bluuebunny/crossref_metadata_2025 huggingface dataset:
Fully Endoscope-Controlled Clipping Ruptured Intrameatal Anterior Inferior Cerebellar Artery Aneurysm: Report of 2 Cases
Authors: Gao Wenbo , Liu Pengfei , Deng Guozhi , Li Zefu
Published: March 2021

Aneurysms of the anterior inferior cerebellar artery (AICA) are a rare entity. Purely intrameatal aneurysms are even rarer. The author reported 2 ruptured intrameatal aneurysms that were treated by fully endoscope-controlled clipping. Retrosigmoid craniotomy was performed and the aneurysm was clipped definitely intraoperative without postoperative deficits except hearing loss and slight facial nerve paresis. Follow-up angiography demonstrated exclusion of the aneurysm, confirming preservation of the distal aneurysms of the anterior inferior cerebellar artery. Endoscopic enhancement of the visual field provided by the endoscope may be a safe and effective application to increase the quality of treatment for intrameatal aneurysm, especially for deep aneurysm.
The Effect of Bimaxillary Orthognathic Surgery on Voice Characteristics in Skeletal Class 3 Deformity Patients: An Evaluation Using Acoustic Analysis
Authors: Emrani Erfan , Ghaemi Hamide , Labafchi Ali , Samieirad Sahand
Published: March 2021

The aim of this study was to analyze the effects of bimaxillary orthognathic surgery on the acoustic voice characteristics of skeletal class 3 patients. All healthy nonsyndromic patients with Class 3 deformity who were eligible for bimaxillary orthognathic surgery, were included in this before and after quasi-experimental study. This experiment's main intervention was mandibular setback surgery by bilateral sagittal split osteotomy plus maxillary advancement using LeFort 1 osteotomy. Age, sex, and intraoperative jaw movements were recorded. Acoustic analysis of voice samples (vowels /a/ and /i/) was performed with Praat software as outcome variables. The formant frequencies (F0, F1, F2, and F3) of these vowels were extracted 1 week preoperatively (T0), 1 and 6 months (T1, T2) postoperatively by a speech therapist. The significance level was set at 0.05 using SPSS 19. The study sample comprised 20 patients including 11 women (55%) and 9 men (45%) with a mean age of 31.95 ± 4.72 years. The average mandibular setback and maxillary advancement were 3.30 ± 0.86 and 2.85 ± 0.74 mm, respectively. The fundamental frequency (F0) and the first, second, and third formants (F1, F2, F3) of vowels /i/ and /a/ were significantly decreased over time intervals, postoperatively (P < 0.05). The finding revealed that bimaxillary orthognathic surgery (maxillary advancement and mandibular setback with bilateral sagittal split osteotomy) might reduce the acoustic formant parameters of voice to the normal frequency ranges, in patients with class 3 skeletal deformities. More clinical trials with greater sample sizes and long-term follow-ups are suggested in the future.
Ocular Related Sports Injuries
Authors: Ohana Oded , Alabiad Chris
Published: March 2021

Ocular injuries occur frequently in sports, affecting the globe, surrounding soft tissues, and the orbital bony structure. This review provides the craniofacial surgeon a broad general overview of epidemiology, mechanism of disease, and prevention.
Kick Start to an Epidemiological Report of Soccer-Related Craniofacial Trauma Analysis
Authors: Nahas John V. , Choi Melinda J. , Wolfe Erin M. , Pierrot Randall G. , Slavin Benjamin R. , Plotsker Ethan L. , Mathew Prakash J. , Thaller Seth R.
Published: March 2021

Introduction:

Soccer is a global sport played by millions annually with an increasing popularity in the United States. Game is played by a wide range of participants from all ages and levels of competition. This scenario leads to a potential disparity in the injury profile based on quantifiable demographics. As the game continues to grow, injury detection and side-line assessment must change as well.

Methods:

Utilizing a national injury database, a retrospective cohort study was conducted using 10 years of data collected from randomly selected emergency departments across the United States. Patient demographics, injury sites, and diagnosis were recorded. Diagnoses examined included concussion, contusion or abrasion, dental injury, fracture, hematoma, hemorrhage, internal injury, and laceration.

Results:

Highest percentage of craniofacial injuries was observed in soccer players between the ages of 12 and 18. In ages 6 to 11 the most common injuries were contusions and dental injuries, with a significantly low number of fractures. Within the age group of 12 to 18 the highest percentage of injuries was concussions. Finally, the highest percentage of injury in the ages of 19 to 34 were fractures and lacerations.

Discussion:

There is a shift in injury profile as the age of soccer players increases and the level of play becomes faster-paced. In youth players, there is a higher percentage of soft tissue injury. Older players are more likely to suffer a higher degree of injury including fractures, concussions, and lacerations. This suggests a great utility for a layperson-friendly educational intervention initiative applicable to all demographics for the sport of soccer.
Complement Blockade in Recipients Prevents Delayed Graft Function and Delays Antibody-mediated Rejection in a Nonhuman Primate Model of Kidney Transplantation
Authors: Eerhart Michael J. , Reyes Jose A. , Blanton Casi L. , Danobeitia Juan S. , Chlebeck Peter J. , Zitur Laura J. , Springer Megan , Polyak Erzsebet , Coonen Jennifer , Capuano Saverio , D’Alessandro Anthony M. , Torrealba Jose , van Amersfoort Edwin , Ponstein Yolanda , van Kooten Cees , Burlingham William , Sullivan Jeremy , Pozniak Myron , Zhong Weixiong , Yankol Yucel , Fernandez Luis A.
Published: March 2021

Background.

Complement activation in kidney transplantation is implicated in the pathogenesis of delayed graft function (DGF). This study evaluated the therapeutic efficacy of high-dose recombinant human C1 esterase inhibitor (rhC1INH) to prevent DGF in a nonhuman primate model of kidney transplantation after brain death and prolonged cold ischemia.

Methods.

Brain death donors underwent 20 h of conventional management. Procured kidneys were stored on ice for 44–48 h, then transplanted into ABO-compatible major histocompatibility complex-mismatched recipients. Recipients were treated with vehicle (n = 5) or rhC1INH 500 U/kg plus heparin 40 U/kg (n = 8) before reperfusion, 12 h, and 24 h posttransplant. Recipients were followed up for 120 d.

Results.

Of vehicle-treated recipients, 80% (4 of 5) developed DGF versus 12.5% (1 of 8) rhC1INH-treated recipients (P = 0.015). rhC1INH-treated recipients had faster creatinine recovery, superior urinary output, and reduced urinary neutrophil gelatinase-associated lipocalin and tissue inhibitor of metalloproteinases 2-insulin-like growth factor-binding protein 7 throughout the first week, indicating reduced allograft injury. Treated recipients presented lower postreperfusion plasma interleukin (IL)-6, IL-8, tumor necrosis factor-alpha, and IL-18, lower day 4 monocyte chemoattractant protein 1, and trended toward lower C5. Treated recipients exhibited less C3b/C5b-9 deposition on day 7 biopsies. rhC1INH-treated animals also trended toward prolonged mediated rejection-free survival.

Conclusions.

Our results recommend high-dose C1INH complement blockade in transplant recipients as an effective strategy to reduce kidney injury and inflammation, prevent DGF, delay antibody-mediated rejection development, and improve transplant outcomes.
Kidney Allograft and Recipient Survival After Heart Transplantation by Induction Type in the United States
Authors: Riad Samy , Alexy Tamas , Jackson Scott , Goswami Umesh , Martin Cindy
Published: March 2021

Background.

Induction choices for kidney-after-heart transplant recipients are variable. We examined the impact of kidney induction types on kidney graft and patient survival in heart transplant recipients.

Methods.

We analyzed the Scientific Registry of Transplant Recipient database from inception through the end of 2018 to study kidney and patient outcomes in the United States after heart transplantation. We only included recipients who were discharged on tacrolimus and mycophenolate maintenance. We grouped recipients by induction type into 3 groups: depletional (N = 307), nondepletional (n = 253), and no-induction (steroid only) (n = 57). We studied patients and kidney survival using Cox PH regression, with transplant centers included as a random effect. We adjusted the models for heart induction, recipient and donor age, gender, time between heart and kidney transplant, heart transplant indication, HLA mismatches, payor, live-donor kidney, transplant year, dialysis status, and diabetes mellitus at the time of kidney transplant.

Results.

The 1-y kidney rejection rates and creatinine levels were similar in all groups. The 1-y rehospitalization rate was higher in the depletional group (51.7%) and nondepletional group (50.7%) than in the no-induction group (39.1%) although this was not statistically significant. There were no differences in recipient or kidney survival by kidney induction type. Live-donor kidney was associated with improved patient (hazard ratio, 0.74; 95% confidence interval, 0.54-1.0; P = 0.05) and kidney survival (hazard ratio, 0.45; 95% confidence interval, 0.24-0.84; P = 0.012].

Conclusions.

Type of kidney induction did not influence patient or kidney graft survival in heart transplant recipients. No-induction may be the preferred choice due to the lack of clinical benefits associated with induction use.
Successful use of the sodium-glucose co-transporter-2 inhibitor dapagliflozin in patients with renal transplant and diabetes: a case series and literature review
Authors: Gul Wajiha , Naem Emad , Elawad Safa , Elhadd Tarik
Published: March 2021

Background

Management of patients with diabetes and renal transplant could be challenging. Transplant patients use multiple immune suppressants that can worsen or even trigger hyperglycemia. There are no data about the use of the new class of sodium-glucose co-transporter-2 (SGLT-2) inhibitor dapagliflozin in patients with renal transplant and diabetes.

Case series

Four patients, with diabetes, who are attending the diabetes clinic at our institution, are presented here. They were all counseled to be started on dapagliflozin 10 mg to improve diabetes control as they were on multiple agents and not achieving targets. All four patients showed significant improvement in hemoglobin A1c, with no adverse effects on renal parameters and had favorable effect on weight and blood pressure (BP).

Conclusion

Use of the SGLT-2 inhibitor dapagliflozin in the standard dose of 10 mg helped to achieve satisfactory control with favorable effects on BP and weight with no adverse effects on renal function.
Atypical hemolytic uremic syndrome: when pregnancy leads to lifelong dialysis: a case report and literature review
Authors: Cadet Bair , Meshoyrer Daniel , Kim Zae
Published: March 2021

Atypical hemolytic uremic syndrome (aHUS), a challenging disorder, commonly caused by inherited defects or regulatory processes of the complement alternative pathway. There are multiple causes, including pregnancy. Pregnancy provokes life-threatening episodes, preeclampsia, hemolysis elevated liver enzymes low platelets, microangiopathic hemolytic anemia (MAHA) and end-stage renal disease. Additionally, complement dysregulation and, with aHUS, affects fetal and maternal outcomes. Pregnancy-associated aHUS results in a poor prognosis with irreversible renal damage. Likewise, it is imperative to know that MAHA can provoke endothelial disruption, destruction of red cells and thrombocytopenia. We present a case of a young 18-year-old woman with MAHA and aHUS, requiring emergent cesarean section at 34 weeks of gestation and hemodialysis, secondary to complications from a recent pregnancy. Elevated blood pressure readings, rising creatinine levels, as well as her mother being on dialysis after pregnancy raised suspicion for thrombotic microangiopathy and aHUS. She was subsequently managed with plasma exchange, steroids, eculizumab and hemodialysis. Thus, plasma exchange should be initiated, with pending additional workup. Upon a definitive diagnosis of aHUS, eculizumab would be warranted to mitigate immune dysregulation. Understanding thrombotic microangiopathies diagnosis, and recognizing concomitant consequences, is vital. Having better insights into endothelial injuries can prevent unfortunate outcomes.
COVID-19 IN IRAQ, THE RURAL INITIATION (AL-MUTHANNA PROVINCE AS AN EXAMPLE)
Authors: Thwiny Hazim Talib , Jaber Safa Ibrahim , Ateya Hekmat Kadhum , Al-Yasari Ali Mosa Rashid , Alsalih Nawar Jasim , AL- Saadawe Moyed A. , Jasim Emad Salih , Alsaadawi Mohenned A.
Published: March 2021

A sustained pneumonia outbreak associated with a novel coronavirus named acute respiratory coronavirus 2 syndrome (SARS-CoV-2) was identified in Wuhan, Hubei Province, China in December 2019 which was later called COVID-19. The first confirmed case of COVID-19 was reported in Najaf/ Iraq on 24th February. This paper provided some information on COVID-19 infection in the Province of Al-Muthanna / South Iraq, which was then statistically analyzed and concluded. Confirmed cases of COVID-19 infections were reported by the Iraqi Ministry of Health in the Province of Al-Muthanna. The first foci started and the first dead infected individual was from Hilal which refers mainly to the role or rural places in starting and transmission of COVID-19 in Iraq. Many of the infections resulted in non-traveling persons because they were contaminated by contact (96%). Therefore, contact is perceived to be the best-recognized form of transmission. It was also reported that infections in Soweir District of Samawah City were the highest (45%) compared to other areas of the region. They should also be observed, however, that the steps to enforce and monitor the curfew are directly related to the direction of the City Centre, because the more they drive away from the city centers, the less stringent the procedures. Infections were focused between the ages of 20 and 50 years old, as that is the expected result, because these ranges are at the core of active age groups including social and sports events.

Graphical abstract
Targeted Hybridization Capture of SARS-CoV-2 and Metagenomics Enables Genetic Variant Discovery and Nasal Microbiome Insights
Authors: Nagy-Szakal Dorottya , Couto-Rodriguez Mara , Wells Heather L. , Barrows Joseph , Debieu Marilyne , Butcher Kristin , Chen Siyuan , Berki Agnes , Hager Courteny , Boorstein Robert J. , Taylor Mariah K. , Jonsson Colleen B. , Mason Christopher E. , O’Hara Niamh B.
Published: March 2021

The emergence of novel SARS-CoV-2 genetic variants that may alter viral fitness highlights the urgency of widespread next-generation sequencing (NGS) surveillance. To profile genetic variants, we developed and clinically validated a hybridization capture SARS-CoV-2 NGS assay, integrating novel methods for panel design using dsDNA biotin-labeled probes, and built accompanying software. The positive and negative percent agreement were defined in comparison to an orthogonal RT-PCR assay (PPA and NPA: both 96.7%). The limit of detection was established to be 800 copies/ml with an average fold-enrichment of 46,791x. We identified novel 107 mutations, including 24 in the functionally-important spike protein. Further, we profiled the full nasopharyngeal microbiome using metagenomics and found overrepresentation of 7 taxa and macrolide resistance in SARS-CoV-2-positive patients. This hybrid capture NGS assay, coupled with optimized software, is a powerful approach to detect and comprehensively map SARS-CoV-2 genetic variants for tracking viral evolution and guiding vaccine updates.

TEASER

This is the first target hybridization capture-based NGS assay to detect SARS-CoV-2 genetic variants for tracking viral evolution.
Modelling addition and replacement mechanisms of plasmid-based beta-lactam resistant E. coli infections
Authors: Godijk Noortje G. , Bootsma Martin C.J. , van Werkhoven Henri C. , Schweitzer Valentijn A. , de Greeff Sabine C. , Schoffelen Annelot F. , Bonten Marc J.M.
Published: March 2021

It is unknown whether antibiotic-resistant bacterial infections occur in addition to antibiotic-susceptible bacterial infections, thereby increasing the infection incidence, or whether they replace such infections, leaving total incidence unaffected. Observational longitudinal studies cannot separate both mechanisms. Using plasmid-based beta-lactam resistant E. coli as example, we applied a mathematical neutral null model to investigate whether biological mechanisms implying either a fitness cost or a benefit due to resistance lead to replacement or addition. Fitness costs cause resistant strains to die out if other strain characteristics are maintained equal. Under the assumptions tested, only increased virulence increases the total number of infections, while other of resistance lead to replacement without changing the total number of infections. As there is no biological evidence that plasmid-based beta-lactam resistance increases virulence, these findings suggest that the burden of disease is determined by attributable effects of resistance rather than by an increase in infections.
Investigation of the ventilation situation in a lecture room of building 033 at the Universität der Bundeswehr München
Authors: Kähler Christian J. , Fuchs Thomas , Hain Rainer
Published: March 2021

The SARS-CoV-2 pandemic is limiting both the private and public lives of many people around the world. It is now considered certain that SARS-CoV-2 is transmitted via droplets, smear infection, and aerosol particles. While simple masks, spacing, and hand hygiene significantly reduce the risk of infection via the first two routes mentioned, the risk from aerosol particles remains. These small particles move with the air in the room and spread unhindered throughout it. To reduce the risk of infection from viruses present in aerosol particles, the following options exist. First, good respiratory masks can be worn to reduce the viral load in the inhaled air. Another option is to make the viruses harmless (e.g., by UV light). A third option is to reduce the viral load in the room by bringing in virus-free air and moving contaminated air out or cleaning the air in the room. To investigate how well virus load reduction via ventilation works in a real lecture room, measurements were carried out at the Universität der Bundeswehr München (University of the Federal Armed Forces Munich). The lecture room holds a maximum of approx. 90 people and has a ventilation system as well as 2 windows that can be opened. In the absence of a ventilation system in a comparable room, the effectiveness of a room air cleaner was also investigated.
Impact of the COVID-19 pandemic on surgical procedures in Brazil: a descriptive study
Authors: Luizeti Bárbara Okabaiasse , Perli Victor Augusto Santos , da Costa Gabriel Gonçalves , Eckert Igor da Conceição , Roma Aluisio Marino , da Costa Karina Miura
Published: March 2021

Background

The COVID-19 pandemic has deeply affected medical practice, and changes in healthcare activities were needed to minimize the overload and avoid healthcare systems collapse. The aim of this study was to evaluate the impact of the pandemic on surgical procedures in Brazil.

Materials and Methods

We conducted a descriptive study of the number of hospitalizations for surgical procedures in Brazil from 2016 to 2020. Data were collected from the Brazilian Department of Informatics of the Unified Health System (DATASUS). Analyzes were performed according to the type of procedure, geographical region, subgroups of surgical procedures, and the number of surgeries from 2020 were compared with the average from 2016 to 2019.

Results

There were 4,009,116 hospitalizations for surgical procedures in the Brazilian Public Health System in 2020. When comparing it to the average of hospitalizations from 2016-2019, there was a decrease of 14.88% [95%IC (14.82-14.93)]. Decrease rates were 34.82% [95%IC (34.73-34.90)] for elective procedures and 1.11% [95%IC (1.07-1.13)] for urgent procedures. Decrease rates were similar in all the five regions of the country (average 14.17%). Surgical procedure subgroups with the highest decrease rates were endocrine gland surgery (48.03%), breast surgery (40.68%), oral and maxillofacial surgery (37.03%), surgery of the upper airways, face, head and neck (36.06%), and minor surgeries and surgeries of skin, subcutaneous tissue and mucosa (33.16%). Conclusion: The overload of healthcare facilities has demanded a reduction of non-urgent activities to prevent a collapse of healthcare systems, resulting in a decrease in elective surgeries. Recommendations about the performance of surgical procedures were made, and continuous refinements of these recommendations are encouraged.
PREDICTIVE IMMUNOLOGICAL, VIROLOGICAL, AND ROUTINE LABORATORY MARKERS FOR CRITICAL COVID-19 ON ADMISSION
Authors:   Immunocovid study, García-Gasalla Mercedes , Ferrer Juana M , Fraile-Ribot Pablo A , Ferre-Beltrán Adrián , Rodríguez Adrián , Martínez-Pomar Natalia , Ramon-Clar Luisa , Iglesias Amanda , Losada-López Inés , Fanjul Francisco , Pou Joan Albert , Llompart-Alabern Isabel , Toledo Nuria , Pons Jaime , Oliver Antonio , Riera Melchor , Murillas Javier
Published: March 2021

Introduction

Early identification of COVID-19 patients at risk of critical illness is challenging for clinicians. Immunological, virological, and routine laboratory markers to be used in addition to clinical data are needed.

Aim and methods

Blood tests to measure neutrophil/lymphocyte ratio (NLR), levels of ferritin, CRP, D-dimer, complement components (C3, C4), lymphocyte subsets, and cytokines, and SARS-Cov2 RT-PCR tests were performed in COVID-19 confirmed cases within 48 hours of admission. Cycle threshold (Ct) values were determined by RT-PCR from oral or nasopharyngeal swabs on the day of admission. Severity of symptoms was categorized as mild (grade 1), severe (grade 2), and critical (grade 3).

Results

120 patients were included. COVID-19 was mild in 49, severe in 32, and critical in 39. Ferritin >370 ng/mL (OR 16.4, 95% CI 5.3-50.8), D-dimer >440 ng/mL (OR 5.45, 95% CI 2.36-12.61), CRP >7.65 mg/dL (OR 11.54, 95% CI 4.3-30.8), NLR >3.77 (OR 13.4, 95% CI 4.3-41.1), IL-6 >142.5 pg/mL (OR 8.76, 95% CI 3.56-21.54), IL-10 >10.8 pg/mL (OR 16.45, 95% CI 5.32-50.81), sIL-2rα (sCD25) >804.5 pg/mL (OR 14.06, 95% CI 4.56-43.28), IL-1Ra >88.4 pg/mL (OR 4.54, 95% CI 2.03-10.17), and IL-18 >144 pg/mL (OR 17.85, 95% CI 6.54-48.78) were associated with critical COVID-19 in the univariate age-adjusted analysis. In the multivariate age-adjusted analysis, this association was confirmed only for ferritin, CRP,NLR, IL-10, sIL-2rα, and IL-18. T, B, and NK cells were significantly decreased in critical patients. SARS-CoV-2 was undetected in blood except in 3 patients with indeterminate results. Ct values determined by RT-PCR from oral/nasopharyngeal swabs on admission were not related to symptom severity.

Conclusion

levels of ferritin, D-dimer, CRP, NLR, and cytokines and cytokine receptors IL-6, IL1-Ra, sCD25, IL-18, and IL-10, taken together with clinical data, can contribute to the early identification of critical COVID-19 patients.
Conceptualizing centers of excellence: A global evidence
Authors: Manyazewal Tsegahun , Woldeamanuel Yimtubezinash , Oppenheim Claire , Hailu Asrat , Giday Mirutse , Medhin Girmay , Belete Anteneh , Yimer Getnet , Collins Asha , Makonnen Eyasu , Fekadu Abebaw
Published: March 2021

Objective

Globally, interest in excellence has grown exponentially, with public and private institutions shifting their attention from meet targets to achieving excellence. Centers of Excellence (CoEs) are standing at the forefront of healthcare, research, and innovations responding to the world’s most complex problems. However, their potential is hindered by conceptual ambiguity. We conducted a global synthesis of the evidence to conceptualize CoEs.

Design

Scoping review, following Arksey and O’Malley’s framework and methodological enhancement by Levacet alto analyze the evidence and the PRISMA-ScR to guide the retrieval and inclusion of the evidence.

Data sources

PubMed, Scopus, CINAHL, Google Scholar, and the Google engine from their inception to 01 January 2021.

Eligibility

Papers that describe CoE as the main theme, which could be defining, theorizing, implementing, or evaluating a CoE.

Results

The search resulted in 52,161 potential publications, with 78 articles met the eligibility criteria. The 78 articles were from 33 countries, of which 35 were from the United States of America, 3 each from Nigeria, South Africa, Spain, and India, and 2 each from Ethiopia, Canada, Russia, Colombia, Sweden, Greece, and Peru. The rest 17 were from various countries. The articles involved six thematic areas - healthcare, education, research, industry, information technology, and general concepts on CoE. The analysis documented success stories of using the brand “Center of Excellence” - an influential brand to stimulate technical skills, innovation, and technology. We identified 12 essential foundations of CoE - specialized expertise; infrastructure; innovation; high-impact research; quality service; accreditation or standards; leadership; organizational structure; strategy; collaboration and partnership; sustainable funding or financial mechanisms; and entrepreneurship.

Conclusions

CoEs have significant scientific, political, economic, and social impacts. A comprehensive framework is needed to guide and inspire an institution as a CoE and to help government and funding institutions shape and oversee CoEs.

Strengths and limitations of this study

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To the best of our knowledge, this is the first scoping review to conceptualize centers of excellence based on global evidence.

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The study followed Arksey and O’Malley’s framework and methodological enhancement by Levac et al to and the PRISMA-ScR methodological frameworks.

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Five databases were systematically searched to identify scientific and gray literature

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The study was limited by language restrictions.
SARS-CoV-2 show no infectivity at later stages in a prolonged COVID-19 patient despite positivity in RNA testing
Authors: Wan Xiu-Feng , Tang Cynthia Y. , Ritter Detlef , Wang Yang , Li Tao , Segovia Karen , Kosikova Martina , Johnson Marc , Kwon Hyung Joon , Xie Hang , Hammer Richard D. , McElroy Jane A. , Hamid Aws , Collins Natalie D , Hang Jun , Camp Simone
Published: March 2021

Inpatient COVID-19 cases present enormous costs to patients and health systems. Many hospitalized patients may still test COVID-19 positive, even after resolution of symptoms. Thus, a pressing concern for clinicians is the safety of discharging these asymptomatic patients if they have any remaining infectivity. This case report explores the viral viability in a patient with persistent COVID-19 over the course of a two-month hospitalization. Positive nasopharyngeal swab samples, analyzed by quantitative reverse transcription polymerase chain reactions (qRT-PCR), were collected and isolated in the laboratory, and infectious doses were analyzed throughout the hospitalization period. The patient experienced waning symptoms by hospital day 40 and had no viable virus growth in the laboratory by hospital day 41, suggesting no risk of infectivity, despite positive RT-PCR results, which prolonged his hospital stay. Notably, this case showed infectivity for at least 24 days from disease onset, which is longer than the discontinuation of transmission-based precautions recommendation by CDC. Thus, our findings suggest that the timeline for discontinuing transmission-based precautions may need to be extended for patients with prolonged illness. Additional large-scale studies are needed to draw definitive conclusions on the appropriate clinical management for these patients.
Dental care of patients with dementia: A survey on practice equipment, training, and dental treatment
Authors: Schaper Sophie , Meyer-Rötz Sinja , Bartels Claudia , Wiltfang Jens , Rödig Tina , Schott Björn H. , Belz Michael
Published: March 2021

For patients with dementia, dental care can pose a considerable challenge due to cognitive impairment, behavioral, and psychological symptoms, and (often subsequently) limited autonomous oral care. In this study, we aimed to assess the proficiency of dentists in general practice in the outpatient dental care of these patients. A total of 119 dentists from private practices in Lower Saxony, Germany, participated in this study. Concerning treatment of patients with dementia, they provided details about (1) practice equipment/consultation, (2) training/ expertise, and (3) special circumstances of dental treatment.

Participating dentists predominantly reported to use medical aids (e.g., positioning cushions) to improve the treatment situation for patients with dementia. Over two thirds (68.6%) offered consultations in nursing homes, and at the patients’ homes (47.0%). The training rate was remarkably low in the field of gerodontology for dentists and their practice staff (< 10%), however, 54.5% expressed interest in such training. The majority of dentists reportedly adapted their treatment strategy to the needs of patients with dementia (e.g., communication, inclusion of caregivers, time management). Furthermore, most participants adapted dental treatment adequately (e.g., strict indication for tooth extraction, simple design of dental prostheses).

In summary, even though training in the field of gerodontology must be considered insufficient, most dentists in this study showed an adequate adaptation of their treatment strategy as well as consideration of dental characteristics in patients with dementia, along with interest in trainings. We conclude that dementia-specific training should be expanded in the field of dentistry, preferably already at university level.
Diagnostic accuracy of rapid antigen tests in pre-/asymptomatic close contacts of individuals with a confirmed SARS-CoV-2 infection
Authors: Schuit E , Veldhuijzen IK , Venekamp RP , van den Bijllaardt W , Pas SD , Lodder EB , Molenkamp R , GeurtsvanKessel CH , Velzing J. , Huisman RC , Brouwer L , Boelsums T , Sips GJ , Benschop KSM , Hooft L , van de Wijgert JHHM , van den Hof S , Moons KGM
Published: March 2021

Background

Pre-/asymptomatic close contacts of SARS-CoV-2 infected individuals were tested at day 5 after contact by real-time reverse transcriptase polymerase chain reaction (RT-PCR). Diagnostic accuracy of antigen-detecting rapid diagnostic tests (Ag-RDT) in pre-/asymptomatic close contacts was up till now unknown.

Methods

We performed a prospective cross-sectional diagnostic test accuracy study. Close contacts (e.g. selected via the test-and-trace program or contact tracing app) aged ≥16 years and asymptomatic when requesting a test, were included consecutively and tested at day 5 at four Dutch public health service test sites. We evaluated two Ag-RDTs (BD Veritor™ System Ag-RDT (BD), and Roche/SD Biosensor Ag-RDT (SD-B)) with RT-PCR as the reference standard. Virus culture was performed in RT-PCR positive individuals to determine the viral load cut-off above which 95% was culture positive, as a proxy of infectiousness.

Results

Of 2,678 BD-tested individuals, 233 (8.7%) were RT-PCR positive and BD detected 149 (sensitivity 63.9%; 95% confidence interval 57.4%-70.1%). Out of 1,596 SD-B-tested individuals, 132 (8.3%) were RT-PCR positive and SD-B detected 83 (sensitivity 62.9%; 54.0%-71.1%). When applying an infectiousness viral load cut-off ≥ 5.2 log10 gene copies/mL, the sensitivity was 90.1% (84.2%-94.4%) for BD, 86.8% (78.1% to 93.0%) for SD-B overall, and 88.1% (80.5%-93.5%) for BD, 85.1% (74.3%-92.6%) for SD-B for those still asymptomatic at the actual time of sampling. Specificity was >99% for both Ag-RDTs in all analyses.

Conclusions

The sensitivity for detecting SARS-CoV-2 of both Ag-RDTs in pre-/asymptomatic close contacts is over 60%, increasing to over 85% after applying an infectiousness viral load cut-off.

Trial registration number

Not applicable. A study protocol is available upon request.
First wastewater surveillance-based city zonation for effective COVID-19 pandemic preparedness powered by early warning: A study of Ahmedabad, India
Authors: Kumar Manish , Joshi Madhvi , Shah Anil V. , Srivastava Vaibhav , Dave Shyamnarayan
Published: March 2021

Following the proven concept, capabilities, and limitations of detecting the RNA of Severe Acute Respiratory Coronavirus 2 (SARS-CoV-2) in wastewater, it is pertinent to understand the utility of wastewater surveillance data on various scale. In the present work, we put forward the first wastewater surveillance-based city zonation for effective COVID-19 pandemic preparedness. A three-month data of Surveillance of Wastewater for Early Epidemic Prediction (SWEEP) was generated for the world heritage city of Ahmedabad, Gujarat, India. In this expedition, one hundred sixteen wastewater samples were analyzed to detect SARS-CoV-2 RNA, from September 3rd to November 26th, 2020. A total of 111 samples were detected with at least two out of three SARS-CoV-2 genes (N, ORF 1ab, and S). Monthly variation depicted a significant decline in all three gene copies in October compared to September 2020, followed by a sharp increment in November 2020. Correspondingly, the descending order of average genome concentration was: November (∼10729 copies/ L) > September (∼3047 copies/ L) > October (∼454 copies/ L). Monthly variation of SARS-CoV-2 RNA in the wastewater samples may be ascribed to a decline of 19.3% in the total number of active cases in October 2020 and a rise of 1.82% in November 2020. Also, the monthly recovery rate of patients was 16.61, 19.31, and 15.58% in September, October, and November 2020, respectively. The percentage change in the genome concentration was observed in the lead of 1-2 weeks with respect to the provisional figures of confirmed cases. SWEEP data-based city zonation was matched with the heat map of the overall COVID-19 infected population in Ahmedabad city, and month-wise effective RNA concentration variations are shown on the map. The results expound on the potential of WBE surveillance of COVID-19 as a city zonation tool that can be meaningfully interpreted, predicted, and propagated for community preparedness through advance identification of COVID-19 hotspots within a given city.

Graphical Abstract

Highlights

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Wastewater surveillance-based city zonation is effective for COVID-19 pandemic preparedness.

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Three months variation of SARS-CoV-2 RNA in the wastewaters of Ahmedabad, India is presented.

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Wastewater monitoring offers a lead of ∼2 weeks to realize and manage the pandemic situation.

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Mapping powered by early warning can strengthen the preparedness of community.

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WBE based COVID-19 surveillance is a high end technique for identifying hotspots on city scale.
Detecting impaired language processing in MCI patients using around-the-ear cEEgrid electrodes
Authors: Segaert K. , Poulisse C. , Markiewicz R. , Wheeldon L. , Marchment D. , Adler Z. , Howett D. , Chan D. , Mazaheri A.
Published: March 2021

Mild cognitive impairment (MCI) is the term used to identify those individuals with subjective and objective cognitive decline but with preserved activities of daily living and an absence of dementia. While MCI can impact functioning in different cognitive domains, most notably episodic memory, relatively little is known about the comprehension of language in MCI. In this study we used around-the-ear electrodes (cEEGrids) to identify impairments during language comprehension in MCI patients. In a group of 23 MCI patients and 23 age-matched controls, language comprehension was tested in a two-word phrase paradigm. We examined the oscillatory changes following word onset as a function of lexico-semantic single-word retrieval (e.g. swrfeq versus swift) and multi-word binding processes (e.g. horse preceded by swift versus preceded by swrfeq). Electrophysiological signatures (as measured by the cEEGrids) were significantly different between MCI patients and controls. In controls, lexical retrieval was associated with a rebound in the alpha/beta range and binding was associated with a post-word alpha/beta suppression. In contrast, both the single-word retrieval and multi-word binding signatures were absent in the MCI group. The signatures observed using cEEGrids in controls were comparable to those signatures obtained with a full-cap EEG set-up. Importantly, our findings suggest that MCI patients have impaired electrophysiological signatures for comprehending single-words and multi-word phrases. Moreover, cEEGrids set-ups provide a non-invasive and sensitive clinical tool for detecting early impairments in language comprehension in MCI.
Anterior Spinal Artery Syndrome due to Intervertebral Disc Herniation
Authors: Islam Asraful , Hossain Mohammad D. , Siddik Abu Bakar , Rahman Tyfur , Alam Ashraful , Shourav Md.Manjurul Islam , Afrida Nahian , Rahman Sajedur , Rahman Masum
Published: March 2021

Objective

Anterior spinal artery syndrome (ASAS) has been rarely reported as a complication of intervertebral disc herniation (IVDH). Precipitation factors, presentation, evaluation, treatment strategy, and degrees of recovery have not yet been well documented.

Methods

Systematic review was conducted according to PRISMA guidelines to review and summarize for the qualitative synthesis of the data from reported cases of anterior spinal artery syndrome due to intervertebral disc herniation from 1980 to February 2021.

Results

A total of 12 cases were reviewed, the median age was 48.5 years. Motor weakness with or without pain was the most frequent presenting symptom accompanying bowel or bladder incontinence (25%) or diminished pain and temperature sensation with spared dorsal column sensation. 40% of conservatively treated patients had complete recovery without any residual deficit. Whereas all patients who managed surgically regained fully functional status with shorter recovery intervals.

Conclusion

Abrupt onset of motor weakness is a potential warning symptom of spinal cord infarction, rarely attributed to ASA compression by a herniated disc. Moreover, an accompanying diminished pain and temperature sensation with spared dorsal column sensation is further intimation. Reestablishment of blood flow may bear a favorable outcome.
A convergence based assessment of relative differences in age-stratified susceptibility and infectiousness for SARS-CoV-2 variants of B.1.1.7 lineage
Authors: Rasmussen Sarah D
Published: March 2021

We propose (a) a method for aggregating and processing age-stratified subregional time series data for positive tests of infection given partial sampling for variant-of-concern biomarkers, and (b) a simple model-based theoretical framework for interpreting these processed data, to assess whether observed heterogeneity in age-specific relative differences can be explained by environmental effects alone.

We then apply this strategy to public-domain subregional time series data with S-gene target failure (SGTF) sampling as a proxy for B.1.1.7 lineage, from weeks 45 to 50 of 2020 from England. For the time period in question, we observe convergence toward a 1.27 (95% CI 1.17-1.38) times higher ratio of SGTF to non-SGTF infection for 0-9-year-olds than for the total population, and a 1.16 (95% CI 1.09-1.23) times higher ratio for 10-19-year-olds. These are roughly comparable to previous findings, but this time we find high-significance evidence for adequate compatibility with our proposed modelling framework criteria to conclude that these relative elevations for 0-19-year-olds are very unlikely to be explained by environmental effects alone. We also find possible indications that 0-19-year-olds might experience a higher relative increase in infectiousness than susceptibility for B.1.1.7.
Testing the inferred transcription rates of a dynamic, gene network model in absolute units
Authors: Urquiza-García Uriel , Millar Andrew J.
Published: March 2021

The circadian clock coordinates plant physiology and development. Mathematical clock models have provided a rigorous framework to understand how the observed rhythms emerge from disparate, molecular processes. However, models of the plant clock have largely been built and tested against RNA timeseries data in arbitrary, relative units. This limits model transferability, refinement from biochemical data and applications in synthetic biology. Here, we incorporate absolute mass units into a detailed, gene circuit model of the clock inArabidopsis thaliana. We re-interpret the established P2011 model, highlighting a transcriptional activator that overlaps the function of REVEILLE 8/LHY-CCA1-LIKE 5, and refactor dynamic equations for the Evening Complex. The U2020 model incorporates the repressive regulation ofPRRgenes, a key feature of the most detailed clock model F2014, without greatly increasing model complexity. We tested the experimental error distributions of qRT-PCR data calibrated for units of RNA transcripts/cell and of circadian period estimates, in order to link the models to data more appropriately. U2019 and U2020 models were constrained using these data types, recreating previously-described circadian behaviours with RNA metabolic processes in absolute units. To test their inferred rates, we estimated a distribution of observed, transcriptome-wide transcription rates (Plant Empirical Transcription Rates, PETR) in units of transcripts/cell/hour. The PETR distribution and the equivalent degradation rates indicated that the models’ predicted rates are biologically plausible, with individual exceptions. In addition to updated, explanatory models of the plant clock, this validation process represents an advance in biochemical realism for models of plant gene regulation.
Sex-specific transcript diversity is regulated by a maternal transcription factor in earlyDrosophilaembryos
Authors: Ray Mukulika , Conard Ashley Mae , Urban Jennifer , Aguilera Joseph , Huang Annie , Mahableshwarkar Pranav , Vaidyanathan Smriti , Larschan Erica
Published: March 2021

Co-transcriptional splicing coordinates the processes of transcription and splicing and is driven by transcription factors (TFs) and diverse RNA-binding proteins (RBPs). Yet the mechanisms by which specific TFs and RBPs function together in context-specific ways to drive precise co-transcriptional splicing at each of thousands of genomic loci remains unknown. Therefore, we have used sex-specific splicing inDrosophilaas a model to understand how the function of TFs and RBPs is coordinated to transcribe and process specific RNA transcripts at the correct genomic locations. We show widespread sex-specific transcript diversity occurs much earlier than previously thought and present a new pipeline called time2splice to quantify splicing changes over time. We define several mechanisms by which the essential and functionally-conserved CLAMP TF functions with specific RBPs to precisely regulate co-transcriptional splicing: 1) CLAMP links the DNA of gene bodies of sex-specifically spliced genes directly to the RNA of target genes and physically interacts with snRNA and protein components of the splicing machinery; 2) In males, CLAMP regulates the distribution of the highly conserved RBPMaleless (MLE) (RNA Helicase A) to prevent aberrant sex-specific splicing; 3) In females, CLAMP modulates alternative splicing by directly binding to target DNA and RNA and indirectly through regulating the splicing ofsex lethal, the master regulator of sex determination. Overall, we provide new insight into how TFs function specifically with RBPs to drive alternative splicing.
Rats in the city: implications for zoonotic disease risk in an urbanizing world
Authors: Blasdell Kim R. , Morand Serge , Laurance Susan G.W. , Doggett Stephen L , Hahs Amy , Perera David , Firth Cadhla
Published: March 2021

Urbanization is rapidly transforming much of Southeast Asia, altering the structure and function of the landscape, as well as the frequency and intensity of the interactions between people, animals, and the environment. In this study, we began to explore the impact of urbanization on zoonotic disease risk by simultaneously characterizing changes in the abundance and diversity of reservoir hosts (rodents), ectoparasite vectors (ticks), and microbial pathogens across a gradient of urbanization in Malaysian Borneo. We found that although rodent species diversity decreased with increasing urbanization, two species appeared to thrive in anthropogenic environments: the invasive urban exploiter,Rattus rattusand the native urban adapter,Sundamys muelleri.R. rattuswas strongly associated with the presence of built infrastructure across the gradient and dominated the urban rodent community where it was associated with high microbial diversity and multi-host zoonoses capable of environmental transmission, includingLeptospiraspp., andToxoplasma gondii. In contrast,S. muelleriwas restricted to sites with a significant vegetative component where it was found at high densities in the urban location. This species was strongly associated with the presence of ticks, including the medically important generaAmbylomma,Haemaphysalis, andIxodes. Overall, our results demonstrate that the response to urbanization varies by species at all levels: host, ectoparasite, and microbe. This may lead to increased zoonotic disease risk in a subset of environments across urban and urbanizing landscapes that can be reduced through improved pest management and public health messaging.
Specific protein-membrane interactions promote the export of metallo-β-lactamases via outer membrane vesicles
Authors: López Carolina , Prunotto Alessio , Bahr Guillermo , Bonomo Robert A. , González Lisandro J. , Dal Peraro Matteo , Vila Alejandro J.
Published: March 2021

Outer membrane vesicles (OMVs) act as carriers of resistance determinants such as metallo-β-lactamases. The metallo-β-lactamase NDM-1 is present in OMVs produced by Gram-negative bacteria since it is a lipidated, membrane-anchored protein. The soluble domain of NDM-1 also forms electrostatic interactions with the membrane. Herein, we show that these interactions promote its export into OMVs produced by Escherichia coli. We report that favorable electrostatic protein-membrane interactions are also at work in the soluble enzyme IMP-1, while being absent in VIM-2. These interactions correlate with an enhanced secretion into OMVs of IMP-1 compared to VIM-2. Disruption of these interactions in NDM-1 and IMP-1 impairs export into vesicles, confirming their role in defining the protein cargo in OMVs. These results also indicate that export of metallo-β-lactamases into vesicles in their active form is a common phenomenon that involves cargo selection based on molecular features.