bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of health-related habits and metabolic syndrome risk factors according to obesity type in Korean postmenopausal women
Authors: Choi Han-Gyo , Kim Hye-Jin
Published: June 2020

Objective:

This study aimed to investigate the differences in health-related habits, metabolic syndrome risk factors, and related diseases prevalence according to obesity type in postmenopausal women.

Methods:

This cross-sectional study used a data set of 1,443 postmenopausal women who were 40 years or older (range = 45-80, mean = 64.10) from the 2016 Korean National Health and Nutrition Examination Survey VII-1. The participants were classified into normal group (body mass index [BMI] <25 kg/m2, waist circumference (WC) <85 cm), BMI obesity group (BMI ≥25 kg/m2, WC <85 cm), abdominal obesity group (BMI <25 kg/m2, WC ≥85 cm), and BMI and abdominal obesity group (BMI ≥25 kg/m2, WC ≥85 cm). To compare health-related habits and metabolic syndrome risk factors according to obesity type, a chi-square test and t test were performed. The relationship between obesity and metabolic syndrome was assessed using a logistic regression analysis of adjusted demographic and women's health covariates.

Results:

The abdominal obesity group had a significantly longer sedentary time per day (524.31 min), a higher activity restriction rate (25.0%), and a lower nutrition labeling recognition rate (3.6%) than the other groups (P < 0.001). The occurrence of metabolic syndrome was the highest in the BMI and abdominal obesity group (66.1%), followed by the abdominal obesity group (59.3%). Compared with the normal group, the prevalence of metabolic syndrome was significantly higher in the BMI obesity group (adjusted odds ratio [OR] = 2.23, 95% CI = 1.15-4.31), abdominal obesity group (adjusted OR = 7.33, 95% CI = 4.38-12.25), and the BMI and abdominal obesity group (adjusted OR = 12.44, 95% CI = 8.78-17.62).

Conclusions:

In postmenopausal women, the abdominal obesity group was associated with a high prevalence of metabolic syndrome and related diseases. Therefore, to reduce abdominal obesity in postmenopausal women, it is necessary to correct long sedentary time, high activity restriction rate, and low nutritional labeling recognition rate identified as health-related habits of the abdominal obesity group.
Mediatory role of abdominal obesity in the association of early menopause with diabetes among middle-aged and older Chinese women
Authors: Li Yanzhi , Zheng Han , Tian Lu , Jia Chongqi
Published: June 2020

Objective:

The aim of this study was to assess the association of early menopause with diabetes and the mediating effect of abdominal obesity.

Methods:

This cross-sectional study was conducted among 5,693 participants. The data from the second follow-up (2015) of the China Health and Retirement Longitudinal Study were used. Participants self-reported their age at menopause and were divided into three age groups (<45, 45-54, and >54 years) according to the 10th, 10th to 90th, and 90th percentiles, with a menopausal age of 45 to 54 years serving as reference. The total effect was decomposed into direct and indirect (mediating) effects using logistic regression based on the Karlson-Holm-Breen method.

Results:

Compared to the menopausal age of 45 to 54 years, early menopause (<45 years) was associated with diabetes (odds ratio  = 2.19, 95% CI: 1.29-3.69) among Chinese women. The mediating effect of early menopause (<45 years) on diabetes was 4.98% (P = 0.321) for abdominal obesity.

Conclusions:

Early menopause may be associated with diabetes among Chinese women. Moreover, the mediating effect of abdominal obesity makes up a small percentage and has no statistical significance. Further studies are needed to examine other mechanisms behind the association of early menopause with diabetes.
Refractive approaches to visual rehabilitation in patients with keratoconus
Authors: Kim Kyeong Hwan , Mian Shahzad I.
Published: June 2020

Purpose of review

As keratoconus is a chronic disease affecting young people, vision-related quality of life is often significantly impaired in patients with this disease. However, successful management of keratoconus, including visual rehabilitation strategies, can improve quality of life in these patients. This review will describe clinical approaches that improve vision-related quality of life in patients with stable keratoconus.

Recent findings

Several types of contact lenses including scleral lenses have been used successfully to manage keratoconus. Eyes with severe keratoconus, even those in which fitting with other types of lenses is challenging, can be successfully fitted with scleral lenses. Although laser ablative procedures, such as photorefractive keratectomy (PRK) have been traditionally contraindicated in patients diagnosed with or suspected of having keratoconus, PRK has been attempted to partially correct refractive errors in keratoconus. Although phototherapeutic keratectomy and radial keratotomy have been reported to be used in eyes with keratoconus, effectiveness and safety results have varied. Implantation of phakic intraocular lenses and intraocular lenses, including toric intraocular lenses, which primarily correct regular astigmatism, with cataract extraction or refractive lens exchange can improve vision-related quality of life in patients with keratoconus by significantly reducing cylinder while improving uncorrected visual acuity.

Appropriate selection and application of treatment options based on consideration of multiple factors will help patients with keratoconus, improving their vision-related quality of life and delaying or avoiding keratoplasty.
Persistent Hypotony and Annular Ciliochoroidal Detachment After Microhook Ab Interno Trabeculotomy
Authors: Ishida Akiko , Mochiji Mihoko , Manabe Kaoru , Matsuoka Yotaro , Tanito Masaki
Published: June 2020

Précis:

Creation of a cyclodialysis cleft can be a mechanism of ciliochoroidal detachment (CCD) and associated persistent hypotony after microhook ab interno trabeculotomy (μLOT).

Aims:

To report persistent hypotony after μLOT, a minimally invasive glaucoma surgery (MIGS).

Subjects and Methods:

This observational case series included 4 consecutive cases (3 men, 1 woman; mean age, 48.8±15.1 y) of persistent hypotony that developed after μLOT between May 2015 and March 2018. The patients’ data and surgical results were obtained from the medical charts.

Results:

All patients had open-angle glaucoma (2 juvenile, 1 primary, and 1 pigmentary) and were myopic (axial lengths, >24 mm). Two patients had undergone previous refractive surgery. μLOT alone was performed in 2 cases and combined with cataract surgery in 2 cases. In all cases, hypotony below 5 mm Hg was recorded 1 day postoperatively and sustained. In all cases, ultrasound biomicroscopy showed an annular CCD; communication between the anterior chamber and suprachoroidal space was detected in 3 of 4 cases. The hypotony resolved in 3 of the 4 cases from 2 to 8 months postoperatively, that is, spontaneously in 2 cases (cases 1 and 4) and after sulfur hexafluoride gas injection into the anterior chamber in 1 case (case 2). CCD resolution accompanied remarkedly high intraocular pressure, which required filtration surgeries. The incidence of persistent hypotony was 0.7% (4/547 eyes).

Conclusions:

After MIGS, persistent hypotony because of CCD rarely occurs. Increased uveoscleral outflow because of LOT or creation of a cyclodialysis cleft by traction of the pectinate ligament can be a mechanism of CCD development. Young age and myopia can be risks for cyclodialysis cleft formation and hypotony maculopathy after MIGS.
Atypical Presentation of the Novel Coronavirus Disease 2019 and Lessons Learned
Authors: Mithani Farhan , Adrogue Alexander , Liu Jonathan , Adrogue Horacio E.
Published: June 2020

Coronavirus disease 2019 (COVID-19) is a viral infection caused by severe acute respiratory syndrome coronavirus 2 and transmitted mainly via respiratory droplets. It is associated with several risk factors for nosocomial spread, including low sensitivity of reverse transcription-polymerase chain reaction (PT-PCR) testing and a nonspecific clinical presentation, mimicking other respiratory pathogens. Early isolation precautions and accurate testing are therefore crucial in preventing the spread of nosocomial infection. This case of an elderly, 80-year-old man, discusses one of the first reported cases of COVID-19 in Texas and addresses the topics of nosocomial spread due to inaccurate RT-PCR testing, underused isolation precautions, and atypical presentation in extremes of age. Recommendations include (1) early isolation precautions for any hospitalized patient who begins exhibiting respiratory symptoms with continued isolation precautions throughout the hospital course and (2) thorough clinical investigation of symptomatic patients with negative RT-PCR results using computed tomography chest imaging and basic laboratory findings. Early isolation precautions and accurate diagnosis of disease are crucial to prevent and contain the spread of COVID-19.
What's new in endobronchial ultrasound for mediastinal staging?
Authors: Marcoux Mathieu , Ost David E.
Published: June 2020

Purpose of review

The essential role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in lung cancer diagnosis and staging is now well established. With a growing body of evidence seen over the last decade, the objective of this article was to review the newest findings, provide evidence-based guidance to clinicians and identify areas for future research related to EBUS-TBNA and staging in lung cancer.

Recent findings

Recent literature regarding EBUS-TBNA for lung cancer staging was reviewed, with a focus on evidence published subsequent to the 2016 guideline on technical aspects of EBUS-TBNA by the American College of Chest Physicians (ACCP). New findings were reported for the following: role of rapid on-site cytological evaluation (ROSE), needle size, lymph node ultrasound characteristics, molecular testing, as well as practice patterns and gaps in quality of care.

Significant advances in EBUS-TBNA have been realized since the publication of the 2016 ACCP guideline. Future areas of investigation have been identified and will require collaboration between centers of expertise. Additional work will be required to translate these technological advances into improved value-based care in the lung cancer population.
The management of the hospitalized ulcerative colitis patient: the medical-surgical conundrum
Authors: Levy L. Campbell , Coburn Elliot S. , Choi Sarah , Holubar Stefan D.
Published: June 2020

Purpose of review

In this review article, we address emerging evidence for the medical and surgical treatment of the hospitalized patient with ulcerative colitis.

Recent findings

Ulcerative colitis is a chronic inflammatory disease involving the colon and rectum. About one-fifth of patients will be hospitalized from ulcerative colitis, and about 20–30%, experiencing an acute flare will undergo colectomy. Because of the significant clinical consequences, patients hospitalized need prompt evaluation for potential complications, stratification of disease severity, and a multidisciplinary team approach to therapy, which involves both the gastroenterologist and surgeon. Although corticosteroids remain first-line therapy, second-line medical rescue options, primarily infliximab or cyclosporine, are considered within 3–5 days of presentation. In conjunction, an early surgical consultation to present the possibility of a staged proctocolectomy as one of the therapeutic options is equally important.

A coordinated multidisciplinary, individualized approach to treatment, involving the patient preferences throughout the process, is optimal in providing patient-centered effective care.
Management of regurgitation in patients with gastroesophageal reflux disease
Authors: Bell Reginald C.W.
Published: June 2020

Purpose of review

Precision treatment of medically-refractory regurgitation differs from that of heartburn. Regurgitation is an often-overlooked symptom characterized as a bitter taste in the mouth or a sense of fluid moving up from the stomach occurring in approximately 80% of gastroesophageal reflux disease (GERD) patients with varying severity. Its response to standard medical therapy is significantly less than heartburn while significantly lessening quality of life in 10–20% of GERD patients.

Recent findings

The therapeutic gain of proton pump inhibitors (PPIs) above placebo averages 17% for regurgitation compared with 41% for heartburn. Increased dosing of medication is commonly, yet futilely, used. The symptom is probably mediated more by fluid volume than by the acidity of the refluxate. PPIs significantly decrease gastric acid secretion and to some extent volume of gastric juice. Significantly, doubling the PPI dose does not incrementally decrease gastric juice volume though it may decrease gastric acid secretion further. Studies on refractory regurgitation using some of the newer antireflux procedures (magnetic sphincter augmentation and transoral fundoplication) demonstrated success in over 85% of patients whereas increased PPI dosing helped in approximately 15%.

Precision care of regurgitation should recognize the low-therapeutic impact of acid control, while antireflux procedures are very successful.
Epigenetics of paraoxonases
Authors: Mahrooz Abdolkarim , Mackness Mike
Published: June 2020

Purpose of review

Studies have shown the three-member paraoxonase (PON) multigene family to be involved in the development of a large variety of diseases with an inflammatory component. Environmental factors such as lifestyle-related factors differ widely between populations and it is important to consider that their impacts may be exerted through the epigenetic mechanisms, which connect genes, the environment and disease development and are a potential therapeutic avenue.

Recent findings

In the review period, very little was published on epigenetics of PON2 or PON3, mostly on their diagnostic value in cancer by measuring methylation levels of these genes. However, the picture is more promising with PON1. Here, several studies have linked the epigenetic regulation of PON1 to various metabolic processes and particularly to the development of several diseases, including stroke, heart disease, aortic valve stenosis and chronic obstructive pulmonary disease.

Studies into the epigenetic regulation of the PON family are in their infancy. However, recent studies linking epigenetic regulation of PON1 to disease development will encourage further research and open up the possibility for new potential therapeutic interventions.
Transfusion-related Iron Overload in Children With Leukemia
Authors: Cacciotti Chantel , Athale Uma
Published: June 2020

Background:

Children with leukemia commonly receive red blood cell (RBC) transfusions and transfusion-related iron overload (TRIO) is a major complication. However, few studies have evaluated TRIO in children with leukemia and no guidelines for screening exist. This retrospective, observational cohort study in children with acute leukemia evaluates the prevalence of TRIO and its impact on end-organ function.

Results:

The study included 139 patients; 60% standard-risk acute lymphoblastic leukemia (ALL), 32% high-risk (HR) ALL, and 9% acute myeloid leukemia (AML). The mean age at diagnosis was 6 years (range: 5 mo to 18 y). Patients with HR-ALL and AML were more likely to be transfused with ≥10 RBC units (59% and 92%, respectively) compared with those with standard-risk ALL (18%) (P<0.0001). Ferritin levels were measured in 68% patients and elevated (>1000 mcg/L) in 23%. Endocrinopathies were the most common end-organ abnormality. Hepatic dysfunction was significantly higher in patients with ≥10 RBC units transfused compared with those with <10 units (P=0.008).

Conclusions:

Although the RBC transfusion burden is highest in patients with AML and HR-ALL, TRIO screening was not commonly performed. Patients who receive ≥10 RBC units are at risk for hepatic and endocrine dysfunction. We recommend routine screening for TRIO in children with leukemia, who are at risk for a higher transfusion burden.
Management of Anticoagulation in Pregnant Women With Mechanical Heart Valves
Authors: Daughety Molly M. , Zilberman-Rudenko Jevgenia , Shatzel Joseph J. , McCarty Owen J. T. , Raghunathan Vikram , DeLoughery Thomas G.
Published: June 2020

Importance

Mechanical heart valves (MHVs) pose significant thrombogenic risks to pregnant women and their fetuses, yet the choice of anticoagulation in this clinical setting remains unclear. Various therapeutic strategies carry distinct risk profiles that must be considered when making the decision about optimal anticoagulation.

Objective

We sought to review existing data and offer recommendations for the anticoagulation of pregnant women with MHVs, as well as management of anticoagulation in the peripartum period.

Evidence Acquisition

We performed a literature review of studies examining outcomes in pregnant women receiving systemic anticoagulation for mechanical valves, and also reviewed data on the safety profiles of various anticoagulant strategies in the setting of pregnancy.

Results

Warfarin has been shown to increase rates of embryopathy and fetal demise, although it has traditionally been the favored anticoagulant in this setting. Low-molecular-weight heparin, when dosed appropriately with close therapeutic monitoring, has been shown to be safe for both mother and fetus.

Conclusions and Relevance

We favor the use of low-molecular-weight heparin with appropriate dosing and monitoring for the anticoagulation of pregnant women with MHVs. Data suggest that this approach minimizes the thrombotic risk associated with the valve while also providing safe and effective anticoagulation that can be easily managed in the peripartum period.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After completing this activity, the learner should be better able to: describe the clinical considerations in choosing an anticoagulation strategy for a pregnant patient with an MHV; evaluate the existing data about the safety profile of various anticoagulation strategies and the potential benefits and risks of each approach to the mother and fetus; and discuss one recommended approach to management of mechanical valves in the pregnant patient and assess the clinical nuances associated with each individual patient's decision.
Learning to See Racism: Perspective Transformation Among Stakeholders in a Regional Health and Equity Initiative
Authors: Walsh Colleen C. , Willen Sarah S. , Williamson Abigail Fisher
Published: June 2020

Context:

Achieving a meaningful reduction in health inequities will require not only policy and programmatic changes but also an increased understanding of structural racism and its deleterious impact on health and well-being. One way to enhance understanding is to actively promote “perspective transformation” (PT) around race among health equity stakeholders. Experiences of PT are defined as moments or events that bring about a deepened understanding of racism and that may result in new ways of thinking and acting.

Objective:

To identify catalysts and effects of PT among health equity stakeholders.

Design:

Semistructured, in-person interviews were conducted with stakeholders (n = 50) as part of a 2-phase, mixed-methods study (n = 170). Interviews were audio-recorded, transcribed, and coded using a mixed-methods software platform.

Setting:

Health Improvement Partnership-Cuyahoga (HIP-Cuyahoga), a regional health and equity initiative in Greater Cleveland, Ohio.

Participants:

A purposive sample of participants in HIP-Cuyahoga spanning 5 groups: metro-wide decision makers, public health professionals, clinicians, community leaders, and community members.

Results:

More than two-thirds of interviewees reported at least one discrete experience that catalyzed PT, as defined earlier. Three catalysts were especially common: witnessing, learning, and personally experiencing racism. A fourth, less common catalyst involved getting uncomfortable during discussions of race and racism. Experiences of PT resulted in common effects including acquiring new terms, concepts, and frameworks; carrying the conversation forward; finding fellow travelers; and feeling energized and motivated to confront structural racism and its consequences. People of color tended to experience PT, and its catalysts and effects, differently than White interviewees.

Conclusions:

Many health equity stakeholders have experienced PT around racism and its impact. Experiencing PT is associated with new skills, capacities, and motivations to confront racism and its impact on health and well-being. Understanding how different groups experience PT can help advance efforts to promote health equity.
Associations Between State Public Health Agency Structure and Pace and Extent of Implementation of Social Distancing Control Measures
Authors: Strickland Colten J. , Karaye Ibraheem M. , Horney Jennifer A.
Published: June 2020

Objective:

To assess associations between state public health agency governance and timing and extent of implementation of social distancing control measures during COVID-19 response.

Design:

State public health agencies were stratified by governance, and data on timing and extent of social distancing were collected from the Institute for Health Metrics and Evaluation. Multinomial logistic regression and time-to-event analyses were conducted to quantify impacts of governance structure on timing and extent of social distancing.

Setting:

State health departments in the United States.

Results:

States operating under centralized public health governance structures enacted social distancing 4 days after decentralized states and had a 73% reduced likelihood of enacting a social distancing policy (hazard ratio = 0.27; 95% CI, 0.08 to 0.86).

Conclusion:

State health department governance structure may have implications on timing and extent of social distancing control measures implemented during a public health emergency.
The Mental Health Crisis in America: Recognizing Problems; Working Toward Solutions: Part 3. Access to Care
Authors: PLAKUN ERIC M.
Published: June 2020

This column is the third in a series summarizing the 2-day Centennial Conference of the Austen Riggs Center. The conference framed problems in access to care and in the nature of care provided that are part of a mental health crisis in America and then worked to propose solutions. This column addresses problems with access to care and summarizes the conference’s closing keynote by Peter Fonagy, PhD, OBE, addressing issues both of access to care and of the nature of care provided. These issues play roles in ultimately “bending the curve” to improve outcomes for those struggling with mental and substance use disorders.
Postpartum Mental Health Care for Mothers of Multiples: A Qualitative Study of New Mothers’ Treatment Preferences
Authors: WENZE SUSAN J. , MIERS QUINN A. , BATTLE CYNTHIA L.
Published: June 2020

Objectives:

Despite the expanding literature on empirically supported strategies for treating perinatal mental health concerns in new mothers, no published reports have examined tailored support interventions for parents of twins or higher-order multiples. The goal of this study was to improve our understanding of the unique postpartum experiences of new mothers of multiples, gauge interest in both traditional and e-health approaches to mental health care, and discuss aspects of mental health treatment viewed to be most helpful.

Methods:

Twenty-eight women who had given birth to their first set of multiples within the past year were recruited online. Participants completed self-report measures of depression, anxiety, and sleep disruption and took part in telephone focus groups.

Results:

On average, participants had elevated depression and anxiety symptoms and notably disrupted sleep. Although some positive elements of the postpartum period were noted, most participants described this time as stressful, overwhelming, and exhausting. They identified experiences that were unexpected or unique to parenting multiples and indicated numerous desired aspects of mental health treatment. Interest in internet-delivered care was especially high.

Conclusions:

This study lays the groundwork for the development of a targeted psychosocial intervention to address mental health concerns among new mothers of multiples, particularly those who are already engaged and seeking support and community online. This report also suggests myriad ways in which providers can best address the needs of this population (eg, utilize providers with expertise in multiples, deliver care in the home, use e-health approaches, and normalize unique stressors and negative moods).
Technological Advances of Magnetic Resonance Imaging in Today's Health Care Environment
Authors: Attenberger Ulrike I. , Biber Stephan , Wichtmann Barbara D.
Published: June 2020

Today's health care environment is shifting rapidly, driven by demographic change and high economic pressures on the system. Furthermore, modern precision medicine requires highly accurate and specific disease diagnostics in a short amount of time. Future imaging technology must adapt to these challenges.

Demographic change necessitates scanner technologies tailored to the needs of an aging and increasingly multimorbid patient population. Accordingly, examination times have to be short enough that diagnostic images can be generated even for patients who can only lie in the scanner for a short time because of pain or with low breath-hold capacity.

For economic reasons, the rate of nondiagnostic scans due to artifacts should be reduced as far as possible. As imaging plays an increasingly pivotal role in clinical-therapeutic decision making, magnetic resonance (MR) imaging facilities are confronted with an ever-growing number of patients, emphasizing the need for faster acquisitions while maintaining image quality.

Lastly, modern precision medicine requires high and standardized image quality as well as quantifiable data in order to develop image-based biomarkers on which subsequent treatment management can rely.

In recent decades, a variety of approaches have addressed the challenges of high throughput, demographic change, and precision medicine in MR imaging. These include field strength, gradient, coil and sequence development, as well as an increasing consideration of artificial intelligence. This article reviews state-of-the art MR technology and discusses future implementation from the perspective of what we know today.
Dermoid Cyst in the Postauricular Area
Authors: Jeong Junhui , Choi Yoon Jung , Lee Kyuin , Choi Hyun Seung
Published: June 2020

Dermoid cyst is a rare benign tumor and about 7% of occurrences are found in the head and neck region. Its location is almost always in the midline of the body such as the orbit, oral cavity, and nose, but it is rarer in and around the auricle. The authors present a 31-year-old woman with dermoid cyst in the postauricular area which is a rare site for this lesion. In surgery under local anesthesia, the mass was limited to the subcutaneous area and excised completely. Surgical excision should be considered for cosmetic reasons and the mass should be excised completely to prevent recurrence and infection. Histopathologic confirmation is important and mandatory after excision to confirm the pathologic diagnosis and rule out the possibility of malignancy.
Optimizing Perioperative Red Blood Cell Utilization and Wastage in Pediatric Craniofacial Surgery
Authors: Reddy Srijaya K. , Volpi-Abadie Jacqueline , Gordish-Dressman Heather , Chao Jerry W. , Luban Naomi L.C. , Deutsch Nina
Published: June 2020

Utilization, wastage, and adverse consequences of assigning one full red blood cell (RBC) unit were investigated for children undergoing craniosynostosis surgery. The authors hypothesized that significant RBC wastage in the perioperative period exists for pediatric craniofacial surgery. The authors sought to determine what factors could guide patient-specific blood product preparation by evaluating utilization and wastage of RBCs in pediatric patients undergoing surgical correction of craniosynostosis. Eighty-five children with craniosynostosis undergoing surgical correction at our institution between July 2013 and June 2015 were identified. Fifty-three patients received RBC transfusion in the perioperative period, while 32 patients were not transfused. Primary outcome measures were intraoperative, postoperative, and total percent of RBC wastage. Secondary analysis compared the impact of patient weight and procedure type on perioperative RBC wastage. Of the 53 patients who received perioperative RBC transfusion, 35 patients received a volume of blood less than the full volume of the RBC unit while 18 patients received the full volume of blood. There was no significant relationship between perioperative RBC wastage, the type of craniofacial procedure performed, or the duration of surgical time. Children who received a perioperative transfusion and had RBC wastage weighed significantly less than those who received a full volume. These findings suggest that for craniofacial surgical patients weighing less than 10 kg, a protocol that splits cross-matched RBC units can decrease perioperative RBC wastage and blood donor exposure. A future prospective study will determine the success of this intervention as well as the potential to decrease exposure to multiple blood donors.
Laparoscopic Transabdominal Preperitoneal (TAPP) Inguinal Hernia Repair Using Fibrin Glue for Fixation of the Mesh and Peritoneum Closure
Authors: Ielpo Benedetto , Ferri  , Silva Jesus , Quijano Yolanda , Vicente Emilio , Diago Maria V. , Caruso Riccardo
Published: June 2020

Purpose:

The aim of this case series is to describe our ongoing experience of laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair using Tisseel fibrin glue for the fixation of the mesh and peritoneum closure.

Materials and Methods:

From October 2018, patients who underwent laparoscopic TAPP for unilateral inguinal hernia repair using Tisseel fibrin glue to secure the mesh and the peritoneum, with a minimum of 1 year of follow-up, have been included. Patient demographics, main operative findings, and main postoperative outcomes were analyzed prospectively using a visual analgesic scale (VAS) and a modified short-form 36 (SF-36) questionnaire.

Results:

A total of 26 patients have been included and none have been lost during the follow-up. The mean operative time was 92.1 minutes and there was no conversion. The median hospital stay was 1.03 day (range, 1 to 2). The mean follow-up duration was 19.3 months (range, 12 to 26 mo) and none had a recurrence. The postoperative VAS score at 1, 7, 30 days, and 6 months from surgery was 3.18, 1.52, 0, and 0, respectively. The mean SF-36 score at 1, 6, and 12 months from surgery was 90.09, 94.8, and 05.1, respectively.

Conclusions:

The use of fibrin glue for TAPP inguinal hernia repair is a safe and feasible technique with favorable results. Larger comparative randomized studies are needed to confirm these early results.
CIGB-258 immunomodulatory peptide: a novel promising treatment for critical and severe COVID-19 patients
Authors: Venegas-Rodriguez R , Santana-Sanchez R , Peña-Ruiz R , Bequet-Romero M , Hernandez-Cedeño M , Santiesteban-Licea B , Garcia A , Aroche PR , Oliva-Perez D , Ortega-Gonzalez LM , Baldomero J E , Cruz LR , Guillén G , Martinez-Donato G , Dominguez-Horta MC ,   for the CIGB-258 Study Group
Published: June 2020

This study characterizes the first clinical application of CIGB-258 in COVID-19 patients. CIGB-258 is an immunoregulatory peptide, derived from the cellular heat shock protein 60 (HSP60). Sixteen patients with COVID-19 in serious (31%) or critical (69%) conditions were included in this study. All critically ill patients recovered from the respiratory distress condition. Two of these patients had a fatal outcome due to nosocomial infections.The five seriously ill patients considerably improved. C-reactive protein (CRP) and interleukin-6 (IL-6) levels significantly decreased during treatment. CIGB-258 seems to be an effective and safe treatment option in COVID-19 patients under cytokine storm.

TRIAL REGISTRATION: RPCEC00000313
G6PD variant distribution in sub-Saharan Africa and potential risks of using chloroquine/hydroxychloroquine based treatments for COVID-19
Authors: Rocha Jorge da , Othman Houcemeddine , Tiemessen Caroline T. , Botha Gerrit , Ramsay Michèle , Masimirembwa Collen , Adebamowo Clement , Choudhury Ananyo , Brandenburg Jean-Tristan , Matshaba Mogomotsi , Simo Gustave , Gamo Francisco-Javier , Hazelhurst Scott ,   as members of the H3Africa Consortium
Published: June 2020

Chloroquine/hydroxychloroquine have been proposed as potential treatments for COVID-19. These drugs have warning labels for use in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Analysis of whole-genome sequence data of 458 individuals from sub-Saharan Africa showed significant G6PD variation across the continent. We identified nine variants, of which four are potentially deleterious to G6PD function, and one (rs1050828) that is known to cause G6PD deficiency. We supplemented data for the rs1050828 variant with genotype array data from over 11,000 Africans. Although this variant is common in Africans overall, large allele frequency differences exist between sub-populations. African sub-populations in the same country can show significant differences in allele frequency (e.g. 16.0% in Tsonga vs 0.8% in Xhosa, both in South Africa, p = 2.4 × 10−3). The high prevalence of variants in the G6PD gene found in this analysis suggests that it may be a significant interaction factor in clinical trials of chloroquine and hydrochloroquine for treatment of COVID-19 in Africans.
Clinical features of COVID-19 patients in Abdul Wahab Sjahranie Hospital, Samarinda, Indonesia
Authors: Paramita Swandari , Isnuwardana Ronny , Marwan Marwan , Alfian Donny Irfandi , Masjhoer David Hariadi
Published: June 2020

Introduction

Coronavirus Disease (COVID-19) is caused by SARS-CoV-2 infection. Indonesia officially established the first COVID-19 confirmation case in early March 2020. East Kalimantan has been determined as a candidate for the new capital of Indonesia since 2019. This makes Abdul Wahab Sjahranie Hospital Samarinda as the largest hospital there has been designated as the main referral hospital for COVID-19 patients in East Kalimantan. We report the epidemiological, clinical, laboratory, and radiological characteristics of these patients.

Methods

All patients with laboratory-confirmed COVID-19 by RT-PCR were admitted to Abdul Wahab Sjahranie Hospital in Samarinda. We retrospectively collected and analyzed data on patients with standardized data collection from medical records.

Results

By May 8, 2020, 18 admitted hospital patients had been identified as having laboratory-confirmed COVID-19. Most of the infected patients were men (16 [88.9%] patients); less than half had underlying diseases (7 [38.9%] patients). Common symptoms at the onset of illness were cough (16 [88.9%] patients), sore throat (8 [44.4%] patients), and fever (8 [44.4%] patients). Laboratory findings of some patients on admission showed anemia. Levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were increased in 10 (55.6%) of 18 patients. On admission, abnormalities in chest x-ray images were detected in 6 (33.3%) patients who had pneumonia. The mean duration from the first hospital admission to discharge was 33.1 ± 9.2 days.

Discussion

The majority of COVID-19 patients are male. COVID-19 comorbidities were found in several patients. The main clinical symptoms of COVID-19 in this study were cough, sore throat, and fever. The abnormal laboratory finding in COVID-19 patients is anemia, an increase in AST and ALT levels, and chest x-ray images of pneumonia. All patients are in mild condition. The average length of hospital admission patients to discharge is more than 30 days.

Conclusion

Although all patients are in mild condition, the inability of a local laboratory to check for positive confirmation of COVID-19 makes the admission period of the patient in the hospital very long. The availability of RT-PCR tests at Abdul Wahab Sjahranie Hospital Samarinda will greatly assist the further management of COVID-19 patients.
COVID-19 containment in the Caribbean: the experience of Small Island Developing States
Authors: Murphy MM , Jeyaseelan SM , Howitt C , Greaves N , Harewood H , Quimby KR , Sobers N , Landis RC , Rocke KD , Hambleton IR
Published: June 2020

Background

Small island developing states (SIDS) have limited absolute resources for responding to national disasters, including health emergencies. Since the first confirmed case of COVID-19 in the Caribbean on 1st March 2020, non-pharmaceutical interventions (NPIs) have been widely used to control the resulting COVID-19 outbreak. We document the variety of government measures introduced across the Caribbean and explore their impact on aspects of outbreak control.

Methods

Drawing on publically available information, we present confirmed cases and confirmed deaths to describe the extent of the Caribbean outbreak. We document the range of outbreak containment measures implemented by national Governments, focussing on measures to control movement and gatherings. We explore the temporal association of containment measures with the start of the outbreak in each country, and with aggregated information on human movement, using smartphone positioning data. We include a set of comparator countries to provide an international context.

Results

As of 25th May, the Caribbean reported 18,755 confirmed cases and 631 deaths. There have been broad similarities but also variation in the number, the type, the intensity, and particularly the timing of the NPIs introduced across the Caribbean. On average, Caribbean governments began controlling movement into countries 27 days before their first confirmed case and 23 days before comparator countries. Controls on movement within country were introduced 9 days after the first case and 36 days before comparators. Controls on gatherings were implemented 1 day before the first confirmed case and 30 days before comparators. Confirmed case growth rates and numbers of deaths have remained low across much the Caribbean. Stringent Caribbean curfews and stay-at-home orders coincided with large reductions in community mobility, regularly above 60%, and higher than most international comparator countries.

Conclusion

Stringent controls to limit movement, and specifically the early timing of those controls has had an important impact on containing the spread of COVID-19 across much of the Caribbean. Very early controls to limit movement into countries may well be particularly effective for small island developing states. With much of the region economically reliant on international tourism, and with steps to open borders now being considered, it is critical that the region draws on a solid evidence-base to balance the competing demands of economics and public health.
Latent Therapeutic Demand of Immunoglobulin therapies in neuropathies – chronic inflammatory demyelinating polyneuropathy (CIDP), Guillain–Barré syndrome (GBS) and multifocal motor neuropathy (MMN) in the United States
Authors: Bansal Megha , Farrugia Albert
Published: June 2020

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a neurological disorder characterized by progressive weakness and impaired sensory function in the legs and arms. Guillain-Barré syndrome is a disorder in which the body’s immune system attacks part of the peripheral nervous system. The first symptoms of this disorder include varying degrees of weakness or tingling sensations in the legs (NIH). Multifocal motor neuropathy is a progressive muscle disorder characterized by muscle weakness in the hands, with differences from one side of the body to the other in the specific muscles involved (NIH). We have modeled a latent therapeutic demand (LTD) of IVIg for CIDP and similar neuropathies in the US. We used the decision analysis methodology similar to the methods used by Stonebraker et al1for modeling LTD of IVIg. The model is based on the relationships of the epidemiological and clinical factors. Most of the usage patterns and dosage level of albumin are according to the epidemiological studies and clinical trials. The model is built in Microsoft Excel. The analysis is conducted based on oneway sensitivity analysis and probabilistic sensitivity analysis. The demand in terms of grams per 1,000 inhabitants is calculated depending on the treatment schedule and the prevalence of the disease. The model for CIDP has eight variables including prevalence of CIDP, patients using IVIg, dosage and treatment patterns. The annual demand of IVIg is based on initial treatment of 24 weeks followed by a maintenance period, with lower dosage and frequency of treatment for another 24 weeks2. The model for GBS has eight variables with a loading dose for 3-6 days followed by a second dose in case of relapse. The model for MMN has nine variables. It has a loading dose followed by maintenance dose every 1-6 weeks depending on the clinical factors of the patient. On an average, IVIg use was calculated as 100 gms, 5.6 gms and 35 gms per 1,000 inhabitants for CIDP, GBS and MMN, respectively, in the US annually.
Correlation of the global spread of coronavirus disease-19 with atmospheric air temperature
Authors: Bezabih Yihienew M. , Mequanint Alemitu , Alamneh Endalkachew , Bezabih Alemayehu , Sabiiti Wilber , Roujeinikova Anna , Bezabhe Woldesellassie M.
Published: June 2020

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an enveloped virus that may be sensitive to heat. We assessed whether the spread of coronavirus disease 2019 (COVID-19) correlates with air temperature. We also studied whether additional climate, geographical, and population variables were correlated. The total number of confirmed COVID-19 cases and mortality rates reported in each country between 1st Jan and 31st Mar 2020 were compared with the country’s three-month average atmospheric air temperature, precipitation and latitude. Spearman’s correlation coefficient (ρ) was used to identify significant correlations. Our analysis included a total of 748,555 confirmed COVID-19 cases worldwide. The total number of patients with COVID-19 decreased with increasing atmospheric air temperature (ρ = –0.54, 95%CI: [-0.64, –0.42]; P <0.001) and increased with an increasing latitude (ρ = 0.60, 95%CI: [0.48, 0.70]; P <0.001). Our findings justify further studies to examine the effect of air temperature on infectivity of SAR-CoV-2.
Toll-like Receptor 9 in breast carcinoma is a good prognostic marker in patients treated with neoadjuvant chemotherapy
Authors: Singh Aradhana , Bandyopadhyay Arghya , Mukherjee Narendranath , Basu Anupam
Published: June 2020

Purpose

TLR9 is the sensor of fragmented nucleic acid signature as a part of innate immune surveillance. TLR9 can recognize the DNA fragments released from the chemotherapy-treated cancer cells in tumour tissue and induce an inflammatory response.

The aim of this was toinvestigate the prognostic importance and survivability benefit of TLR9 expression in breast cancer patients treated with neoadjuvant chemotherapy.

Methods

Expression of TLR9 in breast carcinoma samples was studied in two patient cohorts, with neoadjuvant chemotherapy (NACT), and without NACT, by immunohistochemistry. Expression of TLR9 was analysed in relation to prognosis, overall survivability as well as risk factor analysis for neoadjuvant chemotherapy treatment using web-tools like SurvExpress and K-M Plotter.

Results

TLR9 was expressed in malignant epithelial cancer cells as well as in adjacent stromal cells. TLR9 in malignant epithelial cells was significantly high in patients treated with neoadjuvant chemotherapy compared to the patients without neoadjuvant chemotherapy. The prognostic and survival analysis by SurvExpress and Kaplan-Meier plotter demonstrated that high TLR9 expression is related to better overall survival in patients treated with NACT.

Conclusions

Thus, we are showing for the first time that TLR9 is good prognostic marker in breast cancer treated with neoadjuvant chemotherapy and can be used for the selection of the neo-adjuvant regime.
A Simple, SIR-like but Individual-Based l-i AIR Model: Application in Comparison of COVID-19 in New York City and Wuhan
Authors: Liu Xiaoping
Published: June 2020

COVID-19 has spread around the world with nearly 360,000 deaths from the virus as of today (5/28/2020). Mathematical models have played an important role in many key policy discussions about COVID-19. SIR or SIR-derived models are a common modeling technique. However, the application of these models needs to solve complicated differential equations, enabling use of these models only by professional researchers. In this study, a simple, SIR-like but individual-based model, the l-i AIR model, is presented. The parameters l and i represent the length of the latent period and the infectious period, respectively. The variable A stands for the number of the infected people in the active infectious period, I for the number of cumulative infected people, and R for the number of the people in recovery or death. The nth terms of the three variables are derived, which can be easily calculated in Microsoft Excel, making the program easy to be used in most offices. A transmission coefficient k and a transient incidence rate a of the infected people are induced in the model to examine the effect of social distancing and the testing capacity of coronavirus on the epidemic curves. The simulated daily new cases from this l-i AIR model can fit very well with the reported daily new cases of COVID-19 in Wuhan, China and in New York City, USA, providing important information about latent period, infectious period and lockdown efficiency, and calculating the number of actual infected people who are positive in antibodies.
Direct diagnostic testing of SARS-CoV-2 without the need for prior RNA extraction
Authors: Wei Shan , Kohl Esther , Djandji Alexandre , Morgan Stephanie , Whittier Susan , Mansukhani Mahesh , Hod Eldad , D’Alton Mary , Suh Yousin , Williams Zev
Published: June 2020

The COVID-19 pandemic has resulted in an urgent global need for rapid, point-of-care diagnostic testing. Existing methods for nucleic acid amplification testing (NAAT) require an RNA extraction step prior to amplification of the viral RNA. This step necessitates the use of a centralized laboratory or complex and costly proprietary cartridges and equipment, and thereby prevents low-cost, scalable, point-of-care testing. We report the development of a highly sensitive and robust, easy-to-implement, SARS-CoV-2 test that utilizes isothermal amplification and can be run directly on viral transport media following a nasopharyngeal swab without the need for prior RNA extraction. Our assay provides visual results in 30 min with 85% sensitivity, 100% specificity, and a limit of detection (LoD) of 2.5 copies/μl, and can be run using a simple heat block.