30 research outputs found
Improving statistical inference on pathogen densities estimated by quantitative molecular methods: malaria gametocytaemia as a case study
BACKGROUND: Quantitative molecular methods (QMMs) such as quantitative real-time polymerase chain reaction (q-PCR), reverse-transcriptase PCR (qRT-PCR) and quantitative nucleic acid sequence-based amplification (QT-NASBA) are increasingly used to estimate pathogen density in a variety of clinical and epidemiological contexts. These methods are often classified as semi-quantitative, yet estimates of reliability or sensitivity are seldom reported. Here, a statistical framework is developed for assessing the reliability (uncertainty) of pathogen densities estimated using QMMs and the associated diagnostic sensitivity. The method is illustrated with quantification of Plasmodium falciparum gametocytaemia by QT-NASBA. RESULTS: The reliability of pathogen (e.g. gametocyte) densities, and the accompanying diagnostic sensitivity, estimated by two contrasting statistical calibration techniques, are compared; a traditional method and a mixed model Bayesian approach. The latter accounts for statistical dependence of QMM assays run under identical laboratory protocols and permits structural modelling of experimental measurements, allowing precision to vary with pathogen density. Traditional calibration cannot account for inter-assay variability arising from imperfect QMMs and generates estimates of pathogen density that have poor reliability, are variable among assays and inaccurately reflect diagnostic sensitivity. The Bayesian mixed model approach assimilates information from replica QMM assays, improving reliability and inter-assay homogeneity, providing an accurate appraisal of quantitative and diagnostic performance. CONCLUSIONS: Bayesian mixed model statistical calibration supersedes traditional techniques in the context of QMM-derived estimates of pathogen density, offering the potential to improve substantially the depth and quality of clinical and epidemiological inference for a wide variety of pathogens
Metabolomic profiling of Burkholderia pseudomallei using UHPLC-ESI-Q-TOF-MS reveals specific biomarkers including 4-methyl-5-thiazoleethanol and unique thiamine degradation pathway
Effect of Preoperative Continuous Femoral Nerve Block in Ease of Administration of Spinal Anaesthesia for Fracture Neck of Femur Stabilisation: A Case-control Study
Introduction: Subarachnoid block remains the anaesthesia
modality of choice for surgical fixation of femur. Extreme fracture
pain makes ideal positioning for spinal anaesthesia difficult.
Preoperative continuous femoral block can provide analgesia for
such patients.
Aim: To evaluate the effect of continuous femoral nerve block in
ease of administration of spinal anaesthesia for fracture neck of
femur stabilisation.
Materials and Methods: This was a prospective case-control
study conducted at the Government Medical College, Kozhikode,
Kerala, India, from September 2020 to September 2021. Total of
86 adult patients posted for fracture femur neck stabilisation were
selected and divided into two groups- group 1 and group 2. Patients
in group 1, were administered ultrasound guided continuous
femoral nerve block with 0.2% ropivacaine (15 mL) followed by
subarachnoid block and group 2 patients were administered
subarachnoid block without prior femoral nerve block. Parameters
observed included were Visual Analogue Score (VAS) score while
positioning for spinal anaesthesia, ease of palpating interspinous
space, time required to perform spinal anaesthesia, number of
attempts required to achieve dural puncture, patient satisfaction score as well as haemodynamic and respiratory changes while
positioning for subarachnoid block. Statistical analysis was done
using IBM SPSS (Statistical Package for the Social Sciences)
Statistics for Windows, version 20.0.
Results: Group 1 patients had significantly lower VAS scores
while positioning for spinal anaesthesia (4.2±1.8 in group 1 as
compared to 6.3±1.2 in group 2, p-value=0.001). There was a
significant difference in the number of attempts required for dural
puncture (1.3±0.4 in group 1 as compared to 1.8±0.6 in group 2,
p-value=0.04) and total performance time for spinal anaesthesia
(2.2±0.4 min in group 1 as compared to 3.3±0.9 minutes in
group 2, p-value=0.02) between two groups. Patient satisfaction
scores were significantly higher in group 1 compared to group
2 (9.3±0.6 in group 1 as compared to 6.5±0.5, p-value <0.001).
Both groups were comparable in terms of ease of palpating inter
spinous space, haemodynamic and respiratory changes during
positioning for subarachnoid block.
Conclusion: Preoperative administration of continuous
femoral nerve block provides better conditions for performing
subarachnoid block in fracture neck of femur surgeries by
reducing the pain while positioning