bluuebunny/crossref_metadata_2025 huggingface dataset:
A literature review of commercially available demineralized bone matrix products and their clinical evidence in acute fractures, nonunions, and fusion procedures
Authors: Downing Michael , Niedzielak Timothy , De La Rosa Charles , Ting Alexander , Berko Joshua , Lampasona Nicholas , Cross Brian
Published: January 2021

Demineralized bone matrix (DBM) is an allograft obtained from human cadaveric bone that has osteoinductive and osteoconductive properties. A wide array of specific DBM products is available, and each has its own biochemical, safety, and efficacy profiles. This study reviews comparison studies of brand-specific DBM products, including Allomatrix (Wright Medical Technology, Memphis, Tennessee), DBX (Depuy Synthes, Suchwil, Switzerland), Grafton (Osteotech, Eatontown, New Jersey), Orthoblast (Integra Orthobiologics, Plainsboro, New Jersey), and Osteosponge (Bacterin International, Belgrade, Montana), in an attempt to propose the most efficacious DBM product for bone grafting of various orthopaedic applications. Secondarily, we evaluate these specific DBM products in their potential use of tibial plateau fractures, which our future clinical research aims to achieve. A definitive gold-standard DBM product is lacking for orthopaedic use because of the scarcity of clinical research comparing specific brand products, limited study sample sizes, and lack of standardization in the creation of DBM products.

Level of Evidence:

Level III.
The Spectrum of Cutaneous Reactive Angiomatoses in End Stage Renal Failure
Authors: Bali Radhika , Wali Gorav Neel , Ieremia Eleni
Published: January 2021

Cutaneous reactive angiomatoses encompass a spectrum of conditions driven by underlying occlusive vasculopathy. We present 2 cases of reactive angioproliferation in the context of end-stage renal failure (ESRF) manifesting as painful cutaneous ulceration. The first case demonstrates histologic features of diffuse dermal angiomatosis. The second case illustrates a nonspecific pattern of vascular proliferation which does not conform to any of the classically described subtypes, therefore reinforcing the concept of a spectrum of histopathologic changes in reactive angioproliferations. Diffuse dermal angiomatosis has been described in ESRF alone and in association with calciphylaxis, a life-threatening condition. Recognizing the patterns of reactive angioproliferation in the context of ESRF therefore has clinical relevance. Earlier identification may facilitate mitigation of risk factors and improve prognosis.
Brief report on the advantages of ovulation monitoring using home urinary LH immunoassays in ovulation induction cycles with a gonadotropin-releasing hormone agonist trigger
Authors: Katler Quinton S. , Tricarico Nicole M. , Bishop Lauren A.
Published: January 2021

Numerous medications are available to assist with follicular stimulation and ovulation induction in women with ovulatory dysfunction, including clomiphene citrate, aromatase inhibitors, and injectable gonadotropins. In patients that are at a higher risk for the development of ovarian hyperstimulation syndrome in an ovulation induction cycle, a gonadotropin-releasing hormone agonist trigger may be substituted for traditional hCG trigger at the expense of an increased potential for suboptimal response. When compared with serum luteinizing hormone (LH) evaluation, using a home urinary LH immunoassay for ovulation detection in gonadotropin-releasing hormone agonist agonist trigger cycles may serve multiple advantages. Accordingly, a home LH immunoassay may play a novel role as a safe, inexpensive and effective alternative to conventional phlebotomy, particularly in lower-resource settings.
High-resolution magnetic resonance imaging in the detection of subtle nuances of uterine adenomyosis in infertility
Authors: Khandeparkar Meenal S. , Jalkote Shivsamb , Panpalia Madhavi , Nellore Swarup , Mehta Trupti , Ganesan Karthik , Parikh Firuza R.
Published: January 2021

Introduction:

Magnetic resonance imaging (MRI) is the current reference standard for noninvasive imaging of the pelvis. In patients with infertility potentially earmarked for in vitro fertilization/intracytoplasmic sperm injection procedures, the distinction between adenomyosis and its mimics is extremely vital. This article highlights the vital role of MRI in the detection of subtle nuances of adenomyosis in infertility and the key imaging features of its associated conditions and mimics.

Materials and Methods:

This is a retrospective Health Insurance Portability and Accountability Act compliant study. Inclusion criteria consisted of (a) clinically diagnosed cases of primary infertility; (b) suspicion of adenomyosis on transabdominal and transvaginal ultrasonography; (c) nonvisualization/obscuration of the junctional zone; (d) multiparametric MRI performed at 3 T. Exclusion criteria included (a) other causes of primary infertility including Mullerian ductal anomalies, ovulation factors, and, hormonal factors such as hypothalamic-pituitary axis abnormalities; (b) secondary infertility. We identified a cohort of 114 patients who underwent multiparametric pelvic MRI on a 3 T system between July 2011 and March 2017 at our institution to rule out adenomyosis as a cause of primary infertility.

Results:

A total of 38 of 114 patients were diagnosed with adenomyosis, with focal adenomyosis seen in 20 patients and diffuse adenomyosis in 18 patients. Isolated adenomyosis was seen in 10 patients, whereas 28 patients had adenomyosis in combination with other pelvic pathologies. Twelve patients had isolated junctional zone thickening without any other features of adenomyosis or deep pelvic endometriosis.

Conclusions:

Pelvic MRI is the reference standard for the noninvasive detection of the subtle nuances of uterine adenomyosis, and, its associations including deep pelvic endometriosis in patients with infertility.
Comparing the Effect of Lens Extraction With Endocycloplasty to Lens Extraction Alone in Eyes With Plateau Iris Configuration: Pilot Study
Authors: Lu Monica , Chuang Alice Z. , Feldman Robert M.
Published: January 2021

Precis:

Lens extraction with endocycloplasty (LE/ECPL) results in greater angle deepening than LE alone in plateau iris eyes. This study directly compares an LE/ECPL treatment group with a control group.

Purpose:

Quantitatively determine the effect of LE/ECPL versus LE alone for eyes with plateau iris configuration/plateau iris syndrome (PIC/PIS) on angle parameters

Methods:

Patients with PIC/PIS who underwent LE/ECPL or LE alone were reviewed. Eyes with ultrasound biomicroscopy-documented PIC that underwent anterior segment optical coherence tomography examination before and after treatment were included. Angle parameters, angle opening distance (AOD), trabecular-iris space area (TISA), and trabecular-iris circumference volume (TICV) were calculated. Angle parameters were compared between treatments using a 2-sample t test. P-values were adjusted by the false discovery rate method (P*). A paired t test was used to compare treated (nasal) and untreated (temporal) angles in LE/ECPL-treated eyes.

Results:

Twenty-three eyes of 14 participants were included. Ten eyes (43%) eyes of 7 participants were treated with LE/ECPL, and 13 eyes (57%) of 7 participants were treated with LE alone. Angles were deepened in both groups (P<0.001). Changes in AOD, TISA, and TICV showed that the magnitude of deepening in treated (nasal) quadrants was greater in LE/ECPL eyes than in LE alone eyes (P<0.05). ECPL-treated angles deepened more than the untreated angles by AOD, TISA, and TICV (P<0.002).

Conclusion:

Our study suggests that LE/ECPL is more effective than LE alone in opening the anterior chamber angle and that ECPL deepens treated angles more than untreated angles. This study directly compares an LE/ECPL treatment group with a control group, LE alone, allowing for separation of the effect of ECPL from LE.
Treatment of Nevoid Basal Cell Carcinoma Syndrome by Surgery Combined With ALA-PDT: A Case Report
Authors: Pan Chun , Zhang Qian , Bu Wen-Bo , Chen Hao , Wang Yan , Fang Fang
Published: January 2021

Introduction:

Nevoid basal cell carcinoma syndrome is an autosomal dominant disorder characterized by developmental malformations and carcinogenic activity. Multi-systemic anomalies may occur in this syndrome, such as odentogenic keratocysts of the mandible and postnatal tumors, especially multiple basal cell carcinoma.

Case presentation:

A 60 year old man presented with systemic plaques and nodules for more than 30 years. Cutaneous examination revealed that invasive erythema and black papules scattered on the face, trunk and limbs. He underwent extended surgical excision of lesions at multiple sites. No new lesions were found in the treated areas during a 3-year follow-up. Topical 5-aminolevulinic acid-mediated photodynamic therapy (ALA-PDT) was given as a palliative treatment for ulcerated tumors on the right lower eyelid and bleeding of the right temporal lesion. After application of ALA-PDT, the ulcers almost healed and the recurring hemorrhage ceased.

Discussion:

The management of multiple tumors in patients with nevoid basal cell carcinoma syndrome is extremely difficult, especially in the face. Surgical excision is the standard method, but the procedure can be applied in limited sites and may result in significant disfigurement and the difficulty of wound recovery. PDT can play a significant role in combination therapy for tumors that are extremely difficult to remove completely by surgical excision.

Conclusion:

We present a rare case manifested as multiple basal cell carcinoma and palmar pits who treated by surgery combined with topical 5-aminolevulinic acid-mediated photodynamic therapy. The combined therapy plays a complementary role in the treatment of nevoid basal cell carcinoma syndrome.
The use of telehealth to increase mental health services access and promote medication adherence in rural locations
Authors: Talarico Irene
Published: January 2021

Background:

Fifteen million residents living in rural locations in the United States struggle with mental illness, substance dependence, or comorbid conditions, and are not receiving adequate health care (CDC, 2017). Approximately 55% of the 3,075 rural communities in the United States lack psychiatric providers.

Local problem:

A specialty mental health treatment facility in northeast Florida cannot meet the needs of the patients because of limited psychiatric-mental health nurse practitioner (PMHNP) on site. By design, patients are expected to be seen in the clinic every three months.

Methods:

A pilot project was initiated using telehealth as a venue for patient care as an alternative to a face-to-face consultation with a PMHNP. The project was implemented with adults diagnosed with schizophrenia, bipolar disorder, major depression, posttraumatic stress disorder, anxiety, and/or substance abuse.

Interventions:

A 3-month pilot of telehealth consultations with a remote PMHNP tracking access, medication adherence at 30 and 60 days after the consultation, appointment follow-up, and patient satisfaction.

Results:

Access increased from 4.86% to 10.19% following implementation of the telehealth model. Medication adherence was 82% at 30 days and 77.5% at 60 days, compared to a benchmark of 80%. In addition, 89% of patient responses indicated comfort with telehealth and a willingness to continue to see PMHNPs in this venue.

Conclusions:

Telehealth with PMHNPs was shown to be a viable option in rural locations to meet the needs of mental health and dual diagnosis patients. Because of this project, the facility increased to three remote PMHNPs in the telehealth role.
The impact of provider training on patient education for pediatric early food introduction
Authors: Hodges Juliana M. , Stackhouse Christian T. , Smith Glenda L.
Published: January 2021

Background:

Pediatric food allergies (FAs) present significant health and economic problems. Currently, there are no cures for FAs. Recent studies suggest that early introduction (EI), between 4 and 6 months of age, of commonly allergenic foods (CAFs) may reduce the risk of developing FAs. This contradicts the current standard of care, food avoidance.

Local problem:

A federally qualified health center saw 894 patients aged 0–24 months during a 12-month period with only 18.9% receiving nutrition education. New dietary recommendations to prevent FA were not in place.

Methods:

A retrospective chart review was used to evaluate use of an order set with patient education on EI to CAFs in the electronic medical record (EMR).

Interventions:

Providers attended training on EI to CAFs and use of the EMR order set. Data were collected on the use of the order set over a 3-month period.

Results:

Provider training significantly improved knowledge of FA as well as EI guidelines. After 3 months of implementation, 25.95% of eligible encounters contained the EI order set; 52% of patients received the order set during the measurement period. In the impact population, patients 4–12 months of age, 74.55% of patients received the order set.

Conclusions:

Evidence-based clinical content in EMR order sets coupled with provider training ensure clinical decision support in identifying, monitoring, and optimizing quality care standards.
Simplified management of epistaxis
Authors: Randall David A.
Published: January 2021

Primary care, urgent care, and emergency department providers periodically treat epistaxis, either as recurrent nosebleed or an acute persistent episode. Silver nitrate application to the decongested and anesthetized nasal mucosa addresses the former in most cases. The plethora of commercial nasal packing devices testifies to the discomfort, technical difficulty, and frustration associated with traditional gauze-packing methods. Inflatable anterior nasal balloon packs reliably control most nosebleeds. Addition of a Foley catheter nasopharyngeal balloon pack manages most posterior epistaxis. Cautery and the two packing techniques mentioned above should treat most cases not requiring otolaryngology consultation or interventional radiology. Appropriate anesthetic and analgesics lessen the unpleasantness for both the patient and the provider. Topical moisturizing facilitates mucosal healing. Oxymetazoline 0.05% nasal spray provides the patient means to address rebleeding after discharge from treatment.
Improving care for patients with atrial fibrillation through the use of a personal electrocardiogram
Authors: Praus Teresa , Li Jonathan , Barbarash Svetlana , Proenza Manuel , Bondmass Mary D.
Published: January 2021

Background:

Atrial fibrillation (AF) is the most common arrhythmia affecting more than six million people in the United States. The economic burden is estimated to be >$6 billion annually with catastrophic events dramatically increasing expenditure. When patients experience symptoms, they commonly present to an acute care facility; this can be costly and anxiety provoking.

Local problem:

Same-day access issues prohibit patients from communicating directly with their cardiology provider, forcing them to use resources and increasing psychological burden.

Methods:

A convenience sample, made up of 43 patients, was given a KardiaMobile device. Eligible patients had ≥2 AF-related emergency department (ED) or urgent care (UC) visits over 12 months, needed rate control with medication titration, or were monitored for AF reoccurrence after reestablishing sinus rhythm.

Interventions:

Patients emailed recordings daily and when experiencing symptoms. The recordings were reviewed by a nurse practitioner (NP); abnormal readings were followed by a phone call, telehealth, or in-person visit.

Results:

An independently designed survey was conducted online; almost all respondents (97%) found value in the project and the device. Virtually all respondents (97%) felt that the program improved access. A majority (86%) reported decreased anxiety. Had the respondents not been in the program, 34% indicated that they would have presented to an ED and 25% would have presented to an UC, realizing a cost savings of $81,950 in reduced ED visits alone.

Conclusion:

A personal electrocardiogram, with NP oversight, to manage AF is cost-effective and reduces unnecessary resource utilization. It is patient centered, improves access, and empowers patients to manage their symptoms.
Micronutrient zinc roles in adjunctive therapy for COVID-19 by enhancing patients immunoregulation and tolerance to the pathogen
Authors: Hoang Ba Xuan , Han Bo
Published: January 2021

SARS-CoV-2 infection (COVID-19) has caused a high number of hospitalizations and deaths. There are currently no approved antiviral drugs or vaccine options available for treatment. Patients with severe cases of COVID-19 are receiving supportive care to manage life-threatening symptoms of viral pneumonia and acute respiratory distress syndrome (ARDS). Clinical and pathological evidence suggests that patients with severe COVID-19 infections suffer from cytokine storm syndrome, which leads to unfavorable health outcomes. Unfortunately, the conventional pharmacotherapies for cytokine storm syndrome are associated with immunosuppression and various other side effects that may worsen the patients’ health status and healing capability. This study is to review the literature on how zinc status may affect susceptibility and outcomes of a viral infection, as well as to explore the possible beneficial effects of supplementing zinc to alleviate COVID-19 duration and severity. We propose zinc supplementation as a viable therapeutic approach when used alone or in combination with other drugs to combat cytokine storm syndrome in COVID-19 patients. The supplementation may be especially effective for elderly patients or patients with co-morbidity already deficient in zinc. More level I randomized controlled studies are needed to determine the clinical efficacy of zinc supplementation as a potential low-cost intervention to reduce morbidity and mortality due to pneumonia and ARDS in COVID-19 patients.
Satisfaction and Technology Acceptance of Staff Regarding Use of Continuous Video Monitoring in Comparison With Sitters
Authors: Hebb Abigail , Kistler Michael , George Elisabeth , Zamboni Beth
Published: January 2021

OBJECTIVE

The purpose of this study was to determine staff satisfaction and technology acceptance of continuous video monitoring (CVM) in comparison to sitters.

BACKGROUND

Traditionally, sitters have been used to prevent falls in hospitals. Continuous video monitoring has emerged to reduce costs associated with sitters while maintaining safety.

METHODS

A descriptive online survey using a modified version of the Technology Acceptance Model was used to gain insight on technology acceptance and satisfaction levels of clinical staff related to CVM.

RESULTS

Only 12.73% found CVM to be as effective as sitters. Statistical significance was shown comparing sitters with CVM. A positive correlation was found with perceived ease of use and perceived usefulness of CVM.

CONCLUSIONS

Understanding staff satisfaction and technology acceptance is imperative for nurse leaders and administration when implementing new technologies.
Standardizing Multidisciplinary Discharge Planning Rounds to Improve Patient Perceptions of Care Transitions
Authors: Bumpas Jerilyn , Copeland Donna J.
Published: January 2021

Patients' satisfaction with care transitions is low, especially when it comes to understanding their care when discharged home from the hospital. Therefore, a quality improvement effort was initiated with the aim of improving patients' satisfaction with care transitions. Specific goals of the project were to improve communication between healthcare providers and patients, increase patient satisfaction, and enhance patient education by standardizing multidisciplinary discharge planning rounds.
Clinicopathologic Features of COVID-19: A Case Report and Value of Forensic Autopsy in Studying SARS-CoV-2 Infection
Authors: Ren Liang , Liu Qian , Wang Rongshuai , Chen Rong , Ao Qilin , Wang Xi , Zhang Jie , Deng Fei , Feng Yan , Wang Guoping , Zhou Yiwu , Li Ling , Liu Liang
Published: January 2021

As of August 23, 2020, the 2019 novel coronavirus disease (COVID-19) has infected more than 23,518,340 people and caused more than 810,492 deaths worldwide including 4,717 deaths in China. We present a case of a 53-year-old woman who was admitted to the hospital because of dry coughs and high fever on January 26, 2020, in Wuhan, China. She was not tested for SARS-CoV-2 RNA until on hospital day 11 (illness day 21) because of a significant shortage of test kits at the local hospital. Then, her test was positive for COVID-19 on hospital day 20. Despite intensive medical treatments, she developed respiratory failure with secondary bacterial infection and expired on hospital day 23 (3 days after she was tested positive for SARS-CoV-2 RNA). A systemic autopsy examination, including immunohistochemistry and ultrastructural studies, demonstrates that SARS-CoV-2 can infect multiple organs with profound adverse effect on the immune system, and the lung pathology is characterized by diffuse alveolar damage. Extrapulmonary SARS-CoV-2 RNA was detected in several organs postmortem. The detailed pathological features are described. In addition, this report highlights the value of forensic autopsy in studying SARS-CoV-2 infection and the importance of clinicopathological correlation in better understanding the pathogenesis of COVID-19.
Mastectomy and Chest Masculinization in Transmasculine Minors
Authors: Sood Rachita , Jordan Sumanas W. , Chen Diane , Chappell Ava G. , Gangopadhyay Noopur , Corcoran Julia F.
Published: January 2021

Mastectomy for chest masculinization is a commonly performed gender-affirming surgery in minor patients, a vulnerable population with unique developmental and psychosocial needs. We aimed to use principles of medical ethics (eg, autonomy, beneficence, nonmaleficence, and justice) as a framework to analyze preoperative clinical decision making by pediatric plastic surgeons who work with transmasculine and nonbinary adolescents designated female at birth presenting for chest masculinization. Two patients were selected for inclusion in this case series based on the senior author's (J.F.C.) clinical experience. A retrospective chart review was conducted to extract relevant psychosocial and clinical information from clinic notes and supplemental documentation (eg, letters from outside providers) available in the electronic medical record. In case A, a 17-year-old patient presented to a plastic surgery clinic with mixed parental support and restrictive insurance requirements. In case B, a 16-year-old patient presented to the emergency room after an attempt to remove his own breasts. The cases highlight the role of the plastic surgeon in advocating for adolescent autonomy and justice by facilitating shared family decision making and navigating barriers to care. In addition, we recommend multidisciplinary care, including trusted, transcompetent mental health professionals, to ensure beneficence and nonmaleficence by providing timely care when appropriate.
Nasal Reconstruction Using a Myocutaneous Island Pedicle Flap Based on the Nasalis Muscle With Bilevel Undermining
Authors: Nahai Farzad R. , Papadopoulos Diamondis J. , Papadopoulos John Paul , Thatos Paris , Manalo Iviensan F.
Published: January 2021

Background

Nasal reconstruction after Mohs resection of skin cancer commonly uses local flaps, many of which present limitations concerning their movement and skin color/texture match. In this article, the use of a myocutaneous island pedicle flap based on the nasalis muscle with bilevel undermining for the management of defects at challenging locations on the nose is described as a versatile and cosmetically appropriate flap option. In addition, a novel mathematical sizing methodology for this flap is presented.

Methods

Between March 2013 and May 2016, 57 patients having undergone Mohs resection of skin cancer underwent nasal reconstruction using a myocutaneous island pedicle flap based on the nasalis muscle with bilevel undermining at our clinic. During the postoperative follow-up, patients were monitored for complications and received proper wound care.

Results

The mean age was 68.4 (range, 34–94) years. The mean follow-up was 10.1 (range, 3.0–34.9) months. The mean defect size was 1.99 (range, 0.70–5.25) cm2. No complete losses of flap occurred. Incidence of minor complications (pin cushion effect, minor delayed healing, etc) was minimal (4/57; 7.0%). Two of the cases in this series involved the utilization of cartilage grafts in combination with the myocutaneus island pedicle flap.

Conclusions

The myocutaneous island pedicle flap based on the nasalis muscle with bilevel undermining can be used as a versatile flap for the closure of defects of various sizes and locations on the nose because of its rich blood supply, ease and convenience of use, and highly acceptable cosmetic outcome.
Auricular Arteriovenous Malformation With Macrotia Treated With Transcatheter Arterial Embolization, Polidocanol Foam Sclerotherapy and Subsequent Otoplasty Following Resection
Authors: Ishikawa Kosuke , Fujita Munezumi , Sasaki Satoru
Published: January 2021

Auricular arteriovenous malformation (AVM) occasionally accompanies macrotia. Here, the authors report a case of AVM with macrotia that was treated with transcatheter arterial embolization, percutaneous sclerotherapy, and subsequent otoplasty following partial resection. A 46-year-old man presented with Schobinger stage III AVM. After transcatheter arterial embolization of the feeding arteries using n-butyl-2-cyanoacrylate, 9 sessions of sclerotherapy were performed using 3% polidocanol foam. Partial resection of the AVM nidus and subsequent otoplasty for ear reduction were performed at the age of 50 years. Two years later, the remnant nidus was resected and the protruding ear was surgically corrected. No recurrence was observed, and the enlarged ear was reduced at follow-up 6 months after the final operation.
Attention deficit/hyperactivity disorder and epilepsy
Authors: Rheims Sylvain , Auvin Stephane
Published: January 2021

Purpose of review

Attention deficit/hyperactivity disorder (ADHD) is a frequent comorbidity in patients with epilepsy and is associated with important psychosocial and academic consequences. Evidence are now available to guide diagnosis and treatment of patients with both ADHD and epilepsy.

Recent findings

The prevalence of ADHD varies from 12 to 39% in patients with newly diagnosed epilepsy to 70% in drug-resistant epilepsy. The diagnosis of ADHD requires parent-validated and teacher-validated rating scales, based on the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV and DSM-V, to confirm the information in the rating scales by interviewing parents and to exclude other causes of symptoms. Treatment with methylphenidate is associated with clinically significant improvement of ADHD symptoms in 60–75% of patients. Recent data reinforce the hypothesis that ADHD medications do not increase risk of seizures, even in patients with epilepsy. Beyond pharmacological management, experts have recommended to include multidisciplinary involvement in transition clinics for patients with both comorbid ADHD and epilepsy.

Management of ADHD in patients with epilepsy requires implementation of evidence-based data in clinical practice both for diagnosis and treatment. Currently, there is no specific treatment of ADHD associated with epilepsy and its treatment is based on the usual treatments of ADHD, with reassuring data about their safety in epilepsy.
Novel multiplex PCRs for detection of the most prevalent carbapenemase genes in Gram-negative bacteria within Germany
Authors: Cerezales Mónica , Biniossek Lea , Gerson Stefanie , Xanthopoulou Kyriaki , Wille Julia , Wohlfarth Esther , Kaase Martin , Seifert Harald , Higgins Paul G.
Published: January 2021

Introduction. Gram-negative bacteria are a common source of infection both in hospitals and in the community, and antimicrobial resistance is frequent among them, making antibiotic therapy difficult, especially when these isolates carry carbapenem resistance determinants.

Hypothesis/Gap Statement. A simple method to detect all the commonly found carbapenemases in Germany was not available.

Aim. The aim of this study was to develop a multiplex PCR for the rapid and reliable identification of the most prevalent carbapenemase-encoding genes in Gram-negative bacteria in Germany.

Methodology. Data from the German Gram-negative reference laboratory revealed the most prevalent carbapenemase groups in Germany were (in order of prevalence): bla
VIM, bla
OXA-48, bla
OXA-23, bla
KPC, bla
NDM, bla
OXA-40, bla
OXA-58, bla
IMP, bla
GIM, bla
GES, ISAba1-bla
OXA-51, bla
IMI, bla
FIM and bla
DIM. We developed and tested two multiplex PCRs against 83 carbapenem-resistant Gram-negative clinical isolates. Primers were designed for each carbapenemase group within conserved regions of the encoding genes obtained from publicly available databases. Multiplex-1 included the carbapenemase groups bla
VIM, bla
OXA-48, bla
OXA-23, bla
KPC, bla
NDM and bla
OXA-40, while multiplex-2 included bla
OXA-58, bla
IMP, bla
GIM, bla
GES, ISAba1-bla
OXA-51 and bla
IMI.

Results. In the initial evaluation, all but one of the carbapenemases encoded by 75 carbapenemase-positive isolates were detected using the two multiplex PCRs, while no false-positive results were obtained from the remaining eight isolates. After evaluation, we tested 546 carbapenem-resistant isolates using the multiplex PCRs, and all carbapenemases were detected.

Conclusion. A rapid and reliable method was developed for detection and differentiation of 12 of the most prevalent carbapenemase groups found in Germany. This method allows for the rapid testing of clinical isolates prior to species identification and does not require prior phenotypical characterization, constituting a rapid and valuable tool in the management of infections in hospitals.
Modeling the COVID-19 transmission in Italy: The roles of asymptomatic cases, social distancing, and lockdowns in the first and the second waves
Authors: Khairulbahri Muhamad
Published: January 2021

The SEIR model of COVID-19 is developed to investigate the roles of physical distancing, lockdowns and asymptomatic cases in Italy. In doing so, two types of policies including behavioral measures and lockdown measures are embedded in the model. Compared with existing models, the model successfully reproduces similar multiple observed outputs such as infected and recovered patients in Italy by July 2020. This study concludes that the first policy is important once the number of infected cases is relatively low. However, once the number of infected cases is very high so the society cannot identify infected and disinfected people, the second policy must be applied soon. It is thus this study suggests that relaxed lockdowns lead to the second wave of the COVID-19 around the world. It is hoped that the model can enhance our understanding on the roles of behavioral measures, lockdowns, and undocumented cases, so-called asymptomatic cases, on the COVID-19 flow.
An Informatics Consult approach for generating clinical evidence for treatment decisions
Authors: Lai Alvina G. , Chang Wai Hoong , Parisinos Constantinos A. , Katsoulis Michail , Blackburn Ruth M. , Shah Anoop D. , Nguyen Vincent , Denaxas Spiros , Smith George Davey , Gaunt Tom R. , Nirantharakumar Krishnarajah , Cox Murray P. , Forde Donall , Asselbergs Folkert , Harris Steve , Richardson Sylvia , Sofat Reecha , Dobson Richard J.B. , Hingorani Aroon , Patel Riyaz , Sterne Jonathan , Banerjee Amitava , Denniston Alastair K. , Ball Simon , Sebire Neil J. , Shah Nigam H. , Foster Graham R. , Williams Bryan , Hemingway Harry
Published: January 2021

An Informatics Consult has been proposed in which clinicians request novel evidence from large scale health data resources, tailored to the treatment of a specific patient, with return of results in clinical timescales. However, the availability of such consultations is lacking. We seek to provide an Informatics Consult for a situation where a treatment indication and contraindication coexist in the same patient, i.e., anti-coagulation use for stroke prevention in a patient with both atrial fibrillation (AF) and liver cirrhosis. We examined four sources of evidence for the effect of warfarin on stroke risk (efficacy) or all-cause mortality (safety) from: (i) randomised controlled trials (RCTs), (ii) meta- analysis of prior observational studies, (iii) trial emulation (using population electronic health records (N = 3,854,710) and (iv) genetic evidence (Mendelian randomisation). We developed prototype forms to request an Informatics Consult and return of results in electronic health record systems. We found 0 RCT reports and 0 trials recruiting for patients with AF and cirrhosis. We found broad concordance across the three new sources of evidence we generated. Meta-analysis of prior observational studies showed that warfarin use was associated with lower stroke risk (hazard ratio [HR] = 0.71). In a target trial emulation, warfarin was associated with lower all-cause mortality (HR = 0.61) and ischaemic stroke (HR = 0.27). Mendelian randomisation served as a drug target validation where we found that lower levels of vitamin K1 (warfarin is a vitamin K1 antagonist) are associated with lower stroke risk. A pilot survey with an independent sample of 34 clinicians revealed that 85% of clinicians found information on prognosis useful and that 79% thought that they should have access to the Informatics Consult as a service within their healthcare systems. We identified candidate steps for automation to scale evidence generation and to accelerate the return of results within clinical timescales.
Monitoring the proportion infected by SARS-CoV-2 from age-stratified hospitalisation and serological data
Authors: Hozé Nathanaël , Paireau Juliette , Lapidus Nathanaël , Kiem Cécile Tran , Salje Henrik , Severi Gianluca , Touvier Mathilde , Zins Marie , Lamballerie Xavier de , Lévy-Bruhl Daniel , Carrat Fabrice , Cauchemez Simon
Published: January 2021

Background

Regional monitoring of the proportion infected by SARS-CoV-2 is important to guide local management of the epidemic, but is difficult in the absence of regular nationwide serosurveys.

Methods

We developed a method to reconstruct in real-time the proportion infected by SARS-CoV-2 and the proportion of infections being detected from the joint analysis of age-stratified seroprevalence, hospitalisation and case data. We applied our approach to the 13 French metropolitan regions.

Findings

We estimate that 5.7% [5.1%-6.4%] of adults in metropolitan France had been infected by SARS-CoV-2 by May 2020. This proportion remained stable until August and increased to 12.6% [11.2%-14.3%] by the end of November. With 23.8% [21.2%-26.8%] infected in the Paris region compared to 4.0% [3.5% - 4.6%] in Brittany, regional variations remained large (Coefficient of Variation CV: 0.53) although less so than in May (CV: 0.74). The proportion infected was twice higher (17.6% [13.4%-22.7%]) in 20-49 y.o. than in 50+ y.o (8.0% [5.7% - 11.5%]). Forty percent [33.7% - 45.4%] of infections in adults were detected in June-August compared to 55.7% [48.7% - 63.1%] in September-November. Our method correctly predicted seroprevalence in 11 regions in which only hospitalisation data were used.

Interpretation

In the absence of contemporary serosurvey, our real-time monitoring indicates that the proportion infected by SARS-CoV-2 may be above 20% in some French regions.

Funding

EU RECOVER, ANR, Fondation pour la Recherche Médicale, Inserm.
Early detection of prostate gland and breast cancer risk based on routine check-up data using survival analysis trees for left-truncated and right-censored data
Authors: Coster Dan , Fisher Eyal , Shenhar-Tsarfaty Shani , Menes Tehillah , Berliner Shlomo , Rogowski Ori , Zeltser David , Shapira Itzhak , Halperin Eran , Rosset Saharon , Gorfine Malka , Shamir Ron
Published: January 2021

Objective

To predict breast cancer (BC) and prostate gland cancer (PGC) risk among healthy individuals by analyzing routine laboratory measurements, vital signs and age.

Materials and Methods

We analyzed electronic medical records of 20,317 healthy individuals who underwent routine checkups, encompassing more than 600 parameters per visit, and identified those who later developed cancer. We developed a novel ensemble method for risk prediction of multivariate time series data using a random forest model of survival trees for left truncated and right-censored data.

Results

Using cross-validation, our method predicted future PGC and BC 6 months before diagnosis, achieving an area under the ROC curve of 0.62±0.05 and 0.6±0.03 respectively, better than standard random forest, Cox-regression model and a single survival tree. Our method can complement existing screening tests such as clinical breast examination and mammography for BC, and help in detection of subjects that were missed by these tests.

Discussion

Computational analysis of results of routine checkups of healthy individuals can improve the detection of those at risk of cancer development.

Conclusion

Our method may assist in early detection of breast and prostate gland cancer.
Hospital load and increased COVID-19 related mortality - a nationwide study in Israel
Authors: Rossman Hagai , Meir Tomer , Somer Jonathan , Shilo Smadar , Gutman Rom , Arie Asaf Ben , Segal Eran , Shalit Uri , Gorfine Malka
Published: January 2021

The spread of Coronavirus disease 19 (COVID-19) has led to many healthcare systems being overwhelmed by the rapid emergence of new cases within a short period of time. We explore the ramifications of hospital load due to COVID-19 morbidity on COVID-19 in-hospital patient mortality. We address this question with a nationwide study based on the records of all 22,636 COVID-19 patients hospitalized in Israel from mid-July 2020 to mid-January 2021. We show that even under moderately heavy patient load (>500 countrywide hospitalized severely-ill patients; the Israeli Ministry of Health defined 800 severely-ill patients as the maximum capacity allowing adequate treatment), in-hospital mortality rate of patients with COVID-19 significantly increased compared to periods of lower patient load (250-500 severely-ill patients): 14-day mortality rates were 22.1% (Standard Error 3.1%) higher (mid-September to mid-October) and 27.2% (Standard Error 3.3%) higher (mid-December to mid-January). We further show this higher mortality rate cannot be attributed to changes in the patient population during periods of heavier load.
The Relationship between Democracy embracement and COVID-19 reported casualties worldwide
Authors: Hussein Muhammad R. , AlSulaiman Thamer , Habib Mohamed , Awad Engy A. , Morsi Islam , Herbold John R.
Published: January 2021

Background

The COVID-19 toll of cases and deaths followed an uneven pattern across the world. The literature has partly explained the observed discrepancy between the different countries by country-specific and systemic patterns worldwide. In this study, we propose an additional explanation that the magnitude of COVID-19 toll reported to the WHO could be influenced by the level of free speech and Democracy in the reporting countries.

Methods

We constructed a longitudinal dataset including the daily COVID-19 count of cases and deaths worldwide and each country’s respective score on the Freedom in the World index. We applied two Generalized Estimating Equation models to investigate if a country’s reported toll count of COVID-19 cases and deaths is related to that country’s freedom level. We controlled for factors identified in the current literature to affect the pandemic’s spread.

Results

A country’s score on the Freedom In the World Index was associated with its reported COVID-19 cases count (57028.43, 95% CI 985.3619 - 113071.5, P= 0.0461) and deaths count (3473.273, 95% CI1217.12-5729.42, P=.002). Also, despite having almost equal shares of the world’s population, countries at the bottom category of the Freedom index reported 21% and 11% of the COVID-19 toll cases and death counts reported by countries of highest scores on the index, respectively.

Conclusions

The known magnitude of the COVID-19 pandemic’s morbidity and mortality appears to be as transparent as the reporting countries uphold free speech and Democracy. This pattern could potentially misguide international aid and global vaccine distribution plans.
A Scoping Review of the Experience of Implementing Population Testing for SARS-CoV-2
Authors: Foster Clare R , Campbell Fiona , Blank Lindsay , Cantrell Anna , Black Michelle , Lee Andrew C K
Published: January 2021

Background

The SARS-CoV-2 pandemic has led to the swift introduction of population testing programmes in many countries across the world, using testing modalities such as drive-through, walk-through, mobile and home visiting programmes. Here, we provide an overview of the literature describing the experience of implementing population testing for SARS-CoV-2.

Methods

We conducted a scoping review using Embase, Medline and the Cochrane Library in addition to a grey literature search. We identified indicators relevant to process, quality and resource outcomes related to each testing modality.

Results

2,999 titles were identified from the academic literature and the grey literature search, of which 22 were relevant. Most studies were from the USA and the Republic of Korea. Drive-through testing centres were the most common testing modality evaluated and these provided a rapid method of testing whilst minimising resource use.

Conclusions

The evidence base for population testing lacks high quality studies, however, the literature provides evaluations of the advantages and limitations of different testing modalities. There is a need for robust evidence in this area to ensure that testing is deployed in a safe and effective manner in response to the Covid-19 pandemic.
Seroprevalence of Chagas in urban and rural indigenous populations of the south of Gran Chaco
Authors: Colussi Carlina , Stafuza Mariana , Nepote Marcelo , Mendicino Diego
Published: January 2021

Background & objectives

In Latin America, Chagas disease is endemic, with high prevalence in rural indigenous communities and increasing prevalence in urban areas due to migration from rural areas with active vector transmission. The objective of the work was to assess differences in the prevalence of Chagas disease in urban and rural moqoit communities of the south of Gran Chaco, Santa Fe province, Argentina.

Methods

A seroprevalence study was conducted in six moqoit populations. Belonging to an urban community was considered as an exposure variable, whereas seropositivity for Chagas disease was considered as an outcome variable

Results

The results showed that 9.26% of the 702 volunteers evaluated and 3.50% of women of childbearing potential were seropositive. The prevalence of Chagas disease in urban communities was 6.41 times higher than in rural communities.

Interpretation & conclusions

The seroprevalence found in the moqoit community is higher than that estimated for the general population of the same region, with greater impact in the urban area than in the rural area. The decline of vector transmission in the rural area could be related to the conservation of ancestral practices and the expansion of the agricultural model.
Labeling self-tracked menstrual health records with hidden semi-Markov models
Authors: Symul Laura , Holmes Susan
Published: January 2021

Globally, millions of women track their menstrual cycle and fertility via smartphone-based health apps, generating multivariate time series with frequent missing data. To leverage data from self-tracking tools in epidemiological studies on fertility or the menstrual cycle’s effects on diseases and symptoms, it is critical to have methods for identifying reproductive events, e.g. ovulation, pregnancy losses or births. We present two coupled hidden semi-Markov models that adapt to changes in tracking behavior, explicitly capture variable– and state– dependent missingness, allow for variables of different type, and quantify uncertainty. The accuracy on synthetic data reaches 98% with no missing data, 90% with realistic missingness, and 94% accuracy on our partially labeled real-world time series. Our method also accurately predicts cycle length by learning user characteristics. It is publicly available (HiddenSemiMarkov R package) and transferable to any health time series, including self-reported symptoms and occasional tests.
National interest may require distributing COVID-19 vaccines to other countries
Authors: Rotesi Tiziano , Pin Paolo , Cucciniello Maria , Malik Amyn A. , Paintsil Elliott E. , Bokemper Scott E. , Willebrand Kathryn , Huber Gregory A. , Melegaro Alessia , Omer Saad B.
Published: January 2021

As the clinical trials for COVID-19 vaccine progress, understanding how to distribute the initially scarce doses is of paramount importance and a quantitative analysis of the trade-offs involved in domestic-only versus cooperative distribution is still missing. In this study we use a network Susceptible-Infected-Removed (SIR) model to show under which circumstances it is in a country’s self-interest to ensure other countries can also obtain a COVID-19 vaccine rather than focusing only on vaccination of their own residents. In particular, we focus our analysis on the US’s decision and estimate the internal burden of COVID-19 disease under different scenarios about vaccine cooperation. We show that in scenarios in which the US has reached the threshold for domestic herd immunity, the US may find it optimal to donate doses to other countries with lower vaccination coverage, as this would allow for a sharp reduction in the inflow of infected individuals from abroad.
The feasibility of targeted test-trace-isolate for the control of SARS-CoV-2 variants
Authors: Bradshaw William J. , Huggins Jonathan H. , Lloyd Alun L. , Esvelt Kevin M.
Published: January 2021

The SARS-CoV-2 variant B.1.1.7 reportedly exhibits substantially higher transmission than the ancestral strain and may generate a major surge of cases before vaccines become widely available, while the P.1 and B.1.351 variants may be equally transmissible and also resist vaccines. All three variants can be sensitively detected by RT-PCR due to an otherwise rare del11288-11296 mutation in orf1ab; B.1.1.7 can also be detected using the common TaqPath kit. Testing, contact tracing, and isolation programs overwhelmed by SARS-CoV-2 could slow the spread of the new variants, which are still outnumbered by tracers in most countries. However, past failures and high rates of mistrust may lead health agencies to conclude that tracing is futile, dissuading them from redirecting existing tracers to focus on the new variants. Here we apply a branching-process model to estimate the effectiveness of implementing a variant-focused testing, contact tracing, and isolation strategy with realistic levels of performance. Our model indicates that bidirectional contact tracing can substantially slow the spread of SARS-CoV-2 variants even in regions where a large fraction of the population refuses to cooperate with contact tracers or to abide by quarantine and isolation requests.