bluuebunny/crossref_metadata_2025 huggingface dataset:
Natural competence inChlorogloeopsis fritschiiPCC 6912 and other ramified cyanobacteria
Authors: Springstein Benjamin L. , Nies Fabian , Dagan Tal
Published: June 2020

Lateral DNA transfer plays an important role in the evolution of genetic diversity in prokaryotes. DNA acquisition via transformation involves the uptake of DNA from the environment. The ability of recipient cells to actively transport DNA into the cytoplasm – termed natural competence – depends on the presence of type IV pili and competence proteins. Natural competence has been described in cyanobacteria for several organisms including unicellular and filamentous species. However, the presence of natural competence in ramified cyanobacteria, which are considered the peak of cyanobacterial morphological complexity, remains unknown. Here we show that ramified cyanobacteria harbour the genes essential for natural competence and experimentally demonstrate natural competence in the ramified cyanobacteriumChlorogloeopsis fritschiiPCC 6912 (hereafterChlorogloeopsis). Searching for homologs to known natural competence genes in ramified cyanobacteria showed that these genes are conserved in the majority of tested isolates. Experimental validation of natural competence using several alternative protocols demonstrates thatChlorogloeopsiscould be naturally transformed with a replicative plasmid. Our results show that natural competence is a common trait in ramified cyanobacteria and that natural transformation is likely to play an important role in cyanobacteria evolution.

Importance

Cyanobacteria are crucial players in the global biogeochemical cycles where they contribute to CO2- and N2-fixation. Their main ecological significance is the oxygen-producing photosynthetic apparatus that contributes to contemporary food chains. Ramified cyanobacteria form true-branching and multiseriate cell filament structures that represent a peak of prokaryotic multicellularity. Species in that group inhabit fresh and marine water habitats, thermal springs, arid environments, as well as endolithic and epiphytic habitats. Here we show that ramified cyanobacteria harbor the mechanisms required for DNA acquisition via natural transformation. The prevalence of mechanisms for natural uptake of DNA has implications for the role of DNA acquisition in the evolution of cyanobacteria. Furthermore, presence of mechanisms for natural transformation in ramified cyanobacteria opens up new possibilities for genetic modification of ramified cyanobacteria.
Comparative analysis reveals the modular functional build-up of megaplasmid pTTS12 ofPseudomonas putidaS12: a paradigm for transferable traits, plasmid stability and inheritance?
Authors: Kusumawardhani Hadiastri , Hosseini Rohola , de Winde Johannes H.
Published: June 2020

ThePseudomonas putidaS12 genome contains 583 kbp megaplasmid pTTS12 that carries over 600 genes enabling tolerance to various stress conditions, including the solvent extrusion pump SrpABC. We performed a comparative analysis of pTTS12 against 28915 plasmids from NCBI databases. We investigated putative roles of genes encoded on pTTS12 and further elaborated on its role in the establishment and maintenance of several stress conditions, specifically focusing on solvent tolerance inP. putidastrains. The backbone of pTTS12 was found to be closely related to that of the carbapenem-resistance plasmid pOZ176, member of the IncP-2 incompatibility group, although remarkably the carbapenem resistance cassette is absent from pTTS12. Megaplasmid pTTS12 contains multiple transposon-flanked cassettes mediating resistance to various heavy metals such as tellurite, chromate (Tn7), and mercury (Tn5053 and Tn5563). Additionally, pTTS12 also contains a P-type, Type IV secretion system (T4SS) supporting self-transfer to otherP. putidastrains. This study increases our understanding in the build-up of IncP-2 plasmids and several promising exchangeable gene clusters to construct robust microbial hosts for biotechnology applications.

Importance

Originating from various environmental niches, large numbers of bacterial plasmids have been found carrying heavy metal and antibiotic resistance genes, degradation pathways and specific transporters for organic solvents or aromatic compounds. Such genes may constitute promising candidates for novel synthetic biology applications. Our systematic analysis of gene clusters encoded on megaplasmid pTTS12 underscores that a large portion of its genes is involved in stress response increasing survival under harsh conditions like heavy metal and organic solvent resistance. We show that pTTS12 belongs to the IncP-2 plasmid family. Comparative analysis of pTTS12 provides thorough insight into the structural and functional build-up of members of the IncP-2 plasmid family. pTTS12 is highly stable and carries a complex arrangement of transposable elements containing heavy metal resistance clusters as well as distinct aromatic degradation pathways and solvent-extrusion pump. This offers interesting insight into the evolution of solvent tolerance in theP. putidafamily.
Transmission Clusters of Hepatitis C Virus among Public Health and Correctional Settings in Wisconsin, 2016-2017
Authors: Hochstatter Karli R. , Tully Damien C. , Power Karen A. , Koepke Ruth , Akhtar Wajiha Z. , Prieve Audrey F. , Whyte Thomas , Bean David J. , Seal David W. , Allen Todd M. , Westergaard Ryan P.
Published: June 2020

Ending the hepatitis C virus (HCV) epidemic requires stopping transmission among networks of people who inject drugs (PWID). Identification of transmission networks through the application of genomic epidemiology may inform community response models that can quickly interrupt transmission. We retrospectively identified HCV RNA-positive specimens corresponding to 459 individuals tested in public health settings, including correctional facilities and syringe service programs, in Wisconsin from 2016-2017. Next-generation sequencing of HCV was conducted and analyzed for phylogenetic linkage using the CDC’s Global Hepatitis Outbreak Surveillance Technology platform. Transmission network analysis showed that 126 individuals were linked across 42 clusters (range: 2-11 individuals per cluster). Phylogenetic clustering was higher in rural communities and associated with female gender and younger age among rural residents. These data highlight that the increasing rurality of opioid injection use and HCV transmission among young PWID could be better supported by the expansion of molecular-based surveillance strategies to reduce transmission.

Article Summary Line

Integrating existing public health surveillance and molecular analyses with Global Hepatitis Outbreak Surveillance Technology allows for the identification and characterization of growing HCV transmission clusters among key populations in Wisconsin.
LOCKDOWN AS A PANDEMIC MITIGATING POLICY INTERVENTION IN INDIA
Authors: Mandal Subhayan , Kumar Manoj , Sarkar Debasish
Published: June 2020

Abstract

We use publicly available timeline data on the Covid-19 outbreak for nine indian states to calculate the important quantifier of the outbreak, the sought after Rt or the time varying reproduction number of the outbreak. This quantity can be measured in in several ways, e.g. by application of Stochastic compartmentalised SIR (DCM) model, Poissonian likelihood based (ML) model & the exponential growth rate (EGR) model. The third one is known as the effective reproduction number of an outbreak. Here we use, mostly, the second one. It is known as the instantaneous reproduction number for an outbreak. This number can faithfully tell us the success of lockdown measures inside indian states, as containment policy for the spread of Covid-19 viral disease. This can also, indirectly yield notional value of the generation time inteval in different states. In doing this work we employ, pan India serial interval of the outbreak estimated directly from data from January 30th to April 19th, 2020. Simultaneously, in conjunction with the serial interval data, our result is derived from incidences data between March 14th, 2020 to June 1st, 2020, for the said states. We find the lockdown had marked positive effect on the nature of time dependent reproduction number in most of the Indian states, barring a couple. The possible reason for such failures have been investigated.
ApoE e4e4 genotype and mortality with COVID-19 in UK Biobank
Authors: Kuo Chia-Ling , Pilling Luke C , Atkins Janice L , Masoli Jane AH , Delgado João , Kuchel George A , Melzer David
Published: June 2020

We previously reported that the ApoE e4e4 genotype was associated with COVID-19 test positivity (OR=2.31, 95% CI: 1.65 to 3.24, p=1.19×10−6) in the UK Biobank (UKB) cohort, during the epidemic peak in England, from March 16 to April 26, 2020. With more COVID-19 test results (March 16 to May 31, 2020) and mortality data (to April 26, 2020) linked to UKB, we re-evaluated the ApoE e4 allele association with COVID-19 test positivity, and with all-cause mortality following test-confirmed COVID-19. Logistic regression models compared ApoE e4e4 participants (or e3e4s) to e3e3s with adjustment for sex; age on April 26th or age at death; baseline UKB assessment center in England (accounting for geographical differences in viral exposures); genotyping array type; and the top five genetic principal components (accounting for possible population admixture). ApoE e4e4 genotype was associated with increased risks of test positivity (OR=2.24, 95% CI: 1.72 to 2.93, p=3.24×10−9) and of mortality with test-confirmed COVID-19 (OR=4.29, 95% CI: 2.38 to 7.72, p=1.22×10−6), compared to e3e3s. Independent replications are needed to confirm our findings and mechanistic work is needed to understand how ApoE e4e4 results in the marked increase in vulnerability, especially for COVID-19 mortality. These findings also demonstrate that risks for COVID-19 mortality are not simply related to advanced chronological age or the comorbidities commonly seen in aging.
Distress among Brazilian university students due to the Covid-19 pandemic: survey results and reflections
Authors: Von Krakauer Hübner Carlos , de Lima Bruscatto Marcella , Lima Rafaella Dourado
Published: June 2020

The first case of infection with the new coronavirus was identified in December 2019 in Wuhan, China. In March, the World Health Organization (WHO) defined the disease epidemic as a pandemic. Thus, a quarantine was imposed by many governments. As a consequence, and given that epidemiological outbreaks of infectious diseases, such as Covid-19, are associated with psychological disorders and symptoms of mental illness, researchers at the Shanghai Mental Health Center have created the Covid-19 Peritraumatic Distress Index (CPDI), in which the results are obtained: normal, mild/moderate distress and severe distress. The main objective of the study was based on the application of CPDI, in order to identify the health and well-being of Brazilian students from different undergraduate courses at the Pontifical Catholic University of São Paulo (PUC/SP) during the Covid-19 pandemic and to test the hypothesis that medical students suffer more than students from other courses. The research is based on a cross-sectional observational study, in which we applied, using Google FormsR, the questions contained in CPDI, among with demographic data: age, sex, educational institution, undergraduate course and school year. The Index was applied online for seven days in which a total of 654 valid responses were obtained: 501 (76.6%) female and 149 (22.8%) male. Regarding age, 333 students (50.91%) were 17-20 years old, 279 (42.66%) between 21-25, 30 (4.59%) between 26-30 and 12 (1.84%) between 31-50. The results indicate that the participants reported significant psychological distress, according to the CPDI score. Practically 90% (87.92%) of the students experienced suffering, while only 12.08% did not suffer. The study provides the first empirical evidence on the level of psychological distress in Brazilian university students during the Covid-19 pandemic. Also, it suggests support and monitoring of university students during and after the pandemic, with effective and efficient intervention in their mental health.

Summary boxes

SECTION 1

Researchers at the Shanghai Mental Health Center have created the Covid-19 Peritraumatic Distress Index (CPDI), to measure the amount of psychological suffering of the population, due to the pandemic of Coronavirus. Before our research, the survey had been applicated in China and Iran. The main objective of the study was to identify with the survey, the health and well-being of Brazilian students from different undergraduate courses at the Pontifical Catholic University of São Paulo (PUC/SP) during the Covid-19 pandemic and to test the hypothesis that medical students suffer more than students from other courses.

SECTION 2

The study provides the first empirical evidence on the level of psychological distress in Brazilian university students during the Covid-19 pandemic, practically 90% (87.92%) of the students experienced some suffering.
Affected medical services in Iwate prefecture in the absence of a COVID-19 outbreak
Authors: Sasaki Noriyuki , Nishizuka Satoshi S.
Published: June 2020

The Japanese government has declared a national emergency and travel entry ban since the coronavirus disease 2019 (COVID-19) pandemic began. As of June 19, 2020, there have been no confirmed cases of COVID-19 in Iwate. Here, we analyzed the excess deaths as well as the number of patients and medical earnings due to the pandemic from prefectural hospitals located in one of the least-affected areas in Japan. From January to March 2020, the excess death rates per month were not significantly higher than the past-year average. Compared to January 2020, the numbers of both outpatients and inpatients in April 2020 showed a 5.2% and 6.1% decrease, respectively. Accordingly, the amount of medical earnings of both outpatients and inpatients in April 2020 showed a 3.0% and 6.3% decrease, respectively. Present analysis demonstrated that there were no excess deaths due to “unidentified” COVID-19 infections in Iwate; however, hospital budgetary management has been affected by the social restrictions. Regardless of COVID-19 infection spread, it may be difficult to maintain daily medical services if such low service activity continues in the existing hospitals. Additional longitudinal studies will be necessary to evaluate the effects of social restrictions on hospital management, but the true demand of regional medical services may emerge after this outbreak.
COVID-19 preventive behaviors among people with anxiety and depression: Findings from Japan
Authors: Stickley Andrew , Matsubayashi Tetsuya , Sueki Hajime , Ueda Michiko
Published: June 2020

Little is known about COVID-19 preventive behaviors among individuals with mental health problems. This study used cross-sectional online survey data from 2000 Japanese adults collected in April and May, 2020, to examine the association between anxiety and depression and COVID-19 preventive behaviors. Results from logistic regression analyses showed that both anxiety and depression were associated with lower odds for engaging in preventive behaviors such as wearing a face mask and hand washing. Our results highlight the importance of facilitating the performance of preventive behaviors in individuals with mental health problems to prevent the spread of COVID-19 in this population.
Half of children entitled to free school meals do not have access to the scheme during the COVID-19 lockdown in the UK
Authors: Parnham Jennie C , Laverty Anthony A , Majeed Azeem , Vamos Eszter P
Published: June 2020

Objectives

To investigate access to free school meals (FSM) among eligible children, to describe factors associated with uptake and investigate whether receiving FSM was associated with measures of food insecurity in the UK using the COVID-19 wave of the UK Household Longitudinal Study (UKHKS).

Study design

Cross sectional analyses of questionnaire data collected in April 2020.

Methods

635 children who were FSM eligible with complete data were included in the analytic sample. Accessing a FSM was defined as receiving a FSM voucher or a cooked meal at school. Multivariable logistic regression was used to investigate (i) associations between characteristics and access to FSM and (ii) associations between access to FSM and household food insecurity measures. All analyses accounted for survey design and sample weights to ensure representativeness

Results

51% of eligible children accessed a FSM. Children in junior schools or above (aged 8+ years) (Adjusted Odds Ratio (AOR) 11.81; 95% CI 5.54,25.19), who were low income (AOR 4.81; 95% CI 2.10,11.03) or still attending schools (AOR 5.87; 95% CI 1.70,20.25) were more likely to receive FSM. Children in Wales were less likely to access FSM than those in England (AOR 0.11; 95% CI 0.03,0.43). Receiving a FSM was associated with an increased odds of recently using a food bank, but not reporting feeling hungry.

Conclusions

In the month following the COVID-19 lockdown, 49% of eligible children did not receive any form of FSM. The present analyses highlight that the voucher scheme did not adequately serve children who could not attend school during the lockdown. Moreover, more needs to be done to support families relying on income-related benefits, who still report needing to access a foodbank. As the scheme may be continued in summer or in a potential second wave, large improvements will be needed to improve its reach.
Estimating the proportion of coronavirus disease 2019 (COVID-19) cases among households in France: a cross-sectional study based on individuals with myocardial infarction history
Authors: Fraticelli Laurie , Freyssenge Julie , Claustre Clément , Martinez Mikaël , Redjaline Abdesslam , Serre Patrice , Bochaton Thomas , Khoury Carlos El
Published: June 2020

Background

Previous studies have identified that adults with cardiovascular diseases were disproportionately associated with a significantly increased risk of a severe form of COVID-19 and all-cause mortality. We aimed to describe the diagnosed COVID-19 cases and to estimate the symptomatic and asymptomatic suspected cases among individuals with pre-existing myocardial infarction myocardial infarction and their relatives in lockdown period. Methods: We conducted a two-week cross-sectional telephone survey, from May 4 to May 15, 2020, including all households with at least one individual with pre-existing cardiovascular disease in the past two years. We defined a suspected COVID-19 case when living with at least one individual tested positive to COVID-19, or when an individual has been in contact with a suspected or confirmed case since the March 1rst, or when a relative from the same house has been hospitalized or deceased for COVID-19.

Results

We observed high rates of compliance with health measures during the lockdown period, regardless of age or risk factors. Among individuals with myocardial infarction history, two were COVID-19 confirmed, 13·37% were suspected (94/703) of whom 70·21% (66/94) asymptomatic.

Conclusions

Individuals with myocardial infarction history presented different symptoms association with more respiratory signs. This population, which is older and associated with more comorbidities, is exposed to a high risk of complication in the event of contamination. Infection rates are relevant to adjusting the management of emergency departments in our region.
Prescribing patterns for medical treatment of suspected prostatic obstruction: A spatiotemporal statistical analysis of Scottish open access data
Authors: Andreis Federico , Bryant Richard , Giorgi Emanuele , Williamson Andrea , Ward Ashleigh
Published: June 2020

Background

Healthcare services treating men with prostate conditions are increasingly burdened worldwide. One of the competing factors in this demand is increasing diagnosis and treatment of lower urinary tract symptoms in men, much of which is suspected bladder outflow obstruction secondary to benign prostate hyperplasia/enlargement. However, the impact of increases on services is largely hidden, and there is limited knowledge of potential differences in management based on geography.

Objective

To investigate potential variation in the prescribing of drugs for suspected bladder outflow obstruction in Scotland based on analysis of publicly available data, and identify trends that may help to inform future prescribing behaviour.

Design, setting, and participants

We linked the relevant publicly available prescribing and patient data to all general practices in Scotland between October 2015 and November 2019.

Outcome measurements and statistical analysis

We analysed the numbers of daily doses of drugs prescribed for suspected bladder outflow obstruction per month using a Bayesian Poisson regression analysis, incorporating random effects to account for spatial and temporal elements in prescribing.

Results

Prescriptions of drugs to treat suspected bladder outflow obstruction increased during the observation period in Scotland, consistent with an ageing population and increased diagnosis. Whilst some determinants of health inequality regarding prescribing practices across health boards are consistent with those known from the literature, other inequalities remain unexplained after accounting for practice- and patient-specific characteristics such as socio-economic deprivation and rurality.

Conclusions

Variations in spatiotemporal prescribing for suspected bladder outflow obstruction exist in Scotland, some of which are unexplained and require further investigation.
Chloroquine, but not hydroxychlorquine, prolongs the QT interval in a primary care population
Authors: Isaksen Jonas L. , Holst Anders G. , Pietersen Adrian , Nielsen Jonas B. , Graff Claus , Kanters Jørgen K.
Published: June 2020

Background

Chloroquine (CQ) and Hydroxychloroquine (HCQ) have recently been suggested as treatment for the current Corona Virus Disease 2019 (COVID-19) pandemic. However, despite their long-term use and only few case reports on adverse effects, CQ and HCQ are listed as a known risk of the lethal ventricular arrhythmia Torsade de Pointes and their cardiac safety profile is being questioned. Thus, we aimed to investigate the electrocardiographic and mortality effects of CQ and HCQ in a primary care population.

Methods

We used Danish health care registers and electrocardiograms (ECGs) from primary care to define three studies. 1) A paired study of subjects with ECGs before and during use of CQ/HCQ, 2) a matched ECG study of subjects taking CQ/HCQ compared to controls, and 3) a mortality study on people taking HCQ matched to control. In both matched studies, we adjusted for connective tissue diseases, use of QT-prolonging drugs, and cardiac disease. We used the QTc interval as the marker for electrocardiographic safety. In the mortality study, cases were followed from first claimed prescription until 300 days after estimated completion of the last prescription. 95% confidence intervals follow estimates in parenthesis.

Results

Use of CQ was associated with a 5.5 (0.7;10) ms increase in QTc in the paired study (n=10). In the matched study (n=28, controls=280), QTc was insignificantly increased in subjects taking CQ by 4.7 (−3.4;13) ms. With a ΔQTc of 1.0 (−5.6;7.5), use of HCQ was not associated with an increased QTc in the paired study (n=32). In the matched study (n=172, controls=1,720), QTc also was not different between groups (p=0.5). In the mortality study (n=3,368), use of HCQ was associated with a hazard ratio of 0.67 (0.43;1.05).

Conclusions

In subjects free of COVID-19, we found a small increase in QTc associated with use of chloroquine, but not hydroxychloroquine. We found no increased mortality associated with use of hydroxychloroquine.
Epidemiological Risk Factors Associated with Death and Severe Disease in Patients Suffering From COVID-19: A Comprehensive Systematic Review and Meta-analysis
Authors: Dorjee Kunchok , Kim Hyunju
Published: June 2020

Introduction

Progression of COVID-19 to severe disease and death is insufficiently understood.

Objective

Summarize the prevalence adverse outcomes, risk factors, and association of risk factors with adverse outcomes in COVID-19 patients.

Methods

We searched Medline, Embase and Web of Science for case-series and observational studies of hospitalized COVID-19 patients through May 22, 2020. Data were analyzed by fixed-effects meta-analysis, using Shore’s adjusted confidence intervals to address heterogeneity.

Results

Forty-four studies comprising 20594 hospitalized patients met inclusion criteria; 12591 from the US-Europe and 7885 from China. Pooled prevalence of death [%(95% CI)] was 18% (15-22%). Of those that died, 76% were aged≥ 60 years, 68% were males, and 63%, 38%, and 29% had hypertension, diabetes and heart disease, respectively. The case fatality risk [%(95% CI)] were 62% (48-78) for heart disease, 51% (36-71) for COPD, and 42% (34-50) for age≥ 60 years and 49% (33-71) for chronic kidney disease (CKD). Summary relative risk (sRR) of death were higher for age≥ 60 years [sRR=3.8; 95% CI: 2.9-4.8; n=12 studies], males [1.3; 1.2-1.5; 17], smoking history [1.9; 1.1-3.3; n=6], COPD [2.0; 1.6-2.4; n=9], hypertension [1.8; 1.7-2.0; n=14], diabetes [1.5; 1.4-1.7; n=16], heart disease [2.0; 1.7-2.4; 16] and CKD [2.0; 1.3-3.1; 8]. The overall prevalence of hypertension (55%), diabetes (31%) and heart disease (16%) among COVODI-19 patients in the US were substantially higher than the general US population.

Conclusions

Public health screening for COVID-19 can be prioritized based on risk-groups. A higher prevalence of cardiovascular risk factors in COVID-19 patients can suggest increased risk of SARS-CoV-2 acquisition in the population.
Patterns of IgM Binding to Tumor Associated Antigen Peptides Correlate with the Type of Brain Tumors
Authors: Ferdinandov Dilyan , Kostov Viktor , Hadjieva Maya , Shivarov Velizar , Bussarsky Assen , Pashov Anastas
Published: June 2020

The immune system can be used as a biosensor of the internal environment. Changes in the reactivities of the antibody repertoire can be used as a readout for a wide range of disturbances including various inflammatory conditions and malignant tumors. Extending our previous work based on IgM mimotope libraries, here we report our studies on the interpretability of profiles of IgM reactivities to a library of natural 15-mer peptides derived from 20 tumor associated antigens and 193 linear B cell epitopes involved in tumor pathogenesis. Sera from 21 patients with glioblastoma multiforme (GBM, n=10), brain metastases of other tumors (n=5) and non-tumor bearing neurosurgery patients (n=6) were used to probe their IgM reactivity with an array of 4526 peptide sequences. Using feature selection algorithms, we were able to extract profiles that separated well the three diagnostic groups with accuracy of up to 0.9. A key feature of the profiles extracted was their size (138 peptides for differentiating GBM and 340 – for tumor bearing patients) and origin from practically all tested antigens. Comparable numbers of reactivities were gained or lost in tumor bearing patients. A minimal set of the most significant 41 reactivities from 16 antigens contained disproportionately large number of epitopes from stromelysine-3 and erbB2 receptor with some of the reactivities gained and other lost in cancer patients. Epitopes from human papilloma virus 16 and HTLV-1 were included too. Some of the reactivities were readily interpretable both as antigen source and structural context (signal peptides). The interpretation of the rest requires further confirmatory studies. Thus, a set of natural peptides from tumor antigens readily provides profile of interpretable IgM reactivities which can serve as classifiers for clinically relevant patient stratification.
The immediate psychological response of the general population in Saudi Arabia during COVID-19 pandemic: a cross-sectional study
Authors: Joseph Royes , Alshayban Dhfer , Lucca Jisha M , Alshehry Yasir Abdulaziz
Published: June 2020

Background

The health and economic burden of pandemic diseases significantly cause psychosocial problems. The outbreak of COVID-19 may differentially exacerbate anxiety and stress in people subjected to the real or perceived threat of the virus.

Method

An online cross-sectional survey was carried out to assess the general population’s immediate psychological response during the initial state of the outbreak in Saudi Arabia. The study used brief screening tools PHQ-4 for anxiety-depression symptoms and IES-6 for posttraumatic stress disorder symptoms.

Results

Among the 584 respondents, 19.8% and 22.0% reported moderate to severe anxiety and depression symptoms respectively. According to the combined PHQ-4 score, 14.5% of participants showed moderate to severe anxiety or depression disorder. Overall, 64.8% met the level of clinical concern for posttraumatic stress disorder and 51.3% met the level of probable posttraumatic stress disorder diagnosis. Multivariate analyses showed that females, non-Saudi nationalities, and those who had a history of mental illness were more vulnerable to anxiety and depression disorders than their counterparts, whereas a higher prevalence of distress symptoms was reported among those who prefer Arabic over English for communication. It was found that people whose colleagues or family infected with the disease were more likely to report moderate to severe symptoms of anxiety or depression and distress. The study further showed that the higher the perceived threat, the higher the chances of exhibiting anxiety-depressive disorder symptoms and distress symptoms.

Conclusion

The findings might be a matter for serious concern, and considerable attention is required from authorities and policymakers regarding early detection and treatment of these illnesses in order to reduce the burden of the pandemic related mental illness.
Five years functional connectivity reorganization without clinical or cognitive decline in MS
Authors: Høgestøl Einar August , Ghezzo Samuele , Nygaard Gro Owren , Espeseth Thomas , Sowa Piotr , Beyer Mona K. , Harbo Hanne Flinstad , Westlye Lars T. , Hulst Hanneke E. , Alnæs Dag
Published: June 2020

Objective

1) To assess fMRI-based functional connectivity (FC) anomalies in early multiple sclerosis (MS), 2) To determine the relation between FC changes and structural brain damage due to disease progression 3) To study the association between FC changes and cognitive and physical disability.

Methods

Structural MRI and resting-state fMRI were acquired from 76 early relapsing-remitting MS patients at baseline (average disease duration 71.7 months ± 63) and after five years. Ninety-four healthy controls (HCs) matched for age and sex were included at baseline. Independent component analysis (ICA) and network modelling were used to measure FC. FC variation was related to expanded disability status scale and neuropsychological outcomes. Brain and lesion volumes were quantified using standard methods. We used the 25 independent components obtained from ICA to estimate the longitudinal stability of the brain connectome as a proxy for functional reorganization over time.

Results

The MS subjects were clinically and cognitively stable. Compared to HCs, FC abnormalities were detected within networks and in single connections in patients with early MS at baseline. Over time, FC was relatively invariable, but changes in FC were associated with progression of brain atrophy (ρ = 0.39, p = .06). No significant relationship with clinical and cognitive measures or lesion load was detected.

Conclusion

Patients with MS showed evidence of altered FC in the early stages of the disease. Over time, changes in FC seem to be related to a progression of brain atrophy, which are known to precede changes in clinical and cognitive functioning.
The potential for digital patient symptom recording through symptom assessment applications to optimize patient flow and reduce waiting times in Urgent Care Centers: a simulation study
Authors: Montazeri Maryam , Multmeier Jan , Novorol Claire , Upadhyay Shubhanan , Wicks Paul , Gilbert Stephen
Published: June 2020

Background

Overcrowding can negatively affect the performance of the health care facilities not only for patients in terms of delayed care delivery and increased health risk, but also for health care workers in terms of increased burden and stress. Sometimes overcrowding is a result duplicate activity such as history taking and recording of patients’ symptoms. In this case, using a digital symptom assessment application can prevent duplication of such activities and may decrease the crowding in health care facilities.

Objective

We sought to understand the effect of a digital symptom assessment app that facilitates the taking of patient clinical history to optimize patient flow. We hypothesized that waiting times and crowding in an urgent care center could be reduced through the introduction of a digital history taking tool, and that this would be more efficient than simply adding more staff.

Methods

A discrete event approach was used to simulate patient flow in an urgent care center during a hypothetical 4-hour time window. The baseline case simulated a small center with 2 triage nurses, 2 doctors, 1 treatment/examination nurse and 1 discharge administrator in service. In addition to the base case, the center is simulated in 32 scenarios either with different number of staff or different assumption on time saved by the app. Target outcomes included average queue length, waiting time, idle time and utilization of staff

Results

Discrete event simulation found that a few minutes saved by a digital history taking app during triage could significantly increase efficiency. An estimated time-saving per patient of 2.5 minutes decreased average patient wait for triage by 26.17%; a 5 minutes time-saving would lead to a 54.88% reduction. Alternatively, adding an additional triage nurse was less efficient, as the additional staff were only required at the busiest times. While reduction in waiting time for triage was similar (approximately 50%) for either approach, adding a triage nurse reduced the median nurse utilization from 97% to 41%, while adding the tool resulted in median nurse utilization of 88%.

Conclusions

Digital history taking could result in substantial reduction in patient waiting time for triage nurses, which is associated with reduced patient anxiety, staff anxiety and improved patient care. Patient history taking could be carried out in waiting room (via a check-in kiosk or portable tablet computer) or out at home. This simulation has the potential to impact service provision and approaches to digitalization at scale.
COVID-19 and first trimester spontaneous abortion: a case-control study of 225 pregnant patients
Authors: Cosma Stefano , Carosso Andrea , Cusato Jessica , Borella Fulvio , Carosso Marco , Bovetti Marialuisa , Filippini Claudia , D’Avolio Antonio , Ghisetti Valeria , Di Perri Giovanni , Benedetto Chiara
Published: June 2020

Background

Evidence for the impact of COVID-19 during the second and the third trimester of pregnancy is limited to a relatively small series, while data on the first trimester are scant. With this study we evaluated COVID-19 infection as a risk factor for spontaneous abortion in first trimester of pregnancy.

Methods

Between February 22 and May 21, 2020, we conducted a case-control study at S. Anna Hospital, Turin, among first trimester pregnant women, paired for last menstruation. The cumulative incidence of COVID-19 was compared between women with spontaneous abortion (case group, n=100) and those with ongoing pregnancy (control group, n=125). Current or past infection was determined by detection of SARS-CoV-2 from nasopharingeal swab and SARS- CoV-2 IgG/IgM antibodies in blood sample. Patient demographics, COVID-19-related symptoms, and the main risk factors for abortion were collected.

Findings

Twenty-three (10.2%) of the 225 women tested positive for COVID-19 infection. There was no difference in the cumulative incidence of COVID-19 between the cases (11/100, 11%) and the controls (12/125, 9.6%) (p=0.73). Logistic regression analysis confirmed that COVID-19 was not an independent predictor of abortion (1.28 confidence interval 0.53-3.08).

Interpretation

COVID-19 infection during the first trimester of pregnancy does not appear to predispose to abortion; its cumulative incidence did not differ from that of women with ongoing pregnancy.
Sex Moderates the Relationship that Number of Professional Fights has with Cognition and Brain Volumes
Authors: Bennett Lauren L. , Stephen Steve , Bernick Charles , Shan Guogen , Banks Sarah J.
Published: June 2020

Objective

Incidence of concussions and report of symptoms are greater amongst women across sports. While structural brain changes and cognitive declines are associated with repetitive head impact (RHI), the role of sex is not well understood. This study aimed to determine if there is a moderating effect of sex on the relationship number of professional fights has with cognitive functioning and regional brain volumes in a cohort of boxers, mixed martial artists, and martial artists.

Methods

55 women were matched with 55 men based on age, years of education, ethnicity, and fighting style. Cognition was assessed via CNS Vital Signs computerized cognitive battery and supplemental measures. Structural brain scans, demographic data, and number of professional fights (NoPF) were also considered. Matched pairs were compared via analysis of covariance, accounting for total brain volume. Within-subject moderation models were utilized to assess the moderating effect of sex on the relationship between NoPF and brain volumes and cognitive performance.

Results

Men were observed to have poorer performance on measures of psychomotor speed when compared to women. On a series of analyses assessing the role of sex as a moderator of the relationship between NoPF and regional brain volumes/cognitive performance, a significant moderation effect was observed across multiple measures of cognitive functioning, such that men had poorer performance. Differences in numerous regional brain volumes were also observed, such that the relationship between NoPF and brain volumes was steeper amongst men.

Conclusion

Sex was observed to be an important moderator in the relationship between NoPF, aspects of cognitive functioning, and volumes of numerous brain regions, suggesting that sex differences in neuroanatomic and cognitive response to RHI deserve further attention.
Impact of mental disorders on active tuberculosis treatment outcomes: a systematic review and meta-analysis
Authors: Lee Ga Eun , Scuffell James , Galea Jerome T. , Shin Sanghyuk S. , Magill Elizabeth , Jaramillo Ernesto , Sweetland Annika C.
Published: June 2020

Background

Comorbid mental disorders in patients with tuberculosis (TB) may exacerbate TB treatment outcomes. We systematically reviewed current evidence on the association between mental disorders and TB outcomes.

Methods

We searched eight databases for studies published from 1990-2018 that compared TB treatment outcomes among patients with and without mental disorders. We excluded studies that did not systematically assess mental disorders and studies limited to substance use. We extracted study and patient characteristics and effect measures and performed a meta-analysis using random-effects models to calculate summary odds ratios (OR) with 95% confidence intervals (CI).

Findings

Of 7,687 studies identified, ten were included in the systematic review and nine in the meta-analysis. Measurement of mental disorders and TB outcomes were heterogeneous across studies. The pooled association between mental disorders and any poor outcome, loss to follow-up, and non-adherence were OR 2.13 (95% CI: 0.85-5.37), 1.90 (0.33-10.91), and 1.60 (0.81-3.02), respectively. High statistical heterogeneity was present.

Interpretation

Our review suggests that mental disorders in TB patients increase the risk of poor TB outcomes, but pooled estimates were imprecise due to small number of eligible studies. Integration of psychological and TB services might improve TB outcomes and progress towards TB elimination.
Highly Accurate and Reproducible Diagnosis of Peanut Allergy Using Epitope Mapping
Authors: Kearney Paul , Getts Robert , Hayward Clive , Luta David , Porter Alex , Witmer Marc , du Toit George , Lack Gideon , Chinthrajah R. Sharon , Galli Stephen J , Nadeau Kari , Grishina Galina , Suárez-Fariñas Mayte , Suprun Maria , Sampson Hugh A
Published: June 2020

Background

Misdiagnosis of peanut allergy is a significant clinical challenge. Here, a novel diagnostic blood-based test using a Bead-Based Epitope Assay (“peanut BBEA”) has been developed on the LEAP cohort and then independently validated on the CoFAR2 and POISED cohorts.

Methods

Development of the peanut BBEA followed the National Academy of Medicine’s established guidelines with discovery performed on 133 subjects from the non-interventional arm of the LEAP trial and an independent validation performed on 81 subjects from the CoFAR2 study and 84 subjects from the POISED study. All subject samples were analyzed using the BBEA methodology. The peanut BBEA test measures levels of two Ara h 2 epitopes and compares their combination to a pre=specified threshold. If the combination of the two epitope levels is at or below the threshold, then the subject is ruled “Not Allergic”, otherwise the subject is ruled “Allergic”.

All allergic diagnoses were OFC confirmed and subjects’ ages were 7-55 years.

Results

In validation on the CoFAR2 and POISED cohorts, the peanut BBEA test had a combined sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and accuracy of 91%, 95%, 95%, 91%, 18.2, 0.09 and 93%, respectively.

Conclusion

The peanut BBEA test performance in validation demonstrated overall high accuracy and compared very favorably with existing diagnostic tests for peanut allergy including skin prick testing, peanut sIgE and peanut component testing.
Global years of life lost to COVID-19
Authors: i Arolas Héctor Pifarré , Acosta Enrique , Casasnovas Guillem López , Lo Adeline , Nicodemo Catia , Riffe Tim , Myrskylä Mikko
Published: June 2020

Understanding the mortality impact of COVID-19 requires not only counting the dead, but analyzing how premature the deaths are. We calculate years of life lost (YLL) across 42 countries due to COVID-19 attributable deaths, and also conduct an analysis based on estimated excess deaths. As of June 13th 2020, YLL in heavily affected countries are 2 to 6 times the average seasonal influenza; over two thirds of the YLL result from deaths in ages below 75 and one quarter from deaths below 55; and men have lost 47% more life years than women. The results confirm the large mortality impact of COVID-19 among the elderly. They also call for heightened awareness in devising policies that protect vulnerable demographics losing the largest number of life-years.

One Sentence Summary

Across 42 countries, the years of life lost due to COVID-19 are up to 6 times that of the average seasonal flu.
Real-time assessment of daytime sleepiness in drivers with multiple sclerosis
Authors: Devos Hannes , Alissa Nesreen , Lynch Sharon , Sadeghi Maryam , Akinwuntan Abiodun E. , Siengsukon Catherine
Published: June 2020

Background

Daytime sleepiness is a common symptom of multiple sclerosis (MS) that may jeopardize safe driving. The aim of this study was to compare daytime sleepiness, recorded in real-time through eyelid tracking, in a simulated drive between individuals with MS (iwMS) and healthy controls.

Methods

Fifteen iwMS (age = median (Q1 – Q3), 55 (50 – 55); EDSS = 2.5 (2 – 3.5); 12 (80%) female) were matched for age, sex, education, and cognitive status with 15 controls. All participants completed self-reported fatigue and sleepiness scales including the Modified Fatigue Impact Scale (MFIS), Pittsburg Sleep Quality Inventory (PSQI), and Epworth Sleepiness Scale (ESS). Percentage of eyelid closure (PERCLOS) was extracted from a remote eye tracker while completing a simulated drive of 25 minutes.

Results

Although iwMS reported more symptoms of fatigue (MFIS, p =0.003) and poorer sleep quality (PSQI, p = 0.008), they did not report more daytime sleepiness (ESS, p = 0.45). Likewise, there were no differences between groups in real-time daytime sleepiness, indexed by PERCLOS (p = 0.82). Both groups exhibited more real-time daytime sleepiness as they progressed through the drive (time effect, p< 0.0001). The interaction effect of group*time (p = 0.05) demonstrated exacerbated symptoms of daytime sleepiness towards the end of the drive in iwMS compared to controls.

PERCLOS correlated strongly (Spearman ρ = 0.76, p = 0.001) with distance out of lane in iwMS.

Conclusion

IwMS show exacerbated symptoms of daytime sleepiness during monotonous, simulate drive. Future studies are warranted to investigate the effect of MS on daytime sleepiness during real-world driving.
CD14 (C-159T) polymorphism is associated with increased susceptibility to SLE, and plasma levels of soluble CD14 is a novel biomarker of disease activity: a hospital-based case-control study
Authors: Panda Aditya K , Tripathy Rina , Das Bidyut K
Published: June 2020

Background

Cluster of differentiation 14 (CD14) plays a crucial role in the innate immune response of the host in protection against various pathogens. The importance of soluble CD14 in autoimmune disorders has been described in different populations. However, the role of sCD14 in systemic lupus erythematosus (SLE) is poorly understood. Further, the association of functional variants at the promoter region of the CD14 gene (−159 C>T) with susceptibility to SLE or disease severity needs to be defined.

Methods

Two hundred female SLE patients diagnosed on SLICC classification criteria and age, sex, matched healthy controls were enrolled in the present study. PCR-RFLP method was used to genotype CD14 (C-159 T) polymorphism. Plasma levels of IFN-α, TNF-α, and sCD14 were quantified by ELISA.

Results

Prevalence of mutant genotypes (CT and TT) and minor allele of CD14 (C-159T) polymorphism was significantly higher in SLE cases compared to healthy controls (CT:P<0.0001; OR=3.26, TT:P<0.0001; OR=3.39; T:P=0.0009, OR=1.62). Further, lupus nephritis patients had a higher prevalence of homozygous mutants (TT) and mutant allele (T)(TT: P=0.0002, OR=8.07; T: P=0.001, OR=1.32). SLE patients displayed significantly increased plasma sCD14, TNF-α, and IFN-α levels in comparison to healthy controls. These cytokines were significantly elevated in patients of lupus nephritis compared to those without kidney involvement. Interestingly, sCD14 levels correlated positively with SLEDAI-2K scores and 24 hours proteinuria.

Conclusion

CD14 (C-159T) polymorphism is associated with an increased predisposition to the development of SLE and lupus nephritis: sCD14 is a promising novel biomarker for assessing disease activity and lupus nephritis.