bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of intramedullary nailing fixation and percutaneous locked plating fixation for the treatment of proximal tibial fractures: A meta-analysis
Authors: Ren Cheng , Li Ming , Sun Liang , Li Zhong , Xu Yibo , Lu Yao , Wang Qian , Ma Teng , Xue Hanzhong , Zhang Kun
Published: July 2021

Objective:

This meta-analysis aimed to systematically compare the clinical outcomes of intramedullary nailing (IMN) fixation and percutaneous locked plating (PLP) fixation in the treatment of proximal tibial fractures.

Methods:

We searched PubMed, Embase, Cochrane library, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), and Wan Fang to select relevant articles up to March 29, 2020 without language limit. Continuous variables were estimated by weighted mean difference (WMD) with a 95% confidence interval (CI) and dichotomous outcomes were calculated by relative risk (RR) with 95% CI. Moreover, heterogeneity analysis was evaluated. Furthermore, publication bias assessment and sensitivity analysis were conducted. Stata 11.0 software was used to perform the statistical analysis.

Results:

Ten studies involving 667 cases (321 from IMN fixation group and 346 from PLP fixation group) were included. The type of fractures involved in the included articles was extra-articular proximal tibia fractures. IMN fixation method achieved significantly shorter union time ( WMD = −2.88, 95% CI: −3.23 to −2.53, p < 0.001) and full weight-bearing time ( WMD = −2.81, 95% CI: −3.64 to −1.97, p < 0.001) than PLP fixation method. Meanwhile, IMN fixation resulted in lower risks of infection ( RR = 0.50, 95% CI: 0.27 to 0.91, p = 0.02) and total complications ( RR = 0.36, 95% CI: 0.22 to 0.60, p < 0.001) than PLP fixation. No significant differences were found in the incidence of nonunion ( p = 0.33), malunion ( p = 0.38), and osteofascial compartment syndrome (OCS, p = 0.62) between the two groups.

Conclusions:

Compared to PLP fixation, IMN fixation had several advantages in treating proximal tibial fractures, including the short time of union and full weight-bearing, as well as a low risk of infection and total complications.
The Ugly Side of Colchicine
Authors: Cozza Justin , Do Tuong Vi Cassandra , Ganti Shyam , Depa Jayaramakrishna
Published: July 2021

We report a rare case of a 32-year-old male who ingested 32.4 to 54 mg of colchicine and presented after 44 hours. He developed progressive multiple organ failure with shock, acute kidney failure, troponemia, pancytopenia, absolute neutropenia, disseminated intravascular coagulation, acute liver failure, rhabdomyolysis, and lactic acidosis. He also developed electrolyte abnormalities and refractory hypoglycemia. Initial treatment consisted of activated charcoal, fluids, and broad-spectrum antibiotics with supportive treatment of mechanical ventilation, hemodialysis, vasopressors, N-acetylcysteine, colony-stimulating factors, and blood products. Literature shows potential benefit of colchicine-specific Fab fragments for acute toxicity with limited studies and is not currently available in the United States. Further research for N-acetylcysteine protocol for acute liver failure in colchicine toxicity and potential use of colchicine-specific Fab fragments is needed. Our case demonstrates the importance of early use of activated charcoal for ingestion overdose with the incorporation of poison control into multidisciplinary team for coordinated patient care.
An Imperfect Marker: SLE and TTP-Like MAHA Without Low ADAMTS13
Authors: Chiruvolu Neha V. , Scott Jonathan , Yeh Sam S.
Published: July 2021

Thrombotic thrombocytopenic purpura (TTP) is a potentially fatal condition that can be challenging for clinicians to identify in the setting of autoimmune diseases such as systemic lupus erythematosus (SLE). This difficulty is compounded when a patient presents with all of the clinical signs of a TTP-like microangiopathy, however, with near normal ADAMTS13. This case report describes a 44-year-old female with a history of SLE who was hospitalized with acute on chronic anemia, thrombocytopenia, and altered mental status. The patient’s ADAMTS13 was mildly low; hence, she was initially treated for SLE-associated immune thrombocytopenic purpura without any clinical response. The patient then underwent plasmapheresis (plasma exchange [PLEX]) for treatment of a suspected TTP-like microangiopathy. She responded to PLEX with improvement in her platelet count and mental status. This case illustrates the importance of considering TTP-like microangiopathic hemolytic anemia in the differential for patients with a history of SLE presenting with clinical signs of TTP even in the setting of near-normal ADAMTS13, thus warranting prompt treatment with PLEX.
COVID-19 Post-Infectious Encephalitis Presenting With Delirium as an Initial Manifestation
Authors: Hara Makoto , Kouda Kento , Mizoguchi Tomotaka , Yokota Yuki , Hayashi Kentaro , Gon Yasuhiro , Nakajima Hideto
Published: July 2021

We report the case of a 65-year-old man with COVID-19 (coronavirus disease-2019) post-infectious encephalitis who presented with delirium as an initial manifestation. He had severe COVID-19 pneumonia and recovered with dexamethasone and tocilizumab. One week after discharge, he developed abnormal behavior and delirium without fever and respiratory symptoms. Brain magnetic resonance imaging showed no abnormalities. Cerebrospinal fluid showed pleocytosis and elevated protein concentrations and was negative for severe acute respiratory syndrome-coronavirus-2 RNA. No anti-neuronal autoantibodies against intracellular and neuronal surface proteins were detected. The cerebrospinal fluid inflammatory changes compatible with post-infectious encephalitis, and the patient recovered with intravenous methylprednisolone and intravenous immunoglobulin therapy. Delirium could be an initial symptom of post-infectious encephalitis in older adults with COVID-19, and these patients may require immunosuppressive therapy.
Preventing Falls and Malnutrition among Older Adults in Municipal Residential Care in Sweden: A Registry Study
Authors: Gusdal Annelie K. , Johansson-Pajala Rose-Marie , Arkkukangas Marina , Ekholm Anna , Zander Viktoria
Published: July 2021

Introduction

Older adults in municipal residential care are among the most vulnerable and in need of most care. The prevalence of negative events, such as falls and malnutrition, is increased among these older adults. The need for strategies to prevent falls and malnutrition is emphasized in guidelines and systematic, individualized risk assessments are prerequisites for adequate interventions.

Objectives

The overall purpose of this study was to investigate the assessed risks of, and risk factors for, falling and malnutrition and the correlations between these assessed risks among older women and men in residential care. Further, the purpose was to investigate the consistency between planned and performed interventions among women and men assessed as at risk.

Methods

A cross-sectional registry study based on risk assessment data in the Swedish national quality registry, Senior Alert. Altogether, 5,919 older adults ≥65 in nursing homes and dementia care units in 19 municipalities in Sweden were included.

Results

Of the older adults, 77% were at risk of falls, and 59% were at risk of malnutrition. The most prevalent risk factors for falls were previous falls and not being cognitively oriented; and for malnutrition were having mild or severe dementia or depression. A significant positive correlation between the risk of falling and the risk of malnutrition was found. Less than half of the planned interventions for falls and malnutrition were performed. Care staff’s least common interventions to prevent falls were balance, muscular function, and strength training, which contrasts with the recommendations; interventions to prevent malnutrition were only partially adhering to recommendations.

Conclusions

This cross-sectional registry study points towards the importance of using an evidence-based approach, based on adherence to recommended guidelines, in the prevention of falling and malnutrition. Further, the implementation of clinical practice guidelines is needed, which requires educational training for care staff and supportive leadership.
Principalization of the Anatomical Subunit Approximation Technique of Unilateral Cleft Lip Repair
Authors: Swanson Jordan W. , Van Slyke Aaron C. , Chong David K.
Published: July 2021

Background: The Anatomical Subunit Approximation cleft lip repair advantageously achieves a balanced lip contour with the line of repair placed along seams of aesthetic subunits. Since Fisher’s original description, it has been adopted widely and adapted, but some surgeons find the transition away from a cut-as-you-go approach challenging. Methods: We present an adapted Anatomic Subunit Approximation technique based on essential components of Fisher’s repair. The order of surgical execution is emphasized. Paradigm shifts are presented to help the surgeon used to more traditional rotation advancement techniques understand the Subunit philosophy. Minor adaptations such as surgically releasing lateral lip elements prior to marking are discussed. Results: A total of 53 eligible patients were treated with unilateral cleft lip repair by the senior author (D.C.) between February 2008 and April 2012 at Royal Children’s Hospital in Melbourne, Australia. Representative cases were chosen to demonstrate achievable results with the described technique. Conclusion: The proposed technique employs essential skin markings to achieve an anatomic subunit approximation lip repair, and appears to facilitate surgical outcomes with a high degree of symmetry. Core principles of repair include precise anatomical planning, tissue component separation, and muscle-driven advancement.
Gene therapy for hemophilia: a review on clinical benefit, limitations, and remaining issues
Authors: Leebeek Frank W. G. , Miesbach Wolfgang
Published: July 2021

In the last decade, enormous progress has been made in the development of gene therapy for hemophilia A and B. After the first encouraging results of intravenously administered adeno-associated virus (AAV)-based liver-directed gene therapy in patients with severe hemophilia B were reported in 2011, many gene therapy studies have been initiated. Most of these studies, using AAV vectors with various gene constructs, showed sufficient factor VIII and IX expression in patients to significantly reduce the number of bleeds and the need for prophylaxis in most patients with severe hemophilia. This resulted in great clinical benefit for nearly all patients. In this review, we will summarize the most recent findings of reported and ongoing gene therapy trials. We will highlight the successful outcome of trials with focus on the results of recently reported phase 1 trials and preliminary results of phase 2b/3 trials for hemophilia A and B. These new reports also reveal the impact of side effects and drawbacks associated with gene therapy. We will therefore also discuss the limitations and remaining issues of the current gene therapy approaches. These issues must be resolved before gene therapy will be widely available for the hemophilia patient population.
The alternative RelB NF-κB subunit is a novel critical player in diffuse large B-cell lymphoma
Authors: Eluard Baptiste , Nuan-Aliman Stéphanie , Faumont Nathalie , Collares Davi , Bordereaux Didier , Montagne Aurélie , Martins Isabelle , Cagnard Nicolas , Caly Martial , Taoui Oussama , Lordello Leonardo , Lehmann-Che Jacqueline , Tesson Bruno , Martinez-Climent Jose-Angel , Copie-Bergman Christiane , Haioun Corinne , Tilly Hervé , Bonsang Benjamin , Vincent-Salomon Anne , Jais Jean-Philippe , Jardin Fabrice , Leroy Karen , Maiuri Maria Chiara , Kroemer Guido , Molina Thierry Jo , Feuillard Jean , Baud Véronique
Published: July 2021

Diffuse large B-cell lymphoma (DLBCL) is the most frequent lymphoid malignancy affecting adults. The NF-κB transcription factor family is activated by 2 main pathways, the canonical and the alternative NF-κB activation pathway, with different functions. The alternative NF-κB pathway leads to activation of the transcriptionally active RelB NF-κB subunit. Alternative NF-κB activation status and its role in DLBCL pathogenesis remain undefined. Here, we reveal a frequent activation of RelB in a large cohort of DLBCL patients and cell lines, independently of their activated B-cell–like or germinal center B-cell–like subtype. RelB activity defines a new subset of patients with DLBCL and a peculiar gene expression profile and mutational pattern. Importantly, RelB activation does not correlate with the MCD genetic subtype, enriched for activated B-cell–like tumors carrying MYD88L265P and CD79B mutations that cooperatively activate canonical NF-κB, thus indicating that current genetic tools to evaluate NF-κB activity in DLBCL do not provide information on the alternative NF-κB activation. Furthermore, the newly defined RelB-positive subgroup of patients with DLBCL exhibits a dismal outcome after immunochemotherapy. Functional studies revealed that RelB confers DLBCL cell resistance to DNA damage–induced apoptosis in response to doxorubicin, a genotoxic agent used in the front-line treatment of DLBCL. We also show that RelB positivity is associated with high expression of cellular inhibitor of apoptosis protein 2 (cIAP2). Altogether, RelB activation can be used to refine the prognostic stratification of DLBCL and may contribute to subvert the therapeutic DNA damage response in a segment of patients with DLBCL.
CYB561A3 is the key lysosomal iron reductase required for Burkitt B-cell growth and survival
Authors: Wang Zhonghao , Guo Rui , Trudeau Stephen J. , Wolinsky Emma , Ast Tslil , Liang Jin Hua , Jiang Chang , Ma Yijie , Teng Mingxiang , Mootha Vamsi K. , Gewurz Benjamin E.
Published: July 2021

Epstein-Barr virus (EBV) causes endemic Burkitt lymphoma, the leading childhood cancer in sub-Saharan Africa. Burkitt cells retain aspects of germinal center B-cell physiology with MYC-driven B-cell hyperproliferation; however, little is presently known about their iron metabolism. CRISPR/Cas9 analysis highlighted the little-studied ferrireductase CYB561A3 as critical for Burkitt proliferation but not for that of the closely related EBV-transformed lymphoblastoid cells or nearly all other Cancer Dependency Map cell lines. Burkitt CYB561A3 knockout induced profound iron starvation, despite ferritinophagy ad plasma membrane transferrin upregulation. Elevated concentrations of ascorbic acid, a key CYB561 family electron donor, or the labile iron source ferrous citrate rescued Burkitt CYB561A3 deficiency. CYB561A3 knockout caused catastrophic lysosomal and mitochondrial damage and impaired mitochondrial respiration. Conversely, lymphoblastoid B cells with the transforming EBV latency III program were instead dependent on the STEAP3 ferrireductase. These results highlight CYB561A3 as an attractive therapeutic Burkitt lymphoma target.
Introduction to a review series on gene therapy and gene editing for sickle cell disease and hemophilia
Authors: Bollard Catherine M.
Published: July 2021

Introduced by Associate Editor Catherine Bollard, this review series focuses on the state of the art of gene therapy for sickle cell disease and hemophilia. These papers review the range of clinical trials for gene therapy of these two inherited diseases, with a focus on outcomes and safety. In addition, we include a Perspective article reflecting on the development of hematologic malignancy in 2 patients after gene therapy for sickle cell disease, which led to a brief suspension of 1 clinical trial that has now resumed enrollment.
DeepHBV: a deep learning model to predict hepatitis B virus (HBV) integration sites
Authors: Wu Canbiao , Guo Xiaofang , Li Mengyuan , Shen Jingxian , Fu Xiayu , Xie Qingyu , Hou Zeliang , Zhai Manman , Qiu Xiaofan , Cui Zifeng , Xie Hongxian , Qin Pengmin , Weng Xuchu , Hu Zheng , Liang Jiuxing
Published: July 2021

Background

The hepatitis B virus (HBV) is one of the main causes of viral hepatitis and liver cancer. HBV integration is one of the key steps in the virus-promoted malignant transformation.

Results

An attention-based deep learning model, DeepHBV, was developed to predict HBV integration sites. By learning local genomic features automatically, DeepHBV was trained and tested using HBV integration site data from the dsVIS database. Initially, DeepHBV showed an AUROC of 0.6363 and an AUPR of 0.5471 for the dataset. The integration of genomic features of repeat peaks and TCGA Pan-Cancer peaks significantly improved model performance, with AUROCs of 0.8378 and 0.9430 and AUPRs of 0.7535 and 0.9310, respectively. The transcription factor binding sites (TFBS) were significantly enriched near the genomic positions that were considered. The binding sites of the AR-halfsite, Arnt, Atf1, bHLHE40, bHLHE41, BMAL1, CLOCK, c-Myc, COUP-TFII, E2A, EBF1, Erra, and Foxo3 were highlighted by DeepHBV in both the dsVIS and VISDB datasets, revealing a novel integration preference for HBV.

Conclusions

DeepHBV is a useful tool for predicting HBV integration sites, revealing novel insights into HBV integration-related carcinogenesis.
Sequoia: an interactive visual analytics platform for interpretation and feature extraction from nanopore sequencing datasets
Authors: Koonchanok Ratanond , Daulatabad Swapna Vidhur , Mir Quoseena , Reda Khairi , Janga Sarath Chandra
Published: July 2021

Background

Direct-sequencing technologies, such as Oxford Nanopore’s, are delivering long RNA reads with great efficacy and convenience. These technologies afford an ability to detect post-transcriptional modifications at a single-molecule resolution, promising new insights into the functional roles of RNA. However, realizing this potential requires new tools to analyze and explore this type of data.

Result

Here, we present Sequoia, a visual analytics tool that allows users to interactively explore nanopore sequences. Sequoia combines a Python-based backend with a multi-view visualization interface, enabling users to import raw nanopore sequencing data in a Fast5 format, cluster sequences based on electric-current similarities, and drill-down onto signals to identify properties of interest. We demonstrate the application of Sequoia by generating and analyzing ~ 500k reads from direct RNA sequencing data of human HeLa cell line. We focus on comparing signal features from m6A and m5C RNA modifications as the first step towards building automated classifiers. We show how, through iterative visual exploration and tuning of dimensionality reduction parameters, we can separate modified RNA sequences from their unmodified counterparts. We also document new, qualitative signal signatures that characterize these modifications from otherwise normal RNA bases, which we were able to discover from the visualization.

Conclusions

Sequoia’s interactive features complement existing computational approaches in nanopore-based RNA workflows. The insights gleaned through visual analysis should help users in developing rationales, hypotheses, and insights into the dynamic nature of RNA. Sequoia is available at https://github.com/dnonatar/Sequoia.
Incidence of in-hospital cardiac arrest at general wards before and after implementation of an early warning score
Authors: Creutzburg Andreas , Isbye Dan , Rasmussen Lars S.
Published: July 2021

Background

In order to reduce the incidence of in-hospital cardiac arrest (IHCA) at general wards, medical emergency teams (MET) were implemented in the Capital Region of Denmark in 2012 as the efferent part of a track and trigger system. The National Early Warning Score (NEWS) system became the afferent part. This study aims at investigating the incidence of IHCA at general wards before and after the implementation of the NEWS system.

Material and methods

We included patients at least 18 years old with IHCA at general wards in our hospital in the periods of 2006 to 2011 (pre-EWS group) and 2013 to 2018 (post-EWS group). Data was obtained from a local database and the National In-Hospital Cardiac Arrest Registry (DANARREST). We calculated incidence rate ratios (IRR) for IHCA at general wards with 95% confidence interval (95% CI). Odds ratios (OR) for return of spontaneous circulation (ROSC) and 30-day survival were also calculated with 95% CI.

Results

A total of 444 IHCA occurred before the implementation of NEWS at general wards while 494 IHCA happened afterwards. The incidence rate of IHCA at general wards was 1.13 IHCA per 1000 admissions in the pre-EWS group (2006–2011) and 1.11 IHCA per 1000 admissions in the post-EWS group (2013–2018). The IRR between the two groups was 0.98 (95% CI [0.86;1.11], p = 0.71). The implementation did not affect the chance of ROSC with a crude OR of 1.14 (95% CI [0.88;1.47], p = 0.32) nor did it change the 30-day survival with a crude OR 1.30 (95% CI [0.96;1.75], p = 0.09).

Conclusion

Implementation of the EWS system at our hospital did not decrease the incidence rate of in-hospital cardiac arrest at general wards.
Consequences of ignoring clustering in linear regression
Authors: Ntani Georgia , Inskip Hazel , Osmond Clive , Coggon David
Published: July 2021

Background

Clustering of observations is a common phenomenon in epidemiological and clinical research. Previous studies have highlighted the importance of using multilevel analysis to account for such clustering, but in practice, methods ignoring clustering are often employed. We used simulated data to explore the circumstances in which failure to account for clustering in linear regression could lead to importantly erroneous conclusions.

Methods

We simulated data following the random-intercept model specification under different scenarios of clustering of a continuous outcome and a single continuous or binary explanatory variable. We fitted random-intercept (RI) and ordinary least squares (OLS) models and compared effect estimates with the “true” value that had been used in simulation. We also assessed the relative precision of effect estimates, and explored the extent to which coverage by 95% confidence intervals and Type I error rates were appropriate.

Results

We found that effect estimates from both types of regression model were on average unbiased. However, deviations from the “true” value were greater when the outcome variable was more clustered. For a continuous explanatory variable, they tended also to be greater for the OLS than the RI model, and when the explanatory variable was less clustered. The precision of effect estimates from the OLS model was overestimated when the explanatory variable varied more between than within clusters, and was somewhat underestimated when the explanatory variable was less clustered. The cluster-unadjusted model gave poor coverage rates by 95% confidence intervals and high Type I error rates when the explanatory variable was continuous. With a binary explanatory variable, coverage rates by 95% confidence intervals and Type I error rates deviated from nominal values when the outcome variable was more clustered, but the direction of the deviation varied according to the overall prevalence of the explanatory variable, and the extent to which it was clustered.

Conclusions

In this study we identified circumstances in which application of an OLS regression model to clustered data is more likely to mislead statistical inference. The potential for error is greatest when the explanatory variable is continuous, and the outcome variable more clustered (intraclass correlation coefficient is ≥ 0.01).
Demographic and clinical characteristics of severe Covid-19 infections: a cross-sectional study from Mashhad University of Medical Sciences, Iran
Authors: Goshayeshi Ladan , Akbari Rad Mina , Bergquist Robert , Allahyari Abolghasem , Hashemzadeh Kamila ,   MUMS Covid-19 Research Team, Milani Nasrin , Gholian-Aval Mahdi , Rezaeitalab Fariba , Sadeghi Quchani Mohammad Jafar , Nahbandani Zahra , Khodashahi Mandana , Javid Zahra , Mozdourian Mahnaz , Yaghoubi Mohammad Ali , Mozaheb Zahra , Seddigh-Shamsi Mohsen , Moeini Nodeh Mohammad , Nabavi Shima , Mosannen Mozaffari Hooman , Farzanehfar Mohammadreza , Lotfi Zahra , Shariati Alireza , Bonakdaran Shekoofe , Rezaieyazdi Zahra , Mirfeizi Zahra , Miri Maryam , Bassiri Reza , Ataei Azimi Sajjad , Hoseini Benyamin
Published: July 2021

Background

Coronavirus Disease 2019 (Covid-19) is expanding worldwide. The characteristics of this infection in patients varies from country to country. To move forward, clinical data on infected patients are needed. Here, we report a comparison between fatalities and recovery of patients with severe Covid-19, based on demographic and clinical characteristics.

Methods

Between 5 March and 12 May 2020 in Mashhad, Iran, 1278 of 4000 suspected Covid-19 patients were confirmed positive by real-time reverse-transcriptase–polymerase-chain-reaction assay of upper respiratory specimens. We compared the demographic, exposure history and clinical symptoms of 925 survivors and 353 fatal cases with confirmed disease.

Results

Mean (SD) age for all confirmed patients was 56.9 (18.7) years, 67.1 (15.9) years in fatal cases and 53.0 (18.3) years in survivors. Multivariate logistic regression analysis showed that the outcome of patients was associated with age (odds ratio = 1.049, P = 0.0001, 95% CI = 1.040–1.057). Despite a high burden of Covid-19 infections in the 30–39 and 40–49 year age groups, most of these (89.6 and 87.2%, respectively) recovered. The median (IQR) duration of hospitalization was 9.0 (6.0–14.0) days. The most prevalent co-morbidities were cardiovascular disorders (21%) and diabetes (16.3%). Dyspnoea (72.7%), cough (68.1%) and fever (63.8%) were the most frequent clinical symptoms. Healthcare workers, of whom two (3%) died, comprised 5.2% of infected cases. Combination antiviral and antibiotic therapy was used in 43.0% of cases.

Conclusions

The characteristics of severe Covid-19 varied substantially between fatal cases and survivors, with diabetes and cardiovascular disorders the most prevalent co-morbidities. In contrast to other studies, there were a higher number of fatalities in younger patients in our setting.
The 12-month period prevalence and cardiac manifestations of HIV in patients with acute coronary syndrome at a tertiary hospital in Cape Town, South Africa: a retrospective cross-sectional study
Authors: Pennefather Camilla , Esterhuizen Tonya , Doubell Anton , Decloedt Eric H.
Published: July 2021

Background

HIV-positive patients are increasingly being affected by non-communicable diseases such as coronary artery disease (CAD). Data from high-income countries (HICs) indicate that HIV-positive patients have different risk-factor profiles for acute coronary syndrome (ACS) as well as different cardiac manifestations of this syndrome compared to HIV-negative patients. There is limited data from Sub-Saharan Africa (SSA), and particularly from South Africa with the biggest HIV epidemic in the world. The objective of this study was to determine the 12-month period prevalence of HIV in patients with ACS and to compare the risk-factor profile, ACS presentation and management between HIV-positive and HIV-negative adults.

Methods

We included all patients hospitalised with ACS from 01 January to 31 December 2018 in a tertiary hospital, Tygerberg Hospital, in Cape Town, South Africa. The HIV-status of all patients was determined using routine clinical records. We performed multiple conditional logistic regression on HIV-positive and HIV-negative patients (1:3 ratio) to compare the risk factor profile, ACS presentation and management between the groups.

Results

Among 889 patients, 30 (3.4%) were HIV-positive (95% confidence interval (CI): 2.3–4.8). HIV-positive patients were younger, more frequently men, and had a lower prevalence of medical comorbidities and a family history of CAD. They were more likely to present with ST-elevation myocardial infarction (STEMI) [odd’s ratio (OR) (95% CI): 3.12 (1.2–8.4)], and have single-vessel disease [OR (95% CI): 3.03 (1.2–8.0)]. Angiographic and echocardiographic data, as well as management, did not differ between the groups. Among HIV-positive patients, 17 (65%) were virally suppressed (HIV viral load < 200 copies/mL) with a median CD4+ count of 271 cells/mm3. The majority (20, 67%) of HIV-positive patients were receiving antiretroviral therapy at the time of the ACS.

Conclusions

We found an HIV-prevalence of 3.4% (95% CI 2.3–4.8) in adults with ACS in a high endemic HIV region. HIV-positive patients were younger and more likely to present with STEMIs and single-vessel disease, but had fewer CAD risk factors, suggesting additional mechanisms for the development of ACS.
Construction of a risk prediction model for Alzheimer’s disease in the elderly population
Authors: Wang Lingling , Li Ping , Hou Ming , Zhang Xiumin , Cao Xiaolin , Li Hongyan
Published: July 2021

Background

Dementia is one of the greatest global health and social care challenges of the twenty-first century. The etiology and pathogenesis of Alzheimer’s disease (AD) as the most common type of dementia remain unknown. In this study, a simple nomogram was drawn to predict the risk of AD in the elderly population.

Methods

Nine variables affecting the risk of AD were obtained from 1099 elderly people through clinical data and questionnaires. Least Absolute Shrinkage Selection Operator (LASSO) regression analysis was used to select the best predictor variables, and multivariate logistic regression analysis was used to construct the prediction model. In this study, a graphic tool including 9 predictor variables (nomogram-see precise definition in the text) was drawn to predict the risk of AD in the elderly population. In addition, calibration diagram, receiver operating characteristic (ROC) curve and decision curve analysis (DCA) were used to verify the model.

Results

Six predictors namely sex, age, economic status, health status, lifestyle and genetic risk were identified by LASSO regression analysis of nine variables (body mass index, marital status and education level were excluded). The area under the ROC curve in the training set was 0.822, while that in the validation set was 0.801, suggesting that the model built with these 6 predictors showed moderate predictive ability. The DCA curve indicated that a nomogram could be applied clinically if the risk threshold was between 30 and 40% (30 to 42% in the validation set).

Conclusion

The inclusion of sex, age, economic status, health status, lifestyle and genetic risk into the risk prediction nomogram could improve the ability of the prediction model to predict AD risk in the elderly patients.
MCM6 indicates adverse tumor features and poor outcomes and promotes G1/S cell cycle progression in neuroblastoma
Authors: Gu Yaoyao , Hu Xiaoxiao , Liu Xiaowei , Cheng Cheng , Chen Kai , Wu Yeming , Wu Zhixiang
Published: July 2021

Background

Minichromosome maintenance complex component 6 (MCM6), as an important replication permission factor, is involved in the pathogenesis of various tumors. Here we studied the expression of MCM6 in neuroblastoma and its influence on tumor characteristics and prognosis.

Methods

Publicly available datasets were used to explore the influence of the differential expression of MCM6 on neuroblastoma tumor stage, risk and prognosis. In cell experiments, human neuroblastoma cell lines SK-N-SH and SK-N-BE [ (2)] were utilized to verify the ability of MCM6 to promote cell proliferation, migration and invasion. We further explored the possible molecular mechanism of MCM6 affecting the phenotype of neuroblastoma cells by mutual verification of RNA-seq and western blotting, and flow cytometry to inquire about its potential specific roles in the cell cycle.

Results

Through multiple datasets mining, we found that high expression of MCM6 was positively correlated with elevated tumor stage, high risk and poor prognosis in neuroblastoma. At the cellular level, neuroblastoma cell proliferation, migration and invasion were significantly inhibited after MCM6 was interfered by siRNA. Mutual verification of RNA-seq and western blotting suggested that the downstream cell cycle-related genes were differentially expressed after MCM6 interference. Flow cytometric analysis revealed that neuroblastoma cells were blocked in G1/S phase after MCM6 interference.

Conclusion

MCM6 is considered to be the driving force of G1/S cell cycle progression, and it is also a prognostic marker and a potential novel therapeutic target in neuroblastoma.
Descriptive epidemiological study of rare, less common and common cancers in Western Australia
Authors: Bilkey Gemma A. , Trevithick Richard W. , Coles Emily P. , Girschik Jennifer , Nowak Kristen J.
Published: July 2021

Background

There are no epidemiological studies describing rare cancers in Western Australia (WA). We aimed to fill this gap by estimating the incidence and five-year survival of rare, less common and common cancers in WA, based on definitions for rarity used by the Australian Institute of Health and Welfare and cancer groupings from the project on Surveillance of Rare Cancers in Europe (RARECARE). This research will enable policy- and decision-makers to better understand the size and nature of the public health problem presented by rare cancers in WA. It is anticipated that this study will inform improved health service design and delivery for all WA cancer patients, but particularly those with rare and less common cancers.

Methods

We estimated incidence and five-year survival rates of rare, less common and common cancers in WA using data sourced from the WA Cancer Registry for the 2013–2017 period. Cancers were defined as rare (< 6), less common (6–12), or common (> 12) based on their crude incidence rate per 100,000 people per year.

Results

Rare cancers make up 21.5% of all cancer diagnoses in WA, with a significantly poorer five-year survival of 58.2% (95% confidence interval (CI) 57.3–59.1%), compared to patients diagnosed with a common cancer, whose five-year survival was 87.8% (95% CI 87.3–88.3%). Survival for less common cancers was significantly poorer than both rare and common cancers, at 48.1% (95% CI 47.3–49.0%). Together, rare and less common cancers represent 48.4% of all cancer diagnoses in WA.

Conclusions

While rare cancers are individually scarce, collectively over one in five cancer patients in WA are diagnosed with a rare cancer. These patients experience significantly worse prognoses compared to patients with common cancers.
Duration of basic and attenuated-psychotic symptoms in individuals at clinical high risk for psychosis: pattern of symptom onset and effects of duration on functioning and cognition
Authors: Staines Lorna , Gajwani Ruchika , Gross Joachim , Gumley Andrew I. , Lawrie Stephen M. , Schwannauer Matthias , Schultze-Lutter Frauke , Uhlhaas Peter J.
Published: July 2021

Introduction

Duration of risk symptoms (DUR) in people at clinical high risk for psychosis (CHR-P) has been related to poorer clinical outcomes, such as reduced functioning, but it is currently unclear how different symptoms emerge as well as their link with cognitive deficits. To address these questions, we examined the duration of basic symptoms (BS) and attenuated psychotic symptoms (APS) in a sample of CHR-P participants to test the hypothesis that BS precede the manifestation of APS. As a secondary objective, we investigated the relationship between DUR, functioning and neuropsychological deficits.

Methods

Data from 134 CHR-P participants were assessed with the Comprehensive Assessment of At-Risk Mental State and the Schizophrenia Proneness Interview, Adult Version. Global, role and social functioning and neurocognition were assessed and compared to a sample of healthy controls (n = 57).

Results

In CHR-P participants who reported both APS and BS, onset of BS and APS was not significantly related. When divided into short and long BS duration (</> 8 years), CHR-P participants with a longer duration of BS showed evidence for an onset of BS preceding APS (n = 8, p = 0.003). However, in the short BS duration group, APS showed evidence of preceding BS (n = 56, p = 0.020). Finally, there were no significant effects of DUR on cognition or functioning measures.

Conclusion

The present findings do not support the view that APS constitute a secondary phenomenon to BS. Moreover, our data could also not confirm that DUR has a significant effect on functioning and cognitive deficits. These findings are discussed in the context of current theories regarding emerging psychosis and the importance of DUR.
The association of household and child food insecurity with overweight/obesity in children and adolescents in an urban setting of Ethiopia
Authors: Biadgilign Sibhatu , Gebremariam Mekdes K. , Mgutshini Tennyson
Published: July 2021

Background

Existing evidence on the association between food insecurity and childhood obesity is mixed. In addition, literature from developing countries in general and Ethiopia in particular on the nexus and impact of household and child food insecurity on childhood obesity in the context of urbanization remains limited. The objective of this study was to explore the association between household and child food insecurity and childhood obesity in an urban setting of Ethiopia.

Methods

An observational population based cross-sectional study was conducted in five sub-cities of Addis Ababa. Multi-stage sampling techniques were employed to identify the study unit from the selected sub-cities. Multivariable logistic regression models with robust estimation of standard errors were utilized to determine the associations. Interactions by age and sex in the associations explored were tested.

Results

A total of 632 children and adolescents-parent dyads were included in the study. About 29.4% of those in food secure households and 25% of those in food insecure households were overweight/obese. Similarly, 29.8% of food secure children and 22% of food insecure children were overweight/obese. Household and child food insecurity status were not significantly associated with child and adolescent overweight or obesity in the final adjusted models.

Conclusions

Household and childhood food insecurity status were not associated with child and adolescent overweight/obesity in the study setting. Interventions aimed at combating overweight and obesity in the study setting should target children and adolescents irrespective of their food security status.
Anaemia among mother-father-child pairs in India: examining co-existence of triple burden of anaemia in a family
Authors: Kumar Pradeep , Chauhan Shekhar , Patel Ratna , Srivastava Shobhit
Published: July 2021

Background

Anaemia is a global health concern and is also a common comorbidity in multiple medical conditions. Very limited research is available examining anaemia among family members in India and across various countries. The present study aimed to examine the co-existence of the triple burden of anaemia among mother-father-child pairs in a family.

Methods

The data utilized was from the National Family Health Survey conducted in 2015–16. The effective sample size for the study was 26,910 couples, along with children aged 6–59 months. The bivariate and binary logistic regression analysis were applied to assess the factors associated with family-level anaemia. In bivariate analysis, a chi-square test was performed to determine the association of socio-demographic factors with anaemic family.

Results

More than half of the mothers (57.5%) and their children (58%), along with 10% of fathers, were found to be anaemic; however, the co-existence of triple burden of anaemia among mother-father-child pairs was 4.7% in the study. The likelihood of family-level anaemia was low when both the parents were educated [OR: 0.69, CI: 0.58–0.81], and it was high when both the parents were employed [OR: 1.40 CI: 1.10–1.80]. Families from the Scheduled Tribe had a 62% higher likelihood to suffer from anaemia [OR: 1.62, CI: 1.33–1.97].

Conclusions

The suggested interventions include early diagnosis, effective management, and treatment of anaemia. Moreover, adequate complementary feeding practices for children shall also be promoted. Parental education on nutrition is also required, and community interventions are needed to improve parental education on nutrition. At last, there is a need for greater policy and program attention to improving nutritional knowledge among mothers so as to tackle the triple burden of anaemia among mother-father-child pairs.
Day-to-day pattern of work and leisure time physical behaviours: are low socioeconomic status adults couch potatoes or work warriors?
Authors: Rasmussen Charlotte Lund , Dumuid Dorothea , Hron Karel , Gupta Nidhi , Jørgensen Marie Birk , Nabe-Nielsen Kirsten , Holtermann Andreas
Published: July 2021

Background

Most studies on day-to-day patterns of physical behaviours (i.e. physical activities and sedentary behaviour) are based on adults with high socioeconomic status (SES) and without differentiating between work and leisure time. Thus, we aimed to characterise the day-to-day leisure time physical behaviours patterns among low SES adults and investigate the influence of work physical behaviours.

Methods

This cross-sectional study included 963 adults from low SES occupations (e.g. manufacturing, cleaning and transportation). The participants wore accelerometers for 1–7 days to measure physical behaviours during work and leisure time, expressed as time-use compositions consisting of time spent sedentary, standing or being active (walking, running, stair climbing, or cycling). Compositional multivariate multilevel models were used to regress daily leisure time-use composition against work time-use compositions. Interaction between weekday and (1) type of day, (i.e., work/non-work) and (2) the work time-use composition were tested. Compositional isotemporal substitution was used to interpret the estimates from the models.

Results

Each weekday, workers consistently spent most leisure time being sedentary and most work time standing. Leisure time physical behaviours were associated with type of day (p < 0.005, more sedentary on workdays vs. non-workdays), weekday (p < 0.005, more sedentary on Friday, Saturday and Sunday), standing work (p < 0.005, more sedentary and less standing and active leisure time on Sunday), and active work (p < 0.005, less sedentary and more standing and active leisure time on Sunday). Sedentary leisure time increased by 18 min, while standing and active leisure time decreased by 11 and 7 min, respectively, when 30 min were reallocated to standing at work on Sunday. Conversely, sedentary leisure time decreased by 25 min, and standing and active leisure time increased by 15 and 10 min, respectively, when 30 min were reallocated to active time at work on Sunday.

Conclusions

While low SES adults’ leisure time was mostly sedentary, their work time was predominantly standing. Work physical behaviours differently influenced day-to-day leisure time behaviours. Thus, public health initiatives aiming to change leisure time behaviours among low SES adults should consider the influence of work physical behaviours.
Acceptability of patient-centered hypertension education delivered by community health workers among people living with HIV/AIDS in rural Uganda
Authors: Batte Charles , Mukisa John , Rykiel Natalie , Mukunya David , Checkley William , Knauf Felix , Kalyesubula Robert , Siddharthan Trishul
Published: July 2021

Background

The prevalence of hypertension is increasing among people living with HIV/AIDS (PLWHA) in low- and middle-income countries (LMICs). However, knowledge of the complications and management of hypertension among PLWHA in Uganda remains low. We explored the acceptability of implementing hypertension (HTN) specific health education by community health workers (CHWs) among PLWHA in rural Uganda.

Methods

We conducted a qualitative study consisting of 22 in-depth interviews (14 PLWHA/HTN and 8 CHWs), 3 focus group discussions (FGDs), 2 with PLWHA/HTN and 1 with CHWs from Nakaseke district, Uganda. Participants were interviewed after a single session interaction with the CHW. Data were transcribed from luganda (local language) into English and analyzed using thematic analysis. We used Sekhon’s model of acceptability of health Interventions to explore participants’ perceptions.

Results

Participants believed CHWs utilized easy-to-understand, colloquial, non-technical language during education delivery, had a pre-existing rapport with the CHWs that aided faster communication, and had more time to explain illness than medical doctors had. Participants found the educational material (PocketDoktor™) to be simple and easy to understand, and perceived that the education would lead to improved health outcomes. Participants stated their health was a priority and sought further disease-specific information. We also found that CHWs were highly motivated to carry out the patient-centered education. While delivering the education, CHWs experienced difficulties in keeping up with the technical details regarding hypertension in the PocketDoktor™, financial stress and patient questions beyond their self-perceived skill level and experience. PLWHA/HTN had challenges accessing the health facility where the intervention was delivered and preferred a household setting.

Conclusions

Hypertension patient-centered education delivered by CHWs using the PocketDoktor™ was acceptable to PLWHA and hypertension in Nakaseke area in rural, Uganda. There is need for further studies to determine the cost implications of delivering this intervention among PLWHA across LMIC settings.
Prevalence of abuse among the elderly population of Syangja, Nepal
Authors: Acharya Shiva Raj , Suman B. K. , Pahari Sandip , Shin Yong Chul , Moon Deog Hwan
Published: July 2021

Background

Elder abuse is recognized as a serious public health concern and top priority aging issues. World Health Organization reported that around 1 out of 6 old people in the world experienced some form of abuse. This study was carried out to find out the prevalence of different forms of abuse among elderly Nepalese people.

Methods

The cross-sectional, quantitative analytical study was carried out among 373 elders of the Syangja district of Nepal. The study population was selected through simple, proportionate, and systematic sampling methods. Data was collected through face-to-face interviews using a structured questionnaire.

Results

The majority of participants were female (54.5%). The prevalence of elderly abuse was found to be 54.5%. The most common form of abuse among the elderly population was neglect (23.1%), psychological abuse (20.6%), physical abuse (6.5%), financial abuse (2.4%), and sexual abuse (1.9%). Elderly females were significantly more likely to experience physical and psychological abuse.

Conclusion

More than half of the elderly experienced at least one form of abuse. Neglect was found to be the most common form of abuse. The abuse was prevalent among elderly who were ill and with the habit of tobacco and alcohol consumption.