bluuebunny/crossref_metadata_2025 huggingface dataset:
Point-of-care echocardiography and thoracic ultrasound in the management of critically ill patients with COVID-19 infection: Experience in three regional UK intensive care units
Authors: Jordan Helen , Preston Hannah , Hall David P , Gifford Hugh , Gillies Michael A
Published: September 2021

Introduction

Point-of-care ultrasound (POCUS) has an established role in the management of the critically ill. Information and experience of its use in those with COVID-19 disease is still evolving. We undertook a review of cardiac and thoracic ultrasound examinations in patients with COVID-19 on the intensive care unit (ICU). Our aim was to report key findings and their impact on patient management.

Methods

A retrospective evaluation of critically ill patients with COVID-19 was undertaken in three adult ICUs, who received point-of-care cardiac and/or thoracic ultrasound during the 2019–2020 COVID-19 pandemic. We recorded baseline demographic data, principal findings, change in clinical management and outcome data.

Results

A total of 55 transthoracic echocardiographic examinations scans were performed on 35 patients. 35/55 (64%) echocardiograms identified an abnormality, most commonly a dilated or impaired right ventricle (RV) and 39/55 (70%) scans resulted in a change in management. Nine patients (26%) were found to have pulmonary arterial thrombosis on CTPA or post-mortem. More than 50% of these patients showed evidence of right ventricular dilatation or impairment. Of the patients who were known to have pulmonary arterial thrombosis and died, 83% had evidence of right ventricular dilatation or impairment. 32 thoracic ultrasound scans were performed on 23 patients. Lung sliding and pleural thickening were present bilaterally in all studies. Multiple B-lines were present in all studies, and sub-pleural consolidation was present bilaterally in 72%.

Conclusion

POCUS is able to provide useful and clinically relevant information in those critically ill with COVID-19 infection, resulting in change in management in a high proportion of patients. Common findings in this group are RV dysfunction, multiple B-lines and sub-pleural consolidation.
Pregnancy in a woman with congenital adrenal hyperplasia with 11-beta-hydroxylase deficiency: A case report
Authors: Krishnan Kavitha , Pillai Silja , Vaidyanathan Gowri
Published: September 2021

Background

Successful pregnancy with congenital adrenal hyperplasia due to 11-beta-hydroxylase deficiency is an extremely rare condition. Only two cases have been reported in the literature.

Methods and results

Described here is a 30-year-old woman diagnosed as a neonate with congenital adrenal hyperplasia related to 11-beta-hydroxylase deficiency classic type, who subsequently underwent clitoral resection and vaginoplasty. She was started on lifelong steroid therapy after surgery. She developed hypertension at 11 years of age and was on antihypertensive therapy from then on. In later life, she underwent division of vaginal scar tissue and perineal refashioning. She spontaneously conceived but her pregnancy was complicated by severe pre-eclampsia and delivery was required at 33 weeks of gestation by cesarean section. A healthy male infant was delivered.

Conclusion

Management of these women is similar to those with more common causes of congenital adrenal hyperplasia, with careful monitoring throughout pregnancy for complications such as gestational diabetes, gestational hypertension, and intrauterine growth restriction.
Mala nutrición en población escolar mexicana: factores geográficos y escolares asociados
Authors: Ávila Curiel Abelardo , Galindo Gómez Carlos , Juárez Martínez Liliana , García-Guerra Armando , Del Monte Vega Marti Yareli , Martínez Domínguez Jesús , Ávila Arcos y Marco Antonio
Published: September 2021

Resumen:

Objetivos:

Determinar prevalencias de mala nutrición [sobrepeso u obesidad (Sp+O) y talla baja (TB)] en población mexicana de 6 a 12 años de edad de nivel básico de primaria, y su asociación con características geográficas (ámbito, marginación y región del país), y de la escuela (tipo, turno y grado).

Métodos:

Con información de 10 528 676 escolares, se estimaron prevalencias (e I.C. 95%), a nivel nacional y por características de interés, y su asociación mediante modelos de regresión logística.

Resultados:

La prevalencia nacional de Sp+O fue 34.4%, 36.5% en ámbito urbano y 40.2% en escuelas privadas. La prevalencia nacional de TB fue 8.7%; en área rural, 13.7% y 28.8% en escuelas tipo indígenas. El Sp+O y la TB se asociaron significativamente con características geográficas y de escuelas.

Conclusiones:

Existe una polarización nutricional en el contexto escolar del país. Es importante continuar con sistemas de monitoreo y vigilancia nutricional.
Winter diet of Long-eared Owls (Asio otus) in the southern Pannonian Plain (Serbia, Vojvodina)
Authors: Tulis Filip , Poljak Nadja , Ruzic Milan , Obuch Ján
Published: September 2021

Owl diets undergo qualitative changes across the different regions of their area of distribution. During the four winters (from 2014–15 to 2017–18), Long-eared Owls’ pellets were collected at three winterroosts located at the southern part of Pannonian Plain, in the Serbian province of Vojvodina. In 8070 prey items from pellets, we identified 16 mammal and 32 bird species. The Common Vole was the dominant prey species with a proportion in a range from 27.4% to 71.6%. The Muridae family formed a supplementary part of the diet: Mus sp., wood mouse and harvest mouse, during all winters. Birds were also a major supplementary prey during winter 2014–15, comprising 10.6%. A comparison of our results with the diet of Long-eared Owls wintering at the northern Pannonian plain (southwestern Slovakia) indicated an increase the proportion of some species in the southern part. How different land uses in agriculture and environmental conditions may be reflected in the food supply are discussed in relation to the diet composition of Long-eared Owls and an environment whose is richer provides both growing diversity in the diet of these owls and an expansion of their food niche. Our study described the Long-eared Owl as opportunistic predators expanding their food niche in the presence of diversified prey.
Training and experience of coding with the World Health Organization’s International Classification of Diseases, Eleventh Revision
Authors: Eastwood Cathy A , Southern Danielle A , Doktorchik Chelsea , Khair Shahreen , Cullen Denise , Boxill Alicia , Maciszewski Malgorzata , Varela Lucia Otero , Ghali William , Moskal Lori , Quan Hude
Published: September 2021

Background:

The new International Classification of Diseases, Eleventh Revision for Mortality and Morbidity Statistics (ICD-11) was developed and released by the World Health Organization (WHO) in June 2018. Because ICD-11 incorporates new codes and features, training materials for coding with ICD-11 are urgently needed prior to its implementation.

Objective:

This study outlines the development of ICD-11 training materials, training processes and experiences of clinical coders while learning to code using ICD-11.

Method:

Six certified clinical coders were recruited to code inpatient charts using ICD-11. Training materials were developed with input from experts from the Canadian Institute for Health Information and the WHO, and the clinical coders were trained to use the new classification. Monthly team meetings were conducted to enable discussions on coding issues and to select the correct ICD-11 codes. The training experience was evaluated using qualitative interviews, a questionnaire and a coding quiz.

Results:

total of 3011 charts were coded using ICD-11. In general, clinical coders provided positive feedback regarding the training program. The average score for the coding quiz (multiple choice, True/False) was 84%, suggesting that the training program was effective. Feedback from the coders enabled the ICD-11 code content, electronic tooling and terminologies to be updated.

Conclusion:

This study provides a detailed account of the processes involved with training clinical coders to use ICD-11. Important findings from the interviews were reported at the annual WHO conferences, and these findings helped improve the ICD-11 browser and reference guide.
Six Digital Health Technologies That Will Transform Diabetes
Authors: Klonoff Alexander N. , Lee Wei-An (Andy) , Xu Nicole Y. , Nguyen Kevin T. , DuBord Ashley , Kerr David
Published: September 2021

The digital health revolution is transforming the landscape of medicine through innovations in sensor data, software, and wireless communication tools. As one of the most prevalent chronic diseases in the United States, diabetes is particularly impactful as a model disease for which to apply innovation. As with any other newly developed technologies, there are three key questions to consider: 1) How can the technology benefit people with diabetes?, 2) What barriers must be overcome to further advance the technology?, and 3) How will the technology be applied in the future?. In this article, we highlight six areas of innovation that have the potential to reduce the burden of diabetes for individuals living with the condition and their families as well as provide measurable benefits for all stakeholders involved in diabetes care. The six technologies which have the potential to transform diabetes care are (i) telehealth, (ii) incorporation of diabetes digital data into the electronic health record, (iii) qualitative hypoglycemia alarms, (iv) artificial intelligence, (v) cybersecurity of diabetes devices, and (vi) diabetes registries. To be successful, a new digital health technology must be accessible and affordable. Furthermore, the people and communities that would most likely benefit from the technology must be willing to use the innovation in their management of diabetes.
Resveratrol and Quercetin Potentiate the Cell Protection and Rescue Effects of NAD+ Precursors in HEK293 Cells Challenged by DNA Damaging Agent, N-Methyl-N′-nitro-N-nitrosoguanidine
Authors: Yang Yun , Liu Zhongwen , Zhao Baosheng , Joseph Sunil , Ma Yuanchun , Xu Hong , Cheng Hongwei
Published: September 2021

DNA damage plays an essential role in the human ageing process. Recently, accumulating evidence has demonstrated that a decreased level of nicotinamide adenine dinucleotide (NAD+) is involved in human ageing and suggested that the natural supplements of NAD+ precursors and its homeostasis regulators might serve as a promising modality to slow down the human ageing process. In the present study, we analyzed the combinational effects and potential mechanism of NAD+ precursors, nicotinic acid (NA) and nicotinamide (NM), and the NAD+’ homeostasis regulators, resveratrol (R), and quercetin (Q) in the protection and rescue of HEK293 cells from N-methyl- N'-nitro- N nitrosoguanidine (MNNG)-induced DNA damage. The results indicate that resveratrol and quercetin can significantly potentiate the cell protection and rescue effects of NAD+ precursors in HEK293 cells attacked by the DNA damaging agent, MNNG. Intracellular NAD+ homeostasis and the PARP1 activation status are the key factors in determining the fate of the cells under DNA damaging stress.
Eight Weeks of Self-Resisted Neck Strength Training Improves Neck Strength in Age-Grade Rugby Union Players: A Pilot Randomized Controlled Trial
Authors: Attwood Matthew J. , Hudd Lewis-Jon W. , Roberts Simon P. , Irwin Gareth , Stokes Keith A.
Published: September 2021

Background:

Greater neck strength is associated with fewer head and neck injuries. Neck-strengthening programs are commonly burdensome, requiring specialist equipment or significant time commitment, which are barriers to implementation.

Hypothesis:

Completing a neck-strengthening program will increase isometric neck strength in age-group rugby players.

Study Design:

A pilot randomized controlled exercise intervention study.

Level of Evidence:

Level 2.

Methods:

Twenty-eight U18 (under 18) male regional age-group rugby union players were randomized (intervention n =15/control n = 13). An 8-week exercise program was supervised during preseason at the regional training center. Control players continued their “normal practice,” which did not include neck-specific strengthening exercises. The 3-times weekly trainer-led intervention program involved a series of 15-second self-resisted contractions, where players pushed maximally against their own head, in forward, backward, left, and right directions.

Outcome Measure:

Peak isometric neck strength (force N) into neck flexion, extension, and left and right side flexion was measured using a handheld dynamometer.

Results:

Postintervention between-group mean differences (MDs) in isometric neck strength change were adjusted for baseline strength and favored the intervention for total neck strength (effect size [ES] = 1.2, MD ± 95% CI = 155.9 ± 101.9 N, P = 0.004) and for neck strength into extension (ES = 1.0, MD ± 95% CI = 59.9 ± 45.4 N, P = 0.01), left side flexion (ES = 0.7, MD ± 95% CI = 27.5 ± 26.9 N, P = 0.05), and right side flexion (ES = 1.3, MD ± 95% CI = 50.5 ± 34.4 N, P = 0.006).

Conclusion:

This resource-efficient neck-strengthening program has few barriers to implementation and provides a clear benefit in U18 players’ neck strength. While the present study focused on adolescent rugby players, the program may be appropriate across all sports where head and neck injuries are of concern and resources are limited.

Clinical Relevance:

Greater neck strength is associated with fewer head and neck injuries, including concussion. Performing this neck exercise program independently, or as part of a whole-body program like Activate, an interactive guide for players and coaches, could contribute to lower sports-related head and neck injuries.
On the genealogy of machine learning datasets: A critical history of ImageNet
Authors: Denton Emily , Hanna Alex , Amironesei Razvan , Smart Andrew , Nicole Hilary
Published: September 2021

In response to growing concerns of bias, discrimination, and unfairness perpetuated by algorithmic systems, the datasets used to train and evaluate machine learning models have come under increased scrutiny. Many of these examinations have focused on the contents of machine learning datasets, finding glaring underrepresentation of minoritized groups. In contrast, relatively little work has been done to examine the norms, values, and assumptions embedded in these datasets. In this work, we conceptualize machine learning datasets as a type of informational infrastructure, and motivate a genealogy as method in examining the histories and modes of constitution at play in their creation. We present a critical history of ImageNet as an exemplar, utilizing critical discourse analysis of major texts around ImageNet’s creation and impact. We find that assumptions around ImageNet and other large computer vision datasets more generally rely on three themes: the aggregation and accumulation of more data, the computational construction of meaning, and making certain types of data labor invisible. By tracing the discourses that surround this influential benchmark, we contribute to the ongoing development of the standards and norms around data development in machine learning and artificial intelligence research.
The Rise of Private Tutoring in Denmark: An Entrepreneur's Perspectives and Experiences
Authors: Kany Nicklas
Published: September 2021

• This article sheds light on the emergence of private tutoring in Denmark. Written from the perspective of a tutoring entrepreneur, it discusses the challenges and opportunities faced by a fledgling tutoring company in present-day Danish society.

• The article is a personal narrative of the author's experience with establishing the first major Danish tutoring company.

• The enthusiastic response by parents to the services offered by the author's company shows that there has long existed a hitherto unmet need for private tutoring in Denmark. However, the author also argues that the political turmoil surrounding the 2013 Danish school reform made parents increasingly sceptical that mainstream schools could effectively address the needs of their children. It thereby prepared the ground for launching a private tutoring concept.

• It is only in the last decade that private tutoring has emerged in Denmark. The article provides a unique insider's perspective on this largely unexplored development.
Digital Transformation: An Overview of the Current State of the Art of Research
Authors: Kraus Sascha , Jones Paul , Kailer Norbert , Weinmann Alexandra , Chaparro-Banegas Nuria , Roig-Tierno Norat
Published: September 2021

The increasing digitalization of economies has highlighted the importance of digital transformation and how it can help businesses stay competitive in the market. However, disruptive changes not only occur at the company level; they also have environmental, societal, and institutional implications. This is the reason why during the past two decades the research on digital transformation has received growing attention, with a wide range of topics investigated in the literature. The following aims to provide insight regarding the current state of the literature on digital transformation (DT) by conducting a systematic literature review. An analysis of co-occurrence using the software VOSviewer was conducted to graphically visualize the literature’s node network. Approached this way, the systematic literature review displays major research avenues of digital transformation that consider technology as the main driver of these changes. This paper qualitatively classifies the literature on digital business transformation into three different clusters based on technological, business, and societal impacts. Several research gaps identified in the literature on DT are proposed as futures lines of research which could provide useful insights to the government and private sectors in order to adapt to the disruptive changes found in business as a result of this phenomenon, as well as to reduce its negative impacts on society and the environment.
Contemporary Practice Patterns for the Treatment of Anterior Cruciate Ligament Tears in the United States
Authors: Cevallos Nicolas , Soriano Kylen K.J. , Lansdown Drew A. , Ma C. Benjamin , Feeley Brian T. , Zhang Alan L.
Published: September 2021

Background:

There is a lack of research investigating current practice trends in the treatment of anterior cruciate ligament (ACL) tears as well as common concomitant procedures and reoperations associated with ACL reconstruction (ACLR).

Purpose:

To analyze current practice patterns for ACLR as well as the frequency of concomitant and revision procedures with respect to patient characteristics in a cross-sectional population of the United States.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

Patient data between 2010 and 2017 were queried using the Mariner PearlDiver database. International Classification of Diseases, Ninth Revision (in 2010-2014) and Tenth Revision (ICD-10; in 2015-2017), diagnosis codes were used to identify ACL tears, and Current Procedural Terminology codes were used to identify ACLR and concomitant surgical procedures. Patient characteristics were stratified by sex and age. Cases of subsequent knee surgery and conversion to total knee arthroplasty (TKA) within 2 years after ACLR were tracked using ICD-10 codes between 2015 and 2017 to ensure ipsilateral laterality.

Results:

Of 229,295 patients identified with an ACL tear diagnosis during the study period, 75% underwent ACLR. In patients aged 10 to 39 years, 84% to 92% underwent ACLR, while patients aged 50 to 59 (50%) and 60 to 69 (28%) years were less likely to have surgery after an ACL tear. Female and male patients underwent ACLR at a similar rate (75%). Within the patients who underwent ACLR, 44% underwent concomitant meniscal debridement as compared with 11% with concomitant meniscal repair. Male patients were more likely to undergo meniscal debridement (48% vs 40%; P < .0001). The frequency of meniscal repair increased from 9% in 2010 to 14% in 2017, while the frequency of meniscal debridement decreased from 47% to 41% ( P < .0001). Within 2 years of ACLR, 6% of patients underwent revision ACLR; 4%, subsequent meniscal debridement; 1%, meniscal repair; and 1%, conversion to TKA.

Conclusion:

The frequency of ACLR for ACL tears has remained relatively stable in recent years and was similar between female and male patients in this cross-sectional population. The majority of patients aged 10 to 39 years underwent ACLR, while less than half of patients >50 years underwent surgery.
The Experiences of Caregivers of Persons Living with Dementia in Jamaica during COVID-19
Authors: Stubbs Marissa , Govia Ishtar , Robinson Janelle N. , Amour Rochelle , Freeman Emily
Published: September 2021

This article provides descriptive insights of the experiences of family caregivers of persons living with dementia during the COVID-19 pandemic. Data were generated as part of a qualitative cross-national project to explore the costs and consequences of providing unpaid dementia care. Participants in Jamaica, who were recruited using community gatekeepers, information booths at health fairs, conferences, and other outreach events, were contacted by telephone to discuss their experiences of the pandemic. When face-to-face in-depth interview data collection was suspended due to the pandemic, ethical approval was received to contact all research participants who were informal unpaid family caregivers, both those whose care recipients had died and those who were active caregivers ( N = 19). Participants in this study were the 10 active family caregivers ( n F = 8; aged 45+; 60% from high socio-economic status). Their updates and reflections during these calls were documented in fieldnotes and analyzed for key themes. Data showed that the pandemic has illustrated the direct costs, both financial and otherwise, that informal dementia carers bear in Jamaica. It also intensified pre-existing challenges faced by family carers. We provide recommendations for sustainable support for family carers.
Mycoplasma pneumoniaecarriage evades induction of protective mucosal antibodies
Authors: de Groot Ruben Cornelis Anthonie , Estevão Silvia Cristina , Meyer Sauteur Patrick Michael , Perkasa Aditya , Hoogenboezem Theo , Spuesens Emiel Benny Margriet , Verhagen Lilly Maria , van Rossum Anna Maria Christiane , Unger Wendy Wilhelmina Josephina
Published: September 2021

Background

Mycoplasma pneumoniaeis the most common bacterial cause of pneumonia in children hospitalised for community-acquired pneumonia (CAP). Prevention of infection by vaccines may be an important strategy in the presence of emerging macrolide-resistantM. pneumoniae.However, knowledge of immune responses toM. pneumoniaeis limited, complicating vaccine design.

Methods

We studied the antibody response duringM. pneumoniaerespiratory tract infection and asymptomatic carriage in two different cohorts.

Results

In a nested case–control study (n=80) ofM. pneumoniaecarriers and matched controls we observed that carriage byM. pneumoniaedoes not lead to a rise in either mucosal or systemicM. pneumoniae-specific antibodies, even after months of persistent carriage. We replicated this finding in a second cohort (n=69) and also found that duringM. pneumoniaeCAP, mucosal levels ofM. pneumoniae-specific IgA and IgG did increase significantly.In vitroadhesion assays revealed that high levels ofM. pneumoniae-specific antibodies in nasal secretions of paediatric patients prevented the adhesion ofM. pneumoniaeto respiratory epithelial cells.

Conclusions

Our study demonstrates thatM. pneumoniae-specific mucosal antibodies protect against bacterial adhesion to respiratory epithelial cells, and are induced only duringM. pneumoniaeinfection and not during asymptomatic carriage. This is strikingly different from carriage with bacteria such asStreptococcus pneumoniaewhere mucosal antibodies are induced by bacterial carriage.
Factors affecting adherence with treatment advice in a clinical trial of patients with severe asthma
Authors: Busby John , Matthews John G. , Chaudhuri Rekha , Pavord Ian D. , Hardman Timothy C. , Arron Joseph R. , Bradding Peter , Brightling Christopher E. , Choy David F. , Cowan Douglas C. , Djukanovic Ratko , Hanratty Catherine E. , Harrison Tim W. , Holweg Cecile T. , Howarth Peter H. , Fowler Stephen J. , Lordan James L. , Mansur Adel H. , Menzies-Gow Andrew , Niven Robert M. , Robinson Douglas S. , Walker Samantha M. , Woodcock Ashley , Heaney Liam G.
Published: September 2021

Background

Understanding why patients with severe asthma do not follow healthcare provider (HCP) advice to adjust treatment is critical to achieving personalised disease management.

Methods

We reviewed patient choice to follow HCP advice to adjust asthma treatment in a UK-based randomised, controlled, single-blind (study participant), multicentre, parallel group 48-week clinical study comparing biomarker-directed treatment adjustment with standard care in severe asthma.

Results

Of 1572 treatment advisories (291 participants), instructions were followed in 1377 cases (87.6%). Patients were more likely to follow advice to remain on treatment (96.7%) than to either reduce (70.3%) or increase (67.1%) their treatment, with 64% of patients following all treatment advice. Multivariate analysis associated belonging to an ethnic minority group (OR 3.10, 95% CI 1.68–5.73) and prior study medication changes (two or more changes: OR 2.77, 95% CI 1.51–5.10) with failure to follow treatment advice. In contrast, emergency room attendance in the prior year (OR 0.54, 95% CI 0.32–0.92) was associated with following treatment advice. The largest effect was seen with transition onto or off oral corticosteroids (OR 29.28, 95% CI 16.07–53.36) when compared with those requested to maintain treatment. Centre was also an important determinant regarding the likelihood of patients to follow treatment advice.

Conclusions

Belonging to an ethnic minority group and multiple prior treatment adjustments were associated with not following HCP treatment advice. Patients also responded differently to HCP advice across UK specialist centres. These findings have implications for the generalisability of models of care in severe asthma and require further focused studies.
Salivary detection of COVID-19: clinical performance of oral sponge sampling for SARS-CoV-2 testing
Authors: Boutros Jacques , Benzaquen Jonathan , Marquette Charles Hugo , Ilié Marius , Labaky Mickelina , Benchetrit Didier , Lavrut Thibaut , Leroy Sylvie , Chemla Richard , Carles Michel , Tanga Virginie , Maniel Charlotte , Bordone Olivier , Allégra Maryline , Lespinet Virginie , Fayada Julien , Griffonnet Jennifer , Hofman Véronique , Hofman Paul
Published: September 2021

Background

The current diagnostic standard for coronavirus disease 2019 (COVID-19) is reverse transcriptase-polymerase chain reaction (RT-PCR) testing with nasopharyngeal (NP) swabs. The invasiveness and need for trained personnel make the NP technique unsuited for repeated community-based mass screening. We developed a technique to collect saliva in a simple and easy way with the sponges that are usually used for tamponade of epistaxis. This study was carried out to validate the clinical performance of oral sponge (OS) sampling for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing.

Methods

Over a period of 22 weeks, we collected prospectively 409 paired NP and OS samples from consecutive subjects presenting to a public community-based free screening centre. Subjects were referred by their attending physician because of recent COVID-19 symptoms (n = 147) or by the contact tracing staff of the French public health insurance because they were considered as close contacts of a laboratory-confirmed COVID-19 case (n = 262).

Results

In symptomatic subjects, RT-PCR SARS-CoV-2 testing with OS showed a 96.5% (95% CI: 89.6–94.8) concordance with NP testing, and a 93.2% (95% CI: 89.1–97.3) sensitivity when using the IdyllaTM platform and a sensitivity of 76.3% (95% CI: 69.4–83.2) on the Synlab Barla laboratory platform. In close contacts the NP-OS concordance (93.8%, 95% CI: 90.9–96.7) and OS sensitivity (71.9%, 95% CI: 66.5–77.3) were slightly lower.

Conclusion

These results strongly suggest that OS testing is a straightforward, low-cost and high-throughput sampling method that can be used for frequent RT-PCR testing of COVID-19 patients and mass screening of populations.
Fungal keratitis caused by Pseudallescheria boydii: clinical and mycological characteristics
Authors: Izadi Alireza , Soleimani Mohammad , dos Santos Claudy Oliveira , Tehupeiory-Kooreman Marlou C. , Daie Ghazvini Roshanak , Hashemi Seyed Jamal , Gramishoar Mohssen , Aminizadeh Mehdi , Abedinifar Zohre , Verweij Paul E. , Khodavaisy Sadegh
Published: September 2021

Background

Pseudallescheria keratitis is rare but important type of fungal keratitis because of the inherently resistance of the organism to many existing antifungal agents.

Methods

Slit-lamp and confocal microscopy were used for clinical examinations. Fungal isolates were identified based on morphological characteristics and DNA sequence of the internal transcribed spacer region (ITS). In vitro antifungal susceptibility testing for fungal isolates was performed according to the Clinical and Laboratory Standards Institute (CLSI, M38-A2).

Result

All patients had a history of ocular trauma. In clinical examination hypopion were seen in three patients. The main antifungal medications were topical voriconazole. After treatment the visual acuity of all patients improved in 2–3 weeks.

Conclusion

All four patients of Pseudallescheria keratitis had similar clinical features. Accurate and rapid identification of species should be helpful in treating p. boydii keratitis.
Effects of different plasma target concentrations of remifentanil on the MACBAR of sevoflurane in children with laparoscopic surgery
Authors: Wang Dan , Xu Juan , Yang Xiao-Lin , Guo Yan-Xia , Jiang Ping-Ping , Zhang Guo-Yuan
Published: September 2021

Background

To investigate the effects of different plasma target concentrations of remifentanil on the minimum alveolar concentration (MAC) for blocking adrenergic response (BAR) of sevoflurane in children with laparoscopic herniorrhaphy.

Methods

Seventy-five children with 3-7 years old scheduled for laparoscopic herniorrhaphy were randomly divided into group R0, group R1, and group R2 according to different remifentanil plasma target concentration (0, 1, and 2 ngml-1), respectively. The MACBAR of sevoflurane was determined by the up-and-down and sequential method in each group. The concentrations of epinephrine and noradrenaline were also determined at corresponding time points.

Results

A total of 52 child patients were used among the anticipated 75 patients. In groups R0, R1, and R2, the MACBAR of sevoflurane was (3.29 ± 0.17) %, (2.12 ± 0.10) % and (1.29 ± 0.11) %, respectively, and a significant difference was found among the three groups (P<0.05). The changes of epinephrine and noradrenaline concentrations in each group before and after insufflation of carbon dioxide pneumoperitoneum showed no significant differences.

Conclusion

Remifentanil by target-controlled infusion can effectively reduce the MACBAR of sevoflurane during laparoscopic surgery in children. At a similar effect of MACBAR, both the changes of epinephrine and noradrenaline concentrations are not affected by the infusion of different remifentanil target concentrations.

Trial registration

The trial was registered at http://www.chictr.org.cn(ChiCTR1800019393, 8, Nov, 2018).
Effects of low-frequency repetitive transcranial magnetic stimulation combined with cerebellar continuous theta burst stimulation on spasticity and limb dyskinesia in patients with stroke
Authors: Li Dawei , Cheng Aixia , Zhang Zhiyou , Sun Yuqian , Liu Yingchun
Published: September 2021

Background

Repetitive transcranial magnetic stimulation (rTMS) has been reported to treat muscle spasticity in post-stroke patients. The purpose of this study was to explore whether combined low-frequency rTMS (LF-rTMS) and cerebellar continuous theta burst stimulation (cTBS) could provide better relief than different modalities alone for muscle spasticity and limb dyskinesia in stroke patients.

Methods

This study recruited ninety stroke patients with hemiplegia, who were divided into LF-rTMS+cTBS group (n=30), LF-rTMS group (n=30) and cTBS group (three pulse bursts at 50 Hz, n=30). The LF-rTMS group received 1 Hz rTMS stimulation of the motor cortical (M1) region on the unaffected side of the brain, the cTBS group received cTBS stimulation to the cerebellar region, and the LF-rTMS+cTBS group received 2 stimuli as described above. Each group received 4 weeks of stimulation followed by rehabilitation. Muscle spasticity, motor function of limb and activity of daily living (ADL) were evaluated by modified Ashworth Scale (MAS), Fugl-Meyer Assessment (FMA) and Modified Barthel Index (MBI) scores, respectively.

Results

The MAS score was markedly decreased, FMA and MBI scores were markedly increased in the three groups after therapy than before therapy. In addition, after therapy, LF-rTMS+cTBS group showed lower MAS score, higher FMA and MBI scores than the LF-rTMS group and cTBS group.

Conclusion

Muscle spasticity and limb dyskinesia of the three groups are all significantly improved after therapy. Combined LF-rTMS and cTBS treatment is more effective in improving muscle spasticity and limb dyskinesia of patients after stroke than LF-rTMS and cTBS treatment alone.
Cultural adaptation of the mental health first aid guidelines for assisting a person at risk of suicide for Sri Lanka: a Delphi expert consensus study
Authors: Chandrasiri Amila , Fernando Madhawee , Dayabandara Madhubhashinee , Reavley Nicola J.
Published: September 2021

Background

Approximately 3000 people die by suicide each year in Sri Lanka. As family and friends may play a role in supporting a person at risk of suicide to get appropriate help, there is a need for evidence-based resources to assist with this. The aim of this study was to culturally adapt the existing English-language mental health first aid guidelines for helping a person at risk of suicide to the Sri Lankan context.

Methods

A Delphi expert consensus study was conducted, involving mental health professionals and consumers (people with lived experience) and caregivers, who were identified by purposive and snowball sampling methods. Participants were recruited from a wide variety of professional roles and districts of Sri Lanka in order to maximize diversity of opinion. The original questionnaire was translated into Sinhala and participants were requested to rate each item according to the importance of inclusion in the guidelines.

Results

Data were collected over two survey rounds. Altogether, 148 people participated in the study (130 health professionals and 18 consumers). A total of 165 items were included in the final guidelines, with 153 adopted from the guidelines for English-speaking countries and 12 generated from the comments of panellists.

Conclusions

The adapted guidelines were similar to the English-language guidelines. However, new items relating to the involvement of family members were included and some items were omitted because they were not considered appropriate to the Sri Lankan context (particularly those relating to explicit mention of suicide). Further research is warranted to explore the use of these guidelines by the Sri Lankan public, including how they may be incorporated in Mental Health First Aid training.
Physical fighting among adolescents in eastern Ethiopia: a cross-sectional study
Authors: Semahegn Agumasie , Dessie Yadeta , Assefa Nega , Canavan Chelsey R. , Berhane Yemane , Fawzi Wafaie W.
Published: September 2021

Background

Physical fights have been a common health problem among adolescents, and approximately a million adolescents’ lives are lost due to violence-related incidents worldwide. There is a lack of information on the burden of adolescents’ physical fights in eastern Ethiopia. Hence, the study aims to estimate the magnitude and assess factors associated with physical attacks and fighting among adolescents in eastern Ethiopia.

Methods

A community-based cross-sectional study was conducted among 2424 adolescents in eastern Ethiopia in 2016. Simple random sampling was used to recruit study participants. Data were collected by trained interviewers using a structured questionnaire developed by the Africa Research, Implementation Science and Education (ARISE) network and adapted from the World Health Organization Global school-based student health survey. Descriptive statistics, binary and multivariable logistic regression were performed. Statistical associations were determined using adjusted odds ratio (AOR) at 95% Confidence Intervals (95% CIs) and P-value < 0.05.

Results

Prevalence of physical attacks and physical fights was 5.8%, and 26.4%, respectively. Adolescents who attended school (AOR 0.4, 95% CI: 0.2–0.9) and who chewed Khat (AOR 0.4, 95% CI: 0.2–0.8) were less likely to experience physical attacks. Male adolescents were two times more likely to engage in physical fights than female adolescents (AOR 2.4, 95% CI: 1.8–3.2). In-school adolescents who attended secondary (AOR 0.4, 95% CI: 0.2–0.7) or tertiary level of education (AOR 0.2, 95% CI: 0.1–0.7) were less likely to participate in physical fighting than those with primary level education. Adolescents who had ever engaged in physical work to earn money for food or drink were 1.9 times more likely to be physically attacked compared to those who had not (AOR 1.9, 95% CI: 1.0–3.5).

Conclusion

Physical attacks and fights were found to be common experiences of adolescents in eastern Ethiopia. Future research and programs should emphasize preventive health programs for reducing violence and promoting school enrolment and retention.
Validity of the ACTS intimate partner violence screen in antenatal care: a cross sectional study
Authors: Hegarty K. , Spangaro J. , Kyei-Onanjiri M. , Valpied J. , Walsh J. , Chapman J. , Koziol-McLain J.
Published: September 2021

Background

Intimate partner violence (IPV) is a major public health problem with harmful consequences. In Australia, there is no national standard screening tool and screening practice is variable across states. The objectives of this study were to assess in the antenatal healthcare setting: i) the validity of a new IPV brief screening tool and ii) women’s preference for screening response format, screening frequency and comfort level.

Methods

One thousand sixty-seven antenatal patients in a major metropolitan Victorian hospital in Australia completed a paper-based, self-administered survey. The survey included four screening items about whether they were Afraid/Controlled/Threatened/Slapped or physically hurt (ACTS) by a partner or ex-partner in the last 12 months; and the Composite Abuse Scale (reference standard). The ACTS screen was presented firstly with a binary yes/no response format and then with a five-point ordinal frequency format from ‘never’ (0) to ‘very frequently’ (4). The main outcome measures were test statistics of the four-item ACTS screening tool (sensitivity, specificity, predictive values, and area under the curve) against the reference standard and women’s screening preferences.

Results

Twelve-month IPV prevalence varied depending on the ACTS response format with 8% (83) positive on ACTS yes/no format, 12.8% (133) positive on ACTS ordinal frequency format and 10.5% (108) on the reference Composite Abuse Scale. Overall, the ACTS screening tool demonstrated clinical utility for the ordinal frequency format (AUC, 0.80; 95% CI = 0.76 to 0.85) and the binary yes/no format (AUC, 0.74, 95% CI = 0.69 to 0.79). The frequency scale (66%) had greater sensitivity than the yes/no scale (51%). The positive and negative predictive values were 56 and 96% for the frequency scale and 68 and 95% for the yes/no scale. Specificity was high regardless of screening question response options. Half (53%) of the women categorised as abused preferred the yes/no scale. Around half of the women (48%, 472) thought health care providers should ask pregnant women about IPV at every visit.

Conclusions

The four-item ACTS tool (using the frequency scale and a cut-off of one on any item) is recommended for written self-administered screening of women to identify those experiencing IPV to enable first-line response and follow-up.
Optimizing inhalation therapy in the aspect of peak inhalation flow rate in patients with chronic obstructive pulmonary disease or asthma
Authors: Hua Jian-lan , Ye Xiao-fen , Du Chun-ling , Xie Ning , Zhang Jie-qing , Li Man , Zhang Jing
Published: September 2021

Background

Pressurized metered dose inhalers (pMDIs) and dry powder inhalers (DPIs) are commonly used drug-delivering devices for patients with chronic airway diseases. Appropriate peak inhalation flow rate (PIFR) and inhaler technique is essential for effective therapy. We aimed at optimizing inhalation therapy through the analysis of PIFRs in patients with chronic obstructive pulmonary disease (COPD) or asthma as well as the effect of technique training using In-Check DIAL® to help patients to achieve their optimal inspiratory flow rates.

Methods

The study continuously enrolled patients who were diagnosed as COPD or asthma from respiratory clinics. PIFRs were described and analyzed between the newly-diagnosed and follow-up patients, and the stable and acute exacerbation patients, respectively. Every participant was trained inhaler technique using In-Check DIAL®. PIFRs before and after training was compared by self-control analysis.

Results

Among a total of 209 patients, the average age was 56.9 years. For DPIs users, 10.8% patients had a PIFR < 30 L/min and 44.1% patients had a PIFR ≥ 60 L/min before technique training. After technique training, scarcely patient (1.5%) had a PIFR < 30 L/min, and 60.5% patients had a PIFR ≥ 60 L/min. The patient’s average PIFR increased by 5.6L/min after training. The increase in PIFR before and after training was significant (p < 0.001) for most patients, but no significant variation was found in patients with acute exacerbation (p = 0.822).

Conclusions

A considerable number of patients with COPD or asthma were not able to achieve the minimum or optimal PIFR for DPIs. Inhaler training can increase patients’ PIFRs and improve their ability to use DPIs.

Trail registrationThe study has registered in chictr.org.cn (ChiCTR1900024707) and been approved by the Ethics Committee of Zhongshan Hospital of Fudan University (B2019-142).
Safety and effectiveness of saving sphincter procedure in the treatment of chronic anal fissure in female patients
Authors: D’Orazio Beatrice , Geraci Girolamo , Bonventre Sebastiano , Calì Dario , Di Vita Gaetano
Published: September 2021

Introduction

Lateral internal sphincterotomy (LIS) is still the approach of choice for the treatment of chronic anal fissure (CAF) regardless to the internal anal sphincter tone but it is burdened by high risk post-operative faecal incontinence (FI). In female patient there are some anatomical and functional differences of the sphinteric system which make them more at risk of FI and vaginal birth could cause sphinteric lesions affecting the anal continence function. The aim of our study is to evaluate the results of saving sphincter procedure as treatment for female patients affected by CAF.

Methods

We studied 110 female patients affected by CAF undergone fissurectomy and anoplasty with V–Y cutaneous flap advancement associating pharmacological sphincterotomy in patients with hypertonic IAS. The follow up was at least for 2 years. The goals were patient’s complete healing, the evaluation of FI, recurrence rate and manometry parameters.

Results

All wounds healed within 40 days after surgery. We recorded 8 cases of recurrences 6 healed with medical therapy and 2 with dilatation. We recorded 2 “de novo” temporary and low grade post-operative cases of FI. Post-operative value of MRP were unmodified in patient with normotonic IAS but significantly lower at 12 months follow up as compared with the pre-operative ones in patients with hypertonic IAS; after 24 months from surgery MRP values were within the normal range.

Conclusion

The fissurectomy and anoplasty with V–Y cutaneous flap alone or in association with a pharmacological sphincterotomy in patients with hypertonic IAS may represent an effective approach for the treatment of CAF in female patients.
Good role models? Tooth brushing capabilities of parents: a video observation study
Authors: Deinzer Renate , Shankar-Subramanian Sadhvi , Ritsert Alexander , Ebel Stefanie , Wöstmann Bernd , Margraf-Stiksrud Jutta , Eidenhardt Zdenka
Published: September 2021

Background

Research in adolescents reveals that they are not capable to remove dental plaque effectively. Inconsistent application of brushing techniques and neglect of certain areas while brushing are very common. As parents play a major role in the oral health education, the present study aimed to examine and describe the tooth brushing performance of the parents of adolescents.

Methods

Parents of adolescents (N = 66) were asked to perform oral hygiene to the best of their capabilities in front of a video camera and dental plaque was recorded before and afterwards. Papillary bleeding was also assessed.

Results

The tooth contact time (i.e. net brushing duration) averaged 155 s ± 58 s. Gingival margins showed persistent plaque at 68% ± 14% of the sections assessed. Papillary bleeding was found at 52% ± 18% of the papillae. Parents brushed inner surfaces lesser than the outer surfaces (41 s ± 24 s vs. 73 s ± 33 s) and 29% of the parents completely missed the inner surfaces of at least one sextant. On the outer surfaces parents predominantly applied circular movements (66% ± 25% of brushing time). Vertical brushing prevailed on the inner surfaces (52% ± 30%). However, horizontal scrubbing was also very common (46% ± 31%).

Conclusions

Parents’ tooth brushing performance was neither effective in terms of plaque removal nor did they fully comply with tooth brushing recommendations such as considering all inner surfaces when brushing or application of other than horizontal movements to lateral surfaces. Regarding oral hygiene, parents should not only be a good role model in terms of timing, frequency and duration of tooth brushing but should also be able to demonstrate how to brush teeth completely and effectively. The current research indicates that they might lack the latter skill.