bluuebunny/crossref_metadata_2025 huggingface dataset:
Perception of Gaze Direction in Glaucoma: A Study on Social Cognition
Authors: Denoyelle Aude , Rouland Jean François , Goual Naima , Boucart Muriel
Published: April 2020

SIGNIFICANCE

Discriminating quickly where another person's gaze is directed is a key component of social interaction, as gaze direction conveys information about others' intentions (approach or avoidance) and shift in gaze is used in group conversation. This study shows that patients with glaucoma are delayed in their discrimination of gaze direction.

PURPOSE

The purpose of this study was to investigate whether glaucoma affects the perception of gaze direction.

METHODS

Twenty-four patients with open-angle glaucoma, 24 age-matched controls, and 20 young normally sighted controls were presented with faces displayed centrally for 200 milliseconds. The gaze could either be direct or averted, and the head could be a frontal view or a rotated view. Half of the participants in each group were asked to press a key only for faces with a direct gaze. The other half responded for a face with an averted gaze. The orientation of the head had to be ignored.

RESULTS

Accuracy was greater than 90% correct for all three groups. We found no difference in performance between young and older controls, except for shorter response times for the frontal view than for the rotated face in young participants. Patients with glaucoma needed on average 140 milliseconds longer to decide if the gaze was averted than for the direct gaze, and they were less accurate than controls in perceiving the gaze as direct when the head was rotated.

CONCLUSIONS

Patients with glaucoma often experience impaired vision due to a reduced sensitivity in central vision. Although lower central sensitivity had little effect on their ability to discriminate gaze orientation, they required on average 140 milliseconds longer than age-matched controls to perceive an averted gaze.
Effects of Blood Flow Restriction at Different Intensities on IOP and Ocular Perfusion Pressure
Authors: Vera Jesús , Jiménez Raimundo , Redondo Beatríz , García-Ramos Amador
Published: April 2020

SIGNIFICANCE

The use of blood flow restriction allows obtaining beneficial physical adaptions when combined with low-intensity exercise or even when used alone. We found that using blood flow restriction may be a potential strategy to avoid IOP and ocular perfusion pressure fluctuations provoked by strength and endurance training.

PURPOSE

The purpose of this study was to assess the influence of bilateral blood flow restriction in the upper and lower body at two different intensities on IOP and ocular perfusion pressure, as well as the possible sex differences.

METHODS

Twenty-eight physically active university students (14 men and 14 women) took part in the study, and blood flow restriction was bilaterally applied with two pressures in the legs and arms. There were five experimental conditions (control, legs-high, legs-low, arms-high, and arms-low). IOP was measured by rebound tonometry before, during (every 4 seconds), and immediately after blood flow restriction. Ocular perfusion pressure was measured before and after blood flow restriction.

RESULTS

We found that only the arms-high condition promoted a statistically significant IOP rise when compared with the rest of the experimental conditions (all Bayes factors10, >100; effect sizes, 1.18, 1.06, 1.35, and 1.73 for the control, arms-low, legs-high, and legs-low conditions, respectively). For ocular perfusion pressure, there was strong evidence for the null hypothesis regarding the type of blood flow restriction (Bayes factor10, 0.012); however, men showed an ocular perfusion pressure reduction after blood flow restriction in the arms-high condition (Bayes factor10, 203.24; effect size, 1.41).

CONCLUSIONS

This study presents preliminary evidence regarding the safety of blood flow restriction in terms of ocular health. Blood flow restriction may be considered as an alternative training strategy to reduce abrupt fluctuations in IOP and ocular perfusion pressure because its use permits a considerable reduction of exercise intensity.
The Use of Autologous Serum Eye Drops after Epithelium-off Corneal Collagen Crosslinking
Authors: Kirgiz Ahmet , Akdemir Mehmet Orcun , Yilmaz Ahu , Kaldirim Havva , Atalay Kursat , Asik Nacaroglu Senay
Published: April 2020

SIGNIFICANCE

After epithelium-off crosslinking (CXL), epithelial closure time and post-operative pain are an important issue in terms of possible complications and patient comfort. We report a prospective randomized study about the use of autologous serum eye drops after CXL.

PURPOSE

This study aims to evaluate the effect of autologous serum eye drops on epithelial healing and post-operative pain after CXL.

METHODS

Sixty patients diagnosed as having progressive keratoconus and treated with accelerated CXL (9 mW/cm2 for 10 minutes) randomly received 20% autologous serum eye drops (autologous serum group, n = 30) or artificial tears (control group, n = 30). Patients were evaluated every day after the surgery, and the day of epithelial closure was recorded. All patients were asked to report the maximum pain level using the Wong-Baker FACES Pain Rating Scale at the end of each day until the epithelial closure was completed. The change in topographic parameters and haze were recorded at 6 months.

RESULTS

The mean epithelial closure time was significantly lower in the autologous serum group than in the control group (2.37 ± 0.49 and 2.67 ± 0.47 days, respectively; P = .02). There was a statistically significant difference between the pain scores in the first and second days of surgery between the two groups (first-day autologous serum autologous serum group: 2.80 ± 0.66 and control group: 3.50 ± 0.82, P = .01; second-day autologous serum group: 1.73 ± 0.69 and control group: 2.20 ± 0.76, P = .02). Pre-operative and post-operative topographic parameters and haze at 6 months were similar between the two groups (P > .05 for all).

CONCLUSIONS

Use of autologous serum eye drops after CXL accelerates epithelial healing and reduces post-operative pain. Shortening the duration of epithelial closure would be beneficial in reducing possible complications and increasing patient comfort.
Feasibility of Social Distancing Practices in US Schools to Reduce Influenza Transmission During a Pandemic
Authors: Uscher-Pines Lori , Schwartz Heather L. , Ahmed Faruque , Zheteyeva Yenlik , Tamargo Leschitz Jennifer , Pillemer Francesca , Faherty Laura , Uzicanin Amra
Published: April 2020

Background:

Schools are socially dense environments, and school-based outbreaks often predate and fuel community-wide transmission of seasonal and pandemic influenza. While preemptive school closures can effectively reduce influenza transmission, they are disruptive and currently recommended only for pandemics. We assessed the feasibility of implementing other social distancing practices in K-12 schools as a first step in seeking an alternative to preemptive school closures.

Methods:

We conducted 36 focus groups with education and public health officials across the United States. We identified and characterized themes and compared feasibility of practices by primary versus secondary school and region of the United States.

Results:

Participants discussed 29 school practices (25 within-school practices implemented as part of the school day and 4 reduced-schedule practices that impact school hours). Participants reported that elementary schools commonly implement several within-school practices as part of routine operations such as homeroom stay, restriction of hall movement, and staggering of recess times. Because of routine implementation and limited use of individualized schedules within elementary schools, within-school practices were generally felt to be more feasible for elementary schools than secondary schools. Of reduced-schedule practices, shortening the school week and the school day was considered the most feasible; however, reduced-schedule practices were generally perceived to be less feasible than within-school practices for all grade levels.

Conclusions:

Our findings suggest that schools have many options to increase social distance other than closing. Future research should evaluate which of these seemingly feasible practices are effective in reducing influenza transmission in schools and surrounding communities.
Application of Fabric-Type Spinal Orthosis for Flexible Neuromuscular Scoliosis
Authors: Shin Hyun Iee , Shin Hyung-Ik
Published: April 2020

Objective

This study used a 3-point pressure spinal orthosis made of fabric material in neuromuscular scoliosis patients with flexible spinal curve to evaluate the in-brace correction of the spinal curve and to estimate changes in pulmonary function associated with brace wearing.

Design

Twenty-eight children with neuromuscular scoliosis with spinal curve flexibility of more than 50% were enrolled. A custom-made 3-point pressure spinal orthosis was fitted for each patient. The Cobb angles in sitting and supine positions, forced vital capacity, forced expiratory volume in the first second, and peak cough flow were measured before and after applying spinal orthoses. Each participant recorded the brace wearing duration, and questionnaires on brace tolerance were collected.

Results

Cobb angles after application of orthosis decreased from 31.0 degrees (interquartile range = 21.9–45.0 degrees) to 16.6 degrees (interquartile range = 10.0–34.0 degrees) in the sitting position and from 13.3 degrees (interquartile range = 4.0–21.0 degrees) to 1.4 degrees (interquartile range = 0.0–19.0 degrees) while supine (P< 0.01,P= 0.04, respectively). Preorthosis and postorthosis application forced vital capacity, forced expiratory volume in the first second, and peak cough flow were unaffected. Caregivers reported improved sitting postures and manual activities.

Conclusions

In children with flaccid-type neuromuscular scoliosis, curve correction can be achieved using a simple fabric-type spinal orthosis when applied to patients with flexible scoliosis, without compromising lung function.

To Claim CME Credits

Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME

CME Objectives

Upon completion of this article, the reader should be able to: (1) Describe the factors associated with the effects of spinal braces in neuromuscular scoliosis; (2) Discuss the characteristics of flaccid-type neuromuscular scoliosis; and (3) Discuss the benefits of fabric-type orthosis regarding pulmonary function and patient compliance.

Level

Advanced.

Accreditation

The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Activation Profile of Scapular Stabilizing Muscles in Asymptomatic People
Authors: Tooth Camille , Schwartz Cédric , Croisier Jean-Louis , Bornheim Stephen , Brüls Olivier , Denoël Vincent , Forthomme Bénédicte
Published: April 2020

Objective

The aim of the study was to assess the activation profile of scapular stabilizing muscles in dyskinetic asymptomatic people.

Design

This is a noninterventional observational study. Two groups of 20 people were included in the study. The first group involved asymptomatic athletes with scapular dyskinesis. The second one included athletes without scapular dysfunction. Muscle activation of upper trapezius, lower trapezius, and serratus anterior were recorded by a surface electromyography during shoulder flexion and shoulder abduction, in unloaded and loaded conditions.

Results

A significant increase of the activity of the upper trapezius (between 23% and 31%) and a significant decrease of the activity of the lower trapezius (between 32% and 65%) were observed in the dyskinetic group in comparison with the nondyskinetic group in asymptomatic athletes. A significant increase between 17% and 31% of the activity of the serratus anterior was also observed in dyskinetic people. Likewise, a significant increase approximately 24%–61% and 23%–70% was noted respectively in upper trapezius/lower trapezius and upper trapezius/serratus anterior ratio’s in the dyskinetic group.

Conclusions

An alteration of periscapular muscular activation exists in dyskinetic asymptomatic people. Future studies will be needed to know whether those alterations increase the risk of shoulder injuries.
The Effect of Virtual Reality on the Ability to Perform Activities of Daily Living, Balance During Gait, and Motor Function in Parkinson Disease Patients
Authors: Lina Chen , Guoen Cai , Huidan Weng , Yingqing Wang , Ying Chen , Xiaochun Chen , Qinyong Ye
Published: April 2020

Objective

The study aimed to evaluate the effect of virtual reality on balance, motor function, gait, and the ability to perform activities of daily living in patients with Parkinson disease.

Methods

We searched Cochran Central Register of Controlled Trials, Embase, PubMed, Wanfang Data, VIP Database, and China National Knowledge Infrastructure from their inception to June 2019. Two authors independently screened articles for inclusion, extracted data, and evaluated quality.

Results

Twelve randomized clinical trials involving 360 patients were included. It demonstrated that virtual reality can improve balance, measured by the Berg Balance Scale (fixed model weighted mean difference = 2.28, 95% CI = 1.39 to 3.16, P < 0.00001); strengthen motor function, assessed by the Timed Up and Go test (fixed model weighted mean difference = −1.66, 95% CI = −2.74 to 0.58, P = 0.003); enhance gait ability, assessed by the 10-Meter Walk Test Time (fixed model weighted mean difference = 0.13, 95% CI = 0.02 to 0.24, P = 0.02) in patients with Parkinson disease. It also showed that virtual reality can improve individuals’ ability to perform activities of daily living, assessed by modified Barthel Index (fixed model weighted mean difference = 2.93, 95% CI = 0.8 to 5.06, P = 0.007).

Conclusions

The findings suggest that virtual reality rehabilitation may be valuable in improving the balance, motor function, gait, and ability to perform activities of daily living in patients with Parkinson disease.
Anogenital Human Papillomavirus and HIV Infection in Rwandan Men Who Have Sex With Men
Authors: Murenzi Gad , Kim Hae-Young , Munyaneza Athanase , Tuyisenge Patrick , Zawadi Thierry M. , Buteera Alex M. , Adedimeji Adebola , Mutesa Leon , Castle Philip E. , Anastos Kathryn , Palefsky Joel M.
Published: April 2020

Background:

Men who have sex with men (MSM) have a high prevalence of anal and penile human papillomavirus (HPV) infections with MSM living with HIV (MSMLH) bearing the highest rates. Data on anogenital high-risk HPV (hrHPV) among MSM in Rwanda and the associated risk factors are scant.

Methods:

We recruited 350 self-identified MSM aged 18 years living in Kigali, Rwanda, with 300 recruited from the community and 50 from partner clinics. Anal and penile specimens from all participants were analyzed for hrHPV using the AmpFire platform. Logistic regression was used to calculate crude odds ratios (ORs) and adjusted ORs (aORs) with 95% confidence intervals (95% CIs) as a measure of association between various factors and anal and penile hrHPV infection prevalence.

Results:

Anal hrHPV prevalence was 20.1%, was positively associated with having receptive anal sex with more partners (aOR: 9.21, 95% CI: 3.66 to 23.14), and was negatively associated with having insertive anal sex with more partners (aOR: 0.28, 95% CI: 0.12 to 0.66). Penile hrHPV prevalence was 35.0%, was negatively associated with having receptive anal sex with more partners (aOR: 0.29, 95% CI: 0.13 to 0.66), and differed significantly by HIV status, with 55.2% and 29.7% for MSMLH and HIV-negative MSM, respectively (P < 0.01).

Conclusion:

Penile hrHPV prevalence was higher than that of anal hrHPV and it was significantly higher in Rwandan MSMLH than in HIV-negative MSM. The prevalence of anal and penile HPV infections is likely variable at different locations in Africa, according to a number of factors including HIV status and sexual practices.
Addressing Uptake of HIV Testing and Linkage to Care Among Men in Côte d'Ivoire: An Evaluation of the Brothers for Life Program Implementation
Authors: Naugle Danielle A. , Dosso Abdul , Tibbels Natalie J. , Van Lith Lynn M. , Hendrickson Zoé M. , Kouadio Anne M. , Kra Walter , Kamara Diarra , Dailly-Ajavon Patricia , Cissé Adama , Seifert-Ahanda Kim , Thaddeus Sereen , Mallalieu Elizabeth C. , Kaufman Michelle R. , Hoffmann Christopher J.
Published: April 2020

Background:

Historically, men in sub-Saharan Africa have worse outcomes along the HIV care continuum than women. Brothers for Life (BFL) is a community-based behavior change intervention for men, adapted for Côte d'Ivoire, involving group discussions that address salient gender norms and promote HIV prevention, testing, and linkage to care with support from peer navigators. The goal of this study was to describe the BFL program as implemented in Côte d'Ivoire, evaluate program implementation, and report uptake of HIV testing and treatment among BFL participants.

Setting:

Three urban and periurban sites in Côte d'Ivoire.

Methods:

The implementation evaluation assessed the fidelity and acceptability of the BFL program and the reach of program completion, testing and peer navigation using qualitative and quantitative approaches.

Results:

BFL facilitation fidelity and content fidelity were high. Semistructured interviews with BFL participants indicated that men appreciated the format and content and that the BFL program helped some participants overcome their fears and adopt more positive attitudes and behaviors around testing and treatment. Assessments of reach showed that, of the 7187 BFL participants, 81% tested for HIV as part of BFL and 2.3% (135) tested HIV-positive. Of those, 76% (102) accepted peer navigator support, and 97% (131) initiated treatment. After 6 months, 100% of the 131 men who initiated treatment remained in care.

Conclusion:

The implementation of BFL in Côte d'Ivoire successfully achieved the goals of engaging participants in discussions around HIV prevention, encouraging HIV testing, and achieving linkage to care, treatment initiation, and retention.
Update on group A streptococcal vaccine development
Authors: Dale James B. , Walker Mark J.
Published: April 2020

Purpose of review

There is a global need for well tolerated, effective, and affordable vaccines to prevent group A streptococcal infections and their most serious complications. The aim of this review is to highlight the recent progress in the identification of promising vaccine antigens and new approaches to vaccine design that address the complexities of group A streptococcal pathogenesis and epidemiology.

Recent findings

Combination vaccines containing multiple shared, cross-protective antigens have proven efficacious in mouse and nonhuman primate models of infection. The development of complex multivalent M protein-based vaccines is continuing and several have progressed through early-stage human clinical trials. Formulations of vaccines containing universal T-cell epitopes, toll-like receptor agonists, and other adjuvants more potent than alum have been shown to enhance protective immunogenicity. Although the group A streptococcal vaccine antigen landscape is populated with a number of potential candidates, the clinical development of vaccines has been impeded by a number of factors. There are now concerted global efforts to raise awareness about the need for group A streptococcal vaccines and to support progress toward eventual commercialization and licensure.

Preclinical antigen discovery, vaccine formulation, and efficacy studies in animal models have progressed significantly in recent years. There is now a need to move promising candidates through the clinical development pathway to establish their efficacy in preventing group A streptococcal infections and their complications.
Antibody glycosylation in pregnancy and in newborns: biological roles and implications
Authors: Rice Thomas F. , Holder Beth , Kampmann Beate
Published: April 2020

Purpose of review

Glycosylation patterns have the potential to affect the function of antibody, antibody half-life and transplacental transfer from mother to foetus. Here, we review recent advances in our understanding of how glycosylation patterns of antibodies may be altered during pregnancy, vaccination and infection.

Recent findings

During pregnancy, there is preferential transplacental transfer of natural killer (NK) cell-activating antibodies that are galactosylated and sialylated, against both bacterial and viral antigens. Markers of NK cell function are also associated with a higher abundance of galactosylation and sialylation in respiratory syncytial virus-specific IgG, compared with total IgG, in infants up to 7 months of age which may suggest a role for NK-cell activating antibodies as important mediators of immunity during early infancy. Differential glycosylation patterns have been observed in some respiratory conditions, as increased nongalactosylated antibodies have been associated with the development of chronic inflammatory bronchopulmonary dysplasia (BPD) in preterm infants. Glycosylation patterns in children appear age-dependent, which could modulate the effector function of IgG. The clinical relevance of these findings needs to be established.

Glycosylation plays a key role in mediating antibody function. Glycosylation patterns associated with positive outcomes from infection in mothers and infants could inform the design of the next generation of vaccines for use in pregnancy and infancy.

SDC video link:

http://links.lww.com/COID/A29.
The Performance of Chest CT in Evaluating the Clinical Severity of COVID-19 Pneumonia: Identifying Critical Cases Based on CT Characteristics
Authors: Lyu Peijie , Liu Xing , Zhang Rui , Shi Lei , Gao Jianbo
Published: April 2020

Objectives

The aim of this study was to assess the clinical severity of COVID-19 pneumonia using qualitative and/or quantitative chest computed tomography (CT) indicators and identify the CT characteristics of critical cases.

Materials and Methods

Fifty-one patients with COVID-19 pneumonia including ordinary cases (group A, n = 12), severe cases (group B, n = 15), and critical cases (group C, n = 24) were retrospectively enrolled. The qualitative and quantitative indicators from chest CT were recorded and compared using Fisher exact test, one-way analysis of variance, Kruskal-Wallis H test, and receiver operating characteristic analysis.

Results

Depending on the severity of the disease, the number of involved lung segments and lobes, the frequencies of consolidation, crazy-paving pattern, and air bronchogram increased in more severe cases. Qualitative indicators including total severity score for the whole lung and total score for crazy-paving and consolidation could distinguish groups B and C from A (69% sensitivity, 83% specificity, and 73% accuracy) but were similar between group B and group C. Combined qualitative and quantitative indicators could distinguish these 3 groups with high sensitivity (B + C vs A, 90%; C vs B, 92%), specificity (100%, 87%), and accuracy (92%, 90%). Critical cases had higher total severity score (>10) and higher total score for crazy-paving and consolidation (>4) than ordinary cases, and had higher mean lung density (>−779 HU) and full width at half maximum (>128 HU) but lower relative volume of normal lung density (≦50%) than ordinary/severe cases. In our critical cases, 8 patients with relative volume of normal lung density smaller than 40% received mechanical ventilation for supportive treatment, and 2 of them had died.

Conclusions

A rapid, accurate severity assessment of COVID-19 pneumonia based on chest CT would be feasible and could provide help for making management decisions, especially for the critical cases.
Assessing Expository Discourse Abilities Across Elementary, Middle, and High School
Authors: Lundine Jennifer P.
Published: April 2020

For academic success, it is increasingly important that students of all ages can produce and comprehend expository discourse. This article provides guidance to clinicians and educators on using language sample analysis (LSA) to assess the expository language abilities of students across grades. Focusing on microstructural and macrostructural characteristics and comparing with grade-level standards, clinicians can use LSA to assess a student's production and comprehension of academic language and to guide intervention planning. Example discourse samples are included, along with a brief discussion of how the LSA results for these samples can be used for intervention planning. Using curriculum-based materials, LSA in expository contexts can lead to improved identification of students who struggle with the complex language of the classroom. Educator–clinician collaboration to identify and address these struggles can lead to improved student success at school and beyond.
Minimizing Variability in Language Sampling Analysis
Authors: Spencer Elizabeth , Bryant Lucy , Colyvas Kim
Published: April 2020

Variability is common in language sample analysis (LSA), arising from personal factors such as age or level of education, or from factors within the text such as its length and purpose. Variability can affect interpretation of results in clinical practice and research studies, as well as the ability to detect change in individuals over time. This article focuses on sample length and time-based variability in the LSA literature and how it has been addressed through a scoping review. We then propose a method for estimating the effect of this common source of variability to allow determination of reliable change in individuals over time. Although some sources of variability are acknowledged in the research literature and clinical evidence-based practice, there has been no consistent method to account for these. The proposed method we present offers a means to address text length and time-based variability and materials and examples to facilitate its implementation in future studies and practice.
Posttraumatic headache: recent progress
Authors: Howard Levi , Schwedt Todd J.
Published: April 2020

Purpose of review

Posttraumatic headache (PTH) attributed to mild traumatic brain injury is common and debilitating. In up to one-half of those with acute PTH, the PTH becomes persistent (PTH), enduring for longer than 3 months. The high incidence and persistence of PTH necessitate research into PTH pathophysiology and treatment. In this review, recent developments regarding the diagnostic criteria for PTH, the pathophysiology of PTH, and PTH treatment are discussed.

Recent findings

International Classification of Headache Disorders 3 diagnostic criteria for PTH attributed to head trauma require that ‘a headache of any type’ starts within 7 days of a head injury. PTH is considered ‘persistent’ when it endures for more than 3 months. Preclinical and human PTH research suggest multiple pathophysiologic mechanisms including genetic influences, neuroinflammation, increased release and inadequate clearance of neuropeptides and neurotransmitters, mast cell degranulation, and brain structural and functional remodeling. Even when it has a phenotype similar to a primary headache, data suggest that PTH is distinct from primary headaches. There is a lack of high-quality evidence for the acute or preventive treatment of PTH. However, results from published studies of conventional headache therapies and newer therapies, such as calcitonin gene-related peptide mAbs and transcranial magnetic stimulation, justify the current and future randomized controlled trials.

Evidence points towards a complex pathophysiology for PTH that is at least partially distinct from the primary headaches. Although properly conducted clinical trials of PTH treatment are needed, existing work has provided important data that help to plan these clinical trials. Current and future investigations will help to identify PTH mechanisms, predictors for PTH persistence, therapeutic targets, and evidence-based treatment options.
Clinical Characteristics of Children with COVID-19: A Rapid Review and Meta-Analysis
Authors: Wang Zijun , Zhou Qi , Wang Chenglin , Shi Qianling , Lu Shuya , Ma Yanfang , Luo Xufei , Xun Yangqin , Li Weiguo , Baskota Muna , Yang Yinmei , Zhai Hui , Fukuoka Toshio , Ahn Hyeong Sik , Lee Myeong Soo , Luo Zhengxiu , Liu Enmei , Chen Yaolong
Published: April 2020

Background

Most guidelines on COVID-19 published so far include recommendations for patients regardless of age. Clinicians need a more accurate understanding of the clinical characteristics of children with COVID-19.

Methods

We searched studies reporting clinical characteristics in children with COVID-19 published until March 31, 2020. We screened the literature, extracted the data and evaluated the risk of bias and quality of evidence of the included studies. We combined some of the outcomes (symptoms) in a single-arm meta-analysis using a random-effects model.

Results

Our search retrieved 49 studies, including 25 case reports, 23 case series and one cohort study, with a total of 1667 patients. Our meta-analysis showed that most children with COVID-19 have mild symptoms. Eighty-three percent of the children were within family clusters of cases, and 19% had no symptoms. At least 7% with digestive symptoms. The main symptoms of children were fever (48%, 95% confidence interval [CI]: 39%, 56%) and cough (39%, 95% CI: 30%, 48%). The lymphocyte count was below normal level in only 15% [95% CI: 8%, 22%] of children which is different from adult patients. 66% [95% CI: 55%, 77%] of children had abnormal findings in CT imaging.

Conclusions

Most children with COVID-19 have only mild symptoms, and many children are asymptomatic. Fever and cough are the most common symptoms in children. Vomiting and diarrhea were not common in children. The lymphocyte count is usually within the normal range in children.
Potential Effectiveness and Safety of Antiviral Agents in Children with Coronavirus Disease 2019: A Rapid Review and Meta-Analysis
Authors: Shi Qianling , Zhou Qi , Wang Xia , Liao Jing , Yu Yang , Wang Zijun , Lu Shuya , Ma Yanfang , Xun Yangqin , Luo Xufei , Li Weiguo , Fukuoka Toshio , Ahn Hyeong Sik , Lee Myeong Soo , Luo Zhengxiu , Liu Enmei , Chen Yaolong , Li Qubei , Yang Kehu
Published: April 2020

Background

The COVID-19 outbreak presents a new, life-threatening disease. Our aim was to assess the potential effectiveness and safety of antiviral agents for COVID-19 in children.

Methods

Electronic databases from their inception to March, 31 2020 were searched for randomized controlled trials, clinical controlled trials and cohort studies of interventions with antiviral agents for children (less than 18 years of age) with COVID-19.

Results

A total of 23 studies of indirect evidence with 6008 patients were included. The risks of bias in all studies were moderate to high in general. The effectiveness and safety of antiviral agents for children with COVID-19 is uncertain: For adults with COVID-19, lopinavir/ritonavir had no effect on mortality (risk ratio [RR]= 0.77, 95% confidence interval [CI] 0.45 to 1.30) and probability of negative PCR test (RR=0.98, 95 CI% 0.82 to 1.18). Arbidol had no benefit on probability of negative PCR test (RR=1.27, 95% CI 0.93 to 1.73). Hydroxychloroquine was not associated with increasing the probability of negative PCR result (RR=0.93, 95% CI 0.73 to 1.18). For adults with SARS, interferon was associated with reduced corticosteroid dose (weighted mean difference [WMD]=-0.14 g, 95% CI -0.21 to -0.07) but had no effect on mortality (RR=0.72, 95% CI 0.28 to 1.88); ribavirin did not reduce mortality (RR=0.68, 95% CI % 0.43 to 1.06) and was associated with high risk of severe adverse reactions; and oseltamivir had no effect on mortality (RR=0.87, 95% CI 0.55 to 1.38). Ribavirin combined with interferon was also not effective in adults with MERS and associated with adverse reactions.

Conclusions

There is no evidence showing the effectiveness of antiviral agents for children with COVID-19, and the clinical efficacy of existing antiviral agents is still uncertain. We do not suggest clinical routine use of antivirals for COVID-19 in children, with the exception of clinical trials.
What influences COVID-19 infection rates: A statistical approach to identify promising factors applied to infection data from Germany
Authors: Mercker Moritz , Betzin Uwe , Wilken Dennis
Published: April 2020

The recent COVID-19 pandemic is of big and world-wide concern. There is an intense discussion and uncertainty which factors and sanctions can reduce infection rates. The overall aim is to prevent an overload of the medical system. Even within one country, there is frequently a strong local variability in both – political sanctions as well as other local factors – which may influence infection rates. The main focus of study is analysis and interpretation of recent temporal developments (infection rates). We present a statistical framework designed to identify local factors which reduce infection rates. The approach is robust with respect to the number of undetected infection cases. We apply the framework to spatio-temporal infection data from Germany. In particular, we demonstrate that (1) infection rates are in average significantly decreasing in Germany; (2) there is a high spatial variability of these rates, and (3) both, early emergence of first infections and high local infection densities has led to strong recent decays in infection rates, suggesting that psychological effects (such as awareness of danger) lead to behaviour changes that reduce infection rates. However, the full potential of the presented method cannot yet be exploited, since more precise spatio-temporal data, such as local cell phone-based mobility data, are not yet available. In the nearest future, the presented framework could be applied to data from other countries at any state of infection, even during the exponential phase of the growth of infection rates.
Landscape of Gene Mutation in Synovium of Patients with Rheumatoid Arthritis
Authors: Inamo Jun
Published: April 2020

Objective

To investigate accumulating single nucleotide variants (SNVs) in synovium of patients with early, pre-treatment rheumatoid arthritis (RA).

Methods

I leveraged RNA-seq dataset derived from patients with RA deposited in database. To capture synovium-specific mutations, I applied standardized SNVs-calling method to paired synovium and blood samples per individual.

Results

De novo mutational signatures constructed by non-negative matrix factorization reflected continuous relationship of synovial histology, namely lymphoid-myeloid (Lymphoid), diffuse myeloid (Myeloid) and pauci-immune fibroid (Fibroid). Using COSMIC signature, defective DNA damage repair-associated mutational signature was associated with the level of inflammation in synovitis. Further, pathway analysis based on specific genes harboring SNVs in each histological group represent different types of synovitis, with differing pathogenic process and inflammatory environment.

Conclusion

This data will promote our understandings about pathogenic status of synovitis, and suggests evidence that stratified treatments would be optimal according to histological subgroup.
Novel approach reveals lipid metabolite reduction in nails of breast cancer patients as potential biomarker
Authors: Mitruka Manmohan , Gore Charusheela R. , Kumar Ajay , Sarode Sachin C , Sharma Nilesh Kumar
Published: April 2020

BACKGROUND

Molecular adaptations in intracellular and extracellular microenvironment of breast cancer cells promote pro-tumor metabolic reprogramming. Hence, metabolic reprogramming is seen as a crucial factor in various tumor hallmarks including drug resistance, invasiveness and metastasis. Among well-known metabolic features of breast carcinoma including Warburg effects, altered amino acid metabolism, lipid remodeling is considered as key factors in achieving pro-tumor microenvironment. Therefore, a better understanding on molecular aspects of lipid remodeling is highly appreciated that may contribute towards future therapeutics and diagnostics purpose including the need of potential biomarkers. The identification and validation of lipid biomarkers are reported in the literature, but evidence on lipid metabolites as biomarkers in nails of breast cancer patients is completely unexplored.

METHODS

This study reported a novel and specifically designed vertical tube gel electrophoresis (VTGE) system to assist in the purification of metabolites in the range of (∼100-1000 Da) from nail samples. Fingernail clippings of breast cancer patients (N=10), and healthy subjects (N-12) were used for extraction and purification of metabolites. The VTGE system uses 15% polyacrylamide under non-denaturing and non-reducing conditions that makes eluted metabolites directly compatible with LC-HRMS and other analytical techniques. The characterization of lipid metabolites in nail lysates was done by positive ESI mode of Agilent LC-HRMS platform.

RESULTS

Data suggest a novel observation that healthy and breast cancer patients show distinct accumulation of lipid metabolites specifically choline-based lipids. This is a first report that suggests that levels of choline, phosphorylcholine and lyso-PC are highly reduced and undetectable in nails of breast cancer patients over healthy subject. Furthermore, the potential use of reduced level of choline, phosphorylcholine and lyso-PC in nails of breast cancer patients is in line with current notion that these lipids are diverted to meet the pro-tumor activities in the tumor microenvironment.

CONCLUSION

Data strongly provide a proof of concept for the potential use of lipid metabolites including choline, phosphorylcholine and lyso-PC as a set of biomarkers in nails of breast cancer patients. However, the authors propose that validity of these lipid biomarkers may be extended to large population size of breast cancer patients for future applications in early detection, grading, staging, predicting prognosis and therapeutic targeting of breast carcinoma.
Countries should aim to lower the reproduction number ℛ close to 1.0 for the short-term mitigation of COVID-19 outbreaks
Authors: Hochberg Michael E.
Published: April 2020

The COVID-19 pandemic is still in its early stages and given the speed and magnitude of local outbreaks it is urgent to understand how mitigation measures translate into changes in key epidemiological and clinical outcomes. Here, we employ a mathematical model to explore the short-term consequences of lowering the reproduction number ℛ0and delaying measures on total infections and fatalities. The positive implications of mitigation generally accrue as these measures are adopted early, with the most striking effects seen when the reproductive number is lowered to a level ℛC≈1.0. As the delay in adopting measures exceeds approximately the half-way point to the peak of an outbreak, the effects of lowering ℛ0markedly decrease. Aiming for reproduction numbers close to 1.0 can substantially reduce fatality probabilities over short time scales, particularly for larger populations. We conclude that research is urgently needed on how mitigation measures impact ℛ0and how these can be optimized so as to achieve ℛC≈1.0 whilst supporting individual freedoms, society and the economy.
State-level variation of initial COVID-19 dynamics in the United States: The role of local government interventions
Authors: White Easton R. , Hébert-Dufresne Laurent
Published: April 2020

During an epidemic, metrics such asR0, doubling time, and case fatality rates are important in understanding and predicting the course of an epidemic. However, if collected over country or regional scales, these metrics hide important smaller-scale, local dynamics. We examine how commonly used epidemiological metrics differ for each individual state within the United States during the initial COVID-19 outbreak. We found that the case number, and trajectory of cases, differs considerably between states. We show that early non-pharmaceutical, government actions, were the most important determinant of epidemic dynamics. In particular, restricting restaurant operations was correlated with increased doubling times. Although individual states are clearly not independent, they can serve as small, natural experiments in how different demographic patterns and government responses can impact the course of an epidemic.

Daily updates to figures in this manuscript are available at:https://github.com/eastonwhite/COVID19_US_States
Predicting hospital demand during the COVID-19 outbreak in Bogotá, Colombia
Authors: Rivera-Rodriguez Claudia , Urdinola Piedad
Published: April 2020

Colombia, like many developing nations, does not have a strong health system able to respond to a pandemic of the magnitude of Covid-19. There is an increasing need to create a model that allows particular clinics and hospitals to estimate the number of patients that require Intensive Care Units-ICU care (critical), and the number of patients that require hospital care (severe), but not ICU care, in order to manage their limited resources.

This paper presents a prediction of the total number of ICU and regular beds that will be needed during the pandemic COVID-19 for Bogotá-Colombia. We use a SEIR model that includes three different compartments of infection: those who can stay at home, those in regular hospital beds and those in need of ICU treatment. The model allows for a time varying transmission rate which we use to incorporate the measures introduced by the government over the period of one semester. The model predicts that by mid October 2020, the city will need 4 524 prevalent ICUs needed and 16 738 regular hospital beds needed. By the third week of July 2020, the number of patients that need ICUs will overpass the capacity set at 1 200 beds for ICU hospital beds in the city. The model predicts that the death toll by the same date will reach 1 752 people and the number of cases will be 30 216 inhabitants by then. We provide a Shiny app available in https://claudia-rivera-rodriguez.shinyapps.io/shinyappcovidclinic/. The original values in the app reproduce the results of this paper, but the parameters and starting values can be changed according to the users needs. COVID-19 has posed too many challenges to health systems around the globe, this model is an useful tool for cities, hospitals and clinics in Colombia that need to prepare for the excess demand of services that a pandemic like this one generates. Unfortunately, the model predicts that by the third week of July the projected capacity of the system in Bogotá will not be enough. We expect the lockdown rules strength in the future days, so the death toll is not as bad as predicted by this model.
Failing our Most Vulnerable: COVID-19 and Long-Term Care Facilities in Ontario
Authors: Fisman David N. , Bogoch Isaac , Lapointe-Shaw Lauren , McCready Janine , Tuite Ashleigh R. ,   the COVID-19 Ontario Modelling Group
Published: April 2020

Background

The COVID-19 epidemic has taken a fearsome toll on individuals residing in long-term care facilities (LTC). As of April 10, 2020 half of Canada’s COVID-19 deaths had occurred in LTC. We sought to better understand trends and risk factors for COVID-19 death in LTC in Ontario.

Methods

We analyzed a COVID-19 outbreak database created by the Ontario Ministry of Health, for the period March 29-April 7, 2020. Mortality incidence rate ratios for LTC were calculated with community living Ontarians aged > 69 used as the comparator group. Count-based regression methods were used to model temporal trends and identify associations between infection risk in staff and residents, and subsequent LTC resident death.

Results

Confirmed or suspected cases of COVID-19 were identified in 272/627 LTC by April 7, 2020. The incidence rate ratio for COVID-19 death was 13.1 (9.9-17.3) relative to community living adults over 69. Incidence rate ratio increased over time and was 87.28 (90% CrI 9.98 to 557.08) by April 7, 2020. Lagged infection in staff was a strong predictor of death in residents (e.g., adjusted IRR for death per infected staff member 1.17, 95% CI 1.11 to 1.26 at a 6-day lag).

Interpretation

Mortality risk in elders in Ontario is currently concentrated in LTC, and this risk has increased sharply over a short period of time. Early identification of risk requires a focus on testing and provision of personal protective equipment to staff, and restructuring the LTC workforce to prevent movement of COVID-19 between LTC.

Funding

The research was supported by a grant to DNF from the Canadian Institutes for Health Research (2019 COVID-19 rapid researching funding OV4-170360).
Applying the SEIR Model in Forecasting The COVID-19 Trend in Malaysia: A Preliminary Study
Authors: Mahmud Aidalina , Lim Poh Ying
Published: April 2020

On March 18, 2020 the Malaysian government implemented a 14-day Movement Control Order (MCO) as part of the mitigation plan in controlling the COVID-19 epidemic in the country. The MCO aims to limit the contact rates among the population and hence prevent the surge of infected individuals. However, the trend of the epidemic before and after the MCO was not apparent. By applying the Susceptible, Exposed, Infectious and Removed (SEIR) mathematical model, we aimed to forecast the trend of COVID-19 epidemic in Malaysia using data from March 17 to 27, 2020. Based on several predetermined assumptions, the results of the analyses showed that after the implementation of the 14-day MCO from March 18 to 31, 2020, it is forecasted that the epidemic in Malaysia will peak approximately in the end of April 2020 and will subside by about the first week of July 2020. The MCO will “flatten the epidemic curve” but will prolong the duration of the epidemic. Decision to extend the duration of the MCO should depend on the consideration of socioeconomic factors as well.

Author summary

Dr. Aidalina Mahmud is a Public Health Specialist and a medical lecturer in the Department of Community Health, Universiti Putra Malaysia. Dr. Lim Poh Ying is a Biostatistician and is a senior lecturer in the Department of Community Health, Universiti Putra Malaysia.