bluuebunny/crossref_metadata_2025 huggingface dataset:
Causes of Corneal Melt After the Boston Keratoprosthesis Type I: The Chinese People's Liberation Army General Hospital Experience
Authors: Yang Zhe , Wang Yu-Qi , Wang Qun , Xu Weiwei , Zhang Shifeng , Li Zhao , Huang Yulei , Huang Yi-Fei , Wang Li-Qiang
Published: May 2024

Purpose:

The purpose of this study was to evaluate the long-term incidence, risk factors, and the management of corneal melt following Boston type I keratoprosthesis (B-KPro I) implantation.

Methods:

This is a retrospective observational case series. Data were collected regarding demographics, preoperative characteristics, incidence, and outcomes of corneal melt in 102 patients who underwent B-KPro I in the Chinese PLA General Hospital between 2011 and 2018, with a follow-up period ranging from 4 to 11 years.

Results:

Chemical burn was the most common indication for B-KPro I (n = 56; 53.8%), followed by ocular trauma (n = 26; 25.0%). During the follow-up period (107 ± 25.7 months), corneal melt occurred in 60 cases among 37 eyes (35.6%), with an incidence of 20.2% at 1 year after surgery. Fourteen cases presented with recurrent corneal melt. Patients with multiple corneal allograft failures had a higher risk of corneal melt. Thermal burns, compared with alkali burns, significantly elevated the odds ratio (OR) of corneal melt (OR, 5.11; 95% confidence interval, 1.05–24.86; P = 0.043).

Conclusions:

Corneal melt significantly reduced the retention time of KPro (P < 0.01), and its coexistence with other complications further shortened the retention time. A specific pattern of corneal melt occurrence was identified, with a peak incidence at 1 year postoperatively. Our findings suggest variations in the risk of corneal melt among different indications, with thermal burns carrying the highest OR. Moreover, each previous failed keratoplasty doubled the risk of corneal melt after B-KPro I.
Immunohistochemical findings of lens capsules obtained from patients with dead bag syndrome
Authors: Sumioka Takayoshi , Werner Liliana , Yasuda Shingo , Okada Yuka , Mamalis Nick , Ishikawa Nobuyuki , Saika Shizuya
Published: May 2024

Purpose:

To investigate the extracellular matrix and cellular components in lens capsules extracted from patients with dead bag syndrome (DBS) through immunohistochemistry.

Setting:

Department of Ophthalmology, Wakayama Medical University School of Medicine, Wakayama, Japan, and Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah.

Design:

Immunohistochemical experimental study.

Methods:

9 capsular bag specimens from DBS cases, as well as 2 control specimens from late-postoperative in-the-bag intraocular lens dislocation cases related to previous vitrectomy, pseudoexfoliation, and blunt trauma were included. They were processed for histopathology; unstained sections were obtained from each one and analyzed by immunohistochemistry targeting collagen type IV, laminin, vimentin, collagen type I, and fibronectin.

Results:

Immunohistochemistry in DBS showed lens capsule stained for basement membrane components. The outer part of the anterior capsule that was split from the inner part was more markedly stained for type IV collagen as compared with the posterior part. Faint staining for fibrous posterior capsular opacification (PCO) components, for example, collagen type I and fibronectin, was detected in limited areas, but the major portion of the capsule was free from these components. Small spotty vimentin-positive materials, suggesting the presence of cell debris, were also detected in limited samples.

Conclusions:

Small amounts of fibrotic PCO components were detected in capsules extracted from patients with DBS, but their major parts were free from PCO components. Current findings suggest small amounts of lens epithelial cells were present after surgery and secreted fibrous components before undergoing cell death process.
Psychiatric diagnoses are common after liver transplantation and are associated with increased health care utilization and patient financial burden
Authors: Lieber Sarah R. , Jones Alex R. , Jiang Yue , Gowda Prajwal , Patel Madhukar , Lippe Ben , Shenoy Akhil , Evon Donna M. , Gurley Tami , Ngo Van , Olumesi Mary , Trudeau Raelene E. , Noriega Ramirez Alvaro , Jordan-Genco Layne , Mufti Arjmand , Lee Simon C. , Singal Amit G. , VanWagner Lisa B.
Published: May 2024

Psychiatric disorders after liver transplantation (LT) are associated with worse patient and graft outcomes, which may be amplified by inadequate treatment. We aimed to characterize the burden of psychiatric disorders, treatment patterns, and associated financial burden among liver transplantation recipients (LTRs). IQVIA PharMetrics (R) Plus for Academics—a large health plan claims database representative of the commercially insured US population—was used to identify psychiatric diagnoses among adult LTRs and assess treatment. Multivariable logistic regression analysis identified factors associated with post-LT psychiatric diagnoses and receipt of pharmacotherapy. Patient financial liability was estimated using adjudicated medical/pharmacy claims for LTRs with and without psychiatric diagnoses. Post-LT psychiatric diagnoses were identified in 395 (29.5%) of 1338 LTRs, of which 106 (26.8%) were incident cases. Treatment varied, with 67.3% receiving pharmacotherapy, 32.1% psychotherapy, 21.0% combination therapy, and 21.5% no treatment. Among 340 LTRs on psychotropic medications before transplant, 24% did not continue them post-LT. Post-LT psychiatric diagnoses were independently associated with female sex, alcohol-associated liver disease (ALD), prolonged LT hospitalization (>2 wk), and pre-LT psychiatric diagnosis. Incident psychiatric diagnoses were associated with female sex, ALD, and prolonged LT hospitalization. Patients with a post-LT psychiatric diagnosis had higher rates of hospitalization (89.6% vs. 81.5%, p<0.001) and financial liability (median $5.5K vs. $4.6K USD, p=0.006). Having a psychiatric diagnosis post-LT was independently associated with experiencing high financial liability >$5K. Over 1 in 4 LTRs had a psychiatric diagnosis in a large national cohort, yet nearly a quarter received no treatment. LTRs with psychiatric diagnoses experienced increased health care utilization and higher financial liability. Sociodemographic and clinical risk factors could inform high-risk subgroups who may benefit from screening and mitigation strategies.
Factor Xa inhibitors versus low-molecular-weight heparin for preventing coagulopathy following COVID-19: a systematic review and meta-analysis of randomized controlled trials
Authors: Amin Laraib , Qayyum Komal , Uzair Muhammad , Khan Fatima , Sethi Parkha , Hanif Laiba , Azhar Aima , Mazhar Saad , Ejaz Umer , Jawad Sayed
Published: May 2024

Background:

Hospitalized patients with COVID-19 have shown a significant occurrence of thromboembolism and a heightened risk of death. It remains unclear whether factor Xa inhibitors are superior to enoxaparin in this context. Hence, there is a need for a direct comparison to assess the preventive effects and safety of factor Xa inhibitors versus enoxaparin in hospitalized COVID-19 patients.

Methods:

MEDLINE, Embase, and Cochrane Central databases were searched for randomized controlled trials (RCTs) or retrospective studies that compared the effectiveness or safety of factor Xa inhibitors and enoxaparin in preventing thromboembolism in hospitalized patients with COVID-19. Embolic incidence, incidence of bleeding, and all-cause mortality were among the outcomes of interest. Mantel–Haenszel weighted random-effects model was used to calculate relative risks (RRs) with 95 percent CIs.

Results:

The analysis included six RCTs and two retrospective studies containing 4048 patients. Meta-analysis showed a statistically significant reduction among patients on factor Xa inhibitors compared with low-molecular-weight heparin (LMWH) in the embolic incidence [risk ratio (RR) 0.64 (95%, CI 0.42, 0.98); P=0.04, I2=12%]. Upon subgroup analysis by type of study design, no significant reductions were noted in patients on factor Xa inhibitors in RCTs (RR: 0.62; 95% CI: 0.33–1.17; P=0.14) or observational studies (RR: 0.53; 95% CI: 0.23–1.26; P=0.15) when compared with enoxaparin Factor Xa inhibitors were not significantly associated with incidence of bleeding [RR 0.76 (95% CI 0.36, 1.61); P=0.47, I2=0%] or all-cause mortality (RR: 0.81; 95% CI: 0.48–1.36; P=0.43). Consistent results were obtained upon subgroup analysis by the type of study design.

Conclusion:

Factor Xa inhibitors are more effective than enoxaparin in preventing thromboembolism among patients with COVID-19 who are not acutely ill and are hospitalized. Additional rigorous RCTs comparing factor Xa inhibitors with enoxaparin are warranted.
Direct carotid cavernous fistula treated with transvenous approach: a case report
Authors: Phuyal Subash , Thapa Chhetri Suchit , Phuyal Prakash , Khanal Deepa , Paudel Sushanta
Published: May 2024

Introduction:

Carotid cavernous fistulas are uncommon vascular abnormalities marked by anomalous connections between the carotid artery and the cavernous sinus. The authors present a case of a direct carotid cavernous fistula and its successful treatment in a 42-year-old female.

Case presentation:

A 42-year-old female presented with right eye painful swelling and visual disturbance. She had no known comorbidities or history of injury. Examination showed proptosis, chemosis, and orbital bruit. Carotid angiography confirmed a carotid cavernous fistula, which was managed endovascularly. The patient fully recovered after treatment.

Discussion:

Carotid cavernous fistula occurs spontaneously or as a result of trauma or other vascular abnormalities. Common clinical manifestations include proptosis, chemosis, and orbital bruit, with vision loss being a feared complication. Diagnosis is typically confirmed through angiography, with digital subtraction angiography being the gold standard. Endovascular treatment is usually effective, although surgical management may be necessary in certain cases.

Conclusion:

Carotid cavernous fistula is a rare but potentially sight-threatening neurological condition. Treatment with a transvenous approach is effective for the management of direct carotid cavernous fistula.
Strengthening laboratory systems for ensuring accurate diagnoses in mother-to-child transmission (MTCT) prevention programs in Uganda: a narrative review
Authors: Ifeanyi Obeagu Emmanuel , Uzoma Obeagu Getrude
Published: May 2024

Mother-to-child transmission (MTCT) of HIV remains a significant public health challenge in Uganda, necessitating a focused examination of the state of laboratory systems to ensure accurate diagnoses and effective prevention. The aim of this narrative review is to assess the current state of laboratory systems supporting MTCT prevention programs in Uganda, identify challenges hindering accurate diagnoses, and propose strategies for strengthening these systems to enhance the effectiveness of MTCT prevention efforts. This narrative review explores the current landscape of laboratory infrastructure in Uganda, addressing challenges unique to the country and proposing strategies for improvement. The discussion encompasses the integration of molecular testing, the role of point-of-care diagnostics, the implementation of quality assurance programs, and capacity-building initiatives for laboratory personnel. Additionally, technological innovations and their applicability in the Ugandan context are explored alongside the crucial aspect of integrating laboratory services into antenatal care. Drawing on global lessons, the review provides tailored recommendations for Uganda, spanning policy considerations, funding mechanisms, infrastructure enhancements, and workforce development. Looking towards the future, the review outlines potential collaborations, technological advancements, and strategic investments that can further fortify laboratory systems, ultimately contributing to the elimination of MTCT in Uganda.
Orbital Mass Identified With Point-of-Care Ultrasound in a Child Presenting With Eyelid Swelling
Authors: Callegari Alison , Abulfaraj Maher M.
Published: May 2024

Point-of-care ultrasound was used in a child presenting to the emergency department with progressively worsening left eyelid swelling. The early use of ultrasound was helpful in detecting a soft tissue mass that is exhibiting pressure effect on the eyeball. Point-of-care ultrasound helped expedite advanced imaging and consultation with the specialist. The patient eventually had a biopsy and was diagnosed with idiopathic orbital inflammation.
Efficacy and Safety of Dexmedetomidine Compared to Other Needle-Free Pharmacological Sedation Methods in Pediatric Patients Undergoing Imaging Procedures
Authors: Alsabri Mohammed Alsabri Hussein , Abdelshafi Abdelrahman , Bostamy Elsnhory Ahmed , Selim Noha Samir , Elsnhory Alaa Bostamy , Albelal Douaa , Akram Fatima , Elshanbary Alaa Ahmed
Published: May 2024

Background

Pediatric patients often require sedation during magnetic resonance imaging (MRI) and computed tomography (CT) to ensure stillness and minimize stress. This meta-analysis compared the effectiveness and safety of 3 sedative agents—dexmedetomidine, midazolam, and chloral hydrate—for pediatric MRI/CT sedation.

Methods

Six studies with a total of 633 patients were included in the analysis. Quality assessment revealed varying levels of bias risk. Dexmedetomidine exhibited a significantly higher successful sedation rate compared to midazolam (risk ratio [RR] = 0.43, 95% confidence interval [CI] [0.29–0.64]), but no statistically significant difference compared to chloral hydrate (RR = 0.94, 95% CI [0.60–1.45]). Chloral hydrate also showed a higher successful sedation rate compared to midazolam (RR = 0.46, 95% CI [0.25–0.83]). The onset of sedation time did not significantly differ between the 3 agents.

Results

The dexmedetomidine group had a significantly higher incidence of bradycardia compared to the chloral hydrate group (RR = 0.17, 95% CI [0.05–0.59]), but no significant difference compared to the midazolam group (RR = 0.29, 95% CI [0.06–1.26]). No statistically significant differences were observed in the incidence of nausea and vomiting between the 3 groups.

Conclusions

Dexmedetomidine demonstrates effectiveness in pediatric MRI/CT sedation, offering advantages over midazolam and similar efficacy to chloral hydrate. Careful cardiovascular monitoring is essential during administration, particularly in patients with congenital heart disease. Sublingual and intranasal administration of dexmedetomidine is a viable option with high bioavailability. This meta-analysis contributes valuable insights into refining sedation protocols for pediatric imaging procedures, emphasizing efficacy and safety considerations.
Volar Distal Radius Buckle Fractures
Authors: Nandigam Meghana , Chmil Margarita , Thompson Benjamin Patrick , Samora Julie Balch , Ruess Lynne
Published: May 2024

Background

A removable brace with home management is widely accepted treatment for distal radius buckle fractures, which most commonly involve the dorsal cortex.

Purpose

The purpose of this study is to determine if a removable brace and home management treatment is safe for volar distal radius buckle fractures.

Materials and Methods

Isolated distal radius buckle fractures in children (3–16 years) diagnosed at an acute care visit (April 1, 2019 to May 31, 2022) were identified. Final diagnosis was confirmed using strict criteria including cortical buckling without cortical breach or physeal involvement. Cortical buckling was categorized as either dorsal or volar. Demographic data, mechanism of injury, treatment, and any complications were recorded and analyzed.

Results

Three hundred thirty-three fractures were either dorsal (254, 76%) or volar (79, 24%) buckle fractures. Mean age (SD) for volar fractures (9.3 [2.2 years]; range, 4–14 years) was significantly higher than for dorsal fractures (8.5 (3.0 years); range, 3–15 years; P = 0.012). More girls had volar fractures (48 [60%], P = 0.006). Most fractures occurred after a standing-height fall. Two hundred forty-four (96%) dorsal and 76 (96%) volar fractures were initially treated with a removable brace. Two hundred fourteen (84%) dorsal and 66 (84%) volar fractures had orthopedic follow-up. Brace treatment continued for 167 (167/204, 82%) dorsal and 56 (56/63, 89%) volar fractures. Treatment changed from initial brace to cast for 37 (37/204, 18%) dorsal fractures and 7 (7/63, 11%) volar fractures, influenced by caregiver preference and/or sport participation requirements. Only 1 (1/79, 1%) patient with a volar fracture returned for an additional visit for persistent pain.

Conclusions

When diagnosis of volar buckle fracture is made using the same strict criteria used for dorsal buckle fractures, removable brace and home management treatment is safe. Shared decision making with caregivers may alter buckle fracture treatment.
Efficacy and Safety of Intranasal Fentanyl in Pediatric Emergencies
Authors: Alsabri Mohammed , Hafez Abdelrahman H. , Singer Emad , Elhady Mahmoud M. , Waqar Muhammad , Gill Paviter
Published: May 2024

Background

Intranasal fentanyl (INF) has gained popularity in pediatric emergency departments (EDs) as an effective alternative to intravenous morphine for treating acute moderate to severe pain. Intranasal fentanyl eliminates the need for invasive access, making it advantageous for patients with minor injuries. Our study aims to provide a comprehensive evaluation of the available evidence regarding the effectiveness and safety of INF administration in pediatric emergency wards, particularly compared with other treatment options described in the literature.

Methods

A thorough search strategy identified randomized controlled trials assessing INF in the pediatric emergency ward. Eligible studies were independently screened, and relevant data were extracted. The analysis used pooled risk ratio (RR) for dichotomous outcomes and the standardized mean difference (SMD) for continuous ones. Randomized controlled trials' quality was assessed using the Cochrane Risk of Bias Assessment Tool 2.

Results

In our study, 8 randomized controlled trials involving 806 patients, INF demonstrated superior effectiveness in reducing pain compared with other comparators at the 15- to 20-minute mark (SMD, −0.23; 95% confidence interval, −0.37 to −0.08; P = 0.002). However, no significant differences were found at the 30- and 60-minute time points (SMDs, −0.16; 95% CI, −0.50, 0.19; P = 0.37; and −0.16; 95% CI, −0.50 to 0.19; P = 0.78) except when excluding one study to resolve heterogeneity at the 30-minute mark (RR, −0.02; 95% CI, −0.24 to 0.20; P = 0.87). Intranasal fentanyl also exhibited a better adverse outcome profile, with a lower risk of total adverse events and nausea/vomiting (RR, 0.66; 95% CI, 0.48–0.91; P = 0.01; and RR, 0.43; 95% CI, 0.30–0.63; P > 0.001) compared with other analgesics. However, no significant differences were observed for dizziness and hallucination (RR, 0.43; 95% CI, 0.30–0.63; P = 0.68; and RR, 0.43; 95% CI, 0.30–0.63; P = 0.35).

Conclusions

Our study assessed the effectiveness of INF compared with other analgesics in pain reduction. Intranasal fentanyl demonstrated superior pain reduction at the 15- to 20-minute point but showed no significant differences at 30 and 60 minutes. Intranasal fentanyl also had a more favorable adverse event profile, with a lower risk of nausea and vomiting than other analgesics. However, no significant differences were observed in dizziness and hallucination between the groups.
Lactate Levels as a Predictor of Emergency Department Revisits in Infants With Acute Bronchiolitis
Authors: Kim Gihyeon , Han Sangsoo , Bae Seong Phil , Lee Jungwon , Heo Nam Hun , Lee Dongwook , Kim Hyun Joon
Published: May 2024

Objective

This study aimed to identify predictive biomarkers for unscheduled emergency department (ED) revisits within 24 hours of discharge in infants diagnosed with acute bronchiolitis (AB).

Methods

A retrospective observational study was conducted on infants diagnosed with AB who visited 3 emergency medical centers between January 2020 and December 2022. The study excluded infants with comorbidities, congenital diseases, and prematurity and infants who revisited the ED after 24 hours of discharge. Demographic data, vital signs, and laboratory results were collected from the medical records. Univariable and multivariable logistic regression analyses were performed on factors with P of less than 0.1 in univariable analysis. Receiver operator curve analysis was used to assess the accuracy of lactate measurements in predicting ED revisits within 24 hours of discharge.

Results

Out of 172 participants, 100 were in the revisit group and 72 in the discharge group. The revisit group was significantly younger and exhibited higher lactate levels, lower pH values, and higher pCO2 levels compared to the discharge group. Univariable logistic regression identified several factors associated with revisits. Multivariable analysis found that only lactate was a variable correlated with predicting ED revisits (odds ratio, 18.020; 95% confidence interval [CI], 5.764–56.334). The receiver operator curve analysis showed an area under the curve of 0.856, with an optimal lactate cutoff value of 2.15.

Conclusion

Lactate value in infants diagnosed with AB were identified as a potential indicator of predicting unscheduled ED revisits within 24 hours of discharge. The predictive potential of lactate levels holds promise for enhancing prognosis prediction, reducing health care costs, and alleviating ED overcrowding. However, given the study's limitations, a more comprehensive prospective investigation is recommended to validate these findings.
Peter Martin Biggs. 13 August 1926—27 December 2021
Authors: Nair Venugopal , Shirley Martin W.
Published: May 2024

Peter Biggs was a towering figure in poultry health research, making substantial contributions in avian infectious diseases in the second half of the twentieth century and first two decades of the twenty-first century. The world's poultry industry owes an immense debt to his pioneering research into Marek's disease (MD), a major threat to poultry health in the early years of intensive poultry production. On graduating from the Royal Veterinary College, London, in 1953, Peter chose a research career studying avian diseases. Peter's dedicated research in the 1960s led to the identification of the MD virus and the subsequent development of a vaccine against MD. The development of MD vaccine, the first ever vaccine against a virus-induced cancer, had a major impact on sustaining the fledgling poultry farming that was crucial for the thriving modern poultry industry. Later, as the director of the Houghton Poultry Research Station in Cambridgeshire, UK, Peter led a programme of innovative scientific research exploiting scientific developments and technological advances to meet the needs of the rapidly expanding poultry industry. In addition to his outstanding leadership on research, Peter also contributed immensely to the formation of the World Veterinary Poultry Association, a global professional association for avian health specialists, and establishment of the journal
Avian Pathology
. Even after retirement, Peter continued to make valuable contributions to avian science through august bodies such as the Royal Society, Animal Health Trust, British Egg Marketing Board, British Veterinary Association and Houghton Trust. Peter was also a great mentor to many scientists who went on to leading roles.
Genetic variations of penicillin-binding protein 1A: insights into the current status of amoxicillin-based regimens for Helicobacter pylori eradication in Malaysia
Authors: Ng Heng Kang , Chua Kek Heng , Kee Boon Pin , Chuah Kee Huat , Por Lip Yee , Puah Suat Moi
Published: May 2024

Introduction. Resistance towards amoxicillin in Helicobacter pylori causes significant therapeutic impasse in healthcare settings worldwide. In Malaysia, the standard H. pylori treatment regimen includes a 14-day course of high-dose proton-pump inhibitor (rabeprazole, 20 mg) with amoxicillin (1000 mg) dual therapy.

Hypothesis/Gap Statement. The high eradication rate with amoxicillin-based treatment could be attributed to the primary resistance rates of amoxicillin being relatively low at 0%, however, a low rate of secondary resistance has been documented in Malaysia recently.

Aim. This study aims to investigate the amino acid mutations and related genetic variants in PBP1A of H. pylori, correlating with amoxicillin resistance in the Malaysian population.

Methodology. The full-length pbp1A gene was amplified via PCR from 50 genomic DNA extracted from gastric biopsy samples of H. pylori-positive treatment-naïve Malaysian patients. The sequences were then compared with reference H. pylori strain ATCC 26695 for mutation and variant detection. A phylogenetic analysis of 50 sequences along with 43 additional sequences from the NCBI database was performed. These additional sequences included both amoxicillin-resistant strains (n=20) and amoxicillin-sensitive strains (n=23).

Results. There was a total of 21 variants of amino acids, with three of them located in or near the PBP-motif (SKN402-404). The percentages of these three variants are as follows: K403X, 2%; S405I, 2% and E406K, 16%. Based on the genetic markers identified, the resistance rate for amoxicillin in our sample remained at 0%. The phylogenetic examination suggested that H. pylori might exhibit unique conserved pbp1A sequences within the Malaysian context.

Conclusions. Overall, the molecular analysis of PBP1A supported the therapeutic superiority of amoxicillin-based regimens. Therefore, it is crucial to continue monitoring the amoxicillin resistance background of H. pylori with a larger sample size to ensure the sustained effectiveness of amoxicillin-based treatments in Malaysia.
Evaluation of the accuracy of bacterial genome reconstruction with Oxford Nanopore R10.4.1 long-read-only sequencing
Authors: Sanderson Nicholas D. , Hopkins Katie M.V. , Colpus Matthew , Parker Melody , Lipworth Samuel , Crook Derrick , Stoesser Nicole
Published: May 2024

Whole-genome reconstruction of bacterial pathogens has become an important tool for tracking transmission and antimicrobial resistance gene spread, but highly accurate and complete assemblies have largely only historically been achievable using hybrid long- and short-read sequencing. We previously found the Oxford Nanopore Technologies (ONT) R10.4/kit12 flowcell/chemistry produced improved assemblies over the R9.4.1/kit10 combination, however long-read only assemblies contained more errors compared to Illumina-ONT hybrid assemblies. ONT have since released an R10.4.1/kit14 flowcell/chemistry upgrade and recommended the use of Bovine Serum Albumin (BSA) during library preparation, both of which reportedly increase accuracy and yield. They have also released updated basecallers trained using native bacterial DNA containing methylation sites intended to fix systematic basecalling errors, including common adenosine (A) to guanine (G) and cytosine (C) to thymine (T) substitutions. To evaluate these improvements, we successfully sequenced four bacterial reference strains, namely Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Staphylococcus aureus, and nine genetically diverse E. coli bloodstream infection-associated isolates from different phylogroups and sequence types, both with and without BSA. These sequences were de novo assembled and compared against Illumina-corrected reference genomes. In this small evaluation of 13 isolates we found that nanopore long-read-only R10.4.1/kit 14 assemblies with updated basecallers trained using bacterial methylated DNA produce accurate assemblies with ≥40×depth, sufficient to be cost-effective compared with hybrid ONT/Illumina sequencing in our setting.
Risk scores and coronary artery disease in patients with suspected acute coronary syndrome and intermediate cardiac troponin concentrations
Authors: Perez-Vicencio Daniel , Thurston Alexander JF , Doudesis Dimitrios , O’Brien Rachel , Ferry Amy V. , Fujisawa Takeshi , Williams Michelle C. , Gray Alasdair J. , Mills Nicholas L , Lee Kuan Ken
Published: May 2024

Background

Guidelines recommend the use of risk scores to select patients for further investigation after myocardial infarction has been ruled out but their utility to identify those with coronary artery disease is uncertain.

Methods

In a prospective cohort study, patients with intermediate high-sensitivity cardiac troponin I concentrations (5 ng/L to sex-specific 99thpercentile) in whom myocardial infarction was ruled out were enrolled and underwent coronary computed tomography angiography (CCTA) after hospital discharge. HEART, EDACS, GRACE, TIMI, SCORE2 and PCE risk scores were calculated and the odds ratio (OR) and diagnostic performance for obstructive coronary artery disease determined using established thresholds.

Results

In 167 patients enrolled (64±12 years, 28% female), 29.9% (50/167) had obstructive coronary artery disease. The odds of having obstructive disease was increased for all scores with the lowest and highest increase observed for an EDACS score ≥16 (OR 2.2 [1.1-4.6]) and a TIMI risk score ≥1 (OR 12.9 [3.0-56.0]), respectively. The positive predictive value (PPV) was low for all scores but was highest for a GRACE score >88 identifying 39% as high-risk for a PPV of 41.9% (30.4-54.2%). The negative predictive value (NPV) varied from 77.3% to 95.2% but was highest for a TIMI score of 0 identifying 26% as low-risk for a NPV of 95.2% (87.2-100%).

Conclusions

In patients with intermediate cardiac troponin concentrations in whom myocardial infarction has been ruled out, clinical risk scores can help identify patients with and without coronary artery disease, but the performance of established risk thresholds requires optimisation for this purpose.

Clinical Trial Registration

https://clinicaltrials.gov/study/NCT04549805
Investigating the prevalence of tuberculosis and associated risk factors among prisoners at Peter Singogo Prison in Ndola: a retrospective cross-sectional study
Authors: Manda Chipo , Chisompola Namaunga Kasumu
Published: May 2024

Background

Tuberculosis primarily affects the lungs and is influenced by risk factors such as diabetes, HIV/AIDS, substance abuse, and crowded living conditions. Prisons can be high-risk environments for tuberculosis transmission due to overcrowding, poor ventilation, and limited access to medical care. Substance misuse and HIV infection are common among prisoners, increasing the risk of tuberculosis. The Peter Singogo Prison in Ndola, Zambia was studied to determine the prevalence of tuberculosis and its associated risk factors.

Methods

To ascertain the prevalence of Tuberculosis and related risk factors among inmates at Peter Singogo Prison, a retrospective cross-sectional study was done. Out of the 450 prisoners who passed screening, 220 prisoners were chosen using a purposive sampling strategy after Tuberculosis records were reviewed, considering known risk factors, Tuberculosis symptoms, and Sputum microbiology laboratory results. The collected results were then examined using Statistical Package for the Social Sciences Version 23; statistical significance was recognized for a P value of less than or equal to 0.05.

Results

Two hundred and twenty prisoners had Tuberculosis symptoms. From these, a total of 51 prisoners (23%) had a Tuberculosis diagnoses with only 18 prisoners (35%) having a bacteriological confirmation of Tuberculosis, while 33 prisoners (65%) had a clinical diagnosis. In cases with bacteriological confirmation, the smear was positive. Human Immunodeficiency Virus positive inmates had a much greater frequency of Tuberculosis than Human Immunodeficiency Virus negative inmates (80% vs. 20%).

Conclusion

A significant prevalence of Tuberculosis at Peter Singogo prison was identified, with the majority of cases occurring in inmates who were Human Immunodeficiency Virus positive. The high prevalence found in this study may help to explain how Tuberculosis spreads within the prison, amongst inmates, and among different communities. Therefore, it is important to pay attention to prison environments to stop the spread of Tuberculosis to both convicts and the wider public.
Effects of climatic variables on dengue incidence in Cali
Authors: Frieri Mauricio , Gordillo Marisol , Sepúlveda Lilian S.
Published: May 2024

In this work we studied the relationship between dengue incidence in Cali and the climatic variables that are known to have an impact on the mosquito and were available (precipitation, relative humidity, minimum, mean, and maximum temperature). Since the natural processes of the mosquito imply that any changes on climatic variables need some time to be visible on the dengue incidence, a lagged correlation analysis was done in order to choose the predictor variables of count regression models. A Principal Component Analysis was done to reduce dimensionality and study the correlation among the climatic variables. Finally, aiming to predict the monthly dengue incidence, three different regression models were constructed and compared using de Akaike information criterion. The best model was the negative binomial regression model, and the predictor variables were mean temperature with a 3-month lag and mean temperature with a 5-month lag as well as their interaction. The other variables were not significant on the models. And interesting conclusion was that according to the coefficients of the regression model, a 1°C increase in the monthly mean temperature will reflect as a 45% increase in dengue incidence after 3 months. The rises to a 64% increase after 5 months.

Author Summary

Dengue is transmitted by the bite of an infected mosquito, and mosquitoes, in turn, are affected by climatic conditions. In this work studied the relationship between dengue incidence in Cali and climatic variables, namely precipitation, relative humidity, minimum temperature, mean temperature, and maximum temperature using statistical methods. Since this is a natural and biological process, the changes in climatic conditions need time to have a visible effect on dengue incidence, hence we identified the significant climatic variables and the time they take to have a visible effect on dengue incidence. Then, we created three different models for predicting dengue incidences using the lagged variables and picked the best one. We concluded that the most critical variable is mean temperature with a 3- and 5-month lag. We also found that a 1°C increase in the monthly mean temperature will reflect as a 45% increase in dengue incidence after 3 months. The rises to a 64% increase after 5 months.
Evaluating a Large Language Model’s Ability to Answer Clinicians’ Requests for Evidence Summaries
Authors: Blasingame Mallory N. , Koonce Taneya Y. , Williams Annette M. , Giuse Dario A. , Su Jing , Krump Poppy A. , Giuse Nunzia Bettinsoli
Published: May 2024

Objective

This study investigated the performance of a generative artificial intelligence (AI) tool using GPT-4 in answering clinical questions in comparison with medical librarians’ gold-standard evidence syntheses.

Methods

Questions were extracted from an in-house database of clinical evidence requests previously answered by medical librarians. Questions with multiple parts were subdivided into individual topics. A standardized prompt was developed using the COSTAR framework. Librarians submitted each question into aiChat, an internally-managed chat tool using GPT-4, and recorded the responses. The summaries generated by aiChat were evaluated on whether they contained the critical elements used in the established gold-standard summary of the librarian. A subset of questions was randomly selected for verification of references provided by aiChat.

Results

Of the 216 evaluated questions, aiChat’s response was assessed as “correct” for 180 (83.3%) questions, “partially correct” for 35 (16.2%) questions, and “incorrect” for 1 (0.5%) question. No significant differences were observed in question ratings by question category (p=0.39). For a subset of 30% (n=66) of questions, 162 references were provided in the aiChat summaries, and 60 (37%) were confirmed as nonfabricated.

Conclusions

Overall, the performance of a generative AI tool was promising. However, many included references could not be independently verified, and attempts were not made to assess whether any additional concepts introduced by aiChat were factually accurate. Thus, we envision this being the first of a series of investigations designed to further our understanding of how current and future versions of generative AI can be used and integrated into medical librarians’ workflow.
The COMT Val158Met Polymorphism is Significantly Associated with Early Onset Preeclampsia in Both African American and Caucasian Mothers
Authors: Kaufman Melissa R. , Hwang Amy E. , Pickrel Anthony M. , Gray Cassandra M. , Goel Kriti M. , Dhanraj David N. , Yaklic Jerome L. , Maxwell Rose A. , Brown Thomas L.
Published: May 2024

The aim of this study was to evaluate maternal and infant Val158Met polymorphisms of Catechol-O-Methyltransferase (COMT), a reported indicator of preeclamptic risk, in a United States population. Healthy control, early-onset preeclamptic, and late-onset preeclamptic patients were enrolled in this study. Genomic DNA was isolated from mothers and infants via buccal swabs and DNA was genotyped via tetra-primer amplification PCR. Our findings indicate that the COMT genotype was not significantly associated with late-onset PE. While there were no significant differences between African American and Caucasian races, the maternal COMTMet158Metgenotype was significantly associated with early-onset preeclampsia in both African Americans and Caucasians when compared to COMTVal158Valor COMTVal158Met. These results suggest that the maternal COMTMet158Metgenotype may be a risk factor for early-onset PE.
Assessment of knowledge and perception of prescribers towards rational medicine use in the Ashanti Region of Ghana
Authors: Djochie Richard Delali Agbeko , Owusu-Donkor Rita , d’Almeida Elizabeth Modupe , Akwah Francis Kwadwo Gyamfi , Kyeremateng Emmanuel , Opoku-Afriyie Samuel , Tabiri Cecilia Akosua , Frimpong Francis Kyei , Dwomoh Samuel , Yiadom Jonathan Boakye
Published: May 2024

Background

Prescribers must possess extensive knowledge and maintain a positive attitude towards the rational use of medicines to achieve desirable treatment outcomes and effectively prevent treatment failures, increased costs, drug toxicities, and interactions. The objective of this study was to evaluate prescribers’ understanding and perception concerning the rational use of medicines in public hospitals. Additionally, the study aimed to identify the factors that influence rational prescribing practices.

Methods

A structured data instrument was developed to collect demographic data and evaluate participants’ knowledge and perception of rational medicine use, in line with the study objectives. Chi-squared statistics and Fisher’s exact test were utilized to identify factors associated with good knowledge and perception among participants. Logistic regression was then employed to assess the strength of the associations, with odd ratios reported at a significant level of 0.05.

Results

Out of 192 participants, 85.4% held a positive view of rational medicine use, stressing patient safety and recognizing risks like antimicrobial resistance and polypharmacy. Perception was influenced by factors such as prescriber profession, access to references, and drug bulletin updates. Additionally, 65.6% demonstrated good knowledge of rational medicine use, which was notably influenced by factors like using standard prescribing guidelines, having a functional Drug and Therapeutics Committee, prescriber profession, and the frequency of drug bulletin updates.

Conclusion

The study emphasizes the critical need to address knowledge gaps among healthcare professionals, especially nurses and other prescribers, to ensure the safe and effective use of medications. It highlights the positive influence of utilizing preferred prescribing references and the existence of functional Drug and Therapeutics Committees in hospitals on knowledge levels. However, the unexpected findings regarding the limited impact of frequent updates of drug bulletins require further investigation.
Genomic sequencing surveillance of patients colonized with vancomycin-resistantEnterococcus(VRE) improves detection of hospital-associated transmission
Authors: Sundermann Alexander J. , Rangachar Srinivasa Vatsala , Mills Emma G. , Griffith Marissa P. , Evans Eric , Chen Jieshi , Waggle Kady D. , Snyder Graham M. , Pless Lora Lee , Harrison Lee H. , Van Tyne Daria
Published: May 2024

Background

Vancomycin-resistant enterococcal (VRE) infections pose significant challenges in healthcare. Transmission dynamics of VRE are complex, often involving patient colonization and subsequent transmission through various healthcare-associated vectors. We utilized a whole genome sequencing (WGS) surveillance program at our institution to better understand the contribution of clinical and colonizing isolates to VRE transmission.

Methods

We performed whole genome sequencing on 352 VRE clinical isolates collected over 34 months and 891 rectal screening isolates collected over a 9-month nested period, and used single nucleotide polymorphisms to assess relatedness. We then performed a geo-temporal transmission analysis considering both clinical and rectal screening isolates compared with clinical isolates alone, and calculated 30-day outcomes of patients.

Results

VRE rectal carriage constituted 87.3% of VRE acquisition, with an average monthly acquisition rate of 7.6 per 1000 patient days. We identified 185 genetically related clusters containing 2-42 isolates and encompassing 69.6% of all isolates in the dataset. The inclusion of rectal swab isolates increased the detection of clinical isolate clusters (from 53% to 67%, P<0.01). Geo-temporal analysis identified hotspot locations of VRE transmission. Patients with clinical VRE isolates that were closely related to previously sampled rectal swab isolates experienced 30-day ICU admission (17.5%), hospital readmission (9.2%), and death (13.3%).

Conclusions

Our findings describe the high burden of VRE transmission at our hospital and shed light on the importance of using WGS surveillance of both clinical and rectal screening isolates to better understand the transmission of this pathogen. This study highlights the potential utility of incorporating WGS surveillance of VRE into routine hospital practice for improving infection prevention and patient safety.
From Necessity to Preference: A Study of Predictors Influencing Elective Caesarean Section in Rwanda
Authors: Koray Munawar Harun , Dushimirimana Theophile , Curry Tanya , Adupo Katia Olaro , Faabie Alfred Pie , Punguyire Damien
Published: May 2024

Background

Caesarean section is an important obstetric intervention that saves the lives of mother and newborn babies. However, its increase is of global public health concern. Despite tremendous reduction in maternal and newborn morbidity and mortality, Rwanda has shown a very high incidence of CS among mothers in recent years. Therefore, this study investigated the predictors of patient-initiated elective CS in Rwanda.

Methods

In this cross-sectional study, we used nationally representative data from Rwanda Demographic and Health Survey 2019/20. A total of 6,167 females were included in this study. Chi-square test was used to test association between the type of caesarean section and demographic characteristics. Both binary and multivariate regression analysis were performed to assess the predictors of elective caesarean section at a p-value ≤ 0.05 and 95% confidence interval. Model fitness was rigorously conducted to ensure validity and reliability of study findings. The data was analysed using STATA version 14 SE.

Results

The rate of CS among women who delivered (6,167) in the last five years preceding the survey was 1,015 (16.46%). Among the women who underwent CS, 36.6% opted for elective CS. Our findings showed that women aged 30 – 39 years were more likely to opt for elective CS [aOR: 3.130, 95%CI:1.969 - 4.978] compared to those aged 29 years or below. Women living in rural areas were less likely to opt for elective CS in the binary regression model [cOR: 0.587, 95%CI: 0.448 – 0.768]. Also, mothers who received ANC assistance by nurse/midwife were 40% less likely [aOR: 0.529, 95%CI: 0.349 – 0.803] to undergo elective CS, than those assisted by doctors.

Conclusion

The rate of elective CS is very high among mothers in Rwanda. By using the 2019/20 RDHS data, the study found the key predictors behind the high rate of CS in Rwanda. These predictors should be deeply considered in developing comprehensive measures and policies to mitigate the unnecessary CS in Rwanda, which has detrimental impact on maternal and newborn outcome.
Single Cell Profiling Distinguishes Leukemia-Selective Chemotypes
Authors: Thirman Hannah L. , Hayes Madeline J. , Brown Lauren E. , Porco John A. , Irish Jonathan M.
Published: May 2024

A central challenge in chemical biology is to distinguish molecular families in which small structural changes trigger large changes in cell biology. Such families might be ideal scaffolds for developing cell-selective chemical effectors – for example, molecules that activate DNA damage responses in malignant cells while sparing healthy cells. Across closely related structural variants, subtle structural changes have the potential to result in contrasting bioactivity patterns across different cell types. Here, we tested a 600-compound Diversity Set of screening molecules from the Boston University Center for Molecular Discovery (BU-CMD) in a novel phospho-flow assay that tracked fundamental cell biological processes, including DNA damage response, apoptosis, M-phase cell cycle, and protein synthesis in MV411 leukemia cells. Among the chemotypes screened, synthetic congeners of the rocaglate family were especially bioactive. In follow-up studies, 37 rocaglates were selected and deeply characterized using 12 million additional cellular measurements across MV411 leukemia cells and healthy peripheral blood mononuclear cells. Of the selected rocaglates, 92% displayed significant bioactivity in human cells, and 65% selectively induced DNA damage responses in leukemia and not healthy human blood cells. Furthermore, the signaling and cell-type selectivity were connected to structural features of rocaglate subfamilies. In particular, three rocaglates from the rocaglate pyrimidinone (RP) structural subclass were the only molecules that activated exceptional DNA damage responses in leukemia cells without activating a detectable DNA damage response in healthy cells. These results indicate that the RP subset should be extensively characterized for anticancer therapeutic potential as it relates to the DNA damage response. This single cell profiling approach advances a chemical biology platform to dissect how systematic variations in chemical structure can profoundly and differentially impact basic functions of healthy and diseased cells.