bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlation Between Prevalence of Selected Enteropathogens and Diarrhea in Children: A Case–Control Study in China
Authors: Huang Zheng , He Zixiang , Wei Zhongqiu , Wang Wei , Li Zhenpeng , Xia Xin , Qin Di , Zhang Ling , Guo Jiayin , Li Jie , Diao Baowei , Zhan Zhifei , Zhang Jingyun , Zeng Mei , Kan Biao
Published: August 2021

Background

The application of nucleic acid detection methods improves the ability of laboratories to detect diarrheal pathogens, but it also poses new challenges for the interpretation of results. It is often difficult to attribute a diarrhea episode to the detected pathogens. Here we investigated the prevalence of 19 enteropathogens among diarrheal and nondiarrheal children and provided support for understanding the clinical significance of the pathogens.

Methods

A total of 710 fecal samples were collected from children under 5 years old in 2 different regions of China from May 2017 to March 2018, comprising 383 mild to moderate diarrheal cases and 327 nondiarrheal controls. The enteropathogens were detected using real-time polymerase chain reaction (PCR) or real-time reverse transcription PCR (RT-PCR).

Results

Enteropathogens were detected in 68.9% of cases and 41.3% of controls. Rotavirus A (adjusted OR [aOR], 9.91; 95% CI, 4.99–19.67), norovirus GI and GII (aOR, 3.82; 95% CI, 2.12–6.89), and Campylobacter jejuni (aOR, 20.12; 95% CI, 2.57–157.38) were significantly associated with diarrhea (P < .05). Adenovirus, norovirus GII, rotavirus A, and enteroaggregative Escherichia coli (pCVD432) gave lower cycle threshold (Ct) values in cases than in controls (P < .05). Rotavirus A and norovirus GII were associated with diarrhea when the Ct values were ≤30 and ≤25, respectively.

Conclusions

The types and loads of enteropathogens are likely to influence the interpretation of the clinical significance of positive results.
Meningovascular Syphilis Presenting as a Brain Mass in an Immunocompetent Male
Authors: Pham Khanh , Gottesdiener Lee , Simon Matthew S , Trzebucki Alex , Maldarelli Grace A , Cisse Babacar , Lieberman Joshua , DeHaan Elliot , Pisapia David
Published: August 2021

We present a case of a human immunodeficiency virus–negative man with syphilitic meningovascular disease with subjacent involvement of brain parenchyma leading to a mass-forming inflammatory lesion that was pathologically distinct from a typical gumma. Syphilis was diagnosed after tissue obtained from a brain biopsy demonstrated spirochetes consistent with Treponema pallidum and confirmed by 16S ribosomal RNA sequencing.
Auricular acupressure for treating early stage of knee osteoarthritis: a randomized, sham-controlled prospective study
Authors: Zhang X , He B , Wang H , Sun X
Published: August 2021

Objective

We examined whether auricular acupressure (AA) at four specifically preselected AA points can alleviate knee pain and decrease non-steroidal anti-inflammatory drugs (NSAIDs) consumption and its adverse effects for osteoarthritis patients.

Methods

Sixty-two patients (more than 40 years) with knee osteoarthritis of Kellgren–Lawrence grades of I or II upon radiographic classification were enrolled in this randomized, sham-controlled prospective study, and divided into two groups (AA group and control group). The AA group received true AA by embedding vaccaria seeds at four specific AA points (knee joint, shenmen, subcortex and sympathesis) ipsilateral to the knee osteoarthritis site, while the control group received four nonacupuncture points on the auricular helix. Visual analog scale (VAS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score, the number of patients who needed celecoxib pills and adverse effects were recorded.

Results

VAS and WOMAC scores in the AA group were significantly lower than that in the control group (P < 0.05) at Days 3 and 7 postsugery. The VAS and WOMAC score were significantly decreased after the treatment in the AA group compared with that before the treatment (P < 0.05). The use of celebrex is significantly lower in the AA group than in the control group (P < 0.05), no major side effects were observed during the auricular acupressure treatment.

Conclusion

Auricular acupressure plays a role in analgesic effect and can effectively decrease NSAIDs requirements without causing adverse events for the treatment of human knee osteoarthritis.
Causes of Raynaud’s phenomenon and the predictive laboratory and capillaroscopy features for the evolution to a definite connective tissue disease
Authors: Shenavandeh Saeedeh , Ajri Mehrnoush , Hamidi Sahand
Published: August 2021

Objective

In patients with RP, capillaroscopy is useful for discriminating primary from secondary causes. There are certain capillaroscopy and lab values as predictive factors leading to a known CTD. We conducted the present study to evaluate the causes of RP in our area and followed the studied subjects to find prognostic factors indicating a definite CTD or remaining a UCTD.

Methods

In this retrospective cohort study we included all adult patients with RP who were referred for capillaroscopy from 2010 to 2019. All the patients with primary and secondary RP with follow-up were evaluated for demography, laboratory results and capillaroscopy to find the risk factors of their progression to a CTD.

Results

A total of 760 of 776 patients were included, with 679 being female (89.3%) and 81 (10.7%) male. There were 660 subjects (90.8%) with secondary RP [mostly UCTD (48.2%) and then SSc (16.4%)] and 67 (9.2%) with primary RP; 109 patients were followed up and 42 (42%) of those with secondary RP developed a definite CTD. The scleroderma pattern and some capillary changes on capillaroscopy and/or positive ANA had statistically significant differences for CTD transition.

Conclusion

We had a small number of patients with primary RP. The most prevalent causes of secondary RP in our patients were UCTD and SSc. Some capillaroscopy and laboratory results alone or in combination could be used as a predictive marker for the transition of patients with UCTD to CTD.
2-deoxy-2[18F]fluoro-D-glucose positron emission tomography–computed tomography in rheumatological diseases
Authors: Subesinghe Manil , Bhuva Shaheel , Arumalla Nikita , Cope Andrew , D’Cruz David , Subesinghe Sujith
Published: August 2021

2-deoxy-2[18F]fluoro-D-glucose (FDG) PET-CT has revolutionized oncological imaging. The cellular processes that make cancer cells visible on FDG PET-CT also occur in a number of inflammatory cells. Exploiting this phenomenon has led to a growth of evidence supporting the use of FDG PET-CT in a wide range of infective and inflammatory diseases. Rheumatological diseases can affect multiple sites within the musculoskeletal system alongside multi-organ extra-articular disease manifestations. Inflammation is central to these diseases, making FDG PET-CT a logical choice. In this review article we describe the various applications of FDG PET-CT in rheumatological diseases using illustrative examples to highlight the beneficial role of FDG PET-CT in each case.
Survey of Vineyard Insects and Plants to Identify Potential Insect Vectors and Noncrop Reservoirs of Grapevine Red Blotch Virus
Authors: Wilson Houston , Hogg Brian N. , Blaisdell G. Kai , Andersen Jeremy C. , Yazdani Armand S. , Billings Alexis C. , Ooi Kei-lin M. , Soltani Nourolah , Almeida Rodrigo P. P. , Cooper Monica L. , Al Rwahnih Maher , Daane Kent M.
Published: August 2021

Grapevine red blotch virus (GRBV) is a DNA virus in the family Geminiviridae. This pathogen is the causal agent of grapevine red blotch disease, which affects cultivated grapevines and leads to negative effects on crop quality and yield. GRBV is present in commercial vineyards across North America, indicating that spread might have been largely human mediated. That said, recent surveys have demonstrated that there appears to be secondary transmission, most likely by an insect vector. In this study, vineyard insects and plants were surveyed to identify potential candidate vectors and noncrop plants that could act as reservoirs for this pathogen. Results reconfirm that GRBV is limited to Vitis spp., including both cultivated and wild grapevines. Eleven insect genera or species, field collected in vineyards, tested positive for GRBV using quantitative polymerase chain reaction. These insect taxa include unknown Aphididae, the cicadellids Aceratagallia spp., Acinopterus angulatus, Caladonus coquilleti, Colladonus montanus reductus, Colladonus sp., Empoasca spp., Erythroneura elegantula, and Scaphytopius graneticus, along with the membracid Spissistilus festinus and an unknown delphacid. Of these organisms, S. festinus is already known to be capable of transmitting GRBV, and Scaphytopius graneticus may merit closer evaluation as a candidate vector.

[Formula: see text] Copyright © 2022 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Rethinking Bias to Achieve Maternal Health Equity: Changing Organizations, Not Just Individuals
Authors: Green T.L. , Zapata J.Y. , Brown H.W. , Hagiwara N.
Published: August 2021

(Obstet Gynecol. 2021;137:935–940)

Disparities exist in communication with and treatment of black women compared with white women within the health care setting, and biases play a role. Subsequently, black women receive inferior care, significantly impacting risk of maternal morbidity. Strategies and trainings have been put in place to reduce implicit bias and, though well intentioned, no evidence suggests that (1) disparities between black-white health care treatment have lessened and (2) biases and behaviors of health care professionals have been affected long term. These trainings also focus on individual-level biases rather than social-context biases and, therefore, are less effective in a health care setting. As maternal and neonatal outcomes are impacted, it is important to underscore the implicit and explicit biases that occur within health care at large.
Management of Clinical Chorioamnionitis: An Evidence-based Approach
Authors: Conde-Agudelo A. , Romero R. , Jung E.J. , Sánchez A.J.G.
Published: August 2021

(Am J Obstet Gynecol. 2020;223:848–869)

Clinical chorioamnionitis affects 1% to 6% of US pregnancies and is a risk factor for postpartum hemorrhage, neonatal sepsis, neonatal intensive care unit admission, neonatal death, and other adverse outcomes. Clinical chorioamnionitis has typically been diagnosed by maternal fever combined with at least 2 other symptoms: maternal tachycardia, fetal tachycardia, uterine tenderness, purulent or foul-smelling amniotic fluid or vaginal discharge, or maternal leukocytosis. This condition is usually treated with antibiotics and antipyretic agents, along with expedited delivery, though management regimens vary widely in terms of types of antibiotic and timing of treatment. This review aimed to examine evidence on the treatment of clinical chorioamnionitis to develop an evidence-based management approach. A literature search was conducted using MEDLINE, EMBASE, POPLINE, LILACS, CINAHL, the Cochrane Central Register of Controlled Trials, clinical trial registries, and Google Scholar.
The Political Nature of Sex—Transgender in the History of Medicine
Authors: Slagstad K.
Published: August 2021

(N Engl J Med. 2021;384:1070–1074)

Recent policy changes in the United States concerning discrimination, sex, and gender identity are only the most recent developments in a long social and medical history of sex and gender. As ideas of sex and gender change in society, so does medical understanding and approaches.
SSRI Use During Pregnancy and Risk for Postpartum Hemorrhage: A National Register-based Cohort Study in Sweden
Authors: Skalkidou A. , Sundstrom-Poromaa I. , Wikman A. , Hesselman S. , Wikstrom A.K. , Elenisa E.
Published: August 2021

(BJOG. 2020;127:1366–1373)

Up to 1 in 6 women globally are affected by maternal mood disorders and perinatal depression, and over the course of the last 20 years, treatment with selective serotonin reuptake inhibitors (SSRIs) has dramatically increased. SSRIs remain the drug of choice for depression affecting pregnant women despite the small elevated risk of persistent pulmonary hypertension of the newborn, cardiovascular defects, and need for neonatal intensive care. However, as the use of SSRIs in nonpregnant populations is associated with elevated risk for upper gastrointestinal tract bleeding, intracranial hemorrhage, and increased postoperative blood loss, this study’s primary aim was to investigate whether or not SSRIs used by pregnant women lead to a higher risk of postpartum hemorrhage (PPH). The hypothesis was that use of SSRIs in pregnancy would increase the risk of PPH in women with low-risk pregnancies in Sweden.
Association of Lumbar Puncture With Spinal Hematoma in Patients With and Without Coagulopathy
Authors: Bodilsen J. , Mariager T. , Vestergaard H.H. , Christiansen M.H. , Kunwald M. , Lüttichau H.R. , Kristensen B.T. , Bjarkam C.R. , Nielsen H.
Published: August 2021

(JAMA. 2020;324:1419–1428)

A crucial procedure for central nervous system infections, certain types of cancer, and neurological diseases is lumbar puncture. Spinal hematoma is a possible complication of the procedure and presents with paraparesis, back pain, and urinary incontinence. This study aimed to examine lumbar punctures and determine the risk of spinal hematoma following this procedure for patients with and without coagulopathy in Denmark.
Intrauterine Versus External Tocodynamometry in Monitoring Labour: A Randomized Controlled Clinical Trial
Authors: Hautakangas T. , Uotila J. , Huhtala H. , Palomäki O.
Published: August 2021

(BJOG. 2020;127:1677–1686)

Intrauterine tocodynamometry (IT) is sometimes used when external tocodynamometry (ET) cannot provide adequate information on uterine contractions. Four studies have previously compared IT and ET and found no difference in terms of neonatal outcomes, but these studies did not include patients undergoing trial of labor after cesarean, and 3 used small (<250 patients) sample sizes and were conducted >20 years ago. This randomized controlled study compared ET and IT in patients admitted for delivery in terms of mode of delivery, neonatal outcomes, and oxytocin use.
Anaphylaxis in Pregnancy: A Population-based Multinational European Study
Authors: McCall S.J , Bonnet M.P. , Ayras O. , Vandenberghe G. , Gissler M. , Zhang W.H. , Van Leeuw V. , Deneux-Tharaux C. , Kurinczuk J.J. , Knight M.
Published: August 2021

(Anaesthesia. 2020;75:1469–1475)

Anaphylaxis is an immunoglobulin E–mediated event that occurs without warning after exposure to an inciting antigen. In pregnancy, this rare condition may result in severe maternal and fetal morbidity and mortality, as it has multisystemic effects. Limited high-quality studies exist regarding anaphylaxis during pregnancy. As the occurrence is rare in a single nation’s population, this European multinational study used prospective and retrospective data collection methods to estimate the causative agents, incidence, management, and outcomes of anaphylaxis during pregnancy.
Anaphylaxis in Obstetrics—Double the Trouble
Authors: Savic L.C. , Lucas D.N.
Published: August 2021

(Anaesthesia. 2020;75:1424–1427)

Anaphylaxis in obstetrics, a rare but life-threatening event, can be expected for an individual anesthetist to witness once every 7 years. As the infrequency coupled with difficulties and challenges of resuscitation may heighten anxieties with such events, investigations such as the pan-European study provide further insight into beneficial management methods.
Prenatal Exposure to General Anesthesia and Childhood Behavioral Deficit
Authors: Ing C. , Landau R. , DeStephano D. , Miles C.H. , von Ungern-Sternberg B.S. , Li G. , Whitehouse A.J.O.
Published: August 2021

(Anaesthesia. 2020;75:1424–1427)

(Anesth Analg. 2021. doi: 10.1213/ANE.0000000000005389. Epub ahead of print)

While the US Food and Drug Administration has issued a warning about the neurodevelopmental effects of anesthetic drugs in the third trimester of pregnancy and children under the age of 3, no clinical study has evaluated long-term neurodevelopmental outcomes following prenatal exposure to anesthetics. Since anesthetic drugs cross the placenta and the brain is particularly vulnerable in the prenatal period, it is plausible that prenatal anesthetic exposure could lead to adverse neurodevelopmental effects. This study examined the effects of prenatal exposure to general anesthetic agents and neuropsychological and behavioral survey scores at age 10.
In Vitro Fertilization as an Independent Risk Factor for Placenta Accreta Spectrum
Authors: Salmanian B. , Fox K.A , Arian S.E. , Erfani H. , Clark S.L. , Aagaard K.M. , Detlefs S.E , Aalipour S. , Espinoza J. , Nassr A.A. , Gibbons W.E. , Shamshirsaz A.A. , Belfort M.A. , Shamshirsaz A.A.
Published: August 2021

(Am J Obstet Gynecol. 2020;223:568.e1–568.e5)

Placental accreta spectrum (PAS) is an increasingly prevalent and possibly life-threatening condition. While major risk factors for the condition are well-recognized (placenta previa and history of cesarean delivery), identifying additional risk factors will also facilitate the focus on at-risk populations. Antenatal diagnosis, in turn, allows for development of multidisciplinary management plans before labor onset or bleeding with PAS, thus improving outcomes and limiting morbidity. Prior studies have suggested a possible association between in vitro fertilization (IVF) and PAS. The primary goal of this study was to investigate if there was an independent association between IVF and PAS, with the hypothesis that patients undergoing IVF are at increased risk for PAS. The primary outcome variable was PAS.
Preeclampsia-like Syndrome Induced by Severe COVID-19: A Prospective Observational Study
Authors: Mendoza M. , Garcia-Ruiz I. , Maiz N. , Rodo C. , Garcia-Manau P. , Serrano B. , Lopez-Martinez R.M. , Balcells J. , Fernandez-Hidalgo N. , Carreras E. , Suya A.
Published: August 2021

(BJOG. 2020;127:1374–1380)

Coronavirus disease 2019 (COVID-19) typically presents as a respiratory infection. Of note, compared with the general pregnant population, increased rates of preeclampsia have been reported in mothers infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Endothelial damage caused by placental oxidative stress leads to the clinical features of preeclampsia including hypertension, proteinuria, elevated levels of liver enzymes, renal dysfunction, thrombocytopenia, and other symptoms. This study aimed to examine the prevalence of clinical, biochemical, and ultrasonographic findings of preeclampsia in women infected with SARS-CoV-2 and also to assess the accuracy in differentiating between actual preeclampsia and preeclampsia-like features associated with COVID-19.
Evaluation for SARS-CoV-2 in Breast Milk From 18 Infected Women
Authors: Chambers C. , Krogstad P. , Bertrand K. , Contreras D. , Tobin N.H. , Bode L. , Aldrovandi G.
Published: August 2021

(JAMA. 2020;324:1347)

While the concern that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may be transmitted to infants via breastfeeding has been raised, organizations recommend women infected with SARS-CoV-2 may continue to breastfeed if they so choose. There had been no documented cases of transmission of the virus to the infant through breast milk and to date the virus has not been directly isolated from breast milk.
Critical Obstetric Patients During the Coronavirus Disease 2019 Pandemic: Operationalizing an Obstetric Intensive Care Unit
Authors: Martinez R. , Bernstein K. , Ring L. , Ona S. , Baptiste C. , Syeda S. , Aziz A. , Robinson K. , Valderrama N. , Sheen J.-J. , D’Alton M. , Goffman D. , Gyamfi-Bannerman C. , Moroz L. , Landau R.
Published: August 2021

(Anesth Analg. 2021;132:46–51)

In the early months of the coronavirus pandemic, the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in pregnant patients presenting to labor and delivery (L&D) units in New York City was 15.4%. As intensive care unit (ICU) beds became scarce and nonemergent surgeries were halted, one large academic institution in NYC decided to create an obstetric intensive care unit (OBICU), which was fully operational by the end of March 2020. This article describes how the hospital staffed and operated the OBICU to treat critically ill peripartum patients with a quality of care equal to that of a surgical or medical ICU.
The Effect of Carbetocin Dose on Transmural Dispersion of Myocardial Repolarization in Healthy Parturients Scheduled for Elective Cesarean Delivery Under Spinal Anesthesia: A Prospective, Randomized Clinical Trial
Authors: Clunies-Ross N. , Roston T.M. , Taylor J. , Whyte S. , Albert A. , Görges M. , Chau A.
Published: August 2021

(Anesth Analg. 2021;132:485–492)

Transmural dispersion of myocardial repolarization (TDR) is the interval between the peak of the T wave and end of the TV wave (Tp-e). Increased TDR is a more reliable predictor of drug torsadogenicity than prolonged QT interval. Carbetocin, a synthetic analog of oxytocin, is used to prevent postpartum hemorrhage following cesarean delivery, though the effect dose varies. Carbetocin has been shown to increase mean correct QT, but there is a paucity of information on the effects of carbetocin of TDR. This study examined the effects of carbetocin dose on TDR in patients undergoing cesarean delivery under spinal anesthesia.
Intrapartum-related Perinatal Deaths in Births Planned in Midwifery-led Settings in Great Britain: Findings and Recommendations From the ESMiE Confidential Enquiry
Authors: Rowe R. , Draper E.S. , Kenyon S. , Bevan C. , Dickens J. , Forrester M. , Scanlan R. , Tuffnell D. , Kurinczuka J.J.
Published: August 2021

(BJOG. 2020;127:1665–1675)

The UK has higher rates of stillbirth and neonatal mortality than similar countries. A 2015 UK-wide confidential inquiry, Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK), identified key issues contributing to perinatal death, including inadequate maternal monitoring, errors in fetal monitoring, and failure to recognize the transition from the latent phase of labor to the active phase. The majority of deaths included in MBRRACE-UK occurred in hospital obstetric units (OUs), but the proportion of births occurring in midwifery-led settings in England is increasing. While there is no evidence that midwifery-led settings experience higher rates of intrapartum-related perinatal deaths compared with OU, contributing factors to perinatal deaths in midwifery settings may differ. Enhancing the safety of Midwifery-led births Enquiry (ESMiE) reviewed the quality of care in pregnancy, labor, birth, and postpartum in births resulting in intrapartum-related deaths in midwifery-led settings and compared the findings with those of MBRRACE-UK.
Emergency Cerclage in Singleton Pregnancies With Painless Cervical Dilatation: A Meta-analysis
Authors: Chatzakis C. , Efthymiou A. , Sotiriadis A. , Makrydimas G.
Published: August 2021

(Acta Obstet Gynecol Scand. 2020;99:1444–1457)

Cervical insufficiency in the second trimester has essentially 3 treatment options at the discretion of the clinician: expectant management, placement of a cervical pessary, and placement of cervical cerclage. These methods are typically used in addition to courses of antibiotics, additional prescriptions (ie, progesterone, corticosteroids), and bed rest. This meta-analysis aimed to compare emergency cerclage versus expectant management for maternal and perinatal outcomes, as well as to identify areas requiring additional or better-quality clinical evidence.
Changes in Seizure Frequency and Antiepileptic Therapy During Pregnancy
Authors: Pennell P.B. , French J.A. , May R.C. , Gerard E. , Kalayjian L. , Penovich P. , Gedzelman E. , Cavitt J. , Hwang S. , Pack A.M. , Sam M. , Miller J.W. , Wilson S.H. , Brown C. , Birnbaum A.K. , Meador K.J.
Published: August 2021

(N Engl J Med. 2020;383:2547–2556)

The management of pregnant women with epilepsy involves weighing the need to control seizures with the risks of antiepileptic drugs negatively affecting the development of the fetus. Epilepsy is associated with higher rates of maternal mortality compared with nonepileptic mothers. Pregnancy has been reported to increase the rate of seizures in women with epilepsy. This study aimed to compare the frequency of seizures in pregnant and nonpregnant women and investigated changes in required doses of antiepileptic drugs in pregnant women compared with nonpregnant women.
The Effect of Spinal Hypotension and Anesthesia-to-delivery Time Interval on Neonatal Outcomes in Planned Cesarean Delivery
Authors: Knigin D. , Avidan A. , Weiniger C.F.
Published: August 2021

(Am J Obstet Gynecol. 2020;223:747.e1–747.e13)

While spinal anesthesia is the preferred anesthetic in planned cesarean deliveries (CDs), one of its major drawbacks is the potential for maternal hypotension. The literature has demonstrated the relationship between the degree of hypotension and neonatal acidosis, but the effect of hypotension duration is unclear. In addition, the window between the administration of anesthesia to delivery may provide an opportunity to decrease the risk of adverse neonatal events. The aim of this study was to examine the effect of maternal hypotension and the anesthesia-to-delivery time interval on neonatal events in planned CDs.
Spinal Anesthesia-induced Hypotension: Is it More Than Just a Pesky Nuisance?
Authors: Wong C.A.
Published: August 2021

(Am J Obstet Gynecol. 2002;223:621–623)

As early as the 1930s, maternal hypotension had been recognized as a significant problem when administering spinal anesthesia. Over the decades, the use of spinal anesthesia has peaked and waned as the practice of anesthesia has evolved. But since the 1990s, it has seen a resurgence as pencil-point needles reduced headache risk and the hemodynamic changes were better understood and management strategies were developed.
A 26-Year-Old Pregnant Woman With Ventricular Tachycardia and Shock
Authors: Scott N.S. , Thomas S.S. , DeFaria Yeh D. , Fox A.S. , Smith R.N.
Published: August 2021

(N Engl J Med. 2021;384:272–282)

A 26-year-old patient, pregnant with monochorionic, diamniotic twins at 32 weeks gestation, was transferred to the hospital following cardiac arrest caused by ventricular tachycardia. This was the patient’s third pregnancy and the previous 2 were uncomplicated. One week before presenting to the hospital, the patient had a cough, sore throat and ear pain, and new edema in her legs. She was prompted to seek care at an emergency department when pain in her right leg progressed. While in the emergency department, painful contractions began, the cervix was 2 cm dilated, and preterm labor management began. There was no further cervical dilation after 24 hours but the patient remained hospitalized. After 5 days the edema had worsened, and an occlusive thrombus was found in the left peroneal vein. Intravenous heparin was administered. The next day, the patient experienced chest pain before becoming unresponsive. Monomorphic ventricular tachycardia was detected. Spontaneous circulation resumed after epinephrine and cardioversion were administered. The patient underwent tracheal intubation and then emergency cesarean section, which resulted in 2 health male infants and an intraoperative blood loss of 1600 mL.
Addressing Body Image After Reconstructive Surgery in Adult Patients with Cancer
Authors: Williams Tish
Published: August 2021

Body image or how a person views their body and the way it functions ultimately influences their quality of life and functional well-being in their daily environments. The changes to appearance or to body structures and functions that occur as a result of cancer and its treatment can cause individuals to become dissatisfied with their body image where maladaptive emotions, thought processes, and behaviors develop and may lead to deleterious consequences including social avoidance and isolation. Although reconstructive surgery is restorative in nature, it does not guarantee the mitigation of body image dissatisfaction when treating adults with cancer. The majority of adults who undergo reconstructive surgery for the treatment of cancer demonstrate some level of body image dissatisfaction during or after the reconstructive process. Therefore, a need exists for nurses and other oncological team members to recognize and address body image dissatisfaction and the detrimental emotional and behavioral consequences associated with it. This article provides guidance for nurses to address body image by understanding the effects of cancer and its treatment on body image, by recognizing the impact of reconstructive surgery on body image when treating cancer in adults, and by integrating body image assessment and interventions into practice.
Atypical Presentation of Cutaneous Squamous Cell Carcinoma of the Head and Neck: A Case Report
Authors: Hagiga Ahmed , Mosalem Osama , Hamdan Muhammad Y.
Published: August 2021

Tumors of the head and neck can spread by direct extension, hematogenous spread, or lymphatic dissemination. However, a process known as perineural invasion (PNI) allows nerves to act as a direct conduit for tumor growth away from the primary site. Perineural invasion is a rare, atypical presentation of cutaneous squamous cell carcinoma of the head and neck that affects about 2.5%–14% of the population. It is known to be associated with an increased risk of local recurrent and distant metastasis, thus adversely affecting the patient's prognosis. The majority of PNI cases are asymptomatic, often discovered during pathological evaluation. We report the case of a patient who presented with a 1-year history of right-sided face pain and symptoms suggestive of trigeminal facial neuralgia. A skin biopsy taken from a lesion on his right cheek showed PNI secondary to cutaneous squamous cell carcinoma of the head and neck. We treated the patient with radiotherapy and chemotherapy and his clinical condition improved significantly. We are publishing this case report to increase awareness of practicing physicians and nurses to PNI as an atypical presentation of squamous cell carcinoma that may affect selection of treatment modality and the patient's prognosis.
Immunity status in patients with periprosthetic knee joint infection
Authors: Mamonova Irina A. , Babushkina Irina. V. , Bondarenko Aleksandr S. , Ulyanov Vladimir Yu.
Published: August 2021

Implant-associated infection is one of the most severe complications after total replacement of larger joints. The diagnosis of periprosthetic infection are often impeded as 5-34% of bacteriological tests are false-negative. Now the investigations of the immune status of patients suspected of periprosthetic infection are considered perspective as these are aimed at finding the most significant indicators for underlying the diagnosis of this pathology. In this research, we assessed immunology indicators in peripheral blood of patients with periprosthetic infection in their knee joints. We determined immunology characteristics associated with the clinical aspects of the progressing pathology. Our findings can be used as the basis for further search of pathophysiological mechanisms of periprosthetic infection progress in the knee joint as well as defining new diagnostic approaches.

Reviewers:

Ivanov A.N., MD, DSc;

Prof. Puchinyan D.M., MD, DSc
You aren’t what you eat, you become what you eat
Authors: Stephens Christopher R. , Easton Jonathan F. , Sicilia Heriberto Román
Published: August 2021

Obesity (and the consequent obesity epidemic) is a complex, adaptive process, taking place over a time span of many years. Energy intake is recognized as a potentially important driver of obesity, especially in the context of an identifiable energy imbalance which, it is surmised, must lead to weight gain. Similarly, energy expenditure must play an important role. However, both show an enormous degree of individual variation. Therefore, measuring them is an exceedingly difficult task, especially in the context of large populations and long time periods. It has been argued that population-level observed weight gain can be traced back to very small daily energy imbalances while, at the same time, positing that a much larger maintenance energy gap is responsible for maintaining the energy requirements of the increased weight population. In this paper we examine the relation between BMI and energy intake as functions of age. The convexity of the BMI curves as a function of age and gender demonstrate the enhanced obesity risk apparent in young adults and women, and imply that no settling points exist at the population level. Consistent with other studies, overall weight increases are consistent with a very small daily energy imbalance, about 7 cal. Consumption as a function of age shows a small, steady, linear decrease of about 8 cal per year, and can be associated with a maximal energy excess/deficit of about 250cal for the youngest and oldest age groups. By examining weight differences between age groups as a function of age, we argue that this excess/deficit is an important motor for the observed weight differences, and argue that the apparent energy imbalance of 250 cal, due to excess consumption, leads to an effective imbalance of only 7 cal due to the existence of various physiological and behavioral mechanisms that enhance weight homeostasis and effectively reduce the energy excess from 250 cal to 7 cal. We discuss several possibilities for such mechanisms.
Towards the global equilibrium of COVID-19: statistical analysis of country-level data
Authors: Last Mark
Published: August 2021

Objectives: In our study, we explore the COVID-19 dynamics to test whether the virus has reached its equilibrium point and to identify the main factors explaining R and CFR variability across countries. Design: A retrospective study of publicly available country-level data. Setting: Fifty countries having the highest number of confirmed COVID--19 cases at the end of September 2021. Participants: Aggregated data including 213 976 306 COVID-19 cases confirmed in the selected fifty countries from the start of the epidemic to September 30, 2021. Primary and secondary outcome measures: The daily values of COVID-19 R and CFR measures were estimated using country-level data from the Our World in Data website. Results: The mean values of country--level moving averages of R and CFR went down from 1.118 and 6.3\%, respectively, on June 30, 2020 to 1.083 and 3.6\% on September 30, 2020 and to 1.015 and 1.8\% by September 30, 2021. In parallel, the 10\% to 90\% inter-percentile range of R and CFR moving averages decreased from 0.288 and 13.3\%, respectively, on June 30, 2020, to 0.151 and 7.7\% on September 30, 2020, and to 0.107 and 3.3\% by September 30, 2021. According to a comparison of the country--level 180--day moving averages of R and CFR calculated on September 30, 2021, an increase of 1\% in the Delta variant share is associated with an increase of 0.0009 (95\% CI 0.000 to 0.002) in the average Reproduction Number R, while an increase of 1\% in the total percentage of confirmed COVID-19 cases per country's population is associated with a decrease of 0.005 (95\% CI 0.000 to 0.010) in the average R. Also, an increase of 1\% in the total percentage of fully vaccinated people per country's population is associated with a decrease of 0.04\% (95\% CI 0.01\% to 0.06\%) in the average CFR. Other virological, demographic, economic, immunization, or stringency factors were not statistically significantly associated with either R or CFR across the explored countries. Conclusions: The slow decrease in the country-level moving averages of R, approaching the level of 1.0 and accompanied by repeated outbreaks ("waves") in various countries, may indicate that COVID-19 has reached its point of a stable endemic equilibrium. A regression analysis implies that only a prohibitively high level of herd immunity (about 63\%) may stop the endemic by reaching a stable disease-free equilibrium. It also appears that fully vaccinating about 70\% of a country's population should be sufficient for bringing the CFR close to the level of a seasonal flu (about 0.1\%). Thus, while the currently available vaccines prove to be effective in reducing the mortality from the existing COVID-19 variants, they are unlikely to stop the spread of the virus in the foreseeable future. It is noteworthy that no statistically significant effects of government measures restricting the people's behavior (such as lockdowns) were found in the analyzed data.
Environmental Exposure to Volatile Organic Compounds is Associated with Endothelial Injury
Authors: Riggs Daniel W. , Malovichko Marina V. , Gao Hong , McGraw Katlyn E. , Taylor Breandon S. , Krivokhizhina Tatiana , Rai Shesh N. , Keith Rachel J. , Bhatnagar Aruni , Srivastava Sanjay
Published: August 2021

Objective

Volatile organic compounds (VOCs) are airborne toxicants abundant in outdoor and indoor air. High levels of VOCs are also present at various Superfund and other hazardous waste sites; however, little is known about the cardiovascular effects of VOCs. We hypothesized that ambient exposure to VOCs exacerbate cardiovascular disease (CVD) risk by depleting circulating angiogenic cells (CACs).

Approach and Results

In this cross-sectional study, we recruited 603 participants with low-to-high CVD risk and measured 15 subpopulations of CACs by flow cytometry and 16 urinary metabolites of 12 VOCs by LC/MS/MS. Associations between CAC and VOC metabolite levels were examined using generalized linear models in the total sample, and separately in non-smokers. In single pollutant models, metabolites of ethylbenzene/styrene and xylene, were negatively associated with CAC levels in both the total sample, and in non-smokers. The metabolite of acrylonitrile was negatively associated with CD45dim/CD146+/CD34+/AC133+cells and CD45+/CD146+/AC133+, and the toluene metabolite with AC133+cells. In analysis of non-smokers (n=375), multipollutant models showed a negative association with metabolites of ethylbenzene/styrene, benzene, and xylene with CD45dim/CD146+/CD34+cells, independent of other VOC metabolite levels. Cumulative VOC risk score showed a strong negative association with CD45dim/CD146+/CD34+cells, suggesting that total VOC exposure has a cumulative effect on pro-angiogenic cells. We found a non-linear relationship for benzene, which showed an increase in CAC levels at low, but depletion at higher levels of exposure. Sex and race, hypertension, and diabetes significantly modified VOC associated CAC depletion.

Conclusion

Low-level ambient exposure to VOCs is associated with CAC depletion, which could compromise endothelial repair and angiogenesis, and exacerbate CVD risk.
Spatial inequity in distribution of COVID-19 vaccination services in Aotearoa
Authors: Whitehead Jesse , Carr Polly Atatoa , Scott Nina , Lawrenson Ross
Published: August 2021

Aim

This research examines the spatial equity, and associated health equity implications, of the geographic distribution of Covid-19 vaccination services in Aotearoa New Zealand.

Method

We mapped the distribution of Aotearoa’s population and used the enhanced-two-step-floating-catchment-method (E2SFCA) to estimate spatial access to vaccination services, taking into account service supply, population demand, and distance between populations and services. We used the Gini coefficient and both global and local measures of spatial autocorrelation to assess the spatial equity of vaccination services across Aotearoa. Additional statistics included an analysis of spatial accessibility for priority populations, including Māori (Indigenous people of Aotearoa), Pacific, over 65-year-olds, and people living in areas of high socioeconomic deprivation. We also examined vaccination service access according to rurality, and by District Health Board region.

Results

Spatially accessibility to vaccination services varies across Aotearoa, and appears to be better in major cities than rural regions. A Gini coefficient of 0.426 confirms that spatial accessibility scores are not shared equally across the vaccine-eligible population. Furthermore, priority populations including Māori, older people, and residents of areas with socioeconomic constraint have, on average, statistically significantly lower spatial access to vaccination services. This is also true for people living in rural areas. Spatial access to vaccination services, also varies significantly by District Health Board (DHB) region as does equality of access, and the proportion of DHB priority population groups living in areas with poor access to vaccination services. A strong and significant positive correlation was identified between average spatial accessibility and the Māori vaccination rate ratio of DHBs.

Conclusion

Covid-19 vaccination services in Aotearoa are not equitably distributed. Priority populations, with the most pressing need to receive Covid-19 vaccinations, have the worst access to vaccination services.
Endophenotype Effect Sizes Provide Evidence Supporting Variant Pathogenicity in Monogenic Disease Susceptibility Genes
Authors: Morrill Valerie N. , Halford Jennifer L. , Choi Seung Hoan , Jurgens Sean J. , Melloni Giorgio , Marston Nicholas A. , Weng Lu-Chen , Nauffal Victor , Hall Amelia W. , Gunn Sophia , Austin-Tse Christina A. , Pirruccello James P. , Khurshid Shaan , Rehm Heidi L. , Benjamin Emelia J. , Boerwinkle Eric , Brody Jennifer A. , Correa Adolfo , Fornwalt Brandon K. , Gupta Namrata , Haggerty Christopher M. , Harris Stephanie , Heckbert Susan R. , Hong Charles C. , Kooperberg Charles , Lin Henry J. , Loos Ruth J. F. , Mitchell Braxton D. , Morrison Alanna C. , Post Wendy , Psaty Bruce M. , Redline Susan , Rice Kenneth M , Rich Stephen S. , Rotter Jerome I. , Schnatz Peter F. , Soliman Elsayed Z. , Sotoodehnia Nona , Wong Eugene K. ,   NHLBI Trans-Omics for Precision Medicine (TOPMed) Consortium, Sabatine Marc S. , Ruff Christian T. , Lunetta Kathryn L. , Ellinor Patrick T. , Lubitz Steven A.
Published: August 2021

Accurate and efficient classification of variant pathogenicity is critical for research and clinical care. Using data from three large studies, we demonstrate that population-based associations between rare variants and quantitative endophenotypes for three monogenic diseases (low-density-lipoprotein cholesterol for familial hypercholesterolemia, electrocardiographic QTc interval for long QT syndrome, and glycosylated hemoglobin for maturity-onset diabetes of the young) are proxies for variant pathogenicity. Effect sizes were associated with pathogenic ClinVar assertions (P<0.001 for each trait) and discriminated pathogenic from non-pathogenic variants (area under the curve 0.82-0.83 across endophenotypes). Large effect size thresholds provided evidence supporting pathogenicity for up to 35% of rare variants of uncertain significance or not in ClinVar in disease susceptibility genes, using an effect size threshold of ≥ 0.5 times the endophenotype standard deviation. We propose that variant associations with quantitative endophenotypes for monogenic diseases can provide evidence supporting pathogenicity.
“Prevalence, Patterns, Clinico-social and Behavioural factors associated with the Consumption of Sugar Sweetened Beverages among Undergraduate Medical Students of Central India”
Authors: Mandal Soumya Kanti , Revadi G , Parida Darshan , Majumdar Anindo
Published: August 2021

Background

Excessive consumption of Sugar Sweetened Beverages (SSBs) in adolescents has become a global issue. As its link to obesity and non-communicable diseases is clear, it is imperative to understand SSB consumption behaviours in the future healthcare professionals.

Objective

To document the prevalence, patterns and clinic-social and behavioural factors predicting high intake of SSBs among medical students.

Methods

This cross-sectional study was conducted using a self-reported, web-based, questionnaire. All the students and interns who were part of a publicly funded premiere teaching hospital during October and November 2019 were included. The semi-structured questionnaire enquired regarding socio-demographic, clinical details, amount, behavioural patterns and money spent in connection with SSB consumption. Data were analysed using IBM SPSS version 24.

Results

The mean (SD) age of participants was 19.3 (1.6) years, 71.7% being males. The current prevalence of SSB consumption was 90.5 %. Also, 49.9% and 29.1% participants preferred soft drinks and sweetened fruit juice respectively. Multivariable analysis showed that male gender (aOR 1.83, 95% CI 1.03-3.25), current alcohol consumption (aOR 4.09, 95% CI 1.25-13.42), and recent (last week) consumption of a SSB predicted high intake of SSBs (aOR 7.36, 95% CI 3.41-15.87) whereas, preference of energy/sports category of drinks predicted low intake of SSBs (aOR 0.10, 95% CI 0.02-0.47).

Conclusion

The consumption of SSBs among medical students was high. Targeted health education and behaviour change interventions should be provided to males, alcohol users and frequent consumers.
The emergence of SARS-CoV-2 variants of concern is driven by acceleration of the evolutionary rate
Authors: Tay John H. , Porter Ashleigh F. , Wirth Wytamma , Duchene Sebastian
Published: August 2021

The ongoing SARS-CoV-2 pandemic has seen an unprecedented amount of rapidly generated genome data. These data have revealed the emergence of lineages with mutations associated to transmissibility and antigenicity, known as variants of concern (VOCs). A striking aspect of VOCs is that many of them involve an unusually large number of defining mutations. Current phylogenetic estimates of the evolutionary rate of SARS-CoV-2 suggest that its genome accrues around 2 mutations per month. However, VOCs can have around 15 defining mutations and it is hypothesised that they emerged over the course of a few months, implying that they must have evolved faster for a period of time. We analysed genome sequence data from the GISAID database to assess whether the emergence of VOCs can be attributed to changes in the evolutionary rate of the virus and whether this pattern can be detected at a phylogenetic level using genome data. We fit a range of molecular clock models and assessed their statistical fit. Our analyses indicate that the emergence of VOCs is driven by an episodic increase in the evolutionary rate of around 4-fold the background phylogenetic rate estimate that may have lasted several weeks or months. These results underscore the importance of monitoring the molecular evolution of the virus as a means of understanding the circumstances under which VOCs may emerge.