bluuebunny/crossref_metadata_2025 huggingface dataset:
Acquired rifampicin resistance during first TB treatment: magnitude, relative importance, risk factors and keys to control in low-income settings
Authors: Van Deun Armand , Bola Valentin , Lebeke Rossin , Kaswa Michel , Hossain Mohamed Anwar , Gumusboga Mourad , Torrea Gabriela , De Jong Bouke Catharine , Rigouts Leen , Decroo Tom
Published: March 2022

Background

The incidence of acquired rifampicin resistance (RIF-ADR; RR) during first-line treatment varies.

Objectives

Compare clinically significant RIF-ADR versus primary and reinfection RR, between regimens (daily versus no rifampicin in the continuation phase; daily versus intermittent rifampicin in the continuation phase) and between rural Bangladesh and Kinshasa, Democratic Republic of Congo.

Methods

From patients with treatment failure, relapse, or lost to follow-up, both the outcome and baseline sputum sample were prospectively collected for rpoB sequencing to determine whether RR was present in both samples (primary RR) or only at outcome (RIF-ADR or reinfection RR).

Results

The most frequent cause of RR at outcome was primary RR (62.9%; 190/302). RIF-ADR was more frequent with the use of rifampicin throughout versus only in the intensive phase (difference: 3.1%; 95% CI: 0.2–6.0). The RIF-ADR rate was higher with intermittent versus daily rifampicin in the continuation phase (difference: 3.9%; 95% CI: 0.4–7.5). RIF-ADR after rifampicin-throughout treatment was higher when resistance to isoniazid was also found compared with isoniazid-susceptible TB. The estimated RIF-ADR rate was 0.5 per 1000 with daily rifampicin during the entire treatment. Reinfection RR was more frequent in Kinshasa than in Bangladesh (difference: 51.0%; 95% CI: 34.9–67.2).

Conclusions

RR is less frequently created when rifampicin is used only during the intensive phase. Under control programme conditions, the RIF-ADR rate for the WHO 6 month rifampicin daily regimen was as low as in affluent settings. For RR-TB control, first-line regimens should be sturdy with optimal rifampicin protection. RIF-ADR prevention is most needed where isoniazid-polyresistance is high, (re)infection control where crowding is extreme.
Diagnostic Accuracy of SARS-CoV-2 Nucleocapsid Antigen Self-Test in Comparison to Reverse Transcriptase–Polymerase Chain Reaction
Authors: Sukumaran Ajaikumar , Suvekbala Vemparthan , R Arun Krishnan , Thomas Rhema Elizabeth , Raj Aneesh , Thomas Thushara , Abhijith B L , Jose Jisha , Paul Jofy K , Vasudevan D M
Published: March 2022

Background

Currently, the rapid antigen test (RAT) and reverse transcriptase–polymerase chain reaction (RT–PCR) are considered the main stakeholders in COVID-19 diagnosis. In RT–PCR, any of at least 2 evolutionary conserved genes (RdRP, E-, N-, ORF1ab gene) and S-gene of SARS-CoV-2 are endorsed, and in RAT, the nucleocapsid antigen (N-Ag) of SARS-CoV-2 is considered due to its stability and fewer chances of mutation effects. In the present work, we evaluated the performance of the AG-Q COVID-19 N-Ag self-test kit and conducted a validation study in comparison with the RT–PCR.

Methods

AG-Q COVID-19 N-Ag rapid test kit is an Indian Council of Medical Research (ICMR) approved product developed and marketed by Agappe Diagnostics Limited. The RT–PCR assay was performed with a COVIPATH COVID-19 RT–PCR kit from Thermo Fisher Scientific.

Results

We observed 19 false-negative results in antigen self-tests, including samples of threshold cycle (Ct) values 22/22 (N-gene/ORF1ab-gene) in RT–PCR, indicating inadequate sampling by the patients in self-tests, leading to false-negative results and increased chances of the disease spreading. Based on the RT–PCR Ct value vs antigen self-test comparison, it is evident that proper sampling is crucial in performing antigen self-tests. Also, there were weak positive results in antigen self-tests with a Ct value of 18/19 in RT–PCR.

Conclusions

Although the sensitivity and diagnostic accuracy offered by the AG-Q COVID-19 N-Antigen self-test in comparison with RT–PCR fulfills the ICMR tenets for RAT, this study recommends the laboratory/hospital-based RAT execution would be appropriate, rather than the self-test.
Sanctioning to Change State Behaviour
Authors: Ridi Niccolò , Fikfak Veronika
Published: March 2022

This article, which sits in the context of a wider project devoted to understanding how state behaviour may be changed, seeks to focus on the act of sanctioning, broadly construed, as functional to that goal. Freeing ourselves from the constraints of too narrow a definition of the term ‘sanction’, we consider a wider gamut of instances of penalties on target states which are intended to accomplish the goal of changing state behaviour. Our goal is threefold: first, we aim to stimulate a debate on the nature of the act of sanctioning, which, we argue, is more embedded within international law than generally conceded; second, by looking at different sanctioning practices, we aim to identify their common elements and offer a taxonomy of the act of sanctioning within international law; third, we aim to consider the implications of different sanctioning practices and, in particular, understanding how and when they can amount to effective and acceptable tools to change state behaviour.
Potentially curative resection of an abdominal wall metastasis from pancreatic adenocarcinoma: a case report
Authors: Odisho Tanya , Joseph Stephanie , Shahait Awni , Choi-Kim Lydia , McGee Jessica , Kim Steve
Published: March 2022

Pancreatic cancer has a low survival rate even after ostensible complete resection, and treatment for recurrence is usually only palliative. However, rare solitary metastasis can occur and may be operable. In this report, we describe such a case and review the literature on metastasectomy for pancreatic adenocarcinoma. A 66-year-old female underwent Whipple procedure at our institution in 2014 for a pT3N0 pancreatic adenocarcinoma. A slowly growing umbilical mass was noted 6 years later with concomitant rise in her CA 19-9 levels. CT-guided biopsy of her abdominal wall mass confirmed a well-differentiated adenocarcinoma consistent with her primary pancreatic cancer. The patient underwent metastasectomy of the isolated abdominal wall mass, with negative margins. She received no further postoperative treatment. The patient remains disease and symptom-free over 18 months after resection of the metastasis. In highly selected cases of pancreatic adenocarcinoma, resection of solitary metastasis may be therapeutic.
Surviving in cities: the case of a year-round territorial bird in the Neotropics
Authors: Juárez Roselvy , Ruiz-Gutiérrez Viviana , Sandoval Luis
Published: March 2022

Urban expansion has been identified as one of the main threats to biodiversity because it can negatively affect wildlife populations. However, wildlife population dynamics have not been studied in one of the most rapidly urbanizing regions in the world—the Neotropics. To examine the effect of urbanization on the population dynamics of Neotropical wildlife, we used recapture data from a marked population (2011–2017) of White-eared Ground-Sparrow (Melozone leucotis) across an urban–rural gradient in the Costa Rican Central Valley. Additionally, we tested if this effect differed between males and females. Contrary to our prediction, ground-sparrow survival rates were higher in urban and suburban sites than in the rural site, and we found that survival was positively correlated to the proportion of urban surface inside each territory (β = 0.90, 95% CI: 0.71–0.97). We did not find differences in survival rates between the sexes and the mean survival rate was high overall (0.79 ± 0.06). Surprisingly, our results suggest that the survival rate of this urban avoider is positively influenced by urbanization, and therefore, suggest that the potential cost to some urban avoiders may not be driven by reduced survival in more urbanized environments, and could be driven by reductions in other vital rates. Therefore, we encourage research to evaluate multiple vital rates of urban avoiders and urban adapters to achieve more comprehensive knowledge on how urbanization is affecting avian populations in the Neotropics.
Aesthetic Humility: A Kantian Model
Authors: Matherne Samantha
Published: March 2022

Unlike its moral and intellectual counterparts, the virtue of aesthetic humility has been widely neglected. In order to begin filling in this gap, I argue that Kant’s aesthetics is a promising resource for developing a model of aesthetic humility. Initially, however, this may seem like an unpromising starting point as Kant’s aesthetics might appear to promote aesthetic arrogance instead. In spite of this prima facie worry, I claim that Kant’s aesthetics provides an illuminating model of aesthetic humility that sheds light not only on the self- and other-directed attitudes it involves, but also on how aesthetic humility can serve as a corrective to the vices of aesthetic arrogance and aesthetic servility. In addition to revealing the ways in which Kant’s aesthetics prizes humility rather than arrogance, I aim to show that the Kantian model of aesthetic humility can enrich our understanding of humility more generally and contribute to the on-going effort in aesthetics to analyse specific aesthetic virtues and vices.
The Increased Length of Hospital Stay and Mortality Associated With Community-Associated Infections in Australia
Authors: Wozniak Teresa M , Dyda Amalie , Lee Xing
Published: March 2022

Background

An increasing proportion of antibiotic-resistant infections are community acquired. However, the burden of community-associated infections (CAIs) and the resulting impact due to resistance have not been well described.

Methods

We conducted a multisite, retrospective case–cohort study of all acute care hospital admissions across 134 hospitals in Australia. Patients admitted with a positive culture of 1 of 5 organisms of interest, namely Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, and Enterococcus faecium, from January 1, 2012, through December 30, 2016, were included. Data linkage was used to link hospital admissions and pathology data. Patients with a bloodstream infection (BSI), urinary tract infection (UTI), or respiratory tract infection (RTI) were included in the analysis. We compared patients with a resistant and drug-sensitive infection and used regression analyses to derive the difference in length of hospital stay (LOS) and mortality estimates associated with resistance.

Results

No statistically significant impact on hospital LOS for patients with resistant CAIs compared with drug-sensitive CAIs was identified. CAI patients with drug-resistant Enterobacteriaceae (E. coli, K. pneumoniae) BSIs were more likely to die in the hospital than those with drug-sensitive Enterobacteriaceae BSIs (odds ratio [OR], 3.28; 95% CI, 1.40–6.92). CAI patients with drug-resistant P. aeruginosa UTIs were more likely to die in the hospital than those with the drug-sensitive counterpart (OR, 2.43; 95% CI, 1.12–4.85).

Conclusions

The burden of CAI in the hospital is significant, and antibiotic resistance is adding to associated mortality.
Case report: cause of hyperprolactinemia in an elderly patient
Authors: Moslehi Sarah , Iliff Jonathan , Goudaman Surya
Published: March 2022

Irritation to the chest wall due to herpes zoster virus (HZV) infection is one of many potential underlying causes of hyperprolactinemia. Hyperprolactinemia can lead to various different symptoms including anorgasmia. It is important to identify any sexual dysfunction, but also any other symptoms of hyperprolactinemia, in elderly patients during medical history taking and not to assume that elderly people are sexually inactive. Anorgasmia and any other sexual dysfunction in elderly can have an impact on their mental health and may even lead to depression and anxiety.
A rare case of asymptomatic right coronary artery ectasia associated with giant aneurysm
Authors: Hishikawa Takanori , Ohashi Takeki , Tadakoshi Masao , Kamikawa Yuji , Kageyama Soichiro , Kojima Akinori , Hioki Kaoru , Yamauchi Hirotaka
Published: March 2022

A rare case of giant coronary artery ectasia associated with coronary artery aneurysm was recognized. A 69-year-old woman presented with an ischemic electrocardiogram changes during a medical check-up. Coronary computed tomography angiography showed right coronary artery (RCA) ectasia associated with a giant aneurysm originating from the distal RCA. She was asymptomatic and exhibited no risk factors, including Kawasaki disease, hypertension, diabetes mellitus or family history. The patient underwent surgery for giant coronary aneurysms to prevent rupture. The aneurysm was on the peripheral side of the right coronary artery; hence, coronary artery bypass was not performed. The patient’s postoperative course was uneventful. Histopathological examination of the aneurysm revealed degeneration due to atherosclerosis. She was prescribed warfarin and aspirin for thrombus prevention.
Pembrolizumab-induced toxic epidermal necrolysis: case report
Authors: Chow Kar Ven Cavan , O’Leary Connor , Paxton-Hall Fiona , Lambie Duncan , O’Byrne Kenneth
Published: March 2022

A 63-year-old man with metastatic lung adenocarcinoma presented with biopsy confirmed toxic epidermal necrolysis (TEN). Symptoms commenced following 3 cycles of carboplatin, pemetrexed and pembrolizumab, with the first cycle given ~9.5 weeks prior to presentation. The patient was managed with immunosuppressive therapy including high dose methylprednisolone, cyclosporine, intravenous immunoglobulin, antibiotics and optimal skin care, and achieved excellent recovery of the skin lesions with minimal sequelae. This rare occurrence of pembrolizumab-induced TEN has only been reported previously in a few cases with limited evidence on management. Given the increasing use of immune checkpoint inhibitors and the long half-life of these agents, our case highlights the importance of recognizing this complication and of a multidisciplinary approach to management.
In Defense of Vaccine Mandates: An Argument from Consent Rights
Authors: Wilkenfeld Daniel A , Johnson Christa M
Published: March 2022

This article will focus on the ethical issues of vaccine mandates and stake claim to the relatively extreme position that outright requirements for people to receive the vaccine are ethically correct at both the governmental and institutional levels. One novel strategy employed here will be to argue that deontological considerations pertaining to consent rights cut as much in favor of mandating vaccines as against them. The presumption seems to be that arguments from consent speak semi-definitively against forcing people to inject something into their bodies, and so any argument in favor of mandates must produce different and overriding logical and ethical considerations. Our central claim will be that the same logic that might seem to prohibit vaccine mandates as violations of consent actually supports such mandates when viewed from the perspective of the potential bystander who might otherwise be exposed to COVID-19.
Prone Position Minimizes the Exacerbation of Effort-dependent Lung Injury: Exploring the Mechanism in Pigs and Evaluating Injury in Rabbits
Authors: Yoshida Takeshi , Engelberts Doreen , Chen Han , Li Xuehan , Katira Bhushan H. , Otulakowski Gail , Fujino Yuji
Published: March 2022

Background

Vigorous spontaneous effort can potentially worsen lung injury. This study hypothesized that the prone position would diminish a maldistribution of lung stress and inflation after diaphragmatic contraction and reduce spontaneous effort, resulting in less lung injury.

Methods

A severe acute respiratory distress syndrome model was established by depleting surfactant and injurious mechanical ventilation in 6 male pigs (“mechanism” protocol) and 12 male rabbits (“lung injury” protocol). In the mechanism protocol, regional inspiratory negative pleural pressure swing (intrabronchial balloon manometry) and the corresponding lung inflation (electrical impedance tomography) were measured with a combination of position (supine or prone) and positive end-expiratory pressure (high or low) matching the intensity of spontaneous effort. In the lung injury protocol, the intensities of spontaneous effort (esophageal manometry) and regional lung injury were compared in the supine position versus prone position.

Results

The mechanism protocol (pigs) found that in the prone position, there was no ventral-to-dorsal gradient in negative pleural pressure swing after diaphragmatic contraction, irrespective of the positive end-expiratory pressure level (–10.3 ± 3.3 cm H2O vs. –11.7 ± 2.4 cm H2O at low positive end-expiratory pressure, P = 0.115; –10.4 ± 3.4 cm H2O vs. –10.8 ± 2.3 cm H2O at high positive end-expiratory pressure, P = 0.715), achieving homogeneous inflation. In the supine position, however, spontaneous effort during low positive end-expiratory pressure had the largest ventral-to-dorsal gradient in negative pleural pressure swing (–9.8 ± 2.9 cm H2O vs. –18.1 ± 4.0 cm H2O, P < 0.001), causing dorsal overdistension. Higher positive end-expiratory pressure in the supine position reduced a ventral-to-dorsal gradient in negative pleural pressure swing, but it remained (–9.9 ± 2.8 cm H2O vs. –13.3 ± 2.3 cm H2O, P < 0.001). The lung injury protocol (rabbits) found that in the prone position, spontaneous effort was milder and lung injury was less without regional difference (lung myeloperoxidase activity in ventral vs. dorsal lung, 74.0 ± 30.9 μm · min–1 · mg–1 protein vs. 61.0 ± 23.0 μm · min–1 · mg–1 protein, P = 0.951). In the supine position, stronger spontaneous effort increased dorsal lung injury (lung myeloperoxidase activity in ventral vs. dorsal lung, 67.5 ± 38.1 μm · min–1 · mg–1 protein vs. 167.7 ± 65.5 μm · min–1 · mg–1 protein, P = 0.003).

Conclusions

Prone position, independent of positive end-expiratory pressure levels, diminishes a maldistribution of lung stress and inflation imposed by spontaneous effort and mitigates spontaneous effort, resulting in less effort-dependent lung injury.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Preintubation Sequential Organ Failure Assessment Score for Predicting COVID-19 Mortality: External Validation Using Electronic Health Record From 86 U.S. Healthcare Systems to Appraise Current Ventilator Triage Algorithms*
Authors: Keller Michael B. , Wang Jing , Nason Martha , Warner Sarah , Follmann Dean , Kadri Sameer S.
Published: March 2022

OBJECTIVES:

Prior research has hypothesized the Sequential Organ Failure Assessment (SOFA) score to be a poor predictor of mortality in mechanically ventilated patients with COVID-19. Yet, several U.S. states have proposed SOFA-based algorithms for ventilator triage during crisis standards of care. Using a large cohort of mechanically ventilated patients with COVID-19, we externally validated the predictive capacity of the preintubation SOFA score for mortality prediction with and without other commonly used algorithm elements.

DESIGN:

Multicenter, retrospective cohort study using electronic health record data.

SETTING:

Eighty-six U.S. health systems.

PATIENTS:

Patients with COVID-19 hospitalized between January 1, 2020, and February 14, 2021, and subsequently initiated on mechanical ventilation.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Among 15,122 mechanically ventilated patients with COVID-19, SOFA score alone demonstrated poor discriminant accuracy for inhospital mortality in mechanically ventilated patients using the validation cohort (area under the receiver operating characteristic curve [AUC], 0.66; 95% CI, 0.65–0.67). Discriminant accuracy was even poorer using SOFA score categories (AUC, 0.54; 95% CI, 0.54–0.55). Age alone demonstrated greater discriminant accuracy for inhospital mortality than SOFA score (AUC, 0.71; 95% CI, 0.69–0.72). Discriminant accuracy for mortality improved upon addition of age to the continuous SOFA score (AUC, 0.74; 95% CI, 0.73–0.76) and categorized SOFA score (AUC, 0.72; 95% CI, 0.71–0.73) models, respectively. The addition of comorbidities did not substantially increase model discrimination. Of 36 U.S. states with crisis standards of care guidelines containing ventilator triage algorithms, 31 (86%) feature the SOFA score. Of these, 25 (81%) rely heavily on the SOFA score (12 exclusively propose SOFA; 13 place highest weight on SOFA or propose SOFA with one other variable).

CONCLUSIONS:

In a U.S. cohort of over 15,000 ventilated patients with COVID-19, the SOFA score displayed poor predictive accuracy for short-term mortality. Our findings warrant reappraisal of the SOFA score’s implementation and weightage in existing ventilator triage pathways in current U.S. crisis standards of care guidelines.
Downstream Impact for Plastic Surgeons in the United States from the “No Surprises Act”
Authors: Zbar Ross I. S , Zbar Denise , Canady John W.
Published: March 2022

Background:

The No Surprises Act, signed into the US federal law in 2020, establishes a floor for reimbursement determined by insurance payors for out-of-network charges rendered by providers in emergency services. Physicians are not permitted to balance bill patients for the difference. An arbitration process is outlined for mediation between provider and payor if needed.

Methods:

Policy analysis demonstrates many plastic surgeons utilize a revenue stream including both fee-for-service cosmetic work and insurance-covered reconstructive intervention. For Maintenance of Certification from the American Board of Plastic Surgery and/or membership to the American Society of Plastic Surgeons, plastic surgeons must operate only in accredited facilities, which in turn require that similar privileges are held in a hospital.

Results:

Given rapidly developing economic pressures, hospitals no longer remain neutral sites for surgical privileging as they seek strategies to mitigate financial loss by directly competing for patients. A downstream consequence of the requirement for hospital privileging is that plastic surgeons are forced to manage increasing on-call responsibilities despite shrinking reimbursement. Plastic surgeons whose board certification was the first to be time-limited are now reaching the stage of practice where they may transition exclusively to out-patient services.

Conclusions:

Plastic surgeons in independent solo or small group practices are rendered vulnerable since they may not be able to find coverage of in-patient responsibilities at lower reimbursement rates. Rather than allowing loss of board certification in this population, rational alternatives on an organizational level are proposed for keeping the process equitable as plastic surgeons progress along the practice pathway.
Thygeson Superficial Punctate Keratitis: A Clinical and Immunologic Review
Authors: Moshirfar Majid , Peterson Telyn , Ungricht Emilie , McCabe Shannon , Ronquillo Yasmyne C. , Brooks Ben , Towne Francina , Hoopes Phillip
Published: March 2022

Thygeson superficial punctate keratitis (TSPK) is clinically characterized by exacerbations and remissions of gray–white opacities within the corneal epithelium, most often bilateral but may be asymmetric. Symptoms typically include photophobia, tearing, blurring, and eye irritation. Although disease progression and prognosis are well described, the exact cause is unknown. Hypotheses exist implicating virus-mediated immunity as the cause of TSPK following cases of viral keratitis; however, several polymerase chain reaction studies refute the infectious process concurrently with symptomatic TSPK. This is further supported by the consistent lack of response to antiviral and antibacterial treatment. A subset of dendritic cells known as Langerhans cells (LC) found within the corneal epithelium has been positively correlated with exacerbations of TSPK. Langerhans cells proliferate to protect and mitigate the cornea's inflammatory response, but the inflammatory triggers and relapses associated with TSPK are not well understood. Several topical drugs exist to treat inflammation related to TSPK; however, drug delivery is a major barrier to treatment because of the tear film and epithelial barrier. Drug-eluting contact lenses that target intermediates of inflammation could serve as a more effective treatment modality because of the increased bioavailability of the drugs. This review is an in-depth survey of the literature regarding the relationship between the origin and pathophysiology of LC and TSPK at the immunologic level. We also discuss potential pharmacotherapeutic interventions for TSPK prevention and treatment.
Diagnostic Accuracy of Artificial Intelligence in Glaucoma Screening and Clinical Practice
Authors: Chaurasia Abadh K. , Greatbatch Connor J. , Hewitt Alex W.
Published: March 2022

Purpose:

Artificial intelligence (AI) has been shown as a diagnostic tool for glaucoma detection through imaging modalities. However, these tools are yet to be deployed into clinical practice. This meta-analysis determined overall AI performance for glaucoma diagnosis and identified potential factors affecting their implementation.

Methods:

We searched databases (Embase, Medline, Web of Science, and Scopus) for studies that developed or investigated the use of AI for glaucoma detection using fundus and optical coherence tomography (OCT) images. A bivariate random-effects model was used to determine the summary estimates for diagnostic outcomes. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis of Diagnostic Test Accuracy (PRISMA-DTA) extension was followed, and the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used for bias and applicability assessment.

Results:

Seventy-nine articles met inclusion criteria, with a subset of 66 containing adequate data for quantitative analysis. The pooled area under receiver operating characteristic curve across all studies for glaucoma detection was 96.3%, with a sensitivity of 92.0% (95% confidence interval: 89.0–94.0) and specificity of 94.0% (95% confidence interval: 92.0–95.0). The pooled area under receiver operating characteristic curve on fundus and OCT images was 96.2% and 96.0%, respectively. Mixed data set and external data validation had unsatisfactory diagnostic outcomes.

Conclusion:

Although AI has the potential to revolutionize glaucoma care, this meta-analysis highlights that before such algorithms can be implemented into clinical care, a number of issues need to be addressed. With substantial heterogeneity across studies, many factors were found to affect the diagnostic performance. We recommend implementing a standard diagnostic protocol for grading, implementing external data validation, and analysis across different ethnicity groups.
Review of Advanced Techniques for Data Security Technology and Applications
Authors: Elamir Mona M. , Mabrouk Mai S. , Al-Atabany Walid I.
Published: March 2022

COVID-19 continues to dominate world news because of its severe damage to human health, which may lead to death. It has been forcing people to handle their work, studies, and examinations in the public cloud. In this situation, data security should be ensured to prevent data from being hacked or altered. One of the most promising fields in data security is DNA cryptography, which refers to using DNA molecules in storing, hiding, and transmitting the information. This systematic review discusses some cryptographic techniques and their progress.
Frequency of Statin Prescription Among Individuals with Coronary Artery Calcifications Detected Through Lung Cancer Screening
Authors: Majeed Amry , Ruane Brooke , Shusted Christine S. , Austin Melissa , Mirzozoda Khulkar , Pimpinelli Marcella , Vojnika Jetmir , Ward Lawrence , Sundaram Baskaran , Lakhani Paras , Kane Gregory , Lev Yair , Barta Julie A.
Published: March 2022

Individuals eligible for lung cancer screening (LCS) are at risk for atherosclerotic cardiovascular disease (ASCVD) due to smoking history. Coronary artery calcifications (CAC), a common incidental finding on low-dose CT (LDCT) for LCS, is a predictor of cardiovascular events. Despite findings of high ASCVD risk and CAC, a substantial proportion of LCS patients are not prescribed primary preventive statin therapy for ASCVD. We assessed the frequency of statin prescription in LCS patients with moderate levels of CAC. Among 259 individuals with moderate CAC, 95% had ASCVD risk ≥ 7.5%. Despite this, 27% of patients were statin-free prior to LDCT and 21.2% remained statin-free after LDCT showing moderate CAC. Illustratively, while a substantial proportion of LCS patients are statin-eligible, many lack a statin prescription, even after findings of CAC burden. CAC reporting should be standardized, and interdisciplinary communication should be optimized to ensure that LCS patients are placed on appropriate preventive therapy.
Predictors of Success on the National Physical Therapy Examination in 2 US Accelerated-Hybrid Doctor of Physical Therapy Programs
Authors: Reynolds Breanna , Unverzagt Casey , Koszalinski Alex , Gatlin Roberta , Seale Jill , Gagnon Kendra , Eaton Kareaion , Koppenhaver Shane L.
Published: March 2022

Introduction:

Although predictors of success have been reported within Doctor of Physical Therapy (DPT) education previously, accelerated-hybrid models of DPT education have not been included and may yield different results. The purpose of this study was to examine predictors of National Physical Therapy Examination (NPTE) performance within 2 US-accredited accelerated-hybrid DPT programs.

Review of Literature:

Current evidence examining predictors of NPTE success have included admissions data (undergraduate or prerequisite grade point average [GPA] and Graduate Record Examination [GRE]), DPT program GPA, noncognitive variables, and program variables. Although results of the relationship of these variables to NPTE success are inconsistent, DPT program GPA seemed to be the most consistent finding.

Subjects:

Student records from the 2019 and 2020 graduating classes of 2 accelerated-hybrid DPT programs (4 classes total, n = 355).

Methods:

Preadmission, noncognitive, within-program, and NPTE preparatory variables were assessed to determine their relationship with NPTE score. The association between each variable and NPTE score was assessed using bivariate correlations. The most parsimonious predictive model was determined using stepwise linear regression analysis. After determining the best predictive threshold for continuous level variables, odds ratios were calculated between each variable and passing the NPTE on the first attempt.

Results:

Statistically significant associations with NPTE score were noted with most preadmission, within-program, and NPTE preparatory variables; the strongest association was midpoint program GPA (r = 0.576, P < .05). The most parsimonious predictive model consisted of midpoint program GPA, first attempt passing Practice Exam & Assessment Tool (PEAT; dichotomous outcome, passing score ≥600), Scorebuilders Online Advantage examination score, and combined GRE percentage, which accounted for 52.6% of the variance in NPTE scores. The odds of passing NPTE on the first try were 14 times higher in individuals who passed the PEAT examination on the first try and 8 times higher in students with a midpoint GPA of at least 3.35.

Discussion and Conclusion:

Midpoint program GPA was the strongest predictor of NPTE score, followed by the PEAT and Online Advantage (2 NPTE preparatory variables). Combined GRE percentage was the only admissions variable contributing to the prediction of NPTE score. These findings are not different from previous research examining predictors of NPTE success in other DPT education models.
Tectal Hemorrhage in the Setting of COVID-19 Infection
Authors: O’Brien Patrick F. , Johnson Erica C. , Graham Robert S.
Published: March 2022

Introduction:

Coronavirus disease 2019 (COVID-19) has emerging evidence of a relationship to intracranial hemorrhage. The hemorrhages described to date often affect patients on anticoagulation, of advanced age, of nonwhite race, and requiring mechanical ventilation. Unusual or rare hemorrhage patterns have not as yet been described in the literature as being associated with COVID-19.

Case Report:

A 36-year-old Hispanic male with no significant past medical history presented with isolated tectal intraparenchymal hemorrhage with intraventricular hemorrhage in the setting of no identifiable risk factors other than COVID-19. His management required temporizing with external ventricular drainage and subsequent endoscopic third ventriculostomy for ongoing obstruction of the cerebral aqueduct following the hemorrhage. He was discharged and did clinically well. To our knowledge, this is the first report of an intraparenchymal hematoma of the brain isolated to the midbrain tectum with only COVID-19 as a risk factor.

Conclusion:

COVID-19 may predispose patients to rare types of intraparenchymal hematomas which remain amenable to standard management algorithms.
Therapeutic Plasma Exchange (TPE) Complications in Patients With Multiple Sclerosis (MS) and Clinically Isolated Syndrome (CIS)
Authors: Mavandadi Shirin , Moghaddami Mehran , Meysami Ali P. , Sahraian Mohammad A. , Paybast Sepideh , Ghajarzadeh Mahsa , Maemodan Farhad Golipoor , Nahayati Mohammad A. , Azimi Amirreza
Published: March 2022

Background:

Therapeutic plasma exchange (TPE) is a conventional second-line treatment for patients with multiple sclerosis (MS) or clinically isolated syndrome with steroid-refractory relapses.

Methods:

MS and clinically isolated syndrome patients with a steroid-refractory relapse, who fulfilled the indications for TPE were enrolled in this study. An expert nurse recorded the data comprising age, sex, type of MS, disease modifying therapy, disease duration, relapse rate, vital signs at the beginning, during and at the end of each plasma exchange session, plasma exchange volume, normal saline volume, and TPE complications. Ultimately, the statistical association was estimated amongst the variables.

Results:

A total of 122 cases were assessed. Twelve cases (9.8%) received plasmapheresis for the second time. The mean age was 32.2±8.7 years and 107 (87.7%) were female. In total, 609 plasma exchange sessions were completed. Hypotension and skin reaction were the most clinical complications. Hemoglobin loss and hypokalemia were the most laboratory complications. Fifty-four cases (44.3%) had no complications, 40 (32.8%) had 1 complication, 21 (17.2%) 2 complications, 6 (4.9%) had 3 complications, and 1 (0.8%) disclosed 4 complications. The relapse rate in the past 12 months and the mean plasma volume exchange were significantly different between the groups.

Conclusions:

We revealed that TPE could be considered as a safe second-line therapy in MS relapses. Hypotension, skin reaction, hemoglobin loss, and hypokalemia were the most complications of TPE in our patients.
Rehabilitation for Total Hip Arthroplasty: A Systematic Review
Authors: Konnyu Kristin J. , Pinto Dan , Cao Wangnan , Aaron Roy K. , Panagiotou Orestis A. , Bhuma Monika Reddy , Adam Gaelen P. , Balk Ethan M. , Thoma Louise M.
Published: March 2022

We sought to determine the comparative benefits and harms of rehabilitation interventions for patients who have undergone elective, unilateral THA surgery for the treatment of primary osteoarthritis. We searched PubMed, Embase, The Cochrane Register of Clinical Trials, CINAHL, PsycINFO, Scopus, and ClinicalTrials.gov from January 1, 2005 through May 3, 2021. We included randomized controlled trials and adequately-adjusted nonrandomized comparative studies of rehabilitation programs reporting performance-based, patient-reported, or healthcare utilization outcomes. Three researchers extracted study data and assessed risk of bias, verified by an independent researcher. Experts in rehabilitation content and complex interventions independently coded rehabilitation interventions. The team assessed strength of evidence (SoE). Large heterogeneity across evaluated rehabilitation programs limited conclusions. Evidence from 15 studies suggests diverse rehabilitation programs may not differ in terms of risk of harm or outcomes of pain, strength, activities of daily living, or quality of life (all low SoE). Evidence is insufficient for other outcomes. In conclusion, no differences in outcomes were found between different rehabilitation programs following THA. Further evidence is needed to inform decisions on what attributes of rehabilitation programs are most effective for various outcomes.
Ultrasound-Guided Botulinum Toxin Injection for the Treatment of Teres Major Fasciculations: A Case Report
Authors: Cushman Daniel M. , Carefoot Andrea , Rees Mikayla R.
Published: March 2022

This case study presents a 31-year-old male weightlifter without known neuromuscular disease who presented with five weeks of atraumatic, constant fasciculations of his right teres major muscle without recent injury. Electromyography identified fasciculation potentials within the teres major and pronator teres suggesting an acute C6 radiculopathy, though a cervical MRI demonstrated no significant neuroforaminal stenosis. Trigger point injections and multiple medications failed to stop the fasciculations. Under electromyography and ultrasound guidance, he was focally injected with botulinum toxin to the teres major ten weeks from initial onset with subsequent complete resolution of the symptoms and no side effects.
Role of Schooling and Comprehensive Sexuality Education in Reducing HIV and Pregnancy Among Adolescents in South Africa
Authors: George Gavin , Beckett Sean , Reddy Tarylee , Govender Kaymarlin , Cawood Cherie , Khanyile David , Kharsany Ayesha B.M.
Published: March 2022

Background:

Comprehensive sexuality education (CSE) seeks to reduce risky sexual behaviour and subsequent incidence of unintended pregnancy and HIV among schoolgoing adolescents. This study estimates the association between exposure to CSE and key biomedical and behavioural indicators among adolescent girls in South Africa.

Setting:

Four DREAMS implementation districts in Gauteng and KwaZulu-Natal provinces in South Africa.

Methods:

Data from a household-based representative sample of adolescent girls (between the ages 12–18 years) (n = 9673) was collected. Independent variables included school attendance and exposure to CSE, with outcome variables measuring prevalence of HIV, pregnancy, and sexual risky behaviour, including condom use, incidence of age-disparate relationships, and transactional sex.

Results:

Adolescent girls in school and who had attended CSE classes in the previous 12 months were associated with reduced adjusted odds of being HIV-positive [full sample: adjusted odds ratios (AOR): 0.76, 95% confidence interval [CI]: 0.61 to 0.95, P < 0.05; sexually active sample: AOR: 0.62, 95% CI: 0.40 to 0.96, P < 0.05]. Those in school who attended CSE in the previous 12 months were also more likely to get tested for HIV (AOR: 1.48, 95% CI: 1.32 to 1.65, P < 0.001).

Conclusions:

The results indicate that school attendance and exposure to CSE is associated with a reduction in risky sexual behaviour. Exposure to CSE is also associated with increased access to HIV testing for adolescent girls both in and out of school. Keeping adolescent girls in school produces the greatest positive sexual behavioural effect; this, coupled with the delivery of quality CSE, is a key strategy for reducing HIV risk.
Genomic and antigenic diversity of colonizing Klebsiella pneumoniae isolates mirrors that of invasive isolates in Blantyre, Malawi
Authors: Lewis Joseph M. , Mphasa Madalitso , Banda Rachel , Beale Mathew A. , Mallewa Jane , Heinz Eva , Thomson Nicholas R. , Feasey Nicholas A.
Published: March 2022

Members of the

Klebsiella pneumoniae

species complex, particularly

K. pneumoniae

subsp.

pneumoniae

are antimicrobial resistance (AMR) associated pathogens of global importance, and polyvalent vaccines targeting

Klebsiella

O-antigens are in development. Whole-genome sequencing has provided insight into O-antigen distribution in the

K. pneumoniae

species complex, as well as population structure and virulence determinants, but genomes from sub-Saharan Africa are underrepresented in global sequencing efforts. We therefore carried out a genomic analysis of extended-spectrum beta-lactamase (ESBL)-producing

K. pneumoniae

species complex isolates colonizing adults in Blantyre, Malawi. We placed these isolates in a global genomic context, and compared colonizing to invasive isolates from the main public hospital in Blantyre. In total, 203 isolates from stool and rectal swabs from adults were whole-genome sequenced and compared to a publicly available multicounty collection and previously sequenced Malawian and Kenyan isolates from blood or sterile sites. We inferred phylogenetic relationships and analysed the diversity of genetic loci linked to AMR, virulence, capsule and LPS O-antigen (O-types). We find that the diversity of Malawian

K. pneumoniae

subsp.

pneumoniae

isolates represents the species’ population structure, but shows distinct local signatures concerning clonal expansions. Siderophore and hypermucoidy genes were more frequent in invasive versus colonizing isolates (present in 13 % vs 1 %) but still generally lacking in most invasive isolates. O-antigen population structure and distribution was similar in invasive and colonizing isolates, with O4 more common (14%) than in previously published studies (2–5 %). We conclude that host factors, pathogen opportunity or alternate virulence loci not linked to invasive disease elsewhere are likely to be the major determinants of invasive disease in Malawi. Distinct ST and O-type distributions in Malawi highlight the need to sample locations where the burden of invasive

Klebsiella

disease is greatest to robustly define secular trends in

Klebsiella

diversity to assist in the development of a useful vaccine. Colonizing and invasive isolates in Blantyre are similar, hence O-typing of colonizing

Klebsiella

isolates may be a rapid and cost-effective approach to describe global diversity and guide vaccine development.
Genomic diversity and antimicrobial resistance among non-typhoidal Salmonella associated with human disease in The Gambia
Authors: Darboe Saffiatou , Bradbury Richard S. , Phelan Jody , Kanteh Abdoulie , Muhammad Abdul-Khalie , Worwui Archibald , Yang Shangxin , Nwakanma Davis , Perez-Sepulveda Blanca , Kariuki Samuel , Kwambana-Adams Brenda , Antonio Martin
Published: March 2022

Non-typhoidal

Salmonella

associated with multidrug resistance cause invasive disease in sub-Saharan Africa. Specific lineages of serovars Typhimurium and Enteritidis have been implicated. Here we characterized the genomic diversity of 100 clinical non-typhoidal

Salmonella

collected from 93 patients in 2001 from the eastern, and in 2006–2018 from the western regions of The Gambia respectively. A total of 93 isolates (64 invasive, 23 gastroenteritis and six other sites) representing a single infection episode were phenotypically tested for antimicrobial susceptibility using the Kirby–Bauer disc diffusion technique. Whole genome sequencing of 100 isolates was performed using Illumina, and the reads were assembled and analysed using SPAdes. The Salmonella in Silico Typing Resource (SISTR) was used for serotyping. SNP differences among the 93 isolates were determined using Roary, and phylogenetic analysis was performed in the context of 495 African strains from the European Nucleotide Archive.

Salmonella

serovars Typhimurium (26/64; 30.6 %) and Enteritidis (13/64; 20.3 %) were associated with invasive disease, whilst other serovars were mainly responsible for gastroenteritis (17/23; 73.9 %). The presence of three major serovar Enteritidis clades was confirmed, including the invasive West African clade, which made up more than half (11/16; 68.8 %) of the genomes. Multidrug resistance was confined among the serovar Enteritidis West African clade. The presence of this epidemic virulent clade has potential for spread of resistance and thus important implications for systematic patient management. Surveillance and epidemiological investigations to inform control are warranted.
En1 and Lmx1b do not recapitulate embryonic dorsal-ventral limb patterning functions during mouse digit tip regeneration
Authors: Johnson Gemma L. , Glasser Morgan B. , Charles Julia F. , Duryea Jeffrey , Lehoczky Jessica A.
Published: March 2022

The mouse digit tip is a complex tissue that is capable of regeneration after amputation. How the regenerated digit tip is patterned is unknown, but a long-standing hypothesis in the field of regeneration proposes that developmental patterning mechanisms are re-used during regeneration. The digit tip bone exhibits strong dorsal-ventral (DV) polarity, so we focus on Engrailed 1 (En1) and LIM homeobox transcription factor 1B (Lmx1b), two well-studied transcription factors necessary for DV patterning during limb development. We investigate if En1 and Lmx1b are re-expressed during regeneration in a developmental-like spatially restricted pattern, and if they direct DV morphology of the regenerated digit tip. We find that both En1 and Lmx1b are expressed in the regenerating mouse digit tip epithelium and mesenchyme, respectively, but without DV polarity. We use conditional genetics and quantitative analysis of digit tip bone morphology to determine that genetic deletion of En1 or Lmx1b in adult digit tip regeneration modestly reduces bone regeneration but does not affect DV patterning of the regenerate. Collectively, our data suggest that while En1 and Lmx1b are re-expressed during mouse digit tip regeneration, they do not define the DV axis during regeneration.
Integrated protein and transcriptome high-throughput spatial profiling
Authors: Ben-Chetrit Nir , Niu Xiang , Swett Ariel D. , Sotelo Jesus , Jiao Maria S. , Roelli Patrick , Stoeckius Marlon , Landau Dan A.
Published: March 2022

Spatial transcriptomics and proteomics have independently transformed our understanding of complex biological processes; however, integration of these modalities is currently limited. To overcome this challenge, we developedSpatialPrOtein andTranscriptomeSequencing (SPOTS) for high-throughput integration of transcriptome and protein profiling within the spatial context. Applying SPOTS to spleen and breast cancer samples revealed that spatially-resolved multi-omic integration provides a comprehensive perspective on key biological processes in health and disease.