bluuebunny/crossref_metadata_2025 huggingface dataset:
Determining the Most Suitable Tomography-Based Parameters to Describe Progression in Keratoconus. The Retrospective Digital Computer Analysis of Keratoconus Evolution Project
Authors: Jiménez-García Marta , Kreps Elke O. , Ní Dhubhghaill Sorcha , Koppen Carina , Rozema Jos J. ,   The REDCAKE Study Group
Published: May 2021

Objectives:

To identify the most suitable parameters to describe keratoconus progression.

Methods:

Longitudinal retrospective cohort study. Monotonicity and consistency of over 250 parameters extracted from the Pentacam tomographies (Oculus, Germany) of 743 patients was analyzed. Repeatability was calculated for 69 patients (published elsewhere). The parameters were scored based on their performance for each desired feature and a global ranking was created.

Results:

Overall, parameters that average a higher number of corneal points performed better than single-point parameters. Zonal keratometries on areas surrounding the maximum curvature point and the steepest front keratometry performed best, followed by front best-fit sphere and mean keratometry of both surfaces. Platform-dependent indices (e.g., Belin-Ambrósio Deviation- or index height decentration-) obtained good scores, but platform-independent LOGIK performed slightly better. Finally, although minimum radius in both surfaces worked competently, minimum pachymetry (PachyMin) performed considerably poorer.

Conclusions:

We presented a list of parameters whose behavior was repeatable, monotonic and consistent, features desirable to describe change. The parameters normally used to follow keratoconus progression may not be the most adequate, as evidenced by the poor performance of PachyMin. Although calculated for a specific Scheimpflug device, most of the best-performing parameters are platform-independent variables, and results may be generalized, pending validation.
The symmetry indices of malar mounds for zygomatic bone fracture management based on a computed tomographic model
Authors: Wang Tien-Hsiang , Yu Wen-Chan , Chen Zih-Hua , Tien Yao-Hsuan , Chen Wei-Ming , Chiu Fang-Yau , Wang Shyh-Jen
Published: May 2021

Background:

To date, plastic surgeons do not have an objective method of measuring facial symmetry for zygomatic bone fracture management. Based on clinical practice, the authors utilized a 3-dimensional (3D) model to propose the symmetry index from the anterior view (SIAV) and the symmetry index from inferior view (SIIV). This study aimed to assess the application of these 2 indices.

Methods:

The SIAV is defined as the distance between the superior and lower orbital rims (DSLOR) of the defective side divided by that of the healthy side in the anterior view. The SIIV is defined as the area within the region of interest (AROI) of the defective side divided by that of the healthy side in the inferior view. We retrospectively reviewed 95 patients who underwent zygomatic fracture surgery at our medical center from January 2017 to September 2020. The Patients who had bilateral zygomatic fractures and did not have both pre- and postoperative computed tomography (CT) images were excluded.

Results:

Five out of the 95 patients were enrolled in this study. The difference between pre- and postoperative mean AROI and DSLOR on the healthy side was not significant. The insignificant difference indicates the repeatability of the measurement of the 3D skull model and different CT machines would not affect the calculation of AROI and DSLOR. The mean values of postoperative SIAV (1.06 ± 0.07) and SIIV (1.02 ± 0.08) were closer to 1 than the preoperative values (0.97 ± 0.09 and 1.10 ± 0.12). Although the difference was not statistically significant, the SIIV and SIAV would numerically present the changes in malar bone fracture postoperatively.

Conclusion:

The SIAV and SIIV based on clinical practice could numerically assess the symmetry of the malar mound.
Mediating Effects of Work Eudemonic Well-being for the Association Between Psychosocial Work Environment and Overall Eudemonic Well-being Among Japanese Workers
Authors: Sato Nana , Watanabe Kazuhiro , Kawakami Norito
Published: May 2021

Objective:

This study aimed to investigate the mediating effects of eudemonic well-being (EWB) at work for the associations between psychosocial work environment and overall EWB among Japanese workers.

Methods:

We conducted a cross-sectional study using data from a 2018 survey. psychosocial work environment measures included: job demands, job control, and supervisor and coworker support. Path analysis using structural equation modeling and mediation analysis were applied to examine the mediating effects of work EWB.

Results:

A total of 834 workers were analyzed. Work EWB completely mediated the associations of job control (β = 0.288, P < 0.001) and coworker support with overall EWB (β = 0.178, P < 0.001).

Conclusions:

The effects of job control and coworker support associated with overall EWB were fully mediated by work EWB.
Assessing Inequities in Cervical Cancer Quality of Care and Survival Related to Ethnicity and Socioeconomic Factors
Authors: Cantwell Christopher J. , Moroney Marisa R. , Sheeder Jeanelle , Guntupalli Saketh R.
Published: May 2021

Objective

This study aimed to assess the effect that race and socioeconomic factors have on the provision of care to cervical cancer patients based on National Comprehensive Cancer Network (NCCN) recommended treatment guidelines.

Materials and Methods

To do this, we completed a retrospective cohort study using the American College of Surgeon's Nation Cancer Database from 2004 to 2016. We identified all reported cases of cervical cancer in that period. Two cohorts were created using self-reported racial demographic data, Hispanic- and White, non-Hispanic–identified patients. Our primary outcome variables were adherence to NCCN-recommended treatment and 5-year overall survival. Adherence to NCCN-recommended treatment was determined by the provision of surgical and/or radiation and/or chemotherapy treatment based on the clinical stage at time of diagnosis and the presence or absence of lymphovascular space invasion. We used bivariate analyses to compare baseline characteristics between the 2 cohorts, multivariable logistic regression to identify independent predictors of 5-year survival, and Cox proportional hazards models to compute survival by group.

Results

The difference in NCCN-adherent care between the 2 cohorts was found to be not statistically significant (p = .880). A log rank (Mantel-Cox) χ2 test showed that there was a statistically significant difference between the 2 groups in overall survival with the Hispanic-identified patients living longer (p < .001). Our study is limited by the effect large databases confer on finding statistical significance.

Conclusions

Hispanic-identified women with cervical cancer receive NCCN-compliant care and live longer than their White, non-Hispanic counterparts.
An End-of-Life Communication Performance Rubric
Authors: Kopp Mary Louisa , Mayberry Adrienne Lynn Marie
Published: May 2021

Nurse educators still struggle with teaching and assessing end-of-life communication skills. Many resources are available to assist in teaching end-of-life communication, but few tools exist to assess performance learning outcomes. Behavior evaluation tools must be user-friendly and provide beneficial student feedback. Quality end-of-life patient care and nursing job satisfaction depend on skillful communication. The purpose of this study was to evaluate the reliability of an end-of-life communication clinical simulation evaluation performance rubric. Moderate interrater consistency and agreement were found between 3 evaluators when assessing the same students. All simulation evaluators agreed that the performance rubric was user-friendly and provided rich feedback for students during simulation debriefing. The performance evaluation tool was moderately effective when evaluating end-of-life communication performance and appears as a worthy framework for other behavior evaluations.
Paired Testing of Sexually Transmitted Infections With Urine Pregnancy Tests in Incarcerated Women
Authors: Dang Christine M. , Pao Julie , Taherzadeh Dena , Nijhawan Ank E.
Published: May 2021

Background

In correctional facilities, sexually transmitted infections (STIs) are common, are often asymptomatic, and may lead to adverse outcomes such as infertility and increased HIV acquisition. In January 2020, testing for Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) was paired with routine urine pregnancy tests among women entering a large county jail to increase testing and detection of STIs.

Methods

The results of all GC/CT urine tests in the Dallas County Jail were collected from October 2019 to February 2020. Medical records were reviewed to collect demographic factors and to determine the positivity of GC/CT infections, time to results, and time to treatment.

Results

With paired testing, monthly testing rates increased 4.7-fold among incarcerated females from 125 to 589 tests without substantial change for males (174 to 163). The number of infections detected in females increased from 25 (7%) of 359 to 62 (5.3%) of 1171 for GC and 42 (11.2%) of 374 to 129 (11%) of 1177 for CT without a significant difference in GC (P = 0.23) or CT positivity (P = 0.66). Younger women (≤25 years) had the highest rates of CT (18.8% [66/350]), whereas GC was highest among women aged 31 to 35 years (9.9% [32/321]). Average time to results and treatment were 5.8 and 1.8 days, respectively.

Conclusions

Pairing GC/CT testing with routine urine pregnancy tests resulted in a large (4.7-fold) increase in the number of STI tests and a comparable increase (3.7- to 4.6-fold) in the number of infections detected. Future efforts should focus on incorporating STI testing into routine jail practices and expediting treatment to further improve outcomes in this vulnerable population.
A Narrative Review of Where We Are With Point-of-Care Sexually Transmitted Infection Testing in the United States
Authors: Gaydos Charlotte A. , Manabe Yukari C. , Melendez Johan H.
Published: May 2021

Background

Point-of-care (POC) tests enable immediate diagnosis and targeted treatment of sexually transmitted infections (STIs), which could accelerate control of ongoing epidemics. Although older nucleic acid amplification tests have improved the accuracy of laboratory-based tests for STIs, newer POC tests can facilitate control efforts. We sought to review the performance and time to result of POC assays for STIs in the last 10 years.

Methods

The authors performed a PubMed, US National Library of Medicine, National Center for Biotechnology Information search for POC tests for STIs or sexually transmitted diseases.

Results

Diagnostic technology for POC assays for STIs has achieved high sensitivity and specificity (>90%) using recent molecular advances in the last 10 years. Three POC tests for chlamydia and gonorrhea and 2 for trichomonas have been cleared by the Food and Drug Administration and can provide rapid results during the clinical encounter. Two POC assays for syphilis are now cleared by the Food and Drug Administration. Other similar POC assays are in development. These “fast followers” have faster time to result and will extend the diagnostic armamentarium at POC.

Conclusions

New technology has improved the performance accuracy of STI POC diagnostics. Innovation in device format has resulted in accurate POC assays, which can decrease the time to result and accelerate the detection and treatment of STIs during the clinical encounter. The full implementation potential of these newer tests will depend on the ability of these tests to achieve Clinical Laboratory Improvement Amendments–waived status so they can be performed by nonlaboratorians with no previous training.
Low Awareness of Mycoplasma genitalium in Men Who Have Sex With Men in Sydney, Australia
Authors: Varma Rick , Bradley Isabella , Patel Prital , McNulty Anna
Published: May 2021

Objectives

Mycoplasma genitalium (M. genitalium) is a sexually transmitted infection of importance because of the high prevalence rates and antimicrobial resistance (AMR) among men who have sex with men (MSM).

Methods

A prospective cross-sectional analysis was carried out on MSM who presented rectally asymptomatic at a central Sydney sexual health clinic or a community site for routine testing. Between March and May 2017, participants were asked to complete a questionnaire before testing. We used multivariable logistic regression to identify factors associated with awareness and concern toward M. genitalium and AMR.

Results

Overall, 692 (92.5%) of 746 (95% confidence interval [CI], 90.7–94.5) MSM had no prior awareness of M. genitalium; 512 (68.6%) of 746 (95% CI, 65.2–72.0) were not concerned or were neutral about the infection; and 234 (31.4%) of 746 (95% CI, 28.0–34.8) were a little, somewhat, or very concerned. High partner numbers (adjusted odds ratio [AOR], 4.2; 95% CI, 2.1–8.2) and inconsistent condom users (AOR, 3.1; 95% CI, 1.2–8.2) and no condoms used (AOR, 3.9; 95% CI, 1.2–12.6) were associated with awareness of the infection. Time since arrival in Australia of more than 10 years (AOR, 1.73; 95% CI, 1.09–2.75), more than 12 months (AOR, 1.91; 95% CI, 1.31–2.79), and recreational drug use (AOR, 1.95; 95% CI, 1.17–3.24) were associated with concern around having M. genitalium. Overall, 61.6% (458/744; 95% CI, 58.2–65.3) MSM reported that they would increase condom use (38.6% agreed and 23.1% strongly agreed) after reading about AMR. Among the remaining 38.4% (286/744), 28.4% indicated a neutral response to increasing their condom use. Relative to MSM born in Australia, Latin American (AOR, 7.3; 95% CI, 2.9–18.4) or Asian MSM (AOR, 2.3; 95% CI, 1.4–3.3), were significantly more likely to increase condom use after reading a statement on AMR.

Conclusions

Knowledge of M. genitalium remains low among MSM. Targeted messages using AMR and treatment difficulties with M. genitalium is unlikely to change behavior for a large proportion of MSM.
Effects of Patient Sexual Orientation and Gender Identity on Medical Students' Decision Making Regarding Preexposure Prophylaxis for Human Immunodeficiency Virus Prevention: A Vignette-Based Study
Authors: Bunting Samuel R. , Feinstein Brian A. , Hazra Aniruddha , Garber Sarah S.
Published: May 2021

Introduction

Preexposure prophylaxis (PrEP) is a pillar of our national strategy to end the human immunodeficiency virus (HIV) epidemic. However, one of the largest obstacles to realizing the effectiveness of PrEP is expansion of prescription to all patients at risk for HIV. In this vignette-based study, we sought to investigate medical students' decision making regarding PrEP by presenting fictional patients, all of whom had HIV risk factors based on sexual behavior.

Methods

We systematically varied patients' sexual orientation or gender identity (heterosexual female, gay male, bisexual male, transgender male, transgender female, gender nonbinary person). We assessed the medical students' willingness to prescribe PrEP to the patients, as well as their perceptions of the patients' HIV risk and behavior.

Results

A total of 670 US medical students completed the study. The heterosexual female patient was least frequently identified as a PrEP candidate, was viewed as least likely to adhere to PrEP, and the most likely to engage in condomless sex if prescribed PrEP; however, was considered at lower overall HIV risk. Lower perceived HIV risk and anticipated PrEP adherence were both associated with lower willingness to prescribe PrEP. Willingness to prescribe PrEP was highest for the gay male patient and lowest for the heterosexual female.

Conclusions

These analyses suggest that assumptions about epidemiological risk based on patients' gender identity or sexual orientation may reduce willingness to prescribe PrEP to heterosexual women, ultimately hindering uptake in this critical population.
What Is New in the Pathologic Staging of Penile Carcinoma in the 8th Edition of AJCC TNM Model: Rationale for Changes With Practical Stage-by-stage Category Diagnostic Considerations
Authors: Sanchez Diego F. , Fernandez-Nestosa Maria Jose , Canete-Portillo Sofia , Rodriguez Ingrid , Cubilla Antonio L.
Published: May 2021

For >50 years the tumor, node, metastasis (TNM) classification model of malignant tumors has been the main resource for clinicians, pathologists, radiologists and public health professionals ensuring a homogeneous classification and patients’ management based on common staging and prognosis factors. Penile cancer was first included for staging in the third edition of the TNM classification with several changes in the last version, the 8th edition of the AJCC TNM Manual, in 2017. Some changes in the pT category were done due to recent knowledge regarding the prognostic importance of anatomical level of invasion, vascular and perineural invasion and tumor grading. These changes must be interpreted in the light of a required understanding of the complex anatomy of penile compartments especially their histological boundaries, the morphological differences of each level needed for the correct classification, the heterogeneity of penile squamous cell carcinomas and an adequate criticism of the current model used by the TNM system. We present here a series of stage-by-stage category diagnostic considerations based on the clinical experience acummulated over the years of applying the different TNM staging classifications in our large clinical practice. Some discrepancies will need well-designed prospective studies for im4proving the actual classification.
Role of the Surgical Pathologist in Diagnosis of Drug-induced Liver Injury: Recognizing Specific Patterns of Drug Injury
Authors: Chopra Shefali , Gawrieh Samer , Vuppalanchi Raj , Saxena Romil
Published: May 2021

Eighteen histologic patterns of drug-induced liver injury (DILI) are described, most of which are also seen in other commonly occurring acute and chronic liver diseases. However, certain patterns such as sinusoidal obstruction syndrome/veno-occlusive disease, “bland” cholestasis and cholestatic hepatitis are more often caused by drugs than other competing etiologies. Amiodarone, acetaminophen, anabolic androgenic steroids and estrogens, result in histologic patterns that are virtually diagnostic of the respective drug. Recognition of a DILI or drug specific injury pattern enables the clinician to focus on eliciting an appropriate history to identify the offending agent, which may otherwise be rare and not immediately apparent. Although drugs can mimic any and every liver disease, the mimicry is often imperfect. Unusual features that do not completely fit the clinicopathologic paradigm of the mimicked liver disease are clues to diagnosis of DILI. When mimicking a liver disease, drugs tend to hasten or accelerate the natural progression of the disease. Novel immunomodulatory drugs for inflammatory disorders and cancer may cause unintended effects on the immune system, resulting in immune-related side effects. The role of the pathologist in diagnosis of DILI is to recognize known patterns of DILI, and either confirm a diagnosis when clinically suspected, or alert the clinician to the possibility of DILI when it is not suspected. The latter is particularly vital in contemporary practice, which is witnessing an accelerated pace of drug development, and a surge in consumption of nutritional supplements and herbal compounds by an increasingly health conscious society.
Early Clinical Prediction of Independent Outdoor Functional Walking Capacity in a Prospective Cohort of Traumatic Spinal Cord Injury Patients
Authors: Jean Stephanie , Mac-Thiong Jean-Marc , Jean Marie-Christine , Dionne Antoine , Bégin Jean , Richard-Denis Andréane
Published: May 2021

Objective

The first objective was to identify a method for early prediction of independent outdoor functional walking 1 yr after a traumatic spinal cord injury using the motor and sensory function derived from the International Standards for Neurological Classification of Spinal Cord Injury assessment during acute care. Then, the second objective was to develop a clinically relevant prediction rule that would be accurate, easy to use, and quickly calculated in clinical setting.

Design

A prospective cohort of 159 traumatic spinal cord injury patients was analyzed. Bivariate correlations were used to determine the assessment method of motor strength and sensory function as well as the specific dermatomes and myotomes best associated with independent outdoor functional walking 1 yr after injury. An easy-to-use clinical prediction rule was produced using a multivariable linear regression model.

Results

The highest motor strength for a given myotome (L3 and L5) and preserved light touch sensation (dermatome S1) were the best predictors of the outcome. The proposed prediction rule displayed a sensitivity of 84.21%, a specificity of 85.54%, and a global accuracy of 84.91% for classification.

Conclusions

After an acute traumatic spinal cord injury, accurately predicting the ability to walk is challenging. The proposed clinical prediction rule aims to enhance previous work by identifying traumatic spinal cord injury patients who will reach a mobility level that fosters social participation and quality of life in the chronic period after the injury.

To Claim CME Credits

Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME

CME Objectives

Upon completion of this article, the reader should be able to: (1) Revise the different motor and sensory function assessment methods used for prognostication of walking after an acute traumatic spinal cord injury; (2) Identify clinical factors that are significantly associated with functional walking 1 yr after a traumatic spinal cord injury; and (3) Accurately estimate the likelihood of reaching independent outdoor functional walking in the chronic phase after an acute traumatic spinal cord injury.

Level

Advanced

Accreditation

The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Population-Based HIV Impact Assessments Survey Methods, Response, and Quality in Zimbabwe, Malawi, and Zambia
Authors: Sachathep Karampreet , Radin Elizabeth , Hladik Wolfgang , Hakim Avi , Saito Suzue , Burnett Janet , Brown Kristin , Phillip Neena , Jonnalagadda Sasi , Low Andrea , Williams Dan , Patel Hetal , Herman-Roloff Amy , Musuka Godfrey , Barr Beth , Wadondo-Kabonda Nellie , Chipungu Gertrude , Duong Yen , Delgado Stephen , Kamocha Stanley , Kinchen Steve , Kalton Graham , Schwartz Leah , Bello George , Mugurungi Owen , Mulenga Lloyd , Parekh Bharat , Porter Laura , Hoos David , Voetsch Andrew Charles , Justman Jessica
Published: May 2021

Background:

The population-based HIV impact assessment (population-based HIV impact assessments) surveys are among the first to estimate national adult HIV incidence, subnational prevalence of viral load suppression, and pediatric HIV prevalence. We summarize the survey methods implemented in Zimbabwe, Malawi, and Zambia, as well as response rates and quality metrics.

Methods:

Each cross-sectional, household-based survey used a 2-stage cluster design. Survey preparations included sample design, questionnaire development, tablet programming for informed consent and data collection, community mobilization, establishing a network of satellite laboratories, and fieldworker training. Interviewers collected demographic, behavioral, and clinical information using tablets. Blood was collected for home-based HIV testing and counseling (HBTC) and point-of-care CD4+ T-cell enumeration with results immediately returned. HIV-positive blood samples underwent laboratory-based confirmatory testing, HIV incidence testing, RNA polymerase chain reaction (viral load), DNA polymerase chain reaction (early infant diagnosis), and serum antiretroviral drug detection. Data were weighted for survey design, and chi square automatic interaction detection-based methods were used to adjust for nonresponse.

Results:

Each survey recruited a nationally representative, household-based sample of children and adults over a 6–10-month period in 2015 and 2016. Most (84%–90%) of the 12,000–14,000 eligible households in each country participated in the survey, with 77%–81% of eligible adults completing an interview and providing blood for HIV testing. Among eligible children, 59%–73% completed HIV testing. Across the 3 surveys, 97.8% of interview data were complete and had no errors.

Conclusion:

Conducting a national population-based HIV impact assessment with immediate return of HIV and other point-of-care test results was feasible, and data quality was high.
Construct and Criterion-Related Validity of the Clinical Frailty Scale in Persons With HIV
Authors: McMillan Jacqueline M. , Gill Michael J. , Power Christopher , Fujiwara Esther , Hogan David B. , Rubin Leah H.
Published: May 2021

Background:

The co-occurrence of frailty and cognitive impairment in older (50+ years) persons with HIV (PWH) is common and increases the risk of poor outcomes. In HIV clinics, the most commonly used frailty measures are the frailty phenotype (FP), which requires measuring grip strength and gait speed to implement, and the frailty index (FI) based on comprehensive health data collected on patients. We examined construct and criterion-related validity (as it predicts cognition) of the Clinical Frailty Scale (CFS), a less resource-intensive approach for assessing frailty, in relation to these more commonly used frailty assessments (FP and FI).

Setting/Methods:

A total of 143 older (age 50+) PWH (mean age 57 years; 88% male) seen at the Southern Alberta Clinic underwent both frailty screening with the FP, CFS, and FI and neuropsychological testing. Mixed-effects regressions examined the associations between frailty status and cognition.

Results:

Concordance with the FP was slightly superior for the CFS than the FI. The FP and CFS had similar associations with domain-specific cognitive performance with frail PWH performing worse than nonfrail individuals on tests requiring manual dexterity (Trail Making Part A and B; Symbol Digit; and Grooved Pegboard; P values <0.05). Neither were associated with executive function, learning, or memory performance. The FI was associated with worse fluency, fine motor skills (Grooved Pegboard), and Trail Making Part A.

Conclusion:

The CFS is a simple screening tool with good construct and criterion-related validity. It was associated with a similar pattern of cognitive deficits as the FP. If confirmed and the associations are extended to other clinically significant characteristics and outcomes, the CFS can be considered as an alternative to the FP and FI in assessing frailty in older PWH.
Brief Report: Young Age and Sex Work Are Associated With HIV Seroconversion Among Transgender Women in São Paulo, Brazil
Authors: Amelia de Sousa Mascena Veras Maria , Roza Saggese Gustavo S. , Gomez Junior José L. , Silveira Paula , Paiatto Beatriz , Ferreira Denis , Alves de Souza Paola , Calado Rodrigo , Castejon Márcia Jorge , Yamashiro Rosemeire , Fernando de Macedo Brígido Luis , Turner Caitlin , Lin Jess , Wilson Erin C , McFarland Willi
Published: May 2021

Background:

Transgender women worldwide have the highest prevalence of HIV and the lowest access to prevention among groups at risk of HIV. However, few longitudinal studies have directly measured HIV incidence and identified predictors of HIV acquisition among transgender women.

Setting:

São Paulo, Latin America's largest city.

Methods:

We conducted a longitudinal study among transgender women in São Paulo. Participants were recruited by a long-chain peer referral process from May 2017 to July 2019. Those aged 18 years and older and who were HIV-negative at baseline were retested every 6 months up to 18 months. HIV incidence was calculated by dividing the number of seroconversions by the person-years (PYs) of follow-up; 95% confidence intervals (CIs) were constructed assuming a Poisson distribution. Conditional maximum likelihood ratios assessed differences in HIV incidence by risk factors.

Results:

A racially/ethnically diverse sample of 545 HIV-negative transgender women was enrolled. In 485.5 PYs of follow-up, 13 seroconversions were observed, yielding an incidence of 2.68 per 100 PYs (95% CI: 1.43 to 4.58). HIV incidence was significantly higher among transgender women aged 18–24 years (rate ratio 3.85, 95% CI: 1.24 to 12.93) and among those who engaged in sex work in the preceding month (rate ratio 5.90, 95% CI: 1.71 to 26.62).

Conclusions:

HIV transmission continues at a high rate among transgender women in Brazil. Factors such as young age, lower level of education, and limited employment opportunities may lead to dependence on sex work that in turn increases HIV risk. Transgender-friendly prevention services, particularly programs delivering pre-exposure prophylaxis, are urgently needed.
Brief Report: Viral Load Monitoring in Pregnancy to Predict Peripartum Viremia in South Africa
Authors: Odayar Jasantha , Kabanda Siti , Malaba Thokozile R. , Lesosky Maia , Myer Landon
Published: May 2021

Introduction:

Enhanced postnatal prophylaxis is recommended in infants of women with viremia during labor, as identified by viral load (VL) testing late in pregnancy. However, data on the use of antenatal VL to predict peripartum viremia are few, particularly in women starting antiretroviral therapy (ART) in pregnancy who experience initial VL declines.

Methods:

Between January 2016 and August 2017, we identified HIV-infected women who initiated ART (tenofovir, emtricitabine, and efavirenz) antenatally and had a VL <400 copies/mL before delivery in Cape Town, South Africa. VLs were repeated postdelivery, and sensitivity, specificity, and positive and negative likelihood ratios (LR+ and LR−) for antenatal VL <100 copies/mL in predicting peripartum VLs <100 and <400 copies/mL were calculated.

Results:

Among 322 women (median age 29 years, 44% with a history of ART use, median gestation of antenatal VL 33 weeks), antenatal VL was <100 copies/mL in 89% and 100–400 copies/mL in 11%. At a median 9 days postpartum, 91%, 7%, and 2% of women had a VL <100, 100–400, and >400 copies/mL, respectively. Sensitivity of antenatal VL <100 copies/mL in predicting peripartum VL <100 copies/mL was 0.95 (95% confidence interval: 0.92 to 0.97), and specificity was 0.71 (95% confidence interval: 0.51 to 0.87; LR+ 3.28, LR− 0.07). Performance was slightly weaker to detect peripartum VL <400 copies/mL but was similar across strata of gestation at antenatal VL and history of ART use.

Discussion:

Antenatal VL is a useful predictor of peripartum viremia in women who started ART in pregnancy and attained a VL <400 copies/mL antenatally and may be used to target enhanced postnatal prophylaxis interventions.
Mediating effect of genome-wide DNA methylation on suicidal ideation induced by perceived stress
Authors: Dada Oluwagbenga , Adanty Christopher , Dai Nasia , Zai Clement , Gerretsen Philip , Graff Ariel , de Luca Vincenzo
Published: May 2021

Stress is an important risk factor for suicidal ideation, but the mechanisms that link stress, suicidal ideation and neurobiology remain unclear. Epigenetic mechanisms are involved in both vulnerability to suicidal behavior and stress. This is a pilot study of 60 patients with schizophrenia spectrum disorders (36 men and 24 women), with an average age of 43.75 ± 12.24 years. We analyzed the effects of (1) perceived stress and (2) the mediation of genome-wide methylation (~450 000 CpG sites) on suicidal ideation severity. The top CpG site mediating the effect of stress on suicidal ideation was the cg10782349 located in the ZNF701 gene on chromosome 19, facilitating the effect through DNA hypermethylation. These preliminary results indicate that DNA methylation in peripheral tissues can clarify the complex relationship between stress and suicidal ideation in schizophrenia.
Time scale performance of rapid antigen testing for SARS-COV-2: evaluation of ten rapid antigen assays
Authors: Abusrewil Zakarya , Alhudiri Inas M , Kaal Hamza Hussein , El Meshri Salah Edin , Ebrahim Fawzi O. , Dalyoum Tarek , Efrefer Abdussamee A , Ibrahim Khaled , Elfghi Mohammed Ben , Abusrewil Suleiman , Elzagheid Adam
Published: May 2021

There is a great demand for more rapid tests for SARS-COV-2 detection to reduce waiting time, boost public health strategies for combating disease, decrease costs, and prevent overwhelming laboratory capacities. This study was conducted to assess the performance of 10 lateral flow device viral antigen immunoassays for the detection of SARS-CoV-2 in nasopharyngeal swab specimens. We analyzed 231 nasopharyngeal samples collected from October 2020-December 2020, from suspected COVID-19 cases and contacts of positive cases at Biotechnology Research Center laboratories, Tripoli, Libya. The performance of 10 COVID-19 Antigen (Ag) rapid test devices for the detection of SARS-CoV-2 antigen was compared to RT-qPCR. In this study 161 cases had symptoms consistent with COVID-19. The mean duration from symptom onset was 6.6 ±4.3 days. The median cycle threshold (Ct) of positive samples was 25. Among the 108 positive samples detected by RT-qPCR, the COVID-19 antigen (Ag) tests detected 83 cases correctly. All rapid Ag test devices used in this study showed 100% specificity. While tests from 6 manufacturers had an overall sensitivity range from 75-100%, the remaining 4 tests had sensitivity of 50-71.43%. Sensitivity during the first 6 days of symptoms and in samples with high viral loads (Ct<25), was 100% in all but 2 of the test platforms. False negative samples had a median Ct of 34 and an average duration of onset of symptoms of 11.3 days (range=5-20 days). Antigen test diagnosis has high sensitivity and specificity in early disease when patients present less than 7 days of symptom onset. Patients are encouraged to test as soon as they get COVID-19 related symptoms within 1 week and to seek medical advice within 24 hrs. if they develop disturbed smell/taste. The use of rapid antigen tests is important for controlling COVID-19 pandemic and reducing burden on molecular diagnostic laboratories.
Monitoring emergence of SARS-CoV-2 B.1.1.7 Variant through the Spanish National SARS-CoV-2 Wastewater Surveillance System (VATar COVID-19) from December 2020 to March 2021
Authors: Carcereny Albert , Martínez-Velázquez Adán , Bosch Albert , Allende Ana , Truchado Pilar , Cascales Jenifer , Romalde Jesús L , Lois Marta , Polo David , Sánchez Gloria , Pérez-Cataluña Alba , Díaz-Reolid Azahara , Antón Andrés , Gregori Josep , Garcia-Cehic Damir , Quer Josep , Palau Margarita , González Ruano Cristina , Pintó Rosa M , Guix Susana
Published: May 2021

Background

Since its first identification in the United Kingdom in late 2020, the highly transmissible B.1.1.7 variant of SARS-CoV-2, become dominant in several European countries raising great concern.

Aim

The aim of this study was to develop a duplex real-time RT-qPCR assay to detect, discriminate and quantitate SARS-CoV-2 variants containing one of its mutation signatures, the ΔHV69/70 deletion, to trace the community circulation of the B.1.1.7 variant in Spain through the Spanish National SARS-CoV-2 Wastewater Surveillance System (VATar COVID-19).

Results

B.1.1.7 variant was first detected in sewage from the Southern city of Málaga (Andalucía) in week 20_52, and multiple introductions during Christmas holidays were inferred in different parts of the country, earlier than clinical epidemiological reporting by the local authorities. Wastewater-based B.1.1.7 tracking showed a good correlation with clinical data and provided information at the local level. Data from WWTPs which reached B.1.1.7 prevalences higher than 90% for ≥ 2 consecutive weeks showed that 8.1±1.8 weeks were required for B.1.1.7 to become dominant.

Conclusion

The study highlights the applicability of RT-qPCR-based strategies to track specific mutations of variants of concern (VOCs) as soon as they are identified by clinical sequencing, and its integration into existing wastewater surveillance programs, as a cost-effective approach to complement clinical testing during the COVID-19 pandemic.
PUM1 represses CDKN1B translation and contributes to prostate cancer progression
Authors: Li Xin , Yang Jian , Chen Xia , Cao Dandan , Xu Eugene Yujun
Published: May 2021

Posttranscriptional regulation of cancer gene expression programs plays a vital role in carcinogenesis; identifying the critical regulators of tumorigenesis and their molecular targets may provide novel strategies for cancer diagnosis and therapeutics. Highly conserved RNA binding protein PUM1 regulates mouse growth and cell proliferation, propelling us to examine its role in cancer. We found human PUM1 is highly expressed in a diverse group of cancer, including prostate cancer; enhanced PUM1 expression is also correlated with reduced survival among prostate cancer patients. Detailed expression analysis in twenty prostate cancer tissues showed enhanced expression of PUM1 at mRNA and protein levels. Knockdown of PUM1 reduced prostate cancer cell proliferation and colony formation, and subcutaneous injection of PUM1 knockdown cells led to reduced tumor size. Downregulation of PUM1 in prostate cancer cells consistently elevated CDKN1B protein expression through increased translation but did not impact its mRNA level, while overexpression of PUM1 reduced CDKN1B protein level. Our finding established a critical role of PUM1 mediated translational control, particularly the PUM1-CDKN1B axis, in prostate cancer cell growth and tumorigenesis. We proposed that PUM1-CDKN1B regulatory axis may represent a novel mechanism for the loss of CDKN1B protein expression in diverse cancers and could be potential targets for therapeutics development.
A rapid and simple protocol for concentration of SARS-CoV-2 from sewage
Authors: Wehrendt Diana P. , Massó Mariana G. , Gonzales Machuca Adrián , Vargas Claudia V. , Barrios Melina E. , Campos Josefina , Costamagna Damián , Bruzzone Luis , Cisterna Daniel M. , Iglesias Néstor Gabriel , Mbayed Viviana A. , Baumeister Elsa , Centrón Daniela , Quiroga María Paula , Erijman Leonardo
Published: May 2021

The aim of this study was to set up a simple protocol to concentrate SARS-CoV-2 from sewage, which can be implemented in laboratories with minimal equipment resources. The method avoids the need for extensive purification steps and reduces the concentration of potential inhibitors of RT-qPCR contained in sewage. The concentration method consists of a single step, in which a small volume of sewage sample is incubated with polyaluminum chloride (PAC). Virus particles adsorbed to the precipitate are collected by low-speed centrifugation, after which the recovered pellet is resuspended with a saline buffer. The PAC concentration method produced an average shift of 4.4-units in Cq values compared to non-concentrated samples, indicating a 25-fold increase in detection sensitivity. The lower detection limit corresponded approximately to 100 copies per ml. Kappa index indicated substantial agreement between PAC and PEG precipitation protocols (k=0.688, CI 0.457-0.919). PAC concentrated samples can be processed immediately for RNA purification and qPCR or sent refrigerated to a diagnosis center, where SARS-CoV-2 detection should be performed in the same way as for clinical samples. This low cost protocol could be useful to aid in the monitoring of community circulation of SARS-CoV-2, especially in low- and middle-income countries, which do not have massive access to support from specialized labs for sewage surveillance.
Inference of SARS-CoV-2 generation times using UK household data
Authors: Hart W.S. , Abbott S. , Endo A. , Hellewell J. , Miller E. , Andrews N. , Maini P.K. , Funk S. , Thompson R.N.
Published: May 2021

The distribution of the generation time (the interval between individuals becoming infected and passing on the virus) characterises changes in the transmission risk during SARS-CoV-2 infections. Inferring the generation time distribution is essential to plan and assess public health measures. We previously developed a mechanistic approach for estimating the generation time, which provided an improved fit to SARS-CoV-2 data from January-March 2020 compared to existing models. However, few estimates of the generation time exist based on data from later in the pandemic. Here, using data from a household study conducted from March-November 2020 in the UK, we provide updated estimates of the generation time. We consider both a commonly used approach in which the transmission risk is assumed to be independent of when symptoms develop, and our mechanistic model in which transmission and symptoms are linked explicitly. Assuming independent transmission and symptoms, we estimated a mean generation time (4.2 days, 95% CrI 3.3-5.3 days) similar to previous estimates from other countries, but with a higher standard deviation (4.9 days, 3.0-8.3 days). Using our mechanistic approach, we estimated a longer mean generation time (6.0 days, 5.2-7.0 days) and a similar standard deviation (4.9 days, 4.0-6.3 days). Both models suggest a shorter mean generation time in September-November 2020 compared to earlier months. Since the SARS-CoV-2 generation time appears to be changing, continued data collection and analysis is necessary to inform future public health policy decisions.
The rapid reemergence of seasonal respiratory viruses in Houston, Texas, after relaxing COVID-19 restrictions
Authors: Hodjat Parsa , Christensen Paul A. , Subedi Sishir , Bernard David W. , Olsen Randall J. , Long S. Wesley
Published: May 2021

Brief abstract

Implementation of measures to limit the spread of the SARS-CoV-2 virus at the start of the COVID-19 pandemic resulted in a rapid decrease in all other respiratory pathogens. As COVID-19 containment measures were relaxed, the first non-COVID respiratory viruses to return to prepandemic levels were members of the rhinovirus/enterovirus, followed by the rapid return of seasonal coronaviruses, parainfluenza, and respiratory syncytial virus after the complete removal of COVID-19 precautions at the state level, including an end to mask mandates. Inasmuch as COVID-19 has dominated the landscape of respiratory infections since early 2020, it is important for clinicians to recognize the return of non-COVID respiratory pathogens may be rapid and significant when COVID-19 containment measures are removed.
Small Airways Disease is a Post-Acute Sequelae of SARS-CoV-2 Infection
Authors: Cho Josalyn L. , Villacreses Raul , Nagpal Prashant , Guo Junfeng , Pezzulo Alejandro A. , Thurman Andrew L. , Hamzeh Nabeel Y. , Blount Robert J. , Fortis Spyridon , Hoffman Eric A. , Zabner Joseph , Comellas Alejandro P.
Published: May 2021

Background

The sequelae of SARS-CoV-2 infection on pulmonary structure and function remain incompletely characterized.

Methods

Adults with confirmed COVID-19 who remained symptomatic more than thirty days following diagnosis were enrolled and classified as ambulatory, hospitalized or requiring the intensive care unit (ICU) based on the highest level of care received during acute infection. Symptoms, pulmonary function tests and chest computed tomography (CT) findings were compared across groups and to healthy controls. CT images were quantitatively analyzed using supervised machine-learning to measure regional ground glass opacities (GGO) and image-matching to measure regional air trapping. Comparisons were performed using univariate analyses and multivariate linear regression.

Results

Of the 100 patients enrolled, 67 were in the ambulatory group. All groups commonly reported cough and dyspnea. Pulmonary function testing revealed restrictive physiology in the hospitalized and ICU groups but was normal in the ambulatory group. Among hospitalized and ICU patients, the mean percent of total lung classified as GGO was 13.2% and 28.7%, respectively, and was higher than in ambulatory patients (3.7%, P<0.001). The mean percentage of total lung affected by air trapping was 25.4%, 34.5% and 27.2% in the ambulatory, hospitalized and ICU groups and 7.3% in healthy controls (P<0.001). Air trapping measured by quantitative CT correlated with the residual volume to total lung capacity ratio (RV/TLC; ρ=0.6, P<0.001).

Conclusions

Air trapping is present in patients with post-acute sequelae of COVID-19 and is independent of initial infection severity, suggesting obstruction at the level of the small airways. The long-term consequences are not known.
SARS-CoV-2 spike glycoprotein-reactive T cells can be readily expanded from COVID-19 vaccinated donors
Authors: Taborska Pavla , Lastovicka Jan , Stakheev Dmitry , Strizova Zuzana , Bartunkova Jirina , Smrz Daniel
Published: May 2021

Introduction

The COVID-19 vaccine was designed to provide protection against infection by the severe respiratory coronavirus 2 (SARS-CoV-2) and coronavirus disease 2019 (COVID-19). However, the vaccine’s efficacy can be compromised in patients with immunodeficiencies or the vaccine-induced immunoprotection suppressed by other comorbidity treatments, such as chemotherapy or immunotherapy. To enhance the protective role of the COVID-19 vaccine, we have investigated a combination of the COVID-19 vaccination withex vivoenrichment and large-scale expansion of SARS-CoV-2 spike glycoprotein-reactive CD4+and CD8+T cells.

Methods

SARS-CoV-2-unexposed donors were vaccinated with two doses of the BNT162b2 SARS-CoV-2 vaccine. The peripheral blood mononuclear cells of the vaccinated donors were cell culture-enriched with T cells reactive to peptides derived from SARS-CoV-2 spike glycoprotein. The enriched cell cultures were large-scale expanded using the rapid expansion protocol (REP) and the peptide-reactive T cells evaluated.

Results

We show that vaccination with the SARS-CoV-2 spike glycoprotein-based mRNA COVID-19 vaccine induced humoral response against SARS-CoV-2 spike glycoprotein in all tested healthy SARS-CoV-2-unexposed donors. This humoral response was found to correlate with the ability of the donors’ PBMCs to become enriched with SARS-CoV-2 spike glycoprotein-reactive CD4+and CD8+T cells. Using an 11-day rapid expansion protocol, the enriched cell cultures were expanded nearly a thousand fold, and the proportions of the SARS-CoV-2 spike glycoprotein-reactive T cells increased.

Conclusions

These findings show for the first time that the combination of the COVID-19 vaccination andex vivoT cell large-scale expansion of SARS-CoV-2-reactive T cells could be a powerful tool for developing T cell-based adoptive cellular immunotherapy of COVID-19.