bluuebunny/crossref_metadata_2025 huggingface dataset:
Laparoscopic Ventral Rectopexy for Obstructed Defecation: Functional Results and Quality of Life
Authors: Degasperi Silvia , Scarpa Marco , Zini Oscar , Ruffolo Cesare , Gruppo Mario , Bardini Romeo , Angriman Imerio
Published: August 2020

Background:

Laparoscopic ventral mesh rectopexy (LVR) is gaining wider acceptance as the preferred procedure to correct internal and external rectal prolapse with obstructed defecation syndrome (ODS) and/or fecal incontinence. The aim of our study was to analyze functional outcome and quality of life (Health-Related Quality of Life) after LVR for symptomatic internal prolapse and/or rectocele with ODS.

Methods:

Prospectively collected data on LVR for internal rectal prolapse were analyzed in 50 consecutive female patients operated between January 2011 and December 2018. In all cases, we performed a LVR according to the D’Hoore technique. Patients had ODS and internal rectal prolapse (grade 3 or 4) confirmed at the defecogram study. We registered only 1 major complication that required surgical treatment (Clavien-Dindo IIIb). The median hospital stay was 4 days [interquartile range (IQR): 2 to 5 d]. Functional results were measured with the Wexner Constipation Score and the 36-Item Short-Form Health Survey, and were analyzed before surgery and after 3, 6, or 12 months.

Results:

After a median follow-up of 16.5 months (IQR: 10 to 44.25 mo), the Wexner Total Score was significantly improved in almost all items passing from 14 (IQR: 11 to 18) to 11 (IQR: 6.25 to 14.75) after surgery (P<0.0001). Incontinence was cured in 8 of 11 patients (P=0.036). Compared with the preoperative score, the 36-Item Short-Form Health Survey score improved, especially for physical activity, varying from 75 to 87.5 (P=0.0156). No worsening of continence status, constipation, or sexual function was observed.

Conclusion:

LVR appears to provide a sustained improvement in Health-Related Quality of Life, constipation, and incontinence in patients with ODS without worsening constipation with low morbidity and recurrence.
A Case-matched Comparative Study of Laparoscopic Versus Open Right Colonic Resection for Colon Cancer: Developing Country Perspectives
Authors: Ammori Basil J. , Kakish Hanna , Asmer Huthaifa , Al-Najjar Hani , Hamed Osama H. , Al Ebous Ali , Dabous Ali , Daoud Faiez , Almasri Mahmoud
Published: August 2020

Background:

The open approach to right hemicolectomy remains the most widely adopted, whereas laparoscopic surgery is technically more demanding with possible loss of benefit for lengthy procedures compared with open surgery. The aim of this study is to compare the outcomes of the laparoscopic versus open surgery for right colon cancer resections.

Materials and Methods:

Patients who underwent an elective and potentially curative right colectomy for colon cancer between 2015 and 2019 were included and those who underwent emergency surgery, palliative resection, or cytoreductive surgery were excluded. Patients were randomly matched on 1:2 basis for age, disease stage, neoadjuvant chemotherapy, and extent of colectomy (right vs. extended right hemicolectomy, and additional major resection). The analysis was conducted on an intention-to-treat basis. The outcomes were reported as median (range) or percent as appropriate.

Results:

Among 160 patients, 18 were excluded. The final matching included 69 patients. The were no significant differences between the groups regarding patients’ age and sex distribution, tumor size, and preoperative serum albumin and hemoglobin. There were 2 conversions (8.7%) to open surgery. Although the operating time for laparoscopic surgery was longer (200 vs. 140 min, P<0.001), it was associated with less blood loss (50 vs. 100 mL, P=0.001) and shorter primary and total hospital stay (4.1 vs. 6.0 days, P<0.001). There were no differences in the rates of severe complications (0% vs. 13%), reoperations (0% vs. 4.3%), readmissions (13% vs. 8.7%), mortality (0% vs. 2.2%), R
0 resections (95.7% vs. 97.8%), and lymph node retrieval rate (28 in each group).

Conclusion:

The laparoscopic approach to right colon resection for colon cancer is associated with less operative trauma and quicker recovery compared with open surgery and offers an equivalent oncologic resection.
The role and value of family therapy for people living with cancer: a rapid review of recent evidence
Authors: Forbat Liz
Published: August 2020

Purpose of review

Cancer impacts the whole family and relational system, not just the individual with the diagnosis. The present article identifies and reviews publications in the field of family therapy and cancer since 2019, to describe the theoretical models and techniques applied, and the outcomes achieved.

Recent findings

A search of databases and grey literature led to the identification of five articles from four studies. Four papers described primary research and one summarized a case example. Papers were published by teams in the USA, Sweden and Iceland. Each article described the benefits of adopting a family therapy approach on outcomes such as family communication, bereavement and decreased carer burden. Four papers described specialist family therapists delivering the interventions, and one used oncology nurses drawing on the theories and techniques of family therapy.

The rarity of family therapy publications in the past year reflects the individual-level approach to cancer which permeates both medicine and talking therapies. The utility of family therapy could be further surfaced through more large-scale studies which thoroughly describe the unique theoretical basis and techniques, alongside outcomes for multiple people within the family system.
Management of cisplatin-associated toxicities in bladder cancer patients
Authors: Desilets Antoine , Adam Jean-Philippe , Soulières Denis
Published: August 2020

Purpose of review

Cisplatin remains the treatment cornerstone for bladder cancer, either in neoadjuvant or in metastatic (cisplatin-gemcitabine or dose-dense methotrexate, vinblastine, and doxorubicin). Timely and adequate management of cisplatin's adverse events is important in order to avoid dose reductions, treatment delays, or cessation. Over the last years, several randomized studies and updated guidelines have been published on this subject.

Recent findings

The incidence, physiopathology, risk factors, preventive treatment, and optimal management of such complications will be presented, with special focus on cisplatin-associated nausea and vomiting, acute kidney injury (AKI), hypomagnesemia, neurotoxicity, and ototoxicity.

Optimal prevention of cisplatin-associated nausea and vomiting requires an aggressive approach with the use of a four-drug prophylactic regimen (NK1 receptor antagonist, 5-HT3 receptor antagonist, dexamethasone, olanzapine). The use of intensive hydration before and after cisplatin infusion has been the mainstay of AKI prevention. The management of hypomagnesemia and neurotoxicity remains largely symptomatic. In an adult population, no therapy has yet demonstrated benefits in the prevention or treatment of platinum-related ototoxicity.
Heart, lungs, and muscle interplay in worsening activity-related breathlessness in advanced cardiopulmonary disease
Authors: Alberto Neder J. , O’Donnell Denis E.
Published: August 2020

Purpose of review

Activity-related breathlessness is a key determinant of poor quality of life in patients with advanced cardiorespiratory disease. Accordingly, palliative care has assumed a prominent role in their care. The severity of breathlessness depends on a complex combination of negative cardiopulmonary interactions and increased afferent stimulation from systemic sources. We review recent data exposing the seeds and consequences of these abnormalities in combined heart failure and chronic obstructive pulmonary disease (COPD).

Recent findings

The drive to breathe increases (‘excessive breathing’) secondary to an enlarged dead space and hypoxemia (largely COPD-related) and heightened afferent stimuli, for example, sympathetic overexcitation, muscle ergorreceptor activation, and anaerobic metabolism (largely heart failure-related). Increased ventilatory drive might not be fully translated into the expected lung–chest wall displacement because of the mechanical derangements brought by COPD (‘inappropriate breathing’). The latter abnormalities, in turn, negatively affect the central hemodynamics which are already compromised by heart failure. Physical activity then decreases, worsening muscle atrophy and dysfunction.

Beyond the imperative of optimal pharmacological treatment of each disease, strategies to lessen ventilation (e.g., walking aids, oxygen, opiates and anxiolytics, and cardiopulmonary rehabilitation) and improve mechanics (heliox, noninvasive ventilation, and inspiratory muscle training) might mitigate the burden of this devastating symptom in advanced heart failure–COPD.
Informal carers and peer support in pulmonary rehabilitation: an underutilized resource?
Authors: Patel Suhani , Man William D.-C. , Roberts Nicola J.
Published: August 2020

Purpose of review

The aim of this review is to discuss the recent literature relating to the involvement of informal carers and peer support in pulmonary rehabilitation.

Recent findings

Informal carers and peer support have been identified by both patients and healthcare workers as a crucial component in the care of those with chronic respiratory disease at home. Pulmonary rehabilitation, a cornerstone in the management of patients with breathlessness, is limited in its clinical effectiveness by poor referral, uptake and completion rates. Engagement of informal carers and support from peers may help maximize the utilization of pulmonary rehabilitation.

This review highlights the need for more good-quality randomized controlled trials in identifying suitable interventions that may increase uptake and completion of pulmonary rehabilitation programmes. Qualitative studies have highlighted the potential for informal carers and peer support to play a key role in the design of research programmes, and in the delivery of pulmonary rehabilitation. This needs to be addressed in future research.
Supportive and palliative care for people with chronic respiratory disease and frailty
Authors: Brighton Lisa Jane , Bone Anna E. , Maddocks Matthew
Published: August 2020

Purpose of review

Frailty is a multidimensional syndrome associated with increased risk of poor outcomes. It is estimated that at least one in five people with chronic respiratory disease is also living with frailty. In this review, we consider recent advances in how frailty can be recognized, and its associated impact on people with chronic respiratory disease. We then discuss advances in supportive and palliative care for those with both chronic respiratory disease and frailty.

Recent findings

The interconnectedness of chronic respiratory disease and frailty is being better understood. An increasing number of factors associated with frailty in respiratory disease have been identified, from increased symptom burden (e.g. breathlessness, fatigue) to increased exacerbations and higher mortality. These contribute to accumulating multidimensional losses in reserve, and unpredictable health. Recent advances in respiratory research, while not always with people with frailty, may inform supportive and palliative care to address frailty in chronic respiratory disease. These include rehabilitation interventions to strengthen reserves, advance care planning interventions to help manage unpredictable trajectories, and integrated models of care (e.g. incorporating respiratory, geriatric, and palliative care) to address multidimensional needs.

Recent evidence supporting the role of rehabilitation, advance care planning, and early palliative care, may be of benefit to people living with chronic respiratory disease and frailty. Models showing integration across multiple specialities and professionals may have the most potential to meet the multidimensional needs of this group. Future research should develop and test models of care that address frailty and/or explore the role of frailty in triggering integrated multidisciplinary input.
Ecological momentary assessment in eating disorders research: recent findings and promising new directions
Authors: Schaefer Lauren M. , Engel Scott G. , Wonderlich Stephen A.
Published: August 2020

Purpose of review

Ecological momentary assessment (EMA) is an important tool for clarifying common precipitants and consequences of eating disorder symptoms that might be meaningfully targeted in treatments for these pernicious disorders. This article reviews recent advances in EMA work conducted within clinical eating disorder samples.

Recent findings

Published studies from the past 2.5 years can broadly be categorized as involving functional analysis of eating disorder behaviors, examining hypothesized predictors of eating disorder symptoms, or applying novel approaches to EMA data. Examples of the latter category include the use of latent profile analysis with EMA data, integration of neurocognitive (e.g., ambulatory inhibitory control task) or biological indicators (e.g., fMRI, plasma leptin), and examining changes in associations between momentary variables over time through multiwave EMA data collection.

EMA studies in eating disorders have advanced significantly in recent years, with findings demonstrating strong support for the emotion regulation function of eating disorder behaviors and momentary predictors of distinct eating disorder symptoms. The use of novel statistical and data collection approaches represent exciting areas of growth, with likely implications for intervention approaches, including those that utilize ambulatory technology to deliver treatment.
Impact of tocilizumab administration on mortality in severe COVID-19
Authors: Tsai Andrew , Diawara Oumou , Nahass Ronald G. , Brunetti Luigi
Published: August 2020

Purpose

The novel coronavirus disease 2019 (COVID-19) worldwide pandemic has placed a significant burden on hospitals and healthcare providers. The immune response to this disease is thought to lead to a cytokine storm, which contributes to the severity of illness. There is an urgent need to confirm whether the use of tocilizumab provides a benefit in individuals with COVID-19.

Methods

A single-center propensity-score matched cohort study, including all consecutive COVID-19 patients, admitted to the medical center who were either discharged from the medical center or expired between March 1, 2020, and May 5, 2020, was performed. Patients were stratified according to the receipt of tocilizumab for cytokine storm and matched to controls using propensity scores. The primary outcome was in-hospital mortality.

Results

A total of 132 patients were included in the matched dataset (tocilizumab=66; no tocilizumab=66). Approximately 73% of the patients were male. Hypertension (55%), diabetes mellitus (31%), and chronic pulmonary disease (15%) were the most common comorbidities present. There were 18 deaths (27.3%) in the tocilizumab group and 18 deaths (27.3%) in the no tocilizumab group (odds ratio, 1.0; 95% confidence interval, 0.465 – 2.151; p=1.00). Advanced age, history of myocardial infarction, dementia, chronic pulmonary disease, heart failure, and malignancy were significantly more common in patients who died.

Conclusion

The current analysis does not support the use of tocilizumab for the management of cytokine storm in patients with COVID-19. Use of this therapeutic agent should be limited to the context of a clinical trial until more evidence is available.
Real-Time Monitoring of COVID-19 in Scotland
Authors: Calder-Gerver Giles David , Mazeri Stella , Haynes Samuel , Simonet Camille Anna , Woolhouse Mark EJ , Brown Helen
Published: August 2020

To manage the public health risk posed by COVID-19 and assess the impact of interventions, policy makers must be able to closely monitor the epidemic’s trajectory. Here we present a simple methodology based on basic surveillance metrics for monitoring the spread of COVID-19 and its burden on health services in Scotland. We illustrate how this has been used throughout the epidemic in Scotland and explore the underlying biases that have affected its interpretation.
Is my Arm moving? Proprioceptive impairment in Developmental Dyslexia
Authors: Julie Laprevotte , Charalambos Papaxanthis , Sophie Saltarelli , Patrick Quercia , Jeremie Gaveau
Published: August 2020

Developmental Dyslexia is a specific learning disorder causing reading deficits. Although it has long been considered a purely cognitive disorder, mounting evidence revealed that Developmental Dyslexia is associated with sensory impairments. Because these impairments are restrained to vision and hearing – both senses being heavily involved in reading – a large controversy exists regarding their role in the pathophysiology of Developmental Dyslexia. Cognitive theories argue that sensory impairments are caused by the lack of reading practice, and mainly represent an aggravating factor. Sensory theories argue that damaged neural mechanisms cause sensory impairments that, themselves, cause reading disabilities. An important prediction from sensory theories is that sensory troubles should encompass the whole sensory system. Here, we directly tested proprioceptive acuity in dyslexic children and age-matched controls. We used a well-known speed perception task where a robotic manipulandum passively rotates a child’s elbow and the child presses a trigger as soon as he felts the motion. Although dyslexics and controls equally well detected salient stimuli, dyslexics were strongly impaired at detecting weaker stimuli. Furthermore, we found that proprioceptive acuity positively correlated with reading abilities. These results cannot be explained by a lack of reading practice and thus strongly support sensory theories of Developmental Dyslexia.
Projecting hospital resource utilization during a surge using parametric bootstrapping
Authors: Chiang Jeffrey N. , An Ulzee , Kordi Misagh , Jew Brandon , Kravit Clifford , Dunne William J. , Perez Ronald , Parikh Neil R. , Weil Drew , Azar Richard F. , Cherry Robert , Grimley Karen A. , Skootsky Samuel A. , Saigal Christopher E. , Manuel Vladimir , Eskin Eleazar , Halperin Eran
Published: August 2020

During the initial wave of the COVID-19 pandemic in the United States, hospitals took drastic action to ensure sufficient capacity, including canceling or postponing elective procedures, expanding the number of available intensive care beds and ventilators, and creating regional overflow hospital capacity. However, in most locations the actual number of patients did not reach the projected surge leaving available, unused hospital capacity. As a result, patients may have delayed needed care and hospitals lost substantial revenue.

These initial recommendations were made based on observations and worst-case epidemiological projections, which generally assume a fixed proportion of COVID-19 patients will require hospitalization and advanced resources. This assumption has led to an overestimate of resource demand as clinical protocols improve and testing becomes more widely available throughout the course of the pandemic.

Here, we present a parametric bootstrap model for forecasting the resource demands of incoming patients in the near term, and apply it to the current pandemic. We validate our approach using observed cases at UCLA Health and simulate the effect of elective procedure cancellation against worst-case pandemic scenarios. Using our approach, we show that it is unnecessary to cancel elective procedures unless the actual capacity of COVID-19 patients approaches the hospital maximum capacity. Instead, we propose a strategy of balancing the resource demands of elective procedures against projected patients by revisiting the projections regularly to maintain operating efficiency. This strategy has been in place at UCLA Health since mid-April.
Visualizing and Assessing US County-Level COVID19 Vulnerability
Authors: Cahill Gina , Kutac Carleigh , Rider Nicholas L.
Published: August 2020

Objective

Like most of the world, the United States’ public health and economy are impacted by the COVID19 pandemic. However, discrete pandemic effects may not be fully realized on the macro-scale. With this perspective, our goal is to visualize spread of the pandemic and measure county-level features which may portend vulnerability.

Materials and Methods

We accessed the New York Times GitHub repository COVID19 data and 2018 US Census data for all US Counties. The disparate datasets were merged and filtered to allow for visualization and assessments about case fatality rate (CFR%) and associated demographic, ethnic and economic features.

Results

Our results suggest that county-level COVID19 fatality rates are related to advanced population age (p <0.001) and less diversity as evidenced by higher proportion of Caucasians in High CFR% counties (p < 0.001). Also, lower CFR% counties had a greater proportion of the population reporting has having 2 or more races (p <0.001). We noted no significant differences between High and Low CFR% counties with respect to mean income or poverty rate.

Conclusions

Unique COVID19 impacts are realized at the county level. Use of public datasets, data science skills and information visualization can yield helpful insights to drive understanding about community-level vulnerability.
Estrogen and COVID-19 symptoms: associations in women from the COVID Symptom Study
Authors: Costeira Ricardo , Lee Karla A. , Murray Benjamin , Christiansen Colette , Castillo-Fernandez Juan , Lochlainn Mary Ni , Pujol Joan Capdevila , Macfarlane Heather , Kenny Louise C. , Buchan Iain , Wolf Jonathon , Rymer Janice , Ourselin Sebastien , Steves Claire J. , Spector Timothy D. , Newson Louise R. , Bell Jordana T.
Published: August 2020

Background

Men and older women have been shown to be at higher risk of adverse COVID-19 outcomes. Animal model studies of SARS-CoV and MERS suggest that the age and sex difference in COVID-19 symptom severity may be due to a protective effect of the female sex hormone estrogen. Females have shown an ability to mount a stronger immune response to a variety of viral infections because of more robust humoral and cellular immune responses.

Objectives

We sought to determine whether COVID-19 positivity increases in women entering menopause. We also aimed to identify whether premenopausal women taking exogenous hormones in the form of the combined oral contraceptive pill (COCP) and post-menopausal women taking hormone replacement therapy (HRT) have lower predicted rates of COVID-19, using our published symptom-based model.

Design

The COVID Symptom Study developed by King’s College London and Zoe Global Limited was launched in the UK on 24thMarch 2020. It captured self-reported information related to COVID-19 symptoms. Data used for this study included records collected between 7thMay - 15thJune 2020.

Main outcome measures

We investigated links between COVID-19 rates and 1) menopausal status, 2) COCP use and 3) HRT use, using symptom-basedpredictedCOVID-19, tested COVID-19, and disease severity based on requirement for hospital attendance or respiratory support.

Participants

Female users of the COVID Symptom Tracker Application in the UK, including 152,637 women for menopause status, 295,689 for COCP use, and 151,193 for HRT use. Analyses were adjusted for age, smoking and BMI.

Results

Post-menopausal women aged 40-60 years had a higher rate ofpredictedCOVID (P=0.003) and a corresponding range of symptoms, with consistent, but not significant trends observed for tested COVID-19 and disease severity. Women aged 18-45 years taking COCP had a significantly lowerpredictedCOVID-19 (P=8.03E-05), with a reduction in hospital attendance (P=0.023). Post-menopausal women using HRT or hormonal therapies did not exhibit consistent associations, including increased rates ofpredictedCOVID-19 (P=2.22E-05) for HRT users alone.

Conclusions

Our findings support a protective effect of estrogen on COVID-19, based on positive association betweenpredictedCOVID-19 and menopausal status, and a negative association with COCP use. HRT use was positively associated with COVID-19 symptoms; however, the results should be considered with caution due to lack of data on HRT type, route of administration, duration of treatment, and potential comorbidities.

Trial registration

The App Ethics has been approved by KCL ethics Committee REMAS ID 18210, review reference LRs-19/20-18210
High SARS-CoV-2 seroprevalence in Health Care Workers but relatively low numbers of deaths in urban Malawi
Authors: Chibwana Marah G. , Jere Khuzwayo C. , Kamn’gona Raphael , Mandolo Jonathan , Katunga-Phiri Vincent , Tembo Dumizulu , Mitole Ndaona , Musasa Samantha , Sichone Simon , Lakudzala Agness , Sibale Lusako , Matambo Prisca , Kadwala Innocent , Byrne Rachel L. , Mbewe Alice , Morton Ben , Phiri Chimota , Mallewa Jane , Mwandumba Henry C , Adams Emily R. , Gordon Stephen B. , Jambo Kondwani C.
Published: August 2020

Background

In low-income countries, like Malawi, important public health measures including social distancing or a lockdown, have been challenging to implement owing to socioeconomic constraints, leading to predictions that the COVID-19 pandemic would progress rapidly. However, due to limited capacity to test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, there are no reliable estimates of the true burden of infection and death. We, therefore, conducted a SARS-CoV-2 serosurvey amongst health care workers (HCW) in Blantyre city to estimate the cumulative incidence of SARS-CoV-2 infection in urban Malawi.

Methods

Five hundred otherwise asymptomatic HCWs were recruited from Blantyre City (Malawi) from 22nd May 2020 to 19th June 2020 and serum samples were collected all participants. A commercial ELISA was used to measure SARS-CoV-2 IgG antibodies in serum. We run local negative samples (2018 - 2019) to verify the specificity of the assay. To estimate the seroprevalence of SARS CoV-2 antibodies, we adjusted the proportion of positive results based on local specificity of the assay.

Results

Eighty-four participants tested positive for SARS-CoV-2 antibodies. The HCW with a positive SARS-CoV-2 antibody result came from different parts of the city. The adjusted seroprevalence of SARS-CoV-2 antibodies was 12.3% [CI 9.0–15.7]. Using age-stratified infection fatality estimates reported from elsewhere, we found that at the observed adjusted seroprevalence, the number of predicted deaths was 8 times the number of reported deaths.

Conclusion

The high seroprevalence of SARS-CoV-2 antibodies among HCW and the discrepancy in the predicted versus reported deaths, suggests that there was early exposure but slow progression of COVID-19 epidemic in urban Malawi. This highlights the urgent need for development of locally parameterised mathematical models to more accurately predict the trajectory of the epidemic in sub-Saharan Africa for better evidence-based policy decisions and public health response planning.
High rate of major drug-drug interactions of lopinavir-ritonavir for COVID-19 treatment
Authors: Macías Juan , Pinilla Ana , Lao-Dominguez Francisco A. , Corma Anaïs , Contreras-Macias Enrique , González-Serna Alejandro , Gutierrez-Pizarraya Antonio , Fernández-Fuertes Marta , Morillo-Verdugo Ramón , Trigo Marta , Real Luis M. , Pineda Juan A.
Published: August 2020

The impact of drug-drug interactions (DDI) between ritonavir-boosted lopinavir (LPV-r) to treat patients with coronavirus disease 2019 (COVID-19) and commonly used drugs in clinical practice is not well-known. Thus, we evaluated the rate and severity of DDI between LPV-r for COVID-19 treatment and concomitant medications. This was a cross-sectional study including all individuals diagnosed of SARS-CoV-2 infection treated with LPV-r and attended at a single center in Southern Spain (March 1st to April 30th, 2020). The frequency [95% confidence interval (95% CI)] of potential and major DDI were calculated. Overall, 469 patients were diagnosed of COVID-19, 125 (27%) of them were prescribed LPV-r. LPV-r had potential DDI with concomitant medications in 97 (78%, 95% CI: 69%-85%) patients, and in 33 (26%, 95% CI: 19%-35%) individuals showed major DDI. Twelve (36%) patients with major DDI and 14 (15%) individuals without major DDI died (p=0.010). After adjustment, only the Charlson index was independently associated with death [adjusted OR (95% CI) for Charlson index ≥5: 85 (10-731), p <0.001]. LPV-r was discontinued due to side effects in 31 (25%) patients. Management by the Infectious Diseases Unit was associated with a lower likelihood of major DDI [adjusted odds ratio (95% CI): 0.14 (0.04-0.53), p=0.003). In conclusion, a high frequency of DDI between LPV-r for treating COVID-19 and concomitant medications was found, including major DDI. Patients with major DDI showed worse outcomes, but this association was explained by the older age and comorbidities. Patients managed by the Infectious Diseases Unit had lower risk of major DDI.
Quantification of the association between predisposing health conditions, demographic, and behavioural factors with hospitalisation, intensive care unit admission, and death from COVID-19: a systematic review and meta-analysis
Authors: Fernandez Villalobos Nathalie Verónica , Ott Jördis Jennifer , Klett-Tammen Carolina Judith , Bockey Annabelle , Vanella Patrizio , Krause Gérard , Lange Berit
Published: August 2020

Background

Comprehensive evidence synthesis on the associations between comorbidities and behavioural factors with hospitalisation, Intensive Care Unit (ICU) admission, and death due to COVID-19 is lacking leading to inconsistent national and international recommendations on who should be targeted for non-pharmaceutical interventions and vaccination strategies.

Methods

We performed a systematic review and meta-analysis on studies and publicly available data to quantify the association between predisposing health conditions, demographics, and behavioural factors with hospitalisation, ICU admission, and death from COVID-19. We provided ranges of reported and calculated effect estimates and pooled relative risks derived from a meta-analysis and meta-regression.

Results

75 studies were included into qualitative and 74 into quantitative synthesis, with study populations ranging from 19 - 44,672 COVID-19 cases. The risk of dying from COVID-19 was significantly associated with cerebrovascular [pooled RR 2.7 (95% CI 1.7-4.1)] and cardiovascular [RR 3.2 (CI 2.3-4.5)] diseases, hypertension [RR 2.6 (CI 2.0-3.4)], and renal disease [RR 2.5 (CI 1.8-3.4)]. Health care workers had lower risk for death and severe outcomes of disease (RR 0.1 (CI 0.1-0.3). Our meta-regression showed a decrease of the effect of some comorbidities on severity of disease with higher median age of study populations. Associations between comorbidities and hospitalisation and ICU admission were less strong than for death.

Conclusions

We obtained robust estimates on the magnitude of risk for COVID-19 hospitalisation, ICU admission, and death associated with comorbidities, demographic, and behavioural risk factors. We identified and confirmed population groups that are vulnerable and that require targeted prevention approaches.

Comorbidities such as cardiovascular disease or hypertension are less strongly associated with hospitalization and ICU admission than with death in COVID-19 patients. Increasing age is associated with a lower effect on comorbidities on disease severity.
Outpatient screening of health status and lifestyle among post-bariatric patients during the Covid-19 pandemic in Sao Paulo, Brazil.
Authors: Goessler Karla Fabiana , Nicoletti Carolina Ferreira , Rezende Diego Augusto Nunes , Sieczkowska Sofia Mendes , Esteves Gabriel Perri , Genario Rafael , de Oliveira Júnior Gersiel Nascimento , Meireles Kamila , Jéssica Pinto Ana , Nakahara-Melo Michele , Cleva Roberto de , Aurélio Santo Marco , Kirwan John , Roschel Hamilton , Gualano Bruno
Published: August 2020

Background/Objectives

This was an out-of-hospital screening of health status and lifestyle during the Covid-19 pandemic in post-operative bariatric patients from Sao Paulo, Brazil, prevented from face-to-face health care.

Subjects/Methods

In this cross-sectional study, 66 patients were remotely (via phone call) and in-person (by home visit) assessed for health status and lifestyle habits. Results: Mean age was 47.4 years. Patients were obese grade I (30.0%), II (22.0%), and III (30.0%), and 94.2% had above reference waist circumference values. Sixty-four percent displayed high blood pressure, whereas 24% showed CRP levels above normal range. Nineteen percent of patients reported irregular use of nutritional supplementation and 6.0% reported binge eating habits. Thirty-three exhibited symptoms of depression. Mild-to-moderate and moderate-to-severe anxiety symptoms were reported by 27.4% and 11.3% of the patients; 4.5% exhibited suicidal ideation and were referred to a specialist for healthcare. Of relevance, inactive patients (59.6%) had poorer global mental and physical health scores as compared to active peers (both p<0.05). Conclusion: This out-of-hospital screening revealed that the absence of face-to-face health care due to the Covid-19 pandemic is associated with suboptimal status of physical and mental health as well as lifestyle inadequacies among patients who have recently undergone bariatric surgery.

Key points

We performed an out-of-hospital screening in post-operative bariatric patients prevented from face-to-face health care during the Covid-19 pandemic.

Sixty-five percent displayed high blood pressure, whereas 24% showed C-reactive protein levels above normal range.

About one third showed mild to severe symptoms of depression, whereas ∼40% showed mild to severe anxiety symptoms.

Inactive patients (59.6%) had poorer global mental and physical health scores as compared to active peers.

Three patients exhibited suicidal ideation and were referred to a specialist for healthcare.

During the Covid-19 pandemic, there are a considerable number of post-bariatric patients in need of direct health care.
Improving COVID-19 critical care mortality over time in England: A national cohort study, March to June 2020
Authors: Dennis John M. , McGovern Andrew P. , Vollmer Sebastian J. , Mateen Bilal A.
Published: August 2020

Objectives

To determine the trend in mortality risk over time in people with severe COVID-19 requiring critical care (high intensive unit [HDU] or intensive care unit [ICU]) management.

Methods

We accessed national English data on all adult COVID-19 specific critical care admissions from the COVID-19 Hospitalisation in England Surveillance System (CHESS), up to the 29th June 2020 (n=14,958). The study period was 1st March until 30th May, meaning every patient had 30 days of potential follow-up available. The primary outcome was in-hospital 30-day all-cause mortality. Hazard ratios for mortality were estimated for those admitted each week using a Cox proportional hazards models, adjusting for age (non-linear restricted cubic spline), sex, ethnicity, comorbidities, and geographical region.

Results

30-day mortality peaked for people admitted to critical care in early April (peak 29.1% for HDU, 41.5% for ICU). There was subsequently a sustained decrease in mortality risk until the end of the study period. As a linear trend from the first week of April, adjusted mortality risk decreased by 11.2% (adjusted HR 0.89 [95% CI 0.87 - 0.91]) per week in HDU, and 9.0% (adjusted HR 0.91 [95% CI 0.88 - 0.94]) in ICU.

Conclusions

There has been a substantial mortality improvement in people admitted to critical care with COVID-19 in England, with markedly lower mortality in people admitted in mid-April and May compared to earlier in the pandemic. This trend remains after adjustment for patient demographics and comorbidities suggesting this improvement is not due to changing patient characteristics. Possible causes include the introduction of effective treatments as part of clinical trials and a falling critical care burden.
Five approaches to the suppression of SARS-CoV-2 without intensive social distancing
Authors: Drake John M. , Rohani Pej , Dahlin Kyle , Handel Andreas
Published: August 2020

Initial efforts to mitigate transmission of SARS-CoV-2 relied on intensive social distancing measures such as school and workplace closures, shelter-in-place orders, and prohibitions on the gathering of people. Other non-pharmaceutical interventions for suppressing transmission include active case finding, contact tracing, quarantine, immunity or health certification, and a wide range of personal protective measures. Here we investigate the potential effectiveness of these alternative approaches to suppression. We introduce a conceptual framework represented by two mathematical models that differ in strategy. We find both strategies may be effective, although both require extensive testing and work within a relatively narrow range of conditions. Generalized protective measures such as wearing face masks, improved hygiene, and local reductions in density are found to significantly increase the effectiveness of targeted interventions.
Sustained Cellular Immune Dysregulation in Individuals Recovering from SARS-CoV-2 Infection
Authors: Files Jacob K. , Boppana Sushma , Perez Mildred D. , Sarkar Sanghita , Lowman Kelsey E. , Qin Kai , Sterrett Sarah , Carlin Eric , Bansal Anju , Sabbaj Steffanie , Long Dustin M. , Kutsch Olaf , Kobie James , Goepfert Paul A. , Erdmann Nathan
Published: August 2020

SARS-CoV-2 causes a wide spectrum of clinical manifestations and significant mortality. Studies investigating underlying immune characteristics are needed to understand disease pathogenesis and inform vaccine design. In this study, we examined immune cell subsets in hospitalized and non-hospitalized individuals. In hospitalized patients, many adaptive and innate immune cells were decreased in frequency compared to healthy and convalescent individuals, with the exception of B lymphocytes which increased. Our findings show increased frequencies of T-cell activation markers (CD69, Ox40, HLA-DR and CD154) in hospitalized patients, with other T-cell activation/exhaustion markers (CD25, PD-L1 and TIGIT) remaining elevated in hospitalized and non-hospitalized individuals. B cells had a similar pattern of activation/exhaustion, with increased frequency of CD69 and CD95 during hospitalization, followed by an increase in PD1 frequencies in non-hospitalized individuals. Interestingly, many of these changes were found to increase over time in non-hospitalized longitudinal samples, suggesting a prolonged period of immune dysregulation following SARS-CoV-2 infection. Changes in T-cell activation/exhaustion in non-hospitalized patients were found to positively correlate with age. Severely infected individuals had increased expression of activation and exhaustion markers. These data suggest a prolonged period of immune dysregulation following SARS-CoV-2 infection highlighting the need for additional studies investigating immune dysregulation in convalescent individuals.
Data-driven method to infer the seizure propagation patterns in an epileptic brain from intracranial electroencephalography
Authors: Sip Viktor , Hashemi Meysam , Vattikonda Anirudh N. , Woodman Marmaduke M. , Wang Huifang , Scholly Julia , Villalon Samuel Medina , Guye Maxime , Bartolomei Fabrice , Jirsa Viktor K.
Published: August 2020

Surgical interventions in epileptic patients aimed at the removal of the epileptogenic zone have success rates at only 60-70%. This failure can be partly attributed to the insufficient spatial sampling by the implanted intracranial electrodes during the clinical evaluation, leading to an incomplete picture of spatio-temporal seizure organization in the regions that are not directly observed. Utilizing the partial observations of the seizure spreading through the brain network, complemented by the assumption that the epileptic seizures spread along the structural connections, we infer if and when are the unobserved regions recruited in the seizure. To this end we introduce a data-driven model of seizure recruitment and propagation across a weighted network, which we invert using the Bayesian inference framework. Using a leave-one-out cross-validation scheme on a cohort of fifty patients we demonstrate that the method can improve the predictions of the states of the unobserved regions compared to an empirical estimate. Furthermore, a comparison with the performed surgical resection and the surgery outcome indicates a link between the inferred excitable regions and the actual epileptogenic zone. The results emphasize the importance of the structural connectome in the large-scale spatio-temporal organization of epileptic seizures and introduce a novel way to integrate the patient-specific connectome and intracranial seizure recordings in a whole-brain computational model of seizure spread.
Mathematical modeling of the transmission of SARS-CoV-2 – Evaluating the impact of isolation in São Paulo State (Brazil) and lockdown in Spain associated with protective measures on the epidemic of covid-19
Authors: Yang Hyun Mo , Lombardi Junior Luis Pedro , Morato Castro Fabio Fernandes , Yang Ariana Campos
Published: August 2020

Coronavirus disease 2019 (covid-19), with the fatality rate in elder (60 years old or more) being much higher than young (60 years old or less) patients, was declared a pandemic by the World Health Organization on March 11, 2020. Taking into account this age-dependent fatality rate, a mathematical model considering young and elder subpopulations was formulated based on the natural history of covid-19 to study the transmission of the SARS-CoV-2. This model can be applied to study the epidemiological scenario resulting from the adoption of isolation or lockdown in many countries to control the rapid propagation of covid-19. We chose as examples the isolation adopted in São Paulo State (Brazil) in the early phase but not at the beginning of the epidemic, and the lockdown implemented in Spain when the number of severe covid-19 cases was increasing rapidly. Based on the data collected from São Paulo State and Spain, the model parameters were evaluated and we obtained higher estimation for the basic reproduction number R0 (9.24 for São Paulo State, and 8 for Spain) compared to the currently accepted estimation of R0 around 3. The model allowed to explain the flattening of the epidemic curves by isolation in São Paulo State and lockdown in Spain when associated with the protective measures (face mask and social distancing) adopted by the population. However, a simplified mathematical model providing lower estimation for R0 did not explain the flattening of the epidemic curves. The implementation of the isolation in São Paulo State before the rapidly increasing phase of the epidemic enlarged the period of the first wave of the epidemic and delayed its peak, which are the desirable results of isolation to avoid the overloading in the health care system.
The association between plasma metabolites and sleep quality in the Southall and Brent Revisited Study (SABRE): A cross-sectional analysis
Authors: Topriceanu Constantin-Cristian , Tillin Therese , Chaturvedi Nishi , Joshi Roshni , Garfield Victoria
Published: August 2020

Background

Disordered metabolic processes have been associated with abnormal sleep patterns. However, the biological triggers and pathways are yet to be elucidated.

Methods

Participants were from the Southall and Brent REvisited (SABRE) cohort. Nuclear Magnetic Resonance spectroscopy provided 146 circulating plasma metabolites. Sleep questionnaires identified the presence or absence of: difficulty falling asleep (DFA), early morning waking (EMW), waking up tired (WUT) and snoring. Metabolites were compared between the sleep quality categories using the t-test, then filtered using a false discovery rate of 0.05. Generalized linear models with logit-link assessed the associations between filtered metabolites and sleep phenotypes. Adjustment was made for important demographic and health-related covariates.

Results

2718 SABRE participants were included. After correcting for multiple testing, 3 metabolites remained for DFA, 59 for snoring and none for EMW and WUT. In fully-adjusted models, 1 standard deviation increase in serum histidine, leucine and valine associated with lower odds of DFA by 0.84-0.89 (95% confidence intervals [CIs]: 0.75-0.99). Branched chain amino acids (ORs 1.11-1.15, 95%CIs 1.01-1.26) were positively associated with snoring. Docosahexaenoic acid (DHA) (OR 0.89, 95% CI 0.82-0.96) and total cholesterol in low-density lipoprotein (LDL) (OR 0.89, 95% CI 0.82-0.96) and high-density lipoprotein (HDL) (ORs 0.90, 95% CIs 0.83-0.99) associated with lower odds of snoring.

Conclusion

Histidine, leucine and valine associated with lower odds of difficulty falling asleep, while docosahexaenoic acid and cholesterol LDL and HDL subfractions associated with lower odds of snoring. Identified metabolites could provide guidance on the metabolic pathways behind the adverse sleep quality.

Key messages

Higher histidine, leucine and valine associate with lower odds of difficulty falling asleep.

Branched amino acids (isoleucine, leucine and valine) were higher in participants experiencing snoring.

Total cholesterol in LDL and HDL appeared to be beneficial in terms of snoring.
Temporal and Spatial Heterogeneity of Host Response to SARS-CoV-2 Pulmonary Infection
Authors: Desai Niyati , Neyaz Azfar , Szabolcs Annamaria , Shih Angela R. , Chen Jonathan H. , Thapar Vishal , Nieman Linda T. , Solovyov Alexander , Mehta Arnav , Lieb David J. , Kulkarni Anupriya S. , Jaicks Christopher , Pinto Christopher J. , Juric Dejan , Chebib Ivan , Colvin Robert B. , Kim Arthur Y. , Monroe Robert , Warren Sarah E , Danaher Patrick , Reeves Jason W , Gong Jingjing , Rueckert Erroll H , Greenbaum Benjamin D. , Hacohen Nir , Lagana Stephen M. , Rivera Miguel N. , Sholl Lynette M. , Stone James R. , Ting David T. , Deshpande Vikram
Published: August 2020

The relationship of SARS-CoV-2 lung infection and severity of pulmonary disease is not fully understood. We analyzed autopsy specimens from 24 patients who succumbed to SARS-CoV-2 infection using a combination of different RNA and protein analytical platforms to characterize inter- and intra-patient heterogeneity of pulmonary virus infection. There was a spectrum of high and low virus cases that was associated with duration of disease and activation of interferon pathway genes. Using a digital spatial profiling platform, the virus corresponded to distinct spatial expression of interferon response genes and immune checkpoint genes demonstrating the intra-pulmonary heterogeneity of SARS-CoV-2 infection.
A Compartmental Epidemic Model Incorporating Probable Cases to Model COVID-19 Outbreak in Regions with Limited Testing Capacity
Authors: Hasan A. , Nasution Y.
Published: August 2020

We propose a new compartmental epidemic model taking into account people who has symptoms with no confirmatory laboratory testing (probable cases). We prove well-posedness of the model and provide an explicit expression for the basic reproduction number (ℛ0). We use the model together with an extended Kalman filter (EKF) to estimate the time-varying effective reproduction number (ℛt) of COVID-19 in West Java province, Indonesia, where laboratory testing capacity is limited. Based on our estimation, the value of ℛt is higher when the probable cases are taken into account. This correction can be used by decision and policy makers when considering re-opening policy and evaluation of measures.