bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of proprioception and postural control at a minimum 1 year follow-up after ankle capsuloligamentous lateralplasty with Brostrom technique
Authors: Mosca Massimiliano , Caravelli Silvio , Massimi Simone , Fuiano Mario , Catanese Giuseppe , Barone Giuseppe , Bragonzoni Laura , Benedetti Maria Grazia
Published: April 2020

Recovery of postural control and proprioception in patients affected by chronic ankle instability (CAI) and operated on capsulo-ligaments reconstructive surgery lacks of objective assessment. The aim of this study was to evaluate long-term post-surgical postural and proprioceptive control through the DPPS device in a cohort of patients operated on ligaments reconstruction through the modified Brostrom procedure at a minimum follow up of 12 months.

Eleven patients with post-traumatic lateral CAI, operated of external capsulo-ligamentous complex repair according to Brostrom technique at a minimum follow-up of 1 year were enrolled. Physical examination and American Orthopaedics Foot and Ankle Society (AOFAS) ankle-hindfoot score. Proprioceptive and postural stability was assessed by DPPS - Delos Postural Proprioceptive System, linked to a computer with a specific software and including a flat table, an electronic unstable proprioceptive board, a Delos Vertical Controller, a monitor and a horizontal bar fitted with an infra-red sensor for hand support.

Patients were 5 males and 6 females, mean age of 38.4 ± 12 years. Mean BMI of the patients was 26.8 ± 4.4. Mean follow up was 13.4 ± 2.1. The mean value of (AOFAS) clinical score was 90.3/100. Mean Static Stability Index (SSI) with open eyes was 87.7% (±7.6) in the operated leg and 90.4% (±6.1) in the contra-lateral. SSI with closed eyes was 64.5% (±11.2) in the operated leg and 61.6% (±16.8) in the contra-lateral. Mean Dynamic Stability Index (DSI) without restrictions was 56.2% (±14.6) in the operated leg and 56.8% (±10.6) in the contra-lateral. DSI with restricted upper limbs, had a mean value of 56.3% (±11.4) in the operated leg and 58.1% (±11.9) in the contra-lateral.

Re-tensioning capsular-ligamentous surgery of the external compartment for CAI allow to recovery proprioceptive and postural control on the operated side, comparable with data from the contralateral limb and from the healthy population of the same age and sex.
Thickened liquids: do they still have a place in the dysphagia toolkit?
Authors: Lazenby-Paterson Tracy
Published: April 2020

Purpose of review

The use of commercially or naturally thickened liquids is a well-established treatment for patients with dysphagia to fluids, the aim of which is to improve swallow safety by minimizing risk of aspiration. Although the most recent systematic reviews conclude that this treatment lacks evidential support and leads to patient-reported worsening health and quality of life, thickened liquids continue to be used with patients with dysphagia across clinical settings. This review briefly summarizes the evidence and considers potential reasons for the apparent mismatch between the evidence and clinical practice.

Recent findings

Continuing practice with thickened liquids is influenced by a range of factors, including gaps in clinical knowledge, inadequate patient involvement, a culture of common practice and a reliance on invalid surrogate studies or research lacking a credible association between thickened liquids and clinically meaningful endpoints.

While awaiting further research, clinical decision-making about thickened liquids can be improved by considering the evidence of clinically meaningful endpoints, promoting shared decision-making with patients and underpinning practice with knowledge about the complex relationship between dysphagia, aspiration and pneumonia.
Head and neck surgical antibiotic prophylaxis in resource-constrained settings
Authors: Chiesa-Estomba Carlos Miguel , Calvo-Henriquez Christian , Siga Diom Evelyne , Martinez Federico
Published: April 2020

Purpose of review

Antimicrobial resistance represents a global threat and causes almost 700 000 deaths per year. The rapid dissemination of resistant bacteria is occurring globally, turning this into the primary threat to public health in the 21st century and forcing organizations around the globe to take urgent action.

Recent findings

About risks related to surgical site infection (SSI) in head and neck surgery, surgical limitations in resource-constrained settings, comorbidities and the risk of SSI, evidence about surgical prophylaxis from low and middle-income countries, SSI gap between the developed and developing worlds and how to reduce resistance.

Antibiotic protocols can be adjusted to local and regional bacterial resistance profiles, taking into account the availability of antibiotics and cost limitations on each country in order to decrease the SSI risk.
Are we missing the mark? Relationships of psychosocial issues to outcomes after injury
Authors: Simske Natasha M. , Breslin Mary A. , Hendrickson Sarah B. , Vallier Heather A.
Published: April 2020

Objectives:

To observe the availability of information about social, emotional, and psychological factors in abstracts presented at the Orthopaedic Trauma Association (OTA) annual meeting.

Data source:

OTA website (https://ota.org/education/meetings-and-courses/meeting-archive/)

Study Selection:

All abstracts selected for paper or poster presentation at the 2016 through 2018 OTA annual meetings, as published in the final program. Studies were included if they sought to measure mental illness, substance use or abuse, pain, or other psychosocial issues. If studies utilized 1 or more patient-reported outcome measures (PROMs), they were also included.

Data extraction:

For each abstract meeting inclusion criterion, studies were assessed for interventions intended to improve outcomes in any of the listed psychosocial domains.

Data synthesis/Results:

Nine hundred forty-two abstracts were evaluated over a 3-year period. Of these, 294 (31.2%) met inclusion criteria. Twenty-five abstracts (8.5% of 294) reported mental illness, with depression (n = 14), anxiety (n = 9), and posttraumatic stress disorder (n = 5) being the most common. Eighty-eight abstracts (29.9% of 294) reported substance-use of tobacco, alcohol, narcotics, and/or recreational drugs. Tobacco-use was most prevalent (n = 59), followed by opioid-use (n = 31). Ten abstracts reported substance abuse. Pain was measured in 95 abstracts, and 203 abstracts utilized PROMs. Thirty-five abstracts found that these psychosocial elements significantly impacted outcomes or complications. Many abstracts did not assess the influence of these factors on clinical outcomes (n = 99). Sixteen studies described an intervention aimed at mitigating these features.

Conclusions:

This study illustrates limited attention to the impact of psychological, social, and environmental factors on outcomes after orthopaedic trauma. Substance-abuse problems and mental health concerns are not only predictors of poor clinical and PROMs of pain and quality of life after injury, but have also been implicated in subsequent recidivism. Only 3% of 942 abstracts observed mental health and 1% reported substance-abuse. Moving forward, greater understanding of psychosocial issues may enhance interventions to impact long-term outcomes.
Patient-Reported Outcomes after Syndactyly Reconstruction
Authors: Park Eugene , Bi Andrew , King Erik C. , Adkinson Joshua M.
Published: April 2020

Background:

There is scant literature regarding patient-reported outcomes after reconstruction for congenital hand syndactyly. Understanding patient perceptions of the postoperative outcome may facilitate a more evidence-based discussion of expectations after reconstruction.

Methods:

All patients undergoing congenital syndactyly reconstruction at Ann and Robert H. Lurie Children’s Hospital of Chicago between January of 2007 and December of 2015 were identified. Patient-Reported Outcomes Measurement Information System questionnaires were completed by patients; parent-proxy questionnaires were completed for patients 10 years of age and younger and those unable to complete the questionnaire independently. A retrospective chart review was also performed to capture demographic and clinical information.

Results:

The authors identified 124 patients meeting inclusion criteria; 51 completed the Patient-Reported Outcomes Measurement Information System surveys (response rate, 41.1 percent). The survey score for upper extremity function was 41.8 ± 11. Upper extremity function was further impaired in patients with a documented history of developmental delay (23.8 ± 6.2 versus 44.2 ± 10.2). Parents completing surveys on behalf of their children reported higher pain interference scores than self-responders.

Conclusions:

The Patient-Reported Outcomes Measurement Information System is a valuable tool for measuring patient-reported outcomes in patients with syndactyly. Patients who have undergone reconstruction for syndactyly experience minor impairments in upper extremity function, but other aspects of their health-related quality of life are comparable to those of the general population. Developmental delay may be associated with additional impairments in upper extremity function and should be discussed when considering surgical reconstruction.
Transmucosal Pterygomaxillary Separation in the Le Fort I Osteotomy
Authors: Susarla Srinivas M. , Ettinger Russell E. , Egbert Mark A.
Published: April 2020

The Le Fort I osteotomy is a versatile operation for correction of developmental, congenital, and posttraumatic deformities of the lower midface. One of the challenges of the osteotomy is pterygomaxillary separation, with the potential for unfavorable fractures to the orbit/skull base or vascular injury. A modified technique for pterygomaxillary disjunction is the transmucosal tuberosity osteotomy. The authors have used this technique for pterygomaxillary separation in 200 consecutive Le Fort I osteotomies over a 3-year period (2014 to 2017). There were no episodes of unfavorable propagation to the skull base or orbit, oroantral or oronasal fistulae, excessive bleeding/vessel injuries, or vascular insufficiency to the maxilla. The transmucosal tuberosity approach is a reliable and safe method of performing the pterygomaxillary separation during the Le Fort I osteotomy.
Tips and Pearls on Social Media for the Plastic Surgeon
Authors: Chen Austin D. , Furnas Heather J. , Lin Samuel J.
Published: April 2020

Learning Objectives:

After studying this article, the participant should be able to: 1. Identify the key social media platforms to use. 2. Recall the primary components of the code of conduct when using social media. 3. Recognize how to build a social media presence and brand. 4. Summarize the primary applications of social media in plastic surgery.

Social media are a growing new tool that has emerged in recent years, with numerous applications that have allowed for an effective means to rapidly disseminate information. Plastic surgeons must gain an understanding of the technology to both grow their practices and the specialty as a whole in an ethical and responsible way. The different platforms available; code of conduct; how to build a social media presence; and the main applications of advertising, education, and research, as based on evidence-based recommendations, are presented.
Hyperestrogenism on 18F-FDG PET/CT in a Patient With Estrogen-Producing Ovarian Clear Cell Carcinoma
Authors: Koyasu Sho , Otani Tomoaki , Minamiguchi Sachiko , Nakamoto Yuji , Togashi Kaori
Published: April 2020

A 78-year-old woman was referred to the gynecologic outpatient department because she was suspected of having ovarian cancer based on an imaging study performed during a general medical examination. Further examination using 18F-FDG PET/CT revealed a bulky mass lesion with low FDG avidity, as well as surprisingly strong bilateral breast radiotracer uptake despite the patient's age. Thus, an estrogen-producing tumor was suspected. Bilateral salpingo-oophorectomy was performed, and surgical pathology diagnosed the tumor as clear cell carcinoma of the ovary.
Isolated Intravascular Prostate Carcinoma Recurrence Confirmed With 18F-Fluciclovine PET/CT and MRI
Authors: Agely Ali , Sharma Akash , Parent Ephraim E. , Nawaz Anem , Jain Manoj K.
Published: April 2020

Late recurrence of prostate cancer after remission with prior radical prostatectomy is uncommon. This is a unique case of biochemical recurrence after being in remission for 12 years. The patient presented with swelling of the right lower extremity with pelvic MRI demonstrating an arterially enhancing filling defect in the right common iliac. An 18F-fluciclovine PET/CT showed corresponding increased intravascular radiotracer activity. Targeted biopsy of the intravascular lesion showed poorly differentiated carcinoma, suggestive of prostate origin. Although MRI evaluation is the mainstay for pelvic evaluation, characterization with 18F-fluciclovine PET/CT imaging adds high whole-body specificity and diagnostic accuracy.
The Influence of Transverse Carpal Ligament Thickness on Treatment Decisions for Idiopathic Mild to Moderate Carpal Tunnel Syndrome
Authors: Lee Sang Ki , Hwang Seok Young , An Young Sun , Choy Won Sik
Published: April 2020

Purpose

The main cause of carpal tunnel syndrome (CTS) is pathological changes in the flexor synovium, which is a known cause of pressure elevation in the carpal tunnel. The importance of the transverse carpal ligament (TCL) in the pathogenesis of CTS has hitherto been overlooked. However, the TCL significantly affects carpal biomechanics; the TCL is known to affect the carpal bone to a greater extent when intra carpal tunnel pressure is high. In addition, the effect of TCL properties on the progression course of idiopathic CTS is unknown.

Therefore, we hypothesized that TCL thickness, measured using ultrasonography, would influence the results of conservative treatment for CTS patients with mild to moderate symptoms. We aimed to investigate the relationship between the ultrasound-measured TCL thickness and idiopathic carpal tunnel conservative treatment surgery rate.

Materials and Methods

We analyzed the wrists of 127 patients with mild to moderate symptoms of CTS. The patients were diagnosed on the basis of electrophysiological assessment outcomes, median nerve cross-sectional area in the carpal tunnel, and clinical symptoms. The Boston carpal tunnel questionnaire score was also measured. Patients with a TCL thinner than 1.5 mm were classified into group A (n = 62), and those with a TCL thicker than 1.5 mm were classified into group B (n = 65). Patients with severe symptoms or other diseases were excluded. The patients were initially treated with night splinting after diagnosis. If symptoms were not ameliorated, steroid injection and surgical treatment were performed consecutively. The procedures were determined by a single surgeon.

Results

The mean TCL thickness was 1.51 mm: 0.98 mm in group A and 2.28 mm in group B. The percentages of patients who underwent surgery were 43.0% in group A and 67.7% in group B. Group B was 1.77 times more likely to have surgery, and the interval between diagnosis and surgery and/or steroid injection was shorter. The TCL thickness in group B was also related to cross-sectional area and symptom duration.

Conclusions

Transverse carpal ligament thickness affects disease progression and may affect treatment efficacy, depending on the treatment method. Transverse carpal ligament thickness may be a criterion for deciding between surgical and conservative treatments based on a thickness threshold of 1.5 mm.
Perioperative Use of Antiestrogen Therapies in Breast Reconstruction
Authors: Spera Leigh Jenna , Cook Julia A. , Dolejs Scott , Fisher Carla , Lester Mary E. , Hassanein Aladdin H.
Published: April 2020

Background

Patients with hormone receptor-positive breast tumors receive hormonal therapy with either selective estrogen receptor modulators (SERMs) (eg, tamoxifen) or aromatase inhibitors (AIs) (eg, anastrozole) for 5 to 10 years. Patients are using these therapies frequently during breast reconstruction. Literature investigating the effects of hormonal modulators on breast reconstruction outcomes demonstrates conflicting results. We sought to perform a systematic evaluation to assess the effects of hormonal therapy on breast reconstruction outcomes and to guide perioperative management of antiestrogen therapies.

Methods

A MEDLINE, PubMed, and EBSCO Host search of articles regarding the effects of SERMs and AIs on breast reconstruction was performed. Outcomes evaluated included wound complications, total or partial flap loss, and thromboembolic events. Included studies were assigned Methodological Index for Nonrandomized Studies quality scores.

Results

A total of 2581 flaps were analyzed for complete loss: patients taking SERMs at the time of reconstruction had higher rates of flap loss compared with patients not taking hormone modulators (P < 0.001). Flap loss was not affected by concurrent AI use (P = 0.11). Both SERMs and AIs had an increased risk of donor site complications (P = 0.0021 and P < 0.0001, respectively). Neither hormone modulator had an effect on flap wound complications or venous thromboembolic event rates.

Conclusions

Evidence indicates patients using SERMs at the time of operation are at an increased risk of flap loss and those taking either SERMs or AIs have higher rates of donor site complications. These findings support holding these medications for 1 to 2 half lives (tamoxifen, 14–28 days; AIs, 2–4 days) preoperatively.
CoV2ID: Detection and Therapeutics Oligo Database for SARS-CoV-2
Authors: Carneiro João , Gomes Catarina , Couto Cátia , Pereira Filipe
Published: April 2020

The ability to detect the SARS-CoV-2 in a widespread epidemic is crucial for screening of carriers and for the success of quarantine efforts. Methods based on real-time reverse transcription polymerase chain reaction (RT-qPCR) and sequencing are being used for virus detection and characterization. However, RNA viruses are known for their high genetic diversity which poses a challenge for the design of efficient nucleic acid-based assays. The first SARS-CoV-2 genomic sequences already showed novel mutations, which may affect the efficiency of available screening tests leading to false-negative diagnosis or inefficient therapeutics. Here we describe the CoV2ID (http://covid.portugene.com/), a free database built to facilitate the evaluation of molecular methods for detection of SARS-CoV-2 and treatment of COVID-19. The database evaluates the available oligonucleotide sequences (PCR primers, RT-qPCR probes, etc.) considering the genetic diversity of the virus. Updated sequences alignments are used to constantly verify the theoretical efficiency of available testing methods. Detailed information on available detection protocols are also available to help laboratories implementing SARS-CoV-2 testing.
Optimized qRT-PCR approach for the detection of intra- and extra-cellular SARS-CoV-2 RNAs
Authors: Toptan Tuna , Hoehl Sebastian , Westhaus Sandra , Bojkova Denisa , Berger Annemarie , Rotter Björn , Hoffmeier Klaus , Ciesek Sandra , Widera Marek
Published: April 2020

The novel coronavirus SARS-CoV-2 is the causative agent of the acute respiratory disease COVID-19 which has become a global concern due to its rapid spread. Meanwhile, increased demand in testing has led to shortage of reagents, supplies, and compromised the performance of diagnostic laboratories in many countries. Both the world health organization (WHO) and the Center for Disease Control and Prevention (CDC) recommend multi-step RT-PCR assays using multiple primer and probe pairs, which might complicate interpretation of the test results especially for borderline cases. In this study, we describe an alternative RT-PCR approach for the detection of SARS-CoV-2 RNA that can be used for the probe-based detection of clinical isolates in the diagnostics as well as in research labs using a low cost SYBR green method. For the evaluation, we used samples from patients with confirmed SARS-CoV-2 infection and performed RT-PCR assays along with successive dilutions of RNA standards to determine the limit of detection. We identified an M-gene binding primer and probe pair highly suitable for quantitative detection of SARS-CoV-2 RNA for diagnostic and research purposes.
A statistical forecast of LOW mortality and morbidity due to COVID-19, in ARGENTINA and other Southern Hemisphere countries
Authors: Barbero Cesar A.
Published: April 2020

A set of open source programs in Python is devised to fit a parametric integrated Gaussian equation to cumulative deaths due to COVID-19 in Southern Hemisphere countries. The programs were successfully tested using data from advanced outbreak trajectories (Italy and Spain). The procedure was applied to data reported by Argentina. The projected total death toll will be 182 (277-182) with a peak of deaths (6(+/-2)) the 14 of April. The outbreak begins the 9thof March and end completely the 20thof May. However, already on 1stof May, 2 s (95.45%) of the deaths have occurred. The death toll arises from a number of infected individuals between 36412 and 2275. Then, they were to use to process data from several Southern Hemisphere countries: Argentina, Brazil, Mexico, Peru, Colombia, Ecuador, Cuba, Chile, Panama, Australia, Bolivia, Honduras, New Zealand, Paraguay, Guatemala, Venezuela, Uruguay, El Salvador, Jamaica, Haiti, Costa Rica and Nicaragua. The trend is to show low number of total deaths compared with other disease outbreaks. A total projected number of deaths between 15148 and 9939 deaths for a total population of ca. 664 M inhabitants. The projected death toll is much lower (5-10 times) than those forecasted by the Imperial College Group (ICG) even considering the best scenario of total suppression of virus transmission. Using actual mortality rates it is possible to back calculate which number of infected individuals would produce such mortality. The calculated number of infected individuals (worst case scenario) is below 2.5 million. This is significantly lower than that calculated by ICG (> 45 millions). In most countries the outbreak will end in May or early June. The dynamics of the outbreaks seems to do not saturate the health services (hospital beds) but only Peru, Ecuador and Panama should have not enough ICU beds for grave COVID-19 patients.
Thermal stratification and fish thermal preference explain vertical eDNA distributions in lakes
Authors: Littlefair Joanne E. , Hrenchuk Lee E. , Blanchfield Paul J. , Rennie Michael D. , Cristescu Melania E.
Published: April 2020

Significant advances have been made towards surveying animal and plant communities using DNA isolated from environmental samples. Despite rapid progress, we lack a comprehensive understanding of the “ecology” of environmental DNA (eDNA), particularly its temporal and spatial distribution and how this is shaped by abiotic and biotic processes. Here, we tested how seasonal variation in thermal stratification and animal habitat preferences influence the distribution of eDNA in lakes. We sampled eDNA depth profiles of five dimictic lakes during both summer stratification and autumn turnover, each containing warm- and cool-water fishes as well as the cold-water stenotherm, lake trout (Salvelinus namaycush). Habitat use by lake trout was validated by acoustic telemetry and was significantly related to eDNA distribution during stratification. Fish eDNA became “stratified” into layers during summer months, reflecting lake stratification and the thermal niches of the species. During summer months, lake trout, which rarely ventured into shallow waters, could only be detected at the deepest layers of the lakes, whereas the eDNA of warm-water fishes was much more abundant above the thermocline. By contrast, during autumn lake turnover, the fish species assemblage as detected by eDNA was homogenous throughout the water column. These findings contribute to our overall understanding of the “ecology” of eDNA within lake ecosystems, illustrating how the strong interaction between seasonal thermal structure in lakes and thermal niches of species on very localised spatial scales influences our ability to detect species.
Rapid SARS-CoV-2 whole genome sequencing for informed public health decision making in the Netherlands
Authors: Oude Munnink Bas B. , Nieuwenhuijse David F. , Stein Mart , O’Toole Áine , Haverkate Manon , Mollers Madelief , Kamga Sandra K. , Schapendonk Claudia , Pronk Mark , Lexmond Pascal , van der Linden Anne , Bestebroer Theo , Chestakova Irina , Overmars Ronald J. , van Nieuwkoop Stefan , Molenkamp Richard , van der Eijk Annemiek , GeurtsvanKessel Corine , Vennema Harry , Meijer Adam , Rambaut Andrew , van Dissel Jaap , Sikkema Reina S. , Timen Aura , Koopmans Marion ,   on behalf of the Dutch-Covid-19 response team
Published: April 2020

SARS-CoV-2 is a novel coronavirus that has rapidly spread across the globe. In the Netherlands, the first case of SARS-CoV-2 has been notified on the 27th of February. Here, we describe the first three weeks of the SARS-CoV-2 outbreak in the Netherlands, which started with several different introductory events from Italy, Austria, Germany and France followed by local amplification in, and later also, outside the South of the Netherlands. The timely generation of whole genome sequences combined with epidemiological investigations facilitated early decision making in an attempt to control local transmission of SARS-CoV-2 in the Netherlands.
Research on CNN-based Models Optimized by Genetic Algorithm and Application in the Diagnosis of Pneumonia and COVID-19
Authors: Zeng Zihan , Wang Bo , Zhao Zhiwen
Published: April 2020

In this research, an optimized deep learning method was proposed to explore the possibility and practicality of neural network applications in medical imaging. The method was used to achieve the goal of judging common pneumonia and even COVID-19 more effectively. Where, the genetic algorithm was taken advantage to optimize the Dropout module, which is essential in neural networks so as to improve the performance of typical neural network models. The experiment results demonstrate that the proposed method shows excellent performance and strong practicability in judging pneumonia, and the application of advanced artificial intelligence technology in the field of medical imaging has broad prospects.
The Approved Dose of Ivermectin Alone is not the Ideal Dose for the Treatment of COVID-19
Authors: Schmith Virginia D. , Zhou Jie (Jessie) , Lohmer Lauren RL
Published: April 2020

Introduction

Caly, Druce (1) reported that ivermectin inhibited SARS-CoV-2 in vitro for up to 48 h using ivermectin at 5μM. The concentration resulting in 50% inhibition (IC50, 2 µM) was >35x higher than the maximum plasma concentration (Cmax) after oral administration of the approved dose of ivermectin when given fasted.

Method

Simulations were conducted using an available population pharmacokinetic model to predict total (bound and unbound) and unbound plasma concentration-time profiles after a single and repeat fasted administration of the approved dose of ivermectin (200 μg/kg), 60 mg, and 120 mg. Plasma total Cmax was determined and then multiplied by the lung:plasma ratio reported in cattle to predict the lung Cmax after administration of each single dose.

Results

Plasma ivermectin concentrations of total (bound and unbound) and unbound concentrations do not reach the IC50, even for a dose level 10x higher than the approved dose. Even with higher exposure in lungs than plasma, ivermectin is unlikely to reach the IC50 in lungs after single oral administration of the approved dose (predicted lung: 0.0857 µM) or at doses 10x higher that the approved dose administered orally (predicted lung: 0.817 µM).

Conclusions

The likelihood of a successful clinical trial using the approved dose of ivermectin is low. Combination therapy should be evaluated in vitro. Re-purposing drugs for use in COVID-19 treatment is an ideal strategy but is only feasible when product safety has been established and experiments of re-purposed drugs are conducted at clinically relevant concentrations.
Nonlinear Markov Chain Modelling of the Novel Coronavirus (Covid-19) Pandemic
Authors: Catak Muammer , Duran Necati
Published: April 2020

Almost all countries around the world are struggling against the novel coronavirus (Covid-19) pandemic. In this paper, a nonlinear Markov chains model is proposed in order to analyse and to understand the behaviour of the Covid-19 pandemic. The data from China was used to build up the presented model. Thereafter, the nonlinear Markov chain model is employed to estimate the daily new Covid-19 cases in some countries including Italy, Spain, France, UK, the USA, Germany, Turkey, and Kuwait. In addition, the correlation between the daily new Covid-19 cases and the daily number of deaths is examined.
Understanding the asymmetric spread and case fatality rate (CFR) for COVID-19 among countries
Authors: Iype Eldhose , Gulati Sadhya
Published: April 2020

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections are rising rapidly every day in the world, causing the disease COVID-19 with around 2 million people infected and more than 100,000 people died so far, in more than 200 countries. One of the baffling aspects of this pandemic is the asymmetric increase in cases and case fatality rate (CFR) among countries. We analyze the time series of the infection and fatality numbers and found two interesting aspects. Firstly, the rate of spread in a region is directly connected to the population density of the region where the virus is spreading. For example, the high rate of increase in cases in the United States of America (USA) is related to the high population density of New York City. This is shown by scaling the cumulative number of cases with a measure of the population density of the affected region in countries such as Italy, Spain, Germany, and the USA and we see that the curves are coinciding. Secondly, we analyzed the CFR number as a function of the number of days, since the first death, and we found that there are two clear categories among countries: one category with high CFR numbers (around 10%) and the other category with low CFR numbers (2% to 4%). When we analyzed the results, we see that countries with lower CFR numbers more or less tend to have implemented active control measures such as aggressive testing, tracking down possible infections, effective quarantine measures, etc. Moreover, we did not see any convincing correlation between mortality rates and the median age of the population.
The proportion testing positive for SARS-COV-2 among the tested population in the U.S.: Benefits of the positive test ratio under scaled testing scenarios
Authors: Ng George , Wang Constance
Published: April 2020

The ratios offer simple ways to account for variations in testing and reporting. Tracking the ratios in addition to cases offer a more precise view of the pandemic. Our observations underscore the need to scale mass testing with accurate and reliable tests, to implement testing systematically and report results consistently.
Analysis of Effectiveness of Quarantine Measures in Controlling COVID-19
Authors: Kaushik Garima , Mantri Shaney , Kaushik Shrishti , Kalbande Dhananjay , Chaudhari B. N.
Published: April 2020

COVID-19 has created an interesting discourse among the people of the world particularly regarding preventive measures of infectious diseases. In this paper, the authors forecast the spread of the Coronavirus outbreak and study how the reduction of transmission rates influences its decline. The paper makes use of the SIR (Susceptible Infected Recovered) Model which is a deterministic model used in the field of epidemiology-based on differential equations derived from sections of the population. The Basic Reproduction Number (Ro) represents the criticality of the epidemic in numeric terms. Forecasting an epidemic provides insights about the geographic spreading of the disease and the case incidences required to better inform intervention strategists about situations that may occur during the outbreak. Through this research paper, the authors wish to provide an insight into the impact of control measures on the pandemic. By drawing a comparison of three countries and their quarantine measures, observations on the decline of the outbreak are made. Authors intend to guide the intervention strategies of under-resourced countries like India and aid in the overall containment of the outbreak.
The spatio-temporal epidemic dynamics of COVID-19 outbreak in Africa
Authors: Gayawan Ezra , Awe Olawale , Oseni Bamidele M , Uzochukwu Ikemefuna C. , Adekunle Adeshina , Samuel Gbemisola , Eisen Damon P , Adegboye Oyelola A
Published: April 2020

The novel coronavirus (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in the city of Wuhan, China in December 2019. Although, the disease appears on the African continent late, it has spread to virtually all the countries. We provide early spatio-temporal dynamics of COVID-19 within the first 62 days of the disease’s appearance on the African continent. We used a two-parameter hurdle Poisson model to simultaneously analyze the zero counts and the frequency of occurrence. We investigate the effects of important healthcare capacities including hospital beds and number of medical doctors in the different countries. The results show that cases of the pandemic vary geographically across Africa with notable high incidence in neighboring countries particularly in West and North Africa. The burden of the disease (per 100,000) was most felt in Djibouti Tunisia, Morocco and Algeria. Temporally, during the first 4 weeks, the burden was highest in Senegal, Egypt and Mauritania, but by mid-April it shifted to Somalia, Chad, Guinea, Tanzania, Gabon, Sudan, and Zimbabwe. Currently, Namibia, Angola, South Sudan, Burundi and Uganda have the least burden. The findings could be useful in implementing epidemiological intervention and allocation of scarce resources based on heterogeneity of the disease patterns.
COVID-19 Epidemic in Algeria: Assessment of the implemented preventive strategy
Authors: Hamidouche Mohamed
Published: April 2020

Since the spread of the COVID-19 epidemic in China, several preventive strategies have been implemented worldwide to fight against the spread of SARS-CoV-2, in Algeria the control actions have been mainly social distancing, movement’s restriction, quarantine and lockdown.

In order to assess the preventive strategy adopted in Algeria, we studied three zones (whole country, the main outbreak at Blida, and whole country except Blida), we used as a indicator the basic reproduction number R0, we compared the mean R0-before and R0-after the implementation of the mitigation measures using bivariate analysis, then we used the results we found to estimate the number of COVID-19 cases avoided by these measures, then after, we predicted the peak of the epidemic’s first wave.

We note that the decrease in R0 after the preventive measures implementation was statistically significant (p value<10−4) in the three areas, thus, the preventive strategy in Algeria has been effective in its entirety. Our projection revealed that 15613 cases of COVID-19 were avoided in 14 days (from April 6, to April 19, 2020) in the whole country, and 1747 cases were prevented in Blida during the same period. We estimate that the peak of the first wave of the epidemic in Algeria will be reached with herd immunity of 15.93% as of November 2020, however, at least 56% of people with protective immunity would be needed to be sufficient to avoid a second wave. The used method to carry out the evaluation has given us a good overview, but, R0 is not the only factor to consider when estimating the burden of the epidemic, to do that, the number of daily admissions to intensive care units and hospitalizations remain good indicators.

In order to better the epidemic control in Algeria, it is possible to act on contact efficacy rate by adding an instruction to wear medical mask by ordinary population outside, this measure has been reported to be effective in some countries.

To conclude, it is good to keep in mind that a new way of life based on good hygiene habits and social distancing must therefore be in place and adopted by the population for at least several months, otherwise the demand for health care will exceed the availability.
Covid-19 and Inequity: A comparative spatial analysis of New York City and Chicago hot spots
Authors: Maroko Andrew , Nash Denis , Pavilonis Brian
Published: April 2020

There have been numerous reports that the impact of the ongoing COVID-19 epidemic has disproportionately impacted traditionally vulnerable communities, including well-researched social determinants of health, such as racial and ethnic minorities, migrants, and the economically challenged. The goal of this ecological cross-sectional study is to examine the demographic and economic nature of spatial hot and cold spots of SARS-CoV-2 rates in New York City and Chicago as of April 13, 2020.

In both cities, cold spots (clusters of low SARS-CoV-2 rate ZIP code tabulation areas) demonstrated typical protective factors associated with the social determinants of health and the ability to social distance. These neighborhoods tended to be wealthier, have higher educational attainment, higher proportions of non-Hispanic white residents, and more workers in managerial occupations. Hot spots (clusters of high SARS-CoV-2 rate ZIP code tabulation areas) also had similarities, such as lower rates of college graduates and higher proportions of people of color. It also appears to be larger households (more people per household), rather than overall population density, that may to be a more strongly associated with hot spots.

Findings suggest important differences between the cities’ hot spots as well. They can be generalized by describing the NYC hot spots as working-class and middle-income communities, perhaps indicative of service workers and other occupations (including those classified as “essential services” during the pandemic) that may not require a college degree but pay wages above poverty levels. Chicago’s hot spot neighborhoods, on the other hand, are among the city’s most vulnerable, low-income neighborhoods with extremely high rates of poverty, unemployment, and non-Hispanic Black residents.
Modelling the potential impact of social distancing on the COVID-19 epidemic in South Africa
Authors: Nyabadza F. , Chirove F. , Chukwu W. , Visaya M.V.
Published: April 2020

The novel coronavirus (COVID-19) pandemic continues to be a global health problem whose impact has been significantly felt in South Africa. Social distancing has been touted as the best form of response in managing a rapid increase in the number of infected cases. In this paper, we present a deterministic model to model the impact of social distancing on the transmission dynamics of COVID-19 in South Africa. The model is fitted to the currently available data on the cumulative number of infected cases and a scenario analysis on different levels of social distancing are presented. The results show a continued rise in the number of cases in the lock down period with the current levels of social distancing albeit at a lower rate. The model shows that the number of cases will rise to above 4000 cases by the end of the lockdown. The model also looks at the impact of relaxing the social distancing measures after the initial announcement of the lock down measures. A relaxation of the social distancing by 2% can result in a 23% rise in the number of cumulative cases while on the other hand increasing the levels of social distancing by 2% would reduce the number of cumulative cases by about 18%. These results have implications on the management and policy direction in the early phases of the epidemic.
COVID-19 Fatality and Comorbidity Risk Factors among Diagnosed Patients in Mexico
Authors: Solís Patricio , Carreño Hiram
Published: April 2020

As of April 18, 2020, 2.16 million patients in the world had been tested positive with Coronavirus (COVID-19) and 146,088 had died, which accounts for a case fatality rate of 6.76%. In Mexico, according to official statistics (April 18), 7,497 cases have been confirmed with 650 deaths, for a case fatality rate of 8.67%. These estimates, however, may not reflect the final fatality risk among COVID-19 confirmed patients, because they are based on cross-sectional counts of diagnosed and deceased patients, and therefore are not adjusted by time of exposure and right-censorship. In this paper we estimate fatality risks based on survival analysis methods, calculated from individual-level data on symptomatic patients confirmed with COVID-19 recently released by the Mexican Ministry of Health. The estimated fatality risk after 35 days of onset of symptoms is 12.38% (95% CI: 11.37-13.47). Fatality risks sharply rise with age, and significantly increase for males (59%) and individuals with comorbidities (38%-168%, depending on the disease). Two reasons may explain the high COVID-19 related fatality risk observed in Mexico, despite its younger age structure: the high selectivity and self-selectivity in testing and the high prevalence of chronic-degenerative diseases.
The role of comorbidities and clinical predictors of severe disease in COVID-19: a systematic review and meta-analysis
Authors: Tabrizi Reza , Lankarani Kamran B , Nowrouzi-sohrabi Peyman , Shabani-Borujeni Mojtaba , Rezaei Shahla , Hosseini-bensenjan Mahnaz , vakili Sina , Heydari Seyed Taghi , Ashraf Mohammad Ali
Published: April 2020

Background

COVID_19 is unpredictable due to non-specific symptoms and clinical course diversity in different individuals. We analyzed studies regarding the factors associated with severe status of the disease to identify unique findings in severely affected patients.

Methods

We systematically searched the electronic databases, including PubMed, Scopus, EMBASE, Web of Science, and Google Scholar from inception to 12thof March 2020. Cochrane’s Q and I-square statistics were used to assess the existence of heterogeneity between the included studies. We used the random-effects model to pool the odds ratios (ORs) at 95% confidence intervals (CIs).

Results

Seventeen articles out of 3009 citations were included. These contained 3189 patients, of whom 732 were severely affected (severe group) and 3189 were in non-severe group. Using the random-effects model, our meta-analyses showed that the odds of comorbidities, including COPD, DM, HTN, CVD, CKD, and symptoms, including dyspnea, dizziness, anorexia, and cough, were significantly higher among the severe group compared with the non-severe group. There were no significant changes in odds of CVA, liver disease, immunodeficiency/immunosuppression, fever, fatigue, myalgia, headache, diarrhea, sore throat, nasal congestion, sputum, nausea, vomiting, chest pain between the two groups.

Conclusions

Early recognition and intervention can be critical in management, and might stop progression to severe disease. Predictive symptoms and comorbidities can be used as a predictor in patients who are at risk of severe disease.
Association between rRT-PCR test results upon admission and outcome in hospitalized chest CT-Positive COVID-19 patients; a provincial retrospective cohort with active follow-up
Authors: Nemati Saeed , Najari Hamid Reza , Eftekharzadeh Anita , Kazemifar Amir Mohammad , Qandian Ali , Fattahi Pedram , Nikoo Maedeh Zokaei , Leghaei Shiva , Rouhollahi Mohammad Reza
Published: April 2020

Background

The Covid-19 pandemic imposed the most devastating challenge on healthcare systems worldwide. Iran was among the first countries that had to confront serious shortages in RT-PCR testing for SARS-CoV-2 and ventilators availabilities throughout the COVID-19 outbreak. This study aimed to investigate the clinical course of hospitalized COVID-19 patients with different rRT-PCR test results during the first 3 weeks of the outbreak in Qazvin province, Iran.

Methods

For this retrospective cohort study, data of hospitalized patients primarily diagnosed as having COVID-19 in all 12 centers across the whole Qazvin province during Feb 20-Mar 11, 2020 was analyzed. A multivariate logistic regression model was applied to assess the independent associates of death among COVID-19 patients.

Results

998 patients (57% male, median age 54 years) with positive chest CT-scan changes were included in this study. Among them, 558 patients were examined with rRT-PCR test and 73·8% tested positive. Case fatality rate was 20·68% and 7·53% among test-positive and test negative hospitalized patients, respectively. While only 5·2% of patients were ICU admitted, case fatality rates outside ICU were 17·70% and 4·65% in test-positive and test-negative non-ICU admitted patients, correspondingly. The independent associates of death were age ≥ 70 years, testing positive with rRT-PCR test, having immunodeficiency disorders and ICU admission.

Conclusions

Hospitalized COVID-19 patients with mild symptoms despite positive chest CT changes and major comorbidities were more probable to have negative rRT-PCR test result, hence lower case fatality rate and a more favorable outcome.
COMPENSATED HYPOGONADISM IN MEN WITH SICKLE CELL DISEASE
Authors: Ribeiro Anna Paloma Martins Rocha , Silva Carolina Santos , Zambrano Jean Carlos , de Oliveira Freitas Miranda Juliana , Molina Carlos Augusto Fernandes , Gomes Cristiano Mendes , de Paula Miranda Eduardo , de Bessa Júnior José
Published: April 2020

Introduction

Sickle cell disease (SCD) is associated with the development of hypogonadism, but there is still controversy regarding its etiology and clinical implications.

Objective

To evaluate the prevalence of hypogonadism in a population of men with SCD and characterize its etiology.

Methods

We performed a cross-sectional study of 34 men with SCD aged > 18 years. Sociodemographic and clinical data, including anthropometric measurements (weight, height, and BMI), were obtained. Early morning blood samples were collected and total testosterone (TT), free testosterone (FT), luteinizing hormone (LH), follicle-stimulating hormone (FSH), a complete blood count, and hemoglobin electrophoresis were measured.

Results

Median age was 33 [26-41] years, and SS genotype was the most frequent (73.5%). The prevalence of eugonadism, compensated, and secondary hypogonadism was 67.5%, 26.4%, and 5.88%, respectively. No men with primary hypogonadism were identified in our sample. Those with compensated hypogonadism had also higher FSH levels than individuals with eugonadism; p < 0.001).

Conclusion

In our study population of men with SCD a high prevalence of compensated hypogonadism was identified, which is a controversial and distinct clinical entity that warrants monitoring and further research.
VERSO: a comprehensive framework for the inference of robust phylogenies and the quantification of intra-host genomic diversity of viral samples
Authors: Ramazzotti Daniele , Angaroni Fabrizio , Maspero Davide , Gambacorti-Passerini Carlo , Antoniotti Marco , Graudenzi Alex , Piazza Rocco
Published: April 2020

We introduce VERSO, a two-step framework for the characterization of viral evolution from sequencing data of viral genomes, which improves over phylogenomic approaches for consensus sequences. VERSO exploits an efficient algorithmic strategy to return robust phylogenies from clonal variant profiles, also in conditions of sampling limitations. It then leverages variant frequency patterns to characterize the intra-host genomic diversity of samples, revealing undetected infection chains and pinpointing variants likely involved in homoplasies. On simulations, VERSO outperforms state-of-the-art tools for phylogenetic inference. Notably, the application to 6726 Amplicon and RNA-seq samples refines the estimation of SARS-CoV-2 evolution, while co-occurrence patterns of minor variants unveil undetected infection paths, which are validated with contact tracing data. Finally, the analysis of SARS-CoV-2 mutational landscape uncovers a temporal increase of overall genomic diversity, and highlights variants transiting from minor to clonal state and homoplastic variants, some of which falling on the spike gene. Available at:https://github.com/BIMIB-DISCo/VERSO.