bluuebunny/crossref_metadata_2025 huggingface dataset:
Social gradient in health-related quality of life among urban residents in Limassol, Cyprus: Research article
Authors: Ellina Panagiota , Middleton Nicos , Lambrinou Ekaterini , Kouta Christiana
Published: August 2020

Background: Social inequalities in health threaten social cohesion and, therefore, their investigation is an important research field. Monitoring the health of the population is necessary to identify health needs, design programs focused in people’s needs and to evaluate the effectiveness of health policies.Methods: A cross-sectional survey using primary data was applied. The study investigates the size and the extent of social inequalities in quality of life and health behaviours in Limassol, Cyprus. Data collection was done by door-to-door survey, in the form of interviews. The sample consisted of 450 residents aged 45-64 across 45 randomly selected neighbourhoods, that met the selection criteria. The tools used were: Demographic questionnaire, SF 36 Questionnaire, IPAQ- International Physical Activity Questionnaire short form.Results: The social gradient appears in all social indicators. As for the physical dimension of health has a strong relationship between health-related quality of life with the education index. Specifically, the difference between the two poles is 12 points for men and 14 points for women (p = 0.16). Profession systematically appears to have a stronger relationship with men than with women, and is present in both physical and mental dimensions. Specifically, the difference between the two poles is 13 points for men and 10 points for women (p = 0.31).Conclusions: Exploring social inequalities in health-related quality of life, is a complex situation influencing social, physical and psychological health state. It seems that young male individuals, who are highly educated, employed full time, earning high incomes and engaging in mild physical activity, have significantly higher level of health-related life quality, compared to other middle age adult groups, living in Limassol. This finding is in agreement with other studies that show correlations between gender and the patterns of risk factors.
Point Prevalence Survey of antimicrobial use in three hospitals in North-eastern Tanzania
Authors: Horumpende Pius Gerald , Mshana Stephen Eliatosha , Mouw Elise F , Mmbaga Blandina Theophil , Chilongola Jaffu Othniel , de Mast Quirijn , deMast Quirijn
Published: August 2020

Background: Antimicrobial resistance (AMR) is one of the most urgent global health threats with low-resource countries being disproportionately affected. Targeted interventions require insight in antibiotic prescription practices. A point prevalence survey (PPS) is a well-known tool to get insight in antibiotic dispensing practices in hospitals and identify areas for improvement. Here, we describe the results of a PPS performed in a tertiary, regional and district hospital in Kilimanjaro region in Tanzania. Methods: A PPS was performed in the Kilimanjaro Christian Medical Centre (KCMC; tertiary hospital), Mawenzi (regional) and St. Joseph (district) hospital in November and December 2016. Antibiotic use in all patients admitted more than 24 hours and those undergoing surgery was recorded. All clinical wards were included except the pediatrics. Data from a single ward were collected on the same day. Results: A total of 399 patients were included in the PPS: 232 patients from KCMC, 94 from Mawenzi hospital and 73 patients from St. Joseph hospital. Overall prevalence of antibiotic use was 44.0%: 38% in KCMC, 59% in Mawenzi and 63% in St. Joseph. Ceftriaxone (n=94, 29.8%), metronidazole (n=79, 23.9%) and other antibiotics belonging to the penicillin class (n=89, 28.3%) were most commonly prescribed. Antibiotics prescribed for surgical prophylaxis were continued for more than 3 days in 57% of cases.Conclusion: Our study shows a rate of broad-spectrum antibiotic use in Tanzanian hospitals and prolonged surgical antibiotic prophylaxis being a common practice. PPS is an important tool to improve future antibiotic use in Tanzania hospitals.
Expanding the reach. Ethnobotanical knowledge and technological intensification in beekeeping among the Ogiek of the Mau Forest, Kenya
Authors: Zocchi Dauro Mattia , Volpato Gabriele , Chalo Duncan , Mutiso Patrick , Fontefrancesco Michele Filippo
Published: August 2020

Background Initiatives for beekeeping intensification across the tropics can foster production and income, but the changes triggered by the introduction of modern beehives might permeate traditional knowledge and practices in multiple ways, and as such should be investigated and understood. We conducted an ethnobotanical study in the Eastern part of the Mau Forest among Ogiek beekeepers who customarily practice forest beekeeping and who are involved in a project aimed at the modernization of their beekeeping activities. We aimed to document the beekeeping-associated ethnobotanical knowledge, exploring the relationships and complementarity between modern and traditional knowledge and practices. Methods Field research was carried out through semi-structured interviews with 30 Ogiek beekeepers and 10 additional stakeholders. We collected ethnobotanical data about plants used for beekeeping purposes, and ethnographic information on traditional and modern beekeeping systems. Results We report 66 plant species, distributed across 36 botanical families representing 58 genera, important as melliferous, for the construction and placing of hives, attracting bees, and harvesting and storing honey. Dombeya torrida (J.F.Gmel.) Bamps, Juniperus procera Hochst. ex Endl., and Podocarpus latifolius (Thunb.) R.Br. ex Mirb are the species with the most mentions and the highest number of uses. Our study reveals that the Ogiek possess a detailed knowledge of the forest’s flora, its importance and uses, and that this knowledge underpins beekeeping practices. Under the influence of external actors, the Ogiek have progressively adopted modern versus traditional log hives and moved beekeeping out of the forest into open areas of pastures and crop fields. Beekeepers are also experimenting with combinations of practices borrowed from modern and traditional beekeeping systems, particularly in the field of hive construction and in the criteria to set up apiaries. Conclusions The study indicates a complementarity and an incipient hybridization of traditional and modern beekeeping, in a way that suggests that modern beehives are instrumental in expanding the reach of beekeeping into deforested and cultivated areas. The study also points to the existence of a rift in the effects of beekeeping intensification on the livelihoods of the Ogiek and on their relationship with the forest. We argue that this intensification might be improving the former but weakening the latter, carrying the associated risk of erosion of traditional forest-based ethnobotanical knowledge.
Hydroxyurea Optimization through Precision Study (HOPS): Study Protocol for a Randomized, Multicenter Trial in Children with Sickle Cell Anemia
Authors: Meier Emily R. , Creary Susan E. , Heeney Matthew M. , Dong Min , Appiah‐Kubi Abena O , Nelson Stephen C. , Niss Omar , Piccone Connie , Quarmyne Maa-Ohui , Quinn Charles T. , Saving Kay L. , Scott John P. , Talati Ravi , Latham Teresa S. , Pfeiffer Amanda , Shook Lisa M. , Vinks Alexander A. , Lane Adam , McGann Patrick
Published: August 2020

Background : Sickle cell disease (SCD) is a severe and devastating hematological disorder that affects over 100,000 persons in the United States and millions worldwide. Hydroxyurea is the primary disease-modifying therapy for the SCD, with proven benefits to reduce both short-term and long-term complications. Despite the well-described inter-patient variability in pharmacokinetics (PK), pharmacodynamics and optimal dose, hydroxyurea is traditionally initiated at a weight-based dose with a subsequent conservative dose escalation strategy to avoid myelosuppression. Because the dose escalation process is time consuming and requires frequent laboratory checks, many providers default to a fixed dose, resulting in inadequate hydroxyurea exposure and suboptimal benefits for many patients. Results from a single-center trial of individualized, PK-guided dosing of hydroxyurea for children with SCD suggest that individualized dosing achieves the optimal dose more rapidly and provides superior clinical and laboratory benefits than traditional dosing strategies. However, it is not clear whether these results were due to individualized dosing, the young age that hydroxyurea treatment was initiated in the study, or both. The Hydroxyurea Optimization through Precision Study (HOPS) aims to validate the feasibility and benefits of this PK-guided dosing approach in a multi-center trial. Methods : HOPS is a randomized, multicenter trial comparing standard vs. PK-guided dosing for children with SCD as they initiate hydroxyurea therapy. Participants (ages 6 months through 21 years), recruited from 11 pediatric sickle cell centers across the United States, are randomized to receive hydroxyurea either using a starting dose of 20 mg/kg/day (Standard Arm) or a PK-guided dose (Alternative Arm). PK data will be collected using a novel sparse microsampling approach requiring only 10μL of blood collected at 3 time-points over 3 hours. A protocol-guided strategy more aggressive protocols is then used to guide dose escalations and reductions in both arms following initiation of hydroxyurea. The primary endpoint is the mean %HbF after 6 months of hydroxyurea. Discussion: HOPS will answer important questions about the clinical feasibility, benefits, and safety of PK-guided dosing of hydroxyurea for children with SCD with potential to change the treatment paradigm from a standard weight-based approach to one that safely and effectively optimize the laboratory and clinical response. Trial registration: ClinicalTrials.gov, NCT03789591. Registered on December 28, 2018.
Severe Pantothenic Acid Deficiency Induces Alterations in The Intestinal Mucosal Proteome of Starter Pekin Ducks
Authors: Tang Jing , Feng Yulong , Zhang Bo , Wu Yongbao , Guo Zhanbao , Liang Suyun , Zhou Zhengkui , Xie Ming , Hou Shuisheng
Published: August 2020

Background: Pantothenic acid deficiency (PAD) results in growth depression and intestinal hypofunction of animals. However, the underlying mechanisms remain to be established. We investigated intestinal mucosal proteome changes induced by PAD in ducks to explain its effects on growth and intestine. Results: A total of 128 one-day-old Pekin ducks were divided into two groups, with 8 replicates and 8 birds per replicate. All the ducks were fed either a PAD or a pantothenic acid adequate (control, CON) diet for 16 days. High mortality, growth retardation, fasting hypoglycemia, reduced plasma insulin, and oxidative stress were observed in the PAD group compared to the CON group. Furthermore, PAD induced morphological alterations of the small intestine indicated by reduced villus height and villus surface area of duodenum, jejunum, and ileum. The duodenum mucosal proteome of ducks showed that 198 proteins were upregulated and 223 proteins were downregulated (> 1.5-fold change) in the PAD group compared to those in the CON group. Pathway analysis of these proteins exhibited the suppression of glycolysis and gluconeogenesis, fatty acid beta oxidation, tricarboxylic acid cycle, oxidative phosphorylation, oxidative stress, and intestinal absorption in the PAD group, indicating impaired energy generation and abnormal intestinal absorption. We also show that nine out of eleven proteins involved in regulation of actin cytoskeleton were upregulated by PAD, probably indicates reduced intestinal integrity. Conclusion: PAD leads to growth depression and intestinal hypofunction of ducks, which are associated with impaired in energy generation, abnormal intestinal absorption, and regulation of actin cytoskeleton processes. These findings have important implications for understanding the effect of PAD on intestines.
Exploring Current Iran’s Primary Healthcare System: Challenges and Solutions
Authors: Shirjang Ahmad , Doshmangir Leila , Assan Abraham
Published: August 2020

Background: Since 1980s, establishing Primary Healthcare (PHC) network in Iran to promote health care delivery and population’s health, the PHC system has experienced various achievements and changes. This study aimed to explore current PHC in Iran focusing on challenges and solutions.Methods: Documentary review and interviews were used to collect qualitative data. The interviews were conducted with 26 stakeholders in various levels of the health system including health policymakers, academics, health managers and staffs are expert in public health and the PHC. National upstream documents including the Five Year Development Plans, General Health Policies, and the Iran’s 20 year national vision were reviewed. Data analysis was done using deductive content analysis assisted by MAXQDA 12 software. Results: Although Iranian PHC has enjoyed significant successes, it does not match with the changing populations’ health needs especially during the last years. The current workforce cannot respond to new public health challenges, health data are not collected and analyzed in a consistent manner, modern appropriate technologies in the PHC are not used and electronic service delivery are not provided yet. PHC financial difficulties and the current rigid structure of the health system cannot satisfy the new emerging needs of the population.Conclusion: Given the challenges and the new health needs, the current PHC structure and services should use the private sector involvement for better respond to the public health needs and flexible structure and services while dealing with the changes. The workforce needs to be updated, and the referral system should be established for providing the health care services based on FP plan.
The use of Peripheral Blood-Mononuclear Cells in Scleroderma patients: an observational preliminary study
Authors: Carella Sara , Rossi Caterina , Ribuffo Diego , Onesti Maria Giuseppina
Published: August 2020

Background

Systemic sclerosis (SSc) is a systemic autoimmune disease characterized by vasculopathy and excessive production of collagen, which lead to skin and visceral fibrosis. The aim of our study is to assess the potential benefits of peripheral blood mononuclear cells (PB-MNCs) implants in the treatment of clinical manifestations such as mouth impairment, hand disability, digital ulcers and Raynaud’s phenomenon in Scleroderma patients.
Methods

From February 2016 to May 2019, 10 female patients were enrolled from the outpatient clinic of the Plastic Surgery Unit of Sapienza University of Rome. Parameters evaluated were: patients’ disability, using the Health Assessment Questionnaire (HAQ) disability index (DI) and the scleroderma HAQ (sHAQ); mouth opening capacity, by measuring the maximum interincisal distance and the mouth perimeter; hand mobility, assessed with clinical exam and the Hand Mobility in Scleroderma (HAMIS) scale; Raynaud’s phenomenon, evaluated through nailfold capillaroscopy; digital ulcers, examined through their features and incidence of appearance. SPSS software was used for a simple descriptive statistical analysis performed by the Student's paired t-test. P values less than 0.05 were considered statistically significant.
Results

The treatment showed a significant improvement of all the parameters evaluated at 1-year follow-up, it was well-tolerated by all the patients and the only complications noticed were small areas of ecchymosis.
Conclusions

Our results suggest that PB-MNCs injection could represent a treatment option to take into account for SSc patients. The procedure we used is easy and fast to perform, minimally invasive and not-operator dependent. We hope our observational and preliminary study could be considered as a starting point for further research studies.
The Prevalence, Risk Factors and Prognosis of Acute Kidney Injury after Lung Transplantation: A Single-center Cohort Study in China
Authors: Sang Ling , Chen Sibei , Nong Lingbo , Xu Yonghao , Zheng Haichong , Zhou Liang , Liang Wenhua , Sun Huadong , He Jianxing , Liu Xiaoqing , Li Yimin
Published: August 2020

Background
To evaluate the incidence, risk factors, and prognosis of acute kidney injury (AKI) after lung transplantation (LTx).
Methods
Records of patients who underwent LTx in a single center were retrospectively reviewed. The prevalence of post-transplant AKI, the use of continuous renal replacement therapy (CRRT), and the risk factors for AKI were investigated. The impact of AKI and CRRT on short-term outcomes and long-term survival was measured.
Results
148 patients were included with 67 cases developed post-operative AKI. 31 patients underwent CRRT; the percentage of CRRT was 6.2%, 0%, 10% and 86.2% in no-AKI, and stage 1, 2 and 3 AKI, respectively. Patients with AKI had significantly higher ICU mortality and in-hospital mortality. The 1-year post-LTx survival rate of patients with AKI was 47.8%, significantly lower than those without (74.1%). There was no difference in the 1-year survival rate of those with stage 1 and stage 2 AKI, but patients with stage 3 AKI showed the worst survival. Patients who underwent CRRT had an inferior survival outcome (9.7% vs. 76.1%, P < 0.05). We found that higher APACHE II score (OR 1.082, P = 0.009), and higher intraoperative fluid balance (OR 1.001, P = 0.012) were independent risk factors, and female (OR 2.539) and pulmonary hypertension (OR 2.869) were potential risk factors for post-LTx AKI. A prediction model integration of the above factors showed a good concordance with actual risks and had a C-index of 0.76 (95% CI, 0.66–0.87).
Conclusion
Severe AKI which needed CRRT had a negative impact on the short-term and long-term outcomes.
Evaluation of Carbapenem-Resistant Enterobacteriaceae (CRE) Guideline Implementation in the Veteran’s Affairs Medical Centers Using the Consolidated Framework for Implementation Research
Authors: Goedken Cassie Cunningham , Guihan Marylou , Brown Charnetta R. , Ramanathan Swetha , Vivo Amanda , Suda Katie J. , Fitzpatrick Margaret A. , Poggensee Linda , Perencevich Eli N. , Rubin Michael , Reisinger Heather Schacht , Evans Martin , Evans Charlesnika T.
Published: August 2020

Background Infections caused by carbapenem-resistant Enterobacteriaceae (CRE) and carbapenemase-producing (CP) CRE are difficult to treat, resulting in high mortality in healthcare settings every year. The Veteran’s Health Administration (VHA) disseminated guidelines in 2015 and an updated directive in 2017 for control of CRE focused on laboratory testing, prevention, and management. The Consolidated Framework for Implementation Research (CFIR) framework was used to examine contextual factors and identify best practices influencing implementation of the 2015 guidelines/2017 directive in VA Medical Centers (VAMCs).Methods Qualitative interviews were conducted at 29 VAMCs with staff involved in implementing CRE guidelines at their facility. Survey and VHA administrative data were used to identify geographically representative large and small VAMCs with varying levels of CRE incidence. Interviews addressed perceptions of guideline dissemination, laboratory testing, staff attitudes and training, patient education, and technology support. Participant responses were coded using a consensus-based mixed deductive-inductive approach guided by CFIR. A quantitative analysis comparing CFIR constructs and emergent codes to sites actively screening for CRE (vs. non-screening) and any (vs. no) CRE positive cultures was conducted with a Fisher’s exact test.Results Forty-three semi-structured interviews were conducted between 10/2017-8/2018 with laboratory staff (47%), Multi-Drug Resistant Organism Program Coordinators (MPCs, 35%), infection preventionists (12%), and physicians (6%). Participants cited the need for more standardized tools to promote effective communication (e.g., electronic screening). Participants also indicated that CRE-specific educational materials were needed for staff, patient, and family members. Quantitative analysis identified the following CFIR constructs as being significantly associated with CRE screening or presence of CRE: Leadership Engagement, Relative Priority Available Resources, Team Communication, and Access to Knowledge & Information.Conclusions Effective CRE identification, prevention and treatment requires ongoing collaboration between clinical, microbiology, infection prevention, antimicrobial stewardship, and infectious diseases specialists. Our results emphasize the importance of leadership’s role in promoting positive facility culture, including increasing healthcare worker’s awareness of infection control and prevention for emerging pathogens, access to resources, improving communication and facilitating successful implementation of the CRE guidelines.
Geometry of the fusiform excision for skin lesions
Authors: Rouzier Roman , Rocher Gregoire
Published: August 2020

Objective

The fusiform excision technique is commonly used by surgeons to remove round skin lesions to minimize "dog-ears" at the ends of the incision. We propose a geometric analysis to easily design the fusiform incision and consequently standardize the surgical procedure.
Background

The classic ellipse is formed by tracing 2 arcs of a circle on the skin. The arcs, which are symmetrical with respect to the midline axis separating them, intersect at their ends to form a convex shape and classically result in a 1:3 width-length ratio between the short and long axes of the ellipse.
Methods

Using basic geometry rules, namely Pythagorean theorem and the ratios of the angles of right triangles, we first calculated the ratio between the radius of the lesion and the radius of the arcs of the circle of the fusiform incision and then the distance between the center of the lesion and the intersection between the line perpendicular to the axis of the fusiform excision and the tangent to the arcs of the circle.
Results

The ratio between the radius of the lesion and the radius of the arcs of the circle of the fusiform incision is 5 and the distance between the center of the lesion and the intersection between the vertical axis and the tangent is 2.25 for a fusiform incision with a width-length ratio of 1:3. We then generalized the formulas.
Conclusions

Our approach provides an introduction to the geometry of dermatologic surgery to students in order to standardize the surgical procedure.
Prevalence of Gingivitis in Second Trimester of Pregnancy
Authors: Shrestha Rejina , Pradhan Shaili , Baral Gehanath
Published: August 2020

Background: There is rare documentation on the prevalence of gingivitis in pregnancy in the least developed countries. The aim of the study is to evaluate the prevalence of gingivitis in the second trimester of pregnancy and assess its relationship with age, parity, education, occupation, gravidity, oral hygiene habit and frequency of brushing.Methods: An observational descriptive study was conducted among 384 pregnant females in their second trimester in Kathmandu, Nepal. Demographic variables and general information including those related to oral hygiene practices and habits were collected during an interview. Plaque index and Gingival Index was recorded among the patients through full mouth examination at four sites.Results: The prevalence of gingivitis in the second trimester of pregnancy was 76.3%. Statistically significant relationship was found between gingivitis and gravida and parity. A relation could not be established between gingivitis with age, education, occupation, oral hygiene habit and frequency of brushing.Conclusions: The prevalence of gingivitis is found to be high in Nepalese pregnant women. Special strategies should be introduced targetting the pregnant women of least developed countries to uplift their periodontal health.
Predictors of Anemia Among Pregnant Women of Under-privileged Ethnic Groups Attending Antenatal Care at Provincial Level Hospital of Province 2, Nepal
Authors: Yadav Umesh Kumar , Ghimire Prabesh , Amatya Archana , Lamichhane Ashish
Published: August 2020

Background: This study aims to determine the predictors of anemia among pregnant women of underprivileged ethnic groups attending antenatal care at provincial level hospital of Province 2.Methods: A hospital based cross-sectional study was carried out in Janakpur Provincial Hospital of Province 2, Southern Nepal. 287 pregnant women from underprivileged ethnic groups attending antenatal care were selected and interviewed. Face to face interviews using structured questionnaire was undertaken. Anemia status was assessed based on hemoglobin levels determined at the hospital’s laboratory. Bivariate and multiple logistic regression analyses were used to identify the predictors of anemia. Analyses were performed using IBM SPSS version 23 software.Results: The overall anemia prevalence in the study population was 66.9% (95% CI 61.1-72.3). The women from most under-privileged ethnic groups (Terai Dalit, Terai Janajati and Muslims) were twice more likely to be anemic than Madhesi women. Similarly, women having education lower than secondary level were about 3 times more likely to be anemic compared to those with secondary level or higher education. Women who had not completed four antenatal visits were twice more likely to be anemic than those completing all four visits. The odds of anemia were three times higher among pregnant women who had not taken deworming medication compared to their counterparts. Furthermore, women with inadequate dietary diversity were four times more likely to be anemic compared to women having adequate dietary diversity.Conclusions: The prevalence of anemia is a severe public health problem among the pregnant women of under-privileged ethnic groups in Province 2. Being Dalit, Janajati and Muslim, having lower education, less frequent antenatal visits, not receiving deworming medication and having inadequate dietary diversity are found to be the significant predictors. The present study highlights the need of improving the frequency of antenatal visits and coverage of deworming program in ethnic populations. Furthermore, promoting a dietary diversity at the household level would help lower the prevalence of anemia. The study findings also imply that the nutrition interventions to control anemia must target and reach pregnant women from most-marginalized ethnic groups and those with lower education.
Leaf δ15N, δ13C and Their Associations with Soil Fungal Biodiversity, Ectomycorrhizal and Plant Pathogenic Abundance in Forest Ecosystems of China
Authors: Song Wenchen
Published: August 2020

Leaf δ15N and δ13C are important functional traits in biogeographic studies of forest ecosystems. However, little is known about their relationships with soil fungal biodiversity, ectomycorrhizal, and plant pathogen abundance at large scales. In this study, leaf and soil samples were collected from 33 forest reserves along a large range across China to explore the associations between leaf δ15N and δ13C and soil fungal biodiversity, ectomycorrhizal, and plant pathogen relative abundance using molecular and stable isotope techniques. We found large-scale biogeographic patterns for leaf δ15N, δ13C, soil fungal biodiversity, and ectomycorrhizal relative abundance. The soil-plant-microbial interaction may contribute to the variations in leaf δ15N, δ13C, and soil fungal communities across different types of forest ecosystems. Temperature and precipitation were the main factors affecting large-scale biogeographic patterns of latitude and longitude. Leaf δ15N was mainly affected by the relative abundance of ectomycorrhizal fungi and leaf δ13C was affected by the relative abundance of plant pathogens. Leaf δ15N and δ13C may be indicators reflecting soil fungal communities in forest ecosystems.
Rotational Thromboelastometry Predicts Care Level in COVID-19: A Prospective, Observational Study.
Authors: Almskog Lou M. , Wikman Agneta , Svensson Jonas , Wanecek Michael , Bottai Matteo , Linden Jan van der , Ågren Anna
Published: August 2020

BackgroundHigh prevalence of thrombotic events in severely ill COVID-19 patients have been reported. Pulmonary embolism as well as microembolization of vital organs may in these individuals be direct causes of death. The identification of patients at high risk of developing thrombosis may lead to targeted, more effective prophylactic treatment. The aim of this study was to test whether Rotational Thromboelastometry (ROTEM) indicates hypercoagulopathy in COVID-19 patients, and whether patients with severe disease have a more pronounced hypercoagulopathy compared with less severely ill patients. MethodsThe study was designed as a prospective observational study where COVID-19 patients over 18 years admitted to hospital were eligible for inclusion. Patients were divided into two groups depending on care level: 1) regular wards or 2) wards with specialized ventilation support. ROTEM was taken after admission and the data were compared with ROTEM in healthy controls.ResultsThe ROTEM variables Maximum Clot Firmness (EXTEM-/FIBTEM-MCF) were higher in COVID-19 patients compared with healthy controls (p<0.001) and higher in severely ill patients compared with patients at regular wards (p<0.05). Coagulation Time (EXTEM-CT) was longer and Clot Formation Time (EXTEM-CFT) shorter in COVID-19 patients compared with healthy controls. Our results suggest that hypercoagulopathy is present in hospitalized patients with mild to severe COVID-19 pneumonia. ConclusionsROTEM variables were significantly different in COVID-19 patients early after admission compared with healthy controls. This pattern was more pronounced in patients with increased disease severity, suggesting that ROTEM-analysis may be useful to predict thromboembolic complications in these patients.
Institutional Anticoagulation Protocol for Septic DIC is Associated with Differences in In-Hospital Mortality. J-SEPTIC DIC STUDY (A Nationwide Registry Study)
Authors: Tanaka Keiko , Matsumoto Hironori , Ohshita Muneaki , Annen Suguru , Nakabayashi Yuki , Aibiki Mayuki
Published: August 2020

Background: We analyzed data from Japanese nationwide registry study of severe sepsis/septic shock to determine the influence of institutional treatment protocol, which has not been evaluated, on in-hospital mortality rate in septic DIC. Methods: From among all sepsis patients (n=3193), we selected those (n=1856) diagnosed with DIC according to the JAAM criteria, then divided them into three groups depending on DIC treatment protocol: patients admitted to hospitals providing basically no anti-coagulation therapy (NO-TX group: n=287); those admitted to hospitals routinely providing such treatment (anti-thrombin concentrate and/or rh-thrombomodulin or other anti-coagulants such as heparin/heparinoids: DO-TX group: n=1202); and those admitted to hospitals providing treatment at the discretion of the physician-in-charge (DEP-TX group: n=446). Results: In DIC patients only, in-hospital mortality was much higher in the NO-TX group (46.2%) than in the DO-TX group (34.1%) despite comparable APACHE II scores. The hazard ratio (HR) of mortality was much lower in the DO-TX group (0.76, 95% CI: 0.61-0.96) than in the NO-TX group (set at 1.0). When non-DIC subjects whose records contained complete information on JAAM and ISTH scores were also included (n=2513), however, different treatment protocols were no longer associated with differences in HR. Nevertheless, in-hospital mortality rates still differed among the three groups even after non-DIC patients were included. Conclusions: Thus, the present results support the use of anti-coagulation treatments for septic DIC and suggest that outcomes are affected by other institutional factors besides anti-coagulation protocol, such as an institutional approach to sepsis. The mechanisms underlying this effect should be clarified.
Early Critical Care Transthoracic Echocardiography Improves the Mortality of Patients Undergoing Mechanical Ventilation: Observational Data From Two Large Databases.
Authors: Yu Xueshu , Jiang Hao , Chen Wenjing , Pan Lingling , Fang Zhendong , Zhang Xianwei , Chen Zhiqiang , Shu Jie , Ye Yincai , pan jingye
Published: August 2020

Background: Critical care transthoracic echocardiography (TTE) can quickly and accurately assess haemodynamic changes in ICU patients. However, it is not clear whether transthoracic echocardiography improves the prognosis of mechanically ventilated patients. In this study, we hypothesized that early critical care transthoracic echocardiography independently contributes to improvements in mortality in mechanically ventilated patients in the ICU.Methods: This was a retrospective study based on the Medical Information Mart for Intensive Care III (MIMIC-III) database and the eICU Collaborative Research Database (eICU-CRD). Patients undergoing mechanical ventilation for more than 48 hours were selected. The exposure of interest was early TTE. The primary outcome was in-hospital mortality. We used propensity score matching to analyse the association between early TTE and in-hospital mortality and sensitivity analysis, including the inverse probability weighting model and covariate balancing propensity score model, to ensure the robustness of our findings.Results: A total of 8862 patients undergoing mechanical ventilation were enrolled. The adjusted OR showed a favourable effect between the early TTE group and in-hospital mortality [MIMIC: OR 0.77, 95% CI (0.63–0.94), (P=0.01); eICU-CRD: OR 0.78, 95% CI (0.68–0.89), (P<0.01) ]. Furthermore, TTE was also associated with 30-day mortality in the MIMIC database [OR 0.74, 95% CI (0.6-0.92), P=0.01].Conclusions: Early application of critical care transthoracic echocardiography during mechanical ventilation is beneficial for improving in-hospital mortality. Further investigation with prospectively collected data is required to validate this relationship.
Maternity Waiting Home and Maternal Mortality Ratio in EI Salvador
Authors: Yoon Heesang , Kim Chong-sup
Published: August 2020

Background: El Salvador is recognized as a country which could effectively reduce the maternal mortality ratio (MMR). In El Salvador, there was an improvement in health indicators, such as fertility rate, adolescent fertility rate, skilled birth attendance, health expenditures, but this improvement was not extraordinary compared with other developing countries. The reason El Salvador could achieve an outstanding decrease in MMR in spite of a not so special improvement in health or non-health indicators, deserves a deep research.Methods: We used quantitative as well as qualitative methods to show that the reason El Salvador could reduce maternal mortality ratio more than expected is the health policy that not only aimed at reducing the (adolescent) fertility rate, but also provided a safe birth service to pregnant women through maternity waiting home. As quantitative methods we ran regressions using maternal mortality ratio as dependent variable, health and non-health factors as independent variables. As qualitative methods, we carried out a case study of maternal waiting home in El Salvador.Results: El Salvador could reduce maternal mortality ratio through the improvement of health factors, such as fertility rate, skilled birth attendance, and non-health factors, such as GDP per capita and woman empowerment. However, even considering these factors, maternal mortality ratio of El Salvador decreased more than expected. We confirmed this by analyzing the residuals of the regression model. This improvement in MMR, which is more than expected from the regression results, can be attributed partly to the government measures, such as maternity waiting home.Conclusions: The reason of the unexplained reduction in El Salvador’s maternal mortality ratio seems to be attributable to the health policy that not only aimed at reducing the fertility rate, but also provided a safe birth service to pregnant women through maternity waiting home.
Risk Factors for the Environmental Spread of Different Multi-Drug-Resistant-Organisms (MDRO)
Authors: Saliba Rindala , Ghelfenstein-Ferreira Théo , Lomont Alexandra , Pilmis Benoît , Carbonnelle Etienne , Seytre Delphine , Ayoub Eliane Nasser , Zahar Jean Ralph , Sarkis Dolla Karam
Published: August 2020

BackgroundSubstantial scientific evidence has accumulated that the contamination of environmental surfaces in hospitals plays an important role in the transmission of MDRO. To date, all studies have failed to identify the risk factors associated with environmental contamination. In this work, we aimed to evaluate, compare and identify factors associated with environmental contamination around carriers of different MDRO.MethodsWe conducted a prospective cohort study from May 2018 to February 2020. We included 125 patients admitted to Avicenne Hospital and Hotel Dieu de France de Beyrouth Hospital, fecal carriers of MDRO (ESBL-PE, CPE, VRE). For each patient, we did a quantification of MDRO in stool, a qualitative evaluation of presence of MDRO in 6 different environmental sites and collected several clinical data.ResultsESBL-PE represented 34% of the carried MDRO, CPE 45% and VRE 21%. The most frequent MDRO species was E.coli . Contamination of at least one environmental site was observed for 22 (18%) patients. Only carriage of VanA was associated with a significantly higher risk of dissemination. Having a urinary catheter, carriage of OXA48 and E.coli were protective factors against environmental contamination. We didn’t find any statistically significant difference in environmental contamination between E.coli and other Enterobacteriaceae carriers, also between ESBL-PE and CPE carriers.ConclusionsIn conclusion, our results showed that hospital environmental contamination rates are substantially higher for patients with VRE, compared to the low environment dissemination rates around ESBL-PE and CPE. Further studies on a larger scale are needed to confirm the validity of our findings.
Efficacy and Safety of Tocilizumab in the Treatment of SARS-CoV-2: A Systematic Review and Meta-analysis
Authors: Singh Surjit , Khera Daisy , Chugh Ankita , Mittal Niti , Mittal Rakesh , Chugh Vinay Kumar
Published: August 2020

Background: Cytokine storm is the main cause of mortality in COVID-19. Tocilizumab, an IL-6 inhibitor, is being tested for its therapeutic potential in this condition. To evaluate the efficacy and safety of Tocilizumab in comparison to Standard therapy in the treatment of COVID-19 in adult patients. Methods: Using Medline (via PubMed), The Cochrane Central Register of Controlled Trials, preprint server (medRxiv) and clinicaltrials.gov, a final search was conducted on 26th June 2020. All types of clinical studies (prospective or retrospective cohort studies, observational case-control studies, clinical trials) aiming to evaluate the role of Tocilizumab in the treatment of patients with COVID-19 were considered eligible for this systematic review. Tocilizumab was considered as the intervention group and standard of care or drugs other than tocilizumab as control group. Meta-analysis was performed by Cochrane review manager 5 (RevMan) version 5.3. For quality assessment, ROBINS-I (The Risk Of Bias In Non-randomised studies – of Interventions) assessment tool for observational studies was used. The overall quality of evidence for each of the outcomes was assessed using the GRADE Pro GDT. Results: Out of 362 records identified, 13 studies were included in qualitative and quantitative analysis. Tocilizumab treatment was associated with 46% decrease in probability of mortality rate [Adjusted HR = 0.54 (95% CI = 0.44-0.68), p<0.00001; I2=74%] and 66% odds decrease in progression of disease [OR = 0.34 (95% CI = 0.21 – 0.55), p<0.0001; I2=76%] compared to control. However, there was no difference in hospital discharge [OR = 1.35 (95% CI = 0.84 – 2.18), p=0.22; I2=22%] and clinical improvement [OR = 1.02 (95% CI = 0.61 – 1.69), p=0.95; I2=84%] with tocilizumab. There was statistically significant increase in risk of secondary bacteraemia [OR = 2.75 (95% CI = 1.86 – 4.06), p< 0.00001] and superinfections [OR = 2.93 (95% CI = 1.92 – 4.46), p< 0.00001].Conclusions: With current evidence on efficacy and safety of tocilizumab, we recommend use of tocilizumab treatment for moderate to severe COVID-19 patients caused by SARS-CoV-2, along with caution for superinfections.Systematic review registration: PROSPERO registration number: CRD42020189517
Heteronormativity in schools is associated with unhealthy weight-control behaviors in Lesbian, Gay, and Bisexual youth: A multilevel analysis.
Authors: Santos Carolina da Franca Bandeira Ferreira , Godoy Fabiana , Menezes Valdenice , Colares Viviane , Zarzar Patrícia , Ferreira Raquel , Kawachi Ichiro
Published: August 2020

Background Previous studies found that a school climate of more heteronormativity is associated with adverse effects on the mental health of LGB students. Accordingly, our aim was to assess the association between low LGB visibility in schools and unhealthy weight-control behaviors among LGB youth. Methods Cross-sectional, multilevel study based in public high schools in the city of Olinda, Northeast Brazil. A multilevel logistic regression was performed, including 2,500 adolescents enrolled in 27 schools. The contextual variable was the prevalence of LGB youth in each school (as a proxy for heteronormativity in schools) while the outcome was unhealthy weight-control behaviors (fasting, purging, and taking diet pills). We controlled for socioeconomic characteristics (age, gender, receiving a family allowance), obesity, and self-reported happiness. Results Low LGB visibility in schools was associated with higher odds of engaging in unhealthy weight-control behaviors (OR: 1.5, 95%CI: 1.0, 2.2) among all youth, regardless of sexual orientation. Among LGB youth, there was some suggestion that the association between LGB visibility and unhealthy weight control behaviors was mediated by experiences of victimization and self-perceptions of unhappiness. Conclusion A school environment of low LGB visibility was associated with unhealthy weight-control behaviors in youth.
Fasting and non-fasting lipid profile for cardiovascular risk assessments using China ASCVD risk estimator and Europe SCORE risk charts in Chinese participants
Authors: Zhang Shi-Lan , Du Xiao , Xu Jin , Xiang Qun-yan , Liu Ling
Published: August 2020

Background Previous studies have shown that non-fasting lipids have similar values in cardiovascular risk estimation as fasting, but it is not clear whether this could also be applicable to Chinese participants.Methods A total of 127 (76 men, 51 women) participants without atherosclerotic cardiovascular diseases (ASCVD) were enrolled in the study. Serum levels of blood lipids were monitored at 0 h, 2 h and 4 h after a daily breakfast. Ten-year cardiovascular disease (CVD) risk was estimated with China ASCVD risk estimator and Europe SCORE risk charts. Kappa statistic was used to determine agreement among estimators.Results there was substantial agreement between China ASCVD risk estimator based on fasting and non-fasting lipid profiles (Kappa = 0.731 or 0.718, P < 0.001), but poorly agreement between China ASCVD risk estimator and SCORE low- or high-risk chart (Kappa = 0.339 or 0.300, P < 0.001).Conclusions Promoting use of non-fasting blood lipids in diagnosis, evaluation, and prediction of CVD are feasible. Furthermore, non-fasting blood lipids could be used in China ASCVD risk estimator to evaluate assess 10-year risk of ASCVD among Chinese general participants.
Facilitators and Barriers to Implementation of Childhood Tuberculosis Control Program in Bangladesh: a Mixed-methods Study From BRAC Urban DOTS Centres in Dhaka
Authors: Pantha Sandesh , Aguinaldo Ma. Jennylyn , Bari S.M. Hasan-ul , Chowdhury Sayantan , Dendup Ugyen , Gupta Rajat Das , Sutradhar Ipsita , Bari Rahamatul , Sarker Malabika
Published: August 2020

BackgroundWorld Health Organisation (WHO) estimates childhood tuberculosis (tb) in high burden countries to be at least 10-15% of all cases. Despite intensive efforts on the childhood tb control program in Bangladesh, case detection rates stand below 5%. This study investigated the implementation pathway of childhood tb in Bangladesh. The study aims to identify the factors that enable and hinder the diagnosis and treatment of childhood tb in Bangladesh.MethodsAn exploratory-explanatory mixed-methods study was carried out in eight (top four and bottom four based on new case identification) urban DOTS (Directly Observed Treatment, Short-course) centres of the BRAC tb program in Dhaka Metropolitan City, Bangladesh. The study was conducted between September and December 2017. The knowledge, attitude, and practice (KAP) assessment on diagnosis and treatment of childhood tb were conducted among 111 Shasthya Shebika (SS), frontline health care workers engaged in the tb program. Field workers (n=32) and mothers of tb patients (n=4) participated in In-Depth Interviews. Key Informant Interviews (n=9) were conducted with program managers of BRAC and other key stakeholders involved in implementing the tuberculosis program in Bangladesh. ResultsThe survey showed a low level of knowledge on routes of transmission. The knowledge score was significantly associated with the recall of the components of training (p=0.02). Government stewardship, the presence of specific guidelines, capacity building of health workers, knowledge of frontline health workers were identified as key facilitators for the diagnosis and treatment of childhood tuberculosis. Major constraints identified included the presence of stigma, delays in seeking care, lack of diagnostic facilities, and poor engagement of private practitioners in the national tuberculosis program.ConclusionA triad of strategies including capacity building of frontline health care workers, use of recent technological advances in diagnosis, and continuous monitoring of the suspected or identified cases in the field have resulted in increased case notification of childhood tb in Bangladesh over the past few years. Frequent turnover and change of key positions in National Tuberculosis Program (NTP) and absenteeism of paediatricians in government hospitals were important barriers to implementation of childhood tb program.
Effects of Dietary Tongmai Granule Residue Supplementation on Growth Performance, Nutrient Digestibility, Blood Biochemical Parameters and Rumen Fermentation in Sheep
Authors: Zhang Pei , Sun Shiwen , Cheng Wenge , Abdallah Abedin , Sun Zewei , Zhong Qingzhen
Published: August 2020

The purpose of this study was to investigate the effects of Tongmai granule residue (TGR) on the growth performance, apparent nutrient digestibility, blood biochemical parameters, and rumen fermentation in Doper x Small Tail Han hybrid sheep. Twenty-four healthy female lambs (6–7 months of age; 29.64 ± 1.80 kg initial body weight) were randomly divided into 3 groups and fed for 75 days. The control group was fed a commercial concentrate and the other groups were fed diets supplemented with 10% and 15% TGR respectively. Dietary 15% TGR supplementation decreased average daily gain, apparent digestibility of neutral detergent fiber, but increased the feed conversion ratio, apparent digestibility of crude fat and organic matter in lambs (P < 0.05). The 10% TGR group significantly increased the apparent digestibility of organic matter (P < 0.05). Dietary supplementation of 10% and 15% TGR significantly increased serum high density lipoprotein cholesterol (HDL-C) content on day 15, IgG content on day 30, and IgA content on day 60 of the feeding period (P < 0.05). Dietary supplementation of 15% TGR significantly increased the content of IgA on the 30th day (P < 0.05), and significantly decreased blood urea nitrogen (BUN) on the 30th day (P < 0.05) of the feeding period. TGR at 15% significantly decreased the contents of acetic acid, propionic acid, butyric acid, and total volatile fatty acids (TVFA) in the rumen (P < 0.05), and significantly increased the pH, NH3-N concentration, and acetic acid: propionic acid ratio (P < 0.05). The results suggest that, the addition of TGR to diet can improve the apparent digestibility of crude fat and organic matter, and improve the anti-atherosclerosis ability and immune function of Doper x Small Tail Han hybrid female lambs. The dietary addition of 10% TGR yielded the best feeding effect in this experiment.