bluuebunny/crossref_metadata_2025 huggingface dataset:
Anesthetic management of patients with peripartum cardiomyopathy
Authors: Eerdekens Gert-Jan , Devroe Sarah , Budts Werner , Rex Steffen
Published: February 2023

Purpose of review

Cardiovascular disease is increasingly emerging as a cause of peripartum morbidity and mortality. Peripartum cardiomyopathy (PPCM) is defined as pregnancy-related heart failure with a reduced left ventricular ejection fraction <45%. PPCM develops in the peripartum phase and is not an aggravation of an existing prepregnancy cardiomyopathy. Anesthesiologists typically encounter these patients in the peripartum phase in a variety of settings and should be aware of this pathology and its implications for the perioperative management of parturients.

Recent findings

PPCM has been investigated increasingly over the last few years. Significant progress has been made in the assessment of global epidemiology, pathophysiological mechanisms, genetics and treatment.

Although PPCM is an overall rare pathology, patients can potentially be encountered by any anesthesiologist in many different settings. Therefore, it is important to be aware of this disease and understand the basic implications for anesthetic management. Severe cases often require early referral to specialized centers for advanced hemodynamic monitoring and pharmacological or mechanical circulatory support.
“You’re Socially Distant and Trying Not to Be Emotionally Distant.” Physicians’ Perspectives of Communication and Therapeutic Relationships in the ICU During the COVID-19 Pandemic: A Qualitative Study
Authors: Nugent Shannon M. , Golden Sara E. , Chapa Joaquin , Tuepker Anaïs , Slatore Christopher G. , Vranas Kelly C.
Published: February 2023

OBJECTIVES:

To: 1) characterize how COVID-19–related policies influence patient-clinician communication and relationships in the ICU, with attention to race and ethnicity as factors and 2) identify interventions that may facilitate patient-clinician communication.

DESIGN:

We conducted a qualitative study between September 2020 and February 2021 that explored facilitators and barriers to patient-clinician communication and the formation of therapeutic relationships. We used thematic analysis to develop findings describing patient-communication and therapeutic relationships within the ICU early in the COVID-19 pandemic.

SETTING:

We purposively selected hospital dyads from regions in the United States that experienced early and/or large surges of patients hospitalized with COVID-19.

SUBJECTS:

We recruited a national sample of ICU physicians from Veteran Affairs (VA) Health Care Systems and their associated academic affiliate hospitals.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Twenty-four intensivists from seven VA hospitals and six academic-affiliate hospitals participated. Intensivists noted the disproportionate impact of the pandemic on among people holding minoritized racial and ethnic identities, describing how language barriers and restrictive visitation policies exacerbated institutional mistrust and compromised physicians’ ability to develop therapeutic relationships. We also identified several perceived influences on patient-clinician communication and the establishment of therapeutic relationships. Barriers included physicians’ fear of becoming infected with COVID-19 and use of personal protective equipment, which created obstacles to effective physical and verbal interactions. Facilitators included the presence of on-site interpreters, use of web-based technology to interact with family members outside the ICU, and designation of a care team member or specialist service to provide routine updates to families.

CONCLUSIONS:

The COVID-19 pandemic has threatened patient-clinician communication and the development of therapeutic relationships in the ICU, particularly among people holding minoritized racial and ethnic identities and their families. We identified several facilitators to improve patient-clinician communication as perceived by intensivists that may help improve trust and foster therapeutic alliances.
Through the looking glass
Authors: Gifford Rachel , van de Baan Frank , Westra Daan , Ruwaard Dirk , Fleuren Bram
Published: February 2023

Background

The challenges brought on by the pandemic triggered a renewed scholarly focus on managing during crises. Now, 3 years on, having covered the initial crisis response, it is important to reevaluate what the crisis has taught us about health care management more generally. In particular, it is useful to consider the persistent challenges that continue to face health care organizations in the wake of a crisis.

Purpose

The present article aims to identify the biggest challenges that currently face health care managers in order to formulate a postcrisis research agenda.

Methodology/Approach

We employ an exploratory qualitative study, utilizing in-depth interviews with hospital executives and management to explore the persistent challenges facing managers in practice.

Results

Our qualitative inquiry reveals three key challenges that extend beyond the crisis and are salient for health care managers and organizations in the years to come. Specifically, we identify the centrality of human resource constraints (amidst increasing demand), the necessity of collaboration (amidst competition), and a need to reconsider the approach to leadership (utility of humility).

Conclusion

We conclude by drawing upon relevant theories such as paradox theory to formulate a research agenda for health care management scholars that can support the creation of novel solutions and approaches to persistent challenges in practice.

Practice Implications

We identify several implications for organizations and health systems, including the need to eliminate competition and the importance of building human resource management capacities within organizations. In highlighting areas for future research, we provide organizations and managers with useful and actionable insights to address their most persistent challenges in practice.
Hemorrhagic Complications Following Trabecular Bypass Microstent Surgery in the Setting of Antithrombotic Therapy
Authors: Shalaby Wesam Shamseldin , Patel Sonali , Lam Sophia S. , Bechay Joseph , Zadrozny Izabella , Reyes Johannie , Zhang Qiang , Sharpe James , Lee Daniel , Myers Jonathan S. , Kolomeyer Natasha Nayak , Razeghinejad Reza , Pro Michael J. , Moster Marlene R. , Garg Shukla Aakriti
Published: February 2023

Précis:

In this retrospective study, the use of chronic antithrombotic therapy (ATT) did not increase the risk of hemorrhagic complications after trabecular bypass microstent surgery and phacoemulsification. Stent type and female sex were associated with hyphema.

Purpose:

To report the incidence of hemorrhagic complications after trabecular bypass microstent surgery and phacoemulsification with and without (ATT).

Methods:

Retrospective case series on glaucoma patients on chronic ATT who underwent trabecular bypass microstent surgery (iStent, iStent inject, and Hydrus) combined with phacoemulsification between 2013 and 2019 with ≥3-month follow-up. The primary outcome measure was the incidence of hemorrhagic complications within a 3-month postoperative period. Generalized estimating equations were created to account for inter-eye correlation and logistic regression analysis was performed to identify factors predictive of hemorrhagic complications.

Results:

Of 333 patients (435 eyes), 161 patients (211 eyes) were on ATT and 172 patients (224 eyes) were not on ATT; both groups were similar in age and baseline ocular characteristics. The only hemorrhagic complication was hyphema, which occurred in 84 (19.3%) eyes (41 ATT, 43 non-ATT eyes; P = 1.00). Onset was at postoperative day 1 in 98.8% of eyes, with a duration of 1 week in 73.8% of eyes, without difference between ATT and non-ATT groups. Hyphema was most common with Hydrus microstent (36.4%) versus iStent (19.9%) and iStent inject (8.5%) (P = 0.003). In the multivariate model, the female sex was a predictor of hyphema [hazard ratio (HR) = 2.062; P = 0.009], iStent inject was protective against hyphema (HR = 0.379; P = 0.033), whereas Hydrus did not reach statistical significance (HR = 2.007; P = 0.081). Age, systemic comorbidities, ATT use, and baseline ocular characteristics were not significant predictors.

Conclusions:

Hemorrhagic complications after trabecular bypass microstent surgery were limited to transient hyphema and were not associated with chronic ATT use. Stent type and female sex were associated with hyphema.
Outcomes of Ultrasound Cyclo Plasty in Primary Angle Closure Glaucoma
Authors: Almobarak Faisal A. , Alrubean Ahmed , Alsarhani Waleed K. , Aljenaidel Abdullah , Osman Essam A.
Published: February 2023

Précis:

Ultrasound cyclo plasty (UCP) can be useful in decreasing the intraocular pressure (IOP) and burden of antiglaucoma medications in eyes with primary angle closure glaucoma (PACG). Nevertheless, baselines IOP was an important determinant for failure.

Purpose:

To evaluate the intermediate-term outcomes of UCP in PACG.

Methods:

This retrospective cohort study included patients with PACG who underwent UCP. The main outcome measures were IOP, number of antiglaucoma medications, visual acuity, and presence of complications. The surgical outcomes of each eye were classified as a complete success, qualified success, or failure based on the main outcome measures. Cox regression analysis was performed to identify possible predictors for failure.

Results:

Sixty-two eyes of 56 patients were included in the study. The mean follow-up period was 28.81 months (±18.2). The IOP and number of antiglaucoma medications decreased from a mean of 23.03 (±6.4) mmHg and 3.42 (±0.9) to 15.57 (±6.4) mmHg and 2.04 (±1.3), respectively, in the 12th month and to 14.22 (±5.0) mmHg and 1.91 (±1.5) in the 24th month (P<0.01 for all). The cumulative probabilities of overall success were 72.6±5.7% and 54.8±6.3% at 12 and 24 months, respectively. A high baseline IOP was associated with a higher risk of failure (hazard ratio=1.10, P=0.03). The most common complications were cataract development or progression (30.6%), rebound or prolonged anterior chamber reaction (8.1%), hypotony with choroidal detachment (3.2%), and phthisis bulbi (3.2%).

Conclusions:

UCP offers reasonable 2-year IOP control and reduction of the antiglaucoma medication burden. However, counseling on possible postoperative complications is needed.
A Randomized, Controlled Comparison of 180 Versus 360 Degrees Selective Laser Trabeculoplasty in Open Angle Glaucoma and Glaucoma Suspects
Authors: Michaelov Evan , Sachdeva Robin , Raniga Aparna , Lin Tony
Published: February 2023

Précis:

Three hundred sixty degrees selective laser trabeculoplasty (SLT) produces greater intraocular pressure (IOP) lowering effects with no changes in safety profile compared with 180 degrees SLT.

Purpose:

To determine whether there is any difference in the IOP lowering effects and safety profiles of 180 versus 360 degrees SLT, using a paired-eye design to limit confounders.

Methods:

This single-center randomized control trial included patients presenting with treatment naïve open angle glaucoma or glaucoma suspects. Once enrolled, 1 eye was randomized to 180 degrees SLT, and the other was treated with 360 degrees SLT. Patients were followed for 1 year and assessed for change in visual acuity, Goldmann IOP, Humphrey visual fields, retinal nerve fiber layer thickness, optical coherence tomography derived cup to disc ratio, and any adverse events or requirements for additional medical interventions.

Results:

A total of 40 patients (80 eyes) were included in the study. IOP in the 180 degrees group was reduced from 25.3±2.3 mm Hg to 21.5±2.7 mm Hg, and in the 360 degrees group, from 25.5±2.1 mm Hg to 19.9±2.6 mm Hg (P<0.01), both at 1 year. There was no significant difference in the number of adverse events or serious adverse events in the 2 groups. There were no statistically significant differences in visual acuity, Humphrey visual field mean deviation, retinal nerve fiber layer thickness, or C:D ratio at 1-year follow-up.

Conclusion:

At 1 year, 360 degrees SLT was more efficacious at lowering IOP compared with 180 degrees SLT with a similar safety profile in patients with open angle glaucoma and glaucoma suspects. Further studies are needed to determine the long-term effects.
Ultrasound Cyclo Plasty in Patients with Open Angle Glaucoma and High Myopia
Authors: Figus Michele , Palma Alessandro , Covello Giuseppe , Agnifili Luca , Posarelli Chiara
Published: February 2023

Précis:

Ultrasound cyclo plasty (UCP) using high-intensity focused ultrasound is an effective and safe procedure in lowering intraocular pressure (IOP) in patients with glaucoma, even in those with high myopia.

Purpose:

This study aimed to evaluate the efficacy and safety of UCP in glaucoma patients with high myopia.

Materials and Methods:

In this retrospective, single-center study, we enrolled 36 eyes divided into 2 groups based on axial length: group A (≥26.00 mm) and group B (<26.00 mm). We collected data about visual acuity, Goldmann applanation tonometry, biomicroscopy, and visual field before the procedure and at 1, 7, 30, 60, 90, 180, and 365 days after the procedure.

Results:

Mean IOP significantly decreased in both groups after treatment (P<0.001). Mean IOP reduction from baseline to the last visit was 9.8±6.6 mmHg (38.7%) in group A and 9.6±6.3 mmHg (34.8%) in group B (P<0.001). Mean IOP at the last visit was 15.8±4.1 mmHg in the myopic group and 18.1±5.6 mmHg in the non-myopic one. Regarding the number of IOP-lowering eyedrops being taken by our patients, statistically significant differences were found between groups A and B neither at baseline (2.8±0.9 and 2.6±1.0; P=0.568) nor 1 year after the procedure (2.5±1.1 and 2.6±1.1; P=0.762). No major complications occurred. All minor adverse events resolved within a few days.

Conclusion:

UCP seems to be an effective and well-tolerated strategy to lower IOP in glaucoma patients with high myopia.
Pseudoexfoliation Glaucoma as a Predictor of Refractive Surprise After Uneventful Cataract Surgery
Authors: Tekcan Hatice , Alpogan Oksan , Imamoglu Serhat
Published: February 2023

Précis:

The pseudoexfoliation glaucoma group produced higher mean absolute error (MAE) and higher percentages of large-magnitude prediction error, in all investigated intraocular lens formulas. Postoperative anterior chamber angle and change in intraocular pressure (IOP) were associated with absolute error.

Purpose:

The purpose of this study is to evaluate refractive outcomes of cataract surgery in patients with pseudoexfoliation glaucoma (PXG) and to determine the predictive factors for refractive errors.

Materials and Methods:

Fifty-four eyes with PXG, 33 eyes with primary open angle glaucoma (POAG) and 58 normal eyes undergoing phacoemulsification, in Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey, were included in this prospective study. The follow-up was 3 months. Preoperative and postoperative anterior segment parameters measured by Scheimpflug camera were compared after adjusting for age, sex, and axial length. The mean prediction error, MAE, and percentages of large-magnitude prediction error (>±1.0 D) in SRK/T, Barrett Universal II, and Hill-RBF formulas were compared.

Results:

There was a significantly greater anterior chamber angle (ACA) enlargement in PXG eyes compared with POAG (P=0.006) and normals (P=0.04). The PXG group showed significantly higher MAE in SRK/T, Barrett Universal II, and Hill-RBF (0.72, 0.79, and 0.79 D, respectively) than POAG (0.43, 0.25, and 0.31 D, respectively) and normals (0.34, 0.36, 0.31 D, respectively) (P<0.0001). The large-magnitude error was significantly more frequent in the PXG group among the 3 groups with SRK/T (37%, 18%, and 12%, respectively) (P=0.005), Barrett Universal II (32%, 9%, and 10%, respectively) (P=0.005), and Hill-RBF (32%, 9%, and 9%, respectively) (P=0.002). The MAE was correlated with postoperative ACA and IOP decrease in Barrett Universal II (P=0.02 and 0.007, respectively) and Hill-RBF (P=0.03 and 0.02, respectively).

Conclusions:

PXG may be a predictor for refractive surprise after cataract surgery. Prediction errors may be due to IOP-lowering effect of surgery and larger postoperative ACA than expected, in the presence of zonular weakness.
Osteoarticular Involvement in Childhood Brucellosis: Evaluation of Clinical, Laboratory and Radiologic Features of 185 Cases
Authors: Akkoc Gulsen , Tekerek Serhat
Published: February 2023

Backgrounds:

Brucellosis is a systemic zoonotic disease. Osteoarticular (OA) system involvement is a common complication and the predominant manifestation of brucellosis in children. We aimed to evaluate the epidemiologic, demographic, clinical characteristics, and laboratory and radiologic findings of children with brucellosis and how these related to OA involvement.

Methods:

This retrospective cohort study consisted of all consecutive children and adolescents diagnosed as having brucellosis who were admitted to the pediatric infectious disease department of University of Health Sciences Van Research and Training Hospital between August 1, 2017, and December 31, 2018, in Turkey.

Results:

A total of 185 patients diagnosed as having brucellosis were evaluated, 50.8% had OA involvement (n = 94). Seventy-two patients (76.6%) exhibited peripheral arthritis involvement, among of them, hip arthritis (63.9%; n = 46) was the most common manifestation, followed by arthritis of knee (30.6%; n = 22), shoulder (4.2%; n = 3) and elbow (4.2%; n = 3). A total of 31 patients (33.0%) had sacroiliac joint involvement. Seven patients (7.4%) had spinal brucellosis. Erythrocyte sedimentation rate level above 20 mm/h at admission and age were independent predictor of OA involvement (respectively odds ratio [OR] = 2.82; 95% confidential interval [CI] = 1.41–5.64, ORperyear = 1.10; 95% CI: 1.01–1.19). Increasing age was associated types of OA involvement.

Conclusion:

A half of brucellosis cases had OA involvement. These results can help physicians to make early identification and diagnosis of childhood OA brucellosis who present with arthritis and arthralgia to enable the disease to be treated in time.
Risk Factors for Infection and Mortality Associated With Stenotrophomonas maltophilia Bloodstream Infections in Children; Comparison With Pseudomonas aeruginosa Bloodstream Infections
Authors: Bilen Nimet Melis , Sahbudak Bal Zumrut , Güner Özenen Gizem , Yildirim Arslan Sema , Ozek Gulcihan , Ozdemir Karadas Nihal , Yazici Pinar , Cilli Feriha , Kurugöl Zafer
Published: February 2023

Introduction:

The increasing incidence of Stenotrophomonas maltophilia (S. maltophilia) infections raises concern because of the high fatality/case ratio. This study aimed to evaluate the risk factors for infection and mortality associated with S. maltophilia bloodstream infections (BSIs) in children and compare them with Pseudomonas aeruginosa BSIs.

Methods:

All BSIs caused by S. maltophilia (n:73) and P. aeruginosa (n:80) were enrolled in this study between January 2014 and December 2021 at the Medical School of Ege University.

Results:

Previous Pediatric Intensive Care Unit (PICU) admission, prior glycopeptide, and carbapenem use were significantly more common in patients with S. maltophilia BSIs (P = 0.044, P = 0.009, and P = 0.001, respectively) than with P. aeruginosa BSIs. C-reactive protein (CRP) levels were significantly higher in S. maltophilia BSIs (P = 0.002). Multivariate analysis showed that prior carbapenem use was associated with S. maltophilia BSIs (P = 0.014, adjusted odds ratio [AOR]: 2.710; 95% confidence interval [CI]: 1.225–5.992). PICU admission because of BSI, prior carbapenem and glycopeptide use, neutropenia, and thrombocytopenia were significantly more common in patients with mortality because of S. maltophilia BSIs (P < 0.001, P = 0.010, P = 0.007, P = 0.008, P = 0.004, respectively), while only PICU admission because of BSI, and prior glycopeptide use were significant in multivariate analysis (AOR, 19.155; 95% CI: 2.337–157.018; P = 0.006 and AOR, 9.629; 95% CI: 1.053–88.013; P = 0.045, respectively).

Conclusion:

Prior carbapenem use is a significant risk factor for developing S. maltophilia BSIs. PICU admission because of BSI and prior glycopeptide use are risk factors associated with the mortality rate in patients with S. maltophilia BSIs. Therefore, S. maltophilia should be considered in patients with these risk factors, and empirical treatment should include antibiotics for S. maltophilia.
Geographic Expansion of Japanese Encephalitis Virus to Australia: Neuroinflammatory Sequelae and Consideration of Immunomodulation
Authors: Cole Elizabeth , Boast Alison , Yiu Eppie M. , Kornberg Andrew J. , Jadhav Trupti , Mignone Cristina , Abo Yara-Natalie , Britton Philip N. , Osowicki Joshua , Macdonald-Laurs Emma
Published: February 2023

We report a child from Southern Australia (New South Wales) who presented during a La Niña event with encephalopathy and acute flaccid paralysis. Magnetic resonance imaging suggested Japanese encephalitis (JE). Steroids and intravenous immunoglobulin did not improve symptoms. Therapeutic plasma exchange (TPE) resulted in rapid improvement and tracheostomy decannulation. Our case illustrates the complex pathophysiology of JE, its’ geographic expansion into Southern Australia and potential use of TPE for neuroinflammatory sequelae.
Bloodstream Infection in Children With Epidermolysis Bullosa
Authors: García-Espinosa Laura , del Rosal Teresa , Quintana Lucía , Maseda Rocío , Grasa Carlos , Falces-Romero Iker , Menéndez-Suso Juan José , Pérez-Conde Isabel , Méndez-Echevarría Ana , Aracil Santos Francisco Javier , Alonso Luis Alfonso , de Lucas Raúl , Calvo Cristina , Baquero-Artigao Fernando
Published: February 2023

Background:

Epidermolysis bullosa (EB) is frequently complicated by skin infection, which can lead to bacteremia. However, bloodstream infections (BSI) in patients with EB have not been well described.

Methods:

Retrospective study of BSI in children 0–18 years with EB from a national reference unit in Spain, in 2015–2020.

Results:

Among 126 children with EB, we identified 37 BSI episodes in 15 patients (14 recessive dystrophic EB, 1 junctional EB). The most frequent microorganisms were Pseudomonas aeruginosa (n = 12) and Staphylococcus aureus (n = 11). Five P. aeruginosa isolates were ceftazidime-resistant (42%), 4 of which were also resistant to meropenem and quinolones (33%). As for S. aureus, 4 (36%) were methicillin-resistant and 3 (27%) clindamycin-resistant. In 25 (68%) BSI episodes skin cultures had been performed in the previous 2 months. The most frequent isolates were also P. aeruginosa (n = 15) and S. aureus (n = 11). In 13 cases (52%), smear and blood cultures grew the same microorganism, with the same antimicrobial resistance pattern in 9 isolates. Twelve patients (10%) died during follow-up (9 RDEB and 3 JEB). BSI was the cause of death in 1 case. In patients with severe RDEB, a history of BSI was associated with higher mortality (OR 6.1, 95% CI: 1.33–27.83, P = 0.0197).

Conclusions:

BSI is an important cause of morbidity in children with severe forms of EB. The most frequent microorganisms are P. aeruginosa and S. aureus, with high rates of antimicrobial resistance. Skin cultures can help guide treatment decisions in patients with EB and sepsis.
An Outbreak of Coxsackievirus B Type 2 Acute Meningoencephalitis in Children, Israel, July–September 2022
Authors: Kriger Or , Abramovich Alon , Fratty Ilana S. , Leshem Eyal , Amit Sharon , Stein Michal , Ben-Zeev Bruria , Via-Dorembus Sara , Hoffmann Chen , Rabinowicz Shira , Weil Merav
Published: February 2023

During July–September 2022, 14 children suffering from meningoencephalitis tested positive for Coxsackievirus B2 (8 cerebrospinal fluid, 9 stool samples). Mean age 22 months (range 0–60 months); 8 were males. Seven of the children presented with ataxia and 2 had imaging features of rhombencephalitis, not previously described in association with Coxsackievirus B2.
Realizing the Promise of Dolutegravir in Effectively Treating Children and Adolescents Living With HIV in Real-world Settings in 6 Countries in Eastern and Southern Africa
Authors: Bacha Jason Michael , Dlamini Sandile , Anabwani Florence , Gwimile Judith , Kanywa Jacqueline Balungi , Farirai John , Bvumbwe Menard , Tsotako Mabene , Steffy Teresa , Nguyen Diane , Mendez-Reyes Jose Euberto , Elyanu Peter , Haq Heather
Published: February 2023

Background:

Despite encouraging results from clinical trials and in high-income countries, large-scale data on the effectiveness and safety of dolutegravir (DTG) in children and adolescents living with HIV (CALHIV) are lacking in low- and middle-income countries (LMICs).

Methods:

Retrospective analysis was performed among CALHIV 0–19 years old and weighing greater than or equal to 20 kg who received DTG from 2017 to 2020 at sites in Botswana, Eswatini, Lesotho, Malawi, Tanzania and Uganda to determine effectiveness, safety and predictors of viral load suppression (VLS) among CALHIV using DTG, including through single drug substitutions (SDS).

Results:

Among 9419 CALHIV using DTG, 7898 had a documented post-DTG VL, and VLS post-DTG was 93.4% (7378/7898). VLS for antiretroviral therapy (ART) initiations was 92.4% (246/263), and VLS was maintained for the ART-experienced [92.9% (7026/7560) pre- vs. 93.5% (7071/7560) post-DTG; P = 0.14). Among previously unsuppressed, 79.8% (426/534) achieved VLS with DTG. Only 5 patients reported a Grade 3 or 4 adverse event (0.057 per 100 patient-years) requiring DTG discontinuation. History of protease inhibitor-based ART [odds ratio (OR) = 1.53; 95% confidence interval (CI): 1.16–2.03], care in Tanzania (OR = 5.45; 95% CI: 3.41–8.70), and being 15–19 years old (OR = 1.31; 95% CI: 1.03–1.65) were associated with gain of VLS post-DTG. Predictors of VLS on DTG included VLS before DTG (OR = 3.87; 95% CI: 3.03–4.95) and using the once-daily, single tab tenofovir-lamivudine-DTG regimen (OR = 1.78; 95% CI: 1.43–2.22). SDS maintained VLS [95.9% (2032/2120) pre- vs. 95.0% (2014/2120) post-SDS with DTG; P = 0.19], and 83.0% (73/88) of unsuppressed gained VLS using SDS with DTG.

Conclusions:

We found DTG to be highly effective and safe within our cohort of CALHIV in LMICs. These findings can empower clinicians to prescribe DTG confidently to eligible CALHIV.
Dementia among older people with schizophrenia: an update on recent studies
Authors: Adamowicz David H. , Lee Ellen E.
Published: February 2023

Purpose of review

This narrative review examines recently published research that examines the prevalence, underlying causes, and treatments for dementia among people with schizophrenia.

Recent findings

People with schizophrenia have high rates of dementia, compared with the general population, and cognitive decline has been observed 14 years prior to onset of psychosis with accelerated decline in middle age. Underlying mechanisms of cognitive decline in schizophrenia include low cognitive reserve, accelerated cognitive aging, cerebrovascular disease and medication exposure. Although pharmacologic, psychosocial and lifestyle interventions show early promise for preventing and mitigating cognitive decline, few studies have been conducted in older people with schizophrenia.

Recent evidence supports accelerated cognitive decline and brain changes in middle-aged and older people with schizophrenia, relative to the general population. More research in older people with schizophrenia is needed to tailor existing cognitive interventions and develop novel approaches for this vulnerable and high-risk group.
Erosive balanitis caused by Staphylococcus haemolyticus in a circumcised adult male.
Authors: Mazuecos-Blanca José , Mazuecos-Gutiérrez José Rafael , Jiménez-Gil Ana
Published: February 2023

Introduction

Balanitis is an inflammation of the glans penis. Balanoposthitis involves both the glans penis and prepuce and occurs only in uncircumcised males. Recurrent balanoposthitis represents a strong indication for circumcision. After candida infections, bacteria are the second etiological cause of infectious balanoposthitis, mainly streptococci, groups A and B, and staphylococci, usually S. aureus. Staphylococcus haemolyticus is a part of skin microflora and one of the main species of coagulase-negative staphylococci. S. haemolyticus causes various infections of the male urogenital tract such as urinary tract infections, chronic prostatitis and epididymo-orchitis, but it has not been associated with balanitis.

Case presentation

A 45-year-old man underwent circumcision due to several episodes of balanoposthitis with only partial responses to the established treatments. The patient consulted for an episode of painful, erosive, and exudative lesions on the glans penis and over the post-operative scars. He had no urinary discomfort or inguinal lymphadenopathy. Abundant growth of Staphylococcus haemolyticus was obtained in the culture in standard bacterial media of the sample taken from the genital lesion. The fungal culture was negative. Based on the antimicrobial susceptibility test, treatment was started with oral ciprofloxacin and topical mupirocin, and the genital infection was completely cured.

Conclusion

we present a non-diabetic, circumcised male patient with severe, erosive, and painful balanitis due to S. haemolyticus.
Tau-Neurodegenerationmismatchreveals vulnerability and resilience to comorbidities in Alzheimer’s continuum
Authors: Lyu Xueying , Duong Michael Tran , Xie Long , de Flores Robin , Richardson Hayley , Hwang Gyujoon , Wisse L.E.M. , DiCalogero Michael , McMillan Corey T. , Robinson John L. , Xie Sharon X. , Grossman Murray , Lee Edward B. , Irwin David J. , Dickerson Bradford C. , Davatzikos Christos , Nasrallah Ilya M. , Yushkevich Paul A. , Wolk David A. , Das Sandhitsu R. ,   Alzheimer’s Disease Neuroimaging Initiative
Published: February 2023

Variability in the relationship of tau-based neurofibrillary tangles (T) and degree of neurodegeneration (N) in Alzheimer’s Disease (AD) is likely attributable to the non-specific nature of N, which is also modulated by such factors as other co-pathologies, age-related changes, and developmental differences. We studied this variability by partitioning patients within the Alzheimer’s continuum into data-driven groups based on their regional T-N dissociation, which reflects the residuals after the effect of tau pathology is “removed”. We found six groups displaying distinct spatial T-Nmismatchand thickness patterns despite similar tau burden. Their T-N patterns resembled the neurodegeneration patterns of non-AD groups partitioned on the basis of z-scores of cortical thickness alone and were similarly associated with surrogates of non-AD factors. In an additional sample of individuals with antemortem imaging and autopsy, T-N mismatch was associated with TDP-43 co-pathology. Finally, T-Nmismatchtraining was then applied to a separate cohort to determine the ability to classify individual patients within these groups. These findings suggest that T-Nmismatchmay provide a personalized approach for determining non-AD factors associated with resilience/vulnerability to Alzheimer’s disease.
The impact of spinal surgery on the locomotive syndrome in patients with lumbar spinal stenosis in CDL stage 3: a retrospective study
Authors: Nakae Ichiro , Hashida Ryuki , Otsubo Ryota , Iwanaga Sohei , Matsuse Hiroo , Yokosuka Kimiaki , Yoshida Tatsuhiro , Fudo Takuma , Morito Shinji , Shimazaki Takahiro , Yamada Kei , Sato Kimiaki , Shiba Naoto , Hiraoka Koji
Published: February 2023

Objectives

Locomotive syndrome (LS) is characterized by reduced mobility. Clinical decision limit (CDL) stage 3 in LS indicates physical frailty. Lumbar spinal canal stenosis (LSS) is one cause of LS, for which lumbar surgery is considered to improve the CDL stage. This study aimed to investigate the efficacy of lumbarsurgery and independent factors for improving CDL stage in patients with LSS.

Design

A retrospective study

Setting

The study was conducted at the Department of Orthopaedic Surgery at University Hospital.

Participants

A total of 157 patients aged ≥ 65 years with LSS underwent lumbar surgery.

Interventions

The 25-Question Geriatric Locomotive Function scale (GLFS-25) was used to test for LS, and the timed up and go test (TUG) was used to evaluate functional ability. Lower limb pain was evaluated using a visual analog scale. Patients with at least one improvement in CDL stage following lumbarsurgery were included in the improvement group. Differences in lower-limb pain intensity between the groups were evaluated using the Wilcoxon rank-sum test.

The Spearman’s rank correlation coefficient was used to determine correlations between Δ lower limb pain and Δ GLFS-25. Logistic regression analysis was used to identify factors associated with improvement in LS.

Results

The proportion of patients with improved CDL stage was 45.1% (improvement/non-improvement: 32/39). Δ Lower limb pain was significantly reduced in the improvement group compared to that in the non-improvement group (51.0 [36.3-71.0] vs 40.0 [4.0-53.5]; p =0.0107). Δ GLFS-25 significantly correlated with Δ lower-limb pain (r =0.3774, p =0.0031). In a multiple logistic regression analysis, TUG and age were significantly associated with improvement in LS (odds ratio, 1.22; 95% confidence interval: 1.07-1.47).

Conclusions

The lumbar surgery effectively improved the CDL stage in patients with LSS. In addition, TUG was an independent factor associated with improvement in the CDL.

Strengths and limitations of the study

The Japanese Orthopaedic Association defines locomotive syndrome as patients with reduced motor function. We reported the effect of surgical treatment on clinical decision limit 3 (CDL3), which corresponds to physical frailty.

We investigated improvement factors for locomotive syndrome CDL stage 3 in patients with lumbar spinal stenosis in a retrospective study.

Seventy-one patients who underwent surgical treatment were included in the study.

Factors associated with improvement in locomotive syndrome were analyzed using multivariate logistic analysis and decision tree analysis.
Indian COVID-19 Preprints Submissions in bioRxiv and medRxiv Preprint Servers
Authors: Raju Narayanaswamy Vasantha , Adakawa Murtala Ismail , Harinarayana N.S. , Chandrappa
Published: February 2023

This research aimed at determining the growth of deposition of preprints on servers by Indian researchers during COVID-19 pandemic. In the pre-pandemic period, the dominant server was arXiv upon which research from physics and other related domains have been the most predominant depositors. When the pandemic erupted and the need to share research findings became imperative, many previously dormant preprint servers received vibrant activations from several scientists across the globe. This is with the intention of bridging the gap between delays inherent in reviewing process and the dire need to share information for finding everlasting solutions to the raging pandemic. Many researchers, institutions, countries, etc. have contributed in this regard. The study used quantitative method and iSearch Portfolio expert-curated source for publications and preprints related to either COVID-19 or the novel coronavirus SARS-CoV-2 developed and maintained by National Institute of Health (NIH), US iSearch COVID-19 Portfolio. The study examined the Indian COVID-19 preprints deposited in bioRxiv and medRxiv preprint servers. The findings indicated that, Indian researchers have posted their papers in large numbers in bioRxiv and medRxiv servers with the medRxiv having the highest preprints (417, 40.44%) in 2020 against its counterpart bioRxiv (118, 10.96%) in the same year. Similarly, infectious diseases (except HIV/AIDS) (311) had the highest recurrence of the preprints submitted for deposition in servers. This is followed by epidemiology (263), public and global health (122), bioinformatics (59), among others. There is high collaboration among researchers who deposited their preprints in these servers where about 257 (24.93%) preprints were co-authored by 11+ authors followed by 3-authored and 4-authored with 124 preprints respectively (together accounts for 24.06%) and 2-authroed (114 (11.04%) preprints) respectively in a diminishing manner. The study concluded that, Indian researchers are actively participating in depositing preprints in servers notably bioRxiv and medRxiv.
Prdm16 and Vcam1 regulate the postnatal disappearance of embryonic radial glia and the ending of cortical neurogenesis
Authors: Li Jiwen , Godoy Marlesa I. , Zhang Alice J. , Diamante Graciel , Ahn In Sook , Cebrian-Silla Arantxa , Alvarez-Buylla Arturo , Yang Xia , Novitch Bennett G. , Zhang Ye
Published: February 2023

Embryonic neural stem cells (NSCs,i.e., radial glia) in the ventricular-subventricular zone (V-SVZ) generate the majority of neurons and glia in the forebrain. Postnatally, embryonic radial glia disappear and a subpopulation of radial glia transition into adult NSCs. As this transition occurs, widespread neurogenesis in brain regions such as the cerebral cortex ends. The mechanisms that regulate the postnatal disappearance of radial glia and the ending of embryonic neurogenesis remain poorly understood. Here, we show that PR domain-containing 16 (Prdm16) promotes the disappearance of radial glia and the ending of neurogenesis in the cerebral cortex. Genetic deletion ofPrdm16from NSCs leads to the persistence of radial glia in the adult V-SVZ and prolonged postnatal cortical neurogenesis. Mechanistically, Prdm16 induces the postnatal reduction in Vascular Cell Adhesion Molecule 1 (Vcam1). The postnatal disappearance of radial glia and the ending of cortical neurogenesis occur normally inPrdm16-Vcam1double conditional knockout mice. These observations reveal novel molecular regulators of the postnatal disappearance of radial glia and the ending of embryonic neurogenesis, filling a key knowledge gap in NSC biology.
Quantifying patient- and hospital-level antimicrobial resistance dynamics inStaphylococcus aureusfrom routinely collected data
Authors: Leclerc Quentin , Clements Alastair , Dunn Helen , Hatcher James , Lindsay Jodi A , Grandjean Louis , Knight Gwenan M
Published: February 2023

Antimicrobial resistance (AMR) to all antibiotic classes has been found in the pathogenStaphylococcus aureus. The reported prevalence of these resistances vary, driven by within-host AMR evolution at the patient level, and between-host transmission at the hospital level. Without dense longitudinal sampling, pragmatic analysis of AMR dynamics at multiple levels using routine surveillance data is essential to inform control measures.

We exploredS. aureusAMR diversity in 70,000 isolates from a UK paediatric hospital between 2000-2020, using electronic datasets containing multiple routinely collected isolates per patient with phenotypic antibiograms, hospitalisation information, and antibiotic consumption.

At the hospital-level, the proportion of isolates that were meticillin-resistant (MRSA) increased between 2014-2020 from 25 to 50%, before sharply decreasing to 30%, likely due to a change in inpatient demographics. Temporal trends in the proportion of isolates resistant to different antibiotics were often correlated in MRSA, but independent in meticillin-susceptibleS. aureus. Ciprofloxacin resistance in MRSA decreased from 70% to 40% of tested isolates between 2007-2020, likely linked to a national policy to reduce fluoroquinolone usage in 2007. At the patient level, we identified frequent AMR diversity, with 4% of patients ever positive forS. aureussimultaneously carrying, at some point, multiple isolates with different resistances. We detected changes over time in AMR diversity in 3% of patients ever positive forS. aureus. These changes equally represented gain and loss of resistance.

Within this routinely collected dataset, we found that 65% of changes in resistance within a patient’sS. aureuspopulation could not be explained by antibiotic exposure or between-patient transmission of bacteria, suggesting that within-host evolution via frequent gain and loss of AMR genes may be responsible for these changing AMR profiles. Our study highlights the value of exploring existing routine surveillance data to determine underlying mechanisms of AMR. These insights may substantially improve our understanding of the importance of antibiotic exposure variation, and the success of singleS. aureusclones.
Development and prognostic validation of a three-level NHG-like deep learning-based model for histological grading of breast cancer
Authors: Sharma Abhinav , Weitz Philippe , Wang Yinxi , Liu Bojing , Hartman Johan , Rantalainen Mattias
Published: February 2023

Histological Grade is a well-known prognostic factor that is routinely assessed in breast tumours. However, manual assessment of Nottingham Histological Grade (NHG) has high inter-assessor and inter-lab variability, causing uncertainty in grade assignments. To address this challenge, we developed and validated a three-level NHG-like deep learning-based histological grade model. The primary performance evaluation focuses on prognostic performance.

This observational study is based on two patient cohorts (SöS-BC-4, N=2421 (training and internal test); SCAN-B-Lund, N=1262 (test)) that include routine histological whole slide images together with patient outcomes. A Deep Convolutional Neural Network (CNN) model with an attention mechanism was optimised for the classification of the three-level histological grading (NHG) from hematoxylin and eosin-stained WSIs. The prognostic performance was evaluated by time-to-event analysis of Recurrence-free survival (RFS) and compared to clinical NHG grade assignments in the internal test set as well as in the fully independent external test cohort. We observed effect sizes (Hazard Ratio) for grade 3 vs 1, for the conventional NHG method (HR=2.60 (1.18-5.70 95%CI, p-value = 0.017)) and the deep learning model (HR = 2.27, 95%CI: 1.07-4.82, p-value = 0.033) on the internal test set after adjusting for established clinicopathological risk factors. In the external test set, the unadjusted HR for NHG 1 vs 2 was estimated to be 2.59 (p-value = 0.004) and NHG 1 vs 3 was estimated to be 3.58 (p-value < 0.001). For predGrade, the unadjusted HR for grade 1 vs 2 HR=2.52 (p-value = 0.030), and 4.07 (p-value = 0.001) for grade 1 vs 3. In multivariable analysis, HR estimates for neither NHG nor predGrade were found to be significant (p-value >0.05). We tested for differences in HR estimates between NHG and predGrade in the independent test set, and found no significant difference between the two classification models (p-value > 0.05), confirming similar prognostic performance between conventional NHG and predGrade.

Routine histopathology assessment of NHG has a high degree of inter-assessor variability, motivating the development of model-based decision support to improve reproducibility in histological grading. We found that the proposed model provides similar prognostic performance as NHG. The results indicate that deep CNN-based models can be applied for breast cancer histological grading.
Specialty-type and state-level variation in paroxetine use among older adult patients
Authors: Cavanah Luke R. , Goldhirsh Jessica L. , Huey Leighton Y. , Piper Brian J.
Published: February 2023

Introduction

Paroxetine is an older “selective” serotonin reuptake inhibitor (SSRI) that is notable for its lack of selectivity, resulting in a cholinergic adverse-effect profile, especially among older adults (65+).

Methods

Paroxetine prescription rates and costs per state were ascertained from the Medicare Specialty Utilization and Payment Data. States’ annual prescription rate, corrected per thousand Part D enrollees, outside 95% confidence interval were considered significantly different from the average.

Results

There was a steady decrease in paroxetine prescriptions (-34.52%) and spending (-16.69%) from 2015-2020 but a consistent, five-fold state-level difference. From 2015-2020, Kentucky (194.9, 195.3, 182.7, 165.1, 143.3, 132.5) showed significantly higher prescriptions rates relative to the national average, and Hawaii (42.1, 37.9, 34.3, 31.7, 27.7, 26.6) showed significantly lower prescription rates. North Dakota was often a frequent elevated prescriber of paroxetine (2016: 170.7, 2018: 143.3), relative to the average. Neuropsychiatry and geriatric medicine frequently prescribed the largest amount of paroxetine prescriptions, relative to the number of providers in that specialty, from 2015-2020.

Discussion

Despite the American Geriatrics Society prohibition against paroxetine use in the older adults and many effective treatment alternatives, paroxetine was still commonly used in this population, especially in Kentucky and North Dakota and by neuropsychiatry and geriatric medicine. These findings provide information on the specialty types and states where education and policy reform would likely have the greatest impact on improving adherence to the paroxetine prescription recommendations.
A comprehensive analysis of rheumatoid arthritis B cells reveals the importance of CD11c+vedouble-negative-2 B cells as the major synovial plasma cell precursor
Authors: Wing Elinor , Sutherland Catherine , Miles Katherine , Gray David , Goodyear Carl , Otto Thomas , Breusch Stefan , Cowan Graeme , Gray Mohini
Published: February 2023

B cells are key pathogenic drivers of chronic inflammation in rheumatoid arthritis (RA). There is limited understanding of the relationship between synovial B cell subsets and pathogenic antibody secreting cells (ASCs). This knowledge is crucial for the development of targeted therapies. Here, we combine flow cytometry of circulating B cells with single-cell RNA and paired repertoire sequencing of over 27,000 synovial B cells from patients with established RA. Twelve B cell clusters were identified including previously recognised subsets, and a novel cluster that strongly expressed heat shock proteins. All lineages identified by trajectory analysis contribute to the DN2 B cell population, which is the major precursor to synovial ASCs. This was further supported by B cell receptor (BCR) lineage analysis, which revealed clonal relationships between DN2 cells and ASCs. This study advances our understanding of B cells in RA and reveals the origin of pathogenic ASCs in the RA synovium.