluctuating dynamics of China and Pakistan. The models discussed in this communication can be used for public, private and government organizations and compared with other countries stratospheric ozone layer dynamics

Investigating Explorative Character of Ozone Layer Depletion Between Pakistan and China: A Comparative Regional Study

In this communication we have assessed explorative nature of ozone layer dynamics using data of ozone depth from 1984-to 2010 at the stratospheric region of China and Pakistan. This study comprises the parametric evaluation that characterizes the physical behaviour of stratospheres of both the regions. For this purpose we have adopted exploratory data analysis (EDA). The results indicated an obvious distinction in the fluctuating dynamics of China and Pakistan. The models discussed in this communication can be used for public, private and government organizations and compared with other countries stratospheric ozone layer dynamics

Efficacy of Non-Linear Approach in the Study of Ozone Layer Depletion

The stratosphere is one of the constituents of thermal structure of the atmosphere. The maximum concentration of ozone is found at the stratospheric region where it is interacted by many species including chemical and physical processes. Atmosphere as a whole is an open system that is regarded as a non linear system and that seems to be complex. Therefore, a non-linear trend is plausible to explain phenomenon of ozone layer depletion (OLD). In this manuscript we have paid our attention in the analysis of the major portion of historic data on stratospheric O3based on ground-based measurements by the Dobson Spectrophotometer. In this communication we have estimated parameters for describing non-linearity in the process using polynomial trend functions and predicted values are calculated for the period from 1960 to 1999. Future values for ozone depths are computed till 2006 and compared with the minor portion of the data set

Efficacy of Non-Linear Approach in the Study of Ozone Layer Depletion

The stratosphere is one of the constituents of thermal structure of the atmosphere. The maximum concentration of ozone is found at the stratospheric region where it is interacted by many species including chemical and physical processes. Atmosphere as a whole is an open system that is regarded as a non linear system and that seems to be complex. Therefore, a non-linear trend is plausible to explain phenomenon of ozone layer depletion (OLD). In this manuscript we have paid our attention in the analysis of the major portion of historic data on stratospheric O3based on ground-based measurements by the Dobson Spectrophotometer. In this communication we have estimated parameters for describing non-linearity in the process using polynomial trend functions and predicted values are calculated for the period from 1960 to 1999. Future values for ozone depths are computed till 2006 and compared with the minor portion of the data set